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21 pages, 1696 KB  
Article
Psychometric Properties of the Turkish Version of the Dietary Fat and Free Sugar-Short Questionnaire (DFS-TR) in Adults: A Validity and Reliability Study
by Çiler Özenir, Mihrican Çubuk, Canan Altınsoy and Duygu Ağagündüz
Nutrients 2026, 18(3), 421; https://doi.org/10.3390/nu18030421 - 27 Jan 2026
Abstract
Background/Objectives: The aim of this study was to translate the Dietary Fat and Free Sugar-Short Questionnaire (DFS) into Turkish (DFS-TR) and to establish its construct validity and reliability. Methods: Quota sampling was used to ensure demographic homogeneity across gender and age groups. Participant [...] Read more.
Background/Objectives: The aim of this study was to translate the Dietary Fat and Free Sugar-Short Questionnaire (DFS) into Turkish (DFS-TR) and to establish its construct validity and reliability. Methods: Quota sampling was used to ensure demographic homogeneity across gender and age groups. Participant distribution by age categories was proportionally aligned with the demographic statistics of the adult Turkish population. The study comprised 314 participants aged 19–64 years (38.78 ± 12.10), of which 54.5% were female. The data collection form consisted of demographic characteristics, anthropometric measurements, information on eating habits, DFS-TR, the Food Frequency Questionnaire (FFQ), and the Power of Food Scale (PFS). Results: Test–retest reliability was confirmed in the 314 participants with a 4-week interval (r = 0.997, p < 0.01). The Cronbach α reliability coefficient was α = 0.777. Using the split-half method, the correlation coefficient between the two halves was 0.681, the Spearman–Brown coefficient was 0.811, and the Guttman coefficient was 0.809. Participants’ total DFS-TR scores and sub-dimension scores varied according to age, education level, income level, anthropometric characteristics, physical activity, and dietary habits, but did not vary according to gender or marital status. To investigate convergent validity, participants’ DFS-TR scores were correlated with the FFQ and PFS. DFS-TR scores showed a significant correlation with the percentage of energy from saturated fat and free sugar assessed by the FFQ. Positive relationships were found between DFS-TR scores and the total PFS score, particularly with the sub-dimension scores for food available and food present. Conclusions: The DFS-TR can be used as a reliable and valid measurement tool for estimating saturated fat and free sugar intake among Turkish adults. Full article
(This article belongs to the Special Issue Dietary Assessment and Dietary Improvement Suggestions for Obesity)
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17 pages, 276 KB  
Article
Nurse Educators’ Self-Reported Level of Teaching Competence and Its Correlation with Sociodemographic, Professional, Training and Research Variables: A Cross-Sectional Multicentre Study
by Isabel Martínez-Sánchez, Marta Romero-García, Sergio Alonso-Fernández, Maria-Antonia Martínez-Momblan, Judith Lleberia and Montserrat Puig-Llobet
Nurs. Rep. 2026, 16(2), 41; https://doi.org/10.3390/nursrep16020041 - 27 Jan 2026
Abstract
Background: Nurses’ teaching skills in the clinical setting are crucial to ensuring that students receive high-quality training. Despite the growing importance of competency frameworks, there is little research on the relationship between nurses’ teaching competence and sociodemographic, professional, training, and research variables. Methods [...] Read more.
Background: Nurses’ teaching skills in the clinical setting are crucial to ensuring that students receive high-quality training. Despite the growing importance of competency frameworks, there is little research on the relationship between nurses’ teaching competence and sociodemographic, professional, training, and research variables. Methods: This was a cross-sectional, descriptive, and correlational study conducted at nine hospitals linked to the clinical placement subjects of the Bachelor of Nursing of the University of Barcelona. The study population comprised all nurses directly involved in clinical teaching. Participants’ level of self-reported teaching competence was evaluated using the Spanish version of the Capabilities of Nurse Educators (S-CONE) questionnaire, and the sociodemographic, professional, and academic variables were collected in an ad hoc questionnaire. Descriptive statistics, non-parametric tests, and linear and logistic regression models were used to analyse the associations between the S-CONE total score and the variables collected. Results: The mean age of the participants (n = 596) was 41.9 years (standard deviation: 8.82), and 85.6% of them were women (n = 510). The overall mean S-CONE score was 3.81 (SD: 0.73). Higher scores were observed in those with advanced academic degrees, formal teacher training, and participation in academic activities. Professionals with mixed roles (clinical mentor and academic tutor) self-reported significantly higher competence levels. Multivariate analyses identified participation in conferences, tutoring of undergraduate theses, and involvement in research or development projects as the main predictors of higher teaching competence as measured by the S-CONE questionnaire. The lowest-scoring factor was research and evidence, which points to a potential area for improvement. No significant associations were found with age, sex, or years of clinical experience. Conclusions: Participants had a high self-reported level of teaching competence and rated themselves as competent overall, especially in professional practice and curriculum design. However, we identified areas for improvement related to pedagogical innovation and the use of evidence. The findings reinforce the importance of professional development and academic involvement to strengthen teacher competence. Full article
(This article belongs to the Section Nursing Education and Leadership)
21 pages, 639 KB  
Article
Hydration Knowledge, Water Consumption, and Attitudes Toward Drinking Water Quality Among Adults in Romania: A Cross-Sectional Study
by Corina Dalia Toderescu, Melania Munteanu, Laura Ioana Bondar, Brigitte Osser, Roland Fazakas, Gyongyi Osser, Iosif Ilia, Ionuț Daniel Răducan, Maria Alina Andresz and Svetlana Trifunschi
Nutrients 2026, 18(3), 419; https://doi.org/10.3390/nu18030419 - 27 Jan 2026
Abstract
Background/Objectives: Adequate hydration is essential for health; however, water consumption behaviors are influenced not only by physiological needs but also by hydration knowledge and perceptions of drinking water quality. Empirical evidence examining these factors in Eastern European populations remains limited. This study [...] Read more.
