Search Results (499)

Informal waste picking and scrap collection constitute critical yet highly precarious livelihood strategies among economically marginalised women in rural South Africa. This article presents a cross-sectional mixed-methods study, guided by Sen’s Capability Approach as its analytical framework, examining the lived experiences, motivations, and livelihood outcomes of 126 Black African women engaged in scrap collection along the N2 Highway in the Eastern Cape, specifically in Mthatha, Xhora, and Qumbu. The study integrates quantitative descriptive statistics with qualitative thematic analysis derived from structured interviewer-administered questionnaires. The findings indicate that participation in scrap collection is overwhelmingly driven by structural economic constraints, including chronic unemployment, household poverty, and extensive caregiving responsibilities, rather than autonomous occupational choice. The sample is characterised by limited educational attainment, frequently disrupted by poverty, bereavement, early marriage, and early caregiving roles, which collectively constrain access to formal employment opportunities. Participants consistently described scrap collection as physically hazardous, economically insecure, and detrimental to both physical health and psychosocial wellbeing, while remaining indispensable for household survival. Through the lens of the Capability Approach, these conditions reflect severe restrictions in substantive freedoms, particularly in relation to economic security, bodily health and human dignity. Expressions of acceptance are interpreted as manifestations of adaptive preferences formed under conditions of prolonged structural deprivation rather than indicators of genuine agency. The study contributes to informal economy scholarship by demonstrating how intersecting structural inequalities constrain capability sets and limit livelihood trajectories and calls for targeted policy interventions to enhance occupational safety, income security and access to sustainable livelihood alternatives. Full article

Sleep and dietary behavior are deeply conserved biological processes that co-evolved under ecological pressures shaping human anatomy, metabolism, immunity, cognition, and life history strategies. Major transitions in human dietary ecology, including plant-dominant hominin foraging, increased meat consumption, control of fire and cooking, agricultural domestication, industrialization, and postindustrial globalization, restructured nutrient intake, pathogen exposure, microbial ecology, metabolic demands, and temporal organization of behavior. Emerging evidence from evolutionary genomics, chronobiology, neuroendocrinology, and microbiome science indicates that sleep–feeding interactions represent a conserved adaptive regulatory module optimized for fluctuating energy availability and strong photoperiodic entrainment. Modern environments characterized by widespread availability of highly palatable, energy-dense foods rich in refined carbohydrates, added sugars, and multiple industrial additives, together with artificial light at night, continuous caloric access, sedentary behavior, and psychosocial stress produce a profound evolutionary mismatch destabilizing circadian–metabolic homeostasis. This mismatch is characterized by circadian disruption, temporal misalignment of feeding and sleep behaviors, and, in many populations, insufficient sleep duration. Within this conceptual landscape, the emerging framework of “evolutionary chrononutrition” proposes that metabolic health and sleep integrity depend not only on what humans eat, but critically on when food is consumed in relation to endogenous circadian architecture shaped across deep evolutionary time. This review synthesizes anthropological, physiological, and molecular evidence to develop an integrative evolutionary framework linking sleep and diet to contemporary cardiometabolic, neurodegenerative, inflammatory, and psychiatric disorders, with particular emphasis on how each major dietary transition plausibly altered sleep duration, architecture, circadian timing, neuroendocrine regulation, and the temporal alignment between feeding behavior and biological rhythms. Full article

Background: Quality of life (QoL) after spinal cord injury (SCI) is influenced by psychosocial factors, yet less is known about how these factors are examined across national contexts. Objective: This scoping review mapped studies examining depression, employment, and social participation in relation to QoL or health-related QoL (HRQoL) among individuals with SCI in the United States and South Korea. Methods: Following PRISMA-ScR guidelines, five databases were searched for peer-reviewed English- and Korean-language studies published between 2007 and 2025. Results: Sixteen studies were included: nine from South Korea and seven from the United States. Depression and psychological distress were associated with lower QoL/HRQoL in both countries, although South Korean studies more often examined depression with stress and functional concerns, whereas U.S. studies situated depression within participation, spirituality, and youth psychosocial functioning. Employment was linked to QoL/HRQoL in both contexts, with South Korean studies emphasizing economic activity, vocational rehabilitation, and financial strain, and U.S. studies emphasizing employment status and vocational outcomes. Social participation was important in both countries, but South Korean studies focused more on community transition, functional independence, and social attitudes, whereas U.S. studies emphasized participation contexts, accessibility, and social relationships. Conclusions: Across the three domains, depression, employment, and social participation emerged as recurring psychosocial domains associated with QoL/HRQoL after SCI in both countries. These differences suggest that psychosocial adaptation after SCI should be understood within cultural and rehabilitation contexts. Full article

