Prior observational studies have reported conflicting results regarding whether antidepressant treatment reduces long-term dementia risk, likely due to confounding by indication and reverse causation. We aimed to investigate the association between baseline antidepressant use and incident dementia, incorporating cognitive and neuroimaging outcomes.

We conducted a prospective cohort study using UK Biobank participants free of dementia at baseline. Antidepressant use was self-reported at baseline (2006-2010). Incident dementia was identified through linked electronic health records until December 19, 2022. Cox proportional hazards models estimated hazard ratios (HRs) for all-cause dementia, Alzheimer's disease (AD), and vascular dementia (VD), adjusting for sociodemographic, lifestyle, health-related, antidepressant indication factors, and co-medication of other anticholinergics. In subsamples, cognitive performance (n = 57,330) and structural brain imaging (n = 42,276) were examined as intermediate outcomes.

Among 461,464 participants, 33,721 (7.3%) reported baseline antidepressant use. Over a mean follow-up of 13.4 years, 7,922 (1.7%) developed incident dementia. Baseline antidepressant use was associated with higher risks of all-cause dementia (adjusted HR: 1.47, 95% CI 1.36-1.60), AD (1.53, 1.36-1.73), and VD (1.44, 1.23-1.70). Users performed worse on fluid intelligence and prospective memory tasks and showed lower total and gray matter volume, regional reductions in the hippocampal gray matter and basal nucleus, and greater white matter hyperintensity volume.

Baseline antidepressant use was linked to a higher risk of dementia, poorer cognitive performance, and adverse brain structural changes. These findings underscore the importance of judicious prescribing, regular cognitive monitoring, and consideration of non-pharmacological approaches in clinical care.

Sacral ulcers can be precipitated by poor circulation, damaged skin and tissue from immobility or direct trauma, poor nutrition, diabetes, and incontinence. If not treated promptly, the sacral ulcer can serve as a portal of entry for bacteria, such as methicillin-resistant Staphylococcus aureus (MRSA), into the bloodstream, leading to complications including bacteremia, abscesses, sepsis, and possible infectious endocarditis, as occurred in this case. During the patient's hospital stay, he was diagnosed with possible schizoaffective disorder with full mental capacity, but had multiple episodes of paranoia that made treatment planning even more difficult due to both his persistent refusal to diagnostic tests and physical therapy. The refusal of necessary diagnostic testing, particularly to rule out infectious endocarditis, limited treatment planning and could have provided important insight into his persistent bacteremia despite susceptible antibiotic therapy. Along with the sacral decubitus ulcer, the patient's case was complicated by paraspinal, psoas, epidural, and multiloculated gluteal abscesses with fungal infections around the groin. Overall, this case highlights the importance of correct antibiotic therapy, prevention, aggressive wound care, nutrition, and adherence to therapy recommendations, even if the patient has psychiatric issues, to mitigate severe complications associated with MRSA secondary to a sacral decubitus ulcer.

To evaluate the mental health of play-age children affected by the 2023 Türkiye-Syria earthquakes and their mothers, using single-item scales.

Four hundred earthquake survivor mother-child dyads were included. The mental health of mothers and children was assessed using single-item screening tools, the Self-Reported Mother Mental Health (SRMH) and the Mother-Reported Child Mental Health (MRCMH).

The prevalence of negative mental health increased from 10% to 52% in play-age children and from 13% to 70% in their mothers after the earthquakes. For post-earthquake negative SRMH, associated factors included limited access to safe water (AOR = 2.52, 95% CI: 1.10-5.75, P = 0.029), good perception of security services (AOR = 0.30, 95% CI: 0.12-0.73, P = 0.008), and post-earthquake negative MRCMH (AOR = 8.65, 95% CI: 4.70-15.91, P < 0.001). For post-earthquake negative MRCMH, associated factors were out-of-house sheltering (AOR = 3.13, 95% CI: 1.72-5.69, P < 0.001), good perception of nutritional services (AOR = 0.46, 95% CI: 0.22-0.96, P = 0.039), pre-earthquake negative MRCMH (AOR = 4.68, 95% CI: 1.87-11.73, P = 0.001), and post-earthquake negative SRMH (AOR = 11.35, 95% CI: 5.92-21.76, P < 0.001).

