Search Results (238)

Comprehensive sex education (CSE) is recognized globally as a key strategy for promoting adolescent well-being and preventing gender-based violence (GBV). Yet, in the United States, the absence of a federal mandate and deep political division results in inconsistent and often inadequate CSE within and across the 50 states. Our review critically examined U.S. sex education policy and programming research literature in relation to GBV prevention. We also conducted a 50-state policy content analysis of sex education requirements, alongside related political trends and overlapping conservative policies. Discussed as, the “politics of sex education,” our findings reveal that states lacking medically accurate CSE also are more likely to support abstinence-only education, restrict discussions of race and gender in secondary educational settings, and adopt laws limiting reproductive and LGBTQ+ rights. We also found that CSE, when culturally responsive, trauma-informed, and medically accurate, can reduce GBV and equip youth with essential skills necessary to understand consent in intimate relationships. Overall, our literature review and policy clustering underscores how educational content is shaped by broader ideological agendas. Findings point to a dearth of research, particularly concerning educational practice in more conservative political contexts. We conclude with recommendations around the need for coordinated policy reform, educator training, and community collaboration to address GBV through evidenced-based CSE. Full article

Placebo, nocebo, and lessebo effects are very frequent in patients with both neurological and psychiatric disorders. Interestingly, the neural mechanisms underlying placebo effects have been found to be the same as or similar to mechanisms targeted by active pharmaceutical interventions for many of these disorders. In the case of functional neurological disorders (FNDs), there are shared neural substrates between the central nervous system “placebo network” and the dysfunctional networks implicated in the pathophysiology. These networks are primarily involved in emotion regulation, stress responses, and the sense of self-agency. Therefore, placebo effects have also been discussed as therapeutic interventions in FNDs. Such an approach, however, has a variety of ethical implications evolving around informed consent, autonomy, nonmaleficence, beneficence, and justice. In this paper, we discuss the use of placebo, nocebo, and lessebo in FNDs as well as related ethical issues. Overall, the use of placebo in FNDs is currently still considered controversial both for diagnostic as well as therapeutic purposes. Although it is a safe and almost unique intervention, its use violates the core principles of medical ethics and doctor–patient interactions involving autonomy or openness in the therapeutic relationship. Full article

Introduction: Aesthetic surgery addresses subjective desires for morphological enhancement and differs from reconstructive surgery due to its elective, non-therapeutic nature. This distinction introduces complex medico-legal challenges, particularly concerning informed consent, patient expectations, and the legal evaluation of aesthetic damage. Materials and Methods: A narrative review was conducted using national legislation, Italian and international clinical guidelines, peer-reviewed literature from PubMed, Scopus, and Web of Science, and Italian Supreme Court rulings. Eight commonly litigated aesthetic procedures were analyzed in terms of clinical indications, public reimbursement criteria, and medico-legal risk. Results: Findings revealed significant variability in medico-legal exposure among procedures. Fully elective interventions such as liposuction and breast augmentation carried the highest litigation risk. Common legal claims included inadequate informed consent, poor psychological assessment, and mismatched expectations. The review emphasizes the need for personalized consent processes and comprehensive preoperative evaluations. Discussion: Italian case law increasingly adopts a “mixed obligation” model for aesthetic surgery, requiring not only technical skill but also a prognostic and relational evaluation of the intervention. Informed consent must be detailed, individualized, and well-documented, as it holds greater legal weight than in therapeutic procedures. Predictive medico-legal tools such as psychological profiling and structured consent protocols are essential for risk mitigation. Conclusions: Modern aesthetic surgery requires a redefined approach to damage assessment that incorporates psychological, relational, and identity factors. In both clinical and surgical practice, an approach tailored to the patient’s psychological profile must be increasingly taken into consideration, both when proposing and carrying out treatments and in medical-legal assessments. A legally and ethically sound practice depends on transparency, documentation, and patient-centered care, especially in the absence of therapeutic indications. Full article