There is increasing evidence that intergenerational programs (IGPs), which use shared activities to connect older and younger age groups, lead to educational and psychosocial benefits for young children. However, insufficient attention to implementation within the emerging, cross-disciplinary field limits understanding of how evidence-informed IGP practices support positive outcomes in early childhood. These difficulties impede the interpretation, comparison and application of IGP findings by researchers, practitioners and policymakers. Therefore, the purpose of this review was to employ explicit, systematic methods to examine and synthesise recent evidence relating to the implementation of sustained, non-familial group-based IGPs in early childhood contexts. Specifically, we aimed to: (a) evaluate the current evidence for effective IGP implementation and (b) investigate key methodological considerations using core implementation process constructs drawn from the Consolidated Framework for Implementation Research 2.0. Following a robust screening process, eighteen peer-reviewed articles were identified. The findings highlight achievements, challenges and gaps in the field from an implementation science lens. Some important implications for practice in intergenerational contexts include the need to build implementation teams, plan IGPs, assess context-specific and participant needs, and adapt IGPs for optimal fit. Full article

Lymphoid neoplasms such as multiple myeloma (MM), indolent non-Hodgkin lymphoma, and chronic lymphocytic leukemia are increasingly managed as chronic, relapsing conditions characterized by prolonged surveillance, repeated treatment transitions, and cumulative self-management demands. These trajectories expose patients and caregivers to persistent illness uncertainty, fluctuating fear of progression, symptom and comorbidity burden, communication challenges, and treatment-related workload. This theory-informed framework development paper uses an overview of selected psycho-oncological, hematological, nursing, theoretical, and patient-reported outcome literature to propose the LUMINA framework: Longitudinal illness trajectory, Uncertainty fields, Multidimensional symptom and comorbidity load, Information and interaction context, Navigation work and self-management load, and Adaptive outcomes and alignment. LUMINA is intended as a hypothesis-generating conceptual structure to organize clinically relevant domains, clarify potential relationships among uncertainty, symptom burden, communication, navigation work, and adaptive outcomes, and guide future assessment, validation, and intervention research in chronic lymphoid neoplasms. The framework builds on prior theories of illness uncertainty, treatment burden, workload–capacity balance, fear of recurrence/progression, and lymphoma-specific qualitative work on uncertainty management and psychosocial adaptation. Potential research applications include structured assessment, shared decision-making research, and domain-matched supportive-care concepts; however, these applications remain theoretical and require empirical testing. Future studies should evaluate feasibility, acceptability, construct validity, domain overlap, predictive validity beyond quality of life, and the clinical utility of LUMINA-informed research profiles. Until such validation is available, LUMINA should be interpreted as a conceptual model rather than a validated clinical tool or care pathway. Full article

Background: Diabetes-related stigma is an underrecognized psychosocial factor that may contribute to emotional burden among individuals with diabetes. In Saudi Arabia, where the prevalence of diabetes is among the highest globally, limited evidence exists on how stigma across different social contexts influences interpersonal diabetes distress. We aimed to assess the association between diabetes-related stigma and interpersonal diabetes distress and to determine whether these associations differed across family, workplace, and healthcare stigma domains among adults with diabetes in Saudi Arabia. Methods: This cross-sectional study analyzed survey data collected from 438 patients with diabetes. Diabetes-related stigma was measured using an adapted 12-item diabetes stigma scale covering family, workplace, and healthcare domains, while interpersonal diabetes distress was assessed using the Interpersonal Distress subscale of the Diabetes Distress Scale (DDS). The relationships between stigma and distress were estimated using multiple linear regression analysis adjusted for age, gender, education level, years since diagnosis, and presence of complications. Results: Participants reported moderate levels of stigma (mean: 2.50, SD: 1.08) and interpersonal distress (mean: 2.31, SD: 1.23). Higher stigma scores were strongly associated with greater interpersonal distress (β = 0.57, 95% CI: 0.48 to 0.66). Domain-specific analysis showed that workplace (β = 0.26, 95% CI: 0.10 to 0.42) and healthcare stigma (β = 0.23, 95% CI: 0.07 to 0.38) were significantly associated with distress, while family stigma was not. Individuals with diabetes complications had higher distress (β = 0.49, 95% CI: 0.25 to 0.73). No evidence of effect modification by gender or education was observed. Spline models confirmed a positive and strengthening association at higher levels of stigma. Conclusions: Diabetes-related stigma is a strong and consistent factor associated with interpersonal diabetes distress in Saudi Arabia, with workplace and healthcare stigma demonstrating the strongest associations. These findings highlight the importance of addressing stigma within both social and healthcare environments and suggest that stigma reduction strategies may help alleviate the psychosocial burden associated with diabetes. Full article

