Prolactinomas are the most common functioning pituitary adenomas and can present with a broad spectrum of manifestations. As pituitary adenomas grow insidiously and often result in nonspecific symptoms, diagnostic delay is common. The duration of symptoms first reported by the patient to diagnosis can vary greatly, from patients being diagnosed within one year to over 40 years after symptom onset. Early detection of pituitary adenomas is essential to avoid the accumulation of both hyperprolactinemia and mass effect manifestations, such as visual field loss, infertility, and fatigue among others. Worsening of such manifestations in prolactinomas specifically has an inevitable impact on physical and mental health, comorbid conditions, and quality of life (QOL). Here, we review the literature regarding the prevalence, pathophysiology, and clinical evaluation of presenting manifestations of prolactinomas, discuss contributory factors to diagnostic delay and methods to facilitate earlier identification.

Chronic kidney disease (CKD) is a progressive condition characterized by structural and functional impairments in the kidneys, affecting around 10-15% of the global population. Kidney transplantation from living donors is regarded as the most effective treatment for CKD. Little is known about the consequences in kidney donors in term of quality of life, work ability and overall health status, including pain syndromes developing. This may drive intervention to support donors and promoting their engagement.

This scoping review evaluates the quality of life (QoL), pain syndromes occurrence, mental health and work ability of adult living kidney donors.

A scoping review was performed using the PubMed/Medline, Embase, CINAHL, and Cochrane Library databases between April and September 2023. The review followed the Arksey and O'Malley framework, incorporated guidance from the Joanna Briggs Institute (JBI), and reported to PRISMA-ScR guidelines. The protocol for this review was registered on the Open Science Framework. Risk of bias and study quality were assessed using JBI checklists.

Starting from the analysis of 5069 records, 10 studies were included in the present study. The results show scanty data about the issues. The occurrence of medium and high intensity pain after surgery is reported; mental health seems to be moderately compromised and related to symptoms of anxiety and depression. Of interest, QoL seems to be overall improved after the kidney donation, suggesting a phase of adaptation following the surgery. No data are available on the work ability changes after donation.

This review emphasizes the presence of positive effects of kidney donation in living donors and, on the other hand the need of improving pain management and mental health support in the first time after surgery. The information about the consequences of kidney donation on work ability is completely lacking. This could be relevant to be known for new potential donors. It also advocates for continued interdisciplinary research for developing evidence-based care strategies to promote donors' multifaceted well-being.

Depression is common among individuals with cancer and has been associated with impaired quality of life, reduced treatment adherence, and increased morbidity and mortality. We sought to characterize the timing and predictors of early- and late-onset depression among adults with gastrointestinal (GI) cancer.

Adults aged ≥18 years with a diagnosis of GI cancer were identified from the "All of Us" Research Program V8. Incident depression was defined as new clinical diagnosis following cancer diagnosis and its onset was categorized as early (<5 years) or late (≥5 years). Multinomial logistic regression and Cox proportional hazards models were used to evaluate association with sociodemographic factors, cancer subtype, baseline anxiety, and treatment.

Among 4,349 individuals, 68.2% (n=2,964) patients developed incident depression with 54.3% (n=2,360) of patients classified as having early-onset depression. On multivariable analysis, younger age was associated with lower odds of both early- (aOR 0.99, 95%CI 0.98-0.99) and late-onset depression (aOR 0.97, 95%CI 0.96-0.98), whereas female sex was associated with higher odds of early- (aOR 1.20, 95%CI 1.01-1.44) and late-onset depression (aOR 1.31, 95%CI 1.01-1.70). Compared with colorectal cancer, esophageal (aOR 1.74, 95%CI 1.19-2.56), pancreatic (aOR 1.59, 95%CI 1.25-2.02) and liver/hepatic bile duct (aOR 1.51, 95%CI 1.23-1.86) cancer were associated with higher odds of early-onset depression.

