Recent findings indicate attenuated myostatin (MSTN) signalling in idiopathic inflammatory myopathies (IIM) and an inverse association between circulating MSTN and disease activity. The temporal and mechanistic relationship of these alterations to disease pathogenesis remains unclear. We therefore investigated systemic and skeletal muscle MSTN regulation in newly diagnosed patients at disease onset, after six months of therapy, and in chronic IIM.

A total of 101 patients with IIM and 134 healthy controls (HC) were enrolled. Muscle biopsies were obtained from 59 newly diagnosed untreated or shortly treated patients, 19 patients after six months of therapy, 19 chronic IIM patients, and 21 HC. Serum samples and clinical data were collected during routine visits. Circulating MSTN, follistatin (FST), follistatin-like 3 (FSTL3) and activin A (ActA) were measured by ELISA. mRNA and protein expression of MSTN pathway components in muscle tissue were assessed by qPCR (TaqMan^®) and immunoblotting. Associations of serum MSTN, FST, FSTL3 and ActA with clinical outcomes were analysed using linear mixed-effects models (LMM) and partial least squares regression during the first six months of therapy.

Newly diagnosed IIM patients had significantly lower circulating MSTN and higher FST levels than chronic patients and HC, whereas ActA was elevated only in chronic disease. After normalization to body cell mass, MSTN remained reduced in newly diagnosed patients and increased after six months of therapy, while FST, ActA and FSTL3 did not change significantly. LMM analysis demonstrated strong associations of FSTL3 with systemic inflammation, disease activity and reduced physical and mental health scores, predominantly in female patients. In muscle tissue, newly diagnosed patients showed increased expression of MSTN pathway genes and proteins, including MSTN, SMAD2/3 and ubiquitin-proteasome components. Multivariate analyses integrating clinical, biochemical and molecular parameters identified a latent component linking MSTN pathway activation with muscle disease activity.

Early IIM is characterized by dissociation between reduced circulating MSTN and activation of MSTN signalling in skeletal muscle, which diminishes with treatment and disease chronicity. Circulating FSTL3 is associated with systemic inflammation, disease activity and patient-reported outcomes, with pronounced associations in female patients. These findings highlight stage- and sex-dependent alterations of the MSTN regulatory network in IIM.

Rheumatic disease significantly alters a child's quality of life. Rheumatologists often apply a patient global assessment score (PGA) in real time to gauge quality of life, effectiveness of treatment, and disease activity for clinical and research purposes. Previous studies showed a discrepancy between the PGA and objective disease activity measures. This study explores patients' self-reported reasons behind their PGA score, especially the role of anxiety and depression.

This is a single-center, cross-sectional, survey-based study. Seventy-one patients 12-18 years old with JIA, SLE or JDM completed a survey including the PGA, Patient Health Questionnaire-9 (PHQ9) and Screen for Childhood Anxiety Related Disorders (SCARED). The associations of high (≥ 3) and low (< 3) PGA scores with mental health scores and reasons for selecting a PGA were analyzed using appropriate nonparametric tests.

Twenty-seven participants (38.0%) had clinically significant anxiety symptoms and sixteen (22.5%) had moderate or worse depressive symptoms. Patients with high PGA scores were more likely to have clinically significant depressive (32.4% vs. 11.8%, p = 0.05) or anxiety symptoms (48.6% vs. 26.5%, p = 0.05) compared to patients with low PGA scores. Patients with either high depressive symptoms or anxiety symptoms were more likely to report trouble sleeping, feeling stressed about their disease, feeling anxious or sad/depressed, having to take too many medications, and an inability to participate in sports/activities as reasons for their PGA score compared to patients without high depressive or anxiety symptoms. In contrast, the degree of objective disease activity was only associated with the reason "inability to participate in sports".

Mental health likely influences how adolescents with rheumatic disease view the impact of their disease on their quality of life and functioning. This is important to consider when applying PGA scores in research studies and clinical care. The rheumatology community must develop efficient ways to better evaluate and treat potential factors mediating their patients' overall health and functioning.