Russia’s invasion of Ukraine has exposed millions of individuals to traumatic experiences, displaced them under temporary protection, and caused psychological distress. This exploratory study examined resilience, emotional experiences, and psychosocial profiles among displaced and non-displaced Ukrainian women affected by the war. A total of 249 adult women participated, including 122 displaced women under temporary protection residing in Spain and 127 women living in Ukraine. Participants completed the Brief Resilient Coping Scale (BRCS) and the Scale of Positive and Negative Experience (SPANE). Group comparisons and cluster analyses were conducted to identify distinct psychosocial patterns. Displaced women showed slightly higher resilience scores than non-displaced women, although differences were not statistically significant. Non-displaced women reported significantly higher levels of both positive and negative emotional experiences, suggesting greater emotional intensity among those remaining in Ukraine. Cluster analyses identified three psychosocial profiles: an adaptive profile characterized by high positive affect, low negative affect, stronger social support, and higher resilience; a vulnerable profile marked by low social support, elevated negative affect, and lower resilience; and an intermediate profile showing high negative affect despite moderate-to-high social support. Although displaced women under temporary protection were more represented in the vulnerable profile, this association was not statistically significant. The findings highlight the heterogeneity of psychological adaptation during war and displacement and emphasize the protective role of resilience and social support. Full article

Background: Burn injuries are increasingly being recognized as chronic conditions with long-term physical, emotional, and social consequences. As survival after acute burn trauma improves, greater attention has shifted toward health-related quality of life (QoL) in survivors, particularly in regions where data remain limited. Methods: This study included burn survivors treated between January 2022 and December 2023 in the Department of Plastic Surgery and Reconstructive Microsurgery of the Emergency Clinical Hospital “Bagdasar-Arseni,” Bucharest, Romania. Patients who survived hospitalization and follow-up were invited to complete a Romanian-adapted version of the Burn Specific Health Scale-Brief (BSHS-B). Demographic and clinical data were collected from medical records, including burn type, total body surface area (TBSA), burn depth, burn localization, and access to rehabilitation services. Statistical analysis included descriptive methods, chi-square tests, t-tests, Kendall’s tau-b, Cramer’s V, Cronbach’s alpha, and exploratory factor analysis. Results: Thirty-eight patients were included. Most burns were thermal (94.74%), while burns involving <10% TBSA were most frequent (60.53%). Functional outcomes were generally favorable, with most patients reporting no difficulty in basic daily activities such as bathing, dressing, and writing. However, fine motor activities and return to previous work were more frequently affected. Emotional recovery appeared less complete, with persistent mild-to-moderate loneliness, sadness, and emotional distress reported by many participants. Women reported higher levels of loneliness (p = 0.015), while third-degree burns were associated with more frequent depressive symptoms (p = 0.008). Depressive symptoms were also significantly associated with functional limitations (such as getting dressed, p = 0.002) and work impairment (p < 0.001). The adapted functional and emotional subscales showed excellent internal consistency. Conclusions: Post-burn recovery extends beyond physical healing. Although most patients regained functional independence, emotional distress and occupational difficulties often persisted. These findings support the need for multidisciplinary long-term burn care integrating physical rehabilitation, psychological screening, and psychosocial support. Full article

