Psychiatric involuntary hospitalization (IH) rates differ across the United States (U.S.), but few studies have investigated what physician characteristics influence the decision-making process for IH. This cross-sectional survey study used the Psychiatric Involuntary Hospitalization Decision-making (PIHD) instrument, a previously validated, vignette-based tool, to measure individual psychiatrists' likelihood to admit patients involuntarily and their confidence in IH decision-making. Psychiatrists and psychiatry trainees (N = 246) from eight pre-selected academic psychiatry departments across major U.S. regions completed an online survey that included the PIHD instrument and questions on physician demographics, clinical experience, attitudes and beliefs about patient care, and level of paternalism. Results indicated that demographic factors and years of experience were not associated with likelihood of admittance or physician confidence in decision-making. Likelihood of IH admittance was higher among participants in the Northeast and Southeast. Among attending physicians, likelihood of IH admittance was higher among those with inpatient experience and lower among those with experience in psychiatric emergency services. Likelihood of admittance was also positively correlated with higher levels of paternalism and physician beliefs that IH is beneficial. Among trainees, greater worries about patient safety were associated with higher likelihood of IH admittance. In the full sample, confidence in IH decision-making was highest in the Northeast, Southeast, and Southwest, and was positively correlated with emergency psychiatry experience. Confidence in IH decision-making was associated with paternalism, but only among attending physicians. This study is one of the first to identify individual factors that may influence psychiatrist decision-making around IH in the U.S.

This study evaluated the effectiveness of a combination technique for managing severe composite tibial and soft-tissue defects, without requiring complex soft-tissue procedures. A retrospective analysis was conducted on 33 patients with tibial and soft-tissue defects and Gustilo type IIIB open fractures treated between April 2017 and December 2023. The management protocol for all patients consisted of two stages. The first stage involved thorough debridement in the emergency department, removal of all free tibial bone fragments, and fixation with an external frame. The second stage involved Ilizarov bone transport, utilizing chess-shaped polymethyl methacrylate (PMMA) cement (thickness: approximately 1 cm) to fill the tibial bone defect. The PMMA was gradually removed until bone union was achieved. Bone union and soft-tissue healing were achieved in all patients, without the need for additional flap transplantation. The mean bone-union time was 7.5 ± 1.4 months, and the mean soft-tissue healing duration was 70.9 ± 24.1 days. The mean traction period was 105.3 ± 48.2 days, the mean external fixation time was 444.0 ± 137.2 days, and the mean external fixation index was 58.2 ± 23.1 days/cm. Using the Lower Extremity Functional Scale (LEFS) and 36-Item Short-Form Health Survey to evaluate functional scoring, the mean LEFS, physical health component, and mental health component scores were 59.8±13.9, 70.5±17.7, and 77.8±20.1, respectively. According to Paley's classification of complications, there were 14 problems, 6 obstacles, and no sequelae. The chess-shaped PMMA-Ilizarov technique effectively treated composite tibial and soft-tissue defects. This approach facilitated the gradual regeneration and repair of bone and soft-tissue defects, avoided the need for additional skin flap transplantation, and achieved satisfactory clinical results.

Aphasia increases the risk of mental health issues, yet psychological care for aphasia (APC) is not routinely available. Given the significant psychosocial impact, APC requires input from multiple disciplines and settings, and necessarily responds to a person's needs, which shift over time. As a complex intervention, it is important that service providers, users, and policymakers are involved in developing effective and contextual implementation strategies. In this study, the aim was to meaningfully engage people with aphasia and inter-disciplinary aphasia clinicians to create a shared vision of ideal APC and to identify context-specific implementation considerations in Ireland.

A series of interdisciplinary clinician research workshops and parallel aphasia Public and Patient Involvement (PPI) meetings were convened. Participatory Learning and Action (PLA) tools and techniques supported inclusive research spaces; and discussions were scaffolded by constructs from the implementation science framework, Normalisation Process Theory (NPT). PPI contributors inputted into planning the clinician workshops and reviewed and commented on the discussion summaries.

Key principles for APC and Ireland-specific implementation considerations were identified. These included the need for a unified vision, clear clinical roles and referral pathways, improved team structures and resources, clinician training, and active involvement of people with aphasia in APC design.

Through NPT and PLA informed workshops, people living with aphasia and clinicians generated ideas about how an interdisciplinary coordinated model of APC might be developed and implemented. The findings offer early guidance for developing coordinated, interdisciplinary APC in Ireland. The participatory implementation approach may be adapted to other conditions or contexts to support locally relevant intervention planning.

