Search Results (208)

Background: Pediatric oncological diagnoses and treatments pose complex biopsychosocial challenges for both patients and their families. These experiences can significantly disrupt daily life, evoke intense emotional responses, and raise concerns about the future, often leading to long-term psychological implications. Objective: This study aimed to assess the emotional functioning of children undergoing cancer treatment and to explore the lasting psychological effects reported by young adult survivors of pediatric cancer. Methods: A mixed-methods approach was employed. In total, 52 minors and their caregivers were recruited from two pediatric oncology units in Italy (Turin and Bari), while 18 young adults diagnosed during childhood were recruited from clinical and community settings in Ancona and Bari. Standardized instruments were used to evaluate emotional symptoms and broader psychological functioning in the pediatric sample, while self-report measures assessed psychological well-being and quality of life in the young adult group. To complement these data, semi-structured interviews were conducted with the young adult survivors to investigate the long-term psychosocial and psychological impacts of pediatric cancer. Results: The quantitative results indicate generally low levels of psychological distress in both groups. However, the qualitative findings reveal the complexity of post-cancer identity, highlighting experiences of resilience, emotional ambivalence, and redefinition of self. Conclusions: These results underscore the importance of addressing the psychological well-being of pediatric oncology patients and young adult survivors beyond the medical treatment phase, with a focus on long-term psychosocial support and individualized care. Full article

Background: Recovery is an emerging approach. In Chile, attempts are being made to introduce the Recovery Model with specific guidelines for the care of people diagnosed with Severe Mental Disorders. The participation of nurses in this process is peripheral to the biomedical model. Objectives: To explore the participation of nurses in the recovery process of people hospitalised in Psychiatric Intensive Care between 2023 and 2024. Methods: Qualitative research, collective-case multisite study design in four hospitals. With the approval of four ethics committees, 18 nurses who signed informed consent were interviewed. Rapid qualitative analysis was performed. Results: Nursing care is mainly related to the caregiving, educational, and management roles. Recovery is associated with clinical improvement, and different components are identified, such as family and social support, the ability to resume control of one’s life, the existence of a future life plan, and the ability to manage one’s own illness. Conclusions: The results are consistent with elements described in contemporary approaches to recovery, incorporating autonomy, confidence in the person’s abilities, and shared decision-making. However, they are still far from modern approaches to personal and non-clinical recovery. Nursing needs to redirect its efforts toward recovery with a paradigm shift toward a model in which the person affected by a mental health condition is the protagonist of their own health process. Full article

Background: Autism Spectrum Disorder (ASD) affects ~1 in 36 children and is increasingly studied as a candidate for non-invasive neuromodulation. Two of the most widely applied modalities are quantitative EEG (QEEG)-guided repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), both targeting the dorsolateral prefrontal cortex (DLPFC). While both have shown promise, questions remain regarding their relative clinical profiles and scalability. Objective: To conduct a within-cohort reanalysis of QEEG-guided rTMS outcomes in paediatric ASD and to contextualise these findings alongside published reports of home-supervised tDCS. Methods: Individual participant data (n = 56, ages 6–17) from a prospective rTMS cohort were reanalysed, focusing on the Social Responsiveness Scale (SRS-2), Autism Diagnostic Observation Schedule (ADOS-2), Aberrant Behavior Checklist (ABC), Repetitive Behavior Scale–Revised (RBS-R), and QEEG biomarkers. Findings were then situated within a narrative synthesis of published paediatric tDCS trials, which consistently report caregiver-supervised feasibility but did not provide raw, baseline-adjusted data suitable for reanalysis. Results: rTMS was associated with large within-cohort improvements (Hedges’ g ≈ 1.0–1.6), including an 11-point reduction in SRS-2 T-scores, a 12-point reduction in ABC totals, and robust QEEG normalisation (β/γ suppression, α enhancement). Published tDCS studies report moderate, clinically meaningful improvements in social communication, executive functioning, and regulation (Cohen’s d ≈ 0.4–0.6), with excellent adherence and no serious adverse events. Conclusions: rTMS produced robust behavioural and neurophysiological improvements within its cohort, while published tDCS trials demonstrate moderate, feasible benefits in home settings. Because of incomplete baseline data and protocol differences, no direct statistical comparison was possible. These findings suggest complementary roles: rTMS as a high-intensity clinic-based intervention, and tDCS as a scalable, family-centred option. A stepped-care framework that combines both modalities should be considered hypothesis-generating only and requires validation in harmonised, randomised controlled trials. Full article

