Search Results (732)

Objective: Anxiety symptoms frequently occur alongside mood disorders and are associated with poorer clinical outcomes, highlighting the importance of early and accurate detection. This study evaluated the diagnostic accuracy and psychometric properties of the Anxious Distress Assessment Scale (ADS), a newly developed brief self-report instrument designed to detect anxious distress. Method: The study was conducted in two phases. Phase 1 involved the development of the ADS as a five-item instrument reflecting the DSM-5-TR anxious distress criteria. In Phase 2, 105 adults diagnosed with major depressive disorder (MDD) completed the ADS alongside the Generalized Anxiety Disorder-7 (GAD-7) and the Montgomery–Åsberg Depression Rating Scale (MADRS). Psychometric evaluation included internal consistency reliability (Cronbach’s α), analyses of convergent validity, and diagnostic accuracy assessment using correlation and receiver operating characteristic (ROC) analyses. Results: Anxious distress was highly prevalent, with 71% of participants meeting DSM-5-TR criteria. The ADS demonstrated strong diagnostic performance, with sensitivity of 88.0%, specificity of 90.0%, positive predictive value of 95.7%, and negative predictive value of 75.0%. ROC analysis yielded an area under the curve (AUC) of 0.97 (95% CI: 0.943–0.997), with an optimal cut-off score of ≥10. Internal consistency was excellent (Cronbach’s α = 0.897). Principal component analysis supported a unidimensional structure, accounting for 71.5% of the total variance, with all items loading above 0.80. The ADS also demonstrated strong convergent validity, correlating significantly with the GAD-7 (r = 0.82) and MADRS (r = 0.68). Conclusions: The ADS demonstrates promising psychometric properties, including strong reliability, meaningful convergent validity, and excellent diagnostic accuracy. Its brief format and direct alignment with DSM-5-TR anxious distress criteria support its potential utility as a practical screening tool in clinical settings. However, these findings should be interpreted in light of the study’s focus on English-speaking Malaysian adults with MDD recruited from a tertiary-care setting. Further validation across diagnostic groups, clinical contexts, and cultural and linguistic populations is warranted. Full article

Objective: This study aimed to develop and psychometrically evaluate the Functional Vision Scale for Adults (FVSA), an occupation-centred patient-reported outcome measure on daily functioning across key occupational performance domains. Methods: The scale development process followed incorporating a comprehensive literature review and expert consultations (n = 10) to establish content validity. An initial item pool of 51 items was refined through expert review and pilot testing (n = 55), resulting in a 33-item scale. The final version was administered to 526 adults (372 without visual problems, 154 with visual problems). Construct validity was evaluated using exploratory and confirmatory factor analysis. Known-group validity was assessed by comparing scores between participants with and without visual problems. Reliability was tested through internal consistency (Cronbach’s α, McDonald’s ω) and test–retest reliability (ICC) in a subsample (n = 62). Results: Exploratory and confirmatory factor analyses supported a four-factor structure corresponding to education, activities of daily living (ADLs), social participation and instrumental ADLs (IADLs). Known-group validity was confirmed with statistically significant differences across all subscales (p < 0.05). The FVSA Total Score demonstrated excellent reliability, as evidenced by a strong ICC value (ICC = 0.835, p < 0.001) supported by high internal consistency coefficients (ω = 0.946; α = 0.933). Conclusions: The FVSA is a reliable and valid instrument that provides a comprehensive, occupation-centred assessment of functional vision in adults. Full article

