Childhood threat exposure (CTE) has been linked to altered fear-learning, yet its prospective role in adolescent paranoia remains unclear. This study examined whether threat-safety discrimination (TSD) and fear generalization (FG) predict virtual reality (VR)-assessed state paranoia 18 months later, and whether CTE and gender moderate these associations.

A total of 120 adolescents (aged 12-16) participated at wave 1, completing a classical conditioning and FG task and reporting CTE. At wave 2, 97 participants completed a VR social environment assessing state paranoia. Linear regression models tested TSD and FG main effects, followed by moderation by CTE, and the FG × CTE × gender interactions.

Neither TSD (β = 0.14, P = .198) nor FG (β = -0.07, P = .530) predicted wave 2 paranoia at group level. However, CTE significantly moderated the association between TSD and later paranoia (β = 0.21, P = .035), whereby adolescents with higher CTE and better discrimination showed higher paranoia. A significant FG × CTE × gender interaction (β = 0.53, P = .044) revealed divergent pathways: in boys, higher FG predicted lower paranoia (F(1, 84) = 7.34, P = .008), particularly with higher CTE, which was absent in girls.

Exploratory interactions, partly opposite to our hypotheses, suggested that better TSD and reduced FG were associated with higher paranoia in threat-exposed youth, particularly boys. This pattern may reflect a "better safe than sorry" strategy involving fine-grained appraisal of threat and safety cues, potentially adaptive in unpredictable and threatening environments but at the cost of greater distrust.

While there is consensus that well-being is a multidimensional construct shaped by various factors, there is a significant knowledge gap on what constitutes well-being for communities immersed in cultural collectivism. This discrepancy limits the field's knowledge on what constitutes well-being for Latine communities, who often prioritize interpersonal relationships over the self. For this reason, the current study sought to develop and determine the initial factor structure of a measure assessing Latine well-being. The Latine Well-being Scale (LWBS), a self-report measure of well-being, was developed and administered to a sample of Spanish- and English-speaking Latine adults (N = 239). The scale factor structure was explored, and internal consistency and construct validity were examined. The results of an exploratory factor analysis tentatively supported a 51-item scale with 4 factors: Spiritual well-being, Adaptive well-being, Collective well-being, and Convivial well-being. Cronbach's alphas for the LWBS and subscales demonstrated strong internal consistency. Construct validity analyses revealed that the LWBS scores were positively associated with a measure of well-being, familism, and Latine culture, but not associated with life satisfaction. The present study identified a tentative factor solution and initial evidence of construct validity for the LWBS derived from an EFA, providing foundational empirical guidance for subsequent research using Confirmatory Factor Analyses to determine the measure's research and clinical utility.

Negative symptoms in schizophrenia often persist for prolonged periods, severely impairing patients' social functioning, while the therapeutic benefits of existing pharmacological treatments remain limited. Recent meta-analyses suggest that high-frequency stimulation of the left dorsolateral prefrontal cortex (L-DLPFC) provides short-term adjunctive benefits for negative symptoms, with effects ranging from small to moderate. However, treatment response is influenced by the stimulation parameters, target localization, and patient characteristics; thus, overall therapeutic efficacy remains heterogeneous. In patients with schizophrenia, peripheral immune-inflammatory abnormalities may occur, and some inflammatory markers are associated with disease stage, cognitive function, and negative symptom severity. Repetitive transcranial magnetic stimulation (rTMS) can modulate the prefrontal cortex and related brain networks, but its effects on immune-inflammatory processes, neuroendocrine-autonomic function, and neuroplasticity remain to be further elucidated. This review summarizes the immune-inflammatory mechanisms underlying negative symptoms, the clinical efficacy of rTMS, and the biological link between them, and discusses the potential of inflammatory markers for patient stratification and treatment-response prediction. In the future, standardized symptom assessment, stimulation parameters, and target localization are warranted, alongside repeated biological sample collection, prespecified stratified analyses, and external validation. Until inflammatory markers have been sufficiently validated with respect to predictive performance, reproducibility, and clinical net benefit, they should not be used alone to determine rTMS treatment eligibility, select stimulation parameters, or guide stratification decisions.

