A younger subjective age is often associated with positive health and well-being outcomes among adults over the age of 65. However, it is possible that those who attempt to look or act younger than their chronological age may face backlash, given that this behavior is in violation of prescriptive stereotypes that serve to maintain hierarchical age group boundaries and mitigate threats to younger people's social and economic resources. The degree to which younger and middle-aged adults perceive violations of prescriptive age stereotypes (i.e., that older adults should act their age) may predict negative evaluations of older adult targets who feel "younger than their years." Across two studies, we examined younger and middle-aged adults' attitudes and evaluations regarding older adult targets who varied by gender and felt age. Perceptions of older targets' counterstereotypical behavior and demeanor mediated the relationship between older targets' younger felt age and participants' ratings of targets' warmth, competence, overall liking, and interaction intentions. Specifically, older targets who felt younger than their chronological age were perceived as violating prescriptive stereotypes, which in turn decreased ratings of targets' warmth, competence, and likeability, and lessened participants' willingness to interact with targets. Consistent with affordance management theoretical approaches, older adults who defy stereotypicality may be appraised as a threat to younger perceivers' goals and, in turn, face backlash. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
According to affect valuation theory (Tsai et al., 2006), culture shapes the emotions people ideally want to feel. In middle-class European-American settings, people usually report that they would ideally like to feel high-arousal positive (HAP) emotions (enthusiastic, excited, and elated). In Asian American and East-Asian settings, people are more likely to report ideally wanting to feel low-arousal positive (LAP) emotions (calm, relaxed, and peaceful). We tested whether popular song lyrics in the United States and Japan reflect these values. We collected the lyrics of the 100 most popular songs from each year between 1968 and 2015 from the United States and Japan (N = 7,464). A natural language processing tool called Contextualized Construct Representation (Chen et al., 2024) estimated HAP and LAP content in each song. Lyrics were higher on ideal than actual positive emotions. U.S. American popular songs scored higher on ideal and actual HAP, and Japanese popular songs scored higher on ideal and actual LAP. Longitudinal analyses showed that both HAP and LAP increased slightly over time in Japan, while HAP declined slightly in the United States. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Patients' access to their electronic health record (EHR) supports their participation and satisfaction with care. Despite the benefits, some patients have been upset after reading their EHR. Additionally, health care professionals are concerned that patients, particularly those with mental health conditions, may be offended, and they have expressed a need for further guidelines on how to write EHRs. Experiences among various patient groups are essential to support the relationship between patients and professionals. However, prior studies have often focused on single patient groups or specific clinical contexts, leaving a limited understanding of differences across multiple patient groups. This study aimed to determine whether certain patient groups are more likely to feel offended while reading their EHRs and which information is perceived as offensive and to provide a comparison across multiple patient groups using a mixed methods approach. A cross-sectional survey was conducted via the Finnish national patient portal using a web-based patient survey, adopting a mixed methods approach. The survey included multiple-choice and open-ended questions. The total sample comprised 4681 respondents. The survey respondents were placed into 4 patient groups: those who had received care for mental health, cancer, or other conditions and those who had received no care. Associations between the type of care and patients who felt offended were estimated using multivariate binary logistic regression. Inductive content analysis (n=502) was conducted to identify information perceived as offensive in the EHR. The patients who had received mental health care (166/654, 25.4%) or cancer and mental health care (9/39, 23.1%) were more likely to be offended by information in their EHR compared to the other groups (cancer care: 37/375, 9.9%; other conditions care: 383/3316, 11.6%; no care: 22/206, 10.7%; other conditions care: odds ratio 0.37, 95% CI 0.29-0.46; P<.001; model A). Additionally, female patients, those with bad or very bad health conditions, and patients with bachelor's or master's degrees were significantly more likely to feel offended. Errors, the health care professionals' disrespectful language, and perceived unnecessary information were the most frequently mentioned reasons for being offended. Patients with mental health care reported more often that unnecessary information and professionals' opinions and word choices were experienced as offensive compared to other patients. This study contributes new knowledge by identifying differences across multiple patient groups. Although a minority of patients felt offended by their EHR, health care professionals should consider that some patients, particularly those who have received mental health care or cancer and mental health care, may be offended by specific information or word choices in their EHRs. To address this, health care professionals should receive education on how to write their notes in a neutral tone and avoid potentially offensive topics. Improving the quality of EHRs could strengthen the relationship between patients and professionals.
