Search Results (2,871)

Background: Evidence-based complex psychological interventions have been widely applied and appear promising in improving emotional and behavioral disturbances such as depression and sleep problems. However, the effectiveness of these complex psychological interventions, particularly in comparison to active control groups, has yet to be confirmed. Objectives: To explore the effects of a complex set of intervention strategies on depression and sleep quality, two randomized controlled trials with active control conditions were conducted. Method: A total of 97 college students with depressive symptoms were enrolled in study 1 (Intervention = 48; Active control = 49) and participated in the intervention for depression. A total of 110 college students with sleep problems (intervention = 54; active control = 56) participated in the intervention for sleep quality in study 2. College students in the intervention group received a combination intervention program of cognitive behavioral therapy, mindfulness exercises, and positive psychology for depression or sleep quality, while participants in the active control group read popular science articles about mental health. The intervention lasted two weeks. Depression, sleep quality, and related factors were measured before, during, and after the interventions. Results: Although both the intervention and active control conditions effectively reduced depression and sleep problems, the trend of change over time was consistent between both groups. Overall, the effects of the intervention group were not better than those of the active control group. Conclusions: The effects of short-term, multi-strategy interventions on depression and sleep quality in our study were not better than simply reading articles about mental health. These findings suggest that simply combining evidence-based components does not necessarily produce superior outcomes. Full article

(1) Background: Insomnia is one of the most prevalent sleep disorders worldwide and a growing public health concern, yet the combined contribution of psychological and demographic factors remains understudied in Latin America. This study aimed to examine how perceived stress, generalized anxiety, and sociodemographic variables predict insomnia severity in Ecuadorian adults. (2) Methods: A community sample of 698 participants (31.7% men; M = 25.6 years, SD = 10.4) completed an online survey during nationwide electricity blackouts in 2024. Measures included the Insomnia Severity Index (ISI), the Perceived Stress Scale (PSS-10), the Generalized Anxiety Disorder Scale (GAD-7), and a demographic questionnaire. Hierarchical linear regressions were conducted to evaluate the relative contribution of predictors. (3) Results: Demographic variables (age, sex, employment status, and socioeconomic level) were not significant predictors of insomnia severity (R² = 0.007). Perceived stress strongly predicted insomnia (ΔR² = 0.207, p < 0.001), and generalized anxiety added further explanatory power (ΔR² = 0.074, p < 0.001), with both factors contributing independently (β ≈ 1.96 and β ≈ 2.67). Interaction effects with socioeconomic status were non-significant. (4) Conclusions: Psychological factors explained nearly one-third of the variance in insomnia severity, underscoring the importance of stress and anxiety as core predictors and supporting the need for integrated psychological interventions to improve sleep health in Ecuador. Full article

Background/Objectives: Eating disorders (EDs) in adolescents are increasingly prevalent. In South Tyrol, a bilingual region in Northern Italy, not only actual gender and age prevalences can be compared to screening rates, but even the comparability of screening tools across languages can be examined. Methods: A cross-sectional analysis integrated clinical registry data with representative, online school-recruited adolescents (11 to 17) self-reports. 166 clinically diagnosed cases and 1465 screened adolescents (1246 German, 219 Italian), were examined. The SCOFF questionnaire (cutoff ≥ 2 for German and ≥3 for Italian), body mass index, body image perception, psychosocial and lifestyle indicators in proxy and self-reports were examined using descriptive statistics and logistic regression. Results: The clinical dataset for 2024 has a prevalence rate of 0.4%. The SCOFF screening tool identified symptomatic cases in 10.6%, and an age-increasing trend among females. The overall SCOFF-prevalence did not differ between language versions, although responses to individual items varied significantly. Predictors of ED included body image, psychosomatic complaints, problematic social media use, and low social support, with differences between genders. Parents tended to underestimate their children’s perception of being “too thick.” Conclusions: In early adolescence, preventive strategies are needed and targeted interventions in late adolescence. For early detection and intervention, gender-sensitive prevention and active parental involvement is needed. The SCOFF questionnaire demonstrates utility across both languages, but bilingual comparison highlights the need for culturally adapted tools and cross-language validation. Full article