Caregivers of young children in low-resource urban settings face multiple stressors, which can affect their mental health. There is limited population-based evidence on the prevalence and correlates of depression and anxiety among caregivers of young children in these contexts. This study assessed the prevalence and associated factors of depressive and anxiety symptoms among caregivers of young children in Nairobi City County. We conducted a cross-sectional household survey with 2,903 primary caregivers of children 0-3 years. Depressive and anxiety symptoms were assessed using validated Swahili versions of the Patient Health Questionnaire-9 and the Generalised Anxiety Disorder-7, respectively, with a cut-off score of ≥10 indicating clinically relevant symptoms. Random intercept logistic regression models were fitted to assess the factors associated with depressive and anxiety symptoms while accounting for clustering within Nairobi City County's sub-counties. Approximately 13.8% of caregivers had depressive symptoms, and 8.0% had anxiety symptoms. Stronger paternal involvement in childcare and parenting responsibilities was associated with lower odds of depressive and anxiety symptoms (adjusted odds ratio (aOR)=0.95 and aOR=0.93, both P < 0.001). Factors associated with higher odds of depressive and anxiety symptoms were pregnancy-related complications (depression: aOR=2.36, P < 0.001; anxiety: aOR=1.61, P = 0.003), and moderate household food insecurity relative to a food secure status (depression: aOR=3.67; anxiety: aOR=4.59; both P < 0.001). Higher wealth status was associated with lower odds of depressive and anxiety symptoms. A child's history of hospital admission was additionally associated with higher odds of depressive symptoms (aOR=1.56, P = 0.018), while tertiary level education was associated with lower odds (aOR=0.65, P = 0.049). The noted prevalence of depressive and anxiety symptoms among caregivers in low-resource urban settings elucidates the need to integrate mental health services into the existing maternal and child health programmes in Kenya.

Oral squamous cell carcinoma (OSCC) is an aggressive malignancy that influences patient prognosis and quality of life. Identifying appropriate prognostic indicators may help improve clinical decision-making. This study aimed to evaluate the association of preoperative serum hepatocyte growth factor (HGF) and inflammatory prognostic score (IBPS) with postoperative pathological outcomes in patients with OSCC. A total of 158 subjects were enrolled in this retrospective study (2020-2022), including 79 cases in the A group (healthy control group) and 79 cases in the B group (OSCC group). Serum HGF and inflammatory markers were measured, and IBPS was calculated. Comparative analyses were performed between the A and B groups, and prognostic analyses were conducted within the B-group cohort. Logistic regression was used to examine associated factors, while survival and receiver operating characteristic (ROC) analyses were performed to assess prognostic performance. Baseline characteristics were comparable between the two groups (P > 0.05). HGF levels and IBPS were significantly higher in the B group than in the A group (P < 0.05). In the B group cohort, elevated HGF and IBPS were associated with poorer prognosis (HGF OR = 2.010, 95% CI: 1.046-3.863; IBPS OR = 2.603, 95% CI: 1.316-5.148, P < 0.05) and adverse postoperative pathological outcomes. The combination of HGF and IBPS showed improved discriminative capacity for prognostic prediction (AUC = 0.776, P < 0.001). Preoperative HGF and IBPS are abnormal in OSCC patients and are associated with postoperative pathological outcomes after 20-month follow-up. These observations may support further investigations into preoperative risk stratification and clinical monitoring for patients with OSCC.

The risk of cognitive decline and dementia following cardiovascular disease (CVD) events is well recognized. However, it remains unclear whether cognitive changes observed after such events reflect a process that begins prior to the event itself.

To compare the cognitive trajectories of older adults preceding an incident CVD event with those of a matched control group without an event.

Data for this nested case-control study were obtained from a prospective cohort of older, community-dwelling individuals (aged ≥65 years) in Australia and the US with no history of CVD at the time of study enrollment in the Aspirin in Reducing Events in the Elderly (ASPREE) randomized clinical trial and the extension (ASPREE-XT) observational study. The ASPREE trial was conducted between March 2010 and December 2014, with follow-up to June 2017. The ongoing ASPREE-XT trial continued annual follow-up; this study reports data through December 2022. Case patients with an adjudicated CVD event, including fatal coronary heart disease (CHD), nonfatal myocardial infarction (MI), fatal or nonfatal stroke, and hospitalization for heart failure (HHF), were matched by age, sex, and educational attainment to control participants without a CVD event. Data were analyzed from June to December 2024.

Cognitive function as assessed by the Modified Mini-Mental State Examination, the Hopkins Verbal Learning Test-Revised, the Symbol Digit Modalities Test, and the Controlled Oral Word Association Test.

Linear mixed-effects models were used to estimate the trajectories of cognitive function among case patients with a CVD event and control participants.

