Search Results (15,595)

Alzheimer’s disease (AD) is an aging-related neurodegenerative disease characterized by an initial memory impairment that progresses to a widespread cerebrocortical failure, culminating in death. Understanding the molecular mechanisms that protect brain function during aging may help reveal novel targets for the development of effective treatments for the memory and cognitive deficits associated with AD. In this study, we analyzed a gene expression dataset generated from the prefrontal cortices of individuals showing no neurological or cognitive abnormalities. The gene expression profiles were used to identify candidate protective genes. We then compared the expression patterns of these genes in aging with their expression patterns in AD, thereby enabling us to pinpoint the genes that potentially contribute to brain resilience that delays or prevents aging-related dementia. We selected seven genes that are potentially protective for aging and AD, and have known homologues in Caenorhabditis elegans (C. elegans). Among these genes, SRPK2, AAK1, EFR3A and MAPK10 were previously implicated in attenuating AD-related cognitive decline. Our experiments demonstrated that all seven genes prioritized by our resilience model significantly extended the lifespan of C. elegans. Given the important relationship between neuronal functional integrity and lifespan (i.e., lifespan vs. brain health span), this work suggests the predicted AD resilience genes could serve as important candidate targets for therapeutic intervention. Full article

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: Healthcare professionals face high occupational stress, emotional burden, and demanding conditions that increase the risk of burnout, depression, and anxiety, with recent post-pandemic evidence indicating a high and rising global prevalence. Early identification of distress is therefore essential. This review compared three widely used instruments—the Depression, Anxiety and Stress Scales (DASS), the Maslach Burnout Inventory (MBI), and the Zung Self-Rating Depression Scale (SDS)—selected because they jointly cover depression, anxiety, stress, and burnout, unlike unidimensional tools (PHQ-9, GAD-7, PSS, CBI) that would need combining for comparable coverage. Methods: A narrative integrative review searched PubMed, Scopus, Web of Science, ScienceDirect, and Google Scholar for peer-reviewed articles (English/Croatian) published up to December 2025 (final search: 26 June 2026). Two reviewers independently screened records, resolving disagreements by consensus; quality was appraised narratively. Of 55 records, 35 were included. Results: The DASS showed a replicated three-factor structure and strong reliability, with shortened forms (DASS-8, DASS-12) enabling rapid screening at reduced domain coverage. The MBI remained the most widely used burnout measure but was limited by its emotional-exhaustion focus, proprietary licensing, and scoring heterogeneity. The Zung SDS offered a brief depression screen, though dated wording and context-dependent cut-offs favor initial-screen use. Notably, much evidence is derived from non-healthcare populations—the principal limitation. Conclusions: The instruments appear complementary rather than interchangeable; their combined use is proposed—as a reasonable suggestion from the literature, not an empirically demonstrated finding—as a multidimensional approach, contingent on context, objective, and appropriate cultural validation. Full article

Extant research has documented elevated rates of alcohol use among the fire service. While some studies have sought to examine the role of drinking motives in firefighter alcohol use, findings are limited by a lack of exploration into the validity of established alcohol use measures among this population. The present study explored the factor structure of the Alcohol Use Disorders Identification Test (AUDIT) and the revised, short-form Drinking Motives Questionnaire (DMQ-R-SF) among a large sample of career firefighters in the southern U.S. (N = 679). Participants were included in this secondary analysis if they reported any lifetime alcohol use and completed the measures of interest. Confirmatory factor analyses supported the established three-factor AUDIT and four-factor DMQ-R-SF. SEM results indicated that coping-motivated alcohol use was statistically significantly positively associated with each AUDIT subscale (i.e., hazardous consumption, dependence symptoms, and harmful consequences). Notably, conformity-motivated alcohol use was inversely associated with hazardous consumption. Findings underscore the importance of understanding and addressing alcohol use among firefighters, particularly drinking to cope with negative affect. Full article

