A roadmap for future clinical research in advanced prostate cancer: Findings from the Advanced Prostate Cancer Consensus Conference (APCCC) 2024.

Health and social inequities among cisgender gay and bisexual men in Japan: a nationwide cross-sectional study using a large-scale web-based survey.

Despite representing a disproportionately high percentage of new HIV diagnoses in France annually, women who have migrated from Sub-Saharan Africa (WMSSA) remain underserved by HIV prevention strategies, including Pre-Exposure Prophylaxis (PrEP). This study aimed to understand healthcare providers’ experiences and attitudes toward PrEP delivery to WMSSA within family planning centers (FPCs) of the Paris region in France. We conducted a web-based cross-sectional survey from February to June 2024 to explore the knowledge, attitudes, and experiences of providers in FPCs in Paris and Seine-Saint-Denis (SSD) County. The survey link was emailed to FPC providers via their departmental mailing lists. Of the 284 providers who were contacted, 64 completed the survey (response rate of 23%). Respondents were predominantly women (95%), with a median age of 44 (IQR 35–53) and a median of 17.5 (IQR 10–26) years of professional experience. They worked as physicians (44%), midwives (34%), or nurses (22%), primarily in FPCs within SSD County (77%). All providers had heard of PrEP; 42% had already discussed it with a client; 28% reported PrEP prescriptions being offered in their FPC; and 21% had already prescribed it for a woman. Among participants, 42% had received PrEP training, and 53% rated their overall PrEP knowledge as good or very good. About one-third of providers reported feeling uncomfortable discussing or prescribing PrEP to women. The top three barriers to PrEP implementation were the lack of PrEP awareness among clients (32%), inadequate provider training (21%), and the limited number of PrEP prescribers in FPCs (21%). Providers endorsed multiple interventions to increase PrEP delivery, including PrEP training, educational materials, and policy shifts to broaden prescriber roles. FPC providers in Paris and SSD County have limited experience in delivering PrEP to women. Several facilitators were identified to inform PrEP implementation strategies at the provider, client and structural levels.

BACKGROUNDDespite societal guidelines recommending targeted screening for Barrett’s esophagus (BE) and esophageal adenocarcinoma (EAC) in individuals with gastroesophageal reflux symptoms (GERS), screening adherence is suboptimal. Current screening approaches fail to identify individuals not seeking medical consultation for GERS or whose GERS are managed with ‘over-the-counter’ (OTC) acid suppressant therapies.AIMTo assess patients’ self-management and help-seeking behavior for GERS.METHODSThis cross-sectional study collected data from the Dutch general population aged 18-75 years between January and April 2023 using a web-based survey. The survey included questions regarding self-management (e.g., use of acid suppressant therapy with or without prescription) and help-seeking behavior (e.g., consulting a primary care provider) for GERS. Simple random sampling was performed to select individuals within the target age group. In total, 18156 randomly selected individuals were invited to participate. The study protocol was registered in ClinicalTrials.gov (identifier: NCT05689918).RESULTSOf the 18156 invited individuals, 3214 participants (17.7%) completed the survey, of which 1572 participants (48.9%) reported GERS. Of these, 904 participants (57.5%) had never consulted a primary care provider for these symptoms, of which 331 participants (36.6%) reported taking OTC acid suppressant therapy in the past six months and 100 participants (11.1%) fulfilled the screening criteria for BE and EAC according to the European Society of Gastrointestinal Endoscopy Guideline.CONCLUSIONThe population fulfilling the screening criteria for BE and EAC is incompletely identified, suggesting potential underutilization of medical consultation. Raising public awareness of GERS as a risk factor for EAC is needed.