While many gymgoers do not experience psychological barriers to gym use, some feel anxious and intimidated there in the presence of other users. Qualitative research has suggested gyms can be places of unequal power leading to threats to one's adequacy of self, and privilege certain users based on demographics, masculinity, size, fitness, performance, competence, etc. Social comparison and trait social anxiety have been suggested as contributing to gym anxiety. However, a theoretical approach is needed to provide a coherent explanation of gym anxiety which can inform interventions; there is no current theory in use in the research literature. I argue that gym anxiety is not the same as social physique anxiety (a limited concern about physique evaluation) nor social anxiety (often conceptualized as a mental health "disorder" rather than a response to the norm-laden setting of the gym). I propose that the most suitable theoretical framework to explain gym anxiety is Johnstone and Boyle's Power-Threat-Meaning Framework (PTMF), designed to explain psychological problems or distress. Gym anxiety or intimidation does not represent a disorder or pathology but an understandable response among some users to the power differentials of the gym environment. The PTMF explains how the negative operation of social power, in combination with societal and personal meaning-making, can lead to a perception of subtle threats to one's psychological needs, such as exclusion, invalidation, or rejection; the resulting "symptoms" such as anxiety, shame, hypervigilance, and avoidance are conceptualized as coping strategies called threat responses. By addressing one or more of power imbalances, perception of threat, meaning-making and threat responses, interventions have the potential to make gym anxiety more manageable by addressing some of its root causes, either in individual interventions or at wider group level, including by changes that can be made to specific gym settings.
Pelvic pain is a common presentation in general practice and can significantly affect women's quality of life. Ensuring that women feel heard and their concerns acted upon is integral to accurate diagnosis and early management in primary care. To explore patient perspectives on the emotional and diagnostic journey of pelvic pain. A survey was distributed to 550 female patients aged >18 at a GP practice in West Bridgford, Nottingham. It explored the physical and emotional impacts of pelvic pain and interactions with healthcare professionals using multiple-choice questions, 10-point Likert scales, and open-ended responses. Quantitative data were analysed descriptively, and qualitative data thematically. Between July and September 2025, 81 responses were received and 45 (55.6%) reported pelvic pain (mean age 41.9 years, range 18-90). Of these, 22 (48.9%) had a diagnosis explaining their symptoms. Pain descriptors frequently reflected physical and emotional trauma ('stabbing', 'agonising', 'crippling'). Average impact scores were high: 7.5 out of 10 for quality of life; 7.9 out of 10 for emotional well-being. Disruptions were reported in physical functioning (20 mentions), work and education (18), and social restrictions (13), alongside relationships, fertility, and mental health. Thirty-eight sought GP advice; 7 did not, citing normalisation of pain and fear of dismissal. Experiences in GP consultations were mixed: some felt validated and supported (15 mentions), others described dismissal or patronisation (20), confusion (8), and frustration (7). Pelvic pain has profound physical, psychological, and social impacts. Patient accounts highlight the need for timely recognition, empathetic listening, and clear communication in primary care.
