Search Results (3,822)

Paralympic athletes are challenged by unique systemic strain due to impairment-related physiological and psychological stressors. This study aims to synthesize the current evidence regarding post-exercise recovery modalities in Paralympic athletes, providing an overview of their physiological considerations and practical applications. A narrative review was conducted across PubMed/MEDLINE, Scopus, and Web of Science (inception to December 2025). Inclusion criteria prioritized original research on competitive para-athletes evaluated through physiological or performance-based markers. Evidence identifies four critical domains: (1) Thermoregulation: In spinal cord injury (SCI), upper-body cooling is significantly more effective than lower-body strategies for core temperature reduction; objective monitoring of playing time is essential, as subjective perception is unreliable. (2) Systemic recovery: Sleep quality is compromised by secondary complications (e.g., nocturia and spasticity), and heart rate variability (HRV) serves as a sensitive autonomic marker to validate readiness. (3) Neuromuscular restoration: The early-phase rate of force development (RFD ≤ 50 ms) is more sensitive than the peak strength for detecting neural fatigue, particularly in SCI. (4) Contextual modulators: Infrastructure accessibility and psychological resilience are primary determinants of intervention efficacy. Effective recovery in para-sports requires a shift toward “active-assisted” impairment-specific interventions. Future research must validate specialized monitoring tools and longitudinal impacts on long-term health. Full article

Fibromyalgia (FM) is a chronic pain syndrome characterized by central sensitization and impaired pain modulation, involving dysfunctional descending inhibitory pathways and altered nociceptive processing. These processes contribute to persistent musculoskeletal pain, difficulties with sleep, feelings of depression, and ongoing fatigue. Serotonin and norepinephrine are key mediators of pain control, and evidence indicates that dual reuptake inhibition provides superior analgesia compared to single-pathway approaches. Accordingly, serotonin–norepinephrine reuptake inhibitors (SNRIs), including milnacipran and duloxetine, approved for FM treatment, show favorable efficacy and tolerability compared with tricyclic antidepressants. This integrative literature review aimed to evaluate the impact of SNRIs on musculoskeletal pain, fatigue, depression, and quality of life in patients with FM by analyzing randomized clinical trials (RCTs), identified via PubMed/MEDLINE searches (2015–2025) in English/Portuguese using descriptors: “Fibromyalgia”, “Serotonin and Norepinephrine Reuptake Inhibitors”, “Duloxetine” and “Milnacipran”. From 195 records screened, 18 studies met inclusion criteria (9.2% inclusion rate); duloxetine evaluated in 16 studies (88.9%), milnacipran in 2 (11.1%); SNRIs demonstrated superior efficacy vs. placebo: pain reduction 30–40%, fatigue improvement 25%, quality of life enhancement 20%. SNRIs were overall more effective than placebo but did not achieve high levels of analgesia, underscoring the need for further research on long-term efficacy and comparisons with combination pharmacological and non-pharmacological therapies. SNRIs significantly alleviate musculoskeletal pain (30–50% of patients), fatigue, depression symptoms, and improve quality of life in FM versus placebo. Duloxetine showed superior efficacy for pain/depression; milnacipran excelled in sleep quality. Long-term studies and combination therapies warrant further investigation. Full article

Ashwagandha, a revered herb in Ayurvedic medicine for over 3000 years, is recognized for its potential benefits in regulating sleep and supporting overall vitality. This study evaluated the comparative effects of Ashwagandha root extract (ARE) and melatonin (MLT) on sleep quality in adults. In this prospective, randomized, double-blind, placebo-controlled trial, 200 men and women aged 18–50 years were randomized to receive ARE (300 mg twice daily; n = 50), MLT (3 mg/day; n = 50), a combination of ARE (600 mg/day) and MLT (3 mg/day; n = 50), or placebo (n = 50) for eight weeks. The primary outcome was the change in sleep onset latency (SOL) from baseline to week eight, measured by actigraphy. Secondary outcomes included actigraphy-based changes in total sleep time (TST), wake after sleep onset (WASO), and sleep efficiency (SE), as well as subjective measures such as the Pittsburgh Sleep Quality Index (PSQI) and the Hamilton Anxiety Scale (HAM-A). At week eight, SOL was significantly reduced across treatment groups, with the ARE–MLT (p < 0.0001) combination showing the greatest improvement. The combination group also demonstrated significant improvements in TST (p < 0.0001), WASO (p < 0.0001), and SE (p < 0.0001), whereas ARE and MLT monotherapy produced moderate but comparable benefits. Inferential analyses confirmed statistically significant improvements in objective and subjective sleep measures (p < 0.0001). Safety analyses indicated that mild adverse events occurred across all groups, with no clinically significant between-group differences. Overall, both Ashwagandha and melatonin improved sleep disturbances in adults, with combination therapy producing the most consistent and pronounced benefits. Full article

