Abstract: Background/Objectives: The diagnosis of a rare disease, such as Sturge-Weber syndrome, in a newborn has a profound emotional impact on parents and presents a significant challenge, as they must face an unexpected and unfamiliar reality. The aim of this study was to analyze the meaning of caregiving among parents of children with Sturge-Weber Syndrome, identifying the different coping styles they adopt. Methods: A cross-sectional descriptive study was conducted with 28 parents of children with Sturge-Weber Syndrome in Spain. Data were collected using the Brief COPE inventory and the Finding Meaning Through Caregiving Scale (FMTCS). Results: Responses from 28 participants were analyzed, revealing that parents experienced a sense of fulfillment in providing meaning to the care of their children, coping with the diagnosis, and assessing their child’s development. A higher sense of care was observed in families where both parents cohabited. Additionally, as the affected descendant grew older, the perceived sense of care increased. Conclusions: The most frequently used coping strategies among parents were active coping and acceptance of the disease, regardless of sociodemographic characteristics. As parents aged, they began to adopt additional strategies such as emotional venting, positive reframing, or humor.

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Background/Objectives: Nurses play a key role in supporting patient adherence to biosimilars, a responsibility that depends on their knowledge and understanding of biological therapies. This study aimed to assess nurses’ knowledge and attitudes toward biosimilars in Spain and to examine the demographic and professional factors that shape them. Methods: A self‑administered, web‑based survey was distributed in Spain between May and June 2024 to evaluate registered nurses’ knowledge and attitudes toward biosimilars. Associations were explored using Spearman’s correlation and Fisher’s exact tests, and predictors were examined through ordinal regression models. Results: A total of 402 nurses responded. 63.7% reported at least basic knowledge of biosimilars. Access to industry‑led training was strongly associated with higher knowledge levels (OR = 11.256; p < .001), whereas lack of awareness of biosimilar use in the workplace was associated with lower knowledge (OR = 0.176; p < .001). Nurses’ confidence in the safety and efficacy of biosimilars increased with knowledge level—from basic (OR = 3.823; p < .001) to intermediate (OR = 4.747; p < .001) and advanced (OR = 14.594; p < .001). Confidence was also greater among nurses working with biosimilars in their units (OR = 3.959; p = .004) and those in hospital ambulatory care services (OR = 2.506; p = .022). Conclusions: Nurses in Spain predominantly demonstrate basic knowledge of biosimilars, emphasizing the need for broader access to training. industry‑led courses emerged as the most relevant modifiable factor for improving both knowledge and confidence. Strengthening collaboration with the pharmaceutical industry may support informed clinical practice and improve patient adherence to biosimilar therapy.

Abstract: Abstract Background: Nurses’ perception of nursing care quality is related to their impression of the quality of care they deliver. There is a paucity of information about nurses’ perceptions of nursing care quality. Therefore, this study aimed to assess nurses’ perception of nursing care quality and associated factors in Jimma Town public hospitals, Southwest, Ethiopia, 2023 Methods: A mixed study design was employed among nurses working in Jimma Town public hospitals. Data were collected using a self-administered questionnaire and a semi-structured interview by simple random and purposive sampling techniques. Data were analysed using SPSS for quantitative data and narrative analysis for qualitative data. Result: Of the total 364 nurses about 50.50% (95%CI, 45. 39, 55.71) of them perceived nursing care quality delivered to the patient as good. Work experience of >10 years (AOR=5.16, 95%CI (1.87, 14.24), having an educational level of BSc and above (AOR=4.04, 95%CI (1.65, 9.95), working in referral hospital, (AOR=4.13, 95% CI, (1.72, 9.89)), working in the favorable work environment (AOR=3.29, 95%CI (1.90, 5.66) and being satisfied on one’s job (AOR=2.20, 95%CI (1.30, 3.74) were statistically associated with nurses perception of nursing care quality. Conclusion and Recommendation: Nurses working in Jimma Town public hospitals split in half on their perception of the nursing care quality they render to the patients. Therefore, nurses, hospitals, and nurse managers have to work together to address factors affecting nurses’ perception of nursing care quality.

