Search Results (2,261)

Background: and objective: Globally, breast cancer (BC) raises global health concerns, being the most common cancer. Women with BC experience a significant increase in perception of stress. Therefore, this study aims to evaluate the stress levels and associated sociodemographic and clinical factors among BC women in Saudi Arabia. Methods: A cross-sectional study was conducted between January and May 2025. Women diagnosed with BC, who were at least 18 years old, were recruited conveniently from outpatient and inpatient departments in King Fahad Specialist Hospital, Dammam, Saudi Arabia. Data were collected in the Arabic language through self-reported questionnaires, including sociodemographic/clinical characteristics and the Cohen’s Perceived Stress Scale. The data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 27. Results: A total of 200 participants were included in the study. The mean stress perception score was 26.52 ± 7.34. A high proportion (71.5%) of the sample reported elevated stress. A significant association was observed between age and stress levels. Most women aged 20–40 and 41–60 reported high stress, compared to women in the 61–80 age group (p = 0.003). Among all predictors, age was the only variable significantly associated with stress scores. Increasing age was associated with lower stress levels (B = −0.179, p = 0.013), indicating that younger participants tended to report higher stress. This corresponds to an adjusted decrease of approximately 1.8 points in the PSS-10 score per 10-year increase in age. Although participants with Stage IV cancer showed higher stress scores compared to those with Stage I cancer, this association approached but did not reach statistical significance (p = 0.054). Conclusions: This study highlights the substantial psychological burden experienced by women living with BC in Saudi Arabia. The majority of participants reported high levels of perceived stress. Younger women were particularly vulnerable to elevated stress. These findings highlight the need for targeted psychosocial support within oncology care to improve emotional well-being and quality of life. Full article

Background and Objectives: Medication adherence is a key determinant of treatment effectiveness in early-stage breast cancer, particularly during long-term systemic therapies. As breast cancer is increasingly diagnosed at younger ages, a growing number of women continue to carry active parenting responsibilities during treatment. However, the associations between parenting-related psychosocial factors and medication adherence remain insufficiently explored. This study aimed to examine the associations between parenting stress, spiritual well-being, and medication adherence in women with early-stage breast cancer who maintain active parenting roles. Materials and Methods: This multicenter, cross-sectional study included 432 women with early-stage (I–III) breast cancer receiving active systemic therapy across nine oncology centers. Parenting stress was assessed using the Parenting Stress Scale (PSS), spiritual well-being using the Functional Assessment of Chronic Illness Therapy–Spiritual Well-Being Scale (FACIT-Sp-12), and medication adherence using the 6-item Modified Morisky Adherence Scale (MMAS-6). Spearman correlation analyses and multivariable linear regression models were used to evaluate associations between variables. Mediation analysis was performed using Hayes’ PROCESS macro (Model 4) with 5000 bootstrap samples to assess statistical mediation. Results: Parenting stress was positively associated with poorer medication adherence (ρ = 0.248, p < 0.01), whereas spiritual well-being was negatively associated with non-adherence (ρ = −0.225, p < 0.01). Parenting stress showed a strong inverse association with spiritual well-being (ρ = −0.597, p < 0.01). In multivariable regression analyses, both parenting stress and spiritual well-being were independently associated with medication adherence (β = 0.180, p = 0.002 and β = −0.199, p = 0.001, respectively). Mediation analysis demonstrated a significant indirect statistical association between parenting stress and medication adherence through spiritual well-being (indirect effect = 0.0155), consistent with partial statistical mediation. Conclusions: Medication adherence among women with early-stage breast cancer and active parenting responsibilities is associated with psychosocial context in addition to clinical factors. Parenting stress is associated with poorer adherence, whereas greater spiritual well-being is associated with better adherence within a statistical mediation framework. These findings generate hypotheses for future longitudinal and interventional studies. Full article

