Background: Although nurses' health-related quality of life (HRQoL) is critical for mitigating the growing intention to leave the profession, the association between nurse-patient mutuality and nurses' HRQoL remains unexplored. Therefore, this study aims to examine the association between nurse-patient mutuality and nurses' HRQoL. Methods: A cross-sectional, multicentre study was conducted across four tertiary hospitals in Italy. Data were collected from a sample of 726 nurses working in medical and surgical inpatient and outpatient wards. Mutuality was measured using the Nurse-patient Mutuality in Chronic Illness scale, comprising three dimensions: developing and going beyond, being a point of reference, deciding and sharing care; HRQoL was assessed via the Short Form-12 Health Status Questionnaire (SF-12), providing Physical (PCS) and Mental (MCS) Component Summaries. Two multiple linear regression models were conducted to evaluate the impact of mutuality dimensions on HRQoL components. Results: Among the 726 participants, none of the three mutuality dimensions were significantly associated with physical HRQoL (PCS). Conversely, two mutuality dimensions were significantly and positively associated with higher MCS scores: developing and going beyond (B = 0.54, 95% CI [0.14, 0.95], p = 0.009) and being a point of reference (B = 0.38, 95% CI [0.09, 0.68], p = 0.010). However, the overall regression model demonstrated a modest explanatory value for MCS (R² = 0.075). Among covariates, female sex (ref: male; B = -2.29, 95% CI [-4.10, -0.49], p = 0.013) and taking care of relatives (B = -2.07, 95% CI [-3.55, -0.60], p = 0.006) were associated with lower MCS, whereas older age (B = 0.17, 95% CI [0.01, 0.34], p = 0.039) was related to higher MCS. Regarding physical health (R² = 0.261), having chronic conditions (B = -5.08, 95% CI [-6.48, -3.69], p < 0.001), previous experience as a patient (B = -1.88, 95% CI [-3.07, -0.69], p = 0.002), and taking care of relatives (B = -1.49, 95% CI [-2.62, -0.36], p = 0.010) were significantly associated with lower PCS scores. Conclusions: The reciprocal nature of mutuality could be a potential relational resource for nurses' mental HRQoL. Healthcare organizations should prioritize structural frameworks and interventions that allow nurses the time and resources to cultivate these essential clinical connections.

The current scoping review examined cognitive, behavioral, and developmental deficits in children aged 1 month to 17 years with neonatal abstinence syndrome (NAS), with implications for longitudinal outcomes, such as attention-deficit/hyperactivity disorder (ADHD), language delay, and learning disabilities.

A scoping review methodology was used to identify and analyze 36 studies from CINAHL, PubMed, ERIC, and PsycINFO to comprehensively capture nursing and psychology literature. Inclusion criteria focused on children with NAS and neurocognitive outcomes across five developmental stages.

Nine subthemes of neurocognitive change were evaluated: cognition; behavior; emotion; motor activity; learning or intelligence; vision or visual perception; social interaction; language; and physiological developmental. Preschool and school-age children showed the highest prevalence of ADHD and language delays, whereas adolescents exhibited increased behavioral and emotional disturbances.

Findings have important implications for psychiatric-mental health nurse practitioners, principally in the early identification, planning, screening, and clinical integration for neurodevelopmental and mental health sequelae in children with NAS.

Objectives: This study aimed to evaluate the prevalence of pathological anxiety and to identify clinical, functional, and surgical factors associated with anxiety disorders in adults who underwent hypospadias repair during childhood. Patients and Methods: This cross-sectional analysis included adult males (≥18 years) previously treated surgically for hypospadias in childhood who underwent clinical evaluation and completed validated questionnaires assessing anxiety (State-Trait Anxiety Inventory, STAI-Y1/Y2), depression (Beck Depression Inventory-II), urological function (uroflowmetry and International Prostate Symptom Score), sexual function, and genital perception. Pathological anxiety was defined as STAI-Y1 ≥ 40. Patients with and without anxiety were compared using univariate analyses, and variables reaching statistical significance were entered into a binary logistic regression model to identify clinical variables independently associated with anxiety. Results: A total of 302 patients who underwent hypospadias surgery between 1975 and 2005 were included in this study. Of the 302 traced patients, 113 (37.4%) were contacted successfully, and a total of 36 adult male patients met the inclusion criteria for this study (mean age at assessment 23.6 years). Pathological anxiety was present in 14 patients (38.9%). Compared with non-anxious individuals, anxious patients were younger at assessment (p = 0.012), showed more impaired voiding dynamics, with lower flow index values (p = 0.060), and reported more severe urinary symptoms (p = 0.050). Depressive symptoms were significantly higher in the anxiety group (BDI-II: 9.5 vs. 3.1; p < 0.001) and were independently associated with pathological anxiety on multivariable analysis (OR 1.84, 95% CI 1.16-2.92; p = 0.01). Postoperative complications were more frequent and more severe among anxious patients, although this did not reach statistical significance. Subjective and objective aesthetic outcomes did not differ between groups. Conclusions: This study demonstrates that anxiety in adults treated for hypospadias during childhood is more closely related to functional urinary impairment, surgical complications, and depressive symptoms than to aesthetic outcomes. These findings emphasise the need for long-term, multidisciplinary follow-up incorporating routine mental health assessment. Early psychological screening and targeted supportive interventions may be associated with better functional and psychosocial outcomes, supporting a holistic, integrated model of care for hypospadias patients.

