The COVID-19 pandemic and its associated lockdowns had a detrimental impact on adolescent mental health, exacerbating levels of emotional difficulties that were already increasing in this population. The course of these difficulties after lockdown protocols ended, however, is not fully understood. Further, the effects of early life stress (ELS) and biological sex on mental health during and following the pandemic are also not clear. This study leverages data from a longitudinal project examining adolescent mental health that predates the pandemic. Internalizing problems were assessed in 222 children (58.6% females) ages 9-13 years at recruitment (baseline; 2013-2016) and at four more timepoints, each approximately two years apart. Participants also completed an interview assessing ELS at baseline. We assessed internalizing problems across each phase of the pandemic (i.e., pre-COVID, during the COVID lockdown, after reopening) as a function of ELS and biological sex. We found that whereas unpredictability-related ELS was associated with internalizing problems in girls across all COVID phases, the association between threat-related ELS and internalizing problems from pre-lockdown to post-reopening decreased in girls and increased in boys. Further, threat-related ELS was associated with post-reopening internalizing problems in boys through lower adaptability. Sensitivity analysis showed that the attenuation of the threat-internalizing association in girls and strengthening of the association in boys was not due to aging. Collectively, these findings suggest that there are sex- and ELS-specific changes in psychological functioning in relation to the pandemic. Further research is needed to better understand mechanisms that foster risk or resilience following stress exposure.
To investigate whether the increased birth size linked to frozen-thawed embryo transfer (FET) compared with fresh embryo transfer (FreET) and natural conception persists at 12 years of age. This multicenter prospective cohort study included singleton children born between 2008 and 2009 at 23 JISART-affiliated facilities in Japan. Children conceived via assisted reproductive technology (ART) (FreET and FET) were compared with those conceived naturally by couples who are infertile without ART. Overweight and obesity were defined according to the International Obesity Task Force criteria (overweight: body mass index [BMI] ≥ 23, obesity: BMI ≥ 27). Analyses were performed using analysis of covariance and multiple regression, adjusting for gestational age, maternal age, parity, small/large for gestational age (SGA/LGA), parental body size, education, and infertility duration. Logistic regression was used to assess the risk of overweight/obesity. Of 6,434 children initially contacted, 3,002 eligible singletons (1,115 FreET, 1,341 FET, and 546 non-ART) were included in the birth cohort, with 671 (331 boys, 340 girls) finally enrolled. The adjusted mean weight, height, and BMI did not differ among the FreET, FET, and non-ART groups. The odds ratios for overweight and obesity also showed no significant group differences. Parental body size was associated with child anthropometry, and LGA at birth independently predicted a larger body size and being overweight in boys. At 12  years, body size and overweight risk were comparable among the three conception groups (FreET, FET, and non-ART groups). We found no statistical evidence that the FET-associated increase in birth size persisted into early adolescence. Continued follow-up during adolescence is warranted.
To evaluate whether bullying, physical aggression, and peer rejection cluster among Brazilian adolescent students and whether aggressive-behavior cluster pairs are associated with leisure-time physical activity according to sex. This cross-sectional study analyzed data from PeNSE 2019, including 157,921 adolescents aged 13 to 17 years. Bullying, physical aggression, and rejection in the previous 30 days were dichotomized as present or absent. Clustering was assessed using observed/expected ratios (O/E) and 99% confidence intervals. Logistic regression models estimated associations between aggressive-behavior cluster pairs and sufficient leisure-time physical activity, defined as ≥300 min/week. Bullying, physical aggression, and rejection were reported by 39.41%, 14.60%, and 26.69% of adolescents, respectively. The simultaneous occurrence of all three behaviors exceeded expectation in the overall sample (O/E = 127.69), boys (O/E = 122.05), and girls (O/E = 170.23). In boys, physical aggression plus rejection was associated with lower odds of sufficient leisure-time physical activity (aOR = 0.99, 99%CI: 0.97-0.99). In girls, physical aggression plus rejection (aOR = 0.88, 99%CI: 0.86-0.89), bullying plus rejection (aOR = 0.97, 99%CI: 0.96-0.98), and bullying plus physical aggression (aOR = 0.98, 99%CI: 0.97-0.99) were associated with lower odds of sufficient leisure-time physical activity. Aggressive behaviors clustered among Brazilian adolescents and were associated with leisure-time physical activity, particularly among girls. Because this study was cross-sectional and several effect sizes were small, findings should be interpreted as associations rather than causal effects.
