To quantify sociodemographic differences in the prevalence of diagnosed psoriasis and to evaluate temporal trends in its epidemiologic distribution.

Data from the 2003-2006 and 2009-2014 National Health and Nutrition Examination Survey and the 2023-2024 National Health Interview Survey were analyzed. Meta-analysis was performed to determine whether age, sex, race/ethnicity, interview language, marital status, BMI, education, income, and health insurance are independently associated with odds of diagnosed psoriasis. Estimates from each survey period were tested for linear trends over time.

The total sample included 53,225 participants. Spanish speakers, compared to English speakers, demonstrated markedly lower prevalence of diagnosed psoriasis (pooled aOR = 0.40, 95% CI = 0.25-0.65), even after adjusting for other sociodemographic factors including race/ethnicity. Other factors independently associated with psoriasis were older age, non-Hispanic White race/ethnicity, and higher BMI (all P < 0.001). No temporal trends in prevalence were found in any sociodemographic subgroup.

This analysis of national data covering an almost 25-year period indicates psoriasis has consistently been one of the most common inflammatory skin diseases with a stable sociodemographic distribution over this time. High rates of potentially undiagnosed psoriasis among vulnerable sociodemographic subgroups may be a persistent issue spanning over 2 decades. Patients with limited English proficiency may have difficulty interacting with the healthcare system, leading to undiagnosed psoriasis. Difficulty of diagnosis in patients with skin of color may also contribute. Given that psoriasis is a condition with systemic effects, including impacts on cardiovascular risk, accurate and timely diagnosis is essential to ensure appropriate clinical management.

Data on the efficacy and safety of sacubitril/valsartan in hemodialysis patients with heart failure and preserved left ventricular ejection fraction (≥ 50%, HFpEF) or mildly reduced left ventricular ejection fraction (41%-49%, HFmrEF) were analyzed, as well as cardiac functional parameters and safety after withdrawal of sacubitril/valsartan.

Ninety-eight maintenance hemodialysis patients with heart failure with preserved or mildly reduced ejection fraction were included in the present study. Patients were divided into sacubitril/valsartan and control groups according to whether they had been, or were being, treated with sacubitril/valsartan. Patients were further divided into continuation and discontinuation groups based on whether sacubitril/valsartan was discontinued at the end of follow-up. Laboratory examination results, echocardiographic parameters, and the occurrence of major adverse cardiac events were recorded and analyzed.

There were 50 patients in the control group and 48 in the sacubitril/valsartan group. The median follow-up time was 14.5 months. Compared with the control group, the serum B-type natriuretic peptide levels and echocardiographic parameters in the sacubitril/valsartan group significantly decreased from baseline at 6-month follow-up (p < 0.05). In the sacubitril/valsartan group, there were 28 patients in the continuation group and 20 in the discontinuation group. The reduction in left ventricular end-diastolic diameter in the sacubitril/valsartan group reversed in the discontinuation group (by 10%) after drug withdrawal, whereas it was stable in the continuation group (change 0.66%, p = 0.030). Patients with lower left ventricular end-diastolic diameters at the end follow-up (≤ 50 mm) exhibited a lower incidence of major adverse cardiac events compared to those with higher diameters (>50 mm; p = 0.012).

Sacubitril/valsartan improved cardiac function in patients on hemodialysis with heart failure and preserved or mildly reduced left ventricular ejection fraction. Long-term continuous use of sacubitril/valsartan may reduce left ventricular end-diastolic diameter and positively impact prognosis.

