Search Results (252)

Background and Clinical Significance: Juvenile ossifying fibroma (JOF) is a rare, benign, but locally aggressive fibro-osseous neoplasm that primarily affects the craniofacial skeleton of children and adolescents. Early surgical intervention is often required due to the lesion’s rapid growth and potential for significant facial deformity. Long-term functional and esthetic rehabilitation following maxillary resection in early childhood remains a clinical challenge. Case Presentation: This case reports a unique long-term follow-up of a 22-year-old female patient who underwent partial maxillary resection at the age of five due to JOF. Initial reconstructive efforts failed, necessitating a removable prosthesis to restore function and appearance. The patient experienced persistent self-consciousness and social withdrawal during adolescence, attributed to altered facial esthetics and repeated surgical disappointment. Nevertheless, prosthetic rehabilitation significantly improved mastication, phonetics, facial symmetry, and psychological well-being. Conclusions: The enduring psychosocial and functional impact of early maxillary resection for JOF and the pivotal role of prosthodontic management in long term rehabilitation are highlighted. A multidisciplinary approach that includes psychological support is suggested. This case report is among the few reports documenting long-term prosthetic outcomes for pediatric JOF patients extending into adulthood. Full article

Marked by a highly diverse workforce, the Indian construction industry faces ongoing challenges in fostering employee engagement and minimizing organizational withdrawal. This study examines the role of diversity climate in influencing psychological and physical withdrawal behaviors among construction professionals, assessing job satisfaction as a mediating variable. Grounded in Social Exchange Theory, the research employed a quantitative survey approach, gathering responses from 318 professionals across the sector. Partial least squares structural equation modeling (PLS-SEM) was used to test the hypothesized relationships. Results indicate that reduced psychological (β = –0.462, f² = 0.465, p < 0.01) and physical withdrawal (β = –0.311, f² = 0.194, p < 0.05) are associated with more positive perceptions of the diversity climate. Furthermore, this relationship is partially mediated by job satisfaction, with diversity climate positively influencing job satisfaction (β = 0.618, p < 0.001), which in turn reduces withdrawal tendencies (indirect effect on psychological withdrawal β = −0.094, p < 0.01 and physical withdrawal β = −0.068, p < 0.01). These results show that encouraging a supportive diversity climate not only helps but is also absolutely necessary for enhancing job satisfaction, lowering withdrawal behavior, and retaining trained talent. The findings offer concrete evidence that construction firms and policymakers should prioritize inclusive human resource strategies that directly improve project outcomes, reduce attrition, and enhance workforce engagement in the Indian construction sector. Full article

The research analyzed the cognitive styles, sexist attitudes and social competencies that hinder gender equality in secondary education students. It identified sexist attitudes, cognitive styles and social skills that hinder change towards gender equality; explored significant differences in sexist attitudes and cognitive strategies and social attitudes by age; studied the relationship between sexist attitudes and cognitive and social strategies that perpetuate gender inequality; and analyzed how age may predict the use of these strategies. A total of 1034 students aged 11 to 18 participated in a cross-sectional study. The Ambivalent Sexism Inventory for Adolescents and the Questionnaire of Attitudes and Cognitive Social Strategies were administered. The results indicate that young people exhibit moderate levels of cognitive and social strategies that hinder the change in sexist behaviors. At ages 12–14, the acceptance of ambivalent and benevolent attitudes such as paternalism and heterosexual intimacy increases. We found greater aggressiveness–stubbornness, apathy–withdrawal, impulsivity, and rigidity of thought at ages 15–17. Age explains a small proportion of the variance in sexist attitudes, cognitive styles, and social competencies that hinder gender equality. The study highlights the need for coeducational measures that ensure equal cognitive and socio-emotional development in women and men. Full article

