Dementia diagnosis in sub-Saharan Africa is constrained by limited access to specialist neuroimaging interpretation and reduced specificity of brief cognitive tools in low-literacy populations. We evaluated the agreement, incremental value, and comparative performance of Mini Mental State Exam (MMSE), visual MRI medial temporal atrophy (MTA), and automated brain morphometry in older Ugandan adults with suspected dementia.

In this cross-sectional study, adults aged ≥50 years with suspected dementia were recruited from neurology and psychiatry clinics at two hospitals and from a community cohort. Participants underwent MMSE and standardized 1.5T brain MRI. Visual MRI ratings were performed by radiologists blinded to clinical data, and automated morphometry was generated using NeuroQuant^® normative percentiles. Hippocampal occupancy (HOC <5th percentile) was used as a reference MRI biomarker for comparative classification. Agreement between visual and automated measures was assessed using Spearman correlation and intraclass correlation. Incremental value was assessed using regression models, and comparative performance using area under the curve (AUC).

Sixty-three participants were included (mean age 75.6 ± 8.7 years; 49 female). Agreement between visual ratings and automated morphometry was poor. MMSE correlated inversely with MTA (ρ = -0.47; p = 0.049) and correlated positively with hippocampal volume percentile (ρ = 0.46; p = 0.056). Adding hippocampal volume to MTA did not improve model fit for MMSE (ΔR² = 0.028; p = 0.18). For comparative classification, MMSE alone was sensitive but poorly specific, while the combined MMSE-MTA model improved specificity and discrimination (AUC 0.70 vs 0.62 for either measure alone).

Visual and automated MRI measures were not interchangeable in this heterogeneous cohort. Automated hippocampal volumetry added limited value beyond visual MTA for global cognition, while combining MMSE with visual MTA showed modest improvement in comparative classification and warrants further validation.

Postnatal common mental disorders (PCMDs) are the most common complications after childbirth and are associated with many adverse effects on infant growth and development. Undiagnosed and untreated PCMDs significantly affect the health and lives of the mother, their children, and families. Although PCMDs are a significant public health concern, evidence from Ethiopia is limited. This study aimed to assess PCMDs and their predictors among postnatal women in the Dabat HDSS, Northwestern Ethiopia.

A community-based cohort study involved 872 pregnant women, who were evaluated for common mental disorders during their second and third trimesters and again two to 8 weeks postpartum. Women with a self-reporting questionnaire-20 (SRQ-20) score of ≥6 were considered to have common mental disorders. A modified Poisson regression model was used to identify the independent predictors of pCMDs.

The prevalence and incidence of pCMDs were 16.05% (95% CI: 13.67, 18.74) and 14.02% (95% CI: 11.64, 16.79), respectively, with 3.83% of women exhibiting perinatal CMD during the study period. PCMDs are independently predicted by experiencing labor complications (IRR = 2.43, 95% CI: 1.69, 3.47), preterm birth (IRR = 1.72, 95% CI: 1.26, 2.35), antenatal CMD (IRR = 1.89, 95% CI: 1.37, 2.61), and a history of CMD before pregnancy (IRR = 2.29, 95% CI: 1.32, 3.98).

The observed incidence and prevalence of PCMDs in Ethiopia were lower than in previous studies. Common mental disorders before and during pregnancy, preterm birth, and the presence of labor complications increase the risk of pCMDs. Early detection and treatment of mental disorders before and during pregnancy, along with interventions to reduce preterm birth and labor complications, could decrease the incidence of postnatal mental disorders.

Generative artificial intelligence (AI) is reshaping the way clinicians record their clinical notes. AI-scribe systems leverage generative AI capabilities to transcribe clinical encounters into draft clinical notes. In this study, we assessed clinician uptake and estimated modelled documentation time savings for an AI-scribe system in an emergency department (ED).

ED physicians and trainees were provided access to an AI-scribe for 5 weeks. Data from the first week were excluded. The transcript of each presentation, the initial AI-generated clinical note and the final EMR clinical notes were used to calculate time to finalise AI-assisted notes.

