Search Results (254)

Introduction: Functional gastrointestinal disorders (FGIDs), conceptualized as disorders of gut–brain interaction, are among the most common chronic or recurrent conditions in childhood, affecting approximately 20–30% of children worldwide across community and clinical settings. FGIDs are associated with substantial impairments in quality of life, frequent school absences, and high levels of psychological comorbidity, contributing to a considerable burden for families and healthcare systems. Despite their high prevalence, the pathophysiology remains incompletely understood, with evidence pointing to a multifactorial interplay of biological, psychological, and environmental factors. Given their frequency across healthcare settings and their significant psychosocial and economic impact, a better characterization of FGIDs in real-world pediatric populations is needed. This retrospective chart review aimed to examine patterns of FGIDs and their associations with gender, temporal factors, geographic setting, and hospitalization burden in a Swiss pediatric cohort within a biopsychosocial framework. Methods: This retrospective chart review study included 1445 patients aged 0–18 years. Patients were selected based on having received an ICD-10 diagnosis attributed to FGID. The frequency and distribution of the aforementioned factors were determined, as well as their associations with each other. Results: A male predominance of FGIDs in newborns (p < 0.001), a female predominance in adolescents (p < 0.001), and sex-based differences in subtype distribution (p < 0.001) was found in this cohort of patients. A higher proportion of FGID cases were found among children in urban areas than in rural and suburban areas. Infants were hospitalized for significantly longer periods on average than older children and males were hospitalized for longer periods on average than females. Discussion and conclusions: These findings highlight the importance of early, integrated, interdisciplinary care pathways. Given the growing mental health issues affecting adolescent girls and the well-documented bidirectional relationship between emotional stress and FGID symptoms, it is suggested that early psychological screening and family-based interventions could reduce the chronicity of symptoms, prevent unnecessary hospitalizations and improve long-term health outcomes. Full article

Background/Objectives: Interest in mental health research from the Arab world has grown in recent years, yet evidence on effective care remains uneven across subregions. The unique landscape of the Gulf countries underscores the need for culturally responsive psychosocial interventions for these vulnerable populations. This scoping review aimed to map psychosocial interventions for psychosis and schizophrenia that have been evaluated in Gulf countries, including Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates. Methods: Following scoping review methodology and PRISMA-ScR reporting guidance, we conducted systematic searches across five databases (APA PsycINFO, PubMed, Embase, Scopus, and Web of Science). Records were screened using predefined eligibility criteria and grouped thematically based on intervention type. Results: Ten studies met the inclusion criteria, including six English-language studies and four Arabic-language studies. Studies were conducted in Saudi Arabia, Kuwait, Oman, and the United Arab Emirates, with no eligible studies found from Bahrain or Qatar. Intervention types clustered into four categories: psychosocial rehabilitation platforms, social and functional skills interventions, caregiver-focused psychosocial interventions, and transdiagnostic studies. Outcomes, cultural adaptation processes, and methodological reporting varied considerably across studies. Conclusions: The findings highlight gaps in intervention development, evaluation standards, and the reporting of cultural adaptation, which may inform culturally responsive service planning for people with psychosis and schizophrenia across the region. Future studies should use standardized concepts, validated outcome measures, and clearer reporting of cultural adaptation processes to support direct comparisons and improve treatment evaluation across Gulf countries. 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

