Search Results (7,569)

As the global population continues to age, mental health issues such as depression, anxiety, stress, loneliness, and social isolation among older adults are receiving increasing attention. The built environment is closely associated with older adults’ daily mobility, environmental perception, social participation, and mental health and well-being, but the evidence remains heterogeneous across spatial contexts, environmental indicators, and study designs. Previous umbrella reviews have summarized broad links between the built environment and healthy aging, but less attention has been paid to recent original empirical studies published after the COVID-19 pandemic, the distinction between objective environmental exposure and subjective environmental perception, and the role of social participation as a pathway linking environmental conditions to mental health and well-being. This study employs a systematic literature review approach, searching and screening peer-reviewed empirical studies published between 2015 and January 2026 that focus on the associations between the built environment and older adults’ mental health and well-being. PubMed, Scopus, and Web of Science databases were used for searching, supplemented by manual searching. After title and abstract screening and full-text evaluation, a total of 60 studies were included. Subsequently, a comprehensive analysis was conducted on aspects such as research design, spatial scale, environmental indicators, types of mental health outcomes, and potential pathways of action. In this review, core mental health and well-being outcomes included negative outcomes, such as depression, anxiety, stress, psychological distress, loneliness, and social isolation, and positive outcomes, such as life satisfaction, subjective well-being, psychological well-being, and mental well-being. Social participation was examined as a behavioral and psychosocial pathway rather than as a core outcome. Emerging methods, including street-view image analysis, FCN-based semantic segmentation, and XGBoost-SHAP, were examined because they can refine environmental exposure measurement and support variable-importance interpretation, rather than because they provide causal evidence. The main synthesis suggests that several built environment factors are associated with older adults’ mental health and well-being, although the strength and consistency of evidence vary across outcome types, spatial contexts, and study designs. (1) Exposure to green and blue spaces, quality of public open spaces, walkability and accessibility, accessibility of neighborhood facilities and services, housing and living conditions, and positive environmental perception are mostly associated with lower levels of depression, anxiety, stress, and loneliness, as well as higher levels of life satisfaction, subjective well-being, and psychological well-being. (2) Conversely, adverse environmental exposures such as proximity to roads, pollution, non-vegetated spaces, and high-intensity urbanization are more likely to exacerbate negative psychological outcomes. Existing evidence also suggests that social participation is one of the important behavioral pathways through which the built environment is linked to the mental health of older adults, but it is not the only mechanism. (3) In addition, the direction and intensity of environmental associations remain heterogeneous under different spatial scales, indicator types, and research methods. Overall, this review contributes by organizing recent empirical evidence into a built environment–social participation–mental health and well-being framework, while emphasizing that most findings should be interpreted primarily as evidence of association rather than as stable or uniform causal effects. Full article

Background/Objectives: The family constitutes a primary ecological system shaping infant emotional and mental health. Parent responsiveness in particular shapes early regulatory capacities in the developing child. Added contextual stress such as that associated with natural disasters may strain caregiving relationships. Brief, universally accessible parenting interventions offer scalable support for strengthening early relational health and may be useful in contexts of natural disaster-related stress as well as in the general population. This qualitative study examined the perceived impact and contextual relevance of MERTIL (My Early Relational Trust-Informed Learning) for Parents, a brief digital psychoeducational parenting program targeting early relational health, among families raising young children in disaster-affected communities. Methods: Fourteen parents residing in the Hunter New England and Central Coast region of New South Wales, Australia, with young children aged 0–5 years, participated in semi-structured interviews conducted approximately 6 months after completing MERTIL for Parents. Interviews explored lived experiences of parenting in the context of natural disaster (analysed via applied phenomenological methods) and parents’ perceptions of program components that supported everyday caregiving (analysed via reflexive thematic analysis and content analysis). Results: Parents described interconnected personal, relational, and environmental stressors that influenced aspects of the parent–infant relationship. Key retained knowledge from the program included a normalisation of parenting challenges, a strengthened understanding of attachment, trust, safety and repair, and attuned, emotion-focused parenting practices. Conclusions: This pilot study illuminates the lived experience of parenting in disaster prone regions and highlights the potential for this brief, universal digital parenting program to provide support for early relational health in such contexts. Full article