Aims: To conduct an exploratory analysis the psychometric properties of the Spanish version of the Soft Skills Questionnaire for Nurses (SSQN) and examine its conceptual coherence and its preliminary empirical behavior among nursing professionals and students. The aim is to critically assess the instrument’s suitability as a tool for exploring perceptions and self-reported soft skills rather than to establish its psychometric validity. Design: Exploratory methodological study focused on analyzing the empirical performance and conceptual adequacy of the SSQN within a Spanish sample, with particular attention to the internal patterns of responses and the coherence between the instrument’s items and its proposed dimensions. Methods: The process included the translation of the questionnaire and an empirical application in a sample of nursing professionals and students. Exploratory analyses were performed, including exploratory factor analysis and reliability assessment (Cronbach’s alpha and McDonald’s omega), using Jeffreys’s Amazing Statistics Program (JASP) (version 1.18.3), in order to examine the structural performance of the instrument and detect possible conceptual and methodological limitations. Results: The SSQN showed notable inconsistencies in its empirical structure, with dimensions that did not display clear or theoretically coherent patterns. Factor inconsistencies and low internal consistency suggest that the instrument does not adequately capture the multidimensionality of interpersonal skills, reflecting weaknesses inherent in its original formulation rather than in the adaptation process. Conclusions: The Spanish version of the SSQN cannot be considered valid or reliable in its current form. The results underscore the need for a thorough revision of the questionnaire and a conceptual rethinking to develop more robust tools for assessing soft skills. Impact: This study highlights the need for a solid methodological evaluation before introducing instruments designed to measure complex and subjective competencies in the healthcare field. Full article

Background/Objectives: Simulation-based education often lacks personalization, focusing on technical competence rather than individual student profiles. This protocol describes a study designed to evaluate whether adapting gamified narratives to nursing students’ personality profiles has the potential to support academic performance in obstetrics. This study aims to validate the integration of psychometric profiling and AI as a sustainable strategy for personalized clinical training. Methods: A cluster-randomized controlled longitudinal pilot trial will be conducted at the University of Atlántico Medio. The protocol has been submitted for registration at ClinicalTrials.gov (Registration Pending). Thirty-eight second-year nursing students meeting inclusion criteria (excluding repeaters or those with prior specialized training) will be assigned by natural practice to either a control group (generic gamification) or an experimental group (gamification adapted according to Player Personality and Dynamics Scale profiles using AI-generated content). The intervention comprises four clinical simulation sessions focusing on pregnancy and childbirth, which are managed via the Wix platform. The primary outcome is academic performance, measured as “Learning Gain” (post-test scores minus pre-test scores). Secondary outcomes include student satisfaction measured via the Gameful Experience Scale. Data will be analyzed using Mann–Whitney U tests to compare overall efficacy and intragroup evolution. To minimize observer bias, knowledge assessments will utilize automated, objective scoring, and participants will be blinded to the study hypothesis. Expected Outcomes: The study aims to establish the technical and pedagogical feasibility of integrating AI-adapted narratives into nursing curricula. It is anticipated that the personalized approach will show positive trends in learning gains and engagement patterns, providing a baseline for larger multicenter trials. Conclusions: This protocol presents a framework for “Precision Education” in nursing, shifting from “one-size-fits-all” simulations to student-centered adaptive training. The use of Generative AI makes such personalization sustainable and cost-effective for health science faculties. Full article

Background: Population aging represents a major public health challenge, accompanied by an increasing prevalence of chronic diseases and age-related functional decline. Declines in lower-extremity physical function are particularly important, as they are strongly associated with mobility limitations, loss of independence, increased risk of falls, hospitalization, and mortality in older adults. Reliable and valid tools to assess physical performance are therefore essential in both clinical and research settings. The Short Physical Performance Battery (SPPB) is a widely used instrument for assessing lower-extremity physical performance in older adults and is recommended within the diagnostic algorithm of the European Working Group on Sarcopenia in Older People (EWGSOP2) for evaluating physical performance severity. However, the SPPB has not yet been psychometrically validated in the Croatian older population. This study aimed to evaluate the reliability and validity of the SPPB in Croatian older adults. Methods: This study examined the metric properties of the SPPB in a sample of 153 older adults recruited from nursing homes and community settings. Results: The SPPB demonstrated acceptable internal consistency (Cronbach’s alpha = 0.74) and good test–retest reliability (ICC = 0.893) for the total score. Convergent and construct validity were supported by significant associations with established measures of functional mobility and muscle strength. Conclusions: The Croatian version of the SPPB is a reliable and valid instrument for assessing lower-extremity physical performance in older adults. Its use is supported in clinical practice and research settings in Croatia. Further studies should examine responsiveness and predictive validity in nationally representative samples. Full article

