Psychosocial Implications Research Articles

Assessment of psychosocial parameters in adolescents seeking orthodontic treatment

AimThe aim of this study was to investigate the psychosocial impact of malocclusion and the motivation for seeking orthodontic treatment among adolescents.MethodsA cross-sectional study included 102 adolescents (ages 11–18) whose malocclusion was rated using 3 occlusal indices: IOTN, DAI, and PAR. The participants answered three structured questionnaires selected to measure Oral Health Related Quality of Life (OHRQoL) through the short form of the Child Oral Health Impact Profile (COHIP), the patient's perceived impact related to orthodontics through the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ), and self-esteem through the Rosenberg Self-Esteem Scale (RSES). Independent two-tailed t-tests, one-way mixed analysis of variance (ANOVA), and Spearman's correlations were used to test various associations.ResultsPatients with higher malocclusion scores displayed increased psychosocial impact with weak to moderate correlations (0.2 < r < 0.3; p < 0.05), but 98% wished their teeth looked better, and 70% were unhappy about their smile esthetics. The IOTN esthetic component AC was better associated with psychosocial implications of malocclusion (p < 0.01). Self-motivated patients (over 80%) had higher impactful psychosocial scores than patients whose parents were motivated for treatment. Sex did not influence the findings. Older adolescents and bullied individuals were more affected by the psychological burden of malocclusion.ConclusionThe results indicate the prevalence of psychosocial and esthetic impacts of malocclusion over oral and functional problems. PIDAQ discriminated better than COHIP between varying degrees of dental aesthetics. The results suggest that the orthodontist should explore patients' expectations of treatment outcomes, not only the chief complaint.

Lived and care experiences of young people with chronic musculoskeletal pain and mental health conditions. A systematic review with qualitative evidence synthesis.

Chronic musculoskeletal pain (CMP) and coexisting mental health conditions impact young people; however, little is known about their lived and care experiences. In a prospectively registered systematic review with qualitative evidence synthesis (PROSPERO: CRD42022369914), we explored the following: (1) lived physical, psychological, and social experiences; and (2) care experiences/preferences of young people living with CMP and mental health conditions. Inclusion criteria: studies using qualitative methods; participants aged 16 to 24 years with CMP and coexisting mental health condition(s); phenomenon explored included lived and/or care experiences. Seven databases were searched (inception to 19-May-2024), study quality was assessed, data were extracted and analysed thematically, and GRADE-CERQual was used to assess confidence in findings. Twenty-two studies (23 reports) were included (>239 participants, 82% women). Lived experiences yielded 4 themes (9 findings): 2-way relationship between CMP and mental health (2 findings, low to moderate confidence); psychosocial implications of CMP (3 findings, very low-moderate confidence); uncertainty about future (2 findings, low-moderate confidence); coping with CMP and mental health conditions (2 findings, low-moderate confidence). Care experiences/preferences yielded 3 themes (8 findings): navigating healthcare systems (2 findings, moderate confidence); receiving appropriate care (3 findings, very low-moderate confidence); point-of-care experiences and care preferences (3 findings, very low-moderate confidence). Chronic musculoskeletal pain and mental health conditions are interconnected, significantly impacting young people's lives, identities, and socialisation, yet services for CMP and mental health are often inadequate and poorly integrated. The mechanisms and interplay of CMP and mental health require deeper exploration, including how young people may be better supported with personalised, holistic, developmentally and/or life-stage-appropriate integrated care.

A Comprehensive Review on the Screening Models for the Pharmacological Assessment of Antipsychotic Drugs

