Search Results (2,711)

Background/Objectives: Improved survival rates have led to an increase in the number of children with medical complexity (CMC) receiving home-based care. However, there is a lack of clarity regarding the relationships among collaborative environments, environmental modifications, and positive family health among families of CMC in daily living settings. This study aimed to examine these relationships and identify their associated factors. Methods: This study was a secondary analysis of data derived from a self-administered questionnaire that was distributed to the families of CMC with experience in organizing the care environment. Ninety responses were included in the study, and regression analyses were performed using complete cases (n = 41–63). Results: Family-led environmental modifications (β = 0.670, p < 0.001) and physical environmental modifications (β = 0.679, p = 0.015) were positively associated with the collaborative environment, whereas professional-facilitated family-led environmental modifications were negatively associated with the collaborative environment (β = −0.775, p = 0.009). Regarding positive health in families, family-led environmental modifications (β = 0.487, p = 0.018), environmental modifications for care improvement (β = 0.597, p = 0.031), pre-modification family well-being (β = 0.464, p < 0.001), and the presence of someone to consult (β = 0.330, p = 0.011) were significantly associated with positive health in families. Because this study employed a cross-sectional design, causal relationships cannot be inferred. Conclusions: Collaborative environments in daily living settings may be associated with family involvement, physical environmental conditions, and professional engagement. Healthcare professionals may support family autonomy and participation in environmental modification processes. Full article

Healthcare professionals must acquire and maintain both declarative knowledge and fine psychomotor skills across a wide range of clinical procedures. Human working memory is physiologically limited, and the high cognitive demands of clinical environments frequently contribute to medical errors and adverse events. Intra-individual performance variability—driven by fatigue, stress, and motivation—represents a further challenge that conventional medical safety education has not adequately addressed. According to the World Health Organization, patient harm ranks fourteenth in the global burden of disease, with approximately 10% of hospitalised patients in high-income countries experiencing harm within healthcare facilities. This study reports the design, theoretical rationale, and preliminary outcomes of an augmented reality (AR) glasses system for hands-free, self-directed medical procedural training, developed from a human factors and ergonomics (HFE) perspective. The system integrates a see-through head-mounted display (HMD; Epson Moverio BT-40S), bone-conduction earphones (Shokz OpenComm), and an industrial-grade voice recognition application (NEC Solution Innovators), achieving fully hands-free operation compatible with aseptic technique. Content design is grounded in cognitive load theory (CLT) and the cognitive theory of multimedia learning (CTML), extended by neuroscientific evidence on multisensory integration and memory consolidation. More than 40 procedure-specific modules have been developed in-house at Tokyo University of Technology, spanning airway management, vascular access, respiratory therapy, dialysis, and cardiac support. In a four-year longitudinal survey (virtual reality (VR) simulator; n = 286), major satisfaction items consistently exceeded the scale midpoint. In an AR endotracheal suctioning cohort (n = 38/22), procedural flow understanding was rated 3.95/5.0. A peer-reviewed randomised controlled trial (Clinical Simulation in Nursing, n = 36) demonstrated significantly superior skill improvement (p < 0.001) and learning motivation (p = 0.001) in the AR group versus textbook self-practice. Principal ergonomic limitations of current HMD hardware—excessive weight, narrow field of view, and absence of medical-grade certification—are documented, and AI-based real-time procedural assessment is identified as a priority for the next research phase. Full article

Introduction: Musculoskeletal conditions impose a substantial economic burden on the United States (U.S.) healthcare system, but contemporary national estimates of condition-specific spending for common orthopaedic conditions remain limited. This study utilized the 2023 Medical Expenditure Panel Survey (MEPS) to estimate the national prevalence, condition-specific expenditures, and payer distribution for treated knee injuries and shoulder disorders. Methods: Adults with treated knee injuries or shoulder disorders were identified using ICD-10-CM codes from the MEPS Medical Conditions File. Condition-specific expenditures were estimated by linking diagnoses to medical events and payments using the MEPS Condition–Event Link File. Expenditures were aggregated across inpatient, outpatient, office-based, emergency, home health, and prescribed medicine categories. Survey-weighted analyses were used to estimate national prevalence, mean expenditures, service-level spending patterns, and payer distributions. Survey-weighted Gamma generalized linear models with log link were used to examine patient characteristics associated with expenditures among the U.S. civilian noninstitutionalized population with positive condition-specific spending. Results: The analysis identified 2.55 million adults with treated knee injuries and 2.58 million adults with treated shoulder disorders. Mean annual condition-specific expenditures per person were higher for knee injuries ($10,552; 95% CI: $6128–$14,975) than for shoulder disorders ($4310; 95% CI: $3337–$5283). Knee injury expenditures were concentrated in inpatient and home health care, whereas shoulder disorder expenditures were concentrated in outpatient and office-based care. Private insurance, Medicare, out-of-pocket payments, and Worker’s Compensation each contributed to the financial burden, with payer distributions varying by condition. In adjusted models, fair/poor self-rated health and female sex were associated with higher knee injury expenditures, while no covariates were statistically significant for shoulder disorder expenditures. Conclusions: Treated knee injuries and shoulder disorders showed distinct condition-specific expenditure profiles across care settings and payer sources. These findings provide contemporary national benchmarks for orthopaedic spending and may support future research, utilization monitoring, and value-based reimbursement planning. Full article

