This study assessed the relationship between cardiac electrophysiological indicators and blood lipid parameters in patients with coronary artery disease complicated by arrhythmia and evaluated their combined influence on the development of heart failure. A cohort of 240 patients admitted to the Cardiac Center of The First Affiliated Hospital of Xiamen University between April 2023 and April 2025 was screened; 80 met the inclusion criteria and were included in the analysis. Participants were categorized according to the occurrence of heart failure. Clinical characteristics, including lipid profiles (triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and total cholesterol), were analyzed alongside echocardiographic parameters, including left ventricular ejection fraction (LVEF) and carotid intima-media thickness (CIMT). Statistical analyses included correlation testing, multivariable logistic regression, and receiver operating characteristic (ROC) curve analysis. Impaired cardiac function, increased CIMT, and abnormal lipid concentrations were significantly associated with heart failure risk. QTc interval showed positive correlations with LDL-C (r = 0.342, P < 0.01) and triglycerides (r = 0.366, P < 0.01), whereas HDL-C showed inverse correlations with electrocardiographic parameters. In multivariable logistic regression analysis, prolonged QTc interval (OR = 1.08, 95% CI: 1.02-1.15), widened QRS duration (OR = 1.05, 95% CI: 1.01-1.11), elevated LDL-C (OR = 1.74, 95% CI: 1.12-2.63), increased triglycerides (OR = 1.62, 95% CI: 1.05-2.48), reduced HDL-C (OR = 0.68, 95% CI: 0.50-0.91), and decreased LVEF (OR = 0.89, 95% CI: 0.83-0.94) were independent predictors of heart failure. ROC analysis confirmed the predictive value of multiple risk factors, with AUCs ranging from 0.68 to 0.75. HDL-C had the highest predictive accuracy individually (AUC = 0.75), while QTc interval and LVEF also demonstrated strong discrimination (AUC = 0.73).

Many people are still using traditional medicine in various countries. This is a challenge for governments because they must effectively manage services, maintain quality, and protect patients. Integrating traditional medicine into public health centers provides safe and quality services. This study aimed to explore the perceptions and experiences of traditional medicine users and program implementers in Indonesian public health centers.

This study used an exploratory qualitative research design. Data were collected from program implementers and traditional medicine users. Data were collected through focus group discussions and in-depth interviews from March to June 2023. The study had 16 participants which included 10 implementers in focus group discussions and six users in in-depth interviews. Analysis using an inductive approach was employed.

Three key themes emerged: user preferences, success factors for integration, and challenges for improvement. Users preferred traditional medicine at public health centers over traditional medicine practitioners due to trust, accessibility, and therapeutic effects. Implementers highlighted the importance of human resource readiness and community support for successful integration, despite obstacles like limited training and resources.

The integration of traditional medicine services into public health centers is essential to provide easy access and preserve traditional health services that are in line with local wisdom, effective, and safe.

Informal caregivers play a crucial and continuous role in supporting individuals living with severe mental health problems, hereinafter referred to as supported individual, yet their involvement in formal care remains poorly understood. While existing research has often focused on professional perspectives or institutional barriers, the lived experiences of caregivers, how they perceive and negotiate their roles and shifts in involvement with formal care, have received limited attention. This qualitative study addresses these research gaps by investigating how twenty informal caregivers experienced their involvement in the formal care trajectories of individuals living with severe mental health problems across different care settings in the Netherlands. Through in-depth interviews, we identified three archetypes of caregiver involvement with formal care: the Active Partner, the Formalized Caregiver, and the Disconnected Caregiver. These archetypes represent different degrees and qualities of caregiver involvement and show how caregivers move between roles over time, influenced by interpersonal relationships, professional attitudes, legal constraints, and systemic challenges. Rather than being fixed, caregiver involvement is shown to be a dynamic, negotiated process shaped by all members of the care triad, the supported individual, the professional, and the caregiver, as well as the broader care system. The study highlights how caregivers who occupy the role of the Formalized Caregiver often assume significant responsibilities without adequate recognition or support, while those positioned as the Disconnected Caregiver is excluded from the formal care trajectory or unable to participate in ways that align with their own wishes and capacities. However, if relationships within the care triad are characterized by trust, open communication, and mutual respect, caregivers can assume the role of Active Partner. By drawing on caregivers' lived experiences, this study offers a nuanced and empirically grounded understanding of caregiver involvement in practice, providing new insights for the development of more inclusive and supportive care systems for caregivers and ultimately the individuals they support.

