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Vaccination is an important tool to prevent infectious disease morbidity and mortality. Increased vaccine hesitancy and declining vaccination are contributing to larger infectious disease outbreaks. This review presents the current state of research and knowledge on vaccine hesitancy, focused on the United States (US). This review covers the history of vaccination and vaccine hesitancy, recent and ongoing outbreaks, and updates in understanding of vaccine hesitancy and use of new psychology-based tools to address it. Articles for inclusion were sourced from extant understanding of the vaccine hesitancy literature as well as PubMed searches to ensure appropriate context. Population-level outreach and effective communication about vaccines is a central component to addressing vaccine hesitancy and restoring and maintaining trust in the vaccination system. With new ways of understanding vaccine hesitancy rooted in the psychology of decision-making, there is a need for research into outreach, message development, and implementation, within the information and social media environment that allows even faster dissemination of mis- and dis-information. Balancing the rigor of communications and implementation research with the need for timely communications is a pressing challenge to be faced by public health and medical professionals when addressing vaccine hesitancy.

People affiliate with others who share their psychological traits. Does the same phenomenon occur with AI instructed to mimic human psychology? Large language models (LLM) were prompted to use language that mimicked anxious symptoms or their absence (Experiment 1; n = 100), extroversion or introversion (Experiment 2; n = 100), and an exact mirror or inverse of participants' personality (preregistered Experiment 3; n = 100). With full knowledge that they were interacting with an artificial system, participants engaged in written interactions with both LLM versions and then evaluated their engagement. Those with anxiety reported a stronger connection to the LLM that mimicked anxiety, a distinction also reflected in the sentiment of the messages they exchanged. Extroverted participants affiliated more with the AI that mimicked extroversion. Finally, when participants interacted with LLMs that mimicked either their own personality profile or the inverse of their personality (i.e., the opposite pattern of their Big-Five scores), they reported more affiliation with the LLM mimicking their personality; this distinction was also reflected in the sentiment of their messages. Results support affiliation in human-AI interactions based on the linguistic presentation of a shared psychology. We propose that through socioaffective tuning, LLMs might achieve greater human-like correspondence.

In 2024, England implemented a world-first initiative providing free vapes and behavioural support to encourage smoking cessation, focussing on groups with higher smoking prevalence. This study aimed to assess awareness of the initiative and associations with socio-demographics, smoking, vaping and past smoking cessation behaviour. Representative cross-sectional surveys conducted January 2024-December 2025 of adults (aged 16+) who currently smoked or had stopped in the last year in England (N=6,950). Associations between awareness and gender, age, ethnicity, socioeconomic position (occupational social grade), region, smoking status, urges to smoke, vaping status, survey time were assessed using weighted percentages with 95% confidence intervals and multivariable logistic regressions. Multivariable logistic regressions assessed associations with past-year cessation attempts and support used. Post-hoc country comparisons using October-December 2025 included Scotland and Wales (n=153). Overall, 24.1% (95% CI: 23.0%-25.2%) were aware of the initiative. Awareness was lower among people aged 45-54 [adjusted OR=0.78 (0.64-0.97)] than among people aged <25 and among Asian, Black, Mixed/Other compared with white ethnicities [adjOR=0.82 (0.70-0.96)]. Awareness was higher among people reporting slight [adjOR=1.22 (1.02-1.46)] or moderate [adjOR=1.27 (1.08-1.50] urges than among those reporting no urges to smoke. Awareness was associated with having used vapes during the last cessation attempt [adjOR=1.40 (1.09-1.81)]; other characteristics were not significantly associated. About a quarter of people in England who smoked in the past year were aware of a new smoking cessation initiative and awareness was linked with use of vapes for cessation but not higher among socio-economically disadvantaged groups. To reach smoke-free goals, increased smoking cessation is needed; a unique initiative made free vapes and support available to people in England who smoke. While a quarter of the target population had heard about the initiative, coordinated communications may have increased awareness among less advantaged groups with higher smoking prevalence to further improve impact on inequalities.

