Autism screening in childhood is common, yet little is known about its potential psychological impact on caregivers. The U.S. Preventive Services Task Force, an independent national panel of disease prevention experts, stated that this gap in knowledge limited their ability to endorse universal autism screening. This study examined the psychological impact of autism screening, using data from a large community-based sample (n = 1272) involving online caregiver-completed autism screeners at child age 6, 9, 12, 18, and 24 months. Caregivers completed the Participation Impact Questionnaire retrospectively (mean child age at completion 37.2 ± 4.8 months) to measure feelings about screening. A minority (34.7%) of the sample reported presence of ≥ 1 negative feeling; the most commonly endorsed was "worried". Among this subset, negative feelings were of short duration (lasted for < 1 day in 56.9%), were mild in severity (86.4%), and did not affect functioning (85.3%). A majority (86.2%) also reported ≥ 1 positive feeling. Our findings address a critical evidence gap regarding potential harms of autism screening and support universal screening, given that psychological harms are not common and have low functional impact, as well as possible psychological benefits. Although screening for presence of autism among young children is commonly done, little is known about its potential psychological impact on caregivers. There is very limited information related to this topic currently, with the U.S. Preventive Services Task Force, an independent national panel of experts, stating that this gap in knowledge limited their ability to make recommendations related to guidelines on routine autism screening for all children. This study addresses this knowledge gap and aimed to study the potential psychological impact (harms, as well as benefits) of autism screening in caregivers. Data was obtained from a longitudinal study involving online caregiver‐completed autism screeners at child age 6, 9, 12, 18, and 24 months. Caregivers were notified at child age 18–24 months if their children had screened positive at any time‐point and offered diagnostic evaluation to determine a final outcome by 36 months. Subsequently caregivers were invited to complete the Participation Impact Questionnaire (PIQ) which was designed to measure negative and positive feelings about screening, their duration, and functional impact. In our study, a total of 1272 caregivers completed the PIQ. Only a minority (34.7%) reported presence of ≥ 1 negative feeling; the most commonly endorsed feeling was “worried”. Among those who reported these feeling(s), they were of short duration, were mild in severity and did not affect day‐to‐day activities in the majority. A majority (86.2%) also reported ≥ 1 positive feelings; the most common ones were “interested” and “curious.” Study findings suggest that psychological harms reported by caregivers following autism screening are less common than positive feelings and even if present, have short duration, low functional impact, and low severity. Our findings are in support of recommendations toward universal autism screening recommendations, given low harm potential and possible psychological benefits of screening on caregivers.
Oral lichen planus (OLP) is a chronic autoimmune mucocutaneous disorder influenced by oxidative stress (OS) and psychological factors. Malondialdehyde (MDA), a lipid peroxidation product, serves as a reliable non-invasive biomarker of OS, measurable in saliva. While elevated MDA levels have been reported in OLP, limited research has explored its association with psychological stress. This study aimed to assess salivary MDA levels in OLP patients and correlate them with psychological parameters. This cross-sectional study included 25 clinically and histopathologically confirmed OLP patients and 25 age- and sex-matched healthy controls. Unstimulated saliva samples were collected and analysed for MDA using ELISA. Psychological stress was evaluated using the Depression, Anxiety, and Stress Scale-21 scale. Data were analysed using an independent t-test and the Karl Pearson correlation coefficient test (P < 0.05). Mean salivary MDA levels were significantly higher in the OLP group (3.58 ± 1.69 nmol/mL) than in controls (1.73 ± 1.32 nmol/mL) (P = 0.0001). No significant difference in MDA levels was observed between reticular (3.61 ± 1.46) and erosive (3.54 ± 2.01) OLP types. Psychological scores were significantly elevated in OLP patients, stress 15.12 ± 5.10 (P < 0.0001), anxiety 9.68 ± 4.61 (P < 0.0001), depression 13.60 ± 4.40 (P < 0.0001). However, no significant correlation was found between salivary MDA levels and psychological scores in the OLP group. Salivary MDA is a valid marker of OS in OLP. While psychological stress levels were significantly higher in OLP patients, no direct correlation was found between OS and psychological parameters.
