The aims of this study were to investigate the factors affecting career satisfaction within the Pakistani dental community and to assess demographic characteristics as significant predictors of professional satisfaction.

Cross-sectional survey.

Data were collected from registered dentists across urban and rural areas of Pakistan via an electronic survey distributed through professional forums, social media groups and email lists to ensure nationwide representation.

A total of 600 registered dental surgeons were selected across Pakistan using single-stage cluster sampling, with inclusion based on a permanent Pakistan Medical and Dental Council licence, excluding temporary licence holders, non-consenting individuals and those practising abroad.

Career satisfaction was measured using the validated Dentist Satisfaction Survey, which assessed various factors affecting professional fulfilment.

Of 600 participants, 566 valid responses were received, with n=134 (23.67%) men and n=432 (76.33%) women, and a mean age of 33.7±7.4 years. Most were early-career (68.9%), with a mean professional satisfaction score of 3.13±1.35. Gender, provincial background and work experience significantly influenced satisfaction, while current working status did not. Participants were neutral on career domains, such as auxiliary staff quality, professional relations, professional time, management and work-life balance, but had positive views on doctor-patient relationships. Many expressed dissatisfaction with their income, and 35.69% found dentistry stressful. While 26.15% would not recommend dentistry, 30.04% would support their child's choice to pursue it. Despite uncertainty about career fulfilment, most dentists remained strongly committed to their profession and did not plan to change careers in the near future.

This study highlights factors influencing career satisfaction among Pakistani dentists, offering insights to improve well-being and career fulfilment and inform policy reforms aimed at enhancing professional retention and mental well-being.

Many pregnant women have a history of trauma, such as abuse or violence, which can significantly impact their mental and physical health. Discussing these experiences in maternity care presents an opportunity to support women, reduce stigma and connect them with resources. However, concerns persist about stigmatisation, re-traumatisation and unwarranted safeguarding referrals.The objective of this study was to explore how trauma discussions should be approached in maternity care, drawing on the perspectives of women with lived experience, voluntary sector representatives and healthcare providers in the UK. Findings aim to inform the development of a future intervention.

Semistructured interviews were conducted with women with trauma histories (experts by experience; n=4), representatives of voluntary sector organisations (n=7) and healthcare providers (n=12). Reflexive thematic analysis was used to analyse the data. A qualitative content analysis approach was employed, supported by a Patient and Public Involvement and Engagement group (named as the 'Research Collective' for this study) comprising experts by experience, maternity care professionals and voluntary sector practitioners. The group contributed to both study design and data analysis.

Five descriptive categories emerged: (1) Rationale for discussions-whether and why trauma should be addressed; (2) Professionals and settings-who should lead discussions and in what environment; (3) Timing considerations-when discussions should occur; (4) Communicating about trauma-strategies to sensitively explore prior trauma; and (5) Supporting care providers-training and emotional support needs. Participants highlighted both the benefits of trauma discussions and the practical, emotional and systemic challenges involved.

Trauma discussions in maternity care are complex but essential. Findings provide practical, UK-specific insights into timing, communication and staff support considerations, highlighting the need for culturally sensitive, co-designed approaches to facilitate safe and effective trauma-informed care.

Alcohol use disorder (AUD) is a prevalent, chronic condition generating considerable global morbidity, mortality and socioeconomic burden. Despite the availability of established pharmacotherapies, overall treatment uptake remains low and effect sizes are moderate at best. Emerging evidence highlights substantial differences in treatment response between sexes and genders, yet these factors are rarely systematically considered in clinical trials or routine care. Existing reviews have limited scope and often exclude gender-diverse populations. This project aims to (1) Synthesise evidence on gender- and sex-specific efficacy, safety and adherence in AUD pharmacotherapies, (2) Evaluate the consideration of sex and gender beyond binary classifications in existing research and (3) Develop recommendations for gender- and sex-sensitive treatment strategies.