Abstract: Background/Objectives: The International Classification for Nursing Practice (ICNP®) is a standardized nursing terminology that enables the description of nursing care through diagnoses, interventions, and outcomes. An ICNP® Subset is a sub-group of ICNP® terms appropriate for settings of practice, facilitating the direct use of the ICNP® in nursing documentation. As far as we know, there are no Subsets concerning neonatology and Neonatal Intensive Care Unit (NICU) settings. The aim of this study is to develop a Subset of ICNP® NICU and neonatology setting, presenting terms that are validated and harmonized with SNOMED CT nomenclature. Methods: This is a two-phase study. In the first phase ICNP® terms were validated through a qualitative study using a four-round Delphi method and a focus group involving experts in NICU, neonatology settings, and education. The second phase focused on harmonizing the proposed ICNP® Subset with SNOMED CT. Results: A total of 479 ICNP® terms belonging to the Diagnosis/Outcome (DC) and Intervention (IC) axes were validated by the experts. Of these, 99.65% were found to be compatible with SNOMED CT. In addition, 97 new terms (30 Diagnoses/Outcomes and 67 Interventions) were validated and are currently awaiting approval by the International Council of Nurses. Of the newly proposed terms, 93.81% were compatible with SNOMED CT. Conclusions: The proposed Subset consists of 576 ICNP® terms, including 177 Diagnoses/Outcomes and 399 Interventions. Its implementation may support the adoption of electronic health records in neonatal and NICU settings and contribute to improving the quality and standardization of nursing care.

Abstract: Background: Pressure injuries (PIs) in surgical settings is a major patient safety concern, contributing to increased morbidity, prolonged hospitalization, and greater healthcare costs. Prolonged immobility, anesthesia, surgical positioning, and device-related pressure place perioperative patients at particularly high risk. This mini review synthesizes contemporary literature on PIs prevention and risk assessment in perioperative environments, with emphasis on the use of specialized tools, particularly the Munro Scale and evidence-based strategies such as optimized support surfaces, positioning, moisture management, and early skin assessment. Comparative findings indicate that the Munro Scale offers superior predictive accuracy for surgical patients compared with the widely used Braden Scale. The review also highlights persistent challenges, including limited implementation, lack of standardization, and insufficient knowledge among perioperative staff. A multidisciplinary, proactive, and individualized approach is essential to effective PI prevention, while future work should prioritize EHR-integrated risk tools, enhanced staff training, and broader adoption of periopera-tive prevention bundles.

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Background/Objectives: Despite extensive research on nurses' knowledge and attitudes toward pain management globally, limited evidence exists regarding the actual implementation of multimodal pain management practices among Vietnamese nurses. This study aimed to (1) assess nurses' implementation of pharmacological and non-pharmacological pain management interventions, (2) examine the relationships among knowledge, attitude, and practice (KAP), and (3) identify predictors of competent practice with attention to the relative contributions of formal training versus clinical experience. Methods: A cross-sectional survey was conducted among 230 nurses from two tertiary public hospitals in Ho Chi Minh City, Vietnam, between April and June 2024. Pain management knowledge, attitudes, and practices were assessed using validated instruments. Independent samples t-tests compared trained versus untrained nurses. Multiple linear regression identified predictors of practice competency. Effect sizes (Cohen's d) quantified the magnitude of training effects. Results: Nurses demonstrated moderate-to-good competency, with pharmacological interventions (M = 3.74) implemented more consistently than non-pharmacological interventions (M = 3.48, p < 0.001). Trained nurses significantly outperformed untrained nurses across all domains with large effect sizes (Cohen's d = 1.34–1.54). A clear hierarchy emerged in non-pharmacological practice: environmental (M = 4.01) > physical (M = 3.69) > cognitive-behavioral (M = 3.27) > spiritual (M = 2.60). Strong KAP correlations were observed (r = 0.70–0.85, p < 0.001). Prior training was the strongest predictor of both pharmacological (β = 1.31, p < 0.001) and non-pharmacological practice (β = 0.58, p < 0.001), while clinical experience showed no significant effect (p > 0.40). Conclusions: This study provides novel evidence that formal training—not clinical experience—drives competent pain management practice among Vietnamese nurses, with large effect sizes demonstrating practical significance. The strong KAP relationships support targeted educational interventions addressing knowledge gaps to improve practice. These findings have direct implications for nursing education policy in Vietnam and similar healthcare settings.

