搜索结果：International journal of behavioral development

In early 2025, the report by the World Health Organization indicates that caesarean section use continues to rise accounting for more than 21% of all world childbirths and predicts that C-sections will be used in nearly 30% of all births globally by 2030, this being well above intended rate of roughly 10%-15% The rate of caesarean section in Brazil is over 50%, and in China, it is already as high as 41%, of which 31.2% are undertaken without clinical indication. Labor analgesia can reduce the rate of caesarean section by influencing women's willingness to give birth vaginally. Yet, many pregnant women are not aware of the painless delivery alternatives. The objective of this article is to generate evidence on painless delivery intentions among pregnant women and identify influencing factors. A total of 404 pregnant women were surveyed using the general information questionnaire and the self-rating scale of painless intention to deliver based on the theory of planned behavior. STROBE protocol guidelines were followed. Pearson correlation analysis was performed based on the scores of basic knowledge, behavioral attitude, subjective norm, and perceptual behavior control of the self-rating scale of painless delivery intention in the planned behavior theory. The results suggest a positive correlation between basic knowledge, behavioral attitude, subjective norm, and perceptual behavior control, with correlation coefficients. Rural versus urban backgrounds and monthly household income were the two main influencing factors for the choice of painless delivery. Further correlation analysis revealed that perceived behavioral control exhibited the strongest correlation with behavioral intention in the linear regression model for total intention score, which was the largest in magnitude among all predictors, indicating it is the strongest predictor of behavioral intention toward painless childbirth. The results of this study suggest that there are a number of health management challenges for healthcare professionals, in general and nursing professionals, in particular. A key challenge is the ongoing need to generate international evidence on the current status of painless delivery intentions among pregnant women and identify influencing factors. This type of evidence will allow a diverse set of comparative international options for intervention based on the different influencing factors identified in this study.

Cognitive-communication disorders are pervasive following traumatic brain injury (TBI), disrupting communication at the level of discourse and social interaction. Discourse impairments impact functioning across major life domains, such as work and social relationships, and overall quality of life. Problems with discourse affect all severity levels of TBI and persist over time. Veterans may experience even greater functional decline due to comorbid health conditions (eg, posttraumatic stress disorder, pain). The functional impact and chronicity of discourse impairments following TBI underscore the importance of treating these impairments. This study aims to (1) develop, refine, and manualize a treatment protocol targeting narrative discourse-Talking About Life Experiences (TALE)-in people with TBI and (2) evaluate the feasibility of the TALE discourse treatment in a pilot randomized controlled trial (RCT). This is a stage 1a (phase 1) and stage 1b (phase 2) treatment development study aligned with the Stage Model of Behavioral Therapies Research. All participants will be individuals with TBI and communication difficulties. In the treatment development phase (phase 1), 5-10 participants will be recruited to obtain key stakeholder feedback for treatment refinement. In the feasibility pilot phase (phase 2), 40 participants with TBI and communication difficulty will be randomized to receive the TALE intervention or treatment as usual. We will obtain information on the tolerability, acceptability, and feasibility of recruitment for the TALE intervention, as well as preliminary data on treatment delivery, assessment methods, and treatment effects. Assessments will be conducted at baseline, posttreatment, and at 1-month follow-up and will include measures of discourse ability, cognition, mental health, pain, functional communication, and daily functioning. Feedback regarding assessment and treatment will also be collected via surveys and exit interviews. This study was funded in October 2021. Recruitment for phase 1 began on September 26, 2022. Seven participants were enrolled. Phase 1 concluded on November 17, 2023. Recruitment for phase 2 began on November 27, 2023. Thirty-four participants were enrolled. Data collection was completed on November 3, 2025. Data analysis has been conducted concurrently with data collection and is expected to continue until early-mid 2026. Results are expected to be published in peer-reviewed journals in late 2026 and early 2027. Stakeholder feedback from the phase 1 treatment development trial will facilitate refinement of the TALE protocol in preparation for the phase 2 feasibility pilot RCT. Results from phase 2 will be used to determine the tolerability, acceptability, and feasibility of methods. Findings from this study will inform the development and implementation of a future fully powered RCT evaluating treatment efficacy. ClinicalTrials.gov NCT05008419; https://clinicaltrials.gov/ct2/show/NCT05008419. DERR1-10.2196/86329.

