In many settings, postgraduate psychiatry training now emphasizes neuroscience, evidence-based treatment, diagnostic criteria, and structured psychological models. These advances have improved psychiatric care in important ways. They have strengthened diagnosis, expanded treatment options, and improved scientific understanding of mental illness. At the same time, this increasing focus on structure and measurable symptoms can unintentionally narrow clinicians' understanding of patients. Psychiatry deals with more than just the brain. It also deals with meaning, identity, relationships, suffering, and lived experience. Unlike many other medical specialties, psychiatry regularly requires clinicians to work with uncertainty, personal narratives, emotional complexity, and experiences that do not always fit neatly into diagnostic categories. In real clinical practice, patients rarely present as textbook cases. Clinicians must often decide whether a person's suffering reflects a meaningful human response to life circumstances, a psychiatric disorder requiring intervention, or sometimes both. In this editorial, I argue that postgraduate psychiatry training should integrate philosophy-informed and reflective approaches alongside scientific and evidence-based models. In this context, philosophy primarily encompasses phenomenology, ethics, philosophy of mind, reflective reasoning, and approaches that deepen clinicians' understanding of subjective experience. Earlier phenomenological perspectives emphasized the importance of understanding the patient's inner world. At the same time, more recent pluralistic and neuroscience-informed models support a broader understanding of psychiatric illness that integrates biological, psychological, and social dimensions. I also discuss how the rigid application of diagnostic frameworks can contribute to overmedicalization when clinicians fail to distinguish between distress and disorder carefully. Practical approaches such as reflective case discussions, formulation-focused supervision, phenomenological interviewing, ethics-based discussions, and narrative reflection can help integrate these perspectives into postgraduate training without requiring major curricular restructuring. This approach does not reject scientific psychiatry. Instead, it complements scientific practice by strengthening reflective thinking, patient-centered understanding, ethical reasoning, and tolerance of clinical complexity. Psychiatry needs both scientific rigor and humane understanding if it hopes to remain fully connected to patients' lived experiences.
Research into the functioning of the human brain is essential both for the biological assessment of the species and for our self-comprehension. However, following the "neuroscientific turn" in several areas of research, such as psychology, philosophy, and AI, interdisciplinary collaboration in this area gave birth to an important phenomenon that is still active today: "neuro-hype" or "brain-hype." In this paper, we will inquire about one particular aspect of this widespread phenomenon: for-profit neuro-related products. Due to the lack of a vast and robust literature on the topic, the first aspect of our inquiry will concern products that have two major similarities with our focus topic: they are direct-to-consumer (DTC) health-related products, and they have a certain effect on consumer health. The second aspect of our inquiry will delve deeper into DTC neurotechnology by investigating how such products are advertised on major online platforms. In our analysis, we will consider both supplements and biomedical devices, taking into account their ratings, their cost, how they are made, their patent (if present), and will compare this information with the available research data on such objects or similar ones. Finally, this paper argues that while DTC neurotechnologies democratize access to brain health tools, they frequently fail to align with core bioethical principles-autonomy, beneficence, non-maleficence, and justice. These shortcomings highlight an urgent need for robust regulatory frameworks and ethical guidelines to ensure responsible development, equitable access, and transparent commercialization.
Biologists and physicists have a rich tradition of modeling dynamics of living systems with simple models composed of a few interacting components. Despite the remarkable success of this approach, it remains unclear how to use such finely tuned models to study complex biological systems composed of numerous heterogeneous, interacting components. One possible strategy for taming this biological complexity is to embrace the idea that many biological behaviors we observe are "typical" and can be modeled using random systems that respect biologically motivated constraints. Here, we review recent works showing how this approach can be used to make close connection with experiments in biological systems ranging from neuroscience to ecology and evolution and beyond. Collectively, these works suggest that the "random-with-constraints" paradigm represents a promising new modeling strategy for capturing experimentally observed dynamical and statistical features in high-dimensional biological data and provides a powerful minimal modeling philosophy for biology.
