Maternal mental health is a major global concern affecting both pregnant women and fetal development. Mindfulness-based interventions (MBIs) have shown benefits in improving maternal mental health. This study assessed the effects of digital and conventional face-to-face MBIs on psychological distress among pregnant women. Two independent reviewers conducted the literature search and study selection. PubMed, SCOPUS, Web of Science, Cochrane Library and ScienceDirect were searched for studies published between 2014 and 2025; 27 studies were included, involving 1,793 participants in the digital MBI group and 2,406 in the face-to-face MBI group. Standardized Mean Difference (SMD) with 95% CI was calculated for psychological distress (depression, stress, and anxiety) outcomes. Heterogeneity was assessed using Chi-square and I statistics. Due to substantial heterogeneity, a random-effects model and subgroup analyses were applied. MBIs during pregnancy were found to be effective, with overall SMDs of -0.77 for anxiety, -0.57 for depression and -0.64 for stress. In the subgroup analysis, digital MBI studies also showed significant reductions in anxiety (SMD =  -0.56, 95% CI: -0.92 to -0.20;  = 0.006), depression (SMD =  -0.43, 95% CI: -0.69 to -0.17;  = 0.001), and stress (SMD =  -0.70, 95% CI: -1.12 to -0.27;  = 0.001) compared with standard care. MBIs were effective in reducing psychological distress among pregnant women. Both digital and face-to-face MBIs improved maternal psychological well-being, with digital MBIs showing comparable benefits in some studies. However, substantial heterogeneity across studies indicates the need for further high-quality research to confirm these findings.

OBJECTIVE: While the association between suicide and sleep problems has been reported, the effect size and temporal directionality remain unclear. This study examined whether sleep problems prospectively predict suicidal ideation. METHODS: In 2022, a self-administered online questionnaire including the Pittsburgh Sleep Quality Index (PSQI), the Patient Health Questionnaire-9, and the Suicidal Ideation Scale (SIS) was distributed to a stratified random sample from a web survey panel and to local city government officers. The same questionnaire was administered again after 3 months. Cross-lagged model analyses were conducted to assess temporal and directional associations. RESULTS: A total of 652 participants (mean age, 49.7 years) provided valid responses at both time points. Weak suicidal ideation was observed in 25.2% of participants, and moderate-to-strong ideation in 3.7% (SIS Q1: "wish to die"). Sleep disturbance (PSQI ≥ 6) was observed in 32.8% of participants. Cross-lagged analyses showed that PSQI global score and sleep latency prospectively predicted suicidal ideation. These associations remained significant after adjusting for depressive symptoms. Bidirectional associations between sleep disturbance and suicidal ideation were also observed. The presence of sleep disturbance predicted future suicidal ideation in univariate analysis (OR = 3.97) and remained significant in the PHQ-9-adjusted model (OR = 1.59). CONCLUSION: Sleep problems were identified as prospective predictors of suicidal ideation. Sleep disturbances may represent modifiable targets for intervention in suicide prevention.

An estimated 60% of autistic adults suffer from insomnia symptoms, which significantly impairs daily functioning and wellbeing. This study evaluated the effectiveness of i-Sleep Autism, a 5-week, guided self-help internet-delivered cognitive behavioral therapy-based intervention (ICBT-I) for insomnia in autistic adults. In co-creation with seven autistic adults with sleeping problems, i-Sleep Autism was adapted from i-Sleep, a pre-existing non-autism specific intervention. A total of 163 adults with autism and insomnia (ISI≥10) was randomly allocated to i-Sleep Autism (n=82) or waitlist control (n=81; receiving psychoeducation and sleep hygiene). Participants were assessed at baseline (T0), mid-intervention (T1; 3-weeks), post-test (T2; 6-weeks), and follow-up (T3; 6 months) on insomnia severity (primary outcome), pre-sleep arousal, anxiety, depression, daily functioning, and quality of life. In the intervention group, 56.1% completed four, and 50% all five modules. Intent-To-Treat analyses revealed a significant reduction in insomnia severity at T1 and T2 (d = 1.02, 95%CI = [0.65, 1.40]), and cognitive- and somatic pre-sleep arousal at post-test, when comparing intervention to control. The intervention group showed significantly higher quality of life at post-test. At T2, 37.8% of the intervention group versus 11.1% of the control group showed clinically meaningful improvement of insomnia. Effects on insomnia severity were maintained at 6-month follow up. No significant effects were found for anxiety, depression, or daily functioning. This is the first RCT to investigate autism-adapted ICBT-I for autistic adults suffering from insomnia. i-Sleep Autism effectively and sustainably improves insomnia. Additional strategies are needed to support dropouts and those who did not benefit.