Background: Effective shared decision-making (SDM) for life-sustaining treatment (LST) requires alignment between physicians and surrogates. However, discrepancies in perceptions and communication may hinder ethically sound decisions. This study aimed to compare the perceptions and attitudes of physicians and surrogates toward SDM for LST in a Chinese hospital setting. Methods: This pre-planned secondary analysis included data from two cross-sectional surveys administered to physicians and surrogates. Participants were 325 surrogates of critically ill adult patients admitted to the Emergency Intensive Care Unit (EICU) of a tertiary teaching hospital and 351 physicians from hospitals in Beijing. Survey items assessed triggers and preferred models of decision-making, disclosure practices, perceived decisional capacity, and factors influencing LST decisions. Statistical comparisons were performed using appropriate tests for categorical data. Results: Although a majority in both groups nominally preferred SDM (physicians: 52.7%; surrogates: 44.3%; p = 0.155), significant discrepancies emerged across other domains. Physicians were more likely than surrogates to initiate LST discussions earlier (88.0% vs. 75.3%; p < 0.001). Perceived understanding differed markedly: 87.7% of surrogates rated their comprehension as “good” or “excellent”, whereas 73.8% of physicians rated surrogate understanding as “fair” or “poor” (p < 0.001). Surrogates expressed a stronger preference for receiving quantitative prognostic information and decision-support tools. Most physicians (94.9%) reported directing consent discussions primarily to families, with limited patient involvement. Priorities for LST decisions diverged: physicians emphasized clinical indicators such as prognosis (96.0%) and comorbidities (91.7%), whereas surrogates emphasized patient age (72.0%). Conclusions: Marked discordances exist between physicians and surrogates in their perceptions and practices regarding SDM for LST in China. Differences in communication strategies, informational expectations, and decision-making priorities underscore the need for contextually adapted interventions, such as structured communication tools and culturally sensitive clinician training, to bridge these gaps and support ethically aligned decision-making. Full article

Background: The nipple–areolar complex (NAC) necrosis is a rare yet significant complication following breast reduction surgery, primarily linked to compromised vascularization of the NAC, particularly in nipple-sparing techniques. While multiple therapeutic strategies have been described in the postoperative setting, their application remains limited in clinical practice. Case series: We report on three patients that developed early NAC venous distress following bilateral breast reduction. Following discussion of therapeutic options—ranging from conventional methods such as scarification and local heparin therapy to off-label pharmacologic treatment—all three patients received oral sildenafil citrate (20 mg every 6 h), after excluding contraindications and obtaining informed consent. In two patients, sildenafil alone was sufficient to restore venous outflow and salvage the NAC. In one case, adjunct scarification and heparin therapy were necessary due to partial response. No arterial damage or major adverse effects related to sildenafil were observed during the postoperative period. Conclusions: This small series supports the potential use of off-label sildenafil citrate as a valuable, non-invasive pharmacologic option for treating postoperative areolar venous congestion. Its favorable safety profile, widespread hospital availability, and mechanism of enhancing microvascular circulation make it a promising adjunct in managing this complication. Further studies are warranted to standardize its use and determine its place within a broader postoperative management spectrum of compromised vascularization in breast surgery. Full article

Evidence-based medicine (EBM) supplies the best available data, yet clinicians still face low-value care, surrogate-driven reversals, and pseudoscientific claims. We propose Semi-Imperative Evidentialism (SIE), a normative framework that links evidential warrant to proportionate professional duties while preserving patient autonomy. Using a targeted narrative review in philosophy of science, bioethics, and clinical epidemiology, we distilled six binary attributes to classify activities as Science, Pseudoscience, or Non-science. Scientific items enter a two-tier ladder—Tier 1 (established clinical evidence) or Tier 2 (emerging or preclinical evidence)—with status re-scored as randomized trials, living meta-analyses, and post-marketing safety signals accrue. SIE maps tiers to action: Tier 1 should be offered or strongly recommended, with reasons documented if declined; Tier 2 should be discussed with explicit consent, preferably within trials or registries; Pseudoscience should be refused or discontinued with corrective education; Non-science may be acknowledged as contextual support when safe and non-substitutive. Worked examples—antiarrhythmic suppression post–myocardial infarction (CAST) and “complementary cancer cures”—illustrate earlier and more transparent course-correction. SIE provides a fallibilist bridge from evidence to duty, constraining discretion without eroding autonomy; prospective audits and cluster trials should test its impact on prescribing and consent. Full article