Background and objectives: Social media use has become pervasive among the general population, with growing concern regarding its potential effects on mental health and sleep. While existing studies report associations between social media engagement and psychological outcomes, limited attention has been given to users’ self-perceived impact. To assess the self-perceived impact of social media use on mental health and sleep-related outcomes among healthy adolescents and adults aged 16–50 years old, and to identify associated demographic and behavioral factors. Methods: A cross-sectional survey was conducted among residents of Jeddah, Saudi Arabia, aged 16–50 years without a history of psychiatric or chronic sleep disorders, using a structured online questionnaire. Perceived mental health impact was assessed using a six-item study-specific questionnaire evaluating participants’ subjective perceptions regarding emotional and psychological responses to social media exposure. Higher perceived impact was defined as a composite score of 12–24 points on the study-specific scale. Data included sociodemographic characteristics, patterns of social media use, perceived mental health impact assessed through a 6-item Likert scale, and sleep-related outcomes. Associations were evaluated using chi-square tests and logistic regression analysis. Results: Most participants reported daily social media use exceeding 3 h, with 44.9% engaging in late-night use and 87.6% using devices within 30 min before sleep. Overall, 18.6% exhibited higher perceived mental health impact. Higher odds were observed among younger participants, students, and single individuals. Snapchat and YouTube use, and late-night engagement were independently associated with increased perceived impact. Approximately one-third reported insomnia after social media use, and 44.3% perceived improved sleep with reduced usage. Conclusions: Social media use is widely prevalent and commonly perceived to negatively affect mental well-being and sleep, particularly with intensive and late-night use. Self-awareness of these effects may represent a valuable leverage point for prevention, supporting the need for targeted digital wellness strategies and public health interventions. Full article

Background/Objectives: Antimicrobial resistance (AMR) is a major public health problem driven partly by inappropriate antibiotic use. Students of health studies represent future healthcare professionals with an important role in patient education, infection prevention, and antimicrobial stewardship. This study assessed knowledge, attitudes, and behaviours regarding antibiotic use and AMR among students of the Faculty of Health Studies, University of Mostar. Methods: An anonymous cross-sectional online survey was conducted in March 2025 using a self-selected convenience sample. The questionnaire was adapted from a previously published survey among Cypriot university students and distributed through student WhatsApp groups and by e-mail. Of 1113 invited students, 220 completed the survey, yielding a response rate of 19.8%. Results: During the previous 12 months, 39.5% of respondents reported antibiotic use. Most respondents reported adherence to medical instructions regarding dosage and duration of therapy, while 20.5% reported self-medication with antibiotics and 29.5% reported keeping unused antibiotics at home. Approximately 42% perceived antibiotics as easy or very easy to obtain without a prescription. Only 36.4% of respondents correctly distinguished antibiotics from other medications. Although most respondents recognised that bacteria can develop resistance, misconceptions persisted regarding humans and viruses. Differences between study programmes were observed for some attitudes and perceptions, whereas gender and year of study were not significantly associated with most responses. Conclusions: Health studies students demonstrated partial knowledge of antibiotics and AMR, together with behaviours that may contribute to inappropriate antibiotic use. Strengthened curricular content on rational antibiotic use, infection management, infection prevention, and antimicrobial stewardship appears justified. The findings are also consistent with the need to consider broader stewardship measures, including better enforcement of existing prescription-only dispensing requirements in Bosnia and Herzegovina. Full article

