Search Results (2,296)

Objectives: Intolerance of uncertainty (IU) is a transdiagnostic factor implicated in emotional disorders and has recently been linked to maladaptive eating attitudes. Body dissatisfaction, a core risk factor for maladaptive eating, may represent a key pathway through which IU exerts its effects. This study examined whether body dissatisfaction has an indirect effect on the association between IU and disordered eating attitudes in female university students, controlling for body mass index (BMI) and trait anxiety. Methods: A cross-sectional study was conducted with 141 female psychology students aged 18–35 years (M = 21.23, SD = 2.31). Participants completed self-report measures of IU (Intolerance of Uncertainty Scale–Short Form), body dissatisfaction (Body Shape Questionnaire), disordered eating attitudes (Eating Attitudes Test-26), trait anxiety (State–Trait Anxiety Inventory), and reported weight and height to calculate BMI. Indirect effects were tested using bootstrapped mediation models. Results: IU was positively associated with body dissatisfaction (β = 1.139, p = 0.001), which in turn significantly predicted dieting (β = 0.126, p < 0.001) and bulimia/food preoccupation (β = 0.033, p < 0.001), but not oral control. Bootstrapped analyses showed significant indirect effects of IU on dieting (β = 0.144, 95% CI [0.047, 0.251]) and bulimia/food preoccupation (β = 0.037, 95% CI [0.010, 0.074]) via body dissatisfaction. Direct effects of IU on eating attitudes were not significant. Conclusions: IU to be associated with disordered eating attitudes primarily through body dissatisfaction, independently of BMI and anxiety. These findings extend evidence of IU as a cognitive vulnerability for eating-related psychopathology to non-clinical populations, highlighting the need for preventive interventions addressing both body image concerns and IU in female university students. Full article

Background and Objectives: Keratoconus (KC) is a progressive corneal ectasia with multifactorial etiology, increasingly studied for potential associations with psychiatric disorders. This systematic review aimed to evaluate recent evidence linking KC with depression and other psychiatric conditions, including psychotic disorders, personality disorders, attention deficit hyperactivity disorder (ADHD), Tourette syndrome (TS), autism spectrum disorder (ASD), and obsessive–compulsive disorder (OCD). Materials and Methods: Following PRISMA guidelines, PubMed, ScienceDirect and SpringerLink were searched for English-language observational studies published since 2015 that examined psychiatric disorders in adults with keratoconus. We excluded reviews, case reports, pediatric, non-English, and inaccessible articles. Study quality was assessed using the Newcastle–Ottawa Scale and JBI Checklist. Data were narratively summarized and tabulated—without meta-analysis due to heterogeneity. Results: Twelve studies met inclusion criteria, including 41,906 KC patients and 63,267 controls. Eleven studies investigated depression and one ADHD. Findings on depression were mixed: five studies showed higher depressive symptoms among KC patients, while others found no significant association. Most were cross-sectional and of moderate-to-high quality. The single study on ADHD reported a higher prevalence of KC in males, but no evidence of casual association. Evidence on TS, ASD, and OCD was scarce and largely limited to case reports. The review was limited by heterogeneous methodologies, small sample sizes, an absence of longitudinal data, and reliance on self-report or registry data. Conclusions: Current evidence indicates increased psychological burden among some individuals with KC, particularly regarding depressive symptoms, yet casual relationships remain unproven. Male ADHD patients may have an elevated risk of KC, especially in the presence of eye rubbing. Registration: Not registered. Full article

