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Leisure-time physical activity (LTPA) participation among Chinese college students remains insufficient despite growing public health concerns regarding sedentary lifestyles and obesity. Social media platforms have increasingly become important channels for delivering social support related to physical activity (PA); however, different dimensions of social support on social media may exert distinct psychological influences on exercise intentions. Guided by the theory of planned behavior, this study aimed to examine the direct and indirect relationships between different dimensions of social support on social media and Chinese college students' intentions to engage in LTPA. A cross-sectional online survey was conducted among undergraduate and graduate students from a comprehensive university in East China between February and June 2022. A total of 310 valid responses were analyzed using structural equation modeling in R. Three dimensions of social support on social media, including companionship support, informational support, and self-esteem support, were examined as predictors of LTPA intention, with the theory of planned behavior constructs (attitude, subjective norms, and perceived behavioral control) modeled as mediators. Demographic characteristics, BMI, social media use, and prior PA behaviors were included as covariates. Companionship support demonstrated the strongest positive association with LTPA intention, including both a direct effect (&#x3b2;=.348; P=.005) and an indirect effect through attitudes toward PA (&#x3b2;=.286; P=.002). Self-esteem support also showed a significant positive indirect association with LTPA intention via attitude (&#x3b2;=.138; P=.02). In contrast, informational support demonstrated a significant negative indirect effect on LTPA intention through attitude (&#x3b2;=-.291; P<.001). Subjective norms and perceived behavioral control did not significantly mediate the relationships between social support dimensions and LTPA intention. The findings suggest that companionship-oriented interactions on social media may strengthen positive exercise attitudes, whereas excessive or low-credibility informational content may undermine exercise motivation. Different dimensions of social support on social media play distinct roles in shaping Chinese college students' intentions to engage in LTPA. Social media-based PA interventions should prioritize companionship and esteem support while improving the credibility, personalization, and quality of informational support to reduce potential negative effects associated with misinformation and information overload.

Social media has become an increasingly prevalent platform for exchanging health information, facilitating professional networking, promoting education, and fostering public engagement. For surgeons, its benefits-rapid dissemination of knowledge, community building, conference amplification, advocacy, and recruitment-coexist with heightened ethical risks, including breaches of confidentiality, blurred professional boundaries, misinformation, conflicts of interest, and inequities in access. This SAGES Ethics Committee white paper provides an ethics-focused overview of surgeon social media use and offers practical recommendations aligned with core bioethical principles, incorporating previous work from the SAGES Social Media Committee, the SAGES Facebook Taskforce, and the SAGES Ethics Committee. We synthesize existing professional guidance and the peer-reviewed literature on social media in healthcare and surgery to identify recurring ethical dilemmas across stakeholder groups (surgeons, patients, institutions, and society). We organize these issues using the four principles of biomedical ethics-autonomy, beneficence, non-maleficence, and justice-and translate them into actionable standards for professional conduct, content stewardship, and institutional oversight. Key ethical domains include the following: (1) professionalism and identity management in blended personal/professional spaces; (2) confidentiality and the Health Insurance Portability and Accountability Act of 1996 (HIPAA)-informed safeguards when sharing clinical images, videos, and case discussions; (3) disclosure and conflict-of-interest management in self-promotion, marketing, endorsements, and "non-evidence-based" content; (4) boundaries in patient interaction, emphasizing that social media should not be used for direct patient-provider communication in lieu of secure, trackable clinical platforms; (5) respect for patient privacy, including a general expectation that clinicians should not search patients' social media absent compelling, disclosure-supported exceptions (e.g., emergent identification needs); (6) consent standards for recording or posting media involving patients or clinicians; (7) equity considerations, recognizing that reliance on social platforms can worsen disparities for individuals lacking access or digital health literacy; and (8) societal-level implications such as clinical trial recruitment, crowdsourcing, misinformation correction, wellness harms from excessive use, and emerging risks/opportunities from artificial intelligence (AI)-enabled amplification and data mining. Ethical social media engagement by surgeons is feasible and often beneficial when guided by transparency, accuracy, confidentiality protection, boundary maintenance, and equity. We recommend clear disclosures, separation of personal/professional accounts when feasible, institutional and society-level monitoring frameworks for official messaging, strict consent and de-identification standards for clinical content, avoidance of social media as a clinical communication channel, and ongoing review of AI-driven changes to platform dynamics and privacy risk.