Background and Objectives: Adults diagnosed with type 2 diabetes mellitus (T2DM) frequently exhibit diminished sleep quality, which is affected by their glycemic control. Both poor sleep and inadequate glycemic management increase the risk of complications worldwide. However, the relationship between sleep quality, daytime dysfunction, and glycemic control in adults with T2DM is not well understood. To address this gap, this study aimed to examine the association between overall sleep quality, including daytime dysfunction, and glycemic control in adults with T2DM. Materials and Methods: A hospital-based cross-sectional study included 200 T2DM patients (103 females, 97 males) from January 2019 to January 2020. The Pittsburgh Sleep Quality Index (PSQI) was administered to each participant to assess sleep quality, including daytime dysfunction. Glycemic control was assessed by measuring hemoglobin A1c (HbA1c) and fasting blood glucose (FBG) levels. The associations among sleep quality, daytime dysfunction, and glycemic metrics were examined utilizing both conventional statistical methods and Bayesian analytical approaches. Results: A total of 32% of patients had poor sleep quality (PSQI > 5), and 43.5% reported daytime dysfunction. Higher HbA1c and fasting blood glucose were each correlated with longer sleep-onset latency and greater daytime dysfunction. In multivariable analyses, higher HbA1c and longer sleep-onset latency were independently associated with poor sleep quality (generalized linear model, R² = 0.602), whereas higher fasting blood glucose and longer sleep-onset latency were associated with greater daytime dysfunction severity (R² = 0.378). Conclusions: Sleep quality and delay in falling asleep are interdependent with impaired glycemic control and daytime dysfunction in T2DM. Future randomized trials targeting sleep-onset latency are warranted to determine causal effects on glycemic outcomes. Full article

Background/Objectives: In recent years, the migrant population has been increasing. Migrants are at risk for malnutrition, mental disorders and related health problems. In this study, we aimed to examine the relationships among diet quality, eating behavior, posttraumatic stress disorders and sleep quality in Syrian migrants. Methods: This study included 78 female and 72 male Syrian adult migrants. The participants completed a questionnaire including demographic information, the Pittsburgh Sleep Quality Index, the Posttraumatic Stress Disorder Short Scale, and a three-factor eating questionnaire. For the diet quality calculation, a 24 h retrospective food consumption record was taken. Results: A total of 94.0% of the participants had mild to moderate risk of posttraumatic stress disorder. It was determined that 90.7% of Syrian migrants had low or moderate diet quality. There was a positive correlation between the PTSD score and age (r = 0.244) and the Pittsburgh sleep quality index score (r = 0.244) and between the Pittsburgh sleep quality index score and uncontrolled eating (r = 0.171) (p < 0.05). The probability of impaired sleep quality increased in individuals with PTSD scores in the T2 (11–19 points) (OR: 1.342; 95% CI: 1.073–1.678) and T3 (20–31 points) (OR: 1.485; 95% CI:1.157–1.905) groups, whereas the probability of improved diet quality increased in individuals in the T2 (11–19 points) (OR: 1.042; 95% CI: 1.000–1.086) group. Conclusions: Poor diet quality, risk of posttraumatic stress disorder and poor sleep quality are very common among Syrian migrants. In this respect, evaluating Syrian migrants and taking necessary precautions may help reduce the risk of chronic diseases related to nutrient deficiencies and mental problems. There is a need for policies and programs to manage PTSD among Syrian refugees. Full article

