The full-scale invasion of Ukraine by the Russian Federation, soon entering its fourth year, has caused immense destruction of life and property and massive population displacement in Ukraine. Mothers and children have disproportionally been affected by this war. Children's physical and mental health have deteriorated, especially in the occupied territories and among those displaced by the invasion. Health services are stretched thin, and resources are severely limited. It has become more difficult to obtain care for the increasing number of children with disabilities and mental health crises. Education has been disrupted. Through it all, the Ukrainian people have been resilient.

There is a need to improve shared decision making about goals of care (GOC) for patients with chronic critical illness (CCI). Understanding the mental models that inform how physicians approach GOC decisions in CCI is necessary to improve shared decision making.

What factors prompt physicians to revisit existing GOC decisions for patients with CCI and influence their judgments of appropriate GOC in CCI? How do external health system factors, including access to long-term ventilator facilities, influence physicians' mental models about GOC in CCI?

AND METHODS: We conducted semi-structured interviews with a purposive sample of intensivists in the United States and Canada. We used a mental models approach from the field of decision science to identify the factors that these intensivists described as influencing their judgments of appropriate goals of care in CCI and when to revisit goals of care.

We interviewed 29 physicians from six institutions with varying access to long-term ventilator facilities. The primary factors that physicians described as influencing their personal judgments about GOC in CCI and their decisions to initiate new GOC discussions were an illness trajectory that remained flat over days to weeks, especially with limited apparent potential for a good functional outcome and acceptable quality of life. Increased access to long-term ventilator facilities was perceived to delay or defer GOC decisions. Other external influences included institutional norms and priorities regarding high-intensity treatments, patient turnover, and use of palliative care.

In this qualitative interview study, physicians described predictions about future quality of life and functional outcome as central to initiating and resolving decisions about goals of care in CCI. Greater awareness of functional and quality of life outcomes in CCI, as well as how health system factors influence physician mental models may improve GOC decision-making in chronic critical illness.

Burn injury may have lasting effects on work participation because of prolonged rehabilitation, functional limitations, appearance-related concerns, and psychological distress. Return-to-work status alone may obscure ongoing disruption in work roles, career appraisal, and support needs. How these elements cluster during post-burn occupational recovery remains insufficiently characterized.

We analyzed 166 adult burn survivors with baseline demographic, clinical, and psychosocial assessments and occupational follow-up data collected 24 months later. Outcomes included employment status, job change among employed survivors, perceived career impact, and predefined return-to-work barriers and facilitators. High occupational impact was defined a priori as burn-attributed workforce detachment or negative perceived career impact among employed survivors. Baseline correlates were examined using multivariable logistic regression. Positive perceived career impact was examined descriptively.

Ongoing work participation was reported by 51.2%, burn-attributed workforce detachment by 41.0%, and other unrelated changes by 7.8%. Among those who remained employed, job change was common (60.0%). Overall, 43.4% reported negative perceived career impact, and 54.2% met the definition of high occupational impact. Greater burn severity, higher baseline distress, and older age were associated with higher odds of high occupational impact; baseline posttraumatic growth showed an inverse exploratory trend. Model discrimination was moderate (AUC=0.733; 95% CI, 0.656-0.810).

Employment status, job change, and career appraisal together characterized post-burn occupational disruption beyond workforce detachment alone. High occupational impact identified survivors with greater burn severity, higher baseline distress, and concurrent work-related barrier endorsements. These findings support a broader vocational recovery framework that links sustained work participation, role adaptation, and career appraisal to differentiated rehabilitation and vocational support.

Schizophrenia is a leading cause of disability worldwide. Functional outcomes vary widely across individuals, yet evidence on long-term functional trajectories is scarce. We aim to identify 20-year trajectories of global functioning, examine baseline predictors of trajectory membership, and explore distal outcomes.

Three hundred seventy-six participants with a first-episode schizophrenia spectrum disorder from the OPUS randomized controlled trial were included. We applied Latent Growth Mixture Models to identify distinct trajectories of global functioning over 20-years, tested baseline variables as predictors of trajectory membership, and 20-year clinical, cognitive, and quality-of-life outcomes were mapped to explore the distal consequences of following each trajectory.

Three functional trajectories emerged: Functional recovery (21%), maintaining high functioning; Moderate improvement group (37%), with initial gains and later decline; and Impaired functioning group (42%), showing persistent disability. Membership in the impaired trajectory was predicted by the following baseline variables: male sex, older age, schizophrenia diagnosis, higher negative symptom, and not completing high school. At the 20-year follow-up, individuals in the Functional recovery trajectory demonstrated the most favorable outcomes, while those in the Impaired functioning trajectory exhibited the poorest outcomes across all key domains-symptom remission, cognitive performance, psychological quality of life, self-perceived general health, substance use, and suicide ideation.