Rheumatoid arthritis (RA) and ankylosing spondylitis (AS) are chronic inflammatory rheumatic diseases associated with impaired quality of life, persistent disease burden, and increased healthcare utilization. Treatment adherence and psychosocial factors may influence outcomes, but their longitudinal associations in real-world hospitalized populations remain insufficiently characterized. We conducted a single-center, retrospective, mid-term longitudinal observational study including 50 adults with RA or AS who experienced repeated hospitalizations over a four-year period. The final dataset comprised 196 hospitalization episodes analyzed as repeated observations nested within individual patients. Disease activity was assessed using DAS28 in RA and ASDAS and/or BASDAI in AS, according to data availability and routine clinical practice. Treatment adherence, quality of life, anxiety, social isolation, patient-provider communication, dietary support, inflammatory markers, and hospitalization-related outcomes were extracted from medical records and structured inpatient assessments. Linear mixed-effects models were used for continuous outcomes, and ordinal mixed-effects models were used for ordered categorical outcomes, with adjustment for age, sex, and time where appropriate. In RA, higher treatment adherence was associated with lower disease activity over time. In AS, comparable associations were not detected, possibly reflecting disease-specific factors, limited variability in adherence, and reduced statistical power in the smaller AS subgroup. Better patient-provider communication was associated with higher adherence and lower anxiety, whereas greater social isolation was associated with poorer quality of life. More favorable dietary support was associated with better adherence, although the magnitude of this association should be interpreted cautiously because of sparse categories and wide confidence intervals. Lower inflammatory burden, particularly lower CRP over time, was associated with lower hospitalization-related costs. In this selected cohort of repeatedly hospitalized patients with RA or AS, treatment adherence, psychosocial factors, and supportive care indicators were associated with clinically relevant longitudinal outcomes. The findings support a multidisciplinary, patient-centered approach to inflammatory rheumatic disease care. However, because of the retrospective design, modest sample size, selected inpatient population, non-standardized assessment of several variables, and possible instability of some ordinal model estimates, the results should be interpreted as exploratory and confirmed in larger prospective cohorts.

This study examines the family and social consequences associated with using Artificial Intelligence (AI) to manage workplace conflicts within hybrid workplaces. Hybrid workplaces are a new workplace environment, where technology is used in emerging area of inquiry concerning the degree to which AI related stressors bleed across boundaries into family life. Research has primarily focused on either the technological, or organizational aspects of algorithmic management. As such, there exists a dearth of theoretical understanding as to how workplace systems utilizing AI drive employee psychological security and subsequently their family dynamics. Thus, our objective was to understand how transparency regarding AI, fairness in algorithms used by AI, and digital surveillance employed by employers affects hybrid employee's psychological security and ultimately their family dynamics within the UAE. We utilized an explanatory sequential design to utilize both quantitative survey data collected from 420 hybrid workers, along with qualitative thematic analysis of scenario based vignette responses. Our results indicate a stark disconnect; while participants had moderate confidence in AI systems resolving conflicts; they were extremely concerned about issues of fairness, privacy and lack of algorithmic transparency. Most importantly, 63% of respondents indicated that work-related stress experienced due to AI mediated workplace surveillance and evaluation of performance had a negative effect on communication and emotional stability with family members at home. Therefore, we have proposed the Social Algorithmic Justice Framework (SAJF) to identify the pathways from algorithmic transparency to family resiliency with the influence of social support. Ultimately, this study will provide a theoretically supported framework for integrating workplace AI with socially sustainable values so as to ensure that workplace AI integration enhances family harmony rather than diminishes it.

