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The present study aimed at the early detection of Polish teacher education students vulnerable to burnout and occupational health issues, using the work-related coping behavior and experience patterns (Arbeitsbezogenes Verhaltens- und Erlebensmuster - AVEM) diagnostic inventory to identify risk work-related patterns (the excessively ambitious pattern A and the resigned pattern B). Participants were 431 full-time first-year teacher education students enrolled at various higher education institutions in Poland. They completed a survey including the AVEM inventory, the Motivation for Choosing Teacher Education Questionnaire, the intrinsic religiosity subscale of the Duke University Religion Index, and the revised Life Orientation Test. The predictive values of background variables, attitudes toward teaching and teacher education, career choice motivation, intrinsic religiosity, and dispositional optimism for assignment to the work-related patterns were examined using multinomial logistic regression, with the healthy ambitious pattern G serving as the reference group. A total of 59.63% of participants were assigned to risk patterns indicating increased vulnerability to burnout and occupational health issues. Older students were less likely to be assigned to pattern A (b = -1.28, p < 0.05), whereas those working longer hours alongside their studies were more likely to be assigned to pattern A (b = 1.09, p < 0.05). Students who identified teacher education as their most preferred study choice (b = -6.58, p < 0.05) were less likely to be assigned to pattern B, as were those who chose teacher education based on ability belief (b = -1.61, p < 0.05). Higher levels of optimism protected against both pattern A (b = -3.99, p < 0.001) and pattern B (b = -4.71, p < 0.001). It is necessary to implement preventive measures to reduce long-term health risks in future teachers. However, the results should be interpreted with caution due to study limitations, such as the use of purposive sampling. Med Pr Work Health Saf. 2026;77(2):119-136.
Academic plastic surgery continues to face challenges in recruiting and retaining faculty. Although prior studies have reported rising faculty attrition, updated national data in academic plastic surgery reflecting recent workforce and institutional changes are lacking. A 29-item electronic survey was distributed in March to April of 2025 to chairs and chiefs of Accreditation Council for Graduate Medical Education-accredited plastic surgery programs. The survey assessed trends during the past decade in faculty hiring, resignation, compensation, mentorship, benefits, and retention strategies. Thirty-five programs (43.8% response rate) were included. Faculty recruitment was concentrated at the assistant professor level, with an average of 1.7, 4.3, and 6.5 faculty added during the past 1, 5, and 10 years, respectively. Concurrently, faculty losses averaged 0.4, 2.2, and 3.0, with turnover rates of 4.2%, 29.1%, and 38.9% during the past 1, 5, and 10 years, respectively. Retention rates declined over time, from 95.8% at 1 year to 61.1% at 10 years, with only 8.6% of programs having a formal retention committee. Family considerations (54.3%) and inadequate compensation (34.3%) were the most cited reasons for faculty departure. Reported retention strategies included competitive compensation packages (80.0%), professional development initiatives (74.3%), mentorship programs (65.7%), and work-life balance accommodations (45.7%), awards and recognition (37.1%), and flexible scheduling (28.6%). Despite continued faculty growth, long-term retention remains a significant challenge in academic plastic surgery. Compensation alone does not seem sufficient to ensure faculty longevity. Broader institutional strategies, including formal retention committee creation, are needed to sustain faculty engagement and ensure workforce stability in the decade ahead.
