Search Results (4,376)

Older adults are vulnerable to changes in sleep with age. Poor sleep quality is associated with self-reported cognitive changes, which can occur before the onset of objective cognitive decline associated with Mild Cognitive Impairment and Alzheimer’s disease. The objective of this study was to examine associations between self-reported sleep complaints, objective sleep quality, and self-reported cognitive changes and their relations to symptoms of depression and anxiety in a group of community-dwelling older adults. Adults aged ≥ 50 without dementia (n = 45) were recruited and completed 1–2 weeks of rest-activity monitoring using a wrist-worn device, underwent a test of global cognitive functioning (Mini-Mental State Examination; MMSE), and completed questionnaires assessing insomnia (Insomnia Severity Index; ISI), subjective sleep quality (Pittsburgh Sleep Quality Index; PSQI), self-reported cognitive changes (Cognitive Function Instrument; CFI), and symptoms of depression and anxiety (Beck Depression Inventory-II; BDI-II and Generalized Anxiety Disorder 7-item assessment; GAD-7). Pearson partial correlations assessed relations among subjective and objective sleep quality, insomnia ratings, CFI ratings, and global cognition, while controlling for BDI-II and GAD-7 ratings. Exploratory analyses examined the correlation between PSQI component scores and CFI ratings and global cognition. Greater ISI (r = 0.50, p ≤ 0.001) ratings significantly correlated with higher CFI scores. PSQI total ratings and actigraphy-based measures (n = 41) did not significantly correlate with CFI scores. Exploratory PSQI subscale analyses revealed that worse subjective sleep quality (r = 0.31, p = 0.048), shorter sleep duration (r = 0.32, p = 0.04), and greater use of sleep medications (r = 0.31, p = 0.048) correlated with higher CFI scores. Poorer sleep quality due to less time spent asleep, fragmented or disturbed sleep, and requiring medications to sleep, may be associated with greater memory concerns. Alternatively, worries about cognition may deleteriously affect sleep. Subjective measures of sleep quality may be useful to identify older adults at increased risk of cognitive decline. Full article

This umbrella review provides a comprehensive synthesis of the available evidence on the relationship between digital device use and adolescent sleep. It summarizes results from systematic reviews and meta-analyses, presenting the magnitude and direction of observed associations. A total of seven systematic reviews, including five qualitative reviews and two meta-analyses, were included, comprising 127 primary studies with a combined sample of 867,003 participants. The findings suggest a negative impact of digital device use on various sleep parameters, including sleep duration, bedtime procrastination, and sleep quality. Devices such as smartphones and computers were found to have a greater adverse effect, while television use showed a weaker association. The most significant disruptions were observed in relation to social media and internet use, with problematic usage leading to delayed bedtimes, shorter sleep duration, and increased sleep onset latency. The review also highlights the role of timing and duration of device use, with late-night use particularly contributing to sleep disturbances. Biological, psychological, and social mechanisms are proposed as potential pathways underlying these effects. Despite moderate evidence supporting the negative impact of digital media on sleep, there is considerable heterogeneity across studies, and many relied on self-reported data, which may limit the generalizability of the findings. Future research should aim to standardize exposure and outcome measures, incorporate objective data collection methods, and explore causal relationships through longitudinal studies. This umbrella review underscores the importance of developing targeted public health strategies, parental guidance, and clinical awareness to mitigate the potential adverse effects of digital device use on adolescent sleep and mental health. Full article

Household food waste remains a persistent challenge despite widespread pro-environmental intentions. Drawing on Brehm’s Motivational Intensity Theory, this study examined how perceived difficulty and perceived ability interact with motivation to predict self-reported food waste. We surveyed 939 participants in Flanders and Spain, measuring motivation to avoid waste, self-rated perceived ability to manage food, meal planning perceived difficulty, and food waste. Moderated moderation analyses revealed that motivation and perceived ability each independently predicted lower waste. Crucially, a significant three-way interaction showed that motivation most effectively reduced waste when perceived difficulty was low and perceived ability was high; when perceived difficulty exceeded perceived ability, motivation had no mitigating effect. These findings underscore that effort mobilization influenced by both individual capacity and situational demands is key to closing the intention–behavior gap in food waste. Practically, interventions should go beyond raising awareness to simplify tasks and bolster consumers’ skills, aligning action demands with realistic effort levels. Full article

