Thoracic aortic disease (TAD), including type A acute aortic dissection and Marfan Syndrome, requires lifelong management. Exercise may offer benefits, but the impact of exercise on quality of life (QoL), cardiovascular outcomes, and safety remains unclear. This scoping review synthesizes evidence on exercise effects in patients with TAD.

A comprehensive search was conducted in PubMed, Embase, and CINAHL for studies published up to June 30, 2025. Eligibility criteria included original studies evaluating exercise interventions in patients with TAD or related genetic conditions. Studies reporting outcomes on QoL and cardiovascular status or safety were included. Two reviewers independently screened titles and abstracts, followed by a full-text review; discrepancies were resolved by a third. Data extraction covered population, intervention, and outcomes related to QoL, cardiovascular health, and adverse events.

Nine studies were included, comprising randomized controlled trials, cohort studies, and observational designs. Exercise interventions varied from moderate-intensity aerobic training, resistance training, and personalized rehabilitation programs. Most studies reported improved physical function and capacity, particularly in post-surgical patients with type A acute aortic dissection. Mental health outcomes showed mixed results; some studies reported significant reductions in anxiety and depression, while others found no significant changes in the mental component of QoL. No serious adverse events occurred, although systolic blood pressure responses varied greatly. Despite limited evidence, exercise may enhance physical performance in patients with TAD, although the impact on mental health remains uncertain. Future research should focus on optimizing intervention protocols, incorporating psychosocial support, and establishing evidence-based safety thresholds for exercise-induced blood pressure changes.

Severe behavioral outbursts characterized by reactive aggression (RA) are common and highly impairing for young children and their families. A growing body of research suggests RA may characterize a distinct group of youth with behavior problems; however, there is a lack of validated, RA-specific assessment tools for children. The current work presents psychometric evidence for a novel screening tool and outcome measure: the 16-item Reactive Aggression Assessment (RAGA-16).

A nationally representative US sample (N = 1,162) of parents with children ages 5 to 19 (M = 11.4; SD = 3.98) completed an as-yet unpublished assessment of mood and behavior problems. Using this item pool, we employed two distinct test development approaches, Data-Informed vs. Automated Test Assembly (ATA), and compared the resulting scales based on multiple facets of reliability and associations with parent-reported health information.

Both the Data-Informed and ATA-derived forms showed high reliability (r_xx > .80) across a wide range of symptom severity and excellent internal consistency despite containing largely different items. The Data-Informed version showed descriptively higher detection of parent-report externalizing disorders (AUC = .76 vs. .73). Percentile and T-Score norms for scores on the Data Informed form are reported.

The Data-Informed version was selected as the final version of the RAGA-16. Having a brief, highly reliable, targeted assessment of RA with epidemiological norms allows researchers and clinicians to better characterize RA behaviors in youth. Forthcoming work will validate the RAGA-16 as a screening tool in clinical settings.

Reactive aggression (RA) is a transdiagnostic symptom associated with more severe illness and worse clinical course. Despite the clinical importance of RA, few validated screening measures or outcome assessments exist for use with children under 12. The 16-item Reactive Aggression Assessment (RAGA-16) is a novel parent-report instrument with promising evidence of psychometric reliability. The current work presents clinical validation evidence for RAGA-16.

A retrospective chart review examined the records of children seeking inpatient and outpatient services. Parents completed the RAGA-16 and additional questionnaires assessing depression, hypomania, ADHD symptoms, and aggression at intake. The chart review also included clinical diagnoses, demographic information, and treatment details. Graded response models (GRMs) evaluated the RAGA-16 factor structure and associations with criterion variables evaluated the scores' validity as a screening measure assessing RA.

Confirmatory models showed good fit to the hypothesized two-factor structure with high marginal reliability (ωt = .98). RAGA-16 scores showed large significant positive associations with measures of aggression, impulsivity, and oppositionality (rs > .70, ps < .001), lower associations with hypomanic symptoms (r = .40, p < .01), and no significant association with depression (p > .05). RAGA-16 scores statistically discriminated diagnoses associated with severely externalizing symptoms from other diagnoses. Endorsement of RA in more contexts (home, school, or elsewhere) was associated with higher aggression symptoms.

