Lifestyle medicine (LM) provides a high-value framework for treating and potentially reversing chronic diseases, such as type 2 diabetes (T2D), obesity, cardiovascular diseases, and some cancers. Yet, the field of LM is still growing, and few examples exist of how to successfully implement LM into clinical care. This paper describes the implementation of 1:1 lifestyle medicine (LM) coaching visits for 45 patients with uncontrolled type 2 diabetes (T2D), (mean HbA1c 10.5%) and on multiple diabetes medications, at Cone Health's Reidsville Endocrinology practice in North Carolina, USA. In brief, during routine endocrinology visits, the lead physician of the LM program at Cone Health, who is trained in LM, identified patients with uncontrolled T2D where scheduling allowed him to fit in some additional time for coaching. Forty-five interested patients selected over a period of several weeks from Spring of 2022 to Fall of 2022 made the first cohort. During a typical LM encounter, immediately after addressing their referral concerns with a routine endocrinology consult, verbally consenting patients were personally invited to learn more about LM. They were provided with a packet of materials focused predominately on prescribing nutrition and exercise as treatment for chronic disease. The physician spent an additional 10-15 minutes with each verbally consenting patient to go through selected materials in the packet, focusing largely on nutrition and physical activity, and successfully billed for the additional time. The patients were encouraged to take the packet home for further learning and return to their next routine visits with questions and to engage in further coaching. Following this brief but intensely focused coaching session which was done in addition to the routine endocrinology visit, lifestyle medicine coaching was able to be incorporated into subsequent, routine endocrinology visits in many of the initially identified patients. The majority of these patients also accepted a referral to a dietitian in the same practice. This experience highlights a model for potentially integrating LM coaching into routine practice and, consistent with previous research, highlights the importance of a site champion for successful LM implementation. Future research is needed to formally assess the success of coaching visits, particularly in terms of assessing health outcomes in patients who engaged in the 1:1 coaching.

Incarcerated people are often excluded from health research, limiting the evidence available to address the specific needs of this population. US federal regulations provide a foundation for research involving incarcerated people, but many prison and jail systems have developed institution-specific policies that further govern research. Carceral research policies may represent an underexamined mechanism for regulating research access in prisons and jails. We analyzed US carceral research policies and found substantial variation across systems, including approaches to ethical oversight and institutional discretion over research activities and dissemination of research findings. The wide variation in policies, power facilities have over research access, and potential censoring of findings highlights the need for more standardized practices. We propose policy changes that would better align carceral research policies with best practices in research governance, facilitating ethical research access and strengthening the evidence needed to address the health needs of this marginalized population.

Health-care workers' mental health is closely related to workforce stability, quality of care, and health-system resilience. In China, medical alliances are a model for integrating tertiary hospitals, secondary hospitals, and community health-service centres, but evidence on staff mental health within such systems remains limited. The primary objective was to describe the distribution and severity of depressive symptoms, anxiety symptoms, perceived stress, insomnia, and burnout dimensions; the secondary, exploratory objective was to examine adjusted associations with selected demographic and occupational characteristics.

We audited item-level data from an institution-based cross-sectional online survey conducted in 2024 among health-care workers in a Shanghai medical alliance. Exact duplicate exported records were removed. Depression, anxiety, and stress were scored separately using the DASS-21; sleep symptoms were scored with the ISI; and MBI-GS exhaustion, cynicism, and professional efficacy were analysed as separate dimensions. Internal consistency, multiplicity-adjusted subgroup comparisons, and indicator-coded multivariable models were evaluated.

