Opioid overdose is a public health crisis. Globally, ~ 600,000 deaths each year are attributable to drug use, and roughly three-quarters are linked to opioids. The rising prevalence of high-potency synthetic opioids like fentanyl necessitates comprehensive prevention and treatment strategies. This scoping review aims to map the published literature on the early detection and community management of opioid overdose and post-overdose care and identify research gaps. The aim was also to inform the potential research questions for updating the WHO and other international guidelines.

We systematically searched PubMed, EMBASE, PROSPERO, and the Cochrane Database for systematic reviews for studies published between January 2014 and March 2024. Inclusion criteria encompassed systematic reviews and review protocols, randomized clinical trials, and their secondary analysis, and guidelines published in those databases, addressing opioid overdose early detection and treatment strategies.

A total of 3,057 unique records were screened, resulting in 105 studies meeting the inclusion criteria. Thirty studies examined the effects of the acute opioid overdose treatment. Among the preventive strategies, 46 studies focused on "Take Home Naloxone" strategies, reflecting a significant emphasis on naloxone distribution as a primary intervention. However, 11 studies examined post-overdose care, highlighting a notable gap in the literature. Additionally, research predominantly concentrated in the Americas (70 studies) and Europe (27 studies), with limited representation from Africa and Southeast Asia. There was a marked absence of studies on polysubstance use and ultrapotent opioids, with one systematic review addressing the treatment of fentanyl overdose.

Findings support future international guidelines, such as those of the WHO, to examine the effectiveness of take-home naloxone, peer training, and community-based distribution models, higher-dose naloxone protocols for ultrapotent opioids, and digital delivery models. This review identifies gaps in post-overdose care, fentanyl and polysubstance overdose management, and research from low-resource settings.

Guidelines recommend implementing medication reconciliation (MR) at every healthcare transition. However, limited research has been conducted in outpatient clinics to explore whether MR affects the physicians' decisions. This study aims to evaluate the clinical impact of MR in these settings, specifically investigating whether MR leads to adjustments in treatment policies. The study also aims to assess the severity of potential harm avoided by these adjustments.

A cross-sectional study was performed between 1 June 2019 to 18 April 2022 at Maastricht University Medical Center+, The Netherlands, involving 20 different outpatient clinics. All patients who had an appointment at one of the involved clinics were assessed for eligibility (n = 3,031). Pharmacy technicians obtained the best possible medication history (BPMH) through MR. The BPMH was shared with the physician after the patient's visit. The physician could adjust his initial treatment policy based on the new information provided with the BPMH. The physician scored the severity of these policy adjustments, using the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) index.

The primary outcome was the proportion of patients with a policy adjustment. Secondary outcomes included the proportion of patients with potential severe harm and the physician's perceived value of the BMPH for possible future treatment. Descriptive data analysis was used.

In total, 2,289 patients were included (mean age: 59, 47.6% male). MR in outpatient clinics resulted in treatment policy adjustments by physicians in 3.8% of patients, with physicians deeming 0.5% of all MRs necessary to prevent severe harm. Physicians considered the BPMH valuable for future treatment in 13.8% of patients.

Routine medication reconciliation for all patients at every outpatient visit is not justified by this study. Future research should focus on identifying high-risk patient who would benefit most from MR in outpatient clinics.

As mental health professionals, psychiatric nurses have the knowledge and skills to play a key role in responding to the psychological needs of physically ill patients. However, their presence in non-psychiatric wards is often accompanied by role ambiguity and limited use of specialized competencies. The aim of this study is to explain the experiences of psychiatric nurses concerning the role of their specialized competencies on their work experiences in non-psychiatric wards.

This qualitative study employed a conventional content analysis approach. Data were collected between February and December 2024 through unstructured interviews with 16 psychiatric nurses working in non-psychiatric wards of different hospitals in Iran. Data analysis was conducted concurrently with data collection using the qualitative content analysis method described by Graneheim and Lundman (2004).

Three main categories and ten subcategories were identified: (1) "Usefulness of mental health nursing skills in physical care alongside the perceived need for improvement" with subcategories "clinical application of mental health nursing skills", "early identification and anticipation of psychological outcomes", and "perceived need for empowerment in applying mental health nursing skills"; (2) "Enhancement of interpersonal and interprofessional interactions" with subcategories "improved interaction with the treatment team", "establishing more effective communication with patients", "attention to nonverbal skills and empathy in communication", and "re-recognition of the importance of psychiatric nurses' roles"; and (3) "Expansion and deepening of the professional role" with subcategories "generalization of mental health nursing skills to personal life and individual growth", "performing informal advisory and supportive roles in the ward", and "achieving a holistic approach to care".