Cancer screening (CS) is a core element of preventive care. While international studies highlight that individuals with migration backgrounds often show varied participation in CS, there is a lack of specific evidence regarding first-generation migrants from Middle Eastern countries in Germany. This study aims to bridge that gap by examining CS participation patterns within this group and exploring how individual, social, and structural factors influence these patterns. The focus on Middle Eastern migrants is particularly important due to recent shifts in migration trends, which have led to an increase in the number of individuals from this region relocating to Germany. We conducted a qualitative, triangulated study with two datasets: interviews with laypersons (LPs; n = 18) who are first-generation migrants, and interviews with healthcare professionals (HCPs; n = 17) (first or second generation) across disciplines related to CS; all with ties to Middle East countries. LPs were recruited and interviewed by community researchers; HCPs via physician registries and by academic researchers. Interviews were carried out online or in person, recorded, translated, and transcribed. Analysis followed qualitative content analysis within a socioecological framework. A typology of participation patterns was developed from LP interviews and contextualised with HCP accounts. CS participation was shaped by interdependent influences across individual, social, and structural levels, including knowledge and perceptions of prevention, language skills and available interpretation services, family roles, network support, organisational procedures, and experiences in care encounters. Comparative analysis of LP and HCP material identified convergences and divergences in how conditions for participation are perceived and navigated. Based on these dynamics, we identified four participation patterns: prevention-oriented, situational, withdrawn/resigned, and marginalised. Participation among first-generation migrants from Middle East countries is best understood as patterned engagement shaped by intersecting conditions. The typology makes these patterns visible and provides an analytic basis for context-sensitive health promotion. Practically, the study underscores the value of participatory, multilingual approaches in research and the importance of organisational health literacy and communicative and structural competence to support equitable access to preventive services. The online version contains supplementary material available at 10.1186/s12939-026-02843-w.
This study uses latent profile analysis to explore the latent characteristics of body image and emotional response in postoperative breast cancer patients and its influencing factors. From November 2023 to April 2024, a convenience sampling method was used to select 338 postoperative breast cancer patients for the study. A general information section, Chinese version of the Body Image and Relationships Scale, Positive and Negative Affect Scale, Impact on Participation and Autonomy, Social Support Rating Scale, and Medical Coping Mode Questionnaire were used to conduct the survey. Conducted latent profile analysis of body image and emotional response characteristics of postoperative breast cancer patients identified the influencing factors of their latent profiles through univariate and multivariate logistic stepwise regression analyses and combined with back propagation neural network. Three latent categories were identified: mild body image concerns with emotion stability group (37.8%), social-physical distress with emotion containment group (51.8%), and pronounced appearance-social barriers and affect ambivalence group (10.4%). The results of multivariate logistic stepwise regression and BPNN (AUC: 0.743-0.923) showed that the factors influencing the body image and emotional response patterns of postoperative breast cancer patients were, in descending order of importance: confrontation, resignation, social participation, social support, and chemotherapy. Most postoperative breast cancer patients belonged to the social-physical distress with emotion containment group. Clinical staff should focus on the patients in the pronounced appearance-social barriers and affect ambivalence group, strengthening the core coping patterns of "Confrontation" and "Resignation".
Stigma is one of the most important factors affecting the quality of life (QOL) of syphilis patients. Our study aimed to assess QOL in syphilis patients through a cross-sectional study design and examine the mediating role of coping strategies in the relationship between stigma and QOL. A survey using the sociodemographic questionnaire, the Social Impact Scale, the Medical Coping Modes Scale, and the Dermatology Life Quality Index was administered to 365 syphilis patients. Structural equation modeling (SEM) was used to assess the relationship between coping strategies, stigma, and QOL. The QOL was correlated with stigma and coping strategies. Stigma score was positively correlated with QOL score (r = 0.613, P < 0.01). The score of confrontation coping was negatively correlated with QOL score (r =  - 0.367, P < 0.01), while the score of resignation and avoidance coping were positively correlated with QOL score (r = 0.385, r = 0.290, P < 0.01). Our study revealed that coping strategy can significantly mediate the effects of stigma on the QOL of syphilis patients, with resignation being the strongest mediator (41.25%), followed by confrontation (29.85%) and avoidance (20.85%). The findings suggest that adaptive coping mitigates stigma's harm, whereas resignation exacerbates it. Healthcare providers should address stigma and promote effective coping strategies to improve QOL.
