Search Results (5,507)

Background: South African university students face escalating levels of psychological distress driven by academic overload, financial precarity, and social challenges. Health professions students are particularly vulnerable due to the demanding nature of clinical training and repeated exposure to human suffering. Aim: This study aims to propose an Integrated Student Well-being and Resilience Model tailored to the South African health professions education context. Methods: This conceptual paper draws on empirical evidence from South African studies on student mental health, global campus well-being frameworks, and socio-ecological theory. Bronfenbrenner’s Socio-Ecological Systems Theory and a tiered public health approach were synthesized to develop a multi-level model aimed at addressing the academic, financial, and social determinants of student mental health. Conceptual synthesis: The study unequivocally identified a syndemic of interconnected factors predisposing students to depression, which included the interplay of academic rigour and cognitive burnout, financial vulnerability as a determinant of mental health, the crisis of social connection and psychological safety, and institutional failure and the resilience fallacy. Conclusions: The Integrated Student Well-being and Resilience (ISWR) Model is a systemic architecture designed to coordinate institutional governance with the complex psychosocial needs of health professions students. The model provides a holistic, scalable framework for strengthening student well-being within health professions education. By shifting from reactive counselling to proactive, system-level interventions, the model offers a strategic blueprint for creating resilient, supportive learning environments capable of improving student mental health and fostering a healthier future healthcare workforce. Full article

Environmental chemicals are rarely considered stressors in the way that psychological or physical stressors are. Yet many endocrine-disrupting chemicals (EDCs) interact with the body’s core stress response system. This review examines how EDCs alter hypothalamic–pituitary–adrenal (HPA) regulation and how biological sex influences those responses. Drawing on human epidemiological data and experimental models, we describe how EDC exposure affects cortisol dynamics, feedback sensitivity, and adrenal signaling, with a particular focus on sex-dependent outcomes. We propose the concept of endocrine noise to describe how low-dose, often mixed EDC exposures introduce persistent interference into hormone signaling without necessarily causing overt endocrine deficiency or excess. In this framework, EDCs act as chronic, low-grade stressors that reset the timing, feedback precision, and rhythmic organization of the HPA axis rather than as isolated reproductive toxicants. We argue that EDCs should be understood as chronic, context-dependent stress modifiers that reshape sex-specific “risk architectures” for affective, metabolic, and immune disorders. Recognizing sex-specific HPA architecture and endocrine noise has immediate implications for study design and regulation, including the need for sex-stratified analyses, circadian-sensitive sampling of cortisol, and risk assessments that consider how the same exposure can push female and male stress systems in divergent directions. Full article

Lighting quality in interior spaces is not determined solely by horizontal illuminance at the workplace, but to a large extent by the spatial distribution of light, in particular by the luminance of ceilings and walls. Building on classical principles of lighting technology and visual perception, this article examines the influence of the ratio of indirect to direct lighting on the perception of room brightness, the spatial impression, and overall preference. To this end, two complementary studies were conducted: a visual assessment of realistic room simulations and a user study in a real meeting room with variable illuminance levels and systematically varied proportions of indirect and direct lighting. The results consistently show that perceived room brightness and user preference correlate much more strongly with the illumination of ceilings and walls than with the horizontally measured illuminance on the table, which was kept constant. A balanced ratio of indirect to direct light—typically in the range of approximately 35% to 65% indirect lighting—is preferred by users, whereas predominantly direct or nearly purely indirect lighting is associated with lower acceptance. The study clearly demonstrates that existing standards, which primarily focus on horizontal illuminance, neglect essential aspects of lighting quality. The findings highlight the need to systematically integrate light distribution, vertical illuminance, and spatial–psychological effects into lighting design, evaluation, and standardization in order to achieve visually comfortable, widely accepted, and spatially appropriate lighting solutions. Full article

The aim of this study was to investigate older adults’ engagement in sport through the lens of the Positive Development in Sport (PDS), a framework aimed at fostering human growth in sport environments. This qualitative study involved 80 older athletes (M = 71.91 years, SD = 7.91; 45 women) engaged in regular sport practice and four experienced coaches (37–57-years-old). Data was collected across multiple contexts: brief in-person individual or small-group interviews during a competitive event; five in-person focus groups; and individual interviews. Data was analyzed using reflexive thematic analysis. Findings revealed a central theme, autonomy to engage in sport, supported by three subthemes: competence and confidence, health, and setting priorities. Participants described sport as a meaningful component of their identity, with sustained engagement driven by intrinsic motivation and harmonious passion. They reported increased self-awareness, intentional health management, and the ability to balance sport participation with other life domains, highlighting positive implications for mental health. Coaches who actively supported athletes’ psychological needs played a key role in fostering autonomy and personal development. Participants also emphasized the importance of inclusive relationships and pedagogical strategies tailored to older athletes’ goals and lived experiences. The findings suggest that sport in older adulthood can be a context for personal growth and mental health development. Full article

