Search Results (10,256)

Background: Celiac disease (CD) is a chronic, immune-mediated condition requiring lifelong adherence to a gluten-free diet. In children, CD can negatively impact not only physical health but also psychological well-being and quality of life. The burden of dietary restrictions, social limitations, and emotional stress may lead to increased anxiety and depressive symptoms. This study aims to compare the quality of life, anxiety, and depression levels in children with celiac disease to those of healthy peers without chronic illness. Methods: The research involved a total of 129 individuals aged 8–18 years (64 with celiac disease and 65 healthy volunteers) and their parents. To assess children with celiac disease and healthy children, we used a sociodemographic form that we created, along with the State-Trait Anxiety Inventory (STAI), Trait Anxiety Inventory (TAI), Children’s Depression Inventory (CDI), Pediatric Quality of Life Inventory (PedsQL), and Parent Quality of Life Inventory tests. Results: Celiac patients’ diet adherence, parental education level, and family income were found to be significantly associated with quality of life, as well as levels of depression and anxiety. (p < 0.037, p < 0.04, p < 0.004, respectively). Celiac patients had significantly lower BMI SDS (mean −0.55 ± 1.13, p < 0.001) and height SDS scores (mean −0.49 ± 1.28, p < 0.017). Key factors negatively affecting the quality of life in individuals with celiac disease were difficulty adhering to the diet and low family income levels. Conclusions: Elevated anxiety with reduced quality of life highlights the importance of integrating psychosocial support into the routine care of children with celiac disease. A holistic treatment approach that considers the psychosocial well-being of children can significantly improve their quality of life. Full article

Background: In this study, we investigated patients in the early stages of COPD to support the hypothesis that symptoms of anxiety and depression are related to mild and moderate COPD and not only to the chronic complications that accompany severe disease. Methods: A total of 250 mild to moderate COPD patients were randomly selected from a population of 5239 individuals who were part of a study on early COPD detection and smoking cessation that was carried out in Central Macedonia, Greece. An age-matched control group of three hundred current or former smokers was also included. A questionnaire was used for demographic data collection, along with the Hospital Anxiety and Depression Scale (HADS) questionnaire for the evaluation of anxiety (HADS-A) and depressive (HADS-D) symptoms. Results: The COPD and non-COPD groups were similar in age, gender, and socioeconomic background. The majority of COPD patients were classified as Grade 1 or 2 and belonged to Group A or B according to the GOLD classification. Among the COPD patients, 19.6% had a score greater than 7 in the HADS-A subscale, 14% in the HADS-D subscale, and 10.8% in both, compared with 6%, 5%, and 5%, respectively, for the non-COPD individuals (p < 0.01). A regression analysis showed that the presence of at least one comorbidity (β = 0.43, p < 0.001) and the presence of at least one respiratory symptom (β = 0.49, p < 0.001) significantly predicted the total HADS score in the COPD group. Conclusions: The prevalence of depression and anxiety symptoms in early COPD patients was greater in comparison to non-COPD smokers. Implementing routine screening for mood disorders using the HADS in mild to moderate COPD outpatients may improve overall disease management and patients’ quality of life. Full article

Objective: To analyze the association between physical activity, health-related quality of life (HRQoL), and perceived barriers to physical activity with the risk of symptoms of depression, anxiety, and stress in Chilean adolescents. Method: A quantitative, cross-sectional, descriptive-correlational study was conducted with a sample of 351 secondary school students (mean age = 15.75 ± 1.47 years) from several educational institutions in the south-central region of Chile. Validated instruments were used to assess physical activity (PAQ-A), symptoms of mental health (DASS-21), HRQoL (Kidscreen-52), and the short scale of barriers to physical activity. For exploratory purposes, mental health outcomes were dichotomized based on standard cut-off scores, and binary logistic regression models were estimated to identify associated factors. Results: Based on the binary categorization, a substantial proportion of students exceeded the risk thresholds for depressive (54.4%), anxiety (63%), and stress symptoms (42.2%). Across models, lower physical activity levels, reduced autonomy and weaker relationships with parents, and barriers related to self-concept and motivation were consistently associated with higher mental health risk. Additionally, passive commuting and the perceived school environment emerged as specific predictors of stress and depression risk, respectively. Conclusions: These findings suggest that individual and contextual factors linked to lifestyle behaviors and perceived social support may play a critical role in adolescent mental health, and could represent key targets for school-based interventions. Full article

