Search Results (158)

Background/Objectives: Mental health problems are common among university students and are more consistently associated with dissatisfaction with academic performance than with low grades alone. This study examined the prevalence and determinants of perceived stress, depressive symptoms, and low psychological well-being among university students in Punjab, Pakistan, and assessed their association with academic performance. Methods: A cross-sectional survey was conducted among students aged 15 to 29 years at three public universities in Punjab, Pakistan. A total of 1308 questionnaires were completed, yielding a response rate of 91.4%. This study uses data collected in 2015 as a pre-COVID historical baseline, providing valuable insights into student mental health before the global pandemic. This temporal context offers a benchmark for future comparative studies, especially when assessing the mental health impact of COVID-19 on university students. Data were analyzed using SPSS with descriptive statistics, chi-square tests, binary logistic regression, and multinomial logistic regression. Results: The findings revealed that perceived stress and depressive symptoms were prevalent, with 54.9% of students reporting high levels of stress (mean PSS score = 27.6, SD = 8.3), and 44.2% experiencing depressive symptoms (mean M-BDI score = 33.8, SD = 16.2). Female students exhibited higher stress and depressive symptoms compared to male students. Year of study was also a factor, with second- and third-year students experiencing more stress than their final-year counterparts (p < 0.05). Financial strain was associated with poorer mental health outcomes; 62% of students who reported inadequate financial support also reported higher stress levels (p < 0.05). In contrast, students with sufficient financial resources had lower odds of experiencing stress and depressive symptoms (AOR = 0.55, p < 0.05). Additionally, students living in university or private hostels reported better psychological well-being than those living at home (AOR = 0.47, p < 0.01). Mental health issues, particularly high stress and depression, were more strongly linked with academic dissatisfaction than low grades alone, with students in the “low grades and unsatisfied” group exhibiting higher odds of mental health problems (AOR = 2.30, p < 0.05). Conclusions: Mental health problems were common among university students and were associated with poorer academic experiences, particularly dissatisfaction with academic performance. Universities should strengthen accessible mental health support through counseling services, stress-management programs, and stigma-reduction initiatives. Full article

Immune checkpoint inhibitors (ICIs) have substantially improved outcomes in advanced melanoma but are frequently linked to immune-related adverse events (irAEs). Vitiligo is a common cutaneous irAE and has been consistently associated with improved patient outcome, including prolonged progression-free and overall survival. It also represents significant visual stigma, particularly when the face is involved. Traditional treatment comprises topical steroids, calcineurin inhibitors, laser, and phototherapy which often have insufficient effects. Since 2023, the first approved drug for non-segmental vitiligo (NSV) with facial involvement, the topical Janus kinase inhibitor ruxolitinib, has been available. However, experience with its use in ICI-induced vitiligo remains limited. In this exploratory analysis, three patients who developed facial vitiligo following ICI therapy applied 1.5% ruxolitinib cream to affected facial areas twice daily. After six (two patients), and twelve months (one patient), extensive repigmentation was observed, quantified at 95.7%, 78.9%, and 99.1% using a novel semi-automatic tool. Quality-of-life questionnaires showed mean reductions of 57.6% (Vitiligo DLQI) and 68.2% (Vitiligo-specific Quality of Life) in disease burden. Treatment was associated with substantial repigmentation without observed side effects. Further evaluation in larger, prospective cohorts is warranted to better define treatment effects, clinical applicability, and long-term safety. Full article

Background: The vagina undergoes important changes across the life course that are shaped not only by hormonal transitions but also by shifts in the vaginal microbial environment. Despite growing interest in the vaginal microbiome, research has disproportionately centered reproductive-aged populations, leaving the aging vagina comparatively understudied. Objective: This article examines the aging vagina through a life-course lens, with emphasis on microbial and clinical transitions associated with midlife and older adulthood. Key Content: The article highlights menopause-related changes and approaches for reducing stigma and missed clinical opportunities. Particular attention is given to menopause-related declines in estrogen, reduced glycogen availability, increased vaginal pH, and accompanying changes in microbial balance, as well as their relationship to dryness, irritation, genitourinary symptoms, and susceptibility to adverse outcomes. The article also provides health professionals with a practical educational framework for symptom recognition, patient communication, vaginal health assessment, menopause-related education, stigma reduction, and prevention of missed clinical opportunities. Conclusions: Positioning the aging vagina within life-course and microbial-health frameworks can strengthen prevention, improve symptom recognition, and support more age-inclusive, informed, and responsive care for older women. Full article

