Search Results (3,655)

Background/Objectives: The relationship between expressive flexibility—the capacity to enhance and suppress visible emotional responses according to situational demands—and mental health has not been systematically synthesized. This systematic review examined associations across psychopathology, psychological well-being, resilience and adaptive functioning, and social functioning. Methods: Following preregistration on the Open Science Framework (10.17605/OSF.IO/BA5HD), PsycINFO, PsycArticles, and PubMed were searched on 23 June 2026, supplemented by citation searching and expert consultation. English-language, peer-reviewed studies of participants aged at least 12 years assessing expressive flexibility and mental health were eligible. Two reviewers independently selected studies and assessed methodological quality using design-specific JBI critical appraisal tools. Narrative synthesis, random-effects meta-analyses, and a structured narrative appraisal of the evidence for each outcome were conducted. Results: Twenty-nine studies were included (cumulative analytic sample: N = 8357). Appraisals identified limitations in confounding control, handling of incomplete follow-up, and methodological reporting. Greater overall expressive flexibility was generally associated with lower psychopathological symptom burden, greater psychological well-being, greater resilience and adaptive functioning, and better social functioning. Component findings varied. Pooled associations were inverse for depressive symptoms (k = 9, N = 3622, r = −0.14, 95% CI [−0.26, −0.01]) and, exploratorily, anxiety (k = 7, N = 3134, r = −0.13, 95% CI [−0.23, −0.03]). The positive association with life satisfaction was preliminary (k = 4, N = 1910, r = 0.27, 95% CI [0.02, 0.49]). Leave-one-out analyses indicated uncertainty across all three syntheses. Heterogeneity was substantial to very high and all prediction intervals included zero. Conclusions: Findings suggest that expressive flexibility is an emotion-expression capacity associated with several dimensions of mental health, primarily in non-clinical samples. Its potential transdiagnostic relevance warrants further investigation, but limited robustness, substantial heterogeneity, and predominantly cross-sectional evidence preclude firm conclusions about generalizability and causal effects. Full article

Evidence regarding long-term breathing-practice maintenance and associated psychological outcomes remains limited. This observational longitudinal follow-up examined psychological outcomes and self-reported breathing-practice status 12 months after a structured program in university students. Thirty-four students from the intervention group of a 14-week breathing study were assessed immediately after the program (T1) and at the 12-month follow-up (T2). At T2, 18 reported occasional or regular practice, and 16 reported no or rare practice. All 13 psychological outcomes were included in the longitudinal analyses. For each outcome, the T2 score was regressed on the corresponding T1 score and T2 practice group using HC3 robust standard errors. Benjamini–Hochberg correction was applied across all 13 outcomes. Compared with the no/rare-practice group, the ongoing-practice group had more favorable T2 scores for subjective happiness, general happiness, positive affect, sleep quality, all six dimensions of psychological well-being, and life satisfaction after adjustment for the corresponding T1 scores; all q < 0.001. However, the ongoing-practice group also had higher worry scores (adjusted difference 4.52, 95% CI 1.44 to 7.60; q = 0.006). Negative affect did not differ between groups (−0.50, 95% CI −3.51 to 2.50; q = 0.735). Sensitivity analyses produced the same pattern. Ongoing breathing practice was associated with several favorable psychological outcomes at 12 months, but also with higher worry scores and no difference in negative affect. Because practice status was self-selected and measured concurrently with the outcomes, these findings are associative rather than causal and may be influenced by common-method bias, recall bias, and social-desirability bias. Full article

