Search Results (768)

Background/Objectives: Community psychiatric care aims to support recovery, autonomy, and lower reliance on inpatient services, but co-occurring substance use may reduce these gains. This study examined associations between psychiatric care pathway, non-tobacco substance-use severity, recovery-related patient-reported outcomes, clinical instability, and direct mental health cost in adults with severe mental illness in Romania. Methods: This cross-sectional observational study included 128 adults receiving psychiatric hospital care, long-term residential care, or protected community housing within one regional psychiatric care network. Participants had at least 12 months of uninterrupted care in their current setting. Substance use was assessed with the World Health Organization Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), excluding tobacco from the analytic severity score. Outcomes included SF-36 physical and mental scores, brief service-experience ratings of autonomy and perceived coercion, emergency department visits, relapse, readmission, inpatient days, outpatient visits, and annual direct mental health cost. Results: Any non-tobacco substance use was most common in hospital care, intermediate in residential care, and least common in community housing. Mental quality of life was lowest among hospital participants with substance use and highest among community participants without substance use. In multivariable models, ASSIST-derived severity was independently associated with a lower SF-36 mental score and a higher direct cost, while autonomy was independently associated with better mental quality of life and lower direct cost. The cost outcome was modeled primarily with a gamma generalized linear model with a log link because costs were positive and right-skewed. Because pathway allocation was clinically determined rather than randomized, and because autonomy, perceived coercion, and mental quality of life were all self-reported at a single assessment, every multivariable and path estimate is exploratory. Conclusions: Community psychiatric pathways were associated with more favorable recovery indicators, but non-tobacco substance use remained an important marker of poorer outcomes and greater service burden. The findings support addiction-sensitive community psychiatric care and routine monitoring of autonomy and perceived coercion as service-quality indicators. Because the design was cross-sectional and the care pathways were non-equivalent at baseline, these results are hypothesis-generating and do not establish that care pathway, substance use, or autonomy exerts a causal effect on any outcome measured. Full article

Neoadjuvant immunochemotherapy (NICT), mainly anti-PD-1/PD-L1 therapy combined with cytotoxic chemotherapy, significantly improved perioperative outcomes for resectable solid tumors such as lung cancer and breast cancer. But a large number of patients still had residual lesions and eventually relapsed. Residual tumor cells are not simply unremoved cellular debris, but represent a therapy-selected and therapy-amplified subset of a pre-existing heterogeneous and plastic tumor ecosystem. To avoid implying that therapy generates a new form of tumor plasticity de novo, we use the term “plasticity of non-apoptotic residual tumor cells” to describe the plastic behavior of viable malignant cells that survive treatment-induced cytotoxicity rather than entering apoptosis. In this review, we define the plasticity of non-apoptotic residual tumor cells as the capacity of residual malignant cells to preserve, switch, or re-enter phenotypic states such as dormancy, hybrid EMT, stem-like regeneration, and immune evasion under the combined influence of intrinsic tumor heterogeneity, systemic therapy pressure, and microenvironmental protection. Before the NICT-specific discussion, we outline general theoretical frameworks including therapeutic stress response, apoptosis-induced regeneration, genetic and non-genetic heterogeneity, as well as spatial heterogeneity of involved lymph nodes, so as to provide a more robust interpretation of residual lesion biology under NICT. Also, this review proposes that residual disease may be reconceptualized as a treatment-shaped plastic niche, whose biological behavior is jointly shaped by clonal selection, reversible phenotypic transformation, and microenvironmental ecological protection. We summarize several key states of residual tumor cells: persistent-like/resting state, hybrid EMT/invasive plasticity state, stem-like/regenerative state, and immune escape state, and elucidate the underlying epigenetic basis, including DNA methylation, histone modification, chromatin remodeling, and non-coding RNA network reprogramming. Meanwhile, niche factors such as immune stress, CAF/TAM enrichment, fibrotic matrix, hypoxia, and metabolic stress can further stabilize these states and promote the survival of relapse seeds. Based on this, we propose that future postoperative assessments should be upgraded from residual volume to a stratified residual state, and dynamically identified by combining single-cell omics, spatial pathology, and ctDNA/MRD monitoring. Furthermore, treatment strategies should shift from simply shrinking tumors to plasticity-locking therapy, that is, identifying, classifying, and blocking the plasticity escape pathways of residual lesions before they evolve into recurrence. Full article

