Search Results (5,478)

Social determinants of health (SDoH) are non-medical factors shaped by the socioeconomic status of individuals or communities that influence the onset and progression of diseases and affect their outcomes. We have narratively analyzed the most important findings relating chronic kidney disease (CKD) and SDoH, evaluating the following items: (i) medical care and social determinants of health, (ii) socioeconomic risk for kidney disease at the individual level and (iii) socioeconomic risk for kidney disease at the population level. SDoH can be categorized by how they influence a person’s daily life. Individual factors include personal lifestyle choices such as smoking habits, alcohol consumption, and how a patient spends their non-working time. Community factors include structural elements such as average household income, educational attainment, employment rates, and the quality of the surrounding physical environment. Research consistently shows that a low socioeconomic status is a primary driver of poor clinical outcomes. While healthcare systems vary globally, the negative impact of socioeconomic deprivation on CKD patients remains a constant. Disadvantaged patients experience a faster loss of renal function, and there is a significantly higher incidence of cardiovascular events and mortality compared to those with financial stability. Financial hardship often leads to a “double burden,” where the struggle to afford care triggers a decline in both physical health and mental well-being. To improve patient care, it is essential to raise awareness among healthcare providers regarding the profound impact of these social factors. More precise data and thorough research are needed to fully understand these associations and develop targeted interventions. Full article

Background/Objectives: Hypothyroidism, including subclinical hypothyroidism, may affect mental health in children and adolescents through disturbances of neurotransmission and dysregulation of the hypothalamic–pituitary–thyroid and stress axes. Anxiety disorders are common in this population and frequently coexist with somatic symptoms overlapping those of hypothyroidism, complicating diagnosis and treatment. This study aimed to evaluate the association between levothyroxine treatment for hypothyroidism and the need for psychiatric interventions in children and adolescents with anxiety disorders. Methods: A retrospective cohort study was performed using data from the TriNetX global research network. Patients aged 5–18 years with diagnoses of hypothyroidism (ICD-10: E03) and anxiety disorders (ICD-10: F41) were included. Two propensity score–matched cohorts were analysed: patients treated with levothyroxine (n = 1861) and untreated patients (n = 1861). Outcomes included psychiatric hospitalisations, use of selective serotonin reuptake inhibitors and tricyclic-like antidepressants, frequency of psychiatric and psychotherapeutic consultations, and the occurrence of suicidal ideation and self-harm. Results: Levothyroxine treatment was associated with lower odds of SSRI use (OR = 0.58; p < 0.001), fewer psychiatric consultations (OR = 0.48; p < 0.001), and lower recorded use of psychotherapy (OR = 0.75; p = 0.029). Suicidal ideation and self-harm were recorded less frequently in the treated group (OR = 0.53; p = 0.001). No significant differences were observed in psychiatric hospitalisation rates. Use of tricyclic-like antidepressants was uncommon and did not differ significantly between groups. Conclusions: Among children and adolescents with comorbid anxiety disorders, levothyroxine treatment for hypothyroidism is associated with lower recorded utilization of certain psychiatric services and lower recorded rates of suicidal ideation and self-harm. Due to the retrospective design, causal inferences cannot be made, and the findings should be considered hypothesis-generating, requiring confirmation in prospective studies with standardised psychiatric outcome measures. Full article

