Search Results (809)

Mistreatment is a pervasive and normalized feature of medical culture. In medical residencies, it functions as a structural rite of passage that shapes professional socialization. While the prevalence of mistreatment is documented, there is a lack of qualitative research exploring its role as a mechanism of identity construction. The aim of this study was to understand the experiences of mistreatment among internal medicine residents in Medellín, Colombia, through the lens of ritual theory and symbolic violence. A particularistic ethnographic study was conducted with 12 residents selected via theoretical sampling. Data were collected through semi-structured interviews and a reflexive field journal. Rigor was ensured using investigator triangulation and analytical bracketing to manage researchers’ biases. The training process follows a three-stage rite. (1) Separation: Symbolic violence and social pressure to specialize frame general medicine as “mediocre,” turning admission into a “battlefield” where self-worth is tied to success. (2) Marginalization (Liminality): Residents endure systemic mistreatment, including sleep deprivation (3.5 h rest cycles), public ridicule (“pimping”), and physical/verbal abuse (e.g., being hit with stethoscopes or called “testicles/jerks”). This stage is governed by a “purificatory logic” where suffering is internalized as a meritocratic requirement. This leads to high morbidity, with clinical diagnoses of anxiety and depression. (3) Integration (Postliminality): Professional autonomy and financial stability act as a “redemption” that justifies past suffering. Mistreatment is not an isolated interpersonal issue but a structurally embedded ritual and a core element of the hidden curriculum. It reinforces toxic hierarchies and a “tyranny of merit” that obscures structural barriers. These findings offer analytically transferable insights for global medical education, calling for a deconstruction of ritualized violence to foster more humanistic training environments. Full article

Background: Parents of children undergoing liver transplantation face substantial caregiving demands that may adversely affect their mental health across multiple domains. Systematic evaluation of psychosocial outcomes in this population remains limited, particularly in settings that include immigrant families. Method: This was a single-center, cross-sectional study including the parents of 50 children after liver transplantation. Major sociodemographic variables included parental age, sex, education, chronic disease, and immigration status. We also recorded children’s demographics, transplant-related data, follow-up findings, and mental health status. Instruments for psychiatric assessment included the Generalized Anxiety Disorder 7-item scale (GAD-7; anxiety), Patient Health Questionnaire-9 (PHQ-9; depression), Perceived Stress Scale-10 (PSS-10; stress), and Pittsburgh Sleep Quality Index (PSQI; sleep quality). Results: We enrolled 50 parents of 50 pediatric liver transplant recipients (43 Turkish citizens, 7 Syrian immigrants; 28 fathers, 22 mothers; mean age: 40.10 ± 6.65). Time since transplantation showed weak negative correlation with PHQ-9 and GAD-7. Stress (PSS) levels had weak to strong positive correlation with PSQI, PHQ-9, and GAD-7. Sleep quality (PSQI) was positively correlated with PHQ-9 and GAD-7. Depressive findings (PHQ-9) were strongly and positively correlated with GAD-7. In Firth-penalized multivariable models, high PHQ-9 scores were independently associated with shorter time since transplantation (p = 0.001) and high PSS (p = 0.003). High GAD-7 scores were independently associated with shorter time since transplantation (p = 0.025) and high PSS (p = 0.001). Conclusions: The parents of pediatric liver transplant recipients experience high levels of stress, sleep issues, depression, and anxiety, which demonstrate multiple correlations. Full article

