To quantify continuity of care in general practice in the Australian population, including variation according to patient characteristics and over time, to support ongoing policy reforms directed towards improving general practice care. Repeated cross-sectional analyses of linked whole-of-population data from the Medicare Benefits Schedule, the Medicare Consumer Directory and the Census of Population and Housing (2021). Continuity was assessed in people with at least four general practitioner visits in a 2-year period (about 80% of the population). Relational continuity of care in general practice, measured with the Usual Provider Index, for eight overlapping 2-year periods (2016-2017 to 2022-2023). High continuity was defined as having ≥ 70% of visits with one provider. About one-third of the population had high continuity of care (range: 31.3% in 2018-2019 to 37.2% in 2020-2021). After adjustment for age, sex and remoteness, high continuity was more common among those with greater care needs, including those who were older (≥ 70 years vs. 0-14 years: adjusted prevalence ratio [aPR], 1.88) or with health conditions (e.g., ≥ 3 vs. none: aPR, 1.14) and those who were living in more disadvantaged areas (e.g., most vs. least disadvantaged: aPR, 1.22), born overseas (e.g., born in Southern or Eastern Europe vs. born in Australia or New Zealand: aPR, 1.20) or not proficient in English (aPR, 1.29). However, it was less common for females compared with males (aPR, 0.90) and those living remotely (e.g., very remote vs. major cities: aPR, 0.43). While most people in Australia do not receive continuous care in general practice with a specific provider, those with greater healthcare needs are more likely to. With ongoing policy reforms, monitoring continuity of care may provide insights into the consequences for quality of care. Continuity of care is central to quality primary care, but data for the general Australian population are lacking. Among the approximately 80% of Australians with at least four general practitioner visits in a 2‐year period, around one‐third had high continuity (≥ 70% of visits with their usual general practitioner), with small increases since 2020. Proportions were higher among those with greater healthcare needs (e.g., older age, more socioeconomically disadvantaged, with health conditions), but lower in remote areas. Monitoring continuity may provide insights into consequences of health policy reforms, both intended and unintended, to optimise primary care in Australia.
A central question in cognitive neuroscience is how the brain implements abstract computations that must generalize across superficially different inputs. Language provides a strong test case: the same grammatical operation, such as pluralization, can be realized through distinct rules and forms across languages. Whether such transformations rely on language-specific neural systems or on abstract mechanisms that generalize across linguistic contexts remains unresolved. Crucially, these transformations must be computed online and integrated into speech planning within a tightly constrained time window. Using magnetoencephalography (MEG), we tracked the millisecond dynamics of grammatical word-form transformations during semi-naturalistic phrase completion in humans of both sexes. Highly proficient Spanish-English bilinguals produced singular and plural noun forms in both languages in a design that fully orthogonalized semantic number, phonological changes, grammatical inflection and produced language. Adjusting words to fit their grammatical context engaged a left-lateralized fronto-temporal network beginning ∼100 ms after cue onset. Multivariate decoding revealed that the neural patterns supporting this computation generalized across languages, across different surface plural forms, and to pseudowords, demonstrating that abstractly equivalent operations are instantiated in the same neural substrates despite differences in linguistic form. Together, these findings provide time-resolved neural evidence for a language-general computational mechanism, showing that the brain implements grammatical transformations as abstract, generative operations. More broadly, they show how bilingualism can be used to probe general principles of neural organization, revealing how abstract computations may be shared and reused across representational systems.Significance Statement Human language relies on the ability to modify words to convey information like number and tense, but languages vary widely in how these transformations are implemented. This variation raises a fundamental question in cognitive neuroscience: do such transformations depend on language-specific neural systems, or are they processed by abstract neural mechanisms that generalize across languages? We demonstrate that Spanish-English bilinguals engage a shared left frontal-temporal network when producing grammatically appropriate forms in both languages. This common neural signature emerges early during speech planning and even generalizes to novel words. These findings indicate that the brain builds abstract, reusable neural mechanisms, consistent with models where language is organized by computational principles rather than by language-specific systems.
