Children with medical complexity (CMC) represent a diverse population who face unique challenges when interacting with the health care system. They are particularly susceptible to disability-based discrimination, or ableism, from health care professionals due to their frequent utilization of health care services. Families and caregivers of CMC also experience psychosocial stressors, mental health challenges, and financial and employment constraints while interfacing with health systems. These factors can negatively impact clinical outcomes and overall quality of life for CMC. It is imperative for health care professionals to understand the impact of disability-based discrimination and social drivers of health on health care outcomes for CMC to advocate for improved care.

Borderline personality disorder (BPD) is highly stigmatized. Stigma, including clinicians' resistance, stigmatizing attitudes, and discriminatory beliefs, could be mitigated by a better knowledge of the disorder. This study evaluates the impact of a one-day training session on stigmatization by health personnel (HP).

This two-center study prospectively included 172 HP who completed a face-to-face interactive training day embodying dialectical and destigmatizing positions. Elements of psychoeducation, emotional dysregulation model and practical tools were presented. Stigma attitudes and open-mindedness were assessed by the Opening Minds Stigma Scale for Health Care Providers self-questionnaire (OMS-HC); and beliefs (feeling of incompetence, pejorative perception of prognosis, guilt) by a custom Beliefs Questionnaire (BQ). Scores before and immediately after the training were compared using Student's paired t-test.

Most HP worked in psychiatry (69%) and had no prior education on BPD (89%). Nurses were most represented (35%), ahead of nursing assistants (22%), psychologists (18%), and psychiatrists (10%). All scores decreased after training (p < 0.001): total OMS-HC (MD ± SD=-4 ± 8), attitude sub-score (2 ± 4), disclosure sub-score (1 ± 4); total BQ (6 ± 9), nurse feeling of incompetence sub-score (4 ± 4) and pejorative perception of prognosis sub-score (-2 ± 3).

A one-day training session reduces HPs' stigmatizing attitudes and beliefs and has a positive impact on knowledge and open-mindedness about BPD patients. Training can lean on education about BPD nature, treatment and prognosis, experience-sharing with practical cases, and testimonies. It would enable compassionate and destigmatizing care. Further research is needed about the clinical impact of BPD training and its wider implementation in mental healthcare settings.

Postpartum post-traumatic stress disorder (PTSD) symptoms are a significant mental health concern. Although obstetric complications are often considered central, growing evidence suggests that women's emotional and subjective responses to childbirth may play a more decisive role in the development of trauma-related symptoms.

To estimate the prevalence of postpartum PTSD symptoms one month after childbirth and to identify the most relevant obstetric, psychological, and psychosocial risk factors, with a particular focus on emotional and dissociative responses.

A prospective observational study was conducted in a high risk maternity hospital between 2021 and 2024. Women completed validated self-report questionnaires one month postpartum, including the PTSD Checklist for DSM-IV (PCL-S), the Peritraumatic Dissociative Experiences Questionnaire (PDEQ), the Peritraumatic Distress Inventory (PDI), and the Edinburgh Postnatal Depression Scale (EPDS). Clinically significant PTSD symptoms were defined by a PCL-S score ≥ 26. Multivariate logistic regression analyses were performed to identify independent predictors.

Among 1,451 women included, 11.8% reported clinically significant PTSD symptoms at one month postpartum. In multivariate analyses, peritraumatic dissociation was the strongest predictor of PTSD symptoms (adjusted odds ratio [aOR] = 2.61), followed by fear of dying during childbirth (aOR = 2.34), stressful life events during pregnancy (aOR = 2.31), and early depressive symptoms (aOR = 1.16 per EPDS point). Obstetric complications, including emergency cesarean section and instrumental delivery, were not significantly associated with PTSD symptoms after adjustment.

Emotional and dissociative responses to childbirth, particularly peritraumatic dissociation, are more strongly associated with postpartum PTSD symptoms than obstetric complications. These findings highlight the importance of early psychological screening using validated tools and support integrated psychoeducation and emotional support into routine perinatal care by somatic healthcare providers.

