Search Results (1,008)

Background/Objective: Executive functions (EFs) are essential in the daily management of arthritis, as they influence treatment adherence, decision-making, and the ability to cope with disease-related challenges. The objective of this study was to compare EFs alongside functional status and quality of life in patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA) and examine their associations with disease activity and clinical variables. Methods: In this cross-sectional study, 140 patients (70 RA, 70 PsA) were assessed using the Stroop-TBAG, Wisconsin Card Sorting Test (WCST), and Adult Executive Functioning Inventory (ADEXI). Functional status and quality of life were measured with the Health Assessment Questionnaire (HAQ) and WHOQOL-BREF, respectively. Correlations with disease activity (DAS28-CRP), age, and disease duration were examined. Results: RA patients had significantly higher disease activity and longer disease duration. They showed poorer performance on the Stroop Test (color–word time: 61.6 ± 14.8 vs. 52.4 ± 10.9 s, p < 0.001; errors: 3.2 ± 2.1 vs. 2.1 ± 1.5, p = 0.001), more WCST perseverative errors (p = 0.002), and higher ADEXI inhibition scores (13.9 ± 2.5 vs. 12.9 ± 3.0, p = 0.013). DAS28-CRP was correlated with EF impairments, disability, and poorer quality of life in RA (p < 0.05). In PsA, EFs remained relatively stable, although higher disease activity was associated with worse HAQ scores (p = 0.001). Treatment type was not linked to EF, but patients on combination therapy reported lower physical (p = 0.009) and psychological (p = 0.014) quality of life, along with higher HAQ scores (p = 0.016). Conclusions: This study revealed that patients with RA exhibit more pronounced executive dysfunction, along with lower ADL skills and quality of life compared to those with PsA. These findings highlight the need for multidimensional assessment strategies in inflammatory arthritis, especially in RA, where cognitive and functional outcomes are closely tied to clinical burden. Full article

Background: Concerns over women’s mental health have intensified globally, especially among mothers managing dual careers and family responsibilities. Positive Psychology Interventions (PPIs), such as gratitude journaling and well-being workshops, have demonstrated promise in enhancing mental health; however, their applicability in Arab contexts remains underexplored. This study aims to investigate the effectiveness of PPIs on mothers’ well-being, gratitude, depression, anxiety, and stress in Saudi Arabia. Methods: This quasi-experimental, one-group pretest–posttest study assessed the effects of a four-week PPI on 37 Saudi working mothers (aged 21–50 years) employed at a private school in Riyadh. The intervention included guided gratitude journaling thrice weekly and two workshops on positive psychology and gratitude. Pre- and post-intervention assessments used validated Arabic versions of the Depression Anxiety Stress Scale (DASS-21), WHO-5 Well-being Index, and Gratitude Questionnaire (GQ-6). Results: Significant improvements were found post-intervention: depression, anxiety, and stress scores decreased (p < 0.001), while well-being and gratitude increased (p = 0.001). However, participants with lower household income (<50,000 SAR) showed less improvement, indicating a potential moderating effect of socioeconomic status. Conclusions: The intervention demonstrated promising short-term improvements in mental health and well-being among Saudi mothers. The findings underscore the importance of culturally appropriate PPIs and highlight the need for further research using controlled, long-term designs. Limitations include the small, non-random sample, absence of a control group, and restriction to a single geographic region. Full article

Background/Introduction: Psychological inflexibility, which includes experiential avoidance, is a transdiagnostic process associated with multiple mental health issues in adolescence. Physical fitness (PF) has shown benefits for mental well-being, yet its specific relationship with psychological inflexibility remains understudied, particularly among youth. Objectives: To examine the association between components of PF and psychological inflexibility, measured by the Acceptance and Action Questionnaire-II (AAQ-II), in a representative sample of Spanish adolescents. Methods: A cross-sectional analysis was conducted using data from 631 adolescents (aged 12–17) participating in the Eating Healthy and Daily Life Activities (EHDLA) study. PF was assessed by the Assessing the Levels of PHysical Activity and Fitness (ALPHA-Fit) Test Battery (cardiorespiratory fitness, muscular strength, agility, and flexibility). Psychological inflexibility was measured using the AAQ-II. Generalized linear models (GLMs) were used to evaluate associations, adjusting for age, sex, body mass index, socioeconomic status, physical activity, sedentary behavior, sleep duration, and energy intake. Results: Unadjusted analyses showed weak but significant associations between psychological inflexibility and performance in the 20 m shuttle run test (p = 0.002), the 4 × 10 shuttle run test (p = 0.005), and the sit-and-reach test (p < 0.001). However, after adjusting for covariates, none of the PF components maintained a statistically significant association with the AAQ-II scores. Conclusions: In this adolescent sample, PF components were not independently associated with psychological inflexibility after adjustment for key confounders. These findings suggest that, while PF may contribute to general well-being, it is not a primary determinant of psychological inflexibility. Further longitudinal and intervention studies are needed to clarify the mechanisms linking physical and psychological health in youth. Full article

