Objective: Compared to other components of social cognition, knowledge of social norms has received less attention in the scientific literature. While social cognitive and semantic memory deficits appear early in the course of Alzheimer's disease (AD), no study has examined knowledge of social norms at earlier stages of the disease. In addition, it is unclear whether the knowledge of social norms in AD is associated with socioemotional deficits, as may be seen in the behavioral variant of frontotemporal dementia (bvFTD). Method: This study included 136 participants with amnestic mild cognitive impairment (aMCI), 134 with AD, most of whom were younger than 65 years, 280 with bvFTD, and 361 older healthy controls (HC). All participants were selected from the National Alzheimer's Coordinating Center (NACC). They completed the Social Norms Questionnaire (SNQ), which assesses the tendency to break or overadhere to social norms. They also completed tests assessing executive, semantic, and socioemotional functions. Results: Between-group comparisons showed that individuals with AD and aMCI made significantly more Break and Overadhere errors than HC, while they demonstrated better social norms knowledge than individuals with bvFTD. In aMCI and AD, social norms overadherence errors were most consistently associated with executive functioning. In bvFTD, semantic memory was the most consistent correlate across all SNQ variables. Conclusions: These findings may help clinicians and researchers better understand social cognitive changes in patients, support the inclusion of social norms knowledge assessment within broader neuropsychological evaluations, and provide complementary insight into the cognitive correlates of social knowledge loss in major neurocognitive disorders.
Social isolation is an important social determinant of health, but its relationship with health-related outcomes remains incompletely understood. This study examined whether structural social isolation is associated with subjective health, symptom burden, chronic disease diagnoses, and healthcare-seeking behaviors in a nationwide Japanese population. We conducted a nationwide cross-sectional study using data from the 2024 Japan coronavirus disease 2019 and Society Internet Survey, including adults aged 18-79 years. Social isolation was assessed using the Lubben Social Network Scale-6. Primary outcomes were poor self-rated health and high symptom burden, defined by the Somatic Symptom Scale-8. Secondary outcomes included self-reported chronic diseases and healthcare-seeking behaviors. Among 25,014 participants (mean age: 50.0 years; 49.9% men), 59.3% were classified as socially isolated. Social isolation was associated with higher odds of poor self-rated health (adjusted odds ratio [AOR]: 1.54, 95% confidence interval [CI]: 1.32-1.81) and high symptom burden (AOR: 1.23, 95% CI: 1.09-1.38). In contrast, social isolation was not associated with a higher prevalence of most chronic diseases. Socially isolated individuals were also less likely to have a regular doctor or receive preventive services. Structural social isolation was associated with poorer subjective health and greater symptom burden but not with a higher prevalence of diagnosed chronic diseases. These findings suggest that reliance on diagnosis-based indicators alone may underestimate the health needs of socially isolated individuals, even in healthcare systems with broad accessibility.
Inflammatory bowel disease (IBD) is a long-standing, recurrent disorder that affects not only physical health but also emotional well-being and social functioning, ultimately diminishing patients' health-related quality of life (HRQL). This paper assessed the association between psychological distress and perceived social support and HRQL in people with Crohn's disease (CD) and ulcerative colitis (UC). A cross-sectional survey was conducted among 504 adults with IBD in outpatient gastroenterology clinics. Participants completed measures of psychological distress, perceived social support, and HRQL. Correlation, independent-samples t-tests, one-way analysis of variance, and multiple linear regression were used to analyze the data. There were significant negative correlations between psychological distress and social support (r = -0.53, p < 0.001) and between psychological distress and HRQL (r = -0.48, p < 0.001); however, there was a positive correlation between social support and HRQL (r = 0.62, p < 0.001). There was increased distress and poorer HRQL in females and younger adults. Patients with CD showed a higher level of distress and reduced HRQL compared to patients with UC. Regression revealed that HRQL was negatively predicted by psychological distress and disease activity, but positively predicted by social support and age. HRQL is negatively associated with greater distress and active disease, whereas greater social support is positively associated with well-being of patients with IBD. Psychosocial care is potentially effective in improving clinical management.