To investigate long-term outcomes of individuals at risk of or who developed resignation syndrome (RS) in childhood and who received residence permits in Sweden. We followed individuals born 1988–2002, living in Stockholm, in healthcare registers until December 2016 (N = 5,226). The exposed group was defined as exhibiting potential symptoms of RS of varying severity in childhood (n = 107), and compared with their siblings, refugees, unaccompanied migrants, individuals who received child and adolescent mental health services (CAMHS) without RS, and Swedish-born individuals with Swedish-born parents. We estimated the cumulative incidence of psychiatric diagnoses until age 18. Outcomes included psychiatric care utilization, prescribed/purchased psychotropic medication in adulthood, and education attainment. We estimated crude and adjusted hazard ratios (aHR) using Cox proportional hazards models and crude and adjusted odds ratios using multivariable logistic regression models, with 95% confidence intervals, and adjusted for socioeconomic factors. The exposed group not only had the risk of RS or developed RS in childhood but a large share was also diagnosed with anxiety/PTSD, depression, eating disorders and attempted suicide. At follow-up, psychiatric care utilization and psychotropic medication prescription rates did not differ significantly between the exposed group (as the reference) and Swedish-born individuals with Swedish-born parents, nor among refugees or unaccompanied migrants. Individuals who received CAMHS without RS, had a significantly higher risk of having been prescribed medication (aHR 2.41; CI:1.51, 3.83) and using outpatient psychiatric care (aHR 1.78; CI:1.15, 2.75). Siblings of the exposed group had a significantly lower risk of using outpatient psychiatric care (aHR 0.28; CI:0.12, 0.67). The exposed group was similar to all the comparison groups with regards to having finished high school at age 22 except for unaccompanied migrants and the sibling group who had a significantly lower odds of the outcome. In a sensitivity analysis including only individuals with fully developed RS symptoms (n = 53), other comparison groups had lower relative risks of using outpatient psychiatric care compared with individuals with fully developed RS symptoms (the reference group), including the Swedish-born general population group (aHR 0.57; CI:0.35, 0.93), refugees (aHR 0.43; CI: 0.26, 0.72) and unaccompanied migrants (aHR 0.54; CI: 0.33, 0.86) but people who used CAMHS during childhood had no difference in relative risk. Despite severe baseline morbidity, individuals at risk of or who developed RS did not altogether exhibit an increased risk of psychiatric care during follow-up and attained an educational level on par with individuals who had received CAMHS. However, individuals with fully developed RS symptoms had a higher risk of psychiatric care utilization compared to Swedish-born children with Swedish-born parents. As the findings reflect a heterogeneous group of children assessed to be at varying risks of developing RS rather than only confirmed, fully developed RS cases, further research on long-term outcomes of RS is needed particularly in larger, representative samples of RS cases including those not granted residency permits in Sweden. Not applicable. The online version contains supplementary material available at 10.1186/s12888-026-07830-7.
To explore the experiences of female physiotherapists facing workplace violence. A descriptive phenomenological approach. Twenty-two Spanish female physiotherapists from both public and private practice settings were recruited using purposive and snowball sampling. Data were collected through individualized semi-structured interviews. Interviews averaged 40 minutes, were audio-recorded, transcribed verbatim in Spanish, and analysed. Thematic analysis was used for data analysis with ATLAS.ti computer software. Four main themes were identified: (1) characterizing workplace violence against physiotherapists, which includes physical and verbal aggression, as well as sexual harassment, primarily perpetrated by patients, their relatives, and occasionally superiors; (2) socialization and reporting of workplace violence, where participants often refrained from sharing or reporting incidents due to shame, fear of retaliation, or perceived impunity; (3) coping styles and consequences of workplace violence, which ranged from minimisation and emotional distancing to significant psychological distress, professional devaluation, and, in some cases, resignation; and (4) prevention of workplace violence, highlighting the importance of setting clear boundaries, developing protocols, improving workplace safety measures, and providing training on violence prevention and labour rights. Physiotherapists experience physical, verbal, and sexual violence, mainly from patients and their relatives, causing significant emotional impact. Underreporting is driven by fear of retaliation and perceived impunity. Preventive strategies, training on violent behaviour, workplace protocols, and improved policies are essential to ensure their safety and protection. CONTRIBUTION OF PAPER.
