Nursing students with high levels of perceived stress may be vulnerable to problematic mobile phone use. Morningness-eveningness preference may shape the relationship between mobile phone addiction and perceived stress. Using network analysis and computer-simulated interventions, this study explored symptom-level associations and potential intervention targets among nursing students.

Participants enrolled in the "Be Resilient to Nursing Career" program completed the Mobile Phone Addiction Index, Perceived Stress Scale, and Morningness-Eveningness Questionnaire. Network analysis was conducted to identify central and bridge symptoms. Computer-simulated intervention analysis was used to identify potential symptom targets within the network. Moderated network analysis was further performed to examine the moderating role of morningness-eveningness preference.

The central symptoms were inability to control craving (Str = 0.88, Bet = 2, Clo = 0.039, and EI = 0.77) and productivity loss (Str = 1.13, Bet = 3, Clo = 0.038, EI = 0.95). Feelings of nervousness emerged as an important bridge symptom between perceived stress and mobile phone addiction. Inability to control craving showed the strongest influence in the simulated intervention analysis and may represent a potential intervention target. Feelings of nervousness showed the greatest change in the simulated intervention analysis. Four significant three-way interactions suggested a potential moderating role of morningness-eveningness preference.

This study identified potential symptom targets associated with perceived stress and mobile phone addiction among nursing students through network analysis and computer-simulated interventions. The findings may help inform future student support strategies and mental health management in nursing education. Morningness-eveningness preference may play a moderating role in the association between perceived stress and mobile phone addiction.

Social determinants of health (SDOH) disproportionately affect racial/ethnic groups. However, little is known about how the cumulative burden of SDOH disadvantage on health status varies by race/ethnicity.

To examine the relative burden of SDOH disadvantage by race/ethnicity on two measures of health status of Health Resources and Services Administration-funded health center patients.

Cross-sectional study design.

We used the 2022 Health Center Patient Survey to identify a sample of adult health center patients (n = 3912).

We developed an overall composite score and five specific sub-scores for each SDOH domain-health risk, economic, social, access, and built environment-to measure cumulative burden of SDOH disadvantage. We used self-reported fair or poor health status and moderate or high psychological distress to measure general and mental health, respectively. We used logistic regression models to examine the independent association of each SDOH domain and their relative burden on health status measures by racial/ethnic groups.

Across all groups, higher health risk (OR = 1.57), economic (1.29), social (1.30), access (1.56), and built environment (1.15) disadvantage; and higher health risk (1.14), economic (1.44), and access (1.77) disadvantage were associated with fair or poor general health and greater psychological distress, respectively. However, some relationships differed by race/ethnicity. For example, higher health risk and access disadvantage increased the likelihood of poor general health among Non-Hispanic Black/African American and Hispanic/Latino patients. But economic disadvantage was significant for the former and social disadvantage was significant for the latter.

Our study highlighted the importance of accounting for differential burden of SDOH domains on racial/ethnic groups. This requires comprehensive measurement of SDOH and its meaningful use to inform and improve care for diverse health center patients. Access disadvantage across all racial/ethnic groups emphasized the importance of culturally appropriate care coordination to improve patient health.

Qualitative research offers key insights into enablers and obstacles of healthcare-seeking behavior, and the credibility of findings depends on methodological quality. This study aims to critically appraise the methodological quality of existing qualitative studies on delayed medical consultation in obstructive sleep apnea (OSA) patients, thereby identifying common limitations and offering recommendations for future improvements.

A systematic search was conducted in EMBASE, MEDLINE, and CENTRAL databases, covering literature from inception to February 2026. Inclusion criteria were qualitative studies (e.g., phenomenological, ethnographic, or grounded theory paradigms) on medical consultation delays in adult OSA patients, excluding single-case studies or narrative reports with very small samples. Two reviewers independently assessed studies against five dimensions, with disagreements resolved by discussion.

Three studies were included, from which eight methodological issues were identified: (1) potential "survivorship bias" from including only diagnosed patients; (2) recall bias in retrospective designs; (3) insufficient consideration of the role of comorbidities in the healthcare-seeking process; (4) unclear directionality between cognitive factors and delayed behavior; (5) lack of in-depth analysis of deviant cases; (6) oversimplified view of family/friend support; (7) insufficient transparency in reporting interview guides and data saturation; and (8) absence of researcher reflexivity during data collection and analysis.

Current qualitative studies on delayed medical consultation in OSA patients have several methodological flaws that may affect their validity. Future research should prioritize prospective, community-based studies targeting high-risk OSA populations not yet seeking medical help, and comprehensively document the entire trajectory of their medical consultation delay. This will enhance research rigor and provide clearer guidance for developing more actionable intervention strategies.