Background/Objectives: Persons identifying as lesbian, gay, bisexual, pansexual, omnisexual, queer, questioning, fluid, asexual, or other non-heterosexual orientations (LGB+ persons) have been identified as a risk group for sexual victimization (SV), which can have long-lasting negative effects on well-being and physical, mental, sexual, and reproductive health. Othering-Based Stress (OBS)—reflecting societal processes of othering and resulting from stigma, prejudice, and discrimination—may contribute to increased vulnerability to SV and its consequences in LGB+ persons and affect help-seeking behavior following victimization. This study examines the impact of SV on LGB+ persons and their help-seeking behavior after victimization. Methods: Using a mixed-methods explanatory sequential design, first survey data from a nationally representative sample of the Belgian population on SV, its consequences, and subsequent help-seeking behavior were collected from 4632 individuals. Of these, 2965 participants (2601 heterosexual and 364 LGB+ individuals) experienced SV and represented the final sample for the quantitative analyses. In a second phase, in-depth interviews were conducted with 40 LGB+ victims to explore their experiences more thoroughly. Results: LGB+ individuals reported more negative consequences following SV than heterosexual persons, particularly regarding identity-related processes such as questioning gender expression and decreases in self-esteem. They also reported additional barriers to disclosing SV and seeking help from professional services or the police, including fears of stigma, invalidation, and concerns about professionals’ LGB+ competence. No significant differences were found between LGB+ persons who explicitly identified as belonging to a sexual minority group and those who did not, neither in the perceived consequences of SV nor in help-seeking barriers. Conclusions: LGB+ victims of sexual violence experienced more severe identity-related consequences and faced greater barriers to professional support than heterosexual victims. These results highlight the urgent need for trauma-informed, LGB+-inclusive services and structural policy measures to improve access to appropriate care. Full article

The growing negative consequences of climate change support the need to deepen and investigate factors that may sustain the engagement of pro-environmental behaviors. In this scenario, eco-emotions represent a key factor that can potentially shape sustainable behaviors. In keeping with this, the present study aimed at observing the potential relationships between eco-emotions and readiness to change (RTC), namely a psychological construct closely related to pro-environmental behaviors. Specifically the RTC dimensions were the following: perceived importance of the problem, motivation, self-efficacy, effectiveness of the proposed solution, social support, action, and perceived readiness. In detail, Generalized Additive Models (GAMs) were performed in order to detect both linear and non-linear associations between eco-emotions and the dimensions of RTC by assuming a complex perspective. The final sample was composed of 252 participants (mean age = 32.99, SD = 14.640). The results pointed out several significant associations (both linear and non-linear) between eco-emotions and the RTC dimensions. In detail, the perceived importance of the problem was linearly associated with anger and anxiety, while sorrow and enthusiasm showed non-linear effects. Furthermore, motivation was linearly linked to anger and guilt and non-linearly to contempt, enthusiasm, and sorrow. In terms of self-efficacy, anger, enthusiasm, and sorrow showed linear relationships, whereas isolation showed a non-linear association. Perceived effectiveness of the proposed solution was linearly related to enthusiasm and sorrow and non-linearly to anger, powerlessness, isolation, and anxiety. Similarly, social support was linearly connected with enthusiasm, isolation, and sorrow, and non-linearly with powerlessness and anxiety. Moreover, action was primarily driven by anger in a linear relationship, while enthusiasm, powerlessness, guilt, and anxiety showed non-linear associations. Finally, perceived readiness was linearly related to anxiety and non-linearly to anger, contempt, enthusiasm, powerlessness, guilt, and sorrow. These findings should be interpreted in light of the study’s limitations, including its cross-sectional nature, reliance on self-reported measures, use of snowball sampling, and sample demographic characteristics, all of which may affect the generalizability of the results. Nevertheless, the results pointed out the presence of several significant linear (e.g., anxiety and the perceived importance of the problem) and non-linear (e.g., contempt and motivation) associations between various eco-emotions and RTC factors. The findings underscore the need for a complex approach to this field of research, suggesting that further studies, policies, and environmental awareness programs should consider the multifaceted nature of these phenomena in order to develop effective and valuable interventions. Full article