Premature ovarian insufficiency (POI) is a clinical condition characterized by loss of ovarian function indicated by amenorrhea or irregular menstrual cycles for at least 4 months and elevated gonadotrophins (FSH > 25 IU/L, measured on one occasion) and low estrogen serum levels in women under the age of 40. Premature ovarian insufficiency can be non-iatrogenic or spontaneous (idiopathic or due to genetic, autoimmune, or metabolic reasons, or infections) and iatrogenic (a consequence of oophorectomy, chemotherapy, radiotherapy, or uterine artery embolization). Women with POI are faced not only with estrogen deficiency but also with infertility and psychological implications. Hormonal replacement therapy is effective in treating the symptoms of premature ovarian insufficiency as well as in lowering the health risk of long-term consequences of premature ovarian insufficiency. Currently, oocyte donation is the standard treatment for patients with POI desiring pregnancy. Recently developed methods for the regeneration of ovarian tissue, such as stem cell therapy, platelet-reach plasma therapy and in vitro activation of ovarian tissue, are still under research and further adequate multicentric clinical studies are needed to develop standardized effective and safe protocols for the infertility treatment of patients with premature ovarian insufficiency. Full article

Background: Cultural competence is essential in nursing, enabling the delivery of ethical, patient-centered, and respectful care that respects diverse cultural backgrounds in an increasingly diverse healthcare setting. Improving cultural competence can substantially reduce stereotyping, time pressure, and distress among nurses. Objective: This study aimed to examine the relationship between cultural competence and loneliness among nurses working at a university medical city in Saudi Arabia and to identify associated demographic and psychological factors. Methods: A descriptive cross-sectional study was conducted using a convenience sample of 184 nurses. Data were collected via an online questionnaire that included the Cultural Capacity Scale, the Revised UCLA Loneliness Scale, and the Patient Health Questionnaire-4 between April and May 2024. Descriptive statistics, Spearman’s correlation, and multiple linear regression were used in the data analysis. Result: Findings indicate high cultural competence (mean score: 78.82) but moderate loneliness (mean score: 11.9). Notably, a strong negative correlation exists between cultural competence and feelings of loneliness (r = −0.777) and anxiety/depression (r = −0.818), suggesting that increased cultural competence is associated with lower loneliness and mental health issues. Conclusions: Both cultural knowledge and sensitivity emerged as significant predictors of lower anxiety and depression levels. These findings highlight the association between cultural competence and reduced loneliness and psychological distress among nurses, suggesting the need for targeted training interventions to improve nurses’ well-being and the quality of patient-centered care in culturally diverse healthcare settings. Full article

Objective: This study assessed the influence of a highly publicized influenza-related death event on caregivers’ influenza vaccination intention for kindergarten and primary school children in Zhejiang, China, and identified associated factors. Methods: A cross-sectional survey was conducted from March to April 2025 using a multi-stage, stratified cluster sampling method across 10 districts/counties. Caregivers completed electronic questionnaires covering sociodemographics, event awareness, vaccination history, hesitancy, and cognitive attitudes. Factors associated with vaccination intention were analyzed using chi-square tests and logistic regression. Results: Among 2153 caregivers, overall vaccination intention for the 2025 season was 60.10%, markedly higher than the 2024 season’s actual rate (27.45%). Caregiver awareness of this event was 91.92%, primarily via social media (92.02%). In univariate analyses, event-related characteristics were significantly associated with vaccination intention: perceived “completely objective” coverage showed the highest willingness (79.68%, χ² = 79.92, p < 0.001), whereas the “exaggerated risk” (52.44%) and “unaware” (51.15%) groups showed lower willingness. Exposure frequency also correlated positively: low exposure (0–2 times) had 53.39% willingness, moderate (3–5) 61.11%, and high (≥6) 66.10% (χ² = 27.75, p < 0.001). However, stronger vaccination intention was independently associated with factors such as no prior vaccination refusal [aOR(95% CI) = 2.74(2.03,3.72)] or hesitancy history [1.47(1.13,1.92)], greater information need (aOR = 6.42–8.83), and disbelief in influenza’s spontaneous resolution [1.39(1.08,1.77)]. Weaker intention was associated with poorer child health status [0.19(0.04,0.74)], no influenza vaccination in 2024 [0.41(0.30,0.55)], no influenza illness in 2024 [0.73(0.56,0.95)], belief in vaccine protection [0.60(0.46,0.79)], and the perception that most parents have their children vaccinated [0.70(0.53,0.93)]. Conclusions: Following a highly publicized celebrity influenza death, vaccination intention was primarily driven by caregivers’ cognitive, psychological, and behavioral experience factors. Caregivers who perceived event coverage as completely objective showed higher vaccination intention, while prior vaccination behavior exhibited inertia. Targeted interventions should enhance information credibility and focus on previously unvaccinated and vaccine-hesitant groups to improve coverage. Full article

