Search Results (4,181)

Background: This study aimed to assess the illness perceptions of patients diagnosed with hypertension from a primary care perspective. It also sought to identify the sociodemographic and clinical factors associated with illness perception. Methods: A cross-sectional descriptive study was conducted between February and March 2025, involving 116 hypertensive patients who attended family medicine outpatient clinics at Rize Training and Research Hospital, Turkey. Data were collected using a sociodemographic questionnaire and the Brief Illness Perception Questionnaire (BIPQ). Nonparametric tests, including the Mann–Whitney U test, Kruskal–Wallis H test with Dunn’s post hoc analysis, and Spearman’s correlation analysis, were employed to evaluate the data. Results: The mean age of the participants was 69.01 ± 6.07 years, with 76.7% of the participants aged over 65 years. The median total BIPQ score was 47.0, indicating a moderate illness perception. A significant negative correlation was observed between age and the total BIPQ score (Rho = −0.443, p < 0.001). Higher illness perception levels were significantly associated with lower educational attainment, shorter duration of antihypertensive treatment, and attribution of hypertension to stress, genetic predisposition, diet, and occupational factors (p < 0.05). Conclusions: Illness perceptions among patients with hypertension are shaped by various sociodemographic and clinical determinants. Enhancing awareness of these perceptions in primary care may support improved treatment adherence and better health outcomes. Interventions that strengthen health literacy and offer psychosocial support may contribute to more effective hypertension management. Full article

Diverse realities challenge the management capacity of public and private systems to ensure equitable quality and efficient access to resources, in line with the 2030 Agenda and the Sustainable Development Goals, which aim to close gaps in essential services and ensure quality of life. The reality in Spain, and more specifically in the Principality of Asturias, is that most resources are concentrated in urban areas rather than rural ones, partly due to the region’s geography. Background/Objectives: This study aimed to explore the perspectives of various stakeholders on the early childhood care system in the Principality of Asturias (Spain), with the purpose of analyzing the mechanisms and determinants involved in its functioning and identifying opportunities for improvement. Methods: A qualitative study was conducted using the theoretical framework of the National Institute on Minority Health and Health Disparities (NIMHD) as a conceptual basis. Semi-structured interviews were carried out with 24 participants selected based on their relationship with early childhood care systems, encompassing different levels of responsibility and operational roles. Data were analyzed using a phenomenological approach, employing inductive and deductive coding to identify recurring patterns and code co-occurrences within ATLAS.ti software. Conclusions: This study reveals major barriers to equitable early childhood intervention (ECI) in rural areas, such as geographic isolation, lack of specialists, long waiting times, and poor transport. Six key themes emerged, including the need for standardized system management, better family support, and digital tools like centralized electronic health records. Rural areas are directly limited regarding their access to services, highlighting the need for fair territorial planning and a holistic, inclusive care model. Improving coordination, accessibility, and technology is vital. Full article

Background and Objectives: The COVID-19 pandemic placed substantial mental and physical burdens on healthcare workers, particularly nurses. In the post-pandemic period, sustained stress, elevated mental workload and disturbed sleep may continue to affect well-being and job performance. This study aimed to assess perceived stress levels, occupational stress, and sleep quality among Hungarian nurses, while identifying key demographic, occupational, and behavioral predictors. Materials and Methods: A cross-sectional, quantitative study was conducted from April to July 2022 among nurses employed in Hungarian general hospitals (N = 418). Data were collected via an online self-administered questionnaire. Stress and sleep quality were measured using the Perceived Stress Scale (PSS-14), Expanded Nursing Stress Scale (ENSS), and Groningen Sleep Quality Scale (GSQS). Statistical analysis included descriptive statistics, ANOVA, post hoc tests, t-tests, and Pearson’s correlation (p < 0.05). Results: The mean PSS-14 score was 27.82 (SD = 7.82), indicating moderate stress. Sleep quality was poor (mean GSQS = 7.29, SD = 4.28), with significant positive correlation with perceived stress (r = 0.442, p < 0.001). Low income, lower education, and high coffee or alcohol consumption, and multiple night shifts were significantly associated with higher stress and poorer sleep quality. Occupational stress and mental workload, as measured by ENSS, was highest in internal medicine (mean = 122.16, SD = 37.09; p = 0.033). The most burdensome ENSS subscale was “workload” (mean = 2.30, SD = 0.92), with “not enough staff to adequately cover the unit” identified as the most stressful item. Additional cognitive and emotional workload components included dealing with violent patients and a lack of emotional preparedness in supporting families. Conclusions: Post-COVID nurses in Hungary experience moderate stress and impaired sleep. Excessive workload, emotional demands, and shift patterns significantly contribute to psychological and cognitive strain. Institutional and policy-level interventions are needed to reduce occupational stress and promote workforce resilience. Full article

