While the knowledge about developing an effective therapeutic alliance (TA) with patients diagnosed with an antisocial personality disorder (ASPD) is growing, little is known from patients' perspective. Given the important role of TA in therapy outcomes, a deeper understanding of the factors contributing to a strong TA is essential. This study aims to expand current knowledge by exploring the experiences and preferences of patients with ASPD regarding TA development.

A qualitative research design was employed using reflective thematic analysis. Fifteen in-depth interviews were conducted with patients diagnosed with ASPD and analyzed for recurring themes.

Seven themes were identified and grouped into two categories. The first category, "Facilitators" reflects therapeutic attitudes that align with the needs of patients with ASPD. The second category, "Barriers to engage" describes the difficulties patients experience in forming a TA.

Although patients with ASPD often experience establishing a TA as challenging, TA development can be achieved when therapists adapt their approach to patients' needs. Patients want a genuine, authentic therapist who can provide a pleasant, collaborative atmosphere. By maintaining a non-judgmental and calm attitude, while adopting a firm and clear style, therapists support patients' engagement and promote TA development.

High rates of human papillomavirus (HPV) vaccination could eliminate cervical cancer and reduce other HPV-related morbidity. Studies outside of the United States (US) have found lower HPV vaccine uptake among adolescents with Autism and/or intellectual disability (ID) than their peers. This cross-sectional analysis of all 2022-23 New York City (NYC) public school students aged 13-21 used official vaccination records and Individual Educational Plan (IEP) statuses to assess whether HPV vaccination differed for students with Autism, ID, or other IEP conditions compared to no IEP, with COVID-19 vaccination as a control outcome. We used multivariable Poisson regression to estimate adjusted prevalence ratios (aPR) for vaccination status by disability, adjusting for sociodemographic characteristics. The sample comprised 365,167 students; 2.5% had Autism, 0.9% ID and 19.2% another IEP status. In total, 80.5% had received at least one dose of the HPV vaccine and 70.8% one dose of the COVID-19 vaccine. Students with Autism were less likely (aPR 0.89, 99% CI 0.88, 0.91) and students with ID were as likely (aPR 1.02, 99% CI 1.00, 1.04) to have received an HPV vaccine as those with no IEP, with no differences by IEP status for COVID-19 vaccination. Targeted outreach and education on the HPV vaccine is needed for adolescents with Autism in NYC public schools. Future research should assess barriers to HPV vaccination among this population.

Aboriginal and Torres Strait Islander people can experience inequitable access to health services. This study assessed the effectiveness of a culturally responsive medication management service (referred to as IMeRSe).

This is a pre-post single-arm study involving Aboriginal and Torres Strait Islander health services and community pharmacies. Participants had a chronic condition, were pregnant or postpartum within 2 years. Pharmacists wrote a collaborative Medicines Plan and made recommendations to clinicians. The primary outcome was serious medication-related problems 6-months post-IMeRSe. Secondary outcomes included medication adherence.

For 255 participants, mean serious medication-related problems reduced from 4.11 to 3.85 per 6 months at risk (incidence rate ratio, 0.93; 95% confidence interval, 0.86-1.01), although rates of potentially preventable medication-related hospitalisations remained similar. Significant improvements in medication adherence were observed. General practitioners accepted 709 of 762 pharmacist recommendations.

A culturally responsive medication management service delivered by community pharmacists can contribute to reduced serious medication-related problems, improved medication adherence and consumer empowerment.

Growth of generative artificial intelligence (GenAI) has exploded in recent years. Many have noted its substantial potential to increase access to scalable digital mental health interventions or provide companions for individuals who are socially isolated. At the same time, seeking mental health support from mainstream GenAI models may involve risks. Several recent examples of exacerbation of delusions have received attention in the popular press, leading to a call for empirical research to document the scope of interactions with GenAI among individuals experiencing symptoms of psychosis.

This study aimed to evaluate associations of psychosis risk to GenAI use frequency, motivations for use, and GenAI interactions involving potential delusions.

We conducted a large-scale cross-sectional survey of 1003 young adults in United States, divided the sample of individuals that had used GenAI into "elevated risk" (Prodromal Questionnaire, Brief Version Distress Score ≥20; N=267, 28%) and "low risk" groups (Prodromal Questionnaire, Brief Version Distress Score <20; N=685, 72%), and compared groups on several assessments related to GenAI use.

