搜索结果：Journal of health psychology

Patients with disorders of consciousness (DoC) resulting from severe traumatic brain injury (TBI) may recover consciousness and independence years later. There is a prevailing belief that recovery, when limited to the restoration of independence in activities of daily living, will be accompanied by poor self-reported quality of life (QOL) and psychological health. This perception may influence early clinical decision-making related to the provision of life-sustaining treatment and access to specialized rehabilitation. In this observational study, we utilized data from the multisite TBI Model Systems (TBIMS) to evaluate the outcomes of QOL (Satisfaction With Life Scale [SWLS]), anxiety (Generalized Anxiety Disorder-7 Scale [GAD-7]), and depression (Patient Health Questionnaire-9 [PHQ-9]) in participants who were admitted to inpatient rehabilitation with DoC and recovered the ability to provide self-report on these measures by 1 year post-TBI. Among 887 TBIMS participants admitted to inpatient rehabilitation with DoC (defined as the absence of command-following; 74% male; mean [standard deviation, SD] age = 36.82 [17.87] years; days post-injury on rehabilitation admission = 33.63 [22.51]), 50% regained the capacity to respond to questions on self-report measures at the 1-year follow-up time point. The mean (SD) total scores were as follows: SWLS = 20.38 (7.81), GAD-7 = 4.00 (5.66), and PHQ-9 = 5.22 (5.04). A minority of patients endorsed dissatisfaction (15%) or extreme dissatisfaction (9%) with life, and similarly, only 14% and 16%, respectively, reported anxiety and depression symptoms above the clinical cutoff points. The results were similar at the 2- and 5-year follow-up time points. In summary, at the group level, QOL and psychological health in persons who recover from DoC are similar to those of individuals with less severe brain injuries and to the general population. These findings challenge the assumption that recovery from DoC is associated with poor QOL and psychological health. Clinicians should be aware that patients with a broad range of residual disability after DoC are unlikely to report dissatisfaction with life or have significant anxiety and depression up to 5 years post-TBI.

Menopause is a physiological stage in a woman's life characterized by the permanent cessation of menstruation and decreased ovarian function, which leads to hormonal changes responsible for vasomotor, genitourinary, psychological, cognitive, and sexual symptoms. Given the increasing life expectancy in Mexico, women spend a substantial period in the postmenopausal state, posing clinical and public health challenges for reproductive health professionals. This review provides a clinical update on the pathophysiology and symptomatology of menopause, as well as a comprehensive approach that includes therapeutic and psychosocial support strategies. Emphasis is placed on the importance of individualized assessment, patient education, and the integration of pharmacological and non pharmacological interventions, with the aim of improving quality of life and well being for women during this stage. The article offers practical tools and evidence-based recommendations for health professionals, promoting multidisciplinary, patient centered care. La menopausia es una etapa fisiológica en la vida de la mujer caracterizada por el cese permanente de la menstruación y la disminución de la función ovárica, lo que conlleva una serie de cambios hormonales responsables de síntomas vasomotores, genitourinarios, psicológicos, cognitivos y sexuales. Dada la creciente esperanza de vida en México, las mujeres viven un periodo significativo en estado posmenopáusico, lo que implica retos clínicos y de salud pública para los profesionales de salud reproductiva. Esta revisión ofrece una actualización clínica de la fisiopatología y la sintomatología de la menopausia, así como un abordaje integral que incluye estrategias terapéuticas y de acompañamiento psicosocial. Enfatizamos la importancia de la evaluación individualizada, la educación de la paciente y la integración de intervenciones farmacológicas y no farmacológicas, con el objetivo de mejorar la calidad de vida y el bienestar de las mujeres en esta etapa. El artículo proporciona herramientas prácticas y recomendaciones basadas en la evidencia para el profesional de la salud, además de que promueve una atención multidisciplinaria y centrada en la paciente.