To examine the association of age, gender, and race/ethnicity with depression stigma, barriers to care, and treatment-seeking intentions among adolescents. 1127 US adolescents (aged 14-18) recruited via CloudResearch, a crowdsourcing platform, completed online measures of depression stigma, treatment-seeking intentions and barriers to care. Significant differences were found across gender groups in depression stigma (F(2,1124)=78.05, p < .001), barriers to care (F(2,1124)=5.96, p=.003) and treatment-seeking intentions (F(2,1124)=53.71, p<.001). Boys reported the highest depression stigma and lowest treatment-seeking intentions compared to girls and TGD youth (stigma: boys vs. TGD, t = 13.5, p < .001, d = 1.21; treatment-seeking: boys vs. TGD, t = 10.19, p < .001, d = 1.02). TGD youth endorsed the highest barriers to care (boys vs. TGD, t=-3.07, p = .007, d = 0.37). Significant differences were also found across racial/ethnic groups in depression stigma (F(3,1123)=11.49, p < .001) and treatment-seeking intentions (F(3,1123)=4.11, p = .007). Older adolescents reported higher treatment-seeking intentions (t=-2.99, p=.003) and higher barriers to care (t=-2.92, p=.004) than younger ones. Depression stigma, barriers to care, and treatment-seeking intentions vary significantly across different demographic groups. Tailored interventions addressing specific subgroup needs are therefore essential. Crowdsourcing offered results comparable to traditional recruitment strategies, alongside large-scale sample recruitment with hard-to-reach populations such as TGD youth. The trial was prospectively registered with clinicaltrials.gov (NCT06222528).
Globally, vitamin D deficiency (VDD) represents a significant public health concern. Population-level data on vitamin D status in Tunisia are lacking. This study aimed to estimate the national prevalence of VDD among Tunisian school-aged children and identify associated factors. A national cross-sectional survey in 2023 randomly sampled 2670 children aged 6-12 years. Plasma 25-hydroxyvitamin D was measured. Dietary vitamin D (VD) intake and socio-demographics were assessed via questionnaires. Logistic regression identified factors associated to inadequate VD status. The prevalence of VDD (< 30 nmol/L) was 15.8%. Adjusted analysis showed that older children (10-12 years) had a 1.4-fold (P = 0.030) higher likelihood of VDD than younger children. Girls were twice as likely to be VD deficient as boys (adjusted relative prevalence ratio (aRPR) = 2.1; P = 0.001). Significant regional variations in VDD were observed (P < 0.0001). Low and moderate consumption of VD-rich foods was associated with significantly increased odds of severe deficiency (aRRR = 2.0, P = 0.026; aRRR = 1.6, P = 0.005, respectively) relative to high consumption. Finally, overweight status was associated with a 2.0-fold (P < 0.0001) increased odds of severe VDD compared to children with normal weight. VDD is prevalent and increases with age. Vitamin D supplementation strategies should be considered to optimize vitamin D status among children.
School active commuting is a key behavior to promote physical activity in children, yet limited evidence exists in Chile. This study examined its prevalence and associated factors among Chilean schoolchildren. A cross-sectional study was conducted using data from the Chilean National Physical Activity and Sports Habits Survey, including a subsample of 1137 children aged 5-10 years derived from a nationally representative survey. School active commuting was defined as the dependent variable. Independent variables included sex, area of residence, socioeconomic status (SES), caregiver's education, self-rated health, leisure activities, and home-based physical or sedentary behaviors. About one in three children (35%) reported commuting actively to school. Boys showed higher participation than girls, and active commuting was more common among children from lower SES households and among those whose caregivers had lower educational attainment. Children who preferred physical activities during leisure time were also more likely to commute actively. No differences were observed by geographic area, self-rated health, or home-based activity levels. Schools and local communities should work together to ensure safe, equitable, and accessible environments that support active commuting. Active commuting remains low in Chilean children, emphasizing the need for multisectoral policies to promote physical activity and reduce inequalities.