OBJECTIVES: A mixed-methods process evaluation was conducted alongside a randomised controlled trial of iACT4CARERS: an eight-session, online, self-help, Acceptance and Commitment Therapy (ACT) intervention with minimal therapist support for family carers of people with dementia. While the RCT evaluated its effects on anxiety, depression, and psychological flexibility, this study examined intervention implementation (fidelity and dose), contextual factors influencing engagement, and mechanisms of impact, focusing on how participants engaged with intervention content and therapist support to produce expected changes. METHODS: Data were collected from 249 intervention-group carers, including demographics, between-session ACT skill use, weekly values-based goal completion, and change in psychological flexibility (CompACT) from baseline to post-intervention. Platform analytics captured session completion and therapist interaction. Semi-structured interviews were conducted with a purposive sample of 28 carers (21% ethnic minority). RESULTS: iACT4CARERS was generally well received, with high completion, particularly among older, unemployed, and spousal carers. Engagement was shaped by carers' perceived need, reflecting subjective experience rather than dementia stage. Changes in psychological flexibility were influenced by carers' resonance with metaphors and case examples, and by their engagement with intervention content (e.g. note-taking) and therapists (e.g. therapeutic relationships). CONCLUSION: iACT4CARERS largely operated as intended; identified refinements could further enhance engagement and benefits.

OBJECTIVES: There is a scarcity of mental health promotion interventions tailored to older adults. This study describes a pilot test of Ethical Will Circle, a novel five-session digitally delivered group intervention in which participants create, revise, and share legacy-focused ethical wills to facilitate the developmental tasks of life review and self-acceptance. METHODS: This mixed methods, single-arm study tested preliminary feasibility, acceptability, and mental health benefits of the Ethical Will Circle. Two cohorts ( = 30) of community-dwelling adults were 60-87 years old ( = 69.83, SD = 6.19), 80% cisgender women, 76.7% White, 16.7% Black or Black Multiracial, and 40% disabled. Well-being and social connectedness outcomes were assessed through study engagement, semi-structured interviews, and pre-, post- and follow-up self-report measures. RESULTS: Study retention was 83.33%; 100% of interviewed participants would recommend the intervention. Participants' depression decreased ( = -0.60), generativity increased ( = 0.48), and psychological well-being increased ( = 0.34) at post-test. Participants reported that writing ethical wills was challenging yet gratifying and described themes of peer validation and enhanced self-understanding, self-acceptance, social connectedness, and narrative coherence. CONCLUSIONS: Findings support the feasibility and acceptability of the Ethical Will Circle intervention among community-dwelling older adults. Evidence of potential mental health benefits suggests further rigorous investigation with diverse samples is warranted.

INTRODUCTION: Depression is a highly heterogeneous disorder with a similarly heterogeneous neurobiological background. Understanding separate depressive phenotypes, driven by distinct aetiological pathways like early trauma and neurobiological contributors, can improve treatment. Furthermore, sex differences must be considered, as both the development and treatment of depression may be sex-specific. We aimed to investigate the sex-dependent association between polygenic risk for chronotypes, childhood traumas, and depression. METHODS: In a discovery sample of 273,033 participants GWASs were ran and polygenic risk scores (PRS) were calculated in a target sample of 25,476 participants, separately for morning and evening chronotypes. Effects of chronotype-PRS in interaction with childhood adversities were analysed. RESULTS: We identified 39 significant lead-SPNs (single nucleotide polymorphisms) and 44 genes associated with morning chronotype, and 69 significant lead-SNPs and 76 genes for evening chronotype. Heritability was comparable, at 12.1% for morning and 11.8% for evening chronotypes. No significant main effect of either chronotype-PRS was found on depressive symptom scores, however, in interaction with childhood traumas, morningness-PRS showed a significant effect on depressive symptom scores in women. DISCUSSION: Our findings highlight important sex differences in the aetiological role of known risk factors for depression, such as chronotype or early trauma, and may have implications in the prevention of mood disorders in those genetically vulnerable and exposed to early risk factors.

BACKGROUND: Radiologically isolated syndrome (RIS) is traditionally viewed as a preclinical state. However, emerging evidence suggests it represents an active subclinical stage of the multiple sclerosis (MS) spectrum. This systematic review integrates evidence across cognitive and psychosocial domains, along with secondary neuroimaging and biomarker findings, to explore the clinical conceptualization of RIS. METHODS: Following PRISMA guidelines, a systematic search was conducted across PubMed, Cochrane Library, and ClinicalTrials.gov for studies published between January 2010 and May 2026. Eligible studies focused on cognitive performance, psychosocial measures, and biomarkers in RIS. Quality was evaluated using the ROBINS-E tool. RESULTS: Thirteen studies met the eligibility criteria and were included in the final synthesis. The evidence reveals that a substantial proportion of individuals with RIS exhibit cognitive impairment, with information processing speed and executive functions being the most affected domains. Psychosocial burdens, including clinical depression and pathological fatigue, are prevalent and significantly impact quality of life. Furthermore, advanced neuroimaging and molecular biomarkers confirm ongoing neurodegeneration and inflammatory activity, characterized by cortical thinning, thalamic atrophy, and elevated neurofilament levels. Despite these subclinical changes, evidence suggests that baseline cognitive performance does not consistently predict short-term clinical conversion to symptomatic MS. CONCLUSIONS: Current evidence suggests that at least a subset of individuals with RIS may represent an active subclinical phase of MS involving measurable neuroaxonal damage and psychosocial deterioration. However, given the limited number of studies and high risk of bias, definitive conclusions remain challenging. These findings highlight the potential need for a paradigm shift in clinical management, where incorporating targeted neuropsychological assessments and sensitive biomarkers could aid in accurate disease staging and optimized risk stratification.