Dementia affects approximately 55 million people worldwide, yet the psychological experience of diagnosis and the determinants of post-diagnostic well-being remain underexplored relative to biomedical research priorities. The existing literature has been predominantly deficit-oriented, focusing on cognitive decline, neuropsychiatric symptoms, and carer burden, with limited attention to preserved psychological capacities and what supports flourishing following diagnosis. This narrative review applies a positive psychology framework to synthesise evidence on meaning, purpose, hope, and post-diagnostic adjustment in early-stage dementia. A central empirical observation motivating the review: the well-being paradox—subjective well-being in early-to-moderate dementia is frequently higher than carers and clinicians predict. It is also more strongly associated with psychosocial variables than with objective cognitive status. Evidence from the IDEAL (Improving the experience of Dementia and Enhancing Active Life) cohort and related longitudinal research demonstrates that emotional responsiveness, need satisfaction, and capacity for meaning-making are preserved in early-stage dementia and constitute clinically relevant assets. Four positive psychology constructs are identified as evidence-based targets for intervention: hope, self-compassion, social identity, and meaningful engagement. Clinical implications include integrating strengths-based assessment, meaning-centred group interventions, structured peer support, and validated positive outcome measures into post-diagnostic care pathways. Health equity considerations and research priorities are addressed, including the underrepresentation of minority ethnic communities and people with young-onset dementia in existing research. The review argues that meaningful progress requires deliberate reorientation of clinical, commissioning, and research priorities toward a positive psychology framework for dementia care. Full article

Background/Objectives: Scabies is a contagious dermatological infestation that can cause not only physical symptoms but also considerable psychosocial burden. This study aimed to investigate the relationships between fear of scabies, internalized stigma, and dermatology-related quality of life in patients with scabies. Methods: This cross-sectional study included 131 patients diagnosed with scabies in a dermatology outpatient clinic. Data were collected using a structured questionnaire including sociodemographic and clinical characteristics, the Fear of Scabies Scale (FSS), the Internalized Stigma Scale (ISS), and the Dermatology Life Quality Index (DLQI). Correlation and regression analyses were conducted to examine the associations between fear of scabies, internalized stigma, and quality of life. Results: The mean DLQI score was 15.82 ± 5.69, indicating a considerable impairment in dermatology-related quality of life. Fear of scabies showed a weak but significant positive correlation with DLQI scores (r = 0.326, p < 0.001), whereas internalized stigma demonstrated a stronger correlation (r = 0.484, p < 0.001). Among the stigma subdimensions, social withdrawal showed the strongest association with impaired quality of life (r = 0.622, p < 0.001). Regression analyses revealed that internalized stigma explained 23% of the variance in DLQI scores (R² = 0.234), while fear of scabies explained 10% (R² = 0.106). In addition, longer symptom duration (β = 0.708, p < 0.001), nocturnal pruritus (β = 0.408, p = 0.009), and visible skin lesions (β = 0.263, p = 0.002) were associated with higher levels of fear of scabies. Conclusions: Internalized stigma and disease-related fear were associated with reduced quality of life, with stigma-related mechanisms appearing to play a particularly prominent role. These findings suggest that addressing stigma and providing psychosocial support may be important components of comprehensive scabies management. Full article

Background: Adolescents with type 1 diabetes (T1D) face considerable psychosocial demands that may increase vulnerability to diabetes-specific disordered eating behaviors. This study investigated the relationships among diabetes-specific disordered eating behaviors, social anxiety, social appearance anxiety, and psychological resilience in adolescents with T1D. Methods: This cross-sectional and correlational study included 176 adolescents diagnosed with T1D. Data were obtained using the Diabetes Eating Problem Survey-Revised (DEPS-R), the Social Anxiety Scale for Adolescents (SAS-A), the Social Appearance Anxiety Scale (SAAS), and the Child and Youth Resilience Measure (CYRM-12). Results: The mean age was 14.16 ± 2.73 years; 51.1% were male, and 63.1% had a disease duration of ≥3 years. Elevated levels of diabetes-specific disordered eating behaviors were observed in 85.8% of participants. Mean scores were 36.06 ± 15.26 (DEPS-R), 58.86 ± 12.90 (SAS-A), 48.82 ± 12.09 (SAAS), and 35.17 ± 10.61 (CYRM-12). Disordered eating behaviors showed positive correlations with social anxiety and social appearance anxiety and negative correlations with psychological resilience (all p < 0.001). Regression analyses indicated that social anxiety remained independently associated with disordered eating behaviors, whereas social appearance anxiety and psychological resilience did not. Psychological resilience was inversely related to both anxiety measures. Conclusions: Diabetes-specific disordered eating behaviors are common in adolescents with T1D and are closely linked to social anxiety-related factors. Social anxiety appears to be a key associated variable. Although psychological resilience was not independently related to disordered eating behaviors, it showed inverse associations with social anxiety. These findings support integrating routine psychosocial screening and targeted interventions into multidisciplinary diabetes care. Full article

