Vitiligo is a chronic depigmenting disorder that imposes a substantial psychological, social, and economic burden, extending beyond its physical manifestations. This narrative review synthesizes and critically evaluates current evidence on the determinants of quality of life impairment among individuals with vitiligo. A review of the published literature was conducted, focusing on studies evaluating health-related quality of life, psychosocial outcomes, stigma, psychiatric comorbidities, and validated quality of life assessment instruments in patients with vitiligo. Evidence from systematic reviews, cohort studies, cross-sectional analyses, and instrument validation studies was examined to identify the clinical, demographic, and sociocultural factors associated with disease burden. Across studies, vitiligo was consistently associated with significant impairment in psychological and social domains of quality of life. Disease visibility, particularly involvement of the face or genital regions; greater body surface area involvement; active disease progression; and longer disease duration emerged as key clinical factors associated with worse outcomes. Several demographic and sociocultural characteristics, including female sex, younger age, darker skin phototype, unmarried status, and residence in highly stigmatizing cultural environments, were also associated with greater quality of life impairment. Depression and anxiety were more frequently reported in individuals with vitiligo than in the general population, with pediatric and adolescent patients demonstrating particularly high vulnerability. Although dermatology-specific instruments such as the Dermatology Life Quality Index are commonly used in research and clinical practice, vitiligo-specific tools may more accurately capture stigma, social participation limitations, and disease-specific psychosocial impact. Overall, the available evidence indicates that vitiligo imposes a profound psychosocial burden that often exceeds the objective clinical severity of depigmentation. Quality of life impairment appears to be driven primarily by lesion visibility, sociocultural context, and psychological comorbidity rather than symptom severity alone. These findings underscore the importance of incorporating validated quality of life assessment tools into routine clinical care, screening for psychiatric comorbidities, and adopting culturally sensitive and patient-centered approaches to vitiligo management.
Research in nursing, occupational therapy and dental hygiene indicates that clinical practice engagement enhances academic faculty's credibility with students and skill retention. However, common barriers include limited time, institutional constraints and unclear policies. Despite ongoing clinical involvement among physical therapy faculty, little is known about how these activities influence teaching performance and workload management. This study examined the experiences of full-time faculty members with clinical practice, focusing on the perceived benefits, barriers and institutional factors that affect their ability to sustain patient care while fulfilling academic duties. This phenomenological pilot study examined the lived experiences of seven full-time physical therapy faculty at a public land-grant institution. Data were collected through semistructured interviews and analysed using Colaizzi's method with thematic coding. Research questions addressed experiences, perceived benefits and barriers and the influence of personal and institutional factors on clinical engagement. Four themes emerged: the experiences of engaging in physical therapist clinical practice, the perceived benefits of clinical practice, the perceived barriers to clinical practice and the impact of participant characteristics on experience. Clinical practice was viewed as essential for maintaining competence and enhancing teaching. Faculty valued it as a professional motivator, but institutional barriers often limited participation. Formalising clinical practice through policies, workload models and curricular integration may help sustain dual academic and clinical roles. These findings suggest that supporting faculty in maintaining clinical engagement benefits educators and students in physical therapy education.
Background and Objectives: Hereditary angioedema (HAE) represents a specific form of life-threatening inborn errors of immunity. Current guidelines recommend regular assessment of the disease burden, disease control and quality of life. This study describes the profile of HAE patients in Slovakia, disease control, quality of life, states of anxiety and depression, and socioeconomic situation. Materials and Methods: We used a set of standardized questionnaires-AE-QoL, AECT, HADS and Socioeconomic Status Questionnaire, and a non-standardized questionnaire-to describe the characteristics of the population. Results: We collected data on 56.44% (57 out of 101) of HAE adult patients registered in Slovakia. Moderate to severe HAE was present in 61.40% of patients; 73.68% were on long-term prophylactic treatment; and 19.30% received rescue treatment due to an acute HAE attack during the last 4 weeks. Most patients achieved lower AE-QoL scores, indicating a good quality of life. The AECT score indicated well-controlled disease in 91.23% of patients. Anxiety and/or depression scores were higher than normal in 17.54% of patients. Patients with HAE earned less than the average population, but most of them were economically active with relatively low rates of presenteeism and absenteeism. Only a minority of patients used social system benefits. Patients were exclusively cared for by relatives. Conclusions: The QoL scores achieved in all three standardized questionnaires indicate a good quality of life of HAE patients in Slovakia, which is associated with a high and specialized standard of care. Anxiety and/or depression were present in 17.54% of patients. Direct patients costs and social care costs are low, but there is an indirect socioeconomic burden on patients and their families.