Background: Sport-related concussion (SRC) is a recognised public health concern, with combat sport athletes particularly vulnerable due to frequent head impacts. In Taekwondo, concussion incidence is comparable to other contact sports, yet underreporting and misconceptions may hinder safe management. Understanding knowledge, attitudes, and behaviours in this cohort is critical for athlete safety. Methods: This cross-sectional online survey was distributed to Australian Taekwondo athletes (AKA). Participants completed demographic, concussion history, and the Rosenbaum Concussion Knowledge and Attitudes Survey. Knowledge (CKI) and attitudes (CAI) indices were derived. Group differences were analysed using non-parametric tests, with associations between knowledge, attitudes, and reporting behaviours explored via correlation and logistic regression. Results: Athletes (n = 98) demonstrated good knowledge (mean CKI 19.8/25) and positive attitudes (mean CAI 61.6/75), though misconceptions remained. While 92% indicated they would seek medical attention, 21% reported returning to play the same day as a suspected concussion, and over 20% admitted to concealing symptoms. Higher CAI scores, but not CKI, were associated with safer reporting intentions. Conclusions: AKA showed strong knowledge and attitudes towards concussion; however, risky behaviours persisted. Attitudes, rather than knowledge, were more predictive of reporting behaviours, underscoring the need for interventions that strengthen positive attitudes and cultural support for symptom disclosure. Full article

Physical activity (PA) is recommended in pregnancy and postpartum to support mental and physical well-being. However, little is known about the association between pregnancy and postpartum PA and interrelated factors in PA engagement. The objectives of this study were to (a) measure and understand PA engagement in pregnancy and postpartum and how related variables (i.e., work status, number of children, time since birth, PA during pregnancy) are associated with postpartum PA and (b) to examine two self-reported methods for assessing PA postpartum: self-reported PA volume and intensity through questionnaire vs. asking whether women met PA guidelines of 150 min of moderate-to-vigorous PA per week. A total of 526 women who had given birth within the past 18 months completed an online questionnaire (majority were Canadian or American). Descriptive statistics were used to assess PA during pregnancy and postpartum, and chi-square analyses were run to assess the association between related variables and to evaluate self-report methods. During pregnancy, 27.4% of women reported meeting PA guidelines and 25.3% reported meeting PA guidelines postpartum. No significant relationship between return-to-work status or number of children and meeting PA guidelines was found. Participants ≤12 weeks postpartum were less likely to meet PA guidelines compared to those >12 weeks postpartum. There was a significant relationship between meeting PA guidelines during pregnancy and engagement in PA postpartum. Lastly, there was a significant relationship between a binary measure of meeting PA guidelines (i.e., yes or no) and calculated PA volume and intensity when provided through type, frequency, and duration. This study provides insights into PA patterns of women during pregnancy and postpartum. Findings highlight the need for targeted interventions to support maternal health and well-being, emphasizing the importance of establishing PA habits during pregnancy to assist in maintenance postpartum. Results also suggest that simplified assessment methods may be effective for monitoring women’s PA, potentially making it easier for healthcare providers to track and promote healthy behaviors among new mothers. Full article

Background: The Food Insecurity Experience Scale (FIES), developed by the Food and Agriculture Organization of the United Nations (FAO), is a standardized tool for measuring food insecurity (FI) and enabling international comparisons. Although reliable tools are essential, the FIES has not yet been applied or validated in research conducted in Japan. This study aimed to assess the internal validity of the FIES among Japanese individuals and to identify the sociodemographic, socioeconomic, and psychological characteristics and public assistance status of individuals experiencing FI. Methods: A large-scale, cross-sectional online survey targeting Japanese adult panel members was conducted in 2022. In total, 23,576 respondents were included in the final analysis. The internal validity of the FIES was evaluated according to FAO guidelines. Multivariate-adjusted odds ratio (AOR) and 95% confidence interval (CI) were calculated to determine the associations between FI and sociodemographic factors as well as other factors. Results: The FI scale in this population was acceptable, as indicated by infit statistics ranging from 0.7 to 1.3. Reliability was adequate (0.72). Additionally, the number of types of public assistance (AOR [95% CI] = 1.17 [1.00–1.47]) and factors such as greater severity of psychological distress (AOR [95% CI] = 5.89 [4.74–7.33]) were significantly associated with a higher risk of FI. Conclusions: This study confirmed the reliability and internal validity of the FIES in a Japanese population and identified characteristics of groups at high risk of FI. Focusing on these populations may help detect previously overlooked FI in developed countries and enable timely interventions. Full article