Older adults are the fastest-growing group of cannabis consumers in the US, seeking relief from age-related ailments (eg, pain or difficulty sleeping) and improved quality of life. However, little is known about the motivations and factors that influence their use of edible cannabis and product choice. To explore the motivations of older adults in Colorado purchasing edible cannabis products to improve sleep, pain, or mental health concerns, and to understand how they perceive the benefits and drawbacks of different cannabinoid profiles: cannabidiol (CBD)-dominant, tetrahydrocannabinol (THC)-dominant, or a THC-CBD combination product. This community-based, qualitative study was study conducted in Colorado from November 2021 to November 2023 as part of a larger clinical trial. Individual interviews were audio-recorded, transcribed, and analyzed. Participants were a convenience sample of adults aged 60 years or older who were interested in using edible cannabis for sleep, pain, or mental health symptoms. Participants completed an in-person interview prior to purchasing 1 of 3 edible product types. Use of edible cannabis products. The primary outcomes were self-reported motivations for cannabis use and perceived benefits and drawbacks of different cannabinoid profiles, assessed through semistructured interviews conducted before product purchase. Among 169 participants (mean [SD] age, 70.8 [5.8] years, 89 female [54%]), 96 (57.5%) selected a THC and CBD combination product, 48 (28.7%) selected a CBD-dominant product, and 23 (13.8%) selected a THC-dominant product. Primary motivations for cannabis use included avoiding pharmaceuticals, exhausting other options, new or increasing problems, and evidence or claims of benefits. Evidence or claims of associated outcomes were seen as a benefit for all 3 product types. The most common drawback for THC and combination products was concern about getting high or being impaired, while limited efficacy was the most common drawback for CBD products. Combination products were perceived to offer dual benefits of THC-CBD, yet determining the ideal ratio was seen as a challenge. In this qualitative study, older adults were motivated to use cannabis as an alternative approach to address health concerns. These findings highlight the importance of physician awareness of older adults' motivations and concerns to support informed counseling and resources.

Sleep disturbance and quality of life have been widely studied; however, there is a lack of theory-based, nursing-specific tools that directly assess their relationship. This study aimed to develop a valid and reliable measurement tool based on Kolcaba's Comfort Theory. Methodological study. The study included 781 patients and followed standard procedures for scale development. The scale was rated on a 5-point Likert scale, and item scores were averaged to obtain overall scores. Data were collected using the Personal Information Form, the Pittsburgh Sleep Quality Index, the Visual Analog Scale (impact of sleep disturbance), the World Health Organization Quality of Life Scale, and the newly developed scale. Content validity, exploratory factor analysis, and confirmatory factor analysis were used to assess validity. Reliability was evaluated using Cronbach's alpha, McDonald's omega, and split-half reliability. The final scale consists of 23 items and two sub-dimensions: Physical-Psycho-Spiritual and Environmental-Sociocultural. Mean scores range from 1 to 5, with higher scores indicating a greater negative impact of sleep disturbance on quality of life. These findings suggest that the scale may capture the multidimensional impact of sleep disturbance on quality of life. Reliability coefficients were 0.96 for both sub-dimensions and 0.98 for the overall scale. However, the confirmatory factor analysis results indicated an acceptable yet borderline model fit, particularly with respect to the RMSEA value, and therefore should be interpreted with caution. The Effect of Sleep Disturbance on Quality of Life Scale may offer a theory-based approach to assessing how sleep disturbances relate to patients' quality of life. It may assist healthcare professionals in clinical assessment by helping to identify the multidimensional impact of sleep-related problems and could potentially contribute to clinical decision-making and care planning. The findings suggest that the scale demonstrates adequate psychometric properties and may be a useful tool for research, education, and clinical practice. In addition, criterion-related validity showed correlations ranging from weak to moderate levels, indicating partial support rather than strong evidence. These findings should therefore be interpreted with caution, as the observed correlations provide limited rather than conclusive evidence of criterion validity. The scale appears to be a valid and reliable tool for assessing the impact of sleep disturbance on quality of life. The scale may provide a theory-based framework for assessing patient needs, which may support holistic assessment and individualized care.

Childhood obesity constitutes a complex medical and psychosocial challenge that requires both nutritional knowledge and sensitive, relationship-oriented doctor-patient communication. The Planetary Health Diet links individual health promotion with environmental sustainability and represents a relevant framework for contemporary medical education. This proof-of-concept study investigated how different information sources influence medical students' acquisition, structuring, and application of knowledge on childhood obesity and the Planetary Health Diet within a communication-based teaching setting, including the exploratory use of artificial intelligence-based tools. A total of 359 second-year medical students participated in a mandatory communication seminar during the 2023-2024 academic year. Following a precourse knowledge assessment and a brief theoretical introduction, students worked on a standardized counseling scenario addressing childhood obesity. In small groups, students used only 1 assigned information source (ChatGPT, Google Search, scientific papers, or instructional videos) to prepare a counseling approach. Group outcomes were assessed using a predefined scoring system based on a sample solution, complemented by thematic content analysis. All information sources enabled students to acquire relevant knowledge on childhood obesity and the Planetary Health Diet. However, groups differed with regard to the depth, differentiation, and structuring of their responses. The ChatGPT group achieved the highest conformity scores with the sample solution and provided the most additional information, followed by the Google and video groups, while the paper group achieved the lowest scores. Prior to the course, students reported limited knowledge of the Planetary Health Diet and little practical experience in counseling children with obesity and their families. Communication-based teaching formats provide an effective framework for introducing medical students to complex topics such as childhood obesity and sustainability-related nutrition early in their training. Easily accessible digital tools, including artificial intelligence-based systems, may facilitate knowledge acquisition and elaboration; however, their use requires explicit didactic framing, critical source evaluation, and reflection on the complexity of chronic conditions to support responsible and realistic learning outcomes in future physicians.

