Search Results (220)

Ongoing conflicts in sub-Saharan Africa negatively affect the population’s mental health and weaken health care systems. Collaboration among stakeholders is recommended to strengthen mental health services in post-conflict settings, despite limited evidence on context-specific strategies. This paper aimed to identify strategies for collaboration between traditional and biomedical services to improve mental health care. An adapted nominal group technique was employed during a one-day stakeholder workshop. Fourteen participants representing traditional and biomedical mental health services discussed and prioritised strategies based on importance and feasibility to reach consensus. Five collaborative care strategies were prioritised based on stakeholder consensus regarding importance and feasibility: (1) collaborative learning, (2) formalising coordination, (3) capacity building, (4) joint intervention programs, and (5) regulatory support. Key mechanisms for implementing these strategies were also identified, including piloting integrated interventions, appointing a dedicated focal person to coordinate, providing basic psychosocial counselling skills, reducing harmful practices, and strengthening supportive supervision. Mutual learning was identified as a crucial cross-cutting component of all approaches. The conclusion was that implementing these prioritised strategies could improve mental health care. Further research is needed to evaluate the effectiveness of these strategies in enhancing collaborative care and improving mental health outcomes for individuals. Full article

Background: Truck drivers constitute a high-risk occupational group due to irregular schedules, prolonged sedentary work, fatigue, and limited access to healthcare, contributing to adverse physical and mental health outcomes. Although mobile health (mHealth) tools offer potential to support driver health, sustained engagement remains a persistent challenge. Objectives: This systematic review aimed to identify behavioural, technological, and contextual determinants influencing truck drivers’ compliance, retention, and long-term engagement with digital health interventions. Methods: Following the PRISMA 2020 guidelines, six eligible studies were identified and thematically synthesised across technology acceptance, behaviour change, and persuasive system design perspectives. Results: Across studies, sustained engagement was facilitated by self-monitoring, real-time feedback, goal-setting, coaching support, and simple, flexible system design. In contrast, technological complexity, high interaction demands, limited digital literacy, privacy concerns, misalignment with irregular schedules, and fatigue consistently undermined engagement and retention. Autonomy, trust, and voluntary participation emerged as cross-cutting determinants supporting continued use. Based on the synthesis, an integrative framework was developed to explain how behavioural, technological, and contextual factors interact to shape truck drivers’ compliance, engagement, and retention with mHealth. Despite generally moderate to high study quality, the evidence base remains fragmented and dominated by short-term evaluations. Conclusions: The findings highlight the importance of context-sensitive, user-centred design to support effective digital health interventions in the trucking sector. Full article

Objectives: Postpartum depression is a major global mental health concern, yet epidemiological evidence from the Baltic region remains limited. This study aimed to estimate the prevalence of depressive symptoms among postpartum women attending postpartum outpatient care in Latvia and identify associated sociodemographic and clinical factors. Methods: A cross-sectional study was conducted at the outpatient department of the largest maternity hospital in Latvia from May 2024 to June 2025. All women aged 18 years or older, who attended a routine postpartum gynaecological visit 4 to 6 weeks after delivery and screened positive on the Patient Health Questionnaire-9 (PHQ-9) (≥5 points), completed a sociodemographic and clinical questionnaire and the Edinburgh Postnatal Depression Scale (EPDS). Descriptive statistics were used in the study, and logistic regression was used to examine factors associated with postpartum depressive symptoms. Results: A total of 272 women aged 18 to 49 years (mean age 30.66 ± 5.59) participated. PHQ-9 results indicated that 43.02% of respondents met the threshold for a positive screen (≥5 points) and were included in the further analysis. Using a cut-off EPDS ≥11, the point prevalence of clinically significant depressive symptoms among women who screened positive on the PHQ-9 was 11.4%. In univariate analyses, postpartum depressive symptoms were most strongly associated with comorbid mental disorders (OR = 4.55; 95% CI 1.85–11.18; p = 0.001), caesarean section (OR = 3.05; 95% CI 1.18–7.92; p = 0.022), stress (OR = 2.49; 95% CI 1.04–5.94; p = 0.04) and obstetric complications (OR = 2.78; 95% CI 1.01–7.64; p = 0.048) during pregnancy. In the multivariate model, only three independent predictors remained: comorbid mental disorder (aOR = 9.54; 95% CI 2.72–33.49; p < 0.001) and caesarean section (aOR = 5.80; 95% CI 1.66–20.21; p = 0.006) were associated with higher odds of postpartum depression, while first-time motherhood was associated with a substantially lower likelihood of depressive symptoms (aOR = 0.14; 95% CI 0.04–0.49; p = 0.002). Sociodemographic characteristics, including age, education, employment, and income, were not significant predictors. Conclusions: The point prevalence of clinically significant depressive symptoms among Latvian postpartum women screening positive for depression appears similar to other European settings. Comorbid mental disorders and caesarean section were the strongest predictors of depressive symptoms, while primiparity showed a protective effect. Sociodemographic factors did not independently contribute to risk. As the first study of its kind in Latvia and conducted within a clinical setting that captures a large and diverse proportion of postpartum women, these findings highlight the context-specific nature of postpartum depression and underscore the need for further longitudinal research to inform effective screening and intervention strategies. Full article