Student nurses' clinical placements are essential in shaping their competencies and professional identity. However, hostile or unsupportive clinical environments may hinder learning. This study explored the experiences of ostracism among student nurses during clinical placements in Ghanaian hospitals. Semi-structured, in-depth interviews were conducted on 18 participants between March and May 2025 with student nurses following their clinical placements in Ghanaian hospitals. The interview guide was explicitly structured around Williams' Temporal Need-Threat Model of Ostracism, ensuring alignment with its core constructs and stages. Data analysis followed Braun and Clarke's six-phase thematic analysis and was conducted within a deductive framework, in which coding and theme development were guided by the model's predefined categories. This theory-driven approach enabled systematic examination of participants' experiences in relation to the reflexive, reflective, and resignation stages of ostracism, as well as the associated threats to belonging, self-esteem, control, and meaningful existence. Participants (N = 18) described four key exclusionary behaviours by professional nurse's impact students' confidence, learning, and motivation. These included emotional isolation, professional gatekeeping, perceived devaluation, and coping strategies. The study highlighted the need for collaborative educational cultures in clinical settings and recommends structured mentorship, staff orientation, and feedback mechanisms to promote inclusive learning environments. Not applicable.
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Nepal is experiencing increasing need for palliative care through the rising prevalence of non-communicable disease and an aging population. Most people live in rural areas where access to healthcare is limited. This study explores experiences of suffering and health seeking behaviour amongst people with palliative care needs (PWPCN) and their unpaid family caregivers in rural Nepal. A constructivist multiple case study design was employed across four rural municipalities (cases) in two districts. Cases included communities of varied ethnicity and human development indices served by a community hospital and village health posts. A house-to-house survey using the Supportive and Palliative Care Indicators Tool for Low Income Settings (SPICT-LIS) identified PWPCN. Following completion of a structured questionnaire, a purposive sample of PWPCN was constructed (unit of analysis). They, their carers and key informants completed semi structured interviews. Quantitative data were analysed using descriptive statistics and qualitative data were analysed thematically both within and across case. Among 587 households surveyed, 58 PWPCN were identified. 20 units of analysis were formed with interviews from 17 PWPCN and 17 caregivers and 16 key informants. None of the PWPCN had access to palliative care services. Three themes emerged: (1) Everyone suffers: reflecting high levels of physical, emotional, spiritual and social pain. (2) Paying for healthcare: high out-of-pocket expenditure, debt, and financial vulnerability mitigated partially for some by health insurance. (3) Decision-making - no right answer: exposed difficulties choosing between limited local services and distant, costly tertiary care. Decisions were affected by distance to and location of health facility (particularly those offering health insurance), transportation, cost/family resources, and a strong belief that “better care is found in the city.” Bypassing nearby facilities for distant tertiary hospitals was common. High level of suffering and unmet need led to a feeling of lack of control. Older people particularly did not access health care because of cost and were resigned to their fate. PWPCN in rural Nepal endure substantial suffering through unmet holistic needs and limited access to appropriate care. Financial hardship, geographical barriers, and perceived low-quality local services drive people toward distant facilities thus increasing costs. The online version contains supplementary material available at 10.1186/s12904-026-02055-7.
Mobile apps not only offer numerous benefits but also entail the risk of sharing sensitive data with third parties. This research addresses which factors shape privacy trade-offs among young adults and adults when downloading apps. The investigation involved two experimental vignette studies: In Study 1 (N = 500, 79.6% women), we examined young adults, mostly university students, aged 16-29 years to assess if low and high privacy-ratings for apps recommended by friends or a social media platform and offering relevant developmental opportunities affect the probability of downloading them. In Study 2 (N = 148, 70.9% women), we examined users aged 18-69 years to assess if low and high privacy-rated apps recommended by friends or found when browsing online, age-related differences, and privacy resignation affect the probability of sharing data with them. In both studies, we found that participants considered privacy ratings when deciding whether to download or share data with an app. While Study 1 found no differences for apps offering relevant developmental opportunities, both studies show a higher reported probability of downloading and sharing data with apps when these were recommended by friends compared to the control conditions (social media platform; browsing). Additionally, Study 2 demonstrated that participants under 29 years of age and with higher levels of resignation exhibited a higher probability of sharing data. These findings highlight that privacy ratings can support privacy decisions at the app download stage, but also emphasize the need for future interventions, especially for younger and resigned users.
