To compare the longitudinal cognitive changes of AChEIs and mAbs separately across three different cognitive measurements.

We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) in individuals with mild cognitive impairment (MCI) or mild Alzheimer's disease (AD). Major databases (PubMed, Embase, CENTRAL, PsycINFO, and ClinicalTrials.gov) were searched from inception to April 6, 2025. The primary outcomes were changes in the Alzheimer's Disease Assessment Scale-Cognitive Subscale-14 Items (ADAS-Cog), Mini-Mental State Examination (MMSE), and Clinical Dementia Rating-Sum of Boxes (CDR-SB).

Overall, monoclonal antibodies (7 trials, n = 8010) exhibited comparatively homogeneous and an increasing separation from placebo over time within trials, whereas acetylcholinesterase inhibitors (9 trials, n = 4993) showed greater heterogeneity and an apparent attenuation of effect with longer follow-up. On ADAS-Cog, acetylcholinesterase inhibitors demonstrated a nonsignificant pooled effect with substantial heterogeneity (MD = -0.24, 95% CI -1.22 to 0.73; I² = 76%), whereas monoclonal antibodies were associated with a statistically significant and relatively consistent improvements within trials (MD = -1.27, 95% CI -1.69 to -0.84; I² = 0%). On MMSE and CDR-SB, acetylcholinesterase inhibitors yielded modest and borderline effects, respectively (MMSE MD = 0.10, 95% CI 0.07 to 0.13; CDR-SB MD = -0.11, 95% CI -0.22 to 0), whereas monoclonal antibodies showed statistically significant benefits (MMSE MD = 0.42, 95% CI 0.07 to 0.77; CDR-SB MD = -0.41, 95% CI -0.62 to -0.20). For CDR-SB, AChEIs showed minimal statistical heterogeneity (I² = 0%) despite variable individual trajectories, whereas mAbs showed moderate heterogeneity (I² = 56%).

In patients with MCI or mild AD, mAbs showed consistent efficacy on MMSE and ADAS-Cog but demonstrated heterogeneous effects on CDR-SB. In contrast, AChEIs showed heterogeneous and modest efficacy across all three measurements. These findings should be interpreted with caution due to the study's limitations.

The coexistence of substance use disorders (SUD) and other mental disorders - commonly referred to as dual disorders (DD) - is highly prevalent and clinically significant. Although various terms have been used over time (e.g., psychiatric comorbidity, dual pathology), the lack of a standardised definition has created inconsistencies in diagnosis, communication, research, and treatment. Epidemiological studies estimate that 30-80% of individuals with SUD have co-occurring psychiatric disorders, with prevalence depending on the substance involved, gender, age, and the population studied (general population, people in emergency rooms, mental health addiction facilities, harm reduction facilities, prison). Compared to individuals with a single disorder, people with DD exhibit more severe psychopathological symptoms, higher suicide risk, increased relapse rates, poorer treatment adherence, more medical comorbidities, and worse psychosocial outcomes, including unemployment, homelessness, and social exclusion. Despite extensive evidence, both SUD and other mental disorders often remain underdiagnosed and undertreated, partly due to diagnostic complexities such as overlapping symptomatology and the syndromic nature of psychiatric classifications. Additional barriers include the structural separation between mental health and addiction services and limited integrated care expertise. The "wrong door syndrome" exemplifies how patients are frequently directed to services unable to address both conditions, leading to suboptimal outcomes. Furthermore, individuals with DD are often excluded from clinical research, limiting the evidence base for tailored interventions. Improving the detection and treatment of DD is a major challenge for mental health and addiction systems. Integrated, holistic treatment approaches from the outset are essential to optimise outcomes for this highly vulnerable population.

This study aimed to explore the educational experiences of medical students and psychiatry residents within a large mental health trust, identifying areas for improvement. A qualitative methodology using four focus groups was employed, grouped by training level: medical students, foundation doctors, core psychiatry residents and higher-specialty residents. Discussions were guided by a standardised topic guide and analysed thematically.

Participants highlighted key issues including induction length and quality, access to written information, rota gaps and inadequate facilities; challenges in achieving psychotherapy competencies, teaching inconsistency, lack of supervision and insufficient development of non-clinical skills were also noted.

Enhancement of induction, supervision, psychotherapy training and non-clinical skills development can significantly improve psychiatric education. Addressing structural and systemic issues will strengthen trainee experience and support high-quality patient care.

