The study recruited participants through a vascular clinic in Calabria, South Italy. The final sample included 14 men and 14 women, aged 42 to 78, with 14 participants diagnosed with PAD and 14 with CVD. Everyone had lived with a confirmed vascular condition for at least six months and could communicate in Italian. Individuals were eligible after expressing interest, and each participated in a semi-structured interview lasting about 40 to 50 minutes, usually in their home or a quiet healthcare setting; two interviews were conducted digitally because of geographic constraints. The researchers asked about symptoms, bodily awareness, perceived severity, emotional responses, self-care, healthcare engagement, normalization, gender and social context. Gender-related questions were introduced near the end of each interview so that participants could first describe their experiences without being prompted to frame them through gender.

All interviews were recorded, transcribed verbatim and anonymized with pseudonyms. The researchers used reflexive thematic analysis, beginning with familiarization and coding before consolidating roughly 60 descriptive and interpretive codes into four broader themes: hierarchies of vascular risk, embodied anxiety and anticipation, trivialization and normalization of venous disease, and gendered interpretations. Coding was treated as an interpretive process rather than a test of statistical agreement between coders. The researchers compared arterial and venous accounts, examined how participants described their bodies and care decisions, and refined the thematic structure through an abductive process in which interview patterns were considered alongside theories of risk, chronic illness and embodied experience. They considered thematic sufficiency reached when later interviews elaborated existing patterns rather than introducing substantively new ones.

The central distinction emerged in the consequences participants imagined. PAD was linked with myocardial infarction, stroke, limb loss and sudden deterioration, giving ordinary sensations a potentially diagnostic significance. “Every twinge in my leg makes me think, could it be a blockage? I try to stay calm, but it’s always there in the back of my mind,” said Paolo, 62, who had PAD. This interpretation made the body an object of continuous scrutiny. Luigi, 59, also living with PAD, described a daily inspection of his legs: “Every morning I check my legs. It has become almost automatic now. I look at the color of the skin, I touch them to see if they feel cold, and sometimes I press on my feet to see if there is any swelling.” Small sensations were no longer experienced simply as sensations; they became possible signs of worsening circulation.

For many arterial patients, this monitoring generated anticipatory anxiety. They imagined not only present discomfort but possible future complications, creating tension between the need to remain alert and the desire to live normally. Alessia, 54, with arterial disease, said, “Sometimes I wake up in the middle of the night and start checking my pulse or touching my feet to make sure everything feels normal. It’s not that something has necessarily happened, but my mind goes straight to the worst possibilities. It’s exhausting because you know you should relax, but you also feel that you have to pay attention.” Patients also learned through experience to distinguish sensations that seemed important from those they considered manageable, often drawing on previous illness and medical consultations.

Patients with CVD described a different relationship with their bodies. Swelling, heaviness, aching and visible veins were generally framed as manageable discomforts rather than warning signs. Giulia, 65, said, “My legs hurt sometimes, especially at the end of the day, but I just put on my stockings and keep going. It’s not like it could kill me, so I don’t worry too much.” Sara, 61, similarly treated swelling after prolonged standing as something she had learned to live with and manage with compression stockings. Roberto, 67, said his varicose veins were “mostly annoying rather than worrying,” and that he sat down, raised his legs and continued his activities. These accounts showed how practical coping could integrate a condition into everyday routines without generating sustained concern about serious outcomes.

Normalization was supported by comparisons with other illnesses and with the aging body. Some participants regarded CVD as less serious because they knew people with heart problems or cancer. Caterina, 72, connected her symptoms to a family pattern: “My legs swell sometimes, especially at the end of the day, but it doesn’t really worry me. My mother had the same problem, and my sisters too. In our family it’s something quite common.” Marco, 70, said that after living with varicose veins for years, the condition felt like part of getting older and did not seem like “a big issue” compared with heart disease or cancer. Occupational strain also supplied an ordinary explanation. Lucia, 62, initially did not seek care because she believed her swelling resulted from standing all day at work and from similarities among her colleagues; she sought advice only after the swelling became substantially worse.

Gender modified these patterns without determining them. Women with arterial disease frequently described vigilance in emotional and relational terms, including concern about losing mobility, independence or the ability to care for family. Elena, 58, said, “I check my legs constantly because I’m afraid of missing something important,” while linking this attention to preventing a serious event. Men with arterial disease also monitored symptoms, but often presented their response as control, discipline and self-reliance. Luca, 60, said: “I know my arteries are blocked, and of course the doctors told me to be careful. But I try not to think about it too much. If you keep worrying about every little thing you can’t live your life.” His account acknowledged danger while limiting the apparent emotional impact of the diagnosis.

Gender was especially visible in how participants with venous disease discussed visible changes. Women frequently mentioned swelling, skin appearance, the visibility of varicose veins, comfort with clothing and shoes, and the effect of symptoms on social presentation. Anna, 63, said she noticed swelling when she wanted to wear particular clothes or shoes and also thought about how her legs looked in summer. Daniela, 55, linked visible veins and heaviness to her appearance while using compression stockings for relief. Men were more likely to dismiss discomfort as a feature of aging, work or family predisposition and to consult a doctor only if symptoms became severe. Matteo, 68, said, “The veins hurt a little sometimes, especially after walking a lot, but it’s nothing serious… I’ll go to the doctor if it gets really bad, but otherwise you just carry on.”

The findings suggest that delayed care should not automatically be read as indifference or non-compliance, while intense monitoring should not automatically be reduced to anxiety. Both responses can arise from culturally shaped understandings of seriousness, vulnerability and responsibility. The researchers identified men with venous disease as especially likely to trivialize symptoms and postpone consultations, and women with arterial disease as often showing the greatest vigilance and anticipatory concern. Women with venous disease frequently focused on comfort, mobility and appearance, while men with arterial disease combined precaution with restrained emotional expression. These were recurring tendencies in this sample, not fixed profiles: age, prior illness, family history, occupation, social roles, symptom severity and previous healthcare experiences also shaped how participants interpreted risk.

The study has important limits. It was exploratory and interpretive, based on retrospective self-reports rather than direct measures of behavior or objective vascular risk, and the 28 participants came from one clinic and regional healthcare context. The researchers did not systematically analyze socioeconomic position, age, disease duration or severity as independent categories, and they did not establish that the perceived hierarchy caused delayed care or better self-management. Transferability to other populations, regions and healthcare systems therefore requires caution, and the gendered patterns cannot be generalized as universal or binary. Nevertheless, the interviews show how biomedical diagnoses are translated through personal experience, family narratives, cultural ideas about aging and gender expectations. In that setting, vascular risk is not only a physiological fact; it is a lived interpretation of which bodily changes deserve attention, which illnesses are allowed to disrupt daily life and whose discomfort is treated as medically significant.

Subject of Research: Gendered perceptions of vascular risk among Italian patients with arterial or venous disease

Article Title: Hierarchies of vascular risk: gendered perceptions of arterial and venous disease

Article References: Costa, D., & Serra, R. (2026). Hierarchies of vascular risk: gendered perceptions of arterial and venous disease. Frontiers in Sociology, 11, Article 1923281. https://doi.org/10.3389/fsoc.2026.1923281

Image Credits: AI Generated

DOI: 10.3389/fsoc.2026.1923281

Keywords: peripheral arterial disease, chronic venous disease, vascular risk, gender, healthcare engagement, risk perception, chronic illness, qualitative interviews, medical sociology, embodiment, Hierarchies, vascular

The authors ground their analysis in the historical legacy of hysteria, a diagnosis popularised in the early twentieth century that attributed physical symptoms to emotional distress primarily among women. They argue that this diagnostic framework provides essential context for contemporary patterns of dismissal and pathologisation, particularly towards marginalised populations. The term medical gaslighting itself did not appear in the academic literature until 2020, emerging in an account of a woman with long COVID who reported repeated dismissal prior to diagnosis. Since then, the concept has gained recognition in literature on chronic or contested illnesses, yet it still lacks a clear, consistent, and theoretically grounded definition that could guide research, clinical practice, and public understanding.