Background/Objectives: Depression and anxiety in children pose a significant public health concern, with long-term implications for well-being. Over 10% of children and adolescents are affected by emotional disorders such as depression and anxiety. African American youth face disproportionate exposure to mental health risk factors, including poverty, adverse childhood events, community violence, and racial discrimination, which elevate their vulnerability to these disorders. A particularly at-risk subgroup includes African American children in kinship care arrangements (e.g., grandparents raising grandchildren), who may face additional factors such as family disruption and separation from birth parents. Methods: This mixed-methods sequential study examined how caregiver stress and birth mother–child relationship quality relate to depression and anxiety symptoms in African American children in kinship care. Phase I included survey data from 58 caregivers of children aged 5 to 12; Phase II involved interviews with 16 of these caregivers. Results: Results indicated that lower caregiver stress was associated with reduced child depression and anxiety symptoms. Furthermore, findings suggest that a high quality of the birth mother–child relationship serves as a promotive factor, particularly for depressive symptoms. Qualitative findings highlighted two themes: (1) the weight of kinship care, marked by factors such as ongoing grief and financial strain; and (2) birth parent relationships, defined by a mix of connection, conflict, and loss that affects children’s mental health. Conclusions: These findings underscore the need for greater understanding of the strengths and resources within kinship families that support positive mental health outcomes and highlight the importance of targeted interventions to reduce caregiver stress and foster supportive parent–child relationships. Full article

Background/Objectives: Family caregivers in palliative care often face complex physical, emotional, and logistical challenges, which can result in a significant caregiving burden. Dyadic interventions—designed to support both the patient and the caregiver simultaneously—have emerged as a promising holistic approach to enhancing well-being and quality of life. This systematic review aimed to evaluate the effects of dyadic support interventions in reducing caregiver burden among middle-aged and older adults receiving palliative care. Methods: A systematic literature search was conducted following PRISMA guidelines across five databases (CINAHL, MEDLINE, Web of Science, Scopus, and Google Scholar for grey literature) covering the period from 2019 to January 2025. Results: Of 653 records identified, 8 studies met the inclusion criteria. Interventions were typically delivered by multidisciplinary teams and included weekly in-person consultations, telephone follow-up, telemedicine, physical exercise sessions, laughter therapy, and music therapy over durations ranging from 16 weeks to 6 months. These programs resulted in reduced anxiety and depressive symptoms (PHQ-4, HADS, SDS, BAI, SAS), improved functional and social performance (SF-36), and/or enhanced quality of life (MQLQ, QOL-AD, KCCQ-12, EORTC QLQ-C30). In patients, they contributed to better symptom control (ESAS, CFS), while in caregivers, they effectively reduced burden (ZBI-12, FCBSI, CBI) and/or supported the anticipatory grief process (PGQ, AGS). However, not all studies reported consistently positive outcomes. Conclusions: Structured dyadic interventions that involve both patients and caregivers significantly improve outcomes in palliative care for middle-aged and older adults. Future research should examine their long-term impact and explore the integration of artificial intelligence to optimize intervention delivery. Full article

Objective: To assess gestational diabetes mellitus (GDM) awareness among women in the Northern Borders Province of Saudi Arabia and identify factors associated with knowledge levels. Methods: A cross-sectional study was conducted among 461 women using a structured, validated online questionnaire assessing demographics, medical history, and knowledge of GDM’s effects on maternal and neonatal outcomes. Associations between demographic factors and GDM awareness were analyzed using chi-square tests. Results: Most participants (98.5%) were Saudi nationals, with a mean age of 34.5 ± 10.0 years; 82.6% had university-level education. Overall, 42.3% demonstrated fair awareness of GDM, 34.3% had good awareness, and 23.4% had poor awareness. Knowledge of GDM’s maternal complications varied: 70% recognized the risk of emergency cesarean section, but only 8.2% were aware of increased preeclampsia risk. For neonatal outcomes, 58.4% identified high birth weight as a risk, while only 31.9% recognized the risk of congenital anomalies. Higher awareness was significantly associated with education level (p = 0.02), pregnancy status (p = 0.001), trimester (p = 0.002), and family history of relevant conditions (p = 0.04). Conclusion: Although many women showed fair-to-good awareness of GDM, notable gaps remain, especially regarding specific complications. Targeted educational interventions, particularly for less-educated and non-pregnant women, are recommended to improve GDM awareness and pregnancy outcomes. Full article

