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22 pages, 1024 KB  
Article
A Randomised, Double-Blind, Placebo-Controlled Trial of Probiotic and Postbiotic Strains in Healthy Adults with Self-Reported Anxiety: Effects on Mood, Vitality, Quality of Life and Perceived Stress
by Richard Day, Daniel Friedman, Ana Cardoso, Malwina Naghibi, Adria Pont, Juan Martinez-Blanch, Araceli Lamelas, Empar Chenoll, Charles Kakilla, Kieran Rea and Vineetha Vijayakumar
Brain Sci. 2026, 16(4), 419; https://doi.org/10.3390/brainsci16040419 - 16 Apr 2026
Abstract
Background: Subclinical psychological symptoms—such as low mood, perceived stress, and poor sleep—affect a large portion of the population and can impair quality of life despite remaining below clinical thresholds. The gut–brain axis has emerged as a promising target for interventions that support emotional [...] Read more.
Background: Subclinical psychological symptoms—such as low mood, perceived stress, and poor sleep—affect a large portion of the population and can impair quality of life despite remaining below clinical thresholds. The gut–brain axis has emerged as a promising target for interventions that support emotional and psychological resilience. Probiotics and postbiotics are gaining attention for their potential to modulate mood and stress via microbiome-related mechanisms, but human evidence remains limited, particularly in non-clinical populations. Objectives: We aimed to assess the effects of a two-strain combination of live microorganisms alongside a two-strain combination of heat-treated inactivated microorganisms on outcomes associated with anxiety, mood, perceived stress, and quality of life in healthy adults experiencing mild stress. Methods: This study was conducted in two parts. In Part I, a randomized, double-blind, placebo-controlled study, 100 participants were randomized to receive either a blend of live microorganisms (Bifidobacterium longum CECT 7347 and Lactobacillus rhamnosus CECT 8361) or an identical placebo once daily for 12 weeks. In Part II, a pilot feasibility study, a subset of eight placebo non-responders from Part I received the heat-inactivated preparation of the same bacterial strains in a 6-week trial extension phase. For Parts I and II, the primary outcome was the change in the Hamilton Anxiety Rating Scale (HAM-A). Secondary outcomes included measures of mood (Beck Depression Inventory (BDI); Patient Health Questionnaire-9 (PHQ-9)), stress (state and trait anxiety inventory (STAI); Perceived Stress Scale (PSS)), sleep (Pittsburgh Sleep Quality Index (PSQI)), quality of life (36-item Short Form Survey (SF-36)), gastrointestinal symptoms (Gastrointestinal Symptom Rating Scale (GSRS)), salivary cortisol and microbiome modulation. Results: In Part I, there were no significant effects of the live blend on the HAM-A, indicating that the primary endpoint was not met. In addition, no significant effects were seen on the STAI or PSS scores when compared to the placebo. However, participants consuming the live blend trended toward a reduction in total PHQ-9 scores compared to placebo (p = 0.089), whilst preliminary exploratory analyses suggested an improvement in anhedonia (p = 0.045). Furthermore, there was a significant improvement in the vitality domain of the SF-36 compared to placebo (p = 0.017). On microbiome analysis, it was noted that consumption of the live blend was linked to the preservation of butyrate-producing bacteria, particularly members of the Pseudoflavonifractor genus and the Clostridium SGB6179 species. Furthermore, the abundance of B. longum species was found to be inversely associated with the total PSS Scores. In Part II, supplementation with the inactivated preparation resulted in significant within-group improvements for the vitality (p = 0.006) and social functioning (p = 0.010) domains of the SF-36 and improvements in PSS scores compared to baseline (p = 0.050). Conclusions: Supplementation with either the dual-strain live or inactivated formulations was associated with significant improvements in the vitality domain of the SF-36, whilst participants receiving the inactivated formulation demonstrated lower perceived stress and improved social functioning compared to baseline. Overall, the findings from this pilot study suggest that these two biotic consortia are well-tolerated and may be associated with improvements in measures of vitality in individuals with subclinical psychological symptoms. The subtle observations detected for stress and anhedonia suggest that further well-powered trials are needed to better characterize these findings, potentially in populations with greater baseline symptomatology. Full article
30 pages, 2487 KB  
Review
Ferroptosis in Neuropsychiatric and Neurodegenerative Disorders: Shared Mechanisms and Disease-Specific Signatures
by Mingxin Liu, Chen Zeng and Zizhen Si
Pharmaceuticals 2026, 19(4), 629; https://doi.org/10.3390/ph19040629 - 16 Apr 2026
Abstract
Neuropsychiatric and neurodegenerative disorders impose a substantial global health burden, yet progress in mechanism-based therapy remains limited by clinical heterogeneity and an incomplete understanding of disease biology. Emerging evidence implicates ferroptosis—an iron-dependent form of lipid peroxidation-driven cell death—as a shared pathogenic process across [...] Read more.