Enhancing nursing expertise contributes to the advancement of healthcare as a whole. Therefore, it is crucial that nurses be able to perform specialized tasks. However, the factors related to nursing profession self-efficacy are insufficiently understood. This study aimed to theoretically and comprehensively examine the factors associated with nursing profession self-efficacy.

This cross-sectional study involved 325 nurses from seven facilities in the Chubu region of Japan. Based on prior research, factors influencing nursing profession self-efficacy were established as professional autonomy, communication skills with patients, work motivation, self‑education, perceived stress, and basic attributes. Data were analyzed using descriptive statistics, nonparametric tests, and multiple regression analysis.

Nursing profession self-efficacy was positively associated with work motivation (β = 0.384), self‑education (β = 0.246), professional autonomy (β = 0.236), and communication skills with patients (β = 0.157) (all p <.001). In contrast, perceived stress and basic attributes were not statistically significant in the final model. Model fit indices (R =.756, R² = 0.571, adjusted R² = 0.557; Durbin-Watson = 1.988) indicated no issues with residual independence or autocorrelation.

This study identified work motivation, self‑education, professional autonomy, and communication skills with patients as factors associated with nursing profession self-efficacy. These findings suggest that workplace environments that support professional meaning in daily work and promote continuous learning may help strengthen nursing profession self-efficacy among nurses. Organizational cultures that encourage autonomous decision-making and educational programs that incorporate practical communication training may also be useful for supporting nursing profession self-efficacy.

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Sleep disorders are prevalent among general hospital patients, significantly impairing quality of life and exacerbating existing medical conditions, leading to prolonged hospital stays and increased costs. Current treatments primarily rely on pharmacological and psychological interventions, often neglecting the complex interactions between sleep disorders and emotional disturbances such as anxiety and depression, as well as psychological traits like self-affirmation. This study aims to address this gap by systematically exploring the multidimensional factors influencing sleep disorders and elucidating their interrelations. Utilizing a cross-sectional design, the research involved 5,523 hospital patients, employing standardized scales (PHQ-9, GAD-7, SA-9, and AIS-8) alongside multiple linear regression and network analysis methods to assess the impact of psychological factors on sleep disturbances. The results demonstrated that anxiety, depression, and self-affirmation are significantly associated with sleep disorders, with depression emerging as the strongest correlate. The network analysis revealed core symptoms and bridging pathways, notably highlighting the strong statistical associations of depressive symptoms with sleep disturbances. Additionally, no significant differences were observed in network structures across gender and marital status subgroups, suggesting that intervention strategies may maintain broad applicability. This research not only enriches the theoretical framework surrounding the comorbidity of sleep disorders and psychological symptoms but also provides critical insight for the development of targeted psychological health management strategies in hospital settings, emphasizing the need for comprehensive approaches that address both psychological and sleep health. The findings present innovative implications for future research and clinical practice, advocating for a nuanced understanding of psychological factors in sleep disorder interventions.

Reports suggest that > 90% of the cases go undetected in low- and middle-income countries (LMICs) leading to a huge treatment gap. Evidence shows that task-sharing interventions such as training HWs, screening led to improved detection of depression at the primary level. In this regard, the World Health Organization (WHO) developed the mhGAP-IG to aid non-specialist HWs to detect and manage common mental health disorders such as depression to bridge the gap. The present study aims to design and test the effectiveness of a digital mental health intervention designed by contextualizing e-mhGAP in improving the detection and management of depression at the primary care level.

Formative phase will involve qualitative interviews, literature review aimed at co-developing a mobile application with the district mental health program. This will be followed by a cRCT. The trial will be conducted in eight PHCs, located in Tumkur district, Karnataka, and Wardha district, Maharashtra. Randomisation will be done at the PHC level. We plan to enrol non-specialist HWs working in these PHCs and a sample of 2400 adults who are availing the PHC services. Intervention PHC will receive training for HWs and a mobile application. Control PHCs will follow usual care. Both the groups will be encouraged to identify, manage, and follow-up people with mild depression. Study tools include PHQ-2, PHQ-9, acceptability of intervention measure, and Eq. 5D5L instrument. Change in the detection rates of depression between intervention and control arms will be the primary outcome. Cost effectiveness analysis will be done.