Iraq has faced escalating water scarcity over the past two decades, driven by climate change, upstream water withdrawals, and prolonged economic instability. These factors have caused deterioration in irrigation systems, inefficient water distribution, and growing social unrest. As per capita water availability falls below critical levels, Iraq is entering a period of acute water stress. This escalating water scarcity directly impacts water and food security, public health, and economic stability. This study aims to develop a general framework combining decision support systems (DSSs) with Integrated Comprehensive Water Management Strategies (ICWMSs) to support water planning, allocation, and response to ongoing water scarcity and reductions in Iraq. Implementing such a system is essential for Iraq to alleviate its continuing severe situation and adequately tackle its worsening water scarcity that has intensified over the years. This integrated approach is fundamental for enhancing planning efficiency, improving operational performance and monitoring, optimizing water allocation, and guiding informed policy decisions under scarcity and uncertainty. The current study highlights various international case studies that show that DSSs integrate real-time data, artificial intelligence, and advanced modeling to provide actionable policies for water management. Implementing such a framework is crucial for Iraq to mitigate this critical situation and effectively address the escalating water scarcity. Furthermore, Iraq’s water management system requires modifications considering present and expected future challenges. This study analyzes the inflows of the Tigris and Euphrates rivers from 1933 to 2022, revealing significant reductions in water flow: a 31% decrease in the Tigris and a 49.5% decline in the Euphrates by 2021. This study highlights the future 7–20% water deficit between 2020 and 2035. Furthermore, this study introduces a flexible, tool-based framework supported by a DSS with the DPSIR model (Driving Forces, Pressures, State, Impacts, and Responses) designed to address and reduce the gap between water availability and increasing demand. This approach proposes a multi-hazard risk matrix to identify and prioritize strategic risks facing Iraq’s water sector. This matrix links each hazard with appropriate DSS-based response measures and supports scenario planning under the ICWMS framework. The proposed framework integrates hydro-meteorological data analysis with hydrological simulation models and long-term investment strategies. It also emphasizes the development of institutional frameworks, the promotion of water diplomacy, and the establishment of transboundary water allocation and operational policy agreements. Efforts to enhance national security and regional stability among riparian countries complement these actions to tackle water scarcity effectively. Simultaneously, this framework offers a practical guideline for water managers to adopt the best management policies without bias or discrimination between stakeholders. By addressing the combined impacts of anthropogenic and climate change, the proposed framework aims to ensure rational water allocation, enhance resilience, and secure Iraq’s water strategies, ensuring sustainability for future generations. Full article

Background/Objectives: The co-occurrence of Attention-deficit/hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD) is very common and worsens adaptive functioning. This systematic review evaluates both pharmacological and non-pharmacological interventions in this underserved population. Methods: Registered on PROSPERO (CRD42024526157), a systematic search was conducted on PubMed, Embase, and Web of Science until 5 April 2025. The review includes (a) pilot studies and RCTs, (b) participants aged <18 years, (c) diagnoses of ASD and ADHD based on DSM-IV/V or ICD-9/10, (d) at least one group receiving any intervention, and (e) publications in English, Italian, Spanish, or German. Newcastle Ottawa Scale tools for non-randomized studies and the Cochrane Risk of Bias Tools for randomized controlled trials were used to assess studies’ quality. Results: A total of 32 studies were included: 87.5% concerning pharmacological treatments. Specifically, methylphenidate (MPH, n = 11), atomoxetine (ATX, n = 11), guanfacina (n = 4), clonidine (n = 1), or atypical antipsychotics (n = 1) were examined. MPH and ATX were most frequently studied, with both showing positive effects in reducing ADHD core symptoms compared to placebo. ATX also reduces stereotyped behaviors and social withdrawal, although more withdrawals due to adverse events (AEs) were reported for ATX than MPH. Four studies (12.5%) examined non-pharmacological interventions, including treatment with virtual reality tools, digital platforms, educational animations, and biomedical protocols; improvements in emotion recognition, behavioral regulation, attention, and social functioning were found. Conclusions: While limited data prevent definitive conclusions, MPH and ATX appear to be relatively safe and effective on hyperactivity-impulsivity symptoms, even in individuals with ASD. Evidence on non-pharmacological treatments is limited, and further studies are needed to better establish their therapeutic potential. Full article