Vasodilator challenge during right heart catheterization (RHC), by improving right ventricular (RV) loading conditions, could provide an assessment of RV functional reserve. We hypothesized that a dynamic evaluation of RV function with sodium nitroprusside (NTP) infusion could enhance conventional risk stratification for post-left ventricular assist device (LVAD) early RV failure (RVF). We performed an observational retrospective multicenter study including consecutive LVAD recipients undergoing vasodilator challenge within 3 months from surgery. We evaluated the association of clinical, echocardiographic, and hemodynamic data at baseline and after NTP infusion with post-LVAD early RVF. Of 160 patients, RVF occurred in 58 (36.3%) and was associated with higher in-hospital mortality (32.8% vs. 3.9%, p < 0.001). Among baseline hemodynamics, pulmonary artery pulsatility index (PAPi) <2 was the single variable associated with RVF (p = 0.038). In a multivariable model adjusted for in-study outcome predictors, a blunted PAPi response to vasodilator challenge (PAPi increase <2.2) emerged as the strongest independent RVF predictor (odds ratio [OR] = 4.56, 95% confidence interval [CI] = 1.88-11.07, p = 0.001). Patients with a blunted PAPi response had an increased RVF risk both in the baseline PAPi <2 (61.9% vs. 12.5%, p = 0.022) and in the baseline PAPi ≥2 (40.2% vs. 17.5%, p = 0.004) groups. Vasodilator challenge, by unveiling RV functional reserve, could improve patient selection and optimization before LVAD implant.

Current diagnostic criteria for type 2 diabetes (T2D) capture disease heterogeneity poorly, and do not reliably predict progression, complications, or treatment response. The phenotypic clustering model proposed by Ahlqvist et al. identified five T2D subtypes using six clinical variables at diagnosis, each associated with distinct metabolic profiles and complication risks. Although this framework has been replicated in several cohorts, evidence in Mediterranean populations is lacking.

We conducted a prospective cohort study in Catalonia (Northeast Spain) including adults with newly diagnosed T2D recruited between March 2022 and January 2026. Using baseline data, we evaluated the Ahlqvist clustering approach. Autoantibody-positive individuals were classified as severe autoimmune diabetes (SAID), and sex-stratified k-means clustering (k = 4) was applied to autoantibody-negative participants. Cluster separation and stability were assessed using principal component analysis and silhouette analyses.

A final total number of 991 individuals with newly diagnosed T2D were included in the analysis. Autoantibodies were present in 67 subjects (6.8%), thereby being classified as SAID. Among the remaining 924 participants, sex-stratified k-means clustering (k = 4) identified clusters with metabolic profiles consistent with the classical subtypes: mild age-related diabetes (MARD, n = 326), severe insulin-resistant diabetes (SIRD, n = 241), mild obesity-related diabetes (MOD, n = 206), and severe insulin-deficient diabetes (SIDD, n = 151). However, cluster separation was modest, and bootstrap stability was limited (Jaccard 0.555-0.718). In an unconstrained analysis, apart from the autoimmune diabetes group, silhouette optimisation identified three clusters as the most internally optimal structure, corresponding broadly to obesity/insulin-resistant (C1, n = 347), insulin-deficient (C2, n = 186), and age-related (C3, n = 391) phenotypes. Stability was substantially higher for the three-cluster solution (Jaccard 0.799-0.863). Concordance between the Ahlqvist and data-driven models was moderate (ARI = 0.473), with MOD individuals distributed across the other clusters.

The Ahlqvist clustering architecture could be approximated in this Mediterranean cohort at diagnosis, but internal stability of the five-cluster solution was limited. In this population, a four-cluster structure showed substantially better internal validity. These findings support the feasibility of phenotypic subclassification of T2D while underscoring the importance of evaluating population-specific cluster structures and their clinical relevance in longitudinal studies.

NCT05333718.

As more children with autism enter adulthood, updated data on co-occurring conditions throughout the lifespan are needed. We examined mental, neurodevelopmental and neurological (MNN) conditions among people with and without autism overall and by demographics.

Using Medicaid claims data for beneficiaries aged ≥ 1 year enrolled during 2020, we identified autism and MNN diagnoses using ICD-10 codes. Adjusted prevalence ratios (aPRs) in beneficiaries with versus without autism were calculated using log-binomial models.

Among 993,965 beneficiaries with autism, attention-deficit-hyperactivity and conduct disorders (ADHD/CD, 30.5%), intellectual disabilities (ID, 20.4%), and anxiety disorders (19.3%) were most common. Prevalence of every condition except ADHD/CD increased with age and was higher in females. For most conditions, prevalence was lowest in American Indian/Alaska Native (AI/AN) and Hispanic individuals. Every condition except alcohol/drug use disorders was significantly more prevalent in those with autism; aPRs ranged from 1.8 (depression) to 21.2 (ID). APRs were higher in middle and older ages for neurodevelopmental conditions, in children and adolescents for mental and neurological conditions, and in women for neurodevelopmental and neurological conditions. AI/AN beneficiaries had the highest aPRs for nearly all conditions.

