Nurse burnout poses a significant risk to workforce stability. This study investigated the impact of equine-assisted learning (EAL) on secondary traumatic stress, job burnout, subjective distress, and resiliency among nurses. Effective interventions for early detection and management of stress and burnout are essential for workforce stability. Using a pre-post-interventional design, this study evaluated the impact of EAL on psychosocial well-being. Outcomes were measured using self-reported questionnaires at baseline, postintervention, and 1-month follow-up. Linear mixed models were used to assess score differences over time. EAL significantly reduced secondary stress by an average of 6.83 (P<0.001), job burnout by a mean drop of 6.45 (P<0.05), and subjective distress by a mean decrease of 9.02 (P<0.01) at 1-month follow-up, while resilience showed a short-term increase postintervention by 1.4 (P<0.001). Implementing EAL for nurses may enhance nurses' well-being and improve the quality of patient care.

The influence of dyspnea on social frailty in elderly patients with chronic obstructive pulmonary disease: The mediating effects of social support and depression symptoms.

Cat owners tend to be more reluctant to take their animals to the veterinarian than dog owners. This reluctance may be related to factors such as the difficulty of placing the cat in the carrier, the animal’s behavior during transport to the clinic, and the reactions observed during the consultation itself. For cats, the visit may also be a stressful experience, as they are exposed to visual and olfactory stimuli from other animals. Furthermore, there is evidence that cats can perceive human signals and emotions, particularly those expressed by their owners. Thus, stressful situations for the owner may also be perceived as stressful by the cat. This study primarily aimed to investigate whether the owner’s anxiety level is associated with the cat’s behavioral and stress responses during veterinary consultations. Additionally, it sought to explore whether the owner’s presence or absence during the consultation influences these feline responses. Understanding these relationships may help clarify how the owner’s emotional state and presence interact to affect feline welfare in the clinical context. The behavior of both cats and their owners was evaluated during two consultations: the first with the owner present and the second without the owner. Two self-report questionnaires were used to assess the owners’ anxiety levels. To evaluate feline stress, the Cat Stress Score (CSS) was applied under both conditions: owner present and owner absent. Although both the owners’ anxiety and cats' stress scores indicated a moderate emotional response, no correlation was found between owner anxiety and cat stress during the veterinary consultations. However, cats exhibited different stress-related behaviors depending on the owner’s presence or absence, which may reflect some comfort associated with the owner’s presence. Given the study design, this effect could not be isolated. Future studies using a randomized crossover design are required to further understand the impact of owner presence on feline stress. Understanding these dynamics is essential to improving feline welfare during veterinary visits and developing strategies to reduce stress for both cats and their caregivers.

The association between screen time and cognitive function in children: The partially mediating role of putamen volume.

Life-long treatment is critical in Wilson disease (WD), a rare genetic disease leading to copper accumulation with hepatic and extrahepatic manifestations. Poor adherence is a well-known contributor to unfavourable clinical outcomes. Measuring adherence in these chronic patients may be challenging, as no gold standard method is available. We aimed at evaluating adherence in a well-characterised WD cohort and ultimately designing individualised nursing interventions. Prospective, single-centre study, including adult WD patients. Adherence to medication was assessed by a three-dimensional approach: (1) self-reported ARMSe questionnaire; (2) pharmacy service dispensing records and (3) physician-based evaluation. Concordance between methods was assessed, and variables associated with low adherence were evaluated. Inclusion of 54 WD patients (54% female, median age 39 years, median time since diagnosis 20 years). According to ARMSe, 39% of the patients reported low adherence, which was significantly associated with younger age at evaluation, higher ALT and higher exchangeable copper levels. Although a trend towards a positive association between methods was observed, concordance was low and patients were not classified in a constant manner, as only 12% were noncompliant by the three methods. Despite the critical role of adherence for adequate control of WD, one-third of our cohort exhibited low adherence. The limited agreement among the different assessment methods reinforces the need for a combined strategy. The ARMSe questionnaire proved useful for guiding individualised educational nursing interventions by enabling the identification of patient-specific barriers to adherence.

