Search Results (3,863)

Fibromyalgia is a chronic pain condition associated with reduced quality of life, psychological symptoms, cognitive impairment, and low adherence to exercise-based interventions. Immersive virtual reality (IVR) has gained attention as a rehabilitation approach; however, the relationship between user experience, adherence, and clinical outcomes remains unclear. This post hoc exploratory secondary analysis was derived from a randomized controlled clinical trial (NCT07605143) and included 16 women with fibromyalgia who completed a six-week IVR-based rehabilitation program. Associations between user experience, adherence, and clinical outcomes were explored among participants exposed to IVR. Quality of life was assessed using the Fibromyalgia Impact Questionnaire-Revised (FIQ-R), psychological symptoms using the Depression Anxiety Stress Scales (DASS-21), and user experience using the Player Experience of Need Satisfaction (PENS) questionnaire. Within-group changes were observed in FIQ-R scores (p = 0.001; d = 1.08) and DASS-21 stress levels (p = 0.025). Participants demonstrated favorable adherence and positive user experience. A significant correlation was identified between intuitive control and changes in depression scores (ρ = 0.63, p = 0.008). This exploratory analysis identified favorable user experience and adherence among women participating in an IVR-based rehabilitation program. However, due to the absence of a concurrent control group, no conclusions regarding treatment efficacy can be drawn. These findings should be considered hypothesis-generating. Full article

Background/Objectives: The rapid expansion of social media platforms has profoundly changed the way adolescents access reproductive health information. While digital environments increase accessibility to contraceptive content, they also facilitate the dissemination of misinformation, potentially influencing both contraceptive literacy and psychological well-being. The present study aimed to evaluate the relationship between sources of contraceptive information, contraceptive misinformation endorsement, contraceptive knowledge, and mental health indicators among Romanian adolescents and young adults. Methods: A cross-sectional observational study was conducted in a cohort of 210 Romanian adolescents and young adults. Participants completed a structured self-administered questionnaire assessing demographic characteristics, contraceptive information sources, digital health behaviors, contraceptive misconceptions, and contraceptive knowledge. Anxiety and depressive symptoms were evaluated using the Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) scales. Correlation analyses and multivariable logistic regression models were performed to identify factors associated with poor contraceptive knowledge and moderate-to-severe anxiety. Results: Social media represented the primary source of contraceptive information for 58.1% of participants. Individuals relying predominantly on social media demonstrated significantly lower contraceptive knowledge questionnaire (CKQ) scores compared to those obtaining information from healthcare professionals (5.9 ± 1.8 vs. 8.1 ± 1.7, p < 0.001). Contraceptive misinformation endorsement was inversely correlated with CKQ scores (r = −0.44, p < 0.001) and positively associated with anxiety (r = 0.47, p < 0.001) and depressive symptoms (r = 0.41, p < 0.001). In multivariable analyses, primary reliance on social media (OR 2.21, 95% CI 1.12–4.34, p = 0.022) and low digital health literacy (OR 2.94, 95% CI 1.51–5.71, p = 0.001) were independently associated with poor contraceptive knowledge. Higher misinformation endorsement, infertility-related fears, and high social media exposure were independently associated with moderate-to-severe anxiety. Conclusions: Contraceptive misinformation endorsement was associated with lower contraceptive literacy and poorer psychological outcomes among adolescents and young adults. These findings highlight the growing importance of digital health literacy. However, given the cross-sectional design, the observed relationships should be interpreted as associations rather than causal effects, and longitudinal studies are required to clarify their directionality. Full article

