Frontiers in Public Health

Introduction The occupational well-being of rural preschool teachers is important for their professional development, mental health, and the quality of preschool education. However, persistent resource constraints in rural education may pose challenges to teachers’ occupational well-being. This study examined the association between occupational stress and occupational well-being among rural preschool teachers, focusing on the indirect role of job burnout and the moderating role of professional identity. Methods A cross-sectional questionnaire survey was conducted among 3,228 rural preschool teachers in Zhejiang Province, China, of whom 98.8% were women. Participants completed validated measures of occupational stress, job burnout, professional identity, and occupational well-being. The hypothesized associations were examined using a moderated mediation model. Results Occupational stress was significantly and negatively associated with occupational well-being. A significant indirect association between occupational stress and occupational well-being was observed through job burnout, while the direct association remained significant. Professional identity moderated the association between occupational stress and job burnout: this positive association was weaker, but remained statistically significant, at higher levels of professional identity. However, professional identity did not moderate the direct association between occupational stress and occupational well-being. Discussion The findings suggest that professional identity may serve as a modest personal resource that attenuates the association between occupational stress and job burnout. They also highlight the importance of reducing job demands and strengthening organizational resources to support the occupational well-being of rural preschool teachers.

مقدمه: بهزیستی شغلی معلمان پیش‌دبستانی روستایی برای توسعه حرفه‌ای، سلامت روان و کیفیت آموزش پیش‌دبستانی آنان اهمیت دارد. با این حال، محدودیت‌های مداوم منابع در آموزش روستایی ممکن است چالش‌هایی برای بهزیستی شغلی معلمان ایجاد کند. این پژوهش به بررسی ارتباط بین استرس شغلی و بهزیستی شغلی در میان معلمان پیش‌دبستانی روستایی پرداخت و نقش غیرمستقیم فرسودگی شغلی و نقش تعدیل‌گر هویت حرفه‌ای را مورد توجه قرار داد. روش‌ها: یک پیمایش مقطعی با پرسشنامه در میان ۳٬۲۲۸ معلم پیش‌دبستانی روستایی در استان ژجیانگ چین انجام شد که ۹۸٫۸٪ آنان زن بودند. شرکت‌کنندگان ابزارهای معتبر سنجش استرس شغلی، فرسودگی شغلی، هویت حرفه‌ای و بهزیستی شغلی را تکمیل کردند. ارتباطات فرض‌شده با استفاده از مدل میانجی‌گری تعدیل‌شده مورد بررسی قرار گرفت. نتایج: استرس شغلی با بهزیستی شغلی رابطه منفی و معناداری داشت. یک ارتباط غیرمستقیم معنادار بین استرس شغلی و بهزیستی شغلی از طریق فرسودگی شغلی مشاهده شد، در حالی که ارتباط مستقیم نیز معنادار باقی ماند. هویت حرفه‌ای ارتباط بین استرس شغلی و فرسودگی شغلی را تعدیل کرد: این ارتباط مثبت در سطوح بالاتر هویت حرفه‌ای ضعیف‌تر، اما همچنان از نظر آماری معنادار بود. با این حال، هویت حرفه‌ای ارتباط مستقیم بین استرس شغلی و بهزیستی شغلی را تعدیل نکرد. بحث: یافته‌ها نشان می‌دهد که هویت حرفه‌ای می‌تواند به عنوان یک منبع شخصی محدود، ارتباط بین استرس شغلی و فرسودگی شغلی را تضعیف کند. همچنین اهمیت کاهش تقاضاهای شغلی و تقویت منابع سازمانی برای حمایت از بهزیستی شغلی معلمان پیش‌دبستانی روستایی را برجسته می‌کند.

Background Against the backdrop of digital empowerment, generative artificial intelligence has been widely applied in school-age children’s reading education, and digital reading has become one of the primary types of environmental exposure for school-age children. However, school-age children face challenges such as insufficient age-appropriate content and uncontrollable physical and mental strain. There is an urgent demand for a public health intervention model that balances reading-related health benefits, prevents and controls digital exposure risks, avoids physical and mental health impairments, and adapts to school-age children from diverse socioeconomic backgrounds. Methods A retrospective control study design was used in this study. A total of 100 cases of school-age children aged 6–12 were collected from the standardized intervention archive of our institution from September 2025 to December 2025. According to the intervention plan actually accepted in the archive records, they were divided into the collaborative intervention group and the AI-only reading group with 50 cases in each group. In the AI-only reading group, the recorded intervention is purely generative AI independent reading intervention (college students are only responsible for equipment operation and maintenance, and do not participate in reading guidance and emotional intervention), while in the collaborative intervention group, the recorded intervention is the structured auxiliary collaborative intervention of the whole process of generative AI voice multi-round interactive reading combined with standardized training for college students. The intervention period is 12 weeks, three times a week, and each time is 20–25 min. Retrospective analysis of longitudinal data at baseline, 6 weeks of intervention, 12 weeks of follow-up and 4 weeks of follow-up, with the comprehensive score of early reading as the only preset main outcome index, repeated measurement analysis of variance, independent sample t -test and chi-square test were used to analyze the inter-group and time effects, Cohen’s d was used to evaluate the effect, and the test level was α = 0.05. Results Retrospective archive data shows that, after intervention, the collaborative intervention group achieved significantly higher composite early reading scores, phonological awareness, vocabulary comprehension accuracy, reading attention duration and reading interest scores than the AI-only reading group ( p < 0.05). The main effects of group, time and the group-time interaction were all highly statistically significant ( p < 0.01), with an effect size of Cohen’s d = 0.50 representing a moderate intervention effect. The collaborative intervention group also showed significantly higher intervention adherence rate, AI interaction completion rate, reading task completion rate and frequency of active participation than the AI-only reading group ( p < 0.05). In terms of digital health-related outcomes, the collaborative intervention group had significantly lower incidence of adverse psychological states, incidence of prodromal signs of visual fatigue and digital eye strain symptoms, and study dropout rate ( p < 0.05). Among the digital health-related safety indicators, the incidence of negative emotions, visual fatigue and research dropout rate were significantly lower than those of the AI-only reading group ( p < 0.05). The archived records showed that the whole screen duration was strictly in compliance, and there was no privacy leakage and serious adverse events. The 10% lost visit rate was controllable, and the complete rate of informed consent and the qualified rate of implementation were all 100%, and there was no privacy leakage and serious adverse events. Conclusion The generative AI interaction mode paired with college student auxiliary support is associated with sustained improvement school-age children’s core early reading ability via cumulative short-term follow-up effects. Meanwhile, this collaborative model enables effective management of digital environmental exposure risks and may reduce risks related to visual and psychological health among school-age children. The intergroup differences remained stable with reliable effect sizes. This intervention model can be may provide a reference for future implementation as a digital public health intervention targeting school-age children’s early reading, and provides preliminary empirical evidence for the standardized application of AI-supported education for school-age children. This retrospective study only reflects the differences between groups of compound intervention programs in archived cases, and cannot establish strong causal inference.

زمینه: در بستر توانمندسازی دیجیتال، هوش مصنوعی مولد به طور گسترده‌ای در آموزش خواندن کودکان سن مدرسه به کار گرفته شده است و خواندن دیجیتال به یکی از انواع اصلی مواجهه‌ی محیطی برای کودکان سن مدرسه تبدیل شده است. با این حال، کودکان سن مدرسه با چالش‌هایی مانند کمبود محتوای متناسب با سن و فشارهای جسمی و روانی غیرقابل کنترل مواجه هستند. نیاز فوری به یک الگوی مداخله‌ی سلامت عمومی وجود دارد که منافع سلامت مرتبط با خواندن را متعادل کند، خطرات مواجهه‌ی دیجیتال را پیشگیری و کنترل نماید، از آسیب‌های سلامت جسمی و روانی جلوگیری کند و با کودکان سن مدرسه از زمینه‌های اجتماعی-اقتصادی متنوع سازگار باشد. روش‌ها: در این مطالعه از طرح کنترل گذشته‌نگر استفاده شد. در مجموع ۱۰۰ مورد از کودکان سن مدرسه ۶ تا ۱۲ ساله از آرشیو مداخله‌ی استانداردشده‌ی مؤسسه‌ی ما از سپتامبر ۲۰۲۵ تا دسامبر ۲۰۲۵ جمع‌آوری شد. بر اساس برنامه‌ی مداخله‌ای که واقعاً در سوابق آرشیو پذیرفته شده بود، آن‌ها به دو گروه مداخله‌ی مشارکتی و گروه خواندن صرفاً با هوش مصنوعی تقسیم شدند که هر گروه شامل ۵۰ نفر بود. در گروه خواندن صرفاً با هوش مصنوعی، مداخله‌ی ثبت‌شده صرفاً مداخله‌ی خواندن مستقل با هوش مصنوعی مولد بود (دانشجویان دانشگاه فقط مسئول راه‌اندازی و نگهداری تجهیزات بودند و در راهنمایی خواندن و مداخله‌ی عاطفی شرکت نداشتند)، در حالی که در گروه مداخله‌ی مشارکتی، مداخله‌ی ثبت‌شده، مداخله‌ی ساختاریافته‌ی کمکی مشارکتی در کل فرایند خواندن تعاملی چندمرحله‌ای صوتی با هوش مصنوعی مولد همراه با آموزش استانداردشده برای دانشجویان دانشگاه بود. دوره‌ی مداخله ۱۲ هفته، سه بار در هفته و هر بار ۲۰ تا ۲۵ دقیقه بود. تحلیل گذشته‌نگر داده‌های طولی در خط پایه، ۶ هفته مداخله، ۱۲ هفته پیگیری و ۴ هفته پیگیری انجام شد و امتیاز جامع خواندن اولیه به عنوان تنها شاخص اصلی از پیش تعیین‌شده در نظر گرفته شد. برای تحلیل اثرات بین‌گروهی و زمانی از تحلیل واریانس اندازه‌گیری مکرر، آزمون t مستقل و آزمون کای-دو استفاده شد، اندازه‌ی اثر با Cohen’s d ارزیابی شد و سطح آزمون α = ۰٫۰۵ بود. نتایج: داده‌های آرشیوی گذشته‌نگر نشان داد که پس از مداخله، گروه مداخله‌ی مشارکتی در امتیاز ترکیبی خواندن اولیه، آگاهی واجی، دقت درک واژگان، مدت زمان توجه به خواندن و امتیاز علاقه به خواندن به طور معناداری بالاتر از گروه خواندن صرفاً با هوش مصنوعی بود (p < 0.05). اثرات اصلی گروه، زمان و تعامل گروه-زمان همگی از نظر آماری بسیار معنادار بودند (p < 0.01) و اندازه‌ی اثر Cohen’s d = 0.50 نشان‌دهنده‌ی اثر مداخله‌ای متوسط بود. گروه مداخله‌ی مشارکتی همچنین نرخ پایبندی به مداخله، نرخ تکمیل تعامل با هوش مصنوعی، نرخ تکمیل وظیفه‌ی خواندن و فراوانی مشارکت فعال به طور معناداری بالاتری نسبت به گروه خواندن صرفاً با هوش مصنوعی نشان داد (p < 0.05). از نظر پیامدهای مرتبط با سلامت دیجیتال، گروه مداخله‌ی مشارکتی شیوع معناداری کمتری از وضعیت‌های روانی نامطلوب، نشانه‌های پیش‌درآمد خستگی بینایی و علائم خستگی چشمی دیجیتال و نرخ ترک تحصیل داشت (p < 0.05). در میان شاخص‌های ایمنی مرتبط با سلامت دیجیتال، شیوع هیجانات منفی، خستگی بینایی و نرخ ترک پژوهش به طور معناداری کمتر از گروه خواندن صرفاً با هوش مصنوعی بود (p < 0.05). سوابق آرشیوی نشان داد که مدت زمان کل استفاده از صفحه نمایش کاملاً مطابق با مقررات بوده و هیچ نشتی حریم خصوصی و رویداد نامطلوب جدی وجود نداشته است. نرخ مراجعه‌ی از دست رفته ۱۰٪ قابل کنترل بود و نرخ کامل بودن رضایت آگاهانه و نرخ اجرای واجد شرایط هر دو ۱۰۰٪ بود و هیچ نشتی حریم خصوصی و رویداد نامطلوب جدی وجود نداشت. نتیجه‌گیری: شیوه‌ی تعاملی هوش مصنوعی مولد همراه با حمایت کمکی دانشجویان دانشگاه با بهبود پایدار توانایی خواندن اولیه‌ی هسته‌ای کودکان سن مدرسه از طریق اثرات تجمعی پیگیری کوتاه‌مدت مرتبط است. در عین حال، این مدل مشارکتی امکان مدیریت مؤثر خطرات مواجهه با محیط دیجیتال را فراهم می‌کند و ممکن است خطرات مرتبط با سلامت بینایی و روانی کودکان سن مدرسه را کاهش دهد. تفاوت‌های بین‌گروهی با اندازه‌های اثر قابل اعتماد پایدار باقی ماندند. این مدل مداخله می‌تواند به عنوان مرجعی برای اجرای آینده به عنوان یک مداخله‌ی سلامت عمومی دیجیتال با هدف خواندن اولیه‌ی کودکان سن مدرسه مورد استفاده قرار گیرد و شواهد تجربی مقدماتی برای کاربرد استاندارد آموزش مبتنی بر هوش مصنوعی برای کودکان سن مدرسه فراهم می‌کند. این مطالعه‌ی گذشته‌نگر فقط تفاوت‌های بین گروه‌های برنامه‌های مداخله‌ی ترکیبی در موارد آرشیوی را منعکس می‌کند و نمی‌تواند استنباط علّی قوی ایجاد کند.

