A younger subjective age is often associated with positive health and well-being outcomes among adults over the age of 65. However, it is possible that those who attempt to look or act younger than their chronological age may face backlash, given that this behavior is in violation of prescriptive stereotypes that serve to maintain hierarchical age group boundaries and mitigate threats to younger people's social and economic resources. The degree to which younger and middle-aged adults perceive violations of prescriptive age stereotypes (i.e., that older adults should act their age) may predict negative evaluations of older adult targets who feel "younger than their years." Across two studies, we examined younger and middle-aged adults' attitudes and evaluations regarding older adult targets who varied by gender and felt age. Perceptions of older targets' counterstereotypical behavior and demeanor mediated the relationship between older targets' younger felt age and participants' ratings of targets' warmth, competence, overall liking, and interaction intentions. Specifically, older targets who felt younger than their chronological age were perceived as violating prescriptive stereotypes, which in turn decreased ratings of targets' warmth, competence, and likeability, and lessened participants' willingness to interact with targets. Consistent with affordance management theoretical approaches, older adults who defy stereotypicality may be appraised as a threat to younger perceivers' goals and, in turn, face backlash. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
According to affect valuation theory (Tsai et al., 2006), culture shapes the emotions people ideally want to feel. In middle-class European-American settings, people usually report that they would ideally like to feel high-arousal positive (HAP) emotions (enthusiastic, excited, and elated). In Asian American and East-Asian settings, people are more likely to report ideally wanting to feel low-arousal positive (LAP) emotions (calm, relaxed, and peaceful). We tested whether popular song lyrics in the United States and Japan reflect these values. We collected the lyrics of the 100 most popular songs from each year between 1968 and 2015 from the United States and Japan (N = 7,464). A natural language processing tool called Contextualized Construct Representation (Chen et al., 2024) estimated HAP and LAP content in each song. Lyrics were higher on ideal than actual positive emotions. U.S. American popular songs scored higher on ideal and actual HAP, and Japanese popular songs scored higher on ideal and actual LAP. Longitudinal analyses showed that both HAP and LAP increased slightly over time in Japan, while HAP declined slightly in the United States. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Patients' access to their electronic health record (EHR) supports their participation and satisfaction with care. Despite the benefits, some patients have been upset after reading their EHR. Additionally, health care professionals are concerned that patients, particularly those with mental health conditions, may be offended, and they have expressed a need for further guidelines on how to write EHRs. Experiences among various patient groups are essential to support the relationship between patients and professionals. However, prior studies have often focused on single patient groups or specific clinical contexts, leaving a limited understanding of differences across multiple patient groups. This study aimed to determine whether certain patient groups are more likely to feel offended while reading their EHRs and which information is perceived as offensive and to provide a comparison across multiple patient groups using a mixed methods approach. A cross-sectional survey was conducted via the Finnish national patient portal using a web-based patient survey, adopting a mixed methods approach. The survey included multiple-choice and open-ended questions. The total sample comprised 4681 respondents. The survey respondents were placed into 4 patient groups: those who had received care for mental health, cancer, or other conditions and those who had received no care. Associations between the type of care and patients who felt offended were estimated using multivariate binary logistic regression. Inductive content analysis (n=502) was conducted to identify information perceived as offensive in the EHR. The patients who had received mental health care (166/654, 25.4%) or cancer and mental health care (9/39, 23.1%) were more likely to be offended by information in their EHR compared to the other groups (cancer care: 37/375, 9.9%; other conditions care: 383/3316, 11.6%; no care: 22/206, 10.7%; other conditions care: odds ratio 0.37, 95% CI 0.29-0.46; P<.001; model A). Additionally, female patients, those with bad or very bad health conditions, and patients with bachelor's or master's degrees were significantly more likely to feel offended. Errors, the health care professionals' disrespectful language, and perceived unnecessary information were the most frequently mentioned reasons for being offended. Patients with mental health care reported more often that unnecessary information and professionals' opinions and word choices were experienced as offensive compared to other patients. This study contributes new knowledge by identifying differences across multiple patient groups. Although a minority of patients felt offended by their EHR, health care professionals should consider that some patients, particularly those who have received mental health care or cancer and mental health care, may be offended by specific information or word choices in their EHRs. To address this, health care professionals should receive education on how to write their notes in a neutral tone and avoid potentially offensive topics. Improving the quality of EHRs could strengthen the relationship between patients and professionals.