Chronic kidney disease (CKD) is a progressive condition characterized by structural and functional impairments in the kidneys, affecting around 10-15% of the global population. Kidney transplantation from living donors is regarded as the most effective treatment for CKD. Little is known about the consequences in kidney donors in term of quality of life, work ability and overall health status, including pain syndromes developing. This may drive intervention to support donors and promoting their engagement. This scoping review evaluates the quality of life (QoL), pain syndromes occurrence, mental health and work ability of adult living kidney donors. A scoping review was performed using the PubMed/Medline, Embase, CINAHL, and Cochrane Library databases between April and September 2023. The review followed the Arksey and O'Malley framework, incorporated guidance from the Joanna Briggs Institute (JBI), and reported to PRISMA-ScR guidelines. The protocol for this review was registered on the Open Science Framework. Risk of bias and study quality were assessed using JBI checklists. Starting from the analysis of 5069 records, 10 studies were included in the present study. The results show scanty data about the issues. The occurrence of medium and high intensity pain after surgery is reported; mental health seems to be moderately compromised and related to symptoms of anxiety and depression. Of interest, QoL seems to be overall improved after the kidney donation, suggesting a phase of adaptation following the surgery. No data are available on the work ability changes after donation. This review emphasizes the presence of positive effects of kidney donation in living donors and, on the other hand the need of improving pain management and mental health support in the first time after surgery. The information about the consequences of kidney donation on work ability is completely lacking. This could be relevant to be known for new potential donors. It also advocates for continued interdisciplinary research for developing evidence-based care strategies to promote donors' multifaceted well-being.

Depression is currently one of the most impactful mental health conditions worldwide, with more than 280 million reported cases. However, there is a critical lack of data on Indigenous populations due to language barriers and the absence of culturally adapted assessment tools, limiting timely diagnosis and appropriate care. The aim of this work is to culturally and linguistically adapt the Patient Health Questionnaire-9 (PHQ-9) into the Shawi language and to evaluate its psychometric properties among Indigenous adults in Alto Amazonas, Peru. A rigorous cultural adaptation process was carried out, including translation by bilingual experts and back-translation. Validation involved expert technical review and a pilot phase conducted within the participating community. Content validity was assessed using Aiken's V coefficient as a statistical indicator. The internal structure was evaluated using confirmatory factor analysis and structural equation modeling. The sample consisted of 432 members of the Shawi community. The instrument showed excellent content validity (V = 0.90 to 1.00). Confirmatory factor analysis supported a unidimensional model with good fit (comparative fit index: 0.98; root mean square error of approximation: 0.06) and adequate internal consistency (α = 0.80; ω = 0.81). In addition, invariance of the PHQ-9 was demonstrated across age, sex, educational level, and marital status, supporting its applicability across different population subgroups. The Shawi version of the Patient Health Questionnaire-9 has proven to be a reliable and valid tool for detecting depressive symptoms in this Indigenous population. This advancement represents a significant contribution to reducing mental health disparities by facilitating culturally appropriate diagnoses and improving care in historically underserved Amazonian communities. En la actualidad la depresión representa una de las condiciones de salud mental con mayor impacto, son más de 280 millones de casos reportados en el mundo. Sin embargo, en poblaciones originarias existe una carencia crítica de datos debido a barreras lingüísticas y ausencia de instrumentos adaptados, lo que limita el diagnóstico y la atención oportuna. El objetivo de este trabajo es adaptar cultural y lingüísticamente el Cuestionario de Salud del Paciente - 9) a la lengua shawi y evaluar sus propiedades psicométricas en adultos indígenas de Alto Amazonas, Perú. Se realizó un proceso riguroso de adaptación cultural que incluyó traducción por expertos bilingües y retro-traducción. La validación incluyó la revisión técnica de expertos y una fase piloto realizada dentro de la comunidad participante. Para determinar la validez de contenido, se recurrió al uso de coeficiente V de Aiken como indicador estadístico. Para la estructura interna se usó análisis factorial confirmatorio y modelamiento de ecuaciones estructurales. La muestra estuvo integrada por 432 miembros de la comunidad shawi. El instrumento mostró excelente validez de contenido (V = 0,90 a 1,00). El análisis factorial confirmatorio validó un modelo unidimensional con buen ajuste (índice de ajuste comparativo: 0,98, error cuadrático medio de aproximación: 0,06) y adecuada consistencia interna (α = 0,80; ω = 0,81). Además, se demostró la invarianza del PHQ-9 por edad, sexo, nivel educativo y estado civil, lo que respalda su aplicabilidad en distintos subgrupos de la población. La versión shawi del Cuestionario de Salud del Paciente - 9 ha mostrado ser una herramienta confiable y válida para detectar síntomas depresivos en esta población indígena. Este avance representa un aporte significativo en la reducción de brechas en salud mental, al facilitar diagnósticos culturalmente pertinentes y contribuir a mejorar la atención en comunidades amazónicas históricamente desatendidas.