Asian Americans are disproportionately affected by chronic hepatitis B (CHB), which is caused by infection with hepatitis B virus (HBV). While adherence to antiviral medication is an effective practical approach to managing CHB and preventing liver cancer, medication adherence rates among Chinese and Vietnamese Americans with CHB, two vulnerable yet understudied populations, remain largely unknown.

We designed and implemented a randomized controlled clinical trial to investigate the potential improvement of long-term adherence to HBV medication in Asian American populations. Eligible Asian American HBV patients were recruited from the Greater Philadelphia and New York City. HBV medication adherence was assessed using the 8-Item Morisky Medication Adherence Scale. We conducted ordinary least squares (OLS) regression to examine the intervention effects on medication adherence among 129 Chinese and Vietnamese Americans taking CHB medication.

Among 129 participants (91 Chinese and 38 Vietnamese), about three-quarters (74.4%) reported limited English proficiency. Almost one out of 10 (9.3%) did not have any health insurance. OLS regression results indicated that the intervention had a significant impact on improving medication adherence at 12-month follow-up assessment (coefficient = 0.56, p = 0.04). In addition, we found that depression score at baseline was negatively associated with medication adherence at 12-month follow-up assessment (coefficient = -0.10, p = 0.003), with other covariates held constant.

The findings show that a community-based culturally appropriate intervention significantly improved adherence to medication among Chinese and Vietnamese Americans with CHB in a 12-month period. Providing mental health support to CHB patients in this population may play an important role in improving medication adherence.

[https://clinicaltrials.gov/study], identifier [NCT04082338].

People with lived experience of mental ill-health (PWLE) face inequities in health care, including experiences of stigma and discrimination due to mental ill-health, as well as diagnostic overshadowing. This study aimed to investigate facilitators, barriers, and experiences of diagnostic overshadowing of PWLE within four European health care systems (Austria, Greece, Poland, and Spain).

This qualitative interview study included PWLE and other relevant stakeholders (N = 85) with an age range from 22 to 76 years (M = 47.01, SD = 12.95). Semi-structured interviews were transcribed verbatim and thematically analysed.

The analyses revealed three themes: (1) "Factors located within the health care system," (2) "Factors in regard to the personal situation," and (3) "Impact of diagnostic overshadowing on health." The results indicated that experiences of not being taken seriously and issues of stigma and discrimination in the health care setting were recognized across all countries. Additionally, self-stigmatization was mentioned as an additional burden.

These findings show the limitations in access to and utilization of health care services by PWLE across different health care systems. Additional efforts are needed to improve access and utilization of physical health care for PWLE to promote equity in health care and, ultimately, health.

General practitioners (GPs) are at high risk of burnout, which threatens physicians' mental health, care quality, and the sustainability of primary health care systems. Although a growing number of interventions have been developed to prevent or reduce burnout among GPs, their effectiveness and the mechanisms through which they work remain unclear.

We will conduct a systematic review and meta-analysis of interventions aimed at preventing or reducing burnout in GPs, following the Cochrane Handbook and the PRISMA 2020 statement. Randomized controlled trials, cluster-randomized trials, and non-randomized controlled studies evaluating individual-, group-, organisational-, or system-level interventions will be eligible. We will search PubMed (MEDLINE), Embase (Elsevier), Web of Science Core Collection, CNKI, Wanfang Data, and VIP (Weipu) and other databases from inception, without language restrictions. Two reviewers will independently screen studies, extract data and assess risk of bias using the revised Cochrane risk-of-bias tool (RoB 2) and the ROBINS-I tool. Where appropriate, we will pool effect sizes for overall burnout and its dimensions using random-effects models, and explore heterogeneity and subgroup effects based on the job demands-resources model. When meta-analysis is not feasible, we will provide a narrative synthesis. Certainty of the evidence will be assessed with GRADE.

PROSPERO, Identifier CRD420251064119.

Individuals living with Systemic Lupus Erythematosus (SLE), experience complex interplay between fatigue, mental health challenges, and workplace inclusion. SLE-related fatigue extends beyond physical exhaustion, encompassing cognitive and emotional depletion, while anxiety and depression further compound its effects. By integrating Paradox Theory and the Social Model of Disability, this research conceptualizes how competing workplace demands and structural barriers contribute to employment instability and reinforce exclusion.

A qualitative research design is employed, drawing from in-depth narrative interviews with six individuals living with SLE in South Africa.

Two critical themes emerged from the study: pervasive fatigue and mental health cycles. The findings underscore the need for structural changes that shift responsibility from individuals managing their symptoms to workplaces creating adaptable environments.