The 2023 iteration of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) estimated prevalence, incidence, and health burden for 375 diseases and injuries, including 12 mental disorders. We assess past, current, and emerging trends in the prevalence and burden of mental disorders across sexes and age groups, for 21 regions, 204 countries and territories, and by Socio-demographic Index (SDI) quintile, from 1990 to 2023. Mental disorders included in GBD 2023 were anxiety disorders, major depressive disorder, dysthymia, bipolar disorder, schizophrenia, autism spectrum disorders, conduct disorder, attention-deficit hyperactivity disorder, anorexia nervosa, bulimia nervosa, idiopathic developmental intellectual disability, and a residual category of other mental disorders. A literature review identified epidemiological data for each disorder. These were analysed via a Bayesian meta-regression to estimate prevalence by disorder, sex, age, location, and year. Disorder-specific prevalence was multiplied by disability weights representing the severity of health loss associated with each disorder to estimate years lived with disability (YLDs). Deaths due to anorexia nervosa were assessed with a Cause of Death Ensemble modelling strategy to estimate deaths by sex, age, location, and year, and then multiplied by the standard life expectancy at age of death to estimate years of life lost (YLLs). YLDs equalled disability-adjusted life-years (DALYs) for all mental disorders except anorexia nervosa (the only mental disorder considered as an underlying cause of death in GBD), for which DALYs represented the sum of YLDs and YLLs. We presented prevalence, deaths, YLDs, YLLs, and DALYs as counts, age-specific rates per 100 000 population, and age-standardised rates per 100 000 population. We estimated 1·17 billion (95% uncertainty interval 1·06-1·31) prevalent cases of mental disorders globally in 2023, equivalent to an age-standardised prevalence rate of 14 210·7 cases (12 849·5-15 940·1) per 100 000 population. These estimates represented a 95·5% (75·0-121·2) increase in prevalent cases and 24·2% (11·4-41·4) increase in age-standardised prevalence rate between 1990 and 2023. All mental disorders showed increases in prevalent cases between 1990 and 2023, while notable increases were seen in age-standardised prevalence rates for anxiety disorders, major depressive disorder, dysthymia, anorexia nervosa, bulimia nervosa, schizophrenia, and conduct disorder. There were an estimated 171 million (127-228) DALYs due to mental disorders globally across sex and age in 2023, equivalent to an age-standardised DALY rate of 2070·5 DALYs (1519·1-2750·5) per 100 000 population. Mental disorders contributed to 6·1% (4·8-7·6) of all-cause DALYs in 2023, making them the fifth leading cause of global DALYs (up from 12th in 1990). DALYs were almost entirely composed of YLDs. Mental disorders were the leading cause of YLDs in 2023 (up from second in 1990), explaining 17·3% (14·8-20·6) of all-cause global YLDs. Leading causes of mental disorder DALYs were anxiety disorders (ranked 11th among the 304 diseases and injuries at Level 4 of the GBD cause hierarchy), major depressive disorder (15th), and schizophrenia (41st). Globally in 2023, mental disorder age-standardised DALY rates were higher among females (2239·6 [1643·7-3014·1] per 100 000) than among males (1900·2 [1399·8-2510·8] per 100 000), and peaked in the 15-19 years age group (2617·3 [1850·6-3696·8] per 100 000). All locations showed increased mental disorder DALY rates in 2023 compared with 1990, ranging across countries and territories from 1302·4 (952·7-1683·7) per 100 000 in Viet Nam to 3555·8 (2661·9-4715·0) per 100 000 in the Netherlands. Across SDI quintiles, DALY rates ranged from 1853·0 (1352·1-2469·3) per 100 000 for middle SDI to 2184·1 (1606·1-2890·3) per 100 000 for high SDI. A significant health burden was imposed by mental disorders in all countries and territories in 2023, irrespective of the health resources available. In some instances, this burden has increased over time and is unevenly distributed across populations. Stronger surveillance systems, particularly in low-income and middle-income countries, are required. Additionally, we need more coordinated and inclusive policies to reduce the burden through early treatment and prevention, tailored to sex and age differences across locations. Responding to the mental health needs of our global population, especially those most vulnerable, is an obligation, not a choice. Gates Foundation, Queensland Health, and University of Queensland.