Background/Objectives: Adequate hydration is essential for health; however, water consumption behaviors are influenced not only by physiological needs but also by hydration knowledge and perceptions of drinking water quality. Empirical evidence examining these factors in Eastern European populations remains limited. This study aimed to assess hydration knowledge, water consumption patterns, and attitudes toward drinking water quality among adults in Romania, and to examine their associations with daily water intake and water source preferences. Methods: A cross-sectional study was conducted between November 2024 and November 2025 among adults residing in Romania. Data were collected from 165 participants using an anonymous, self-developed, paper-based questionnaire administered in person to adult patients attending routine visits in four primary care clinics in Arad, Romania, using a convenience sampling approach. The questionnaire assessed sociodemographic characteristics, hydration knowledge, water consumption behaviors, and attitudes toward drinking water quality. Descriptive statistics, chi-square tests, correlation analyses, and multivariable linear and logistic regression models were applied to identify factors associated with daily water intake, adequate hydration (≥2 L/day), and bottled water consumption. Results: Hydration knowledge was moderate overall and was significantly associated with education level and gender. Higher hydration knowledge was positively correlated with daily water intake (r = 0.21, p = 0.006) and was independently associated with higher intake and adequate hydration (OR = 1.28, 95% CI: 1.10–1.49; p = 0.002). Greater trust in tap water was also positively associated with daily intake (r = 0.27, p = 0.001) and adequate hydration (OR = 1.31, 95% CI: 1.12–1.54; p < 0.001). Lower trust in tap water and stronger beliefs regarding bottled water were significant predictors of bottled water use as the primary drinking water source. Education level emerged as a consistent predictor across multiple hydration-related outcomes. Conclusions: Hydration knowledge and perceptions of drinking water quality are key, modifiable factors associated with water consumption behaviors. Educational strategies integrated into primary care and transparent communication regarding tap water safety may support adequate and sustainable hydration among adults. Full article
(This article belongs to the Section Nutrition and Public Health)
16 pages, 295 KB  
Article
Subclinical Respiratory Impairment and Quality of Life Among Non-Smoking Adults in Rural Chiang Mai, Thailand
by Muhammad Samar, Tipsuda Pintakham, Muhammad Naeem Rashid, Nan Ei Moh Moh Kyi, Natthapol Kosashunhanan, Teetawat Santijitpakdee, Sawaeng Kawichai, Tippawan Prapamontol and Anurak Wongta
J. Clin. Med. 2026, 15(3), 1019; https://doi.org/10.3390/jcm15031019 - 27 Jan 2026
Abstract
Background: Subclinical respiratory impairment among non-smokers in regions with haze-affected regions is still under-recognized, particularly in low- and middle-income countries (LMICs). This study assessed the prevalence of subclinical respiratory impairment among non-smoking adults and examined its determinants and associations with health-related quality [...] Read more.