Major depressive disorder (MDD) is a heterogeneous disorder with diverse symptom profiles and treatment responses. Psychomotor retardation and agitation represent clinically relevant dimensions of MDD heterogeneity, but their neurobiological basis remains unclear. Given the role of the thalamus in motor regulation and affective processing, this study examined thalamic gray matter volume (GMV) differences among patients with MDD with predominant psychomotor retardation (MDD-R), patients with MDD with predominant psychomotor agitation (MDD-A), and healthy controls (HCs).

Structural MRI data from the REST-meta-MDD consortium included 54 patients with MDD-A, 123 with MDD-R, and 122 HCs. Total, hemispheric, and 30 subregional thalamic GMV measures were extracted using voxel-based morphometry and the AAL3v1 atlas. ComBat harmonization was applied before analysis. Group differences were tested with analysis of covariance controlling for sex, age, education, and total gray matter volume. Exploratory partial Spearman correlations examined associations with psychomotor symptoms, HAMD(adj), and anxiety symptoms.

After FDR correction, significant group effects were limited to the bilateral ventral anterior nucleus (VA). Patients with MDD-R had greater bilateral VA GMV than HCs, whereas MDD-A did not differ from HCs. No direct MDD-A vs MDD-R difference survived FDR correction; only the left inferior pulvinar showed a nominal difference. Exploratory correlations linked several thalamic nuclei, including the reuniens nucleus, ventral posterolateral nucleus, lateral geniculate nucleus, and anteroventral nucleus, to psychomotor, depressive, or anxiety symptoms.

MDD-R was associated with selective bilateral VA structural differences rather than widespread thalamic abnormalities. No direct thalamic GMV difference between MDD-A and MDD-R survived FDR correction. The exploratory symptom associations suggest that thalamic structure may relate to multidimensional clinical heterogeneity in MDD. These findings require replication given the cross-sectional design, unequal subgroup sizes, and incomplete medication data.

In April 2025, Brazil's Federal Council of Medicine (CFM) issued Resolution 2.427/2025 banning puberty blockers, restricting hormone therapy until age 18, and delaying gender-affirming surgeries until age 21. These measures sharply contrast with previous national protocols aligned with international standards of care. We conducted a qualitative study to explore how transgender adolescents and their caregivers perceive these new restrictions.

Nine focus groups were held between May and June 2025 with 5 pre-adolescents and 26 adolescents (11-18 years) and 21 caregivers receiving care at Brazil's largest gender identity outpatient clinic. Discussions were transcribed verbatim, coded, and analyzed using qualitative content analysis.

Participants consistently viewed the resolution as unjust, ideologically motivated, and detached from scientific evidence. Adolescents described puberty blockers and hormone therapy as life-saving, emphasizing their positive physical and psychological effects. They rejected detransition as a valid justification for restrictions, framing it as rare and often driven by external pressures. Caregivers echoed these concerns, describing the resolution as harmful, unscientific, and likely to exacerbate inequalities, mental health challenges, and unsafe self-medication practices. Both groups highlighted that gender-affirming care is preceded by long-term, multidisciplinary follow-up under robust clinical protocols, minimizing risks of regret or adverse outcomes.

Findings show that restrictive policies are not perceived as neutral regulation but as an assault on the rights, health, and dignity of transgender youth. By amplifying the lived experiences of adolescents and caregivers, this study points out the urgent need for evidence-based, inclusive, and participatory health policies that do not exclude trans voices.

Daily patterns of activity, rest, and sleep, referred to as rest-activity rhythms (RARs), can be characterized by their day-to-day regularity, within-day fragmentation, and contrast between active and rest periods across the 24-h cycle. Disruptions (e.g., irregular schedules, fragmented activity, or reduced day-night contrast) have been associated with cognitive decline among older adults. Few studies have used repeated actigraphy to distinguish person-level average RARs from visit-specific deviations.