Over-the-counter (OTC) hearing aids were introduced to improve the affordability and accessibility of hearing health care for adults with perceived mild-to-moderate hearing loss. While these devices have demonstrated effectiveness in cognitively healthy older adults-particularly in the domains of audibility, self-reported hearing ability, and speech recognition in quiet-their use and outcomes in people with dementia remain underexplored. This issue warrants further attention, as people with dementia often experience co-occurring hearing loss and may rely on OTC hearing aids to overcome cost and access barriers to prescription amplification. However, given the cognitive and functional challenges of dementia, it is unclear whether and how OTC hearing aids can support the hearing care needs of these individuals. To explore interest-holder perspectives on the feasibility and acceptability of OTC hearing aids for community-dwelling older adults with dementia, identifying key facilitators and barriers that influence their use in this population. Semistructured interviews were conducted with 45 participants across three interest-holder groups (15 per group): (1) community-dwelling older adults with dementia and hearing loss, (2) family caregivers of community-dwelling older adults with dementia and hearing loss, and (3) geriatric direct care professionals. Interviews were conducted and recorded via secure Zoom (Zoom Communications) videoconferencing, then transcribed and analyzed using thematic analysis. Participants endorsed several facilitators and barriers to OTC hearing aid use in people with dementia. Facilitators included increased accessibility, perceived affordability and value, and enhanced autonomy and control. Barriers included mistrust of OTC hearing aids, difficulty assessing candidacy due to unreliable self- and proxy reports of hearing status, caregiver uncertainty regarding device programming and adjustment, challenges evaluating device effectiveness, and concerns about caregiver burden and burnout from long-term device management. OTC hearing aids offer meaningful advantages for people with dementia and their family caregivers. However, significant barriers must be addressed to ensure their feasibility and acceptability for this population. Future research should further examine and quantify these barriers to inform the development of tailored devices, services, and delivery models that promote successful OTC hearing aid use in people with dementia and their family caregivers.

Globally, approximately 8.6% of people will meet criteria for alcohol use disorder (AUD) in their lifetimes, with 2.2% meeting criteria for AUD in the past 12 months. In the United States, AUD prevalence is even greater, with 13.9% meeting criteria in the past 12 months. Effective treatments for AUD exist, although most people receive help through mutual support groups (ie, Alcoholics Anonymous [AA]). However, AA and other mutual support programs may not be desirable for all individuals, particularly those who do not seek abstinence-based approaches. Treatments that support reductions in drinking have been shown to be as effective as abstinence-based treatments in reducing alcohol-related harms, and may be more appealing to a broader range of people. Mindfulness-based interventions may be particularly effective in supporting long-term recovery, whole-person health, and functioning for those with abstinent and nonabstinent recovery goals. This study is designed to test a novel rolling group-based mindfulness-based relapse prevention (MBRP) delivered via videoconferencing, focused on drinking reduction goals and whole-person functioning. This study is a hybrid type 1 effectiveness-implementation design to prospectively test the effectiveness of MBRP and to identify barriers and facilitators of group participation to inform future implementation of MBRP as continuing care. Individuals with AUD (n=470) interested in stopping or reducing their drinking, meet criteria for AUD based on a symptom checklist, report heavy drinking at least once in the past 6 months, consent and understand study procedures in English, and provide a valid US mailing address are recruited nationwide via online sources in the United States. Participants are randomized to either MBRP groups via Zoom (Zoom Video Communications, Inc) or referral to online mutual support (eg, AA). All participants receive an individual orientation session delivered via Zoom that includes brief motivational interviewing and an overview of their assigned condition and next steps (MBRP condition: overview of the MBRP groups and instructions on participating in MBRP via Zoom; referral condition: referral to online mutual support groups). Participants provide blood samples for phosphatidylethanol testing at baseline and 3-year follow-up and complete self-report measures of psychosocial functioning, alcohol and other drug use, addiction cycle domains, and previously established predictors of recovery every 6 months for 3 years. Recruitment began on September 13, 2023, and the last recruited participant was randomized on March 20, 2025. Follow-up data collection is ongoing with all 6-month follow-ups completed (86% retention). This study evaluates the effectiveness and mechanisms of MBRP delivered via videoconferencing, compared with referral to online mutual support groups, in supporting recovery among individuals with AUD. It also examines the reach, effectiveness, adoption, implementation, and maintenance of MBRP as an accessible, freely available continuing care option to support long-term recovery from AUD.

