Fear of falling (FOF) is a phenomenon prevalent among older adults associated with adverse outcomes, including reduced mental and physical health, decreased quality of life, and an overall reduction in social participation. Based on cross-sectional and longitudinal studies, recent reviews have provided information on the prevalence of FOF and its association with different health outcomes. To gain a deeper understanding of factors relevant to interventions to prevent or reduce FOF, this review goes beyond previous evidence syntheses by focusing on psychosocial factors that are longitudinally associated with FOF. The objective of the review is to provide an overview on evidence levels of psychosocial factors assumed to be longitudinally associated with FOF. Studies examining associations between psychosocial factors (predictors) and FOF (outcome) longitudinally were included. Cochrane CENTRAL, Embase, Scopus, and Web of Science were searched up to October 25, 2025. An ordinal rating scheme was used for data synthesis to assess beyond sociodemographic variables and other psychosocial factors. A modified version of the Newcastle-Ottawa scale was employed to evaluate study quality. Sixteen studies (n at baseline: 255-9,060) with a total of 30,724 participants reported longitudinal associations of 14 psychosocial factors with FOF. Higher depressive symptoms, anxiety, negative affect, and symptom burden, lower social activity, social participation, emotional support, and feeling older were linked to higher FOF. The relationship between depressive symptoms and higher FOF showed the most robust evidence, with six studies finding evidence for incremental validity of depressive symptoms beyond sociodemographic variables and other psychosocial factors. In contrast, higher self-efficacy, positive affect, social support, and social cohesion were associated with lower FOF. In some cases, the magnitude of associations was reduced when controlling for other variables. The evidence base remained weak for psychosocial factors other than depressive symptoms. Further longitudinal research is needed on the role of psychosocial factors for FOF. Such studies enlarge the evidence base for factors identified in this review and should include additional factors (e.g., loneliness). Our findings highlight the need for further research on the relationship between depressive symptoms and FOF for the development of effective interventions. Pre-registration ID: https://doi.org/10.17605/OSF.IO/X5ZGR.
Better evaluation of the contribution of the main diseases, injuries, and risk factors for mortality and life expectancy is crucial for more efficient policy making at the national and subnational levels in Iran. The aim of this study is to assess the effect of emerging causes of mortality on health, specifically COVID-19, which can help policy makers implement preventive measures in similar situations. In this systematic analysis of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023, we present estimates of cause-specific mortality at the national and subnational levels in Iran from 1990 to 2023. New to this iteration of GBD, we present a decomposition analysis of the contribution of specific causes of death to net gain or loss in life expectancy across 31 provinces of Iran. We used an array of data sources including censuses, vital registration, and surveys for national and subnational estimates. The two leading causes of death in Iran were ischaemic heart disease and stroke in both 1990 and 2019. However, in 2020 and 2021, the COVID-19 pandemic displaced the leading causes of death, ranking first with age-standardised mortality rates of 286·2 deaths (95% uncertainty interval 267·9-310·5) per 100 000 in 2020 and 250·0 deaths (233·2-272·5) per 100 000 in 2021. COVID-19 ranked second and tenth in 2022 and 2023, respectively. Life expectancy at birth for both sexes combined declined from 78·0 years (77·7-78·1) in 2019 to 74·3 years (74·0-74·4) in 2020. It steadily recovered to 78·8 years (78·5-79·2) in 2023. COVID-19 was the main cause of loss in life expectancy, by 4·19 years, between 2019 and 2020. There was a net gain of 12·4 years in life expectancy in Iran from 1990 to 2023. The net gain at the national level can be mostly attributed to reduced mortality from ischaemic heart disease (2·61 years), stroke (1·63 years), neonatal disorders (1·26 years), transport injuries (0·88 years), and neoplasms (0·64 years). The decline in mortality rates of major causes continued to 2023 despite the pandemic. An exception was Alzheimer's disease, which showed a 4·0% increase in rate between 2019 and 2023 and led to a net loss of 0·04 years in life expectancy since 1990. Diabetes led to a net loss of 0·09 years since 1990. There were variations between provinces in terms of age-standardised rates and the net change in life expectancy before and after the COVID-19 pandemic. The COVID-19 pandemic disrupted the rising trend of life expectancy in Iran, varying across provinces. Findings show that the health-care infrastructure and policies in Iran were not efficient in controlling the pandemic in 2020 and 2021, mainly due to inadequate vaccination coverage and timeliness, specifically for vulnerable subgroups. Sanctions may have aggravated the effect of COVID-19 on loss in life expectancy of Iranians. Despite the pandemic, the declining trend in age-standardised rates for top causes of mortality has continued to 2023, leading to a full recovery of life expectancy and underscoring the ultimate resilience of Iran's health system. Gates Foundation.
