Trichotillomania (TTM) is a body-focused repetitive behavior disorder characterized by recurrent hair pulling and psychosocial impairment. Although theoretical models emphasize emotion regulation as a key mechanism in TTM, the precise relationship between emotional states, urge intensity, and hair pulling behavior remains unclear. This study examined the momentary interplay between affective states, urge intensity, and hair pulling episodes in daily life using Ecological Momentary Assessment (EMA). Sixty-one Individuals diagnosed with TTM reported seven times daily for ten days on their hair pulling behavior, urge intensity and current emotional states, resulting in 2557 data points with 702 reported hair pulling episodes. Multilevel analyses were used to assess concurrent and prospective associations, with "prospective" referring to predictions of the subsequent assessment. Urge intensity was a robust predictor of hair pulling episodes, both concurrently and prospectively. Previous pulling episodes predicted subsequent episodes indicating some temporal stability over the course of the day. Boredom prospectively predicted hair pulling episodes, while tiredness prospectively predicted urge intensity. Negative affect and rumination were associated with stronger concurrent urges but did not predict subsequent urges or episodes. However, positive and negative affect were associated with the concurrent urge intensity. Findings highlight the central role of urge intensity and boredom in the short-term emergence of hair pulling behavior. The results challenge models that focus primarily on emotional dysregulation and call for a more differentiated perspective on urge and behavior. Future etiological models should incorporate broader contextual, cognitive and sensory factors to better capture the mechanisms underlying TTM.
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Suicidal risk fluctuates rapidly, yet suicide monitoring primarily relies on retrospective assessments. Ecological momentary assessment (EMA) offers a promising approach for capturing real-time fluctuations in suicidal urges and identifying elevated suicidal risks beyond clinical settings, but poses substantial participant burden. This study aimed to examine the incremental predictive value of EMA and its optimal sampling frequency. Military service members and veterans (N = 62) with recent suicidal ideation or attempts received outpatient psychotherapy weekly. Participants completed measures of suicidal ideation at each session and four daily EMA surveys of suicidal urges over 28 days. Mixed-effects models examined whether EMA-assessed suicidal urges during the inter-session window predicted suicidal ideation at the subsequent therapy session beyond retrospective measures. We simulated reduced EMA frequencies by probabilistically thinning EMA observations and re-estimated model performance with different EMA frequencies. Both the mean and maximum levels of EMA-assessed suicidal urges significantly improved the prediction of next-session suicidal ideation beyond prior session-based measures (p < .001). Simulation analyses revealed a nonlinear relationship between EMA frequency and its predictive utility. The predictive utility of EMA remained nearly unchanged as sampling frequency decreased from highly frequent (twice per day) to moderately frequent (once every other day) schedules but declined more sharply with further reductions in EMA frequency. EMA enhanced the prediction of near-term suicidal risks beyond session-based assessments. Moderate EMA sampling frequencies (once every other day) may preserve most predictive utility while reducing participant burden, offering a practical approach for scalable suicide monitoring in clinical populations.
Compulsive sexual behavior disorder (CSBD) is characterized by persistent difficulty controlling sexual urges and behaviors associated with marked distress or impairment. Population-based data indicate that ~8.6% of US adults experience distress related to difficulty controlling sexual urges, feelings, and behaviors, while large international screening studies suggest that ~5% of individuals may be at high risk for CSBD, yet only a minority seek treatment. Diagnostic classification remains challenging in early or evolving presentations and in patients with complex psychiatric and neurodevelopmental comorbidities. The International Classification of Diseases, 11th Revision (ICD-11) requires a 6-month symptom duration for formal diagnosis and specifies exclusion when symptoms are better explained by another mental disorder, substance use, or medication effects. Here we describe a man in his 20 s with bipolar I disorder, attention-deficit/hyperactivity disorder, anxiety, and intellectual developmental disorder (IDD), along with medical comorbidities, who was hospitalized for severe intrusive sexual thoughts associated with distress and safety concerns. Phenomenology suggested overlap between obsessive-compulsive disorder (OCD) with sexual obsessions and an emerging CSBD-like syndrome, with ego-dystonic intrusive cognitions alongside strong gratification-driven urges and restraint primarily driven by anticipated negative consequences. Given symptom severity and imminent risk of behavioral enactment, the presentation was conceptualized as an early CSBD-like syndrome despite not meeting the ICD-11 duration criterion. Symptoms remained acutely refractory despite multiple psychotropic optimizations; the most temporally associated improvement occurred after initiation of naltrexone, with marked improvement within 5 days and resolution of intrusive sexual thoughts by hospital day 16. Although concurrent medication changes preclude attribution to naltrexone monotherapy, the rapid response supports further investigation of reward- and impulse-targeted interventions for severe subthreshold presentations and highlights the need for clearer diagnostic frameworks and evidence-based guidance for acute management of diagnostically ambiguous compulsive sexual and sexual obsessive syndromes.
