This is the third paper in the peripheral arterial disease (PAD) Series. The first and second papers in this Series outline that PAD affects over 300 million people worldwide and can be diagnosed by non-invasive tests, as well as that treatment requires medications to reduce modifiable risk factors and that exercise therapy and revascularisation are required in selected patients. In this paper, the devastating effects of PAD at the individual level are described, including chronic pain, functional limitation, loss of independence, impaired physical and mental quality of life, unemployment, and financial instability. Individuals with PAD are also at high risk of major adverse events, including major amputation, myocardial infarction, stroke, and death. The burden of PAD falls heavily on underserved groups, including women, First Nations Peoples globally, other non-White individuals, patients with financial insecurities, and those living in remote areas. Recommendations to advance PAD management are presented and include short-term changes, such as improving disease awareness and introducing multidisciplinary models of care that deliver more holistic medical and rehabilitation care, as well as long-term changes, such as testing whether screening and initiation of early medical management can reduce the burden of PAD. Furthermore, modification of health-care services is needed to provide better access for underserved, rural and remote, First Nations, and low-income populations.

Digital interventions offer a promising avenue for scalable parenting support in low- and middle-income countries, where in-person coverage remains limited. However, engagement disparities may reduce their potential for population-level impact.

This study examined caregiver-level predictors of engagement with ParentApp, a smartphone-based adaptation of the Parenting for Lifelong Health (PLH) for Teens program for caregivers of adolescents aged 10 to 17 years.

This study was nested within a cluster-randomized factorial trial of ParentApp in Mwanza, Tanzania, implemented according to the optimization phase of the Multiphase Optimization Strategy. Clusters (n=16), comprising 614 caregivers (n=205, 33.4% men), were randomized to 3 components: guidance (guided vs self-guided), app design (unstructured vs structured), and digital support (enhanced vs basic). Digitally tracked app engagement outcomes included the number of modules completed, the first module not started, and the first module not completed. Baseline candidate predictors included demographic, socioeconomic, behavioral, and psychological factors assessed via an app-embedded questionnaire. Poisson generalized linear mixed-effects models with random effects for clusters assessed associations between predictors and each outcome. Interaction terms were specified to test whether associations differed by caregiver gender.

Among 614 caregivers, 596 (97.1%) completed the first module; however, engagement declined rapidly thereafter, with only 281 (45.8%) completing module 2 and 49 (7.9%) completing all 12 modules. Overall, mean content completion was 35.6% (SD 33.1%) of the program. Women completed approximately 15% more modules than men (incidence rate ratio 1.15, 95% CI 1.05-1.27, P=.003), despite reporting higher levels of financial stress, food insecurity, child maltreatment, and depressive symptoms at baseline (all P≤.02; Cohen d=0.19-0.37). No other caregiver characteristics were significantly associated with engagement.

This is the first known study to investigate caregiver-level predictors of engagement with a digital parenting intervention in a low- and middle-income country. Engagement with ParentApp was broadly consistent across caregiver subgroups, with the exception that women completed significantly more modules than men. To equitably engage men and fathers, future studies should pair father-inclusive, identity-affirming content with implementation strategies that reduce social and economic barriers to participation.

Many adolescents experience elevated stress and anxiety; yet, access to effective psychological support is limited. Brief digital mental health interventions, such as slow breathing (SB) and detached mindfulness (DM), offer a potentially scalable approach to promoting emotion regulation in daily life.

This study aimed to investigate whether 1 week of daily practice with a SB or DM intervention reduced stress, anxiety, and negative metacognitive beliefs in youth, and explored participants' experiences to inform the development of accessible, youth-tailored digital interventions.

A mixed method approach was used, including quantitative and qualitative data. A total of 147 university students between 16 and 19 years old were randomly allocated to the DM (n=49), SB (n=49), or passive control group (n=49). Participants who were allocated to DM or SB practiced the intervention for 1 week. Stress, anxiety, and negative metacognitive beliefs were assessed at pre- and postintervention using self-report questionnaires. The quantitative data were analyzed with linear mixed-effects models, and we explored daily changes in intervention effect. After posttest, participants were invited to focus groups to evaluate their experience with the interventions (n=37). The qualitative data were analyzed with a content analysis.