Background: Medical internship is a demanding transition into supervised clinical responsibility, but longitudinal evidence on interns’ well-being and work investment remains limited. Objective: To examine change across Q1–Q3 in self-reported well-being, work investment, and organizational perceptions. Methods: This prospective interim study included 126 questionnaires from 42 interns. The prespecified primary endpoint was change in general life satisfaction, assessed using the five-item Satisfaction With Life Scale (SWLS). Secondary repeated-measures outcomes were work satisfaction, work enjoyment, perceived stress, emotional and physical fatigue, weekly work hours, and perceived organizational culture. Repeated-measures ANOVA assessed omnibus time effects; linear contrasts were reported separately. Exploratory analyses used one mean score per intern. Results: Among 41 interns with complete SWLS scores across quarters, means were 4.36 ± 1.24, 4.56 ± 1.18, and 4.72 ± 1.04 on the 1–7 scale. The omnibus time effect did not reach statistical significance (F[2,80] = 3.005, p = 0.055, partial η² = 0.070), although the linear contrast was nominally significant (p = 0.021); the Q3–Q1 difference was 0.36 points (95% CI 0.06–0.67). Weekly work hours increased from 58.98 ± 12.25 to 62.98 ± 11.82. Their omnibus effect was not significant (F[2,82] = 2.726, p = 0.071, partial η² = 0.062), whereas the linear contrast was nominally significant (F[1,41] = 4.954, p = 0.032, partial η² = 0.108). Other prespecified secondary omnibus tests were not significant. Internal consistency varied across measures and quarters. Exploratory participant-level comparisons indicated lower stress and physical fatigue among males and several inter-domain associations. Conclusions: No significant omnibus change was detected in the primary endpoint or the prespecified secondary outcomes. Nominal upward linear trends in life satisfaction and work hours warrant further investigation. Our findings should be regarded as preliminary and hypothesis-generating, rather than as evidence of sustained stability, resilience, or causal adaptation throughout internship. Full article

The widespread adoption of information and communication technology enables passengers to transform travel into productive time. However, constant internet connectivity creates multitasking environments that do not necessarily improve passengers’ subjective well-being. To support sustainable urban mobility and social sustainability, public transport must provide high-quality travel experiences. Based on a survey of Tokyo railway passengers (N = 461), the association between digital media usage and subjective well-being was evaluated concerning motivation, media format, and the on-train environment. Cluster analysis and multi-group structural equation modeling revealed that intrinsic motivation strongly predicted onboard well-being. While analog media users exhibited high onboard well-being, digital media usage demonstrated a multitasking distortion: onboard well-being decreased despite high intrinsic motivation. This negative impact was prominent in High-Duration/High-Adaptation environments characterized by abundant travel time and habituation. Furthermore, enhanced onboard well-being significantly spilled over to overall life satisfaction. These findings suggest that constant connectivity in High-Duration/High-Adaptation environments consumes cognitive resources, obstructing travel’s restorative potential. Improving passenger well-being and maintaining modal shifts requires designing environments as cognitive shelters that support intentional disconnection. Full article

