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Background: This pilot study examined the feasibility, acceptability, usability, and preliminary outcomes of apt.mind, a mobile app-based mindfulness intervention with an exploratory smartwatch component, among healthcare worker families during the COVID-19 pandemic. Methods: Using a micro-randomized trial (MRT) design, 102 healthcare workers and co-parents of children aged 4-13 years were randomized once per day over 30 days to one of three conditions: (1) an audio-guided mindfulness exercise delivered via the apt.mind mobile app, (2) an in-app push notification prompting a brief mindfulness activity, or (3) no intervention. Feasibility was assessed through participant enrollment, retention, and daily engagement rates, while acceptability and usability were evaluated through qualitative and quantitative feedback. Exploratory multilevel analyses examined proximal effects of intervention conditions on momentary stress. Results: Retention was high, with all participants completing the 30-day protocol, and 80% of participants completed at least one daily survey. Participants reported moderate-to-high acceptability and usability. However, smartwatch battery life and sensor reliability limited the collection of usable physiological data. Multilevel analyses did not identify any significant main effects of intervention condition on momentary stress, but age moderated the association between the audio exercise condition and stress, benefiting older participants. Conclusions: Mobile-based mindfulness interventions appear feasible and acceptable for healthcare worker families in high-stress contexts. Although proximal stress effects were limited and exploratory, the findings inform future optimization of just-in-time adaptive interventions. Improvements in wearable technology and MRT implementation strategies are needed to enhance physiological data quality and reduce assessment-related anxiety.

Background and Objectives: Sepsis and septic shock remain leading causes of morbidity and mortality in intensive care settings worldwide. While substantial epidemiological data exist from Western countries, the clinical profile of sepsis in regions with exceptionally high diabetes prevalence remains inadequately characterized. Saudi Arabia, with one of the highest diabetes mellitus prevalence rates globally, may exhibit distinct sepsis epidemiology, infection patterns, and outcomes. This study aimed to characterize the clinical profiles, antimicrobial management, and outcomes of sepsis and septic shock in a tertiary intensive care unit (ICU) in the Aseer region of southwestern Saudi Arabia. Materials and Methods: A retrospective observational study was conducted including 263 adults meeting Sepsis-3 criteria (232 sepsis, 31 septic shock) admitted to a tertiary ICU between January 2020 and December 2024. Demographics, comorbidities, laboratory parameters, microbiological data, antibiotic timing, interventions, and in-hospital mortality were analyzed. Logistic regression identified independent mortality predictors. This study adhered to the STROBE reporting guidelines. Results: The median age was 73 years with male predominance (58.4%). Diabetes mellitus (71.5%) and hypertension (65.8%) were highly prevalent. Urinary tract infections (UTIs) predominated (79.8%), with Escherichia coli as the most common pathogen (26.2%). The median time to antibiotic administration was 1.8 h; piperacillin-tazobactam was the most frequent empiric regimen (43.7%). Septic shock patients exhibited higher creatinine (1.65 vs. 1.08 mg/dL, p = 0.026) and lower platelets (194 vs. 271 × 10³/μL, p = 0.030). Mortality was 38.7% in septic shock versus 8.2% in sepsis (p < 0.001). Multivariate analysis confirmed septic shock (aOR: 5.23; 95% CI: 1.89-14.48) and mechanical ventilation (aOR: 15.42; 95% CI: 5.67-41.95) as independent mortality predictors. Conclusions: High diabetes prevalence shapes regional sepsis epidemiology with UTI predominance. Early antibiotic administration and recognition of septic shock remain critical for improving outcomes in this population.

Background: Exercise during pregnancy is known to benefit physical and mental health. However, pregnant women's lived experiences of its psychological impact remain insufficiently explored. This study aimed to explore pregnant women's experiences and perceptions of how exercise influences mental health during pregnancy. Methods: A qualitative study design was employed. Pregnant women were recruited using purposive sampling from a clinical hospital setting between March and September 2025. Eligible participants met predefined inclusion and exclusion criteria. Data saturation guided sample size (N = 38). Data were collected through semi-structured online interviews. Interviews were audio-recorded, transcribed verbatim, and analysed using inductive thematic analysis. Results: Four major participant-derived themes emerged: emotional regulation and mood stabilization, reduction of anxiety and depressive symptoms, enhanced self-confidence and body acceptance, and increased self-efficacy and sense of control. These themes illustrate the range of psychological benefits associated with maintaining exercise during pregnancy. Conclusions: This study highlights the psychological meanings pregnant women attribute to exercise, extending beyond its established physical benefits. These insights underscore the importance of integrating mental health perspective into prenatal physical activity counselling and support the development of more individualized, patient-centered prenatal care strategies.

