Search Results (10,028)

Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality worldwide, and lowering low-density lipoprotein cholesterol (LDL-C) remains a cornerstone of cardiovascular prevention. Statins are among the most extensively studied and widely prescribed medications and have demonstrated substantial benefits in reducing major adverse cardiovascular events in both primary and secondary prevention settings. Nevertheless, the effectiveness of statin therapy in routine clinical practice is frequently compromised by poor adherence, treatment discontinuation, concerns regarding adverse effects, and persistent residual cardiovascular risk. This narrative review synthesises contemporary evidence relating to the mechanisms of action of statins, their role in primary and secondary prevention, determinants of medication adherence, statin-associated muscle symptoms (SAMSs), and emerging developments in precision cardiovascular medicine. Current evidence indicates that although statins remain highly effective in reducing cardiovascular risk, long-term treatment success is strongly influenced by behavioural, psychological, social, and healthcare system factors. Increasing attention has also been directed towards the multifactorial nature of SAMSs and the contribution of nocebo effects to perceived statin intolerance. Emerging approaches involving pharmacogenomics, artificial intelligence, digital health technologies, and multidimensional risk assessment offer opportunities for more individualised prevention strategies, although important limitations relating to cost, accessibility, and external validity remain. Overall, contemporary cardiovascular prevention requires a patient-centred approach that integrates biological, behavioural, and social determinants of health to optimise treatment adherence and improve long-term cardiovascular outcomes. Full article

Education is a well-established determinant of health and well-being, yet its benefits may not be equally distributed across populations. This study examines whether educational attainment predicts psychological well-being, financial difficulty, and social support among deaf adults and whether these associations differ from those observed among hearing adults. Using nationally representative data from the U.S. Household Pulse Survey, we analyzed a weighted sample of adults aged 25–54 (N = 36,810), employing multivariate linear regression models that included education, hearing status, their interaction, and demographic covariates. Higher education was generally associated with more favorable outcomes among deaf adults, particularly in psychological well-being and social and emotional support, though effects were modest and less consistent for financial difficulty. Hearing adults reported significantly better outcomes across all domains, and interaction effects indicated that the benefits of education were significantly larger for hearing adults than for deaf adults. These findings suggest that while education remains beneficial for deaf people, its protective effects are limited, likely due to persistent structural and communication barriers. Given the importance of education, improving access alone will not eliminate disparities in well-being without concurrent efforts to address structural and social inequities. Full article

International students in China frequently encounter academic and acculturative challenges that adversely affect their psychological wellbeing. However, limited research has integrated quantitative and qualitative evidence to comprehensively examine the determinants of stress, anxiety, and depression among this population. This study investigated the effects of academic and acculturative stressors on the mental health of international students and explored their coping experiences and perceptions of institutional support. An explanatory sequential mixed-methods technique was employed. Quantitative data were collected from 500 international students enrolled at four universities in Changsha, China, followed by semi structured interviews with 10 participants. Confirmatory factor analysis demonstrated satisfactory construct validity (CFI = 0.93, TLI = 0.92, RMSEA = 0.052, SRMR = 0.047). Hierarchical regression and thematic analysis were used to analyze the quantitative and qualitative data, respectively. Academic workload emerged as the strongest predictor of psychological distress, significantly predicting stress (β = 0.37, p < 0.001), anxiety (β = 0.34, p = 0.001), and depression (β = 0.31, p = 0.003). Language barriers and social isolation were also significantly associated with poorer mental health outcomes. Qualitative findings further revealed that research and publication pressures, cultural adjustment difficulties, and inadequate institutional support intensified students’ psychological distress, whereas academic mentoring and peer support enhanced coping and resilience. Strengthening culturally responsive counseling, language support, academic mentoring, and social integration programs can substantially improve international students’ mental wellbeing and academic success. These findings provide practical evidence for developing inclusive university support policies in China. Full article