Background/Objectives: Dental fear and anxiety (DFA) in children can negatively affect oral health behaviors and dental care utilization. Family-related factors, particularly parental anxiety, parenting styles, and socioeconomic characteristics, may be associated with DFA. This study aimed to investigate the association between family-related factors and DFA among children aged 6–8 years in Jakarta, Indonesia. Methods: A cross-sectional study was conducted among 294 child–parent pairs recruited from 10 primary schools using multistage cluster sampling. Children’s DFA was assessed using the Children’s Fear Survey Schedule–Dental Subscale (CFSS-DS), whereas parental dental anxiety was measured using the Modified Dental Anxiety Scale (MDAS). Sociodemographic and family-related characteristics, including parenting styles, were collected using self-administered questionnaires. Data were analyzed using chi-square tests and multivariable logistic regression. Results: Overall, 34.7% of the children were classified as having DFA. Maternal employment was significantly associated with children’s DFA, with children of formally employed mothers having higher odds of DFA (aOR = 2.01, 95% CI: 1.05–3.85; p = 0.034). Parental dental anxiety was associated with children’s DFA. Children whose fathers and mothers reported high levels of dental anxiety had 4.68-fold (95% CI: 1.64–13.33; p = 0.004) and 2.50-fold (95% CI: 1.10–5.74; p = 0.029) higher odds of experiencing DFA, respectively. Dental drilling and injections were the most frequently reported fear-provoking stimuli. The final regression model explained 13% of the variance in children’s DFA. Conclusions: Parental dental anxiety and maternal employment were significantly associated with DFA among children aged 6–8 years. Family-centered preventive strategies and early identification of at-risk children may help reduce DFA and promote positive dental experiences and oral health outcomes. Full article

Background and Objectives: Appendectomy during pregnancy is associated with preterm birth, but downstream neonatal outcomes, neonatal intensive care resource use, and caregiver-reported psychological symptom burden remain insufficiently characterized. We aimed to compare neonatal infection rates, NICU resource utilization, and caregiver psychosocial outcomes between preterm infants born after maternal appendectomy during pregnancy and preterm controls frequency-matched by gestational-age strata without antecedent non-obstetric surgery. Methods: In this single-center prospective cohort study (March 2023–December 2025), 121 preterm infants were enrolled: 54 born after maternal appendectomy during pregnancy (31 laparoscopic, 23 open) and 67 non-surgical preterm controls. Neonatal outcomes included culture-confirmed infection, death, or major neonatal morbidity, and neonatal intensive care resource metrics. Caregiver outcomes were assessed near discharge using the 36-Item Short Form Survey, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7 scale, and Hospital Anxiety and Depression Scale. Group comparisons used normality-guided parametric or non-parametric tests and multivariable logistic regression; subgroup and mediation analyses were exploratory. Mediation analyses explored indirect pathways. Results: Culture-confirmed infection was numerically more frequent in appendectomy-group neonates than in controls (35.2% versus 20.9%; p = 0.078), but this difference was not statistically significant. NICU length of stay was significantly longer (47.3 ± 14.8 vs. 41.2 ± 12.6 days; p = 0.014), and caregiver Patient Health Questionnaire-9 depressive symptom scores were higher (12.4 ± 4.3 vs. 9.6 ± 3.8; p < 0.001). Open appendectomy and negative histopathology subgroups showed the strongest adverse signals. Exploratory mediation analysis suggested that a substantial portion of the appendectomy-caregiver depression association statistically co-varied with prolonged hospitalization (Sobel p = 0.008); this exploratory pathway analysis does not establish a causal mediation pathway. Conclusions: Preterm infants born after maternal appendectomy during pregnancy showed non-significant numerical increases in infection outcomes, significantly higher neonatal intensive care resource use, and higher caregiver-reported psychological symptom scores compared with non-surgical preterm controls, with open surgery and negative appendectomy representing clinically complex subgroups with less favorable exploratory signals. Full article

Background/Objectives: This study aimed to examine the associations between diet-related quality of life (DRQOL) and psychological distress, autonomic dysfunction, and migraine in patients with dizziness and balance disorders. Methods: In this retrospective cross-sectional study, 122 patients (56 men, 66 women; mean age 40.4 ± 12.8 years, minimum 14, maximum 65) from the vertigo outpatient clinic at JR Tokyo General Hospital completed self-reported questionnaires. These included the DRQOL scale, Dizziness Handicap Inventory (DHI), Hospital Anxiety and Depression Scale (HADS), Self-rating Depression Scale (SDS), Orthostatic Dysregulation (OD) checklist, and migraine assessments (POUNDing [Pulsating, duration of 4–72 h, Unilateral, Nausea, Disabling], MIDAS, migraine screener). Correlational analyses, group comparisons, and receiver operating characteristic (ROC) analyses were conducted. Results: Higher DRQOL scores indicate poorer DRQOL. DRQOL scores showed positive correlations with psychological distress (SDS: ρ = 0.57; HADS-A: ρ = 0.50; HADS-D: ρ = 0.53; all p < 0.001) and OD severity (ρ = 0.50, p < 0.001) but not with age, DHI, or individual migraine indices. Migraine screener-positive patients had significantly higher DRQOL scores (p < 0.01). DRQOL alone showed modest ability to discriminate migraine screener-positive from migraine screener-negative patients (AUC = 0.65); discrimination improved to an AUC of 0.77 in a multivariable model that also included age and sex. Conclusions: DRQOL appears to capture psychological and autonomic symptom burden rather than vestibular or headache severity, suggesting that it may serve as a complementary, patient-centered metric that adds a multidimensional perspective to conventional vestibular and headache assessments. Full article

