Using AI-powered mobile applications for mental health screening can help reduce maternal mental health disparities among Black mothers who are pregnant or parenting in the United States. A maternal health education question and answer mobile application chatbot has the potential to intervene in the maternal depression cascade, specifically screening. Extant research demonstrates the usability of mobile applications addressing mental health. However, limited scholarship explores the intersection between AI-powered mobile application chatbots and maternal mental health. This study uses a multimethod analysis to evaluate the usability of an AI-powered mobile application to address maternal mental health among Black women. Data sources, including mobile application engagement, mental health disorder scales, and secondary qualitative analysis from focus group discussions (n = 5), will be assessed through a multimethod approach. The study team previously collected data across the United States for this clinical intervention in 2022. Findings indicate that the mobile application demonstrated promise in the application's usability to screen for maternal health depression indicators. This was achieved using the mobile application's intent classification functionality that classified users' questions that contained targeted search terms (e.g., postpartum depression) or specific inquiries about mental health and appropriate follow-up from the study team to provide mental health resources. Critical interconnected themes were assessed and reflected high confidence, acceptance, and usability of the mobile application in addressing maternal mental health inquiries. Findings contribute to evidence about the usability of AI-powered mobile applications informed by Black mothers in appropriate screening for maternal depression indicators and inquiries. This study provides insight into closing the gap in maternal health disparities in depression outcomes for Black mothers.Trial Registration: ClinicalTrials.gov NCT06053515; https://clinicaltrials.gov/study/NCT06053515.

In rural Thailand, caregiving for bedridden older adults often emphasizes physical support, while their emotional and psychological needs remain unmet. The Five Love Languages framework offers a positive psychology-based approach to enhancing emotional care. This study aimed to explore the lived experiences of Thai children and to use the Five Love Languages framework to promote the emotional well-being of bedridden older adults in a rural Thai community.

A phenomenological study using Colaizzi's method was conducted on eleven children (aged 11-12) who were purposively recruited. Data were collected and analyzed from April to May 2025 through semi-structured interviews until conceptual richness was achieved. All transcripts were then manually analyzed using Colaizzi's seven-step process.

Three overarching themes with eight subthemes emerged: 1) Awakening emotional sensitivity in caregiving- transitioning from task-based care to emotionally responsive care; (2) Reconstructing social bonds-strengthening intergenerational connections and reduced isolation; and (3) Personal growth and reciprocity-developing empathy, leadership, and civic responsibility.

Applying the Five Love Languages framework enabled children to foster intergenerational bonds that enhanced the emotional well-being of older adults and supported children's personal growth. Nurse-led programs can sustain intergenerational caregiving in rural communities.

Managing stress carries significant implications for the mental wellbeing, academic achievements, career advancement, and overall life satisfaction of medical students. However, the coping mechanisms for stress management are diverse. The current systematic review examines the proposals and consequences of stress management for students in medical education, acknowledging the array of challenges inherent to their academic journey.

A search was conducted from 2013 to 2023 (September) across databases such as PubMed, Web of Science, and Scopus to retrieve articles on "Medical students," "Coping mechanisms," and "Stress management". The English-language articles were the only ones considered in the study. The articles that discussed coping mechanisms, such as resilience training, mindfulness-based stress reduction (MBSR) programs, and/or wellness and self-care workshops, were included in the study. This review was not prospectively registered in PROSPERO; however, PRISMA 2020 guidelines were followed throughout.

Nine articles were included in the study based on the inclusion and exclusion criteria. Among 2,334 medical students, 11%, 72.7%, and 16.3% reported low, moderate, and high stress levels, respectively. The selected nine articles aimed to address these far-reaching effects of stress management strategies. The stress management programs encompass creating robust mental health support systems within institutions, incorporating anxiety management education into regular coursework, offering workshops that teach practical techniques for handling emotional turmoil effectively, and fostering an environment where discussing one's challenges is encouraged rather than stigmatized. Such programs encourage students to seek expert guidance when needed, undertake systematic investigations to tailor interventions to changing needs and circumstances, and emphasize the importance of balancing work responsibilities, academic commitments, and personal life.

By implementing these suggestions within their framework, institutions can more effectively prepare their medical learners to overcome educational challenges and cultivate empathetic, resilient professionals skilled in delivering healthcare services.

To identify factors distinguishing frail from pre-frail status in community-dwelling older adults and construct a risk prediction model with logistic regression as the primary method to identify independent risk factors, and a neural network as a supplementary approach to explore complex relationships.