Background/Objectives: The Dutch National Immunisation Programme (NIP) aims to protect children against severe infectious diseases. As with all vaccines, adverse events following immunisation (AEFIs) may occur with the use of vaccines in the NIP. Safety of the vaccines is monitored by The Netherlands Pharmacovigilance Centre Lareb. This study aimed to systematically document AEFIs following administration of the MMR and DT-IPV vaccines, which are given simultaneously at the age of 9 years. Methods: A cohort event monitoring (CEM) study was performed, employing a longitudinal cohort design. Parents or guardians of 9-year-olds receiving the MMR and DT-IPV vaccines completed questionnaires following vaccination to report the presence or absence of AEFI. Results: AEFIs were reported for more than 73% of children given an MMR and DT-IPV vaccination. The great majority of the reported reactions were non-serious and self-limiting and consistent with those listed in the official product information for the MMR and DT-IPV vaccines. Injection site reactions were significantly more frequent at the site of the DT-IPV vaccination than the MMR vaccination. AEFIs were mostly perceived as little or moderately burdensome. Conclusions: AEFIs very frequently occurred after MMR and DT-IPV vaccination. This study provides further insight into the timing and duration of AEFIs after MMR and DT-IPV vaccination. In addition, detailed insight into the adverse event profile of these vaccines is provided, which helps to set realistic expectations for children and their parents or caretakers who follow the NIP and helps health professionals in their communication regarding AEFIs. Full article

Background: The deployment of large language models (LLMs) in mental health therapy presents a compelling yet deeply fraught opportunity to address widespread disparities in access to psychological care. Recent empirical evidence reveals that these AI systems exhibit substantial shortcomings when confronted with complex clinical contexts. Methods: This paper synthesizes key findings from a critical analysis of LLMs operating in therapeutic roles and argues for the urgent establishment of comprehensive risk management frameworks, policy interventions, and ethical protocols governing their use. Results: LLMs tested in simulated therapeutic settings frequently exhibited stigmatizing attitudes toward mental health conditions and responded inappropriately to acute clinical symptoms such as suicidal ideation, psychosis, and delusions. Real-world evaluations reinforce these concerns. Some studies found that therapy and companion bots endorsed unsafe or harmful suggestions in adolescent crisis vignettes, while others reported inadequate chatbot responses to self-harm and sexual assault queries, prompting concern from clinicians, disappointment from patients, and calls for stronger oversight from policymakers. These failures contravene fundamental principles of safe clinical practice, including non-maleficence, therapeutic alliance, and evidence-based care. Moreover, LLMs lack the emotional intelligence, contextual grounding, and ethical accountability that underpin the professional responsibilities of human therapists. Their propensity for sycophantic or non-directive responses, driven by alignment objectives rather than clinical efficacy, further undermines their therapeutic utility. Conclusions: This analysis highlights barriers to the replacement of human therapists with autonomous AI systems. It also calls attention to the regulatory vacuum surrounding LLM-based wellness and therapy applications, many of which are widely accessible and unvetted. Recommendations include professional standards, transparency in training and deployment, robust privacy protections, and clinician oversight. The findings underscore the need to redefine AI as supportive, not substitutive. Full article

Background and Clinical Significance: Hell’s Itch is a rare, intensely uncomfortable post-sunburn condition with burning pruritus emerging 24–72 h after UV exposure. This condition often goes unrecognized and is frequently misdiagnosed by healthcare providers due to a lack of knowledge and familiarity. Standard antipruritic measures are often ineffective, and patients frequently rely on anecdotal self-management. Case Presentation: Three healthy adult males between 23 and 28 years old experienced multiple episodes of delayed-onset intense pruritus following moderate-to-severe sun exposure. The patients experienced a burning or stinging pain which they described as “fire ants” or “thumbtacks,“ and their symptoms started between 24 and 72 h after sun exposure without any rash or fever symptoms. The patients did not achieve symptom relief from standard treatments which included oral antihistamines and topical lidocaine, NSAIDs, aloe vera, and cold compresses. The patients received β-alanine treatment through pre-workout supplements or pure powder after consulting non-clinical sources. Each patient ingested β-alanine and reported rapid relief (itch 8–10/10 → 1–2/10) lasting 2–3 h. The only adverse effect reported by one patient was mild paresthesia. Conclusions: This case introduces β-alanine as a potential off-label therapy for Hell’s Itch and emphasizes the psychological burden and clinical complexity of the condition. While anecdotal, further study is needed to elucidate the mechanism of action of β-alanine in relieving symptoms of Hell’s Itch, as well as assess safety and efficacy in controlled settings. Increased clinical awareness of Hell’s Itch may reduce patient distress and improve management strategies. Full article