American Indian/Alaska Native (AI/AN) people represent a culturally diverse people group within the United States. AI/AN people experience some of the most severe health disparities in the United States, including behavioral health. A quarter of AI/AN people in the United States live on tribal lands, experiencing significant barriers to mental health resources and broadband infrastructure for telehealth. We developed Amplifying Resilience Over Restricted Internet Access (ARORA)-a mobile health (mHealth) smartphone app, promoting mindfulness practices and community building through AI/AN culture and values. Originally co-designed with both Hopi/Tewa and Navajo youth and adults, this study evaluated app resonance among Hopi/Tewa youth, supporting its iterative design. While we initially planned in-person user testing, this was moved online due to the COVID-19 pandemic. This study assessed the potential and acceptability of an mHealth app supporting Hopi/Tewa youth practicing mindfulness inspired by their culture, values, and beliefs. This research served as preliminary work for an ongoing, iterative participatory action research study, identifying points of improvement to align with our partner community's goals. After meeting with 6 community advisory board members and focus groups prior to this study, we developed a prototype for ARORA. This study evaluated intuitiveness and usability through testing and interviews with Hopi/Tewa youth. All meetings with stakeholders were moved online due to the COVID-19 pandemic. Using screen-sharing via Zoom (Zoom Communications, Inc) and Android emulators, we received feedback for the iterative design process. This study involved 9 participants aged 16-24 years. Of these participants, 1 was male and 8 were female; all identified as Hopi/Tewa and/or Tewa. This study included a quantitative assessment using a modified version of the User Version of the Mobile Application Rating Scale. The mean score across all questions was 3.71 (SD 0.427), suggesting generally positive reception. Qualitative results from thematically analyzing open-ended focus group data produced 5 open codes and 12 axial themes, reaching thematic saturation after engaging with 9 participants. Qualitative feedback revealed that while its use was generally enjoyable, the ARORA app could be more specific to Hopi/Tewa culture. Finally, we reflect on adaptations made to our initial protocol in response to the COVID-19 pandemic, offering guidelines for future mHealth work involving rural or hard-to-reach communities. In this evaluation and usability testing of the ARORA prototype, participants expressed interest and engagement in the mindfulness activities. Participants also identified spaces in which the app could improve, both in usability and in cultural groundedness, especially with the visual dimensions of the app. Reflecting on our experience in facilitating remote user testing, we encourage future work in rural mHealth to consider practices for conducting research when in-person meetings are not feasible.

Parricide is an exceptionally rare phenomenon, constituting approximately 2% to 3% of all homicides in the United States. Double parricide, involving multiple victims and/or offenders, is even less common. The most famous case of double parricide in recent history is that of the Menendez brothers, who were convicted of the 1989 murders of their parents. This narrative review examines the evolving societal, academic, and legal attitudes toward the Menendez brothers' case over 35 years. An examination was conducted of criminological studies, media analyses, legal records, and primary source materials such as letters and drawings from the Menendez case. Findings indicate a shift over 35 years from framing the brothers as deviant and greedy to understanding their actions as extreme responses to prolonged familial trauma. Media narratives, true crime portrayals, social media advocacy (through documentaries and platforms like TikTok), and evolving victimology and trauma theories have influenced public opinion and legal reconsideration. The application of machine learning and artificial intelligence (AI)-driven analysis through multiple professional lenses reveals patterns in pre-offense communications and artwork that may have been underappreciated in traditional forensic evaluation. Forensic nurses are essential in assessing trauma, documenting abuse, and contributing to interdisciplinary evaluations. Trauma-informed approaches enhance accurate risk assessment and ethical consideration of both survivors' and offenders' experiences in cases of extreme familial violence. The emerging integration of AI tools in forensic practice offers forensic nurses new capabilities for systematic case analysis, while maintaining the critical human expertise needed for clinical judgment and compassionate care. The Menendez case serves as a powerful reminder that our understanding of complex human behavior deepens over time, and that maintaining openness to new perspectives and methodologies is essential to providing ethical, evidence-based forensic care.