This study examined the role of perceived stress in intervention-related change during a mindfulness-based intervention (MBI) for emotional distress across two randomized controlled trials. In Study 1, 636 participants (M_age = 31.06, SD_age = 9.54; 83.18% female) with high psychological distress were randomized to an MBI group (N = 318) or a Waitlist control group (N = 318), measuring perceived stress, anxiety and depression at baseline and postintervention. Study 2 randomized 607 participants (M_age = 30.13, SD_age = 8.15; 82.08% female) with high psychological distress to an MBI group (N = 304) or a Waitlist control group (N = 303), with the same measurements at baseline, Week 3, Week 5 and postintervention. In both studies, linear mixed-effects models showed greater reductions in all variables in the intervention group than in the Waitlist control group. In Study 1, simple mediation analyses showed changes in perceived stress accounted for part of the intervention-related reductions in anxiety and depression. In Study 2, parallel process latent growth curve models indicated that changes in perceived stress accounted for substantial proportions of the intervention effects on anxiety and depression. Random intercept cross-lagged panel models further suggested that perceived stress functioned as a temporally prior process particularly for subsequent depression, whereas the temporal association with anxiety was more bidirectional. Perceived stress may represent an important process underlying the MBI effects on emotional distress, especially in reducing depression. Early reductions in perceived stress may help identify subsequent improvement in anxiety and depression. Trial Registration: Study1: Chinese Clinical Trial Registry number: ChiCTR2200057398. Study2: Clinical Trials number: NCT06035003.

Parkinson's disease (PD) is a progressive neurodegenerative disorder characterized by motor and non-motor symptoms, deeply affecting quality of life. While pharmacological and surgical treatments like levodopa and deep brain stimulation (DBS) are standard, limitations in long-term efficacy and accessibility have led to growing interest in non-invasive neuromodulatory approaches such as transcranial magnetic stimulation (TMS). This systematic review aims to critically appraise the evidence on the clinical efficacy and neurobiological effects of TMS in PD, encompassing motor and non-motor symptom modulation, neurophysiological biomarkers, and neuroimaging findings. Following PRISMA-ScR guidelines, literature was searched in MEDLINE, EMBASE, and Scopus. Fifty eligible clinical studies were analyzed, with 28 directly addressing TMS effects on PD through clinical, neurophysiological, or imaging outcomes. High-frequency repetitive TMS (rTMS) over the primary motor cortex (M1) shows moderate efficacy in improving bradykinesia and rigidity. Stimulation of supplementary motor area (SMA) and dorsolateral prefrontal cortex (DLPFC) yielded variable effects on gait and mood. Neurophysiological studies consistently report alterations in intracortical excitability (e.g., reduced SICI, shortened CSP), partially restored by TMS and modulated by medication or DBS. Imaging studies revealed changes in functional connectivity and dopamine release post-TMS. Notably, the clinical state ("on" vs. "off" medication), stimulation parameters, and methodological heterogeneity significantly influenced outcomes. TMS represents a promising adjunctive therapy in PD, with evidence supporting its modulatory role on cortical excitability and potential clinical benefit. However, heterogeneity in protocols, small sample sizes, and placebo effects limit definitive conclusions. Future research should prioritize standardized methodologies, exploration of optimal stimulation parameters, identification of predictive biomarkers, and integration with rehabilitative strategies to personalize treatment. Rigorous, sham-controlled trials with long-term follow-up are essential to establish TMS as a reliable therapeutic tool in PD management.

Relapsing polychondritis (RP) is a rare, multisystem inflammatory disease characterized by heterogeneous clinical manifestations and a substantial impact on patients' daily functioning and well-being. Health-related quality of life (HR-QoL) in RP remains insufficiently characterized, and no disease-specific measurement tool is available so far. This study aimed to develop and validate the RP-QoL, a multilingual, patient-reported outcome instrument specifically designed to assess HR-QoL in individuals with RP.

The RP-QoL was developed within the European Reference Network ReCONNET using a structured four-step approach: (1) identification of relevant HR-QoL domains through systematic literature review, an international patient survey, and expert consensus; (2) item generation; (3) pilot testing including cognitive debriefing; and (4) comprehensive psychometric validation. Validation analyses included assessment of internal consistency, structural validity, construct validity, convergent validity with the SF-36, and criterion-related validity.

Domain identification incorporated input from 274 patients across 22 countries, leading to a 31-item pilot questionnaire with a 28-day recall period and 5-point response scale. Cognitive debriefing confirmed clarity, relevance, and feasibility. Validation in 239 patients from 19 countries (median age 55 years; 80% female) demonstrated excellent internal consistency (Cronbach's α = 0.96). Exploratory factor analysis supported near-unidimensionality, with the first factor explaining 46.6% of variance. RP-QoL scores correlated strongly with disease impact (ρ = -0.62, p< 0.0001) and SF-36 physical (ρ = 0.65) and mental (ρ = 0.55, p< 0.0001) components (both p< 0.0001, p< 0.0001). Discriminative ability was high (AUC = 0.87).

The RP-QoL is the first validated, disease-specific HR-QoL instrument for RP, with robust psychometric performance and applicability in both clinical practice and research.

