Daily sedation interruption (DSI) aims to limit drug accumulation and promote a more awake state, thereby reducing the duration of mechanical ventilation and its associated complications. This is an update of a Cochrane review first published in 2014.

To assess the effects of DSI versus sedation management without DSI on the duration of invasive mechanical ventilation, mortality, intensive care unit (ICU) length of stay, adverse events related to under- or oversedation (including accidental removal of endotracheal tube and tracheostomy), total doses of sedative and analgesic drug administered, and health-related quality of life, for critically ill people requiring intravenous sedation.

We used CENTRAL, MEDLINE All, Embase Classic+Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science Core Collection, and two trial registers, together with reference checking, citation searching, and contact with study authors to identify the studies included in the review. The latest search date was 8 October 2025.

We included randomised controlled trials (RCTs) comparing DSI with sedation strategies that did not include DSI (protocolised sedation, non-protocolised usual care (clinician discretion), or analgesia first/no sedation) in mechanically ventilated, critically ill people (adults and infants or children under 18 years of age).

Our critical outcomes were duration of mechanical ventilation (from randomisation to successful extubation or death), mortality, and ICU length of stay (LOS). Our important outcomes included hospital LOS, adverse events related to under- or oversedation (e.g. accidental removal of endotracheal tube or other lines or catheters, tracheostomy, new onset of delirium occurrence, use of physical restraint, and cardiac events), total drug doses, and health-related quality of life (HRQoL).

We used the original Cochrane tool, RoB 1, to assess bias in the RCTs.

We synthesised results for each outcome using meta-analysis (random-effects modelling). We conducted subgroup and sensitivity analyses according to pre-defined criteria. We used GRADE to assess the certainty of evidence.

This update included 23 trials (one cluster-randomised trial; 18 RCTs in adults, five in children) with 5987 (4910 adjusted) participants (3238 adults, 2750 (1673 adjusted) children). Nine trials used a sedation protocol comparator, nine used 'usual sedation practices' with sedative and analgesic drugs at the clinical team's discretion, and five used analgesia-first or no-sedation comparators.

Daily sedation interruption may reduce the duration of mechanical ventilation compared with sedation strategies that do not include DSI (mean difference (MD) -0.15 log days, 95% confidence interval (CI) -0.29 to -0.01; I² = 88%; 18 studies, 3815 participants; low-certainty evidence). These data translate to a relative reduction of 14% (95% CI 1% to 25%). Daily sedation interruption probably reduces mortality compared with sedation strategies that do not include DSI (relative risk (RR) 0.88, 95% CI 0.77 to 0.99; I² = 0%; 18 studies, 4057 participants; 725 events; moderate-certainty evidence). Daily sedation interruption probably reduces ICU LOS (MD -0.12 log days, 95% CI -0.22 to -0.02; I² = 72%; 18 studies, 4477 participants; moderate-certainty evidence). These data translate to a relative reduction of 11% (95% CI 2% to 20%). Daily sedation interruption probably reduces hospital LOS (MD -0.12 log days, 95% CI -0.22 to -0.02; I² = 39%; 13 studies, 3589 participants; moderate-certainty evidence). These data translate to a relative reduction of 11% (95% CI 2% to 20%). For adverse events related to under- or oversedation, DSI may result in little to no difference in the rate of self/accidental removal of the endotracheal tube (RR 0.88, 95% CI 0.66 to 1.19; P = 0.41, I² = 0%; 16 studies, 4342 participants; 171 events; low-certainty evidence) or self/accidental removal of lines or catheters (RR 1.44, 95% CI 0.80 to 2.57; P = 0.22, I² = 0%; 7 studies, 1536 participants; 42 events; low-certainty evidence). DSI probably reduces rates of tracheostomy (RR 0.68, 95% CI 0.55 to 0.85; P < 0.001, I² = 0%; 8 studies, 2503 participants; 263 events; moderate-certainty evidence). It may result in little to no difference in the rate of delirium occurrence, but the evidence is very uncertain (RR 0.92, 95% CI 0.74 to 1.15; P = 0.48, I² = 59%; 4 studies, 1009 participants; 520 events; very low-certainty evidence). Compared with sedation management without DSI, DSI may result in little to no difference in the total dose of benzodiazepines, fentanyl, or propofol administered over the ICU admission. However, the evidence is very uncertain. Daily sedation interruption probably increases the total dose of morphine administered over the ICU admission (MD 0.07 log mg, 95% CI 0 to 0.13; P = 0.05, I² = 0%; 4 studies, 404 participants; moderate-certainty evidence). These data translate to a relative increase of 7% (95% CI 0% to 14%). DSI may result in little to no difference in HRQoL compared with sedation management without DSI, with evidence in the mental health domain being very uncertain. Evidence certainty is limited by inconsistency (statistical heterogeneity) and imprecision due to wide CIs, including CIs that encompass both benefit and harm for some outcomes.