Background/Objectives: The optimal surgical approach for patients with lumbar degenerative disc disease (DDD) remains a subject of ongoing debate, particularly when comparing anterior lumbar interbody fusion (ALIF) and total disc replacement (TDR). The primary objective of this study was to compare short-term outcomes between these two surgical approaches in terms of clinical efficacy, patient satisfaction, and safety profile. The secondary objective was to evaluate patient-specific variables associated with postoperative improvement in order to identify potential factors that may guide a personalized surgical strategy. Methods: This retrospective, single-center observational study included 87 patients who underwent single-level lumbar surgery using either an ALIF (n = 38) or TDR (n = 49) approach between January 2021 and May 2025. Eligible patients were younger than 45 years and had complete preoperative, intraoperative, and 1-year follow-up data. Demographic, clinical, preoperative, and intraoperative variables, as well as patient satisfaction and quality-of-life improvement, were collected, analyzed, and compared between groups. The primary between-group analysis used analysis of covariance (ANCOVA) with adjustment for baseline outcome values and prespecified confounders (age, sex, body mass index, smoking status, ASA class). Longitudinal effects were assessed using a linear model with treatment × time interaction and cluster-robust standard errors. A formal smoking × surgical-strategy interaction was tested in a multivariable regression on 12-month Oswestry Disability Index (ODI) change. Reporting followed the STROBE guidelines for observational studies. Results: Both groups showed substantial within-group improvement at all follow-up time points (all p < 0.05 except ALIF leg pain at 6 months; paired Wilcoxon test). Baseline-adjusted between-group comparisons (ANCOVA) showed a numerically modest early difference favoring TDR for Visual Analogue Score (VAS) low-back pain at 3 and 6 months (adjusted Δ = −1.46, 95% CI −2.63 to −0.30, p = 0.016 at 3 months; −1.35, 95% CI −2.63 to −0.07, p = 0.043 at 6 months), below the minimum clinically important difference of 2 points though neither survived Holm–Bonferroni correction for multiple comparisons. The formal treatment × time interaction test was not significant for any outcome (ODI p = 0.39; VAS back p = 0.29; VAS leg p = 0.06. Overall, 92% of patients in the ALIF group and 86% of patients in the TDR group reported being satisfied or very satisfied, and 60–72% of patients returned to work. Radiographic analysis in the TDR group showed maintained segmental mobility, with median range of motion of 4.0° (IQR 2.0–8.0°) overall (median 6.0°, IQR 4.0–8.5° at L4–L5; 3.0°, IQR 2.0–6.0° at L5–S1). A multivariable regression model on 12-month ODI change, adjusted for age, sex, BMI, ASA class, and baseline ODI, showed a highly significant smoking-burden × surgical-strategy interaction (dose–response smoker code × TDR coefficient = −9.47, 95% CI −15.6 to −3.3, p = 0.004): higher preoperative smoking burden was associated with reduced ODI improvement specifically in the TDR group (Spearman r = −0.41, p = 0.004) but not the ALIF group (Spearman r = +0.17, p = 0.32). Conclusions: This cohort study suggests that both ALIF and TDR were associated with substantial clinical improvement and high patient satisfaction at 1 year postoperatively; because treatment selection was not randomized, these findings should not be interpreted as evidence of comparative effectiveness. A modest early difference favoring TDR was observed for VAS low-back pain (below the minimum clinically important difference); no statistically significant between-group differences were demonstrated for any outcome after correction for multiple comparisons. The observed associations between 1-year ODI improvement and patient-specific variables require confirmation in larger independent cohorts. The finding of a significant smoking-burden × surgical-strategy interaction is an exploratory and hypothesis-generating and, if confirmed in prospective cohorts, may inform preoperative optimization strategies for TDR candidates. Full article

Background/Objectives: Compassion fatigue can affect nursing professionals exposed to demanding clinical environments and may be influenced by individual and work-related factors. The objective of this study was to analyze the factors associated with the compassion and fatigue/exhaustion dimensions of compassion fatigue (CF) among nursing professionals in Peru. Methods: This was an observational, analytical, and cross-sectional study in 374 nursing professionals from Peru, with data on the study variables collected at a single point in time through a virtual survey. Primary analyses used the two original EFat-Com subscales and complete-case multiple linear regression without automated selection (n = 339), with HC3 robust 95% confidence intervals (CIs). Sensitivity analyses examined age, resilience, continuous life satisfaction, workplace grouping, and an exploratory 11-item version; stepwise models underwent bootstrap validation. Results: The sample was predominantly female (88.2%) and had a mean age of 39.77 years (SD = 9.11). Empathy was associated with compassion (b = 0.312; 95% CI 0.237 to 0.387); adjusted R² was 0.216. Experience exceeding ten years (b = −0.201; 95% CI −0.396 to −0.006) and neutral job satisfaction (b = 0.226; 95% CI 0.057 to 0.395) were associated with fatigue/exhaustion scores; adjusted R² was 0.080. Several associations varied across sensitivity analyses, whereas the empathy–compassion association persisted. Conclusions: The dimensions showed different association patterns, but the fatigue/exhaustion model had limited explanatory capacity, suggesting that other relevant factors not assessed in this study may also contribute to this dimension. Measurement uncertainty, missing data, and model instability warrant cautious interpretation. Full article

