Search Results (21,424)

Background: Medical students are at high risk of psychological distress due to academic and personal pressures. This study assessed stress, depression, and associated factors among medical students, with emphasis on social support. Methods/Material: A cross-sectional survey was conducted among 367 medical students at King Faisal University using the Perceived Stress Scale (PSS) and Patient Health Questionnaire (PHQ). Data were analyzed using IBM SPSS version 29.0. Results: Participants were nearly equally distributed by gender (51.5% females), with a mean age of 22–23 years. The mean corrected PSS-10 score was 20.19 ± 6.21 and the mean PHQ-9 score was 9.45 ± 5.58; 48.2% screened positive for clinically significant depressive symptoms (PHQ-9 ≥ 10). High stress and depressive symptoms were prevalent; 43.1% frequently felt nervous, 44.7% reported hopelessness, and 43.1% endorsed any thoughts of being better off dead or of self-harm on the PHQ-9 screening item. Peer support was associated with significantly lower stress (PSS: 17.77 vs. 21.25, p < 0.001) and depression scores (PHQ: 8.09 vs. 11.0, p < 0.001), and remained an independent predictor of lower odds of a positive depression screen in adjusted analysis (adjusted OR 0.90, 95% CI 0.83–0.96). Female and pre-clinical students showed poorer psychosocial outcomes (p < 0.05). Conclusions: Psychosocial distress is common among medical students, particularly females and pre-clinical students. Higher perceived social support, particularly peer support, was associated with lower stress and depressive symptom scores; given the cross-sectional design these associations cannot establish causation, but they support strengthening peer- and faculty-support systems within medical schools. Findings should be interpreted in light of the cross-sectional, single-centre, self-report design and a response below the pre-specified target, which limit causal inference and generalisability. Full article

Background and Objectives: Effective palliative care relies on accurate identification and management of symptoms, especially in patients referred for palliative radiotherapy (PRT). This study aimed to identify symptom clusters (SCs)—defined as ≥2 interrelated symptoms—in patients evaluated at a multidisciplinary Radiotherapy and Palliative Care (RaP) outpatient clinic, using the Edmonton Symptom Assessment System (ESAS). Materials and Methods: We retrospectively analyzed data from patients referred to the RaP clinic between February 2017 and April 2020. Demographic and clinical characteristics, including ESAS scores at first visit, were collected. SCs were identified with principal component analysis (PCA) and unsupervised k-means clustering (KMC), determining the number of SCs based on the maximum gap statistic and interpretability. Associations with ECOG performance status (PS), primary tumor and metastases site, and PRT administration were analyzed. Exploratory survival analyses were performed. Results: Among 215 patients (median age = 71 years; 53% male), the mean total ESAS score was 24.03 (SD = 15.28). PCA identified four SCs: SC_PCA1 (tiredness, drowsiness, dyspnea, malaise), SC_PCA2 (depression, anxiety), SC_PCA3 (nausea, loss of appetite) and SC_PCA4 (pain). KMC revealed three SCs: SC_KMC1 (pain, tiredness, drowsiness, malaise), SC_KMC2 (nausea, loss of appetite, dyspnea), and SC_KMC3 (depression, anxiety). Worse ECOG PS correlated with physical SCs (p < 0.05). Psychological SCs were associated with lower likelihood of receiving PRT (OR_PCA2 = 0.26, CI: 0.07–0.80, OR_kmc3 = 0.19, CI: 0.02–0.85, p < 0.05), but when associated with pain/systemic clusters correlated with greater PRT use. A trend toward shorter survival was seen in SC_KMC2. Conclusions: SC analysis could improve personalized symptom management and clinical decision-making in the PRT setting. Full article

Sedentary behavior is conventionally defined as waking time spent sitting, reclining, or lying at very low energy expenditure (≤1.5 METs), a definition that supports surveillance and guideline translation. For cognitive and mental-health outcomes in later life, however, total sedentary minutes may be too coarse: seated episodes differ in cognitive demand, social context, autonomy over pacing, and stopping cues. This perspective advances a falsifiable thesis: distinguishing cognitively active from cognitively passive sedentary domains should yield more coherent and interpretable associations with cognition and mental health than total sedentary time alone. Existing evidence suggests that passive, media-dominant patterns and cognitively engaging seated practices relate differently to cognitive decline, dementia risk, and depression-related outcomes, although confounding and reverse causality remain central concerns. We propose a minimal measurement agenda: domain reporting, key modifiers, reliability flags for mixed episodes, episode-linked ecological momentary assessment, and time-reallocation contrasts. If domain resolution does not improve stability, coherence, or substitution-based interpretability, the thesis should be rejected or revised. Full article