Background and Objectives: Coronary artery bypass grafting (CABG) is one of the most common cardiac surgeries worldwide. However, postoperative cognitive decline (POCD) remains a significant concern, affecting a substantial proportion of patients. One of the pathogenic mechanisms underlying POCD involves inflammatory responses and oxidative stress. Dexamethasone, a corticosteroid with potent anti-inflammatory properties, has been proposed as a potential neuroprotective agent. This study aimed to assess the effect of a single perioperative dose of dexamethasone on postoperative cognitive function in patients undergoing CABG surgery. Materials and Methods: This retrospective cohort study was conducted at the Hospital of Lithuania. Inclusion criteria: elective CABG surgery, non-neurocognitive anamnesis, Minimal Mental State Examination score ≥25 before surgery, and age >50. Patients were divided into two groups: DEXA (those who received preoperative dexamethasone 0.1 mg/kg) and non-DEXA (those who did not). Cognitive functions were assessed with the Addenbrooke’s Cognitive Examination test (ACE-III) 7 days post operation. Results: The study enrolled 60 patients (DEXA = 30, non-DEXA = 30): male (85%), female (15%). The mean age of the study was 66.1 ± 8.1 and the education was 12 (12–30) years. The groups were similar in the evaluated preoperative characteristics (sex, age, education) (p > 0.05). Cognitive impairment (ACE-III score cut–off 88 points) was identified in 40% (n = 12) of participants in the DEXA and 69.3% (n = 21) in the non-DEXA group, with no statistically significant difference between groups (p = 0.073). However, the DEXA group had significantly better cognitive scores in attention (Z = 3.145, p = 0.002), fluency (Z = 2.25, p = 0.024), and spatial ability (Z = 4.444, p < 0.001) while language (Z = 1.167, p = 0.243) and memory scores (Z = 1.906, p = 0.057) showed no significant differences. Conclusions: These findings suggest that dexamethasone may provide neuroprotective benefit, reducing postoperative cognitive function domains, such as attention, fluency, and spatial ability, after CABG surgery. Further prospective studies are needed to confirm these findings. Full article

This study investigated the feasibility and preliminary effects of enhanced midwifery care in reducing subclinical depression symptoms among women in ethnically diverse areas of the South Western Sydney Local Health District (SWSLHD). A pilot randomised controlled trial was conducted among pregnant women attending the Fairfield and/or Liverpool antenatal clinic with an Edinburgh Depression Scale (EDS) score of 10–12 (i.e., just below the generally accepted clinical cut-off score of 13 to indicate subclinical depressive symptoms) during the first antenatal visit (i.e., before 26 weeks gestation). Participants were randomly allocated to either the intervention group which received continuous and coordinated support from a dedicated Registered Midwife (RM) trained in counselling and linked with a multidisciplinary team, or the usual care group, which received standard maternity care from various providers without continuity or additional coordinated support. Primary outcomes included feasibility of recruitment, randomisation, intervention delivery and fidelity, and retention and follow-up. The secondary outcomes were improvement in depressive symptom severity assessed via EDS, psychological distress (Kessler’s psychological distress scale—K10), and parenting confidence (Karitane Parenting Confidence Scale (KPCS). Descriptive analyses were used to assess the feasibility outcomes, whereas mixed-effects models were used to examine the effects of treatment on secondary outcomes. Thirty-seven mothers were recruited into the study, of which eighteen were randomised to the intervention group and nineteen to the usual care group. The intervention was delivered with good fidelity, and remote adaptations during COVID-19 ensured both continuity of care and high retention at 6-month follow-up. Findings of the mixed-effects models showed significant within-group reduction in EDS scores over time, with scores at 8 weeks postpartum (T2) significantly lower than at baseline (T0; β = −2.77, SE = 1.36, p < 0.05) but no significant differences between the groups (β = −0.02, SE = 1.63, p = 0.992) or time-by-group interactions at any timepoint for EDS, K10, and KPCS. These findings demonstrate the feasibility of enhanced midwifery care in a “hard to reach” population of SWSLHD and highlight the need for adequately powered trials to determine its effectiveness on maternal mental health and parenting outcomes. Full article