Family carers have a key role in supporting malnourished older adults; yet, intervention evidence is lacking in the rehabilitation setting. This study aimed to explore the preliminary effects and acceptability of a family-centred, telehealth-enhanced dietary counselling intervention for treating protein-energy malnutrition (PEM) in rural-living older adults transitioning from rehabilitation to home, compared with usual care, in matched patient-carer dyads. A pragmatic, historically controlled, prospective, two-arm non-randomised controlled trial was conducted as a pilot study. Fifteen malnourished older adults admitted to rural rehabilitation units in New South Wales, Australia, and their family carers, were recruited and matched to 15 historical controls. The Patient-Generated Subjective Global Assessment (PG-SGA) was the primary outcome for nutrition status assessed at rehabilitation admission, discharge, and 3 months post-discharge. Quality of life, physical function, length of stay, discharge location, institutionalisation, mortality, carer burden, and service satisfaction were secondary outcomes. The historical control group received usual care. The intervention group received a telehealth-enhanced dietary counselling intervention developed with co-design principles, which engaged the family carer as a partner in the nutrition care team, delivered during the rehabilitation admission and for 3 months post-discharge. The difference in PG-SGA score from baseline to 3 months post-discharge between the two groups was 3.46 (95%CI: -2.07, 9.01; p = 0.238). The intervention group had a higher proportion of patients who were well-nourished at 3 months post-discharge compared to controls (60% vs 13%). At 3 months post-discharge, the intervention group had lower odds of being rated malnourished or with more severe malnutrition (i.e., moderate vs. well-nourished, severe vs. moderate) on the PG-SGA (OR 0.01, 95%CI: 0.00, 0.27; p = 0.005). There was a trend towards the intervention group having reduced odds of being discharged to a location other than home (OR 0.18, 95%CI: 0.03, 1.07; p = 0.06). The intervention was perceived as acceptable to patients and family carers. There were no differences between groups in other outcomes. Compared with usual care, the family-centred telehealth-enhanced dietary counselling intervention for the treatment of PEM in rural-living older adults transitioning from rehabilitation to home demonstrated preliminary efficacy and was acceptable to both patients and family carers. Future research aiming to improve PEM should meaningfully engage family carers as partners in the nutrition care team.
Moral distress has become one of the most prominent ethical constructs in contemporary nursing, widely used to describe nurses' experiences of constraint, frustration and ethical unease. While moral distress scholarship continues to retain important ethical and structural dimensions, the broader operationalisation of moral distress within healthcare organisations and professional discourse may influence how ethical conflict is understood and managed within healthcare organisations. This paper argues that such framings can have unintended consequences for nursing's moral authority and professional standing. Adopting a critical theoretical and conceptual synthesis, and drawing on feminist theory, Foucauldian analyses of power and contemporary nursing scholarship, this paper reconceptualises moral distress as functioning within conditions of subordination by design, understood as organisational, discursive and material arrangements that may systematically constrain nursing authority while influencing the conditions under which ethical dissent is manageable and non-disruptive. Within this framework, this paper advances three related concepts: moral containment, referring to organisational responses that absorb and redirect ethical dissent; ethical erosion, describing the cumulative diminishment of nurses' moral agency over time, and ethical laundering, naming the institutional process through which ethical harm may be acknowledged yet rendered politically inert. Rather than rejecting moral distress scholarship, the paper situates moral distress within a broader architecture of organisational power, contributing to contemporary debates regarding nursing voice, professional authority and the structural conditions under which nursing ethics can be meaningfully enacted.
