Climate-related disasters can disrupt health-care delivery and treatment continuity. Evidence on their effects on opioid dispensing in middle-income countries remains scarce. We assessed whether the May 2024 floods were associated with changes in outpatient opioid dispensing in Rio Grande do Sul, Brazil.

We conducted a retrospective ecological time-series study using official Brazilian Ministry of Health data on codeine, morphine, and methadone dispensations from 2015 to 2025. Monthly rates per 10,000 inhabitants were modelled with quadratic secular and seasonal terms, month-specific effects from May 2024 to May 2025, and Newey-West standard errors. Analyses were stratified by opioid and age, applied to Minas Gerais as a comparison state, and repeated after excluding 2020-2021.

Among 131 states-months analysed, May 2024 was associated with an abrupt reduction of 68.86 dispensed units per 10,000 inhabitants relative to the counterfactual (95% CI -73.57 to -64.15; p < 0.001), followed by a smaller reduction in June (-14.81 per 10,000 inhabitants; 95% CI -21.12 to -8.51; p < 0.001). Females accounted for 63.6% of all dispensed units. From July to September, dispensing no longer differed significantly from expected levels, followed by an uneven recovery with intermittent above-expected increases. Disruption was most prolonged for morphine. The immediate decline remained after excluding the COVID-19 period.

The abrupt, transient decline suggests that the floods disrupted the health-care network and continuity of access to controlled medicines. Although aggregate dispensing recovered, this does not ensure that therapeutic continuity was fully restored for all patients. Disaster preparedness and response should therefore prioritise health-system resilience capable of preserving essential treatments during climate-related emergencies.

Fundação de Amparo à Pesquisa do Estado do Rio Grande do Sul (FAPERGS), Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), and Instituto Nacional de Ciência e Tecnologia em Saúde Mental Digital (INCT-SMD).

Pregabalin (PGB) is commonly used for postherpetic neuralgia (PHN), but its clinical effectiveness may be limited by insufficient pain relief or adverse events (AEs). Crisugabalin (CGB) is a novel α2δ-1 ligand that has demonstrated efficacy in randomized placebo-controlled trials. However, comparative real-world evidence for CGB and PGB remains limited.

This single-center retrospective cohort study included patients with PHN who completed at least 12 weeks of CGB or PGB monotherapy between January and June 2025. In October 2025, a single structured telephone interview was conducted to retrospectively assess patients' recalled status at treatment initiation (T0) and at Weeks 1, 4, and 12. Outcomes included the Numerical Rating Scale (NRS), Pittsburgh Sleep Quality Index (PSQI), and the physical and mental component summary scores of the 36-Item Short Form Health Survey (SF-36). Linear mixed effects models (LMMs) were designated as the primary analyses and adjusted for age, sex, pain location, pre-enrollment pain duration, hypertension, and diabetes. Repeated measures analysis of variance and the LMM analysis based on inverse probability weighting of propensity scores were performed as sensitivity analysis. Safety outcomes were descriptively assessed among treatment completers.

A total of 113 patients were included, including 56 in the CGB group and 57 in the PGB group. In the adjusted LMMs, significant treatment-by-time interactions were observed for NRS scores (p < 0.001), PSQI scores (p < 0.001), and SF-36 mental component summary scores (p = 0.003), the extent to which these three scores of the CGB group improved over time may be higher than that of the PGB group. The treatment-by-time interactions were not statistically significant for SF-36 physical component summary scores (p = 0.377). Sensitivity analyses using repeated measures analysis of variance produced concordant findings for NRS, PSQI, and SF-36 mental component scores but not for SF-36 physical component scores. At least one AE was reported by 11 of 56 patients in the CGB group and 18 of 57 patients in the PGB group, but there was no overall significant difference in AEs (p = 0.196).

Among patients who completed 12 weeks of treatment, the CGB group was associated with statistical differences to some extent in NRS, PSQI, and SF-36 mental component scores than PGB group, and these degree of improvement over time may be more pronounced. Due to the substantial bias in retrospective studies and the relatively small sample size, these findings should be interpreted as exploratory, merely have reference value, and require more confirmation in prospective controlled studies in the future.