Pediatric gastrointestinal polyps are frequently associated with an underlying hereditary syndrome associated with multisystem manifestations and increased risk of early-onset cancer. Thus, the identification of polyps in a child should prompt evaluation with genetic testing to (1) characterize the syndrome to determine next clinical steps including surveillance recommendations, and (2) conduct cascade testing to identify affected family members. Given the considerations for pediatric genetic testing, including autonomy and psychosocial stressors associated with the early detection of a cancer risk syndrome, it is important to conduct targeted testing. Herein, we propose a stepwise approach to genetic testing in the pediatric patient with gastrointestinal polyps. Full article

Breast implants are among the most frequently used long-term implantable medical devices in aesthetic and reconstructive surgery. In addition to correcting anatomical deficits, they have significant psychosocial effects, influencing body image, self-esteem, and quality of life, particularly in patients undergoing postmastectomy reconstruction. This review provides a comprehensive overview of the historical development, biological interactions, material characteristics, and clinical outcomes of breast implants. Early reconstructive attempts using foreign materials and injectable substances were associated with severe complications, underscoring the need for safer technologies. The introduction of silicone gel implants in the 1960s marked a pivotal advancement, followed by the development of saline-filled devices and highly cohesive silicone gels with enhanced mechanical stability. Key surgical considerations, including incision type and implant placement plane (subglandular, submuscular, dual-plane, and subfascial), are discussed in relation to aesthetic outcomes and complication risk. Emphasis is placed on the implant–tissue interface and the foreign body response (FBR), a process involving protein adsorption, immune cell activation, fibrous capsule formation, and potential chronic inflammation. Persistent inflammatory stimulation, often associated with bacterial biofilm formation, contributes to capsular contracture, the most common long-term complication. Additional adverse events include implant rupture, silicone gel bleed, granulomatous reactions, infection, hematoma, implant malposition, and rare but clinically significant conditions such as breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). The review also summarizes implant classification according to construction, filling material, shape, and surface topography, highlighting the influence of surface characteristics on host response and clinical outcomes. Advances in biomaterials, cohesive gel formulations, and surface engineering aim to enhance biocompatibility and long-term safety, supported by standardized mechanical and biological testing protocols. Full article

Diabetes Mellitus is a chronic metabolic disorder characterized by elevated blood glucose due to defects in insulin secretion or action, or both, leading to serious short- and long-term complications if not effectively managed. However, there is limited qualitative evidence exploring how youths diagnosed with Type 1 Diabetes Mellitus (T1DM) experience disease onset, management, complications, emotional adaptation, and education within the South African public healthcare system. The study aims to investigate the lived experiences of youths living with T1DM in a selected public hospital in Limpopo province, South Africa. The objectives were to explore and describe the lived experiences of youths living with T1DM. A qualitative, explorative, descriptive, and contextual design was used to gain a thorough understanding of the experiences of youths living with T1DM. A non-probability sampling technique was used to select 12 participants using a pre-determined criterion. Data were collected through individual semi-structured interviews using an interview guide. The data were analyzed using Colaizzi’s method, where themes and sub-themes were developed with the inclusion of an independent coder. Measures to ensure trustworthiness and ethical considerations were adhered to throughout the study. The findings revealed that, despite the participants sharing the same diagnosis, they experience multiple interrelated barriers that significantly hindered effective self-care management, such as limited access to diabetic diet, glucometers and supplies, treatment and informational-related barriers, school-related challenges, transportation constraints and inadequate social support. Furthermore, the findings highlighted gaps in early recognition of symptoms, standardized diabetes education, psychosocial support, and continuity of care. The study recommends the need for holistic, patient-centred, and contextualized interventions that do not only address medical management but the socioeconomic, educational, and psychological needs of youths. Full article