Endometriosis is a chronic inflammatory disorder affecting about 190 million women of reproductive age worldwide. It represents a major health challenge due to its broad impact on physical, reproductive, and psychological well-being and is clinically characterized by pelvic pain, menstrual irregularities, and infertility. This narrative review synthesized current evidence on the relationship between adiposity, metabolic and inflammatory markers, and endometriosis from a biopsychosocial and intersectional perspective. A comprehensive search was conducted in PubMed, Scopus, and Web of Science for peer-reviewed studies published in English over the past decade.: Results pointed out that endometriosis significantly affects inflammatory activity within adipose tissue, especially in visceral adipose tissue. Studies also reported reduced adipocyte size and altered adipose tissue function. The endometriosis cytokine profile exhibited a pattern of systemic and tissue-specific inflammatory activation (i.e., elevated levels of interleukin-6 and monocyte chemoattractant protein-1). Sociodemographic factors (i.e., age, race/ethnicity, socioeconomic status, and educational level) also play a significant role in differences in symptomatology, disease course, and healthcare access. To sum up, endometriosis need to be considered as a multisystem condition related to metabolic, inflammatory, and psychosocial factors. It is necessary to adopt a biopsychosocial and intersectional perspective to improve diagnosis and support more equitable and personalized therapeutic approaches. Full article

Background: Postpartum depression and anxiety are common in the perinatal period and can adversely affect maternal functioning and infant outcomes. Self-esteem is a relevant psychosocial factor, yet evidence from Eastern Europe remains limited. Objectives: To describe self-esteem levels among postpartum Romanian women, examine correlational associations between self-esteem and postpartum depression/anxiety symptoms, and assess whether these associations persist after adjustment for sociodemographic and clinical covariates, across two maternity centers in a cross-sectional design. Methods: This cross-sectional study included 201 postpartum women recruited consecutively during their initial postpartum hospitalization from two public maternity hospitals in Western Romania (Bihor, n = 100; Timiș, n = 101) during 2024–2025. Participants completed the Rosenberg Self-Esteem Scale (RSES), Edinburgh Postnatal Depression Scale (EPDS), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder-7 (GAD-7). Associations were assessed with χ² tests (categorical comparisons), Pearson correlations, and multivariable linear regression models including center and selected sociodemographic/obstetric covariates. Results: Self-esteem showed a strong inverse correlation with postpartum depressive symptoms (RSES–EPDS: r = −0.542 overall; r = −0.537 in Bihor; r = −0.552 in Timiș; all p < 0.001). Negative correlations were also observed with anxiety (RSES–GAD-7: r = −0.400; p < 0.001) and PHQ-9 depressive severity (r = −0.370; p < 0.001). Stratified analyses indicated graded symptom burden across self-esteem categories, with higher EPDS risk proportions among women with moderate/low self-esteem within each center (χ²p ≤ 0.039). In adjusted models, EPDS (B = −0.37; p < 0.001) and GAD-7 (B = −0.15; p = 0.021) remained independently associated with lower RSES, alongside study center (Timiș vs. Bihor: B = −1.08; p = 0.043) and educational attainment. Conclusions: Lower self-esteem co-occurs with postpartum depressive symptoms and, secondarily, anxiety in Romanian women. While the cross-sectional design precludes causal inference, these robust correlational associations support the potential value of self-esteem assessment for early psychosocial risk identification. Longitudinal research is needed to establish temporal relationships and evaluate whether self-esteem can prospectively predict postpartum mental health outcomes. Full article

