Psychological distress, particularly anxiety and depression, is prevalent among KOA patients and may exacerbate functional disability through maladaptive cognitive processes such as pain catastrophizing. This study examined whether pain catastrophizing mediates the relationship between psychological distress and functional disability in KOA patients. We enrolled 90 KOA patients between January 2024 and January 2025. Anxiety (GAD-7), depression (PHQ-9), pain catastrophizing (Pain Catastrophizing Scale, PCS), functional disability (WOMAC), and pain intensity (visual analog scale, VAS) were assessed. Pearson correlation, hierarchical regression, and bootstrap-based mediation analyses were performed. The mean age was 61.77 ± 7.63 years, and 58.9% were female. Anxiety (GAD-7: 8.58 ± 4.68), depression (PHQ-9: 8.92 ± 5.31), and pain catastrophizing (PCS: 23.59 ± 10.43) were moderately elevated. All psychological variables were significantly correlated with WOMAC scores (r = 0.464-0.637, P < 0.001). Hierarchical regression showed psychological variables significantly increased explained variance in functional disability (ΔR = 0.095, P < 0.001). Mediation analysis revealed pain catastrophizing partially mediated the anxiety-disability relationship (indirect effect = 0.816, 95% CI [0.425, 1.256], proportion mediated = 48.5%) and fully mediated the depression-disability relationship (indirect effect = 1.028, 95% CI [0.557, 1.636], proportion mediated = 65.0%). Within these cross-sectional data, pain catastrophizing statistically mediated the associations of anxiety and depression with functional disability; because temporal precedence cannot be established, these relationships should be interpreted as associational rather than causal. The findings nonetheless identify pain catastrophizing as a potentially modifiable cognitive correlate of disability and support evaluating cognitive-behavioral interventions targeting catastrophizing within comprehensive KOA management.

BACKGROUND: Approximately 15% of women report depressive symptoms during pregnancy, with Black women more likely to report depressive symptoms prenatally compared with White women. Depressive symptoms are associated with small for gestational age infants and preterm birth. Neighborhood affordability, socioeconomic, ethnic, and racial segregation may adversely influence maternal mental health. OBJECTIVE: We sought to estimate the effect(s) of residential racial composition (ie, percentage of Black residents living within the block group) and neighborhood socioeconomic factors on depressive symptoms among Black pregnant women attending prenatal clinics in Detroit, MI and Columbus, OH. METHODS: This was a secondary analysis of the Biosocial Impact on Black Births study. We analyzed self-reported depressive symptoms in Black women (N = 565) at 8 to 18 weeks' gestation. The primary measure was the Center for Epidemiological Studies-Depression Scale (CES-D). The primary explanatory variables were neighborhood-level residential racial composition and rates of poverty, homeownership, household assistance, and educational attainment. A 2-level mixed-effects regression model was used to account for clustering of participants within the study areas. RESULTS: For each percent increase in residential racial composition, there was a 0.66-point decrease in the Center for Epidemiological Studies-Depression Scale (-0.66; 95% CI, -0.112 to -0.021). Adjusting for individual differences among women, the protective effect of residential racial composition on the CES-D persisted (-0.62; 95% CI, -0.108 to -0.017). CONCLUSION: Our results suggest that living in neighborhoods with a greater proportion of Black individuals may be protective of depressive symptoms for pregnant Black women. These findings were not significant for neighborhood socioeconomic factors.

OBJECTIVES: This study used latent profile analysis to identify profiles of subjective prospective memory (PM) difficulty in older adults, examine associations with depressive symptoms, anxiety, and self-rated health, and determine whether profiles differed in objective time-based PM (TBPM) performance. METHODS: Two hundred sixty-three community-dwelling older adults in Hong Kong ( = 69.20,  = 5.48) completed the Prospective and Retrospective Memory Questionnaires's PM subscale , the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7, a self-rated health measure, and a single-trial time-based PM task. RESULTS: Three profiles emerged: Low PM Difficulties (47.9%), Moderate PM Difficulties (33.5%), and Severe PM Difficulties (18.6%). Profiles differed in event- and time-based PM patterning. Depressive and anxiety symptoms increased across profiles and self-rated health differed between profiles, with the lowest ratings in the Severe profile (overall  < 0.001). Profiles did not differ in objective TBPM performance. CONCLUSION: Subjective PM difficulty profiles differed in mental health and self-rated health but not objective TBPM performance. Even moderate difficulties were associated with higher depressive and anxiety symptoms. Findings suggest that subjective PM experience carries information not fully captured by objective performance and support routine assessment of PM complaints in older adults, alongside rather than only relying on objective performance.