Background/Objectives: There is still debate about students’ health in medical schools. The aim of this study was to assess the proportion of chronic diseases among medical students and analyze their predictors. Methods: We performed a secondary cross-sectional analysis using a database from a single Portuguese university. The sociodemographic/clinical variables of 309 medical students were included. Logistic regression was performed to ascertain the effects of sex, age, medical course year, financial situation, and family history of chronic diseases on the likelihood of medical students having chronic disease. Results: Median age (Q1, Q3) was 21 (17, 43) years, with females comprising 79.9% of the sample. The distribution of students by school year was similar. The majority (65.7%) reported having sufficient money. Twenty-three percent suffered from chronic disease, and around forty percent had parents or siblings with chronic disease. In the regression model, only a family history of chronic disease was associated with a personal history of chronic disease. Medical students with parents or siblings who have a chronic disease are 3.3 times more likely to have a chronic disease themselves. Conclusions: Future interventions targeting the medical student population will be needed in Portugal to reduce the prevalence and burden of chronic diseases, particularly among those with a positive family history. Full article

Neurodevelopmental disorders are one of the most prevalent conditions today, and among the limitations in activity and restrictions in the participation of children and their families, we find intervention in activities of daily living; therefore, research focused on outcome measurement is one of the most active lines, and after COVID-19, telerehabilitation has garnered special interest. Background/Objectives: The study objective was to evaluate the effectiveness of a mobile health (mHealth) application in improving the performance of activities of daily living in children with neurodevelopmental disorders. Methods: The study employed a quasi-experimental design with a control group, using a fully remote mHealth-based intervention. The instruments used were a sociodemographic ad hoc, Pediatric Evaluation of Disability Inventory Computer, Family Outcomes Survey, Family Confidence Scale, and System Usability Scale. The final sample consisted of 13 participants. Results: The mHealth intervention showed significant improvements in occupational performance in the experimental group, especially in the global score and in the Responsibility dimension of the PEDI-CAT. No relevant differences were observed in the CON-FAN and FOS scales between groups, although the latter showed improvements over time. The usability of the app was rated positively (SUS = 69.75). Conclusions: The developed application presents good usability for families of children with neurodevelopmental disorders, but to obtain better outcome measures, the intervention should combine face-to-face sessions and the use of mHealth, as well as employing the family-centered model. Full article

Work–life balance (WLB) is central to sustainable social and economic development, as reflected in the UN Sustainable Development Goals 3, 5, and 8. The purpose of this article is to identify and examine the key organisational and personal factors influencing the perceived work–life balance of employees in rural areas. The theoretical framework is grounded in three complementary approaches: the job demands–resources (JD-R) model, spillover theory, and boundary theory. Together, they offer a comprehensive perspective on role dynamics in the context of limited resources, technostress, and family-related tensions. The study was conducted on a sample of 700 rural employees in Poland, predominantly women (60.6%), with the majority aged 35–55 years (53.0%). Data were collected via a structured questionnaire and analysed using an exploratory approach based on regression trees (CART), which are effective in identifying latent and multidimensional relationships. The findings highlight the mechanisms underlying WLB disruptions in rural contexts and pinpoint areas for intervention through public and organisational policies aimed at supporting employee well-being. The most influential factors were workplace comfort, work flexibility, time autonomy, and employee age. Notably, younger employees require better working conditions than older ones to achieve similar WLB levels. The CART analysis also indicates that some disadvantages, such as low workplace comfort, can be mitigated by more flexible work schedules. Employers should therefore provide multidimensional support through complementary measures, monitor job demands, and educate employees on the effective use of available resources. Full article