Gender-based violence constitutes a major public health and social concern, with particularly complex implications in structurally vulnerable contexts such as rural settings. However, empirical evidence regarding the specific profile and risk perception of women experiencing gender-based violence in small municipalities remains limited. The aim of this study was to analyze the sociodemographic characteristics of women victims of gender-based violence residing in small rural municipalities and to examine their associations with mental health indicators and perceived risk of future violence. The sample comprised 30 women receiving support at a Specialized Care Centre for Victims of Gender-Based Violence (CAVI) serving three small municipalities in the Vega Media region (Region of Murcia, Spain). Standardized measures of depression, anxiety, and stress were administered, together with an assessment of perceived risk. The findings suggest a specific sociodemographic profile characterized by moderate levels of depression, anxiety, and stress symptoms and generally low perceived risk. Women without children reported higher levels of psychological distress and perceived risk than those with children, although these differences should be interpreted with caution given the sample size. Overall, these findings provide preliminary insights into the characteristics and risk perception of women experiencing gender-based violence in rural settings and highlight the need for context-sensitive prevention and intervention strategies. Full article

Motherhood is a profoundly transformative stage, associated with both emotional fulfillment and psychological and physical vulnerability. The aim of this study was to assess the perceptions, difficulties and resources needed by mothers in the experience of motherhood. We conducted an exploratory cross-sectional observational study, based on an online questionnaire administered to 172 mothers. We analyzed socio-demographic data, experiences related to pregnancy and childbirth, perceived level of support, emotional difficulties, and resources considered useful in the role of motherhood. Most participants were women aged 30 to 45, with university or postgraduate education, married and with one or more children. Although motherhood was predominantly described in positive terms such as “fulfillment”, “love” and “joy”, a significant percentage of mothers reported increased fatigue, lack of personal time and emotional difficulties. The resources considered essential for maternal balance were family support, personal time, emotional support and access to clear and empathetic medical information. In conclusion motherhood is perceived as a complex experience, in which fulfillment frequently coexists with emotional overload and vulnerability. This exploratory study highlights the complex emotional and psychosocial dimensions of motherhood among Romanian women. The findings suggest the need for accessible emotional and social support resources. A comprehensive approach addressing both emotional and practical needs may contribute to improved maternal well-being. Full article

