IntroductionEffective communication between family members, intensive care unit (ICU) patients, and healthcare providers is essential for easing family member's distress. We sought to understand how virtual communication patterns between family members, ICU patients, and healthcare providers are related to the mental health outcomes of family members.MethodsWe systematically searched CINAHL and PubMed for peer-reviewed studies published between January 2015 and August 2024 that documented virtual communication with the family member of an adult ICU patient (e.g., phone calls, video calls) and used the family member's mental health as an outcome. Guided by the adapted Source, Channel, Message, Receiver, Outcome Model of Communication, quantitative mental health outcomes were categorized as "improved, neutral, or negative," and qualitative study findings were synthesized into themes.ResultsAmong 2,573 articles initially identified, 21 were selected for review. Phone and video calls were the most common communication modalities, and text messages were uncommon. Measured mental health outcomes included anxiety, depression, post-traumatic stress disorder, and stress or distress. Virtual communication was associated with either improved or no difference in measured mental health outcomes. However, meta-synthesis revealed two themes that suggest ways virtual communication can negatively influence emotions: (1) anxiety with variations in communication source, message, and frequency and (2) reassurance versus distress with communication modality.DiscussionPromoting communication through virtual communication strategies may improve mental health outcomes or emotions experienced among family members of ICU patients. ICU healthcare providers should consider tailoring virtual communication modality and frequency to family members' preferences. When a person is in the intensive care unit (ICU), it can be very stressful for family members—especially when they cannot visit or talk to the patient, doctors, or nurses in person. This study looked at how virtual communication, like phone calls, video calls, and text messages between families, patients, and ICU doctors and nurses, is related to the mental health of family members.We reviewed 21 studies published between 2015 and 2024. These studies measured how virtual communication is related to family members’ mental health and emotional well-being. Most studies focused on anxiety, depression, post-traumatic stress disorder, or stress. For the studies that directly measured mental health, we found that virtual communication usually helped family members feel better or made no difference—none of the studies showed that virtual communication made mental health worse. However, some studies that interviewed family members showed that video calls could either reassure families or make them have negative emotions, such as feeling worried.It is important for ICU doctors and nurses to ask families about their communication preferences. This way, they can adjust the type and frequency of virtual communication to support the mental health of family members of ICU patients.
In team-based learning, students are typically placed in fixed teams based on the idea that stable group membership fosters collaboration: as teammates get to know each other, they share more information, resolve differences and feel motivated to contribute. This rationale had not been tested in a randomized controlled trial. The study compares team-based learning in temporary teams with the default permanent teams regarding individual and team readiness assurance test performance (iRAT, tRAT), reaching team consensus, the learning climate, and intrinsic motivation. In a randomized controlled trial, first-year medical students were assigned either to permanent TBL teams or to teams that were re-assigned for each problem. The team readiness assurance test (tRAT) votes, submitted individually and covertly, served as an indirect indicator for team consensus (concordant versus discordant tRAT vote). Discordant tRATs (n = 268, 11.8% of all votes) were submitted more frequently in temporary than in permanent teams, both for correct and incorrect majority decisions. The self-rated learning climate was more cooperative in permanent than in temporary teams, while intrinsic motivation and tRAT scores were similar for both types of teams. A poorer learning climate was associated with a higher proportion of discordant tRATs. Working in temporary teams does not lead to inferior intrinsic motivation; this was previously also shown for knowledge gain. However, the poorer learning climate, together with reaching a consensus less often, might indicate that at least some members of temporary teams feel not adequately appreciated in the discussion and do not accept the majority decision. With instructional strategies promoting a cooperative learning climate in temporary teams, preclinical TBL courses might serve as an early promoter of the relational team competencies required for subsequent clinical workplace learning in temporary teams.