Background. Children’s health-related quality of life (HRQoL) has been associated with both individual and family-related factors, including internalizing symptoms and parental psychological well-being. Although previous research has highlighted the role of parental mental health, evidence from non-clinical community samples remains limited, particularly when parent-proxy reports are used. Methods. A cross-sectional study was conducted among 242 parents of children aged 8–12 years in Northern Greece. Parents completed proxy measures of children’s HRQoL and internalizing symptoms, as well as self-reported measures of their own HRQoL and anxiety. Nonparametric tests were used for bivariate analyses, and multiple linear regression was applied to identify independent predictors of children’s HRQoL. Results. Higher parental mental HRQoL was positively associated with children’s HRQoL (ρ = 0.213, p = 0.031), while parental anxiety (trait anxiety: ρ = −0.204, p = 0.004; state anxiety: ρ = −0.314, p < 0.001) and parent-reported child internalizing symptoms (depression: ρ = −0.369, p < 0.001; anxiety: ρ = −0.322, p < 0.001) were negatively associated with HRQoL; however, in the multivariable model, only parental mental HRQoL (B = 0.344, p = 0.020) and parental education (B = −2.944, p = 0.044) remained significantly associated with parent-proxy child HRQoL, explaining 29.2% of the variance in children’s HRQoL (R² = 0.292). Conclusions. The findings suggest that parent-proxy child HRQoL is associated with parental psychosocial functioning in this community-based sample. Parental mental HRQoL was the strongest independent correlate of parent-proxy child HRQoL. However, given the exclusive use of parent-proxy reports and the convenience-based sample, these findings should be interpreted cautiously, as shared method variance, rater-related effects, and limited generalizability may have contributed to the observed associations. Further multi-informant and longitudinal studies conducted in more diverse populations are warranted. Full article

Narrative psychotherapy focuses on jointly discussing life stories with patients to promote shifts in sense of self and narrative identity. Narrative approaches have roots in constructivism which requires various elements or cognitive processes necessary for meaning making, such as the discussion of thoughts and feelings, how thoughts and feeling change over time, and how the patient’s construction of meaning contributes to their sense of self and place in the world. Narrative psychotherapy may have unique elements that promote recovery for people with psychosis. For instance, narrative approaches may help to integrate narratives that are fragmented or focused on illness identity, though the research is limited. The current study is a narrative review that aims to (1) discuss current theoretical and research findings related to narratives and narrative identity in people with psychosis; (2) identify and describe psychotherapy approaches that focus on narratives. We summarize recent findings that highlight positive outcomes for people experiencing psychosis, and how people move towards more integrated and complex narratives. We found a range of therapeutic approaches that focus on narratives including metacognitive therapy (i.e., metacognitive reflection and insight therapy), trauma-based psychotherapy (i.e., trauma-focused cognitive-behavioral therapy for psychosis and narrative enhancement therapy), treatment focused on self-stigma or illness identity (i.e., narrative enhancement and cognitive therapy and self-concept and engagement and life), and art and creative therapies. We discuss interpretation of findings and their implication for mechanisms of change. Full article

Background: Natriuretic peptides, including B-type natriuretic peptide (BNP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP), are established biomarkers of myocardial stress and circulatory overload. Although originally validated for diagnosis and exclusion of heart failure, their diagnostic and prognostic applications have expanded significantly in the context of critical illness. However, interpretation in critically ill patients is complicated by confounding factors such as systemic inflammation and renal dysfunction. Objective: This review synthesizes current evidence on the diagnostic, monitoring, and prognostic applications of natriuretic peptides in critically ill adults. It further outlines practical considerations, confounding variables, and emerging complementary biomarkers pertinent to clinical decision-making. Methods: A structured search of PubMed, Embase, and the Cochrane Library (January 2000 to October 2025) identified studies evaluating BNP, NT-proBNP, and atrial natriuretic peptide (ANP) in intensive care unit (ICU) patients. Eligible studies and review articles assessed diagnostic utility, volume status, hemodynamic monitoring, and prognostic performance. Narrative synthesis was employed using information obtained from eligible studies. Results: Twenty-four studies met the inclusion criteria. BNP and NT-proBNP facilitate differentiation between cardiogenic and noncardiogenic respiratory failure, identification of mixed shock states, and assessment of volume status when used in association with other modalities such as echocardiography and ultrasonography. Elevated natriuretic peptide concentrations consistently predict mortality, acute kidney injury, prolonged mechanical ventilation, and adverse outcomes in several disease states, including sepsis, acute respiratory distress syndrome [ARDS], postoperative cardiac dysfunction, and COVID-19-related critical illness. However, interpretation remains limited by confounders, including renal impairment, age, systemic inflammation, brain injury, mechanical ventilation, and right-ventricular strain/dysfunction. Conclusions: Natriuretic peptides serve as valuable adjuncts for diagnostic assessment, hemodynamic monitoring, and risk stratification in the ICU. When interpreted with attention to biological kinetics and clinical context, these biomarkers enhance multimodal monitoring and support individualized management. Future research should refine ICU-specific cutoffs and assess natriuretic peptide–guided therapeutic strategies in prospective multicenter trials. Full article

