Monitoring of population mental health is now considered to play a vital role in health, risk factor and demographic surveillance systems across the globe. Adopting a public mental health perspective on monitoring and surveillance requires us to consider the entire spectrum of mental health, which broadly ranges from positive mental health and well-being to severe mental disorders, including at-risk populations. This population mental health approach has become the mainstay of public mental health provision in many European countries but there is a dearth of research on this issue in Germany in the past 20 years and fundamental conceptual and methodological issues remain to be addressed at both the national and international levels.

The Mannheim incidence and inception cohort study is a recently established two-arm population-based incidence (arm 1) and inception cohort (arm 2) study in the catchment area of Mannheim, Germany. In the incidence-arm, case ascertainment of incident cases is carried out for the years of 2024 and 2025 based on clinical assessment via structured clinical interviews and retrospective case record evaluation. In the inception cohort arm, we recruit and follow an epidemiologically characterised population-based cohort of individuals (1) without symptoms (ie, stage 0), (2) meeting the criteria for non-specific psychological distress (ie, stage 1 a) or (3) a Clinical High At-Risk Mental State for severe mental disorder (ie, stage 1b) at baseline and up to four follow-up assessments every 6 months. Assessments include clinical interviews, self-report measures and ecological momentary assessment.Poisson regression will be conducted to quantify variation in incident rates by age, sex and migrant/ethnic minority group status. In the inception cohort arm, we will perform maximum likelihood estimation of hazard rates to estimate rates of transition from earlier stages to later stages. Latent class analysis will be used to identify empirically-based clinical stages to test convergence with contemporary staging models.

The study has received ethical approval from the local ethics committee (Medical Faculty Mannheim, Heidelberg University, 585-21). Results will be published in peer-reviewed journals, presented at academic conferences and disseminated through (social) media to address a broader public audience.

Metabolic diseases are rising rapidly across the Asia-Pacific region as traditional diets are displaced by refined, low-fibre foods. Resistant starch (RS) is a fermentable dietary component that modulates gut microbial activity and short-chain fatty acid (SCFA) production, representing a promising strategy for metabolic and gut health. However, responses to RS vary according to dose, RS type, and individual context.

This narrative review synthesised evidence from animal and human studies on RS classification, food sources, microbial interactions, and metabolic regulation. We evaluated how responses differ by dose, RS type, baseline microbiome composition, metabolic phenotype, and habitual diet, with particular attention to traditional Asia-Pacific staple foods and ongoing dietary transitions.

Across studies, RS supplementation at moderate-to-high doses improves insulin sensitivity, hepatic lipid accumulation, and markers of gut barrier function, primarily through SCFA-mediated and gut hormone pathways. However, responses are highly context-dependent, varying with baseline metabolic status, micro-biome composition, habitual fibre intake and RS type. Individuals with metabolic disturbances or low fibre intake tend to show greater metabolic and microbial shifts.

RS is a promising strategy for supporting metabolic and gut health in Asia-Pacific populations undergoing rapid nutritional transition. Culturally familiar RS-rich foods offer practical, regionally tailored intervention opportunities. Standardised characterisation, microbiome-stratified analyses and long-term human studies are needed to clarify who benefits most, under which conditions and through which mechanisms.

The objective of this study is to investigate functional, cognitive, physical and nutritional outcomes in adults with intellectual disabilities (IDs), comparing individuals with and without Down syndrome from São Paulo, Brazil, and to evaluate the associations of group, degree of disability, age and sex with these outcomes. Additionally, we hypothesized that individuals with Down syndrome would present greater vulnerability to cognitive and physical decline compared to those with ID of other aetiologies.

This cross-sectional observational study included 52 adults with ID divided into two groups: (1) 24 participants with Down syndrome (ID-DS) and (2) 28 participants with non-DS aetiologies (ID-nonDS). Assessments included sociodemographic and clinical data; functional independence measure (FIM); physical performance (handgrip strength, 30-s sit-to-stand test, gait speed test and MiniBESTest); nutritional status (Mini Nutritional Assessment [MNA]); cognitive function (Cambridge Cognitive Examination for Mental Disorders of the Elderly-Down Syndrome [CAMCOG-DS]); cognitive decline (Informant Questionnaire on Cognitive Decline in the Elderly [IQCODE]); and functional activities (Pfeffer Questionnaire [QPAF]). Data were obtained through self-report whenever possible, and proxy report (caregivers) when necessary, based on participants' communication abilities.

Compared with the ID-nonDS group, the ID-DS group demonstrated significantly poorer learning (β = -2.56; p = 0.049) and remote memory performance (β = -1.18; p = 0.011), a nonsignificant trend towards lower handgrip strength (β = -4.68; p = 0.051) and more falls (β = -0.39; p = 0.050). Sex and degree of disability were associated with several outcomes, whereas age showed no significant effect.

