Although prior studies have examined the psycho-socio-sexual outcomes associated with problematic engagement with online dating apps and pornography, these behaviors remain largely unexplored from an existential perspective. Romantic love can also be viewed through an existential lens (e.g., contributing to one's sense of essence). This study investigated the relatively understudied relationships between problematic online dating app use, problematic pornography consumption, and existential perceptions of romantic love.

A total of 664 Iranian adults (M_age = 26.4, SD_age = 7.6) who used dating apps and pornography websites were surveyed. Structural equation modeling was conducted to assess the relationships among the study variables.

The results showed that, controlling for demographics, problematic online dating app use and problematic pornography consumption were negatively associated with existential reflection on love and perceived meaningfulness of love. Both behaviors were positively associated with a pragmatic view of love and emotional promiscuity. A positive association was found between problematic online dating app use and problematic pornography consumption. Additionally, mindful social media use, which has recently been suggested as a protective factor among social media users, demonstrated a strong negative association with both problematic behaviors.

Considering the potential for negative experiences associated with online dating app use (e.g., partner choice overload) and pornography consumption (e.g., sexual objectification), problematic engagement with these platforms may, to some extent, contribute to the commodification of romantic relationships and the fragmentation of existential perceptions toward romantic love. Mindful use of these platforms may therefore need to be considered by users.

Patients with Alzheimer's disease (AD) exhibit early alterations in the Default Mode Network (DMN), a key brain network involved in episodic memory where the precuneus plays a central role. Precision-targeted, non-invasive brain stimulation represents a promising strategy to improve cognitive function in individuals with dementia. The DMN can be modulated through personalized non-invasive electromagnetic stimulation, a therapeutic approach that enhances neural plasticity and stabilizes network connectivity. This trial implements an innovative therapeutic protocol based on precision delivery of personalized electromagnetic stimulation targeting the precuneus, the main hub of the DMN.

This phase 2 multicenter, randomized, double-blind, sham-controlled, three-arm trial evaluates the safety and efficacy of combined repetitive transcranial magnetic stimulation (rTMS) and transcranial alternating current stimulation (tACS) targeting the precuneus in AD patients. rTMS will be applied using the intermittent theta burst stimulation (iTBS) protocol, while tACS will be delivered at gamma frequency (70 Hz). Personalization of iTBS-tACS treatment is established using neuronavigated TMS with electroencephalography (TMS-EEG). The 24-week intervention starts with a 2-week intensive course of daily combined treatment over the precuneus (5 sessions per week), followed by a 22-week maintenance phase with weekly stimulation. The primary outcome measure is the change in the integrated Alzheimer Disease Rating Scale (iADRS) between baseline and week 24. Secondary outcomes include score changes in the Alzheimer's Disease Cooperative Study - Activities of Daily Living (ADCS-ADL) scale, Clinical Dementia Rating Scale-Sum of Boxes (CDR-SoB), the Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog₁₃), the Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA), the Frontal Assessment Battery (FAB), the Face-Name Association Task (FNAT), the Neuropsychiatric Inventory (NPI), and the Apathy Motivation Index (AMI). Exploratory outcomes will include changes in cortical activity and connectivity (assessed through TMS-EEG, MRI), in blood based biomarkers of neurodegeneration, synaptic activity and neural inflammation, and sensorimotor functions in virtual environments. Evaluation at week 12 and a follow-up assessment at week 32 will be conducted to assess short-term and follow-up treatment effects, respectively.

This trial aims to provide evidence that personalized combined electrical and magnetic stimulation of the DMN may slow functional and cognitive decline in AD patients, contributing to the development of personalized interventions for AD treatment.

ClinicalTrials.gov, NCT07075770, registered 10 July 2025.

Acute coronary syndrome (ACS) is a critical manifestation of cardiovascular disease, which necessitates rigorous secondary prevention to reduce recurrent events and mortality. While lipid-lowering therapy (LLT) is integral to post-ACS secondary prevention, long-term adherence remains a significant clinical challenge. This study evaluated psychological, socioeconomic, and clinical factors associated with LLT adherence in patients after ACS, with a specific focus on mental health components and chronic comorbidities.

