Musculoskeletal injuries such as patellofemoral pain syndrome (PFPS) result in loss of readiness in military warfighters, underscoring the importance of therapies to accelerate recovery for rapid return-to-duty. Non-pharmacologic interventions, including exercise, neuromuscular electrical stimulation (NMES), and blood flow restriction (BFR), may be beneficial in garrison and far-forward settings. However, since the electrical currents used in NMES and the restriction of blood flow during NMES and BFR therapies cause pain and discomfort that may be intensified when combined, there is concern that these therapies could lead to heightened physical and psychological difficulties. Thus, the present secondary analysis examined whether the combined use of BFR, NMES, and exercise affected pain intensity, functional abilities, and the physical (PCS) and mental (MCS) components summary scores of the Health-Related Quality of Life (HRQoL) questionnaire.

This randomized controlled trial entailed the random assignment of 84 service members with PFPS to 1 of 2 groups: sham with application of 20 mmHg pressure or BFR pressure to 80% occlusion. BFR-NMES was performed in clinic 2 times per week, while NMES with exercise and exercise alone were performed at home on alternating days and omitted on in-clinic days. The outcome measures included the 12-item Short Form Health Survey v.2 (SF-12v2) MCS and PCS scales. Pain levels were measured using the Anterior Knee Pain Scale (AKPS) and Visual Analog Scale (VAS).

Over the 9-week intervention, both groups demonstrated similar improvements in pain as measured by the AKPS and VAS scales. Both groups also showed similar improvements on the SF-12v2 PCS, progressing from well below normal to almost normal over the 9 weeks. However, a significant difference in the MCS scores between the 2 groups was observed over time, as evidenced by a notable group-by-time interaction (P = .01). At baseline, both groups scored above the average "normal" score of 50 (SD = 10) on the MCS. By week 9, the MCS score for the sham BFR group remained essentially unchanged, while that of the high BFR group declined below average.

Mental health is as important as physical health in optimizing the recovery of injured military warfighters. The balanced use of non-pharmacologic interventions such as exercise, NMES, and BFR therapy is essential for promoting mental and physical readiness. The observed decline in mental scores over time highlights the potential need for integrating pain management techniques, behavioral strategies, and social support into future rehabilitation protocols to enhance overall outcomes. By addressing these elements comprehensively, military warfighters can develop the resilience required for a successful return-to-duty in both resource-rich clinical settings and demanding far-forward environments.

The Blood Flow Restriction trial was registered in ClinicalTrials.gov (Identifier: NCT04086615), first posted on September 11, 2019.

Nationwide trends from 2018 to 2022 demonstrated rising pediatric mental health diagnoses amidst a specialist shortage, shifting care to primary care settings. Specific trends among patients seen by family physicians in the military health system have not previously been published. This study addresses a research gap by characterizing mental, emotional, neurodevelopmental, and behavioral health (MEDB) care trends provided by family physicians to military dependent children in direct (military treatment facilities) and purchased (civilian) care systems, focusing on preventive visits.

A retrospective observational analysis was conducted examining preventive visits (N = 193,495) between 2018 and 2022. MEDB diagnoses were grouped into 16 categories based on ICD-10 codes. Descriptive statistics and joinpoint regression analyses assessed changes in diagnosis rates and trends by age group (5-11, 12-17, 18-25 years) and care system. Logistic regression and odds ratios looked at associations between MEDB diagnosis and care system, adjusting for age, sex, and year of diagnosis. Further analyses looked at associations between MEDB diagnosis and care system, adjusting for sex and year of diagnosis and stratified by age.

MEDB diagnoses during preventive visits significantly increased (P < .05) in both systems and all age groups between 2018 and 2022. Children aged 5-11 most commonly received neurodevelopmental diagnoses, while anxiety, depressive, and trauma/stress related disorders predominated among adolescents and young adults. The number of preventive visits with multiple MEDB diagnoses nearly doubled in purchased care (2018 N = 481; 2022 N = 936). In direct care, there was an average quarterly increase in MEDB diagnoses between 7.6% (5- to 11-year olds) and 10.9% (12- to 17-year olds); in purchased care the average quarterly increase was between 6.6% (5- to 11-year olds) and 14.7% (18- to 25-year olds) in MEDB diagnoses.

