Search Results (286)

Background: Resilience plays a fundamental role in the professional functioning of psychiatric nurses, supporting coping with stress, adaptation to demanding work environments, and job satisfaction. Regular assessment of resilience and perceived stress is important for timely psychological and organizational support. This study aimed to examine the relationship between resilience and perceived occupational stress among psychiatric nursing staff. Methods: The present study employed a cross-sectional research design. Standardized psychometric instruments were used, including the Resilience Assessment Scale (SPP-25) and the Perceived Stress Scale (PSS-10). Additionally, a self-developed questionnaire was administered to gather sociodemographic data. The study was conducted in five psychiatric hospitals located in the southern region of Poland. Data collection took place between January and June 2023 and involved a total of 555 nurses (449 women and 106 men) employed in inpatient psychiatric wards. A statistical significance level of p < 0.05 was adopted. Statistical analyses were performed using IBM SPSS Statistics 25. Results: The overall resilience level in the study group was 57.83 points (SD = 24.33). The mean level of perceived stress among psychiatric nurses was 18.43 points (SD = 10.91). Both resilience and perceived stress levels varied significantly depending on selected sociodemographic and occupational characteristics. A statistically significant negative correlation was found between perceived stress and both the overall level of resilience and each of its individual components (p < 0.001). Conclusions: Regular assessment of psychological resilience and stress levels among psychiatric nurses is an essential component of monitoring their well-being. Such evaluations provide insights into the role of individual resources in coping with occupational demands and serve as a foundation for developing targeted support programs. Strengthening resilience not only promotes the mental health of nursing staff but also contributes to higher quality of patient care and greater effectiveness in fulfilling professional responsibilities. Full article

Background/Objectives: Whole-body cryotherapy (WBC) is increasingly utilized as a physical modality for managing chronic pain, although its mechanism of action remains incompletely understood. This study evaluated whether WBC influences serum levels of substance P, calprotectin, β-nerve growth factor (β-NGF), and calcitonin gene-related peptide (CGRP), which are implicated in pain modulation. Methods: Serum samples from 61 participants—37 undergoing WBC and 24 not receiving WBC—were collected at the start and end of a multimodal inpatient pain treatment program. Pain intensity was assessed using a numerical rating scale (NRS). Biomarker concentrations were measured by enzyme-linked immunosorbent assay (ELISA). Results: Both groups reported an average significant pain reduction of more than 1.39 points on the NRS. Of the biomarkers analyzed, only calprotectin showed a statistically significant reduction in the overall cohort (p = 0.007) and in the WBC subgroup (p = 0.032). Among patients who did not experience significant pain reduction, those in the WBC group exhibited a greater decline in calprotectin compared to controls (p = 0.042), especially among those without medication changes (p = 0.016). No significant differences were detected for the other serum parameters. Conclusions: The analgesic effects of WBC could not be attributed to changes in the neuromodulatory peptides measured. However, the significant reduction in calprotectin suggests a potential anti-inflammatory effect of WBC on the innate immune response. Full article

Background/Objectives: Major depressive disorder (MDD) is often characterized by mood instability and occupational imbalance, leading to impaired functioning and reduced quality of life. Despite increasing recognition of occupational therapy’s (OT’s) role in mental health, few interventions comprehensively describe both their development process and their theoretical rationale. This article aims to present the systematic development of the mood–occupation balance reciprocal model (MOBILE) intervention for people with MDD, guided by the Medical Research Council (MRC) framework for complex intervention. Methods: Development followed three phases: (1) identifying the evidence base, (2) developing theory, and (3) modeling processes and outcomes. Theoretical foundations integrated occupation- and mood/function-based models with client-centered, lived-experience perspectives. A preliminary ecological momentary assessment (EMA) study on mood and daily function interplay further informed the intervention development. Input from focus groups with occupational therapists and individuals with lived experiences supported its iterative refinement. Following MRC guidelines, a small pilot study (N = 2) was conducted with inpatients diagnosed with MDD to assess the feasibility and acceptability of the intervention and EMA procedures. The pilot evaluated recruitment, adherence, engagement, and practicality of delivery within a clinical setting. Results: The pilot study, although it included only two inpatients and thus limits generalizability, demonstrated high adherence, engagement, and feasibility. The EMA protocol was well tolerated, leading to minor refinements that enhanced its clinical applicability. Stakeholders emphasized the program’s relevance, adaptability, and the value of personalized planning tools. Conclusions: The MOBILE intervention is delivered as an individualized program to enhance mood stability and daily functioning among inpatients with MDD. It provides a theoretically grounded, context-sensitive framework integrating personalized goal setting and strategy use with the construction of a balanced routine. Implications: This article provides a comprehensive account of development procedures to support future evaluation, implementation, and integration into OT mental health practice. Full article

