Abstract Background Educators have long faced occupational pressures such as heavy teaching loads, and the incidence of emotional disorders is on the rise, which has affected the quality of education and professional happiness. Current intervention methods mostly focus on single mental health counseling, lack of systematic integration with library and information resources, and lack of continuity and pertinence of intervention. Based on this, we study the intervention value of bibliotherapy, construct an integrated path of mental health care and library and information support, and provide a new perspective for educators to intervene with emotional disorders. Methods Using a randomized controlled trial design, 120 educators with mild to moderate affective disorders were selected as research subjects and randomly divided into an experimental group (n = 60) and a control group (n = 60). The control group received conventional mental health lecture intervention, and the experimental group implemented an integrated path intervention (including the development of personalized reading plans, accurate push of library and information resources, and professional psychological nursing follow-up), with an intervention period of 8 weeks. The Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) were used to evaluate the intervention effect, and independent sample t-test was conducted using SPSS 26.0. Results The specific data of SAS and SDS scores of the two groups before intervention are shown in Table 1. After the intervention, the scores and effectiveness of the experimental group were better than those of the control group, and the difference was statistically significant (p<.05). Before the intervention, there was no significant difference in the SAS and SDS scores of the two groups (p>.05); after the intervention, the SAS scores (41.23 ± 5.17) and SDS scores (40.89 ± 4.92) of the experimental group were both It was significantly lower than the control group (SAS: 48.65 ± 5.34; SDS: 47.96 ± 5.21), and the differences were statistically significant (t = 7.823, 7.546, p<.001). The intervention effectiveness rate of the experimental group (86.67%) was significantly higher than that of the control group (63.33%), and the difference was statistically significant (χ2 = 8.352, p=.004). Discussion Bibliotherapy under an integrated approach can effectively improve the emotional disorders of educators, allowing library and information support to improve the accuracy of reading intervention, and mental health care to ensure the professionalism and sustainability of the intervention. Research shows that the synergistic effect of personalized reading resource matching and professional psychological guidance can more effectively relieve anxiety and depression. In the future, the sample size can be expanded to explore personalized intervention plans for educators with different teaching ages and disciplines, and further optimize the practicality of the integration path.

Abstract Background Currently, psychological intervention services still require improvements in process standardization, personalized programming, and sustained efficacy, which limits their overall effectiveness. Although structured intervention models have been widely adopted, empirical research on systematic process optimization remains insufficient, particularly lacking in-depth exploration of efficacy mechanisms and sustainability. To address this, we designed an optimized service process integrating evaluation, personalized interventions, and long-term follow-up. This study aims to assess its effectiveness in alleviating psychological symptoms, enhancing mental resilience, and improving service satisfaction, thereby providing empirical evidence for service improvement in the field of psychotherapy. Methods The study enrolled 400 students receiving psychological services at a university, randomly assigned to either an optimized process group or a conventional process group, with 200 participants in each group. The optimized process group underwent a 12-week systematic intervention, including preliminary assessments using the Symptom Checklist-90 (SCL-90) and the Connor-Davidson Resilience Scale (CD-RISC), individualized intervention plans, regular progress feedback, and a three-month post-intervention follow-up. The conventional process group received general support interviews and standardized counseling. Assessments were conducted using the SCL-90 and CD-RISC at pre-intervention, post-intervention, and three months post-intervention. Data analysis employed repeated-measures ANOVA and independent samples t-tests. Results The optimized process group demonstrated significant improvements across all metrics, with sustained effects. Table 1 summarizes the key data of both groups at three time points. The data in Table 1 show that both the total score of SCL-90 and the score of CD-RISC in the optimized process group have achieved significant and continuous improvements compared with those before the intervention (all p<.001), while the change range in the conventional process group is limited. In terms of service satisfaction, the score of the optimized process group was also significantly higher than that of the conventional group (p<.001). Discussion Research demonstrates that process optimization through systematic, structured, and personalized approaches can significantly enhance the sustainability of psychological interventions while improving participants' psychological resilience and service satisfaction. This model highlights the critical role of evaluation and feedback in the intervention process, facilitating the transition from standardized to precision-oriented services. Future studies should further explore the applicability of this process across different clinical populations and integrate digital tools to enable dynamic monitoring and adaptive adjustments during interventions, thereby advancing psychological services toward more efficient and sustainable development.

