Search Results (947)

Background and Objectives: Poor sleep is common in community and primary-care settings, yet very brief sleep measures suitable for routine use remain limited. We developed and evaluated the five-item Promoting Evaluation and Awareness of Comfort in Sleep (PEACE) scale and examined its associations with well-being and fatigue. Materials and Methods: In a cross-sectional, clinician-mediated online survey, 312 community-dwelling adults in Italy who were not receiving active treatment for major diseases completed PEACE, the World Health Organization-Five Well-Being Index (WHO-5), and a short fatigue questionnaire. The sample was stratified and split into exploratory and confirmatory subsamples for factor analyses. Results: Factor analyses supported the use of a single total score and showed acceptable reliability. Results were broadly similar in women and men, with no evidence of item-level bias, although some model-comparison indices were mixed. Higher PEACE scores were associated with better well-being and lower fatigue. Adding PEACE to a model predicting well-being from body mass index and sex increased explained variance from 4.0% to 11.5%. Conclusions: PEACE is a brief sleep-quality measure with promising initial psychometric properties. In this sample, it was associated with well-being and fatigue and may add information beyond body mass index and sex in community and primary-care settings. Full article

Introduction: Caffeine is the most widely consumed psychoactive stimulant worldwide and acts primarily through antagonism of adenosine A1 and A2A receptors, thereby reducing sleep pressure and promoting wakefulness. Although its alerting and performance-enhancing effects are well established, its influence on sleep-related electroencephalography (EEG) has been investigated across diverse paradigms with substantial methodological heterogeneity. This systematic and mechanistic review aimed to synthesize human evidence on how caffeine affects sleep architecture, quantitative sleep EEG, and neurophysiological markers of sleep homeostasis, and to interpret these findings within current models of adenosine-mediated sleep–wake regulation. Materials and methods: A systematic search of PubMed/MEDLINE, Web of Science, Scopus, Embase, PsycINFO, ResearchGate, and Google Scholar was conducted for studies published between January 1980 and January 2026, with the final search performed on 10 January 2026. Eligible studies were original human investigations examining caffeine exposure or administration and reporting sleep-related EEG outcomes, including polysomnographic sleep staging, spectral EEG analyses, or other EEG-derived sleep metrics. Two reviewers independently screened records and assessed eligibility, with disagreements resolved by consensus. Data on study design, participant characteristics, caffeine interventions, EEG methodology, and outcomes were extracted using a predefined form. Risk of bias was evaluated using the RoB 2 and ROBINS-I tools. Owing to marked heterogeneity across studies, findings were synthesized narratively within a mechanistic interpretive framework. Results: Thirty-two studies were included. Across highly heterogeneous paradigms—including acute bedtime or evening dosing, daytime or repeated caffeine use before nocturnal sleep, administration during prolonged wakefulness followed by recovery sleep, withdrawal protocols, and ambulatory/home EEG monitoring—the most consistent finding was suppression of low-frequency NREM EEG activity, particularly slow-wave activity and the lowest delta frequencies. Caffeine frequently increased faster EEG activity, including sigma/spindle and beta ranges, producing a lighter, more aroused, and more wake-like sleep EEG profile. These effects were especially prominent during early-night NREM sleep and in recovery sleep after sleep deprivation, where caffeine attenuated the expected homeostatic rebound in low-frequency power. REM-related effects were less consistent, but some studies reported delayed REM timing and subtler alterations in REM EEG. Emerging evidence further suggests that caffeine increases EEG complexity and shifts sleep dynamics toward a more excitation-dominant state. Several studies indicated that quantitative EEG measures were more sensitive than conventional sleep-stage variables in detecting caffeine-related sleep disruption. Dose, timing, habitual caffeine use, withdrawal state, age, circadian context, and adenosinergic genetic variation, particularly involving ADORA2A, moderated the magnitude of effects. We also highlighted the connection between current results and sports and sports science. Conclusions: Caffeine reliably alters the neurophysiological architecture of human sleep in a direction consistent with reduced sleep depth and weakened homeostatic recovery. The overall evidence supports a mechanistic model centered on adenosine receptor antagonism, attenuation of sleep-pressure build-up and expression, and a shift toward greater cortical arousal during sleep. Sleep EEG appears to be a sensitive marker of these effects, often revealing physiological disruption even when conventional sleep architecture changes are modest. Future research should prioritize larger and more diverse samples, pharmacokinetic and pharmacogenetic characterization, and ecologically valid high-resolution sleep monitoring to clarify the real-world and functional consequences of caffeine-induced EEG changes. Full article

