Aging well in an aging society: physical health in older lesbian, gay, and bisexual adults.

Introduction: Older sexual minority people meet a double stigma in our society related to their sexual identity and chronological age. The present study explores how experiences of discrimination and prejudice, coming out, and personal resiliency influence physical health of older lesbian, gay, and bisexual (LGB) adults. Methods: Respondents were recruited through online advertisements and an online-based survey. The sample included 82 Italian cisgender LGB adults over 65 years: young older adults (65-70 years; 78%) and old-old adults (over 71 years; 22%). Regarding sexual orientation, the sample was composed of sexual minority women (n = 30; 37%) and sexual minority men (n = 52; 63%). Results: ANOVAs' findings showed that sexual minority women described lower levels of physical health compared to sexual minority men. At the same time, old-old adults reported higher experiences of discrimination and prejudice compared to young older adults. Moreover, findings from hierarchical multiple regression analysis described that coming out, higher levels of personal resiliency, and fewer experiences of discrimination were predictors of physical health, regardless of age and sexual minority categories. Conclusion: These findings seem to align with previous studies that underline the relevance of investigating aging well in sexual minority people. Knowledge and awareness of LGBTQ+ issues are necessary for recognizing the unique needs and resources of older LGB people for promoting a healthy aging process.

Emotional Distress Symptoms, Coping Efficacy, and Social Support: A Network Analysis of Distress and Resources in Persons With Cancer.

BACKGROUND: The study's main aim was to analyze the structure and configuration of distress symptoms and resource factors. PURPOSE: Common methods of assessing distress symptoms in cancer patients (i) do not capture the configuration of individual distress symptoms and (ii) do not take into account resource factors (e.g., social support, coping, caring health professionals). Network analysis focuses on the configuration and relationships among symptoms that can result in tailored interventions for distress. Network analysis was used to derive a symptom-level view of distress and resource factors. METHODS: Nine hundred and ninety-two cancer patients (mixed diagnoses) completed an abridged Distress Screening Schedule that included 24 items describing symptoms related to distress (depression, anxiety) and resource factors (social support, coping, caring health professionals). RESULTS: In network analysis, the centrality strength index (CSI) is the degree to which an item is connected to all other items, thus constituting an important focal point in the network. A depression symptom had the highest CSI value: felt lonely/isolated (CSI = 1.30). In addition, resource factors related to coping efficacy (CSI = 1.20), actively seeking support (CSI = 1.10), perceiving one's doctor as caring (CSI = 1.10), and receiving social support (CSI = 1.10) also all had very high CSI scores. CONCLUSIONS AND IMPLICATIONS: These results emphasize the integral importance of the social symptoms of loneliness/isolation in distress. Thus, distress symptoms (loneliness) and resource factors (coping efficacy, seeking social support, and perceiving medical professionals as caring) should be integral aspects of distress management and incorporated into assessment tools and interventions to reduce distress.

Many persons with cancer experience emotional distress (i.e., depression and anxiety). Traditional methods of assessing distress do not capture the complex organization of individual symptoms of depression/anxiety or their relationship with specific personal resources such as seeking support and coping strategies. This study used network analysis to represent the structural configuration of individual distress symptoms and specific resources (agentic coping, seeking support, receiving support, satisfaction with medical care) and relationships between them. Participants were 992 persons with cancer who completed an inventory assessing distress and personal resources. The network configuration showed that loneliness and social isolation were most central to the network of distress symptoms, suggesting that these feelings are the most significant aspects of distress for persons with cancer. Importantly, agentic coping, seeking support, perceiving one's doctor as caring, and receiving social support were also highly central in the network. The results highlight the significance of the social symptoms of distress, namely loneliness and isolation, as well as the central importance of resource factors such as coping efficacy, seeking social support, and perceiving medical professionals as caring. These distress symptoms and resources can be incorporated into assessment tools and interventions to alleviate distress among persons with cancer.

Meta-analysis of the Difficulties in Emotion Regulation Scale and its short forms: A two-part study.