The FRAIL Frailty Screening Scale was used to screen adults aged 65 and above meeting inclusion criteria for pre-frailty and frailty. A cross-sectional survey collected basic information and disease status, while scales assessed nutritional risk, sarcopenia, and activities of daily living (ADL), alongside physical measurements. Binary logistic regression was used as the primary method to identify factors associated with frailty status. A multi-layer perceptron neural network was employed secondarily to explore complex, non-linear associative patterns.

Of 1,451 participants, 46.0% were pre-frailty, and 54.0% were frail. Age, education level, smoking status, number of chronic diseases, SNAQ nutritional risk, SARC-F sarcopenia, and ADL disability were independent associated with frailty status, with SARC-F sarcopenia showing the strongest association with frailty status. The neural network model identified SARC-F sarcopenia (100.0%), waist circumference (67.0%), and age (62.8%) as the most influential factors.

Our findings identify several factors strongly associated with frailty status in a cross-sectional sample. While these factors represent potential targets for intervention, future longitudinal studies are needed to confirm their predictive value for frailty progression. The logistic regression model provides clinically interpretable factors associated with frailty (e.g., SARC-F sarcopenia, ADL disability, nutritional risk). The neural network analysis corroborated the paramount importance of sarcopenia and highlighted additional non-linear associations. Community decisions should be primarily based on the interpretable outputs of the logistic regression model. Given the cross-sectional design, these findings represent associations at a single time point.

Unhealthy diets are major contributors to the global burden of non-communicable diseases, particularly cardiovascular disease and metabolic syndrome, where dietary fat quality plays a critical role. Among dietary fats, linoleic acid (LA)-the predominant omega-6 polyunsaturated fatty acid-has been at the center of a long-standing and evolving controversy. Initially promoted for its cholesterol-lowering properties, LA later became the focus of debate due to hypotheses suggesting pro-inflammatory and oxidative effects, which led to conflicting interpretations of its metabolic impact and inconsistent dietary guidelines over time. This review traces the origins and progression of this controversy, examining how shifts in biochemical understanding, experimental design, and population dietary patterns have shaped current perspectives on LA and cardiometabolic health. By integrating evidence from biochemical, preclinical, and human studies, we clarify the mechanistic and clinical bases underlying LA's actions and re-evaluate its role in lipid metabolism, inflammation, and glucose regulation. Overall, most human evidence supports beneficial associations between LA exposure and cardiometabolic outcomes, though heterogeneity across studies underscores the relevance of dietary context, genetic background, and metabolic status. Understanding how the controversy emerged and evolved is essential to refine current recommendations for dietary fat and disease prevention.

The emerging concept of cardiovascular-kidney-metabolic syndrome (CKM) highlights the pathophysiological interconnection between cardiorenal and metabolic disorders. This study investigates the longitudinal association between the cardiometabolic index (CMI) and CKM stage progression.

This study utilized data from the China Health and Retirement Longitudinal Study. The baseline CMI was computed utilizing the triglycerides-to-high-density lipoprotein cholesterol ratio multiplied by the waist-to-height ratio. CKM is defined and categorized into five stages (0-4) based on metabolic, cardiovascular, and renal disorders. We evaluated the impact of CMI on the CKM stage progression from Wave 1(2011) to Wave 3(2015). Multivariable logistic regression and restricted cubic spline (RCS) models were constructed to illustrate the relationship between CMI and CKM stage progression. A total of 4080 patients were included. The rate of CKM progression to advanced stages significantly increased with higher CMI quartiles. When entered into the multivariable logistic regressions as a continuous variable, elevated CMI was a remarkable predictor for progression to CKM stages 2-4 among participants at baseline CKM stages 0-1 [OR(95%CI) 1.66 (1.32-2.11)], progression to CKM stages 3-4 among those at baseline CKM stages 0-2 [OR(95%CI) 1.14 (1.03-1.26)], and progression to CKM stage 4 among those at baseline CKM stages 0-3 [OR(95%CI) 1.13 (1.00-1.28)], after adjustment for potential confounders. This association persisted when CMI was modeled as a categorical variable. RCS analysis demonstrated significant positive associations between elevated CMI levels and an increased risk of progression to advanced CKM stages (all P < 0.05).

Elevated CMI is significantly associated with CKM stage progression over time. CMI could act as a simple, useful tool for the risk assessment of CKM.

This nationwide cohort study examined the effects of discontinuation versus continuation of renin-angiotensin system inhibitors (RASis) on major renal and cardiovascular outcomes after the estimated glomerular filtration rate (eGFR) decreased to below 45 mL/min/1.73 m² in patients with type 2 diabetes and treated with RASis.