Background/Objectives: Men who have sex with men (MSM) carry a disproportionate share of the HIV burden in Portugal, yet the psychosocial characteristics of MSM living with HIV remain insufficiently described. This cross-sectional study examined how compulsive sexual behavior, internalized homonegativity, psychological distress, emotion regulation difficulties, and substance use relate to HIV serostatus, independent of sociodemographic characteristics. Methods: A convenience sample of 480 cisgender MSM (66 living with HIV) completed validated self-report measures online. Because the measures departed from normality, group differences were tested with Mann–Whitney U tests, and associations with serostatus were estimated with a parsimonious binary logistic regression, re-estimated with Firth penalization and evaluated with discrimination diagnostics. Results: Participants living with HIV showed small but significant differences on four indicators: higher compulsive sexual behavior and internalized homonegativity and lower scores on one emotion regulation subscale; depression, anxiety, and stress did not differ. In the adjusted model, compulsive sexual behavior, internalized homonegativity, and problematic substance use were associated with higher odds and the emotion regulation subscale with lower odds of living with HIV. In sensitivity analyses, the substance use association depended on how the construct was defined and was specific to chemsex with core drugs. Model discrimination was limited. Conclusions: HIV serostatus was associated with a small set of psychosocial and behavioral correlates rather than sociodemographic characteristics. These group-level associations describe correlates of serostatus, not a clinical profile of men living with HIV; they cannot establish direction and generate hypotheses, for longitudinal and structurally informed research, about stigma and social context. Full article

The COVID-19 pandemic transformed online and distance learning from a supplementary educational option into a central component of education systems, bringing anxiety, stress, and psychological well-being to the forefront of digital learning research. This study traces the two-decade evolution of research on anxiety and stress in online and distance learning between 2005 and February 2026 and examines the thematic reorientation associated with the COVID-19 period. Bibliometric mapping of 243 Web of Science (WoS) records was used to identify publication trends, intellectual structures, international collaboration patterns, and thematic developments. Piecewise analysis indicated a significant post-2020 break in annual scientific output, with the growth rate increasing nearly eightfold (p = 0.0015). Thematic evolution showed that pre-pandemic studies mainly focused on technology acceptance, computer anxiety, and learner adaptation, whereas pandemic and post-pandemic research shifted toward mental health, psychological well-being, social isolation, technostress, and resilience. China and the United States dominated scientific production, while Australia and Saudi Arabia showed notable mobility in collaboration networks. Overall, the findings suggest that the COVID-19 period was associated with a field-level reorientation toward an interdisciplinary psychosocial agenda for future online education. Full article

Background/Objectives: The digital transition in school settings is reshaping children’s learning, writing practices, and mental health trajectories. This narrative review examines whether handwriting still matters in contemporary hybrid educational environments from a multidisciplinary perspective. Methods: Evidence from neuroscience, developmental psychology, educational sciences, pediatrics, and child psychiatry was narratively synthesized, with attention to handwriting, digital exposure, learning, emotional regulation, and vulnerable populations. Results: Handwriting uniquely integrates fine motor control, visuomotor coordination, orthographic processing, attention, and embodied cognition, supporting early literacy, memory consolidation, conceptual learning, and reflective writing. Conversely, excessive or poorly mediated digital exposure may interact with attentional fragmentation, sleep disruption, online stressors, problematic use, and internalizing symptoms, particularly in vulnerable children and adolescents. Digital tools remain essential for personalization, accessibility, and compensatory support, especially for students with neurodevelopmental or learning difficulties. Conclusions: Handwriting and digital technologies should not be framed as competing educational paradigms. A developmentally sensitive hybrid model is needed, preserving handwriting during key stages of literacy and self-regulation while integrating digital tools as purposeful, individualized resources for learning, inclusion, and school mental health promotion. Full article

Background: Disordered eating attitudes are major public health concerns associated with adverse physical, psychological, and social outcomes. Therefore, brief, psychometrically sound screening tools are needed to identify individuals at risk early. The Eating Attitudes Test-7 (EAT-7) is a shortened screening tool developed to assess disordered eating attitudes. However, its Turkish validity and reliability have not been previously examined. Therefore, this study aimed to assess the validity and reliability of the Turkish version of the EAT-7 among Turkish-speaking adults. Methods: This methodological validation study was conducted between November 2025 and January 2026. Data were collected online using a snowball sampling technique. After a pilot study with 210 participants, the main study included 1635 adults aged ≥18 years. Exploratory factor analysis was performed with 500 participants, and confirmatory factor analysis was performed with an independent sample of 1135 participants. Internal consistency and construct validity were assessed. Convergent validity was evaluated through correlations with the EAT-26, Eating Disorder Examination Questionnaire-13 (EDE-Q-13), and Depression Anxiety Stress Scale Short Form (DASS-8). Results: The Turkish version of the EAT-7 demonstrated excellent internal consistency, with a Cronbach’s alpha coefficient of 0.925. The Kaiser–Meyer–Olkin value was 0.909, and Bartlett’s test results were significant. Exploratory factor analysis supported a single-factor structure explaining 70.133% of the total variance. Confirmatory factor analysis confirmed a good model fit. The total EAT-7 score was positively correlated with the EAT-26, EDE-Q-13, and DASS-8 scores. Conclusions: The Turkish version of the EAT-7 is a valid, reliable, brief, and practical screening tool for assessing disordered eating attitudes among Turkish-speaking adults. Full article

