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The neurotoxic effects of certain heavy metals are well established, but only a few studies have investigated the joint effect of concurrent exposure to multiple ones. The study aims to evaluate the association between mixed exposure to neurotoxic metals and the psychosocial behavior of preschool children. Using a stratified sampling strategy, we recruited participants from 105 kindergartens in 41 townships of Taiwan and excluded those with blood lead levels ≥ 3.5 µg/L. The first-morning void urines were collected and analyzed for cadmium, manganese, arsenic, chromium, lead, and nickel concentrations using inductively coupled plasma mass spectrometry. We applied the parentally reported Strengths and Difficulties Questionnaire (SDQ) and Swanson, Nolan, and Pelham IV (SNAP-IV) scales to evaluate the psychosocial behaviors. Multiple linear regressions were utilized to evaluate the associations between each heavy metal and the outcomes, while the mixed effect of concurrent exposure was estimated by using a Quantile g-computation approach. A total of 977 preschool children were included in the study, and the mean (SD) age was 5.7 (0.7) years old. In single pollutant models, we observed adverse effects of urinary manganese, nickel, arsenic, and lead on the specific subsets of SDQ. Furthermore, the combined effect of six heavy metals significantly affected the hyperactivity/inattention symptoms (beta = 0.46, 95% CI: 0.13-0.78, with all metals increased by one quartile), and chromium and lead were the two major contributors. Similar detrimental effects of urinary cadmium and lead were also observed in the SNAP-IV subsets, although the joint effect analysis was not significant. The study provided evidence that concurrent exposure to multiple heavy metals may exert increased risks of hyperactivity/inattention in children compared to single pollutant exposure. Further studies are needed to verify our findings regarding mixed exposure to multiple neurotoxic metals.

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A comprehensive questionnaire with 43 questions was designed to evaluate quality of life, based on rehabilitation with a facial prosthesis. Each patient's psychological situation was assessed using the validated questionnaire and associated scales. Different patient groups were compared with each other in terms of questionnaire scores and general data. In total, 76 patients with a prosthesis of the orbit, nose, or ear, or a combination thereof, were included. There was a highly significant difference in overall satisfaction with defect reconstruction via a prosthesis of the ear compared with the orbit and nose (F(3) = 6.511, p = 0.001). Patients with congenital defects showed a significantly higher level of general satisfaction compared with patients with acquired defects (F(2) = 5.795, p = 0.001). Patients who returned to work were significantly more satisfied with their quality of life (T(57) = 2.626, p = 0.011). With regard to improvements to the state-of-the-art prostheses, the majority of patients suggested better retention, more durable colors, make-up possibilities, less noticeable margins, softer materials, and a movable orbital prosthesis. Within the limitations of the study it seems that facial epitheses improved mental wellbeing and increased quality of life among patients with facial defects. Multiple factors, such as type of facial defect, location of residence, and education can have a potential influence on the quality of life of affected patients. However, further studies are needed, since the psychological and social challenges remain.

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BACKGROUND: Healthcare professionals have fought hard to restrain the COVID-19 pandemic by providing high-quality care for their infected patients, but in doing so they have developed fears of becoming sick and feelings of isolation and loneliness. The lived experience of respiratory therapists (RTs) in Saudi Arabia who works with these infected patients needs further investigation. The study sought to describe the experiences and coping strategies of Saudi RT managing patients with COVID-19. MATERIALS AND METHODS: The study utilized qualitative research methods, specifically employing a phenomenological research design. A total of 25 Saudi RT (RTs) who were in direct contact with COVID-19 patients were selected after they agreed to participate in this study. The study followed a one-on-one semi-structured interview process using the Zoom platform. This qualitative data collection technique focuses on the participants' lived experiences and feelings to discover shared patterns. The data were analyzed via an inductive approach. RESULTS: Six themes were found in the RT perceptions including stress while treating COVID patients, managing the fear of catching of Covid 19, feelings towards COVID-19 patients, challenges faced by female RTs, workplace experiences, and excessive workload. CONCLUSIONS: RTs feelings dramatically changed throughout the COVID-19 pandemic. All the RTs have developed a self-copying style that has helped them improve their psychosocial behavior to face the pandemic. During the outbreak, frontline RTs' positive and negative emotions intertwined and coexisted. Negative emotions predominated in the beginning, while good feelings emerged gradually. Self-coping methods and psychosocial development were significant factors in RTs mental health while caring for COVID-19 patients.