While family focused practice can improve outcomes for families affected by parental mental illness, globally there is limited understanding regarding associated factors and enablers. This mixed methods study aimed to identify associated factors and enablers of family focused practice. A range of adult mental health and children's social care professionals in Northern Ireland completed the Family Focused Mental Health Practice Questionnaire (n = 868). The survey measured the extent of professionals' family focused behaviors (Referral; Psycho-Education; and Skills and Knowledge to support parent and their parenting) and four organizational (e.g., Workplace Support) and four individual professional factors (e.g., Connectedness) associated with these activities. The STROBE checklist for cross-sectional research was adhered to. Nested regressions identified nine factors associated with family focused practice; most significant were professionals' gender, professional discipline, years of experience, training in the Family Model and other training in child or family focused practice. Male professionals, social workers and those with more years of experience and who had received training in the Family Model and other training in child and family focused practice were most family focused. Subsequently 30 professionals and 21 service users participated in semistructured interviews to elaborate on factors associated with family focused practice. Both professionals and service users described the importance of family focused training while social workers more often discussed receiving the training and engaging in family focused practice than other disciplines. As clear skill, knowledge, and confidence differences are indicated between the professions they require consideration by organizations in developing training, policy and initiatives to promote FFP within adult mental health and children's social services in Northern Ireland and internationally.
To our knowledge, previously there have been no reviews about the impact of social isolation on physical and mental health among people aged over 60, who are empty-nest older adults. To conduct an integrative review of empirical studies to provide a comprehensive understanding of social isolation and its influence among empty-nest older adults' health. An integrative literature review. PubMed, Web of Science, Scopus, Embase, EBSCOhost, CNKI, Wanfang data, VIP were searched for studies from the database inception to October 2025. Of 2,833 scrutinized articles, 14 were eligible for inclusion and subjected to independent quality appraisal. One mixed-method study, two qualitative research studies, and 11 quantitative research studies were selected. Social isolation among empty-nest older adults is linked to elevated physical health risks, including higher mortality, as well as mental health issues such as depression, self-neglect, loneliness, reduced life satisfaction, and cognitive decline. It also impacts comprehensive health indicators like intrinsic capacity and quality of life. Mediating factors, including aging attitudes, loneliness, perceived stress, and health-promoting behaviors, exacerbate these effects. Social isolation adversely affects both physical and mental health in empty-nest older adults, underscoring the need for developing interventions to promote social support networks and expand social connections.
Fear of childbirth (FOC) is a significant psychological concern that can adversely affect maternal well-being and childbirth outcomes. While various factors influencing FOC have been investigated, the influence of sexual quality of life (SQOL) has not yet been sufficiently researched. This study aimed to examine the relationships among FOC, SQOL, and depression in pregnant women. A descriptive, cross-sectional study. A cross-sectional study was conducted among 614 low-risk primiparous pregnant women aged 18-35 years in Kerman, Iran, between June 2022 and April 2023. Data were collected using the Wijma Delivery Expectancy/Experience Questionnaire Version A, the Edinburgh Postnatal Depression Scale, and the Female Sexual Quality of Life Questionnaire. A path analysis was conducted to examine the effects of SQOL, depression, and sociodemographic factors on FOC. The average age of the mothers was 26.9 ± 4.5 years, and that of the spouses was 29.9 ± 4.2 years. The average gestational age was 35 weeks. SQOL was not significantly correlated to FOC. In contrast, FOC was positively associated with depression (p < 0.001) and the age of the spouse (p = 0.008). The mother's age (p = 0.004) and the presence of chronic diseases (p < 0.001) were also significant negative predictors. In addition, maternal age was associated with better SQOL (p = 0.022), while depression (p < 0.001) and gestational age (p = 0.029) were significant negative predictors. Depression was a significant factor negatively related to both FOC and SQOL. Early detection and timely intervention for depression may reduce fear before labor and improve overall well-being during pregnancy. Depression, sexual quality of life, and fear of childbirth: A study of first-time pregnant women in IranFear of childbirth is a common concern for many women during pregnancy, especially those expecting their first child. In this study, more than 600 first-time mothers in Iran were surveyed to investigate whether depression and sexual quality of life were related to fear of childbirth. The results showed that women with depressive symptoms and women with older spouses were more likely to fear childbirth, while older women and women with chronic illnesses reported less fear of childbirth. Sexual quality of life was not related to fear of childbirth; however, it was influenced by other factors: older women reported better sexual quality of life, while depression and later stage of pregnancy were associated with poor sexual quality of life. These findings indicate the importance of early detection and timely intervention for depression in antenatal care to reduce fear of childbirth.