Background: Psychosis is a debilitating mental disorder characterized by a profound disconnection from reality, manifesting in symptoms such as hallucinations, delusions, and disorganized thinking. The pathophysiology of psychosis is multifaceted, involving an interplay of neurobiological, genetic, and environmental factors. Neurobiologically, dysregulation of neurotransmitter systems particularly dopaminergic, serotonergic, and glutamatergic pathways-plays a central role, with excessive dopaminergic activity linked to positive symptoms and glutamatergic dysfunction implicated in cognitive impairments. Genetic predisposition, evidenced by significant heritability and associations with specific genetic variants, intersects with environmental factors such as stress, trauma, and substance use to influence the onset and progression of psychosis. Cognitive disruptions, including deficits in attention, memory, and executive function, exacerbate the disorder’s impact. This phenomenon has led to short-term as well as long-term psychosocial and mental health implications for all. Objective: To determine the antipsychotic activity of pharmaceuticals, numerous antipsychotic screening models are available. Determining the optimal animal model for measuring antipsychotic activity is the primary goal of this study. Methods: A search for literature was carried out using several keywords, including "Antipsychotic," "In-vivo models," "In-vitro models," and "Behavior models," on the databases Science Direct and PubMed. For the purpose of obtaining the most appropriate articles to fulfil the goal of this review article, the search was customized by using the necessary filters. Results: Research and review articles based on neuroleptic screening models are available to determine the antipsychotic activity of novel pharmacological compounds. Conclusion: Following our research, we identified several helpful models for evaluating the antipsychotic activity of pharmaceuticals and proposed that combining invitro and in-vivo techniques with behavioral methodologies might yield the most appropriate results for our field of study.

“EPIDERMÓLISE BOLHOSA DISTRÓFICA RECESSIVA.”

This study addresses Recessive Dystrophic Epidermolysis Bullosa (RDEB), a rare genetic disorder characterized by extreme fragility of the skin and mucous membranes. The objective is to explore the clinical, genetic, and psychosocial implications for patients with RDEB, with an emphasis on emerging therapies such as gene and biotechnological interventions. Using a qualitative methodology and a literature review from reputable scientific databases, the study will analyze the effectiveness of these new therapies and their impact on patients’ quality of life. The main expected outcomes include validating the new therapies and formulating guidelines to improve the management of RDEB. It is concluded that emerging therapeutic approaches have the potential to transform the prognosis of RDEB, although further studies are necessary to consolidate these strategies.

Natural Skin Care Regimen Improves Clinical Parameters and Quality of Life in Children with Atopic Dermatitis

Background: Atopic dermatitis (AD) is a prevalent, chronic inflammatory skin disorder, characterized by xerosis, itching and recurrent eczematous lesions. The condition also has major psychosocial implications for patients and their families. A daily skincare regimen of gentle cleansing and moisturization is an important part of atopic dermatitis therapy. Objective: This study evaluated the tolerability and efficacy of a nature-based shampoo/wash and moisturizer in children with mild to moderate atopic dermatitis Methods: This open-label study involved 23 children (6 months – 13 years) with atopic dermatitis. A daily skin care regimen of nature-based shampoo/wash and moisturizer was used for 4 weeks. The primary endpoint was tolerability assessed through clinical grading of erythema, dryness and roughness. The study pediatrician graded the eczema condition using the Eczema Area and Severity Index (EASI), and assessments of stratum corneum hydration and transepidermal water loss were performed before and after treatment. Parent/guardian completed two validated quality of life questionnaires. Results: Twenty children completed the study. Clinical evaluations showed significant improvement in subjects’ atopic disease with daily use of nature-based regimen. Significant reduction in dryness and roughness was observed, indicating that both products were well-tolerated. Moisture content and transepidermal water loss measurements showed directional improvements in skin barrier function. Parent/guardian reported significant improvements in quality-of-life assessments. Conclusions: The study demonstrated that nature-based skin care regimen was well tolerated and improved quality of life and skin condition in children with atopic dermatitis and can be used either alone or in adjunction with traditional treatment for disease control.

Exploring the Psychological Side of Fentanyl: A Scoping Review to Disclose the Psychosocial Dimensions of Illicitly Manufactured Fentanyl Users

Background Fentanyl is a powerful opioid. The abuse and overdoses related to Illicitly Manufactured Fentanyl (IMF) have become more prevalent. The majority of clinical studies on fentanyl have focused on its medical and biological aspects, particularly its addictive properties. Few studies have delved into the psychological aspects of illicit fentanyl use, and there is currently no comprehensive review providing a structured psycho-social profile of the population groups most vulnerable to its effects. The goal of this Scoping Review was to construct a psychological and social profile of individuals at risk of using illicit fentanyl. This profile will serve as a guiding force for shaping behavioral policies and public health prevention efforts necessary to face the recent pandemic. Methods Following the PRISMA guidelines we conducted a Scoping Review focused on the following research question: What are the practical psycho-social implications of illicit fentanyl use in the global population? Results The bibliographic research was carried out in the databases of Medline, Scopus, and PsycNet. The articles resulting from the research phase in the databases listed above produced a total of 17737 reports. After the screening process, 10 studies were included in the scoping review. Discussion and Conclusion This scoping review was the first to consistently and systematically outline the psychosocial implications of fentanyl dependence. Users of IMF are consistently younger than other drug users. People using fentanyl have a relatively low perception of risk. On the psycho-social levels, there is a significant correlation between fentanyl use and mental disorders such as suicidal thoughts, anxiety disorders, and depression. The development of psychotherapy, along with digital tools such as apps and online platforms, can be an initial step in addressing this challenge.

