Most research has primarily focused on negative emotions and has only recently begun to empirically assess the role of difficulties experiencing positive emotions. This study aimed, for the first time, to examine evidence of validity for the Difficulties in Emotion Regulation Scale-Positive (DERS-P) in Spanish adolescents and young adults and to assess its relationship with measures of substance use and mental health disorder risk.

The sample comprised 6,365 community-based participants who completed an e-assessment including sociodemographic measures, the DERS-P, the Brief Symptom Inventory-18, self-reported measures of substance use, and validated measures of substance use disorder risk. Exploratory and confirmatory factor analyses were conducted to examine the internal structure of the questionnaire, with complementary measurement invariance assessments across sex and past-year substance use. Convergent validity in relation to substance use and emotional disorder risk was assessed.

The DERS-P comprised three factors (impulse, acceptance, and goals) and showed excellent internal consistency (ω = 0.91; ω_Impulse = 0.90, ω_Acceptance = 0.86, ω_Goals = 0.91). Scalar invariance was established across sex and past-year substance use groups. The optimal cutoff score for detecting emotional dysregulation among males was 16.5, whereas for females it was 17.5. The DERS-P showed evidence of concurrent validity in relation to emotional disorder and substance use disorders risk.

The DERS-P shows excellent reliability and validity evidence in relation to clinical measures of substance use and mental health risk. Findings suggested young populations exhibit marked difficulties in emotional acceptance, although further research is needed to clarify their implications for transdiagnostic interventions. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Hearing loss is a significant modifiable risk factor for cognitive decline, but the effectiveness of hearing intervention for cognition stabilization or improvement still remains controversial.

To investigate whether hearing intervention could reduce dementia-level impairment incidence in older adults with coexisting hearing loss and mild cognitive impairment (MCI).

This multicenter, parallel-group, open-label randomized clinical trial was conducted between September 2021 and February 2024, with the 24-month follow-up completed in February 2026. This study was conducted at 3 tertiary otology outpatient clinics and 3 CHOICE cohort community health stations in Shanghai, China. Of 21 908 adults aged 60 years or older assessed for eligibility, 703 participants with coexisting MCI (Clinical Dementia Rating [CDR] global score of 0.5) and moderate to severe hearing loss were enrolled and randomized. These data were analyzed from February 2026 to July 2026.

Participants were randomized 1:1 to receive either hearing aid intervention (n = 353) or hearing care education (n = 350).

The primary outcome was the conversion rate from MCI to dementia-level impairment over 24 months, defined as a CDR global score 1 or more. Key prespecified secondary outcomes comprised rate of cognitive improvement (CDR = 0) and CDR global and domain scores.

Among 703 randomized patients (mean [SD] age, 74.53 [7.16] years; range, 60-96 years; 250 female [35.56%] and 452 male [64.44%]), 610 (86.77%) completed the trial. No significant difference was observed in the primary outcome, in which the conversion rate from MCI to dementia-level impairment was 3.09% (95% CI, 1.62%-5.74%) in the intervention group vs 4.74% (95% CI, 2.60%-8.29%) in the control group (risk difference [RD], -2.07%; 95% CI, -4.74% to 0.61%; relative risk [RR], 0.59; 95% CI, 0.25-1.38; P = .23). Meanwhile, prespecified secondary analysis demonstrated that hearing intervention increased the rate of cognitive improvement (15.34%; 95% CI, 11.84%-19.62% vs 2.36%; 95% CI, 0.99%-5.22%; RD, 12.00%; 95% CI, 8.79%-15.21%; RR, 5.94; 95% CI, 2.46-14.37). No study-related adverse events were reported.

In this study, among older adults with mild cognitive impairment and coexisting hearing loss, a hearing aid intervention did not significantly reduce the incidence of dementia-level impairment at 24 months.

Chinese Clinical Trial Registry Identifier: ChiCTR2000036139.

Firearm violence is a leading cause of morbidity and mortality for US adolescents and emerging adults (A/EAs). Health care visits are an important opportunity to provide preventive counseling addressing risky firearm behaviors (RFBs), which increase fatal and nonfatal firearm injury risk, as well as associated negative health and social outcomes.

To determine the efficacy of a technology-augmented behavioral counseling intervention addressing RFBs among A/EAs seeking emergency department (ED) treatment.

