Search Results (902)

Background: Repeat induced abortion (defined as ≥two lifetime procedures) is becoming more common worldwide, yet its independent influence on women’s psychological health remains contested, particularly in settings where access to modern contraception is restricted. Objectives: This review sought to quantify the burden of depression, anxiety, stress, and generic quality of life (QoL) among women with repeat abortions and to determine how barriers to contraceptive access alter those outcomes. Methods: Following the preregistered PRISMA-2020 protocol, PubMed, Embase and Scopus were searched from inception to 31 June 2025. Results: Eight eligible studies comprising approximately 262,000 participants (individual sample sizes up to 79,609) revealed wide variation in psychological morbidity. Prevalence of clinically significant symptoms ranged from 5.5% to 24.8% for depression, 8.3% to 31.2% for anxiety, and 18.8% to 27% for perceived stress; frequent mental distress affected 12.3% of women in neutral policy environments but rose to 21.9% under highly restrictive abortion legislation. Having three or more abortions, compared with none or one, increased the odds of depressive symptoms by roughly one-third (pooled OR ≈ 1.37, 95% CI 1.13–1.67). Contextual factors exerted comparable or stronger effects: abortions sought for socioeconomic reasons elevated depression odds by 34%, unwanted disclosure of the abortion episode increased depressive scores by 0.62 standard deviations, and low partner support raised them by 0.67 SD. At the structural level, every standard deviation improvement in a state’s reproductive rights index reduced frequent mental distress odds by 5%, whereas enactment of a near-total legal ban produced an absolute increase of 6.8 percentage points. QoL outcomes were less frequently reported; where measured, denied or heavily delayed abortions were associated with a 0.41-unit decrement on a seven-point life satisfaction scale. Conclusions: Psychological morbidity after abortion clusters where legal hostility, financial hardship, or interpersonal coercion constrain contraceptive autonomy while, in comparison, the mere number of procedures is a weaker predictor. Interventions that integrate stigma-free mental health support with confidential, affordable, and rights-based contraception are essential to protect well-being in women who experience repeat abortions. Full article

Background: This study was a cross-sectional online survey aimed at examining health-related quality of life and the effect of different symptoms and lifestyle factors on health-related quality of life in a sample of women with endometriosis in Hungary. Methodology: A cross-sectional online survey was carried out in a sample of women with endometriosis. Self-edited and Hungarian versions of validated questionnaires were used to assess health-related quality of life (Sf-36-Health Survey—SF-36), pain (Numeric Rating Scale-NRS), effect of pelvic pain on everyday life (Pelvic Pain Impact Questionnaire—PPIQ), perceived stress levels (Perceived Stress Scale—PSS), and physical activity (Global Physical Activity Questionnaire—GPAQ). Data analysis was conducted using IBM SPSS Statistics 28.0, and the level of significance was set at p < 0.05. Multivariate linear regression analysis was performed to examine the effect of different lifestyle factors, pain-related, and physical symptoms on the participants’ health-related quality of life (HrQoL). Results: The health-related quality of life of Hungarian women with endometriosis in our sample was significantly lower than the latest Hungarian normative values. Multiple linear regression analyses revealed that psychological, pain-related, and lifestyle factors significantly predicted HrQoL across SF-36 subscales in women with endometriosis (all models, p < 0.001; Adjusted R² = 0.274–0.654). Pain self-efficacy (PSEQ) was a consistent positive predictor that was significantly associated with better scores in five SF-36 domains, including physical and social functioning. Perceived stress (PSS) is a strong negative predictor that particularly affects emotional well-being, energy/fatigue, and social functioning. Pain interference (PPIQ) was linked to poorer HrQoL in seven out of eight SF-36 domains, while average pain intensity (NRS) negatively predicted Physical Functioning and General Health. Vigorous physical activity was positively associated with Social Functioning, whereas moderate activity had no significant effect. Among the demographic factors, only age was negatively associated with Physical Functioning; BMI and education were not significant predictors. Conclusions: Psychological, lifestyle, and symptom-related factors play key roles in health-related quality of life among women with endometriosis. Self-efficacy was a strong positive predictor, whereas perceived stress and pain interference were linked to poorer outcomes. High-intensity physical activity supported better social functioning. These findings highlight the need for multidisciplinary interventions targeting psychological support, pain management, and physical activity to improve quality of life in this population. Full article