Background: Subclinical respiratory impairment among non-smokers in regions with haze-affected regions is still under-recognized, particularly in low- and middle-income countries (LMICs). This study assessed the prevalence of subclinical respiratory impairment among non-smoking adults and examined its determinants and associations with health-related quality of life (HRQoL) in Chiang Mai, Thailand. Methods: In this cross-sectional study, 244 non-smoking adults (18–65 years) from three rural districts underwent standardized spirometry and completed the Thai WHOQOL-BREF-26. Subclinical impairment was defined as an FEV1/FVC < 0.70 or FVC < 80% predicted in the absence of symptoms. Demographic, occupational, and environmental information was obtained through structured questionnaires. Statistical analyses included non-parametric tests, univariate linear regression, and logistic regression. Results: A total of 37 participants (15.2%) had subclinical respiratory impairment. No demographic, occupational, or environmental factors such as sex, age, BMI category, agricultural work, marital status, and self-reported pollution exposure were found to be independently linked to impaired lung function. There was no correlation between spirometry indices and any WHOQOL-BREF domain. Elderly participants (>50 years) reported a higher level of physical and psychological HRQoL. Those with a higher Body Mass Index (BMI) were more likely to have a lower environmental quality of life. Farmers reported a better QoL, while women reported a lower QoL than men. Conclusions: Subclinical respiratory impairment occurs frequently in non-smoking rural adults exposed to haze pollution in Chiang Mai, and isn’t presently assessed by general HRQoL instruments. These findings support early spirometry screening for asymptomatic adults in polluted regions, as well as more stringent air cleanliness strategies to prevent the evolution towards overt respiratory pathology. Full article
(This article belongs to the Section Respiratory Medicine)
12 pages, 405 KB  
Article
Implementation of Evidence-Based Practice Among Respiratory Therapists in Saudi Arabia: A Cross-Sectional Study
by Fahad H. Alahmadi, Ali M. Alasmari, Keir E. J. Philip, Ziyad Alshehri, Maher Aljohani, Majed K. Aljohani, Abdulrahman M. Hawsawi, Abdullah S. Alsulayyim, Rami A. Alyami, Yahya A. Alzahrani, Maher M. Alquaimi, Mohammed A. Almeshari, Batool Alnakhli, Nowaf Y. Alobaidi and Ahmed A. Alzahrani
Healthcare 2026, 14(3), 324; https://doi.org/10.3390/healthcare14030324 - 27 Jan 2026
Abstract
Background: Evidence-based practice (EBP) has become a foundational component of modern healthcare globally. In Saudi Arabia, the understanding and application of EBP by respiratory therapists (RTs) remains underexplored. This study aimed to assess RTs’ behaviors, attitudes, awareness, knowledge, and barriers related to [...] Read more.
Background: Evidence-based practice (EBP) has become a foundational component of modern healthcare globally. In Saudi Arabia, the understanding and application of EBP by respiratory therapists (RTs) remains underexplored. This study aimed to assess RTs’ behaviors, attitudes, awareness, knowledge, and barriers related to EBP. Methods: A previously validated online questionnaire was distributed to RTs across Saudi Arabia between February and July 2025. The survey collected sociodemographic data and included 14 items assessing behaviors, attitudes, awareness, knowledge, prior formal EBP training, and perceived barriers to EBP implementation. Results: A total of 301 RTs participated, with 290 completing the survey. Most participants (75.2%) held a bachelor’s degree. Overall, respondents demonstrated positive attitudes toward EBP, with more than 60% agreeing that understanding research methods is essential to respiratory therapy practice. The most frequently used resources for clinical decision-making were personal experience (67.3%), expert opinion (65.5%), and national or international guidelines (65.5%). Awareness of core EBP concepts was moderate; approximately 30% of participants reported a good understanding of terms such as “systematic review,” “quality of evidence,” and “risk of bias.” Several barriers to EBP implementation were identified, most commonly limited access to resources (25.2%), insufficient research knowledge and skills (23.8%), and lack of interest (21.0%). Conclusions: RTs in Saudi Arabia generally support EBP principles and use evidence-based resources in clinical decision-making. However, gaps in training, access to resources, and research competency limit full EBP implementation. Targeted strategies, including integrating mandatory EBP education, expanding professional development, and enhancing access to research resources, are recommended. Full article
(This article belongs to the Section Healthcare Organizations, Systems, and Providers)
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13 pages, 530 KB  
Article
Insulin Resistance and Metabolic Dysfunction in Early-Stage Parkinson’s Disease: Evidence from a Preliminary Case-Control Study
by Elena Contaldi, Lorenzo Ciocca, Francesco Mignone, Michela Barichella, Alessia Siribelli, Giulia Lazzeri, Ioannis Ugo Isaias, Gianni Pezzoli and Federica Invernizzi
J. Clin. Med. 2026, 15(3), 1021; https://doi.org/10.3390/jcm15031021 - 27 Jan 2026
Abstract
Background: Parkinson’s disease (PD) is increasingly recognized as a multisystem disorder in which metabolic dysfunction may contribute to disease susceptibility and progression. Peripheral insulin resistance (IR) has been implicated in PD, but data in levodopa-naïve patients are currently limited. Objective: To investigate the [...] Read more.