This trial advocates for integrating mental health services into primary healthcare, which aligns with the Comprehensive Mental Health action plan that seeks to enhance the capacity of non-specialist HWs in mental healthcare delivery. Co-development with the district mental health program, features of app such as offline functionality, multimedia visuals, and follow-up tracking are some of the strengths. If this intervention is found effective, then it could significantly impact the treatment gap for depression by integrating mental health within the ambit of primary care model across India.

Prospectively registered with the Clinical Trials Registry of India on 23/04/2024 (Reference number- CTRI/2024/04/066142).

Healthcare worker burnout is a national challenge, with implications for healthcare worker well-being and mental health, the quality of patient care, and healthcare costs. The Clinician Wellness Council (CWC), a 15-month well-being leadership development training program, was designed and implemented to provide practicing clinicians ("CWC members") across several clinical groups within the Providence health system with skills, coaching, and community to address the local drivers of their clinical groups' burnout. The purpose of this study was to explore CWC members' experiences with and perceptions of the impact of this program on their well-being leadership development, including their knowledge, insight, and mindset toward addressing workplace burnout.

We conducted four virtual focus groups with a total of 21 Providence clinicians who recently completed the well-being leadership development training program. Focus groups were analyzed using a rapid qualitative analysis method.

We generated three themes in our analysis: transformed well-being mindsets, guiding well-being leadership principles, and cultivating factors for well-being leader development.

In-depth insights from our analysis suggest a positive impact on participating clinicians. They shared a transformational well-being leadership development experience that included mindset shifts and the emergence of guiding well-being leadership principles. They also reported a reduction in burnout and increased confidence in their capacity to effect change. Participating clinicians highlighted health system financial commitment, relationships and sense of community, and knowledge and skill-building as the three structural program components that cultivated their development as well-being leaders. Study findings can inform other health systems seeking to design and implement a similar training program to support clinician well-being leadership development and address local drivers of clinician burnout.

Accurate survival estimation is important for clinical decision-making in advanced cancer. Prognostic models can support prediction of end-of-life and should ideally undergo staged evaluation across a development framework encompassing model development, validation, and impact evaluation before clinical implementation. No synthesis currently maps existing models across this framework, making it difficult to determine which tools are available and the extent to which they are ready for clinical use. This review aimed to identify end-of-life prediction models for advanced cancer and map them across this development framework.

This scoping review included studies reporting prognostic models combining at least two predictor variables to predict end-of-life (≤ 12 months) in adults with advanced cancer. MEDLINE, Embase, CINAHL, and the Cochrane Library were searched from inception to August 2025. Studies were classified as model development, internal validation, external validation, or impact evaluation, with findings summarised descriptively and narratively.

A total of 106 studies were included: 17 (16%) reported development only, 36 (34%) internal validation, and 53 (50%) external validation. Across all studies, 77 distinct models were identified: 8 (10%) had undergone development only, 34 (44%) had been internally validated, and 35 (46%) externally validated. However, most externally validated models had been evaluated only once and within a single country, limiting confidence in their generalisability. No models had undergone impact evaluation.

Although many end-of-life prognostic models exist for advanced cancer, fewer than half have been externally validated and none have been assessed for clinical impact. Their validity, generalisability, and usefulness therefore remain uncertain. Future research should prioritise independent external validation and robust impact evaluation before routine clinical implementation.

Peri-adolescence (ages 10-13) is a sensitive-and clinically critical-developmental window for the emergence of psychiatric symptoms, yet scalable strategies for early risk detection in pediatric primary care (PPC) remain limited. Sleep disturbances are among the most prevalent, predictive, and modifiable indicators of youth mental health, but current pediatric assessments rely heavily on subjective, single-source reports that fail to capture the multidimensional nature of sleep health. The Pediatric Precision Sleep Network (PPSN) is a longitudinal, multi-site study designed to integrate multimodal sleep data with longitudinal clinical outcomes to improve early identification of psychiatric risk during peri-adolescence-a period marked by rapid changes in sleep-circadian biology and vulnerability to psychopathology.