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Background: Patient safety is a top priority for healthcare organization leadership worldwide, as approximately one in ten patients experiences an adverse event, and nurses often report that the quality of the care they deliver is poor. Objectives: The present study aim was to examine the impact of work gaslighting on perceived quality of care, patient safety and quiet quitting on nursing staff. Methods: A cross-sectional study was conducted in Greece and data were collected using an online survey during October to November 2025, with 492 nurses. We used the Gaslighting at Work Scale (GWS) and the Quiet Quitting Scale to measure workplace gaslighting and quiet quitting. Perceived quality of care and perceived patient safety were measured with single items, representing the overall assessments in nurses’ unit. Results: Nurses reported low to moderate levels of workplace gaslighting and quiet quitting, as well as almost half of the participants (52.0%, n=256) evaluated the quality of care in their unit as good, and 33.1% (n=163) of nurses perceived patient safety as good. In the univariate comparisons, greater workplace gaslighting was significantly associated with lower odds of reporting perceived quality of care to be good or excellent (OR = 0.650, 95% CI: 0.527–0.803; p < 0.001). This association was still statistically significant in the multivariable model after gender, years of work experience, working in shifts and working in an understaffed department were included (adjusted OR = 0.655; 95% CI: 0.529–0.810; p < 0.001). Workplace gaslighting was also strongly related to perceived patient safety. In the univariate analysis increased workplace gaslighting was associated with decreased odds of good-to-excellent patient safety (OR = 0.553, 95% CI: 0.445–0.686, p < 0.001). This association remained after controlling for the potential confounders (adjusted OR = 0.561, 95% CI: 0.450–0.700, p < 0.001). In the multivariable model, workplace gaslighting was significantly and positively associated with quiet quitting (adjusted beta = 0.224, 95% CI = 0.163 to 0.285, p < 0.001) after adjusted for demographic and work-related characteristics. Conclusions: The present study is the first that highlighted the significant association between workplace gaslighting and the quality and safety of care, as well as nurses’ quiet quitting. A zero-tolerance stance by senior leadership, coupled with the establishment of clear policies and procedures that encourage staff to report such behaviors, is essential to dismantle the barriers created by psychological manipulation.

Abstract: Background: Invisible or humanized care (High-Touch) is inherent to the nursing profession. Professionals with sensory processing sensitivity perceive and process more sensory information simultaneously and more deeply than usual, which may be more closely linked to invisible care. Objective: To analyze the influence of sensory processing sensitivity on nursing professionals' perception of invisible care. Method: A cross-sectional descriptive observational study. Seventy-nine professionals from a level III hospital completed an online form assessing various situations encountered by nursing staff in their daily practice related to the different dimensions of invisible care (Care-Q) and the sensory processing sensitivity temperament trait (HSPS). Results: Showed that 15% (12) of nursing professionals were highly sensitive. A statistically significant relationship was also found between the components of invisible care and the overall Care-Q score for professionals in general and for highly sensitive professionals. The invisible care component "maintains a trusting relationship" with the HSPS overall (ρ = 0.224), but no significant correlations were observed when professionals were identified as highly sensitive with scores ≥ 160 points with the different Care-Q components. Conclusion: The perception of invisible care is inherent to the nursing profession and is not strongly influenced by the SPS trait. Therefore, invisible care is an essential component of nursing practice.

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Background: HL and eHL are essential for future nurses. Their low levels in adults are linked to poorer outcomes and higher healthcare costs, emphasizing the need to assess these skills in nursing education. Aim: This study examined HL and eHL levels among nursing students across different years of a Bachelor of Nursing programme and identified subgroups of students. Methods: A cross-sectional study was conducted among students enrolled in all academic years. HL and eHL were assessed using the Health Literacy Questionnaire and the eHealth Literacy Scale (eHEALS). Descriptive statistics summarized participant characteristics and literacy levels. Differences across academic years were examined, and cluster analysis was performed to identify homogeneous student groups. Results: HL and eHL varied across the nursing curriculum. Four distinct clusters emerged: (1) older students, concurrently employed; (2) young, on-track second-year students; (3) students with prior university education; and (4) first-year students without an academic background. ANOVAs indicated significant differences in eight HL dimensions, with Cluster 2 consistently achieving the highest scores and Cluster 4 the lowest. Conclusions: HL and eHL among nursing students appear to be dynamic competencies shaped by sociodemographic and academic factors. Identifying student profiles supports the development of differentiated instructional strategies in nursing education. Although previous research has examined HL and eHL in nursing students, no study to date has defined these competencies in relation to the structure of the nursing curriculum or used cluster analysis to identify subgroups. This represents the main innovative contribution of the current study.