The sample included 169 older adults without MCI or dementia at the first actigraphy visit, based on consensus clinical and neuropsychological review. Seven-day wrist actigraphy required at least three 24-h intervals with <5% missing data each; 122 participants had repeated assessments (362 observations total). RARs were characterized using three non-parametric features: (1) day-night contrast [relative amplitude (RA)], (2) day-to-day regularity [interdaily stability (IS)], and (3) within-day fragmentation [intradaily variability (IV)]. Each metric was decomposed into a person-level average and a visit-specific deviation from that average. Linear mixed-effects models examined associations with executive function and BMI-adjusted plasma markers of Alzheimer's disease-related pathophysiology [pTau181/(Aβ42/Aβ40)], neuroaxonal injury (NfL), and astroglial activation (GFAP); exploratory Cox models evaluated incident MCI; and amyloid PET interaction models were conducted in participants with PET data (n = 141).

Higher average RA and IS and lower average IV were associated with higher executive function. At the visit level, higher-than-average RA and lower-than-average IV relative to each participant's own average were associated with higher executive function at corresponding assessments. Higher average RA was associated with lower risk of incident MCI. RAR metrics were not significantly associated with GFAP, NfL, or pTau181/(Aβ42/Aβ40) in the plasma biomarker models. Amyloid PET status moderated within-person RAR associations with executive function: higher-than-usual RA and IS and lower-than-usual IV were more strongly associated with better executive function among amyloid PET-positive participants. For the plasma biomarkers, the between-person IS × amyloid PET interaction remained significant after correction only for pTau181/(Aβ42/Aβ40).

These findings highlight the value of repeated actigraphy for distinguishing average RAR levels from assessment-level departures from each participant's own average RAR profile and suggest that visit-specific RAR variation may be particularly relevant to executive function among amyloid PET-positive older adults.

Sleep disturbances are frequently observed in cancer patients. In addition to validated multi-item scales for assessing sleep disturbances, there are also single-item measures. The aim of this study was to investigate the extent to which such ultra-short single-item assessments of sleep disturbances provide useful information in cancer patients.

This is a secondary analysis of a prospective multicenter study involving a sample of 970 patients with newly diagnosed cancer (mean age: 60.3 years; 46.8% women; mixed cancer diagnoses). We analyzed sleep disturbances using three single-item measures: the sleep items of the European-Organization-For-Research-And-Treatment-Of-Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and the Patient Health Questionnaire-9 (PHQ-9), and the dichotomous sleep item included in the Problem List of the Distress Thermometer. Samples of the general population were used as comparison groups.

The sleep quality of the cancer patients was markedly poorer than that of the general population, with effect sizes between 0.67 and 0.74. The correlations between the sleep measures in the patients' sample were between 0.61 and 0.74. The three sleep measures provided similar results regarding group differences based on sociodemographic and clinical variables, and their correlations with other scales of quality of life and mental health were also similar.

Despite the lower reliability of the single-item measures of sleep quality in comparison with multi-item scales, these single items can help identify groups of patients who are at increased risk of sleep disturbances and the factors that contribute to poor sleep.

Augmented reality (AR) has emerged as a promising educational tool in mental health care; however, evidence regarding its integration into routine psychiatric nursing practice remains limited. This study examined whether participation in an AR-supported self-care training program was associated with improved clinical and functional outcomes among patients with Major Depressive Disorder (MDD) receiving standard psychiatric nursing care.

A retrospective propensity score-matched cohort study was conducted using electronic medical record data from 342 inpatients and outpatients treated at a tertiary psychiatric hospital in Changsha, Hunan, China between January 2023 and June 2025. All patients received routine psychiatric nursing services. A subgroup additionally participated in an AR-supported self-care education program focused on illness management, daily self-care, emotion regulation, and social functioning. Propensity score methods were used to balance baseline demographic and clinical characteristics between exposure groups. Primary outcomes included changes in depressive symptom severity measured by the Hamilton Depression Rating Scale (HAM-D-17) and self-care agency measured by the Exercise of Self-Care Agency (ESCA) Scale. Secondary outcomes included medication adherence and healthcare utilization indicators.