Vaccine hesitancy remains a global health challenge, undermining gains in routine immunization coverage and the uptake of COVID-19 vaccines worldwide. Effective, responsive health communication is needed to counter 'infodemics' and strengthen public trust in vaccination. Evidence on how to design effective digital campaigns to strengthen vaccine demand is limited, particularly in low- and middle-income countries. Results from this four-country study demonstrate a process for the design and randomized controlled testing of evidence-based, context-driven persuasive messaging to strengthen vaccine demand. Campaigns led to 3.5&#xa0;M+ clicks to additional resources, and messages were successful at shifting attitudes toward vaccine confidence, with campaigns in local languages performing better in encouraging information-seeking behavior (clickthrough rate). Strategic partnership with UNICEF country offices was key to convert behavioral insights into effective communication strategies. This work provides a replicable process that local health agencies can adopt to strengthen their digital social and behavior change communications.

Patient safety is important when evaluating a healthcare organization's ability to control and eliminate patient dangers when implementing evidence-based practice (EBP). There is limited understanding of how EBP affects safety culture. The purpose of this study was to assess nurses' perceptions of EBP utilization and its effect on patient safety culture. A cross-sectional, descriptive design was employed utilizing self-report questionnaires. A convenience sample of 381 registered nurses was recruited from four major hospitals in Jordan. Descriptive and multivariate linear regression analyses were used. EBP knowledge/skills had the highest positive score. Meanwhile, organizational learning and continuous improvement were the greatest positive scores of patient safety culture among nurses. Nurses who perceived greater knowledge/skill associated with EBP reported higher levels of organizational learning and continuous improvement (&#x3b2;&#x2009;=&#x2009;0.15, p&#x2009;<&#x2009;0.001), increased teamwork within units (&#x3b2;&#x2009;=&#x2009;0.11, p&#x2009;<&#x2009;0.05), lower perceptions of nonpunitive responses to error (&#x3b2;&#x2009;=&#x2009;-0.15, p&#x2009;<&#x2009;0.001), greater communication openness (&#x3b2;&#x2009;=&#x2009;0.16, p&#x2009;<&#x2009;0.001), and improved feedback and communications about errors (&#x3b2;&#x2009;=&#x2009;0.13, p&#x2009;<&#x2009;0.01). The association between EBP and patient safety underscores the importance of systematically implementing EBP in healthcare settings. As scientific evidence informs clinical practice, it is crucial for hospitals to integrate EBP into their policies and strategies to sustainably foster a culture of safety and optimize nursing practices.

Women with gestational diabetes mellitus (GDM) face increased lifetime risk of type 2 diabetes (T2DM). Genetic risk-predictive testing could help identify those at highest risk and guide preventative care. We aimed to assess perceptions of genetic risk scores to help inform future implementation. An online survey of 112 women with current or prior GDM assessed willingness for genetic and non-genetic risk testing, attitudes, lifestyle motivation, and data-use concerns. Quantitative analyses were complemented by thematic analysis of free-text responses. Overall, willingness was high for both genetic testing (83.9%) and non-genetic (90.2%), with no significant difference between them (p&#x2009;=&#x2009;0.083). Participants identifying as White reported greater willingness for genetic testing (p&#x2009;=&#x2009;0.020) and stronger agreement that testing should be available on the NHS (p&#x2009;=&#x2009;0.032) than Non-White participants. Attitudes toward genetic testing were positive and associated with both willingness to test and support for NHS availability (p&#x2009;<&#x2009;0.001). Younger participants were more motivated to modify lifestyle behaviours (p&#x2009;=&#x2009;0.015). Overall, concerns around data collection were low; although free-text responses highlighted health insurance implications, psychological burden, actionability of results, and timing of testing as salient themes. Women with GDM were receptive to genetic risk-prediction for T2DM, with low concerns around data usage. Demographic differences in acceptability and motivation highlight the need for inclusive, targeted communications and lifestyle support alongside integration testing into postnatal-GDM care.