Post-earthquake mental health outcomes were most consistently predicted by limited basic resources (water and nutrition services), not good service quality, and pre-existing or co-occurring negative mental health.

To identify distinct subtypes of emotional labor among Chinese oncology nurses; explore the heterogeneous network structures linking emotional labor, change fatigue, and burnout across subgroups; and explore potential intervention targets via computer simulation.

Oncology nurses face three key occupational challenges: inherent emotional labor demands, frequent organizational changes inducing change fatigue, and subsequent burnout risk. Although emotional labor is essential for quality care, its misregulation-especially the resource-intensive deep acting-depletes psychological resources per conservation of resources theory. Yet, existing research often overlooks heterogeneity in nurses' emotional labor strategy use.

This study enrolled 924 nurses from a tertiary-level specialized cancer hospital in Zhejiang Province, assessing them using scales for emotional labor, burnout, and change fatigue. First, latent profile analysis identified distinct subgroups based on emotional labor indicators. Subsequently, network analysis constructed symptom networks for the overall cohort and subgroups. Finally, computer simulation technology compared the effects of activating or inhibiting network nodes on overall symptom burden.

LPA revealed three profiles: "Efficient Type-Proactive Regulation" (C1), "Stressed Type-Natural Expression" (C2), and "Exhausted Type-Dysregulated Regulation" (C3). In the total sample network, deep acting (E14) emerged as the most central and influential bridge symptom. Significant interprofile differences in network structure and global strength were observed, with unique core symptoms for each profile: professional efficacy (M10) for C1, overwhelming change (F1) for C2, and morning exhaustion (M3) for C3. Computer simulation identified potential core risk targets (M14, F1) and mitigation targets (E4, E8), with E8 showing cross-profile robustness.

Oncology nurses exhibit distinct emotional labor subtypes, and their burnout and change fatigue display significant, profile-specific associative patterns. Simulation analysis highlights potential intervention targets: managing excessive work engagement and organizational evaluation pressure, while simultaneously promoting adaptive emotional regulation. This suggests that customized, systemic intervention strategies should be adopted, integrating individual skill development with organizational policy adjustments.

The findings of this study advocate for nursing managers to adopt evidence-based, typology-specific management strategies. For C1, professional recognition should be leveraged to enhance their sense of professional efficacy, while optimizing performance evaluations to reinforce adaptive regulation patterns. For C2, management should focus on buffering organizational change stress and leveraging the protective role of equitable evaluation through measures such as establishing flexible feedback mechanisms. For C3, immediate psychological support and short-term leave resources are needed to alleviate physical and mental exhaustion and curb excessive work engagement. At the organizational level, systematically revising performance evaluation systems to reduce instrumental stress and embedding psychological resource support modules into change management processes is recommended. Concurrently, establishing a dynamic monitoring mechanism focused on core bridging symptom E14 facilitates early identification of high-risk individuals.

Despite most school-based food and nutrition programmes improving determinants of healthy eating, most programmes are abandoned within 2 years due to external vulnerabilities in funding and political support. The aim of this study was to explore the enablers and barriers to the implementation and sustainability of Pick of the Crop. Pick of the Crop is a whole-school nutrition programme aimed at increasing opportunities for primary school students to learn about and consume more vegetables and fruit.

Qualitative methods were used for this study. Purposive sampling targeted the recruitment of the Pick of the Crop programme champions from primary schools in three regions of Queensland, Australia (socio-educationally disadvantaged areas; ranging in degree of remoteness). The schools had to be in their third year of implementation. Semi-structured interviews that were informed by the domains of the Consolidated Framework for Implementation Research (CFIR) were conducted with participants. The interviews were transcribed verbatim and coded deductively and inductively. Deductive coding was based on the constructs and sub-constructs of the CFIR, and inductive coding was applied when CFIR constructs were not suitable. The coding informed the development of themes through thematic analysis.