Background: Pain during orthodontic debonding is a common clinical concern. Although previous studies have mainly focused on mechanical approaches to reduce discomfort, the influence of emotional characteristics of patients on pain perception remains insufficiently explored. In this study, we aimed to evaluate the association between pain perception, emotional affect, and anxiety during orthodontic bracket removal using different clinical protocols. Methods: A prospective observational comparative study was conducted at Rey Juan Carlos University (Madrid, Spain). A total of 140 orthodontic patients underwent bracket removal according to four routine clinical protocols determined by clinical scheduling: ligated with interocclusal cotton rolls (used for tooth stabilization), non-ligated with cotton rolls, ligated without cotton rolls, and non-ligated without cotton rolls. Pain intensity was assessed using a Visual Analog Scale (VAS) immediately before (T0) and after (T1) bracket removal. Baseline pain (T0) was recorded to control for pre-existing discomfort. Anxiety and emotional affect were measured using the State–Trait Anxiety Inventory (STAI) and the Positive and Negative Affect Schedule (PANAS), respectively. Statistical analyses included ANOVA, factorial ANCOVA adjusted for baseline pain, and multivariable regression models. Results: No significant baseline differences were observed among groups. The highest post-debonding pain scores were found in the group without cotton rolls and without ligatures. ANCOVA revealed a significant main effect of cotton roll use, with lower adjusted pain scores in patients treated with cotton rolls, whereas ligation showed no statistically significant independent effect. In multivariable regression analyses, baseline pain, age, and negative affect were independently associated with higher post-debonding pain. Conclusions: Within the limitations of a non-randomized design, cotton roll use was associated with lower post-debonding pain, whereas ligation appeared to have a limited influence. Patient-related factors—particularly negative affect, age, and baseline pain—were also associated with pain perception, supporting a biopsychosocial perspective. These findings should be interpreted as exploratory evidence rather than causal effects. Full article

The dimensionality of the Ego-Resilience Scale (ER89) remains contested, and little is known about the performance of the original and revised versions of the scale in South Africa. This study examined the psychometric properties of the 14-item ER89 and the 10-item ER89-R in 337 undergraduate students from a university in the Western Cape province of South Africa. Participants completed the ER89, the Sense of Coherence Scale, the Center for Epidemiological Studies Depression Scale, and the trait scale of the State-Trait Anxiety Inventory. The scales were evaluated using classical test theory, confirmatory factor analysis, bifactor modeling, parallel analysis, Mokken scale analysis, and Rasch analysis. For both versions, bifactor models fit better than one-factor models, but the specific factors showed anomalous loadings and accounted for little reliable variance. Parallel analysis and Rasch analysis supported an essentially unidimensional interpretation of both instruments. Although both versions showed acceptable internal consistency and expected associations with sense of coherence, depression, and anxiety, several findings raised concerns about their broader psychometric adequacy. Overall, both scales appeared to reflect a broad general factor of ego-resilience, but their performance in this context was mixed and, in important respects, problematic. Further refinement and validation are needed before either instrument can be recommended for confident use in South African research and practice. Full article