This study examines the perceptions of Palestinian Arab students enrolled in teacher training colleges regarding their religious, ethnic, and educational identities and investigates the associations between these identities and life orientation, self-mastery, and self-esteem. In addition, the study evaluates a hypothesized model in which life orientation is posited to mediate the relationship between religious identity, ethnic identity, self-esteem, self-mastery, and educational identity. The research includes a sample of 512 Arab Palestinian Israeli students studying in Israeli teacher training colleges who filled out an online questionnaire. The findings show that participants reported clear and coherent perceptions of their religious, ethnic, and educational identities, along with a generally positive life orientation and moderate levels of self-esteem and self-mastery. Significant correlations were found between the variables. Furthermore, religious and ethnic identity, self-esteem, self-mastery, and life orientation were all directly associated with educational identity. Bias-corrected bootstrap analyses confirmed significant indirect effects through positive life orientation, supporting the hypothesized mediation model. These findings help to illustrate the extent to which the religious and ethnic identities of indigenous multi-religious and multicultural minorities contribute to the growth and development of individuals and advocate for their strengthening, contrary to claims that belittle these identities or call for ignoring and suppressing them. Furthermore, the study underscores the potential role of identity awareness in fostering adaptive psychosocial adjustment and reducing social polarization. Full article

Background: Prenatal diagnosis of life-limiting fetal conditions often leads to counseling focused primarily on therapeutic abortion. Perinatal hospice has emerged as an alternative model of care for families who choose to continue the pregnancy. This paper has two primary aims. First, it discusses structured perinatal hospice programs and their role in supporting parental decision-making after such diagnoses, with attention to ethical and emotional complexities. Second, the paper introduces NOVA-L (Navigating Options & Vital Assistance for Life-limiting conditions), a conceptual Decision Support System (DSS) designed to complement perinatal hospice care. Methods: The paper provides a conceptual and descriptive analysis of the Comfort Care clinical model. It also outlines the proposed architecture of NOVA-L. DSSs combine clinical guidelines, research data, and outcome registries on digital platforms, providing evidence-based information and AI-supported analytical tools. Their potential adaptation to perinatal hospice care is explored. Results: The Comfort Care model involves interdisciplinary counseling, structured communication, and psychosocial support to facilitate clarification of parental values and care pathways. NOVA-L is presented as a complementary tool that may enhance transparency in risk evaluation and option comparison through accessible interfaces under professional supervision. Conclusions: Structured perinatal hospice programs may enhance clarity and compassion in decision-making. The conceptual integration of AI-supported DSS tools, such as NOVA-L, could strengthen ethically grounded, emotionally sensitive parental support. Full article

Background/Objectives: Drooling is a common and clinically relevant issue in children with neurodevelopmental conditions, with important consequences for daily functioning, social participation, and caregiver burden. The lack of validated tools in Italian makes it difficult to quantify the impact of drooling on daily life, support appropriate care pathways, and evaluate the effectiveness of interventions. The aim of this study was to translate, culturally adapt, and evaluate the psychometric properties of the Italian version of the Drooling Impact Scale (DIS) in a pediatric population. Methods: The DIS is a 10-item caregiver-reported outcome measure, with each item rated on an ordinal 0–10 scale, designed to assess the functional and psychosocial impact of drooling. It was translated using a standard forward–backward procedure, followed by expert review and cognitive debriefing with caregivers. Caregivers of children aged ≥2 years with heterogeneous neurodevelopmental conditions and feeding/swallowing impairments were consecutively recruited from a tertiary pediatric hospital. Psychometric properties were assessed in line with COSMIN recommendations, including internal consistency (Cronbach’s α), structural validity through exploratory factor analysis, inter-rater and test–retest reliability (intraclass correlation coefficients, ICC), measurement error (standard error of measurement, SEM; smallest detectable change, SDC), and construct validity through correlation with the Pediatric Quality of Life Inventory (PedsQL). Results: The Italian DIS was completed by caregivers of 126 children. It showed excellent internal consistency (Cronbach’s α = 0.92). Factor analysis indicated a clear dominant factor, explaining 56.5% of the variance, while additional factors contributed only marginally. Agreement between caregivers was excellent (ICC = 0.94), and test–retest reliability was good (ICC = 0.85). Measurement error analysis yielded SEM = 8.66, SDC_individual = 24.00, and SDC_group = 2.14. As expected, DIS scores were associated with health-related quality of life. Conclusions: The Italian version of the DIS appears to be a reliable and structurally sound instrument for assessing the impact of drooling in children with neurodevelopmental conditions. It may be useful in both clinical practice and research, although further studies are needed to explore its responsiveness and confirm these findings in different settings. Full article