Background: Congenital heart defects (CHD) are prevalent, affecting 1% of live births globally. Despite improved survival rates, adults with CHD face increased risks of psychological distress and neurocognitive deficits. The P-BAHn study (P-BAHn = “Psyche Bei Angeborenen Herzfehlern”, Psyche for congenital heart defects) evaluates the mental health status and psychosocial challenges of German children and adolescents with CHD, focusing on retrospectively assessed COVID-19-related burden and patient-/parent-rated experiences with psychological, psychotherapeutic, or psychiatric treatment (PST). Methods: A cross-sectional, online-based survey was conducted using the National Register for Congenital Heart Defects (NRCHD). The final dataset comprised 1567 respondent-level records from 1310 families, including 992 parent reports and 575 self-reports from children/adolescents aged 6 to <18 years. The survey assessed mental health, emotional well-being, psychosocial status, demographics, medical history, and psychological treatment. Data were analyzed descriptively using chi-square tests and t-tests for exploratory unadjusted group comparisons. In addition, exploratory multivariable logistic regression analyses were performed for selected key outcomes. Results: School-related stress was common in young CHD patients (45.3%) and was associated with older age and female sex (51.5% female vs. 35.6% male) in adjusted analyses. Overall, 17.0% of patients reported having a mental illness, most commonly anxiety (6.8%), eating disorders (5.6%), and depression (4.7%); neither sex nor CHD severity was significantly associated with self-reported mental illness in adjusted analyses. Less good/poor self-rated health was associated with older age and complex CHD in both patient and parent reports. Retrospectively assessed pandemic-related changes were perceived as quite or extremely stressful by 23.9% of patients. High COVID-19-related burden was associated with female sex, whereas CHD severity was not significant after adjustment. Among patients with previous or current PST, patient- and parent-rated treatment benefit varied by patient sex and CHD complexity. Previous/current PST was reported by 25.9% of patients and 23.8% of parents and was associated with older age in both respondent groups and with complex CHD in parent reports. Among patients with previous/current PST, 56.4% reported high perceived support. Conclusions: The P-BAHn study highlights the need for targeted psychosocial support for children and adolescents with CHD, including female patients, those with complex conditions, and patients reporting school- or crisis-related burden. Retrospectively reported pandemic-related burden underscores the importance of integrating crisis-sensitive strategies into psychosocial care frameworks. Longitudinal studies are essential to understand mental health trajectories and to evaluate the sustained patient- and parent-perceived benefit as well as clinical effectiveness of PST use. Enhancing support services and refining intervention models will improve the well-being and quality of life for young CHD patients. Full article