This study aims to explore whether psychological detachment mediates the relationship between job stress and presenteeism among clinical nurses, and to determine the extent of the interaction between job stress, psychological detachment, and presenteeism. This study employed a convenience sampling method to select clinical nurses from five hospitals in Sichuan Province as the subjects of the investigation. A questionnaire survey was conducted using a general information survey form, the Chinese Nurses Stressor Scale (CNSS), the Psychological Detachment Questionnaire (PDQ), and the Stanford Presenteeism Scale-6 (SPS-6). A total of 325 valid questionnaires were collected. The mean scores for the CNSS, PDQ, and SPS-6 were (94.64 ± 15.89), (9.76 ± 3.60), and (21.01 ± 5.42), respectively. A positive correlation was observed between clinical nurses' presenteeism and job stress, while a significant negative correlation was found with psychological detachment (all p < 0.05). Job stress positively predicted presenteeism, whereas psychological detachment negatively influences presenteeism. Furthermore, psychological detachment partially mediates the relationship between job stress and presenteeism among clinical nurses, with an indirect effect of 0.06, accounting for 30% of the total effect. The findings indicate that job stress exerts both direct and indirect effects on the presenteeism of clinical nurses, with psychological detachment serving as a partial mediating factor that attenuates nurses' levels of presenteeism.
Despite most of the world's population having poor access to mental health services, scalable interventions delivered by trained non-specialists are implemented widely in low-income and middle-income countries (LMICs). Many people do not respond to these interventions, which has led to initiatives to adopt stepped care frameworks that provide people who do not respond to initial interventions with more intensive interventions. However, to date, the efficacy and cost-effectiveness of stepped care frameworks for scalable interventions have not been evaluated in LMICs. This trial aims to evaluate effectiveness and cost-effectiveness of psychological stepped care for distressed adults in an LMIC. We did a single-blind, parallel, randomised controlled trial in Jordan with psychologically distressed adults who were randomly assigned (1:1) to a single intervention or stepped care model. Participants were required to be aged 18 years and older, Jordanians or refugees residing in Jordan, and have scores of at least 20 on the Kessler Distress Scale. Exclusion criteria were imminent suicide risk, psychotic disorder, severe cognitive impairment, risk to the person's safety, plan to return to Syria in the next 12 months, or no telephone access. Computerised software was used for randomisation to generate random number sequences in blocks of four, stratified according to nationality status by personnel independent of the trial. Assessors were masked to intervention condition. All participants received WHO's Doing What Matters in Time of Stress (DWM) programme, which comprised a five-session guided self-help programme. For participants who reported psychological distress after DWM, those in the single intervention group received enhanced usual care, whereas those in the stepped care group received WHO's Problem Management Plus, a five-session group psychological intervention. The primary outcome was between treatment group change in anxiety and depression severity assessed at 3 months after treatment (primary outcome timepoint) based on intention-to-treat analysis. Cost-effectiveness was also assessed. The trial was prospectively registered on the Australian New Zealand Clinical Trials Registry, ACTRN12621000189820, and is completed. Between June 8 and Oct 8, 2023, 1233 individuals were screened for study inclusion and 432 were excluded (371 due to minimal distress, 30 due to a suicide risk, and 31 decided not to proceed), resulting in 801 participants being enrolled into the study. 400 participants were randomly assigned to the stepped care group and 401 were randomly assigned to the single intervention group. 753 participants were female (94%), 48 (6%) were male, and the mean age was 40·7 years (SD 11·1). At the 3-month assessment, participants enrolled in stepped care reported greater reduction of anxiety (mean difference 1·9 [95% CI 0·6-3·2; p=0·0030; effect size 0·3 [95% CI 0·1-0·5]) and depression (mean difference 2·9 [0·9-5·0]; p=0·0050; effect size 0·3 [0·1-0·5]) than participants in the single intervention group. The incremental cost per quality-adjusted life-year gained for stepped care (in international dollars [INT$]) would be INT$23 641 and has a 76% likelihood of being cost-effective at a threshold of INT$31 879 in Jordan. Stepped care of WHO's evidence-based scalable interventions can provide greater benefits in reducing common mental disorders compared with a single intervention. Although a more resource-demanding treatment strategy, stepped care can be cost-effective in terms of its capacity for relatively greater improvements in mental health in LMICs. Elrha through the Research for Health in Humanitarian Crises (R2HC) programme. For the Arabic translation of the abstract see Supplementary Materials section.
Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) represent a major advancement in obesity treatment, offering robust efficacy in weight loss and metabolic regulation. Beyond these effects, emerging evidence indicates that GLP-1 RAs also modulate appetite, reward sensitivity, and self-regulation, domains that intersect with behavioral and psychological functioning. This review adopts a biopsychosocial perspective to examine how GLP-1 RAs interact with eating behavior, mood, identity, and self-regulation, particularly in individuals with binge eating disorder (BED) or other psychiatric comorbidities. A clinical framework is proposed to integrate pharmacotherapy with lifestyle and psychological interventions. The temporary reduction in appetite and food reward may create a "low-drive window" in which behavioral strategies such as self-monitoring or stimulus control become more effective. However, high emotional eating, mood symptoms, or identity conflicts may moderate treatment response. Given the high prevalence of psychiatric comorbidities, structured screening using tools like the Patient Health Questionnaire-9 (PHQ-9) or Binge Eating Scale (BES) is recommended. A stepped-care approach from brief digital interventions to formal psychotherapy may help address varying support needs. Crucially, weight regain after discontinuation is common. The review discusses behavioral, psychological, and social mechanisms of relapse and highlights strategies for long-term stabilization. These include emotion regulation, body image work, and maintenance-focused behavioral interventions. GLP-1 RAs should therefore be seen not as standalone treatments but as facilitators of self-directed, sustainable change within integrated care models. Future research should define composite outcomes, explore digital tools for relapse prevention, and develop adaptive pathways tailored to individual psychological profiles.
Stigma is a critical barrier to adolescents' willingness to seek professional mental health support, yet less is known about whether non-stigmatizing attitudes toward peers with mental health problems are associated with adolescents' help-seeking attitudes. This study examined correlates of adolescents' attitudes toward seeking professional psychological help. A sample of 686 Chinese adolescents (Mean age = 16.67 years, SD = 2.39 years; 55.2% were females) completed measures of depressive and anxiety symptoms, non-stigmatizing attitudes toward peers with mental health problems (perceived competence and social acceptance), and attitudes toward seeking professional psychological help. Hierarchical regression analyses indicated that female adolescents reported more positive help-seeking attitudes compared to males. Higher levels of depressive and anxiety symptoms were associated with less favorable help-seeking attitudes. Notably, perceived competence positively predicted help-seeking attitudes, whereas social acceptance showed a negative association. The final regression model accounted for 13.1% of the variance in help-seeking attitudes. These findings suggest that adolescents' help-seeking attitudes are shaped not only by emotional distress, but also by how psychological difficulties are understood and evaluated within the peer context. Interventions may benefit from addressing both emotional distress and peer-related stigma processes while fostering supportive environments that make professional help more acceptable and accessible to adolescents.
This study aimed to examine the prevalence of mobbing experiences among family medicine residents in Turkey. A cross-sectional prevalence study was conducted with 406 volunteer physicians undergoing family medicine residency training. Data were collected via an online survey including sociodemographic questions and a modified Mobbing Scale, which assessed mobbing behaviors across five sub-dimensions: lack of communication, boycott and isolation, threats and violence, reduced work commitment, and job and career barriers. Statistical analyses were performed using IBM SPSS Statistics version 25, with statistical significance set at p < 0.05. The findings revealed that 12.68% of participants experienced mobbing, while an additional 12.70% were uncertain whether they had experienced mobbing. The most frequently reported mobbing experiences occurred in the domains of reduced work commitment (34.69%) and job and career barriers (24.13%). No statistically significant differences were observed based on gender, years of professional experience, or institutional affiliation. However, mobbing related to job and career barriers was more prevalent in Turkish Health Sciences University hospitals. Additionally, a positive correlation was identified between age and job commitment, suggesting that older participants exhibited higher levels of commitment to their work. The study indicates that mobbing remains a significant issue among family medicine residents, particularly concerning job commitment and career-related obstacles. These findings highlight the need for increased awareness and the implementation of preventive strategies to mitigate mobbing in healthcare environments, especially within large and hierarchical institutions.