As digital technology has become increasingly integrated into rural governance and daily life in China, Internet use among rural residents exerts a multifaceted influence on their mental health. A key mechanism lies in its restructuring of the neighborhood social environment. Uncovering this mechanism is essential for understanding the theoretical and practical connections between rural social transformation and individual well-being in the digital age. This study applied a binary probit model to data from the 2020 China Family Panel Studies (CFPS) to examine the impact of Internet use on the mental health of rural residents. Mediation analysis was used to examine the role of the neighborhood social environment, and the conditional mixed process method was applied to address potential endogeneity issues. Empirical results demonstrate that access to the Internet, along with the breadth and depth of its use all significantly improve the mental health of rural residents. Internet use promotes mental health by strengthening neighborhood relationship and trust, whereas it also negatively affects mental health by suppressing neighborhood identity. Heterogeneity analyses reveal three key dimensions of variation. (1) By usage type: Activities such as gaming, short-video consumption, and WeChat communication show positive associations with mental health, whereas online shopping and learning exhibit non-significant effects. (2) By user group: The mental health benefits are more pronounced among women, less-educated individuals, and middle-aged to older adults. (3) By region: Positive associations are observed in central and western China, with the most substantial effect in the central region. This study elucidates the mechanism through which Internet use affects mental health: the restructuring of traditional, place-based social capital in rural neighborhoods. These findings offer robust empirical support for policies that integrate digital initiatives with the nurturing of local community bonds to improve rural mental health and foster livable and harmonious villages.

This feasibility randomised controlled trial (RCT) evaluated Purrble, a socially assistive robot for emotion regulation, as a low-intensity adjunct during waitlist periods in adult eating disorder services. Adults waiting for outpatient eating disorder treatment were randomised to four weeks of Purrble use or waitlist-as-usual. The primary outcome was emotion regulation, assessed with the Difficulties in Emotion Regulation Scale; secondary outcomes included sensory sensitivity, anxiety, depression, and motivation for change. Analyses were conducted using paired t-tests and linear mixed-effects models. Acceptability was explored via a qualitative survey. 39 participants were enrolled in the trial and 37 participants were retained (19 Purrble, 18 control). A significant group&#xa0;&#xd7;&#xa0;time interaction emerged for depression, with greater reductions in symptoms among Purrble participants. No significant interactions were found for emotion regulation, sensory sensitivity, motivation, or anxiety, though the Purrble group showed small-to-moderate improvements in emotion regulation, sensory sensitivity, and anxiety, and a significant within-group increase in motivation. Qualitative findings identified four categories: situational use during distress, sensory comfort and emotional connection, design limitations/barriers, and continued use with integration into self-care. Purrble proved acceptable and feasible as a waitlist adjunct in adult eating disorder outpatient services. A significant between-group effect on depression and a within-group improvement in motivation provide preliminary support for a fully powered trial.

Contractualism is valuable, but morality is not a means to agreements for mutual benefit. Beyond what we expect others to agree to, morality is - by almost any definition - about what we think others ought to agree to. Children, youth, and adults form judgments about social inequalities based on reasoning about rights and justice, whether they expect agreement or not.

Digital tools are increasingly used in diabetes care, but their long-term effectiveness remains uncertain. A previous randomized controlled trial (RCT) demonstrated promising effects on perceived burden and quality of life after 6 months. The present study extends these findings through a 12-month follow-up, aiming to evaluate the long-term effects of virtual care on glycaemic control, treatment satisfaction, and quality of life among young adults with type 1 diabetes. This single-centre wait-list RCT included 70 young adults aged 18-25 years with type 1 diabetes in Stockholm, Sweden. Participants randomized to the intervention group had access to the virtual platform for 12 months whereas participants in the wait-list control group received access after 6 months. The platform facilitated real-time communication with healthcare providers. Glycated haemoglobin (HbA1c) levels, time in range, time below range, diabetes treatment satisfaction, and quality of life were assessed at baseline and at the 6- and 12-month follow-ups. Comparisons within and between groups were performed using Welch's paired and independent samples t-test, the Wilcoxon signed rank test, and the Mann-Whitney test. At the 12-month follow-up, the intervention group showed a decreased HbA1c level from baseline (62.8 to 58.6 mmol/mol; P = 0.051) and improved time in range (46.6% to 56.9%; P = 0.002). In the wait-list control group, social burden decreased significantly from baseline to 12 months (4.3 to 0.03; P = 0.030). Other measures of quality of life, including social and emotional health, showed no significant differences. Virtual diabetes care may enhance engagement and modestly improve glycaemic control in young adults, serving as a practical complement to standard outpatient follow-up. ISRCTN (ref: 73435627, registration date: 23/10/2019): https://doi.org/10.1186/ISRCTN73435627.