Background: Parkinson’s disease (PD) is increasingly recognized as a multisystem disorder in which metabolic dysfunction may contribute to disease susceptibility and progression. Peripheral insulin resistance (IR) has been implicated in PD, but data in levodopa-naïve patients are currently limited. Objective: To investigate the prevalence of IR and metabolic dysfunction in early-stage, levodopa-naïve PD patients and their association with clinical features. Methods: We conducted an exploratory case–control study including 20 levodopa-naïve PD patients and 40 age-, sex-, and BMI-matched healthy controls. Participants underwent comprehensive clinical and metabolic assessments, including fasting glucose, insulin, lipid profiles, and HOMA-IR calculation. Peripheral IR was defined using HOMA-IR cut-offs of ≥2.0 (primary analysis) and ≥2.5 (sensitivity analysis). ANCOVA adjusted for age, sex, and BMI was used for between-group comparisons. Results: PD patients exhibited higher fasting insulin (10.7 ± 5.2 vs. 8.0 ± 4.4 µIU/mL; p = 0.020) and HOMA-IR (2.63 ± 1.40 vs. 1.89 ± 1.21; p = 0.014) compared to controls. Using a HOMA-IR ≥ 2.0, IR prevalence was 70% in PD vs. 32.5% in controls (OR = 4.85, 95% CI 1.52–15.50, p = 0.012). ANCOVA analysis confirmed group differences after adjusting for covariates (respectively, p = 0.032 for insulin and p = 0.023 for HOMA-IR). A sensitivity analysis excluding six patients receiving dopaminergic therapy further supported the robustness of the results. No significant correlations were observed between IR and disease severity scores. Conclusions: Early-stage, levodopa-naïve PD patients exhibit a higher prevalence of peripheral insulin resistance compared with matched controls. These findings support the hypothesis that metabolic dysfunction is an intrinsic component of PD pathophysiology and may represent a target for early intervention. Full article
(This article belongs to the Special Issue Parkinson's Disease: Recent Advances in Diagnosis and Treatment)
24 pages, 1116 KB  
Protocol
Feasibility of “DiverAcción”: A Web-Based Telerehabilitation System for Executive Functions Training in Children and Adolescents with ADHD—Longitudinal Study Protocol
by Marina Rivas-García, Carmen Vidal-Ramírez, Abel Toledano-González, María del Carmen Rodríguez-Martínez, Esther Molina-Torres, José-Antonio Marín-Marín, José-Matías Triviño-Juárez, Miguel Gea-Mejías and Dulce Romero-Ayuso
Healthcare 2026, 14(3), 323; https://doi.org/10.3390/healthcare14030323 - 27 Jan 2026
Abstract
Background: Attention Deficit Hyperactivity Disorder (ADHD) is associated with executive function deficits—such as planning, organization, and prospective memory—that impair autonomy and daily functioning, increase family stress, and create challenges in educational contexts. These consequences underscore the need for accessible and ecologically valid [...] Read more.
Background: Attention Deficit Hyperactivity Disorder (ADHD) is associated with executive function deficits—such as planning, organization, and prospective memory—that impair autonomy and daily functioning, increase family stress, and create challenges in educational contexts. These consequences underscore the need for accessible and ecologically valid interventions addressing the cognitive, familial, and educational dimensions. Traditional approaches often lack ecological validity, and pharmacological treatment shows a limited impact on functional cognition. Objectives: This protocol outlines a feasibility study of DiverAcción, a web-based telerehabilitation system designed to enhance functional cognition through interactive and gamified tasks integrated into a comprehensive healthcare programme. Methods: A quasi-experimental feasibility study before and after the study will recruit 30 participants aged 9 to 17 years with ADHD. The study comprises an initial face-to-face session for instructions and baseline assessment (T0), followed by twelve supervised online sessions over six weeks. Therapeutic support is provided via integrated chat, email, and two scheduled videoconference check-ins. Feasibility outcomes: include recruitment, adherence, retention, usability (SUS), acceptability (TAM), satisfaction, user-friendly design, therapeutic alliance (WAI-I), and professionals’ attitudes toward technology (e-TAP-T). Exploratory measures: include parental self-efficacy (BPSES), parenting stress (PSI-4-SF), ADHD symptomatology (SNAP-IV), executive functioning (BRIEF-2), time management (Time-S), emotional regulation (ERQ-CA), prospective memory (PRMQ-C), and health-related quality of life (KIDSCREEN-52). Analyses emphasize descriptive statistics for feasibility metrics (recruitment, adherence, retention, dropout and fidelity). Assessments are conducted post-intervention (T1) and at three-month follow-up (T2) and analyzed relative to baseline using repeated-measures ANOVA or Friedman tests, depending on data distribution. Conclusions: This feasibility protocol will provide preliminary evidence on the usability, acceptability, and implementation of DiverAcción. Findings will guide refinements and inform the design of a subsequent randomized controlled trial. Full article
12 pages, 923 KB  
Article
Reliability of Sternocleidomastoid Muscle Stiffness Assessment Using Shear-Wave Elastography Under a Standardized Protocol with Novice and Experienced Examiners: An Intra- and Inter-Examiner Reliability Study
by Germán Monclús-Díez, Sandra Sánchez-Jorge, Jorge Buffet-García, Mónica López-Redondo, Davinia Vicente-Campos, Umut Varol, Ricardo Ortega-Santiago and Juan Antonio Valera-Calero
Medicina 2026, 62(2), 267; https://doi.org/10.3390/medicina62020267 - 27 Jan 2026
Abstract
Background and Objectives: Sternocleidomastoid (SCM) dysfunction is commonly implicated in several musculoskeletal conditions. Accordingly, shear-wave elastography has been used to characterize SCM stiffness in asymptomatic and clinical cohorts. However, the only reproducibility study available reported limited reliability, so clinical interpretations should be [...] Read more.