Background: Nursing research has evolved through different historical stages, from the initial development of theoretical models to today’s challenges involving advanced practice and emerging technologies. Within this context, Middle-Range Nursing Theories (MRNTs) play a crucial role as a bridge between abstract conceptual frameworks and clinical practice. However, their recent production appears limited. Aims: To identify MRNTs published in the last five years, determine the main thematic fields addressed, and analyze current trends in their development. Methods: A scoping review was conducted in accordance with PRISMA-ScR guidelines. Databases searched included MEDLINE, CINAHL, PsycINFO, EMBASE, and Education Research Complete (August 2025). Eligible studies were published within the last five years in journals indexed in the Journal Citation Reports and explicitly proposed an MRNT. Exclusion criteria encompassed non-nursing theories, secondary applications of existing models, and purely methodological studies. Results: From 1230 initial records, 18 articles met the inclusion criteria. The Revista Brasileira de Enfermagem accounted for the highest number of publications. The identified MRNTs predominantly addressed clinical diagnoses and phenomena such as heart failure self-care, overweight, occupational stress, peripheral tissue perfusion, and social support networks. Most theories were derived from established nursing models (Orem, Roy, Levine, Neuman, Watson). Despite thematic diversity, few MRNTs had undergone methodological validation. Conclusions: Recent MRNT development remains limited and geographically concentrated, with Brazil emerging as a leading contributor. Strengthening methodological validation, clinical integration, and international dissemination is essential, as MRNTs continue to be pivotal tools for advancing nursing science, reinforcing disciplinary identity, and reducing the persistent gap between theory and practice. Full article

Background: Performance-enhancing drug (PED) use has become increasingly prevalent among adolescents and emerging adults, not solely for athletic advantage but as a psychological and sociocultural coping mechanism. In Türkiye, where Westernized body ideals intersect with traditional values, the emotional and symbolic meanings of PED use among youth remain underexplored. Methods: This qualitative study employed semi-structured interviews and reflexive thematic analysis to examine the subjective experiences of 26 Turkish adolescents and emerging adults (19 males, 7 females; ages 16–22) in Istanbul who reported non-medical use of steroids or other PEDs. Participants were recruited through snowball sampling in gym-adjacent communities across six urban districts. Interviews were conducted online, recorded, transcribed, and analyzed to identify emergent psychological themes. Results: Six interconnected themes were identified: (1) body-based insecurity and the fantasy of reinvention; (2) emotional regulation through bodily control; (3) secrecy as autonomy; (4) compulsive enhancement and dissatisfaction; (5) psychological dependency and regret; and (6) PED use as agency and protest. While male and female participants differed in aesthetic goals and social narratives, both groups framed PED use as a means of identity construction, emotional survival, and social validation. Participants did not perceive themselves as deviant but as strategic actors navigating a performance-driven culture. Conclusions: PED use among youth in urban Türkiye emerges as a psychologically embedded coping mechanism rooted in emotional regulation, self-concept, and perceived control. Rather than a deviant behavior, it reflects an adaptive but precarious strategy for managing insecurity and achieving recognition during a critical developmental stage. Full article

Objective: This study aims to examine activity engagement across stages of cognitive health among older adults. Methods: We used a cross-sectional study analysis of baseline data collected as part of the prospective Microbiome in Aging of Gut and Brain (MiaGB) longitudinal study; the study period was August 2022 to December 2023. Health history and activity engagement questionnaires and the Montreal Cognitive Assessment (MoCA) were used to examine the study objective. One-way ANOVA and chi-squared tests, with Bonferroni post hoc analyses, assessed group differences. Results: The weighted samples reflected 417 participants: 54% females, 70.7% White, with an average age of 72 (±8.7) years, 90% with at least high school education, and 75% self-reported medium income status. Results suggested that individuals who scored ≤17 points on the MoCA had an average age of 84 years, were White, non-Hispanic, female, had less than a high school education, and medium income status (p < 0.001). Significant differences were found in active engagement in all health behaviors (p < 0.05). The frequency of engagement in activities was all statistically significant (p < 0.05), except the frequency of looking after grandchildren (p > 0.05). Older adults who scored ≤17 MoCA points reported higher rates of hypertension, osteoarthritis, and depression compared with individuals who scored higher on the MoCA assessment. Conclusions: Older adults with lower cognitive status report a higher rate of clinical ailments and have less engagement in meaningful activities. We should promote meaningful activities to improve the quality of life in older adults with decreased cognition. We make recommendations for appropriate modifications for activity engagement across cognitive health levels. Full article