The use of large language models and natural language processing (NLP) in medical education has expanded rapidly in recent years. Because of the documented risks of bias and errors, these artificial intelligence (AI) tools must be validated before being used for research or education. Traditional and novel conceptual frameworks can be used. This study aimed to validate the application of an NLP method, bidirectional encoder representations from transformers (BERT) model, to identify the presence and patterns of sentiment in end-of-course evaluations from M3 (medical school year 3) core clerkships at multiple institutions. We used the Patino framework, designed for the use of artificial intelligence in health professions education, as a guide for validating the NLP. Written comments from de-identified course evaluations at four schools were coded by teams of two human coders, and human-human interrater reliability statistics were calculated. Humans identified key terms to train the BERT model. The trained BERT model predicted the sentiments of a set of comments, and human-NLP interrater reliability statistics were calculated. A total of 364 discrete comments were evaluated in the human phase. The range of positive (30.6%-61.0%), negative (4.9%-39.5%), neutral (9.8%-19.0%), and mixed (1.7%-27.5%) sentiments varied by school. Human-human and human-AI interrater reliability also varied by school. Human-human and human-AI reliability were comparable. Several conceptual frameworks offer models for validation of AI tools in health professions education. A BERT model, with training, can detect sentiment in medical student course evaluations with an interrater reliability similar to human coders.

Caregivers manage complex demands with little support, contributing to significant psychological distress. Though caregiver-focused supportive care is scarce, this type of psychosocial support enhances well-being and caregiving ability. Given the caregiver support gap, we developed an online, self-directed intervention (Healthy Communication Practice) to reduce caregivers' distress by enhancing their online, clinical, and family communication skills. It was first developed for adult children of parents with blood cancer. We previously established the acceptability and feasibility of the intervention in partnership with Blood Cancer United (formerly The Leukemia & Lymphoma Society). This proof-of-concept analysis examined the impact of Healthy Communication Practice on adult-child caregivers' distress and secondary psychosocial outcomes. Participants were adult-child caregivers of parents with blood cancer diagnosed at least 3 months prior and in treatment or completed treatment within a year. Outcomes were assessed pre-, immediate-post, and 3-month post-intervention using paired t-tests to analyze pre- and post-intervention differences. Participants (N = 55) were aged 18-59, mostly female (76%) and white (78%). Caregivers experienced reduced distress between pre-intervention and 3-month post completion as well as increased positive meaning associated with their caregiving role between pre-intervention to 3-month post completion. Communication skills in each care domain (online, clinical, and family communication) increased between pre- and 3-month post completion. Results provide proof-of-concept evidence that the Healthy Communication Practice can enhance caregivers' psychological well-being and caregiving communication skills. Results further demonstrate a sustainable, innovative communication-focused approach to providing caregiver-targeted supportive care that can also be widely disseminated, thus warranting further evaluation.

