Syria's protracted conflict has produced a mental health crisis of extraordinary scale, with post-traumatic stress, depression, and anxiety estimated at several times global baselines, set against fewer than 0.37 psychiatrists per 100,000 people. Existing AI mental health tools have been developed and evaluated primarily for English-speaking, non-humanitarian populations, and their transfer to this setting is constrained by three simultaneous structural deficiencies-extreme clinical scarcity, Arabic natural-language-processing underperformance for dialect, and cultural misalignment with Syrian idioms of distress-which we term the Triple Gap. This article is a conceptual contribution in the Hypothesis and Theory genre, and its central claim is theoretical rather than technical: that AI-assisted mental-health triage at a safety floor adequate for crisis relevant care in this setting is conditional on the joint satisfaction of three constraints-linguistic adequacy for the local dialect, cultural validity for local idioms of distress and help-seeking, and bounded clinical responsibility through human oversight. These constraints interact, so that a system satisfying fewer than all three is expected to fail in clinically consequential rather than random ways. As one possible design response to this proposition-neither the only one nor a validated one-we describe a conceptual multi-agent architecture aligned with the WHO mhGAP task-shifting model: a four-stage pipeline (screening, risk stratification, routing, follow-up) constrained by a cross-cutting cultural-adaptation layer, augmented by candidate verification mechanisms with explicit abstention, and governed by human oversight in which clinical responsibility rests with a licensed clinician. The proposal is a hybrid clinical decision support hypothesis, not an autonomous system. Because no Syrian Arabic clinical corpus yet exists, the conversational components of the design cannot presently be evaluated; we therefore set out a staged sequencing argument for future work in which the construction of a Syrian Arabic Mental Health Evaluation Corpus (SAMHEC) is the first and rate-limiting condition. We present no prototype, no corpus, and no clinical, cultural, or safety evaluation, and we make no claim of clinical validity, safety, or readiness for deployment. The contribution is the integration of multi-agent triage with task-shifting and cultural adaptation into a single conditional argument whose adequacy can be established only through the staged empirical work we describe.

Limited evidence exists on how multimorbidity combinations influence the risk of secondary bacterial infections. This study identified multimorbidity clusters among hospitalised COVID-19 patients in Victoria (2020-2023) and examined their association with secondary bacterial infections and admission outcomes, including ICU admission, hospital and ICU length of stay, and mortality.

We used population-wide linked hospital data and applied cluster analysis to ICD-10 coded chronic conditions to identify multimorbidity clusters. Risks of secondary bacterial infection across clusters were compared to patients with one or no chronic conditions. We used multivariate logistic regression, negative binomial regression, Kaplan-Meier curves, and Cox proportional hazards models to analyse associations with secondary bacterial infection and admission outcomes.

Among 179,688 COVID-19 hospital admissions, three multimorbidity clusters were identified: neuropsychiatric, cardiometabolic-multisystem, and neoplastic. Compared to no multimorbidity, each cluster was associated with significantly higher odds of secondary bacterial infection: neuropsychiatric (Odds Ratio (OR) 2.74, 95% CI 2.59-2.89), cardiometabolic-multisystem (OR 3.87, 95% CI 3.63-4.13), and neoplastic (OR 1.98, 95% CI 1.84-2.14; all p<0.001). For patients with secondary bacterial infection, cardiometabolic-multisystem multimorbidity had the highest increase in hospital length of stay (Incident Rate Ratio (IRR) 1.94, 95% CI 1.82-2.05) and ICU length of stay (IRR 2.75, 95% CI 2.36-3.20). Mortality was significantly elevated across all clusters and was highest in the cardiometabolic-multisystem group.

Multimorbidity was associated with increased risk of secondary bacterial infection and poorer clinical outcomes in hospitalised COVID-19 patients. Integrating multimorbidity profiles into clinical decision-making may enhance antimicrobial stewardship by identifying patients most likely to benefit from antibiotic therapy.