Social isolation is a prevalent issue among older people in long-term care facilities (LTCFs), with profound negative impacts on their quality of life and mental health. However, the authentic experiences and underlying mechanisms of social isolation among older people in LTCFs remain understudied. A nuanced understanding of these experiences is essential for designing targeted nursing interventions. This study aimed to systematically review and synthesize qualitative evidence to explore the experiences of social isolation among older adults in LTCFs and analyze them in terms of causes, mechanisms, outcomes, and strategies. A systematic review and qualitative meta-synthesis were conducted. We searched PubMed, Web of Science, Embase, PsycInfo, Cochrane Library, CINAHL, Scopus, Chinese Biomedical Literature Database, CNKI, Wanfang Data, and Weipu (VIP) with no restriction on the start year, up to February 2025. Two reviewers (WL and ZM) independently screened studies, extracted data using a Microsoft Excel spreadsheet, and assessed study quality with the Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research. Qualitative data synthesis was performed following Thomas and Harden's thematic and content analysis method, including line-by-line coding of participant quotes, organizing codes into descriptive themes, and developing analytical themes. A total of 4856 papers were retrieved through systematic searches, and 14 qualitative studies met the inclusion criteria. Four overarching analytical themes were identified: (1) root cause: person-environment mismatch (encompassing 4 interrelated dimensions: imbalance between declining individual capacity and insufficient environmental support, negative self-perception paired with inadequate positive environmental feedback, personal biases conflicting with homogeneous institutional social ecology, and disrupted social roles due to rigid institutional management); (2) overt behavioral patterns: proactive isolation, defensive isolation, and adaptive isolation; (3) inner emotional experiences: feelings of confinement, sorrow, and weariness; and (4) strategies for restoring person-environment match: active engagement in interaction, rational acceptance of coexistence, and passive avoidance and withdrawal. Notably, person-environment mismatch was confirmed as the core mechanism driving the onset and persistence of social isolation in this population. Person-environment mismatch is the fundamental driver of social isolation among older adults in LTCFs. Interventions should prioritize restoring person-environment alignment-including optimizing physical environments, reconstructing supportive social environments, and enhancing psychological empowerment. Future studies should focus on developing tools to quantify person-environment matching degrees in LTCFs and conduct longitudinal evaluations of targeted interventions to further reduce social isolation and promote active social participation among older people.
With the intensification of global population aging, the incidence of depressive symptoms among older women has increased year by year, affecting their quality of life and physical and mental health. Therefore, investigating the impact of daytime napping behavior on depressive symptoms in older women, particularly the regulatory effects of napping on frailty status and inflammatory response, is of important clinical and public health significance. This study aims to explore the relationship between daytime napping behavior and depressive symptoms in older women, with a focus on the chain mediating roles of frailty status and C-reactive protein (CRP) between napping and depressive symptoms. This study used 5 waves of data from the China Health and Retirement Longitudinal Study (CHARLS), including 3755 female participants aged ≥45 years. First, descriptive statistics and difference analyses were used to summarize baseline characteristics of the participants. Second, Cox proportional hazards regression models were used to analyze the effects of napping habits and nap duration on depressive symptoms. To explore the biological mechanisms linking napping and depressive symptoms, path analysis was further conducted to examine the chain mediating roles of frailty status and CRP in the effect of napping on depressive symptoms. To control for potential confounding factors, all analyses were adjusted for multiple covariates, including age, education level, marital status, smoking, drinking, social participation, and physical exercise. Finally, subgroup analyses were conducted to further verify the moderating effects of different lifestyles on the impact of napping. Napping behavior was significantly associated with a lower risk of depressive symptoms, particularly among women with nap durations of 5 to 30 minutes, who had the lowest risk of depressive symptoms. Specifically, individuals with nap durations of 5 to 30 minutes had a lower risk of depressive symptoms (HR=0.750, 95% CI 0.637 to 0.883, P<0.001), whereas those with naps longer than 60 minutes did not show a significant reduction in depressive symptom risk (HR=0.934, 95% CI 0.811 to 1.076, P=0.347). Further path analysis showed that there is a total indirect effect between napping and depressive symptoms (β=-0.0219, P<0.05), and there is an overall effect between the two (β=-0.081, P<0.05), indicating that napping could indirectly alleviate depressive symptoms by slowing frailty progression and reducing CRP levels. Subgroup analysis showed that the protective effect of napping on depressive symptoms was more pronounced among women who did not smoke or drink, exercised regularly, and participated in social activities, suggesting that the psychological protective effect of napping depends on an individual's overall health behavior pattern. Daytime napping exerts a chain mediating effect on depressive symptoms in older women through frailty status and CRP levels. Moderate napping, especially short naps of 5 to 30 minutes, can effectively reduce the risk of depressive symptoms, and this effect may be achieved by improving physical function and alleviating frailty and inflammatory responses. 