The rapid rise of generative AI tools such as ChatGPT has prompted significant shifts in how higher education institutions approach academic integrity. Many universities have implemented AI detection tools like Turnitin AI, GPTZero, Copyleaks, and ZeroGPT to identify AI-generated content in student work. This qualitative evidence synthesis draws on peer-reviewed journal articles published between 2021 and 2024 to evaluate the effectiveness, limitations, and ethical implications of AI detection tools in academic settings. While AI detectors offer scalable solutions, they frequently produce false positives and lack transparency, especially for multilingual or non-native English speakers. Ethical concerns surrounding surveillance, consent, and fairness are central to the discussion. The review also highlights gaps in institutional policies, inconsistent enforcement, and limited faculty training. It calls for a shift away from punitive approaches toward AI-integrated pedagogies that emphasize ethical use, student support, and inclusive assessment design. Emerging innovations such as watermarking and hybrid detection systems are discussed, though implementation challenges persist. Overall, the findings suggest that while AI detection tools play a role in preserving academic standards, institutions must adopt balanced, transparent, and student-centered strategies that align with evolving digital realities and uphold academic integrity without compromising rights or equity. Full article

Arthritis and arthrosis are prevalent joint diseases that cause pain and disability, and their early diagnosis is crucial for preventing irreversible damage. Conventional diagnostic methods such as X-ray, ultrasound, and MRI have limitations in early detection, prompting interest in alternative techniques. This work presents the design and clinical evaluation of a prototype device for non-invasive early diagnosis of arthritis (inflammatory joint disease) and arthrosis (osteoarthritis) using infrared thermography and deep neural networks. The portable prototype integrates a Raspberry Pi 4 microcomputer, an infrared thermal camera, and a touchscreen interface, all housed in a 3D-printed PLA enclosure. A custom Flask-based application enables two operational modes: (1) thermal image acquisition for training data collection, and (2) automated diagnosis using a pre-trained ResNet50 deep learning model. A clinical study was conducted at a university clinic in a temperature-controlled environment with 100 subjects (70% with arthritic conditions and 30% healthy). Thermal images of both hands (four images per hand) were captured for each participant, and all patients provided informed consent. The ResNet50 model was trained to classify three classes (healthy, arthritis, and arthrosis) from these images. Results show that the system can effectively distinguish healthy individuals from those with joint pathologies, achieving an overall test accuracy of approximately 64%. The model identified healthy hands with high confidence (100% sensitivity for the healthy class), but it struggled to differentiate between arthritis and arthrosis, often misclassifying one as the other. The prototype’s multiclass ROC (Receiver Operating Characteristic) analysis further showed excellent discrimination between healthy vs. diseased groups (AUC, Area Under the Curve ~1.00), but lower performance between arthrosis and arthritis classes (AUC ~0.60–0.68). Despite these challenges, the device demonstrates the feasibility of AI-assisted thermographic screening: it is completely non-invasive, radiation-free, and low-cost, providing results in real-time. In the discussion, we compare this thermography-based approach with conventional diagnostic modalities and highlight its advantages, such as early detection of physiological changes, portability, and patient comfort. While not intended to replace established methods, this technology can serve as an early warning and triage tool in clinical settings. In conclusion, the proposed prototype represents an innovative application of infrared thermography and deep learning for joint disease screening. With further improvements in classification accuracy and broader validation, such systems could significantly augment current clinical practice by enabling rapid and non-invasive early diagnosis of arthritis and arthrosis. Full article