Background and Objectives: Stress urinary incontinence (SUI) is a common condition among women and is frequently associated with impaired sexual function and increased sexual distress. Pelvic floor muscle training (PFMT) is considered a first-line conservative treatment for SUI; however, its effects on female sexual function remain incompletely understood. The present study aimed to evaluate the impact of PFMT on sexual function, sexual distress, and pelvic floor muscle performance in women with SUI. Materials and Methods: This prospective controlled observational study included sexually active women with clinically confirmed SUI and female sexual dysfunction. Participants were allocated either to a control group (Group A) or to a supervised 12-week PFMT program (Group B). Sexual function and distress were assessed using the Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale–Revised (FSDS-R), respectively. Pelvic floor muscle performance was evaluated using Peritron perineometry, including peak vaginal squeeze pressure, endurance, and resting tone. Objective severity of SUI was assessed using the one-hour pad test. Results: A total of 102 women completed the study, including 44 in the control group and 58 in the PFMT group. After 12 weeks, women undergoing PFMT demonstrated significant improvements in urinary continence, pelvic floor muscle strength, and sexual function compared with controls (all p < 0.01). Mean FSFI total score increased from 21.5 ± 2.5 to 26.6 ± 3.3, while the proportion of women with clinically significant sexual distress decreased from 100% to 58.6%. Peak vaginal squeeze pressure and endurance also improved significantly following PFMT. Conclusions: PFMT significantly improves sexual function, reduces sexual distress, and enhances pelvic floor muscle performance in women with SUI. These findings support the integration of PFMT into the comprehensive management of women with SUI and associated sexual dysfunction. Full article

Background: Dynapenic abdominal obesity (DAO), the coexistence of low muscle strength and abdominal obesity, may accelerate disability. However, its longitudinal association with disability remains unclear. In this study, we examined the relationship between DAO and disability in middle-aged and older adults. Methods: A systematic review and random-effects meta-analysis of prospective cohort studies was conducted to examine longitudinal associations following the PRISMA 2020 guidelines (PROSPERO: CRD42024609352). Comprehensive database searches were conducted in PubMed, Embase, MEDLINE (Ovid), CINAHL (EBSCOhost), and the Cochrane Library from database inception through 31 January 2025. To ensure that the review reflected the most recent evidence prior to manuscript submission, an updated search using the same search strategy and eligibility criteria was conducted on 31 May 2026. When multiple effect estimates were reported, the most fully adjusted estimates were selected. Because odds ratios (ORs) and hazard ratios (HRs) are different effect measures and are not directly comparable, they were analyzed separately. A random-effects model was used for quantitative synthesis. Results: Five cohort studies (n = 33,670; mean follow-up: 5.3 years) were included. Of these, four studies reported adjusted ORs and one reported an HR. DAO was associated with significantly higher odds of disability (pooled OR = 2.13, 95% CI: 1.74–2.60, I² = 0%). Subgroup analyses demonstrated significant associations across predominant population types and age groups, with ORs ranging from 2.09 to 2.18. Conclusions: DAO is associated with increased odds of future disability across population types and age groups. These findings highlight the importance of early identification of DAO and suggest that interventions targeting muscle strength and abdominal obesity represent promising strategies for disability prevention; however, their effectiveness should be confirmed in future prospective intervention studies. Full article

Pain is highly prevalent during hospitalization, and inadequate assessment contributes to avoidable suffering, prolonged length of stay, and increased resource use. Nurses play a central role in pain assessment, timely analgesic administration, patient education, and escalation of care. Background/Objectives: This study assessed nurses’ knowledge and attitudes regarding pain assessment and management and examined perceived causes of delayed pain treatment and perceived barriers to timely pain control at a tertiary hospital in Saudi Arabia. Methods: A descriptive cross-sectional study was conducted in inpatient and outpatient departments at King Abdulaziz Medical City, Jeddah, Saudi Arabia (August–December 2023). Registered nurses providing direct patient care were recruited via convenience sampling. Data were collected using a demographic and clinical practice questionnaire, the Nurses’ Knowledge and Attitudes Survey Regarding Pain (NKASRP), and an adopted instrument assessing perceived causes of delayed pain treatment and perceived barriers. Data were analyzed using descriptive statistics, two-tailed t-tests, one-way ANOVA with assumption checks and post hoc testing, Pearson correlations, and multiple linear regression. Results: A total of 125 nurses participated; 95.2% were female and 80.8% held a bachelor’s degree. The mean NKASRP composite score was 46.69% (SD = 9.90), indicating a suboptimal knowledge-and-attitudes profile. Age group was significantly associated with NKASRP scores (F = 5.136, p = 0.007), and age remained the only significant independent predictor in the multivariable model (b = 0.055, p = 0.006). The most frequently perceived delay was contacting a physician for opioid prescription (58.4%), followed by obtaining opioids from the pharmacy (46.4%). Major perceived barriers included insufficient staff–patient communication (60.0%), insufficient patient knowledge of pain control (52.8%), and inadequate staffing (49.6%). Conclusions: Nurses demonstrated a low composite knowledge-and-attitudes score and reported communication, workflow, and system-related barriers relevant to timely analgesia. These findings support further prospective evaluation of targeted educational and system-level strategies in similar settings. Full article