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Objective:To investigate the psychosocial behavior status and related factors in patients with adolescent idio-pathic scoliosis(AIS),in order to pay attention to the mental health and provide an empirical evidence of mental health service and rehabilitation for AIS patients. Method:Fifty participants with AIS and 50 matched healthy adolescents were selected.General information of the participants in the two groups was collected.The Scoliosis Research Society-22(SRS-22),the strengths and difficulties questionnaire-self-report(SDQ-S),self-rating anxiety scale(SAS),nine-item patient health ques-tionnaire(PHQ-9)were used to evaluate the quality of life,anxiety,depression and other psychosocial behav-ior of all subjects.Statistical analysis was conducted to determine whether psychosocial behavior was difference between two groups.The correlation between the type and degree of scoliosis and the quality of life and psy-chosocial behavior was further analyzed. Result:The SAS results indicated that the number of participants with different degrees of anxiety in the AIS group was significantly higher than that in the control group(Z=-3.998,P＜0.001);SDQ-S results showed that the scores of partner interaction problems(t=3.168,P=0.002)and prosocial behavior(t=2.529,P=0.013)in AIS group were significantly higher than those in control group.The scores of pain in double-bend patients were lower than those in single-bend patients(t=2.824,P=0.007);The degree of lateral bending(Cobb Angle)was correlated with the mobility(r=-0.283,P=0.008)and psychological status(r=-0.300,P=0.047)of SRS-22,and was positively correlated with the score of PHQ-9(r=0.356,P=0.011). Conclusion:AIS patients have different levels of anxiety,peer interaction problems and poor prosocial behav-ior.It is necessary to be high valued and screened,evaluated and intervened as soon as possible.

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Background: In extant literature, the concept of social isolation has been explored primarily in the context of older adults. However, people with cancer may also experience social isolation, and there is a need for increased clarity regarding this phenomenon in this population. Objective: To conceptualize social isolation in adult cancer care. Methods: PubMed, Web of Science, PsycINFO, CINAHL, China National Knowledge Infrastructure, Wanfang Data, and the Chinese Biomedical Literature Database were systematically searched using the key terms "cancer," "social isolation," "social alienation," and "social exclusion" for studies (from the earliest date available to June 2022). The main disciplines involved were psychology, nursing, medicine, and public health. Rodgers' evolutionary concept analysis was employed to clarify the antecedents, attributes, and consequences of social isolation in adults with cancer. Results: A total of 60 eligible articles were reviewed entirely and the main findings were categorized into antecedents, attributes, and consequences. The antecedents of social isolation were classified into six categories: cancer-related physiological changes, cognitive beliefs, psychological wellbeing, unsatisfactory social supports or relationships, restrictions associated with receiving treatments, and social-level barriers. Attributes were characterized according to behavior or social avoidance and negative affective experiences, while consequences were attributed to low therapeutic compliance, poor health conditions and mental health problems, and low quality of life. White's heuristic model is a potential theoretical context applicable to social isolation in adults with cancer. Conclusion: This concept analysis provides a basis for developing multidimensional assessment tools and measures to alleviate social isolation in adults with cancer, a complex and varied phenomenon. However, while this review contributes to the current knowledge on social isolation in people with cancer, studies should further investigate the relationships among attributes associated with social isolation.

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Background: Nowadays, in an informational society, digital technologies are present in most areas of life, including school education fields. Students encounter risks or threats during online experiences. Digital resilience helps individuals recognize and manage the risks and threats they come across when they socialize, explore, or work online and plays an important role in the digital technology challenges. However, so far, the concept of digital resilience among individuals in the educational field has not been analyzed in detail. Objectives: The purpose of this study is to clarify the concept of digital resilience among students in a school education context, describe antecedents and consequences, and suggest a conceptual model for health educators. Methods: Walker and Avants' concept analysis method and standards of the scoping review were used to clarify the attributes, antecedents, and consequences from the included articles. A thematic analysis approach of literature was utilized to describe the study findings. No date limitations were applied. Results: A total of 22 included articles provided data for digital resilience conceptualization. Five defining attributes for the concept were identified as follows: (1) understanding online threats; (2) knowing solutions; (3) learning knowledge and skills; (4) recovering from stress; and (5) moving forward through self-efficacy. Antecedents included digital technology-related threats influenced by individual external and internal factors. Consequences were divided into two categories: behavioral performance and psychosocial functioning. Conclusion: Based on the results of the concept analysis, a preliminary conceptual model of digital resilience was described as a circular process toward greater performance and function in the form of understanding, knowing, learning, recovering, and moving forward, when facing stressors, challenges, or adversity. The conceptual model of digital resilience can be further tested and may inform the enhancement of digital-specific resilience measures and interventions for students.