Widespread social media use may be one of the most important factors influencing individuals' romantic relationships. In particular, excessive, uncontrolled, and problematic social media use may negatively affect both individuals' psychological processes and their relational functioning in interpersonal interactions. The aim of the present study is to examine the serial predicting roles of psychological inflexibility and insomnia in the relationship between social media addiction and romantic relationship quality. The sample consisted of 466 adults from different regions of Türkiye. Of the participants, 368 were female (79%) and 98 were male (21%). The mean age of the participants, whose ages ranged from 18 to 72, was 34.32 years (SD = 10.93). In line with the aim of the study, the relationships among variables were examined using correlation analysis, and structural equation modeling was employed to test the mediation model. The findings indicated that social media addiction was positively associated with psychological inflexibility and insomnia and negatively associated with romantic relationship quality. According to the structural equation modeling results, the model fit indices suggested that the proposed model demonstrated a good fit to the data. The analysis further revealed that psychological inflexibility and insomnia played serial predicting roles in the relationship between social media addiction and romantic relationship quality. These findings suggest that social media addiction may increase levels of psychological inflexibility, which in turn may contribute to sleep-related problems, and that these processes may be reflected in lower perceived romantic relationship quality. Accordingly, interventions aimed at enhancing psychological flexibility and improving sleep patterns may be useful in understanding the relational consequences of social media addiction.
Males are more commonly diagnosed with autism spectrum disorder (ASD) than females with a ratio of about 4-1. However, the neural mechanisms underlying the sex differences in ASD are unknown. Social deficits are the core symptoms of patients with ASD. Previous studies showed that diminished activity-dependent brain-derived neurotrophic factor (BDNF) signaling induced differential severity of autism-like social preference deficits in male and female mice by using a mouse model with genetic knock-in of human BDNF methionine (Met) allele, which significantly decreased activity-dependent BDNF release without affecting basal BDNF secretion. Here, we investigated the synaptic mechanisms for diminished activity-dependent BDNF-induced differential severity of social preference deficits in males and females. The prefrontal cortex (PFC) is a critical brain region for social behaviors. Whole-cell patch-clamp brain slice recordings showed that diminished activity-dependent BDNF signaling differentially increased the frequency of spontaneous action potentials (sAPs) of pyramidal neurons in the PFC of male and female BDNF+/Met mice. The frequency of sAPs in male BDNF+/Met mice was higher than in female BDNF+/Met mice. Diminished activity-dependent BDNF signaling differentially enhanced excitatory synaptic transmission and dampened inhibitory synaptic transmission of pyramidal neurons at pre- and post- synapses in males and females, which were mediated by dysregulated transcriptional levels of key synaptic genes. Chemogenetic inhibition of pyramidal neurons in the PFC of BDNF+/Met mice was sufficient to ameliorate autism-like social preference deficits in males and females. This study reveals synaptic mechanisms underlying the differential severity of social preference deficit in male and female BDNF+/Met mice, which provides a potential neural basis for sex differences in male and female ASD patients with and without the BDNF Val66Met SNP.
Increased intestinal permeability is implicated in the pathogenesis of depression. Modified Xiaoyaosan (MXYS) has demonstrated antidepressant-like effects in chronic social defeat stress (CSDS) mice, particularly in improving social avoidance behavior. However, direct evidence that MXYS improves depressive behavior by regulating intestinal permeability remains lacking. Using a CSDS-induced depression mouse model, we investigated the effects of MXYS through an integrated multi-omics approach, combining intestinal histopathology, microbiome, metabolomics, and molecular biology techniques. This strategy allowed systematic assessment of pathological changes, gut microbial composition, metabolite profiles, and protein expression. MXYS treatment significantly alleviated social avoidance behavior in CSDS mice. It upregulated the expression of tight junction proteins in the colon, jejunum, and hippocampus. MXYS also reduced serum permeability markers of lipopolysaccharide (LPS), D-lactate (D-Lac), and diamine oxidase (DAO), as well as concentrations of pro-inflammatory cytokines TNF-α and IL-1β in both intestinal tissues and the hippocampus. Gut microbiota analysis revealed that MXYS notably decreased the relative abundance of Desulfovibrio in the colon, which was associated with modulation of β-alanine metabolism. In the jejunum, MXYS increased the relative abundance of Clostridium sp. mbf VZ-132 and influenced glycerophospholipid metabolism. MXYS alleviates social avoidance in CSDS-induced depressed mice is associated with the restoration of intestinal barrier function via gut microbiota-mediated pathways. Specifically, it may reduces colon Desulfovibrio abundance to modulate β-alanine/aspartate metabolism and enhance claudin-1 expression, while increasing jejunal Clostridium sp. mbf VZ-132 to regulate glycerophospholipid metabolism and upregulate occludin expression. These findings suggested that MXYS may improves depression-like behavior through segment-specific microbial and metabolic modulation of intestinal permeability.