Adverse childhood experiences (ACEs), toxic stress, relational insecurity, and structural adversity are major public-health concerns for children and adolescents, but ACE evidence should not be treated as an individual diagnostic score or deterministic prognosis. This Hypothesis and Theory article proposes developmental literacy and epistemic dignity as linked upstream constructs for primary child protection. Developmental literacy is defined as developmentally staged and disability-inclusive neurobiopsychosocial knowledge and skills concerning bodies, emotions, stress, attachment, co-regulation, play, nutrition, safety, rights, boundaries, non-violent care, and help-seeking. Epistemic dignity refers to the supported capacity and right of children-including preverbal, disabled, neurodivergent, and communication-diverse children-to have bodily, emotional, relational, play-based, and communicative signals interpreted with seriousness, humility, and appropriate response. Drawing on research on ACEs and positive childhood experiences (PCEs), nurturing care, relational health, health-promoting schools, social and emotional learning, mental-health literacy, sexuality/safety education, child participation, epistemic injustice, disability studies, implementation science, and critiques of ACE and trauma-informed practice, the article develops a universal, proportionate, relationally safe, anti-bias, and non-coercive public-health framework. It argues that early-childhood services, schools, pediatric/public-health touchpoints, caregiver support, and community systems can provide age-appropriate developmental knowledge without turning schools into clinics, teachers into trauma detectors, or children into individual risk scores. The framework does not recommend routine individual ACE-score screening in schools as a default practice; it supports ethically governed, service-linked pathways for recognizing distress and unmet support needs. Coercive reproductive control is treated only as a rejected comparator because it targets reproductive status rather than modifiable developmental environments, support access, and institutional trust. The article concludes with safeguards and testable hypotheses for evaluating developmental literacy, epistemic dignity, relational safety, accessibility, help-seeking, response quality, caregiver support, referral continuity, and unintended harms.

Health literacy is an important determinant of health outcomes, yet many approaches continue to emphasize individual cognitive skills while giving limited attention to the sociocultural resources that shape how people engage with health information. This study examined the association between cultural capital and multiple dimensions of health literacy among urban communities in Malaysia. A cross-sectional study was conducted among 325 adults residing in selected urban communities in Ipoh, Perak. A cluster-based approach was used to identify study locations, followed by community-based convenience recruitment within selected clusters. Cultural capital was assessed across embodied, objectified and institutionalized dimensions, while health literacy was measured using the validated HLS-M-Q18 instrument, which captures access, understanding, evaluation and application of health information. All constructs demonstrated good internal consistency (Cronbach alpha&#x2009;=&#x2009;0.822 to 0.931). Spearman's rank correlation was used for bivariate analysis due to non-normality, while multiple linear regression estimated the independent contribution of each form of cultural capital to each health literacy domain. Cultural capital was significantly associated with all dimensions of health literacy (p&#x2009;<&#x2009;0.001). Institutionalized cultural capital was the strongest predictor of access (&#x3b2;&#x2009;=&#x2009;0.298, p&#x2009;<&#x2009;0.001) and understanding (&#x3b2;&#x2009;=&#x2009;0.305, p&#x2009;<&#x2009;0.001), whereas embodied cultural capital was the only significant predictor of evaluation (&#x3b2;&#x2009;=&#x2009;0.537, p&#x2009;<&#x2009;0.001) and the strongest predictor of application (&#x3b2;&#x2009;=&#x2009;0.359, p&#x2009;<&#x2009;0.001). Cultural capital explained between 28.2% and 41.9% of the variance across outcomes. Differences were also observed across education and income levels. These findings indicate that health literacy is not determined by access to information alone but is shaped by broader social and cultural resources. Public health interventions should therefore move beyond information provision and strengthen the experiential and contextual capacities that enable individuals to evaluate and apply health information in everyday life.

