The acute ischemic stroke code that culminates in mechanical thrombectomy (MT) is accompanied by a significant amount of neuroimaging-CT head, CT angiogram of the head and neck, often a CT perfusion, and then the conventional angiogram performed by the neuroendovascular specialist. Immediately postprocedurally, patients who have undergone MT are at risk for reocclusion, hemorrhagic conversion of stroke, and malignant cerebral edema. While CT and MR imaging provide static images, transcranial Doppler (TCD) is becoming more commonly used to evaluate cerebral hemodynamics post-MT and screen for potential complications. Here, we outline the arguments for and against routine performance of TCD in the immediate post-MT phase of care.

Insulin-like growth factor binding protein 6 (IGFBP6) is thought to be associated with the progression of atherosclerosis (AS). However, whether IGFBP6 is involved in ferroptosis, a key biological process, in the progression of AS remains unclear. In this study, IGFBP6 expression was downregulated in oxidized low-density lipoprotein (ox-LDL)-treated human umbilical vein endothelial cells (HUVECs). Overexpression of IGFBP6 inhibited reactive oxygen species (ROS) production, reduced Fe2+ concentration and and inflammatory factor levels, and increased Glutathione (GSH) content in ox-LDL-treated HUVECs. Ferrostatin-1 (Fer-1), an inhibitor of ferroptosis, reversed IGFBP6 silencing induced ferroptosis of HUVECs. Mechanistic studies revealed that IGFBP6 is a target of Methyltransferase-like protein 3 (METTL3) that mediates N6-methyladenosine (m6A) modification, and YTH N6-methyladenosine RNA binding protein 2 (YTHDF2) recognizes and promotes METTL3-m6A-mediated IGFBP6 mRNA degradation. Downregulated IGFBP6 reduces its protein level by interacting with GPX4, thereby promoting ferroptosis in HUVECs. In addition, APOE-/- mice fed with a high-fat diet were used as an AS animal model, and the results showed that endothelial cell specific METTL3 knockdown or IGFBP6 overexpression hindered the development of AS in mice. In conclusion, knockdown of METTL3 inhibited the degradation of IGFBP6 mRNA in a YTHDF2 dependent manner, thereby inhibiting GPX4-mediated ferroptosis and alleviating AS progression. Insight Box This study provided new molecular targets for the effective treatment of AS. In this study, we constructed an AS cell model and an AS mouse model to explore whether METTL3 affects ferroptosis of HUVECs by regulating IGFBP6 expression through m6A modification through gain of function and loss of function experiments of METTL3 and IGFBP6, thus revealing the molecular mechanism of its involvement in the occurrence and development of AS. Results showed that METTL3 induced GPX4-mediated ferroptosis in HUVECs through m6A-YTHDF2-dependent downregulation of IGFBP6, thereby promoting the progression of AS. These findings suggest that interfering with the METTL3/YTHDF2/IGFBP6/GPX4 axis with small molecules or gene therapy may be a new strategy to intervene the occurrence and development of AS.

Large language models (LLM) and generative Artificial Intelligence are increasingly providing health information. We have applied a novel method to evaluate the harm reduction information generated by popular LLMs. We focused on the filtration of oral medications for injection and the availability of local harm reduction services.

We designed a scoring rubric to evaluate the accuracy of the information provided by each LLM and applied it to four unique, commonly used LLMs.

Gemini 2.5 Flash (87%) and ChatGPT-4o (77%) scored higher than DeepSeek R1 Distill Llama 3.3 70B (22%) and Llama 4 (18%). Overall, both Gemini and ChatGPT-4o gave comprehensive and accurate instructions for the use of micron filters for drug injection, while neither DeepSeek R1 nor Llama 4 provided instructions on their use. Gemini 2.5 and ChatGPT-4o both scored highly for harm reduction general information and situational questions, while DeepSeek R1 and Llama 4 provided limited to no responses. Gemini 2.5 and ChatGPT-4o both provided accurate, location-specific information on local harm reduction services. Specific models also generated misinformation, further affirming the need for in-person, nuanced discussions with harm reduction specialists.

In this study, we presented a novel method for evaluating LLMs' potential effectiveness for harm reduction across common techniques and situations. Most of the tested LLMs provided reasonable information in a non-judgmental manner, but they also provided misinformation, and some wouldn't answer questions due to built-in safety parameters. The developed scoring rubric can be easily adapted to other harm reduction topics for ongoing evaluation.