Objective: Nocturia, defined as waking from sleep to void, is a frequent lower urinary tract symptom associated with impaired sleep quality and reduced quality of life. This study aimed to evaluate the prevalence of nocturia episodes and their impact on sleep disturbance and health-related quality of life. Methods: A questionnaire-based cross-sectional study was conducted at the Urology Outpatient Clinic of the General Hospital of Eastern Achaia between November 2023 and May 2024. Participants reporting nocturia were assessed using the Nocturia Quality of Life (N-QOL) questionnaire, the Athens Insomnia Scale (AIS), and the EQ-5D questionnaire. Demographic data and comorbid conditions were also collected. Univariate analyses and multiple linear regression were applied to identify factors associated with nocturia-related outcomes. Results: A total of 89 participants (78 men and 11 women; mean age 68.9 years) were included. Most participants reported 2–3 nocturnal voids per night. The N-QOL score was significantly associated with the frequency of nocturia episodes (r = −0.55, p < 0.0001), and regression analysis confirmed this relationship (coefficient: −6.7; 95% CI: −10.4 to −3.1). Individuals scoring ≥ 8 on the OAB-V8 scale demonstrated significantly lower N-QOL performance. Conclusions: Increasing nocturia frequency is associated with impaired sleep, reduced vitality, and diminished quality of life, particularly among older adults. Nocturia should be recognized as a clinically relevant symptom requiring targeted evaluation and personalized management strategies. Full article

Background/Objectives: Nomophobia, the irrational fear of being without a mobile phone, is increasingly prevalent among university students and has emerged as a concerning form of digital dependence. Among nursing students, this condition is particularly relevant due to the emotional demands and cognitive challenges of healthcare education. Nomophobia has been linked with adverse psychological outcomes, sleep disturbances, and impaired academic and clinical performance. However, existing evidence remains fragmented and lacks an integrated conceptual synthesis. This review aimed to synthesize current evidence on the prevalence, correlates, and outcomes of nomophobia among nursing students. Methods: An integrative review was conducted following Whittemore and Knafl’s methodology and PRISMA guidelines. A systematic search was performed in PubMed, CINAHL, PsycINFO, PsycArticles, and Medline (between 2015 and 2025), supplemented by Google Scholar. Cross-sectional studies and literature focusing on nomophobia in nursing students were included. The primary studies and selected review articles were considered when no overlap with the included primary evidence was identified. Methodological quality appraisal was assessed using validated tools (QuADS and JBI). Results: Twenty-two studies were included (19 cross-sectional and 3 reviews). Four thematic areas emerged: prevalence and severity (50–90% moderate to severe); psychological correlates (anxiety, depression, stress, insomnia, alexithymia, fear of missing out); academic and cognitive outcomes (impaired performance, procrastination, reduced decision-making); and behavioural predictors (excessive smartphone use and emotional dysregulation). The Nomophobia Questionnaire (NMP-Q) was the most frequently used instrument. Conclusions: Nomophobia represents a relevant dimension of the mind–technology relationship in nursing education, with implications for students’ mental health, academic engagement, and clinical readiness. Addressing nomophobia may support healthier learning environments and contribute to the development of emotionally competent and safe future healthcare professionals. However, significant gaps remain, particularly regarding longitudinal evidence and intervention-based approaches. Full article

Menopause is a natural biological transition marked by the cessation of regular menstrual cycles and is associated with significant endocrine, hormonal, and metabolic changes. Sleep disturbances are among the most common and distressing symptoms during this period, affecting approximately 40–60% of women in the menopausal transition and postmenopause. Vasomotor symptoms, including hot flushes and night sweats, often occur alongside fatigue, anxiety, and mood disturbances. These symptoms frequently coexist with sleep disorders such as insomnia, early morning awakenings, fragmented sleep, obstructive sleep apnea, restless legs syndrome, and circadian rhythm disruptions. Evidence from animal models, translational research, and clinical studies highlights the complex interaction between hormonal fluctuations, neuroendocrine dysregulation, metabolic changes, and circadian rhythm disruption. These factors contribute to altered sleep regulation, appetite control, and weight gain during the menopausal transition. This review summarizes current evidence on the mechanisms of underlying sleep disturbances in menopause, their clinical manifestations, diagnostic approaches, and available therapeutic strategies. Improving the management of sleep disorders during this stage may substantially enhance overall health and quality of life in menopausal women. We discuss presentation of different sleep disorders in menopause, their current management and future direction of research for development of precision-based algorithm of treatment considering the endocrine and hormonal profile of the women. Full article