Mobile health (mHealth) apps are useful tools for research and disease management. However, implementation of mHealth apps is lacking in many areas. While mHealth apps offer various advantages to researchers and patients, their effectiveness depends on their actual use. Barriers to using mHealth apps are often due to human factors such as usability or technology acceptance. Although prior studies have examined the acceptance of mHealth apps in patient treatment, the key factors driving or hindering the use of mHealth apps in research remain unclear. This study explores user perceptions of 2 mHealth apps in the setting of an observational technology evaluation study using the unified theory of acceptance and use of technology. We aim to evaluate the technology acceptance of these specific apps and to investigate challenges in choosing suitable mHealth apps in research. The apps were intended for data collection; no effect on health was expected. Patients with chronic diseases as well as healthy participants used a symptom tracking app and a cognitive test app over the course of 4 weeks within the feasibility study of the project "Identifying Digital Endpoints to Assess Fatigue, Sleep and Activities of Daily Living in Neurodegenerative Disorders and Immune-Mediated Inflammatory Diseases." Thereafter, 61 qualitative interviews were conducted, recorded, and transcribed. A qualitative content analysis using the unified theory of acceptance and use of technology was performed. An important aspect of motivation for participants was feedback on their health data and performance in the cognitive tests. Effort played a significant role in app use. Patients rated the apps as easy to use and quick. Using the app multiple times per day at fixed times was perceived as disruptive. Participants preferred using their own phone. Social influence as well as facilitating conditions played a lesser role in intention to use the apps. Data security was no concern for most participants. They stressed the importance of good relations with the study team. In choosing suitable apps, one size will certainly not fit all. For medical research, pretesting of all materials with the potential users is of utmost importance. If the positive effects of the app on users' health are not immediately apparent, other factors may motivate use, for example, feedback, gamification, adjustable functions, applicability on all smartphone operating systems, and good relations to the study team.
Background and Objectives: Postpartum depression (PPD) is a prevalent mental health condition with substantial consequences for mothers, infants, and families. The Edinburgh Postnatal Depression Scale (EPDS) is the most widely used screening instrument for PPD; however, optimal cut-off scores vary across populations, necessitating local validation. No prior study has evaluated the diagnostic performance of the EPDS against a structured clinical interview in Latvia. To assess the reliability and diagnostic accuracy of the Latvian version of the EPDS and to determine the optimal cut-off score for detecting PPD in a Latvian outpatient population 4-6 weeks after childbirth. Materials and Methods: A cross-sectional study was conducted at the outpatient department of Riga Maternity Hospital between June 2024 and May 2025. Women aged ≥18 years attending routine postnatal check-ups were screened using the Patient Health Questionnaire-9 (PHQ-9). Those scoring ≥5 were invited to complete the EPDS and participate in a structured diagnostic interview using the Mini International Neuropsychiatric Interview (MINI) 7.0.2. Internal consistency was assessed using Cronbach's alpha. Receiver operating characteristic (ROC) analysis was performed to evaluate diagnostic accuracy and identify the optimal cut-off score based on sensitivity, specificity, likelihood ratios, and the Youden Index. Results: A total of 272 women were screened, and 101 completed the EPDS; 78.63% of screen-positive participants underwent the MINI. The EPDS demonstrated excellent internal consistency (Cronbach's α = 0.871). ROC analysis indicated strong discriminative ability (AUC = 0.852, 95% CI 0.759-0.945, p < 0.001). A cut-off score of ≥11 provided the optimal balance between sensitivity (0.74) and specificity (0.82), with the highest Youden Index (0.56) and a positive likelihood ratio of 4.14. Conclusions: The Latvian version of the EPDS is a reliable and diagnostically accurate screening instrument for PPD 4-6 weeks after delivery. A cut-off score of ≥11 appears optimal for routine screening in Latvian outpatient settings. These findings support the integration of EPDS-based screening into structured postpartum care and underscore the value of validating screening instruments within specific cultural and clinical contexts.