To construct their definition, the researchers draw on the origins of gaslighting in Patrick Hamilton’s 1938 play Gas Light, which depicts a husband manipulating his wife into doubting her sanity by dimming the gaslights in their home. The term entered academic literature through case studies of involuntary hospitalisation as psychological abuse and has since come to describe a form of psychological abuse in which an individual is manipulated into questioning their own perception of reality. The authors highlight sociologist Paige Sweet’s interviews with forty-three survivors of domestic violence, which demonstrated that gaslighting becomes especially abusive when embedded within social inequities and power dynamics, particularly those related to gender. Sweet conceptualises gaslighting as repeated efforts to construct a surreal environment in which victims are made to feel or appear crazy, thereby undermining their sense of reality, identity, autonomy, and mobility.

Building on this foundation, the researchers examine how medical gaslighting operates within Western medicine’s structural constraints. They cite a qualitative analysis of 334 online survey responses in which respondents with long COVID used the language of medical gaslighting to make sense of their experiences seeking care. Participants described repeated dismissal by medical professionals who were unable or reluctant to recognise their symptoms as real, with physicians invoking biomedical objectivity, including negative diagnostic test results, to discount patients’ subjective symptoms. The authors of that study suggest that medical gaslighting can be understood as a rhetoric of ontological politics, echoing Annemarie Mol’s argument that what counts as real in medicine is inherently political. This framing positions medical gaslighting not merely as an interpersonal failure but as a systemic condition embedded within the epistemology of Western medicine itself.

The researchers emphasise that Western medicine has historically been constructed around a normative body: wealthy, White, able-bodied, heterosexual, cisgender, and endosex male. Although medical gaslighting is not exclusive to marginalised communities, this structural bias systemically disadvantages those outside the norm. They cite interviews with twelve gynaecologists and general practitioners in which women with endometriosis were characterised as hysterical and labelled crazy when they failed to respond to diagnosis or treatment as expected. Miranda Fricker’s concept of epistemic injustice, which describes harm done to someone in their capacity as a knower due to prejudice or limited interpretive resources, provides a useful framework for understanding how implicit biases and power dynamics produce such harm. The authors also highlight the role of intersectionality, noting that while Black women may experience compounded marginalisation within healthcare, White women benefit from racial privilege while still experiencing gender-based disadvantage.

The perspective piece engages critically with alternative framings that have emerged in recent medical literature. Emergency physician Robert Jedick has argued that the term medical gaslighting overlooks physicians’ perspectives and frames patient-provider relationships in conflict, proposing miscommunication as an alternative that better acknowledges the organisational pressures facing medical professionals. The Australian researchers counter that characterising such encounters as miscommunication risks reframing structurally embedded power dynamics as interpersonal misunderstandings, shifting responsibility towards patients seeking recognition of their symptoms. They argue that this reframing may invalidate the lived experiences of those harmed by medical gaslighting, and that the language of medical gaslighting can function as a form of self-advocacy, enabling patients to make sense of their experiences within a medical system that has failed to recognise their legitimacy.

The researchers also address the question of intent, which has divided scholars in the field. Some have distinguished manipulative gaslighting from epistemic gaslighting on the basis of intent, while others have proposed medical invalidation to describe gaslighting-like behaviours that occur without manipulative intent, including those arising from well-meaning clinical practice. The authors argue that patients cannot reasonably be expected to discern the intent of medical professionals, and that introducing additional terminology is unlikely to resolve underlying epistemic tensions when the meaning of the existing term remains contested. They contend that the outcomes of both manipulative and unintentional dismissal are often similar, leading individuals to question or doubt the legitimacy of their concerns, and that a definition of medical gaslighting must recognise that it occurs regardless of intent.

Having surveyed the conceptual landscape, the researchers advance their own definition, which they present as a framework for empirical and clinical inquiry. They define medical gaslighting as a complex phenomenon, understood through psychological and sociological frameworks, in which individuals experience the repeated dismissal and invalidation of their health concerns by medical professionals, healthcare organisations, or the broader medical system, an experience that leads them to question or doubt the legitimacy of their concerns. Influenced by systemic inequities and power dynamics, it occurs regardless of intent and often in the absence of evidence-based care. The authors stress that this definition should continue to evolve as the field progresses, and that it establishes a foundation for academics and medical professionals to identify and address systemic inequities within Western medicine while reinforcing accountability within the medical system.

The researchers argue that such accountability can inform training that prioritises patient-centred care and transparent communication in clinical decision-making, strengthening patient-provider relationships, particularly in the management of chronic or contested illnesses within internal medicine. They distinguish their framing from legal claims of medical negligence, which typically focus on isolated incidents or individual providers, noting that medical gaslighting is more accurately understood as a psychological and institutional process that normalises the devaluation of individuals lacking testimonial power within the medical system. Over time, repeated encounters may generate a documented history of misdiagnoses and ineffective treatments, leading to patients being labelled as psychosomatic or manipulative, with clinical records potentially reflecting the implicit biases of previous providers and leaving patients with limited authority to challenge such assumptions.

Ultimately, the authors call for Western medicine to turn its diagnostic gaze towards medical gaslighting and work to extinguish the systemic inequities that sustain it. They contend that sensationalisation of the term has limited meaningful engagement, leaving insufficient empirical and clinical work to guide practice, and that there is an urgent need to identify and address medical gaslighting within Western medicine to prevent further dismissal and invalidation. By advancing a clear, theoretically grounded definition that affirms the lived experiences of those harmed while establishing a framework for research and clinical inquiry, the researchers aim to ensure that the phenomenon is consistently understood across public, academic, and clinical contexts, transforming a viral term into a rigorous instrument for structural change.

Subject of Research: Medical Gaslighting

Article Title: Defining Medical Gaslighting—To Extinguish It

Article References: Janiszewski, C. M. S., Mosterd, D., Emerson, C., Mikocka-Walus, A., & Grech, L. B. (2026). Defining Medical Gaslighting—To Extinguish It. Journal of General Internal Medicine. https://doi.org/10.1007/s11606-026-10787-8

Image Credits: AI Generated

DOI: 10.1007/s11606-026-10787-8

Keywords: medical gaslighting, patient dismissal, chronic illness, epistemic injustice, healthcare inequities, long COVID, patient-provider communication, systemic bias, internal medicine, medical sociology, Defining, Medical

The research team, led by investigators from Guilin Medical University, Xiangnan University, and The Chinese University of Hong Kong, compared ChatGPT, Gemini, and Doubao across twenty simulated-patient scenarios spanning two contrasting chronic conditions: type 2 diabetes mellitus (T2DM) and chronic spontaneous urticaria (CSU). Each scenario was independently submitted to all three systems in two testing rounds, yielding 120 responses. Blinded raters with medical degrees assessed overall psychological support appropriateness, recognition and emotional support, chronic-illness contextualization, psychological support and referral, psychosomatic balance and safety, and major clinical or safety errors. Repeated testing assessed response consistency.

Overall psychological support appropriateness differed significantly across systems (P = 0.002), with 90.0% of ChatGPT, 75.0% of Gemini, and 55.0% of Doubao responses meeting the prespecified appropriateness threshold. Recognition and emotional support was consistently strong across all three systems, with no significant difference (P = 0.247). However, greater differences emerged in chronic-illness contextualization (P = 0.001), psychological support and referral (P = 0.002), and psychosomatic balance and safety (P < 0.001). The clearest and most consistent separation was between ChatGPT and Doubao, with ChatGPT retaining higher scores after Holm adjustment for contextualization (adjusted P = 0.008), psychological support and referral (adjusted P = 0.014), and psychosomatic balance and safety (adjusted P = 0.005).

The most consequential finding concerned symptom severity. All 24 responses to mild presentations were classified as psychologically appropriate, compared with only 14 of 24 responses to moderate presentations (exact permutation P = 0.016). This indicates that performance became substantially less reliable when digital support required stronger escalation toward professional assessment. Recognition and emotional support remained stable across severity levels (P = 0.500), suggesting that the systems could still identify distress even when they failed to recalibrate contextual interpretation, proportional referral, and psychosomatic balance as clinical severity increased.