Background: Anorexia nervosa (AN) is a complex psychiatric disorder that requires a multidisciplinary approach. The World Health Organization recognizes the therapeutic value of expressive arts, including drama, in enhancing emotional, cognitive, and relational domains in severe mental illnesses such as AN. Expressive arts interventions may improve emotional intelligence, empathy, and self-awareness while reducing anxiety and alexithymia. This study evaluated the impact of an adjunctive expressive arts program on alexithymia in pediatric inpatients with AN. Methods: We enrolled patients aged 11–18 years hospitalized for AN, according to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision, at the Pediatric Unit of Bambino Gesù Children’s Hospital, Rome. The study period ran from December 2024 to April 2025. Participants attended drama therapy sessions and expressive arts workshops in a dedicated recreational space integrated into a multidisciplinary treatment plan. Alexithymia was assessed at admission and discharge using the Toronto Alexithymia Scale (TAS-20), with scores ≥ 61 indicating alexithymia. At the end of the program, participants completed a semi-structured satisfaction questionnaire to evaluate subjective experiences and mood. Results: Thirty patients met inclusion criteria. The TAS-20 scores were statistically different between pre-/post-theater activity (p < 0.001). The proportion of alexithymic participants declined from 73.3% at baseline to 26.7% at discharge. Most participants reported mood improvements: 66.6% “somewhat” and 26.7% “greatly.” Additionally, 90% reported improved peer relationships. Conclusions: Expressive arts, particularly drama-based interventions, may represent an effective adjunctive therapy for adolescents with AN, supporting emotional awareness, self-regulation, and social connectedness. Arts-based interventions are associated with nonverbal avenues for emotional processing and may promote neuroplasticity, representing valuable complementary strategies for AN treatment. Full article

Background: This randomized controlled trial aimed to assess the effects of a yearly Multi-Component Exercise Training (MCET) program performed within the hospital setting on the functional capacity and Health-Related Quality of Life (HRQoL) of inpatients with psychotic disorders. Methods: Forty-eight inpatients of a public Psychiatric Hospital with a diagnosis of psychosis participated in the study and were randomly assigned to two groups: (i) the intervention group (mean age: 46.6 ± 13.2) and (ii) the control group (mean age: 47.7 ± 8.9). The MCET program consisted of moderate-intensity aerobic exercise (AE), Pilates exercises, and strengthening, balance, corrective and flexibility exercises, using rubber bands, mobility sticks and balls. Sessions were implemented three times per week over a 12-month period and each group session lasted for 30–45 min. The primary outcomes of the study included functional capacity and HRQoL. Functional capacity was assessed through measurements of strength (using handgrip and leg dynamometer), balance, and body positioning, while HRQoL was evaluated using the 36-Item Short Form Health Survey (SF-36). Results: At the end of the treatment, participants in the intervention group demonstrated significantly increased lower and upper extremity muscle strength by 35.9% (p < 0.01) and 23.6% (p < 0.01), respectively, improved balance by 18.1% (p < 0.001), and enhanced sit-and-reach and sit-to-stand results by 47.6% (p < 0.001) and 18.2% (p < 0.001), respectively, as well as increased distance covered at 6MWT by 26.2% (p < 0.001). Regarding the HRQoL, all the parameters of the SF-36 were improved, including general and mental health (p < 0.05), physical (p < 0.001) and social function (p < 0.05), physical (p < 0.01) and emotional roles (p < 0.01) and vitality and bodily pain (p < 0.001 and p < 0.05, respectively). The Physical Component Summary score (PCS) was enhanced significantly (p < 0.001), while the Mental Component Summary score (MCS) remained unchanged. Compliance with the 1-year ET program was 80%. Conclusions: The findings of the study indicated that a 1-year moderate-intensity MCET performed three times per week was safe, well accepted and efficient in improving physical functioning and HRQoL among inpatients with psychotic disorders. These results suggest that structured exercise interventions could be prescribed as add-ons to the pharmacological treatment for psychotic disorders. Full article