Background: Atopic dermatitis (AD) is a chronic, pruritic and relapsing inflammatory skin disorder affecting children’s quality of life (QoL). Despite rising global prevalence, data on its impact on QoL in low-resource settings remain limited. This study aimed to assess the impact of AD and associated factors on the QoL of children and assesses the effect of educational intervention in Ethiopia. Methods: A prospective cohort study was conducted among 461 AD children and their caregivers across four randomly selected hospitals dermatology clinics in Ethiopia from October 2022 to March 2024. Assessments included AD Severity using Scoring Atopic Dermatitis (SCORAD), Infants’ Dermatitis Quality of Life Index (IDLQI) for children aged 0–4, and Children’s Dermatology Life Quality Index (CDLQI) for children aged 5 to 16. Participants received educational guidance from trained nurses during follow-up beyond routine AD treatment. Trained personnel collected clinical and sociodemographic data. AD severity and QoL were reassessed after 6 months. Descriptive, univariate, and linear regression analyses identified factors influencing QoL, with associations reported as odds ratios (95% CI) and significance set at p < 0.05. Results: Of 461 children, 424 (92%) completed follow-up. Most were under five (67%) with a median age of 3 years; 72.2% had AD onset before age two. Most caregivers were female (68.9%). After six months, clinical signs of AD, including dryness, erythema, excoriation, and lichenification, improved notably. Mild AD increased by 33.5%, while moderate and severe cases decreased by 17.5% and 16%, respectively. QoL significantly improved across all domains (p = 0.001). Baseline disease severity (β = 0.11), change in severity (ΔSCORAD) (β = 0.043), number of dependents (β = −0.71), and age at disease onset (β = 0.005) as significant predictors of QoL. Conclusions: AD significantly impairs QoL in Ethiopian children, with greater severity causing more disruption. Routine treatments with educational interventions significantly improve disease severity and QoL. Integrated clinical and psychosocial care approaches for pediatric AD are crucial in resource-limited settings. Full article

Background/Objectives: Cystic fibrosis (CF) is a genetic condition with an increasing life expectancy in recent years. As a result, addressing psychosocial aspects in this population has become an increasingly important concern. This mixed-methods systematic review aimed to update the current knowledge on the psychosocial aspects of living with CF in adults. Methods: Following PRISMA guidelines, a literature search was conducted in November 2024 across several databases, including Scopus, ScienceDirect, Academic Search Complete, MEDLINE, Supplemental Index, Complementary Index, APA PsycInfo, Business Source Complete, SciELO, and the Directory of Open Access Journals via EBSCO. Results: Of the 701 articles retrieved, 24 were analyzed, including a total of 2023 participants (mean age: 31.2 years; 57.2% female). Quantitative findings identified optimistic coping as the most frequent strategy associated with improved survival. High social support and gratitude emerged as key factors for treatment adherence and quality of life, while depression remained the primary mental health concern. Qualitatively, the findings highlighted concerns with adult life transitions and financial stressors. Participants described experiences of social stigma and embarrassment linked to chronic symptoms, often leading to selective disclosure to avoid discrimination. Conclusions: This review confirms that psychosocial factors are central to the adult CF experience, shifting the focus beyond biological survival and highlighting areas that require clinical intervention. As life expectancy increases, clinical care must evolve to incorporate interventions that address these factors to improve mental health and overall quality of life (QoL), ensuring that patients are supported through the unique challenges of extended adulthood. Full article

Cardiac rehabilitation is strongly recommended in secondary cardiovascular prevention. In patients after coronary artery bypass grafting, this intervention is suggested to reduce mortality, morbidity, and disability. In addition, rehabilitation programs improve quality of life and cardiorespiratory fitness. Modern cardiac rehabilitation programs include structured exercise training, education, nutritional counseling, psychosocial support, and management of cardiovascular risk factors, each tailored to the specific needs of post-coronary artery bypass grafting patients who often face a high burden of comorbidities and surgical recovery challenges. For these reasons, cardiac rehabilitation should be regarded as standard of care. Evidence supports early cardiac rehabilitation initiation and individualized multidisciplinary plans, which have shown to improve exercise capacity, health-related quality of life, and medication adherence. Long-term follow-up is essential, as studies have demonstrated a clear association between sustained cardiac rehabilitation engagement and decreased rates of rehospitalization and all-cause mortality. Therefore, this comprehensive review presents recent advances and updates on the management of patients after coronary artery bypass grafting during cardiac rehabilitation, with a focus on the core components and long-term follow-up. Full article