Introduction The increasing integration of digital and artificial intelligence-supported systems into sport organizations has transformed managerial processes such as performance monitoring, evaluation, planning, scheduling, and decision-making. This study examined the association between algorithmic management and technostress among sport science professionals and investigated the moderating role of techno-related control. Methods A quantitative cross-sectional design was employed with 372 sport science professionals working in sport-related organizations where digital or AI-supported systems were used to perform or support managerial functions. Algorithmic management was assessed using the Algorithmic Management Questionnaire, technostress was measured using the Turkish version of the Technostress Creators Scale, and techno-related control was assessed using the Techno-related Control subscale of the Technology-Related Moderator Scale. The measurement model was evaluated through confirmatory factor analysis, and the hypothesized moderation model was tested using Hayes’ PROCESS Macro Model 1. Results Algorithmic management was positively associated with technostress (B = 0.38, p < 0.001), whereas techno-related control was negatively associated with technostress (B = −0.17, p < 0.001). In addition, the interaction between algorithmic management and techno-related control was negative and statistically significant (B = −0.12, SE = 0.038, p = 0.002, 95% CI [−0.19, −0.05]). The interaction explained an additional 2.1% of the variance in technostress (ΔR² = 0.021), indicating that the positive association between algorithmic management and technostress became weaker as techno-related control increased. Discussion These findings suggest that techno-related control may represent a meaningful, although modest, boundary condition in the relationship between algorithmic management and technostress and may help explain differences in how sport science professionals experience technology-mediated managerial demands.

مقدمه: ادغام فزاینده سامانه‌های دیجیتال و مبتنی بر هوش مصنوعی در سازمان‌های ورزشی، فرایندهای مدیریتی نظیر پایش عملکرد، ارزیابی، برنامه‌ریزی، زمان‌بندی و تصمیم‌گیری را دگرگون ساخته است. این مطالعه به بررسی ارتباط بین مدیریت الگوریتمی و تکنواسترس در میان متخصصان علوم ورزشی پرداخت و نقش تعدیل‌گری کنترل مرتبط با فناوری را مورد بررسی قرار داد. روش‌ها: یک طرح کمی مقطعی با مشارکت ۳۷۲ متخصص علوم ورزشی شاغل در سازمان‌های مرتبط با ورزش که در آن‌ها سامانه‌های دیجیتال یا مبتنی بر هوش مصنوعی برای انجام یا پشتیبانی از وظایف مدیریتی به کار گرفته می‌شود، اجرا شد. مدیریت الگوریتمی با استفاده از پرسشنامه مدیریت الگوریتمی، تکنواسترس با نسخه ترکی استانبولی مقیاس ایجادکنندگان تکنواسترس، و کنترل مرتبط با فناوری با زیرمقیاس کنترل مرتبط با فناوری از مقیاس تعدیل‌گر مرتبط با فناوری ارزیابی شد. مدل اندازه‌گیری از طریق تحلیل عاملی تأییدی ارزیابی شد و مدل فرضی تعدیل‌گری با استفاده از مدل ۱ ماکروی PROCESS Hayes آزمون گردید. یافته‌ها: مدیریت الگوریتمی با تکنواسترس رابطه مثبت داشت (B = 0.38, p < 0.001)، در حالی که کنترل مرتبط با فناوری با تکنواسترس رابطه منفی داشت (B = −0.17, p < 0.001). همچنین، تعامل بین مدیریت الگوریتمی و کنترل مرتبط با فناوری منفی و از لحاظ آماری معنادار بود (B = −0.12, SE = 0.038, p = 0.002, 95% CI [−0.19, −0.05]). این تعامل ۲.۱٪ واریانس اضافی تکنواسترس را تبیین کرد (ΔR² = 0.021)، که نشان می‌دهد با افزایش کنترل مرتبط با فناوری، ارتباط مثبت بین مدیریت الگوریتمی و تکنواسترس تضعیف می‌شود. بحث: این یافته‌ها نشان می‌دهد که کنترل مرتبط با فناوری می‌تواند به عنوان یک شرط مرزی معنادار، هرچند نسبتاً کوچک، در رابطه بین مدیریت الگوریتمی و تکنواسترس مطرح باشد و به تبیین تفاوت‌های تجربه متخصصان علوم ورزشی از الزامات مدیریتی مبتنی بر فناوری کمک کند.

Objective This study aims to identify the latent profiles of secondary traumatic stress-secondary posttraumatic growth (STS-SPTG) among clinical nurses and explore factors associated with profile membership. Methods A convenience sampling method was used to recruit clinical nurses from a provincial tertiary Grade A hospital in Anhui Province between June and August 2024. Data were collected using the general information questionnaire, the Secondary Traumatic Stress Scale, the Secondary Posttraumatic Growth Inventory, the 10-item Big Five Inventory, and the Social Support Rating Scale. Latent profile analysis was performed to identify distinct STS-SPTG profiles among clinical nurses, and multinomial logistic regression analysis was used to explore factors associated with profile membership. Results A total of 496 valid questionnaires were collected. Three latent profiles of STS-SPTG were identified among clinical nurses: the low-response profile (34.3%), the high-risk profile (42.3%), and the positive-growth profile (23.4%). Self-rated health status, job satisfaction, perceived job burnout, administrative position, personality traits, and social support were associated with latent profile membership among clinical nurses ( p < 0.05). Conclusion Clinical nurses exhibited substantial heterogeneity in STS-SPTG patterns. The identified profiles and associated factors may provide preliminary evidence for early identification and stratified supportive approaches for nurses with different psychological response patterns. However, associations involving personality traits should be interpreted cautiously and require further validation in future studies.

هدف: این مطالعه با هدف شناسایی پروفایل‌های نهفته استرس ثانویه ناشی از تروما-رشد پساتروما ثانویه (STS-SPTG) در میان پرستاران بالینی و بررسی عوامل مرتبط با عضویت در پروفایل‌ها انجام شد. روش‌ها: نمونه‌گیری در دسترس برای جذب پرستاران بالینی از یک بیمارستان درجه یک سه‌گانه استانی در استان آنهویی بین ژوئن تا اوت ۲۰۲۴ به کار گرفته شد. داده‌ها با استفاده از پرسشنامه اطلاعات عمومی، مقیاس استرس ثانویه ناشی از تروما، فهرست رشد پساتروما ثانویه، نسخه ۱۰ ماده‌ای فهرست پنج عامل بزرگ شخصیت و مقیاس ارزیابی حمایت اجتماعی جمع‌آوری گردید. تحلیل پروفایل نهفته برای شناسایی پروفایل‌های متمایز STS-SPTG در میان پرستاران بالینی انجام شد و تحلیل رگرسیون لجستیک چندوجهی برای بررسی عوامل مرتبط با عضویت در پروفایل‌ها به کار رفت. نتایج: در مجموع ۴۹۶ پرسشنامه معتبر جمع‌آوری شد. سه پروفایل نهفته STS-SPTG در میان پرستاران بالینی شناسایی گردید: پروفایل پاسخ پایین (۳۴٫۳٪)، پروفایل پرخطر (۴۲٫۳٪) و پروفایل رشد مثبت (۲۳٫۴٪). وضعیت سلامت خودارزیابی‌شده، رضایت شغلی، فرسودگی شغلی ادراک‌شده، سمت اداری، ویژگی‌های شخصیتی و حمایت اجتماعی با عضویت در پروفایل نهفته در میان پرستاران بالینی مرتبط بودند (p < 0.05). نتیجه‌گیری: پرستاران بالینی ناهمگونی قابل توجهی در الگوهای STS-SPTG نشان دادند. پروفایل‌ها و عوامل شناسایی‌شده می‌توانند شواهد مقدماتی برای شناسایی زودهنگام و رویکردهای حمایتی لایه‌بندی‌شده برای پرستاران با الگوهای مختلف پاسخ روان‌شناختی فراهم کنند. با این حال، ارتباطات مربوط به ویژگی‌های شخصیتی باید با احتیاط تفسیر شود و نیازمند اعتبارسنجی بیشتر در پژوهش‌های آینده است.

Background Agricultural workers face some of the highest suicide rates in the United States, yet limited research has examined suicide among immigrant and migrant farmworkers (IMFs), a population recognized as particularly vulnerable within occupational health surveillance priorities. This study examined circumstances contributing to suicide among IMFs and compared these to circumstances among U.S.-born farmworkers using National Violent Death Reporting System (NVDRS) data. Methods This multiple methods study used NVDRS data from 2013 to 2023, restricted to decedents in agricultural worker occupations (SOC Minor Group 45–2000) who died by suicide. Decedents were classified as IMFs (foreign-born) or U.S.-born based on birthplace. Bivariate analyses examined associations between nativity and reported circumstances preceding suicide, followed by multivariable logistic regression adjusted for age, sex, race, ethnicity, marital status, and education. A single-author qualitative analysis of investigative narratives, using an iterative inductive coding process with peer debriefing as a rigor check, identified themes describing IMF suicide circumstances. Results Of 1,162 decedents, 17% ( n = 201) were foreign-born. IMFs were older, more likely male, more likely Hispanic, and had lower educational attainment than U.S.-born decedents. IMFs were less likely to die by firearm (22% vs. 57%) and more likely to die by hanging/strangulation/suffocation (64% vs. 30%). In adjusted analysis, Hispanic ethnicity (OR = 0.014), older age (OR = 0.961), and being married (OR = 0.366) were associated with lower odds, while firearm method (OR = 2.126) was associated with higher odds, of U.S.-born status. Investigative documentation completeness did not differ significantly by nativity. Qualitative analysis identified four themes: stigma and avoidance of mental health care; violent and conflictual intimate relationships; substance use and associated familial shame; and immigration-related vulnerability and compounded isolation. Conclusion IMFs experience intersectional stressors—including immigration-related vulnerability, stigma, and isolation—that shape suicide risk in ways distinct from U.S.-born farmworkers, and that align with constructs of thwarted belongingness and perceived burdensomeness from the Interpersonal-Psychological Theory of Suicide. Predominant use of hanging/strangulation among IMFs highlights limitations of conventional lethal means restriction strategies for this population. Culturally responsive, community-based, and workplace interventions—including stigma reduction, social connection programming, and multilingual lethal means safety messaging—are needed to address suicide risk among this underrecognized and vulnerable occupational group.

زمینه: کارگران کشاورزی با یکی از بالاترین نرخ‌های خودکشی در ایالات متحده مواجه هستند، اما پژوهش‌های محدودی به بررسی خودکشی در میان کارگران مهاجر و فصلی کشاورزی (IMFs) پرداخته‌اند؛ جمعیتی که به عنوان گروهی به‌ویژه آسیب‌پذیر در اولویت‌های پایش سلامت شغلی شناخته می‌شود. این مطالعه به بررسی شرایط مؤثر بر خودکشی در میان IMFs و مقایسه آن با شرایط کارگران کشاورزی متولد ایالات متحده با استفاده از داده‌های سامانه ملی گزارش‌دهی مرگ‌های خشونت‌آمیز (NVDRS) پرداخته است. روش‌ها: این مطالعه با روش‌های ترکیبی از داده‌های NVDRS طی سال‌های ۲۰۱۳ تا ۲۰۲۳ استفاده کرد که به متوفیان با شغل کارگر کشاورزی (SOC Minor Group 45–2000) که بر اثر خودکشی فوت کرده‌اند، محدود شد. متوفیان بر اساس محل تولد به عنوان IMF (متولد خارج) یا متولد ایالات متحده طبقه‌بندی شدند. تحلیل‌های دو متغیره ارتباط بین محل تولد و شرایط گزارش‌شده پیش از خودکشی را بررسی کرد و سپس رگرسیون لجستیک چندمتغیره با تعدیل برای سن، جنس، نژاد، قومیت، وضعیت تأهل و تحصیلات انجام شد. تحلیل کیفی روایات تحقیقی توسط یک نویسنده، با استفاده از فرایند کدگذاری استقرایی تکرارشونده و بازبینی همتایان به عنوان کنترل دقت، مضامینی را که شرایط خودکشی IMFها را توصیف می‌کردند شناسایی کرد. یافته‌ها: از میان ۱٬۱۶۲ متوفی، ۱۷٪ (n = 201) متولد خارج بودند. IMFها مسن‌تر، بیشتر مرد، بیشتر با قومیت اسپانیایی و دارای سطح تحصیلات پایین‌تر نسبت به متوفیان متولد ایالات متحده بودند. IMFها کمتر با سلاح گرم (۲۲٪ در مقابل ۵۷٪) و بیشتر با حلق‌آویز/خفگی/انسداد تنفسی (۶۴٪ در مقابل ۳۰٪) فوت کرده بودند. در تحلیل تعدیل‌شده، قومیت اسپانیایی (OR = 0.014)، سن بالاتر (OR = 0.961) و متأهل بودن (OR = 0.366) با احتمال کمتر و روش سلاح گرم (OR = 2.126) با احتمال بیشتر وضعیت متولد ایالات متحده همراه بود. کامل بودن مستندسازی تحقیقی بر اساس محل تولد تفاوت معناداری نداشت. تحلیل کیفی چهار مضمون را شناسایی کرد: انگ و اجتناب از مراقبت سلامت روان؛ روابط صمیمی خشونت‌آمیز و پرتنش؛ مصرف مواد و شرم خانوادگی مرتبط؛ و آسیب‌پذیری مهاجرتی و انزوای مضاعف. نتیجه‌گیری: IMFها با فشارهای تلاقی‌یافته‌ای از جمله آسیب‌پذیری مهاجرتی، انگ و انزوا مواجه هستند که خطر خودکشی را به شیوه‌هایی متمایز از کارگران کشاورزی متولد ایالات متحده شکل می‌دهد و با مفاهیم تعلق ناکام و سربار ادراک‌شده از نظریه بین‌فردی-روانشناختی خودکشی هم‌راستا است. شیوع بالای استفاده از حلق‌آویز/خفگی در میان IMFها محدودیت‌های راهبردهای متعارف محدودسازی ابزارهای کشنده را برای این جمعیت برجسته می‌کند. مداخلات پاسخگو به فرهنگ، مبتنی بر جامعه و محیط کار ـ از جمله کاهش انگ، برنامه‌های ارتباط اجتماعی و پیام‌رسانی ایمنی ابزارهای کشنده به چند زبان ـ برای کاهش خطر خودکشی در این گروه شغلی کمتر شناخته‌شده و آسیب‌پذیر ضروری است.

