This study evaluated whether intramuscular (IM) ketamine is non-inferior to intranasal (IN) esketamine for treatment-resistant depression (TRD) and assessed differences in safety and healthcare costs.

In a retrospective, observational sequential cohort at the VA San Diego, 179 Veterans with TRD received eight treatments of either IN esketamine (n = 89) or IM ketamine (n = 90). The primary outcome was change in depressive symptoms (PHQ-9) analyzed via linear mixed-effects models with a non-inferiority margin of -1.25 points. Secondary outcomes included Post-Traumatic Stress Disorder (PTSD) Checklist for DSM-5 symptoms, adverse events, and a cost-difference analysis.

IM ketamine was non-inferior to IN esketamine for depression, with a baseline-adjusted estimated marginal mean PHQ-9 difference of 0.04 points (95% CI: -1.21 to 1.29). Reductions in PTSD symptoms were also non-inferior. Incidence of sentinel adverse events were comparable, with no significant differences in emergency department visits or hospitalizations. Cost analysis revealed a significant disparity: the total cost per eight-treatment course was $6069 for IN esketamine versus $647 for IM ketamine, with this difference driven primarily by the cost of IN esketamine.

IM ketamine demonstrated comparable clinical effectiveness and safety to FDA-approved IN esketamine while offering a significant reduction in cost. These findings suggest IM ketamine may be a high-value alternative to IN esketamine that could significantly expand access to psychiatric care for individuals with TRD.

These findings provide real-world evidence supporting the use of IM ketamine for TRD, and suggests that this formulation could offer a pathway for improving access to ketamine treatment by lowering the cost to healthcare systems.

Adolescent major depressive disorder (MDD) is clinically heterogeneous, with sleep disturbance often emerging as a prominent but variably expressed symptom dimension. This study aimed to identify latent symptom profiles in drug-naïve adolescents with MDD and examine their associations with recorded trauma/stressor exposure and neuroendocrine markers.

This cross-sectional study included 711 drug-naïve adolescents with MDD. Latent profile analysis (LPA) was conducted using 16 symptom indicators derived from the Hamilton depression rating scale (HDRS), Hamilton anxiety rating scale (HAMA), and Pittsburgh sleep quality index (PSQI). Multinomial logistic regression examined associations of recorded trauma/stressor exposure and neuroendocrine markers with profile membership.

A three-profile solution was retained: low overall symptoms (Profile 1; n = 200, 28.1%), PSQI-elevated subjective sleep disturbance (Profile 2; n = 215, 30.2%), and high overall symptoms (Profile 3; n = 296, 41.6%). Recorded family trauma/stressor exposure and violent incident exposure were associated with higher odds of Profile 3 membership relative to Profile 1, and these associations remained significant after neuroendocrine markers were added. Higher standardized testosterone (T) showed a modest association with Profile 3 membership, whereas FT3 showed only a marginal association. However, adding neuroendocrine markers did not significantly improve model fit beyond trauma-related variables.

LPA identified three clinically interpretable symptom profiles in adolescent MDD, including a profile characterized primarily by elevated PSQI-assessed subjective sleep disturbance. Recorded trauma/stressor exposure was associated with the high overall symptom profile, whereas neuroendocrine markers showed limited incremental value. These findings highlight multidimensional symptom profiling and trauma assessment in adolescent depression, while suggesting that neuroendocrine findings should be considered exploratory.

Experience-based co-design (EBCD) seeks to bring together people with lived experience of healthcare with other interest holders to collaboratively generate creative solutions.

A cluster randomised controlled trial is planned to assess the feasibility, acceptability and effectiveness of a co-designed multicomponent intervention to improve communication in aged care services.

This paper describes a nested process evaluation design for the EBCD and implementation of the intervention with the aim of understanding the role of co-design and other factors in achieving impact.

Primary data sources will include surveys, interviews, focus groups, field notes and observations of co-design activities. Secondary sources will include data collected and materials produced by the researchers developing the intervention.