Abstract Background Students with Bipolar Disorder (BD) often encounter problems such as severe mood swings, impaired social functions, and poor adaptability to life. Traditional interventions mostly focus on drug treatment and single psychological counseling, lacking interest and participation, and are difficult to maintain long-term effects. Digital ink-wash animation combines artistic appeal and interactivity. After integrating psychological theories such as cognitive behavioral therapy and mindfulness-based stress reduction, it can regulate emotions and enhance psychological resilience through immersive learning. Existing studies have not explored the intervention effects of such integrative activities on BD students. Therefore, this research aims to analyze their impacts on BD students’ emotional stability, social functions, and quality of life, providing a basis for formulating personalized psychological intervention plans. Methods A total of 90 students with mild to moderate BD diagnosed by the psychiatry department were selected for the study and divided into the combination group, the single animation learning group and the control group according to the intervention methods, with 30 students in each group. The combined group participated in the learning of digital ink-wash animation integrating psychological theories (including emotional regulation guidance and mindfulness creation practice), the single group only participated in the learning of digital ink-wash animation skills, and the control group maintained conventional intervention. The intervention period was 3 months. The Emotional Stability Inventory (ESI) and the Social Functioning Scale were adopted respectively at baseline and 3 months later. The SFS was evaluated by the Short Form 36 Health Survey (SF-36). The data were expressed as Mean ± Standard Deviation (SD), and the independent sample t-test was used for comparison between groups. Results At baseline, there was no significant difference in the ESI, SFS, and SF-36 scores among the three groups (p>.05). After 3 months of intervention, the ESI score of the combination group decreased from 68.5 ± 7.3 to 42.3 ± 6.1 (p<.001), which was significantly lower than that of the single group (56.7 ± 6.8) and the control group (65.2 ± 7.1) (p<.001). The SFS score of the combination group increased from 52.6 ± 6.5 to 78.4 ± 5.9 (p<.001), and the SF-36 score increased from 53.8 ± 6.2 to 79.3 ± 5.7 (p<.001), both significantly higher than those of the two control groups (p<.01). The results show that the digital ink-wash animation learning activity integrating psychological theories has the best effect in stabilizing emotions, improving social functions and the quality of life. Discussion The research results show that the digital ink-wash animation learning activity integrating psychological theories can more significantly improve the psychological state of BD students, and its synergistic effect is superior to that of a single intervention mode. This activity, through the combination of artistic expression and psychological intervention, provides BD students with an interesting and sustainable intervention path. In the future, the sample size can be expanded and the tracking period extended to explore suitable solutions for BD students of different age groups, optimize the activity content and implementation model, and enhance the pertinence and effectiveness of the intervention.

Abstract Background With the rapid development of e-commerce and modern supply chains, the size of the logistics industry continues to increase, and their work is characterized by high intensity, high timeliness, and high risk. Long term work pressure, irregular sleep patterns, and occupational safety hazards make this group a high-risk group for emotional disorders. Exploring the characteristics of emotional disorders among logistics employees and evaluating the effects of structured nursing intervention are of great practical significance for ensuring the healthy development of the industry and improving the well-being of employees. By analyzing the epidemiological characteristics of emotional disorders among logistics practitioners and testing the intervention effect of a structured evidence-based nursing model, this study aims to provide empirical evidence and feasible intervention plans for promoting mental health of this group. Methods This study adopts a mixed research method and conducts a cross-sectional survey to conduct sample evaluations on employees in a large logistics hub. From the participants who were screened to have mild to moderate symptoms of anxiety or depression, 160 people were randomly selected and divided into intervention group (n = 80) and control group (n = 80). The intervention group received an evidence-based structured cognitive behavioral and supportive group care model, which included: psychoeducation, stress cognitive restructuring, relaxation training, problem-solving skills and peer support group activities, once a week for 90 minutes each time. The control group received routine mental health brochures. Before the intervention, at the end of the intervention and 3 months after the intervention, the Generalized Anxiety Disorder Scale (GAD-7), Patient Health Questionnaire (PHQ-9), Occupational Burnout Inventory (MBI-GS) and Short Form of Quality of Life (SF-12) were used for evaluation respectively. Repeated measures analysis of variance and multiple regression analysis were used to process the data. Results The results showed that the detection rate of anxiety symptoms among logistics employees was 38.2%, and the detection rate of depressive symptoms was 31.6%, significantly higher than that of the general adult population. The end of the 8-week intervention and at the 3-month follow-up, the emotional exhaustion and depersonalization dimension scores of the intervention group in GAD-7, PHQ-9 and MBI-GS were significantly lower than those in the control group (p<.01), while the mental health dimension score of SF-12 was significantly improved (p<.01). The results show that the proposed evidence-based nursing model can effectively alleviate the emotional disorder symptoms of logistics practitioners, reduce work burnout. Discussion This study shows that an evidence-based nursing model that integrates cognitive behavioral techniques and peer support systems can effectively alleviate the anxiety and depression symptoms of this group, reduce occupational burnout, and improve their subjective mental health. Mental health intervention for high-pressure occupational groups such as logistics should go beyond individual psychological adjustment, embed awareness of the stress of the occupational environment, and focus on building supportive social networks. Future research will further explore comprehensive strategies that combine such psychological intervention with the optimization of organizational management of logistics enterprises to achieve more fundamental and extensive health promotion.