Background and Objectives: Venous thromboembolic disease (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a major cause of morbidity and mortality worldwide and imposes a substantial financial burden on health systems due to both the direct and indirect costs of acute management and long-term complications. This systematic review aimed to assess patient satisfaction with anticoagulation therapy for VTE and to highlight potential differences according to the type of anticoagulant. The review focused on factors influencing the patient experience, such as perceived efficacy, ease of use, adverse effects, and health-related quality of life. Materials and Methods: A systematic review, without quantitative meta-analysis, was conducted in accordance with PRISMA 2020 guidelines. Articles were identified through searches in major databases (PubMed, Scopus, Cochrane Library and others) using keywords including "patient satisfaction", "anticoagulation", "venous thromboembolic disease", and "quality of life". In total, 21 studies published between 2009 and 2025 met the inclusion criteria. The studies assessed patient satisfaction with different types of anticoagulation, including vitamin K antagonists (VKAs), direct oral anticoagulants (DOACs), and low-molecular-weight heparin (LMWH) injections. Results: Across the included studies, patients generally reported higher levels of treatment satisfaction with DOACs compared with VKAs, mainly due to the absence of routine laboratory monitoring and fewer dietary restrictions. However, satisfaction varied according to age, sex, and clinical status. In specific patient populations, such as those with cancer-associated thrombosis, factors including fewer drug-drug interactions and perceptions of safety with LMWH appeared to influence treatment choice and satisfaction. Adverse effects, particularly bleeding, were identified as major drivers of dissatisfaction. Several studies suggested that higher treatment satisfaction was associated with better adherence, while quality of life appeared to improve in patients treated with DOACs in comparison with VKAs. Conclusions: Patient satisfaction is a critical component of successful VTE management. Overall, DOACs appear to be associated with higher treatment satisfaction than traditional therapies such as VKAs, although further high-quality research is needed to individualise anticoagulation strategies. Systematic incorporation of patient-reported satisfaction into clinical decision-making and into international guidelines may improve adherence, enhance quality of life, and ultimately increase the effectiveness of anticoagulation therapy.
Patients with nasopharyngeal carcinoma often face sleep and anxiety problems during chemoradiotherapy. These two issues interact with each other, forming a vicious cycle that seriously affects the patients' quality of life and treatment outcomes. In order to address the neglect of group heterogeneity in traditional studies, this study employs latent profile analysis and network analysis methods to explore patient subgroups and reveal the association patterns between symptoms, thereby providing a basis for precise nursing interventions. From September 2023 to March 2025, a convenience sampling method was used to select 513 patients with nasopharyngeal carcinoma who were receiving initial treatment in the Radiotherapy Department of a Grade A tertiary hospital in Nanning, Guangxi. General information questionnaires, the Pittsburgh Sleep Quality Index (PSQI), and the Anxiety Subscale of the Hospital Anxiety and Depression Scale (HADS-A) were used to assess the patients' sleep quality and anxiety. Latent Profile All assessments were conducted at the mid-stage of concurrent chemoradiotherapy (2-4 weeks after the initiation of treatment), and the specific treatment phase of each participant was recorded and summarized. Latent Profile Analysis (LPA) was applied to identify potential patient subgroups with different "sleep-anxiety" characteristics. For different subgroups, symptom networks of sleep and anxiety were constructed respectively, and the core symptoms were identified and compared. The sleep quality and anxiety symptoms of nasopharyngeal carcinoma patients undergoing chemoradiotherapy can be divided into 4 latent profiles: low distress group (43.86%), emotional distress dominant group (21.25%), sleep problem dominant group (23.59%), and high anxiety-sleep disorder group (11.31%). Network analysis shows that in the low distress group network, the association between HADS1 and PSQI2 was the strongest, and PSQI2, PSQI3, and PSQI4 had the highest centrality. In the network of the emotional distress dominant group, the association between PSQI3 and PSQI4 was the strongest, and HADS4 also had relatively high centrality. In the sleep problem dominated group network, the association between HADS1 and PSQI2 was the strongest among all subtypes, and PSQI2, HADS1, and PSQI3 were the core symptoms in this network. In the network of the high anxiety-sleep disorder group, the association between HADS3 and PSQI3 was the strongest, and PSQI3, HADS3, and HADS2 were the core symptoms with high centrality. There is group heterogeneity in sleep-anxiety symptoms among patients with nasopharyngeal carcinoma undergoing chemoradiotherapy, which can be divided into four subgroups with different core symptom characteristics. The identified symptom associations provide hypothesis-generating insights for clinical intervention, and targeted strategies for core symptoms in each subgroup may help optimize symptom management in this population.
Indolent non-Hodgkin lymphoma (iNHL) is a chronic, incurable lymphoid malignancy with a slow course. In absence of symptoms, a 'watchful waiting' approach is often chosen. The emotional burden of uncertainty and monitoring may affect patients' psychological well-being. This study investigates the extent of psychological distress in iNHL patients and its relationship with sociodemographics, clinical characteristics, and quality of life. A cross-sectional study was conducted among adults with histologically confirmed indolent B-cell or T-cell NHL, recruited via a regional Dutch hospital and the online patient platform CMyLife. Data were collected through self-administered online questionnaires, including sociodemographics, clinical characteristics, psychological distress (HADS) and quality of life (EORTC QLQ-C30/LG-NHL). A total of 352 iNHL patients completed the questionnaires (response rate: 37.5%). The mean age was 69 years, 58.5% were male and psychological distress (HADS ≥ 13) was observed in 30.7% of participants. Distressed patients were more often female, less educated, more frequently in the period of watchful waiting, and had more medical comorbidities (p < .01). They reported significantly lower health-related quality of life (HRQoL) (mean 51.2 vs. 77.6) and a higher symptom burden. Psychological distress was strongly correlated with lower HRQoL (r = -.63). In hierarchical regression analysis, psychological distress was the strongest predictor of lower HRQoL (β = -0.605, p < .001). Approximately one-third of iNHL patients experience psychological distress, significantly associated with female gender, a lower education level, a watchful waiting approach, medical comorbidities, and a lower HRQoL. This underscores the importance of attention for these factors during consultations.
