Illness identity refers to the degree to which a severe health condition is integrated into a person's sense of identity. Patients with congenital heart disease (CHD) vary in how they relate their CHD to their identity, which has implications for mental health, quality of life, and perceived health. This study explored inter-country variation in illness identity, and examined associations with patient characteristics and patient-reported outcomes in a large, international sample.

This study utilized data from the APPROACH-IS-II project which included 8415 patients from 32 countries (collected between 2019 and 2022). Patients completed questionnaires on patient characteristics (i.e., age, sex, marital status, employment, education, ethnicity, NYHA class, and CHD complexity), illness identity, and patient-reported outcomes (i.e., depressive symptoms, anxiety, quality of life, self-perceived [mental and physical] health). National culture was included using Hofstede's cultural dimensions. Data were analyzed using multivariable generalized linear mixed models.

Inter-country variation was observed in the illness identity dimensions. Patient characteristics (i.e., sex, age, marital status, employment, education, NYHA class, and CHD complexity) and national culture were related to differences in how patients related their CHD to their identity. Acceptance and enrichment were related to better well-being, quality of life, and self-perceived health, while engulfment and rejection were associated with worse patient-reported outcomes.

Personal and contextual factors were associated with differences in the illness identity dimensions. Moreover, the present study substantiated the unique value of illness identity dimensions in explaining individual differences in well-being, quality of life, and self-perceived health in this population.

The continuous emergence of structurally diverse indazole-based synthetic cannabinoids (SCs) challenges routine analytical detection because parent compounds are rapidly metabolized and often absent in urine. Therefore, sensitive metabolite-targeted analytical methods are required for reliable exposure assessment. In this study, we adapted and fully validated a targeted high-resolution LC-HRMS method for the quantitative determination of eight contemporary indazole-based SC markers in human urine and applied it to 50 authentic urine specimens from treatment-seeking individuals attending an addiction treatment clinic. The method allowed the identification of robust analytical performance, with LOD and LOQ values of 0.01-0.46 ng/mL and 0.04-1.53 ng/mL, respectively, along with acceptable recovery (81.54-111.72%), bias (-4.47-13.17%), precision (RSD 5.12-15.03%), and matrix effects (75.92-100.03%). All target analytes were stable for one week at room temperature, 4 °C, and -20 °C, and no significant carryover was observed. In this treatment-seeking cohort, 76% of samples were positive for at least one SC marker, with eight markers identified across MDMB-PINACA, MDMB-BINACA, and ADB-BUTINACA analogs. MDMB-4en-PINACA butanoic acid was the dominant biomarker (62%), followed by MDMB-INACA 3,3-dimethylbutanoic acid (42%), for which this study provides the first validated quantitative urine data. Other markers were detected at lower frequencies, and frequent co-detection indicates widespread polydrug SC use. The validated high-resolution LC-HRMS method enables reliable metabolite-based assessment of exposure to emerging SCs in authentic urine samples. The predominance of MDMB-type metabolites demonstrates the applicability of the method for monitoring current trends in SC exposure, while the quantitative characterization of MDMB-INACA 3,3-dimethylbutanoic acid expands the available analytical data for newly emerging SCs. This analytical platform provides a robust tool for forensic and clinical toxicology laboratories to monitor SC exposure in rapidly evolving drug markets.

Intrinsic capacity (IC), the composite of physical and mental capacities, underpins the WHO Integrated Care for Older People (ICOPE) program. IC may be measured as a brief screen, a comprehensive assessment, or a latent factor score; whether the simpler measures retain the prognostic information of the complex ones remains untested within a single population.

In the nationwide Korean Frailty and Aging Cohort Study, 3011 community-dwelling adults aged 70-84 years (mean age, 76.0 [SD, 3.9] years; 52.5% women) were assessed for frailty and for activities of daily living (ADL) and instrumental ADL (IADL) disability and followed for mortality (median, 8.0 years). IC was measured by a Korean ICOPE screening score (K-ICOPE), a comprehensive clinical score (CIC), and a bifactor latent score (LIC); differences in discrimination were tested formally.

Discrimination for frailty rose with measurement intensity (area under the curve, 0.82, 0.86, 0.90; all pairwise P < .001) but not for ADL or IADL disability (all P ≥ .25). There were 500 deaths. Adjusted for sociodemographics and multimorbidity, each 1-SD higher IC was associated with lower mortality (hazard ratio 0.83 [95% CI, 0.75-0.91], 0.71 [0.64-0.78], 0.65 [0.58-0.73]), with closely similar discrimination (C statistic, 0.723, 0.731, 0.736; largest difference, 0.013 [0.005-0.021]). Discrimination from IC alone was lower and similar across measures (0.583, 0.604, 0.585).