Participation in the local community is linked to well-being among seniors, yet little is known about how experiences of mattering shape community participation. This study aims to generate a more nuanced understanding of what facilitates and inhibits participation in community contexts, thereby contributing to the expansion of research on how seniors experience community participation through the lens of mattering. Thirty-six seniors from two Norwegian municipalities participated in semi-structured interviews. Interviews transcripts were analyzed using reflexive thematic analysis. Three themes emerged. Feeling seen in the community: This highlights how seniors experience community participation as more than attendance at community events. It involved being recognized, welcomed, and believing that one's actions make a meaningful contribution. Mattering to others: This emphasizes the emotional significance of being invited, remembered, or missed. Such relational cues strengthened social connectedness and well-being. When mattering fades: This reflects experiences of reduced participation following retirement and being classified as "old." Many described a sense of invisibility, which weakened their motivation to participate in the community. Participation is fundamentally relational. Feeling valued and believing one's presence makes a difference are central to seniors' well-being. Community practices that promote recognition may strengthen mattering.
According to the American Association of Biological Anthropologists Code of Ethics, "departments offering anthropology degrees should include and require ethical training in their curriculums." Ethics training is essential, but are Anthropology undergraduate and graduate programs incorporating ethics education as part of their core curriculum? Do Anthropology undergraduate and graduate students feel like they are receiving adequate education and training in ethics as part of their program curriculum? This study attempts to answer these questions by analyzing undergraduate degree requirements for Anthropology majors in the U.S. and by surveying U.S.-based Anthropology teaching faculty and undergraduate and graduate students. These surveys include questions about Anthropology curricula, program and course learning objectives, and student preparedness in facing ethical dilemmas post-graduation. In total, 142 individuals participated in the survey (94 students, 48 faculty members). The results of this survey indicate that some Anthropology undergraduate and graduate programs are incorporating ethics education as part of their core curriculum, but this is not true for all programs. Unfortunately, the most frequent response was that ethics education was not incorporated into the core curriculum, and students, especially graduate students, do not feel that they are receiving adequate ethics education. Results of this study reveal a gap between the ideal practice proposed in professional academic organizations' codes of ethics and the reality of this application, as well as a disconnect between faculty and student perceptions of the sufficiency of the ethics education being provided. Specific recommendations for filling these gaps are provided.
Typodont simulation is a key part of undergraduate dental training globally, allowing prospective dentists to repeatedly practice the necessary skills to safely and effectively care for their future patients. Anecdotally, and in previous small studies, typodonts fall short when compared to what they aim to replicate: human teeth. This study aimed to evaluate opinions on the effectiveness, use, advantages and disadvantages of typodonts. This study gathered quantitative and qualitative data from 338 dentists and dental students using an online questionnaire, evaluating their opinion on the effectiveness of typodont simulation. Likert scales to 32 questions collected opinions on effectiveness of various typodont attributes such as tactile feedback and appearance. Responses were analysed to examine differences in opinion across participant groups using the appropriate parametric and non-parametric tests; free-text responses were analysed thematically. Typodonts were used extensively in all surveyed institutions. They were considered to be moderately effective and readily available for repeated practice of direct and indirect preparations. Improvement is required in several key areas: caries simulation, anatomical layering and endodontic simulation, particularly in relation to material properties related to tactile realism. There were varying opinions on cost and environmental impact when comparing methods of manufacture. Standardisation and customisation of typodonts for education was valued by all. Anatomical layering, tactile realism and caries are important factors to students and dentists in simulation education. Traditionally manufactured typodont were used by the majority of those surveyed but lack key qualities such as realistic tactile feedback required for effective simulation of human teeth, simulation of caries and root canal anatomy. There is potential for more modern methods of manufacture such as 3D-printing to assist in this need for better representation of the complex anatomy and feel of teeth, positively impacting both patient safety and dental education, yet these still fall short in realistic haptic feel and caries simulations. Alongside these features, environmental, financial and availability should be considered.
Oral cancer survival remains poor in Scotland, which is partly due to the delay of early detection. Patients' poor awareness contributes to such delays. Dentists often avoid raising the topic of oral cancer during routine check-ups, fearing patient anxiety. Question Prompt Lists (QPLs) may help by shifting the initiative to patients. This study explored dentists' perceived acceptability of using a QPL to facilitate oral cancer discussions in primary dental care. A pre-study patient focus group informed the design. Semi-structured interviews were conducted with 21 primary care dentists working in NHS Scotland. Purposive sampling was used to ensure variation in experience. Interview data were analysed using framework analysis informed by the Theoretical Framework of Acceptability (TFA). Dentists welcomed the QPL as a valuable, patient-centred tool that could fulfil their ethical duty to inform patients about oral cancer screening. However, significant concerns emerged around time constraints and staffing shortages within high-pressured NHS environments, making any additional intervention feel burdensome. For successful implementation, dentists suggested two prerequisites: (1) design optimisation using short, categorised design with simple language, and (2) systemic integration which was proposed to embed QPLs into booking systems with clear clinical guidelines and systematic training. While dentists supported QPLs as an acceptable and ethical aid for opening difficult conversations about oral cancer, its successful implementation is contingent upon a user-friendly design of the tool and a systemic integration by addressing the fundamental structural inhibitors of NHS dentistry. Future interventions should focus on integrating QPLs into routine workflows rather than treating them as an add-on task.