While most of the Alzheimer’s disease (AD) cases are sporadic and manifest after age 65 (late-onset AD, LOAD), a subset of patients develop symptoms earlier in life (early-onset, EOAD) due to mutations in the PSEN1, PSEN2, or APP genes with an autosomal-dominant inheritance pattern (AD-EOAD). In this study, we examined the association between age of onset (AoO) and first clinical manifestation (FCM) with the APOE and DAOA genotypes, previously described as modifiers of clinical phenotypes in LOAD and EOAD in 88 individuals clinically diagnosed with AD-EOAD due to the PSEN1 A431E variant (39 females, 49 males). We classified the population according to their genotype (APOEε2, APOEε3, and APOEε4 and DAOA G/G, G/A, and A/A) and FCM (cognitive, behavioral, motor, and memory impaired). Memory impairment was the most frequent symptom (51%), followed by motor disturbances (31.8%), cognitive symptoms other than memory (10.4%), and behavioral changes (6.8%). We found a significant association between APOE genotype and AoO (p < 0.001), with the APOEε4 allele being linked to a delayed onset (β = 4.04, SE = 1.11, p = 0.0003). Similarly, individuals with the DAOA rs2391191 A/A genotype showed a significantly later AoO compared to G/G carriers (β = 2.13, SE = 0.96, p = 0.0301). No significant association was found between APOE or DAOA genotypes and FCM. The findings suggest that both the APOEε4 allele and DAOA rs2391191 A/A genotype may act as genetic modifiers of AoO, delaying symptom onset in individuals with AD-EOAD. Further research is needed to elucidate the molecular pathways through which APOE and DAOA influence AD-EOAD progression. Full article

Background/Objectives: Human leukocyte antigen B27 (HLA-B27) is a genetic marker strongly associated with various inflammatory rheumatic diseases, particularly those within the spondyloarthritis spectrum. Its presence influences disease onset, clinical severity, and therapeutic strategies. However, comparative data between HLA-B*27-positive and -negative patients, especially in Eastern European populations, remain limited. The study aimed to investigate the clinical, paraclinical, and psychosocial differences between HLA-B*27-positive and -negative individuals diagnosed with rheumatic diseases, in order to better understand the implications of HLA-B27 status on disease expression and patient quality of life. Methods: A cross-sectional, observational study was conducted between June 2023 and December 2024 at the Emergency Clinical Hospital for Children “Sf Ioan” in Galati, Romania, in collaboration with “Dunarea de Jos” University. Fifty adult patients with various rheumatic conditions were enrolled and stratified into HLA-B*27-positive (n = 22) and -negative (n = 28) groups. Data collection included clinical evaluations, laboratory biomarkers (CRP = C-reactive protein; ESR = erythrocyte sedimentation rate), and a structured quality-of-life questionnaire. Statistical analysis was performed using SPSS v27. Results: HLA-B*27-positive patients were significantly younger (mean age 46.00 vs. 55.07 years, p = 0.018) and had higher CRP levels (>1 mg/dL in 53.33% vs. 0%, p = 0.001). Ankylosing spondylitis was more prevalent in this group (22.73% vs. 3.57%, p = 0.039). Magnetic resonance imaging (MRI) was more frequently used (68.18% vs. 39.29%, p = 0.042), indicating greater suspicion of axial involvement. HLA-B27-positive patients also reported higher perceived stress (mean score 2.41 vs. 1.21, p< 0.001). Conclusions: HLA-B*27 positivity is associated with earlier disease onset, increased systemic inflammation, greater axial involvement, and higher psychological stress. These findings emphasise the need for personalised, multidisciplinary care that integrates both medical and psychological support for HLA-B*27-positive patients. Full article

Objective: The aim of this study is to examine the effect of social support on the mental state of cancer patients using a phenomenological approach. Materials–Methods: In this study, a phenomenological research orientation was used, and semi-structured in-depth interviews were conducted with 14 people diagnosed with cancer living in a province in central Turkey. The criterion sampling method, one of the purposeful sampling methods, was used for the sample group. The interviews continued until data saturation was achieved, and all interviews were recorded and later transcribed verbatim. The data were analyzed using thematic analysis, and the study was conducted and reported according to the COREQ checklist. Results: Two categories (effects of cancer and needs of the cancer patient (invisible components)) and five themes (psychological effects, social effects, physical effects, social support, and spiritual care) were identified in the analysis of the data. Conclusions: It has been determined that individuals are affected by cancer mentally, physically, and socially, and have difficulty coping. In particular, it has been found that social support and thinking about the purpose of life, supporting hope, and self-acceptance are quite important in increasing individuals’ spirituality. Full article