The brainstem nucleus locus coeruleus (LC) is a rod-shaped, cylindrical, deeply pigmented neuromelanin (NM)-rich cluster of noradrenergic cells placed bilaterally in the dorsolateral tegmentum of the pons. The main neurotransmitter synthesised by these neurons is norepinephrine (NE), which polymerises to NM. Collectively, it regulates a plethora of activities, including vigilance, synaptic plasticity, memory processing, pain, stress responses, selective attention, cognition, sleep, emotion, capillary wall permeability and cerebral blood flow, thereby holding a 'master key' to several processes. Despite being small in dimensions, it is of enormous significance in diverse functions. Degeneration of the LC occurs early and progressively in both Alzheimer's disease (AD) and Parkinson's disease (PD), with diverse impacts, and is linked to neuropsychiatric entities such as depression, anxiety, cognitive impairment, schizophrenia and rapid eye movement sleep disorders, thereby raising considerable interest in normal physiology as well as in disease.

This review is to better understand the neuroanatomical connections of human LC (master regulator of the central nervous system), pigmentation, cellular types, neurotransmitters/co-transmitters, and its role in ageing and neurodegenerative diseases. Recent and relevant classical research and review articles were referred to from PubMed to prepare a short review of the structure of LC, its projections, NM pigment and neuroprotection. We further examined the details of its cell types, neurotransmitters, co-transmitter functions and its effects in ageing, AD and PD, with emphasis on human studies.

LC is a vital region that offers neuroprotection, assists in the maintenance of cognitive reserve and enhances resilience and neuronal survival, despite the presence of AD and PD pathology for several decades. Further, it synthesises NE and co-transmitters that regulate attention, sleep-wake cycle, mood, cognition and so on. Maintaining its integrity and function promises potential scope to promote its health with normal ageing and improve clinical strategies in patients with neurodegeneration.

Medical students and junior doctors undergo rigorous acad emic, clinical and personal demands during early adulthood, a period characterized by identity formation and major life transitions. These pressures contribute to high rates of burnout, diminished motivation and impaired professional development. Personality traits and integrated personality profiles are increasingly recognized as influential factors shaping individuals' responses to stress, sense of vocational calling and career trajectories. However, few studies have simultaneously applied both variable-centered and person-centered approaches within a theoretically grounded framework. This study aims to examine how Cloninger's temperament and character dimensions, as well as validated personality profiles, relate to burnout, sense of calling, research proclivity, and career preferences among medical students and junior doctors in New Zealand.

This cross-sectional study surveyed medical students from all three campuses of the University of Otago and junior doctors working at Health New Zealand-Christchurch hospitals. Participants completed validated measures of burnout, personality (TCI-R) and sense of calling, alongside demographic and career preference items. Two-Step Cluster Analyzes were used to derive temperament, character and integrated personality profiles, constrained to replicate Cloninger's empirically established configurations. Personality profiles were validated using multivariate analyzes of variance. Associations between personality, calling and burnout were examined using correlations, ANOVAs and multiple regressions. Hierarchical regressions assessed whether sense of calling explained additional variance in burnout beyond personality traits.

This study provides a comprehensive investigation of the interplay between personality, sense of calling, and burnout within a large cohort of New Zealand medical trainees. By integrating established personality profiles with contemporary educational outcomes, findings are expected to contribute to a better understanding of the associations between these factors, and to inform future research and educational strategies aimed at supporting well-being, professional identity and sustainable career development.

Evidence on the relationship of autism spectrum disorder (ASD) to overweight/obesity and underweight is mixed. Moreover, it is unclear how this relationship changes with age.

We carried out a systematic review (SR) with meta-analysis on the association between ASD and obesity, overweight and underweight across the life span. The study was based on a pre-registered protocol (PROSPERO: CRD42024524084). Web of Science and PubMed were searched until the 8th of April 2025. We assessed the quality of the included studies with the Newcastle-Ottawa scales (NOS).