Background: Pediatric inflammatory multisystem syndrome (PIMS), also referred to as multisystem inflammatory syndrome in children (MIS-C), is a rare but serious post-infectious complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection characterized by systemic hyperinflammation and multiorgan involvement. New-onset neurological and psychiatric symptoms have emerged as critical clinical features, occurring in approximately 12-27% of pediatric patients aged 2-15 years (median age, 10 years) and often indicating a more severe disease course. This narrative review aims to provide a comprehensive overview of the current literature regarding the neurological and psychiatric manifestations of PIMS/MIS-C, focusing on epidemiology, pathophysiology, clinical presentation, neuroimaging findings, biomarkers, treatment strategies, and outcomes. Methods: A narrative literature review was conducted to synthesize current evidence on the neurological and psychiatric spectrum of PIMS/MIS-C. Evaluated parameters included clinical presentations ranging from common symptoms (such as headache, encephalopathy, altered mental status, and seizures) to rare complications (such as ischemic stroke, acute disseminated encephalomyelitis, Guillain-Barré syndrome, and cerebral edema), alongside associated psychiatric disturbances, diagnostic findings, and therapeutic approaches. Results: Neurological and psychiatric manifestations significantly impact the clinical trajectory of PIMS/MIS-C. Acute symptoms include headache, encephalopathy, seizures, and psychiatric disturbances like behavioral changes, hallucinations, delirium, anxiety, and sleep disorders. Neuroimaging in many cases reveals reversible lesions of the splenium of the corpus callosum, while electroencephalography typically demonstrates diffuse slowing consistent with encephalopathy. Early recognition and prompt administration of immunomodulatory therapy-primarily intravenous immunoglobulin and corticosteroids-correlate with favorable neurological recovery in the majority of patients. However, current evidence remains largely observational and heterogeneous, precluding definitive causal conclusions regarding this treatment-outcome relationship. Affected children more frequently require intensive care unit admission and remain at risk for persistent cognitive, behavioral, and psychiatric sequelae. Conclusions: Neurological and psychiatric complications in PIMS/MIS-C are clinically significant indicators of disease severity that require vigilant monitoring and early immunomodulatory intervention. Continued multidisciplinary follow-up and prospective studies are essential to elucidate the long-term neurodevelopmental and psychiatric consequences and to optimize therapeutic strategies for these patients.

Pediatric chronic kidney disease (CKD) is traditionally viewed as a disorder of impaired renal function, yet its effects extend far beyond the kidneys. Growing evidence indicates that CKD may disrupt brain development through interconnected biological, vascular, inflammatory, and psychosocial mechanisms, with lasting consequences for cognition, mental health, and educational attainment. In this perspective, we propose the kidney-brain axis as a neuro-renal framework for understanding these neurological consequences of pediatric CKD. We discuss current evidence linking CKD with neurocognitive impairment, structural brain abnormalities, psychosocial burden, and adverse educational outcomes, while examining the biological mechanisms that may underlie these associations. We also consider the role of kidney transplantation, emphasizing that restoration of renal function does not necessarily restore normal neurodevelopmental trajectories. Finally, we outline the clinical implications of integrating routine neurodevelopmental assessment into pediatric nephrology care and highlight priorities for future research. Recognizing neurodevelopment as a core component of pediatric CKD may help redefine disease burden and support more comprehensive, lifelong care for affected children.