We found that while members of the elevated risk group were no more likely to have ever used GenAI, they were significantly more likely to report intensive use (odds ratio 1.70 to 2.56; ie, several times per day, more than 30 minutes per day, 6 or more chatbot conversations per day). Those at elevated risk were more likely to report using GenAI to receive social and emotional support and significantly more likely to ascribe human-like roles to their chatbot interactions (odds ratio 1.76 to 3.08; ie, companion, friend, therapist, and romantic partner). Delusion-related interactions were also commonly reported among those at risk for psychosis (item endorsements from 13.3% to 30.7%).

While it is unclear whether they have a positive or negative impact overall, GenAI chatbots may have the potential to impact symptom-related experiences among young adults at risk.

Given the intimate link between muscle function and the skeleton's ability to adapt to mechanical loads, it is no surprise that individuals with neuromuscular disorders (NMDs) are at risk for low-trauma (i.e., osteoporotic) fragility fractures. In this review, we highlight the interdependent relationship between muscle and bone strength and the need to assess individuals with NMD who demonstrate muscle weakness that interferes with weight bearing and typical activities of daily living. This review also emphasizes the importance of the clinical context when evaluating the risk of bone fragility, as well as the potential to reclaim bone strength in the absence of bone-targeted therapy. Indeed, longitudinal skeletal phenotyping is key to understanding the individual's bone health trajectory and the need for progressive intensification (or de-escalation) of osteoporosis prevention and treatment. Overall, osteoporosis management has moved away from a bone mineral density (BMD)-centric approach to a fracture-focused approach, with vertebral fractures a clear indicator for bone-strengthening therapy (recognizing that they are frequently asymptomatic, necessitating periodic spine imaging for their timely identification). BMD assessments help guide the frequency of spine imaging and response to bone-targeted therapy and are best undertaken at multiple skeletal sites given the potential for "regional osteoporosis." Multidisciplinary osteoporosis prevention and treatment, including an expert in skeletal health, is the cornerstone of effective osteoporosis management. Looking forward, the field is shifting from secondary osteoporosis prevention to a more proactive, anticipatory approach in those with persistent risk factors, one that involves initiation of bone-targeted therapy prior to first-ever fractures.

To compare the utility of a mechanical laparoscopic articulating needle driver (ALI) to standard laparoscopic instrumentation (SLI) during the creation of a total laparoscopic gastropexy (TLG) in dogs.

Prospective clinical trial.

A total of 17 client owned dogs.

Dogs underwent elective prophylactic TLG and were randomized to ALI or SLI for the first gastropexy suture line. The second line was performed with the alternate instrumentation. Duration of intracorporeal suturing, NASA-Task Load Index (TLX) questionnaire, modified Instrument Function and Ergonomics survey, and intraoperative incidents were documented per suture line.

Seven female, seven male, two male-sterilized, and one female-sterilized dogs were included. Median weight was 38 kg (range: 17.9-66 kg). Four Standard Poodles and German Shepherd dogs each, two Bernese Mountain dogs, and one each of the Airedale, Armenian Gampr, Great Dane, Doberman Pinscher, Anatolian Shepherd, Irish Wolfhound, and mixed breed were enrolled. Median time to complete the suture line with SLI (6 min, range: 5-10) was significantly shorter than ALI (8 min, range: 6-11, p < .001). Averaged NASA-TLX scores of mental demand (p = .030), performance (p = .014), effort (p = .030), and frustration (p = .042) were significantly greater for ALI suture lines compared to SLI. Two grade 2 adverse events occurred during TLG.

Suture time and surgeon workload was negatively affected by ALI use compared to SLI. Adverse events were rare and all dogs had TLG successfully completed.

Both devices can be used to perform TLG. While initial comparison favored SLI, the utility of ALI requires further investigation.

Men are underserved in research on eating, exercise and body image psychopathology (EEBIP), and remain underrepresented within healthcare settings despite growing clinical need. One barrier to men's help-seeking for EEBIP-related concerns is that public-facing healthcare information/resources often appear unwelcoming to them, suggesting the need for more inclusive, gender-sensitive resources that engage men and address their specific needs. This study aimed to explore men's perspectives on the design of inclusive EEBIP resources, to inform the iterative co-design of guidance for future resource development.

This study employed a lived experience-led approach, integrating a modified nominal group technique with participatory research methods, as part of an iterative co-design of a guidance document. Six men with lived experience of EEBIP ranked their preferred features of male-inclusive resources from a broader list of content and format ideas generated through a survey of 42 men. Interview and focus group discussions followed, exploring the underlying reasons why the men with EEBIP experience believed these content and format ideas would support men's help-seeking for EEBIP. Finally, a draft guidance document, underpinned by the results of the discussions, was designed and iteratively edited, following feedback from healthcare organisation representatives, academics, and men with lived experience.