The consumption of dietary supplements is increasing worldwide, yet national data from Saudi Arabia remain limited. This study examined the prevalence, patterns, and predictors of dietary supplement use, with emphasis on vitamin intake. A cross-sectional survey was conducted among 477 adults meeting inclusion criteria. Self-reported data included demographics, supplement use in the past 12 months, types and forms consumed, frequency, motivations, and information sources. Descriptive statistics and logistic regression were applied. Overall, 58% reported using at least one supplement in the past year, with vitamins comprising 81% of use. Pills and capsules were preferred, and daily intake was most common (58%). Female gender (AOR = 2.04; 95% CI: 1.26–3.31) and higher education (AOR = 4.04; 95% CI: 1.88–8.64) significantly predicted vitamin use. Common motivations included health promotion (19%), symptom relief (24%), and physical appearance (10%), with gender differences in reasons related to general health and immunity. Nearly three-quarters of participants relied on informal sources for supplement intake. Dietary supplement use is prevalent, particularly among women and the highly educated. Targeted education and regulatory measures are needed to promote safe, informed use, aligning with the national health strategies under Saudi Vision 2030. Full article

Human–machine trust has shifted over the past three decades from trust in automation to trust in AI, while research paradigms, disciplines, and problem spaces have expanded. Centered on AI in healthcare, this narrative review offers a longitudinal synthesis that traces and compares phase-specific changes in theory and method, providing design guidance for human-AI systems at different stages of maturity. From a cross-disciplinary view, we introduce an Interdisciplinary Human-AI Trust Research (I-HATR) framework that aligns explainable AI (XAI) with human–computer interaction/human factors engineering (HCI/HFE). We distill three core categories of determinants of human-AI trust in healthcare, user characteristics, AI system attributes, and contextual factors, and summarize the main measurement families and their evolution from self-report to behavioral and psychophysiological approaches, with growing use of multimodal and dynamic evaluation. Finally, we outline key trends, opportunities, and practical challenges to support the development of human-centered, trustworthy AI in healthcare, emphasizing the need to bridge actual trustworthiness and perceived trust through shared metrics, uncertainty communication, and trust calibration. Full article

Background/Objectives: Pain neuroscience education (PNE) has demonstrated efficacy in adults with chronic pain, but the pediatric evidence is still developing, despite its increasingly frequent use. Evidence for the effectiveness of PNE in pediatrics remains fragmented across settings and outcomes, which justifies a systematic evaluation focused on children and adolescents. Methods: Following PRISMA, two reviewers independently screened records (PubMed, Web of Science, PEDro; through 21 July 2025), extracted data, and assessed risk of bias (RoB 2 for randomized controlled trials; NIH/CASP for non-randomized studies). Given the heterogeneity, we conducted a structured narrative synthesis (SWiM) and rated the certainty of evidence with GRADE. PROSPERO: CRD420251062922. Results: Eleven studies met the inclusion criteria. PNE consistently improved pain-related knowledge, with effects maintained at follow-up (moderate certainty); effects on pain intensity, function, and emotional outcomes were small and inconsistent (low certainty), with more favorable patterns when PNE was combined with exercise and/or booster sessions. Digital and gamified formats proved feasible and engaging; parental outcomes showed small improvements where measured. Conclusions: PNE is a promising, low-cost, and scalable component of pediatric chronic pain care, strengthening self-efficacy and adaptive coping. Integration into biopsychosocial, multidisciplinary programs—particularly alongside exercise and family involvement—may optimize outcomes. Larger, standardized trials with long-term follow-up and systematic adverse-event reporting are needed to solidify guidance for clinical practice. Full article

In higher education, institutional quality is traditionally assessed through metrics such as academic programs, research output, educational resources, and community services. However, it is important that their activities align with student expectations, particularly in relation to interactive learning environments, learning management system interaction, curricular and co-curricular activities, accessibility, support services and other learning resources that ensure academic success and, jointly, career readiness. The growing popularity of student engagement metrics as one of the key measures to evaluate institutional efficacy is now a feature across higher education. By monitoring student engagement, institutions assess the impact of existing resources and make necessary improvements or interventions to ensure student success. This study presents a comprehensive analysis of student feedback from the StudentSurvey.ie dataset (2016–2022), which consists of approximately 275,000 student responses, focusing on student self-perception of engagement in the learning process. By using classical topic modelling techniques such as Latent Dirichlet Allocation (LDA) and Bi-term Topic Modelling (BTM), along with the advanced transformer-based BERTopic model, we identify key themes in student responses that can impact institutional strength performance metrics. BTM proved more effective than LDA for short text analysis, whereas BERTopic offered greater semantic coherence and uncovered hidden themes using deep learning embeddings. Moreover, a custom Named Entity Recognition (NER) model successfully extracted entities such as university personnel, digital tools, and educational resources, with improved performance as the training data size increased. To enable students to offer actionable feedback, suggesting areas of improvement, an n-gram and bigram network analysis was used to focus on common modifiers such as “more” and “better” and trends across student groups. This study introduces a fully automated, scalable pipeline that integrates topic modelling, NER, and n-gram analysis to interpret student feedback, offering reportable insights and supporting structured enhancements to the student learning experience. Full article

