To provide expert recommendations for the development of a specialty bipolar clinic that promotes best clinical practices for the delivery of safe and effective care.

Members of the National Network of Depression Centers (NNDC) Bipolar Clinics Work Group met in a series of 1-h monthly video calls over 18 months to discuss all aspects of their respective institution's bipolar clinics, including services provided, administrative processes, staffing models, characteristics of patients treated, patient volumes, finances, and research. The group also invited psychiatrists from outside of the NNDC who ran large bipolar clinics to contribute their thoughts and experiences on the subject. In addition, the NNDC sent a 20-question survey to all 27 sites asking clinic directors specific questions about their bipolar clinics, if applicable. Further meetings and discussions incorporating results from the survey took place to produce a comprehensive set of recommendations.

Twenty-one of 27 NNDC sites (81%) responded to the survey. Twelve of 21 (57%) sites had a specific bipolar clinic, and another 4 (19%) were looking to start one. Clinics were based in university settings. The meetings, clinic survey, and discussions resulted in 10 recommendations describing services and operations for bipolar specialty clinics.

Given the complexity of bipolar disorder, specialty clinics are important to enhance care. Clinics with a wide array of services that include consultation, medication management, bipolar-specific psychotherapies, and patient/family psychoeducation provide the most comprehensive care. Challenges to these clinics include maintaining ongoing patient access as well as ensuring long-term financial stability.

Although machine learning has increasingly been used to predict mental health symptoms and maladaptive behaviors, real-world prediction of addiction-related risk remains limited. Emotional and temperamental vulnerabilities are established correlates of alcohol-related problems, yet few studies have integrated these factors with wearable-derived biosignals in alcohol-risk prediction models.

This study evaluated whether machine learning models could predict weekly high-risk drinking episodes among young adults with elevated alcohol-use risk by integrating wearable-derived health data with baseline emotional and personality vulnerability indicators.

In this prospective observational study, adults in their 20s completed weekly self-report surveys and wore Fitbit devices for 4 weeks. Features from week t were used to predict the Alcohol Use Disorders Identification Test-Korean version (AUDIT-K)-based high-risk drinking label at week t+1. Positive labels were defined using AUDIT-K high-risk drinking cutoffs, with scores of ≥20 for men and ≥10 for women. Extreme gradient boosting (XGBoost) and random forest models were evaluated across self-report-only, wearable-only, and integrated feature sets using 5-fold participant-level grouped cross-validation.

A total of 206 participants contributed 620 week-level observations, of which 85 (13.7%) were labeled as positive high-risk drinking episodes. In participant-level grouped cross-validation, the integrated random forest model showed the most favorable sensitivity-oriented performance, with a mean accuracy of 0.617 (SD 0.078), recall/sensitivity of 0.653 (SD 0.144), area under the receiver operating characteristic curve (ROC AUC) of 0.681 (SD 0.079), and area under the precision-recall curve (PR AUC) of 0.255 (SD 0.090). The integrated XGBoost model achieved an accuracy of 0.670 (SD 0.089), recall/sensitivity of 0.399 (SD 0.174), ROC AUC of 0.651 (SD 0.089), and PR AUC of 0.228 (SD 0.074). Shapley additive explanations analyses indicated that both baseline vulnerability indicators and wearable-derived weekly summaries contributed to model predictions.

Integrating baseline emotional and personality vulnerability indicators with wearable-derived weekly health signals may provide useful information for week-ahead prediction of high-risk drinking episodes. These findings provide preliminary support for wearable-assisted alcohol-risk stratification, although the modest positive predictive performance indicates that external validation and more proximal within-person measures are needed before real-world early-warning or just-in-time adaptive intervention applications.