A total of 9075 records were screened, of which 64 studies reporting data on obesity, overweight and/or underweight on ASD and controls general participants were included in the SR and 62 meta-analyzed. We found a significant association between ASD and obesity (OR = 1.93; CI = 1.70-2.19; i ² = 99.02%), ASD and overweight (OR = 1.73; CI = 1.43-2.09; i ² = 95.44%) but, at the group level, not ASD and underweight (OR = 1.22; CI = 0.91-1.64; i ² = 78.37%). There was a statistically significant association between ASD and underweight in adolescents (OR = 1.32; CI = 1.12-1.56) and adults (OR = 2.14; CI = 1.5-3.04). The score on the Newcastle-Ottawa Scale showed that, overall, studies had a medium risk of bias (median = 6, range 1-10).

Individuals with ASD have an elevated risk of being obese or overweight, and, in adolescents and adults, of underweight. Our study may contribute to the development and implementation of targeted prevention and intervention strategies, aimed at enhancing the physical well-being of individuals with ASD and their caregivers, ultimately improving their quality of life.

The climacteric is a stage in women's lives that, even today, remains taboo in many regions of the world where social contexts are otherwise highly advanced. Although women's experiences have generated growing interest there is still a need for greater understanding. Learning about and studying the experiences and needs that determine women's emotional well-being during the various stages of the climacteric provides a knowledge base that allows future research to design evidence-based, high-quality health promotion and intervention programs aimed, from a holistic perspective, at fostering well-being during this stage of life. In this sense, a project was proposed to explore these experiences and needs and to co-create a Decalogue for Positive Mental Health during the climacteric.

A qualitative, interpretive phenomenological study was conducted. Data were collected through an online questionnaire and two focus groups (n = 12) between February and April 2025. The sample was recruited by convenience. Inclusion criteria were women currently experiencing the climacteric who were available to participate in the focus groups. All discussions were recorded, transcribed verbatim, and analyzed using ATLAS.ti version 25 through content analysis.

Three main categories emerged: symptoms, self-care, and aesthetic pressure. A total of 59 codes were identified, and sentiment analysis was conducted, showing predominantly neutral and negative results across the three categories.

The modern lifestyle has transformed the profile of women experiencing the climacteric. Today, they are more aware of this stage and demand clear information and standardized protocols to better understand it. Furthermore, self-care and positive mental health have consolidated as key elements to navigate this transition period with well-being.

Simulation-based education is a highly effective method for enhancing psychiatric nurses' communication and history-taking skills, effectively bridging the gap between theoretical knowledge and clinical practice in the relationally intensive field of mental health.

This study aimed to assess the effectiveness of a simulation-based educational intervention in improving psychiatric nurses' communication and history-taking competencies through a quasi-experimental design.

A quasi-experimental pre-post intervention study was conducted among psychiatric nurses working in selected psychiatric wards. Participants underwent a structured simulation-based training program delivered over four sessions, each lasting 45-60 min. The program incorporated standardized patient scenarios, role-play, guided reflection, and debriefing, all focused on therapeutic communication and systematic psychiatric history-taking. Data were collected using a validated knowledge assessment tool, an observational communication skills checklist, and a structured case history-taking performance tool. Descriptive and inferential statistics were employed to evaluate pre-post differences and intervention effects.

Participants were predominantly young to middle-aged nurses (mean age 37.4 ± 7.6 years), with balanced gender representation. Most held a bachelor's degree and had moderate clinical experience (≥5 years). Post-intervention findings revealed statistically significant improvements in nurses' knowledge, communication skills, and history-taking performance compared to baseline (p < 0.001). Large to very large effect sizes were observed across all domains, indicating clinically meaningful gains. Nurses showed marked enhancement in the use of open-ended questions, empathic responses, structured data collection, and integration of psychosocial and clinical information during both simulated and clinical encounters.

Simulation-based training is an effective and impactful educational strategy for reframing psychiatric nurse-patient interactions as intentional, therapeutic processes. The intervention significantly improved psychiatric nurses' communication and history-taking competencies, supporting the integration of simulation-based learning into psychiatric nursing education and continuing professional development programs.