Skilled readers plan and execute saccades to target the center of upcoming words, ensuring optimal placement for recognition. Accurate saccadic targeting is crucial for efficient reading. This study examines whether children at the end of their first year at school target saccades toward the center of words, whether this behavior is influenced by reading proficiency, and whether children are able to rapidly adapt their eye movements to visual input. Seventy-three Russian-speaking first graders (36 girls and 37 boys; mean age = 7) read sentences composed of words of uniform (3, 4, or 5 letters) and nonuniform length (3-to-5 letters) while their eye movements were tracked. Children's saccades and fixation locations were compared to a matched adult dataset from Parshina et al. (2024). Results revealed that, unlike adults, children tended to land near the beginning of the word, with longer saccades and landing positions shifting slightly closer to the beginning of the word as word length increased. Children's reading proficiency was associated with longer saccades and landing positions closer to the word center, suggesting that more fluent readers process words more efficiently, resembling adults. At the same time, children were able to quickly adapt their eye movements in uniform sentences. These findings indicate that efficient saccadic targeting is shaped by reading proficiency rather than by maturation of the eye-movement system, and that at the end of their first year at school, children have not yet accumulated sufficient proficiency to fully resemble adult-like saccade targeting.
To investigate the genetic basis of early-onset systemic lupus erythematosus (EOSLE) in a large Indian pediatric SLE (pSLE) cohort. This prospective observational study investigated monogenic causes in 97 of 365 pSLE patients. Inclusion criteria for the study comprised patients with EOSLE (age ≤8 years) and/or those with a clinical suspicion of monogenic lupus. Monogenic cause was suspected in 97 patients. Genetic screening using targeted next-generation sequencing on the Ion S5 system in 55 of 97 patients [complement defect gene panel in 28 and type 1 interferonopathy gene Interferon (IFN)+ Adaptive Immunity panel in 27] was performed. The remaining 42 patients underwent whole-exome sequencing (WES). Among 97 patients, 22 (22.68%; 11 boys and 11 girls) were found to carry pathogenic variants. Median symptom onset in monogenic cases was 2 years (range: 2 months to 9 years). Monogenic lupus was identified in both EOSLE and older children with strong clinical suspicion. EOSLE patients showed a higher diagnostic yield (28.4%) compared with older children (4.4%). Consanguinity was reported in 7/22 (31.8%) patients. Variants were found in C1QA (n = 7), C1QC (n = 2), C1QB (n = 1), C1R (n = 1), C3 (n = 2), ACP5 (n = 2), STING1, DNASE2, ADAR, TREX1, DNASE1L3, PEPD and SLC7A7 (each n = 1). Monogenic causes were found in at least 6.1% of the overall cohort of pSLE and in 22.7% of genetically screened cases, with the highest yield in EOSLE (28.4%). C1QA was the most common single-gene defect (7.2%). These findings underscore the value of genetic testing in pSLE, especially those with EOSLE or suggestive clinical features.
Mental health providers face serious challenges identifying risks and providing effective and accessible help for young people with eating disorders. The present study conducted a preliminary evaluation of Operation Self-esteem (OS), a manualized school-based intervention program for promoting eating disorder related mental health in adolescents, delivered by a patient advocacy group for eating disorders. A cluster-randomized design was used to study OS or controls with no OS in eight high schools (girls: OS N = 104, controls N = 120; boys: OS N = 60, controls N = 60; total N = 344). Three months post-intervention OS participants scored significantly lower than controls on Internalization of Media Ideals and had a greater propensity to turn to teachers and school health services when encountering mental health problems. However, there were no significant differences on other key measures (e.g. Self-esteem, Body Dissatisfaction, and General help-seeking behavior). The study suggests that collaboration between researchers and patient advocacy groups in the development and implementation of interventions is highly important for addressing today's mental health challenges. OS shows promise as a low-cost, implementation focused intervention to reduce internalization of media ideals and promote help-seeking behavior, but more research is needed to further optimize intervention.
Through intersectionality theory, this study examines how gender and geographical location interact to shape adolescents' access to health education in centralized systems, using sex education in Chinese vocational high schools as an illustrative case. Drawing on data from 3167 adolescents across regions with varying development levels, we demonstrate how educational institutions reproduce gender hierarchies and geographical inequalities through differential access to sex education. Students in economically developed regions and urban areas show significantly higher odds of receiving sex education, with particularly pronounced effects for girls in developed regions. Gender emerges as the primary determinant of exposure to specific content, with girls consistently showing higher chances of being taught topics like pregnancy, contraception, and sexual behavior. These findings suggest two intersecting forms of disadvantage. Resource-wise, boys in less developed regions appear most likely to be excluded from sustained provision. Norm-wise, girls may be more harmed by how sex education is framed through gendered expectations that treat sexual and reproductive health as primarily their responsibility rather than a shared concern. Together, these patterns illustrate how intersecting dimensions of advantage and disadvantage, alongside underlying patriarchal assumptions, create systematic disparities that reinforce both gender and geographical inequalities.