Background: College students’ well-being is a critical determinant of academic success, and for Native American students, cultural strengths, resilience, and community support are key in fostering persistence in higher education. Alongside these assets, health behaviors are key contributors to psychological well-being (PWB) and academic performance. This study examined how modifiable health behaviors, such as physical activity (PA) and sleep duration, relate to PWB and academic performance among Native American college students. Methods: A secondary data analysis was conducted using a nationally representative sample of Native Americans (N = 1914) from the Spring 2023 American College Health Association-National College Health Assessment (ACHA-NCHA) survey. Independent variables include meeting PA guidelines (≥150 min moderate or ≥75 min vigorous/week) and sleep duration (categorized as poor or good). The Diener Flourishing Scale measured PWB. Academic performance was measured based on self-reported cumulative grade averages. Findings: Biological sex and PA were significantly associated, χ² = 40.60, p < 0.001, with a higher proportion of males meeting PA guidelines. Students with good sleep reported higher PWB than others, F(1, 1817) = 62.08, p < 0.001. Similarly, students who met PA guidelines reported higher PWB, F(1, 1817) = 35.71, p < 0.001. Poor sleep was associated with lower odds of higher academic performance (B = −0.33, p < 0.001). Contrarily, PA was not significant (p = 0.350). PWB was positively associated with academic performance (B = 0.031, p < 0.001). Conclusions: Sleep and PWB are key factors associated with both PWB and academic performance, while PA is associated with PWB. These findings highlight the importance of relevant interventions that promote these factors to support overall well-being, academic success, and retention among Native American college students. Full article

This study explores health and care workers’ perceptions of the longer-term influence of a rapidly developed digital support package designed to promote psychological wellbeing during the COVID-19 pandemic. A qualitative design was used, involving semi-structured interviews with 20 health and care professionals, including frontline clinicians and senior leaders, who had used and disseminated a theory-informed digital wellbeing package, accessed globally by 82,425 users within its first year. Interviews conducted in 2025 examined participants’ accounts of perceived effects at individual, professional, and organisational levels. Data were analysed using reflexive thematic analysis informed by public mental health, organisational resilience, and implementation science perspectives. Four themes were identified: enhanced psychological wellbeing and coping; changes to professional practice and fatigue management; reframing resilience as a collective and organisational responsibility; and the sustainability and ongoing relevance of the resource beyond the pandemic. Participants described experiences such as reduced stress and anxiety, improved sleep and emotional regulation, sustained use of cognitive–behavioural strategies, and perceived improvements in functioning at work. Some participants also reported that the resource informed their thinking about leadership, psychological safety, and wellbeing practices, and described its continued relevance five years post-release. These qualitative findings illustrate how the digital wellbeing intervention was experienced by participants and how they interpreted its relevance over time. The study suggests that digitally delivered, theory-informed resources may have perceived value for individual capacity building, professional practice, and organisational approaches to resilience within health systems facing ongoing structural pressures. Full article

