Search Results (346)

Background: Young men experience substantial mental health and mortality-related risks, yet they often do not engage in conventional health promotion programs. This highlights the need for gender-specifc interventions that are acceptable, engaging, and feasible for young men. Purpose of Research: Guided by self-determination theory, this single-group proof-of-concept study evaluated the feasibility and acceptability of a dual-component intervention combining an in-person nature-based intervention (NBI; two days of group activities and guided reflection in a forested park) and a subsequent virtually supported resistance training (RT) program for young men and explored secondary, exploratory pre- to post-changes in depressive and anxiety symptoms. Methods: Eight men aged 18–34 not meeting RT recommendations (i.e., <2 sessions/week) completed a two-day, in-person NBI followed by six weeks of virtually supported RT with weekly group check-ins. Primary feasibility outcomes were satisfaction and qualitative acceptability for NBI/RT, recruitment, retention, and adherence. Secondary, exploratory quantitative outcomes were pre- to post-changes in depressive and anxiety symptom scores. Brief semi-structured exit interviews were conducted at the study end and audio-recorded for analysis. Results: Satisfaction met a priori thresholds for both components (NBI = 3.4/4; RT = 4.3/5; criteria ≥ 3.0 and ≥ 3.5). Recruitment was 46% and retention 100%, exceeding the 42% and 80% criteria, respectively. Exit interview themes highlighted guided learning, accountability, and feeling more connected to nature as acceptability drivers, with the scheduling burden noted but manageable. Depressive and anxiety symptom scores were lower post-intervention. Conclusions: Challenges in recruitment, group dynamics, and participant selection require refinement before the next phase; however, high satisfaction with both the NBI and RT segments, together with improvements in anxiety and depression symptom scores, supports progressing to a feasibility trial once these enhancements are in place. Full article

Traffic accidents represent a significant threat to individuals, with motorcycles frequently involved. Despite concerted efforts by organizations like the World Health Organization and governments worldwide, reducing accident rates remains a challenge. Notably, Indonesia has witnessed a surge in traffic accidents, with motorcycles being a prominent mode of transport. This study aims to evaluate situational awareness and motorcycle riders’ behavior among Indonesians, with respect to factors such as riding time and age. This study involves laboratory-based research and uses quantitative primary data collected with the Situation Awareness Global Assessment Technique (SAGAT), the Situation Present Assessment Method (SPAM), and the Motorcycle Rider Behavior Questionnaire (MRBQ). The results indicate that overall situation awareness is low, with the lowest level among young riders. Nighttime situational awareness is also lower than during the daytime. Recommendations to improve situation awareness include periodic training with scenario-based sessions for motorcycle riders, strict adherence to driving regulations, the potential integration of motorcycle simulators, and prioritizing the program to enhance young riders’ situation awareness. These recommendations aim to boost rider safety and reduce motorcycle accidents. Full article

Background: Mindful eating strategies have shown promise in addressing obesity and food insecurity among children. However, limited research has examined the acceptability of mindful eating programs among low-socioeconomic families in rural areas. This study evaluated caregivers’ and teachers’ acceptability and satisfaction with a 14-week, school-based mindful eating program for preschoolers to inform future implementation. The program effectively improved home eating environment, household food insecurity, and child body mass index. Methods: A convergent parallel mixed methods study design was used to evaluate the 14-week mindful eating intervention among 200 preschoolers from 26 Head Start classrooms in rural Michigan, United States. After intervention completion, acceptability and satisfaction data were collected and assessed from 192 caregivers and 23 classroom teachers via (1) quantitative online survey data analyzed using descriptive statistics, and (2) qualitative data from individual interviews completed with a subset of parents and teachers that were analyzed with thematic analysis. Results: Both quantitative and qualitative data showed high acceptability and satisfaction. Caregivers (survey: 88.9%, interview: 94.1%) and teachers (survey: 87.0%, interview: 100%) were satisfied with the program. Teachers (survey: 82.6%, interview: 87.5%) agreed the program improved children’s eating behaviors. Most surveyed caregivers (81.1%) agreed the completion of child letters sent home after the program session helped caregiver–child communication. Several barriers and suggestions for implementation were also identified by interviewed teachers and caregivers, including the limited availability of specific fruits and vegetables in local areas, concerns about preschoolers’ comprehension of curriculum, and recommendations on improving recruitment strategies. Conclusions: This study highlighted the high acceptability and satisfaction of a mindful eating program among caregivers and classroom teachers. The findings offered implications for future interventions to integrate mindful eating programs into early childcare organizations to help address child obesity and food insecurity. Future research exploring nutrition-related policies to sustain implementation of mindful eating programs is needed. Clinical Trial Registration: The clinical trial was registered at ClinicalTrials.gov (NCT05780008) on 27 February 2023. Full article

