Background/Objectives: A1 segment asymmetry, including hypoplasia and aplasia, is a well-recognized anatomical variation associated with altered hemodynamic stress and anterior communicating artery (ACoA) aneurysm formation. However, its influence on subsequent aneurysm rupture risk remains controversial. This study aimed to evaluate the relationship between A1 segment morphology and aneurysm rupture risk, as well as its association with aneurysm size and morphological complexity. Methods: A retrospective single-institution analysis was conducted on 211 patients treated for ACoA aneurysms between June 2016 and March 2025. A1 segment morphology was assessed using digital subtraction angiography and categorized as symmetric, hypoplastic (diameter < 1 mm or <50% of the contralateral vessel), or aplastic. Demographic, clinical, and radiological variables were recorded. Statistical analyses included univariate comparisons with Bonferroni correction for multiple testing and multivariable logistic regression to identify independent predictors of aneurysm rupture. Results: The study population had a mean age of 54.72 ± 10.97 years, with a male-to-female ratio of 1.24:1 (55.5% male, 44.5% female). Symmetric A1 segments were observed in 49.3% of patients, hypoplastic segments in 31.3%, and aplastic segments in 19.4%. No statistically significant association was identified between A1 morphology and aneurysm rupture rates (p = 0.251) or mean aneurysm diameter (p = 0.996). Univariate analysis demonstrated that younger age (p = 0.006), male sex (p = 0.016), and smoking (p = 0.033) were associated with rupture. However, none of these factors, including A1 morphology, remained independent predictors of rupture in the multivariable logistic regression model. Conclusions: Although A1 segment asymmetry is common in patients with ACoA aneurysms, it does not independently influence rupture risk or aneurysm morphology. Our findings suggest that rupture behavior is driven primarily by dynamic hemodynamic factors rather than static anatomical variations.

Background/Objectives: This study examined gender-specific psychological and interpersonal correlates of suicidal behaviour using the framework of the Interpersonal Theory of Suicide (IPTS). Methods: The study included a total of 181 respondents from a clinical group (N = 93) and a control group (N = 88). Logistic regression analyses were conducted separately for women (N = 86) and men (N = 80) for cases that met leverage values (LEV) ≤ 0.2. Variables included personality traits, coping style, hopelessness, self-esteem, hope, perceived burdensomeness, thwarted belongingness, and acquired capacity for suicide. Interaction terms were also tested. Results: Among women, hopelessness (Exp(B) = 1.37; p = 0.038) and perceived burdensomeness (Exp(B) = 1.12; p = 0.033) were identified as significant correlates of suicidal behaviour. Among men, an avoidance-focused style (Exp(B) = 1.18; p = 0.009) and the interaction of general capacity for suicide x perceived burdensomeness x thwarted belongingness (Exp(B) = 5.29; p = 0.043) emerged as significant correlates. Further analysis indicated that thwarted belongingness became a significant factor in men only when perceived burdensomeness and capacity for suicide were high (Nagelkerke R² = 0.33; Exp(B) = 1.17; p = 0.042). Conclusions: Gendered expressions of suicidality appear to follow distinct pathways. Within the IPTS framework, women's suicidality is more closely shaped by internalized cognitive and affective processes, including hopelessness and perceived burdensomeness, whereas men's behaviour is influenced by maladaptive coping, social disconnection, and acquired capacity for suicide. These findings highlight the importance of gender-specific prevention and intervention strategies across clinical and community contexts. Early identification of these correlates may reduce suicidal intent, prevent rehospitalization, and improve mental health outcomes.

