Acceptability study of a co-designed educational game about dementia for children: The Kids Dementia Game

BACKGROUND

Dementia has physical, psychological, social and economic impacts, not only for people living with dementia, but also for their carers, families and wider society. Due to the growing number of people living with dementia, children are increasingly likely to encounter family members living with dementia. The aim of this project was to pilot an educational game which was co-designed with children and people living with dementia with the intention of improving children's understanding and perception of dementia.

RESEARCH DESIGN AND METHODS

An acceptability study of the Kids Dementia Game was conducted in three classes in three schools in Northern Ireland. This study investigated acceptability of the game and the feasibility of online data collection using a pre-post test methodology to explore how best to collect evaluation data if the game was to be delivered on a larger scale.

RESULTS

Evaluation of the game with children showed a positive level of acceptability of the game. Children found the game engaging, easy to navigate and fun to play. Feasibility of the data collection method was found to be a barrier to the pre-post test evaluation of the game.

DISCUSSION AND IMPLICATIONS

These findings suggest that the game shows evidence of promise for improving public perception and understanding of dementia using an early intervention approach with children.

"Phone in the Room, Mind on the Roam": Investigating the Impact of Mobile Phone Presence on Distraction

In the digital age, mobile phones significantly impact human cognition and behavior. This experimental study examined the effects of passive mobile phone presence on attentional control in young adults aged 18-25. Participants were randomly assigned to a control (no phone) or an experimental group (phone present). Attention control was measured using the Attention Network Test (ANT). In contrast, smartphone nomophobia and addiction were measured with the Nomophobia Questionnaire (NMP-Q) and the Smartphone Addiction Scale-Short Version (SAS-SV). Contrary to previous literature, the presence of a mobile phone did not significantly distract participants or impair attentional performance. No significant relationship emerged between self-reported levels of distraction or nomophobia and actual attentional performance, although smartphone addiction seemed to have a weak effect on the errors made by those who performed in the presence of their mobile phone. Significant gender differences were found in terms of nomophobia, with women reporting higher levels than men. This study suggests that the relationship between mobile phone presence and attentional processes is more complex than previously hypothesized, bringing the existing literature under further consideration.

Risk factors for cardiovascular disease among Saudi students: Association with BMI, current smoking, level of physical activity, and dietary habits

Cardiovascular disease (CVD) risk factors, including poor diet, lack of physical activity (PA), smoking, and obesity, are associated with unhealthy lifestyle choices and contribute significantly to the global disease burden. This study aims to investigate the prevalence of behavioral risk factors associated with overweight/obesity, PA, smoking, and eating habits among Saudi students and explores how these vary by region, age, gender, relationship status, and income. A total of 968 participants (285 males and 681 females), aged 18-50, were recruited from bachelor's, master's, doctoral, and other university programs across the Eastern, Riyadh, and Western provinces. Each participant completed the Saudi Food Frequency Questionnaire (SFFQ). The risk of CVD was assessed by summing individual risk factors related to BMI, tobacco use, PA level, glycemic load (GL) of ingested foods, and consumption of saturated fats (SF), processed meats, oily fish, nuts, and cereal fiber (CF). Participants were classified into minimal, medium, or high-risk categories based on their total scores. A high prevalence of CVD risk factors was observed, with 93.6% of participants having three or more risk factors. After adjusting for demographic variables, living in Riyadh was associated with a 12% lower probability of CVD risk. Conversely, students aged 46-50 showed a five- to nine-fold increase in CVD risk. Significant factors influencing CVD risk included BMI (Exp(β) = 11.70), smoking status (Exp(β) = 6.54), PA (Exp(β) = 7.61), SF intake (Exp(β) = 4.79), GL (Exp(β) = 7.00), CF intake (Exp(β) = 24.58), and oily fish consumption (Exp(β) = 2.99). Low CF intake and high BMI were the most prominent risk factors. Lifestyle interventions targeting overweight/obesity, physical inactivity, smoking, high GL and SF intake, and promoting CF and oily fish consumption could improve CV health among participants. Addressing these modifiable risk factors is essential for effective prevention.

Loneliness Links Adverse Childhood Experiences to Mortality Risk Across 26 Years

OBJECTIVES

Adverse childhood experiences (ACEs) are associated with increased mortality risk. Individuals with a history of certain adversity during childhood tend to report higher levels of loneliness in later life. In our preregistered study, we examined whether loneliness mediates the ACEs to mortality risk relation.

METHODS

Participants were from the Midlife in the United States Survey (N = 4,963; M [SD] = 46.44 [12.52] years, 53.3% female). Follow-up period spanned 26 years. A comprehensive measure of ACEs was employed consisting of 20 ACEs from 5 categories: physical abuse, emotional abuse, socioeconomic disadvantage, adverse family structure, and poor health at age 16 years.

RESULTS

ACE was a significant predictor of mortality risk. Loneliness mediated the ACEs-mortality risk relation. In other words, loneliness in adulthood accounted for the relation between ACEs and future death. These effects withstood a range of sensitivity checks and adjustments for important factors, such as social isolation.

DISCUSSION

Loneliness appears to be a central mechanism in the long-term impact of ACEs on longevity, such that, for adversity during childhood, loneliness experienced during adulthood may be a toxic pathway to future death.

Improving Acceptability of mHealth Apps-The Use of the Technology Acceptance Model to Assess the Acceptability of mHealth Apps: Systematic Review

BACKGROUND

Mobile health apps (MHAs) are increasingly used in modern health care provision. The technology acceptance model (TAM) is the most widely used framework for predicting health care technology acceptance. Since the advent of this model in 1989, technology has made generational advancements, and extensions of this model have been implemented.

OBJECTIVE

This systematic review aimed to re-examine TAM models to establish their validity for predicting the acceptance of modern MHAs, reviewing relevant core and extended constructs, and the relationships between them.

METHODS

In this systematic review, MEDLINE, Embase, Global Health, APA PsycINFO, CINAHL, and Scopus databases were searched on March 8, 2024, with no time constraints, for studies assessing the use of TAM-based frameworks for MHA acceptance. Studies eligible for data extraction were required to be peer-reviewed, English-language, primary research articles evaluating MHAs with health-related utility, using TAM as the primary technology acceptance evaluation framework, and reporting app use data. Data were extracted and grouped into 5 extended TAM construct themes. Quality assessment was conducted using the Joanna Briggs Institute (JBI) tools. For cross-sectional methodologies (9/14, 64%), the JBI checklist for analytical cross-sectional studies was used. For non-cross-sectional studies (5/14, 36%), the JBI checklist most relevant to the specific study design was used. For mixed methods studies (1/14, 7%), the JBI checklist for qualitative studies was applied, in addition to the JBI checklist most suited to the quantitative design. A subsequent narrative synthesis was conducted in line with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology.

RESULTS

A total of 2790 records were identified, and 14 were included. Furthermore, 10 studies validated the efficacy of TAM and its extensions for the assessment of MHAs. Relationships between core TAM constructs (perceived usefulness, perceived ease of use, and behavioral intention) were validated. Extended TAM constructs were grouped into 5 themes: health risk, application factors, social factors, digital literacy, and trust. Digital literacy, trust, and application factor extended construct themes had significant predictive capacity. Application factors had the strongest MHA acceptance predictive capabilities. Perceived usefulness and extended constructs related to social factors, design aesthetics, and personalization were more influential for those from deprived socioeconomic backgrounds.

CONCLUSIONS

TAM is an effective framework for evaluating MHA acceptance. While original TAM constructs wield significant predictive capacity, the incorporation of social and clinical context-specific extended TAM constructs can enhance the model's predictive capabilities. This review's findings can be applied to optimize MHAs' user engagement and minimize health care inequalities. Our findings also underscore the necessity of adapting TAM and other acceptability frameworks as the technological and social landscape evolves.

TRIAL REGISTRATION

PROSPERO CRD42024532974; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024532974.

Implementation of tobacco control policy at the local level in Thailand: Performance evaluation and associated factors

INTRODUCTION

Tobacco use is one of the top five risk factors for disability-adjusted life years globally, including Thailand. Consequently, Thailand has enacted the Tobacco Products Control Act in alignment with the World Health Organization Framework Convention on Tobacco Control. To facilitate national tobacco control policies at the local level, Provincial Tobacco Products Control Committees (PTPCCs) have been established in all 77 provinces. This study aimed to assess the performance of PTPCCs in implementing the tobacco control policy and to identify its associated factors.

METHODS

This cross-sectional survey utilized a self-reported online questionnaire to collect data between May and August 2023. The target population comprised secretaries of PTPCCs across 77 provinces. The survey achieved a completion rate of 75.32%, with responses from 58 provinces.

RESULTS

Among the 58 responding provinces, 53% achieved the law enforcement indicator, 43% met the target for prevention of new smokers, and only 34% achieved the smoking cessation performance. Multiple logistic regression analysis revealed that adequate access to policy information was strongly associated with achieving law enforcement (AOR=10.53; 95% CI: 1.20-92.23). The availability of adequate media resources was significantly associated with successful prevention of new smokers (AOR=8.64; 95% CI: 2.09-35.67). Stronger characteristics of implementing agencies - referring to the provincial governor's commitment to tobacco control policy and the engagement of public and private stakeholders - were positively associated with smoking cessation performance (AOR=2.05; 95% CI: 1.13-3.71).