This study investigates how bio-inspired versus sustainability-focused framing influences lay evaluations of a specific bio-inspired building-technology scenario, testing the empirical validity of the so-called “biomimetic promise”. Employing a between-subjects experimental design ($N=582$), we examined assessments of a weather-responsive self-shading façade across bio-inspired, sustainable, and neutral framing conditions. We developed and validated the 12-item Perceived Bio-Inspiration Scale (PBS)—a novel standardized psychometric instrument designed to quantify lay recognition of biomimetic features across visual, intentional, and naturalistic dimensions. While results showed robust direct framing effects, we identified a significant negative spillover: emphasizing biological inspiration significantly reduced the technology’s perceived sustainability, while sustainability framing diminished its perceived bio-inspiration. These findings demonstrate, in this façade context, that laypersons evaluate bio-inspiration and sustainability as cognitively distinct and potentially competing constructs, indicating that “natural-is-better” bias is not universal across all technology domains. Consequently, merely invoking biological origins is insufficient to enhance a technology’s ecological appeal. To foster public trust, science communication should shift from abstract biological metaphors toward a performance-driven communication strategy that prioritizes the disclosure of verifiable life-cycle assessment and specific operational advantages over symbolic nature-based analogies. Full article

Background/Objectives: Daily sleep patterns are associated with cognitive health and Alzheimer’s disease (AD). However, it remains unclear how suboptimal irregular sleep manifests in AD from the preclinical stage to dementia. This study aimed to establish the dose–response association between sleep irregularity and psychometrically defined stage-specific AD as well as executive dysfunction, among adults with subjective cognitive and sleep issues. Methods: Cross-sectional data were obtained from 532 Japanese adults (mean age = 63.9 years) between March 2023 and April 2024. Sleep irregularity was quantified using the Sleep Regularity Index (SRI) with 24/7 accelerometer data. A modified Poisson regression with cubic splines was performed to establish the dose–response association. Results: This study identified novel non-linear associations. The prevalence ratios of cognitive impairment, defined as being in the preclinical and more advanced stages of AD, significantly declined beyond a median SRI of 60. Participants within this SRI range also showed significantly lower prevalence ratios of poorer Trail Making Test B performance. All results were independent of age, sleep duration, and risk of depression. Conclusions: Maintaining balanced-to-regular daily sleep patterns might be optimal for AD progress from its preclinical stages, with a potential benchmark at SRI of 60, especially for those individuals at risk for cognitive decline and sleep disorders. Further research is needed to replicate this benchmark in diverse populations and to evaluate the effect of rigid sleep regularity on cognitive health. Full article

Background/Objectives: Breast cancer awareness is essential for early detection and timely help-seeking among women and represents a key component of multidisciplinary breast cancer prevention. The Breast Cancer Awareness Measure (Breast-CAM) is widely used to assess awareness of breast cancer symptoms, risk factors, and screening behaviors. Its measurement quality across populations has not yet been comprehensively evaluated. As Breast-CAM is a population-reported measurement instrument, evaluation using a standardized framework for measurement properties is required. This systematic review and meta-analysis aimed to assess the psychometric properties of the Breast-CAM across diverse populations and cultural adaptations, in accordance with COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) methodological standards. Methods: Major bibliographic databases and trial registries were systematically searched for peer-reviewed English-language studies published between 2010 and 2025 that evaluated at least one psychometric property of the Breast-CAM in adult women. Methodological quality was assessed using the COSMIN Risk of Bias checklist. Measurement properties were evaluated according to COSMIN criteria, and the certainty of evidence was graded using a modified GRADE approach. Meta-analysis was performed when data were sufficiently comparable. Results: Seventeen studies met the inclusion criteria for narrative synthesis, of which eleven were included in a meta-analysis, representing fourteen cultural adaptations of the instrument. A descriptive random-effects meta-analysis of reported Cronbach’s α yielded a pooled estimate of 0.89 (95% confidence interval 0.85–0.92). This value should be interpreted cautiously, as structural validity was frequently insufficient across cultural adaptations, limiting interpretation of internal consistency according to COSMIN guidance. Other measurement properties, including reliability and measurement error, were frequently inadequately assessed or unreported. The certainty of evidence ranged from very low to moderate. Conclusions: Content validity was generally rated as sufficient, although certainty of evidence was low. Despite the high pooled α estimate, the reliability of Breast-CAM cannot be firmly established because structural validity was frequently insufficient across cultural adaptations. In accordance with the COSMIN ceiling rule, internal consistency was not considered sufficient in the absence of adequate structural validity. Key measurement properties, including test–retest reliability, measurement error, and responsiveness, were rarely evaluated. Further high-quality psychometric studies, particularly in culturally diverse populations, are needed to address these gaps and support appropriate use of the instrument in research and public health practice. Full article