The onset of an illness has the potential to induce profound changes in a person's life. However, being diagnosed with a physical illness may not carry the same impact as being diagnosed with a mental health disorder. Among them, psychotic disorders exhibit the highest level of social stigma and acceptance challenges, along with compromised social functioning, diminished quality of life, and disruptions in personal, social, and vocational domains. The Impact of Illness Scale (IIS) measures how an illness has adversely affected a person's life as perceived by that person. This study aimed to assess the psychometric properties of the IIS in a sample of 141 people with a first episode of psychosis (FEP) (mean age 35.7 years, 51.8% female). The study explored the factor structure, internal consistency, convergent and discriminant validity, and temporal stability of the IIS. The confirmatory factor analysis (CFA) model showed an excellent fit of the data, confirming a one-factor structure, internal solid consistency (McDonald's ω = .95; Cronbach's α = .94), theoretically coherent convergent and discriminant validity with measures of internalized stigma, negative beliefs, symptoms of psychosis and general psychopathology symptoms, and moderate test-retest reliability. Overall, these findings support the IIS as a reliable and valid tool for assessing the subjective impact of psychosis, offering clinical and research utility for understanding patient experiences beyond symptom severity.

The UAE is facing a critical shortage in the midwifery workforce. Maternity care is predominantly obstetric-led. The UAE government is committed to increasing the number of midwives by 38 per year until 2030 and has invested in midwifery education, with the first direct-entry Bachelor's degree programs in midwifery available. However, little is known about public perspectives on the availability, accessibility and quality of midwifery services in the UAE. Our aim was to explore public perspectives on challenges and gaps in midwifery services in the UAE.

An exploratory qualitative study was conducted using responses to an open-ended question within a bilingual (English/Arabic) online survey distributed across the UAE via social media and snowball sampling from November 2024 to February 2025. Responses to the open-ended question were analyzed thematically.

Out of 207 (100%) survey respondents, 119 (57%) answered the open-ended question. Thematic analysis identified five central themes: limited availability and accessibility of midwifery services; cultural and public perceptions of midwives; limited scope of practice and autonomy for midwives; education, awareness and professional development; and quality and scope of postpartum care.

The findings highlight significant public support for the expansion and enhancement of midwifery services in the UAE. Tackling the identified challenges has the potential to improve the quality and accessibility of maternity care, empower women's choices and strengthen midwives' contribution to national maternal health objectives. Embedding midwifery reforms into national strategies will help the UAE meet its healthcare goals, including those outlined in Vision 2030, by building a sustainable, evidence-based, high-quality maternity care system.

The global HIV epidemic is undergoing a demographic transition as expanded access to antiretroviral therapy (ART) has increased life expectancy among people living with HIV (PLWH). As a result, the population of older adults living with HIV (OPLWH) is rapidly growing, introducing new clinical, psychosocial, and public health challenges. In the Philippines, one of the fastest-growing HIV epidemics in the Asia-Pacific region, this shift is occurring alongside rising incidence, creating a dual burden of ongoing transmission and emerging survivorship needs.

This study employed a structured narrative review and policy-oriented conceptual synthesis of multidisciplinary literature published between 2010 and 2025. An ecological framework guided analysis across individual, interpersonal, community, and structural levels, with emphasis on accelerated and accentuated ageing, multimorbidity, stigma, and health literacy (HL). The Optimizing Health Literacy and Access (OPHELIA) framework was applied to translate findings into equity-centered public health strategies.

OPLWH in the Philippines face compounded vulnerabilities driven by biological ageing, multimorbidity, and intersecting forms of stigma, including ageism and HIV-related discrimination. Structural barriers such as fragmented health systems, workforce limitations, geographic inequities, and limited HL capacity, constrain sustained engagement in care. Diagnostic invisibility and late presentation among older adults persist, while inadequate age-disaggregated surveillance limits recognition of ageing-related burden. Psychosocial factors, including loneliness, internalized stigma, and cultural norms surrounding sexuality and ageing, further influence adherence, care retention, and quality of life.

The findings underscore the need for integrated, age-responsive HIV care models that incorporate geriatric principles, mental health services, and culturally grounded stigma reduction. Expanding the OPHELIA framework demonstrates how HL-informed, community co-designed interventions can strengthen care continuity and survivorship outcomes. Policy priorities include workforce training in HIV and gerontology, improved age-disaggregated surveillance, HL interventions, and climate-resilient service delivery. Addressing ageing with HIV in the Philippines requires coordinated, system-level reform to ensure that increased longevity is accompanied by equitable, sustained health outcomes.