Background/Objectives: Poor diet quality is common among young Saudi adults, characterised by high fast-food intake and low fruit and vegetable consumption. This study investigated the association between diet quality and lifestyle factors using a validated short Healthy Eating Index (sHEI). Methods: This study adopted a cross-sectional design, gathering responses through a self-completed online questionnaire. Demographic data were collected. Diet quality was assessed using the Arabic version of the sHEI, physical activity was evaluated with the Arabic short form of the International Physical Activity Questionnaire (IPAQ), and sleep quality was measured using the Athens Insomnia Scale (AIS). Saudi residents aged 18–25 years were eligible; pregnant or lactating individuals and those with chronic conditions affecting dietary intake were excluded. Results: Among 478 participants (mean age 21.1 ± 1.9 years), 88.1% were female, 24.7% were overweight or obese, and half reported poor diet quality. Moderation scores were slightly higher (54.2% high), whereas adequacy scores were nearly equal (49.8% high and 50.2% low). Most participants reported low physical-activity levels (78.5%) and poor sleep quality (55.2%). Sleep quality was significantly associated with all diet quality measures, increasing the odds of good total sHEI (OR = 1.74, p = 0.003), adequacy (OR = 1.49, p = 0.034), and moderation (OR = 1.54, p = 0.021). Conclusions: Sleep quality is significantly associated with diet quality among young Saudi adults. While body mass index and physical activity showed no significant associations, improving sleep quality may promote healthier dietary behaviours. Future studies should explore pathways linking sleep and diet. Full article

Background: Childhood obesity is a major public health concern associated with adverse metabolic outcomes later in life. Despite increased awareness, unhealthy lifestyle behaviors—including suboptimal diet quality, physical inactivity, insufficient sleep, and unfavorable body composition—remain prevalent in pediatric populations. Effective, child-centered educational tools for early prevention are still limited. Methods: We developed the Lifestyle Tridimensional Pyramid, an educational model integrating nutrition, physical activity, and sleep within a single, three-dimensional framework. The model also addresses body composition by emphasizing the balance between skeletal muscle and adipose tissue and the interdependence of lifestyle behaviors. This narrative review is supported by an umbrella review of 17 systematic reviews and meta-analyses published between 2010 and 2025, synthesizing evidence on lifestyle behaviors of pediatric obesity. Results: High- to moderate-quality evidence indicates that adherence to Mediterranean-style dietary patterns, regular moderate-to-vigorous physical activity, adequate sleep duration, and a healthier body composition might prevent the development of obesity and improved cardiometabolic profiles in children and adolescents. The pyramid provides a structured, visually accessible tool to support lifestyle counseling in pediatric outpatient settings and is adaptable to school- and community-based health promotion. Conclusions: Although prospective validation studies are warranted, the Lifestyle Tridimensional Pyramid represents a practical, evidence-informed framework to support integrated lifestyle education and improve primary and secondary prevention of pediatric obesity. Full article

Background: Chronic Kidney Disease-associated Pruritus (CKD-aP) is a frequent, debilitating, and often underestimated symptom in clinical practice, with significant impacts on quality of life, sleep, mental health, and therapeutic adherence. This study aimed to develop a structured, person-centered nursing care overview for the management of CKD-aP. Methods: A comprehensive narrative review of the recent scientific literature on CKD-aP was conducted, adapting the conceptual domains of the European Specialist Nurses Organisation (ESNO) Common Training Framework (CTF) to nephrology nursing practice. The theoretical model guiding the work was Virginia Henderson’s paradigm, selected for its consistency with care models focused on promoting independence and meeting fundamental human needs. The study would answer the main research question “Which nursing evidence, tools, and strategies can support integrated, patient-centered management of CKD-aP?”. Results: A structured nursing care process was developed, articulated in sequential phases (assessment, problem definition, planning, intervention, and re-evaluation), visually represented in an operational flowchart and supported by validated clinical tools. The model emphasizes the nurse’s role in the multidimensional management of the symptom, incorporating educational, relational, therapeutic, and coordination-focused interventions. Conclusions: This proposal contributes to nephrology nursing practice by providing a theoretical and practical framework to standardize the management of CKD-aP. It promotes a holistic, evidence-based approach tailored to individual care needs, establishing a foundation for future clinical, educational, and research developments. Full article