Background/Objectives: Fatigue is a highly prevalent and burdensome symptom among individuals with Marfan syndrome (MFS), yet its heterogeneity and underlying psychosocial and clinical correlates remain underexplored. This study aimed to identify and characterize distinct fatigue-related profiles in MFS patients using a data-driven cluster analysis approach. Methods: A cross-sectional study was conducted involving 127 patients with MFS from a specialized connective tissue disorder center in Italy. Participants completed self-reported measures of fatigue severity (Fatigue Severity Scale, FSS), depressive symptoms (Patient Health Questionnaire-9, PHQ-9), and insomnia (Insomnia Severity Index, ISI). The body mass index (BMI) and clinical data were also collected. A t-distributed stochastic neighbor embedding (t-SNE) analysis was performed to reduce dimensionality, followed by hierarchical clustering (Ward’s method), exploring solutions from k = 2 to k = 10. The optimal cluster solution was identified based on silhouette scores and clinical interpretability. Results: Three distinct clusters emerged: (1) a cluster characterized by low fatigue with minimal psychological and sleep-related symptoms (younger patients, lower PHQ-9 and ISI scores), (2) a cluster characterized by moderate fatigue with moderate psychological and sleep-related symptoms (intermediate age, moderate PHQ-9 and ISI scores), and (3) a cluster characterized by high fatigue with elevated psychological and sleep-related symptoms (older patients, higher PHQ-9, ISI, and FSS scores). Significant differences were observed across clusters in age, BMI, depressive symptoms, insomnia severity, and fatigue levels (all p < 0.05). Conclusions: Our findings highlight the heterogeneity of fatigue experiences in MFS and suggest the importance of profiling patients to guide personalized interventions. This approach may inform precision medicine strategies and enhance the quality of life for individuals with this rare disease. Full article

Background/Objectives: The extension of euthanasia and physician-assisted suicide to individuals with mental disorders presents a profound ethical, clinical, and legal challenge. While increasingly accepted in some jurisdictions, their application in psychiatric contexts—particularly in cases of depression—raises concerns about diagnostic precision, therapeutic adequacy, and the validity of informed consent. This study examines two controversial Belgian cases to explore the complexities of euthanasia for psychological suffering. Methods: A qualitative case analysis was conducted through a qualitative analysis of publicly available media sources. The cases were examined through clinical, psychoanalytic, and medico-legal lenses to assess diagnostic clarity, treatment history, and ethical considerations. No access to official medical records was available. Case Presentation: The first case involved a young woman whose depressive symptoms were reportedly linked to trauma from a terrorist attack. The second concerned a middle-aged woman convicted of infanticide and later diagnosed with Major Depression. Discussion: In both cases, euthanasia was granted on the grounds of “irreversible psychological suffering.” However, the absence of detailed clinical documentation, potential unresolved trauma, and lack of psychodynamic assessment raised doubts about the robustness of the evaluations and the validity of informed consent. Conclusions: These findings highlight the need for a more rigorous, multidisciplinary, and ethically grounded approach to psychiatric euthanasia. This study underscores the importance of precise diagnostic criteria, comprehensive treatment histories, and deeper exploration of unconscious and existential motivations. Safeguarding clinical integrity and ethical standards is essential in end-of-life decisions involving mental illness. Full article

Background and objectives: Overweight and obesity are global public health problems, as they increase the risk of chronic diseases, reduce quality of life, and generate a significant economic and healthcare burden. This study evaluates the capacity of nutritional patterns and psychological status to predict the presence of cardiometabolic risk among overweight and obese young adults, from a neural network approach. Method: The study included N = 188 overweight or obese students, who provided measures on their dietary intake, physical and psychological state, and sociodemographic profile. Neural networks were used to predict their metabolic status, classified into two categories based on anthropometric, biochemical, and cardiometabolic risk factors: metabolically unhealthy obesity (MUO) versus metabolically healthy obesity (MHO). Results: The predictive models demonstrated differences in specificity and sensitivity capacity depending on the criteria employed for the classification of MUO/MHO and gender. Among the female subsample, MUO was predicted by poor diet (low consumption of mineral and vitamins, and high consumption of fats and sodium) and high levels of depression and stress, while among the male subsample high body mass index (BMI), depression, and anxiety were the key factors. Protective factors associated to MHO were lower BMI, lower psychopathology distress and more balanced diets. Predictive models based on the HOMA-IR criterion yielded very high specificity and low sensibility (high capacity to identify MHO but low accuracy to identify MUO). The models based on the IDF criterion achieved excellent discriminative capacity for men (specificity and sensitivity around 92.5%), while the model for women obtained excellent sensitivity and low specificity. Conclusions: The results provide empirical support for personalized prevention and treatment programs, accounting for individual differences with the aim of promoting healthy habits among young adults, especially during university education. Full article