Interviews were conducted with 10 school champions including three principals and seven teachers from across all three regions. Forty-five constructs and 14 sub-constructs of the CFIR were identified, with an additional three inductive codes. Five main themes emerged: (1) implementation facilitators; (2) compatibility with education priorities; (3) generation and use of funding; (4) partnerships and connections with community and (5) programme impact.

To enhance and promote sustainability of the initiative, partnerships between schools and community need to be actively fostered, funding attainment needs to be systematic and programme coordinators play an integral role to supporting Pick of the Crop implementers and their partners.

Anxiety disorders involve abnormal fear learning and exaggerated generalization, proposed as potential risk factors. However, it is unclear whether these processes reflect stable vulnerability markers or symptoms of psychopathology, as most research relies on cross-sectional correlations and few longitudinal studies assess their predictive role in anxiety. Furthermore, little is known about the test-retest reliability of fear learning paradigms, despite their suggested function as trait-like markers for anxiety.

This longitudinal study reassesses initially healthy adults after 3-12 years, and children first examined at ages 8-12, then 12-16, and now at 16-22. Participants repeat the "screaming lady" paradigm, including fear acquisition and generalization. We integrate fear learning, psychometrics, HPA-axis activity, and (epi)genetics to assess the stability of fear generalization, its predictive value for later anxiety, and the link of fear learning to the HPA system.

Our findings will clarify the long-term stability of fear learning paradigms and evaluate their value as markers of anxiety risk. In addition, a random forest model will explore multiple risk factors and their interaction in anxiety symptomatology. This may improve understanding of anxiety disorders and support early detection and prevention.

Retrospectively registered on AsPredicted.org (#238,927).

Psychological/functional absences may be obscured within broad medical leave categories in routine attendance records. This study examined whether parent-reported psychological/functional absence is patterned and persistent in a Chinese secondary school context.

We analyzed retrospective attendance records from 2183 students and 26,092 absence events across the 2022-2025 academic years. Parent-reported reasons were coded into 8 categories. Event-level logistic regression with student-clustered robust standard errors examined associations with grade, sex, cohort, academic year, and month; student-year lagged models examined recurrence.

Psychological/functional absence accounted for 5179 events (19.8%). In the fully adjusted event-level model, Grade 11 students had higher odds of psychological/functional absence than Grade 8 students (OR = 2.62, 95% CI [1.45, 4.72], p = 0.001). Prior-year psychological/functional absence predicted current-year occurrence (OR = 3.50, 95% CI [2.67, 4.59], p < 0.001), and prior-year count predicted current-year count (IRR = 1.06, 95% CI [1.04, 1.07], p < 0.001) IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: Repeated psychological/functional absences may help schools identify students needing timely, non-punitive follow-up.

Psychological/functional absence appears to be a recurring administrative signal, but should not be interpreted as a clinical diagnosis.

To examine the association between climate change awareness, climate anxiety, and carbon footprint awareness among nursing students.

A cross-sectional, descriptive, and correlational study.

The study was conducted with 715 nursing students using self-administered questionnaires to assess their climate change awareness, climate change anxiety, and carbon footprint awareness. Sociodemographic information was also collected. Associations among variables were examined using correlation analysis, and associated factors related to carbon footprint awareness were evaluated through hierarchical regression analysis.

Carbon footprint awareness was positively associated with both climate change awareness and climate change anxiety, with anxiety showing a stronger association. Psychosocial variables explained variance in carbon footprint awareness more strongly than sociodemographic characteristics (R² = 0.13). Subgroup analyses showed no significant differences in carbon footprint scores according to academic year, previous awareness of the term 'carbon footprint', or place of residence. Climate change awareness was higher among students who had previously heard the term 'carbon footprint' (p = 0.013), whereas climate change anxiety differed significantly by academic year (p < 0.001).

The findings suggest that carbon footprint awareness among nursing students is more closely related to psychosocial processes than sociodemographic characteristics. Climate change anxiety, in particular, appears to be an important factor associated with environmentally related awareness. Additional subgroup analyses showed no significant differences in carbon footprint scores across subgroups, whereas climate change awareness and anxiety varied according to certain subgroup characteristics. However, the findings should be interpreted cautiously given the cross-sectional design and the relatively low explained variance of the model.