Abstract Background With social aging deepening, the number of empty-nest elderly in cities is rising. Due to long-term loneliness, limited social interaction, chronic diseases, economic pressure, or the loss of a spouse and friends, this group faces a higher risk of depression. Traditional interventions mainly include psychological counseling, group guidance, or drug treatment, but many elderly have limited acceptance of these methods. Research shows that dancing has unique therapeutic effects on psychological disorders such as obsessive-compulsive disorder, depression, and anxiety. Thus, using dance as psychotherapy is an effective way to release emotions, enhance self-perception, and improve social interaction. Based on this, the study explores the effect of folk dance training on depressive symptoms in urban empty-nest elderly, aiming to provide a scientific and practical reference for non-pharmacological psychological interventions for the elderly. Methods A total of 100 urban empty-nest elderly people were included in the study. All participants were screened through the Mini-Mental State Examination (MMSE) and the Geriatric Depression Scale (GDS). Meets the criteria for mild to moderate depression risk. Participants were randomly divided into the experimental group and the control group, with 50 cases in each group. Both groups maintained their daily living activities. On this basis, the experimental group received folk dance intervention for 12 weeks, three times a week, for 60 minutes each time. The intervention content includes basic folk dance step training, rhythm and movement coordination practice, as well as group collaborative dance performances. Before and after the intervention, the GDS Scale, MMSE scale and Social Support Rating Scale (SSRS) were used respectively to evaluate depressive symptoms, cognitive status and social support level. Data analysis was conducted using paired t-tests and intergroup comparisons. A p<.05 was considered statistically significant. Results After the intervention, the GDS score of the experimental group decreased from 18.5 ± 4.7 to 10.2 ± 3.8, which was significantly lower than that of the control group (p<.01). The MMSE score of the experimental group increased from 26.1 ± 2.9 to 27.8 ± 2.5, while the change in the control group was not significant (p>.05). The total score of SSRS in the experimental group increased from 31.2 ± 5.3 to 37.6 ± 4.9, and the level of social support significantly improved. The results show that folk dance training can effectively alleviate the depressive symptoms of empty-nest elderly people in cities, while improving their cognitive state and sense of social support. Discussion Folk dance training, as a non-pharmaceutical intervention method integrating exercise, music and social interaction, can significantly improve the depressive symptoms of empty-nest elderly people in cities, enhance their cognitive function and increase their sense of social support. This intervention method is safe, operable and easy to promote, providing an effective approach for mental health intervention in the elderly. In the future, Coco will further explore the differentiated roles of different dance elements (such as rhythm and movement complexity) on the improvement paths of mental health, providing theoretical support for the formation of standardized and individualized intervention plans.