Background and Objectives: Sternocleidomastoid (SCM) dysfunction is commonly implicated in several musculoskeletal conditions. Accordingly, shear-wave elastography has been used to characterize SCM stiffness in asymptomatic and clinical cohorts. However, the only reproducibility study available reported limited reliability, so clinical interpretations should be made with caution. Therefore, this study revisits key methodological aspects of that protocol to assess intra-examiner reliability and includes two examiners with different levels of expertise to evaluate inter-examiner reliability. Materials and Methods: A longitudinal observational study was conducted, recruiting twenty-five asymptomatic participants. Two examiners with different experience levels participated in this study after following structured training. For each side, images were obtained in immediate succession in the sequence experienced–novice–experienced–novice (with side order randomized), using an ROI spanning full muscle thickness, stabilizing approximately 10 s before freezing to record Young’s modulus and shear-wave speed. Results: Inter-examiner agreement was good–excellent: single-measurement ICCs were 0.77–0.86, improving to 0.79–0.87 when averaging two trials, which also reduced the standard error of measurement (SEM) and minimal detectable changes (MDCs). Between-examiner mean differences were small and nonsignificant (p ≥ 0.068). Intra-examiner reliability was excellent (ICC ≈ 0.93–0.94) with small absolute errors. Precision was high (SEM ~5–6 kPa; 0.22 m/s), and MDCs were ~15–16 kPa and ~0.60 m/s, with no trial-to-trial bias (all p ≥ 0.311). Conclusions: The revised protocol showed excellent intra-examiner repeatability and good–excellent inter-examiner reliability with minimal bias. Averaging two acquisitions improved precision, while a single operator optimized longitudinal stability. Full article
(This article belongs to the Section Neurology)
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14 pages, 1143 KB  
Article
Geriatric Nutritional Risk Index as a Predictor for Osteoporosis Risk in Elderly Patients with Type 2 Diabetes Mellitus: A Hospital-Based Study
by Abdalla M. Abdelrahman, Michael Edwar Farg, Hanaa A. Nofal, Shaherah Yousef Andargeery, Dina S. Elrafey, Wesam M. R. Ashour and Ahmed Ibrahim Gad
Diagnostics 2026, 16(3), 408; https://doi.org/10.3390/diagnostics16030408 - 27 Jan 2026
Abstract
Background: Osteoporosis is a major complication in older adults with type 2 diabetes mellitus (T2DM). Malnutrition contributes to bone loss, and the Geriatric Nutritional Risk Index (GNRI) has emerged as a simple tool for assessing nutritional status. Evidence on the predictive value [...] Read more.
Background: Osteoporosis is a major complication in older adults with type 2 diabetes mellitus (T2DM). Malnutrition contributes to bone loss, and the Geriatric Nutritional Risk Index (GNRI) has emerged as a simple tool for assessing nutritional status. Evidence on the predictive value of the GNRI for osteoporosis in elderly patients with T2DM remains limited. Objective: To evaluate the association between GNRI scores and osteoporosis and determine its predictive performance in elderly patients with T2DM. Methods: A cross-sectional study was conducted on 200 elderly patients with T2DM attending the internal medicine outpatient clinics at Zagazig university hospitals between January and October 2025. Clinical data, biochemical parameters, and bone mineral density (BMD) at the lumbar spine, femoral neck, and total hip were assessed. GNRI scores were calculated using standard formulas. Participants were classified into osteoporosis and non-osteoporosis groups according to WHO criteria. Correlations and ROC curve analysis were performed to assess the predictive ability of the GNRI in comparison with age, BMI, and serum albumin. Results: Osteoporosis was present in 15% of the cohort. Patients with osteoporosis had significantly lower GNRI scores and lower BMD values at all measured sites (p < 0.05). The GNRI showed significant positive correlations with BMD parameters in both sexes. ROC analysis demonstrated that the GNRI had the highest predictive performance for osteoporosis (AUC = 0.80 for all patients; AUC = 0.85 in males; AUC = 0.77 in females). Optimal GNRI cutoff values were <100.03 for the total sample, <99.10 for males, and <100.3 for females. Conclusions: The GNRI is a valuable and simple clinical tool for predicting osteoporosis in elderly patients with T2DM. Lower GNRI scores are significantly associated with reduced BMD. Incorporating the GNRI into routine assessment may help identify high-risk patients who require early screening and intervention. Full article
(This article belongs to the Section Clinical Diagnosis and Prognosis)
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20 pages, 2461 KB  
Article
Mechanism of Action of Therapeutic Exercise in Rotator Cuff Tendinopathy: What Does Elastography Add?
by Irene Pérez-Porta, Claudia de la Fuente-Escudero, Ángel Luis Bueno-Horcajadas, Elia Pérez-Fernández, Fernando García-Pérez, María Velasco-Arribas and Mariano Tomás Flórez-García
J. Clin. Med. 2026, 15(3), 1015; https://doi.org/10.3390/jcm15031015 - 27 Jan 2026
Abstract
Background/Objectives: In rotator cuff-related shoulder pain (RCRSP) without associated tendon rupture, therapeutic exercise is one of the main treatment strategies; however, the mechanisms through which it exerts its effects remain poorly understood. The aim of this study was to analyze the role [...] Read more.