To validate the Diabetic Foot Ulcer Scale (DFS-SF) in a sample of Portuguese patients diagnosed with chronic diabetic foot ulcers (DFUs). The sample included 163 participants who completed the DFS-SF, the Short-Form Health Survey (SF-36), and the Hospital Anxiety and Depression Scale (HADS). Construct validity was tested using confirmatory factor analysis. Reliability was evaluated through Cronbach α composite reliability (CR). Convergent validity was tested using Pearson correlations and average variance extracted (AVE). The Portuguese version retains 26 of the original 29 items and introduced one additional subscale, whereas the remaining subscales mirror the original dimensional structure. Reliability for the total scale was excellent (α=0.93; CR=0.97), with subscales values ranging from acceptable to very good, (α and CR=0.69 to 0.90). Significant correlations with SF-36 (r=0.32 to 0.71), and HADS (r=-0.21 to -0.69), alongside AVE coefficients (0.36 to 0.82), supported the construct validity of the Portuguese version. Although further studies are needed, the Portuguese DFS-SF is a reliable and valid tool for assessing quality of life in patients with DFU in both research and clinical settings.
Gypsy, Roma, and Traveller communities experience significant health inequalities, yet alcohol consumption within these communities remains under-researched. This paper offers a methodological and ethical contribution by reflecting on two qualitative studies of alcohol use in Romany Gypsy and Traveller communities in the United Kingdom: project 1 explores youth drinking, and project 2 examines intergenerational drinking narratives. Drawing on a collaborative partnership with Friends, Families and Travellers, we highlight the importance of equitable partnerships and the role of peer researchers in enabling access to seldom-heard communities, particularly when researching sensitive and potentially stigmatised topics. We demonstrate the value of culturally credible methods, including craft-elicitation and story-telling interviews, which align with community traditions, support participant agency, and generate nuanced, relational accounts that challenge stereotypical and pathologising narratives of alcohol use. Participatory data analysis further enabled participants to shape interpretation, repositioning them as active contributors to knowledge production, rather than passive subjects. We also critically reflect on ethical dimensions of the research process, including accessible approaches to informed consent, the complexities and unintended consequences of remuneration, and the importance of prioritising participant comfort, care, and flexibility in research design. We argue that researching alcohol with Romany Gypsy and Traveller communities requires methodological openness, cultural sensitivity, and adaptive, participant-led design. More broadly, the paper contributes practice-based insights that extend debates on participatory and ethical research, offering guidance for qualitative health researchers working with seldom-heard populations on sensitive topics.
Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide and imposes a substantial economic and social burden on healthcare systems and society. To analyse recent evidence (2020-2024) on the economic and social burden of COPD, including direct, indirect, and intangible costs. A systematic review was conducted to synthesise recent evidence on the economic and social burden of COPD published between January 2020 and December 2024. Searches were performed in PubMed/MEDLINE, Scopus, and Web of Science. Original studies reporting direct healthcare costs, direct non-healthcare costs, indirect costs or intangible costs related to health-related quality of life (HRQoL) were included. Thirty studies from 15 countries were included. Direct healthcare costs represent the main component of expenditure, largely driven by hospitalisations and exacerbations. Annual costs ranged from €3500 to €10,000 per patient in Europe and from US$10,000 to US$17,000 in the United States. Although absolute costs were lower in Asia, the relative financial burden on patients was considerable. Direct non-healthcare costs, including out-of-pocket expenses and long-term care, were particularly relevant in severe disease. Indirect costs related to productivity losses and unemployment were substantial and, in some middle-income countries, exceeded healthcare costs. Intangible costs included anxiety, depression, caregiver distress, impaired quality of life, and perceived financial toxicity, with high overall prevalence. COPD creates a considerable economic and social burden. Although direct costs are predominant, indirect, and intangible costs are decisive, particularly in contexts with lower healthcare coverage. Clinical factors (severity, exacerbations, and comorbidities) and socio-economic factors (educational level, income, and employment) explain much of the variability. A holistic approach that addresses health, social, and emotional dimensions is required for a more equitable and sustainable management.