Abstract: Background/Objectives: Medical device–related pressure injury (MDRPI) is a significant patient safety issue associated with increased morbidity, prolonged hospitalization, and healthcare costs. Although evidence-based guidelines for MDRPI prevention exist, nurses’ prevention performance remains suboptimal, and the mechanisms linking workload to preventive practice remain insufficiently elucidated. Within a patient safety and quality improvement framework, this study aimed to examine whether occupational coping self-efficacy (OCSE) mediates the relationship between nurses’ workload and MDRPI prevention performance across the nursing practice continuum. Methods: This descriptive correlational study used a mediation model with data from 181 registered nurses working in intensive care units, general wards, and integrated nursing care wards in South Korea. Workload, occupational coping self-efficacy, and MDRPI prevention performance were measured using validated instruments. Mediation was tested using hierarchical regression and bootstrapped analysis (PROCESS macro Model 4, 5,000 resamples), controlling for demographic and work-related variables. Results: Workload was negatively associated with occupational coping self-efficacy (β = −.392, p < .001) and MDRPI prevention performance (β = −.229, p < .001), whereas occupational coping self-efficacy was positively associated with prevention performance (β = .336, p < .001). When occupational coping self-efficacy was included in the model, the direct association between workload and prevention performance became non-significant (β = −.097, p = .201). Bootstrapping confirmed a significant indirect effect of workload on prevention performance through occupational coping self-efficacy (95% CI: −.006 to −.002). Conclusions: The association between nurses’ workload and MDRPI prevention performance appears to operate indirectly through occupational coping self-efficacy. These findings suggest that improving MDRPI prevention as a patient safety outcome requires more than workload-focused structural interventions. Strengthening nurses’ coping self-efficacy through organizational and educational strategies may enhance the sustainability of preventive nursing practices across the nursing practice continuum.

Abstract: Objectives: To summarize the best evidence regarding folic acid supplementation for preventing neural tube defects (NTDs) in women of childbearing age and to develop a structured evidence summary for guiding clinical practice. Methods: We systematically searched multiple databases and professional websites from January 1, 2013, to September 18, 2025. Sources included 7 databases (PubMed, Embase, CINAHL, Web of Science, CNKI, Wanfang, VIP) and 20 professional websites (e.g., Medlive, GIN, NICE, ACOG, UpToDate, Chinese Medical Knowledge Database, etc.). The search targeted clinical guidelines, expert consensuses, and recommended practices on folic acid supplementation for NTD prevention in women of childbearing age. The retrieved literature underwent quality assessment, evidence extraction, and summarization. Results: The review included 17 publications: 8 guidelines, 4 expert consensuses, and 5 recommended practices. From these, we synthesized 14 distinct evidence statements, organized into five thematic dimensions: risks of neural tube defects and the role of folic acid, time window of neural tube closure, timing and dosage of folic acid supplementation, relationship between dietary folic acid and folic acid tablets, and folic acid-related testing. Conclusions: his study synthesized the best available evidence regarding folic acid supplementation for preventing NTDs in women of childbearing age, providing an evidence-based foundation to inform clinical practice. Future implementation efforts should focus on integrating recommendations into electronic health systems, developing precision public health interventions, and employing visual aids for health education.