Despite the global increase in cat ownership, some cats exhibit owner-directed aggression, resulting in caregiver injury, infection, and anxiety. Severe cases are commonly treated with selective serotonin reuptake inhibitors such as fluoxetine; however, adverse effects, particularly transient anorexia, often discourage treatment initiation. Cannabidiol (CBD), a natural compound with reported anxiolytic properties and minimal anorexic effects, may represent an alternative therapy. This study aimed to characterise owner-directed feline aggression in Thailand, identify associated factors, and compare the efficacy of CBD with fluoxetine. Most caregivers were females aged 20-40 years, and most cats were neutered mixed-breeds aged 1-6 years living indoors in multi-human and multi-cat households. For demographic variables, only human-cat interactions (e.g., petting) were significantly associated with aggression. Handling-induced aggression was universal, with grooming as the most common trigger (56%). In a single-blind, 4-8-week trial, 100 cats were randomly assigned to control, CBD 1 mg/kg/day, CBD 2 mg/kg/day, fluoxetine 0.5-1 mg/kg/day, or combined CBD and fluoxetine. Aggression scores decreased significantly in all treatment groups compared with control (p < 0.05), with no differences among active treatments. CBD at 1 mg/kg/day showed efficacy comparable to fluoxetine without anorexic effects.

Background: Motor imagery (MI) and mirror therapy (MT) are widely used neurorehabilitation strategies to enhance motor recovery after stroke and are commonly applied as adjuncts to conventional rehabilitation therapy (CRT). However, direct comparative evidence between these interventions remains limited. This systematic review compared the effects of MI and MT on motor function, functional performance, spasticity, and gait-related outcomes in adults after stroke. Methods: A systematic comparative review with narrative synthesis was conducted following PRISMA guidelines and registered in PROSPERO (CRD420251274308). PubMed, Cochrane Library, CINAHL, Scopus, Web of Science, and ScienceDirect were searched up to July 2025. Clinical trials directly comparing MI and MT in adults with stroke were included. Methodological quality was assessed using the PEDro scale, and risk of bias was evaluated with the Cochrane RoB 2 tool. Results: Six clinical trials involving 206 participants were included. Both MI and MT were associated with significant pre-post improvements across motor function, functional performance, spasticity, and gait-related outcomes. Between-group comparisons yielded heterogeneous findings, with no consistent evidence supporting the superiority of either intervention. Isolated advantages of MI were reported for specific upper-limb subdomains, but these effects were not consistently replicated. Overall methodological quality ranged from low to moderate, and all included studies were judged to be at high risk of bias according to the RoB 2 tool. Conclusions: MI and MT appear to provide comparable benefits for motor and functional recovery after stroke when used as adjuncts to CRT. Current evidence does not support the preferential use of one intervention, highlighting the need for well-designed trials with improved methodological rigor.

Background and Objectives: This systematic review investigates the relationship between preoperative psychological disorders and postoperative satisfaction among patients undergoing aesthetic surgery. While aesthetic procedures can enhance self-image, growing evidence indicates that underlying mental health conditions, particularly BDD, depression, and anxiety, may compromise surgical outcomes. Materials and Methods: A comprehensive literature search was performed in PubMed, the Cochrane Library, and Google Scholar between January 2010 and December 2024. Eligible observational studies assessed preoperative psychological conditions-primarily body dysmorphic disorder, depression, and anxiety-using validated instruments, such as the Body Dysmorphic Disorder Questionnaire (BDDQ), Body Dysmorphic Disorder Examination (BDDE), Hospital Anxiety and Depression Scale (HADS), Beck Depression Inventory (BDI), and structured clinical interviews, and reported postoperative patient-reported satisfaction following aesthetic surgery. Study quality was evaluated using an adapted QUIPS framework. Results: Across the 13 included studies, six reported a negative association between moderate-to-severe preoperative psychological symptoms and postoperative satisfaction, five found no significant association, and two described positive or conditional associations. Methodological heterogeneity in psychological assessment tools and satisfaction measures was a major source of divergence across studies. Despite these differences, the evidence underscores the need for standardized, validated psychological evaluation protocols in aesthetic surgery. Incorporating mental health screening into routine surgical planning can enhance ethical practice, reduce dissatisfaction, and improve long-term patient outcomes. Conclusions: These findings advocate for a multidisciplinary approach that includes psychological assessment as an essential component of patient care in aesthetic medicine.