Thematic analysis of the discussions identified five themes to inform the development of future resources. The five themes are titled: (1) Designing accessible resources that navigate men's readiness; (2) Authentic voices: inclusive, conversation-led outreach; (3) Self-realisation: refraining from labelling men as 'unhealthy' or 'disordered'; (4) Purpose and progress driven resources; (5) Images: the line between helpful and harmful isn't always clear. These themes are discussed alongside EEBIP and men's mental health help-seeking literature.

This is the first study to centre men's experiential knowledge to explore how healthcare organisations can facilitate men's help-seeking for EEBIP-related concerns via public-facing resources. The themes generated in this study reflect findings of studies exploring the facilitation of men's general mental health help-seeking, whilst contributing novel EEBIP-specific findings. The results of this study can support EEBIP healthcare organisations to develop public-facing resources that are more inclusive of men.

This paper presents a protocol for a planned systematic review and meta-analysis that will investigate the impact of short rest periods between shifts (i.e., quick returns, <11 h rest) on various outcomes in terms of physical health of workers (e.g., cardiovascular disease, infections, headaches, back pain) and/or mental health of workers (e.g., anxiety, depression, fatigue, sleep problems, insomnia, impaired mental health), as well as sickness absence (proxy of health), work performance (e.g., occupational accidents), social factors (e.g., social support), and psychosocial work-related factors (e.g., job satisfaction). The planned review further aims to identify different types of quick returns, such as evening to day shift and night to evening shift, and examine their relationship to these outcomes provided a sufficient number of studies (e.g., ≥5). The research will identify demographic and methodological factors that may moderate the relationship between quick returns and the specified outcomes.

A systematic review and meta-analysis will be carried out. Predefined search terms for short rest between consecutive shifts will be developed and employed to identify relevant studies examining quick returns and all aforementioned outcomes. The databases MEDLINE, Web of Science, PsychInfo, EMBASE, ProQuest, BASE, and Cochrane Trials and the 200 first hits in Google Scholar will be searched up to April 2026. Two reviewers will independently screen identified records and assess eligible full texts for inclusions. The risk-of-bias of included studies will be assessed using the Mixed Methods Appraisal Tool (MMAT) for systematic mixed study reviews. A random effects meta-analytic synthesis will be conducted using Comprehensive Meta-Analysis software. The primary measure of effect size will be odds ratio with 95% confidence interval. Heterogeneity will be evaluated using Cochran's Q test and the I² statistics. Publication bias will be assessed using Duval and Tweedie trim and fill procedure. The protocol adheres to PRISMA and MOOSE reporting guidelines and is registered in the International Prospective Register of Systematic Reviews.

This planned systematic review and meta-analysis will be the first to synthesize the current evidence systematically and quantitatively regarding the consequences of quick returns, including demographic and methodological moderators. Aggregation of the existing evidence will improve our understanding of the consequences of quick returns and, as such, provide directions for practitioners in terms of possible preventive initiatives and work environment improvements.

PROSPERO CRD42024533607.

Digital therapeutics have emerged as a promising non-pharmacological intervention for children with attention-deficit/hyperactivity disorder (ADHD). Personalized adaptation is key to the success of digital therapeutics. However, most existing systems depend solely on observable performance rather than real-time internal attentional state, which lead to misinterpretation or delayed adaptation.

In this study, we evaluated the effects of a tablet-based attention training game with and without EEG-informed real-time neurofeedback in children with ADHD. Participants were assigned to one of two groups: a neurofeedback group (NFb) in which the game adapted in real time based on single-channel frontal EEG signals and a standard game intervention group without neurofeedback (n-NFb). Attention and cognitive control were assessed before and after a one-month intervention.

All children showed improvements in attention in both parent report and children's performance in attentional tasks. The NFb group showed greater improvements in hitting accuracy (go trials) and less reductions in inhibition accuracy (no-go trials) than the n-NFb group. Both groups had significantly shorter reaction times after training. EEG analyses revealed greater improvement in attention index during training for NFb group.

Our findings suggest that video game-based digital therapeutics with EEG-informed real-time neurofeedback can effectively enhance attention in children with ADHD. The results support the potential of using adaptive neurofeedback with portable devices to enhance intervention effects.