Using linked Taiwanese databases with claims and clinical data, we identified patients with type 2 diabetes who used RASis during 2016-2020, and either discontinued or continued RASis within 180 days when their eGFR fell below 45 mL/min/1.73 m². The outcomes of interest included end-stage renal disease (ESRD), myocardial infarction, stroke, heart failure, and all-cause mortality. We estimated the hazard ratios (HRs) and 95% confidence intervals (CIs) for RASi discontinuation versus RASi continuation using on-treatment and intention-to-treat analyses and inverse probability weighting to adjust for baseline and time-varying covariates.

We identified 251 853 eligible patients, of whom 37 108 (15%) discontinued RASis and 214 745 (85%) continued RASis. The on-treatment HR associated with RASi discontinuation was 2.52 (95% CI, 2.33-2.73) for ESRD, 1.18 (1.08-1.30) for myocardial infarction, 1.28 (1.19-1.37) for stroke, 1.18 (1.13-1.24) for heart failure, and 1.77 (1.70-1.84) for all-cause mortality. Results from the intention-to-treat analysis were similar, albeit more conservative. Findings remained consistent across eGFR strata (≥ 30 to < 45 and < 30 mL/min/1.73 m²), urine albumin-creatinine ratio categories (≥ 300 and < 300 mg/g), and patient subgroups with various baseline characteristics.

Our results support continuing RASi treatment even when the eGFR declines to below 45 mL/min/1.73 m² based on potential renal, cardiovascular, and survival benefits.

Advances in mesothelioma management have translated into longer patient survival and different treatment-related side effects including nephrotoxicity. The risk of developing adverse renal outcomes in patients with mesothelioma and associated risk factors remains undefined.

We analysed territory-wide data from electronic health records of patients with mesothelioma followed at public hospitals in Hong Kong between 1st January 2000 to 31st December 2022. Prevalence of acute kidney injury (AKI), renal progression (> 30 mL/min drop in eGFR), and upstaging of chronic kidney disease (CKD) and associated risk factors were evaluated.

222 patients were included. 18 (5.1%) patients developed acute kidney injury (AKI), and risk factors included diabetes mellitus (DM), use of bevacizumab and the presence of third space fluid (pleural effusion, pericardial effusion, ascites). 47 (21.2%) patients had upstage of CKD, and 31 (14.0%) patients showed renal progression. 18, 9, and 4 patients developed renal progression within 12 months from diagnosis, 12-24 months from diagnosis, and more than 24 months from diagnosis. Risk factors for upstage of CKD included the presence of third space fluid, platinum-based chemotherapy, use of immune check-point inhibitors, AKI during follow-up, more lines of cytotoxic chemotherapy received, and cycles of pemetrexed used. Predictors for renal progression included the presence of ascites and use of bevacizumab.

Short- and long-term adverse kidney outcomes are prevalent in patients with mesothelioma and show strong associations with treatments received. Careful patient selection and close monitoring of renal function may help avoid untoward acute and chronic nephrotoxicity.

To describe the clinical presentation of a patient with early-onset diabetes and to report a novel heterozygous WFS1 variant of uncertain significance (VUS) identified in this case. This report aims to contribute to the phenotypic and genotypic spectrum of WFS1-related disorders and to discuss the challenges of interpreting VUS in complex clinical scenarios.

Clinical data were collected from the proband and his family members. Whole-exome sequencing was performed on the proband. Sanger sequencing was subsequently utilized to validate the identified variant in the proband and his parents. A review of the relevant literature was also conducted.

A previously unreported heterozygous missense variant in the WFS1 gene, c.1550G>C (p.Arg517Pro), was identified in the proband. Segregation analysis confirmed that this variant was inherited from his father, a non-diabetic carrier; the mother did not carry the variant. The proband's clinical phenotype was primarily characterized by early-onset diabetes and its vascular complications. No discernible neurosensory features typical of classical Wolfram syndrome-such as optic atrophy, deafness, or diabetes insipidus-were observed. Following the American College of Medical Genetics and Genomics (ACMG) guidelines, this variant was classified as one of uncertain significance (VUS). The classification was based on the following supporting criteria: PM2_Supporting (due to its extremely low allele frequency of 0.000077 in population databases) and PP3_Moderate (based on in silico predictions from the REVEL tool, which suggested a deleterious effect).

This case report describes a novel WFS1 missense variant of uncertain significance (p.Arg517Pro) identified in a patient with early-onset diabetes. This finding contributes to the growing catalog of rare WFS1 variants and highlights the interpretive challenges they pose. It suggests that WFS1 could be considered in the genetic evaluation of selected cases of early-onset diabetes, even in the absence of full syndromic features. Prospective monitoring of asymptomatic carriers of similar variants may be warranted, pending further evidence to clarify their clinical significance.