Valentina Stefanica

Objective: To develop and validate a musculoskeletal disorder screening scale for motorcycle operators. Methods: In a cross-sectional study, 140 Tunisian operators rated pain in nine body regions on a four-point scale. Results: Two factors separated upper-body from lower-body regions and explained 67.5 percent of the variance. Cronbach alpha reached 0.910 and 0.881. The two-factor model outperformed the one-factor model (chi-square difference 67.92, p < 0.001), with loadings from 0.75 to 0.91 and approximation error of 0.103 under ordinal estimation. Engine displacement separated the groups on both subscales (partial eta squared 0.196), age band on the upper body alone (p = 0.007), and riding discipline on neither (p = 0.183). Conclusions: The scale shows a coherent two-factor structure and high internal consistency, with model fit short of the approximation-error threshold.

Background: Disordered eating behaviors (DEBs) and psychological distress may complicate type 2 diabetes mellitus (T2DM) care. Objective: To estimate the frequency of DEB screening positivity and examine associated characteristics in a Tunisian T2DM clinic sample. Methods: This cross-sectional study included 400 adults assessed between January and April 2023 using the Sick, Control, One stone, Fat, Food (SCOFF) questionnaire; Bulimic Investigatory Test Edinburgh (BITE); four-item Perceived Stress Scale (PSS-4); and Hospital Anxiety and Depression Scale (HADS). Exploratory analysis estimated crude prevalence ratios (PRs). Adjusted odds ratios (aORs) came from a logistic model including age, sex, body mass index (BMI), diabetes duration, and PSS-4. Separate secondary models replaced PSS-4 with the Hospital Anxiety and Depression Scale anxiety subscale (HADS-A) or depression subscale (HADS-D). Results: DEB positivity was 26.8% (107/400; 95% confidence interval [CI], 22.6–31.3%). Crude DEB prevalence was higher in women than men (30.4% versus 19.2%; PR, 1.58; 95% CI, 1.06–2.35), in participants with HADS-A ≥11 versus 2, 1.083; 95% CI, 1.042–1.126), and higher PSS-4 (aOR per point, 1.133; 95% CI, 1.067–1.203). HADS scores were positively associated in separate adjusted models. Glycated hemoglobin (HbA1c) was high in both groups (10.36% versus 9.91%; difference, 0.45 percentage points; 95% CI, −0.01 to 0.92). Conclusions: Approximately one-quarter of this clinic sample had a positive DEB screen. Associations with psychological symptoms support attention to eating concerns and emotional well-being in diabetes care. However, cross-sectional data limit causal interpretation, and future longitudinal studies are warranted.

Background and Objectives: Anxiety is highly prevalent among breast cancer patients and significantly impairs quality of life. Although both conventional physical exercise (PE) and mind–body interventions (MBE) are used in supportive care, their relative efficacy remains unclear. This systematic review and meta-analysis compared the effects of PE and MBE on anxiety in breast cancer patients. Materials and Methods: PubMed, Web of Science, Embase, PsycINFO, and CINAHL were systematically searched through April 2026 for controlled trials comparing structured PE or MBE with control conditions. Effect sizes were pooled as standardized mean differences (SMDs; Hedges’ g) using a random-effects model with restricted maximum likelihood estimation and modified Hartung–Knapp inference. Subgroup analyses and univariable meta-regressions explored potential moderators. Results: Twenty-four reports (N = 2197) represented 25 independent trials; 22 estimates from 21 reports entered the meta-analysis, and three reports were synthesized narratively. Interventions significantly reduced anxiety on average (SMD = −0.58, 95% CI [−1.01, −0.15], p = 0.011), with substantial heterogeneity (I² = 85.0%) and a 95% prediction interval of −2.38 to 1.22. Both PE (SMD = −0.67) and MBE (SMD = −0.46) favored intervention numerically, although both subgroup confidence intervals included no effect, with no significant difference between modalities (p = 0.697). A larger, yet non-significant, effect was observed during active treatment (SMD = −0.84, 95% CI [−1.68, 0.01]) compared with survivorship (SMD = −0.34, 95% CI [−0.62, −0.07]); the between-phase comparison was inconclusive (p = 0.291). The comparison across diagnostic stages was also inconclusive (p = 0.366). None of the seven continuous moderators met the multiplicity-adjusted significance threshold. Conclusions: Current findings suggest an average reduction in anxiety following physical and mind–body interventions in breast cancer patients. However, no statistically significant differences were observed between intervention modalities or treatment stages. Very low certainty, substantial heterogeneity and indirect subgroup comparisons limit confidence in the size and consistency of benefit. Overall, individualized interventions may have a role in oncology care, but these findings do not establish superiority, equivalence or differential efficacy between modalities or treatment phases.