Background: The acquisition of adaptive skills is critical for independence and participation in activities of daily living (ADL). While caregiver perceptions provide valuable insights, most studies on autistic participation have focused on older children and relied on one-time clinic-based assessments. As a result, little is known about how autistic toddlers function in their natural environments across time. Ecological momentary assessment (EMA) is a real-time, context-sensitive method in which parents can report behaviors at multiple time points in the child’s natural environment. This pilot study aimed to examine ADL independence in autistic toddlers compared to their typically developing (TD) peers, to assess the feasibility of using EMA in early childhood, and to compare EMA-based assessments with a one-time standardized report. Methods: 23 autistic toddlers and 28 TD toddlers (aged 18–40 months) participated in the study. Parents completed a one-time report on the self-care scales of the Pediatric Evaluation of Disability Inventory (PEDI) and the Functional Independence Measure for Children (WeeFIM) and then rated their child’s independence on the WeeFIM twice a day for two weeks via their smartphones. Results: EMA was feasible with high response rates (ASD: 91.1%, TD: 88.55%). Autistic toddlers showed different participation profiles, with less independent performance in ADL compared to TD peers. In the autism group, the average EMA scores (M = 16.53, SD = 6.58) were significantly higher than the one-time WeeFIM scores (M = 13.74, SD = 5.23), t (22) = 3.23, p < 0.01, suggesting underreporting in single-time assessments. In contrast, no such difference was found in the TD group. Significant positive correlations were found between the EMA mean and the one-time WeeFIM scores in both groups (r > 0.80), indicating convergent validity. In the autism group only, greater variability in EMA was moderately associated with higher functional independence (r = 0.46, p < 0.01). Conclusions: These findings indicate that autistic toddlers demonstrated higher levels of participation in their natural environment than reflected by the one-time assessment, emphasizing the limitations of single-time-point evaluations. This underscores the importance of collecting data across multiple time points to accurately assess adaptive functioning and ADL participation. The EMA technique demonstrated in this study provides exploratory evidence of feasibility as an ecologically valid approach to assessing functional independence in autistic toddlers, offering a richer and more context-sensitive alternative to traditional one-time clinical assessments. Full article

The U.S. loneliness epidemic is associated with substantial morbidity and mortality. While higher social media use (SMU) has been associated with higher loneliness among youth, these associations have not been sufficiently examined in adult populations. Additionally, insufficient research has assessed both SMU time and frequency in the same study. Therefore, the primary aim was to evaluate associations between SMU, both by time and frequency, and loneliness in a nationally representative sample of U.S. adults. We recruited 1512 U.S. adults ages 30–70 in 2023. We assessed loneliness using the NIH PROMIS four-item scale and self-reported SMU time and SMU frequency. Survey-weighted logistic regression models determined associations between both SMU measures and loneliness, controlling for gender, age, sexual orientation, educational attainment, employment status, and marital status. Both SMU time and SMU frequency were independently and linearly associated with loneliness (p < 0.001 for both). Although odds of loneliness increased for each increase in frequency, the association between time spent on social media and loneliness demonstrated an inverted U-shape with maximal loneliness in the third quartile of SMU. Results suggest that both time and frequency of SMU may be useful targets for interventions aimed at curbing the negative impact of SMU on loneliness. Full article

Background: Self-medication (SM) among women during pregnancy poses a critical risk to maternal health, and SM is still commonly practiced in Saudi Arabia. Therefore, this study aims to assess the factors, attitudes, and prevalence of SM among pregnant women in the Ministry of Health (MOH) First Health Cluster. Methods: A cross-sectional design was used among 400 pregnant women who received care at primary, secondary, and tertiary healthcare levels. A structured tool was adopted and modified based on the literature review, expert and focus group interviews, and the experiences of the target participants. The dependent variables included history of illness, access to healthcare services, medication usage, and perception of SM, while the independent variables included socioeconomic status. Statistical Package for the Social Sciences (SPSS), Version 25 was used for analysis. Results: The prevalence of SM was 36.5%. Cough syrup and antipyretics were the most commonly used medications, while hair problems and weight loss were the most frequently reported reasons for SM. The primary sources of information guiding SM behavior were prior prescriptions and previous experience. Education level, occupation, age, number of pregnancies, and miscarriage history were all significantly associated with SM (p < 0.05). Conclusions: SM was found to be frequent among pregnant women in the First Health Cluster, highlighting the need for educational interventions and regulatory measures to reduce unsafe practices and improve maternal health. Full article