Depression was common among GI cancer survivors and frequently emerged years after diagnosis. These findings underscore the importance of longitudinal, risk-stratified mental health screening throughout GI cancer survivorship, extending beyond periods of active treatment.

Collegiate athletes commonly report higher physical function and lower pain interference than the average population. However, limited information is available regarding how patient-reported outcome scores change across a sports season or following a mid-season injury or illness. It was hypothesized that collegiate athletes would report higher scores in Patient-Reported Outcomes Measurement Information System (PROMIS) physical, mental, and social health domains compared to the general population, and mid-season injury/illness would be associated with worsened post-season scores compared to pre-season.

Collegiate athletes across all varsity sports from one Division I institution were surveyed pre-season and post-season in this prospective cohort study. Mid-season injury/illness was self-reported and defined as an event interrupting in-season participation. Pre- and post-season PROMIS Physical Function (PF), Pain Interference (PI), Ability to Participate in Social Roles and Activities (APSRA), and Depression (D) were collected. Change from pre-season was compared between non-injured/non-ill and injured/ill athletes with paired non-parametric tests.

A total of 211 athletes were included, consisting of 117 (55%) males and a similar distribution across collegiate year (26%, 28%, 22%, 23%, respectively). Team field sports including football (42%), female lacrosse (12%) and female soccer (9%) made up a majority of respondents. Pre-season PROMIS PF (59.9±7.8) and APSRA (60.1±7.1) scores were nearly one standard deviation higher than the US population T-score (50±10). PI (48.6±7.6) and Depression (45.5±8.4) were within typical range. Athletes sustaining a mid-season injury/illness reported worse post-season scores in PF (-3.9±9.0, p<0.001, r=0.396), PI (2.5±10.7, p=0.034, r=0.213), APSRA (-2.6±7.5, p=0.003, r=0.325), and Depression (1.9±7.5, p=0.011, r=0.276) compared to their pre-season. Non-injured/ill athletes also demonstrated mildly worsened scores in PF (-2.3±7.3, p<0.001, r=.312) and APSRA (-1.3±7.9, p=0.049, r=0.183) compared to their pre-season.

Mid-season injury/illness was associated with worsened PROMIS scores across all measured physical and mental health domains. Athletes without an injury/illness also reported worsened PF and APSRA, indicating a potential impact from the sports season. However, the clinical significance of these score changes remains uncertain. The declines were modest and athlete-specific minimal clinically significant difference thresholds are needed to better define clinical significance in this population.

Level 2.

Chronic liver disease (CLD) is increasingly prevalent, and stigma remains a barrier to care, particularly for alcohol-associated liver disease (ALD). No validated instruments measure liver disease-specific stigma. We developed and evaluated the Liver Disease Stigma Scale (LDSS).

We conducted a cross-sectional study of 211 patients from inpatient and outpatient hepatology services at a tertiary center. Participants were categorized as alcohol-associated liver disease (ALD; n=128) or non-ALD (n=83). The LDSS assessed internalized, anticipated (family and healthcare), and experienced (family and healthcare) stigma. Psychometric evaluation included exploratory factor analysis (EFA), internal consistency (Cronbach's alpha), and convergent validity with the Substance Use Stigma Mechanisms Scale (SU-SMS) and mental health symptoms. Known-groups validity was assessed using t-tests and adjusted linear regression.

EFA supported a five-factor structure accounting for 73.7% of variance. Subscale reliability was excellent (α = 0.90-0.97). LDSS subscales showed strong convergent validity with corresponding SU-SMS subscales (r = 0.43-0.80) and moderate correlations with mental health (r = 0.18-0.60). Known-groups validity was demonstrated by higher stigma scores among participants with ALD, particularly for internalized stigma (2.34 vs 1.50, p < 0.001, d = 0.85) and family-experienced stigma (1.80 vs 1.18, p < 0.001, d = 0.77). After adjustment, differences in internalized and family-experienced stigma remained significant.