Abstract Background Depression, as a globally high burden mental disorder, is closely related to individuals' psychological processing of external information in terms of cognitive biases, inadequate emotional regulation, and impaired social functioning. Literary works have gradually been incorporated into auxiliary psychological intervention tools in recent years due to their narrative structure and emotional clues that can trigger emotional resonance. However, existing research has mostly focused on the overall effectiveness of literary therapy, lacking empirical exploration of the specific mechanism of the core textual element of "character image" in regulating patients' emotions and cognition. Therefore, this study explores the influence of character images in English literary works on the cognition and psychological reactions of patients with depression, aiming to clarify the feasibility and mechanism of their use as a non pharmacological psychological intervention approach. Methods The study adopted a randomized controlled design and recruited 96 patients with mild to moderate depression, who were randomly divided into an experimental group of 48 and a control group of 48. The experimental group received literary text exposure of three types of character images (resilience, tragedy, and growth), while the control group read neutral texts with weaker emotional clues. The intervention period is 6 weeks, and the Self Rating Depression Scale (SDS), Emotional Stroop Task (EST), and Cognitive Reflection Test (CRT) are implemented before and after to evaluate changes in depressive symptoms, negative attention bias, and cognitive reflection ability. Research synchronous recording of reading behavior and psychophysiological data to form a comparable evaluation of intervention effectiveness. Results The experimental results show that character image traits have a significant impact on depression symptoms and cognitive processing. According to SDS, the depression level in the experimental group decreased by 27.4% after 6 weeks, significantly better than the control group's 12.1% (p<.01). In EST, exposure to resilient and growth oriented characters resulted in a decrease of about 15% in negative attentional bias, while tragic characters only decreased by 4.2% (p<.05). The CRT results indicate that growth oriented characters can increase cognitive reflection scores by 18.3%, which is better than other character types. Overall, different character images exhibit differentiated effects in improving emotions, regulating attention bias, and enhancing cognitive abilities. Discussion Research has shown that character images in literary works can serve as key psychological clues for regulating the emotions and cognitive processing of patients with depression, and have the potential for auxiliary interventions in the field of public health. Resilient and growth oriented characters are more likely to promote positive cognitive reconstruction, while tragic characters need to be applied cautiously under emotional support conditions. In the future, the sample can be expanded, brain imaging can be combined to explore its mechanism of action, and a precise literary intervention plan based on character traits can be constructed to enhance the application value of community psychological rehabilitation and digital public health services.

treatment of obstructive coronary artery disease (CAD) requires accurate planning to ensure effective revascularization and full restoration of myocardial perfusion. In this study, we introduce Virtual PCI, a novel computational tool designed to support pre-operative planning of Percutaneous Coronary Intervention (PCI) by predicting the hemodynamic consequences of selected revascularization treatments. the tool leverages a fully personalized 3D multiscale perfusion model, calibrated using pre-intervention stress CT perfusion (CTP) imaging, to simulate the hemodynamic impact of different revascularization strategies in terms of post-intervention stress myocardial blood flow (MBF) and FFR. The computational framework is also capable of computing the FFR index. We conduct a validation study on patients treated with elective PCI and compare model predictions with dynamic stress CTP at follow-up. the validation study demonstrates high accuracy in predicting post-PCI myocardial perfusion, including potential residual ischemia and cardiac mass at ischemic risk. Through an integrated analysis with FFR, the tool shows potential for its prospective use, identifying in two patients optimal treatment strategies and, in one case, outperforming the executed revascularization in reduction of ischemic burden. Virtual PCI enables the prediction of post-PCI myocardial blood flow (MBF) and FFR, offering a comprehensive assessment of treatment outcomes to identify the best revascularization option from the hemodynamic standpoint. since it relies solely on non-invasive imaging (cCTA, stress-CTP), Virtual PCI can be integrated early in the diagnostic workflow, providing cardiologists with a powerful, patient-specific tool to optimize PCI planning.

Background Bovine jugular vein conduit (BJVC) is widely used for right ventricular outflow tract (RVOT) reconstruction, yet long-term durability varies and individualized risk tools remain limited. Methods We conducted a single-center retrospective cohort of consecutive children undergoing primary BJVC implantation between 2011 and 2020. The primary endpoint was BJVC failure, defined as surgical or catheter-based reintervention for conduit dysfunction or infective endocarditis. Freedom from failure was summarized at 1, 3, 5, and 7 years. Candidate predictors comprised demographics, pre-operative echocardiography/laboratory data, operative metrics (conduit internal diameter, cardiopulmonary bypass and cross-clamp times), and pre-discharge residual RVOT gradient. Missing data (0%–11%) were handled using multiple imputation by chained equations. Predictors selected by LASSO were entered into multivariable Cox regression. Model performance was evaluated for discrimination (Harrell's C; time-dependent AUC) and calibration, with internal validity assessed by bootstrap optimism correction. A nomogram was constructed to provide individualized 1-, 3-, 5-, and 7-year estimates of freedom from failure. Results Seventy-eight patients were included (median follow-up, 7.7 years); 29 conduit failures occurred (37.2%). All conduit reinterventions were surgical redo procedures; no patient underwent catheter-based balloon dilation of the BJVC prior to surgical reintervention. Independent risk factors were pre-discharge residual gradient ≥20 mmHg (HR 18.67; 95% CI 7.43–46.94), longer cardiopulmonary bypass time (per 10-minute increase HR 1.28; 95% CI 1.15–1.43), male sex (HR 2.25; 95% CI 1.11–4.58), age ≤1 year (HR 1.76; 95% CI 1.09–2.86), and conduit diameter ≤14 mm (HR 1.68; 95% CI 1.04–2.74). The model demonstrated good discrimination (Harrell's C-index 0.82) and acceptable calibration; bootstrap internal validation yielded similar performance, with time-dependent AUCs of 0.888, 0.850, 0.900 and 0.897 at 1, 3, 5, and 7 years, respectively. Freedom from failure at 1, 3, 5, and 7 years was 97.4%, 87.2%, 75.6%, and 62.8%, respectively. Conclusions Using routinely available peri-operative variables, we developed an interpretable nomogram to estimate the risk of BJVC failure and to inform individualized surveillance and intervention planning. The model showed good internal performance but was derived in a single-center cohort with a modest number of events; prospective multicenter validation and, if necessary, recalibration are required before routine clinical implementation.