Adolescents engage in non-suicidal self-injury (NSSI) and social media more than any other age group. To understand the role of adolescents' subjective social media experiences in NSSI, this study examined the relationships between emotional responses to social media and NSSI urges and engagement. Data were collected from two studies, which included a cross-sectional study (N = 408) and an 8-week intensive-longitudinal study (N = 80) with ecological momentary assessment (3 surveys/day). The cross-sectional study revealed that positive responses to social media were associated with the presence of NSSI urges across all time points and frequency of NSSI engagement in the past year and lifetime. Negative responses to social media were associated with the presence of NSSI urges and engagement across all time points and frequency of NSSI engagement in the past week, month, and year. The intensive-longitudinal study revealed that positive responses to social media were not associated with daily NSSI urge intensity or presence of engagement, although negative responses to social media were associated with both daily NSSI urge intensity and presence of engagement. Interventions aiming to reduce adolescent NSSI may benefit from addressing ways to cope with negative social media experiences and promoting positive experiences.
Tourette syndrome (TS) has traditionally been conceptualized as a movement disorder characterized by involuntary motor and vocal tics. However, growing evidence suggests that tic generation involves complex interactions between neural, physiological, and psychological processes, particularly the role of premonitory urges (PU). This paper aims to develop an integrative model of tic generation by synthesizing recent evidence across neurobiological, neurophysiological, and psychological domains. A narrative review of PubMed-indexed literature (2020-2026) was conducted, complemented by landmark earlier studies. Evidence was selected and synthesized to explore the relationships between cortico-striato-thalamo-cortical dysfunction, motor inhibition, interoception, and reinforcement mechanisms. Findings indicate that TS is associated with multilevel dysfunction, including impaired inhibitory control, altered cortical excitability, and abnormal interoceptive processing. Premonitory urges emerge as central drivers of tic behavior, linking internal states to motor output. Tic execution produces temporary relief, reinforcing behavior through negative reinforcement mechanisms. These processes form a dynamic urge-action-relief loop, further shaped by perception-action coupling and neural noise. TS can be conceptualized as a disorder of action regulation, in which tics arise from the interaction between dysfunctional neural systems, abnormal interoceptive signals, and reinforcement-based learning processes. The proposed model provides a unified and testable framework for understanding tic generation and has potential implications for clinical intervention targeting the functional relationship between urges and behavior.
Health-damaging surface ozone tends to be lower in populated urban areas than in the surroundings, yet this urban-rural difference is narrowing. While evidence from observations have attributed this narrowing to the reduced inhibition effect of urban nitrogen oxides, we lack clarity on how intensified humid-heat modulates precursor sensitivity in ways that reconfigure the urban-rural gradient under climate warming. Here, we integrated high-resolution air pollutant reanalysis with interpretable machine learning to quantify the global spatial patterns and temporal evolution of paired urban-rural ozone gradients. We show that meteorology-chemistry synergy in urban areas, encompassing weakened inhibition effects of NO2 and dewpoint temperature and an intensified positive effect of radiation, contributes significantly to the reversal of urban-rural ozone disparities in tropical regions and to the long-term global convergence (0.1 μg m-3 year-1, 2005-2023). Although heatwaves have become more frequent, ozone anomalies have diminished driven by moist atmospheric conditions and stringent emission cuts. Yet urban anomalies exceed rural ones, with the differences during moist heatwaves nearly 2-fold those observed in dry events. Our study urges targeted and proactive policies to prevent climate warming synergies from disproportionately worsening urban ozone burdens.