Background/Objectives: Academic burnout is an emerging problem among nursing students, characterized by emotional exhaustion, cynicism, and reduced academic efficacy. Sports interventions have been shown to have a positive effect on nurses as a preventive strategy against burnout. The aim of this study was to evaluate the effect of a nature sports program on the levels of academic burnout in nursing students. Methods: A randomized clinical trial was performed. The intervention was a 12-week nature exercise program with two sessions each week. The main dependent variables were burnout (measured using the Maslach Burnout Inventory—Student Survey), stress (measured using the Perceived Stress Scale), and anxiety and depression (measured using the Hospital Anxiety and Depression Scale). The post-intervention sample size was n = 58 in the control group and n = 48 in the intervention group. Results: After the intervention, significant differences were found in respect of emotional exhaustion (p < 0.001; Cohen’s D: 0.483), stress (p < 0.05; Cohen’s D: 0.456), and mean steps per day (p < 0.001; Cohen’s D: −1.09), with the mean values being reduced in the intervention group by around three points in emotional exhaustion and stress; the intervention group also achieved a higher mean number of daily steps compared to the control group. Conclusions: A nature sports program could help to reduce emotional exhaustion and stress, and increase the number of steps per day. Full article

Objective: This study aimed to evaluate food insecurity and associated factors during and after remote learning among undergraduates at Brazilian public universities. Methods: This is a comparative study of two cross-sectional studies; the first had its data collection from August 2020 to February 2021, and the second from May 2023 to December 2023. The questionnaire contained socio-economic variables, the Brazilian Food Insecurity Scale, the Diet Quality Scale, and the Perceived Stress Scale. Results: In total, 4799 undergraduates of Brazilian public universities responded in the first study, and 2897 responded in the second. Food insecurity was present in 36.5% of the students in 2020/2021 and 35.9% of the students in 2023. In the correspondence analysis, low income, poor health, stress and poor diet were associated with food insecurity in 2020/2021. Low income, reduced income, poor health, stress and diet quality were associated with food insecurity in 2023. Logistic regressions demonstrated that the year of collection, whether during or after remote learning, did not significantly contribute to food insecurity. However, students from low-income families had the highest AOR for food insecurity; no change in income or weight and lower perceptions of stress were associated with a lower AOR for food insecurity. Full article

This article examines how Ukrainian migrants and war refugees in Finland perceive and use Suržyk, a cluster of intermediate varieties between Ukrainian and Russian, as a transitional stage facilitating the shift from Russian-dominant to Ukrainian-dominant speech. Drawing on 1615 survey responses collected between November 2022 and January 2023, the study reveals that 42 respondents view Suržyk as a bridge that supports the gradual acquisition of standard Ukrainian. Qualitative content analysis of open-ended responses shows repeated references to Suržyk as a “stepping stone”, “temporary means” or “bridge”, highlighting its role in maintaining intelligibility and fluency for speakers who are not confident in standard Ukrainian. Although some respondents acknowledge the stigma associated with mixed speech, they also stress Suržyk’s practical advantages in contexts shaped by the 2022 full-scale war and heightened purist discourses. Speakers report pressure to adhere to purist language norms in formal settings, whereas in informal spaces, they consider Suržyk a natural outcome of bilingual backgrounds. These findings illuminate the interplay between language ideologies, sociopolitical dynamics, and individual agency, suggesting that for many Ukrainians in Finland, Suržyk serves as a temporary yet functional means to align with Ukrainian identity under rapidly changing circumstances. Full article

This study researches the effects of a biofeedback-based Dynamic Difficulty Adjustment (DDA) system on player stress management in a survival-horror video game. For this purpose, a game titled Code: Terror was developed, in which players’ psychophysiological data—such as heart rate, stress level, and voice level—were collected in real time through a smartwatch. Based on these data, game parameters were dynamically adjusted. The adaptation process was guided by the “Relax-to-win” model, which aims to make the game easier as players remain calm, using their level of relaxation as a baseline. A total of 40 participants were recruited and divided into two reciprocal groups: one group experienced the game solely with the DDA system activated, while the other played first with the DDA system disabled and then with it enabled. Player experience was evaluated using the Intrinsic Motivation Inventory (IMI) and the Challenge Originating from Recent Gameplay Interaction Scale (CORGIS). Results showed that the dynamic biofeedback system significantly enhanced intrinsic motivation and perceived challenge, while also reducing physiological arousal, indicating its effectiveness in promoting emotional regulation—the inclusion of both gameplay conditions for participants allowed for the collection of more consistent and meaningful data. The results suggest that biofeedback-driven DDA systems have the potential to enrich player experience both emotionally and motivationally. Furthermore, the findings highlight the potential of such adaptive biofeedback mechanisms to serve as intelligent medical decision support tools for stress management, mental health monitoring, and personalized intervention strategies. Full article