Do coexistent overactive bladder symptoms affect the outcome of single-incision sling in women with urodynamic stress incontinence?

Linking early adversity to trait level cortisol: The role of cultural resilience in latino adolescents.

Adverse childhood experiences (ACEs) are risk factors for anorexia nervosa (AN). We compared patients with AN and Healthy Control subjects (HCs) on the frequency and type of ACEs, assessed the association between each ACE and the likelihood of having specific psychopathological features in AN, and explored the relationship between the number of ACEs and clinical severity. One-hundred and twenty-nine patients with AN and 111 HCs completed several self-report questionnaires assessing ACEs, post-traumatic symptoms, eating-related, and general psychopathology. Patients with AN reported a higher number of and more mixed (i.e.,both emotional and physical abuse) ACEs than HCs. Each ACE, except for physical abuse and neglect, was associated with an increasing likelihood of comorbid features, including self-harm, lifetime probable PTSD, and substance/alcohol abuse, independently of AN subtype. An increased number of ACEs was linked to a doubled likelihood of being in the AN versus HC group, and to emotion dysregulation, somatoform dissociation, and depression, both in patients and HCs. ACEs contributed to a more complex picture in AN, with the specific influence of each ACEs type. The study revealed a cumulative effect of ACEs on dissociation and emotional symptoms, suggesting an important role of traumatic history in individuals with AN.

The cognitive-behavioral model of body dysmorphic disorder (BDD) implicates impaired cognition; yet existing evidence of cognitive impairment in the disorder is often inconsistent. To date, cognitive performance in BDD has not been measured utilizing the Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV), a gold standard cognitive assessment in clinical settings. Accordingly, this study compared WAIS-IV performance between individuals with BDD and healthy controls. Participants included 59 BDD patients and 56 controls. Cognitive performance was evaluated via the WAIS-IV, and clinical characteristics of the BDD group were examined via multiple clinician and self-report questionnaires. The BDD group demonstrated significantly poorer performance compared to the control group in the WAIS-IV index and subtests that reflect processing speed abilities (Processing Speed Index: d = -0.55, 95% CI [-0.92, -0.18], Symbol Search: d = -0.70, 95% CI [-1.07, -0.32], Coding: d = -0.79, 95% CI [-1.17, -0.41]), yet other indices were not significantly different. These impairments were not correlated with anxiety or BDD-YBOCS symptom severity. Reduced overall cognitive performance was primarily driven by impairments in processing speed. The study suggests that in BDD, processing speed is notably lower than other index scores, falling in the low average range. This may reflect difficulties with rapid visual processing, attention to detail, or motor speed. Performance in domains reflective of reasoning and verbal functioning were unimpaired relative to controls. This selective cognitive pattern in BDD may be driven by increased cognitive load associated with perfectionistic traits. This has clinical implications for cognitive-behavioral treatment.

ABSTRACT We aimed to assess the perception of Imams regarding the causes and treatment of mental illness in Bangladesh. We collected data from Imams between August 2023 and July 2024, using a convenience sampling method and a self-report questionnaire. The questionnaire included sociodemographic variables and variables for assessing the perception of the cause and treatment of mental illness. The mean age of 537 Imams was 29.9 years. The collective importance of the cause of mental illness ranged from 41.3% (demonic possession) to 85.3% (stressful life events). Imams perceived hereditary (82.5%), chemical imbalance (84.1%), stressful life events (85.3%), childhood trauma (82.9%), and drug abuse (82.9%) as important causes of mental illness. The collective agreement ranged from 67.4–79.1% in the medication helpful domain. A mixed perception was noted on the preferences for prayer over medications. This study indicates a favourable perception of Imams on the cause and treatment of mental illness in Bangladesh.