Diagnosis coding is a large-scale multi-label task in which each clinical encounter may require one or more coding labels from a large label space. Conventional top-k and threshold-based classifiers provide practical coding suggestions but do not directly characterize uncertainty over alternative coding sets. This study proposes sparse Mahalanobis conformal scoring for set prediction in diagnosis coding under extreme multi-label classification (XMC), intended for coding-assist workflows that require compact and reviewable coding suggestions. A sparse XMC model first generates candidate coding labels for each encounter. Candidate label sets are then constructed from the sparse proposal space and scored using a diagonal Mahalanobis nonconformity function calibrated on held-out data. Empirical conformal p-values are assigned to candidate sets, and downstream decision rules are used to obtain a final coding output from the retained region. The framework was evaluated using outpatient EHR data from a tertiary-care hospital, comprising approximately 8.0 million visits from 2018 to 2025 and up to 12,829 diagnosis labels. The primary SMaCS output achieved Micro-F1 close to the strongest threshold-based comparator and the highest exact match ratio among flexible-size decision rules. Compared with the other nonconformity scores, the Mahalanobis score produced a smaller retained region with fewer distinct labels, while preserving the same point-prediction performance. Additional analyses examined conformal region validity, robustness to label-frequency thresholds, code-depth performance, label-frequency subgroups, sample cardinality, department-level variation, and confidence–credibility stratification. Our results suggest that sparse Mahalanobis conformal scoring provides a useful framework for uncertainty-informed outpatient coding set prediction, while also highlighting the importance of candidate-space adequacy in extreme multi-label diagnosis coding. Full article

Background: Proton pump inhibitors (PPIs) are widely used for the treatment of gastrointestinal (GI) disorders. Omeprazole is one of the most commonly prescribed PPIs in Thailand. However, it is frequently overprescribed in hospital settings, increasing the risk of adverse effects. Moreover, such overuse imposes unnecessary healthcare costs. Objectives: To determine the prevalence of potentially inappropriate omeprazole prescribing and its associated factors, and to assess the financial impact of its overuse. Methods: This retrospective cross-sectional study was conducted in a general hospital in Thailand. Outpatients who received omeprazole between 1 January 2025 and 30 June 2025 were included. Descriptive statistics were used to summarize the data. The Chi-square test and Fisher’s exact test were used to compare categorical variables, as appropriate. Factors associated with inappropriate omeprazole prescribing were evaluated using logistic regression analysis. Results: A total of 229 patients receiving 347 omeprazole prescriptions were included. The mean age was 61.35 ± 17.17 years, and 59.4% were female. Inappropriate omeprazole prescribing was identified in 58.2% of prescriptions, primarily due to lack of appropriate indications (75.2%), followed by inappropriate duration. Antiplatelet use (OR 0.21, 95% CI 0.11–0.38, p < 0.001) and dual antiplatelet therapy (OR 0.05, 95% CI 0.01–0.37, p = 0.004) were significantly associated with a lower likelihood of inappropriate prescribing. Conclusions: Inappropriate omeprazole prescribing was common and largely driven by the absence of a clear indication, which was the main contributor to excess costs. Targeted interventions focusing on appropriate initiation, GI risk assessment, and regular reassessment may improve prescribing quality and reduce unnecessary healthcare expenditure. Full article