Cognitive behavioral therapy (CBT) is the most examined psychotherapy for depression and anxiety, but delivery faces significant barriers such as limited access, cost, and time constraints. CBT-oriented psychological chatbots offer a promising means of addressing these challenges. Yet, their overall efficacy, user engagement, and acceptability have not been systematically synthesized. This study aimed to evaluate the efficacy, user engagement, and acceptability of CBT-oriented chatbots for adults with depressive and/or anxiety symptoms. A systematic search of 9 databases, including PubMed, Cochrane Central Register of Controlled Trials, Embase, Web of Science, PsycINFO, CINAHL, China National Knowledge Infrastructure, WanFang, and VIP Databases, was conducted from inception to February 2026. Eligibility criteria included randomized controlled trials comparing CBT-oriented chatbots with control groups in adults with depressive and/or anxiety symptoms. Risk of bias (ROB) was assessed using the Cochrane ROB tool. Random-effects meta-analyses (Hartung-Knapp-Sidik-Jonkman adjustment) calculated pooled effect sizes (Hedges g), 95% CIs, and 95% prediction intervals (PIs). Heterogeneity was evaluated using the I² statistic, and Galbraith plots were used to identify outliers for subsequent sensitivity analyses. Subgroup and meta-regression analyses examined potential moderators. The certainty of evidence was evaluated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. Data on user engagement and acceptability were extracted and synthesized using narrative and quantitative methods where available. Twenty-nine eligible randomized controlled trials were included. CBT-oriented psychological chatbots produced a moderate reduction in depressive symptoms at postintervention (g=-0.55, 95% CI -0.70 to -0.40, 95% PI -1.23 to 0.13) and a small reduction in anxiety symptoms (g=-0.26, 95% CI -0.37 to -0.14, 95% PI -0.67 to 0.15). At follow-up, effects were small for depression (g=-0.32, 95% CI -0.55 to -0.09, 95% PI -0.93 to 0.29) and nonsignificant for anxiety (g=-0.19, 95% CI -0.43 to 0.04, 95% PI -0.84 to 0.46). Subgroup and meta-regression analyses revealed that anxiety outcomes were significantly moderated by clinical profiles-showing distinct advantages for comorbid symptoms-and the proportion of female participants. The CBT-oriented chatbots received an adequate level of engagement that complied with digital intervention standards. Although user satisfaction ratings were generally favorable, technical limitations and repetitive interaction patterns remain to be addressed to enhance overall acceptability. Regarding the limitations of evidence, the overall certainty was rated as very low to low, predominantly driven by high ROB and substantial heterogeneity. This study innovatively isolates CBT-oriented chatbots from broader digital interventions, providing a precise, methodology-driven evaluation of theoretically grounded therapeutics. This review brings critical evidence to the field that these tools yield significant short-term relief, particularly for comorbid anxiety profiles. In the real world, CBT chatbots offer profound potential as scalable, low-barrier first-line tools. To sustain engagement, future developments must evolve from rigid rule-based scripts toward adaptive, large language model-driven architectures while ensuring clinical safety.

Evaluating resident physicians is essential for resident development and patient safety. Fear of retaliation from residents may be a barrier to faculty completing resident physician evaluations. This study examined family medicine program directors' perceptions on fear of retaliation from resident physicians as a barrier to faculty completing honest, high-quality evaluations. The study was conducted as part of the 2024 Council of Academic Family Medicine Educational Research Alliance study of family medicine residency program directors. The 10-item survey assessed program directors' perceptions of faculty fear of retaliation, the impact of this fear, and rates of retaliation occurring in their programs in the last 3 years. The response rate was 45.39% (320/705). More than half (56.4%, 172/305) perceived that faculty in their programs are reluctant to give critical feedback on evaluations; nearly half (48.9%, 150/305) believed that fear of retaliation is a barrier. Fear of a reciprocal negative evaluation (34.5%, 106/305) and fear of formal complaints (38.9%, 119/305) were prevalent. Lack of adequate documentation was attributed to a failure to remediate and dismiss a resident in 19.8% (61/307) and 11.7% (36/306) of programs, respectively. Formal complaints against an evaluator or program occurred in 18.6% (57/307) of programs, and civil lawsuits were filed in 5.2% (16/306) in the preceding 3 years. Family medicine program directors perceive fear of retaliation from residents as a barrier to faculty completing honest, high-quality evaluations. Formal complaints and even civil lawsuits against evaluators or programs are not uncommon.

Timely palliative care can reduce the disease burden and improve quality of life in patients with cancer. Although several studies have developed assessment models for palliative care needs in cancer patients, the quality and clinical applicability of these models remain unclear. To systematically review existing assessment models for palliative care needs in patients with cancer, with a focus on their characteristics, predictors, risk of bias, and applicability. A systematic search was conducted in PubMed, Cochrane Library, Embase, Web of Science, CINAHL, Scopus, China National Knowledge Infrastructure (CNKI) through September 12, 2025. Data extraction and evaluation were rigorously performed by two researchers based on the Prediction Model Risk of Bias Assessment Tool (PROBAST). A total of 5714 articles were identified, and eight studies were included, which covered 24 models for assessing palliative care needs. The sample size of the included studies ranged from 179 to 54,628, with areas under the curve ranging from 0.724 to 0.998. The models in all the included studies encompassed four categories of predictive factors: general demographic data, symptom/functional assessments, laboratory indicators, and treatment status. Five studies were rated as having a high risk of bias, primarily due to high risks associated with participants and conclusions, with generally low applicability. Existing models demonstrate potential for identifying patients with cancer who have increased palliative care needs using routinely collected clinical data. Commonly included predictors were symptom burden, functional status, laboratory parameters, treatment-related factors, and demographic characteristics. However, the overall body of evidence is constrained by a substantial risk of bias, particularly arising from inappropriate data sources, limited sample sizes, suboptimal handling of continuous variables, insufficient reporting of missing data, and the lack of robust internal or external validation. In addition, many models adopted mortality-based surrogate outcomes rather than clinically meaningful indicators of palliative care needs. Therefore, the currently available models should be interpreted with caution, and further high-quality model development and external validation are required before they can support broader routine clinical implementation. Future research should prioritize clinically actionable outcomes and incorporate patient-, caregiver-, and family-level factors to improve the relevance of these models for referral decisions and care planning.

