Introduction Sleep quality is an important health index in the elderly. As age increases, changes occur in sleep quality leading to sleep disorders and recurrent complaints. Sleep quality management of the elderly requires identification of its determinants. The present study aimed to determine the mediating roles of stress, anxiety, and depression in the relationship between constipation and sleep quality among the elderly using structural equation modeling (SEM). Materials and Methods A correlational design was used in the present study through structural equation modeling. In this work, 363 elderlies were examined by multi-stage random sampling. Data collection tools included four questionnaires, namely a demographic information questionnaire, the constipation questionnaire (ROME III), the Depression, Anxiety, and Stress Scale-short form, and the Pittsburgh Sleep Quality Index (PSQI), which were completed by interview and the self-report method. The SPSS Statistics for Windows, version 22.0, and SPSS AMOS (IBM Corp., Armonk, NY, USA) were used to analyze the data. Results The results indicated that the proposed model had an acceptable fit (p < 0.000, root mean square error of approximation [RMSEA] = 0.062, comparative fit index [CFI] = 0.83, goodness-of-fit index [GFI] = 0.87, and Χ²/df = 1.94). The fitted model could explain 60% of the sleep quality variance. According to the proposed model, constipation could significantly predict sleep quality due to the mediation of stress, anxiety, and depression (p < 0.05). Conclusion The constructs of this model (constipation, stress, anxiety, and depression) can be used as a reference framework to design effective interventions and improve sleep quality in old people. Received: 13 December 2021 Accepted: 05 April 2022 Article published online: 19 April 2023 © 2023. Brazilian Sleep Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/) Thieme Revinter Publicações Ltda. Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

Background: The aim of this study was to determine the effect of a team-based educational program through smartphone applications on Iranian nursing students’ problem-solving ability and clinical skills. Methods: This quasi-experimental study with two groups, including an experimental and a control group, was conducted among 60 nursing students who spent internship period in post CCU and CCU wards for 16 weeks. The control group received routine training, and the students of the experimental group received a team-based program through a smartphone application in addition to routine training. Students involved in the program were invited to complete the clinical skills questionnaire and Heppner's Problem-Solving Inventory at baseline and week four, and week 12 of follow-up. Data were analyzed using SPSS software (Version 22). Results: A significant improvement was found in nursing students’ clinical skills and problem-solving ability at week four and week 12 of follow-up compared with baseline (P < 0.001). However, the mean scores increased more in the experimental group. Conclusions: This study suggests that team-based training through smartphone applications can enhance problem-solving perception and clinical skills in nursing students. It is expected that in the future, team-based training through smartphone applications may be used in the internship training of nursing students continuously.

Eating behaviors in early childhood are crucial for long-term health and weight management. Behavioral interventions grounded in social and family dynamics may play a pivotal role in improving these habits. This study evaluates the effectiveness of a Social Cognitive Theory (SCT) and Family System Theory (FST)-based intervention in modifying eating behaviors in preschool children. An experimental study was conducted from September 2022 to July 2023 with 120 preschool children in Behbahan City, Iran. Participants were selected using a multi-stage random sampling method. The intervention was delivered to mothers over six educational sessions, focusing on parenting styles and behavior modification strategies. The Child Eating Behavior Questionnaire (CEBQ) was administered at baseline, three months, and six months post-intervention. Data analysis was performed using SPSS version 24. In the intervention group, Satiety Responsiveness (SR) and Slowness in Eating (SE) scores increased by 0.60 and 0.14, respectively, while Desire to Drink (DD), Emotional Over-Eating (EOE), Enjoyment of Food (EF), and Food Responsiveness (FR) decreased by 2.20, 0.85, 0.22, and 0.56 points, respectively. Repeated-measures ANOVA revealed significant differences in SR, DD, and FR across time points (p < 0.05), suggesting a sustained effect of the intervention. A family-focused intervention integrating SCT and FST can effectively improve eating behaviors in preschool children by empowering mothers with behavioral and parenting strategies. These findings support the importance of early, structured interventions in preventing childhood obesity. A family-based SCT- and FST-driven intervention improved preschoolers’ eating behaviors. SR and SE increased, while DD, EOE, EF, and FR significantly decreased (p < 0.05). Parental involvement and behavioral reinforcement were key to intervention success. Findings support cost-effective, parent-centered strategies for childhood obesity prevention. Future research should assess the long-term effects of BMI and refine dietary interventions.

Influence of lifestyle factors on Body Mass Index in preschoolers in Behbahan city, southwest Iran, 2016

The world is experiencing an alarming increase in prevalence of childhood obesity. The aim of this study was to determine the demographic determinants of obesity and adherence to dietary and physical activity guidelines among children aged 4 to 6 years old in Behbahan city, southwest Iran, in 2016. This cross-sectional study was conducted on 120 preschool children aged 4 to 6 years old in Behbahan city, southwest Iran, in 2016. Multi-stage random sampling was done. The weight and height of the children were measured with standard methods. The demographic and behavioral factors data were collected in self report questionnaires which were completed by the children’s mothers. The Chi-square test, Independent-samples t-tests, One-way analysis of variances and logistic regression analysis were used for data analysis. SPSS software (version 22) was employed. This study showed that 88.3% of the children did not meet the guideline of 5 servings per day of fruit and vegetables. Only 2.5% met the guideline of 60 minutes of structured physical activity every day. Sex and mother’s occupation status were associated with adhering to screen time guideline. This study found a significant difference in the mean of screen time between sexes. Boys were more likely to meet the screen time guideline. A significant association between adhering to physical activity guidelines and mother’s occupation status was revealed. Significant statistical relationship between demographic factors and BMI categories was not illustrated. Demographic covariates were not significantly related to adherence to dietary and physical activity guidelines. In preventive programs of obesity among 4 to 6-year-old children key lifestyle behaviors and demographic factors need to be considered.

Chronic kidney disease (CKD) presents a growing global challenge among aging populations. Effective self-care remains a cornerstone of disease management in elderly patients. This study investigated the association between loneliness and self-care behaviors, including basic and instrumental activities of daily living (ADLs), in elderly individuals with CKD attending selected educational and medical centers affiliated with Tabriz University of Medical Sciences. In this descriptive-analytical study conducted in 2022, 310 elderly individuals diagnosed with CKD were assessed using validated instruments: the Chronic Kidney Disease Self-Care (CKDSC) questionnaire, basic and instrumental ADL scales, and a standardized loneliness measure. Structural equation modeling using AMOS software was employed to evaluate model fit and estimate the predictive value of loneliness on variance in self-care. The proposed model demonstrated acceptable fit indices (p < 0.001; root mean square error of approximation, RMSEA = 0.072; comparative fit index, CFI = 0.995; goodness-of-fit index, GFI = 0.994). The final model accounted for 83% of the variance in self-care. Loneliness exerted the most substantial effect on self-care behaviors (β = 1.29, 95% CI [1.17, 1.41]; p < 0.001). Findings indicate that loneliness may unexpectedly enhance self-care engagement among elderly individuals with CKD. These results underscore the importance of context-specific interventions that address the complex psychological dynamics influencing self-management. Future longitudinal studies are warranted to explore the mediating pathways underlying this association.