Background/Objectives: Despite ongoing innovation, few interventions—including Clinical Decision Support Systems (CDSS)—are successfully integrated into routine care. Understanding the process through which innovations are implemented is therefore essential for advancing practice and research. In perinatal settings, evidence on how CDSS implementation unfolds and which strategies support adoption, scale-up, and sustainment remains limited. This study aimed to understand the implementation process, key determinants and implementation strategies of a shared antenatal psychosocial CDSS (i.e., the Born in Belgium Professionals [BIB-Pro]) implemented in a real-world, cross-sectoral perinatal care setting. Methods: A qualitative exploratory case study was conducted between January and March 2025. Data included semi-structured interviews with all seven implementation agents, document analysis of the implementation plan. Directed content analysis was applied using the Exploration, Preparation, Implementation, Sustainment (EPIS) framework to categorise contextual determinants and the ERIC taxonomy to classify implementation strategies. Data were synthesised across the four EPIS phases. Results: The implementation process unfolded across all EPIS phases, showing a shift in responsibility from the policy level to the implementation team and healthcare organisations. Implementation was shaped by key determinants across multiple levels: (1) the bridging functions by the BIB-Pro implementation agents connecting policy, innovation, and organisational practice; (2) the system-level leadership and funding by the National Institute for Health and Disability Insurance that enabled initiation and sustainability; and (3) the multilevel stakeholder involvement and inter-organisational collaboration across care settings. In addition, the personal attributes of implementation agents—accessibility, active listening, adaptability, and persistent follow-up—were also identified as relevant factors in the implementation process. Across the implementation process, a broad range of implementation strategies was identified. The most prominent ERIC strategies were developing stakeholder interrelationships, evaluative and iterative strategies, engaging stakeholders, training and educating stakeholders, and providing interactive assistance. Barriers encountered during the implementation process included fragmented care networks, inconsistent regional referral structures, legal uncertainties, and variable digital readiness. In response to these challenges, implementation strategies were applied to support collaboration, clarify procedures and provide targeted support. Conclusions: This study provides insight into how a CDSS was introduced, scaled, and sustained across complex multiple Belgian perinatal care settings. Strong bridging functions, stakeholder interrelationships, iterative evaluation, and system-level support were key factors throughout the implementation process. Across all phases, stakeholder interrelationship strategies and evaluative and iterative strategies were the most prominent and consistently applied, supporting stakeholder engagement and sustained use of the platform. These findings offer actionable guidance for implementing digital tools in multi-organisational and multi-level contexts within perinatal care and other healthcare settings. Full article

Introduction: Advances in pediatric oncology have transformed cancer into a condition with chronic and long-term developmental consequences. While survival rates have improved significantly, the literature on psychosocial outcomes remains fragmented and inconsistent, with a notable lack of person-centered analyses that account for the heterogeneity of adaptive trajectories. Current evidence fails to explain why survivors with similar clinical profiles exhibit divergent psychological phenotypes, particularly regarding the late effects of multimodal treatments. The aim of this study was to identify heterogeneous psychosocial profiles among adolescent cancer survivors and to examine their associations with treatment complexity and quality of life. Materials and Methods: This cross-sectional study included 165 adolescents aged 12–18 years (mean age: 14.64 years) who were in clinical remission following oncological treatment. Standardized assessment tools were used: the Children’s Depression Inventory 2 (CDI-2™) to measure depressive symptoms, the KIDSCREEN-10 index to assess health-related quality of life (HRQoL), and a scale evaluating satisfaction across 14 life domains. Adaptive profiles were identified using a Two-Stage Cluster Procedure, and risk factors were examined using multinomial logistic regression. Results: Four clusters were identified in the study population: a depressive–dysphoric profile, an anhedonic-withdrawn profile, a highly adaptive profile, and a mixed (struggling) profile. Treatment complexity was identified as a significant independent predictor of membership in the high-distress (depressive) cluster. While each additional therapeutic modality beyond standard chemotherapy was associated with a markedly increased risk (OR = 8.91; p < 0.001), the relatively wide confidence interval (95% CI: 3.27–24.31) suggests that the exact magnitude of this effect should be interpreted with caution. The high lower bound of the interval (3.27), however, strongly supports the directional association of cumulative iatrogenic burden with psychological adaptation. Subjective quality of life functioned as a protective factor against depressive symptoms (OR = 0.57); however, paradoxically, higher self-reported quality of life increased the likelihood of classification into the anhedonic group (OR = 1.81). This divergence between high self-reported HRQoL and social withdrawal potentially suggests a ‘well-being paradox’. It is hypothesized that standard HRQoL instruments may primarily capture physical remission and relief from acute somatic symptoms, potentially masking underlying social–emotional deficits. This suggests that HRQoL scores in survivors should be interpreted with caution and complemented by specific affective screenings. Conclusions: The absence of a uniform pattern of psychological response to cancer among adolescent survivors supports the validity of a patient-centered approach. The burden associated with intensive multimodal treatment significantly increases the likelihood of full-syndrome depression during adolescence. Moreover, the identification of a cluster suggestive of anhedonic and socially withdrawn features highlights the limitations of standard screening tools focused solely on the detection of overt sadness. This heterogeneity underscores the need for personalized psycho-oncological care and the implementation of intensified monitoring for patients at high medical risk. Full article

