Search Results (464)

Background/Objectives: Frailty is a complex geriatric syndrome that requires a comprehensive evaluation. This approach should consider not only physical symptoms but also cognitive, psychological, functional, nutritional, and social aspects. Nutritional status is a critical and modifiable factor, making it a key area for intervention in the prevention and management of frailty. Therefore, a scoping review was conducted to determine the effectiveness of nutritional intervention in frail/pre-frail older adults. Methods: We adopted the PRISMA-Scoping approach, and we sought studies published in MEDLINE and Scopus databases. Results: We screened 3038 studies and finally we included a total of 19 studies. The interventions included nutritional education, counseling, and supplementation, most in combination with exercise. Nutritional interventions improved frailty status, physical performance, functional status, and quality of life in older adults. Conclusions: Consequently, this scoping review indicates that multifactorial interventions combining nutritional interventions with physical activity are clearly more effective than a single approach in improving the quality of life of older patients with frailty. These provisional findings may generate hypotheses for policymakers to consider multifaceted interventions for older patients with frailty. Full article

Background: Achieving breast symmetry is an important aesthetic goal following reconstruction post-mastectomy; however, little is known about women’s awareness, attitudes, and barriers regarding Contralateral Breast Symmetry Procedures (CBSP) in Jordan. Objectives: To assess awareness, perceptions, and barriers toward contralateral breast symmetry procedures among breast cancer survivors who underwent reconstruction at King Hussein Cancer Center. Methods: A cross-sectional study was conducted from July to Oct 2025 at KHCC, among 314 women diagnosed with breast cancer who had post-breast reconstruction. Data were collected using a structured Arabic questionnaire, which was developed based on existing literature, validated by an expert panel, and piloted on 10 women for clarity and reliability. The final tool demonstrated acceptable internal-consistency (Cronbach’s α = 0.712). The questionnaire captured sociodemographic and clinical data and detailed knowledge, attitudes, and barriers related to CBSP. Descriptive statistics summarized the data. Results: Participants’ mean age was 45.8 years; the majority were married (83.8%) and held university degrees (65.6%). Most reconstructions used silicone implants (94.6%). Only 6.4% had undergone CBSP, primarily delayed breast augmentation or mastopexy, with 75% reporting satisfaction. Awareness of CBSP was limited (37.9%), and less than one-third had discussed CBSP options with their surgeon or knew about insurance coverage. While 82.5% valued symmetry for body image, 31.5% viewed it as unnecessary after cancer recovery. Main barriers included satisfaction with current appearance (48.1%), fear of additional surgery (32.2%), financial constraints (37.3%), and lack of physician counseling (27.1%). Trust in medical team recommendations was high (89.2%). Conclusions: Contralateral breast symmetry procedures are under-recognized and infrequently pursued, primarily due to limited awareness, financial concerns, and insufficient counseling. Focused education and enhanced surgeon–patient communication are essential to support women’s aesthetic and psychological needs after reconstruction in Jordan. Full article

Biomarker-based prevention is rapidly expanding, driven by advances in molecular diagnostics, genetic profiling, and commercial direct-to-consumer (DTC) testing. General practitioners (GPs) increasingly encounter biomarker results of uncertain relevance, often introduced outside the guideline frameworks. This creates new challenges in interpretation, communication, and equitable resource use in primary care. This narrative review synthesizes evidence from population-based studies, guideline frameworks, consensus statements, and communication research to evaluate the predictive value, limitations, and real-world implications of biomarkers in asymptomatic adults. Attention is given to polygenic risk scores, DTC genetic tests, neurodegenerative and cardiovascular biomarkers, and emerging multi-omics and aging markers. Several biomarkers, including high-sensitivity cardiac troponins, N-terminal pro–B-type natriuretic peptide, lipoprotein(a), coronary artery calcium scoring, and plasma p-tau species, showed robust predictive validity. However, many widely marketed biomarkers lack evidence of clinical utility, offer limited actionable benefits, or perform poorly in primary care populations. Unintended consequences, such as overdiagnosis, false positives, psychological distress, diagnostic cascades, and widening inequities, are well documented. Patients often misinterpret unvalidated biomarker results, whereas DTC testing amplifies demand without providing adequate counseling or follow-up. Only a minority of biomarkers currently meet the thresholds of analytical validity, clinical validity, and clinical utility required for preventive use in general practices. GPs play a critical role in contextualizing biomarker results, guiding shared decision-making, and mitigating potential harm. The responsible integration of biomarkers into preventive medicine requires clear communication, strong ethical safeguards, robust evidence, and system-level support for equitable, patient-centered care. Full article