Background: Early childhood motor development plays a critical role in shaping participation and quality of life for children diagnosed with autism spectrum disorder. Parental perspectives provide unique insights into barriers, facilitators, and the real-world impact of interventions. Objectives: This study applied qualitatively led an exploratory mixed-method design grounded in a biopsychosocial paradigm. The qualitative component captured parental narratives, while quantitative summaries were generated to identify consensus areas of motor challenges and environmental influences. This dual approach aimed to reveal both the diversity of lived experience and recurring patterns that may inform screening and intervention planning. Methods: Semi-structured interviews were conducted with 58 parents of preschool-aged children diagnosed with autism spectrum disorder in Hungary. Transcripts were analysed thematically, and through descriptive frequency summaries and exploratory chi-squared analyses of coded data. Results: Parents consistently reported fine and gross motor differences, with consequences extending to participation in family, school, and community contexts. Early diagnosis was seen as beneficial primarily when it facilitated access to supportive services. Environmental adaptations, such as inclusive playgrounds and adaptive tools, were perceived by parents as enhancing children’s opportunities to participate, while the lack of accommodations amplified difficulties. Interventions embedded in real-life contexts and actively involving families were viewed as most effective. Exploratory quantitative summaries indicated consensus on five key challenges, including pencil grip, small object manipulation, and playground participation. Conclusions: The findings demonstrate that motor development in autism spectrum disorder is best understood within a biopsychosocial framework linking individual abilities, environmental modifications, and social acceptance. By integrating qualitative and quantitative perspectives, this study illustrates how family experiences can inform the design of family-centred interventions and context-sensitive policies that foster meaningful participation.

BACKGROUND The global rise in the elderly population has amplified the urgency to address age-related nutritional risks, as malnutrition among older hospitalized patients contributes to poor clinical outcomes and shows the need for targeted nutritional interventions. This study aimed to assess the clinical nutrition management of elderly hospitalized patients. MATERIAL AND METHODS A total of 227 hospitalized patients who received nutrition consultations in the Department of Geriatrics at Peking University People's Hospital from May 2017 to September 2020 were included in this study. We conducted a retrospective review of their medical records, collecting basic clinical information, nutritional status, consultation times and recommendations, compliance with clinical advice, and changes in blood biochemical indicators. RESULTS Among 227 patients, 160 (68.75% male and 73.49% female) were at nutritional risk. Those with type 2 diabetes, pulmonary infections, gastrointestinal diseases, chronic kidney disease, and anemia had a higher incidence of nutritional risk (* P<0.05). Of these, 204 adhered to the nutritionists' intervention plan, with the highest implementation rate for health education (98.73%) and the lowest for oral nutritional supplements (ONS) at 83.87%. Noncompliance included 69% failing to take oral supplements and 22% refusing tube feeding. Patients following nutritional advice had significantly shorter hospital stays (P=0.03, P=0.00). After the intervention, total protein and albumin improved, with low-risk patients showing higher levels in total enteral nutrition (* P<0.05). No significant differences were found in high-risk patients (P>0.05). CONCLUSIONS Effective clinical nutrition management for elderly patients requires enhanced dietary supply practices, standardized consultation implementation, and the active involvement of patients' families in nutritional planning, ultimately improving overall healthcare outcomes.