A systematic review and meta-analysis will be conducted using (PubMed, Web of Science, Scopus, Google Scholar, German Clinical Trials Register and ClinicalTrials.gov). We will include randomised controlled trials of pharmacotherapies for AUD with a minimum treatment duration of 4 weeks, reporting gender-specific and/or sex-specific results. The literature search will cover studies published up to October 2025, with inclusion restricted to articles published in English or German, regardless of setting. Two reviewers will independently screen records and assess risk of bias (Cochrane RoB), with evidence certainty evaluated using Grading of Recommendations Assessment, Development and Evaluation and aligned to Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 and Sex and Gender Equity in Research guidelines.

Ethics approval is not required as only data from already completed studies and supplementary information directly provided by study authors are used. Findings and recommendations will be disseminated in peer-reviewed journals and presented at conferences and workshops.

CRD420251079160.

Anxiety disorders, obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD) are common in children and adolescents and can lead to significant impairment. Cognitive behavioural therapy (CBT) with exposure is the first-line treatment, yet approximately half of treated youth do not achieve full remission. Dysfunctional cognitions-negative automatic thoughts, maladaptive beliefs and distorted interpretations-are considered key targets of CBT, but evidence in youth is mixed and underpowered. This study will examine whether change in dysfunctional cognitions mediates treatment outcome in anxiety, OCD and PTSD symptoms and whether this association varies across individual characteristics.

An individual participant data meta-analysis (IPDMA) of randomised controlled trials of CBT for youth aged 5-18 years with anxiety disorders, OCD or PTSD will be conducted. The search strategy includes the databases APA PsycINFO, MEDLINE and Web of Science Core Collection from inception to 8 September 2025. It is supplemented by screening reference lists, trial registries, grey literature and outreach to relevant research groups. Eligible trials must include at least one validated measure of dysfunctional cognitions administered at minimum pre- and post-treatment, and clinical outcomes assessed at post-treatment and follow-up. The two primary outcomes are (1) child-reported symptom severity and (2) clinician-rated clinical severity. Data will be harmonised for dysfunctional cognition scores, moderators (age, gender, socioeconomic status, comorbidity), and primary outcomes. One-stage Bayesian mixed-effects models will examine whether changes in dysfunctional cognitions predict improvements in primary outcomes and whether these effects are moderated by individual characteristics. Missing data will be addressed using multiple imputation within the Bayesian framework, and study-level heterogeneity will be modelled using random intercepts and slopes.

All datasets will be de-identified and managed under General Data Protection Regulation standards. Each included trial will have ethical approval permitting data sharing and reuse, and the secondary analysis of the shared datasets has been approved by the University of Amsterdam. Findings will be disseminated via a peer-reviewed publication, scientific conferences and open sharing of analysis scripts and harmonisation procedures.

CRD420251139130.

Psychosocial stress is a major public health concern, contributing to significant suffering and costs to society. There is a lack of effective interventions that could be offered at an early stage to people who need to reduce their stress in life. Recent advances in psychology have provided evidence-based exercises suitable for testing in an entirely digital intervention. This study aims to estimate the effectiveness of a 12-week digital course in mindfulness- and acceptance-based stress reduction.

The effectiveness of the 12-week digital course will be estimated in a parallel-groups randomised controlled trial, in which the control group will receive referrals to self-studies on mental health information found online. The study population will be individuals 15 or older, seeking help online for stress and who have access to a mobile phone. Employing a Bayesian sequential design, the primary outcome will be monitored monthly, after the 6-month follow-up, to calculate target criteria for when to stop recruiting. Perceived stress (Cohen's 10-item version) will be the primary outcome, with estimands of interest being differences between groups at 3 (immediate), 6 (prolonged) and 12 months (maintained). Mediation analysis will reveal if differences between groups are mediated by acquired equanimity. Effectiveness will be analysed with Bayesian regression models, and mediation will be analysed by using a causal inference framework.

The research was approved by the Swedish Ethical Review Authority on 2024-05-07 (2024-01974-01). The study will reach out to a vulnerable population, and participation may displace efforts to seek professional help. We have built-in automatic advice to seek additional help for participants scoring high on the depression scale at baseline, before allocation to study groups. The findings from this study will be submitted to peer-reviewed journals and presented at relevant national and international meetings.

