Search Results (294)

This study evaluated the feasibility of including a computerized dynamic test of analogical reasoning in standard neuropsychological assessments in a heterogeneous psychiatric population. The participants were 40 adult patients (M_age = 33.15 ± 12.27, range 19–68; 60% male) enrolled in specialized mental health and forensic care programs in The Netherlands, who were randomly assigned into either a training, a passive, or a control group. A pretest–training–posttest paradigm was used for the training group, and the dynamic test consisted of 26 items of the A:B::C:? type. In terms of practical use, it was found that the administration time varied largely, and 22% of the data was lost due to drop out or technical malfunctions. Test–retest reliability was acceptable for the training group (r = 0.61) and good for the practice and control groups (resp. r = 0.88 and 0.80). A statistical trend was observed for the training vs. practice group (Z = −1.598, p = 0.055), but not for the training vs. control group (Z = −0.839, p = 0.201). It was concluded that an indication of training effectiveness was found; however, in this clinical sample, the applicability of the current form of the dynamic test is still limited. Several modification options are discussed. Full article

This study interrogates whether Augmented Reality (AR) enhances vocabulary and content acquisition within Content and Language Integrated Learning (CLIL), situating the question in the broader debate on how immersive, multimodal technologies shape achievement and engagement. This study’s novelty lies in its direct AR-versus-print comparison in a real CLIL classroom using markerless, smartphone-based technology. Using a mixed-methods, classroom-based experiment, we drew on a convenience sample of 129 secondary students (ages 16–18), assigning them to an AR intervention (n = 64) or a print-based control (n = 65). Both cohorts received parallel instruction covering identical objectives and materials; vocabulary attainment was gauged using matched pretest and post-test measures, while engagement, attitudes, and perceived usefulness were captured through paired pre- and post-surveys and open-ended prompts. Quantitative analyses compared change scores across conditions and were complemented by qualitative summaries of learner comments. Results indicate that exposure to AR exerted a positive influence on learners’ engagement and supported learning processes, with perceptible shifts in students’ views of AR between baseline and post-intervention; nevertheless, effects were heterogeneous across instruments, items, and subgroups, suggesting that benefits accrued in a targeted rather than uniform fashion. Compared to the print-based group, students using AR demonstrated greater gains on visually supported vocabulary and content items, while other items showed no significant differences between groups. We conclude that AR constitutes a promising pedagogical resource for CLIL, capable of scaffolding vocabulary/content development and motivating participation, while the observed variability underscores the need for principled, context-sensitive integration. Future work should specify boundary conditions—such as task type, prior proficiency, cognitive load, and technology familiarity—and employ robust mixed-methods designs to determine for whom, and under which instructional circumstances, AR yields the greatest and most sustainable gains. Full article

Non-traditional learners comprise approximately 73% of undergraduate enrollment, representing diverse populations including first-generation college students, adult learners, veterans, multilingual learners, and students with family responsibilities. Despite their numerical dominance, these students face systemic barriers that traditional pedagogical approaches often fail to address. This mixed-methods study examined how Universal Design for Learning (UDL) principles impact non-traditional learners’ educational experiences in higher education. Using a convergent parallel design with 154 participants from a Hispanic-serving institution, the study collected quantitative data through the validated Personalized Learning Supporting Instrument (PLSI) and qualitative data from open-ended questions. The refined 12-item PLSI demonstrated strong psychometric properties. While UDL factors showed limited direct association with GPA overall, Flexible Instructional Methods and Materials significantly predicted academic performance. Qualitative analysis identified six barrier themes (online learning difficulties, course content issues, financial constraints, balancing responsibilities, accessibility challenges, and health interruptions) and five positive impact themes (interactive learning, supportive environments, skill development, goal clarification, and effective assignments). Demographic analysis revealed counterintuitive patterns—students with traditional “barriers” achieved high GPAs at rates of 73–76%, while first-generation students showed the lowest high GPA rate (53.2%). These findings challenge deficit-based assumptions about non-traditional learners while revealing important equity gaps. This study demonstrates both the promise and limitations of UDL for diverse populations, suggesting institutions need comprehensive approaches with differentiated support strategies. Full article