Diabetes distress is a key mental health dimension of type 2 diabetes (T2D) and a growing concern as populations age, yet its determinants in older adults remain insufficiently characterized. The independent contributions of demographic and metabolic factors to severe distress and their implications for multidisciplinary screening across the lifespan remain unclear.

In this cross-sectional study, we assessed 453 adults with T2D using the 17-item Diabetes Distress Scale (DDS-17). We categorized participants as experiencing low (<2), moderate (2-2.9), or severe (≥3) distress. We compared categories using the Kruskal-Wallis H test and chi-square tests. Logistic regression models were constructed with severe distress (DDS ≥ 3) as the outcome, adjusting for sex, educational level, and HbA1c.

Severe distress was identified in 19 participants (4.2%). Age differed significantly across DDS categories (Kruskal-Wallis H test, p = 0.003), with the severe group being significantly older (72.95 ± 4.38 years). Emotional burden was the dominant subscale across all groups. In multivariable logistic regression, increasing age (aOR = 1.163 per year; 95% CI: 1.055-1.282; p = 0.002) and lower educational level (high school vs. basic: aOR = 0.187; p = 0.020) were independently associated with severe distress, whereas metabolic variables were not independently associated with severe distress. ROC analysis identified age ≥ 70 years as an exploratory, sample-derived cut-off (AUC = 0.726, 95% CI 0.602-0.827; sensitivity 84%, specificity 55%). Results were robust in sensitivity analyses that excluded patients with diabetes duration < 5 years.

Severe diabetes distress is more strongly associated with demographic vulnerability than with metabolic burden. Age ≥ 70 years and lower educational attainment may help identify older adults at increased risk of diabetes-related distress, supporting targeted psychological screening strategies in this lifespan stage.

Background: Medical students who volunteer during armed conflict may help sustain overwhelmed health services while experiencing concurrent social, academic, psychological, and physical consequences. However, no context-sensitive instrument has been available to assess these multidimensional benefits and burdens in active conflict settings. This study primarily aimed to develop and conduct an initial psychometric evaluation of the Volunteering Impact Scale (VIS) among medical students volunteering in Gaza and, secondarily, to characterize their volunteering experiences. Methods: A cross-sectional survey was conducted among 169 medical students who volunteered in hospitals in Gaza during the ongoing war. An initial 28-item pool was generated from a focused literature review, relevant theoretical frameworks, and consultations with Gaza-based medical students and clinicians. A multidisciplinary team reviewed the items for relevance, clarity, redundancy, and contextual appropriateness. Following item refinement and psychometric evaluation, the final 16-item VIS comprised five domains: social impact, mental burden, physical burden, academic development, and wellbeing and fulfillment. Its structure was assessed using exploratory factor analysis with principal axis factoring and Promax rotation, followed by confirmatory factor analysis. Internal consistency and convergent and discriminant validity were also examined. Domain scores and their associations with participant, volunteering, and war-exposure characteristics were subsequently analyzed. Results: Exploratory factor analysis revealed a five-factor structure explaining 51.2% of the variance. Parallel analysis favored three factors, whereas a theoretically informed five-domain solution was retained for further evaluation. Primary factor loadings ranged from 0.23 to 0.89. Most items met the prespecified loading criterion of 0.40; however, three Social items demonstrated weaker loadings and were retained provisionally because of their conceptual relevance to the construct. Confirmatory analysis provided support for the proposed measurement structure (RMSEA = 0.059, SRMR = 0.075, CFI = 0.911, and TLI = 0.888). Cronbach's alpha coefficients ranged from 0.64 to 0.75, and discriminant validity was supported by heterotrait-monotrait ratios below 0.85. Participants reported perceived social (M = 4.31/5), academic (M = 4.19), and wellbeing-related (M = 3.96) benefits. Mean reverse-scored Mental and Physical scores were 2.71 and 2.60, respectively, with lower scores indicating greater burden. Longer volunteering was associated with greater physical strain but also with stronger academic and wellbeing outcomes. Conclusions: The VIS demonstrated a conceptually coherent five-domain structure and promising initial psychometric properties for assessing the concurrent benefits and burdens of healthcare volunteering in a war-affected setting. Further validation in independent and more diverse samples is required. The findings also indicate that volunteer programs should combine meaningful clinical participation with structured supervision, recovery time, role rotation, and context-sensitive psychosocial support.