The mechanisms underlying the clinical benefit of intravenous iron in patients with heart failure (HF), left ventricular ejection fraction (LVEF) < 50%, and iron deficiency (ID) remain incompletely defined. Clinical evidence suggests that iron repletion may improve ventricular synchrony and augment the response to cardiac resynchronization therapy (CRT). The longitudinal systolic dyssynchrony index (L-SDI), derived from cardiac magnetic resonance feature tracking (CMR-FT), provides a non-invasive measure of mechanical dyssynchrony. This subanalysis of the Myocardial-IRON trial evaluated the short-term effects of ferric carboxymaltose (FCM) on L-SDI and explored its relationship with global left ventricular longitudinal strain (GLS). In this post hoc analysis of the randomized, double-blind, placebo-controlled Myocardial-IRON trial (NCT03398681), 51 of 53 ambulatory patients (96.2%) with stable HF, LVEF < 50%, and ID underwent CMR-FT at baseline, and at 7-day, and 30-days post-FCM. Linear mixed-effects models assessed the effect of FCM versus placebo on L-SDI, including subgroup analyses by baseline QRS duration, and evaluated associations between changes in L-SDI and changes in GLS, T2*, and T1-mapping. Data are presented as mean ± SD or median (IQR), as appropriate. The participants have a mean age of 70.4 ± 9.6 years, with a median CMR-derived LVEF of 38.5% (IQR 33-45); the mean global longitudinal strain is -7.5 ± 3.6%. FCM leads to a greater reduction in L-SDI over time versus placebo (omnibus p = 0.015), with significance at 30 days (Δ=-3.8; 95% CI -6.9 to -0.7; p = 0.011). The benefit is most pronounced in patients with baseline electrical dyssynchrony (interaction p < 0.001). Improvements in L-SDI are strongly associated with GLS gains (p < 0.001) and myocardial iron uptake [T2*changes (p = 0.045) and T1-mapping changes (p = 0.011)]. In HF with LVEF < 50% and ID, FCM improves short-term LV mechanical synchrony, particularly in those with electrical dyssynchrony, and this is linked to enhanced systolic function and greater myocardial iron repletion. Iron deficiency is common in patients with heart failure and makes their condition worse. Although giving iron through an intravenous infusion is known to improve how patients feel and function, we do not fully understand how it benefits the heart itself. In this study, we used a type of heart imaging, cardiac magnetic resonance scans, to determine whether iron treatment improves heart pump coordination and synchronization. We found that patients who received an iron infusion showed clearer improvement in how well their heart muscle worked within 30 days compared with those who received a placebo. The benefit was especially noticeable in patients who already had abnormal heart electrical patterns. These findings suggest that iron treatment helps the heart muscle contract more uniformly, making the heart pump more efficiently and helping to explain why this therapy improves the health of people with heart failure.
Explainable Artificial Intelligence (XAI) has the potential to enhance clinical decision support (CDS) systems however, it remains unclear how XAI systems are perceived by healthcare professionals in hospital settings, and if new challenges arise as a result of explanations. This scoping review aimed to understand healthcare professionals' perceptions of CDS systems with XAI in the hospital setting; specifically, the drivers of acceptance and use, explainability needs, and design preferences. Databases were searched. Studies were included if they reported qualitative findings on health professionals' perceptions of XAI-enabled CDS systems used in hospital settings. MEDLINE, Embase, and Web of Science were searched, and reference lists were screened for additional papers. Study characteristics and health professional perceptions were extracted and inductively coded. A quality assessment was performed using the CASP checklist. Sixteen studies were identified. Included studies primarily focused on ML-based CDS systems for predicting various clinical outcomes. Most studies used feature importance or model agnostic techniques like SHapley Additive exPlanations (SHAP). Overall, healthcare professionals perceived CDS systems with XAI as useful for supporting clinical tasks, decision-making, and teamwork. Acceptance was influenced by integration into workflows, performance, data quality, and alignment with clinical knowledge. Concerns were raised about overreliance and reduced professional autonomy. Health professionals predominantly used explanations to validate outputs, and desired actionable information from systems. SHAP plots and visualizations were difficult to interpret. Participants preferred explanation designs that included concise, high-level information, and simple plots for quick interpretation. Clear visual indicators such as colour coding, contextual patient data, and aggregating similar features also aided interpretation. Poorly designed XAI explanations can hinder understanding and increase cognitive burden in busy clinical settings. Future research should optimise the design and delivery of explanations, so clinicians can appropriately trust in XAI CDS systems and feel confident in their clinical decision making.
Young migrants encounter heightened challenges as the intersection of their youth and migrant identities magnifies the influence of risk factors for suicide. Social media offers a platform for young migrants to express emotions, seek support and connect with others, often anonymously. However, how they communicate about self-harm and suicide online remains underexplored. This qualitative study involved 17 online interviews with young migrants aged 15-25 years. Transcribed data were coded and thematically explored using Braun and Clarke's reflexive thematic analysis methodology. Four key themes were identified: (1) Exposed and isolated: The emotional toll of viewing self-harm and suicide-related content on young migrants; (2) Connected but at-risk: The dual role of social media in migrant belonging; (3) Digital belonging across borders: Benefits and strains of staying connected; and (4) Helpful and harmful: The dual nature of support on social media. Social media has a complex impact on young migrants, offering both protective and harmful effects. While exposure to distressing or discriminatory content may exacerbate feelings of isolation and disconnection, social media can also promote belonging, cultural understanding and resilience. It also provides accessible support, though poor-quality advice and stigma may deter help-seeking. These insights can inform culturally responsive mental health interventions.