Background/Objectives: Adolescent suicidal ideation and non-suicidal self-injury (NSSI) are major public health concerns, yet differences between active interventions are often modest. This retrospective study provides preliminary descriptive evidence regarding short-term symptom change across two school-based intervention pathways—Sandplay Therapy with Suicidal ideation and Self-injury Focused Engagement (SPT-SAFE) and a Dialectical Behavior Therapy-informed Brief Intervention (DBT-BI)—in a clinical sample of middle- and high-school adolescents with suicidal ideation and NSSI. Methods: Archival clinical records from 112 adolescents treated in a school-based suicide prevention center were analyzed retrospectively. The sample included 52 adolescents who received SPT-SAFE and 60 who received DBT-BI. Outcomes included suicidal ideation, NSSI frequency, depressive symptoms, anxiety, aggression, impulsiveness, and self-concept. Pre–post changes were examined using mixed-design ANOVAs, with baseline-adjusted ANCOVAs conducted as supplementary analyses. Given the retrospective and clinically assigned design, findings were interpreted as observational associations rather than causal treatment effects. Results: Both intervention groups showed significant pre–post improvements across multiple outcome domains. Overall between-group differences were limited. A nominal, uncorrected Group × Time interaction was observed for impulsiveness, with the DBT-BI group showing a descriptively larger pre–post decrease than the SPT-SAFE group. However, this effect was small and did not remain statistically significant after Bonferroni correction or Benjamini–Hochberg false discovery rate correction across the seven interaction tests. No other outcome showed a multiplicity-adjusted Group × Time interaction. Conclusions: The present study did not provide robust multiplicity-adjusted evidence for differential treatment effects between SPT-SAFE and DBT-BI. The nominal impulsivity finding should be interpreted only as a small, uncorrected exploratory signal for future hypothesis generation. The contribution of this study is therefore descriptive and preliminary, characterizing short-term symptom change in a treatment-engaged adolescent completer sample within a routine school-based service system, rather than supporting domain-specific comparative efficacy or domain-sensitive intervention planning. Full article

Sexuality education is a key component of sexual and reproductive rights; however, important inequities persist across populations, particularly among people with disabilities. This study examines perceived quality of sexuality education in Chile, with a primary focus on disability-related inequities and a specific analytic emphasis on women with disabilities. We analysed data from the 2022–2023 National Survey on Health, Sexuality, and Gender (n = 17,679). The outcome was self-reported perceived quality of sexuality education. Survey-weighted descriptive analyses and ordinal logistic regressions were conducted. One model included the full sample, and a second focused on women with disabilities (n = 2324). Predicted probabilities were estimated for key interactions. Nearly half of participants reported poor sexuality education (47.2%). Predicted probabilities indicated consistently lower probabilities of reporting good sexuality education among people with disabilities across gender groups and most age groups. Among women with disabilities, higher education (secondary: odds ratio (OR) = 2.53, 95% Confidence Interval (CI): 1.84–3.49; tertiary: OR = 1.74, 95% CI: 1.12–2.72), foreign nationality (OR = 2.87, 95% CI: 1.27–6.50), and good self-rated health (OR = 1.74, 95% CI: 1.14–2.66) were associated with higher perceived quality, indicating heterogeneity within this population. These findings highlight consistent disability-related inequities in the perceived quality of sexuality education and underscore the need for inclusive, accessible, and gender-sensitive approaches grounded in human rights. Full article

Background/Objectives: South Korea became a super-aged society in 2024, and this demographic shift is unfolding alongside the depopulation of rural municipalities across the country. How spatial inequality and community social capital jointly relate to elderly health—and whether those relationships look different for younger versus older elderly—remains an open question. We investigated associations between two dimensions of community social capital (sense of belonging and neighbor communication), subjective perception of capital–provincial inequality, and self-rated health among Korean elderly, with separate analyses for the Young-Old (aged 60–69) and Old-Old (aged 70+). Methods: We used the 2024 Social Integration Survey from the Korea Institute of Public Administration (full sample N = 2588; elderly subsample N = 1020). Random intercept hierarchical linear models accounted for the nesting of individuals within 17 metropolitan cities and provinces. Stepwise models examined social capital antecedents, a healthcare satisfaction indirect association pathway, and the direct association of spatial inequality perception with health. The elderly subsample was stratified into Young-Old (N = 289) and Old-Old (N = 731). A mixed-effects ordered logistic regression with Liang–Zeger cluster-robust standard errors was estimated as a robustness check. Results: Sense of belonging was positively associated with subjective health among the elderly (B = 0.065, p < 0.05) as a net of rurality and socioeconomic controls. Perceived spatial inequality showed a negative association (B = −0.070, p < 0.05). The indirect association pathway through healthcare satisfaction was not supported (Sobel Z = −1.458, p = 0.144). Age-stratified models revealed a striking split: belonging was the dominant predictor for the Young-Old (B = 0.149, p < 0.01), while neighbor communication (B = 0.078, p < 0.05) and spatial inequality perception (B = −0.092, p < 0.01) were significant only among the Old-Old. The ordered logistic robustness check confirmed the negative association of perceived spatial inequality across all specifications. Conclusions: What predicts health in the younger elderly is not what predicts health in the older elderly. Korea’s Integrated Community Care Act, set for nationwide rollout in 2026, should account for this divergence—prioritizing psychological community attachment for the Young-Old and face-to-face social contact combined with regional equity for the Old-Old. Full article

