Rural communities face persistent health disparities and ongoing healthcare workforce shortages, especially in nursing. Despite national attention on strengthening the rural nursing pipeline, little synthesis exists on how rural health is integrated into nursing curricula. This narrative review provides an overview of the current landscape of rural health content within Bachelor of Science in Nursing (BSN) programs in the United States.

A comprehensive search of peer-reviewed and institutional sources was conducted using CINAHL, PubMed, ERIC, Scopus, and the Commission on Collegiate Nursing Education (CCNE) database. U.S.-based BSN programs with explicit rural health training or learning components were included. Data were extracted and synthesized using a narrative approach to identify recurring themes and institutional variations.

Sixty-three nursing programs met our inclusion criteria; however, many had various courses or initiatives for a total of 93 courses/initiatives. The majority of courses/initiatives were community-focused (n = 59), followed by underserved communities (n = 37). Few BSN programs had explicit rural health content (n = 20) that incorporated rural-specific courses or structured clinical experiences addressing rural practice.

Rural health remains underrepresented in BSN curricula. Findings underscore the need for systematic integration of rural concepts through coursework, simulation, and partnerships with rural healthcare facilities to strengthen the rural nursing workforce.

Criteria used by healthcare practitioners (HCPs) to set goals and assess when treatment was successful, met its goals, and/or should be ended has not been studied for men seeking treatment of premature ejaculation (PE). This study describes HCPs' priorities regarding treatment goals, assessment of success, and decisions to end treatment for men with PE, and examined whether HCP characteristics influenced these decisions. Overall, 240 medical and mental health professionals completed an online or in-person survey on treatment objectives and termination criteria in PE care. Results indicated that, according to HCP reports, patients' primary treatment goal was increased ejaculation latency, whereas HCPs themselves most strongly prioritized reducing distress and improving coping. For ejaculation latency, 44.7% of HCPs defined success according to the client's preferred level. Beyond latency, reduced stress and improved coping received the highest success rating, and 76.9% of HCPs reported moderate-to-high success in treating men with PE. Treatment termination was most often linked to increased sexual satisfaction and reduced distress. Professional training, identity, and PE treatment experience influenced goals, success assessment, and termination decisions. PE treatment requires explicit shared decision-making to align clinicians' biopsychosocial priorities with patients' symptom-specific expectations.

Killing in war is associated with multiple adverse outcomes, including posttraumatic stress disorder (PTSD), moral injury (MI), and suicide. Impact of killing (IOK) is an individual psychotherapy developed to treat the mental health impact of killing in war.

To determine whether IOK improves veterans' mental health symptoms and functioning at posttreatment and 6-month follow-up.

This multisite, superiority, randomized clinical trial was conducted from August 2018 to November 2023. Participants were veterans randomized to IOK or present-centered therapy (PCT). Diagnostic assessments were administered at screening and posttreatment by blinded evaluators. Self-report measures were collected at baseline, midtreatment, posttreatment, and 6-month follow-up at 3 Veterans Affairs health care systems in California, New York, and North Carolina via in-person and remote appointments. Participants were a sample of veterans with PTSD who reported distress related to killing in war or feeling responsible for the death of others. Primary exclusion criteria were a psychotic disorder diagnosis, moderate or severe alcohol or substance use disorder, untreated mania, or recent suicidal or homicidal behavior.

IOK, an individual psychotherapy that focuses on killing cognitions, acceptance, self-forgiveness, and moral repair, and PCT, which addresses current functional issues due to moral distress with related problem-solving.

The primary outcomes were psychosocial functioning assessed by the World Health Organization Quality of Life Scale-Brief (WHOQOL-BREF) and the Sheehan Disability Scale (SDS). Secondary outcomes included PTSD and MI measures.

A total of 100 individuals (98 male; mean [SD] age, 48.4 [13.7] years) were randomized. Linear mixed models revealed that psychosocial functioning improved for both groups at posttreatment (WHOQOL-BREF and SDS) and the IOK group had a significantly greater improvement than those in PCT on the SDS (-3.50; z score, -2.42; Cohen d, -0.51; P = .02; 95% CI, -5.65 to -0.59). There was no significant difference between treatments on the WHOQOL-BREF at posttreatment. Compared to PCT participants, IOK participants also reported significantly greater improvement in PTSD and MI symptoms.

Individuals in both treatments improved on measures of psychosocial functioning (WHOQOL-BREF and SDS). Those who received IOK evidenced greater improvements in work or school, social life, and home or family life (as measured by the SDS) compared to those in PCT at posttreatment. IOK participants also reported improved PTSD and MI symptoms. The findings suggest that IOK may improve several outcomes for those who experience distress due to killing in war.