The Difficulties in Emotion Regulation Scale (DERS) is the most used self-report questionnaire to assess deficits in emotion regulation (ER), composed of 6 dimensions and 36 items. Many studies have evaluated its factor structure, not always confirming the original results, and proposed different factor models. A possible way to try to identify the dimensionality of the DERS could be through a meta-analysis with structural equation models (MASEM) of its factor structure. The MASEM indicated that a six-factor model with 32 items (DERS-32) was the most suitable to represent the dimensionality of the DERS (χ2 = 2095.96, df = 449, p < .001; root mean square error of approximation [RMSEA] = 0.024, 95% confidence interval [CI]: 0.023-0.025; comparative fit index [CFI] = 0.97; Tucker Lewis index [TLI] = 0.96; standardized root mean squared residual [SRMR] = 0.04). This result was also confirmed by a confirmatory factor analysis (χ2 = 3229.67, df = 449, p < 0.001; RMSEA = 0.075, 95% CI: 0.073-0.078; CFI = 0.94; TLI = 0.93; SRMR = 0.05) on a new sample (1092 participants; mean age: 28.28, SD = 5.82 years) recruited from the Italian population. Analyses and results from this sample are reported in the second study of this work. The DERS-32 showed satisfactory internal consistency (i.e., ordinal α, Molenaar Sijtsma statistic, and latent class reliability coefficient) for all its dimensions and correctly categorized individuals with probable borderline symptomatology. In conclusion, the DERS-32 has demonstrated to be the best model for the DERS among all the others considered in this work, as well as a reliable tool to assess deficits in ER.

Daily associations between global self-esteem and self-concept clarity and their relationships with subjective well-being in a sample of adult workers.

OBJECTIVES: The present pre-registered study examined the reciprocal day-to-day associations between global self-esteem and self-concept clarity and their incremental validity with respect to daily life satisfaction, positive affect, and negative affect. METHODS: We used intensive longitudinal data from 153 adult workers (45.1% women), over a period of 31 days. Data were analyzed using dynamic structural equation modeling. RESULTS: Results attested higher global self-esteem and self-concept clarity mean levels for older vs. younger participants, and lower global self-esteem and self-concept clarity variability for older vs. younger participants. Furthermore, global self-esteem and self-concept clarity were correlated at a cross-sectional daily level, yet only self-concept clarity states positively predicted subsequent global self-esteem states, while global self-esteem states did not predict subsequent self-concept clarity states. Daily global self-esteem and daily self-concept clarity further predicted subsequent daily higher life satisfaction and positive affect, respectively. CONCLUSION: Overall, our findings shed light on the short-term relationships linking global self-esteem and self-concept clarity, pointing to their discriminant validity in predicting individuals' subjective well-being.

The relationship between caregiver contribution to self-care and patient quality of life in heart failure: A longitudinal mediation analysis.

BACKGROUND: Patients with heart failure may experience poor quality of life due to a variety of physical and psychological symptoms. Quality of life can improve if patients adhere to consistent self-care behaviors. Patient outcomes (i.e., quality of life) are thought to improve as a result of caregiver contribution to self-care. However, uncertainty exists on whether these outcomes improve as a direct result of caregiver contribution to self-care or whether this improvement occurs indirectly through the improvement of patient heart failure self-care behaviors. AIMS: To investigate the influence of caregiver contribution to self-care on quality of life of heart failure people and explore whether patient self-care behaviors mediate such a relationship. METHODS: This is a secondary analysis of the MOTIVATE-HF randomized controlled trial (Clinicaltrials.gov registration number: NCT02894502). Data were collected at baseline and 3 months. An autoregressive longitudinal path analysis model was conducted to test our hypotheses. RESULTS: We enrolled a sample of 510 caregivers [mean age = 54 (±15.44), 24% males)] and 510 patients [mean age = 72.4 (±12.28), 58% males)]. Patient self-care had a significant and direct effect on quality of life at three months (ß = 0.20, p < .01). Caregiver contribution to self-care showed a significant direct effect on patient self-care (ß = 0.32, p < .01), and an indirect effect on patient quality of life through the mediation of patient self-care (ß = 0.07, p < .001). CONCLUSION: Patient quality of life is influenced by self-care both directly and indirectly, through the mediation of caregiver contribution to self-care. These findings improve our understanding on how caregiver contribution to self-care improves patient outcomes.

"I RUN CLEAN Project"-An Innovative and Self-Sustainable Approach to Develop Clean Sport Behaviours in Grassroots Athletes.