Background: Chronic Obstructive Pulmonary Disease (COPD) is a common condition that can cause dyspnea, pain, and biomechanical-postural alterations, especially when overlapping with Myofascial Pain Syndrome (MPS). Balneological rehabilitation medicine can help manage COPD and MPS, but it lacks homogeneity and detailed descriptions of effective therapeutic protocols. Therefore, we conducted a case series to preliminarily evaluate the clinical effects of a detailed and codified approach, called Bio-Physico-Metric Integrated Thermal Care (BPM-ITC), for COPD+MPS. Methods: 10 patients were observed while undergoing 20 sessions of BPM-ITC in 4 weeks. Patients were assessed before and after the protocol using the Medical Research Council (MRC) dyspnea scale, Numeric Pain Rating Scale (NPRS), and the Bio-Postural Questionnaire (BPQ) for bio-physical health status. Treatments included manual therapy of key myofascial trigger points combined with crenotherapy, steam inhalations, mud therapy, vascular path, and water-based motor re-education. Results: At the end of the protocol, clinically relevant improvements were observed in almost all parameters considered in single observed cases; overall statistical analysis of the data highlighted significant positive effects in concomitance with the BPM-ITC protocol. Conclusions: The BPM-ITC protocol was followed by significant clinical improvements in the observed cases, suggesting its potential as a complementary approach for COPD+MPS. Further studies on this topic are recommended. Full article

Introduction: Over 100 studies demonstrate the efficacy of Emotional Freedom Techniques (EFT), an evidence-based therapeutic method. However, most research is on in-person delivery of EFT. Only a few studies examine EFT delivered virtually, and to date no research has provided a direct comparison of group virtual EFT to group in-person delivery. Objectives: Delivery of EFT shifted to online platforms in the wake of the 2020 COVID-19 pandemic. This makes a comparison of virtual delivery to in-person delivery timely. The research question of whether online group delivery is as effective as in-person group delivery is of high clinical relevance, given the increased access and convenience offered by virtual treatment options. Methods: Participants in the online group were a convenience sample of 172 participants drawn from four four-day virtual EFT training sessions. Changes in psychological and physiological symptoms were measured pre, post, and at six-month follow-up using the Patient Health Questionnaire (PHQ-4). The two-item Post Traumatic Stress Disorder (PTSD) Checklist (PCL), the Happiness Scale, and the QuickDASH pain scale. These results were then compared to those of a previously published study of in-person group EFT (n = 203) that used an identical training curriculum delivered face-to-face. Due to COVID restrictions, the physiological measures used in the face-to-face delivery could not be replicated in the virtual group. Results: Online group EFT demonstrated significant improvements in PTSD, anxiety, depression, pain, and happiness (all p < 0.001) pre to post EFT. These improvements were maintained at six-month follow-up for PTSD (p < 0.001), depression (p = 0.048), pain (p = 0.002), and happiness (p < 0.001). Although there was a reduction in anxiety in the online group at six-month follow-up, this did not reach significance (p = 0.102). When compared to the in-person group (pre-COVID), the percent change in symptoms, while still clinically and statistically significant, was for most conditions smaller in the virtual group (post COVID) at both post and follow-up time points. Conclusions: EFT is associated with significant improvements in psychological and physiological conditions including PTSD, anxiety, depression, pain, and happiness, whether delivered virtually in groups or in-person in groups. The psychological and physiological benefits identified in online treatment are similar to those found during in-person delivery, though not as large or clinically significant. This finding is consistent with the literature demonstrating that online treatment is an effective method of delivering psychological therapies. The results reinforce other studies showing COVID produced a significant increase in mental health symptoms. Published treatment guidelines already recommend in-person EFT as an efficient and potentially cost-effective first-line intervention in primary care; virtual group EFT can be similarly recommended. Full article