Due to the burdens of critical operations, firefighters are at occupational risk of developing mental health problems such as post-traumatic stress symptoms (PTSS) or anger. In this study, we assessed the impact of a firefighting operation with two fatalities and eleven injuries among colleagues on the mental health of those involved. Aims: The study hypothesizes that firefighters who were acquainted with the wounded or deceased show more PTSS and score higher on the STAXI-2 State Anger, Anger Expression-In/Out, and Anger Control-In/Out compared to those who were not. The second hypothesis assumes that the deployed group shows more PTSS and scores higher on the STAXI-2 State Anger, Anger Expression-In/Out, and Anger Control-In/Out compared to the grouping of non-deployed colleagues. Methods: A total of N = 138 firefighters were included, of which n = 32 were deployed and n = 106 were not (n = 26 acquainted with wounded or injured; n = 107 not acquainted with wounded or injured; n = 5 not specified). Both groups completed a standardized questionnaire voluntarily and after providing written informed consent ten months after the incident. The questionnaire consisted of the Posttraumatic Stress Checklist for DSM-5 (PCL-5) and the State-Trait Anger Inventory (STAXI-2) questionnaire. Results: Firefighters who knew the injured or deceased colleagues had significantly higher PTSS [T(23.7) = −2.5; p = 0.019; d = 0.67; 95% CI = (−10.8, −1.0)], state anger [T(74.2) = 2.4; p = 0.021; d = 0.41; 95% CI = (0.2, 2.0)], and anger control scores [T(124) = −2.7; p = 0.008; d = 0.71; 95% CI = (−5.9, −0.9)]. In addition, the deployed group showed higher anger control [T(134) = 2.0; p = 0.046; d = 0.42; 95% CI = (0.0, 4.2)] and outward anger expression [T(73.5) = −2.2; p = 0.032; d = 0.40; 95% CI = (−2.3, −0.1)] scores compared to their non-deployed colleagues. Discussion: Future psychological pre- and post-deployment interventions should place more focus on the increased vulnerability of those acquainted with wounded or deceased colleagues. Full article

Evidence from the international literature indicates alarming prevalence rates associated with various forms of intimate partner violence since adolescence. To prevent gender-based violence and increase psychological well-being in intimate relationships, both the scientific literature and policy makers agree on the importance of implementing specific prevention and education programs targeting adolescents. The purpose of this longitudinal study was to evaluate the impact of an educational intervention to promote awareness of one’s relationship with one’s own body, stereotypes related to gender and sexuality, and the issue of sexual consent. Participants were adolescents aged 15–16 years who filled a questionnaire prior to the start of the intervention (Time 0, N = 192, 55.7% male) and two weeks following its conclusion (Time 1, N = 178, 53.9% male). Results indicate that compared to Time 0, after participation, body surveillance, benevolent sexism, and endorsement of the sexual double standard decreased, while no significant effect emerged in relation to the issue of sexual consent. Implications for research and intervention are discussed, with the goal of providing useful guidance for those implementing interventions for young people to address intimate partner violence and promote relationship well-being. Full article

Background and Objectives: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy caused by chronic compression of the median nerve within the carpal tunnel. Patient education is a cornerstone of informed consent and postoperative outcomes, yet time constraints often limit traditional consultations. Recently, generative AI tools such as ChatGPT have emerged as potential adjuncts in delivering standardized medical information. Materials and Methods: This study evaluated the quality and comprehensiveness of ChatGPT-generated patient education on CTS and open carpal tunnel release. A standardized prompt was used with ChatGPT-4o to generate educational material. A structured and standardized questionnaire was then administered to both patients and physicians (n = 8) to assess content quality, clarity, comprehensiveness, and perceived usefulness. Results: Both patients and physicians reported high satisfaction with the information provided. The etiology, procedural risks, and general anatomical principles were well conveyed. However, certain intraoperative concepts—such as neurolysis, synovectomy, and hemostasis—were underrepresented. While conservative therapies were addressed, the omission of endoscopic surgical options limited informational completeness. Prognostic information and long-term consequences of untreated CTS were rated as average by some participants. Postoperative guidance was adequately covered but lacked individualized nuance. Conclusions: ChatGPT shows promise as an adjunct in surgical patient education, offering clear and standardized information. Nevertheless, it is not a substitute for clinician–patient interaction. While it may bridge preliminary knowledge gaps, emotional support and individualized consent discussions remain essential. Further refinement and clinical validation of AI-generated educational content are needed to ensure safe and effective integration into routine practice. Full article