The family-centred Early Intervention model based on routines and natural environments has been widely supported by international evidence in recent decades. Within this framework, Family-Centred Practices (FCP) and their development in natural environments have emerged as an evidence-based intervention model of reference, promoting parental empowerment, shared decision-making, and functional intervention through daily routines. However, its effective implementation in real contexts presents multiple challenges, especially from the perspective of families receiving the service. Background/Objectives: This study explores the experiences, meanings, and assessments of Spanish families with children who have disabilities or developmental difficulties in relation to the application of these professional practices. This study is carried out in the Spanish context, since Campus Capacitas (Campus Capacitas—Catholic University of Valencia, Spain) has been implementing, in recent years, the family-centred model as a model of early intervention. Methods: A qualitative, descriptive, and interpretative methodology was used. Data collection was carried out through semi-structured interviews and discussion groups with 30 families from the 17 Spanish autonomous communities. Data analysis was carried out through thematic coding following criteria of qualitative rigour such as triangulation and theoretical saturation. Results: The findings show a significant gap between the theoretical model of family-centred practices and their practical application. Families who have experienced a clinical model criticise the absence of personalised intervention, unidirectional communication, as well as lack of participation in decision-making. In that sense, it is the different specialists of the early intervention team who are responsible for making intervention decisions. Therefore, these families demand more emotional and educational support. On the other hand, other families report positive experiences associated with collaborative, transdisciplinary, and home-based models based on a family-centred model. Conclusions: The results highlight the urgent need to move towards early intervention that strengthens the active role of families, promotes professional co-responsibility, and adapts to real child development environments, in line with international recommendations. Regarding future lines of research, we are committed to the development of longitudinal studies on the sustainable effects of interventions centred on families and on the global development of children and families. To carry out comparative studies between autonomous communities, to assess the influence of regulatory factors and regional resources on the practices implemented, as well as to carry out triangulation studies of the professional practices implemented, incorporating the perspectives of professionals and other intervention agents to enrich the analysis. Full article

Background/Objectives: Young families experiencing high levels of psychosocial stress should be addressed at an early stage to counteract potential negative effects on the parents’ and child’s wellbeing. This became particularly relevant during the COVID-19 pandemic when especially families have been strained by restriction measures. Early Childhood Intervention services (ECI) can provide low-threshold support, to which access should be encouraged. Methods: The randomized controlled trial of the CoronabaBY study with N = 1384 participants focuses on the effects of a newly developed app-based intervention on the awareness and usage of ECI services by young families with infants and toddlers during the COVID-19 pandemic in Germany. The analysis compares knowledge and usage rates of an intervention group (IG) and a waitlist control group (WCG) at three survey stages (pre-test, post-test and follow-up). Results: There was a significant increase in awareness of ECI services from pre-test to post-test in both the IG (15.2%) and WCG (10.7%) (p < 0.001), but the difference between the two groups was not significant. In contrast, the usage rate of further ECI services at post-test was significantly higher in the IG (12.1%) compared to the WCG (8.2%) (V = 0.060, p = 0.012), especially in a subgroup of highly stressed parents. Conclusions: Digital applications show potential to improve access to ECI services and should be continuously developed and evaluated to appropriately address young families and their needs. Full article

Background and Objectives: Borderline personality disorder (BPD) is a complex psychiatric condition characterized by emotional instability, impulsivity, a fluctuating self-image, and persistent difficulties in maintaining close interpersonal relationships. Among university students, these traits may be associated with social adjustment and academic functioning difficulties. The present study aimed to examine the prevalence of borderline traits within a Romanian student population and to investigate the associations between these traits and interpersonal difficulties encountered in family life, romantic relationships, and academic environments. Materials and Methods: This cross-sectional study included a total of 151 undergraduate students enrolled in higher education institutions across Romania. Data were gathered through an online questionnaire available between March and May 2025. The instrument comprised items addressing socio-demographic characteristics, diagnostic criteria for borderline personality traits according to the DSM, as well as self-reported social behaviour patterns. Statistical analysis was performed using GraphPad Prism 9, version 9.3.1 for Windows, employing Fisher’s exact test and the odds ratio (OR), with a significance threshold set at p < 0.05. Results: Most participants reported experiencing affective instability (71.5%) and distorted self-image (58.9%). Fear of abandonment was present in 29.4% of the respondents, while impulsivity was identified in 37.7%. Borderline personality traits were significantly associated with a range of social difficulties, including relational anxiety, outbursts of anger, peer conflicts, social withdrawal, and dissociative symptoms. Individuals who exhibited impulsivity, self-injurious behaviours, or dissociative episodes demonstrated a markedly increased risk of social dysfunction, with odds ratios ranging from 3 to 10 (p < 0.0001). Conclusions: The findings reveal a high prevalence of borderline traits within the analysed sample, along with statistically significant associations with social and emotional difficulties. These results underscore the importance of implementing psychological screening programs in universities, as well as early intervention strategies focused on the mental well-being of young adults. Establishing a supportive academic environment and fostering collaboration between faculty members and mental health professionals may play a key role in preventing symptom escalation and in promoting healthy personal and relational development. Full article