Background and Objectives: The COVID-19 pandemic has led to an unprecedented mental health crisis among workers in the healthcare field, with average burnout rates increasing from about 32% before the pandemic to 46-52% during peak times and post-traumatic stress disorder (PTSD) affecting 24-34% of frontline staff. The primary objective of this article is to synthesize evidence on the prevalence of burnout and PTSD among healthcare workers before and during the COVID-19 pandemic. The secondary objectives are: (a) to examine the mechanisms and empirical evidence linking clinician mental health to medical errors and patient safety outcomes and (b) to analyze the medico-legal implications of this relationship, including malpractice liability, institutional responsibility, and opportunities for policy reform. Materials and Methods: We conducted a narrative review searching PubMed (November 2025-January 2026) using predefined keyword combinations. Inclusion criteria comprised original research, systematic reviews, and meta-analyses examining mental health outcomes or patient safety among clinical staff. Data were synthesized narratively across five thematic domains. Results: Burnout prevalence increased from approximately 32% pre-pandemic to 46-52% during peak periods, with emotional exhaustion reaching 67.5% in some settings. PTSD rates rose to 24-34% among frontline staff, exceeding pre-pandemic levels of 15-20%, with ICU staff particularly affected (27-40%). Substantial overlap exists between conditions (86-98% comorbidity). Physician burnout is associated with 2.72 times higher odds of self-reported errors (95% CI: 2.19-3.37), with each point increase in emotional exhaustion raising the error risk by 5-11%. Mechanisms include cognitive impairment (reduced executive function, g = -0.39; impaired working memory, g = -0.36) and sleep disturbance. Malpractice litigation compounds psychological harm, increasing depression and suicidal ideation. Conclusions: This review, synthesizing data from over 500,000 healthcare workers, demonstrates bidirectional relationships among burnout, PTSD, and medical errors with significant medico-legal ramifications. Addressing this crisis requires systemic interventions including workload management, psychological support, blame-free reporting cultures, and policy reforms balancing accountability with recognition of system-level contributors to error.

Background and Objectives: Chronic kidney disease (CKD) and maintenance hemodialysis (HD) are frequently associated with psychological distress and impaired health-related quality of life (HRQoL). However, the relationships between depressive, anxiety, and stress symptoms, clinical factors, and HRQoL remain insufficiently understood in routine care. This study aimed to assess the prevalence of psychological distress and to explore cross-sectional correlates of kidney disease-specific and generic HRQoL in Romanian patients receiving long-term HD, providing one of the first detailed characterizations of these relationships in an Eastern European maintenance HD cohort. Materials and Methods: This single-center cross-sectional study included 125 adult patients undergoing maintenance HD for at least one year. Baseline assessment comprised socioeconomic, demographic and clinical and paraclinical data, including Charlson Comorbidity Index (CCI), dialysis adequacy (spKt/V), cognitive function, psychological distress assessed with the Depression, Anxiety and Stress Scale (DASS-21R), and HRQoL evaluated using the Kidney Disease Quality of Life Short Form (KDQOL-SF™ 1.3). HRQoL domains and physical and mental component summary scores (PCS, MCS) were analyzed using descriptive statistics, correlation analyses, and multivariable linear regression. Follow-up assessments at approximately one year were summarized descriptively. Results: Disease-specific HRQoL revealed marked impairment in perceived disease burden and work status, while physical HRQoL was substantially reduced (PCS 36.5 ± 9.6). Mental HRQoL was relatively preserved (MCS 48.8 ± 8.8). At baseline, 48.0% of patients reported at least mild depressive symptoms, 34.4% anxiety symptoms, and 44.0% stress symptoms. spKt/V showed a modest association with PCS. Psychological distress demonstrated weak associations with HRQoL; stress was independently associated with lower MCS, with limited explained variance (R² ≤ 0.15). Conclusions: Psychological distress is common among Romanian HD patients and is cross-sectionally associated with markedly impaired physical HRQoL. While the present design does not allow causal inferences, these findings support the implementation of routine psychological screening and the consideration of targeted psychosocial interventions in HD care.