ACS survivors were included from the Transitions, Risks, and Actions in Coronary Events-Center for Outcomes Research and Education cohort (TRACE-CORE). Baseline demographic, medical history and mental health data - including the 36-Item Short Form Survey (SF-36) Mental Component (MCS) and Physical Component Scores (PCS) and the Patient Health Questionnaire-9 (PHQ-9)- were collected during hospitalization. Adherence to LLT was assessed up to twelve-months post-discharge. We performed a comparative analysis between patients with complete versus incomplete follow-up and utilized binary logistic regression to identify factors associated with adherence to LLT.

Of the cohort, 51% completed the 12-month follow-up. Completers were significantly older, had higher education, better mental health metrics (higher MCS, lower PHQ-9), and higher prevalence of chronic conditions including diabetes, hypertension, and hyperlipidemia. Participants in the adherent group were more likely to be males and White and had higher MCS and PCS scores. Lower income (<$35,000) was associated with adherence in unadjusted analyses but did not remain independently associated after multivariable adjustment. In the regression, each 10-point increase in MCS (OR 1.24; 95% CI 1.07-1.44), hyperlipidemia (OR 1.42;1.05-1.92), male sex (OR 1.36;1.02-1.81) and white race (1.47;1.02-2.13) were associated with increased odds of adherence.  CONCLUSIONS: Mental health-related quality of life, as measured by MCS, along with hyperlipidemia, male sex, and White race, was associated with LLT adherence after ACS. These findings suggest that post-ACS secondary prevention may benefit from incorporating patient-reported mental health assessment to identify individuals at increased risk for nonadherence.

Sleep duration and weekday-weekend sleep variability are increasingly recognised as important determinants of mental health. However, evidence from African populations on the relationship between sleep patterns and symptoms of generalised anxiety disorder (GAD) and depression remains limited. This study examined the associations of sleep duration and multidimensional sleep patterns with GAD and depressive symptoms among Nigerian adults.

A cross-sectional study was conducted among 1,223 adults with complete data. Weekday and weekend sleep duration were categorised as short (< 7 h), normal (7-9 h), or long (> 9 h). Sleep patterns were classified as: (1) optimally based (optimal, suboptimal weekday, suboptimal weekend, mixed) and (2) consistency based (consistent normal, consistent short, consistent long, inconsistent). Anxiety and depressive symptoms were assessed using the GAD-7 and PHQ-9. Multivariable logistic regression examined associations between sleep variables and mental health outcomes.

Overall, 55.8%, 36.4%, and 7.8% of participants reported short, normal, and long weekday sleep duration, respectively, compared with 36.7%, 47.8%, and 15.5% during weekends. The prevalence of GAD and depressive symptoms was 12.8% and 31.4%. Compared with normal sleep duration, short and long weekday sleep were associated with higher odds of GAD (AOR = 2.96, 95% CI: 1.89-4.63 and AOR = 3.46, 95% CI: 1.68-7.10, respectively). Similarly, short and long weekend sleep were associated with higher odds of GAD (AOR = 2.17, 95% CI: 1.44-3.25 and AOR = 2.92, 95% CI: 1.75-4.87, respectively). Suboptimal weekday, mixed, consistent short, consistent long, and inconsistent sleep patterns were also significantly associated with GAD (AORs = 2.72-4.08). For depressive symptoms, long weekday sleep (AOR = 1.67, 95% CI: 1.01-2.75), long weekend sleep (AOR = 2.59, 95% CI: 1.81-3.73), suboptimal weekday sleep (AOR = 1.41, 95% CI: 1.02-1.94), mixed sleep patterns (AOR = 2.22, 95% CI: 1.43-3.43), and inconsistent sleep patterns (AOR = 1.77, 95% CI: 1.26-2.48) were associated with higher odds of depressive symptoms.

Both sleep duration and sleep regularity were associated with anxiety and depressive symptoms among Nigerian adults. Interventions targeting both sleep duration and sleep regularity may help promote mental well-being.