Background and Objectives: The aim of this retrospective cohort study was to determine the frequency of early-stage nipple necrosis and wound complications in patients undergoing unilateral skin-sparing mastectomy (SSM) and direct implant-based reconstruction and describe the conservative/advanced wound care approaches used for these complications. Materials and Methods: A retrospective review was made of the medical records of 84 patients who underwent same-session unilateral SSM and implant-based reconstruction in the Surgical Oncology Clinic between November 2019 and February 2024. Statistical analyses were performed using the Shapiro–Wilk test, Mann–Whitney U-test, and Chi-square/Fisher tests. Results: The mean age of the patients was 43.51 ± 6.5 years, 35.7% of the patients received neoadjuvant chemotherapy, and smoking prevalence was 7.1%. Wound complications developed in 16.7% of the patients, distributed as follows: wound dehiscence 6%, NAC necrosis 8.4%, infection 1.2%, and hematoma 1.2%. Interventions due to complications were performed at rates of 2.4% for areola excision, 2.4% for debridement, and 2.4% for implant excision. The only variable significantly associated with complication development was excision volume, which was higher in the complication group (p = 0.033). Logistic regression analysis showed that a one-unit increase in excision volume was associated with a statistically significant increase in the likelihood of complication development (O.R = 1.002; 95% CI: 1.000–1.004; p = 0.019). No significant association was found between age, height/weight, neoadjuvant therapy, smoking, breast side, pathology subtype, axillary approach, and the development of complications (p > 0.05). Advanced wound management was provided in 10 of the 14 cases (71.4%) that developed complications. Conclusions: Excision volume was found to be the only variable associated with wound complication development after implant-based reconstruction following unilateral SSM. Most complications were managed successfully with advanced wound care, minimizing the need for re-operation. For patients undergoing high-volume excision, risk-based early multidisciplinary, close follow-up is recommended. Full article

As the number of electric vehicles (EV) increases, the demand for recommending the best charging location when using a large-scale charge network to charge is also increasing. A successful recommendation will utilize the user’s preference and the operational constraints of the charging network to make sure that it also takes into account the real-time operational requirements of the network. Most current papers focus on optimizing individual algorithmic components in isolation; consequently, many of these papers neglect to provide a holistic view of an integrated system. In addition, there are many operational requirements that current research does not consider, such as cold-start personalization for new users and enforcing real-time operational constraints like station availability, power capacity, maintenance windows, etc. This paper describes a deployable multi-stage recommendation system that creates a candidate list based on location and ranks preferences based on user, station and context features. The recommendation system also adds a configurable rule-based re-ranking layer to ensure that both hard constraints (i.e., charger availability and power-cap limits) and soft objectives (i.e., load balancing and operator priority) are enforced. A method for enabling mixed use between stable Bayesian and adaptive Bayesian methods was developed to provide users starting with cold-start performance that do not have adequate histories. Evaluation of this method using 100k+ real charging sessions showed that the fraction of sessions where the ground-truth station appears in the top-two recommendations (Hit@2) for the recommendation system was 0.82, representing a 37% increase in performance compared to proximity-based recommendation methods. The online deployed recommendation system has a 99th-percentile serving latency (P99) of less than 200 ms. The findings of this paper provide a framework for the implementation of operationally-relevant user-centric recommendation systems for EV services at scale. Full article