Background/Objectives: Artificial intelligence (AI) is increasingly used in clinical decision-support systems, yet its adoption in low- and middle-income countries, including Jordan, remains limited and underexplored. Understanding how healthcare professionals perceive AI-assisted clinical decision-making is essential for safe and contextually appropriate implementation. This study explored healthcare professionals’ perceptions of AI-assisted clinical decision-making in Jordan, with particular attention to trust, accuracy, accountability, professional judgement, digital literacy, and health-system readiness. Medication-related safety and prescribing concerns were examined as secondary cross-cutting issues where they emerged from participants’ accounts. Methods: A qualitative study was conducted using semi-structured, in-depth interviews with 22 purposively sampled healthcare professionals from public, private, and university-affiliated healthcare institutions in Amman, Irbid, and Zarqa. Participants included physicians, nurses, pharmacists, and allied health professionals with varied specialties and levels of seniority. Data were analysed using Braun and Clarke’s reflexive thematic analysis. Member checking, peer debriefing, reflexive memos, and audit trails were used to enhance trustworthiness, and reporting followed the Consolidated Criteria for Reporting Qualitative Research (COREQ). Results: Eight overarching themes were identified: conditional trust in AI-assisted clinical decision-making; concerns regarding accuracy and confident algorithmic errors; accountability and professional responsibility; AI as an adjunct rather than a substitute for clinical judgement; the influence of experience, specialty, and digital literacy on AI acceptance; Jordanian health-system readiness; privacy, confidentiality, and algorithmic bias; and training requirements for safe AI use. Medication-related safety emerged as a cross-cutting concern, particularly in relation to dosing, polypharmacy, drug–drug and drug–herb interactions, and the risk of over-reliance on AI-generated recommendations. Conclusions: Healthcare professionals in Jordan expressed cautious but constructive views toward AI-assisted clinical decision-making. AI was perceived as potentially useful when used to support, rather than replace, professional judgement. Participants’ accounts suggest that safe implementation depends on local validation, clear accountability frameworks, ethical data governance, interprofessional training, and careful consideration of medication-safety expertise where AI tools influence prescribing or therapeutic decisions. These findings highlight the importance of context-sensitive AI governance strategies that support trustworthy, accountable, and professionally supervised AI adoption in healthcare. Full article

Introduction: Population aging is a growing and challenging phenomenon, primarily due to its association with functional decline and sarcopenia, which increase the risk of falls. These events have significant impacts on public health and the quality of life of older adults. Regular physical activity has shown benefits in reducing falls and their consequences, with systemic vibratory therapy (SVT) emerging as a promising strategy to mitigate these adverse outcomes. However, evidence on the actual effectiveness of this therapeutic approach remains limited, as does clarity regarding optimal body position, protocol parameters, and equipment when combined with physical activity programs. Objectives: To compare the effect of systemic vibratory therapy (SVT) associated with a physical activity program on the perception of fear of falling in older adults (M01.060.116.100). As secondary outcomes, the study will assess functional physical conditioning, electromyographic activity, muscular synergy, and center of pressure oscillation in this population. Methods: A randomized controlled clinical trial with blinded outcome assessors and blinded statistical analysis will be conducted with 192 older adults participating in the UNATI/UNISUAM program. Participants will be allocated into three groups: (A) usual physical activity; (B) usual physical activity + SVT in a semi-squat position; and (C) usual physical activity + SVT in a seated position. Assessments will include sociodemographic data, concern about falling assessed using the Falls Efficacy Scale-International (FES-I), physical performance (2 min stationary march test), surface electromyography of the tibialis anterior and medial gastrocnemius muscles, along with posturography using a force platform. Results: This study will provide information on outcomes related to fall risk, balance, physical fitness, and neuromuscular variables in older adults undergoing two distinct SVT protocols. Clinical Trials Registration: Brazilian Registry of Clinical Trials RBR-68pry5j. Registered on 8 December 2025. Full article