Systemic lupus erythematosus (SLE) and ankylosing spondylitis (AS) are common autoimmune disorders presented in a Rheumatology Clinic. However, their co-existence in the same patient is extremely rare. This case denotes the rare occurrence of such including the diagnostic dilemma and possible therapeutic options of the condition. A 54-year-old woman, a known case of SLE under immunomodulator and glucocorticoid therapy, presented to the clinic with persistent low back pain for 1 year. History and physical examination hinted toward the diagnosis of axial spondyloarthritis which was later confirmed by magnetic resonance imaging of hip with bilateral sacroiliac joint thereby refuting differentials of avascular necrosis of hip, osteoporotic vertebral fractures as the possible causes for low back pain. Patient was treated with sulfasalazine for AS along with hydroxychloroquine, prednisolone, and mycophenolate for SLE. Patient reported improvement in lower back pain and increased range of motion of hip joint as well as examination revealed only mild sacroiliac joint tenderness on 3 months follow-up. Co-existence of SLE and axial spondyloarthritis is uncommon and often presents as a diagnostic dilemma for the clinicians. Imaging is required to rule out common differential diagnoses. Conventional therapy in form of sulfasalazine can provide relief. This case highlights the rare occurrence of SLE and AS in the same patient and raises awareness to consider axial spondyloarthritis as differential for low back pain in patients of SLE. This case also advocates for the use of conventional drug modifying anti-rheumatic drugs such as sulfasalazine in treating axial spondyloarthritis and urges the readers for further research.
BackgroundHigh-quality obstetrical and gynaecological care is vital for physical, psychological, and sexual health. However, research has documented widespread patterns of dehumanized and discriminatory care, with marginalized groups disproportionately impacted. Such care can cause lasting harm, underscoring the need for a trauma-informed and person-centred research to better understand and address these experiences.ObjectivesThe present study aimed to: (1) identify profiles of recent obstetrical and gynaecological patient-provider interactions in Québec, Canada, and (2) examine their links to sociodemographic characteristics, mental health, and sexual wellbeing.DesignThe current study is cross-sectional.MethodsA community sample (n = 1490) having received gynaecological or obstetric care in the last seven years in Québec completed an online survey assessing sociodemographic characteristics, mental health and sexual wellbeing indicators, as well as provider mistreatment, perceived discrimination, and decisional autonomy during the most recent care experience.ResultsLatent class analyses (LCA) identified a four-class solution. Humanizing care (39.7%) featured high decisional autonomy and no mistreatment or perceived discrimination. Subpar care (30.7%) showed moderate autonomy with provider neglect, but no discrimination or provider aggression. Dehumanizing care (17.7%) and patronizing care (11.8%;) involved discrimination and neglect, with the former also facing judgement, aggression, and rights infringements, and the latter, low autonomy but no provider aggression. Dehumanizing care class participants were the youngest and most likely to be socially marginalized (e.g., gender- and sexually diverse, racialized, less educated) and to report poor mental health and poor sexual wellbeing. Humanizing care participants were predominantly older and cisheterosexual and were the least likely to report poor mental health and sexual wellbeing. Subpar care and patronizing care classes included more gender- and sexually diverse individuals and intermediate levels of poor mental health and sexual wellbeing.ConclusionThis study reveals systemic mistreatment in medical care and urges structural reforms, including anti-Black racism training and culturally competent, inclusive practices in gynaecology and obstetrics. Good obstetrical and gynaecological care supports physical, mental, and sexual health, but many people report care that feels dehumanizing or discriminatory, especially those from marginalized groups. Using a trauma-informed, person-centred approach, this study describes recent patient-provider interactions in Québec and examines links with sociodemographic background, mental health, and sexual wellbeing. We surveyed 1,490 people in Québec who recieved obstetrical or gynaecological care within the past seven years. Respondents reported sociodemographics, mental health, sexual wellbeing, and details of their most recent care (mistreatment, perceived discrimination, and decisional autonomy). Latent class analysis identified four groups: (1) Humanizing care (39.7%): high decisional autonomy and no reported mistreatment or discrimination, (2) Subpar care (30.7%): moderate autonomy with provider neglect, but no discrimination or aggression, (3) Dehumanizing care (17.7%): discrimination and neglect plus judgment, aggression, and rights violations, and (4) Patronizing care (11.8%): discrimination and neglect with low autonomy but no aggression. Those in the Dehumanizing care class were youngest, more commonly socially marginalized (e.g., gender- and sexually diverse, racialized, lower education), and most likely to report poor mental health and low sexual wellbeing. Humanizing care participants were more often older and cisheterosexual and reported the best mental health and sexual outcomes. Subpar and Patronizing classes included more gender- and sexually diverse people and had intermediate levels of mental health and sexual wellbeing outcomes. These results reveal systemic mistreatment in obstetrical and gynaecological care and support structural reforms such as anti-Black racism training and culturally competent, inclusive practices to make care safer and more respectful for all.
