To assess the impact of medium-chain triglycerides (MCTs) and fibre on health-related quality of life (QOL), morning stiffness and pain in rheumatoid arthritis (RA) patients.

A randomised, double-blind, placebo-controlled clinical trial enrolled 61 RA patients on stable drug treatment. Participants received twice-daily MCT supplementation (30 g/day) for 8 weeks, followed by 8 weeks of MCTs (30 g/day) combined with fibre (30 g/day). The control group received the same supplementation as the test group, with long-chain triglycerides instead of MCTs. QOL parameters, morning stiffness, pain intensity and lipid profile were assessed at baseline (T0), week 8 (T2) and week 16 (T4).

After 16 weeks, the test group showed statistically and clinically significant improvements both in mental and physical health-related scores. MCT consumption significantly ameliorated mental health, emotional well-being, social behaviour and vitality (measured using 36-Item Short Form Survey) from baseline to T4 and relative to control. An increased motivation, as assessed with the Multidimensional Fatigue Inventory-20 questionnaire, was reported as well. Regular intake of MCTs significantly reduced the intensity and duration of morning stiffness and pain intensity (assessed using the Visual Analogue Scale) from baseline to T4 compared with control group. Reported effects were maintained after adding fibre to supplementation. Baseline blood lipid profile showed no significant differences.

Patients with RA supplemented with MCTs obtained significant improvements in several health-related QOL components compared to control, and fibre inclusion did not interfere with MCT efficacy. These results underscore the importance of targeted non-pharmacological approaches integrated to drug therapy in managing patients with RA.

DRKS00025413.

Periodic universal screening for anxiety and for intimate partner violence (IPV) for women and adolescent girls are national clinical practice recommendations. However, screening rates in primary care settings are low. This study aimed to increase awareness and adoption of screening for anxiety and for IPV in women and adolescent girls by identifying screening barriers and facilitators to inform clinical resource development.

Two-phase, qualitative study using semistructured interviews to identify screening barriers and facilitators; thematic analysis of interview data using a rapid evaluation approach.

Twenty-seven clinicians and staff members were interviewed in 12 clinics in 2 primary care networks in Oregon. All participants recognized the importance of screening in primary care settings but were generally unaware of screening recommendations and insurance coverage and were unsure of their clinic's policies and practices, citing a lack of protocols for referrals for positive screens. Barriers to both anxiety and IPV screening included screening fatigue, lack of metrics, uncertain documentation and reporting, and unclear referral and follow-up procedures. For IPV screening specifically, barriers included discomfort with screening, privacy concerns, and perceived low occurrence. Facilitators for both services included leveraging existing screening practices and electronic health record tools, and clear recommendations for universal screening best practices.

Implementation of routine screening for anxiety and IPV in women and adolescents in primary care is low but may improve with targeted clinician resources and education. Workflow diagrams and resource guides responsive to identified screening barriers and facilitators, including clarification of insurance coverage for preventive services, and resources to support implementation of protocols of screening methods, clinical documentation, and referrals for anxiety and IPV in primary care settings, could improve screening practices.

To understand the experiences of burnout and coping strategies among healthcare professionals working in the emergency department of tertiary care public and private hospitals in Karachi.

A qualitative exploratory design was employed.

One public-sector and one private-sector tertiary care hospital located in Karachi, Pakistan were selected for this study. Audio-recorded in-depth interviews were conducted with a total of 15 healthcare professionals working in the emergency department, which were later transcribed verbatim and analysed inductively.

The findings of the study identified two major themes contributing to burnout: individual and organisational themes, along with coping strategies used by healthcare professionals. Individual-level subthemes included emotional distress, arising from ethical dilemmas and constraints within the work environment, and work-life imbalance, where participants experienced difficulty maintaining personal well-being due to professional demands. Organisational-level subthemes included lack of leadership support and recognition, role conflict, inadequate resources, excessive workloads and exposure to workplace violence, all of which contributed significantly to burnout. Healthcare professionals reported both adaptive and maladaptive coping strategies. Adaptive strategies included positive reframing, peer support and relaxation techniques, whereas maladaptive strategies involved venting frustration and, in some cases, substance use to manage prolonged stress.

The findings revealed that the experience of burnout is caused by a range of interdependent factors at the individual and organisational levels. Multifaceted interventions are needed to address these issues such as national and emergency department staffing policies, mental health support, resilience training, workload management, flexible scheduling and the promotion of work-life balance.

Adults with Tourette syndrome (ATS) face increased risks of self-injury behaviours (SIBs) and suicidality, yet research has largely focused on biological factors. Despite stigma being a known contributor to these outcomes in marginalised groups, its role in ATS remains unexplored. This study aims to address this gap by examining the impact of stigma on SIBs and suicidality in ATS.

