While there is much research on stigma toward marginalized populations, public perceptions regarding deservingness of basic human and civil rights of these groups have not been examined in a nationwide sample of US adults.

To understand the US public's perceptions regarding deservingness of basic human and contested civil rights for people with severe physical disabilities (SPDs), severe mental illness (SMI), and substance use disorders (SUDs).

This cross-sectional study was a nationwide US internet-based quota panel survey of US adults (aged ≥18 years) who completed the survey. Responses were collected from January 17 to February 12, 2025.

Participants rated their support for 5 human rights (adequate standard of living, high standards of health, legal capacity, freedom from torture, living independently) and 3 civil rights (being a parent, running for political office, owning a gun) for people with SPDs, SMI, and SUDs using a 5-point Likert scale, with marginalized subgroups presented to participants in randomized order. McNemar test for paired binary data was used to examine differences in mean support across subgroups, and linear probability regression models were used to identify demographic variables associated with support.

In this survey of 1442 US adult participants (849 female [58.9%]; 588 male [40.8%]; 3 nonbinary [0.2%]; and 2 preferred not to say [0.1%]), the SPD subgroup received significantly higher support across all 5 human rights and 3 civil rights compared with SMI and SUD subgroups. For example, 79.0% (95% CI, 76.9%-81.2%) of participants supported the right to live independently for people with SPDs, while 67.0% supported this right for those with SMI (95% CI, 64.6%-69.5%) and 68.4% supported this right for those with SUDs (95% CI, 66.0%-70.9%). Civil rights received lower support across all 3 subgroups; for example, 40.1% (95% CI, 37.5%-42.6%) supported the right to run for political office for those with SMI and 41.4% (95% CI, 38.8%-44.0%) for those with SUDs compared with 62.7% (95% CI, 60.1%-65.2%) for those with SPDs. Democratic affiliation and lived experience with behavioral health care were associated with higher support for human rights (eg, among those with SUDs, up to 17.1 and 14.2 percentage points higher support, respectively). Male sex and younger age (18-24 years) were associated with greater support for civil rights (eg, male sex with 17.9 percentage points higher support for gun ownership among those with SPDs and age 18-24 years with a 27.1 percentage-point difference among those with SMI).

These findings contribute important evidence to the existing literature on stigma, highlighting discrepancies in public support for basic human and contested civil rights across marginalized subgroups, which can inform interventions to address public attitudes toward people with behavioral health conditions.

Hepatocellular carcinoma (HCC) is a cancer with rising incidence and economic burden. However, evidence on healthcare resource utilization (HCRU) and associated costs is scarce in Europe. This study aims to determine HCRU and costs of HCC from a German third-party payer's perspective.

This longitudinal claims study (BARMER statutory health insurance) included patients with HCC (ICD-10-GM C22.0; 2016-2020). HCRU and costs within 2 years after diagnosis were analyzed descriptively and reported per patient (PP) and per patient per month (PPPM).

The cohort included 2778 patients. Mean age was 71.9 years (SD ±9.7); 69% were male. Total cost within 2 years after diagnosis was approximately €105 million, with mean cost PP of €37,970 (SD ±€43,840), primarily due to inpatient stays (67%). Median costs PP were highest for patients receiving liver transplantation (€126,943; interquartile range [IQR]: €104,340-€167,205) and lowest for patients without any tumor-specific therapy (€10,132; IQR: €5875-€19,663). Considering the observation period, costs PPPM were lowest for liver resection (€2434; IQR: €1282-€5425) and thermal ablation (€2349; IQR: €1233-€4316), whereas costs PPPM were highest for patients without tumor-specific HCC treatment (€5984; IQR: €2764-€10,908). Similar patterns were observed in the HCRU assessment.

In this German claims data analysis, PP costs and HCRU in patients with HCC were higher among those who underwent liver transplantation and lower among those without tumor-specific treatment. However, after adjustment for follow-up duration, the high costs PP among patients receiving curative-intent treatments were significantly relativized. These findings support structured HCC surveillance to potentially improve clinical and economic outcomes.

