Healthcare最新文献

{"title":"Factors Associated with Anchor-Number Preference Among Orthopedic Surgeons Performing Bankart Repair in Saudi Arabia: A Cross-Sectional Survey.","authors":"Ismail Almogbil, Lama AlOraini, Abdulhakeem AlKharraz, Shaden Alenezi, Najoud AlFuhaid, Yumna Almishary, Raghad Al-Awn, Abdullah AlShahrani","doi":"10.3390/healthcare14193304","DOIUrl":"10.3390/healthcare14193304","url":null,"abstract":"<p><p><b>Objective:</b> This study described anchor-number preferences among orthopedic surgeons performing arthroscopic Bankart repair in Saudi Arabia and explored unadjusted associations with surgeon- and practice-related characteristics. <b>Methods:</b> A cross-sectional electronic survey used purposive recruitment across five Saudi regions. Descriptive analyses included 71 respondents. Because 'Both' represented case-dependent use rather than a discrete anchor count, these three responses were reported descriptively and excluded from inferential comparisons; exact analyses compared 1-2 anchors (n = 18) with 3-4 anchors (n = 50). Fisher-Freeman-Halton exact tests, Cramér's V, and bootstrap 95% confidence intervals were reported. <b>Results:</b> Fifty surgeons (70.4%; 95% CI: 59.0-79.8%) reported usually using 3-4 anchors. In exploratory unadjusted analyses, anchor-number preference was associated with annual Bankart-repair volume (exact <i>p</i> = 0.021; Cramér's V = 0.371, 95% CI: 0.194-0.548) and hypothetical future preference when cost and other factors were not considered (exact <i>p</i> = 0.044; Cramér's V = 0.298, 95% CI: 0.068-0.529). Other assessed associations were nonsignificant. Tear size and extent was the most frequently reported consideration (95.8%). <b>Conclusions:</b> Most respondents preferred 3-4 anchors, and tear size/extent was the most frequently reported consideration. The observed associations were exploratory and unadjusted and did not establish independent determinants, cost effects on actual practice, superior stabilization, or guideline recommendations.</p>","PeriodicalId":12977,"journal":{"name":"Healthcare","volume":"14 19","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13665102/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in Visual Acuity and Dry Eye Parameters Following One Month of Scleral Lens Wear in Patients with Keratoconus: A Prospective Observational Study from Saudi Arabia.","authors":"Saleh R Alshammeri","doi":"10.3390/healthcare14193296","DOIUrl":"10.3390/healthcare14193296","url":null,"abstract":"<p><strong>Background/objectives: </strong>To evaluate the immediate visual correction provided by scleral lens insertion and short-term changes in ocular surface parameters associated with one month of scleral lens wear in patients with keratoconus in Saudi Arabia.</p><p><strong>Methods: </strong>This prospective observational study included 18 participants with keratoconus (18 study eyes). Scleral lenses were fitted bilaterally, while one eye per participant was selected for ocular analysis; when both eyes were eligible, the eye with the higher Kmax was selected. Participants were instructed to wear ONEFIT MED^® scleral lenses for at least 8 h per day for one month. Outcomes included logMAR visual acuity, Ocular Surface Disease Index (OSDI), Schirmer I test, and invasive tear break-up time (ITBUT). Paired-samples t-tests were used for paired comparisons.</p><p><strong>Results: </strong>All 18 participants completed follow-up. Mean logMAR visual acuity improved immediately after lens insertion from 0.723 ± 0.550 to 0.089 ± 0.126 at baseline and from 0.760 ± 0.544 to 0.099 ± 0.126 at one month (both <i>p</i> < 0.001). Mean OSDI decreased from 45.45 ± 20.31 to 24.84 ± 11.24 (<i>p</i> < 0.001). Schirmer I increased from 14.50 ± 7.23 to 16.89 ± 7.15 mm (<i>p</i> = 0.001), and ITBUT increased from 4.94 ± 2.04 to 5.97 ± 1.74 s (<i>p</i> = 0.010). No adverse events or complications were reported.</p><p><strong>Conclusions: </strong>Scleral lenses provided substantial immediate visual correction, while one month of regular wear was associated with reduced dry eye symptoms and modest changes in tear secretion and tear-film stability. Because this was an uncontrolled observational study, the ocular-surface findings should be interpreted as associations rather than causal effects.