ISRCTN39222610.

Food insecurity has been rising in the United States, disproportionally affecting populations with no insurance, low socioeconomic status, and racial minorities. It is associated with overall poorer health, especially in terms of glycemic control, mental health, and cardiovascular disease. Addressing it is critical because although studies show its significance, most physicians do not screen for different social determinants of health, including food insecurity.

A cross-sectional study of household food security status was performed on 209 patients from June to August 2021 at the University of Florida's Springhill Clinic (run by Internal Medicine) and the Equal Access Clinic, a student-run free clinic. The US Department of Agriculture's Spanish and English versions of the Household Food Security Survey were used. The χ² tests were used to determine whether the number of respondents in each food security category varied significantly by sex, age group, primary language, presence of children in the home, insurance status, and clinic site.

Among the 209 participants, food insecurity was reported by 23.4% of patients. The only statistically significant sociodemographic factors that corresponded to food security status levels were the patient's insurance status and clinic site. A total of 82.6% of insured patients were food secure, whereas only 65.2% of uninsured patients were food secure. A total of 14.5% of Equal Access Clinic patients experience severe food insecurity, whereas 0% of patients at the Springhill Clinic do. The χ² tests determined that the number of respondents in each food security category varied significantly by insurance status (P = 0.01).

This study highlights the prevalence of food insecurity at primary care clinics, especially student-run clinics. Although limited by sample size and cultural barriers of the given survey, the findings emphasize the gap in standardized screening protocols for food security and the importance of physician sensitivity. Addressing this topic can improve food security and the health benefits that follow through early intervention.

Treatments for mental health and substance use problems have historically been unintegrated, limiting co-occurring disorders treatment. Blending discrete payment models is one potential facilitator of integrated care. This study assesses the impact of one blended payment strategy on the diagnosis of co-occurring disorders in a community mental health system.

Electronic health record data for 19373 individuals, with 173889 observations from January 2017 through December 2019 was analyzed for this study. Multilevel growth modelling was used for data analysis. A binary dependent variable represented whether a service user held diagnoses of co-occurring disorders within a month. Fixed effects included time variables and a variable representing blended payment initiation as well as race, gender, age, and payor. Service user and agency variables were modeled as random effects.

Blended capitated and fee-for-service payments were found to increase the odds of service users receiving co-occurring diagnoses. People of color had lower odds of receiving a co-occurring diagnosis, although this effect did not hold in an analysis of rural agencies. Service users receiving care in unintegrated agencies had higher odds of receiving co-occurring diagnoses.

This study is one of the first to assess the impacts of a blended payment model on behavioral health access. Blended payment models can incentivize behavioral health providers and systems to identify complex diagnoses that may go unrecognized in routine care.

This study (ClinicalTrials.gov: NCT05300204) evaluated the effectiveness and acceptance of two distinctive components of web-based psychoeducation in improving knowledge among adolescents with major depression.

Adolescents (n = 85), aged 12-18 years, with a current or past diagnosis of depression, were randomly assigned to one of two components of the German psychoeducational website "ich bin alles" ("I am everything"), tailored for youth. The General Information Group received content on general information about depression, whereas the Self-Management Group received content on self-management. Knowledge outcomes included knowledge of general information and self-management, and acceptance measures. Changes in knowledge were analyzed using linear mixed-effect models at post-test and follow-up.

A significant Time x Group interaction emerged for both knowledge outcomes (general information: F(3,82) = 41.7, p < .001; self-management F(3,85) = 3.2, p = .031). The General Information Group showed significantly greater scores in knowledge of general information than the Self-Management Group at post-test and follow-ups (all p < .001 d = 1.79-2.99). No significant between-group differences in knowledge of self-management remained after Bonferroni correction. Both groups rated the website positively in terms of usability, design, and content.

Web-based psychoeducation, particularly general information about depression, is an effective and well-accepted approach to improve specific knowledge in adolescents with major depression.

Open-access, evidence-based psychoeducational content tailored to adolescents offers a scalable tool to enhance depression literacy, with potential applicability in clinical practice.