Psychiatric nurses in non-psychiatric wards utilize their specialized competencies by integrating mental health care into physical care, enhancing therapeutic and interprofessional communication, and developing their professional roles. These findings also highlight the need for further development of practical competencies in non-psychiatric settings.

Not applicable.

Chronic illness among adults is common, and an increasing number of children grow up in households where one or more adults live with long-term health conditions. While previous research has shown that parental physical or mental illness may influence children's mental health, less is known about how adult multimorbidity affects children's physical health and their healthcare use. This study aimed to investigate the association between household-level multimorbidity and healthcare use among school-aged children.

This cross-sectional study used data from the Danish Lolland-Falster Health Study (LOFUS), including 1,065 children aged 6-12 years living in 777 households. Children's questionnaire data were linked to adult data and national health registers. Adult chronic conditions were identified using questionnaire data and ICD-10 diagnoses, and household multimorbidity was defined as ≥ 2 chronic conditions among co-resident adults. Children's healthcare use, including general practice contacts, out-of-hours/emergency room visits, hospital admissions, and redeemed antibiotic prescriptions, was assessed over 12 months. Associations were analyzed using two-part regression models adjusted for children- and household-level covariates. Analyses were further stratified according to the presence of adult mental illness in the household.

Children living in households with multimorbidity had a significantly higher overall volume of contacts with general practice compared with children from households without multimorbidity. This association was primarily driven by households in which multimorbidity included adult mental illness. Among children who had experienced hospital admission, those from households with multimorbidity had more frequent admissions, although the overall likelihood of admission did not differ between groups. No statistically significant differences were observed for out-of-hours contacts, emergency room visits, or antibiotic prescriptions.

Household multimorbidity was associated with increased healthcare use among children, particularly in relation to general practice. The findings suggest that children's healthcare use is influenced not only by their own health needs but also by the household's broader health context. A household-level perspective may therefore contribute to a more nuanced understanding of patterns of healthcare use among children and support clinical awareness in primary care.

Knee osteoarthritis (KOA) is a prevalent chronic condition associated with pain, functional limitation, and reduced quality of life. Psychological distress is common among patients with KOA and may influence symptom perception and functional outcomes; however, its independent association with functional disability remains uncertain when major clinical determinants are considered.

To examine the associations between psychological distress, pain intensity, and functional disability in patients with knee osteoarthritis.

A cross-sectional analytical study was conducted in adult patients with symptomatic knee osteoarthritis. Psychological distress was assessed using the Hospital Anxiety and Depression Scale (HADS), the Patient Health Questionnaire-9 (PHQ-9), and the Mental Component Summary (MCS) of the SF-36. Pain and functional disability were evaluated using the WOMAC index. WOMAC function scores were reverse-coded such that higher values indicate better functional status. Correlation analyses and two complementary multivariable linear regression models were performed to identify factors associated with functional disability. Model 1 adjusted for age, body mass index, and radiographic severity, while Model 2 additionally included pain intensity as a covariate to examine the extent to which pain accounted for the association between depressive symptoms and functional status.

Depressive symptoms assessed by the HADS-D were highly prevalent, with all participants (100%) presenting scores ≥ 8, and were significantly associated with pain intensity and functional status in unadjusted analyses. In multivariable regression (Model 1), depressive symptoms were significantly associated with functional disability after adjustment for age, body mass index, and radiographic severity (β = -1.14; 95% CI [- 1.95; -0.33]; p = 0.006), indicating that higher depressive symptom severity was associated with poorer functional status. However, this association was attenuated and no longer statistically significant after additional adjustment for pain intensity (Model 2; β = -0.42; 95% CI [- 0.91; 0.07]; p = 0.092), whereas pain intensity emerged as the strongest independent determinant of functional status (β = 1.99; 95% CI [1.64; 2.35]; p < 0.001).

Knee osteoarthritis is associated with a substantial psychological burden. Depressive symptoms are closely linked to pain and functional status; however, their association with functional limitation was largely attenuated after adjustment for pain intensity, suggesting that pain may play a central role in this relationship. These findings support integrated management strategies focusing on both pain control and psychological assessment.