Ultrafine particles (≤100 nm) and other environmental nanoparticles have emerged as biologically active pollutants that can cross biological barriers, including the blood-brain barrier and the placenta. Growing evidence implicates ultrafine particles in a wide range of neuropsychiatric conditions, yet their effects remain poorly integrated into clinical and public health frameworks. In this review, we distinguish between size-defined ultrafine particles (UFPs, ≤100 nm), composition-defined environmental nanoparticles originating from combustion and secondary formation processes, and engineered nanomaterials (ENPs), which differ in physicochemical properties, exposure scenarios, and regulatory status. This narrative systematic review synthesizes findings from human and experimental studies on the neuropsychiatric and neurodevelopmental effects of environmental nanopollutants. A structured search was conducted in PubMed, Web of Science, Scopus, and Google Scholar up to November 2025, following explicit inclusion and exclusion criteria. Eligible studies included peer-reviewed human and animal research assessing mental health or neurological outcomes of nanopollutant exposure. Epidemiological studiesprimarily involving traffic-related air pollution and mixed combustion-derived ultrafine particle exposuressuggest associations with increased risk of cognitive impairment, autism spectrum disorder, depression, schizophrenia, and neurodegenerative diseases, including Alzheimer's, Parkinson's, and amyotrophic lateral sclerosis. Prenatal and early life exposures were linked to cortical thinning, altered neurodevelopmental trajectories, and early proteinopathies. Underlying mechanisms include neuroinflammation, oxidative stress, and protein aggregation. Despite methodological heterogeneity, the evidence supports the urgent need for regulation and prevention. Environmental nanopollutants constitute an under-recognized, modifiable risk factor for neuropsychiatric and neurodegenerative conditions. A paradigm shift is needed to incorporate environmental exposure history into mental health research, risk assessment, and prevention strategies. Regulatory action targeting nanopollutant emission and exposure, particularly in vulnerable populations, is critical to mitigating long-term neurological consequences.

Doctoral research degrees, particularly Doctor of Philosophy (PhDs), are integral to advancing medical science, clinical research, and therapeutic practices in orthopedics. Despite their significance in fostering innovation and evidence-based medicine, prospective PhD scholars encounter numerous barriers and challenges. Institutional inaccessibility, logistical constraints, and geographical challenges in developing countries hinder the pursuit of advanced research education. In addition, the gap between clinical practices and research-based studies highlights the struggle of translating evidence-based medicine into routine care. Researchers face challenges like inadequate mentorship, disorganized feedback, insufficient preparatory guidance, and cultural differences, affecting both foreign and native scholars. Furthermore, balancing research responsibilities with clinical duties often leads to burnout, family disruptions, and compromised patient care standards. Mental health issues and lack of confidence are prevalent among PhD students, exacerbated by time management challenges and inadequate institutional incentives. Despite these obstacles, opportunities for interdisciplinary collaboration, bridging gaps between clinical and research practices, and adopting innovative methodologies have emerged. Technological advancements in orthopedics, such as robotics and artificial intelligence, are revolutionizing patient care and inspiring new research directions. PhDs contribute to career progression by equipping clinicians with advanced knowledge, fostering policy-making skills, and promoting specialization in fields like sports medicine and regenerative therapies. While challenges persist, the academic rigor and career incentives offered by PhDs create a promising pathway for orthopedic professionals to impact healthcare systems and patient experiences significantly. Continued focus on education, research methodologies, and interdisciplinary cooperation will ensure the integration of innovation and evidence-based practice for improved outcomes in orthopedics.