Healthcare providers in oncology experience exceptionally high stress rates. Research emphasizes that stress management programs must be quick to implement, flexible to accommodate demanding schedules, cost-effective, accessible to all staff, and tailored to the needs of oncology personnel. Programs that fail to meet these criteria often struggle with uptake and sustainability. This mixed-methods exploratory study aimed (1) to design an online stress management program, Breathe with the Waves (BWW), based on breathing techniques; (2) to evaluate its acceptability, satisfaction, and relevance; (3) to identify perceived benefits and challenges; and (4) to generate potential outcome measures for future studies. A team of Canadian researchers and end-users co-designed the intervention. Twenty oncology professionals completed BWW, which featured pre-recorded breathing videos, and provided feedback via questionnaires and semi-structured interviews. We used t-tests and Wilcoxon rank tests to analyze quantitative data, and template analysis for qualitative data. Participants found BWW highly acceptable, satisfactory, and relevant. Participants reported three categories of benefits: stress reduction, improved work performance, and increased mindfulness. Challenges included anticipated challenges and experienced challenges. Potential outcome measures fell into six categories: physical health, mental health, relational, work, mindfulness and personal practice. BWW, available in English and French, represents a promising and accessible approach to supporting the well-being of oncology personnel. Full article

Inclusive education represents a central pillar of social sustainability, demanding a nuanced understanding of the factors shaping students’ attitudes toward people with disabilities. Grounded in the social–relational model of disability—which conceptualizes disability as the interaction between individual characteristics and environmental barriers—this study examined the effects of emotionally valenced video stimuli (positive, negative, neutral), gender, and tolerance level on university students’ attitudes, using a randomized quasi-experimental design with repeated measures. The intervention was implemented entirely online to ensure consistency and accessibility. A total of 179 undergraduate students from the National University of Science and Technology Politehnica Bucharest (Romania), aged 20 to 23 years (M = 21.4, SD = 1.6), participated in the study, which lasted approximately two weeks. Participants completed pre- and post-intervention assessments, including the Elementary Tolerance Scale and a 25-item Attitude Scale combining strengths-based descriptors with stereotype-consistent items used diagnostically to detect bias (without endorsing such framings). Results revealed a significant main effect of video type, F(2,176) = 10.07, p < 0.001, with higher post-test scores for the positive condition (M = 93.82) compared to the negative (M = 85.88) and neutral (M = 82.67) conditions. Gender (p = 0.033) and tolerance level (p = 0.034) also emerged as significant moderators. We explicitly reject deficit-oriented terminology, contextualizing its use solely for diagnostic and analytical purposes; wherever possible, affirming, strengths-based, and socially grounded language is prioritized. These findings highlight the value of brief, emotionally tailored interventions for fostering inclusive attitudes in higher education and emphasize the importance of ethically curated, co-designed educational materials and measurement practices grounded in dignity and human rights. Ethical Note (Content Warning): The study adopts a social–relational, human-rights perspective on disability. Deficit-based narratives were analyzed exclusively as subjects of critique and are not endorsed. Descriptions of the “negative” stimulus were deliberately minimized to reduce potential harm and included only for scientific transparency. Negative-valence questionnaire items reflect prevalent stereotypes and were used solely as diagnostic indicators of bias. Future research should prioritize collaborative co-creation with scholars and advocates with disabilities and employ ethically curated, inclusive stimuli. Full article

Background/Objectives: The COVID-19 pandemic profoundly disrupted the daily lives of children with neurodevelopmental disorders, particularly Autism Spectrum Disorder (ASD) and Attention-Deficit/Hyperactivity Disorder (ADHD). Lockdowns, therapy interruptions, and reduced access to educational and healthcare services significantly affected developmental progress and family functioning. This pilot study aimed to assess the long-term impact of the pandemic on children with ASD and ADHD in Northern Greece and to explore consequences for their families in the post-pandemic period. Methods: Parents or legal guardians of 72 children (ages 2–17 years) with confirmed diagnoses of ASD (n = 57) or ADHD (n = 15) participated. A structured 25-item questionnaire captured information on developmental, psychological, and social functioning, family well-being, therapy disruption, screen use, and access to online support. Data were collected across urban, semi-urban, and rural areas of Northern Greece over six months. Descriptive and inferential analyses were performed. Results: Most participants were boys (77.8%) and in primary school (73.6%). Common co-occurring conditions included learning difficulties (33.3%), anxiety (8.3%), and epilepsy (6.9%). Nearly half of families (45.8%) reported therapy reductions exceeding 70%, while 29.2% accessed online therapy, often with limited perceived effectiveness. New behavioral symptoms emerged in 45.8% of children, including irritability, anxiety, and emotional instability. Parental psychological distress was reported by 29.2% of caregivers. Screen time increased in over 90% of cases, and 87.5% of parents perceived the pandemic as negatively affecting their child. Financial strain was noted by 37.5% of families. Conclusions: The findings highlight the significant developmental, psychological, and social consequences of the COVID-19 pandemic for children with ASD and ADHD and their families. Service disruptions, unmet therapeutic needs, and increased caregiver burden emphasize the urgency of sustainable, flexible care models. Strengthening telehealth, integrating community-based interventions, and enhancing educational accommodations are essential for resilience in the post-pandemic era. Full article