Contextualization was also less consistent in CSU than in T2DM. Among the 48 responses generated from matched depression and anxiety scenarios, 20 of 24 T2DM responses (83.3%) and 18 of 24 CSU responses (75.0%) were classified as psychologically appropriate, with no significant difference in overall appropriateness between the two contexts (P = 0.313). However, chronic-illness contextualization was significantly lower in CSU (P = 0.008), particularly when responses needed to incorporate flare unpredictability, pruritus, sleep disruption, and illness uncertainty. The condition-specific scenarios reinforced this distinction: five of six responses to the two T2DM distress variants were classified as appropriate, compared with only one of six responses to the two CSU flare- and uncertainty-related distress variants.

Major clinical or safety errors occurred in 0%, 10.0%, and 15.0% of first-round ChatGPT, Gemini, and Doubao responses, respectively. No system generated a major unsafe medication or treatment recommendation. The errors that did occur were principally failures of calibration rather than overtly hazardous treatment advice: three involved disproportionate psychological attribution of physical or illness-related symptoms, and two reflected insufficient escalation in moderate presentations with meaningful functional impairment. Inter-rater agreement was substantial across all evaluated domains, with linearly weighted Cohen’s κ ranging from 0.79 to 0.88 for the secondary domains and 0.84 for overall appropriateness.

Test–retest consistency was moderate and varied between systems. Exact agreement in overall appropriateness was 85.0% for ChatGPT, 75.0% for Gemini, and 65.0% for Doubao, with corresponding linearly weighted κ values of 0.69, 0.59, and 0.49. Agreement in the binary psychologically appropriate classification was higher than exact ordinal agreement, indicating that some repeat variability reflected movement within rather than across the clinically relevant appropriateness threshold. This graded reduction in response-level stability across systems suggests that even the best-performing model cannot yet guarantee reproducible clinical formulation across identical prompts.

The study introduces the concept of psychosomatic calibration as a more useful framework for evaluating AI in chronic illness than diagnostic accuracy alone. Psychosomatic calibration refers to the capacity to preserve the clinical relationship between bodily symptoms, psychological distress, and disease context without collapsing one into the other. Over-psychologising a physical symptom can be as clinically misleading as ignoring the psychological burden of a chronic condition. Conversely, repeatedly attributing distress to the disease itself can obscure the emergence of a clinically significant depressive or anxiety syndrome. The challenge is not to choose between a psychological and somatic explanation, but to recognize when both remain plausible and when further assessment is warranted.

The contrast between T2DM and CSU illustrates why this matters. T2DM imposes a relatively structured psychological burden shaped by self-monitoring, treatment adherence, dietary regulation, and repeated evaluation of disease control, experiences that map readily onto established narratives of treatment fatigue and diabetes distress. CSU poses a different interpretive problem, shaped by recurrence, unpredictability, pruritus, disrupted sleep, and uncertainty about triggers. Such experiences do not map as neatly onto standard psychological templates. A response that merely identifies anxiety may therefore be technically plausible yet clinically shallow, because what is required is not simply recognition of affect but an understanding of the structure of uncertainty that sustains it.

The broader conclusion is not that general-purpose AI succeeds or fails at psychological support in chronic illness, but that the frontier has moved. Basic emotional recognition is no longer the most informative test of model capability. The harder problem is whether AI can formulate distress in context, preserve appropriate uncertainty between psychological and somatic explanations, and adjust its recommendations as clinical severity changes. The authors suggest that implementation should emphasize context-sensitive guidance, severity-responsive referral, and clear integration with rather than substitution for professional care. As AI becomes increasingly embedded in how patients understand and respond to chronic illness, evaluation should shift from asking whether models can produce plausible mental-health responses to asking whether those responses are appropriately contextualized, proportionate, and reproducible.

Subject of Research: AI chatbots

Article Title: Psychological support for depression and anxiety across chronic illness contexts: a comparative evaluation of three general-purpose AI chatbots

Article References: Xiao, W., Cao, X., Jin, W., Chen, X., Cai, J., Luo, X., & Deng, J. (2026). Psychological support for depression and anxiety across chronic illness contexts: a comparative evaluation of three general-purpose AI chatbots. Frontiers in Psychiatry, 17, Article 1962615. https://doi.org/10.3389/fpsyt.2026.1962615

Image Credits: AI Generated

DOI: 10.3389/fpsyt.2026.1962615

Keywords: AI chatbots, ChatGPT, Gemini, Doubao, depression, anxiety, chronic illness, type 2 diabetes, chronic spontaneous urticaria, digital mental health, psychosomatic medicine, large language models

The research design is a textbook example of what psychologists call an intensive longitudinal or daily diary approach. Rather than asking couples to recall, weeks or months later, how their relationship had fared since the stroke, the team captured moment-to-moment dynamics as they unfolded. Each morning and each evening, participants reported their current levels of anger and sadness as well as their satisfaction with the relationship. This repeated-sampling strategy matters because retrospective recall is notoriously distorted by current mood and by the overall trajectory of recovery. By anchoring measurements to specific days, the researchers could separate the within-person question—does a morning of unusual anger predict an evening of diminished satisfaction for that individual, on that day?—from the between-person question of whether generally angrier or sadder people are simply less satisfied overall.

Methodologically, the heart of the analysis is the actor-partner interdependence model, or APIM, a statistical framework built specifically for dyadic data. In a two-level APIM, observations are nested within couples, allowing researchers to estimate actor effects—how my own morning emotion shapes my own evening satisfaction—alongside partner effects, which capture how my spouse’s morning emotion shapes my evening satisfaction. This distinction is crucial in the context of chronic illness. A stroke survivor’s emotional volatility may affect a caregiving spouse through direct interpersonal friction, while a spouse’s distress may bleed into the survivor’s sense of the relationship through guilt, worry, or perceived withdrawal. The model treats these pathways as distinct and estimable, rather than collapsing them into a single blended signal.

The results were unambiguous on the risk side. Within-person analyses indicated that both actor and partner anger and sadness were associated with lower same-day relationship satisfaction. In plain terms, on days when either member of the couple woke up feeling angrier or sadder than was typical for them, both they and, in many configurations, their partner ended the day feeling less positive about the relationship. The fact that partner effects emerged alongside actor effects underscores a central tenet of dyadic health psychology: emotions in close relationships are contagious, and the interpersonal transmission of negative affect is not a metaphor but a measurable statistical pathway. One person’s bad morning can, quite literally, become two people’s bad evening.

Why would anger and sadness be so potent in this population? The authors frame chronic illness as a salient stress context that introduces sustained uncertainty and regulatory demands for both members of the couple. After a stroke, ordinary emotional regulation becomes harder for the survivor—fatigue, cognitive changes, and the sheer burden of recovery can lower the threshold for irritability—while the spouse absorbs caregiving responsibilities, financial strain, and the grief of watching a partner change. Anger, in particular, is an approach-oriented emotion that tends to be expressed outwardly, through sharp words, impatience, or conflict, and it is precisely these interpersonal behaviors that corrode daily satisfaction. Sadness, by contrast, is withdrawal-oriented, and its interpersonal cost may run through perceived emotional unavailability: a partner who seems distant or despondent offers fewer of the small affirmations that sustain a sense of connection.

The protective finding is where the study becomes genuinely hopeful. The researchers assessed perceived post-stroke intimacy at study exit—a retrospective measure of how much closeness each spouse felt the relationship had retained or rebuilt since the stroke. When this intimacy variable was incorporated into the models, it buffered the association between partners’ morning sadness and stroke survivors’ satisfaction. In other words, for couples with lower intimacy, a spouse’s sad morning translated into a markedly worse day for the stroke survivor’s relationship satisfaction. For couples with higher intimacy, that same sad morning had a considerably weaker impact. Intimacy, in this framing, functions as a kind of relational shock absorber: it does not prevent the sadness itself, but it changes what the sadness means and how far its consequences travel.

This buffering pattern fits a broader theoretical tradition in which intimacy operates as a resource that reinterprets negative emotional signals. When couples feel fundamentally close and secure, a spouse’s transient sadness is more likely to be read as a passing state that elicits compassion rather than as evidence of rejection or relational decline. When intimacy has been eroded—by disability, role reversal, or the loss of shared activities—the same signal is filtered through a lens of vulnerability, amplifying its corrosive effect. The finding also aligns with the stress-buffering hypothesis long established in social support research, extending it into the domain of daily emotional dynamics within couples facing chronic illness.