Background/Objectives: Adverse childhood experiences (ACEs), including physical and sexual abuse, are significantly associated with long-term health issues, particularly among socially disadvantaged populations. The study examines the social determinants of health, such as poverty, racial inequities, and limited access to care, to assess their association with adverse childhood experiences, including exposure to physical violence and sexual abuse. Methods: We performed multivariable logistic regression analyses using data from the 2023 Georgia Behavioral Risk Factor Surveillance System (BRFSS) (n = 8227) to examine associations between selected ACEs and key social determinants of health (SDOH). Results: Our results indicated that a lack of emotional and social support was associated with increased odds of witnessing parental violence (AOR = 2.00) and physical abuse (AOR = 1.90). Absence of food insecurity was associated with lower odds of witnessing parental violence (AOR = 0.65), unwanted sexual touching (AOR = 0.77), and forced sex (AOR = 0.63). Similarly, not reporting transportation barriers was associated with lower odds across ACE outcomes (AORs ranging from 0.54 to 0.65). Sexual and gender minority individuals exhibited substantially higher odds of childhood sexual abuse (AORs = 3.64-5.56). Hispanic ethnicity was associated with increased odds of physical abuse (AOR = 1.47), and older adults (ages 45-64) had greater odds of experiencing forced sex (AORs = 2.08-2.48). These findings highlight complex relationships between SDOH and early trauma. Conclusions: Trauma-informed public health strategies must address structural inequities and strengthen emotional and material support for vulnerable populations.

Aims: This study aims to assess the effect of a structured universal self-care practices module on improving self-care compliance and health maintenance behaviors among women with endometriosis, and to determine if it reduces pain severity. Design: A quasi-experimental design was used. Methods: A total of 90 women confirmed a diagnosis of endometriosis, who were free from any chronic medical or gynecological comorbidities, and who had not received any pain relief pharmacological interventions. Results: The study and control groups were comparable at baseline regarding socio-demographic and clinical characteristics (p > 0.05). Following the intervention, the study group demonstrated significant improvements in universal self-care practices compared to the control group at one month (M = 69.2 ± 11.6 vs. 58.3 ± 8.83; t = -4.93, p = 0.001) and three months (M = 76.4 ± 16.5 vs. 61.5 ± 12.2; t = -4.89, p = 0.001). A strong negative correlation was found between self-care and symptom severity at one month (r = -0.70, p < 0.001) and three months (r = -0.83, p < 0.001), indicating that improved self-care was associated with reduced symptoms. Conclusions: This study highlights the vital role of nursing-led, WHO-based self-care interventions in improving compliance and reducing pain among women with endometriosis. Integrating such programs into routine care can enhance self-management and overall quality of life. Patient or Public Contribution: Integrating individualized, nursing-led self-care programs into routine endometriosis management can improve symptom control through ongoing education and follow-up. Nurses play a pivotal role in empowering women's self-management, while adopting the WHO Universal Self-Care Framework can strengthen gynecological care policies and practices.

Background: Physical inactivity is linked to falls, cognitive decline, and reduced independence, underscoring the need for accessible interventions that enhance balance and cognitive functions. In this context, sustainability refers to affordability, accessibility, feasibility, and potential for long-term adherence. Table tennis, an open-skill sport requiring motor coordination and cognitive engagement, may help improve balance and cognitive functions. This meta-analysis synthesized available evidence to investigate the effects of table tennis interventions on balance and cognitive functions. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines and PROSPERO registration, six electronic databases were searched. A meta-analysis was conducted with 14 randomized controlled trials comprising 1565 participants in total. Additionally, subgroup analyses were conducted based on intervention participants, health status, intervention duration, and session length. Results: Pooled analyses showed that individuals who received table tennis interventions demonstrated significantly improved balance (standardized mean difference [SMD] = 0.78, 95% confidence interval [CI] [0.57, 0.98]) and cognitive (SMD = 2.05, 95% CI [1.27, 2.83]) functions than those who did not. Subgroup analyses indicated consistent benefits across different age groups and health statuses, along with larger cognitive function effects with longer interventions. Despite considerable heterogeneity across studies and limited evidence for some subgroups, sensitivity analyses supported the robustness of the results. Conclusions: Table tennis appears to be a feasible and low-cost intervention that can effectively enhance balance and cognition functions, with potential applicability in community, educational, and rehabilitation settings. However, considering the observed heterogeneity and methodological limitations, the findings should be interpreted with caution.