Neuropsychiatric and neurodegenerative disorders impose a substantial global health burden, yet progress in mechanism-based therapy remains limited by clinical heterogeneity and an incomplete understanding of disease biology. Emerging evidence implicates ferroptosis—an iron-dependent form of lipid peroxidation-driven cell death—as a shared pathogenic process across primary psychiatric disorders and neurodegenerative diseases with prominent neuropsychiatric features. In this review, we synthesize evidence from major depressive disorder, schizophrenia, substance use disorders, Alzheimer’s disease (AD), and Parkinson’s disease (PD), highlighting ferroptosis as a common mechanism linking iron dyshomeostasis to neuronal dysfunction. Mechanistically, ferroptosis is organized around three interconnected modules: amino acid metabolism, lipid peroxidation, and iron handling. These pathways converge on mitochondrial dysfunction, oxidative damage, and neuroinflammatory amplification. We further propose that each disorder displays a distinct ferroptosis signature, including dopamine quinone-mediated GPX4 loss in PD, AICD-dependent transcriptional reprogramming in AD, and inflammatory–glutamatergic lowering of the ferroptotic threshold in depression and schizophrenia. Together, these insights position ferroptosis as a candidate framework for biomarker development, patient stratification, and mechanism-informed therapeutic intervention across neuropsychiatric disease. Full article
(This article belongs to the Section Pharmacology)
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22 pages, 333 KB  
Article
From Nature to Strength: A Proof-of-Concept Study Integrating a Nature-Based Intervention with Virtually Supported Resistance Training in Young Men
by Alfred S. Y. Lee, Bradley A. Rudner, Ryan E. Rhodes and Nevin J. Harper
Healthcare 2026, 14(7), 937; https://doi.org/10.3390/healthcare14070937 - 3 Apr 2026
Viewed by 398
Abstract
Background: Young men experience substantial mental health and mortality-related risks, yet they often do not engage in conventional health promotion programs. This highlights the need for gender-specifc interventions that are acceptable, engaging, and feasible for young men. Purpose of Research: Guided by self-determination [...] Read more.
Background: Young men experience substantial mental health and mortality-related risks, yet they often do not engage in conventional health promotion programs. This highlights the need for gender-specifc interventions that are acceptable, engaging, and feasible for young men. Purpose of Research: Guided by self-determination theory, this single-group proof-of-concept study evaluated the feasibility and acceptability of a dual-component intervention combining an in-person nature-based intervention (NBI; two days of group activities and guided reflection in a forested park) and a subsequent virtually supported resistance training (RT) program for young men and explored secondary, exploratory pre- to post-changes in depressive and anxiety symptoms. Methods: Eight men aged 18–34 not meeting RT recommendations (i.e., <2 sessions/week) completed a two-day, in-person NBI followed by six weeks of virtually supported RT with weekly group check-ins. Primary feasibility outcomes were satisfaction and qualitative acceptability for NBI/RT, recruitment, retention, and adherence. Secondary, exploratory quantitative outcomes were pre- to post-changes in depressive and anxiety symptom scores. Brief semi-structured exit interviews were conducted at the study end and audio-recorded for analysis. Results: Satisfaction met a priori thresholds for both components (NBI = 3.4/4; RT = 4.3/5; criteria ≥ 3.0 and ≥ 3.5). Recruitment was 46% and retention 100%, exceeding the 42% and 80% criteria, respectively. Exit interview themes highlighted guided learning, accountability, and feeling more connected to nature as acceptability drivers, with the scheduling burden noted but manageable. Depressive and anxiety symptom scores were lower post-intervention. Conclusions: Challenges in recruitment, group dynamics, and participant selection require refinement before the next phase; however, high satisfaction with both the NBI and RT segments, together with improvements in anxiety and depression symptom scores, supports progressing to a feasibility trial once these enhancements are in place. Full article
14 pages, 737 KB  
Article
SARS-CoV-2 Infection and COVID-19 Vaccine Antibody Responses in Two Canadian Cohorts of Persons Living with HIV
by Sharon L. Walmsley, Leif Erik Lovblom, Bryan Boyachuk, Curtis Cooper, Valérie Martel-Laferrière, Mona Loutfy, Marie-Louise Vachon, Shariq Haider, Pamela Aldebes, Karen Colwill, Anne Claude Gingras, Freda Qi and Marina B. Klein
Antibodies 2026, 15(2), 30; https://doi.org/10.3390/antib15020030 - 3 Apr 2026
Viewed by 302
Abstract
Objectives: To determine the incidence and outcomes of SARS-CoV-2 infection and to evaluate seroconversion rates and quantify antibody responses to COVID-19 vaccines in two cohorts of persons living with HIV at a possible higher risk of poor outcomes (HCV coinfection and those over [...] Read more.