From 2018 to 2022, the percent of preventive visits associated with MEDB diagnoses managed by family physicians significantly increased. These findings emphasize the importance of enhancing behavioral health training and resources for family physicians to optimize military family well-being and support service member readiness.

Pain catastrophizing has been shown to negatively affect health outcomes in chronic musculoskeletal pain. This study examined factors associated with clinical levels of pain catastrophizing that could guide effectiveness of pain control and management.

The study was a cross-sectional, retrospective review of intake surveys completed by 158 soldiers (31.3 ± 7.1 years old) seen at Womack Interdisciplinary Pain Management Center for chronic back or low back pain. Measurements included the Pain Catastrophizing Scale (PCS), Defense and Veterans Pain Rating Scale, and Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference Short Form, and the depression (PHQ-9) and anxiety (GAD-7) scales from the Patient Health Questionnaire. The patients were categorized into clinical (n = 65) vs. non-clinical (n = 93) pain catastrophizing groups. From the PCS developer, a total PCS score of 30 or above represents clinical level of catastrophizing. Data were analyzed using descriptive statistics and independent sample t-tests.

Statistically significant difference was found between the clinical and non-clinical pain catastrophizing groups on scores of pain intensity (6.1 vs. 4.9, P < .001) and pain effect on activity (6.7 vs. 5.3, P < .001), sleep (6.8 vs. 4.7, P < .001), and stress level (7.2 vs. 4.5, P < .001). Pain interfered in functioning to a greater extent in the clinical group than the non-clinical group (19.3 vs. 15.0, P < .001). The clinical group also reported greater severity of depression (13.1 vs. 4.8, P < .001) and anxiety (11.1 vs. 3.5, P < .001) than the non-clinical group.

As pain catastrophizing thoughts increase in frequency and intensity, they can lead to long-lasting detrimental effects on overall quality of life and coping. The findings underscore the importance of targeting clinical pain catastrophizing in chronic pain treatment, given its link with numerous pain-related factors that include functioning and mental health.

Safety Aid Reduction Treatment for Anxiety and Related Disorders (START) is a transdiagnostic group therapy found to reduce self-reported anxiety symptoms among veterans. The Practice Based Implementation (PBI) Network, a program designed to assess small-scale implementation pilots of mental health therapies and trainings, partnered with START experts and military mental health (MH) clinics to implement START. Evaluation of perceptions of facilitators and barriers in these trials is important before considering wider Military Health System (MHS) adoption.

Following training, providers used the START protocol to facilitate in-person START group sessions. Pilot champions provided qualitative data on implementation in the form of verbal feedback to semi-structured questions during facilitation calls held throughout the study. Providers shared qualitative data at the end of the study in the form of verbal feedback during semi-structured interviews. Providers and champions also responded to surveys developed for this study assessing their perceptions of barriers to and facilitators of START delivery.

Overall, the manualized protocol and therapeutic techniques used in START helped providers engage patients. Although providers and champions acknowledged barriers, all were modifiable and most barriers were described as having minimal impact. The 10-session length was cited as impractical given station changes and work schedules.

The study was successful in identifying facilitators and barriers common across sites. Results reinforce the value of identifying provider, clinic, and organizational obstacles and supports to intervention implementation in MHS BH clinics. Findings may have applicability to future efforts to introduce START and similar treatments in military BH clinics.

Clinical and demographic factors influencing prescribed sleep medication use in children and young people (CYP) have been studied inadequately. We aimed to examine the prevalence of prescribed sleep medication use among CYP experiencing mental health crises and its associations with clinical and demographic factors.

Electronic medical records of CYP (n = 201) attending the Macarthur Safeguards Acute Mental Health Crisis Service (referred to as the Safeguards Service) in Sydney, Australia, were reviewed. Descriptive statistics and bivariate and multivariate logistic regression analyses were performed. Multivariate logistic regression was used to estimate the Adjusted Odds Ratio (AOR) with 95% confidence intervals, examining the associations between prescribed sleep medication use and clinical and demographic factors.

The prevalence of prescribed sleep medication use (e.g., melatonin, benzodiazepines) among CYP was 20.9%. Multivariate regression analysis indicated that CYP's length of stay with the Safeguards Service was positively associated with increased prescribed sleep medication use (AOR = 3.61, 95% CI: 1.19-10.94, p = 0.023). CYP who were diagnosed with trauma-related psychiatric conditions tended to use more prescribed sleep medication use (AOR = 2.81, 95% CI: 1.09-7.19, p < 0.032). Moreover, multiple medication prescriptions (polypharmacy) were strongly associated with increased prescription of SM (AOR = 11.36, 95% CI: 4.46-28.95, p < 0.000).