Background/Objectives: Outpatient stroke rehabilitation is expanding as inpatient episodes shorten. Virtual reality (VR) exergaming can extend practice and standardize progression, but setting-specific effectiveness and implementation factors remain unclear. This scoping review mapped VR exergaming in outpatient stroke care and identified technology typologies and functional outcomes. Methods: Guided by the JBI Manual and PRISMA-ScR, searches of MEDLINE, Embase, CENTRAL, Scopus, and Web of Science were conducted in April 2025. The study included adults post-stroke undergoing VR exergaming programs with movement tracking delivered in clinic-based outpatient or home-based outpatient settings. Interventions focused on functional rehabilitation using interactive VR. Results: Sixty-six studies met the criteria, forty-four clinic-based and twenty-two home-based. Serious games accounted for 65% of interventions and commercial exergames for 35%. Superiority on a prespecified functional endpoint was reported in 41% of trials, 29% showed within-group improvement only, and 30% found no between-group difference; effects were more consistent in supervised clinic programs than in home-based implementations. Signals were most consistent for commercial off-the-shelf and camera-based systems. Gloves or haptics and locomotor platforms were promising but less studied. Head-mounted display interventions showed mixed findings. Adherence was generally high, and adverse events were infrequent and mild. Conclusions: VR exergaming appears clinically viable for outpatient stroke rehabilitation, with the most consistent gains in supervised clinic-based programs; home-based effects are more variable and sensitive to dose and supervision. Future work should compare platform types by therapeutic goal; embed mechanistic measures; strengthen home delivery with dose control and remote supervision; and standardize the reporting of fidelity, adherence, and cost. Full article

Background: This study examined changes in psychological adjustment among patients with Anorexia Nervosa (AN) and Binge Eating Disorder (BED) following a 3-week inpatient multidisciplinary (disease-tailored) rehabilitation program. Methods: twenty consecutive Italian female adults with a diagnosis of AN (mean age ± SD: 25.9 ± 9.4 years; mean Body Mass Index: BMI: kg/m²: 15.8 ± 1.61) and fifteen consecutive Italian female adults with diagnosis of BED (mean age ± SD: 43.5 ± 15.3 years; mean Body Mass Index: BMI: kg/m²: 41.1 ± 7.82) were admitted to the study. Psychological functioning and well-being were assessed pre- and post-intervention using the Strengths and Difficulties Questionnaire and the Psychological General Well-Being Index. Results: Significant improvements in emotional symptoms [F(1, 31) = 21.1973, p < 0.001, ƞ²p = 0.406] and overall psychological functioning [F(1, 31) = 10.0062, p = 0.373, ƞ²p = 0.026] were observed in both groups, with the most pronounced changes in internalizing symptoms, such as anxiety and depression. Changes in BMI were significantly associated with emotional symptoms, vitality [F(1, 31) = 4.89, p = 0.035, ƞ²p = 0.136], and total well-being scores [F(1, 31) = 6.341, p = 0.017, ƞ²p = 0.170]. By contrast, no significant changes were observed in domains such as behavioral problems, hyperactivity/inattention, and peer relationships, probably indicating the need for more prolonged and targeted, domain-specific interventions. Conclusions: A 3-week inpatient multidisciplinary program was associated with improvements in internalizing symptoms and psychological well-being in women with AN and BED. Domains such as behavioral regulation and social functioning showed limited change, indicating the need for longer and targeted psychosocial components. Full article