Background: Healthcare policy in the United Kingdom recognizes that teenagers and young adults (TYAs: 16–24 years at diagnosis) require specialist care. In England, Principal Treatment Centers (PTCs) exist, delivering enhanced care exclusively within the PTC or as ‘joint care’ with designated hospitals (DHs). Central to this is the TYA multidisciplinary team (MDT) and an outreach model coordinating care between hospitals. We previously reported similar outcomes regardless of care location. Aims: To compare TYA experiences of care with healthcare professionals’ perspectives of the service they deliver. Methods: Mixed methods across England and Wales were used. The TYA-MDT identified TYAs who then received a postal invite to a cross-sectional survey capturing experiences of places of care, treatment, healthcare professional support (HCP), mental health, sexuality/fertility, clinical trials and care coordination. Comparisons were made based on exposure to care in a specialist TYA environment within 6 months of diagnosis: all-TYA-PTC (all care in the TYA-PTC, n = 70, 28%), no-TYA-PTC (no care in the TYA-PTC (n = 87, 35%): care delivered in a children/adult unit only), and joint care (care in a TYA-PTC and in a children’s/adult unit, n = 91, 36%). HCP perspectives were captured by rapid ethnography. Results: A total of 250/1056 (24%) TYAs participated. Overall, 200 (80%) rated their teams as excellent/good for helping them prepare for treatment. No evidence of significant differences existed between categories of care for proportions receiving support from key TYA-related professionals: TYA cancer nurse specialists (all-TYA-PTC n = 58, 91%; joint care n = 71, 88%; no-TYA-PTC n = 64, 82%) and social workers (all-TYA-PTC n = 30, 55%; joint care n = 36, 48%; no-TYA-PTC n = 28, 38%). A trend of diminishing support from youth support co-coordinators existed (all-TYA-PTC 63%; joint care 49%; no-TYA-PTC 40%, p = 0.069). This may explain why few differences in patient experiences existed across categories of care. Forty-nine HCPs participated. They were more critical in their interpretation of care, highlighting inequity in resources and challenges in some pathways and coordination. Conclusions: Similar access to age-appropriate support across care settings is likely to reflect recruitment methods. When TYAs are known to the MDT, age-appropriate care can be mobilized beyond TYA units, which could explain the equitable outcomes observed across different care locations in young people who responded to the survey. Nevertheless, gaps persist in communication and coordination, particularly within joint care models, and in the involvement of allied health professionals such as dieticians and physiotherapists, whose input is essential for rehabilitation and return to normal life. Strengthening these areas will require continued investment in workforce capacity and digital infrastructure to support genuinely coordinated, developmentally appropriate TYA cancer care. Full article

Background/Objectives: Fibromyalgia is a painful syndrome with biopsychosocial components that predominantly affects middle-aged women. This study aimed to evaluate changes in sleep quality and quality of life following intravenous (IV) lidocaine treatment in patients with fibromyalgia (FM). Methods: This retrospective observational study included patients diagnosed with fibromyalgia who underwent intravenous lidocaine treatment at a tertiary pain clinic between June 2023 and June 2024 and had a Pittsburgh Sleep Quality Index (PSQI) score > 5. The patients’ demographic data, Fibromyalgia Impact Questionnaire (FIQ) scores at baseline and at 1 and 3 months post-treatment, Numerical Rating Scale (NRS-11) scores, Short Form-12 (SF-12) mental and physical component scores (MCS-12, PCS-12), and PSQI scores were recorded. Results: Overall, 51 patients were included. 92.2% of the patients were women, with a mean age of 41.6 ± 9.5 years. Statistically significant reductions in NRS-11, FIQ, and PSQI scores and increases in SF-12 component scores were observed at 1 and 3 months compared with baseline (p < 0.001). Negative correlations were found between NRS-11 and PCS-12 and MCS-12, and a positive correlation was found between FIQ and PSQI. Sleep quality showed a marked improvement at 1 month; however, attenuation of this benefit was observed at the 3-month follow-up. Conclusions: Sleep quality appeared to be associated with short-term functional outcomes, whereas pain intensity was associated with mid-term clinical status in patients with fibromyalgia. Prospective randomized controlled trials are required to confirm these findings and to determine optimal dosing and treatment schedules. Full article