ABSTRACT Evidence regarding the impact of dementia care training on the confidence of healthcare support workers (HSWs) is relatively scarce. This study aimed to explore the current status and factors influencing HSWs’ confidence in providing dementia care. A cross-sectional survey was conducted with 345 HSWs in Taiwan, who completed self-reported questionnaires, the Dementia Knowledge Assessment Scale (DKAS), and the Approach to Dementia Questionnaire (ADQ). Linear multiple regression analysis was used to identify the major factors related to confidence in providing care that meets the needs of individuals with dementia. Notably, 94.8% of the participants had completed dementia care training, and the average confidence rating in providing dementia care was 3.67 (SD = 0.77). Participants who completed the dementia caregiving course were typically older, had more work experience, and were more likely to have cared for individuals with dementia compared to those who did not complete the course; both factors were associated with higher levels of confidence in providing dementia care. Key factors related to confidence included prior experience in caring for individuals with dementia and familiarity with, or learning about, Person-Centered Dementia Care (PCDC). Therefore, in addition to dementia care training courses, the integration of practical dementia care training and a deeper understanding of PCDC could further enhance HSWs’ confidence in delivering dementia care.

Predicting donation behavior from psychophysiological responses to music with prosocial lyrics.

Purpose Social participation and post-traumatic growth (PTG) both exert beneficial effects on well-being of patients receiving maintenance dialysis. However, the temporal directionality of their association has remained unexamined. This study aimed to examine the bidirectional, longitudinal relationship between PTG and social participation over 1-year period among patients receiving maintenance dialysis. Methods Research data were collected from patients receiving dialysis treatment for over 3 months at two tertiary hospitals in China. A total of 193 participants completed the baseline survey, and 147 completed the second-wave survey. Self-reported questionnaires were delivered to assess their PTG and social participation. Cross-lagged analysis was used to examine the possible relationship between PTG and social participation. Results After adjusting for confounding factors, a unidirectional linear relationship was observed: higher levels of PTG at baseline were associated with greater social participation over time (β = 0.290, 95% CI: 0.151–0.430, p < 0.001), whereas baseline social participation was not significantly associated with subsequent PTG. Conclusions This study revealed low levels of social participation among patients receiving maintenance dialysis. Based on the cross-lagged analysis, PTG appears to play a contributing role in improving social participation over time.

Intraventricular hemorrhage (IVH) occurs in 30% to 50% of intracerebral hemorrhage (ICH) cases and frequently requires permanent cerebrospinal fluid (CSF) shunting. This study aims to identify factors associated with permanent CSF shunt and its related outcomes. A retrospective analysis of prospectively collected data from the Ethnic/Racial Variations of Intracerebral Hemorrhage study was conducted. Factors associated with permanent CSF shunting were assessed using univariable and bidirectional stepwise logistic regression models. Patients were dichotomized based on permanent CSF shunting and propensity score-matched 1:1. The primary outcome was 3-month mortality. Secondary outcomes included in-hospital mortality; 3-, 6-, and 12-month modified Rankin Scale; EuroQoL Group 5-dimension self-report questionnaire; and Barthel Index. Among 2995 patients with ICH (median age 61 years, IQR 51-73), 141 (4.7%) underwent permanent CSF shunting. Factors independently associated with permanent shunting included younger age (odds ratio [OR] = 0.96 [0.95-0.98]), previous antiplatelet (OR = 1.61 [1.08-2.42]) or anticoagulant use (OR = 2.41 [1.28-4.53]), lower admission Glasgow Coma Scale (OR = 0.90 [0.86-0.94]), thalamic hemorrhage (OR = 1.59 [1.06-2.39]), and concomitant IVH (OR = 5.64 [3.38-9.39]). After 1:1 propensity matching (n = 124 per group), 3-month mortality was lower in the permanent CSF shunt group (OR = 0.32 [0.17-0.59]). Ambulatory independence and Barthel Index scores were significantly worse at 3 and 6 months after shunt placement. The odds of incontinence at 3 months were higher among this group (OR = 3.30 [1.58-6.87]). By 12 months, functional outcomes were comparable between groups. Younger age, antiplatelet or anticoagulant use, lower admission Glasgow Coma Scale, thalamic hemorrhage, and concomitant IVH are independently associated with shunt dependency in patients with ICH. Permanent CSF shunting was associated with a 60% reduction in 3-month mortality. Although early functional outcomes were worse among shunted patients, overall functional status was comparable by 12 months. Permanent CSF shunting may offer survival benefits, highlighting the need to determine the optimal timing for placement and rehabilitation programs following the procedure.