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Individuals with a Diagnostic and Statistical Manual of Mental Disorders (DSM) anxiety or depressive disorder tend to report a lack of agency in social situations. Agency represents one dimension in the interpersonal circumplex model while communion represents the other dimension. In the present study, we mapped six anxiety and depressive disorders examined within the Netherlands Study of Depression and Anxiety (NESDA) onto this model. To this end, we used the structural summary method to reduce Inventory of Interpersonal Problems scores of NESDA Wave 6 participants with a current diagnosis (n = 412) to interpersonal profiles for each of the six examined disorders. The Displacement parameter represents the blend of agency and communion and provided insight into which interpersonal problem theme is most characteristic for a disorder. Amplitude represents the distinctiveness of this theme, and Elevation provides an indication of the level of general interpersonal distress associated with the disorder. Unexpectedly, general interpersonal distress was highest for dysthymia, not major depressive disorder. As expected, however, all disorders (social phobia, generalized anxiety disorder, panic disorder, agoraphobia, dysthymia, and major depressive disorder) were primarily characterized by a submissive interpersonal style. Additionally, we found greater general interpersonal distress among participants with comorbid anxiety and depression than among participants with depression or anxiety alone. The main finding was that the different anxiety and depressive disorders had comparable interpersonal profiles. This supports the notion that interpersonal style may be a transdiagnostic factor in the emergence and maintenance of these disorders, contributing to interpersonal distress particularly in individuals with comorbid disorders.
Adult language learning varies widely among individuals, with some learners quickly acquiring knowledge and skills while others struggle with specific components or overall proficiency despite similar exposure. This variability, once linked to frontotemporal language regions, is increasingly seen as originating from distributed networks involved in attention, control, and memory. The role and organization of these networks in explaining these differences remain unclear. We hypothesized that intrinsic multi-network connectivity underpins these variations, revealing potential neuromarkers of interactions among systems beyond language regions. We tested this in 101 healthy adults (72 females and 29 males) using multimodal neuroimaging before seven days of artificial language training across six tasks targeting auditory and speech categories, words, morphosyntax, and sentence structures. We identified one general component shared across tasks and five task-specific ones. Using cross-validated predictive modeling and graph-theoretic metrics, we found that the general component's learning outcome (LO) and rate (LR) were primarily driven by the dorsal attention and frontoparietal networks. Their local efficiency was a strong predictor, highlighting local resilience and mesoscale segregation. Local connectivity dominated in association cortical networks, while global integration occurred in subcortical regions, reflecting a balance between segregation and integration influences learning. Only task-specific word learning was predictable, relying on default-mode and frontoparietal hubs. Single-modality predictions were weaker, emphasizing the value of multimodal approaches. These findings suggest that the intrinsic network topology underlies individual success in language learning, supporting a multiple-system model in which attention, default, and subcortical networks work together to shape learning trajectories and advance mechanistic understanding.Significance Statement Adult learners vary greatly in how effectively and successfully they learn a new language, but the neural basis for this variability remains unclear. Using multimodal MRI data collected before training and connectome-based graph-theoretic measures, we demonstrate that intrinsic brain network topology predicts both a general language-learning factor and learning speed across six artificial-language-learning tasks in 101 adults. The strongest predictive features were found in the dorsal attention and frontoparietal control networks, with nodal local efficiency emerging as the most consistent marker. A cortical-subcortical dissociation in local-efficiency and global-integration properties may underlie these individual differences. These findings highlight potential network-level neuromarkers for predicting adult language learning success beyond language areas.
This study examined the prevalence and associations of personality dysfunction and antisociality among youth accessing residential substance use disorder (SUD) withdrawal. Participants were 100 youth (57% female) aged 18-25 scheduled or admitted to residential SUD withdrawal in Victoria, Australia. Personality dysfunction was assessed using the Level of Personality Functioning Scale-Self Report and Antisocial Personality Disorder (ASPD) Impairment Interview. SUDs were assessed using the Structured Clinical Interview for DSM-5, early maladaptive schemas using the Young Schema Questionnaire-Rach, and antisocial attitudes using the Measures of Criminal Attitudes and Associates. All participants met criteria for at least one SUD (M = 2.2, SD = 2.1); 66% endorsed two or more SUDs. Nearly half the sample met the threshold for likely general personality disorder (PD; 48%), while 43% met criteria for likely ASPD. Chi-square analyses indicated that likely general personality disorder (χ2 = 12.4, p < 0.001) and likely ASPD (χ2 = 13.5, p < 0.001) were associated with polysubstance use. Likely ASPD was associated with cannabis (χ2 = 9.3, p < 0.01), methamphetamine (χ2 = 4.9, p < 0.05), alcohol (χ2 = 4.3, p < 0.05) and sedative (χ2 = 4.9, p < 0.05) use disorders. Elevated early maladaptive schemas were common; 59% reported a prior arrest, and 23% reported 10 or more. Personality dysfunction and antisociality appear common among youth accessing residential withdrawal, supporting the assessment of personality functioning in this population. Future research should examine whether integrating personality-informed or schema-focused approaches within withdrawal services improves outcomes.