Background: Dysregulation of the hypothalamic–pituitary–adrenal axis is implicated in both gestational diabetes mellitus (GDM) and mood disorders, suggesting a shared pathophysiology. However, the impact of GDM on maternal depressive symptoms, particularly among women with “low and late” fertility, remains poorly characterized. Methods: We compared the risk of postpartum depressive symptoms, assessed on the second postpartum day using the Edinburgh Postnatal Depression Scale (EPDS), with a cut-off score ≥ 12, and the Anhedonia, Anxiety, and Depression subscales, between Northeast Italian women with GDM and control participants with normal oral glucose tolerance tests (OGTT), classified as having “low and late fertility”. Results: Among the 2560 women included in the analysis, 231 (9.02%) had GDM. Compared with controls with normal OGTT, women with GDM were older (36.0 vs. 33.0 years, p < 0.001) and had higher pre-pregnancy BMI (23.4 vs. 21.6 kg/m², p < 0.001), but lower gestational weight gain (GWG) (11.0 vs. 13.0 kg, p < 0.001), with no difference in parity [2.00 vs. 1.00, p = 0.5. In addition, GDM was not associated with increased postpartum depressive symptoms (15% EPDS scores ≥12 in both groups, p > 0.9) or with Anhedonia, Anxiety, or Depression subscale scores (p = 0.7). Conclusions: Advanced maternal age and reduced parity, hallmarks of women postponing childbearing, do not appear to confer an increased risk of early postpartum mood comorbidities in the context of GDM. Promoting healthy physical and mental well-being among women in this demographic category requires integrated strategies encompassing nutrition, healthcare, and education. Full article

Background: There is a growing demand for sensitive and accurate screening tools for the early detection of cognitive impairment. The Rowland Universal Dementia Assessment Scale (RUDAS) has shown promise in multicultural populations. It may offer advantages over the widely used Mini-Mental State Examination (MMSE), which has limited sensitivity, particularly in assessing executive functions. The aim of this study was to adapt and validate the Polish version of the RUDAS and to compare its diagnostic performance with the MMSE in detecting cognitive impairment among patients with Alzheimer’s disease (AD) and vascular dementia (VaD). Methods: A total of 126 subjects were evaluated, including 37 with AD, 30 with VaD, and 59 healthy controls. All participants were assessed with both the MMSE and RUDAS, and their test results were subsequently compared. Results: A strong correlation was found between total scores on the RUDAS and MMSE (RS = 0.81, p < 0.001). The area under the ROC curve was slightly higher for RUDAS (AUC = 0.94) than for MMSE (AUC = 0.89), suggesting better diagnostic accuracy. At a cut-off score of 25, RUDAS showed a sensitivity of 0.84 and a specificity of 0.87; MMSE showed a sensitivity of 0.74 and a specificity of 0.91. Conclusions: The Polish version of RUDAS demonstrates strong diagnostic utility and may offer a slightly more sensitive alternative to MMSE for dementia screening, especially in its early stages. Further normalization studies on larger and more diverse clinical populations are recommended. Full article