Background Mental health challenges among university students have intensified globally, with rising anxiety and social isolation reported across diverse educational contexts. These trends demand innovative, accessible, and non-stigmatizing approaches that complement traditional clinical services. This study examined whether participation in Rock “n” Roll Dancesport (Jive and Cha-Cha) was prospectively associated with improvements in self-efficacy, anxiety symptoms, and heart rate variability (HRV) among Chinese university students over 6 months. Methods A three-wave longitudinal mixed-methods design was employed. Quantitative assessments were conducted at baseline (T1, n = 152), 3 months (T2, n = 136), and 6 months (T3, n = 131). Measures included the General Self-Efficacy Scale (GSES), Social Self-Efficacy Scale (SSES), GAD-7 for anxiety symptoms, and resting HRV. Linear mixed-effects models examined the effects of time, baseline dance frequency group (high: ≥3 sessions/week vs. low: 1–2 sessions/week), and their interaction on each outcome, controlling for age, gender, and academic year. Semi-structured interviews ( n = 32) and 50 + hours of observation explored participants’ lived experiences. Results Mixed-effects models revealed significant main effects of frequency group across all outcomes: high-frequency participants showed higher GSES ( β = 3.60, p < 0.001), higher SSES ( β = 8.62, p < 0.001), lower GAD-7 ( β = −2.80, p < 0.001), and higher HRV ( β = 7.64 ms, p < 0.001). Significant Time × Frequency Group interactions indicated that high-frequency participants showed greater improvements over 6 months in SSES (T2: β = 2.40, p = 0.001; T3: β = 2.37, p = 0.001), GSES (T3: β = 0.99, p = 0.007), and HRV (T3: β = 3.10, p = 0.004). Qualitative analysis identified four interconnected experiential themes: rhythmic entrainment as affective catalyst, embodied mastery as a source of self-efficacy, synchronized partnership as a context for trust, and meaning-making as narrative integration. Conclusion More frequent Rock “n” Roll Dancesport participation was prospectively associated with improvements in self-efficacy, anxiety symptoms, and HRV over 6 months. The convergence of quantitative trajectories and qualitative narratives supports a directional interpretation consistent with participation temporally preceding psychological gains, while acknowledging that self-selection and reciprocal effects remain plausible. These findings suggest that structured, arts-based physical activities may serve as promising, non-stigmatizing contexts for resource-building among university students.

زمینه: چالش‌های سلامت روان در میان دانشجویان دانشگاه‌ها در سراسر جهان شدت یافته است و افزایش اضطراب و انزوای اجتماعی در بسترهای آموزشی متنوع گزارش شده است. این روندها نیازمند رویکردهای نوآورانه، در دسترس و غیرانگ‌زننده‌ای است که خدمات بالینی سنتی را تکمیل کنند. این مطالعه بررسی کرد که آیا مشارکت در Rock “n” Roll Dancesport (Jive و Cha-Cha) به طور پیش‌بینانه با بهبود خودکارآمدی، علائم اضطراب و تغییرپذیری ضربان قلب (HRV) در دانشجویان دانشگاه‌های چین طی ۶ ماه ارتباط دارد یا خیر. روش‌ها: یک طرح طولی سه‌موجی با روش‌های ترکیبی به کار گرفته شد. ارزیابی‌های کمی در آغاز مطالعه (T1، n = 152)، سه ماه (T2، n = 136) و شش ماه (T3، n = 131) انجام شد. ابزارها شامل مقیاس خودکارآمدی عمومی (GSES)، مقیاس خودکارآمدی اجتماعی (SSES)، GAD-7 برای علائم اضطراب و HRV در حالت استراحت بود. مدل‌های خطی اثرات ترکیبی، اثرات زمان، گروه فراوانی رقص در آغاز مطالعه (زیاد: ≥۳ جلسه/هفته در مقابل کم: ۱–۲ جلسه/هفته) و تعامل آن‌ها را بر هر پیامد، با کنترل سن، جنسیت و سال تحصیلی بررسی کردند. مصاحبه‌های نیمه‌ساختاریافته (n = 32) و بیش از ۵۰ ساعت مشاهده، تجارب زیسته شرکت‌کنندگان را کاوش کرد. نتایج: مدل‌های اثرات ترکیبی، اثرات اصلی معناداری از گروه فراوانی در همه پیامدها نشان دادند: شرکت‌کنندگان با فراوانی بالا، GSES بالاتر (β = 3.60, p < 0.001)، SSES بالاتر (β = 8.62, p < 0.001)، GAD-7 پایین‌تر (β = −2.80, p < 0.001) و HRV بالاتر (β = 7.64 ms, p < 0.001) داشتند. تعاملات معنادار زمان × گروه فراوانی نشان داد که شرکت‌کنندگان با فراوانی بالا، بهبودهای بیشتری طی ۶ ماه در SSES (T2: β = 2.40, p = 0.001؛ T3: β = 2.37, p = 0.001)، GSES (T3: β = 0.99, p = 0.007) و HRV (T3: β = 3.10, p = 0.004) داشتند. تحلیل کیفی چهار مضمون تجربی به‌هم‌پیوسته را شناسایی کرد: هم‌زمانی ریتمیک به عنوان کاتالیزور عاطفی، تسلط تجسم‌یافته به عنوان منبع خودکارآمدی، مشارکت همزمان به عنوان زمینه‌ای برای اعتماد و معناپردازی به عنوان یکپارچه‌سازی روایتی. نتیجه‌گیری: مشارکت بیشتر در Rock “n” Roll Dancesport به طور پیش‌بینانه با بهبود خودکارآمدی، علائم اضطراب و HRV طی ۶ ماه ارتباط داشت. همگرایی مسیرهای کمی و روایت‌های کیفی از تفسیر جهت‌دار مطابق با تقدم زمانی مشارکت نسبت به دستاوردهای روان‌شناختی حمایت می‌کند، در حالی که امکان انتخاب خودخواسته و اثرات متقابل نیز محتمل باقی می‌ماند. این یافته‌ها نشان می‌دهد که فعالیت‌های بدنی ساختاریافته مبتنی بر هنر می‌تواند زمینه‌ای امیدبخش و غیرانگ‌زننده برای تقویت منابع در میان دانشجویان دانشگاه باشد.

Introduction Effective community health promotion requires information about residents’ health-related characteristics and the interpersonal, environmental, organizational, and policy supports they perceive. The Multidimensional Assessment Scale for Social-Ecological Healthy Communities MASE-HC was designed as a multidimensional resident-reported instrument, not as a unidimensional measure or an objective community-level rating. We report its development and initial psychometric evaluation. Methods Items were generated through literature review, a two-round Delphi survey, content-validity assessment, and cognitive interviews. A purposive sample of 412 adult community residents was recruited from one community health service center in Anhui Province, China. Subsample 1 ( n = 206) was used for item analysis and exploratory factor analysis, and Subsample 2 ( n = 206) was used for confirmatory factor analysis, convergent and discriminant validity assessment, and hypothesis-based associations with self-rated health. Internal consistency was evaluated in the total sample ( n = 412). Results Data from 412 participants were analyzed. EFA identified a six-factor solution for the final 39-item MASE-HC, accounting for 61.411% of the variance. The final CFA specified six correlated first-order factors and did not evaluate a higher-order general factor. After four post-hoc within-factor residual covariances were added, the refined model showed generally acceptable fit (χ 2 /df = 1.741, RMSEA = 0.060, SRMR = 0.0649, CFI = 0.906, TLI = 0.898, and IFI = 0.907); TLI was marginally below 0.90. The Fornell–Larcker criterion was satisfied for all six factors, whereas convergent validity and internal consistency were comparatively weaker for Diet and Nutrition. Self-rated health was positively associated with five of the six subscales. Conclusion The MASE-HC showed preliminary support for a six-factor multidimensional structure in the present sample. The Diet and Nutrition subscale requires further refinement, and independent psychometric evaluation and replication in larger, more representative samples are needed before routine use or any community-level comparison.

مقدمه: ارتقای مؤثر سلامت جامعه مستلزم اطلاعاتی درباره ویژگی‌های مرتبط با سلامت ساکنان و حمایت‌های بین‌فردی، محیطی، سازمانی و سیاستی است که آن‌ها ادراک می‌کنند. مقیاس سنجش چندبعدی جوامع سالم اجتماعی-بوم‌شناختی (MASE-HC) به عنوان ابزاری چندبعدی و خودگزارش‌دهی توسط ساکنان طراحی شده است و نه به عنوان یک سنجه تک‌بعدی یا ارزیابی عینی در سطح جامعه. در این پژوهش، توسعه و ارزیابی روان‌سنجی اولیه این ابزار گزارش می‌شود. روش‌ها: گویه‌ها از طریق مرور متون، پیمایش دلفی دو مرحله‌ای، ارزیابی روایی محتوا و مصاحبه‌های شناختی تولید شدند. نمونه هدفمند شامل ۴۱۲ نفر از ساکنان بزرگسال یک مرکز خدمات سلامت جامعه در استان آن‌هویی چین بود. زیرنمونه ۱ (n = 206) برای تحلیل گویه و تحلیل عاملی اکتشافی و زیرنمونه ۲ (n = 206) برای تحلیل عاملی تأییدی، ارزیابی روایی همگرا و افتراقی و بررسی ارتباطات مبتنی بر فرضیه با سلامت خودارزیابی‌شده استفاده شد. پایایی در کل نمونه (n = 412) ارزیابی گردید. نتایج: داده‌های ۴۱۲ شرکت‌کننده تحلیل شد. تحلیل عاملی اکتشافی، راه‌حل شش‌عاملی برای نسخه نهایی ۳۹ گویه‌ای MASE-HC را شناسایی کرد که ۶۱/۴۱۱٪ واریانس را تبیین می‌کرد. تحلیل عاملی تأییدی نهایی، شش عامل همبسته مرتبه اول را مشخص کرد و عامل کلی مرتبه بالاتر را ارزیابی نکرد. پس از افزودن چهار کوواریانس باقیمانده درون‌عاملی به صورت پس‌نگر، مدل اصلاح‌شده برازش قابل قبولی نشان داد (χ2 /df = 1.741، RMSEA = 0.060، SRMR = 0.0649، CFI = 0.906، TLI = 0.898 و IFI = 0.907)؛ مقدار TLI اندکی کمتر از ۰/۹۰ بود. معیار فورنل-لارکر برای هر شش عامل احراز شد، در حالی که روایی همگرا و پایایی برای زیرمقیاس رژیم غذایی و تغذیه نسبتاً ضعیف‌تر بود. سلامت خودارزیابی‌شده با پنج زیرمقیاس از شش زیرمقیاس ارتباط مثبت داشت. نتیجه‌گیری: MASE-HC در نمونه حاضر حمایت اولیه‌ای برای ساختار شش‌عاملی چندبعدی نشان داد. زیرمقیاس رژیم غذایی و تغذیه نیازمند اصلاح بیشتر است و پیش از استفاده روتین یا هرگونه مقایسه در سطح جامعه، ارزیابی روان‌سنجی مستقل و تکرار در نمونه‌های بزرگ‌تر و نماینده‌تر ضروری است.