</p>","PeriodicalId":12977,"journal":{"name":"Healthcare","volume":"14 19","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13665194/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Digital-Use/Efficiency Phenotypes Versus Professional Role in Explaining Perceived Digital Benefit in Anaesthesia and Intensive Care.","authors":"Corina Vernic, Ovidiu Bedreag, Dorina Cristina Sulițanu, Liliana Ioana Muntean, Sorin Ursoniu","doi":"10.3390/healthcare14193306","DOIUrl":"10.3390/healthcare14193306","url":null,"abstract":"<p><p><b>Background and Objectives</b>: We compared professional role with digital-use/efficiency phenotype as explanations of perceived digital benefit in anaesthesia and intensive care. <b>Materials and Methods</b>: Cross-sectional survey data from 161 professionals were analysed. Latent class analysis used 12 indicators of technology/educational-resource use and perceived operational efficiency; four benefit items remained external outcomes. Although BIC favoured two classes, a three-class exploratory solution was retained using aBIC, entropy, bootstrap testing, class size and interpretability. Nested logistic models with seniority retained in every model, likelihood-ratio tests and Shapley partitioning of McFadden's pseudo-R² compared role and phenotype; pre-planned sensitivity analyses re-estimated the comparison under two- and four-class solutions, with classification-error (BCH) correction and with use-only indicators, and discrimination was internally validated by bootstrap. Descriptive decomposition and Rasch/DIF analyses were exploratory. <b>Results</b>: The three phenotypes (<i>n</i> = 83, 44 and 34; entropy of 0.815) crossed professional boundaries (Cramér's V = 0.439). Phenotype did not improve seniority-and-role models for broad benefit (likelihood ratio 2.4, <i>p</i> = 0.301) or high uncertainty (2.8, <i>p</i> = 0.248), whereas adding role to seniority-and-phenotype models improved fit (23.6 and 26.2; both <i>p</i> < 0.001); this pattern was unchanged across all sensitivity specifications. Role received 68.3% and 62.3% of the Shapley-partitioned pseudo-R², versus 11.9% and 11.4% for phenotype. Exploratory decompositions provided little evidence of an indirect association through adoption breadth or phenotype. Rasch analysis suggested patient safety was easiest and managerial benefit hardest to endorse; person separation reliability was 0.07, and DIF contrasts were descriptive. <b>Conclusions</b>: In this sample, professional role carried more explanatory information about perceived benefit than the exploratory phenotype, and this ranking was robust to class enumeration and classification-error correction. The phenotype findings remain exploratory, and cross-sectional associations do not establish causation.</p>","PeriodicalId":12977,"journal":{"name":"Healthcare","volume":"14 19","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13665016/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exercise-Context Sleep Quality Scale (ECSQS): Validity and Reliability Study.","authors":"Servet Ozoruc, Sultan Yavuz Eroglu, Erdem Eroglu, Mustafa Can Koc, Mahmut Ulukan, Laurentiu-Gabriel Talaghir, Gabriel Marian Manolache, Daniel Mădălin Coja, Teodora Mihaela Iconomescu, Bogdan Sorin Olaru","doi":"10.3390/healthcare14193265","DOIUrl":"10.3390/healthcare14193265","url":null,"abstract":"<p><strong>Background: </strong>The purpose of this study is to develop a valid and reliable measurement tool to assess sleep quality and sleep perceptions in the context of exercise among adults who engage in regular exercise.</p><p><strong>Methods: </strong>In line with this aim, the Exercise-Context Sleep Quality Scale (ECSQS) was developed, and exploratory and confirmatory factor analyses were conducted on two independent samples. It was determined that the scale has a structure consisting of a total of 12 items and three factors (Perception of Exercise-Related Sleep, Sleep Hygiene and Environmental Factors, general Sleep Adequacy). The results of the exploratory factor analysis showed that the total explained variance was 56.8%, which is above the thresholds recommended for construct validity in the social sciences.</p><p><strong>Results: </strong>The findings of the confirmatory factor analysis indicated that the three-factor model exhibited a good level of fit to the data according to the χ²/df ratio, RMR, RMSEA and fit indices such as GFI, AGFI, NFI, IFI, TLI and CFI. In reliability analyses, Cronbach's alpha coefficient was 0.83 for the first factor, and 0.65 and 0.64 for the second and third factors, respectively; for the total scale, Cronbach's alpha and McDonald's omega values were found to be 0.77. Discriminant validity was supported by the Fornell-Larcker criterion, while convergent validity received only partial support because AVE values were below 0.50. Composite reliability (CR) values were acceptable. Item discrimination analyses showed that all items had item-total correlations above 0.30, and that Cohen's d effect sizes in comparisons of the lower and upper 27% groups were mostly at \"large\" or \"very large\" levels; these results indicate that the scale strongly distinguishes between individuals with low and high levels of sleep quality in the context of exercise.