Objective: Prolonged sitting is a major risk factor for adverse health outcomes, even among physically active individuals. This study evaluated the effectiveness of a six-month sit-stand desk intervention in reducing sitting time and improving psychological outcomes in office workers. Methods: A clustered randomized controlled trial was conducted with 38 office workers, allocated to either a sit-stand desk intervention or a traditional desk control group. Outcomes were assessed using validated self-report questionnaires. Results: A significant group-by-time interaction favouring the intervention group was observed for weekday sitting time, which decreased from 8.00 to 5.22 h/day (p=0.03), but not during weekends. No significant between-group differences were found for psychological outcomes, though exploratory analyses highlighted potential predictors explaining the reductions in sitting time. Conclusions: Sit-stand desks reduced occupational sitting time, suggesting potential value for workplace health interventions.

The present study examined the longitudinal associations and directionality of effects between self-concept and eating disorder symptoms in late childhood and early adolescence. A total of 380 participants (Time 1: 52.2% female; M age = 9.97 years, SD = 0.84, range = 8–12 years) completed self-report questionnaires annually for 3 years. Cross-lagged panel models were used to examine the associations over time between global and domain-specific self-concept (i.e., physical appearance, scholastic competence, athletic competence, social acceptance and behavioral conduct) and eating disorder symptoms. The findings revealed that lower global self-concept and appearance-related self-concept predicted higher eating disorder symptoms over time, and vice versa. Eating disorder symptoms also negatively predicted scholastic competence and behavioral conduct over time. These results underscore the developmental interplay between self-concept and eating disorder symptoms, highlighting the importance of early self-concept interventions to prevent eating disorder symptomatology in children transitioning to adolescence.

BACKGROUND Adolescent depression is a pressing global public health challenge. Current screening largely depends on self-reported questionnaires, which are vulnerable to response biases and underreporting. Integrating objective behavioral signals with validated scales may bridge this subjective-objective gap and improve detection performance. AIM To develop a novel multimodal protocol integrating video-recorded facial expressions, vocal prosody, and the Chinese Secondary School Students Depression Scale (CSSSDS) to improve the accuracy and robustness of depression detection for adolescents in Mainland China. METHODS A total of 771 adolescents (aged 12-18 years, mean 15.23 ± 1.68) were recruited. Facial expressions, reading-aloud voices, and CSSSDS scale data were collected from all participants. Five machine learning algorithms [extreme gradient boosting (XGBoost), logistic regression, random forest, support vector machine, and artificial neural network] were trained under two conditions: (1) A multimodal protocol that combined facial expressions, vocal prosody, and the CSSSDS; and (2) A bimodal protocol that combined facial expressions and vocal prosody. Performance was evaluated using accuracy, precision, recall, F1 score, area under the receiver operating characteristic curve (AUC-ROC), and area under the precision-recall curve (AUC-PR) with repeated 10-fold cross-validation. RESULTS Statistical analysis confirmed XGBoost as the preferred algorithm in both multimodal and bimodal protocols, showing statistically significant superiority (P &lt; 0.05) across several key metrics (multimodal recall and F1 score; bimodal AUC-ROC, AUC-PR, and F1 score). In stark contrast, the artificial neural network exhibited high volatility and low precision despite achieving perfect recall in both protocols (all P &lt; 0.001). Statistical comparisons further confirmed the superiority of the multimodal XGBoost over its bimodal counterpart, demonstrating higher AUC-ROC (t = 4.52, P &lt; 0.001) and AUC-PR (t = 3.87, P &lt; 0.001), both with large effect sizes (Cohen’s d &gt; 1.0). The multimodal model also demonstrated significantly greater stability in core discriminative metrics (AUC-ROC, AUC-PR, and recall; all P &lt; 0.05). CONCLUSION The XGBoost-driven multimodal model demonstrated superior discriminative power, greater stability, and a balanced precision-recall profile compared with bimodal models and other algorithms. Nevertheless, limitations related to sample size, use of a regionspecific scale, and task-driven data collection mean that further validation in larger, more diverse, and ecologically valid settings is warranted.