Background Optimizing self-care decision-making is important for healthy aging, chronic disease management, and health promotion in rapidly aging populations. However, the absence of culturally validated instruments limits the systematic assessment of decision-making styles and the development of person-centered health management strategies for older adults in China. This study aimed to translate and culturally adapt the Inventory of Self-Care Decision-Making Styles of Older Adults (DECIDE) and evaluate its psychometric properties among Chinese older adults. Methods This study was conducted in two phases. In phase 1, the DECIDE was translated and cross-culturally adapted into Chinese using Brislin’s forward-backward translation procedure. Expert review and pilot testing were conducted to refine linguistic clarity and cultural relevance. In phase 2, a multicenter cross-sectional validation study was conducted from November 2025 to January 2026. A total of 3,470 older adults were recruited through multicenter convenience sampling from 15 cities in Sichuan, Liaoning, Zhejiang, and Hunan provinces, China. Psychometric evaluation included item analysis, validity assessment, and reliability testing. Results All 20 items met the prespecified retention criteria, and the Chinese version retained the four-dimensional structure of the original DECIDE. Content validity was satisfactory, with I-CVI values ranging from 0.800 to 1.000 and an S-CVI of 0.950. Exploratory factor analysis yielded four factors explaining 65.73% of the common variance, and confirmatory factor analysis supported the resulting model (CMIN/DF = 2.513, RMSEA = 0.028). The AVE and CR values ranged from 0.502 to 0.588 and from 0.834 to 0.877, respectively, and the findings supported both convergent and discriminant validity. Cronbach’s α, split-half reliability, and 2-week retest reliability for the total inventory were 0.896, 0.790, and 0.861, respectively. Conclusion The C-DECIDE demonstrated satisfactory psychometric properties in this multicenter convenience sample of older adults from four Chinese provinces. It may support the assessment of self-care decision-making styles and inform individualized health education, decision-support strategies, and public health-oriented chronic disease management for older adults.

زمینه و هدف: بهینه‌سازی تصمیم‌گیری خودمراقبتی برای سالمندی سالم، مدیریت بیماری‌های مزمن و ارتقای سلامت در جمعیت‌های در حال سالمند شدن سریع اهمیت دارد. با این حال، فقدان ابزارهای اعتبارسنجی‌شده فرهنگی، ارزیابی نظام‌مند سبک‌های تصمیم‌گیری و توسعه راهبردهای مدیریت سلامت فردمحور برای سالمندان در چین را محدود می‌کند. هدف این مطالعه ترجمه و انطباق فرهنگی پرسشنامه سبک‌های تصمیم‌گیری خودمراقبتی سالمندان (DECIDE) و ارزیابی ویژگی‌های روان‌سنجی آن در میان سالمندان چینی بود. روش‌ها: این مطالعه در دو مرحله انجام شد. در مرحله اول، پرسشنامه DECIDE با استفاده از روش ترجمه پیشرو-پسرو Brislin به زبان چینی ترجمه و به صورت بین‌فرهنگی انطباق داده شد. بازبینی توسط خبرگان و آزمون مقدماتی جهت بهبود وضوح زبانی و تناسب فرهنگی انجام شد. در مرحله دوم، یک مطالعه اعتبارسنجی مقطعی چندمرکزی از نوامبر 2025 تا ژانویه 2026 انجام شد. در مجموع ۳۴۷۰ سالمند از طریق نمونه‌گیری در دسترس چندمرکزی از ۱۵ شهر در استان‌های سیچوان، لیائونینگ، ژجیانگ و هونان چین جذب شدند. ارزیابی روان‌سنجی شامل تحلیل ماده، ارزیابی روایی و آزمون پایایی بود. یافته‌ها: هر ۲۰ ماده معیارهای نگهداری از پیش تعیین‌شده را برآورده کردند و نسخه چینی ساختار چهاربعدی نسخه اصلی DECIDE را حفظ کرد. روایی محتوا رضایت‌بخش بود، به طوری که مقادیر I-CVI بین ۰٫۸۰۰ تا ۱٫۰۰۰ و S-CVI برابر با ۰٫۹۵۰ بود. تحلیل عاملی اکتشافی چهار عامل استخراج کرد که ۶۵٫۷۳٪ از واریانس مشترک را تبیین کردند و تحلیل عاملی تأییدی مدل حاصل را تأیید کرد (CMIN/DF = 2.513، RMSEA = 0.028). مقادیر AVE و CR به ترتیب بین ۰٫۵۰۲ تا ۰٫۵۸۸ و ۰٫۸۳۴ تا ۰٫۸۷۷ بود و یافته‌ها از روایی همگرا و متمایز حمایت کردند. آلفای کرونباخ، پایایی دو نیمه و پایایی بازآزمایی دو هفته‌ای برای کل پرسشنامه به ترتیب ۰٫۸۹۶، ۰٫۷۹۰ و ۰٫۸۶۱ بود. نتیجه‌گیری: نسخه چینی DECIDE ویژگی‌های روان‌سنجی رضایت‌بخشی را در این نمونه در دسترس چندمرکزی از سالمندان چهار استان چین نشان داد. این ابزار می‌تواند از ارزیابی سبک‌های تصمیم‌گیری خودمراقبتی و اطلاع‌رسانی به آموزش سلامت فردی، راهبردهای حمایت از تصمیم‌گیری و مدیریت بیماری‌های مزمن مبتنی بر سلامت عمومی برای سالمندان حمایت کند.

This article argues that the persistent burden of burnout reflects a fundamental conceptual problem—burnout continues to be framed primarily as an individual condition rather than as an occupational phenomenon shaped by interacting structural, organizational, and leadership conditions. Burnout has emerged as a major occupational health challenge. In a 2024 survey across eight predominantly high and upper-middle-income countries, 48% of respondents reported currently grappling with burnout. Separately, depression and anxiety cost the global economy approximately one trillion dollars annually in lost productivity. Drawing on evidence from neuroimaging, stress biology, cognitive neuroscience, and organizational research, this article examines plausible pathways through which leadership behavior may influence conditions that contribute to or protect against burnout, including social threat–reward processing, cognitive flexibility, emotional intelligence, psychological safety, emotional contagion, and stress-related neurobiological responses. Among physicians, burnout has been associated with depression and anxiety, while evidence regarding substance abuse is less consistent. These proposed mechanisms are proximal and potentially modifiable, but operate within broader structural conditions that constrain or enable their effects. Human-centered work design and neuroleadership-informed leadership practices are proposed as complements to broader structural interventions, with implications for health systems, workforce sustainability, and policy design.

این مقاله استدلال می‌کند که تداوم بار فرسودگی شغلی نشان‌دهنده یک مشکل مفهومی اساسی است—فرسودگی شغلی همچنان عمدتاً به عنوان یک وضعیت فردی در نظر گرفته می‌شود، نه به عنوان یک پدیده شغلی که توسط شرایط ساختاری، سازمانی و رهبری متقابل شکل می‌گیرد. فرسودگی شغلی به عنوان یک چالش عمده سلامت شغلی مطرح شده است. در یک پیمایش در سال ۲۰۲۴ در هشت کشور عمدتاً با درآمد بالا و متوسط رو به بالا، ۴۸٪ از پاسخ‌دهندگان گزارش کردند که در حال حاضر با فرسودگی شغلی دست و پنجه نرم می‌کنند. به طور جداگانه، افسردگی و اضطراب سالانه حدود یک تریلیون دلار هزینه به اقتصاد جهانی از طریق کاهش بهره‌وری وارد می‌کنند. با استناد به شواهدی از تصویربرداری عصبی، زیست‌شناسی استرس، علوم اعصاب شناختی و پژوهش‌های سازمانی، این مقاله مسیرهای محتملی را بررسی می‌کند که از طریق آن‌ها رفتار رهبری می‌تواند شرایطی را که به فرسودگی شغلی منجر می‌شود یا از آن محافظت می‌کند، تحت تأثیر قرار دهد؛ از جمله پردازش تهدید–پاداش اجتماعی، انعطاف‌پذیری شناختی، هوش هیجانی، ایمنی روان‌شناختی، سرایت هیجانی و پاسخ‌های نوروبیولوژیک مرتبط با استرس. در میان پزشکان، فرسودگی شغلی با افسردگی و اضطراب مرتبط بوده است، در حالی که شواهد مربوط به سوءمصرف مواد کمتر منسجم است. این سازوکارهای پیشنهادی، نزدیک و بالقوه قابل تغییر هستند، اما در چارچوب شرایط ساختاری گسترده‌تری عمل می‌کنند که اثرات آن‌ها را محدود یا تسهیل می‌کند. طراحی کار انسان‌محور و شیوه‌های رهبری مبتنی بر نورورهبری به عنوان مکمل‌هایی برای مداخلات ساختاری گسترده‌تر پیشنهاد می‌شوند که پیامدهایی برای نظام‌های سلامت، پایداری نیروی کار و طراحی سیاست دارند.

Purpose To evaluate trends in psychotropic prescription rates (PRs) in a Peruvian general hospital during and after the COVID-19 pandemic. Materials and methods We conducted an interrupted time-series (ITS) study using routinely collected clinical data from hospitalized patients with psychiatric diagnoses between September 2020 and December 2024. Psychotropic PRs, defined as the number of weekly psychotropic prescriptions per 1,000 psychiatric consultations, were calculated overall and by subclass: antidepressants (N06A), antipsychotics (N05A), anxiolytics (N05B), and mood stabilizers (N05AN01/N03A). For ITS analysis, the study period was divided into six predefined phases (two waves, three relaxation phases, and one post-pandemic phase) based on COVID-19 mortality and transmission trends in Peru. Segmented regression models were applied to estimate phase-specific level and slope changes. Results A total of 6,151 patients were included. The overall psychotropic PR was higher during the post-pandemic period compared with the pandemic period (1,308 vs. 1,254; p = 0.023). ITS analyses showed a significant downward trend in overall psychotropic prescribing during phase 1 (post-first wave stabilization, β = −25.53; 95% CI = −43.82 to −7.01; p = 0.007), followed by a structural break in phase 2 (second pandemic wave) with an abrupt level increase (β = 295.53; 95% CI = 60.48 to 530.57; p = 0.014) and slope reversal (β = 23.79; 95% CI = 3.33 to 44.26; p = 0.016), after which prescribing stabilized. A similar temporal pattern was observed for antidepressant PR. Anxiolytic PR displayed a transient upward slope change in phase 2 (β = 14.15; 95% CI = 1.80 to 26.50; p = 0.01), whereas antipsychotic and mood stabilizer prescribing remained stable across phases. Conclusions Overall psychotropic prescribing showed phase-specific disruption followed by structural rebound and subsequent stabilization across the COVID-19 and post-pandemic periods. These findings provide real-world evidence and underscore the need to monitor psychiatric prescribing and mental health service adaptation in middle-income settings.

هدف: ارزیابی روندهای نرخ تجویز داروهای روان‌گردان (PRs) در یک بیمارستان عمومی پرویی در دوران و پس از همه‌گیری COVID-19. مواد و روش‌ها: یک مطالعه سری زمانی منقطع (ITS) با استفاده از داده‌های بالینی جمع‌آوری‌شده به طور روتین از بیماران بستری با تشخیص روان‌پزشکی بین سپتامبر 2020 تا دسامبر 2024 انجام شد. نرخ‌های تجویز داروهای روان‌گردان، که به عنوان تعداد تجویزهای هفتگی داروهای روان‌گردان به ازای هر ۱٬۰۰۰ مشاوره روان‌پزشکی تعریف شد، به طور کلی و بر اساس زیرگروه‌ها محاسبه گردید: داروهای ضدافسردگی (N06A)، داروهای ضدروان‌پریشی (N05A)، داروهای ضداضطراب (N05B) و تثبیت‌کننده‌های خلق (N05AN01/N03A). برای تحلیل ITS، دوره مطالعه به شش فاز از پیش تعیین‌شده (دو موج، سه فاز کاهش محدودیت و یک فاز پس از همه‌گیری) بر اساس روندهای مرگ‌ومیر و انتقال COVID-19 در پرو تقسیم شد. مدل‌های رگرسیون قطعه‌ای برای برآورد تغییرات سطح و شیب مختص هر فاز به کار رفت. نتایج: در مجموع ۶٬۱۵۱ بیمار وارد مطالعه شدند. نرخ کلی تجویز داروهای روان‌گردان در دوره پس از همه‌گیری نسبت به دوره همه‌گیری بالاتر بود (۱٬۳۰۸ در مقابل ۱٬۲۵۴؛ ۰٫۰۲۳ = p). تحلیل‌های ITS کاهش معنادار روند تجویز کلی داروهای روان‌گردان را در فاز ۱ (تثبیت پس از موج اول، β = ‎−۲۵٫۵۳؛ ۹۵٪ CI = ‎−۴۳٫۸۲ تا ‎−۷٫۰۱؛ ۰٫۰۰۷ = p) نشان داد، که به دنبال آن در فاز ۲ (موج دوم همه‌گیری) یک شکست ساختاری با افزایش ناگهانی سطح (β = ۲۹۵٫۵۳؛ ۹۵٪ CI = ۶۰٫۴۸ تا ۵۳۰٫۵۷؛ ۰٫۰۱۴ = p) و معکوس شدن شیب (β = ۲۳٫۷۹؛ ۹۵٪ CI = ۳٫۳۳ تا ۴۴٫۲۶؛ ۰٫۰۱۶ = p) رخ داد و پس از آن تجویز تثبیت شد. الگوی زمانی مشابهی برای نرخ تجویز داروهای ضدافسردگی مشاهده شد. نرخ تجویز داروهای ضداضطراب در فاز ۲ تغییر شیب افزایشی موقتی نشان داد (β = ۱۴٫۱۵؛ ۹۵٪ CI = ۱٫۸۰ تا ۲۶٫۵۰؛ ۰٫۰۱ = p)، در حالی که تجویز داروهای ضدروان‌پریشی و تثبیت‌کننده‌های خلق در طول فازها پایدار باقی ماند. نتیجه‌گیری: تجویز کلی داروهای روان‌گردان دچار اختلال فازمحور شد و پس از آن بازگشت ساختاری و در نهایت تثبیت در طول دوره‌های همه‌گیری و پس از همه‌گیری مشاهده گردید. این یافته‌ها شواهد دنیای واقعی ارائه می‌دهد و بر ضرورت پایش تجویز روان‌پزشکی و سازگاری خدمات سلامت روان در محیط‌های با درآمد متوسط تأکید می‌کند.

