Family caring roles create significant impacts on individual family members' physical, mental and social wellbeing, and can disrupt family financial stability, relationships and functioning. The perspectives of family members other than mothers are often omitted from research, reducing understanding of the broader impacts of supportive interventions such as care coordination.

This study aimed to understand how multiple family members experience the impacts of caring for children with medical complexity (CMC) in a rural setting in Australia, and how paediatric care coordination influences their experiences.

This qualitative study involved thematic narrative analysis and multimember comparison to identify themes within and across families, which were then mapped against the socioecological model.

Members of 13 families of CMC receiving a nurse-delivered care coordination intervention, the Rural Kids Guided Personalised Service, participated in semi-structured interviews, including mothers (n = 12), fathers (n = 7), siblings (n = 3), CMC (n = 2) and an aunt (n = 1).

Five themes were generated, including: Caring for CMC in varied family contexts, Coordinating care to support family strengths, Accessing appropriate care when living in a rural area, Impact on the whole family (including two subthemes: Family relationships and Enabling support within and for families) and Quality care closer to home.

These findings are relevant for future implementation of integrated care models, and can inform the development of expanded models of care that address broader family health and social needs. Future service evaluations would benefit from inclusion of multiple family members, rather than only mothers, to allow a more comprehensive understanding of how best to support whole families.

Parents with lived experience of caring for CMC in rural areas sat on the steering committee guiding the implementation and evaluation of RuralKidsGPS, alongside clinicians, Aboriginal health workers and advisors, health managers, researchers and policy officers.

This study examined the relationship between peer subjective social status (SSS), a measure of perceived social position within social hierarchies, and health outcomes in a young adult population.

A cross-sectional study was conducted in 2025 at the College of Medicine, King Saud University, Saudi Arabia, involving 390 undergraduate students aged 18 and older. Peer SSS was assessed using the validated MacArthur Scale, a 10-rung ladder representing perceived social standing relative to peers. Multiple logistic regression models were used to estimate associations between peer SSS and four health outcomes, adjusting for age, sex, and indicators of parental socioeconomic position.

Each one-rung increase in peer SSS was associated with 15-33% lower odds of poor health outcomes, including less than good physical health (odds ratio [OR] = 0.85, 95% confidence interval [CI] = 0.72-1.00), less than good mental health (OR = 0.81, 95% CI = 0.68-0.95), low psychological well-being (OR = 0.81, 95% CI = 0.69-0.95), and low life satisfaction (OR = 0.67, 95% CI = 0.54-0.82). Sensitivity analyses showed no effect modification by sex, age, or parental socioeconomic position.

These findings suggest that perceived social position within peer hierarchies is an important correlate of physical and mental health in young adults, independent of family background. Further longitudinal and qualitative research is needed to clarify the direction of the association and the underlying mechanisms, and to examine whether addressing the psychosocial consequences of status comparisons may be relevant for reducing health inequalities in competitive social environments.Key messagesPerceived peer social status is strongly associated with both physical and mental health among medical students, independent of parental socioeconomic background.Students with lower peer status have substantially higher odds of poor health outcomes, including reduced well-being and life satisfaction.Competitive peer dynamics within medical education may be an important factor related to student well-being and warrant further investigation.

Medetomidine, an alpha-2 adrenergic agonist, emerged as a U.S. drug adulterant in 2022. In May 2024, the Chicago Department of Public Health identified a cluster of opioid overdoses with unusual clinical features linked to medetomidine.

We performed a retrospective chart review of patients presenting to three Chicago emergency departments with suspected opioid-involved overdoses during May 11-17, 2024. We classified cases as confirmed, probable, or suspected based on independent clinical criteria and laboratory screening results. We performed descriptive statistics and exploratory logistic regression to assess the association between case status and hospital outcomes.

Out of 181 patients presenting with suspected opioid-involved overdoses during the one-week window, 15 patients identified during the initial phase of the outbreak underwent supplemental testing, yielding 12 laboratory-confirmed cases of medetomidine exposure. In patients with confirmed medetomidine exposure (n = 12), all exhibited persistent altered mental status despite naloxone administration and demonstrated marked hypertension at presentation. Bradycardia was present in 9 patients (75%). Compared to suspected cases, confirmed or probable cases had a higher odds of experiencing asymptomatic markedly elevated blood pressure (OR = 3.2, 95% Cl = 1.5-6.9), hospital admission (OR = 3.2, 95% Cl = 1.4-7.3), and admission to intensive care (OR = 4.0, 95% Cl = 1.4-11.8).