The present study aims to contribute to a better understanding of the attitude–behavior link in the sphere of environmental issues by taking into account the role of moral disengagement. Pro-environmental attitudes, at both the implicit and explicit levels, were considered under the hypothesis that they may have direct and indirect effects on pro-environmental behaviors (PEBs) through moral disengagement. The hypothesized relationships specified in the mediation model were tested by administering a cross-sectional online survey to a convenience sample of adult students enrolled in a digital university (N = 176; M_age = 40.54, SD_age = 14) via Millisecond Inquisit Web. The assessment included instruments measuring environmental moral disengagement and explicit attitudes toward the adoption of PEBs, together with an ad hoc Implicit Association Test designed to capture implicit attitudes toward sustainability, and the use of a pro-environmental behavior rating scale. While the sensitivity to model misfit was limited given the achieved sample size, the results from the path analysis show that implicit attitudes do not have a direct effect on PEBs, while explicit attitudes directly influence them. Moreover, as positive explicit and implicit pro-environmental and sustainability attitudes increase, moral disengagement decreases, which in turn negatively affects PEBs. Overall, the present findings confirm that moral disengagement plays a mediating role, and that attitudes can be targets for potential interventions aimed at promoting pro-environmental behaviors and addressing justificatory mechanisms that hinder their adoption. Full article

Background/Objectives: Genicular artery embolization (GAE) is an emerging, minimally invasive treatment for symptomatic osteoarthritis. This study assesses global online search trends for GAE compared with traditional knee replacement using Google Trends data. Methods: This retrospective observational study analyzed global search trends for osteoarthritis treatments using the publicly accessible Google Trends platform. Monthly relative search volumes (RSV; scaled 0–100) for English-language queries were retrieved from January 2018 to December 2024. Three emerging minimally invasive terms (“genicular artery embolization”, “knee embolization”, “interventional radiology”), and three traditional surgical terms (“knee arthroplasty”, “knee replacement”, “total knee replacement”) were included. Temporal trends were evaluated using linear and non-linear regression models, with model fit evaluated using coefficients of determination (R²), ANOVA, and accuracy measures. Statistical significance was defined as p < 0.05. Results: GAE-related terms demonstrated significant growth over time. “Genicular artery embolization” increased by 0.9% per month (R² = 0.795, p < 0.001), and “knee embolization” increased at 0.9% per month (R² = 0.627, p < 0.001) in a linear model. Traditional terms showed slower growth rates of 0.13–0.23% per month (R² = 0.159–0.271). Exponential and quadratic models confirmed these patterns. Mean RSV values over the study period were higher for traditional procedures (e.g., “total knee replacement”: 83.13) than for GAE-related terms (e.g., “genicular artery embolization”: 22.5). Conclusions: Global online interest in GAE-related terms is increasing at a substantially faster rate than interest in traditional knee replacement. Rapidly growing search interest highlights the need for accurate and accessible online patient education regarding emerging treatments. Full article

Background: eHealth literacy (eHL) is the ability to seek, find, understand, and apply digital health information. Adolescents often overestimate their eHL skills, potentially leading to poor health decisions and posing a public health concern. Objectives: This study aimed to examine the knowledge, attitudes, and behaviors toward eHL and seeking health information online among a sample of Italian adolescents aged 10–19 to identify the sociodemographic characteristics and other variables that are associated with the outcomes of interest. Methods: A cross-sectional study was conducted using a structured questionnaire, including the eHealth Literacy Scale (eHEALS). Results: A total of 793 Italian adolescents from seven public schools in Naples, southern Italy, participated in the survey. Among the participants, 58.6% had an eHEALS score below 27. A higher eHL was associated with being male, perceiving the Internet as useful for health decisions, the use of electronic devices for seeking health information, consulting institutional/scientific sources, having a mother with lower education, and having parents without underlying chronic conditions. Additionally, a higher eHL, male sex, younger age, and Internet use for seeking health information in the last three months were linked to perceiving the Internet as a helpful tool for health decision making. Conclusions: Overall, Italian adolescents reported suboptimal eHL with sex, attitudes, and parental factors playing significant roles. Targeted educational interventions are needed to enhance eHL in this specific age group. Full article