Background: A sedentary behavior and being overweight represent major public health issues associated with both physical and psychological risks. Based on self-determination theory (SDT), the psychoeducational intervention PsicoFIT—a component of the TIGREFIT program—aims to foster motivation toward physical activity, to promote healthy habits, and to reduce psychological ill-being in sedentary adults who are overweight and are fans of a football club. Methods: This protocol corresponds to a longitudinal comparative pragmatic clinical trial, designed in accordance with the recommendations of the SPIRIT Statement. The intervention, preceded by a training program for the coaches involved, will comprise 12 weekly modules delivered in two modalities: (1) face-to-face, through group sessions, and (2) semi face-to-face, through short video capsules hosted on a digital platform. Changes associated with the intervention will be evaluated using hierarchical multiple regression and pre-post comparisons, assessing baseline and post-intervention data within and between the intervention modalities. Primary outcomes will include changes in healthy lifestyle and burnout as indicators of well-being and ill-being, respectively. Secondary outcomes will assess basic psychological needs satisfaction and autonomous motivation as potential mediators of these effects, as well as the coach’s controlling interpersonal style as a possible contextual predictor. The modality of participation will be analyzed as a potential moderator of the observed changes. Finally, the acceptability and perceived contribution of the intervention will be explored through a focus group. Discussion: PsicoFIT will provide a methodological framework for designing interventions within multicomponent programs aimed at promoting healthy lifestyles and psychological well-being in sedentary adults who are overweight, considering the social context of football fandom and allowing for an exploration of the impact of the face-to-face and semi-face-to-face modalities. Future empirical application of the protocol will help verify its effectiveness, guide adaptations across contexts, and contribute to the development of evidence-based interventions. Conclusions: The implementation of PsicoFit will allow for the evaluation of its effectiveness, psychological mechanisms, and delivery modalities, thus guiding future evidence-based interventions in sport. Full article

Background/Objectives: Family caregivers play a central role in long-term care but are frequently exposed to considerable physical, emotional, and social strain. In Germany, care counseling pursuant to §45 SGB XI aims to identify caregiver burden at an early stage and provide preventive, resource-oriented support. Structured self-assessment tools may facilitate reflective dialogue within time-limited counseling sessions. The Self-Assessment Tool for Family Caregivers (SSA-PA) was developed to support this process; however, empirical evidence regarding its applicability in statutory counseling settings remains limited. This exploratory mixed-methods study aimed to generate empirical insights into (1) the perceived usefulness and acceptance of the SSA-PA among care advisors, (2) opportunities and challenges associated with its practical implementation, and (3) its perceived integration potential within routine counseling practice. Methods: Thirteen care advisors working under §45 SGB XI applied the SSA-PA in routine counseling and subsequently completed a structured online survey combining Likert-scale items and open-ended questions. Quantitative data were analyzed descriptively using IBM SPSS Statistics (Version 29), and qualitative responses were examined using thematic analysis. Given the moderate sample size (n = 13), analyses were primarily descriptive and exploratory in nature. Results: Care advisors reported high perceived usefulness and broad acceptance of the SSA-PA as a structuring and reflective instrument in counseling sessions. The tool was described as supportive in facilitating discussion of caregiver burden across multiple life domains and enhancing transparency of stress-related issues. At the same time, participants identified practical challenges, including time constraints, emotional strain for caregivers, technical barriers, and the need for clearer evaluation outputs. Suggestions for further development included automated result processing, individualized recommendations, and longitudinal tracking functions. Conclusions: From the perspective of participating care advisors, the SSA-PA demonstrates promising feasibility and acceptance within statutory preventive counseling under §45 SGB XI. While the findings provide practice-based evidence for its applicability, conclusions regarding effectiveness or outcome improvements cannot be drawn. Further research with larger samples and outcome-oriented designs is required to evaluate its impact on caregiver burden and counseling processes. Full article