ClinicalTrials.gov Identifier: NCT03764033.

Psychiatric diagnosis, prognosis, and management currently rely on subjective assessments. There is hope that peripheral (eg, blood) biomarkers or combinations thereof could transform clinical care by bringing objectivity and patient stratification while being accessible and scalable. The time is ripe to find molecular biomarkers: omics technologies can now profile hundreds to millions of molecules across thousands of individuals, while funders recognize the clinical need and have responded with ambition. However, this enthusiasm will likely be finite, and there is no guarantee that a biomarker will be found.

It is essential to design and perform studies that are most likely to deliver robust peripheral biomarkers with a clear path to translation. This narrative review provides recommendations to optimize peripheral psychiatric biomarker study design. The review first introduces conceptual grounding illustrating how biomarker study design must triangulate clinical utility, technological fit, and biological plausibility. Biomarker studies should optimize for signal-to-noise ratio via careful phenotype selection and minimization of biological and technical noise. However, feasibility issues-in collecting sufficient data on enough representative participants for an adequately powered and clinically translatable analysis-constrain study design.

Study design is the single most influential and controllable factor for future psychiatric biomarker discovery. This is because many years elapse between study design and data analysis (particularly for biobanked samples held for future use) and because no technological or analytical advances can answer questions that the dataset was not designed for, or overcome unmeasured confounding. Moreover, the direction of biomarker research is constrained by what is possible to design. Many clinical questions and contexts need biomarkers, but realistically, some are better primed for biomarker discovery than others. In this generation of peripheral psychiatric biomarker studies, designs most likely to demonstrate proof-of-principle should be prioritized to ensure the long-term sustainability of the field.

Lifestyle habits, cognitive reserve, and affective reserve (secure attachment, extraversion, psychological resilience) predict resilience in the oldest-old, though the underlying biological mechanisms remain unclear. This study explored relationships between these protective factors, 120 + NULISA CNS blood biomarkers, and multidimensional health outcomes (global cognition, mental health, walking speed) in 401 dementia-free participants (age 83-87) from the InveCe.Ab study. Using sparse partial least squares (sPLS) regression, eight biomarkers were stably associated with the protective factors: HBA1, DDC, IFNG, IL15, GOT1, ACHE, SNAP25, and SNCB. Structural equation modeling (SEM) showed that the three protective factors exerted an independent and domain-specific effect on health outcomes. Moreover, lifestyle habits were associated with ACHE (β = 0.26), IL15 (β = 0.22), and GOT1 (β = 0.28); affective reserve showed inverse associations with IFNG (β = -0.13) and IL15 (β = -0.31), and GOT1 (β = -0.18). Regarding health domains, SNAP25 was inversely related to global cognition (β = -0.10), while SNCB was associated with global cognition (β = 0.16) and walking speed (β = 0.13). Notably, no significant mediated effects were found, suggesting that the clinical benefits observed were not directly driven by the aforementioned biological pathways. The present study paves the way for further investigations on the biological mechanisms underlying resilient aging, while further demonstrating the key protective role of individual habits and psychosocial characteristics during the life course.

To explore how neonatal nurses in Level III (high-acuity) neonatal intensive care units recognise, interpret, and escalate early signs of clinical deterioration.

A qualitative interpretive description study underpinned by critical realism.

Twenty-two registered nurses were purposively recruited from four Level III units in the Jouf Region of northern Saudi Arabia using criterion-based maximum-variation sampling. Semi-structured interviews were conducted in Arabic or English and analysed in their original language. Situation awareness and invisible work scholarship served as sensitising lenses. Rigour was supported through member reflection, negative-case analysis, peer debriefing and an audit trail.

Four interrelated themes were identified: (1) 'the infant tells you before the monitor does', reflecting recognition of subtle deviation from the infant's baseline; (2) 'building the case', in which nurses tested and assembled evidence to make concern clinically credible before escalation; (3) 'the escalation calculus', describing how anticipated physician responses, hierarchy and previous dismissal shaped escalation and (4) 'the unit works against you', showing how alarm burden, documentation demands and staffing variability constrained vigilance. Recognition and escalation formed a cyclical, organisationally situated process rather than a single response to abnormal observations.

Escalation involved interpretive, relational and legitimising work before early concern became actionable. Participants' accounts suggest that timely response depends on clinical expertise and environments that protect bedside attention and legitimise early escalation.

Neonatal services should protect surveillance capacity through staffing and workload design, alarm reduction, simulation of ambiguous deterioration and constructive escalation feedback.