Problematic cannabis use has been linked to cognitive impairment and psychopathology, which may adversely affect an individual's ability to regulate attention and drive safely. This study examined associations between likely cannabis dependency, cannabis-related psychological symptoms, subjective general driving efficacy, and general driving inattention. It also aimed to compare these factors between specific cohorts of active cannabis users and a comparative sample of low-frequency substance users. An online survey was disseminated to Australian residents aged 20-65 years, who drove at least one hour per week, and did not have a physical condition impairing driving. Active users (N = 271) had consumed cannabis within the past month, whereas the comparison group (N = 159) reported minimal substance use. MANOVAs showed that likely dependent cannabis (n = 114) users reported the greatest psychological symptoms and driving inattention, and the lowest subjective driving efficacy, followed by low-frequency substance users, and then likely non-dependent cannabis users (n = 157). However, no significant differences emerged between those who used medically prescribed compared to non-prescribed cannabis. Correlational analyses further revealed significant associations between likely cannabis dependency, psychological symptoms, subjective driving efficacy, and driving inattention. Finally, structural equation modeling showed that likely cannabis dependency was indirectly associated with subjective driving efficacy and driving inattention through its relationship with emotional and cognitive dysfunction. Overall, these findings suggest that problematic cannabis use is associated with poorer driving capabilities, likely linked to greater psychological dysfunction and cognitive-attentional deficits. In turn, the findings highlight the importance of integrating chronic cannabis-related risks into driving research, policy, and regulation.
Given the high incidence of postoperative cognitive decline and reduced self-efficacy in lung cancer patients undergoing radical thoracoscopic surgery, this study aimed to investigate the effect of evidence-based nursing combined with health empowerment intervention on self-efficacy and cognitive function in this patient population. A total of 516 patients who underwent thoracoscopic radical lung cancer surgery between February 2021 and June 2025 in The First People's Hospital of Zunyi were included. The patients were divided into an observation group (232 cases, who received evidence-based nursing combined with health empowerment intervention) and a control group (284 cases, who received conventional nursing). General data of the patients, along with their visual analogue scale (VAS) scores, forced vital capacity (FVC), maximal voluntary ventilation (MVV), forced expiratory volume in 1 second to FVC ratio (FEV1/FVC), General Self-Efficacy Scale (GSES) score, and Mini-Mental State Examination (MMSE) score, were collected. There was no significant difference between the two groups in terms of baseline characteristics (p > 0.05). After the intervention, the observation group achieved significantly greater improvement than the control group in terms of VAS pain scores, pulmonary function indices (FVC, MVV, FEV1/FVC), GSES scores and MMSE scores (p < 0.001). In addition, the total incidence of postoperative adverse reactions was significantly lower in the observation group than in the control group (7.76% vs. 13.73%, p = 0.031). Evidence-based nursing combined with health empowerment intervention significantly relieves postoperative pain, promotes recovery of lung function, enhances self-efficacy and cognitive function, and reduces the incidence of postoperative adverse events.
Flexible and effective emotion regulation (ER) is crucial for mental health and well-being. Research on individual differences in ER, however, has often relied on global self-reports or controlled laboratory settings, which may not fully capture the dynamic and context-dependent nature of regulation in daily life. To address this, we examined how ER variability and flexibility in real-world contexts relate to executive functions (EF), affective well-being, and age in a general population sample (N = 161, aged 14-78). EF performance was assessed using six online cognitive tasks, while ER variability and flexibility were assessed using a 14-day ambulatory assessment of daily emotional experiences. As expected, EF performance declined with increasing age across shifting, inhibition, and updating domains. Beyond these age-related differences in cognitive performance, older age was robustly associated with lower within- and between-strategy ER variability. In contrast, ER flexibility remained relatively stable across adulthood. Individual differences in EF were not associated with everyday ER variability, suggesting that cognitive control capacity does not account for regulatory dispersion in daily life. For affective well-being, ER flexibility showed specific, nonlinear associations: within-strategy flexibility based on situational valence and social context demonstrated U-shaped relations with unpleasant mood, suggesting that both low and high context sensitivity may be linked to elevated negative affect. In contrast, flexibility indices were unrelated to between-strategy variability or depressive symptoms. Overall, these findings indicate that adaptive ER cannot be reduced to greater executive control capacity, greater variability, or greater flexibility per se. Instead, they underscore the importance of distinguishing variability from flexibility and highlight that the adaptiveness of ER may depend more on the appropriateness of strategy-context matches than on general patterns of strategy use.