Intensive mothering is a widespread cultural ideology positioning mothers as uniquely responsible for their children’s optimal development through emotionally and cognitively intensive caregiving. A key belief within this framework is maternal essentialism, which asserts that mothers are biologically and morally best suited for parenting young children. Guided by the Family Stress–Proximal Process (FSPP) model, this study examined whether maternal essentialist beliefs act as distal sociocultural stressors influencing children’s executive functioning indirectly through parenting stress and positive parenting behaviors. Data were collected via self-report from 255 U.S. mothers of 3- to 5-year-old children. Path analyses showed that stronger maternal essentialism was associated with increased parenting stress, which predicted lower engagement in positive parenting and greater reported difficulties in children’s executive functioning. The indirect effect of maternal essentialism on children’s executive functioning was statistically significant. These findings suggest that internalized cultural ideologies, often viewed as aspirational, may inadvertently increase parenting stress and reduce caregiving quality, which is associated with diminished child cognitive outcomes. This study extends prior research by linking maternal essentialist beliefs to child developmental outcomes through specified psychological and relational processes, supporting the usefulness of the FSPP framework in understanding how sociocultural pressures influence family dynamics and child development. Full article

Background: Parent-reported experience in neonatal units is a key but under-measured dimension of family-centred care in Poland. We piloted a brief parent-experience questionnaire informed by the Neonatal Satisfaction Survey (NSS-8) and communication constructs from the Parents’ Experiences of Communication in Neonatal Care (PEC) to describe in-hospital experience and identify actionable targets for improvement. Methods: Observational, cross-sectional pilot at a Polish tertiary centre (September–November 2021). Parents of hospitalized neonates completed a 21-item survey covering educational materials, medical care/communication, parental stress/confidence, hospitalization details, and sociodemographics. Analyses were descriptive with item-wise denominators (n = 32–46). Results: Forty-six parents participated. Educational materials were rated very highly: parental guide 9.8/10 (n = 46); brochure readability 10/10 (n = 46), indicating ceiling effects. Perceptions of care and communication were favourable: overall care 4.47/5, physician concern 4.62/5, ward conditions 4.47/5, explanation of test indications 4.23/5, and adequacy/understandability of information 4.35/5 (each n = 35; medians = 5). Despite this, parental stress/anger/insomnia was moderate (3.00/5; n = 35), while confidence in basic home care remained high (4.10/5; n = 35). Following discharge, 17/46 (37.0%) sought specialist consultations. Length of stay (n = 34) had a median of 1 day (0–4). Reasons for admission most frequently included multisymptom presentations (20/46, 43.5%); respiratory (8.7%) and infectious (6.5%) causes were less common. Conclusions: Parents reported very positive care and communication alongside persistent emotional burden and substantial post-discharge information needs. Findings support pairing a broad experience framework with a focused communication module, standardizing discharge communication (including a 48–72 h “bridging” contact), and progressing to a multicentre psychometric validation. This exploratory pilot was not a formal validation study; mixed scales and item-wise missingness should guide instrument refinement. Full article

Background/Objectives: Unintentional home injuries (UHIs) are a major yet preventable cause of morbidity and mortality among children. This study aimed to analyze the epidemiological characteristics, injury mechanisms, and clinical outcomes of pediatric UHIs over a nine-year period in Türkiye. Methods: This retrospective study included all children under 18 years who were diagnosed with UHIs in the Pediatric Emergency Department (PED) of a tertiary university hospital between January 2016 and November 2024. Demographic data, injury mechanisms, imaging findings, surgical interventions, hospitalizations, and Pediatric Intensive Care Unit (PICU) admissions were statistically analyzed. Results: Among 852,090 PED visits, 12,327 (1.4%) were diagnosed with UHIs. Most patients were younger than five years (72.1%) and male (56.8%). The leading causes were falls/collisions (60.6%), burns (12.1%), and foreign body aspirations (10.4%). Hospitalization and PICU admission rates were 11.7% and 1.2%, respectively, mainly involving children aged 2–4 years. Younger age and corrosive ingestion were independent predictors of hospitalization, while burns, falls/collisions, corrosive ingestion, poisoning, and foreign body aspiration significantly increased PICU admission risk. A marked rise in both hospital and PICU admissions was observed during the COVID-19 pandemic. Two fatalities occurred following falls. Conclusions: Falls, burns, and foreign body aspirations were the most common causes of pediatric UHIs, predominantly affecting children aged 2–4 years. Strengthening caregiver supervision, promoting safer home environments, and implementing targeted prevention programs are essential to reduce their impact on children and healthcare systems. Full article