Objectives: To determine the incidence and outcomes of SARS-CoV-2 infection and to evaluate seroconversion rates and quantify antibody responses to COVID-19 vaccines in two cohorts of persons living with HIV at a possible higher risk of poor outcomes (HCV coinfection and those over the age of 65 years). Methods: We included participants from two established cohorts of persons living with HIV, those who were older than 65 years of age, and those with hepatitis C (HCV) co-infection. Four hundred and seventy-one participants completed questionnaires on SARS-CoV-2 infection and COVID-19 vaccine doses and submitted peripheral blood specimens for measuring antibody levels to COVID-19 antigens, full-length spike trimer, its receptor binding domain (RBD), and nucleocapsid protein (N) at 6-month intervals up to three visits between February 2021 and December 2024. Logistic and ordinal logistic regression models evaluated predictors of seroconversion and antibody levels. Results: Overall, 51% of participants developed a SARS-CoV-2 infection, but it was mild, with only nine requiring hospital admission and no deaths. Overall, 99% of tested specimens had antibodies above threshold to either spike or RBD proteins. Specimens that did not and those with lower antibody levels had testing earlier in the pandemic, and were from participants with fewer vaccine doses, and did not have natural infection. Age, depression, comorbidity, HCV co-infection, current substance use, CD4 count, or HIV viral load were predictive of antibody level. Those with hybrid immunity had higher antibody responses. Conclusions: In cohorts of persons with HIV-HCV coinfection and those who are ageing, we observed high rates of seroconversion to COVID-19 antigens. Antibody levels were higher among those with more vaccine doses, hybrid immunity, and later in the pandemic waves. Although 51% developed a breakthrough infection, outcomes were mild with no deaths. Full article
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16 pages, 245 KB  
Article
Quality of Life and Its Psychosocial Determinants Among Cancer Patients: Insights from the Qassim Region, Saudi Arabia
by Abdullah Alqifari, Lama Alharbi, Meshari Aloufi, Alwaleed Alsaawi, Fatimah Almutairi, Norah Alodhaybi, Hana Alqifari and Bader Alshamsan
Healthcare 2026, 14(7), 892; https://doi.org/10.3390/healthcare14070892 - 31 Mar 2026
Viewed by 294
Abstract
Background: Cancer incidence is increasing in Saudi Arabia and the Qassim region. While survival has improved, quality of life (QoL) remains a vital outcome. However, limited research in Qassim has examined determinants of QoL. This study assessed factors associated with QoL among cancer [...] Read more.
Background: Cancer incidence is increasing in Saudi Arabia and the Qassim region. While survival has improved, quality of life (QoL) remains a vital outcome. However, limited research in Qassim has examined determinants of QoL. This study assessed factors associated with QoL among cancer patients, focusing on sociodemographic, clinical, and psychological variables. Methods: A cross-sectional study was conducted at the Oncology Centre in Qassim (January–June 2024). QoL was measured using the Arabic version of the EORTC QLQ-C30, and psychological distress was assessed using the GAD-7 and PHQ-9. Statistical analyses were performed using SPSS v30. Chi-square and Mann–Whitney U tests were used to compare group differences, and logistic regression was used to identify factors associated with global QoL. Results: Among 187 patients, the median age was 48 years (range, 18–94), and 73.8% were female. Breast cancer (52.2%) and colorectal cancer (16.1%) were the most common diagnoses. The mean global quality-of-life score was 73.8 (SD = 22.2). Anxiety and depression prevalence rates were 12.8% and 29.9%, respectively. Moreover, psychiatric history and psychological distress were significantly associated with poorer QoL in unadjusted analyses. Only higher depression scores were independently associated with lower odds of good QoL (AOR = 0.85, 95% CI [0.77–0.95], p = 0.004). Physical and emotional functioning were significantly higher among patients with good global QoL (both p < 0.001). In contrast, fatigue, pain, nausea and vomiting, and insomnia were significantly more common among those with poor QoL (p < 0.001, p < 0.001, p = 0.005, and p < 0.001, respectively). Based on Therapeutic Change Index thresholds, clinically meaningful impairment was identified in 31.6–47.6% of functional scales and 15.5–45.0% of symptom scales. Conclusions: Depressive symptom severity, functional limitations, and symptom burden were associated with poorer QoL among cancer patients. Integrating psychological and supportive care is essential to enhance well-being in Qassim. Full article
20 pages, 1291 KB  
Article
Development, Feasibility, and Appreciation of the Collaborative Integrated Depression Care (IDECA) Project in Flanders, Belgium
by Ruben Willems, Kris Van den Broeck, Reini Haverals, Lieven Annemans, Pauline Boeckxstaens, Didier Schrijvers, Geert Goderis, Elke Peeters and Liesbeth Borgermans
J. Clin. Med. 2026, 15(6), 2326; https://doi.org/10.3390/jcm15062326 - 18 Mar 2026
Viewed by 351
Abstract
Background: Depression remains a major global health burden, yet fragmented care often leads to waiting times and unmet needs. Therefore, the Belgian collaborative Integrated Depression Care (IDECA) project strengthened primary care depression management by introducing a Reference Person Mental Wellbeing (RPMW) who [...] Read more.