Physiological dysregulation arising from chronic stress is a key mechanism linking psychosocial factors to long-term health outcomes, yet early identification typically relies on invasive or resource-intensive measurements. This study evaluates whether high-dimensional psychometric survey data can support scalable, non-invasive screening for latent physiological dysregulation. Using longitudinal data from the Midlife in the United States (MIDUS) Waves 2 and 3, we develop a screening-oriented modeling framework that separates longitudinal risk estimation from deployable screening model construction. Physiological targets are defined across inflammatory, metabolic, and neuroendocrine domains using three canonical allostatic load formulations. A teacher–ranking–pruning–student pipeline combines stable feature ranking, parsimony-driven dimensionality reduction, and knowledge distillation. Predictor dimensionality is reduced by more than an order of magnitude without loss of screening performance. Distilled student models consistently outperform linear, tree-based, and direct neural baselines, achieving area under the receiver operating characteristic curve values up to approximately 0.78 and substantial precision–recall lift over baseline prevalence. Longitudinal information is exploited during model development but not required at inference, enabling deployment using psychometric data alone. These findings demonstrate the feasibility of non-invasive screening for latent physiological dysregulation and provide a generalizable framework for translating longitudinal cohort data into deployable population health tools. Full article

Recent advances in large language models (LLMs) have made automated multiple-choice question (MCQ) generation increasingly feasible; however, reliably producing items that satisfy controlled cognitive demands remains a challenge. To address this gap, we introduce ReQUESTA, a hybrid, multi-agent framework for generating cognitively diverse MCQs that systematically target text-based, inferential, and main idea comprehension. ReQUESTA decomposes MCQ authoring into specialized subtasks and coordinates LLM-powered agents with rule-based components to support planning, controlled generation, iterative evaluation, and post-processing. We evaluated the framework in a large-scale reading comprehension study using academic expository texts, comparing ReQUESTA-generated MCQs with those produced by a single-pass GPT-5 zero-shot baseline. Psychometric analyses of learner responses assessed item difficulty and discrimination, while expert raters evaluated question quality across multiple dimensions, including topic relevance and distractor quality. Results showed that ReQUESTA-generated items were consistently more challenging, more discriminative, and more strongly aligned with overall reading comprehension performance. Expert evaluations further indicated stronger alignment with central concepts and superior distractor linguistic consistency and semantic plausibility, particularly for inferential questions. These findings demonstrate that hybrid, agentic orchestration can systematically improve the reliability and controllability of LLM-based generation, highlighting workflow design as a key lever for structured artifact generation beyond single-pass prompting. Full article