Our results showed that a week-long DM intervention significantly reduced stress compared with the control condition. No other differences emerged for the main outcomes on pre- and postmeasurements. However, in the SB group, higher perceived usability was associated with greater reductions in stress. Qualitative findings showed that both interventions were viewed as calming, easy to use, and acceptable, while also highlighting challenges such as maintaining motivation and integrating the exercises into daily routines.

This study provides early formative evidence that brief digital interventions such as SB and DM are feasible and usable, with preliminary indication that DM intervention may support short-term stress reduction. Future research should focus on enhancing motivation and sustained engagement to maximize the effectiveness of digital mental health tools for late adolescents.

To examine the association between educational support and transition status among novice home healthcare nurses and to assess whether resilience shows an indirect association in this relationship.

A descriptive, cross-sectional, correlational study was conducted with 215 novice nurses employed in home healthcare agencies.

Data were collected using two standardized English instruments: the Educational Support Assessment Scale, the Transition Status Scale for Newly Graduated Nurses and the Arabic version of the Connor-Davidson Resilience Scale. Two instruments were translated into Arabic and culturally adapted for this study through forward-backward translation, expert panel review and pilot testing. Internal consistency and confirmatory factor analysis were used to examine reliability and preliminary construct validity. Descriptive statistics, Pearson correlations, linear regression and structural equation modelling were used to analyse the data.

Participants reported moderate to high educational support, high resilience and generally positive transition status. Active coping strategies and interpersonal integration were the highest-rated transition dimensions, whereas work-life balance was the lowest. Educational support was positively associated with resilience and transition status. Resilience also showed a statistically significant indirect association between educational support and transition status. Because data were collected at one time point, this indirect pathway should be interpreted as an associative statistical model rather than evidence of causal mediation.

Educational support, resilience and transition status were positively associated among novice home healthcare nurses. Resilience may be an important psychological factor linked to the relationship between educational support and transition status. Longitudinal studies are needed to confirm the temporal and causal nature of these associations.

Home healthcare agencies should provide structured educational support that combines clinical skill development with resilience-building strategies, including guided reflection, mentoring, stress-management training and peer support.

None.

Social determinants of health (SDOH), including education, socioeconomic status, place of residence, genetic risk, and perceived stress, influence brain health and Alzheimer's disease (AD), yet their role in genetically at-risk populations remains underexplored. This study examined the influence of SDOH on early brain health, specifically its cognitive dimension, in Colombian individuals from the world's largest kindred with autosomal dominant AD (ADAD) caused by the PSEN1 E280A mutation. Participants included 86 mutation carriers and 71 non-carriers. Brain health was assessed using the BHA_CS index from the TabCAT battery, and perceived stress using the PSS-14. Carriers showed significantly lower brain health and higher perceived stress than non-carriers. Multiple regression analyses identified genetic status, age, education, and place of residence as significant predictors of brain health, with higher education and urban residence associated with better performance. These results demonstrate that SDOH contribute to early cognitive variability even decades before clinical onset in ADAD.

The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry. Prim Care Companion CNS Disord 2026;28(5):26f04247. Author affiliations are listed at the end of this article.

Agitation is a common and clinically significant neuropsychiatric condition in Alzheimer's dementia. Clinicians across the spectrum of care settings frequently encounter agitation but often lack practical clinical guidance. In April 2026, a consensus panel of clinical experts reviewed the literature and developed guidance for managing agitation in Alzheimer's dementia. The panel emphasized the critical role of primary care in agitation management and discussed different treatment approaches for optimizing patient and caregiver outcomes. Treatment should prioritize reduction of patient and caregiver distress and preservation of function rather than mere sedation. Discussion of neurobiology focused on the evolving models of frontal-limbic imbalance as the key driver of agitation in progressing Alzheimer's disease and implications for pharmacologic selection. The panel reviewed evidence on safety and efficacy of pharmacologic agents commonly used in agitation management and concluded that efficacy and safety profiles should guide clinical decision-making. The panel recommended conducting a behavioral assessment using validated tools, ruling out reversible causes, and using nonpharmacologic interventions as the first-line approach prior to starting pharmacologic treatment. Finally, setting-specific considerations were discussed. These recommendations complement prior guidance with a primary-care clinical decision pathway that matches treatment to the neurobiology of agitation and to comparative safety profiles, and that extends to the assessment, documentation, and coding clinicians need at the point of care. The goal is to help clinicians select evidence-based interventions for agitation in Alzheimer's dementia that prioritize safety, alertness, functional engagement, and caregiver well-being while minimizing the serious harms that have historically accompanied off-label management in this population, including excess mortality, cerebrovascular events, cognitive impairment, falls, and sedation. Prim Care Companion CNS Disord 2026;28(5):haadachi2603.