Hyperbaric oxygen therapy (HBOT) is an established treatment for pelvic late radiation tissue injuries (LRTIs) in cancer survivors, yet its impact on sexual health outcomes has previously not been examined. To investigate longitudinal changes in sexual health following HBOT in pelvic cancer survivors with LRTIs and to examine whether baseline severity and changes in pelvic LRTI symptoms predict sexual health outcomes, including gender differences. This one-group longitudinal observational study included eight assessment points. A total of 137 cancer survivors with pelvic LRTIs underwent 27-30 HBOT in monoplace chambers, breathing 100% oxygen for 90 min at 2.4 atmospheres absolute. Data were analyzed using latent growth curve modeling. Sexual health was assessed using the EORTC Quality of Life Sexual Health Questionnaire, while pelvic LRTIs (urinary and bowel) were measured using the Expanded Prostate Cancer Index Composite. Sexual health scores did not change significantly over 58 weeks (total change = -0.49, P = .742), despite significant improvements in urinary (total change = 8.98 points; P < .001) and bowel symptoms (total change = 8.25 points; P < .001). Greater early improvement in urinary symptoms predicted higher sexual satisfaction (95% CI = 0.02-0.19; P = .015), with stronger associations observed among men (bmale*change = 3.30, P = .032, CI = 0.38, 6.32). Although HBOT improves pelvic LRTIs, persistent sexual health challenges highlight the need for comprehensive, multidisciplinary survivorship care. Strengths include a relatively large, gender-balanced sample, longitudinal design, validated measures, and a standardized treatment protocol. The absence of a control group limits causal inference. Despite improvement of urinary and bowel symptoms, HBOT does not seem to restore sexual health. Further research is needed to confirm these findings and address other sexual health interventions. ClincalTrials.gov registration number NCT03570229.
This paper examines how Italian teenagers construct meanings, norms and boundaries around sexting within their everyday digital cultures. Drawing on six vignette-based focus groups with 49 participants aged 16-18 years, the study used a media practice approach to analyse how teenagers collectively interpret a hypothetical sexting vignette. Findings show that participants overwhelmingly rely on heteronormative scripts, reproducing the dominant "girl-sends-nude-to-boy" narrative and positioning boys as initiators, while girls bear the potential risks. Sexting was consistently framed through risk discourses-particularly the threat of non-consensual dissemination-leading girls to internalise fear, self-policing, and responsibility for managing potential harm. Peer gossip further reinforced these risk narratives, circulating cautionary tales that blurred the boundaries between consensual and non-consensual practices and sustained moral regulation among peers. In response, teenagers constructed informal boundaries distinguishing "appropriate" from "unsafe" sexting, often limiting acceptable practices to long-term relationships and less explicit content. These findings highlight how risk discourses, peer surveillance and entrenched gender norms constrain teenagers' digital intimacies, particularly in an Italian context marked by limited sexuality education and persistent gender inequalities. The paper argues for research and pedagogical approaches that move beyond risk prevention to support teenagers' rights to agentic digital intimacies.
Color production in lizards has traditionally been explained by interactions among dermal chromatophores, yet the full diversity of coloration mechanisms remains incompletely understood. Additionally, while most studies focus on visible colors, UV reflectance plays a crucial role in lizard signaling and its mechanistic basis remains poorly characterized. Here, we investigate the UV-blue patches of Podarcis lizards. Using spectrophotometry, histology, electron microscopy, Raman spectroscopy, and optical modeling, we show that UV-blue coloration arises from interactions between carotenoid-containing epidermal xanthophore-like cells-an uncommon feature in vertebrate skin-and two morphologically distinct classes of iridophores. Superficial iridophores shape short-wavelength UV-blue reflectance, whereas deeper iridophores contribute to a secondary yellow-green peak. Although this mechanism is generalizable to other skin organizations, the UV-blue patches of Podarcis lizards exhibit a skin architecture not previously documented in vertebrates.