Humans value communicating information about themselves to others, and exchanges of such information between two individuals are fundamental to social bond formation. Yet, people often keep information private, potentially forfeiting the chance to connect with someone new. In this preregistered functional MRI study, participants who experienced more missed social opportunities in an iterative self-disclosure task-or instances where withholding information was met with an ostensible partner's self-disclosure-tended to feel closer to this partner faster. Missed social opportunities were regrettable and most likely followed by a change in subsequent decisions, making participants switch from withholding to sharing their information. Using conjunction analysis, activities in the medial prefrontal cortex and posterior superior temporal sulcus (pSTS), regions implicated in social-cognitive processes, were greater in response to missed social opportunities than in response to other social interactions (e.g. mutual self-disclosure). Notably, greater pSTS responses to missed social opportunities were linked to a higher likelihood of disclosing to a partner, as well as a higher amount of money willing to be spent to disclose to a partner in a follow-up task, highlighting the role of the pSTS in predicting a sustained interest in the new partner. Our findings elucidate the neurobiological, affective, and behavioral attributes of forgone moments of connection that contribute to interpersonal closeness development. We further identify context-dependent pSTS activities that support closeness-generating behaviors like self-disclosure.
Early Intervention in Psychosis (EIP) services offer up to 3 years' treatment in the community to people who have experienced a first episode of psychosis. Service users (SUs) are then discharged to primary care (the majority) or community mental health teams. There is limited research on SU experiences of discharge from EIP to primary care and the roles of care providers through this transition. Longitudinal, case study approach. Ethics and HRA approvals gained. Semi-structured interviews with SUs shortly after EIP discharge (x16); follow up interviews after 6-11 months (x12). Care providers interviewed with SU consent (x14). 8 SUs formed into case studies - interviews with 1-3 care providers for each.Thematic analysis conducted using principles of constant comparison within and across cases. Patient and public involvement throughout, including contributing to data analysis. SUs discharged to primary care report little to no support in the early post-discharge period and can be reluctant to approach primary care due to lack of relationships and trust.Care providers highlight gaps in communication across SU support networks.We were unable to recruit GPs to the case studies, which may reflect their lack of relationship with EIP SUs. Family carers can play a 'case manager' role, but do not always feel listened to. This study highlights the need for improved collaboration between SUs, carers and healthcare practitioners through transition from EIP. We suggest that there should be a joint consultation between SU, carer, EIP care coordinator and GP at point of discharge.
A national shortage of mental health professionals has shifted much of youth mental and behavioral health care to primary care professionals (PCPs), who often feel underprepared, especially in Kansas, where most counties are designated mental health shortage areas. Project ECHO provides continuing medical education (CME) to strengthen PCPs' ability to manage pediatric mental health conditions. Authors administered a 10-item survey immediately after ECHO sessions from April 2020 to October 2024. A cross-sectional analysis of 512 CME surveys was conducted, and descriptive statistics were used to summarize responses across eight mental health topics. Respondents included physicians (n = 346), APRNs (n = 114), nurses (n = 81), PAs (n = 18), and other professionals (n = 157). Survey counts varied by topic: ADHD (n = 92), Anxiety (n = 65), Autism (n = 28), Depression (n = 59), ID/DD (n = 56), Sleep (n = 86), Suicide (n = 41), and Trauma (n = 85). Across topics, 50-71% of PCPs strongly agreed they learned information that could improve patient outcomes. Many respondents (45-70%) reported no barriers to applying new strategies. When barriers were identified, lack of knowledge was the most common (19-30%), except in suicide sessions, where "other" barriers were cited most frequently (17%). Findings indicate that knowledge gaps remain the primary barrier to implementing pediatric mental health care, underscoring the value of programs such as KSKidsMAP ECHO in improving provider confidence and practice uptake. Participants also reported gaining information they could share with colleagues, suggesting a broader team-level impact.