Violence towards companion animals (CAs) is prevalent in cases of intimate partner violence (IPV), and several studies have emphasized its impact on survivors' well-being and decision-making process. However, little is known about its effect on perceived social support among female IPV survivors. This study aims to address this gap. In this study, a sample of 70 female IPV survivors who owned a CA at the time of the abuse completed a protocol including the Portuguese version of the Personality Assessment Inventory (PAI). Independent samples -tests compared Nonsupport (NON) scale scores between survivors with and without reports of violence towards CAs, and linear regression examined the predictive effect of reported CA-directed violence, controlling for other relevant variables (e.g., unemployment, other PAI scales). Over half of the participants reported abuse directed at their CAs by their partners. Those who reported CAs abuse scored significantly higher on the NON scale, indicating a greater perceived lack of social support. The linear regression model was statistically significant, suggesting that reporting violence against CAs, higher Depression scale scores, lower Traumatic stress scale scores, and unemployment had a significant impact on NON scale scores. Potential explanations are discussed, including the dual role of CA as both social and emotional support providers, and as tools of coercion and control used by the perpetrator. These findings underscore the importance of integrated human and animal welfare services and support the development of professional training programs and legislative reforms to protect IPV survivors and their CAs.

BACKGROUND: Ovarian cancer is one of the most common gynecological cancers in women. Its diagnosis and treatment often cause significant psychological distress, mainly reflected in depression and anxiety, which arise from multiple interacting factors. This study, grounded in Lazarus's Stress and Coping Model and from the perspective of set theory, aimed to investigate the correlates and configurational pathways of high and low levels of depression and anxiety symptoms in ovarian cancer patients by integrating stress sources, coping styles, and coping resources. METHODS: The study recruited ovarian cancer patients from a tertiary general hospital in Shenyang, China. The analysis included 169 ovarian cancer patients. The configurational factors included self-perceived burden (SPB), positive and negative coping styles, self-esteem, and general self-efficacy. Multiple linear regression and fuzzy-set qualitative comparative analysis (fsQCA) were used to explore the factors and configurational pathways related to depression and anxiety symptoms. RESULTS: The fsQCA identified six configurational pathways linked to high and low levels of depression symptoms. Similarly, the fsQCA identified two configurations linked to high anxiety symptoms and four configurations related to low anxiety symptoms. Moreover, the configurations associated with low psychological symptoms did not stand in opposition to those associated with high psychological symptoms. Substitutability and complementarity were observed among the various elements in the configuration. CONCLUSION: The study generated multiple configurational pathways for depression and anxiety symptoms in ovarian cancer patients by examining the combined effects of stress sources, coping styles, and coping resources. The configuration allows caregivers and medical staff to implement targeted measures to reduce burden perception and negative coping, enhance positive coping and self-esteem considering their substitutability and complementarity.

PURPOSE: To evaluate whether oliceridine, a G protein-biased μ-opioid receptor agonist, reduces postoperative nausea and vomiting (PONV) compared with sufentanil in women undergoing gynecological laparoscopic surgery. PATIENTS AND METHODS: This prospective, double-blind, randomized controlled trial recruited 260 female patients, ASA physical status I-III, undergoing elective gynecological laparoscopic surgery under general anesthesia at Shanghai East Hospital, Shanghai, People's Republic of China. Patients were randomized to receive oliceridine (induction 0.05 mg/kg; postoperative infusion 0.4 mg/kg) or sufentanil (induction 0.5 μg/kg; postoperative infusion 2.0 μg/kg), with standardized general anesthesia and prophylactic antiemetics. The primary outcome was 48-hour cumulative PONV incidence. Secondary outcomes included PONV severity, opioid-induced respiratory depression (OIRD), adverse events, pain scores, 15-item Quality of Recovery (QoR-15) score, and patient satisfaction. All analyses were performed on the modified intention-to-treat population. RESULTS: The 48-hour PONV incidence was significantly lower with oliceridine (22.5% vs 43.0%; odds ratio 0.38; 95% CI 0.22-0.66; < 0.001), with consistent findings after multivariate adjustment. The absolute risk reduction was 20.5%, with a relative risk of 0.52, and a number needed to treat of 5, representing a clinically meaningful antiemetic advantage. Severe PONV was reduced (3.9% vs 15.6%, = 0.02). No significant differences were observed in pain scores or rescue analgesia. Oliceridine patients reported higher QoR-15 scores (median 123 vs 116, = 0.002) and greater satisfaction (69.0% vs 50.8%, = 0.02). OIRD and dizziness trended lower but were not significant after multiplicity correction. CONCLUSION: Oliceridine significantly reduced PONV incidence and improved recovery quality and patient satisfaction compared with sufentanil, without compromising analgesia, in women undergoing gynecological laparoscopic surgery.