Mastectomy, while a life-saving intervention for breast cancer, often leads to profound psychological and emotional challenges for affected women. Feelings of loss altered body image, and anxiety about recurrence can significantly impact mental well-being. This study aimed to explore and describe the experiences of women after mastectomy at Mankweng Tertiary Hospital in Limpopo Province, South Africa. In this study, a qualitative phenomenological design was used. Data were collected through semi-structured in-depth interviews with women who had undergone mastectomy. Fifteen participants were purposively sampled, and thematic analysis was used to identify key patterns and meanings in their narratives. The findings revealed that the participants initially described feelings of being ‘disabled’, incomplete, and anxious about cancer recurrence or their ability to perform maternal functions such as breastfeeding. However, over time, many developed resilience and acceptance, seeing surgery as a life-saving measure and an opportunity for renewal. The adjustment of women after mastectomy is a complicated emotional transition from crisis and loss to adjustment and empowerment. The results identify the need for holistic psychosocial support that combines counseling, peer networks, and education for their family members addressing their emotional healing, body image, and social reintegration. Full article

Background/Objectives: This study aims to explore both the psychosocial outcomes of hearing aid use and the factors that differentiate users from non-users among older adults with sensorineural hearing loss (SNHL) in Romania. Methods: We conducted a cross-sectional, comparative study with follow-up, including 201 patients aged between 49 and 92 years (mean age 70.76 ± 11.86 years), diagnosed with moderate to severe SNHL, evaluated between 1 November 2023, and 30 November 2024, at the Municipal Clinical Hospital Orăștie, Romania. Audiological assessment involved pure-tone audiometry and speech testing. Outcome measures included the Word Recognition Score (WRS), International Outcome Inventory for Hearing Aids (IOI-HA), Hearing Handicap Inventory for Adults (HHIA), Tinnitus Handicap Inventory (THI), and the Self-Esteem Scale (SES). Results: Of the 201 patients, 105 (52.2%) accepted hearing aid (HA) fitting and 96 (47.8%) declined. No significant differences were found in age (p = 0.565) or sex (p = 0.476) between groups. HA users reported significantly lower perceived handicap (HHIA: 46.48 ± 24.83 vs. 77.74 ± 28.02, p = 0.015) and higher self-esteem scores (SES: 35.68 ± 4.88 vs. 23.03 ± 4.90, p < 0.001), while tinnitus-related distress (THI) did not differ significantly (p = 0.785). Word recognition scores improved significantly post-fitting across all degrees of hearing loss: moderate (48.52% → 86.13%), moderately severe (47.47% → 85.31%), and severe (47.55% → 85.46%), all p < 0.001. Conclusions: Hearing aid use in older adults with SNHL was associated with significant improvements in speech perception and reduced perceived hearing handicap. These benefits were consistent across all severity levels and were independent of unilateral or bilateral device use. The difference in self-esteem observed between users and non-users may reflect pre-existing psychological factors influencing HA adoption, underlining the importance of personalized counseling in hearing rehabilitation. Full article