Sleep is critical for physical growth and healthy child development. Traditionally, interventions targeting sleep improvement in children have focused on the parents. This scoping review aimed to identify and summarize the available evidence on child-focused interventions designed to promote healthy sleep habits among children aged 3–12 in healthcare settings. The review was conducted in accordance with JBI guidelines. A comprehensive search strategy was employed, encompassing databases such as PubMed, CINAHL, Psychology & Behavioral Sciences Collection, Education Source, Scopus, Web of Science, the Public Health Database, and Portugal’s Open Access Scientific Repository. Following identification and screening, 15 articles were included. Three types of interventions were identified: isolated, combined, and structured programs. Overall, the studies suggest that, while sleep-related knowledge tends to improve, achieving sustained, long-term behavioral change remains challenging in this age group. Active child participation appears essential for promoting lasting results and developing more tailored, child-friendly interventions. Full article

Background: Obesity remains a major public health challenge, with central and visceral fat distribution conferring particularly high cardiometabolic risk. Lifestyle factors, including diet, physical activity, and sleep quality, have been implicated in adiposity, yet their combined and interactive effects in working populations remain insufficiently characterized. Methods: We conducted a cross-sectional study in 88,343 Spanish employees (53,122 men, 35,221 women) attending occupational health examinations between 2021 and 2024. Obesity was assessed using four complementary indices: body mass index (BMI), waist-to-height ratio (WHtR), Clínica Universidad de Navarra–Body Adiposity Estimator (CUN-BAE), and Metabolic Score for Visceral Fat (METS-VF). Lifestyle factors included sleep quality (Pittsburgh Sleep Quality Index), Mediterranean diet adherence (MEDAS), and physical activity (IPAQ). Multivariable logistic regression models were adjusted for sociodemographic and lifestyle variables, with interaction, stratified, joint exposure, and dose–response analyses. Results: Obesity prevalence varied widely by index, ranging from 18.9% (BMI) to 55.6% (CUN-BAE). Poor sleep quality was independently associated with higher odds of obesity across all indices, particularly central obesity (WHtR OR 1.58, 95% CI 1.48–1.69), with stronger associations observed in women. Physical inactivity and non-adherence to the Mediterranean diet were robust predictors, with inactivity showing the largest effect sizes (METS-VF OR 9.92, 95% CI 8.70–11.15). Interaction analyses indicated that both Mediterranean diet adherence and regular physical activity attenuated the adverse association between poor sleep and obesity outcomes. Restricted cubic spline models revealed a progressive dose–response relationship between increasing PSQI score and central obesity. Joint exposure analyses showed nearly five-fold higher odds of central obesity among workers with concurrent poor sleep, physical inactivity, and low Mediterranean diet adherence. A graded inverse association was observed between a composite healthy lifestyle score (0–3) and obesity, with a score of 3 associated with 72–75% lower odds of BMI-obesity and WHtR-high. Conclusions: In this large occupational cohort, poor sleep quality, physical inactivity, and low Mediterranean diet adherence emerged as independent and combined determinants of general, central, and visceral obesity. Integrated workplace strategies promoting sleep hygiene, physical activity, and dietary quality—particularly among women and lower socioeconomic groups—may represent an effective approach to reducing obesity risk in working populations. Full article

Sleep quality is essential for maintaining physical health and psychological resilience. Because sleepwear remains in direct contact with the skin throughout the night, it may affect thermoregulation and comfort and, thereby, influence sleep. This randomized two-period, two-sequence crossover study investigated whether sleepwear infused with nanodiamond and nanoplatinum particles (DPV576) could improve sleep quality and promote fatigue recovery under free-living conditions. Fourteen healthy men (23.9 ± 1.7 years) wore DPV576 sleepwear and visually indistinguishable standard polyester sleepwear for one week each, separated by a one-week washout. Sleep was assessed using a wearable ECG-based actigraphy device; trained researchers additionally performed manual rescoring to verify automated outputs, including independent determination of sleep onset latency. Subjective sleep was assessed daily using the Sleep Quality Index of Daily Sleep and a visual analog scale; exploratory outcomes included voice-derived biomarkers and pre-/post-sleep grip strength. In manual rescoring, DPV576 was associated with higher sleep efficiency (93.0 ± 0.9% vs. 89.5 ± 1.5%, p < 0.05), fewer awakenings (8.4 ± 1.3 vs. 10.7 ± 1.4, p < 0.01), and shorter wake after sleep onset (30.4 ± 4.7 vs. 41.6 ± 6.0 min, p < 0.01), whereas total sleep time did not differ significantly (p = 0.096). These findings suggest that one-week use of DPV576 sleepwear may improve wearable ECG-derived sleep consolidation in young men, supporting a nonpharmacological wearable strategy to enhance sleep efficiency in everyday settings. Full article