Black immigrant young adults of African descent (BIYAD), defined here as African-born Black young adults aged 18 to 34 living in Canada, are a growing yet persistently underserved population facing mental health challenges at a formative life stage. Despite elevated distress and documented underutilisation of services, they remain largely absent from the Canadian literature as a distinct group. This narrative review synthesises evidence on the demographic context, intersecting identities and multilevel barriers shaping mental health access among BIYAD. Drawing on intersectionality theory and Levesque's framework of healthcare access, it maps race, immigration status, and developmental stage against the five dimensions of access, recording for each whether the evidence is direct or extended to this population. Black youth in Canada disproportionately enter services through emergency and forensic pathways, reflecting systemic failures in preventative and culturally responsive care. Recurrent barriers include stigma, cultural incompatibility, unaffordable outpatient services, prolonged wait times and underrepresentation of Black professionals. Because these patterns hold across both a long-established Canadian-born Black community and a predominantly African immigrant-origin population, they are extended to BIYAD on the reasoning that the operative mechanism is racialization rather than migration. Barriers arising from migration itself, and its interaction with racialization, remain undocumented for this group, which reflects a gap in measurement as much as in attention. The review calls for research disaggregating BIYAD from broader Black and immigrant populations, culturally responsive service reform, and race-conscious policy action.

Depression among adolescents and young adults is often underestimated and overlooked in society. Adolescence is a critical period marked by significant social, psychological, and physical changes. Despite the growing prevalence of mental health problems, help-seeking from healthcare providers is minimal. This study examines the dynamic interplay of parental, peer, and individual factors affecting depression among adolescents and young adults using a within-between model.

The study utilized longitudinal data from the "Understanding the Lives of Adolescent and Young Adults" study, conducted in Uttar Pradesh and Bihar in 2015-16 (Wave 1) and 2018-19 (Wave 2). The sample for this study was restricted to unmarried adolescents and young adults, comprising 4,221 boys and 5,987 girls. A hybrid model was employed to disentangle the within- and between-person effects of parental, peer, and individual factors on depressive symptoms.

Average depressive symptoms score increased from 1.1 (SD = 2.2) at baseline to 2.2 (SD = 3.1) in wave 2, accompanied by a sharp upward shift from no depression toward minimal and mild symptom categories. Adolescents who discussed school performance with parents, participated in educational decisions, and had educated mothers reported lower depression compared to their counterparts. However, mobility restrictions, parental violence, and internet access were reported to be associated with higher depression at both within- and between-person levels. An increase in peer size showed a modest association with higher depression.

The findings highlight the importance of supportive parental engagement, freedom of mobility, and educational autonomy to reduce depressive symptoms among adolescents.

The aim of the study is to identify factors associated with the intake of psychotropic medication in prison among a sample of Spanish female prisoners.

Information was collected from 1544 female prisoners in 39 prisons using a self-completed questionnaire in the presence of the researchers. The questionnaire had 60 questions. A descriptive, bivariate analysis and a logistic regression analysis were performed to calculate the ORs.

Our results show that 44.1% (681) were taking medication for their mental health in prison. In the logistic regression, seven variables were significantly associated with taking psychiatric medication and mental health problems: being Spanish meant a prisoner was five times more likely compared to being foreign (OR 5.31); intellectual disability was eight times more likely (OR 7.88); to have been treated for anxiety or depression was three times more likely (OR 3.32); a negative assessment of psychological health (OR 0,72) and older age (OR 1,03) were correlated; having been in solitary confinement was twice as likely (OR 2.65); and feeling unwell and self-injury meant a prisoner was almost five times more likely to be medicated (OR 4.89).

Mental health in prison should be addressed from a therapeutic as well as a pharmacological perspective, requiring a model of intervention for mental disorders that is centred on the needs of women and not androcentric. Furthermore, the use of solitary confinement is questioned due to its negative impact on mental health. The creation of a prison environment that promotes recovery and includes gender perspective is a key component for a comprehensive mental health policy in prisons.