Background/Objectives: Persons living with dementia (PLwD) receive informal care services from loved ones, commonly referred to as care partners (CPs). While the symptoms (e.g., depressive affect, cognitive impairment) experienced by PLwD are recognized to influence CP wellbeing, longitudinal investigations into the association of CP QoL and PLwD symptoms have yet to be fully explored. The present study sought to address this gap and highlight how CP QoL and PLwD symptoms systematically covary over time. Methods: Participants were composed of 33 dyads (PLwD and their CP) who partook in the Voices in Motion project, a social-cognitive intervention for dementia. CP QoL (WHOQOL-BREF), PLwD depressive symptomology (Patient Health Questionnaire-9) and PLwD global cognitive functioning (Mini-Mental State Examination) were assessed every three to four weeks in an intensive repeated-measures design. Time-varying covariation models using multilevel modeling examined systematic covariation between CP QoL and PLwD symptoms between and within dyads. Results: Increased CP psychological and social QoL were both associated with increased PLwD global cognitive functioning between dyads and vice versa (p < 0.05). Within dyads, increased CP social QoL was associated with improved PLwD depressive symptoms (p < 0.05), while increased CP environmental QoL was associated with increased depressive symptoms (p < 0.05). Conclusions: Significant coupling associations were observed both between and within dyads. Such results highlight the association between CP QoL and the symptoms experienced by their care recipient and provide important, novel longitudinal contributions to the literature. 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

When women choose a contraceptive method, the decision depends not only on what they prefer but also on the quality of the information they encounter online and on how confident they feel about using a method. We examined how exposure to inaccurate online contraceptive information (“digital misinformation”) and uncertainty about contraceptive decisions (“decisional conflict”) related to mental health and quality of life in women with and without a history of abortion. This was a cross-sectional study of 134 women aged 18–42 years attending obstetrics–gynecology or family-planning services at one Romanian tertiary center. Women were grouped as having no prior abortion (n = 41), one prior abortion (n = 53), or repeat abortion (n = 40). We measured a study-specific digital misinformation index, an access barrier index, contraceptive self-efficacy, reproductive autonomy, depression (PHQ-9), anxiety (GAD-7), well-being (WHO-5), quality of life (WHOQOL-BREF), and current use of highly effective contraception. We compared groups and used regression, mediation, and exploratory profiling. Women with repeat abortion reported the most online misinformation (10.0 ± 2.0), the most decisional conflict (43.9 ± 9.3), the lowest quality of life (61.3 ± 5.6), and the lowest use of highly effective contraception (45.0%). More misinformation and more access barriers were each associated with greater decisional conflict, while higher self-efficacy was associated with less. In this cross-sectional sample, online misinformation and decisional uncertainty were associated with reproductive vulnerability more closely than abortion count alone. Findings are associational and require prospective confirmation. Full article

Background: Hemodynamic depression, characterized by bradycardia and hypotension, is a common complication of carotid artery stenting (CAS) and is primarily attributed to carotid sinus baroreceptor stimulation. While prophylactic atropine is often used in high-risk patients, predictors of unexpected hemodynamic depression among patients initially deemed low-risk remain incompletely defined. Objective: To identify clinical, anatomical, and procedural predictors of hemodynamic depression in patients undergoing CAS without prophylactic atropine. Methods: We performed a retrospective, single-center observational study of consecutive patients undergoing CAS between January 2015 and May 2024. Patients who received prophylactic atropine for low baseline heart rate (HR) were excluded. Hemodynamic depression was defined as a >20% reduction in HR from baseline. Absolute bradycardia (HR <50 bpm) and hypotension (>40% reduction in systolic blood pressure) were recorded descriptively. Results: A total of 158 patients underwent CAS, of whom 33 (20.9%) were excluded due to prophylactic atropine administration for low pre-procedural heart rates (<60 bpm). Among 125 included patients, 62 (49.6%) experienced significant HR reduction during CAS. In multivariable analysis, a shorter distance between the stenotic lesion and the carotid bifurcation was independently associated with hemodynamic depression (OR 0.90 per mm increase; 95% CI 0.82–0.99; p = 0.023). Greater intraprocedural reductions in systolic and mean arterial pressure were also associated with HR depression. Traditional clinical risk factors, including age, sex, comorbidities, degree of stenosis, calcification severity, anesthesia type, and procedure urgency, were not independently predictive. Conclusions: Hemodynamic depression remains frequent during CAS even among patients classified as low risk. Lesion proximity to the carotid bifurcation is a key anatomical predictor of autonomic instability, highlighting the limitations of standard risk stratification and supporting a lesion-specific approach to periprocedural hemodynamic management. Full article