To identify and characterize distinct types of authoritative cardiology-related key opinion leaders (ACKOLs) on Xiaohongshu and examine their communication characteristics and engagement patterns. A social media profiling study was conducted on Xiaohongshu. Eligible ACKOLs were identified through manual searches and screened using predefined criteria. We applied a theory-informed 14-indicator profiling framework covering communicator credibility, social network visibility, message production, message expression and communication style, and audience engagement. K-means clustering was performed to classify ACKOLs, and word clouds were generated to visualize thematic characteristics. A total of 150 ACKOL accounts comprising 46,616 posts were included. Four distinct types were identified: Public Health Educators, Clinical Narrators, Academic Interactors, and Authoritative Experts. Public Health Educators focused on accessible prevention-related science popularization content. Clinical Narrators emphasized clinical case sharing and psychosocial support. Academic Interactors showed the highest engagement and the strongest academic dissemination profile. Authoritative Experts had the largest follower base and strongest professional authority but relatively lower engagement. Together, these ACKOL types demonstrated complementary roles in information dissemination, emotional support, and audience engagement. ACKOLs on Xiaohongshu exhibit substantial heterogeneity in communication strategies and audience engagement. Different ACKOL types jointly form a complementary digital health communication ecosystem that may support cardiovascular disease management and patient-centered health communication.
Unintentional injuries represent a primary cause of child mortality worldwide. However, child injury research in China exhibits a distinct disparity in research coverage; while studies on urban populations are abundant, deep qualitative research exploring multi-level vulnerability factors among children in rural southwestern regions remains scarce. This study aimed to explore and conceptualize the multi-level vulnerability factors for unintentional injuries among children aged 3-12 years in Guizhou Province. Semi-structured interviews were conducted with 290 participants, including children, their caregivers, teachers, and local social workers across three regions in Guizhou. Data collection involved focus group discussions with children and in-depth interviews with adults. We conducted thematic analysis using NVivo 15 software. Data analysis yielded four overarching themes encompassing 16 sub-themes: (1) Family vulnerability factors (absence of guardianship, inadequate parental safety initiative, emotional alienation, hazards in the home environment, and economic constraints); (2) Children's individual vulnerability factors (weak safety awareness, risks of daily activities in the absence of supervision, personality traits, and disabilities); (3) Community vulnerability factors (safety hazards in the community environment and facilities, inadequate safety promotion, Insufficient interdepartmental collaboration, insufficient social attention, and imbalance of power and responsibility); (4) School vulnerability factors (safety hazards in the school environment and facilities, and inadequate safety education). Among these, the absence of family supervision, inadequate parental safety initiative, and home environmental hazards exacerbated by economic pressure emerged as core vulnerability factors. Furthermore, this study identified the cultural phenomenon of "filial silence," reflecting how traditional filial piety influences injury concealment among children. Unintentional childhood injuries in Guizhou stem from intersecting multi-level vulnerabilities. The phenomenon of "filial silence" presents unique cultural challenges for injury surveillance. Interventions must integrate immediate environmental modifications, collaborative guardianship networks, and long-term rural revitalization strategies.