Background/Objectives: Myotonic dystrophy type 1 (DM1) is a multisystem disorder that affects the central nervous system. Despite previous studies, blood-based biomarkers have not been sufficiently characterized. This study investigated plasma neurofilament light chain (NfL), phosphorylated tau (p-tau181), amyloid-β (Aβ42/40), and glial fibrillary acidic protein (GFAP) in a Japanese cohort with DM1 to assess their potential as biomarkers. Methods: Forty patients with genetically confirmed DM1 were enrolled in this study. Plasma NfL, p-tau181, Aβ42/40, and GFAP were quantified using single-molecule array technology. Clinical and genetic variables, including age, CTG repeat size, Mini-Mental State Examination (MMSE) score, modified Rankin Scale (mRS) score, and creatine kinase levels, were analyzed for correlations. Results: NfL and p-tau181 were significantly elevated in patients with DM1 compared with controls, with 95% exceeding the p-tau181 cut-off. NfL was moderately correlated with age, age at onset, and mRS, and no significant associations were observed between p-tau181 and other biomarkers, although a correlation was noted with serum creatine kinase. Conclusions: These findings support that NfL is a marker of disease severity in DM1 and identified plasma p-tau181 as a potential novel biomarker. While the mechanisms underlying the increased p-tau181 levels remain unclear, they may reflect DM1-related pathologies in the brain and possibly in skeletal muscle. Study limitations include a small sample size and lack of age-matched controls, highlighting the need for longitudinal validation. This study demonstrates the utility of NfL and suggests that p-tau181 is an emerging biomarker for DM1, supporting future work toward biomarker-guided monitoring and therapeutic evaluation. Full article

Background/Objectives: Post-stroke cognitive impairment (PSCI) affects ~40% of survivors. Diffusion Tensor Imaging Analysis Along the Perivascular Space (DTI-ALPS) is a fast, contrast-free surrogate of perivascular (glymphatic-aligned) diffusivity that may stratify PSCI risk. We systematically synthesized evidence on the diagnostic and prognostic performance of ALPS in ischemic stroke. Methods: Following PRISMA 2020, we searched PubMed/MEDLINE, Scopus, and Web of Science from inception to August 2025 for human ischemic stroke studies reporting ALPS and cognitive or functional outcomes. Eligible designs were cohort or case–control. Outcomes included group differences, associations with cognition (Montreal Cognitive Assessment [MoCA]/Mini-Mental State Examination [MMSE]), prognostic accuracy for PSCI/functional outcome, and longitudinal change. Risk of bias was appraised with QUADAS-2 (diagnostic) and QUIPS (prognostic). The protocol was registered on OSF. Heterogeneity among studies precluded a meta-analysis. Results: Five single-center cohorts (n per cohort 29–120) from Asia, Europe, and the USA used 3T DTI with ventricular-level ALPS ROIs. Across studies, ALPS was lower after stroke, with early ipsilesional depression and partial recovery over weeks to months. ALPS correlated with cognition (MoCA r ≈ 0.43–0.56) and discriminated early cognitive impairment (AUC 0.868; sensitivity 96%, specificity 66%). Follow-up ALPS predicted poor 6-month outcome (AUC 0.786). In lacunar stroke with small-vessel disease, higher baseline ALPS related to better cognitive trajectories and lower incident dementia risk (HR ≈ 0.33), though associations attenuated after adjustment for diffusion microstructural covariates (PSMD/MD). Reporting of acquisition parameters and ROI methods varied; overall risk of bias was moderate. Conclusions: DTI-ALPS shows consistent post-stroke reductions, recovery-sensitive trajectories, and promising—though context-dependent—prognostic value for PSCI and longer-term outcomes. Clinical translation will require standardized acquisition/analysis, multimodal adjustment, prespecified cut-offs, and prospective multicenter validation. Full article