Background: Misperception of body weight has been found to negatively impact both diet and physical activity levels, particularly in youth with overweight and obesity. Objectives: This study assessed consistency between actual and perceived weight status and lifestyle factors in a sample of 455 children and adolescents (55% males, 8–13 years) attending a summer camp in Northern Italy. Methods: Weight status was defined applying Body Mass Index (BMI) cut-offs. Adherence to the Mediterranean Diet (MD), physical activity level, sleep duration, and sleep quality were assessed through validated questionnaires. Self-perception was evaluated through 5-point Likert scales, with graphical representations. Results: Comparison between self-perceived and assessed parameters revealed a poor concordance across all types of variables. Approximately half of participants (43–55%) correctly rated their weight status (κ = 0.12; 95% CI: 0.05–0.19), diet quality (κ = 0.09; 95% CI: 0.02–0.15), physical activity level (κ = 0.18; 95% CI: 0.11–0.26), sleep time (κ = 0.10; 95% CI: 0.03–0.17), and sleep quality (κ = 0.18; 95% CI: 0.12–0.24). Participants 12–13 years old were more likely to have a greater weight status perception compared to younger subjects (OR = 2.13; 95% CI: 1.08–4.21). Being in a condition of overweight or obesity significantly decreased the odds of correct weight perception (OR = 0.13; 95% CI: 0.08–0.21). Similarly, subjects with higher adherence to the MD, adequate sleep time, and low sleep quality were more conscious about their diet and sleep patterns. Conclusions: Overall, these findings highlight a certain degree of misclassification, especially in subjects who need to improve their lifestyles, highlighting the potential relevance of fostering accurate self-perception during developmental age. Full article

Background/Objectives: Evidence suggests that modifiable lifestyle interventions improve disability in relapsing multiple sclerosis (MS); however, interactions between different factors may impact outcomes. Thus, the objective of this secondary analysis was to investigate diet-induced effects on the impact of MS and effect modification by other modifiable lifestyle factors. Methods: The physical and psychological impact of MS was assessed with the MS Impact Scale-29 (MSIS) at run-in, baseline, 12 weeks, and 24 weeks. Participants were randomized at baseline to the Swank low-saturated fat or Wahls modified Paleolithic elimination diets and instructed to maintain usual physical activity, objectively measured with an accelerometer, throughout the trial. Baseline information on sleep, physical activity, alcohol, and smoking was explored as effect modifiers. Results: Among the Swank group, MSIS-Physical scores improved from 33.8 ± 3.8 at baseline to 28.7 ± 3.6 at 12 weeks (p = 0.04) and 25.3 ± 3.5 at 24 weeks (p < 0.001). MSIS-Psychological scores also improved from 35.7 ± 3.3 at baseline to 25.6 ± 2.6 at 12 weeks (p = 0.001) and 22.8 ± 2.4 at 24 weeks (p < 0.001). Among the Wahls group, MSIS-Physical scores improved from 33.8 ± 3.1 at baseline to 21.7 ± 3.0 at 12 weeks (p < 0.001) and 19.0 ± 3.1 at 24 weeks (p < 0.001). MSIS-Psychological scores also improved from 38.4 ± 3.8 at baseline to 25.5 ± 3.8 at 12 weeks (p < 0.001) and 20.6 ± 3.6 at 24 weeks (p < 0.001). Improvements in MSIS-Physical were greater among participants who were physically inactive or drank little alcohol at baseline. Conclusions: Both diets led to favorable within-group improvements in the perceived impact of MS. People with MS who are physically inactive or drink little alcohol may benefit the most from dietary interventions. Full article