Bone Loss and Fractures in Post-Menopausal Women Living with HIV: A Narrative Review.

Post-menopausal women living with Human Immunodeficiency Virus (WLHIV) face an increased risk of bone fractures due to the relationship between HIV-related factors and menopause. This narrative review aims to summarise the current knowledge about fracture risk among post-menopausal WLHIV in particular looking at hormonal changes, combined antiretroviral therapy (cART), lifestyle factors, and psychosocial implications. We also profiled a summary of the significant, recent studies of post-menopausal WLHIV residing in low-income countries (LIC). A thorough search of the literature was performed across PubMed, Medline, Scopus, and Google Scholar, focussing on studies published between 2000 and 2024. Inclusion criteria entailed original research, reviews, and meta-analyses addressing bone mineral density (BMD), fracture incidence, and related risk factors in post-menopausal WLHIV. The review identified 223 relevant studies. Post-menopausal WLHIV exhibit significantly lower BMD and higher fracture rates compared to both HIV-negative post-menopausal women and pre-menopausal WLHIV. cART, particularly tenofovir disoproxil fumarate (TDF), contributes to reduced BMD. Menopausal status exacerbates this risk through decreased oestrogen levels, leading to increased bone resorption. Moreover, lifestyle choices such as smoking, alcohol consumption, and low physical activity are more prevalent in PWHIV, which further elevates fracture risk. Different psychosocial factors may make WLWHIV more vulnerable at this stage of their life, such as depression, isolation, stigma, and housing and nutritional issues. Women living in LICs face a variety of challenges in accessing HIV care. There are gaps in research related to the prevalence of osteoporosis and bone loss in post-menopausal WLHIV in LICs. Post-menopausal women living with HIV face a significantly higher risk of bone loss and fractures due to the combined effects of HIV and menopause. Antiretroviral therapy (particularly TDF), lifestyle factors, and psychosocial challenges exacerbate this risk. There is a need for careful selection of cART, hormone replacement therapy (HRT), and emerging treatments such as Abaloparatide. A holistic approach including lifestyle changes and psychosocial support is crucial to reduce fracture risk in WLHIV, especially in low-income countries.

A Case of Breast Cancer Patient with Li–Fraumeni Syndrome: Psychosocial Implications and Literature Review

Li–Fraumeni syndrome (LFS) is defined by the early emergence of tumors and is associated with mutations in the tumor suppression gene known as tumor protein 53 ( TP53). Information is scarce regarding the psychosocial challenges encountered by individuals with LFS and how it affects their treatment decisions. A 21-year-old woman developed multiple breast tumors over a period of nine years. Genetic testing identified a heterozygous missense substitution in exon 6 of the TP53 gene, specific variant chr17:7578190T&gt;C c.659A&gt;G (p.Tyr220Cys) listed in the dbSNP database. The report also highlights the psychosocial implications of the diagnosis at a young age and the patient’s reluctance to undergo the recommended bilateral mastectomy. The patient exhibited a significantly higher incidence of secondary tumors, underscoring the importance of comprehensive screening and timely diagnosis for managing LFS. This case highlights the challenges faced and the importance of emotional and psychological support after the diagnosis of hereditary syndromes, especially among young women.

Online and offline shopping addiction and its relationship with state-trait anxiety and impulsivity

Compulsive buying is a phenomenon that involves dysfunctional shopping behaviors together with a continuous concern about buying and problems derived from said behaviour that impact different aspects of daily life. This study aims to analyse some of the psychological factors related to compulsive buying both online and offline, such as anxiety and impulsivity. 202 Volunteers from both sexes between the ages 18 and 69 participated. A questionnarie was designed based on the Barrat Impulsiveness Scale (BIS-11, 1995), the Bergen Shopping Adicction Scale (BSAS, 2015) and the State-Trait Anxiety Questionnarie (STAI, 1983). It was verified that the most impulsive and anxious individuals tend to perform more behaviors related to compulsive buying. No differences in compulsive buying based on age were found. It is interesting to delve into the implications derived from dysfunctional purchasing behaviors and the psychosocial implications of such practices.