The implications for clinical practice are tangible. Stroke rehabilitation has traditionally concentrated on motor recovery, speech, and physical independence, with psychosocial support often treated as secondary. This study suggests that relationship functioning is not a luxury outcome but a daily mechanism through which chronic stress becomes embedded in lived experience, in the authors’ words. Interventions that explicitly target couples—teaching partners to recognize and communicate about morning emotional states, fostering shared activities that rebuild intimacy, and normalizing the anger and sadness that follow stroke—could plausibly interrupt the downward spiral the data reveal. Because the effects were observed at the daily level, even modest, low-cost interventions timed to moments of vulnerability might yield outsized returns in relational well-being.

The study’s limitations are worth noting with the same clarity the authors bring to their findings. The sample of eighty-nine couples, while respectable for an intensive diary design, is modest, and the intimacy measure was collected once at study exit rather than tracked daily, which constrains causal inference about the buffering mechanism. The observation window of up to fourteen days captures a snapshot of what may be a much longer adjustment trajectory. Nonetheless, the work stands as a compelling demonstration that the aftermath of a stroke is lived not in dramatic crises but in hundreds of ordinary mornings and evenings—and that the emotional tone of those moments, in both partners, shapes whether the relationship bends or breaks. For the millions of couples navigating life after stroke, the message is both sobering and empowering: daily anger and sadness are real relational risks, but closeness, deliberately cultivated, can absorb much of their force.

Subject of Research: Daily emotional dynamics and relationship satisfaction in couples after stroke

Article Title: Daily anger and sadness undermine relationship satisfaction after a stroke with spousal post-stroke intimacy as a protective factor

Article References: Birthelmer, S., Zambrano Garza, E., Pauly, T., Murphy, R. A., Ashe, M. C., Madden, K. M., Linden, W., DeLongis, A., Gerstorf, D., & Hoppmann, C. A. (2026). Daily anger and sadness undermine relationship satisfaction after a stroke with spousal post-stroke intimacy as a protective factor. Communications Psychology. https://doi.org/10.1038/s44271-026-00544-2

Image Credits: AI Generated

DOI: 10.1038/s44271-026-00544-2

Keywords: stroke, relationship satisfaction, couples, daily diary study, anger, sadness, intimacy, actor-partner interdependence model, chronic illness, caregiving, emotional spillover, psychology

The study, led by Mohammad Zaib of the Department of Medicine at MTI-Lady Reading Hospital in Peshawar, together with Usman Mahboob of Khyber Medical University and Naheed Mahsood of Khyber Girls Medical College, set out to understand why residents with chronic illness choose to perform their clinical duties while unwell. Presenteeism, the act of attending work despite being sick, is common among postgraduate residents, yet the authors note it has received negligible attention in the policies that shape graduate medical education. Rather than measuring how often it happens, the team wanted to understand what it feels like from the inside, and what forces push young doctors to sacrifice their own health in service of their patients and their careers.

To capture that lived experience, the researchers employed a qualitative phenomenological design, an approach that seeks to describe the essence of a shared experience through the eyes of those who live it. They conducted semi-structured interviews with twelve postgraduate residents drawn from different medical specialties in hospitals across Khyber Pakhtunkhwa province in Pakistan. Semi-structured interviews allowed participants to speak freely about their experiences while ensuring that key topics were covered consistently. The researchers then analyzed the transcripts using Braun and Clarke’s reflexive thematic analysis, a widely used method in which researchers systematically code the data and develop themes that capture patterns of meaning across the accounts. The study received ethics approval from the Advanced Studies and Research Board of Khyber Medical University, and all participants provided written informed consent, with confidentiality and the right to withdraw explicitly guaranteed.

A distinctive strength of the work lies in its theoretical framing. The researchers interpreted their findings through two complementary psychological theories. The first is Conservation of Resources theory, which holds that people strive to obtain, retain, and protect resources they value, and that stress arises when those resources are threatened, lost, or invested without return. The second is Self-Determination theory, which describes human motivation in terms of three basic psychological needs: autonomy, competence, and relatedness. Together, these frameworks allowed the team to explain presenteeism not as an isolated individual choice but as the outcome of an interaction between motivational stress and resource-related pressures. A resident who fears losing income, career standing, or professional respect is experiencing a resource threat; a resident whose sense of purpose depends on being present at the bedside is experiencing a motivational pull. In the lives of chronically ill residents, both forces operate at once.

From the analysis, five major themes emerged, and together they sketch a portrait of a group caught between what they believe they owe their patients and what their bodies and circumstances demand. The first theme, described by the authors as the essence of duty, revealed an internalized professional identity in which physical presence at the workplace defined what it meant to be a good doctor. For these residents, showing up while sick was not seen as recklessness but as the very expression of medical virtue. Absence, by contrast, carried the sting of failure and guilt. This finding illustrates how deeply the culture of medicine equates commitment with corporeal presence, a norm that leaves little room for the realities of chronic disease.

The second theme, the reality of precarity, exposed the material conditions underlying that commitment. Participants described financial precariousness and persistent anxiety about their careers, including fear of economic victimization, rooted in a dearth of resources. In a training system where residents often depend on their positions for income and future employment, the prospect of taking sick leave can feel economically dangerous. Conservation of Resources theory illuminates this dynamic clearly: when material resources are scarce, any threat to them, such as a supervisor’s disapproval or a lost paycheck, is magnified, and residents respond by protecting their jobs at the expense of their health.

The third theme, the moral burden, captured the painful conflict between self-care and responsibility to patients. Residents described feeling morally torn when illness forced them to weigh their own needs against the care they believed their patients deserved. This tension is precisely where Self-Determination theory becomes explanatory: the residents’ motivation to work while ill was not purely external pressure but also an internalized sense of duty that shaped their identity. Yet when motivation is driven by obligation and fear rather than by genuine autonomy, the theory predicts, psychological well-being suffers. The fourth theme, the erosion of self, confirmed that prediction in lived detail. Participants reported that ongoing presenteeism and exhaustion were adversely affecting both their well-being and their learning, undermining the very competence that residency is designed to build. A chronically exhausted resident absorbs less, errs more, and burns out faster, a cycle that threatens not only the individual but also patient safety and the integrity of the training program itself.

The fifth theme, the yearning for support, expressed what residents said they needed to break this cycle: empathetic institutional systems, financial stability, and psychological safety. They wanted workplaces where admitting illness would not invite stigma or penalty, where leave policies were equitable, and where the basic economic anxieties of training life did not make every sick day feel like a gamble. The authors argue that sustainable graduate medical education requires a balance between the service needs of hospitals and organizational support for trainees, including the promotion of autonomy, financial and psychosocial support, and fair leave policies. In their conclusion, they place the safeguarding of residents’ health at the center of professional development, patient safety, workforce stability, and the integrity of medical education itself.

The significance of the study extends beyond the hospitals of Khyber Pakhtunkhwa. Presenteeism among healthcare workers is a global concern, because a sick clinician who keeps working can transmit illness, make errors, and model unhealthy norms for the next generation of doctors. What this research adds is a theoretically grounded explanation of why the problem persists even among highly motivated professionals. It is not simply that residents lack awareness of the risks; it is that the architecture of their training, combining scarce resources, rigid expectations of presence, and moralized notions of duty, makes working while ill the rational and even virtuous-seeming choice. Changing that calculus requires policy, not exhortation. The authors’ findings suggest that reforms addressing financial security, psychological safety, and equitable sick leave would attack the resource threats that Conservation of Resources theory identifies as the engine of the problem, while reforms that expand resident autonomy would satisfy the motivational needs described by Self-Determination theory.

For a phenomenon so consequential, presenteeism among chronically ill residents has been remarkably under-studied, and this phenomenological account is a step toward making it visible. The study’s limitations are those inherent to qualitative work: twelve participants in one region of Pakistan cannot represent every training system, and the findings describe experiences rather than quantify prevalence. Yet the depth of the themes, and their coherence with established psychological theory, give the work explanatory power that surveys alone cannot provide. The image that emerges is sobering: young doctors, already carrying the weight of chronic disease, performing their duties through pain and exhaustion because their profession has taught them that a good doctor is one who is always there. Until medical education systems learn to value the health of their trainees as highly as their attendance, presenteeism will remain the hidden price of medical training, paid in the well-being of the very people entrusted with patients’ lives.