Measurement intensity improved the characterization of frailty but added little to the ranking of long-term mortality risk. Because K-ICOPE was aligned by construction to the latent structure, these findings support the potential feasibility of brief ICOPE-style screening rather than validating the WHO instrument.

Impaired sustained attention is common in patients with obstructive sleep apnea (OSA), but the influencing factors are unclear. OSA patients with high Arousal threshold (ArTH) often experience severer hypoxia, possibly worsening sustained attention.

To determine the association between ArTH and sustained attention in OSA.

OSA was defined as apnea-hypopnea index (AHI) ≥5 events/hour in polysomnography. ArTH was scored using three criteria (1 point each): 1) AHI<30 events/hour, 2) minimum peripheral oxygen saturation >82.5%, and 3) hypopnea proportion >58.3%. High and low ArTH was defined as 0-1 and ≥2 points respectively. Sustained attention was evaluated by Psychomotor Vigilance Task (PVT). Impaired sustained attention manifested as higher lapse probability, slower mean 1/reaction time (RT), slower slowest 10% 1/RT, and slower fastest 10% 1/RT.

We included 97 OSA patients, with 59 high and 38 low ArTH patients. High ArTH group exhibited higher lapse probability (15.08±3.12 vs. 4.72±1.61%, p=0.004), lower slowest 10% 1/RT (1.76±0.09 vs. 2.06±0.07 s^-1, p=0.009), mean 1/RT (2.77±0.09 vs. 3.05±0.05 s^-1, p=0.008), fastest 10% 1/RT (3.64±0.10 vs. 3.86±0.06 s^-1, p=0.068) with adjustment of age, gender, and overweight. These results remained similar after additionally adjusting education levels and percentages of non-rapid eye movement sleep stage 3. Linear trends were observed between lower ArTH scores and higher lapse probability (p-for-trend=0.015), lower slowest 10% 1/RT (p-for-trend=0.009), mean 1/RT (p-for-trend=0.010) and fastest 10% 1/RT (p-for-trend=0.092).

High ArTH may be associated with impaired sustained attention in OSA patients. Assessing ArTH may help identify OSA patients at high risk for attention impairment.

Astrocytic dysfunction has been implicated in schizophrenia, but biomarkers of astrocytic activity have shown inconsistent patterns. Studies on disease heterogeneity, specifically treatment-resistant schizophrenia (TRS) and ultra-treatment-resistant schizophrenia (UTRS) are lacking. In this study, plasma glial fibrillary acidic protein (GFAP) was measured using an ultrasensitive Simoa assay in 174 participants (58 controls, 35 first-degree relatives, and 81 patients with TRS, according to Treatment Response and Resistance in Psychosis (TRRIP) criteria. A further n = 35 fulfilled TRRIP criteria for UTRS. Data included symptom severity, cognition, and functioning assessments. Cortical thickness was measured with magnetic resonance imaging (MRI). Associations between GFAP and demographic, clinical, cognitive, and imaging variables were examined using regression models adjusted for age, sex, and BMI. Plasma GFAP concentrations did not differ between controls and TRS or UTRS participants. GFAP showed no associations with symptom severity, cognition, functioning, or cortical thickness. Duration of illness showed a significant interaction with UTRS diagnosis associated to higher GFAP levels (b = 3.67, 95% CI 1.62-5.72, p < 0.001), while individuals with TRS showed the opposite pattern. The axonal marker neurofilament light chain (NfL), showed a positive relationship with disease duration in both disease categories. The results suggest that plasma GFAP does not act as diagnostic or severity marker in schizophrenia, but can highlight astroglial-related processes where UTRS and TRS show different trajectories.

Mental health interventions have increasingly shifted beyond symptom reduction toward strengthening psychological resources that support adaptive functioning and well-being. Emotional intelligence (EI), encompassing competencies related to emotional awareness, understanding, regulation, and interpersonal functioning, represents a potentially modifiable target for promoting mental health. However, existing evidence remains fragmented regarding the EI domains targeted, intervention characteristics, and effectiveness across symptom-based and positive psychological outcomes.

This systematic review and meta-analysis synthesized evidence on EI-based interventions by (a) mapping targeted EI competencies and intervention characteristics, (b) examining their effects on symptom-based and positive psychological indicators of mental health, and (c) exploring participant, intervention, and methodological factors associated with variability in outcomes.