Background: Lower limb amputation (LLA), due to non-traumatic causes such as vascular diseases and diabetes, significantly impacts patients’ physical, psychological, and social well-being. While multidisciplinary rehabilitation programs commonly address physical and functional recovery, psychological and subjective experiences related to limb loss remain less explored. Thus, this preliminary study aimed to investigate the psychological and behavioral adaptation processes in patients undergoing rehabilitation following lower limb amputation. Methods: A preliminary observational study with a mixed-method approach based on quantitative and qualitative data triangulation was conducted. This approach involves integrating multiple data sources and methodologies—in this case, quantitative psychometric measures and qualitative interviews via the prospective of amputees and those who use prostheses—to enhance the validity and depth of the research findings. Results: Fourteen inpatient amputees and fourteen inpatient prosthesis users (years: 66.6 ± 2.5 for amputee and 61.5 ± 1.9 for prosthesis users, male amputees: 85.7%, male prosthesis users: 100%) of a research hospital in the North of Italy were assessed using validated psychometric tools (GAD-7, PHQ-9, PID-5-BF, BIS, ASonA) alongside semi-structured interviews analyzed through the Interpretive Description approach. Key themes highlighted illness acceptance, prosthesis adaptation, body image, medication and behavioral adherence, anxiety, depression, quality of life, denial, optimism, and social support. Overall, anxiety–depressive symptomatology tended to decrease with the prosthesis, and pharmacological and behavioral adherence improved, as did the disease acceptance. Body image was fairly preserved in all patients despite some fears of others’ judgment with respect to the prosthesis. Interestingly, there was poor agreement between quantitative and qualitative data in both the amputee’ and prosthesis users’ groups: while the former returned a partial and neutral picture, a more multifaceted picture emerged from the interviews collected. Conclusions: These findings underline the importance of integrating quantitative psychometric evaluations with qualitative methods to comprehensively understand patients’ adaptive experiences. Such combined insights are essential to inform tailored psychological interventions throughout the rehabilitation journey. Full article

Background: Undernutrition is a major public health concern, accounting for nearly half of global under-five mortalities and leading to serious long-term consequences for those who survive. Most nutritional screening programs give priority to acute undernutrition (wasting). The co-presence of chronic undernutrition (stunting) has been shown to have the highest risk of mortality. To date, few studies have assessed outpatient treatment outcomes of children with wasting + stunting (WaSt), with some inconsistencies in results and only one study having investigated the outcome of patients requiring hospitalization. The aim of the present study is to investigate the impact of stunting on the outcomes of severely wasted children admitted for inpatient treatment in an Ethiopian referral hospital. Methods: A retrospective cross-sectional study was conducted to compare treatment outcomes (length of hospital stay, weight gain, recovery rate, readmission rate) of wasted and WaSt children admitted to “St. Luke Catholic Hospital and College of Nursing and Midwifery” between January 2018 and February 2023. Results: The analysis comprised 616 children aged 6–60 months and stunting was diagnosed in 559 children (90.7%). Children with stunting had a longer length of stay (median difference 3 days, 95% confidence interval 0 to 5; p = 0.03) and improved weight gain (median difference 4 g/kg/day, 95% confidence interval 0 to 4; p = 0.002) compared to children without stunting. Discharge rate (p = 0.99) and readmission rate (p = 0.25) were not statistically different between children with or without stunting. Conclusions: Stunting was found to be present in most children admitted for severe wasting to the Stabilization Centers in a sub-Saharan setting. Stunting was associated with longer hospitalization and greater weight gain, but discharge and readmission rate were comparable between children with or without stunting. Full article

Background/Objectives: Hospital-at-home (HaH) programs expanded hospital capacity during the COVID-19 pandemic, but data on which HaH patients receiving intravenous (IV) remdesivir may require hospital escalation is limited. We therefore aimed to explore clinical characteristics associated with escalation to inpatient care. Methods: Single-center, retrospective cohort of adults with confirmed COVID-19 who received IV remdesivir via a HaH service was employed (September 2020–September 2024). Primary outcome was hospital escalation. Associations between baseline variables and escalation were assessed with bivariate statistics. Results: Seventy-eight HaH episodes were analyzed. Hospital escalation occurred in 4 cases (5.1%); 30-day readmission after HaH discharge occurred in 4 additional cases (5.1%). Immunosuppression and persistent COVID-19 were significantly associated with escalation (p = 0.03 and p < 0.001, respectively). Patients who escalated underwent more frequent blood testing and had longer HaH stays. Classical comorbidities (age, hypertension, diabetes, obesity, pulmonary disease) were not associated with escalation. No remdesivir discontinuations due to adverse events were recorded. Conclusions: In this real-world HaH cohort, IV remdesivir was well tolerated with low escalation and readmission rates. Immunosuppression and persistent COVID-19 showed significant associations with escalation, suggesting the need for refined selection and closer monitoring in these subgroups. Findings are exploratory and hypothesis-generating given the small number of events. Full article