Over the last decade, the scientific community has increasingly focused on forest-based practices for human well-being (FBPW), a term that includes all forest activities (e.g., forest bathing, forest therapy, social outdoor initiatives) important for improving people’s health and emotional status. This paper aims to develop a quantitative literature review on FBPW based on big data analysis (text mining on Scopus title and abstract) and PRISMA evaluation. The two techniques facilitate investigations across different geographic areas (major areas and geographical regions) and allow a focus on various topics. The results of text mining highlight the prominence of publications on FBPW for the improvement of human health in East Asia (e.g., Japan and South Korea). Furthermore, some specific themes developed by the literature for each geographical area emerge: urban green areas, cities, and parks in Africa; sustainable forest management and planning in the Americas; empirical studies on physiological and psychological effects of FBPW in Asia; and forest management and FBPW in Europe. PRISMA indicates a gap in studies focused on the reciprocal influences of forest variables and well-being responses. An investigation of the main physiological indicators applied in the scientific literature for the theme is also developed. The main strengths and weaknesses of the method are discussed, with suggestions for potential future lines of research. Full article

Background/Objectives: Psychosocial (PS) factors and cognitive dysfunction (CD) in patients with atrial fibrillation (AF) may negatively impact treatment compliance. The PS profile covers multiple psychological and socio-economic factors, although research is mostly limited to depression, anxiety, and work stress. This study assessed the prevalence of a broad range of PS factors in patients with AF and their relationship with cognitive decline. Methods: We retrospectively analyzed data from patients referred to a cardiovascular rehabilitation clinic between March 2017 and April 2023 who underwent standardized assessments of PS factors, cognition, and quality of life. Results: Of the 798 included patients, 230 (28.8%) had AF, with a mean age of 68.07 years (SD 9.60 years). Six of nine PS factors were present in more than half of the overall sample. Compared to non-AF patients, those with AF showed significantly higher levels of social isolation, depression, and hostility, whereas low socioeconomic status, family and work-related stress, and other mental disorders were more frequent in the non-AF group. CD was present in 67.4% of the total cohort and was more prevalent in AF patients with a higher PS burden. Patients with permanent AF reported the poorest health status. Conclusions: Integrating assessments of PS factors and cognition in cardiac rehabilitation is feasible and supports a more comprehensive, patient-centred model of care in AF. Full article

Differences exist between rural–urban migrants and urban–urban migrants in terms of human capital’s accumulation and pathways of social integration, yet few studies have systematically compared these distinctions. Based on the CMDS2017 survey data, this study constructed a comprehensive social integration index across four dimensions—economic integration, behavioral adaptation, identity recognition, and psychological assimilation—to analyze the influencing factors and decompose the disparities in social integration levels between the two groups from a human capital perspective. Using Oaxaca mean decomposition and Machado–Mata (MM) quantile decomposition, the results indicated that urban–urban migrants exhibited higher social integration levels than rural–urban migrants, with human capital significantly influencing integration outcomes. Better education, health status, longer migration duration, and more work experience positively enhanced migrants’ social integration. Human capital accounted for 38.35% of the social integration gap between the two groups, while coefficient differences were the primary driver of disparities. The returns to education diminish at higher integration levels, suggesting education played a stronger role for those with lower integration. The social integration gap between the two groups followed an inverted U-shaped trend, with smaller disparities at higher quantiles. As integration levels rose, characteristic differences declined continuously, indicating convergence toward homogeneity among high-integration migrants. These research findings indicated that the improvement in the social integration level of migrants still requires continuous investment in cultivating the human capital of migrants. Full article