CONCLUSIONS

PTPCCs should be strengthened through adequate access to policy information, sufficient media resources, and strong provincial leadership with multi-sectoral engagement, as these factors are critical to effective policy performance. Enhancing these components will improve the implementation of tobacco control policy at the local level.

The relationship between physical activity and social network site addiction among adolescents: the chain mediating role of anxiety and ego-depletion

BACKGROUND AND OBJECTIVES

Physical activity is associated with social network site addiction in adolescents, yet the mechanisms remain unclear. This study examines whether anxiety and ego-depletion mediate this relationship.

METHODS

A survey was conducted among 1,174 Chinese adolescents (614 boys, 560 girls; mean age = 12.59, SD = 1.13). Physical activity was assessed with a single item on moderate-to-vigorous exercise in the past 7 days. Social network site addiction, anxiety, and ego-depletion were measured using validated self-report questionnaires. Descriptive statistics, correlation analyses, and a chained mediation model were employed.

RESULTS

Physical activity was negatively correlated with social network site addiction (r = -0.165, p < 0.001), anxiety (r = -0.121, p < 0.001), and ego-depletion (r = -0.119, p < 0.001). Anxiety was positively correlated with ego-depletion (r = 0.574, p < 0.001) and social network site addiction (r = 0.388, p < 0.001). Ego-depletion was positively associated with social network site addiction (r = 0.456, p < 0.001). Anxiety and ego-depletion sequentially mediated the relationship between physical activity and social network site addiction.

CONCLUSION

This study clarifies the psychological mechanisms linking physical activity and social network site addiction in adolescents, identifying anxiety and ego-depletion as key mediators. The findings emphasize the need to target these factors for more effective interventions.

Identifying context-specific determinants to inform improvement of antimicrobial stewardship implementation in healthcare facilities in Asia: results from a scoping review and web-based survey among local experts

International guidelines are available for the assessment and improvement of antimicrobial stewardship (AMS) programmes: an important strategy to address the escalating global antimicrobial resistance problem. However, existing AMS assessment tools lack contextual specificity for resource-limited settings, leading to limited applicability in Asia. This project aimed to identify relevant themes from current guidance documents to help develop a context-specific assessment tool that can be applied by healthcare facilities (HCFs) to improve local implementation.We performed a sequential approach of a scoping review to identify relevant assessment themes for Asia and an expert survey for getting feedback on the relevance of assessment stems developed from the scoping review. We reviewed English-language published documents discussing AMS implementation or assessment at HCFs globally and in Asia. Themes were derived through content analysis and classified following the predefined context dimensions to develop assessment stems, defined as containing one identified determinant that may influence implementation outcomes. The survey consisting of identified assessment stems was reviewed by 20 locally identified experts in Asia who rated the level of relevance of these stems in AMS implementation in the region.National leadership, training and technical support, and policy and guidance were the most commonly identified themes among 100 themes identified from 73 reviewed documents. From these themes, we developed 131 assessment stems for the expert survey. Of the 131 assessment stems, 117 (89%) were considered relevant for AMS implementation in Asia by at least 80% of respondents. These stems were included in the process of developing a global AMS assessment tool to support HCFs to improve their programmes.In conclusion, national leadership and support represent a distinct and important aspect affecting AMS implementation in HCFs in Asia. The identified assessment themes have substantial value for the formulation of locally relevant implementation strategies tailored to the Asian context.

The broad range of self-management strategies that people with rheumatic and musculoskeletal conditions apply: an online survey using a citizen science approach

Rheumatic and musculoskeletal diseases (RMDs) cause several restrictions in daily living. Self-management is an important aspect of managing RMDs. However, little is known about the self-management strategies that are currently applied in daily life. This study aimed to identify the current self-management strategies that people with RMDs apply through a citizen science approach. An online survey was iteratively developed together with people with RMDs. The survey was distributed among people with all types of RMDs. Survey responses were collected within Qualtrics, and once anonymized, analysed using Atlas.ti. General self-management strategies and motivations to start performing a strategy were deductively coded by two reviewers, after consultations with patient partners. 250 complete surveys were collected. 91.2% of the respondents were female. 1305 self-management strategies were mentioned, and 669 elaborations were given. Most participants applied self-management strategies within the 'physical activity' category in their daily lives (e.g., walking, biking). Motivations to start performing a certain self-management strategy mostly originated from the bodily functioning dimension (e.g., reducing pain). 1275 facilitators to start a self-management strategy were mentioned, which were mostly related to the 'support' category. Barriers (N = 480) were most frequent in the 'condition-related' category. Self-management is an important aspect of managing a person's condition in daily life. People choose one or several strategies based on the challenge they are facing, depending on their feasibility and preferences in line with their personal context. The comprehensive overview of strategies informs both patients and healthcare professionals to support a personalized self-management journey.

Quality of life in Saudi Arabia: a patient-reported outcome measurement information system (PROMIS) - 10 global health study

BACKGROUND

Measuring the quality of life of a population provides a baseline for future comparisons and is essential for decision-makers, especially regarding resource allocation. Despite substantial investment in healthcare services in Saudi Arabia, no study has captured the general Saudi population's overall health-related quality of life. This study utilized existing healthcare system data to develop reference values for the Patient-Reported Outcome Measurement Information System - Global Health (PROMIS-GH) survey for the population in Saudi Arabia and to examine associated sociodemographic predictors of health-related quality of life.

METHODS

From a nationwide survey conducted by the Saudi Ministry of Health, records of 40,000 out of 37,160,000 individuals were randomly selected with stratification for sex, age groups and regions. Participants received notifications via the national digital health platform (Sehhaty) to complete the PROMIS-GH survey.

RESULTS

A total of 3,630 individuals filled out the survey (response rate of 9.1%); the mean age was 38.6 ± 12.1 years, and 60.1% (n = 2182) were men. The general Saudi population had mean T-scores of 50.5 (± 10.3) for global mental health and 48.5 (± 9.8) for global physical health, both classified as "very good" based on the established Saudi-specific thresholds. Being Saudi or female was associated with lower physical and mental health scores.

CONCLUSION

The health-related quality of life scores in Saudi Arabia are classified as "very good"; however, disparities exist. Future studies are needed to further investigate the reasons behind the sociodemographic and regional variations in HRQoL among the general population of Saudi Arabia.

"Sport is NOT a luxury." The perceived impact of the cost-of-living crisis on sport and physical activity opportunities for children and adolescents in Northern Ireland (NI): A cross-sectional survey

BACKGROUND

Worldwide, it is of public health concern that the majority of children and adolescents fail to meet physical activity guidelines. Evidence shows a positive association between socioeconomic status (SES) and levels of physical activity. Socioeconomic health inequalities are persistent and the socioeconomic gap in physical activity may be exacerbated during periods of economic downturn such as the current cost-of-living crisis affecting many countries globally. This study aimed to understand the perceived impact of the cost-of-living crisis on access to sport and physical activity opportunities for children and adolescents.

METHODS

Parents/guardians (aged > 18 years) resident in Northern Ireland (NI) were invited to participate in an online survey (March-June 2024) which assessed SES, parental support for physical activity and the perceived impact of the cost-of-living crisis on access to sport and physical activity opportunities for children and adolescents. Thematic (qualitative data) and statistical analysis (quantitative data) was undertaken.

RESULTS

In total, 855 parents/guardians completed the survey. The majority of parents/guardians (85%) agreed that sport and physical activity were important for their children to manage stress, however, 30% were unable to afford the equipment and clothing that their children needed to participate in sport/physical activity. More than a third of parents/guardians (35%) had reduced spending on sport and physical activity for their children since the onset of the cost-of-living crisis. For 37% of parents/guardians, their children had missed out on sport/physical activity because of the costs involved and 24% of parents/guardians reported using credit or borrowing money to cover sport and physical activity costs. The perceived impact of the cost-of-living crisis on sport and physical activity opportunities for children varied by SES. A greater proportion of parents/guardians with lower SES reported reducing spending and borrowing money to cover sport/physical activity related costs.

CONCLUSIONS

Despite parental support for children's sport and physical activity, cost was a barrier for many families. The 'socioeconomic gap' in physical activity and sports provision was evident and although establishing positive physical activity and sedentary behaviours during childhood is crucial, the cost-of-living crisis is likely to worsen the existing SES gap in physical activity and requires urgent intervention.

TRIAL REGISTRATION

N/A.

Social media use in adolescents with and without mental health conditions

Concerns about the relationship between social media use and adolescent mental health are growing, yet few studies focus on adolescents with clinical-level mental health symptoms. This limits our understanding of how social media use varies across mental health profiles. In this Registered Report, we analyse nationally representative UK data (N = 3,340, aged 11-19 years) including diagnostic assessments by clinical raters alongside quantitative and qualitative social media measures. As hypothesized, adolescents with mental health conditions reported spending more time on social media and were less happy about the number of online friends than adolescents without conditions. We also found hypothesized differences in social media use by condition type: adolescents with internalizing conditions reported spending more time on social media, engaging in more social comparison and experiencing greater impact of feedback on mood, alongside lower happiness about the number of online friends and lower honest self-disclosure. In contrast, those with externalizing conditions only reported higher time spent. These findings emphasize the need to consider diverse adolescent mental health profiles in policy and clinical practice.

The impact of ChatGPT training in the nursing process on nursing students' problem-solving skills, attitudes towards artificial intelligence, competency, and satisfaction levels: Single-blind randomized controlled study

AIM

This study aimed to evaluate the impact of training on the use of ChatGPT in the nursing process on nursing undergraduate students' problem-solving skills, attitudes towards artificial intelligence, competencies related to the nursing process, and satisfaction levels.