Objective: Emerging adulthood often involves a greater degree of disordered eating behaviors, especially among women. In this psychosocial context, extant evidence suggests that psychological distress is a major contributing factor to disordered eating behaviors. The present cross-sectional study examined whether psychological distress was positively associated with disordered eating behavior in a sample of emerging adult women, and whether difficulty in emotion regulation, self-concealment, or both together, at least partially explained this association. Method: Participants were 723 emerging adult women aged 18 to 25 years old (M_age = 19.5, SD_age = 1.6) who were recruited from a four-year public university in Hawaii, USA. Upon the completion of the informed consent procedure, they voluntarily completed an online survey package that included the self-report measures assessing disordered eating behavior, psychological distress, difficulties in emotion regulation, and self-concealment. Results: We found that psychological distress was positively associated with disordered eating behaviors. We also found that both difficulty in emotion regulation and self-concealment partially accounted for the positive association between psychological distress and disordered eating behavior. Discussion: Future research should examine the conceptual and applied implications of these findings further. Full article

A 75-year-old Jehovah’s Witness with recent ST-elevation myocardial infarction (STEMI) underwent percutaneous coronary intervention (PCI) with stenting of the proximal LAD. She was later diagnosed with gallbladder cancer and required urgent surgery but firmly refused allogeneic blood transfusion. This posed a major challenge, as the surgery was expected to cause significant bleeding, and the patient had undergone coronary stenting within the previous three months, which is when the risk of stent thrombosis is highest if dual antiplatelet therapy (DAPT) is interrupted. After conducting a careful multidisciplinary discussion and obtaining informed consent, both aspirin and clopidogrel were discontinued five days preoperatively. Through comprehensive blood conservation strategies—including acute normovolemic hemodilution (ANH), intraoperative cell salvage, and robotic-assisted minimally invasive surgery—the patient successfully underwent extended cholecystectomy without transfusion. This case highlights the possibility of safe, completely transfusion-free major surgery in patients with recent PCI and high thrombotic risk when individualized perioperative planning is applied. Full article

This article examines the integration of artificial intelligence (AI) into qualitative psychological research, focusing specifically on AI-assisted data analysis and its epistemological and ethical implications. While recent publications highlight AI’s potential to support analysis, such approaches risk undermining the reflexive, situated, and culturally sensitive foundations of qualitative inquiry. Drawing on relational and social constructionist epistemologies, as well as examining risks inherent in AI technologies, this work critiques the superficial outsourcing of analytical and interpretive processes to AI models. This trend reflects a broader tendency to regard AI as a neutral and objective research tool, rather than as an active participant whose outputs are shaped by, and in turn shape, the social, cultural, and technological contexts in which it operates. An alternative framework is proposed for integrating AI into qualitative inquiry, particularly in psychological research, where data are often sensitive, situated, and ethically complex. A list of best practices is also included and discussed. Key ethical concerns, such as data privacy, related algorithmic affordances, and the need for comprehensive informed consent, are examined. The article concludes with a call to nurture a qualitative research culture that embraces relational and reflective practices alongside a critical and informed use of AI in research. Full article

This paper addresses issues around the viral safety of plasma derivatives, which have led to a spate of public inquiries over the past thirty years. These inquiries have ensued following the infection of recipients of plasma derivatives and have focused on identifying which, if any, parties were responsible for these events. The most recent of these inquiries—the Infected Blood Inquiry in the United Kingdom—ran between 2018 and 2022, and has reached conclusions regarding the allocation of responsibility, some of which are discussed in this review. The published reports of the inquiries, supplemented by evidence sourced from the peer-reviewed literature, the policies of government agencies, and public reactions to these processes, form the basis of this review. In addition, the perspective of the author, who has a background in plasma fractionation science as well as being a recipient of plasma products during the period covered by these various inquiries, is offered as a way of augmenting the issues covered. The benefits arising from these, occasionally controversial, inquiries are described, including the heightened commitment to blood safety by policymakers, the embedment of precautionism as a safety principle, and the need for transparency and informed consent in patient management. Full article