Background/Objectives: In rotator cuff-related shoulder pain (RCRSP) without associated tendon rupture, therapeutic exercise is one of the main treatment strategies; however, the mechanisms through which it exerts its effects remain poorly understood. The aim of this study was to analyze the role of two potential mechanisms of action: increases in muscle strength and changes in the microarchitecture of the supraspinatus muscle. Methods: This prospective study included 39 patients with RCRSP treated with a strengthening exercise program. Muscle strength was assessed using dynamometry, and supraspinatus muscle stiffness was evaluated using shear wave elastography (SWE) at baseline and after 6 months of exercise. These measurements were correlated with clinical and perceived improvement in the patients. Results: Thirty-seven patients completed follow-up. At 6 months, 67.6% of participants reported being much better or fully recovered, 29.7% reported being somewhat better, and only one patient (2.7%) reported worsening. Overall, the increase in muscle strength was small. In participants reporting marked improvement or full recovery, strength gains were slightly greater, but a significant increase in supraspinatus muscle stiffness was observed. In contrast, participants with mild improvement or worsening showed smaller strength gains and no changes in muscle stiffness. Conclusions: Strength gains following strengthening exercises in RCRSP are small and of limited clinical relevance. In contrast, increased supraspinatus muscle stiffness assessed by SWE was observed after the exercise intervention and may reflect exercise-related adaptations; however, its biological meaning should be interpreted with caution. Full article
(This article belongs to the Section Clinical Rehabilitation)
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22 pages, 668 KB  
Article
VDR Gene Polymorphisms and Inter-Individual Variability in Response to Resistance Training
by Chen Yang and Yanchun Li
Genes 2026, 17(2), 137; https://doi.org/10.3390/genes17020137 - 27 Jan 2026
Abstract
Background: Vitamin D receptor (VDR) gene polymorphisms are linked to muscle and bone physiology, yet their influence on individual differences in resistance training adaptations, especially between sexes, is not well understood. Methods: In total, 191 healthy Chinese Han adults [...] Read more.
Background: Vitamin D receptor (VDR) gene polymorphisms are linked to muscle and bone physiology, yet their influence on individual differences in resistance training adaptations, especially between sexes, is not well understood. Methods: In total, 191 healthy Chinese Han adults (94 men, 97 women) completed a 12-week, twice-weekly resistance training program (squat and bench press). Key indicators of strength, power, body composition, and muscle morphology were assessed before and after the intervention. Participants were genotyped for VDR polymorphisms (rs731236/TaqI, rs7975232/ApaI, rs1544410/BsmI, rs2228570/FokI). Data were analyzed to compare responses across genotype groups. Results: Training induced significant improvements in multiple outcomes. Overall, the AG genotype of rs731236 and the CT genotype of rs1544410 were associated with greater gains in bone mineral content. Sex-specific analyses revealed distinct patterns: in women, the rs731236-AA genotype correlated with better strength and power gains, while the AG genotype linked to greater body composition improvements. In men, the rs1544410-CC genotype was associated with superior lower-limb muscle growth. The rs7975232 showed no significant overall effect, and rs2228570 deviated from Hardy–Weinberg equilibrium. Conclusions: VDR gene polymorphisms, particularly rs731236 and rs1544410, are associated with inter-individual variability in resistance training responses among Chinese Han adults, demonstrating clear sex and phenotype specificity. These findings offer preliminary support for genotype-informed personalized training. Full article
(This article belongs to the Section Genes & Environments)
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14 pages, 275 KB  
Article
Emotional Dysregulation and Temperament in Adolescents with Acute Psychiatric Conditions: Gender Differences and the Role of Psychiatric Diagnosis
by Alessandra Minutolo, Maria Pontillo, Massimo Apicella, Gino Maglio, Giulia D’Amario, Giulia Serra, Giorgia Della Santa, Francesca Boldrini, Milena Labonia, Roberto Averna and Stefano Vicari
J. Clin. Med. 2026, 15(3), 1012; https://doi.org/10.3390/jcm15031012 - 27 Jan 2026
Abstract
Background: Emotional dysregulation (ED) is a transdiagnostic construct implicated in a broad range of psychiatric conditions. However, the influence of gender on ED remains understudied, particularly among adolescents with severe mood and behavioral disorders. Furthermore, few studies have controlled for confounding effects of [...] Read more.
