Search Results (12,616)

Background: Traditional cardiovascular risk models often overlook “residual risk” driven by psychopathological factors. This study investigates the exploratory prognostic baseline associations of Type D personality (TDP) and specific symptomatic dimensions with long-term all-cause mortality in patients with coronary artery disease (CAD). Methods: We conducted a retrospective case study based on hospital records evaluating 221 patients with confirmed CAD. Anatomical complexity was quantified via the SYNTAX Score (SS). Psychological profiling utilized the DS14 scale for TDP and the SCL-90 for granular symptoms (depression, anxiety, and hostility). Mortality was analyzed over a mean follow-up of 1026 days using multivariate Cox proportional hazards models. Results: Over a mean follow-up of 1026 days, the overall all-cause mortality rate was 33.0% ($n=73$). TDP prevalence was 19.0% ($n=42$) and significantly correlated with higher anatomical complexity (SS: 26.21 vs. 15.49; $p<0.001$). In the adjusted psychological model, baseline anxiety symptom severity presented an exploratory, borderline relationship with survival (HR = 0.941; $p=0.049$), with the 95% confidence interval upper bound reaching the null threshold (1.000), suggesting a potential, hypothesis-generating “Anxiety Paradox”. The psychological model demonstrated variations in descriptive validation indices (C-index = 0.624) compared to a baseline model integrating trait metrics and anatomical severity (C-index = 0.527). Significant correlations were confirmed between SS and psychological distress ($r=0.493$). Conclusions: TDP components and granular psychological tracks show significant baseline associations with coronary anatomical distributions, while anxiety dimensions present an exploratory relationship with long-term survival. Given the lack of adjustment for major clinical determinants of mortality (such as age, comorbidities, or ventricular function), these findings must be interpreted strictly as hypothesis-generating and exploratory. Full article

Background/Objectives: Diet-disease-related knowledge (DDRK) is theorized to foster healthier lifestyles; however, the structural interconnectedness between nutritional knowledge and personal biomarker awareness is not well understood. This study aimed to identify independent predictors of DDRK and cardiovascular health (CVH) literacy among Lebanese adults using a psychometric framework. Methods: A cross-sectional convenience-sampled online survey was conducted among 406 Lebanese adults. Standard validated questionnaires were used, including the GNKQ-Section 4, GPAQ, and MEDAS. CVH literacy was computed as the total awareness of five main CV biomarkers: total cholesterol, LDL, HDL, triglycerides, and HbA1c. Data were analyzed through multivariable logistic regression and EBICglasso network analyses. Results: Overall, the prevalence of cardiovascular (CV) biomarker unawareness was 65.5% across participants. Fully adjusted regression models showed that a continuous DDRK score was a significant factor independently associated with lower odds of CV biomarker unawareness (aOR = 0.878, 95% CI [0.824–0.936], p < 0.001), followed by a higher MEDAS score (aOR = 0.842, p = 0.003) and aging (aOR = 0.961, p < 0.001). The network model was dense (sparsity = 0.133) and showed DDRK–CVH literacy as the strongest conditional edge (r_partial = 0.202). The conditional associations of BMI (r = 0.000) and physical activity (r = 0.036) with CVH literacy collapsed after conditioning on DDRK and MEDAS. Centrality indicators showed that DDRK had the highest closeness and strength (both = 1.000). Conclusions: DDRK shows strong conditional network associations with Mediterranean diet adherence and CVH literacy. These exploratory findings generate hypotheses for future longitudinal or interventional research. Full article

This exploratory research investigates the perceived educational potential of visual, spatial, and auditory immersions as integral components of innovative healthcare simulation technologies. The study examines user experiences in learning health assessment concepts through purposefully designed 360° immersive virtual reality video (360° IVRV). Utilizing a case-study approach, insights were gathered from four subject-matter experts and four doctoral students regarding the perceived effectiveness of 360° IVRV for instructional activities focused on patient health assessment, commonly known as the Onset, Location, Duration, Characteristics, Aggravating/Alleviating factors, Related symptoms, Treatment, and Severity method (OLD CARTS). The research aimed to enhance the accessibility of learning materials by optimizing 360° IVRV content for personal phones and mobile devices, accommodating both online and traditional instructional formats. Interviews were transcribed and analyzed using qualitative data analysis software, with results categorized into subthemes, themes, and perspectives. The findings highlight the distinct perceived advantages of immersive technologies in advancing teaching methods for nursing practitioners. The discussion addresses concerns related to integrating 360° IVRV simulation technology in nursing education and the limitations of current instructional interventions. Practical implications for future research, design, and development of immersive learning materials and their integration with instructional design elements are emphasized. Full article