Tactical athletes, including military service members, are exposed to occupational demands that increase their risk of mild traumatic brain injury (mTBI), particularly through blast exposure, falls, collisions, and repeated sub-concussive events. Although clinical tools and progressive return-to-activity protocols support acute management, recovery may remain fragmented when physical, cognitive, psychological, and performance domains are not integrated. Military personnel require recovery models which extend beyond symptom resolution and return-to-duty clearance. Holistic performance programming offers a multidimensional framework which incorporates subject matter experts across strength and conditioning, rehabilitation, nutrition, behavioural health, cognitive performance, and human performance optimisation. This narrative review examines the role of holistic performance programming in optimising recovery from mTBI among tactical athletes, with emphasis on interdisciplinary care, structured assessment, recovery periodisation, monitoring technologies, and return-to-duty readiness. The role of embedded subject matter experts in identifying and monitoring mTBI; interdisciplinary care models which integrate clinical and performance expertise; structured recovery pathways from assessment to reintegration; and the importance of flexibility, communication, and service member engagement are examined. In addition, the review assesses the potential use of biomarkers, wearable technologies, and multi-domain assessment tools to guide individualised recovery. Holistic performance programming may bridge the gap between clinical recovery and operational readiness following mTBI. By integrating physical, cognitive, psychological, nutritional, and sleep-related strategies, this approach may reduce fragmented care and better address the complex nature of mTBI recovery. Interdisciplinary performance teams may improve early recognition, individualised rehabilitation, safer return-to-duty decisions, and long-term readiness. Future practice should prioritise standardised assessment, real-time monitoring, education, and stigma reduction. Full article

This paper examines the role of graphic medicine as a critical design tool that should be used in harm reduction messaging, focusing on its capacity to address barriers to opioid overdose response. Through three case studies, we illustrate how visual storytelling in the form of comics, animation, and other graphic elements can encourage empathy, reduce stigma, and improve understanding of overdose interventions, particularly naloxone administration. Barriers to effective overdose response include stigma, fear, mistrust, limited knowledge, and poor access to lifesaving tools. Stigma—both societal and internalized—remains one of the most persistent and hardest barriers for effective overdose response. In response, design researchers and practitioners have explored communication methods to reshape public and professional discourse. By drawing on critical design tools in a cross-disciplinary way, this paper situates comics and animation within a broader effort to engage communities, shift narratives, and build more inclusive, compassionate approaches to opioid overdose prevention. Full article

Background: Artificial intelligence (AI) is widely used in mental health care for screening, monitoring, and intervention. Notably, most studies of AI in mental health have been performed in Western contexts, with limited evidence from the Arab Gulf region, where cultural factors such as stigma, privacy, and help-seeking norms may influence acceptance. Objective: Investigating university students’ perceptions of AI in mental health support, including awareness, trust, readiness, and preferences in a Gulf context. Methods: A cross-sectional survey was administered to 220 university students in Qatar. Data were analyzed using descriptive statistics, Chi-square tests, and one-way ANOVA to explore associations and group differences. Results: Students showed low-to-moderate levels of awareness and trust in AI-based mental health tools. The majority of participants showed that they were prepared to employ AI for stress management, but they do not prefer to replace face-to-face therapy, suggesting a preference for complementary use. A significant association was found between readiness and expectations (p < 0.00001), which means ambivalence toward AI effectiveness. No significant differences were observed across gender or academic level (p > 0.05). Key concerns included loss of human interaction, overreliance on technology, and diagnostic accuracy, while perceived benefits included cost reduction and 24/7 accessibility. Conclusions: Students exhibit cautious adoption of AI in mental health services. Acceptance is influenced by trust, privacy issues, and apparent compassion. AI is optimally situated as a supplementary instrument within ethically regulated, culturally attuned hybrid care frameworks that maintain the fundamental importance of human connection. Full article