This pilot randomized controlled trial evaluated the effectiveness of a social media detoxification intervention in reducing social media addiction and usage time among undergraduate pharmacy students at Chiang Mai University. A total of 23 students were randomly assigned to either an experimental group (n = 12) or a control group (n = 11). The intervention involved reducing screen time on mobile devices by 50% over four weeks using built-in screen time restriction settings, while the control group continued regular usage. The primary outcome was the Social Media Addiction Test (SMAT) score (16-item scale; higher scores indicate greater addiction), assessed at baseline and at week 4. The secondary outcome was weekly social media usage time (minutes per week, obtained from device screen-time reports), recorded over 4 weeks. Linear regression and Generalized Estimating Equation (GEE) models were used for the primary and secondary outcomes, respectively, with both models adjusting for baseline values. Results: At baseline, both groups were comparable in terms of key characteristics, SMAT score, and weekly usage. After 4 weeks, the experimental group had a significantly greater reduction in SMAT scores compared to the control group (adjusted difference = −7.92, 95% CI: −13.35 to −2.49, p = 0.006). For the secondary outcome, GEE analysis showed that the experimental group used social media for 1223.9 min/week (about 20 h/week) less than the control group (95% CI: −1720.6 to −727.1, p < 0.001). In short, social media detoxification through screen time restrictions appears to reduce social media addiction and usage time among pharmacy students. This intervention offers a promising and realistic way to help reduce social media addiction. Full article

Background: Gamification may enhance engagement and higher-order learning in health-care profession education, but evidence from undergraduate nursing programs—particularly in the Middle East—is limited. We evaluated whether integrating structured gamified activities into an anatomy and physiology course improves class engagement and knowledge-based critical thinking. Methods: In this pragmatic, nonrandomized, section-allocated quasi-experimental study at a single Saudi institution, 121 first-year female nursing students were assigned by existing cohorts to traditional instruction (control; n = 61) or instruction enhanced with gamified elements (intervention; n = 60) groups. The intervention (introduced mid-semester) comprised time-limited competitive quizzing with immediate feedback and aligned puzzle tasks. Outcomes were measured at baseline, mid-semester, and end-semester using a four-item Class Engagement Rubric (CER; scale 1–5) and a 40-item high-cognitive multiple-choice (MCQ) assessment mapped to course objectives. Analyses used paired and independent t-tests with effect sizes and 95% confidence intervals. Results: No attrition occurred. From baseline to end-semester, the intervention group had a mean CER increase of 0.59 points (95% CI, 0.42 to 0.76; p < 0.001)—approximately a 15% relative gain—and a mean MCQ increase of 0.30 points (95% CI, 0.18 to 0.42; p < 0.001), an ~8% relative gain. The control group showed no material change over the same interval. Between-group differences in change favored the intervention across CER items and for the MCQ outcome. Semester grade-point average did not differ significantly between groups (p = 0.055). Conclusions: Embedding a brief, structured gamification package within an undergraduate nursing anatomy and physiology course was associated with measurable improvements in classroom engagement and modest gains in knowledge-based critical thinking, with no detectable effect on overall semester GPA. Given the nonrandomized, single-site design, causal inference is limited. Multi-site randomized trials using validated critical-thinking instruments are warranted to confirm effectiveness and define dose, durability, and generalizability. Full article

The transition from secondary to higher education presents numerous academic, social, and psychological challenges that can negatively impact students’ well-being, particularly during the first year. This randomized controlled trial aimed to evaluate the effectiveness of hypnosis as a non-pharmacological intervention for managing perceived stress among first-year nursing students at the Higher Institute of Nursing and Health Techniques (ISPITS) in Rabat, Morocco. A total of 166 students from five academic tracks were randomly assigned to intervention and control groups with comparable baseline characteristics. Their perceived stress levels were assessed using two validated instruments, the Visual Analog Scale (VAS) and the 14-item Perceived Stress Scale (PSS-14), administered before and after a five-session hypnosis program conducted over 10 weeks. The results showed a marked and statistically significant reduction in stress among the intervention group, with the mean VAS scores decreasing from 7.82 ± 2.05 to 3.00 ± 1.71 compared to a smaller reduction in the control group (from 7.65 ± 1.78 to 5.80 ± 1.72; between-group difference = 2.8, p < 0.0001). Similarly, the PSS-14 scores in the intervention group declined significantly from 26.42 ± 7.54 (moderate stress) to 24.32 ± 8.20 (still moderate), with a mean difference of 2.09 ± 7.70 (t = 2.21, p = 0.0307, 95% CI [0.20; 3.98]). These findings indicate that hypnosis is an effective mind–body approach for alleviating perceived stress, improving emotional regulation, and could be incorporated into academic support programs to enhance student well-being. Full article