Not applicable.

Migraine, a common neurological disorder, is categorized into episodic (EM) and chronic (CM) forms. Understanding their hormonal and metabolic differences can enhance insights into migraine pathophysiology and guide clinical approaches.

To explore hormonal and metabolic imbalances in EM and CM patients and identify key factors contributing to migraine chronicity.

This retrospective, cross-sectional study included 500 patients with migraine (318 EM and 182 CM). Data were retrospectively extracted from pre-existing clinical records, structured intake forms, physician examination notes, questionnaire-based assessments, and available laboratory results to evaluate demographic, clinical, metabolic, stress-related, mental health-related, and comorbidity variables.

CM patients were older (46.28 vs. 43.13 years, p = 0.002) and had more frequent severe attacks (15 vs. 8/month) and mild attacks (12 vs. 6/month) (p < 0.001). CM patients exhibited higher rates of anaemia (34.9% vs. 25.7%, p = 0.035), asthma (12.8% vs. 7.3%, p = 0.046), and sleep apnea (4.7% vs. 1.3%, p = 0.034). Fibromyalgia-related symptoms were common in both groups (82.1% in CM vs. 78.2% in EM), while the number of fibromyalgia tender points was higher in CM than in EM patients (median 8 vs. 6). Ferritin levels were lower in CM but not significantly so (p = 0.139). Suicidal thoughts and feelings of helplessness were more common in CM (p = 0.016, p = 0.002). CM patients used Botox more often but with lower efficacy and engaged in more cognitive behavioural therapy (p = 0.002).

CM was associated with more severe symptoms, higher comorbidity burden, more widespread pain features, and distinct metabolic and stress-related profiles compared with EM. These findings support the early recognition of clinical and comorbid factors associated with the chronic migraine phenotype.

This study aimed to examine the predictors of physical and mental health in a large sample of young people with disabilities.

A total of 1,134 participants (mean age: 17.46 years; standard deviation: 3.71) completed the SF-12 questionnaire, which provides physical (PCS) and mental (MCS) health scores. Participants were categorized based on their Paralympic participation (individual, team, or non-athlete), disability type, geographical region, and residential context. Multivariate linear regression models were used to identify independent predictors of PCS and MCS scores while controlling for relevant covariates.

PCS scores were higher in participants of individual (46.5) and team (47.6) sports than in non-athletes (39.3; p < 0.001), with no significant differences between the athlete groups (p = 0.324). Similarly, MCS scores were higher in participants in both individual (48.9) and team (48.8) sports than in non-athletes (34.3; p < 0.001), with no significant differences between sport types (p = 0.999). The PCS model (R² = 0.172) identified the following positive predictors: residence in Northern or Southern Europe (p = 0.001 and p = 0.020, respectively); participation in sports activities (p < 0.001); living in rural areas (p = 0.016); and presence of an intellectual disability (p = 0.003). A negative predictive factor was the presence of a neurological disability (p < 0.001). The MCS model (R² = 0.348) identified southern European origin (p = 0.014), participation in sports activities (p < 0.001) and intellectual disability (p = 0.037) as positive predictors, while advanced age (p = 0.025) and acquired disability (p < 0.001) were identified as negative predictors.

Paralympic sport was the strongest predictor of better physical and mental health, followed by geographical origin, age, disability type and residential setting.

Early childhood is a sensitive developmental period for the acquisition of cognitive and socio-emotional skills that are strongly associated with later mental health, academic achievement, and social functioning. Children growing up in socioeconomically disadvantaged contexts are at increased risk for early emotional and behavioral difficulties, highlighting the need for accessible, scalable, and developmentally appropriate preventive interventions. Japi 2.0 is a tablet-based gaming platform designed to stimulate six interrelated cognitive and socio-emotional skills-working memory, inhibitory control, emotion recognition, social competence, empathy, and cognitive planning-through structured play in preschool settings.