Background: Stigma is a pervasive, though understudied, psychosocial factor affecting people with multiple sclerosis. This review synthesizes the literature on the impact of perceived, enacted, and internalized stigma on psychological health and illness identity in PwMS. Methods: A comprehensive narrative review approach was adopted, integrating findings from peer-reviewed quantitative and qualitative studies. Databases including PubMed, PsycINFO, and Scopus were searched using combinations of terms such as “multiple sclerosis”, “stigma”, “internalized stigma”, “mental health”, and “illness identity”. Studies were included if they reported on stigma-related outcomes in PwMS, discussed psychological or identity variables, or examined interventions aimed at reducing stigma or enhancing adaptive identity. The analysis focused on thematic synthesis, identifying recurrent findings, mediating mechanisms, and clinical implications. Results: Stigma in MS is consistently linked to higher depression, anxiety, and lower quality of life. Internalized stigma disrupts illness identity, often fostering engulfment and rejection of the self. Psychological mediators—such as cognitive fusion, diminished self-compassion, and weakened sense of coherence—amplify these outcomes. Particularly vulnerable are individuals with progressive disease, severe disability, minority status, or limited social support. A recursive loop emerges: stigma triggers psychological distress, which increases stigma awareness and social withdrawal. In addition to traditional psychological interventions, several emerging approaches have shown promise in reducing internalized stigma and fostering adaptive identity integration. Conclusions: Stigma is a central factor in emotional suffering and identity fragmentation in PwMS. Integrative, narrative-informed, and culturally sensitive interventions are essential to reduce stigma and foster resilience. Future research should prioritize longitudinal, mixed-method approaches to develop effective, scalable solutions. Full article

With increasing substance misuse among older adults, we examined the question of whether older adults may be less likely to endorse certain DSM-5 criteria for alcohol and cannabis use disorders (AUD and CUD). We used the 2021–2023 National Surveys on Drug Use and Health (N = 17,494 for AUD and N = 12,264 for CUD) and descriptive statistics to compare the 65+ and under 65 age groups in their endorsements of 11 DSM-5 criteria. A multivariable logistic regression model was fitted for each criterion as the dependent variable with the age group as the independent variable and other characteristics as covariates. For AUD, the 65+ age group was associated with lower odds of endorsing seven out of eleven DSM-5 criteria, including social impairments (e.g., failure to fulfill role obligations (aOR = 0.30, 95% CI = 0.16–0.56); social problems (aOR = 0.46, 95% CI = 0.30–0.71); given-up activities (aOR = 0.66, 95% CI = 0.47–0.94); hazardous use (aOR = 0.53, 95% Yes CI = 0.34–0.81); and physical/psychological problems (aOR = 0.51, 95% CI = 0.37–0.70). For CUD, the 65+ age group was less likely than the under 65 age group to endorse hazardous use (aOR = 0.04, 95% CI = 0.01–0.17) and withdrawal (aOR = 0.39, 95% CI = 0.20–0.73 for criterion A and aOR = 0.16, 95% CI = 0.05–0.48 for criterion B). Clinicians should be aware that older adults might not express the full range of symptoms in the same way as the younger age groups. A more nuanced understanding of older adults’ social context may be needed for accurate diagnosis. Full article

Objectives Depression is characterized by a lack of energy, social withdrawal, and fatigue, and it is also associated with increased inflammation in the brain. Some studies suggest that adropin may have anti-inflammatory effects and could reduce the inflammatory processes contributing to depression. Methods: We included 54 newly diagnosed patients experiencing their first episode of depression and 56 healthy volunteers in this study. The participants with depression were divided into three subgroups based on DSM-5 and BDI-II criteria. The focus of the study was to compare adropin levels between depressive patients and healthy volunteers, as well as to monitor changes in adropin levels after six months of treatment for depressive patients. Results: Initial measurements showed no significant differences in standard laboratory parameters or adropin levels between the depression and control groups. However, adropin and vitamin D levels increased in the group of depressive patients during the six-month follow-up. Conclusions: Our research indicates that adropin plays a significant role in the development of depression and may influence the effectiveness of depression treatments. Full article