Background: Physical inactivity among Saudi Arabian adolescents is a critical public health concern due to its contribution to the rising prevalence of overweight, obesity, and non-communicable diseases. Despite this, the motivational profiles and perceived barriers that differentiate athletic from non-athletic adolescents remain understudied in the Saudi literature, particularly within the school Physical Education (PE) context. Grounded in Self-Determination Theory (SDT), the present study examined the factors preventing and motivating Saudi adolescents to engage in physical activity (PA) and discusses findings in terms of their implications for PE teachers and school-based intervention. Method: A cross-sectional study was conducted with 124 male high school students in Riyadh (mean age: 16.79 ± 0.66 years). Participants were categorized as either athletes (n = 70) or non-athletes (n = 54) based on pre-defined engagement criteria: athletes were required to report vigorous-intensity sport participation on three or more days per week for a minimum of 60 min per session. Anthropometric measurements, lifestyle behaviors (diet, screen time, sleep), motivations, and barriers were assessed using the validated Arab Teens Lifestyle Study (ATLS) questionnaire. Independent samples t-tests and chi-square tests were used to compare between-group differences; effect sizes are reported. Result: Non-athletes had a significantly higher mean BMI (29.40 ± 6.77 kg/m²) and waist circumference (98.65 ± 21.63 cm) compared to athletes (BMI: 22.19 ± 4.44 kg/m²; waist: 78.84 ± 9.51 cm; both p < 0.001). No significant differences were observed in screen time, sleep duration, or dietary habits. The primary motivations for PA among athletes were health benefits (27.1%), recreation (25.7%), and competition (20.0%), reflecting an autonomous motivational profile consistent with SDT. Among non-athletes, the predominant barriers were the lack of suitable facilities (25.9%) and the absence of an exercise partner (22.2%); reflecting unmet SDT needs for competence and relatedness respectively, while only 9.3% cited having a lack of time. Conclusions: Non-athletic participants face a significant health disadvantage characterized by higher rates of overweight and central obesity. In contrast to global trends, where academic commitments dominate barriers to PA, the principal barriers in this population are environmental and social, reflecting unmet psychological needs that PE teachers are uniquely positioned to address. Rather than focusing solely on infrastructure, PE promoters should implement need-supportive teaching practices, including competence-building tasks and cooperative peer structures, to foster the intrinsic motivational profile observed in the athletes and promote long-term PA adherence among non-athletic students, in alignment with the health objectives of Saudi Vision 2030. Full article

Background/Objectives: Adherence to the Mediterranean diet (MD) is associated with reduced risk of non-communicable diseases but has declined among children, even in traditionally high-adherence settings such as Greece. As parental lifestyle behaviors strongly influence children’s dietary patterns, this study examined the associations between parental lifestyle factors and children’s MD adherence in Crete, Greece. Methods: A total of 760 parent–child dyads participated in this cross-sectional study. Children’s adherence to the MD was assessed using the KIDMED index. Parents completed validated instruments, including the MEDAS (MD adherence), IPAQ (physical activity), PSQI (sleep quality), and NLS (nutrition literacy), along with questions on dietary habits and screen time behaviors. ANOVA/Kruskal–Wallis tests and multivariable linear regression identified predictors of KIDMED scores. Results: Mean KIDMED score was 5.95 ± 2.65; 32% achieved optimal adherence. Younger children showed higher adherence. Higher children’s adherence to MD was positively associated with parental MD adherence (β = 0.493), urban residence (β = 0.544), higher parental education (β = 0.493), consistent daily meal routines (breakfast and mid-morning and mid-afternoon snacks), higher water intake, and fresh juice consumption (all p < 0.05) were positively associated with parental MD adherence. Conversely, lower adherence was associated with parental age ≥ 45 years (β = 0.987), higher parental BMI (β = 0.072), consumption of sugar-sweetened (β = 0.390) or artificially sweetened beverages (β = 0.497), and weekend screen time ≥ 3 h/day (β = 0.383) (all p < 0.05). Conclusions: Children’s adherence to the MD is strongly associated with parental dietary behaviors and structured meal routines. These findings support family-focused interventions that emphasize parental dietary role modeling to counter declining MD adherence among Mediterranean youth. Full article

Background/Objectives: This longitudinal study examined the association between sleep duration, sleep difficulties, and sleeping place at one year (t1) and corresponding characteristics at 4/5 years of age (t2). Methods: Data were collected from 2018 to 2021 (t1) and from 2021 to 2024 (t2) in the LIFE Child cohort study conducted in Leipzig, Germany. Parents completed the Brief Infant Sleep Questionnaire at t1 and the Child Sleep Habits Questionnaire at t2. Associations between sleep characteristics at t1 and t2 were estimated using linear and logistic regression models. All associations were adjusted for child sex, age at t2, and maternal education. Results: The analyses showed significant associations between shorter sleep durations, later sleep onset times, more frequent nightly awakenings and bed sharing and room sharing at t1 and more sleep difficulties at t2. A shorter sleep duration at t2 was predicted by shorter sleep and more parent-perceived sleep difficulties at t1. Bed sharing and room sharing at t1 were significantly associated with a lower probability of sleeping alone at t2. Conclusions: These results indicate that sleep duration, sleep difficulties, and sleeping places are already stable in early childhood. Full article

