Although increasing numbers of young people are trying to quit e-cigarettes, personalized tools to support vaping cessation remain limited. We aimed to build a machine learning model to predict individual probability of short-term relapses and identify person-specific barriers to successful cessation. Data were taken from the "Stop Vaping Challenge" smartphone app. We included past 30-day e-cigarette users aged 15-35 years (n = 311) who completed 387 quit challenges. Feature selection minimized number of predictors while maximizing predictive ability. We built multiple GBM survival models with different sets of predictors to predict time to vaping relapse. The five-feature model yielded the best performance (C-index 0.751), thereby was selected as the final model. These five features were: self-confidence in quitting, intention to quit, average e-liquid used per week, time to first vape and mood trend during challenge. We stratified the challenges by the individual relapse risk by 7 days into low-, medium-, and high probability of quit success. This approach can inform tailored quit plans for vaping cessation. SHAP analysis demonstrated individual-level barriers to cessation, which can guide the development of personalized, predictor-centric, adaptive behavioral interventions. However, future research is needed to implement the model in real-world settings and evaluate its effectiveness and generalizability.

Healthcare systems contribute significantly to environmental pollution, energy consumption, and resource depletion, making sustainability an increasingly important environmental and public health priority. Nurses, as frontline healthcare professionals, play a critical role in promoting environmentally responsible practices and advocating for sustainable healthcare within clinical settings.

The study aimed to examine the associations between nurses' sustainability consciousness, green advocacy, and work grit in hospital settings.

A descriptive cross-sectional correlational study was conducted among 377 nurses working in two university-affiliated hospitals in Egypt. Data were collected using validated instruments assessing sustainability consciousness, green advocacy, and work grit. Descriptive statistics were calculated to summarize participant characteristics and study variables. Associations among sustainability consciousness, green advocacy, and work grit were examined using Pearson correlation analysis. Multiple linear regression analysis was conducted to identify significant predictors of green advocacy, while noting that the study design allows for identification of associations rather than causal relationships.

The findings indicated generally high levels of sustainability consciousness among nurses. Significant positive associations were observed between sustainability consciousness, green advocacy, and work grit (p < 0.01). Multiple linear regression analysis identified sustainability consciousness and work grit as significant predictors of green advocacy, explaining 34.2% of its variance.

These findings highlight the interconnected roles of sustainability awareness, advocacy behaviors, and psychological resilience in promoting environmentally sustainable healthcare practices. Strengthening nurses' sustainability consciousness and work grit may enhance green advocacy and contribute to the development of sustainable healthcare systems, supporting global environmental and public health goals aligned with the United Nations Sustainable Development Goals.

Peru's recent national mental health (MH) reforms aim to decentralise care and expand access to MH services for rural populations by integrating services into primary healthcare through the expansion of Community Mental Health Centres (CMHCs). Evidence on the implementation of these reforms at the local level remains limited. This qualitative study aimed to (i) describe the structure and implementation framework of MH services, (ii) analyse local understandings of MH; and (iii) examine pathways to care and identify barriers and facilitators to MH service implementation from both the supply (service providers) and demand (users and community members) perspectives. MH services were mapped across three provinces of northern Peru using a review of national MH policies, 2 focus group discussions, and 31 semi-structured interviews. Data were analysed thematically to explore local understandings of MH, pathways to care, and health system barriers. Local understandings of MH are shaped by cultural beliefs, social norms, and economic conditions, with many individuals experiencing distress initially relying on family networks or traditional healers. Stigma and expectations of a quick recovery hinder engagement with formal services. While the expansion of CMHCs has improved geographical access to specialised care in rural areas through proximity and being patient-centred, the implementation of respectful provider interactions remains uneven. Weak referral pathways and limited coordination between primary care centres and CMHCs frequently shift the responsibility for navigating care onto users and their families. Family involvement and culturally sensitive practices foster trust and support continued engagement. Persistent challenges include the limited capacity of service providers, high staff turnover, and the follow-up mechanisms, stigma, and tensions between cultural and biomedical understandings of MH. Peru's expansion of CMHCs represents a significant health system reform to improve equitable access for rural populations. To sustain these gains, it will be necessary to strengthen workforce stability, clarify referral processes, and integrate culturally responsive approaches within primary care systems, offering lessons for similar resource-constrained contexts.