Abstract: Objectives: Intensive care units (ICUs) are characterised by high care complexity and nursing workload, which directly affects patient safety and staff sustainability. Latvia faces a chronic shortage of nurses, particularly in intensive care, yet systematic national data on nursing workload have been lacking. This study aimed to quantitatively assess nursing workload in Latvian ICUs using the Nursing Activities Score (NAS) and to evaluate its relationship with staffing adequacy. Methods: A prospective, multicentre observational study was conducted over six months (May–November 2025) in 14 Lat-vian ICUs representing all three levels of intensive care. Nursing workload was meas-ured using the NAS during each 12-hour shift. A total of 28,079 complete NAS obser-vations were analysed using descriptive statistics, inferential tests (t-tests, ANOVA), mixed-effects modelling, regression analysis, and time-series forecasting. Results: The mean NAS was 65.45 (SD = 25.76), equivalent to an average of 15.71 nursing care hours per patient per day. Workload remained similarly high during day and night shifts. Significant differences were observed between ICUs and care levels, with level 2 units showing the highest workload. The average nursing shortage rate was 42.6% and was strongly predicted by NAS values (R² = 0.115), whereas shift type and unit level had minimal explanatory power. Conclusions: ICU nursing workload in Latvia is persis-tently high and unevenly distributed across units. Staffing levels are not adequately adjusted to actual care demands. Integrating NAS-based workload monitoring into staffing models is essential for evidence-based workforce planning, improving patient safety, and reducing nurse overburdening.

Abstract: Introduction: Nursing educators and clinical leaders face persistent challenges in engaging the next generation of nurses, often characterized by short attention spans, frequent phone use, and underdeveloped communication skills. This article describes the design and delivery of a full-day interactive teaching workshop for nursing faculty, senior clinical nurses, and nurse leaders, developed using a design-thinking approach supported by generative AI. Methods: The workshop comprised three thematic sessions: (1) Learning styles across generations, (2) Interactive teaching methods, and (3) Application of interactive teaching strategies. Generative AI was used during planning to create icebreakers, discussion prompts, clinical teaching scenarios, and application templates. Design decisions emphasized low-tech, low-prep strategies suitable for spontaneous clinical teaching, thereby reducing barriers to adoption. Activities included emoji-card introductions, quick generational polls, color-paper reflections, portable whiteboard brainstorming, role plays, fishbowl discussions, gallery walks, and movement-based group exercises. Results: Analysis of 59 participant reflections revealed six interconnected themes, grouped into three categories: engagement and experiential learning, practical applicability and generational awareness, and facilitation, environment, and motivation. Participants emphasized the workshop’s lively pace and hands-on design, noting “It was impossible to fall asleep; we were always talking, sharing, writing, or moving.” Experiencing strategies firsthand built confidence for application, while generational awareness encouraged reflection on adapting methods for younger learners. The facilitator’s passion, personable approach, and structured use of peer learning created a psychologically safe and motivating climate, leaving participants recharged and inspired to integrate interactive methods. Discussion: The workshop illustrates how AI-assisted, design-thinking-driven professional development can model effective strategies for next-generation learners. When paired with skilled facilitation, AI-supported planning enhances engagement, fosters reflective practice, and promotes immediate transfer of interactive strategies into diverse teaching settings.

Abstract: Background: In healthcare, Electronic Medical Records (EMRs) offer centralized access to patient data and enable evidence-based clinical decision-making. and operational efficiency. However, they have introduced administrative burdens for the clinicians, potentially impacting job satisfaction and care quality. Despite the widespread EMR adoption in Saudi Arabia, the issue of time burden related to EMRs and the factors re-lated to it are underexplored. Objectives: To measure the average number of hours (per month and as percentage out of total monthly working hours) of EMR use among physicians and nurses, compare the mean monthly hours of EMR use between them, and identify the demographic predictors of extended hours of EMR use. Moreover, it aims to understand the perceived challenges and barriers of timely filling EMRs, and the impact of EMRs on quality of patient care. Methods: A sequential mixed-methods study was conducted at three Security Forces Hospitals in Riyadh, Dammam, and Makkah. Quantitively, a correlational cross-sectional design was used was employed with multistage stratified sampling using a validated 30-item questionnaire, and data were analyzed using differential and inferential statistics. The qualitative phase in-volved purposive sampling of ten clinicians and semi-structured interviews analyzed through thematic analysis. Results: A total of 503 professionals (162 physicians, 341 nurses) participated. Majority were females (67.2%), aged 30 to 40 years (44.9%), and non-Saudi (62%). Nurses reported significantly higher mean of EMR usage hours/day than physicians (5.43 versus 4.34 hours/day, p=0.001). Significant predictors of ex-tended EMR use include age 30-50 years, female gender, non-Saudi nationality, higher education, nursing profession, longer healthcare experience, 5-10 years EMR experi-ence, 10+ hours EMR training, and participants from Makkah. Qualitative analysis identified barriers such as infrastructure constraints, system performance and tech-nical issues, lack of IT support, and workflow and professional burden. Regarding EMR impact, they improved professional practice and patient safety, however, concerns were raised regarding adjustments in work routine Conclusion: EMR use carries con-siderable administrative burden, especially nurses when compared to physicians. Ad-dressing the identified barriers through targeted training, better system design, and improved workflows could boost efficiency and support high-quality patient care. The findings offer evidence-based insights to guide policy and system-level improvements.