Background: Clear post-extraction sessions are vital for good patient outcomes. Traditional methods, such as verbal and printed information, have historically been prevalent; however, digital health care methods for analysis and communication are increasingly being adopted. Still, evidence comparing preferences for digital versus traditional instruction, especially for routine post-extraction care, remains limited. Objectives: This study aimed to evaluate preferences between digital methods (QR code-based videos) and traditional methods (verbal and printed leaflets) for delivering post-extraction care instructions among dental patients and students. It also assesses perceptions of communication quality, confidence, and patient interaction associated with each method. Methods: A cross-sectional study involved 200 dental students and 200 patients undergoing routine tooth extractions. The sample size was determined based on a 5% margin of error at a 95% confidence level for proportion estimation. Participants experienced all three instructional delivery methods—verbal, printed leaflet, and QR code-based video—for post-extraction care and completed validated questionnaires. The study assessed preferences for each delivery method, communication quality, confidence in following or providing instructions, ease of access, perceived usefulness, and impact on patient-provider interaction. Data were analyzed using descriptive statistics, the Mann–Whitney U test for group comparisons, and Spearman correlation for relationships among ordinal data. Results: Among all participants, 67.5% chose QR codes as the preferred method for improving communication (p < 0.001). Among dental students, 49% favored QR codes as the best method for postoperative instructions, and 50.5% indicated that QR codes boosted their confidence in providing instructions to patients. Preference for QR codes ranged from 43.5% to 65.5% across different aspects evaluated. Notably, among patients aged 60 years or older, 65.5% considered QR codes the most convenient for the elderly. Mann–Whitney U tests showed statistically significant differences between students and patients for ease of access (p = 0.009, rank biserial r = −0.143), video length appropriateness (p = 0.003, rank biserial r = −0.160), and the unlikelihood of missing instructions (p < 0.001, rank biserial r = −0.446). Conclusions: QR code-based video instructions were widely preferred over traditional methods by both dental students and patients for post-extraction care delivery. These findings support the integration of digital communication tools into post-extraction care protocols as a complement to traditional instruction delivery methods, though longitudinal studies assessing actual clinical outcomes are needed. Full article

While artificial intelligence is rapidly reshaping the healthcare sector, it is important to assess readiness for AI integration to properly prepare healthcare professionals, particularly in countries where clinical AI systems have not yet been implemented in primary healthcare. This qualitative study explores healthcare professionals’ perceptions of the future use of Artificial Intelligence in Greek Primary Healthcare settings. Two focus groups were conducted with 18 Primary Health Care professionals working in a health center and a local primary healthcare unit (TOMY) in Greece. Thematic analysis identified six major themes: potential uses, challenges and risks, ethical concerns, readiness and training needs, trust factors, and AI impact on professional roles and skills. Future research should focus on developing training programs, establishing ethical and regulatory frameworks, and examining the long-term impact of Artificial Intelligence on professional roles, skills, and interprofessional collaboration in Primary Healthcare. Full article

Background/Objectives: Anterior direct composite restorations are evaluated through instrumental color matching, clinician appraisal, and patient perception, but these endpoints may diverge by age. This cross-sectional study compared adolescents/young adults (AYA, 15–25 years) with adults/elderly (AE, 50–75 years) for spectrophotometric color difference (ΔE*ab), patient and clinician aesthetic ratings, patient–clinician agreement, and oral-health-related quality of life (OHRQoL). Methods: Consecutive recall patients with at least one anterior direct composite restoration placed ≥6 months earlier were screened; 128 were enrolled, and 126 completed all assessments (AYA n = 64; AE n = 62). Participants completed the OHIP-14 and aesthetic visual analogue scale (VAS) before receiving any USPHS, clinician VAS, or spectrophotometric feedback. A separate clinician, masked to patient scores and spectrophotometric outputs but not to patient age, recorded clinician VAS and modified USPHS criteria. Results: AE restorations showed higher ΔE*ab than AYA restorations (4.8 ± 1.6 vs. 3.2 ± 1.1; p < 0.001), whereas AYA reported lower patient VAS (72.4 ± 12.3 vs. 81.6 ± 10.8; p < 0.001) and higher OHIP-14 psychosocial burden (7.2 ± 2.8 vs. 4.0 ± 2.3; p < 0.001). Clinician VAS was higher in AYA (85.2 ± 7.3 vs. 79.4 ± 8.9; p < 0.001). Patient VAS correlated modestly with ΔE*ab (ρ = −0.38 in AYA; ρ = −0.31 in AE) and more strongly with psychosocial OHIP-14 scores (ρ = −0.54 and −0.47, respectively). Patient-clinician agreement was poor in AYA (ICC = 0.26) and moderate in AE (ICC = 0.58), with larger negative patient-minus-clinician discrepancies in AYA. Exploratory mediation statistically decomposed the age-related patient-satisfaction difference more through patient–clinician discrepancy than through ΔE*ab; causality cannot be inferred. Conclusions: Younger patients may experience dissatisfaction and psychosocial burden despite better instrumental color match. Assessment of anterior composites should combine objective shade measurement with patient-centered expectation clarification, and longitudinal studies should test temporal mechanisms and communication interventions. Full article