Evidence suggests that positive emotions play a critical role in coping with chronic stress. However, the specific psychological mechanisms underlying the association between positive emotions and chronic stress in lung cancer patients undergoing immunotherapy remain unclear. This study aims to examine the mediating roles of perceived life threat and coping strategies in the relationship between positive emotions and chronic stress, based on the Revised Stress and Coping model. This cross-sectional study included 322 lung cancer patients receiving immunotherapy. Positive emotions, perceived life threat, coping strategies, and chronic stress levels were assessed using the Positive Affect Scale, the Perceived Life Threat Scale, the Cancer Coping Modes Questionnaire, and the Perceived Stress Scale, respectively. Path analysis was conducted utilizing the PROCESS macro (Model 6) to explore the indirect associations among these variables. Positive emotions had a significant negative correlation with chronic stress. Path analyses indicated that positive emotions were indirectly associated with chronic stress through perceived life threat and coping strategies. Significant sequential indirect associations were observed via perceived life threat and specific coping strategies: avoidance and repression (indirect effect = -0.038, 95% CI [-0.059, -0.020]), resignation (indirect effect = -0.041, 95% CI [-0.073, -0.018]), and catharsis coping strategies (indirect effect = -0.026, 95% CI [-0.044, -0.010]). Perceived life threat and coping strategies were statistically associated with how positive emotions relate to chronic stress in lung cancer patients undergoing immunotherapy. These findings align with theoretical models and may inform potential intervention targets to support clinical nursing practice.
Adolescence is a formative period in which self-concept and sexual identity are developed. Unintended teenage pregnancies represent a sensitive and stigmatized issue, often associated with major psychosocial challenges. The aim of this study is to explore the lived experiences of women with unintended teenage pregnancies in Germany, with a particular focus on adverse childhood experiences (ACE) and Teen Dating Violence (TDV). The analysis is based on five biographical narrative interviews conducted within the ELSA project (November 2020-April 2024), which aimed to investigate how unintended pregnancies are managed and to identify needs for counseling and care. Using the documentary method, we reconstructed the meaning of communicative and conjunctive knowledge in adolescents' narratives and compared these orientations across four comparative dimensions: childhood biography, handling of the unintended pregnancy, construction of intimate relationships, and construction of minority. Two contrasting orientation types were reconstructed across the dimensions, shaped by how adolescents processed external framings. Type 1 (subordinated, resigned orientation) was characterized by communicative deficit narratives and conjunctive patterns of resignation, dependency, and restricted agency. Type 2 (reflexive, pro-active orientation) demonstrated communicative acknowledgment of burdens but conjunctive practices of resilience, negotiation, and self-assertion. Unintended pregnancies were frequently constructed as existential crises, in which personal needs and emotions were suppressed. Minority status intensifies these challenges, while ACE -related patterns of behavior were reproduced in the context of pregnancy and intimate relationships. The study provides valuable insights into the complex realities and decision-making processes of female adolescents with unintended pregnancies. The findings highlight the need for specific support services that strengthen girls' empowerment and agency in order to promote sexual and reproductive health and rights. Outdated role models that ascribe contraceptive responsibility solely to women should be replaced by gender-equitable sexual education. In addition, legal regulations and counseling services should be better aligned with the often precarious family and partnership situations of young pregnant women. The teenage years are an important time for young people to develop their identity and sexuality. Becoming pregnant at this age is often unintended and can be a sensitive and stigmatizing