Aged care recipients; family members and significant others; direct care workers; managers; and other healthcare professionals will be engaged as co-designers of the intervention, and as research participants in the evaluation of its co-design and implementation.

Evaluation findings will compare experiences of co-design, within and across informant groups, with an explanatory theoretical model of change described in previous research employing EBCD. Additionally, the role of the co-design and other contextual factors in the intervention's impact will be organised using the RE-AIM (Reach, Efficacy, Adoption, Implementation and Maintenance) framework.

The involvement of people who use and deliver health services in the development of complex interventions is increasingly recommended as a means to improve impact and health outcomes. However, research evidence supporting the mechanisms of impact of co-design and related approaches in healthcare is limited.

Nested process evaluations of co-design are needed to support the continued theoretical and methodological development and resourcing of co-design in healthcare.

A lived experience advisory group (LEAG) of older people receiving aged care services and family or other informal supporters of those receiving aged care services has provided input to the evaluation design described in this manuscript, and a member of this group has co-authored this article. LEAG members will continue to contribute to the conduct of the evaluation as well as the analysis and dissemination of the evaluation findings.

Digital technology has brought many advantages to healthcare, but it has also given rise to a new form of worker abuse called "cyberbullying." This type of bullying can happen anytime and can greatly harm workers' mental health. Since "professional quality of life" is vital for how well the healthcare system functions and there is not much research on how this connects to online bullying in Iranian nursing, it is important to look closer at this relationship. This study aimed to assess the association between cyberbullying and professional quality of life among nurses in Southeast Iran.

This research utilized a descriptive cross-sectional design and recruited 335 nurses from Kerman University of Medical Sciences affiliated hospitals during 2025. Subjects were enrolled using a convenience sampling approach, and data were collected using the Menesini Cyberbullying Questionnaire and the Professional Quality of Life Scale (ProQOL). Data were analyzed using SPSS Version 24 and descriptive statistics, independent t-tests, analysis of variance, spearman correlation coefficients, and stepwise multivariate regression, with a significance level of less than 0.05.

Data analysis indicated a low prevalence of cyberbullying among nurses. The mean scores of compassion satisfaction, burnout, and secondary traumatic stress were 34.71 ± 5.47, 16.03 ± 3.92, and 31.63 ± 4.90, respectively, all of which fell within the moderate range. Inferential findings indicated a significant positive correlation between cyberbullying and compassion fatigue, burnout, and secondary traumatic stress. Furthermore, cyberbullying emerged as a significant positive predictor across all three dimensions of professional quality of life in regression analyses. Additionally, key demographic and occupational factors including educational degree, shift type, employment status, gender, and marital status emerged as significant predictors within their respective models.

The findings indicated that cyberbullying was generally low and showed significant statistical associations with compassion fatigue in the analyses. Targeted interventions to enhance nurses' professional quality of life should be prioritized in healthcare settings. Furthermore, longitudinal and interventional studies are needed to better elucidate the temporal and causal relationships among these variables.

Nurse administrators should adopt preventive strategies addressing workplace cyberbullying and compassion fatigue to enhance nurses' professional quality of life.

The concepts of reserve and resilience in aging and Alzheimer's disease (AD) are widely used but their operationalization remains challenging and often lacks conceptual and methodological consistency. In this narrative review, we describe the chronological history of these concepts and then summarize and discuss key theoretical and practical issues, along with proposed solutions and different perspectives, in the context of aging and AD. Theoretical challenges include risk versus protective factors, dynamic brain and cognitive trajectories, overestimation of resilience and inflection points. Practical challenges include proxy measures, study designs, residual approaches, and influential cases. We highlight the need for greater methodological harmonization, improved validation of proxy, and lifespan longitudinal approaches. Addressing these challenges will strengthen interpretability, reproducibility, and causal inference, ultimately facilitating the translation of reserve and resilience research into preventive and therapeutic strategies.