OBJECTIVE: The study aimed to investigate whether participants with early- versus late-diagnosed ADHD differed in relation to family, school, sociodemographic, and clinical factors. METHOD: The study population consisted of 508 adolescents (aged 13-17) hospitalized in a psychiatric unit at Oulu University Hospital between 2001-2006, with follow-up until 2023 the Finnish Care Register for Healthcare. Participants were grouped as follows: early-diagnosed ADHD (diagnosed before the age of 18) ( = 29), late-diagnosed ADHD (diagnosed after the age of 18) ( = 55), and no ADHD ( = 424). Differences between ADHD groups were assessed using chi-squared, Fisher's exact, one-way ANOVA, or Kruskal-Wallis tests. Associations were analyzed with logistic regression using late-diagnosed ADHD as the outcome and comparing it separately with the no-ADHD and early-diagnosed ADHD groups. RESULTS: Early-diagnosed ADHD was more prevalent in males, while late-diagnosed ADHD was more common in females. The late-diagnosed ADHD group had more psychiatric comorbidities and was found to report fewer ADHD symptoms in adolescence than the group with no ADHD diagnosis. Female sex combined with anxiety disorders increased the likelihood for late-diagnosed ADHD, whereas conduct disorder was associated with early-diagnosed ADHD. The study also revealed a sharp rise in new ADHD diagnoses during the COVID-19 pandemic in 2021-2022. CONCLUSION: This study suggests that female-majority late-diagnosed cases may represent a distinct often underdiagnosed clinical group in adolescence. The debate over whether late-diagnosed ADHD is equal to late-onset ADHD and it could reflect a genuine neurodevelopmental variation or arises from comorbidities and life circumstances highlights the need for further longitudinal research.

Thirteen new 4-acyl-5-amino-1-imidazole alkaloids () were identified from cultures produced by the marine-derived sp. OUCMDZ-944 using feature-based molecular networking (FBMN)-guided isolation. Notably, compounds and were identified as phenyl-containing derivatives, specifically 5-amino-4-phenylpropionylimidazole () and 5-amino-4-phenylbutyrylimidazole (). Ten isolates (-) are hydroxylated, with compound being identified as a novel dimeric analogue. Furthermore, five methylated derivatives, , , , , and , were synthesized. In an in vitro depression model, compounds , , , , , , and were found to significantly reduce IL-1β levels, while compounds , , , and notably reversed the corticosterone-induced decrease in brain-derived neurotrophic factor (BDNF) expression, suggesting a potential antidepressant-like activity. In the zebrafish anxiety model, compounds , , , , and significantly enhanced spontaneous locomotor activity, reduced thigmotaxis behavior, and increased time spent in the inner zone under various lighting conditions, demonstrating clear anxiolytic-like effects. These five compounds were identified as promising lead candidates with dual anxiolytic and antidepressant potential.

Although tree imagery in projective drawing tests is a promising nonverbal tool for screening mental disorders, its clinical utility remains constrained by inconsistent predictor selection. To address this gap, the present systematic review and meta-analysis synthesizes the characteristics of tree imagery linked to mental disorders and evaluates their predictive efficacy. Following the PRISMA guidelines, we analyzed 42 studies involving 8552 participants from English and Chinese databases published between 1948 and 2024. The results showed that 24 specific characteristics significantly predicted mental disorders ( < 0.05), which were classified into five distinct categories: blackened out (e.g., blackened tree, odds ratio [OR] = 2.01), scribbled lines (e.g., weak lines, OR = 2.82), oddly shaped (e.g., flattened crown, OR = 3.10), no vitality (e.g., very small tree, OR = 3.93), and overly simple (e.g., simplified drawing, OR = 7.07). Furthermore, subgroup analyses indicated that features such as "blackened tree" (OR = 1.71), "no motion" (OR = 3.34), and "excessive separation" (OR = 2.77) were significantly associated with affective disorders, whereas the presence of "roots" (OR = 4.89) was uniquely associated with the thought-disorder subgroup. Ultimately, tree imagery may offer a valuable nonverbal, adjunctive approach to screening for mental disorders, offering several statistically supported indicators that may effectively complement traditional assessment tools.

BACKGROUND: Treatment for Ménière's disease remains a subject of debate. A surgical technique in which the endolymphatic duct is blocked was proposed as a new treatment modality for patients with intractable Ménière's disease, but a double-blind trial was lacking. Therefore, the aim of this double-blind trial was to assess whether EDB is more effective than ESD in patients with intractable Ménière's disease. METHODS: This is a double-blind, randomised, multicentre trial comparing endolymphatic duct blockage (EDB) to endolymphatic sac decompression (ESD). Patients had unilateral, active Ménière's disease despite treatment with at least two corticosteroid injections. All patients were recruited from two university and five non-university hospitals in the Netherlands. During surgery, patients were randomly assigned to either the EDB or ESD group. Following surgery, patients were followed for 1 year, with both physical visits and an app in which attacks could be reported. Both patients and investigators were blinded throughout the follow-up period. The primary outcome was freedom from vertigo attacks at 12 months, defined as no attacks during the preceding 6 months. Secondary outcome measures included attack incidence, quality of life, dizziness, tinnitus, and inner ear function. Analyses were performed according to the intention-to-treat principle. This trial was registered in the ISRCTN registry (registered 24-02-2021, https://www.isrctn.com/ISRCTN12074571). FINDINGS: Between 23 June 2021 and 12 September 2023, 75 patients with definite Ménière's disease were enrolled; 39 underwent EDB, while 36 underwent ESD. No loss to follow-up was recorded. At 12 months, 23/39 (59%) patients in the EDB group and 24/36 (67%) in the ESD group were free from vertigo attacks (OR 0.72, 95% CI 0.28-1.84; p = 0.65). Secondary outcomes, including quality of life, dizziness, tinnitus, and hearing function did not differ between groups. Higher baseline patients expectations were associated with treatment success. Three serious adverse events occurred (one in the EDB group, two in the ESD group) and no deaths were reported. INTERPRETATION: This trial does not demonstrate a benefit of EDB over ESD for patients with refractory Ménière's disease. Given the comparable outcomes between groups, EDB should not be preferred over ESD. The association between baseline expectations and outcome suggests that non-specific treatment effects may contribute to perceived benefit. Future studies should consider inclusion of a non-surgical or sham-surgery control to more definitely determine the effect of this type of surgery, although such trials would be challenging. FUNDING: Dutch National Healthcare Institute and ZonMw ('Veelbelovende Zorg' grant).