Background: Depression remains a major global health burden, yet fragmented care often leads to waiting times and unmet needs. Therefore, the Belgian collaborative Integrated Depression Care (IDECA) project strengthened primary care depression management by introducing a Reference Person Mental Wellbeing (RPMW) who functions as a case manager, supported by shared-care tools, structured psychoeducation modules, and targeted training for general practitioners (GPs). This study examines normalization in primary care practice. Methods: A single-arm, mixed-method study was implemented over 18 months in two Flemish Primary Care Zones (PCZ). Implementation outcomes were assessed every four months using the NoMAD questionnaire and analyzed using Wilcoxon signed-rank tests. Peer review sessions with professionals and interviews with patients were analyzed thematically. Caseload and service delivery were assessed using process evaluation logs. Results: Twenty-two professionals (17 GPs, two RPMWs, and three PCZ staff members) completed the NoMAD questionnaire. Intervention familiarity increased during the first eight months (T0–T1: p < 0.001; T1–T2: p = 0.022) and continued to rise thereafter (T3–T4: p = 0.008). Integration into daily practice and perceived impact on professional work improved progressively, reaching near-ceiling scores. Peer review sessions highlighted the RPMW’s central role in trust-building and care coordination. Over 12 months, one full-time equivalent RPMW supported 175 patients (mean age 40.7 years; 75% female), with an average of five consultations per patient. Patients reported high satisfaction, emphasizing accessibility, empathy, and practical support. Conclusions: Sustained results suggest successful normalization and support the potential of collaborative, low-threshold depression care. Future work will assess clinical and economic outcomes. Full article
(This article belongs to the Special Issue Innovations and Advances in Primary Care and Family Medicine)
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17 pages, 1898 KB  
Article
Cefepime Alleviates Comorbid Pain and Depression Induced by Lipopolysaccharide in Female Mice
by Amna Khan, Patrick J. Ronan and Shafiqur Rahman
Brain Sci. 2026, 16(3), 306; https://doi.org/10.3390/brainsci16030306 - 12 Mar 2026
Viewed by 446
Abstract
Background/Objectives: Evidence indicates that aberrant glutamate transporter function and expression are linked to the pathophysiology of comorbid major depressive disorder (MDD) and pain. We have previously reported that cefepime (CFP) attenuates lipopolysaccharide (LPS)-evoked pain and depression by regulating hyperglutamatergic activity in male [...] Read more.
Background/Objectives: Evidence indicates that aberrant glutamate transporter function and expression are linked to the pathophysiology of comorbid major depressive disorder (MDD) and pain. We have previously reported that cefepime (CFP) attenuates lipopolysaccharide (LPS)-evoked pain and depression by regulating hyperglutamatergic activity in male mice. However, the effects of CFP on LPS-evoked pain, depression-related anxiety, and cognitive impairment in female mice regarding sex-specific glial mechanisms remain unknown. Methods: Using behavioral paradigms, we evaluated the therapeutic potential of CFP in mitigating LPS-evoked pain, depression-related anxiety, and cognitive impairment in female mice. Furthermore, we used Western blot analysis to examine the effects of CFP on ionized calcium-binding adaptor molecule 1 (Iba-1) and glutamate transporter 1 (GLT-1) protein levels in the prefrontal cortex (PFC) and hippocampus (HPC). We also measured tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) concentrations in the HPC and PFC after CFP treatment using ELISA. Results: Pretreatment with CFP significantly increased the mechanical threshold and withdrawal latency in female mice. Additionally, systemic treatment with CFP markedly reduced immobility during the forced swim and tail suspension tests. Moreover, pretreatment with CFP remarkably augmented the open arm time during elevated plus maze test and spontaneous alternation between arms during Y-maze test. Western blot analysis indicated that systemic administration of CFP significantly reversed the downregulation of astroglial GLT-1 expression and reduced the microglial Iba-1 protein levels in the HPC and PFC. Furthermore, pretreatment with CFP significantly attenuated the LPS-evoked increase in the production of pro-inflammatory cytokines in the HPC and PFC. Conclusions: These results represent the novel inaugural report of a combined pain-MDD phenotype in female mice. The findings imply that positive glutamate transporter modulator CFP could be a novel treatment for comorbid pain and MDD in female patient population. Full article
(This article belongs to the Section Behavioral Neuroscience)
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15 pages, 251 KB  
Article
Sleep Quality and Mental Health of High-Level Esports Competitors: A Cross-Sectional Study
by Hiroaki Yamamoto, Hiroyuki Muraoka and Ken Inada
Healthcare 2026, 14(5), 582; https://doi.org/10.3390/healthcare14050582 - 26 Feb 2026
Viewed by 494
Abstract
Background: Sleep quality and mental health are important concerns for esports competitors. However, epidemiological data regarding sleep quality and psychological distress among high-level esports players remain limited. Objective: This study aimed to examine sleep quality and mental health status among high-level esports competitors [...] Read more.