Professional comportment is widely treated in nursing education and practice as a necessary marker of trustworthiness, maturity and professional identity. Yet comportment is rarely examined as more than a neutral code of appropriate conduct. In this paper, I argue that professional comportment functions as a discipline of seriousness through which nursing regulates credibility, embodiment and belonging. Comportment does not simply guide what nurses should do; it also shapes how nurses should look, sound, feel, and appear in order to be recognised as legitimate. In this sense, it operates as an aesthetic and affective norm as much as an ethical one. Drawing on Camp as a philosophical method, I show that nursing's ideal of seriousness depends on disavowed forms of performance, composure, restraint and respectability. I argue that seriousness is not merely a personal virtue but a socially conferred style of legitimacy that unevenly rewards some forms of embodiment while marking others as excessive, immature or unprofessional. Camp is valuable here not because it rejects care, but because it exposes the artifice of seriousness and creates critical distance from norms that present themselves as natural. Through this lens, professional comportment can be understood as a site where gendered, racialized, classed and heteronormative expectations are reproduced under the language of professionalism. As an illustrative case, I consider nursing memes and online self-stylization as minor but revealing sites where professional seriousness is publicly negotiated. These cultural forms do not simply resist professional norms; they can also reproduce the exclusions they appear to unsettle. I conclude by proposing a plural ethics of professional presence, one that distinguishes ethical obligation from respectability, preserves accountability and care, and loosens the hold of singular, assimilative models of seriousness.
The global population is experiencing rapid aging, and the mental health needs of older adults have become an urgent public health concern, with anxiety levels becoming increasingly prevalent among older adults. In Thailand, stress and anxiety among older adults are anticipated to double in the next decade. Neuroticism, characterized by emotional instability and an impulse for negative feelings, is a significant psychological characteristic associated with anxiety. Older adults with higher neuroticism have heightened sensitivity to stress and frequently struggle with emotional regulation, hence increasing their vulnerability to anxiety and other mental health disorders. Loving-kindness, a core Buddhist principle, has been shown to benefit mental health by reducing stress, anxiety, and depression, primarily in Western or short-term settings. However, there is limited research assessing its role among older adults in Buddhist cultural contexts, such as Thailand. This study investigated whether loving-kindness moderated the relationship between neuroticism and anxiety symptoms among 232 Thai adults aged 60 and above, using secondary data collected between December 2019 and September 2022. Measures included the Neuroticism Inventory, Core Symptom Index for anxiety, and the Inner Strength-Based Inventory for loving-kindness. Multiple regression analysis evaluated potential moderating effects. The results revealed that anxiety had a positive correlation with neuroticism and a negative correlation with loving-kindness and education; nevertheless, an unexpected pattern occurred in the moderation analysis. Loving-kindness specifically enhanced the correlation between neuroticism and anxiety at high levels, rather than mitigating it. Older adults exhibiting higher levels of neuroticism and loving-kindness reported increased anxiety symptoms. Education was identified as a protective factor, exhibiting a negative correlation with anxiety. Loving-kindness did not mitigate the effect of high neuroticism on anxiety in Thai older adults. Rather, it intensified this correlation, indicating that robust prosocial characteristics lacking sufficient emotional regulation may exacerbate stressful emotions. These findings contradict prevailing theories regarding the universal advantages of loving-kindness and underscore the necessity for therapies that incorporate loving-kindness with emotional regulation and self-care in older adults.
Advanced practice registered nurses often feel unprepared for end-of-life (EOL) care due to gaps in training. This study assessed the impact of an EOL simulation on the attitudes and preparedness of 83 students who completed pre- and post-simulation surveys. Results showed significant improvement in post-simulation scores, suggesting that simulation is effective in enhancing attitudes and comfort with EOL care. The findings support integrating simulation into nursing curricula to close educational gaps and foster readiness.