Contemporary crises increasingly draw health systems, humanitarian access, medical supply chains, and civilian protection into security-oriented governance. While the health consequences of war and economic coercion, and geopolitical rivalry are widely documented, less attention has been paid to the discursive processes through which such consequences are rendered legitimate, unavoidable, or politically peripheral. This paper addresses this gap by applying a critical geopolitics framework and critical discourse analysis to examine how geopolitical narratives may structure health-relevant governance during crises. Drawing on a purposive, illustrative corpus - (i) a primary corpus of institutional and policy discourse (state communications, United Nations and World Health Organization documents, sanctions guidance, and international non-governmental organizations' reports) and (ii) a secondary corpus of scholarly literature, the study identifies three recurring discursive mechanisms: securitization, exception-making, and displacement of responsibility. Across five illustrative case contexts-US-China geopolitical rivalry, the Russia-Ukraine war, the Israel-Palestine/Gaza crisis, Iran-related sanctions and protest governance, and US-Venezuela sanctions governance-the analysis suggests how security narratives can condition humanitarian access, reshape the practical meaning of civilian protection, and diffuse accountability for health harms. Rather than arguing that discourse alone causes health outcomes, the paper treats discourse as one governance condition among others: it influences what becomes politically thinkable and institutionally actionable while interacting with military, economic, legal, and health-system factors. The findings advance critical health geopolitics and peace and security scholarship by showing how health inequities can function as a diagnostic lens through which norm erosion and the normalization of exceptional governance become empirically visible.Clinical trial numberNot applicable.

Existing evidence demonstrates the benefits of integrated palliative care for people with cancer and their carers, for improved symptom burden, quality of life and appropriate healthcare resource use. The integration of palliative care and oncology has the potential to improve the quality of life and is recommended by international guidelines. However, it is not yet consistent practice. There are many approaches to integration, but it is unclear what works, for whom and in what contexts to achieve the best possible outcomes for people with cancer, carers and healthcare systems. To conduct a realist synthesis to develop a programme theory of how integrated palliative care in cancer works, for whom and in what contexts to achieve improved symptom management and increased quality of life for people with cancer and their carers. To use the programme theory to coproduce, with stakeholders (e.g. patient and public involvement representatives, local, national, international content experts and multidisciplinary practitioners), guidance to inform delivery of best practice and guide future research. Realist review, conducted in accordance with Realist and Meta-narrative Evidence Synthesis: Evolving Standards. Evidence was identified through systematically searching academic databases and through stakeholder engagement. Data were extracted from included articles and were synthesised using a realist logic of analysis to develop explanations of how and why integrated palliative care in oncology works, for whom and in what contexts. One hundred and sixty-four papers from 33 countries were included in the review. Integrated palliative care and oncology could improve people with cancer's outcomes, increase the goal-concordance of care and support workforce well-being. Interventions to support integration should be tailored to the context in which they are delivered. Ensuring the timely delivery of palliative care for people with cancer requires integration that overcomes siloes between oncology, specialist palliative care and primary and community care. The motivation to prioritise the integration of palliative care relies upon all stakeholders first understanding its value. Enriched interdisciplinary collaboration involves developing confidence in their own and their colleagues' skillsets, facilitating co-ordination between care settings and supporting communication within and between teams. Supportive leadership could promote an institutional culture of acceptance of the value of integrating palliative care into oncology management. The realist approach to analysis means that findings are based on our interpretation of the data. To manage the high volume of studies, we limited inclusion to documents published since 2010, using qualitative, mixed or economic methods; therefore, we may have excluded relevant documents. The success of integration is influenced by the ways in which palliative care is understood, prioritised, operationalised and measured within oncology. Through the synthesis of international evidence, this project draws on implementation science to contribute clarity on how integrated palliative care and cancer care can be achieved in practice. Future work should use the implications and recommendations to initiate and optimise palliative care in oncology management. This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number NIHR152115. There are currently 3 million people living with cancer in the United Kingdom. To better meet the needs of people living with cancer and their carers, it is recommended that cancer care (oncology) is brought together with palliative care. This is described as &#x2018;integration&#x2019;. Research shows that palliative care is helpful for people with cancer, especially when they have access to it at the right time. Although there is evidence that people do better when there is integration, it is difficult to do this in practice. We aimed to understand the best ways for palliative care and cancer care to work together. We used a type of literature review called a &#x2018;realist synthesis&#x2019; and worked with expert stakeholders. The stakeholders involved 17 people who have experience where palliative care and cancer care work together, and 4 members of the public who have been patients, or carers for patients. We explain how the success of integration is affected by the ways in which palliative care in cancer is understood, prioritised, delivered and measured. We recommend taking action to address the misunderstandings about palliative care both in health care and the wider community. Addressing community understandings of palliative care could enable openness to early integration, alleviating fears through more accurate knowledge of what it does and does not involve. The different professionals involved in making changes need to understand why integration of palliative care with cancer care is important. Teams within and across different care settings need more opportunities to talk to each other and to collaborate when they are caring for people with cancer. They need to involve the person with cancer and their carers in decision-making and assess the overall benefits of integration. Bringing palliative care and oncology together could help to provide care which integrates and supports family, community and society.