The LDSS demonstrated a stable five-factor structure, strong reliability, and good convergent validity, supporting its use as a psychometrically sound measure of liver disease-specific stigma. Patients with ALD showed higher stigma levels, underscoring the scale's clinical relevance and the need for further research on stigma and outcomes in liver disease. Findings require validation in larger, more diverse, and independent samples.

The Liver Disease Stigma Scale fills an important measurement gap by providing the first multidimensional instrument specifically developed to assess stigma among adults with chronic liver disease. Stigma levels were higher among individuals with alcohol associated liver disease, underscoring the relevance of stigma as a psychosocial factor that may influence engagement and wellbeing in this population. The scale provides a standardized and psychometrically robust approach for assessing stigma and offers a foundation for future research and quality improvement efforts aimed at identifying stigma burden and informing targeted clinical or behavioral strategies. These findings may help clinicians, researchers, and health systems more systematically understand how stigma shapes patient experience and consider approaches to promote more equitable and person-centered liver disease care.

Air pollution was recently recognised as one of the 12 major modifiable risk factors for dementia. Although China's clean air policies have substantially reduced fine particulate matter (PM_2·5) concentrations since 2013, the implications for dementia-associated mortality remain unclear in the context of an ageing population. We aimed to quantify historical trends and future trajectories of PM_2·5-attributable dementia mortality in China under different clean air policy scenarios.

In this health impact assessment study, we integrated exposure data, population data, exposure-response association data, and mortality information from multiple sources, to estimate PM_2·5-attributable dementia deaths in China from 2000 to 2024, and projected future burdens from 2025 to 2060 under five clean air policy scenarios with progressively increasing stringency. For each scenario, analyses were done across four stages: a pollution growth phase (2000-13), an air quality improvement phase (2013-24), a mid-term projection phase with accelerating population ageing (2024-50), and a late-term projection phase with a stabilising age structure (2050-60). We calculated contributions of key driving factors (PM_2·5 exposure, age structure, population size, and baseline dementia mortality rate) in each stage.

From 2000 to 2013, PM_2·5-attributable dementia deaths increased from 55 668 (95% CI 12 179-175 132) to 106 571 (24 202-329 233). From 2013 to 2024, despite substantial declines in population-weighted PM_2·5 concentration, PM_2·5-attributable dementia deaths dramatically increased from 106 571 (95% CI 24 202-329 233) to 171 420 (38 398-533 436), with population ageing as the dominant driver of increasing dementia deaths, contributing approximately 67 000 (95% CI 15 000-205 000) PM_2·5-attributable dementia deaths, followed by population size (approximately 5000 [1000-15 000] deaths) and baseline dementia mortality (approximately 4000 [0-17 000] deaths), with reductions in PM_2·5 exposure avoiding approximately 11 000 [2000-32 000] deaths during this period. Across all five environmental policy scenarios, PM_2·5-attributable dementia deaths were projected to increase steadily from 2024 to 2050. By 2050, the number of PM_2·5-attributable dementia deaths was estimated to range from 278 411 (95% CI 59 535-851 652) in the most stringent environmental policy scenario to 490 301 (105 698-1 484 714) in the least stringent scenario. Population ageing was the main driver of increases in PM_2·5-attributable dementia deaths until 2050 in all clean air policy scenarios. From 2050 to 2060, declines in PM_2·5-attributable dementia deaths are observed only under scenarios combining carbon neutrality and stringent clean air policies.

Rapid population ageing has substantially offset the dementia-related health benefits of air pollution control in China. Only under stringent air pollution controls can the benefits of reduced PM_2·5 exposure meaningfully offset the effects of population ageing on PM_2·5-attributable dementia deaths. Integrating ambitious environmental policies with public health strategies is essential to mitigate PM_2·5-attributable dementia deaths in the context of an ageing population.