The university student period is of great importance as it is easier to exhibit risky behaviors such as unhealthy eating. The aim of this study is to assess the food literacy and eating disorders of university students to contribute to the planning of remedial interventions. This study was conducted with 813 students from Kütahya Health Sciences University, in 2022. Data were collected through a survey form. Factors associated with food literacy and eating disorders were demonstrated using chi-square tests and binary logistic regression analysis. Food literacy was found to be more inadequate/limited in men, younger individuals, those who perceive themselves as weak, those who do not prioritize healthy eating, those who consume less than five servings of fruits, vegetables, legumes, and grains (excluding potatoes and corn), and those who consume more than 50 grams of sugar daily. Eating disorders were more common among those who perceive themselves as overweight or normal weight, those who do not eat regularly, those who restrict their eating to stay thin or maintain an ideal weight, those with fast food habits, those whose food intake varies with emotions, and those with lower BMI and associate degree education. In order for university students, who are the future of the country, to acquire healthy eating habits, we think that planning remedial interventions such as the inclusion of healthy nutrition in educational curricula and various activities, regulations in the nutrition facilities of universities and dormitories, and in the amount of loans/scholarships given will have a positive effect.

Alzheimer's disease is a progressive neurodegenerative disorder characterized by memory loss and cognitive decline, with no known cure. Early detection of dementia, a primary manifestation of Alzheimer's disease, is critical to enable timely intervention and treatment planning. This study introduces ensemble learning models for predicting Alzheimer's disease and presents a comparative analysis between traditional machine learning and advanced ensemble models. The evaluation is conducted using the "Open Access Series of Imaging Studies" 2 (OASIS-2) dataset. Traditional models, including logistic regression, decision tree, support vector machine, and random forest, are benchmarked against ensemble models such as adaptive boosting, extreme gradient boosting, and a hyperparameter-tuned majority voting ensemble models. Performance is assessed using accuracy, precision, and the area under the receiver operating characteristic curve. Results show that ensemble models, particularly the optimized majority voting classifier, consistently outperform traditional methods. To complement the supervised comparison, exploratory unsupervised methods were applied using multiple correspondence analysis and k-means clustering to uncover latent structures in the dataset. By categorizing all variables, these unsupervised methods highlight patterns of clinical and demographic similarity. Unlike prior studies that focus solely on predictive accuracy, this work integrates supervised classification, ensemble learning, and unsupervised exploratory analysis within a unified framework. This combined approach enables both robust performance comparison and deeper insights into latent data structures relevant to Alzheimer's disease. All computational experiments were conducted using the Python programming language.

Abstract Understanding human mobility is vital to solving societal challenges, such as epidemic control and urban transportation optimization. Recent advancements in data collection now enable the exploration of dynamic mobility patterns in human flow. However, the vast volume and complexity of mobility data make it difficult to interpret spatiotemporal patterns directly, necessitating effective information reduction. The core challenge is to balance data simplification with information preservation: methods must retain location-specific information about human flows from origins to destinations while reducing the data to a comprehensible level. This study proposes a two-step dimensionality reduction framework: First, combinatorial Hodge theory is applied to the given origin–destination (OD) matrices with timestamps to construct a set of potential landscapes of human flow, preserving imbalanced trip information between locations. Second, principal component analysis (PCA) expresses the time series of potential landscapes as a linear combination of a few static spatial components, with their coefficients representing temporal variations. The framework systematically decouples the spatial and temporal components of the given data. By implementing this two-step reduction method, we reveal large weight variations during a pandemic, characterized by an overall decline in mobility and stark contrasts between weekdays and holidays. These findings demonstrate the effectiveness of our framework in uncovering complex mobility patterns and its potential to inform urban planning and public health interventions.