experience. It usually comes with major challenges. This study looks at how teenagers in Germany experience unintended pregnancies, especially when they have faced difficult experiences in childhood (known as Adverse Childhood Experiences, ACE) or violence in relationships (Teen Dating Violence, TDV). Interviews were analyzed with five young women who experienced an unintended pregnancy as teenagers. These interviews were conducted as part of a larger research project called ELSA, which ran between 2020 and 2024. The study shows that there are two main ways in which teenage girls deal with unintended pregnancy: 1. The subordinated, resigned type (basic type): These young women often feel powerless, controlled by their environment, and limited in their ability to act. 2. The reflexive, pro-active type (maximum contrast): These young women are able to reflect on their situation, make their own decisions, and act more independently. The findings also show that traumatic childhood experiences strongly how teenagers cope with pregnancy and how they experience their relationships. The study highlights the need for specialized support services for teenagers with unintended pregnancies. Such services should strengthen self-determination and agency, replace outdated role models with fairer and more gender-equitable sex education, and ensure that legal regulations and counseling take into account the often difficult family and partnership siuatons of young pregnant women. Die Adoleszenz ist eine prägende Lebensphase, in der das eigene Selbstverständnis und die sexuelle Identität entwickelt werden. Ungewollte Schwangerschaften im Jugendalter sind ein sensibles und stigmatisiertes Thema, das häufig mit erheblichen psychosozialen Herausforderungen verbunden ist. Ziel dieser Studie ist es, die Erlebenswelt junger Frauen mit ungewollten Teenagerschwangerschaften in Deutschland zu untersuchen, mit besonderem Fokus auf Adverse Childhood Experiences (ACE) und Teen Dating Violence (TDV). Die Analyse basiert auf fünf biografisch-narrativen Interviews die im Rahmen des ELSA-Projekts (November 2020–April 2024) durchgeführt wurden. Das Projekt zielte darauf ab, Einblicke in den Umgang mit ungewollten Schwangerschaften zu gewinnen und Beratungs- und Versorgungsbedarfe abzuleiten. Mittels der dokumentarischen Methode wurde eine sinngenetische Rekonstruktion kommunikativer und konjunktiver Erfahrungen verfolgt, die auf Basis von vier Vergleichsdimensionen kontrastiert wurden: Kindheitsbiografie, Umgang mit der ungewollten Schwangerschaft, Konstruktion der Paarbeziehung und Konstruktion von Minderjährigkeit. Die Analyse zeigt, dass sich über die verschiedenen Vergleichsdimensionen hinweg konsistente handlungsleitende Orientierungen rekonstruieren lassen,. Diese sind durch den Umgang mit Fremdrahmungen geprägt, die entscheidend für die Handlungsfähigkeit und Selbstbestimmung der Jugendlichen sind. Rekonstruiert wurden zwei kontrastive Typen: ein subordinierter, resignierter Typ, der durch Fremdbestimmung und eingeschränkte Handlungsfähigkeit gekennzeichnet ist, sowie ein reflexiver, pro-aktiver Typ, der trotz äußerer Begrenzungen Handlungsoptionen entwickelt und Selbstbestimmung wahrt. Ungewollte Schwangerschaften werden häufig als existentielle Krisen konstruiert, in denen persönliche Bedürfnisse und Emotionen ignoriert oder zurückgestellt werden. Minderjährigkeit verschärft diese Herausforderungen zusätzlich. Die Ergebnisse verdeutlichen, wie traumatische Kindheitserfahrungen (ACE) zu habitualisierten Handlungsmustern werden und wie sich diese Muster im Kontext der Schwangerschaft und in Paarbeziehungen reproduzieren. Die Studie liefert wertvolle Einblicke in die komplexen Lebensrealitäten und Entscheidungsprozesse jugendlicher Frauen mit ungewollten Schwangerschaften. Sie unterstreicht die Notwendigkeit spezifischer Unterstützungsangebote, die die Selbstbestimmung und Handlungsfähigkeit der Betroffenen stärken, um die sexuelle und reproduktive Gesundheit und Rechte zu fördern. Veraltete Rollenbilder, die die Verhütungsverantwortung ausschließlich Frauen zuschreiben, sollten durch eine geschlechtergerechte Sexualaufklärung ersetzt werden. Zudem sollten gesetzliche Regelungen sowie Beratungs- und Versorgungsangebote stärker auf die oftmals prekären familiären oder partnerschaftlichen Konstellationen jugendlicher Schwangerer abgestimmt werden.