Background: Sleep quality and mental health are important concerns for esports competitors. However, epidemiological data regarding sleep quality and psychological distress among high-level esports players remain limited. Objective: This study aimed to examine sleep quality and mental health status among high-level esports competitors in Japan and to identify factors associated with psychological distress. Methods: This cross-sectional study included 275 competitors (269 males, 3 females, and 3 who did not report sex) participating in the 2023 National Prefectural Esports Championship. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), psychological distress using the Kessler Psychological Distress Scale (K6), and depressive symptoms using the Patient Health Questionnaire-9 (PHQ-9). Multivariable logistic regression analyses were performed to identify associated factors. Results: The response rate was 61.8% (275/445). Poor sleep quality (PSQI > cut-off) was observed in 38.5% of competitors. Based on the K6, 24.4% reported psychological distress above the mild threshold, and 29.5% reported mild or greater depressive symptoms according to the PHQ-9. Overall mental health levels were comparable to those reported in previous studies of general populations. Nighttime esports training was significantly associated with psychological distress (adjusted odds ratio 3.80; 95% confidence interval 1.50–9.64; p = 0.005). Conclusions: More than one-third of Japanese esports competitors experience poor sleep quality, and approximately one-quarter report mild or greater psychological distress. Nighttime esports training may be an important factor associated with mental health among competitors. Further longitudinal studies are warranted to clarify temporal relationships and to examine whether reducing nighttime training is associated with improved mental health outcomes among esports competitors. Full article
(This article belongs to the Section Mental Health and Psychosocial Well-being)
13 pages, 496 KB  
Article
Association of Impulse Control Disorders with Cognitive Performance and Frontal Dysfunction in Patients with Parkinson’s Disease
by Maria Bougia, Aristeidis Papadaniil, Evangelia Smaragdaki, Nikolaos Papagiannakis, Athina-Maria Simitsi, Ion Beratis, Dionysia Kontaxopoulou, Stella Fragkiadaki, Ioanna Alefanti, Evangelos Sfikas, Ioanna Alexandratou, Roubina Antonelou, Sokratis G. Papageorgiou, Leonidas Stefanis and Christos Koros
J. Clin. Med. 2026, 15(5), 1698; https://doi.org/10.3390/jcm15051698 - 24 Feb 2026
Viewed by 312
Abstract
Background: Frontal lobe circuit dysfunction, including the mesolimbic network, plays an important role in learning reward behaviors and is involved in the development of impulsive compulsive disorders (ICDs) in Parkinson’s disease (PD). ICDs in PD are characterized by disinhibited, reward-driven behaviors performed [...] Read more.
Background: Frontal lobe circuit dysfunction, including the mesolimbic network, plays an important role in learning reward behaviors and is involved in the development of impulsive compulsive disorders (ICDs) in Parkinson’s disease (PD). ICDs in PD are characterized by disinhibited, reward-driven behaviors performed with poor impulse control, often linked to dopaminergic treatment. The purpose of the present study was to assess the presence of these behaviors in relation to frontal dysfunction and overall cognitive status in a cohort of patients with sporadic PD. Methods: The study consisted of 55 patients (n = 55), 36 males (65.5%), diagnosed with Parkinson’s disease, assessed at the First Neurological Clinic of Eginition University Hospital in Athens. The participants had a mean age of 62.6 (±13.54) years, with an average of 11.94 (±3.00) years of education and a mean disease duration of 7.17 (±5.90) years. The evaluation tools used to assess the participants were the Questionnaire for Impulsive-Compulsive Disorders in Parkinson’s Disease (QUIP), Montreal Cognitive Assessment (MoCA), Frontal Assessment Battery (FAB), and Geriatric Depression Scale (GDS). Results: The mean score on the QUIP was 0.64 (±1.05), with a threshold of 1. Of the total number of patients (n = 55), 18 (32.72%) showed behaviors related to ICDs. The most commonly reported impulsive compulsive behavior was an excessive preoccupation with hobbies (n = 7, 38.9%), followed by a tendency toward gambling (n = 6, 33.3%). The mean score on the MoCA scale was 24.69/30 (±4.25), while the mean score on the FAB scale was 14.70/18 (±2.45). Pearson’s correlation analysis revealed a moderate positive correlation between total MoCA score and FAB (r = 0.588, p < 0.000) and a weak to moderate negative correlation between MoCA score and QUIP (r = −0.291, p = 0.038). Additionally, there was a statistically significant negative correlation between QUIP scores and performance on the MoCA attention subtests (Forward Digit Span, Backward Digit Span, and Vigilance tasks), (r = −0.389, p = 0.009). Conclusions: Lower global cognitive function, as measured by the MoCA, was strongly associated with reduced frontal lobe function, as measured by the FAB, in Parkinson’s patients. Additionally, lower scores on the MoCA, particularly in the attention subtests, showed a weak to moderate correlation with increased impulsive compulsive behaviors, as measured by the QUIP. Full article
(This article belongs to the Special Issue Symptoms and Treatment of Parkinson’s Disease)
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32 pages, 2039 KB  
Review
Artificial Intelligence for Opioid Safety Surveillance from Clinical Text: A Clinically Focused Review
by Md Muntasir Zitu, Dwight Owen, Ashish Manne, Yuxi Zhu, Samar Binkheder and Lang Li
J. Clin. Med. 2026, 15(4), 1649; https://doi.org/10.3390/jcm15041649 - 22 Feb 2026
Cited by 1 | Viewed by 1282
Abstract
Opioid-related iatrogenic harms, including opioid use disorder, overdose, and opioid-induced respiratory depression, constitute a major patient safety challenge. Although clinicians document key safety signals in unstructured clinical narratives, many of these indicators are not readily captured by conventional surveillance approaches that rely on [...] Read more.