To synthesize and evaluate current evidence on the responsiveness, interpretability (MID/MIC), and clinical utility of validated health-related quality of life (HRQoL) patient-reported outcome (PRO) instruments used in adults with head and neck cancer (HNC). A systematic search of PubMed, Scopus, Web of Science, Embase, and Cochrane Library (Central) identified studies published from January 2015 to July 2025. The review was registered in PROSPERO (CRD420251128978) and followed PRISMA 2020 guidelines. Observational and interventional studies assessing HRQoL using validated HNC instruments (EORTC QLQ-C30, QLQ-H&N35/H&N43, UW-QOL, FACT-H&N or MDADI) were included. Eligible studies reported responsiveness (ability to detect meaningful change) or clinical applicability. Methodological quality was evaluated using the COSMIN Risk of Bias checklist, and results were narratively synthesized due to methodological heterogeneity. Thirteen studies involving 8,075 patients met the inclusion criteria. The EORTC QLQ-C30 and H&N35/43, UW-QOL, FACT-H&N, and MDADI exhibited consistent responsiveness, capturing expected HRQoL deterioration during treatment and partial recovery within 6-12 months. Reported minimal important difference (MID) and minimal important change (MIC) values typically ranged from 4 to 15 points for improvement and 10-20 points for deterioration, supporting the interpretability of change scores. Several patient-reported outcome measures (PROMs) also demonstrated prognostic relevance, with early HRQoL changes associated with survival or recurrence. Validated HRQoL questionnaires in HNC demonstrate robust responsiveness and meaningful clinical applicability, supporting their integration into routine oncology practice. Their use may enhance early detection of complications, guide rehabilitative interventions, and facilitate more individualized, patient-centered care.
Cognitive-communication disorders are pervasive following traumatic brain injury (TBI), disrupting communication at the level of discourse and social interaction. Discourse impairments impact functioning across major life domains, such as work and social relationships, and overall quality of life. Problems with discourse affect all severity levels of TBI and persist over time. Veterans may experience even greater functional decline due to comorbid health conditions (eg, posttraumatic stress disorder, pain). The functional impact and chronicity of discourse impairments following TBI underscore the importance of treating these impairments. This study aims to (1) develop, refine, and manualize a treatment protocol targeting narrative discourse-Talking About Life Experiences (TALE)-in people with TBI and (2) evaluate the feasibility of the TALE discourse treatment in a pilot randomized controlled trial (RCT). This is a stage 1a (phase 1) and stage 1b (phase 2) treatment development study aligned with the Stage Model of Behavioral Therapies Research. All participants will be individuals with TBI and communication difficulties. In the treatment development phase (phase 1), 5-10 participants will be recruited to obtain key stakeholder feedback for treatment refinement. In the feasibility pilot phase (phase 2), 40 participants with TBI and communication difficulty will be randomized to receive the TALE intervention or treatment as usual. We will obtain information on the tolerability, acceptability, and feasibility of recruitment for the TALE intervention, as well as preliminary data on treatment delivery, assessment methods, and treatment effects. Assessments will be conducted at baseline, posttreatment, and at 1-month follow-up and will include measures of discourse ability, cognition, mental health, pain, functional communication, and daily functioning. Feedback regarding assessment and treatment will also be collected via surveys and exit interviews. This study was funded in October 2021. Recruitment for phase 1 began on September 26, 2022. Seven participants were enrolled. Phase 1 concluded on November 17, 2023. Recruitment for phase 2 began on November 27, 2023. Thirty-four participants were enrolled. Data collection was completed on November 3, 2025. Data analysis has been conducted concurrently with data collection and is expected to continue until early-mid 2026. Results are expected to be published in peer-reviewed journals in late 2026 and early 2027. Stakeholder feedback from the phase 1 treatment development trial will facilitate refinement of the TALE protocol in preparation for the phase 2 feasibility pilot RCT. Results from phase 2 will be used to determine the tolerability, acceptability, and feasibility of methods. Findings from this study will inform the development and implementation of a future fully powered RCT evaluating treatment efficacy. ClinicalTrials.gov NCT05008419; https://clinicaltrials.gov/ct2/show/NCT05008419. DERR1-10.2196/86329.