Explainable Artificial Intelligence (XAI) has the potential to enhance clinical decision support (CDS) systems however, it remains unclear how XAI systems are perceived by healthcare professionals in hospital settings, and if new challenges arise as a result of explanations. This scoping review aimed to understand healthcare professionals' perceptions of CDS systems with XAI in the hospital setting; specifically, the drivers of acceptance and use, explainability needs, and design preferences. Databases were searched. Studies were included if they reported qualitative findings on health professionals' perceptions of XAI-enabled CDS systems used in hospital settings. MEDLINE, Embase, and Web of Science were searched, and reference lists were screened for additional papers. Study characteristics and health professional perceptions were extracted and inductively coded. A quality assessment was performed using the CASP checklist. Sixteen studies were identified. Included studies primarily focused on ML-based CDS systems for predicting various clinical outcomes. Most studies used feature importance or model agnostic techniques like SHapley Additive exPlanations (SHAP). Overall, healthcare professionals perceived CDS systems with XAI as useful for supporting clinical tasks, decision-making, and teamwork. Acceptance was influenced by integration into workflows, performance, data quality, and alignment with clinical knowledge. Concerns were raised about overreliance and reduced professional autonomy. Health professionals predominantly used explanations to validate outputs, and desired actionable information from systems. SHAP plots and visualizations were difficult to interpret. Participants preferred explanation designs that included concise, high-level information, and simple plots for quick interpretation. Clear visual indicators such as colour coding, contextual patient data, and aggregating similar features also aided interpretation. Poorly designed XAI explanations can hinder understanding and increase cognitive burden in busy clinical settings. Future research should optimise the design and delivery of explanations, so clinicians can appropriately trust in XAI CDS systems and feel confident in their clinical decision making.
Pelvic pain is a common presentation in general practice and can significantly affect women's quality of life. Ensuring that women feel heard and their concerns acted upon is integral to accurate diagnosis and early management in primary care. To explore patient perspectives on the emotional and diagnostic journey of pelvic pain. A survey was distributed to 550 female patients aged >18 at a GP practice in West Bridgford, Nottingham. It explored the physical and emotional impacts of pelvic pain and interactions with healthcare professionals using multiple-choice questions, 10-point Likert scales, and open-ended responses. Quantitative data were analysed descriptively, and qualitative data thematically. Between July and September 2025, 81 responses were received and 45 (55.6%) reported pelvic pain (mean age 41.9 years, range 18-90). Of these, 22 (48.9%) had a diagnosis explaining their symptoms. Pain descriptors frequently reflected physical and emotional trauma ('stabbing', 'agonising', 'crippling'). Average impact scores were high: 7.5 out of 10 for quality of life; 7.9 out of 10 for emotional well-being. Disruptions were reported in physical functioning (20 mentions), work and education (18), and social restrictions (13), alongside relationships, fertility, and mental health. Thirty-eight sought GP advice; 7 did not, citing normalisation of pain and fear of dismissal. Experiences in GP consultations were mixed: some felt validated and supported (15 mentions), others described dismissal or patronisation (20), confusion (8), and frustration (7). Pelvic pain has profound physical, psychological, and social impacts. Patient accounts highlight the need for timely recognition, empathetic listening, and clear communication in primary care.
While many gymgoers do not experience psychological barriers to gym use, some feel anxious and intimidated there in the presence of other users. Qualitative research has suggested gyms can be places of unequal power leading to threats to one's adequacy of self, and privilege certain users based on demographics, masculinity, size, fitness, performance, competence, etc. Social comparison and trait social anxiety have been suggested as contributing to gym anxiety. However, a theoretical approach is needed to provide a coherent explanation of gym anxiety which can inform interventions; there is no current theory in use in the research literature. I argue that gym anxiety is not the same as social physique anxiety (a limited concern about physique evaluation) nor social anxiety (often conceptualized as a mental health "disorder" rather than a response to the norm-laden setting of the gym). I propose that the most suitable theoretical framework to explain gym anxiety is Johnstone and Boyle's Power-Threat-Meaning Framework (PTMF), designed to explain psychological problems or distress. Gym anxiety or intimidation does not represent a disorder or pathology but an understandable response among some users to the power differentials of the gym environment. The PTMF explains how the negative operation of social power, in combination with societal and personal meaning-making, can lead to a perception of subtle threats to one's psychological needs, such as exclusion, invalidation, or rejection; the resulting "symptoms" such as anxiety, shame, hypervigilance, and avoidance are conceptualized as coping strategies called threat responses. By addressing one or more of power imbalances, perception of threat, meaning-making and threat responses, interventions have the potential to make gym anxiety more manageable by addressing some of its root causes, either in individual interventions or at wider group level, including by changes that can be made to specific gym settings.
