Past Month Research Articles

Individual-level harm reduction intervention coverage among people in Australia who inject drugs.

Altered functional connectivity of reward circuits in adolescents with addictive nonsuicidal self-injury.

Introduction Physical exercise influences the function of multiple organs, including the skin. Previous studies demonstrated an increase in transepidermal water loss rates (TEWL) after exercise. However, TEWL measured shortly after exercise may not truly reflect the epidermal permeability barrier function. And the limited sample size may also affect the generalizability of the findings. Therefore, we assessed the influence of physical exercise on epidermal biophysical properties in a larger cohort prior to exercise. Participants and Methods A total of 327 university students without inflammatory skin disorders or other diseases which may affect epidermal function were enrolled in this study. Epidermal biophysical properties, including TEWL, stratum corneum hydration levels and skin surface pH on the volar site of the forearm and shin were measured with a multifunctional skin physiology monitor. The correlation between epidermal biophysical properties and duration of daily exercise were determined. Results This cohort included 168 females and 159 males with a mean age of 18.91 ± 0.04 years. On the forearm, TEWL were lower in females than in males, while on the shin, both stratum corenum hydration levels and skin surface pH were significantly higher in females than in males. No significant differences in other parameters were boserved between males and females. Overall, there were no significant differences in epidermal biophysical propertied among individuals with various daily exercise duration over the past month although there was a trend of higher stratum corneum hydration levels among individuals with longer duration of exercise. However, TEWL on the shin of females positively correlated with the daily exercise duration. Conclusions. There are slight but significant differences in some epidermal biophysical properties between male and female university students. Overall, exercise does not dramatically affect TEWL, stratum corneum hydration levels and skin surface pH on both the shin and forearm except on the shin of females where shows a positive correlation between the daily exercise duration and TEWL.

INTRODUCTIONSecondhand smoke (SHS) exposure remains a significant global public health issue. Identifying the factors contributing to SHS exposure is crucial for developing targeted, evidence-based interventions to mitigate its impact. This study examines the patterns and determinants of SHS exposure at home among non-smoking Malaysians.METHODSData were derived from the National Health and Morbidity Survey (NHMS) 2019, which employed a cross-sectional design and multistage sampling to gather a representative sample of Malaysians aged ≥15 years. Demographic data and information on SHS exposure at home within the past month, were collected via a structured questionnaire. Weighted data were analyzed using chi-square tests and multivariable logistic regression.RESULTSOf the 1876 participants (representing an estimated 3.54 million individuals), 19.8% (95% CI: 18.5–21.1) reported SHS exposure at home. Several sociodemographic factors were significantly associated with SHS exposure. Logistic regression analysis revealed higher odds of exposure among females (adjusted odds ratio, AOR=1.85; 95% CI: 1.55–2.29), Malays (AOR=2.65; 95% CI: 1.86–3.78), Bumiputera Sabah (AOR=4.16; 95% CI: 2.72–6.37), and Bumiputera Sarawak (AOR=3.67; 95% CI: 2.32–5.80). Other significant factors included being aged ≤24 years (AOR=1.87; 95% CI: 1.26–2.78) and belonging to a low income group (quintile 1; AOR=1.42; 95% CI: 1.12–1.95). Interaction analysis also identified significant two-way interactions between sex and some sociodemographic independent variables.CONCLUSIONSApproximately two in ten non-smoking Malaysians were exposed to SHS at home. These findings underscore the need for comprehensive tobacco control measures that raise awareness about the health risks of SHS exposure at home. Educational campaigns should focus on promoting smoke-free home environments, particularly among the high-risk groups identified in this study.