Driving simulators offer a safe and controlled way to study fatigue in truck drivers, but variation in scenario design and incomplete reporting limit reproducibility and cross-study comparison. This systematic review synthesized scenario parameters used in truck-driving simulators to induce fatigue-related reductions in alertness and identified recurring protocol patterns associated with interpretable fatigue-related change. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines and a prospectively registered protocol (PROSPERO CRD420261302272), systematic searches were conducted in February 2026 in Scopus, Web of Science, IEEE Xplore, PubMed, and ScienceDirect. Peer-reviewed original studies published in English were eligible if they involved truck drivers, used a driving simulator, reported fatigue-relevant scenario parameters, and measured at least one fatigue-related outcome; no restriction was applied to publication year. Twenty-three studies comprising 419 participants met the eligibility criteria and were synthesized narratively. Risk of bias was appraised using an adapted 11-item checklist for driving simulator experiments, developed with the National Heart, Lung, and Blood Institute (NHLBI) quality assessment tools as a reference framework. Across the qualitative evidence base, fatigue-related change was reported more consistently in protocols combining sustained time on task with low-variability driving demands, typically implemented through monotonous road environments and reduced traffic complexity. Effects were more readily interpretable when sessions were scheduled at night or after work shifts and when outcomes were assessed repeatedly during the drive. However, incomplete control or reporting of baseline sleep pressure, stimulant intake, counterbalancing, familiarization, simulator sickness, and outlier handling limited causal interpretation and confidence in cross-study comparison. Overall, the evidence supports recurring design patterns rather than a single optimal protocol and highlights the need for standardized scenario descriptions and minimum reporting requirements. Full article

Introduction: Lifestyle is characterized by identifiable behavioral patterns that can affect individuals’ health, and is considered one of the predominant factors for maintaining both quality of life and people’s health. This triad (lifestyle, quality of life and health) is closely associated with well-being. Objective: The aim of this study is to evaluate the relationship between lifestyles, well-being, and self-esteem in students who have completed secondary education and are in the process of transitioning to higher education. Methods: Data were collected using a questionnaire of sociodemographic (e.g., age, gender) and physical (e.g., BMI) variables, a Self-Esteem Scale, a Well-Being scale, and the FANTASTICO Lifestyle questionnaire. Statistical analysis was performed using canonical correlation analysis and a Structural Equation Model. Results: The sample consisted of 235 students, with a mean age of 18.4 years. Canonical correlation analysis revealed that lifestyle explains 58.5% of the variance in mental health. The first (most important) canonical function (r = 0.86; p < 0.001) highlighted that the domains of introspection, sleep/stress management, and family/social support are the primary predictors of higher levels of self-esteem and psychological well-being. Structural Equation Modeling confirmed that lifestyle positively predicts psychological well-being through both direct and indirect pathways (β = 0.172; 95.0% BC CI [0.095, 0.253]). Self-esteem emerged as a significant partial mediator in this relationship, suggesting that healthy lifestyle habits reinforce the perception of personal competence, which, in turn, enhances emotional adjustment. Together, these findings validate the dynamic triad between behavior, self-perception, and well-being during the transition to higher education. Conclusions: This study shows that the transition to higher education is a pivotal period where lifestyle patterns significantly shape students’ psychological adjustment. The findings confirm that a healthy lifestyle, specifically centered on stress management, sleep, and social support, serves as a robust predictor of both self-esteem and psychological well-being. By identifying self-esteem as a key partial mediator, the results suggest that healthy habits do more than just improve physical health. Full article