Hispanic breast cancer survivors reported worse quality of life, and fatalism is considered one of the mediators for this disparity. This study aimed to identify the factors associated with fatalism within a diverse Hispanic population. Hispanic origin was self-reported, and the Multidimensional Fatalism Measure questionnaire, a validated tool that measures fatalism across multiple dimensions, was used to assess fatalism. A total of 390 women, consisting of 210 Puerto Ricans, 34 Colombians, 29 Dominicans, 25 Cubans, 24 Venezuelans, 22 Mexicans, and 46 individuals of other Hispanic backgrounds, completed the fatalism assessment. The mean fatalism score was 16.4 (95% CI = 15.8–17.0), characterized by a high internal locus of control and strong religious beliefs, along with moderate beliefs in luck and a low external locus of control. The higher fatalism scores were reported in Dominican, Mexican, and Venezuelan groups, while Colombians reported the lowest score. Multivariable analysis showed that Colombians (β = −4.0), individuals with higher household incomes (β = −2.3 for USD 20,000–USD 75,000, β = −2.4 for ≥75,000), higher education levels (β = −1.9), and those using English more frequently at home (β = −2.0) reported lower fatalism compared to their reference group. To enhance the quality of life for these survivors, culturally tailored interventions should focus on improving perceived control and mitigating fatalism. Full article

Background/Objectives: Subcutaneous immunoglobulin (SCIg) is a well-established alternative to intravenous immunoglobulin (IVIg) in patients with primary (PID) and secondary immunodeficiency (SID), with demonstrated benefits in safety and quality of life. However, its implementation remains limited in parts of Southern Europe, partly due to frequent local adverse reactions (LARs), which, despite being mild, can affect adherence and clinician confidence. This study aimed to identify clinical, anatomical, psychosocial, and geographical factors associated with LARs and to develop an exploratory model for individualized risk estimation. Methods: We conducted a retrospective, multicenter observational study in eight Spanish hospitals using data from the GEIE Registry. Patients aged ≥14 years with PID or SID receiving SCIg for ≥1 month were included. Demographic, clinical, anatomical, and psychosocial variables were collected. A multivariable logistic regression model was built to identify independent predictors of LARs and internally validated using bootstrap resampling (500 iterations). A nomogram was constructed for personalized risk prediction. Results: Among 223 included patients, 73.1% reported LARs, primarily swelling, pruritus, and rash. Independent predictors included smaller abdominal perimeter (OR 0.955, p < 0.001), history of skin disease (OR 2.75, p = 0.044), greater distance to hospital (OR 1.01, p = 0.050), and absence of anxiety (OR 0.089, p = 0.001). Model discrimination was good (AUC 0.801), with minimal optimism after internal validation (validated AUC 0.788). Conclusions: LARs are common among patients receiving SCIg and could be influenced by anatomical, dermatological, psychological, and geographical factors. This exploratory multicenter study underscores the clinical relevance of these factors and may guide more personalized and safer use of SCIg. Full article

Background/Objectives: Diabetic sensorimotor polyneuropathy (DSPN) is a frequent microvascular complication of diabetes mellitus, associated with increased morbidity and reduced quality of life. The existing literature offers a limited understanding of sex-specific cardiovascular risk profiles and their association with DSPN, particularly within Central and Eastern European populations. Methods: A retrospective analysis was conducted using data from 621 individuals with type 1 or type 2 diabetes mellitus who underwent comprehensive neuropathy screening at the University of Debrecen between 2017 and 2021. The diagnosis of DSPN was made in accordance with international criteria, incorporating symptom scores, and electrophysiological measurements. Multivariate logistic regression was applied in order to identify independent predictors. Results: The diagnosis of DSPN was made in 444 individuals (71.5%), of whom 58.2% were female. Despite similar glycemic control (HbA1c: 7.81% in men vs. 7.65% in women, p = 0.297), men had significantly more frequent occurrences of previous myocardial infarction (11.8% vs. 5.0%, p = 0.008), peripheral vascular disease (19.9% vs. 12.7%, p = 0.041) and atherosclerosis (31.7% vs. 22.0%, p = 0.021). Multivariate analysis showed that female gender was independently associated with a lower incidence of DSPN (odds ratio [OR] = 0.592, 95% confidence interval [CI]: 0.369–0.950, p = 0.030), while diabetic retinopathy was a significant predictor (OR = 2.728, 95% CI: 1.300–5.725, p = 0.008). Electrophysiological testing revealed lower nerve conduction amplitudes in females for selected nerves. Conclusions: Our findings highlight sex-specific differences in neuropathy risk and support the implementation of individualized screening strategies in diabetic populations with region-specific risk factors. Full article