DESIGN

Single blind randomized controlled study.

METHODS

The sample of the study consisted of 48 experimental and 48 control groups, totaling 96 nursing students. The intervention group received the "Artificial Intelligence Integrated Nursing Process" training program. The control group only received the standard nursing process education. The data collection instruments were administered before the training and after the training. Chi-square analysis was used to compare variables, independent samples t-tests were used for comparisons between groups, and paired t-tests were used for within-group comparisons.

RESULTS

In the post-education measurements, students in the intervention group demonstrated a significantly lower average total problem solving inventory score compared to those in the control group, indicating an improvement in problem-solving skills. The intervention group showed an increase in positive attitudes towards artificial intelligence compared to the control group and a decrease in negative attitudes. In the intervention group, students showed a significant increase in their nursing process competency levels and satisfaction levels after the training, whereas no significant change was observed in the control group.

CONCLUSION

This study demonstrates that the training provided on the use of ChatGPT in the nursing process positively impacted nursing students' problem-solving skills, attitudes towards artificial intelligence, competencies related to the nursing process, and levels of satisfaction.

Updates and current trends in deaf education teacher preparation programs: an update to Dolman (2010)

Deaf education teacher preparation programs (TPP) are essential for ensuring that teachers entering the classroom are equipped with the most up-to-date knowledge and skills for providing effective education to deaf and hard of hearing learners. However, research over a decade old already suggested that enrollment, graduation rates, and even numbers of programs has been on the decline even while demand for deaf education teachers remains steady. The purpose of this article was to update our current knowledge in the field of deaf education TPP, including the number of programs still operating, their student enrollment and demographics, their instructor employment, demographics, and areas of expertise. We found that despite a deep need for trained teachers, programs have continued to close since the most recent survey (completed in 2010). We also note a significant demographic mismatch between current faculty leading preparation programs, the pre-service teachers enrolled in these programs, and deaf and hard of hearing students enrolled in PK-12 schooling. These findings indicate the need to push for programs to operate despite relatively small numbers, as well as the need to purposefully recruit diverse faculty and future teachers working in deaf education classrooms.

Crisis pack prescribing in terminal haemorrhage: a national survey of specialist palliative medicine physicians

OBJECTIVES

To establish practice among senior palliative medicine physicians regarding anticipatory prescribing to manage a terminal haemorrhage.To generate a guideline informed by data collected.

METHODS

An electronic questionnaire was sent to palliative medicine consultants and specialist registrars in Ireland.

RESULTS

The response rate was 50%. All respondents (100%) prescribe crisis packs. The most prescribed medications were morphine and midazolam. Over 95% prescribe medication via the subcutaneous route. Regarding indications for prescribing, about two-thirds of respondents would prescribe for a patient with a head and neck malignancy. Almost two-thirds of respondents do not follow any policy or guideline. The main area of variation is in the dose prescribed for those already on a scheduled opioid and/or benzodiazepine.

CONCLUSIONS

The proposed guideline is based on the expert opinion of questionnaire respondents. The recommended medications, route of prescription and broad indications for prescribing included in the guideline were based on a clear consensus. Most respondents vary the dose of crisis medication prescribed based on whether the patient is on a baseline anxiolytic/opioid. As the calculations used for dose variation were not consistent between respondents, the most reported calculation, 1/6 of 24-hour dose, is recommended in the guideline.

Acceptability and Usability of a Digital Behavioral Health Platform for Youth at Risk of Suicide: User-Centered Design Study With Patients, Practitioners, and Business Gatekeepers

BACKGROUND

Youth suicide rates are climbing, underscoring the need to improve clinical care. Personal smartphones can provide an understanding of proximal risk factors associated with suicide and facilitate consistent contact between patients and practitioners to improve treatment engagement and effectiveness. The Vira digital behavior change platform (Vira) consists of a patient smartphone app and a web-based practitioner portal (Vira Pro) that integrates objective mobile sensing data with Health Insurance Portability and Accountability Act (HIPAA)-compliant communication tools. Through Vira, practitioners can continuously assess patients' real-world behavior and provide clinical tools to enhance treatment via just-in-time behavior change support.

OBJECTIVE

This study aimed to explore the acceptability and usability of the minimal viable product version of Vira through a user-centered design (UCD) approach and to identify barriers to implementing Vira in the context of an adolescent intensive outpatient program.

METHODS

Over 2 iterative phases, feedback was gathered from adolescent patients (n=16), mental health practitioners (n=11), and business gatekeepers (n=5). The mixed methods UCD approach included individual semistructured interviews (eg, perspectives on treatment and attitudes toward digital tools), surveys (eg, usability), and unmoderated user testing sessions (eg, user experience).

RESULTS

Overall, participants expressed optimism regarding Vira, particularly among adolescents, who showed high satisfaction with the app's interface and design. However, clinicians reported more mixed views, agreeing that it would be useful in treatment but also expressing concerns about the volume and displays of patient data in Vira Pro, workload management, and boundaries. Gatekeepers identified usability issues and implementation barriers related to electronic health records but also recognized Vira's potential to enhance treatment outcomes. Feedback from stakeholders informed several crucial changes to the platform, including adjustments to data-sharing protocols, user interface enhancements, and modifications to training methods.

CONCLUSIONS

Vira has a high potential to improve patient engagement and improve clinical outcomes among high-risk youth. Iterative UCD and ongoing stakeholder engagement are essential for developing technology-based interventions that effectively meet the needs of diverse end users and align with clinical workflows.

To focus on a confederate or oneself? Attentional bias and state anxiety in socially anxious individuals during real-time online video calls

Attentional bias toward threatening stimuli and heightened self-focused attention are pivotal factors in the activation and perpetuation of high social anxiety. Literature on attentional biases between external social cues and self-relevant information has yielded inconsistent findings due to diverse experimental tasks and materials. With a videoconferencing platform and eye-tracking technology, this study assessed state anxiety and attentional bias between self- and other-related cues among individuals with different sex and social anxiety levels (n = 82) in various social contexts (speech and conversation) and social feedback (positive, neutral, and negative). Eye-movement data revealed that individuals focus more on the other person than themselves during online video interactions. However, individuals with high social anxiety tend to focus more on themselves and less on others compared to those with low social anxiety, particularly in males. Males with high social anxiety distributed their attention equally between their social partners and themselves, while females with high social anxiety did not. Self-reported data indicated higher anxiety during speeches than conversations. Those with high social anxiety showed significant differences from baseline levels during tasks, in contrast to those with low social anxiety. Subjective anxiety was more pronounced for negative feedback than for neutral or positive feedback, especially in females. These findings enhance understanding of attentional biases in individuals with high social anxiety and suggest that videoconferencing could benefit therapy for individuals with social anxiety disorder.

Social media are many things: Addressing the components and patterns of adolescent social media use

Adolescent development is increasingly shaped by social media contexts, with implications for well-being. In this commentary, we discuss and present conceptual and methodological alternatives for two persistent limitations in prior research. First, most prior work measures screen time, implicitly treating social media as a monolith. Emerging research highlights that social media are multifaceted environments where youth encounter diverse experiences. We advocate for more work taking this nuanced approach and for the development of a comprehensive taxonomic framework that categorizes specific online experiences afforded by social media features and content. To support this approach, we call for the development of psychometrically rigorous self-report scales to measure affective and cognitive social media experiences and for innovative behavioral observation techniques. Second, research that considers specific online experiences typically focuses on one in isolation. We argue that a holistic, interactionist approach to understanding human development requires integrating the numerous positive and negative online experiences that co-occur in distinct patterns for diverse adolescents. We discuss the merits of mixture models as one potential analytic solution to address configurations of online experiences and systematically model heterogeneity among youth. These conceptual and methodological shifts can lead to targeted interventions and policies that recognize the interactive effects of digital experiences.

Gender differences in the prevalence and psychopathological mechanisms of internet addiction among Iranians aged 18 to 24: A nationwide study

BACKGROUND

The rapid advancement of technology has revolutionized interaction, learning, and entertainment but also led to Internet addiction, characterized by excessive internet use causing impairment or distress.

OBJECTIVE

The study explores gender differences in prevalence, risk factors, and clinical aspects of Internet addiction among Iranian youth, highlighting cultural and societal influences.

METHODS

A nationwide sample of 3149 individuals aged 18 to 24 was categorized into two groups: those with Internet addiction (n = 1040) and those without (n = 2109). Participants completed the Childhood Trauma Questionnaire-28, Dissociative Experiences Scale (DES), Difficulties in Emotion Regulation Scale (DERS), and Internet Addiction Test (IAT). Data analyses were conducted using SPSS software version 26, with a significance level set at <0.05.

RESULTS

Overall prevalence of Internet addiction was found to be 33 %, with a higher incidence in males (63.3 %) compared to females (36.7 %) (χ2 = 13.28, p = 0.001). In men, the severity of Internet addiction was significantly linked to emotional abuse (β = 0.20, p˂0.001), DES (β = 0.39, p˂0.001), and DERS (β = 0.16, p˂0.001) (F(3, 654) = 89.85, p˂0.001, R2 = 0.29); while in women, it was associated with emotional abuse (β = 0.18, p˂0.001) and dissociative experiences (β = 0.16, p˂0.001) (F(2, 379) = 13.70, p˂0.001, R2 = 0.06). The DES partially mediated the relationship between emotional abuse and IAT scores in both genders, whereas DERS only did so in males.