Introduction: Hepatitis C virus (HCV) infection prevalence in Italy varies according to geographical areas and clusters of infection. Moreover, epidemiological studies are old, and the actual prevalence of HCV active infections is also affected by the use of direct-acting antiviral therapies (DAAs) that achieve sustained virologic response (SVR) in >95% of treated patients. We aimed to evaluate the prevalence of HCV infections in in- or outpatients referred to a Sicilian hospital. Materials and methods: The study was conducted in the Buccheri La Ferla Hospital, in Palermo (Sicily), from 1 November 2019 to March 2022. We consecutively screened for HCV infections all inpatients who were evaluated on admission to the ward and all outpatients who referred to the central laboratory. All patients were screened using serological detection of HCV antibodies. Results: In the entire cohort, 469 out of 15,550 patients (3%) showed anti-HCV positivity, and this rate progressively increased according to classes of age (0.4% for <40 yrs, 3% for 40–60 yrs, 4% for >60–80 yrs, and 6.4% for >80 yrs). Among patients with anti-HCV positivity, 44.3% were HCV-RNA negative, 39.2% had HCV-RNA not available, and 16.4% were HCV-RNA positive. In total, 44.1% of patients with HCV-RNA positivity underwent DAA-based antiviral therapy. Conclusions: HCV screening programs can be useful in identifying infected patients at risk of liver disease progression and/or infection spreading. The implementation of laboratory strategies based on HCV reflex testing, the activation of dedicated linkage-to-care plans, and a focus on higher-risk groups could increase the effectiveness of screening programs. Full article

Background/Objectives: Anorexia nervosa (AN) is marked by cognitive deficits, particularly reduced mental flexibility and weak central coherence, which may sustain the core psychopathological symptoms. While cognitive remediation therapy (CRT) has shown efficacy in improving these cognitive processes in AN, evidence on computer-based CRT remains limited. This study aims to evaluate the feasibility and efficacy of integrating computer-assisted cognitive remediation therapy (CA-CRT) into standard nutritional rehabilitation (treatment as usual, TAU) to improve the targeted cognitive and psychological parameters among inpatients with AN in a more personalized and scalable way. Methods: A multicenter randomized controlled trial (RCT) will be conducted. At least 54 participants with a diagnosis of AN will be recruited at each site and randomized into either the experimental or control group after initial screening. The intervention will last five weeks and include 15 individual CA-CRT sessions alongside 10 individual CR sessions, delivered in addition to standard care. The primary and secondary outcomes will be assessed at the end of the intervention to evaluate the changes in cognitive flexibility, central coherence, and psychological functioning. Results: Participants receiving CA-CRT are expected to develop more flexible and integrated thinking styles and achieve greater improvements in clinical outcomes compared to those receiving standard care alone, supporting a more personalized therapeutic approach. Conclusions: These findings would underscore the feasibility and clinical value of incorporating CA-CRT into standard inpatient treatment for AN. By specifically targeting cognitive inflexibility and poor central coherence in a scalable, individualized format, CA-CRT may enhance treatment effectiveness and support the development of patient-centered interventions tailored to the cognitive profiles of individuals with AN. Full article