Burning mouth syndrome (BMS) is a chronic orofacial neuropathic pain disorder, occurring in the absence of clinically evident mucosal lesions or identifiable oral pathology that can explain the symptoms. A significant proportion of patients experience uncontrolled symptoms despite multiple therapies. OnabotulinumtoxinA (onaBoNT/A) is used in neuropathic pain, as clinical trials have shown benefits in peripheral and central neuropathic pain management with its application. We present an exploratory case series of four patients with refractory BMS treated with intradermal onaBoNT/A injections.

Four patients with refractory BMS were included in this study. OnaBoNT/A intradermal injections were performed in the inner labial mucosae and tip of the tongue. We assessed pain intensity before the procedure and after 15 days, adverse effects, time to symptom recurrence, cumulative effects with multiple procedures, and patients' global impression of change.

All patients reported the procedure was quick and well tolerated. No immediate adverse effects were identified. All patients had significant pain reduction at 15-day follow-up assessment. Regarding adverse effects, one patient reported transient lower lip asymmetry in one procedure, and another reported transient mild mouth closure impairment. Symptoms recurred between 2.5 and 3.0 months after the first procedure. Three patients desired to continue the treatment. One patient reported no symptom recurrence after four procedures with three-month intervals; after four procedures, the treatments were suspended, and she remained asymptomatic until the end of follow-up. One patient reported incremental benefit from repeated procedures. All patients reported the treatment had a meaningful impact on their daily life.

Our results suggest that intradermal onaBoNT/A injections may constitute an effective and durable treatment option for patients with BMS refractory to conventional therapies. Despite these favourable outcomes, adverse events were noted in procedures targeting the labial mucosa. In future applications, we aim to examine technical variations between sessions associated with and without adverse effects, to optimise safety and refine the technique.

Task shifting and task sharing are strategies for redistributing healthcare responsibilities to optimise healthcare services. The World Health Organization (2008) framed 'shifting' as the delegation of tasks from higher- to lower-qualified workers, while subsequent scholarship characterised 'sharing' as collaborative, team-based redistribution. However, the two approaches are often used interchangeably in literature and by practitioners. Drawing on interviews and observations across 16 Indian organisations working in primary healthcare, mental health, and emergency medical services, we identified two types of operational ambiguities: organisations simultaneously employed both strategies for different tasks within the same service and also demonstrated practices that did not match their design intent or initial appearances. Based on these, we reiterate the importance of classifying task redistribution (Shifting OR Sharing) at individual task levels, consistent with the task-specific wording of conventional definitions, and additionally propose a new operational criterion: whether the delegating provider is functionally present or absent during task execution. We suggest revised working definitions incorporating this criterion as a hypothesis for prospective testing, and invite the global health community to validate these for clearer implementation, evaluation, and policy.

The educational alliance describes a framework for the trusting relationship between trainee and supervisor as they engage in meaningful, effective feedback. This framework emphasizes interpersonal relationships, shared goals, and agreement on actionable steps to achieve these goals. In this theory-informed conceptual analysis, the authors propose that the educational alliance logically extends to support and enhance competency-based medical education and health professions education, collectively known as competency-based health professions education (CBHPE). Authors describe how key features of the educational alliance align with the five core components of CBHPE: outcome-based competencies, sequenced progression, tailored learning experiences, competency-focused instruction, and programmatic assessment - by facilitating individualized learning that is centered on the trainee-supervisor relationship. Relevant theories that support the effective implementation of the educational alliance in CBHPE to advance learning include growth mindset and self-regulated learning theories. Authors present specific actionable recommendations regarding trainee and supervisor roles and responsibilities within an educational alliance for creating shared mental models, building relationships, engaging in team training, and attending to ethical considerations, including conflicts of interest and using data for the determination of trainee competency and advancement. Additionally, the authors introduce an Educational Agreement applicable to all training levels, designed to foster, guide, and strengthen the educational alliance. The Agreement is intended to be voluntary, co-constructed, and may be adapted to local contexts. Finally, the authors identify areas for future empirical examination through research on the educational alliance in CBHPE programs.