Background: Peristomal leakage is one of the most troublesome complications of living with a stoma, affecting skin integrity, quality of life, and healthcare costs. However, definitions, measurement methods, and prevalence estimates remain heterogeneous. This scoping review aimed to (i) map the international prevalence of peristomal leakage across stoma subtypes; (ii) identify associated or correlated factors; and (iii) describe the tools used to assess leakage. Methods: A scoping review was performed following the Joanna Briggs Institute (JBI) guidelines. MEDLINE, CINAHL, Scopus, Embase, and the Cochrane Library were searched, with publication language restricted to English and Italian. Primary studies and evidence syntheses addressing peristomal leakage were included. Results: Twenty-seven studies were included, most of which were primary observational studies conducted in Europe, North America, and the Nordic countries. Ileostomy was the most frequently investigated stoma type, followed by colostomy and urostomy. Across settings, peristomal leakage was highly prevalent, with most period or lifetime prevalence estimates exceeding 50%. Reported determinants clustered into anatomical, surgical, device-related, behavioral, care-related and psychosocial factors. Multiple tools were used, including leakage-specific and broader stoma questionnaires, but definitions and leakage grading were inconsistent. Conclusions: Peristomal leakage is a common, multifactorial, and largely preventable complication with substantial clinical, psychosocial and economic consequences. Clinical practice should prioritize early detection, validated assessment tools, patient education, specialized stoma nursing and structured follow-up. Future research should establish consensus definitions, robustly validate leakage-specific instruments, include under-represented regions and conduct high-quality economic evaluations to guide equitable, cost-effective care models. Full article

Introduction: Myasthenia gravis (MG) is a chronic autoimmune disorder in which fatigue represents one of the most burdensome symptoms. This multidimensional manifestation extends beyond neuromuscular fatigability and has a substantial impact on daily functioning, mental health, and quality of life. The present study aimed to evaluate the perception of fatigue in patients with MG, with particular emphasis on its interference with everyday activities and the extent to which it is understood by others. Methods: The study included 67 MG patients (61.2% women, mean age 53 years) treated at the Neurology Outpatient Department of the University Clinical Center in Gdańsk. Data were collected using an author-developed survey and standardized instruments: Chalder Fatigue Scale (CFQ), MG-ADL, MG-QoL15, HADS-M, Mini-COPE, and ACDS. Results: More than 70% of patients reported constant or frequent fatigue. Higher fatigue severity was positively associated with functional impairment (MG-ADL) and lower quality of life (MG-QoL15). More than 70% of patients reported constant or frequent fatigue. Higher fatigue severity was moderately associated with greater functional impairment and poorer quality of life. The extent to which fatigue interfered with daily life was associated with higher levels of depressive symptoms, poorer self-rated health, and less favorable disease-related perceptions (acceptance and influence). In contrast, perceiving fatigue as being better understood by others was associated with lower anxiety and depression and more favorable disease-related perceptions (acceptance, control, understanding), while it was not significantly related to fatigue severity, functional status, or quality of life. Conclusions: Fatigue in myasthenia gravis is a prevalent symptom, closely related to functional impairment and reduced quality of life. Different aspects of fatigue perception show distinct psychosocial correlates, highlighting the importance of considering subjective and social dimensions of fatigue alongside its severity. These findings support the relevance of psychosocial factors in the comprehensive care of patients with MG. Full article

Primary ovarian insufficiency (POI) affects up to 3% of reproductive-aged women and is a critical yet underrecognized contributor to infertility and systemic accelerated aging. While most cases remain idiopathic, advances in genomics increasingly reveal a genetic basis, implicating pathways that govern DNA repair, meiosis, chromosomal stability, and folliculogenesis. This review synthesizes the multifactorial etiology of POI, integrating genetic contributions with emerging evidence on epigenetic dysregulation, mitochondrial dysfunction, and environmental influences such as toxins and lifestyle factors. These mechanisms converge on core cellular processes, driving premature follicular depletion and shortening reproductive lifespan. We also highlight racial and ethnic disparities in POI prevalence and research representation, alongside the profound psychosocial burden experienced by affected individuals. Addressing these challenges through integrative strategies that unite mechanistic insight with equity is essential, not only for improving POI care but also for advancing precision approaches to ovarian aging and safeguarding reproductive health across the lifespan. Full article