Cannabis use among university students has been increasingly linked to psychological distress; however, most evidence comes from Western contexts, and little is known about how cannabis use intersects with emotional functioning in non-Western settings. In Türkiye, where cannabis use remains illegal and highly stigmatized, students who use cannabis may represent a particularly vulnerable group. This study examined the associations between cannabis-related problems, psychological distress, and distress tolerance among Turkish university students, and explored students' lived psychological experiences of cannabis use.

A sequential explanatory mixed-methods design was employed. In the quantitative phase, 512 university students from Istanbul, Ankara, and Izmir completed self-report measures assessing cannabis-related problems (Cannabis Use Problems Identification Test), depressive symptoms (Beck Depression Inventory-II), anxiety symptoms (Beck Anxiety Inventory), and distress tolerance (Distress Tolerance Scale). In the qualitative phase, semi-structured interviews were conducted with a purposively selected subsample of 43 students with elevated cannabis-related problems and/or psychological distress. Quantitative data were analyzed using descriptive and correlational analyses, while qualitative data were examined using reflexive thematic analysis. Findings were integrated at the interpretation level.

Greater cannabis-related problem severity was moderately associated with higher levels of depressive and anxiety symptoms and with lower distress tolerance. Qualitative analyses yielded four overarching themes: (1) psychological effects of cannabis use, (2) cannabis use as a distress regulation strategy, (3) perceived loss of control and ambivalence, and (4) academic and interpersonal consequences. Integration of quantitative and qualitative findings suggested a cyclical pattern in which psychological distress motivates cannabis use for short-term relief, which in turn undermines distress tolerance and contributes to further psychological and functional difficulties.

Cannabis use among Turkish university students appears closely intertwined with emotional distress and reduced capacity to tolerate negative affect. Rather than being solely recreational, cannabis use often functions as a maladaptive coping strategy. Interventions targeting emotion regulation and distress tolerance may be particularly beneficial in this population. These findings highlight the importance of integrated mental health and substance-use approaches within university settings, especially in culturally conservative contexts.

Chronic musculoskeletal pain is among the leading causes of non-fatal health loss, sickness absence and disability. These patients frequently present with co-occurrent symptoms of anxiety and/or depression (A/D). Return to work (RTW) is an important measure of functional recovery, but the longitudinal impact of A/D on RTW in patients with chronic pain is less understood.

This study investigates the association between A/D symptoms and RTW among sick-listed patients referred to multidisciplinary physical medicine outpatient clinics with chronic neck or back pain (n = 3291), using comprehensive follow-up data from Norwegian national registers. The contribution of A/D symptoms to non-RTW was calculated using population attributable fractions (PAF), with self-reported pain intensity as reference.

The prevalence of case level A/D symptoms was 56.8%. There was an association between case level A/D symptoms and non-RTW at 12 months both in the unadjusted model (RR 1.32, 95% CI 1.22-1.44) and after adjustment for sociodemographic factors and symptom severity (RR 1.12, 95% CI 1.03-1.23), and PAF was estimated to be 6.6% in the fully adjusted model. In a separate model with adjustment for the same variables, there were no association between pain intensity and non-RTW (RR 1.02, 95% CI 0.93-1.11).

The results suggest that A/D symptoms are more important than pain intensity for RTW at 12 months in sick-listed patients with chronic neck or back pain, irrespective of self-reported severity of musculoskeletal symptoms and sociodemographic factors. Approximately 7% of non-RTW cases could be attributed to case level A/D symptoms. Addressing A/D symptoms as part of assessment and treatment is essential to improve RTW outcomes in patients with chronic neck or back pain.

IntroductionAs mental health challenges rise globally, arts engagement offers an evidence-based strategy for promotion and treatment. However, cross-sectoral US policy efforts at this intersection remain limited and largely top-down.MethodsThis study employed constructivist grounded theory to explore conceptions of arts in mental health advocacy among stakeholders actively engaged in cross-sectoral practice - artists, public health practitioners, and municipal leaders. Semi-structured interviews were held with 44 participants that represented each of the three primary sectors and spanned work across national and local initiatives.ResultsThe data yielded five theoretical categories: Knowledge Needs, Skill and Tool Needs, Policy Needs, Considerations for Advocacy Engagement, and Strategies for Advocacy. These categories informed the development of the IMPACT Theory, a grounded theory that outlines pathways for mobilizing equitable and effective advocacy. Findings emphasize the need for increased stakeholder preparedness, public awareness, and policy mechanisms that support funding, access, and cross-sectoral integration.ConclusionTo develop actionable and informed advocacy, efforts should increase advocacy preparedness for invested stakeholders, prioritize the time and energy of advocates, and work to improve public awareness about arts and health. This theory offers a framework for advancing arts in mental health policy and may inform broader interdisciplinary advocacy efforts.