Millions of children worldwide are experiencing prolonged symptoms after SARS-CoV-2 infection, yet social risk factors for developing long COVID are largely unknown. As child health is influenced by the environment in which they live and interact, adverse social determinants of health (SDOH) may contribute to the development of pediatric long COVID. To identify whether adverse SDOH are associated with increased odds of long COVID in school-aged children and adolescents in the US. This cross-sectional analysis of a multicenter, longitudinal, meta-cohort study encompassed 52 sites (health care and community settings) across the US. School-aged children (6-11 years; n = 903) and adolescents (12-17 years; n = 3681) with SARS-CoV-2 infection history were included. Those with an unknown date of first infection, history of multisystem inflammatory syndrome in children, or symptom surveys with less than 50% of questions completed were excluded. Participants were recruited via health care systems, long COVID clinics, fliers, websites, social media campaigns, radio, health fairs, community-based organizations, community health workers, and existing research cohorts from March 2022 to August 2024, and surveys were completed by caregivers between March 2022 and August 2024. Twenty-four individual social determinant of health factors were grouped into 5 Healthy People 2030 domains: economic stability, social and community context, caregiver education access and quality, neighborhood and built environment, and health care access and quality. Latent classes were created within each domain and used in regression models. Presence of long COVID using caregiver-reported, symptom-based, age-specific research indices. The mean (SD) age among 4584 individuals included in this study was 14 (3) years, and 2330 (51%) of participants were male. The number of latent classes varied by domain; the reference group was the class with the least adversity. In unadjusted analyses, most classes in each domain were associated with higher odds of long COVID. After adjusting for many factors, including age group, sex, timing of infection, referral source, and other social determinant of health domains, economic instability characterized by difficulty covering expenses, poverty, receipt of government assistance, and food insecurity were associated with an increased risk of having long COVID (class 2 adjusted odds ratio [aOR], 1.57; 95% CI, 1.18-2.09; class 4 aOR, 2.39; 95% CI, 1.73-3.30); economic instability without food insecurity (class 3) was not (aOR, 0.93; 95% CI, 0.70-1.23). Poorer social and community context (eg, high levels of discrimination and low social support) was also associated with long COVID (aOR, 2.17; 95% CI, 1.77-2.66). Sensitivity analyses stratified by age group and adjusted for race and ethnicity did not alter or attenuate these results. In this study, economic instability that included food insecurity and poor social and community context were associated with greater odds of pediatric long COVID. Those with food security, despite experiencing other economic challenges, did not have greater odds of long COVID. Further study is needed to determine if addressing SDOH factors can decrease the rate of pediatric long COVID.

Early breast cancer (BC) detection enhances survival, with treatment options influenced by cancer stage, pathological characteristics and patient preferences. Patient decision aids (PDAs) promote shared decision-making (SDM), enhancing patients' engagement, adherence to treatment and satisfaction. However, few PDAs for early-stage BC patients exist in the Italian context. A first developmental phase will include a systematic review on current PDAs and semistructured interviews with patients and healthcare professionals. Outcomes will be used to develop a first draft of PDA. Following international guidelines, the PDA will be sent to patients to gather first qualitative feedback and subsequently quantitative feedback regarding the attractiveness, usability and comprehensibility of the tool and patients' health literacy. Once having reached a final version of PDA, a pilot randomised controlled trial study will be implemented: a control group will receive standard care (n=75) and an experimental group (n=75) will receive standard care and the PDA. Depression, anxiety, SDM, quality of life (QoL) and distress levels will be assessed through validated questionnaires in both groups at three different time points. Measures will include attractiveness, usability and comprehensibility of the PDA as well as efficacy measures assessed through evaluation of patients' levels of anxiety, depression, distress and QoL. This protocol was approved by the ethical committee Comitato Etico Territoriale Lombardia 2 of the Istituto di Ricovero e Cura a Carattere Scientifico European Institute of Oncology (L2-253; approved in November 2024). All participants will be given written and verbal information, and informed consent will be obtained from all participants across all phases of our project. Participation in the study will be fully voluntary. All the methodologies mentioned in this protocol will be carried out according to both national and international declarations, guidelines and regulations compliant with proper ethical research involving human subjects. Results will be published in peer-reviewed journals, through traditional academic pathways. This protocol study has been registered on clinicaltrials.gov in January 2025 (Identifier: NCT06762496). NCT06762496.

Chronological age is a poor indicator of interindividual differences in biological aging. DNA methylation-based epigenetic clocks provide a reliable measure of biological age and epigenetic age acceleration (EAA). Although modifiable behavioral, environmental, and social factors appear to influence EAA, the magnitude, consistency, and potential preventability of these associations have never been systematically quantified. We conducted a systematic review and meta-analysis following PRISMA 2020 guidelines. PubMed/MEDLINE and Scopus were searched from inception to 7 April 2026 for English-language observational and interventional studies reporting quantitative associations between modifiable determinants and EAA measured using validated clocks (Horvath, PhenoAge, GrimAge, DunedinPACE). Effect sizes were harmonized into four analytical pools. Random-effects meta-analyses were performed using the DerSimonian-Laird estimator, with pre-specified subgroup analyses by exposure category. Heterogeneity, publication bias, and robustness were thoroughly assessed. A novel Modifiable Epigenetic Aging Burden Index (MEAB-Index) was developed to quantify the cumulative preventable burden. Only studies conducted in adult populations (≥18 years) were eligible. Eighty-three studies providing 118 distinct exposure-clock associations were included. In the primary analysis (Pool A, n = 60), adverse modifiable exposures were associated with accelerated EAA (pooled β = +0.310 years per unit exposure, 95% CI 0.255-0.366). The strongest associations were observed for metabolic and inflammatory markers (β = +0.913) and environmental exposures (β = +0.466). The MEAB-Index yielded a Cumulative Preventable Burden of +1.566 years (bootstrap 95% CI 1.011-2.123). Findings were robust across sensitivity analyses and remained directionally consistent in secondary pools (B-D). This study provides the most comprehensive quantitative synthesis to date on the modifiability of epigenetic aging. Our findings demonstrate that EAA is meaningfully shaped by behavioral, environmental, and social determinants. The MEAB-Index introduces a novel framework for estimating the preventable burden of biological aging and for prioritizing interventions. Reducing key modifiable risk factors, particularly metabolic/inflammatory and environmental exposures, could substantially slow biological aging at the population level and support the transition toward ageing-centered preventive strategies.