BACKGROUND: Survival following critical illness has improved substantially; however, many individuals experience persistent psychological sequelae after discharge from intensive care units. These outcomes may adversely affect long-term recovery, quality of life, and reintegration into daily roles, underscoring the need for a comprehensive synthesis of current evidence. OBJECTIVE: To synthesize evidence published between 2021 and 2025 on psychological outcomes among ICU survivors and identify associated factors. METHODS: This systematic review employed a convergent integrated approach for data synthesis. The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Six electronic databases (PubMed, MEDLINE via EBSCO, ScienceDirect, Scopus, Nursing & Allied Health Premium, and the Cochrane Library) were searched for studies published between 2021 and 2025. Studies were included if they reported psychological outcomes and associated factors among adult ICU survivors. Data were synthesized following the Joanna Briggs Institute methodology. RESULTS: Thirteen studies met the inclusion criteria. The most frequently reported psychological outcomes were depression, (9 studies; 69.2%), anxiety (8 studies; 61.5%), post-traumatic stress disorder (8 studies; 61.5%), and stress-related symptoms (1 study; 7.7%). Associated factors were grouped into seven domains: personal characteristics, length of stay, distress-related factors, pre-existing mental health or substance use, physical and cognitive function, and protective factors. Women were more frequently reported to experience higher psychological distress across several studies, while some evidence suggested higher symptom burden among patients with longer ICU stays and poorer physical or cognitive function. While consistent patterns were observed, the strength of evidence varied across domains. CONCLUSION: Psychological outcomes are commonly reported among ICU survivors and appear to be influenced by multiple interrelated factors. However, given the limited number, heterogeneity, and predominantly observational nature of included studies, these findings should be interpreted with caution. Further research is warranted to strengthen the evidence base and inform targeted interventions.

Postoperative respiratory depression (PORD) and other postoperative pulmonary complications (PPCs) represent significant contributors to perioperative morbidity and mortality in companion animal practice. The Confidential Enquiry into Perioperative Small Animal Fatalities (CEPSAF) established that cardiovascular and respiratory causes account for approximately 74% and 72% of perioperative deaths in dogs and cats, respectively, with 47% of canine and 61% of feline anesthetic-related deaths occurring in the postoperative period. PORD arises from a convergence of opioid-induced respiratory depression (OIRD), residual inhalant anesthetic effects, other drug-induced effects (e.g., neuromuscular blockade), and patient-specific vulnerabilities. PPCs encompass a broad spectrum of conditions, including atelectasis, aspiration pneumonia, pneumonia, hypoventilation, acute respiratory distress syndrome (ARDS), and respiratory arrest, with laparotomy studies reporting a PPC incidence of 22% in dogs. This narrative review synthesizes current evidence on the pathophysiology, risk factors, diagnostic approaches, prevention strategies, and treatment of PORD and PPCs in veterinary practice, incorporating insights from both veterinary-specific and translational human anesthesia literature, while explicitly identifying areas where veterinary-specific evidence remains limited. The importance of continuous monitoring during the postanesthetic period, multimodal analgesia to reduce opioid exposure, protective lung ventilation strategies, and early intervention is highlighted as a key strategy to improve outcomes, together with the unmet need for reversal-independent ("agnostic") respiratory stimulants capable of countering PORD irrespective of the causative agent.

Nutrition plays a pivotal role in determining the health outcomes of people living with human immunodeficiency virus (PLHIV), particularly those undergoing antiretroviral therapy. This narrative review explores the bidirectional relationship between HIV and nutritional status, highlighting both undernutrition and overnutrition as significant concerns. Evidence suggests that deviations from recommended dietary allowances negatively impact CD4 counts, body mass index, hemoglobin levels, and overall quality of life (QoL). Multiple studies reveal a growing prevalence of obesity among PLHIV, particularly among males, raising concerns about comorbidities such as cardiovascular disease and diabetes. Conversely, undernutrition remains a persistent issue in resource-limited settings and is associated with increased mortality and opportunistic infections. Socioeconomic factors, food insecurity, education, and behavioral practices strongly influence dietary habits and nutritional outcomes. In addition, studies from diverse geographic regions underscore the role of nutrition in modulating QoL, with mental health, social support, and education emerging as key determinants. A comprehensive, context-sensitive approach to nutrition is vital for optimizing HIV care and long-term management.

BACKGROUND AND OBJECTIVES: Gambling in older adults represents an emerging but still underrecognized mental health concern. Although gambling participation is increasingly observed in later life, the specific psychological, social, cognitive, and biological factors associated with gambling-related problems in older adults remain insufficiently characterized. METHODS: A systematic review was conducted in accordance with PRISMA guidelines. Empirical studies involving adults aged ≥55 years with Gambling were identified through searches of Web of Science, PubMed/MEDLINE, Scopus, PsycNET, ClinicalTrials.gov, and WHO ICTRP from January 15 to June 15, 2025. RESULTS: From 40,263 identified records, 35 studies met the inclusion criteria. The included studies, published between 2000 and 2025, primarily investigated gambling behaviors, severity, psychosocial correlates, and associated mental health outcomes in older adults. Commonly identified correlates to gambling-related problems included loneliness, reduced social support, financial difficulties, male gender, stressful life events, and early gambling initiation. Gambling was frequently reported as a recreational activity but could become maladaptive when used as a strategy to regulate negative emotions or cope with social isolation. Psychiatric comorbidity, particularly depression and anxiety, was frequently observed in clinical and high-risk samples. Evidence regarding psychological interventions remains limited but suggests potential benefits. DISCUSSION AND CONCLUSIONS: Current evidence highlights substantial gaps in age-specific assessment and targeted interventions. Future studies should prioritize tailored psychological interventions addressing loneliness, emotional regulation, cognitive distortions, and life transitions in later adulthood.