Background This study compared educational outcomes between nursing students receiving a CDIO-guided case-based and gamified teaching program and those receiving conventional teaching. Materials and methods This two-class quasi-experimental study included 140 nursing students from two classes between March and June 2025. Classes were assigned by lottery to the intervention ( n = 65) or control ( n = 75) group. The intervention integrated progressive cases, microlectures, teamwork, board games, and escape-room simulation, whereas the control received traditional lectures and Small Private Online Course self-study. Self-directed learning, critical thinking, and learning engagement were assessed before and after the course. Post-course outcomes included theoretical performance, cardiopulmonary resuscitation performance, course performance, and teaching evaluation. Analysis of covariance, Welch’s t tests, and Holm correction were applied. Results The intervention class had higher adjusted post-course scores for self-directed learning (mean difference, 7.68; 95% CI, 3.29–12.07), critical thinking (15.27; 95% CI, 11.53–19.00), and learning engagement (7.06; 95% CI, 1.82–12.30). It also achieved higher theoretical, cardiopulmonary resuscitation, course, and teaching-evaluation scores. Students generally found the activities engaging, although some reported nervousness. Conclusion The program was associated with improved educational outcomes, but intervention and class effects could not be separated. Multicenter studies with multiple classes per arm are required.

زمینه: این مطالعه پیامدهای آموزشی دانشجویان پرستاری دریافت‌کننده برنامه آموزشی مبتنی بر مورد و بازی‌وارسازی با راهنمایی CDIO را با دانشجویان دریافت‌کننده آموزش متداول مقایسه کرد. مواد و روش‌ها: این مطالعه شبه‌آزمایشی دوکلاسه شامل ۱۴۰ دانشجوی پرستاری از دو کلاس بین مارس تا ژوئن ۲۰۲۵ بود. کلاس‌ها به‌صورت قرعه‌کشی به گروه مداخله (n = 65) یا کنترل (n = 75) اختصاص یافتند. مداخله شامل موارد پیشرونده، میکرولکچرها، کار تیمی، بازی‌های رومیزی و شبیه‌سازی اتاق فرار بود، در حالی که گروه کنترل آموزش سنتی و خودآموزی Small Private Online Course را دریافت کرد. یادگیری خودراهبر، تفکر انتقادی و درگیری یادگیری قبل و بعد از دوره ارزیابی شد. پیامدهای پس از دوره شامل عملکرد نظری، عملکرد احیای قلبی‌ریوی، عملکرد دوره و ارزیابی تدریس بود. از تحلیل کوواریانس، آزمون t ولچ و تصحیح هولم استفاده شد. نتایج: کلاس مداخله نمرات تعدیل‌شده بالاتری در یادگیری خودراهبر (تفاوت میانگین، ۷٫۶۸؛ ۹۵٪ CI، ۳٫۲۹–۱۲٫۰۷)، تفکر انتقادی (۱۵٫۲۷؛ ۹۵٪ CI، ۱۱٫۵۳–۱۹٫۰۰) و درگیری یادگیری (۷٫۰۶؛ ۹۵٪ CI، ۱٫۸۲–۱۲٫۳۰) پس از دوره داشت. همچنین نمرات بالاتری در عملکرد نظری، احیای قلبی‌ریوی، عملکرد دوره و ارزیابی تدریس کسب کرد. دانشجویان به طور کلی فعالیت‌ها را جذاب یافتند، اگرچه برخی احساس اضطراب داشتند. نتیجه‌گیری: این برنامه با بهبود پیامدهای آموزشی همراه بود، اما اثرات مداخله و کلاس قابل تفکیک نبود. مطالعات چندمرکزی با چند کلاس در هر بازو مورد نیاز است.

Background Diabetes self-management requires consistent daily behaviors. Social jetlag, the mismatch between workday and free-day sleep timing, may disrupt daily behavior routines. This study examined the association between social jetlag and self-management in adults with type 2 diabetes (T2D), and whether sleep quality and depressive symptoms statistically accounted for portions of this association. Methods This cross-sectional study recruited employed adults aged 18–60 years with T2D from the endocrinology departments of three tertiary public general hospitals in Ningxia Hui Autonomous Region, China, from January to April 2026. Social jetlag was calculated from the micro Munich Chronotype Questionnaire; sleep quality, depressive symptoms, and diabetes self-management were assessed using the Pittsburgh Sleep Quality Index, Patient Health Questionnaire-9, and Summary of Diabetes Self-Care Activities, respectively. Multivariable linear regression and serial mediation analysis with 5,000 bootstrap resamples were performed. Results A total of 339 participants were analyzed. Each additional h of social jetlag was associated with higher PSQI score ( B = 1.352, 95% CI 1.042 to 1.663), higher PHQ-9 score ( B = 3.772, 95% CI 3.314 to 4.229), and lower SDSCA score ( B = −6.623, 95% CI −7.566 to −5.679). The direct association remained significant after PSQI and PHQ-9 scores were included ( B = −3.830, 95% CI −5.048 to −2.611). The specific indirect association through depressive symptoms alone was −2.230 (95% bootstrap CI −3.053 to −1.469), and the serial indirect association through sleep quality and depressive symptoms was −0.314 (95% bootstrap CI −0.534 to −0.150). Conclusion Greater social jetlag was associated with poorer diabetes self-management. Significant indirect associations were observed through depressive symptoms alone and through the serial pathway from sleep quality to depressive symptoms. These associations do not establish temporal ordering or causal mediation because the data were cross-sectional.

زمینه و هدف: خودمدیریتی دیابت نیازمند رفتارهای روزانه منظم است. جت‌لگ اجتماعی، که به عدم تطابق زمان خواب در روزهای کاری و تعطیل اشاره دارد، ممکن است روال‌های رفتاری روزانه را مختل کند. این مطالعه ارتباط بین جت‌لگ اجتماعی و خودمدیریتی در بزرگسالان مبتلا به دیابت نوع ۲ (T2D) و همچنین نقش کیفیت خواب و علائم افسردگی به عنوان عوامل تبیین‌کننده بخشی از این ارتباط را بررسی کرد. روش‌ها: این مطالعه مقطعی، بزرگسالان شاغل ۱۸ تا ۶۰ ساله مبتلا به T2D را از بخش‌های غدد سه بیمارستان عمومی سطح سوم در منطقه خودمختار نینگ‌شیا هوی، چین، از ژانویه تا آوریل ۲۰۲۶ جذب کرد. جت‌لگ اجتماعی با استفاده از پرسشنامه Micro Munich Chronotype Questionnaire محاسبه شد؛ کیفیت خواب، علائم افسردگی و خودمدیریتی دیابت به‌ترتیب با شاخص کیفیت خواب پیتسبورگ، پرسشنامه سلامت بیمار-۹ (PHQ-9) و خلاصه فعالیت‌های مراقبت از دیابت (SDSCA) ارزیابی شدند. رگرسیون خطی چندمتغیره و تحلیل میانجی‌گری زنجیره‌ای با ۵۰۰۰ بازنمونه‌گیری بوت‌استرپ انجام شد. یافته‌ها: مجموعاً ۳۳۹ شرکت‌کننده مورد تحلیل قرار گرفتند. هر ساعت افزایش جت‌لگ اجتماعی با نمره بالاتر PSQI (B = 1.352، فاصله اطمینان ۹۵٪: 1.042 تا 1.663)، نمره بالاتر PHQ-9 (B = 3.772، فاصله اطمینان ۹۵٪: 3.314 تا 4.229) و نمره پایین‌تر SDSCA (B = −6.623، فاصله اطمینان ۹۵٪: −7.566 تا −5.679) همراه بود. ارتباط مستقیم پس از وارد کردن نمرات PSQI و PHQ-9 همچنان معنادار باقی ماند (B = −3.830، فاصله اطمینان ۹۵٪: −5.048 تا −2.611). ارتباط غیرمستقیم خاص از طریق علائم افسردگی به تنهایی برابر با −2.230 (فاصله اطمینان بوت‌استرپ ۹۵٪: −3.053 تا −1.469) و ارتباط غیرمستقیم زنجیره‌ای از طریق کیفیت خواب و علائم افسردگی برابر با −0.314 (فاصله اطمینان بوت‌استرپ ۹۵٪: −0.534 تا −0.150) بود. نتیجه‌گیری: جت‌لگ اجتماعی بیشتر با خودمدیریتی ضعیف‌تر دیابت همراه بود. ارتباطات غیرمستقیم معناداری از طریق علائم افسردگی به تنهایی و همچنین از طریق مسیر زنجیره‌ای کیفیت خواب تا علائم افسردگی مشاهده شد. این ارتباطات به دلیل مقطعی بودن داده‌ها، ترتیب زمانی یا میانجی‌گری علّی را اثبات نمی‌کنند.

Introduction Although police personnel are exposed to substantial occupational stress and Kerala has one of the highest suicide rates in India, evidence on suicidal ideation and suicidal behavior among police personnel in the state remains limited. This study estimated the prevalence of suicidal ideation and suicidal behavior and identified their associated factors among police personnel in Kerala, India. Methods A cross-sectional study was conducted among 400 police personnel (mean age 37.94 years; 81% men), from Civil Police Officers (CPOs) to Inspectors, recruited from 15 police stations in Ernakulam and Malappuram districts of Kerala using a multistage cluster sampling approach. Data were collected using a self-administered structured questionnaire. Suicidal ideation and suicidal behavior during the past 12 months were assessed using the Columbia-Suicide Severity Rating Scale (C-SSRS), with the reference period adapted to the past 12 months. Survey-weighted generalised linear models with a Poisson distribution and log link were used to estimate adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) for factors associated with suicidal ideation and suicidal behavior. Results The survey-weighted prevalence of suicidal ideation was 9.39% ( n = 36; 95% CI: 6.18–14.01%), while 4.11% ( n = 14; 95% CI: 1.68–9.70%) reported suicidal behavior during the past 12 months. Actual suicide attempts were reported by 1.47% ( n = 6; 95% CI: 0.66–3.25%). Among participants with suicidal ideation, 13.56% ( n = 6) reported active suicidal ideation with a specific plan and intent. A higher prevalence of suicidal ideation was observed among participants aged >36 years (aPR: 2.90; 95% CI: 1.31–6.38), CPOs (aPR: 2.31; 95% CI: 1.59–3.37), those working >12 h per day (aPR: 1.67; 95% CI: 1.05–2.65), those with a previous psychiatric illness (aPR: 1.67; 95% CI: 1.19–2.35), and those reporting workplace violence or harassment (aPR: 3.16; 95% CI: 1.11–9.04). A higher prevalence of suicidal behavior was observed among participants with >15 years of service (aPR: 13.82; 95% CI: 5.00–38.19), CPOs (aPR: 12.32; 95% CI: 6.12–24.80), those with a previous psychiatric illness (aPR: 5.94; 95% CI: 2.58–13.66), and those reporting workplace violence or harassment (aPR: 13.81; 95% CI: 2.71–70.34). Conclusion Nearly one in ten police personnel reported suicidal ideation and approximately one in twenty-five reported suicidal behavior during the past 12 months. The findings highlight the need for workplace mental health strategies addressing occupational stressors and improving access to confidential mental health support among police personnel.