First responders are at high risk of posttraumatic stress disorder (PTSD), yet little research has examined PTSD prevalence within this population after individuals retire or resign from service. The current study is the first systematic review and meta-analysis aiming to describe the evidence available on point and lifetime PTSD prevalence among former first responders, estimate pooled PTSD prevalence, and examine differences between subgroups. Searches were conducted across the PsycInfo, Web of Science, Embase, PubMed, and Google Scholar databases in November 2025. Peer reviewed observational studies were included. Separate random effects meta-analyses were run on point PTSD prevalence among studies assessing PTSD related to any (general) exposures and PTSD related to single disasters. A total of 10 studies (12 unique samples) were included in the analyses. Studies were exclusively conducted within high-income, English-speaking countries among nonvolunteer former first responders and predominantly focused on firefighter and police samples. A pooled point PTSD prevalence of 15.4% was found among eight general exposure studies, and a pooled prevalence of 11.8% was found among two single-disaster exposure studies. No subgroup differences were significant, although these analyses were constrained by the restricted pool of available studies. Insufficient data were obtained to examine lifetime PTSD prevalence. The limited attention this population has received in the literature does not reflect their high level of need. Former first responders constitute a high priority for further research and mental health intervention, particularly given their loss of access to systems, services, and social support available to them through their prior roles.
Young adult patients with cancer are particularly vulnerable to psychological distress due to various unique developmental challenges. This study explored the network structure of psychological distress and its interconnections with associated factors with the aim of further ascertaining targets for precise prevention and control of psychological distress. This is a descriptive, cross-sectional study. Eight questionnaires were distributed to capture demographics, anxiety, depression, social support, illness perception, cancer coping strategies and psychological distress among participants. Multivariate linear regression analysis was used to investigate the main factors influencing psychological distress. Network analysis was further used to visualize the network model and to calculate the centrality indexes, network stability and accuracy. A total of 924 young adult patients with cancer (59.2% male; 48.4% aged 31-40 years) participated in this study. Significant factors for psychological distress were consequences, symptom identity, emotional representation, avoidance and suppression, resignation, fantasy, catharsis, severity of anxiety and severity of depression. The emotion domain of psychological distress was the most central factor in the network model, with the highest strength, betweenness, and expected influence. Anxiety exhibited the highest closeness, while depression had the highest bridge expected influence. Psychological distress is a complex system in which emotions, anxiety, and depression play distinct and critical roles. To effectively alleviate overall distress, clinical interventions should prioritize emotion regulation, target the central influence of anxiety, and disrupt the bridging role of depression.
Maternal guilt is a common emotional experience among working mothers, often associated with challenges in fulfilling both professional and caregiving roles. Female nurses, especially those working in intensive care units (ICUs), encounter pressures due to heavy workloads, irregular schedules, and the emotional intensity of patient care. These conditions make them particularly vulnerable to feelings of guilt when family responsibilities are perceived as being neglected. This study aimed to explore how maternal guilt is experienced in the personal and professional lives of female ICU nurses in South Kalimantan, Indonesia. A qualitative descriptive design using thematic analysis within a constructivist paradigm was employed. Ten married female ICU nurses who were mothers and had at least five years of ICU experience were purposively recruited through nurse managers from three regional public hospitals. Data were collected through in-depth semi-structured interviews, with member checking and researcher triangulation used to enhance credibility. Interviews were conducted between March and June 2024, transcribed, translated, and analyzed following Braun and Clarke's six-phase framework. Three themes were identified: (1) the internal burden of perceived inadequacy, reflected in persistent feelings of inadequacy, emotional exhaustion, cognitive overload, anxiety and sadness, and self-blame; (2) relational strain and compensatory parenting, including disrupted parent-child bonding, compensatory parenting behaviors, and increased emotional dependence on spouses; and (3) professional strain and competing care responsibilities, characterized by reduced work focus and distraction, fatigue and thoughts of resignation, and role conflict between professional and maternal responsibilities. These findings indicate that maternal guilt emerged as a multidimensional experience permeating both personal and professional domains. Maternal guilt emerged as a salient experience shaping nurse mothers' emotional well-being, family relationships, and professional functioning. The findings suggest that collectivist cultural expectations and idealized motherhood norms may contribute to shaping the experience of guilt among Indonesian ICU nurses. These insights underscore the need for supportive workplace policies, flexible scheduling, and accessible psychosocial services to sustain nurses' well-being and retention in high-demand clinical environments.