Background and Objectives: Suicide is one of the leading causes of death worldwide. Identifying psychopathological factors and personality traits associated with suicidal ideation is crucial for improving prevention. This study investigates the association between current suicidal ideation—measured by item 4 of the Brief Psychiatric Rating Scale-24 items (BPRS-24)—and personality traits assessed with the Personality Inventory for DSM-5 (PID-5) in a transdiagnostic outpatient psychiatric population. The association of BPRS-24 item 4 with early traumatic experiences, attachment styles, and dissociative phenomena is also explored as a secondary objective. Materials and Methods: We propose a secondary analysis on a sample of 137 individuals receiving care at an academic community mental health center. Personality traits were assessed using the PID-5, while attachment styles were assessed with the Experiences in Close Relationships-Revised (ERC-R), childhood traumas with the Childhood Experience of Care and Abuse Questionnaire (CECA.Q), and dissociative experiences with the Dissociative Experience Scale II (DES-II). Suicidal ideation was measured with item 4 of the BPRS-24. Associations were examined using Spearman’s correlation and ordinal logistic regression models, adjusted for age, sex assigned at birth, and global clinical severity (CGI-S). Results: We found statistically significant associations between suicidal ideation and the PID-5 trait of depressivity (OR = 1.80, 95 % CI 1.23–2.63, p = 0.002, p-value adjusted Holm’s method 0.012). However, this association lost significance after adjusting for depressive symptoms (BPRS-24 item 3), suggesting a mediating role of depression. We found no significant associations with childhood trauma, attachment styles, or dissociative experiences. Conclusions: Our findings suggest a potential link between specific personality traits and suicidal ideation, mediated by depressive symptomatology. We explore how future studies may evaluate PID-5 as a clinical tool to support the identification of individuals at long-term risk of suicidality or for targeting specific populations for tailored interventions. Full article

Background/Objectives: This secondary analysis aimed to compare the effects of time-restricted eating (TRE) versus calorie restriction (CR) and controls on mood and quality of life in adults with type 2 diabetes (T2D). Methods: Adults with T2D (n = 69) were randomly assigned to one of three interventions for 6 months: 8 h TRE (eating only between 12 and 8 pm daily); CR (25% energy restriction daily); or a no-intervention control group. At baseline and 6 months, mood was assessed using the Beck Depression Inventory-II (BDI-II) and the Profile of Mood States (POMS) questionnaires, while quality of life was assessed using the Rand 36-Item Short Form (SF-36). Results: Body weight significantly decreased in the TRE group (−3.38%; 95% CI, −6.04 to −0.71%, p = 0.008), but not in the CR group (−1.80%, 95% CI, −4.50 to 0.91%, p = 0.32) versus controls by month 6. Fat mass, lean mass, and visceral fat mass remained unchanged in TRE and CR groups, versus controls, from baseline to month 6. No changes were observed in depression scores (BDI-II), total mood disturbance, or any POMS subscales (tension, depression, anger, fatigue, confusion, or vigor) in either the TRE or CR groups compared to controls. Similarly, there were no significant changes in the quality-of-life SF-36 constructs of vitality, bodily pain, mental health, and general physical health in the TRE or CR group versus controls. By month 6, there were no associations between changes in body weight, quality of life, and mood outcomes in any group. Conclusions: In conclusion, our findings suggest that TRE and CR do not have any effect on mood or quality of life in adults with T2D, relative to controls. However, the participants’ baseline mood and quality of life were generally within healthy ranges, and only minimal weight loss was achieved (3.5%, TRE only), which may explain the lack of observed effects. Full article