مقدمه: اگرچه کارکنان پلیس در معرض استرس شغلی قابل توجهی قرار دارند و ایالت کرالا یکی از بالاترین نرخ‌های خودکشی در هند را داراست، اما شواهد مربوط به افکار خودکشی و رفتار خودکشی در میان کارکنان پلیس این ایالت همچنان محدود است. این مطالعه شیوع افکار خودکشی و رفتار خودکشی را برآورد کرده و عوامل مرتبط با آن‌ها را در میان کارکنان پلیس در کرالا، هند شناسایی نمود. روش‌ها: یک مطالعه مقطعی در میان ۴۰۰ نفر از کارکنان پلیس (میانگین سنی ۳۷٫۹۴ سال؛ ۸۱٪ مرد) از افسران پلیس مدنی (CPOs) تا بازرس‌ها، که از ۱۵ ایستگاه پلیس در شهرستان‌های ارناکولام و مالاپورام کرالا با استفاده از روش نمونه‌گیری خوشه‌ای چندمرحله‌ای انتخاب شدند، انجام شد. داده‌ها با استفاده از پرسشنامه ساختارمند خودگزارشی جمع‌آوری گردید. افکار خودکشی و رفتار خودکشی در ۱۲ ماه گذشته با استفاده از مقیاس Columbia-Suicide Severity Rating Scale (C-SSRS) و با تطبیق دوره مرجع به ۱۲ ماه گذشته ارزیابی شد. برای برآورد نسبت‌های شیوع تعدیل‌شده (aPRs) و فواصل اطمینان ۹۵٪ (CIs) برای عوامل مرتبط با افکار خودکشی و رفتار خودکشی، از مدل‌های خطی تعمیم‌یافته با توزیع پواسون و لینک لگاریتمی با وزن‌دهی پیمایشی استفاده شد. نتایج: شیوع وزنی افکار خودکشی ۹٫۳۹٪ (n = 36؛ ۹۵٪ CI: ۶٫۱۸–۱۴٫۰۱٪) و رفتار خودکشی ۴٫۱۱٪ (n = 14؛ ۹۵٪ CI: ۱٫۶۸–۹٫۷۰٪) در ۱۲ ماه گذشته گزارش شد. اقدام به خودکشی واقعی توسط ۱٫۴۷٪ (n = 6؛ ۹۵٪ CI: ۰٫۶۶–۳٫۲۵٪) گزارش گردید. در میان شرکت‌کنندگانی که افکار خودکشی داشتند، ۱۳٫۵۶٪ (n = 6) افکار فعال خودکشی با برنامه و قصد مشخص را گزارش کردند. شیوع بالاتر افکار خودکشی در میان شرکت‌کنندگان بالای ۳۶ سال (aPR: 2.90؛ ۹۵٪ CI: ۱٫۳۱–۶٫۳۸)، CPOs (aPR: 2.31؛ ۹۵٪ CI: ۱٫۵۹–۳٫۳۷)، افرادی که بیش از ۱۲ ساعت در روز کار می‌کنند (aPR: 1.67؛ ۹۵٪ CI: ۱٫۰۵–۲٫۶۵)، افراد با سابقه بیماری روانپزشکی (aPR: 1.67؛ ۹۵٪ CI: ۱٫۱۹–۲٫۳۵) و افرادی که خشونت یا آزار در محیط کار را گزارش کردند (aPR: 3.16؛ ۹۵٪ CI: ۱٫۱۱–۹٫۰۴) مشاهده شد. شیوع بالاتر رفتار خودکشی در میان شرکت‌کنندگانی با بیش از ۱۵ سال سابقه خدمت (aPR: 13.82؛ ۹۵٪ CI: ۵٫۰۰–۳۸٫۱۹)، CPOs (aPR: 12.32؛ ۹۵٪ CI: ۶٫۱۲–۲۴٫۸۰)، افراد با سابقه بیماری روانپزشکی (aPR: 5.94؛ ۹۵٪ CI: ۲٫۵۸–۱۳٫۶۶) و افرادی که خشونت یا آزار در محیط کار را گزارش کردند (aPR: 13.81؛ ۹۵٪ CI: ۲٫۷۱–۷۰٫۳۴) مشاهده شد. نتیجه‌گیری: تقریباً یک نفر از هر ده نفر از کارکنان پلیس افکار خودکشی و حدود یک نفر از هر بیست‌وپنج نفر رفتار خودکشی را در ۱۲ ماه گذشته گزارش کردند. یافته‌ها بر ضرورت راهبردهای سلامت روان در محیط کار که به عوامل استرس‌زای شغلی پرداخته و دسترسی به حمایت محرمانه سلامت روان را در میان کارکنان پلیس بهبود می‌بخشد، تأکید می‌کند.

Background External ventricular drainage (EVD) is an important intervention in the management of patients with severe neurological conditions, and standardized nursing care is essential for preventing complications and ensuring patient safety. Nurses’ knowledge of recommended EVD care practices is an important foundation for safe and evidence-based care. However, existing instruments for assessing EVD-related nursing knowledge are often lengthy or have limited psychometric validation, which may restrict their use in routine clinical assessment and large-scale training. Therefore, a brief, reliable, and psychometrically robust instrument is needed to efficiently assess nurses’ knowledge of EVD care practices and identify areas requiring targeted education. Aim To translate and culturally adapt the Short Knowledge Test to Evaluate Awareness of External Ventricular Drain Care Practices and evaluate its psychometric properties among Chinese nurses using the Rasch model, thereby providing a reliable tool for the rapid assessment of nurses’ self-reported knowledge of recommended EVD care practices and the identification of targeted training needs. Method The original scale was translated and culturally adapted into Chinese using the Brislin forward–backward translation method, resulting in the Chinese version of the Short Knowledge Test to Evaluate Awareness of External Ventricular Drain Care Practices (C-SKT-EVD). A cross-sectional survey was conducted among clinical nurses recruited from First Affiliated Hospital of Jinzhou Medical University, Liaoning Province, mainland China. 242 valid participants included in the final analysis. Descriptive statistics were performed using SPSS version 26.0, and the psychometric properties of the scale were evaluated using the Rasch Rating Scale Model in Winsteps version 3.72.3, focusing on unidimensionality, item fit, category functioning, item–person distribution, test information function, separation indices and reliability, and differential item functioning (DIF). Results The empirical variance explained by the measures was 55.1%, and the eigenvalue of the first contrast was 1.4, supporting the unidimensionality of the C-SKT-EVD. The Infit mean-square (MNSQ) values for the seven items ranged from 0.94 to 1.16, while the Outfit MNSQ values ranged from 0.94 to 1.07, all indicating acceptable fit to the Rasch model. The point-measure correlation coefficients (PT-Measure Corr.) ranged from 0.63 to 0.70, suggesting good alignment between the items and the underlying latent construct. The observed average measures across the five rating categories increased monotonically, and the category thresholds were ordered sequentially. The category probability curves also showed clearly defined peaks, indicating that the rating categories functioned well and that no category collapsing was required. The item difficulty distribution was generally well matched to the respondents’ levels of self-reported EVD care knowledge, and the test information function indicated higher measurement precision around the average level of the measured construct, with relatively less information provided for respondents with extremely high or low levels of the latent trait. Conclusion The C-SKT-EVD demonstrated generally acceptable Rasch measurement properties in the present sample of Chinese nurses, providing preliminary evidence for its use as a brief screening and educational assessment tool for self-reported knowledge of recommended EVD care practices. However, these findings do not establish comprehensive validity or objective clinical competence. Further multicenter studies in diverse nursing populations are needed to confirm its broader applicability.

زمینه: درناژ بطنی خارجی (EVD) یک مداخله مهم در مدیریت بیماران با شرایط شدید نورولوژیک است و مراقبت پرستاری استاندارد برای پیشگیری از عوارض و تضمین ایمنی بیمار ضروری است. دانش پرستاران درباره مراقبت‌های توصیه‌شده EVD، پایه‌ای مهم برای مراقبت ایمن و مبتنی بر شواهد به‌شمار می‌رود. با این حال، ابزارهای موجود برای سنجش دانش پرستاری مرتبط با EVD اغلب طولانی یا دارای روایی و پایایی روان‌سنجی محدودی هستند که ممکن است استفاده از آن‌ها را در ارزیابی‌های بالینی روتین و آموزش‌های وسیع محدود کند. بنابراین، وجود ابزاری کوتاه، پایا و دارای ویژگی‌های روان‌سنجی قوی برای سنجش کارآمد دانش پرستاران درباره مراقبت‌های EVD و شناسایی حوزه‌های نیازمند آموزش هدفمند ضروری است. هدف: ترجمه و بومی‌سازی فرهنگی آزمون کوتاه دانش برای ارزیابی آگاهی از مراقبت‌های درناژ بطنی خارجی و ارزیابی ویژگی‌های روان‌سنجی آن در میان پرستاران چینی با استفاده از مدل Rasch، به‌منظور ارائه ابزاری پایا برای ارزیابی سریع دانش خودگزارشی پرستاران از مراقبت‌های توصیه‌شده EVD و شناسایی نیازهای آموزشی هدفمند. روش: مقیاس اصلی با استفاده از روش ترجمه پیشرو–پسرو Brislin به زبان چینی ترجمه و بومی‌سازی فرهنگی شد و نسخه چینی آزمون کوتاه دانش برای ارزیابی آگاهی از مراقبت‌های درناژ بطنی خارجی (C-SKT-EVD) حاصل گردید. یک مطالعه مقطعی در میان پرستاران بالینی شاغل در بیمارستان وابسته اول دانشگاه علوم پزشکی Jinzhou، استان لیائونینگ، چین انجام شد. ۲۴۲ شرکت‌کننده معتبر در تحلیل نهایی وارد شدند. آمار توصیفی با استفاده از SPSS نسخه ۲۶.۰ انجام شد و ویژگی‌های روان‌سنجی مقیاس با مدل Rasch Rating Scale در نرم‌افزار Winsteps نسخه ۳.۷۲.۳ ارزیابی گردید و بر یک‌بعدی بودن، برازش ماده، عملکرد دسته‌بندی، توزیع ماده–فرد، تابع اطلاعات آزمون، شاخص‌های جداسازی و پایایی، و عملکرد افتراقی ماده (DIF) تمرکز شد. نتایج: واریانس تجربی تبیین‌شده توسط اندازه‌گیری‌ها ۵۵.۱٪ بود و مقدار ویژه اولین کنتراست ۱.۴ به‌دست آمد که یک‌بعدی بودن C-SKT-EVD را تأیید می‌کند. مقادیر Infit میانگین مربع (MNSQ) برای هفت ماده بین ۰.۹۴ تا ۱.۱۶ و مقادیر Outfit MNSQ بین ۰.۹۴ تا ۱.۰۷ بود که همگی برازش قابل قبول به مدل Rasch را نشان می‌دهند. ضرایب همبستگی نقطه–اندازه‌گیری (PT-Measure Corr.) بین ۰.۶۳ تا ۰.۷۰ بود که هم‌راستایی خوب مواد با سازه نهفته را نشان می‌دهد. میانگین اندازه‌گیری مشاهده‌شده در پنج دسته‌بندی امتیازدهی به‌صورت یکنواخت افزایش یافت و آستانه‌های دسته‌بندی به‌ترتیب مرتب بودند. منحنی‌های احتمال دسته‌بندی نیز اوج‌های مشخصی داشتند که نشان‌دهنده عملکرد مناسب دسته‌بندی‌ها و عدم نیاز به ادغام دسته‌ها بود. توزیع دشواری مواد به‌طور کلی با سطح دانش خودگزارشی مراقبت EVD پاسخ‌دهندگان تطابق داشت و تابع اطلاعات آزمون دقت اندازه‌گیری بالاتری را در سطح متوسط سازه اندازه‌گیری‌شده نشان داد، در حالی که برای پاسخ‌دهندگان با سطوح بسیار بالا یا پایین ویژگی نهفته، اطلاعات نسبتاً کمتری فراهم شد. نتیجه‌گیری: C-SKT-EVD در نمونه حاضر از پرستاران چینی ویژگی‌های اندازه‌گیری Rasch قابل قبولی را نشان داد و شواهد اولیه‌ای برای استفاده از آن به‌عنوان ابزار غربالگری و ارزیابی آموزشی کوتاه برای دانش خودگزارشی مراقبت‌های توصیه‌شده EVD فراهم کرد. با این حال، این یافته‌ها روایی جامع یا شایستگی بالینی عینی را اثبات نمی‌کند. مطالعات چندمرکزی بیشتر در جمعیت‌های متنوع پرستاری برای تأیید کاربرد وسیع‌تر آن مورد نیاز است.

Background Trans, non-binary and gender diverse (TNBGD) sexual function has historically been narrowly defined as physical capacities following medical and surgical gender affirming (GA) interventions; and this population's sexual health has been researched more in terms of external influences considered risky rather than being founded in individuals' desires and needs. This can produce discrepancies between services and people who access them. This study explores the service-related barriers, facilitators and compensatory strategies for TNBGD people seeking healthcare related to sexual function. Methods Based on qualitative interview data from n = 19 TNBGD adults in the UK, the dataset was deductively analyzed using Levesque's framework of healthcare access. Results TNBGD people face barriers in distance and transport to appropriate sexual health services, overlaps between sexual healthcare and GA services, and limits in professionals' TNBGD specific knowledge and cultural competence. To navigate these TNGBD people pursued independent knowledge acquisition, were selective during clinical interactions and access, and sought to meet their needs outside clinical settings. The analytical themes demonstrate varied barriers and their interrelatedness. For example, acceptability of a service was informed by the appropriateness of clinician's knowledge and interactions. In turn, TNBGD people's anticipation of un (der) met needs motivated compensatory measures, such as seeking information online or from peers before approaching formal services or sometimes instead of approaching them. Conclusions Healthcare services' design and delivery can present significant barriers to TNBGD adults seeking healthcare to support their sexual function. Providers' ways of interacting may offset some of the barriers and TNBGD adults may deploy strategies that enable them to access care that leads to satisfactory health outcomes. However, while significant barriers persist, TNBGD adults are liable to have unmet needs and consequent health inequalities.

Background Cumulative exposure to adverse childhood experiences (ACEs) is associated with an increased risk of substance use, overdose, and suicide. Rural children are more likely to experience most ACEs. There is limited literature contextualizing rural individuals’ experiences with ACEs. Public Health 3.0 calls for multisector partner engagement to generate collective impact. The purpose of this study was to evaluate rural providers’ perspectives on challenges and recommendations for ACEs mitigation in their community from a cross-sector context. Participants and setting Participants were 74 providers enrolled in an online ACEs training. Participants lived and/or worked in five rural Missouri counties with high drug overdose death rates. Methods This was a conventional content analysis of written responses to structured discussion prompts from three training modules. Analysis included familiarization, inductive identification of major codes, and refinement of codes, followed by independent coding by two authors until consensus, and reporting major patterns. Artificial intelligence supported preliminary code development. An adapted Sequential Intercept Model (SIM) framework organized challenges and recommendations by setting. Results Results included personal stories about how ACEs impacted their communities through overdose, suicide, homelessness, unemployment, and adverse health effects. Settings included schools, government, healthcare, daycares, criminal justice, Extension, fire departments, libraries, and nonprofits. Participants recommended expanding the ACEs definition to include satanic abuse, bullying, incest, war, genocide, military family stressors, and death of a loved one. Intervention recommendations included whole-family interventions, community-wide training, trauma-informed training, expanded access to treatment, classes in prison/jails, and fostering positive childhood experiences. Conclusion Community voice is necessary to contextualize setting-specific insights that inform development of upstream interventions appropriate for and tailored to the community. Participants identified both strategies that could be incorporated into everyday practice—including empathy, listening, providing judgment-free and safe spaces, providing food for children experiencing hunger, encouraging positive childhood experiences, mentoring, and connecting individuals with resources for food, shelter, clothing, and mental health—and broader structural changes that may require policy-level action. The adapted SIM organizes these concepts.