Consciousness in Zen meditation has garnered considerable interest in psychology and neuroscience, particularly in relation to its association with enhanced self-awareness. Zen meditation fosters social harmony by addressing mental and social conflicts, linking individuals to various societal aspects through the practice. This meditation, rooted in Buddhism, aims to perceive thoughts without judgment by attentively focusing on the present. However, the neural mechanisms behind its benefits have remained elusive. To investigate, we used functional magnetic resonance imaging on two groups: Zen monks with extensive meditation experience (average 7.53&#x202f;years) and a control group without meditation background. Both groups completed the Stroop cognitive conflict task followed by meditation. Zen meditation, when performed by skilled monks, improved responses and cognitive control, and reduced cognitive conflict in the lateral and medial prefrontal cortices compared to the control group. Conflict tasks are generally associated with increased activity in the central executive network (CEN), whereas activity in the medial prefrontal cortex, a core component of the default mode network (DMN), has been linked to internally oriented processes such as self-referential thought and mind-wandering. The involvement of the DMN during meditation, however, appears to depend on the specific meditation style and cognitive state, with prior studies reporting mixed findings. These networks are often considered to exhibit an antagonistic relationship, with task engagement typically accompanied by CEN activation and concurrent DMN suppression. However, Stroop conflict trials in the present study did not show a strong inverse relationship between DMN and CEN activity. Instead, connectivity analyses indicated suppression within DMN-related regions.

Prior research suggests a link between maternal depression and mothers' problematic media use (PMU), defined as compulsive or dysregulated media use that interferes with daily functioning. This study examined whether parenting self-efficacy mediates this association using a random intercept cross-lagged panel model. Participants were 532 mothers (Mage = 30.34 years) and their infants (Mage = 5.83 months at Wave 1) followed across five annual waves. We analyzed data from Waves 1 to 5 of Project MEDIA, capturing both between- and within-person effects over time. Results showed that higher maternal depression correlated with lower parenting efficacy and higher PMU. Depression remained relatively stable across 5 years, whereas PMU and parenting efficacy fluctuated. Within-person analyses revealed that increases in maternal depression predicted decreases in parenting self-efficacy, but neither depression nor efficacy significantly predicted PMU. These findings suggest that while maternal depression undermines parenting self-efficacy, additional factors may explain its connection to PMU. Further research is needed to clarify these pathways and inform intervention strategies. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Song, a human cultural universal, fuses music and speech into a single auditory signal, one of the first among infants' auditory experiences. While parents sing to their babies in all human cultures, we still know little about how this experience shapes babies' perception abilities and their neural correlates. This work, therefore, investigates how the newborn brain processes song compared to its two components, speech and hummed melody. Specifically, we test the hypothesis that by regularizing the rhythm of speech, song may support language acquisition. Using functional near-infrared spectroscopy (fNIRS), we found that newborns' (n&#x2009;=&#x2009;40) showed stronger responses for both speech and song in the right temporoparietal regions than activation triggered by humming. Despite their clear acoustic distinctions, no significant differences were observed between the neural response of speech and song. This suggests that singing, just like speech, may represent a salient input for the newborn brain, potentially supporting early speech perception and language development.