Globally, breast cancer remains the most prevalent cancer among women, with multidisciplinary team care emerging as the gold standard for its management. The multidisciplinary team care integrates expertise from diverse specialists, including oncologists, radiologists, pathologists and nurses, to develop individualised, evidence-based treatment plans. This collaborative approach improves diagnostic accuracy, enhances patient outcomes, and fosters holistic care by addressing both medical and psychosocial needs. Studies show that multidisciplinary team involvement leads to better survival rates, reduced treatment variability, and improved quality of life. However, challenges, such as resource limitations, logistical barriers and communication inefficiencies, can hinder its effectiveness, particularly in low-resource settings. Advances in telemedicine and virtual multidisciplinary teams are improving access and streamlining collaboration, especially in underserved areas. To optimise multidisciplinary team care, ongoing training, patient-centred decision-making and technological integration are essential. Multidisciplinary team care ensures comprehensive breast cancer treatment, enhances patient satisfaction, and sets the foundation for continued improvements in cancer management.

Tuberculosis (TB) remains one of the most persistent infectious diseases worldwide, particularly in resource-limited and densely populated regions. While community-based TB strategies are central to early detection, treatment success, and transmission interruption, their implementation often raises complex ethical and legal concerns. This paper examines the tension between public health imperatives and the protection of individual rights within community TB control programs. Determine a legal principles, human rights frameworks, and on-the-ground practice, we explore how interventions such as active screening, contact tracing, and Directly Observed Treatment (DOT) may unintentionally compromise autonomy, confidentiality, and freedom of movement when not carefully designed. Through case studies in India, South Africa, and Thailand, we illustrate that voluntary, patient-centered approaches outperform coercive systems in sustaining treatment engagement, reducing stigma, and strengthening community trust. Quantitative outputs-including improved treatment initiation and completion rates, decreased stigma, and enhanced participation highlight the practical value of rights-based models. The paper argues that equitable TB control requires balancing collective responsibility with respect for individual dignity. Policies anchored in informed consent, data protection, transparent communication, and social support are essential to achieving this balance.