The rapid transition towards electromobility urges a concurrent focus on safety and intelligent vehicle control. In this regard, Advanced Driver Assistance Systems (ADAS) are paramount, playing a critical role in mitigating human error and enhancing road and passenger safety. However, challenges remain in the robust formulation and integration of such control systems, particularly considering the difficulty in modeling sophisticated architectures and the power synergy paths of hybrid/electric drivelines. This paper presents a comprehensive, novel methodology that utilizes a single-platform solution for model parameters tuning and online optimization of the control layers within an Adaptive Cruise Control (ACC) system for Electric Vehicles (EVs). To this aim, an intelligent Model Predictive Control (MPC) is developed, based on decentralized control modes for cruising, spacing, and braking. A unified prediction model is implemented to provide look-ahead estimation of the driving situation based on real-time measurements. The efficacy of the model prediction and control mode swapping was investigated through experimental testing of a real EV on a chassis dynamometer, with an emulated lead vehicle detected by an on-board LiDAR sensor. The single-platform, featuring updated model parameters and optimized control gains, demonstrated an ability to maintain speed-tracing and precise spacing when exposed to different disruptive scenarios. The per-mode tracking accuracy achieved 98% in cruise control, 87.8% in spacing control, and 55.0% in braking mode under coasting-only constraints. The proposed work thus offers a significant, unified solution to handle the complex challenges of driveline modeling and control system design, mitigating computational and technical difficulties.
The study examines sibling brokerage as a form of cultural, linguistic and institutional labour performed by siblings of individuals with intellectual and developmental disabilities from historically marginalised communities. Ten adult sibling brokers were recruited and completed open-ended questionnaires. Data were analysed thematically, guided by conceptual frameworks of epistemic injustice. Findings reveal that sibling brokers serve as system navigators, translating institutional logics, advocating for services and rearticulating family knowledge. Their labour often began in childhood, was shaped by hegemonic expectations to fit into the system and was frequently unacknowledged or co-opted by professionals. Sibling brokerage is not ancillary but structurally embedded labour that compensates for systemic gaps in accessibility and inclusion. Future research should examine how such roles are institutionally produced and sustained and envision justice-oriented systems that recognise the expertise of sibling brokers. This study explores the experiences of siblings who help their families navigate disability services for a brother or sister with intellectual or developmental disabilities' service access, namely, sibling brokers. Many of these sibling brokers, especially from culturally and linguistically diverse communities, take on important roles like translating, interpreting, filling out forms and advocating for services—often starting at a young age. Their work goes far beyond helping out at home; they are doing important tasks usually handled by trained professionals, yet their efforts are often overlooked or taken for granted. This research calls for greater recognition of sibling expertise and urges systems to support these siblings with appropriate acknowledgement.
Tourette syndrome (TS) involves motor and vocal tics, often with obsessive-compulsive disorder (OCD) and attention-deficit/hyperactivity disorder (ADHD). Cannabis-based medicines (CBMs) are a potential therapy due to their interaction with the endocannabinoid system, potentially reducing tics and associated symptoms. Compared to antipsychotics, CBMs may offer improved tolerability and fewer side effects. Although evidence is limited, emerging studies suggest their potential to improve quality of life in TS. This review was registered with PROSPERO (CRD420251088633). To evaluate the effectiveness of CBMs in treating TS. We systematically searched PubMed, Google Scholar, ScienceDirect, and the Cochrane Collaboration Database for cohort studies and randomized controlled trials (RCTs) up to July 2, 2025. Data extraction included study characteristics and efficacy outcomes measured by the Yale Global Tic Severity Scale (YGTSS) and Premonitory Urge for Tics Scale (PUTS). Meta-analysis using Review Manager 5.4 compared pre- and post-treatment scores using mean difference (MD) and 95% confidence intervals (CI). From 1,105 screened articles, eight studies met inclusion criteria for the review, and seven were included in the meta-analysis, involving 306 adult TS patients. CBMs significantly reduced YGTSS scores (MD =  - 13.29, 95% CI [-21.67 to - 4.91], P = 0.002) and PUTS scores (MD =  - 4.09, 95% CI [-7.24 to - 0.93], P = 0.01). CBMs show promising potential in reducing tics and premonitory urges in TS. Larger, placebo-controlled trials are needed to confirm efficacy, ensure safety, and optimize dosing.