Postprostatectomy incontinence (PPI) is a common complication after robot-assisted radical prostatectomy and significantly impairs patients' quality of life. Although behavioral interventions such as pelvic floor muscle training and bladder diaries are evidence-based, their effectiveness is often limited by poor adherence and lack of personalization. This study aimed to develop and evaluate a reinforcement learning (RL)-driven clinical behavioral intervention-supporting system (CBISs) for adaptive, personalized rehabilitation in patients with PPI. The study comprised 2 sequential stages. First, the CBISs was developed through (1) construction of a medical record database from a prospective cohort of PPI patients using standardized 3-day bladder diaries, (2) design of functional modules and user interfaces based on clinical rehabilitation needs, and (3) development of an RL model using XGBoost (extreme gradient boosting) and Bayesian optimization to generate individualized training plans. Second, a separate cohort of 16 patients participated in a single-arm, pre-post pilot study to evaluate feasibility and preliminary outcome trends over a 3-month intervention period, with assessments based on bladder diary parameters and system usage metrics. The CBISs successfully implemented an adaptive, closed-loop behavioral rehabilitation framework that dynamically tailored training recommendations according to individual voiding patterns, fluid intake behaviors, and adherence signals. Feasibility outcomes were favorable, with high system engagement observed throughout the intervention (mean usage frequency 5.2, SD 1.1 times per day). In exploratory pre-post analyses (n=16), consistent directional improvements were observed across multiple outcomes. Mean daytime urinary frequency decreased from 5.74 (SD 1.21) episodes per day to 4.69 (SD 1.08) episodes per day, while median nighttime urinary frequency declined from 1.8 (IQR 1.6-2.2) episodes per night to 1.0 (IQR 1.0-1.6) episodes per night. Median incontinence episodes were reduced from 7.0 (IQR 6.0-11.0) episodes per day to 4.0 (IQR 2.0-6.0) episodes per day. Objective urine leakage measured by the 1-hour pad test decreased from a median of 8.5 (IQR 4.0-19.0) g to 3.5 (IQR 2.0-9.0) g. Patient-reported symptom burden, assessed using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-UI SF), showed a median reduction from 14.0 (IQR 12.0-20.0) points to 9.0 (IQR 6.0-16.0) points. Although several within-participant changes were statistically detectable, effect magnitudes varied across individuals. Given the single-arm design, small sample size, and lack of a control group, findings are presented as exploratory and hypothesis-generating rather than confirmatory of clinical efficacy. The CBISs represents the first RL-powered digital therapeutic system for PPI, enabling adaptive, evidence-based behavioral optimization. By addressing limitations of static rehabilitation protocols and declining adherence, it offers a scalable approach for personalized PPI management. Future multicenter trials are needed to confirm its clinical effectiveness.

Bodily Distress Disorder (BDD) is a newly introduced diagnosis in the International Classification of Diseases, 11th Revision (ICD-11) that aims to capture the interplay between somatic symptoms and psychological distress. Existing diagnostic tools based on the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the ICD-10 do not fully encompass BDD as defined in ICD-11, highlighting the need for a psychometrically robust assessment tool. To address this issue, the present study examines the psychometric properties of the newly constructed Bodily Distress Disorder Scale (BoDI) in continuously trauma exposed individuals. Data were collected from 3000 Israeli general population participants under conditions of collective trauma. The validation of the 10-item BoDI included factor analysis to test the BoDI's factor structure. In addition, tests of internal consistency, convergent, and discriminant validity were conducted to assess the psychometric properties of the scale. A two-factor structure was identified and showed excellent fit. The two factors - Persistent Preoccupation (cognitive-affective component) and Medical Reassurance-Seeking (behavioral component) showed adequate internal consistency. The BoDI exhibited high convergent validity with established measures of somatic symptoms and good discriminant validity, showing moderate correlations with measures of depression, anxiety, and adjustment disorder, and weaker associations with post-traumatic stress disorder (PTSD) and Complex PTSD. These findings provide initial support for the BoDI as a psychometric tool for assessing BDD. While the findings highlight the potential of the BoDI in trauma-exposed general populations, its practical application in general populations with no collective trauma in the background remains to be explored. The present results provide a valuable foundation for future studies to evaluate its real-world utility in guiding assessment and intervention.