Background: Cardiovascular-kidney-metabolic syndrome (CKM) represents a multisystem condition involving obesity, diabetes, chronic kidney disease, and cardiovascular diseases. Frailty, as measured by the Frailty Index (FI), is linked to adverse outcomes, but its association with CKM severity and mortality remains unclear. This study aimed to evaluate the relationship between frailty status, CKM staging, and mortality risk. Methods: We analysed data from 19,407 adults aged ≥ 45 years from NHANES 1999–2018. Frailty status was assessed using a 49-item Frailty Index (FI) and categorised as robust (FI ≤ 0.08), pre-frail (0.08 < FI < 0.25), or frail (FI ≥ 0.25). CKM was staged from 1 to 4 based on established clinical criteria. Multinomial logistic regression assessed the association between frailty status and CKM staging. Cox proportional hazards models evaluated the associations between frailty status and all-cause, cardiovascular, and non-cardiovascular mortality among CKM patients. Results: A total of 19,407 participants (median [IQR] age: 63.00 [54.00–72.00] years, 50.77% male), with 19,089 CKM patients. Frail individuals exhibited significantly higher odds of being assigned to advanced CKM stages. Over a median follow-up of 8.4 years, 4794 participants died. Kaplan–Meier curves and restricted cubic spline analyses demonstrated a clear gradient in mortality risk across frailty categories. Compared with the robust group, pre-frail and frail individuals had significantly higher risks of all-cause (HR = 1.47 and 2.83, respectively), cardiovascular (HR = 1.71 and 3.78), and non-cardiovascular mortality (HR = 1.40 and 2.57). Conclusions: Frailty status demonstrated a significant association with CKM staging and mortality outcomes. Early identification of frailty may help guide risk stratification and inform tailored interventions for individuals with CKM. 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/Objectives: Effective teamwork is crucial for minimizing human error in healthcare settings. Medical teams, typically composed of physicians and nurses, supported by auxiliary professionals, achieve better outcomes when they possess strong collaborative competencies. High-quality teamwork is associated with fewer adverse events and complications and lower mortality rates. Based on this background, the objective of this study is to analyze the perception of non-technical skills and immediate learning outcomes in interprofessional simulation settings based on E-CRM items. Methods: A cross-sectional observational study was conducted involving participants from the official postgraduate Medicine and Nursing programs at the Catholic University of Murcia (UCAM) during the 2024–2025 academic year. Four interprofessional E-CRM simulation sessions were planned, involving randomly assigned groups with proportional representation of medical and nursing students. Teams worked consistently throughout the training and participated in clinical scenarios observed via video transmission by their peers. Post-scenario debriefings followed INACSL guidelines and employed the PEARLS method. Results: Findings indicate that 48.3% of participants had no difficulty identifying the team leader, while 51.7% reported minor difficulty. Role assignment posed moderate-to-high difficulty for 24.1% of respondents. Communication, situation awareness, and early help-seeking were generally managed with ease, though mobilizing resources remained a challenge for 27.5% of participants. Conclusions: This study supports the value of interprofessional education in developing essential competencies for handling urgent, emergency, and high-complexity clinical situations. Strengthening interdisciplinary collaboration contributes to safer, more effective patient care. Full article

Background and Objectives: A provegetarian (PVG) food pattern, also known as a plant-based food pattern, which prioritizes the consumption of plant-based foods without completely excluding animal-based foods has been associated with health benefits. However, not all plant-based foods are healthy. We prospectively evaluated the association between different PVG food patterns and the risk of total mortality in the “Seguimiento Universidad de Navarra” (SUN) cohort. Methods: The SUN Project is a Mediterranean cohort study involving Spanish university graduates. A validated 136-item semi-quantitative food frequency questionnaire was used. A PVG food pattern, as previously proposed, was calculated assigning positive scores to plant-based foods and inverse scores to animal-based foods. Participants were categorized into quintiles based on their adherence to this pattern. Additionally, healthy and unhealthy PVG food patterns were derived. Results: Data from 17,989 participants with a mean baseline age (standard deviation) 38 (±12) years were analyzed. Over a mean follow-up period of 12 years, 460 deaths (2.6%) were recorded. Participants with higher adherence to the PVG food pattern (Q5) exhibited a 32% lower risk of total mortality [hazard ratio (HR): 0.68 (95% CI: (0.50–0.93); p for trend = 0.020] as compared to those with lower adherence (Q1), after adjusting for multiple confounders. This inverse association persisted for the healthy PVG food pattern [HR: 0.65 (95% CI: 0.47–0.90); p for trend = 0.016]. In contrast, the unhealthy PVG food pattern did not show any significant association with mortality [HR: 1.31 (95% CI: 0.94–1.83)]. Conclusions: Higher adherence to a PVG food pattern, which emphasizes the consumption of plant-based foods, reduces the risk of total mortality in the SUN cohort. Full article