Background/Objectives: Intranasal esketamine has emerged as an effective treatment for patients with treatment-resistant depression (TRD), providing rapid symptom relief when conventional antidepressant strategies fail. While its pharmacological efficacy has been demonstrated in randomized controlled trials, less attention has been paid to the organizational, relational, and multidisciplinary aspects that influence its real-world implementation and clinical effectiveness. While practical recommendations for intranasal esketamine services exist, an implementation-ready framework integrating psychiatry, nursing, and psychotherapy across treatment phases is still lacking. This narrative review synthesizes the clinical and real-world evidence and proposes a phase-based integration framework with explicit role delineation and measurable implementation/fidelity indicators. Methods: We conducted a narrative review informed by a structured literature search in major databases from inception to the most recent update. Search terms combined ‘esketamine’/‘Spravato’ with ‘treatment-resistant depression’, ‘nursing’, ‘psychotherapy’, ‘multidisciplinary’, and ‘implementation’. Outcomes prioritized in the synthesis included depressive symptom severity/response, relapse prevention, safety/tolerability, anhedonia, suicidality monitoring, functional outcomes, and patient-reported experience/retention. Based on this evidence, an integrated, phase-based multidisciplinary framework for esketamine treatment was developed. Results: Available evidence supports the efficacy of intranasal esketamine in reducing depressive symptoms in TRD, with growing real-world data confirming its effectiveness and safety. Beyond global symptom improvement, studies highlight benefits on clinically relevant domains such as anhedonia and suicidality trajectories, as well as meaningful patient-reported outcomes. However, the complexity of esketamine delivery requires structured clinical pathways. The proposed model delineates complementary roles for medical supervision, nursing care, and psychotherapy across pre-treatment assessment, induction and session delivery, post-session integration, and maintenance phases, emphasizing safety, continuity of care, and patient-centred monitoring. Conclusions: Intranasal esketamine represents not only a pharmacological innovation but also a treatment that necessitates an integrated multidisciplinary approach. A structured phase-based multidisciplinary approach may support safer, more acceptable delivery of intranasal esketamine and potentially improve retention and patient experience; however, prospective implementation and comparative studies are needed to evaluate clinical effectiveness, feasibility, and cost-effectiveness. Full article

Recently, recommendation systems have actively integrated Transformers to capture real-time context. However, these systems often suffer from generalization imbalance, where predictions are biased toward popular (head) items due to the sparsity and volatility inherent in session-based data. To address this challenge, this paper proposes MoE-SLMRec, a Mixture-of-Experts (MoE)-based recommendation model that selects expert networks based on session-level contextual information. The proposed model extracts a session latent representation, $h$, through a session-aware controller and forms balanced predictive characteristics across the entire data distribution via dynamic routing. Experimental results demonstrate that MoE-SLMRec significantly outperforms the baseline SLMRec, improving accuracy by 1.51 percentage points (from 18.76% to 20.27%). Furthermore, the model achieved state-of-the-art performance in Recall@20 (0.8358) and MRR@20 (0.3455), validating simultaneous improvements in both retrieval capability and ranking quality. Notably, the model effectively stabilized the performance for head items while coordinating the generalization trade-off between head and tail segments. By ensuring a favorable capacity–cost trade-off while maintaining robust performance, this study presents a promising alternative under session-based recommendation settings, facilitating scalable deployment in real-time recommendation services. Full article

Background/Objectives: College student athletes can experience sleep and circadian rhythm disturbances. Methods: A PRISMA-based systematic review about young adult athletes’ sleep and circadian rhythms was conducted, with 41 published studies analyzed. Results: Studies suggest that extending sleep duration could enhance athletic performance and support mental health. Risk factors for sleep and circadian rhythm disturbances include early morning practice sessions, late night games, jet lag, and female sex. Consequences of inadequate sleep include reduced reaction times and mental health problems, such as depressive symptoms and anxiety. Across the studies, numerous research design limitations reduced scientific rigor and hindered the ability to test hypotheses about sleep, circadian rhythms, athletic performance, and mental health outcomes. For example, most studies were underpowered due to small sample sizes and missing data. Many studies lacked randomization, control groups, and objective measures of sleep. Researchers commonly failed to control for variables that could confound results (e.g., caffeine, diet, and menstrual cycle hormones). Conclusions: Recommendations for future directions include conducting randomized clinical trials to test interventions related to sleep patterns, nutrition, light exposure, training schedules, and cognitive behavioral therapies to enhance sleep quality. Evidence-based education programs about healthy sleep are essential for coaches and athletes. Full article