Methamphetamine use disorder (MUD) has risen among women globally and is disproportionately higher in prisons. In Indonesia, correctional facilities still lack any structured and evidence-based psychological therapy. To address this gap, we developed the Indonesia Substance Use Reduction for Female Therapy (Indo-SURFT). A single-arm unblinded design with a 3-month follow-up was conducted among incarcerated women with MUD. Participants completed 12 sessions over six weeks. Assessments included user perception ratings, Addiction Severity Index (ASI), Visual Analog Scale for craving, University of Rhode Island Change Assessment Scale, Self-Reporting Questionnaire-20 (SRQ-20), and WHO Quality-of-Life Brief (WHOQOL-BREF). A total of 33 incarcerated women with MUD participated and the median age was 35 (21-57). All of the participants had complete attendance during the 6-week program. By week 12, participants rated the Indo-SURFT module as useful (Mdiff = 0.484, 95%CI [0.235, 0.732], p < 0.001, d = 0.482). Employment-related ASI scores improved post-intervention (B = -0.076, p = 0.002) and at follow-up (B = -0.106, p = 0.004). Psychiatric domain of ASI remained stable post-intervention but increased after follow-up (B = 0.200, p ≤ 0.001). Craving declined post-treatment but rose at follow-up (B = 1.247, p = 0.036). SRQ-20 increased over time, while WHOQOL-BREF declined. Indo-SURFT is tolerable and feasible for women with MUD in incarceration. Participants highly rated the module and delivery. The module demonstrates initial improvement in functional domain and curbs craving level during treatment. Maintenance sessions may be required to fully maintain and enhance improvements. These findings support Indo-SURFT's as a potential intervention but requires further multisite investigation to enhance generalizability.

How does intolerance of uncertainty affect digital self-harm? The mediating role of anxiety symptoms and the buffering role of psychological capital.

Dental hygienists work in a stressful environment and often experience substantial personal distress, which can adversely affect their empathy as well as their professional quality of life. The present study attempted to evaluate stress coping strategies and their effect on empathy, burnout, compassion satisfaction and secondary traumatic stress among dental hygienists. A cross-sectional online survey was conducted using the following self-report questionnaires (i) Jefferson Scale of Physician Empathy for Health Professionals (JSPE-HP); (ii) professional quality of life questionnaire (ProQoL) to measure burnout, compassion satisfaction and secondary traumatic stress; and (iii) Coping Inventory for Stressful Situations-Situation Specific Coping inventory (CISS-SSC) to measure task-focused coping, emotion-focused coping and avoidance focused coping strategies. 127 hygienists responded. Subjects' empathy could be best predicted by task-oriented coping style and burnout (stepwise linear regression, R2 = 0.19, p < 0.01.). Subjects' burnout could be best predicted by emotion-focused coping style, empathy and age (R2 = 0.346, p < 0.001.), their level of secondary traumatic stress could be best predicted by emotional-focused coping (R2 = 0.283, p < 0.001) and level of compassion satisfaction could be best predicted by task-focused coping style, emotion-focused coping style and professional experience (R2 = 0.315, p < 0.01). Findings suggest that in the dental hygiene profession, coping styles play a significant role in empathy and the different aspects of subjects' professional quality of life. While task-coping style positively affects subjects' empathy, emotion-focused coping causes dental hygienists to be more vulnerable to secondary traumatic stress and burnout.