The purpose of this study was to use the Columbia Suicide Severity Rating Scale (C-SSRS) to assess the prevalence and patterns of suicidality among young women living in poverty to guide effective, targeted interventions for vulnerable populations. Data were drawn from ‘The Onward Project On Wellbeing and Adversity’ (TOPOWA) study, a prospective cohort examining mental health in the context of social determinants of young women aged 18 to 24 years in Kampala’s urban slums. A cohort of 300 women, recruited from three study sites, participated in baseline assessments. Suicidality was assessed using the C-SSRS. Demographic and psychosocial factors and their associations with suicidality are presented. Of the 300 women participants, 66.0% had some secondary education and 62.0% had children, with most of them living with their children (81.7%). Suicidal thoughts were reported by 46.0%, and 17.3% had attempted suicide, with poisoning (23.1%) and hanging (21.2%) being the most common methods. The prevalence of suicidality in this population was very high, indicating significant unmet mental health needs. Since not all suicide attempts are associated with preceding thoughts or plans, it is crucial to consider a broader range of risk factors and warning signs. Social support systems and socioeconomic strengthening may be fruitful strategies for the prevention of suicidality in this population. Full article

Background/Objectives: This study aimed to compare clinical and psychosocial characteristics of substance-using adolescents in Türkiye with and without a history of suicide attempts to identify distinguishing risk factors. Methods: A retrospective analysis was conducted using medical records from 140 adolescents (aged 13–18) treated at a specialized Child and Adolescent Substance Use Center in Türkiye between March 2023 and February 2025. Sociodemographic, clinical, and substance use data were collected. Group comparisons were performed using chi-square and t-tests. Logistic regression was used to identify predictors of suicide attempt history. Results: Among the sample, 52 adolescents (37.1%) had a history of suicide attempts. Compared to their counterparts, the substance-using adolescents were more likely to be female (73.1%) and have histories of psychiatric hospitalization, institutional care, criminal behavior, and polysubstance use (p < 0.05). High-frequency use (≥3 days/week) of methamphetamine, stimulants, cannabinoids, and alcohol was significantly more common in this group (all p < 0.01). The Addiction Profile Index–Adolescent form (API-A) scores indicated more severe addiction profiles. Using cross-validated LASSO and confirmatory logistic regression, female gender emerged as the only robust independent predictor of suicide attempt history (OR = 6.84). Conclusions: Adolescents with a history of suicide attempts exhibit more severe substance use, particularly involving cannabinoids, and greater psychosocial adversity. This distinct risk profile underscores the need for early, gender-sensitive, and multidimensional interventions. Full article

Background: Perinatal depression and anxiety are common but often under-detected. Current screening relies on depression-centered instruments and may miss relational drivers including sexual dysfunction, low self-esteem, and psychosocial adversity. Objective: To synthesize evidence on sexual function, self-esteem/body image, and psychosocial context as correlates of perinatal depression and anxiety, and propose a risk-stratified screening framework. Methods: We conducted a narrative evidence synthesis of studies from January 2010 to May 2025 (PubMed/MEDLINE, Scopus, Web of Science) examining associations between perinatal mood/anxiety outcomes and sexual function (Female Sexual Function Index), self-esteem/body image (Rosenberg Self-Esteem Scale), and psychosocial factors (perceived support, intimate partner violence). Results: Sexual dysfunction was highly prevalent and consistently associated with depressive and anxiety symptoms. Longitudinal evidence demonstrated bidirectional pathways: mood symptoms reduced sexual satisfaction, while sexual difficulties intensified relational strain and symptom persistence. Low self-esteem and negative body image mediated links between physiological changes and postpartum depression. Psychosocial adversity, particularly low partner support and intimate partner violence, identified high-risk subgroups with greater severity and slower recovery. Single-instrument approaches (Edinburgh Postnatal Depression Scale alone) may miss pregnancy-specific anxiety and postpartum relational drivers. Conclusions: A staged, risk-stratified model is recommended: assess pregnancy-specific anxiety alongside depression screening in the second/third trimesters; postpartum, selectively add sexual function and self-esteem assessment for women with elevated symptoms or psychosocial risk. Integration within defined referral pathways may improve detection and enable targeted perinatal mental health care. Full article