Kazakhstan has lacked validated tools to comprehensively assess physicians' perceptions, usability, and perceived effectiveness of telemedicine services. International frameworks such as the Telehealth Usability Questionnaire (TUQ) and the Model for Assessment of Telemedicine (MAST) have not previously been adapted to the national clinical and organizational context. This study aims to develop and validate TUQ-MAST-KZ, a Kazakhstan-adapted questionnaire integrating components of the TUQ and MAST models to assess physicians' perceptions, usability, and effectiveness of telemedicine services. A multiphase study was conducted, including literature review, questionnaire development, linguistic and cultural adaptation, expert content validity assessment, and pilot testing. An online survey (Google Forms) was administered to 156 physicians representing different regions and levels of health care delivery in Kazakhstan. Internal consistency (Cronbach α) and content validity indices were calculated. Additional evaluations covered clarity, structure, and practical applicability. The final TUQ-MAST-KZ instrument contains 27 items capturing technological, clinical, organizational, and behavioral dimensions of telemedicine use. The scale demonstrated high content validity (scale-level content validity index=0.94). Internal consistency was excellent, with an overall Cronbach α of 0.924. Respondents reported that the questionnaire was clearly structured, easy to complete, and relevant to clinical practice. Organizational items identified key barriers to telemedicine adoption, including limited infrastructure, insufficient managerial support, and the need for additional training. TUQ-MAST-KZ is a valid, reliable, and practice-oriented instrument for assessing physicians' perceptions of telemedicine services in Kazakhstan. It can support digital health monitoring, implementation analysis, educational planning, and policy development. Future studies should evaluate its applicability across broader samples and diverse clinical specialties.

Breast cancer is a leading cause of mortality and morbidity among females worldwide. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023, we provided an updated comprehensive assessment of the epidemiological trends, disease burden, and risk factors associated with breast cancer globally, regionally, and nationally from 1990 to 2023. Breast cancer incidence, mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) were estimated by age and sex for 204 countries and territories from 1990 to 2023. Mortality estimates were generated using GBD Cause of Death Ensemble models, leveraging data from population-based cancer registration systems, vital registration systems, and verbal autopsies. Mortality-to-incidence ratios were calculated to derive both mortality and incidence estimates. Prevalence was calculated by combining incidence and modelled survival estimates. YLLs were established by multiplying age-specific deaths with the GBD standard life expectancy at the age of death. YLDs were estimated by applying disability weights to prevalence estimates. The sum of YLLs and YLDs equalled the number of DALYs. Breast cancer burden attributable to seven risk factors was examined through the comparative risk assessment framework. The GBD forecasting framework was used to forecast breast cancer incidence and mortality from 2024 to 2050. Age-standardised rates were calculated for each metric using the GBD 2023 world standard population. In 2023, there were an estimated 2·30 million (95% uncertainty interval [UI] 2·01 to 2·61) breast cancer incident cases, 764 000 deaths (672 000 to 854 000), and 24·1 million (21·3 to 27·5) DALYs among females globally. In the World Bank low-income group, where a low age-standardised incidence rate (ASIR) was estimated (44·2 per 100 000 person-years [31·2 to 58·4]), the age-standardised mortality rate (ASMR) was the highest (24·1 per 100 000 [16·8 to 31·9]). The highest ASIR was in the high-income group (75·7 per 100 000 [67·1 to 84·0]), and the lowest ASMR was in the upper-middle-income group (11·2 per 100 000 [10·2 to 12·3]). Between 1990 and 2023, the ASIR in the low-income group increased by 147·2% (38·1 to 271·7), compared with a 1·2% (-11·5 to 17·2) change in the high-income group. The ASMR decreased in the high-income group, changing by -29·9% (-33·6 to -25·9), but increased by 99·3% (12·5 to 202·9) in the low-income group. The increase in age-standardised DALY rates followed that of ASMRs. Risk factors such as dietary risks, tobacco use, and high fasting plasma glucose contributed to 28·3% (16·6 to 38·9) of breast cancer DALYs in 2023. The risk factors with a decrease in attributable DALYs between 1990 and 2023 were high alcohol use and tobacco. By 2050, the global incident cases of breast cancer among females were forecast to reach 3·56 million (2·29 to 4·83), with 1·37 million (0·841 to 2·02) deaths. The stable incidence and declining mortality rates of female breast cancer in high-income nations reflect success in screening, diagnosis, and treatment. In contrast, the concurrent rise in incidence and mortality in other regions signals health system deficits. Without effective interventions, many countries will fall short of the WHO Global Breast Cancer Initiative's ambitious target of achieving an annual reduction of 2·5% in age-standardised mortality rates by 2040. The mounting breast cancer burden, disproportionately affecting some of the world's most vulnerable populations, will further exacerbate health inequalities across the globe without decisive immediate action. Gates Foundation, St Jude Children's Research Hospital.