Background: Hospital-generated digital health content (HGC) represents an emerging psychosocial influence on young adults’ internalizing trajectories. This study examined how perceived HGC variables may associate with psychological well-being (PWB) through cognitive-behavioral and affective mediators, with neuroticism (NEU) moderating these associations. Methods: In a cross-sectional online survey, 248 Indonesian respondents (born 1997–2012) who regularly consumed HGC completed validated and adapted instruments. The data were analyzed using PLS-SEM. Results: Perceptions of HGC function as key social-cognitive correlates of PWB in emerging adults. Perceived scientific reliability (PSR) and peace of mind (PEM) are positively associated with digital health literacy (DHL), cyberchondria resilience (CYR), and emotional regulation strategies (ERS). Conversely, humanizing value (HMV) is linked with a potential “comfort-without-competence” trajectory. The CYR construct emerged as the primary mediating mechanism for PWB, whereas NEU was found to weaken the positive association between DHL and PWB. Conclusion: These results suggest that HGC is associated with enhanced PWB by facilitating information competence, reducing compulsive health-seeking, and supporting emotional regulation, though emotionally warm formats may be linked with lower literacy development. The personality trait NEU selectively moderates cognitive pathways while leaving affective and behavioral pathways intact, suggesting a need for risk-stratified approaches. By providing clinically screened content that integrates cognitive-behavioral scaffolding, healthcare institutions can support early psychological prevention and self-regulation. Full article

Occupational mental-health risk in knowledge-work settings is an important public-health and psychosocial-support concern because workload demands, career insecurity, limited mentoring, uneven institutional support and barriers to care can increase psychological risk, including in early-career academic environments. Workplace well-being assessments rely on aggregate survey summaries or conventional prediction models, limiting calibration, interpretability, subgroup evaluation and transfer validation. This study develops a computational-intelligence framework for public mental-health decision support using heterogeneous workplace survey data with early-career academics treated as a motivating knowledge-work context rather than as the direct empirical cohort. The proposed approach combines attention-based tabular learning, variational autoencoder latent profiling, stacked ensemble prediction, probability calibration, feature attribution, perturbation analysis, fairness assessment and cross-dataset adaptation. Calibrated probabilities are converted into a transparent 0–100 risk index to support preventive outreach, psychosocial-support planning and resource-allocation decisions. The model is compared with baselines, including logistic regression, support vector machine, random forest, XGBoost, LightGBM, CatBoost, TabNet, FT–Transformer, NODE and DCN. Results show strong held-out performance with AUC = 0.885, average precision = 0.872, F1 = 0.808, Brier score = 0.145 and expected calibration error = 0.022, outperforming tested baselines. Five-fold robustness analysis produced a conservative mean test AUC of $0.809\pm 0.044$, indicating moderate partition sensitivity. Key predictors include work interference, perceived stress, care access and support variables. Latent profiling identifies two behavioural subgroups with distinct risk patterns. After feature harmonization, target-domain adaptation and recalibration, external evaluation on an occupational burnout dataset achieves AUC = 0.941 and average precision = 0.936, supporting calibrated, interpretable and subgroup-aware decision support under dataset shift. Full article