Parenting practices, such as emotional support and warmth, are key determinants of adolescent mental health, whereas the role of parental knowledge is less well understood. Parental warmth is thought to foster openness and disclosure, raising the question of whether parental knowledge independently predicts mental health outcomes or primarily reflects the quality of the parent-adolescent relationship. The present study used prospective data to test whether parental knowledge in late adolescence contributes independently to depression and anxiety symptoms in young adulthood after accounting for parental warmth and relevant covariates. Data from two waves of the national Swedish cohort study Futura01 were used (n = 2,697). Parental warmth and parental knowledge were measured at age 18, each using two items. Depression and anxiety symptoms were measured at age 21 with the Patient Health Questionnaire-4 (PHQ-4). Covariates included participant sex, parental education, immigration background, living arrangements at age 18, and indicators of mental health problems at age 18. Linear probability models were performed. In unadjusted analyses, higher parental warmth and parental knowledge during late adolescence were both associated with a lower probability of reporting depressive and anxiety symptoms in young adulthood. However, when mutually adjusting for parental warmth and parental knowledge, the effect of parental knowledge was no longer statistically significant, indicating that its association with mental health outcomes was confounded by parental warmth. In contrast, parental warmth remained significantly associated with lower probabilities of both depression and anxiety symptoms, even after accounting for parental knowledge, sociodemographic characteristics, and earlier mental health problems. There were no significant interactions between parental warmth and parental knowledge, and participant sex did not moderate the associations. This study highlights the protective role of parental warmth during late adolescence for depression and anxiety symptoms in young adulthood, with warmth showing a consistent association with lower probabilities of these outcomes. However, parental knowledge did not demonstrate an independent effect on mental health after accounting for warmth and covariates. The findings underscore the importance of fostering warm, supportive parent-adolescent relationships during late adolescence, as these relationships appear to have lasting benefits into young adulthood.
Caregiving spouses often experience substantial physical and emotional strain, placing them at elevated risk for psychological distress. While nearby social support networks and neighborhood social cohesion have each been linked to caregiver well-being, neighborhood social cohesion may serve as a complementary resource, particularly for those without nearby social support. However, little is known about whether the association between neighborhood social cohesion and psychological distress varies depending on the availability of nearby social support among caregiving spouses. Using data from the 2006-2012 waves of the Health and Retirement Study, this study examined associations between perceived neighborhood social cohesion and psychological distress among caregiving spouses of older adults (N = 1,375), stratified by nearby social support network status. Regression models were estimated to assess associations of neighborhood social cohesion with anxiety, hopelessness, and depressive symptoms, adjusting for sociodemographic characteristics and caregiving intensity. Approximately 13.0% of caregiving spouses reported having no nearby social support network. Caregivers without nearby social support reported higher levels of anxiety, hopelessness, and depressive symptoms compared with those who had nearby social support networks. Across all outcomes, higher neighborhood social cohesion was significantly associated with lower psychological distress in both groups. However, associations were consistently stronger among caregivers lacking nearby social support networks (anxiety: b = -0.12, p < 0.001; hopelessness: b = -0.42, p < 0.001; depressive symptoms: b = -0.26, p < 0.05) than among those with nearby social support networks (anxiety: b = -0.05, p < 0.01; hopelessness: b = -0.16, p < 0.001; depressive symptoms: b = -0.12, p < 0.01). These findings highlight the importance of neighborhood-level social environments as a potential resource for caregiver mental health, particularly for caregivers with limited proximate social support. They further suggest that community-based efforts to strengthen social cohesion may complement caregiver support strategies and enhance psychological well-being among caregiving spouses.