Background/Objective: A substantial proportion of infected individuals develop persistent symptoms after the acute phase of COVID-19, regardless of initial disease severity. Long COVID (LC) remains a public health challenge characterized by impaired functional exercise capacity (FEC) and quality of life (QoL). We systematically synthesized evidence on the effects of in-person outpatient pulmonary rehabilitation (OPR) with individualized and supervised exercise in adults with LC. Methods: Following PROSPERO (CRD42023389365), this study reviewed randomized controlled trials (RCTs) and observational cohort studies (OCSs) published between November 2019 and January 2026 in MEDLINE/PubMed, Web of Science, PEDro, and EMBASE. Results: Fifteen studies (n = 803) were included. OPR improved FEC (6MWT; MD: 53.72 m, 95% CI 43.69–63.75) and 30″SST (MD: 4.68, 95% CI 3.59–5.77) and reduced exertional dyspnea. RCTs showed benefits in physical (MD: 8.04, 95% CI 3.02–13.05) and mental QoL (MD: 6.60, 95% CI 2.01–11.18) and dyspnea impact, with inconsistent PF findings. Fatigue showed a trend toward improvement but was measured using heterogeneous patient-reported tools in RCTs and OCSs. Conclusions: Supervised PR improves FEC, QoL, and dyspnea in individuals with LC. In patients with fatigue/PEM, systematic assessment and continuous symptom monitoring are essential. High-quality controlled studies are needed to strengthen evidence and clinical guide. Full article

Patients undergoing hemodialysis often experience reduced quality of life, with psychological symptoms and nutritional risk representing important determinants of patient functioning. This study aimed to examine the relationships between depression, anxiety, stress, nutritional risk, mental health, and physical functioning in patients undergoing hemodialysis, with particular emphasis on the mediating role of mental health. A cross-sectional study was conducted among 199 patients receiving hemodialysis in five Croatian hospitals. Depression, anxiety, and stress were assessed using the DASS-42, quality of life using the SF-36, and nutritional risk using the NRS-2002. Associations between variables were examined using Spearman’s correlation coefficient, while structural equation modeling was used to analyze direct and indirect relationships among psychological symptoms, nutritional risk, mental health, and physical functioning. Depression and stress showed significant negative effects on mental health, while mental health showed a significant positive effect on physical functioning. Nutritional risk had a significant direct negative effect on physical functioning. Mental health significantly mediated the relationship between depression and stress and physical functioning. These findings indicate that psychological symptoms and nutritional risk are important determinants of functioning and quality of life in hemodialysis patients and support the need for an integrated care approach that includes regular psychological and nutritional screening. Full article

Background: Art therapy is an experiential, non-threatening intervention, used especially with children. The current study aimed to explore the effect of integrative art therapy on the psychological well-being (mental health and self-perception) of pediatric cancer patients. Methods: Using a single-group pre–post research design, each therapy session was individually administered to participants for approximately 45 min. Fourteen participants (Boys = 9, Girls = 5) were recruited from the inpatient oncology unit at Shaukat Khanum Memorial Cancer Hospital & Research Centre over two months. The age range was from 5 years to 13 years (M = 7.95; SD = 1.65). Mental health, including physical and emotional symptoms associated with cancer, was assessed using the Edmonton Symptom Assessment Scale-Revised, while self-perception was measured with the House Tree Person projective drawing test. Results: The integrative art therapy model significantly improved positive self-image (F = 16.77, p < 0.01) and reduced negative self-image (F = 99.11, p < 0.01) and mental health problems from the baseline to the second and third phases (F = 19.50, p < 0.01). Conclusions: This integrative approach demonstrates its potential as an effective method to enhance self-perception, alleviate mental health challenges, and improve overall quality of life. Full article

