AimTo explore studies on mental health support and educational programs for new graduate nurses to enhance their workplace adaptation, job satisfaction, and well-being.BackgroundNew graduate nurses face significant mental health challenges during the transition to practice, contributing to high turnover rates.MethodsThis scoping review used Arksey and O'Malley's framework and Joanna Briggs Institute's methodology to identify quantitative and mixed-methods studies in English or Japanese, published between January 2014 and July 2024, involving new graduate nurses within 12 months of graduation.ResultsOf 1,024 records, 14 studies were included. The analysis identified three categories of mental health support programs (clinical nurse educator-led mentorship, mindfulness-based interventions, and workplace environment support) and four types of educational programs (resilience education, communication skills training, positive psychology interventions, and stress management education). Research gaps included limited evidence regarding long-term effectiveness and the lack of standardized measurement tools.ConclusionExisting programs show promise; however, researchers need to conduct rigorous, longitudinal, multisite studies using standardized measurement tools, along with research that evaluates program sustainability, cost-effectiveness, and cultural adaptability.

Three objectives guided this study: (1) to test whether a brief, two-week running intervention changes heart rate variability (HRV) and mental-health parameters; (2) to examine whether running alone versus in groups differentially affects these outcomes; and (3) to assess whether participants' gender moderates these effects.

131 young adults with sedentary lifestyles were randomized to an individual (solo) running condition, a group-running condition, or a waitlist control, and were assessed before and after the two-week intervention.

Primary self-report outcomes were perceived stress, positive affect, negative affect, and depressive symptoms. Autonomic regulation was indexed by different HRV measures quantifying both parasympathetic and sympathetic aspects of autonomic function, derived from ECG recordings obtained pre- and post-intervention.

There were no general effects of running on any HRV index, in either the solo or the group-running condition. However, HRV changes were moderated by gender and running context, as evidenced by significant TIME × GROUP × GENDER interactions in vagally mediated (parasympathetic) indices: among women, HRV increased particularly in the group-running condition, whereas among men, HRV increases were observed primarily in the solo condition.

This exploratory study indicates that HRV might not generally adapt to physical activity, but rather depends on individual or contextual factors such as gender and running context (in groups versus solo). The findings reinforce the value of HRV metrics as a tool to further support the role of physical activity in enhancing overall health and underscore the importance of tailoring physical activity interventions to individual characteristics.

Perimenopause is associated with increased vulnerability to depressive symptoms, partly driven by fluctuations in gonadal steroid hormones, particularly estradiol. The neurobiological mechanisms underlying this vulnerability remain unclear. Alterations in the endocannabinoid system (ECS) during perimenopause may represent a mechanistic pathway contributing to mood disturbance, given its role in emotion regulation and stress responsivity, as well as its modulation by estradiol. However, circulating endocannabinoids have not been examined in relation to perimenopausal depressive symptoms or estradiol variability.

This secondary analysis included 242 repeated measures from 38 perimenopausal women with untreated mild-to-moderate depressive symptoms enrolled in an 8-week longitudinal observational study. Linear mixed models evaluated: (i) associations of endocannabinoids (N-arachidonoylethanolamine [AEA], 2-arachidonoylglycerol [2-AG]) and related lipids (palmitoylethanolamide [PEA], oleoylethanolamide [OEA], 2-oleoylglycerol [2-OG]) with depressive symptom severity; (ii) longitudinal changes in these analytes; and (iii) associations between ECS-related lipid analytes and estradiol concentrations. Exploratory analyses examined progesterone associations.

Higher PEA concentrations were inversely associated with depressive symptom severity (β = -0.27; 95% CI [-0.49, -0.05]; p = 0.01), independent of estradiol variability. AEA concentrations declined significantly over time (β = -0.04, p < 0.0001), independent of estradiol variability and history of major depressive disorder. No significant associations of estradiol or progesterone concentrations with endocannabinoid-related analytes were observed.

Select endocannabinoids and related lipids show distinct patterns during the menopausal transition. Associations of higher PEA concentrations with lower depressive symptom severity potentially reflect modulation of neurosteroid and inflammatory pathways implicated in perimenopausal mood disturbances. In contrast, declining AEA may reflect reduced endocannabinoid signaling, contributing to vulnerability to depressive symptoms.