CONCLUSIONS

The study suggests Internet addiction as a maladaptive coping mechanism for early emotional abuse, highlighting the need for prevention programs and emotion regulation interventions. Future research should consider longitudinal effects and cultural influences.

Physicians-in-training and advanced practice providers perceptions in managing perioperative obstructive sleep apnea: a multi-institutional survey

STUDY OBJECTIVES

Physicians-in-training (residents, fellows) and advanced practice providers (APPs) receive limited education on sleep disorders, including obstructive sleep apnea (OSA). They often assess patients first. We aimed to understand their views on OSA and screening for OSA in the perioperative period.

METHODS

Electronic-mail surveys were sent to physicians-in-training and APPs, in 5 categories of practice (anesthesiology, internal medicine, family medicine, obstetrics/gynecology/gynecologic oncology, and surgery) at 9 major institutions. Cochran-Mantel-Haenszel tests evaluated associations between participant characteristics (clinical role, physician years of training, APP years of practice, categories of practice) and survey responses (perception of OSA, perioperative risk factor, screening/managing of perioperative OSA) stratified by institution. False discovery rate (FDR) adjustment accounted for multiple comparisons (FDR-adjusted-P values) of associations between multiple characteristics and a given response. Breslow-Day tests evaluated the homogeneity of odds ratios from Cochran-Mantel-Haenszel tests.

RESULTS

We received 2,236/6,724 (33.3%) responses. Almost all (97%) agreed OSA represents a risk factor for perioperative complications. Many (37.9%) were unaware which screening tool was used at their institution, with differences by clinical role (FDR-adjusted-P < .001), with APPs reporting not knowing more than residents and fellows, and across category of practice (FDR-adjusted-P < .001). While 66.5% routinely asked perioperative patients about signs/symptoms of OSA, 33.5% did not. There were differences by clinical role (FDR-adjusted-P < .001), as APPs reported asking about OSA more frequently than residents/fellows; and, by category of practice (FDR-adjusted-P < .001) as anesthesia and medical specialties reported asking about OSA more than surgical services. Importantly, approximately half of the respondents in surgery (48%) and obstetrics/gynecology/gynecologic oncology (46%) reported not routinely asking. Differences also existed by physician postgraduate year clinical training (FDR-adjusted-P = .005) with those with higher postgraduate year reporting they asked about OSA more often.

CONCLUSIONS

Significant differences exist in screening by clinical roles and categories of care. This highlights the importance of improving provider education on the role of OSA in perioperative risk assessment and patient care.

CITATION

Lyons MM, Auckley DH, Mokhlesi B, et al. Physicians-in-training and advanced practice providers perceptions in managing perioperative obstructive sleep apnea: a multi-institutional survey. J Clin Sleep Med. 2025;21(5):765-773.

The correlation between mindfulness and problematic smartphone use: A meta-analysis

OBJECTIVES

In the modern era of constant digital technological advancements, problematic smartphone use has become a key issue in educational psychology. This phenomenon affects individual psychological well-being and academic or other performance and encompasses interpersonal relationships and societal aspects, divulging the intricate correlation between technology usage and human behavior. This study aims to explore mindfulness as an intervention measure to lessen problematic smartphone use.

METHODS

Based on the PRISMA method, this study used a meta-analytic approach to explore the relationship between mindfulness and problematic smartphone use systematically. Systematic literature searches for papers published before February 2024 yielded 29 studies, including 17,534 individuals and 30 effect sizes. The sample comprised participants from Eastern cultures (n = 22 studies) and Western cultures (n = 8 studies).

RESULTS

The meta-analysis revealed a significant negative correlation between mindfulness and problematic smartphone use (r = -0.399, 95 % CI [-0.457, -0.338], p < 0.001). Moderator analyses revealed the strongest relationship when using the Child and Adolescent Mindfulness Measure (CAMM) (r = -0.498), while the Five Facet Mindfulness Questionnaire (FFMQ) showed the weakest (r = -0.245). Cultural background analyses indicated stronger effects in Eastern cultures (r = -0.428) compared to Western cultures (r = -0.316). Gender analyses revealed stronger effects among female participants (β = -0.510, p < 0.05).

CONCLUSION

These findings demonstrate that mindfulness serves as an effective approach to addressing problematic smartphone use. The significant moderating effects identified have important implications for the implementation of mindfulness-based interventions in educational settings.

Acceptance of Using Artificial Intelligence and Digital Technology for Mental Health Interventions: The Development and Initial Validation of the UTAUT-AI-DMHI

Digital health technologies are being increasingly integrated into mental healthcare. This means that patients have different treatment options, and clinicians need to consider different ways of supporting their patients too. The adoption of Digital Mental Health Intervention (DMHI) technologies will be influenced by patients' and clinicians' attitudes towards these technologies. The Unified Theory of Acceptance and Use of Technology (UTAUT) is the most commonly used model to examine acceptance of technologies in professional settings, which identifies determinants of behavioural intention to use technologies, such as artificial intelligence (AI). We aimed to develop and validate the UTAUT-AI-DMHI measure to assess acceptance various types of digital and AI-based mental health interventions. We assessed the UTAUT-AI-DMHI's psychometric properties in three interventions: teletherapy via videoconferencing, AI chatbot and AI virtual therapist interventions in two samples. Sample 1 included n = 528 patients, n = 155 clinicians and n = 432 participants belonging to both groups; Sample 2 was used to corroborate the results and included a representative US community sample of n = 536. Our results demonstrated adequate construct validity and reliability of the UTAUT factors. In line with previous UTAUT literature, confirmatory factor analysis revealed that the final 17-item (plus one item assessing Behavioural Intention) scale consisted of seven factors: ease of use, social influence, convenience, human connection, perceived privacy risk, hedonic motivation and therapy quality expectations. All factors were positively associated with general attitudes towards AI and intention to use the intervention in the future in each of the three DMHI formats. This implies that the UTAUT-AI-DMHI self-report scale can be applied to assess acceptance of various kinds of digital and AI-based mental health interventions. Further, the UTAUT-AI-DMHI can be administered as a self-report scale for patients, clinicians and the general public and thus allows for a direct comparison of acceptance of different intervention formats.

Predictive Ability of Previous Pain and Disease Conditions on the Presentation of Post-COVID Pain in a Danish Cohort of Adult COVID-19 Survivors

BACKGROUND

Even though many post-COVID pain risk factors have been identified, little is known about the predictive profiles of these risk factors for the development of post-COVID pain.

METHODS

Data was collected from two separate questionnaires assessing demographics, pre-existing medical comorbidities, pain history, and post-COVID pain experience. Socioeconomic data and COVID-19 RT-PCR test results were collected from Danish registries. The study cohort (n = 68,028) was stratified into two groups reporting pre-COVID pain (n = 9090) and no pre-COVID pain (n = 55,938). Forward-selection prediction models were employed to identify predictor profiles for post-COVID pain in the full study cohort (Model 1) and the stratified groups with (Model 2) and without (Model 3) pre-COVID pain from 58 potential risk factors.

RESULTS

Model 1 achieved a 5-fold cross-validated AUC (cvAUC) of 0.68. Use of pain medication, stress, high income, age, female gender, and weight were the top predictors contributing to 97% of the model performance. Model 2 (cvAUC = 0.69) identified use of pain medication, breathing pain, stress, height, physical activity, and weight as the top predictors contributing to 98.6% of model predictive performance. Model 3 (cvAUC = 0.65) identified stress, female gender, weight, higher education, age, high income, and physical activity as the top predictors contributing to 98.5% of model predictive performance. Height was unique to Model 2, while being female and higher income were unique to Model 3.

CONCLUSIONS

The study highlights potential important predictors, and further research is needed to describe these in detail. The results may apply to the understanding of post-viral pain sequelae after other viral infections.

SIGNIFICANCE STATEMENT

The explorative study investigates the predictive ability of a battery of pre-COVID risk factors potentially associated with the development of post-COVID pain. This article presents the profiles of predictors of interest in COVID-19 survivors with and without pre-COVID pain. The results will contribute to the understanding of patient profiles that might develop post-COVID pain conditions and provide a first step towards focused clinical predictive research.

Internet addiction affects college students' intuitive eating over physical activity: Evidence from multiple studies

Intuitive eating is a key focus in health psychology and has been closely linked to negative emotions, particularly among college students. A study examining the protective and risk factors influencing students' intuitive eating could be valuable in helping them manage their weight and improve their emotional well-being. We therefore examined the effects of physical activity and internet addiction. A total of two studies were conducted: a questionnaire survey and an ecological transient assessment. Ultimately, we found that physical activity did not influence students' intuitive eating. However, we found that internet addiction negatively influenced college students' intuitive eating, both in terms of immediate and short-term delayed effects. Using multiple studies, we found that physical activity was not a predictor of intuitive eating and that internet addiction had both immediate and short-term delayed effects on intuitive eating. Furthermore, there was no interaction effect between the two.