Among publicly-insured individuals, MNN conditions were more common in beneficiaries with than without autism across the lifespan, in both sexes and across racial/ethnic groups. Demographic variation may reflect underdiagnosis of autism in previous generations and females, respectively, and less access to mental health services in some racial/ethnic groups. Screening for ADHD and mental health disorders in youth and adults with autism may improve health outcomes. Screening for ADHD and mental health disorders in youth and adults with autism may improve health outcomes.

Disruptive behaviours of children with intellectual disabilities predispose mothers to mental and physical morbidities, leading to caregiving burnout, lower childcare quality, and poor child progress.

This cross-sectional study investigated the psychometrics of the Arabic version of the Generalised Anxiety Disorder 2-item scale (GAD-2) among 85 Saudi mothers of children with intellectual disabilities through latent variable model and receiver-operating characteristic curve analyses.

The unidimensional GAD-2 demonstrated good construct validity, invariance at the configural, metric, and scalar levels across age groups, and adequate convergent/divergent validity-It was negatively predicted by high mood and happiness and positively predicted by stress, and it mediated the effect of stress and happiness on depression. Its known-group validity was determined by elevated anxiety levels among mothers using psychotropic drugs. Two cut-offs (≥2.5 and ≥3.5) flagged the best trade-off between sensitivity and specificity for predicting low mood, poor sleep quality, nightmares, high stress, low general physical health, and willingness to join a psychological support program. The positive predictive value for the cut-off ≥3.5 was higher for all outcomes than that of the cut-off ≥2.5.

The GAD-2 is a valid and reliable tool, which at thresholds ≥3.5 can identify anxious mothers, aiding early diagnosis and intervention.

Physician workload in pediatric emergency departments (PEDs) is associated with patient safety, quality of care, and clinician well-being, but is commonly inferred from proxy measures such as visit volume, acuity, or throughput metrics that incompletely capture the contextual and cognitive demands of clinical care. The Standardized Workload Assessment Metric for Pediatric Emergency Departments (SWAMPED) was developed to quantify workload at the level of discrete clinical tasks. We derived workload estimates and evaluated the reliability, precision, and contextual responsiveness of SWAMPED.

We conducted a multicenter cross-sectional study of PED physicians at tertiary children's hospitals within the Pediatric Emergency Research Canada network. Participants independently scored 46 care components using the NASA Task Load Index, a validated multidimensional instrument that measures perceived workload associated with a specific task (in this case a clinical care component) accounting for six domains of effort (mental, physical, time, effort, performance, and frustration). Six extrinsic patient and systems-level modifiers were assessed for their impact on component-level workload. We assessed score distributions, interrater agreement using intraclass correlation coefficients (ICC), precision of component estimates, and extrinsic modifiers' effects using mixed-effects models.

Sixty-two physicians from 11 sites participated. Interrater agreement across care components was good (ICC: 0.69, 95% CI: 0.60-0.78). Mean workload scores varied across care components (range 22.1-99.5) with high precision (95% CI margin of error of 2.5-6.5 points; relative margin 5%-10%). Most components demonstrated increased workload in the presence of extrinsic modifiers, while intrinsic physician characteristics were not associated with significant differences in workload scores.

SWAMPED generated reliable and precise, task-specific workload estimates and demonstrated sensitivity to clinically relevant contextual modifiers. This approach enables quantitative assessment of physician workload at the task level and provides a foundation for future investigations linking workload to clinical outcomes, clinician performance, and health system planning.

Auditory hallucinations (AHs) are debilitating symptoms of schizophrenia spectrum disorders (SSDs) associated with several negative outcomes. AHs are often resistant to existing pharmacological and psychological interventions. Virtual reality (VR) has emerged as a promising intervention for AHs. This systematic review and meta-analysis aimed to assess the effectiveness of VR interventions in treating AHs in SSDs.

A comprehensive literature search was conducted on Embase, APA PsycINFO, and MEDLINE via the Ovid Database. Studies with a randomized controlled trial (RCT) or randomized cross-over trial design that had treatment and active or treatment-as-usual control conditions were included. Random-effects meta-analyses compared the change in the primary outcome of AH severity from baseline to post-treatment and at follow-up between the groups.