We conducted a pilot cluster randomized controlled trial in low-income preschools in Santiago, Chile. Schools were randomized to either the Japi 2.0 intervention or treatment as usual. The intervention consisted of 24 individual sessions delivered over 12 weeks during regular class hours. Primary outcomes were acceptability (perceived by children, early years educators, and parents) and feasibility (recruitment, retention, attendance, intervention delivery, and data completeness). Secondary outcomes explored preliminary changes in cognitive, socio-emotional, and behavioral functioning using standardized assessments and parent- and teacher-reported measures. Exploratory analyses were conducted using multilevel models adjusted for baseline scores and clustering, based on available outcome data from randomized participants.

Japi 2.0 showed high acceptability across stakeholders. Educators and parents reported that the game and the accompanying web-based dashboard were engaging, age-appropriate, easy to use, and pedagogically relevant. Children reported high levels of enjoyment and positive emotional experiences during gameplay. Feasibility indicators were satisfactory: most planned sessions were delivered as scheduled, attendance was high, and outcome data completeness was adequate. Exploratory analyses indicated improvements over time in both groups across most outcomes. Preliminary exploratory signals favoring the intervention were observed for empathy and parent-reported emotional and behavioral difficulties; however, these findings should be interpreted cautiously given the small number of clusters and exploratory nature of the analyses.

This pilot trial demonstrates that Japi 2.0 is a feasible and highly acceptable digital intervention for preschool children in low-income educational settings. Although efficacy findings are preliminary, results support progression to a fully powered randomized controlled trial to evaluate effectiveness and longer-term impacts on cognitive, socio-emotional, and behavioral development. Trial registration Clinical Trials NCT06420544, May 20th, 2024. https://www.

gov/study/ NCT06420544.

Suicide prevention is increasingly gaining attention, especially for those who have suicidal ideation. Nursing students face unique stressors from academic and clinical demands, leading to high rates of anxiety, depressive symptoms, and suicidal tendencies. While previous research has focused on prevalence and single-variable associations, the complex interrelationships among these mental health issues remain understudied. This study aims to use network analysis to explore the connections between anxiety, depressive symptoms, and suicidal tendencies in nursing students with recent suicidal ideation.

A cross-sectional study was conducted among 558 nursing students from Guangxi Health Science College who reported recent suicidal ideation. Data on anxiety symptoms (Generalized Anxiety Disorder-7(GAD-7) Scale), depressive symptoms (Patient Health Questionnaire-9 (PHQ-9)), and suicidal tendencies (Chinese Version of the Beck Scale for Suicide Ideation (BSI-CV)) were collected via online surveys. Network modeling was performed using the Gaussian graph model with the graphical least absolute shrinkage and selection operator (GLASSO) algorithm to identify key symptoms and their relationships. Central and bridge symptoms were analyzed, and network stability was evaluated using bootstrapping. Additionally, a separate network of suicidal ideation and suicidal tendency was constructed to further explore the intrinsic associations of suicide-related symptoms.

The network model included 30 symptom nodes, with an average predictability of 62%, indicating strong interconnections. The most central symptoms were "motor changes," "actual preparation for suicide," and "lack of energy," which played pivotal roles in driving network connectivity. "Irritability," "anhedonia," and "depressed mood" emerged as critical bridge symptoms, linking anxiety, depression, and suicidal tendency communities. Strong within-community connections were found in each symptom group. The network showed robust stability. The separate suicidal ideation-suicidal tendency network had an average predictability of 0.45, with "actual preparation for suicide" as the most central symptom; "desire to live" and "passive suicidal desire" served as key bridge nodes in this network.

This study is the first to construct a network of anxiety, depressive symptoms, and suicidal tendencies in nursing students with recent suicidal ideation. Central symptoms like motor changes and actual preparations for suicide are key targets for disrupting the progression from ideation to action, while bridge symptoms such as irritability and depressed mood highlight the interconnected nature of these states. The identification of "desire to live" as a critical link between suicidal ideation and suicidal tendency provides a novel protective target for suicide prevention. The findings provide a holistic perspective for developing targeted interventions to improve mental health and prevent suicidal behavior in this high-risk group.

Not applicable.