Background/Objectives: Patients undergoing open aortic and valvular surgery often experience postoperative deconditioning, yet research on the role of inpatient cardiac rehabilitation (CR) in this population remains limited. This study aimed to examine the effects of inpatient CR on muscle strength, mobility, psychological well-being, and quality of life in patients recovering from open aortic surgery. Methods: We conducted a retrospective study using the medical records of patients who participated in inpatient CR after open aortic surgery. Functional and psychological outcomes were evaluated using the Medical Research Council (MRC) sum score, Timed Up and Go (TUG) test, Five Times Sit-to-Stand test (5STS), Six-Minute Walk Distance (6MWD), Berg Balance Scale (BBS), Modified Barthel Index (MBI), Patient Health Questionnaire-9 (PHQ-9), and the EuroQol-5D (EQ-5D). Pre- and post-rehabilitation scores were compared to assess changes in functional status, mobility, and quality of life. A post-discharge satisfaction survey was also analyzed. Results: A total of 33 patients were included. Significant improvements were observed in MBI (p < 0.001), MRC sum score (p < 0.001), 6MWD (p < 0.001), BBS (p < 0.001), TUG (p = 0.003), 5STS (p < 0.001), EQ-5D (p = 0.011), and PHQ-9 (p = 0.009) following inpatient CR. Patients with lower baseline mobility (6MWD ≤ 120 m) exhibited greater improvement in MBI (p = 0.034). Of the 33 patients, 26 completed the satisfaction survey; most reported high satisfaction, perceived health improvements, and willingness to recommend the program. Conclusions: Inpatient CR following open aortic and valvular surgery resulted in significant gains in muscle strength, mobility, psychological health, and overall quality of life. Patients with greater initial impairment demonstrated especially notable functional improvement, supporting the value of tailored CR in this population. Full article

Purpose: Smoking is a major preventable cause of illness and death. Quitting smoking can reduce related health complications. Numerous factors, including age, socioeconomic status, smoking habits, and availability of support, influence smoking cessation success. Despite anti-smoking measures and smoking cessation clinics in Saudi Arabia, smoking-related deaths are increasing. This study aimed to identify factors influencing successful smoking cessation among Saudi adults and examine the relationship between cessation methods and success rates. Patients and methods: A cross-sectional study was conducted through an online survey targeting Saudi adults who had attempted to quit smoking of all types, whether traditional cigarettes, e-cigarettes, shisha, or others. Success was defined as quitting for at least six months. The data collected included sociodemographic details, smoking history, and experiences with cessation. Logistic regression analysis was used to identify factors associated with successful cessation. Results: Of 364 participants, 18.4% were successful quitters, with a mean age of 34.94. Occupation was a key predictor; freelance workers had significantly higher odds of unsuccessful quitting (OR = 12.96, 95% CI: 2.08–80.79, p = 0.006). Those who continued smoking despite illness were less likely to quit successfully (OR = 2.33, 95% CI: 1.16–4.68, p = 0.018). Early initiation of smoking also negatively impacted cessation success (OR = 1.10, 95% CI: 1.03–1.17, p = 0.006). Successful quitters reported fewer adverse symptoms during their attempts (p = 0.018) and employed behavioral strategies, such as disposing of tobacco products (p < 0.001), avoiding smoking triggers (p = 0.002), and engaging in exercise (p < 0.001). Confidence in quitting significantly contributed to success (p < 0.001). Conclusions: This study highlights the role of individual, social, and environmental factors in smoking cessation. Tailored interventions that address socioeconomic, psychological, and lifestyle factors are crucial for enhancing cessation success among Saudi adults. Full article

Famed lawyer Clarence Darrow (1857–1938) argued strongly for an early-life public health approach to crime prevention, one that focused on education, poverty reduction, and equity of resources. Due to his defense of marginalized persons and his positions that were often at odds with his legal colleagues and public opinion, he was known as the Big Minority Man. He argued that the assumption of free will—humans as free moral agents—justifies systems of inequity, retributive punishment, and “unadulterated brutality.” Here, the authors revisit Darrow’s views and expand upon them via contemporary research. We examine increasingly louder argumentation—from scholars across multiple disciplines—contending that prescientific notions of willpower, free will, blameworthiness, and moral responsibility, are contributing to social harms. We draw from biopsychosocial perspectives and recent scientific consensus papers calling for the dismantling of folk psychology ideas of willpower and blameworthiness in obesity. We scrutinize how the status quo of the legal system is justified and argue that outdated notions of ‘moral fiber’ need to be addressed at the root. The authors examine recent arguments for one of Darrow’s ideas—a public health quarantine model of public safety and carceral care that considers the ‘causes of the causes’ and risk assessments through a public health lens. In our view, public health needs to vigorously scrutinize the prescientific “normative” underpinnings of the criminal justice system. Full article