目的: 随着全球老龄化问题的加剧，老年女性抑郁症状的发病率逐年上升，影响其生活质量和身心健康。因此，研究午睡行为对老年女性抑郁症状的影响，特别是午睡对虚弱状态和炎症反应的调节作用，具有重要的临床和公共卫生意义。本研究旨在探讨午睡行为与老年女性抑郁症状的关系，重点分析虚弱状态和C反应蛋白(C-reactive protein，CRP)在午睡与抑郁症状之间的链式中介作用。方法: 采用中国健康与养老追踪调查(China Health and Retirement Longitudinal Study，CHARLS)的5期数据，涵盖3 755名年龄≥45岁的女性参与者。首先，通过描述性统计和差异性分析对参与者的基线特征进行整理。其次，采用Cox比例风险回归模型分析午睡习惯及午睡时长对抑郁症状的影响。为探讨午睡与抑郁症状之间的生物学机制，进一步使用路径分析方法，探索虚弱状态和CRP在午睡对抑郁症状影响中的链式中介作用。为排除潜在的混杂因素，所有分析均调整了年龄、教育程度、婚姻状况、吸烟、饮酒、社交、锻炼等多个协变量。最后，通过亚组分析进一步验证不同生活方式对午睡效应的调节作用。结果: 午睡习惯与较低的抑郁症状风险显著相关，尤其是午睡时长在5~30 min的女性群体，有抑郁症状的风险最低。具体而言，午睡时长为5~30 min的个体抑郁症状的风险较低(HR=0.750，95% CI 0.637~0.883，P<0.001)，而午睡超过60 min的个体未能显著降低抑郁症状的风险(HR=0.934，95% CI 0.811~1.076，P=0.347)。进一步的路径分析表明，午睡与抑郁症状之间存在总间接效应(β=-0.0219，P<0.05)，二者存在总体效应(β=-0.081，P<0.05)，表明午睡能够通过减缓虚弱状态和降低CRP水平间接减轻抑郁症状。亚组分析显示，午睡对抑郁症状的保护作用在不吸烟、不饮酒、积极锻炼和参与社交活动的女性群体中更加显著，这表明午睡行为的心理保护作用依赖于个体的整体健康行为模式。结论: 午睡行为通过虚弱状态和CRP水平在老年女性抑郁症状中起链式中介作用。适度午睡，尤其是5~30 min的短时午睡，能有效降低抑郁症状的风险，且这一效应通过改善身体功能、减缓虚弱状态和炎症反应实现。.
Indigenous communities in Canada have high age-standardized rates of cancer mortality. Remote communities in Canada's northern territories have a high proportion of Indigenous residents and disproportionately low utilization rates of screening services for breast, cervical, and colorectal cancers, which could contribute to delayed cancer diagnosis and less favourable clinical outcomes. Knowledge is limited regarding the under-utilization of cancer screening services. This study identified factors contributing to the underutilization of breast, cervical, and colorectal cancer screening services and documented suggestions to promote utilization in remote Indigenous communities in Northwest Territories, Canada. This qualitative study consisted of four sessions of sharing circles and two one-on-one interviews with nine healthcare professionals, eight community members including Elders, and five community leadership from two Northwest Territories communities. Data were transcribed verbatim and coded and analyzed using NVivo-10. The constant comparative method determined emergent themes. Data identified four themes of factors influencing the utilization of cancer screening services (socio-environmental, socio-cultural, socio-political, and personal themes), covering limited resources, limited cultural considerations, the legacy of colonial practices, and fear. Five themes regarding suggested approaches to encourage utilization were community outreach, collaboration, sustainability, cultural safety, and support for healthcare professionals. Factors identified to affect cancer screening service utilization and suggested approaches to improve the utilization are supported by other studies and initiatives in the region highlighting the relevance and feasibility of the findings. The findings could further inform community-based interventions for improving the utilization of cancer screening and support services in remote Indigenous communities. Main findings: This qualitative study explores socio-environmental, socio-cultural, socio-political, and personal aspects of utilizing publicly funded breast, cervical, and colorectal cancer screening services in remote Indigenous communities in Northwest Territories, Canada.Added knowledge: Addressing low rates of utilizing cancer screening services in remote Indigenous communities in Northwest Territories requires implementing community outreach, encouraging community collaboration, supporting sustainability, establishing cultural safety, and providing support for healthcare professionals.Global health impact for policy and action: The findings can inform interventions, practices, and policies to improve the utilization of cancer screening services for remote Indigenous communities, where increasing cancer mortality warrants promoting the utilization of cancer screening services and early detection.
This study examined the relationship between relative fat mass (RFM) and the risk of new-onset cognitive impairment and tested the mediating effect of social determinants of health (SDOH). Data originated from the China Health and Retirement Longitudinal Study. Data from 6147 participants without cognitive impairment at baseline were included. RFM was calculated and categorised into quartiles, whereas a cumulative SDOH score was constructed and grouped into tertiles. The association between RFM and new-onset cognitive impairment was assessed by using Kaplan-Meier curves, multivariable Cox proportional hazards models and restricted cubic splines (with piecewise regression for threshold analysis). Subgroup and joint effect analyses were performed on SDOH and RFM. During a mean follow-up of 7.16 years, 1242 incident cases of cognitive impairment occurred. Elevated RFM was a significant risk factor for cognitive impairment (hazard ratio [HR] = 1.024, 95% confidence interval [CI]: 1.015-1.033, p < 0.001). This correlation was nonlinear, and RFM was estimated to have an inflection point of 26.45. The analysis of interaction effects showed that the risk of cognitive impairment in the population at risk (low SDOH/obesity) was higher by 91% (HR = 1.908, 95% CI: 1.516-2.401, p < 0.001) relative to that in the high SDOH/nonobesity group. Notably, amongst obese individuals, high SDOH/obesity was not associated with a significantly increased risk (HR = 1.047, 95% CI: 0.828-1.325, p = 0.701). Elevated RFM is significantly associated with an increased risk of cognitive impairment. However, this relationship is moderated by socioeconomic context. Low SDOH is a serious aggravating factor for the risk of high RFM, whereas high SDOH may play a massive buffering and protective role. Intervention approaches should be designed by accounting for personal metabolic factors along with the social environment, with particular attention paid to dually disadvantaged groups to avoid cognitive deterioration.