Intimate partner violence (IPV) encompasses physical, emotional, and sexual abuse within intimate relationships and is commonly encountered in clinical practice, affecting individuals across all backgrounds. Globally, healthcare settings represent a critical point of contact for individuals who have experienced intimate partner violence. IPV is associated with adverse health outcomes including depression, post-traumatic stress disorder, substance use disorders, traumatic brain injury, and adverse pregnancy outcomes. Despite high prevalence and recommendations to routinely screen women of reproductive age, IPV screening rates remain inconsistent, highlighting the need to examine how IPV education is incorporated into medical training. This narrative review evaluates undergraduate medical education on IPV, focusing on timing, instructional methods, and impact of interventions on student preparedness. A search was conducted in PubMed and Embase for studies published between 2000 and 2025, from which eligible articles were selected for full-text review. Existing curricula use multimodal approaches, including didactic sessions, small-group discussions, and simulation-based training, but are often isolated, optional, and rarely reinforced longitudinally. While these approaches improve short-term knowledge and confidence, gaps remain in sustained preparedness and consistent screening practices. Current approaches to IPV education may overestimate preparedness by emphasizing self-reported, short-term confidence, while failing to evaluate whether skills are consistently applied in real-world clinical settings. Repeated exposure to trauma-informed IPV education during preclinical years may help normalize screening and strengthen recognition skills. Future strategies should prioritize longitudinal, community-based curricula that reinforce IPV screening and response across multiple stages of medical training to better prepare physicians for real-world patient care.

BACKGROUND: Infertility is associated with significant psychological distress and impaired quality of life (QoL) in women. Polycystic Ovarian Syndrome (PCOS), a common cause of infertility, is frequently associated with metabolic and psychological symptoms. However, limited evidence directly compares psychological symptom burden and QoL between women with PCOS-related infertility and unexplained infertility, including across PCOS phenotypes. METHODS: This cross-sectional observational study included 240 women aged 18-40 years with infertility due to PCOS or unexplained causes, conducted at a tertiary care center between October 2019 and March 2021. PCOS was diagnosed using revised Rotterdam criteria, and unexplained infertility was defined after exclusion of known causes. Psychological outcomes were assessed using validated screening instruments (PHQ-9, BDI, BAI, and GAD-7), representing symptom severity rather than clinical psychiatric diagnoses. QoL was assessed using WHOQOL-BREF. Statistical analysis included group comparisons using appropriate parametric and non-parametric tests, with p < 0.05 considered statistically significant. RESULTS: Women with PCOS demonstrated significantly higher screening-based depressive symptom burden (60% vs. 14%, p < 0.001) and anxiety symptom burden (63% vs. 21%, p < 0.001) compared to women with unexplained infertility. QoL scores were significantly lower in the PCOS group (66.8% vs. 85.1%, p < 0.001), particularly in psychological and social domains. Among PCOS phenotypes, hyperandrogenic phenotypes (B and C) showed relatively higher psychological symptom burden and lower QoL scores compared to other phenotypes. The PCOS group also demonstrated higher BMI and androgen levels. CONCLUSION: Infertility associated with PCOS is linked to higher screening-based psychological symptom burden and reduced quality of life compared to unexplained infertility. Hyperandrogenic PCOS phenotypes appear to be more affected. These findings support the integration of routine psychological screening and multidisciplinary support into infertility care for women with PCOS.

BACKGROUND: We conceptualize the Real-World Reassessment Threshold (RWRT) as representing the smallest change that exceeds expected measurement variability while accounting for clinically expected cognitive decline over the assessment interval, whereas the minimum clinically important difference (MCID) indicates the smallest change likely to be clinically meaningful. To date, no study has empirically defined the RWRT or MCID for Mini-Mental State Examination (MMSE) scores in Lewy body dementia (LBD) or frontotemporal dementia (FTD), limiting the interpretation of longitudinal changes and clinical trial designs. We therefore aimed to estimate 12-month, diagnosis-specific MMSE thresholds for RWRT and MCID among individuals with LBD and FTD, and to evaluate the generalizability of these thresholds in an independent validation cohort. METHODS: This registry-based cohort study included individuals diagnosed with LBD or FTD from the Swedish Registry for Cognitive/Dementia Disorders (SveDem, 2007-2022) with a 91-400-day MMSE follow-up, and an independent validation cohort from the U.S. National Alzheimer's Coordinating Center (NACC). The RWRT was estimated using distribution-based methods based on intraclass correlation coefficients (ICCs). MCID was estimated using both anchor-based and distribution-based (0.5 standard deviation) approaches. RESULTS: We included 1,158 individuals from SveDem (873 LBD, 285 FTD) and 1,060 individuals from NACC (469 LBD, 591 FTD). Over the 91-400-day follow-up interval, MMSE scores demonstrated moderate to high reliability (ICC 0.70-0.90), corresponding to RWRT estimates ranged from 5 to 7 MMSE points. Anchor-based MCIDs differed by diagnosis, with a mean threshold of 0.7 points in LBD and 3.8 points in FTD in SveDem; similar diagnosis- and baseline severity-dependent patterns were observed in NACC. In contrast, distribution-based MCIDs were consistent across diagnoses, clustering around 2-3 MMSE points. CONCLUSIONS: MMSE changes of less than five points over one year may reflect expected test variability combined with expected individual decline. However, average changes of 2-3 points may still be meaningful when combined with a clinical anchor of change, depending on diagnosis and disease stage. These results emphasize the importance of using both RWRT and MCID when evaluating MMSE change and selecting clinical trial endpoints.