This study aims to explore the lived experiences of families caring for breast cancer patients undergoing chemotherapy, focusing on the multidimensional impacts and coping mechanisms in the Indonesian cultural context. Using Van Manen's hermeneutic phenomenological approach, this qualitative study involved 20 family members of breast cancer patients undergoing chemotherapy at a government hospital in Semarang, Indonesia. Data were collected through in-depth, semi-structured interviews, supported by field notes and demographic questionnaires. Thematic analysis was conducted using NVivo software and Colaizzi's method to extract key themes and subthemes. Four major themes emerged: (1) information on the impact of chemotherapy, which included physical, psychological, and socioeconomic changes experienced by patients and observed by families; (2) unpreparedness to face side effects, revealing families' confusion and emotional responses due to a lack of knowledge; (3) The need for adequate information and support, highlighting the demand for clear communication and psychological guidance from healthcare providers; and (4) Hope and the meaning of being a caregiver, in which families found renewed strength, spiritual growth, and purpose throughout the caregiving journey. These findings highlight the complex emotional and social dynamics that families encounter during the cancer treatment process. Chemotherapy has a profound impact not only on patients but also on their families. A lack of preparedness and insufficient support intensify emotional and practical burdens. Therefore, a culturally sensitive, family-centered nursing intervention is crucial to enhance family resilience, ensure effective caregiving, and improve overall quality of life during cancer treatment in developing countries. Such culturally sensitive, family-centered nursing support is essential to strengthen caregiver resilience, reduce burden, and improve the quality of life for both patients and families during chemotherapy.

Communicative-pragmatic dysfunction is recognized as a core feature of schizophrenia, as well as a hallmark of Autism Spectrum Disorders (ASD), strongly intertwined with neurocognitive and sociocognitive domains. Autistic symptoms, i.e., autistic-like traits below ASD diagnostic threshold, occur in over 50% of patients with schizophrenia, affecting social cognition and functioning. Strikingly, their specific link with pragmatics remains unexplored. This study tests the relationship between autistic symptoms and pragmatics in schizophrenia, modelling their interplay with executive functions (EF) and Theory of Mind (ToM), in the context of the sprout model of pragmatics. A sample of 125 individuals with schizophrenia was assessed for autistic symptoms, pragmatics, ToM, and EF. Path analysis examined direct and indirect effects of autistic symptoms on global pragmatics and on pragmatic production and comprehension, with EF and ToM as mediating variables. Autistic symptoms were negatively associated with EF, ToM, and pragmatics. Path analysis revealed that autistic symptoms have a direct effect on global pragmatics, as well as an indirect one, via EF and ToM consecutively. Furthermore, autistic symptoms indirectly affected both pragmatic production, via EF, and comprehension, through EF and ToM sequentially. Results show a strong link between autistic symptoms and pragmatics in schizophrenia, highlighting a cognitive pathway from EF to ToM in supporting pragmatics, in line with the sprout model, with a key role of the former in production and of the latter in comprehension. Clinically, this study highlights that assessing autistic symptoms in routine care may help identify patients at higher risk for pragmatic deficits and guide targeted rehabilitation strategies.

Voice phishing represents a rapidly evolving form of cyber-enabled financial fraud that exploits telecommunications networks to deceive victims. Traditional reactive policing approaches face significant limitations in preventing such crimes in real time. This study introduces a data-driven framework for the proactive detection of phone numbers linked to voice phishing operations using large-scale call log data from South Korea. Behavioral features derived from call metadata were utilized to capture distinctive communication patterns that differentiate fraudulent users from legitimate ones. A stepwise logistic regression model was initially employed to identify key predictors of fraudulent behavior, followed by advanced machine learning models-including random forest, gradient boosting, and Multi-Layer Perceptron (MLP)-for classification. The results reveal that voice phishing numbers display unique behavioral characteristics, such as concentrated weekday activity, shorter call durations, higher outgoing call ratios, and a preference for Mobile Virtual Network Operator (MVNO) usage. The proposed models achieved high performance, exceeding 95% accuracy and 97% recall, demonstrating their robustness in detecting suspicious numbers. These findings underscore the potential of integrating artificial intelligence and behavioral analytics into proactive fraud detection systems and contribute to the development of early-warning mechanisms for preventing telecommunication-based financial crimes.