Ministry of Science and Technology of the People's Republic of China and National Natural Science Foundation of China.

Cognitive impairment is a core and enduring deficit in schizophrenia, severely affecting social functioning and quality of life. Traditional assessments such as the MATRICS Consensus Cognitive Battery face limitations in validity and engagement. Virtual reality (VR) serious games may offer an immersive alternative, and machine learning (ML) can uncover complex behavioral patterns. However, integrating VR-based assessment with ML for discriminating stable-phase schizophrenia remains unexplored.

This prospective cohort study aimed to examine whether a VR serious game ("Fruit Pioneer") can effectively assess cognitive function in stable schizophrenia, verify its correlation with the standard Brief Cognitive Assessment Tool for Schizophrenia (B-CATS), and test the discriminative capacity using ML models. We hypothesize that (1) patients with schizophrenia will show poorer VR game performance than healthy controls (HCs), (2) VR metrics will correlate with B-CATS scores, and (3) ML models will help classify patients with schizophrenia and HCs using VR data.

A total of 42 patients with stable schizophrenia and 65 HCs (aged 18-40 years) were enrolled. Exclusion criteria included color blindness, visual impairment, substance abuse, and comorbid chronic physical diseases. Finally, 39 patients with schizophrenia and 64 HCs were included. Materials included the VR serious game "Fruit Pioneer," B-CATS (Digital Symbol Substitution Test, Trail Making Test Part A, Trail Making Test Part B, and Animal Fluency), Simulator Sickness Questionnaire, and Game Experience Questionnaire. Data were collected via standardized VR gameplay and paper-based assessments. Logistic regression and a support vector machine (SVM) model were built using VR metrics.

Patients with schizophrenia performed worse on all B-CATS subtests (all P<.001). They also showed lower VR total scores (median 467, IQR 376-544 vs median 683, IQR 616-753; P<.001), longer reaction times (median 1.11, IQR 0.995-1.23 vs median 1.03, IQR 0.96-1.1; P=.006), lower gaze hit rates (median 0.515, IQR 0.442-0.554 vs median 0.552, IQR 0.497-0.592; P=.01), and higher bomb penalty scores (median 150, IQR 95-170 vs median 108, IQR 85-131; P=.002). In the schizophrenia group, VR metrics correlated with B-CATS results, whereas this relationship was minimal in HCs. Classification performance of the SVM (average area under the curve [AUC]=0.874, 95% CI 0.860-0.888) was comparable to logistic regression (average AUC=0.854, 95% CI 0.838-0.870).

This study demonstrates the innovative integration of a VR serious game with ML to assess cognitive function in stable schizophrenia. Unlike prior VR studies focused mainly on validation, our approach combines behavioral metrics with an SVM model, achieving effective classification. The findings support the potential of a scalable digital assessment correlated with standard tests. In clinical practice, this system may serve as an engaging alternative to traditional methods, facilitating long-term cognitive monitoring and personalized rehabilitation strategies.

Childhood obesity constitutes a complex medical and psychosocial challenge that requires both nutritional knowledge and sensitive, relationship-oriented doctor-patient communication. The Planetary Health Diet links individual health promotion with environmental sustainability and represents a relevant framework for contemporary medical education.

This proof-of-concept study investigated how different information sources influence medical students' acquisition, structuring, and application of knowledge on childhood obesity and the Planetary Health Diet within a communication-based teaching setting, including the exploratory use of artificial intelligence-based tools.

A total of 359 second-year medical students participated in a mandatory communication seminar during the 2023-2024 academic year. Following a precourse knowledge assessment and a brief theoretical introduction, students worked on a standardized counseling scenario addressing childhood obesity. In small groups, students used only 1 assigned information source (ChatGPT, Google Search, scientific papers, or instructional videos) to prepare a counseling approach. Group outcomes were assessed using a predefined scoring system based on a sample solution, complemented by thematic content analysis.