Complexes of the μ-oxo-bis(μ-acetate)diruthenium class exhibit ligand lability at the positions trans to the μ-oxo bridge. Lability is an important property for numerous drugs, such as cis-[Pt(NH3)2Cl2], given that its biological activity is related to an aquation reaction taking place in the biological environment. Inspired by that, we have synthesized, characterized, and explored the lability of the new complex [Ru2(μ-O)(μ-CH3COO)2(py)4(thiq)2](PF6)2 (1, py = pyridine; thiq = 5,6,7,8-tetrahydroisoquinoline). The aquation rates in water, phosphate, and tris-HCl buffered solutions were in the 10-4 s-1 range. Complex 1 quenched HSA fluorescence predominantly through a dynamic mechanism (kq = 1.74 to 2.50 × 1012 M-1 s-1, at 298 to 322 K, pH 7.2 tris-HCl buffer), and the HSA excited state lifetime changed markedly. Circular dichroism data showed that the HSA secondary structure did not change in the presence of complex 1. We rationalized these observations in terms of its hydrophilicity (logP = -0.42 ± 0.04), which probably prevented it from accessing the HSA inner hydrophobic pockets. On the basis of our data, lability in complex 1 did not favor any sort of interaction. Compared to the chemically inert [Ru3(μ-O)(μ-CH3COO)6(thiq)3]PF6 compound, complex 1 presented lower cytotoxicity against B16F10 and MCF7 cells. We assigned the small cytotoxic effect to complex 1 releasing the thiq organic ligand during its aquation. Despite not being a good metallodrug, complex 1 is a chemically useful scaffold for exploring ligand-release strategies in biological medium while yielding a non-cytotoxic aqua-complex.
Nanostructured sensors are increasingly deployed to mitigate the complexities of the global polycrisis, including climate instability, antimicrobial resistance, pandemics, and emerging technological disruptions. While advanced nano-interfaces (such as MXenes, quantum dots, and MOFs) possess the requisite sensitivity, their efficiency is hindered by large-scale, high-dimensional, and stochastic physicochemical responses. This review articulates a necessary paradigm shift toward unsupervised machine Intelligence as the primary interface between nanostructured sensor hardware, raw data manifolds, and system-level interpretation. It critically examines the foundational methodologies, including clustering for discrete-state identification, Principal Component Analysis for decoupling cross-sensitive material kinetics, manifold learning for nonlinear structure visualization, Independent Component Analysis for blind source separation, and autoencoders for nonlinear denoising and anomaly detection. These approaches extract latent dynamical structures directly from raw nanosensor measurements without dependence on extensive labelled datasets, effectively handling drift, hysteresis, and environmental noise. Moving beyond purely statistical optimisation, it analyse hybrid architectures that embed conservation principles, symmetry conditions, and topological regularities directly into learning algorithms, ensuring outputs follow the system's physical constraints. Finally, to address scalability challenges, including edge-native computing and privacy-preserving federated learning, it argues that converging advanced sensing nano-interfaces with constraint-regulated unsupervised intelligence is critical for developing self-calibrating material-sensor intelligence ecosystems to navigate polycrisis.