ObjectivesThe central aim of this study was to develop a questionnaire that can be used to assess the combined emotional and physical wellbeing of pet cats - that is, to evaluate their quality of life (QoL). Using answers to this questionnaire, we then aimed to develop a statistically validated and robust algorithm (an instrument) to derive a set of reproducible QoL dimensions for evaluating and comparing the wellbeing of cats.MethodsResponses from 1324 cat owners in the USA and UK were collected and used to identify key cat QoL dimensions using well-established approaches. Statistical analysis was used to evaluate the extent to which our algorithm produced comparable results when used across different populations of cats (validity and robustness). Furthermore, data from 385 cats were collected again after 2 weeks to evaluate the extent to which scores of the QoL dimensions varied over time (reliability).ResultsA data-driven analysis was used to develop an instrument with seven QoL dimensions across daytime and mealtime behaviours: Active, Talkative, Satisfied, Relaxed, Mobile, Appetite and Sociable. Statistical analysis confirmed the robustness, validity and reliability of the instrument.Conclusions and relevanceThe Feline Quality of Life questionnaire and its associated instrument evaluated cat QoL across seven dimensions and allowed exploration of wellbeing across different cat demographics and health conditions. The questionnaire can be used by pet owners interested in better understanding the wellbeing of their cat and by veterinary professionals to gather information that complements in-clinic health assessments. Understanding your cat&#x2019;s quality of life: the FelQoL questionnaireThis study is about a questionnaire called the Feline Quality of Life (FelQoL) that helps pet owners understand their cats&#x2019; quality of life, which refers to a cat&#x2019;s overall happiness and wellbeing. It can be difficult to know how well a cat is doing, especially at the vet when cats often feel scared. This can make it challenging for vets and owners to help them. There is not much scientific information about what makes cats happy. This study aims to change that by creating an easy tool to find and measure cats&#x2019; quality of life, helping to improve care. The researchers created a short questionnaire about the quality of life of cats. They asked 1324 cat owners to answer it and used their responses to identify what really matters for cats&#x2019; happiness and wellbeing. The study found several areas that contribute to a cat&#x2019;s quality of life: being active, talkative, satisfied, relaxed, mobile, having a good appetite and being sociable. Most cats were seen by their owners as having a good quality of life. The questionnaire was also tested to ensure it works well in different situations. The FelQoL questionnaire helps pet owners and vets check and improve their cats&#x2019; happiness and wellbeing. By looking at different areas, like how active or social a cat is, owners can work with their vets to make improvements. This tool also helps cat owners and vets communicate better about cats&#x2019; needs.

As the global cancer burden rises, adults with advanced cancer face significant physical and psychosocial symptoms requiring early integration of palliative and supportive care. Nurses in oncology, emergency, and community settings are central to symptom assessment, care coordination, communication, and advance care planning, yet their roles in early integration remain underexplored. This scoping review mapped nursing contributions to early palliative and supportive care for adults with advanced cancer and described related patient, caregiver, and system outcomes. A search of PubMed, CINAHL, Scopus, and ScienceDirect was conducted for English-language studies published between January 2016 and November 2025 involving nursing-relevant interventions in early palliative or supportive care. Fourteen studies were included: trials, observational studies, qualitative research, reviews, and a meta-analysis. Six domains emerged. Early integration consistently improved quality of life and reduced symptom burden. Nurse-led interventions increased end-of-life discussions and advance directive completion. Telehealth and telephone follow-up proved feasible for symptom management. Studies noted moderate palliative competence but gaps in communication and structural support. Caregiver-focused interventions enhanced caregiver quality of life and self-efficacy. Conclusions: Nurses are pivotal in early palliative care. Expanding structured nurse-led models, strengthening communication training, and addressing organizational barriers are essential to deliver timely, person-centered care.