Generative artificial intelligence (GAI) has created new avenues for the commercial sexual exploitation of children through the creation or manipulation of sexually explicit images using a child's likeness. Such images constitute a form of child sexual abuse material (CSAM), including when they are generated or manipulated without physical contact with the child. Because this abuse may occur without the child's awareness, it can complicate recognition, disclosure, and intervention while contributing to ongoing psychological harm. When such content is produced, distributed, or monetized in exchange for anything of value, it may also constitute commercial sexual exploitation of children (CSEC), a term commonly used to describe child sex trafficking. Healthcare providers play an important role in identifying possible GAI child sexual abuse material (GAI-CSAM), supporting affected children and caregivers, and incorporating digital safety into routine care. This article highlights clinical considerations for pediatric, primary care, and mental health settings, including developmentally appropriate assessment of online experiences, caregiver education, trauma-informed response, and multidisciplinary collaboration. As generative technologies evolve, clinician awareness is essential to strengthen prevention, early intervention, and responses to technology-facilitated exploitation.

Firearm suicide is highly prevalent among U.S. veterans. Research suggests that firearm ownership and unsecure firearm storage elevate risk, both of which are common among veterans. Posttraumatic stress disorder (PTSD) may contribute to both suicide risk and unsecure storage, yet research examining PTSD symptom clusters and firearm storage practices remains limited.

Veterans (n = 145) who owned a firearm or lived in a home with a firearm were recruited from an outpatient VA mental health clinic. Participants completed the PTSD Checklist for DSM-5 (PCL-5) which provides subscale scores for intrusion, avoidance, changes in cognition and mood, and arousal symptoms. Veterans were also assessed for unsecure firearm storage and carrying practices. Logistic regressions were conducted to examine the associations between PCL-5 symptom clusters and four discrete firearm storage or carrying behaviors.

PCL-5 arousal symptoms were associated with increased odds of storing firearms unlocked (OR = 1.164, 95% CI [1.045-1.297], p = .006). PCL-5 avoidance symptoms were associated with decreased odds of carrying a loaded firearm (OR = 0.676, 95% CI [0.488, 0.935], p = .018).

Findings highlight that specific PTSD symptom clusters are associated with discrete firearm storage and carrying behaviors. These results may inform more precise lethal means counseling approaches for veterans with PTSD and contribute to broader efforts to develop more tailored and effective suicide prevention interventions for this vulnerable population.

Ecological momentary assessment (EMA) enables real-time monitoring of suicidal thoughts, offering a window into dynamic risk processes that static assessments miss. However, it remains unclear whether patterns of EMA engagement-rather than the content of responses-carry clinical significance for suicide risk. This year-long prospective cohort study examined whether EMA engagement predicted daily suicidal ideation and clinician-assessed suicide attempts during the 12-month period among psychiatric outpatients at elevated suicide risk. Participants (N = 585; M age = 44.1 years, SD = 14.4; 64.4% female) completed daily EMAs via the MEmind mobile application. Engagement was indexed by (1) total EMA responses and (2) EMA consistency, defined as the cumulative proportion of days with at least one EMA completed. Mixed-effects models estimated associations between engagement and (a) daily active and passive suicidal ideation and (b) suicide attempts obtained from electronic health records. Quadratic models revealed an inverted-U relationship between EMA consistency and active ideation (β₂ = -185.55, p = .035). Higher EMA consistency predicted a lower likelihood of a suicide attempt (aOR = 0.72, p = .038), and this protective effect followed a nonlinear pattern (β₂ = -10.75, p = .031). Consistent EMA engagement was associated with reduced suicide-attempt risk, independent of demographic factors. Engagement itself, beyond self-reported ideation, may serve as a behavioral marker of suicidality.

Adolescents with hearing impairments may face elevated emotional risks related to personal traits and family environments. Guided by the differential susceptibility model, this study examined how environmental sensitivity was associated with depressive symptoms and whether parental overprotection showed indirect associations in hearing and hearing-impaired adolescents. A cross-sectional questionnaire survey was conducted with 2008 adolescents (1386 hearing and 622 hearing-impaired; 1006 males and 1002 females; mean age = 15.25 years, SD = 3.97) who completed measures of environmental sensitivity, perceived parental overprotection, and depressive symptoms. Mediation and network analyses were performed separately for the two groups. Results indicated that hearing adolescents reported higher environmental sensitivity, whereas hearing-impaired adolescents reported higher perceived parental overprotection and depressive symptoms. Maternal overprotection showed a significant indirect association between environmental sensitivity and depressive symptoms among hearing adolescents (β = 0.07, p < .001), whereas both paternal and maternal overprotection showed significant indirect associations among hearing-impaired adolescents (βs = 0.08, p < .001). Network analysis further showed distinct item-level network patterns: bridge nodes were distributed across three communities in hearing adolescents, but were primarily concentrated within parental overprotection and depressive symptom items in hearing-impaired adolescents. These findings suggest that parenting processes may be differently related to depressive symptoms in adolescents with and without hearing impairments. They also highlight the potential value of family-centered support tailored to adolescents with hearing impairments.