To examine associations between cardiometabolic conditions and health-related quality of life (HRQoL) and evaluate temporal trends in condition-associated HRQoL decrements from 2001 to 2022. We analyzed nationally representative data from U.S. adults aged ≥ 18 years in the Medical Expenditure Panel Survey (2001-2022), excluding years without BMI data collection (2017, 2019, 2021). HRQoL was measured using EQ-5D utilities mapped from SF-12 scores with a validated algorithm. For each year, survey-weighted multivariable regression models estimated associations of sociodemographic characteristics, BMI, and six cardiometabolic conditions with HRQoL. Temporal trends in condition-associated HRQoL decrements were assessed using meta-regression. To estimate recent average associations, we pooled data from 2015, 2016, 2018, and 2022. HRQoL improved over time, with lower values in 2001-2012 than 2013-2022 and an increase from its lowest value in 2012 (0.873) to highest in 2018 (0.888). Stroke contributed the greatest adjusted HRQoL decrement, followed by heart disease, diabetes, high blood pressure, obesity, and high cholesterol. Diabetes- and heart disease-associated decrements attenuated linearly over time (-0.0500 in 2001 to -0.0414 in 2022 and -0.0611 to -0.0487, respectively) , whereas high blood pressure-associated decrement was greatest around 2012 (-0.0361 in 2001, -0.0404 in 2012, and - 0.0313 in 2022) and obesity-associated decrement was smallest around 2012 (- 0.0311, - 0.0290, and - 0.0370). Changes in condition-associated HRQoL decrements over time suggest that utility values may not remain constant across calendar years. Smaller decrements for diabetes and heart disease may reflect better treatment and management, whereas the growing obesity-related decrement may indicate changes in the national severity of obesity. These patterns highlight the need for current, nationally representative utility estimates in population health research. Cardiometabolic conditions such as diabetes, heart disease, stroke, high blood pressure, obesity, and high cholesterol are common chronic diseases in the United States and can reduce health-related quality of life. However, it is unclear whether their impact on health-related quality of life has changed over time as disease management and treatment have improved. Using nationally representative survey data from U.S. adults collected between 2001 and 2022, we estimated how much each cardiometabolic condition reduced health-related quality of life and whether the condition-specific estimates have changed over time. Overall health-related quality of life improved between 2001 and 2022, with the greatest gains among older adults. Stroke had the largest negative impact on health-related quality of life, followed by heart disease, diabetes, high blood pressure, obesity, and high cholesterol. The health-related quality-of-life gap between adults with and without diabetes or heart disease has narrowed over time, a pattern consistent with improved disease management and treatment. In contrast, the quality-of-life gap associated with obesity increased in recent years, a pattern consistent with the rise in severe obesity nationally. Researchers and policymakers may use up to date quality of life estimates rather than older figures when evaluating the burden of cardiometabolic disease. Using updated disease-attributable health-related quality of life estimates would better reflect the current burden of cardiometabolic disease.
Postoperative adjuvant radiotherapy for breast cancer is frequently associated with acute treatment-related symptoms that negatively affect quality of life (QoL). This prospective controlled study evaluated the efficacy of an electronic patient-reported outcome (ePRO)-guided symptom management pathway integrated into routine radiotherapy care. A total of 117 patients were enrolled, and 105 completed radiotherapy and were included in the final analysis (usual care, n = 52; usual care plus ePRO-guided management, n = 53). The primary endpoint was the longitudinal trajectory of acute symptom burden, while the secondary endpoint was change in QoL during treatment. Validated symptom and QoL instruments were administered longitudinally, and outcomes were analyzed using linear mixed-effects models adjusted for prespecified baseline covariates. Compared with usual care, the ePRO-guided group demonstrated significantly lower peak symptom severity, faster symptom recovery toward the end of treatment, and more favorable longitudinal trends in global and breast cancer-specific QoL domains (all P < 0.05). The ePRO-guided pathway integrated weekly monitoring, automated alert generation, and nurse-led stratified interventions into a closed-loop management workflow. These findings suggest that integrating ePRO-triggered symptom management into routine radiotherapy practice may reduce acute symptom burden and support patient-centered care during breast cancer radiotherapy.