Background: Sleep disturbances are linked to adverse outcomes in postpartum women. While behavioral interventions can potentially improve sleep, research in this area during the postpartum period is limited. This study aims to evaluate the effect of a behavioral education program on sleep quality among postpartum women. Methods: A quasi-experimental design with a pretest–posttest approach was employed, including a control group for comparative analysis. The research was conducted at the Maternal and Child Health Center in Egypt, focusing on the sleep disturbances experienced by postpartum women. The study involved 280 postpartum women (140 in the study group and 140 in the control group) who had given birth within the last two months. Results: Post-intervention, the study group demonstrated significant improvements in all components of sleep quality, with p-values < 0.001. Conversely, the control group experienced a deterioration in sleep quality, with 77.9% reporting poor sleep quality post-intervention. Conclusion: The behavioral education program significantly enhanced sleep quality among postpartum women, suggesting that such interventions should be integrated into maternal healthcare practices to improve postpartum sleep management. Full article

Background/Objectives: Disc herniation, also termed herniated nucleus pulposus (HNP), is a common spinal disorder affecting approximately 10% of the global population, associated with pain, neurological complications, and diminished quality of life. Despite its global burden, regional variations in public awareness and sociodemographic determinants remain inadequately characterized, particularly in Middle Eastern populations. This study aimed to assess the prevalence, public awareness, and sociodemographic determinants of HNP among adults in Saudi Arabia at a nationwide level. Methods: An analytical cross-sectional study was conducted from December 2024 to July 2025. Using a convenience sampling approach via social media platforms, an online questionnaire was distributed nationwide across Saudi Arabia. Data from 1112 participants were analyzed using descriptive statistics and multiple logistic regression. The questionnaire comprised two sections: sociodemographic characteristics and knowledge and awareness of HNP. Results: The prevalence of disc herniation was 8.9%, consistent with global estimates. Overall awareness was relatively high at 67.6%, though knowledge of specific risk factors varied considerably. Most participants recognized obesity (88.0%), poor sitting posture (85.8%), history of lower back trauma (86.2%), and work requiring physical effort (88.8%) as risk factors, while fewer acknowledged smoking (46.4%), diabetes (51.2%), sleeping on a soft bed (36.9%), and increased height (35.9%). Multiple logistic regression, adjusted for all sociodemographic, lifestyle, and health-related covariates, identified significant independent predictors of HNP including marital status (married OR = 2.90), current smoking (OR = 2.91), hyperlipidemia (OR = 1.86), family history (OR = 8.95), and prior knowledge of the condition (OR = 2.28). Knowledge of HNP was significantly associated with university education (OR = 1.70), higher income levels (OR = 2.23 for ≥15,000 SAR; OR = 2.07 for 5000–9999 SAR), and family history (OR = 4.70), while those in low and medium workload jobs demonstrated lower knowledge. Conclusions: Although overall public awareness of HNP is relatively high in Saudi Arabia, substantial gaps persist in knowledge of modifiable risk factors, particularly smoking and diabetes mellitus. Targeted smoking cessation campaigns, diabetes awareness programs, and ergonomic education initiatives delivered through primary healthcare centers, workplaces, and schools are recommended. Full article

Tactical athletes, including military service members, are exposed to occupational demands that increase their risk of mild traumatic brain injury (mTBI), particularly through blast exposure, falls, collisions, and repeated sub-concussive events. Although clinical tools and progressive return-to-activity protocols support acute management, recovery may remain fragmented when physical, cognitive, psychological, and performance domains are not integrated. Military personnel require recovery models which extend beyond symptom resolution and return-to-duty clearance. Holistic performance programming offers a multidimensional framework which incorporates subject matter experts across strength and conditioning, rehabilitation, nutrition, behavioural health, cognitive performance, and human performance optimisation. This narrative review examines the role of holistic performance programming in optimising recovery from mTBI among tactical athletes, with emphasis on interdisciplinary care, structured assessment, recovery periodisation, monitoring technologies, and return-to-duty readiness. The role of embedded subject matter experts in identifying and monitoring mTBI; interdisciplinary care models which integrate clinical and performance expertise; structured recovery pathways from assessment to reintegration; and the importance of flexibility, communication, and service member engagement are examined. In addition, the review assesses the potential use of biomarkers, wearable technologies, and multi-domain assessment tools to guide individualised recovery. Holistic performance programming may bridge the gap between clinical recovery and operational readiness following mTBI. By integrating physical, cognitive, psychological, nutritional, and sleep-related strategies, this approach may reduce fragmented care and better address the complex nature of mTBI recovery. Interdisciplinary performance teams may improve early recognition, individualised rehabilitation, safer return-to-duty decisions, and long-term readiness. Future practice should prioritise standardised assessment, real-time monitoring, education, and stigma reduction. Full article