All information sources enabled students to acquire relevant knowledge on childhood obesity and the Planetary Health Diet. However, groups differed with regard to the depth, differentiation, and structuring of their responses. The ChatGPT group achieved the highest conformity scores with the sample solution and provided the most additional information, followed by the Google and video groups, while the paper group achieved the lowest scores. Prior to the course, students reported limited knowledge of the Planetary Health Diet and little practical experience in counseling children with obesity and their families.

Communication-based teaching formats provide an effective framework for introducing medical students to complex topics such as childhood obesity and sustainability-related nutrition early in their training. Easily accessible digital tools, including artificial intelligence-based systems, may facilitate knowledge acquisition and elaboration; however, their use requires explicit didactic framing, critical source evaluation, and reflection on the complexity of chronic conditions to support responsible and realistic learning outcomes in future physicians.

Measurement-Based Care (MBC) is a clinical approach that uses objective measurements to quantitatively assess patients' symptoms and conditions as the basis for treatment, with the assessments shared with patients and used in practice. One indicator of MBC, the Guideline Adherence Rate (GAR), provides a comprehensive evaluation of the extent to which psychiatrists' prescribing practices conform to clinical practice guidelines. Although the practice of MBC has been reported to improve clinical outcomes in depressive disorders, improvements in clinical outcomes with MBC have not been reported in schizophrenia. We examined longitudinal changes in psychiatric symptoms and the GAR among patients with schizophrenia receiving MBC.

Sixty-five patients with schizophrenia were included. The Positive and Negative Syndrome Scale (PANSS) total score and the GAR were compared longitudinally between time point 1 (T1) and time point 2 (T2).

The PANSS total score was significantly lower at T2 than at T1. The GAR was significantly higher at T2 than at T1.

Improvements in psychiatric symptoms were consistent with previous findings on MBC reported in depressive disorders. In addition, improvements in the GAR indicated that psychiatrists' prescribing practices aligned more closely with the guideline over time within an MBC environment. These findings suggest that the MBC framework may also be clinically useful in the treatment of schizophrenia. The results were obtained from a specialized schizophrenia outpatient clinic in a national center, which represents a best-case environment for guideline adherence and monitoring. Therefore, further studies are needed to examine the generalizability of these findings.

IntroductionYouth with substance use disorders (SUDs) might be at heightened risk for suicidal behavior, yet early identification remains challenging. This study aimed to estimate the prevalence of the NANDA-I nursing diagnosis (ND) Risk for suicidal behavior in this population and explore its associations with clinical and socio-demographic factors and diagnostic indicators burden and risk profiles emerging from clustering risk factors (RFs).MethodsA cross-sectional study was conducted in July 2024 at a public youth community addiction care service. All clients under 25 receiving nursing care were included. The ND was formulated by consensus through a structured clinical assessment based on NANDA-I diagnostic indicators.ResultsAmong 90 participants (median age 21; 62.2% male), the Risk for suicidal behavior ND was identified in 81 individuals (90.0%). Higher frequency was observed among those lacking family support (p = 0.027), unemployed (p = 0.010), with lower education (p = 0.025), involved with multiple services (p = 0.003) or receiving longer duration of care (p < 0.001). Among those, 42 of 60 possible RFs were present at least once, with a median of nine RFs per person. A two-cluster solution revealed a subgroup with a markedly higher indicator burden and a prominent affective profile characterized by deep sadness, unhappiness, depressive symptoms, hopelessness and greater social adversity. The other subgroup showed a lower burden and more externalizing features.ConclusionsThe high prevalence Risk for suicidal behavior ND suggest that the diagnosis may function as a universal safety flag in youth addiction care. However, differences in indicator burden and cluster-derived profiles offer a more nuanced understanding of vulnerability, supporting the need to prioritize care based on individualized configurations of RFs rather than the diagnostic label alone. Findings reinforce the relevance of standardized nursing language for structured assessment and tailored intervention planning in this population.