The aims of this study were to investigate whether children from different culturally and linguistically diverse (CALD) backgrounds in Australia have similar Health Related Quality of Life (HRQoL), in early childhood, middle childhood, and adolescence. We used data from 9099 children from the Longitudinal Study of Australian Children (LSAC), aged between 2 and 17 years, including HRQoL measured with the parent proxy Pediatric Quality of Life Inventory (PedsQL). The study pertained to cohort data from 2004 to 2018. CALD groups were defined according to child, mother's and father's country of birth and main language spoken at home. The association of child HRQoL with CALD group, was analysed using generalised estimating equations, adjusted for age, sex, socioeconomic position (SEP) and weight status. Children of Middle Eastern or North African, South-East Asian, South and Central Asian and Oceania backgrounds had significantly lower HRQoL (p < 0.05) than children from English speaking backgrounds. These disparities were greatest during middle childhood and adolescence and only partly explained by lower SEP and weight status. Disparities in physical HRQoL were greater than psychosocial HRQOL. Considerable inequity in HRQoL is present in Australian children from different CALD backgrounds. This study highlights the need for culturally tailored programs for school-aged children to improve their physical HRQoL. Health-related quality of life is an important measure of child overall health and includes physical and psychosocial health. There is evidence for lower quality of life in some culturally diverse populations, but no studies have examined this in children and adolescents. We used data from a very large Australian study that measured quality of life of children from age 2 to age 17 years and found lower quality of life among some cultural groups that developed primarily in middle childhood. Disparities in physical HRQoL were greater than psychosocial HRQOL. This highlights the need for culturally tailored programs for school-aged children to improve their physical HRQoL.
To date, there is no reliable and valid screening tool for paraphilic disorders (PDs) based on the diagnostic criteria of the International Classification of Diseases (ICD-11). The present study aimed to develop and cross-culturally examine the cross-cultural applicability of a new screening tool for PDs following the ICD-11 guidelines. Top-down item development was conducted with expert practitioners in the field. Data were collected in 26 languages across 42 countries (N = 82,243; 39.5% men; 57.0% women; 3.4% gender-diverse; Mage = 32.39 years, SD = 12.52). Cut-off scores were established per ICD-11 guidelines, and at-risk groups were compared with low-risk groups along theoretically relevant correlates (e.g., depression, anxiety). The Paraphilic Disorders Short Screen (PDSS) assesses seven paraphilias via 21 items. Voyeurism was most common paraphilic interest (PI) (19.42% of the total sample; n = 15,970), which also had the highest number of participants meeting the ICD-11 diagnostic cut-off (3.24%; n = 2,662). PI and PD groups consistently demonstrated more severe depression and anxiety symptoms than others. The PDSS is a reliable and valid screening tool that follows the latest ICD-11 guidelines; therefore, it has the capacity to enhance clinical practice and research by identifying individuals at risk.
This study aimed to assess aspects of validity of four FACE-Q Aesthetics scales in a sample of patients undergoing and planning facial minimally invasive cosmetic procedures (MICPs), such as botulinum toxin, lip augmentation and soft tissue augmentation treatments. In 2023, a cross-sectional survey included 210 Hungarian women who had undergone and 147 planning facial MICPs, with similar mean ages Respondents completed four FACE-Q scales (Aging Appraisal, Appearance Distress, Early Life Impact and Age VAS), EQ-5D-5L, Rosenberg Self-Esteem Scale (RSES) and the Brief Fear of Negative Evaluation Scale-Straightforward Items (BFNE-S). Comprehensibility, ceiling/floor effects, structural validity (principal component analysis, confirmatory factor analysis), internal consistency, and construct validity (convergent, divergent, known-group validity) of the four FACE-Q scales were assessed. All FACE-Q scales, except the Age VAS, showed a ceiling effect (20-28%). Appearance Distress showed strong convergent validity with RSES (r = 0.742), BFNE-S (r = - 0.702), and EQ-5D-5L anxiety/depression (r = - 0.519). Aging Appraisal and Appearance Distress scales were unidimensional, whereas Early Life Impact Scale had a three-factor structure. All four FACE-Q scales were able to differentiate between known groups of patients based on self-esteem, fear of negative evaluation and acceptance of bodily appearance. Women who had undergone procedures reported higher Aging Appraisal (72.9 vs. 63.3) and Appearance Distress (77.1 vs. 68.4) scores and felt younger (- 5.0 vs. - 2.8 years) than those planning them (p < 0.001 for all). Our findings provide initial support for the validity of the four FACE-Q scales in MICP populations, but further validation (e.g. assessment of responsiveness and test-retest reliability) is needed.
