Search Results (2,626)

This study examined data from participants who completed the SLeep Education for Everyone Program (SLEEP) to explore how various demographic variables affected sleep outcomes and to determine which participant characteristics predicted success. A total of 104 individuals participated. The Sleep Hygiene Index (SHI) measured undesirable sleep behaviors; the Pittsburgh Sleep Quality Index (PSQI) assessed sleep quality and self-reported sleep duration. Participant demographic information was collected at baseline. A mixed ANOVA evaluated group differences, and a multiple linear regression model identified predictors of sleep improvements. Change in SHI scores from pre- to post-intervention demonstrated a significant time × group interaction between Black and white participants (p = 0.024); further analysis indicated Black participants improved more. Better baseline scores predicted more favorable post-intervention outcomes for SHI, PSQI, and sleep duration. Fewer chronic conditions predicted better post-intervention SHI and PSQI scores. Older age also predicted better SHI scores. More favorable initial scores, fewer chronic conditions, and older age were the strongest predictors of positive outcomes following SLEEP. Improved sleep hygiene, sleep quality, and sleep duration were observed over time within subjects across all groups. In summary, SLEEP appears to be effective. Further work exploring challenges experienced by younger participants or those with multiple co-morbidities is warranted. Full article

Objectives: This study assessed the effectiveness of a cognitive behavioral therapy (CBT)-based fine dust education program, grounded in the Health Belief Model (HBM), on elementary students’ fine dust knowledge, related behaviors, and mental health (depression, anxiety, stress, sleep quality). Methods: From September to November 2024, 95 students (grades 4–6) living near a coal-fired power plant in midwestern South Korea were assigned to either an intervention group (n = 44) or a control group (n = 51). The intervention group completed a three-session CBT-based education program; the control group received stress management education. Assessments were conducted at weeks 1, 2, 4, and 8 using standardized mental health and behavior scales (PHQ: Patient Health Questionnaire, GAD: Generalized Anxiety Disorder Assessment, PSS: Perceived Stress Scale, ISI: Insomnia Severity Index). Results: A chi-square test was conducted to compare pre- and post-test changes in knowledge and behavior related to PM2.5. The intervention group showed significant improvements in seven fine dust-related knowledge and behavior items (e.g., PM2.5 awareness rose from 33.3% to 75.0%; p < 0.05). The control group showed limited gains. Regarding mental health, based on a mixed-design ANCOVA, anxiety scores significantly declined over time in the intervention group, with group and interaction effects also significant (p < 0.05). Depression scores showed time effects, but group and interaction effects were not significant. No significant changes were observed for stress, sleep, or group × PM2.5 interactions. Conclusions: The CBT-based education program effectively enhanced fine dust knowledge, health behaviors, and reduced anxiety among students. It presents a promising, evidence-based strategy to promote environmental and mental health in school-aged children. Full article

Background: High-intensity gait training (HIT) is an evidence-based intervention recommended for stroke rehabilitation; however, its implementation in routine practice is inconsistent. This study examined the real-world implementation of HIT in an inpatient rehabilitation setting in Norway, focusing on fidelity, barriers, and knowledge translation (KT) strategies. Methods: Using the Knowledge-to-Action (KTA) framework, HIT was implemented in three phases: pre-implementation, implementation, and competency. Fidelity metrics and coverage were assessed in 99 participants post-stroke. Barriers and facilitators were documented and categorized using the Consolidated Framework for Implementation Research. Results: HIT was delivered with improved fidelity during the implementation and competency phases, reflected by increased stepping and heart rate metrics. A coverage rate of 52% was achieved. Barriers evolved over time, beginning with logistical and knowledge challenges and shifting toward decision-making complexity. The KT interventions, developed collaboratively by clinicians and external facilitators, supported implementation. Conclusions: Structured pre-implementation planning, clinician engagement, and external facilitation enabled high-fidelity HIT implementation in a real-world setting. Pragmatic, context-sensitive strategies were critical to overcoming evolving barriers. Future research should examine scalable, adaptive KT strategies that balance theoretical guidance with clinical feasibility to sustain evidence-based practice in rehabilitation. Full article