Research on learning in higher education focuses heavily on cognitive factors and academic performance. However, affective learning outcomes are crucial for overcoming learning difficulties and for personal development. Consequently, this study explores which personal factors are associated with affective learning outcomes among university students. We consider academic self-concept, learning goal orientation, and years of study as personal factors, and politeness, trustworthiness, cooperation, support, and friendship as affective learning outcomes. We collected data from 200 university students who provided self-ratings on the study variables via an online survey. Correlation and multiple regression analyses revealed that academic self-concept was the most strongly related to affective learning outcomes. Unexpectedly, years of study did not show any significant effects. In our discussion, we address the theoretical, methodological, and practical challenges of research and development activities on affective learning in higher education. Full article

Background: Neonatal hyperbilirubinaemia (NHB) affects approximately 60% of term infants and is a recognised cause of bilirubin-induced neurologic dysfunction (BIND); however, its subclinical neurodevelopmental sequelae have not been well characterised at the level of specific developmental domains. Objectives: We aimed to use the Griffiths Developmental Scales–Chinese Edition (GDS-C) to characterise the domain-specific neurodevelopmental profile of term infants with NHB and to identify clinical risk factors for adverse outcomes. Methods: We conducted a single-centre, retrospective cohort study of 123 term newborns delivered between September 2019 and August 2023 at a tertiary hospital in Shanghai, China; 77 had NHB and 46 were healthy controls. Neurodevelopmental outcomes were assessed using the GDS-C at a median age of 46.9 months (interquartile range [IQR], 36.4–59.7) by a single certified examiner who was blinded to bilirubin status. A developmental quotient (DQ) below 85 (>1 SD below the standardised mean of 100) or at or below the 10th percentile was classified as below cutoff; otherwise, performance was classified as within the normal range. To account for testing across six domains, a Bonferroni-adjusted significance threshold of p < 0.0083 was applied. Results: Compared to the control group, the jaundice group had higher proportions of below-cutoff performance in the Locomotor (26.0% vs. 10.9%; p = 0.045), Personal–Social (28.6% vs. 10.9%; p = 0.022), Eye and Hand Coordination (29.9% vs. 10.9%; p = 0.015) and Performance (35.1% vs. 15.2%; p = 0.018) domains. Among infants with severe hyperbilirubinaemia (total serum bilirubin (TSB) ≥ 342 μmol/L; n = 19), the proportions of below-cutoff performance in the Locomotor (47.4% vs. 19.0%; p = 0.032), Personal–Social (57.9% vs. 19.0%; p = 0.003) and Performance (57.9% vs. 27.6%; p = 0.034) domains exceeded those in the non-severe subgroup. Jaundice lasting ≥ 14 days was associated with poorer personal–social outcomes (p = 0.007). In multivariable logistic regression, both a peak TSB ≥ 342 μmol/L (adjusted odds ratio [aOR], 5.59; 95% confidence interval [CI], 1.64–19.02; p = 0.006) and a jaundice duration ≥ 14 days (aOR, 5.68; 95% CI, 1.61–20.04; p = 0.007) were independently associated with below-cutoff personal–social performance. Conclusions: Among term infants, NHB was associated with an increased risk of below-cutoff performance across several GDS-C domains, particularly those reflecting gross motor, personal–social and visual-spatial functions. Severe hyperbilirubinaemia and prolonged jaundice were independent risk factors. The GDS-C may serve as a sensitive, domain-specific instrument for the early identification of infants at risk of adverse neurodevelopmental outcomes. Full article

Transition to higher education represents a critical period marked by academic, emotional, and social challenges that can affect students’ well-being. Although social and emotional competence (SEC) and self-care practices have been identified as protective factors of well-being, there is a gap in understanding how these concepts intersect within higher education. In an exploratory sequential mixed-methods study, we first explored the main challenges perceived by higher education students in adapting to university and which SEC and self-care practices they perceived as most relevant to promoting their personal and academic well-being. Building on these insights, we then investigated the mediating role of self-care practices in the relationship between students’ SEC and their well-being. In the first stage of the study, 16 higher education students (81.3% female, M = 22.19 years) participated in semi-structured interviews; additionally, 204 higher education students (77.9% female, M = 22.10 years) responded to an online survey. Qualitative findings suggested that the most significant challenges in the adaptation to university were of a social and emotional nature, related to emotional challenges, interpersonal relationships, and personal organization. To overcome these, students primarily valued intrapersonal competencies such as self-awareness and self-regulation. Participants predominantly described using personal self-care practices, focusing on psychological and emotional care. Generalized linear model-based mediation analysis sustained that both personal and academic self-care practices mediated SEC effects on students’ personal well-being. However, only academic self-care practices mediated SEC effects on their academic well-being. Self-regulation competencies had the strongest effect on students’ personal and academic well-being, providing quantitative support for the prominence attributed to this competency by students during the qualitative phase. This research contributes to a strengthened theoretical understanding of the interplay between higher education students’ SEC, self-care practices, and well-being, offering new empirical evidence on how these relate. Full article