Older adults with intellectual disability experience high levels of loneliness and social exclusion. MATILDA is a community-based intervention supporting participation in mainstream community groups through volunteer mentors.

To use Normalisation Process Theory (NPT) to explore the processes, mechanisms, and barriers influencing implementation and sustainability.

A qualitative study (focus groups and interviews with 29 adults with intellectual disability, volunteer mentors, intellectual disability staff, and community-group managers) across two UK sites. Data analysed using an NPT-informed framework.

Implementation was supported through sense-making, engagement, collective action, and appraisal. Key mechanisms included Volunteer Co-ordinators, mentor support, participant-group matching, adaptable community groups, and strong relationships. Community inclusion emerged as relational work. Staffing pressures, transport difficulties, and resource constraints limited participation for some individuals.

MATILDA shows potential as a sustainable community inclusion intervention. Successful implementation depends on programme components and the relational and organisational work needed to support participation and belonging.

ISRCTN, ISRCTN15294181. Registered 20th December 2022, https://doi.org/10.1186/ISRCTN15294181.

To explore how organisational support systems shape psychological safety and cultural adaptation among expatriate nurses working in Saudi Arabian hospitals.

Expatriate nurses make up a substantial share of the nursing workforce in Gulf health systems, and their integration is a recurring nurse management concern. Psychological safety, the shared belief that a team is safe for interpersonal risk-taking, is a plausible but underexamined organisational mechanism linking management practice to expatriate nurse adaptation, voice and retention.

Qualitative interview study with an interpretative phenomenological orientation, reported in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ). Seventeen expatriate nurses (Philippines n = 7, India n = 5, Pakistan n = 3 and Egypt n = 2) were purposively recruited from three hospitals in Riyadh, Saudi Arabia (two government and one private), and each took part in one semistructured interview (45-75 min). Analysis followed a hybrid inductive-deductive procedure: Each transcript was first analysed idiographically and inductively, cross-case patterns were then developed and only at that point were the patterns examined against Edmondson's four psychological safety dimensions.

Three themes were constructed, each represented across the whole sample. Safety-undermining workplace contexts comprised rigid hierarchies, implicit doubt about foreign credentials and unclear norms about how mistakes would be treated. Organisationally facilitated psychological safety was described in relation to formal mentorship, collegial assistance, hierarchical accessibility and explicit cultural competency work. Safety-enabled adaptation captured accounts in which perceived safety accompanied question-asking, experimentation, help-seeking and authentic cross-cultural engagement. Participants with access to structured mentorship (n = 8) described more consistent experiences of safety than those relying on informal or no support (n = 9); the design does not permit comparative or causal inference.

Participants described psychological safety as an organisational condition that managers can act on, rather than an incidental by-product of a pleasant workplace.

Nurse managers can treat psychological safety as something to be built and monitored: Train mentors, explicitly in safety-building behaviours, make access to nursing leadership routine rather than nominal and locate cultural competency in everyday ward practice rather than in one-off induction sessions.

Artificial intelligence (AI) is increasingly being incorporated into clinical nursing practice, but evidence remains limited on how nurses experience AI-supported systems and how decision-making orientation relates to missed nursing care (MNC).

To explore nurses' experiences with AI-supported clinical decision support (CDS) and examine associations among clinical decision-making orientation, professional characteristics, and MNC.

A convergent parallel mixed-methods study.

The study was conducted in six hospitals in Beni Suef Governorate, Egypt. The quantitative sample included 210 intensive care unit (ICU) nurses who completed the Nursing Decision-Making Instrument-Revised 2014 (NDMI-R) and the Missed Intensive Nursing Care Scale (MINCS). Fourteen nurses completed semistructured interviews, and all transcripts were included in the thematic analysis.