Subject of Research: Presenteeism among postgraduate medical residents with chronic illness

Article Title: Exploring the lived experiences of presenteeism among postgraduate residents with chronic illness

Article References: Zaib, M., Mahboob, U., & Mahsood, N. (2026). Exploring the lived experiences of presenteeism among postgraduate residents with chronic illness. Discover Psychology. https://doi.org/10.1007/s44202-026-00937-8

Image Credits: AI Generated

DOI: 10.1007/s44202-026-00937-8

Keywords: presenteeism, postgraduate medical education, chronic illness, conservation of resources theory, self-determination theory, qualitative research, reflexive thematic analysis, resident well-being, occupational health, Pakistan, medical training, patient safety

The demographic backdrop gives the argument its urgency. Europe is undergoing an unprecedented transition, with longer life expectancy and a growing prevalence of chronic conditions reshaping health systems from the ground up. People increasingly live for decades with illnesses such as diabetes, heart failure, chronic obstructive pulmonary disease, and dementia, moving repeatedly between primary care, specialist clinics, hospitals, rehabilitation facilities, home care, and long-term residential settings. Each of these services may deliver technically competent interventions, but the overall experience is often fragmented. Righi contends that repeated transitions, limited continuity, and insufficient attention to personal goals and values can gradually erode a patient’s sense of dignity—and that this erosion is currently invisible to the quality indicators systems routinely collect.

The intellectual foundations for measuring dignity are far stronger than most policymakers realise. The philosopher Lennart Nordenfelt distinguished between an intrinsic and universal dimension of dignity, inherent to every human being, and contingent dimensions that illness, dependency, stigma, or social vulnerability can threaten. Building on that framework, Harvey Max Chochinov and colleagues in Canada demonstrated through empirical research that dignity is not merely an abstract ethical principle but a clinically relevant phenomenon, closely associated with suffering, psychological well-being, and the overall experience of care. Their landmark studies in terminally ill patients showed that dignity-related distress could be identified, characterised, and addressed, giving the concept tangible implications for health outcomes and quality of life rather than leaving it in the realm of rhetoric.

What has changed most significantly in recent years is the recognition that dignity is not an end-of-life concern alone. Studies involving people living with chronic diseases have shown that dignity may be affected by loss of autonomy, functional decline, social isolation, uncertainty about the future, and shifts in personal identity that accompany long-term illness. For many individuals, dignity shapes how they interpret their illness, how they engage with healthcare professionals, and how they evaluate the care they receive. This finding challenges the traditional assumption that dignity matters mainly in hospices and palliative wards. Instead, it supports treating dignity as a central dimension of living with disease across the entire trajectory of chronic illness, from first diagnosis through years of monitoring, treatment, and adaptation.

The measurement gap is particularly striking given the sophistication of contemporary outcome assessment. Healthcare systems across Europe and beyond increasingly collect Patient-Reported Outcome Measures, known as PROMs, and Patient-Reported Experience Measures, known as PREMs, to evaluate clinical results, care experiences, and value generation. Yet the dimension that patients themselves most consistently identify as fundamental to their well-being is rarely assessed systematically. Within the framework of person-centred care and Value-Based Healthcare—the movement that seeks to tie spending to outcomes that genuinely matter to patients—Righi argues that this omission is becoming increasingly difficult to justify. A system can quantify symptom burden, readmission rates, and satisfaction scores while remaining blind to whether patients feel their sense of self, autonomy, and personal worth has been respected.

The tools to close this gap already exist. The Patient Dignity Inventory, developed by Chochinov’s team, has demonstrated that dignity can be assessed reliably and meaningfully, capturing dignity-related distress across multiple domains. Subsequent research has supported the instrument’s applicability beyond palliative care, including among individuals living with chronic illness, with studies confirming its factorial structure in non-end-of-life populations. Righi is careful to note that measuring dignity does not reduce this complex construct to a bare numerical score. Rather, systematic assessment provides a structured means of identifying unmet needs, evaluating interventions, and understanding whether healthcare systems are achieving one of their most fundamental objectives. In this sense, a dignity metric functions less like a laboratory value and more like a diagnostic lens on the relational and organisational quality of care.

Dignity may also prove to be a distinctly nursing-sensitive outcome. Nurses maintain some of the most continuous and sustained relationships with older adults and people living with chronic conditions, often across years of home visits, ward shifts, and care coordination. Through therapeutic communication, emotional support, promotion of autonomy, and relationship-based care, nursing practice can substantially influence how patients experience dignity in everyday encounters. Evaluations of structured interventions such as the Dignity Care Pathway for community nurses suggest that dignity-focused practice can be operationalised and assessed. Incorporating dignity into nursing outcomes research, Righi argues, would open new opportunities to evaluate interventions, organisational models, and care pathways aimed at improving person-centred care—turning a value that currently depends on individual professional commitment into a systematic organisational priority.

Recent scholarship has broadened the concept further, linking dignity to human rights, participation, social inclusion, relational care, and epistemic justice. These perspectives suggest that dignity is not simply about treating people politely; it involves recognising patients as persons whose values, preferences, identities, and goals remain central throughout the course of illness. This framing matters for ageing societies in particular. Dignity, the article stresses, is relevant not only in the context of frailty or care dependency but as a fundamental dimension of the ageing process itself, influencing how individuals experience autonomy, identity, participation, and social inclusion throughout later life. Recognising dignity in ageing means acknowledging older persons not merely as recipients of care but as individuals whose life projects remain meaningful across the entire life course.

The structural challenge, however, is that dignity preservation currently depends more on the goodwill of individual professionals than on systems designed to support it. Across Europe, substantial differences remain in how health and social care services are organised and integrated, and fragmentation between acute care, community services, and long-term care continues to be a major challenge in many countries despite a shared rhetorical commitment to person-centred care. When care pathways fracture, dignity erodes in the gaps between services—no single provider feels responsible, and no dashboard records the damage. Righi’s central question cuts to the heart of this paradox: if dignity is widely recognised as a fundamental goal of healthcare, why is it so rarely measured as an outcome? The answer, he suggests, lies less in technical difficulty than in the absence of accountability structures that would make dignity visible to managers, commissioners, and clinicians alike.

The next step, the article concludes, is to transform dignity from a universally endorsed principle into a measurable and actionable outcome. Within Value-Based Healthcare, dignity offers a rare opportunity to connect ethical values, patient experience, and quantifiable results in a single framework, bridging the gap between rhetorical commitments to person-centred care and meaningful accountability for what truly matters to patients. Adding dignity to outcome assessment would not merely create another indicator; it would make visible one of the most fundamental purposes of care itself—recognising individuals as persons whose values, identities, preferences, and goals remain central despite illness, dependency, and vulnerability. For ageing European societies, and for health systems everywhere confronting the chronic disease era, the argument lands with force: only by integrating dignity into routine measurement can healthcare move closer to care that combines clinical effectiveness, sustainability, and genuine respect for the human dimension of growing old and living ill.

Subject of Research: Measuring dignity as a patient-reported outcome in chronic illness, ageing, and long-term care

Article Title: The missing metric: Why dignity must be measured in chronic illness and long-term care

Article References: Righi, L. (2026). The missing metric: Why dignity must be measured in chronic illness and long-term care. PLOS Aging and Health, 1(1), e0000022. https://doi.org/10.1371/journal.page.0000022

Image Credits: AI Generated

DOI: 10.1371/journal.page.0000022

Keywords: dignity, patient-reported outcomes, chronic illness, long-term care, ageing, person-centred care, nursing outcomes, Patient Dignity Inventory, Value-Based Healthcare, PROMs, healthcare quality, palliative care

The two frameworks at the heart of the study are related but distinct. Successful aging, a concept with deep roots in gerontological research, emphasizes physical health, the avoidance of disease and disability, and the maintenance of high cognitive and physical function. Active aging, a broader model promoted heavily in European policy circles, extends the picture to include social participation, security, and continued engagement with life. The researchers set out to determine how health literacy, often described as a vital tool for achieving good outcomes in later life, relates to both paradigms simultaneously, and to identify which factors are associated with higher levels of active aging in a real-world community setting.