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BACKGROUND: Infectious outbreaks are known to cause fear and panic. Exploration of pregnant individuals' psychosocial condition using a qualitative lens during an infectious outbreak is limited. In this study we explore pregnant individuals' lived experiences as well as their psychological and behavioural responses during COVID-19 with the goal of providing useful strategies from the patient's perspective to enable health care providers to help pregnant patients navigate this and future pandemics. METHODS: Pregnant individuals between 20-weeks gestation and 3 months postpartum who received maternity care from an urban academic interprofessional teaching unit in Toronto, Canada were invited to participate. Semi-structured 60 min interviews were audio-recorded, transcribed and analyzed using descriptive thematic analysis. Interview questions probed psychological responses to the pandemic, behavioural and lifestyle changes, strategies to mitigate distress while pregnant during COVID-19 and advice for other patients and the healthcare team. RESULTS: There were 12 participants, mean age 35 years (range 30-43 years), all 1 to 6 months postpartum. Six main themes emerged: 1) Childbearing-related challenges to everyday life; 2) Increased worry, uncertainty and fear; 3) Pervasive sense of loss; 4) Challenges accessing care; 5) Strategies for coping with pandemic stress; 6) Reflections and advice to other pregnant people and health care professionals. Pregnant individuals described lack of social support due to COVID-19 pandemic restrictions and a profound sense of loss of what they thought their pregnancy and postpartum period should have been. Advice to healthcare providers included providing mental health support, clear and up to date communication as well as more postpartum and breastfeeding support. CONCLUSIONS: These participants described experiencing psychosocial distress during their pregnancies and postpartum. In a stressful situation such as a global pandemic, health care providers need to play a pivotal role to ensure pregnant individuals feel supported and receive consistent care throughout the pregnancy and postpartum period. The health care provider should ensure that mental health concerns are addressed and provide postpartum and breastfeeding support. Without addressing this need for support, parental mental health, relationships, parent-infant bonding, and infant development may be negatively impacted.

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Childhood obesity has been associated with greater risks of psychopathology, including externalizing behaviors and social dysfunction. However, there has been limited research on the effect of obesity on psychosocial functioning among pediatric patients with epilepsy. Accordingly, this study aimed to examine the association between overweight/obesity and behavioral and social functioning among pediatric patients with epilepsy, as function of their developmental status. We completed a retrospective chart review of data (seizure factors, intellectual functioning, caregiver ratings of aggression/defiance and social problems, sex- and age-adjusted body mass index (BMI) percentile) from 30 school-age children and 30 adolescents with epilepsy evaluated through our institute. Body mass index percentile and overweight/obesity status were not associated with seizure variables. Despite controlling for intellectual functioning, overweight/obesity was associated with greater aggression/defiance among child patients but not adolescents. In contrast, adolescence, but not weight status, was associated with social dysfunction. In brief, while early interventions focused on behavior and weight management among children with epilepsy may mitigate risk of aggression and oppositional behavior, among adolescent patients, therapies directed towards promoting interpersonal skills, sense of social competency, and expansion of social support system may reduce psychosocial maladjustment. Findings highlight need to understand the developmental effects of common medical comorbidities on neurobehavioral functioning among youth with epilepsy.

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Background: The impact of a sedentary and unhealthy lifestyle on cardiovascular health is well-documented, however the current obesity and hypertension trends among children is concerning. The ExAMIN Youth SA study aims to investigate the impact of lifestyle behaviors (physical fitness/activity, dietary intake and psychosocial factors) involved in early vascular aging among South African children. Methods: This study is an analytical, multidisciplinary, observational cohort study in a school-based setting. We aim to phenotype a cohort of ~1,000 primary school children (black and white boys and girls between ages 5-9 years) based on current clinical childhood conditions including hypertension and obesity. The primary phenotype is large artery stiffness and retinal microvascular diameters, both biomarkers of early vascular aging. The risk factors and mediators of early vascular aging and also responsible for the clinical conditions include physical inactivity, unhealthy diet, and life stress. Additionally, urinalysis and salivary analyses will be performed to identify biomarkers related to the pathophysiology of early vascular aging. Discussion: In line with the growing prevalence of obesity and hypertension responsible for the development of early vascular aging from childhood to adulthood, this study will address the critical areas in which we observe unfavorable arterial modulation related to dietary behaviors, physical inactivity, and early life stress. Implementation of novel biological markers may further contribute to our understanding of early cardiovascular adaptations in childhood, and aid in the development of primary prevention programs. Trial registration: The study was retrospectively registered on ClinicalTrials.gov on 15 August 2019 (NCT04056377).