Cross-sectional Analysis of Zoom Fatigue on Clinical Decision-making in Nursing Students

Zoom fatigue may affect nursing students, as there has been an increase in the use of videoconferencing for academic as well as clinical applications. Fatigue can negatively interfere with clinical decision-making and lead to clinical errors. This study aimed to explore the association between Zoom fatigue and perceived clinical decision-making ability of nursing students. This cross-sectional study assessed self-reported sociodemographic characteristics, Zoom fatigue, and clinical decision-making. Nursing students reported a medium level of Zoom fatigue (2.50 ± 0.78) and moderate effects on clinical decision-making (150.924 ± 12.561). Statistically significant differences were found between Zoom fatigue, the number of videoconferences held in the last month ( rs = 0.065, P = .030), prolonged use of electronic devices ( χ23 = 12.817, P = .005), and sex of the participants ( U = 4043.500, P = .046). In addition, a negative relationship was observed between Zoom fatigue and clinical decision-making ( rs = -0.519, P < .001). Nursing students have shown a moderate level of Zoom fatigue. The number of videoconferences attended as well as the prolonged use of electronic devices could increase students' level of Zoom fatigue. Students' perception of their clinical decision-making is moderate. As the Zoom fatigue levels of nursing students increased, their perception of clinical decision-making ability decreased. In the academic and clinical settings, there is a need to develop strategies to prevent Zoom fatigue in nursing students and improve the quality of care provided to patients.

To boldly go where no text has gone before: The effects of boldface letters on eye movements in reading

Over the years, numerous speed-reading technologies have proposed ways for people to improve their reading speed and efficiency. The current study empirically tested Bionic Reading's claims that bolding the first half of words provides an optimal location for the eyes to land and is enough to process the entire word. Participants read paragraphs in five bolding conditions to see how reading patterns and eye movements were impacted. Bionic Reading's claims were not supported by this study, as bolding the first half of every word did not facilitate reading relative to bolding the middle half or last half of every word and, in fact, led to costs relative to regular unbolded reading. Additionally, visual access to only the first few letters was not enough to recognize whole words. The differential effects of bolding were also explored across different individual difference measures, but Bionic Reading was not found to be beneficial for any specific population on reading speed or in eye movement measures.

Lived Experiences of Older Adults with Advanced CKD and Their Caregivers: A Qualitative Study Uncovering Risk and Resilience Dynamics

Key Points

Background

To date, very little is known about the lived experiences of families affected by CKD, especially regarding the adaptive coping strategies these families use to successfully cope with the chronic stress they must face because of CKD.

Methods

An exploratory qualitative descriptive study was conducted by recruiting a subsample of adults with advanced CKD participating in the Canadian Frailty Observation and Interventions Trial study and some of their caregivers. As part of this ongoing larger study, 12 adults with advanced CKD and seven of their caregivers (N=19) completed one focus group discussion that explored topics related to their unique lived experiences as individuals affected by CKD. Narrative data were analyzed using a three-step inductive thematic analysis process.

Results

Three themes that portray participants' lived experiences were identified, including (1) experiencing chronic stress because of CKD, (2) coping successfully with the stress caused by CKD, and (3) recommendations to improve family well-being.

Conclusions

Social and health services for families affected by CKD may be more effective in promoting the health, well-being, and quality of life of both adults with CKD and their caregivers if they acknowledge the chronic stressors these families face daily and provide support strategies that help them successfully cope with such stressors.

Scrolling through adolescence: a systematic review of the impact of TikTok on adolescent mental health

Amidst rising concerns about mental health in adolescents, the role of social media (SM), particularly highly visual platforms such as TikTok, has become a growing focus of investigation. In the extant literature, conclusive evidence is limited by the aggregate analysis of very heterogeneous SM platforms. This systematic scoping review examines the relationship between TikTok and mental health in adolescents. Additionally, it aims to highlight potential interactions between typical developmental processes and the unique aspects of TikTok, exploring their relevance to mental health within this demographic. Following PRISMA guidelines, a systematic search across PubMed, Scopus, Web of Knowledge, and PsychINFO yielded 20 studies that met the inclusion criteria, encompassing a total of 17,336 subjects from 10 countries. The retrieved studies analyzed four main topics related to TikTok use, i.e., the overall impact on adolescents' mental health, risk of problematic use and behavioral addiction, consequences on body image and self-esteem, and possible spreading of mental illness behaviors. While TikTok offers creative opportunities for self-expression and peer connection, the literature raises concerns about its potential negative effects on teens, such as lower life satisfaction, increased risk of "contagion" of certain psychiatric symptoms, and problematic usage patterns. Significant variations in study methodologies and outcome measures were observed. In the current era of evolving SM landscapes, a comprehensive approach informed by developmentally grounded research is critically needed to further understand the interplay between SM and adolescent mental health, providing insights for health authorities and policymakers.

E-Cigarette Education and Training in Medical Schools: A National Survey

INTRODUCTION

E-cigarette use is increasing amongst current smokers, nonsmoking adults and young people. Doctors are in a unique position to encourage patients to quit and help achieve their goal of nicotine abstinence. Teaching on tobacco-related disease is well established and a "smoking history" is a routine part of undergraduate medical curricula. Despite education about smoking, little is known about what students are taught about E-cigarettes.

METHODS

Scottish medical students were invited to participate in an online survey to assess their own attitudes, the curricular coverage of smoking, E-cigarettes, and cessation programmes.

RESULTS

Approximately 5000 students were invited; a total of 606 responses were received (12%). 8.4% currently vape (3% are current smokers). The majority (95%) reported that E-cigarette use was not covered well within their curriculum (61% stated it had not been mentioned). Despite this, 72% were aware of some health risks associated with E-cigarettes but only 6% reported they would feel confident explaining this to patients. 98% were unaware of any available cessation services.

CONCLUSIONS

Practical advice and training regarding E-cigarette use and cessation is lacking across Scottish medical school curricula. Medical students lack the knowledge and confidence to explain the health consequences to patients. To enable future medical staff to deal with the rise in nicotine addiction, it is essential that medical schools improve access to information on acute and chronic health effects and cessation support. Evidence-based education and cessation programmes should be developed to ensure students feel confident in supporting future patients in attempting to quit nicotine addiction.

Predicting social anxiety disorder based on communication logs and social network data from a massively multiplayer online game: Using a graph neural network

AIM

Social anxiety disorder (SAD) is a mental disorder that requires early detection and treatment. However, some individuals with SAD avoid face-to-face evaluations, which leads to delayed detection. We aim to predict individuals with SAD based on their communication logs and social network data from a massively multiplayer online game (MMOG).

METHOD

The study included 819 users of Pigg Party, a popular MMOG in Japan. Participants completed the Japanese version of the Liebowitz Social Anxiety Scale (LSAS-J) and a social withdrawal scale (hikikomori) questionnaire. Participants scoring ≥60 on the LSAS-J were classified as having SAD, while those scoring <60 were classified as not having SAD (non-SAD). A total of 142,147 users' communication logs and 613,618 social edges from Pigg Party were used as input to predict whether participants had SAD or non-SAD. Graph sample and aggregated embeddings (Graph SAGE) was utilized as a graph neural network model.

RESULTS

Individuals with SAD were more likely to be socially withdrawn in the physical community (hikikomori), had fewer friends, spent less time in other users' virtual houses, and showed lower entropy in their visitation times in MMOG. Based on their social network data, the Graph SAGE model predicted SAD, with an F1 score of 0.717.

CONCLUSION

The communication logs and social network data in an MMOG include indicators of interpersonal avoidance behaviors, which is typical of individuals with SAD; this suggests their potential use as digital biomarkers for the early detection of SAD.

Navigating who I was and who I am online: How people with dementia use social media platforms to support identity

A diagnosis of dementia can have a powerful impact on identity, and social media platforms offer promising avenues for identity expression and reconciliation. Addressing limited research in this area, we used semi-structured interviews to explore how 10 people with dementia used social media to navigate their identity. Our thematic analysis produced four themes, showing how social media platforms afford unique opportunities for self-expression, visibility, and association, thereby empowering users to maintain their sense of self, challenge stereotypes, and foster community connections. Additionally, social media facilitated a multifaceted and holistic sense of identity beyond the confines of diagnosis. While there were concerns about online self-disclosure, sharing experiences of dementia had therapeutic benefits, aiding in acceptance and adjustment. Participants also leveraged social media to establish continuity between their pre- and post-diagnostic selves, providing a sense of stability amid uncertainty. With the increasing prevalence of social media use among people with dementia, proactive measures by healthcare professionals, policymakers, technology developers, and carers are required to cultivate online experiences that are safe, supportive, and inclusive of people with dementia.

The Mediating Role of Hopelessness in the Relationship Between Social Media Addiction and Loneliness Among Adolescents

PURPOSE

This study aims to explore the mediating role of hopelessness in the relationship between social media addiction and loneliness among adolescents.

METHODS

This study was conducted using a descriptive cross-sectional correlational design. The study population comprised high school students in a provincial center in eastern Turkey. Through cluster sampling, 946 adolescents were included. This study was conducted between May 2024 and Sep 2024. Data collection involved a personal information form, the Social Media Addiction Scale for Adolescents (SMAAS), the UCLA Loneliness Scale Short Form (ULS-8), and the Beck Hopelessness Scale (BHS). Data analysis was conducted using SPSS 25, G*Power 3.1, and AMOS 24 software.

RESULTS

The mean scores were as follows: SMAAS (20.44 ± 6.96), ULS-8 (16.14 ± 3.97), and BHS (7.25 ± 5.16). Significant positive correlations were found between the scales. The model describing the relationships among social media addiction, loneliness, and hopelessness was within acceptable limits and yielded significant results (Χ2/df=2.978, RMSEA = 0.052, CFI = 0.962, GFI = 0.971, IFI = 0.912). Social media addiction significantly affected loneliness, and time spent on social media also had a significant impact on loneliness (p < 0.001).