The study was designed as a descriptive and cross-sectional survey, conducted between October 2024 and May 2025 at the Metropolitan Municipality’s Active Aging Service Center in Antalya. Participants were 306 adults aged 65 and over, with an average age of 67.79 years and a standard deviation of 3.56. The sample was predominantly female, with women making up 79.4 percent of participants, and highly educated, as 70.6 percent were university graduates. Data were collected through a demographic information form and three validated instruments: the Active Ageing Scale, the Successful Ageing Scale, and the Turkish Health Literacy Scale.

The statistical toolkit was conventional but comprehensive. Descriptive statistics summarized the sample, independent samples t-tests and Chi-square tests explored group differences, Pearson correlation analysis quantified the relationships between the three main constructs, and multiple linear regression identified the independent predictors of active aging. This combination allowed the team to move beyond simple associations and estimate how much each factor contributed to active aging when all others were held constant.

The portrait that emerged of the participants was one of a relatively health-engaged group of older adults. A majority, 66.0 percent, reported living with a chronic illness, and 64.7 percent took medication regularly, reflecting the disease burden typical of this age group. Yet the same participants reported high levels of protective behavior: 58.5 percent engaged in regular physical exercise and an impressive 80.7 percent engaged in regular mental activities. The mean total score on the Active Ageing Scale was 190.10 with a standard deviation of 39.37, the Successful Ageing Scale mean was 57.74 with a standard deviation of 7.61, and the Health Literacy Index mean was 32.97 with a standard deviation of 9.53.

The bivariate analyses revealed a consistent pattern. Higher levels of education and income were significantly associated with better health literacy and better aging outcomes, as were regular physical exercise and regular mental activity, with all of these associations reaching statistical significance at the p < 0.05 level. More striking still, the researchers found positive correlations among active aging, successful aging, and health literacy that were significant at the p < 0.01 level. In other words, older adults who understood health information better tended to score higher on both aging frameworks, and the two frameworks themselves rose and fell together, supporting the idea that they capture complementary dimensions of a single underlying phenomenon.

The regression analysis provided the study’s headline result. The full model statistically significantly predicted active aging and explained 56.4 percent of the total variance, a substantial proportion for research in this field, with an R² of 0.564 and p < 0.05. Within that model, three variables stood out as significant predictors: age, mental activity, and health literacy. Perhaps the most intriguing finding was what fell away. Education and regular physical exercise, both strongly associated with aging outcomes in the bivariate analyses, were no longer significant once health literacy and the other variables were accounted for. This suggests that health literacy may sit on the causal pathway through which education and exercise exert their influence, or at least that it captures something those measures miss.

Why would the ability to navigate health information matter so much for how people age? The technical literature offers several plausible mechanisms. Older adults with stronger health literacy are better equipped to understand medication instructions, interpret symptoms, evaluate prevention advice, and communicate with health professionals, which supports the disease management that successful aging demands. The same skills may also underpin the confidence and autonomy that fuel social participation, a core component of active aging. Conversely, limited health literacy can create a cascade of misunderstanding, poor adherence, and disengagement that erodes both physical health and social connection over time. The Antalya findings cannot prove causation, since the design was cross-sectional, but the strength and consistency of the correlations, together with the regression results, make health literacy a compelling target for intervention.

The study also carries a pointed message for the institutions that serve older adults. The authors conclude that health literacy is a key factor of active and successful aging, and that older adult care centers should prioritize health literacy if they want to promote active aging. That recommendation is notable because active aging service centers are precisely the kind of community infrastructure where health literacy can be built: through accessible health education, plain-language communication, and programs that teach older adults how to evaluate and apply health information in daily life. The Antalya center’s own participants, with their high rates of mental and physical activity, illustrate the kind of engaged population such centers can cultivate.

The researchers were transparent about the study’s boundaries. The perspectives of individuals registered with the Active Aging Service Center who have lived experience were sought during the analysis and validation of the research data, helping interpret the findings from a real-world perspective, though there was no direct patient or public involvement in the study’s initial design, conduct, or writing. The sample, drawn from a single municipal center in a city where most participants were university-educated women, may not represent the broader older population, and the cross-sectional design means the direction of the relationships cannot be established with certainty. Ethics approval was obtained from the Akdeniz University Clinical Research Ethics Committee, and all participants provided verbal and written informed consent. The study received no external funding, and the authors declare no competing interests. Even with those caveats, the core result stands out: in a statistical model explaining more than half of the variance in active aging, health literacy was among the significant predictors, while more commonly cited advantages like education lost their edge. As populations across the world age at unprecedented speed, the study suggests that one of the most powerful investments societies can make in their older members is not more medical care but better health understanding, delivered in the community spaces where aging actually happens.

Subject of Research: The relationship between health literacy and active and successful aging among older adults attending an active aging service center

Article Title: The relationship between health literacy and active and successful aging: a cross-sectional study of active aging service center

Article References: Akdeniz, Ş., & Wolf-Ostermann, K. (2026). The relationship between health literacy and active and successful aging: a cross-sectional study of active aging service center. BMC Geriatrics, 26(1), Article 1232. https://doi.org/10.1186/s12877-026-08341-6

Image Credits: AI Generated

DOI: 10.1186/s12877-026-08341-6

Keywords: health literacy, active aging, successful aging, older adults, geriatrics, gerontology, public health, cross-sectional study, health education, social participation, chronic illness, healthy aging

The research team, led by investigators affiliated with Beirut Arab University, recruited 299 adults with confirmed heart failure from outpatient clinics and primary healthcare services across all major regions of Lebanon between January 2024 and October 2025. Participants were Arabic-speaking adults aged 30 to 80 years with either reduced ejection fraction of 40 percent or less, or symptomatic preserved ejection fraction confirmed by echocardiography, diagnosed for at least three months according to the Framingham criteria. Of 475 people initially screened, some were excluded because their understanding of the term heart failure was distorted, a striking detail in itself: many patients who had undergone open-heart surgery misinterpreted the diagnosis, underlining how much work remains in patient education. After removing cases with missing data, 299 participants formed the analytical sample.

The burden carried by this group was considerable. More than 90 percent had hypertension, roughly 60 percent had diabetes, and the average Charlson Comorbidity Index was 5.58, indicating substantial multimorbidity. Depression had been formally diagnosed in 35.5 percent of participants. The mean left ventricular ejection fraction was 37.52 percent, nearly half the sample was in New York Heart Association functional class III, and participants had lived with heart failure for an average of 5.3 years. Most were unemployed, nearly half reported a monthly household income between 200 and 500 US dollars, and almost all relied on a family caregiver, most often a spouse or an adult child. These socioeconomic realities matter, because in Lebanon out-of-pocket medication costs and repeated hospital admissions place enormous financial pressure on households already battered by currency collapse and inflation.

To measure the study’s central construct, the researchers used the Connor-Davidson Resilience Scale, a 25-item instrument covering domains such as personal competence, trust in one’s instincts, positive acceptance of change, control, and spiritual influences, scored from 0 to 100. In this Lebanese sample the scale showed exceptional internal consistency, with a Cronbach’s alpha of 0.965. Quality of life was assessed with the Arabic-validated Minnesota Living with Heart Failure Questionnaire, depressive symptoms with the Patient Health Questionnaire-9, and self-care with the Revised Self-Care Heart Failure Index version 7.2, which captures self-care maintenance, symptom monitoring, and self-care management as distinct subscales. All instruments had been previously translated and psychometrically evaluated for the Lebanese population, and reliability coefficients in the current study ranged from 0.86 to 0.965.