Background: Research in pelvic floor muscle-related symptoms (PFM-related symptoms) in Saudi Arabia remains limited. Clearer identification of symptom burden and its predictors is needed to guide physiotherapy strategies for prevention and management. Objective: We aimed to determine the prevalence of PFM-related symptoms among adult Saudi men and identify behavioral and lifestyle predictors associated with symptom burden. Methods: A community-based cross-sectional survey was conducted among 458 men aged >18 years from the Al-Baha region of Saudi Arabia. PFM-related symptoms were assessed using five items adapted from the Pelvic Floor Distress Inventory-20 (PFDI-20), their impact using five items from the Pelvic Floor Impact Questionnaire-7 (PFIQ-7), and urinary incontinence using the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF). Data were analyzed with descriptive statistics, correlation analysis, one-way ANOVA, and binary logistic regression. Results: Urinary incontinence was reported by 14% (86% reported none), but 19% disclosed regular "preventive" voiding. Symptom incidence increased with age (p < 0.001). Logistic regression identified smoking (OR = 1.34, p = 0.029) and preventive voiding (OR = 1.54, p = 0.002) as significant predictors of greater symptom burden. Conclusions: These results highlight the need for physiotherapy-led strategies in primary care, prioritizing smoking-cessation support and structured bladder training, with escalation when required. Prospective studies are needed to confirm temporality and to develop a practical rehabilitation pathway for men.

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Background/Objectives: Mothers of preterm infants face complex postpartum challenges, yet their needs are often overlooked in neonatal care. This review synthesizes evidence on maternal health needs, service utilization, perceived adequacy, and barriers to care. Methods: A systematic search of PubMed, CINAHL, and PsycINFO identified 16 peer-reviewed studies published between 2007 and 2025 on mothers of preterm infants. A narrative synthesis integrated quantitative and qualitative findings from NICU settings. Results: Across 16 included studies, all reported psychological and emotional needs, with anxiety, distress, and fear for infant survival frequently highlighted. Informational needs were identified in 11 studies, particularly regarding infant care and postpartum guidance. Physical needs were reported in 10 studies, including fatigue and pain affecting NICU engagement. Nursing support and lactation services were consistently accessed, whereas psychosocial services and postpartum follow-up were reported in fewer than half of the studies. Perceived adequacy depended on empathetic, individualized communication, while structural and contextual barriers, such as transportation, financial burden, and NICU policies, limited maternal engagement. Despite available services, gaps in emotional, informational, and practical support persisted. Conclusions: Mothers of preterm infants experience substantial postpartum health needs that are insufficiently addressed within current NICU-centered care structures. Integrating maternal-focused, continuous, and psychosocially informed postpartum care into neonatal services is essential to reduce care gaps and support maternal well-being during NICU hospitalization.

Background/Objectives: This study aimed to describe temporal trends in deep brain stimulation (DBS) use for Parkinson's disease (PD), essential tremor (ET), and dystonia; characterize patient age and sex distribution and comorbidity; assess postoperative complications and in-hospital mortality (IHM) after implantation and explantation; and explore sex-specific differences in utilization and outcomes. Methods: We conducted a retrospective nationwide population-based study using the Spanish National Hospital Discharge Database (RAE-CMBD) from 2002 to 2019. All hospital admissions with DBS implantation or explantation/revision and a diagnosis of PD, ET, or dystonia were identified. Sociodemographic variables, the Charlson Comorbidity Index (CCI), length of hospital stay (LOHS), postoperative complications, and IHM were analyzed across three calendar periods and stratified by diagnosis and sex. Results: A total of 4883 admissions for DBS electrode implantations and 497 admissions for DBS explantation/revision were recorded. PD accounted for 82.6% of implantations, followed by ET (11.2%) and dystonia (6.3%). DBS activity increased significantly over time, while median LOHS declined from 12 to 6 days for implantations and from 13 to 5 days for explantations. Overall IHM after implantation was 0.27%, decreasing to 0.05% in 2014-2019; IHM after explantation was 0.6%. Most hospitalizations had low comorbidity (CCI = 0 in 87.8%), although comorbidity increased over time. Men represented approximately 60% of procedures in PD and ET. Women with PD underwent DBS at older ages, despite similar LOHS and IHM. Postoperative complications were recorded in 14.6% of implantations, mainly hardware-related issues (5-6%) and infections (1-2%), whereas infections (33%) and mechanical problems (27%) predominated among explantations. Conclusions: DBS use in Spain has expanded substantially, with shorter hospital stays and very low in-hospital mortality. Sex-related differences in utilization are increasing, and hardware complications and infections remain the most frequent conditions associated with explantation. As complications were identified only during the same hospitalization as the DBS procedure, late post-discharge events are not captured and could be underestimated; patient-level risks cannot be derived.