Peer mentorship by individuals with lived experience is increasingly recognized as supporting recovery after severe injury. Yet evidence on its role in hospital-based rehabilitation remains limited, particularly in cases of severe war-related physical injury during ongoing military conflict. This study examines the benefits and barriers of peer mentorship within the Israel Defense Forces Casualties Affairs Unit, which trains previously injured veterans to accompany newly injured soldiers during hospitalization in healthcare settings as part of their reserve duty.

The study employed a qualitative design, comprising 41 in-depth interviews: 21 with severely injured soldiers (with amputations, traumatic brain injury, spinal cord injury, burns, polytrauma) who were assigned peer mentors, and 20 with parent-caregivers. Interviews underwent linguistic and thematic analyses.

Peer mentorship was found to support recovery across three domains: functional (independent functioning, exercising rights, community participation), social-emotional (fostering hope, belonging, trust, and mediation of re-entering the public space), and cognitive (autonomous choice, insight, identity reconstruction, and developing an effective mindset when interacting with others). Barriers were also identified across three domains: technical-functional (matching and timing issues), emotional (managing rejection, shattering the illusion of full recovery, appearance-related avoidance), and cognitive (discrepancies in worldviews).

Integrating peer mentorship into the post-acute continuum of care facilitates recovery of severely injured soldiers and their families but requires careful implementation. Healthcare systems and rehabilitation units may integrate peer mentorship as part of their comprehensive support framework. The study's significance lies in the need to develop diverse responses for war casualties following military conflicts worldwide.

Competency-based education is widely endorsed in health professions education (CBHPE) as an outcomes-focused approach to ensuring that all graduates demonstrate the competencies needed to improve patient and population health. Despite adoption of outcomes frameworks, accreditation requirements, and CBHPE tactics, interventions remain siloed within programs and training levels rather than spanning the education to practice continuum. Consequently, learners and teachers experience fragmented educational journeys that can fall short of addressing each learner's needs for continuous learning and growth. To advance efforts toward a CBHPE continuum, this systems-informed conceptual analysis uses a systems thinking perspective to analyze leverage points, places within complex systems where small, strategic interventions can cause large-scale, lasting changes. Drawing on Meadows' framework for understanding leverage points in complex systems, we examined barriers and opportunities to achieve a continuum and present five theoretically informed, literature-based, and expert-derived recommendations for transformation. Our analysis revealed that strategic intervention points, including paradigm shifts from 'time-served' to 'competence-demonstrated' readiness, structural changes through cross-continuum governance alignment, and process modifications via shared competency language and data systems, enable meaningful transformation beyond surface-level adjustments. Key recommendations include: (1) restructuring system architecture to enable seamless learner progression through competency committees and joint governance bodies; (2) shifting mental models to normalize time-variable progression and reconceptualize assessment as growth-supporting; (3) implementing high-impact approaches to assessment with longitudinal learner analytics; (4) changing rules and incentives to reward competency achievement; and (5) establishing continuous data-driven feedback systems. Understanding these leverage points informs targeted approaches, enabling a cohesive, coordinated, learner-centered CBHPE continuum.

Veteran issues in the United States often figure prominently in policy debates and media coverage surrounding psychedelic substances, such as psilocybin mushrooms and ibogaine. This is partially driven by the need to improve access and efficacy of treatments for mental health conditions, especially conditions (such as posttraumatic stress disorder) that are more common among veterans than nonveterans. In this study, the authors present new data from the 2025 RAND Psychedelics Survey. The study focuses on the use of specific psychedelic substances and policy preferences among U.S. veterans and compares them with nonveterans. The study also includes data on veterans' willingness to try these substances and their attitudes about U.S. Department of Veterans Affairs (VA) policies on certain psychedelics.