Abstract Background Pain is one of the most distressing symptoms in patients with cancer. Although established guidelines now recommend appropriate opioid use, even for mild-to-moderate pain, Japan’s prescription volume remains markedly lower than that of Western countries. Public ambivalence, recognizing opioids as effective yet fearing dependence and adverse effects, may contribute to this underuse. However, little is known about how indirect exposure to opioids through family members’ cancer treatments shapes such attitudes. This study examined the perceived barriers to and willingness to use medical opioids among cancer-free adults, focusing on the influence of family experiences with opioid use. Methods A cross-sectional web-based survey was conducted on July 30, 2025, among 618 Japanese adults aged 20–49 years without a history of cancer. Participants were categorized into three groups: Opioid+ (family with cancer and opioid use), Opioid− (family with cancer but no opioid use), and None (no family history of cancer). Psychological barriers were assessed using the Japanese version of the Barriers Questionnaire II (JBQ-II), comprising an overall score and five subscales. Willingness to use opioids in a hypothetical mild-to-moderate cancer pain scenario was rated on a 10-point Likert scale. Group differences were analyzed using Kruskal–Wallis and Steel–Dwass tests (two-tailed p < 0.05). Results Compared with the None group, the Opioid + group showed significantly higher scores for overall JBQ-II (3.23 vs. 3.11, p < 0.01), Physiological Effects (3.47 vs. 3.32, p < 0.05), Harmful Effects (3.32 vs. 3.12, p < 0.001), and Disease Progression (3.65 vs. 3.39, p < 0.01), but lower Fatalism scores (2.25 vs. 2.46, p < 0.05). Willingness to use medical opioids was also higher in the Opioid + group (7.43) than in the Opioid− (6.55, p < 0.01) and None groups (6.59, p < 0.01). Conclusions Indirect exposure to opioids through family members’ cancer treatment was associated with ambivalent attitudes, characterized by greater recognition of barriers alongside increased willingness to use medical opioids. Addressing this experience-based ambivalence through evidence-based education, individualized counseling using the JBQ-II, and family-involved communication support may help promote the safe and appropriate use of medical opioids in Japan’s cultural and public health contexts. Clinical trial number Not applicable.

BackgroundArtificial intelligence (AI)–enabled devices are increasingly used in health care. However, there has been limited research on patients’ informational preferences, including which elements of AI device labeling enhance patient understanding, trust, and acceptance. Clear and effective patient-facing communication is essential to address patient concerns and support informed decision-making regarding AI-enabled care.ObjectiveWe evaluated 3 aims using simulated AI device labels in a cardiovascular context. First, we identified key information elements that influence patient trust and acceptance of an AI device. Second, we examined how these effects varied based on patient characteristics. Third, we explored how patients evaluated informational content of AI labels and their perceived effectiveness of the AI labels in informing decision-making about the use of AI device, building trust in the device, and shaping their intention to use it in their health care.MethodsWe recruited 340 US patients from ResearchMatch.org to participate in a web-based survey that contained 2 experiments. In the discrete choice experiment, participants indicated preferences in terms of trust and acceptance regarding 16 pairs of simulated AI device labels that varied across 8 types of information needs identified in our previous qualitative work. In the single profile factorial experiment, participants evaluated 4 randomly assigned label prototypes regarding the label’s legibility, comprehensibility, information overload, credibility, and perceived effectiveness in informing about the AI device, as well as participants’ trust in the AI device and intention to use the device in their health care. Data were analyzed using mixed effects binary or ordinal logistic regression.ResultsThe discrete choice experiment showed that information about regulatory approval, high device performance, provider oversight, and AI’s value added to usual care significantly increased the likelihood of patient trust by 14.1%‐19.3% and acceptance by 13.3%‐17.9%. Subgroup analyses revealed variations based on patient characteristics such as familiarity with AI, health literacy, and recency of last medical checkup. The single profile factorial experiment showed that patients reported good label comprehension, and that information about provider oversight, regulatory approval, device performance, and AI’s added value improved perceived credibility and effectiveness of the AI label (odds ratio [OR] range: 1.35‐2.05), reduced doubts in the AI device (OR range: 0.61‐0.77), and increased trust and intention to use the AI device (OR range: 1.47‐1.73). However, information about data privacy and safety management protocols was less influential.ConclusionsPatients value information about an AI device’s performance, provider oversight, regulatory status, and added value during decision-making. Providing transparent, easily understandable information about these aspects is critical to support patient determinations of trust and acceptance of AI-enabled health care. Information elements’ impact on patient trust and acceptance varies by patient characteristics, highlighting the need for a tailored approach to address the concerns of diverse patient groups about AI in health care.

