The introduction of Egypt's national nursing pre-licensure examination has created new academic and psychological challenges for final-year nursing students, particularly because of limited familiarity with the examination format and insufficient structured preparation resources. Although combined examination-preparation and stress-management programs may improve students' readiness, evidence regarding their effectiveness in reducing perceived stress among Egyptian nursing students remains limited. To evaluate the effect of a structured Maintenance of Certification-based training program on perceived stress among final-year nursing students preparing for the Egyptian national pre-licensure examination. A quasi-experimental comparative study was conducted among 1000 final-year nursing students recruited from 8 nursing faculties across Egypt. Participants were allocated to an intervention group that received a four-week structured training program comprising theoretical review, mock examinations, individualized feedback, and stress-management strategies, or a control group that continued with the standard curriculum. Perceived stress was assessed before and after the intervention using the 10-item Perceived Stress Scale. Data were analyzed using independent-samples and paired-samples t-tests, analysis of variance, and multiple linear regression. Baseline perceived stress scores were comparable between the intervention and control groups (28.8 ± 5.7 vs 29.2 ± 6.0, P > .05). Following the intervention, the intervention group had a significantly lower mean stress score than the control group (12.1 ± 3.2 vs 31.1 ± 7.1, P < .001). Perceived stress decreased significantly within the intervention group, whereas it increased significantly within the control group (both P < .001). Higher academic GPA, good computer skills, and prior knowledge of the pre-licensure examination were significant predictors of lower post-intervention stress, while smoking was associated with higher stress. The regression model explained 54% of the variance in post-intervention perceived stress. The structured training program was associated with a substantial reduction in perceived stress among nursing students preparing for Egypt's national pre-licensure examination. Integrating structured examination preparation and psychological support into final-year nursing curricula may improve students' readiness for the transition from education to professional practice.

Bipolar disorder (BD) is a chronic psychiatric illness. Thyroid hormones play a crucial role in maintaining normal brain function and have a significant impact on mood regulation and neuroendocrine activity. Increasing evidence suggests that thyroid dysfunction is closely related to the onset, progression, and severity of BD. A systematic bibliometric analysis of this field is important for understanding its research trajectory and identifying emerging hotspots.

Literature on BD and thyroid hormones published between 1998 and 2022 was retrieved from the Web of Science Core Collection. Data were analyzed and visualized using VOSviewer and CiteSpace software to explore publication trends, major contributing countries and institutions, authors, journals, and keyword characteristics.

A total of 452 relevant publications were identified, covering 229 journals, 2318 authors, 1443 institutions, and 188 countries. The United States, China, and Germany were the most active countries in this field. Major contributing institutions included the University of California, Los Angeles, the University of Toronto, and the Technical University of Dresden. Leading scholars were Bauer M, Whybrow PC, and Rybakowski JK. The Journal of Affective Disorders published the most relevant papers. Keyword analysis revealed that research hotspots mainly focused on BD, thyroid function, and depression, particularly around themes such as "risk," "affective illness," and "bipolar affective disorder."

The relationship between thyroid hormones and BD has become an important research focus in recent years, providing new directions for future studies in this field. This study systematically reveals the research landscape and developmental trends from 1998 to 2022, offering valuable references and guidance for future research and clinical practice.