Environmental exposures such as heat and air pollution are critical determinants of health, yet traditional assessment methods rely on stationary monitors or residential address proxies that fail to capture the exposures that individuals experience throughout the day. This pilot study aimed to assess the feasibility of integrating ecological momentary assessment (EMA), wearable devices, and continuous GPS tracking to capture real-time environmental exposures and to explore associations with concurrent health outcomes. In total, 7 young adults (aged approximately 16 to 24 years; 5/7, 71% female) wore Fitbit Charge 6 watches from July 2025 to August 2025 (mean 28.1, SD 1.1 days), recording sleep quality and duration, resting heart rate, breathing rate, heart rate variability, and physical activity. GPS location measured at up to 5-minute intervals (mean 19.7, SD 25.8 measurements per day) was linked to ambient temperature, humidity, and air pollution data (particulate matter <2.5 um or <10 um in diameter, nitrogen dioxide, sulfur dioxide, ozone, and carbon monoxide) derived from monitoring stations, satellites, and climate models using data-integration algorithms accessed via an application programming interface. EMA surveys administered 3 times per day captured participants' emotional states and location (inside or outside). Feasibility targets were &#x2265;3 GPS measurements per day, &#x2265;1 survey completed per day, and complete sleep data on &#x2265;50% of days. We examined exploratory bivariate correlations between environmental exposures, physiological measures, and self-reported mood, adjusting for multiple comparisons using false discovery rate correction. Of the 7 participants, 5 (71%) met predefined feasibility targets. Mean compliance included 565 (SD 457) GPS coordinates per participant, 1.4 (SD 0.2) EMA surveys per day, and complete Fitbit sleep data on 64% (SD 27%) of days. Surveys identified barriers to compliance, including perceived complexity of the system and forgetting to put the Fitbit watch back on after removing it. Exploratory correlations (6/7, 86% of participants with complete Fitbit data) revealed associations between nitrogen dioxide and heat exposure and reduced heart rate variability (a marker of parasympathetic tone), and between air pollutants (sulfur dioxide) and increased negative emotions. Heat exposure showed a paradoxical pattern of lower self-reported sadness but reduced heart rate variability with higher levels of heat exposure. Given the small sample size, these correlations should be considered preliminary and hypothesis generating rather than definitive findings. This study demonstrates that the multimodal integration of wearable devices, GPS tracking, and EMA is feasible for capturing real-time environmental exposures and concurrent health outcomes in young adults. This approach addresses critical exposure misclassification issues in environmental health research that relies on residential addresses as proxies. Preliminary patterns suggest complex relationships between environmental exposures and both physiological and emotional outcomes, warranting further investigation in larger, more diverse samples. This approach could inform future personalized environmental health interventions.

An attractive practice environment for nurses is essential in cardiac hospitals; however, limited studies are known about practice environment in this setting. This study aimed to evaluate nurses' perceptions of the practice environment in XXX cardiac hospitals. Additionally, this study seeks to identify nurse-related factors that influence nurses' nursing practices in these hospitals. A cross-sectional study utilizing a self-report questionnaire was conducted among a convenience sample of 115 nurses working in cardiac hospitals. Nurses' perceptions of the practice environment in cardiac hospitals were explored via the Nursing Work Index. A descriptive analysis was performed in the form of categorical variables presented as frequencies and percentages, and the continuous variables were presented as the means and standard deviations. Multiple linear regression was performed to analyze the relationship between sociodemographic factors and the level of environmental practice. The level of significance was set at a p value&#x2009;=&#x2009;(p &#x2264; 0.05). The findings indicate an overall favorable practice environment, with 56% of the nurses reporting a good level of practice in the cardiac setting. Cardiac nurses held a positive perception of their nursing practice in cardiac care settings. Overall, the participants responded well, with a total mean score of (M&#x2009;&#xb1;&#x2009;SD&#x2009;=&#x2009;3.38&#x2009;&#xb1;&#x2009;0.02) for their perceptions of leadership, staff support, nursing supervisory skills, participation in hospital committees, staffing and resource adequacy and collegial nurse&#x2012;physician relations. Nursing qualifications, years of experience and participation in nursing work management-related training courses were predictors of cardiac nurses' perceptions of the practice environment (p value&#x2009;=&#x2009;p&#x2009;&#x2264;&#x2009;0.014). Survey nurses' perceptions of the practice environment in cardiac hospitals provide insight into nurses' actual readiness for providing high-quality care and hence positive patient health outcomes. Cardiac nurses should be involved in decision-making authority and advocate for the workplace to better support their independence, all to improve the nursing practice environment in cardiovascular hospitals.