BACKGROUND: Anxiety disorders, depressive disorders, migraine, and rheumatoid arthritis are common chronic conditions that contribute substantially to disability, recurrent care needs, and productivity losses, yet remain comparatively under-prioritised in health policy. In Mexico, these conditions disproportionately affect women, but their economic burden has not been comprehensively quantified from a gender perspective. OBJECTIVE: To estimate the direct and indirect economic burden of anxiety disorders, depressive disorders, migraine, and rheumatoid arthritis in Mexico among adults aged 20 years and older between 2005 and 2021, from a societal perspective and by gender. METHODS: We conducted a cost-of-illness analysis from a societal perspective. Direct costs were estimated by combining condition-specific prevalence from the Global Burden of Disease Study 2021 (GBD 2021) with normative per-case treatment costs derived from national clinical guidelines and official cost sources. Indirect costs were valued using three complementary approaches: the Human Capital Approach (HCA), based on predicted annual labour income from nationally representative employment surveys; a GDP-per-capita benchmark (1 DALY = 1 GDP per capita); and a willingness-to-pay approach using the value of a statistical life year (VSLY) transferred to Mexico following OECD methods. All costs were expressed in 2021 international dollars (Int$). RESULTS: Between 2005 and 2021, the four disorders accounted for 28.8 million DALYs lost. Migraine was the most prevalent condition, but depressive disorders generated the highest direct costs (Int$310.5 billion) and the largest share of indirect costs (41.1%). Indirect costs totalled Int$106.8 billion under the HCA, Int$582.2 billion under the GDP-per-capita valuation, and Int$2.9 trillion under the willingness-to-pay approach. Under the GDP-per-capita benchmark, the combined economic burden of the four disorders reached approximately Int$1.2 trillion over the study period. Women consistently bore a greater burden than men across all four conditions and under all valuation methods; total indirect costs borne by women were 2.0 times higher for anxiety disorders, 2.1 times higher for depressive disorders, 2.2 times higher for migraine, and 3.8 times higher for rheumatoid arthritis. CONCLUSIONS: Anxiety disorders, depressive disorders, migraine, and rheumatoid arthritis impose a substantial and unequally distributed economic burden in Mexico. The persistent excess burden among women indicates that these high-disability chronic disorders should be understood not only as a public health problem, but also as a health equity concern. More gender-responsive priority setting, stronger continuity of care, and better financial protection may help reduce both disability and its downstream economic consequences in Mexico and other LMICs with segmented health systems.

BACKGROUND: Clinical practice is essential for developing competence, yet students in resource-limited settings often face multiple barriers. This study assessed the level of clinical learning challenges and associated factors among undergraduate nursing students at Wachemo University, Ethiopia. METHODS: An institution-based cross-sectional study was conducted from 18 February to 22 March, 2026. A census approach was used; all eligible regular undergraduate nursing students with clinical attachment were invited to participate. Data were collected via structured, self-administered questionnaires deployed through Kobo Toolbox. The tool incorporated a 9-item clinical learning challenge scale (5-point Likert), the Generalized Anxiety Disorder-2 (GAD-2) scale, the Patient Health Questionnaire-2 (PHQ-2) scale, and dedicated skill laboratory preparedness. High clinical learning challenge was defined as a total score[Formula: see text] percentile ([Formula: see text]. Data were analyzed using descriptive statistics and logistic regression analysis. Variables with p-value < 0.25 in Bivariable analysis were considered for multivariable logistic regression. Statistical significance was declared at p-value < 0.05. RESULTS: A total of 280 nursing students participated (response rate 93.3% of 300 invited). The most prevalent challenges were overcrowding in the clinical ward (74.3%), inadequate clinical materials and equipment (69.9%), and a high student-to-patient ratio limiting hands-on practice (67.5%). Overall, 137 (48.9%) students experienced high clinical learning challenges. In multivariable analysis, third-year academic standing (AOR = 2.48, 95% CI: 1.36-4.52), moderate-to-severe anxiety (AOR = 2.58, 95% CI: 1.49-4.46), moderate-to-severe depression (AOR = 1.95, 95% CI: 1.14-3.33), and inadequate skill laboratory preparation (AOR = 2.18, 95% CI: 1.32-3.60) were independently associated with high clinical learning challenges. CONCLUSION AND RECOMMENDATION: Nearly half of nursing students experienced clinical learning challenges during clinical attachment. Poor skill laboratory preparation, psychological distress, and advanced academic year were key determinants. Strengthening skill laboratory training, improving clinical supervision, and providing psychological support services were recommended.