Background and Objectives: Dental anxiety can hinder both treatment delivery and dental education. Few studies have examined this issue among Romanian dental students. This study assessed the prevalence, intensity, and main procedural triggers of dental anxiety, with a focus on experiences related to local anesthesia. Methods: A cross-sectional survey was conducted (January–May 2024) among 122 fourth-year students using the validated Romanian version of the Modified Dental Anxiety Scale (MDAS) and additional items on demographics, prior anesthesia and perceived complications. Data analysis included descriptive statistics, chi-square tests, and t-tests. Results: Overall, 21.3% of respondents scored in the low anxiety range, 75.4% in the moderate range, and 3.3% in the severe range (MDAS ≥ 19). No significant gender differences were identified (p > 0.05). Injections with local anesthetic were rated as the most distressing procedure, followed by drilling, whereas scaling was reported as least stressful. The majority (86.9%) had undergone previous local anesthesia, with very few adverse events recalled. Conclusions: Romanian dental students reported moderate dental anxiety overall, with local anesthesia injections as the main trigger. The lack of gender differences points to a potential buffering effect of clinical exposure. Incorporating structured anxiety management into dental curricula may enhance both student well-being and patient care. Full article

This study comprehensively evaluates the impact of remote work intensity on employee well-being, productivity, and sustainable practices within the IT sector, utilizing a cross-sectional online survey of 1003 employees. Findings reveal that remote work consistently boosts self-rated health, enhances perceived productivity, and promotes the adoption of sustainable workplace practices, with these benefits largely consistent across gender and most age groups. However, its effect on perceived stress is complex and significantly age-dependent, showing increased stress for younger employees (under 25) while mid-career professionals (26–35) experience stress reduction. Perceived stress did not emerge as a statistically significant mediator in the remote work-productivity relationship, suggesting that positive effects on productivity are primarily driven by direct mechanisms such as increased autonomy and flexibility. This research contributes to the Job Demands-Resources and Self-Determination Theory by illuminating how digital work demands and psychological needs are experienced heterogeneously across demographics in the remote context. Practical implications emphasize the need for differentiated stress management strategies tailored to younger employees, as well as a broader promotion of remote work, to enhance sustainable behavior within organizations. Methodologically, the study highlights the value of utilizing large, non-probability datasets, along with carefully constructed proxy scales, and proposes the future integration of AI-powered analytics for deeper insights. Full article

Background and Objectives: The COVID-19 pandemic has had severe and far-reaching repercussions for health systems and societies, creating a global mental health crisis that has persisted after the pandemic. This study examined differences in mental health (i.e., psychological distress and well-being) by gender and pandemic period (i.e., lockdown, second and third pandemic waves, the last year of the pandemic, and the post-pandemic period) among Spanish individuals in two stages of adulthood: established adulthood and midlife. The second objective was to identify the risk and protective factors for psychological distress and well-being during the post-pandemic period. Materials and Methods: The study design was repeated cross-sectionally. The non-probability sample included 3677 people (66.2% women) from the general Spanish population, aged 30 to 59 years. Participants were assessed between 1 June 2020 and 23 May 2024 using the following self-reports: the General Health Questionnaire-12 item version, the Scale of Positive and Negative Experience, the Brief Inventory of Thriving, the Satisfaction with Life Scale, the Rosenberg Self-Esteem Scale, the Social Support Scale, the Stressful Events Questionnaire, the Brief Resilience Scale, and the Perceived Vulnerability to Disease Questionnaire. Results: Although rates of psychological distress varied across pandemic periods, women consistently experienced higher rates than men. During the post-pandemic period, the rates of psychological distress were 47.5% for women in established adulthood and 34.7% for midlife women, compared to 28.6% and 22% for men, respectively. Low self-esteem was the main predictor of greater psychological distress and lower well-being for both genders and age groups in the post-pandemic period. Another significant predictor was lower stress resilience. Conclusions: The COVID-19 pandemic threatened women’s mental health and well-being more than men’s, and this threat persists after the pandemic, especially among women in established adulthood. The study’s findings are relevant for the design of policies, programs, and strategies to achieve better mental health and well-being among citizens and greater gender equality. Full article