Background: Dentists constitute one of the most heavily burdened groups of healthcare professionals, experiencing high levels of musculoskeletal disorders, occupational stress, burnout, and diminished quality of life. Although extensive literature addresses these issues, no study has directly examined biological age or epigenetic markers of aging in this population. This narrative review, informed by systematic methodological principles, seeks to fill this gap by connecting established occupational stressors with contemporary concepts of biological aging and chronomedicine, ultimately proposing a preventive well-being framework specifically for dentists. Methods: A narrative review informed by systematic methodology was conducted following PRISMA 2020 guidelines. Searches in PubMed, Scopus, and the Cochrane Library (2015–2025) used combined keywords and MeSH terms related to lifestyle factors, occupational stress, musculoskeletal disorders, quality of life, and wellness among dentists. Of the 943 records identified, 15 met the inclusion criteria and were assessed for outcomes, methodological quality, and relevant risk factors. Results: The included studies consistently indicated a significant occupational burden, with musculoskeletal pain, emotional exhaustion, anxiety, and depersonalization as frequent findings. Quality of life was generally moderate to low, especially regarding mental health. Lifestyle patterns were characterized by inadequate sleep, limited physical activity, irregular eating habits, and insufficient recovery. These conditions-chronic stress, poor sleep, inactivity, and suboptimal nutrition-are recognized accelerators of biological aging, implying that the professional demands of dentistry may adversely influence the biological clock. Although none of the studies measured biological age directly, the collective evidence underscores the need for preventive strategies informed by chronomedicine. Conclusions: This review highlights a critical gap in the dental literature: the complete absence of biological-age assessment in a professional population exposed to multiple aging accelerators. Integrating occupational health data with modern concepts of biological aging and chronomedicine, the study proposes a targeted preventive framework to regulate biological rhythms, reduce cumulative biological deterioration, and improve the long-term quality of life and professional sustainability of dentists. Full article

This article addresses physical activity during pregnancy and the postpartum period, a crucial public health concern. We examine the latest insights into physical activity during the perinatal phase, highlighting key findings on the attitudes, perceived barriers, and factors that influence participation. Engaging in moderate physical activity during this period is deemed safe and offers numerous benefits, such as lowered risks of gestational diabetes, preeclampsia, and excessive weight gain, alongside enhanced mental health and sleep quality. After childbirth, continued physical activity provides advantages such as weight management, reduced postpartum depression risk, improved sleep patterns, and a better overall quality of life. However, activity during these stages is often hindered by various barriers stemming from personal issues, societal influences, knowledge gaps, and environmental obstacles. Notably, these challenges tend to shift between pregnancy and postpartum; safety concerns are more prevalent during pregnancy, while issues like fatigue, lack of time, and childcare responsibilities become more significant after delivery. This article uses a socio-ecological framework to analyze these obstacles in depth, categorizing them into intrapersonal, interpersonal, environmental, organizational, and policy-based levels. Full article

Background: Poor sleep quality is common in older adults and closely tied to emotional well-being. While life satisfaction has been linked to sleep outcomes, the psychological pathways remain underexplored. Purpose: This study examines whether psychological resilience and anxiety symptoms mediate the relationship between life satisfaction and sleep quality among older adults, and whether chronic disease moderates these pathways. Methods: Data were drawn from the 2018 wave of the Chinese Longitudinal Healthy Longevity Survey, including 3089 community-dwelling adults aged 65 years and older. Sleep quality and life satisfaction were measured using validated single-item indicators. Psychological resilience was assessed using five self-reported items capturing adaptive functioning, and anxiety symptoms were measured using the 7-item Generalized Anxiety Disorder Scale. A parallel mediation model and a moderated mediation model were tested using SPSS with bootstrapping procedures (5000 samples). Results: Life satisfaction was significantly associated with sleep quality among older adults. This association was partially mediated by both psychological resilience (indirect association = −0.0100, 95% CI [−0.0163, −0.0045]) and anxiety symptoms (indirect association = −0.0356, 95% CI [−0.0483, −0.0238]). The direct association remained significant (β = −0.2399, p < 0.001), indicating a partial mediation pattern. Furthermore, in the moderated mediation model, chronic disease moderated the association between anxiety symptoms and sleep quality, whereas the indices of moderated mediation were not significant. Conclusions: Life satisfaction was associated with sleep quality, with psychological resilience and anxiety symptoms accounting for part of this association. Although chronic disease strengthened the association between anxiety symptoms and poorer sleep quality, the overall moderated mediation effect was not significant. Full article