Maternal mental health (MMH) remains a critical public health issue across Sub-Saharan Africa (SSA). Despite the high burden, access to culturally appropriate and evidence-based mental health interventions remains limited. This scoping review examines interventions targeting mental health outcomes for pregnant and postpartum women across SSA countries. Guided by PRISMA-ScR and Arksey and O'Malley's framework, a comprehensive search was conducted across 14 electronic databases for peer-reviewed intervention studies published in English between 2000 and March 2026. A total of 57 studies across 18 SSA countries were identified with interventions primarily focused on the individual or mother-infant level. The majority used strong research methods, with widely varying intervention content, including cognitive-behavioral therapy, problem-solving therapy, psychoeducation, and community-based programs, often delivered by community health workers, focusing on problem-solving skills, and involving cash transfers. While most studies reported reductions in depressive symptoms and improved psychosocial outcomes, few addressed scalability, health system integration, or cost-effectiveness. Few studies worked with health professionals or included technology interventions. A wide range of mental health interventions show promise in addressing perinatal mental health in SSA. However, gaps remain in scaling up sustainable, culturally relevant, and system-integrated interventions. Future efforts should prioritize provider education, health system strengthening, and evaluation of economic impact to enhance MMH outcomes across the region. To have a significant impact on perinatal mental health, future interventions that focus on cost-effectiveness, scalability, health professions education, and integration of technology are needed.

The significance of community mental health workers in coordinating hospital discharge of patients with diagnosed mental health conditions is globally recognised, yet research on their experiences is scarce. This study contributes to knowledge through a qualitative empirical intrinsic case study of community mental health workers' experiences. This study aimed to explore community mental health workers' experiences of care-coordinating patients diagnosed with mental health conditions discharged from the hospital into community mental health integrated services. Guided by constructivist inquiry, the qualitative study focused on co-constructing meaning to understand community mental health workers' experiences in care coordination. Two theoretical lenses informed the study: Ecological Systems Theory, to understand multi-level influences, and Normalisation Process Theory, to explore how care coordination practices are embedded in discharge processes. Fourteen community mental health workers aged 18 and above were recruited from one NHS Trust in Northwest England from October 2021 to June 2022. Data were collected through semi-structured interviews, audio-recorded, transcribed verbatim, and analysed using reflective thematic analysis, generating themes and subthemes. Analysis identified 13 subthemes grouped into four major themes: (1) Experiences of collaborative working; (2) Challenges and enablers to care coordination; (3) Experiences of organisational system and culture; and (4) Community Mental Health Workers' personal experiences of professional growth. Findings highlight poor communication, staff shortages, high caseloads, limited community mental health services, and challenges in care coordination. The study provides valuable insights for improving community mental health workers' clinical practice and informs future research and policy development in community mental health care.

The COVID-19 pandemic increased perinatal mental health needs and disrupted routine obstetric care, disproportionately affecting Black and economically disadvantaged communities. Michigan's Perinatal Collaborative Care Model (Peri CoCM), a publicly funded virtual program, launched during the pandemic and continued after the public health emergency. This qualitative study examined participant experiences with Peri CoCM, including perceived usefulness, acceptability, and barriers/facilitators to engagement, particularly among marginalized perinatal people to inform post-COVID service delivery.

Eligible participants were pregnant or up to one year postpartum Peri CoCM patients recruited from a May-July 2025 referral cohort. Nine women ages 27-42 completed one-hour, semi-structured Zoom interviews between August and September 2025; the sample intentionally overrepresented self-identified Black women. Interviews were recorded, transcribed, verified against audio, and analyzed by a coding team using grounded-theory-informed thematic analysis with constant comparison.

Participants reported positive experiences with Peri CoCM across four thematic areas: (1) Pathways to care, (2) Perceived impacts of program, (3) Importance of culturally responsive care, and (4) Recommendations for program optimization. Trusted referrals from obstetric and other providers facilitated entry into care, often for anxiety, depression, grief, or first-time mental health support. Participants described Peri CoCM as accessible, supportive, and valuable during pregnancy and postpartum. Virtual options, flexible scheduling, compassionate behavioral health clinicians, and consistent follow-up reduced barriers and promoted openness. The short-term model helped some transition to longer-term therapy, while clinicians supported insurance navigation, medication decisions, and community resource connections. Participants gained coping skills, validation, and self-understanding. They emphasized culturally responsive provider fit and recommended longer continuity, broader wraparound services, and sustained no-cost access to reduce stress and improve engagement.