Background: A cesarean section (CS) is a method of childbirth involving a surgical cut made in the abdominal and uterine wall to deliver the infant. But while it saves the lives of women and infants, it has been implicated in several immediate and long-term complications and adverse consequences as a result of its ineffective use. This study attempts to address the major public health issue of the inappropriate use of CS by exploring its impact on maternal, neonatal, and child health. More specifically, the study aims to investigate the immediate and long-term health impacts on the mother, including her physical and mental health, as well as the immediate and long-term psychosomatic consequences on the neonate’s, infant’s, and child’s health as a result of the inappropriate use of CS. Methods: A scoping review was conducted spanning from 2015 to 2025 according to the PRISMA criteria and checklist. Searches were performed in PubMed, Scopus, and Google Scholar. The inclusion criteria comprised original articles with clear exposure and outcome written in English, and studies that did not involve reviews of any kind or letters to the editors. Results: The review identified 42 relevant studies. The results showed several immediate and long-term complications of CS in mothers, neonates, infants, and children, while its ineffective use carries equally high risks, such as high levels of morbidity and mortality. Conclusions: This scoping review presents the problems that arise in the immediate and long-term health of mother and child from the improper use of cesarean section and underlines the need for immediate action and measures to be taken by health policy makers. Full article

Large language model (LLM)-based virtual patient (VP) simulations are emerging to complement traditional medical and nursing education by enabling safe, repeatable, and context-rich clinical practice. This review synthesizes recent developments from 2023 to 2025, mapping implementation approaches, data practices, evaluation methods, and cross-cutting challenges across forty studies. Six implementation categories are identified: scenario generation; prompt-driven VPs; feedback-integrated automated scoring; realism- and adaptability-enhanced systems; knowledge-driven and multi-agent hybrids; and mental health-oriented systems. The analysis summarizes dataset usage (including knowledge sources and governance) and evaluation frameworks, and it introduces quantitative indicators for reproducible assessment. Persistent challenges include factual accuracy, role consistency, emotional realism, and ethical and legal accountability. Overall, LLM-based VP systems show growing potential to extend simulation-based learning, but stronger evidence from multi-site controlled studies, standardized metrics, transparent reporting (model versions, prompts), and robust data governance is needed to establish educational validity and generalizability. Full article

Psychiatric illness during childhood and adolescence is a growing concern, placing increased pressure on psychiatric services. Reliance on an evidence-based assessment tool may facilitate the identification and management of symptoms and may facilitate accountability. The purposes for this study were to characterize the psychiatric symptoms of a sample of pediatric patients accessing outpatient psychiatry using the DSM Level 1 Cross-Cutting Measure (CCSM), compare patient and caregiver ratings (CCSM), and explore patients’ acceptability of using the CCSM. The sample consisted of 51 patients (mean age 14 years) and 46 caregivers (mean age 43 years). Patient and caregiver ratings suggested problems with sleep, inattention, depression, irritability/anger, and anxiety. The most common discordance concerned suicide ideation. Most patients (34 of 38) reported that the assessment tool was easy to complete. The CCSM may be a useful, evidence-based, standardized, transdiagnostic assessment tool aligned with the DSM-5 that can be used in a variety of mental health settings to identify symptoms, inform treatment planning, and track progress. Full article

Objectives: This cross-sectional case–control study, conducted at the Department of Physiotherapy, Academy of Physical Education, in Katowice, between July 2022 and April 2023, aimed to assess the overall health status (OHS) of patients with mild-to-moderate cubital tunnel syndrome (CuTS) compared with a healthy control population. Methods: The SF-36 questionnaire was used to evaluate the following domains: physical functioning (PF), role limitations due to physical health problems (RP), bodily pain (BP), general health (GH), vitality (VT), social functioning (SF), role limitations due to emotional problems (RE), and mental health (MH). Results: A total of 152 participants were enrolled in the study. The CuTS and control groups consisted of 82 and 70 individuals, respectively. The CuTS group had significantly lower scores in most domains when compared with the control group; however, no significant difference was observed in the BP domain. Notably, the VT domain showed a statistically significant difference in favor of the CuTS group, indicating slightly higher perceived vitality despite functional limitations. Conclusions: Mild and moderate forms of CuTS are associated with significant deterioration in general health, encompassing both physical and psychological components, as assessed by the SF-36 questionnaire; however, no significant difference was observed in the BP domain, suggesting that the burden of CuTS may manifest more strongly in functional, psychosocial, and mental health aspects rather than in generalized pain perception. These findings highlight the importance of a comprehensive evaluation and management strategy that addresses both physical and psychosocial dimensions of patient care. Full article