To examine sociodemographic, clinical, and healthcare-related factors associated with preoperative health-related quality of life (HRQoL) among patients undergoing surgery for degenerative lumbar spine conditions in a multi-ethnic Asian population. This cross-sectional study used baseline data from the Spine PROM Surgery Registry, including 1194 patients scheduled for surgery within a Singapore healthcare cluster between 2017 and 2022. HRQoL was measured using the EQ-5D-3L, with utility scores crosswalked to the EQ-5D-5L index using the van Hout crosswalk. Hierarchical linear regression assessed factors associated with HRQoL across three blocks: sociodemographic, clinical, and healthcare/lifestyle. Multivariable logistic regression identified factors associated with reporting problems within each EQ-5D dimension. Mean age was 58.1 years (SD 16.1); 51.5% were female. Mean EQ-5D-5L index was 0.43 (SD 0.38). Pain/discomfort (93.6%) and usual activities problems (84.3%) were most commonly reported. Lower EQ-5D scores were independently associated with non-outpatient presentation (β = -0.37), non-Chinese ethnicity (e.g., Malay: β = -0.10), secondary education (β = -0.15), and accident/trauma history (β = -0.11). Dimension-level analyses showed secondary education was associated with higher odds of problems in mobility (OR = 2.72), self-care (OR = 1.87), usual activities (OR = 1.80), and anxiety/depression (OR = 1.97). Non-outpatient presentation was associated with markedly higher odds of self-care problems (OR = 2.98). Patients awaiting lumbar spine surgery appear to have impaired preoperative HRQoL. Although the modest explained variance limits robust risk prediction, preoperative profiles may still help inform clinical discussions and shared decision-making. Non-outpatient presentation may help identify patients who could benefit from enhanced preoperative support, although this requires prospective validation. Differences by ethnicity and education suggest opportunities for culturally tailored counselling. EQ-5D dimension profiles may indicate targets for prehabilitation and provide Singapore-based benchmark data for a lumbar spine surgery cohort for patient-centred care, service benchmarking, and health technology assessment. Low back pain is a common reason why people lose the ability to work, move, and take part in daily life. Many patients with long-lasting back problems eventually need surgery, but their quality of life before surgery can vary widely. Understanding how patients feel and function before surgery is important for planning care, setting expectations, and deciding who may need extra support. This study looked at how good or poor quality of life is in patients waiting for surgery for degenerative lumbar spine conditions, and which personal, social, and clinical factors are linked to worse quality of life. We studied over 1100 patients in Singapore using a standard health questionnaire that measures mobility, self-care, daily activities, pain, and mental wellbeing. This allowed us to examine both overall quality of life and specific problem areas. We found that patients had substantial problems before surgery, especially with pain and daily activities. Quality of life did not differ by diagnosis, but was worse in patients who entered care through emergency or inpatient routes, and in some ethnic and educational groups. These findings suggest that identifying patients with poorer preoperative quality of life may help clinicians tailor support and plan care before surgery.
The new Universal Health Insurance (UHI) reforms aim to improve equity and quality of healthcare delivery; however, their sustainability depends on engagement and retention of the nursing workforce. Psychological empowerment has been identified as a key factor influencing nurses' attitudes and work-related behaviors, yet the evidence on how it relates to job embeddedness among nurses working in the early phase of UHI implementation in Egypt remains underexplored. This study aimed to assess the association between psychological empowerment and job embeddedness among nurses under the umbrella of the new Universal Health Insurance in Egypt. A descriptive cross-sectional design was employed from August 2025 to November 2025. A total of 213 nurses working at Aswan Specialized Hospital, affiliated with the UHI system in Upper Egypt, were recruited. Data were collected using a demographic questionnaire, and psychological empowerment was measured using the Psychological Empowerment Scale, and job embeddedness was assessed using the Global Job Embeddedness Scale. Descriptive statistics, Pearson correlation analysis, and hierarchical linear regression were used for data analysis. Among 213 nurses, the mean score of psychological empowerment was reported at high overall levels of 5.75 (SD = 0.77), particularly in the dimensions of competence and meaning, alongside moderately high levels of job embeddedness, with a mean score of 4.76 (SD = 0.89). Psychological empowerment showed a significant positive correlation with job embeddedness (r = 0.512, p < 0.001). In hierarchical regression analysis adjusting for demographic and professional covariates, psychological empowerment emerged as a strong and independent predictor of job embeddedness (β = 0.55, 95% CI: 0.398-0.701, p < 0.001), explaining an additional 16.5% of the variance after controlling for covariates (ΔR2 = 0.165). In adjusted analyses, the covariates were not independently associated with job embeddedness. Psychological empowerment was positively associated with nurses' job embeddedness in the UHI implementation setting. Higher levels of empowerment-related factors were positively associated with greater embeddedness, suggesting their relevance to workforce engagement and retention during health system reform. Our study findings highlight that psychological empowerment plays a crucial role in fostering nurses' job embeddedness, which is critical for sustaining workforce retention and stability. Enhancing supportive leadership and nurses' involvement in decision-making is critical, especially during the early phase implementation of the universal health insurance system reform.