People with long-term conditions often require assistance from informal carers to support medication use. Therefore, carers frequently access community pharmacies to collect medications and seek advice. This study aimed to explore the experiences and support needs of carers in medication management (MM) within community pharmacies in the United Kingdom. Carers who provided unpaid support with MM for individuals with at least one long-term condition took part in semi-structured interviews. Experiences and perspectives regarding the barriers to, and facilitators of, MM roles and accessing community pharmacies were discussed. Interviews were recorded, transcribed verbatim, and analysed using a reflexive thematic approach. Ethical approval was obtained from Newcastle University Research Ethics Committee (50254/2023). Twenty-four carers were included, all of whom were familial, with most (n = 17) providing care for one or both parents. The sample included a wide range of perspectives, reflected by diverse MM involvement, care recipients' conditions, and carers' backgrounds. Three themes were constructed: 1) the multifaceted nature of caring, 2) carers wading through MM related information and systems, and 3) community pharmacy staff supporting carers to feel empowered in MM. Carers undertake a broad range of complex MM roles as part of their wider caregiving responsibilities. Improving communication between community pharmacy staff and carers is vital to support their MM role and enable safe medication use. Carer support could be tailored to each individual's unique needs. Further research is needed to address how to structure carer support from the perspective of community pharmacy staff.
Healthcare assistants delivering home-based palliative and end-of-life care face complex emotional and clinical demands with limited workplace support. Peer support had been suggested as a potential solution, yet no reviews of such interventions exist. To understand and explain how, why, for whom and in what contexts workplace peer support interventions for healthcare assistants work (or do not work) in palliative and end-of-life care delivery at home. Realist review registered with PROSPERO (registration number CRD42024606133). CINAHL, MEDLINE, AMED, Scopus and grey literature with no date restrictions. Searches undertaken November-December 2024. All study designs containing data relevant to programme theory were included. Evidence was assessed for relevance, trustworthiness and rigour. Synthesis of 24 sources generated 12 context-intervention-mechanism-outcome configurations used to develop initial programme theory. Four workforce outcomes of intervention include: enhanced wellbeing and resilience, reduced loneliness and isolation, development of a sense of community of practice and strengthened role identity. Three intervention strategies: peer-facilitated group meetings, 24/7 peer support access, and informal peer mentorship, create psychologically safe spaces, where individuals feel validated, valued, connected with others, enabling social learning. The intervention elements align with the fulfilment of three basic psychological needs: competence, autonomy, and relatedness. The initial programme theory reveals peer support may address core workforce challenges through psychologically safe peer connections and social learning, aligning with fulfilment of basic psychological needs. It provides a foundation for designing and testing evidence-informed peer support interventions for this workforce.