Background and Objectives: Acute exercise lowers vagal HRV, yet it is unclear who will show the largest drop and whether simple questionnaires can identify them. To test whether resting HRV complexity (Sample Entropy) predicts the magnitude of acute vagal withdrawal and whether this physiology-based marker has greater practical utility than self-report activity/sleep measures for screening and recovery decisions. Materials and Methods: In a single-arm pre–post experimental study, twenty-nine students (20.4 ± 0.5 y; 13 males, 16 females) completed one morning visit (08:00–12:00 h). After a 2 min resting ECG and a Sustained Attention to Response Task (SART), participants cycled 15 min at 0.85 × (220 − age) bpm following a 5 min 25 W warm-up. HRV was re-recorded within ~2 min and SART ~5 min post exercise. The IPAQ defined low/medium/high activity tertiles. Correlations related baseline measures to change scores. Results: RMSSD decreased by −12.93 ms [−25.71, −2.03] (p = 0.003, r = 0.60) and SDNN by −14.91 ms [−22.30, 7.66] (p = 0.011, r = 0.51). Reaction time shortened slightly (−8.77 ms [−59.33, 30.40], p = 0.35). Activity tertiles did not differ in ΔRMSSD, ΔSDNN, or ΔRT (all p > 0.10). Sample Entropy predicted autonomic change (ΔRMSSD r = 0.43, p = 0.034; ΔSDNN r = 0.59, p = 0.002), whereas the PSQI and IPAQ did not. Equivalence tests showed non-significant tertile differences were not within our predefined equivalence bounds. Conclusions: Individuals with more complex resting HRV were more likely to show a larger immediate vagal withdrawal after moderate cycling. Questionnaires did not identify these responders. Non-linear HRV may aid practical screening/monitoring, whereas self-reports alone appear insufficient. Generalizability is limited by the homogeneous young adult sample. Full article

Type 2 diabetes (T2D) presents growing public health challenges due to its strong links to modifiable behaviors. This systematic review examined how researchers have studied behavioral domains such as diet, physical activity, medication adherence, and blood glucose monitoring in adults with T2D. A structured search of PubMed, Scopus, and Web of Science identified peer-reviewed studies published between 2003 and 2025, with studies from 2014 onward prioritized to reflect the rise in mobile health technologies. 30 core studies were systematically reviewed, with 10 additional comparative studies included for supplementary methodological insights. Quantitative approaches were most common, offering measurable outcomes but often relying on self-report. Qualitative studies provided valuable cultural and psychosocial context yet lacked generalizability. Mixed-methods designs integrated statistical and narrative insights but posed practical challenges in execution. Technology-assisted methods, such as mobile applications and wearable devices, supported real-time monitoring and improved accuracy but raised concerns regarding privacy and equitable access. Physical activity and dietary behaviors were most frequently studied, while medication adherence and glucose monitoring received less consistent attention. Despite methodological diversity, most studies relied on cross-sectional designs and underutilized culturally tailored frameworks. This review emphasizes the need for longitudinal, equity-focused research methodologies to improve diabetes prevention and management strategies. Full article

Background/Objectives: Executive functioning (EF) and prospective memory (PM) difficulties have been documented in adults with developmental dyslexia. However, research has tended to focus on university students with a formal diagnosis, overlooking adults who may experience symptoms of dyslexia without ever being formally diagnosed. The present online study aimed to investigate the effects of dyslexia traits on EF and PM in a larger, community-based sample by prioritising the use of self-report measures that include and differentiate between underexplored aspects of EF and PM in the dyslexia literature. Methods: One hundred and eighty adult volunteers of a wide range of ages were included in the final analysis. Participants completed four self-report questionnaires with good pedigrees assessing dyslexia traits and ADHD symptomatology, as well as everyday experiences of five distinct EFs, PM and PM strategies. Results: Hierarchical regression analyses revealed that, after controlling for age and ADHD symptomatology, more self-reported dyslexia traits were associated with more frequent EF problems overall and lower confidence in PM Abilities. Elevated dyslexia traits were significantly associated with self-reports of more difficulties with time-management, organisation and self-restraint, but not with more difficulties with motivation and regulation of emotion. No significant associations were found between dyslexia traits and the self-reported use of PM-enhancing strategies. Conclusions: The findings are considered in the light of potential metacognition deficits and theoretical and practical implications are discussed. Full article