BACKGROUND: Discontinuation of mental health care is a persistent global challenge, with up to one-third of patients dropping out before treatment completion. Evidence on discontinuation from facility-based tele-mental health services in low- and middle-income countries remains limited. This study explores why patients disengage from facility-based tele-mental health services delivered through Wellbeing Centres in Bangladesh. METHOD: A qualitative study was conducted between October 2024 and February 2025 using mobile phone interviews. Participants were service recipients who had discontinued follow-up services provided by the Wellbeing Centres. A total of 26 interviews were conducted, and the data were analyzed thematically. RESULTS: Discontinuation was shaped by dynamic and sometimes contradictory patient experiences. First, perceptions of treatment outcomes influenced disengagement in complex ways: both perceived improvement and perceived lack of benefit led to discontinuation, reflecting shifting expectations of care. Second, everyday constraints-including fluctuations in mental wellbeing, competing life demands, distance from facilities, and communication gaps with providers-disrupted continuity of care. Third, family dynamics played a critical role, with limited support and motivation reducing sustained engagement with services. CONCLUSION: Discontinuation from facility-based tele-mental health services is not solely driven by access barriers but emerges from the interaction between perceived recovery, unmet expectations, and socio-cultural influences, particularly family involvement. Interventions should move beyond access-focused models to incorporate continuous patient engagement, clearer communication of treatment pathways, and active involvement of family members. These findings have implications for the design and scale-up of facility-based tele-mental health services in low- and middle- income countries (LMICs).

BACKGROUND: Alkaline phosphatase (ALP) plays an essential role in skeletal mineralization and bone metabolism. While elevated ALP levels are commonly investigated in clinical practice, persistently low ALP values are often overlooked despite their potential association with hypophosphatasia (HPP), a rare metabolic bone disorder caused by pathogenic variants in the ALPL gene. This study aimed to determine the prevalence and clinical characteristics of adults with persistently low ALP in a large tertiary care hospital. METHODS: We conducted a retrospective review of adult patients who underwent serum ALP testing at King Abdulaziz Medical City, Riyadh, between January 2017 and December 2024. Patients with ≥ 2 ALP measurements < 40 IU/L separated by at least 30 days were identified. Secondary causes of low ALP were excluded through review of clinical history, laboratory data, and medication records. Demographic, clinical, biochemical, and imaging data were analyzed. RESULTS: Among 243,362 adults with 928,403 ALP measurements, 7,307 patients (3.0%) had at least one ALP value < 40 IU/L. A total of 179 patients had ≥ 2 ALP measurements < 40 IU/L. After excluding 154 patients with secondary causes or incomplete data, 25 patients were identified with unexplained persistently low ALP (0.01% of the total tested population). The mean age was 52.2 years (range 18-92), and 68% were female. The mean nadir ALP was 30.2 IU/L. Musculoskeletal (MSK) symptoms (92%) and fatigue (79%) were the most common clinical manifestations, followed by dental abnormalities (50%), anxiety (33%), and depression (29%). Fractures were reported in 46% of patients, most commonly affecting the vertebrae, hips, and metatarsals. In subgroup analysis, patients with MSK symptoms had significantly lower nadir ALP levels (p = 0.021). Familial clustering of persistently low ALP was observed in 25% of patients. Notably, none of the reviewed electronic medical records documented recognition of persistently low ALP or consideration of hypophosphatasia. CONCLUSION: Persistently low ALP is uncommon but clinically relevant. Many affected patients demonstrated clinical features compatible with possible adult hypophosphatasia, and familial clustering suggests a possible genetic contribution. Greater awareness of this biochemical finding may improve recognition of potential HPP, prevent inappropriate antiresorptive therapy, and facilitate earlier diagnostic evaluation, including biochemical and genetic testing.

BACKGROUND: Young men who have sex with men (MSM) and transgender women (TGW) in Southern Africa experience a disproportionate burden of HIV, compounded by stigma related to HIV status and sexual orientation or gender identity (SOGI). These stigmas undermine mental health and antiretroviral therapy (ART) adherence, yet few integrated, community-informed interventions exist in low-resource settings. This study assessed the feasibility, acceptability, and preliminary impact of a peer-led pilot intervention to reduce stigma, improve mental health, and strengthen ART adherence among young MSM and TGW living with HIV in Malawi, Zambia, and Zimbabwe. METHODS: A mixed-methods parallel design was used, combining quantitative self-administered questionnaires with qualitative in-depth interviews. Seventy-two participants aged 18-24 years were recruited through community-based organisations, with 70 completing baseline and endline assessments. The intervention was initially designed as an 8-week programme grounded in the information-motivation-behavioural skills (IMB) model, however, it was subsequently reduced to 4 weeks due to time and logistical constraints and was delivered by trained peer facilitators under clinical supervision. Quantitative outcomes included measures of HIV-related stigma, SOGI stigma, depressive symptoms (CES-D-10), alcohol use (AUDIT), and ART adherence self-efficacy. Descriptive statistics were generated, paired sample t-tests were used for continuous variables, and McNemar's tests assessed changes in categorical outcomes. Qualitative data were analysed thematically to explore participant experiences and perceptions of the intervention. RESULTS: Statistically significant improvements were observed from baseline to endline, including reductions in internalised HIV stigma (p = 0.01), anticipated HIV stigma (p = 0.01), healthcare-related stigma (p < 0.001), SOGI-related harassment (p = 0.02), and depressive symptoms (p = 0.01). ART adherence self-efficacy increased significantly (p < 0.001). Although changes in sexual risk behaviours were not statistically significant, trends suggested increased condom use and reduced substance use before sex. Qualitative findings indicated enhanced self-acceptance, improved coping strategies (including reduced reliance on alcohol), increased confidence around disclosure, and strong acceptability of the peer-led, group-based intervention. However, some participants reported that sessions were delivered too quickly. CONCLUSIONS: This pilot peer-led intervention was perceived feasible, acceptable, and showed promising improvements in stigma, mental health, and ART adherence self-efficacy among young MSM and TGW in three Southern African countries. The findings support the potential value of theory-informed, peer-delivered interventions to address HIV-related stigma and SOGI-related stigma and adherence challenges in highly marginalised populations, warranting further evaluation through larger and longer-term studies.