Background: The paediatric dentistry domain requires effective management of pain in children during invasive procedures such as the inferior alveolar nerve block (IANB). This study aimed to evaluate the effectiveness of Buzzy BEE^TM in reducing pain perception during IANB in children. Methods: This crossover study recruited 38 children aged 6–10 years scheduled for bilateral dental procedures requiring IANB. The washout period was 7 days, and two visits were scheduled for procedures on either side. Two randomly allocated groups received the study intervention, with each group receiving it alternately at each visit. Outcomes measured were pulse rate; subjective pain assessment using the Wong–Baker FACES Rating Scale (WBS); objective pain assessment using the Sound, Eyes and Motor (SEM) scale; and parental rating of observed pain on a scale of 1–10. Results: A statistically significant reduction in pulse rate after IANB was observed in the Buzzy BEE group at the first (p = 0.02) and second (p = 0.002) visits. At the second visit, the WBS scores (p < 0.001) and ‘eye’ (p = 0.004) and ‘motor’ (p = 0.002) scores on the SEM scale were significantly reduced in the Buzzy BEE group. The crossover analysis identified a significant treatment effect on pulse rate (p < 0.001) and significant carryover effects on WBS and SEM scores (p < 0.001). Conclusions: The use of Buzzy BEE reduced pulse rates during IANB, suggesting a positive impact on children’s anxiety. The carryover effects in the current study limit the consistency of improvements in subjective and objective pain perceptions. Further studies with a larger sample size and an extended washout period are recommended to evaluate the effectiveness of Buzzy BEE in reducing pain perception during IANB. Full article

Background: Uterine fibroids are among the most common benign tumors affecting women of reproductive age and may substantially impair health-related quality of life (HRQL). Although anxiety and stress are frequently reported by affected women, their contribution to HRQL remains unclear. This study aimed to evaluate the relationships between symptom severity, anxiety, stress, and HRQL in women with uterine fibroids. Methods: A cross-sectional study was conducted among 107 women hospitalized for uterine fibroid treatment. Symptom severity and HRQL were assessed using the Uterine Fibroid Symptom and Quality of Life (UFS-QoL) questionnaire. Anxiety and information needs were evaluated using the Amsterdam Preoperative Anxiety and Information Scale (APAIS), while subjective anxiety and stress levels were measured with the Visual Analog Scale (VAS). Associations between variables were analyzed using non-parametric tests, Spearman’s correlations, and multiple regression analysis. Results: Clinically significant anxiety was observed in 41.1% of participants. The mean HRQL score was 57.4 ± 22.3 points. In multivariate analysis, symptom severity was the only independent predictor of HRQL (β = −0.67, p < 0.001), explaining approximately 45% of its variance. Anxiety, stress, and sociodemographic factors were not independently associated with overall HRQL. However, higher levels of anxiety and stress were significantly associated with poorer sexual functioning. Women living in rural areas and those with higher body weight reported poorer outcomes in selected quality-of-life domains. Conclusions: Symptom severity is the primary determinant of HRQL in women with uterine fibroids. Although anxiety and stress do not independently predict overall quality of life, they may adversely affect sexual functioning. These findings support a comprehensive management approach that combines symptom-oriented treatment with psychological and educational support. Full article

This study conducted an initial psychometric evaluation of the Japanese version of the Social Safeness and Pleasure Scale (SSPS-J). In Study 1 (N = 477), exploratory factor analysis supported a single-factor structure with excellent internal consistency (alpha = 0.95, omega = 0.95). Significant correlations with depression (r = −0.53), anxiety (r = −0.26), stress (r = −0.36), life satisfaction (r = 0.67), and social support (r = 0.47–0.52) demonstrated robust convergent validity. In Study 2, confirmatory factor analysis (N = 262) confirmed the reproducibility of the single-factor model with an acceptable overall fit (CFI = 0.943, SRMR = 0.036, RMSEA = 0.108). Test–retest reliability over a three-week interval (N = 113) was also high (ICC = 0.88). These results suggest that the SSPS-J is a reliable and valid preliminary measure for assessing social safeness in the Japanese general population. Full article