Diabetic retinopathy (DR) is more than a capillary disorder. Diabetes affects neurons, glial cells, vascular cells, and immune signals within the retinal neurovascular unit (NVU). Retinal neurovascular coupling (NVC) is a useful functional marker of NVU integrity because it reflects the rise in local blood flow that follows neural activity. Many human flicker-light studies report smaller vessel dilation or weaker flow responses in diabetes. This finding can appear even in patients without clear fundus lesions. When NVC is reduced, retinal tissue may receive less oxygen. Lower oxygen delivery can raise oxidative stress and promote inflammation. These changes can then worsen vascular injury. This review describes key NVC pathways and diabetes-related NVU changes in Müller glia, astrocytes, microglia, pericytes, and endothelial cells. The review highlights sympathetic activation as a common stress signal. Pain, anxiety, perioperative stress, and sleep loss can increase sympathetic activity and circulating catecholamines. In the diabetic retina, vascular reserve is often limited. Under these conditions, catecholamines can increase mural cell constriction, reduce nitric oxide (NO)-dependent relaxation, and increase endothelial activation and barrier strain. These effects can shift the baseline state of glial and immune cells and further weaken NVC. The review also summarizes translational tools that can test these links. These tools include heart rate variability, standardized NVC protocols with diameter and flow measures, and retinal organoid and organ-on-a-chip platforms with controlled adrenergic exposure. The review discusses perioperative care packages that reduce stress responses, protect sleep, and manage glucose as practical ways to support retinal microcirculation. More longitudinal human studies are still needed. Retina-specific perioperative endpoints are also needed to clarify causality and to guide intervention trials. Full article

Canine cognitive dysfunction (CCD) is a common age-related neurodegenerative disorder in dogs that shares several pathological and clinical features with human Alzheimer’s disease (AD). In both species, β-amyloid (Aβ) accumulates within the brain parenchyma and cerebral vessel walls and is associated with synaptic loss, oxidative stress, mitochondrial dysfunction, and chronic neuroinflammation, ultimately leading to progressive cognitive decline. Increasing evidence indicates that impairment of brain clearance mechanisms, particularly the glymphatic system, represents a central pathogenic mechanism in both CCD and AD. The glymphatic system is a glia-dependent perivascular network involved in the clearance of Aβ and other metabolic waste products from the brain. Its function declines with aging, vascular disease, and astrocytic alterations, including changes in aquaporin-4 distribution. Reduced glymphatic and periarterial drainage promotes the retention and aggregation of Aβ and tau proteins. Compared with AD, tau pathology in CCD is generally less extensive, supporting the interpretation of CCD as an Aβ-predominant condition and a partial pathological analog of Alzheimer’s disease. Clinically, CCD is characterized by a constellation of behavioral changes including, disorientation, altered social interactions, sleep–wake cycle disturbances, a loss of housetraining, changes in activity levels, and increased anxiety, commonly summarized by the DISHAA acronym. Overall, CCD represents a valuable spontaneous large-animal model for investigating neurodegenerative mechanisms and clearance-related therapeutic targets relevant to both veterinary and human medicine. Full article