The supplied file contained 669 rows; 175 were literal copies of earlier records, leaving 494 unique respondents. Descriptively, mean (SD) scores were 9.53 (8.61) for depression, 8.81 (7.95) for anxiety, 11.84 (8.71) for stress, and 9.12 (6.16) for ISI. Scores at or above the mild-symptom threshold occurred in 47.6, 48.6, and 29.4%, respectively; 51.4% scored above the ISI no-clinically-significant-insomnia range. Mean MBI-GS dimension scores were 2.58 (1.62) for exhaustion, 2.26 (1.41) for cynicism, and 3.65 (1.21) for professional efficacy. Cronbach's alpha ranged from 0.798 to 0.959. In unadjusted subgroup comparisons, only ISI differences by years of work remained statistically significant after Holm correction across 70 tests. In exploratory adjusted models, on-call work was associated with higher depression, anxiety, and ISI scores, and age was associated with ISI; these estimates did not account for institution-level clustering and should not be interpreted as causal effects.

The results indicate a substantial burden of psychological symptoms and measurable burnout dimensions in this medical alliance. Most unadjusted subgroup differences did not withstand multiplicity correction, whereas only a small number of associations were observed in exploratory adjusted models. These findings are non-causal and require confirmation with institution-clustered analyses before being used to define target groups.

Visual Snow Syndrome (VSS) is a neurological condition characterized by the persistent perception of dynamic, flickering, dot-like visual disturbances across the entire visual field, resembling television static. Increasing evidence indicates that VSS is frequently accompanied by a broad spectrum of psychiatric symptoms, including anxiety, depression, depersonalization, fatigue, and sleep disturbances, all of which substantially impair quality of life. Although the pathogenesis of VSS remains incompletely understood, Current evidence increasingly suggests that VSS may represent a multisystem neuropsychiatric network disorder involving visual cortical hyperexcitability, thalamocortical dysrhythmia, widespread abnormalities in functional connectivity, and limbic system dysfunction. Psychiatric symptoms may partly reflect intrinsic neurobiological mechanisms of the syndrome rather than being solely secondary psychological reactions to chronic visual disturbances. Current pharmacological therapies generally show limited efficacy. Preliminary evidence suggests that non-pharmacological approaches, including neuromodulation, tinted lenses, and mindfulness-based interventions, may offer therapeutic potential with relatively favorable tolerability, although larger controlled studies are still required. Future research should adopt multidisciplinary strategies integrating neurology, psychiatry, neuroimaging, and genetics to further elucidate the mechanisms underlying VSS and facilitate the development of precision diagnostic and therapeutic approaches.

Subclinical metabolic disturbances have been associated with functional brain changes; however, the neural pathways mediating their cognitive effects remain unclear.

This study investigated whether large-scale brain network connectivity mediates associations between metabolic risk factors and cognition in healthy young adults.

Data were obtained from 676 participants (22 - 37 years) in the Human Connectome Project. Metabolic indices (body mass index (BMI), glycated hemoglobin, thyroid-stimulating hormone (TSH), systolic/diastolic blood pressure, and hematocrit) were assessed alongside the National Institutes of Health (NIH) Toolbox Cognition Battery scores, the Mini-Mental State Examination, and fluid intelligence measures. Resting-state fMRI data underwent group independent component analysis to identify 14 intrinsic connectivity networks. Partial correlations were computed between network time series, and multiple regression models were adjusted for age, sex, race, and education. Mediation analyses with bootstrapped confidence intervals were conducted to test whether network connectivity explained the metabolic-cognition relationships.

We found that large-scale resting-state networks significantly mediated the associations between specific metabolic risk factors and cognitive performance. Specifically, BMI, hematocrit, and TSH showed significant associations with both cognition and network connectivity (all P < 0.05). BMI-related reductions in vocabulary performance were fully mediated by altered connectivity in the frontoparietal-language, sensorimotor-frontoparietal, primary visual-auditory, and default mode-executive attention networks and partially mediated (compensatory effect) by salience-sensorimotor connectivity (indirect effects: -0.0238, -0.0115, -0.0110, -0.0096, and 0.0068, respectively; 95% CIs: [-0.0421, -0.0085], [-0.0239, -0.0030], [-0.0237, -0.00016], [-0.0206, -0.0014], and [0.0001, 0.0165], respectively). Hematocrit's positive association with vocabulary performance was partially mediated by the primary visual-auditory, salience-auditory, and language-dorsal attention networks, with primary visual-ventral attention connectivity exerting a suppressive effect (indirect effects: 0.0094, 0.0149, 0.0074, and -0.0113, respectively; 95% CIs: [0.0007, 0.0215], [0.0032, 0.0319], [0.0001, 0.0197], and [-0.0249, -0.0012], respectively). TSH was positively associated with fluid intelligence via a direct pathway (P = 0.010), without mediation by resting-state connectivity.