BACKGROUND: Depression is a global disease that significantly increases the risk of stroke. The cholesterol, high-density lipoprotein, and glucose index (CHG index) as an emerging composite metabolic marker has shown value in cardiovascular diseases and diabetes, but its predictive role in new-onset stroke among depressed individuals remains unclear. METHODS: This study is based on the data from the Chinese Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2018. A total of 5,138 participants aged 45 and above, who had depressive symptoms (CES-D score ≥ 10) at the baseline and had no history of stroke, were included. Sequential Cox proportional hazards regression models were used as the main analysis to evaluate the association between the CHG index and new-onset stroke, and multivariable logistic regression was used as a secondary analysis to verify the consistency of the direction. Multiple imputation (20 datasets) was used to handle missing values of covariates. Restricted cubic splines and two-stage Cox regression models were used to explore potential nonlinear relationships and threshold effects. RESULTS: During a total follow-up period of 35,554 person-years (with a median follow-up of 7 years), a total of 421 new-onset stroke events occurred. In the fully adjusted Cox model, for every 1-unit increase in the CHG index, the risk of new-onset stroke increased by 48% (HR = 1.48, 95% CI: 1.15-1.90, P = 0.003). However, the restricted cubic spline analysis revealed a significant non-linear relationship (D1 test P = 0.005), with the inflection point occurring at a CHG index of 5.59. When the CHG index was below 5.59, for every 1-unit increase, the risk of stroke increased by 117% (HR = 2.17, 95% CI: 1.37-3.44, P = 0.001); above this inflection point, no statistically significant association was observed (HR = 1.00, 95% CI: 0.62-1.62, P = 0.996). Multivariable logistic regression yielded a consistent significant association (OR = 1.53, 95% CI: 1.16-2.03, P = 0.003). Subgroup analysis and multiple sensitivity analyses (quartile analysis, exclusion of early stroke events, median binary classification analysis) all supported the robustness of the main findings. CONCLUSION: Among middle‑aged and older Chinese adults with depressive symptoms, the CHG index shows a significant non-linear positive association with the risk of new-onset stroke, and the risk increases sharply when the index is below 5.59. The CHG index may serve as a potential indicator for the early risk of stroke in this high-risk population.

Employees experiencing mental health difficulties frequently encounter barriers to both securing and sustaining employment. Despite increased recognition of mental health in the workplace, most interventions continue to target employees in isolation, with limited attention to the relational and organisational contexts in which mental health issues arise. To address this gap, we developed MENTOR 2.0 - the first joint employee-manager workplace intervention designed to enhance employee wellbeing and job retention through targeted improvements in work engagement, interpersonal relationships at work, and psychological flexibility. Building on our initial feasibility study (MENTOR 1.0) (Prudenzi et al., 2024, https://doi.org/10.1016/j.jcbs.2023.100720), MENTOR 2.0 involved four individual and one joint session with employees and their line managers, facilitated by a trained Mental Health Employment Liaison Worker (MHELW) - a novel role designed to facilitate conversations between employees and line managers. Twenty-three employees and nineteen managers participated in the study. All completed baseline, mid-intervention, and post-intervention surveys, along with 18 brief daily diaries per participant. Feasibility outcomes were positive: 94% of planned sessions were delivered as scheduled, the average programme duration was 65 days, and post-intervention retention was 87%. Qualitative feedback indicated high acceptability, with participants valuing the opportunity for open and confidential dialogue with managers, as well as the supportive role of the MHELW. Preliminary quantitative findings suggested reductions in psychological distress and improvements in productivity, psychological flexibility, work engagement, and workplace interpersonal functioning. While the single-arm design and limited sample size constrain generalisability, the study followed rigorous feasibility trial methods and demonstrates a novel, context-sensitive intervention model with clear translational potential. MENTOR 2.0 advances current practice by embedding mental health promotion within the social dynamics of the workplace, shifting away from individualised treatment models toward a more relational and systemic approach. Feasibility trial registration MENTOR: ISRCTN79256498 (20/09/2021).