Within the propensity score-matched cohort, participation in the AR-supported program was associated with significantly greater improvement in self-care agency and modestly greater reduction in depressive symptoms compared with standard care alone (both p <.001). Medication adherence was also higher among AR participants. Within the AR group, the number of completed sessions was positively correlated with improvement in self-care agency (r = 0.29, p <.001), whereas the association with symptom reduction was weaker. Multivariable analyses identified AR participation as an independent predictor of both functional and clinical improvement.

AR-supported self-care education may represent a useful adjunct to psychiatric nursing practice by enhancing patient engagement, self-management capacity, and treatment adherence among individuals with MDD. Prospective studies are needed to confirm these findings and evaluate long-term outcomes.

Oncological prehabilitation aims to strengthen cancer patients physically and mentally before treatment, yet it is not standard care. The Prehabilitation through an Integrative Medicine Day Clinic (PRIME-DC) study examined the feasibility of a multimodal program during neoadjuvant therapy prior to surgery.

In this single-arm, mono-center interventional feasibility trial, patients attended a closed-group program once weekly for eight weeks (6.5-hour sessions) scheduled across the neoadjuvant treatment period. The curriculum integrated physical exercise, nutritional and naturopathic counseling, and Mind-Body Medicine practices. The primary outcome was program adherence, defined by attendance rate. Secondary outcomes included patient-reported measures of quality of life, anxiety, depression, fatigue, sleep, mindfulness, and physical fitness tests assessed at baseline and post-intervention. Patient satisfaction were evaluated at program completion.

Twenty-three of the 41 patients who were assessed for eligibility were enrolled, with an adherence rate of 69%. An exploratory within-group improvement in the 1-minute sit-to-stand test was observed from baseline to post-intervention (V1: 26.00 (22.00/34.00), V10a: 27.00 (24.99/34.00), 95% CI = 1.000 - 6.000, p = 0.02, r = 0.66), while other functional and patient-reported outcomes showed no statistically detectable within-group changes (p > 0.05). No study-related adverse events occurred. Patient satisfaction was assessed using a 17-item Likert scale (0-4). Overall, patients reported high levels of satisfaction (range: 0.00 - 1.88).

This pilot feasibility study provides preliminary evidence that participation in an integrative prehabilitation day-clinic program may be associated with the preservation of physical and mental health during neoadjuvant treatment. The findings indicate good feasibility and acceptability, providing a strong rationale for further investigation in larger, controlled trials.

https://drks.de/search/de/trial/DRKS00028126, identifier DRKS00028126.

To evaluate the effect of the modified Know-Want-Learn-How-Apply-Questions (KWHLAQ) strategy on critical thinking and self-directed learning among third-semester undergraduate nursing students enrolled in a critical care nursing course.

A quasi-experimental, nonequivalent control group pretest-posttest design was employed. One hundred undergraduate nursing students (n = 50 per group) enrolled in the Critical and Emergency Nursing Department, Faculty of Nursing, Alexandria University, participated during the 2025 academic session. The study group received a 12-week structured intervention based on the KWHLAQ framework; the control group received standard lecture-based instruction. Both groups completed the Critical Thinking Questionnaire (CThQ; α = 0.80) and the Self-Directed Learning Instrument (SDLI; α = 0.80) before and after the intervention.

After covariate adjustment, the study group demonstrated significantly higher post-intervention critical thinking scores than the control group (p < 0.05; Cohen's d = 0.67, moderate-to-large effect). The study group improved significantly in overall critical thinking (mean difference = 5.66; p < 0.01) and in the evaluating subscale (mean difference = 4.50; p < 0.001; Cohen's d = 2.10, whereas the control group's scores declined. Self-directed learning improved substantially in the study group (mean difference = 23.06; p < 0.001; Cohen's d = 2.45), with significant gains across all four SDLI subscales.

Integration of this structured, low-cost, and replicable pedagogical framework into nursing curricula may promote active learning, reflective reasoning, and clinical decision-making competencies essential for high-acuity practice.