White adipose tissue (WAT) is essential for maintaining energy homeostasis during hibernation by supplying lipolysis-derived fatty acids as a major fuel source. In raccoon dogs (Nyctereutes procyonoides), the activity of brown adipose tissue is diminished, providing a unique model to investigate how WAT supports metabolic homeostasis in a largely non-thermogenic state. Here, we integrated physiological, histological, transcriptomic, and molecular analyses of back-fat and tail-fat depots during autumn fattening and winter sleep. Despite reduced food intake, body weight loss, and mild hypothermia, raccoon dogs maintained systemic glucose and lipid homeostasis. Both WAT depots exhibited adipocyte atrophy and the coordinated suppression of core metabolic and biosynthetic pathways, indicating a shared program of metabolic depression. However, the two depots adopted distinct remodeling strategies. Back-fat showed collagen densification and vascular-associated remodeling, suggesting a structural adaptation that may preserve tissue integrity during winter sleep. In contrast, tail-fat displayed enhanced innate immune signaling and M2 macrophage enrichment, indicating immune niche remodeling that may support tissue protection during prolonged lipid mobilization. Together, these findings reveal that raccoon dogs maintain metabolic homeostasis during shallow hibernation through a non-thermogenic, WAT-centered strategy characterized by shared metabolic depression and depot-specific structural and immunometabolic remodeling. Full article

Aim: Premenstrual Syndrome (PMS) substantially impairs quality of life, while standard pharmacologic treatments are often limited by adverse effects or contraindications. This systematic review and meta-analysis evaluated the efficacy of vitamin D supplementation compared to passive control (placebo or standard care) for PMS symptom relief. Methods: PubMed, Web of Science, Scopus, Google Scholar, and CENTRAL were searched for randomized controlled trials (RCTs) up to January 2026. The primary outcome was change in total PMS severity scores. Secondary outcomes included depression, anxiety, physical symptoms, craving, and water retention. Standardized mean differences (SMDs) with 95% confidence intervals (CI) were pooled using a random-effects model. Heterogeneity was assessed using the I² statistic. Results: Five RCTs including 436 participants were reviewed. The overall risk of bias was rated as “some concerns” in four RCTs and “low risk” in one trial. Vitamin D significantly reduced total PMS severity (SMD: −0.78, 95% CI: −1.30, −0.26, I² = 58.22%) as well as physical symptoms (SMD: −1.00, 95% CI: −1.99, −0.01, I² = 90.53%) and depression (SMD: −0.78, 95% CI: −1.53, −0.02, I² = 84.56%). No significant effects were observed for anxiety, craving, or water retention. Vitamin D was well tolerated with no reported adverse events. Conclusions: Vitamin D supplementation may reduce overall PMS severity, particularly physical and depressive symptoms. However, results show substantial heterogeneity across outcomes, and the certainty of evidence remains “very low”, underscoring the need for further high-quality, well-powered RCTs. Full article

Major depressive disorder (MDD) is clinically heterogeneous, and peripheral inflammatory biomarkers may help clarify early biological mechanisms before illness chronicity or pharmacologic treatment confound interpretation. This systematic review synthesized evidence on peripheral inflammatory biomarkers in first-episode, drug-naïve major depressive disorder (FEDN-MDD) compared with healthy controls and examined associations with clinical severity. Following PRISMA 2020, searches of PubMed/MEDLINE, Embase, PsycINFO, and Scopus from inception to 19 March 2026 identified 313 records; after screening, 16 publications were included in qualitative synthesis. Studies varied in age group, biological matrix, assay platform, and statistical reporting, precluding meta-analysis. The most frequently assessed biomarkers were IL-1β, TNF-α, IL-6, and CRP/hs-CRP. IL-6 showed the clearest recurrent tendency toward elevation in FEDN-MDD, whereas CRP/hs-CRP findings were partially positive but methodologically limited. TNF-α and IL-1β findings were mixed, and clinical correlations with depressive severity were sparse and inconsistent. Overall, the evidence supports heterogeneous early immune dysregulation in a subset of patients with FEDN-MDD rather than a single reproducible inflammatory signature. Peripheral inflammatory biomarkers should currently be considered research tools for biological stratification and mechanistic hypothesis generation, pending larger standardized longitudinal studies. Full article