Background/Objectives: Cancer survivors admitted to inpatient rehabilitation suffer from a complex burden of interrelated physical and psychological symptoms. While mean-level improvements during rehabilitation are well-documented, it remains unknown whether rehabilitation modifies the underlying structure of symptom interconnections—the symptom network—beyond reducing individual symptom scores. This study aimed to characterize symptom network structure at admission and discharge of a 21-day inpatient cancer rehabilitation program based on cancer-related physical symptoms and psychosocial functioning, formally compare network topology across timepoints, identify structurally central treatment targets, and assess the transdiagnostic generalizability of findings. Methods: Secondary analysis of routinely collected, electronic patient-reported outcome (PRO) data from 5066 cancer survivors (mean age 60.3 years, SD 12.2; 64.2% female; most frequent diagnoses: breast cancer = 36.9%, hematological malignancies = 10.4%; prostate cancer = 8.5%) admitted to a single-center inpatient rehabilitation program was performed between January 2017 and November 2022. The EORTC QLQ-C30 and the Hospital Anxiety and Depression Scale (HADS) questionnaires were utilized. Bayesian Gaussian Graphical Models were estimated at admission (T0) and discharge (T1) across 17 symptom and functioning domains using Bayesian Model Averaging (15,000 iterations). Edge-level change was quantified via posterior distributions of pairwise differences with 95% Highest Density Intervals. Node-level changes were assessed using Bayesian paired t-tests. Centrality was quantified by Expected Influence and Bridge Expected Influence. Results: Patients showed clinically meaningful improvements across all 17 domains during rehabilitation (all Bayes Factors >10; posterior probability of direction >99.9%). The largest standardized effects were observed for emotional functioning (Cohen’s d = 0.76), global health status (d = 0.69), and fatigue (d = 0.53). These improvements were clinically meaningful for a substantial proportion of patients: 62% improved by at least the minimal important difference in fatigue and 58% in emotional functioning, and the proportion of patients with probable anxiety fell from 15% to 6% and probable depression from 10% to 4%. Emotional functioning and anxiety were the most central domains in the symptom network—most strongly connected to the rest of patients’ symptom burden—at both admission and discharge. Despite the clinical improvements, the overall architecture of symptom interconnections changed little (83% of connections were unchanged). This indicates that the severity of symptoms was mitigated while the structure linking them together remained largely intact. The one connection that strengthened was that between impaired social functioning and financial difficulties (Δ = −0.112). Structural findings were consistent across ten cancer types (leave-one-out r > 0.80 in seven of ten). Conclusions: Over the course of inpatient cancer rehabilitation, patients showed large improvements against a background of largely stable symptom network architecture. Emotional functioning and anxiety occupy structurally central positions at both admission and discharge, identifying them as candidate domains warranting further investigation for network-informed rehabilitation. These findings provide a novel structural perspective on oncological rehabilitation and a framework for developing more targeted intervention strategies. Full article