Objective neural markers that reflect the underlying pathophysiological mechanisms of affective disorders are needed to facilitate early identification of individuals most at risk of future affective disorders and ultimately provide neural targets to guide therapeutic interventions. Using an emotional n-back paradigm designed to examine working memory (WM) and emotional regulation (ER) capacity, we previously showed that WM-related elevated left dlPFC activity (a key node of the central executive network (CEN)) and elevated right precuneus activity (a key node of the default mode network (DMN)), as well as ER-related elevated left dlPFC activity were positively associated with future depression severity in young adults at risk for affective disorders. We now aimed to replicate and extend these previous longitudinal findings by examining relationships among right precuneus activity and left dlPFC activity during WM and ER tasks and future depression severity in a new independent young adult sample (n = 77: 50 female, age = 24.68), and a larger combined sample (n = 121: 83 female, age = 23.81) comprising the original and new samples. The Hamilton Rating Scale for Depression (HAM-D) and Young Mania Rating Scale (YMRS) were measured at 12 months post scan to assess future depression and mania/hypomania severity respectively. In the new sample, we showed patterns of left dlPFC activity and right precuneus activity during WM, and left dlPFC activity during ER that were consistent with the original sample. In both the new and combined samples, future depression severity was robustly predicted by WM-related left dlPFC activity and right precuneus activity, and ER-related left dlPFC activity (all ps < 0.05 qFDR). These findings were specific to future depression severity. The effect sizes (pseudo R-squared values) for the full models including all IVs in the new and combined samples ranged from approximately 25-43%, with left dlPFC and right precuneus activity during WM explaining 15.59% of variance in future depression severity in the new sample; and left dlPFC activity during ER explaining 14.63% of variance in future depression severity in the combined sample. These replicated, longitudinal findings provide candidate neural markers to guide risk identification and targeting of new interventions for individuals with and those at risk for future affective disorders.

Impulsivity is a defining feature of borderline personality disorder (BPD), yet it remains unclear whether it reflects a stable deficit in inhibitory control or a context-dependent breakdown in behavioural regulation under conditions of emotional arousal. Existing models variably emphasise trait, cognitive or affective mechanisms, with limited integration of contextual influences. This scoping review synthesised empirical evidence examining affective mechanisms, neurobiological and methodological accounts of impulsivity in BPD.

Following PRISMA-ScR guidelines, CINAHL, EMBASE, EMCARE, MEDLINE, and PsycINFO were searched for studies published between 1980 to November 2025. Forty-six studies meeting inclusion criteria were synthesised across affective, neurobiological, and methodological domains. Study designs included cross-sectional/correlational investigations (n = 17), experimental or task-based paradigms (n = 13), neuroimaging studies (n = 11), lesion or quasi-experimental designs (n = 3), and randomised controlled trials (n = 2).

Impulsive behaviour in BPD was most consistently associated with affective instability, with negative urgency emerging as the most robust correlate. Self-report measures showed consistent elevations, whereas behavioural measures of inhibitory control under neutral conditions yielded heterogeneous findings, with several studies indicating preserved performance. Impairments were more reliably observed under emotionally salient or stress-inducing conditions. Neurobiological findings converged on dysregulation within frontolimbic and salience networks, particularly amygdala-prefrontal circuitry. Convergence across measurement modalities was limited, highlighting substantial heterogeneity.

Evidence supports a model in which impulsivity in BPD reflects affect-modulated, context-dependent behavioural dyscontrol rather than a pervasive trait-level deficit. Heightened negative urgency and disrupted amygdala-prefrontal regulation appears central, linking affective instability to impulsive behaviour. These findings support mechanism-informed and context-sensitive approaches to assessment and intervention.

The interrelationship between unemployment and substance use disorders, especially opioid use disorders, is complex, and basic epidemiological data are lacking both in Germany and elsewhere. This study aimed to evaluate the prevalence rates of opioid use disorder, work ability, and associated factors among unemployed individuals with opioid use disorder who underwent socio-medical assessment by the Medical Service (MS) of the Federal Employment Agency (FEA).

All socio-medical assessments conducted between 2016 and 2021 (N = 4,249,028) were extracted from the FEA database and analyzed with respect to relevant sociodemographic characteristics, opioid use disorder (ICD-10 F11.x diagnosis) and work ability. Descriptive statistics were used to summarize the data.

A total of 4,249,028 unemployed individuals were assessed. Of these, 22,683 clients (0.5%) met an F11.x diagnosis (primary or secondary); mostly opioid dependence (N = 20,506; 94.3%). The number of diagnoses increased over time (2016-2021). Mean age was 40.7 ± 9.4 years. Overall, 15,065 (73.5%) were male and 5,441 (26.5%) were female. For individuals with a secondary diagnosis of F11.x, most frequent psychiatric comorbidities were alcohol dependence (27.8%), polysubstance use (17.6%), schizophrenia (8.8%), depression episode (8.3%) or recurrent depression (5.9%) and persistent pain disorder (6.1%). Regarding daily work capacity, 58.3% (n = 11,962) of individuals were able to work less than 3 h per day, 10.0% (n = 2,051) were able to work 3-6 h per day, and 17.4% (n = 3,568) were able to work more than 6 h per day.