Background: Post-COVID-19 condition (‘long COVID’) involves fluctuating symptoms across multiple organ systems and disability or functional loss, which may be episodic, continuous, or permanent. Qualitative research is essential to capture lived experiences and explain how social and health system contexts may influence improvement, recovery, and service use. We synthesised perspectives from people living with long COVID and healthcare professionals to inform service design and policy. Methods: We conducted a systematic review and qualitative meta-synthesis. MEDLINE, Embase, PsycINFO, CINAHL, Scopus, and Web of Science were searched for studies published between 1 January 2020 and 19 August 2025. Eligible studies reported qualitative data from adults with long COVID (≥12 weeks after acute infection) and/or healthcare professionals in any setting. We excluded non-qualitative, non-primary, or non-English reports. Two reviewers independently screened, extracted, and appraised studies using the Critical Appraisal Skills Programme checklist. Data were synthesised thematically. The protocol was registered with the Open Science Framework. Findings: Of 1544 records screened, 49 studies met the inclusion criteria: 41 involving patients, two involving professionals, and six involving both. Eight patient themes (including symptom burden, identity disruption and stigma) and four professional themes (including recognition, care coordination and holistic care models) were identified. Recognition emerged as a cross-cutting mechanism: validation and consistent pacing guidance facilitated engagement and safer activity, whereas invalidation and inconsistent advice were associated with distress, avoidance, and disengagement. Trajectories showed gradual expansion of multidisciplinary care models, but major capacity and equity gaps persisted. Most studies had low methodological concerns, although heterogeneity in populations and settings was substantial. Interpretation: Long COVID is a chronic, biological condition that also intersects with social and psychological dimensions, and may present with episodic, continuous, or progressive trajectories. Healthcare services must prioritise early validation, provide consistent pacing and relapse prevention guidance, expand access to multidisciplinary and peer-supported rehabilitation, integrate mental healthcare, strengthen coordinated pathways, and support graded return to work. Explicit attention to equity is required to avoid widening disparities. Full article

Aim: With the intensification of population aging, the public health challenges posed by multimorbidity have become increasingly severe. This study employs bibliometric analysis to elucidate research hotspots and trends in the field of multimorbidity against the backdrop of global aging. The immediate aim is to systematically map the intellectual landscape and evolving patterns in multimorbidity research. The ultimate long-term aim is to provide a scientific basis for optimizing chronic disease prevention systems and guiding future research directions. Methods: The study adopted the descriptive research method and employed a bibliometric approach, analyzing 8129 publications related to multimorbidity from the Web of Science Core Collection. Using CiteSpace, we constructed and visualized several knowledge structures, including collaboration networks, keyword co-occurrence networks, burst detection maps, and co-citation networks within the multimorbidity research domain. Results: The analysis included 8129 articles from 2004 to 2024, published across 1042 journals, with contributions from 740 countries/regions, 33,931 institutions, and 40,788 authors. The five most frequently occurring keywords were prevalence, health, older adult, mortality, and risk. The top five contributing countries globally were the United States, the United Kingdom, Germany, China, and Spain. Five pivotal research trajectories delineate the intellectual architecture of this field: ① Evolution of Disease Cluster Management: Initial investigations (2013–2014) prioritized disease cluster coordination within general practice settings, particularly cardiovascular comorbidity management through primary care protocols and self-management strategies. ② Paradigm Shifts in Health Impact Assessment: Multimorbidity outcome research demonstrated sequential transitions—from physical disability evaluation (2013) to mental health consequences like depression (2016), culminating in current emphasis on holistic health indicators including frailty syndromes (2015–2019). ③ Expansion of Risk Factor Exploration: Analytical frameworks evolved from singular physical activity metrics (2014) toward comprehensive lifestyle-related determinants encompassing behavioral and environmental dimensions (2021). ④ Emergence of Polypharmacy Scholarship: Medication optimization studies emerged as a distinct research stream since 2016, addressing therapeutic complexities in multimorbidity management. ⑤ Frontier Investigations: Cutting-edge directions (2019–2021) feature cardiometabolic multimorbidity patterns and their dementia correlations, signaling novel interdisciplinary interfaces. Conclusions: The prevalence of multimorbidity is on the rise globally, particularly in older populations. Therefore, it is essential to prioritize the prevention of cardiometabolic conditions in older adults and to provide them with appropriate and effective health services, including disease risk monitoring and community-based chronic disease care. Full article