Chronic obstructive pulmonary disease (COPD) imposes a substantial physical and psychosocial burden, yet the role of loneliness remains under-recognised in clinical practice. Loneliness, defined as a subjective discrepancy between desired and actual social relationships, has emerged as a clinically relevant determinant of patient outcomes. This narrative review synthesises current evidence on the epidemiology, mechanisms, and clinical consequences of loneliness in COPD, and evaluates its implications for disease management. Available evidence indicates that loneliness affects a considerable proportion of individuals with COPD, with prevalence estimates ranging from approximately 18% to over 30%, particularly among patients with greater symptom burden, functional limitation, and oxygen dependence. Dyspnoea and advancing disease severity reduce social participation and increase vulnerability to perceived social disconnection. Loneliness influences COPD outcomes through interconnected behavioural, biological, and healthcare engagement pathways, including systemic inflammation, neuroendocrine stress responses, physical inactivity, impaired self-management, and reduced engagement with healthcare services. These mechanisms contribute to poorer clinical trajectories, as loneliness is consistently associated with reduced health-related quality of life, increased exacerbations, higher healthcare utilisation, greater risk of hospitalisation, and elevated mortality, independent of depression and anxiety. Despite this, loneliness is rarely assessed in routine respiratory care, and targeted interventions remain limited. Emerging strategies, including pulmonary rehabilitation, peer support, and digital health interventions, show promise in reducing loneliness and improving outcomes. Loneliness represents a modifiable and clinically actionable risk factor in COPD, and its integration into routine assessment and management may enhance patient engagement, optimise treatment effectiveness, and reduce healthcare burden. Addressing loneliness represents a critical opportunity to advance more effective and comprehensive COPD care. Full article

Background/Objectives: Food and nutritional insecurity (FNI) is a major social determinant of health that disproportionately affects older adults, with significant implications for their health, nutrition, and well-being. In this context, this scoping review aims to map and synthesize the available scientific evidence on the main determinants of FNI among older adults, considering socioeconomic, health-related, functional, psychosocial, and structural factors. Methods: A scoping review was conducted in accordance with the Joanna Briggs Institute methodology and reported following the PRISMA-ScR guidelines. A comprehensive search was performed across eight databases (PubMed/MEDLINE, EMBASE, Scopus, Web of Science, CINAHL, LILACS, ProQuest, and Google Scholar), up to November 2024. Original studies addressing FNI in individuals aged ≥60 years were included. Study selection and data extraction were conducted independently by two reviewers, with disagreements resolved by consensus. Results: Of 5897 records identified, 15 studies met the inclusion criteria. FNI in older adults was described as a multifactorial phenomenon associated with low income, limited education, social isolation, widowhood, chronic diseases, functional limitations, depressive symptoms, and poor housing conditions. Structural determinants, including institutional racism, gaps in social protection systems, and barriers to accessing food assistance programs, were also reported. Considerable heterogeneity in measurement instruments highlights the complexity of assessing FNI in this population. Conclusions: Addressing FNI in older adults requires moving beyond isolated interventions toward integrated, intersectoral strategies that tackle its underlying social and structural drivers. Strengthening social protection systems, reducing access barriers, and promoting equity-oriented policies are essential to ensure adequate nutrition and support healthy and dignified aging. Full article