Ankylosing spondylitis (AS) is a chronic inflammatory rheumatic disease characterized by inflammatory low back pain, new bone formation, and progressive ossification of the axial skeleton. Over time, it causes irreversible structural damage to the spine and sacroiliac joints, profoundly impairing patients' quality of life and physical function. Without timely and effective intervention, AS can lead to permanent functional disability. Evidence suggests that biological, psychological, and social factors jointly undermine treatment adherence, with complex interactions among these dimensions that make single-domain interventions insufficient. Improving adherence to treatment regimens therefore requires a thorough understanding of these multifaceted influences and the development of evidence-based, multicomponent strategies. This narrative review synthesizes literature published from 2010 to 2024, drawn from PubMed/MEDLINE, Embase, Web of Science, the Cochrane Library, and CNKI, to identify factors contributing to non-adherence in AS patients, with particular attention to disease knowledge, perceptions of treatment efficacy, exercise and rehabilitation adherence, and social support. Wherever possible, evidence derived directly from AS or axial spondyloarthritis (axSpA) populations is distinguished from findings extrapolated from broader rheumatology or chronic-disease literature. Based on this synthesis, targeted recommendations for optimizing treatment management and enhancing long-term patient outcomes are proposed, together with priority directions for future AS-specific adherence research.
Compounded by physical inactivity and an obesogenic environment, adolescent obesity represents a significant public health challenge for Saudi Arabia. Drawing on Social Cognitive Theory (SCT) as a conceptual lens, this study aimed to compare obesity-related risk behaviors among physically active and physically inactive male Saudi adolescents. Using a cross-sectional design and convenience sampling, male Saudi high school students (N = 124) aged 16-17 years in Riyadh were classified into physically active (n = 70; self-reported vigorous-intensity activity or structured ≥3 days/week) and physically inactive (n = 54) participants. BMI was classified according to International Obesity Task Force (IOTF) cutoffs, and waist-to-height ratio (WHtR) defined abdominal obesity. Lifestyle behaviors (PA, screen time, sleep, and diet) were assessed using the Arab Teen Lifestyle Study (ATLS) questionnaire. Physically inactive participants had a significantly higher BMI than physically active peers (30.28 vs. 23.64 kg/m2; p < 0.001; d = 1.060), waist circumference (97.35 vs. 85.46 cm; p < 0.001; d = 0.866), and WHtR (0.562 vs. 0.488; p < 0.001; d = 0.927). By IOTF criteria, 51.9% of physically inactive participants were obese versus 17.1% of physically active participants, and 72.2% exhibited abdominal obesity (WHtR ≥ 0.50) versus 31.4%. Physically active participants accumulated significantly greater METs-min/week (4,083.9 vs. 2,225.0; p < 0.001; d = 0.667) and PA minutes/week (795.6 vs. 421.9; p < 0.001; d = 0.758); 68.6% were highly active versus 24.1% of physically inactive participants, while 63.0% of physically inactive participants were sedentary. Screen time and sleep did not differ significantly between groups; insufficient sleep was prevalent in both groups (84.3% vs. 83.3%). Of ten dietary behaviors assessed, only fresh fruit consumption was significantly higher among physically active participants (5.44 vs. 4.24 days/week; p = 0.006; d = 0.520). Physically active was associated with lower obesity risk in male Saudi adolescents, with large between-group differences in BMI, WHtR, and abdominal obesity. Unsatisfactory screen time and sleep profiles across both groups suggest a pervasive obesogenic environment irrespective of PA status. These cross-sectional findings highlight the potential value of PA promotion, dietary reforms, and screen time and sleep initiatives for this population.
Peripheral artery disease (PAD) contributes disproportionately to disability, limb loss, and premature mortality, and U.S. major amputation rates have risen in the past decade among increasingly younger adults. Traditional risk tools incompletely explain these trends. We propose to examine a hypothesis generating risk-stacked model in which three interacting layers: 1) genetic susceptibility via lipoprotein(a) [Lp(a)]; 2) cardiovascular-kidney-metabolic syndrome (CKM; chronic kidney disease/diabetes mellitus/insulin resistance); and 3) social determinants of health (SDOH) jointly influence PAD incidence, phenotype at presentation (critical limb-threatening ischemia), and outcomes (major adverse limb events [MALE], including amputation). We summarize the independent and joint associations of elevated Lp(a), CKM/diabetes mellitus/insulin resistance, and adverse SDOH with PAD onset and MALE and practice-level implementation strategies (one-time Lp(a) testing, SDOH screening/routing, intensified preventive therapies). We hypothesize that high Lp(a) and diabetes/insulin resistance synergize to impair collateralization and promote thrombosis-prone plaque biology, while adverse SDOH delay diagnosis and limit access to guideline-directed care, together driving worse PAD outcomes. This conceptual framework supports universal one-time Lp(a) measurement, aggressive prevention, and embedded SDOH workflows while informing trials of equity-focused delivery models for patients with PAD. These factors may refine PAD risk stratification and align prevention resources to those at highest risk of limb loss.