Heart failure (HF) is a chronic condition associated with frequent hospitalizations and impaired quality of life. Malnutrition is common in HF and is linked to adverse clinical outcomes, while self-care is an important component of HF management. This study aimed to examine the associations between nutritional status, self-care behaviors, and clinical characteristics in patients with chronic HF. A cross-sectional study was conducted among 100 hospitalized HF patients (mean age 75.9 ± 9.8 years; 63% men). Nutritional status was assessed using the Mini Nutritional Assessment (MNA), and self-care using the nine-item European Heart Failure Self-care Behaviour Scale (9-EHFScBS). Clinical variables included NYHA class, LVEF, comorbidities, BMI, and laboratory parameters. Comparative analyses and multivariate linear regression were performed. Patients who were malnourished or at risk of malnutrition had significantly higher NT-proBNP levels (p = 0.004) and higher NYHA class (p = 0.002), whereas well-nourished individuals had significantly higher triglyceride levels (p = 0.032). Nutritional status was negatively associated with NYHA class and NT-proBNP, and positively associated with BMI. Among laboratory parameters, significant positive correlations were observed with hemoglobin, hematocrit, albumin, and triglyceride levels. In multivariate analysis, the following variables were independently associated with MNA score: self-care score (B = 0.083 per point), BMI (B = 0.368 per kg/m2), comorbidity burden (B = -0.401 per comorbidity), and NYHA class (NYHA III: B = -2.425; NYHA IV: B = -5.966, vs. NYHA II). In patients with chronic heart failure, nutritional status is associated with disease severity, metabolic parameters, comorbidity burden, BMI, and self-care behaviors. These findings support the importance of routine nutritional screening as part of comprehensive HF management.
Symptoms in chronic obstructive pulmonary disease (COPD) commonly co-occur as 'symptom clusters', yet little is known about how patients interpret and make sense of these experiences. This study aimed to explore the meanings patients with COPD attribute to symptom clusters, their impact on health-related quality of life, and the strategies used to manage them. A qualitative study using semi-structured interviews was conducted with a purposive sample of 30 patients with COPD recruited from a university teaching hospital in China. Data were analysed using the Framework approach, informed by the Theory of Unpleasant Symptoms and the concept of biographical disruption. Three interrelated themes were identified. First, participants understood symptom clusters as dynamic, interacting experiences, often organised around "trigger symptoms" (e.g., cough precipitating breathlessness and fatigue), rather than as isolated symptoms. Second, these clusters disrupted multiple dimensions of everyday life, including physical functioning, social participation, and sense of self. Third, participants actively negotiated symptom burden through a range of adaptive strategies, prioritising symptoms based on their perceived meaning and impact rather than clinical severity. These findings highlight how symptom experiences are shaped by both physiological interconnections and personal interpretations. This study provides novel insight into how people with COPD experience symptom clusters as interconnected, meaning-laden phenomena. Recognising the role of "trigger symptoms" and patients' subjective prioritisation of symptoms has important implications for person-centred assessment and supports the development of targeted, mechanism-informed approaches to symptom management in COPD. I can't walk long distances. I can't go out and spend time with my friends. This is a big problem in my life. (69-year-old male, GOLD stage III) Other people can run around. They visit relatives or friends during the holidays. I can't. I cough all day long and can only stay at home. (63-year-old female, GOLD stage IV).