The study identifies case-building as a distinct stage between noticing deterioration and escalating concern and indicates how organisational conditions may constrain early nursing surveillance.

Consolidated Criteria for Reporting Qualitative Research.

Patients and the public were not involved.

Individuals with autosomal dominant frontotemporal dementia (FTD) exhibit considerable variability in disease onset and progression. Both modifiable and non-modifiable factors-such as sex, educational attainment or geographic region of residence-may contribute to this heterogeneity, potentially through their influence on cognitive reserve. The aim of the present study was to investigate the role of cognitive reserve modulators within the Genetic Frontotemporal dementia Initiative (GENFI) cohort. To this end, we used functional MRI (i.e. spatial chronnectome measures) and neurodegenerative markers (i.e. plasma neurofilament light chains levels) to determine disease stage using a Discriminative Event-Based Model (DEBM). We then examined how potential modulators influence the relationship between disease stage and cognitive performance. We analysed a total of 711 participants, including 106 patients with genetic FTD, 325 presymptomatic mutation carriers and 280 non-carriers healthy controls. Female participants showed a weaker association between disease stage and cognitive performance compared to males (P < 0.001), with difference becoming progressively more pronounced across symptomatic stages. Educational attainment exhibited a similar effect: individuals with higher education demonstrated an attenuated association compared to those with secondary or primary schooling (P < 0.001), with differences already detectable at prodromal disease stages. The effect of geographical region of residence was associated with education levels, but appeared to have an indirect and less strong influence. In summary, sex and educational attainment significantly affect the development and maintenance of cognitive reserve in individuals with genetic FTD. These findings underscore the importance of identifying disease-modifying interventions since the presymptomatic stages of the disease.

Schizophrenia imposes significant economic and social burdens, often resulting in prolonged inpatient length of stay (LOS), particularly for treatment-resistant cases. This study aimed to identify clinical, demographic, and social factors associated with prolonged LOS in a Canadian tertiary schizophrenia inpatient unit to highlight modifiable drivers and inform targeted interventions.

A retrospective chart review of 120 consecutive discharges from January 2021 to May 2023 was conducted. Data on demographics, clinical history, and discharge delays were analyzed using ANOVA and t-tests to identify factors associated with prolonged LOS. Prolonged LOS was examined while differentiating between discharge delays and extended hospital stays.

The mean LOS was 200.43 days (SD = 285.67, median = 100 days). Fifty percent of patients (n = 60) experienced discharge delays, defined as >10 days between readiness and actual discharge. Housing instability was the leading cause (56.67%, n = 34), including patients seeking housing (40%) or awaiting long-term care (16.67%). Longer illness duration (p = 0.048) and treatment-resistant schizophrenia (TRS, indicated by clozapine use; p = 0.011) were significantly associated with length of delayed discharge. Sex, relationship status, and family or community support were not significantly associated with length of delayed discharge. Illness complexity/severity was the primary reason for extended hospital stay in all cases (100%, n = 12).

This exploratory study highlights distinct clinical and system-level contributors to prolonged hospitalization. Housing instability, chronic illness, and TRS are key contributors to delays in discharge. Early discharge planning, enhanced housing support, and specialized TRS care pathways are essential to reduce LOS and optimize inpatient care.

Reliable data on population-level need for rehabilitation services and assistive products (AP) across different settings are lacking. The Functional Needs Assessment Tool (FNAT) is a new survey method for estimating the prevalence of functional difficulties/impairment and the need for services and AP. It combines self-report, clinical impairment and functional assessments across seven domains: vision, hearing, mobility, communication, cognition, self-care, and mental health. Data are collected using a bespoke mobile application and web-based platform. The FNAT methodology is presented in the first paper in this series.

The FNAT was pilot-tested in Kalungu District, Uganda, between March and July 2023 to assess the feasibility of the methodology and the functionality of the mobile data collection application.

Two pilot studies were conducted across 18 communities/villages, including 305 (pilot 1) and 550 (pilot 2) participants aged 2 years and older. Participants were identified using a two-stage cluster sampling method and underwent assessments using standardised tools to evaluate functional difficulties/impairments and the need for services and AP.

The pilot studies identified several key learnings, such as the need for questionnaire revisions and improvements to the application programming. It confirmed the feasibility of completing the two-stage assessments over 2 days with a cluster size of 45 participants (participants aged 2 years and older) while including visual acuity screening for all participants.

The FNAT is a feasible approach for estimating the prevalence of functional difficulties and the need for and coverage of related services and AP, with lessons learned for future development, and should be tested at scale. The field-test study is presented in the final paper in this series.