Adolescent girls and young women (AGYW) remain disproportionately affected by HIV, particularly in sub-Saharan Africa (SSA), where most AGYW living with HIV reside. Although group-based support interventions have been introduced to improve HIV prevention outcomes, evidence on how these models are structured and their effectiveness for AGYW remains limited. This scoping review mapped and synthesised evidence on group support interventions for HIV prevention among AGYW in SSA, with a focus on pre-exposure prophylaxis (PrEP) uptake, adherence, and retention in care. A scoping review was conducted between September and November 2024 following established methodological guidance. Group support models were defined as structured or semi-structured interventions that bring AGYW together to provide peer support, HIV and sexual and reproductive health education, psychosocial support, and skills-building to improve HIV prevention outcomes. Peer-reviewed qualitative, quantitative, and mixed-methods studies were searched across four databases using keywords. Grey literature was excluded. Data were charted and analysed thematically to map and synthesize evidence on group support interventions. The initial search yielded 1,901 results after 62 duplicates were removed. 40 papers were eligible. Following title/abstract and full-text screening, 11 studies met the inclusion criteria. Full-text articles were excluded because they did not meet the target population criteria (n = 5), lacked focus on group support models (n = 12), were irrelevant to study outcomes (n = 10), or were not behavioural/health-related studies (n = 2). Group-based HIV prevention models commonly included peer-led support, HIV and sexual and reproductive health education, psychosocial support, mentorship or buddy systems, communication and negotiation skills-building, and PrEP adherence discussions. Across studies, these interventions were reportedly associated with improved HIV prevention knowledge, increased PrEP uptake and early adherence, stronger motivation to remain engaged in care, reduced stigma, improved social support, and greater confidence in sexual health decision-making. The findings suggest that group support models may help address social, cultural, and gender-related barriers to HIV prevention by creating supportive and empowering spaces for AGYW. However, evidence on long-term PrEP adherence, retention in care, scalability, sustainability, cost-effectiveness, and comparative effectiveness of different approaches was limited. Few studies reported objective adherence outcomes or longer-term HIV prevention impacts.
To identify latent profiles of problematic internet use (PIU) among college students and examine their associations with physical activity (PA) levels. A stratified cluster sampling survey was conducted among 2,660 college students from central China. Problematic short video, social media, and internet game use were assessed using validated scales, and PA level was measured using the Physical Activity Rating Scale-3. Latent profile analysis was performed to identify PIU profiles. Multinomial logistic regression was used to examine the associations between PA levels and profile membership after adjusting for sociodemographic characteristics. Four heterogeneous latent profiles of problematic internet use were identified among college students: the Low-risk problematic use profile (n = 1,630, 61.28%), the Social media-dominant problematic use profile (n = 304, 11.43%), the Gaming-dominant problematic use profile (n = 478, 17.97%), and the High-risk problematic use profile (n = 248, 9.32%). Multinomial logistic regression analyses showed that, compared with the Low-risk profile, male students had higher odds of membership in the Gaming-dominant profile (OR = 2.122, 95%CI:1.697-2.654) and the High-risk profile (OR = 1.714, 95%CI:1.292-2.273), but lower odds of membership in the Social media-dominant profile (OR = 0.767, 95%CI:0.598-0.983). Sophomore and junior students had significantly higher odds of membership in all three non-low-risk profiles, whereas senior students had significantly lower odds. Off-campus residence was associated with lower odds of membership in the Gaming-dominant profile (OR = 0.508, 95%CI:0.298-0.864). High-level physical activity was associated with lower odds of membership in the Social media-dominant (OR = 0.585, 95%CI:0.395-0.866), Gaming-dominant (OR = 0.371, 95%CI:0.255-0.539), and High-risk profiles (OR = 0.552, 95%CI:0.353-0.862). Moderate-level physical activity was associated with lower odds of membership only in the Gaming-dominant profile (OR = 0.795, 95%CI:0.632-0.999). PIU among college students exhibits substantial heterogeneity. The observed associations between PA levels and profile membership may inform targeted PIU prevention strategies.