Tele-ultrasound systems enable remote diagnostic imaging by transmitting both motion commands and haptic feedback between a sonographer and a robotic probe. While these systems aim to replicate conventional ultrasound procedures, they rarely address the physical strain typically experienced by sonographers. In this study, the effect of applying a force scaling strategy to haptic feedback on reducing muscular fatigue and task-induced stress during a realistic tele-ultrasound task is studied. First, a thorough operational and biomechanical analysis of the abdominal US procedure was performed to reconstruct a representative task in the laboratory. Then, a bilateral position–force tele-ultrasound architecture was implemented, and a total of 11 subjects performed the reconstructed remote ultrasound task under two randomized conditions: with and without force scaling. Surface electromyography (sEMG) signals were acquired from seven upper-limb muscles (posterior deltoid, trapezius, anterior deltoid, biceps, triceps, wrist flexors, and wrist extensors). Teleoperation-related stress was also assessed using a seven-item Likert-scale self-report questionnaire administered after each trial. Statistical significance was tested using Repeated Measures ANOVA for EMG data and the Wilcoxon signed-rank test for stress scores. The results showed a statistically significant reduction in muscle activation in 5 out of 7 muscles, and a clear mitigation of fatigue progression over time in the scaled condition. Additionally, perceived stress levels were significantly lower in the presence of force scaling in overall stress scores. These findings support the effectiveness of force scaling as a tool to enhance ergonomics in tele-ultrasound procedures without compromising the operator’s ability to perform the task. The proposed methodology proved robust and generalizable, offering valuable insight into the integration of human-centered design in tele-operated diagnostic systems. Full article

The COVID-19 pandemic increased mental health issues and heavily affected the academic performance of college students. The study aimed to assess the association of psychological health and behavioral factors with academic performance among undergraduate students during the third year of the COVID-19 pandemic. The study was conducted at a small liberal arts undergraduate college in rural Appalachia. A cross-sectional research design was followed. Data was collected online using Qualtrics in person in July 2021. Participants were selected randomly. World Health Organization-5, Perceived Stress Scale 4, The Pittsburgh Sleep Quality Index, Generalized Anxiety Disorder-7, and Patient Health Questionnaire scales for well-being, stress, sleep quality, anxiety, and depression were used, respectively. Spearman’s correlation, t-test, analysis of variance, and multiple regression were conducted. Overall well-being, perceived stress, generalized anxiety, depression, and sleep quality were found to be significantly different by gender and exercise. The Grade Point Average (GPA) was found to be negatively associated with depression and positively associated with Sleep quality. Findings suggest that students who have scored higher on the depression and sleep quality scale may be affected more during this COVID-19 pandemic in maintaining a good GPA. The findings of this study can help generate hypotheses for further research and guide interventions to address poor academic performance. Full article

Background/Objectives: Suicide is the leading cause of death among South Korean military soldiers, accounting for more than 70% of all deaths. This issue is particularly relevant in the military context due to the nature of living in groups in a controlled environment. This study was conducted active-duty south Korean male soldiers aged 18 to 28 who were performing mandatory military service for one year and six months. Additionally, it compares and analyzes the differences in suicidal ideation and risk factors between military soldiers and a comparison group consisting of males in their 20s without military experience. Methods: This study included 248 Korean soldiers and 292 general controls, totaling 540 participants. The research instruments used for evaluation included the Beck Scale of Suicide Ideation (BSI), the Childhood Trauma Questionnaire (CTQ-SF), the Perceived Stress Scale (PSS), the Difficulties in Emotion Regulation Scale (DERS-16), the Barratt Impulsiveness Scale Version 11 (BIS-11), the Rosenberg Self-Esteem Scale (RSES), the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder 7-item scale (GAD-7), the UCLA Loneliness Scale (UCLAS), and the State-Beck Hopelessness Scale (S-BHS). Results: The results of this study showed that suicidal ideation, depression, anxiety, impulsivity, and self-esteem were significantly higher in the military group compared to the comparison group. Conversely, emotional dysregulation was considerably lower in the soldiers than in the comparison group. No significant differences were found in childhood trauma, stress, loneliness, and hopelessness between the two groups. Multiple regression analysis within the military group revealed that childhood trauma, hopelessness, and depression were major factors influencing suicidal ideation. Conclusions: These findings will help identify risk factors for suicide among soldiers and develop effective intervention strategies to prevent it. Full article

