The performance of elite athletes is at the forefront of attention in sports science, with a predominant focus on technical, physiological, mental, or contextual factors that can be leveraged to optimize athlete performance. Athletes’ off-sports activities, however, remain largely unexplored. What is it that elite athletes do in their off-sports time, and how are their off-sports activities related to sports experiences and outcomes? With this qualitative study, we aim to illuminate athletes’ off-sports activities and their implications for sports outcomes. We collected listings of off-sports activities from 46 professional soccer players and interviewed 15 elite speed skaters about their off-sports activities and their potential to enrich or interfere with their sports domain. The resulting category framework of off-sports activities comprises eight categories, reflecting social, cognitive, and physical off-sports activities. Next, the speed skaters described beneficial spillover experiences for active, high-effort mastery-oriented off-sports activities. However, such activities could also cause fatigue if not balanced with sufficient, more passive, restful activities. In all, athletes did experience spillover from non-sports to sports and their qualitative accounts reveal several antecedents, mechanisms, and outcomes of spillover, supporting the process view of the work–home resources (W-HR) model (Ten Brummelhuis & Bakker, 2012).

Evidence regarding the association between dietary choline intake and mortality in individuals with diabetes remains limited. This study aimed to evaluate the relationship between dietary choline intake and all-cause, CVD and cancer-related mortality among adults with diabetes. A total of 4712 participants with diabetes were included from the National Health and Nutrition Examination Survey 2007–2018 cycles. Dietary choline intake was estimated using two 24-h dietary recalls, and mortality outcomes were ascertained via linkage to National Death Index records through 31 December 2019. Cox proportional hazards models and Kaplan-Meier analyses were employed to assess the associations between choline intake and mortality. Restricted cubic spline models were used to examine potential non-linear relationships, and threshold analyses were conducted to identify inflection points. Over a median follow-up of 6·42 years, 805 deaths were documented, including 267 from CVD and 126 from cancer. A U-shaped association was observed between dietary choline intake and all-cause mortality (Pfor non-linearity < 0·0001). Compared with the lowest quartile, multivariable-adjusted hazard ratios for all-cause mortality were 0·64 (95 % CI 0·47, 0·88) for the second quartile, 0·59 (0·43, 0·82) for the third and 0·69 (0·43, 1·09) for the highest quartile. No significant associations were found between choline intake and either CVD or cancer mortality. These findings indicate a U-shaped relationship between dietary choline intake and all-cause mortality in individuals with diabetes, with intakes between 286·77 and 538·86 mg/d associated with the lowest risk – providing potential implications for dietary guidance in diabetes management.

The Russia-Ukraine war generates fear, depression, loneliness, burnout and substance misuse among civilians. Our study examines mental health among Ukrainian university female students during 3 years of war. A total of 3,467 students were surveyed on three occasions: August to October 2022 (T1, n = 1,416), March to July 2023 (T2, n = 747) and September to November 2024 (T3, n = 1,304). The respondent’s average age was 19.3 years, 25.3% identified as secular and 36.9% were married/partnered. The respondents included 81.2% who were not relocated, 10.7% who were internally displaced and 8.1% who were refugees. Valid and reliable survey instruments were used to gather data. One-way analysis of variance (ANOVA) shows a significant decrease in fear of war, depression and burnout in 2023 compared to 2022; however, there was a marked increase in 2024. Regardless of the survey period, one-way ANOVA shows a significant difference in fear of war and burnout scores associated with depression and loneliness levels. Stepwise regression analysis shows fear of war, depression and loneliness associated with burnout. This study provides usable information for mental health services planning and intervention purposes associated with young women affected by war in Ukraine. Additionally, it has relevance for training to address client and service personnel needs, for academic curriculum development and course instruction, and as a reference source for mental health personnel addressing student needs.

This article addresses the questions of when mental health advance planning documents are created, the points when circumstances which they are intended to address arise and what consequences should flow when such a situation does arise. It addresses these points primarily from the perspective of what the law could/should be at a conceptual level. It looks at three stages: (a) creation of the document; (b) the period between the creation of the document and the point at which the intended circumstances arise; and (c) the point at which the intended circumstances arise. It does not purport to provide solutions at each stage, but rather to frame the dilemmas to aid discussion. In similar vein, it draws upon case studies from England & Wales, not to purport to dictate similarities of approach, but to flesh out dilemmas that have arisen to stimulate consideration.

While the effects of multidisciplinary weight loss (WL) on resting energy expenditure remain unclear in adolescents with obesity, the potential presence of adaptive thermogenesis (AT) has never been explored, which was the objective of the present work. Twenty-six adolescents (14·1 (sd 1·5) years) with severe obesity completed a 9-month inpatient multidisciplinary intervention followed by a 4-month follow-up. Anthropometric measurements, body composition (dual X-ray absorptiometry) and resting energy expenditure (REE, indirect calorimetry) were assessed before (T0) and after 9 months of WL intervention (T1) and after a 4-month follow-up (T2). AT, at the level of REE, was defined as a significantly lower measured v. predicted (using regression models with baseline data) REE. Two pre-cited REE equations were used, using both fat mass and fat-free mass (FFM) (predicted REE using equation 1) or FFM only (predicted REE using equation 2). Measured and predicted REE significantly decreased between T0 and T1 (P < 0·001) and remained lower at T2 compared with T0 (measured REE: P = 0·017; predicted REE: P < 0·001). Predicted REE using equation 2 was significantly higher than measured REE at T1 (P = 0·012), suggesting the presence of AT. FFM at T0 was negatively correlated with ATp1T1 (Rho = –0·428; P = 0·033) and ATp2T1 (Rho = –0·485; P = 0·014). The variation of FFM between T0 and T1 was negatively correlated with AT at T1 and T2. These preliminary results suggest the existence of AT in response to WL in adolescents with obesity, independently of the degree of WL. AT was associated with subsequent body weight and fat regain, suggesting AT may represent a damper to WL attempts while increasing the adolescents’ risks for subsequent weight and adiposity rebounds.