The integration of psychedelic therapies into European healthcare is a nuanced process that involves not only obtaining European Medicines Agency (EMA) approval but also successfully navigating Health Technology Assessment (HTA) evaluations across member states. After EMA approval, which focuses on the safety, efficacy, and quality of the therapeutic, HTA agencies assess these therapies for their "added therapeutic value," considering factors like cost-effectiveness, clinical outcomes, and overall societal impact. Each country's HTA, including the UK's National Institute for Health and Care Excellence (NICE), Germany's Institute for Quality and Efficiency in Health Care (IQWiG), and France's Haute Autorité de Santé (HAS), plays a pivotal role in determining reimbursement and access to these treatments. An added challenge is that HTA bodies in Europe often require active comparator studies rather than just placebo controls to establish a treatment's advantage over existing standard of care - a particular hurdle for psychedelic-assisted therapies, where controlled trials against active comparators are almost completely lacking. Furthermore, psychedelics are typically integrated with psychotherapy, adding complexity to HTA evaluations, as few frameworks currently assess the value of combination therapies within healthcare systems. Creating a standardized HTA approach or a unified European guideline for such novel treatments could promote equitable access across countries, helping to overcome the discrepancies in market access and patient reach across Europe.

Zoster-associated pain (ZAP) is a condition characterized by severe, persistent pain caused by herpes zoster (HZ), which impacts the patient's daily activities, mental health, and quality of life significantly. Low-temperature plasma (LTP) technology, as an emerging therapeutic approach, has been applied widely in various biomedical fields. At our center, this technology has been utilized for the treatment of postherpetic neuralgia. Preliminary studies have demonstrated that LTP can effectively alleviate pain symptoms in patients with ZAP. However, a small subset of patients experiences suboptimal outcomes, with limited pain relief following LTP treatment.

This study was conducted to investigate the efficacy of LTP for treating ZAP, analyze the risk factors for poor therapeutic response, and establish a predictive model to provide clinical decision-making support.

A single-center prospective cohort study was conducted to analyze outcomes of using LTP to treat ZAP.

Patients treated at the Pain Department of Zhongda Hospital, Southeast University, between January 2018 and December 2023, were included.

Patients who received LTP treatment underwent a 6-month follow-up, during which their Visual Analog Scale (VAS) scores were recorded. A post-treatment VAS score ≥ 4 was defined as a poor therapeutic response. Risk factor analysis was performed on patients with poor therapeutic response, and a predictive model was developed. The model was evaluated using threefold cross-validation, with its performance assessed by the area under the receiver operating characteristic (ROC) curve (AUC). Calibration curves and decision curve analysis were used to assess the model's calibration and clinical applicability.

A total of 120 patients who underwent LTP treatment were included in the study, with an overall response rate of 67.5%. Analysis of 43 variables revealed that age, coronary heart disease (CHD), disease duration, albumin-to-globulin ratio (AGR), white blood cell (WBC) count, neutrophil count, and scores on the VAS, Dermatology Life Quality Index (DLQI), Pittsburgh Sleep Quality Index (PSQI), Hamilton Anxiety Rating Scale (HAMA1), HAMA2, and Barthel Index were significantly different between the groups (P < 0.05). Stepwise bidirectional regression identified 4 independent factors significantly associated with outcomes: CHD, AGR, PSQI, and HAMA1. Using logistic regression, a predictive model was constructed and validated through 3 cross-validation methods. The mean AUC for the training set was 0.768 (95% CI: 0.690-0.942), with a sensitivity of 68.7% and a specificity of 83.7%. The mean AUC for the validation set was 0.762 (95% CI: 0.589-0.935), with a sensitivity of 58.5% and a specificity of 76.4%.

The study was conducted at a single center with a small number of cases, which might have limited generalizability. Larger, multicenter prospective studies are needed to validate the findings.

For ZAP patients, CHD, AGR, and PSQI and HAMA1 scores are high-risk factors for the continuation of chronic pain after the administration of LTP treatment. The predictive model demonstrated relatively high sensitivity and specificity. This finding suggests that combining these indicators can, to some extent, predict patients' therapeutic response to LTP.