A national shortage of mental health professionals has shifted much of youth mental and behavioral health care to primary care professionals (PCPs), who often feel underprepared, especially in Kansas, where most counties are designated mental health shortage areas. Project ECHO provides continuing medical education (CME) to strengthen PCPs' ability to manage pediatric mental health conditions. Authors administered a 10-item survey immediately after ECHO sessions from April 2020 to October 2024. A cross-sectional analysis of 512 CME surveys was conducted, and descriptive statistics were used to summarize responses across eight mental health topics. Respondents included physicians (n = 346), APRNs (n = 114), nurses (n = 81), PAs (n = 18), and other professionals (n = 157). Survey counts varied by topic: ADHD (n = 92), Anxiety (n = 65), Autism (n = 28), Depression (n = 59), ID/DD (n = 56), Sleep (n = 86), Suicide (n = 41), and Trauma (n = 85). Across topics, 50-71% of PCPs strongly agreed they learned information that could improve patient outcomes. Many respondents (45-70%) reported no barriers to applying new strategies. When barriers were identified, lack of knowledge was the most common (19-30%), except in suicide sessions, where "other" barriers were cited most frequently (17%). Findings indicate that knowledge gaps remain the primary barrier to implementing pediatric mental health care, underscoring the value of programs such as KSKidsMAP ECHO in improving provider confidence and practice uptake. Participants also reported gaining information they could share with colleagues, suggesting a broader team-level impact.
Humans value communicating information about themselves to others, and exchanges of such information between two individuals are fundamental to social bond formation. Yet, people often keep information private, potentially forfeiting the chance to connect with someone new. In this preregistered functional MRI study, participants who experienced more missed social opportunities in an iterative self-disclosure task-or instances where withholding information was met with an ostensible partner's self-disclosure-tended to feel closer to this partner faster. Missed social opportunities were regrettable and most likely followed by a change in subsequent decisions, making participants switch from withholding to sharing their information. Using conjunction analysis, activities in the medial prefrontal cortex and posterior superior temporal sulcus (pSTS), regions implicated in social-cognitive processes, were greater in response to missed social opportunities than in response to other social interactions (e.g. mutual self-disclosure). Notably, greater pSTS responses to missed social opportunities were linked to a higher likelihood of disclosing to a partner, as well as a higher amount of money willing to be spent to disclose to a partner in a follow-up task, highlighting the role of the pSTS in predicting a sustained interest in the new partner. Our findings elucidate the neurobiological, affective, and behavioral attributes of forgone moments of connection that contribute to interpersonal closeness development. We further identify context-dependent pSTS activities that support closeness-generating behaviors like self-disclosure.
Early Intervention in Psychosis (EIP) services offer up to 3 years' treatment in the community to people who have experienced a first episode of psychosis. Service users (SUs) are then discharged to primary care (the majority) or community mental health teams. There is limited research on SU experiences of discharge from EIP to primary care and the roles of care providers through this transition. Longitudinal, case study approach. Ethics and HRA approvals gained. Semi-structured interviews with SUs shortly after EIP discharge (x16); follow up interviews after 6-11 months (x12). Care providers interviewed with SU consent (x14). 8 SUs formed into case studies - interviews with 1-3 care providers for each.Thematic analysis conducted using principles of constant comparison within and across cases. Patient and public involvement throughout, including contributing to data analysis. SUs discharged to primary care report little to no support in the early post-discharge period and can be reluctant to approach primary care due to lack of relationships and trust.Care providers highlight gaps in communication across SU support networks.We were unable to recruit GPs to the case studies, which may reflect their lack of relationship with EIP SUs. Family carers can play a 'case manager' role, but do not always feel listened to. This study highlights the need for improved collaboration between SUs, carers and healthcare practitioners through transition from EIP. We suggest that there should be a joint consultation between SU, carer, EIP care coordinator and GP at point of discharge.