Professional drivers are exposed to work conditions that may affect sleep quality. Although poor sleep quality has been associated with lower mental health (MH) and vitality (VT), its relationship with these outcomes in professional drivers remains unclear. This cross-sectional study examined the association between sleep quality and selected health-related quality-of-life (HRQoL) domains among 399 professional drivers. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). At the same time, HRQoL was evaluated using the Mental Health, Vitality, and Bodily Pain domains of the 36-Item Short Form Health Survey. Correlation and regression analyses were performed. The mean PSQI score was 8.59, indicating overall poor sleep quality. Higher PSQI scores were negatively associated with MH (ρ = -0.384, p < 0.001) and VT (ρ = -0.495, p < 0.001). Sleep quality remained an independent predictor of MH (B = -2.47, p < 0.001; R² = 0.155) and VT (B = -4.10, p < 0.001; R² = 0.268), whereas age showed a modest association only with VT (B = -0.235, p = 0.035). Poor sleep quality was associated with lower MH and VT scores among professional drivers. The stronger association observed for VT suggests that sleep quality may be particularly relevant to energy levels and daily functioning in this study population.

This study aimed to investigate the impact of cannabis use on young adult suicidal behaviour. Matched cohorts were compared across two regions: Washington State, USA (where recreational cannabis use was legalised in 2012) and Victoria, Australia (where recreational cannabis use remains illegal). The hypotheses were (1) cannabis use would be more prevalent in Washington State in association with legalisation and (2) cannabis use would predict suicidal behaviour similarly in both regions. Data were drawn from the International Youth Development Study (IYDS) involving 1,470 participants (55.4% female; 726 Victoria, 744 Washington State) surveyed at average ages 25 and 29 in 2014 and 2018, respectively. Participants completed self-report surveys assessing demographic data, cannabis use, other forms of substance use, proximity to cannabis sales outlets, and suicidal behaviour. Data were analysed using multivariate negative binomial regression to identify cannabis use predictors of incident suicidal behaviour and differences between the two regions. Washington State participants reported significantly higher past-year cannabis use compared to Victorian participants at age 25 (in 2014) and lower self-harm at age 29 (2018). Victorian participants reported a reduction in cannabis use from age 25 to 29, while increased use was reported by Washington State participants across the same period. Regression analysis showed higher rates of cannabis use at 25 years and increased cannabis consumption at 29 years predicted increased suicidal behaviour. Suicidal behaviour in 2014 predicted this behaviour in 2018, with higher predictive risk in Washington State. Propensity score analysis confirmed a significant effect of cannabis use on suicidal behaviour. The effect of legalisation indicators (Washington State location, proximity to cannabis stores) on cannabis use was also significant based on propensity analysis. Cannabis was more prevalent in Washington State through the late 20 s. Young adult cannabis use increased the likelihood of suicidal behaviours. Despite increased risk from cannabis use, Washington State maintained lower rates of suicidal behaviour compared to Victoria, emphasising the need to understand multiple determinants of state differences in suicidal behaviour.

Mental Disorders are increasingly recognized as modifiers of cardiovascular outcomes, yet their differential impact in peripheral arterial disease (PAD) remains poorly understood. We investigated the prevalence, treatment patterns, and prognostic relevance of depression, anxiety disorders, and dementia in patients hospitalized for PAD.

In this nationwide cohort study based on claims data from AOK - Die Gesundheitskasse, 99,415 patients hospitalized for PAD between January 1, 2019 and December 31, 2020 were identified. Treatment patterns and clinical outcomes were assessed using multivariable-adjusted analyses and Cox regression models.

Overall, 47% of patients hospitalized for PAD had concomitant depression, anxiety, or dementia (D-A-D). Patients with these mental disorders were more frequently female, presented with more advanced PAD stages, and had a higher cardiovascular risk profile. However, marked heterogeneity between mental conditions was observed. Dementia was associated with the most pronounced treatment disparities, including substantially lower rates of revascularization and statin therapy despite more advanced disease at presentation. Dementia further emerged as a strong independent predictor of all-cause mortality (HR 1.57-1.62; p < 0.001) and amputation and/or death (HR 1.49-1.56; p < 0.001). In contrast, depression showed only modest associations with adverse outcomes after adjustment, while anxiety disorders were not consistently associated with increased risk.

Mental Disorders in PAD are not prognostically homogeneous. Dementia identifies a particularly vulnerable and undertreated PAD population characterized by substantial therapeutic disparities and markedly adverse clinical outcomes, highlighting an important and underrecognized gap in vascular care.