PPSN will enroll 1,200 youth ages 10-13 across three metropolitan areas (Pittsburgh, Boston, Miami). Over three years, participants will complete multimodal sleep assessments-including self-report, daily sleep logs, actigraphy, ambulatory electroencephalography (EEG), and passive smartphone-based monitoring-administered primarily at home to maximize ecological validity and reduce burden. Psychiatric symptoms and functioning will be assessed biannually via online surveys and electronic health records (EHRs), including structured fields and unstructured notes processed with natural language processing to extract sleep-related information. Scalable, open-source pipelines will automatically derive sleep features. Analyses will: (1) identify multivariable "sleep signatures"-defined as empirically derived patterns of sleep features across modalities-using factor and cluster methods; (2) evaluate their predictive utility for transdiagnostic mental health outcomes using stepwise machine learning approaches; and (3) examine developmental and contextual moderators (e.g., puberty and sociocultural factors). PPSN will also partner with the NIMH Individually Measured Phenotypes to Advance Computational Translation in Mental Health (IMPACT-MH) Data Coordinating Center to standardize procedures, ensure rigorous quality control, and disseminate open-source analytic tools for the broader research community.

By integrating ecologically valid, longitudinal sleep monitoring with EHR-based and survey outcomes, PPSN aims to identify developmentally sensitive sleep signatures that could be translated into scalable screening tools for PPC. Embedding sleep-informed algorithms into primary care could improve precision and equity of early risk detection and inform future efforts aimed at earlier identification and monitoring of mental health risk in peri-adolescence.

Infant socioemotional development has important implications for later functioning, reflecting capacities for emotional regulation, stress responsivity, and social engagement. Stress and mental health during pregnancy and the postpartum can adversely influence infant socioemotional functioning. This study examined whether postpartum depressive and anxiety symptoms mediate associations between prenatal maternal hair cortisol concentration (HCC) and infant socioemotional development. A sample of 128 participants was followed from the third trimester of pregnancy to 6 months postpartum. Maternal HCC was collected during the third trimester to reflect cortisol during the second half of pregnancy. Symptoms of depression and anxiety were measured at 2 weeks postpartum, and infant socioemotional problems were assessed at 6 months of age. Structural equation modeling tested postpartum depression and anxiety as parallel mediators. Results indicated that lower HCC in pregnancy predicted greater postpartum depression (B = -3.676, p = 0.003) and anxiety (B = -3.41, p = 0.009); depression was associated with greater infant socioemotional problems at 6 months (B = 1.900, p < 0.001). HCC was not directly associated with infant socioemotional outcomes (B = 1.071, p = 0.792); however, the indirect effect, through depressive symptoms, was significant (B = -6.99, p = 0.01). These findings suggest that prenatal physiological stress may influence infant socioemotional development indirectly through early postpartum depressive symptoms, highlighting the importance of integrated perinatal processes.

As market interest and consumer demand for ginseng increase, there remains a limited understanding of ginseng among individuals with health needs. This study investigated these perceptions and their influencing factors through a nationwide survey in China.

A multicenter, cross-sectional questionnaire survey was carried out from September 26 to October 10, 2025, across 15 medical institutions in China, involving a total of 5041 patients.

Individuals with health needs showed different ginseng perceptions based on their health status. Those without chronic diseases demonstrated higher awareness of traditional ginseng benefits such as boosting immunity (89.05%) and combating fatigue (76.22%), greater familiarity with American ginseng (77.18%), and primarily relied on family/friends (70.22%) for information. Individuals with chronic conditions demonstrated a diminished awareness of traditional benefits but a heightened recognition of mood and mental state improvement (61.84%), and an increased familiarity with ginseng cultivated in Korea (71.41%) and mountain-cultivated ginseng (73.45%). Their information sources were predominantly from physicians, pharmacists, and nutritionists (63.26%). Medical professionals demonstrated limited awareness of niche varieties like mountain-cultivated ginseng (23.94%) and specific disease-management benefits like blood sugar regulation (26.02%). Regarding safety perception, 69.56% held neutral or unaware views on potential side effects, and 20.99% incorrectly believed ginseng was suitable for everyone.

There exists heterogeneity in the understanding of ginseng across various groups, and the public health education should employ targeted strategies for people with different health statuses to encourage rational use of ginseng.