Objective: Disorders of gut–brain interaction (DGBIs) are characterized by functional impairments without identifiable organic causes, with their prevalence increasing with age. Emerging evidence suggests that selective serotonin reuptake inhibitors (SSRIs), such as escitalopram oxalate, may influence DGBIs through the brain–gut axis, though the precise mechanisms driving their therapeutic effects remain unclear. This study investigated the impact of escitalopram oxalate on elderly patients with DGBIs in an outpatient department to elucidate these mechanisms. Methods: This study was an observational cohort study. We recruited elderly patients diagnosed with DGBIs. Patients receiving standard treatment alone were assigned to the control group, while patients receiving standard treatment plus 10 mg of escitalopram oxalate daily were assigned to the exposure group. Emotional and gastrointestinal symptoms were assessed at baseline and after 12 weeks of treatment using validated symptom scales. Additionally, stool samples were collected at both time points and analyzed via 16S amplicon sequencing to evaluate the changes in gut microbiota. Results: A total of 83 elderly patients with DGBIs were included in the study, comprising 40 patients in the control group and 43 in the exposure group. After 12 weeks, the exposure group showed significantly greater reductions in their scores on the Gastrointestinal Symptom Rating Scale (GSRS), Short-Form Leeds Dyspepsia Questionnaire (SF-LDQ), Zung Self-Rating Depression Scale (SDS) and Zung Self-Rating Anxiety Scale (SAS) compared with the control group (e.g., GSRS: 17.00 ± 0.85 vs. 22.58 ± 3.18, p < 0.001; p < 0.01 for all other scale comparisons), with higher effective and recovery rates. Notably, the exposure group showed significant alterations in the abundance of four genus-level taxa (Blautia, Butyricicoccus, Prevotellaceae UCG-003, and Streptococcus) and two species-level taxa (Eubacterium-hallii-group and Parabacteroides-merdae). Conclusions: The escitalopram oxalate treatment was associated with significant improvements in both emotional and gastrointestinal symptoms in elderly patients with DGBIs. These improvements may be linked to alterations in specific gut microbiota taxa, offering a preliminary hypothesis for further investigating the underlying mechanisms of the gut–brain axis. Full article

Background/Objectives: Urinary tract infections (UTIs) are among the most common bacterial infections in children and represent a leading indication for antibiotic prescribing across inpatient, emergency department, and outpatient settings. Despite the availability of multiple international guidelines, prescribing practices for pediatric UTI frequently deviate from evidence-based recommendations in antibiotic selection, route of administration, and duration of therapy. These suboptimal practices contribute to the emergence of resistant uropathogens, including extended-spectrum β-lactamase-producing organisms, and highlight the need for a comprehensive stewardship approach specific to this population. Methods: A literature search was performed using PubMed and MEDLINE from January 2000 to May 2026 using the following search terms: urinary tract infection, children, pediatrics, antibiotic stewardship, antimicrobial resistance, diagnosis, treatment, duration, prophylaxis, and intravenous-to-oral transition. Thirteen active international guidelines published between 2011 and 2025 were identified and evaluated with specific emphasis on the integration of antibiotic stewardship principles. Clinical trials, systematic reviews, meta-analyses, and quality improvement studies addressing stewardship-relevant outcomes in pediatric UTI were included. Case reports were excluded. Results: Comparative analysis of 13 international UTI treatment guidelines demonstrated substantial variation in diagnostic criteria, treatment duration, and prophylaxis recommendations, with most guidelines predating the SCOUT, STOP, and INDI-UTI randomized controlled trials. Diagnostic stewardship interventions targeting urine collection methods, urinalysis-guided treatment decisions, and avoidance of antibiotic treatment for asymptomatic bacteriuria represented high-impact opportunities to reduce unnecessary antibiotic exposure. Oral antibiotic therapy was as effective as intravenous therapy for most children with pyelonephritis, and early intravenous-to-oral transition was supported by consistent randomized controlled trial evidence. A 5-day oral course may be reasonable for uncomplicated febrile UTI in children demonstrating clinical improvement, supported by the STOP trial, although the SCOUT trial did not meet its noninferiority margin despite a low absolute failure rate; 3 to 5 days was appropriate for uncomplicated cystitis. Antibiotic prophylaxis was not indicated in children with a normal urinary tract following a first febrile UTI and should be reserved for specific high-risk subgroups, with nitrofurantoin as the preferred agent. Formal antibiotic stewardship programs combining prospective audit and feedback, electronic health record integration, and prescriber education demonstrated measurable improvements in prescribing appropriateness for pediatric UTI. Gepotidacin, a first-in-class oral antibiotic approved in 2025 for uncomplicated UTI in female patients aged 12 years and older and weighing at least 40 kg, represented a limited option for eligible adolescents with resistant infections. Conclusions: Antibiotic stewardship for pediatric UTI addresses the full clinical pathway from diagnostic stewardship through prophylaxis rationalization. Evidence-based interventions targeting urine collection, urinalysis-guided decision-making, early intravenous-to-oral transition, duration optimization, and selective prophylaxis use can collectively reduce unnecessary antibiotic exposure without compromising patient outcomes. A dedicated stewardship-oriented pediatric UTI guideline, standardized resistance surveillance, and multicenter stewardship program evaluations with patient-centered outcomes are critical research priorities. Full article