This study analysed adult data from the Tourette Association of America's 2022 Impact Survey, conducted online via convenience sampling. Stigma was assessed via six items, generating scores ranging from 1.0 to 4.0, with higher scores indicating greater stigma. The outcomes included lifetime self-harm, past-year suicidal ideation and suicide attempts. Owing to missing data, a Heckman selection model with a probit link function was used to examine the relationships between stigma and these outcomes, adjusting for demographic and clinical factors.

The study included 601 US ATS, with moderate to high stigma levels. Among the participants, 58% reported lifetime self-harm, 43% had past-year suicidal ideation and 27% had attempted suicide at least once in the past year. The Heckman selection model confirmed a significant association between stigma and all three outcomes.

This sample of ATS, on average, endures medium-high levels of stigma, which significantly contributes to their risk of self-injury, suicidal ideation and suicidal behaviours. Given this heightened risk, it is crucial to integrate stigma reduction interventions into health and mental health services for this vulnerable population.

This correlational, cross-sectional study examined the mediating role of coping strategies (emotion-oriented, task-oriented and avoidant coping) in relationships between Dark Tetrad traits at the facet level and mental and physical health on a sample of 492 adults. Results of mediation analysis showed that secondary psychopathy and Machiavellianism were directly associated with poorer mental health, while narcissistic admiration and primary psychopathy were linked to better mental health. Secondary psychopathy had a positive and sadism a negative direct effect on somatisation. Emotion-oriented coping emerged as the key mediator between dark traits and mental health, and the only significant mediator for somatisation. Secondary psychopathy, Machiavellianism, and narcissistic rivalry were related to worse health through higher use of emotion-oriented coping and, additionally in secondary psychopathy, through lower use of task-oriented coping. However, narcissistic admiration and primary psychopathy showed the opposite positive relationships with good health through higher task-oriented and avoidant coping or lower emotion-oriented coping. Findings underscore the critical role of coping in these associations.

The burden of depressive and bipolar disorders at the individual and societal level are extraordinary and increasing. For decades, evidence-based treatments for these conditions have been established but outcomes amongst individuals with lived experience remains suboptimal. Notwithstanding calls to close gaps between current practice and best practice, there is an absence of evidence that overall health outcomes are significantly improving. Artificial Intelligence (AI) is the cornerstone of the digital revolution. Currently, AI sources (e.g., Open Source) are widely accessed by healthcare providers and persons with lived experience for search queries and decision support. The aspiration for AI-informed medical practice is to improve health outcomes by assisting in timely diagnostic detection, illness monitoring, informing treatment selection, integrating multimodality care, decreasing barriers to access and facilitating scalability to psychosocial interventions. Against this background, rigorous evidence is still needed to empirically demonstrate transformative improvement in each of the aforementioned areas. In addition, multiple ethical, technical, scientific and economic questions are not adequately answered including aspects of confidentiality and patient engagement. This short commentary endeavors to succinctly summarize the evidentiary base as it relates to the capabilities that AI offers currently, in the near and more intermediate term. The overarching aim is to provide readers with an up-to-date understanding of what aspects of AI are currently applicable versus those that are aspirational.

Unintentional injuries and assaults cause nearly 28 million emergency department (ED) visits each year and can incur lasting physical and psychological damage. This study examined whether unintentional injuries and violence increase mental health disorders and spending.

In 2025 authors analyzed 2022 US MarketScan employer-sponsored insurance enrollees (n=19.1 million). Enrollees with ED visits for unintentional (n=105,389) or assault (n=1,986) injuries were matched to controls (by age, sex, residence region, health plan type, and comorbidity count). All subjects were observed 6 months before and 12 months after the ED visit date. New mental health disorder diagnosis (anxiety, bipolar disorder, major depression, other mood disorders, attention-deficit/hyperactivity disorder, post-traumatic stress disorder, sleep disorders), new psychotropic drug prescription, total injury-attributable medical spending, and mental health-specific medical spending were assessed. Costs were assessed as 2022 USD.

People with ED-treated unintentional injuries were 34% and those with assault injuries were 98% more likely than controls to have a new mental health diagnosis in the year after the ED visit. They were also 50% and 71%, respectively, to have a new psychotropic drug prescription. Excess spending on mental health services and prescriptions during the year after the injury averaged $302 for unintentional injuries and $711 for assaults.

Unintentional injuries and assaults render affected individuals more vulnerable to mental health disorders and increase mental healthcare spending. It is critical to ensure efficient access to mental health services and consider mental health costs as a part of the economic burden of injuries and violence.