Inflammatory processes have been implicated in perinatal mood disorders. Yet, evidence linking prenatal inflammatory markers to postpartum anxiety is limited. We investigated whether third trimester inflammatory markers were associated with postpartum anxiety symptoms. Participants were drawn from Generation C, a prospective pregnancy cohort conducted in New York City (April 2020-February 2022). Prenatal inflammatory markers (IL-6, IL-17A, IL-1β, and C-reactive protein [CRP]) were measured from routine clinical blood samples collected ≥28 weeks' gestation and > 7 days before delivery. Postpartum anxiety symptoms were assessed using the Generalized Anxiety Disorder-7 (GAD-7) questionnaire completed within 24 weeks postpartum. Multivariable quantile regression models (50th, 75th, and 90th percentiles) examined associations between log2-transformed inflammatory markers and postpartum GAD-7 scores, adjusting for sociodemographic, clinical, and pandemic-related factors, including a history of anxiety and/or depression. Missing data were imputed and p-values were adjusted for multiple testing using the false discovery rate (FDR). The analytic sample included 237 participants. After FDR correction, none of the inflammatory markers were associated with postpartum GAD-7 scores at any quantile. A history of anxiety or depression was consistently associated with higher postpartum anxiety symptoms across all quantiles (β range 3.6-4.9; all p < 0.01). Third trimester circulating IL-1β, IL-6, IL-17A, and CRP were not associated with postpartum anxiety symptom burden in this population-based cohort. A history of anxiety/depression remained the strongest risk factor for postpartum anxiety symptoms. These findings suggest that late-pregnancy systemic inflammatory markers may have limited utility for identifying postpartum anxiety risk in general obstetric populations.
Distortions in autobiographical memory processing are implicated in the onset and maintenance of multiple mental health problems in adults. While reduced personal memory specificity has been identified as a transdiagnostic risk factor in adolescents, less is known about other domains of memory processing, including biases in the accessibility and affective intensity of negative and positive memories. We administered a novel recall paradigm, the Good Day-Bad Day task (Hitchcock et al., Journal of Experimental Psychology: General, 2019, 149, 198), to assess autobiographical memory fluency for positive and negative events, memory specificity, and the Fading Affect Bias (FAB) - the extent to which the emotional intensity associated with positive memories fades less than for negative memories overtime - in adolescents, aged 16-18, at high (n = 201, Mage = 17.20, SD = 0.60, 84.6% female, 2% other) and low clinical risk (n = 117, Mage = 17.10, SD = 0.60, 77.8% female) of affective disorder. We found that superior recall for positive relative to negative events and a strong FAB were associated with good mental health. Risk of affective disorder was associated with a significant reduction in these positive biases and recall of a higher number of negative memories compared with Low-Risk adolescents. Memory specificity did not differ by risk status. Findings extend research on autobiographical memory processing to two novel domains in adolescence and further elucidate how differences in autobiographical memory recall may underlie mental health, with implications for the development of memory-based interventions.
Survivors of critical illness and their caregivers often experience a complex constellation of sequelae in the aftermath of their recovery, termed post-intensive care syndrome (PICS) and PICS-Family (PICS-F), respectively. These can have a dire impact on patients and families, and thus require coordinated rehabilitative efforts. However, optimal modes of providing support services remain unclear, with traditional clinic-based strategies showing mixed results. This scoping review aimed to summarize the feasibility and effectiveness of nonclinic-based follow-up and rehabilitation strategies for adult survivors of critical illness and their caregivers. Databases were searched on July 8, 2025, and included Cochrane, Embase, PubMed, and Web of Science. Studies reporting interventions and follow-up options for adult survivors of critical illness requiring ICU stay and targeting PICS and PICS-F were included. Studies examining interventions in the outpatient clinic or ICU settings exclusively were excluded. Two team members used Covidence to screen all the deduplicated citations, with a third team member acting as a tiebreaker. The studies included were reviewed in full to extract general data, the studied syndrome (PICS, PICS-F, or both), component of PICS studied, study population, study objectives, methods, inclusion and exclusion criteria, intervention details, general results, and study conclusions. We screened 8608 studies; 45 studies met criteria and were included in this review. Most (64%) focused on the physical and psychological sequelae of PICS. Interventions varied widely, by setting, duration, and approach. Outcome measures were heterogeneous, limiting comparisons. Most studies evaluated the feasibility of interventions and not effectiveness. Only six articles targeted PICS-F exclusively. This scoping review summarizes the status of different nonclinic-based follow-up and rehabilitation strategies for adult ICU survivors. Future research focused on studies that evaluate effectiveness of these strategies in mitigating the burden of PICS and PICS-F, especially within the cognitive domain, is likely to improve aftercare for both patients and their families.