Presbyopia-correcting IOLs have revolutionized cataract surgery by enabling functional vision across multiple focal distances, thereby reducing dependence on spectacles. These lenses—ranging from multifocal to extended depth-of-focus (EDOF) and hybrid designs—incorporate advanced optical technologies to address the limitations of traditional monofocal IOLs. Despite their clinical promise, patient satisfaction remains variable, with a substantial subset experiencing postoperative visual discomfort. This review provides a comprehensive overview of presbyopia-correcting IOL technologies, detailing their optical principles, design evolution, and clinical performance. It further analyzes the multifactorial causes of postoperative dissatisfaction, which include optical phenomena such as glare, halos, and reduced contrast sensitivity; ocular comorbidities like dry eye disease, corneal irregular astigmatism, glaucoma, and macular pathology; and surgical variables including IOL centration, pupil size, and biometry accuracy. Additionally, non-physiological factors—such as patient expectations, lifestyle demands, and psychological disposition—play a critical role in perceived outcomes. To address these challenges, the review explores evidence-based strategies for improving satisfaction. These include rigorous preoperative screening for ocular surface disease and aberrations, personalized lens selection based on anatomical and functional criteria, and thorough patient counseling to align expectations with achievable results. Emerging IOL designs that blend multifocal and EDOF features offer promising avenues for minimizing visual disturbances while preserving range of vision. By integrating optical innovation with individualized clinical care, ophthalmologists can enhance postoperative outcomes and optimize real-world satisfaction with presbyopia-correcting IOLs. Full article

Mayer–Rokitansky–Küster–Hauser (MRKH) syndrome encompasses a range of Müllerian duct anomalies characterized by congenital absence of the uterus and the upper two-thirds of the vagina in young women who otherwise exhibit normal endocrine function and a 46,XX karyotype. MRKH syndrome can occur in an isolated form (type I) or in association with other congenital anomalies (type II or MURCS association), which may include renal, vertebral, auditory, and cardiac defects. It represents one of the most frequent causes of primary amenorrhea, affecting approximately 1 in every 4000–5000 women. MRKH syndrome often remains undiagnosed until a patient presents with primary amenorrhea, despite normal development of secondary sexual characteristics. Both genetic and non-genetic factors have been proposed as contributing to abnormal embryonic development, although the exact etiopathogenesis remains unclear. Imaging plays a key role in the evaluation of genital tract anomalies, allowing non-invasive and comprehensive assessment. Alongside physical examination and pelvic ultrasound, pelvic MRI is essential for identifying the presence of rudimentary uterine tissue. MRKH syndrome can have profound and lasting psychological impacts, making it essential for patients and their families to receive counseling both before and throughout treatment. A range of therapeutic options—both surgical and non-surgical—have been proposed for managing MRKH syndrome. Vaginal dilation remains the first-line treatment, as it offers high success rates with minimal risk of complications. Vaginoplasty is considered a second-line option for patients who do not respond to dilation therapy. Additionally, uterine transplantation and gestational surrogacy provide opportunities for women with MRKH syndrome to achieve biological motherhood. This review provides an updated overview of Mayer–Rokitansky–Küster–Hauser (MRKH) syndrome, encompassing its etiological, clinical, diagnostic, psychological, therapeutic, and reproductive aspects. We also present a case involving a 19-year-old woman with MRKH syndrome who presented with primary amenorrhea, highlighting the crucial role and advantages of MRI in diagnosis, differential assessment, and treatment planning. Full article