Objective: While the benefits of physical activity are well-documented, the internal mechanisms linking sports interest to adolescent Subjective Well-being (SWB) remain under-explored. This study addresses this gap by investigating the association between Sports Learning Interest and SWB and examining the serial mediating roles of Social Anxiety and Sleep Quality. Methods: Using a stratified random sampling method, 1764 primary and secondary students were surveyed with validated instruments, including the PSQI and the Index of Well-Being. Data were analyzed using Hayes’ PROCESS macro (Model 6) to test the hypothesized chain mediation effects. Results: Sports Learning Interest significantly and positively predicted SWB. The model identified three significant indirect pathways: independent mediation by Social Anxiety, independent mediation by Sleep Quality, and a serial chain from Social Anxiety → Sleep Quality (total indirect effect = 0.18, 95% CI [0.15, 0.21]). Notably, Sleep Quality emerged as the core mediator, accounting for 29.9% of the total effect. Conclusions: Enhancing sports interest is positively associated with SWB through a “psychological-physiological” dual channel—specifically by its association with lower social anxiety and subsequently better sleep. These findings provide empirical evidence for designing school-based interventions that integrate physical education with mental health promotion. Full article

Background: Sleep hygiene protocols (SHPs) have been shown to improve sleep and stress regulation; however, the role of cortisol in shaping downstream physiological and performance adaptations remains unclear. This study primarily examined the effects of a short-term SHP on sleep duration and salivary cortisol responses across resting, pre-exercise, and post-exercise states in female collegiate soccer players and, secondarily, whether cortisol statistically mediated selected aerobic and anaerobic performance outcomes. Methods: Fourteen players (22.1 ± 3.3 y; 157.8 ± 6.0 cm; 53.5 ± 3.9 kg) completed a randomised, counterbalanced crossover study comparing habitual sleep (no sleep hygiene protocol; nSHP) with a comprehensive SHP incorporating environmental, behavioural, and educational strategies. Salivary cortisol was sampled one hour post-waking and 30 min pre- and 15 min post-exercise during standardised testing sessions. Performance outcomes included vertical jump, sprint performance (40 m and repeated sprints [RAST]), and the Yo-Yo Intermittent Recovery Test Level 1. Linear mixed-effects models assessed cortisol responses, and mediation analyses explored cortisol–performance relationships. Results: After SHP, perceived (7.87 h vs. 6.5 h; p = 0.002, ESg = 1.0) and calculated sleep duration (8.5 h vs. 6.9 h; p = 0.004, ESg = 0.95) increased significantly. Cortisol was markedly lower following SHP at selected timepoints, including before RAST (−43.05%, p = 0.006, ESg = 0.84), with additional timepoint-specific, condition-dependent differences post-anaerobic and post-aerobic exercise (Δ = 7.37 and 5.98 nmol·L⁻¹, respectively; p < 0.001). Vertical jump height demonstrated significant total (9.92 cm, p = 0.002) and direct effects (7.72 cm, p = 0.034), and peak repeated-sprint performance showed a significant direct effect (p = 0.026). Cortisol did not significantly mediate any performance outcomes (ACME p > 0.05). Conclusions: Short-term sleep hygiene is associated with increased sleep duration, timepoint-specific modulation of cortisol responses, and selected anaerobic performance benefits; however, these effects were not explained by measured cortisol responses and are unlikely to be sustained without ongoing reinforcement or support, particularly in athletic populations. Full article