Robust outcome measurement is central to evaluating clinical training environments and providing timely support to medical students. Burnout during clinical clerkships is common; however, evidence of the capability of instruments to monitor sustained risks and detect meaningful changes remains limited. To evaluate the responsiveness of the 11-item Oldenburg Burnout Inventory-Medical Student version (OLBI-MS-11) and examine the baseline predictors of individuals' sustained burnout during their clerkships. We examined within-person change correlations between the OLBI-MS-11 and domain-matched anchors (Maslach Burnout Inventory-General Survey [MBI-GS] subscales) in a five-wave longitudinal cohort study of Japanese medical students (N = 162). We assessed the instrument's discrimination of MBI-defined burnout caseness and analysed associations between burnout trajectories and clinically relevant constructs, including psychological flexibility, depressive symptoms, perceived stigma, mistreatment, and absence of clerkship. The OLBI-MS-11 demonstrated moderate, domain-concordant correlations in within-person changes with the MBI-GS subscales across adjacent time points and maintained a stable discrimination of burnout caseness (AUC ≈ 0.82-0.84). Changes in burnout were associated with concurrent changes in psychological flexibility and depressive symptoms. Higher baseline psychological flexibility was associated with a reduced risk of sustained burnout, whereas mistreatment predicted persistent burnout. The OLBI-MS-11 showed responsiveness and discriminative validity in clinical clerkships. Its use may facilitate the longitudinal monitoring of medical students' well-being and inform the identification of sustained burnout risk. Continuous-change metrics may provide a more nuanced evaluation of individual trajectories than dichotomous classifications alone.
Arecoline, a major alkaloid in betel nuts, modulates cognitive function, yet its effects on memory in young, healthy mice remain unclear. We administered arecoline or vehicle to mice and allowed them to perform a novel object recognition task to investigate whether and how acute arecoline administration affected object recognition. Arecoline-treated mice exhibited a significantly higher discrimination index than controls, indicating improved discrimination performance. This enhancement occurred without changes in locomotor activity, anxiety-like behavior, or general exploratory motivation. Time-series analysis further revealed that arecoline treatment led to sustained high discrimination ability during the test session, compared to vehicle treatment. These findings demonstrate that acute arecoline administration enhances object recognition even in a healthy physiological state, possibly by facilitating cholinergic-mediated attention and memory encoding.
To (1) assess the adequacy of cancer-related pain management among hospitalized adult patients with cancer in Oman and (2) examine the association between pain-management adequacy and psychological distress. A descriptive, correlational, cross-sectional design was used with a convenience sample of 202 in-patients with cancer recruited from two tertiary oncology centers in Oman between June and September 2024. Cancer-related pain management was evaluated using the Pain Management Index (PMI), which compares the potency of prescribed analgesics, based on the World Health Organization analgesic ladder, with patients' reported worst pain intensity. Pain intensity and interference were measured with the Brief Pain Inventory-Short Form, and anxiety and depression with the Hospital Anxiety and Depression Scale. Logistic regression was used to identify predictors of inadequate pain management (PMI <0). Pain, anxiety, and depression prevalences were high, and the mean PMI score suggested overall inadequate pain management. Pain most commonly interfered with sleep, normal work, and general activity. Longer time since diagnosis was associated with higher odds of adequate pain management, whereas greater interference in relations with other people was associated with lower odds. Adequacy of pain management showed a weak negative association with anxiety and no significant association with depression. Among hospitalized patients with cancer in Oman, cancer-related pain was highly prevalent and undertreated, in the context of psychological distress. Holistic, culturally sensitive interventions that optimize analgesic prescribing while concurrently addressing anxiety, depression, and social relationships are needed to improve pain control, quality of life, and overall well-being in this population.