BACKGROUND: Non-contact sexual violence (NCSV) and its trauma remain understudied, limiting prevention and legal protection. This national study examined NCSV patterns and compared sexual, psychological, and social health among women with and without NCSV experiences globally. METHODS: A controlled cross-sectional study recruited 540 married women aged 18-76 years from all 31 provinces of Iran between November 2022 and June 2023 using online and in-person convenience sampling. Participants were categorized into NCSV + and NCSV- groups. Demographic data, NCSV patterns, and standardized measures of sexual, psychological, and social health were collected. Data were analyzed using independent t-tests, chi-square tests, and backward logistic regression. RESULTS: Overall, 16.9% of women reported experiencing NCSV, with a mean age of victimization of 12.3 (5-32) years. Nearly half were under 13, 36.6% were 13-18, and 13.8% were over 18 at exposure. Exhibitionism was reported by 86.1%. Most incidents (44.8%) occurred once and were mainly perpetrated by strangers (68.4%). 74% of survivors never disclosed the experience. While univariate analyses showed negative associations between NCSV and multiple sexual and psychological variables, backward logistic regression identified higher risks of depression, sexual dysfunction, sexual avoidance, and lower religiosity. CONCLUSION: The reported prevalence and severity, the wide age range of survivors, and the silence of three in four women highlight that NCSV occurs across diverse groups and warrants attention. These findings also suggest the potential harm associated with NCSV and underscore the importance of raising awareness, providing education on sexual self-care, and ensuring access to support services. TRIAL REGISTRATION: Not applicable.

BACKGROUND: The pervasive penetration of social media is reshaping the generative logic and communication pathways of health anxiety, which is significantly impacting public mental health and individual behavior. This study aimed to examine the topic threads of health anxiety discussions on Sina Weibo as well as the threat and efficacy elements contained in the health-related messages through the Extended Parallel Process Model (EPPM) framework. METHODS: A total of 138,587 social media posts related to health anxiety were collected using keyword combination of "health" AND ("worry" OR "concern" OR "anxiety") on the Weibo open API. Latent Dirichlet Allocation (LDA) model procedures were applied to identify the main topics in health anxiety discussions. Moreover, 1,480 most popular posts ranked by "Like" clicks were selected for manual textual analysis. Based on the Extended Parallel Process Model (EPPM), four dimensions-severity, susceptibility, self-efficacy, and response efficacy-were used as the coding framework for content analysis to systematically ascertain the topic structure, information characteristics and information engagement with health anxiety Weibo discussions. RESULTS: Discussions of health anxiety cover a wide range of topics. The most prominent topic is positive living and health ideals (intensity = 0.4456), and other major topics include sleep disorders and mental health, adolescent mental health education and social adaptation, healthy lifestyle and self-management. There is a noticeable imbalance between elements of threat and efficacy in health anxiety discussions. Threat information dominates health anxiety discussions, with severity being the most prevalent component (73.24%). Conversely, efficacy information is much less featured, particularly regarding response efficacy (16.15%). Higher perceived threat levels in health anxiety discussions correlate with reduced engagement (fewer likes), whereas greater efficacy information levels are associated with increased engagement (more likes). CONCLUSIONS: Health anxiety discussions on social media exhibit a generative logic characterized by thematic threads emphasizing positive confidence-building, proactive measures, ailment-specific guidance, and subgroup-focused solution tips. Users' conception of health anxiety reflects a contradictory pattern of "high threat-low efficacy", wherein information about health threats is far more prevalent than information about self-efficacy. These findings show that EPPM-related threat and efficacy elements are distributed in user-generated Weibo discussions.

BACKGROUND: Post Covid-19 Condition (PCC) can fluctuate over time, yet, no in-depth investigation of the heterogeneous PCC trajectories that can exist in children and young people (CYP) has been undertaken. We aim to examine associations between PCC trajectories in CYP over 2-years following infection and (i) factors prior to the COVID-19 pandemic/infection including socio-demographic variables (e.g., age, sex, ethnicity), health and educational needs status and (ii) factors subsequent to infection including the nature, number, functional impact and severity of symptoms, as well as mental health and wellbeing. METHODS: 943 PCR-test positive CYP (enrolled January-March 2021) were followed-up over two-years (till January-March 2023). Five PCC trajectory groups were specified: (i) chronic, (ii) recovered, (iii) fluctuating, (iv) late onset and (v) never PCC. These groups were compared in terms of factors at baseline using multinomial logistic regression and concurrent health during the two-year period using Chi-Square/Fisher's Exact tests. RESULTS: Baseline factors prior to the pandemic/infection such as female sex, older age, poorer pre-infection mental and physical health, prior healthcare use, and educational needs were strongly and consistently associated with adverse PCC trajectories. Compared to those aged 11-to-14-years at infection, those aged 15-to-17-years had a 2.44 (95%CI:1.39,4.26) higher risk of being in the chronic group (compared to the never group). Similarly, the risk of being in the fluctuating group was 1.57 (95%CI:1.04,2.37), the recovered group was 2.08 (95%CI:1.10,3.92) and the late-onset group was 1.50 (95%CI:1.08,2.07). Other sociodemographic factors, such as ethnicity and region of residence, had more modest and inconsistent associations. PCC trajectories differed by concurrent number, frequency, functional impact and severity of symptoms and mental health. CYP with chronic PCC consistently reported a higher median number of symptoms (5+) compared to the other groups (median symptoms ≤ 3). Mental health and wellbeing, of the chronic PCC group was also consistently worse (e.g., 41% of the chronic group consistently were classified as 'cases' on the Strengths and Difficulties scale vs 17%-to-2% of the other groups). CONCLUSIONS: There were consistent differences between PCC trajectories, in terms of sex, age, pre-infection mental and physical health, healthcare use, and educational needs. Understanding factors associated with PCC trajectory heterogeneity in CYP and how these trajectories differ over time can help with treatment planning.

