Childhood trauma is a key risk factor for adolescent depression, often associated with elevated levels of impulsivity. The Frontopolar Cortex (FPC), critical for executive control and impulse regulation, may be linked to this relationship, but its mechanistic role has not yet been fully elucidated. We examined 54 drug-naïve adolescents with first-episode Major Depressive Disorder (MDD) and 43 Healthy Controls (HCs), assessing trauma via the Childhood Trauma Questionnaire, and impulsivity via the Barratt Impulsiveness Scale. Structural Magnetic Resonance Imaging (MRI) was used to measure FPC thickness. Compared to HCs, MDD patients reported higher levels of trauma and impulsivity, with trauma exposure showing some variation across high and low impulsivity subgroups. The high-impulsivity subgroup exhibited significant left FPC thinning. Mediation analyses suggested that left FPC thickness might be associated with the relationship between childhood trauma and impulsivity, indicating a potential trauma-brain-behavior relationship. These results suggest that the FPC is a neural region involved in early adversity and impulsivity in depression. Clinically, targeting FPC-related circuits may potentially help mitigate impulsive behaviors and improve emotion regulation. Future research should explore the developmental mechanisms by which childhood trauma reshapes brain structure and influences behavioral outcomes in adolescent depression.Clinical trial number Not applicable.

Since the emergence of the Chat Generative Pre-Trained Transformer (ChatGPT), artificial intelligence (AI) has change how medical information is accessed, processed, and utilized. However, its use in clinical environments, particularly in plastic surgery, poses ethical, medical, and safety challenges, especially when it is employed to generate aesthetic recommendations without appropriate professional supervision.

A descriptive analysis was conducted using standardized medical photographs of 20 female patients under 50 years of age from the author's clinical database. Frontal projection images (thorax and abdomen) were uploaded to the ChatGPT-4 platform with the prompt: "What physical changes do you suggest?" and subsequently evaluated by board-certified plastic surgeons. The objective was to compare AI-generated recommendations with those provided by human specialists and to analyze the risks associated with using algorithms to validate or reinforce aesthetic standards.

In 18 of the 20 patients (90%), the AI suggested at least one surgical procedure, most commonly mastopexy (55%), classic abdominoplasty (55%), and liposculpture (20%). Combined breast and abdominal procedures were recommended in 15 cases (75%), whereas only 2 patients (10%) were advised to maintain their current physical condition. Overall similarity between AI and human recommendations was low (mean Jaccard index 0.1-0.2), with wide interpatient variability. Additionally, AI tended to recommend an equal or greater number of procedures compared with surgeons (median - 1, p < 0.05).

Although artificial intelligence represents a promising tool in medicine, AI tends to over-recommend aesthetic procedures without considering the reason for consultation, timing, or patient comorbidities. Its indiscriminate use in the aesthetic domain may contribute to reinforcing distorted perceptions of body image. Lacking clinical judgment, empathy, and sociocultural context, the application of AI in plastic surgery must be carefully regulated and guided by ethical principles.

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Mobile health applications (MHAs) represent a promising low-threshold tool to support obesity treatment. While commercially available MHAs may be most accessible to potential users, concerns exist regarding their quality, data protection, and evidence base. Therefore, this study aimed to systematically identify and evaluate these aspects.

A systematic search was conducted in the Apple App Store and Google Play Store, identifying 1220 apps. After a two-stage screening process, n = 21 MHAs met the inclusion criteria and were evaluated independently by two raters using the German version of the Mobile App Rating Scale (MARS-G) with the five subscales Engagement, Functionality, Esthetics, Information, and Therapeutic Gain. Additionally, data on general characteristics (including information on the age group targeted and data protection and safety measures), inclusion of established treatment components, and evidence base, were collected.

None of the included MHAs explicitly targeted children or adolescents. Concerning privacy and safety, notable deficiencies were identified, particularly with regard to the absence of active confirmation of privacy policy and/or terms of service and a lack of integrated emergency features. Included MHAs demonstrated moderate overall quality (M = 3.31, SD = 0.50). The lowest ratings were observed on the subscales Information (M = 2.74, SD = 0.65) and Therapeutic Gain (M = 2.39, SD = 0.70). Inclusion of all components of evidence-based obesity treatment guidelines was found in only n = 5 MHAs (23.8%). Published evidence for effectiveness was identified for only n = 2 MHAs (9.5%).

The findings indicate a moderate quality level of commercially available MHAs for obesity treatment, with significant deficits in data protection and safety, content, therapeutic value, inclusion of established treatment components, and scientific evidence. To support safe and effective care for those affected by obesity, there is a need for further research and joint efforts (e.g., in terms of translation into routine practice).