Intimate partner violence is a major public health issue, affecting around 10% of women each year in France. Its consequences extend beyond the psychological sphere, directly influencing the control of chronic diseases and the occurrence of psychosomatic disorders frequently encountered in internal medicine. Prolonged exposure to stress and partner coercion perpetuates a vicious cycle between chronic illnesses, diffuse pain, unexplained fatigue, and somatic decompensations. Internists, given the comprehensive nature of their practice and the regular follow-up of vulnerable patients, are often confronted with the challenge of identifying such situations. Screening relies on attentive history-taking, observation of suggestive signs (social isolation, anxiety, medical nomadism), and the use of validated tools such as the WAST or the Violentomètre. Management should be multidisciplinary, integrating psychological, social, and legal support, through referral to specialized structures such as Maisons des Femmes, and through the training of healthcare professionals to improve detection and help break the cycle of violence.
This study explored oral hygiene behavior (OHB), physical and psychological oral discomfort (OD), and their relationship with sense of defeat (SoD) among Indonesian transgender individuals (warias), for whom oral health plays a vital role in social and sexual interactions. Given the orofacial area's impact on attractiveness and intimacy, poor oral health may significantly affect the wellbeing and perceived desirability of warias. A cross-sectional study was conducted in March-April 2019 among 92 warias, with a mean age of 36 years (standard deviation = 10.5) in Jakarta, recruited via cluster sampling from five districts. Data were collected using a digital, semistructured questionnaire, including an OHB index and the Indonesian version of the Oral Discomfort Scale, which measures both psychological and physical discomfort. Sense of defeat was also assessed. The study was classified as a one-time, non-invasive procedure and was exempt from medical research regulations. Correlation analyses showed that smoking was significantly positively associated with SoD (r = 0.25, p = 0.019), but not with OD or OHB. Perceived oral health was significantly positively associated with experienced emotional aspect (r = 0.31, p = 0.003) and with consumption of sugar-containing snacks and/or soft drinks (r = 0.24, p = 0.02), but it was significantly negatively associated with SoD (r = -0.24, p = 0.02), OD (r = -0.26, p = 0.01), and ODPhy (r = -0.27, p = 0.01). Linear regression analysis identified both SoD (β = 0.23, p = 0.023) and experienced emotional aspect (β = -0.30, p = 0.004) as significant independent predictors of OD, explaining 18% of the variance [R 2 = 0.18, F(3,91) = 7.58, p = 0.001]. The variable expectations of optimal OHB did not have a significant effect (β = -0.11, ns). Psychological distress-particularly feelings of defeat-plays a significant role in the oral health of Indonesian warias. Healthcare and social service providers consider this connection and both emotional wellbeing and oral self-care in interventions.
As third-year medical students transition into high-stakes, high-stress clinical environments like the emergency department (ED), they may experience significant personal trauma. However, little is known about how this trauma is experienced early in their training - specifically during the transition from preclinical to clinical learning environments. This study addresses that gap by exploring third-year medical students' experiences of trauma during the emergency medicine (EM) clerkship through the lens of Trauma-Informed Care (TIC) and identifies workplace factors and intersectional demographics influencing these experiences. This qualitative study used the critical incident technique to explore emotionally-significant events encountered by third-year medical students immediately after completing the EM clerkship as their first core clerkship at a single academic institution. We conducted a thematic analysis using the Substance Abuse and Mental Health Services Administration's six TIC principles. Data were triangulated with quantitative demographic data, and data saturation was confirmed through constant comparison and reflexive team discussions. Seventeen students participated, describing 19 critical incidents of trauma. The most common trauma types involved lack of peer support and lack of empowerment or voice. Intersectional factors such as race, gender, and age shaped both the type and nature of trauma. Clinical uncertainty, power differentials, and unprofessional behavior emerged as frequent triggers. Applying a trauma-informed framework to medical education reveals how structural and interpersonal factors contribute to student trauma when they transition to the clinical learning environment. These findings highlight opportunities for trauma-informed clerkship design and structured support to create safer, more inclusive learning spaces. Not applicable.