This study provides user-centered insights into how inclusive forest design can support the physical, emotional, and social well-being of older adults. It operationalizes universal design principles in natural settings and confirms their relevance through empirical evidence. With the acceleration of global population aging, adapting forest recreation environments to meet the specific needs of older adults is increasingly urgent. This study investigates how infrastructure influences both participation and emotional well-being among older visitors to forest recreation areas. Data were collected from 446 participants aged 65 and older, using a structured survey distributed through in-person contact and digital snowball sampling. Participants reported their infrastructure preferences and their emotional responses related to forest visits. The findings show that older adults highly value site cleanliness, shaded seating, accessible restrooms, and clear signage. Expectations varied significantly according to health status, age group, and visitation frequency. Emotional well-being was positively associated with both comfort and visit frequency. These results demonstrate how inclusive infrastructure plays a vital role in supporting older adults’ access to and enjoyment of forest environments. The study affirms that universally designed forests not only reduce barriers but also promote psychological health and active aging, contributing to developing more equitable and sustainable nature-based recreation areas. Full article

Tobacco use disorder remains a leading cause of preventable mortality, with nicotine playing a central role in the development and maintenance of dependence, mainly through its action on α4β2 nicotinic acetylcholine receptors (nAChRs). Smoking cessation treatments must address both physiological withdrawal and the affective disturbances (such as anxiety, irritability, and mood lability) which often facilitate relapses. This review compares two pharmacotherapies used in smoking cessation, varenicline and cytisinicline (cytisine), with particular focus on their impact on emotional regulation, psychological symptoms, and neuropsychiatric safety. Varenicline, a high-affinity partial agonist at α4β2 nAChRs, has demonstrated superior efficacy in maintaining abstinence and is well-supported by robust clinical data, including in psychiatric populations. However, its use may be limited by adverse effects such as nausea and sleep disorders. Cytisinicline, a structurally similar but less potent partial agonist, has recently gained renewed interest due to its lower cost, favorable tolerability profile, and comparable effectiveness in the general population. Although less extensively studied in patients with serious mental illness, preliminary data suggest cytisinicline may offer a better side effect profile, particularly regarding sleep disturbances and emotional reactivity. Both agents appear to ameliorate withdrawal-related affective symptoms without significantly increasing psychiatric risk. Ultimately, pharmacotherapy choice should be guided by individual clinical features, mental health status, treatment tolerability, and resource availability. Further research is needed to establish cytisinicline’s efficacy and safety across diverse clinical contexts, particularly among individuals with severe psychiatric comorbidities. Full article

Background/Objectives: Pathology is often perceived as a technical medical specialty that lacks direct contact with the patient. However, oncological histopathological diagnosis requires a high degree of moral and emotional responsibility. The objective of this study was to investigate how empathy is manifested toward the “invisible” patient, the emotional impact on pathology staff, and potential repercussions in their personal lives. Method: We conducted a descriptive, cross-sectional study with a quantitative component, using an anonymous 22-item questionnaire among Romanian pathologists and medical personnel working in pathology services. The questionnaire was focused on three research directions: professional empathy in the absence of direct patient contact, the emotional impact of oncologic diagnosis on medical personnel in pathology departments, and the carryover of emotions from professional to personal life. A total of 165 respondents were included in the study (physicians, technicians, registrars). Results: Most of the respondents consider that the absence of the patient’s direct contact does not cancel the empathy, this being felt in a cognitive and more natural way. Over 60% of the respondents see oncologic histopathological diagnosis as an emphatic medical act. Over 80% of the respondents experience a sense of emotional responsibility and 70% consider that professional training does not include adequate emotional support. There is a high interest in empathy and psychological support. The professional activity of a pathologist may influence sleep, dreams, and the perception on their own health status. Diagnosing pediatric or young patients is perceived as particularly emotionally challenging. Collegial support is moderate and discussion about professional stress is rare. Conclusions: Empathy is present and relevant in pathology, despite the absence of direct patient interaction. Oncological diagnostics has a significant emotional impact on pathology department personnel, with the need to acknowledge the emotional dimension of the profession and to integrate psychological support mechanisms into pathology practice. Full article