Radiation dermatitis (RD), a common adverse reaction to radiotherapy (RT), is widely discussed on video-sharing platforms. However, user-generated content about RD lacks systematic scientific validation. This study evaluates the reliability and quality of RD-related videos on two major social media platforms: Douyin and Bilibili. We conducted a cross-sectional study on Douyin and Bilibili, using keywords including "radiation dermatitis ()," "radiotherapy-induced dermatitis ()," "radiation skin injury ()," and "radiation dermatitis care ()". A total of 190 eligible short videos were included for analysis. We collected data on video characteristics, including title, uploader identity, upload date, video duration, content type, engagement metrics (likes, comments, shares, saves), presentation format, and quality scores. Video quality and reliability were assessed using the modified DISCERN (mDISCERN), the Journal of the American Medical Association (JAMA) benchmark criteria, and the Global Quality Scale (GQS) by two independent reviewers. The analysis revealed that Douyin videos were significantly shorter in duration than those on Bilibili (p < 0.05), yet they demonstrated higher audience engagement. Douyin yielded significantly higher median mDISCERN and JAMA scores than Bilibili, while the between-group difference in GQS scores did not reach statistical significance. Videos created by professional healthcare providers demonstrated higher reliability and quality, with mDISCERN scores of 3 and GQS scores of 3. Correlation analysis revealed a strong significant positive correlation between video shares and saves. Engagement metrics showed positive correlations with all three quality scores but with gradient differences in strength: strong correlations with mDISCERN scores, moderate correlations with GQS scores, and weak correlations with JAMA scores. Social media platforms support the dissemination of RD-related health information to some extent, but the overall quality of videos remains suboptimal. We recommend that professional healthcare providers obtain official platform certification to promote the spread of high-quality RD-related content.
Epilepsy affects about 50 million people worldwide, with stigma and misconceptions that contribute to social exclusion and psychological distress, sometimes more disabling than the physical symptoms. In Syria, epilepsy awareness among university students remains under-studied, despite their role as future healthcare providers and community leaders. This study assessed epilepsy-related knowledge, attitudes, and first-aid practices among Syrian university students and identified associated factors. A cross-sectional study was conducted including 1005 students from 24 Syrian universities using a structured questionnaire that covered demographics, epilepsy knowledge, first aid, and attitudes. Reliability was assessed using Cronbach's alpha. Data were analyzed using descriptive statistics, t-tests, ANOVA, and logistic regression, with statistical significance set at p < 0.05. High epilepsy knowledge was found in 59% of students, but misconceptions persisted. Although 63% showed good first-aid knowledge, harmful practices were common. Attitudes were mixed, with 56% expressing positive views but significant reluctance toward close personal and professional relationships, potentially leading to social isolation, discrimination in employment and education, and reduced opportunities for marriage and community integration. Syrian students show moderate knowledge but persistent stigma and unsafe practices. Targeted education and first-aid training are needed to reduce misconceptions and improve support for people with epilepsy.
Patients newly diagnosed with hematologic diseases frequently ask, "What should I eat to get better?" This question reflects both a deeply rooted societal narrative linking lifestyle to recovery and a desire for personal agency in moments of vulnerability. Nutrition remains an essential component of supportive care. However, for most malignant and clonal hematologic disorders, there is limited clinical evidence that specific diets or commercially marketed supplements alter disease biology or replace standard therapy. In the digital era, dietary narratives are amplified by social media, online advertising, and commercial interests, increasing the risk of misinformation and exploitation. We argue that clinicians and professional societies should strengthen public medical literacy, clearly distinguish supportive nutrition from disease-modifying therapy, and proactively protect patients from misleading health claims.