Healthcare policy in the United Kingdom recognizes that teenagers and young adults (TYAs: 16-24 years at diagnosis) require specialist care. In England, Principal Treatment Centers (PTCs) exist, delivering enhanced care exclusively within the PTC or as 'joint care' with designated hospitals (DHs). Central to this is the TYA multidisciplinary team (MDT) and an outreach model coordinating care between hospitals. We previously reported similar outcomes regardless of care location. To compare TYA experiences of care with healthcare professionals' perspectives of the service they deliver. Mixed methods across England and Wales were used. The TYA-MDT identified TYAs who then received a postal invite to a cross-sectional survey capturing experiences of places of care, treatment, healthcare professional support (HCP), mental health, sexuality/fertility, clinical trials and care coordination. Comparisons were made based on exposure to care in a specialist TYA environment within 6 months of diagnosis: all-TYA-PTC (all care in the TYA-PTC, n = 70, 28%), no-TYA-PTC (no care in the TYA-PTC (n = 87, 35%): care delivered in a children/adult unit only), and joint care (care in a TYA-PTC and in a children's/adult unit, n = 91, 36%). HCP perspectives were captured by rapid ethnography. A total of 250/1056 (24%) TYAs participated. Overall, 200 (80%) rated their teams as excellent/good for helping them prepare for treatment. No evidence of significant differences existed between categories of care for proportions receiving support from key TYA-related professionals: TYA cancer nurse specialists (all-TYA-PTC n = 58, 91%; joint care n = 71, 88%; no-TYA-PTC n = 64, 82%) and social workers (all-TYA-PTC n = 30, 55%; joint care n = 36, 48%; no-TYA-PTC n = 28, 38%). A trend of diminishing support from youth support co-coordinators existed (all-TYA-PTC 63%; joint care 49%; no-TYA-PTC 40%, p = 0.069). This may explain why few differences in patient experiences existed across categories of care. Forty-nine HCPs participated. They were more critical in their interpretation of care, highlighting inequity in resources and challenges in some pathways and coordination. Similar access to age-appropriate support across care settings is likely to reflect recruitment methods. When TYAs are known to the MDT, age-appropriate care can be mobilized beyond TYA units, which could explain the equitable outcomes observed across different care locations in young people who responded to the survey. Nevertheless, gaps persist in communication and coordination, particularly within joint care models, and in the involvement of allied health professionals such as dieticians and physiotherapists, whose input is essential for rehabilitation and return to normal life. Strengthening these areas will require continued investment in workforce capacity and digital infrastructure to support genuinely coordinated, developmentally appropriate TYA cancer care.
To characterize the heterogeneity of Long COVID (LC) by identifying distinct patient profiles based on symptoms and quality of life (QoL), and to examine the sociodemographic and clinical predictors associated with these profiles. A cross-sectional observational study was conducted. We recruited 363 patients with LC in Spain via an online survey. Symptom patterns were identified through latent class analysis of 15 binary symptoms. QoL was assessed with the patient-derived LC-6D-QoL across six dimensions, and cluster analysis defined QoL subgroups. Logistic regression was applied to examine clinical and sociodemographic predictors of QoL profiles. Two symptom profiles emerged: a low-burden profile, dominated by fatigue and cognitive problems, and a high-burden profile with multisystem involvement. QoL clustered into three profiles-high, middle, and low QoL-with more than half of participants in the low QoL group. Symptom burden and employment status were the strongest predictors of poor QoL, whereas age, sex, education, and income showed limited associations. Social support was more frequently reported among participants with low QoL. LC is characterized by distinct clinical and QoL profiles, with strong interactions between multisystem symptom burden and social determinants. Identifying patients at greatest risk of poor QoL can inform stratified interventions and integrated policies that combine medical care, psychosocial support, and workplace reintegration.