Patients with confirmed medetomidine exposure demonstrated a toxidrome characterized by initial asymptomatic markedly elevated blood pressure, bradycardia, and a prolonged altered mental status requiring clinical stabilization. The increased likelihood of hospital and intensive care unit admission observed in this outbreak highlights the need for heightened clinical awareness and preparedness.

There is a global epidemic of obesity and in this context, the development of novel agents for weight loss has been timely. There have been emerging reports of peripheral nerve complications and this study aimed to systematically review all reported cases associated with medications used for weight loss.

A systematic search of PubMed, Embase and CINAHL databases from inception to 30 June 2026 was performed to identify studies that report new-onset or worsening peripheral nerve complications. Independent screening was conducted by two authors. Data including demographics, medications, weight-loss parameters, neurological presentation and investigations. Descriptive statistics were used.

There were 19 studies, comprising 31 cases and one cohort (103 individuals) identified. All bar one were published from 2024. Of 31 individual cases median weight loss achieved was 20.4 kg (IQR 15.2) or 21.8% (IQR 16.4) of starting body weight. Median rate of weight loss was 3.7 kg/month (IQR 1.7), with symptom onset at 150 days (IQR 135). Semaglutide or tirzepatide were implicated in the majority (83%), and 67% had pre-diabetes/diabetes. Neurological presentations included fibular neuropathy (n = 10), lumbosacral radiculoplexus neuropathy (n = 9) and distal symmetric polyneuropathy (n = 7). Electrodiagnostic and imaging data were supportive of diagnosis.

There is a recent increase in peripheral nerve disorders associated with medical treatment of diabetes and obesity. To reduce the risk, it is recommended to ensure adequate nutritional status and avoid ultrarapid HbA1c and weight loss. Prospective studies are needed to determine incidence and confirm safe rates of weight loss and glycemic correction.

Schizophrenia is a chronic and disabling neuropsychiatric disorder traditionally defined by psychotic and cognitive symptoms. Increasing evidence suggests that neuroinflammatory mechanisms contribute to its pathophysiology and may also underlie common but underrecognized somatic manifestations. These include altered pain perception, characterized by both diminished sensitivity and chronic pain, with important implications for functional outcomes and rehabilitation.

This narrative review examines clinical, preclinical, and translational studies addressing the role of neuroinflammation in schizophrenia, with a specific focus on microglial and astrocytic activation, cytokine signaling, oxidative stress pathways, and their interactions with central pain processing circuits. The review was informed by targeted searches of PubMed, Scopus, Web of Science, and Google Scholar, covering articles published from database inception to January 2026, with emphasis on studies relevant to pain modulation, symptom expression, and neurobiological heterogeneity in schizophrenia.

Neuroinflammation represents a biologically plausible link between core schizophrenia pathology and altered pain perception. Recognition of pain as an integrated component of disease biology, rather than a secondary complaint, may improve clinical assessment and treatment planning. Investigating and targeting neuroinflammatory pathways holds promise for personalized interventions that address neuropsychiatric symptoms and pain, potentially enhancing rehabilitation outcomes and quality of life.

Perinatal mental health problems are prevalent during pregnancy and the postpartum period and can have substantial consequences for both mothers and infants. Chatbot-based interventions represent a promising and scalable approach to perinatal mental health support. However, the evidence base remains heterogeneous and has not been systematically mapped. This scoping review aims to synthesise existing research on chatbot-based interventions for perinatal mental health, focusing on study characteristics, intervention features, outcomes and implementation challenges.

This scoping review protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-analyses Protocols guidelines. A systematic search will be conducted from database inception to May 2026 to identify quantitative, qualitative and mixed-methods studies focusing on chatbot-based interventions for perinatal mental health. Two reviewers will independently screen studies and extract data, with discrepancies resolved through discussion or consultation with a third reviewer. Data will be synthesised descriptively.

This study is based on publicly available literature and does not require ethical approval. The findings will be disseminated through peer-reviewed journal publications and presented at academic conferences related to perinatal and child health and digital health.