Background: Thailand is rapidly transitioning into an aging society, creating an intergenerational caregiving gap that strains existing support systems. Objective: This study evaluated the effectiveness of “Young Care,” a community-based intervention designed to enhance youth knowledge, attitudes, and caregiving practices (KAP) toward older adults. Methods: A two-day structured training was conducted in Maha Sarakham Province in 2023 using a pre-post mixed-methods design. Middle and high school students participated in lectures, multimedia sessions, and experiential learning activities related to caregiving. Quantitative data were collected using validated KAP questionnaires, while qualitative insights were obtained from focus group discussions involving students, older persons, caregivers, and local leaders. Results: Post-intervention analysis revealed significant improvements in knowledge and attitudes (p < 0.001), accompanied by increased empathy, caregiving initiative, and a sense of moral responsibility among participants. Conclusions: The initiative fostered formal partnerships among schools, local governments, healthcare providers, and universities through memoranda of understanding. These collaborations enabled budgetary support and outreach to out-of-school youth, positioning “Young Care” as a scalable, youth-centered strategy to address Thailand’s long-term care challenges. Full article

Aims/Background: Polypharmacy, or the concurrent intake of five or more medications, is a significant issue in clinical practice, particularly in multimorbid elderly individuals. Despite its importance for patient safety, medical education often lacks systematic training in recognising and managing polypharmacy within the framework of patient-centred care. We investigated the impact of a structured learning intervention introducing polypharmacy as a chronic condition, assessing whether it enhances medical students’ diagnostic competence, confidence, and interprofessional collaboration. Methods: A prospective cohort study was conducted with 50 final-year medical students who received a three-phase educational intervention. Phase 1 was interactive workshops on the principles of polypharmacy, its dangers, and diagnostic tools. Phase 2 involved simulated patient consultations and medication review exercises with pharmacists. Phase 3 involved reflection through debriefing sessions, reflective diaries, and standardised patient feedback. Student knowledge, confidence, and attitudes towards polypharmacy management were assessed using pre- and post-intervention questionnaires. Quantitative data were analysed through paired t-tests, and qualitative data were analysed thematically from reflective diaries. Results: Students demonstrated considerable improvement after the intervention in identifying symptoms of polypharmacy, suggesting deprescribing strategies, and working in multidisciplinary teams. Confidence in prioritising polypharmacy as a primary diagnostic problem increased from 32% to 86% (p < 0.01), and knowledge of diagnostic tools increased from 3.1 ± 0.6 to 4.7 ± 0.3 (p < 0.01). Standardised patients felt communication and patient-centredness had improved, with satisfaction scores increasing from 3.5 ± 0.8 to 4.8 ± 0.4 (p < 0.01). Reflective diaries indicated a shift towards more holistic thinking regarding medication burden. The small sample size limits the generalisability of the results. Conclusions: Teaching polypharmacy as a chronic condition in medical school enhances diagnostic competence, interprofessional teamwork, and patient safety. Education is a structured way of integrating the management of polypharmacy into routine clinical practice. This model provides valuable insights for designing medical curricula. Future research must assess the impact of such training on patient outcomes and clinical decision-making in the long term. Full article

This paper explores emotional analysis in Hebrew texts, focusing on improving machine learning techniques for depression detection by integrating psychological feature lexicons. Hebrew’s complex morphology makes emotional analysis challenging, and this study seeks to address that by combining traditional machine learning methods with sentiment lexicons. The dataset consists of over 350,000 posts from 25,000 users on the health-focused social network “Camoni” from 2010 to 2021. Various machine learning models—SVM, Random Forest, Logistic Regression, and Multi-Layer Perceptron—were used, alongside ensemble techniques like Bagging, Boosting, and Stacking. TF-IDF was applied for feature selection, with word and character n-grams, and pre-processing steps like punctuation removal, stop word elimination, and lemmatization were performed to handle Hebrew’s linguistic complexity. The models were enriched with sentiment lexicons curated by professional psychologists. The study demonstrates that integrating sentiment lexicons significantly improves classification accuracy. Specific lexicons—such as those for negative and positive emojis, hostile words, anxiety words, and no-trust words—were particularly effective in enhancing model performance. Our best model classified depression with an accuracy of 84.1%. These findings offer insights into depression detection, suggesting that practitioners in mental health and social work can improve their machine learning models for detecting depression in online discourse by incorporating emotion-based lexicons. The societal impact of this work lies in its potential to improve the detection of depression in online Hebrew discourse, offering more accurate and efficient methods for mental health interventions in online communities. Full article