The phenomenon of doping is a public health issue that poses threats to sport and society. In recent decades, the emphasis on efforts to address the issue and reduce the incidence of doping by young people in sport has shifted from deterrence through testing and punishment to the promotion of clean sport behaviours through values-based education. The "I Run Clean project" sought to develop new and effective tools targeting grassroots athletes and those around them (coaches, medical support personnel, sport leaders, parents). These included sport-specific e-learning and in-person peer-to-peer workshops led by trained volunteer ambassadors. The aim of all "I Run Clean" measures is to go beyond the warnings and provision of factual information about early anti-doping campaigns to a more holistic educational approach that focuses participants on their personal and sport-related values in order to encourage good decision-making and resistance to doping-related behaviours. This study evaluates the efficacy of the peer-to-peer workshops and their impact on selected psycho-social variables. The collaboration of the volunteer ambassadors is shown to effectively transmit the desired reasoning, reduce doping risk factors and enhance protective factors.

"I Am on Top!": An Interactive Intervention Program to Promote Self-Regulation Processes in the Prevention of the Use of Doping in Sports High Schools.

The use of substances to improve sports performance is a widespread phenomenon among adolescents. Several anti-doping programs have been developed, mainly based on knowledge-based evidence. The main aim of the present study was to implement an anti-doping intervention in sports high school students, based on a psychological framework, such as Socio-Cognitive Theory, through the development of a Serious Game (SG), i.e., digital learning based on the game. The experimental design included an intervention group (n = 167; F = 37.7%; Meanage = 17.5 years; SD = 0.58) and a control group (n = 112; F = 42%; Meanage = 17.6; SD = 1). Both of the groups completed the same questionnaire on two different occasions (i.e., time 1 and time 2) for measuring doping intention, self-regulatory efficacy to resist social pressure for the use of substances, moral disengagement, and doping knowledge. Data were analyzed through repeated measures of Group X Time ANOVA, demonstrating some degree of efficacy of the intervention, in particular in terms of the decrease in doping intention and the strengthening of doping knowledge. Moreover, the study demonstrated that the score obtained during the implementation of the SG could partially represent a coherent measure of the participants' beliefs regarding doping. These results could be considered a starting point for future research to better develop technological anti-doping interventions.

Is the Behavioral Regulation in Exercise Questionnaire a Valid Measure in Older People?

BACKGROUND: Despite the widely recognized benefits of physical activity for preventing physical and cognitive decline during aging, global estimates indicate that most older adults do not achieve the recommended amount of physical activity due to a lack of motivation. The current research examined the validity and psychometric properties of the Behavioral Regulation in Exercise Questionnaire (BREQ-3) among older adults. Based on Self-Determination Theory (SDT), the BREQ-3 stands out as one of the most extensively utilized tools among exercise motivation studies. METHODS: A sample of older adults (N = 383; M age = 73.2 years, SD age = 7.2) completed the BREQ-3 and the Godin-Shepard Leisure-Time Physical Activity Questionnaire (GSLTPAQ). RESULTS: Confirmatory factor analyses confirmed the six-factor structure postulated by SDT, showing good fit indices (CFI= 0.95; RMSEA = 0.05; SRMR = 0.04) and supporting the full measurement invariance of the scale across sex and age groups (65 to 74 years; over 75 years). The construct and criterion validity of the BREQ-3 was upheld through the latent correlations between its subscales and their correlations with the GSLTPAQ. CONCLUSIONS: We demonstrated for the first time the effectiveness of the BREQ-3 in assessing all forms of behavioral regulation proposed by SDT in older adults, suggesting that older adults similarly interpreted the items across sex and age groups.

The role of sense of presence in expressing cognitive abilities in a virtual reality task: an initial validation study.

There is a raised interest in literature to use Virtual Reality (VR) technology as an assessment tool for cognitive domains. One of the essential advantages of transforming tests in an immersive virtual environment is the possibility of automatically calculating the test's score, a time-consuming process under natural conditions. Although the characteristics of VR can deliver different degrees of immersion in a virtual environment, the sense of presence could jeopardize the evolution of these practices. The sense of presence results from a complex interaction between human, contextual factors, and the VR environment. The present study has two aims: firstly, it contributes to the validation of a virtual version of the naturalistic action test (i.e., virtual reality action test); second, it aims to evaluate the role of sense of presence as a critical booster of the expression of cognitive abilities during virtual reality tasks. The study relies on healthy adults tested in virtual and real conditions in a cross-over research design. The study's results support the validity of the virtual reality action test. Furthermore, two structural equation models are tested to comprehend the role of sense of presence as a moderator in the relationship between cognitive abilities and virtual task performance.