Eight studies (n = 1004) met the criteria for the meta-analyses. Eight studies used avatar therapy (AT), and 1 study used a VR-based mindfulness intervention. Random-effects meta-analyses found that VR interventions were more effective than the control conditions in reducing AH severity immediately post-intervention (Hedges' g = -0.41, 95% CI [-0.62, -0.20], P < .01) and at follow-up (Hedges' g = -0.28, 95% CI [-0.40, -0.17], P < .001).

This review was limited by a small sample size, study heterogeneity, and intervention homogeneity. Future research should prioritize larger RCTs of VR-based interventions for psychosis before VR can be reliably used in clinical settings. Overall, the results of this meta-analysis suggest that VR-based AT may be a promising avenue to improve AHs in SSDs.

A sex difference in the clinical presentation of schizophrenia is well known. Males have on average an earlier symptom onset, worse functional capacity, and more negative symptoms. Studies on the neurobiological correlates of psychosis show that brain endocannabinoid system (ECS) is dysregulated in male patients with first-episode psychosis (FEP). We now evaluated whether the brain ECS is also altered in female patients with FEP.

In this cross-sectional case-control study, brain CB1R availability was measured in 39 participants, including groups of male and female patients with FEP, and healthy control participants (HC) of similar age and sex (n = 8-11/group). Brain CB1R availability was measured with the selective CB1R radiotracer [18F]FMPEP-d2 and positron emission tomography. Arterial input derived distribution volumes (VT) were extracted from regions of interest (ROI) representing the anterior cingulate cortex, hippocampus, thalamus, and putamen.

Within-subjects analyses showed a regionally differential effect of ROI*sex*group (ε = 0.77; F(2.31,80.85) = 4.31, P = .013). Simple effect analyses indicates that male FEP had significantly lower overall CB1R VT when compared to male HC (F(1,17) = 15.64, pFWER = 0.018), while female FEP VT did not differ from female HC (F(1,18) = 0.12, pFWER = 1). A regionally specific difference of VT between males and females with FEP (F(3,48) = 3.43, P = .024) did not survive the correction for multiple comparisons (pFWER = 0.14).

The availability of brain CB1R is differentially altered in males and females with early psychosis. Sex-related neurobiological patterns including the ECS may offer new treatment strategies for alleviating the core symptoms of psychotic disorders in male and female patients.

Excess mortality in psychotic disorders is largely due to preventable cardiometabolic morbidity. Efforts to evaluate the link between the psychosis spectrum and cardiometabolic health have been confounded by early-life adversity (ELA) and biased sampling. This population-based study examined prospective associations between psychosis-spectrum status and cardiometabolic biomarkers at age 44-45, adjusting for ELA.

We analyzed data from the 2002/03 biomedical sweep of the British National Child Development Study (n = 9377; age 44-45). Psychosis-spectrum status (exposure; n = 171) was defined using repeated screening across adulthood (ages 23 to 44-45), including self-reported diagnoses, antipsychotic medication use, or professional help-seeking for hallucinations. Cardiometabolic biomarkers at age 44-45 (outcomes) were compared between individuals on the psychosis spectrum and psychosis-free controls (comparator; n = 2448). Analyses were conducted using unimputed and multiply imputed datasets (n = 7391-9298), adjusting for 24 indicators of ELA.

In both unimputed/imputed analyses, individuals on the psychosis spectrum had significantly worse cardiometabolic profiles. Adjusted results showed elevated abdominal obesity (exp(b), 1.404; 95% CI, 1.177-1.676; P < .001), higher glycated hemoglobin (B = 0.321; 95% CI, 0.089-0.553; P = .008), lower high-density lipoprotein cholesterol (B = -4.472; 95% CI, -7.782 to -1.162; P = .009), and increased fibrinogen (B = 4.542; 95% CI, 0.939-8.144; P = .015) compared to controls.

Overcoming early-life confounders and biases that limited prior research, our study demonstrates a robust, independent association between psychosis-spectrum status and cardiometabolic dysfunction at age 44-45. These findings underscore the urgent need for comprehensive screening, treatment, and monitoring of cardiometabolic morbidity in psychosis, guided by a life-course perspective.