Background/Objectives: Cow’s milk protein allergy (CMPA), one of the most common allergies in early life, can present psychological, financial, and social challenges for caregivers. For mothers, this burden may be compounded by the fact that experiences with pediatric CMPA typically coincide with the perinatal period, which itself may be challenging. Our study aimed to explore the concerns, experiences, and needs of mothers navigating pediatric CMPA. Methods: We conducted a qualitative study involving three groups: mothers of children (18 months to 4 years) with, or who previously had, CMPA; mothers of infants (<18 months) with CMPA; and pregnant women concerned about their baby developing CMPA. All mothers completed a demographic questionnaire and participated in a virtual focus group or interview that was recorded, transcribed verbatim, and analyzed according to reflexive thematic analysis. Questionnaire data were described (n/N, %) to summarize participant characteristics. Results: In total, 16 mothers participated. Three themes were identified: (1) perceived negative psychosocial impacts, (2) perceived inadequacy of support from healthcare professionals, and (3) perceived negative dietary and financial implications. Conclusions: This study provides valuable insights into the perceived psychosocial implications and unmet management needs of CMPA. Full article

Clozapine-induced hypersalivation (CIH) affects 30–80% of patients on clozapine and is a major contributor of non-adherence. Current managements, largely based on systemic anticholinergics, can worsen other clozapine-related side effects. Here sublingual tropicamide 1% eye drops can be a low-cost alternative worth evaluating. We report a case series of seven patients with schizophrenia treated with sublingual tropicamide 1% ophthalmic solution (4–8 drops/day) for CIH. Treatment response was assessed by patient-reported percentage reduction in salivation. All seven patients reported improvement (25–80%). One patient reported a transient bitter taste; no systemic anticholinergic effects occurred. Sublingual tropicamide was associated with patient-reported improvement in CIH and was well tolerated in this small, uncontrolled series. Its short duration of action and local administration may offer practical advantages over systemic anticholinergics, though the mechanism remains unproven. Randomised trials with validated outcome measures are needed to establish its efficacy and safety. Full article

Malignant gliomas are highly aggressive primary brain tumors for which the therapeutic efficacy of cisplatin is frequently limited by intrinsic or acquired drug resistance. Despite advances in adjuvant therapies, overcoming chemoresistance remains a major challenge in the treatment of these malignancies. Emerging evidence indicates that long non-coding RNAs (lncRNAs), a class of non-protein-coding transcripts involved in gene regulation, play important roles in modulating treatment responses. Several lncRNAs, including differentiation antagonizing non-protein-coding RNA (DANCR), HOXD antisense growth-associated long non-coding RNA (HOXD-AS1), MEG3, MALAT1, and HOTAIR, have been implicated in pathways associated with glioma progression and therapeutic resistance. In particular, DANCR has been reported to promote cisplatin resistance in glioma cells through suppression of apoptosis and activation of pro-survival signaling pathways. This review summarizes current evidence regarding the roles of lncRNAs in cisplatin resistance, highlighting mechanisms such as regulation of drug transport, DNA damage repair, apoptosis, cancer stem-cell maintenance, and signaling pathways associated with treatment adaptation. We also discuss current limitations, challenges for clinical translation, and gaps in the existing evidence. A better understanding of lncRNA-mediated resistance mechanisms may facilitate the identification of novel therapeutic targets and inform future studies aimed at overcoming cisplatin resistance in malignant gliomas. Full article

Objectives: Evidence on the effects of palliative care team interventions on cachexia remains limited. We examined the effects on nutrition impact symptoms (NISs), dietary intake, and eating-related distress (ERD) among advanced cancer patients. Methods: This was a multicenter prospective observational study. Participants completed the baseline survey and the follow-up survey one week later. They evaluated NISs, dietary intake, and ERD. We compared the patient-reported outcomes between the two surveys. We categorized the participants having four or more NISs with a score ≥ 4 into the High-NIS group (otherwise, the Low-NIS group) using their baseline scores. Changes in the number of symptoms with a score ≥ 4, the dietary intake, and the ERD scores were calculated. Multiple regression analyses were performed to identify the factors influencing the improvements in dietary intake and ERD. Results: A total of 123 patients were included. In all patients, pain, fatigue, lack of appetite, sadness, and ERD significantly improved (p = 0.001, 0.023, 0.043, 0.037, <0.001). In the High-NIS group, the number of symptoms with a score ≥ 4 significantly decreased (p = 0.009), dietary intake scores significantly increased (p = 0.037), and ERD scores significantly decreased (p = 0.001). The number of symptoms with a score ≥ 4 at baseline (B = 1.08, p = 0.044, 95% confidence interval 0.03 to 2.14) was the only independent factor influencing the improvements in dietary intake. Conclusions: NISs and ERD improvements were associated with the interventions. Dietary intake improvement was associated with a high baseline symptom burden. Full article