Background/Objectives: Intentional insulin omission (IIO), commonly referred to as diabulimia, is a high-risk behavioural phenomenon observed mainly in adolescents and young adults with type 1 diabetes mellitus (T1D). Defined as the deliberate reduction or omission of insulin to influence body weight, IIO lies at the intersection of metabolic management and eating disorder psychopathology. Despite serious health risks, including diabetic ketoacidosis, microvascular complications, and increased mortality, it remains under-recognised due to stigma, diagnostic ambiguity, and overlap with routine diabetes self-management. This review aimed to examine the prevalence, psychological mechanisms, and clinical consequences of IIO. Methods: On 1 April 2026, we conducted a systematic search of PubMed, Scopus, APA PsycInfo/PsycArticles and Cinahl for studies investigating intentional insulin omission and related metabolic and psychological outcomes in T1D. Clinical and epidemiological studies assessing prevalence, risk factors, and interventions were included. Results: Twenty-nine studies met the inclusion criteria. Prevalence estimates ranged from 20% to 45%, with higher risk among females, adolescents, and individuals experiencing diabetes-related distress or body dissatisfaction. Psychological factors—including fear of weight gain, emotion dysregulation, depressive symptoms, and identity conflicts—were associated with IIO onset and maintenance. IIO was consistently linked to poor glycaemic control, elevated HbA1c levels, and adverse metabolic and psychological outcomes. Screening tools such as the Diabetes Eating Problem Survey–Revised (DEPS-R) may support early identification, while effective management requires integrated multidisciplinary care. Conclusions: Although IIO is not formally classified as an eating disorder in current diagnostic systems, it shares important psychopathological features with eating disorders and may represent a diabetes-specific disordered eating behaviour with life-threatening consequences. Full article

Mpox is a rare but potentially serious vaccine-preventable disease. The 2022 United States outbreak disproportionately impacted gay, bisexual, and other men who have sex with men, people living with HIV, and people of transgender experience. Early vaccination efforts revealed substantial racial and geographic inequities, with lower uptake among Black and Hispanic cisgender men, transgender women, and residents of rural areas. To address these challenges, Fairview’s Minnesota Immunization Networking Initiative (MINI), a 20-year-old mobile health collaborative, partnered with state and local public health agencies and community-based organizations to expand mpox vaccine access. With support from governmental outbreak response funding and stockpiled vaccine, mobile clinics were deployed in trusted community settings, including Pride events and recurring community sites. Targeted outreach, education, and coordination with local providers supported stigma reduction and second-dose series completion. Program data were collected from October 2022 through December 2024. MINI hosted 125 community-based mpox vaccination events, administered 2259 doses to individuals from 220 cities across the United States, including 195 cities in the Midwest. Pride events were key entry points for first-dose vaccination, particularly in rural areas; urban non-Pride clinics played a complementary role in facilitating second-dose completion. Program-level vaccination-to-case ratios were highest among populations experiencing disproportionate mpox burden, including Black, Hispanic, and American Indian/Alaska Native male participants, suggesting alignment of preventive resources with community need. MINI’s mobile, partnership-driven approach demonstrates the value of pairing large-scale community events with recurring clinics to address barriers to both vaccine access and series completion. These findings underscore the importance of flexible, community-centered infrastructure in advancing health equity and strengthening outbreak preparedness. Full article

Background: Although pre-exposure prophylaxis (PrEP) has demonstrated strong clinical efficacy in preventing HIV infection among men who have sex with men (MSM), real-world utilization remains suboptimal. In South Korea, MSM constitute a major population within the domestic HIV epidemic; however, PrEP uptake has not increased pro-portionally to awareness. This discrepancy has been conceptualized as the “awareness–uptake gap,” reflecting multi-level barriers beyond individual knowledge. Purpose: This integrative review aimed to compare PrEP awareness, acceptance, and utilization among MSM populations in South Korea and international settings, and to identify structural, institutional, and psychosocial determinants contributing to the awaness, uptake gap. The study further sought to derive practical implications for nursing practice and health policy. Methods: An integrative literature review was conducted following Whittemore and Knafl’s five-step methodology and reported in line with PRISMA guidance. Electronic searches were performed in PubMed, Google Scholar, RISS, ScienceON, and DBpia for peer-reviewed studies published between 2015 and 2025 in English or Korean. The final search was completed on 31 January 2026. A total of 5952 records were identified, and 187 studies met the inclusion criteria after screening and duplicate removal. Quality appraisal was conducted using AXIS, Newcastle-Ottawa Scale, RoB 2.0, CASP, and MMAT according to study design, and the findings were synthesized within an environmental–structural–individual framework. Results: The included studies consistently showed that awareness of PrEP exceeded actual uptake. Across settings, the awareness–uptake gap was shaped by policy environment, service accessibility, stigma, privacy concerns, economic burden, institutional complexity, and provider preparedness. Comparative evidence from China, Thailand, Belgium and France, Brazil, and West Africa further suggested that awareness alone did not ensure uptake when service pathways were fragmented, culturally unsafe, or poorly understood. Conclusions: Closing the awareness–uptake gap requires integrated policy and practice strategies that extend beyond cost reduction. Strengthening confidentiality systems, simplifying service pathways, and enhancing provider competency—particularly through nurse-centered PrEP navigation and counseling models—may support more sustainable PrEP expansion among MSM populations in global settings. Full article