Prescribed sleep medication use is significant in CYP experiencing mental health crises. This requires careful consideration due to potential risks, drug interactions, and limited evidence of long-term benefits. There needs to be a focus on addressing the underlying causes of sleep difficulties and exploring adjunct non-pharmacological interventions, especially for those with trauma-related psychiatric conditions, those who tend to have a longer length of stay and are prescribed multiple medications, including for sleep.

Adolescent idiopathic scoliosis (AIS) is a three-dimensional spinal deformity that occurs in adolescents, exerting multidimensional and bidirectional impacts on the physical and mental health and social functioning of both patients and their caregivers. Prevalent misconceptions and stigma, insufficient psychological care in clinical practice, and inadequate social support may further exacerbate their negative psychosocial experiences.

This review aimed to integrate and elucidate the core themes and evolving mechanisms of the psychosocial experiences of adolescents with AIS and their caregivers, reveal the interactional dynamics between the two groups throughout the disease trajectory, and provide an evidence-based foundation for optimising healthcare and social support.

Based on the qualitative evidence synthesis (QES) framework, the meta-aggregation method developed by the Joanna Briggs Institute (JBI) was employed. A systematic search of PubMed, Embase, CINAHL, PsycINFO, and Web of Science was conducted from database inception to April 2026. Qualitative studies exploring the psychological burden and lived experiences of adolescents with AIS and their caregivers were included.

Nineteen qualitative studies from 10 countries, involving 323 participants, were included. At the patient level, three core themes were synthesized: acute shock and multidimensional responses during the initial diagnosis phase; dynamic adaptation and transient positive experiences during the treatment phase; and divergent pathways of posttraumatic growth and residual trauma during the recovery phase. At the caregiver level, three core themes were identified: a structural burden comprising both resource safeguarding and logistical demands; an imbalance in support systems characterized by a deficiency in professional guidance and disruption of family equilibrium; and a progression of emotional exhaustion from self-blame and intense pressure to depressive symptomatology. Furthermore, a dynamic of conflictual intimacy, encompassing both direct interactive conflict and enmeshment within the family system, emerged between patients and caregivers.

The psychological experiences of adolescents with AIS evolve through distinct temporal phases, while caregivers' psychological burden follows a cascading pathway from structural strain to emotional exhaustion. The two parties are locked in a bidirectional interaction shaped by the structural tension between parental protection and adolescent autonomy. Healthcare professionals should tailor psychological support to the patient's disease stage, ensure transparent information delivery, and provide transitional training for caregivers to mitigate the transmission of stress. At the societal level, it is essential to strengthen early screening and public education, eliminate stigma, and provide accessible support to help AIS families navigate role transitions throughout the disease course.

Two adolescents with AIS and two family caregivers participated as co-investigators in this review. They contributed to refining the research question, prioritizing outcomes of importance, interpreting the findings, and reviewing the manuscript for clarity and relevance.

This study examined the relationship between transformational leadership and clinical work performance among nursing professionals within the Tabuk Health Cluster. It focused specifically on the association of leadership behaviours with nursing performance.

The study utilized a cross-sectional analytical quantitative research design.

Participants: A convenience sample of 280 nursing professionals (staff nurses and head nurses) from within the Tabuk Health Cluster was enrolled.

Transformational leadership was measured with the Global Transformational Leadership (GTL) scale, and clinical performance through a 51-item scale derived from Yuxiu et al. (2011).

This was a self-administered online questionnaire conducted over approximately 6 weeks, between November and January 2024.

Data were analysed using SPSS version 26 with descriptive statistics, independent samples t-tests, ANOVA, and multiple linear regression to determine the predictive value of transformational leadership.

Nurses perceived leadership positively (mean = 3.96/5). Overall clinical work performance was moderate (Mean = 2.70/4), with the leadership (2.75) and critical-care (2.79) subscales scoring highest. Transformational leadership significantly predicted clinical performance (p < 0.001), accounting for 26.9% of its variance. Nurses with 1-5 years of critical-care experience scored significantly higher than those with more than 5 years on both leadership perception and clinical performance (p < 0.001).