</p><p><strong>Conclusions: </strong>The findings demonstrate that the ECSQS can validly and sufficiently reliably measure sleep quality in regular exercisers through a three-dimensional structure, and that, as one of the first Turkish sleep quality scales specific to the exercise context, it fills an important measurement gap in the sports sciences and sleep science literature.</p>","PeriodicalId":12977,"journal":{"name":"Healthcare","volume":"14 19","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13665563/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Focused Narrative Review of Selected Evidence on Gymnastics Training Optimization, Technology, Athlete Health, and Injury Prevention.","authors":"Nicoleta Zaharie, Sonia Gabriela Neagu, Delia Badescu, Vlad Teodor Grosu, Alina Georgeta Mag, Cristian Stanciu, Ioan Sabin Sopa","doi":"10.3390/healthcare14193285","DOIUrl":"10.3390/healthcare14193285","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Background:&lt;/b&gt; Sustainable gymnastics training requires a balance between performance development, injury prevention, workload management, athlete health, psychological well-being, and long-term participation. This focused narrative review aimed to synthesize selected evidence on training optimization, technological applications, athlete health and injury prevention in gymnastics. &lt;b&gt;Methods:&lt;/b&gt; A structured narrative review was conducted using the Web of Science Core Collection. The literature search covered publications issued between 1 January 2005 and 30 September 2025, with the final search performed on 30 September 2025. English-language publications retrieved through three predefined Topic searches in the Web of Science Core Collection were considered. The searches covered the period from 1 January 2005 to 30 September 2025 and were restricted to the Sport Sciences category. No additional publications were identified through reference-list screening. Three complementary thematic searches addressing gymnastics training models, technological applications, and injury prevention identified 485 records. After applying the eligibility criteria, removing duplicates, assessing full texts, and excluding ineligible or retracted publications, 140 publications were included in the narrative synthesis. No formal risk-of-bias assessment was performed. &lt;b&gt;Results:&lt;/b&gt; The reviewed evidence emphasized progressive and individualized training, workload monitoring, recovery, physical preparation, age-appropriate development, and early identification of pain, fatigue, and other health-related concerns. Injury occurrence was associated with biomechanical loading, rapid growth, training exposure, previous injuries, insufficient recovery, menstrual dysfunction, psychological factors, and discipline-specific technical demands. Wearable sensors, video analysis, biomechanical modelling, artificial intelligence, virtual reality, and digital learning platforms supported movement assessment, technical feedback, training monitoring, and education. Evidence for several emerging technological applications, particularly artificial intelligence and automated assessment, remains preliminary and requires further validation in gymnastics-specific and real-world settings. However, substantial differences in study designs, populations, technologies, outcome measures, and methodological characteristics limited direct comparison across studies. Coaching communication, athlete motivation, psychological well-being, and access to validated technologies also influenced the sustainability of gymnastics training. &lt;b&gt;Conclusions:&lt;/b&gt; Sustainable gymnastics training may benefit from an interdisciplinary and athlete-centered approach integrating individualized load management, injury prevention, health monitoring, recovery, educational coaching practices, and appropriately validated technologies. The evidence identified in this review highlights converging themes suggesting the","PeriodicalId":12977,"journal":{"name":"Healthcare","volume":"14 19","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13665496/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Persistent Socioeconomic Concentration of Cesarean Delivery in Peru Across Selected Survey-Based Obstetric Marker Strata: A Serial Cross-Sectional Analysis of ENDES Rounds, 2018-2024.","authors":"Víctor Juan Vera-Ponce, Fiorella E Zuzunaga-Montoya, Marcos Daniel García-Rodríguez, Witre Omar Padilla, José Celso Paredes Carranza","doi":"10.3390/healthcare14193263","DOIUrl":"10.3390/healthcare14193263","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Cesarean delivery is essential when clinically indicated, but socioeconomic differences in utilization may reflect differences in access, care pathways, preferences, provider practice, or facility characteristics. This study estimated