This prospective, 2-arm randomized clinical trial was conducted at 2 US trauma center EDs in Michigan. A/EAs aged 16 to 30 years reporting past 3-month firearm carriage and smartphone ownership were enrolled from January 24, 2022, through October 25, 2024, and randomized to either IntERact or enhanced usual care (EUC). Follow-up surveys were conducted through April 2025, with data analysis conducted from May 2025 to November 2025.

IntERact included (1) 3 sessions of trauma-informed behavioral counseling delivered by a telehealth health coach and integrating motivational interviewing and strengths-based care management; and (2) a smartphone application delivering additional tailored therapeutic content between counseling sessions. Both were delivered during the 30 days after an ED visit. EUC participants received an assessment-only application for 30 days. Participants in both groups received a resource brochure and gunlock(s).

The primary outcome was self-reported RFBs evaluated at 3 and 6 months. Secondary outcomes included experiencing physical violence and nonfirearm physical aggression. Exploratory outcomes included violent injuries, violence consequences, criminal justice outcomes, substance use and consequences, mental health symptoms, and any firearm violence.

A total of 373 patients were randomized to IntERact (n = 186) or EUC (n = 187). Mean (SD) age was 25.0 (3.7) years, 195 patients (52.3%) were female, and 278 of 371 patients (74.9%) reported past 3-month RFBs at baseline. Compared to EUC, IntERact participants demonstrated significantly greater reductions in RFBs at 6 months (IntERact: -57.4%; EUC: -25.4%; rate ratio [RR] = 0.51; 95% CI, 0.33-0.79). IntERact participants also demonstrated significantly greater reductions in experiencing physical violence at 3 months (RR = 0.46; 95% CI, 0.26-0.81) compared to EUC. Among exploratory outcomes, between-group comparisons demonstrated that compared to EUC, patients in the IntERact group showed greater reductions in violent injuries at 3 and 6 months, as well as violence consequences, substance use, anxiety, and depression outcomes at 6 months. Patients in the IntERact group also showed greater reductions in delinquency, violent offending, and any firearm violence at both 3 and 6 months.

In this randomized clinical trial among A/EAs reporting firearm carriage, technology-augmented behavioral counseling showed promise reducing RFBs, as well as violence, criminal justice, substance use, and mental health outcomes.

ClinicalTrials.gov Identifier: NCT05109325.

This review synthesizes evidence on the phenomenology, neurobiology, assessment, and treatment of neuropsychiatric symptoms in primary progressive aphasia (PPA), with emphasis on variant-specific patterns and consequences.

Neuropsychiatric symptoms are pervasive across PPA and extend beyond language impairment. Contemporary studies identify affective, active behavioural, passive behavioural, and psychotic dimensions, with the greatest behavioural burden observed in semantic variant PPA and apathy prominent across non-fluent/agrammatic and logopenic phenotypes. Converging structural, functional, and molecular evidence implicates distributed language, salience, limbic, and frontostriatal networks, alongside serotonergic and dopaminergic dysfunction. Emerging manifestations, including Problematic Internet Use, broaden the recognised behavioural spectrum. Neuropsychiatric symptoms are integral determinants of disability, caregiver burden, and clinical complexity in PPA. Routine, caregiver-informed assessment and multidisciplinary, non-pharmacological-first management are warranted. Future studies should validate PPA-specific measures, clarify longitudinal trajectories, test targeted interventions, and determine whether neuropsychiatric features should be incorporated into revised PPA diagnostic criteria.