Hand hygiene (HH) is essential for preventing disease transmission, particularly in schools where children are in close contact with other children. This study evaluated a school-based intervention on observed HH practices and hand cleanliness in six primary schools in Guatemala. Hand cleanliness was measured using the Quantitative Personal Hygiene Assessment Tool. The intervention included (1) HH behavior change promotion through Handwashing Festivals, and (2) increased access to HH materials at HH stations. Handwashing Festivals were day-long events featuring creative student presentations on HH topics. Schools were provided with soap and alcohol-based hand rub throughout the project to support HH practices. Appropriate HH practices declined from 51.2% pre-intervention to 33.1% post-intervention, despite an improvement in median Quantitative Personal Hygiene Assessment Tool scores from 6 to 8, indicating cleaner hands. Logistic regression showed higher odds of proper HH when an assistant was present. The decline in HH adherence was likely influenced by fewer assistants and changes in COVID-19 policies, while improvements in hand cleanliness may reflect observational bias. These findings emphasize the importance of sustained behavior change strategies, reliable HH material access, and targeted interventions to address gaps in HH practices, guiding school health policy and resource allocation. Full article

Background: Intravenous vancomycin remains a key agent in the treatment of complex orthopedic infections, particularly those involving methicillin-resistant Staphylococcus aureus (MRSA). However, its use is associated with significant risks, most notably nephrotoxicity. Despite guideline recommendations, standardized dosing and monitoring protocols are often absent in orthopedic settings, leading to inconsistent therapeutic drug exposure and preventable adverse events. This study evaluated the clinical impact of implementing a structured standard operating procedure (SOP) for intravenous vancomycin therapy in orthopedic inpatients. Methods: We conducted a single-center, pre-post cohort study at a university orthopedic department. The intervention consisted of a standard operating procedure (SOP) for intravenous vancomycin therapy, which mandated weight-based loading doses, renal function-adjusted maintenance dosing, trough level monitoring, and defined dose adjustments. Patients treated before SOP implementation (n = 58) formed the control group; those treated under the SOP (n = 56) were prospectively included. The primary outcome was the incidence of vancomycin-associated acute kidney injury (VA-AKI) defined by KDIGO Stage 1 criteria. Secondary outcomes included therapeutic trough level attainment and infusion-related or ototoxic adverse events. Results: All patients in the post-SOP group received a loading dose (100% vs. 31% pre-SOP, p < 0.001). The range of measured vancomycin trough levels narrowed substantially after SOP implementation (7.1–36.2 mg/L vs. 4.0–80.0 mg/L). The proportion of patients reaching therapeutic trough levels increased, although this was not statistically significant. Most notably, VA-AKI occurred in 17.2% of patients in the control group, but in none of the patients after SOP implementation (0%, p = 0.0013). No cases of ototoxicity were observed in either group. Infusion-related reactions decreased after the implementation of the SOP, though not significantly. Conclusions: The introduction of a structured vancomycin protocol significantly reduced adverse drug events and improved dosing control in orthopedic inpatients. Incorporating such protocols into routine practice represents a feasible and effective strategy to strengthen antibiotic stewardship and clinical quality in surgical disciplines. Full article

Background and Objectives: Specialized nurses play an essential role in managing pulmonary fibrosis. While tele-nursing has the potential to optimize disease management, current evidence regarding its impact remains limited. This study aimed to evaluate a tele-nursing intervention that provided unscheduled access to a specialized nurse via phone or email for both patients and caregivers. Materials and Methods: This was a prospective, single-center, open-label, and pre–post pilot study. Participants and their caregivers were provided with direct access to a specialized nurse, by phone and email, for unscheduled consultations. Patient-reported experience measures (PREMs) and patient-reported outcome measures (PROMs) were collected at baseline and after three months of tele-nursing access. PREMs were assessed using a 10-point Likert scale questionnaire, and PROMs were evaluated using the King’s Brief Interstitial Lung Disease (K-BILD) and the Living with Pulmonary Fibrosis (L-PF) questionnaires. Results: A total of 47 patients with pulmonary fibrosis receiving antifibrotic drugs were enrolled. At three months, 44 patients and 34 caregivers completed the questionnaires. Four patients did not complete the study due to death, lung transplantation, or transition to end-of-life care. No significant changes were observed in PROMs. However, PREMs showed significant improvements, with most scores exceeding 9/10. Patient satisfaction increased by 28% (p < 0.001), and caregiver satisfaction by 30% (p < 0.001). Caregivers of patients who did not complete the study also reported high satisfaction, comparable to that of other caregivers. Conclusions: A pragmatic and affordable tele-nursing program, based on direct phone and email consultations, may enhance patient and caregiver satisfaction in the management of pulmonary fibrosis. Full article