Breast cancer surgery and corresponding treatments have significant residual effects on survivors of breast cancer in China. Body image distress and stigma are persistent challenges that negatively affect their quality of life. Accessible, sustainable, and cost-effective support remains scarce. This study aimed to evaluate the effectiveness and cost-effectiveness of an app-based mindfulness breast care (MBC) program in addressing body image distress and stigma for survivors of breast cancer. We carried out a randomized controlled trial in 2 university-affiliated hospitals in China. Survivors of breast cancer who had completed primary treatments and had mobile phone internet access were recruited and randomly assigned at a 1:1 ratio to the intervention (3-month MBC program plus routine care) or the control group (routine care alone). Under the conceptualization of mindfulness-based cognitive therapy, the MBC program was developed, including three modules: (1) Library, (2) Mindfulness Yoga, and (3) Mindfulness Practices. The primary outcomes measured were body image distress and stigma, and secondary outcomes included sleep quality, social support, and quality of life (physical and mental well-being). Assessments were conducted at baseline, 3 months (T1), and 6 months (T2). Multiple imputation was used to handle missing data and generalized estimating equations were fitted to evaluate the effectiveness. The incremental cost per quality-adjusted life year (QALY) gained was used to measure cost-effectiveness. A total of 192 survivors of breast cancer participated in the baseline assessment, with 155 completing the 2 follow-up surveys. The median total usage duration was 199.60 (IQR 70.90-451.31; mean 360.59, SD 511.72) minutes, and total login frequency was 39.50 (IQR 19.00-86.50; mean 57.02, SD 50.26) times. The reduction in body image distress at T2 (adjusted mean difference -1.91; 95% CI -3.40 to -0.42; P=.01; d=-0.31), the reduction in stigma at T1 (adjusted mean difference -5.83; 95% CI -8.46 to -3.20; P<.001; d=-0.61) and T2 (adjusted mean difference -7.79; 95% CI -10.62 to -4.97; P<.001; d=-0.82), and the improvement in mental well-being at T1 (adjusted mean difference 4.44; 95% CI 1.70 to 7.18; P=.002; d=0.43) were statistically significantly greater in the intervention group compared with the control group. No statistically significant group differences were observed regarding sleep quality, social support, and physical well-being. The cost-effectiveness analysis showed that the intervention group gained more QALYs than the control group at T2 (adjusted mean difference 0.008; 95% CI 0.004 to 0.016; P=.01). The incremental cost per QALY gained at T2 was US $19,431.25, indicating a 57% probability that the MBC program is a cost-effective intervention at a threshold of US $37,530, three times the 2023 gross domestic product per capita of China. An app-based MBC program was effective and potentially cost-effective and had the promise to be scalable for clinical practice. Chinese Clinical Trial Registry ChiCTR2200059952; https://www.chictr.org.cn/showproj.html?proj=167247.
Background and Objectives: Metacognition-related processes (e.g., confidence calibration, self-evaluation and the use of feedback) have been linked to cognitive insight, self-evaluation, and daily functioning in psychosis. However, clinic-based assessments only provide limited information. Digital methods may capture state-like variations and contextual factors, but it is unclear to what extent they operationalise core metacognitive monitoring constructs versus adjacent self-evaluative/insight-related constructs. We mapped digital approaches used to assess metacognition-related constructs across the psychosis spectrum, summarising the associated feasibility and validity. Materials and Methods: We conducted a scoping review (PRISMA-ScR) of psychosis-spectrum studies that used digital tools to assess metacognition-related targets. These included ecological momentary assessment/experience sampling (EMA/ESM), task-based paradigms with confidence ratings, and hybrid approaches. Searches covered MEDLINE (via PubMed), Scopus, and IEEE Xplore, with the final search run on 15 December 2025. We charted constructs, operationalisations, feasibility/engagement indices and reported links with clinical or functional measures. Results: The empirical evidence map comprised 13 studies directly assessing metacognition-related constructs; eight additional implementation/methodological sources were synthesised separately to contextualise feasibility, reporting, ethics, and governance. EMA studies more often assessed adjacent self-evaluative constructs, including context-linked self-appraisal bias, conviction, and self-report-context mismatch in daily life, whereas task-based studies more directly assessed confidence-accuracy calibration and feedback updating. Across EMA studies, greater momentary symptom severity and more restricted contexts were often associated with inflated self-evaluations and divergence from observer-rated functioning. Task-based studies indicated that confidence calibration and feedback utilisation may diverge from objective performance; in performance-controlled paradigms, some studies reported comparable metacognitive sensitivity/efficiency, but the overall evidence remains uncertain. Passive sensing was common in psychosis research but was rarely explicitly tied to metacognitive constructs. Conclusions: Current digital work spans both core metacognitive monitoring constructs and adjacent self-evaluative/insight-related constructs, rather than a single unitary construct. Clinical translation remains hypothesis-generating: interpretability may be improved by combining clinical anchors, low-burden EMA, and optional contextual streams, but thresholds, workflows, and signal-action rules require prospective validation.
The reintegration of highly educated nurses into clinical practice represents a critical challenge in global healthcare workforce management. This study explored the re-adaptation experiences of clinical nurses who returned to practice after leaving their positions to pursue postgraduate education, to inform effective support strategies. A phenomenological study was conducted through semi-structured interviews with nine master's-prepared nurses from two tertiary hospitals in Jiangxi Province (Feb-Mar 2025). Data were analysed using Colaizzi's seven-step method. Motivations for return included balancing ideals with reality, career advancement, and policy influences. Common barriers were role conflict, skill gaps, and workplace pressure, while institutional support and self-development facilitated reintegration. Nurses successfully adapted by integrating their new roles, seeking support, and self-adjusting. The re-adaptation process is complex and multifaceted. We recommend that hospitals establish dual clinical-research career tracks and refine tiered employment mechanisms to enhance professional identity and job fit.