BACKGROUND: The relationship between prenatal exposure to low-level air pollution and child autism spectrum disorder (ASD) is unclear. OBJECTIVE: To examine associations of prenatal air pollution exposure with autism. METHODS: We analyzed data from 8,035 mother-child pairs from 44 United States cohorts in the Environmental influences on Child Health Outcomes (ECHO) Cohort. Fine particulate matter (PM_2.5), nitrogen dioxide (NO₂), and 8-h-max ozone (O₃) levels were estimated at residential addresses during pregnancy. Parents rated children's autism-related traits using the Social Responsiveness Scale (SRS) (mean age 9.4 years, SD = 3.6) and reported physician-diagnosed ASD. We examined associations of the three air pollutants with SRS scores (10th, 50th, and 90th quantiles) using quantile regression and with ASD diagnosis using logistic regression. Models were run within census divisions, and coefficients were pooled in a meta-analysis. RESULTS: Average (SD) pregnancy exposures were 9.3 μg/m³ (2.7) for PM_2.5, 21.8 ppb (8.8) for NO₂, and 40.3 ppb (5.5) for O₃, with variations across census divisions. The median SRS T-score was 46 (IQR = 41 to 52), and 444 children (5.5%) had an ASD diagnosis. Higher PM_2.5 was associated with higher SRS scores at the 10th quantile (β = 0.74, 95% CI: 0.09, 1.40) but not at the median or highest quantile. The association between PM_2.5 and ASD diagnosis was highly heterogeneous, with associations present in the South Central, Mountain, and Pacific census divisions. Heterogeneity was also high in the association between NO₂ and SRS at the median and only in the mid-Atlantic, West North Central, and South Atlantic census divisions. Higher O₃ was associated with higher SRS scores at the median (β per IQR increment = 0.83, 95% CI: 0.05, 1.61) and highest quantile (β = 2.19, 95% CI: 0.06, 4.32) in the meta-analysis. Higher O₃ also was associated with ASD. DISCUSSION: Associations with ASD outcomes were present even at low levels of air pollutants.

 Frailty is a complex health condition that can adversely affect both the physical and mental health of patients who are on maintenance hemodialysis. Assessing frailty in this population could help identify patients at risk of adverse outcomes early.

This study aimed to determine frailty condition through the Edmonton Frail Scale (EFS) and investigate its relationship with kidney disease-related quality of life in South Asian patients receiving hemodialysis.

A total of 448 adults who had undergone maintenance hemodialysis for at least three months were included in the current cross-sectional study. Frailty was assessed using the EFS, and quality of life was measured using the Kidney Disease Quality of Life-36 (KDQOL-36) questionnaire. The Spearman's rank correlation, the Mann-Whitney U test, the Kruskal-Wallis H test, and multiple linear regression were among the various statistical approaches utilized for data analysis.

 Frailty showed a strong inverse relationship with quality of life (ρ = -0.317, p < 0.001). Women had a higher frailty score than men but a lower KDQOL score (p < 0.001). The frailty score was positively correlated with age, while quality of life was negatively correlated with age (p < 0.001). According to regression analysis, greater frailty (B = -0.812), older age, female sex, longer duration of dialysis, more frequent dialysis, and higher comorbidity were significant factors associated with lower quality of life (p ≤ 0.01).

 Frailty was significantly associated with reduced quality of life among patients on hemodialysis, highlighting the importance of routine frailty screening during hemodialysis care.

Background  Disability certification is a critical mechanism enabling persons with disabilities to access healthcare, rehabilitation, social welfare measures, and government entitlements under the Rights of Persons with Disabilities (RPwD) Act, 2016. Despite increasing global recognition of disability as a public health priority, data from Northeast India remain limited. This study aimed to evaluate temporal trends in disability certification applications, service utilization patterns, demographic characteristics, and trauma-related locomotor disability burden at a tertiary care center in Northeast India. Methods  A retrospective review of disability certification applications submitted between January 2018 and November 2024 was conducted. Data regarding demographic characteristics, domicile, disability type, and severity were extracted from institutional certification records maintained by the Nodal Officer for disability certification. Applications were evaluated by the Institutional Medical Board according to RPwD guidelines. Results  Of the 132 disability certification applications received between January 2018 and November 2024, 113 were included in the final analysis after excluding 19 incomplete records. Applications showed a progressive increase over time, peaking in 2023, with a temporary decline during the COVID-19 pandemic. Most applicants were male (77.0%) and belonged to the 19-35-year age group (38.9%). Applicants domiciled in Northeast India, predominantly from Meghalaya, constituted the majority of applicants. Physical disabilities accounted for most certifications, with locomotor disability being the predominant subtype. Trauma-related locomotor disabilities were observed particularly among working-age males. Moderate disability severity predominated, while visual impairment was predominantly observed among older adults. Conclusion  The study underscores the increasing awareness and accessibility of disability certification services under the RPwD Act, particularly among rural and underserved populations. However, the low representation of individuals with mental illness, intellectual disability, specific learning disability, autism spectrum disorder, and multiple disabilities highlights the need for more inclusive and multidisciplinary assessment frameworks. Targeted outreach programs and community-based services are essential to address the potential underutilization of certification services in remote regions, particularly among individuals with trauma-induced disabilities.