These findings highlight large-scale brain networks as potential intermediate phenotypes that link metabolic health to cognition, suggesting that targeted neuromodulation of vulnerable circuits, combined with metabolic interventions, may offer novel strategies for preserving cognition in at-risk populations.

This study explored the feasibility and perceived clinical utility of a novel psychotherapy intervention consisting of two components (1) assessment of patients' social context using the experience sampling methodology (ESM) and personal social network data collection (PSN) and (2) a feedback report summarizing the collected data. Four qualitatively driven concurrent embedded mixed-methods case studies were conducted in a large mental health care facility in the Netherlands and included nine young adults receiving either individual or group psychotherapy: six in part-time treatment and three transitioning from inpatient to outpatient care. Feasibility and utility were evaluated using codebook thematic analysis of semi-structured patient and therapist interviews, patient compliance with the intervention components and researchers' reflexive field notes. Overall, the intervention appeared most feasible in individual therapy, in which patient and therapist engaged with it collaboratively. Engagement was more difficult among avoidant patients and when the intervention was experienced as too confronting by patients, highlighting the importance of establishing rapport before its use. The intervention yielded varying degrees of insight for patients, depending on their ability to engage with the assessments and feedback-based therapeutic dialogue. The feedback report specifically improved therapists' understanding of patients' social context. Future implementation will require automation, integration into digital clinical infrastructure, and therapist training to support appropriate interpretation of feedback and follow-up action.

Plasmodium vivax malaria has long been considered less severe than P. falciparum infection. However, there is growing evidence that P. vivax can lead to severe and life-threatening disease, although its burden is likely to be underestimated, particularly in low-transmission settings.This study aimed to contextualize the application of World Health Organization (WHO) severe malaria criteria in a low-transmission setting by describing the clinical and parasitological profile of hospitalized malaria patients in the Peruvian Amazon.

We conducted a retrospective hospital-based study at Hospital Regional de Loreto, Iquitos, Peru, from January 1, 2023, to October 30, 2025. The total hospital malaria caseload was determined from records assigned a laboratory-confirmed ICD-10 malaria diagnosis. The analytic cohort comprised hospitalized patients with microscopy-confirmed malaria who received intravenous artesunate because of severe malaria according to the WHO 2022 criteria, or inability to tolerate oral antimalarial treatment.

During the study period, 519 laboratory-confirmed malaria diagnoses were recorded in the hospital; of these, 127 patients (24.5%) were hospitalized. Of these, 97 had P. vivax infection (76.4%), 27 had P. falciparum infection (21.3%), 2 had mixed P. vivax/P. falciparum infection (1.6%), and 1 had P. malariae infection (0.8%). Overall, 67 patients (52.8%) met criteria for severe malaria, which was observed in 51/97 patients with P. vivax (52.6%) and 14/27 patients with P. falciparum (51.9%), with no significant difference between species. Notably, patients with P. vivax malaria presented with severe manifestations including impaired consciousness, pulmonary oedema or acute respiratory distress syndrome, and shock. Laboratory differences between species were modest, although P. falciparum infections were associated with lower haemoglobin and glucose levels, while P. vivax was associated with more marked thrombocytopenia. Clinical outcomes were generally favourable, with one death to which malaria-related complications may have contributed.

P. vivax contributed substantially to severe malaria in this low-transmission Amazonian setting and showed a severity profile similar to that of P. falciparum. The overlap observed between severe and non-severe presentations supports the contextual application of international severity criteria and continued recognition of the clinically important burden of P. vivax malaria.