Despite decades of research, the conditions under which punishment promotes cooperation remain unclear. Through an integrative experiment varying 14 design parameters of public goods games across 360 experimental conditions (147,618 decisions from 7100 participants), we reveal substantial heterogeneity in punishment effectiveness: Its impact on welfare ranges from 43% improvement to 44% reduction depending on the game parameters. To characterize these patterns, we developed models that outperformed human forecasters in predicting punishment effectiveness in new experiments. Communication emerges as the most important factor, followed by contribution framing (opt out versus opt in), contribution type (variable versus all-or-nothing), game length, and outcome visibility, though these factors often interact. The results reframe the debate from whether punishment works to when it does, demonstrating how integrative experiments enable discovery of generalizable patterns in social phenomena.

Rhythmic abilities are linked to performance across a range of cognitive tasks, yet the mechanisms underlying this relationship remain unclear. We evaluated 98 Mexican participants using the Speech-to-Speech Synchronization Test (SSS-Test), a self-report measure of musical training, and an extensive cognitive battery. Analyses revealed that phonological language processing and temporal attention are the core cognitive skills associated with auditory-motor rhythmic proficiency (as assessed by the SSS-Test). Importantly, this relationship appears thresholded: cognitive benefits emerge only when rhythmic abilities exceed a specific level, with further refinements conferring no additional advantage. Moreover, we show that the link between musical training and cognition is fully mediated by this rhythmic performance threshold. These findings provide a unifying framework for understanding how rhythmic skills impact cognition and clarify the mechanisms through which musical training may confer cognitive benefits.

To effectively communicate and collaborate with others, we must monitor not only other people's cognitive states (e.g., what someone thinks or believes) but also their metacognitive states (e.g., how confident they are in their beliefs). While humans routinely share confidence, either explicitly (e.g., "I am sure") or implicitly (e.g., via response times), metacognitive capabilities are still developing in artificial intelligence (AI), raising the question of how humans attribute confidence to AI systems. In seven pre-registered experiments (post-exclusion Ns&#x2009;=&#x2009;113, 109, 56, 59, 52, 60, 57), participants observed human and AI agents make perceptual choices and reported how confident the observed agent seemed in each choice. Overall, attributions of confidence were sensitive to observed behaviour (e.g., task difficulty, accuracy, and response times), but also agent type: observers consistently overestimated the confidence of AI agents compared to humans-even when their behaviour was identical. This illusion of greater confidence in AI decisions was robust across behavioural profiles, agent descriptions, and decision-making domains (visual perception, general knowledge) but was reduced in more subjective decisions (emotion categorisation). An experimental manipulation further showed that illusions of confidence are rooted in prior beliefs about the agents' capabilities. Together, these investigations of metacognitive attributions reveal a powerful illusion of confidence in artificial systems and highlight a central role for attributions of metacognitive states in human-human and human-AI interactions.

Perceptual processing may rhythmically alternate. There is a line of evidence from dense sampling psychophysics supporting this claim: In such studies, performance in visual target detection or discrimination is repeatedly tested at various fine-grained time intervals relative to a reference event. This reference event is presented at the beginning of each trial, and it is thought to reset some internal oscillation. Performance time courses following the reset often show rhythmic oscillations in the sub-second range. The interpretation has been that several quickly alternating peaks and troughs of perceptual efficiency exist. Here, we propose an alternative. Instead of being rhythmic, the perceptual processing efficiency time course might exhibit only a single peak in each trial. If the temporal location of this peak is constrained to co-occur with one of the peaks of the internal continuing oscillation, rhythmicity in overall performance time courses can be explained when performance is computed across many trials. Applying this perspective to three published datasets (N&#x2009;=&#x2009;44, N&#x2009;=&#x2009;34, N&#x2009;=&#x2009;11) and running simulations, we confirm the possible existence of such phase-aligned peaks in perceptual efficiency. We show that foreperiod priming (behavioural advantage of repeating the same time interval between reference and target from one trial to the next) alternates across time. This is predicted if peaks in perceptual efficiency are consistently allocated to those time intervals that coincide with a peak in the underlying oscillation. Priming therefore works best at these intervals, which coincide with a peak in the underlying oscillation.