Background: Prosthetic foot design continues to evolve to better address the functional needs and daily challenges of individuals with lower limb loss. Energy-Storing and Returning (ESAR) feet are widely prescribed for individuals with transtibial amputation; however, many users continue to report limitations. A novel prosthetic foot incorporates a pivot mechanism intended to enhance ankle motion and support a more natural gait. Objectives: We aimed to compare mobility, comfort, quality of life, and user satisfaction between a novel prosthetic foot and commonly prescribed ESAR feet in adults with unilateral transtibial amputation with unmet mobility needs. Methods: A prospective, multicenter, randomized cross-over trial was conducted across seven rehabilitation centers in France. Thirty adults with unilateral transtibial amputation, all regular ESAR users, were randomized to one of two sequences: their prescribed ESAR foot followed by the novel foot, or the reverse. Each device was worn for four weeks. The primary outcome was mobility assessed using the Prosthetic Limb Users Survey of Mobility (PLUS-M) T-score. Data were analyzed using linear mixed-effects models. Secondary outcomes included comfort, quality of life, satisfaction, falls, participant preference, and adverse events. Results: All participants completed the study. Mobility scores were significantly higher with the novel foot compared to the prescribed ESAR foot (least squares mean PLUS-M/FC-12 T-score: 60.2 vs. 52.3; difference 7.9; p < 0.001). Participants reported greater comfort, improved quality of life (LS mean difference 5.7; p = 0.001), and higher satisfaction with the novel prosthesis (LS mean difference 0.4; p = 0.002). No falls occurred with the novel foot, compared with three falls with the ESAR foot. Most participants (96.7%) preferred the novel foot. No device-related adverse events were reported. Conclusions: In adults with unilateral transtibial amputation, the novel pivot foot was associated with improvements in mobility, comfort, quality of life, and satisfaction compared to commonly prescribed ESAR feet, supporting its potential benefits for individuals with higher mobility demands. Full article

Background: This study aimed to evaluate the performance of machine learning models in predicting depression risk among older adults living alone and to identify the features contributing to those predictions using explainable artificial intelligence (XAI). Methods: We analysed 2022 nationwide survey data in Korea. A total of 1007 older adults remained after excluding respondents who lived in multi-person households, were aged < 65 years, or had physician-diagnosed dementia. Depression risk was defined using the CES-D-10 (cutoff ≥ 10). After removing features with high multicollinearity, logistic LASSO selected 23 predictors. Six algorithms were fitted using the training set, with hyperparameter tuning performed by 5-fold cross-validation where applicable, and evaluated in a held-out test set following a 70/30 split. SMOTE was applied only to the training data. Performance was summarised using AUC, sensitivity, specificity and the F1 score with bootstrap 95% confidence intervals, and stability was assessed by repeated stratified cross-validation. SHAP values provided explainability. Results: LightGBM achieved an AUC of 0.802 (95% CI 0.747–0.852), followed by Random Forest (0.794) and Logistic Regression (0.779). These differences were small relative to the uncertainty of the estimates. SHAP analysis identified oral health-related quality of life, satisfaction with relationships with children, frequency of social contact, overall life satisfaction, satisfaction with health status, and age as the most influential features. IADL limitations, diabetes, hypertension, and perceived social class contributed to predictions with smaller effects. Conclusions: An explainable LightGBM model achieved an AUC of 0.802 for depression risk among older adults living alone and identified psychosocial and health-related features, particularly oral health and social connectedness, that may help inform future screening strategies. Full article

Tin smelting in a top-blowing furnace is a key non-ferrous metallurgical process in which tin recovery, energy consumption, and the service life of the magnesia–chrome refractory lining are affected by strongly coupled operating variables. The degradation of the magnesia–chrome lining is associated with the combined effects of thermal shock, chemical attack by molten slag and metal, and mechanical wear caused by high-temperature, turbulent, and particle-laden flow during blowing, charging, and tapping operations. First-principles modeling is difficult under extreme thermochemical conditions, whereas experience-based adjustment lacks reproducibility and scalability. Existing surrogate-assisted evolutionary methods also suffer from approximation errors, unreliable constraint handling, and limited interpretability in dynamic, data-scarce industrial settings. To address these issues, this study proposes RAMOSTA, an RBFN-assisted dynamic multiobjective state transition algorithm for tin-smelting parameter optimization. The proposed method integrates radial basis function neural-network surrogate models for tin recovery, energy consumption, and refractory-lining degradation; an uncertainty-aware adaptive offset penalty strategy for conservative constraint handling; a Pareto-based dynamic state-transition optimizer for searching time-varying trade-offs with a limited number of real evaluations; and a hybrid-weight TOPSIS decision layer. The latter combines expert preferences derived using the fuzzy analytic hierarchy process (FAHP), which accounts for the relative importance and uncertainty of decision criteria, with objective weights calculated from Shapley values, which quantify the marginal contribution of each objective to the overall decision. Experiments on an industrial tin-smelting dataset compare RAMOSTA with NSGA-II, NSGA-III, MOEA/D, and C-TAEA using Pareto-front quality, constraint satisfaction, hypervolume, and inverted generational distance. Full article