Introduction: Major depressive disorder (MDD) is a leading cause of disability worldwide and contributes significantly to the global burden of disease. Recent data show an increasing prevalence of treatment-resistant depression (TRD). Patients with autism spectrum disorder (ASD) often exhibit MDD as a comorbidity and it is often resistant to conventional treatments. ASD determines emotional dysregulation and a reduced ability to understand mental states (mentalization). These features can lead to suicidal ideation and/or behavior. Intranasal esketamine may offer a novel therapeutic option for this population. Methods: This case series focuses on the clinical response to intranasal esketamine in patients with autism and TRD; esketamine is approved in Italy as an add-on therapy in TRD, so our case study is based on an in-label treatment. Three young patients (n = 3, F/M 2:1, age range 20–25 y) with light to moderate autism (Level 1 or 2) were treated. Esketamine was administered in augmentation with selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) in accordance with EMA/AIFA guidelines. A structured follow-up protocol was set to monitor depressive symptoms, social cognition, and mentalization. Follow-up during treatment was maintained for six months, and psychometric evaluations were performed at six time points: baseline (T0), 1 week (T1), 1 month (T2), 2 months (T3), 3 months (T4), and 6 months (T5). Also, subjective quality of life was investigated before and after the observation period. Results: Despite differences in clinical profile, all patients showed good efficacy of esketamine in reducing depressive symptoms: two patients experienced clinical remission at T5 (MADRS < 10), one patient showed partial response (dMADRS = 43.24%). No major side effects were reported. Significant improvements were observed after the first week of treatment (P1: MADRS_T0 = 37, MADRS_T1 = 12; P2: MADRS_T0 = 32, MADRS_T1 = 21; P3: MADRS_T0 = 25, MADRS_T1 = 12). Depressive relapses occurred (e.g., P1, T3–T4), but they were not associated with hospitalizations and/or suicidal attempts. Suicidal ideation, when present, decreased by the end of the follow-up period. Lack of mentalization and in social cognition was noted, with just mild improvements during therapy. Subjective quality of life improved significantly for all patients (P1: 28% at T0, 73% at T5. P2: 25% at T0, 71% at T5. P3: 35% at T0, 80% at T5). Conclusions: Intranasal esketamine showed a favorable efficacy and safety in these three cases of TRD in comorbidity with ASD (at six months: total remission = 66.66%, partial remission = 33.33%, inefficacy = 0%, drop-out = 0, severe adverse events = 0). Besides improvements in depressive symptoms, esketamine was associated with a constant decrease in suicidal thoughts. A case series is unfit to form statistical conclusions; preliminary data warrant further investigation in randomized controlled studies to validate the therapeutic potential of esketamine in this population. Full article

Organizations face increasing pressure to reduce their environmental impact while preserving worker health, well-being, and performance. While sustainability research increasingly emphasizes organizational and human dimensions, validated tools assessing how environmental sustainability is integrated into ergonomic practice remain limited. Green ergonomics provides a systemic framework linking human factors and environmental objectives in sustainable work system design. This study aimed to develop and validate the Green Ergonomics Questionnaire (GEQ), a psychometric instrument designed to assess employees’ perceptions of organizational readiness to integrate sustainability into ergonomic practice. The GEQ was developed through a structured literature review, expert evaluation, and empirical validation using data from 412 employees across multiple occupational sectors. Exploratory and confirmatory factor analyses supported a seven-factor structure including knowledge, training and organizational learning, organizational practices, perceived impacts, obstacles, organizational culture, and employee involvement. Reliability indices indicated satisfactory internal consistency (α = 0.78–0.86; CR = 0.80–0.88), and convergent and discriminant validity were supported. Overall, the GEQ provides a structured framework to assess employees’ perceptions of how environmental sustainability is embedded within ergonomic and participatory work system design processes, contributing to research at the intersection of ergonomics, sustainability management, and organizational change. Full article