Underemployment in Australia represents a critical facet of precarious work, shaped not only by insufficient hours and skill underutilisation but also by care responsibilities and financial insecurity. Using data from the Household, Income and Labour Dynamics in Australia (HILDA) Survey, this study employed latent class analysis (LCA), a person-centred, model-based clustering method, to uncover hidden subgroups within the underemployed population. Previous studies identify different profiles, but few embed care burden and financial stress as core latent dimensions. This study extends latent class approaches by integrating multidimensional vulnerabilities into subgroup analysis. The LCA analysis revealed four distinct classes. These findings confirmed three hypotheses: (H1) Care burden is a core latent dimension of underemployment (Classes 1 and 2), (H2) economic insecurity is a second defining dimension (Class 3), and (H3) a mental health/social isolation subgroup exists (Class 4). Class 1 exhibits dual care burdens and high representation from culturally and linguistically diverse (CALD) backgrounds. Class 2, Parents with Children, forms the largest group and is defined by intensive childrearing and caregiving roles. Class 3, Financially Strained Undereducated, includes individuals with low educational attainment experiencing pronounced financial hardship. Class 4, Socially Isolated with Poor Mental Health, represents the smallest yet most disadvantaged group, characterised by severe psychological distress, lack of social support, and acute financial vulnerability. Together, these findings highlight the need for tailored policy responses for diverse experiences among the underemployed and reveal intersecting social and economic disadvantages. Full article

Stroke is one of the leading causes of disability worldwide. Its sequelae require early, intensive, and repetitive rehabilitation, but is often ineffective due to a lack of patient motivation. Gamification has been incorporated in recent years as a response to this issue. The aim of incorporating games is to motivate patients to perform therapeutic exercises. This study presents PACTUS, a new version of a gamified device for stroke neurorehabilitation. Using a series of colored cards, a touchscreen station, and a sensorized handle with an RGB sensor, patients can interact with three games specifically programmed to work on different areas of neurorehabilitation. In addition to presenting the technical design (including energy consumption and sensor signal processing), the results of an observational study conducted with neurological patients, healthy older adults, and caregivers (who also completed the System Usability Scale) are also presented. This usability, safety, and satisfaction study provided an assessment of the device for future iterations. The inclusion of the experiences of the three groups (patients, caregivers, and older adults) provided a more comprehensive and integrated view of the device, enriching our understanding of its strengths and limitations. Although the results were preliminarily positive, areas for improvement were identified. Full article

Introduction: Chronic intestinal failure (CIF) and the resulting dependence on home parenteral nutrition (HPN) often occur abruptly, profoundly disrupting the daily lives of patients and their caregivers. Both groups face persistent psychological and relational challenges, yet evidence on their long-term mental-health trajectories remains scarce. This study aimed to assess the progression of anxiety symptoms over 12 months in CIF patient–caregiver pairs, and to explore whether participation in a systemic–relational psychotherapy program could influence these outcomes. Methods: The Hamilton Anxiety Rating Scale (HAM-A) was administered to all participating patient–caregiver pairs, who were also invited to attend free biweekly psychotherapy sessions for one year. Pairs who accepted (Group Y) were compared with those who declined (Group N). Results: At baseline, both patients and caregivers in both groups exhibited high anxiety levels. Group Y (n = 10) patients had significantly higher total HAM-A scores than Group N (n = 40) patients (p = 0.048); a similar, non-significant trend was observed among caregivers. Emotional and somatic component scores remained largely unchanged at 6 and 12 months, regardless of group allocation. Conclusions: CIF imposes a substantial and persistent anxiety burden on both patients and caregivers. In this cohort, a brief systemic–relational psychotherapy program, offered quarterly, did not significantly modify anxiety levels over 12 months. These findings highlight the need for more intensive, sustained, and possibly earlier psychological interventions tailored to the dyadic experience of living with CIF and HPN. Full article