Early life adverse experience, whether prenatal or postnatal, is a prevalent risk factor for altered trajectories of biological development, often culminating in comorbid metabolic and psychiatric disorders in adulthood, which represent a substantial public health burden. In this article, we review evidence that adversity-induced metabolic reconfiguration, specifically involving insulin sensitivity and glucose homeostasis, disrupts developmental processes in neural circuits governing stress regulation, reward learning, and executive control. We discuss how this "metabolic embedding" contributes to specific psychiatric phenotypes, with an emphasis on immuno-metabolic depression. Furthermore, we examine how genomic information can be leveraged to enhance individual-level prediction of at-risk subjects, moving beyond static polygenic risk scores toward biologically informed metrics such as expression-based polygenic scores. We propose a lifespan framework that integrates metabolic, neurobiological, and genomics to advance precision prevention.

Stress is increasingly recognized as a key determinant of aging-related health outcomes, yet the pathways linking stress to epigenetic aging remain ill-defined. Here, we outline a multilevel conceptual framework of stress, where stressors interact with resilience (e.g., emotion regulation, social support) and vulnerability to shape acute and repeated or sustained stress responses that mediate long-term aging trajectories. In the context of this framework, we evaluate the evidence across childhood adversity, traumatic events, chronic stressors, and social determinants of health and identify generally consistent effects of stressors on increased epigenetic age in second- and third-generation clocks, which are moderated by resilience and vulnerability. We find clear evidence for mediation of these effects via maladaptive behavioral stress responses as well as more nuanced results suggesting links between maladaptive psychological and physiological stress response pathways and increased epigenetic age. We conclude with recommendations to harmonize stress measurement, analytic approaches, and clock selection using this conceptual framework to advance our mechanistic understanding of the relationship between stress and epigenetic aging.

In 2016, Nepal adopted the World Health Organization's Package of Essential Non-Communicable Disease Interventions (PEN) to address the rising burden of non-communicable diseases (NCDs). This study evaluated the primary healthcare system's readiness to prevent and manage major NCDs, including cardiovascular diseases (CVDs), diabetes mellitus (DM), and chronic respiratory diseases (CRDs); and explored factors associated with NCD service readiness.

We conducted a convergent parallel mixed-methods study between 2020 and 2022. We adapted the WHO Service Availability and Readiness Assessment (WHO-SARA) tool and quantitatively assessed 105 primary healthcare facilities selected through multistage stratified random sampling. Quantitative data were analyzed using survey-weighted descriptive and multivariable linear regression. Simultaneously, we conducted qualitative interviews with 23 health authorities and 47 health service providers involved in the PEN program. Qualitative data were thematically analyzed.

NCD service readiness was highest for CVDs (48.4, 95% CI: 44.5-52.3), followed by DM (40.8, 95% CI: 36.1-45.5), and CRDs (34.8, 95% CI: 30.8-38.9). Primary Healthcare Centers (PHCCs), primary healthcare facilities in hilly regions, or those charging user fees, demonstrated higher NCD service readiness than health posts, mountain-region primary healthcare facilities, and those without user fees. Qualitative findings explored higher NCD service readiness through better infrastructure, staff training, and social health insurance. Conversely, staff turnover and supply shortages remained key challenges, particularly in health posts and remote areas.

Primary healthcare facilities in Nepal lack equipment, medicines, trained staff, and NCD guidelines. Therefore, improving NCD service readiness requires strengthening the health workforce capacity and essential medicine supply chain management.

The online version contains supplementary material available at https://doi.org/10.1186/s12982-026-02812-2.

Multimorbidity, the co-existence of two or more non-communicable diseases, is increasing in prevalence globally. People with multimorbidity are at an increased risk of developing serious mental illnesses such as major depressive disorder, and anxiety disorders. UAE reports high rates of multimorbidity (metabolic syndrome, type II diabetes, hypertension, obesity). The prevalence of depression and anxiety disorders is significantly elevated in these patients, contributing to increased stress on the healthcare system. Barriers to effective mental healthcare delivery in these patients with multimorbidity include stigma, cultural and linguistic diversity, limited insurance coverage and shortage of mental healthcare professionals, particularly in rural areas. Clinically, depression and anxiety are often associated with somatic symptoms, complicating diagnosis in primary care. Evidence supports implementing measurement-based care using tools such as PHQ-9, GAD-7, and HADS for diagnosing and monitoring treatment in patients with depression and anxiety disorders. Collaborative care models, including primary care physicians, specialists, and clinical pharmacists, are essential for managing people with multimorbidity. UAE initiatives, such as the integrated mental health network SAKINA and the IFHAS population-based screening program, have reduced stigma, enhanced early identification, and increased access to mental health services. This narrative review explores the burden of depression due to multimorbidity in the UAE; corresponding challenges on healthcare delivery, especially in primary care; and national initiatives aimed at integrating mental health into primary care.

