Within the context of the U.S. occupation of Hawai'i, State-sponsored and Hawaiian-led health initiatives cannot be reduced to a binary of "colonial/unhealthy" versus "Hawaiian/healthy." Instead, they operate within overlapping and often conflicting paradigms structured by what we term the Ideology of Occupation. This ideology obscures a central reality: kaumaha-the deep, collective malaise affecting the Hawaiian psyche ( Rezentes, 1996)-is the result of a disruption in the kū'auhau (genealogy) of Hawaiian public health, in which sovereign systems of care were replaced by a bureaucratic apparatus detached from Hawaiian life. Although culturally grounded interventions provide meaningful therapeutic value, the prevailing culture-as-health paradigm remains embedded within the status quo of occupation. As such, it functions as a co-opted form of palliative care that manages the symptoms of a political source of suffering. Drawing on Laenui's phases of Decolonization and grounded in Sai's legal framework of Belligerent Occupation, we reframe healing through the conceptual paradigm of health sovereignty, defined as the authority of a people to determine the knowledge systems, institutions, and political conditions that shape health and well-being. We argue that the health of the Hawaiian nation cannot be realized within an occupied system of care. Meaningful healing requires the restoration of the Hawaiian Kingdom's lawful authority and the reestablishment of self-determined health systems rooted in Hawaiian knowledge, institutions, and jurisdiction.

This study examined the prevalence, correlates, and mental health burden of insomnia in a contemporary, nationally representative sample of 2,632 U.S. military veterans. Using established cutoffs on the Insomnia Severity Index (clinical insomnia, ≥ 15; subthreshold insomnia, 8-14), 13.6% of veterans met criteria for clinical insomnia and 29.7% for subthreshold insomnia, representing significant increases from the 11.4% and 26.0% observed in a nationally representative veteran sample surveyed in 2019-2020. Veterans with clinical and subthreshold insomnia were younger, more likely to belong to racial and ethnic minority groups, and reported greater trauma exposure, military sexual trauma, homelessness, and medical conditions. After adjustment for sociodemographic, trauma, and other health characteristics, subthreshold insomnia was associated with 2- to 6-fold greater odds of depression, anxiety, posttraumatic stress disorder, and suicidal ideation, whereas clinical insomnia was associated with 2- to 12-fold greater odds of these outcomes, including nearly 4-fold greater odds of future suicidal intent. These findings suggest that the burden of insomnia among U.S veterans has increased since the pre-pandemic period and underscore the importance of early identification and evidence-based treatment of insomnia to reduce psychiatric morbidity and suicide risk in this population.

Bipolar disorder (BD) is a chronic mental health condition often associated with emotional isolation, stigma, and social disengagement. While pharmacological and psychotherapeutic interventions remain central to treatment, peer support has emerged as a promising complementary approach that fosters agency, psychosocial recovery, and affective connection. This study explored the perceived effectiveness of Peer Support Groups (also known as Peer Support Circles or CAPs in Spanish)-a pioneering, community-based intervention in Chile for individuals diagnosed with bipolar disorder (BD). The research examined participants' experiences, focusing on relational benefits, challenges, and group dynamics. A qualitative design was used. In-depth semi-structured interviews were conducted with 17 participants (7 peer supporters and 10 peer participants). Data were analyzed using Constructivist Grounded Theory (CGT) and intersubjective validation was performed within the research team. Three main analytical categories were identified: (1) Benefits of participating in the CAPs, (2) Conditions that enable CAPs' effective functioning, and (3) Challenges and limitations CAPs face. The central phenomenon that emerged was the CAPs' capacity to lower the barrier of isolation commonly experienced by people with BD through relational safety and peer-driven meaning-making. CAPs operate not only as spaces for support and psychoeducation but also as platforms for identity reconstruction and community reintegration. Findings highlight the value of peer-led models for advancing recovery-oriented care and the importance of institutional support to sustain them and maximize their impact.

Among the more than 90 identified genetic risk loci for late-onset Alzheimer's disease (AD) and related dementias, the apolipoprotein E (APOE) gene ɛ2/ɛ3/ɛ4 polymorphisms remain the longstanding benchmark for genetic disease risk with a consistently large effect across studies^1-10. Despite this massive signal, the exact mechanisms by which ɛ4 increases and ɛ2 decreases dementia risk remain poorly understood. Notably, recent trials of anti-amyloid therapies suggest less efficacy and higher risks of severe side effects in ε4 carriers^11-13, hampering the treatment of those with the highest unmet need. To improve our understanding of the genetic architecture of AD in the context of its main genetic driver, we performed genome-wide association studies (GWASs) stratified by ε4 and ε2 carrier status. HP1BP3, SLC50A1, PTPRC, NPAS3, DDHD1, CHST9, SMYD2, PRAMEF1 and GFRA1 emerged as new genomic signals for AD risk, appearing only when stratified by APOE carrier status. DDHD1 appeared especially promising, showing protective effects in ε4 carriers, being identified as an expression quantitative trait locus and being involved in rare neuronal diseases. Such APOE-stratified insights may help understand and overcome side effects, inform clinical trial enrollment strategies, and create the scientific basis for targeted, mechanism-driven therapies in neurodegenerative diseases.