Attention-Deficit/Hyperactivity Disorder (ADHD) symptoms are frequently reported among incarcerated populations and have been associated with impulsivity, emotional dysregulation, and adverse mental health outcomes. Despite growing international evidence, no previous studies have examined screening-positive ADHD symptoms among prisoners in Paraguay or evaluated Spanish-language screening tools in correctional settings. To estimate the prevalence of screening-positive ADHD symptoms among incarcerated men and women in Paraguay, examine selected psychological and criminological variables, and assess the reliability and factorial structure of the Spanish version of the Symptom Check List-ADHD (SCL-ADHD). This cross-sectional study included 836 inmates (621 men, 215 women) recruited through probabilistic sampling in three Paraguayan prisons. Screening-positive ADHD status was defined as a score ≥ 12 on the nine-item SCL-ADHD derived from the SCL-90-R. Psychiatric symptoms, suicide risk, and substance-related problems were assessed using validated measures. Multivariable logistic regression identified independent correlates of screening-positive ADHD status. Screening-positive ADHD status was observed in 33.4% of participants, with higher prevalence among women than men (39.1% vs. 31.4%; OR = 1.40, 95% CI 1.02-1.93, p = 0.04). Screening-positive ADHD was independently associated with suicide risk (OR = 3.85, p < 0.001) and elevated SCL-90-R dimensions of hostility, anxiety, depression, and obsessive-compulsive symptoms. Sensitivity analyses using continuous symptom scores showed associations with hostility, anxiety, and obsessive-compulsive symptoms remained, whereas association with depression attenuated. No significant independent associations were observed with criminological variables. The Spanish SCL-ADHD demonstrated acceptable internal consistency (α = 0.76) and a coherent symptom structure. Screening-positive ADHD symptoms were common among incarcerated individuals in Paraguay, particularly women, and were associated with concurrent emotional dysregulation and suicidality. These findings reflect screening-based symptom burden rather than confirmed adult ADHD diagnoses and highlight the potential utility of systematic ADHD screening within correctional mental health services.
Understanding public beliefs about patients at memory centers may inform efforts to promote early diagnosis and guide clinical discussions of Alzheimer's disease (AD). Adults (N=3,527) read a vignette describing a fictional person at a memory center and rated the person's condition as a mental illness, part of typical aging, and psychological or biological origins. Vignettes varied by AD biomarker result, symptom stage, and treatment availability. Participants most strongly believed that the condition was part of typical aging and biological in origin, though beliefs varied across subgroups. Black and Asian participants reported stronger beliefs than White participants that the condition was a mental illness (β=0.39, P<0.001) and psychological (β=0.46, P<0.001). Men reported stronger beliefs that the condition was a mental illness (β=0.19, P<0.001), psychological (β=0.14, P<0.001), and part of typical aging (β=-0.08, P=0.04). Biomarker positivity heightened biological and lowered psychological attributions (all P<0.05). The findings offer specific insights to guide intervention.
Previous studies have linked endogenous pain modulation and corticospinal excitability (CSE), but methodological limitations and overlooking psychological factors may have constrained interpretations. This study aimed to evaluate the interaction between CSE excitability in different muscles and endogenous pain modulation, and to determine whether kinesiophobia and pain catastrophizing modulate this interaction. Twenty-one pain-free participants completed questionnaires on kinesiophobia and pain catastrophizing. Conditioned pain modulation (CPM) was used to assess endogenous pain modulation. Transcranial magnetic stimulation was used to assess the pain-induced modulation in CSE excitability, focusing on slope, S50 and the maximum response parameters of input-output curves (plateau) for the anterior deltoid (AD) and first dorsal interosseous (FDI) muscles, first in pain-free then in painful condition induced by the application of capsaicin cream to the shoulder. A significant correlation was found between the plateau of the AD input-output curves measured at baseline (pain-free condition) and CPM responses (rS = .56, p = 0.01), suggesting that higher maximal corticospinal output is associated with more effective endogenous pain modulation. Pain-induced changes in FDI slope and CPM responses were strongly correlated (rS = -.75, p < 0.001), indicating that individuals with the most effective endogenous pain inhibition mechanisms were those with the greatest increase in CSE. Finally, kinesiophobia was found to alter the association between pain-induced changes in CSE in AD (S50 shift) and CPM response, shedding new light on the influence of psychological factors on pain-induced CSE alterations and their link with descending pain inhibition. These findings underscore the complex interplay between corticospinal projections, pain modulation, and psychological factors, reinforcing the need for further investigation.