In digital retail, where competition intensifies and customer expectations evolve rapidly, understanding the interplay among customer experience metrics is critical for strategic decision-making. Despite widespread adoption of feedback programmes, practitioners struggle to interpret how improvements in transactional ease, experiential quality, and satisfaction propagate across the customer journey to influence retention and growth. This study addresses this gap by examining the interrelations among Customer Effort Score (CES), Customer Experience (CX), Customer Satisfaction (CSAT), Customer Loyalty Index (CLI), and Net Promoter Score (NPS) within a unified framework. A quantitative, cross-sectional survey of recent online shoppers yielded 359 valid responses; the model was estimated with PLS-SEM. All hypothesised direct paths were positive and significant, evidencing a cascade from effort through experience and satisfaction to repurchase and recommendation intentions. Mediation analyses confirmed that CES and CX affect loyalty and advocacy indirectly via CSAT. Out-of-sample prediction validated predictive relevance. The study integrates transactional and relational indicators, establishes the empirical utility of single-item measures within PLS-SEM, and advances a portfolio view of CX metrics. Managerially, effort reduction and experience enhancement emerge as high-leverage interventions: improvements cascade through satisfaction to elevate loyalty and advocacy in digital retail. Full article

Eight Views is a time-honored East Asian cultural-landscape paradigm in which eight emblematic natural—cultural scenes fuse regional character, historical memory, and aesthetic ideals into a coherent narrative. It encodes the collective memory and identity of a city (or garden/region), a premodern ‘mental map’ or proto- ‘city brand’. In China, the historic Urban Eight Views are rooted in local environments and traditions and constitute significant, high-value landscape heritage today. Yet rapid urbanization has inflicted severe physical damage on these ensembles. Coupled with insufficient holistic and systemic understanding among managers and the public, this has led, during development and conservation alike, to spatial insularization, fragmentation, and even disappearance, alongside widening divergences in cultural cognition and biases in value judgment. Taking Longmen Haoyue in Chongqing, one of the historic Urban Eight Views, as a case that manifests these issues, this study develops a holistic–relational approach for the urban, historical Eight Views and explores landscape-based pathways to protect the spatial structure and cultural connotations of the heritage that has been severely damaged and is in a state of disappearance or semi-disappearance amid modernization. Methodologically, we employ decomposition analysis to extract the historical information elements of Longmen Haoyue and its internal relational structure and corroborate its persistence through field surveys. We then apply the FAHP method to grade the conservation value and importance of elements within the Eight Views, quantitatively clarifying protection hierarchies and priorities. In parallel, a multidimensional corpus is constructed to analyze online dissemination and public perception, revealing multiple challenges in the evolution and reconstruction of Longmen Haoyue, including symbolic misreading and cultural decontextualization. In response, we propose an integrated strategy comprising graded element protection and intervention, reconstruction of relational structures, and the building of a coherent cultural-semantic and symbol system. This study provides a systematic theoretical basis and methodological support for the conservation of the urban historic Eight Views cultural landscapes, the place-making of distinctive spatial character, and the enhancement of cultural meanings. It develops an integrated research framework, element extraction, value assessment, perception analysis, and strategic response that is applicable not only to the Eight Views heritage in China but is also transferable to World Heritage properties with similar attributes worldwide, especially composite cultural landscapes composed of multiple natural and cultural elements, sustained by narrative traditions of place identity, and facing risks of symbolic weakening, decontextualization, or public misperception. Full article

Bullying and cyberbullying constitute urgent public health challenges, contributing to significant psychological, social, and developmental harms among youth worldwide. While schools have traditionally served as the primary context for prevention, these efforts are often limited in scope, duration, and systemic integration. Healthcare and public health professionals are uniquely positioned to contribute to early identification, prevention, and resilience-building, but their roles are not consistently integrated into bullying prevention frameworks. This systematic review, conducted in accordance with PRISMA 2020 guidelines, synthesized 12 empirical studies published between 2013 and 2023 that examined healthcare- and public health–led interventions addressing bullying and cyberbullying among children and adolescents. Using a narrative synthesis mapped onto the SHIELD framework (Strengths, Healing, Interventions, Empowerment, Learning, Development), six themes emerged: (1) screening and early identification protocols, (2) family and community involvement, (3) variable focus on mental health and well-being, (4) multi-component, school-based interventions, (5) cognitive-behavioral and solution-focused interventions, and (6) online and digital interventions. Findings highlight the potential of health professionals to deliver trauma-informed, empowerment-based, and culturally responsive approaches that extend beyond traditional educational settings. Recommendations emphasize cross-sector collaboration, integration of digital tools, and equity-centered practices to strengthen prevention, intervention, and resilience-building. This review underscores the critical role of healthcare and public health professionals in creating safer, more supportive environments for youth. Full article