Low anterior resection syndrome (LARS) is a common postoperative complication in patients with low rectal cancer, presenting with a spectrum of bowel dysfunction symptoms, including urgency, incontinence, evacuation disorders, and changes in stool frequency. Pelvic floor muscle training (PFMT) can alleviate LARS, but its effectiveness may be limited by poor accuracy of technique and low adherence during home-based training due to a lack of real-time feedback and monitoring devices. This study aimed to evaluate the effects of a novel integrated balloon biofeedback device for home-based PFMT on accuracy of technique, adherence, quality of life, and LARS reduction in patients after sphincter-preserving surgery for low rectal cancer. A nonrandomized controlled trial was conducted among 164 patients with low rectal cancer who underwent temporary ileostomy without neoadjuvant therapy. Participants were assigned by surgical date to an intervention group (n=82) using an adjustable-pressure balloon device with real-time waveform feedback via a mobile app or a control group (n=82) performing PFMT without equipment. PFMT was initiated within 72 hours after temporary ileostomy and continued throughout the stoma period until 1 month after ileostomy reversal. Outcomes including PFMT accuracy of technique, adherence, LARS score and incidence, and quality of life (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30) were assessed 1 month after stoma reversal. At baseline, major LARS was present in 47.6% (39/82) of patients in the intervention group and 62.2% (51/82) of patients in the control group. Compared with the control group, the intervention group showed significantly higher PFMT training accuracy and adherence (P<.001 in both cases). LARS scores were significantly lower in the intervention group (median 16.00, IQR 11.00-29.00 vs 32.00, IQR 13.75-36.00), with a markedly reduced proportion of major LARS (17/82, 20.7% vs 45/82, 54.9%; P<.001). Global health/quality of life scores were significantly higher in the intervention group (P<.001). The integrated balloon biofeedback device improved the accuracy of technique and adherence to home-based PFMT, reduced the incidence and severity of LARS, and enhanced quality of life in patients after low rectal cancer surgery. These findings support further development and clinical implementation of the device. However, the nonrandomized, time-sequenced study design and baseline differences between groups may limit causal interpretation of the results, and randomized controlled trials with longer follow-ups are needed to confirm long-term efficacy.

Global adolescent-level food insecurity (AFI) and common mental disorders (CMD) represent a significant public health burden. While household-level food security is known to be associated with mental health disorders, there is a dearth of evidence regarding the specific association between AFI and CMDs in Ethiopia, particularly in the Harari Regional State. A school-based cross-sectional study was conducted among 3,326 adolescents in the Harari Regional State, Eastern Ethiopia, utilizing a multistage sampling strategy stratified by locality and school type. Data were collected using validated scales adapted from previous studies, including the HFIAS for adolescent-level food insecurity, KIDSCREEN-10 for health-related quality of life, the Rosenberg Scale for self-esteem, and the SDQ-25 for CMDs. Data were collected using a structured questionnaire translated into Amharic and Afan Oromo and pre-tested for validity. A guided self-administration approach was employed by eight trained BSc nurses and psychiatric nurses. All data collectors and supervisors underwent rigorous training to ensure data quality. Questionnaires were subjected to daily checks for completeness during fieldwork, and double data entry was utilized for final validations and accuracy. Data were analysed using STATA version 16.1. Prior to analysis, data were screened for outliers, missing values, and normality. The structural equation model (SEM) demonstrated a good fit to the data (RMSEA&#x2009;=&#x2009;0.03, CFI&#x2009;=&#x2009;0.90, TLI&#x2009;=&#x2009;0.89 and SRMR&#x2009;=&#x2009;0.05), confirming the structural integrity of the model prior to the interpretation of path coefficients. We conducted SEM using maximum likelihood estimation after adjusting for relevant covariates. The descriptive results revealed that 14.50% of adolescents experienced moderate-to-severe food insecurity, while the prevalence of CMDs was 22.93%. Several factors were significantly associated with the prevalence of CMDs. AFI was linked to a higher likelihood of CMDs (&#x3b2;&#x2009;=&#x2009;0.20, P&#x2009;<&#x2009;0.001), as were substance use (&#x3b2;&#x2009;=&#x2009;0.14, P&#x2009;<&#x2009;0.001) and frequent financial difficulties (&#x3b2;&#x2009;=&#x2009;0.06, P&#x2009;<&#x2009;0.001). Conversely, higher quality of life (&#x3b2;&#x2009;=&#x2009;-0.07, P&#x2009;<&#x2009;0.001) and stronger self-esteem (&#x3b2;&#x2009;=&#x2009;-0.06, P&#x2009;<&#x2009;0.001) were associated with a lower likelihood of CMD symptoms. Furthermore, urban residency emerged as a protective factor, showing a significant negative association with CMDs (&#x3b2;&#x2009;=&#x2009;-0.21, P&#x2009;<&#x2009;0.001). AFI significantly predicts the occurrence of CMDs. A relationship is further driven by poor quality of life, diminished self-esteem, substance use, and financial instability. The study highlights the need for tailored interventions to tackle these functional drivers, suggesting that addressing food insecurity and its associated psychosocial factors is essential to reduce adolescents' CMD burden.