Contemporary health research often examines patient objectification, patient self-objectification, and good patient performance as separate concerns. Treating them in isolation makes it difficult to see how they combine to shape what patients feel able to express in clinical encounters. To address this gap, this study examines how cancer survivors describe objectification, internalization, and performance within oncology care. Through this analysis, we develop a unified analytic account of these three experiences. In doing so, we reframe the "medical gaze" in existential terms as the "medical look," by drawing on Sartre's account of how becoming visible to another reshapes lived experience and existence. We interpret clinical visibility as a structure that unfolds across encounters, rather than as isolated interactional events. Drawing on 29 interviews with cancer survivors, our findings show that being positioned through clinical routines, adopting those framings as self-measures, and calibrating self-presentation in anticipation of clinical judgment were lived as connected movements within one structure of visibility. Recognizing this continuity clarifies communication pressures and constrained agency in oncology, and identifies points where clinical practice may ease the conditions under which patients manage how they appear.
Professional comportment is widely treated in nursing education and practice as a necessary marker of trustworthiness, maturity and professional identity. Yet comportment is rarely examined as more than a neutral code of appropriate conduct. In this paper, I argue that professional comportment functions as a discipline of seriousness through which nursing regulates credibility, embodiment and belonging. Comportment does not simply guide what nurses should do; it also shapes how nurses should look, sound, feel, and appear in order to be recognised as legitimate. In this sense, it operates as an aesthetic and affective norm as much as an ethical one. Drawing on Camp as a philosophical method, I show that nursing's ideal of seriousness depends on disavowed forms of performance, composure, restraint and respectability. I argue that seriousness is not merely a personal virtue but a socially conferred style of legitimacy that unevenly rewards some forms of embodiment while marking others as excessive, immature or unprofessional. Camp is valuable here not because it rejects care, but because it exposes the artifice of seriousness and creates critical distance from norms that present themselves as natural. Through this lens, professional comportment can be understood as a site where gendered, racialized, classed and heteronormative expectations are reproduced under the language of professionalism. As an illustrative case, I consider nursing memes and online self-stylization as minor but revealing sites where professional seriousness is publicly negotiated. These cultural forms do not simply resist professional norms; they can also reproduce the exclusions they appear to unsettle. I conclude by proposing a plural ethics of professional presence, one that distinguishes ethical obligation from respectability, preserves accountability and care, and loosens the hold of singular, assimilative models of seriousness.
Young migrants encounter heightened challenges as the intersection of their youth and migrant identities magnifies the influence of risk factors for suicide. Social media offers a platform for young migrants to express emotions, seek support and connect with others, often anonymously. However, how they communicate about self-harm and suicide online remains underexplored. This qualitative study involved 17 online interviews with young migrants aged 15-25 years. Transcribed data were coded and thematically explored using Braun and Clarke's reflexive thematic analysis methodology. Four key themes were identified: (1) Exposed and isolated: The emotional toll of viewing self-harm and suicide-related content on young migrants; (2) Connected but at-risk: The dual role of social media in migrant belonging; (3) Digital belonging across borders: Benefits and strains of staying connected; and (4) Helpful and harmful: The dual nature of support on social media. Social media has a complex impact on young migrants, offering both protective and harmful effects. While exposure to distressing or discriminatory content may exacerbate feelings of isolation and disconnection, social media can also promote belonging, cultural understanding and resilience. It also provides accessible support, though poor-quality advice and stigma may deter help-seeking. These insights can inform culturally responsive mental health interventions.