Background: Burn injuries have complex physical and psychological consequences, making holistic rehabilitation essential. This mixed methods service evaluation explored the acceptability and perceived benefits of a peer-supported breakfast group delivered as part of routine occupational therapy practice for adult inpatient burn survivors. Methods: A tailored survey integrating PROMIS items with open-ended questions was completed by nine participants. All English-speaking inpatients aged >18 years who attended were invited to participate. In total 36 patients attended and 9 completed the survey (n = 36; n = 9). A convergent design integrated open-ended survey responses with PROMIS patient-reported outcome items, analysed thematically and interpreted using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) and MMR-RHS (Mixed Methods Reporting—Rehabilitation and Health Sciences) frameworks. Results: Quantitative findings suggested high perceived physical function and strong emotional support, with low anxiety and depression, and low social isolation. Reflexive thematic analysis generated four themes: fostering human connection and emotional wellbeing; restoring autonomy and confidence; preparing physically and psychologically for discharge; and the influence of the rehabilitation environment. Conclusion: While descriptive only, findings provide early insight into the value of peer-supported group activity in inpatient burn care. Larger controlled studies with baseline measurement are needed to evaluate effectiveness and implementation feasibility. Full article

Background/Objectives: Postpartum depression (PPD) is a clinically important perinatal mental health condition affecting maternal functioning and early mother–infant interaction. Prospective studies using clinically diagnosed PPD outcomes while jointly assessing antenatal psychosocial resources and obstetric context remain limited. This study examined antenatal psychosocial and obstetric factors associated with clinically diagnosed PPD at 6 weeks postpartum. Methods: This prospective cohort study included 85 pregnant women assessed at ≥24 weeks of gestation in a tertiary university hospital. Women receiving psychiatric treatment during pregnancy or meeting DSM-5 criteria for current depressive disorder at baseline were excluded; women with elevated antenatal depressive symptom scores but no current clinical depressive disorder were retained. Antenatal depressive symptoms, perceived stress, perceived social support, psychological resilience, pain catastrophizing, and clinician–patient relational empathy were assessed using standardized measures. Obstetric and neonatal data were extracted from medical records. PPD was assessed at 6 weeks postpartum using a structured DSM-5-based psychiatric interview. Group comparisons, univariable logistic regression analyses, and an exploratory two-domain adjusted logistic regression model were performed. Results: PPD was diagnosed in 25 women (29.4%). Women who developed PPD had higher parity, more frequent maternal obstetric comorbidity, lower infant birth weight and head circumference, higher depressive symptom severity, perceived stress, and pain catastrophizing, and lower perceived social support and psychological resilience. In the exploratory adjusted model, greater perceived social support was associated with lower odds of PPD (adjusted odds ratio [aOR] = 0.58, 95% confidence interval [CI]: 0.35–0.96), whereas higher parity was associated with higher odds (aOR = 2.24, 95% CI: 1.17–4.28). Conclusions: Clinically diagnosed PPD was associated with antenatal psychosocial vulnerability and obstetric context. Antenatal assessment of perceived social support, parity, and broader psychosocial vulnerability indicators may help identify women requiring closer postpartum monitoring. Full article