Overall, RAGA-16 scores showed a pattern of criterion associations consistent with the construct of interest along with high score reliability. The addition of inpatient and outpatient clinical score characteristics to the existing epidemiological norms makes RAGA-16 a promising new tool for assessing youth RA.

Impaired perivascular aquaporin 4 (AQP4) polarization and glymphatic dysfunction after intracerebral hemorrhage (ICH) may delay hematoma and perihematomal edema resolution. The effects of high-definition transcranial direct current stimulation (HD-tDCS) on glymphatic transport and recovery after ICH, as well as the underlying mechanisms, are investigated in a collagenase-induced mouse model. HD-tDCS (anodal stimulation, 0.1 mA, 10 min daily) significantly enhances cerebrospinal fluid influx, improves interstitial solute clearance, reduces intracerebral tracer retention, and increases drainage to the deep cervical lymph nodes, as assessed by in vivo two-photon imaging, contrast-enhanced MRI, and ex vivo tracer analysis. HD-tDCS also accelerates hematoma and edema resolution, reduces midline shift and diffusion abnormalities, and improves neurological outcomes. Mechanistically, ICH induces astrocytic proinflammatory activation together with impaired perivascular AQP4 polarization, whereas HD-tDCS upregulates peroxisome proliferator-activated receptor gamma (PPARγ), suppresses proinflammatory astrocyte activation, and restores perivascular AQP4 localization. Astrocyte-specific knockdown or pharmacologic inhibition of PPARγ attenuates HD-tDCS-induced AQP4 repolarization, glymphatic recovery, and neurological improvement. These findings indicate that HD-tDCS promotes hematoma and edema resolution after ICH in association with PPARγ-dependent astrocyte remodeling, AQP4 repolarization, and glymphatic restoration.

Health promoting school (HPS) interventions have the potential to improve adolescent health and well-being, but evidence regarding implementation and system-level impact in real-world school settings remains limited. "My Life - I Decide" (My Life) is a systems-oriented HPS intervention developed to strengthen positive mental and physical health, school well-being, and health-promoting school practices among 10th-grade students in Denmark.

This study aims to describe the intervention, study design, and evaluation framework of the "My Life" intervention and its pragmatic controlled trial, including effectiveness, process, and system-level evaluations.

The intervention is informed by the World Health Organization HPS framework and combines curriculum-based health education, action-oriented teaching, life-psychological approaches, and education outside the classroom. The intervention includes four phases: (1) preparation through cross-sectoral collaboration between health and education sectors; (2) planning and local adaptation; (3) delivery of a health education program; and (4) anchoring of health-promoting practices at the school level. Effectiveness is evaluated using a pragmatic controlled waiting-list trial design. Four intervention schools (11 classes) were matched with 4 control schools (15 classes), including approximately 416 students aged 15-17 years. Primary outcomes include social and emotional competences, self-efficacy, mental well-being, health literacy, school connectedness, and student interpersonal relations. Student survey data are collected at baseline, postintervention, and follow-up, and effectiveness will be analyzed using multilevel mixed models. System-level impacts are assessed using a mixed-methods design, including school staff surveys, interviews with school and municipal stakeholders, and student focus groups. A realist-informed multimethod process evaluation examines implementation fidelity, acceptability, contextual factors, and mechanisms of impact across intervention schools. Data sources include observations, interviews, student registration, and postsession surveys completed by health consultants after each teaching session.

The study will generate quantitative and qualitative data on student outcomes, implementation processes, intersectoral collaboration, and development of health-promoting practices within schools. Findings from the effectiveness, process, and system-level evaluations will be triangulated to test and refine the initial program theory of the intervention. Recruitment of schools and student enrollment have been completed, and baseline data collection commenced in September 2025. Follow-up assessments are being conducted according to the study timeline. Qualitative data collection for the process and system-level evaluations were completed in June 2026.

The "My Life" study will contribute knowledge on the implementation and evaluation of complex HPS interventions in real-world educational settings. The findings may inform future HPS initiatives and provide methodological insights into combining effectiveness, process, and system-level evaluations in adolescent health promotion research.