Frailty is associated with impaired physical function, psychological decline, and alterations in the gut microbiome, yet nutritional strategies targeting these interconnected pathways remain limited. Low-methoxy (LM) pectin, a fermentable dietary fibre derived from plant cell walls, has demonstrated immunomodulatory and microbiome-modifying effects in preclinical studies, but evidence in older adults with frailty is scarce. We conducted a 4-week double-blind, randomised, placebo-controlled trial evaluating LM pectin supplementation in older adults with frailty. Thirty-one participants were enrolled, and 29 completed the intervention. Physical performance, psychological well-being, quality of life, inflammatory biomarkers, and gut microbiome composition were assessed at baseline and follow-up. Compared with placebo, low-methoxy pectin supplementation significantly improved lower limb function measured by the 30-second sit-to-stand test (2.07 ± 1.94 vs 0.71 ± 2.27 repetitions; p = 0.038), while no significant changes were observed in Timed Up and Go performance. Supplementation also reduced anxiety and depression scores and improved several Short Form-36 domains, including physical functioning, vitality, mental health, and social functioning. No significant differences were detected in circulating inflammatory biomarkers. Gut microbiome analysis demonstrated increased relative abundance of Coprococcus comes, an acetate-producing species linked to gut-brain signalling and psychological health. These findings provide preliminary evidence that LM pectin supplementation may improve physical and psychological outcomes and alter gut microbial composition in older adults with frailty. Larger, adequately powered trials are needed to determine whether these changes are reproducible and to investigate potential microbiome-related mechanisms. Trial registration number: NCT06955975 ( https://clinicaltrials.gov/study/NCT06955975 ; Clinical Trials.gov; 2025-06-22).

The rise in robotic surgical procedures underscores the need for effective training in minimally invasive surgery, particularly the interactions between robotic and conventional techniques. Aim of this experimental study was to examine whether conventional and robotic laparoscopy require different neuropsychological skills and to evaluate the role of individual experience and expertise.

A single center, randomized crossover training trial was conducted at a university hospital surgical training center. Participants were 86 postgraduates (residents and experts) from general surgery, urology and gynecology who were enrolled in surgical training courses, and 237 fifth-year medical students participated within their gynecology curriculum. Participants underwent neuropsychological testing, followed by surgical training in both conventional and robot-assisted laparoscopy, performing identical tasks six times in a randomized crossover setting.

For conventional laparoscopy, 57 participants were "slow learners," while 212 were "fast learners". For robotic laparoscopy, 193 participants were "slow learners" and 76 "fast learners". Among students, conventional training success was significantly associated with neuropsychological factors such as personality, motivation, psychomotor skills, while robotic training was predominantly associated with personality factors. Among physicians, both personality and psychomotor skills were critical for learning surgical skills in both techniques.

Surgical training outcomes differ significantly between conventional and robotic laparoscopy. Conventional laparoscopy supports faster learning, with a good start performance strongly influencing training success, whereas good robotic start performance correlated with slower learning. Different individual factors influenced effective training of surgical skills according to the surgical method and prior experience and skills level, suggesting tailored training curricula.

The study is registered in The UK´s Clinical Study Registry (ISRCTN79269632).

BackgroundDirect comparisons of different scoring methods of the Clock Drawing Test (CDT) and the copy trial of the Rey Complex Figure Test (RCFT) remain limited.ObjectiveThe study aimed to compare the effectiveness of four- and two scoring systems of the CDT and the RCFT, respectively, in detecting mild neurocognitive disorder (MildND) due to Alzheimer's disease (AD) and major neurocognitive disorder (MajorND) due to AD.MethodsThe study included 141 cognitively unimpaired individuals, 209 people with MildND and 76 with MajorND due to AD. The 3-point CDT scoring method (CDT3), the Gestalt-, Freund-, and Rouleau methods were employed, while the RCFT Copy trial was scored with the 36-point Taylor system and the RCFT central-items (RCFTci) method. Statistical analyses included comparison analyses and proportional odds logistic regression (POLR) models, while stratified bootstrap resampling was used to repeatedly partition the sample into training and validation sets (70/30 ratio).ResultsThe Rouleau CDT scoring method achieved the highest classification performance (F1 = 0.67; 95% CI: 0.59-0.74), followed by the Gestalt method (F1 = 0.65; 95% CI: 0.57-0.72), the Freund method (F1 = 0.64; 95% CI: 0.56-0.72), and the CDT3 (F1 = 0.63; 95% CI: 0.55-0.71). The CDT Rouleau method and the RCFT Copy trial showed similar performance (F1 = 0.67; 95% CI: 0.59-0.74), while RCFTci was less effective (F1 = 0.62; 95% CI: 0.54-0.70).ConclusionsThe CDT and RCFT Copy trial demonstrated comparable diagnostic accuracy, yet their distinct characteristics (administration time, scoring complexity) may guide test selection across healthcare settings.