The internet is increasingly embedded in daily life; however, excessive use may lead to internet addiction, adversely affecting health and academic performance. This study aimed to determine the prevalence of internet addiction and its association with depressive symptoms among pharmacy students at Mahasarakham University. A cross-sectional survey was conducted between 1 October and 31 December 2025 among undergraduate pharmacy students (years 1-6) aged ≥18 years who provided voluntary consent. Data were collected via street-based and online self-administered questionnaires validated for content and reliability. Descriptive and inferential statistics were applied, and binary logistic regression was used to identify associated factors. Among 396 participants, the mean internet use was 9 h 43 min per day. The prevalence of excessive use (risk) was 75.95%, while 17.47% met criteria for internet addiction. High to very high psychological problems were significantly associated with internet addiction (aOR = 3.89; 95% CI: 1.70-8.89; p = 0.001). Risk of depression (2Q) was also significantly associated (aOR = 2.67; 95% CI: 1.39-5.15; p = 0.003). Internet addiction is strongly associated with mental health factors, highlighting the need for targeted prevention and institutional mental health interventions.

This comparative cross-sectional study simultaneously investigated the dual health burden of body mass index (BMI) and common mental disorders (CMDs) driven by occupational stressors in two stepwise regression models. By classifying stress exposure into three clinically relevant tiers (low, moderate, and severe) in two distinctive populations-a hospital and a manufacturing company-we used the validated SDS-30 and SRQ-20 instruments. The robust multiple regression models uncovered a highly nuanced landscape of employee well-being that highlights the context-dependent nature of psychosocial hazards. The most compelling findings emerged from the interaction analyses, which demonstrated that the physical and mental consequences of severe stress do not impact the workforce uniformly. Regarding mental health, severe occupational stress proved to be a potent catalyst for CMD symptoms, but this psychological toll was significantly magnified within the hospital sector relative to the manufacturing environment. An opposite, yet equally context-dependent, pattern emerged regarding physical health. In the main-effects-adjusted model, the severity of occupational stressors did not demonstrate a statistically significant linear association with an overall increase in BMI. However, the interaction model revealed a hidden vulnerability: employees in operational field roles who report severe stress are highly susceptible to severe BMI increases compared with admin personnel. While administrative staff may face sedentary risks, field workers under severe stress likely endure higher physiological allostatic load, erratic shift patterns that disrupt circadian metabolic rhythms, and potentially poorer dietary coping mechanisms during active labor. This combination of physical exhaustion and severe psychological tension severely disrupts metabolic homeostasis, forcing the redistribution of adipose tissue and driving the observed BMI spike.

Frailty is a multifactorial geriatric syndrome marked by reduced physiological reserves and increased vulnerability to adverse outcomes. This multicenter observational study adopted a One Health approach to examine the association between frailty and biological sex, denture use, and antidepressant medication, as well as their impact on bite force, in two transnational cohorts of physically active older adults. The sample included 499 individuals aged ≥60 years (295 from Brazil and 204 from Portugal), all with functional dentition and regular physical activity. Frailty was assessed using the adapted Fried phenotype and classified as non-frail (G0), pre-frail (G1), or frail (G2). Oral health, depressive symptoms (CES-D), bite force, and self-reported use of dentures and antidepressants were analyzed. Frailty was significantly associated with biological sex (p < 0.001), with higher prevalence among women, especially in G2. Antidepressant use was associated with frailty in the Portuguese cohort (p < 0.001) and in the total sample (p = 0.005), but not in Brazil. No significant association was observed between denture use and frailty. However, Brazilian participants without dentures showed significantly higher bite force (p < 0.001), indicating a functional oral health effect. Frailty was associated with female sex and antidepressant use, while bite force emerged as a complementary functional marker for geriatric assessment.

During pregnancy, women are more inclined to modify their habits and lifestyle to find a new balance and promote well-being for themselves and the child-to-be. However, the availability of nutritional and psychological support is often limited by stigma, geographic barriers, and a lack of services. Digital health tools are emerging as possible solutions to cover these needs. This study explores the acceptability, feasibility, and user experience of Demetra, a virtual coach based on Acceptance and Commitment Therapy (ACT), designed to promote healthy lifestyles and mental well-being. Fifty pregnant women will be enrolled in the feasibility study of the intervention. It starts with an educational part on the foundations of healthy eating and suggestions about lifestyle habits, followed by a six-week psychoeducational module. Content is delivered through text, audio, and video formats. User experience and engagement will be measured through validated questionnaires and semi-structured interviews. Psychological well-being will be evaluated both before and after the program. The intervention is expected to be well-received, with high levels of satisfaction and engagement, leading to a greater awareness of healthy behaviors, improved psychological flexibility, and enhanced overall well-being. Demetra offers an accessible solution to support women through the transformative experience of motherhood with a multidisciplinary and innovative approach.