Emotions play an important role in shaping aggressive behavior, and understanding their underlying psychological mechanisms is particularly relevant among college students. However, existing research has predominantly focused on reactive aggression, while comparatively less attention has been paid to proactive aggression, which is more instrumental in nature and associated with more severe social consequences. In addition, empirical evidence regarding the valence-specific effects of awe remains limited. The present study aimed to examine the differential effects of positive and negative awe on proactive aggression and to explore the role of empathy as a potential mediating mechanism. A total of 110 college students were randomly assigned to one of three conditions: positive awe, negative awe, or neutral emotion. Awe was induced through video clips depicting natural landscapes. Proactive aggression was assessed using a modified bug-killing paradigm, including two behavioral indicators: force intensity and proportion of bugs killed. Empathy was measured using the Interpersonal Reactivity Index. The results revealed a clear differentiation based on the valence of awe. Participants in the positive awe condition exhibited significantly lower levels of proactive aggression than those in the neutral condition across both force intensity (M = 2.86, SD = 0.81 vs. M = 4.17, SD = 0.81) and proportion of bugs killed (M = 0.68, SD = 0.25 vs. M = 0.93, SD = 0.11). In contrast, the inhibitory effects of negative awe were weaker and less consistent. Compared with the neutral condition, negative awe was associated with a lower proportion of bugs killed, although this effect only reached marginal significance (p = 0.06, η² = 0.04), and no significant difference was observed for force intensity. Mediation analyses indicated that empathy partially mediated the association between positive awe and proactive aggression. Empathy accounted for 31% of the total effect in the force intensity pathway (B = −0.02, t = −4.25, p < 0.001, 95% CI [−0.04, −0.01]) and 18% in the proportion-of-bugs-killed pathway (B = −0.003, t = −2.37, p = 0.02, 95% CI [−0.006, −0.001]). Notably, no significant mediating effect of empathy was observed in the negative awe condition, suggesting that the psychological processes linking awe to proactive aggression may differ as a function of emotional valence. Taken together, the present findings suggest that positive awe is reliably associated with lower levels of proactive aggression among college students, and that this association is partially explained by increased empathy. By contrast, the effects of negative awe appear to be fragile and context-dependent, as reflected in their failure to reach statistical significance, indicator-specific manifestation, and the absence of a consistent mediating pathway. These results highlight the importance of distinguishing between positive and negative awe when examining the behavioral consequences of self-transcendent emotions and underscore the need for further research to clarify the conditions under which negative awe may influence aggressive behavior. Full article

As modern society grows increasingly complex, access to essential services such as healthcare, legal aid, tailored education, and psychological support remains heavily gated by socio-economic, neurological, and systemic barriers. This paper explores the transformative potential of Large Language Models (LLMs) and Generative Artificial Intelligence not merely as industrial productivity enhancers, but as vital “social scaffolds” capable of fostering a more inclusive society. Crucially, we propose a paradigm shift in the concept of Ethical Computing—moving from a passive defensive framework of non-maleficence (“do no harm”) to an active mandate of beneficence, where AI systems are explicitly developed to serve marginalized and un(der)served populations. Through this expanded ethical lens, we systematically analyze the democratizing impact of AI across four primary axes of inclusivity: socio-economic (providing zero-cost medical triage and legal translation for undocumented populations), neurospicy (acting as a non-judgmental communicative bridge for individuals with Autism Spectrum Disorder), pedagogical (delivering hyper-personalized executive function support for Special Educational Needs), and psychological (serving as an accessible, first-level triage system for mental health crises). By framing LLMs as a modern social safety net, we outline a clear trajectory for future research, advocating for an “ethical-by-design” development paradigm that explicitly prioritizes equity, accessibility, and the active dismantling of historical barriers for the digitally and socially disenfranchised. Full article

Objective: To determine the publication bias of the reported prevalence of malocclusions in Mexican children and adolescents. Background: Publication bias determination is crucial in a systematic review, helping to ensure the conclusions’ validity and reliability. Nevertheless, without accurate knowledge of disease prevalence and patterns, the health system risks inefficiency, inequity, and failure to meet the population’s needs. On the other hand, malocclusions can impair proper chewing efficiency, contributing to digestive alterations, and nutritional deficiencies among other functional, psychological, and social problems. The data of the prevalence of malocclusion is imperative to implement early interventions in health services that prevent more severe skeletal discrepancies and reduce the need for invasive treatments in adolescence or adulthood. Methods: Studies were collected from five databases, following the PRISMA and Cochrane guidelines for systematic reviews. Eligibility criteria were full-text research in which the prevalence of malocclusions was reported. The risk of bias (Hoy tool), publication bias (the Doi plot and the Luis Furuya-Kanamori (LFK) index), and quality assessments (GRADE tool) were performed. The data were combined using a random-effects meta-analysis. Results: The result of the meta-analysis suggests a high prevalence of malocclusions in mixed dentition was 50.2% (95% confidence interval [CI]: 38.9–61.5%). However, the studies showed a risk of bias and publication bias. Conclusions: In Mexico, there is a high prevalence of malocclusions among children and adolescents. However, these results are not robust enough to draw solid conclusions, due to the low certainty of the evidence. Full article