As third-year medical students transition into high-stakes, high-stress clinical environments like the emergency department (ED), they may experience significant personal trauma. However, little is known about how this trauma is experienced early in their training - specifically during the transition from preclinical to clinical learning environments. This study addresses that gap by exploring third-year medical students' experiences of trauma during the emergency medicine (EM) clerkship through the lens of Trauma-Informed Care (TIC) and identifies workplace factors and intersectional demographics influencing these experiences.

This qualitative study used the critical incident technique to explore emotionally-significant events encountered by third-year medical students immediately after completing the EM clerkship as their first core clerkship at a single academic institution. We conducted a thematic analysis using the Substance Abuse and Mental Health Services Administration's six TIC principles. Data were triangulated with quantitative demographic data, and data saturation was confirmed through constant comparison and reflexive team discussions.

Seventeen students participated, describing 19 critical incidents of trauma. The most common trauma types involved lack of peer support and lack of empowerment or voice. Intersectional factors such as race, gender, and age shaped both the type and nature of trauma. Clinical uncertainty, power differentials, and unprofessional behavior emerged as frequent triggers.

Applying a trauma-informed framework to medical education reveals how structural and interpersonal factors contribute to student trauma when they transition to the clinical learning environment. These findings highlight opportunities for trauma-informed clerkship design and structured support to create safer, more inclusive learning spaces.

Not applicable.

Burnout and clinical depression are often experienced by medical students in the United States, which impacts individual wellbeing as well as professionalism, empathy, and patient care. This study aimed to evaluate stress and wellbeing among first-year medical students at one accredited M.D. institution by administering the Medical Student Stress Scale (MSSS), a context-specific measure designed to capture multidimensional sources of medical student stress.

The MSSS, a 22-item questionnaire, was administered to first-year medical students during the 2024-2025 academic calendar, in the fall and spring, alongside a Brief Resilience Scale (BRS) and demographic questionnaire. According to the MSSS, stress was measured by calculating a summative score, ranging from 0 to 88, with higher scores indicative of greater levels of stress. The BRS measures resilience with a total score determined as a summation of the six item responses, categorized as low (1-2.99), normal (3-4.3), or high (4.31-5).

The overall response rate was 61% (107/175) in the fall and 47% (87/175) in the spring. Average student stress scores in the fall and spring were 34.3 and 38.8, respectively. The resilience score in the fall and spring was 3.6 and 3.5, respectively. Multivariable linear regression showed that student stress decreased by 10 and 13 points with every 1-point increase on the BRS in the fall and spring, respectively (p < 0.001). This correlates with a 11-15% reduction in stress. Additionally, at both time points, males displayed a significantly lower estimated stress score than females (p = 0.044 and p = 0.016). In the spring, compared to students of Christian faith, Jewish students displayed an estimated 10-point increase in stress (p = 0.024), and Muslim students displayed an estimated 17-point increase in stress (p = 0.005). Additionally, students that reported they were low-income displayed an estimated 8-point increase in stress compared to non-low-income students (p = 0.009).

To identify trends in both stress and resilience, the MSSS and BRS are feasible surveys to implement in medical schools. Understanding how stress and resilience are affecting medical students provides an opportunity to create tangible interventions to better support student wellness and create resilient physicians.

Patients with amyotrophic lateral sclerosis (ALS) occasionally exhibit autonomic nervous system dysregulation. We examined whether autonomic regulation differed across patients with ALS with varying severity and progression.

A total of 45 patients with ALS were enrolled and classified into three subgroups using cluster analysis. Heart rate variability was assessed using the maximum entropy method. The low-frequency (LF) and high-frequency (HF) components, LF/HF ratio (LF/HF), and heart rate (HR) were measured. Temporal changes in each parameter during rest, mental tasks, and post-task rest were evaluated. The values for all patients and subgroups were compared with those of 11 healthy control subjects. Between-group differences were evaluated at rest and using the Task/Rest and After/Task ratios, and within-group changes across the three phases were also analyzed, with non-parametric statistical tests applied.