Over 11 years, 1934 CVD events occurred among 19 114 participants. In this analysis, 1887 of 1934 case patients (97.6%) with adjudicated CVD events were matched to 7548 control participants (N = 9435; overall median age, 75.7 years [IQR, 72.4-80.0 years]; 4970 males [52.7%]). Individuals with incident CVD events had lower cognitive function, starting at between 3 and 8 years before the event, compared with those without CVD. Faster declines in global cognition (β, -0.19 [95% CI, -0.33 to -0.06]), episodic memory (β, -0.04 [-0.11 to -0.03]), processing speed (β, -0.28 [95% CI, -0.48 to -0.07]), and verbal fluency (β, -0.15 [95% CI, -0.27 to -0.04]) in the years prior to the CVD event were also observed compared with control participants. Composite global cognition (β, -0.11 [95% CI, -0.17 to -0.06]) and executive function scores (β, -0.07 [95% CI, -0.11 to -0.03]), but not memory, also declined faster. Similar cognitive trajectories were observed for fatal CHD, stroke, and HHF; however, this pattern was not observed for nonfatal MI, in which case patients and control participants showed comparable trends.

In this case-control study of community-dwelling older adults, deterioration in cognitive function was prominent prior to CVD events, suggesting that this decline may be associated with subsequent CVD events. These findings may help inform future research aimed at understanding the association between cognitive change and CVD.

Early detection of Alzheimer disease and related dementias (ADRD) may influence outcomes for both patients and their family members, yet the risks and benefits of screening for family members are not established.

To evaluate the benefits and risks of ADRD screening for family members of older adults screened in primary care (PC).

This multisite randomized clinical trial was conducted in 29 PC clinics from October 2018 to September 2023. Dyads of patients aged 65 years and older and a family member were randomized into 1 of 3 groups: screening only, screening plus referral for diagnostic follow-up, and no-screening control. Data were collected at baseline and at 6, 12, 18, and 24 months.

Cognitive screening was conducted in-person, by telephone, or secure video using the Mini-Cog, the Memory Impairment Screen Telephone version (MIS-T), or the MIS-T with the clock drawing test.

The primary outcome was family member health-related quality of life at 24 months measured using the Short Form Health Survey (SF-36) physical and mental component summary scores. Secondary outcomes included family member depressive and anxiety symptoms, caregiver preparedness, and caregiving self-efficacy, as well as patient health-related quality of life and depressive and anxiety symptoms.

A total of 1808 dyads completed baseline assessments. Mean (SD) patient age was 73.7 (5.7) years and 959 (53%) were female. Among family members, 1171 (64.8%) were spouses, 1224 (67.7%) were female, and mean [SD] age was 64.2 [12.9] years. Overall, 62 patients (5.1%) screened positive for cognitive impairment. Among dyads assigned to screen plus, 10 (35.7%) did not pursue diagnostic follow-up. There were no significant differences between the combined screening groups and no-screening group in SF-36 physical (24-month predicted difference, -0.21; 95% CI, -1.26-0.85) or mental (24-month predicted difference, 0.58; 95% CI, -0.18-1.33) component scores. No differences were observed in patient secondary outcomes at 24 months.

This randomized clinical trial found that ADRD screening in PC was not associated with improvement in family member health-related quality of life, caregiver preparedness, or caregiving self-efficacy. Screening was also not associated with increased family member depression or anxiety. Low rates of positive screening and high rates of refusal for follow-up diagnostic assessment may help explain these findings.

ClinicalTrials.gov Identifier: NCT03300180.

Animal use in preclinical research is facing growing scientific, ethical and political scrutiny in Europe. Researchers are increasingly required to justify in vivo studies and are urged to replace them with New Approach Methodologies (NAMs), even where these are not yet fit for purpose. In response to this pressure, members of the COST Action CA20135 "Improving biomedical research by automated behaviour monitoring in the animal home-cage" (TEATIME) held a Strategic Foresight Workshop in March 2025 to examine the future of animal research in Europe. The resulting scenarios reveal risks of over-regulation, outsourcing animal experiments to countries with weaker standards, and erosion of research quality, but also highlight opportunities to combine validated NAMs with high-quality in vivo work under robust ethical oversight. This short communication summarises the workshop's main insights and argues for evidence-based, transparent and internationally aligned regulation that protects both animal welfare and the scientific value of preclinical research.

The burden of noncommunicable diseases (NCDs) is increasing among people living with HIV (PLHIV) in Ethiopia; however, evidence on NCD prevalence among those receiving antiretroviral therapy (ART) is limited. This study assessed the magnitude of NCDs and associated factors among adult PLHIV attending ART clinics in general hospitals of Sidama Region, Ethiopia. We conducted a hospital-based cross-sectional study, involving 422 PLHIV selected through systematic random sampling. Data were collected using Kobo Toolbox and analyzed with SPSS version 26. Logistic regression identified factors associated with NCDs. The magnitude of NCDs was 24.8% (95% CI: 20.6%, 28.9%). The most common conditions included hypertension (7%), diabetes (5.7%), cardiovascular diseases (4.8%), cancers (4%), and chronic respiratory diseases (3.3%). Older age, urban residence, opportunistic infections, overweight/obesity, and abnormal waist circumference were significantly associated factors. NCDs are common among adult PLHIV in the region, necessitating integrated ART and NCD screening.