Background and Objectives: Paediatric palliative care in Romania is underdeveloped and unevenly distributed, which creates major difficulties in accessing services for children with life-limiting illnesses and their families. The lack of a dedicated national strategy, the shortage of specialised staff, and socio-economic barriers exacerbate the vulnerability of these groups. This study aimed to explore parents’ and caregivers’ experiences, to analyse the perspectives of public institutions and NGOs involved in supporting these children, and to identify the main barriers and facilitators in accessing paediatric palliative care. Materials and Methods: Given that all data were collected exclusively through focus group discussions, this study employed a qualitative design based on three focus groups guided by a semi-structured interview guide. The analysis was conducted using MAXQDA software, which enabled the coding and synthesis of emerging themes. Participants were parents/caregivers of children with life-limiting illnesses, representatives of public institutions, and members of relevant NGOs in Bacău County, Romania. Purposive sampling was used to capture diverse and experience-based perspectives, resulting in a total of 24 participants across three focus groups—parents and caregivers (n = 11), public institution representatives (n = 7), and NGO representatives (n = 6). No individual semi-structured interviews were conducted. Results: The analysis highlighted a complex typology of medical, emotional, social, educational, and spiritual needs of children and their families. Parents reported experiences of abandonment in the curative system, emphasising the importance of pain control, safety, and community support. Public institutions acknowledged the lack of skills and inter-sectoral coordination, while NGOs pointed to structural barriers and the low visibility of these children. Major needs include access to specialised care, psychological support, respite services for carers, financial and administrative assistance, education, and spiritual counselling. A significant obstacle is the lack of up-to-date statistical data needed to inform public policy. Conclusions: Paediatric palliative care should be considered a national priority through the development of a dedicated strategy, the expansion of specialised services, and the strengthening of partnerships between the public and non-governmental sectors. An integrated, child- and family-centred approach addressing the medical, social, emotional, and spiritual dimensions of care is essential. The results highlight the need for continuous staff training, information campaigns, and community support mechanisms to reduce inequalities and improve the quality of life of children with life-limiting illnesses. Full article

Background/Objectives: Multidisciplinary care is the gold-standard approach for delivering comprehensive pediatric healthcare. For children undergoing cochlear implant (CI) evaluation, multiple appointments are required to assess candidacy, set realistic expectations, and counsel families on rehabilitation and the psychosocial impact of hearing loss. Established pediatric CI users also need coordinated follow-up to address ongoing auditory, educational, and psychosocial needs. This study evaluated the satisfaction and family perspectives of the implementation of a virtual, team-based multidisciplinary model for both CI candidates and established CI users. Methods: Thirty-nine children and their families participated in discipline-specific telehealth consultations, including audiology, listening and spoken language (LSL) therapy, psychology, and educational services, followed by a 60 min multidisciplinary team meeting. Team meetings occurred during pre-implantation and at six months post-activation for CI candidates. Team meetings for established CI users were scheduled following completion of individual consultations. Providers summarized findings from their individual visits before transitioning to a caregiver-led discussion. Post-visit surveys assessed satisfaction and perceived benefit from the multidisciplinary model. Results: Thirty-nine dyads were enrolled (11 Pre-CI; 28 Established CI). Caregivers were predominantly mothers (89.7%), most identified as Hispanic (55.3%) and White (71.1%). Over half of children identified as Hispanic (59%) and White (71.8%); most were diagnosed with hearing loss at birth (55.9%). Satisfaction with the virtual model was uniformly high: 100% of caregivers were satisfied or very satisfied, and most rated care quality as “very good” or “excellent.” LSL therapy was most frequently rated as the most beneficial visit (70% Pre-CI; 45% Established CI). Caregivers strongly preferred ongoing team-based care, with 55–80% reporting that they would like it to occur every six months and 95–100% preferring remote meetings. Conclusions: A virtual multidisciplinary model offers a high-quality, family-centered approach for both CI evaluations and ongoing management of established CI users. By integrating simultaneous team-based sessions, this model not only supports the ‘whole child’ but also strengthens the family system by improving communication, streamlining care, and reducing the burden of multiple in-person appointments. Families consistently report high levels of satisfaction with the convenience, clarity, and collaboration provided through virtual team visits. Incorporating routine check-ins with families is essential to ensure their needs are addressed, reinforce progress, and guide timely, targeted interventions that maximize each child’s developmental outcomes. Full article