Background: ICD-11 distinguishes post-traumatic stress disorder (PTSD) from complex PTSD (CPTSD) by introducing disturbances in self-organization (DSO) as a defining feature of CPTSD. Accurate identification of these conditions requires instruments aligned with the ICD-11 framework. The International Trauma Questionnaire (ITQ) was specifically developed to assess PTSD and CPTSD from ICD-11, but the Serbian version has not yet been validated in a clinical population.Objective: This study aimed to evaluate the psychometric properties of the Serbian version of the ITQ in a clinical sample, including its factor structure, reliability, and concurrent and discriminant validity in relation to trauma exposure, childhood adversity, emotional distress, emotional dysregulation, dissociation, suicidality, and quality of life.Method: A total of 199 adult psychiatric patients at the Institute of Mental Health in Belgrade completed the ITQ, Life Events Checklist (LEC-5), Impact of Event Scale-Revised (IES-R), Adverse Childhood Experiences Questionnaire (ACE-Q), Depression Anxiety Stress Scales (DASS-21), Difficulties in Emotion Regulation Scale (DERS), Brief Dissociative Experiences Scale (DES-B), Suicidal Ideation Attributes Scale (SIDAS), and the Manchester Short Assessment of Quality of Life (MANSA). Confirmatory factor analysis was used to compare competing ICD-11 models of PTSD and CPTSD.Results: Both the six-factor correlated model and the second-order PTSD-DSO model showed good fit, whereas the single-factor model of CPTSD was not supported. CPTSD was more common than PTSD (25.7% vs. 18.7%) and was associated with higher levels of emotional dysregulation, dissociation, suicidality, and poorer quality of life. PTSD symptoms were more strongly associated with trauma-related distress, while DSO showed stronger associations with depression, anxiety, and negative self-concept.Conclusions: The Serbian version of the ITQ demonstrates good reliability, validity, and clinical utility for the assessment of PTSD and CPTSD according to ICD-11. Its use may improve diagnostic differentiation and support more targeted trauma-informed treatment in Serbian clinical settings. In this study, the International Trauma Questionnaire (ITQ) was adapted and psychometrically evaluated in a clinical population of trauma-exposed adults in Serbia.As a result of this study, the first reliable and valid instrument for assessing Post-Traumatic Stress Disorder (PTSD) and Complex Post-Traumatic Stress Disorder (CPTSD) according to ICD-11 is now available for use in clinical and research settings in Serbia, allowing for accurate differentiation between PTSD and Disturbances in self-organization (DSO).The results of confirmatory factor analyses indicate that the two-factor model provides the most appropriate representation of trauma-related symptoms in this population, supporting the clinical relevance of differentiating CPTSD from PTSD in mental health services in Serbia. Antecedentes: La CIE-11 distingue el trastorno de estr&#xe9;s postraum&#xe1;tico (TEPT) del TEPT complejo (TEPTC) al introducir las alteraciones en la autoorganizaci&#xf3;n (AAO) como una caracter&#xed;stica definitoria del TEPTC. La identificaci&#xf3;n precisa de estas condiciones requiere [instrumentos alineados con la CIE-11]. El Cuestionario Internacional de Trauma (ITQ) se desarroll&#xf3; espec&#xed;ficamente para evaluar el TEPT y TEPTC basados en la CIE-11, pero la versi&#xf3;n serbia [a&#xfa;n no ha sido validada en poblaci&#xf3;n cl&#xed;nica]. Objetivo: Este estudio tuvo como objetivo evaluar las propiedades psicom&#xe9;tricas de la versi&#xf3;n serbia del ITQ en una muestra cl&#xed;nica, incluida su estructura factorial, confiabilidad y validez concurrente y discriminante en relaci&#xf3;n con la exposici&#xf3;n a trauma, adversidades en la infancia, malestar emocional, desregulaci&#xf3;n emocional, disociaci&#xf3;n, suicidalidad y calidad de vida. M&#xe9;todo: Un total de 199 pacientes psiqui&#xe1;tricos adultos del Instituto de Salud Mental en Belgrado completaron la ITQ, LEC-5, IES-R, ACE-Q, DASS-21, DERS, DES-B, SIDAS y MANSA. Se utiliz&#xf3; an&#xe1;lisis factorial confirmatorio para comparar los modelos en competencia de TEPT y TEPTC de la CIE-11. Resultados: Tanto el modelo de seis factores correlacionados [como] el modelo TEPT-AAO de segundo orden mostraron un buen ajuste, mientras que el modelo de un solo factor para el TEPTC no se confirm&#xf3;. El TEPTC fue m&#xe1;s frecuente que el TEPT (25,7% vs. 18.7%) y se asoci&#xf3; con mayores niveles de desregulaci&#xf3;n emocional, disociaci&#xf3;n, suicidalidad y peor calidad de vida. Los s&#xed;ntomas de TEPT se asociaron m&#xe1;s fuertemente con angustia relacionada con el trauma, mientras que las AAO mostraron una asociaci&#xf3;n m&#xe1;s fuerte con depresi&#xf3;n, ansiedad y un autoconcepto negativo. Conclusiones: La versi&#xf3;n serbia del ITQ demuestra buena confiabilidad, validez y utilidad cl&#xed;nica para la evaluaci&#xf3;n del TEPT y TEPTC seg&#xfa;n la CIE-11. Su uso podr&#xed;a mejorar la diferenciaci&#xf3;n diagn&#xf3;stica y respaldar un tratamiento m&#xe1;s espec&#xed;fico basado en trauma en contextos cl&#xed;nicos serbios.