Using data from the OVERCOME study, we examined the influence of household income on access to specialty care and use of recommended acute and preventive treatments for migraine in a large population-based study. This analysis from the OVERCOME study, a multicohort, web-based survey (2018-2020) among adults with migraine in the US, examined the influence of annual household income on (1) care-seeking, (2) the highest level of care received (emergency department/urgent care, primary care, specialty care), and (3) use of acute or preventive treatments recommended by the American Headache Society. We used standardized mean differences and logistic regression (LR) models to estimate the magnitude of differences in health care behavior as a function of household income and insurance status. Among OVERCOME (US) respondents with migraine who provided demographic information (n = 56,667), a higher proportion of people in the lowest income group (< $25,000) received their highest level of migraine care in the emergency department/urgent care setting versus the proportion in the highest income group [≥ $100,000: 12.3% vs 6.5%, standardized mean difference (SMD) = 0.20], and a greater proportion in the highest income group received care in a specialty headache care setting (48.6% vs 36.6% in the lowest income group, SMD = 0.24). The highest income group was more likely to receive a recommended acute treatment [odds ratio (OR) = 1.3, 95% confidence interval (CI) = (1.2, 1.4)] and a recommended preventive treatment [OR = 1.3, 95% CI = (1.2, 1.4)]. Those with health insurance were more likely to receive specialized care [OR = 2.6, 95% CI = (2.4, 2.8)] and recommended acute [OR = 1.9, 95% CI = (1.8, 2.0)] and preventive treatment [OR = 2.1, 95% CI = (1.9, 2.3)]. The effect of insurance was greatest in low-income strata and was not significant in the highest household income group. Disparities in annual household income may be a barrier to appropriate migraine care, but having health insurance mitigates the effect.

Surgeon perspective on the treatment of acute diverticulitis: A survey-based analysis.

To examine the implementation of evidence-based psychotherapy across international healthcare contexts and identify barriers to clinical delivery. We conducted an international, cross-sectional, web-based survey of psychiatrists from October 2024 to March 2025. The questionnaire assessed familiarity with 10 evidence-based psychotherapy modalities, frequency of use, delivery confidence, perceived barriers, and clinical workload. Responses from 16 countries were analyzed across five geographic regions using chi-squared tests and effect sizes. Among 424 respondents, 201 (47.4%) demonstrated low composite familiarity with evidence-based psychotherapies. Cognitive behavior therapy maintained moderate familiarity across regions, while other modalities remained largely unfamiliar. Japan exhibited the most constrained practice environment, with 48.3% reporting consultations under 10 min compared to 15.1% in other regions, and 30.0% seeing 40 or more patients daily. Major time constraints were reported by 63.3% of Japanese psychiatrists, significantly higher than other regions (P = 0.015). Frequent use of evidence-based psychotherapy was lowest in Japan (20.0%) and highest in the Middle East (60.0%). Despite these challenges, 77.4% of all respondents rated these approaches as highly important. Respondents identified improved postgraduate training (54.0%), continuing education access (38.2%), and enhanced supervision (36.0%) as priorities. Implementation varies across healthcare contexts, with Japan exemplifying system-level constraints where brief consultations and high patient volumes override practitioner knowledge and motivation. While psychiatrists value evidence-based approaches and seek to implement them, organizational barriers ultimately determine actual practice patterns. Findings indicate that training initiatives without concurrent structural reforms cannot bridge implementation gaps. Effective integration requires alignment of education, healthcare delivery structures, and payment systems. Not applicable.

For aging combat veterans, experiencing renewed war in old age can exacerbate coping with age-related challenges. The present study sought to examine how past and current war-related stressors affect long-term trajectories of posttraumatic stress disorder (PTSD) symptoms and views of aging (VoA) among a sample of older adult war veterans during wartime. The participants were 239 combat veterans of the 1973 Yom Kippur War (YKW), randomly selected to complete a longitudinal web-based survey, aged between 69 and 88 years (M = 73.76, SD = 3.66 in T3). The present study relied on data collected before the Israel-Hamas War (T1) and several months into the war (T2 and T3). Controlling for chronological age and self-rated health, we conducted three path analyses predicting one of three VoA measures (attitudes toward own aging [ATOA], subjective accelerated aging, and subjective age), PTSD symptoms from the YKW, as well as PTSD symptoms from the Israel-Hamas War at T3. Cross-lagged effects revealed that higher PTSD symptoms from the YKW at T2 predicted higher PTSD symptoms from the Israel-Hamas War at T3, but not vice versa. T1 VoA predicted T2 PTSD symptoms from the YKW, and T2 VoA predicted T3 PTSD symptoms from both the current and the past wars, while PTSD symptoms in previous assessments did not predict subsequent VoA. Present findings suggest that exposure to current trauma of war among older adult war veterans might uniquely shape the long-term trajectories of their VoA and PTSD symptoms, while contradicting the previously found PTSD symptoms-VoA directionality.