Randomized controlled trials (RCTs) are the gold standard for evaluating interventions, but when comparing established care pathways, informed consent processes may alter usual preference-related behaviour, thereby introducing bias. Zelen designs randomize participants before consent to reduce these effects. The Patient Satisfaction and Costs Associated with Total Hip Arthroplasty (CAPS-THA) trial used a modified Zelen approach to compare inpatient versus outpatient discharge after total hip arthroplasty (THA). Participants were pre-randomized and initially consented to an observational study of their assigned discharge pathway; randomization and full study details were disclosed after final follow-up. This survey aims to understand how participants feel about the modified Zelen design and its justification, and whether the deception affected their trust in medical research. We conducted an anonymous cross-sectional survey of all available CAPS-THA participants (n=290), distributed by email (n=193) or mail (n=97). Items assessed understanding of the design, perceived ethical acceptability, responses to disclosure, trust in medical research, and willingness to participate in future studies using similar designs. Descriptive statistics summarized responses. Of 290 eligible participants, 235 completed the survey (81% response rate). Mean age was 70.1±10.2 years, 48% female, and 64% (150/235) reported post-secondary education. Ninety percent (210/235) reported a preference toward one comparison group. If informed of both pathways upfront, 36% (84/233) indicated they would have wanted to learn more about the alternative pathway, suggesting potential for preference-related behaviour and satisfaction effects under a conventional RCT. After disclosure, 76% (177/233) agreed the delayed-consent design was justified and 91% (208/229) agreed the study was conducted ethically with patients' best interests in mind. Trust in medical research was reported as unchanged (57%) or increased (37%) by 94% (219/233) of respondents. Seventy-one percent (163/229) expressed strong willingness to participate in a similar study in the future. Nearly all participants viewed the modified Zelen approach as ethically acceptable and reported no decrease in trust following disclosure. These findings support the responsible use of Zelen designs, paired with a robust debriefing and meaningful post-disclosure choice, when preference-related bias may threaten trial validity.
This article highlights stepwise deconstruction within simulation-based mastery learning (SBML) as a framework for endoscopy training. Endoscopy requires technical precision, sound judgment, and nontechnical skills, but trainees often feel overwhelmed, and trainers may lack structured feedback tools. Deconstruction addresses this by breaking procedures into sequential, teachable steps that are observable, measurable, and defined by expert consensus. In esophagogastroduodenoscopy; for example, this includes scope neutrality, systematic navigation, and complete wall examination. Embedding deconstruction into SBML standardizes learning, enhances patient safety, and ensures all learners achieve competency before performing independently.
Early-life stress has been closely linked to the development of various neuropsychiatric disorders, including anxiety and depression. This study investigated the protective effects of vanillic acid, exercise, and their combination on early-life stress-induced anxiety- and depression-like behaviors and neuronal damage in the maternal separation (MS) rat model. Pups from Wistar albino rats were subjected to a maternal separation protocol, whereas control pups were not. After the MS protocol, rats were randomly divided into four groups: saline, exercise, vanillic acid (VA; 100 mg/kg, oral), or a combination group. Before decapitation, behavioral tests were conducted, and tissue samples were collected for assessments. Compared with the MS group, vanillic acid reduced corticosterone levels and anxiety- and depression-like behaviors (p < 0.05 - 0.001). Compared with the MS group, oxidative damage (malondialdehyde, glutathione, myeloperoxidase), apoptotic parameters (B-cell lymphoma-2 (Bcl-2), Bcl-2-associated X protein (Bax)), neuronal damage, neuroinflammation (TNF-α, IL-6), and BDNF activity were reversed in all groups (p < 0.01 - 0.001). Nuclear factor-κB (NF-κB) was suppressed in the VA and exercise groups compared with the MS group (p < 0.001), whereas no difference was observed in the combined group. These findings suggest that vanillic acid or exercise may offer a promising strategy for mitigating the harmful neurological consequences of early-life psychological stress.
This study aims to test the theoretical model proposed based on the Reinforcement Sensitivity Theory (RST), which states that the individual's Behavioral Inhibition System (BIS) and Behavioral Activation System (BAS) not only directly affect their negative emotions, but also may have indirect effects through the internal psychological process of mindfulness. A total of 200 elderly patients who received hip fracture surgery were included in this study. Self-Rating Depression Scale (SDS), Self-Rating Anxiety Scale (SAS), Behavioral Inhibition/Activation System Scale (BIS/BAS), and five facets mindfulness questionnaire (FFMQ) were used to conduct a cross-sectional investigation. The study mainly employed Pearson correlation analysis to explore the pairwise correlations among four consecutive variables: the behavioral inhibition system, the behavioral activation system, negative emotions, and mindfulness. The behavioral inhibition system of elderly patients negatively correlated with description, observation, and action with mindfulness and nonjudgmental. However, it positively correlated with nonreactivity and negative emotions. The behavioral activation system of elderly patients positively correlated with description, observation, action with mindfulness, and nonjudgmental and negatively correlated with nonreactivity and negative emotions. The results of the multiple linear regression showed that behavioral inhibition/activation system, mindfulness, gender, presence or absence of children, and presence or absence of complications constituted the primary influencing factors for postoperative negative emotions in patients. Bootstrap mediation analysis showed that mindfulness partially mediated the relationship between the behavioral activation system and negative emotions, with a total effect of - 0.051 (95% CI: -0.062 to - 0.040) and a mediation effect accounting for 27.0% of the total effect. Mindfulness also partially mediated the relationship between the behavioral inhibition system and negative emotions, with a total effect of 0.022 (95% CI: 0.016 to 0.027) and a mediation effect accounting for 24.3%. The results of this study generally support the research hypotheses proposed based on the theory of sensitivity to reinforcement. The behavioral inhibition and activation systems are indeed associated with the negative emotions of elderly patients after hip fracture surgery, and mindfulness plays an important mediating role in this relationship. This finding has clear clinical significance: it suggests that for postoperative patients with high BIS and low BAS traits, in addition to direct emotional intervention, enhancing their mindfulness skills training may be a particularly effective breakthrough. By intervening through this mediating path, it is possible to more precisely alleviate their emotional distress and promote psychological rehabilitation.