Introduction: Major depressive disorder (MDD) is a common and often treatment-resistant condition, with many patients showing only partial or minimal response to standard therapies. Repetitive transcranial magnetic stimulation (rTMS) is a well-established, non-invasive treatment for depression, though individual response varies considerably. While demographic and clinical predictors have been explored, the impact of personality styles on rTMS outcomes remains underinvestigated. Herein, we aimed to explore whether personality styles influence treatment response to rTMS. Methods: This retrospective study included 63 in- and outpatients with depressive episodes treated with intermittent theta-burst stimulation (iTBS) between September 2020 and December 2022. Patients were assessed before and after treatment using the 21-item Hamilton Depression Rating Scale (HAMD-21) and the self-reported Major Depression Inventory (MDI). Personality styles were evaluated using the German Persönlichkeits-Stil-und-Störungs-Inventar (PSSI), a dimensional measure of 14 personality styles. Statistical analyses included paired-samples t-tests to assess symptom change and linear regression models to examine whether personality styles predicted treatment outcomes. Effect sizes were reported as Cohen’s d. Results: Patients showed a significant reduction in depressive symptoms following iTBS (HAMD-21: t(62) = 10.86, p < 0.001, d = 1.37. MDI: t(62) = 8.55, p < 0.001, d = 1.06). Stepwise regression for the MDI identified critical–negativistic (NT) and reserved–schizoid (SZ) styles as significant predictors, explaining approximately 16% of the variance (R² = 0.159, p = 0.007). When entered simultaneously in a regression model for the HAMD-21, these same traits also predicted symptom change, though the effect was smaller (R² = 0.108, p = 0.033). Higher scores of critical–negativistic (NT) style were associated with better improvement, whereas higher scores of reserved–schizoid (SZ) style were associated with less improvement. Conclusions: This study confirms the overall efficacy of rTMS in reducing depressive symptoms. While SZ and NT traits showed some predictive value for treatment response—particularly on self-reported outcomes—their influence was modest and inconsistent. Based on our findings, there is no reason why patients with depression and specific personality styles, or even comorbid personality disorders, should be denied rTMS treatment. Full article

Self Determination Theory posits that individuals may be more likely to initiate and maintain behaviors tied to intrinsic (vs. extrinsic) motivations and may provide a useful framework for understanding youth participation in novel sports. Using the Intrinsic Motivation Inventory (IMI) and Patient-Centered Assessment and Counseling for Exercise Plus Nutrition (PACE+) surveys, motivation and physical activity habits were explored in 27 children/adolescents (ages 7–16) enrolled in Parkour, an individual, non-competitive youth sport. Fifteen Parkour participants were also interviewed to gain an understanding of their motivations for participating. Study participants had high median IMI subscale scores related to interest/enjoyment (6.71/7) and perceived choice (6.40/7) compared to the whole scale. Similarly median sub-scale Pros and Self-Efficacy scores for physical activity from the PACE+ were high (4.25/5 and 3.91/5, respectively). The themes of autonomy and enjoyment were consistently reported in the qualitative interviews, expanding on the quantitative results. Other themes included appreciation for camaraderie, creativity, and a drive for improvement. These results provide early evidence that Parkour, and similar lifestyle sports, may be tied more to intrinsic than extrinsic motivations and could have potential for adoption and maintenance by youth with low motivation to engage in physical activity to promote healthy behaviors. Full article