Few primary care patients with hazardous drinking initiate or engage in alcohol care. We conducted a formative evaluation of an intervention, Connect to Care (C2C), designed to support patients with hazardous drinking and mental health symptoms in initiating alcohol care.

C2C's acceptability and barriers and facilitators to its use in the primary care setting were explored.

Participants were enrolled in a pilot randomized controlled trial of C2C. Participants assigned to the C2C condition were selected to participate in a qualitative interview at the completion of their 3-month follow-up. Template analysis was used to analyze qualitative data.

We interviewed 20 primary care patients (90% male) with a positive screen for hazardous drinking and depression and/or PTSD symptoms.

Participants described four ways that C2C was helpful: Using a menu, the coach helped educate participants on their alcohol care options; participants' felt that the coach was non-judgmental, caring, and genuinely interested in helping them learn about their care options and link them to their preferred option; participants' appreciated the flexibility of how and when C2C was offered which facilitated engagement; and it was some participants' perception that C2C helped them reduce both their alcohol use and mental health symptoms. However, some patients reported that the length of C2C sessions, repetitive information provided by the coach, and not wanting to change their drinking habits as barriers to C2C session attendance.

This qualitative study highlights helpful components, potential barriers to session attendance, and potential adaptations to C2C informed by primary care patients participating in a pilot RCT of this strengths-based intervention. The findings could help inform implementation of C2C in the primary care setting.

To evaluate the agreement of the 2-item (PHQ-2) and 8-item (PHQ-8) Patient Health Questionnaires compared to the PHQ-9 and clinical diagnosis for depression screening in Brazilian adults, and to examine associated sociodemographic and behavioral factors. We analyzed cross-sectional data from 148,733 participants in the 2013 and 2019 Brazilian National Health Surveys. ROC curve analyses identified optimal cutoffs for PHQ-8 and PHQ-2 against the PHQ-9 (≥ 10) and clinical indicators. Logistic regression and Ratio of Odds Ratios (ROR) compared associations across screening tools and self-reported diagnosis. The PHQ-8 (cutoff ≥ 10) showed near-perfect agreement with the PHQ-9 (AUC = 0.982). For the PHQ-2, a ≥ 3 cutoff optimized specificity (96.4%) and overall agreement (94.7%), with an AUC of 0.877. Optimal cutoffs against clinical indicators shifted lower (≥ 4 for PHQ-8; ≥ 1 for PHQ-2). Both brief versions identified associations profiles consistent with the PHQ-9 (e.g., higher odds in women, low-income individuals, and those with chronic diseases). However, ROR analyses revealed a significant healthcare gap: higher income and advancing age strongly predicted formal diagnosis, while Black/Brown populations and those with poor health were significantly underrepresented clinically compared to symptom screening. All scales showed strong reliability (α, ω > 0.85), including the PHQ-2 (r = 0.55; ρ_sb = 0.71). The PHQ-8 is a psychometrically equivalent alternative to the PHQ-9 in Brazil, and the PHQ-2 is a reliable, ultra-brief tool ideal for rapid, large-scale population screening. While these scales accurately capture symptom burden, the observed discrepancies with formal diagnosis highlight significant systemic barriers to mental healthcare access for vulnerable subgroups.

Current screening tools for harmful alcohol consumption have fallen out of step with recent guidance on the health risks of alcohol. To address this gap, the Canadian Research Initiative in Substance Matters updated the screening recommendations for high-risk drinking and alcohol use disorder (AUD) in the 2023 national clinical practice guideline.

Following a systematic review of literature published between Jan. 1, 2013, and Feb. 24, 2023, that examined screening tools for high-risk drinking and AUD, the updated recommendations were developed by a multidisciplinary national committee, which included people with lived and living experience. We scored the recommendations and certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation tool. We used the Appraisal of Guidelines for Research and Evaluation II instrument and the Guidelines International Network's principles for disclosure of interests and management of conflicts to ensure the update met international standards for transparency, high quality, and methodological rigour.