The global population is experiencing rapid aging, and the mental health needs of older adults have become an urgent public health concern, with anxiety levels becoming increasingly prevalent among older adults. In Thailand, stress and anxiety among older adults are anticipated to double in the next decade. Neuroticism, characterized by emotional instability and an impulse for negative feelings, is a significant psychological characteristic associated with anxiety. Older adults with higher neuroticism have heightened sensitivity to stress and frequently struggle with emotional regulation, hence increasing their vulnerability to anxiety and other mental health disorders. Loving-kindness, a core Buddhist principle, has been shown to benefit mental health by reducing stress, anxiety, and depression, primarily in Western or short-term settings. However, there is limited research assessing its role among older adults in Buddhist cultural contexts, such as Thailand. This study investigated whether loving-kindness moderated the relationship between neuroticism and anxiety symptoms among 232 Thai adults aged 60 and above, using secondary data collected between December 2019 and September 2022. Measures included the Neuroticism Inventory, Core Symptom Index for anxiety, and the Inner Strength-Based Inventory for loving-kindness. Multiple regression analysis evaluated potential moderating effects. The results revealed that anxiety had a positive correlation with neuroticism and a negative correlation with loving-kindness and education; nevertheless, an unexpected pattern occurred in the moderation analysis. Loving-kindness specifically enhanced the correlation between neuroticism and anxiety at high levels, rather than mitigating it. Older adults exhibiting higher levels of neuroticism and loving-kindness reported increased anxiety symptoms. Education was identified as a protective factor, exhibiting a negative correlation with anxiety. Loving-kindness did not mitigate the effect of high neuroticism on anxiety in Thai older adults. Rather, it intensified this correlation, indicating that robust prosocial characteristics lacking sufficient emotional regulation may exacerbate stressful emotions. These findings contradict prevailing theories regarding the universal advantages of loving-kindness and underscore the necessity for therapies that incorporate loving-kindness with emotional regulation and self-care in older adults.
The mechanisms underlying the clinical benefit of intravenous iron in patients with heart failure (HF), left ventricular ejection fraction (LVEF) < 50%, and iron deficiency (ID) remain incompletely defined. Clinical evidence suggests that iron repletion may improve ventricular synchrony and augment the response to cardiac resynchronization therapy (CRT). The longitudinal systolic dyssynchrony index (L-SDI), derived from cardiac magnetic resonance feature tracking (CMR-FT), provides a non-invasive measure of mechanical dyssynchrony. This subanalysis of the Myocardial-IRON trial evaluated the short-term effects of ferric carboxymaltose (FCM) on L-SDI and explored its relationship with global left ventricular longitudinal strain (GLS). In this post hoc analysis of the randomized, double-blind, placebo-controlled Myocardial-IRON trial (NCT03398681), 51 of 53 ambulatory patients (96.2%) with stable HF, LVEF < 50%, and ID underwent CMR-FT at baseline, and at 7-day, and 30-days post-FCM. Linear mixed-effects models assessed the effect of FCM versus placebo on L-SDI, including subgroup analyses by baseline QRS duration, and evaluated associations between changes in L-SDI and changes in GLS, T2*, and T1-mapping. Data are presented as mean ± SD or median (IQR), as appropriate. The participants have a mean age of 70.4 ± 9.6 years, with a median CMR-derived LVEF of 38.5% (IQR 33-45); the mean global longitudinal strain is -7.5 ± 3.6%. FCM leads to a greater reduction in L-SDI over time versus placebo (omnibus p = 0.015), with significance at 30 days (Δ=-3.8; 95% CI -6.9 to -0.7; p = 0.011). The benefit is most pronounced in patients with baseline electrical dyssynchrony (interaction p < 0.001). Improvements in L-SDI are strongly associated with GLS gains (p < 0.001) and myocardial iron uptake [T2*changes (p = 0.045) and T1-mapping changes (p = 0.011)]. In HF with LVEF < 50% and ID, FCM improves short-term LV mechanical synchrony, particularly in those with electrical dyssynchrony, and this is linked to enhanced systolic function and greater myocardial iron repletion. Iron deficiency is common in patients with heart failure and makes their condition worse. Although giving iron through an intravenous infusion is known to improve how patients feel and function, we do not fully understand how it benefits the heart itself. In this study, we used a type of heart imaging, cardiac magnetic resonance scans, to determine whether iron treatment improves heart pump coordination and synchronization. We found that patients who received an iron infusion showed clearer improvement in how well their heart muscle worked within 30 days compared with those who received a placebo. The benefit was especially noticeable in patients who already had abnormal heart electrical patterns. These findings suggest that iron treatment helps the heart muscle contract more uniformly, making the heart pump more efficiently and helping to explain why this therapy improves the health of people with heart failure.