Virtual reality (VR) offers new opportunities for delivering psychologically meaningful conversations in digitally mediated settings. This study examined how environmental designs influence user experience during emotionally relevant self-disclosure. Fifty university students completed a within-subjects experiment in which they engaged in a structured positive and negative self-disclosure task across four immersive environments (seaside, garden, urban, and sci-fi). After each interaction, participants rated six experiential dimensions relevant to therapeutic communication: comfort, calmness, pleasantness, focus, privacy, and perceived overall suitability for psychological therapy. Repeated-measures analyses showed that nature-themed environments were rated more positively than non-nature environments across all dimensions. Although the seaside and garden environments did not differ in overall composite ratings, the seaside setting was most frequently preferred for comfort, calmness, and pleasantness in participants’ final rankings. These findings demonstrate that virtual environment design meaningfully shapes users’ emotional and interpersonal experience in VR, highlighting the value of nature-based environments for VR counselling systems and digital mental-health applications. Full article

Background: The purpose of this study is to examine the mediating roles of cognitive flexibility and sensation seeking in the relationship between basic psychological needs and problematic social media use. Furthermore, the moderating effect of gender on indirect effects has been examined. Method: The sample of the study consisted of 838 Turkish adolescents aged between 14 and 18 (46.2% female; Mean = 15.6, SD = 1.71). Participants completed the Bergen Social Media Addiction Scale, the Basic Psychological Needs Scale, the Cognitive Flexibility Scale, and the Brief Sensation Seeking Scale. Data were analyzed using structural equation modeling (SEM) with the AMOS 26.0 program. Results: A significant relationship was found between basic psychological needs and problematic social media use (r = 0.43, p < 0.001). Both cognitive flexibility and sensation seeking partially mediated this relationship in girls (β = −0.23, p < 0.001), while fully mediating it in boys (β = 0.03, p = 0.675). Conclusions: The findings suggest that problematic social media use in adolescents may be associated with cognitive flexibility and increased sensation-seeking tendencies stemming from unmet psychological needs, and that gender plays an important role in this relationship. Full article

Background: Transition from paediatric to adult care in congenital heart disease (CHD) represents a pivotal and vulnerable phase that critically influences long-term survival, morbidity, and quality of life. Advances in paediatric cardiology and surgery have generated a rapidly growing population of adults with congenital heart disease who exhibit complex, lifelong, and multidisciplinary needs. However, survival does not equate to cure, and discontinuity of care during adolescence remains a major predictor of adverse outcomes. Despite widespread recognition of their importance, transition programmes are heterogeneous worldwide, and standardised, evidence-based protocols are missing. Objective: This review calls for action acknowledging the urgent need for structured and standardised transition programmes in CHD care, integrating the key elements that should be addressed in any programme to optimise outcomes. Content: Transition should be understood as a multidisciplinary, longitudinal process integrating medical management, patient and family education, psychological preparation, and societal inclusion. Core domains include tailored physical activity, nutritional counselling, cardiovascular risk factor management, infective endocarditis prevention, reproductive health, psychosocial support, and engagement of primary care providers, educators, and employers. Evidence demonstrates that structured transition programmes enhance health literacy, adherence, and self-management, while reducing loss to follow-up. The active involvement of primary care providers, psychologists, educators, and employers is essential to sustain holistic and equitable care. Conclusions: Transition should be reframed as an essential, lifelong component of CHD care. The development and implementation of standardised, multidisciplinary, evidence-based transition protocols are urgently required to ensure continuity, empower patients, and optimise long-term clinical and psychosocial outcomes for adults with CHD. Full article