survey-round-specific weighted prevalence of cesarean delivery by household wealth in Peru, quantified socioeconomic inequality, and examined whether the gradient persisted after sequential adjustment and across selected survey-based obstetric marker strata. <b>Methods:</b> We conducted a serial cross-sectional analysis of ENDES (Encuesta Nacional Demográfica y de Salud Familiar) rounds 2018-2024 using each woman's most recent live birth occurring 0-59 months before interview. The official annual REC0111, REC21, and REC41 modules were linked using audited woman- and birth-level keys. Survey-round-specific analyses used original sampling weights; pooled analyses normalized weights within each round so that all seven rounds contributed equally. We estimated Q5-Q1 gaps and ratios, conventional, Wagstaff-normalized, and Erreygers concentration indices, and survey-adjusted Poisson prevalence ratios. A sensitivity analysis was restricted to births in the preceding 12 months. <b>Results:</b> The analytic sample included 127,469 most recent live births. Equal-round weighted cesarean prevalence was 37.31% (95% CI, 36.92-37.70), ranging from 17.67% in Q1 to 61.90% in Q5; the absolute gap was 44.23 percentage points (95% CI, 42.92-45.54) and the ratio was 3.50 (95% CI, 3.38-3.64). The conventional, Wagstaff, and Erreygers indices were 0.228, 0.363, and 0.340, respectively. In the primary conditional model, the Q5-versus-Q1 prevalence ratio was 1.94 (95% CI, 1.84-2.04). The gradient remained in the 12-month sensitivity analysis (PR, 2.07; 95% CI, 1.86-2.30) and across marker strata. <b>Conclusions:</b> Cesarean delivery among recent live births represented in ENDES was consistently concentrated among wealthier women. These findings document socioeconomic inequality in utilization but do not distinguish clinically appropriate use, overuse, or unmet need.</p>","PeriodicalId":12977,"journal":{"name":"Healthcare","volume":"14 19","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13664888/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149193136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transcutaneous Electrical Nerve Stimulation (TENS) Versus Microcurrent Electrical Neuromuscular Stimulation (MENS) Combined with Kinesiotherapy in Partial-Thickness Rotator Cuff Tears: A 12-Month Randomized Controlled Trial.","authors":"Sotiria Vrouva, Konstantinos Chanopoulos, Eftychia Andreou, Magdalini Stamou, George A Koumantakis","doi":"10.3390/healthcare14193290","DOIUrl":"10.3390/healthcare14193290","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Background/Objective:&lt;/b&gt; Partial-thickness rotator cuff tears represent a distinct, highly prevalent clinical entity governed by a multifactorial continuum of intrinsic senescence and extrinsic biomechanical overload, rather than an oversimplified acute traumatic versus degenerative dichotomy. While conservative management centered on kinesiotherapy is primary, Transcutaneous Electrical Nerve Stimulation (TENS) and Microcurrent Electrical Neuromuscular Stimulation (MENS) are widely utilized as adjunctive electrophysical modalities. However, empirical trials directly comparing their long-term therapeutic longevity and structural stability remain scarce. This prospective, randomized, participant- and outcome assessor-blinded clinical trial evaluated the 12-month effectiveness of combining structured kinesiotherapy with either TENS or MENS in patients with partial-thickness rotator cuff tears. &lt;b&gt;Methods:&lt;/b&gt; Of 47 candidates screened via standardized physical provocation tests and musculoskeletal ultrasound, 5 were excluded prior to treatment allocation. Exactly 42 eligible patients (&lt;i&gt;n&lt;/i&gt; = 42; 22 males, 20 females; mean age: 46.71 ± 12.24 years) were formally enrolled and randomized (1:1) to receive 15 supervised sessions of either conventional sensory TENS (&lt;i&gt;n&lt;/i&gt; = 21; 100 Hz, 10-15 mA) or subsensory MENS (&lt;i&gt;n&lt;/i&gt; = 21; 50 Hz, 100 μA) alongside an identical kinesiotherapy program. Longitudinal evaluations were conducted at baseline, 1, 3, 6, and 12 months post-treatment, achieving a 100% participant retention rate (&lt;i&gt;n&lt;/i&gt; = 42). Clinical outcomes comprised the Shoulder Pain and Disability Index (SPADI), an 11-point Numeric Rating Scale (NRS) for pain, and the EuroQoL 5-Dimension Questionnaire (EQ-5D). Structural tear dimensions were monitored via serial ultrasonography. Longitudinal data were analyzed using two-way repeated-measures Analysis of Variance (RM-ANOVA)with Bonferroni adjustment applied for post hoc pairwise comparisons for normally distributed metrics and the Friedman and Mann-Whitney &lt;i&gt;U&lt;/i&gt; tests for non-parametric variables, assessing both within-group trajectories and between-group interaction