Based on low- and moderate-certainty evidence from 23 trials including nearly 6000 critically ill people, we found that DSI may reduce the duration of mechanical ventilation and probably reduces mortality, intensive care LOS, and hospital LOS compared with other sedation methods. Daily sedation interruption may have little to no effect on the adverse outcomes of accidental removal of the endotracheal tube or other lines or catheters, but probably reduces the need for tracheostomy. The evidence on sedation dosing is very uncertain; however, DSI probably increases opioid dosing. Given the evidence on the effect on sedation dosing is very uncertain, future trials should include data on total sedative and analgesic doses as well as delirium and health-related quality of life, as these remain under-evaluated.

This review received no funding.

Registration (CD009176) and previous version of the review: Cochrane Database of Systematic Reviews via DOI: 10.1002/14651858.CD009176.pub2. Protocol available via DOI 10.1002/14651858.CD009176.pub1.

Recent neuromodulation studies suggest that theta burst stimulation (TBS) applied to the dorsolateral prefrontal cortex (dlPFC) can influence neural circuits involved in cognitive control and emotion-related processing, with relevance for psychiatric disorders. However, large-scale datasets characterizing variability, reliability, and multimodal neural responses to TBS remain limited. To address this gap, we established the Philadelphia Theta Burst Project, a dataset of 100 healthy participants who completed 4 fMRI sessions following cumulatively increasing doses of intermittent or continuous TBS, with participants randomized to one protocol or the other. Each session includes multiband, multi-echo resting-state (16 minutes) and task-based fMRI (16 minutes) during a Sternberg working memory paradigm. TMS targeting was guided by task-evoked activation in the left dlPFC. Structural T1-weighted, T2-weighted, and diffusion-weighted imaging were also acquired. Here, we describe the dataset design, acquisition protocol, and data characteristics, and report initial measures of data quality and reliability. The completed dataset can be accessed at https://openneuro.org/datasets/ds008893, providing an open resource for future investigations of TBS mechanisms and individualized neuromodulation strategies.

Adolescents and young adults (AYAs) with inflammatory bowel disease (IBD) face challenges transitioning from pediatric to adult healthcare, where they assume greater responsibility for their care. The Transition Adolescent & Young Adults implementioN (IBD-TrAYN) intervention is part of a multisite hybrid effectiveness-implementation randomized controlled trial launched in 2022 to address gaps in transition care. Online educational modules were developed to enhance disease knowledge and self-management skills among AYAs.

To explore adult gastroenterologists' perspectives on transition-related education and curriculum developed as part of the IBD-TrAYN intervention.

Adult gastroenterologists across Canada with experience treating AYAs with IBD were recruited using purposive and snowball sampling. Three virtual focus groups were conducted with 11 gastroenterologists to explore perspectives on the curriculum. Transcripts were analyzed by 2 independent reviewers using content analysis.

Participants identified the IBD-TrAYN curriculum as a valuable tool for addressing common educational barriers in AYA care. These included provider- and system-level barriers, such as limited clinical time and allied health support, and differences in patient readiness. Priority content included disease knowledge, self-management skills, mental health, and sexual health. Caregiver education was highlighted as an important part of transition care. Suggested improvements included consolidating content, increasing interactivity, and ensuring flexible, self-paced access to support individualized engagement.

Adult gastroenterologists endorsed the value of the IBD-TrAYN curriculum in bridging educational gaps during transition to adult care. Incorporating these insights, particularly prioritizing key topics and enhancing interactivity, may strengthen future iterations and promote effective, patient-centred transition care for AYAs with IBD.

Adolescent suicide and self-harm have become pressing global public health crises. At the 2026 Asian Society of Child and Adolescent Psychiatry and Allied Professions Grand Forum on Suicide and Self-Harming Behavior in Adolescents Worldwide, researchers, clinicians, and policymakers from multiple countries presented current evidence and field experiences. This study synthesizes the forum's major presentations and discussions in the thematic areas. The forum emphasizes that South Korea continues to report one of the highest adolescent suicide rates among Organisation for Economic Co-operation and Development (OECD) countries and that suicide-related behaviors and non-suicidal self-injury have reached concerning levels across Asia. The cross-national evidence presented at the forum indicated a marked post-pandemic increase in adolescent suicide attempts and self-harm, with a disproportionate burden on adolescents and young women. The speakers further emphasized that aggregate national statistics could obscure the heightened risk faced by the most vulnerable subgroups. Major risk factors included psychiatric comorbidities, diminished sense of belonging, social media use, algorithm-driven content exposure, and socioeconomic disparities in healthcare access. The forum emphasized that for many adolescents, self-harm reflected not a wish to die but an attempt to escape overwhelming psychological pain. Proposed solutions centered on a paradigm shift toward primary prevention, integrated school-government-professional systems incorporating AI-based early warning, the "Safety by Design" principle for social media, community-based safe spaces, and strengthening families and communities. Adolescent suicide prevention is not solely a medical issue but a collective societal responsibility that requires international collaboration.