Rural communities have a close-knit social structure, hindering the disclosure of mental disorders due to fear of negative societal perception. The study aimed to explore the experiences of both clubhouse members and staff with stigma and to examine how the Clubhouse addresses stigma in rural Wyoming through semi-structured interviews. Semi-structured interviews were conducted with 16 participants (12 clubhouse members and 4 staff members). The data analysis was performed in NVivo using reflexive thematic analysis. Three main themes were generated: “mental health prejudices,” where participants reported being perceived as dangerous, unintelligent, incompetent, and attention seekers. The second main theme, “the root causes of mental health stigma,” has three subthemes: “mental health illiteracy”, “the media,” and “personal struggles and background.” The third main theme, “clubhouse effort to address stigma,” encompasses two subthemes: “the unique clubhouse environment for self-stigma recovery” and “advocacy and community outreach.” The study findings highlight the emotional challenges individuals with mental illness face due to stigma from the media and the public. However, the clubhouse provides a non-judgmental environment that addresses both self- and public stigma. The findings also support expanding clubhouses, especially in rural areas, to improve mental health outcomes. Full article

Background: Metabolic dysfunction-associated fatty liver disease (MASLD) affects nearly 20% of the Italian population, with an annual economic burden of € 7.94 billion on the National Health Service, largely due to advanced liver disease and metabolic comorbidities. Progressive liver fibrosis remains the strongest predictor of adverse outcomes. Early diagnosis is crucial, as fibrosis is potentially reversible in its early stages. Sedentary behavior (SB) is one of many modifiable risk factors for several chronic diseases; however, most evidence is based on self-reported data. This study investigates the association between objectively measured daily energy expenditure and liver stiffness in adults with MASLD. Methods: We conducted a cross-sectional analysis of 104 adults (18–65 years) with obesity and moderate-to-severe steatosis (CAP ≥ 248 dB/m) from the Obesity-AF study. Daily energy expenditure (METs/day) was assessed via 7-day wrist-worn actigraphy. Liver stiffness (LSM, kPa) was measured non-invasively using transient elastography (FibroScan^®). Results: Lower daily energy expenditure was independently associated with higher liver stiffness. Each 1-MET increase correlated with a −1.239 kPa reduction in LSM (95% CI: −2.012, −0.466; p = 0.002). Sedentary individuals (≤1.5 METs) exhibited significantly higher LSM (+0.73 kPa, p = 0.03) versus non-sedentary peers, even after full adjustment. Findings were robust across sensitivity analyses. Conclusions: Our study shows that SB, objectively measured by actigraphy, is independently associated with increased liver stiffness in patients with MASLD and obesity. Reducing sedentary time may represent a simple, low-cost, and scalable strategy to mitigate fibrosis progression. However, given the cross-sectional design and the specificity of our sample, longitudinal studies are needed to confirm the causal role of SB and to evaluate the effectiveness of targeted interventions in broader MASLD populations. Full article

Background/Objectives: Participation in patient support groups (PSGs) for long-term cardiac rehabilitation (CR) enables sustainable, cardioprotective lifestyle modification, which can reduce morbidity and cardiovascular mortality. This study evaluates a nationwide network of cardiovascular PSGs in Austria in the holistic management of patients with cardiovascular disease (CVD). Methods: Between December 2023 and March 2024, we evaluated PSGs by surveying members about their knowledge of CVD and self-assessed health status, comparing them with non-member CVD patients. Members’ and healthcare providers’ perceptions of the program were also assessed. Results: PSG members rated their own health literacy regarding CVD higher than non-members (median score: 7.00 vs. 6.00, range 1–10; U = 7088.00, p = 0.014). These results were not confirmed by an objective assessment of participant knowledge, and members did not exhibit better health data. However, members appreciated the association’s services in providing an important social network, enabling them to feel empowered in managing their condition (52.2%), and stated that it “improved their quality of life” (69.6%), while rating detrimental effects of participation as low. Healthcare providers also viewed the program rather positively, though only 5% reported prior contact with it. Conclusions: Cardiovascular PSGs offering long-term CR provide valuable support and are appreciated as important social networks. While further research is needed to confirm improvements in health literacy or health status, participation addresses patients’ psychosocial needs and may particularly benefit those at risk of social isolation and depression, therefore offering a useful addition to comprehensive CVD care. Full article