This critical discussion paper examines how the International Council of Nurses' (ICN) 2025 definition of "nurse" may shape nursing work by functioning as a discursive artifact and proposes the mid-range concept of discursive burdening to help explain the potential downstream effects on nurses' labor. Grounded in Fairclough's critical discourse analysis (CDA) and the social ecology of nursing, this study analyzes the ICN definition alongside its explanatory report and selectively mapped it to scholarly, policy, and gray sources to illustrate how professional definitions can travel into practice. Using CDA tools, linguistic features of the text were linked to discourse and wider social practices. From the CDA of the ICN definition, the concept of discursive burdening emerges with three interrelated dimensions: (1) deontological dumping, (2) amorphous scope expansion, and (3) intensifying emancipatory labor. Mapped onto nursing's social ecology, these dynamics plausibly cascade through overlapping regulatory, bureaucratic, occupational, gender, and multi-professional systems. The ICN report also names buffers that can diffuse these effects when made co-present with the public definition, which includes legal conditionality, regulator mediation, contextualization, resource support, clarifying and sharing roles, and education/leadership investment.

Perceptions of the legitimacy of parental authority (LoPA) reflect the degree to which parents and adolescents believe parental control over an adolescent's behavior is appropriate. LoPA may impact the level of autonomy granted to adolescents and adolescents' compliance with parental demands and rules. Although low perceived LoPA has consistently been linked to increased externalizing symptoms, the association with internalizing symptoms is less clear. Furthermore, few studies have considered whether and how age-related changes in LoPA are related to adjustment, and implications of LoPA trajectories for mental health symptoms. In a community sample of early adolescents (n = 387; 55% female; 83.1% non-Hispanic White; mean age at T1 = 11.61, SD = 0.55) and parents, latent growth curve modeling was utilized to characterize trajectories of LoPA perceptions and test associations with externalizing, anxious, and depressive symptoms. Parent and adolescent perceptions of LoPA generally declined with age although there were differences across domains. Adolescent perceptions of LoPA were prospectively linked to externalizing, anxious, and depressive symptoms and rate of change was associated with externalizing and depressive symptoms such that lower initial levels and steeper declines were associated with poorer adjustment, while parent perceptions of LoPA were not associated with adjustment outcomes.

Predicting the occurrence of late seizures after intracerebral haemorrhage may help in making clinical decisions about treatment. Currently, the CAVE score is the best performing risk score. We aimed to design a different, pragmatic risk prediction score and compared it to the CAVE score. The South Limburg (Netherlands) intracerebral haemorrhage registry, consisting of patients with a primary intracerebral haemorrhage in 2004-2009, was used for the derivation cohort. We made a prediction model using Cox proportional hazard analyses; comparisons between models were made with the c-statistic. We validated our model externally in three independent cohorts. Our derivation cohort consisted of 781 patients, of whom 78 (10%) developed late seizures. We found the following independent predictors for late seizures: any neurosurgical procedure, age&#x2009;<&#x2009;65&#x2009;years, lobar haemorrhage, and early seizures (occurring within the first week). These formed our new prediction score (LEAN score), which had an optimism-corrected c-statistic of 0.80 (95%-confidence interval 0.78-0.86). The LEAN score predicts late seizure risk as 0.7%, 1.6%, 8.8%, 22.0%, 29.8%, 43.5%, 100% for the increasing score groups respectively. External validation showed comparable optimism-corrected c-statistics for both the LEAN score and the CAVE score. The newly developed LEAN score consists of easily available clinical variables and performs equally to the CAVE score. Additionally, the high risk of late seizures in patients with the maximum LEAN score might make a diagnosis of epilepsy possible according to international guidelines despite these patients only had early seizures.

Climate change is a defining challenge of our time, and it disproportionally impacts young people. This poses a call to action for developmental science. How does climate change shape youth's psychological development and well-being? Can we use our expertise to empower youth to cope with and help mitigate climate change? The emerging field of research on climate change and youth development addresses these timely questions. Here I provide a concise perspective on the field, highlighting lines of research and ideas, including our own, that have begun to develop in recent years. Climate change threatens our global society, which means that our research should be global as well. I call for coordinated, international, and cross-cultural investigation to address the big questions ahead of us and empower young people from across the globe to respond to the challenges of a warming world.