Employee happiness has become a central concern for the social dimension of sustainability, particularly within small and medium-sized enterprises (SMEs) operating in emerging economies. However, empirical evidence remains limited regarding how advanced organizational self-management practices—especially when integrating holacracy-inspired practices and broader self-management mechanisms that show a positive and significant association with employee happiness in SME contexts, particularly in Latin America. Addressing this gap, this study examines the relationship between organizational self-management practices and employee happiness in Peruvian SMEs, adopting a predictive approach based on Partial Least Squares Structural Equation Modeling (PLS-SEM). Organizational Self-Management Practices (OSMPs) are modeled as a higher-order construct integrating holacracy-inspired and broader self-management practices. Data were collected from 383 SME employees through a structured questionnaire. The findings indicate that organizational self-management practices exert a positive and significant association with employee happiness, operating through an underlying mechanism in which self-management-oriented practices foster greater employee autonomy, participatory decision-making, role clarity, and shared responsibility, thereby supporting fundamental psychological needs and enhancing employees affective and cognitive well-being at work. By promoting these autonomy-supportive organizational conditions, Organizational Self-Management Practices (OSMPs) strengthen employee happiness in resource-constrained SME contexts, highlighting how Organizational Self-Management Practices function as internal governance mechanisms that enhance employee well-being and contribute to social sustainability by strengthening psychologically supportive, autonomy-enhancing, and socially sustainable work environments in emerging economy SMEs. These findings demonstrate that employee happiness represents a micro-level manifestation of social sustainability, linking internal organizational governance mechanisms with broader sustainable development outcomes in emerging economy contexts. Full article

Dementia caregiving represents a major public health challenge, with spousal caregivers assuming the greatest burden. Spouses, themselves typically older adults, provide high intensity, long-term, and largely unpaid care across all stages of cognitive decline. Despite their central role in dementia care, the health consequences experienced by spousal caregivers remain insufficiently characterized in the literature and inadequately addressed in clinical and public health practice. This structured narrative review synthesizes current evidence on the multidimensional impact of dementia caregiving on the physical, psychological, cognitive, social, and financial health of spousal caregivers. It further contextualizes these consequences within the trajectory of dementia progression, and identifies interventions, support systems, and policy considerations necessary to mitigate caregiver burden. Spousal caregivers experience disproportionate burden due to continuous, escalating responsibilities that often mirror the progressive deterioration of their partners. Emotional burdens, including uncertainty during pre-diagnostic stages, role strain, conflict, loss of intimacy, and anticipatory grief. Physically, spouses endure musculoskeletal strain, sleep disruption, poor nutrition, and heightened frailty risk. Psychologically, spousal caregivers exhibit elevated rates of depression, anxiety, loneliness, and stress-related disorders. Socially, caregivers experience substantial isolation, stigma, and erosion of social networks. Financial hardship, including early retirement, reduced employment, and uncompensated care hours, further exacerbate stress. Evidence suggests that chronic caregiving stress contributes to biological changes such as immune dysregulation, inflammation, acceleration, aging, and potential cognitive decline in caregivers themselves. Caregiver burden influences patient outcomes as evidenced by increased emergency department use, falls, and earlier institutionalization in persons with dementia whose caregiver is subjected to a high burden. Current care models rarely include routine, caregiver assessment or structured guidance following diagnosis, resulting in substantial unmet needs. Effective mitigation requires integrated, stage-sensitive interventions, including psychosocial support, caregiver education, respite services, culturally tailored programs, and digital health tools, alongside broader policy reforms to reduce financial and structural barriers. Full article

Background: Torture, as a fundamental violation of human rights, is unequivocally condemned by all international organizations. Sexual torture is one of the most severe forms of torture, encompassing forced nudity, various forms of humiliation, and physical abuse, including rape. Despite testimonial evidence indicating the incidental use of sexual torture by Israeli authorities, there is a lack of epidemiological research providing a comprehensive understanding of this issue. This study aims to analyze the prevalence and characteristics of ill treatment and sexual torture among Palestinian male detainees and the subsequent impacts. Methods: This cross-sectional study analyzed a database of 517 former male detainees. The interview protocol included items related to psychological and physical methods of sexual torture, medical impacts, subjective psychological impacts, clinical medical and psychological measures, and psychosocial and community impacts. Results: The findings indicate that the majority of detainees experienced some form of sexual torture, with humiliation being the most common type. The impact of sexual torture are severe, affecting both clinical and social domains. The impacts of sexual torture persist over time and, in some cases, worsen, particularly regarding physical health outcomes. Socially, the consequences extend to the detainees’ families and communities. Conclusions: The prevalence of such torture tactics calls for urgent responses from both the authorities and civil society. These findings highlight the need for proactive measures to address and mitigate the impacts of sexual torture, including independent investigations, robust monitoring, secure reporting mechanisms, the prosecution of perpetrators and comprehensive reparation for victims. Full article