Radiotherapy-associated pain is among the most common and debilitating complications in head and neck cancer. Although historically viewed primarily as a treatment-related adverse effect, growing evidence suggests that pain is deeply intertwined with tumor biology, immune remodeling, and therapeutic outcomes. At the same time, recent advances in cancer neuroscience have identified sensory nerves as active components of the tumor microenvironment (TME), capable of influencing antitumor immunity through complex neuroimmune crosstalk. These observations raise the possibility that radiotherapy-associated pain is not merely a clinical symptom but also a biological indicator of dynamic changes within the tumor immune microenvironment (TIME). In this review, we outline the major clinical manifestations of radiotherapy-associated pain in head and neck cancer, including inflammatory or mucositis-related pain, neuropathic pain, and long-term chronic pain, with emphasis on their underlying biological features and potential therapeutic relevance. Given that oral mucositis is the dominant source of acute radiotherapy-associated pain in head and neck cancer, we further summarize evidence-based preventive and supportive strategies, including photobiomodulation, mucosal barrier-forming agents, anti-inflammatory mouthwashes, nutritional interventions, pain control, and multidisciplinary oral care. We further discuss how radiotherapy reshapes the TIME through mechanisms such as immunogenic cell death, activation of the cGAS-STING pathway, vascular and stromal remodeling, and regulation of lymphoid compartments, while also triggering compensatory immunosuppressive responses. Preclinical and translational studies suggest that nociceptive signaling pathways may modulate T-cell function, myeloid-cell activity, and immune-evasive programs. Through these neuroimmune interactions, radiotherapy-induced neural injury and persistent pain may contribute to the establishment of an immunosuppressive, wound-like microenvironment that ultimately affects treatment response and tumor progression. Finally, we discuss the translational significance of incorporating pain phenotyping into combined radiotherapy and immunotherapy strategies for head and neck cancer. Opioid-sparing multimodal analgesia, neuromodulation, and neuroimmune-targeted interventions may represent promising approaches to simultaneously improve symptom control and antitumor immunity. We propose that radiotherapy-associated pain may be considered a candidate neuroimmune phenotype rather than a passive adverse event, providing a new conceptual framework for precision management and translational research in head and neck cancer. Full article

Objective: To analyze the perceived facilitators and barriers promoting and hindering the clinical application of the best evidence of clean intermittent catheterization (CIC) in patients after radical hysterectomy (RH). Methods: This study employed a convergent parallel mixed-methods design. Participants included patients undergoing CIC after RH, medical and nursing practitioners and managers in the gynecological department and outpatient clinics at a tertiary-level women’s and children’s hospital in Chengdu. They were included in both components separately. Interview data were managed using Nvivo 11.0 software and analyzed through directed content analysis. Quantitative data were analyzed using SPSS 29.0 statistical software. Results: A questionnaire survey was conducted among 156 healthcare providers and 300 patients. Qualitative interviews were conducted with 11 healthcare workers and 12 patients. At the evidence itself level, evidence meeting clinical needs and evidence lacking practical applicability, respectively, promoted and hindered clinical implementation of the best evidence. At the potential adopters’ level, healthcare professionals’ insufficient professional competence, low willingness to promote implementation, numerous concerns, and lack of autonomy and awareness regarding the importance of the task were significant barriers, but they maintained an overall positive attitude toward the application. At the practical environment level, patient-related perceived barriers predominantly hindered evidence implementation. Additionally, a supportive practice atmosphere, economic feasibility, and talent development opportunities served as key facilitators. However, existing nursing practice content and workflows directly impacted evidence adoption. Conclusions: The promotion and barriers to the clinical application of the best evidence for CIC in RH postoperative patients are multifaceted. Targeted intervention strategies must be developed to facilitate the effective translation of evidence into clinical practice. Full article