Thirty-two studies evaluating EI-based interventions among adults were included. Narrative synthesis examined study characteristics, EI domains, theoretical frameworks, and intervention techniques. Random-effects meta-analyses were conducted using study-level composite effect sizes to account for within-study dependence. Risk of bias was assessed using Cochrane RoB 2 and ROBINS-I tools, with sensitivity and moderator analyses performed to examine robustness and sources of heterogeneity.

EI-based interventions most frequently targeted stress management, emotion regulation, and emotional awareness, predominantly through experiential and skills-based approaches. Meta-analysis of controlled studies demonstrated significant improvements in overall mental health outcomes (g = 0.65), including symptom-based indicators (g = 0.55) and positive psychological indicators (g = 0.90). Considerable heterogeneity was observed, however, the explored moderators remained insignificant. In a sensitivity analysis excluding studies at high risk of bias, the pooled effect remained statistically significant, although substantial heterogeneity persisted.

EI-based interventions show promise as preventive and promotive approaches for mental health by strengthening emotional competencies relevant to both distress reduction and positive functioning. Future research requires theoretically explicit, mechanism-focused, and methodologically rigorous trials to establish active components and long-term effectiveness.

BackgroundGender-transformative, whole-family, and mental health interventions offer a promising approach to support the well-being of populations in humanitarian settings, but their effectiveness hinges on contextual adaptation to local gender norms, family structures, and displacement-related stressors.ObjectivesThis paper presents the application of a four-phase Human-Centered Design (HCD) process to adapt the Sibling Support for Adolescent Girls in Emergencies (SSAGE) program for forcibly displaced Venezuelan and Colombian returnee families in Cartagena, Colombia.DesignWe employed a participatory, multi-phase adaptation design grounded in HCD principles, integrating qualitative inquiry, co-analysis, piloting, and expert validation to iteratively refine the intervention.MethodsThrough iterative phases of participatory research, thematic co-analysis, piloting with target participants, and expert validation, the team systematically adapted SSAGE's eligibility criteria, curriculum delivery, and curriculum content. Adolescents, caregivers, community stakeholders, and local experts contributed to identifying context-specific needs and informing program modifications.ResultsKey content adaptations addressed local conceptions of gender roles, identity, sexual and reproductive health, mental health, and family dynamics. The HCD process also informed practical modifications-such as age-stratified sessions and trauma-sensitive facilitation protocols-to improve cultural fit and participant engagement.ConclusionThis adaptation underscores the importance of tailoring gender-transformative programming to complex family structures and evolving social norms in displacement settings. The approach offers a replicable model for intervention adaptation in similar contexts and lays the foundation for a Hybrid Type-1 effectiveness-implementation trial of SSAGE in Colombia.

South Africa has mounted the largest HIV prevention and treatment programme in history, delivering substantial gains in survival and prevention of new HIV infections; however, service disruptions and recent funding losses might jeopardise these successes. There is a scarcity of high-quality, population-based empirical evidence on key epidemic metrics needed to accurately gauge recent progress towards epidemic control in South Africa. We aimed to evaluate recent progress towards HIV epidemic control in South Africa by quantifying long-term trends in key epidemic control metrics in a large population-based cohort in rural KwaZulu-Natal, South Africa.

In this population-based, longitudinal cohort study, we used prospectively collected HIV testing, sociodemographic, behavioural, and population viral load data from the Africa Health Research Institute (AHRI) health and demographic surveillance system in rural KwaZulu-Natal from 2003 to 2025. Population-based HIV surveys (encompassing individual health interview and HIV testing) take place annually in all consenting resident individuals aged 15 years or older. We used Poisson regression models to quantify trends in directly observed HIV incidence in repeat testers (aged 15-54 years) who had initially tested negative for HIV and subsequently received at least one valid HIV test result. We further analysed 11 rounds of population viral load testing conducted between 2011 and 2025. We used generalised estimating equations to quantify population viral suppression metrics and calculated trends in the incidence-to-prevalence ratio, a key metric for evaluating progress towards epidemic control.