Forty ED consultants and 23 trainees accessed the AI-scribe. Over the study period, nine consultants (22.5%) and 11 registrars (48%) used the system. The AI-scribe was used for 248 ED presentations, including 185 (74.6%) by trainees and 63 (25.4%) by consultants. The system generated 44,489 words. Following clinician review, 18,140 words were added and 2274 were deleted prior to submitting the final clinical notes. For a clinician with an average typing speed, use of the AI-scribe resulted in a time saving of 7.1 h of documentation. This was reduced to 4.9 h for rapid typer clinicians. Overall, the initial AI-generated notes were modified on 1143 occasions. The most frequently revised section was the history of presenting illness (23.3%) followed by the management plan (22.9%).

Uptake of AI-scribe was higher among trainees than consultants, and the platform achieved substantial time savings. Future studies are required to quantify real-time productivity gains over longer periods.

To determine whether extending home-based rehabilitation beyond the mother-only model to include fathers and siblings is associated with improved developmental outcomes in infants with neuro-developmental delay (NDD) and maternal wellbeing in an urban low-resource setting.

A prospective observational cohort study was conducted at two public neuro-developmental clinics in Bulawayo, Zimbabwe. Infants aged 3-6 months (N = 481) and their mothers were followed for 3 months across three naturally occurring caregiver participation groups: mother-only, mother-father and mother-father-sibling. Developmental outcomes were assessed using the Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III), and maternal wellbeing was measured using Global Quality of Life (QoL) and Mental Health Check-In Visual Analogue Scales. Group differences were analysed using ANCOVA, repeated-measures ANCOVA and multiple linear regression adjusting for baseline scores.

Infants in the mother-father-sibling group demonstrated significantly higher baseline-adjusted BSID-III cognitive scores at 3 months than the mother-only group (p < 0.05), with the largest effect observed in this group. Changes in language, motor, socioemotional, and adaptive domains followed the same direction but showed smaller and less consistent effects, with limited pairwise significance after adjustment. Maternal mental health improved significantly over time across groups, while QoL showed small but statistically significant gains only on repeated-measures analysis.

Involving fathers and siblings in home-based rehabilitation was associated with selective cognitive gains in infants and better maternal mental health over 3 months. These findings provide preliminary support for the integration of father- and sibling-inclusive, family-centred rehabilitation models for paediatric neurorehabilitation in similar low- and middle-income settings.

Continuity of care refers to the consistent and coordinated delivery of healthcare services over time. Continuity has been associated with improvements in morbidity and mortality, yet its decline has been identified as a significant concern amid increasing pressures in primary care.

This review aimed to inform current policy initiatives by synthesizing evidence on how continuity of care is measured, the current challenges faced and proposed future interventions in UK general practice.

We conducted a literature search for articles published before 15 February 2024, to explore continuity in UK primary care. Screening and data extraction followed PRISMA Scoping Review guidelines, with all studies undergoing double screening to determine eligibility.

A total of 180 papers were included (95 quantitative, 76 qualitative and 9 mixed-methods). Across the literature, continuity of care was most commonly conceptualized and measured as relational continuity, the Usual Provider of Care (UPC) Index was the most commonly used metric. Informational and managerial continuity were rarely assessed. Certain patient groups, including those with long-term conditions, mental health needs, and multimorbidity, were reported to place greater value on continuity of care. Higher relational continuity was associated with improved patient satisfaction, care coordination and reduced hospital admissions. However, sustaining continuity was frequently challenged by workforce pressures and fragmented information transfer. Although formal and informal interventions to enhance continuity were described, tensions between continuity and access persisted, and continuity was reported to vary across patient groups.

The decline in continuity of care has implications for patient experience and system outcomes. This review highlights the need for system-level approaches and national policy reforms to support continuity, while addressing workforce constraints, access pressures and unequal experiences of care. Further research is needed to evaluate the effectiveness and sustainability of continuity-enhancing interventions and to identify any potential unintended consequences.

Youth in low- and middle-income countries (LMICs) bear a disproportionate burden of mental health conditions, alongside low health-seeking behaviours and limited access to services. These gaps underscore the need for accessible strategies such as youth peer-based mental health programmes and supports (Y-PBMHPS).