Suicidality is a significant and persistent public health concern, and people who are suicidal report negative experiences with clinical services. Peer-based interventions are a rapidly growing component of mental health care and suicide prevention. This scoping review's aim is to identify, summarise and synthesise the design, features and evidence for peer-led models and interventions for people experiencing emotional distress or suicidal crisis. This study followed the Joanna Briggs Institute scoping review guidelines. Online databases were searched in May 2022 and in October 2024. A total of 59 papers were identified. The scoping review provides an overview of key components of service models and interventions. In general, peer-led programs were widely accepted, with participants reporting positive improvements to mood, social connectedness, communication and coping skills. Despite the importance of training and supervision, a review of training content revealed a discordance between training and peer work principles in some cases. A concentration on facilitation of the service model or intervention rather than on the peer model itself meant there was limited information on the empirical and ethical arguments that supported the model of care. Future research is needed on peer-led models and how involvement and engagement of peers, consumers and carers can positively influence the planning, design, implementation and evaluation of new service models and interventions.

Background: Mental health literacy remains low in South Africa, particularly in nonurban settings. This study aims to determine the sociodemographic and geographic influences of mental health literacy among community health clinic attendees. Methods: This study used secondary data which adopted a cross-sectional study design and was conducted between November 2019 and January 2020. A total of 385 participants were recruited through convenience sampling, with approximately 77 individuals per clinic across five sites. A two-part questionnaire was used, where part A included demographic information and part B consisted of the three fictive clinical case studies which measured the participants' mental health literacy. The participants' responses regarding disorder recognition and perceived causes were analyzed via Pearson's chi-square tests. Using three fictive cases with clinical pictures indicative of mental depressive disorder, schizophrenia and general anxiety disorder, the following were assessed: (1) what type of illness do you think the person is suffering from, and (2) what do you think causes the persons' suffering? To identify predictors of recognition and perceived causes, hierarchical logistic regression was performed. Statistical significance was set at p < 0.05. All analyses were conducted via STATA version 18.1 (StataCorp, College Station, TX, USA). Results: The mean age of the study participants was 37.39 ± 11.14 years (range: 13-80). Factors such as geographic location, gender and level of education were significant predictors of recognition. Participants attending urban clinics were more likely to correctly identify correct mental disorders than those attending township clinics were [OR = 0.32; 95% CI: (0.11, 0.93); Wald χ2(1): 4.3681; p value = 0.036]. For correct causes, significant predictors included gender, education level, and geographic location. Urban clinic attendees were significantly more accurate at identifying the correct cause of mental disorders than township attendees [OR = 0.42; 95% CI: (0.21, 0.83); Wald χ2(1): 6.1504; p value = 0.013]. Conclusions: Mental health literacy in Tshwane community healthcare clinics reflects deep-rooted sociodemographic and geographic inequalities. Strengthening township clinic capacity, integrating culturally relevant health education, and prioritizing gender-sensitive outreach are essential to improve the recognition and understanding of mental disorders in underserved communities.

Urban public green spaces are widely recognized for having positive effects on mental health, yet existing research shows imbalances in subjects and methodologies. Most studies examine healthy adults and self-reported indicators, giving limited attention to vulnerable populations; this may have led to a gap in evidence regarding "who is represented and who is overlooked." This study systematically reviewed 235 empirical papers published in 2004-2024 following PRISMA 2020 to examine epistemic equity. The Equity Bias Framework was applied to operationalize epistemic equity by assessing imbalances in study design, psychometric measures, and population sampling. Results showed that the cross-sectional design, self-report, and community-dwelling adults combination accounted for the largest share (n = 99, 27.8%), whereas only 9 combinations in total (2.5%) involved clinical populations. The experimental design × self-report × university student patterns (n = 14, 3.9%) outnumber all experimental studies involving age-disadvantaged or clinical groups (n = 4, 1.1%). These patterns indicate that existing research evidence is shaped more by feasibility and accessibility than by representativeness and clinical relevance, raising concerns about epistemic equity. By introducing the Equity Bias Framework, this study provides a lens on current evidence and direction for research and policy promoting methodological diversity and sample inclusivity.