With an ageing population comes a growing burden of age-related cognitive decline. While evidence supports a relationship between higher diet quality and better cognitive outcomes, the association between ultra-processed foods (UPFs) and cognitive function remains underexplored. We examined this association using prospective data from the ASPirin in Reducing Events in the Elderly (ASPREE) study, a cohort of Australian adults aged 70 years and older. Dietary intake was assessed via a mail-based diet screening questionnaire and categorised according to the Nova classification. Cognitive performance was assessed using the Controlled Oral Word Association Test (COWAT), Symbol Digit Modalities Test (SDMT), Hopkins Verbal Learning Test-Revised (HVLT-R), Modified Mini-Mental State Examination (3MS), and a composite cognitive Z score. Participants were stratified into high UPF (≥ 4 servings/day) and low UPF (< 4 servings/day). Marginal structural models with inverse probability of treatment weighting estimated associations, adjusting for demographic, lifestyle, and clinical confounders. Among 11,502 participants (3505 high UPF; 7997 low UPF), over a median follow-up of 5.6 (± 2.4) years, higher UPF consumption was associated with poorer performance on the 3MS (mean difference -0.28, 95% CI -0.52 to -0.04), COWAT (-0.23, 95% CI -0.44 to -0.03), SDMT (-0.51, 95% CI -0.94 to -0.08), and the composite Z score (-0.04, 95% CI -0.07 to -0.01), but not HVLT-R (-0.12, 95% CI -0.26 to 0.02). Higher UPF intake was associated with poorer cognitive performance across multiple domains. These findings support initiatives to reduce UPF exposure as a potential strategy to promote healthy cognitive ageing.

Cannabis Use Disorder (CUD) affects ~ 50 million individuals globally. CUD has been associated with adverse psychosocial outcomes, including affective flattening, apathy, and anhedonia, which prominent neuroscientific theories ascribe (in part) to altered integrity in brain reward pathways. Yet, emerging evidence from functional neuroimaging (fMRI) is mixed. We examined the activity in key regions-of-interest (ROIs) of the reward neurocircuitry in moderate-to-severe CUD vs. controls, and associations with cannabis use patterns in addition to Apathy Evaluation Scale scores. Brain reward function was examined in 57 people with moderate-to-severe CUD and 35 age and sex-matched controls using the Monetary Incentive Delay fMRI task. We compared brain function between groups, adjusting for age and sex, using exploratory whole-brain and hypothesis-driven ROI analyses in the ventral striatum, dorsal caudate, putamen, insula, cingulate, and orbitofrontal cortices. ROI analyses showed greater activity in the CUD vs. control group in bilateral insula and right putamen when receiving monetary wins vs. receiving neutral wins (i.e., outcomes with no monetary gain). The ROI analysis also showed greater activity in the CUD vs. controls in the right putamen when receiving monetary wins vs. receiving missed monetary wins. There were no other significant effects for the other ROIs, the whole-brain analyses, or brain-behaviour correlations. Overall, people with CUD showed altered activity in key brain reward regions during the receipt phase of rewards, compared to controls.

To investigate the association between weekend catch-up sleep (WCS) duration and depressive symptoms among young adults in China and the United States, and to explore potential associated factors. We conducted a binational cross-sectional study comprising 1,440 Chinese young adults (collected in 2024) and 892 US young adults (from NHANES 2021-2023). Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9 ≥ 10). WCS duration was categorized. Logistic regression, restricted cubic splines (RCS), and threshold effect models were employed to examine the relationship. Subgroup analyses were conducted by sex, education, and lifestyle factors. A U-shaped association was observed in both populations. Compared to no catch-up sleep (0 h), a WCS duration of 0-1 h was associated with significantly lower odds of depressive symptoms (China: Odds Ratios (OR) = 0.495, 95% Confidence Intervals (CI) 0.339-0.724; US: OR = 0.412, 95% CI 0.209-0.812). Restricted Cubic Spline (RCS) and threshold analyses confirmed this non-linear pattern, with inflection points at approximately 0.58 h (China) and 1.01 h (US). Subgroup analyses indicated the associations were modified by sex and alcohol drinking status. This study reveals a consistent U-shaped association between WCS and depressive symptoms among young adults in two distinct national populations. Moderate weekend catch-up sleep (around 0-1 h) may be associated with lower odds of depressive symptoms. These findings highlight the importance of balanced sleep patterns for mental health in young adults.

Late terminations of pregnancy (after 14 weeks of gestation) can present physicians and other healthcare professionals with complex medical and ethical challenges. In Germany, such terminations require a specific form of medical indication (a danger of grave impairment to the pregnant woman's physical or mental health). Despite these legal provisions, the decision-making process in individual cases often remains characterized by uncertainty, a lack of transparency and insufficient structural support.

This article offers recommendations for the development of institutional ethics guidelines that can support responsible, transparent, and legally sound decision-making in cases of requests for a late termination of pregnancy.

Based on existing recommendations and experience reports, and on the authors' own reflections, key challenges in decision-making are identified and practical guidance for shaping the decision-making process is derived.

Ethical guidelines can help reduce uncertainty, foster interdisciplinary and ethically informed decision-making, and thereby contribute to improving patient care. This requires the development of clear procedures, defined responsibilities, and transparent decision-making frameworks, as well as the promotion of thoughtful engagement with diverse professional perspectives and individual values. The development and implementation of clinical ethics guidelines can offer meaningful structural support for treatment teams in responsibly managing (cases of) late termination of pregnancy.