Addressing Adolescents' Prejudice toward Immigrants: The Role of the Classroom Context.

According to social learning theory, classrooms are essential socialization contexts for intergroup attitudes, but analyses of contextual factors net of the impact of individual variables affecting prejudice toward immigrants are very limited. This study was conducted on a large sample of Italian adolescents (N = 2904; Mage = 13.70; females = 48.5%; 168 classrooms). It examined the role of classroom contextual factors affecting adolescents' prejudice toward immigrants, relying on the combination of groups' warmth and competence, and their antecedents (i.e., competition and status). Multilevel structural equation analyses revealed that classroom contextual factors (i.e., classroom socio-economic status-SES; classroom open to discussion climate; classroom educational achievements) indirectly affected, at the class level, adolescents' perceived warmth and competence of immigrants through the mediating role of perceived competition (and status) of immigrants. These findings suggest that interventions targeting the classroom context can help to hinder prejudice in adolescence at the class level.

Exploring the Psychological Nexus of Virtual and Augmented Reality on Physical Activity in Older Adults: A Rapid Review.

With the global population of older adults projected to double to 2.1 billion by 2050, it becomes crucial to promote healthy aging to alleviate the associated disease burden. In this context, technology, particularly virtual reality (VR) and augmented reality (AR), has garnered attention for its potential to augment physical activity in older adults. These immersive technologies offer interactive and enjoyable exercise experiences, making physical activity more appealing. However, the effectiveness of these interventions is not solely attributed to technology itself but is deeply intertwined with psychological processes. This rapid review examines the effectiveness of VR and AR interventions in enhancing physical exercise among healthy older adults while exploring the role of psychological variables, including mood, self-efficacy, and motivation. The results of the study show that technology-enhanced physical activity interventions hold great promise but call attention to the need for a comprehensive understanding of psychological dynamics that will pave the way for more tailored and effective interventions. Future research endeavors should aim to bridge these gaps in knowledge to optimize the impact of technology on healthy aging.

Sensory Processing Disorders in Children and Adolescents: Taking Stock of Assessment and Novel Therapeutic Tools.

Sensory processing disorders (SPDs) can be described as difficulty detecting, modulating, interpreting, and/or responding to sensory experiences. Because SPDs occur in many individuals with autism spectrum disorder and in other populations with neurodevelopmental disorders, it is important to distinguish between typical and atypical functioning in sensory processes and to identify early phenotypic markers for developing SPDs. This review considers different methods for diagnosing SPDs to outline a multidisciplinary approach useful for developing valid diagnostic measures. In particular, the advantages and limitations of the most commonly used tools in assessment of SPDs, such as caregiver reports, clinical observation, and psychophysical and neuroimaging studies, will be reviewed. Innovative treatment methods such as neuromodulation techniques and virtual reality will also be suggested.

Motor Imagery as a Key Factor for Healthy Ageing: A Review of New Insights and Techniques.

Motor imagery (MI) describes a dynamic cognitive process where a movement is mentally simulated without taking place and holds potential as a means of stimulating motor learning and regaining motor skills. There is growing evidence that imagined and executed actions have common neural circuitry. Since MI counteracts cognitive and motor decline, a growing interest in MI-based mental exercise for older individuals has emerged. Here we review the last decade's scientific literature on age-related changes in MI skills. Heterogeneity in the experimental protocols, as well as the use of populations with unrepresentative age, is making it challenging to draw unambiguous conclusions about MI skills preservation. Self-report and behavioural tasks have shown that some MI components are preserved, while others are impaired. Evidence from neuroimaging studies revealed that, during MI tasks, older individuals hyperactivate their sensorimotor and attentional networks. Some studies have argued that this represents a compensatory mechanism, others claim that this is a sign of cognitive decline. However, further studies are needed to establish whether MI could be used as a promotion factor to improve cognitive functioning and well-being in older people.

Boosting effect of regular sport practice in young adults: Preliminary results on cognitive and emotional abilities.