effects across time. &lt;b&gt;Results:&lt;/b&gt; Baseline demographic, occupational, and clinical characteristics showed no significant differences between cohorts (&lt;i&gt;p&lt;/i&gt; &gt; 0.05). At the 3-month post-treatment mark, both groups exhibited equivalent, statistically significant within-group improvements across all clinical scores (&lt;i&gt;p&lt;/i&gt; &lt; 0.01). However, longitudinal trajectories diverged significantly thereafter. Between-group comparative analyses established that the MENS cohort achieved statistically and clinically superior outcomes over the TENS cohort at both 6 and 12 months. Specifically, at the 12-month primary endpoint, between-group comparisons favored MENS for SPADI Pain (mean difference: 14.39 ± 3.51, 95% CI: 7.28 to 21.50, &lt;i&gt;p&lt;/i&gt; &lt; 0.001), SPADI Disability (mean difference: 13.56 ± 2.89, 95% CI: 7.71 to 19.42, &lt;i&gt;p&lt;","PeriodicalId":12977,"journal":{"name":"Healthcare","volume":"14 19","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13665410/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149193257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Academic Stress in Doctoral Research Scholars in Relation to Biochemical Markers and Mental Health Symptoms: A Single-Center Cross-Sectional Study.","authors":"Kashif Abbas, Nazura Usmani, Safia Habib, Mudassir Alam, Sahab Kausar","doi":"10.3390/healthcare14193280","DOIUrl":"10.3390/healthcare14193280","url":null,"abstract":"<p><p><b>Background:</b> Doctoral training involves prolonged performance demands, uncertainty, supervisory dependence, and career pressure, yet objective biochemical correlates of academic stress remain incompletely characterized. This study examined academic stress in relation to glycemic, neuroendocrine, inflammatory, and thyroid-related markers, alongside psychological symptoms and sleep quality, in doctoral research scholars. <b>Methods:</b> This cross-sectional study included 203 doctoral research scholars (123 female, 80 male; mean age 27.2 years). Academic stress was assessed using a 34-item doctoral-adapted Academic Stress Scale (AST). Glycated hemoglobin (HbA1c), evening cortisol, C-reactive protein (CRP), and thyroid-stimulating hormone (TSH) were measured as biochemical outcomes. Depression, anxiety, and stress symptoms were assessed using the 21-item Depression Anxiety Stress Scales (DASS-21), and sleep quality using the Pittsburgh Sleep Quality Index (PSQI). Primary associations were examined using linear regression with heteroscedasticity-consistent type 3 (HC3) robust standard errors, adjusted for age, gender, body mass index, and lifestyle activity, with false-discovery-rate (FDR) correction. <b>Results:</b> Mean AST was 109.5 (standard deviation 21.0). Above-normal DASS-21 scores were observed for depression in 64.5%, anxiety in 86.7%, and stress in 49.3%, while 79.3% had poor sleep quality. Higher AST was associated with all four biochemical markers. Per 10-point increase in AST, HbA1c was 0.225 percentage points higher (95% confidence interval 0.158-0.291), evening cortisol 0.502 µg/dL higher (0.299-0.706), CRP 13.9% higher (8.4-19.7%), and TSH 0.125 µIU/mL higher (0.049-0.200); all FDR <i>q</i> ≤ 0.0013. Depression and anxiety severity distributions differed by gender, whereas stress did not. Exploratory analyses showed positive correlations between DASS-21 symptoms and all four biomarkers (Spearman <i>ρ</i> = 0.22-0.58; all FDR <i>q</i> < 0.01). <b>Conclusions:</b> Higher academic stress was associated with variation across glycemic, neuroendocrine, inflammatory, and thyroid-related markers in doctoral scholars, alongside substantial psychological symptom and sleep burden. The cross-sectional design precludes conclusions regarding temporal direction or causality and supports the need for longitudinal research on doctoral health and well-being.</p>","PeriodicalId":12977,"journal":{"name":"Healthcare","volume":"14 19","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13665388/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of Methods to Estimate Resting and Total Energy Expenditure in Children and Adolescents with Cerebral Palsy: A Scoping Review.","authors":"Jorge Abraham García-Íñiguez, Andrea Anaís García-Contreras","doi":"10.3390/healthcare14193295","DOIUrl":"10.3390/healthcare14193295","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Accurate assessment of resting energy expenditure (REE) and total energy expenditure (TEE) in children with cerebral palsy (CP) remains challenging. This review aimed to map and synthesize the existing evidence on methods used to estimate REE and TEE in children and adolescents with CP and identify their limitations and research gaps. <b>Methods</b>: A structured search was conducted in PubMed, Scopus, SciELO, EBSCO, and