The number of unemployed individuals with opioid dependence in Germany has increased over time, and most are unable to work more than three hours per day. The most frequent psychiatric comorbidities were other substance use disorders, particularly alcohol use disorder, schizophrenia, and depression. Somatic comorbidities, with the exception of chronic viral hepatitis, were recorded less frequently. Tailored interventions and closer collaboration between employment agencies and mental health care providers are needed to improve the psychosocial integration of this population.

Inflammatory bowel disease (IBD) and ankylosing spondylitis (AS) are common autoimmune disorders that have a serious impact on the physical and mental health of patients. Some patients with AS also suffer from IBD, and some studies have shown that there is a link between the 2. However, the causal relationship between the 2 is not clear. This study aimed to infer a causal relationship between IBD and AS using Mendelian randomization (MR) analysis. We obtained genome-wide association study data related to IBD and AS from the Integrative Epidemiology Unit database and the Finnish database to infer the causal relationship between IBD and AS. MR analyses were performed using 3 methods, mainly inverse-variance weighting (IVW). The robustness of causal effects was ensured by multiple methods (instrumental variables were assessed using F-values, heterogeneity was detected by Cochran's Q, horizontal pleiotropy was assessed by MR-Egger regression, and outliers were detected by Mendelian Randomization Pleiotropy RESidual Sum and Outlier and leave-one-out methods). Subsequently, we selected genome-wide association studies data from 3 different databases for an independent two-sample MR analysis and a meta-analysis based on 3 independent MR estimates to assess the causal relationship between IBD and AS. There was a positive causal relationship between Crohn disease (CD) and AS with IVW results (odds ratio = 1.19, 95% confidence interval = 1.12-1.27; P <.01). There was a positive causal relationship between ulcerative colitis (UC) and AS with IVW results (odds ratio = 1.60, 95% confidence interval = 1.28-2.00; P <.01). Neither CD nor UC had an inverse causal relationship with AS. In order to verify the accuracy of the results, we performed a meta-analysis of the results obtained from the 3 MR analyses, and the results were consistent with the results we had previously obtained. CD and UC may increase the risk of AS.

Although previous studies have assessed the role of statins in managing cardiovascular risk and reducing blood pressure, few have examined their use patterns in relation to hypertension control at population level. This study addresses this gap among Iranian hypertensive patients.

A cross-sectional analysis was conducted using data from the 2021 WHO STEPwise approach to Non-communicable Disease Risk Factor Surveillance (STEPS) in Iran, encompassing all 31 provinces. The study included 6,216 adults aged ≥ 25 years with hypertension, defined as systolic blood pressure (SBP) ≥ 140 mmHg, diastolic blood pressure (DBP) ≥ 90 mmHg, or current use of antihypertensive medication. Participants with missing data for key variables were excluded. Logistic and linear regression models were used to examine associations between statin use, demographic and clinical characteristics, and blood pressure control (SBP < 140 mmHg and DBP < 90 mmHg).

Among included 6,216 hypertensive patients, 1,815 (29.2%) were statin users, predominantly older (mean age: 61.79 years) and female (63.14%). Statin use was significantly associated with a 2.04 mmHg reduction in SBP (95% CI: -3.59, -0.48), whereas the association with DBP was non-significant (0.38 mmHg increase in (95% CI: -0.67 to 1.44). In fully adjusted models, statin use was not associated with blood pressure control (OR = 0.98, 95% CI: 0.79-1.21).

Despite the high frequency of comorbidities in patients with hypertension, statin use remains low, which needs to great attention by clinicians. In addition, the observed association between statin use and blood pressure in current study is required to further clinical trials or cohort studies to confirm.

The online version contains supplementary material available at 10.1007/s40200-026-02018-y.

The purpose of this study was to understand the experiences and challenges with diabetes management and physical activity faced by adults with Type 1 Diabetes Mellitus (T1DM), as well as gather feedback on proposed features for a digital health tool, to inform the development of T1DM-tailored interventions.