Several studies have shown that physical exercise (PE) improves behavior and cognitive functioning, reducing the risk of various neurological diseases, protecting the brain from the detrimental effects of aging, facilitating body recovery after injuries, and enhancing self-efficacy and self-esteem. Emotion processing and regulation abilities are also widely acknowledged to be key to success in sports. In this study, we aim to prove that regular participation in sports enhances cognitive and emotional functioning in healthy individuals. A sample of 60 students (mean age = 22.12; SD = 2.40; M = 30), divided into sportive and sedentary, were subjected to a neuropsychological tests battery to assess their overall cognitive abilities (Raven's Advanced Progressive Matrices, APM), verbal and graphic fluency (Word Fluency Task and modified Five Point Test, m-FPT), as well as their emotional awareness skills (Toronto Alexithymia Scale, TAS-20). Our results showed that sportive students performed better than sedentary ones in all cognitive tasks. Regarding emotional processing abilities, significant differences were found in the TAS-20 total score as well as in the Difficulty Describing Feelings (DDF) subscale and the Difficulty Identifying Feeling (DIF) subscale. Lastly, gender differences were found in the External-Oriented Thinking (EOT) subscale. Overall, our findings evidence that PE has positive effects on cognitive functioning and emotion regulation, suggesting how sports practice can promote mental health and wellbeing.

Adolescents' Characteristics and Peer Relationships in Class: A Population Study.

BACKGROUND: This study aimed to investigate differences in adolescents' social relationships with classmates of diverse gender, socioeconomic status, immigrant background, and academic achievement. METHODS: A population of 10th-grade students (N = 406,783; males = 50.3%; Mage = 15.57 years, SDage = 0.75) completed the Classmates Social Isolation Questionnaire (CSIQ), an instrument specifically designed to measure two distinct but correlated types of peer relationships in class: peer acceptance and peer friendship. To obtain reliable comparisons across diverse adolescent characteristics, the measurement invariance of the CSIQ was established by means of CFAs and then latent mean differences tests were performed. RESULTS: Immigrant background, academic achievement, and socioeconomic status all proved to be important factors influencing relationships with classmates, while being a male or a female was less relevant. Being a first-generation immigrant adolescent appears to be the foremost risk factor for being less accepted by classmates, while having a low academic achievement is the greatest hindrance for having friends in the group of classmates, a finding that diverges from previous studies. CONCLUSIONS: This population study suggests that adolescent characteristics (especially immigrant background, socioeconomic status, and academic achievement) seem to affect social relationships with classmates.

Brain network topology and personality traits: A source level magnetoencephalographic study.

Personality neuroscience is focusing on the correlation between individual differences and the efficiency of large-scale networks from the perspective of the brain as an interconnected network. A suitable technique to explore this relationship is the magnetoencephalography (MEG), but not many MEG studies are aimed at investigating topological properties correlated to personality traits. By using MEG, the present study aims to evaluate how individual differences described in Cloninger's psychobiological model are correlated with specific cerebral structures. Fifty healthy individuals (20 males, 30 females, mean age: 27.4 ± 4.8 years) underwent Temperament and Character Inventory examination and MEG recording during a resting state condition. High harm avoidance scores were associated with a reduced centrality of the left caudate nucleus and this negative correlation was maintained in females when we analyzed gender differences. Our data suggest that the caudate nucleus plays a key role in adaptive behavior and could be a critical node in insular salience network. The clear difference between males and females allows us to suggest that topological organization correlated to personality is highly dependent on gender. Our findings provide new insights to evaluate the mutual influences of topological and functional connectivity in neural communication efficiency and disruption as biomarkers of psychopathological traits.

Application of Real and Virtual Radial Arm Maze Task in Human.

Virtual Reality (VR) emerges as a promising technology capable of creating different scenarios in which the body, environment, and brain are closely related, proving enhancements in the diagnosis and treatment of several spatial memory deficits. In recent years, human spatial navigation has increasingly been studied in interactive virtual environments. However, navigational tasks are still not completely adapted in immersive 3D VR systems. We stipulate that an immersive Radial Arm Maze (RAM) is an excellent instrument, allowing the participants to be physically active within the maze exactly as in the walking RAM version in reality modality. RAM is a behavioral ecological task that allows the analyses of different facets of spatial memory, distinguishing declarative components from procedural ones. In addition to describing the characteristics of RAM, we will also analyze studies in which RAM has been used in virtual modality to provide suggestions into RAM building in immersive modality.

The Psychometric Properties of the Behavioural Regulation in Exercise Questionnaire (BREQ-3): Factorial Structure, Invariance and Validity in the Italian Context.