Background: Fibromyalgia is a chronic condition characterised by widespread pain, fatigue, sleep disturbances, and psychological symptoms. Mindfulness-based approaches are increasingly used as complementary interventions for symptom management. This study aimed to investigate the effectiveness of mindfulness-based yoga (MBY) delivered via telerehabilitation in individuals with fibromyalgia. Methods: This trial included 64 women with fibromyalgia who were randomly assigned to an 8-week mindfulness-based yoga program delivered via telerehabilitation or active control group including walking and physiotherapy modalities. Both groups received patient education at the outset. Assessments were conducted before and after the intervention. Outcome measures included fatigue, anxiety, depression, sleep quality, symptoms associated with central sensitization, kinesiophobia, pain intensity, mindfulness level, impact of fibromyalgia on life, biopsychosocial status, and pain catastrophising. Data were analyzed using mixed-design analysis of variance (ANOVA), with additional t-tests and analysis of covariance (ANCOVA) conducted for post hoc analyses. Results: Compared to the control group, the mindfulness-based yoga (MBY) group showed more pronounced improvements in terms of fatigue, anxiety, symptoms associated with central sensitization, biopsychosocial status, symptom severity, catastrophising about pain, ruminative thoughts about pain, and cognitive dimensions of pain. Although no significant differences were found between groups for other variables, intra-group improvements were observed in the MBY group. Conclusions: It was concluded that the MBY intervention administered via telerehabilitation is a viable complementary approach to traditional treatments in reducing the symptom burden of fibromyalgia. It was thought that the effectiveness of the research could be increased by conducting studies involving long-term follow-up assessments and investigating the integration of different mindfulness-based telerehabilitation interventions into the clinical setting. Full article

Background: This study aimed to compare a limited set of predefined diet-, lifestyle-, knowledge-, and psychosocial indicators across school youth, students, and adults in Poland, and to examine their associations with three predefined outcomes: BMI ≥ 25 kg/m², poorer mental well-being, and high stress/overload. Diet quality, daily health-related practices, psychosocial well-being, and stress/overload may co-occur across different life stages, but online survey data require a focused analytical framework to avoid overinterpretation. Methods: This cross-sectional anonymous online survey included 360 respondents: 154 school youth aged 15–19 years, 127 students aged 20–29 years, and 79 adults aged 30 years or older. Dietary assessment was based on the KomPAN questionnaire and included the pro-healthy diet index, non-healthy diet index, and Diet Quality Index. Study-specific scores were used for knowledge, healthy practices, psychosocial well-being, and stress/overload. Analyses were restricted to predefined group comparisons, selected correlations, and three whole-sample adjusted logistic regression models. Results: Adults had the highest BMI and waist/hip circumference, whereas school youth showed the highest non-healthy diet index and more frequent high processed-food intake. Among the knowledge and psychosocial indicators, only obesity knowledge differed significantly between groups, with the highest mean value among students. Stress/overload was inversely associated with psychosocial well-being, and DQI was positively associated with psychosocial well-being after adjustment for age, sex, and group. In adjusted whole-sample models, BMI ≥ 25 kg/m² was positively associated with age and DQI and inversely associated with physical activity frequency and regular meals; the positive DQI–BMI association was interpreted cautiously as potentially reflecting reverse causality, reporting bias, or compensatory dietary modification among respondents with excess body weight. Poorer mental well-being was associated with higher stress/overload and inversely associated with DQI, physical activity frequency, and family meals. High stress/overload was positively associated with highly processed food intake and inversely associated with regular meals. Conclusions: The findings suggest that diet quality, behavioral regularity, and psychosocial burden may be more informative than knowledge alone when describing health-related profiles across age-defined groups. Because the study was cross-sectional, self-reported, anonymous, and based on a modest sample, the results should be interpreted as preliminary and hypothesis-generating rather than causal. Full article