BACKGROUND: Over 500 million people experience anxiety and/or depression globally, underscoring the need for accessible and sustainable psychological support. In England, Talking Therapy (TT) services provide cost-effective, evidence-based low-intensity interventions for mild to moderate anxiety and/or depression. Although over half of patients reach recovery by the end of treatment, relapse rates exceed 50% within one year, highlighting the importance of understanding how recovery is maintained post-discharge. This study examined current practices supporting the maintenance of treatment gains, identified factors that help or hinder sustained recovery, and explored opportunities to strengthen long-term relapse prevention support. METHODS: Semi-structured interviews were conducted with patients (N = 23) who met recovery criteria for anxiety and/or depression at the end of low-intensity treatment delivered across four NHS Trusts in Northern England. Data were analysed using the Consolidated Framework for Implementation Research (CFIR) to explore multilevel influences on recovery maintenance. RESULTS: Findings mapped onto CFIR domains. Within the intervention domain, relapse-prevention components were limited and inconsistently delivered, with many patients receiving only brief discussion or written materials. In the inner setting, discharge processes and follow-up practices varied, creating gaps in structured maintenance. Outer-setting influences such as employment stressors, bereavement, and access barriers hindered recovery. At the level of individual characteristics, memory difficulties, self-regulation demands, and reliance on social networks shaped the sustainment of treatment gains and wellbeing. Process issues included the absence of planned transitions to community resources, highlighting opportunities to strengthen support pathways. Participants proposed improvements spanning both clinical maintenance (e.g., routine follow-up, consolidation of skills) and personal recovery (e.g., enhanced social/peer networks and clearer community linkages) to promote long-term wellbeing. CONCLUSION: The study highlights the need to strengthen both clinical relapse-prevention practices and broader personal-recovery supports to enhance long-term outcomes following low-intensity psychological treatment. Although situated within NHS TT services, the mechanisms identified-self-regulatory maintenance processes, memory-related barriers, and social-network influences-are internationally relevant and align with global efforts to scale brief psychological interventions. These findings provide transferable insights for improving sustained recovery in diverse mental-health systems. CLINICAL TRIAL NUMBER: Not applicable.

BACKGROUND: Rotator cuff tears are common and debilitating, with arthroscopic repair being the preferred treatment. However, the relationship between kinesiophobia and shoulder function remains insufficiently explored. OBJECTIVES: This study aims to assess shoulder function and kinesiophobia levels in patients six weeks after arthroscopic rotator cuff repair (ARCR) of the supraspinatus tendon, and to explore their interrelationships to provide insights for improving recovery and patient outcomes. METHODS: The study involved 129 patients who had undergone ARCR of the supraspinatus tendon at a tertiary hospital in Wuhan, Hubei Province, China, between March 2023 and May 2024. A general information questionnaire, the Tampa Scale of Kinesiophobia (TSK), the Constant-Murley Score (CMS), the Self-Efficacy for Exercise (SEE) scale, the Groningen Orthopaedic Social Support Scale (GO-SSS), the Numeric Pain rating scale(NRPS), the Generalized Anxiety Disorder-2 (GAD-2) and the Patient Health Questionnaire-2 (PHQ-2) were used to survey. Data were analyzed using descriptive statistics, correlation analysis, and regression models via SPSS 29.0 software. The STROBE checklist guides the reporting of the manuscript. RESULTS: The average TSK score was 46.90 ± 5.40, with 96.12% of patients scoring above the threshold for high kinesiophobia. The mean score for the CMS was 37.93 ± 16.04. Analysis revealed that TSK score (β = -0.149, p = 0.027), age (β = -0.189, p = 0.005), and NRPS score (β = -0.658, p < 0.001) significantly influenced CMS scores, accounting for 52.7% of the variance in shoulder function. CONCLUSIONS: Kinesiophobia is at a high level among patients 6 weeks after ARCR of the supraspinatus tendon. Higher levels of kinesiophobia are associated with poorer shoulder function following the surgery. RELEVANCE TO CLINICAL PRACTICE: Future clinical practice may consider assessing kinesiophobia during early postoperative care to identify patients after ARCR of the supraspinatus tendon with fear of movement, which could be considered when planning individualized rehabilitation strategies.