Michigan's Peri CoCM was perceived as a low-barrier, relationship-centered, culturally responsive virtual pathway supporting perinatal wellbeing and systems navigation in the post-COVID era. Cost transparency and flexible delivery were central to acceptability and expanded access to equitable care.

Postpartum depressive symptoms are common and can adversely affect maternal and infant health. Traditional Chinese medicine health literacy may play an important role in promoting physical and mental recovery during the puerperium. However, evidence regarding the association between traditional Chinese medicine health literacy and postpartum depressive symptoms remains limited, and the underlying mediating mechanisms are unclear.

To explore the relationship between Traditional Chinese Medicine health literacy and depressive symptoms in postpartum women, and to examine the sequential mediating role of social support and self-efficacy.

Using convenience sampling, this cross-sectional study was conducted in Chengdu, China from December 2025 to April 2026. A total of 501 postpartum women completed measures of traditional Chinese medicine health literacy, social support, self-efficacy, and depressive symptoms. After adjusting for covariates, sequential mediation was examined by PROCESS 4.1 Model 6. Bias-corrected bootstrap (5,000 resamples) was used to generate 95% confidence intervals; indirect effects were deemed significant if the interval did not include zero. All tests were two-tailed with α = 0.05.

The scores of traditional Chinese medicine health literacy, postpartum social support, self-efficacy, and depressive symptoms were (118.21 ± 14.56), (47.72 ± 11.41), (29.22 ± 6.44), and (7.16 ± 4.99), respectively. Depressive symptoms were significantly negatively correlated with traditional Chinese medicine health literacy, social support, and self-efficacy (all p < 0.001). Traditional Chinese medicine health literacy exerted a direct negative effect on depressive symptoms (β = -0.206, 95% CI: -0.299 to -0.112). In addition, three significant indirect pathways were identified: the independent mediating pathway through social support (β = -0.102, 95% CI: -0.167 to -0.050), the independent mediating pathway through self-efficacy (β = -0.102, 95% CI: -0.148 to -0.059), and the sequential mediating pathway from social support to self-efficacy (β = -0.033, 95% CI: -0.053 to -0.018). The total indirect effect accounted for 53.6% of the total effect.

Intervention strategies designed to improve postpartum women's traditional Chinese medicine health literacy, strengthen social support and boost self-efficacy may aid the prevention and control of postpartum depressive symptoms. The actual effectiveness of relevant intervention programs needs to be further verified in subsequent longitudinal studies and intervention trials.

The health workforce in Bangladesh is undergoing demographic and structural changes, including increasing feminization and imbalances in specialty distribution. Understanding career choices among young doctors is important for workforce planning. A concurrent mixed-methods study was conducted in 2023 among 159 young medical professionals. Quantitative data were analysed using descriptive and inferential statistics, whereas qualitative data from interviews were analysed thematically. The findings from both components were integrated through triangulation, and an ecological model of career progression was developed to synthesize multilevel influences. Participants were mostly female (59.7%) with a mean age of 26.1 years. Almost all (99.4%) intended postgraduate training, mainly in clinical fields (93.0%), with medicine (53.5%) and surgery (34.0%) most preferred. Government service was the top career choice (65.4%). A large proportion also expressed interest in studying abroad (79.9%), and 28.3% planned permanent migration. Career decisions were influenced by work-life balance (91.2%), mental satisfaction (85.5%), personal interest (84.3%), and family responsibilities (76.7%). Qualitative findings revealed that career progression is often unplanned and delayed due to limited guidance, restricted exposure to non-clinical careers, and early career uncertainty. Structural barriers included lengthy recruitment processes, limited postgraduate training opportunities, inappropriate workplace conditions, and restricted career advancement in both the public and private sectors. Overall, career progression reflects interacting influences at individual, social, training, institutional, and policy levels, with global opportunities serving as an alternative pathway amid perceived domestic constraints. Career progression among young doctors in Bangladesh is influenced by both individual motivations and structural constraints. Strengthening career guidance, expanding training opportunities, and improving working conditions are essential for building a balanced and sustainable health workforce.