The phenomenon of global population ageing is driving a marked increase in the prevalence of diabetes mellitus among the older population, who face multiple health burdens requiring comprehensive management. Current models are limited by an inadequate focus on cultivating patients' self-management capacities. Therefore, the establishment of a scientifically rigorous, holistic, proactive health management system covering the full disease cycle that encompasses the entire range of care for the designated population is essential. This study employs a scoping review methodology in order to systematically map and synthesize domestic and international evidence on proactive health interventions for older patients suffering from diabetes. The objective of this study is to elucidate the various intervention types, the core outcome measures, and the overall effect trends. The objective of this study is to comprehensively map the extant evidence and identify pivotal components, with the aim of informing the future development and implementation of proactive health management models for this group. This study adheres to the Arksey and O'Malley framework for scoping reviews. Systematic searches were conducted across both Chinese and English databases, including CNKI, WanFang, CQVIP, CBM, PubMed, the Cochrane Library, and Web of Science. The search covered publications from January 2015 to October 2025. Two independent researchers screened and extracted the data. The search yielded 813 publications, of which 24 studies were included in the final analysis: 10 in English and 14 in Chinese. The included studies consisted primarily of 15 randomized controlled trials, 2 qualitative studies, 4 quasi-experimental studies, along with 2 cohort studies and 1 pilot study. Proactive health interventions are now analyzed through a dual framework of core components: educational empowerment, and behavioral support. The core outcome measures focused on physiological indicators, such as glycated hemoglobin and fasting blood glucose; patient-reported outcomes, such as quality of life and self-management capacity; and other health-related indicators, such as nutritional status and oral health. The literature includes research findings that indicate a positive trend across all measurement domains. To optimize care for older adults with diabetes, implementation of adaptable proactive health management strategies is crucial. Evidence indicates that patient-centered models emphasizing active participation improve key outcomes like glycemic control, quality of life, and self-management. Their success depends on adaptability to resource levels and individual characteristics, supported by multidisciplinary teams delivering personalized, evidence-based plans. Further clinical translation requires expanded evidence from large-scale randomized controlled trials assessing long-term efficacy and applicability to older subgroups with comorbidities, alongside standardization of core elements under national or professional guidance to enhance system efficiency and patient outcomes.

Human-wildlife coexistence is threatened by perceived conflicting interests between humans and wildlife, as well as among humans themselves. Wildlife management authorities are placed in difficult positions when the species involved is a large, vulnerable carnivore such as the Asiatic black bear (bear; Ursus thibetanus). Reports of negative human-bear encounters underscore the fragility of their coexistence. Persistent impacts range in intensity from damage to human livelihoods to lethal outcomes for bears and people. Despite this, there is a limited understanding of the immediate and long-term consequences of such interactions for the future of human-bear coexistence. This study aimed to investigate the cascade of emotional and behavioral responses triggered by these interactions. We focused on foundational aspects of human cognition-specifically, emotions-and examined the resulting behavioral outcomes among smallholder farmers in the mid-hills of the Eastern Himalayas in India. Using interdisciplinary methods-sentiment analysis, a modern computational technique, and thematic analysis, a more traditional qualitative approach-we analyzed 43 interviews conducted with individuals living in these bear-inhabited landscapes. Participants commonly reported experiencing emotions such as anger, fear, sadness, and disgust (descending order) in response to bear behaviors, particularly crop raiding and livestock predation. A newly emerging behavior-predation on domestic pigs (Sus scrofa domesticus)-appears to have intensified adverse emotional reactions and frustration among respondents. Despite these challenges, participants acknowledge the historical presence of bears in the landscape and do not support lethal control or eradication. This underlying acceptance represents a critical foundation for promoting coexistence. To sustain and strengthen this attitude, it is essential to recognize and support local tolerance through compensation schemes, insurance programs, and the development of alternative livelihood options. Sentiment analysis serves as an effective instrument for assessing human emotions pertaining to wildlife. The implementation of this tool facilitates regular monitoring of the dynamics of human-wildlife interactions (HWI) and aids in tracking the degradation of coexistence scenarios. However, to comprehend the context of the emotions reported, it is imperative to conduct a thorough investigation concurrently, such as by employing thematic analysis.

BackgroundAgitation is a common behavioral and psychological symptom of dementia that places significant burden on caregivers. While its impact on family caregivers is well-documented, its effect on professional caregivers remains underexplored. Additionally, it is unclear whether existing caregiver burden scales adequately capture the International Psychogeriatric Association's (IPA) definition of agitation. Since agitation requires different treatment approaches than cognitive impairment, its distinct burden warrants further investigation.ObjectiveThis systematic review examined scales used to assess professional caregiver burden related to agitation in dementia.MethodsFollowing PRISMA guidelines, we searched MEDLINE, Embase, and ICHUSHI for English and Japanese articles published during January 1980-August 2024. Studies included professional caregivers, either exclusively or alongside informal caregivers. Key outcomes were the number and frequency of scales, target population, and agitation coverage within the scales.ResultsWe identified 52 articles: 22 focused exclusively on professional caregivers, and 30 included both types. Publications involving both caregiver types increased notably in the last decade. Across studies, 39 scales were used. The Zarit Burden Interview (n&#x2009;=&#x2009;21) and Neuropsychiatric Inventory (n&#x2009;=&#x2009;15) were most frequent. Sixteen scales targeted the general population; 11 each were designed for professional and informal caregivers, and one for both. Most scales did not fully reflect the IPA's definition of agitation. Scales for professional caregivers also included work-related factors like coworker conflicts and administrative workload.ConclusionsThere is a critical gap in validated scales to measure agitation-related burden in professional dementia caregivers. Specialized tools are urgently needed to assess this burden and guide support strategies.