Evidence on sex-related mortality differences in critically ill older adults is inconsistent, and frailty is rarely incorporated despite its major prognostic relevance in geriatric intensive care. We performed a pooled analysis of acute ICU admissions from three prospective multinational cohorts within the Very Old Intensive Care Patients project: VIP1 and VIP2, which enrolled patients aged 80 years or older, and COVIP, which enrolled patients aged 70 years or older with COVID-19. Frailty was assessed before the acute illness using the Clinical Frailty Scale. The primary endpoint was 30-day mortality. Associations between sex and mortality were examined using robust Poisson regression adjusted for age, frailty, Sequential Organ Failure Assessment score, organ support, and treatment limitations, with Bayesian models used to estimate posterior probabilities of clinically relevant effect sizes. Among 10,363 acute ICU admissions, 43% were women. Women were older and more often frail, whereas men more frequently received invasive mechanical ventilation, vasopressors, and renal replacement therapy. Crude 30-day mortality was higher in men than in women (44%vs. 40%). Frailty was a strong independent predictor of mortality, with each 1-point increase in the Clinical Frailty Scale associated with an 8% increase in adjusted mortality risk (incidence-rate ratio 1.08, 95% CI 1.06-1.10). After multivariable adjustment for frailty and clinical covariates, male sex remained associated with a small residual increase in 30-day mortality (incidence-rate ratio 1.08; 95% CI 1.01-1.15). This association was attenuated with greater illness severity and more intensive organ support. Bayesian analyses yielded adjusted posterior median incidence-rate ratios of 1.04 to 1.06, and the probability of at least 10% excess mortality in men was low after adjustment (2% to 13%). In older critically ill adults, pre-admission frailty is a major driver of mortality. After explicit adjustment for frailty and illness severity, male sex was associated with only a small residual increase in 30-day mortality. Bayesian analyses suggest that large clinically meaningful sex-based mortality differences are unlikely after accounting for case mix and treatment intensity.
Folate-mediated one-carbon metabolism is essential for DNA synthesis, methylation and genomic integrity during spermatogenesis. To study the associations between status in folate, cobalamin, homocysteine, single nucleotide polymorphisms affecting folate-mediated one-carbon metabolism and sperm quality. In this cross-sectional study, 197 healthy men (18-40 years) were recruited between 2021-2023. Plasma folate, red blood cell folate, plasma cobalamin, total homocysteine, and single nucleotide polymorphisms affecting folate and cobalamin status were determined. Sperm quality parameters were assessed by WHO 2010 criteria. Associations between B-vitamin status, genetic polymorphisms, and sperm quality parameters were assessed using multivariable linear and logistic regression analysis. Median (P25, P75) plasma folate was 14.2 nmol/L (11.0, 17.8) and red blood cell folate was 678.2 nmol/L (582.3, 785.0). Deficiency, plasma folate <7 nmol/L and red blood cell folate (<340 nmol/L), occurred in 4.6% (95%CI: 2.4, 8.5) and 2.6% (95%CI: 1.1, 5.8) of participants, respectively. Lowest compared with highest tertile plasma folate (<11.9 vs ≥17.0 nmol/L) and RBCF (<625.0 vs ≥742.1 nmo/L) were associated with lower sperm count (B = -0.428, SE: 0.196 and B = -0.459, SE: 0.183, respectively) and higher odds of altered seminogram (OR = 3.367, 95% CI: 1.379, 8.220 and OR = 2.305, 95% CI: 1.002, 5.306, respectively). Median (P25, P75) plasma cobalamin was 239.1 (203.0, 282.3) pmol/L and plasma total homocysteine was 9.6 μmol/L (7.8, 11.5). Cobalamin deficiency (<148 pmol/L) and plasma total homocysteine >15 μmol/L were observed in 1.5% (95%CI: 0.5, 4.4) 5.6% (95%CI: 3.1, 9.7) of participants, respectively. Neither were associated with sperm quality parameters. The MTHFD1 1958AA compared with GG genotype was associated with reduced progressive motility (B = -7.732%, SE: 3.782), and higher odds of altered seminogram (OR = 4.388, 95%CI: 1.407, 13.687). Low folate status is negatively associated with sperm quality. The MTHFD1 1958 AA genotype may be negatively associated with sperm quality.