Given the high neuromechanical demands and frequent asymmetries in badminton, this study investigated the impact of a four-week asymmetry-targeted intervention on single-leg hop performance in elite junior badminton players and examined whether asymmetry-based indices could predict training responsiveness. Twenty-two national-level athletes (aged 15–18) were randomized into an experimental group (EG) undergoing neuromechanical training with EMG biofeedback or a control group (CG) following general plyometric exercises. Key performance metrics—Jump Height, Reactive Strength Index (RSI), Peak Power, and Active Stiffness—were evaluated pre- and post-intervention. Two novel composite indices, Force Efficiency Ratio (FER) and Asymmetry Impact Index (AII), were computed to assess force production efficiency and asymmetry burden. The EG showed significant improvements in Jump Height (p = 0.030), RSI (p = 0.012), and Peak Power (p = 0.028), while the CG showed no significant changes. Contrary to initial hypotheses, traditional asymmetry metrics showed no significant correlations with performance variables (r < 0.1). Machine learning models (Random Forest) using FER and AII failed to classify responders reliably (AUC = 0.50). The results suggest that targeted interventions can improve lower-limb explosiveness in youth athletes; however, both traditional and composite asymmetry indices may not reliably predict training outcomes in small elite groups. The results highlight the need for multidimensional and individualized approaches in athlete diagnostics and training optimization, especially in asymmetry-prone sports like badminton. Full article

Background: Post-activation potentiation enhancement (PAPE) is a physiological phenomenon that results in an acute improvement in muscular performance following a resistance training protocol, whose effects have been widely studied. However, due to methodological challenges in matching training stimuli, the results comparing the PAPE effect of strength training with flywheel or free-weight systems show inconsistencies in the literature. Since mean-propulsive velocity (MPV) is the most used parameter for monitoring free-weight intensity in real time, the aim of the study was to analyze the PAPE effect of a resistance training bout using free-weight and flywheel devices, matching intensities through MPV. Methods: Thirty physically active subjects participated in this crossover study, which aimed to compare the PAPE effect between a three-set, six-repetition half-squat exercise with free-weight and flywheel devices. Training intensity was matched in both groups through MPV. Vertical jump and sprint tests were conducted pre- and 4 min post-intervention. Results: There was no group x time interaction for the jump and sprint (p > 0.05). Vertical jump decreased post-exercise (p < 0.001). Conclusions: When training intensity in free-weight and flywheel devices is matched through MPV, the acute performance alterations will be similarly matched, with no PAPE benefits observed at least 4 min post-exercise. Full article

Background and Objectives: Acute appendicitis is a common surgical emergency, and while appendectomy typically results in good outcomes, post-operative complications, like intra-abdominal abscesses, can occur. Traditional biomarkers, such as white blood cells count and C-reactive protein, often lack the accuracy needed for early detection. Procalcitonin is emerging as a potential marker for predicting post-operative infections. This pilot study evaluates the role of kinetics of procalcitonin, measured via point-of-care testing, in predicting abscess formation in patients with non-complicated appendicitis. Materials and Methods: The study involved 33 patients undergoing appendectomy for non-complicated acute appendicitis. The levels of procalcitonin were measured at four time points: pre-operatively (T0), post-operatively (T1), on the first post-operative day (T2), and at discharge (T3). The primary outcome was the development of post-operative abscesses, confirmed by imaging or intervention. Results: Four patients (12%) developed abscesses. The levels of procalcitonin were significantly higher in the abscess group at all time points compared to the non-abscess group (p < 0.05). The levels of procalcitonin in the abscess group plateaued after an initial post-operative decline, while levels steadily decreased in the non-abscess group. Conclusions: Procalcitonin, particularly its kinetic profile, may serve as a valuable early marker for predicting post-operative abscess formation. Point-of-care testing for procalcitonin can enable timely intervention, improving outcomes. Kinetics of procalcitonin show promise as a predictor for post-operative abscesses after appendectomy, though larger studies are needed to confirm these findings. Full article