The headline result was a picture of a population split almost exactly in two. The mean resilience score was 58.41, just above the developer’s suggested cut-off of 55, and 51.2 percent of participants were classified as resilient while 48.8 percent were not. Depressive symptoms averaged 13.76 on the PHQ-9, corresponding to moderate depression, with more than half of the sample falling into the moderate to severe categories. Self-care maintenance and monitoring scores were low at 62.68 and 64.71, below the conventional adequacy threshold of 70, but self-care management scored 78.24, the only subscale to surpass the cut-off. Quality of life, at 56.07 on the Minnesota questionnaire, reflected moderate impairment. Statistically, resilience correlated negatively with depression and positively with all three self-care subscales, with the strongest correlation, r = 0.540, linking resilience to self-care maintenance.

The multivariable regression model identified four independent predictors of resilience, explaining 36.1 percent of the variance in resilience scores. Higher self-care maintenance and higher self-care management each independently predicted greater resilience, with unstandardized coefficients of 0.248 and 0.282 respectively. Male participants scored higher than female participants after adjustment, a gender difference of just over four points on the CD-RISC. Perhaps most intriguingly, participants taking loop diuretics showed resilience scores more than eight points higher than those not taking this class of medication, a finding that likely reflects the association between being on guideline-directed therapy and being engaged with care rather than a pharmacological effect on psychological coping. Bivariate analyses added further texture: resilient patients were more likely to have received influenza and COVID-19 vaccinations, to be current with medical follow-up, to have higher education, and to be cared for by a spouse rather than a child.

One of the most provocative findings is the negative, though statistically non-significant, correlation between resilience and quality of life, which runs counter to virtually all of the published literature, including studies from Egypt, Iraq, and general populations worldwide. The authors argue that no prior research has examined a population exposed to the compounded burden of simultaneous health, political, social, and economic crises as Lebanon has experienced since 2019, encompassing currency devaluation, hyperinflation, the Beirut Port explosion, and continuing regional instability. In such a context, the usual relationship between adaptation and wellbeing may be distorted: patients who have been forced into self-reliance by a failing system may report functional resilience even as their perceived quality of life erodes. The team also notes that quality-of-life scores among Lebanese heart failure patients nearly doubled between 2018 and 2022 before stabilising, a trajectory that mirrors the country’s crisis timeline.

The self-care management result tells a parallel story. In earlier Lebanese studies, self-care management was consistently the weakest subscale, with mean scores around 47. In the present sample it exceeded 78, suggesting a growing culture of self-reliance in disease management driven by necessity, as patients navigate medication shortages, costly follow-up visits, and disrupted continuity of care. This shift occurred despite previously documented deficiencies in discharge education. For nursing science, the implication is that resilience is not a fixed trait but a modifiable domain that can be assessed, monitored, and supported through education, counselling, family-inclusive care planning, and community-based follow-up, particularly in resource-constrained settings where nurses and advanced practice nurses are often the most accessible point of contact.

The authors are careful to acknowledge the limitations of a cross-sectional design, which cannot establish causal direction between resilience and self-care, along with the possibility of social desirability bias in self-reported questionnaires and the constraints of convenience sampling. Even so, the study stands as the first to document resilience and its predictors among heart failure patients living through sustained national collapse, and its patterns may generalise to Lebanese diaspora communities and to other populations enduring protracted instability. The practical message for clinicians is concrete: screening for low resilience, reinforcing self-care maintenance behaviours, supporting female patients who carry lower resilience scores, ensuring guideline-directed medication including diuretic therapy, leveraging spousal caregivers, and promoting vaccination and regular follow-up may together form the scaffolding that keeps chronically ill patients upright when the systems meant to support them cannot.

Subject of Research: Predictors of psychological resilience among patients living with heart failure during prolonged sociopolitical and economic crises in Lebanon

Article Title: Predictors of Resilience Among Patients Living With Heart Failure Amid Escalating Sociopolitical Challenges: A Cross‐Sectional Approach

Article References: Deek, H., Massouh, A. R., & Shatila, W. (2026). Predictors of Resilience Among Patients Living With Heart Failure Amid Escalating Sociopolitical Challenges: A Cross‐Sectional Approach. Nursing Open, 13(9), Article e70816. https://doi.org/10.1002/nop2.70816

Image Credits: AI Generated

DOI: 10.1002/nop2.70816

Keywords: heart failure, resilience, self-care, Lebanon, depression, quality of life, nursing, cross-sectional study, Connor-Davidson Resilience Scale, chronic illness, sociopolitical crisis, cardiology

The World Health Organization’s definition of health as a state of complete physical, mental, and social well-being has driven decades of frameworks built around the social determinants of health. Income, education, housing, and employment all feature prominently in these models. Time, however, remains largely absent, treated instead as a technical parameter within epidemiology. It appears in calculations of disability-adjusted life years, in critical periods of vulnerability, or as an implicit resource that people need to exercise, eat well, attend appointments, and maintain relationships. But this framing assumes everyone has roughly comparable access to time, an assumption the new paper argues is demonstrably false.

Sociology offers a richer picture. Time is not only measured by clocks and calendars but lived as duration, pace, and anticipation, all shaped by economic relations and the finite span of human life. Critically, perceptions of time are tied to identity and a person’s sense of control over their own existence. When people report lacking time, they are not simply reporting an insufficient number of hours; they are describing how their time is structured, valued, and constrained by forces beyond their individual choosing. Reframing time this way transforms it from a methodological convenience into a structural exposure—one that can be measured, modeled, and, in principle, changed through policy.

The paper identifies two interrelated dimensions through which time operates on health: availability and intensity. Availability refers to the absolute quantity of discretionary time a person commands. Intensity captures the lived experience of rushing, acceleration, and constant pressure. In many market-driven societies, emphases on productivity have accelerated daily rhythms at work and at home, intensified by technological change, urbanization, and flexible labor markets that blur the boundary between employment and the rest of life. The result is what researchers describe as boundaryless work—employment that seeps into evenings, weekends, and mental space—alongside the persistent devaluation of unpaid care.

Within labor markets, temporal pressure is organized through two dimensions of working time: control and variability. Working time control describes how much autonomy employees have over when, where, and how they work, which shapes their capacity to protect time for rest, care, and other non-market activities. Working time variability captures how much hours fluctuate, reflecting the predictability of daily rhythms. Evidence from across Europe shows that higher variability, especially when combined with low control, is associated with worse self-rated health, more psychosomatic complaints, and more frequent sleep problems. Meanwhile, indicators such as discretionary time, subjective time scarcity, time poverty, and time excess appear to mediate the well-documented association between socioeconomic status and health—and the health consequences of time poverty differ sharply between high- and low-income groups.

The burdens are not distributed equally. People working multiple jobs, and those combining paid employment with caregiving, face severe constraints on both the amount and the intensity of their time. Women are overrepresented in these situations and globally spend on average 2.8 more hours per day than men on unpaid care and domestic work. Because women, particularly those with lower incomes, perform the largest share of unpaid domestic and care labor, inequalities in time constitute a key mechanism through which social and gender disparities in health are reproduced. Migration, armed conflict, and economic instability deepen these patterns further, as uncertainty and chronic temporal strain become defining features of everyday life.

The relationship between time and health is also bidirectional, creating cycles that entrench disadvantage. Time constraints limit engagement in health-promoting behaviors such as physical activity or preparing nutritious meals, while fostering fatigue, negative mood, and stress-related physiological responses. Conversely, living with illness or disability reshapes how people can use and control their time, restricting participation in paid work, caregiving, and social life. Research on treatment burden shows that managing chronic illness entails substantial unpaid labor—information seeking, medication management, appointments, self-monitoring, lifestyle changes, financial tasks, and navigating health systems. These burdens are socially patterned too: most treatment burden measures were developed in high-income settings and may fail to reflect the experiences of people with lower health literacy or greater socioeconomic constraints. The result is a self-reinforcing loop in which poor health consumes time, and scarce time worsens health.

Healthcare systems themselves are built on temporal assumptions that often fail patients. Care is organized around clock time, standardized schedules, and linear treatment trajectories that rarely match the lived temporalities of chronic illness, disability, or long-term care. Patients juggling paid work and caregiving, or living with limited material resources, must navigate overlapping temporal scales and trade present time for uncertain future benefits. The misalignment disproportionately harms the socially disadvantaged. One promising response is coordinated care that aligns multiple appointments or services within a single visit, reducing the time costs of fragmented care—a model with demonstrated potential for patients with multimorbidity.