Evidence-based psychological interventions are usually not accessed by marginalized groups such as refugees. Culturally adapted psychological interventions have reported larger effect sizes than nonadapted psychological interventions. However, the cultural adaptation of interventions is a lengthy process, entailing a challenge. One potential solution to overcome this challenge is the use of artificial intelligence (AI). The aim of this study was to investigate and compare the perceived cultural relevance and acceptability of 2 common cognitive behavioral therapy (CBT) techniques when translated and culturally adapted by AI versus a human psychologist. In a 2×2 factorial design, the text generator type (AI vs human psychologist) and the CBT technique (cognitive restructuring vs behavior modification) were compared. CBT technique texts translated and culturally adapted either by AI or by a human psychologist were blindly rated using the Cultural Relevance Questionnaire and the Theoretical Framework of Acceptability. Raters were Arabic-speaking refugees and immigrants, aged between 18 and 69 years, residing in Sweden, Denmark, and Germany. Raters were randomly allocated to 1 of 4 conditions. Each condition consisted of 2 stimuli. Two-factor between-subject design analyses were used to analyze the data. A significant main effect of the text generator domain type (P=.02; η²=0.045) was found in the first rating, with texts adapted by the AI domain perceived as more culturally relevant than those adapted by the human domain. No significant main effect of the CBT technique was found in the first rating (P=.10; η²=0.022). There were no differences in the second rating. Regarding acceptability, no significant main effects of text generator domain type (P=.09; η²=0.024) or the CBT technique (P=.88; η²=0.001) were found in either of the ratings. CBT technique materials adapted by AI may be perceived as similarly culturally relevant as those adapted by a human psychologist. This finding implies the potential to accelerate the cultural adaptation of psychological interventions. However, AI still needs to be used with caution and in accordance with rigorous safety standards and robust frameworks.
Cardiovascular diseases (CVDs) are a leading cause of morbidity and mortality globally, with low-resource settings, including Ethiopia facing challenges due to limited early diagnostic services. AI-powered electrocardiography (ECG) interpretation has the potential to improve diagnostic accuracy, decentralize care, and support timely clinical decisions, but evidence on healthcare providers' perspectives and adoption determinants is limited. This exploratory descriptive qualitative study employed 31 in-depth interviews with healthcare providers. Healthcare providers (cardiologists, internists, cardiac and critical care nurses, critical care specialists, and general practitioners) were purposively selected through maximum variation sampling from ten hospitals in four regions of Ethiopia. Data were transcribed verbatim, coded inductively, and analyzed thematically. The data analysis identified six themes: perceived benefit of AI-powered ECG interpretation CDSS, trust development, workflow integration, ethical concerns, functionality, and adoption determinants. Participants emphasized AI's potential to enhance accessibility, consistency, and diagnostic accuracy while reducing subjectivity and unnecessary referrals. Acceptance relied on high accuracy, reliable data, and rigorous validation, with the technology seen as supportive rather than replacing clinicians. Material resources, human resource readiness, and leadership engagement were key factors for adoption. Recommendations included phased implementation, continuous training, and model expansion to ensure sustainability and clinical utility. The AI-powered ECG interpretation CDSS was viewed as a valuable adjunct for strengthening cardiovascular care in Ethiopia, highlighting the need for context-sensitive strategies, ethical safeguards, and multi-level system readiness for successful adoption.
(1) Background: Nurses are exposed to occupational stressors that may impair their well-being and quality of life. This study examined whether burnout and secondary traumatic stress mediate the relationship between perceived stress and physical and psychological quality of life. (2) Methods: A cross-sectional study included 294 nurses employed at the Clinical Hospital Center Osijek, Croatia. Data were collected using the Perceived Stress Scale (PSS-10), the Burnout and Secondary Traumatic Stress subscales of the Professional Quality of Life Scale (ProQOL-5), and the physical and psychological domains of the WHOQOL-BREF. Pearson correlations and path analysis were used. (3) Results: Perceived stress showed significant negative effects on physical (β = -0.291; p < 0.001) and psychological quality of life (β = -0.217; p < 0.001), and positive effects on burnout (β = 0.230; p < 0.001) and secondary traumatic stress (β = 0.171; p = 0.002). Burnout significantly mediated both relationships, while secondary traumatic stress did not. The model explained 20.8% and 19.3% of variance in physical and psychological quality of life. (4) Conclusions: Burnout represents an important pathway linking perceived stress with poorer quality of life among nurses.