For English, the validated part of Psychedelic Experience Scale (PES48) is a four-factor structure called the Mystical Experience Questionnaire (MEQ30). The other validated part of the PES48 consists of four more factors: two more mystical factors (paradoxicality and connectedness, which together with the MEQ30 form the MEQ40), and two more non-mystical factors (visual experience and distressing experience). However, this latter four-factor part of the PES48 has thus far only been validated for the German version of the PES48. We investigated whether the overall eight-factor structure of the PES48 (which includes the MEQ30 four-factor structure) can also be validated, and thus potentially be put to good use in English. Data from 280 English PES measurements (145 different healthy participants) from four placebo-controlled studies with low to high doses of psilocybin were included. The reliability of the eight subscales was evaluated using measures of internal consistency. The validity of the factor structure was assessed through model fit indices from confirmatory factor analysis. English results were then also compared with the German PES validation data set from Stocker et al. (2024). Six of the eight subscales (mystical, positive mood, transcendence of time and space, ineffability, connectedness, distressing experience) of the English PES48 show high internal consistency, one subscale (paradoxicality) shows good, and one (visual experience) acceptable internal consistency. Both MEQ models (MEQ30 and MEQ40) show similar fits (acceptable to good model fits). In English, both MEQ models show better fits than in German. All six MEQ40 scale means of the English data are higher compared to German data. The findings suggest that the eight-factor PES48 is also a valid psychometric tool in English. With the MEQ40 part of the PES48, one can measure mystical experience with a still wider conceptual breath than with the MEQ30. Furthermore, one can also measure non-mystical visual and distressing states in an overall more comprehensive and broader conceptualization of the psychedelic experience. Higher MEQ40 scale means for the English than the German study participants could inspire future research into the role of setting in relation to mystical experience.
To provide an overview of the current state of international research on technology-based applications for informal caregivers of people with advanced cancer, with a particular focus on advanced breast cancer. This scoping review was conducted in accordance with the Joanna Briggs Institute methodology and reported in line with the PRISMA-ScR guideline. The PCC framework was used to define the search terms, and develop the search strategy for the databases PubMed, CINAHL, and Web of Science. The systematic search identified 13 relevant articles describing ten different technology-based applications. One additional article was identified through a manual search. In total, 14 studies covering ten distinct interventions were included. Some interventions were adapted from face-to-face programmes for digital delivery, whereas only a minority were explicitly informed by theoretical models from psychology or health science. The included studies addressed five main areas: informational support, mental and psychosocial support and enhancement of quality of life, physical and practical support, communication support, and preparation for caregiving and death. Evaluations reported predominantly positive findings, particularly with regard to quality of life, anxiety, depressive symptoms, and coping. However, most studies focused on advanced cancer more broadly rather than on advanced breast cancer specifically. The reviewed literature suggests that technology-based interventions for informal caregivers of people with advanced cancer are available in several countries and address a range of support needs. However, no intervention tailored to relatives of patients with advanced breast cancer was identified as having been fully developed and evaluated. The findings highlight the need for future research on targeted, sustainable digital support for this group. The development of the Gesi-BK platform is based on the results of this scoping review.
The use of artificial intelligence (AI) in health care is growing quickly, but there is not enough research that looks at patient concerns from a multilevel perspective. Existing reviews predominantly summarize patient attitudes descriptively, lacking theoretical frameworks to explain the underlying mechanisms of these concerns. This systematic review and meta-synthesis aimed to identify and analyze patient concerns regarding health care AI applications, using social ecological theory to reveal the multilevel interactive mechanisms of concern at the individual, interpersonal, organizational, and societal levels. Following the PRISMA-S (Preferred Reporting Items for Systematic Reviews and Meta-Analyses literature search extension) guidelines, databases including PubMed, Embase, Web of Science, CINAHL, and Scopus were searched on March 1, 2026. Qualitative studies exploring patient perceptions of clinical AI applications were included, excluding those involving only healthy populations, technical performance, or nonclinical settings. Two researchers independently screened the literature and assessed methodological quality using the JBI-QARI (Joanna Briggs Institute Qualitative Assessment and Review Instrument) checklist. Confidence in synthesized findings was assessed using the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative Research) approach. A total of 25 qualitative studies involving 528 participants from diverse patient groups across multiple countries were included. Six themes emerged: (1) microlevel worries about privacy and data security, including data breaches and loss of control over personal health information; (2) worries about the limits and reliability of technology, especially AI diagnostic accuracy and "black box" decision-making; (3) mesolevel effects on physician-patient relationships, including reduced face-to-face interaction and empathy; (4) trust and accountability issues, including unclear responsibility attribution and institutional oversight problems; (5) macrolevel ethical and equity issues, including algorithmic bias and health care access inequalities; and (6) worries about technology diffusion and possible replacement of health care workers. This review represents the first meta-synthesis applying social ecological theory to construct patient concerns regarding medical AI. Unlike previous descriptive reviews, it reveals the interconnected "ecological imbalance" mechanisms at micro-, meso-, and macrolevels when AI is embedded in health care systems. The findings suggest that many patient concerns are based on facts rather than just misunderstandings, indicating that systemic rather than isolated interventions are needed. Practical implications include explainable algorithm design at the microlevel, improved physician-patient communication, and institutional accountability at the mesolevel, and coordinated global ethical norms and equity-promoting policies at the macrolevel. Limitations include the inclusion of studies primarily from developed regions, significant heterogeneity in AI application scenarios, and constraints inherent to secondary research. Nevertheless, addressing these multilevel concerns remains crucial for balancing technological advancement with patient-centered care and enabling sustainable AI integration.