Australia's mental health system is under increasing pressure as demand for the assessment and treatment of attention-deficit/hyperactivity disorder grows. Many people face long wait times, high out-of-pocket costs and limited specialist capacity. This encourages faster assessments, increasing the risk of misdiagnosis and avoidable downstream demand. The policy response has been to improve access and relieve specialist bottlenecks by expanding the role of general practitioners. Assessment for attention-deficit/hyperactivity disorder requires time-intensive clinical evaluation, including careful consideration of developmental history, collateral information and differential diagnoses. Making an attention-deficit/hyperactivity disorder diagnosis in adulthood adds complexity given the need for retrospective assessment to support childhood onset, limitations in the availability of collateral information and the impact of life events on executive functioning. Without dedicated time and training, general practitioners may struggle to maintain consistent diagnostic quality and appropriate prescribing at scale. There is already limited delivery of guideline-recommended multimodal care for Australians experiencing attention-deficit/hyperactivity disorder. Medications reduce core symptoms for many people, but sustained functional improvement typically requires psychoeducation, skill-based therapies, coaching and family, school or workplace interventions. Reform should pursue both access and quality by clarifying guideline advice for difficult adult diagnoses, introducing higher Medicare rebates for longer assessment appointments, linking any general practitioner role expansion to structured training and shared-care support, and funding scalable multimodal attention-deficit/hyperactivity disorder care through multidisciplinary clinics, group-based programmes, workforce upskilling, and national digital psychoeducation and self-management supports.

Latino/a adolescents report worse mental health than other ethnic-racial groups in the United States, including elevated depressive symptoms and anxiety, yet they remain less likely to access mental health services. Negative perception about mental health within Latino/a communities, shaped by negative beliefs about mental illness and limited knowledge of treatment, poses significant obstacles to care. Low mental health literacy, including poor understanding of depression, anxiety, and the role of therapy and medication, further contributes to negative attitudes about mental health. Prior work shows that Latino/a adolescents often avoid disclosing mental health concerns to parents to prevent burdening them, and this lack of communication impacts their help-seeking behaviors. To examine these challenges, we conducted six focus groups (n = 56) with Latino/a parents and adolescents aged 14-17 from Michigan and Texas. Analysis identified negative perceptions about mental health as a central obstacle for both parents and adolescents, limiting open dialogue about mental health. Adolescents reported fears of judgment or symptom minimization, contributing to delayed help-seeking behaviors. Parents expressed a need for greater mental health knowledge, including symptom recognition, treatments, and strategies for discussing mental health with their adolescent children. Adolescents emphasized the importance of trust, confidentiality, and family acceptance in facilitating disclosure and support. Findings underscore the need for interventions that reduce negative perception about mental health, improve mental health literacy, and strengthen parent-adolescent communication to enhance Latino/a adolescents' access to mental health care. Practitioners can support families by providing tools that support dialogue and reduce negative-perceptions about mental health.

This investigation compares the analytical performance of logistic regression (LR) and targeted maximum likelihood estimation (TMLE) methodologies for occupational health research using simulated workforce data. The study employs a simulation framework based on empirical observations from 738 Brazilian public university employees, generating a reference population of 10,000 cases with predetermined distributions of 2 critical exposure variables and some covariables. Through systematic sampling across multiple sample sizes (150-5000 observations), the research evaluates the comparative efficacy of traditional regression techniques versus TMLE framework. Key findings revealed important differences between the methods. For analyzing changes in diagnosis chapters, LR consistently produced more accurate estimates, with odds ratios (ORs) closer to the true population value (0.28) compared with TMLE (0.44-0.46). The precision of LR estimates, as measured by root mean squared error, was significantly better, especially in larger samples (0.02 vs 0.16 at n = 5000). The analysis of mental health conditions showed more complex results. While LR estimates were initially unstable in small samples, they converged to the true OR (27.35) as sample size increased. TMLE produced more stable but consistently conservative estimates across all sample sizes (ORs = 15-17). Notably, TMLE confidence intervals only included the true population value in the smallest sample (n = 150), suggesting potential limitations in its application for this type of analysis. These findings carry significant implications for occupational health research methodology. The results challenge prevailing assumptions about TMLE framework automatic superiority, demonstrating that conventional regression techniques can outperform more complex approaches in specific epidemiological contexts. The study highlights the continued relevance of LR for analyzing occupational health outcomes, particularly when investigating well-defined exposure-outcome relationships with adequate sample sizes. The research contributes to methodological literature by providing empirical evidence for analytical decision-making in public health research contexts.