Integrating carbon footprint literacy and climate change into nursing curricula, considering peer education models, and promoting sustainable practices such as reducing the use of single-use materials during clinical education may contribute to increasing environmental awareness and supporting environmentally responsible nursing practice among nursing students.

This study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guideline.

No patient or public contribution.

Take-home naloxone (THN) programmes have been introduced in many European countries to provide non-medically trained people who are likely to witness an opioid overdose, including people who use opioids, with a naloxone kit and training. This study used data obtained from people supplied with THN and systematically followed up for 6 months to determine the proportion witnessing an overdose, administering naloxone and successfully reversing opioid overdose in real-world settings. The study aimed to compare reports of witnessed opioid overdose between participants in treatment and not in treatment at the time of recruitment.

A multi-country, observational prospective cohort study. Participants supplied with THN were asked to report any witnessed overdose events and participate in a systematic follow-up over a 6-month period.

Participants were recruited from THN programmes at 22 drug treatment and harm reduction services in England, Wales, Scotland and Sweden.

A total of 1025 people who used opioids and who were supplied with THN were recruited between June 2021 and November 2023, of whom 594 (58%) were successfully followed at 6 months. The participants were predominantly men (75%) and white (80%), with a mean age of 45.5 years (standard deviation 10).

Main outcomes: whether or not THN was administered at a witnessed overdose and overdose outcome where THN administered. Accurate recognition of opioid overdose, availability of naloxone and appropriate responses (including administering naloxone) to an opioid overdose were captured. Outcomes were compared between participants in treatment and not in treatment.

Of the 594 followed over 6 months, 160 (27%) witnessed at least one overdose. The likelihood of witnessing an overdose was higher among participants not in treatment than participants in treatment [56% vs. 23%; odds ratio = 4.4; 95% confidence interval (CI) = 2.69-7.21; P = 0.001]. THN was administered at most witnessed overdose events (83%; 95% CI = 74-85). Seven deaths were reported (4.4%; 95% CI = 0.02-8.8) by participants to be due to an overdose. For five deaths, naloxone was administered but was believed by participants to have been administered after death. Ninety-five percent (152) of participants were able to recognise one or more critical signs of overdose and respond appropriately. When naloxone was available, it was administered in almost all (90%; 142) emergency situations.

In the United Kingdom and Sweden, people who use opioids appear to be likely to witness and recognise an opioid overdose, be the only person carrying naloxone at the overdose and be both willing and able to safely and effectively administer naloxone in a timely response. Clinical trial registration details (if applicable): ClinicalTrials.gov Identifier: NCT05072249. Date of Registration: 8.10.2021.

The rapid evolution of large language models has accelerated the development of agentic artificial intelligence (AI) systems capable of pursuing autonomous goals, creating an urgent need for structural frameworks in psychiatry and psychotherapy. While existing classifications often draw parallels to autonomous driving, this paper argues that the mental health domain requires a distinct, domain-specific theoretical foundation, as the 2 domains differ fundamentally in their semantic, ideographic, and epistemological demands. Furthermore, they differ in their end goals, for which we introduce terms such as agentic guidance capability. To guide clinicians and researchers through these developments, we propose a 5-stage taxonomy for language-based AI systems that differentiates technical functionality from clinical effectiveness. The taxonomy progresses from level 1 (knowledge level), in which systems perform static benchmark tasks, to level 2 (elementary level), characterized by dynamic engagement in specific therapeutic microskills. At level 3 (integration level), systems achieve consistency across and within modules, as well as basic case-level conceptualization suitable for blended therapy under human oversight. Level 4 (saturation level) describes therapist-in-the-loop systems capable of autonomous functioning with minimal supervision, whereas level 5 (mastery level) represents AI systems that are technically capable of performing autonomous therapy. By distinguishing technical functionality from clinical effectiveness, we conclude that level 4 or level 5 performance does not automatically translate into full treatment effectiveness, even if high treatment fidelity can be achieved. We conclude by emphasizing the need to shift benchmarking from static knowledge tests to dynamic evaluations of therapeutic capabilities in order to safely navigate the transition toward autonomous care.