This study examines whether economic freedom is indirectly associated with life satisfaction through GDP per capita and whether governance quality conditions the association between GDP per capita and life satisfaction. The revised analysis uses a balanced panel of 30 European countries observed in 2018, 2021, 2022, and 2023 (N = 120). A second-stage conditional process model is estimated with period indicators, country-clustered inference, and cluster bootstrap confidence intervals. The principal result is a negative GDP per capita × governance interaction (B = −0.568, cluster-robust p = 0.001; restricted wild cluster bootstrap p = 0.019): the positive association between GDP per capita and life satisfaction is stronger at comparatively lower governance levels within the European sample and weaker at comparatively higher governance levels. Contemporary conditional indirect associations are positive at comparatively lower and central governance levels but not at the upper representative level; the index of moderated mediation is −0.352, with a country-bootstrap 95% CI [−0.510, −0.211]. Robustness checks using a correlated-random-effects/Mundlak specification, income inequality, exclusion of 2021, six separate governance dimensions, and actual individual consumption preserve the negative interaction. A temporally ordered exploratory model supports the interaction but not the indirect index. Given the observational panel design, the findings should be interpreted as statistical associations rather than causal effects. They provide robust evidence of institutional moderation, whereas evidence for the indirect pathway remains sensitive to model specification and temporal ordering. Full article

Hospital routines can elicit patients’ views without providing a reliable route for acting on them. The aim of this article is to develop a positive organizational model in which patient voice provides the basis for tailoring care, while professional responsibility remains with the clinical team and healthcare organization. We conducted a critical narrative review with conceptual synthesis, drawing on a previously assembled corpus of 105 full-text publications and a targeted update completed on 10 August 2026. The analysis compared patient input, organizational responses and limits of transferability. Search documentation was incomplete, and effects were not pooled. The framework distinguishes four types of input, five request dispositions, seven organizational actions and three response domains. These are working constructs informed by literature and conceptual reasoning. The proposed process retains the patient’s wording, assigns responsibility, explains constraints and checks the result. It places recovery, function and relief of suffering at the center of organizational decisions. Implementation could use existing nursing and care-management roles or a dedicated coordinator, with protected time and clear clinical boundaries. We propose patient and professional co-design followed by a prospective multisite feasibility pilot. The pilot would examine response completeness, accessibility, workload and measurement feasibility. A subsequent comparative study would evaluate goal concordance, quality of life, adherence, satisfaction, safety and costs. The accompanying pilot specification provides candidate questions, coding procedures and progression criteria. No pilot data or evidence of the model’s effectiveness are reported. Full article

Evidence on professional quality of life among psychologists in Latin America remains limited. This multicenter cross-sectional study examined compassion satisfaction, burnout, and secondary traumatic stress among 1078 Ecuadorian psychologists nested within 92 institutions using nonprobability sampling. Participants completed the Professional Quality of Life Scale, Version IV (ProQOL-IV), and the 12-item General Health Questionnaire (GHQ-12). Random-intercept linear mixed-effects models were estimated. Unconditional ICCs were 0.086, 0.097, and 0.139, respectively. Greater psychological distress was associated with lower compassion satisfaction (B = −0.605, 95% CI [−0.674, −0.535]) and higher burnout (B = 0.407, 95% CI [0.354, 0.461]) and secondary traumatic stress (B = 0.906, 95% CI [0.843, 0.969]); all p < 0.001. No secondary sociodemographic or occupational association survived the Benjamini–Hochberg correction (minimum q = 0.163). Findings support cautious, non-diagnostic monitoring and longitudinal research directly assessing institutional job demands and resources. Cross-sectional design and nonprobability sampling limit causal inference and generalizability. Full article