Daytime sleepiness and excessive sleep are frequent symptoms. When these symptoms are recognized, they are often attributed to comorbid depression or, following ambulatory screening, to obstructive sleep apnea (OSA). While OSA affects 20-50% of the population, more frequently in men, its contribution to sleepiness in the general population is modest, and subjective sleepiness shows stronger associations with depression, insufficient sleep, and shift work. As a result, mild OSA in the presence of sleepiness is often overtreated. Further, stimulants are used as adjunct therapy in depression despite limited evidence. When referred to sleep disorder specialists, after exclusion of OSA, these patients are typically evaluated using a daytime nap test, the Multiple Sleep Latency Test (MSLT). The MSLT is used to diagnose Narcolepsy or Idiopathic Hypersomnia. Problematically, the MSLT performs well only to confirm narcolepsy type 1, a disorder with cataplexy and caused by orexin deficiency. A high false positive rate occurs in the absence of cataplexy, leading to questionable diagnoses of narcolepsy type 2 and idiopathic hypersomnia. A return to four historical subtypes of central nervous system hypersomnolence independent of MSLT testing is proposed. Narcolepsy Type 1: cataplexy, refreshing naps, sleep-onset REM periods. It is caused by orexin deficiency, responds to oxybate, antidepressants, stimulants, and low dose orexin receptor 2 agonists (in development). Narcolepsy-like hypersomnolence: Irresistible sleep attacks with short, refreshing naps. Insufficient Sleep must be excluded. It is often responsive to modafinil. Idiopathic Hypersomnia with sleep inertia and unrefreshing sleep: Excessive sleep amounts, severe sleep inertia, and long, unrefreshing naps. Association with psychiatric comorbidities, notably resolved depression, is frequent. Sodium oxybate can be transformative. Kleine-Levin Syndrome: periodic extreme hypersomnia with apathy and derealization. Responds to lithium in ∼50% of cases. A pathophysiological overlap with bipolar disorder is likely. A greater collaboration between psychiatry and sleep medicine is needed considering the emergence of orexin receptor agonists as potential therapies for hypersomnia.
This study aimed to evaluate the effect of Huangqin Qingre Chubi capsule (HQC) on self-perception of patients (SPP) with gouty arthritis (GA) and explore its potential action path. Using a nested case-control design, 150 eligible GA patients were matched into neutrophil to lymphocyte ratio (NLR) improved group and NLR unimproved group based on the presence or absence of NLR improvement. Stratified analysis, association rule, binary logistics regression model and mediating effect analysis were used to evaluate the protective effect of HQC on SPP. At baseline, patients in the NLR improved group demonstrated significantly higher scores in the SPP subscales of physical functioning (PF), bodily pain (BP), general health, vitality (VT), role emotional (RE), and health transition compared to those in the NLR unimproved group (P < .001). And they exhibited significantly lower scores on the Visual Analog Scale (VAS), Self-Rating Anxiety Scale (SAS), and Self-Rating Depression Scale (SDS) (P < .01). HQC significantly improved SPP (including PF, role physical, BP, VT, RE, mental health, VAS, SAS, and SDS) in GA patients (P < .05). Stratified analyses and binary logistics regression showed that HQC had a significant protective effect on the SPP. Association rules showed that there was a co-occurrence pattern between HQC and improvement of SPP. Mediation analysis showed that NLR showed a complete mediating effect in the path of HQC improving PF (P < .001), SDS (P < .001), Syndrome of Dampness-Heat Quantitative Score (SDH) (P < .001) and Syndrome of Blood Stasis Quantitative Score (SBS) (P < .001). HQC is related to the improvement of SPP, inflammatory biomarkers and traditional Chinese medicine syndromes in GA patients, and it plays a protective effect on SPP through NLR.
Time poverty - the subjective experience of insufficient time - has become a pervasive phenomenon in contemporary societies, yet its psychological consequences for consumer decision-making remain underexplored. Drawing on scarcity theory, we examine how time poverty shapes preferences for access-based consumption (ABC) - temporary use without ownership - a market-mediated model transforming consumer societies worldwide. Across four studies (N = 831), we show that time poverty significantly increases ABC preferences through dual mechanisms: amplified convenience orientation while attenuated risk perception. Study 1 established the causal effect of experimentally induced time poverty on ABC preference. Study 2 demonstrated that both mediators independently explain this relationship. Studies 3a and 3b provided convergent causal evidence: experimentally enhancing each mediator significantly attenuated the time-poverty effect on ABC preference while controlling for financial scarcity, general sense of scarcity, and construal level. Together, these dual pathways - heightened convenience-seeking coupled with diminished risk sensitivity - indicate that time-poor consumers may systematically trade risk evaluation for efficiency in ABC decisions. These findings illuminate the psychological forces driving major shifts in contemporary consumption practice and carry implications for consumer welfare and public policy in increasingly time-constrained societies.