NDMI-R scores showed a small negative bivariate correlation with MNC (r = -0.178, p < 0.01), but the adjusted association was not statistically significant (β = -0.124, p = 0.063). The regression model explained 16.9% of the variance in MNC (adjusted R² = 14.5%). Years of experience (β = 0.198, p = 0.004) and bachelor's degree or above compared with a technical nursing diploma (β = -0.255, p < 0.001) were significant predictors. The other education contrast, AI training/support and MISSCARE Reasons were not statistically significant. In interviews, nurses described AI-related tools as potentially helpful for alerts, information review, workflow, and communication while also raising concerns about trust, overreliance, empathy, and training.

Nurses perceived potential benefits from AI-supported tools, but the quantitative findings did not establish an independent effect of AI or a statistically significant adjusted association between decision-making orientation and MNC. These findings support cautious, nurse-centered implementation and further longitudinal evaluation.

Managers should pair any AI-supported CDS implementation with role-specific training, clear accountability, usability monitoring, and safeguards that preserve clinical judgment and humanistic care.

This study aimed to comprehensively investigate the psychometric properties of the Montgomery-Åsberg Depression Rating Scale (MADRS) in a sample from Northeast Brazil.

Data were obtained from a cross-sectional study of 303 participants with depressive disorders assessed using the MINI 7.02, MADRS, GAD-7, and ASSIST 3.0. We evaluated reliability, construct validity, convergent and discriminant validity, and diagnostic accuracy.

Regarding reliability, the instrument demonstrated robust internal consistency, supported by strong Cronbach's alpha and McDonald's omega coefficients. In terms of construct validity, Exploratory Factor Analysis (EFA) indicated a single-factor solution, while the H-index supported a replicable latent structure. However, formal assessments of closeness to unidimensionality suggested that the scale is not strictly unidimensional. For convergent and discriminant validity, correlational analyses showed a moderate association with anxiety symptoms and weak associations with substance use measures, respectively. Regarding accuracy, ROC curve analysis indicated that a cutoff score of 9 is useful for screening, whereas 18 may better identify a depressive episode.

While the MADRS remains a valuable tool, structural refinements could further enhance its psychometric performance across distinct clinical settings.

Cognitive composites offer greater sensitivity to amyloid beta (Aβ)-related decline compared to individual tests for tracking longitudinal cognitive change. We developed and validated data-driven composites from the harmonized Alzheimer's Dementia Onset and Progression in International Cohorts (ADOPIC) study, addressing gaps in psychometric reporting and multi-cohort validation.

The study included 1964 cognitively unimpaired (CU) participants at baseline (longitudinal subset = 1110). Principal component analysis-derived domain-specific and general cognitive composites were evaluated for psychometric properties, sensitivity to Aβ-related decline, and mild cognitive impairment (MCI) progression prediction compared to the Alzheimer's Disease Cooperative Study - Preclinical Alzheimer's Cognitive Composite (ADCS-PACC).

Proposed composites demonstrated good to excellent psychometric properties and sensitivity to differentiating CU Aβ trajectories (p < 0.001). General cognition demonstrated longitudinal sensitivity comparable to the ADCS-PACC (d = -0.20) and equivalent classification performance (area under the receiver operating characteristic curve = 0.70). All composites significantly predicted MCI progression (p < 0.001).

The composites perform comparably to the ADCS-PACC, developed for CU with Aβ, in longitudinal sensitivity while providing comprehensive psychometric characterization and domain-specific measurement, supporting their utility as outcome measures in preclinical Alzheimer's disease studies.