Background/Objectives: University students exhibit high levels of sedentary behavior and low adherence to physical activity recommendations, and immersive virtual reality (IVR) represents an innovative strategy to increase physical activity participation. The aim of this study was to evaluate the effect of a physical activity intervention using IVR on anthropometric variables, physical fitness, and blood pressure in university students. Methods: A randomized controlled trial was conducted with 60 participants (30 control, 30 intervention) over 12 weeks. The intervention group performed three weekly exercise sessions using IVR, while the control group maintained their usual activity. BMI, waist and hip circumferences, handgrip strength, cardiorespiratory fitness, and blood pressure were assessed. Baseline characteristics between groups were compared using Student’s t-test. The effect of the intervention was analyzed using analysis of covariance adjusted for baseline values. Sensitivity analyses were performed to assess between-group changes, and subgroup analyses were conducted to determine the impact of sex. Results: The intervention produced significant improvements in cardiorespiratory fitness (VO₂ and the 20 m shuttle run test); no significant changes were observed in anthropometric variables, strength, or blood pressure. Conclusions: A 12-week intervention with immersive virtual reality-based physical training improves cardiorespiratory fitness in university students, representing a promising tool for health promotion in this population. Full article

Surfing, performed semi-submerged in varied environmental conditions and apparel, evokes unique fluid losses compared to land-based sports, despite the inherent difficulties in collecting urine losses in surfing, making direct sweat loss comparisons challenging. This scoping review aimed to identify factors that influence fluid balance in surfing. Nine databases were systematically searched for relevant studies specific to the concept of fluid balance in surfing participants. A total of 153 studies were screened, and seven met the inclusion criteria. Five studies were cross-sectional designs, and two were randomised controlled trials, aligning to levels of evidence IV and II, respectively. Reported body mass loss was 1.3%, and fluid loss was 0.57 L/h. The surfers wearing wetsuits incurred a greater decrease in body mass following a surf session (1.05% vs. 0.59%, respectively). Elite surfers wearing wetsuits were reported to have high fluid losses (1.68 L/h), resulting in a body mass loss of 3.9%. Reported fluid losses of surfers are lower than those of land-based athletes; however, the elite surfers were reported to have high fluid losses that would likely impede exercise performance. Available information on fluid losses in surfers is of poor quality; thus, further research is needed to elucidate fluid intake recommendations for surfers in varying environmental conditions and wearing different surf apparel. Full article

Fibromyalgia is a chronic condition characterized by widespread pain, fatigue, and reduced quality of life. Exercise therapy, including Pilates, is commonly recommended; however, current reviews report inconsistent findings across specific modalities. This PRISMA 2020 systematic review and meta-analysis with a PROSPERO-registered protocol, designed as a focused update of post-2020 RCTs complementing prior comprehensive syntheses, evaluated Pilates-based interventions for pain and fibromyalgia impact (FIQ). HRQoL outcomes were synthesized narratively due to heterogeneity in measurement instruments, and all outcomes were extracted at the first post-intervention assessment (no pooled long-term data were available). Seven RCTs (6–12 weeks; 2–3 sessions/week) met eligibility criteria. Methodological quality was generally moderate (PEDro), and risk of bias was assessed using RoB 2. Certainty of evidence (GRADE) was rated very low for pain and low for FIQ. Among trials reporting adherence (4/7), values ranged from 68% to 92%; adverse event monitoring was inconsistent (systematically reported in 2/7), limiting tolerability conclusions. Between-group effects versus active comparators were small and non-significant for pain (pooled Hedges’ g = −0.10, 95% CI [−0.83, 0.63], p = 0.79; I² = 73%); this wide interval, spanning potential benefit to harm, precludes definitive conclusions. For FIQ, the primary (unadjusted) analysis was non-significant: pooled MD = −5.53 (95% CI [−11.96, 0.89], p = 0.09); sensitivity analysis using ANCOVA-adjusted estimates yielded MD = −6.71 (95% CI [−13.11, −0.30], p = 0.04). Both estimates remained below MCID thresholds and were sensitive to estimator choice. Absence of statistical significance does not demonstrate equivalence; non-inferiority designs with predefined margins would be required. Given very low (pain) to low (FIQ) certainty of evidence, adequately powered trials with standardized protocols and longer follow-up are needed to resolve uncertainty regarding Pilates’ comparative effectiveness within multimodal fibromyalgia management. Full article