Cluster analysis classified the patients into three groups: "Group 1: early-preserved group", "Group 2: late-preserved group", and "Group 3: late-impaired group". Overall, the patients showed lower HF and higher LF/HF at rest than the controls, indicating parasympathetic hypoactivity and sympathetic predominance. Abnormalities were more prominent in Groups 1 and 3 than in Group 2. The former two groups showed blunted HF, LF/HF and HR responses during the tasks. The late-preserved group (Group 2) showed no difference in the Task/Rest ratios of HF, LF/HF and HR compared with the controls.

Autonomic regulatory functions differ depending on the severity and progression of ALS. The presence of HRV abnormalities in early-preserved patients suggests that autonomic dysregulation in ALS may not be limited to a late-stage secondary complication but may also be present earlier stages. Recognizing HRV abnormalities from early stages may help identify patients at risk of faster progression. Future longitudinal studies in larger cohorts are needed to establish the pathophysiological significance of HRV abnormalities.

The recommended dementia diagnostic pathway comprises non-specialist assessment followed by specialist diagnosis. Given increasing resource constraints and existing inequalities in accessing specialist care, more accurate assessment in non-specialist settings may improve dementia management. This study assessed the diagnostic accuracy of blood biomarkers of Alzheimer's disease (AD) and neurodegeneration for detecting probable AD (PAD) and mild cognitive impairment (MCI) with amyloid positivity (AP), particularly when they supplement current non-specialist practice of administering Mini-Mental State Examination (MMSE).

We accessed data from the Bio-Hermes study which grouped participants as cognitively normal (n=417), MCI (n=312), and PAD (n=272). Blood biomarkers of AD and neurodegeneration included: amyloid-beta 42/40; phosphorylated-tau 181 (p-tau181); p-tau217; glial fibrillary acidic protein (GFAP); and neurofilament light (NfL). Biomarkers were added individually or as panel to MMSE to predict the following diagnostic outcomes: PAD; MCI or PAD (MCI-PAD); PAD with AP measured by positron emission tomography/cerebrospinal fluid (PAD-AP); and MCI-PAD with AP (MCI-PAD-AP). Accuracy was assessed using receiver operating characteristic (ROC) curve and area under ROC curve (AUC) following logistic regression, adjusted for covariates observable in general clinical setting (e.g., alcohol, smoking, functional impairment) and apolipoprotein E ε4 carrier status. Statistically significant differences in AUC were estimated by DeLong test. Subgroup analyses were conducted by age and race/ethnicity.

MMSE plus individual biomarkers or panels significantly improved accuracy to detect PAD-AP and MCI-PAD-AP versus MMSE alone: e.g., AUC for MMSE+p-tau217, adjusted for covariates, to detect MCI-PAD-AP was 0.928 versus 0.844 for MMSE alone (DeLong test for significance P<0.001); MMSE plus optimal panel comprising all five biomarkers achieved AUC of 0.939 (DeLong P<0.001 versus MMSE alone). AUC improvements from biomarker addition were smaller, sometimes not statistically significant, for PAD and MCI-PAD. Composition of optimal panel varied across subgroups: e.g., p-tau217 was included in the optimal panel for non-Hispanic White, while p-tau181 was included in the panel instead for non-White race/ethnicity.

Blood biomarker supplementation of cognitive testing can improve detection of amyloid-positive MCI and dementia. This potentially supports an efficient and equitable dementia diagnostic pathway which contributes to the sustainable delivery of prospective amyloid-targeting therapies with proven safety, effectiveness and cost-effectiveness.