Background: Occupational or work-related stress remains a persistent challenge in nursing, often intensified by sociodemographic factors. In Brazil’s Northeast, particularly in Aracaju, Sergipe, public hospital nurses face unique stressors shaped by regional socioeconomic conditions. Objective: This cross-sectional exploratory study aimed to examine the relationship between perceived work-related stress and the sociodemographic profiles of nursing professionals in three public hospitals in Aracaju. Methods: Data were collected via an online questionnaire incorporating the Perceived Stress Scale (PSS-10) and sociodemographic items. Results: Among 440 participants—comprising nurses (42%), nursing technicians (38.2%), nursing assistants (8.9%), and specialists (10.9%)—moderate to high stress levels were most prevalent among nursing technicians and assistants. Elevated stress was notably associated with adult women working in high-complexity sectors (e.g., pediatrics, obstetrics, ICU), particularly those without partners, earning low incomes, and with over ten years of professional experience. Conclusions: The findings highlight a vulnerable subgroup within the nursing workforce and underscore the need for targeted interventions to mitigate occupational stress in public healthcare settings. This study contributes region-specific insights into the intersection of stress and sociodemographic factors, offering a foundation for future policy and support strategies. Full article

Background/Objectives: Preventive care in Greece remains underdeveloped, especially in workplace settings. To address this, a mixed service model was piloted to integrate preventive and occupational health for public sector employees in Region of Crete. Methods: Between January and July 2025, 180 employees enrolled for a 30 min consultation including medical history review, lifestyle assessment, and evaluation of vaccination and screening status according to age, risk factors, and national guidelines. Standardized tools (PSS-14, PHQ-9) assessed perceived stress and mental well-being. Participants rated satisfaction and perceived care quality on a 10-point Likert scale. Results: Of 180 enrolled, 154 completed the evaluation. The majority of participants were female (68.8%), with a mean age of 54 years, and 42.9% held a higher education degree. Common lifestyle characteristics included current smoking (24.7%), regular alcohol consumption (9.8%), and insufficient sleep (mean 6.5 h/night). Overweight (40.3%) and obesity (29.2%) were prevalent. Chronic conditions were reported in 87.0% of participants, with dyslipidemia (54.5%), allergies (35.8%), and hypertension (26.9%) being the most frequent. Criteria for metabolic syndrome were found in 33.1% of participants with a higher prevalence in men (50.0% vs. 25.0%; p = 0.029). Mental health assessments revealed moderate stress levels (mean PSS-14: 23.7) and mostly minimal depressive symptoms (mean PHQ-9: 4.3). Preventive screening was variable, with higher adherence for mammography (79.2%) and lower for colonoscopy (40.2%). Service satisfaction was high, with significant increases in perceived usefulness (8.96 to 9.80, p < 0.001) and satisfaction (9.08 to 9.87, p < 0.001) after the intervention. Conclusions: This pilot revealed critical gaps in vaccination, cardiometabolic risk, and stress management among public employees. It was also shown that integrated workplace-based health models are both feasible and acceptable. These models can effectively deliver preventive actions on a scale and represent a promising strategy for strengthening occupational health in employed adult population. Full article

Background: Nicotinamide mononucleotide (NMN) has gained attention as an anti-aging compound due to its ability to replenish NAD⁺ levels, which typically decline with age and stress. While improvements in skin conditions have been reported, clinical studies on human hair remain lacking. In this study, we evaluated the effects of NMN supplementation on hair conditions in middle-aged women and explored its association with quality-of-life (QOL) factors such as fatigue. Methods: Torula yeast-fermented NMN was evaluated in this clinical trial. A single-arm, pre-post intervention study was conducted involving 15 healthy Japanese women aged between 40 and 50 years who orally consumed NMN for 12 weeks. Hair growth cycles and hair shaft diameters were assessed using TrichoScan (TrichoGrabV3B) analysis and scanning electron microscopy (SEM). Hair metabolites and hormone levels were also measured. Subjective indices, including fatigue and hair texture, were evaluated using a visual analog scale (VAS) questionnaire. Results: Following NMN supplementation, anagen hair elongation density (hairs/cm²) significantly increased from 55.9 to 87.7 (p = 0.03). Hair diameter (µm) also significantly increased from 75.3 to 78.8 (p < 0.01), with improvements in hair cuticle condition. Metabolomic analyses revealed significant changes in amino acids and energy metabolism-related compounds. No marked changes were observed in hair hormone concentrations. The VAS questionnaire indicated improvements in subjective hair characteristics such as elasticity, gloss, and volume, as well as reductions in fatigue and perceived hair loss, suggesting enhanced QOL. Conclusions: Oral supplementation with NMN may be a beneficial strategy for promoting hair growth and improvement in hair cuticle condition in middle-aged women, thus potentially enhancing overall hair care and quality of life. Full article