This preliminary study examined the efficacy of cathodal transcranial direct current stimulation (tDCS) targeting the medial prefrontal cortex (mPFC) in reducing symptom severity, enhancing cognitive flexibility, and modulating brain-derived neurotrophic factor (BDNF) levels in individuals with obsessive-compulsive disorder (OCD).

A double-blind, randomized, sham-controlled trial was conducted with 20 patients meeting DSM-V criteria for OCD, of whom 15 completed the intervention and were included in the final analysis. Participants received cathodal mPFC-tDCS (2 mA, 20 min, 10 sessions) or sham stimulation. Symptom severity (Y-BOCS), cognitive flexibility (task-switching), salivary BDNF, and frontal alpha activity (qEEG at Fz) were measured at baseline, post-treatment, and follow-up.

The tDCS group exhibited greater reductions in Y-BOCS scores over time (F(2, 26) = 12.562, p < 0.001, partial η² = 0.425). Task-switching performance improved in the experimental group compared with controls (F(2, 26) = 20.351, p < 0.001, partial η² = 0.531). Salivary BDNF levels increased significantly in the tDCS group at follow-up (F(2, 16) = 6.086, p = 0.01, partial η² = 0.432). Trends toward normalization of frontal alpha activity were observed, but did not reach statistical significance.

Cathodal mPFC-tDCS was associated with reduced OCD symptom severity, improved cognitive flexibility, and increased salivary BDNF. These preliminary findings warrant replication in larger controlled samples.

This study extends previous tDCS research in OCD by integrating clinical outcomes with cognitive performance and a peripheral marker of neuroplasticity. It provides preliminary support for mPFC-targeted tDCS as a potential intervention for OCD.

Nurses in neonatal intensive care units (NICUs) face significant emotional and clinical demands affecting caring behaviours. Psychological empowerment is linked to improved nursing outcomes, yet evidence from conflict-affected settings remains limited.

This study examined the relationship between psychological empowerment and caring behaviours among NICU nurses in the West Bank, Palestine and identified predictors of caring behaviours.

A multicentre descriptive correlational cross-sectional design was used. In total, 178 NICU nurses across 12 hospitals participated (response rate: 178/200, 89.0%). Psychological empowerment was measured using Spreitzer's 12-item scale (1-7); caring behaviours were assessed using the Caring Behaviours Assessment Tool Nursing Version-Short Form (27-135). Descriptive statistics, Pearson correlation and multiple linear regression were applied.

Mean age was 34.4 ± 7.5 years; 65.7% were female. Psychological empowerment was moderate-to-high (mean 4.6 ± 1.3), and caring behaviours were relatively high (mean 96.7 ± 14.5). Psychological empowerment was positively correlated with caring behaviours (r = 0.696, p < 0.001) and was the only significant predictor (B = 7.352), explaining 49.4% of variance.

Psychological empowerment was strongly associated with caring behaviours, suggesting that empowerment-focused leadership and professional development strategies may support caring practice among NICU nurses.

Canada legalized the non-medical use and supply of cannabis in 2018. The public health-relevant outcomes of cannabis legalization documented to date have been mixed, with decreases in cannabis-related crime and illegal distribution markets, while with increases for many - acute and chronic - health problem indicators. One public health-relevant aspect of legalization that has not been adequately assessed to date are its potential effects on alcohol and/or tobacco use and related outcomes in the population. Existing literature suggests that cannabis legalization may impact alcohol and/or tobacco use in different ways and directions, through both 'substitution'- and/or 'complementarity'-type dynamics. While cannabis use prevalence has markedly increased through legalization, recent epidemiological indicators suggest the possibility of (small) changes in rspective other substance use, yet it is empirically unclear whether these developments are causally interrelated. Also considering the substantial adverse public health burden arising from alcohol and tobacco use in the Canadian population, this Commentary makes the case for systemic examination of the potential impacts of cannabis legalization on alcohol and/or tobacco use outcomes by way of rigorous analytical methods as part of assessing the overall public health-related effects of cannabis legalization in Canada as well as other jurisdictions where cannabis has been legalized.