BackgroundPhysicians are a professional group at high risk of impaired quality of life (QoL) and mental health due to heavy workloads, exposure to suffering, and structural inequalities. In Brazil, rapid feminisation of the medical workforce has not eliminated gender and regional disparities, and nationwide evidence on physicians’ QoL remains scarce.MethodsThis is a nationwide, cross-sectional, web-based survey of licensed physicians in Brazil between July and August 2024. Eligibility required active registration with a Regional Medical Council and prior use of a digital health platform. QoL was assessed using the WHOQOL-BREF, complemented by items on lifestyle, burnout, depression, and anxiety. Post-stratification weighting aligned the sample with the 2025 Brazilian Medical Census across sex and region. Weighted least squares regression models estimated unique contributions of sex, age, region, career stage, and mental disorders to QoL domains.ResultsA total of 2,005 physicians participated (56.1% women). Weighted WHOQOL-BREF scores post-stratification were 62.2 in the physical, 55.5 in the psychological, 56.5 in the social, and 63.6 in the environment domains, with a global score of QoL (defined as the mean of 0-100 four domains score) of 59.5. Women reported significantly higher prevalence of mental disorders (46.8% vs. 33.5% in men), particularly depression (25.3% vs. 17.7%) and anxiety (39.9% vs. 25.1%). QoL displayed a U-shaped trajectory across the life course, with lower scores in early and mid-career and recovery at older ages. Mental disorders were strongly associated with lower scores across all domains (–9 to –10 points in psychological and QoL, p < 0.001, large effect sizes). Multivariable models identified mental disorder as the dominant predictor of psychological and QoL perception outcomes, while sex explained variance in social relations, and region and age modestly contributed to physical and environment domains.ConclusionsBrazilian physicians report lower QoL than both the general Brazilian population and international physician cohorts, with particular vulnerability in psychological well-being. Gender disparities persist, with women experiencing greater psychiatric morbidity despite higher social relations scores. Structural inequalities, workload, and dissatisfaction with the health system emerged as key stressors. Interventions should combine structural reforms, gender equity policies, and lifestyle-promoting strategies to support physician well-being.

This study aimed to quantify physician perceptions of health utility states after traumatic brain injury (TBI) using the Glasgow Outcome Scale-Extended (GOSE). Conducted via a cross-sectional, web-based survey, it involved 646 board-certified physicians from specialties such as neurology, neurosurgery, surgical critical care, pulmonary critical care, and physical medicine & rehabilitation, with 528 completing all seven GOSE scenarios. The survey employed a standard gamble approach to assess health utility preferences for hypothetical outcomes one-year post-TBI, where physicians chose between living in a specific GOSE state or a gamble with a 50% chance of perfect health and a 50% chance of immediate death. Results showed that median health utility values for GOSE states ranged from - 1 (worse than death) to 1 (full health). Physicians rated lower GOSE states with diminished utility, perceiving levels 2 and 3 as worse than death, and noted a significant decline in perceived quality of life between GOSE 5 and 4, indicating increased sensitivity to greater dependence on caregivers. Physicians assigned lower health utility values to less severe disability states compared to the general population, as well as TBI caregivers and survivors reported in the literature, highlighting potential biases that could impact clinical decision-making. These findings underscore the need for targeted interventions to address physician perceptions, aiming to improve shared decision-making and patient-centered care in TBI treatment.

Acceptance and use of digital health technologies among physiotherapists in Germany: a web-based cross-sectional survey.

In China, the demand for sedation during gastrointestinal endoscopy (GIE) has surged since the introduction of the nationwide Cancer Screening Program in 2012, while anesthesia staffing remains insufficient. Pre-anesthetic evaluation (PAE) is crucial for safe sedation, however, PAE practices in China have not been thoroughly examined. We conducted a national web-based questionnaire survey among anesthesiologists across China from January to February 2024, focusing on PAE and sedation practices for GIE. A total of 413 anesthesiologists from 282 hospitals across the 31 provincial-level administrative regions of mainland China (Taiwan, Hong Kong and Macao were not included) participated. Key findings included: Dual PAE timing (before and on the day of GIE) significantly reduced same-day procedure cancellations (15.2% vs. 31.5%, p < 0.01); Preoperative testing was dominated by non-risk-stratified ECG (95.0%) despite limited evidence; and significant variability existed in assessment strategies among anesthesiologists, unrelated to professional seniority or hospital level. This survey reveals critical gaps in China's PAE practices for GIE. Aligning PAE practices with evidence-based protocols and embracing digital health innovations could optimize perioperative safety and mitigate anesthesia workforce challenges. These measures may significantly enhance perioperative care for GIE patients in China. Moreover, the findings highlight critical educational gaps and provide insights for curriculum design and competency-based training in anesthesia and endoscopy sedation, which may significantly enhance the quality of perioperative care for GIE patients in China.