Treatment-resistant depression (TRD) is characterized by persistent symptoms and poor response to conventional therapies, yet its dynamic neural mechanisms and treatment-related changes remain incompletely understood. This study applied a hidden Markov model (HMM) combined with neurotransmitter atlas mapping to investigate whole-brain spatiotemporal dynamics in TRD and their modulation by electroconvulsive therapy (ECT). Resting-state fMRI data were collected from 72 TRD patients (52 completing follow-up) and 63 healthy controls. HMM identified six recurring brain states defined by distinct patterns of functional connectivity and averaged functional activity. At baseline, TRD patients showed reduced occupancy and stability of globally coordinated states and increased engagement of subcortical-dominant states, indicating impaired global stability and disrupted cortical-subcortical balance. After ECT, clinical symptoms improved significantly, accompanied by increased occupancy of states characterized by higher activity within the default mode and frontoparietal networks, as well as a highly integrated whole-brain state. These changes suggest improved overall brain coordination and cortical engagement rather than full normalization of baseline abnormalities. In contrast, subcortical-dominant states persisted after treatment, consistent with trait-like features of TRD. Neurotransmitter mapping showed that treatment-responsive states were associated with serotonergic, dopaminergic, and glutamatergic systems, whereas persistent subcortical states were linked to noradrenergic and cholinergic markers. Overall, these findings suggest that ECT improves symptoms by shifting brain dynamics toward more adaptive and integrated states, rather than fully restoring baseline function. This dynamic perspective provides new insight into the neural mechanisms of TRD and its treatment.

The Scoliosis Research Society-22 (SRS-22) is a legacy measure used to assess patient-reported outcomes of disease-related disability in adult spinal deformity (ASD), while the Patient-Reported Outcomes Measurement Information System (PROMIS) collects health domain scores (for example, Function) and offers a score relative to population norms. The authors sought to create linkage tables to allow comparison of prior outcomes research in ASD with the SRS-22 to more recent studies using PROMIS.

Patients with symptomatic lumbar scoliosis were enrolled and treated in a combined randomized and observational study and completed SRS-22 and PROMIS Function, Pain Interference, Anxiety, and Depression questionnaires at visits 2 to 8 years after enrollment. Correlations between the SRS-22 and PROMIS domains identified the most appropriate PROMIS domains for each of 3 SRS-22 subscales (Pain, Function, and Mental Health); equipercentile linking constructed linkages. Linkages were evaluated on the basis of bias, error, and criterion-related validity with other patient-reported outcome measures (PROMs), demographic characteristics, and treatment arm.

PROMIS Physical Function linked with SRS-22 Function (r = 0.80, 95% CI 0.75-0.84), PROMIS Pain Interference with SRS-22 Pain (r = -0.75, 95% CI -0.80 to -0.69), and PROMIS Anxiety with SRS-22 Mental Health (r = -0.71, 95% CI -0.79 to -0.62). Smoothing the linking functions yielded little difference in performance (bias, linking error); thus, smoothing was used to construct more continuous crosswalk tables linking the measures. Linking error was modest, suggesting linked scores are most useful for group mean, rather than individual, comparisons. Linkages are useful for yielding comparable scores to compare demographic groups (sex, age) and treatment arms (operative, nonoperative) in clinical research, but scores are not comparable in their relationships with related PROMs.

Linkages between SRS-22 and PROMIS domains allow data harmonization for comparing results of clinical and epidemiological research. Neither sex, age, nor treatment arm affected the interchangeability of the linked scores. There is a need for a PROMIS Self-Image instrument.

Etiological epidemiology and health surveillance are interdependent foundations of physical activity research, yet wearable devices have been adopted disproportionately across these 2 pillars of policy and practice. As physical activity research transitions from mostly self-reports toward a combination of mostly wearables and some self-reports, alignment between etiological evidence generation and surveillance systems is becoming increasingly important. We examine the goals, methods, and emerging convergence between wearable-based policy, surveillance, and etiological epidemiology.

This narrative review compares the wearable-based methods and metrics used for physical activity surveillance and for etiological research and draws on 2 contrasting case studies: the World Health Organization's surveillance-oriented standardization work and the harmonized research infrastructure of the Prospective Physical Activity, Sitting, and Sleep consortium. Building on these case studies and emerging evidence, we outline a 10-year roadmap toward a globally harmonized and translation-ready wearable evidence ecosystem.