Background/Objectives: Physical activity and sedentary behaviour represent related yet distinct movement behaviours with potentially different behavioural, psychosocial, and lifestyle correlates. However, multinational evidence examining these behaviours within the Mediterranean lifestyle framework remains limited. This study investigated correlates of physical activity and sedentary behaviour among adults from Mediterranean and neighbouring countries participating in the MEDIET4ALL survey. Methods: Data were collected from 4010 adults (37.2 ± 15.4 years; 59.5% female) across 10 Mediterranean and neighbouring countries using a standardized multilingual e-survey. Physical activity was assessed using the short International Physical Activity Questionnaire (IPAQ-SF; MET-min/week), and sedentary behaviour was assessed by daily sitting time. Hierarchical multiple linear regression analyses were conducted separately for physical activity and sedentary behaviour. Exploratory bootstrapped mediation analyses examined whether life satisfaction (SLSQ) or social participation (SSPQ) mediated associations between MEDLIFE dietary dimensions and sitting time. Results: Higher physical activity was associated with more rural living environments, lower body mass index, more favourable smoking status, higher alcohol consumption, stronger adherence to Mediterranean dietary habits, longer sleep latency, higher stress, and greater social participation (β ≈ 0.05–0.11), whereas female sex, longer sleep duration, and higher anxiety were associated with lower physical activity (β = −0.04 to −0.23); the positive association with alcohol consumption should be interpreted cautiously in light of potential residual confounding. By contrast, sedentary behaviour was positively associated with higher education, higher body mass index, and more favourable smoking-status (β ≈ 0.04–0.09) and inversely associated with better self-reported health status, Mediterranean dietary consumption patterns, life satisfaction, and social participation (β = −0.04 to −0.07). Mediation analyses showed significant but small-magnitude indirect effects for the pathways linking MEDLIFE dietary consumption patterns and MEDLIFE dietary habits with sitting time through social participation (indirect β = −0.0032 and −0.0045, respectively), which should be interpreted with caution, whereas no significant indirect effects were observed through life satisfaction. Conclusions: Physical activity and sedentary behaviour are associated with different, though partially overlapping, lifestyle and psychosocial correlates within the MEDIET4ALL framework. Social participation may represent a modest behavioural pathway linking Mediterranean dietary dimensions with lower sitting time. Given the cross-sectional design, these findings should be interpreted as associative rather than causal, but they nonetheless reinforce the importance of integrated and context-sensitive lifestyle promotion strategies. Full article

Background and Objectives: Sleep is a vital psychological function for health and well-being in all age groups, from children to adolescents, to adults and the elderly, and impacts quality of life. This study evaluated temporal changes in sleep quality and lifestyle behaviors among medical students in North-Western Romania (Transylvania) between the COVID-19 pandemic and the post-pandemic period. Materials and Methods: A cross-sectional design was employed involving 709 medical students assessed during the first pandemic wave (2020) and the 2023–2024 academic year. Online questionnaires collected data on demographics, body mass index (BMI), substance use, and physical activity. Sleep quality was measured using the validated Athens Insomnia Scale (AIS), and multiple linear regression was performed to identify predictors of sleep outcomes. Results: Post-pandemic data revealed a significant decline in sleep quality, with female gender and lower academic performance identified as significant predictors of insomnia symptoms (R² of 0.258, p < 0.05). While physical activity levels improved significantly in 2024 compared to the confinement period, this was accompanied by increased fast-food consumption and a rise in overweight and obesity rates. Conversely, illicit drug use decreased, and alcohol consumption patterns shifted, characterized by reduced weekly frequency among females but persistent binge drinking episodes. Conclusions: The transition to post-pandemic education yielded mixed health outcomes; while physical activity rebounded, sleep quality and nutritional status deteriorated. These findings highlight the necessity for university-based interventions focusing on sleep hygiene, nutrition, and stress management to support the well-being of medical students. Full article