US-based participants who had T1DM for at least 6 months were recruited online through social media and healthcare platforms. Data were collected through two semi-structured interviews focused on aim (1) understanding lived experiences with managing T1DM during physical exercise and the role of digital tools in exercise routines and aim (2) participant preferences on proposed digital tool features.

Thematic data analysis revealed four major themes for aim 1: (1) lifestyle patterns, (2) motivations and barriers to exercise, (3) confidence with technology, and (4) T1DM-specific application with networking and accountability features. For aim 2, four themes were identified: (1) data interface, (2) tailored coaching and diverse representation, (3) T1DM-specific stigma, and (4) prior experience and current diabetes self-management goals.

It is essential that a digital health tool for people with T1DM offers personalized exercise support that adapts to real-time glucose measurements. The tool should provide educational content, facilitate peer interaction, and integrate with continuous glucose monitors and insulin pump technologies. By incorporating features specifically designed for the T1DM community, a digital health solution can improve diabetes management and promote an active lifestyle.

To assess the burden and temporal trends of blindness and vision loss attributable to type 2 diabetes mellitus (T2DM) in young adults aged 20-39y from 1990 to 2021.

Cross-sectional datasets were extracted from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021. Prevalence and years lived with disability (YLDs) metrics were applied to quantify temporal changes in blindness and vision loss across 1990-2021. Data were stratified by global, regional, and socio-demographic index (SDI) tiers, and further split by age and sex for comprehensive subgroup analysis. Joinpoint regression was adopted to detect inflection points of trend shifts. A Bayesian age-period-cohort model was utilized to forecast disease burden projections for 2045.

Globally, the prevalence of T2DM-related blindness and vision loss in young adults (20-39y) rose from 4.7 per 100 000 population in 1990 to 6.4 per 100 000 population in 2021 [average annual percentage change (AAPC)=1.03; P<0.001]. The YLD rate likewise increased from 0.5 per 100 000 in 1990 to 0.7 per 100 000 in 2021 (AAPC=1.02; P<0.001). Southeast Asia and Grenada bore the highest prevalence, whereas Central Latin America and Cambodia exhibited the highest YLD rates. Both prevalence and YLD rates increased markedly within the high-SDI quintile. Singapore was the only setting presenting declining prevalence and YLD trends. Females experienced steeper rises than males in prevalence (AAPC: 1.16 vs 0.88) and YLDs (AAPC: 1.16 vs 0.82).

The global disease burden of early-onset T2DM-induced visual impairment has increased substantially among 20-39-year-old individuals, particularly in high-SDI regions, with females facing a greater rising prevalence burden. Targeted intervention measures are warranted to guide integrated population-level prevention and clinical management frameworks.

Diabetic retinopathy (DR) is conventionally recognized as a microvascular complication of diabetes mellitus. Nevertheless, accumulating evidence confirms that early retinal neurodegeneration develops in the course of diabetes and drives early visual impairment. Multiple studies have verified that abnormal retinal neural responses frequently emerge before identifiable microvascular lesions. This review therefore systematically summarizes existing evidence confirming retinal neurodegeneration as a core, early pathological event in diabetic retinal disease (DRD), elaborates the cellular and metabolic mechanisms of neurodegeneration inside the retinal neurovascular unit (NVU), and assesses novel neuroprotective therapeutic modalities. Retinal neurodegeneration manifests prior to clinically apparent microvascular complications. NVU dysfunction, triggered by neuroinflammation, oxidative stress, advanced glycation end products (AGEs), excitotoxicity and mitochondrial dysfunction, serves as the pivotal pathway mediating neuronal injury. Notably, current vasculotropic therapies fail to effectively block early neuronal dysfunction. By comparison, neuroprotective interventions targeting oxidative stress, inflammatory cascades, glial dysfunction, deficient neurotrophic supply and mitochondrial damage exhibit promising effects on maintaining retinal neuronal architecture and function. In conclusion, retinal neurodegeneration constitutes a core pathological cascade of DR. Incorporating neuroprotective regimens into established treatment systems facilitates earlier intervention, optimizes visual function prognosis, and ultimately transforms the clinical management paradigm of DRD toward retinal neural protection.