There is a lack of knowledge available on how cats adjust their macronutrient partitioning due to the consumption of single-macronutrient meals. The objective of this study was to evaluate consumption of a single meal of ingredients that contained foods of strictly carbohydrates (CHO), fat (FAT) or protein (PRO), on energy expenditure (EE) and macronutrient metabolism in cats. Ten domestic shorthair adult cats (1·9 years; 4·12 kg) were fed 22–24 g of chicken fat (FAT), 56–62 g of whey protein solution (PRO) or 54–56 g of cornstarch solution (CHO) for a single day in a randomised complete block design. Indirect calorimetry was conducted for 24 h post-feeding. Mean average EE over 24 h was highest in cats fed PRO (44 kcal/kg BW) and FAT (43 kcal/kg BW) compared with that in cats fed CHO (42 kcal/kg BW; P < 0·01). During 0 to 4 h, cats fed FAT had greater EE (49 kcal/kg BW), suggesting that cats respond to oxidising more dietary fat over protein in the early postprandial stage. Mean 24 h respiratory quotient (RQ) was greatest for cats fed CHO (0·76) followed by PRO (0·75) and FAT (0·74; P < 0·05). During 4 to 8 h, the RQ of cats fed PRO was the greatest (0·77), suggesting that cats initially increase gluconeogenesis from amino acids for subsequent glucose oxidation. In comparison to omnivores and herbivores, obligate carnivores have unique responses to single macronutrient intake, where they apparently generate energy from carbohydrate metabolism and rely more on gluconeogenic precursors.

This cross-sectional study investigated how care home size influences COVID-19 transmission dynamics, focusing on outbreaks in England during the second wave of COVID-19 (Wave 2; December 2020 to March 2021) and the Omicron wave (December 2021 to February 2022). Using data from the UK Health Security Agency and the Care Quality Commission, positive SARS-CoV-2 test results were matched to care home registration and occupancy data, examining outbreak trajectories in homes of varying sizes and resident age groups. The study included over 90,000 positive cases across the two waves. Small care homes (SCHs, with 10 or fewer beds), predominantly housing younger adults, showed significantly higher early positivity rates: 42% of residents were positive at outbreak detection, rising to 61% by day 7. In contrast, larger homes had early positivity rates of only 3–6%. These findings suggest that SCHs, often designed for communal living, facilitate rapid within-home transmission similar to household settings. The study concludes that outbreak control strategies in SCHs should differ from those in larger care homes, emphasizing proportionate, individualized approaches that consider resident vulnerability and minimize disruption to social support systems. These results have broader implications for managing future infectious disease outbreaks and support the development of tailored guidance based on care home size and resident demographics.

MRI-guided focused ultrasound (MRgFUS) thalamotomy has expanded the surgical treatment envelope for patients with essential tremor who fail on first-line pharmacological therapies. Understanding differences in access to MRgFUS thalamotomy, a procedure publicly funded in Ontario, is a first step to ensuring equitable opportunity for treatment across the province. In this brief communication, we explore the frequency of referrals directed to our tremor program between 2018 and 2023. We highlight differences in referral rates by jurisdiction and medical specialty, and explore associations with socio-economic factors. Our findings inform public policy and identify geographical areas for targeted outreach to enhance equitable access.

International migrant workers (IMWs) may face insecure work and housing, limited access to healthcare and increased risk of psychological problems. Two scalable, evidence-based interventions to support individuals experiencing psychological distress are Doing What Matters in Times of Stress (DWM) and Problem Management Plus (PM+). This study aimed to explore IMWs’ problems, daily functioning and help-seeking behaviour, to inform cultural adaptation of the DWM/PM+ stepped-care intervention in the Netherlands. Following the Design, Implementation, Monitoring, and Evaluation (DIME) model, we conducted various qualitative interviews and a focus group discussion with IMWs (n = 30) and professionals (n = 18). Data were analysed thematically, and findings informed adaptations. Participants described problems related to work, housing, administration, finances, healthcare access and the COVID-19 pandemic. Daily routines focused on practical needs. Help-seeking was hindered by stigma, fear of job loss, low trust and reliance on informal or cross-border healthcare. Based on these results, the intervention was adapted to the needs of Polish IMWs in the Netherlands, regarding content and examples, which were tailored to their context; the intervention was offered remotely and collaboration with employers was avoided. These findings highlight the structural vulnerabilities of IMWs and demonstrate how qualitative insights can guide the cultural adaptation of a psychological intervention.