Mental healthcare needs are growing, yet awareness of available services remains limited, even in Houston, Texas. This study examined relationships between having experienced or been diagnosed with mental illness and awareness of community-based mental health or crisis services. Approximately 1,000 Houston-area adults were surveyed in 2024 and 2026. Chi-square and multivariable regression analyses showed that experience with mental illness was associated with SGM populations, race/ethnicity, and age after adjustment for sociodemographic characteristics. SGM participants had greater odds of reporting mental illness, whereas Black/African American, Hispanic/Latinx, Asian, and older adults had lower adjusted odds relative to their reference groups. Awareness of community-based services was independently associated with gender, SGM populations, race/ethnicity, age, and annual household income; females had greater odds of awareness, whereas Hispanic/Latinx, Asian, and older adults had lower odds. Findings highlight sociodemographic differences in reported experience with mental illness and awareness of community-based services. Longitudinal research is needed to further examine these relationships.

Background Sleep duration is an important component of healthy aging, yet gender differences in short and long sleep among older adults remain insufficiently understood. This study aimed to examine gender differences in sleep duration among Chinese older adults and quantify the contributions of socioeconomic, behavioral, functional, and health-related factors to these differences. Methods Data were obtained from 9,590 adults aged ≥65 years who participated in the 2018 wave of the Chinese Longitudinal Healthy Longevity Survey. Sleep duration was self-reported and categorized as short (<6 h), normal (6–8 h), or long (>8 h). Multinomial logistic regression was used to identify factors associated with short and long sleep, with weighted analyses and Poisson regression performed as sensitivity analyses. Separate Fairlie decomposition analyses were conducted for short and long sleep to quantify the contributions of observed characteristics to gender differences. Results Overall, 44.95% of participants had abnormal sleep duration, with a higher prevalence among women than men (46.87% vs. 42.66%, p < 0.001). Compared with men, women had a higher relative risk of short sleep (RRR = 1.399, 95% CI: 1.204–1.625) but a lower relative risk of long sleep (RRR = 0.856, 95% CI: 0.754–0.972). The association with short sleep remained significant in the weighted analysis (RRR = 1.530, 95% CI: 1.210–1.935), whereas the gender difference in long sleep was attenuated (RRR = 0.821, 95% CI: 0.661–1.021). For short sleep, observed characteristics explained 21.65% of the gender disparity. Education (22.75%), depressive symptoms (11.07%), IADL limitation (6.02%), and self-assessed health (4.82%) contributed positively to the disparity, whereas smoking status (−22.57%), drinking status (−12.45%), and exercise (−4.87%) partially offset it. The gender difference in long sleep was negligible, with substantial offsetting contributions across factors. Conclusion Gender differences in sleep duration among Chinese older adults were primarily concentrated in short sleep, with women experiencing a higher risk. Socioeconomic, behavioral, psychological, and functional characteristics contributed to this disparity, although most of the short-sleep difference remained unexplained. Gender-sensitive interventions addressing educational disadvantage, depressive symptoms, functional limitations, and health behaviors may help reduce inequalities in sleep duration among older adults.

Introduction Transgender and gender diverse (TGD) older adults in the United States (U.S.) face barriers to accessing health information and resources they need to make informed healthcare decisions. More resources are needed to promote their agency and preparedness to navigate an increasingly complex healthcare system and sociopolitical landscape. The purpose of this study was to develop a testable web-based resource to support informed healthcare decision-making for TGD older adults. Methods This multimethod co-design study integrated a human-centered design approach that centered the perspectives of TGD older adults in the research process. In the prototyping and testing phases of the study, TGD adults and multidisciplinary professionals from across the U.S. were enrolled to co-develop a web-based resource with the research team during individual and paired interviews. Participants also completed a demographic questionnaire and a website usability survey. Thematic analysis of qualitative data was used to identify design themes, which guided iterative prototyping of the web-based resource. Quantitative data were analyzed descriptively. Complementary data from the usability survey and participant interviews were integrated in a joint display. Results A total of 27 participants, of whom 14 (52%) were TGD older adults, enrolled in the prototyping and testing phases. Analysis of qualitative data across both phases yielded five design themes that structured the development of a functional web-based resource: (1) Facilitating healthcare decisions through information and resources; (2) Organizing complex content with clarity and inclusivity; (3) Maintaining security, accessibility, and navigability; (4) Phasing rollout to communities and organizations; and (5) Planning for leadership, stewardship, and partnership. In the prototyping phase, three low- and mid-fidelity prototypes of a health information and resources website for TGD older adults were developed. In the testing phase, participants trialed a mid-fidelity prototype of the website, and their recommendations for improvements were integrated into a high-fidelity prototype for dissemination. Conclusion This study is one of few studies using participatory methods to engage TGD older adults in public health research. Through the development of a health information and resources website, this study demonstrates an innovative and feasible community-based co-design approach to addressing barriers affecting healthcare decision-making for TGD older adults.

Objective This study aimed to estimate the prevalence of musculoskeletal symptoms and work-related musculoskeletal disorders (WMSDs) among orthopedic nurses, identify demographic, occupational, and lifestyle characteristics associated with WMSDs, and explore whether routinely collected characteristics could discriminate nurses with WMSDs from those without. Method A single-center cross-sectional study was conducted among nurses at a tertiary orthopedic specialty hospital in China between March and November 2023. Conventional analyses included multivariable logistic regression, modified Poisson regression with robust standard errors, and negative binomial regression. Logistic regression as a benchmark, elastic-net logistic regression, random forest, XGBoost, and support vector machine were compared using repeated 5-fold cross-validation with fold-specific preprocessing. Prediction performance was assessed using AUC with bootstrap 95% CIs, PR-AUC, Brier score, calibration intercept and slope, and descriptive threshold metrics; TreeSHAP was used for model interpretation. Result Among 948 nurses with valid questionnaires, 654 reported musculoskeletal symptoms in the previous 12 months, irrespective of work attribution (68.99%). After excluding 44 participants with uncertain work-related attribution, 604/904 participants were classified as having work-related WMSDs (66.81%). Each 1-point increase in the strict ergonomic risk score was associated with WMSDs in logistic regression (adjusted OR = 2.631, 95% CI 2.039–3.432; p < 0.001) and modified Poisson regression (adjusted PR = 1.283, 95% CI 1.203–1.369; p < 0.001). The highest observed AUC was 0.752 (95% CI 0.721–0.791) for the domain random forest model; the domain XGBoost model had the highest PR-AUC (0.841). Conclusion Musculoskeletal symptoms and WMSDs were common among orthopedic nurses in this single-center sample. Occupational exposure and postural load were associated with WMSDs. The exploratory prediction models showed limited-to-moderate discrimination and warrant prospective multicenter external validation before practical application.

Background Everyday stress and social inhibition are relevant to mental health during emerging adulthood. Daily psychological richness may help explain the temporal association between perceived stress and subsequent social inhibition. Methods In a 15-day diary study, 186 emerging adults provided 2,790 observations of perceived stress, psychological richness, and social inhibition. Perceived social support was assessed at the person level. Two-level dynamic structural equation modeling (DSEM) was used to examine lagged associations and cross-level moderation. Results Higher perceived stress was associated with lower psychological richness the following day [estimate = −0.588, 95% highest posterior density credible interval (HPD CrI) (−0.672, −0.501)]. Psychological richness was negatively associated with social inhibition on the subsequent day [estimate = −0.093, 95% HPD CrI (−0.108, −0.079)], and perceived stress showed a positive direct association with social inhibition 2 days later [estimate = 0.224, 95% HPD CrI (0.192, 0.257)]. Higher perceived social support was associated with weaker stress–richness and direct stress–inhibition associations. The credible interval for moderation of the richness–inhibition path included zero. The conditional indirect association was smaller at high than low support [difference = −0.040, 95% HPD CrI (−0.065, −0.016)]. Conclusion The findings identify a temporally ordered indirect association involving daily psychological richness and support-related differences in stress-linked pathways. They inform further research on everyday psychosocial experiences and social functioning among emerging adults.

Objective Operating room nurses work long-term in high-intensity, high-risk environments and suffer from a high prevalence of occupational fatigue, which seriously affects their physical and mental health as well as patient safety. Based on the Job Demand-Control-Support (JDCS) model, this study aimed to examine the mediating role of perceived stress between the dimensions of the JDCS model and occupational fatigue—including acute fatigue, chronic fatigue, and inter-shift recovery—among operating room nurses. Methods This multi-center cross-sectional study was conducted from August to September 2026, enrolling 1,122 operating room nurses from 9 tertiary Grade-A hospitals in eastern, central, and western China. A general information questionnaire, the Occupational Fatigue Exhaustion Recovery Scale, the Perceived Stress Scale (PSS-10), and the Job Content Questionnaire (JCQ) were administered. SPSS 25.0 was used for descriptive statistics, difference analysis, correlation analysis, and hierarchical multiple regression; AMOS 21.0 was used to construct a structural equation model, and the bias-corrected Bootstrap method was employed to test mediating effects. Results The scores of acute fatigue, chronic fatigue, and inter-shift recovery among operating room nurses were 45.55 ± 18.77, 44.13 ± 17.89, and 56.27 ± 17.83, respectively, indicating an overall moderate level of occupational fatigue. The perceived stress score was 21.01 ± 5.24; job demand was 36.44 ± 4.80; job control was 71.54 ± 18.07; and social support was 24.02 ± 6.61. Hierarchical regression showed that, after controlling for demographic and work characteristics, job demand, job control, and social support remained independent correlates of all three outcomes (acute fatigue model R 2 = 0.460, chronic fatigue R 2 = 0.305, inter-shift recovery R 2 = 0.353). The structural equation model showed that job demand positively predicted perceived stress ( β = 0.182, p < 0.001), while job control ( β = −0.251, p = 0.033) and social support ( β = −0.168, p = 0.040) negatively predicted perceived stress. Perceived stress positively predicted acute fatigue ( β = 0.336, p < 0.001) and chronic fatigue ( β = 0.209, p < 0.001), and negatively predicted inter-shift recovery ( β = −0.134, p = 0.029). Bootstrap tests indicated that perceived stress played a significant partial mediating role between job demand, job control, and social support and the outcomes of acute fatigue, chronic fatigue, and inter-shift recovery, although the indirect effects were small in magnitude (proportion mediated 3.41–17.35%). Conclusion Occupational fatigue among operating room nurses in 9 tertiary Grade-A hospitals is at a moderate level, and inter-shift recovery needs improvement. Perceived stress acted as a mediating variable linking JDCS dimensions to occupational fatigue, although the mediating effects were modest in magnitude. Nursing managers can improve occupational fatigue and recovery among operating room nurses by reducing unreasonable job demands, enhancing job control, strengthening social support, and alleviating perceived stress.

Background School-aged children that experience social anxiety and have difficulty with interactions among peers can create significant challenges to their development in terms of both psychology and behavior. A team sport such as volleyball provides a common setting that naturally includes all aspects of social interaction (communication, cooperation, role coordination, etc.) and shared goals which is essential to improve the child’s confidence in interacting socially and abilities to interact socially with peers. Objective This research is an examination of the effect that a 12-week collective volleyball cooperative tactical training program will have on social anxiety and peer interaction in children (8–12). Methods A sample of 80 healthy school-age children was obtained via two methods of campus based, voluntary and/or open recruitment. These children were then randomly assigned to either an experimental intervention group ( n = 40) or an active control group receiving standard physical education ( n = 40). For 12 consecutive weeks, participants in the experimental group engaged in a type of volleyball cooperative tactical team training that occurred on 3 days each week at 1 h per day. During this time the participants in the control group engaged in standard physical education classes of matched frequency and duration. Social anxiety was measured by use of the Social Anxiety Scale for Children (SASC); SASC measures include total social anxiety, fear of negative evaluation and social avoidance/distress. Participant peer interaction was evaluated using a study-specific 25-item peer-interaction questionnaire covering interaction initiative, peer acceptance, interaction coordination, interaction openness, and conflict resolution ability. Data collection occurred prior to, as well as subsequent to, the intervention. Statistical analyses were conducted utilizing SPSS version 26.0 software. A 2 × 2 mixed-design ANOVA was conducted to examine Group × Time interaction effects, with group (intervention vs. control) as the between-subjects factor and time (pre-intervention vs. post-intervention) as the within-subject factor. Effect sizes were reported using partial eta squared ( η 2 p ), and post hoc comparisons were performed when significant interactions were identified. Results Group × Time Interaction Effects from a mixed-design ANOVA were found to be statistically significant for both of the outcomes (social anxiety and peer interaction) of this study. Children participating in an intervention that included an instructional program using the Collective Volleyball Cooperative Tactical Training Model showed significantly greater improvement than did those in the Control Condition in reducing their level of social anxiety as well as improving their peer interaction abilities over the course of the 12-weeks. Although we found a statistically-significant improvement in both children’s social anxiety, and their peer interaction skills through a 12-week program, there is no data available for us to understand if those positive results will continue into the future because we did not assess children at later points in time. Thus, future researchers are encouraged to consider extended assessment periods as part of their study designs to determine how long such interventions have an impact. Secondly, as a feasibility study in a controlled environment showed promise for implementation of cooperative tactical volleyball programs, there may be barriers to successful implementation in regular school settings such as lack of facilities, class size and teacher workload. Future research is needed to examine how cooperative tactical volleyball programs can be adapted to encompass large groups of students and incorporated into routine physical education curriculum. Furthermore, although the intervention showed feasibility under controlled conditions, implementation in regular school settings may face practical challenges, including limited facilities, larger class sizes, and teacher workload. Future studies should examine how cooperative volleyball tactical training can be adapted for broader school-based implementation. Conclusion Collective Volleyball Cooperative Tactical Training is an effective method for reducing social anxiety and improving the ability of school aged children to interact with peers. The program offers a viable, school-based model for integrating sport skills acquisition (training) and psychosocial growth through physical activity.