Post-Traumatic Stress Disorder (PTSD) is a prevalent and costly mental health condition characterized by symptoms such as hyperarousal, avoidance, and re-experiencing. While machine learning (ML) approaches have shown promise in detecting PTSD-related physiological patterns, most validation efforts rely on computational metrics rather than real-world user perceptions. This study evaluates the perceived precision of a smartwatch-based ML tool designed to detect PTSD hyperarousal events using heart rate and activity data. The tool, previously developed using XGBoost 1.0.0, was deployed in a 21-day naturalistic study with 12 participants diagnosed with PTSD. Quantitative results showed a median perceived precision of 65.27%, with substantial variability across participants. A Mann–Kendall trend analysis revealed a significant increase in perceived precision over time for most participants, suggesting calibration of trust. Qualitative findings indicated high usability, general trust in the system, and acceptance of false positives, though concerns about notification design and battery life were noted. The results highlight the importance of incorporating user-centered, real-world validation into the evaluation of ML-based mental health monitoring tools. This work provides preliminary evidence supporting the feasibility of wearable-based PTSD monitoring and underscores the role of perceived precision in technology adoption and sustained use. Full article

Objectives: To examine disordered eating behaviors, orthorexic tendencies, binge-eating episodes, attitudes toward exercise, perceived hormone-related symptoms and body image perception among competitive bodybuilders across different levels of competitive experience. Methods: In this cross-sectional study, 60 competitive bodybuilders (29 men, 31 women) completed an anonymous online questionnaire. The survey evaluated demographic characteristics, coaching and training management, phase-specific symptoms (such as libido, sleep, eating behaviors, and menstrual alterations), orthorexic tendencies, exercise addiction, and body-image perception. Results: Both sexes reported reduced libido, increased hunger, and sleep disturbances, along with frequent weight monitoring and common binge-eating episodes. Moreover, females frequently reported menstrual irregularities. ORTO-15 scores indicated a potential risk of orthorexia nervosa, while EAI-3 scores suggested a risk of exercise addiction in novice females and advanced males, with differences in mood regulation and guilt across sex and experience. Males showed higher perceived and ideal muscle mass, whereas females reported higher perceived body fat and a preference for leaner physiques. Conclusions: Competitive bodybuilders of both sexes exhibit post-competition binge eating, mood- and appearance-driven exercise behaviors, and pronounced body-image concerns. Screening, education on energy availability, structured post-competition support, and health-focused coaching are recommended to prevent the progression from sport-specific practices to clinical pathology. Full article

Introduction: Patients are increasingly aware of ways to manage their own health—especially regarding chronic diseases—along with the fundamental factors that should be present in well-organized and patient-oriented healthcare organizations. Due to the fact that the image of healthcare organizations depends on patients’ opinions, healthcare organizations are continuously improving and transforming their processes to increase patient satisfaction. This study aimed to analyze the relationship between patients’ opinions about the public hospitals in which they were treated and selected factors, including socio-demographic characteristics, previous hospital experiences, sources of information, and satisfaction with hospitalization in Poland. Methods: A cross-sectional survey was conducted among patients hospitalized in eight public hospitals in Wrocław. A self-developed questionnaire included two sections: (I) opinions about the hospital (11 items) and (II) expectations and satisfaction (12 items). Questionnaires were distributed in person. Data were analyzed using descriptive and inferential statistics, including correlation and chi-square tests. Results: Hospital image was shaped mainly by interpersonal factors, particularly staff kindness (82.9%), access to specialists (75.4%), and a sense of safety (54.4%). Women were more likely than men to seek information about hospitals before admission (47.6% vs. 39.3%; p = 0.021). A positive correlation was found between patient expectations and satisfaction with hospitalization (ρ = 0.425; p < 0.001). Media exposure played a minor role in shaping hospital image (22.1%), while personal recommendations and previous experience were the dominant sources of influence. Conclusion: Patients’ assessments of hospital image are determined primarily by relational and communication factors rather than infrastructural or technical aspects. Sociodemographic characteristics, such as gender and previous contact with the institution, may moderate these perceptions. The findings highlight the need to strengthen patient-centered care models, improve communication competencies among health professionals, and develop transparent institutional communication strategies. Full article