In megacities, where conventional mitigation strategies exhibit variable and environment-dependent performance, urban air pollution continues to be a significant public health concern. To methodically assess the operational reliability of urban smog mitigation systems under dynamic atmospheric conditions, this study proposes a data-driven failure analysis approach. A machine learning architecture based on Random Forest and XGBoost algorithms is developed using integrated meteorological and air quality metrics from Lahore, Pakistan, such as temperature, wind speed, and relative humidity. AQI is used as an integrated pollution indicator alongside meteorological variables to enhance the model’s ability to capture overall atmospheric pollution impact and improve the accuracy of smog mitigation failure prediction. This study presents a data-driven framework for predicting the failure of smog mitigation methods based on meteorological conditions. Unlike existing approaches that primarily focus only on air quality prediction, this work identifies specific environmental conditions, along with AQI as an input feature, to determine when mitigation strategies become ineffective. This enables proactive decision-making to maintain healthy indoor air quality. A threshold-controlled indoor air purification system that self-activates when the model predicts mitigation failure using real-time sensor inputs is introduced to address outdoor mitigation restrictions. PM_2.5 reduction efficiency, clean air delivery rate, and energy consumption indicators are used to evaluate the purifier’s optimized performance. Predicting mitigation failure rather than just pollution levels and connecting it with an intelligent interior reaction mechanism is what makes this research novel. In a comparative analysis, Random Forest outperforms XGBoost with an accuracy of 95.5% as opposed to 94.5%, as well as higher precision (96.9%), recall (96.1%), and F1-score (96.5%). The purifier lowered indoor AQI from dangerous to safe levels within 30–40 min. Full article

Background: Mental health disorders such as depression, anxiety, and stress are increasingly prevalent among university students and contribute to long-term cardio-cerebrovascular disease (CCVD) risk. However, limited research has examined the interplay between mental health, CCVD risk factors, and religiosity/spirituality within Southeast Asia’s multicultural context. Methods: This cross-sectional study investigated these relationships among 484 undergraduate students enrolled in medical and health sciences programs across Peninsular Malaysia. Mental health status was assessed using the Depression, Anxiety, and Stress Scale (DASS-21). Self-reported clinical indicators associated with early CCVD vulnerability were also assessed. Religiosity and spirituality were measured using the Duke University Religion Index (DUREL), Brief Religious Coping (RCOPE), Spirituality Scale (SS), and Spiritual Coping Questionnaire (SCQ). Results: High prevalence rates of severe anxiety (50.4%), depression (29.3%), and stress (21.1%) were observed, with significant associations across ethnicity, religion, and academic programs. Higher religiosity and spirituality were generally associated with better mental health outcomes. However, coping style emerged as a key modifier of the relationship between religiosity/spirituality and mental health outcomes, with negative religious coping associated with greater psychological distress, whereas positive coping demonstrated mixed associations and partial mediating effects. Students with poorer mental health also exhibited higher CCVD risk burden. Conclusions: These findings highlight the importance of culturally and spiritually sensitive strategies in promoting student well-being. Full article