AI-powered therapy chatbots and virtual companions are beginning to enter routine mental health care, yet safeguards for children and adolescents remain underdeveloped. For youth with attention-deficit/hyperactivity disorder (ADHD), these tools may offer brief coaching, psychoeducation, and structured between-visit check-ins across clinic, school, and home settings, but they also raise concerns about inappropriate content, overreliance, quiet model drift, privacy across health and education systems, and missed crisis escalation. In this Viewpoint, we propose a nurse-led, risk-tiered policy and implementation framework for integrating AI therapy chatbots into youth ADHD care safely, effectively, and equitably. The framework has 3 linked layers: policy levers, implementation enablers, and measurable outcomes. We emphasize child-specific safeguards, predetermined change control for adaptive models, equity-oriented procurement and reimbursement, interoperability and safety reporting, and nurse-led human-in-the-loop oversight. We further clarify that nursing-generated data-such as structured assessments, triage actions, escalation records, and supervision workload-can function both as governance inputs and as outcome-relevant signals within monitoring and service evaluation. We also outline a phased implementation road map and a concise indicator set that schools and clinics can monitor without major new infrastructure. A nurse-led, risk-tiered approach, combined with age-appropriate safeguards, equity-by-design implementation, and privacy-preserving real-world learning, can help health systems and schools move from ad hoc adoption toward safer and more equitable use of AI therapy chatbots for youth with ADHD while the evidence base continues to mature.

Commissural neurons in the spinal cord project axons across the midline to fulfill various critical functions in somatosensory information processing and left-right coordination of motor output. These neurons have long served as a powerful model system for axon pathfinding, driving the identification of molecules and mechanistic principles for neuronal wiring that apply widely across neural circuits and model organisms. Aside from their shared initial projection path, commissural neurons are highly heterogenous, which has hampered lineage-based methods for accessing them, and most prior studies have been limited to small subpopulations of dorsal commissural neurons. The shared transcriptional programs for axonal midline crossing and the divergent gene expression signatures that define commissural neuron subtypes have therefore remained largely elusive. Here, we combine a genetic labeling strategy with single-cell RNA sequencing, birthdating, and complementary methods to study the production and transcriptomic trajectories of developing commissural neurons in the mouse embryonic spinal cord. We identify molecularly distinct commissural neuron subtypes that reveal stratification of this neuronal population beyond progenitor identities and temporal cohorts of neurogenesis, and we provide evidence that axon laterality is not linked to neuronal birthdate. We also uncover a large-scale gene expression switch that coincides with commissural axon growth across the midline and underlies differential axonal protein expression for guidance toward and away from the midline. Our findings elucidate both shared and subtype-specific gene expression programs that drive commissural neuron differentiation and axon midline crossing, and they provide a valuable resource for future studies of commissural neuron development and function.

Psychiatric rehabilitation supports recovery and community reintegration among individuals with schizophrenia, but persistent stigma, impaired social functioning, and disrupted self-identity can hinder psychosocial recovery after rehabilitation, particularly within collectivist socio-cultural environments. This study explored the lived experiences of psychosocial recovery among individuals with schizophrenia following psychiatric rehabilitation in Indonesia. A Husserlian descriptive phenomenological design was used. Twenty individuals with schizophrenia who had completed psychiatric rehabilitation and lived in the community for at least 6 months participated in semi-structured in-depth interviews. Participants were recruited purposively from an outpatient psychiatric clinic in Indonesia, and data were analyzed using Colaizzi's phenomenological method. Four interconnected themes emerged: stigma and disrupted social identity; rebuilding the self through adaptive coping and behavioral regulation; relational recovery through family and community acceptance; and reconstructing meaning and future orientation. Psychosocial recovery was experienced as a dynamic and nonlinear process shaped by stigma, emotional regulation, family support, spirituality, social acceptance, and future aspirations. Mental health nurses should strengthen culturally responsive, family-centered, and community-based interventions that support identity reconstruction, social participation, and long-term psychosocial recovery.

Patient safety is a key pillar of healthcare services and the quality of care provided. Despite ongoing efforts, safety incidents still occur, resulting in victims beyond the patient. The healthcare professionals involved are considered second victims, warranting studies in the field of worker safety.

To map the repercussions experienced by healthcare professionals who have experienced the "second victim" phenomenon resulting from patient safety incidents in healthcare services.

A scoping review guided by the JBI and PRISMA-ScR methodologies. A preliminary search was conducted, finding no evidence of existing records or publications with the same objective. The protocol was registered on the Open Science Foundation platform. The search strategy followed the three recommended steps. The databases consulted were MEDLINE, SCOPUS, CINAHL, WOS, LILACS, and, for gray literature, the Brazilian Digital Library of Theses and Dissertations and ProQuest. There were no restrictions on language, year, or methodology; the PCC mnemonic was used as an eligibility criterion: population-healthcare professionals; concept-second victim phenomenon related to patient safety incidents; context-healthcare services. Studies that did not meet the objective and PCC criteria were excluded. The selection and data extraction were performed by independent researchers and conducted anonymously.

Of the 2,129 records retrieved, 37 publications comprised the final sample. The publications were collected between 2009 and 2024 and were identified in 22 countries across five continents. There was a predominance of publications from Europe (n = 12), with qualitative studies being the most common (n = 14); the hospital setting was the most frequently cited (n = 25), and nursing was the most studied population (n = 27). The most frequently cited health descriptors were "second victims" (n = 17) and "adverse events" (n = 14). Of the selected studies, 13 used measurement instruments to identify the phenomenon. Thirty-nine repercussions were mapped, categorized from the perspective of worker health in physical, mental, professional and social dimensions based on the study's assumptions. The professional dimension presented the highest number of repercussions. The mental dimension identified suicidal thoughts or behavio as a risk to physical integrity.

The repercussions indicate a strong relationship between the second victim phenomenon and worker health and safety, impacting the professional and personal lives of the professionals involved.