This article reviews and synthesizes highlights of the history of neural models of rate-based and spiking neural networks. It explains that theoretical and experimental results about how all rate-based neural network models, whose cells obey the membrane equations of neurophysiology, also called shunting laws, can be converted into spiking neural network models without any loss of explanatory power, and often with gains in explanatory power. These results are relevant to all the main brain processes, including individual neurons and networks for perception, learning, cognition, and navigation. The results build upon the hypothesis that the functional units of brain processes are spatial patterns of cell activities, or short-term-memory (STM) traces, and spatial patterns of learned adaptive weights, or long-term-memory (LTM) patterns. It is also shown how spatial patterns that are learned by spiking neurons during childhood can be preserved even as the child’s brain grows and deforms while it develops towards adulthood. Indeed, this property of spatiotemporal self-similarity may be one of the most powerful properties that individual spiking neurons contribute to the development of large-scale neural networks and architectures throughout life. Full article

Background/Objectives: Individuals with posttraumatic stress disorder (PTSD) tend to show patterns of elevated cardiovascular disease (CVD) risk earlier in life than the general population. The need for effective interventions for CVD risk-reduction in PTSD is increasingly evident. In this paper we present preliminary results from a longitudinal study of a health behavior intervention, as an adjunct to standard trauma therapy in PTSD. The health behavior intervention addresses CVD-related heath behaviors (physical activity, nutrition, sleep, and stress) in a 12-week program delivered individually in 90-min sessions. Behavior change recommendations included: increased aerobic activity; establishing a balanced diet, enhancing consumption of fruits and vegetables and reducing sugars and fat/saturated fat; incorporating strategies to enhance sleep and lower PTSD-related disruptions (e.g., nightmares); and relaxation and cognitive coping skills to reduce general stress. Methods: Participants were randomized to the health behavior intervention plus standard trauma therapy experimental condition or a standard trauma therapy control group. Outcomes were measured at baseline and after the 12-week intervention phase. Sleep efficiency was measured from actigraphy watches. Physical activity was assessed by self-report and blood pressure was measured using an automated device. The preliminary outcomes are for 29 participants to date who have pre-post data. Results: Sleep efficiency was improved in the intervention group compared to controls (p < 0.05). The intervention group also evidenced significant pre-post increases in moderate physical activity compared to the control group (p < 0.05). Changes in vigorous physical activity did not reach statistical significance in this preliminary sample but the pattern of results are similar to those for moderate activity. Trends toward significance were also observed for pre-post changes in systolic (p = 0.06) and diastolic blood pressure (p = 0.07), with small reductions for the intervention group and increases for the control group. Conclusions: These findings provide preliminary information about the effectiveness of the health behavior intervention on multiple parameters for adults with PTSD. The findings suggest that focusing on health behavior change in multidisciplinary treatments for PTSD may enhance outcomes such as sleep and physical activity and potentially result in greater quality of life. However, the small preliminary sample size reported here should be considered when interpreting the outcomes. Further research may also determine how improvements in health parameters impact other indices of long-term cardiovascular health. Full article

This study aimed to describe the risk factors for locomotive syndrome (LS) in Brazilian oldest old individuals. Study subjects were older adults aged ≥80 years who were cognitively healthy, independent for activities of daily living and had been followed since 2011 by a Brazilian cohort study entitled the Longevos Project. A nested case–control study evaluating demographic and clinical characteristics was conducted. Physical tests including the 5 times sit-to-stand, hand-grip strength, 4-m gait speed and two-step test were performed. The World Health Organization Quality of Life Questionnaire short form (WHOQOL-BREF) and Numerical Rating Scale plus Verbal Rating Scale were applied to assess quality of life (QOL) and chronic pain (CP), respectively. LS was diagnosed using the Brazilian version of the 25-question Geriatric Locomotive Function Scale (GLFS-25-p), and sarcopenia by the SARC-F screening tool. The study sample included 52 participants, had a mean age of 89.3 years (±3.9 years) and was predominantly female (76.9%). Of this sample, 24 were diagnosed with LS and 28 were not. The prevalence of osteoporosis (20%), osteoarthritis (22%), depression (13%) and use of a walking device (14%) was higher in the LS group. Participants with LS had worse performance in physical tests. A multivariate logistic regression analysis identified the main risk factors for LS as osteoporosis (OR 10.80, 95%CI 1.08–108.48) and presence of moderate-to-severe chronic musculoskeletal pain (OR 8.92, 95%CI 1.25–63.89). Full article