Background Non-suicidal self-injury (NSSI) is common among adolescents and often remains concealed because of shame and stigma. Voluntary disclosure can provide access to support, but emotional and interpersonal concerns shape the decision to disclose. This review will synthesize disclosure experiences, barriers, and facilitators reported by adolescents who have voluntarily disclosed NSSI at least once. Methods Primary qualitative studies and separately extractable qualitative components of mixed-methods studies involving adolescents aged 10–19 years will be eligible. Searches will cover PubMed, Embase, APA PsycINFO, CINAHL, Scopus, and Web of Science Core Collection. China National Knowledge Infrastructure, Wanfang Data, and the Chinese Biomedical Literature Database will also be searched. Coverage will extend from inception through 31 March 2026, inclusive, without language restrictions; formal searches have not yet been executed. Gray literature, reference lists, and forward citations will also be searched. Two human reviewers will independently select studies, appraise them using the Joanna Briggs Institute (JBI) qualitative checklist, and extract findings. Findings will be synthesized using JBI meta-aggregation, with confidence assessed using ConQual. Discussion The synthesis will examine disclosure decisions, recipients' responses, and subsequent experiences from adolescents' perspectives. Findings may inform clinical, school, and family support for voluntary NSSI disclosure. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420261355173 , identifier: CRD420261355173.

Purpose To investigate the longitudinal relationship between university students’ subjective exercise experiences and their physical exercise behavior using a cross-lagged research design, and to analyze the moderating role of motivational beliefs in this relationship. Methods A one-year, two-stage longitudinal questionnaire survey was conducted among 422 university students in Jiangxi Province (52.6% male, mean age = 18.29 ± 0.632 years) using the Subjective Exercise Experience Scale, the Adolescent Physical Activity Scale, the Exercise Self-Efficacy Scale and the Perceived Value of Exercise Scale. Results (1) Gender differences were observed in both subjective exercise experience and physical exercise behavior across the two phases; male participants scored higher on average than female participants across all measures. (2) There was a significant positive correlation between subjective exercise experience and physical exercise behavior among university students. (3) Results from a cross-lagged model controlling for gender indicated that subjective exercise experience at T1 significantly and positively predicted physical exercise behavior at T2 ( β = 0.385, p < 0.001), and physical exercise behavior at T1 significantly and positively predicted subjective exercise experience at T2 ( β = 0.336, p < 0.001). (4) Motivational beliefs exerted a significant positive moderating effect on both cross-lagged pathways. Conclusion Gender differences exist in both subjective exercise experience and physical exercise behavior among university students; there is a longitudinal relationship across time between subjective exercise experience and physical exercise behavior; and motivational beliefs exert a significant moderating effect on the prospective predictive pathways between subjective exercise experience and physical exercise behavior.

Background Non-suicidal self-injury (NSSI) is common during adolescence and is associated with substantial psychological burden and elevated subsequent suicide risk. Physical activity (PA) may be a modifiable correlate of NSSI, but prospective evidence on potential emotional mechanisms and social boundary conditions remains limited. This study examined whether baseline PA was associated with subsequent NSSI, whether anxiety symptoms accounted for part of that association, and whether baseline social support moderated the relevant pathways. Methods A school-based two-wave cohort of 756 Chinese adolescents and young students (mean age = 17.36 years, SD = 2.58; 51.7% female) was followed for 6 months. At Time 1 (T1), participants reported PA, social support, anxiety symptoms, NSSI, and demographic characteristics; anxiety and NSSI were reassessed at Time 2 (T2). Autoregressive regression models adjusted for baseline anxiety or NSSI as appropriate, together with age, gender, and urban/rural residence. Indirect effects were estimated with 5,000 bootstrap resamples, and interaction terms were used to examine first- and second-stage moderation. Results Higher T1 PA was associated with lower T2 NSSI after adjustment for T1 NSSI. The indirect association through T2 anxiety was −0.12 [95% CI (−0.18, −0.06)], representing 48.0% of the reported total association. T1 social support significantly moderated the T1 PA-T2 anxiety association ( p = 0.003); simple-slope estimates indicated a stronger inverse PA-anxiety association at higher social support. Social support did not significantly moderate the T2 anxiety-T2 NSSI association ( p = 0.281). Conclusion The findings are consistent with a model in which greater PA is prospectively associated with lower NSSI partly through lower subsequent anxiety, while social support may shape the PA-anxiety link. Because anxiety and NSSI were measured concurrently at follow-up, the indirect effect should not be interpreted as definitive causal mediation. Multi-wave and intervention studies are needed to establish temporal ordering and causality.

Background and objectives Health literacy in adulthood plays a major role in an individual’s ability to use health information to benefit their health. Social determinants in early childhood initiate the development of health literacy through newborn brain development and oral language acquisition. Both of these processes are promoted by stimulation from everyday interactions with parents/caregivers at home and in the community. Unequal access to language-learning opportunities during early childhood represents a modifiable developmental and social determinant of later educational and health outcomes. There are inequities in these time-sensitive interactions—specifically language-learning opportunities—across families in the population, which are social determinants of early literacy, achievement in school, and later-life education, health, and economic and social well-being across the life span. This gap is most pronounced among children who grow up in poverty in the United States and internationally. The healthcare system in the United States effectively reaches to nearly all infants; however, language-learning opportunities are not a focus during well-child visits. The term “Language Nutrition” (LN) was coined in prior research to refer to these developmentally rich interactions known to support brain and language growth in children younger than preschool age. We developed Kansas City Brain Builders (KCBB) to address this inequity by promoting LN broadly among families and children in a community so that all children have a more equitable home language environment. The purpose of this study is to report longitudinal empirical findings on families and children related to the implementation of KCBB, a public health approach to community change, over 2 years. Methods The evaluation involved two parallel longitudinal studies: the Community study and the Family study. The Community study assessed the implementation of a KCBB multisectoral community partnership to promote LN-friendly changes in local programs, practices, and policies. The Family study involved longitudinal assessments of a sample of 83 English- and Spanish-speaking families with children younger than 36 months of age, evaluating the KCBB impacts on parental behaviors and child growth in language skills. Results KCBB led to a high level of documented program implementation and substantial LN promotion throughout the community. Repeated parent assessments indicated that participants had received LN messages from multiple community sectors over time, increased their knowledge of the importance of LN, and used LN through storybook reading, verbal responsiveness, and teaching behaviors during interactions with their children. Growth in children’s early language skills was significantly associated with the amount of LN they received. Discussion/Conclusion KCBB is one of the few multisectoral interventions designed to promote community-wide change targeting LN. It is a manualized intervention that can be replicated by other communities. This study employed three levels of measurement such that change could be evaluated in a theoretical framework of influence from community engagement to parental behavior and growth in child language skills. Findings provide preliminary evidence that a multisectoral community approach can achieve broad reach and is associated with changes in caregiver practices and child language growth. Larger, controlled, and replicated studies are needed to establish causal effects and determine whether such approaches reduce disparities in language-learning opportunities.

With the World Health Organization (WHO) estimating 720,000 deaths from suicide each year, the phenomenon of suicide is a priority in public health policy. International policy frameworks highlight the need to adopt biopsychosocial perspectives in order to understand the phenomenon of suicide; however, in practice, it is noted that social components play a minor role in policy design, with a preference for a biopsychological and clinical approach. This paper seeks to answer the question: Does Spanish public policy on suicide prevention operationalize the biopsychosocial model of suicide in its strategic implementation? To answer this question, a documentary analysis of public policies is carried out using the READ method. Current suicide policies in force in Spain are examined at three levels: transnational framework documents, national policies, and regional public policies. In the 15 policies analyzed, a lexicometric analysis is combined with a thematic qualitative policy analysis. The results show that, as one moves down to policies closer to the population, a gap emerges between the discursive use of the biopsychosocial model and its practical application. It is concluded that at the transnational and national policy levels, the biopsychosocial model predominates in the understanding of suicide, while in Spain’s autonomous communities, the psychobiological approach tends to be prioritized over social causes. This has an impact on the types of measures proposed, which have limited intersectional scope, a narrow view of the community-based approach, and prioritize healthcare resources to address the phenomenon of suicide.

Background Sleep problems are common among university students due to academic stress, lifestyle factors, and psychological distress and may adversely affect physical and mental health, academic performance, and social functioning. Mindfulness-based interventions (MBIs) have increasingly been used as a non-pharmacological approach to improve sleep health; however, previous findings remain inconsistent, and evidence specifically addressing sleep quality in university students remains limited. This study aimed to systematically evaluate the effects of MBIs on sleep quality in university students and explore factors that may account for variations in intervention effects. Methods We searched seven databases—PubMed, Web of Science, EBSCO, the Cochrane Library, Scopus, Embase, and ScienceDirect—from inception to June 26, 2026. Randomized controlled trials (RCTs) evaluating MBIs for sleep quality in university students were included. Two reviewers independently conducted study selection, data extraction, and risk-of-bias assessment using the RoB 2 tool. Meta-analysis was conducted in Stata 17.0 using a random-effects model. Subgroup analyses, sensitivity analyses, publication bias assessment, and GRADE assessment were also performed. Results Ten RCTs involving 638 university students were included, with 335 participants in the intervention groups and 303 in the control groups. MBIs significantly improved sleep quality [SMD = −0.97, 95% CI (−1.43, −0.51), p < 0.001], although substantial heterogeneity was observed ( I 2 = 85.1%). Subgroup analyses revealed statistically significant between-group differences with respect to sleep-outcome measurement instrument ( p = 0.001), intervention type ( p = 0.009), and session duration ( p = 0.030), indicating that these variables may partially account for the observed heterogeneity. Sensitivity analyses supported the robustness of the pooled results. Egger’s test revealed no evidence of significant publication bias ( p = 0.270). The certainty of the evidence was rated as low according to the GRADE framework. Conclusion MBIs may improve sleep quality in university students. However, given the substantial heterogeneity and low certainty of evidence, further high-quality RCTs are needed to confirm these findings. Systematic review registration CRD420261458068, https://www.crd.york.ac.uk/PROSPERO/view/CRD420261458068 .

Background As global aging accelerates, age-related psychophysiological conditions have emerged as major public health concerns. Promoting and sustaining vitality, an inherent human capacity, is essential for healthy aging and long-term well-being. The Mindfulness-based Vitality Promotion (MVP) program is a mindfulness-based behavioral intervention designed to enhance physical and psychological vitality and support sustainable well-being. This study evaluated the feasibility and acceptability of the MVP program and explored preliminary pre–post changes in health-related outcomes among community-dwelling individuals in a lifelong learning setting. Methods This study employed a single-arm mixed-methods design. A total of 35 participants were recruited for this study. The MVP program was delivered over 8 weeks, with each session lasting 90 min. Quantitative data were collected through self-report questionnaires, and qualitative data were obtained via semi-structured interviews. Feasibility and acceptability were assessed based on program retention, session attendance, and participant satisfaction. Results Quantitative analysis revealed significant pre–post increases in integrative vitality and well-being, along with significant reductions in depression, fatigue, and anxiety. No statistically significant changes were observed in pain, sleep disturbance, digestive symptoms, anger, or mindfulness. Of the 35 enrolled participants, 31 completed the program (88.6%), with a mean attendance of 6.37 of eight sessions. Among the 30 satisfaction survey respondents, 28 (93.3%) indicated willingness to participate again and 30 (100%) indicated willingness to recommend the program to others. The qualitative analysis identified four major themes: (i) diverse life challenges and self-care needs, (ii) learning through experience, connection, and application, (iii) regaining balance and agency in life, and (iv) sustaining practice requires continued support. Conclusion Mixed-methods findings provide preliminary information regarding the feasibility and acceptability of the MVP program and indicate favorable pre–post changes in several self-reported health-related outcomes. The MVP program may represent a practical lifelong learning intervention with potential relevance for public health promotion. Further controlled studies are warranted to establish its efficacy. Trial registration The trial was first submitted to the Clinical Research Information Service, Republic of Korea (KCT0009961, https://cris.nih.go.kr/cris/search/detailSearch.do?seq=28524&search_page=L ), on October 8, 2024, before participant enrollment began, and registration was finalized on November 28, 2024.