Hypervigilance and kinesiophobia have been associated with temporomandibular disorders (TMD), but their relationship with specific diagnostic profiles remains unclear. This study investigated the association between TMD diagnoses, hypervigilance, and kinesiophobia, and whether these variables could differentiate distinct clinical profiles across painful and non-painful conditions. In this multicenter cross-sectional observational study, 862 adults aged 18 to 50 years from Brazil, Chile, and Portugal were classified as controls, non-painful TMD, or painful TMD. Diagnoses were established using the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). Hypervigilance and kinesiophobia were assessed using the Pain Vigilance and Awareness Questionnaire (PVAQ) and the Tampa Scale for Kinesiophobia for TMD (TSK/TMD). Statistical analyses included factor analysis of mixed data, hierarchical clustering on principal components, and partial least squares discriminant analysis, followed by multivariate and regression analyses to assess potential associations between psychosocial variables and TMD diagnoses. Among 862 participants (312 controls, 550 TMD), kinesiophobia and hypervigilance increased across groups, with the highest levels in painful TMD (p < 0.001). Unsupervised clustering identified three distinct profiles aligned with clinical presentation: controls with low psychological burden, non-painful TMD with intermediate levels, and painful TMD with elevated kinesiophobia and hypervigilance. Multivariate analyses showed associations of psychosocial variables with TMD diagnoses, with kinesiophobia consistently driving group differences, while age, gender, and pain vigilance had a moderate influence. Among TMD subgroups, joint pain was associated with higher pain vigilance and muscular TMD with higher kinesiophobia, suggesting greater clinical complexity. Higher levels of hypervigilance and kinesiophobia were associated with painful and clinical more complex TMD profiles.
This study aimed to determine whether a higher Geriatric Depression Scale-15 (GDS-15) score on admission is associated with worsening of the Clinical Frailty Scale (CFS) score from discharge to 3 months after discharge in older patients hospitalized for acute care. This multicenter prospective study was performed at three university hospitals and one national medical center in Japan between October 2019 and July 2023. A total of 601 patients were analyzed. Post-discharge CFS worsening was defined as a ≥ 1-point increase in CFS score from discharge to 3 months after discharge. Logistic regression, subgroup, sensitivity, and formal interaction analyses were performed. From discharge to 3 months after discharge, the CFS score worsened in 87 patients (14.5%). The worsened group had significantly higher GDS-15 scores on admission (p = 0.047). After adjustment for age, sex, baseline CFS score, CCI value, and MMSE score, a higher GDS-15 score was associated with greater odds of CFS worsening (OR 1.109, p = 0.002). In subgroup analysis, this association was observed in patients with baseline CFS scores ≥ 4 (OR 1.106, p = 0.007), but not in those with baseline CFS scores ≤ 3. The formal interaction test was not significant (p = 0.969). The association remained significant in sensitivity analyses. A higher GDS-15 score on admission independently predicted post-discharge CFS worsening in older acute-care inpatients. GDS-15 screening on admission may help identify patients requiring closer post-discharge monitoring for frailty deterioration.