Background: Although the concepts of meteoropathy and meteosensitivity are not included in official classifications, such as the ICD-11 or DSM-5, they are increasingly being studied as potential symptom complexes linking weather variability to health status. The METEO-Q questionnaire, originally developed in Italy, has been adapted in Japan and Turkey, where it has demonstrated satisfactory reliability parameters, although the authors emphasized the need for further verification of the tool’s temporal stability. The present study aimed to adapt METEO-Q to the Polish language and conduct a critical assessment of its factor structure, measurement invariance, and validity in clinical groups. Methods: This cross-sectional study involved 1128 adults: healthy individuals (n = 711), cardiac outpatients (n = 194), and subclinical group with diagnosed mental disorders (n = 223). Data from healthy participants were divided into a training sample (n = 426) for exploratory factor analysis (EFA) and a test sample (n = 285) for confirmatory factor analysis (CFA). Measurement invariance was assessed in the clinical groups. Validity was verified through correlations with a list of 21 symptoms and measures of anxiety and worry about climate change. Results: A two-factor model (meteoropathy and meteosensitivity) was better fitted to the data than a one-factor model, which is consistent with findings from Italian, Japanese, and Turkish studies. However, absolute fit indices in the test sample indicated significant model misfit [CFA: χ² (43) = 210.192, p < 0.001, RMSEA = 0.120, CFI = 0.927], suggesting the presence of local errors in the tool’s structure. The reliability of the subscales was high (α from 0.86 to 0.93). Multi-group analyses suggested metric and scalar invariance. Patients with mental disorders obtained the highest scores, while cardiac outpatients reported a lower level of meteoropathy (M = 6.13) than healthy individuals (M = 7.24). Conclusions: METEO-Q demonstrates a stable two-factor structure and high internal consistency. The obtained RMSEA index (0.12), although indicative of some misfit, is similar to results obtained in other adaptations, such as the Japanese (RMSEA = 0.10) and the Turkish (RMSEA = 0.11), which suggests it is a consistent feature of this tool across different cultural contexts. Accordingly, the instrument is suitable for research purposes; however, its clinical application requires considerable caution and further work to optimize the model. Full article

Irritable bowel syndrome (IBS) and mental health disorders represent common and significant health concerns in pediatric populations. Objectives: This study aimed to evaluate psychological and social risk factors associated with IBS in children and to identify correlations with their gastrointestinal symptoms. Materials and Methods: Children aged 4 to 18 years diagnosed with IBS according to Rome IV criteria were eligible for inclusion. Both patients and parents completed a comprehensive questionnaire detailing gastrointestinal symptom characteristics. Additionally, all children underwent psychological assessment. Results: The study included 24 children with IBS, with a mean age of 12.7 ± 3.4 years. Anxiety was present in 54.2% of cases, and depression in 12.5%. Comparing children with IBS and anxiety to those without these, no statistically significant differences emerged regarding the duration and frequency of abdominal pain; however, abdominal pain intensity was significantly higher in children without anxiety (p = 0.04). The duration of IBS symptoms did not significantly differ in children with or without anxiety (p = 0.21). Impaired emotional self-regulation was identified in 54.2% of participants, and 41.6% exhibited vegetative symptoms in response to stress. Furthermore, 70.8% of parents and/or children reported experiencing a negative family event. Conclusions: The findings suggest that psychological characteristics and adverse family events are important risk factors associated with pediatric IBS. These factors should be systematically considered as integral components of clinical assessment and management. Full article