Sleep is an essential biological process regulating emotions and involving interactions between limbic and cortical systems. The amygdala, hippocampus, insula, and anterior cingulate cortex function as a bottom-up network for emotional processing, whereas prefrontal regions control the top-down aspect. Neurophysiological, neurochemical, and network modifications affect these circuits during sleep stages i.e. rapid eye movement (REM) and non-REM (NREM) phases. Sleep deprivation throws this balance out of synchrony, making emotional responsiveness increasingly pronounced and regulation more compromised, and can lead to, or aggravate, mental health disorders such as depression, anxiety, and PTSD. This chapter integrates fundamental neuroscience, system modelling, neuroimaging, and clinical insights into account of limbic and cortical brain circuitry in the context of sleep-induced emotional regulation.

Neurocentric bias in psychiatry threatens to reduce psychedelics to neurobiological interventions and distort the experiential, social, and relational aspects of psychedelic-assisted therapy (PAT). PAT demands an ecological and relational orientation to fully account for the various phenomena implicated in mental health, psychedelics' effects, and outcomes of psychedelic experiences. The re-emergence of psychedelics as a legitimate therapeutic modality offers psychiatry an opportunity to embrace more holistic, humanistic, and socially grounded approaches. We argue that PAT should be framed as a capacity-building endeavor that seeks to improve patients' self-perceptions and capabilities to act in ways they find meaningful.

Chronic Insomnia Disorder (CID) is characterized by maladaptive self-referential thinking linked to default mode network (DMN) dysfunction. Network Homogeneity (NH), a measure of local functional integration within networks, may capture this dysregulation but remains underexplored in CID and its response to treatment, particularly herbal medicine.

This study employed resting-state functional magnetic resonance imaging (fMRI) to investigate DMN NH in 82 patients with CID (52 treated with Modified Suanzaoren Decoction [MSZRD], 30 with Estazolam) and 65 matched healthy controls (HCs). NH was calculated for the DMN. Baseline differences, longitudinal treatment effects (mixed-effects model), and correlations with clinical scores were examined. A support vector machine (SVM) classifier used baseline NH features for diagnostic discrimination.

At baseline, CID patients exhibited widespread abnormal NH in DMN nodes, including the temporal lobes, precuneus, and orbitofrontal cortex (OFC), compared to HCs. Post-treatment, a significant time effect (increased NH) was found in the right inferior frontal orbital gyrus (IFOG) and right superior temporal gyrus (STG) across both groups. Crucially, a group-by-time interaction was identified in the right medial frontal orbital gyrus (MFOG), where NH increased after MSZRD but decreased after Estazolam. Baseline NH in temporal regions correlated positively with insomnia and anxiety severity. The SVM classifier achieved significant accuracy in distinguishing patients from HCs.

CID is characterized by dysfunctional integration within the DMN. MSZRD and Estazolam demonstrate both convergent and divergent neuromodulatory effects, with MSZRD uniquely altering NH in a key prefrontal regulatory hub.

Acute type B aortic dissection (ATBD) is a severe cardiovascular event with potential impact on health related quality of life (HRQoL). Evidence on post-operative rehabilitation and exercise guidance remains limited. This study evaluated HRQoL among ATBD patients after thoracic endovascular aortic repair (TEVAR), focusing on follow up duration, sex, and age.

This single centre, cross sectional survey study initially screened 625 patients who underwent TEVAR for ATBD between 1 January 2016 and 31 July 2023. HRQoL was assessed using the Chinese versions of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36v2). Physical Component Summary (PCS) and Mental Component Summary (MCS) scores were compared with sex specific Shanghai normative values, and factors associated with PCS and MCS were analysed.

A total of 306 patients completed interviews. PCS was lower than sex specific Shanghai normative values in both men and women, whereas MCS was not significantly lower than the corresponding normative values. In multivariable analyses, being a woman was associated with lower PCS (β = -2.77, 95% confidence interval [CI] -5.49 - -0.06; p = .045), and increasing age was associated with lower PCS (β = -0.18 per year, 95% CI -0.26 - -0.10; p < .001). For MCS, follow up duration of 13 -24 months compared with ≤ 12 months was associated with lower scores (β = -3.34, 95% CI -5.61 - -1.08; p = .004).

Patients with TEVAR treated ATBD had lower PCS than sex specific Shanghai normative values, while MCS was not significantly lower. Increasing age and being a woman were associated with lower PCS, suggesting that physical HRQoL after TEVAR may differ across patient subgroups. These findings support incorporating patient reported outcomes and individualised assessment of physical recovery into post-TEVAR follow up.