Background: Adolescents with obesity participate in self-directed weight loss attempts, and these may be associated with disordered eating. This study aimed to understand prior engagement with a dietitian and previous dieting practices of adolescents presenting for obesity treatment. Additionally, we aimed to understand the association between prior dieting and eating disorder risk, binge eating, weight bias internalisation and body image. Methods: This cross-sectional study included 141 adolescents (median [IQR] age: 14.8 [13.8–15.7] years) with BMI 35.28 (31.99–38.57) kg/m² and ≥1 related complication presenting for a prescriptive dietary intervention. Adolescents were asked whether they had previously seen a dietitian (yes/no) and/or previously trialled any other diets for weight management. Associations between reported diets and the Eating Disorder Examination Questionnaire (EDE-Q), the Binge Eating Scale, the Weight Bias Internalisation scale and Body Appreciation Scale scores were assessed using multiple one-way ANOVAs. Results: A total of 68 (48.2%) adolescents had previously seen a dietitian and 106 (75.2%) had trialled at least one diet. Most adolescents had used one diet type (n = 74; 52.5%), and 29 (20.6%) had used two or three different diets. Most adolescents reported following a healthy eating pattern (n = 76; 53.9%), with 11 trying a low-carbohydrate diet (7.8%) or a specific eating plan, e.g., low sugar, vegetarian (n = 11; 7.8%). There were no associations between dieting attempts and scores of measures of disordered eating, weight bias or body appreciation. Conclusions: Many adolescents presenting for obesity treatment will have trialled diets, with or without the support of a dietitian. Clinicians providing nutrition education and prescribing dietary interventions should be aware of this and the potential influence on adolescent perceptions of dieting practices. Full article

Background: Adherence to Medical Nutrition Therapy (MNT) is a key determinant of therapy success, particularly in chronic diseases like chronic kidney disease (CKD). MNT in CKD requires significant changes in patient’s dietary habits, which can affect long-term adherence. This study aims to evaluate the adherence to MNT in stage 5 CKD patients undergoing conservative kidney management (CKM), identifying potential challenges and strengths of nutritional intervention. Methods: We enrolled in 94 stage 5 CKD patients undergoing CKM at the University Hospital of Modena, Italy. We collect clinical data from medical and nutrition records. The inclusion criteria comprised patients of all genders, ages, and ethnicity with stage 5 chronic kidney disease (CKD), in pre-dialysis, enrolled in the nephrology and dietetics program, who had access to 24-h urine tests, anthropometric measurements, and dietary history records. Exclusion criteria included patients with CKD stages lower than 5, those who had not undergone at least one nutritional assessment, or lacked accessible 24-h urine data. The study utilized medical and dietary records from September 2017 to March 2025. The primary outcome was the assessment of adherence to medical nutrition therapy (MNT), comparing prescribed protein intake with actual intake, estimated from dietary history (DH). Protein intake was compared with normalized protein nitrogen appearance (nPNA) as stated by recent guidelines. Additional factors influencing adherence, such as age, gender, comorbidities, physical activity, and prior dietary interventions, were also evaluated. Anthropometric measurements and biochemical tests were collected, and dietary intake was assessed using a seven-day DH. Results: Data were analyzed using descriptive statistics, linear correlation models, univariate logistic regression, t-tests, paired t-tests, and chi-square tests, with significance set at p < 0.05. Most of the patients follow suggested energy and protein intakes limits; however, substantial individual variability emerged Bland–Altman analysis indicated a moderate bias and wide limits of agreement for energy intake (+116 kcal; limits of agreement –518.8 to +751.3 kcal), revealing frequent overestimation in self-reports. Protein intake showed less systematic error, but discrepancies between dietary recall and biochemical markers persisted. Protein intake decreased significantly over time (p < 0.001), while correlation with nPNA did not reach statistical significance (ρ = 0.224, p = 0.051). No significant associations were identified between adherence and most clinical or lifestyle factors, although diabetes was significantly associated with lower adherence to protein intake (p = 0.042) and a predominantly sedentary lifestyle showed a borderline association with energy intake adherence (p = 0.076), warranting further investigation. Longitudinal analysis found stable BMI and body weight, alongside notable reductions in sodium (p = 0.018), potassium (p = 0.045), and phosphorus intake (p < 0.001) over time. Conclusions: Assessing dietary adherence in CKD remains complex due to inconsistencies between self-reported and biochemical estimates. These findings highlight the need for more objective dietary assessment tools and ongoing, tailored nutritional support. Multifaceted interventions—combining education, personalized planning, regular monitoring, and promotion of physical activity—are recommended to enhance adherence and improve clinical outcomes in this vulnerable population. Full article