BACKGROUND: Although romosozumab produces substantial increases in bone mineral density (BMD), these densitometric gains may not necessarily translate into parallel clinical and psychosocial recovery. This study aimed to determine whether improvements in BMD reflect meaningful changes in pain, quality of life, kinesiophobia, and psychological status during romosozumab therapy, and to define the multidimensional structure of treatment response. Densitometric, clinical, and psychological responses were hypothesized to follow partially independent and region-specific trajectories. METHODS: This single-center cohort study included 46 postmenopausal women with osteoporosis treated with romosozumab and followed for 12 months. BMD was assessed by dual-energy X-ray absorptiometry at the lumbar spine, femoral neck, and total femur at baseline, 6, and 12 months. Pain (VAS), kinesiophobia (TAMPA), anxiety and depression (HADS), and quality of life (QUALEFFO-41) were evaluated at the same time points. Longitudinal changes were analyzed using repeated-measures ANOVA, correlation analyses, and exploratory hierarchical cluster analysis. RESULTS: BMD increased significantly at all skeletal sites over 12 months (all p < 0.001), with the greatest gains in the lumbar spine (~ 19%), followed by the femoral neck (~ 9%) and total femur (~ 6%). All clinical and psychosocial outcomes improved significantly (all p < 0.001; partial η² = 0.625-0.934). Changes in lumbar spine BMD showed statistically significant but modest associations with quality of life and depressive symptoms (r = - 0.304 to - 0.422, p < 0.05-0.01). Similarly, changes in femoral BMD parameters were modestly associated with pain (r = - 0.341 to - 0.481, p < 0.05-0.01) and kinesiophobia (r = - 0.308 to - 0.342, p < 0.05). Exploratory hierarchical cluster analysis identified distinct clusters separating patient-reported outcomes from densitometric parameters, with prior osteoporosis treatment history emerging as a bridging variable between these domains. CONCLUSION: Densitometric gains during romosozumab therapy do not uniformly translate into patient-perceived recovery. Treatment response is multidimensional and region-specific, indicating that BMD alone is insufficient to capture therapeutic effectiveness. The region-specific pattern of these modest associations, femoral BMD changes with pain and kinesiophobia, and lumbar BMD changes with quality of life and depressive symptoms, supports the need for anatomically informed, patient-centered evaluation frameworks in osteoporosis management.

BACKGROUND: General practitioners (GPs) are central to the treatment and management of injured workers. Australian workers' compensation funds GP consultations for work-related injuries. Almost all other GP consultations are subsidised by public healthcare insurance (Medicare Benefit Scheme). This study aimed to examine changes in publicly-insured GP consultations before and after injury for injured workers with long-duration claims, focusing on consultation duration types and GP-provided mental health and chronic diseases management plans. METHODS: This retrospective cohort study using interrupted time series analysis included 3,755 injured workers and 10,113 community individuals with injury/index date between 2006 and 2016. We compared monthly changes in rates (per 1000 workers) of six GP consultation types for 12-month before and 24-months after injury. Acute and long-term changes were examined both overall (combining all consultation types) and separately by consultation type. Consultation types include four duration-based levels: A (0-6 min), B (6-20 min), C (20-40 min), and D (40-60 min), and two types describing mental health and chronic disease management plans. RESULTS: After injury, injured workers received an additional 1,600 Medicare-subsidised GP consultations per 1,000 workers per year compared to the community group. Post-injury, the largest increase in monthly consultation rates was observed for Level D consultations (IRR: 2.37, 95% CI: 1.35, 4.20), while the smallest increment was observed for Level B consultations (IRR: 1.45, 95% CI: 1.32, 1.59). Monthly GP mental health care and chronic disease development plan rates increased by 84% (IRR: 1.84, 95% CI: 1.17, 2.93) and 20% (IRR: 1.20, 95% CI: 0.78, 1.86) post injury, respectively; however, the monthly rates of these consultations were small (maximum 25/1000 workers) Following these initial increases immediately post-injury, monthly consultation rates decreased by 3% to 9% and by 24-months post-injury had returned to levels observed in the comparison group. CONCLUSION: All six types of publicly insured GP consultations increased temporarily in the initial months following injury, regardless of worker's compensation status. These consultations remained elevated above pre-injury levels for over 12 months, likely reflecting delayed claim acceptance or increased care needs. These findings highlight the need of a comprehensive, whole-person approach to recovery that addresses both immediate and broader healthcare needs.