To examine whether Y-PBMHPS can help address the mental health needs of LMIC youth.

We conducted a rapid review of peer-reviewed literature, searching Medline, PsycINFO, CINAHL, CAB Global Health, Science Citation Index and Social Sciences Citation Index for studies of Y-PBMHPS in LMICs published in English between 1 January 2002 and 19 September 2025. Two review authors performed title/abstract screening and full-text review. Study quality was assessed by one review author using Joanna Briggs Institute critical appraisal tools. The primary outcome was change in mental health status, expressed in standardised difference units.

Of 6105 unique records identified, 329 studies were reviewed in full and 34 were included. All studies were conducted in Asia or Africa; 17 were quantitative studies (including randomised controlled trials), 9 were qualitative studies and 8 used quantitative designs with qualitative findings. Y-PBMHPS included counselling, psychotherapy, psychoeducation and self-help groups, with peers acting as leaders, facilitators, educators or service providers. Quantitative studies most frequently assessed anxiety and depression, reporting negligible to moderate effects. Qualitative findings indicated good fidelity, adherence and acceptability, alongside some feasibility challenges.

Y-PBMHPS can broaden youth mental health support and services in LMICs. Clearer guidelines on peer selection, training and supervision and further research in other LMICs, including cost-effectiveness evaluations, would strengthen the evidence base.

Low retention of allied health professionals remains a major issue in regional, rural and remote areas of Australia. Professions in this catch-all label differ markedly in often fundamental ways. In most workforce research, however, low sample sizes often result in the combining of data from these diverse professions, potentially obscuring differences in employee retention. This study sought to assess employment retention patterns of public sector allied health professionals in regional, rural and remote regions of Southern Queensland, Australia, to determine retention time in location for various allied health professions, the impact of geographic location and other available demographic and employment covariates on risk of leaving location, and key exit times.

A retrospective quantitative longitudinal design used de-identified allied health employee records from two public health services from a 12-year observation period (January 2010 to December 2021). The critical time-based variable for survival analysis and Cox regression of employee retention was years employed in location, with profession and geographic remoteness of work location being primary covariates of interest.

Analysis of records from 1454 allied health employees revealed a median retention time of 1.27 years (95%CI 1.15-1.46). Those working as anaesthetic technicians (hazard ratio (HR) 0.45, 95%CI 0.26-0.77), in radiography/sonography/medical imaging (HR 0.59, 95%CI 0.45-0.77), pharmacy (HR 0.61, 95%CI 0.48-0.78), social work (HR 0.66, 95%CI 0.52-0.83), psychology/mental health (HR 0.68, 95%CI 0.55-0.86) and other allied health positions (HR 0.81, 95%CI 0.62-1.07) were less at risk of leaving location than the physiotherapist reference group. Speech pathologists (HR 0.86, 95%CI 0.66-1.11), occupational therapists (HR 0.83, 95%CI 0.68-1.03) and dieticians (HR 0.81, 95%CI 0.62-1.07) were at no greater risk. Those working in rural (HR 1.61, 95%CI 1.41-1.84) and remote (HR 2.16, 95%CI 1.80-2.61) communities exhibited higher risk of leaving their location than those working in the regional cities, with these risks emerging within 3-6 months after starting a position. Type of employment, age when starting employment, and starting pay grade also had small but significant influences on risk of leaving location.

Despite lower overall median retention time, possibly partly due to using a location-based, time-dependent variable, patterns observed in this study are largely consistent with previous research. Use of a location-based, time-dependent variable is advocated for future research - it most closely aligns with costs associated with replacing location-based positions, continuity of care and ultimately patient outcomes. The findings suggest prioritisation of interventions targeted towards allied health professions at highest risk of leaving location, and delivery of interventions in the first 12 months after starting employment in location. Cosgrave's Whole-of-Person Retention Improvement Framework is a potential framework for tailoring bespoke interventions to maximise allied health professional retention.