Dentists' professional values are shaped by means of both career stage and competitive environments. The authors examined how clinical experience and perceived competitive pressure influence Korean dentists' professional values and explored their broader applicability. An online cross-sectional, web-based survey was conducted in May 2024 among 28,949 members of the Korean Dental Association, of whom 1,932 completed the questionnaire. Professional values (eg, prestige, service, business expansion, scholarly pursuit, lifestyle, autonomy, and the dentist-patient relationship) were assessed as outcome variables and the following 2 explanatory variables were examined: years of clinical experience and perceived competitive pressure. Data were analyzed using t tests, 1-way analysis of variance, and multivariable linear regression analyses (α = .05). Among respondents, 40.0% had 20 years or more of clinical experience and 57.0% reported experiencing high competitive pressure. Dentists with more experience placed greater importance on prestige, service, and scholarly pursuit, and those with fewer years emphasized lifestyle and business expansion. Competitive pressure had weaker effects; dentists experiencing high competitive pressure valued lifestyle more but service less. Autonomy and the dentist-patient relationship consistently had no significant group differences (P value of autonomy .369 and .597, P value of dentist-patient relationship .075 and .380 for years of clinical experience and competitive pressure, respectively). Multivariable regression confirmed that clinical experience was a stronger and more consistent predictor of professional values than competitive pressure. Dentists' professional values are dynamic and context-dependent, evolving with career stage while retaining stable core elements of professionalism. Understanding these dynamics requires a life course perspective that accounts for practice environments. Dental workforce planning and continuing education programs should account for generational and practice environment differences, providing targeted support for younger dentists, strengthening professional identity, and ensuring sustainability of the profession.

To examine primary care physicians' attitudes regarding artificial intelligence (AI) use for administrative clinical tasks. Web-based survey with US physicians in family medicine or internal medicine (N=420, response rate 5.13%). Two hypothetical AI tools for administrative clinical activities were described. We examined physicians' attitudes towards AI tools, and their associations with practice years, exposure to AI, use case and stakeholder type were evaluated using generalised estimating equations. Participants were on average 49.6 years (SD=12.5) and 56.7% men (238/420). Physicians with fewer practice years were more likely to endorse the tools' benefits (OR 1.70-1.96), the tools' benefits outweighing risks (OR 1.79-2.06) and their openness to use (OR 1.63-1.83), and were less likely to endorse disclosure of AI use (OR 0.60 (95% CI 0.36 to 0.998)). Physicians with AI exposure were more likely to agree the tools' benefits outweighed their risks (OR 1.51 (95% CI 1.06 to 2.16)). Physicians were more likely to endorse the tools' benefit to physicians (OR 4.94 (95% CI 4.16 to 5.86)) and physicians' openness to using them (OR 3.53 (95% CI 2.97 to 4.20)) than they were to endorse their benefit to patients and patients' openness. Physicians rated an AI tool for notes generation as more beneficial than one for billing assistance (OR 1.73 (95% CI 1.39 to 2.16)). Although the findings are preliminary, US primary care physicians' attitudes toward AI for clinical administration varied by practice years, prior exposure to AI, use case and stakeholder type. Our findings highlight opportunities to develop training and implementation strategies in service of advancing safe and effective integration of administrative AI tools in primary care.

Understanding U.S. non-religious hospital inpatient approval mechanisms for induced abortion.