Congenital melanocytic nevi and risk of melanoma

The presence of congenital melanocytic nevi (CMN) is determined in utero. The location, size, and number of CMN may be of cosmetic concern with significant psychosocial implications. They may also be associated with symptoms such as pruritus, eczema/xerosis, and skin fragilit; however, the most medically concerning issue is the association of CMN with the risk of developing cutaneous melanoma, extracutaneous melanoma, and neurocutaneous melanocytosis (NCM). Patients with CMN are currently risk-stratified based on the projected adult maximum diameter of the largest CMN and the number of CMN (satellites) present. In small and medium CMN the absolute risk of developing cutaneous melanoma is estimated to be approximately 0.3% with a relative risk of 9.5. While patients with large CMN are at increased risk for developing primary cutaneous melanoma within the CMN, they are also at increased risk for developing primary melanoma within the central nervous system (CNS) in association with CNS melanocytic deposits, an entity known as NCM. The absolute risk for developing melanoma in patients with large CMN is estimated to be between 1.25-10% with a relative risk between 52-1046. Regarding the risk for the presence of NCM, the risk correlates with the number of CMN, with the lowest risk in those with a single CMN and with risk escalation as the number of CMN increase. We have provided an overview of the existing evidence about the risk of melanoma and NCM in patients with CMN. The role of the clinical examination, dermatoscopy, MRI scanning of the CNS, and the role of surgery in the management of CMN of varying sizes is discussed.

50004 The Psychosocial Implications of Acne in Patients with Skin of Colour

50004 The Psychosocial Implications of Acne in Patients with Skin of Colour

Overview of Unilateral and Bilateral Pediatric Facial Paralysis: Workup, Treatment, and Frontiers.

Pediatric facial nerve paralysis can present significant challenges based on its various etiologies, unique approach to treatment options, and overall outcomes. It can impact both the child and parent when regarding function, appearance, and psychosocial implications. The etiology of facial nerve palsy can include congenital, traumatic, iatrogenic, and idiopathic causes. In some, the paralysis is transient while others have permanent loss of function. A thorough evaluation and differential diagnosis are essential to guide treatment planning. The purpose of this paper is to review facial paralysis in children with a focus on surgical management.

Adapting the Lidcombe Program for 6–12-year-olds: insights from a video telehealth trial

ABSTRACT Purpose: Childhood stuttering is common and can have debilitating, long-term psychosocial implications if prompt and effective treatment is not provided. The Lidcombe Program has robust clinical evidence for treating stuttering in early childhood. The results of a recent Phase II trial with a cohort of 6–12-year-old children showed that this treatment may benefit a much broader age range of children than initially thought. Benefits included improved communication attitudes, and reduced impact of stuttering and social anxiety symptoms. This study describes how clinicians can use the Lidcombe Program flexibly to cater to the varied needs of older children. Method: The Johnson et al. (2024) trial of the Lidcombe Program included clinical mentoring meetings every 2 weeks between the treating clinician and a member of the Lidcombe Program Trainers Consortium. Practical recommendations and clinical resources were developed to help clinicians adapt aspects of the available Lidcombe Program Treatment Guide (Onslow et al., 2021) for 6–12-year-old children. Results: Five key themes emerged from the clinical mentoring meetings to support clinicians. These included (a) active generalization of stutter-free speech to everyday conversations, (b) strategies for engaging the child in treatment, (c) examples of non-verbal contingencies, (d) optimizing treatment dosage for busy families, and (e) versatile clinical resources for different settings and child ages. Conclusions: This report provides resources for speech-language pathologists who manage school-age children who stutter. The recommendations and resources described in this report are designed to assist clinicians with adapting the Lidcombe Program for a wider age range of children.

Unraveling Childhood Obesity: A Grounded Theory Approach to Psychological, Social, Parental, and Biological Factors.