Grounded in the I-PACE model, this study examines the mechanisms linking short-video exposure to addiction, specifically investigating the mediating roles of affective and cognitive reactions, and the moderating influence of inhibitory control and addiction status. A large-scale survey (N = 1,274) was used to test a moderated mediation model of addiction, with its core affective and cognitive variables first defined through focus groups with a strategically selected subsample (N = 169) of addicted and nonaddicted users. Results first revealed two distinct user profiles: an addicted group characterized by high emotional involvement and low control, marked by emotional ambivalence and cognitive inconsistency, and a nonaddicted group defined by low emotional involvement and high control. The moderated mediation analysis then uncovered the complex dynamics underlying these profiles. The role of self-regulation was found to be double-edged, profoundly moderated by inhibitory control. For individuals with low inhibitory control, greater use of self-regulatory strategies was associated with higher addiction severity, suggesting a conditional risk pattern consistent with a possible "backfire effect." Conversely, for those with high inhibitory control, such strategies were largely redundant. Furthermore, the pathways to addiction diverged by addiction status. The process for addicted individuals was predominantly driven by the pursuit of positive emotions. In stark contrast, for nonaddicted individuals, the crucial battleground was self-regulation, which functioned as a critical defense, highlighting a vital window for early intervention. Together, these findings underscore the importance of inhibitory control, the double-edged nature of self-regulation, and the primacy of positive affective pathways, thereby refining the I-PACE model and offering targeted insights for prevention and intervention.
Posttraumatic stress disorder (PTSD) significantly influences individuals' daily life, yet little is known about their experiences of occupational participation and the supporting resources they use. To explore the lived experiences of occupational participation among adults with PTSD and identify resources that support their participation in everyday life. Employing a qualitative design grounded in descriptive phenomenology, remote semi-structured interviews were conducted with 10 community-dwelling adults diagnosed with PTSD. Data were processed through reflexive thematic analysis. Analysis revealed three primary themes: (a) the occupational experience of living with PTSD including effort, motivational challenges, and dysregulation; (b) temporal dynamics of participation; and (c) resources supporting participation, such as balance, processing trauma through occupation and doing for others. The findings elucidate the ways in which trauma influences occupational experiences and highlight key resources that can facilitate participation, offering valuable insights to advance occupational therapy practice for individuals with PTSD. How People With PTSD Experience Everyday Occupations and What Supports Their ParticipationLiving with posttraumatic stress disorder (PTSD) can affect how people experience everyday occupations such as work, relationships, and self-care. This study explored how adults with PTSD experience their daily participation and which resources support their participation in occupations. Ten adults were interviewed about their everyday lives. Participants described that daily occupations often require high effort, feel less enjoyable, and are frequently driven by necessity rather than personal choice. Participation was also described as fluctuating over time, with days or periods of greater and lower participation. Participants identified several resources that helped them participate, including having routines, balancing activity and rest, caring for others, using occupations to cope with and process trauma, and receiving social support. These findings show that everyday occupations play an important role in recovery from PTSD and that supporting participation can improve quality of life.
The continued influence effect (CIE) refers to the persistent influence of False Information (FI), even after it has been corrected. This effect has been replicated in numerous experiments and carries significant societal implications. While the existing literature provides various explanations for the CIE, a comprehensive synthesis of these explanations remains lacking. This lack of synthesis hinders the ability to optimize recommendations for mitigating the effect and guiding future research. To address this, a conceptual reorganization of existing explanations is proposed within a heuristic framework encompassing three perspectives: cognitive, motivational, and rational. Drawing on this three-dimensional framework, recommendations are provided for mitigating this social issue and guiding future research.
To identify and synthesize randomized controlled trials (RCTs) of oral traditional Chinese medicine (TCM) for postherpetic neuralgia (PHN), map the volume, methodological quality, and evidence distribution, identify evidence gaps, and inform future research. We systematically searched PubMed, Embase, the Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Data, VIP Database, the Chinese Clinical Trial Registry (ChiCTR), and China Biomedical Literature Database (CBM). RCTs published from database inception to 1 August 2025 were included. The evidence was summarized using evidence maps and narrative synthesis. Risk of bias in the included RCTs was assessed using the Cochrane Risk of Bias tool (RoB 1.0). A total of 357 RCTs were included, most were small studies with sample sizes ranging from 50 to 100 participants. Most studies reported diagnostic criteria and inclusion/exclusion criteria, however, limited attention was paid to TCM syndrome differentiation and its standardization. The main outcomes were pain degree, clinical effective rate, adverse reactions, sleep quality, negative emotions, and quality of life, however, outcomes such as recurrence and TCM syndrome scores were infrequently reported. Overall methodological quality was low, as assessed using the RoB 1.0. Although many included studies reported favourable findings, the formulas and preparations differed substantially in composition, and high-quality evidence remains limited. Future trials should better incorporate key features of TCM (e.g., syndrome differentiation), use standardized and clinically meaningful outcome measures, and strengthen trial design and reporting to reduce risk of bias and improve the credibility of evidence. URL: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251110786, identifier CRD420251110786.