The importance of handwashing with soap (CTPS) behavior during the COVID-19 pandemic plays a significant role in preventing the transmission of infectious diseases. However, document reviews and interviews at Garuda Health Center in Pekanbaru City indicate that the achievement of CTPS is still low, at only 29%. This low achievement is caused by a lack of cross-program coordination between environmental health program holders and health promotion, as well as the non-implementation of Community-Based Total Sanitation (STBM) triggering activities in 2020 due to the COVID-19 pandemic. This study aims to evaluate the implementation of the Clean and Healthy Life Behavior (PHBS) program through CTPS activities in efforts to prevent COVID-19 at Garuda Health Center in Pekanbaru City, and to formulate alternative problem-solving strategies through the development of an intervention plan (Plan of Action). This study uses a qualitative method with data collection techniques in the form of in-depth interviews, field observations, and document reviews regarding the implementation of the STBM program. The research informants consist of the Head of the Community Health Center (Puskesmas), the Head of Administration, the holder of the STBM program, and related staff. The results of the study show that the achievement of CTPS is still low due to weak cross-program coordination and suboptimal community empowerment activities. Improvement efforts are carried out by preparing a work plan (RUK) and a Plan of Action in the form of strengthening cross-program coordination, training environmental health workers, providing health promotion media, and improving CTPS facilities in public places. It is concluded that the evaluation of the PHBS program through CTPS needs to be focused on strengthening cross-sector collaboration to improve clean and healthy living behaviors of the community in the working area of Garuda Community Health Center, Pekanbaru City.

The concept of 'internet addiction' was introduced in the 1990s and has increasingly been recognized as a clinical and public health issue. Although umbrella terms can be useful for screening, theoretical considerations, and intervention planning, the term itself has received criticism because of its conceptual heterogeneity, implying an addiction to a medium and not including a wide range of problematic behavioral patterns that are below the diagnostic threshold of a clinical disorder. To address this criticism, we propose adopting the term 'problematic use' instead of 'addiction'. Furthermore, we argue that while 'problematic usage of the internet' is currently a useful umbrella term, recent technological advancements and increasing online presence may in the future require a conceptual and methodological shift in terminology from 'internet' to the more specific 'screen-based devices' or 'screens' thatwould enable more accurate assessment and intervention strategies. Terms focusing on specific devices, such as 'smartphone addiction,' should also be used with caution, as problematic use relates to applications rather than the hardware itself and may extend to various devices.

Peripherally Inserted Central Catheters (PICCs) are widely utilized in tumor patients due to their lower risk of complications, extended indwelling duration, reduced local tissue trauma, and overall cost-effectiveness. Based on the Health Action Process Approach (HAPA) theory, this study aims to explore the current status and influencing factors of kinesiophobia in tumor patients with PICCs. The study provides reference for clarifying the mechanism of kinesiophobia and developing nursing intervention plans. Through convenience sampling, 162 tumor patients who underwent PICC maintenance in three hospitals in Jiangsu Province from December 4th, 2023, to December 31st, 2024 were selected. The patient general information questionnaire, Tampa scale of kinesiophobia, medical coping modes questionnaire, exercise self-efficacy scale, risk perception questionnaire, outcome expectation scale, exercise intention scale, and social support rating scale were used for evaluation. Tumor patients carrying PICC had a kinesiophobia score of 20.11 ± 6.94 points, and 42.59% of tumor patients with PICC had kinesiophobia. The results of multiple linear regression showed that the duration of catheter placement(t = -3.506,P = 0.001), pain(t = 2.652,P = 0.009), exercise self-efficacy(t = -3.891,P < 0.001), and risk perception(t = 3.157,P = 0.002) are the main influencing factors of kinesiophobia in tumor patients with PICC. The findings underscore a significant clinical concern regarding kinesiophobia among tumor patients with PICC. It is essential for nursing staff to implement systematic assessments and tailored interventions aimed at mitigating kinesiophobia. Addressing this issue can contribute to reducing associated adverse reactions and improving patient mobility and overall quality of life.