Asthma is a heterogeneous chronic airway disease in which oxidative stress (OS) plays a central mechanistic role beyond classical immune-mediated inflammation. Reactive oxygen and nitrogen species (ROS/RNS), generated by recruited inflammatory cells and activated airway structural cells, drive epithelial injury, mucus hypersecretion, airway remodeling, and modulate key transcription factors including nuclear factor kappa B (NF-κB) and mitogen-activated protein kinase (MAPK) pathways. This review synthesizes current evidence on the multilevel redox-based determinants of asthma severity, spanning from genetic polymorphisms to circulating biomarkers. We examine serum antioxidant enzymes, superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), peroxiredoxins (PRDXs), and the thioredoxin (Trx) system as dynamic indicators of systemic redox status and disease severity, alongside oxidative enzymes including NADPH oxidases and dual oxidases (NOX/DUOX), xanthine oxidase (XO), and myeloperoxidase (MPO) that serve as upstream sources of airway oxidant burden. Functional genetic polymorphisms in antioxidant genes (SOD2, CAT, glutathione S-transferase mu 1/glutathione S-transferase theta 1 (GSTM1/GSTT1), heme oxygenase-1 (HO-1), NAD(P)H quinone dehydrogenase 1 (NQO1), nuclear factor erythroid 2-related factor 2/Kelch-like ECH-associated protein 1 (Nrf2/KEAP1)) and oxidative enzyme genes including nitric oxide synthase 1/2/3 (NOS1/2/3), MPO, cytochrome b-245 alpha chain (CYBA), and xanthine dehydrogenase (XDH) are reviewed as modulators of individual redox capacity and asthma susceptibility, with particular attention to gene–environment interactions. We further discuss oxidative damage biomarkers, including malondialdehyde (MDA), 8-isoprostanes, 4-hydroxynonenal, 8-oxo-7, 8-dihydro-2′-deoxyguanosine, protein carbonyls, 3-nitrotyrosine, and advanced oxidation protein products as indicators of lipid, DNA, and protein oxidation that correlate with disease activity and control. The roles of micronutrient cofactors in modulating antioxidant enzyme function and their potential as contextual biomarkers are also addressed. Additionally, emerging evidence on microRNAs (miRNAs) linked to OS biology in asthma is presented. Finally, we critically evaluate the challenges limiting clinical translation, including biomarker non-specificity, analytical variability, gene–environment complexity, and the absence of standardized reference ranges. This integrated framework supports the development of multilevel redox prognostic panels combining genetic, enzymatic, and oxidative damage readouts for improved asthma phenotyping, severity stratification, and personalized therapeutic approaches. Full article

Background: As a crucial transitional period from campus to society, providing comprehensive undergraduate health psychological care is essential for addressing Social Anxiety Disorder (SAD). Current global healthcare research is actively exploring innovative digital interventions, with a specific focus on leveraging Augmented Reality (AR) as a transformative auxiliary tool in clinical settings. Methods: This study investigates the factors influencing the acceptance of AR-assisted Cognitive Behavioral Therapy (CBT) within student healthcare frameworks by developing a research model based on the Technology Acceptance Model (TAM). The framework incorporates key clinical and behavioral constructs: self-efficacy (SE), facilitating conditions (FC), and social influence (SI). Results: SE, FC, and SI significantly and positively impact the willingness to adopt AR technology for mental health purposes. Based on these findings, practical recommendations are provided for healthcare technology developers, therapists, and university psychological care providers to enhance the integration of AR-assisted CBT. Conclusions: Strengthening these digital pathways is vital for improving healthcare outcomes and enabling students to navigate future social and professional environments effectively. Because the sample consisted solely of Chinese undergraduate students, the findings should be interpreted within this specific cultural and educational context and require further validation in cross-cultural and multi-regional samples. Full article