The absence of significant improvement over 2 decades for many patients is alarming and highlights the limitations of current treatment approaches in modifying the functional course of these patients.

Psychiatric hospitalization is a key outcome in first-episode psychosis (FEP). Coordinated Specialty Care (CSC) is increasingly implemented across the United States, but hospitalization outcomes in real-world CSC settings remain uncertain.

This cohort study used data from the Early Psychosis Intervention Network. The sample included 2951 individuals across six networks (87 clinics in 15 states), assessed at admission and every 6 months for 2 years. Outcomes included psychiatric hospitalization, number of admissions, and total nights hospitalized. Logistic, Poisson, and negative binomial regression models were used.

At admission, 71.2% had been hospitalized in the prior 6 months. Older age was associated with lower hospitalization risk (odds ratios [OR], 0.95; 95% confidence intervals [CI], 0.92-0.98; P < .001), fewer admissions (incidence rate ratios [IRR], 0.98; 95% CI, 0.96-0.99; P = .003), and fewer nights hospitalized (risk ratios [RR], 0.96; 95% CI, 0.94-0.99; P = .002). Prior hospitalization predicted higher risk (OR, 1.52; 95% CI, 1.18-1.98; P = .001), more admissions (IRR, 2.89; 95% CI, 2.49-3.36; P < .001), and more nights hospitalized (RR, 3.04; 95% CI, 2.47-3.71; P < .001). Shorter duration of untreated psychosis (DUP) was associated with more admissions (IRR, 0.93; 95% CI, 0.89-0.96; P < .001) and more nights hospitalized (RR, 0.92; 95% CI, 0.88-0.96; P = .001).

Hospitalizations decreased substantially after CSC admission and remained low over 2 years in this large national FEP cohort. Prior hospitalization and markers of earlier illness course (younger age and shorter DUP) were associated with higher hospitalization burden, highlighting targets for CSC care refinement.

Post-stroke depression, anxiety, and cognitive impairment are prevalent in older adults and may impede recovery. We evaluated the comparative efficacy of exercise interventions for these outcomes using network meta-analysis.

We systematically searched five international and two Chinese databases from inception to July 2025 for randomized controlled trials enrolling older adults with stroke receiving exercise-based interventions. Primary outcomes were depression, anxiety, and cognitive function. Treatment effects were estimated as standardized mean differences (SMDs) with 95% credible intervals (CrIs), and interventions were ranked using surface under the cumulative ranking curve (SUCRA). Risk of bias and confidence in estimates were assessed with RoB 2 and CINeMA.

Fifty-two trials involving 4,170 participants were included; 11 were at low risk of bias. For depression, dual-task training (DTT), mind-body exercise (MBE), and balance/coordination training (BCT) ranked highest and showed statistically credible benefits versus usual care. For anxiety, MBE, resistance/strength training (RST), and DTT ranked highest, with statistically credible benefits observed for RST and DTT, whereas EFR was associated with worse anxiety outcomes. For cognitive function, MBE, general aerobic exercise (GA), and moderate-intensity continuous training (MICT) ranked highest, whereas BCT was the only intervention showing a statistically credible benefit versus usual care. Meta-regression suggested that longer time since stroke was associated with smaller benefits for anxiety and cognitive outcomes.

Exercise interventions may yield outcome-specific benefits after stroke in older adults. These findings support individualized, phase-sensitive exercise prescription in post-stroke rehabilitation.

Understanding the joint role of stepping intensity and step counts could inform pragmatic step-based physical activity strategies for premature mortality prevention. We examined the joint association of stepping intensity and daily step counts with all-cause mortality (ACM) and cardiovascular disease (CVD) mortality.

This prospective cohort study included the UK Biobank wrist-worn accelerometers subsample. We used peak 30-min cadence (PK30), the average steps/minute during the highest but not necessarily consecutive 30 minutes of the day, as a stepping intensity metric. We categorised daily steps into less than 5000, 5000-7500, 7500-10 000, above 10 000 steps/day group. We examined the multivariable-adjusted dose-response associations of PK30 and step counts with ACM/CVD mortality using Cox proportional and Fine and Gray subdistribution hazard models, respectively.