The hepatitis B (HBV), C (HCV), and D (HDV) viruses remain a major public health burden. Occult HBV infection (OBI) represents a hidden reservoir with clinical and epidemiological significance, yet its prevalence in Northwest Russia is unknown. We aimed to comprehensively assess the serological and molecular epidemiology of HBV, HCV, and HDV in St. Petersburg and the Leningrad region. Methods. In this cross-sectional study, 6773 apparently healthy volunteers were enrolled. Plasma samples were tested for hepatitis B surface antigen (HBsAg), antibodies to HBV core antigen (anti-HBc), antibodies to HBsAg (anti-HBs), antibodies to HCV (anti-HCV), and antibodies to HDV (anti-HDV) by ELISA. All anti-HCV- and anti-HDV-positive samples were tested for HCV RNA and HDV RNA by real-time PCR. All samples were tested for HBV DNA using a highly sensitive in-house nested real-time PCR assay (detection limit: 5 IU/mL). All “HBV DNA-positive, HBsAg-negative” cases confirmed by two independent extractions were classified as OBI. Vaccination status, self-reported history, and iatrogenic interventions were recorded. Results. Overall seroprevalence values were: HBsAg 1.7%; anti-HBc 11.3%; anti-HBs 43.0%; anti-HCV 1.9%; and anti-HDV 0.6%. Anti-HBc increased sharply with age (3.1% in children to 26.4% in the elderly, p < 0.0001), while anti-HBs declined (69.9% to 29.8%, p < 0.0001). HBV DNA was detected in 118 participants (1.7%). Of these, only 73 individuals (1.1%) were HBsAg-positive, while the remaining 45 participants (0.7%) had undetectable HBsAg, meeting the criteria for OBI. OBI was detected across all age groups, including children. Serological profiling of OBI cases revealed that 57.8% lacked both anti-HBc and anti-HBs, 35.6% had isolated anti-HBs, 2.2% had isolated anti-HBc, and 4.4% had both antibodies. HCV RNA was detected in 15.0% of anti-HCV-positive individuals (all adults). No HDV RNA was detected. Self-reported history underestimated true infection rates: 1.4% of those denying HBV infection were HBsAg-positive and 10.6% were anti-HBc-positive. Among those denying HCV infection, 1.4% were anti-HCV-positive. Vaccination coverage was 70.8%, declining from 90.9% in children to 39.0% in the elderly (p < 0.0001). Among vaccinated individuals, 48.0% lacked protective anti-HBs (<10.0 mIU/mL). Conclusions. This comprehensive serological and molecular study in Northwest Russia is the first to combine population-level serology with molecular detection of HBV, HCV, and HDV, including OBI in this region, and reveals that OBI accounts for a substantial proportion (38%) of all active HBV infections and is strongly associated with a history of iatrogenic interventions. The presence of OBI across all age groups, including children, shows that HBsAg screening alone substantially underestimates the true HBV burden. High rates of unrecognized infection and waning vaccine-induced immunity, highlight critical gaps in current surveillance. These findings provide an evidence-based rationale for integrating molecular testing into screening algorithms and for considering booster vaccination strategies to achieve viral hepatitis elimination goals. Full article

Background: Epidemiological alerts about the possible spread of different pathogens have highlighted the risk of international travelers contracting infectious diseases when visiting endemic areas. The role of travelers in disease transmission underscores the importance of pre-travel consultations, which provide critical information on health risks, vaccinations, and preventive measures. Understanding travelers’ risk perceptions and behaviors is essential for enhancing global health security in the post-pandemic era. Methods: A cross-sectional study (June 2023–January 2024) was conducted by administering an anonymous questionnaire at the Rome-Fiumicino Airport International Prophylaxis Clinic (USMAF-SASN). The questionnaire explored demographics, travel patterns, risk perceptions, vaccination behaviors, and sources of health information. Descriptive statistics and a multivariable logistic regression analysis were performed to identify low-risk perception predictors. Results: Among 217 participants, 89.8% were Italian, with a balanced representation of genders. The primary purpose of travel was tourism (61.6%), followed by work-related trip (23.1%). While 77.1% rated preventive measures as effective, 23.2% evaluated infection risk as low. Being male (aOR 3.63, 95% CI 1.37–9.61), and being a hotel user (aOR 6.27, 95% CI 2.43–16.15), was significantly associated with a lower risk perception. As expected, healthcare professionals and individuals using institutional healthcare sources showed a higher risk awareness. Vaccination uptake at the Airport Clinic was motivated by self-protection, vaccine confidence, and poor time flexibility to access local vaccination services, and last-minute plans, making the airport a more convenient option. Conclusions: Travelers’ risk perception is influenced by gender, profession, accommodation type, and information sources. Public health strategies should enhance health literacy, promote pre-travel consultations, and improve access to preventive services. Strengthening collaborations between health authorities, educational institutions, and the travel sector is key to mitigating health risks and ensuring global health security. Future interventions should address structural vaccination barriers and improve outreach to under-informed travelers. Full article