Background/Objectives: Sleep problems and physical activity are key lifestyle behaviors associated with children’s socioemotional development. However, their relative contribution to emotional regulation and emotional instability during middle childhood remains insufficiently clarified. This study aimed to examine the associations between sleep problems, habitual physical activity, and emotional regulation in elementary school children, while controlling for sociodemographic and lifestyle confounding variables. Methods: A cross-sectional study was conducted with 386 elementary school children (mean age = 11.15 ± 0.66 years; 45.6% boys) from southern Spain. Emotional regulation was assessed using the Emotion Regulation Checklist (ERC), sleep problems were measured with the Children’s Sleep Habits Questionnaire (CSHQ), and habitual physical activity was evaluated using the Physical Activity Questionnaire for Children (PAQ-C). Age, sex, socioeconomic status, and daily screen time were included as covariates. Pearson correlations and multiple linear regression analyses were performed. Results: Sleep problems were strongly associated with lower adaptive emotional regulation and higher emotional lability. In adjusted regression models, sleep problems emerged as the most robust independent predictor of both emotional regulation and lability. Although habitual physical activity was significantly associated with emotional outcomes at the bivariate level, its predictive strength decreased after adjustment for covariates and did not independently predict adaptive emotional regulation. Conclusions: Sleep problems appear to play a central role in children’s emotional functioning during middle childhood. Interventions aimed at promoting socioemotional well-being may benefit from prioritizing sleep health alongside physical activity within a comprehensive 24 h movement behavior framework. Full article

Background: Video gaming is a highly prevalent leisure activity globally, with complex associations across multiple health domains. Methods: This narrative review critically appraised the existing literature identified through targeted searches of PubMed and Google Scholar to synthesise evidence on associations between video gaming and psychosocial stress, physical activity, sleep quality, eating behaviour, and diet quality. Theoretical, biological, and psychosocial mechanisms underlying these relationships were examined, and methodological limitations and research gaps were identified. Results: The relationships between video gaming and health outcomes appear bidirectional and context dependent. While video gaming may provide short-term stress relief and social connection, frequent or prolonged gaming may be associated with sedentary behaviour, physical inactivity, impaired sleep quality, disrupted eating patterns, and poorer diet quality. These associations may vary by age, sex, gaming duration, timing, content, and motivational drivers. Gaming-related cognitive absorption and physiological arousal may influence appetite regulation, sleep onset, and stress responses, while temporal displacement and environmental factors, such as food availability and marketing exposure, also contribute. Conclusions: An integrated biopsychosocial framework is proposed to describe the interconnected pathways through which video gaming may influence health, incorporating biological arousal, psychological immersion, and social and environmental contexts. Significant gaps remain, including the scarcity of longitudinal studies, limited consideration of moderating factors, and inconsistent measurement of gaming behaviours. Addressing these gaps is essential for refining public health surveillance and supporting the development of evidence-based strategies that promote healthy gaming behaviours while preserving potential psychosocial benefits. Full article

Background: Extended digital media consumption affects the mental and overall health of children and adolescents. The role of technology-based parenting (TBP) in limiting or controlling digital media use in this context is controversial. Methods: A representative sample of 5832 parents of schoolchildren aged 6 to 17 participated in an anonymous online survey in 2025. Correlation analysis identified simple associations with health-related parameters, and ANOVA models examined the relationship between TBP, digital media use and health-related parameters across children, early adolescents and late adolescents. Results: Digital media use increased with age, whereas TBP peaked at 11 years of age. In children, both variables were positively associated, but for late adolescents, the association was negative. For early adolescents, both factors were related to mental health symptoms. In late adolescents, both factors are related to sleep duration and physical activity. Social support was positively associated with TBP in early adolescents and negatively associated with digital media use in children and late adolescents. ANOVA showed that late adolescents using digital media between 2.5 and 3.5 h a day slept more when controlled by TBP. Conclusion: Children should limit their digital media use. Early adolescents need strong child–parent relationships. Late adolescents can achieve a healthier lifestyle with TBP. Age-specific information campaigns and intervention programs can support families in managing digital media use and promoting well-being. Full article