Background/Objectives: Higher education requires students to communicate in complex academic and social contexts, including oral presentations, group work, help-seeking, assessment, and peer interaction. For students with developmental communication disorders, and communication-related developmental profiles, these demands may create hidden participation vulnerabilities that affect mental health, academic engagement, and belonging. This scoping review mapped empirical evidence among tertiary students, focusing on mental health, academic participation, social belonging, institutional support, and contextual influences. Methods: A scoping review was conducted in accordance with PRISMA-ScR guidance. Five databases, PubMed, PsycINFO, CINAHL, Scopus, and Web of Science, were searched for English-language, peer-reviewed empirical studies published from 2000 onwards. Eligible studies involved university, college, or tertiary students with developmental speech, language, fluency, pragmatic communication, or communication-related developmental profiles, who reported at least one mental health, academic, or social participation outcome. Data were charted and synthesised thematically, with methodological quality appraised using CASP-informed criteria. Results: Twenty-one studies were included. Evidence was strongest for stuttering and fluency-related participation, while research on developmental language disorder, speech sound disorder, pragmatic language impairment, cluttering, and mixed communication profiles was limited. Across studies, communication needs intersected with anxiety, depression, stress, self-efficacy, oral assessment, help-seeking, disclosure, stigma, accommodation access, and belonging. Key limitations included reliance on self-report, cross-sectional or retrospective designs, inconsistent diagnostic confirmation, and limited evidence for intervention. Conclusions: The available evidence suggests that developmental communication disorders and communication-related developmental profiles can function as hidden participation vulnerabilities in higher education. These vulnerabilities are shaped by students’ communication profiles and by communication-intensive university environments. Universities may therefore need communication-accessible teaching, flexible assessment, visible support pathways, and coordinated support across disability services, counselling, academic support, and speech–language pathology. Full article

Background/Objectives: Evidence on the associations between adherence to different plant-based diet indices and depression in young adults remains limited. This study aimed to analyze the associations of overall, healthy, and unhealthy plant-based diet indices with depressive symptoms in university students. Methods: A cross-sectional study was conducted in 2023 with self-reported data from university students in Cuenca, Spain. Adherence to the overall plant-based diet index (PDI) and to the healthy (hPDI) and unhealthy (uPDI) plant-based diet indices were calculated using data from a 137-item food-frequency questionnaire. Mild-to-severe depression was defined as a Beck Depression Inventory II score > 13 points. Linear and logistic regression models were adjusted for sociodemographic and lifestyle-related confounders. Results: A total of 392 students (mean age: 20.9 ± 2.4 years; 70.4% female) were included. The prevalence of mild-to-severe depression was 36.0%. Higher hPDI and overall PDI scores were associated with lower depressive symptom scores, whereas uPDI scores showed a positive but non-significant association after full adjustment. In logistic regression analyses, high adherence to the hPDI was associated with lower odds of mild-to-severe depression (OR = 0.51; 95% CI: 0.28–0.95; p-for-trend = 0.030). In contrast, higher uPDI adherence was associated with greater odds of depression, although the association was attenuated after adjustment for lifestyle-related variables. Conclusions: Greater adherence to a healthy plant-based diet was associated with lower depressive symptoms and lower odds of mild-to-severe depression among university students. These findings highlight the importance of plant food quality, rather than plant-based diets per se, in relation to depression in young adults. Full article

Chronic sleep deprivation (SD) disrupts gut–brain axis (GBA) homeostasis and is closely associated with gut microbiota dysbiosis, neuroinflammation, and depression-like behaviors. This study investigated whether fermentation enhances the antidepressant-like effects of Dendrobium officinale by comparing fermented Dendrobium officinale (FDO) with unfermented Dendrobium officinale (DO) in a chronic SD mouse model. FDO significantly ameliorated anxiety and depressive-like behaviors in SD mice. It reshaped gut microbial structures, enriched beneficial bacteria taxa such as Dubosiella, [Eubacterium]_coprostanoligenes_group, and Allobaculum, and increased SCFA levels. FDO also enhanced colonic ZO-1 and Occludin expression and reduced serum levels of LPS and the pro-inflammatory cytokines. At the central nervous system level, FDO inhibited the activation of hippocampal microglia and astrocytes; alleviated neuroinflammation; restored hippocampal TPH2, 5-hydroxytryptamine (5-HT), and 5-HIAA levels; and modulated the 5-HT_1A/5-HT_2A receptor balance. In addition, FDO upregulated BDNF, PSD-95, and SYN expression and reduced corticosterone (CORT) levels. Compared with DO, FDO showed more pronounced regulatory effects. Correlation analysis suggested that 5-HT may link gut microbial metabolites, inflammation, and synaptic plasticity. In summary, these findings support FDO as a potential GBA-targeted functional food for SD-related depressive-like behaviors. Full article