CONCLUSIONS

Adolescents were found to use social media extensively, mainly for communication with friends and family. Hopelessness and time spent on social media were identified as mediators in the relationship between social media addiction and loneliness. Findings suggest that reducing social media use may help mitigate loneliness and hopelessness. Mental health assessments should consider social media behavior, and educational programs should address its psychological impacts. Child and adolescent psychiatric nurses should be trained to recognize signs of loneliness and hopelessness in adolescents at an early stage.

Internal and external factors influencing Gen Z wellbeing

BACKGROUND

Gen Z, the cohort of individuals born approximately between the mid-to-late 1990s and the early 2010s, has been noted to experience challenges regarding their wellbeing. Yet, addressing wellbeing issues among individuals in their productive years is crucial due to the significant impacts on innovation, productivity, and performance. Wellbeing is influenced by internal and external factors. One important external factor is technology. Concerns such as excessive screen time and the constant need for updated information, often referred to as the Fear of Missing Out (FoMO), have been associated with a decline in wellbeing. Nevertheless, comprehensive research examining the effects of screen time and FoMO on wellbeing remains limited. This study aims to explore both internal (such as FOMO, extraversion, and resilience) and external factors (such as social support and screen time) that contribute to the wellbeing of Gen Z individuals.

METHODS

The research adopted a quantitative approach involving 408 participants, with Smart-PLS utilized for both the measurement model analysis and the structural model analysis.

RESULT

Findings from the study reveal how social support, as external factor, is positively influencing wellbeing and resilience. The study also shows that resilience plays a role in influencing wellbeing. Therefore, the total impact of social support to wellbeing is strong, directly and indirectly. This study also shows the positive impact of personal traits, specifically extraversion to wellbeing. However, this study fails to show the dark side of technology impacted wellbeing.

CONCLUSION

The study expands knowledge on the direct positive relationship between social support, resilience, and well-being, revealing that social support significantly affects well-being both directly and indirectly through resilience. Additionally, it confirms that well-being is influenced by internal factors, such as resilience and extraversion, and highlights the impact of technology, especially Fear of Missing Out (FoMO) and screen time, on well-being. Practically, it encourages parents and educators to support Gen Z by fostering open communication, guiding resilience development, and monitoring technology usage to combat potential negative effects like FoMO.

Mediating effect of AI attitudes and AI literacy on the relationship between career self-efficacy and job-seeking anxiety

As artificial intelligence (AI) technology quickly grows, college students have new worries and fears. Using Marx's theory of labour alienation, this study explores the complex relationship between college students' job-seeking anxiety (JSA) and career self-efficacy (CSE) in the context of the AI era. A structural equation modeling (SEM) study of data from 455 Chinese students indicates that CSE adversely affects JSA. Moreover, AI attitudes (AIA) and AI literacy (AIL) play significant mediating roles in the relationship between career self-efficacy (CSE) and job-specific anxiety (JSA). Specifically, these factors help explain how CSE influences JSA by fostering positive perceptions of AI and improving students' understanding of AI technologies. The findings underscore the importance of cultivating positive attitudes toward AI, enhancing AI literacy, and strengthening career self-efficacy to reduce job-seeking anxiety and better prepare students for the challenges of an AI-driven job market. These observations provide significant implications for educators and policymakers in developing interventions to enhance students' career preparedness and protect their mental health during technological changes.

The role of artificial intelligence in general, and large language models specifically, for understanding addictive behaviors

Artificial intelligence (AI) presents a general-purpose technology built into diverse products including language assistants on smartphones, recommender systems in e-commerce and social media, and applications in social and industrial robotics. AI became a globally discussed topic when the large language model ChatGPT was launched in November 2022. In the aftermath, scientists in the field of (online) addictive behaviors and internet use disorders have discussed which features or modalities of AI systems underlying video games or social media platforms might result in adverse consequences for users. Therefore, the present short communication sheds light on recent discussions in the realm of addictive behaviors on the eve of the coming AI wave. Furthermore, terms such as ChatGPT addiction are critically discussed and we not only theoretically explain how different AI modalities interact with governing regulation bodies such as the EU with their AI Act, but also personal/psychological factors, paving the way to unique perceived immersive design levels.

The Illness-Related Distress Scale: development and psychometric evaluation of a new transdiagnostic measure

BACKGROUND

Individuals with long-term physical health conditions (LTCs) experience higher rates of depression and anxiety. Conventional self-report measures do not distinguish distress related to LTCs from primary mental health disorders. This difference is important as treatment protocols differ. We developed a transdiagnostic self-report measure of illness-related distress, applicable across LTCs.

METHODS

The new Illness-Related Distress (IRD) scale was developed through thematic coding of interviews, systematic literature search, think-aloud interviews with patients and healthcare providers, and expert-consensus meetings. An internet sample (n = 1,398) of UK-based individuals with LTCs completed the IRD scale for psychometric analysis. We randomly split the sample (1:1) to conduct: (1) an exploratory factor analysis (EFA; n = 698) for item reduction, and (2) iterative confirmatory factor analysis (CFA; n = 700) and exploratory structural equation modeling (ESEM). Here, further item reduction took place to generate a final version. Measurement invariance, internal consistency, convergent, test-retest reliability, and clinical cut-points were assessed.

RESULTS

EFA suggested a 2-factor structure for the IRD scale, subsequently confirmed by iteratively comparing unidimensional, lower order, and bifactor CFAs and ESEMs. A lower-order correlated 2-factor CFA model (two 7-item subscales: intrapersonal distress and interpersonal distress) was favored and was structurally invariant for gender. Subscales demonstrated excellent internal consistency, very good test-retest reliability, and good convergent validity. Clinical cut points were identified (intrapersonal = 15, interpersonal = 12).

CONCLUSION

The IRD scale is the first measure that captures transdiagnostic distress. It may aid assessment within clinical practice and research related to psychological adjustment and distress in LTCs.

Using Pender's health promotion model to understand patient influencers' promotion of chronic disease self-management

Patient influencers are a type of social media influencer who build patient communities and share specific health information based on their "lived experience." The current study applied the Health Promotion Model because patient influencers may be health promotion agents; these nuanced social media influencers are at the intersection of peer-to-peer communication and health promotion, engaging communities of patients about health and chronic disease self-management. Interviews (N = 37) were conducted to better understand patient influencers' promotion of chronic disease self-management behaviors. Three themes were identified: representing the disease community; acting as intermediary of information; and supporting good health. Patient influencers communicated motivational strategies to followers by sharing their own experiences, including their personal experiences with chronic disease, behavioral perceptions, for example, perceived benefits and barriers, and their behavioral outcomes. Patients want to engage in self-management behaviors that produce value, and patient influencers help co-create value through the sharing of content and "lived experience."

Assessing healthcare simulation facilitation using a competency-based tool derived from practice in low-resource settings

INTRODUCTION

The worldwide expansion in healthcare simulation training includes accelerated uptake in low-resource settings. Until recently, no framework has specifically delineated the competencies underpinning effective facilitation practice in low-resource settings. We describe the development of the Facilitation Behavioural Assessment Tool for simulation facilitation training and report reliability in scoring facilitation performance. This tool was informed by healthcare simulation facilitation practice in low-resource settings.

METHODS

The tool has 32 facilitation competencies, organised across three performance categories (techniques, artistry and values) and a three-point scale is used for scoring. Following a short, self-directed online training module, participants scored three videos that depicted facilitation performance at three levels. Videos were presented in a random order. Intraclass correlations and internal consistency with Cronbach's α were calculated. A random intercepts 3 × 3 linear mixed model assessed discrimination across the three levels of facilitation performance and the influence of previous facilitation on scoring.

RESULTS

In total, 104 participants from 29 countries completed rater training and scored at least one video. The inter-rater reliability was 0.73 (95%CI 0.66-0.79) and 0.89 (95%CI 0.85-0.92) for the intraclass correlation coefficient 2 and intraclass correlation coefficient 2k, respectively. Cronbach's α was 0.84 (95%CI 0.79-0.89) for the positive video; 0.84 (95%CI 0.78-0.88) for the mixed video; and 0.91(95%CI 0.87-0.93) for the negative video. Previous simulation facilitation experience did not affect the ability to distinguish between the videos meaningfully, but novice facilitators scored facilitation behaviours higher for mixed and negative videos compared with participants with intermediate and high levels of experience.

DISCUSSION

Our study shows that suitable reliability and internal consistency can be achieved when using the Facilitation Behavioural Assessment Tool. We recommend using the tool to support learning conversations for simulation faculty development in low-resource settings.

Exploring structural stigma towards mental disorders: An analysis of trial verdicts

Mental health issues, particularly depression, often carry a stigma that can infiltrate various societal institutions, including the legal system. This study investigates the structural stigma associated with depression within the context of second-instance criminal trials in China, examining trial verdicts from 2009 to 2023. Through a detailed analysis of 171 cases using Semantic Network Analysis, Critical Discourse Analysis, and logistic regression, this research elucidates the complex ways in which depression is considered in judicial decisions. The findings identify three thematic responses-Neutral Evaluation, Sympathetic Consideration, and Rigorous Standards-that encapsulate diverse judicial attitudes towards the impact of depression on criminal responsibility. Critical Discourse Analysis further reveals three prevailing legal discourses-Stringent Criteria, Inconsistent Approaches, and Individual Negligence-that significantly influence the treatment of defendants with depression. The results also show a declining trend in recognizing depression as a mitigating factor, jointly influenced by crime type, defendant gender, and defendant's education level, suggesting a shift towards more stringent judicial interpretations over time. These findings underscore the critical need for judicial reforms aimed at reducing stigma and promoting a more equitable treatment of mental health issues in the legal system.