Hair is increasingly recognised as playing an important role in body image, yet research in this area has focused predominantly on dissatisfaction and appearance-related concern. As a result, little is known about what it means to have a positive relationship with one's hair, or how such experiences may be understood within broader conceptualisations of positive body image. The present study explored individuals' lived experiences of relating positively to their hair and aimed to develop an initial conceptualisation of hair-related positive body image. One-to-one semi-structured interviews were conducted with 21 adults recruited from the United Kingdom (10 women, nine men, and two non-binary individuals; aged 18-68 years; from a range of racialised and ethnic backgrounds). Data were analysed using reflexive thematic analysis, which generated four themes: Loving My Hair; Working with My Hair; My Hair, My Choice; and Authentic Self-Expression. Together, these themes suggest that hair-related positive body image involves accepting and appreciating one's hair, getting to know and work with it in flexible and responsive ways, making hair-related choices according to one's own preferences over social expectations, and embracing hair as a way of expressing one's identity and authenticity. Although these experiences share important commonalities with broader conceptualisations of positive body image, they also suggest that hair may represent a distinct and psychologically meaningful aspect of body image experience. These findings offer an initial foundation for understanding hair-related positive body image and highlight the importance of considering hair in future body image research and interventions.
The COVID-19 pandemic disrupted healthcare systems and may have influenced mortality trends in hematologic-immune disorders (D50-D89) and Diseases of the circulatory system (I00-I99). This study evaluates US mortality trends from 2010 to 2023 to assess potential pandemic-related changes. We utilized spline regression modeling on CDC WONDER mortality data (2010-2023) to quantify post-pandemic trend shifts in both age-adjusted and sex/age-stratified mortality rates. Post-2019 mortality trends for D50-D89 and I00-I99 diseases showed significant increases, particularly among older adults and younger males. D50-D89 mortality in females ≥ 65 increased ~ 2.6% (95% CI 1.70% to 3.68%) annually, while males ≥ 65 increased ~ 1.6% (95% CI 0.28% to 3.07%) annually; younger males (15-34 years) showed a 4.5% (95% CI 0.49% to 8.87%) annual increase. I00-I99 mortality increases were most pronounced in older females (~ 1.4% annual increase, 95% CI 0.49 to 2.31). Analysis of standardized rates in all groups except for men in I00-I99 showed a positive slope-shift after 2019. (p < 0.05)". These findings highlight the persistent impact of the COVID-19 pandemic on hematologic and circulatory system disease mortality, emphasizing the need for continued monitoring of vulnerable populations.
Sexual dysfunction associated with psychological reasons is one of the factors impacting unfulfilled marriages. There are limited data on treatment outcomes in this context. The aim of this study was determining the treatment of unconsummated marriage in psychogenic erectile dysfunction in Iranian Couples. A total of 66 cases were selected from individuals referred to the Family Health Clinic (from 2006 to 2019), who had unconsummated marriages and experienced psychogenic erectile dysfunction, meeting the inclusion criteria for the study. Research tools included couples' demographic information, face-to-face interviews, and the International Index of Erectile Function (IIEF). The treatment was based on couple's therapy. In the initial session, a comprehensive assessment of the couples' condition was conducted, and research instruments were completed. Additionally, during this session, the formation of psychogenic erectile dysfunction and the lack of successful foreplay were discussed. In subsequent sessions, desensitization, instruction on foreplay, and intercourse were addressed. Treatment success was defined as the ability to achieve complete vaginal penetration. Data was analyzed using SPSS 16 software. All 66 couples continued the treatment until they achieved successful vaginal penetration. All International Index of Erectile Function (IIEF) domains improved significantly after couple-based behavioral therapy in men with psychogenic erectile dysfunction in unconsummated marriages (all p < .001; large effect sizes for most domains). No significant associations were found between educational level, place of residence, engagement duration, or marriage duration and post-treatment scores (all p > 0.05). Male age correlated negatively with overall ED (r = -.314, P = .001), erectile function (r = -.361, P = .003), intercourse satisfaction (r = -.365, P = .003), and overall satisfaction (r = -.266, P = .031). Similar negative associations were observed for female age with overall ED (r = -.371, P = .002), erectile function (r = -.354, P = .004), intercourse satisfaction (r = -.344, P = .005), and overall satisfaction (r = -.246, P = .047). Psychogenic erectile dysfunction in unconsummated marriage can be addressed through couple-based therapy.