Background: People living with HIV (PLWH) are increasingly reaching older ages due to the success of antiretroviral therapy. However, aging with HIV is associated with increased risk of multimorbidity, neurocognitive impairment, frailty, psychosocial stress, and functional decline. Multidomain geriatric screening framed within an Age-Friendly 4Ms Framework (Mentation, Medication, Mobility, What Matters Most) and consideration of multi-complexity may help identify aging-related vulnerabilities and guide multidisciplinary care with greater impact on patient outcomes. However, real-world implementation of such programs within HIV clinical settings remains limited. Methods: We conducted a retrospective analysis of adults aged ≥50 years enrolled in a multidisciplinary Healthy Aging Program within a large, integrated HIV care system. Multidomain screening assessments included cognitive evaluation (Montreal Cognitive Assessment), mental health screening (PHQ-2, GAD-2), functional assessment (Katz ADL, Lawton IADL), frailty screening (Edmonton Frail Scale), and intrinsic capacity domains using the WHO Integrated Care for Older People (ICOPE) framework. Screening results, referrals, clinical interventions, and cardiometabolic risk management measures were extracted from clinical program databases and electronic medical records. Results: A total of 317 adults aged ≥50 years completed multidomain screening. Participants had well-controlled HIV infection, with viral suppression in 96.2% and a median CD4 count of 660 cells/mm³. Despite this, aging-related vulnerabilities were common. Overall, 78.4% of participants had at least one abnormal screening domain. Cognitive impairment was identified in nearly half of individuals screened, including mild impairment in 39.8% and moderate impairment in 8.7%. Functional limitations were identified in 10.1% of participants, while anxiety symptoms were present in 9.5%. Sensory impairments were common, including vision impairment in 36.5% of participants. Polypharmacy was prevalent, with 33.2% of participants prescribed five or more chronic medications. Screening frequently generated multidisciplinary referrals, including behavioral health services (42.3%), social work support (42.9%), and pharmacist-led cardiometabolic risk review (56.8%). Age-stratified analyses demonstrated similar prevalence of screening abnormalities across age groups, including individuals aged 50–59 years. Modest improvements in cardiometabolic preventive care were observed during follow-up. Statin utilization increased from 65.6% at baseline to 70.0% at 12 months, and LDL cholesterol declined modestly during the observation period. Conclusions: Multidomain screening integrated into routine HIV care identified a high prevalence of aging-related vulnerabilities among PLWH aged ≥50 years despite excellent virologic control. These findings suggest that aging-related risk in HIV is not adequately captured by chronological age alone and support early, universal implementation of multidomain screening within HIV care models. Full article

As a significant manifestation of interaction between building occupants and the built environment, adaptive shading adjustment behavior exerts a substantial influence on building energy consumption and indoor lighting and thermal environments. Existing reviews either focus on generalized occupant behavior or were published relatively early, lacking a systematic and up-to-date synthesis specifically addressing adaptive shading adjustment behavior. Through a comprehensive analysis of 68 core articles retrieved from the SCOPUS database and Web of Science database, this review summarizes major research advances, including testing methods for adaptive shading adjustment behavior, analysis of its driving factors, modeling and simulation approaches, and its impacts on energy consumption and indoor lighting and thermal environments. Furthermore, this review identifies limitations in current research, such as limited sample sizes, insufficient consideration of psychosocial factors, and the need for further validation of model generalizability. Future research directions are also proposed, aiming to provide a reference for in-depth investigations into adaptive shading adjustment behavior in buildings. Full article

Breast reconstruction represents an integral component of contemporary breast cancer management, with substantial impact on patients’ psychological well-being, body image, and overall quality of life. Given the profound symbolic and personal significance of the breast, mastectomy—whether total or partial—extends beyond oncologic resection and may result in considerable aesthetic, functional, and psychosocial consequences. For this reason, reconstructive planning should be incorporated into the initial multidisciplinary treatment strategy while ensuring that oncologic safety and adjuvant therapies are never compromised. Breast reconstruction may be achieved using autologous tissue, implant-based techniques, or a combination of both approaches. Each method carries specific advantages, limitations, and potential complications and must be tailored to the individual patient’s oncologic status, anatomy, and expectations. This article provides a historical overview of the evolution of breast cancer treatment and reconstructive techniques. It further examines the principles, benefits, and challenges associated with different reconstructive modalities, highlighting key considerations in clinical decision-making and long-term outcomes. 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