Aquatic recreation significantly enhances well-being; however, individuals experiencing functional limitations remain frequently marginalized from this form of tourism due to infrastructural and environmental barriers. This study investigates the perceived operational risks and apprehensions encountered by users with specific accessibility needs during yacht sailing, aiming to inform inclusive vessel design aligned with the social dimension of sustainable development. A survey of 277 participants with diverse, officially certified functional limitations was conducted to evaluate their maritime experiences and safety concerns. Participants identified a mean of 11 pre-voyage apprehensions out of 19 distinct risk categories. The most prevalent concerns included stumbling, slipping, or falling on board (79%), the risk of falling overboard (73%), and seasickness (70%), with an overall moderate severity ($\overline{X}$ = 2.2 on a 4-point scale). Crucially, severe safety concerns (e.g., vessel sinking or falling overboard) were significantly mitigated following practical sailing experience. Conversely, everyday functional and ergonomic challenges—such as moving between the deck and crew quarters ($\overline{X}$ = 2.6), operating rigging ($\overline{X}$ = 2.7), embarkation ($\overline{X}$ = 2.6), and utilizing sanitary facilities ($\overline{X}$ = 2.1)—persisted irrespective of experience level. Statistical analysis revealed that gender and age had negligible effects on concern levels. Extensive maritime experience reduced apprehensions regarding balance and swimming competencies, while concurrently increasing awareness of communication and comfort-related operational challenges. This study highlights a distinct divergence between initial psychological anxiety—which is largely mitigated by experience—and persistent architectural barriers inherent in standard yacht design. The results underscore that achieving meaningful inclusivity in water tourism requires prioritizing interior spatial layouts, accessible sanitary facilities, and barrier-free vertical circulation in naval architecture, rather than focusing exclusively on emergency safety systems. These insights directly support the advancement of Sustainable Development Goal 10 and the integration of universal and human-centered design principles within the maritime recreation sector. Full article

Background and Objectives: Anxiety can influence the intensity of postoperative pain, anesthesia and the need for analgesia. Likewise, proper anxiety management can reduce hospital stays. Therefore, it is important to review the actions of nursing professionals and estimate the effect size of nursing interventions to reduce anxiety in pre- and postsurgical processes. Therefore, the objective of this study was to analyze the effectiveness of preoperative motivational interviews by nursing to reduce pre- and postoperative anxiety and postoperative pain after surgery. Materials and Methods: A systematic review was carried out according to the PRISMA guidelines, with a record in PROSPERO using DeCS and Boolean operators OR and AND to increase the specificity of the search. In the EBSCOhost, Pubmed, Cochrane Library and Scopus databases, 104 studies were obtained. Patients ≥ 18 years of age with scheduled surgeries, communication skills, clinical trials or quasi-experimental studies were included. The risk of bias 2 (RoB2) tool was used to assess the risk of bias in the studies. A random effects meta-analysis was performed to analyze pre- and postoperative anxiety and postoperative pain. Results: A total of 6 studies were included (4 clinical trials and 2 quasi-experimental studies). All the studies analyzed preoperative anxiety, which was significantly lower (SMD = −1.53; 95% CI: −4.01 to −0.95; I² = 40%). Postoperative pain (SMD = −0.74; 95% CI: −0.94 to −0.54; I² = 35%) and postoperative anxiety (SMD = −0.48; 95% CI: −0.78 to −0.19; I² = 0%) also decreased. Conclusions: Motivational interviews by nurses may help provide clearer information and emotional support and allow patients to express doubts, reducing their fear of anesthesia, pain and the recovery process. Emotional control improved adaptation to the surgical environment, reducing postoperative pain. With respect to implications for clinical practice, it is necessary to use the same scales to measure anxiety to better compare the studies. Full article

Endpoints of a continuous scale have identified the work engagement extremes of psychological flow and burnout. If a scale, employees could hold these experiences simultaneously, to some degree. Instead, there are two types of employees concerning work engagement: those who experience the extremes of psychological flow and burnout, and those who do not. A deductive model concerning General Systems Theory modifies Csikszentmihalyi’s four-quadrant model. It indicates that eliminating burnout requires achieving psychological flow rather than any other form of work engagement. Therefore, not all experiences currently labelled as burnout are such. Considering skill and challenge, apathy, anxiety, and boredom more correctly define these other negative work-engagement experiences. As such, solutions for improving work engagement require: (1) differentiating burnout from other forms of work-related exhaustion concerning employee skill and challenge, (2) interventions promoting the positive aspect of every work engagement type, and (3) abandoning the idea that social justice necessitates all employees achieve psychological flow—instead viewing social justice as achieved work engagement. Relevant work engagement solutions are according to the modified four-quadrant model. This novel perspective offers conceptually simple, research-supported approaches to eliminating burnout and other forms of work-related exhaustion, promoting work engagement as a preferred form of social justice. Full article