Parents play a key role in shaping their children's feelings of safety through supportive approaches that foster mental and social growth. In contrast, harsh, abusive, or erratic parenting can erode the bond between parent and child, which may result in antisocial behaviors and mental health challenges in children. Hence, the importance of parents in delivering healthcare, nutrition, hygiene, and emotional support is vital for their growth and development. This study aimed to evaluate the participation of parents in child health (CH) services for early childhood development and the related factors for children below 5 years old in the Kolfe Karaniyo Sub City of Addis Ababa, Ethiopia, in 2024. A community-based cross-sectional study was conducted among 423 parents selected using systematic random sampling from 3 woredas. Data were collected through interviewer-administered questionnaires. Data entry was done using EpiData 3.1 and analyzed with SPSS version 27. Descriptive statistics were presented as frequencies and percentages. Bi-variable logistic regression (P < .25) was used to identify candidate variables, which were then included in multivariable logistic regression. Statistical significance was set at P < .05. In total, 59.9% (95% confidence interval [CI]: 55, 64.3) of parents exhibited a high level of engagement in CH services. This research uncovered several factors that were significantly linked to parental participation in these services. These factors include: the mother's education level (primary and above): adjusted odds ratio (AOR) = 2.82, 95% CI: (1.73, 3.61), the mother's employment status (housewife): AOR = 2.08, 95% CI: (1.24, 2.97), monthly income (high): AOR = 3.46, 95% CI: (2.95, 6.79), perception of healthcare affordability: AOR = 3.51, 95% CI: (2.19, 4.97), and a strong understanding of childhood developmental milestones: AOR = 2.33, 95% CI: (1.49, 3.64). These factors were identified as having significant correlations with parental involvement in CH services. The results of this research indicate a moderate degree of parental engagement in CH services when compared to other studies. Nonetheless, it is crucial to keep advocating for and improving parental participation in CH services to enhance outcomes.

Defining target problems (TPs) and associated target problem procedures (TPPs) is a key competency of cognitive analytic therapy (CAT). This study sought to categorize types of TPPs identified, assess the acceptability of TP/TPP sessional tracking, assess whether changes in TP/TPP recognition and revision occurred and also whether change in TP/TPPs predicted severity of self-injury urges and psychological distress.

As part of the RELATE clinical trial, N = 31 participants were allocated to eight-session CAT. TPs/TPPs were rated for recognition and revision at every session in a nested ABC plus follow-up single case design. The competency of therapists was assessed. TPPs were coded as to whether they were a snag, trap of a dilemma. Linear mixed-effects models tested whether TP/TPPs changed over time and according to phase of CAT. Change in TPs/TPPs were used to predict self-injury urges and psychological distress (i.e., research follow-up measures taken by blinded researchers).

There was strong interrater agreement on whether the TPP was a snag, trap or dilemma. The sessional rating of TPs/TPPs appeared acceptable, as during 97.68% of treatment sessions and 82.60% of follow-up sessions, tracking occurred. Compared to the reformulation phase, awareness and then therapeutic change of TPs/TPPs significantly increased during the recognition and revision phases. Recognition and revision of TPs/TPPs during CAT in the revision phase did not predict self-injury urges and psychological distress at research follow-up.

Early definition and sessional tracking of TPs/TPPs appear acceptable and changes to awareness and ability to change TPs/TPPs appears linear. CAT therapists should routinely integrate sessional tracking of TP/TPPs into their work.