University students are a high-risk population for mental health problems. However they often face barriers to care. Digital Mental Health Interventions are scalable tools to support well-being, yet evidence regarding optimal delivery formats remains mixed. This study assessed the efficacy of ETUCARE, an 8-week multicomponent digital program comparing online-only and hybrid (online + in-person workshops) delivery formats.A three-arm randomized controlled trial was conducted among 1064 French university students assigned to an online-only (n = 460), a hybrid (n = 235), or a waitlist control group (n = 369). Self-report measures were collected at baseline (T1), post-intervention (T2), and 8-week follow-up (T3). Outcomes included psychological distress, well-being, emotion regulation, insomnia, and alcohol use. Linear mixed-effects models examined time × group effects. Clinical transitions were analyzed using multinomial logistic regressions and chi-square tests.Significant time × group interactions indicated more favorable change trajectories for psychological distress, emotion regulation, insomnia, and several well-being dimensions in both intervention groups than in the waitlist control group. No consistent differences were observed between delivery formats on global outcomes, and no differential intervention effect was found for alcohol use. Sensitivity analyses showed that program completion contributed additively to some outcomes without accounting for group-related differences. Exploratory clinical transition analyses suggested an increased likelihood of remission for psychological distress and insomnia in both intervention groups, with greater symptom improvement in the hybrid format among students with higher baseline severity, and a possible protective effect of the online-only format against symptom aggravation at post-test, an effect not maintained at follow-up.ETUCARE showed small benefits over the waitlist condition for psychological distress, insomnia, emotion regulation, and selected dimensions of psychological well-being. The broadly comparable outcomes of the two delivery formats suggest that the online-only format may provide a more scalable option for universal student mental health promotion.

This trial was not prospectively registered.

The study was approved by the Ethics Committee of Nantes University (IRB No. IORG0011023, Ref. 06042023-2). All participants provided informed consent before enrolment.

The rapid diffusion of conversational artificial intelligence (AI) has reshaped the landscape of digital interaction in later life, with growing attention to its implications for older adults' mental health and wellbeing. Existing research has predominantly interpreted conversational AI through the lens of digital companionship, emphasizing its capacity to simulate social presence, reduce loneliness, and provide emotional support. While this perspective captures important affective outcomes, it offers a limited account of the developmental processes through which AI engagement may influence psychological wellbeing in aging populations. This conceptual analysis proposes a shift from a companionship-oriented paradigm to a capability-building perspective grounded in the Capability Approach. It argues that the primary value of conversational AI lies not in its ability to substitute social interaction, but in its potential to expand older adults' cognitive, emotional, social, and digital capabilities. Building on this argument, this paper develops an AI-Augmented Active Aging Framework that explains how conversational AI affordances, responsiveness, personalization, accessibility, and availability, interact with personal, social, environmental, and system-level conversion factors. Under supportive conditions, these affordances may facilitate cognitive, emotional, social, and digital capability formation, thereby supporting autonomy, competence, social integration, and active aging. Under adverse conditions, however, conversational AI may contribute to capability erosion through over-reliance, cognitive offloading, reduced human contact, or diminished autonomous judgment. The framework therefore emphasizes heterogeneous and conditional outcomes rather than assuming uniform benefits across older adults.

The occupational well-being of rural preschool teachers is important for their professional development, mental health, and the quality of preschool education. However, persistent resource constraints in rural education may pose challenges to teachers' occupational well-being. This study examined the association between occupational stress and occupational well-being among rural preschool teachers, focusing on the indirect role of job burnout and the moderating role of professional identity.

A cross-sectional questionnaire survey was conducted among 3,228 rural preschool teachers in Zhejiang Province, China, of whom 98.8% were women. Participants completed validated measures of occupational stress, job burnout, professional identity, and occupational well-being. The hypothesized associations were examined using a moderated mediation model.

Occupational stress was significantly and negatively associated with occupational well-being. A significant indirect association between occupational stress and occupational well-being was observed through job burnout, while the direct association remained significant. Professional identity moderated the association between occupational stress and job burnout: this positive association was weaker, but remained statistically significant, at higher levels of professional identity. However, professional identity did not moderate the direct association between occupational stress and occupational well-being.