Clean intermittent self-catheterization (CISC) is the reference treatment for neurogenic and non-neurogenic voiding dysfunction, yet adherence falls over time. The Intermittent Catheterization Adherence Scale (ICAS) measures this adherence, but no Arabic version has existed. We translated the ICAS into Modern Standard Arabic (MSA) and tested its psychometric properties in 84 Tunisian adults on CISC at 2 rehabilitation departments. Translation followed forward and back translation guidelines, with a 6-member expert committee and a pretest of 20 patients. We assessed content validity with the content validity index (CVI), structure with exploratory factor analysis (EFA), internal consistency with Cronbach’s alpha, and 10-day test–retest reliability with the intraclass correlation coefficient (ICC). The mean total score was 3.12 ± 2.03 on the 0 to 8 scale, with no floor or ceiling effect. Content validity was strong (scale-level CVI by averaging 0.99). The correlation matrix was suitable for factor analysis (Kaiser–Meyer–Olkin 0.780; Bartlett p < 0.001). Parallel analysis supported a single factor explaining 40.1% of the variance, on which item 5 loaded weakly (0.25). Internal consistency was acceptable (alpha 0.75) and test–retest reliability excellent (single-measures ICC 0.97, 95% CI 0.95–0.98). Associations with clinical indicators were weak and non-significant. The Arabic ICAS reads best as a single-dimension screening measure for Tunisian patients and needs confirmation in larger, independent Arabic-speaking cohorts.

Large language models (LLMs) can answer dietary questions, but their use as substitutes for registered dietitians remains insufficiently quantified. Evaluations have identified inaccurate nutrient targets, incomplete clinical advice, and insufficient personalization, alongside useful performance on some general nutrition tasks. Social media and food-delivery interfaces may also influence dietary choices through food cues, social endorsement, and choice architecture. This conceptual perspective presents ADRIFT (Algorithmic Dietary Reconfiguration through Informational, Framing, and Technological mechanisms) to examine how these influences might interact. Drawing on a targeted, nonsystematic synthesis of nutrition, behavioral, neuroscience, and AI literature, ADRIFT distinguishes three axes: informational errors and unsupported advice; framing through content and interface design; and adaptive personalization and cognitive delegation. Direct evidence supports selected component mechanisms, but their convergence into a feedback loop that reduces nutritional autonomy remains hypothetical. We propose a six-category taxonomy covering hallucinations and related nutrition errors, define nutritional autonomy erosion as declining capacity for informed, self-directed dietary decisions, and outline eight testable hypotheses. The framework concerns unsupervised use and does not predict that language models will replace dietetic professionals. Longitudinal validation, platform experiments, and clinical safety evaluations are needed to determine whether, for whom, and under which conditions the proposed harms occur.

Background: Combat sports require athletes to repeatedly perform explosive actions under conditions of fatigue, demanding high levels of neuromuscular coordination, reactive agility, and intermittent effort capacity. This study examined changes in biomechanical and neuromuscular performance over a 15-week period during which competitive Sambo athletes completed a CrossFit-based functional training program alongside their regular sport-specific training. Methods: Forty male Sambo athletes (22.4 ± 2.6 years) completed a longitudinal repeated-measures intervention consisting of three weekly CrossFit-based sessions integrated into regular sport-specific training. The program was periodized across four progressive mesocycles emphasizing functional strength, explosive power, reactive agility, and fatigue resistance. Pre- and post-intervention assessments included upper- and lower-limb reaction speed, vertical jump height, repeated jump endurance, reactive agility, grip endurance, body-weight squat performance, Romanian deadlift repetitions, and the Special Judo Fitness Test (SJFT). Statistical analyses included paired-samples t-tests or Wilcoxon signed-rank tests with Benjamini–Hochberg false discovery rate correction (α = 0.05). Results: Significant post-intervention improvements were observed in most performance variables. Upper- and lower-limb reaction performance improved by 22.9% and 9.7%, respectively (p < 0.001), while vertical jump height increased by 11.4% and repeated jump endurance by 16.6% (p < 0.001). Reactive agility time decreased by 6.6% (p < 0.001), indicating faster cognitive-motor responsiveness. Functional strength improved substantially, with increases of 43.7% in body-weight squat performance and 71.9% in Romanian deadlift repetitions (p ≤ 0.001). Grip endurance improved by 6.3% (p = 0.007), whereas maximal handgrip strength showed no significant changes. The SJFT index decreased by 5.0% (p < 0.001), reflecting enhanced intermittent effort efficiency and fatigue tolerance. Large effect sizes were identified for upper-limb reaction speed (d = 1.42), explosive endurance (d = 1.46), and reactive agility (d = 0.96). Conclusions: Over the 15-week study period, participation in a CrossFit-based functional training program integrated into regular Sambo practice was associated with improvements in several biomechanical and neuromuscular performance outcomes, including reaction performance, explosive power, agility, muscular endurance, and sport-specific work capacity. However, because the study did not include a control group, these changes cannot be attributed exclusively to the CrossFit-based intervention. Controlled studies are required to distinguish intervention-specific effects from seasonal training adaptations, continued sport-specific practice, and test familiarization.