Adolescent suicide constitutes a critical public health challenge in low-income and middle-income countries (LMICs), where structural deficits in mental health infrastructure compound an already substantial burden. In Nigeria, where suicidal ideation among secondary school students has been documented at a lifetime prevalence of 22.9%, curative clinic-based responses are neither scalable nor sustainable. School-based universal interventions offer a pragmatic upstream alternative. The Youth Aware of Mental Health (YAM) programme has demonstrated robust efficacy in European contexts, reducing incident suicide attempts by approximately 50%; however, its transferability to the West African educational and cultural environment remains untested. This protocol describes a study designed to culturally adapt YAM for Nigerian secondary schools and assess the feasibility of conducting a definitive cluster randomised controlled trial in Lagos State.

This study employs a hybrid type 1 effectiveness-implementation design, structured as a two-arm parallel-group cluster randomised feasibility trial across 10 public secondary schools in Lagos State. Approximately 600 adolescents aged 13-17 years will be recruited. Prior to the trial, YAM will be systematically adapted using the Method for Programme Adaptation through Community Engagement framework, producing the YAM-Nigeria curriculum. Schools will be randomised to receive either the culturally adapted YAM-Nigeria programme (five sessions of 45-60 min each delivered by trained external facilitators) or enhanced usual practice (standard health education curriculum supplemented with suicide awareness materials). Primary feasibility outcomes include school recruitment rates (target ≥60%), student consent rates (target ≥70%), retention at the 3-month follow-up (target ≥75%), implementation fidelity (target ≥80% adherence) and acceptability (target ≥70% student satisfaction). Secondary exploratory outcomes include suicidal ideation, depression, mental health literacy, stigma and help-seeking behaviour, measured to estimate the SD and intraclass correlation coefficient required to power a future definitive trial. Progression to a definitive phase III trial will be governed by pre-specified traffic light criteria.

Ethical approval has been granted by the Lagos State University Teaching Hospital Health Research Ethics Committee (Ref: LREC/06/10/2656) and the Liverpool School of Tropical Medicine Research Ethics Committee (Ref: RGETEM045). A two-stage consent process requiring written parental consent and adolescent assent will be implemented. Findings will be disseminated through open-access peer-reviewed publications, policy briefs for the Lagos State Ministries of Health and Education and plain-language summaries for participating communities.

ISRCTN registry, ISRCTN69846459. Registered on 24 November 2025.

To identify actions of primary care physicians (PCPs) that influence referral to specialist assessment for dementia from the perspective of people with symptoms of dementia and/or their significant others.

A descriptive qualitative design was used, involving 33 semistructured interviews that explored presenting symptoms, consultations with health professionals, tests undertaken and challenges encountered while navigating the prediagnostic phase of dementia. Interview data were mapped deductively to the Candidacy Framework to examine engagement with PCPs and to identify participant-perceived actions that facilitated or impeded timely diagnosis.

Online interviews were conducted between August 2022 and June 2023 with participants across Australia.

Participants were 37 people who had navigated the dementia diagnosis process as a patient or significant other (partner/spouse, adult child, sibling or friend).

Successfully communicating concerns and asserting candidacy was described by participants as determining the diagnosis trajectory. Participants reflected that PCPs assessed available information to determine the need for specialist referral. Participants detailed that following PCP referral and support provision, diagnosis proceeded to a specialist. We also identified participant-reported system-level and PCP-related barriers to facilitating a timely diagnosis, including PCP time-constraints and workload-constraints, dementia-specific knowledge and referral pathway inconsistency. From participants' perspectives, access to a specialist referral and timely diagnosis was facilitated or impeded by an interplay of actions by people experiencing symptoms, significant others, and PCPs.

Primary care barriers and enablers to timely diagnosis spanned across patient, significant other, PCP and system levels. Recommendations to provide timely, accurate and equitable dementia diagnoses include (1) Raise community awareness of dementia symptoms, helping people communicate their concerns effectively with their PCP; (2) Enhance PCP knowledge of dementia to improve their ability to refer and diagnose and (3) Develop clear diagnostic pathways to ensure that individuals receive the appropriate diagnosis and care they need.