Spirituality and religiosity are increasingly recognized as important factors influencing mental health, particularly among women exposed to diverse vulnerabilities such as interpersonal violence, trauma, HIV infection, homelessness, and socioeconomic disadvantage. This systematic review aimed to synthesize evidence on the associations between spiritual or religious resources and mental health outcomes in these populations. A systematic search was conducted in Scopus, PubMed, and Web of Science to identify studies examining the association between spirituality, religiosity, and mental health outcomes in vulnerable women. A total of 28 studies were identified, including cross-sectional, longitudinal, and mixed-methods designs, which measured spirituality and religiosity using validated instruments such as SWBS, DUREL, FACIT-Sp-12, and Brief RCOPE, alongside standardized mental health measures. Narrative synthesis revealed that the majority of studies (n = 15) reported that higher spiritual well-being, intrinsic religiosity, and adaptive religious coping were associated with lower depression, anxiety, and post-traumatic stress, and with higher resilience, quality of life, and post-traumatic growth. These associations appeared to be shaped by contextual factors, including the type and severity of trauma, cultural and religious frameworks, and the lived experiences of the populations studied. Negative associations were primarily linked to negative religious coping (n = 5 studies), rather than religiosity per se. Additional factors that attenuated or reversed the expected positive effects included higher trauma severity or ongoing adversity (n = 4), reactive patterns in which greater psychological distress was associated with increased use of religious coping (n = 3), maladaptive religious beliefs such as interpretations of trauma as divine punishment (n = 2), and cultural or contextual influences (n = 3). Overall, the evidence suggests that spirituality and specific dimensions of religiosity (e.g., intrinsic religiosity, religious coping) can support mental health among vulnerable women, though personal, cultural, and situational factors shape their impact. These findings suggest the potential value of integrating spiritual resources into interventions and the need for further longitudinal and culturally sensitive research. Full article

Children of imprisoned parents, who are often described as ‘orphans of justice’, suffer a multitude of disadvantages when a parent is sent to prison. Whilst their experiences of loss, stigma, and social exclusion are well documented, one area that remains critically under-examined is how court reporting processes may further exacerbate these harms. This study explores the lived experience of children 11–17 yrs (n = 6) who had experienced parental imprisonment, and non-offending adults (parents, caregivers, and adult children of offenders/n = 6) in relation to their experiences of parental crime reported in the press. This study also integrates views from individual interviews conducted with journalists and press regulators (n = 5), as well as data from a content analysis of three regional and two national newspapers across a three-week period. Findings indicate that current court reporting practices can be, for some children and family members, a contributing factor to their difficulties. Participating children and family members assert that publishing partial home addresses and references to family relationships heightens their visibility in the community, which they say contributes to community backlash and negatively affects their physical and mental wellbeing. The content analysis (n = 186 custody related news reports) showed selective disclosure of offenders’ personal and family details. Interviewed journalists strongly defended the principle of open justice and felt legally unable to add the wider context families often wished to share. However, they expressed genuine sympathy for the children, and while resistant to new legal restrictions, were open to developing voluntary guidance to help reduce harm where possible. This study proposes an integrated framework to strengthen ethical journalism and better protect children impacted by parental imprisonment, calling for improved public information, trauma-informed education, participatory research and practitioner tools that centre children’s rights. It argues that open justice must be balanced with relational accountability, ensuring open justice does not come at the expense of children’s wellbeing. Full article

Iron is essential for normal cellular function, but its dysregulation is increasingly recognized as a key factor in colorectal tumorigenesis. This review provides an integrated overview of iron-related biomarkers across the full spectrum of colorectal neoplasia, from preneoplastic lesions to advanced colorectal cancer (CRC). Evidence suggests that alterations in iron metabolism begin early, at the level of colorectal adenomas, where increased iron uptake and impaired export contribute to local iron accumulation and oxidative stress. As lesions progress to carcinoma, this imbalance becomes more pronounced, leading to expansion of the intracellular labile iron pool and supporting tumor growth, metabolic adaptation, and genomic instability. At the systemic level, patients often exhibit reduced circulating iron despite preserved or elevated ferritin levels, reflecting inflammation-driven functional iron deficiency. This pattern is largely mediated by dysregulation of the hepcidin–ferroportin axis. In this context, transferrin saturation and soluble transferrin receptor may provide a more accurate assessment of iron availability than ferritin alone. At the tissue level, increased expression of iron import proteins and impaired iron export promote intracellular iron retention. Excess iron further contributes to reactive oxygen species generation, leading to damage of DNA, lipids, and proteins. Clinically, iron-related biomarkers show variable diagnostic performance but may offer prognostic value. Integrating systemic and tissue biomarkers could improve risk stratification and support personalized approaches across the CRC continuum. Full article