Opioid-related iatrogenic harms, including opioid use disorder, overdose, and opioid-induced respiratory depression, constitute a major patient safety challenge. Although clinicians document key safety signals in unstructured clinical narratives, many of these indicators are not readily captured by conventional surveillance approaches that rely on structured administrative data. This clinically focused narrative review synthesizes 47 empirical studies published between 2009 and 2025 that applied artificial intelligence (AI) methods to identify opioid-related harms from clinical text and to address the resulting ascertainment gap. Across studies, administrative coding systems, including ICD-10, often under-ascertain opioid-related events, whereas text-based AI can identify additional cases and contextual details often documented primarily in narrative records, such as fluctuating mental status, suspected drug causality, and responses to naloxone. Methodologically, the literature has progressed from interpretable rule-based lexicons to machine learning and deep learning models and, more recently, to transformer-based approaches, including large language models (LLMs) for classification and schema-driven extraction. Rule-based systems established the feasibility of transparent surveillance and frequently recovered clinically documented cases missed by billing codes. Subsequent supervised and deep learning approaches expanded scalability and, in a smaller subset of studies, were integrated into electronic health record workflows with operational metrics reported. More recent transformer- and LLM-based studies emphasize richer extraction schemas and benchmark development, including characterization of overdose context and intentionality and identification of potential prodromal neurocognitive signals, although external validation, calibration, and prospective outcome evaluation remain inconsistently reported. Given that the evidence base is predominantly retrospective and that clinical workflow studies remain comparatively few, a pragmatic near-term clinical role is to provide detection-to-triage decision support rather than autonomous diagnosis, in which systems surface candidate cases with reviewable evidence for clinician adjudication. Future progress will require greater standardization of phenotype definitions, routine equity auditing and subgroup reporting, stronger external validation and calibration at operational thresholds, and a shift from retrospective discrimination metrics toward prospective assessments of the clinical workflow impact, clinical utility, and patient-centered outcomes. Full article
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19 pages, 1729 KB  
Article
Association of PFAS, Metals, Phthalate and Organophosphate Metabolites with Depression Among U.S. Adults
by Olamide Ogundare and Emmanuel Obeng-Gyasi
Int. J. Environ. Res. Public Health 2026, 23(2), 205; https://doi.org/10.3390/ijerph23020205 - 6 Feb 2026
Viewed by 607
Abstract
Depression is a major public health concern, and evidence continues to show that environmental toxicants may contribute to its development. This study evaluated the association between depressive symptoms and per- and polyfluoroalkyl substances (PFAS), heavy metals, phthalates, and organophosphate metabolites using data from [...] Read more.
Depression is a major public health concern, and evidence continues to show that environmental toxicants may contribute to its development. This study evaluated the association between depressive symptoms and per- and polyfluoroalkyl substances (PFAS), heavy metals, phthalates, and organophosphate metabolites using data from NHANES 2017–2018. Depressive symptoms were measured with the Patient Health Questionnaire-9 (PHQ-9). Environmental exposure variables were analyzed using multivariable linear regression and Bayesian Kernel Machine Regression (BKMR). All models adjusted for demographic, socioeconomic, behavioral, and clinical covariates. In multivariable linear regression models adjusted for demographic, socioeconomic, behavioral, and clinical covariates, higher urinary dimethylphosphate concentrations were significantly associated with increased depressive symptom scores (β = 0.15; 95% CI: 0.04, 0.27; p = 0.0098). Mono-(2-ethylhexyl) phthalate (MEHP) was also positively associated with PHQ-9 scores (β = 0.001; 95% CI: 0.0003, 0.0019; p = 0.0043). Because environmental mixtures tend to follow non-linear patterns, BKMR analysis was run. BKMR analyses indicated that organophosphate metabolites exhibited the greatest overall contribution to depressive symptoms (group posterior inclusion probability = 0.7875), with diethylphosphate emerging as the most influential individual exposure within the group (conditional PIP = 0.7211). Exposure–response functions suggested non-linear and threshold relationships for several metabolites. These findings identify specific organophosphate and phthalate metabolites as potential contributors to depressive symptoms and support the importance of evaluating chemical mixtures rather than single exposures. Additional longitudinal studies are needed to clarify temporal relationships and to inform public health efforts aimed at reducing exposure to organophosphate pesticides and endocrine-disrupting chemicals. Full article
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16 pages, 895 KB  
Systematic Review
Prolonged Grief-Related Symptoms Among Young Individuals After Loss of a Parent or Sibling to Cancer: A Systematic Review and Meta-Analysis
by Chen Ee Low, Jia Yang Tan, Weiling Amanda Tan, Jayanth Jayabaskaran, Emily Chen Fei Ni, Ga Eun Pang, Dawn Yi Xin Lee, Sean Loke, Hon Jen Wong, Chun En Yau, Ainsley Ryan Yan Bin Lee and Cyrus Su Hui Ho
J. Clin. Med. 2026, 15(3), 1060; https://doi.org/10.3390/jcm15031060 - 29 Jan 2026
Cited by 1 | Viewed by 1080
Abstract
Background/Objectives: Bereavement in childhood, adolescence, and young adulthood is associated with a range of grief responses, and a subset of bereaved individuals develop persistent or severe grief symptoms. Understanding the prevalence and risk factors of prolonged grief symptoms is important for guiding supportive [...] Read more.