Patients undergoing hemodialysis often experience reduced quality of life, with psychological symptoms and nutritional risk representing important determinants of patient functioning. This study aimed to examine the relationships between depression, anxiety, stress, nutritional risk, mental health, and physical functioning in patients undergoing hemodialysis, with particular emphasis on the mediating role of mental health. A cross-sectional study was conducted among 199 patients receiving hemodialysis in five Croatian hospitals. Depression, anxiety, and stress were assessed using the DASS-42, quality of life using the SF-36, and nutritional risk using the NRS-2002. Associations between variables were examined using Spearman's correlation coefficient, while structural equation modeling was used to analyze direct and indirect relationships among psychological symptoms, nutritional risk, mental health, and physical functioning. Depression and stress showed significant negative effects on mental health, while mental health showed a significant positive effect on physical functioning. Nutritional risk had a significant direct negative effect on physical functioning. Mental health significantly mediated the relationship between depression and stress and physical functioning. These findings indicate that psychological symptoms and nutritional risk are important determinants of functioning and quality of life in hemodialysis patients and support the need for an integrated care approach that includes regular psychological and nutritional screening.

The expansion of digital connectivity has reshaped contemporary work environments, increasing flexibility while simultaneously blurring the boundaries between work and personal life. In such contexts, employees may experience difficulties in psychologically detaching from work during off-job time. Drawing on the Effort-Recovery model and Conservation of Resources theory, this study examined whether affective work-related rumination indirectly explained the association between Fear of Missing Out (FoMO) and psychological detachment. A cross-sectional survey was conducted with 228 employees from diverse occupational sectors who completed validated measures of FoMO, affective rumination, and psychological detachment. Indirect effect analyses using bootstrapping procedures indicated that FoMO was positively associated with affective rumination, and affective rumination was negatively associated with psychological detachment. The indirect effect was significant, whereas the direct association between FoMO and detachment was not. These findings are consistent with an indirect association pattern whereby FoMO is related to lower psychological detachment through higher levels of affective rumination. However, given the cross-sectional design, the results should be interpreted as correlational evidence rather than as demonstrating a causal mediation process. The model accounted for approximately 10% of the variance in psychological detachment. Overall, the findings suggest that FoMO may be indirectly related to reduced recovery experiences via emotionally charged repetitive thinking that sustains cognitive activation beyond working hours. Addressing rumination and supporting healthier digital boundary management may therefore represent promising avenues for supporting occupational mental health in increasingly connected work environments.

Background/Objective: Health is a multidimensional construct shaped not only by clinical conditions but also by psychological, social, environmental and cultural factors. In low- and middle-income countries undergoing rapid epidemiological transition, understanding health requires integrated and culturally informed approaches. However, quality of life, perceived health status and lifestyle behaviors are often investigated separately, limiting the interpretation of well-being in specific local contexts. This study aimed to provide an integrated assessment of quality of life, perceived health status and lifestyle behaviours among adults attending a peri-urban public hospital in Kenya, using internationally validated instruments applied within a specific local cultural context. Methods: A cross-sectional observational study was conducted at Tigoni Level 4 Hospital, Kiambu County, Kenya. Adult outpatients (N = 40) were consecutively recruited. Quality of life was assessed using the WHOQOL-BREF, perceived health status using the EQ-5D-5L and EQ-VAS, and lifestyle behaviours using selected modules of the WHO STEPS instrument. Descriptive statistics were performed, and exploratory associations were examined using Spearman's rank correlation coefficient. Results: Participants had a mean age of 35.9 ± 11.4 years, with a balanced gender distribution. Lifestyle risk factors were prevalent, including insufficient physical activity (40%) and overweight or obesity (>50%). WHOQOL-BREF scores revealed a heterogeneous profile, with relatively preserved social relationships and lower scores in the psychological and environmental domains. Pain/discomfort and anxiety/depression were the most frequently reported EQ-5D-5L problems. The mean EQ-VAS score was 68.2 ± 15.7. Perceived health was positively associated with physical and psychological quality of life, while higher body mass index was associated with lower physical quality of life. Mental health emerged as a cross-cutting factor across instruments. Conclusions: The findings highlight the multidimensional nature of health in a peri-urban Kenyan context and suggest the importance of considering local social and cultural influences when interpreting standardized health measures. Mental health and environmental conditions play a central role in shaping quality of life and perceived health, while lifestyle risk factors are already prevalent in a relatively young outpatient population. Integrating standardized health measures within a cross-cultural framework may support more holistic and person-centred approaches in primary care and public health in similar settings.