Alcoholic beverages play a significant role in social engagement worldwide. Excessive alcohol causes a variety of health complications. Alcohol-induced liver disease (ALD) is responsible for the bulk of linked fatalities. The activation of immune mechanisms has a crucial role in developing ALD. No effective medication promotes liver function, shields the liver from harm, or aids in hepatic cell regeneration. Alcohol withdrawal is one of the most beneficial therapies for ALD patients, which improves the patient’s chances of survival. There is a crucial demand for safe and reasonably priced approaches to treating it. Exploring naturally derived phytochemicals has been a fascinating path, and it has drawn attention in recent years to modulators of inflammatory pathways for the prevention and management of ALD. In this review, we have discussed the roles of various immune mechanisms in ALD, highlighting the importance of intestinal barrier integrity and gut microbiota, as well as the roles of immune cells and hepatic inflammation, and other pathways, including cGAS-STING, NLRP3, MAPK, JAK-STAT, and NF-kB. Further, this review also outlines the possible role of phytochemicals in targeting these inflammatory pathways to safeguard the liver from alcohol-induced injury. We highlighted that targeting immunological mechanisms using phytochemicals or herbal medicine may find a place to counteract ALD. Preclinical in vitro and in vivo investigations have shown promising results; nonetheless, more extensive work is required to properly understand these compounds’ mechanisms of action. Clinical investigations are very crucial in transferring laboratory knowledge into effective patient therapy. Full article

Objectives: Hikikomori is a condition characterized by extreme social withdrawal, functional impairment, and mental distress, which has gained increasing recognition worldwide. While it can be associated with comorbid psychiatric disorders, hikikomori shares similarities with autism spectrum, prompting investigations into their relationship. Given that hikikomori commonly manifests in early adulthood, this study aimed to explore the relationship between autistic features and hikikomori tendencies among university students. Methods: A total of 2037 university students were recruited via an online survey and assessed with the Adult Autism Subthreshold (AdAS) Spectrum and the Hikikomori Questionnaire (HQ-25). Participants were categorized into four groups: healthy controls (HCs), subjects with hikikomori tendencies (HKs), subjects with significant autistic traits (ATs), and subjects with both significant ATs and hikikomori tendencies (AT-HKs). Results: Results showed significant effects of both hikikomori presence and significant ATs on AdAS Spectrum and HQ-25 scores, while a significant effect of their interaction was detected on AdAS Spectrum scores. The AT-HK group consistently scored higher on both AdAS Spectrum and HQ-25 compared to other groups, with the AT and HK groups outperforming HCs in specific domains. HQ-25 Socialization and Isolation domains predicted higher AdAS Spectrum scores in hikikomori subjects, while various AdAS Spectrum domains served as predictors of HQ-25 scores in AT subjects. Conclusions: This study highlights a significant relationship between ATs and hikikomori tendencies in university students, suggesting that their comorbidity may represent a more severe phenotype, where each condition may exacerbate the other. Full article

Background/Objectives: This study identifies barriers to maternal and child healthcare access in Afghanistan under the Taliban and proposes solutions using the WHO Health System Building Blocks Framework. Methods: Midwives and mothers were recruited via chain-referral sampling. After obtaining IRB and the participants’ informed consent, in-depth virtual interviews, guided by Social Cognitive Theory, were recorded, transcribed, and analyzed using content analysis in MAXQDA 2020. Results: Data analysis revealed four primary consequences of the political unrest in Afghanistan that have exacerbated barriers to accessing maternal and child healthcare: (a) Taliban-imposed restrictions on women’s education and mobility, reducing female healthcare providers and limiting mothers’ access to care; (b) increased poverty, preventing women from attending perinatal visits due to out-of-pocket costs; (c) the deterioration of healthcare services, including medicine shortages, weakened health financing due to donor withdrawals, lack of insurance, and poor governance; and (d) the increased perpetuation of misinformation and harmful practices, such as the use of clergymen for medical advice instead of doctors. Using the WHO Health Systems Framework, we recommend solutions that address issues in service delivery, health workforce, health information systems, access to essential medicines, financing, and governance. Conclusions: This is the first qualitative study capturing Afghan mothers’ and healthcare providers’ experiences under Taliban rule. Our findings can inform international efforts to advocate for women’s healthcare and education rights and guide global aid programs in strengthening Afghanistan’s healthcare system in alignment with Sustainable Development Goal 5. Full article