Adaptive behavior relies on the ability to translate abstract rules and goals into actions suited to the current context. Neural population activity in the prefrontal cortex (PFC) has been proposed to support such flexible computations through high-dimensional dynamics, whereas activity in the primary motor cortex (M1) is related more directly to movement execution. How contextual representations in PFC are transformed into ensuing action plans within M1 remains unknown. Previous work suggests that low-dimensional coding subspaces might organize interareal communication, but direct evidence for such population-level communication mechanisms in humans is lacking. Here we use intracranial recordings from human PFC and M1 to identify a communication subspace embedded within high-dimensional PFC activity, that selectively relays behaviorally relevant information at the single-trial level. Activity in this subspace predicts context-dependent action more strongly than either region, revealing a fundamental coding principle by which coordinated interareal population dynamics filter and relay predictive information to guide context-dependent actions.

Gait speed, grip strength, and depression are common and often coexist in older adults, and their interaction may provide a comprehensive understanding of fracture risk. This study examined the individual and combined associations of slow gait, weak grip, and depressive symptoms with the risk of fractures in older adults. Sixteen thousand three hundred fifty-seven Australian participants aged ≥ 70 years from the ASPirin in Reducing Events in the Elderly (ASPREE) trial were included. Sub-distribution hazard ratios (sHR) and 95% confidence intervals (CI) were estimated using a multivariable-adjusted Fine-Gray model, accounting for death as a competing risk. The sHR for any fractures was 17% higher among participants with slow gait and 23% higher among those with depressive symptoms, while weak grip was not significantly associated. The co-occurrence of slow gait and weak grip was associated with a 23% higher risk of any fracture (sHR = 1.23; 95% CI 1.04-1.46). Slow gait combined with depressive symptoms was associated with a 46% higher risk of any fracture and a 64% higher risk of MOF (sHR = 1.46; 95% CI 1.06-2.01; sHR = 1.64; 95% CI 1.03-2.61, respectively). Weak grip combined with depressive symptoms was associated with a 47% higher risk of any fracture and a 57% higher risk of MOF (sHR = 1.47; 95% CI 1.08-2.00; sHR = 1.57; 95% CI 1.01-2.47, respectively). These associations were stronger among males and those with diabetes. The combination of slow gait with either weak grip or depressive symptoms was more strongly associated with fracture risk than each factor individually. These findings underscore the importance of incorporating physical function and mental health assessments in clinical evaluations of older adults.

Weight-related bias, stigma, and discrimination significantly affect quality of life and health in persons with obesity. Their influence on post-operative outcomes following metabolic surgery and bariatric remains underexplored.

This systematic review aimed to evaluate any impact of pre- and post-operative weight bias, stigma, and discrimination on post-metabolic and bariatric surgery outcomes, specifically physical health and mental health, including quality of life.

This review was conducted in accordance with the PRISMA 2020 guidelines, with the protocol registered on PROSPERO. Comprehensive searches were performed across MEDLINE, PsycINFO, Embase, Web of Science, PEDro, CINAHL, ISRCTN, and CENTRA. Eligible studies included randomized controlled trials, clinical trials, longitudinal studies, cross-sectional studies, and qualitative research involving patients who underwent metabolic and bariatric surgery. Risk of bias was assessed using validated tools tailored to study design.

Eleven studies met the inclusion criteria, examining the influence of weight bias, stigma, and discrimination on post-surgical outcomes. Physical health outcomes included weight loss and BMI. Mental health outcomes included depressive symptoms, disordered eating behaviours, and quality of life domains such as social interactions, occupational settings, sexual health, educational experiences, and post-surgical health management. Findings suggest that weight bias negatively influences mental health and quality of life, associating with depressive symptoms, problematic eating, and lower adherence to nutritional instructions and exercise, potentially impeding optimal physical outcomes.

Despite some studies suggesting its negative impact on postoperative outcomes, current evidence on the impact of weight bias, stigma, and discrimination on post-metabolic and bariatric surgery outcomes is limited. Critical gaps remain in understanding how these psychosocial factors affect long-term disease management, self-care, and overall quality of life.