Objective: This study aimed to develop the Infectious Diseases Knowledge Questionnaire (IDKQ) and evaluate its psychometric properties for use in community settings. Methods: This methodological study was conducted with 533 adults aged ≥ 18 years. Data were collected using a sociodemographic information form and the IDKQ. Content validity was assessed by expert evaluation. Construct validity was examined using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Reliability was evaluated through item–total correlations, internal consistency (KR-20), test–retest reliability, and intraclass correlation coefficients (ICC). Data analyses were performed using SPSS 25.0 and AMOS 21.0. Results: Content validity index values ranged from 0.94 to 1.00. EFA revealed a four-factor structure consisting of 17 items, explaining 45.66% of the total variance (KMO = 0.784; Bartlett’s test, p < 0.001). CFA demonstrated good model fit (χ²/df = 2.329, RMSEA = 0.074, CFI = 0.946, AGFI = 0.847, GFI = 0.887, SRMR = 0.045). The KR-20 coefficient was 0.735, the test–retest correlation was 0.604, and the ICC was 0.781. Conclusions: The IDKQ demonstrates acceptable internal consistency and moderate temporal stability, providing preliminary evidence of reliability and construct validity. It may serve as a tool for assessing infectious disease knowledge, although further validation in independent samples is recommended. Full article

Background/Objectives: Antisocial personality disorder (ASPD) is strongly associated with violence, substance use, criminal behavior, and elevated suicide risk. Although inflammatory and metabolic dysregulation have been implicated in severe psychiatric disorders, the biological correlates of impulsivity, aggression, and suicide risk in forensic ASPD populations remain unclear. This study aimed to investigate whether routine hematological, inflammatory, and metabolic parameters are associated with these clinical features. Methods: This cross-sectional study included 57 male individuals diagnosed with antisocial personality disorder (ASPD) who had committed crimes and were referred to the Forensic Psychiatry Department of Elazığ Fethi Sekin City Hospital in Turkey by the court, and 56 age-matched healthy controls. Participants completed standardized assessments of impulsivity (BIS-11), aggression (BPAQ), and suicide probability (SPS). Hematological indices, inflammatory markers, and routine biochemical parameters were analyzed. Group comparisons, correlation analyses, and multivariable logistic regression were performed. Results: Compared with age-matched controls, individuals with ASPD showed markedly higher impulsivity, aggression, and suicide probability, alongside substantially higher rates of substance use, imprisonment history, and suicide attempts (all p < 0.001). Hematological and inflammatory analyses revealed lower red blood cell (RBC) counts and elevated mean corpuscular volume (MCV), red cell distribution width (RDW), C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), and CRP–albumin ratio (CAR) in the ASPD group (all p < 0.05). Biochemical profiling showed reduced glucose, total protein, albumin, HDL, ALT, and vitamin B12 levels, with increased uric acid levels in ASPD (p < 0.05). Multivariable analysis indicated that being married and having higher education were protective against ASPD, whereas higher uric acid and CAR levels were associated with increased risk. Conclusions: The findings indicate that criminal offenders with ASPD show increased inflammatory markers and altered hematological and biochemical profiles. Routine blood parameters, combined with psychometric assessments, may help identify individuals at higher behavioral risk and support early risk stratification in forensic psychiatric settings, although causal relationships cannot be inferred from this cross-sectional study. Full article

This study developed and validated a Machine Learning (ML) ecosystem for the early screening of school victimization among Ecuadorian adolescents, a phenomenon that poses a critical barrier to educational equity. Addressing previous methodological limitations, this research intentionally eliminated circular reasoning by excluding all internal psychometric items from the feature set, focusing strictly on sixteen socio-environmental and demographic predictors. A quantitative study was conducted with 1413 students in the province of Tungurahua, utilizing the Synthetic Minority Over-sampling Technique (SMOTE) to correct class imbalance. Supervised classification algorithms, including SVM, Random Forest, and XGBoost, were compared. The results demonstrated that the Random Forest model achieved the most balanced performance, reaching an Accuracy of 60.3% and a Macro F1-score of 0.382. Feature importance analysis identified household structure (Living_With_Monoparental) and Family_Coping_Capacity as the most significant predictors of high-risk profiles. These findings provided a statistically honest and ecologically valid tool for Student Counseling Departments (DECE), enabling a transition toward proactive risk identification grounded in observable social vulnerability rather than reactive symptom reporting. Full article