Adults in the ID-DS group exhibited cognitive and physical profiles suggestive of increased vulnerability to age-related functional impairment compared with adults with other forms of ID. These findings should be interpreted cautiously due to the cross-sectional design and sample size limitations. Replication in larger samples will be necessary to confirm these observations.

Adolescent mental health problems are prevalent, yet assigning individuals to appropriate prevention interventions remains challenging. Latent profile analysis (LPA) offers a person-centered approach to address this. Through LPA, we categorized 1,541 adolescents aged 13-20 from 21 public schools in Chile (M = 15.34, SD = 1.02; 52.3% women) based on symptoms of common mental disorders, suicidal ideation (SI), hopelessness, and emotion regulation (ER) strategies. We found four profiles: "low symptomatology" (16.54%), "mild-moderate symptomatology" (26.98%), "high symptomatology" (27.24%), and "markedly high symptomatology and suicidal ideation" (29.24%), which also differed in ER strategy use. SI, hopelessness, and psychotic experiences were the most influential factors distinguishing the highest-risk profile. The higher-symptom profiles showed elevated cognitive restructuring scores, while cognitive reappraisal characterized healthier profiles. Profile membership also differed by biological sex. These findings support school-based, stratified prevention programs tailored to adolescents' specific risk profiles.

This article aims to analyze the occurrence of work-related mental disorders (WRMD) among healthcare workers, discussing their implications for health workforce management, with a focus on policy development, workforce recognition, and the assurance of adequate working conditions. This descriptive ecological study examined the occurrence and distribution of WRMD between 2015 and 2023, using data from the Notifiable Diseases Information System and the National Registry of Health Establishments. A total of 22,110 cases of work-related mental disorders were identified, of which 3,504 (15.8%) occurred among health workers, with a predominance of women (87.5%). The prevalence increased from 3.5 per 100,000 workers in 2015 to 13.3 in 2023, mainly in the Northeast and Midwest regions. The most affected categories were public health agents, nurses, community health workers and nursing assistants and technicians. The increase in cases demands workforce policies and actions aimed at professional appreciation, prevention, and comprehensive mental health care within the Unified Health System.

Sickle cell disease (SCD) is a chronic inherited disorder characterized by recurrent pain, organ damage, and reduced life expectancy. Beyond its clinical burden, individuals with SCD experience significant stigma that adversely affects psychological well-being, health-related quality of life (HRQoL), and healthcare access. This systematic review synthesizes global evidence on the impact of stigma on HRQoL and healthcare access among individuals with SCD. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, peer-reviewed studies published between January 2010 and December 2025 were retrieved from PubMed, Scopus, Embase, and PubMed Central. A total of 53 studies (27 qualitative, 18 quantitative, 8 mixed methods) met the inclusion criteria. Four key stigma domains were identified: clinical mistrust and dismissal, internalized stigma and psychological distress, intersectional marginalization, and structural invisibility within healthcare systems. Across diverse settings, stigma was consistently associated with reduced HRQoL, delayed healthcare seeking, and weakened patient-provider relationships. Stigma operates across multiple levels, reinforcing health inequities. Addressing stigma through patient-centered care, community engagement, and policy reforms is essential to improve outcomes and ensure equitable healthcare access for individuals with SCD. PROSPERO Registration: CRD420251232621.

To evaluate the efficacy and safety of antithrombotic treatment for migraine prevention in participants with patent foramen ovale (PFO).

Investigator initiated, multicentre, prospective, randomised, active controlled, open label clinical trial with blinded outcome assessment and hierarchical hypothesis testing.

Secondary and tertiary care hospitals across 39 centres in China.

1000 adults aged 18-64 years with a diagnosis of migraine for more than one year, experiencing at least four migraine days per month, and with PFO confirmed by echocardiography. All participants completed a 12 week screening period before randomisation during which eligibility was confirmed and baseline headache data were prospectively recorded. Participants with previous stroke, transient ischaemic attack, intracranial haemorrhage, non-PFO right-to-left shunt, or contraindications to study drugs were excluded. Of the randomised participants, 984 (75.1% female) were included in the full analysis set.

After the screening phase, participants were randomised in a 1:1:1:1 ratio to receive aspirin (300 mg once daily), clopidogrel (75 mg once daily), rivaroxaban (20 mg once daily), or metoprolol (25 mg twice daily) for 12 weeks. No additional preventive migraine treatments were permitted during the intervention period.

The primary outcome was the proportion of participants achieving a ≥50% reduction in monthly migraine days or attacks from baseline to weeks 9-12. Safety outcomes included bleeding and other adverse events.