Addressing these issues is essential for reducing stigma, promoting inclusivity, and ensuring equitable employment opportunities for individuals with invisible disabilities.

Primary school age is a critical period marked by rapid physical growth and significant mental development. While brain development is largely guided by genetic factors, it is also influenced by environmental elements such as nutrition. This study aimed to evaluate the impact of nutritional status on the academic performance of first-cycle primary school children in the North Shoa Zone, Amhara Region, Ethiopia.

A cross-sectional study was conducted from January 21 to August 30, 2023, using a simple random sampling technique. Data were collected through face-to-face interviews using a structured questionnaire, as well as document reviews. Data entry was performed using Epi Data, and analysis was carried out using STATA version 14. Results were summarized using frequency tables and graphs. Binary logistic regression was used to identify variables associated with academic performance, and significant variables (p < 0.05) were further analyzed using multivariable logistic regression.

A total of 514 students participated in the study. Approximately 56% demonstrated good academic performance. Factors significantly associated with academic performance included maternal education level (AOR = 4.08, 95% CI: 1.60-10.40), regular breakfast consumption (AOR = 4.25, 95% CI: 2.16-8.37), body mass index (AOR = 4.12, 95% CI: 3.04-5.57), and dietary diversity score (AOR = 3.33, 95% CI: 1.99-5.57).

The study revealed a relatively low level of academic performance among students in the study area. Maternal education, regular breakfast intake, healthy BMI, and higher dietary diversity were identified as key factors positively associated with academic achievement. Interventions aimed at improving child nutrition and parental education could enhance academic outcomes in this population.

One of the most important criticism about mental health services regards the difficult that people meet when looking for a psychological support from these services. These health problems concern every citizen, but even more so for people with an ethnic background who are more exposed to discrimination, stigma and marginalization than the majority population of a country. For this reason, we decided to conduct research on scientific material on this topic, focusing on articles that shed light on the perspective of users belonging to ethnic minorities. The selected articles refer to some countries belonging to the European Union. Furthermore, the research focused on the main barriers that users reported perceiving when accessing mental health services. This paper offers a review of Europe literature concerning the need to estimate the main critical issues for which ethnic or migrant people are not receiving an appropriate help from mental health services. Another important characteristic is that the work aims to give a voice to the people involved in this review, which is why only articles and works that noted the user's own perspective were considered. Our work found that people with different cultural background face specific barriers when seeking help from mental health services, in particular, we noted two main barriers that will be specifically explained. The results show that people with ethnic or migrant background have to face more and specific critical aspects when seeking psychological help compared to the main population of a nation. In particular, the criticism of being discriminated includes the criticism of being treated differently, unequally or disparately compared to the majority of population of a country. Even today, ethnicity plays a significant role in determining how people receive mental health care. The perception of receiving unfair and often ethnocentric treatment and the underrepresentation of ethnic minority patients in clinical services indicate that ethnic minorities face significant unmet healthcare needs, which may further contribute to the socioeconomic difficulties that some minority groups already face.

Most research on attention deficit hyperactivity disorder (ADHD) focuses on childhood or early adulthood. Less is known about the impact of childhood ADHD traits across the lifespan. This study aims to test (1) whether childhood ADHD traits are associated with trajectories of psychological distress across adulthood up to midlife, and (2) the role of societal exclusion in the relationship between ADHD traits and midlife distress. Data were from the 1970 British Cohort Study (N = 17,196 at birth), a prospective longitudinal cohort. ADHD traits were measured at age 10 using a validated 14-item measure. Psychological distress was assessed at 5 time points (26-46) using the Malaise Inventory Scale. Measures of 5 domains of societal exclusion (health, relational, political, economic and services) were available at age 34. Higher childhood ADHD traits were associated with higher distress across adulthood and being in higher distress trajectories. The predicted probability of having clinically relevant distress in midlife was about 27% for people who had high childhood ADHD traits (5.05%), compared with 18% for those who did not have high ADHD traits, adjusting for sex, ethnicity and childhood social class. Societal exclusion acted as an indirect pathway in the association between ADHD traits and midlife psychological distress through health, relational, economic and services exclusion, but not political exclusion. People with higher childhood ADHD traits are more likely to experience psychological distress in adulthood, which was partly explained by societal exclusion. Exclusion experienced by people with ADHD may be a determinant of long-term adverse mental health outcomes. Addressing structural and relational barriers across the life course is an important step toward promoting well-being for people with ADHD.