Background: Few studies have examined exercise-based treatments for migraine and tension-type headache (TTH), and even fewer have focused on strength training and chronic headache, as these present greater challenges. Objectives: This study aimed to evaluate the effectiveness of a group-based neck and shoulder strength training intervention combined with postural correction for patients with chronic headache. Methods: This prospective, single-arm, uncontrolled pilot study with a pre–post design included patients with chronic migraine (n = 10) and TTH (n = 12) who participated in an 8-week group-based program consisting of neck and shoulder strength training three times per week, along with instructions for postural correction. The primary outcome was change in headache frequency. Secondary outcomes included changes in the intensity and duration of headache, number of days of analgesic use, and functionality. Results: In total, 22 patients completed the intervention and were included in the analysis. Headache frequency decreased at follow-up for the overall group (r = 0.531; p = 0.014). In-depth analysis showed that 45% of participants experienced an average reduction of 38% in headache frequency. Additionally, large to moderate effect sizes were observed for the secondary outcomes. Conclusions: This is the first study to introduce a group-based exercise program targeting the neck and shoulder muscles, combined with postural correction and standard pharmacological treatment, for patients with chronic primary headache. It was found to be a safe, well-tolerated, useful, and promising intervention for improving headache frequency, duration, and functionality. Full article

This study examines the safety and cost-effectiveness of implementing shoulder rumble strips (SRS) and road lighting on Saudi Arabian freeways, providing insights into their roles in fostering sustainable transport systems. By leveraging the Highway Safety Manual (HSM) framework, this research develops localized Crash Modification Factors (CMFs) for these interventions, ensuring evidence-based and context-specific evaluations. Data were collected for two periods—pre-pandemic (2017–2019) and post-pandemic (2021–2022). For each period, we obtained traffic crash records from the Saudi Highway Patrol database, traffic volume data from the Ministry of Transport and Logistic Services’ automated count stations, and roadway characteristics and pavement-condition metrics from the National Road Safety Center. The findings reveal that SRS reduces fatal and injury run-off-road crashes by 52.7% (CMF = 0.473) with a benefit–cost ratio of 14.12, highlighting their high cost-effectiveness. Road lighting, focused on nighttime crash reduction, decreases such crashes by 24% (CMF = 0.760), with a benefit–cost ratio of 1.25, although the adoption of solar-powered lighting systems offers potential for greater sustainability gains and a higher benefit–cost ratio. These interventions align with global sustainability goals by enhancing road safety, reducing the socio-economic burden of crashes, and promoting the integration of green technologies. This study not only provides actionable insights for achieving KSA Vision 2030’s target of improved road safety but also demonstrates how engineering solutions can be harmonized with sustainability objectives to advance equitable, efficient, and environmentally responsible transportation systems. Full article

Background: Soccer is a physically demanding sport characterized by frequent high-intensity efforts, which are particularly relevant in women’s competitions. Improving high-speed running and aerobic capacity has been linked to better on-field performance. Strength training has shown promise in enhancing these physical attributes, but its application in young female soccer players remains underexplored. This study aimed to investigate the effects of a 10-week in-season strength training program on physical performance and match running demands in young female soccer players. Methods: Thirty-two U18 Danish female professional soccer players from two comparable teams voluntarily participated in the study. Teams were allocated to either an experimental group, performing twice-weekly strength training (EG, n = 16) or a control group (CG, n = 16). Vertical jump performance and Yo-Yo IR2 performance as an estimation for maximal oxygen uptake (VO₂max) were assessed both pre and post intervention. Additionally, players’ match external demands (i.e., total distance, distance covered at speeds above 23 km·h⁻¹, and maximum velocity achieved) were monitored using Global Positioning System devices during four matches before and after the intervention. Results: Significant within-group differences were observed across all variables for the EG (p = 0.001; ES = 1.08 to 1.45, large), without differences in the CG (p > 0.01). Between-group analysis indicated significant differences favoring the EG in all variables (F = 27.40 to 47.17; p = 0.001). Conclusions: The application of a 10-week strength training program led to improvements in physical and match running performance among young female soccer players, underscoring the importance of incorporating strength training programs into female soccer periodization to enhance performance. Full article