Background: Pregnancies following perinatal loss present emotional and clinical challenges that require individualized care. While awareness of the psychological vulnerability of bereaved parents is increasing, the perspectives and preparedness of healthcare professionals (HCPs) are still under-investigated. Methods: The UNSURENESS study involved a national cross-sectional web-based survey conducted between August 2023 and February 2024. The questionnaire explored sociodemographic data, professional experience, training in perinatal loss care, communication approaches, and clinical decision making. Results: Two hundred female HCPs participated (midwives 78.0%). One-third had received specific training on managing pregnancies after perinatal loss. On a 0–4 Likert scale, participants emphasized the importance of addressing the previous loss (M = 3.82; SD = 0.03) and building a trusting relationship with parents (M = 3.78; SD = 0.04). Providing comprehensive information (M = 3.59; SD = 0.05) and promoting shared decision making (M = 3.72; SD = 0.04) followed closely. The most challenging tasks included responding to parental fears (M = 3.37; SD = 0.75) and offering reassurance (M = 3.06; SD = 1.06). Clinical decisions were primarily driven by continuity of care (M = 3.70; SD = 0.56) and parental preferences (M = 3.63; SD = 0.57), rather than national guidelines (M = 3.16; SD = 0.82) or research evidence (M = 2.86; SD = 0.94). Conclusions: HCPs are aware of the psychosocial complexity involved in these pregnancies but often lack specific training. There is a clear need for trauma-informed interventions and national guidelines to better support both professionals and bereaved families. Full article

The study of early intervention programs for at-risk children and their families is a continuously evolving field. As a result, researchers, policymakers, and practitioners focus on the effectiveness of these programs. The educational outcomes of the implementation of early intervention programs have been well studied. However, regarding the financial and societal benefit of the implementation of these programs, studies are limited. Studies conducted in the past have indicated that early intervention programs are cost-effective; early intervention programs reduce the need for costly public services in the future by supporting the child’s wellbeing and development, promoting family stability, providing early access to appropriate support services, enhancing families’ knowledge and skills, and providing them with the resources necessary to support their children. There is a great need for updated financial evaluations related to the implementation of early intervention programs for at-risk children and their families to broaden their social impact. Thus, it is important that policymakers consider financial evaluations, in combination with qualitative data, in their decision-making procedures. Policymakers, researchers, and practitioners should closely cooperate in the planning and implementation of programs that meet the needs of the children and families who are at risk. Full article

Background/Objectives: Patients with heart failure (HF) experience increased morbidity, limited daily activities, and diminished quality of life (QoL), thus relying on a family member, widely known as informal caregiver, for support. The objective of this study was to explore (a) QoL, anxiety, and depression; (b) factors associated with QoL; and (c) the impact of associated factors on QoL among HF caregivers. Materials and methods: Data collection was performed using the 36-Item Short Form Survey (SF-36), the Hospital Anxiety and Depression Scale (HADs), and the European Heart Failure Self-care Behavior Scale (EHFScBS). Also recorded were characteristics of caregivers and patients. Results: In the present study, 110 HF caregivers and the family members they provided care to were enrolled. The majority of caregivers were patients’ spouses (60%) and were female (71.8%). Within a QoL score range of 0–100, caregivers showed moderate to high levels in role-physical, role-emotional, emotional well-being, and pain (median: 75, 66.7, 64, and 67.5, respectively); moderate QoL levels in energy/fatigue, social functioning, and general health (median: 55, 56.3, and 62, respectively); and poor QoL levels in physical functioning (median: 18). Moreover, 64.5% of caregivers had anxiety and 41.8% had depression. Caregivers with HADs scores that indicate anxiety and depression had worse QoL (p = 0.001). No association was detected between caregivers’ QoL and patients’ HADs and self-care. Conclusions: QoL and anxiety/depression merit further research by clinicians, health systems, and policymakers so that evidence-based policies and interventional programs tailored to their needs can be implemented. Full article