Rapid urbanization in Lagos, Nigeria, has intensified population density and altered local microclimates, exposing residents to increased risks of heat stress. As one of Africa&amp;rsquo;s largest megacities, Lagos faces challenges in balancing urban growth with environmental sustainability. This study investigates the spatiotemporal characteristics of heat stress vulnerability and the moderating effects of urban green spaces (UGSs) across 11 local government areas (LGAs) in Lagos, Nigeria. Land surface temperature (LST) for 2013, derived from Landsat 8 Operational Land Imager imagery, was analyzed alongside 2013 population statistics and household questionnaire data collected from residents nearest to 15 observation sites. Each LGA was represented as a polygon feature in ArcGIS. Exposure indicators included LST, population density, and LST hotspot clusters; sensitivity indicators included vulnerable age groups (0&amp;ndash;4 and 65+ years), low educational attainment, and income classes; and adaptive-capacity indicators included ownership of air conditioners and fans, proximity to water bodies, and proximity to grass or green spaces. Results reveal five population density categories across the metropolis. Yaba exhibits extremely high density (93,320&amp;ndash;339,100 persons/km2), while areas such as Abule-Egba, Mushin, Ilupeju, and Shomolu fall within high to moderately high density ranges. LST hotspot analysis indicates that Amuwo-Odofin, Isolo, Yaba, Ilupeju, Shomolu, Alagbado, and Ikotun are statistically significant hotspot locations at the 95&amp;ndash;99% confidence level. Conversely, Oko-Afo, Ajangbadi, City Hall, Marina market, and Abule-Egba were not classified as hotspots due to inherent adaptive capacities, while Oshodi and Ejigbo emerged as cold spots. Adaptation measures vary across the metropolis. Ownership of air conditioners and fans, along with proximity to vegetation and water bodies, were the dominant strategies for mitigating heat exposure. The study underscores the critical role of UGSs in reducing heat stress vulnerability and highlights the need for strategic urban planning interventions to enhance adaptive capacity in Lagos.

Climate-resilient groundwater potential zoning and intervention planning in the Nira River basin using ensemble machine learning, AHP, and CMIP6 scenarios

Children with cerebral palsy (CP) frequently experience communication difficulties that limit their participation and social interaction. While previous studies have addressed communication in CP, few have systematically examined communication functions and communicative behaviours using the structured framework of the Communication Matrix, particularly in contexts where augmentative and alternative communication (AAC) is underutilized. This study aimed to examine the communication functions and communicative behaviours of Turkish children with CP using the Communication Matrix and to investigate how these outcomes differ according to levels of gross motor function. This cross-sectional study included 64 children with CP aged 4-18 years who attended special education and rehabilitation centres in Türkiye. Data were collected using the Communication Matrix, Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS), Viking Speech Scale (VSS) and Communication Function Classification System (CFCS). Descriptive statistics were obtained. Given the violation of normality assumptions, non-parametric analyses (Mann-Whitney U and Kruskal-Wallis tests with Bonferroni correction) were employed to compare communication outcomes across GMFCS levels. Among communication functions, obtaining and social interaction were the most prominent, while refusal and providing information were less frequently observed. Visual behaviours (41.88%) and conventional gestures (37.75%) were most common, whereas abstract symbols (9.51%), concrete symbols (19.53%) and body movements (13.45%) were less frequently employed. Across GMFCS levels, children at Level V showed significantly lower abstract symbols and language use than those at Levels I-IV (p = 0.003) and also demonstrated markedly lower scores across all communication functions (refusal, obtaining, social interaction, and providing information) compared to Levels I-IV (p < 0.01). Overall communicative competence decreased in parallel with increasing severity of motor impairment. The findings indicate that children with CP predominantly rely on nonverbal strategies such as gestures and visual behaviours, while symbolic communication is considerably limited, especially among those with severe motor impairments. In addition, communication functions showed a similar pattern: higher-level functions such as providing information were used much less frequently than obtaining or social interaction and all functions declined with increasing GMFCS level. The results underscore the strong link between gross motor functioning and communicative complexity and highlight the importance of early interventions and AAC integration. What is already known on this subject Children with cerebral palsy (CP) often experience significant communication difficulties that restrict their participation in daily life. Previous research has documented the reliance of children with CP on nonverbal communication modes and the association between motor severity and communication outcomes, but systematic analyses using the structured framework of the Communication Matrix are scarce, particularly in Türkiye where AAC use is limited. What this paper adds to existing knowledge This study systematically examined communicative functions and behaviours in Turkish children with cerebral palsy using the Communication Matrix. The findings showed that obtaining and social interaction were the most frequently observed communicative functions, whereas refusal and providing information were less common. Symbolic communication, particularly abstract symbols and spoken language, was markedly limited, especially among children with severe motor impairments. These results highlight the close association between motor severity and communicative complexity, offering valuable evidence to inform both clinical practice and future research. What are the potential or actual clinical implications of this work? The findings underscore the urgent need to integrate augmentative and alternative communication (AAC) strategies into rehabilitation and educational services in Türkiye. The Communication Matrix is demonstrated as a practical tool for identifying individualized communication targets and monitoring progress, supporting more effective clinical decision-making and intervention planning.

Evaluation of the Aged Care On-site Pharmacist (ACOP) program in Australian residential aged care homes: Key considerations and next steps.