Norwegian Child and Adolescent Mental Health Services (CAMHS) use the World Health Organization's (WHO) multiaxial diagnostic system based on the International Classification of Diseases, Tenth Revision (ICD-10); however, analysis of prescribing patterns among axes I-III is underexplored in electronic health records (EHRs) with intertwined patient, episode of care, and contact information. This study aimed to develop and demonstrate an analytic pipeline for mining and mapping information from EHRs to facilitate understanding of clinical processes and support informed decision-making. This study used the Norwegian CAMHS EHR data to identify common diagnoses, comorbidities, and medication use across axes I-III per individual contact. We extracted records of patients &#x2264;19 years old with a primary mental health diagnosis on axes I-III and one or more medications per individual contact. Diagnoses were categorized according to ICD-10 and medications according to the Anatomical Therapeutic Chemical (ATC) classification system. Descriptive analyses quantified contact counts, diagnosis frequency, comorbidity rates, and medication frequency within each diagnostic category. Next, we mapped the medications used across all the contacts and noncomorbid contacts separately along each axis. Of 7214 prescribing contacts (axis I: n=7179, 99.51%; axis II: n=821, 11.38%; axis III: n=65, 0.90%), comorbidity was present in 12.06% (n=866) contacts in axis I, 96.10% (n=789) contacts in axis II, and 96.92% (n=63) contacts in axis III. Leading diagnoses were behavioral-emotional disorders (ICD-10 codes F90-F98) in axis I, school skills and learning difficulties (ICD-10 code F81) in axis II, and mild mental retardation (ICD-10 code F70) in axis III. Most observed comorbidities were F90-F98 with speech and language development disorder (ICD-10 code F80), ICD-10 code F81, and mixed specific skills development disorder (ICD-10 code F83). Psychostimulants predominated across all diagnosis axes, with methylphenidate being the most common. For other ATC categories, the most commonly prescribed medications were antidepressants (sertraline and fluoxetine), antipsychotics (risperidone and aripiprazole), hypnotics and sedatives (melatonin), antiepileptics (lamotrigine), anxiolytics (diazepam), and nonpsychotropics (laxatives, vitamins, and supplements). Medication profiles varied minimally by axis or comorbidity status. We demonstrated a mining and mapping analytic pipeline for EHRs to analyze diagnoses, comorbidities, and prescribing practices at the individual contact level. In the Norwegian CAMHS, axis I diagnoses are common, often behavioral-emotional disorders. Among the medications, psychostimulants and antidepressants are common. Beyond characterizing diagnoses and medication prescribing patterns, the study presents an approach for mining and mapping EHR data to analyze and provide service-level metrics, as well as clinical practice insights.

Shared decision-making (SDM) is a collaborative process that improves patient-centered care and has been widely adopted across healthcare systems internationally. Despite increasing attention, SDM remains underutilized in South Korea, and systematic evidence on its implementation and effectiveness is limited. This study systematically reviewed SDM programs implemented in South Korea, assessed their effectiveness, and aimed to inform the development of context-specific models for broader integration into healthcare practice. This study employed the ECLIPSE (Expectations, Client groups, Location, Impact, Professionals, Services) framework to refine the research questions and conducted a systematic search across seven international and domestic databases, as well as Google Scholar for studies published until July 2024. Eligible studies included quantitative designs that assessed the outcomes of SDM interventions. Study quality was assessed using the QualSyst tool, and a narrative synthesis was conducted due to the heterogeneity in study designs and outcome measures. Of the 14 included studies 13 addressed information provision, 8 involved patient participation, 7 incorporated decision-making processes, and only 3 integrated all core SDM components. Outcomes were reported across three domains: Affective-cognitive (e.g., satisfaction, decisional conflict, knowledge), behavioral (e.g., intention to act), and clinical (e.g., quality of life). SDM was associated with increased patient satisfaction (in 10 out of 14 studies), reduced decisional conflict (in 8 studies), and improved patient knowledge (in 9 studies). However, variations in effectiveness were observed depending on patient characteristics, healthcare settings, and the design and delivery of interventions. This review highlights the potential of SDM to enhance patient-centered care in South Korea. However, inconsistencies in intervention components and evaluation methodologies limit the generalizability of the findings. Given the unique features of the Korean healthcare system-such as very short consultation times, limited reimbursement for counseling, and provider-patient information asymmetry-future research should focus on developing SDM models tailored to these constraints and cultural contexts, supported by appropriate evaluation tools and policy measures. https://www.crd.york.ac.uk/PROSPERO (CRD42024582894).