To determine psychometric cut-off points for the male and female versions of the Sexual Quality of Life Questionnaire for Coronary Heart Disease (SQoL-CHD), and to validate their effectiveness in distinguishing patients with low vs. high sexual quality of life, as well as their association with psychological distress. A cross-sectional study using convenience sampling was conducted among 1,368 patients with coronary heart disease from a large general hospital in Henan Province, China between March and December 2024. The sexual quality of life questionnaire for patients with coronary heart disease (male version and female version), the Generalized Anxiety Scale (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9) were used for measurement. LPA was used to identify latent classes of sexual quality of life, and then ROC analysis was used to determine the optimal cut-off point, and its validity was verified by anxiety and depression levels. LPA results show, the sexual quality of life for both male and female patients was classified into three latent classes, demonstrating high classification accuracy (Entropy > 0.96). ROC analysis determined that the optimal cut-off point for the female version of the questionnaire was 58 (sensitivity 96.8%, specificity 96.6%, AUC = 0.997), and that for the male version was 68 (sensitivity 98.5%, specificity 99.0%, AUC = 0.999). The cut-off point validation results showed that the patients in the low sexual quality of life group had significantly higher scores in sexual physiology, sexual psychology, sexual cognition dimensions, as well as anxiety and depression levels than those in the high sexual quality of life group, and male patients had a higher risk of anxiety and depression. The SQoL-CHD questionnaire cut-off points demonstrate strong psychometric properties and are effective for identifying CHD patients at risk of low sexual quality of life and higher levels of anxiety and depression symptoms, supporting their use in targeted clinical screening and intervention.
Generic measures of health-related quality of life (HRQoL), such as the EQ-5D, may inadequately capture the impact of cognitive impairment in schizophrenia, resulting in incorrect QALY estimates in economic evaluations. This study aimed to obtain health utilities by valuing key items of the Patient-Reported Experience of Cognitive Impairment in Schizophrenia (PRECIS) instrument. First, expert interviews and psychometric analysis of the 28-item version of the PRECIS were performed to identify the best-performing and most relevant items. Second, health states based on the four selected PRECIS items representing memory, communication, executive function and attention (each with five levels of severity) were valued by the UK general public through a discrete choice experiment (DCE) survey and composite time trade-off (cTTO) interviews. To estimate a utility scoring algorithm, the DCE data were analyzed using mixed logit models and rescaled onto a 0-1 (dead to full health) utility scale using the cTTO results. The cTTO utility for the best health state (level 1, "not at all hard", across all domains) had a mean utility of 0.992 (SD 0.038) while the worst state (level 5, "very hard", across domains) had a mean utility of 0.292 (SD 0.479). All domains significantly predicted larger utility decrements with increasing impairment severity. This study demonstrated the feasibility of quantifying health utility values for patient-reported cognitive impairment domains using the validated PRECIS instrument. The resulting utilities can capture the HRQoL impact of cognitive impairment, supporting more accurate future economic evaluations of therapies targeting cognitive function in schizophrenia. New treatments are under development that aim to improve cognitive impairment in schizophrenia. Studies estimating the costs and benefits of these treatments, used for reimbursement decisions, often underestimate the benefits because generic questionnaires used to measure the quality of life of patients, don’t include questions on cognition. This study addresses how to more accurately capture and quantify the impact of cognitive impairment in schizophrenia on quality of life to make accurate reimbursement decisions. Based on an existing questionnaire that assesses the patient-reported cognitive impairment in schizophrenia (PRECIS) the most important aspects of cognitive impairment for patients were selected. The UK general public was asked to value the importance of the selected four items and their answer options, Results showed that the selected aspects, memory, communication, executive function, and attention all had an impact on quality of life with worse quality of life outcomes when the level of impairment was larger. This study contributed to a method for more accurate estimates of the benefits of new treatments aiming to improve cognitive impairment in schizophrenia.