Infants requiring neonatal intensive care are exposed to a range of biological insults during critical periods of brain development, increasing the risk of both bilateral hearing loss (BHL) and neurodevelopmental impairment (NDI). While hearing loss is often seen as a sensory deficit, emerging evidence suggests it may reflect broader disturbances in neurodevelopment. The extent to which multisystem abnormalities associated with BHL are documented at birth or identified during early childhood follow-up remains unclear. This study investigated the temporal relationship between congenital anomalies, hearing loss, and neurodevelopmental outcomes in NICU populations.

A retrospective multi-centre cohort study was conducted across two UK tertiary NICUs. Infants with confirmed permanent BHL were matched to NICU controls without hearing loss based on gestational age, birthweight and sex. Congenital anomalies were assessed at birth and at 2-years using standardised clinical classifications. Neurodevelopmental outcomes at 2-years were categorised as normal-mild or moderate-severe delay. Stratified analyses by site were performed, with pooled associations estimated using Mantel-Haenszel methods. Multivariable logistic regression was used to examine independent predictors of NDI.

At birth, results indicate there was no significant difference in congenital anomaly prevalence between infants with BHL and matched controls (Mantel-Haenszel χ² = 1.17, p = 0.28; OR 1.47, 95% CI 0.80-2.71). By 2-years, however, children with BHL demonstrated a significantly greater burden of congenital anomalies across both centres (pooled χ² = 20.47, p < 0.001), with over four-fold increased odds compared with controls (OR 4.43, 95% CI 2.39-8.20). Differences were most pronounced in abnormalities of the nervous system. In multivariable models, BHL was associated with substantially increased odds of moderate-to-severe NDI (OR 13.89, p < 0.001), with additional contributions from congenital anomalies (OR 2.57, p = 0.023).

These findings suggest that BHL in NICU populations may be associated with broader developmental vulnerability rather than isolated auditory pathology. Longitudinal follow-up may therefore be important for identifying congenital anomalies that are not clinically apparent or documented in the neonatal period and informing more targeted developmental surveillance.

Competitive anxiety is a commonly observed psychological phenomenon within the field of competitive sports such as soccer. Metacognitive beliefs are associated with anxiety in clinical and non-clinical populations, however, few studies have explored the relationship between metacognitive beliefs and competitive anxiety. In this study we aimed to explore the association between metacognitive beliefs and competitive anxiety among Norwegian soccer players. We also investigated differences in competitive anxiety between elite and amateur players, and between women and men.

In a cross-sectional study, 150 Norwegian soccer players at elite and amateur level completed the Metacognitions Questionnaire 30 (MCQ-30), the Sport Anxiety Scale 2 (SAS-2), the Patient Health Questionnaire 9 (PHQ-9), and demographic variables. Independent t-tests were conducted to explore differences in competitive anxiety between elite and amateur and between female and male athletes. Hierarchical regression analyses were conducted to examine the relationship between metacognitive beliefs and total competitive anxiety scores, as well as the three SAS-2 subscales - somatic anxiety, worry and concentration disruption - while controlling for demographic variables and depressive symptoms.

Independent t-tests showed significantly higher competitive anxiety scores among amateur than elite players, and female players reported higher scores than male players. Regression analyses revealed that positive metacognitive beliefs were associated with somatic anxiety, while negative metacognitive beliefs and cognitive self-consciousness were associated with the worry subscale of SAS-2. Metacognitive beliefs were not related to the SAS-2 total score and concentration disruption.

The results indicate a higher level of competitive anxiety among female and amateur players, and that metacognitive beliefs are relevant to somatic anxiety and worry among soccer players, irrespective of their competitive level. This suggests that interventions aimed at challenging metacognitive beliefs to reduce competitive anxiety should be explored in future studies. Theoretical and clinical implications of the current findings are discussed in light of the metacognitive model.