To evaluate the efficacy and safety of Cortexin in the comprehensive treatment of neurological complications in patients with type 2 diabetes mellitus (T2DM). This multicenter, parallel-group, randomized, clinical trial included 110 patients with neurological complications of T2DM including cognitive impairment, anxiety-depressive states, and a painless diabetic polyneuropathy (DPN). Of the participants, 70.6% were females and 29.4% were males, aged 45 to 70 years (mean age: 60.8±0.71 years). All patients received comprehensive treatment consisting of glycine and B-vitamin complexes for 30 days-administered parenterally for the first 10 days and orally for the subsequent 20 days. The patients were followed up until Day 90. Group 1 (n=55) patients received ten additional doses of Cortexin 10 mg i/m, while Group 2 patients received only comprehensive treatment. Changes in symptoms, glycemic hemoglobin (HbA1c) levels, cognitive deficit scores (Montreal Cognitive Assessment, MoCA), anxiety-depressive disorders (Hospital Anxiety and Depression Scale, HADS), and symptoms related to painless DPN (Neuropathy Symptom Score-9, Central Sensitization Index, CSI) were evaluated. The patients' condition and response to therapy were objectively assessed using the Clinical Global Impression (CGI) scale, and adverse events (AEs) were documented. The regression of cognitive symptoms in group 1 patients was superior to that in group 2 (6.0 times vs. 1.7 times), as confirmed by a 1.2-fold increase in the average MoCA score after 3 months of follow-up (p<0.001). In the Cortexin group, the mean HADS anxiety score decreased by 1.6 times, and the mean depression score decreased by 1.7 times, with minimal changes noted in the control group (p<0.001). Significant reductions in numbness were observed, with a 2.2-fold decrease in the Cortexin group compared to a 1.3-fold decrease in the control group. The mean NTSS-9 score dropped by 2.8 times in group 1 and by 1.3 times in group 2 (p<0.001); while the CSI decreased 1.8 times and 1.2 times, respectively (p<0.001). The reduction in HbA1c was also more significant in the Cortexin group (7.3±0.1% vs 7.8±0.1%, p<0.001). According to the CGI scale, 83.3% of patients in group 1 showed good or very good improvement, and a significant therapeutic effect was noted in 55.6% of patients. The proposed therapy demonstrated a high safety profile, with only 5 AEs reported (3 in Group 1 and 2 in Group 2), none of which were related to the study therapy. The comprehensive therapy with Cortexin proved to be highly effective, safe, and well-tolerated in patients with neurological complications of T2DM, and it is recommended for use in general clinical practice. Оценить эффективность и безопасность лекарственного препарата Кортексин в комплексной терапии неврологических осложнений у пациентов с сахарным диабетом (СД) 2 типа. В многоцентровое рандомизированное в параллельных группах клиническое исследование включено 110 пациентов с неврологическими осложнениями СД 2 типа в виде когнитивных нарушений (КН), тревожно-депрессивных расстройств и безболевой формы диабетической полинейропатии (ДПН), 70,6% женщин и 29,4% мужчин, возраст 45—70 лет (60,8±5,7 года), распределенных в 2 группы по 55 пациентов. Все пациенты получали комплексную базисную терапию в течение 30 дней, из них первые 10 дней — парентерально, последующие 20 дней — перорально, далее наблюдались до 90-го дня включительно. Пациенты 1-й группы дополнительно получали Кортексин 10 мг в/м (10 инъекций), пациенты 2-й группы — только комплексную терапию. Оценивались динамика жалоб, уровень гликированного гемоглобина (HbA1c), КН по Монреальской шкале оценки когнитивных функций (MoCA), тревожно-депрессивных нарушений (Госпитальная шкала тревоги и депрессии, HADS); симптомов безболевой формы ДПН (шкалы Общей оценки симптомов нейропатии, NTSS-9; центральной сенситизации, CSI), проводилась оценка состояния пациентов и реакции на терапию (шкала общего клинического впечатления, CGI), частоты нежелательных явлений (НЯ). Регресс жалоб со стороны когнитивной сферы у пациентов 1-й группы превосходил 2-ю группу в 6,0 раз против 1,7, что подтверждено увеличением среднего балла по шкале MoCA в 1,2 раза (p<0,001) через 3 мес наблюдения. В 1-й группе значения по шкале HADS снизились в 1,6 раза, депрессии — в 1,7 раза, в группе сравнения динамика была минимальной, p<0,001. Отмечено уменьшение жалоб на онемение конечностей в 1-й группе в 2,2 раза по сравнению со 2-й. Средний балл по шкале NTSS-9 снизился в 2,8 раза в 1-й группе и в 1,3 раза — во 2-й (p<0,001); по шкале CSI — в 1,8 раза против 1,2 соответственно (p<0,001). Отмечено большее снижение уровня HbA1c в 1-й группе по сравнению со 2-й (7,3±0,1% и 7,8±0,1%, p<0,001). По шкале CGI состояние 83,3% пациентов из 1-й группы расценено как сильное/очень сильное улучшение, а эффект от терапии у 55,6% пациентов — как значимый. Подтвержден высокий профиль безопасности предложенной схемы терапии, всего зарегистрировано 5 НЯ (3 — в 1-й группе, 2 — во 2-й), не связанных с приемом препаратов исследования. Комплексная терапия с Кортексином показала высокую эффективность, безопасность и хорошую переносимость у пациентов с неврологическими осложнениями СД 2 типа и может быть рекомендована к применению в широкой клинической практике.