Background/Objectives: This qualitative study investigated the perspectives and lived experiences of individuals with obesity, with a specific focus on psychological needs, beliefs, attitudes, and experiences related to psychological support. The study aimed to identify perceived barriers and facilitators to adherence in weight management and to examine participants’ views on digital psychological interventions designed to promote mental health and well-being. These findings represent the preliminary phase of a broader research project aimed at developing and implementing personalized digital psychological interventions to enhance engagement, treatment effectiveness, and equity of care in obesity management. Methods: Five focus groups were conducted with a purposive sample of 35 patients (48.6% female) diagnosed with obesity and enrolled in a four-week multidisciplinary weight-reduction program at the IRCCS Istituto Auxologico Italiano, San Giuseppe Hospital, Piancavallo (VB), Italy. Sessions were audio-recorded, supplemented with field notes, transcribed verbatim, and analyzed using reflexive thematic analysis to identify recurrent patterns of meaning across participants’ narratives. Results: Six overarching themes were identified: (1) obesity as an embodied and pervasive experience; (2) the interplay between emotions, weight stigma, and identity construction; (3) family and social relationships as both supportive and ambivalent; (4) personal agency and self-regulation processes in weight management; (5) access to healthcare services and experiences with healthcare professionals; and (6) the perceived role of psychological support within multidisciplinary care. Participants described obesity as a complex, multidimensional condition encompassing physical, emotional, relational, and contextual challenges that directly influence treatment engagement and adherence. Conclusions: Psychological support emerged as a central component of comprehensive obesity care. Findings underscore the need for personalized, flexible, and digitally supported psychological interventions to enhance long-term adherence, acceptability, and overall well-being. Full article

Background: Drug use settings are critical determinants of overdose risk and other drug-related harms. Although sex differences in drug use patterns are well documented, less is known about sex differences in the types of locations where people use drugs. This study examined sex differences in drug use settings among people who use opioids. Methods: Data were from the baseline survey of the OASIS project, a community-based study conducted in Baltimore, Maryland (N = 869), focusing on 9 specific types of locations where participants reported drug use in the past 30 days: their own residence, someone else’s residence, street, alley, park, abandoned building, public restroom, car, and other locations. Bivariate and multivariable logistic regression models examined associations between sex and drug use settings, adjusting for age, race, education, homelessness, and frequency of drug use. Results: The sample included 346 women and 523 men. In adjusted models, women had significantly lower odds than men of using drugs on the street (aOR = 0.49, 95% CI 0.35–0.70), in alleys (aOR = 0.50, 95% CI 0.35–0.69), parks (aOR = 0.57, 95% CI 0.42–0.78), abandoned buildings (aOR = 0.53, 95% CI 0.38–0.75), cars (aOR = 0.55, 95% CI 0.41–0.73), and other locations (aOR = 0.59, 95% CI 0.37–0.94). Sex was not significantly associated with drug use at one’s own residence or someone else’s residence. Conclusions: Women who use opioids were significantly less likely than men to use drugs in public and semi-public settings, which may reflect gendered patterns of stigma, interpersonal violence, and safety concerns. Harm reduction programs should focus on making current drug use settings safer and developing additional safer settings with an emphasis on addressing barriers for women to access harm reduction services, including women-centered overdose prevention centers and household-based overdose response training. Full article

Background/Objectives: Cancer-related terminology is not merely descriptive and plays a critical role in shaping emotional responses, personal identity, and communication across clinical, social, and public spheres. Despite growing interest in the psychosocial dimensions of illness language, few studies have centered the lived experiences of individuals navigating cancer through the lens of terminology. This study explores how people living with and beyond cancer perceive, interpret, and emotionally respond to cancer-related language, focusing on the way terminology influences identity, stigma, and communicative interaction. Methods: A sequential mixed-methods design was employed. The quantitative phase involved 146 participants with a cancer diagnosis completing a structured questionnaire on preferred terminology and emotional impact. The qualitative phase followed, using open-ended questionnaires with 11 participants to deepen understanding of linguistic experiences. Thematic content analysis was used to identify patterns across narratives. Results: These findings reveal that labels such as “cancer patient” evoke strong negative emotional reactions, associated with stigma, fear, and identity reduction. Person-first and context-sensitive language was perceived as more respectful and empowering. Emotional responses to language varied widely, from fear to neutrality, shaped by speaker role, context, and time since diagnosis. Media representations were often seen as dramatizing or moralizing, reinforcing the need for communicative clarity, empathy, and education in both clinical and public discourse. Conclusions: Cancer-related language is a powerful psychosocial force. It shapes how individuals are seen and see themselves and can either reinforce stigma or foster dignity and resilience. This study highlights the urgent need for person-centered, context-aware communication practices across healthcare, media, and society. Full article