Background/Objectives: Bereavement in childhood, adolescence, and young adulthood is associated with a range of grief responses, and a subset of bereaved individuals develop persistent or severe grief symptoms. Understanding the prevalence and risk factors of prolonged grief symptoms is important for guiding supportive care. Methods: We systematically searched PubMed, MedLine, Embase and PsycINFO for all studies comparing the prevalence and prognostic factors of prolonged grief-related symptoms among young individuals following parental or sibling death from cancer. Young individuals were defined as those not more than 25 years old before losing a parent or sibling to any cancer. Prolonged grief-related symptoms were defined as the presence of grief symptoms at least six months following the death of a parent or sibling of the bereaved person. Retrospective cross-sectional studies were included for evaluating prognostic factors affecting prolonged grief-related symptoms, but were not used for meta-analyses. Random-effects meta-analyses were conducted for the primary analysis. Results: From 1561 records identified, thirteen studies were included with five for quantitative pooling in meta-analysis. The pooled prevalence of self-reported prolonged grief-related symptoms was 48% (95% CI: 29–67%). Stratified analyses suggested a prevalence of 28% (95% CI: 7–65%) after parental death and 59% (95% CI: 45–72%) after sibling death. Factors associated with elevated prolonged grief-related symptoms included pre-existing depression, emotional difficulties, and insomnia. As no included studies conducted diagnostic clinical interviews, prolonged grief disorder according to the ICD-11 or DSM-5-TR criteria could not be assessed. Conclusions: Prolonged grief-related symptoms appear common among young individuals bereaved by loss of a parent or sibling to cancer, especially after sibling loss. However, interpretation remains limited by substantial heterogeneity, such as outcome measures, symptom thresholds, assessment time window, non-validated symptom measures, and predominance of cross-sectional studies. Future larger and methodologically rigorous studies using validated grief instruments across diverse settings are needed to clarify grief trajectories and guide developmentally appropriate intervention strategies. Full article
(This article belongs to the Section Mental Health)
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23 pages, 4785 KB  
Article
Spatiotemporal Dynamics and Evaluation of Groundwater and Salt in the Karamay Irrigation District
by Gang Chen, Feihu Yin, Zhenhua Wang, Yungang Bai, Shijie Cai, Zhaotong Shen, Ming Zheng, Biao Cao, Zhenlin Lu and Meng Li
Agriculture 2026, 16(3), 310; https://doi.org/10.3390/agriculture16030310 - 26 Jan 2026
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Abstract
Inland depression irrigation districts in the arid regions of Xinjiang, owing to the absence of natural drainage conditions, exhibit unique groundwater-salt dynamics and face prominent risks of soil salinization, thus necessitating clarification of their water-salt transport mechanisms to ensure sustainable agricultural development. This [...] Read more.