Background: Civic engagement plays an important role in promoting psychological wellbeing among university students. However, little is known about the heterogeneity of civic engagement patterns among nursing students and their association with psychological distress. We aimed to identify latent profiles of civic engagement and examine their associations with depression, anxiety, and stress. Methods: We performed a cross-sectional study among 255 nursing students at King Saud University. Data were collected using a structured self-administered questionnaire assessing civic engagement and psychological distress. To evaluate the psychometric properties of the civic engagement scale, we employed exploratory and confirmatory factor analyses. Latent profile analysis was used to identify distinct civic engagement profiles based on civic attitudes, civic behaviors, and community interest. We also fitted multivariable linear regression models to quantify the associations between civic engagement profiles and psychological distress outcomes. Results: The civic engagement scale demonstrated excellent internal consistency (Cronbach’s α = 0.93). Factor analyses supported a two-factor structure consisting of civic attitudes and civic behaviors. Latent profile analysis identified four distinct civic engagement profiles: Low engagement (16.9%), Moderate Engagement (22.0%), High civic awareness (43.1%), and Attitude Oriented (18.0%). Our findings showed significant differences across profiles in depression, anxiety, and stress scores. We observed that, compared with students in the low engagement profile, those in the Attitude Oriented profile demonstrated significantly lower depression (β = −6.63, 95% CI: −10.79 to −2.48), anxiety (β = −4.72, 95% CI: −8.87 to −0.58), and stress scores (β = −6.95, 95% CI: −10.81 to −3.09). Female students and students aged 21 to 23 years also showed significant association with lower psychological distress levels. Conclusions: Our findings suggested that there was distinct patterns of civic engagement among nursing students that are significantly associated with psychological distress. Higher civic engagement was associated with lower levels of depression, anxiety, and stress. This suggests that higher levels of civic engagement were associated with lower levels of psychological distress among nursing students. Strategies aimed at strengthening civic participation and community involvement may contribute to improved student mental health. Full article

As the number of college students with left-behind experience grows, more scholars focus on their mental health and development. Most existing research highlights the negative consequences of the left-behind experience and rarely explores how individuals turn adversity into resources. In this qualitative study, semi-structured interviews were conducted with 16 college students (men: n = 5, women: n = 11; age: 20–23) who had a left-behind experience. Thematic analysis was used to examine both the negative and positive effects of the left-behind experience and the mechanisms of positive transformation. Findings suggest that left-behind experience can result in both hidden costs and cultivated resilience. Negative effects include increased emotional sensitivity, difficulty forming close relationships, and reduced feelings of belonging. Positive outcomes include greater independence, stronger responsibility, and improved social adaptability. Further analysis shows that students use three strategies—cognitive restructuring, emotional regulation, and behavioral engagement—to convert negative experiences into positive psychological resources, thereby shifting from trauma to empowerment. The study shows that left-behind experience alone does not dictate long-term outcomes. Instead, individual meaning-making and resource integration shape development. By extending resilience theory to this student group, the findings offer a strengths-based framework for psychological support and education. These findings call for university mental health services and educational policies to move beyond a deficit model and incorporate the resilience and self-regulatory strategies identified in this population. Full article

Background/Objectives: This study aimed to examine whether regular exercise and healthy nutrition behaviors are associated with subjective well-being at school among adolescents. Methods: This descriptive study was conducted with 272 high school students aged 15–18 years who participated on a voluntary basis. Data were collected using the Nutrition and Exercise Behavior Scale, the Subjective Well-Being at School Scale, and a demographic information form. Descriptive statistics, group comparisons, correlation analyses, and regression analyses were performed to evaluate the relationships between lifestyle behaviors and subjective well-being at school. Results: The mean age of the participants was 16.27 ± 0.88 years; 55.9% were female and 44.1% were male. According to Body Mass Index (BMI) classification, 15.4% were underweight, 62.9% were normal weight, 16.2% were overweight, and 5.5% were obese. No statistically significant differences were found in subjective well-being at school scores according to gender or BMI categories (p > 0.05). Regression analysis indicated that healthy nutrition and exercise behaviors were positively associated with subjective well-being at school (β = 0.380, p < 0.001), whereas psychological/dependent eating behaviors were negatively associated with subjective well-being at school (β = −0.171, p = 0.043). Conclusions: Healthy nutrition and exercise behaviors were significantly associated with subjective well-being at school among adolescents. School-based lifestyle interventions may help support adolescents’ well-being at school and may inform future health promotion strategies. Full article