Irritable bowel syndrome (IBS) is a disorder of gut-brain interaction with symptoms including abdominal pain associated with a change in stool form or frequency. IBS global prevalence is around 4% and its impact on patient's quality of life and social functioning is substantial. Multidisciplinary working teams of the Israeli Society of Neurogastroenterology and Motility evaluated all validated approaches to IBS management. The aim was to develop a national, evidence-based position document on IBS management for general practitioners and adult and pediatric gastroenterologists. This position document comprehensively reviewed therapeutic options, including patient education (including specific national communities), dietary modifications (particularly the low FODMAP diet), antispasmodic drugs, probiotics, antibiotics (eg, rifaximin), secretagogues (eg, linaclotide), neuromodulators, psychological therapies (including cognitive behavioral therapy and gut-directed hypnotherapy), and complementary medicine approaches. The importance of establishing a positive physician-patient communication with a therapeutic partnership, including an empathic approach and implementation of the bio-psycho-social model, was also strongly emphasized. A structured treatment algorithm incorporating multiple therapeutic tools that are locally available was developed as well. We hope that this position paper will provide a practical and updated tool for the management of IBS in Israel and in other countries as well.
Spinal cord stimulation (SCS) is a well-established intervention for chronic pain, but the factors predicting treatment success remain unclear. This pilot study investigated psychometric and inflammatory biomarkers associated with clinical outcomes in patients undergoing SCS for chronic low back pain. Twenty-two eligible patients were enrolled. Clinical evaluations, psychometric assessments, and blood samples were collected at baseline and at 1-, 3-, and 6-month post-implantation. Pain intensity, psychological status, and quality of life were assessed using validated questionnaires. Inflammatory markers were analyzed in peripheral blood mononuclear cells (PBMCs) at both mRNA and protein levels. Nineteen patients completed the trial and received definitive SCS implantation (Trial Completed, TC group), while three were discontinued (Trial Failed, TF group). In the TC group, pain intensity and its interference with emotional and work life significantly improved. Psychometric scores also improved: pain catastrophizing decreased below the clinical threshold, and anxiety and depression scores were significantly reduced, alongside enhanced quality of life. Greater pain relief at follow-up was associated with lower pre-implant anxiety and depression levels. Cytokine analysis revealed downregulation of pro-inflammatory IL-1β and upregulation of anti-inflammatory IL-10 and IL-4 post-SCS. In the TF group, baseline depression was higher compared to the TC group. SCS trial implantation in these patients induced only IL-4 upregulation, without broader cytokine modulation. SCS significantly improved clinical and psychometric outcomes and positively modulated inflammatory profiles in patients with chronic low back pain. High baseline depressive symptoms may predict poorer SCS outcomes, suggesting the importance of psychological assessment in patient selection.
Cultural diversity is a defining feature of very high Human Development Index countries of the Western world. Asian immigrants represent a growing demographic in these countries and are a vulnerable group at risk of experiencing health disparities, including individuals surviving cancer. We synthesized available research evidence to evaluate the unmet needs, cancer care experience and factors affecting health-related quality of life of Asian immigrant cancer survivors living in countries in the Western world ranked as very high Human Development Index. This systematic review is reported in accordance with Preferred Reporting Item for Systematic Reviews and Meta-Analyses guidelines. Three electronic databases (MEDLINE, EMBASE, and CINAHL) were systematically searched in September 2023 and again in May 2024 to identify research studies of any design. Predefined inclusion criteria were applied, and findings from the included studies were synthesized narratively. Of 515 records identified, 31 studies met the inclusion criteria: 19 qualitative, 10 quantitative, and two mixed-methods studies. Thirty studies reported on samples of Chinese origin (25 studies with exclusive focus on Chinese immigrants). Six studies reported on samples of Arab origin (one study with exclusive focus on Arab immigrants). Frequently reported unmet needs for both Chinese and Arab immigrants included access to high-quality information, psychological and social support services, and professional interpreter services. Communication with healthcare professionals was often reported as problematic. Psychological burden was commonly reported and negatively affected health-related quality of life in both groups. Cultural beliefs strongly influenced cancer experiences, particularly among Chinese immigrants, who often reported experiencing stigma. While our findings apply predominantly to Chinese and Arab immigrant cancer survivors, it is evident that wealthy living environments and well-developed healthcare systems/services are not panacea. Addressing the unique needs of immigrant cancer survivors, as well as barriers experienced in accessing supportive cancer care in the host country is essential to promoting equitable cancer care. Improving accessibility, navigation, and health literacy are key strategies to optimize outcomes for these populations, together with a need to re-shape supportive care approaches to suit cultural norms and preferences. To promote equity, nurses are required to demonstrate cultural sensitivity and proactive awareness of how immigrant status might influence how cancer as a personal and family illness can be experienced. Nurses should carefully assess the specific needs of immigrant cancer survivors and enable bespoke navigation within the health care system and in the community to effectively respond to these needs.
