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.

Although there is a high number of aging populations globally, these elderly populations face the challenges of emergency mental health issues, with often inadequate health care facilities. This article aimed to map and synthesize evidence on the management of mental health emergencies in the elderly population in the World Health Organization (WHO) regions. Using a scoping review design, the search for articles was guided by Population (elderly ≥ 60 years), Concept (mental health emergencies), and Context (WHO region states). The final 25 articles included publications from 2003 to 2021, spanning multiple WHO regions except the African.

To evaluate the association between depression and suicidal ideation (SI) screening results among patients in a pediatric and adolescent gynecology clinic and to determine whether associations differ between school and summer periods.

This retrospective cross-sectional study included patients aged ≥ 13 years who completed both the Patient Health Questionnaire-2 (PHQ-2) and Ask Suicide Screening Questions (ASQ) from June 2023 to April 2025. Depression was defined as a PHQ-2 score ≥ 3; SI was defined as any affirmative ASQ response. Simultaneous positive/negative combinations were evaluated, and associations were tested using chi-square or Fisher's exact tests.

Among 1,481 patients, PHQ-2 and ASQ scores were significantly associated (p < 0.0001). Negative PHQ-2 screens corresponded to negative ASQ screens in 1,192 (92.5%) patients. However, 97 (7.5%) patients screened negative for depression but positive for SI, including one (0.1%) with severe SI. Positive ASQ screens were more frequently associated with positive PHQ-2 screens (40.6%) than negative PHQ-2 screens (7.5%). All severe ASQ scores occurred during the school year.

Screening for depression alone is insufficient to identify all adolescents at risk for suicidality. Dual screening with PHQ-2 and ASQ enables more comprehensive identification of at-risk patients in pediatric and adolescent gynecology settings, thereby enabling practitioners to connect such patients with the necessary mental-health resources.

Clinical decision making (CDM) is a vital competence required by nurses, particularly emergency nurses. This study aimed to investigate the relationship between organizational justice and CDM among emergency nurses.

A cross-sectional correlational design was used with 221 emergency nurses from three major public hospitals in Hai'l City, Northeastern Saudi Arabia, from April to June 2025. Data were collected using a sociodemographic characteristics survey, Nursing Decision-Making Scale, and Organizational Justice Questionnaire. The direction and strength of the association between nurses' CDM and organizational justice were measured using Pearson's correlation coefficient (r). Multiple linear regression analysis was used to identify predictors of CDM.

Registered nurses, charge nurses, staff working more than five days per week, and staff who reported higher organizational justice demonstrated significantly higher levels of nursing CDM (p < 0.05). In contrast, regular night shifts were significantly associated with lower CDM (p = 0.009). A significant positive correlation was found between nursing CDM and organizational justice (r = 0.320, p < 0.001), with a corresponding linear R² value of 0.102, indicating that approximately 10.2% of the variance in nursing CDM can be explained by organizational justice.

This study demonstrates the vital role of organizational justice in influencing emergency nurses' CDM. The findings indicated that nurses' perceptions of procedural justice significantly influenced their engagement and satisfaction in clinical settings.

Research using the multidimensional sleep health (MDSH) framework has increased globally, often relying on self-report measures. The Ru-SATED scale and Sleep Health Index (SHI) are common self-report measures of MDSH, but comparative data on their measurement properties and contextual characteristics remain limited. Seven electronic databases were searched for measurement properties and uses of the two scales over the past twelve years. This review identified 19 psychometric validation studies concerning two original and 17 cross-cultural, and summarized contextual comparison of MDSH measures and frameworks. Measurement properties of both measures were assessed with the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guideline, and contextual comparisons were conducted narratively. Both measures exhibited acceptable psychometric properties across diverse cultural settings, with the SHI findings showing greater consistency than those of the Ru-SATED scale. Aggregating the Ru-SATED and SHI frameworks fully covered the sleep characteristics assessed by five instruments grounded in the World Sleep Society initiative, encompassing regularity, satisfaction, alertness, timing, efficiency, duration, and disorder. Notably, the SHI framework incorporates targeted sleep disorder assessment while the Ru-SATED framework specifically excludes such assessment, highlighting the distinct focus and scope of each tool. Instrument selection depends primarily on research purpose, study sample, and intended use. We recommend characterizing both sleep health and sleep disorders to fully capture the complex relationships between sleep and health outcomes.