Making time visible in epidemiology has direct methodological consequences. Conventional models that treat time as neutral or exogenous obscure how temporal scarcity, acceleration, and uncertainty function as socially patterned exposures, and may systematically misattribute responsibility to individual behavior in ways that reproduce inequity. Existing infrastructures already make measurement feasible: the Harmonised European Time Use Surveys and the Multinational Time Use Study provide harmonised 24-hour diary data on paid work, unpaid care, personal care including sleep, travel, and leisure, alongside sociodemographic information. Incorporating these temporal dimensions into study design would allow research to better reflect lived experience across social groups and countries.

At the level of primordial prevention, the paper calls for engagement through public health diplomacy—advocating health in all policies beyond the health sector. That includes social protection systems that buffer economic uncertainty, labor policies regulating working hours and job security, housing policies shaping residential stability and commuting time, and transport infrastructure that reduces time poverty. Family-related policies such as paid parental leave, accessible childcare, and elder care support can ease the temporal pressures on working-age adults caring across generations. The ultimate claim is ambitious but straightforward: ensuring that people have the temporal conditions necessary to exercise choice, participate in society, and live healthy lives is not a luxury but a prerequisite for health equity, and reclaiming time as a determinant of health is fundamental to advancing population well-being.

Subject of Research: Time as a socially structured determinant of health and health equity

Article Title: Reclaiming time as a fundamental determinant of health equity

Article References: Valente, B. (2026). Reclaiming time as a fundamental determinant of health equity. SSM – Population Health, 35, Article 101939. https://doi.org/10.1016/j.ssmph.2026.101939

Image Credits: AI Generated

DOI: 10.1016/j.ssmph.2026.101939

Keywords: health equity, social determinants of health, time poverty, working time, unpaid care work, gender inequality, treatment burden, chronic illness, public health policy, epidemiology, time use surveys, social acceleration

The study, carried out by Ikechukwu Frank Ogbonna of the Department of Pediatrics at the Federal Medical Centre, Umuahia, in Abia State, set out to answer a deceptively simple question: does the effect of worsening asthma severity on a child’s mental health depend on how well the asthma is controlled? Clinical guidelines, including those of the Global Initiative for Asthma, treat severity and control as related but distinct dimensions of the disease. Severity reflects the intrinsic intensity of the condition, while control describes how well symptoms and exacerbations are managed over time. The researchers hypothesized that these two dimensions might interact, jointly amplifying psychological risk in ways that neither alone could fully explain.

To test that hypothesis, the team conducted a cross-sectional analytical survey involving 101 children with asthma aged between 6 and 17 years, recruited from the hospital’s pediatric asthma clinic, alongside 101 age- and sex-matched controls drawn from the surrounding community. Matching the comparison group by age and sex was a deliberate methodological choice, since both variables are known to influence mental health scores in childhood and could otherwise confound the analysis. Mental health status in both groups was assessed using the Strengths and Difficulties Questionnaire, a widely validated screening instrument that generates a total difficulty score across emotional, conduct, hyperactivity, peer-relationship and prosocial domains.

Among the children with asthma, disease severity was classified using the Asthma Severity Scale, while the degree of symptom control was measured with the Asthma Control Test, a patient-reported instrument that captures daytime symptoms, nighttime awakenings, activity limitation and rescue medication use. The study’s central hypothesis was tested at a significance threshold of P less than 0.05, and the interaction between severity and control was examined using a multivariate logistic regression model, a statistical technique that allows researchers to estimate the independent contribution of each factor while holding the other constant.

The first and most striking result was that children with asthma scored significantly worse on mental health screening than their peers. The median total difficulty score of the asthma group was significantly higher than that of the matched controls, with a P value of 0.001. In practical terms, this means that even before any analysis of severity or control, the children attending the asthma clinic were already carrying a measurably heavier psychological burden than children of the same age and sex without the disease—a pattern consistent with a growing international literature linking chronic childhood illness to emotional and behavioral difficulties.

When the researchers turned to the interaction question, however, the answer was negative. There were no significant interaction effects of asthma severity and control on the mental health of the children with asthma. In the adjusted model, the relationship between mental health problems and asthma severity did not reach statistical significance, yielding an adjusted odds ratio of 8.13 with a 95 percent confidence interval of 0.85 to 101.17 and a P value of 0.10. The very wide confidence interval reflects the limited precision of the estimate in a sample of this size, but the key point is that severity, on its own, could not be shown to independently predict psychological difficulty once other factors were accounted for.

Asthma control told a different story. In the same adjusted model, only asthma control showed a significant effect on mental health: children with poorly controlled asthma had higher odds of developing mental health problems, with an adjusted odds ratio of 4.08, a 95 percent confidence interval of 1.03 to 16.13, and a P value of 0.04. In other words, a child whose asthma was poorly controlled faced roughly four times the odds of screening positive for psychological difficulties compared with a child whose disease was brought under command—regardless of how severe the underlying condition was classified to be.

The authors conclude that there is no interaction effect of asthma severity and control on the mental health of children with asthma, because mental health problems were associated only with poor asthma control, irrespective of severity. This distinction matters clinically. Severity is largely a fixed characteristic of the disease, determined by the intensity of the underlying inflammation and airway physiology, whereas control is the modifiable outcome of treatment adherence, inhaler technique, trigger avoidance and follow-up care. If poor control is the psychological culprit, then improving day-to-day asthma management may offer a direct route to protecting children’s mental health, even for those whose disease is intrinsically mild.

The practical recommendation that flows from the study is the integration of child mental health services into existing asthma management programs. In many low- and middle-income countries, including Nigeria, pediatric asthma clinics focus almost exclusively on respiratory outcomes—symptom scores, peak expiratory flow readings and exacerbation rates—while psychological screening is rarely performed. The findings from Umuahia suggest that this narrow focus may miss a substantial share of the disease burden. A child whose inhaler technique is poor and whose symptoms persist at night is not only at risk of a physical exacerbation; the same child is also at markedly elevated risk of emotional and behavioral problems that can undermine schooling, friendships and family life.

The study also carries lessons for research design. By recruiting matched controls and using validated instruments on both the respiratory and psychological sides, the work demonstrates that rigorous psychosocial measurement is feasible in a tertiary hospital setting in South-Eastern Nigeria, where such data have historically been scarce. The single-author design, funded entirely by the researcher’s personal contribution, underscores both the resourcefulness and the resource constraints of clinical research in the region. The study was approved by the Institutional Review Board and Health Research Ethics Committee of the Federal Medical Centre, Umuahia, in June 2021, with informed consent obtained from caregivers and assent from children aged eight and above, in line with the ethical principles of the Declaration of Helsinki.

For clinicians and policymakers, the message is straightforward but consequential. Screening for mental health problems should become a routine component of pediatric asthma follow-up, and interventions that improve asthma control—better adherence support, patient and caregiver education, and reliable access to controller medications—should be recognized as having potential psychological as well as respiratory benefits. Conversely, the finding that severity alone did not significantly predict mental health outcomes cautions against assuming that only children with severe disease need psychological attention. A child with mild asthma that is badly controlled may be more psychologically vulnerable than a child with severe asthma that is well managed. As childhood asthma continues to affect millions of families across Africa and beyond, studies like this one help redirect attention from what a disease is to how well it is lived with—and that shift, the evidence now suggests, could shape not only children’s lungs but their minds.

Subject of Research: The interaction of asthma severity and control on the mental health of children with asthma in South-Eastern Nigeria.

Article Title: Interaction effects of asthma severity and control on the mental health of children with asthma: findings from a South-Eastern Nigeria Tertiary Hospital

Article References: Ogbonna, I. F. (2026). Interaction effects of asthma severity and control on the mental health of children with asthma: findings from a South-Eastern Nigeria Tertiary Hospital. BMC Pediatrics. https://doi.org/10.1186/s12887-026-07670-0

Image Credits: AI Generated

DOI: 10.1186/s12887-026-07670-0

Keywords: asthma, asthma control, asthma severity, mental health, children, pediatrics, Nigeria, Strengths and Difficulties Questionnaire, Asthma Control Test, child health, chronic illness, BMC Pediatrics