This study compared mental health outcomes in preadolescents with and without a history of late talking (HLT) to determine whether outcomes cascade from early language ability, considering ecological and early mental health factors.

We included 52 Mandarin-speaking preadolescents (100% Han Chinese) 9-11 years of age: 26 with HLT (M = 10.15 years, SD = 0.34; 20 boys, six girls) and 26 without HLT (M = 10.20 years, SD = 0.38; 17 boys, nine girls). Both groups had comparable nonverbal cognitive abilities (p = .721). The mental health outcomes assessed, based on parents' reports and participants' performance in laboratory tasks, included conceptual learning for adaptation, competence and emotion, self-regulation, and autism-like characteristics. Early language ability was assessed during toddlerhood (24-32 months of age) and the preschool period (48-57 months of age).

Preadolescents with HLT performed worse in conceptual learning, self-regulation, and social functioning than those without HLT ([Formula: see text]s = .08-.20), indicating medium-to-large effect sizes. These three domains were associated with early language ability, showing moderate correlations (rs = .31-.52 or -.28 to -.41).

Preadolescents with HLT had more mental health problems than those without HLT, which was linked to early language abilities. Their mental health should be understood from a developmental cascade perspective, emphasizing early identification and intervention, starting in childhood. Monitoring mental health may be particularly important during the transition to formal schooling.

Work-family conflict, defined as a type of inter-role conflict where demands from work and family roles are incompatible, is a global public health concern. Cross-sectional studies consistently demonstrate associations between work-family conflict and adverse mental health outcomes. However, longitudinal evidence remains mixed, highlighting the need for a comprehensive synthesis of available data to better understand its long-term impacts.

We performed a systematic review and meta-analysis of longitudinal studies of associations between work-family conflict and mental health outcomes, involving 112,714 participants and 52 studies in the meta-analysis. The review was prospectively registered in PROSPERO (CRD42022325540). We searched PubMed, Web of Science, Scopus, and PsycINFO for English-language articles and SinoMed for Chinese-language articles in February-March 2026. We further performed backward citation searches by screening the reference lists of previously published reviews to ensure the comprehensive inclusion of all eligible studies. Eligible studies were original longitudinal research focusing on adult workers, examining work-to-family and/or family-to-work conflict as exposures related to mental health outcomes. Risk of bias was assessed using the Newcastle-Ottawa Scale. Random-effects meta-analyses were conducted for outcomes with three or more comparable studies, converting effect sizes to standardised regression coefficients (β), indicating standard deviation (SD) differences in mental health per 1-SD increase in work-family conflict. We synthesised effect sizes with the most comprehensive confounding adjustments when possible, including sociodemographic, work/family-related factors, and baseline mental health. Work-to-family conflict was associated with depressive symptoms (β = 0.10, 95% confidence interval [0.06, 0.15]; p < 0.001), burnout (β = 0.11, 95% CI [0.01, 0.21]; p = 0.040), and general mental distress (β = 0.13, 95% CI [0.03, 0.24]; p = 0.005), independent of baseline mental health and other confounders. Significant associations were also found for family-to-work conflict with depressive symptoms (β = 0.09, 95% CI [0.04, 0.15]; p = 0.006) and burnout (β = 0.08, 95% CI [0.03, 0.13]; p = 0.013) in studies with similar adjustments. No significant differences emerged based on gender, follow-up length, and geographical location. While evidence of publication bias was identified, sensitivity analyses employing a trim-and-fill method to adjust for this bias yielded broadly similar pooled estimates. A causal relationship cannot be fully established as all identified studies were observational.

These findings provide evidence of the longitudinal association between work-family conflicts and mental health outcomes, underscoring the need for context-specific policies in promoting work-family balance and mental health.