Advanced practice registered nurses often feel unprepared for end-of-life (EOL) care due to gaps in training. This study assessed the impact of an EOL simulation on the attitudes and preparedness of 83 students who completed pre- and post-simulation surveys. Results showed significant improvement in post-simulation scores, suggesting that simulation is effective in enhancing attitudes and comfort with EOL care. The findings support integrating simulation into nursing curricula to close educational gaps and foster readiness.
Adolescent emotional issues have gained increasing global attention. The connection between Adverse Childhood Experiences (ACEs) and emotional issues in adolescents is well-established. However, the specific psychological pathways that explain this link are not yet fully understood. Our study aims to clarify the link between ACEs and depressive/anxious symptoms in a large Chinese adolescent cohort. We conducted a cross-sectional analysis with 7,158 students from Shandong Province, China, using a stratified cluster sampling method. Participants completed a series of self-report scales: the Adverse Childhood Experiences Scale (ACE-R), the Perceived Stress Scale (PSS-10), the Self-hate Scale (SHS), and the Patient Health Questionnaire-4 (PHQ-4). To test our chain mediation hypothesis, we used correlation analyses and a bootstrap approach. Female adolescents and those with poorer academic performance had higher scores on childhood adverse experiences, perceived stress, self-hate, and emotional symptoms (p < 0.05). High school students scored higher than middle school students in terms of childhood adverse experiences and self-hate (p < 0.05). Only children had higher scores on childhood adverse experiences compared to non-only children (p < 0.05). Perceived stress and self-hate serve as chain mediators in the relationship between childhood adverse experiences and depressive-anxiety symptoms in adolescents. This study expands the research on the relationship between adverse childhood experiences and depressive and anxious emotions in adolescence, providing new insights for reducing the negative impacts of depressive and anxious emotions in adolescents and promoting their mental health.
Infant temperamental negative affect (NA) poses transdiagnostic risk for psychopathology. Risk often operates indirectly through caregiving, as high NA infants tend to elicit intrusive parental responses. The present study examined whether maternal mind-mindedness (MM), moderates the longitudinal indirect pathway from infant NA, through concurrent maternal intrusive behavior, to child internalizing/externalizing symptoms at 5.5 years. Eighty-eight mother-infant dyads participated (55.7% male, all White, 70.2% middle-high socioeconomic status). Infant NA, maternal intrusiveness, and representational and interactional measures of MM were observed at 4 months. Mothers reported child symptoms at 5.5 years. Representational MM moderated the indirect pathway from infant NA to child symptoms through maternal intrusiveness. At low MM, infant-NA was significantly associated with increased maternal intrusiveness and subsequent risk for externalizing symptoms. At high MM, infant-NA was significantly associated with lower maternal intrusiveness and subsequent reduced externalizing symptoms, thereby creating a developmental advantage for high-NA infants relative to their low-NA counterparts. Findings underscore maternal representational MM as a protective buffer against NA-related risk. Methodological considerations are discussed regarding the employment of interactional versus representational measures of MM. Clinical implications of MM are discussed as a promising target for early interventions, particularly in the context of high-NA infants.