BACKGROUND: Motivation to engage in physical activity plays a central role in ensuring the health of the population. The present study investigated the psychometric properties and validity in Italy of the Behavioral Regulation in Exercise Questionnaire (BREQ-3), a widely used instrument for assessing individuals' motivation to exercise based on self-determination theory (SDT). METHODS: A large sample (N = 2222; females = 55.4%; Mage = 36.4 years, SDage = 13.9, min = 20, max = 69) of young people, and middle aged and older adults completed the Italian translation of the BREQ-3, also indicating their intentions to exercise in the following weeks. RESULTS: Confirmatory factor analyses showed that the posited six-factor structure of the BREQ-3 fitted the data well (CFI = 0.96; RMSEA = 0.05; SRMR = 0.04) and provided evidence for full measurement invariance across gender and different age groups. The construct validity of the BREQ-3 was supported by the latent correlations among the subscales, which were consistent with the quasi-simplex pattern theorized by SDT. The overall level of self-determination and the intention to exercise were positively correlated, providing evidence for the criterion validity of the scale. CONCLUSIONS: The Italian version of the BREQ-3 has proved to be a reliable and valid instrument for measuring the behavioral regulation of exercise in individuals with different demographic characteristics.

Psychological correlates of insomnia in professional soccer players: An exploratory study.

Sleep promotes health, well-being, recovery and athletic performance. As a consequence, sleep problems in athletes may have detrimental effects. Previous investigations showed that professional athletes often reported to suffer of poor sleep quality and insomnia (e.g. difficulties falling asleep and/or maintaining sleep). However, psychological variables exacerbating and maintaining insomnia in professional athletes as well as its mechanistic pathways are still largely unknown. Available literature mostly focused on effects of sport-related variables, such as evening training and stimulant consumption on athletes' sleep. Instead, the contribution of cognitive and emotional variables globally associated with insomnia in athletes in clinical models has been largely neglected. To address these limitations, this study explored the associations between emotional experience, pre-sleep arousal, pre-sleep worry and rumination and insomnia severity in a sample of 210 (25.93 ± 6.68 years) male professional soccer players. Bivariate correlations, multiple regression, and structural equation modelling with manifest variables (path analysis) were computed. Results showed that insomnia severity was associated with stimulants consumption, pre-sleep arousal, negative emotions, positive emotions, and pre-sleep worry/rumination (all p < .05). Path analysis showed that relationship between stimulant consumption, emotional experience, worry/rumination and insomnia was mediated by pre-sleep arousal (p < .05). Our results suggest that preventive and interventional studies in professional soccer players would benefit from considering global cognitive-emotional variables as targets of interventions.HighlightsInsomnia was associated with greater stimulants consumption, pre-sleep arousal, negative emotions, pre-sleep worry/rumination, and lower positive emotions.Path analysis showed that pre-sleep arousal mediated the relationship between stimulant consumption, emotional experience, worry/rumination and insomnia severity.Cognitive-emotional and behavioural factors as well as sport-related variables were important predictors of insomnia in professional soccer players.

Assessing the fear of recurrence using the Cancer Worry Scale in a sample of Italian breast cancer survivors.

PURPOSE: The fear of cancer recurrence (FCR) is one of the most reported problems by cancer survivors. A valid instrument to detect this issue could be useful to identify cancer survivors who are more vulnerable to developing FCR and related adverse outcomes (e.g., anxiety). The present study aimed to evaluate FCR in a sample of Italian breast cancer survivors using an Italian version of the 8-item Cancer Worry Scale (CWS) in order to establish a cut-off for the use in clinical settings. METHODS: The participants were 119 breast cancer survivors (mean age 47.7 years) at least 1 year after their primary treatment. An exploratory factor analysis (EFA) of CWS, internal reliability of CWS, concurrent and divergent validity using a bivariate correlation between the key measures of the study (i.e., FCR, anxiety, depression, fatigue, and self-efficacy), and ROC analysis of CWS were performed. RESULTS: Fit indices for the EFA were considered acceptable and showed a two-factor structure-labeled cancer worries and worries impact. The reliability of the two factors showed a Cronbach's alpha coefficient greater than 0.90. The CWS was positively related to anxiety, depression, fatigue, and negatively related to perceived self-efficacy. The best cut-off score was 24 versus 25, with a sensitivity of 74% and a specificity of 85%. CONCLUSIONS: The CWS is a valid questionnaire to assess FCR among breast cancer survivors. The present study provides an overview of the relationship between CWS and the adverse outcomes related to FCR and coping strategies adopted to face it.