In the realm of recommender systems, the prediction of diverse customer preferences has emerged as a compelling research challenge, particularly for multi-state business organizations operating across various geographical regions. Collaborative filtering, a widely utilized recommendation technique, has demonstrated its efficacy in sectors such as e-commerce, tourism, hotel management, and entertainment-based customer services. In the item-based collaborative filtering approach, users’ evaluations of purchased items are considered uniformly, without assigning weight to the participatory data sources and users’ ratings. This approach results in the ‘relevance problem’ when assessing the generated recommendations. In such scenarios, filtering collaborative patterns based on regional and local characteristics, while emphasizing the significance of branches and user ratings, could enhance the accuracy of recommendations. This paper introduces a turnover-based weighting model utilizing a big data processing framework to mine multi-level collaborative filtering patterns. The proposed weighting model assigns weights to participatory data sources based on the turnover cost of the branches, where turnover refers to the revenue generated through total business transactions conducted by the branch. Furthermore, the proposed big data framework eliminates the forced integration of branch data into a centralized repository and avoids the complexities associated with data movement. To validate the proposed work, experimental studies were conducted using a benchmarking dataset, namely the ‘Movie Lens Dataset’. The proposed approach uncovers multi-level collaborative pattern bases, including global, sub-global, and local levels, with improved predicted ratings compared with results generated by traditional recommender systems. The findings of the proposed approach would be highly beneficial to the strategic management of an interstate business organization, enabling them to leverage regional implications from user preferences. Full article

Background/Objectives: Recent research indicates a global transition from healthy and balanced diets to unhealthy Westernized dietary patterns (WDPs). This transition is linked to increased rates of non-communicable diseases (NCDs), e.g., obesity, type 2 diabetes, and cardiovascular diseases, often preceded by metabolic syndrome (MetS). Therefore, the objective of this study was to develop a diet quality index, termed Westernized Diet Index (WDI), to assess adherence to WDPs and its association with main cardiometabolic health issues, for which MetS and its components were chosen as representatives of NCDs. Methods: The development of the WDI was driven by a semi-systematic and comprehensive examination of the literature (n = 491 articles) that evaluated the influence of WDP components on health outcomes. The scoring algorithm involved multiple steps, assigning scores based on study design, sample size, and the direction of food effects on health outcomes. Results: The final developed index encompassed 30 food groups/items. It was revealed that soft drinks, processed foods, red meat, sodium, and hydrogenated fats had the most detrimental effects on health, significantly influencing the index’s coefficients. In contrast, dietary fiber, plant-based metabolites, vitamins, minerals, nuts/seeds, and fish had the most substantial beneficial impacts. Conclusions: The WDI aligns with the existing literature on the importance of specific food items and with other validated diet quality indices, e.g., the Dietary Inflammatory Index (DII) and Alternate Healthy Eating Index (AHEI). Thus, the WDI can provide evidence for clinicians and researchers in formulating evidence-based dietary guidelines as well as strategies for the prevention and treatment of diet-related health issues. However, further validation is proposed to verify the WDI’s capability across different contexts. Full article

Natural and man-made disasters are occurring more frequently, making household emergency preparedness essential for an effective response. Enrollees of the World Trade Center Health Registry have been found to be less prepared than the US national average despite their prior disaster exposure. The purpose of this study was to evaluate and compare the effectiveness of two interventions—a mailed brochure and a structured phone call—for increasing emergency preparedness knowledge among this population. We conducted a two-arm parallel group trial between February 2019 and August 2020. Participants were Registry enrollees who completed the Wave 4 Registry (2015–2016) survey, whose primary language was English or Spanish, who lived in New York City, and who did not report being a rescue and recovery worker affiliated with FDNY or NYPD. Enrollees were randomized to receive either a brochure by mail summarizing the components of emergency preparedness or a 15 min phone call describing the same. The primary outcome measure was the number of “yes” responses to the ten-item CDC CASPER emergency preparedness questionnaire, measured at baseline and post-intervention. Enrollees were sequentially alternatively assigned to either the brochure or phone call groups. In total, 705 enrollees were assigned to the brochure (n = 353) or phone call (n = 352) groups, and a total of 702 enrollees were analyzed. The Incident Rate Ratio (IRR) for the effect of time was 1.17 (95% CI = (1.14, 1.20)) and for intervention was 1.00 (95% CI = (0.95, 1.05)) Both the brochure and phone call interventions improved knowledge of emergency preparedness from baseline to post-intervention assessment, and to the same extent. Full article