A Social Media Study of Portrayals of Bipolar Disorders on YouTube: Content and Thematic Analyses

BACKGROUND

Individuals with mental disorders frequently use YouTube to express themselves, reach an audience, or as a means of understanding their condition. Testimonies posted on YouTube provide longer and richer perspectives than the short posts found on other social media platforms. Research focusing on the depiction of mental disorders on YouTube is blossoming. Bipolar disorders (BDs) are disabling mood disorders. The diagnosis of any mental disorder, and more so BD, is often a life-changing event. However, no published study has investigated the portrayal of diagnoses of BD on YouTube.

OBJECTIVE

This study aims to investigate the portrayals of BDs on YouTube, focusing on the diagnosis narratives and their accompanying narrative context, in particular, reports of personal experiences and reactions.

METHODS

We performed a manual content analysis of 39 testimonies (women: n=24, 62%) depicting BDs and their diagnosis by individuals with BD. We also performed a thematic analysis of the corpus relying upon a deductive and inductive approach.

RESULTS

Our manual content analysis revealed that portrayals included the disclosure of diagnoses of BD-I (as per both coders' agreement: 10 testimonies) and BD-II (11 testimonies) to a similar extent. The reactions to the diagnosis were mostly negative (8 testimonies), followed by positive (5 testimonies), while fewer portrayals indicated a denial of the condition (4 testimonies). Several portrayals made mention of issues in the areas of money and accommodation (15 testimonies), profession and education (13 testimonies), and relationships (20 testimonies). Medication (31 testimonies) and psychotherapy (23 testimonies) were often mentioned as part of treatment for BD, most generally in positive terms. The 8 themes emerging from the thematic analysis were: "reactions on diagnosis, treatment, and health care professionals' expertise," "trial and error in medication," "positive effects of BD," "disability, stigma, and shame," "loss," "family planning and genetics," "identity change (psychological and physical)," and "human social relationships."

CONCLUSIONS

Overall, our results underline the complexity and richness of the depiction of the diagnosis of BD and its narrative context, and highlight the importance of the moment of the diagnosis, medication, and psychotherapy. Our study emphasizes the need for further exploration of the impact of social media on mental health awareness.

User-centric innovation strategies for cultural creative products in China's rural tourism

Cultural creative products play an important role in the revitalization of tourism-oriented rural areas and the preservation of cultural heritage. However, existing products fail to fully meet the diverse needs of consumers and lack a systematic design framework. This study proposes a user-centered framework aimed at guiding the innovation of cultural creative products in China's rural tourism. During the exploration of user needs, grounded theory was used to identify three core user needs: emotional identification, personalization and uniqueness, and enhancement of quality of life. Using the KANO model, these needs were further categorized into basic needs, performance needs, and excitement needs, clarifying their priorities. In the stage of translating user needs into actionable design elements, the Analytic Hierarchy Process (AHP) was employed to assign weights to each need, and Quality Function Deployment (QFD) theory was used to construct the House of Quality, refining 14 user needs into 9 key design elements. The findings indicate a positive correlation between multifunctional design and ergonomic design, that usability and convenience are closely related to human-machine ergonomics, and that the integration of cultural symbols with emotional design and innovative forms significantly enhances the cultural value and user experience of the products. This study provides a systematic theoretical framework and practical guidance for the innovation of rural cultural creative products, with significant implications for future research and practice.

Ecological Momentary Assessment of Parental Well-Being and Time Use: Mixed Methods Compliance and Feasibility Study

BACKGROUND

Parents often juggle multiple conflicting responsibilities, including work, childcare, and the household, making them a particularly burdened group. However, the impact of daily routines and associated (poor) well-being among parents has received relatively little attention. Ecological Momentary Assessment (EMA) is increasingly being used to capture real-time data and can help address this research gap.

OBJECTIVE

This study aims to examine compliance rates and the feasibility of EMA for measuring daily well-being and time use among parents.

METHODS

An exploratory mixed-methods study was conducted with 74 German parents (57/74, 77% women, (age: mean 37.6, SD 5.9 years). Participants completed a baseline questionnaire, followed by 4 daily EMA surveys (at 7:30 AM, 12 PM, 16:30 PM, and 21:30 PM) over a 1-week period, and a follow-up questionnaire. A subset of parents was also subsequently interviewed. Sociodemographic background and expected feasibility (open-ended questions) were surveyed at baseline, and feasibility was assessed at follow-up (closed- and open-ended questions) and in the interviews. State well-being (affective and cognitive), state stress, state as well as retrospective time-use were measured in the EMA surveys. Compliance and feasibility were examined using a combination of quantitative (descriptive analyses) and qualitative methodologies.

RESULTS

Participants completed an average of 83% (SD 13%) of the daily surveys. Compliance varied by gender and age, where men (90% vs 80%) and older parents showed higher rates. Participants generally found the survey frequency and length manageable, though some suggested adjustments to the study period depending on their individual routines. The 7:30 AM survey was reported as the most challenging due to childcare drop-offs (40%-49%), followed by the 16:30 PM survey for similar reasons (7%-17%). The qualitative analysis further revealed additional points for improvement, for instance, the need for personalization (eg, individual adjustment of the survey timings and intervals), technical support, and the incorporation of gamification elements. Most interviewees (46% vs 23%) found the used measurement of well-being and stress to be appropriate. Regarding time use, they felt that the predefined activity groups (eg, personal care, working) were suitable (46%) but noted challenges assigning less frequent activities (eg, medical appointments) (5%-54%). Reporting the timings of time-use via consecutive questions (ie, specifying the duration or start and end times of an activity) was perceived as confusing (9%-69%), with participants expressing a preference for a visual overview, such as a Gantt chart.

CONCLUSIONS

The study demonstrates that, when accounting for certain sociodemographic and study design factors, EMA can be a feasible method for data collection regarding daily well-being and time use, even in highly time-constrained populations like parents. This shows great potential for future research, such as exploring work-family conflict or performative gender roles and complementing established methods (eg, retrospective daily diaries).

TRIAL REGISTRATION

OSF Registries osf.io/8qj3d; https://osf.io/8qj3d.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/54728.

Caught in the Web of the Net? Part I: Meta-analyses of Problematic Internet Use and Social Media Use in (Young) People with Autism Spectrum Disorder

This article examined the internet and social media usage among (young) individuals with autism spectrum disorder (ASD). Two meta-analyses were conducted to quantify (1) the relation between ASD/autistic traits and problematic internet use (PIU, which included generalized PIU, problematic gaming, excessive smartphone use), and (2) the relation between ASD/autistic traits and social media use. The results of our first meta-analysis-comprising 46 studies and 42,274 participants-revealed that people with ASD or higher levels of autistic traits showed higher levels of PIU, with an average effect size of r = 0.26 (95% CI [0.21, 0.31]). The second meta-analysis-consisting of 15 studies and 7036 participants-indicated that people with ASD or higher levels of autistic traits were less involved on social media platforms as compared to their typically developing counterparts, with the average effect size being r = - 0.28 (95% CI [- 0.38, - 0.18]). The quality of the research on PIU and social media in persons with ASD was critically evaluated and possible directions for future research on this topic are discussed.

Cross-sectional and longitudinal associations of screen time with adolescent depression and anxiety

OBJECTIVE

The relationship between screen time and mental health in adolescents is debated in the scientific literature, with longitudinal studies lacking. This study examined the cross-sectional and longitudinal associations between screen time and depression and anxiety and the influence of maladaptive social media use and gender on these associations.

METHODS

We analysed a sample of 4058 adolescents (mean age = 13.9) recruited from 134 Australian schools as part of the Future Proofing Study, a 5-year prospective cohort study of adolescent mental health. Linear mixed models used Time 1 and Time 2 (12-month follow-up) data to examine cross-sectional and longitudinal associations of screen time with depression and anxiety and the influence of maladaptive social media use and gender.

RESULTS

Screen time was associated with mental health symptoms cross-sectionally, with each additional hour of screen time corresponding with a 1.25 and .79 increase in measures of depression and anxiety, respectively. Longitudinally, these associations were markedly weaker. Each additional hour of screen time corresponded with only a .15 increase in depression at 12 months and showed no association with anxiety at 12 months. Neither gender nor maladaptive social media use substantially influenced screen time-symptom associations.

CONCLUSIONS

Compared to cross-sectional associations, longitudinal associations were weak, indicating that high screen time is unlikely to cause depression and anxiety; instead, observed relationships may be bidirectional. Experimental studies to understand the nuances underlying the relationship between screen time and mental health are needed to support the development of targeted strategies that promote healthy screen time habits among adolescents.

Uniportal video-assisted thoracoscopic surgery for lung cancer: the current opinions and future perspectives of thoracic surgeons in Japan

OBJECTIVES

Uniportal video-assisted thoracoscopic surgery (U-VATS) is gaining global recognition as a minimally invasive approach. However, its current status and issues in Japan remain unclear. This study aimed to assess U-VATS adoption and barriers among Japanese thoracic surgeons through a nationwide survey.

METHODS

The Japanese Uniportal VATS Interest Group conducted an online survey of 3287 thoracic surgeons on the Japan Association for Chest Surgery mail list. Responses were collected from October 25 to November 30, 2024, yielding 851 valid responses (25.9%) from 497 institutions (78.0% of JACS-registered institutions).