Severe mental illness (SMI) is frequently accompanied by substantial impairments in psychosocial functioning. Psychosocial interventions (PSI), therefore, represent an essential component of evidence-based treatment. A key prerequisite for the utilization is adequate knowledge. The aim of this study was to assess the level of knowledge about PSI among individuals with SMI. A cross-sectional multicenter study was conducted among individuals with SMI aged 18 to 65 years (n = 397). Knowledge of PSI, along with sociodemographic, clinical and additional contextual characteristics was assessed. Linear regression analyses were performed to examine associations between PSI knowledge and potential predictors. Overall, participants with SMI were familiar with an average of 10 out of the 17 assessed interventions. Better knowledge was associated with the presence of a chronic physical illness (p = .027), a longer duration of psychiatric problems (p = .030) and higher GAF scores (p = .010). In contrast, having experienced divorce, separation, or widowhood compared to being single (p = .040), as well as having a migration background (p = .003), were associated with lower levels of knowledge. The findings highlight the need for more targeted dissemination of guideline-based information on PSI to individuals with SMI.

Adolescence is a critical period for the onset of major depressive disorder (MDD), during which emotional symptoms frequently co-occur with environmental adversity and maladaptive behavioral coping. In China, these processes may be further shaped by left-behind experience (LBE) - a prevalent structural vulnerability in which children grow up separated from migrating parents. To clarify these relationships, we applied network analysis in a clinical sample of 2341 adolescents (Mage = 14.99 years,77.92% female) with MDD. Participants were recruited from 14 psychiatric outpatient clinics across China. The networks examined associations among mental health symptoms (depression, anxiety, stress, sleep problems, self-esteem, loneliness), ecological factors (childhood trauma, peer victimization, social support), and problematic smartphone use (PSU). We further examined whether network topology differed by LBE (19.99% of the sample). In the full sample network, depression and loneliness demonstrated the highest strength centrality, while sleep exhibited the lowest. Loneliness and PSU acted as bridges between mental health symptoms and ecological factors. Network comparison tests revealed no significant between-group global structural differences. Although childhood trauma and PSU appeared more centrally positioned in the left-behind group and social support showed slightly higher centrality in the non-left-behind network, these subtle trends need further confirmation. These findings underscore critical psychological-ecological-behavioral interaction pathways in adolescents with MDD, and suggest loneliness and PSU as promising targets for bridge-informed clinical intervention.

The oral side effects of selective serotonin reuptake inhibitors (SSRIs) include xerostomia, gingival bleeding, burning mouth syndrome, bruxism, and temporomandibular disorders (TMD), impacting the quality of life (QoL). These stomatognathic diseases are often overlooked in clinical practice. This comment advocates interprofessional relations among physicians, pharmacists and dentists to improve the recognition, prevention and management of SSRI-related oral side effects.

Non-sleep deep rest (NSDR), a brief guided relaxation technique involving slow breathing and sequential body awareness, has recently been proposed as a practical rest strategy. However, evidence on its short-term time course and physiological responses remains limited. This study examined the effects of a brief NSDR session on perceptual, cognitive, physical, and physiological outcomes in physically active young adults. In a parallel-group design, 102 participants (mean age: 22 ± 3 years) were randomly allocated to either a 10-min guided NSDR protocol (n = 51) or a control condition (n = 51). Perceptual outcomes included sleepiness, fatigue, readiness to perform, as well as muscular stress, lack of activation, negative emotional state, overall stress, physical performance capacity, mental performance capacity, emotional balance and overall recovery (short recovery and stress scale), alongside cognitive (Simon task) and physical (handgrip strength and countermovement jump) performance assessed at baseline, immediately, 20 min and 40 min post-intervention. Physiological responses (heart rate, heart rate variability and skin temperature) were recorded continuously during the intervention. Linear mixed-effects models showed that NSDR resulted in significant Group × Time improvements across perceptual measures, including reduced sleepiness (p = .009, η_p ² = .03), fatigue (p = .001, η_p ² = .05), stress (p = .005, η_p ² = .04) and lack of activation (p = .011, η_p ² = .04), alongside enhanced mental performance capacity (p = .008, η_p ² = .04) and overall recovery (p = .014, η_p ² = .03) compared to control. Reaction time in the Simon task (Group × Time: p < .001, η_p ² = .07) was enhanced in the NSDR group immediately post-intervention (p = .012), while no differences were observed at later assessments. Physiological responses showed a significant Group × Time interaction for heart rate, indicating a greater relative reduction during NSDR compared to control, alongside a smaller rise in skin temperature in the NSDR condition (p < .05). No significant effects were observed for physical performance outcomes (p > .05). These findings suggest that NSDR was associated with consistent improvements in perceptual outcomes, while cognitive findings were transient and physiological findings were modest and should be interpreted cautiously. These results support further evaluation of NSDR as a brief, time-efficient acute rest intervention.