The 'eggs' in the allied health basket are indeed 'apples and oranges' when it comes to length of stay in location across different allied health professions and work locations. Employees in four professions (physiotherapy, speech pathology, occupational therapy and dietetics) are at enhanced retention risk when compared with other allied health professions, as are those working in rural and remote areas, particularly within 6 months of commencing a role in location. These findings have important implications as to where and when interventions targeting retention might be most effective.

ObjectiveTo examine the risks and benefits associated with tapering and ceasing antipsychotic medication after treatment for psychotic illness.MethodNarrative synthesis of major guidelines and meta-analyses, landmark trials and recent randomised controlled trials (RCTs).Results(1) Maintenance is consistently protective against relapse and associated harms in the first 1 to 2 years of illness. (2) Some evidence suggests long-term functional benefits from reduction in dose or medication discontinuation, but findings are inconsistent and of low certainty. (3) Relapse after abrupt cessation is common, often within 3 months, possibly due to dopaminergic super-sensitivity. (4) Hyperbolic tapering, with slow and progressively smaller dose reductions, may reduce withdrawal effects and relapse risk. Clinical features associated with safer tapering included sustained remission, insight, absence of substance use, strong social support and access to rapid review.ConclusionDeprescribing is not universally safe, but a structured, gradual and reversible approach is consistent with ethical and patient-centred treatment, and in a small proportion of patients is not followed by relapse. Clinicians should emphasise shared decision-making, hyperbolic tapering and robust relapse-prevention strategies.

Childhood material hardship, including insecurity in housing, utilities, food, and medical care, is a critical factor influencing cognitive functioning and mental health outcomes. However, past research on material hardship is limited by cross-sectional data and reliance on conventional behavioral measures of cognitive functioning that suffer from poor reliability and lack of specificity. To address these gaps, this study used a well-validated computational model of cognition to examine individuals' drift rate, which is hypothesized to be driven by the efficiency of evidence accumulation (EEA) for decision-relevant information, a key process that supports higher-order cognitive functioning. Here, we examined how material hardship during childhood was associated with adolescent drift rate, and whether drift rate was linked with attention difficulties. 187 adolescents recruited from the Future of Families and Child Wellbeing Study were included in the analyses. Adolescents exposed to greater material hardship showed lower drift rate, suggesting less effective processing. Growth curve modeling revealed that initial exposure to material hardship, but not changes across childhood, was associated with drift rate in adolescence. Lower drift rate was also associated with concurrent attentional problems and served as a significant indirect pathway linking material hardship to adolescent attention. This is the first longitudinal study that examined the associations among childhood material hardship exposure, adolescent drift rate, and attentional difficulties. Our results suggest that challenges to essential living conditions in childhood may impact cognitive processes underlying goal-directed behavior in adolescents. These findings highlight the application of computational models to reveal specific cognitive processes impacted by adversity. SUMMARY: Existing research on material hardship and cognitive functioning is limited by reliance on cross-sectional task-based performance, resulting in inconsistent findings. We applied the diffusion-decision model to decompose trial-wise performance into underlying cognitive processes, including drift rate, a key evidence accumulation process underlying goal-directed behavior. Greater cumulative childhood material hardship, beyond exposure to other adversity, is associated with lower drift rate, which is linked with greater attentional problems in adolescents. Findings were specific to drift rate, not average response time or accuracy, emphasizing the value of computational methods in capturing cognitive changes associated with material hardship.

The aim of this study was to analyze the supply, demand, and adequacy of psychiatrists serving adults (PSAs) in the United States.

The authors performed a cross-sectional analysis of full-time equivalent (FTE) PSAs, using the Health Workforce Simulation Model. Supply was defined as the number of FTE physicians, demand as the number of FTE physicians needed under status quo and improved access scenarios, and adequacy as supply over demand.

From 2024 to 2037, the national supply of PSAs was projected to decrease by 12.3% (p<0.001), whereas demand was projected to increase by 43.7% (p<0.001). As a result, PSA workforce adequacy was projected to decrease under status quo (from 70.2% to 42.8%, p<0.001) and improved access (from 49.3% to 29.3%, p<0.001) scenarios.

Critical PSA workforce shortages were identified, including states affected the most severely. Efforts in education and government are needed to improve PSA workforce adequacy.