BackgroundPeriod product insecurity is an emerging form of material hardship with significant implications for mental health. Previous research has shown that financial challenges related to accessing material basic needs hygiene products can increase stress and anxiety.ObjectivesThis study aims to examine the relationship between frequencies of period product insecurity, parenting stress, and mental health outcomes in caregivers with young children.DesignThe study uses cross-sectional survey data from participants (N=541) who menstruated in the past year and were caregivers of children under age four. Data were collected during completion of an online survey from March - April 2024.MethodParticipants reported experiences with period product insecurity and completed standardized measures of anxiety and depression (GAD-2 and PHQ-2). Logistic regression models, adjusting for sociodemographic factors, estimated the association between period product insecurity frequency, parenting stress, and mental health outcomes.ResultsAmong participants, 39.5% (n=214) endorsed period product insecurity at least once in the past year. The majority of caregivers with young children who experienced period product insecurity monthly reported symptoms of Generalized Anxiety Disorder (68.4%, n=156) or major depressive disorder (72.3%, n=112). Fewer caregivers who did not experience period product insecurity reported symptoms (Generalized Anxiety Disorder 27.0%, n=87; major depressive disorder 27.1%, n=87). More than half of all caregivers "completely agree" or "agree" that they felt stressed or anxious about the responsibilities that come with parenting/caretaking (57.7%, n=308). Monthly experiences of period product insecurity, and stress about parenting responsibilities, increased risk of symptoms of anxiety and depression compared with no period product insecurity (p<.001).ConclusionFuture research is needed to strengthen the evidence base to better understand the causal pathways between period product insecurity and caregiver mental health. In the meantime, interventions and policy measures could be explored to integrate both period product distribution and parenting supports within broader caregiver support systems.

Zimbabwe currently faces a rapidly escalating burden of noncommunicable diseases (NCDs) concurrently with persistent communicable disease challenges, resulting in profound epidemiological differences between rural and urban populations. To effectively address this evolving epidemiological landscape and guide evidence-based public health interventions, reliable and high-quality longitudinal data are essential for capturing temporal shifts and contextual determinants often overlooked by conventional health information systems.

This protocol details the methodology for establishing a health and demographic surveillance system (HDSS), a longitudinal, population-based cohort designed to continuously monitor the prevalence, incidence, and key determinants of NCDs, specifically cardiovascular diseases and diabetes, and their associated risk factors in selected rural (Mt Darwin) and urban (Bindura) sites in Mashonaland Central Province over a 5-year period (2024-2029).

The HDSS uses a stratified multistage sampling design to recruit adults (aged ≥18 y) residing across 2 rural and 2 urban wards. Initial activities include comprehensive community profiling and household mapping, followed by a rigorous baseline survey, with systematic follow-ups scheduled every year. Data encompass essential domains such as vital events, migration patterns, detailed social determinants of health, health behaviors, self-reported and clinically assessed NCDs, physical examinations (including height, weight, blood pressure, and waist/hip circumference), biochemical markers (fasting glucose, lipid profiles, and urine sodium/creatinine), and standardized verbal autopsies. Data capture will make use of REDCap (Research Electronic Data Capture) to facilitate real-time data entry and validation. The protocol is underpinned by rigorous quality assurance procedures, continuous community engagement, and comprehensive ethical oversight.

The Zimbabwe HDSS received ethical approval on July 30, 2024 (MRCZ/A/3191). Baseline data collection was completed in Mt Darwin (rural site) in December 2024 and in Bindura (urban site) in March 2025. Statistical analysis of baseline NCD prevalence, risk factor distributions, and rural-urban comparisons is underway, with findings expected to be submitted for publication by the end of 2026. The first annual longitudinal follow-up round is planned for the second quarter of 2027, subject to funding availability, with subsequent rounds scheduled annually through 2029. Longitudinal incidence estimates and NCD trend analyses are expected to be published progressively from 2026 to 2029.

This community HDSS addresses a critical evidence deficit within Zimbabwe's national health information infrastructure. By implementing an ethical, sustainable, and community-engaged research methodology, the HDSS serves as a potent regional model. It is designed to generate actionable, policy-relevant data for national health authorities and stakeholders, thereby accelerating the country's NCD prevention and control agenda while simultaneously acting as an enduring platform for academic innovation, capacity building, and policy translation efforts targeting both rural and urban health disparities.