India's Tele-MANAS (Tele Mental Health Assistance and Networking Across States) programme, launched in October 2022, is the world's largest government-led tele-mental-health initiative. Operating via a multilingual 24/7 helpline, it provides stepped-care support, offering immediate counselling and escalating complex cases to psychiatrists or local services. In its first few years, Tele-MANAS has responded to more than 3.43 million calls across all Indian states and union territories. The majority of callers present with anxiety, depression or psychosocial stressors, while a critical minority report suicidal distress. Features such as linguistic inclusivity, anonymity and integration with India's digital health ecosystem have driven rapid uptake, particularly among young adults. A World Health Organization (WHO) assessment has recognised Tele-MANAS as a scalable and equity-focused solution. The initiative illustrates how low- and middle-income countries can leverage technology and task sharing to reduce the treatment gap, offering a potential global blueprint for digital mental health care. This article aims to provide a programmatic overview of Tele-MANAS, including its design, early outcomes and key implementation challenges.

Recent advances in biotechnology and personalized medicine have driven the development of efficient clinical trial methodologies for assessing treatment efficacy across multiple populations defined by treatment effect modifiers. Within-patient comparison of different treatments is a promising approach for improving study efficiency across multiple populations by eliminating between-patient variability in treatment evaluation. This study provides a framework for evaluating treatment efficacy in multiple populations for 2 × 2 $$ 2\times 2 $$ crossover trials and evaluates the efficacy gain in comparison with the standard parallel-group analysis. Simulation experiments confirm that the crossover analysis consistently outperforms the parallel-group analysis in statistical power, especially when carryover effects are small. An application to a clinical trial in Type 2 diabetes demonstrates the efficiency advantages of the crossover analysis. These numerical results emphasize the potential of the crossover analysis for enhancing the efficiency of clinical development of personalized medicine.

Painful diabetic neuropathy (PDN) is a common complication of diabetes that substantially impairs quality of life and remains challenging to manage. Spinal cord stimulation (SCS), including high-frequency (HF-SCS), low-frequency (LF-SCS), and burstDR (burstDR-SCS) modalities delivered with the De Ridder algorithm, has emerged as a therapeutic option for patients with inadequate response to conventional medical management (CMM). However, the comparative efficacy and safety profiles of these specific SCS modalities remain unclear. A systematic search identified 1,243 records, from which seven studies involving 698 patients met the inclusion criteria and were analyzed using a random-effects Bayesian network meta-analysis framework with minimally informative priors. Primary outcomes included the proportion of patients achieving ≥ 50% pain reduction, change in visual analog scale (VAS) scores, change in EQ-5D-5 L utility scores, and incidence of adverse events. Treatments were ranked using the surface under the cumulative ranking curve (SUCRA), and contribution plots were used to assess the strength and source of evidence. HF-SCS had the highest probability of achieving ≥ 50% pain reduction (SUCRA = 78.3%), with significantly greater efficacy than CMM (OR = 2.70, 95% CrI: 1.84-3.56). Indirect comparison suggested a trend favoring HF-SCS over BurstDR-SCS, though this estimate should be interpreted with caution given the absence of direct comparative trials and limited BurstDR-SCS data. LF-SCS also demonstrated superiority over CMM. HF-SCS yielded the greatest reduction in VAS scores (MD = - 6.06, 95% CrI: -7.17 to - 4.95) and showed the largest improvement in EQ-5D-5 L scores (MD = 0.36, 95% CrI: 0.10-0.62). Adverse event rates were comparable across all modalities, with no significant differences observed. Notably, all efficacy and quality-of-life outcomes reported in this analysis were assessed exclusively at the 6-month follow-up time point; the durability of these treatment effects beyond 6 months remains uncertain. High-frequency spinal cord stimulation was associated with the highest probability of achieving superior pain relief and quality-of-life improvement compared to low-frequency and burst stimulation based on indirect evidence derived exclusively from 6-month follow-up data; however, the absence of direct head-to-head trials, the limited BurstDR-SCS data, and the lack of long-term follow-up beyond 6 months preclude definitive conclusions regarding the sustained relative superiority of any modality. Furthermore, placebo and non-specific effects inherent to unblinded device trials cannot be excluded as contributors to the observed treatment effects. These findings support HF-SCS as a promising neuromodulation strategy for this population, pending confirmation in longer-term, sham-controlled comparative trials.