Difficulties in emotion regulation involving both positive and negative emotional states are central to gambling disorder. This study developed and validated the Emotional Gambling Scale (EGS), a measure designed to assess the extent to which specific emotions trigger gambling urges. The initial 55-item EGS used a five-point Likert scale. Following item analysis, 30 items were removed due to limited variability, extreme non-normality, or low item-total correlations, resulting in a final 25-item scale. The final version was administered to 371 Spanish-speaking individuals with recent gambling experience (mean age = 28.5, SD = 11.6; 54.4% male). Factor structure was examined using exploratory (EFA) and confirmatory factor analysis (CFA). Internal consistency was evaluated via Cronbach's alpha and omega coefficients. Construct validity was assessed through correlations with gambling severity (NODS), gambling-related cognitions (GRCS-S), impulsivity (UPPS-P), anxiety and depression (HADS), and quality of life (QLI). Sampling adequacy was excellent (KMO = 0.93), and Bartlett's test of sphericity was significant, χ²(300) = 11,633.47, p < .001. EFA supported a two-factor structure comprising Positive Emotions (15 items) and Negative Emotions (10 items), explaining 70.8% of the variance. The factors were moderately correlated (r = .58). CFA supported the adequacy of the two-factor model, χ²(274) = 947.80, CFI = 0.993, TLI = 0.993, RMSEA = 0.082, and SRMR = 0.070. Standardized factor loadings ranged from 0.75 to 0.93. Internal consistency was excellent for both Positive Emotions (α = 0.96, ω = 0.97) and Negative Emotions (α = 0.94, ω = 0.96). Both subscales showed significant associations with gambling severity, gambling-related cognitions, impulsivity, anxiety, depressive symptoms, and quality of life. The EGS appears to be a reliable and valid measure of emotional triggers for gambling urges. Findings support the distinction between positive and negative emotion-driven behavior while also suggesting the presence of a broader emotional gambling vulnerability dimension.
This systematic review and meta-analysis aimed to evaluate the efficacy and safety of repetitive transcranial magnetic stimulation (rTMS) in patients with anorexia nervosa (AN) and bulimia nervosa (BN), focusing on its impact on psychological, psychopathological, neurocognitive, and behavioral outcomes. A comprehensive literature search was conducted in PubMed, Scopus, Web of Science, and Cochrane CENTRAL from inception to May 2025. Eligible studies included clinical trials involving adult patients with AN or BN treated with rTMS. Data were pooled using fixed or random-effects models depending on heterogeneity. Mean differences (MD) or standardized mean differences (SMD) with 95% confidence intervals (CI) were calculated. Risk of bias was assessed using Cochrane RoB 2.0 and NIH tools. Thirteen studies were included, yielding a total of n = 195 active rTMS treatments and n = 132 sham treatments. Compared to sham, rTMS did not significantly improve BMI in AN patients (MD: 0.19; 95% CI: -0.50, 0.88; P = 0.59). A significant moderate reduction in eating disorder severity was found in single-arm analysis (31 patients, SMD: -0.50, 95% CI [-0.90, -0.10], p = 0.01). Depression improved with rTMS over sham (105 patients, SMD: -0.41, 95% CI [-0.81, -0.02], p = 0.04), while anxiety, binge frequency, and vomiting frequency did not. Urge to eat increased in AN (30 patients, MD: 1.20, 95% CI [0.20, 2.21], p = 0.02) and decreased in BN (25 patients, MD: -10.25, 95% CI [-15.88, -4.62], p = 0.0004). No serious adverse events were reported. rTMS shows potential in improving eating disorder severity and depressive symptoms in AN, with disorder-specific modulation of food-related urges. Its effects on BMI and behavioral symptoms remain inconclusive. rTMS was well tolerated.