Mental health problems among older adults are an important and underrecognized public health concern in India. Depression, anxiety, and stress in later life are influenced by demographic, social, behavioural, and clinical factors, and identifying their independent predictors is essential for designing targeted preventive strategies.

This study aims to estimate the burden of depression, anxiety, and stress among older adults in rural North India and to identify independent predictors of depression, anxiety, and stress symptoms.

A community-based cross-sectional study was conducted among 384 older adults aged 60 years and above residing in rural districts of North India. Participants were selected through multistage random sampling from three rural blocks, and door-to-door household interviews were carried out. Data were collected using a pretested semi-structured questionnaire. Depression, anxiety, and stress were assessed using the Depression, Anxiety, and Stress Scale (DASS-21). Bivariate analysis was performed using the chi-square test, followed by multivariable binary logistic regression to identify factors independently associated with depression, anxiety, and stress.

The sample included 53.4% males and 46.6% females. Most participants were aged 60-65 years (64.3%), 64.1% were illiterate, 65.9% were married, and 60.9% belonged to lower socioeconomic strata. In this study, depression was present in 98 participants (25.5%), anxiety in 134 participants (34.9%), and stress in 100 participants (26.0%). This study also demonstrated strong positive correlations between depression, anxiety, and stress scores. Depression showed a strong positive correlation with anxiety (ρ = 0.865, p < 0.001) and stress (ρ = 0.852, p < 0.001). The strongest correlation was observed between anxiety and stress scores (ρ = 0.835, p < 0.001). In the final multivariable models, sleep difficulty, social isolation, chronic morbidity, and physical inactivity emerged as factors independently associated with psychological distress.

Psychological distress is common among older adults in rural districts of North India, and sleep difficulty, chronic morbidity, social isolation, and physical inactivity are key predictors. Community-based geriatric mental health programs should incorporate routine screening for these factors and link high-risk older adults to primary care and social support services.

Postgraduate students are six times more susceptible to mental health challenges than the general adult population, making it imperative to identify effective initiatives to support them. This is particularly relevant for master's and doctorate students undertaking distance-learning programmes as this is a dimension of the student experience that remains unexplored. Meditation practices such as those included in Mindfulness and Heartfulness programmes have been shown to improve university students' mental health and wellbeing even when delivered via videoconferencing. However, the efficacy of these approaches remains under-investigated among distance learning postgraduates.

This study aims to explore the impact of an online synchronous Mindfulness-based intervention (MBI) compared to a Heartfulness-based intervention (HBI) on distance-learning postgraduate students' mental health and wellbeing using randomised controlled trial (RCT) design.

The MBI included guided meditations, emphasizing present moment focus through breathwork and body scan exercises, compassion and non-judgmental observations. The HBI included a heart-focused form of silent meditation, with additional mental exercises aimed to facilitate the clearing and release of impressions. Weekly live online instructor-led group sessions facilitated access across 17 countries on six continents. In an initially powered RCT using block randomisation, N = 73 UK-based and international postgraduate students from King's College London (KCL) were allocated to either HBI (n = 37) or MBI (n = 36). 61 (80% female) completed validated questionnaires at baseline (T1), after 8-week intervention (T2) and at twelve-week follow-up (T3) through intention-to-treat (ITT) analysis. Significance was assessed through repeated-measures ANOVA, supplemented by mixed-effects modeling to assess robustness.

In line with hypotheses, the group × time interaction was not statistically significant for primary outcomes, providing no indication of differential change between interventions. Both MBI and HBI were associated with significant improvements in stress, anxiety, depressive symptoms and wellbeing in postgraduates over time, established through secondary within-group outcomes at T2. At T3, improvements were maintained for wellbeing and stress through ITT analysis. Anxiety reductions were sustained only through Per-Protocol (PP) analysis at T3.

These findings are consistent with comparable effects. Both HBI and MBI may be beneficial as preventative and transdiagnostic approaches for postgraduate students' mental health and wellbeing, at scale, and remotely with a global reach.