Prognostic tools are widely used to guide early management of musculoskeletal (MSK) injuries. However, social identity factors such as age, gender, race, and socioeconomic status may influence symptom experience and reporting, potentially affecting the accuracy of risk classification. The purpose of this study is to identify those social identity variables associated with scores on common prognostic tools or their prognostic accuracy. We analyzed data from a cohort of workers (n = 203) with acute musculoskeletal injuries. Participants completed the Numeric Pain Rating Scale (NPRS), Traumatic Injuries Distress Scale (TIDS), EuroQoL (EQ5D-5L), and a demographic survey including age, sex, race, income, education, and perceived discrimination. Differences in baseline scores were assessed between identity groups. Recovery was dichotomized (fully recovered/not fully recovered) using 3 different recovery indicators. Predictive accuracy for recovery was evaluated using area under the receiver operating characteristic curve, sample-wide and when stratified by social identity variables. Older participants reported significantly higher pain (5.5 vs. 4.3/10, p < 0.01) and those indicating more experiences of discrimination rated higher post-trauma distress (11.1 vs. 9.2/24, p < 0.05). 8-week recovery rates were 21.7% to 54.7%. Lower education predicted <full recovery in administrative data only. The TIDS and EQ5D-5L were significantly better at predicting recovery compared to the NPRS. When disaggregated by social identity, the TIDS functioned significantly better in females than males, while the EQ5D-5L functioned similarly across all social categories. The results indicate that different risk/prognosis cut-scores, and even different tools, may be required for people with different intersectional identities. The results should be interpreted in light of some identities being reduced to broad categories. Most risk/prognosis tools in MSK recovery research use a single universal cut-score to distinguish low from high risk, but this study only partially supports that approach.
Diabetes is increasingly prevalent in reproductive-aged women, but the association between social determinants of health (SDOH) and access to A1C monitoring after diagnosis are poorly understood. We explored SDOH and receipt of recommended follow-up A1C testing among postpartum women with diabetes. A retrospective, population-based cohort of 5,590 women who delivered in New York City between 2009-2016 and experienced postpartum-onset diabetes. We explored associations between SDOH (race-ethnicity, nativity, insurance, nutrition program enrollment, education, and parity) and time to first follow-up test/rate of A1C testing using Cox proportional hazards and Poisson regression, respectively. We constructed models that were unadjusted, mutually adjusted, and further adjusted for clinical characteristics (body mass index, gestational diabetes mellitus, and age). Few women received all biannual recommended follow-up tests over the study period (13.0%). Non-Hispanic Black women were more likely to receive their first follow-up test later (adjusted HR (aHR): 0.90, 95% CI 0.80 to 1.00) and had a lower rate of testing over 3 years (adjusted rate ratio (aRR): 0.92, 95% CI 0.84 to 0.99) compared with non-Hispanic White women. Women insured by Medicaid at delivery experienced a higher hazard of an earlier first follow-up A1C test (aHR: 1.14, 95% CI 1.06 to 1.22) and higher rates of testing (aRR: 1.09, 95% CI 1.03 to 1.15) than those with private or other insurance. Women with more children experienced lower rates of testing and a longer time to first A1C test compared with those with no prior children. Few women with postpartum-onset diabetes met A1C monitoring guidelines, suggesting a need to improve routine diabetes monitoring, particularly among Black women. The finding of an advantage in testing among people insured by Medicaid is promising. Additional research should explore mechanisms through which Medicaid insurance and other structural interventions may improve access to and engagement in routine diabetes care.
Cascade screening (CS) for familial hypercholesterolemia (FH) has been found to be cost-effective in many published studies. However, most existing studies (i) ignored or overstated first-degree relative (FDR) participation rate (as 60-100 %), (ii) did not consider novel and expensive therapies, e.g. PCSK9 inhibitors (PCSK9i), and (iii) were conducted outside of Asia. This study, conducted in Singapore, where FDR participation rate is about 25 % among probands who have known pathogenic variants, aims to identify drivers of cost-effectiveness of CS protocols for FH. Four CS protocols, which vary in the application of genetic tests, were examined using a hybrid decision tree-Markov model. Sensitivity analyses were conducted to identify drivers of cost-effectiveness. Cascade acceptance rates are key drivers of cost-effectiveness. Other drivers include age of proband, prevalence of FH among probands, health-related quality of life loss with cardiovascular disease, timeliness of starting treatment post-screening, treatment effectiveness, cost of PCSK9i and discount rate for cost and QALY. With cascade acceptance rates observed in Singapore, among various screening protocols examined, probabilities of being cost-effective ranged from 86 % to 95 % when no access to PCSK9i and ranged from 75 % to 98 % when PCSK9i are provided. The most cost-effective protocol differs depending on cascade acceptance rates and whether PCSK9i is provided. For better cost-effectiveness of CS for FH, health systems need to look for ways to improve proband's willingness to share contact of their relatives and relatives' willingness to be screened and to lower the cost of novel treatment. Other ways to improve cost-effectiveness include to select age groups for proband screening, improve screening detection rate among probands, and start timely treatment post-screening.