Universal suicide risk screening in pediatric primary care settings is lacking, despite the endorsement of this practice by several national organizations. This study explores barriers to and facilitators of implementing universal suicide risk screening in pediatric primary care clinics, with a focus on clinics that had not yet adopted this practice.

We conducted a qualitative study consisting of semi-structured interviews with primary care clinicians and support staff involved in suicide risk screening, risk assessment, and disposition planning. Participants were recruited from 15 pediatric clinics in the Midwestern United States. Interviews were audio-recorded, transcribed verbatim, and analyzed using thematic analysis.

From 55 interviews we identified barriers at three levels: clinic, provider, and patient. Clinic-level barriers included time, workflow, and staffing. Provider-level barriers included lack of training/self-efficacy, frustration at not being able to offer solutions, and burnout. Patient-level barriers included irritation with repetitiveness of screening questions, concerns about honesty and openness, parent/caregiver buy-in, and discomfort and stigma discussing the topic of suicide. Facilitators included perceived value and effectiveness of screening, comfort with screening, clinic buy-in, a team approach to care, providing privacy, and providing context. Suggestions to enhance these suicide prevention practices were also described.

Overall, clinicians and support staff reported seeing value in implementing suicide risk screening in pediatric primary care. Our findings underscore the importance of reducing barriers and enhancing facilitators associated with implementing suicide risk screening, risk assessment, and disposition planning to expand suicide prevention efforts to more youths.

The effects of armed conflict on children are devastating, with more than 520 million children and adolescents residing in conflict zones worldwide. Armed conflicts not only cause death and destruction but also lead to widespread displacement, exposing children to physical injuries, sexual violence, family separation, food insecurity, and disruption of essential services like education and health care. All pediatricians and health care providers play crucial roles in addressing the complex challenges faced by children in these settings. Pediatric professionals are called to advocate for policy reforms, ensure culturally appropriate, sensitive, and trauma-informed care and community support, and engage in research to mitigate short- and long-term harm and promote resilience. Strategic interventions include ensuring access to health care and mental health services, safeguarding education, and providing bereavement and psychosocial support during and after resettlement. In doing so, pediatricians can help protect children's rights and foster a future where every child, regardless of conflict, has the opportunity to thrive.

The COVID-19 pandemic caused major disruptions to health care, affecting the delivery of HIV care and prevention services. We aimed to determine the impact of the pandemic on HIV testing rates in medical settings across regions and racial and ethnic populations in the USA.

In this retrospective cohort study, we used data from the National Clinical Cohort Collaborative (N3C) from Jan 1, 2018, to Dec 31, 2022, of individuals aged 15-64 years with active health-care records. In this dataset, COVID-19 cases were matched (1:2) to COVID-negative controls on the basis of age, sex, and race and ethnicity within each site. We used interrupted time-series analyses to estimate changes in the monthly HIV testing rate, measured as the number of individuals tested per 10 000 people in four geographical regions (midwest, northeast, south, and west) among four racial and ethnic groups (White [non-Hispanic], Black [non-Hispanic], Hispanic, other). We estimated these changes in three time periods: prepandemic (January, 2018, to February, 2020), early pandemic (March, 2020, to August, 2020), and late pandemic (September, 2020, to December, 2022).

9 704 278 individuals were included and had a mean age of 41·2 years (SD 13·5). 5 667 609 (58·4%) of 9 704 278 individuals were female and 4 036 669 (41·6%) were male. Most individuals were White, followed by other, Black, and Hispanic, with notable geographical differences in racial and ethnic composition. Prepandemic, HIV testing rates were relatively stable, although levels varied by region and racial and ethnic group. The impact on testing rates differed substantially during the early and late pandemic, with the west experiencing the sharpest and most prolonged decline (-30·94 per 10 000 people, 95% CI -42·29 to -19·59). Among racial and ethnic groups, the Black population showed the greatest reduction in testing at the onset of the pandemic across all four regions, and specifically in the northeast, which decreased by 53·09 per 10 000 people (95% CI -73·43 to -32·77). The decline was more modest among White individuals at the national level (-13·55 per 10 000 people, -20·27 to -6·84) and no racial or ethnic groups showed a significant decline in the south. Testing rates rebounded to varying degrees during the late pandemic.

The COVID-19 pandemic, particularly early on, caused substantial disruptions in HIV testing rates across the USA, with pronounced racial, ethnic, and regional disparities. These findings highlight the need for targeted interventions to mitigate the impact of public health emergencies on communities disproportionately affected by pre-existing health inequities, including expanding mobile testing units, supporting community-based outreach, and investing in culturally responsive care to improve access to testing during future public health disruptions.

National Institutes of Health, National Institute of Mental Health, and National Institute on Drug Abuse.