Acknowledging that time constraints are the most commonly reported barrier to universal alcohol screening, we developed 5 recommendations involving a simple screening method, to identify and address both unhealthy alcohol consumption and more serious problems related to alcohol. The recommendations include asking all patients about alcohol consumption and providing educational support to all those who drink above Canada's Guidance on Alcohol and Health's low-risk threshold. We propose a simple screening algorithm to optimize and tailor further intervention, including when to assess for possible AUD.

The revised screening recommendations represent a timesaving and pragmatic approach intended to be a resource for universal screening for alcohol risks and problems. The recommendations streamline the process of identifying and addressing the health needs of those who consume alcohol in a hazardous way or may have more serious problems related to alcohol.

People with intellectual disabilities have the right to access mainstream healthcare services. However, research highlights barriers to accessing services and recommends reasonable adjustments to improve this.

Focus groups were held with 21 staff from adult mental health services, including the intellectual disability service in Somerset, UK, to identify barriers and solutions to improve access. Reflexive thematic analysis was used, and change ideas were generated.

Four themes were identified: service barriers to making reasonable adjustments, the need for adequate training, the need for joint working, and reasonable adjustments in practice. Staff reported awareness of adjustments but variable knowledge and confidence in implementing them. Participants highlighted service constraints and wanted increased flexibility, joint working, and clearer record keeping.

From the identified barriers, change ideas were developed and solutions proposed to improve service access. Future service improvements and research need to meaningfully involve people with intellectual disabilities.

The psychological impact of honor cultures and shame societies on the general population has not been examined through a diagnostic lens. Atimiaphobia is a newly recognized psychological condition characterized by an intense fear of losing honor or being labeled shameless, deeply rooted in honor cultures and shame societies. To assess this construct, the Atimiaphobia Scale (AtiPhoS) was developed and rigorously validated. The study was conducted in a series of four phases involving 1232 participants (M_age = 27 years; women = 48.9%). The validation of the AtiPhoS involved exploratory and confirmatory factor analyses along with convergent and predictive validity. The AtiPhoS, comprising 15 items (English) and four subscales (fear of being labeled shameless, fear of violating social norms, fear of public judgement, fear of losing self-respect and honor) demonstrated excellent reliability (α = 0.824; ICC = 0.989). The model fit indices, such as CFI (0.933), TLI (0.916), RMSEA (0.065), and SRMSR (0.044), showed strong validity. Convergent validity was demonstrated by the scale's significantly positive correlation with the Experience of Shame Scale (r = 0.377) and the anxiety sub-scale of the Depression, Anxiety, and Stress Scale (r = 0.262). The predictive validity of the AtiPhoS was established through its inverse predictive values for social intelligence (β = -0.229). A significant positive correlation was found between atimiaphobia and age. Women and married individuals exhibited significantly higher levels of atimiaphobia compared with men and unmarried individuals, respectively. The study provides compelling evidence that atimiaphobia is a distinct and measurable phenomenon, contributing to the broader understanding of cultural stressors related to honor and shame.

Suicide is a major public health issue. Efforts to prevent it must begin as soon as hospitalization. Brief mental health interventions and contacts are known to be effective. The HOPAIR study proposes an innovative combination of peer support intervention and the Hope Box tool, followed by a reminder postcard sent to suicidal individuals hospitalized in psychiatric crisis units at two research centers in Lyon. Focusing on the resources of those affected, hope, and recovery, this study highlights the work of peer support workers and advanced practice nurses while offering encouraging prospects in the field of suicide prevention.

The Psy-Belt program (brief psychiatric care linked to the local area), developed by the Nord-Ouest Val-d'Oise hospital with the support of the Île-de-France regional health agency, aims to improve access to outpatient psychiatric care. Positioned at the beginning of the care pathway, it offers rapid assessment and intensive short-term follow-up by psychiatrists and advanced practice nurses (APNs). Despite limited human resources, it illustrates an innovative organizational approach aimed at streamlining mental health care pathways in a region under pressure and takes full advantage of the new skills offered by the arrival of APNs in psychiatry.