Uterine malformation represents a rare disease with a prevalence of up to 7% of the general population. Background/Objectives: Higher pregnancy complication rates have been reported in the literature; thus, in our study, we aimed to examine not only the obstetric complications encountered but also the psychological interventions and multidisciplinary approaches for parental counseling in our department in the context of preterm birth at the limit of viability. Methods: A retrospective pilot study was conducted on all the women in our department between 2010 and 2017 with congenital uterine malformations associated with infertility or pregnancy. In the study group, we included women with AUCs (n = 26), while the control group included pregnant women with normal uteri (n = 25) (total: n = 51), and then pregnancy complications were investigated. Results: Highly significant pregnancy complications were observed in the study group, the most important being preterm birth (p = 0.003) in comparison with the control group. Out of 26 patients with AUCs, only 14 gave birth to a live fetus compared to 22 out of the 25 with normal pregnancies, meaning that failure to give birth to a live newborn statistically significantly increased among the former group (p = 0.004). In terms of birth weight (p = 0.0001), Apgar score (p = 0.029) and intensive care unit admission (p = 0.0001), we observed significant differences between the newborns in the study group versus controls, with an impact on mental state that required psychological support. Conclusions: A clear correlation was observed in our study between uterine congenital malformations and pregnancy complications. The most common pregnancy outcome was premature delivery, with statistical significance. In addition, higher neonate admissions to the intensive care unit associated with lower Apgar scores were encountered compared with normal pregnancies. Appropriate parental counseling by obstetricians, neonatologists and psychologists could enhance pregnancy outcomes. Full article

Online social platforms increasingly function as informal self-help environments for individuals experiencing depression, offering spaces for emotional expression and peer support outside traditional clinical settings. However, how coping strategies and psychological engagement states—individuals’ emotional and cognitive involvement in managing their condition—are reflected through online self-disclosure remains poorly understood. We analyzed a large-scale dataset from Reddit depression-related communities to investigate how different psycho-linguistic profiles and coping orientations emerge from users’ language. We collected posts and comments from over 300,000 users across six depression-focused subreddits over two years. User-generated text was characterized through multiple psychological and linguistic dimensions capturing emotions, sentiment, subjectivity, and related features, then aggregated at the user-month level and analyzed using unsupervised clustering techniques. Our analysis identifies four distinct groups characterized by different emotional profiles and dominant coping orientations. These states exhibit meaningful correspondences with established theoretical frameworks, including the Coping Orientations to Problems Experienced model and the Patient Health Engagement model. Our findings demonstrate that large-scale textual data from online communities can provide interpretable insights into coping behaviors and engagement patterns, offering a complementary perspective to traditional approaches for studying mental health. Full article

Background: Infertility is a growing global public health concern associated with reduced quality of life and increased anxiety and depressive symptoms across diverse populations. However, factors influencing mental health in women undergoing infertility treatment remain insufficiently understood. This study aimed to assess psychological distress and identify factors associated with anxiety and depression in women receiving infertility treatment. Methods: A cross-sectional study was conducted at a leading regional infertility referral center. Women with confirmed infertility were consecutively recruited during routine visits. Psychological distress was assessed using the validated Patient Health Questionnaire-4. Demographic, reproductive, and clinical data were collected from self-report and medical records. Associations of infertility duration and age with comorbidities and other demographic variables were evaluated using appropriate parametric and nonparametric tests, and correlations were examined using Spearman’s rank coefficient. Results: The mean age was 34.9 ± 5.9 years and the median duration of infertility was 3 years. Nearly half of participants had mild psychological distress (49.3%), while 16.7% and 2.7% had moderate and severe distress, respectively; 32% screened positive for anxiety and 17.3% for depression. Longer infertility duration was significantly associated with higher depressive symptom scores, whereas other demographic and clinical variables showed no significant associations. Conclusions: Psychological distress is highly prevalent among women with infertility, with depressive symptoms increasing with longer infertility duration. These findings highlight the need for routine psychological screening and integration of mental health support into infertility care in clinical practice and long-term treatment planning, emphasizing a comprehensive, patient-centered approach to reproductive medicine. Full article