The duration of untreated psychosis (DUP) is still considerably long in patients with psychotic disorders worldwide. Social determinants, such as the socioeconomic status, can influence DUP, exacerbating health inequalities in access to timely care. We investigated whether subpopulations with shared characteristics are associated with longer DUP. We performed latent class analyses to investigate whether classes with shared configurations of social and substance use-related risks can be identified in two large cohorts with psychotic disorders: N = 780 patients from the GROUP project and N = 847 patients from the EU-GEI project. Subsequently, we conducted survival analyses to analyze whether identified classes are associated with DUP. We identified three classes in both samples. Membership of the class with predominantly younger men, higher proportion of cannabis use, and supported living was associated with longer DUP compared with a class with predominantly White ethnicity, higher education, and current employment in GROUP (HR = 1.28, 95% CI: 1.06-1.56, p = .011) and in EU-GEI (HR = 1.27, 95% CI: 1.07-1.51, p = .007). In GROUP, membership of a third class with predominantly White women, without cannabis use, was associated with the shortest DUP (HR = 0.78, 95% CI: 0.63-0.95, p = .016). Results suggest that specific populations differ in their risk distributions for prolonged DUP and highlight the importance of considering configurations of social determinants in context. Public mental health programs need to establish their differential impact for diverse populations and facilitate more targeted pathways to care.
Quality of life (QoL) questionnaires are used in many disease areas to measure the burden that a disease causes for patients, which help provide insights into disease impact, identify unmet medical needs, and inform patient-centered drug development and value assessment for treatments. The collection of data imposes both a significant burden on patients as well as effort on health care personnel, thus incurring high costs for the health care system. Given that patients share detailed information about their condition and treatment experiences on social media and patient forums, an important research question is to what extent information about QoL can be obtained from patients' online forum posts to potentially complement information obtained from questionnaires. This study aimed to assess how much QoL information can be gained from the analysis of posts by patients in online health care communities and whether this information is rich enough to estimate individual patient's QoL based on their posts. We conducted this feasibility study in the context of breast cancer as it is the most prevalent cancer in the female population. We recruited 134 female patients diagnosed with breast cancer on the Inspire patient online forum, who voluntarily participated in our feasibility study. They filled in the EORTC (European Organisation for Research and Treatment of Cancer) QLQ-C30 and QLQ-BR23 questionnaires consisting of 30 general questions and 23 additional breast cancer-specific questions and provided consent to analyze their posts and comments on the online forum (756 posts and 19,478 comments). Posts were coded manually to identify parts of the text providing answers to 1 of the aforementioned 53 questions. The data annotation yielded a substantial agreement (mean Fleiss κ of 0.5, SD 0.28). Overall, we found answers in the coded data for 50 out of 53 EORTC QLQ-C30 and QLQ-BR23 questions. The information coded in the posts reliably predicted the answers given in the questionnaires (F1-score=0.7), with even better results when grouping similar questions (F1-score=0.8 for fine-grained and 0.9 for coarse-grained grouping). The 5 questions that were most frequently answered on the basis of the coded posts were "Did you feel ill or unwell?" (304 of 2683 annotated posts and comments), "Did you worry?" (105 posts and comments), "Have you had pain?" (104 posts and comments), "Did you feel tense?" (85 posts and comments), and "Were you limited in doing either your work or other daily activities?" (77 posts and comments). Our feasibility study shows that there is valuable QoL-related information in posts of online patient communities, which can potentially serve as an innovative low-burden QoL monitoring approach. Future research should consider how these insights can be used to complement existing QoL instruments and whether the process of extracting QoL-related information can be automated.
Enhancing Quality of Life for Individuals with Stroke (EQL-stroke) is an international, collaborative multiphase project aiming to strengthen supported self-management for older adults recovering from stroke at home in Sweden, Latvia and the Netherlands. Existing poststroke pathways may provide insufficient support for self-management during the transition from hospital to home, and there is limited evidence on interventions that integrate social networks and everyday environmental context. EQL-stroke uses a participatory, multimethod design across three phases. Phase I generates knowledge through policy review, qualitative interviews and people-place mapping (~25 participants per country) and includes cross-cultural adaptation of the Collective Efficacy of Networks Scale. Phase II co-designs and specifies a tailored social network-informed supported self-management intervention (the Network-Based Intervention), including core components and principles for local adaptation (~15 participants per country). Phase III will recruit approximately 20-40 stroke survivors for a single-arm pilot feasibility study with an 8-week follow-up and embedded process evaluation to assess feasibility, acceptability and fidelity in routine practice. Ethical approval has been obtained from the Swedish Ethical Review Authority (reg. no. 2025-00083-01), the Rīgas Stradiņa Universitāte Research Ethical Committee (reg. no. Rīgas Stradiņa Universitāte Research Ethical Committee) and the Research Ethics Committee of the Faculty of Spatial Sciences, University of Groningen (reg. no. 2025-07). Findings will be disseminated through peer-reviewed publications, stakeholder engagement activities and patient/public channels.