Background/Objectives: Undergoing intensive cancer treatment, such as allogeneic haematopoietic stem cell transplantation, challenges the entire life situation of patients and their family caregivers. A prerequisite for effective care is that interventions are tailored to the unique circumstances of each individual. The aim of this study was to examine the feasibility of a developed person-centred nursing model in this context. Methods: The nursing model involves systematic use of conversation tools with subsequent conversations to assess and address the needs of patients (two tools) and their family caregivers (one tool). Patients, family caregivers and registered nurses from two Swedish stem cell transplantation centres testing the model were included. Data to measure practicality were gathered from the tools and documented conversations, while acceptability was assessed from the interviews. Results: 36 patients, 32 family caregivers and 16 registered nurses participated. 67–94% of the patients and 94% of the family caregivers completed the tools. 78–97% of the subsequent conversations were conducted as planned. 78% of the patients and registered nurses were positive about one of the patient tools, while 41% were positive about the other patient tool. 95% of the family caregivers and registered nurses were positive about the family caregiver tool. Most participants considered that the systematic use of tools helped to structure a holistic needs assessment. Conclusions: This feasibility study indicates that most components of our nursing model are practical, acceptable and support registered nurses when conducting person-centred nursing. With further development, the model has the potential to enhance the quality of care and support within the cancer context. Full article

Background: In response to the high prevalence of burnout in nursing, a hospital research team developed, studied, and implemented RISE (Resilience, Insight, Self-Compassion, Empowerment), a novel psychoeducational group program designed to reduce distress and promote well-being among professional caregivers, specifically nurses and nurse leaders. Pilot studies and randomized controlled trials showed positive results, and thus, the program was operationalized. Methods: This quality improvement/quality assurance (QI/QA) project involved scaling the program and gathering data to evaluate implementation and impact on well-being indicators. The intervention involves structured weekly (8–9 weeks) 90-min group sessions integrating mindfulness, cognitive-behavioral techniques, and acceptance and commitment therapy. Eight licensed mental health providers were trained and delivered the program. Implementation outcomes included adoption/stakeholder engagement, fidelity, provider satisfaction, participant engagement, and sustainability. Participant outcomes were measured through validated scales and participant feedback forms. The implementation process was examined at the participant, provider, and organizational levels to identify barriers and enabling factors. Results: The program was implemented in seven acute care hospitals. From January 2023 to December 2024, 160 participants completed the program. Effective implementation strategies included intensive training and supervision of qualified providers, multi-departmental collaborations, and rigorous fidelity monitoring. Quality improvement processes addressed challenges such as early attrition and administrative burden. Evaluation data from pre- and post-intervention surveys demonstrated statistically significant improvements in psychological outcomes, with high satisfaction reported by both participants and providers. Conclusion: The findings support the effective implementation of the program as part of a broader organizational strategy to address nurse burnout and workforce mental health. Lessons, implications, and future directions for healthcare leaders are discussed. Full article

Background/Objectives: Automatic pain detection from speech signals holds strong promise for non-invasive and real-time assessment in clinical and caregiving settings, particularly for populations with limited capacity for self-report. Methods: In this study, we introduce a lightweight recurrent deep learning approach, namely the Gated Recurrent Unit (GRU)-Mixer model for pain level classification based on speech signals. The proposed model maps raw audio inputs into Log-Mel spectrogram features, which are passed through a stacked bidirectional GRU for modeling the spectral and temporal dynamics of vocal expressions. To extract compact utterance-level embeddings, an adaptive average pooling-based temporal mixing mechanism is applied over the GRU outputs, followed by a fully connected classification head alongside dropout regularization. This architecture is used for several supervised classification tasks, including binary (pain/non-pain), graded intensity (mild, moderate, severe), and thermal-state (cold/warm) classification. End-to-end training is done using speaker-independent splits and class-balanced loss to promote generalization and discourage bias. The provided audio inputs are normalized to a consistent 3-s window and resampled at 8 kHz for consistency and computational efficiency. Results: Experiments on the TAME Pain dataset showcase strong classification performance, achieving 83.86% accuracy for binary pain detection and as high as 75.36% for multiclass pain intensity classification. Conclusions: As the first deep learning based classification work on the TAME Pain dataset, this work introduces the GRU-Mixer as an effective benchmark architecture for future studies on speech-based pain recognition and affective computing. Full article