Parental stress is a critical yet understudied dimension of childhood total blindness, a condition that imposes substantial developmental, emotional, and functional challenges on families. This cross-sectional study assessed parenting stress, maternal health symptoms, and children’s functional vision-related quality of life in 81 mothers of children aged 0 to 12 years with total congenital blindness. Parenting stress was assessed in the full sample using the Parenting Stress Index–Fourth Edition (PSI-4). Children’s functional vision-related quality of life was evaluated in age-specific subsamples using the Quality of Family Vision Impact (QFVI-3 for children aged 0–3 years and QFVI-7 for children aged 3–7 years). All participants also completed a sociodemographic and maternal health survey. Total Parent Stress showed moderately elevated percentile scores (mean ≈ 67), with the highest PSI-4 subdomains in Adaptability, Depression, and Health. Approximately 21% of mothers scored within the clinical range for high stress. Maternal symptoms including sadness, insomnia, headaches, forgetfulness, and musculoskeletal pain were significant (all p < 0.01). QFVI global scores indicated moderate impairments in functional vision-related quality of life across age groups. Life Stress demonstrated a small-to-moderate negative correlation with QFVI-7, suggesting that cumulative environmental stressors may adversely affect children’s functional outcomes. Several factors were associated with more favorable outcomes. Among children under three years of age, maternal engagement in physical activity was associated with higher QFVI scores, whereas among children aged 3–7 years, school attendance was associated with higher functional vision-related quality of life scores. In contrast, sociodemographic disadvantage, limited access to educational adaptations, and reduced maternal participation in work or leisure activities were associated with higher levels of parental stress. These findings highlight the importance of multidisciplinary, family-centered care incorporating psychosocial assessment, early stimulation, orientation and mobility support, and maternal mental health interventions in pediatric ophthalmology. Full article

Background: Moral development (MD) arises from the interaction of attachment, temperament, emotion regulation, and decision-making. Children and adolescents with Attention-Deficit/Hyperactivity Disorder (ADHD) frequently show impairments across these domains, suggesting increased vulnerability to disruptions in MD. However, the mechanisms linking ADHD to MD remain poorly understood. Methods: A systematic review was conducted according to PRISMA 2020 guidelines. PubMed was searched for studies published between January 2014 and November 2024 examining MD-related constructs, including moral reasoning, fairness, aggression, bullying, callous–unemotional (CU) traits, decision-making, and reward sensitivity, in individuals aged 0–18 years with diagnosed or subclinical ADHD. Due to substantial heterogeneity in study design, measures, and outcomes, a qualitative synthesis was performed. Results: Of the 2104 records identified, 23 studies met inclusion criteria. Insecure or disorganized attachment, difficult temperament, and emotional dysregulation consistently emerged as developmental risk factors for impaired MD. Hyperactivity–impulsivity and deficient inhibitory control were strongly associated with aggressive and antisocial behaviors. Children with ADHD demonstrated a pronounced preference for immediate over delayed rewards, altered decision-making in social contexts, and reduced sensitivity to positive feedback. CU traits and aggression were frequently identified as behavioral correlates of MD impairments, particularly in interaction with family adversity and comorbid externalizing conditions. Social dysfunction, including bullying involvement, peer rejection, and interpersonal difficulties, was common and contributed to elevated long-term psychosocial risk. Conclusions: ADHD is associated with multidimensional vulnerabilities in MD through intertwined cognitive, emotional, and relational pathways. Interventions targeting attachment security, emotion regulation, reward processing, and social skills may foster MD and reduce later social difficulties. Longitudinal and cross-cultural research is needed to clarify causal mechanisms and inform developmentally sensitive prevention and treatment strategies. Full article