Wearables capture high-resolution dimensions of physical activity including the intensity, accumulation patterns, and 24-hour composition of movement that questionnaires cannot resolve. Wearable-based studies have identified strong dose-response associations at substantially lower absolute activity volumes than currently recommended in national and global guidelines and enabled the emergence of novel behavioral phenotypes including activity fragmentation, movement timing, and physical activity micropatterns. However, substantial challenges remain, including methodological heterogeneity, incompatibility between questionnaire- and wearable-derived evidence, limited representation of low- and middle-income countries, and uncertainty around translation into surveillance and guideline frameworks. World Health Organization surveillance initiatives prioritize simple, scalable, and internationally comparable metrics, whereas etiological epidemiology can accommodate greater complexity and methodological innovation.

Convergence between surveillance and etiological epidemiology is both feasible and necessary, but requires harmonized wear protocols and reporting standards, capacity building and equitable infrastructure in underrepresented communities, and clear translation pathways between research-grade and policy-grade wearable metrics.

Rural communities in the US are experiencing the fastest growing rate of suicide, where firearms are the leading cause of death for youth ages 14 to 18. This study investigates the mental health and firearm exposure burden among this age group in rural Pennsylvania.

We analyzed survey results from 1570 high school students ages 14 to 19 to identify the local prevalence of firearm violence exposure. Logistic regression models estimated the association between exposure and depression among students and their interest in violence prevention education.

Results indicate a high prevalence of exposure to firearm violence overall, with only a third of students not exposed to any form. Exposure was associated with elevated odds of depression, especially among students reporting knowing someone who had tried to harm themselves with a firearm. Exposure was associated with elevated interest in several firearm safety topics related to risk identification and coping with trauma, although several topics had high broad interest.

These insights can translate into the adaptation of existing safety training and suicide prevention tools that are culturally sensitive, acceptable, and feasible to rural communities.

Existing prevention programs in rural schools may be refined to incorporate widespread exposure to firearm injury and broad interest in firearm safety education.

The therapeutic landscape for newly diagnosed multiple myeloma (NDMM) in China has evolved significantly with wider access to novel agents, including proteasome inhibitors (PIs), immunomodulatory drugs (IMiDs), and CD38 monoclonal antibodies. However, real-world data on treatment patterns and outcomes, particularly among high-risk subgroups, remain limited. The CHAMP-MM study aimed to evaluate real-world frontline and post-initial relapse treatment patterns and outcomes in NDMM patients, including high-risk subgroups, defined as those age ≥ 65 (elderly), with renal impairment (RI), and with 1q cytogenetic abnormalities. The study utilized electronic medical record data from five tertiary hematologic centers in China. Adult patients diagnosed with active MM between 2018 and 2022 were included and followed until last visit or end of study (December 31, 2023). A total of 1139 patients were analyzed, including 364 elderly, 148 with RI, and 334 with 1q abnormalities. PI+IMiD-based regimens were the most common frontline therapy (50.0%) overall, as well as in elderly patients and 1q subgroups, whereas PI-based regimens were more frequently used in RI patients. Only 25.1% of NDMM patients received autologous stem cell transplant after induction. Following initial relapse, PI+IMiD-based (32.6%) and CD38-based (30.9%) regimens predominated. Frontline overall response rates were approximately 80% across all groups, whereas the proportion of patients achieving very good partial response (PR) or better ranged from 60.9% to 75.1% across subgroups. While overall 12- and 24-month progression-free survival (PFS) rates remained high, outcomes were poorer in high-risk subgroups. This study reflects real-world treatment trends in China over 5 years and emphasizes the continued need for tailored treatment approaches in high-risk populations.

Rehabilitation needs in Switzerland are rising due to population ageing and the growing prevalence of non-communicable diseases. Yet, these needs are not comprehensively met and rehabilitation remains underrepresented in national strategies. Given the 2023 WHA Resolution on Rehabilitation, there is a growing need to understand how rehabilitation can be strengthened in Switzerland.

A national stakeholder survey identified challenges for strengthening rehabilitation, including financing and workforce issues, limited integration into primary care, and interprofessional collaboration, while main opportunities focused on policy development and advocacy efforts. Based on these findings, experts developed practical policy considerations through structured workshops and a consolidation survey.

The 22 considerations call for high-level commitment through a National Swiss Rehabilitation Alliance, financing reforms that value rehabilitation as investment, and expansion of affordable, high-quality services across all care levels, among others. They emphasize coordinated care pathways, quality mechanisms, workforce development, modern data systems, stronger research and knowledge translation, and equitable access to assistive technologies.

These considerations provide practical directions for integrating rehabilitation into national health priorities and advancing Swiss implementation of the WHA Resolution.