Background: Adolescent obesity is an escalating public health concern globally and in Greece, associated with significant physical and psychological consequences. Pediatricians serve as frontline clinicians in the early identification, counseling, and management of adolescents with excess weight; however, their practices, perceived competence, and the barriers they face remain insufficiently explored in certain Greek regions. Methods: A cross-sectional observational study was conducted using a structured, anonymous questionnaire distributed to all pediatricians working in Western Macedonia (n = 60). Fifty-one pediatricians participated (response rate 85%). The questionnaire assessed demographic characteristics, training, knowledge, clinical practices, attitudes, self-assessed competence, and perceived barriers. Results: Most participants (88.2%) reported no specialized training in adolescent obesity. Nearly half of respondents were unfamiliar with current diagnostic criteria for adolescent obesity. Although pediatricians expressed confidence in providing nutritional and lifestyle counseling, they reported limited competence in pharmacotherapy and bariatric surgery discussions. The most prominent barriers included insufficient family cooperation, lack of referral pathways, and difficulty engaging adolescents. Older and more experienced pediatricians reported higher levels of perceived competence and stronger interdisciplinary collaboration. Conclusions: Significant gaps in training and clinical support hinder the effective management of adolescent obesity in Western Macedonia. Strengthening continuous professional education, establishing multidisciplinary obesity care networks, and improving family engagement strategies appear crucial to enhancing clinical practice and improving health outcomes for adolescents. Full article

Background/Objectives: The mandatory spinal cord stimulation (SCS) trial was established in the era of tonic, paresthesia-dependent stimulation, when pre-implantation outcome prediction was unreliable, validated psychological screening was unavailable, and post-implantation programming options were limited. This narrative review examines whether universal trialing remains justified in the context of contemporary paresthesia-free waveforms, mechanistically informed psychological assessment, and current evidence on the predictive utility of screening trials. The objective was to evaluate the contemporary rationale for selective rather than universal trialing and to propose a structured four-step clinical decision framework integrating contraindication screening, pain phenotype certainty, psychological risk stratification, and centre-level criteria, with the aim of identifying patients in whom a trial is most likely to add prognostic information. Methods: PubMed and the Cochrane Library were searched using predefined search strings. Eligible publications included randomised controlled trials (including the TRIAL-STIM RCT), systematic reviews, registry-based cohort studies, health-economic analyses, and consensus guidelines. Results: The evidence base comprised randomised controlled trials of trial-versus-no-trial strategies, paresthesia-free waveforms, and closed-loop stimulation (including TRIAL-STIM, SENZA-RCT, EVOKE, and ECHO-MAC), together with large registry and cohort studies, systematic reviews, qualitative patient-experience data, and current consensus guidance. Modern paresthesia-free and physiology-guided paradigms reduce several technical functions historically served by trialing, although the extent varies by waveform. The only randomised trial designed specifically to compare trial-first and no-trial strategies (TRIAL-STIM) found no difference in pain outcomes at 6 or 36 months; however, its single healthcare setting and predominantly paresthesia-based waveform mix limit generalisability. Structured pre-implantation psychological evaluation may provide prognostic information that short-duration trialing cannot replicate. At the same time, contemporary guidelines continue to recommend trialing and several clinically relevant arguments for retaining it persist, including patient experiential learning, identification of screening false negatives, and grey-zone decision-making. Conclusions: In carefully selected patients with established neuropathic pain phenotypes and comprehensive pre-implantation evaluation, selective trialing may be clinically reasonable. The proposed four-step framework offers a structured basis for allocating trial stimulation to the patients most likely to benefit from it and should be interpreted as hypothesis-generating pending prospective validation. This review does not advocate abandoning trial stimulation; rather, it argues that its role should be examined within an individualised, phenotype- and risk-stratified pathway. Full article

Aim: This study aims to explore how competitive psychology mediates the relationship between involution and depression–anxiety–stress among college students from three universities in Anhui Province, China. Background: Against the global involution trend, college students excessively pursue academic achievements, leading to heightened self-involution and psychological issues like anxiety and depression, while competitive psychology’s mediating role here remains under-explored. Methods: A multi-cross-sectional survey in three Anhui universities used convenience sampling to collect 592 samples. Results: Three validated scales assessed involution, competitive psychology, and depression–anxiety–stress, with mediation analysis via SPSS Process 3.3. The results showed strong positive correlations between the three variables (r = 0.827, 0.638, p < 0.001), and competitive psychology significantly mediated the involution–depression–anxiety–stress relationship (r = 0.110). Conclusions: The observed data are consistent with a correlational mediation model among college students from three universities in Anhui Province. The findings provide theoretical references for local university educational practice and mental health guidance, without causal inference or nationwide policy generalization; future research should explore related mechanisms and interventions. Clinical Relevance: This study provides empirical evidence for nursing and mental health professionals to design targeted psychological interventions for college students, helping mitigate the negative impacts of involution and competitive pressure on mental health in clinical practice. Full article