For the primary endpoint, aspirin, clopidogrel, and rivaroxaban were all non-inferior to metoprolol. Responder rates were 61.7% (148/240) with aspirin, 66.8% (157/235) with clopidogrel, 78.4% (185/236) with rivaroxaban, and 61.8% (144/233) with metoprolol. Rivaroxaban further showed a statistically higher responder rate than metoprolol, with an absolute difference of 16.2% (98.33% confidence interval 6.0 to 26.4; P<0.001). Among secondary endpoints, rivaroxaban was associated with greater reductions in migraine days and attacks, higher rates of complete migraine cessation, and greater improvements in migraine specific quality-of-life scores than metoprolol. No major bleeding events occurred.

The antithrombotic agents evaluated in this trial (aspirin, clopidogrel, and rivaroxaban) were all non-inferior to metoprolol for responder rate in participants with PFO and migraine. Rivaroxaban also showed superior responder rates over metoprolol without an increase in major bleeding events.

ClinicalTrials.gov NCT05546320.

Severe chronic non-communicable diseases (NCDs) place a significant burden on low- and middle-income countries (LMICs), where overburdened and underprepared health systems lead to misdiagnosis, treatment delays and poor outcomes. While prior research has examined health system gaps, little is known about patient experiences navigating care. This study examines the experiences of inpatients living with severe chronic NCDs in Neno District, Malawi, identifying triggers for care, mapping pathways to diagnosis and patient experience navigating care.

We conducted a cross-sectional study among inpatients admitted for severe chronic NCDs at two rural hospitals. Participants were asked about their journey to diagnosis, associated costs of illness and treatment, barriers encountered along their journey, decisions around seeking care and termination of care. Data collection included clinical record reviews and structured surveys documenting patient demographics and detailed clinical timelines (symptoms and careseeking) and costs, followed by open-ended fieldnotes capturing patient narratives.

Fifty-two patients were recruited, representing 51% of eligible admissions over the study period. Ages ranged from 2 to 80 years (median: 43.5, IQR: 23.5-62). Diagnoses included heart disease, Type 1 and insulin-dependent Type 2 diabetes, kidney and liver disease, epilepsy and schizophrenia, with nearly half of patients admitted for cardiac conditions. Among paediatric patients, common conditions included congenital heart disease, sickle cell disease and epilepsy. One-third sought care within 3 days of recognizing symptoms, and 60% were admitted with new diagnoses. Time from symptom onset to diagnosis varied widely: Type 1 diabetes was diagnosed within 2 months of initial symptoms, and sickle cell disease often took years. Financial burdens were substantial; 77% of patients reported out-of-pocket costs, and 71% borrowed money for care.

Gaps in diagnostic tools and provider expertise contribute to delays in diagnosis and treatment, exacerbating health and financial burdens. Our findings emphasize the need to ensure ongoing patient engagement and to enhance providers' ability to recognize patients who would benefit from the services.

Multimorbidity, defined as the presence of two or more chronic conditions, is a growing public health concern. Understanding disease clustering and risk profiles is crucial for prevention and planning purposes. This study analyzed data from the National Health Survey in Thailand, which included 142,753 participants. Latent class analysis investigated nine non-communicable diseases, while multinomial logistic regression explored the characteristics associated with class membership. Four distinct classes were identified: low burden, hypertension-metabolic, predominant hypertension, and high multimorbidity. Advancing age revealed an increased probability of membership in all multimorbidity classes. Females exhibited a higher propensity to belong to the hypertension-metabolic and predominant hypertension classes. Urban residency was associated with an elevated probability of membership in the hypertension-metabolic and high-multimorbidity classes. The body mass index displayed significant variations across classes. Overweight and obesity were linked to the hypertension-metabolic and predominant hypertension classes, with obesity also associated with the high multimorbidity class. Underweight individuals demonstrated a reduced likelihood of membership in the hypertension-metabolic class but an increased likelihood of membership in the predominant hypertension class. Smoking was correlated with a higher probability of membership across classes, particularly among current smokers. Dietary behaviors were distinctly associated across classes. Frequent consumption of high-fat and instant foods was linked to the hypertension-metabolic class, whereas instant food consumption was also associated with the predominant hypertension class. Fruit consumption was correlated with a higher probability of membership in the hypertension-metabolic class, whereas vegetable consumption was associated with a reduced likelihood of membership in the predominant hypertension class. Moderate consumption of non-alcoholic sugary drinks was associated with a lower probability of hypertension-metabolic class membership. These findings underscore the heterogeneity of multimorbidity patterns in Thailand and delineate the demographic, behavioral, and residential profiles associated with non-communicable disease clustering.

Early ART initiation in children with perinatal HIV (CHIV) greatly improves long-term outcomes. However, little is known of the long-term inflammatory profile. Our longitudinal study compared 26 inflammatory markers in early treated CHIV and HIV-unexposed children. CHIV displayed extensive immune marker elevations, clustered around monocyte activation. Despite early-antiretroviral therapy and sustained viral suppression, these children are at increased risk of non-communicable diseases.