Self-harm is a growing public health concern, particularly among university students facing academic anxiety. This study explored the underlying factors driving suicide planning and attempts in this population. Using a qualitative design, we conducted thematic analysis of interviews with eight counselors and eight students from five public and private universities. Analysis via NVivo Software revealed six core themes: (1) current mental health support and coping strategies, (2) triggers of suicidal ideation linked to family and psychological stressors, (3) perceptions of campus mental health services, (4) cultural and societal misconceptions surrounding suicide, (5) institutional barriers to accessing mental health care, and (6) student-driven recommendations for prevention and support. These findings highlight the complex interplay between academic pressure, emotional distress, and limited institutional support. The study emphasizes the need for universities to enhance access to mental health services, reduce stigma through open dialogue and peer support, and engage families through targeted workshops. Tailored interventions addressing academic, emotional, and familial challenges—such as flexible deadlines and improved counseling access—can significantly reduce suicidal ideation and promote student well-being. Full article

This study investigated the feasibility and preliminary effects of enhanced midwifery care in reducing subclinical depression symptoms among women in ethnically diverse areas of the South Western Sydney Local Health District (SWSLHD). A pilot randomised controlled trial was conducted among pregnant women attending the Fairfield and/or Liverpool antenatal clinic with an Edinburgh Depression Scale (EDS) score of 10–12 (i.e., just below the generally accepted clinical cut-off score of 13 to indicate subclinical depressive symptoms) during the first antenatal visit (i.e., before 26 weeks gestation). Participants were randomly allocated to either the intervention group which received continuous and coordinated support from a dedicated Registered Midwife (RM) trained in counselling and linked with a multidisciplinary team, or the usual care group, which received standard maternity care from various providers without continuity or additional coordinated support. Primary outcomes included feasibility of recruitment, randomisation, intervention delivery and fidelity, and retention and follow-up. The secondary outcomes were improvement in depressive symptom severity assessed via EDS, psychological distress (Kessler’s psychological distress scale—K10), and parenting confidence (Karitane Parenting Confidence Scale (KPCS). Descriptive analyses were used to assess the feasibility outcomes, whereas mixed-effects models were used to examine the effects of treatment on secondary outcomes. Thirty-seven mothers were recruited into the study, of which eighteen were randomised to the intervention group and nineteen to the usual care group. The intervention was delivered with good fidelity, and remote adaptations during COVID-19 ensured both continuity of care and high retention at 6-month follow-up. Findings of the mixed-effects models showed significant within-group reduction in EDS scores over time, with scores at 8 weeks postpartum (T2) significantly lower than at baseline (T0; β = −2.77, SE = 1.36, p < 0.05) but no significant differences between the groups (β = −0.02, SE = 1.63, p = 0.992) or time-by-group interactions at any timepoint for EDS, K10, and KPCS. These findings demonstrate the feasibility of enhanced midwifery care in a “hard to reach” population of SWSLHD and highlight the need for adequately powered trials to determine its effectiveness on maternal mental health and parenting outcomes. Full article

Background/Objective: Psychological scales hold significant importance, measuring cultural sensitivity, experiences, values, and emotional expressions while controlling individuals’ biases regarding certain cultures. Arabic is used in a widespread, predominantly Middle Eastern and North African region, but it has diverse expressive variations. Therefore, the value of translating and validating scales lies in their compatibility with cultural norms. This study focuses on measuring the psychometric properties and factorial structure of the widely used PERMA-Profiler to assess the general well-being of the Saudi adult population. Methods: Using stratified sampling, (N = 2927) Saudi adults were recruited via various electronic and social media. Results: The confirmatory factor analysis showed strong evidence of the instrument’s validity, confirming well-being as a single latent factor composed of five dimensions with an acceptable degree of reliability. The correlation coefficients indicate considerable internal consistency for numerous factors, including positive emotions, engagement, relationships, meaning, accomplishment, health, and happiness (α = 0.83, 0.79, 0.77, 0.84, 0.80, 0.69, 0.71), respectively. The Split-Half coefficient demonstrated significant reliability (0.87). Conclusions: The validity and reliability of the scale are supported, confirming that PERMA can be applied to measure the well-being of Saudi society. Furthermore, the Arabic version of PERMA can be utilized in counseling and psychotherapy practice as well as in research studies. It could be a helpful tool for exploring and preventing mental health issues and improving well-being within the community. Full article