We evaluated the impact of diagnosing and treating curable STIs during pregnancy on adverse pregnancy outcomes in Cape Town, South Africa.

Eligible women ≥ 15 years, without HIV, attending first antenatal care (ANC) visit before 28 weeks gestation, received diagnostic testing at enrolment and either same-day or follow-up treatment for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) using either on-site GeneXpert or laboratory-based testing with TaqMan qPCR assays. We assessed prevalence of CT/NG, time to treatment and the frequency of poor pregnancy outcomes, individually and combined including pregnancy loss (miscarriage [< 20weeks] or stillbirth [≥ 20weeks]) and perinatal outcomes (low birthweight [< 2500 g], preterm birth [< 37weeks], small for gestational age [< 10th percentile] and neonatal death [< 7days]) among women with or without CT/NG at study enrolment. Logistic regression models evaluated the impact of time to CT/NG treatment on the frequency of individual and combined poor pregnancy outcomes, adjusting for maternal characteristics.

Among 1237 pregnant women, the prevalence of CT/NG at first ANC visit was 28% (24% CT, 8% NG). Of those diagnosed with CT/NG (n = 345), 54% received immediate treatment(< 7 days), while 34% experienced delayed treatment (median time to treatment 28 days (interquartile range: 15-57)) and 12% were untreated during pregnancy. Among women with CT/NG, the frequency of miscarriage (12%) and stillbirth (9%) were highest among women with untreated CT/NG, lower among delayed treatment (4% and 3%), and lowest among immediate treatment (1% and 2%), respectively. Among women with CT/NG at enrolment, poor pregnancy outcome was 28%, 23%, and 29% for immediate, delayed, and no treatment, respectively; 22% among women with no CT/NG at enrolment (overall χ² test, p = 0.05). Untreated CT/NG were associated with increased odds of pregnancy loss (adjusted odds ratio (aOR); 3.27, 95% CI: 1.09-9.80) compared to CT/NG with immediate treatment and compared to no CT/NG at study enrolment (aOR; 5.05, 95% CI: 2.23-11.43). Multivariable analysis showed no significant difference in poor pregnancy outcome by time to CT/NG treatment.

Untreated CT/NG during pregnancy increased the odds of experiencing a miscarriage or stillbirth. These findings suggest potential benefits of STI screening using diagnostic tests leading to the timely treatment of curable STIs in pregnancy, and randomized trials are urgently needed to clarify these effects.

Not applicable.

SCN2A variants are among the most common genetic causes of developmental and epileptic encephalopathies (DEEs), which can present with uncontrolled seizures at birth and account for 1-2% of all epileptic encephalopathies. A substantial fraction of causal variants are gain-of-function or mixed-function variants associated with increased channel open probability or greater sodium current flux. Here two parallel n = 1 clinical studies were conducted in two patients (9-year-old and 14-year-old boys) with SCN2A-related DEE. Individualized allele-selective antisense oligonucleotides (ASOs) were designed to target heterozygous intronic single-nucleotide polymorphisms (SNPs) for decreased expression of mutant SCN2A transcript while preserving the wild-type copy. Primary endpoints included quantitative change from baseline in seizure frequency and neurodevelopment, including motor scores. Efficacy measures were also individualized to each patient's phenotype, including refractory seizures, developmental delay, autism spectrum disorder, choreoathetosis and gastrointestinal dysfunction. Patients experienced a reduction in seizure frequency (26% and 90% in the two patients, respectively), decreased use of concomitant medications and improvement in neurodevelopmental skills. Both ASOs were well tolerated, with no ASO-related serious adverse events. Continued long-term follow-up of these preliminary positive safety and efficacy findings is needed to confirm the disease-modifying potential of these ASOs. Haplotype phasing in a separate cohort of infants with SCN2A-related disorder (SCN2A-RD), diagnosed by rapid whole-genome sequencing, identified 16% of patients with compatible SNPs. These data provide a pathway from n = 1 to n of more patients with SCN2A-RD and other monogenic disorders. ClinicalTrials.gov registration: NCT06314490 .