Background: The fibromyalgia syndrome (FMS) is classified as a functional somatic syndrome and is characterized primarily by chronic pain in multiple body regions and physical and/or mental fatigue. The German S3-guideline recommends a multimodal therapy for severe forms. Since research on non-pharmacologic complementary, naturopathic, and integrative therapy approaches shows positive and promising effects, integrative methods are firmly anchored in the S3 guideline. Objective/Methods: Aim of the present study was to investigate whether a multimodal integrative treatment program can be effective in reducing the primary symptoms of FMS (pain and fatigue) and improving psychological aspects such as quality of life (QoL), anxiety, depression, and perceived stress. Another aim of the study is to explore whether potential effects appear only in the short term (immediately after discharge) or persist long term (six months after discharge). The treatment concept is based on mind–body medicine and elements of classical European naturopathy (including fasting interventions) and focusses on stress reduction and lifestyle modification. Results: Of N = 134 originally included longstanding fibromyalgia patients (mean time since diagnosis 9.2 ± 8.5 years), 101 data sets could be analyzed. Results show a significant improvement in both short-term and long-term pain and fatigue intensity (about 12% improvement). Long-term reductions in pain intensity appear to be supported by medical fasting interventions. Regarding psychological aspects and quality of life, there are long-lasting reductions regarding anxiety, depression, perceived stress, and helplessness and a long-lasting increase in self-efficacy, quality of life and current working ability. Conclusions: The two-weeks inpatient stay therefore leads to significant improvements in all mentioned aspects. Therefore, the concept may be a promising component for integration into medical guidelines and thus in the care of FMS patients. Future research including randomized controlled trials is necessary to further evaluate the program. Full article

Background: Return to work (RTW) is a fundamental aspect of recovery after stroke, importantly, for workers of working age. Evidence indicates there is little known about the clinical and systematic predictors of RTW in Hungary. We aimed to determine the independent predictors of RTW for stroke survivors using aggregate hospital data and expert opinion. Methods: A mixed-method study using aggregated national level administrative data from the Pulvita platform (the National Health Insurance Fund of Hungary) and expert interpretation from the physicians who treat stroke survivors. The data analyzed 13,572 inpatient records for stroke hospitalizations from 2015–2024 across Hungarian counties. Results: Stroke severity, cognitive and psychological recovery, and presence of comorbidities were important clinical predictors of RTW. Rehabilitation intensity was greater for people aged 51–65 years, and work-age men appeared to have slightly better access to rehabilitation compared to work-aged women. Patients accessed more medical rehabilitation services than they did occupational or psychosocial services. Access to rehabilitation services may have varied geographically, with patients in counties such as Budapest and Pest having better access due to higher provider availability and cross-county patient movement. In addition, economic extrapolations from the literature on post-stroke care costs may have introduced bias in estimating annual social productivity losses, reported as EUR 19,953 per patient. Conclusions: Clinical and economic factors both impact RTW potential among stroke survivors in Hungary. Although rehabilitation intensity can indicate likelihood of RTW, the lack of a national RTW program acts as a significant barrier to RTW for stroke survivors. This study suggests a need for integrated rehabilitation and RTW systems, with associated future research linking clinical, economic, and labor market status data to develop effective and efficient policy for stroke survivors. Full article

The rising prevalence of CKD, particularly within aging populations, demands effective and accessible self-management strategies. Three middle-aged and older adult inpatients (one female, two males; mean age 58.6 years ± 23) with CKD and preserved cognitive capacity (Mini-Mental State Examination) participated. A multiple case study was conducted in a Portuguese nephrology unit between November 2024 and February 2025, utilizing baseline assessments that included the Braden, Barthel, and Morse scales, as well as the KDQOL-SF. A targeted educational program addressed key CKD management aspects: disease understanding, vascular access care, medication regimens, and dietary restrictions. Pre- and post-intervention assessments measured knowledge gains. Results indicated improvements in participants’ knowledge and self-management capabilities across several domains. These included enhanced understanding of the disease process, vascular access for hemodialysis, dietary requirements, and fluid restrictions. Participants also demonstrated improved self-assessment of support systems, coping mechanisms, and family involvement. A 15% average increase in knowledge scores post-intervention was observed. This study provides preliminary evidence supporting the efficacy of a structured educational nursing program in improving CKD self-management. The significant improvements in knowledge and self-reported confidence suggest that targeted education is a valuable component of comprehensive CKD care. Future research should incorporate larger, more diverse samples and explore the long-term impact of the intervention. Furthermore, the integration of technological tools, such as personalized learning platforms and digital health, holds a significant promise for enhancing the accessibility and effectiveness of such educational programs. Full article