This systematic literature review investigates the complex relationship between religiosity and adolescents' mental health. While previous research has often highlighted the benefits of religiosity for wellbeing, this review synthesises findings from ten studies across multiple countries and religious contexts to examine how religiosity relates to adolescents' mental health, conceptualised broadly as encompassing emotional, psychological and social wellbeing. Seven databases were searched using explicit inclusion and exclusion criteria, and studies were critically appraised using Gough's Weight of Evidence framework. Findings reveal that religiosity can enhance adolescents' mental health by promoting purpose in life, happiness, life satisfaction, self-esteem, and positive affect, and by buffering against anxiety, depressive symptoms, and stress from discrimination. A limited number of studies showed that religiosity can also have neutral or negative effects, particularly when adolescents display extrinsically motivated or passive religious engagement, or hold rigid or negative attitudes toward religion. The review highlights gaps in the literature, including limited exploration of psychological and social wellbeing, the mechanisms through which religiosity influences mental health, and cross-cultural variations. Implications for schools, psychologists, and adolescent mental health interventions are discussed, alongside recommendations for future longitudinal, qualitative, and culturally diverse research to more comprehensively understand how adolescents' religiosity can both support and challenge mental health.

Brain insulin action was measured in adolescents with (cases) and without (controls) depression, by calculating the difference in resting-state functional connectivity (ΔrsFC) following an intranasal insulin challenge. A significant Group × Condition interaction effect was identified: controls exhibited greater ΔrsFC with intranasal insulin compared to cases in brain regions regulating cognitive/emotional processing.

Sociopolitical stress associated with the policies and rhetoric coming from recent U.S. presidential administrations is of particular concern vis-à-vis Hispanic individuals, who have been disproportionately targeted for detention and deportation. Such stress may be associated with symptoms of depression and anxiety, and ultimately with tobacco use. However, there is a paucity of research examining how sociopolitical stress is associated with mental health problems and substance use among Hispanic emerging adults. Accordingly, the present study was designed to examine the extent to which, within a sample of Mexican American college students, sociopolitical stress would be linked with tobacco use indirectly through symptoms of depression and anxiety. A cross-sectional sample of 997 Mexican American college students in Texas completed measures of sociopolitical stress, depressive symptoms, anxiety, and cigarette and e-cigarette use. More than 75% of participants agreed/strongly agreed with each of the sociopolitical stress items, suggesting high levels of sociopolitical stress within the sample. Structural equation models indicated that sociopolitical stress was associated directly with depressive symptoms (β = 0.16, p < .001) and indirectly with both cigarette (b = 0.01, 95% CI = 0.002, 0.015) and e-cigarette (b = 0.02, 95% CI = 0.005, 0.033) use and sociopolitical stress was associated directly with anxiety (β = 0.16, p < .001) and indirectly with both cigarette (b = 0.01, 95% CI = 0.001, 0.014) and e-cigarette (β = 0.02, 95% CI = 0.008, 0.037) use. Intervention and policy work is needed to offset the associations of sociopolitical stress associated with recent U.S. administrations vis-à-vis mental health symptoms and tobacco use among Hispanic populations, including college students.

Chronic physical illnesses such as diabetes and hypertension are risk factors for psychiatric morbidity among medical clinic attendees. Failure to identify psychiatric morbidity may result in a significant financial burden on the healthcare system and on individuals by increasing hospital visits and needless investigations. The Sri Lankan population has been undergoing unprecedented health, political and economic issues since 2019, potentially worsening the mental health of many individuals. This study aims to detect the prevalence of psychiatric morbidity (symptoms of anxiety, stress, and depression) among medical clinic attendees at a tertiary care hospital in Sri Lanka, and explore associated sociodemographic and medical factors. Conducted at the North Colombo Teaching Hospital in Ragama, this descriptive cross-sectional study enrolled 350 consecutive participants who provided informed consent. An interviewer-administered questionnaire collected sociodemographic and medical data, complemented by DASS-21 scale for screening depression, anxiety, and stress. Descriptive statistics were used to summarize the study population. Group comparisons were done using Chi-square tests, Fisher's exact test, and Wilcoxon rank sum test. Independent predictors associated with psychiatric morbidity were identified using binary logistic regression. Of 350 participants, 203 (58%) were females; 195 (55.7%) were aged 60 years or more. 10.0% of participants screened positive for anxiety symptoms (95%CI 6.9-13.1%), 9.7% for stress symptoms (95%CI 6.6-12.8%), and 22.6% for depression symptoms (95%CI 18.2-26.9%). Participants who screened positive for anxiety had a higher number of comorbidities (P = 0.01), as did those who screened positive for stress (P = 0.025). Participants with hypertension (P = 0.04) and asthma (P = 0.01) were more likely to screen positive for depression symptoms. Multiple variable logistic regression revealed that clinical and socioeconomic factors were independent predictors of psychiatric morbidity. The odds of anxiety and stress increased with each additional physical comorbidity (OR 1.45, 95% CI 1.09-1.96 and OR 1.51, 95% CI 1.14-2.03, respectively). Females had nearly three times higher odds of screening positive for anxiety (OR 2.83, 95% CI 1.24-7.19). Depressive symptoms were primarily associated with economic indicators; for every 1000 LKR increase in monthly medication expenditure, the odds of depression rose by 6% (OR 1.06, 95% CI 1.01-1.12). The study highlights a concerning prevalence of symptoms of anxiety, stress and depression among medical clinic attendees, particularly among those with multiple comorbidities and socio-economic challenges. There is a need for effective mechanisms to identify and address these mental health issues within this vulnerable population.