Background: Premenstrual syndrome (PMS) significantly impacts daily functioning among women of reproductive age. Medical and nursing students face exceptional stressors that may exacerbate PMS, yet the interrelationships between sleep quality, perceived stress, and PMS remain understudied in Middle Eastern contexts. This study aimed to investigate the relationships between sleep quality, perceived stress, and self-reported PMS symptoms among Palestinian female medical and nursing students, to assess their prevalence and severity, and to examine variations across sociodemographic and lifestyle factors. Methods: This cross-sectional correlational study recruited 708 female medical and nursing students from three Palestinian universities. Validated Arabic instruments assessed sleep quality (PSQI), perceived stress (PSS-10), and PMS symptoms (A-PMSS). Analyses included Spearman’s correlations, non-parametric tests (Mann–Whitney U Test, Kruskal–Wallis Test), and multivariable linear regression. Results: Nearly all participants (98%) reported some degree of self-reported PMS symptoms at any severity level, with 76% experiencing moderate-to-severe symptoms. Poor sleep quality (PSQI > 5) affected 62.1%, while 94.5% reported moderate-to-high perceived stress. Significant positive correlations were identified between PSQI and PMS (rho = 0.295, p < 0.001) and between PSS-10 and PMS (rho = 0.483, p < 0.001). Multivariable regression revealed that perceived stress and sleep quality were significant independent predictors of PMS severity after adjusting for covariates, with the overall model explaining 27.5% of variance in PMS scores. Conclusions: This study reveals a substantial burden of PMS, poor sleep quality, and stress among Palestinian female medical and nursing students. Perceived stress and sleep quality were independently associated with PMS severity. These findings highlight need for integrated wellness programs in healthcare education for Palestinian students. Full article

Internet Gaming Disorder (IGD) has emerged as an increasingly prevalent behavioral health concern among late adolescent university students, a vulnerable population with emotional distress due to the developmental changes and academic pressures. This research explored the direct correlations between IGD and Mental Health Disorder (MHD), such as depression, anxiety, and stress in Saudi Arabia (SA) with study discipline as a moderator. A total of 480 students participated in the developed self-structured questionnaire, and Partial Least Squares Structural Equation Modeling (PLS-SEM) was employed to analyze the obtained data. The results showed that IGD can exert a positive and significant association with all three aspects of MHD. Moreover, the PLS-SEM slope analysis indicated that study discipline can significantly moderate the link from IGD to both anxiety and depression, with university students in health, science, and engineering fields displaying higher symptoms of depression and anxiety as compared to their peers in humanities and social sciences. However, study discipline failed to moderate the link from IGD to stress. These findings can be interpreted through maladaptive coping mechanisms and behavioral addiction, whereby extreme IG can contribute to social withdrawal, reduce sleep quality, and worsen stress regulation, specifically during the late adolescence period. The results extend current research on IGD by emphasizing the disciplinary differences in mental health vulnerability and offering more empirical evidence from a Middle Eastern context. The study highlighted the urgent need for discipline-oriented mental health screening and targeted proactive interventions to deal with unsettled IG attitude within a higher education context. Full article

Background: Nutrition and sleep are critical determinants of athletic performance and recovery. Direct comparative research between endurance and strength–power athletes remains limited. This study aimed to evaluate and compare nutritional knowledge, dietary habits, sleep quality, and Body Mass Index between ultramarathon runners and American football players, as well as to explore independent predictors of sleep quality. Methods: A cross-sectional study was conducted among 231 male athletes. To address group size disparity and mitigate statistical bias, a random undersampling technique was applied to create a balanced cohort of 86 athletes comprising 43 ultramarathon runners and 43 American football players. Nutritional parameters were assessed using the Kom-PAN questionnaire. Sleep quality was evaluated using the Pittsburgh Sleep Quality Index. Between-group comparisons were performed using the Mann–Whitney U test with False Discovery Rate correction. An integrated multiple regression model was constructed to identify predictors of global sleep quality. Results: Ultramarathon runners demonstrated significantly better overall sleep quality (p = 0.026) and higher nutritional knowledge (p < 0.001) compared to American football players. Differences in adherence to pro-healthy and non-healthy dietary patterns were not statistically significant after False Discovery Rate correction. The integrated multiple regression model revealed that the athletic discipline was the primary independent predictor of global sleep quality (p = 0.001), while dietary variables did not exhibit a significant independent effect. Furthermore, higher Body Mass Index was independently associated with better sleep scores within the multivariate model (p = 0.008). Conclusions: Significant sport-specific differences exist in BMI, nutritional knowledge, and sleep quality. Global sleep quality appears to be primarily associated with the specific physiological and environmental demands of the athletic discipline rather than individual dietary factors, which were not independently significant in the multivariable model. These findings suggest that recovery strategies in strength–power athletes may require a broader, multifactorial approach beyond nutritional education alone. Full article