Identify the trends in research related to bibliometric analysis and investigate the bidirectional impact of mental health concerns and vocal health issues.

Systematic literature review following the Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 statement. Six computerized databases were searched independently by three authors through February 2025 using MESH terms. Bibliometric analysis was completed using VOSviewer software to analyze co-occurrence in key terms. We used the Quality Assessment Tool for Quantitative Studies to rate the methodological quality of each included publication.

In total, 181 records were retrieved. After removing duplicates, non-indexed manuscripts, and book chapters, 147 records were retained. Titles and abstracts were screened, and after applying the inclusion criteria, 49 publications were included for full-text review. After full-text screening, 20 manuscripts were retained for this systematic review. Among the included publications, 75% focused on school teachers, one on teachers, two on university teachers, and one on religious officials. The most common voice assessment tool was the Voice Handicap Index. Eleven publications reported anxiety as the mental health outcome, 50% reported stress, and 45% reported depression. Voice problems were often related to emotional factors. Teachers experiencing voice problems reported a lower quality of life, more stress, fatigue, and exhaustion, while those with an experienced or physiologic voice problem scored significantly lower on both physical and mental health scales compared to those without problems. Burnout syndrome was associated with the likelihood of having a voice disorder.

This review highlights the intricate and reciprocal relationship between vocal and mental health among occupational voice users and teachers in particular. The findings underscore the need for interdisciplinary approaches that address both physical and psychological dimensions of occupational health. By integrating preventive strategies, clinical screening, and workplace interventions, stakeholders can promote well-being and sustainability in the teaching profession.

Late-life depression (LLD) is a debilitating condition, characterized by mood disturbance and cognitive decline. Gamma-aminobutyric acidergic (GABAergic) deficits are a hallmark of both aging and depression; however, few studies have examined the GABAergic system in LLD. We hypothesized that there would be significant decrease in peripheral GABA levels and γ-aminobutyric acid type A (GABA-A) receptor subunit expression in individuals with LLD compared to healthy controls (HC). In this study, we measured plasma GABA levels and the mRNA expression of four GABA-A receptor subunits (GABRA1, GABRA4, GABRA5, and GABRR2) in peripheral blood mononuclear cells (PBMCs) from 87 older adults (LLD, n = 46; HC, n = 41). Plasma GABA levels were quantified using enzyme-linked immunosorbent assay (ELISA), and receptor subunit expression was assessed by quantitative-real time (RT-qPCR). There were no significant differences between LLD and HC in plasma GABA levels or GABA-A receptor subunit expression. In LLD, within-group analyses showed GABRA5, GABRR2, GABRA4, GABRA1 expression were negatively correlated with cognitive performance on the Montreal Cognitive Assessment MoCA scores (ρ = -0.464, p = 0.045, ρ = -0.515, p = 0.041; ρ = -0.414, p = 0.078, and ρ = -0.477, p = 0.062 respectively). This is the first study that investigated GABA-A receptor subunit expression in the periphery of individuals with LLD. Our findings suggest that altered peripheral GABA-A receptor subunit expression, even in the absence of between-group differences, is associated with reduced cognitive function in LLD.

Patients' understanding of pain mechanisms is recognized as a significant factor associated with clinical outcomes. However, relatively little research has explored the impact of patients' post-boosting baseline pain knowledge, beliefs and attitudes on subsequent treatment outcomes. Filling this gap could facilitate informed decision-making at an early stage of intervention.

This study aims to examine the relationship between baseline pain knowledge, beliefs and attitudes and clinical health outcomes, including kinesiophobia, following a multidisciplinary rehabilitation program. It was hypothesized that baseline understanding more aligned with contemporary scientific understanding would be associated with improved post-treatment health outcomes, even after controlling for initial health status.

A total of 330 participants with fibromyalgia were recruited from a Central Sensitivity Syndromes Specialized Unit. Pain knowledge was assessed using the PACKA questionnaire after a brief educational boosting intervention and prior to participation in a three-month multidisciplinary rehabilitation program including physical exercise, psychological intervention, and further pain education. Health-related variables were measured both before and after the intervention to analyze potential associations between post-boosting baseline pain knowledge and post-treatment health outcomes.

After controlling for baseline health outcome scores, higher post-boosting baseline pain knowledge was significantly associated with lower post-treatment kinesiophobia (β = -0.23, 95% CI -0.35 to -0.12, p < 0.001). No significant associations were observed between post-boosting baseline pain knowledge and post-treatment fibromyalgia impact, anxiety, depression, or physical functioning (although the association was positive but non-significant).

These findings partially support the initial hypothesis, indicating that higher levels of pain-related knowledge at treatment entry are associated with lower post-treatment kinesiophobia following the intervention, while accounting for initial health status, specifically for kinesiophobia.