Childhood obesity is a major medical and public health issue of global interest, which is influenced by a diverse array of factors and carries significant medical and psychosocial implications. Despite the extensive studies that have been conducted to explore the specific issue, the impact of several factors that influence, generate, worsen, and make chronic the phenomenon needs further exploration. This study aimed to construct a grounded theory that includes and connects the psychological, social, parental, and biological factors affecting childhood obesity. Key psychological factors include mental health issues such as depression and emotional eating, while social factors encompass socioeconomic status and cultural influences. Parental factors involve parenting styles and feeding practices, and biological factors relate to genetic predispositions and prenatal conditions. These factors interact in complex ways, highlighting the multifactorial nature of childhood obesity. The study employed a qualitative grounded theory approach, using research articles to achieve a thorough understanding. Qualitative analysis of the articles was conducted using Atlas.ti 24.0 software. Twenty-five research articles were required to reach theoretical saturation. The analysis resulted in 336 codes that were grouped into seven broad categories and twenty-four different subcategories. Through the construction of the theoretical framework, it was recognized that obesity in minors is a complex and multifactorial issue and that the network of causes and influencing factors covers a broad spectrum ranging from the individual to the family, and subsequently to society at large, which interact with each other.

The gender congruences and life satisfaction scale for transgender and gender-diverse youth (GCLS-Y): a validation study with samples from the UK and US

Background There are currently no good quality psychometric tools available to assess multi-dimensional outcomes for trans and gender diverse youth. A tool is needed to develop a stronger evidence base regarding the evaluation of gender-affirming healthcare for the population. Aim The current study aimed to adapt and validate the Gender Congruence and Life Satisfaction Scale for young trans and gender diverse people (GCLS-Y) with young trans and gender diverse people aged 14-19 living in the United Kingdom (UK) and the United States (US). Method Initially, the GCLS-Y was adapted through expert consultation and discussion with trans and gender diverse youth to ensure it is meaningful and relevant. A survey that included the GCLS-Y and other psychometric measures that assessed gender incongruence, mental health and wellbeing to determine convergent validity and social desirability to examine discriminant validity was completed by 307 trans and gender diverse youth (n = 175 in the US and n = 132 in the UK). Findings Exploratory Factor Analysis supported a 5-factor model that was assessed as conceptually accurate. The final version of the GCLS-Y included 38 items with the following subscales: Psychosocial Implications of Gender Distress, Incongruence and Dysphoria related to Chest, Incongruence and Distress related to Genitalia, Social Perceptions of Gender, and Life Satisfaction. The measure was also found to be valid and reliable. Conclusions The GCLS-Y is a psychometrically sound tool that can be used to assess multidimensional outcomes among trans and gender diverse youth (14-19 years) related to mental health and wellbeing, gender incongruence and distress, and social experiences of gender. The tool can support the development of evidence-based policy, which has implications for legislation, healthcare funding, and broader societal attitudes.

Nursing's Role in Psychosocial Health Management After a Stroke Event: A Scientific Statement From the American Heart Association.

Stroke can have profound psychosocial health implications. These constructs are often overlooked and undertreated yet can be as devastating as the physical, functional, and cognitive consequences after stroke. This scientific statement aims to evaluate 5 important aspects of psychosocial health (depression, stress, anxiety, fatigue, and quality of life) after a stroke to provide a framework for related nursing care across the poststroke continuum. A narrative review of the literature published from 2018 to 2023 was conducted with databases such as PubMed/MEDLINE, ClinicalTrials.gov, PsychInfo/EBSCOHost, PsychArticles, CINHAL, and the Cochrane Library. Findings reveal a gap in evidence-based nursing interventions for addressing poststroke psychosocial needs. Critical strategies for shaping therapeutic nursing care include enhanced screening with validated tools; educating stroke survivors, families, and staff on symptom recognition, prevention, and treatment; and ensuring appropriate pharmacological management and access to psychological and psychosocial interventions, including referrals to social services and other essential support systems. Care should be comprehensive and interdisciplinary. Nurse-led research can benefit from more inclusive inclusion, including individuals with recurrent strokes and preexisting psychosocial conditions, focusing on the impact of structural racism and care disparities and expanding evidence-based nursing interventions. Although there is limited high-level evidence on the nursing care for patients with suboptimal psychosocial health after stroke, nurses have a crucial role in addressing these needs. Enhanced screening, assessment, supportive services, and education are vital to ensure that patients receive the necessary treatment and care.