Adolescent emotional issues have gained increasing global attention. The connection between Adverse Childhood Experiences (ACEs) and emotional issues in adolescents is well-established. However, the specific psychological pathways that explain this link are not yet fully understood. Our study aims to clarify the link between ACEs and depressive/anxious symptoms in a large Chinese adolescent cohort. We conducted a cross-sectional analysis with 7,158 students from Shandong Province, China, using a stratified cluster sampling method. Participants completed a series of self-report scales: the Adverse Childhood Experiences Scale (ACE-R), the Perceived Stress Scale (PSS-10), the Self-hate Scale (SHS), and the Patient Health Questionnaire-4 (PHQ-4). To test our chain mediation hypothesis, we used correlation analyses and a bootstrap approach. Female adolescents and those with poorer academic performance had higher scores on childhood adverse experiences, perceived stress, self-hate, and emotional symptoms (p < 0.05). High school students scored higher than middle school students in terms of childhood adverse experiences and self-hate (p < 0.05). Only children had higher scores on childhood adverse experiences compared to non-only children (p < 0.05). Perceived stress and self-hate serve as chain mediators in the relationship between childhood adverse experiences and depressive-anxiety symptoms in adolescents. This study expands the research on the relationship between adverse childhood experiences and depressive and anxious emotions in adolescence, providing new insights for reducing the negative impacts of depressive and anxious emotions in adolescents and promoting their mental health.
Despite growing evidence related diet quality to depression, the extent to which the dietary risk factors proposed by the Global Burden of Diseases (GBD) are associated with depression at international level remains unknow. To address this gap, a harmonised protocol has been developed by the Global Burden of Disease Lifestyle And mental Disorder (GLAD) project and we aimed to contribute to the GLAD project by assessing associations between the 15 Global Burden of Diseases (GBD) dietary risk factors, and ultra processed foods (UPF) intakes-and recurrence of depressive symptoms (DepS) over 13 years of follow-up in the British Whitehall II study. Analyses carried out on 4099 participants with no prior history of DepS (73.6% men, mean age = 61.2; SD = 5.9 years) and available assessment of dietary exposures derived from Food-Frequency questionnaire in 2002/04. Recurrent DepS was defined as having DepS in at least two of the four repeated measurements between 2002-2004 and 2015-2016, with DepS assessed using the Center for Epidemiologic Studies Depression Scale (score ≥ 16) or use of antidepressants. After adjusting for sex, age and socio-economic status, results of logistic regression showed that each increase of 1 standard deviation of fruit consumption (228 g) and fibre intake (7.4 g) was associated with 17% and 15% lower odds of recurrent DepS respectively (ORfruit = 0.83, 95% CI 0.73; 0.95, ORfiber = 0.85, 95% CI 0.75; 0.96). These associations persisted after additionally adjusting for socio-demographics, health behaviours and health related factors, including prevalent cognitive impairment. Of the 16-GBD dietary factors, only fruit and fiber showed consistent associations with lower odds of recurrent depressive symptoms in the Whitehall II study.
This study aimed to investigate the predictive value of preoperative radiographic indices, demographic characteristics, and psychological factors for mandibular third molar extraction difficulty, to develop a nomogram, and to interpret feature contributions using SHapley Additive exPlanations (SHAP) analysis. In this retrospective cohort study of 250 patients, demographic characteristics, including age, sex, and body mass index (BMI), together with radiographic indices such as root morphology and psychological factors assessed using the Modified Dental Anxiety Scale (MDAS), were analyzed in relation to surgical difficulty, defined as operative time exceeding 45 minutes. Multivariate logistic regression was used to construct a nomogram, which was validated through receiver operating characteristic (ROC) curves and decision curve analysis (DCA). Feature importance was explored using SHAP analysis, and the association between operative time and perioperative outcomes was assessed. Multivariate logistic regression identified age, root morphology, Winter's angulation, and preoperative dental anxiety (MDAS score) as key predictors of high surgical difficulty (p < 0.05). The resulting nomogram demonstrated excellent discrimination, with an area under the curve (AUC) of 0.91. SHAP analysis illustrated that age and Winter's angulation contribute more to the model's predictions, followed by root morphology. Longer operative time was independently associated with a higher risk of perioperative complications (odds ratio = 1.03, p < 0.05) and showed a positive correlation with pain intensity on postoperative day 1 (Spearman's ρ = 0.712, p < 0.001). Bulbous or curved root morphology, advanced age, high dental anxiety, Winter's angulation, and male sex were associated with the difficulty of mandibular third molar extraction. The developed nomogram serves as a precise, clinically interpretable tool for preoperative risk stratification. Integrating psychological evaluation with anatomical assessment facilitates a holistic approach to surgical planning.