Common adverse reactions to breast cancer chemotherapy (nausea, vomiting, sleep disorders, anxiety, depression) are often suboptimally managed. These symptoms undermine patients's quality of life and reduce chemotherapy adherence. Two non-invasive Traditional Chinese Medicine (TCM) interventions-transcutaneous electrical acupoint stimulation (TEAS) and acupressure have demonstrated efficacy in alleviating such discomforts, data on their effectiveness and dynamic therapeutic characteristics throughout the full chemotherapy course remain insufficient. 198 breast cancer patients receiving chemotherapy were subjected to simple randomization using R4.4.2, and randomly assigned to the control group, TEAS group, and acupressure group for a longitudinal follow-up over four chemotherapy cycles. Generalized estimating equations (GEE) were used to analyze intervention effects and post-hoc multiple comparisons, supplemented by intention-to-treat (ITT) analysis and per-protocol set (PPS) analysis. Main time effect: With the progression of chemotherapy cycles, the risk of delayed chemotherapy-induced nausea and vomiting (delayed CINV) significantly increased; patients' anxiety levels were higher in the early stage of chemotherapy cycles and showed a downward trend after the 3rd cycle. Main intervention effect: TEAS significantly improved patients' quality of life(QOL), while acupressure primarily alleviated psychological symptoms such as anxiety and depression. Interaction effect: The therapeutic effect of TEAS was cumulative, exerting more pronounced benefits in reducing the risk of delayed CINV, improving sleep quality, and relieving delayed nausea during the mid-to-late stages of chemotherapy (cycles 3-4); acupressure achieved optimal anxiety relief in the early stage (cycle 1) and progressively alleviated delayed nausea and enhanced QOL throughout the treatment course. TEAS and acupressure exhibit dynamic and distinct effects in mitigating adverse reactions in breast cancer patients undergoing chemotherapy. TEAS is more suitable for the comprehensive improvement of physical symptoms and QOL during the mid-to-late stages of chemotherapy, while acupressure is preferred for early anxiety relief and gradual improvement of psychosomatic symptoms throughout the treatment. These findings provide a reference for the development of individualized non-invasive clinical intervention strategies. https://www.chictr.org.cn/, identifier ChiCTR2300077667.
The COVID-19 pandemic disrupted nursing education worldwide, limiting clinical learning opportunities and increasing psychological stress. These challenges forced nursing students to make career decisions in uncertain, risky, and changing social environments. To explore the scope, influencing factors, and strategies related to nursing students' career choices after the pandemic. A scoping review following Arksey and O'Malley's framework. Six databases were searched without restrictions on language or publication date. Seventeen studies involving 5167 nursing students from Asia, Europe, and the Middle East were included. Data were analyzed thematically to identify career intentions, influencing factors, and development strategies. Most nursing students intended to remain in the profession, although their intentions varied by country and over time. Key positive influences included strengthened professional identity, societal recognition, and supportive learning environments. Negative influences included perceived occupational risk, inadequate compensation, and reduced clinical experience. Recommended strategies included flexible teaching approaches, enhanced clinical preparation, psychological support, and policy measures to improve working conditions and enhance professional image. Despite these significant challenges, many nursing students showed resilience and a willingness to remain in nursing. Investment in education, mentorship, and workforce policy is vital to sustain the nursing workforce and strengthen healthcare resilience in the face of future crises.