Healthcare worker burnout is a complex phenomenon that traditional linear models fail to fully explain. This study uses network analysis to map the associative interactions between organizational factors, mental health symptoms, and burnout dimensions in a national sample of Peruvian physicians and nurses. Cross-sectional network analysis using data from the 2016 National Healthcare Worker Survey, comprising 4951 healthcare professionals (2125 physicians, 2826 nurses). Twenty-two variables spanning burnout dimensions (MBI-GS), mental health symptoms, work satisfaction, and organizational factors were analyzed using Gaussian Graphical Models with bootstrap validation (1000 iterations). Expected Influence, Betweenness, Closeness, and Strength centrality indices were calculated. Network invariance testing compared structural differences between professions. The network comprised 22 nodes with 82 non-zero edges (density = 0.355). Health services management satisfaction showed the highest expected influence (EI = 2.14), followed by monthly income (EI = 1.49). Emotional exhaustion showed substantial negative influence (EI = -0.46). Network invariance testing revealed statistically significant structural differences between professions (M = 0.2289, P = .0099), though overall similarity was moderate to high (ρ = 0.685). Nurses showed higher expected influence for job stability (EI = 0.619 vs 0.375), while physicians showed higher expected influence for marital status (EI = 0.659 vs 0.416). Bootstrap stability coefficients exceeded recommended thresholds (CS = 0.67-0.75). Burnout components showed network patterns consistent with complex adaptive systems, with organizational factors (management satisfaction, income) displaying higher expected influence than individual mental health symptoms. Network structures differed statistically between professions, though with moderate-to-high overall similarity. We propose a preliminary exploratory framework (SPIRAL model) identifying 6 network-based patterns that require prospective longitudinal validation before clinical application.
Background: Acculturation is a dynamic stress process for those undergoing migration. To date, the association between acculturation and the processing of traumatic events has not been empirically explored despite those concepts being both associated with stress.Objectives: We explore the relationship between acculturation, the cognitive processing of traumatic events and mental health outcomes.Methods: The sample consisted of 161 migrants living in the UK. A k-means cluster analysis was used to classify participants based on their level of acculturation. Analyses of covariance (ANCOVAs) and regression analyses were used to analyse cross-sectional data.Results: Three clusters were identified from the data: higher and easier acculturation (HEA); higher and harder acculturation (HHA); and lower acculturation (LA). Gender and trauma exposure were identified as significant covariates. There were significant effects of acculturation on post-traumatic personal and public negative appraisal measures, and on post-traumatic and depression symptoms. Individuals in the LA cluster presented significantly higher scores on these measures compared to the other two clusters. An exploratory mediation analysis revealed that post-traumatic, depression and anxiety symptoms can be predicted by acculturation through the mediating role of post-traumatic negative appraisals, with significant differences between the HEA cluster and the LA cluster, and between the HHA cluster and the LA cluster.Conclusions: Overall, these findings shed light on the role of acculturation on the processing of traumatic events and subsequent mental health symptoms, both at the intrapersonal and the interpersonal level. That individuals with lower acculturation display clinical levels of mental health symptoms and more negative appraisals warrants the exploration of the acculturative process in therapy. Moving to a new culture can lead to difficulties in the sense of belonging and wellbeing.Individuals differ in their trauma processing depending on their acculturation level.Low acculturation relates to higher negative trauma cognitions and worse mental health outcomes.Mental health can be predicted by acculturation depending on trauma and cognitive processing.Clinicians should consider the impact of acculturation and cognitive trauma processing on mental health.