Background: Emotional dysregulation (ED) is a transdiagnostic construct implicated in a broad range of psychiatric conditions. However, the influence of gender on ED remains understudied, particularly among adolescents with severe mood and behavioral disorders. Furthermore, few studies have controlled for confounding effects of specific psychiatric diagnoses. Methods: We assessed 182 adolescents (80.8% female; mean age 15.7 years) referred to our clinical institution. Participants completed the Cyclothymic–Hypersensitive Temperament Questionnaire (CHTQ), the Reactivity, Intensity, Polarity, and Stability Questionnaire (RIPoSt-Y), and the K-SADS-PL interview. Results: Females reported significantly higher levels of CHTQ mood lability (7.53 vs. 5.94, p = 0.012), RIPoSt-Y affective instability (62.33 vs. 53.31, p = 0.023), and interpersonal sensitivity (30.80 vs. 24.97, p < 0.001). They also exhibited higher rates of cyclothymic–hypersensitive temperament (46.6% vs. 14.7%, p = 0.001). Regression analysis revealed that gender and specific psychiatric diagnoses exerted significant independent effects on ED dimensions. Mood lability/hypersensitivity was significantly predicted by bipolar disorder (p = 0.001), depressive disorder (p = 0.002), and female sex (p = 0.025). Affective instability was independently predicted by bulimia nervosa (p = 0.019), depressive disorder (p = 0.004), and female sex (p = 0.033). Significant predictors for interpersonal sensitivity included female sex (p = 0.002), depressive disorder (p = 0.008), bulimia nervosa (p = 0.044), and the absence of conduct disorder (p = 0.048). Conclusions: Female adolescents with severe psychiatric presentations exhibited higher levels of ED, specifically regarding mood lability, affective instability, and interpersonal sensitivity. These associations persisted independently of current mood disorder diagnoses or comorbidities. While findings from this clinical cohort may not be fully generalizable to the general population, they highlight the need for gender-informed clinical interventions for adolescents characterized by severe ED. Full article
17 pages, 245 KB  
Article
Pharmacists’ Work Experiences and Career Dynamics in Saudi Arabia: A Cross-Sector Study
by Mohammed Alnuhait, Ayidh Alqarni, Leena Alsharafi, Arjwan Alshreef, Renad Althebaiti, Alaa Shahbar, Foud Bahamdain, Abdulhamid Althagafi, Mohamed A. Albekery, Abdullah F. Alharthi and Abdulmalik S. Alotaibi
Pharmacy 2026, 14(1), 18; https://doi.org/10.3390/pharmacy14010018 - 27 Jan 2026
Abstract
Background: Pharmacists in Saudi Arabia are assuming increasingly diverse and specialized roles amid rapid healthcare transformation. However, evolving expectations and expanding responsibilities may influence their job satisfaction, well-being, and career stability. This study aimed to assess job satisfaction, burnout, well-being, and career intentions [...] Read more.
Background: Pharmacists in Saudi Arabia are assuming increasingly diverse and specialized roles amid rapid healthcare transformation. However, evolving expectations and expanding responsibilities may influence their job satisfaction, well-being, and career stability. This study aimed to assess job satisfaction, burnout, well-being, and career intentions among pharmacists across multiple practice sectors in Saudi Arabia. Method: A nationwide cross-sectional survey was conducted between December 2024 and January 2025 using an electronic questionnaire distributed to licensed pharmacists. The instrument assessed mental well-being, job satisfaction, burnout, workplace environment, and career mobility. Descriptive and inferential analyses were performed using SPSS version 20.0. Results: A total of 531 pharmacists completed the survey; 65% were male, and 89.3% were Saudi nationals. Sector distribution differed significantly by gender (p < 0.001): females were more represented in clinical and hospital pharmacy, while males predominated in the pharmaceutical industry–related roles. Male pharmacists reported higher work environment scores (p = 0.028) and greater sector mobility (34.2% vs. 23.7%, p = 0.012). Approximately 30.5% of participants had changed their employment sector at least once. Community pharmacists reported the highest burnout levels, whereas those in regulatory and administrative roles demonstrated the greatest job satisfaction (both p < 0.001). Participation in professional development showed strong positive associations with job satisfaction and intention to remain in the current role. Conclusions: Marked variations exist in pharmacists’ well-being, satisfaction, and career mobility across sectors in Saudi Arabia, with notable gender differences. Enhancing professional development, ensuring equitable work environments, and promoting sector-specific support strategies may help inform discussions on pharmacist engagement and retention within the evolving national healthcare system. Full article
38 pages, 1156 KB  
Article
Implementing Education for Sustainable Development in Primary Schools: Teacher Perceptions, Practices, and Regional Challenges in an Island Context
by Athanasios Katsimpelis, Hera Antonopoulou, Niki Georgiadou and Constantinos Halkiopoulos
Sustainability 2026, 18(3), 1264; https://doi.org/10.3390/su18031264 - 27 Jan 2026
Abstract
(1) Background: Education serves as a catalyst for social transformation toward sustainability, yet limited empirical evidence exists regarding primary education’s contribution to regional sustainable development, particularly in island contexts facing unique environmental and economic pressures. This study examined primary education teachers’ perceptions, practices, [...] Read more.