ACM analyses included 64 743 participants (mean age 61.5 (SD 7.8) years; female 37 497; 1697 events). Compared with the reference (fifth PK30 percentile and <5000 steps/day), both the <5000 and 5000-7500 steps/day groups showed a beneficial linear PK30-ACM risk association. Substantially lower ACM risk was observed at higher PK30 in the <5000 steps/day group (eg, 80 steps/min: HR 0.72 (95% CI 0.54 to 0.97)) and lower PK30 in the 5000-7500 group (eg, 60 steps/min: HR 0.70 (0.58 to 0.86)). Among all groups, 7500-10 000 steps/day had the lowest ACM risk, with a U-shaped pattern and the lowest risk was observed at approximately 100 steps/min (0.57 (0.47 to 0.69)). Higher PK30 was associated with lower ACM at 90 steps/min across all step-groups (eg, <5000 steps/day, 0.64 (0.32 to 1.32); above 10 000, 0.71 (0.59 to 0.87)). The CVD mortality results demonstrated similar dose-response patterns to those of ACM.

Premature ACM/CVD mortality might be prevented through different combinations of stepping intensity and step counts.

Sleep, anxiety, and depression are interconnected processes that greatly influence mental health throughout life. Recent studies indicate that sleep issues are not just symptoms of mental illness but can also cause emotional and cognitive problems. Anxiety and depression can disrupt sleep patterns, and ongoing sleep difficulties can raise the likelihood of mood disorders. This reciprocal relationship involves neural pathways, neurochemicals, hormones, immune responses, and social factors. This chapter explores how sleep, anxiety, and depression interact from various scientific and clinical viewpoints. Topics include circadian rhythms, stress hormones, immune signalling, genetic and environmental effects, cognitive impairments, developmental factors, and new treatment options. Understanding these links is crucial for creating comprehensive approaches to simultaneously address sleep and mental health issues.

Anxiety is common during the perinatal period (pregnancy to 12 months postpartum), yet perinatal women rarely seek help. One help-seeking barrier is low mental health literacy; however, research on perinatal anxiety (PA) and mental health literacy is scarce. This study aims to investigate women's knowledge regarding PA. Participants were 209 pregnant, postpartum, and nonperinatal women. Open-ended responses about perceived symptoms and causes of PA were analyzed using Reflexive Thematic Analysis. Two main themes concerning knowledge of PA symptoms were developed: (1) Perceived symptoms of perinatal anxiety (subthemes: Cognitive, Emotional, Physical, and Behavioral symptoms) and (2) Misattribution of symptoms of other disorders. Four main themes regarding knowledge of perceived causes of PA were developed: (1) Maternal health-related risk factors (subthemes: Preexisting factors, Perinatal factors), (2) Unique perinatal challenges and pressures (subthemes: Pregnancy and labor challenges, Postpartum challenges), (3) Environmental changes and stressors (subthemes: Lifestyle, Relationships), and (4) Absence of meaningful supports (subthemes: "Lack of support system," "Information overload"). The study highlights that women and their partners may benefit from PA-focused psychoeducation to further improve early recognition of symptoms and support well-being.

Post-Intensive Care Syndrome (PICS) is common among intensive care unit (ICU) survivors and is frequently accompanied by post-traumatic stress disorder (PTSD), anxiety and depression. ICU diaries are used to help survivors reconstruct fragmented ICU memories, but their effects on mental health outcomes remain uncertain.

To evaluate the efficacy of ICU diaries in mitigating PTSD, anxiety and depression among adult ICU survivors.

This systematic review and meta-analysis included randomized and non-randomized controlled studies. PubMed, Embase, Web of Science, the Cochrane Library, VIP, Wanfang Data and CNKI were searched from inception to 1 December 2025. Risk of bias was assessed using RoB 2 and ROBINS-I. Random effects meta-analyses were performed. Publication bias was examined using Egger's test and the trim-and-fill method. Trial sequential analysis (TSA) and GRADE assessment were also conducted.

Twenty-one studies (17 RCTs and 4 NRCTs) involving 2180 participants were included. After trim-and-fill correction for publication bias, ICU diaries showed no statistically significant effect on PTSD incidence (adjusted RR 0.73, 95% CI [0.47, 1.12]) or PTSD severity (adjusted SMD -0.23, 95% CI [-1.20, 0.75]). Modest benefits persisted for anxiety and depression symptoms. Substantial heterogeneity was observed across studies (I² ranging from 0% to 95%). Subgroup analyses suggested that healthcare-professional-led diaries (without family involvement) were superior in reducing PTSD symptom severity.

After adjustment for publication bias, ICU diaries did not show statistically significant benefits for PTSD incidence or severity but may provide modest adjunctive benefits in alleviating anxiety and depression symptoms.

ICU diaries may serve as a low-cost, humanistic adjunct to post-ICU psychological support for mental health outcomes. They should not be used as a standalone intervention for any single outcome. Standardized protocols and large trials using consistent outcomes of PTSD, anxiety and depression are needed.

The protocol for this systematic review and meta-analysis was prospectively registered on the International Prospective Register of Systematic Reviews (PROSPERO) (Registration number: CRD420251239895).