As the leading cause of uterine factor infertility, intrauterine adhesion (IUA) poses a severe threat to the fertility and mental health of women at childbearing age. However, the efficacy of the present clinical treatments is unsatisfactory. There remains an urgent need to develop a safe, effective, and clinically feasible therapeutic strategy to restore the damaged endometrium. Here, we fabricated a gelatin-based electrospun nanofibrous membrane (GENM) via electrospinning and chemical crosslinking technique and characterized its properties. The anti-fibrotic and pro-angiogenic effects of GENM were evaluated in cellular models. A rat IUA model induced by mechanical scraping was established to assess the therapeutic efficacy of GENM by histological staining. Additionally, bulk RNA sequencing was performed to explore the underlying mechanisms. Our results demonstrated GENM inhibited transforming growth factor beta 1 (TGF-β1) induced fibrosis in human endometrial stromal cells (HESCs) and promoted angiogenesis of human umbilical vein endothelial cells (HUVECs). Animal experiments also suggested that GENM significantly improved endometrial receptivity and neovascularization while reducing fibrosis in the rat IUA model. RNA sequencing further identified several signaling pathways contributing to uncovering its mechanism of action. These findings indicate that GENM holds significant potential for clinical application in the management of IUA.

To examine the feasibility and acceptability of mindfulness training for adolescents with Type 1 diabetes (T1D) and compassion training for caregivers.

Adolescents aged 12-17 years with T1D, and their caregivers were recruited from two diabetes centres between 2022 and 2023 to participate in an eight-week, online, open-label course (Mindfulness training for adolescents; compassion training for parents). Patient-reported outcomes, glycaemic outcomes and stress measures were collected during pre-specified in-clinic visits. The changes over the course of the study were assessed descriptively.

Thirteen adolescents (age 13.6 ± 1.2 years; 62% female) and 30 caregivers (age 46.8 ± 4.7 years; 65% female; 83% with medium- or long-term education) were enrolled; nine adolescents and 21 parents completed this feasibility study. Interventions were delivered in two rounds. After introducing a face-to-face pre-meeting before the second round, adherence and retention improved, particularly among adolescents. Completers reported positive experiences and showed improvements in diabetes distress (PAID) and well-being (WHO-5). Qualitative findings suggested that increased parental calmness and kindness reduced parent-adolescent conflicts, and parents valued peer support and community.

Compassion and mindfulness training appear feasible and may support mental well-being in families with T1D; however, broader reach requires integration into routine clinical care.

Major depressive disorder (MDD) is a complex disorder caused by genetic and environmental factors. Previous evidence implicates a potential depression subtype from interaction between childhood maltreatment (CM) and kynurenine pathway (KP) gene. Here, we investigated the top-down multi-omics KP alterations for this subtype.

A total of 142 patients with MDD receiving monotherapy were included. Individuals carrying IDO2 rs2340953 TT genotype and reporting CM were classified as IDO2-CM group, whereas the remaining patients were categorized as non-IDO2-CM group. Plasma KP metabolites, DNA methylation, KP-related protein, and inflammatory protein were profiled. Group differences were examined using regression models adjusting for relevant covariates.

Thirty patients met criteria for the IDO2-CM group. Compared with non-IDO2-CM, IDO2-CM individuals exhibited significantly poorer response rate to antidepressant at weeks 4 and 8. Metabolite analyses revealed a significantly elevated quinolinic acid (QA)/kynurenine (KYN) ratio and QA/kynurenic acid (KYNA) ratio in IDO2-CM group (β = 0.086, SE = 0.042, P = 0.023; β = 0.164, SE = 0.045, P = 0.0006). Epigenetic analyses of KP genes demonstrated coordinated methylation shifts favoring QA production (hypomethylation of KMO and AFMID; hypermethylation of ACMSD) and suppression of KYNA related enzymes (hypermethylation of CCBL1, CCBL2, AADAT, and GOT2). Proteomic profiling identified reduced circulating levels of KYNU and VCAM1 in IDO2-CM group.

CM interacting with IDO2 genotype defines a biologically distinct MDD subtype characterized by poor antidepressant response and convergent multi-omics evidence of KP bias toward neurotoxic metabolism. These findings support a stratification strategy and highlight the KP as a potential target for precision treatment in depression.