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BACKGROUND: Social determinants of health play a vital role in population health. Awareness of household social factors and their impact on health can help health professionals to provide effective strategies in health promotion, especially for children and adolescents showing signs of psychosocial dysfunction. The objective of this study was to explore the association between parents' perceptions of the psychosocial behaviour of their children and the functionality of their household. METHODS: This cohort study analysed data from the Coordinated Health Care for Complex Kids programme. The sample included 293 parents of children aged 4-17 years with chronic conditions, and from urban, low-income families. Psychosocial behaviour of the child was measured using the Pediatric Symptom Checklist (PSC-17), which included subscales for internal, external, and attention symptoms. Household functionality was measured using the Confusion, Hubbub, and Order Scale. Responses to both assessments were scored in a standard manner. RESULTS: There was a significant association between parents' perceptions of the psychosocial behaviour of their children and the functionality of the home environment. The mean Confusion, Hubbub, and Order Scale scores in the home environment improved from baseline to the first reassessment (the period between the two assessments ranged from 4 to 8 months). Additionally, positive PSC-17 screening results of the children decreased by 11% in the first reassessment. The odds of having a positive PSC-17 screening result also decreased in the first reassessment after receiving interventions. CONCLUSION: The association between psychosocial dysfunction and household functionality indicates the importance of family-centred care and taking the home environment into consideration when administering health services to low-income children with chronic conditions. This study brings attention to the more hidden factors that influence child mental health, which must be addressed to improve care delivery and child health outcomes.

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Objective To study the psychosocial behavior reaction,psychosocial needs,anxiety and depression among colostomy patients prior to discharge and to explore the relationship between them.Methods Totally 67 colostomy patients from 2 hospitals in Guangzhou were recruited and investigated by demographic questionnaire,Ostomy Psychosocial Behavior Reaction Questionnaire,Ostomy Psychosocial Needs Questionnaire,Hospital Anxiety and Depression Scale 1-2 days prior to discharge.Results The psychosocial behavior reaction among coIostomy patients was in the moderate level with the mean score 2.15±0.27.The psychosocial needs were in medium to high level with the mean score 2.09±0.41.About 37.3％ of colostomy patients showed anxiety,while 20.9％ patients showed depression.Significant positive correlation was shown between psychosocial behavior reaction and psychosocial needs(r=0.565,P＜0.01),while significant positive correlation was also shown between psychosocial behavior reaction and anxiety-depression(r=-0.472,-0.319,P＜0.01).Psychosocial needs and anxiety could predict psychosocial behavior reaction positively(β=0.486,-0.375,P＜0.01).Conclusion The positive acknowledgement and reconstruction are the main psychosocial behavior reactions prior to discharge in colostomy patients.Patients with more psychosocial needs,severe anxiety show more psychosocial behavior reaction.

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Objective To study the reproductive health status in adolescents underwent repeated abortion and their psychosocial behavioral status and to understand their demanding on the knowledge of contraception, so as to provide suggestions on post abortion care. Methods From July ,2007 to May,2008,400 unmarried adolescents who visited doctors and met the following criteria were recruited in the study:①Younger than 24 years old;②Had artificial abortion at least once;③Have been pregnant for 5-10 weeks and asked for artificial abortion. Data were collected through symptom checklist 90 (SCL-90)and anonymous reproductive health questionnaire. The situation of reproductive tract infections (RTIs) were detected through gynecological examination and laboratory tests.The data was analyzed by SPSS 11.5 statistical software. Results The mean age of the subjects was 21. 18 ±2. 46 years. The mean time of previous artificial abortion was 1.96 ± 1.44,with 52% of ≥2 times. Aged less than 20 years old at the first abortion,having sex more than 3 times per week,more than 2 sex partners,and history of painless abortion were associated with repeated abortion in unmarried adolescents. The SCL-90 scores showed that the subjects had higher score of depression, terror, psychiatric symptoms, somatization, interpersonal sensitivity,anxiety and hostility factors than normal population (P < 0. 05). Of the subjects ,34. 5% had history of RTIs, and the current prevalence of RTI was 59. 5% ,and 58. 5% with one kind of RTI and 36. 0% with two kinds of RTI. Of these RTI patients,33. 5% did not present any clinical symptoms. Abortion for more than twice,first sex intercourse occurred at age younger than 18,history of RTI,sex intercourse of more than 3 time per week,multiple sex partners,especially18,history of RTI,sex intercourse of more than 3 time per week,multiple sex partners,especiallyhaving multi sex partner at the same, and poor sex sanitation were risk factors of RTI. Conclusions There are various reproductive health problems among repeated abortion adolescents in mental and physical aspects, lack of knowledge on reproductive health and contraception is the main reason. Improving post-abortion services will be helpful to prevent repeated abortion in adolescents and protect their physical and mental health.