The coronary arteries are a pair of arteries that branch off from the aorta and encircle the heart, providing oxygenated blood to the myocardium. Although coronary artery atherosclerosis remains a main cause of morbidity and mortality worldwide, coronary artery anomalies (CAAs) are increasingly recognized as a clinically relevant cause of ischemic events and can be subdivided into origin, course, or termination anomalies. The aim of this narrative review is to summarize the cross-sectional diagnostic imaging and clinical background of CAAs. Full article

Background: Oroantral communication (OAC) represents a pathological communication between the oral cavity and the maxillary sinus, most commonly occurring after extraction of posterior maxillary teeth. Despite being considered a rare complication, it remains clinically significant due to the risk of chronic sinus pathology. Methods: This study was conducted within the “Arsenie Guțan” Department of Oral and Maxillofacial Surgery at “Nicolae Testemițanu” State University of Medicine and Pharmacy. We evaluated a cohort of 31 patients with OAC treated in an outpatient setting at the Municipal Dental Center in Chișinău during 2022. Results: The first molar was the most frequently involved tooth (45.16%), with molars accounting for 83.88% of cases. Immediate post-extraction diagnosis was achieved in 90.32% of patients. Imaging was required in selected cases, with orthopantomography (OPG) used in 83.87% and computed tomography (CT) in 9.67% of patients. Conclusions: Early diagnosis based on combined clinical and radiographic assessment remains essential for successful management of OAC. Prompt intervention reduces the risk of maxillary sinus infection and chronic fistula formation. Full article

Background: Insomnia is common among people with mental health conditions and can exacerbate symptoms, impair functioning and negatively impact treatment outcomes. Community mental health services require practical data to quantify the burden of insomnia in routine care and to identify groups at a higher risk of experiencing clinically significant insomnia. Methods: We conducted a retrospective analysis of anonymized routinely collected clinical data from adult psychiatric outpatients attending the Community Mental Health Center in Bra (Department of Mental Health, Asl Cuneo 2, Italy). Consecutive patients were included over a three-month period (1 September to 30 November 2025). Insomnia severity was assessed using the Insomnia Severity Index (ISI). Diagnoses were established by psychiatrists using the Structured Clinical Interview for DSM-5 (SCID-5). Results: The sample included 506 patients (mean age: 45.1 ± 16.7 years; 265 women, 52.4%). The mean ISI total score was 12.18 ± 6.99. Clinically significant insomnia (ISI ≥ 15) was present in 205 out of 506 patients (40.5%), while severe insomnia (ISI ≥ 22) was present in 55 out of 506 patients (10.9%). The ISI score differed across diagnostic groups (ANOVA, F(8, 497) = 2.82, p = 0.0046, η² = 0.043). Post hoc comparisons revealed higher ISI scores in patients with depressive disorders than in those with anxiety disorders (Tukey, p = 0.0056). In a multivariable logistic regression model (outcome: ISI score of at least 15), adjusted for age, sex, education and the complexity of concurrent psychotropic medication (number of medication classes), depressive disorders were associated with clinically significant insomnia (OR: 1.99; 95% CI: 1.07–3.73). Attention deficit hyperactivity disorder (ADHD) also showed higher odds (OR: 3.64; 95% CI: 1.26–10.55). Medication complexity was also associated with an ISI score of at least 15 (OR: 1.43 per additional class; 95% CI: 1.16–1.77). In a sensitivity model additionally adjusting for benzodiazepine prescription (yes/no), benzodiazepine prescription was associated with ISI ≥ 15 (OR 1.82; 95% CI 1.13–2.95), while the estimate for medication complexity was attenuated using this association (OR 1.17; 95% CI 0.90–1.53). The eating disorders group was excluded from multivariable models due to the very small sample size (n = 4). Conclusions: Clinically significant insomnia was prevalent among this sample of psychiatric outpatients, with modest differences in insomnia severity across diagnostic groups. Sensitivity analyses suggested that the signal of medication complexity may be partly accounted for by benzodiazepine prescribing, supporting the cautious interpretation of medication-related correlates in routine cross-sectional data. These findings support routine insomnia screening in psychiatric outpatient care, while prospective studies are needed to clarify directionality and clinical implications. Full article