Objectives: Adolescent idiopathic scoliosis (AIS) may negatively affect both the quality of life of adolescents and the quality of life of their families (FQOL). Therefore, the analysis of objective and subjective determinants of FQOL in families of children and adolescents with AIS undergoing long-term conservative treatment becomes important and will allow for a better understanding of factors that may have a significant impact on the prognosis and clinical treatment outcomes. Methods: The analysis covered a total of 200 families of children and adolescents aged 7–18 from the Podkarpackie region (Poland). The medical history chart and the original physical examination card, as well as the Family Adaptability and Cohesion Scales (FACES III) and the Family Quality of Life Scale (FQOL), were used in this study. Results: Families of adolescents without AIS demonstrated significantly higher levels of family cohesion and adaptability compared with families of adolescents with AIS (p < 0.001). The mean overall FQOL score was significantly lower in the AIS group (75.33 ± 9.18) than in the control group (86.97 ± 7.91; p < 0.001, r_rb = 0.58). Multivariate analysis indicated that family adaptability was an independent predictor of FQOL in the AIS group, with higher adaptability associated with lower overall FQOL and reduced scores in parental functioning and emotional well-being domains. Conclusions: A long process of AIS treatment can cause crisis situations for patients and their families and influences both the physical and mental health of patients by changing their family’s quality of life (FQOL). Early identification of families characterized by diminished cohesion and adaptability enables the integration of psychopedagogical support and family consultations into standardized care. Such a multidimensional approach may enhance therapeutic prognosis and accelerate the rehabilitation process. Full article

Background: Chronic Kidney Disease-associated Pruritus (CKD-aP) is a frequent, debilitating, and often underestimated symptom in clinical practice, with significant impacts on quality of life, sleep, mental health, and therapeutic adherence. This study aimed to develop a structured, person-centered nursing care overview for the management of CKD-aP. Methods: A comprehensive narrative review of the recent scientific literature on CKD-aP was conducted, adapting the conceptual domains of the European Specialist Nurses Organisation (ESNO) Common Training Framework (CTF) to nephrology nursing practice. The theoretical model guiding the work was Virginia Henderson’s paradigm, selected for its consistency with care models focused on promoting independence and meeting fundamental human needs. The study would answer the main research question “Which nursing evidence, tools, and strategies can support integrated, patient-centered management of CKD-aP?”. Results: A structured nursing care process was developed, articulated in sequential phases (assessment, problem definition, planning, intervention, and re-evaluation), visually represented in an operational flowchart and supported by validated clinical tools. The model emphasizes the nurse’s role in the multidimensional management of the symptom, incorporating educational, relational, therapeutic, and coordination-focused interventions. Conclusions: This proposal contributes to nephrology nursing practice by providing a theoretical and practical framework to standardize the management of CKD-aP. It promotes a holistic, evidence-based approach tailored to individual care needs, establishing a foundation for future clinical, educational, and research developments. Full article

Background: Sickle cell disease (SCD) is a hereditary disorder affecting red blood cells’ shape and functional capacity. Individuals with SCD report relatively high co-occurrence of neurodevelopmental disorders (NDDs). In addition, these children also have higher rates of enuresis (incontinence) and pica, disorders prevalent in children with developmental delays. Both enuresis and pica can have negative effects on mental health, but their pathophysiology, especially in SCD, remains unclear. Objectives: The objective of this study was to determine the rates of pica and enuresis in a pediatric SCD clinic to compare the co-occurrence of NDDs and enuresis/pica. Methods: To do so, we performed a cross-sectional explanatory retrospective chart review of 275 pediatric SCD patients. Results: Our SCD cohort had a 27% prevalence of enuresis, 9% prevalence of pica, and 24% prevalence of one or more NDDs. We noted significant inter-group overlap between pica/enuresis and other risk SCD severity factors. NDDs were approximately twice as frequent in SCD patients with pica or enuresis compared to those without. While pica was associated with HbSβ⁺, it was not linked to disease severity indicators. Enuresis was associated with hydroxyurea usage (66.7% vs. 42.6%, p = 0.001) and reticulocyte counts, indicative of higher disease severity. Conclusions: Clinically, these results are the first to show co-occurrence between pica, enuresis, and NDDs in SCD. We suggest that the occurrence of pica or enuresis may serve as an indicator for previously unknown NDD risk. Together, these results underscore the need for targeted screenings of pica and enuresis in SCD populations. Full article