Between June 24, 2003, and May 22, 2025, across the population cohort, 59 806 (65·4%) of 91 367 contacted individuals aged 15-54 years consented to participate at least once in population-based HIV testing. Of those tested, 33 754 (56·4%) were female and 26 052 (43·6%) were male, with a median age of 26·7 years (IQR 19·3-39·1) at testing date. Among 42 662 participants who initially tested HIV negative and were recontacted, 29 702 (69·6%) underwent repeat HIV testing and were included in the incidence analysis. In this group, over 182 112 person-years of observation, we observed 4852 HIV seroconversions. From 2013 to 2018, overall annual HIV incidence rates declined by 52·2% in males and 36·9% in females. We found no evidence of a continued downward trend in HIV incidence between 2019 and 2025 among either females or males. After a period of substantial decline (from 2011 to 2018), population detectable viraemia increased significantly from 2019 to 2025 by 9·6 percentage points (95% CI 5·4-13·8), remaining an estimated 30·7 percentage points (95% CI 27·2-34·3) below the UNAIDS 95-95-95 population viral suppression target. The incidence-to-prevalence ratio decreased substantially across consecutive survey rounds, from 0·132 (95% CI 0·114-0·152) in 2006 to its lowest recorded value of 0·034 (95% CI 0·028-0·042) in 2022, representing an overall 74·2% decline. After 2022, the ratio stagnated above the epidemic control benchmark of 0·03.

These epidemic metrics show that progress towards HIV epidemic control is faltering in KwaZulu-Natal, South Africa. The tools to reverse this trajectory are available; the challenge now is to ensure their sustained and effective implementation through coordinated action across research, policy, government, civil society, and international funding partners. We can, and we should, change course now if we want to achieve an AIDS-free generation in South Africa and the world.

National Institute of Mental Health and Wellcome Trust.

Oral health is a fundamental but neglected component of public health, with important consequences for nutrition, communication, dignity, quality of life, and noncommunicable disease (NCD) prevention. In Somalia, oral health remains poorly integrated into health policy and service delivery within a context shaped by health-system fragility, displacement, humanitarian pressures, and limited workforce capacity. This perspective synthesizes available Somalia-specific evidence alongside modeled national estimates and relevant regional evidence to examine the burden, determinants, access barriers, and policy gaps surrounding oral health. It identifies major knowledge gaps, particularly the absence of comprehensive nationally representative oral health surveillance and limited evidence among rural, displaced, and other underserved populations. The article's contribution is to distinguish documented Somali evidence from regional inference while situating oral health within the country's broader universal health coverage, NCD, and humanitarian priorities. Strengthening surveillance, integrating essential oral health services into primary and humanitarian care, expanding preventive programs, and improving workforce and policy capacity are necessary to reduce avoidable oral disease and inequity in Somalia.

Diabetes mellitus markedly increases atherosclerotic cardiovascular risk, and coronary artery disease remains a leading cause of morbidity and mortality. Silent myocardial ischemia (SMI) is clinically relevant in diabetes because autonomic dysfunction and altered pain perception may attenuate typical ischemic symptoms; however, the clinical benefit of routine screening in asymptomatic individuals without known coronary artery disease (CAD) remains uncertain.

To evaluate whether systematic screening for silent myocardial ischemia or occult CAD in asymptomatic adults with diabetes and no known CAD improves major cardiovascular outcomes.

We performed a systematic review of studies published from January 1, 2000 through March 31, 2025. The primary effectiveness synthesis included randomized trials comparing systematic screening with no systematic screening or usual care. Primary outcomes were major adverse cardiovascular events (MACE), cardiovascular mortality, and all-cause mortality; secondary outcomes included detection yield, downstream testing or revascularization, and reported screening-related harms. Compatible study-level hazard ratios (HRs) and risk ratios (RRs) were synthesized on the log scale using random-effects inverse-variance meta-analysis, with heterogeneity and sensitivity analyses prespecified. The review was not prospectively registered.

Five RCTs (n = 3315; DIAD, DYNAMIT, FACTOR-64, DADDY-D, and the pilot trial by Faglia et al.) met the eligibility criteria. Screening did not significantly reduce major cardiovascular outcomes in the four trials included in the quantitative synthesis (pooled HR/RR 0.76; 95% CI 0.48-1.19). DYNAMIT was synthesized narratively because its published primary composite was not directly harmonizable with the pooled endpoint. Reporting of false-positive results and procedure-related harms was incomplete and heterogeneous.

In asymptomatic adults with diabetes and no known CAD, routine screening detects occult ischemia or atherosclerosis but has not demonstrated a reduction in MACE or mortality compared with the trial-era usual-care or protocol-defined medical-management strategies studied. These findings do not support routine population-wide screening; selective testing is most defensible when the result is expected to change management.