Background: Elite soccer performance emerges from the interplay of cognitive, emotional, psychophysiological, and tactical processes that operate in real time during matches. Advances in wearable sensors and artificial intelligence (AI) now allow continuous monitoring of physiological and psychological states. They also allow modeling of how these states relate to tactical and physical performance. Existing reviews have examined machine learning in soccer, heart rate variability (HRV) monitoring, and psychological determinants of performance separately. No scoping review has mapped the intersection of AI analytics, wearable psychophysiological monitoring, and psychological performance constructs as one integrated decision-support framework in elite soccer. Aim: The aim of this study was to map the available evidence on the integration of AI and machine learning with psychophysiological monitoring for performance modeling in elite soccer, to identify the psychological constructs already used as model inputs, to describe the wearable technologies and AI methods applied, and to set out the translational challenges and evidence gaps that need priority attention. Methods: The review followed the PRISMA extension for Scoping Reviews (PRISMA-ScR) and the updated Joanna Briggs Institute (JBI) methodology. The protocol was registered on the Open Science Framework (OSF). Six databases (PubMed/MEDLINE, Scopus, Web of Science, SPORTDiscus, IEEE Xplore, and PsycINFO) were searched from January 2000 to March 2026 using the Population–Concept–Context (PCC) framework. Two reviewers independently screened titles, abstracts, and full texts (Cohen’s kappa = 0.82). Results: Thirty-six sources met the eligibility criteria after screening of 3104 records. AI and machine learning have been applied widely to predict physical and tactical performance in soccer, yet they rarely include psychological constructs. Reported models (decision trees, gradient boosting, and artificial neural networks) reach high accuracy for physical outcomes in internal validation, for example, above 66% for injury risk. Multi-modal models that add physiological and psychological inputs report stronger prediction. These figures come mostly from internal validation, and external validation and overfitting controls are seldom reported, so they should be read as optimistic upper bounds. Psychological and psychophysiological inputs remain under-represented. Explainable AI (XAI) methods, in particular Shapley Addictive exPlanations (SHAP) values, are appearing, but validation with domain experts is scarce. HRV has been reviewed as a psychophysiological marker in soccer, yet its use within AI decision-support tools for real-time psychological readiness has not been mapped. Three translational challenges stand out: the ecological validity gap between laboratory cognitive tests and match-embedded psychophysiology; the interpretability problem of opaque AI in high-stakes decisions; and the data fragmentation problem created by disconnected physical, tactical, and psychological data streams. Conclusions: Integrating AI with wearable psychophysiological monitoring offers a credible route toward integrated performance modeling in elite soccer. Closing this gap calls for multi-modal frameworks that combine psychological constructs, physiological markers, and tactical data within explainable AI. Research priorities include ecologically valid psychophysiological assessment protocols, position-specific psychological profiling, and practitioner-validated tools that turn AI outputs into usable coaching recommendations.

Background: Beetroot-derived nitrate supplementation is a widely studied nutritional strategy to enhance athletic performance. Although ergogenic benefits have been reported in recreational and moderately trained individuals, evidence for highly trained and elite athletes remains inconsistent. Objectives: This scoping review aimed to map and synthesize evidence from randomized controlled trials (RCTs) investigating the effects of beetroot-derived nitrate supplementation on performance, recovery, and physiological outcomes in highly trained and elite athletes. Methods: The review followed the Joanna Briggs Institute methodology and PRISMA-ScR guidelines. Literature searches were conducted in PubMed, Scopus, and Web of Science. Eligible studies included RCTs involving McKay Tier 3–5 athletes and evaluating beetroot-derived nitrate supplementation as a standalone intervention. Results: Thirty-one RCTs met the inclusion criteria, representing athletes from a wide range of sports. Supplementation protocols varied substantially, with nitrate doses ranging from 4 to 19.5 mmol·day⁻¹ (248–1209 mg·day⁻¹) and durations from acute administration to 15 days. Positive effects were most frequently reported for cycling time-trial performance, Yo-Yo intermittent recovery performance, anaerobic power, neuromuscular performance, exercise tolerance, and recovery. In contrast, findings for endurance performance, sport-specific skills, oxygen consumption, and perceptual responses were inconsistent despite marked increases in nitrate and nitrite bioavailability. The outcomes seemed to depend on dosage, duration, sport type, and athletes’ training status. Conclusions: Beetroot-derived nitrate supplementation may enhance performance in highly trained and elite athletes, particularly during high-intensity and anaerobic activities. However, the effects are inconsistent, underscoring the need for further research to establish optimal supplementation strategies and evaluate long-term efficacy in elite sporting populations.