Transformational leadership was positively associated with nurses' clinical performance and represents a modifiable target for improvement. The lower scores among more experienced nurses indicated a need to re-engage mid-to late-career staff.

The findings support investment in transformational leadership development, direct support for clinical performance, a stronger feedback culture, continuing professional development-particularly for mid- to late-career nurses-and quality-improvement efforts within the Health Cluster system. No patient or public contribution: While the study acknowledges the vital participation of nursing staff at the Tabuk Health Cluster, patients and members of the public were not involved in the design, conduct or reporting of this research.

The purpose of this review was to summarise recent relevant studies examining refeeding syndrome risk and related outcomes in patients provided with enteral nutrition and discuss considerations for clinical practice and future research.

Recent studies investigating enteral nutrition and refeeding syndrome were heterogeneous. With the exception of physical indicators of nutritional status, there was no agreement across studies regarding commonly agreed upon risk factors including periods of fasting, feeding rates, or specific medical conditions. Comparisons of three different recommended risk criteria had highly variable results in one study. Confounding factors were evident across studies. Management of refeeding syndrome risk is becoming increasingly debated. Recent research has questioned the need for prolonged high thiamin dosages in adult patients with eating disorders. Conservative feeding practices are also called into question when serum electrolyte levels can be monitored and replaced assertively.

Clinical practice and research in refeeding syndrome is slowly changing, with a focus on preventing unnecessary and prolonged underfeeding in malnourished patients and in children during critical stages of growth. Future research should ensure risk criteria is specific to the clinical conditions and/or age groups being investigated. Refeeding syndrome and its subsequent management should also be considered along a spectrum, rather than as an all or nothing event. By incorporating these recommendations, research in the field will evolve to advance knowledge and enhance clinical practice.

The frequency of reports of abusive violence among US service members deployed to post-9/11 operations and the psychosocial associations of participating in such behaviors are largely unexamined. We examined reports of participation in and observation of abusive violence behaviors in a sample of deployed veterans (N = 1345) and explored their correlates, which were contrasted with reports of exposure to combat stressors, using Emotional Processing Theory as a framework for variable selection. Forty percent of the sample (46% of men, 35% of women) endorsed observing at least one abusive violence behavior and fourteen percent of the sample (23% of men, 6% of women) reported participation in at least one abusive violence behavior. The nomological networks of abusive violence participation and observation were highly similar, but distinct from combat exposure. Abusive violence participation and observation were comparable to combat exposure in their associations with externalizing problems (e.g., alcohol and substance use), but each had consistently smaller associations with internalizing distress (e.g., depression, PTSD symptoms). Reports of exposure to abusive violence, particularly via observation, appear to be relatively common among deployed veterans with varying severities of internalizing distress, and these unique experiences are associated with a range of mental and behavioral health symptoms and functional difficulties that diverge from those associated with combat exposure.

Most people with alcohol use disorder (AUD) do not receive treatment. Few digital evidence-based treatments have been tested among community-based samples of people with AUD. The present trial of Computer-Based Training for Cognitive Behavioral Therapy (CBT4CBT) (1) assessed CBT4CBT usability and acceptability and (2) explored alcohol-related outcomes by study condition in a non-treatment sample of people with AUD.

For the current two-arm clinical trial, a non-treatment sample of people with lifetime AUD and current heavy drinking was recruited using ResearchMatch.org and randomized (3:1) to the CBT4CBT program or an assessment-only control, stratified by sex (N = 160 total; CBT: n = 109; Co: n = 51). Study assessments included post-intervention acceptability ratings and self-reported alcohol-related measures administered at baseline, post-intervention, and 1-month follow-up.

Participants were 68.1% female and 31.9% male, in their early forties (M = 42.6, SD = 15.7, range 19-76 years). Most participants identified as white (65.0%) or Black (27.5%) and non-Latinx (89.4%). Acceptability ratings and usability measures for CBT4CBT were favorable and comparable to studies among clinical treatment samples. Participants in the CBT4CBT group demonstrated faster reductions in the percentage of drinking days and were significantly less likely to report any heavy drinking days than those in the control condition at 1-month follow-up. The CBT4CBT group reported higher recovery scores than the control group.

The present study provides benchmark data on the use of CBT4CBT in a sample of people with AUD not receiving treatment. Findings have important clinical and research implications for expanding the reach of evidence-based addiction treatment beyond traditional treatment settings.