Abstract: Background: Treatment nonadherence in oncology is prevalent and often assessed by surveys that miss the qualitative reasons underpinning nonadherence or treatment discordance. We aimed to synthesize evidence from Natural Language Processing (NLP) studies, primarily sentiment analysis of patient generated content (social media, forums, blogs, review platforms, and survey free text), to identify communication-related and relational factors linked to nonadherence/concordance. Methods: We conducted a scoping review following PRISMA-ScR. Searches of PubMed, CINAHL, and Scopus (2013 early 2024) targeted NLP studies of the cancer patient experience; conventional reports were included where they clarified communication/adherence constructs. Data were charted against source, cancer type, NLP technique, and inferred adherence/concordance factors, then synthesized using discourse analysis and narrative synthesis. Results: Four patient side themes consistently emerged: (1) unmet emotional needs; (2) suboptimal information and communication; (3) unclear treatment concordance within patient/person-centred care; and (4) online misinformation dynamics (and perceptions of clinician bias). Sentiment analysis detected fine grained emotions (fear, disgust, sadness, surprise), informational gaps and trust issues that are often less visible in structured surveys. Conclusions: Patient voice data offer actionable insights for nursing practice: routine distress screening, teach back strategies, misinformation countermeasures, and explicit concordance checks. Integrating these into person-centred workflows may improve adherence and shared decision making. Registration: Not registered.

Abstract: Background/Objectives: Delirium is frequent and serious in older adults attending the emergency department (ED), but evidence on its pharmacological management in this setting is limited. This study aimed to quantify the pharmacological treatment of de-lirium in older adults in the ED and examine its association with subsequent hospital admission. Methods: An observational cross-sectional study was conducted between November 2021 and June 2022 in a Spanish ED. The sample included 153 adults aged 65 years or older with clinician-diagnosed delirium. Clinical, triage, and medication data were obtained from electronic medical records, and associations with hospital admis-sion were analysed using multivariable logistic regression. Results: Ninety-one partic-ipants (59.5%) were hospitalised. Antipsychotic, analgesic, and benzodiazepine use was associated with increased risk of hospitalisation. Absence of an underlying cause was a protective factor. The logistic regression model was significant. Conclusions: Specific drug families were associated with a higher likelihood of hospital admission in older adults with delirium in the ED. These findings support safer and more individualised pharmacological approaches and highlight the need for studies evaluating targeted interventions.

Abstract: Background There is a high correlation between a trauma history and development of mental health conditions. By providing safe and containing (trauma-informed) working relationships, mental health nurses can validate mental distress, reduce re-traumatisation and support recovery. Trauma informed education (TIE) has become commonplace in nurse education however, little is known about students’ experience of this and its impact on their practice. Purpose This study aimed to evaluate and explore student mental health nurses’ perspectives on TIE and its impact on their practice to contribute to the knowledge and evidence base that informs nurse and broader healthcare education. Methods This qualitative, phenomenological study used focus group interviews (n=3) with 11 mental health nursing students, reported using SRQR Checklist. Analysis Data generated was analysed using Braun and Clarke’s (2013) Reflective Thematic Analysis. Findings Three themes were identified: 1. A compass for practice; 2. Mental Health Nursing: Between paradigms; 3. Supporting personal development and wellbeing. Integrating TIE within nurse education can support students to adopt the principles of trauma-informed care (TIC) personally and in their practice. Improved self-awareness, recognition of trauma and adopting self-care strategies were valuable in supporting personal resilience and wellbeing, valuable in managing the challenges of mental health practice. Recommendations TIE has the potential to have a positive impact on wellbeing therefore integration should be considered for all healthcare programmes. Further interprofessional research is needed to establish the longer-term impact of TIE as students’ progress into their professional career. Limitations This is an initial small-scale study with self-selecting students which limits generalisability. Exploring sustained impact through longitudinal study may be valuable.