Background/Objectives: The search for non-therapeutic ways to reduce emotional and behavioral symptoms is an important task. The aim of this study was to assess the potential of pretend play and art-based project activity as easily implementable ways to reduce anxiety, aggression, and anti-social behavior in preschoolers. Methods: A total of 36 preschoolers (mean age 68.7 months) with high anxiety–withdrawal level were selected and divided into four groups: adult-supported pretend play, free pretend play, project activity, and a control group. Each group had 20 sessions, lasting 20–25 min. Pre- and post-test included the assessment of anxiety–withdrawal, anger–aggression, and social competence. Executive functions were also assessed at the pre-test as a control variable. Results: The results showed that art-based project activities reduced anxiety–withdrawal in preschoolers. Pretend play, both with and without adult involvement, did not have a significant effect. No significant changes were found for anger–aggression and social competence. Results revealed that the level of executive functions was a significant predictor of the reduction in anxiety–withdrawal. Conclusions: The study specified the role of executive functions in emotional symptoms and showed the potential of art-based project activities to reduce anxiety. The results obtained can be implemented in kindergarten practice. Full article

Background: This study examined shifts in the productivity and efficiency of Opioid Substitution Treatment (OST) units in Greece from 2019 to 2022. OST units address withdrawal symptoms in individuals discontinuing psychoactive substances. They also offer mental health care, primary healthcare, psychosocial support, and other integrated services, aiming to provide holistic addiction treatment and promote social reintegration. Methods: We assessed the contributions of 54 OST units addressing opioid addiction using non-parametric Malmquist Data Envelopment Analysis (DEA). Data were collected from all OST units operating in Greece during this period, with a focus on key external factors such as the COVID-19 pandemic and rising global trends in stimulant and synthetic opioid use. Results: The analysis revealed a productivity decline in 2020, followed by improvements in the next two years. However, technical efficiency declined, suggesting a decrease in resource utilization. Conclusions: This dip in efficiency likely reflects the impact of emerging drug trends, particularly stimulants and synthetic opioids, which lack standardized treatment protocols. These findings highlight the urgent need for new treatment options to address evolving addiction trends. The study also underscored the need for improved data collection and monitoring to optimize resource allocation and enhance operational efficiency in OST units. Strengthening evidence-based policies and expanding access with low-threshold treatment services could improve patient outcomes and the overall effectiveness of OST programs. Full article

In recent years, some college graduates in China have chosen to postpone or avoid employment due to the disparity between their career expectations and the reality of the job market, leading to the emergence of a group of graduates not in employment, education, or training (NEETs). As the number of individuals in this group continues to grow, exploring effective strategies to mitigate such behavior has become increasingly important. Based on self-determination theory, this study conducted an empirical analysis using a multi-wave questionnaire survey with a sample of 226 graduate NEETs in Shanghai, China. The findings indicate that (1) career expectations do not directly reduce social withdrawal behavior; (2) the mere accumulation of human capital is insufficient to decrease social withdrawal—only when knowledge and skills are further transformed into problem-solving ability does an individual’s tendency toward social withdrawal significantly decline; and (3) human capital and problem-solving ability serve as a sequential mediating mechanism between career expectations and social withdrawal behavior. This study expands the research on the formation mechanisms of social withdrawal behavior and elucidates the proactive adaptation pathways in individuals’ career adjustment processes. The findings provide theoretical insights for higher education institutions to shift from traditional knowledge transmission models toward a greater emphasis on problem-solving ability development. Full article

Hikikomori is a form of social withdrawal lasting more than 6 months with significant associated functional impairment. To date, numerous studies confirm the presence of this condition not only in Japan, where it was first described, but also globally abroad. This is an underestimated clinical condition, and it is emerging especially in adolescents and young adults, representing an increasing management problem for families and society. Prevalence ranges from 1.1% to 6.7%. Hikikomori can be associated with other neurodevelopmental disorders, such as Autism Spectrum Disorder (ASD). Indeed, ASD and hikikomori share numerous characteristics confirmed by functional neuroimaging studies that have highlighted in both conditions the presence of alterations in cerebral regions related to social functioning. We present a case report regarding the history of a 14-year-old girl with characteristics compatible with ASD and hikikomori. At present, there are no specific treatments approved for hikikomori in ASD patients. Further studies are necessary to understand the link between the two conditions, the boundary, and possible overlap. Full article