Globally, the management of adolescents and young people living with HIV has predominantly emphasized clinical outcomes, neglecting their overall well-being and sexual and reproductive health (SRH), making it essential to address these gaps for effective targeted interventions. Existing literature elucidating the SRH experiences of adolescents and young adults (people) living with perinatally acquired HIV (AYA-PHIV) across various countries was synthesized by this scoping review. We conducted a systematic search utilizing electronic database. Fifteen peer-reviewed articles met the inclusion criteria. The review identified 5 key themes in SRH research for AYA-PHIV. These include sexuality and social norms, HIV status disclosure, HIV-related stigma and social isolation, gaps in knowledge and access to SRH education, as well as barriers to healthcare access. To improve the SRH and wellbeing of AYA-PHIV, it is essential to implement targeted interventions including promoting SRH discussions, peer support, and adolescent-friendly facilities. The dynamics of HIV and sexual and reproductive health for children and young adults born with HIVPlain Language SummaryAround the world, providing care to adolescents and young people living with HIV has predominantly emphasized the traditional HIV treatment response, with limited attention to their general well-being, particularly the sexual and reproductive health (SRH). Addressing these gaps is essential for developing targeted interventions and effectively designing adolescent programs that meet the comprehensive SRH requirements of this population. This scoping review examined and analyzed the research findings of the studies conducted on SRH needs of adolescents and young adults born with HIV. We conducted a systematic search of research studies, utilizing electronic databases such as PubMed, Scopus, Web of Science, and Google Scholar. The search was done between February and July 2025 by a group of researchers. After an extensive search, deduplication, and shortlisting, 14 peer-reviewed articles met the inclusion criteria. To streamline the search and identify original research, the team of researchers decided to exclude Review papers, unpublished work and that did not focus exclusively on adolescents and young adults born with HIV. The review identified 5 emergent and repeated themes that characterize the research on SRH for adolescent and young adults born with HIV. These themes include sexuality and social norms, HIV status disclosure, HIV-related stigma and isolation, gaps in knowledge and access to SRH education, as well as barriers to healthcare access. Shared challenges faced by adolescents and young adults born with HIV were identified, including HIV stigma, family dynamics, healthcare access, peer pressure, and educational challenges. The researchers, based on these findings, concluded that targeted interventions are essential to enhance SRH for this group.
Guidelines recommend cognitive screening post-stroke, but there is no consensus on approach. Given the dynamic nature of cognition following stroke, acute screening should both detect prevalent issues (diagnosis) and predict persisting problems (prognosis). We describe the diagnostic and prognostic utility of brief cognitive screening tools. Patients were screened on admission with stroke using 12 modified screening tests: 10 and 4 question Abbreviated Mental Test, Cog-4, Clock Drawing test (CDT), Cognitive Impairment Test, informal bedside assessment, General Practitioner Assessment of Cognition, Minicog, Short Form Montreal Cognitive Assessment, Six-Item Screener (SIS), Harmonised Vascular Cognitive Impairment battery and 4-A's Test. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value were calculated against a Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition adjudicated reference standard of neurocognitive disorders. Test accuracy was compared using area under the receiver operator characteristic curves. Of 335 patients, 54 (16.1%) had pre-stroke neurocognitive disorder, 79 (23.6%) had 18-month neurocognitive disorder. Ten of 12 screening tests were more specific than sensitive. Informal bedside assessment had highest specificity (96%), but low sensitivity (9%); CDT had highest sensitivity (80%) but low specificity (33%). Negative predictive value ranged from 77% to 87%, PPV ranged from 27% to 54%. Area under the receiver operator characteristic curve ranged 0.53 (informal bedside assessment) to 0.69 (SIS). In the acute setting, where the intention of screening is often to triage those who need further assessment, the pattern of high specificity at the expense of sensitivity is the opposite of what is desired. Brief cognitive screening tools, used in isolation, may not be suitable for assessment in acute stroke settings.