Inland depression irrigation districts in the arid regions of Xinjiang, owing to the absence of natural drainage conditions, exhibit unique groundwater-salt dynamics and face prominent risks of soil salinization, thus necessitating clarification of their water-salt transport mechanisms to ensure sustainable agricultural development. This study takes the Karamay Agricultural Comprehensive Development Zone as the research subject. The study examines the distribution characteristics of soil salinity, groundwater depth, and Total Dissolved Solids (TDS) of groundwater across diverse soil textures, elucidates the correlative relationships between groundwater dynamics and soil salinity, and forecasts the evolutionary trajectory of groundwater levels within the irrigation district. The findings reveal that groundwater depth in silty soil regions (3.24–3.11 m) substantially exceeds that in silty clay regions (2.43–2.61 m), whereas TDS of groundwater demonstrates marginally elevated concentrations in silty clay areas (19.05–16.78 g L−1) compared to silty soil zones (18.18–16.29 g L−1). Soil salinity exhibits pronounced surface accumulation phenomena and considerable inter-annual seasonal variations: manifesting a “spring-peak, summer-trough” pattern in 2023, which inversely transitioned to a “summer-peak, spring-trough” configuration in 2024, with salinity hotspots predominantly concentrated in silty clay distribution zones. A significant sigmoid functional relationship emerges between soil salinity and groundwater depth (R2 = 0.73–0.77), establishing critical depth thresholds of 2.44 m for silty soil and 2.72 m for silty clay, beneath which the risk of secondary salinization escalates dramatically. The XGBoost model demonstrates robust predictive capability for groundwater levels (R2 = 0.8545, MAE = 0.4428, RMSE = 0.5174), with feature importance analysis identifying agricultural irrigation as the predominant influencing factor. Model projections indicate that mean groundwater depths across the irrigation district will decline to 2.91 m, 2.76 m, 2.62 m, and 2.36 m over the ensuing 1, 3, 5, and 10 years, respectively. Within a decade, 73.33% of silty soil regions and 92.31% of silty clay regions will experience groundwater levels below critical thresholds, subjecting the irrigation district to severe secondary salinization threats. Consequently, comprehensive mitigation strategies encompassing precision irrigation management and enhanced drainage infrastructure are imperative. Full article
(This article belongs to the Section Agricultural Water Management)
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32 pages, 18294 KB  
Article
Influencing Factors of Hydrocarbon Migration and Adjustment at the Edge of a Stable Cratonic Basin: Implications from Fluid Inclusions, Quantitative Fluorescence Techniques, and Geochemical Tracing
by Zhengqi Yang, Xin Cheng, Siqi Ouyang, Zhe Liu, Yuting Cheng, Shuqi Lan, Lei Xue, Ting Zhang and Yiqian Qu
Energies 2026, 19(3), 638; https://doi.org/10.3390/en19030638 - 26 Jan 2026
Viewed by 528
Abstract
Understanding the mechanisms of hydrocarbon migration, accumulation, and alteration, particularly how evolution controls these processes, is critical for exploring lithologic hydrocarbons in reservoirs. In the complex tectonic settings of the continental margin of the stable North China Craton, there is a significant presence [...] Read more.
Understanding the mechanisms of hydrocarbon migration, accumulation, and alteration, particularly how evolution controls these processes, is critical for exploring lithologic hydrocarbons in reservoirs. In the complex tectonic settings of the continental margin of the stable North China Craton, there is a significant presence of small yet highly prolific hydrocarbon reservoirs. The processes of hydrocarbon migration and accumulation are complex and thus represent an important research focus in geology. This study, based on core, logging, and seismic data and integrating fluid inclusion analysis, quantitative fluorescence techniques, and geochemical experiments, combines the shale smear factor and paleotectonic reconstructions to clarify the hydrocarbon accumulation episodes, migration pathways, and factors controlling reservoir adjustments in the Yanwu area of the Tianhuan Depression in the Ordos Basin, China. The results reveal three types of NE-trending left-lateral strike–slip faults: linear, left-stepping, and right-stepping. Shale Smear Factor (SSF) analysis confirms that these faults exhibit segmented opening behaviors, with SSF > 1.7 identified as the threshold for fault openness. Multiparameter geochemical tracing based on terpanes and steranes shows that lateral migration along fault zones dominates the preferential migration pathways for hydrocarbons. Fluid inclusion thermometry revealed homogenization temperatures within the 100–110 °C and 80–90 °C intervals, while the oil inclusions exhibit blue or blue-and-white fluorescence, reflecting early hydrocarbon charging and late-stage secondary migration. Integrated analysis indicates that during the late Early Cretaceous (105–90 Ma), hydrocarbons were charged upward through open segments of linear strike–slip fault zones in the northern study area, experiencing lateral migration and accumulation along high-permeability sand bodies and unconformities in the shallow strata. Since the Late Cretaceous (65 Ma-present), the regional tectonic framework has evolved from a west–high, east–low to a west–low, east–high configuration, inducing secondary hydrocarbon migration and leading to the remigration or even destruction of early-formed oil reservoirs. This study systematically demonstrates that fault activity and tectonic evolution control the accumulation and distribution of hydrocarbons in the region. These findings provide theoretical insights for hydrocarbon exploration in regions with complex tectonic evolution within stable cratonic basins. Full article
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16 pages, 289 KB  
Article
Mapping Postpartum Depression in Latvia: Prevalence and Associated Factors Among Women Receiving Outpatient Care
by Marija Lazareva, Lubova Renemane, Silvija Cipare, Linda Rubene-Kesele, Vineta Viktorija Vinogradova, Liva Kise, Nancy Byatt and Elmars Rancans
J. Clin. Med. 2026, 15(3), 946; https://doi.org/10.3390/jcm15030946 - 24 Jan 2026
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Abstract
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 [...] Read more.
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
(This article belongs to the Special Issue Perinatal Mental Health Management)
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