The availability of assistive surgical personnel plays a crucial role in optimizing patient outcomes and operational efficiency. In March 2024, South Korea experienced a significant shift in surgical practices due to a nationwide trainee strike, necessitating single-surgeon procedures in most hospitals. This study examines the impact of this transition on surgical outcomes. This study used prospectively collected surgical records at CHA Bundang Medical Center. Patients who underwent hepatobiliary and pancreatic surgery between August 2023 and September 2024 were divided into two groups consecutively (Group 1: August 2023 to February 2024, surgeries performed with an assistant doctor vs. Group 2: March 2024 to September 2024, solo-surgeon surgeries). After propensity score matching, surgical outcomes and prognostic factors were compared. A total of 995 patients were included (499 in the assistant surgeon group, 496 in the solo surgeon group). After propensity score matching, 388 matched pairs were analyzed. While overall complication rates did not significantly differ between groups (3.6% vs. 6.7%, P = 0.074), major complications were significantly more frequent in the solo-surgeon group (1.8% vs. 4.6%, P = 0.042). Hospital length of stay and operative time were comparable between groups. Subgroup analysis suggested a trend toward increased major complications in open surgery and elderly patients, though statistical significance was not reached. The transition to solo-surgeon practice in gallbladder-centric hepatobiliary and pancreatic surgery may be associated with a higher incidence of major complications, particularly in complex cases. Further studies are needed, but a team-based surgical approach may improve outcomes in select patient populations.
To explore concerns and coping experiences regarding sexual well-being in inflammatory bowel disease and examine the relationship between these concerns and affected individuals' background factors. Explanatory sequential mixed methods study. Recruitment flyers (n = 1347) were distributed to individuals attending inflammatory bowel disease outpatient clinics in seven facilities. Participants completed a questionnaire assessing demographics, concerns and coping experiences related to their sexual well-being. Those who provided consent participated in semi-structured online interviews. Quantitative data were analysed descriptively, and qualitative data were analysed using content analysis. A total of 551 participants completed the questionnaire, and 21 participated in the interviews. Among them, 251 (45.6%) reported experiences of concerns related to romantic relationships and marriage, sexual life, pregnancy, childbirth and childcare. The nature of these concerns varied by background factors: unmarried individuals more often reported relationship concerns; those with surgical or perianal history more often reported sexual concerns; and women, married individuals and individuals with Crohn's disease more often reported pregnancy-related concerns. Coping experiences were categorized as (1) active barrier management, (2) partner and professional support, (3) passive or resignation coping and (4) cognitive reframing. Sexual well-being is significantly affected among individuals with inflammatory bowel disease. Many participants reported understanding and support from significant others or relied on personal coping strategies; however, others reported an absence of coping experiences. Sharing these findings with individuals with inflammatory bowel disease and healthcare professionals may enhance awareness and promote support strategies to improve these individuals' sexual well-being. Concerns about sexual well-being are influenced by both clinical and psychosocial factors, including treatment history, life stage and partner relationships. Healthcare professionals should provide individualised and comprehensive care that incorporates the partners and families of individuals with inflammatory bowel disease to better address sexual well-being. This study presents the first large-scale mixed methods evidence on how individuals with inflammatory bowel disease experience sexual well-being, providing direct implications for improving quality of life. By illustrating both adaptive and absent coping strategies, the findings contribute essential insight to inform patient-centred clinical practice and psychosocial care. The Good Reporting of a Mixed-Methods Study (GRAMMS) guidelines were followed. No patient or public contribution.