The participation rate of prenatal healthcare in China has increased slowly, and the imbalances and inadequacies in the development of maternal and child health between urban and rural areas are particularly prominent. A key reason for this is that a comprehensive understanding of rural women's utilization of prenatal healthcare services and their needs has not been fully established, thus failing to fully leverage pregnant women's agency in prenatal healthcare. The study aimed to identify the multi-dimensional needs of rural women in the process of utilizing prenatal healthcare services through constructing a journey map, so as to optimize the full pregnancy cycle management of this group. The study population consists of rural pregnant women who attended obstetric clinics at healthcare institutions in Northeast China from January to May 2024. A qualitative multi-method design was adopted, integrating non-structured field observation and descriptive phenomenological qualitative interviews to comprehensively gather rural women's emotions, perceptions, experiences, and needs regarding prenatal care services. Field observation provided contextual, behavioral, and environmental insights into service delivery processes and stakeholder interactions, while qualitative interviews delved deeply into the subjective lived experiences, emotional responses, and contextual factors shaping care utilization. The collected data were systematically analyzed and synthesized to construct a detailed journey map that delineates the sequential stages of prenatal care, key touchpoints, behavioral patterns, needs, pain points, and opportunities for improvement. Ethical approval was obtained from the Ethics Committee of Harbin Medical University, Daqing, No. HMUDQ20230330001. The journey comprises five phases. The first stage marks the initiation of prenatal care services. Pregnant women are often unfamiliar with the procedures and have various concerns and anxieties about their upcoming pregnancy journey. In the second stage, pregnant women begin participating in non-invasive prenatal screening and start focusing on long-term nutrition and gestational weight management. In the third stage, maternal-fetal interaction increases, and ultrasound screenings for congenital anomalies become a critical task. Lifestyle changes and management pose significant challenges during this period. The fourth stage emphasizes proactive prevention and screening for pregnancy-related complications. Guiding pregnant women in self-monitoring is essential, and their needs for postpartum care for both mother and baby gradually increases. In the fifth stage, pregnant women frequently engage with prenatal care services, experiencing both anticipation and anxiety as they prepare for delivery. This exploratory qualitative multi-method study conducted in rural Northeast China developed a five-stage journey map of prenatal healthcare service utilization. The findings are context-specific to rural Northeast China and do not imply broad generalizability; they highlight key optimization points for prenatal care management for rural pregnant women in similar regional settings.
In attachment-based family therapy (ABFT), shifting the treatment goal from the adolescent as the problem to strengthening family relationships as the solution is the critical first task. No research has explored whether this "relational reframe" works, how it works, and for whom it works. We evaluated the relational reframe for 47 families receiving ABFT for depressed and suicidal adolescents. We coded markers to identify the reframing and contracting phases of the reframe intervention. We coded two key process elements: content and affect. We evaluated whether the degree to which family members discussed the themes of the reframe phase (relational ruptures and softer emotions) were associated with acceptance of the contracting goal. We explored if attachment style and self-reported parental depression and adolescent-reported family conflict were associated with accepting the contract for a relational focused therapy. Markers for the beginning of the reframe and contracting phase could be reliably identified. The degree to which adolescents and parents engaged in discussion about the reframe themes was associated with parents' acceptance of the contracting goal. Adolescents' dismissive attachment style was not associated with engagement in the reframe themes, but was associated with adolescents' reduced acceptance of the contract goal. Adolescents' preoccupied attachment style was associated with greater engagement in the reframing themes, but not associated with acceptance of the contract goals. Parental depression and adolescent- reported family conflict were not linked with acceptance of the relational reframe. This study should help therapist understand specific strategies for creating a relational repair frame for therapy and encourage researchers to study the subtle processes involved in effective therapy.
To investigate the relationships between anxiety, depression, and insomnia and tinnitus severity among high-functioning employed adults, stratified by age and gender, and to describe age- and gender-specific patterns of prevalence and symptom burden in order to support a biopsychosocial framework for understanding tinnitus onset, progression, and clinical management. An analysis was performed on data from 745 patients with chronic subjective tinnitus, aged 25-60 years, to assess levels of anxiety (HADS-A), depression (HADS-D), insomnia (ISI), and the perceived severity of tinnitus (THI and VAS). The findings showed that anxiety was significantly correlated with the tinnitus Handicap Inventory in younger patients, particularly in men (r = 0.611, p  < 0.001) and women (r = 0.577, p  < 0.001) aged 25-40 years. In women aged 51-60 years, depression demonstrated the strongest association with tinnitus (r = 0.545, p  < 0.001). In the overall cohort, insomnia exhibited a weak but statistically significant correlation with tinnitus (r ≤ 0.3). Additionally, women were more likely to link tinnitus loudness to reduced quality of life, especially in the 25-40 (r = 0.722, p  < 0.01) and 51-60 (r = 0.689, p  < 0.01) age groups. The findings indicate that anxiety in younger patients is closely related to tinnitus, whereas depressive symptoms are more prominent among middle-aged and older women. These variations indicate that patients with tinnitus may present different psychological profiles across gender and age groups. Future research may further explore the underlying pathophysiological mechanisms of tinnitus and examine its progression through long-term follow-up to improve understanding of its clinical heterogeneity.