Background: Social participation is an important psychosocial dimension of health, but its associations with multiple lifestyle and psychological domains have rarely been examined simultaneously across Mediterranean and neighbouring countries. This study examined sociodemographic, health-related, Mediterranean dietary, movement-related, sleep-related, psychological, and technology-use correlates of social participation. Methods: Data were analysed from 4010 adults participating in the multinational MEDIET4ALL survey across ten countries. Social participation was assessed using the Short Social Participation Questionnaire (SSPQ). Hierarchical multiple linear regression examined associations across these domains, with the fully adjusted Model 6 designated as the primary inferential model. Sensitivity analyses examined sex- and region-related effect modification, country fixed effects, and categorical-variable coding. Exploratory indirect associations involving selected lifestyle behaviours and life satisfaction were estimated using bootstrapping. Results: The fully adjusted Model 6 explained 23% of the variance in social participation (adjusted R² = 0.224). The largest standardized associations among the statistically supported correlates were observed for age (β = −0.224), anxiety (β = 0.194), life satisfaction (β = 0.160), physical activity (β = 0.152), and depression (β = −0.149). Dietary associations were generally comparable across sexes, but the positive association involving Mediterranean dietary habits was stronger among participants from Mediterranean countries (interaction p = 0.002). The principal associations were materially consistent in country fixed-effects and categorical-coding sensitivity analyses. Exploratory bootstrapped analyses identified statistically supported indirect associations through life satisfaction for both Mediterranean dietary dimensions and physical activity in relation to higher social participation and for sitting time in relation to lower social participation. Conclusions: Social participation was associated with multiple lifestyle, psychological, sleep-related, and sociodemographic domains within the MEDIET4ALL sample. These findings are associative, while the regional and indirect-association findings are exploratory and hypothesis-generating. Given the cross-sectional design, the results establish neither temporal nor causal relationships. Longitudinal and intervention studies are required to determine directionality and practical relevance. Full article

This study examined the indirect role of psychological resilience in the association between hope and life satisfaction among university students. University years involve substantial academic, social, and psychological change; therefore, identifying resources that support well-being during the transition to emerging adulthood is important. The sample comprised 500 undergraduate students from the Faculty of Economics and Administrative Sciences at Akdeniz University, selected through convenience sampling. Data were collected through face-to-face questionnaires. Hypotheses were tested with hierarchical regression, and indirect associations were examined using bootstrap analysis with 5000 resamples and 95% confidence intervals. Hope, psychological resilience, and life satisfaction were positively and significantly associated. Psychological resilience showed a significant indirect association between hope and life satisfaction, while the direct association remained significant. An alternative model with hope as the mediator also yielded a significant indirect association, indicating that temporal ordering cannot be established from these cross-sectional data. Additional analyses found no significant Hope × Psychological Resilience moderation effect. Overall, the findings highlight the interrelated roles of hope and psychological resilience in university students’ life satisfaction and underscore the need for longitudinal research to clarify their temporal relationships. Full article

Population aging is reshaping later-life well-being, yet whether the tie–satisfaction association is itself stable over time is seldom researched. This study compares the 2011 (n = 10,899) and 2023 (n = 9951) waves of the Korean National Survey of Older Persons, a nationally representative repeated cross-section of Koreans aged 65+. Social contact was decomposed into total contact volume and non-face-to-face orientation, retaining socially isolated respondents via structural dummy variables. Models were estimated by year and pooled with year interactions. Mean life satisfaction rose from 3.04 to 3.36 even as the proportion reporting no friends rose from 0.2% to 10.1%. Total contact volume predicted life satisfaction in both years, but the association weakened significantly (interaction B = −0.042, p < 0.001), and this held under sampling weights. The old-old’s relative advantage reversed in the unweighted model (p = 0.001) but not under weights (p = 0.341) and is reported descriptively. Non-face-to-face orientation became a significant positive predictor by 2023, though its between-year change was not confirmed. Because the waves are independent samples, all between-year differences confound cohort and period and are not causal effects. Sustaining later-life satisfaction may depend on the mode, target, and quality of contact, not volume alone. Full article