BACKGROUND: Gastric squamous metaplasia is a rare condition whose clinical significance and malignant potential remain unclear. Most reported cases are located in the cardia and are continuous with the esophageal squamous epithelium. Ectopic gastric squamous metaplasia, defined as lesions discontinuous from the esophagus, is exceedingly rare, and its association with gastric neoplasms has not been well characterized. CASE PRESENTATION: An 81-year-old woman with a history of Helicobacter pylori eradication underwent esophagogastroduodenoscopy for gastric cancer screening. A 20-mm discolored, slightly depressed lesion was identified on the greater curvature of the upper gastric body. The lesion was discontinuous from the esophageal mucosa and appeared as an iodine-unstained area. Magnifying endoscopy with narrow-band imaging revealed intrapapillary capillary loop-like vascular dilation with background coloration. Biopsy specimens suggested squamous metaplasia with reactive atypia, and en bloc resection was performed by endoscopic submucosal dissection. Postoperative histopathological examination identified mature stratified squamous epithelium consistent with gastric squamous metaplasia, and incidentally identified a well-differentiated adenocarcinoma confined to the mucosa adjacent to the metaplastic lesion without lymphovascular invasion. Immunohistochemical analysis revealed a linear arrangement of p63-positive cells along the basal layer of the metaplastic epithelium with a subset of Ki-67-positive cells indicating proliferative activity at the basal layer. p53 expression showed a wild-type pattern. CONCLUSIONS: We report an extremely rare case of ectopic gastric squamous metaplasia associated with well-differentiated adenocarcinoma. Although a direct histogenetic relationship between the two lesions remains uncertain, their coexistence raises important considerations regarding the pathogenesis of gastric squamous metaplasia and its potential clinical significance. The immunohistochemical findings may support a possible role of competitive epithelial replacement in the development of gastric squamous metaplasia. Careful endoscopic and histopathological evaluation is warranted when this rare lesion is encountered.

BACKGROUND: The objective of this study was to test whether the negative effects of inbreeding on production traits varied according to the level of environmental load. Traits analyzed were milk, fat, and protein yields, and somatic cell score (SCS). Environmental conditions were described using temperature (TEMP), relative humidity (RH), and the temperature-humidity index (THI), each divided into five equally sized classes. For each trait, the environmental variable with the largest impact was used to evaluate inbreeding effects across its classes. Inbreeding was measured using pedigree (F), the diagonal of the genomic relationship matrix (F), and runs of homozygosity (F). RESULTS: Genomic-based inbreeding measures resulted in larger estimated inbreeding effects, compared to pedigree measures, with F and F showing similar results. RH most affected milk yield, with losses of ~ 600 g/day in the highest RH class. Inbreeding led to losses of ~ 100 g/day per 1% increase, with genomic measures scaled to match F. For milk yield, losses were ~ 20% greater under higher environmental stress. THI was the most impactful variable for fat yield, with losses of ~ 90 g/day in the highest THI category. Inbreeding-related losses increased in more stressful environments, with average reductions of 3 g/day per 1% inbreeding, reaching 4 g/day in the highest THI class. Protein yield and SCS were mainly influenced by TEMP, with losses of ~ 70 g/day of protein and increases of 0.06 SCS units. Inbreeding caused losses of ~ 3.5 g/day in protein yield and increases of ~ 0.006 SCS units per 1% inbreeding. For these two traits, the relationship between inbreeding effects and environmental stress was less clear. For milk and fat yields, there was a significant interaction between environmental and inbreeding effects, suggesting that inbreeding depression influences heat tolerance in dairy cows. CONCLUSIONS: For milk and fat yields, there was a significant interaction between environmental and inbreeding effects, indicating that environmental conditions modulate the expression of inbreeding depression. These findings suggest that inbreeding depression influences heat tolerance in dairy cows.

Mitochondrial dysfunction has been recognized as one of the three hallmark biological features of autism spectrum disorder. This study is intended to investigate the molecular mechanisms underlying prenatal psychological fear stress‑induced hippocampal mitochondrial damage in offspring. Bioinformatics analysis revealed that the calcium signaling pathway, particularly the phospholipase C beta 1(PLCβ1)- inositol 1,4,5‑trisphosphate receptor (IP3R)- voltage‑dependent anion channel 1(VDAC1) pathway, may play a key role in prenatal stress‑induced hippocampal mitochondrial damage in offspring. To validate this, we examined pathway activation in the offspring hippocampus of prenatal fear stressed rats and in corticotropin-releasing hormone (CRH; also known as CRF in rodents) overexposed SH‑SY5Y cells, along with mitochondrial calcium levels in the cells. Prenatal fear stress induced depressive-like behavior and HPA axis activation in pregnant dams, and reduced survival and growth in offspring. Placental and neonatal brain CRF levels were elevated. At the early socialization stage (Postnatal day 21-30), model offspring showed normal basal but exaggerated stress-induced HPA responses. Their hippocampus exhibited expanded MAM coverage, reduced ER-mitochondria distance, and upregulated PLCβ1, IP3R1, VDAC1 expression, along with increased GRP75‑VDAC1 co‑localization, confirming MAM remodeling at the molecular level. In vitro, CRH (20 µM for 48 h or 5-20 µM for 96 h) inhibited SH-SY5Y cell proliferation, upregulated CRH receptor 1(CRHR1), PLCβ1, VDAC1, and increased mitochondrial calcium; these effects were reversed by the CRHR1 antagonist CP376395 or PLCβ1 knockdown. Furthermore, the MCU inhibitor DS16570511 partially reversed CRH‑induced mitochondrial calcium elevation and proliferation inhibition, suggesting that mitochondrial calcium overload contributes to the proliferation inhibition. Collectively, these results suggest that prenatal fear stress may, via the CRF-CRFR1 axis, influence the PLCβ1-IP3R-VDAC1 pathway, inducing MAM remodeling and mitochondrial calcium overload, thereby contributing to offspring hippocampal neuronal damage.