Psychosocial implications of learning amyloid PET results in an observational cohort.

Information on the psychosocial impact of Alzheimer's disease (AD) biomarker testing in adults at risk of AD is needed to inform best practices for communicating biomarker results. Ninety-nine cognitively unimpaired older adults learned amyloid positron emission tomography (PET) results (mean age=72.0±4.8, 95% White, 28% elevated amyloid). Linear mixed-effects regression models were used to test the main effects and interaction of PET result × time on psychosocial outcomes up to 6 months after learning results. A significant interaction of PET result × time was observed for concern about AD (β=0.28, p=0.02) and intrusive thoughts and avoidance (β=-0.82, p<0.001). A main effect of PET result was observed for AD test-related distress (β=12.09, p<0.001). Cognitively unimpaired adults learning elevated-amyloid PET results reported mildly intrusive thoughts/avoidance initially following disclosure, but these symptoms decreased over time. Concern about AD dementia and AD biomarker test-related distress remained higher in elevated-amyloid compared to non-elevated-amyloid participants. Longitudinal assessment of psychosocial reactions after amyloid PET disclosure was conducted. Transient highly intrusive thoughts or avoidance after learning elevated amyloid results. Persistent test result-related distress after receiving elevated-amyloid results. There is increased concern about AD dementia after receiving elevated-amyloid results. Happiness and relief are experienced after receiving non-elevated-amyloid results.

Living in Italian residential care under COVID-19 restrictions. A survey on adolescents’ perspectives over their psychosocial wellbeing

COVID-19 lockdown has been worldwide considered one of the major collective traumatic experiences for everyone, vulnerable adolescents included. Surprisingly, however, research on the experiences of adolescent living in residential care (RC) – considered it to be particularly exposed to traumas and developmental challenges – has been underdeveloped in the pandemic scenario. Bridging this gap and drawing on a national survey with Italian adolescents living in RC, the current study examines their psychosocial wellbeing, i.e., their perceived subjective and relational wellbeing, during lockdown. In terms of subjective wellbeing, results show increased irritability, but, differently from general population, no sleep quality deterioration. In terms of relational wellbeing, we document a general sense of safeness and protection in RC, a significant sense of being listened to by caregivers, and continuity of care with professionals and keypersons. We confirm and display two distinctive effects as well: a) the “gender effect” – i.e., compared to boys, girls reported higher irritability, and b) the “length of placement in RC” effect – i.e., adolescents living in RC for more than 3 years reported increased irritability and a lower relational wellbeing, counterbalanced by a higher competence in keeping their contact with their schoolmates outside RC. Proposals for targeted psychosocial interventions, limitations and implications for future research in the developmental areas are discussed in the conclusions.

Illness experience and (unmet) needs of women with Mayer-Rokitansky-Küster-Hauser Syndrome (MRKH): a qualitative analysis of an online forum

Objective Mayer-Rokitansky-Küster-Hauser syndrome (MRKH) is a congenital condition characterized by the underdevelopment or complete absence of the uterus and the upper part of the vagina. Diagnosis is commonly made during adolescence, a sensitive period for psychophysical development, following the absence of menstruation. Having MRKH syndrome can have a profound and multifaceted psychosocial impact that characterizes these women’s subjective experiences, although it continues to be qualitatively understudied. This article explores the lived experience of women with MRKH spontaneously recounted on an online support forum. The aim was to gain insight into the features of the syndrome experience to understand deeply the emotional and social impact of the condition and the individual needs expressed online. Methods Using a naturalistic observation stance, data was collected from an online support forum for MRKH women and systematically analyzed using thematic analysis. Results Four main interconnected themes are identified: the impact of being diagnosed with MRKH, the difficult interaction with the medical environment, challenging social relationships, and the unmet needs of MRKH women. Conclusion A multidisciplinary and person-centered approach that provides effective and sensitive management of the condition and its psychosocial implications, is essential. Recommendations for future research and practical clinical implications for healthcare professionals are proposed.

The psycho-social implications of institutional hierarchy: an exploratory study into Chinese doctoral graduates’ engagement in career planning for non-academic employment

The psycho-social implications of institutional hierarchy: an exploratory study into Chinese doctoral graduates’ engagement in career planning for non-academic employment