Climate change urges us to better understand and predict evolutionary responses to temperature shifts. Hybridization, by increasing genetic variation, can widen the range of adaptive responses and genetic mechanisms available to survive temperature changes. However, genomic data on the long-term effect of hybridization on adaptation is rare, and the molecular mechanisms usually remain unclear. Here, we hybridized two divergent species of Saccharomyces yeast. We experimentally evolved both hybrid and parental populations for 200 generations under hot (30°C), cold (16°C), and fluctuating (16-30°C) temperature regimes. Most hybrids showed intermediate growth but the large variance produced by hybridization also led to thermally transgressive hybrids with high performance. Across regimes, response to selection scaled negatively with ancestral growth, consistent with diminishing-returns epistasis. Analysis of genes with identified mutations revealed enrichment in multiple shared annotation terms between populations evolved in cold and fluctuating environments, such as cell wall functions. Evolved hybrid populations, across all evolution regimes, accumulated significantly more de novo copy number variants (CNVs) than both parental species, indicating extensive genome restructuring in hybrids. This increased structural variation may provide a substrate for selection and adaptive divergence among hybrid lineages. Our results suggest that hybridization can lead to increased growth, especially in hot and thermally unstable environments, by capitalizing on the genomic content inherited from one or the other parental species.
We review recent electrophysiological advances that have refined our understanding of tic generation in Tourette syndrome by characterizing dysfunction across cortico-striato-pallido-thalamo-cortical (CSPTC) circuits and their time-resolved dynamics. We integrate evidence across spatial scales - from single-unit activity to large-scale network coupling - and examine how these findings provide a mechanistic framework for interpreting both invasive and noninvasive neuromodulation approaches. Finally, we discuss how electrophysiological signatures of tics and premonitory urges may serve as candidate biomarkers to guide future, dynamically informed interventions. At the microscale, intraoperative recordings indicate that GPi neurons in Tourette syndrome exhibit a burst-pause firing pattern with phasic modulation preceding tic onset, consistent with transient pallidal disinhibition. At the mesoscale, LFP recordings from centromedian nucleus and aGPi show increased low-frequency (3-12 Hz) power and pallido-thalamic coherence during tics, accompanied by reduced phase synchrony, suggesting dysrhythmic rather than coordinated network activity. At the macroscale, combined intracranial and scalp EEG recordings demonstrate that thalamo-frontal alpha-band connectivity progressively declines in the ~1.3 s preceding tic onset, propagating from sensorimotor to prefrontal regions. Importantly, these pretic dynamics are captured by measures of inter-regional coupling rather than local power, highlighting the relevance of distributed network interactions. These findings are beginning to inform neuromodulation strategies across modalities. Deep brain stimulation (DBS) targeting thalamic or pallidal regions provides clinically meaningful tic reduction, while connectomic analyses emphasize the role of distributed fibre pathways over single anatomical targets. In parallel, noninvasive approaches show mixed results: cortical stimulation techniques such as rTMS and tDCS have yielded inconsistent effects, whereas peripheral rhythmic stimulation, such as 10 Hz median nerve stimulation, has demonstrated efficacy in controlled trials, potentially through modulation of sensorimotor network dynamics. Electrophysiological evidence across spatial scales supports a model of Tourette syndrome as a disorder of dynamic CSPTC circuit dysfunction. At the cellular level, GPi neurons exhibit a sparse but high-intensity bursting regime, with activity changes preceding tic onset. At the population level, low-frequency oscillations in pallido-thalamic networks track tic severity and distinguish tics from voluntary movements. At the network level, thalamo-frontal alpha-band coupling appears to exert a stabilizing influence, whose progressive reduction precedes tic expression. Together, these findings suggest that tic generation arises from temporally evolving disruptions in distributed network coordination rather than from static abnormalities within isolated regions. This framework provides a common basis for understanding both invasive and noninvasive neuromodulation and supports the development of electrophysiological biomarkers for adaptive, closed-loop therapeutic strategies.