<b>Background and Objective:</b> The rapid development and deployment of COVID-19 vaccines constituted a critical global public health response; however, vaccine hesitancy posed a substantial challenge, particularly in low- and middle-income countries such as Iraq. Mistrust, misinformation and sociopolitical factors were reported to influence vaccine uptake. This study aimed to assess public perception, acceptance and hesitancy toward COVID-19 vaccines in Iraq during the pandemic and to identify key sociodemographic and informational determinants influencing vaccination behavior. <b>Materials and Methods:</b> A cross-sectional survey was conducted among 1,747 participants across Iraq. Vaccine acceptance was defined as receipt of at least one vaccine dose, while hesitancy included delayed or refused vaccination due to concerns regarding safety, efficacy, or other factors. Public perception reflected attitudes and beliefs toward vaccination irrespective of vaccination status. Data were analyzed using descriptive statistics and inferential tests to examine associations between sociodemographic variables, exposure to misinformation and vaccine acceptance, with statistical significance set at p<0.05. <b>Results:</b> Among the participants, 42.7% were vaccinated and 57.3% were unvaccinated. Vaccine acceptance was significantly higher among men, older individuals and participants with higher educational attainment (p<0.001). The most commonly reported reasons for vaccine hesitancy were concerns about long-term side effects (72.4%) and distrust in vaccine manufacturers (41.9%). Exposure to misinformation via social media platforms showed a significant association with increased vaccine hesitancy (p = 0.03). <b>Conclusion:</b> The findings identify critical sociodemographic and informational factors influencing COVID-19 vaccine acceptance in Iraq. Targeted public health interventions focusing on women, younger populations and individuals with lower educational levels are warranted. Strengthening evidence-based communication strategies to counter misinformation and rebuild public trust may improve vaccine uptake. Future studies should explore longitudinal trends and intervention effectiveness to address persistent vaccine hesitancy.
Solid organ transplant has increased within the last 50 years, particularly as surgical procedures, transplant outcomes, brain death criteria, and immunosuppressive therapies are improving. While transplant programs have specific criteria to help identify ideal transplant candidates, some programs are recognizing the emotional and physical burden that transplant candidates have leading up to the transplant decision; as such, a multidisciplinary approach to candidate evaluation which involves social work, psychiatry, nursing, and other disciplines is necessary for transplant success. Due to the complex nature of medical illnesses that lead to solid organ transplant, and the significant impact on quality of life, palliative care involvement both pre-transplant and post-transplant has been identified as a helpful support for patients. This narrative review summarizes relevant literature on the involvement of palliative care in transplant and provides a conversation guide for supporting patients through the transplant process from a palliative lens. Authors ran a narrative review search in the National Library of Medicine (NLM) PubMed database. The search was restricted to English language articles, and publication date filters limited the results from January 1, 2015 to the day the search was run on April 2, 2026. An effort was made to exclude animal studies. Search terms included Medical Subject Headings (MeSH) terms as well as keywords, including terms for palliative care, palliative medicine, transplantation, solid organ transplant, conversation guide, heart transplant, liver transplant, lung transplant, kidney transplant, attitudes, perspectives, trajectory, utilization, outpatient, inpatient, early palliative care, referral, cost-savings, and their synonyms. While palliative care involvement in transplantation has been well studied, only certain transplant groups, particularly heart and liver, have formally updated guidelines to reflect this. Palliative care providers should continue to partner with transplant teams in order to better support patients and caregivers throughout all stages of end-stage disease, particularly pre- and post-transplant. Further consideration should be given to healthcare outcomes with palliative team involvement in transplant populations. More research is needed to determine optimal timing, setting, and resource availability of palliative teams.