Lithium chloride (LiCl) aqueous solutions are widely used in chemical, biological, and industrial applications due to their high solubility, hygroscopicity, and antifreeze properties. This study investigates how Li and Cl ions influence the structural and dynamic behavior of water molecules during freezing and melting processes. In-situ Raman spectroscopy was employed to analyze these solutions with varied concentrations and temperature ramping rates. Vibrational features, including OH stretching, HOH bending, and low-frequency lattice modes, were monitored to elucidate ion-induced changes. For the 1.5 M LiCl solution, a visual indicator, methylene blue, was used to track freezing and melting transitions. A unique behavior of LiCl, characterized by chain-like aggregation, was observed at low temperatures in the liquid phase, where increasing ion concentration with decreasing temperature coincided with the disappearance of the HOH bending band. The spectral shifts correlated with increased salt concentration, confirming freezing point depression and two-step structural transformations. This work deepens the understanding of ion-specific effects on the vibrational behavior and phase transitions of water.

Obsessive-compulsive disorder (OCD) has been increasingly linked to alterations in functional connectivity (FC) across large-scale brain networks, particularly the default mode (DMN), salience (SN), and central executive network (CEN), known as the triple-networks. However, little is known about how connectivity patterns evolve following treatment. We examined both static and dynamic resting-state FC in 25 adults with OCD and 21 matched healthy controls (HCs) at baseline, one week, and three months following intensive exposure and response prevention (ERP) using the Bergen 4-Day Treatment (B4DT). Independent component analysis (ICA) and sliding-window approaches were used to evaluate network connectivity within and between the triple networks. At baseline, adults with OCD showed stronger static connectivity within the DMN and SN and spent more time in a dynamic connectivity state characterized by strong connectivity within the DMN and decoupling between the DMN and SN compared to controls. Following the 4-day intensive treatment, these abnormal patterns normalized and remained stable at the three-month follow-up. A higher number of transitions between states was associated with reductions in the severity of OCD, anxiety, and depressive symptoms. Additional correlation analyses indicated that higher baseline SN-CEN connectivity was associated with greater symptom severity, while post-treatment reductions in CEN and CEN-SN static connectivity were linked to improvements in depressive symptoms. These findings suggest that effective ERP promotes a normalization of both static and dynamic connectivity within and between the triple networks. Thus, dynamic metrics, alongside static measures, may serve as clinically meaningful biomarkers of therapeutic response.

Psychiatric and cardiovascular diseases (CVDs) are frequently comorbid and are interconnected through the brain-heart axis. However, the underlying shared genetic etiology remains unknown in East Asians. To address this critical gap, we conducted a genome-wide pairwise trait pleiotropy study by leveraging genome-wide association studies of three major psychiatric disorders (schizophrenia [SCZ], bipolar disorder [BIP], major depressive disorder [MDD]) and ten cardiovascular traits (including eight CVDs) in East Asians. We identified genetic overlaps across seven disease pairs, such as SCZ with coronary artery disease. Through this pairwise approach, six of a total of 18 pleiotropic loci demonstrated tissue-specific expression in brain and cardiovascular systems. In the cross-ancestry replication, nine of the pleiotropic loci were validated. Among the novel pleiotropic genes, TPCN1, CACNA2D2, CACNA1D, and ATP2B1 are involved in voltage-dependent calcium channel activity, regulation of calcium influx, enriched in calcium-related pathway. We validated association with calcium signal pathway in an independent cohort. Calcium pathway-specific polygenic risk score for SCZ was associated with prolonged corrected QT (QTc) interval, which remained robust among individuals free from QTc-affecting drugs. Given that calcium-channel blockers are commonly prescribed for heart and blood vessel conditions, we performed drug target analysis by integrating gene expression profiles from the brain and cardiovascular tissues. Our findings implicated that calcium-channel blockers and peripheral vasodilators elevated SCZ risk, diuretics reduced the risks of SCZ, BIP, and MDD. Our study reveals extensive shared genetic architectures underlying psychiatric and CVDs, which warrant prudence in the use of calcium channel blockers among patients with concurrent psychiatric and CVDs.

Plasma protein levels provide important insights into human disease, yet a comprehensive assessment of plasma proteomics across organs is lacking. Using large-scale multimodal data from the UK Biobank, we integrate plasma proteomics with organ imaging to map their phenotypic and genetic links, analyzing 2923 proteins and 1051 imaging traits across multiple organs. We uncover 5067 phenotypic protein-imaging associations, identifying both organ-specific and organ-shared proteomic relations, along with enriched protein-protein interaction networks and biological pathways. Sensitivity analyses suggest that these associations are not substantially influenced by the median 10.18-year interval between plasma sampling and imaging visits. We also map key protein predictors of organ structures and show the stratification capability of plasma protein-based prediction models. Furthermore, we identify 8116 putative causal protein-imaging links. Imaging-associated protein components show enrichment across diverse complex diseases. Our study shows that integrating plasma proteomics with multi-organ imaging provides a comprehensive pan-organ imaging-proteomics map and reveals molecular pathways linking circulating proteins to human organ biology.