With the acceleration of global population aging, rural areas face particularly severe challenges due to youth outmigration and uneven resource distribution. Taking Jiashan Village in Wuhan as a case study, this research combines the planning–activity model of new time–geography with Maslow’s hierarchy of needs to investigate the behavioral and emotional characteristics of the elderly and their spatial adaptation requirements. Using GPS tracking of 30 participants, questionnaires (152 valid responses; 73.4% response rate), facial expression recognition, and the stated preference (SP) method, the study classified elderly lifestyles into four types: leisure-oriented, agricultural-labor-oriented, caregiving-oriented, and self-employment-oriented. The results show significant heterogeneity in spatial needs, social intensity, and emotional responses. A quantitative analysis using the multinomial logit model indicates that farmland optimization had the greatest positive utility (+1.5873), followed by the addition of new plazas and leisure facilities, both significantly enhancing satisfaction. A correlation analysis further revealed that prolonged use of farmland, parks, and walking paths was negatively correlated with satisfaction, underscoring the urgency of targeted renovations. On this basis, the study proposes a three-tiered demand framework of “local service–social interaction–personal value”, offering both theoretical support and practical strategies for multi-level and collaborative retrofitting of suburban rural public spaces, aiming to mitigate “aging depression” and promote urban–rural integration. Full article

Background: Informal caregivers of individuals with mild cognitive impairment (MCI) experience high levels of psychological and physical stress, with limited access to supportive interventions and time constraints. Virtual Reality (VR) technologies may provide brief and accessible opportunities to support caregiver well-being, particularly during waiting periods in clinical settings. This pilot study aimed to explore the potential of a semi-immersive VR intervention to enhance psychological well-being in informal caregivers. Methods: This non-randomized pilot study investigated the effects of a semi-immersive VR-based physical training program (K-HERO^®) on psychological well-being and coping strategies in informal caregivers. Participants were recruited from January to May 2025 at the IRCCS Centro Neurolesi “Bonino-Pulejo” (Messina, Italy), and the intervention was delivered individually in a dedicated room within the rehabilitation facility, while caregivers accompanied their relatives to treatment sessions. Ten caregivers completed six sessions (30–40 min each). The study was conducted in accordance with TREND reporting guidelines. Pre- and post-intervention assessments included the State-Trait Anxiety Inventory (STAI), Perceived Stress Scale (PSS), COPE Inventory, Caregiver Burden Inventory (CBI), and International Physical Activity Questionnaire (IPAQ). Visual Analog Scales and instrumental data from the VR system were used to monitor physical performance and user experience. Non-parametric statistics were applied. Results: Significant reductions were observed in avoidance (p = 0.033) and social support-based (p = 0.023) coping strategies. Differences emerged based on caregiver-patient relationships: parental caregivers showed increased anxiety, while offspring caregivers showed improvements. The intervention was well tolerated, with high usability and no adverse events reported. Conclusions: A short, structured, VR-based intervention delivered during clinical waiting periods may effectively reduce maladaptive coping strategies and support emotional well-being in informal caregivers. These findings highlight the potential of brief digital interventions in real-world care contexts. Larger randomized studies are needed to validate these preliminary findings and personalize interventions to different caregiver profiles. Full article

Prematurity, defined as a birth before 37 weeks of gestation, affects approximately 15 million infants worldwide yearly. Beyond the Neonatal Intensive Care Unit and the possibility of long-term developmental challenges affecting children’s quality of life, prematurity influences family dynamics, including parental mental health, financial stability, employment, and daily life. On a broader scale, research highlights the significant socioeconomic consequences of preterm birth that influence public healthcare policies, healthcare systems, and long-term costs. Addressing these challenges requires a multidisciplinary approach, beginning in the NICUs, with parental inclusion as a key component. The shift toward parental inclusion in the NICU may represent a fundamental transition from a medical to a social model of prematurity. The concept of a social model of prematurity parallels the social model of disability, from disability studies, focusing on premature babies, strengthening their abilities and nurturing early caregiver—infant relationships. It highlights how societal structures, such as accessibility and support systems, shape developmental outcomes and inclusion of premature infants, rather than framing prematurity solely in terms of survival and treatment. Full article