Refractory or unexplained chronic cough (RUCC) represents an unmet clinical need. This study aimed to explore the components constituting the disease burden in patients with RUCC by comparing clinical features, healthcare use, and patient-reported outcomes with those of chronic cough (CC) of recent onset (<&#x2009;1 year). A total of 200 individuals were prospectively enrolled from seven referral clinics in South Korea, including 100 with RUCC and 100 with CC of recent onset (<&#x2009;1 year). Data were obtained through structured interviews and medical record reviews. Measures included general and cough-specific quality-of-life, mood, cough hypersensitivity symptoms, work productivity, and healthcare utilization. Individuals with RUCC were significantly older than those with CC (57.5&#x2009;&#xb1;&#x2009;15.1 vs. 48.9&#x2009;&#xb1;&#x2009;17.6 years) and had markedly longer cough duration (median 80 vs. 4 months). The RUCC group demonstrated higher out-of-pocket costs, more healthcare facility visits, and greater numbers of diagnostic tests and prescribed medications. However, cough-specific and general health-related quality of life scores showed no significant differences. Correlation analysis revealed comparable but stronger associations between cough-specific quality-of-life and general health outcomes in RUCC than in CC. RUCC imposes a substantial and multidimensional burden that extends beyond symptom severity. Chronicity, healthcare complexity, and psychosocial impact appear to be central features. Future evaluation tools should incorporate time and lived experience to more accurately capture the true burden of chronic cough.

Patient safety competency among nurses is increasingly emphasized, yet research on patient safety competency among psychiatric nurses remains scarce. To deeply explore the cognition of psychiatric nurses on patient safety competency and explore the demands of nurses for enhancing patient safety competency. The study was conducted from June to July 2025 with 16 psychiatric nurses. Data were collected through in-depth personal interviews and thematic analyzed using Colaizzi's seven-step phenomenological analysis method. Three main themes and 13 subthemes are formed: (1) The connotation of patient safety competency, including "protecting one's own safety is the prerequisite for ensuring patient safety," "understanding patients," "observation," "nurse-patient communication," "nurse-patient relationship," and "handling adverse events;" (2) influencing factors of patient safety competency, including "manpower resources," "leadership," "teamwork," and "adverse event management system;" and (3) the demand for improvement of patient safety competency, such as "emphasize theory over practice," "outdated training content and monotonous formats," and "desire for more experience sharing." This study conducted an in-depth investigation into the connotation, influencing factors and improvement demands of patient safety competency among nurses in the field of mental health, revealing the specificity of psychiatric nurses' perceptions of patient safety competency. This provides a basis for health administration departments and hospital managers to develop relevant on-the-job training programs and intervention strategies to enhance the patient safety competency of psychiatric nurses, thereby improving the quality of nursing care and delivering superior services to patients. It holds practical significance for the optimization of specialized psychiatric nursing and even the broader healthcare field.

Climate change poses a significant threat to human health and is linked to various direct and indirect outcomes, including infectious diseases, heat-related illnesses, and other climate-sensitive conditions. However, standardized tools assessing perceived knowledge and awareness of climate-related health effects remain limited. This methodological study aimed to develop and validate the ClimHealth-K scale for assessing university students' perceived climate-health knowledge. The sample included 449 students from a public university in T&#xfc;rkiye. Items were generated through literature review and evaluated by seven experts to establish content validity using the Davis method. Psychometric analyses included exploratory and confirmatory factor analyses and reliability testing. Item-level content validity index values ranged from 0.86 to 1.00, and the scale-level index was 0.98. Exploratory factor analysis supported a unidimensional structure explaining 62.67% of total variance, and confirmatory factor analysis showed good model fit (&#x3c7;2/df&#x2009;=&#x2009;2.27, CFI&#x2009;=&#x2009;0.977, RMSEA&#x2009;=&#x2009;0.075). Cronbach's alpha was 0.954, and test-retest reliability indicated moderate stability (ICC&#x2009;=&#x2009;0.653, p&#x2009;<&#x2009;0.001). The 11-item ClimHealth-K is a valid and reliable instrument for assessing perceived climate-health knowledge in educational and public health research.