Symptom severity at first digital self-assessment is not associated with greater subsequent booking of professional care on a Saudi mental health platform: a cohort study of 5,524 users

Transitioning out of professional sport can present challenges for athletes and their wider environments, frequently necessitating coordinated physical, psychological, and economic support. Although these concerns have been documented in elite cycling, the extent to which structured transition programmes exist within the sport remains insufficiently understood, particularly in Europe, the historical centre of professional cycling. We conducted a cross-sectional qualitative documentary analysis, distributing a standardised inquiry to all European Cycling Federations (ECFs; N = 51) between December 2024-March 2025. Federations were asked whether they had formal strategies, policies, or resources related to athlete retirement. Responses were categorised as “ECF-level literature or initiative”, “No ECF-level provision”, or “No response” and relevant materials were descriptively synthesised. Amongst the 21 federations that responded, the majority (n = 17; ≈81%) reported no ECF-level retirement initiatives. Common reasons included limited resources, low perceived demand, or reliance on national or international bodies (i.e., Olympic Committees or sport-specific unions). Four ECFs (~19%) described transition-related structures, though these varied considerably in scope, definition, and delivery. Despite well-documented needs, structured retirement support for professional cyclists remains uncommon across European national federations, and existing programmes appear heterogeneously applied. As cycling expands globally, effective transition planning becomes increasingly important for athlete wellbeing and the long-term sustainability of the sport. Holistic, international collaborations led by cycling’s major governance bodies could strengthen career-long support systems, reinforce the public image of cycling as a health-promoting discipline, and create responsible, athlete-centered ecosystems.

Background: Patients with chronic kidney disease undergoing hemodialysis frequently experience physical and psychological complaints that may affect their sleep quality. Uremic pruritus, restless legs syndrome, anxiety, and post-hemodialysis fatigue are potential factors that may disrupt sleep quality. Objective: This study aimed to identify the factors influencing the sleep quality of patients with chronic kidney disease undergoing hemodialysis at Bahteramas Regional General Hospital, Southeast Sulawesi Province. Methods: This study employed a quantitative analytical approach with a cross-sectional design. The sample consisted of 83 respondents. Data were collected using the Pittsburgh Sleep Quality Index (PSQI), 5-D Itch Scale, International Restless Legs Syndrome Rating Scale (IRLS), Hospital Anxiety and Depression Scale-Anxiety (HADS-A), and a post-hemodialysis fatigue assessment instrument. Data were analyzed using the Chi-square test and binary logistic regression. Results: Bivariate analysis showed that uremic pruritus (p = 0.046), restless legs syndrome (p = 0.015), anxiety (p = 0.029), and post-hemodialysis fatigue (p = 0.049) were statistically significant factors associated with sleep quality. Simultaneously, the four variables had a statistically significant effect on sleep quality (p = 0.007), with a Nagelkerke R Square value of 0.217. In the multivariable analysis, only anxiety showed a statistically significant independent effect (p = 0.019). Conclusion: Uremic pruritus, restless legs syndrome, anxiety, and post-hemodialysis fatigue were statistically associated with sleep quality in the bivariate analysis. The four variables were jointly significant in the multivariable model, whereas only anxiety remained statistically significant after adjustment for the other variables.

Abstract Child and adolescent externalizing problems have often been conceptualized broadly with imprecise language (e.g., “disruptive behavior”) or inconsistently across varying taxonomies (e.g., oppositional defiant and conduct disorder symptoms, aggressive and rule-breaking behaviors). Establishing clarity around dimensions of externalizing problems is an essential step toward more accurate measurement and construct validity across the externalizing domain. To that end, the current study investigated fine-grained dimensions in the structure of youth externalizing psychopathology. Caregiver-report survey data were collected for a national community sample of 576 youth (ages 6–14; 45% female, 25% Hispanic), including measures of irritability, oppositionality, reactive and proactive aggression, conduct problems, hyperactivity/impulsivity, and inattention. We used exploratory factor analysis (EFA) to examine relations among externalizing dimensions at the item-level followed by confirmatory factor analysis (CFA) to examine relations at the construct-level. EFA results suggested that a 3-factor model best fit the data, including factors characterized by externalizing affect (e.g., “felt mad”), externalizing behavior (e.g., “bullies, threatens, or intimidates others”), and ADHD symptoms (e.g., “talks excessively”), with a few cross-loadings. Similarly, confirmatory models indicated that a 3-factor, non-hierarchical structure fit the data best when compared to three other models. Results provide support for distinct facets of the externalizing spectrum in child psychopathology, suggesting a preliminary direction for a unifying framework. These findings highlight the potential for future measurement research to further disentangle the distinct and overlapping facets of externalizing constructs, particularly using multiple methods and informants and with replication across samples.

Background: Prolonged screen exposure, after-hours connectivity, and sedentary work are linked to poor sleep and occupational burnout among Indian working professionals. Ayurvedic Dinacharya regulates waking, Vyayama, Bhojana Vidhi, and Nidra Vidhi; however, digital-era disruption of these domains among working adults remains unstudied. This study aimed to assess digital lifestyle behaviours mapped to Dinacharya principles as behavioural markers of Pragyaparadha, in relation to sleep quality and occupational burnout among working adults, and to identify behaviours independently associated with poor sleep and higher burnout. Methods: A cross-sectional analytical survey (STROBE-reported) was conducted at the All-India Institute of Ayurveda (AIIA), New Delhi, during (January 2026 to July 2026), among 400 working adults aged 25-40 years with ≥1 year of occupational experience. A structured proforma captured sociodemographic details and Dinacharya-mapped digital behaviours across five domains (morning routine, bedtime device use, after-hours connectivity, screen breaks/sedentary time, mealtime practices). Sleep quality and burnout were assessed using the PSQI and Copenhagen burnout inventory. Results: Of 400 participants, 56.8% had poor sleep quality, 61% personal burnout, and 55.8% work-related burnout. Bedtime device use and inadequate screen breaks/sedentary behaviour independently predicted poor sleep (aOR 1.76 and 1.98). After-hours connectivity, sedentary behaviour, and mealtime digital engagement predicted personal burnout; bedtime device use, sedentary behaviour, mealtime digital engagement, and digital overload predicted work-related burnout (all p<0.05). Conclusions: Digital lifestyle behaviours reflect patterns of Pragyaparadha in daily digital conduct. Interpreted through Dinacharya and Nidra, the findings support a culturally grounded, preventive Digital Dinacharya framework for digital-era occupational health.