RESULTS

The adoption rate of U-VATS among the institutions was 42.5%. However, the proportions of thoracic surgeons who primarily performed lobectomy, segmentectomy, and wedge resection using U-VATS were 10.3%, 10.2%, and 22.0%, respectively. The main reasons for non-adoption included concerns regarding safety and surgical precision (57.2%), preference for other approaches (50.9%), and lack of instruments (48.8%). Among surgeons with no prior U-VATS experience, 34.1% were willing to adopt it. To facilitate broader adoption, respondents highlighted the need for troubleshooting resources (61.3%), high-precision surgical videos (59.0%), and hands-on training programs (51.5%).

CONCLUSION

Despite the relatively high institutional adoption rate, the proportion of thoracic surgeons using U-VATS as the primary approach remained low. Key barriers include concerns about safety and surgical precision, limited educational opportunities, and a lack of scientific evidence on U-VATS in Japan. To promote the wider adoption of U-VATS, it is essential to develop structured educational programs and generate evidence to ensure both safety and surgical precision.

A Mobile App-Based Intervention (Parentbot-a Digital Healthcare Assistant) for Parents: Secondary Analysis of a Randomized Controlled Trial

BACKGROUND

Mobile app-based interventions are viable methods of delivering perinatal care support to parents. A mobile app-based intervention entitled Parentbot-a Digital Healthcare Assistant (PDA) was developed and evaluated via a randomized controlled trial. PDA aimed to provide informational, socioemotional, and psychological support to parents across the perinatal period. As developing such interventions is resource intensive, it is important to evaluate participants' use and the components that are appreciated by them.

OBJECTIVE

This study aims to examine the (1) relationship between participants' characteristics and PDA use, (2) relationship between PDA use and parenting outcomes, and (3) relationship between participants' characteristics and the time taken to respond to the surveys (survey response timing).

METHODS

This study is the secondary analysis of a randomized controlled trial. A convenient sample of 118 heterosexual couples (236 participants: n=118, 50% mothers and n=118, 50% fathers) from a public tertiary hospital in Singapore were recruited. Data were collected from November 2022 to August 2023. Descriptive statistics were used to summarize the parents' characteristics and study variables. Linear mixed models were used to examine the effect of (1) participants' sociodemographic characteristics on PDA use metrics, (2) use metrics on parenting outcomes, and (3) participants' sociodemographic characteristics on the survey response timing. The Pearson correlation was also used to examine the linear relationships between the PDA use metrics and parenting outcomes.

RESULTS

The following parental characteristics were found to be associated with PDA use: antenatal course attendance, gender, religion, ethnicity, and the number of children. After adjusting for baseline values and sociodemographic covariates, only the viewing of educational materials was statistically significantly associated with improvements in parents' anxiety (β=-0.48, 95% CI -0.94 to -0.009; P=.046), parent-child bonding (β=-0.10, 95% CI -0.19 to -0.01; P=.03), social support (β=0.31, 95% CI 0.08-0.54; P=.01), and parenting satisfaction (β=0.57, 95% CI 0.07-1.07; P=.03) at 1 month post partum. Moreover, parents' age, ethnicity, grouping, and number of children were found to be related to the survey response timing.

CONCLUSIONS

As the viewing of PDA's educational materials was linked to improvements in parents' perinatal well-being, the provision of educational resources should be prioritized in future app-based parenting interventions. Because the use of other PDA features, such as poster activities, forum posts, and reflection and gratitude exercises, had a limited effect in improving parents' well-being, future interventions could explore alternative activities to better engage parents. Future mobile app-based parenting interventions could conduct similar evaluations on app use and the effectiveness of specific features to validate the findings of this study.

Assessing the effectiveness of group motivational interviewing in raising awareness of mobile gaming addiction among medical students: a pilot study

OBJECTIVE

Group Motivational Interviewing may raise awareness of mobile gaming addiction. MI has reported reduction of gaming addiction in adolescents, although its effectiveness among medical students remains underexplored. This study assessed the effectiveness of group MI in raising awareness of mobile gaming addiction among medical students.

RESULTS

Significant progression in Stages of Change at pre- to post-intervention (χ² = 41.891, p < 0.001; Cramer's V = 0.555) and from post- to two-months post-intervention (χ² = 87.083, p-value < 0.001; Carmer's V = 0.800). IAIM scores improved over time (χ² = 9.349, p = 0.009), with the highest improvement at two-months. A moderate positive correlation (ρ = 0.517, n = 34, p < 0.002) was found between self-reported and mobile game usage at two-months. This pilot study provides early evidence that GMI may enhance motivation to reduce mobile gaming and support progression through stages of change. Future studies could employ larger randomized controlled trials (RCT) with longer follow-up periods.

TRIAL REGISTRATION

International Standard Randomised Controlled Trial Number (ISRCTN) Registry ISRCTN93544148. Date of registration 05/02/2025. Retrospectively registered.

Does more support mean more literacy? The relationship and mechanisms between digital support and college students' digital literacy

Introduction

The growing interest for digitization in education underscores the importance of students' digital literacy. However, few previous studies have focused on the important role of digital support in college students' digital literacy.

Methods

Guided by the person-context interaction theory and based on a survey of 2,157 college students, this study aimed to reveal the effects of digital device support and digital technology support on college students' digital literacy, and to further examine the mediating roles of self-efficacy and interpersonal interactions.

Results

The results showed that both digital device support and digital technology support positively predicted digital literacy, and self-efficacy and interpersonal interaction mediated the relationship between digital device support and digital literacy. Self-efficacy mediated the relationship between digital technology support and digital literacy, while interpersonal interaction had a non-significant mediating effect in this relationship. Additionally, self-efficacy significantly predicted interpersonal interaction, forming a chain mediation effect between digital device support, digital technology support, and digital literacy.

Discussion

This study explores the relationship between digital support and digital literacy in college contexts, emphasizing the important role of individual factors in this connection. The findings contribute to a systematic understanding of how environmental factors influence individual competence, provide empirical support for digital literacy research, and offer actionable insights for improving digital literacy in higher education. It is noteworthy that the research methods used in this study were based on self-reports, which may not accurately reveal causal relationships. Future research could improve the applicability and generalizability of the findings by adopting multimodal approaches.

Mental health practitioners' perceptions and adoption intentions of AI-enabled technologies: an international mixed-methods study

BACKGROUND

As mental health disorders continue to surge, exceeding the capacity of available therapeutic resources, the emergence of technologies enabled by artificial intelligence (AI) offers promising solutions for supporting and delivering patient care. However, there is limited research on mental health practitioners' understanding, familiarity, and adoption intentions regarding these AI technologies. We, therefore, examined to what extent practitioners' characteristics are associated with their learning and use intentions of AI technologies in four application domains (diagnostics, treatment, feedback, and practice management). These characteristics include medical AI readiness with its subdimensions, AI anxiety with its subdimensions, technology self-efficacy, affinity for technology interaction, and professional identification.

METHODS

Mixed-methods data from N = 392 German and US practitioners, encompassing psychotherapists (in training), psychiatrists, and clinical psychologists, was analyzed. A deductive thematic approach was employed to evaluate mental health practitioners' understanding and familiarity with AI technologies. Additionally, structural equation modeling (SEM) was used to examine the relationship between practitioners' characteristics and their adoption intentions for different technologies.

RESULTS

Qualitative analysis unveiled a substantial gap in familiarity with AI applications in mental healthcare among practitioners. While some practitioner characteristics were only associated with specific AI application areas (e.g., cognitive readiness with learning intentions for feedback tools), we found that learning intention, ethical knowledge, and affinity for technology interaction were relevant across all four application areas, underscoring their relevance in the adoption of AI technologies in mental healthcare.

CONCLUSION

In conclusion, this pre-registered study underscores the importance of recognizing the interplay between diverse factors for training opportunities and consequently, a streamlined implementation of AI-enabled technologies in mental healthcare.

Assessment of knowledge and awareness about ovarian cancer and its risk factors among women in Jazan, Saudi Arabia: a cross-sectional study

Ovarian cancer (OC) is the fourth leading cancer form in Jazan, Saudi Arabia. However, limited awareness and delayed healthcare-seeking behaviors might negatively impact screening uptake and early diagnosis. This study aimed to assess awareness and knowledge of OC, and related risk factors among the female population of Jazan region, Saudi Arabia. A cross-sectional web-based survey was conducted asking questions about the general awareness, knowledge, and awareness of risk factors associated with OC using a self-administered questionnaire. Descriptive statistics, chi-square tests, and Pearson's correlation analysis were used to analyze the data and a p ≤ 0.05 was considered statistically significant. Of the 465 participants, 433 completed the questionnaire (response rate = 93%). Internal reliability of questionnaire sections was found acceptable (Cronbach's alpha = 0.794, 0.738, and 0.816). Alarmingly, a significant majority of respondents exhibited poor general awareness (85%), poor knowledge (89.1%), and poor awareness of risk factors (86.1%). Only a small tested population showed good to moderate awareness (14.9%), knowledge (10.9%), and awareness of risk factors (13.8%). Significant positive correlations were observed between OC awareness and knowledge (r = 0.60, p < 0.01), OC awareness and risk factor awareness (r = 0.515, p < 0.01), as well as between knowledge and risk factor awareness (r = 0.634, p < 0.01). Limited awareness of OC and its risk factors were noted in the women population of Jazan region which highlights the importance and critical need for targeted educational initiatives aimed to improve the general public understanding and to promote preventive and screening measures.