Gallbladder cancer (GBC) is highly fatal and, unlike most cancers, is more common in women than in men. Most GBC cases have gallstones, but most people with gallstones do not develop GBC. Thus, a critical question is what drives the risk of GBC in the presence of gallstones. We designed a case-control study to complement the Chile Biliary Longitudinal Study (Chile BiLS) cohort, enriching the number of GBC cases and enhancing our ability to evaluate risk factors for GBC. Starting in July 2022, we began to recruit non-cohort prevalent (diagnosed between January 1, 2016, and July 18, 2022) and incident (diagnosed on or after July 19, 2022) GBC cases, as well as patients with high-grade dysplasia (HGD), in a high-risk area of Chile. Individuals with GBC or HGD are considered cases (HGD +). We are matching gallstone cholecystectomy patients to cases at an approximate 1:1 ratio. We also include unmatched controls (adjudicated) who were initially suspected of having cancer but had benign findings on gallbladder pathology. If a case or control is deceased, we conduct proxy interviews to maximize the potential for detailed epidemiological data collection. Through August 31, 2025, we recruited 196 prevalent and 117 incident HGD + cases. Of these cases, 189 (96%) prevalent and 108 (92%) incident cases were diagnosed with GBC. All prevalent and 98.3% of incident cases have matched controls. Participation rates are 70.8% for HGD + cases and 67.8% for matched controls. The Chile BiLS case-control study is conducted in an area with high risk of GBC and a high proportion of people with Mapuche Amerindian ancestry. This study will provide important insights into the factors associated with GBC among people with gallstones. Here, we provide a thorough description of the design of the study, field procedures, and biological resources, as well as research opportunities, which will enable a more complete picture of the etiology of GBC by combining epidemiological, molecular, digital imaging, and clinical data. This study represents a powerful resource for the identification of new targets for cancer prevention and treatment, which are particularly needed in populations at high risk of GBC.
Advanced chronic kidney disease (ACKD) severely impairs health-related quality of life (HRQoL). Comparative HRQoL outcomes across renal replacement therapy (RRT) modalities and stratified by sex remain poorly characterized in Latin American settings. We compared HRQoL between women and men undergoing peritoneal dialysis (PD), hemodialysis (HD), or kidney transplantation (KT) in Mexico City. A cross-sectional study that examined 300 adults (100 per RRT group; 50 women and 50 men in each) was conducted at the Instituto Mexicano del Seguro Social. HRQoL was measured using the validated Spanish version of the Kidney Disease Quality of Life-36 (KDQoL-36) questionnaire. Multivariable generalized linear models with robust standard errors were used to estimate adjusted marginal means while controlling for age, education, marital status, BMI, and disease duration. Pairwise comparisons were Bonferroni-adjusted. KT patients showed higher SF-12 Physical Composite scores than PD and HD patients. PD scored lower than HD and KT on the Symptoms/Problems and Effects of Kidney Disease subscales (all p <0.001). HD showed the highest SF-12 Mental Composite score. Sex differences were modest. Within the HD group, women scored higher on the Effects of Kidney Disease subscale (Δ +9.0 [95% CI 1.5-16.4], p = 0.018) but lower on SF-12 Mental Composite subscale (Δ -4.4 [95% CI -8.1 to -0.8], p = 0.018). KT was associated with the best HRQoL and PD showed the lowest scores. Sex differences were limited to mental health and kidney disease burden among HD patients, underscoring the need for modality-specific, sex-sensitive approaches in RRT care.