Mental health disorders (MHDs) are prevalent among adolescents and young people living with HIV (AYPLHIV) and can adversely affect wellbeing, antiretroviral therapy adherence and engagement in care. We aimed to determine the prevalence of common MHDs and associated factors among AYPLHIV receiving routine HIV care in Lusaka, Zambia. We conducted a cross-sectional survey embedded within the AdoMinds mixed-methods implementation study. The study was conducted from September 2023 to May 2024 at Chipata Level 1 Hospital, Lusaka. All AYP aged 15-24 years enrolled in ART care during the study period were invited to participate. A trained research assistant administered a tablet-based questionnaire including validated screening tools for depression, anxiety, post-traumatic stress disorder and substance use. Logistic regression was used to determine factors associated with MHDs. We enrolled 416 AYPLHIV (71.4% of 583 registered in care); 268 (64.4%) were female and the median age was 20 years (IQR: 18, 23). Overall 71.4% (297/416) screened positive for at least one MHD. Depression was most prevalent at 67.1% (279/416), followed by anxiety at 35.3% (147/416). Having at least one MHD was associated with feeling stigmatised because of HIV (AOR = 1.99, 95% CI: 1.10-3.63, p = 0.024). There was borderline evidence that a history of smoking was associated with higher odds of having at least one MHD (AOR = 4.24, 95% CI: 0.98-18.30, p = 0.053). Compared with participants with both parents alive, having lost one parent (AOR = 0.46, 95% CI: 0.21-0.97, p = 0.042) or both parents (AOR = 0.38, 95% CI: 0.18-0.80, p = 0.010) was associated with lower odds of having an MHD. Common MHDs were highly prevalent among AYPLHIV receiving routine HIV care, with HIV-related stigma associated with higher odds of MHDs. Integrating mental health screening and referral pathways into adolescent HIV services may support earlier identification and care.

Mental health problems lead to the loss of about 12 billion workdays worldwide each year. This creates a major economic burden. In food manufacturing, workers often face various psychosocial stressors. These include high workload, time constraint, repetitive tasks, and low autonomy. These conditions can affect both mental health and work performance. Workplace mental health interventions have shown promising results in mental health improvement. However, most studies come from high-income countries and service sectors. There is still limited evidence from industrial settings in middle-income countries. To address this gap, a structured Worksite Mental Health Program (WMHP) was developed.

This study will employ a quasi-experimental two arm repeated measures design among workers from food manufacturing factories in Malaysia. The intervention group will receive an eight week WMHP including psychoeducation, mindfulness practices, progressive muscle relaxation, and breathing exercises. The comparison group will continue with routine workplace practices and receive a general mental health information pamphlet. Assessments will be carried out at baseline, one month post intervention, and at three months follow up. Primary outcomes include depression, anxiety, stress, and burnout. Secondary outcomes include job satisfaction, absenteeism, presenteeism, and economic outcomes. Changes over time will be analysed using Generalised Estimating Equations (GEE). A cost-benefit analysis (CBA) will also be conducted to assess economic impact.

The program is expected to improve mental health and work performance, while simultaneously reducing absenteeism and presenteeism. The economic evaluation is expected to demonstrate positive productivity gains associated with the program.

This study will provide evidence on the effectiveness and economic value of a workplace mental health intervention in an industrial setting, informing workplace health strategies in Malaysia and similar contexts.

Thai Clinical Trials Registry (TCTR): TCTR20241217003.

Amyloid-related imaging abnormalities (ARIA) are the most relevant adverse events associated with anti-amyloid therapies in Alzheimer's disease.

We report a case of progressive ARIA after discontinuation of lecanemab in a patient with early-onset Alzheimer's disease carrying the rare APOE ε2/ε4 genotype.

After two infusions, mild ARIA-edema (ARIA-E) and ARIA-hemorrhage (ARIA-H) were detected on routine MRI, prompting treatment interruption. Despite partial radiologic regression, follow-up MRI 8 weeks after discontinuation demonstrated marked progression with multifocal ARIA-H displaying as superficial siderosis, while the patient remained clinically asymptomatic. Corticosteroid treatment was initiated and lecanemab permanently discontinued.

This case highlights that severe ARIA may progress beyond active treatment exposure and emphasizes the importance of continued MRI surveillance even after therapy cessation. Furthermore, the APOE ε2/ε4 genotype may represent a distinct risk factor for cerebral amyloid angiopathy-related vascular fragility and hemorrhagic ARIA.