Chronic pain is the leading cause of disability worldwide and frequently co-occurs with mild traumatic brain injury among Veterans (mTBI + CP), creating complex treatment challenges and a need for novel, non-pharmacological interventions. This study evaluated a pilot intervention combining intermittent theta burst stimulation (iTBS), a neuromodulatory approach, with the evidence-based LoveYourBrain Yoga program to enhance rehabilitation outcomes. In a six-week open-label trial, ten Veterans with mTBI + CP received weekly iTBS followed by yoga sessions. Pilot quantitative outcomes included quality of life (Traumatic Brain Injury Quality of Life [TBI-QoL]) and functional ability (Mayo Portland Adaptability Inventory-4 [MPAI-4]), assessed pre- and post-intervention, alongside qualitative semi-structured interviews and interdisciplinary clinical notes. Significant improvements were observed in TBI-QoL Fatigue (p = 0.021) and MPAI-4 Grief and Loss (p = 0.016), with clinically meaningful but non-significant gains in Ability and Adjustment. Qualitative findings revealed improved pain management and enhanced self-management, with participants describing better emotional regulation, more effective coping strategies, and stronger social connections. Some benefits were more evident in qualitative data than in standardized measures. These pilot findings suggest that combining iTBS with mind–body therapy may provide complementary tools for pain management and functional recovery in Veterans with mTBI + CP, supporting further investigation of integrated neuromodulation and behavioral interventions. Full article

Predictive processing (PP) accounts often characterize mental illness as maladaptive and epistemically distorting due to mismatches between brain-generated top-down models and bottom-up sensory inputs, with this review identifying exceptions. First, hypervigilance in trauma survivors with PTSD or depression may sustain desirable gaps between anticipated problems and actual harms that would otherwise occur. Second, PP defenders have argued that depressive slowdowns follow from maladaptive brain-based regulatory models, yet physiological problems may make activity strenuous—in which case slowing down is adaptive. Third, PP researchers introduce tacit normative assumptions. For example, in autism and ADHD, they stipulate thresholds for how specific (hence error-prone) predictive models should be, and PP interpretations of schizophrenia sometimes presuppose Western concepts of self as normative neurocognitive ideals. Fourth, PP accounts of prediction error can tacitly invoke veridical representation, even though advocates regularly claim that cognition evolved primarily for action, not truth-seeking. While criticizing PP for its overreaches, this review also explores how greater attention to these exceptions and factors such as cultural variability may strengthen the framework’s capacity to understand and contribute to the treatment of a range of psychiatric conditions. Full article

Background: Body image disturbance (BID) involves a distorted perception of one’s body, whereas body dissatisfaction (BDS) reflects negative affective evaluation of body appearance. Both are central features of eating disorders such as anorexia nervosa (AN), but their expression in siblings of affected individuals remains underexplored, particularly in younger populations. Methods: This cross-sectional preliminary study included 53 full sisters of adolescent patients with severe AN treated in a tertiary hospital. Participants underwent anthropometric assessment and completed standardized measures of BID, BDS, physical activity, eating-related attitudes, perfectionism, anxiety, and depressive symptoms. Results: Participants exhibited marked body size overestimation (mean relative BID = +45.2%), with 64.2% classified as high overestimators and 3.8% as underestimators. Overestimation was most pronounced in the waist, chest, and calves. BID was not significantly associated with BDS or with anthropometric measures, including body mass index. BDS showed significant positive correlations with depressive symptoms and self-oriented perfectionism, whereas BID was positively associated with physical activity. No significant associations were found between BID or BDS and age, socioeconomic status, or birth order. Conclusions: Sisters of adolescents with severe AN show substantial perceptual distortion of body size without corresponding levels of body dissatisfaction, suggesting partial independence between perceptual and affective components of body image. These findings identify a potentially vulnerable group and highlight the need for longitudinal studies to clarify mechanisms and inform preventive strategies. Full article