In Complete Vocal Technique (CVT), "metal" and "density" are used as auditory-perceptual concepts to characterize voice quality. Previous studies have explored acoustic, electroglottographic (EGG), and vocal tract-related patterns associated with different metal and density conditions. However, no studies to date have examined how these qualities are reflected in aerodynamic measurements or the glottal flow waveform. This exploratory analysis aimed to provide insights into the concepts of metal and density. The goal was to gain an understanding of how varying degrees of metal and density are reflected in acoustic, EGG, aerodynamic, and glottal inverse-filtering parameters, as well as in vocal efficiency and economy parameters. Two CVT-trained singers (male and female) were recorded while performing consonant-vowel syllables at three pitches across four CVT vocal modes with varying "metal" and "density" conditions. Subglottal pressure (Psub), oral airflow (Q), EGG, and acoustic voice signals were recorded. Contact quotient (CQ) from EGG and an estimate of glottal resistance (GR) were calculated. Glottal flow waveform was studied with inverse filtering. Vocal efficiency and EGG-based estimator of vocal economy (quasi-output-cost ratio [QOCR]) were calculated. Samples were rated for auditory perception of strain by two expert groups with different educational backgrounds. Metallic phonation displayed higher sound pressure level (SPL), Psub, GR, CQ, vocal efficiency (p < 0.001), and lower Q (p < 0.001) and QOCR (p = 0.009) than nonmetallic phonation. Out of glottal parameters, harmonic richness factor was higher and H1-H2 and NAQ lower in metallic phonation. Compared to fuller density, reduced density exhibited lower SPL, Psub, Q, vocal efficiency (p < 0.001), CQ (p = 0.044), AC flow, and MFDR, and higher QOCR (p = 0.055) and NAQ. Strain was rated higher in metallic samples than in nonmetallic samples by vocologists and speech-language pathologists (p < 0.001). The examined parameters were distinguished between nonmetallic and metallic phonation as well as between reduced density and fuller density conditions. While metal and density share common measures, they appear to form their own specific profiles. Larger sample sizes are needed to refine these preliminary findings. Indicators of vocal economy warrant further investigation.