Nicotine pouches (NP) are emerging as a potentially safer alternative to tobacco smoking. However, data on NP users with a history of tobacco smoking are limited. We assessed the patterns of NP use, user characteristics, and perceptions among adults with a history of cigarette smoking. A cross-sectional survey was conducted using a self-administered questionnaire to enroll adults with a history of regular cigarette smoking. Data on sociodemographics, smoking history, NP use patterns, and NP-related urges and perceptions were collected. Group differences were analyzed using χ2 tests, and multivariable logistic regression identified factors associated with high-intensity NP use. A total of 711 adults with a history of combustible cigarette smoking were included, of whom 693 were analyzed. Among them, 560 were current users of NP who had ceased cigarette smoking (NP users) and 133 were current cigarette smokers who had not adopted NP (non-users). We found no difference between the two groups in gender, educational status, income, marital status, years of smoking, and time to first cigarette (all p > 0.05). A total of 236 NP users (42.1%) reported high-intensity NP use (≥10 pouches/day) and a total of 363 NP users (64.8%) used their first NP within 30 min of waking. About half of the NP users reported reduced craving intensity (n = 312; 55.7%), and experienced milder withdrawal symptoms (n = 245; 43.8%) compared with smoking. A total of 339 (60%) rated NP as extremely or very effective for smoking cessation. Higher cigarette per day (CPD) was associated with increased odds of high-intensity NP use (≥10 pouches/day): 21-30 CPD (OR = 2.70; 95% CI: 1.62-4.50) and >30 CPD (OR = 3.15; 95% CI: 1.40-7.10). The present findings suggest that adults with a history of cigarette smoking report NP use patterns that appear broadly similar to their prior smoking behaviors. Users reported that cravings and withdrawal symptoms during NP use were similar to or lower than those recalled during smoking. Although most users viewed NP as effective for cessation, it may instead serve as an alternative nicotine source rather than a cessation tool.
Chronic inflammatory skin conditions such as hidradenitis suppurativa and psoriasis vulgaris exhibit a significantly elevated prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD), with studies indicating rates as high as 57% among affected individuals. This narrative review explores the underlying immunological mechanisms that connect HS and psoriasis with MASLD, emphasising the role of chronic systemic inflammation, immune dysregulation, and shared immunologic links between the diseases. This article also urges for enhanced awareness among dermatologists regarding the potential pharmacological interventions for patients with concurrent HS or psoriasis and MASLD, including glucagon-like peptide-1 receptor agonists and biologics, while acknowledging the need for further research to elucidate the efficacy and safety of these treatments.
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) defines obsessions in obsessive-compulsive disorder (OCD) as recurrent thoughts, urges, or images that are intrusive, unwanted, and distressing. Because the manual does not include an explicit ego-dystonicity requirement, its definition risks conflating anxiety-driven intrusions with gratification-driven impulses. This ambiguity carries significant forensic implications. When violent ideation is emotionally gratifying, it may still be described as distressing or unwanted, in a practical sense. In such cases, it may be misclassified as obsessional, potentially mitigating culpability or distorting assessments of intent and risk. Using the cases of William Heirens and Robert Cameron Houston, this article illustrates how DSM language can blur the boundary between true obsessional phenomena, experienced as alien, morally incongruent, and resisted, and ego-syntonic violent ideation that is volitional, reinforcing, and aligned with behavior. Tracing this vulnerability to the DSM's historical shift from psychodynamic to descriptive nosology, the paper argues that diagnostic precision must be grounded in phenomenological meaning rather than in surface description. In forensic contexts, this distinction safeguards determinations of intent, volition, and responsibility. Clarifying that obsessions are, by definition, ego-dystonic would preserve the conceptual integrity of OCD, prevent its misuse in court, and support the ethical and evidentiary coherence of psychiatric testimony.
An urgent need exists to elevate the agenda of family ethics, rooted in family nursing's moral commitment to the well-being of families and society. This paper highlights the practice, research, and educational implications for this agenda. Grounded in relational ethics, this vision calls for a curriculum and practice landscape that reflects the lived realities of diverse families and communities. Clinically, it recommends the creation of interdisciplinary care protocols that embed structured family ethics conversations, drawing on an understanding of family systems. In research, it advocates for expanding studies that examine how familial and cultural values shape moral distress and care outcomes, and for broadening traditional bioethical inquiries to include family-centered perspectives. Educationally, it urges the integration of real-world scenarios, cultural analysis, and emotional intelligence training into classrooms and skills labs. Together, these strategies aim to cultivate ethically grounded, socially responsive nurses equipped to lead transformative changes in family health care.