Background/Objectives: The performance of musical wind instruments imposes significant neuromuscular and biomechanical demands on the stomatognathic system. Depending on the mouthpiece type, wind instruments are divided into four classes, which may have distinct impacts on the instrumentalists’ quality of life. This study aimed to evaluate musicians’ self-perception regarding the impact caused by wind instruments practice on oral health-related quality of life (OHRQoL), jaw functional limitations, and chronic pain. Methods: A cross-sectional observational study was conducted among 71 wind instrumentalists (52% female; mean age 24.16 years; mean practice history of 12.8 years) using the Oral Health Impact Profile-14 (OHIP-14), the Jaw Functional Limitation Scale (JFLS), and the Graded Chronic Pain Scale (GCPS). Data were analyzed using the Statistical Package for the Social Sciences (SPSS), with statistical significance set at p < 0.05. Results: Musicians in Class 1 (clarinet/saxophone) and Class 4 (transverse flute) reported the worst OHRQoL and chronic pain scores. Orofacial pain in the jaw, temple, or ear was reported by 66% of the participants. Joint sounds (36%) and closed jaw locking (26%) showed a significant association with female gender; however, this relationship is highly confounded by the strong female clustering in Class 4 (85%) and Class 1 (63%). Behavioral and practice habits significantly influenced outcomes: higher daily study duration (mean 170.31 min), the absence of relaxation exercises, and a willingness to endure physical discomfort for technical progress (73.2%) were significantly associated with lower quality of life and greater functional limitations (mastication and mobility). Performance anxiety, warm-up exercises, and practice intensity peaks showed no significant relationships with OHRQoL. Conclusions: Wind instrument practice severely impacts jaw function and musicians’ well-being. These findings underscore the need for interdisciplinary preventive interventions, including targeted ergonomic training, structured rest protocols, and jaw relaxation exercises, alongside oral public health initiatives that recognize wind musicians as an occupationally vulnerable group. Full article

Hyporheic zone exchange processes are strongly influenced by channel morphology, producing heat transfer patterns with distinct vertical stratification. To evaluate the effects of different channel geomorphic units on hyporheic temperature dynamics, monitoring sites were established along a segment of the Xiajiasi River (Hubei Province, China) encompassing four representative channel types: a meandering reach, a pool–riffle reach, a weir reach, and a straight reach. Hyporheic temperatures were recorded at multiple depths (0, 0.1, 0.2, and 0.3 m) during both summer and winter. The results indicate that channel morphology strongly controls the spatiotemporal distribution of hyporheic temperatures. Across all channel types, sediment temperatures exhibited depth-dependent amplitude attenuation and phase lag, with mean temperatures decreasing with depth in summer and increasing with depth in winter. The meandering reach exhibited the highest summer temperatures (28.3–30.6 °C), whereas the pool–riffle reach displayed the steepest thermal gradients (deep sediment temperatures as low as 25.6 °C). In contrast, the straight reach exhibited the weakest thermal buffering capacity. The presence of the weir markedly modified downstream thermal conditions, reducing sediment temperatures by approximately 1.6–3.2 °C during summer, whereas overall winter observations demonstrated a pronounced thermal inversion with deep sediment temperatures increasing by 1.2–2.9 °C. These findings demonstrate that distinct geomorphic units create diverse thermal niches; river managers can incorporate diverse geomorphic features into river restoration designs to create localized thermal refugia, thereby protecting temperature-sensitive aquatic species. Full article