Abstract: Background: University students are often exposed to environments that encourage unhealthy eating, but universities can promote better health and sustainability by making sustainable food options more accessible. Methods: Temporal changes in dietary patterns and environmental footprints of 1684 students at the University of Rijeka, Croatia, over a 16-year period (2009-2025) were retrospectively analyzed using data from three cross-sectional studies. Results: A significant transition toward less sustainable diets, increased consumption of animal-based foods, and proinflammatory eating habits was observed (both p< 0.001). Adherence to the Mediterranean and Planetary Health Diet declined over time (p< 0.001), followed by increased prevalence of overweight and obesity. Consumption of most food groups increased, leading to higher water and ecological footprints. Only the intake of fruits, vegetables, whole grains, and fish declined, which corresponded with reduced carbon footprints for these and a few other food groups, while the environmental impact of other foods significantly increased (all p < 0.001). Gender, diet quality, and a proinflammatory diet were significant predictors of dietary environmental footprints. Conclusion: The findings underscore the need for systemic changes and addressing barriers at the university level to support sustainable eating behaviors. The study offers valuable insights for policymakers, educators, and researchers who aim to help students become health-conscious and environmentally responsible consumers. Further research is needed to explore the broader factors influencing dietary choices and the long-term impact of future institutional interventions.

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Introduction: Community preparedness for earthquakes is a crucial aspect of disaster risk reduction (DRR). Spiritual factors are considered a component that influences how communities perceive risks, respond to threats, and recover after a disaster. Research Method: This study aims to analyze the role of community spiritual aspects in earthquake preparedness through a review of international and national literature published in 2010–2024. Result: The results of the study show that spirituality plays a role in shaping risk perception, increasing psychological coping abilities, strengthening social capital, expanding the function of religious institutions, and supporting the post-disaster recovery process. Conclusion: Integrating a spiritual approach into community-based DRR programs can be an effective strategy in strengthening the social and psychological resilience of communities living in earthquake-prone areas.

Abstract: Background/Objectives: Multiple sclerosis (MS) is a chronic neurological disease characterized by demyelination, inflammation, and autoimmunity, leading to progressive physical and psychological impairments. Anxiety and depression are among the most prevalent neuropsychiatric comorbidities in MS, significantly impacting patients’ quality of life (QoL). This study aimed to assess the evolution of anxiety and depression in individuals with relapsing-remitting multiple sclerosis (RRMS) over a six-month follow-up period, identify associated factors, and explore predictive variables. Methods: A prospective observational study was conducted with 35 RRMS patients diagnosed at the Lucus Augusti University Hospital between January 2023 and March 2025. Psychological symptoms were assessed at baseline, 3 months, and 6 months using Goldberg Anxiety and Depression Scale (GADS), the Beck Depression Inventory (BDI), and the Beck Anxiety Inventory (BAI). Data were analyzed using non-parametric and parametric tests to account for the small sample size and distribution of variables. Results: Anxiety and depression were prevalent and persistent in the study population, with no significant changes in mean scores over time (p &gt; 0.05). However, specific symptoms, such as pessimism and loss of pleasure, showed worsening trends, while sadness and guilt remained stable. Sociodemographic factors, including lower income and employment status, were significantly associated with higher anxiety and depression scores (p &lt; 0.05). Additionally, clinical factors such as autoimmune comorbidities and a history of mononucleosis were linked to higher depressive symptoms. Baseline anxiety and depression scores emerged as strong predictors of future levels (p &lt; 0.01), emphasizing the importance of early assessments. Conclusions: Anxiety and depression are prevalent and persistent in RRMS patients, with specific symptoms fluctuating over time. Sociodemographic and clinical factors play a significant role in psychological outcomes, highlighting the need for integrated care models that address both physical and psychosocial aspects of MS. Early psychological assessments and targeted interventions are critical to improving QoL and mitigating the long-term burden of mental health challenges in RRMS.