Objectives: We aimed to examine the association between bubble tea consumption and anxiety symptoms among adolescents in Eastern China and to explore the potential role of sleep disturbance in the observed association between bubble tea consumption and anxiety symptoms. Methods: This study utilized cross-sectional baseline data from the Zhejiang Childhood Behavior and Health Cohort. Bubble tea consumption frequency was categorized as 0, 1–2, and ≥3 days per week. Anxiety symptoms were assessed using the Generalized Anxiety Disorder—7 (GAD-7) scale, while sleep disturbance was measured through self-reported items. Associations between bubble tea consumption and anxiety symptoms were examined using multivariable logistic regression models, and dose–response relationships were evaluated with restricted cubic spline (RCS) models. Subgroup analyses stratified by age, sex, school type, residence, and body mass index (BMI) were conducted to assess the consistency of the associations. An exploratory mediation analysis with bootstrap confidence intervals was performed to evaluate the indirect association through sleep disturbance. Sensitivity analyses using a stricter definition of anxiety symptoms (GAD-7 ≥ 10) were conducted to assess robustness. Results: A total of 11,847 adolescents aged 12–18 years were included, of whom 32.03% met the GAD-7 threshold for any anxiety symptoms (GAD-7 ≥ 5, including mild symptoms). Compared with non-consumers, adolescents consuming bubble tea 1–2 days per week had higher odds of anxiety (OR = 1.12, 95% CI: 1.02–1.22), while those consuming bubble tea ≥3 days per week had substantially higher odds (OR = 1.53, 95% CI: 1.30–1.80). Each additional day of bubble tea consumption per week was associated with 10% higher odds of anxiety (OR = 1.10, 95% CI: 1.06–1.14). RCS analysis demonstrated a significant positive linear association between bubble tea consumption and anxiety (p for non-linearity > 0.05). Associations were consistent across age, sex, school type, residence, and BMI categories (all p for interaction > 0.05). Sensitivity analyses yielded similar results. Exploratory mediation analysis suggested that sleep disturbance may be statistically related to a portion of the observed association between bubble tea consumption and anxiety symptoms. Conclusions: Higher frequency of bubble tea consumption was associated with greater odds of anxiety symptoms among adolescents in a dose–response pattern. Sleep disturbance may statistically explain part of the association. These findings should be considered hypothesis-generating and require confirmation in prospective longitudinal studies. Full article

Background/Objectives: Dental anxiety (DA) is a well-known obstacle affecting dental care in children. Children living in orphanages are a special population with healthcare needs. The aim of the study was to assess DA among children living in orphanages compared to those living with both biological parents. Methods: This frequency-matched case–control study included 61 children living in orphanages in Jeddah city and 122 age- and gender-matched peers living with both parents in Jeddah, Saudi Arabia. Demographic and background data, including medical history, dental visit history, and Adverse Family Experiences (AFEs), were completed by the caregiver. Dental anxiety was assessed subjectively using the self-reported Abeer Children Dental Anxiety Scale (ACDAS) and objectively by the Venham Clinical Anxiety Rating Scale (VCARS). Results: The prevalence of children with DA in the study sample among those living in orphanages was 18%. AFEs were significantly higher among children living in orphanages (96.7% vs. 32%, p < 0.001). ACDAS and VCARS showed fewer children with DA living in orphanages compared to children living with both parents. Logistic regression showed that living in orphanages decreased the adjusted odds ratio (AOR) of dental anxiety according to ACDAS (AOR = 0.36; p = 0.06) and VCARS (AOR = 0.43, p = 0.040). Conclusions: Although children living in orphanages presented with lower DA than those living with both parents, this may point to differences in emotional expression rather than true emotional state. Clinicians should not rely only on behavioral observations when treating institutionalized children. Full article