The findings suggest that professional identity may serve as a modest personal resource that attenuates the association between occupational stress and job burnout. They also highlight the importance of reducing job demands and strengthening organizational resources to support the occupational well-being of rural preschool teachers.

Early intervention services (EIS) for psychosis are associated with improved clinical and functional outcomes, yet disengagement from treatment remains common. Psychological barriers to early engagement such as stigma, mistrust, and negative treatment expectancies have been identified yet few interventions have been developed to directly target these. Just Do You is a brief, psychotherapeutic meta-intervention originally developed for youth with severe mental illness to target identified barriers to engagement and has been demonstrated to improve engagement and recovery. However, the context of the original trial differs from Canadian early psychosis programs in setting, clinical population characteristics, and timing of delivery, necessitating adaptation for suitability in this context. This project comprises two phases. Phase 1, now complete and reported in this manuscript, used the Formative Method for Adapting Psychotherapy (FMAP) and the Psychotherapy Adaptation and Modification Framework (PAMF) to adapt Just Do You for a Canadian EIS. A multidisciplinary stakeholder group, including service users, participated in structured consultation meetings to guide the adaptation process. Their feedback aligned with four key domains: strengthening trust and autonomy, enhancing relevance to early psychosis, improving feasibility of delivery, and supporting continuity beyond sessions. Resulting modifications and the adapted intervention are described in depth in this manuscript. Phase 2 of this project, aims to evaluate the adapted intervention using a non-randomized wait-list control design. This manuscript also outlines the Phase 2 research protocol, including planned assessment procedures and analytic strategies. Findings from Phase 2 will inform future large-scale evaluation of the adapted intervention.

ClinicalTrials.gov, Identifier NCT06410508.

Loneliness is increasingly recognized as a major public health challenge. Yet, its impact on cognitive function remains poorly understood. A complex interplay of life-course risk factors makes it challenging to disentangle the effect of loneliness from other factors and to assess underlying mechanisms when using traditional approaches.

We applied the parametric g-formula with the Health and Retirement Study (1996-2018; n = 34 774; aged 50-80 years) to simulate an intervention estimating the effect of preventing loneliness on cognitive function. We assessed whether this effect varies by gender. Formal mediation analysis was also performed to assess depression as a potential pathway.

Preventing loneliness was protective against cognitive decline at all ages, with the magnitude increasing with age. Averaged across all ages, an intervention to prevent loneliness would slow cognitive decline by 0.075 points at the population level [95% confidence interval (CI): 0.063-0.089] and by 0.157 points among individuals experiencing loneliness (95% CI: 0.138-0.178). Overall, 17.3% of the total effect of preventing loneliness was mediated via depression, with the proportion mediated being 19.4% among men and 16.9% among women.

Employing an innovative counterfactual framework, this study shows that preventing loneliness could provide an insulative effect against cognitive decline, even at the population level. Importantly, with advancing age, addressing loneliness yields progressively greater cognitive benefits. The effects partly operate through reductions in depression, especially in men. Interventions against loneliness may help maintain cognitive function, with benefits extending to mental health, highlighting a promising avenue for public health strategies.

Smoking has been linked to both peripheral ghrelin levels and depressive symptoms. However, the association between cerebrospinal fluid (CSF) ghrelin levels and depressive symptoms, and the moderating role of smoking, remains unclear. This study aims to investigate the specific relationship among the three categories.

In this case-control study, we examined the association between smoking, depressive symptoms, and CSF ghrelin levels in 173 adult male volunteers (94 non-smokers and 79 active smokers). Demographic data, clinical parameters, and Beck Depression Inventory (BDI-SF) scores were assessed, and CSF ghrelin levels were measured. Statistical analyses, including the Mann-Whitney rank-sum test, Spearman correlation, and linear regression, were used to explore the relationships among these variables.

Active smokers had significantly higher BDI scores (3.57 ± 4.74 vs. 1.44 ± 2.33, p < 0.001) and lower CSF ghrelin levels (1201.99 ± 145.97 vs. 1563.61 ± 153.3, p < 0.001) compared with non-smokers. Correlation analysis revealed a significant negative association between CSF ghrelin levels and BDI scores (r = -0.197, p < 0.01). Smoking was positively correlated with BDI scores (r = 0.332, p < 0.001) and negatively correlated with CSF ghrelin levels (r = -0.780, p < 0.001). Moderation analysis further indicated that smoking significantly moderated the association between CSF ghrelin levels and depressive symptoms (Smoking × CSF ghrelin: p = 0.047).

CSF ghrelin levels are associated with depressive symptoms. A significant negative correlation exists between CSF ghrelin levels and smoking, and smoking appears to moderate the association between CSF ghrelin and depressive symptoms. These findings provide potential insights into the pre-clinical mechanisms of depression and early prevention strategies.