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

Background/Objectives: Adolescents living with HIV (ALHIV) face compounded health and psychosocial challenges while managing lifelong antiretroviral therapy (ART). Mental health difficulties among ALHIV are strongly associated with suboptimal adherence and disengagement from care. While mental illness is well documented, limited empirical evidence exists on the influence of positive mental wellness on adherence self-efficacy among ALHIV. This study assessed mental wellness among ALHIV and identified key psychosocial predictors of adherence self-efficacy in public healthcare facilities in Cape Town, South Africa. Methods: A cross-sectional survey was conducted among ALHIV (N = 251) aged 10–19 years who were receiving ART at public healthcare facilities across the Cape Town metropole. Participants completed an electronic questionnaire that assessed ten mental wellness domains and adherence self-efficacy. Descriptive statistics were calculated to summarise participant characteristics and mental wellness scores, while Pearson correlations and multiple linear regression were done to identify associations and independent predictors of adherence self-efficacy using SPSS v29. Results: Most participants were aged 15–19 years (76.9%) and diagnosed with HIV at birth (68.9%). Mental wellness scores were high across all domains (M = 3.14–3.71). Hope (M = 3.71), spirituality (M = 3.58), and purpose in life (M = 3.52) were the highest-rated domains. All mental wellness domains were positively correlated with adherence self-efficacy (p < 0.001), with the strongest associations being purpose in life (r = 0.66), self-acceptance (r = 0.66) and resilience (r = 0.66). Hope (p < 0.001), resilience (p = 0.001), purpose in life (p = 0.03) and self-acceptance (p = 0.012) emerged as significant independent predictors. Conclusions: Positive mental wellness and adolescent-centred psychosocial support in routine HIV care may strengthen adherence self-efficacy and support adolescents’ confidence in managing treatment. Full article

Background/Objectives: Growing concern about narcissistic traits in younger generations and their effects on empathy, communication, and mental health underscores the need for focused research on medical students as future healthcare professionals. Medical training carries a substantial psychological burden that can compromise students’ well-being, professional development, and the future quality of patient care. Personality traits, including grandiose and vulnerable narcissistic dimensions, may shape susceptibility to such psychological distress. Therefore, this study aimed to examine narcissistic traits and their associations with psychological distress among Croatian medical students across study years and trait levels. Methods: In this cross-sectional study, 413 medical students from the University of Split completed self-administered questionnaires during mandatory classes. Narcissistic traits were assessed using the Pathological Narcissism Inventory (PNI) and psychological distress was measured with the Brief Symptom Inventory (BSI). High pathological narcissistic traits were operationally defined as scores within the highest quartile. Statistical analyses included correlation, comparative, and regression analyses. Results: Overall, pathological narcissistic traits were expressed at low to moderate levels and did not differ across academic years. High narcissistic traits were identified in 35% of students, with 15% exhibiting elevated levels of both grandiose and vulnerable dimensions, suggesting an overlap between the two dimensions. Gender differences emerged across both narcissistic dimensions, with women scoring higher on vulnerable and men scoring higher on grandiose narcissism. One-quarter of students met the criteria for clinically significant psychological distress, which was more prevalent in the earlier years of study. High levels of pathological narcissistic traits, particularly vulnerable traits, were significantly associated with clinically significant distress and elevated symptoms across nearly all BSI domains, most notably interpersonal sensitivity and paranoid ideation. Despite this burden, only a minority of distressed students reported seeking psychological help. Conclusions: Elevated pathological narcissistic traits are significantly associated with psychological distress in medical students. The high prevalence of distress, combined with low help-seeking rates, underscores the need for early identification strategies and structured mental health support within medical education. Addressing personality-related vulnerability factors may improve student well-being, enhance professional development, and, ultimately, elevate the quality of healthcare delivery. Full article

Background: Adolescence is a critical period for emotional well-being, and individuals with gluten-related disorders (GRDs) may face additional psychological challenges. This study aims to explore the relationship between emotional well-being and GRDs in adolescents. Methods: A cross-sectional study was conducted using data from the DESKcohort project, consisting of a biannual panel survey on health, health behaviours, and associated determinants, collected in secondary education centres. The final analytical sample consisted of 9265 students aged 12 to 18 years. Data were collected from October 2021 to June 2022. The dependent variables relate to emotional well-being and are assessed through a series of mood-related questions. The independent variables included were having GRDs, health behaviours and socioeconomic factors. Poisson regression models with robust variance were used to assess the association between the impact of GRDs and emotional states, providing prevalence ratios with 95% confidence intervals. Results: Prevalence of adolescents with GRD was 1.15%, with a higher rate in girls (1.51%) compared to boys (0.79%) (p < 0.001). While there were no significant emotional differences between adolescents with and without GRDs overall (p > 0.05), Poisson regression models with robust variance showed that those with digestive symptoms had a significantly higher prevalence of emotional distress, most notably in feeling sad or depressed (PR = 2.52; 95% CI: 1.64–3.88) and fatigue (PR = 1.90; 95% CI: 1.51–2.38). Conclusions: The presence of digestive symptoms in adolescents with self-reported GRDs is associated with a higher prevalence of emotional distress. Public health strategies should specifically target this symptomatic subgroup to address their psychological and nutritional needs. Full article