(1) Background: Education serves as a catalyst for social transformation toward sustainability, yet limited empirical evidence exists regarding primary education’s contribution to regional sustainable development, particularly in island contexts facing unique environmental and economic pressures. This study examined primary education teachers’ perceptions, practices, and challenges in implementing Education for Sustainable Development (ESD) in Zakynthos, Greece. (2) Methods: A triangulated quantitative approach surveyed a representative sample of 105 primary education teachers from the Zakynthos Primary Education Directorate using a 28-item structured questionnaire assessing ESD knowledge, teaching practices, barriers, and improvement strategies. Teacher questionnaire data were triangulated with KEPEA (Center for Environmental Education and Sustainability) program documentation (103 programs, 2020–2025) and school implementation records from 75 participating schools. Data were analyzed using descriptive statistics, Mann–Whitney U tests, Kruskal–Wallis tests, and Spearman correlations. (3) Results: Most teachers (65.7%) reported adequate knowledge of sustainable development concepts, with 75.3% incorporating ESD into teaching practice often or very often. Triangulation revealed convergent findings: environmental sustainability dominated teacher perceptions (67.3%) and KEPEA programming (78.4%), while economic sustainability received limited attention (18.1%). Female teachers demonstrated significantly higher ESD knowledge (U = 892.5, p < 0.05, r = 0.34). The majority (98.1%) considered ESD integration important, yet only 48.5% felt adequately prepared to teach sustainability topics. A notable attitude-action gap emerged: while 86.6% valued community partnerships, only 47.6% engaged frequently, and KEPEA documented 33.7% of formal collaborations. Primary barriers included insufficient curriculum time (61.9%) and limited resources (51.4%). Teachers identified training programs (71.4%) and access to educational materials (71.4%) as priority interventions. (4) Conclusions: Primary education teachers in Zakynthos demonstrate strong commitment to ESD but face structural barriers limiting implementation effectiveness. The environmental-economic imbalance suggests a need for professional development, integrating economic sustainability concepts through place-based approaches relevant to the island’s tourism-dependent economy. The attitude-action gap in partnerships indicates structural rather than attitudinal barriers requiring policy intervention. Findings support targeted teacher training, curriculum reform, and strengthened school-community collaboration to enhance ESD’s contribution to regional sustainable development. Full article
(This article belongs to the Section Sustainable Education and Approaches)
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17 pages, 256 KB  
Article
‘The Bird Fights Its Way Out of the Egg’: A Phenomenological Study of Nurses’ Lived Experiences of Self-Care in South Korea’s Closed Psychiatric Wards
by Haejin Shin and Younjae Oh
Healthcare 2026, 14(3), 320; https://doi.org/10.3390/healthcare14030320 - 27 Jan 2026
Abstract
Background/Objectives: Nurses working in closed psychiatric wards experience substantial psychosocial and spiritual burdens, emotional strain, and ethical tension due to continuous exposure to patients in crisis. As formal caregivers, nurses’ health and multidimensional well-being are essential for sustaining compassionate, dignity-preserving practice. However, [...] Read more.
Background/Objectives: Nurses working in closed psychiatric wards experience substantial psychosocial and spiritual burdens, emotional strain, and ethical tension due to continuous exposure to patients in crisis. As formal caregivers, nurses’ health and multidimensional well-being are essential for sustaining compassionate, dignity-preserving practice. However, the lived meaning of self-care within highly restrictive psychiatric environments remains insufficiently understood. This study explores how psychiatric nurses in South Korea experience and interpret self-care. Methods: A qualitative phenomenological design was used. Eight psychiatric nurses with more than three years of experience in closed psychiatric wards participated in in-depth, face-to-face interviews conducted between August 2018 and January 2019. Data were analysed using Colaizzi’s method to identify and synthesise essential themes. Results: Five categories captured the essence of nurses’ self-care experiences: (1) struggling to establish therapeutic roles as a psychiatric nurse; (2) conflating professional identity with ideals of good nursing; (3) recognising a gradual loss of motivation and hope to continue psychiatric nursing; (4) acknowledging the need to care for oneself and refocus on inner vitality; and (5) engaging in self-care through interactions with patients. Self-care was understood as a reflective, relational, and transformative process rather than as a set of stress-relief activities. Conclusions: Psychiatric nurses perceived self-care as an existential journey involving vulnerability, self-reflection, and renewal, which fostered both personal and professional growth. By framing self-care as an ethically grounded, relational practice that sustains therapeutic presence and safeguards moral and professional integrity, this study extends existing self-care literature beyond behavioural strategies. Full article
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