Background: Mental health problems are highly prevalent among university students in Saudi Arabia; however, help-seeking behaviors remain low despite the availability of mental health services. There is limited evidence regarding students’ intentions to seek help and preferred sources of support, especially formal or informal sources. This study examined help-seeking intentions for mental health problems among university students. Methods: This cross-sectional descriptive study was conducted using an online self-administered questionnaire. Participants were 248 undergraduate students from various Riyadh universities. Help-seeking intentions were assessed using the General Help-Seeking Questionnaire. SPSS software was used to perform independent t-tests to assess differences in preferred sources across demographic groups, and Pearson’s correlation analyses were conducted to examine relationships between preferred sources and demographic variables. Multiple linear regression analyses were conducted to examine demographic and academic predictors of intentions to seek help from formal and informal sources. Results: Students demonstrated a low overall propensity to seek help. Online sources were the most preferred help-seeking option, followed by mothers, friends, and general physicians, whereas faculty, relatives, and religious persons were the least preferred. Preferred help-seeking sources differed by gender. Seeking help from mental health specialists was positively correlated with age and grade point average. Additionally, the regression analysis for formal help-seeking was significant, explaining 8.4% of the variance, with gender as the only significant predictor. Conclusions: These findings suggest the need for targeted interventions to improve students’ help-seeking behaviors. Universities should prioritize mental health literacy initiatives, stigma reduction strategies, and accessible support pathways, particularly by integrating digital and hybrid services and enhancing the role of faculty and institutional support systems in promoting timely and appropriate help-seeking. Full article

Public debates about psychoactive substances have traditionally been organized around the pharmacology of compounds and the institutional control of supply. In digitally mediated societies, however, the pathways through which people encounter psychoactives are increasingly informational: search engines, recommender systems, social platforms, and—distinctively—conversational AI. These systems do not merely deliver neutral facts. They rank, frame, personalize, and conversationally validate claims in ways that can shape perceived norms, acceptable risk thresholds, and willingness to seek help. This opinion advances the concept of AI-mediated exposure to capture how algorithmic curation and interactive dialogue become upstream determinants of psychoactive-related harms and benefits across the continuum from everyday medicines to non-medical use. From a social-scientific ethics perspective, the central question is not whether AI is “good” or “bad,” but what obligations apply when AI performs interpretive authority in contexts characterized by vulnerability, stigma, and unequal access to trusted expertise. The paper argues for an ethics-centered governance framework grounded in four commitments: epistemic responsibility (how claims are generated, warranted, and communicated), relational responsibility (how users are treated in moments of uncertainty, distress, and stigma), distributive justice (who benefits and who bears risk under unequal conditions), and accountability (how behavior is evaluated, contested, and corrected over time). The aim is to treat conversational AI as a public-facing institution whose design choices must be ethically legible and publicly contestable, oriented toward harm reduction without intensifying surveillance, moralization, or inequity. Full article

Epileptic activities can affect various aspects including neuropsychological and social functions, which lead to reductions in quality of life (QOL) for epileptic children. Social function in epileptic children can be negatively impacted due to emotional instability, including stigma associated with having epilepsy. The parents of children with refractory epilepsy could experience severe anxiety regarding clinical seizures in their children, and this severe parental anxiety state could lead to adaptable dysfunction in their children. Moreover, associations between epilepsy and fatigue or headache are well known to clinicians but insufficiently understood. A deeper understanding of these issues in epilepsy could be important for managing the clinical course and treatment regimen. Seizure activities could be associated with impaired neuropsychological/social functions as represented by stigma, fatigue, and headache. Seizure severities are thus important QOL-related factors in terms of neuropsychological and social issues in epileptic children. A relationship between current seizure activity and perception of stigma could be evident in epileptic children. Seizure activity represented as frequent seizures could also be related to fatigue and seizure-associated headache, which can lead to reduced QOL in children with epilepsy. In addition, seizure-related factors in epileptic children including frequent seizures could lead to a greater perception of stigma among their parents. Meanwhile, educational interventions about epilepsy for parents could reduce negative emotional influences when caring for children presenting with seizure attacks. Therapeutic management thus appears desirable to achieve better seizure control and establish educational support for parents, aiming to improve QOL in children with epilepsy. Full article