The new therapeutic options now available for patients with hepatocellular carcinoma (HCC) have made their assessment more complex, especially due to the different stages of liver cirrhosis typically associated with this tumor. The management of the disease therefore requires an interdisciplinary approach aimed at identifying the most appropriate treatment based on the risk–benefit profile and residual liver function, as well as in relation to the patient’s age and potential for a full or partial recovery, risk of complications, and cancer recurrence. Another factor to be carefully considered in patients with hepatocellular carcinoma is the frequent comorbidities and the associated socio-health variables (substance abuse, addictions, unfavorable economic or family circumstances), which can impact patient management or the possibilities for long-term monitoring, thus influencing the choice of the most appropriate therapeutic pathway. The healthcare services offered in the Province of Salerno (Campania Region, Southern Italy) to ensure all possible diagnostic and therapeutic options for these patients can be difficult to access due to the territorial extension of the Local Health Authority, characterized by clinics and hospitals located in distant locations, as well as the potential fragmentation of expertise between the University Hospital and ambulatorial facilities or small hospitals. An interdisciplinary consensus conference on the management of patients with HCC has been set with the aim of involving clinicians and surgeons working in healthcare facilities located in Salerno and its Province for the optimal care and effective management of these patients, taking into account all the clinical characteristics of the disease and individual health needs or expectations, from the perspective of personalized medicine. Full article

Background: Driven by Vision 2030, Saudi Arabia is rapidly integrating Artificial Intelligence into its healthcare ecosystem. This study investigates the patterns, predictors, and sociodemographic determinants of AI reliance and dependence in healthcare decision making, focusing on how trust influences the shift toward personalized digital diagnosis. Methods: A cross-sectional study was conducted with 627 adults in Saudi Arabia using convenience sampling. Data collected via online questionnaires were analyzed using JMP student edition version 18 software to evaluate user interaction with symptom checkers, wearables, and generative AI. A multidimensional framework assessed how trust and dependence influence health-seeking behaviors. Results: The findings reveal high AI engagement, with 63.7% of respondents using AI tools weekly. Conversational AI and LLMs are the dominant interfaces (92.2%), primarily serving as “gatekeepers” for personalized diagnosis (71.6%) and treatment suggestions (76.9%) before formal consultations. While gender significantly impacts reliance (p = 0.0037), trust was identified as the only significant predictor of overall engagement (p < 0.0001). Notably, age, education, and income had no statistical impact (p > 0.05), indicating uniform adoption across groups. Conclusions: For surveyed cohorts, trust is the primary determinant of AI reliance, overriding traditional demographic factors. Fostering user trust is essential for the successful implementation of AI-driven personalized healthcare solutions. Full article

This study investigates how Languages Other Than English (LOTE) students negotiate their identification amid growing uncertainties about the value of multilingual learning and language degrees. Drawing on ecological systems theory (EST), it identifies eight influencing factors ranging from microsystem to macrosystem that shape students’ identification. These factors are organised across three interconnected spheres: the individual sphere, shaped by personal interest and symbolic resonance with language and culture; the social sphere, driven by socially valued expectations in academic and career domains; and the relational sphere, grounded in interpersonal connections within the departmental community. Relational belonging—nurtured within inclusive and supportive peer–teacher networks—represents a key stabilising force, fostering students’ identification with the major. By proposing a dynamic model of identification, the study suggests that LOTE programmes should strengthen activities related to identity support and cultural engagement. Full article

Dental caries is the world’s most common non-communicable disease with a complex etiology including social, behavioral, medical, biological and economical elements. The distribution among populations and age groups is skewed, which calls for validated clinical tools to identify those with increased caries risk. The aim of this article was therefore to review risk factors for caries development in children, based on global prospective birth cohorts, genetic proceedings and data from validated risk assessment tools. The genetic elements involve four main categories comprising enamel quality, salivary composition, dental biofilm function and taste preferences. Recent studies suggest that genes may account for 35–55% of the variation in caries scores in the young permanent dentition. Prospective birth cohorts have pointed out poverty, socioeconomic level, early introduction and excessive sugar intake as significant factors for a child’s dental caries trajectory up into adulthood. Moreover, prolonged breastfeeding, child obesity and maternal oral conditions are linked to the caries burden later in life. In the clinic, the strongest predictors are past caries history and selected behavioral and social factors. The performance of the validated caries risk assessment models is far from perfect, but still acceptable in terms of reliability during childhood. These tools are the best clinical practice since they add objectivity, consistency and documentation to the clinical routines. In addition, the dental staff has the advantage of using the outcome of the assessment for a structured risk communication with the caregivers. The protocol should also form the basis for a personalized intervention program addressing the entire family, with particular focus on maternal oral health and sugar reduction. Full article