Background/Objectives: Despite the psychological benefits of breast reconstruction (BR) after mastectomy, uptake remains limited among women with breast cancer. This study explores psychosocial and personality predictors of BR intentions in the pre-mastectomy phase, aiming to inform strategies for mental health promotion in oncology care. Methods: This cross-sectional analysis used preoperative data from a longitudinal study at a university hospital in Greece. Women with primary breast cancer scheduled for mastectomy completed a battery of validated self-report measures, including the International Personality Item Big-Five Factor Markers (IPIP-BFFM), the Hospital Anxiety and Depression Scale (HADS), and the Short Form-36 Health Survey (SF-36). Demographic, clinical, and psychosocial data were also collected. Binary logistic regression was used to examine predictors of (a) BR information-seeking and (b) BR intention. Results: Seventy-four women participated (mean age = 61.1 years). Older age predicted lower BR intention (Exp(b) = 0.897, 95% CI: 0.829–0.970) and information-seeking (Exp(b) = 0.925, 95% CI: 0.859–0.997). Single/divorced status was associated with reduced BR information-seeking (Exp(b) = 0.053, 95% CI: 0.005–0.549). Openness to experience significantly predicted both outcomes (BR information-seeking: Exp(b) = 1.115, 95% CI: 1.028–1.209); BR intention: Exp(b) = 1.095, 95% CI: 1.016–1.181). Higher physical health-related QoL scores were associated with increased BR intention (Exp(b) = 1.039, 95% CI: 1.007–1.072), whereas higher mental health-related QoL (Exp(b) = 0.952, 95% CI: 0.912–0.994) and higher depression scores (Exp(b) = 0.797, 95% CI: 0.638–0.996) were linked to decreased BR intent. No psychological factor significantly predicted information-seeking. Conclusions: These findings underscore the value of psychosocial screening and personality-informed counseling prior to surgery. By identifying individuals less likely to seek information or consider BR, pre-mastectomy assessments can contribute to tailored, mental health-promoting interventions and support informed, patient-centered surgical decision-making. Full article

Background and Objectives: Polycystic ovary syndrome (PCOS) is associated with an elevated risk of impaired mental health and psychiatric disorders, such as depression and anxiety. Physical factors like weight and hirsutism, as well as psychological factors, such as self-esteem and coping strategies, are all known to have an influence on mental health status. Aim: To assess psychological symptoms in women with and without PCOS, by use of the well-established, validated self-report questionnaire: Symptom Checklist-90-Revised (SCL-90); to determine the reliability of the SCL-90 for assessment of PCOS patients. Design: Prospective case-control study. Methods: Psychological symptoms were assessed using the German version of the SCL-90 in 31 PCOS women and 31 healthy controls. To test the impact of various parameters on numerical outcome parameters, correlation analyses were conducted. Results: PCOS women revealed significantly increased SCL-90 scores in seven out of the nine subscales (hostility subscale, anxiety subscale, depression subscale, paranoid ideation subscale, psychoticism subscale, somatization subscale, interpersonal sensitivity subscale, obsessive compulsive subscale), as well as in all three global indices (p < 0.05). SCL-90 scores were significantly positively correlated with perceived total stress and perceived helplessness and significantly negatively correlated with perceived self-efficacy (p < 0.05). Conclusions: PCOS women experienced higher levels of psychological symptoms including depressive and anxiety symptoms. Higher perceived stress, higher perceived helplessness and lower self-efficacy were associated with more psychological symptoms. Hence, there is a need to support PCOS women with their emotional regulation and coping strategies. Full article

Background. Several psychological processes can influence the adjustment of cardiac patients. Psychological flexibility has been linked to significant improvements in psychological well-being during cardiac rehabilitation (CR). It can be understood as the dynamic interaction of three key processes: openness to experience (OE), behavioral awareness (BA), and value-driven action (VA). This study aimed to (1) evaluate the distinct role of these processes in predicting anxiety, depression, and psychological well-being in cardiac patients, and (2) assess these associations over the course of CR. Methods. A total of 194 CR patients participated in this longitudinal study, with 156 completing follow-up assessments at T2. Anxiety and depression were measured using the Patient Health Questionnaire-4, psychological well-being with the Psychological Well-being Index-Short, and psychological flexibility using the Comprehensive Assessment of ACT Processes. Results. Cross-sectional regression analysis revealed that all three psychological flexibility dimensions were negatively associated with anxiety and depression and positively associated with psychological well-being at T1. However, longitudinal analyses showed that only VA was positively associated with a decrease in depressive symptoms following CR. A sensitivity analysis conducted on the subgroup of patients with mild to severe symptoms of anxiety and depression further confirmed the robustness of these findings. Conclusions. These results highlight the potential benefits of measuring specific psychological flexibility processes when examining the psychological status of cardiac patients and when planning psychological interventions during CR. Full article