Patient-reported outcome measures are essential tools for assessing disease burden in bronchiectasis. The Quality of Life-Bronchiectasis questionnaire (QoL-B) is widely used in clinical research, but a validated Italian version has not been available. To perform a cross-cultural validation of the Italian QoL-B in a real-world cohort of patients with bronchiectasis. Prospective observational cross-cultural validation study. Adult patients with bronchiectasis attending a tertiary referral clinic were prospectively enrolled. The Italian QoL-B was administered at baseline (T0) and after 15 days (T1) in clinically stable patients to assess internal consistency and test-retest reliability. Construct validity was evaluated through predefined hypotheses by comparing QoL-B domain scores across clinically relevant subgroups, including exacerbation frequency, dyspnea severity, lung function impairment, and Bronchiectasis Severity Index (BSI) class. Exploratory analyses assessed score variation during exacerbations. A total of 108 patients were included (median age 64.5 years; 75.9% female). Internal consistency was good across domains (Cronbach's α 0.78-0.89), and test-retest reliability showed stable scores between T0 and T1 with high intraclass correlation coefficients. Construct validity was supported by significant discrimination across disease-burden groups: patients with frequent exacerbations, severe BSI class, or greater dyspnea reported consistently lower scores, particularly in physical functioning and respiratory symptoms domains. The Emotional Functioning domain showed weaker associations with disease severity indicators and was primarily related to mood disorders. QoL-B scores were substantially lower during exacerbations. The Italian QoL-B demonstrates good reliability and construct validity and provides a robust instrument for assessing quality of life in Italian-speaking patients with bronchiectasis. Validating an Italian questionnaire to measure quality of life in people with bronchiectasisBronchiectasis is a chronic lung condition that can cause persistent cough, mucus production, breathlessness, and repeated lung infections. Understanding how the disease affects patients’ daily life is important, not only through medical tests but also through patients’ own perceptions and experiences. The Quality of Life–Bronchiectasis questionnaire (QoL-B) is a tool designed to measure how bronchiectasis impacts different aspects of daily life, such as physical activity, symptoms, social life, and emotional well-being. However, until now, a validated Italian version of this questionnaire was not available. In this study, we tested the Italian version of the QoL-B in 108 patients with bronchiectasis followed in a specialist clinic. Patients completed the questionnaire twice, two weeks apart, to check whether the results were consistent over time when their condition was stable. We also compared questionnaire scores across patients with different levels of disease severity. The results showed that the Italian QoL-B is reliable and produces consistent results. Patients with more severe disease, more frequent exacerbations, or greater breathlessness reported worse quality of life, especially in physical and respiratory domains. Interestingly, the emotional domain was less closely related to disease severity and appeared to reflect psychological factors such as anxiety or depression. During disease flare-ups, quality of life scores worsened significantly. In conclusion, the Italian QoL-B is a valid and reliable tool to measure quality of life in patients with bronchiectasis. It can help clinicians better understand patients’ experiences and support more personalized care.
Depression is a common and complex mental health condition. It is shaped by many genetic, environmental, and social factors that influence when it starts and how it progresses. The main biological changes behind depression are still not well understood. Current treatments help some patients, but many only experience partial or unstable benefits. There is a clear need for treatments that are both more effective and more precise for depression. In this study, up-to-date genetic and pharmacogenomic data were used to identify genes targeted by drugs and potential therapy targets for depression. Information from several independent resources was brought together, and these datasets were combined in a stepwise way. With this strategy, the aim was to provide a practical starting point for the development of more targeted antidepressant therapies. Cross-tissue expression quantitative trait loci (eQTL) were first used to analyze data, and these data were combined with Genome-Wide Association Study (GWAS) summary statistics for depression. Then Mendelian Randomization (MR) was applied to identify candidate druggable genes. Colocalization analyses were also performed to check whether the eQTL and depression signals were likely to share the same causal variants. To further assess biological and therapeutic relevance, Phenome-Wide Association Studies (PheWAS), functional enrichment analyses, computational drug prediction, molecular docking, and molecular dynamics simulations were carried out. Using Mendelian randomization, 34 blood-derived genes and 25 brain-derived genes were identified that showed evidence of association with depression. Colocalization further supported causal roles for 23 blood-and 14 brain-derived genes, with SNRK, MANF, and P4HTM showing significant signals in both tissues. Enrichment analyses implicated immune-related pathways. Docking and dynamics confirmed stable binding between key targets and compounds such as quercetagetin and myricetin. In this study, 34 potential druggable targets for depression were found, with SNRK, MANF, and P4HTM showing consistent importance across tissues. In addition, quercetagetin and myricetin emerged as promising candidates for depression therapy. These findings provide new therapeutic candidates and help establish a mechanistic framework for the development of targeted antidepressants.