The association between fibromyalgia and changes in muscle mechanical properties is unclear. The primary objective of this study was to compare the mechanical properties (tone, stiffness, and elasticity) of the upper trapezius (UT), extensor carpi radialis brevis (ECRB), and medial gastrocnemius (MG) muscles between patients with fibromyalgia (PwFM) and healthy controls. The secondary objective was to investigate the association between muscle mechanical properties and relevant clinical parameters. Twenty-nine women and two men with fibromyalgia, and 31 age-matched healthy controls were included in this study. Muscle mechanical properties were assessed using myotonometry (MyotonPRO®), pressure pain thresholds (PPTs) with a digital algometer (Commander Echo-Algometer®), pain intensity using a visual analog scale, and disease impact using the Revised Fibromyalgia Impact Questionnaire. Muscle frequency (tone) and dynamic stiffness in the UT, ECRB, and MG were significantly higher in the PwFM group compared to controls (p < 0.05). Effect sizes were strong for the UT (|r|≥0.5), weak to moderate for the ECRB (|r|=0.293-0.306), and weak for the MG (|r|=0.293). No significant between-group differences were observed in logarithmic decrement (elasticity) (p > 0.05). In the PwFM group, a moderate positive correlation was found between the frequency of the MG muscle and its PPT (r = 0.508, p = 0.003). The present study revealed that the tone and stiffness of the UT, ECRB, and MG muscles were increased in PwFM. These findings indicate that altered muscle mechanical properties were associated with fibromyalgia and may warrant consideration in future research exploring clinical management approaches.
Toxic masculinity has increasingly been discussed as a significant psychosocial factor affecting men's mental health, particularly in relation to depression, self-stigma, and low rates of help-seeking. In clinical practice, however, the concept remains ambiguous and may be applied in a reductive or pathologizing manner. This article aims to provide a clinically sensitive understanding of toxic masculinity within the framework of schema therapy. The aim of this article is to explore the relationship between toxic masculinity, early maladaptive schemas, and depressive symptomatology in men, and to demonstrate how schema therapy can facilitate long-term change without pathologizing male identity. This paper is a narrative review complemented by systematized clinical experience of schema therapists. Four composite heuristic vignettes are presented. These vignettes do not represent individual patients but are composite cases reflecting common clinical patterns. Each vignette includes schema-therapeutic conceptualization, a discussion of transgenerational transmission of masculine norms, and examples of therapeutic interventions. Toxic masculinity is clinically expressed through specific early maladaptive schemas (e.g., emotional deprivation, unrelenting standards, emotional inhibition) and protective schema modes (Detached Protector, Overcontroller, Punitive/Demanding Critic). Depression in men often manifests through masked, externalizing, or somatic forms. Schema therapeutic interventions-including limited reparenting, imagery rescripting, chairwork, therapeutic letters, and transgenerational re-scripting-enable gradual access to unmet emotional needs and the strengthening of the Healthy Adult mode. Toxic masculinity is conceptualized as a learned and modifiable pattern embedded in early maladaptive schemas and schema modes rather than as a stable personality trait. Schema therapy provides an integrative clinical framework that links gendered social norms with early maladaptive schemas and schema modes, and offers clinically applicable strategies for promoting sustainable change without pathologizing male identity.
Injuries remain major causes of preventable mortality and premature loss of life. This study aimed to examine 12-year trends in mortality and years of life lost (YLL) due to injuries in West Azerbaijan Province, Iran, and to forecast future mortality patterns. This registry-based retrospective observational study investigated the mortality patterns and YLL due to injuries. Data were extracted from the death registration and classification system of the Iranian Ministry of Health and Medical Education. Indicators including crude mortality rates, Age-Standardized Rates (ASR), and YLL were calculated. Future trends were predicted using ARIMA modeling (313). A total of 20,003 deaths due to injuries were recorded over the 12-year period. The majority of cases were men (76%) and occurred in urban areas (59.7%). The annual number of deaths increased by 37.94%, rising from 1,389 in 2013 to 1,916 in 2024. Traffic accidents remained the primary cause of death (increasing by 21.35%), while suicide rates showed a significant surge of 141.50%. The total YLL during the study period reached 473,700 years (17 per 1,000 in males and 6 per 1,000 in females). The highest burden of YLL was observed in the 15-29-year age group. Prediction models suggest that mortality will continue to fluctuate between 120 and 182 deaths per month over the next three years. Injuries, particularly traffic accidents and the rising trend of suicide, impose a heavy and increasing burden of premature mortality in West Azerbaijan. The high YLL among adolescents and young adults underscores the critical need for urgent preventive strategies, improved road safety measures, and targeted mental health interventions to mitigate this public health crisis.