Pulmonary alveolar proteinosis (PAP) and pulmonary nocardiosis are relatively rare, their co-occurrence constitutes a clinically important comorbidity. Nocardia infection exhibits variable clinical manifestations, and carries a substantial risk of mortality in the absence of timely, pathogen-directed antimicrobial therapy. This study aims to summarize the clinical features of Nocardia infection in PAP patients.

We present four confirmed cases of PAP complicated by Nocardia infection. These cases illustrate the distinct microbial species, disease courses and clinical outcomes. The duration of Nocardia infection among the four patients ranged from 3 months to over 2 years. All patients received anti-infection treatment guided by antimicrobial susceptibility testing (AST) results. Clinical outcomes included microbiological cure of infection, sustained clinical stability without progression, and all-cause mortality.

In patients with PAP, the emergence of fever and new pulmonary opacities warrants strong clinical suspicion for Nocardia infection. Early initiation of pathogen-directed antimicrobial therapy is critical for infection control and enables subsequent PAP stabilization, clinical recovery, and the safe performance of whole-lung lavage.

Extremely severe hypertriglyceridemia associated with diabetic ketoacidosis (DKA), shock, cerebral edema, acute kidney injury (AKI), and pneumonia represents a rare but life-threatening clinical emergency, particularly when occurring as the initial presentation of previously undiagnosed diabetes mellitus (DM). In such critically ill patients, prompt management is challenging because clear evidence-based guidelines regarding the role and timing of therapeutic plasma exchange (TPE) remain limited. To our knowledge, this is the first reported case from Bangladesh describing severe combined hyperlipidemia with DKA as the initial manifestation of DM requiring urgent TPE. A 15-year-old girl presented with altered consciousness and hemodynamic instability. She underwent immediate intubation upon admission due to severe metabolic decompensation. Further evaluation revealed DKA with extremely severe hypertriglyceridemia associated with combined hyperlipidemia. On the second day of hospitalization, her condition was further complicated by pneumonia and AKI. Despite standard intensive management, including insulin therapy, fluid resuscitation, and supportive care, no significant overall clinical improvement was observed. Considering the progressive deterioration and risk of fatal complications, TPE was initiated on day 3. Following a single session of TPE, her clinical status improved dramatically, with rapid hemodynamic stabilization and metabolic recovery, allowing successful weaning from ventilatory support within 24 hours. This case highlights that TPE may be a valuable adjunctive treatment in carefully selected patients with DKA complicated by extremely severe hypertriglyceridemia and multiorgan dysfunction when conventional therapy fails to produce adequate clinical improvement. We also review previously reported cases and discuss the potential role of TPE in managing this rare but life-threatening condition. As plasmapheresis remains costly and less accessible in resource-limited settings like Bangladesh, greater clinical awareness and further evidence are needed to guide future management recommendations for similar critically ill patients.

Fournier's gangrene is a rapidly progressive necrotizing soft tissue infection of the perineal and genital regions associated with significant morbidity and mortality. Patients with poorly controlled diabetes mellitus are at particularly high risk for severe disease and complications. We present the case of a 57-year-old Hispanic male with uncontrolled type 2 diabetes mellitus (hemoglobin A1c of 12.2%), hypertension, and alcohol use disorder who presented with a two-week history of worsening scrotal pain and swelling. Computed tomography demonstrated extensive subcutaneous emphysema involving the perineum, scrotum, penis, bilateral inguinal canals, and anterior abdominal wall. The patient underwent multiple operative debridements, end colostomy creation, and prolonged antimicrobial therapy for polymicrobial bacteremia and severe sepsis. His hospital course was further complicated by bilateral abdominal wall fluid and gas collections concerning for abscess formation, requiring image-guided drainage and subsequent readmission for persistent collections. After a cumulative hospital stay of approximately seven weeks, he was ultimately discharged in stable condition. This case highlights the aggressive nature of Fournier's gangrene and the importance of early surgical intervention, repeated source control, and close follow-up for persistent or delayed infectious complications.