The purpose of this cross-sectional, web-based survey was to identify environmental barriers to accessibility experienced by people with lower limb loss and evaluate the association between environmental barriers and quality of life. Eligibility criteria include people aged 18 years old, have a major lower limb loss (at the ankle or above), greater than or equal to 3 months post-amputation surgery, using a prosthesis for mobility (beyond transfers), are no longer receiving prosthesis-related rehabilitation care, and understand English. Demographic and clinical characteristics were collected through self-report. Outcome measures collected were the Prosthesis Evaluation Questionnaire Mobility Scale, Perceived Environmental Barriers to Outdoor Mobility Scale, Craig Hospital Inventory of Environmental Factors, and WHO Quality of Life-Brief Questionnaire. Descriptive statistics summarized clinical, demographic, and survey variables. Simple linear regression modeling evaluated the association between environmental barriers and quality of life. Seventy-eight [mean age: 59.3 (14.0) years, 67% male, and 59% transtibial] individuals participated. A one-unit increase on the Craig Hospital Inventory of Environmental Factors Scale, indicating greater environmental barriers to mobility, was significantly associated with an 8.07 decrease on the WHO Quality of Life-Brief (95% confidence interval: -15.46 to -0.68, R2 = 0.38). A safe and barrier-free environment is crucial for accessibility following lower limb loss. Future research should enhance accessibility through collaboration among end users, clinicians, and policymakers to address the built environmental needs of this population.

Benefit-risk profiles and mode/frequency of administration vary among the four US-approved treatments for anti-aquaporin-4 antibody-positive neuromyelitis optica spectrum disorder (AQP4-Ab+NMOSD), but no published studies have reported treatment preferences among patients with NMOSD in the USA. Therefore, the objective of this study was to quantify preferences and predict treatment choices among patients with AQP4-Ab+ NMOSD in the USA. A cross-sectional, web-based discrete choice experiment survey was administered to patients with self-reported AQP4-Ab+ NMOSD. Respondents evaluated hypothetical AQP4-Ab+ NMOSD treatment profile pairs defined by efficacy, safety, process-related attributes, and administration mode/frequency. Data were analyzed using a random-parameters logit model to estimate conditional relative importance of attributes, minimum acceptable benefit, and predicted treatment choice in pairwise treatment profile (ravulizumab-like, eculizumab-like, inebilizumab-like, and satralizumab-like) comparisons. Preference heterogeneity was investigated by exploratory subgroup analysis using interaction terms in the regression analysis. The 255 survey completers (mean ± standard deviation [SD] age, 41.4 ± 13.7 years) averaged 6.6 ± 5.4 years since diagnosis, and 63.5% identified as female and 46.7% as Black or African American. Rituximab was the most common treatment (34.1% of respondents), and 15.7%, 9.4%, or 7.1% of respondents were receiving eculizumab, inebilizumab, or satralizumab, respectively. Respondents placed greater importance on reducing chance of relapse within the first year of treatment compared with other attributes such as reducing administration frequency from every 2 weeks to every 8 weeks (Q8W); safety attributes (risks of serious opportunistic or recurrent infection, elevated liver enzymes, and meningococcal infection) were rated similar to each other in importance. Pairwise comparisons favored the ravulizumab-like profile (67.8-87.7%) over the other three treatment profiles (12.3-32.2%). Preferences did not vary by age, disease duration, disease impact, or relapses in the past 12 months, but subgroups defined by current treatment type demonstrated different (p = 0.066) preferences. Respondents receiving intravenous/subcutaneous injections alone or with oral immunosuppressive therapy/corticosteroid treatments placed greater importance on reducing chance of relapse versus those receiving oral treatments alone, but they were not more likely to select a Q24W treatment over a Q8W treatment. Respondents with AQP4-Ab+ NMOSD placed the highest importance on reducing chance of relapse, placed a high importance on reduced administration frequency, and rated the safety attributes (avoiding treatments with a risk of meningococcal infection, risk of elevated liver enzymes, and risk of other infections) as comparable to each other but less influential than relapse prevention. Respondents were more likely to select a ravulizumab-like profile over comparators. These findings can inform shared decision-making in selecting treatments.

This study examined the longitudinal influence of psychosocial safety climate (PSC) on self-endangering work behavior (SEWB), considering working time flexibility (fixed vs. flextime arrangement). A two-wave web-based longitudinal survey was conducted in Japan in November 2021 and May 2022. Responses from 826 full-time workers were analyzed. Fixed-effects model analyses were used to examine the within-person effect of PSC on SEWB and test the moderation effect of working time flexibility. The decrease in PSC was significantly associated with the increase in SEWB under the flextime arrangement, but not under the fixed-time arrangement, presenting the significant moderation effect of working time flexibility. The findings highlight the heightened vulnerability of flextime workers to SEWB in a deterioration of PSC, emphasizing the need for organizations to maintain a healthy organizational climate when implementing flextime.