Physical activity reduces the risk of mortality and age-related chronic diseases, yet its association with biological age measured by DNA methylation (DNAm) clocks remains unclear. This systematic review and meta-analysis aims to evaluate the association between physical activity and biological age measured by DNAm clocks. In this systematic review and meta-analysis, we conducted a systematic search of Embase, Cochrane Central Register of Controlled Trials, PubMed, Ovid, Scopus, and Web of Science from Jan 1, 2011, to June 6, 2025, to identify articles on the associations of physical activity and DNAm age, epigenetic age acceleration (EAA), or epigenetic age deviation in humans. Studies were included if they were peer-reviewed, published in English, included a study population with a mean or median age of 18 years or older, and investigated the association between DNAm clocks and physical activity in humans. Studies were excluded if the study population was a disease-specific population without controls. We evaluated risk of bias using an adapted Newcastle-Ottawa Scale and Cochrane Risk of Bias scale. We then performed a random-effects meta-analysis using reported or estimated standardised β coefficients and SEs. We also conducted a publication bias analysis and influence analysis. The study was registered with PROSPERO, CRD42024499021. We identified 34 437 articles and, after removal of duplicates and screening, 44 studies were included in the systematic review comprising 145 465 participants: 62 887 (43·2%) females and 82 578 (56·8%) males, with mean ages ranging from 24·1 years to 78·5 years. Across studies, higher levels of physical activity were generally associated with lower DNAm age, although many individual associations did not reach statistical significance. Seven cross-sectional studies contributed to the meta-analysis. Each one SD higher in metabolic equivalent of tasks-min per week was associated with 0·03 SD lower Horvath EAA (β=-0·03 [95% CI -0·05 to -0·01]) and 0·09 SD lower GrimAge EAA (-0·09 [-0·12 to -0·05]). No statistically significant association was observed for Hannum EAA or PhenoAge EAA. Higher physical activity is significantly associated with lower biological age as measured by Horvath EAA and GrimAge EAA. However, evidence is predominantly from cross-sectional studies, limiting causal inference. Future longitudinal studies and clinical trials using standardised, objectively measured physical activity are warranted to clarify dose-response relationships, and to determine whether physical activity can causally modify ageing trajectories, thereby informing precision strategies for healthy longevity. The National University of Singapore and the National Medical Research Council of Singapore.
Intimate partner violence (IPV) can negatively impact both maternal and fetal outcomes. The present study aimed to determine the effects of positive psychology-based interventions on the levels of depression and anxiety symptoms, as well as conflict resolution strategies, in pregnant women exposed to IPV during the COVID-19 pandemic. A quasi-experimental design was employed involving 74 pregnant women with a history of IPV. Participants were assigned to either an intervention group (n = 37) or a control group (n = 37) through block randomization. The intervention consisted of 8 weekly sessions of a structured positive psychology program emphasizing positive emotional experiences, adaptive coping, gratitude practices, contentment exercises, and identification of personal strengths. The control group received routine prenatal care. IPV exposure was assessed using a domestic violence screening checklist. Outcomes were measured using the Conflict Tactics Scales, the Spielberger State-Trait Anxiety Inventory, and the Edinburgh Postnatal Depression Scale at baseline, 1 week, and 1 month following the intervention. Data were analyzed using SPSS version 25, with statistical significance set at p < 0.05. At baseline, no significant differences were observed between the groups in depression or state-trait anxiety scores. Post-intervention assessments demonstrated significant reductions in depression and anxiety symptoms in the intervention group compared with the control group at both follow-up time points (p < 0.05). In addition, scores on the negotiation subscale of the Conflict Tactics Scales showed significant improvement in the intervention group 1 week and 1 month after the intervention. Levels of psychological violence reported by participants were also significantly lower in the intervention group at post-intervention and 1-month follow-up (p < 0.05). Positive psychology-based interventions appear to be effective in alleviating psychological distress and strengthening conflict resolution strategies among pregnant women exposed to intimate partner violence.