Embase for English or Spanish language articles published with no restrictions on publication date until September 2026. Studies that included children or adolescents from 0 to 19 years with a confirmed diagnosis of CP and that reported measured or estimated REE, basal metabolic rate (BMR), or TEE were included. <b>Results</b>: Nineteen studies met the inclusion criteria. Indirect calorimetry (IC) was the most frequently used method for measuring REE (n = 11, 57.9%), whereas doubly labeled water (DLW) was the reference method for TEE (n = 6, 31.6%). Standard predictive equations developed for TDC were used in three studies (15.8%) and frequently overestimated REE. In contrast, CP-specific predictive equations were less used and showed better estimations against reference methods. BIA-derived estimates, anthropometric approaches, and biomarker-based models remain insufficiently validated. <b>Conclusions</b>: IC remains the reference method for individualized assessment of REE, whereas DLW is the reference method for measuring TEE. Predictive equations for TDC are not recommended for children with CP. Further validation studies comparing BIA-derived estimates and CP-specific equations against reference methods are needed, particularly across Gross Motor Function Classification System (GMFCS) levels, nutritional status, and feeding method.</p>","PeriodicalId":12977,"journal":{"name":"Healthcare","volume":"14 19","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13665139/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"AI Dependency, Academic Self-Efficacy, and Depressive Symptoms Among Medical Students: A Structural Equation Modeling Study in Saudi Arabia.","authors":"Saeed Asiri","doi":"10.3390/healthcare14193291","DOIUrl":"10.3390/healthcare14193291","url":null,"abstract":"<p><p><b>Background</b>: The rapid integration of artificial intelligence (AI) tools into medical education has opened up new possibilities for academic support. However, it has also raised concerns about over-dependence on AI. Students' use of AI may have implications for students' academic self-concept and psychological well-being, but the interrelationships among these constructs are not yet sufficiently understood. This study aimed to examine the association between AI dependency and academic self-efficacy and depressive symptoms among medical students in Saudi Arabia. <b>Methods</b>: We conducted a cross-sectional study among 207 medical students recruited from three public universities in Riyadh, Saudi Arabia. Data were collected anonymously using an online questionnaire distributed through QR-coded recruitment announcements. AI dependency was assessed using a 9-item subset of the AI Dependence Scale, academic self-efficacy using the 5-item General Academic Self-Efficacy Scale, and depressive symptoms using the two depression items of the PHQ-4. AI dependency and academic self-efficacy were modeled as latent constructs in a structural equation model. The model examined the direct association between AI dependency and depressive symptoms and the indirect associational pathway through academic self-efficacy. <b>Results</b>: The mean AI dependency score was 2.83 (SD = 0.78), while the mean academic self-efficacy score was 3.87 (SD = 1.07) and the mean depressive symptom score was 2.05 (SD = 1.42). AI dependency was positively associated with academic self-efficacy (β = 0.298, 95% CI 0.157-0.439, <i>p</i> < 0.001). Academic self-efficacy was inversely associated with depressive symptoms (β = -0.212, 95% CI -0.382-0.041, <i>p</i> = 0.016). AI dependency showed a strong positive direct association with depressive symptoms (β = 0.608, 95% CI 0.491-0.725, <i>p</i> < 0.001). The indirect association through academic self-efficacy was negative (β = -0.063, 95% CI -0.124-0.002, <i>p</i> = 0.052), while the total association remained positive and significant (β = 0.545, 95% CI 0.409-0.671, <i>p</i> < 0.001). The model explained 49% of the variance in academic self-efficacy and 37% of the variance in depressive symptoms. <b>Conclusions</b>: Greater AI dependency was associated with higher academic self-efficacy but also with substantially higher depressive symptom levels among medical students. Academic self-efficacy was inversely associated with depressive symptoms, although evidence for an indirect pathway between AI dependency and depressive symptoms was limited. Our findings highlight the importance of distinguishing productive AI use from excessive dependence. This supports the need for responsible AI integration alongside attention to medical students' psychological well-being.</p>","PeriodicalId":12977,"journal":{"name":"Healthcare","volume":"14 19","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13665285/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}