PurposeWomen with gestational diabetes mellitus (GDM) may experience disordered eating (DE), leading to adverse pregnancy outcomes and compromised mental health. However, in-depth studies in this field are lacking. This study explored the DE experiences among women with GDM, focusing on behavioral characteristics and potential risk factors.Patients and MethodsThis study was a descriptive qualitative study. Using purposive sampling, 23 pregnant women with GDM who had exhibited DE behaviors within the past month were recruited from a maternal and child health hospital in Nanjing, China. Semi-structured interviews were conducted with the participants. Data were analyzed using conventional content analysis.ResultsThree categories of DE experiences among women with GDM were identified: (1) behavioral characteristics; (2) internal drivers; (3) external enablers. DE behaviors in women with GDM primarily included restrictive eating, binge eating, and inappropriate insulin use. These behaviors often formed a vicious cycle: initial excessive restrictive eating led to binge eating due to intense hunger and food cravings, which in turn caused elevated glycemia and prompted impromptu restrictive eating, restarting the cycle. Inappropriate insulin use aimed at maintaining glycemic stability further perpetuated DE. Additionally, the study identified three internal drivers and three external enablers. Excessive risk perception mainly drove restrictive eating, insufficient internal motivation triggered binge eating, and low self-efficacy exacerbated both. Perceived pressure from dietary norms was a key external risk factor for the development of restrictive eating. Permissive messages from family members and disruptions from unexpected social events induced binge eating.ConclusionInternal and external factors led to a restrictive-binge eating cycle in women with GDM, sustained by inappropriate insulin use. Excessive risk perception about hyperglycemia and fetal health existed as unique risk factors. Future studies should be conducted across diverse cultural and geographical contexts to enhance the generalizability of our findings.

Adolescent cannabis use is a substantial public health concern given its associations with adverse mental and physical health outcomes. Understanding how distinct use patterns are associated with medical care utilization in young adulthood is critical for prevention. To examine the association between patterns of adolescent cannabis use and medical care utilization for mental and physical health conditions in young adulthood. This population-based birth cohort study linked to population-wide administrative medical care databases was conducted in the Province of Québec, Canada. Participants included individuals recruited for the Québec Longitudinal Study of Child Development, followed up from birth (1997-1998) to 23 years of age (2021). Data were analyzed November 2023 to February 2025. Self-reported past 12-month cannabis use at ages 12, 13, 15, and 17 years. Medical care utilization for any mental disorder (including common mental disorders and substance-related disorders), suicide-related behaviors, and any physical health condition (including respiratory diseases, injuries and poisoning, and other physical diseases) between ages 18 and 23 years. Analyses were adjusted for 32 individual, family, and community-level confounders measured from birth to younger than 12 years of age using overlap weights. Data for 1591 individuals (818 female [51.4%]; mean [SD] age at first exposure assessment, 12.1 [0.3] years) were analyzed. Three distinct adolescent cannabis use patterns were identified via group-based trajectory modeling: nonuse (948 [59.6%]), late-onset use (318 [20.0%], initiating after age 15 years), and early-onset and frequent use (325 [20.4%], initiating before age 15 years). In fully adjusted analyses, individuals with early-onset and frequent use had significantly higher odds of medical care utilization for any mental disorder (odds ratio [OR], 1.51 [95% CI, 1.10-2.08]), common mental disorders (OR, 1.57 [95% CI, 1.12-2.21]), any physical health condition (OR, 1.86 [95% CI, 1.30-2.67]), injuries and poisoning (OR, 1.41 [1.05-1.89]), and other physical diseases (OR, 1.47 [95% CI, 1.08-1.98]), compared with individuals with no use. Individuals with late-onset use did not differ significantly from those with nonuse for mental health outcomes (OR, 1.13 [95% CI, 0.80-1.58]) but had higher odds of medical care utilization for any physical health condition (OR, 1.63 [95% CI, 1.16-2.28]). Findings of this birth cohort study indicated that early-onset and frequent cannabis use was associated with greater medical care utilization for both mental and physical health conditions in young adulthood. These findings support the relevance of delaying initiation and reducing intensity of cannabis use during adolescence.

This cross-sectional study described the association between modifiable cancer risk factors and hereditary cancer awareness and knowledge, and attitudes toward genetic cancer testing among German primary care patients. Systematically recruited patients (≥18 years) from six general practices in one federal state (Mecklenburg-Western Pomerania) participated in a survey (n = 479, 67.0% participation). Analysis included those with complete data (n = 424; mean age: 53.7; 34.4% male). Weighted multiple regressions examined associations of modifiable risk factors (BMI, smoking status, past month alcohol use, and physical activity) with the outcomes, adjusting for sociodemographics. As a sensitivity analysis, regression models were stratified by personal cancer history. In the total sample, occasional compared to daily smokers reported significantly higher awareness of genetic counseling [odds ratio = 2.59, 95% confidence interval (CI): 1.03-6.51]. Higher BMI was significantly associated with higher mean importance ratings of concerns about genetic cancer testing (coef. = 0.02, 95% CI: 0.003-0.04; β = 0.12). Patients with a personal cancer history showed broader and, in some cases, stronger associations than those without. For example, significantly lower hereditary breast and ovarian cancer knowledge in daily smokers was observed only in this group. In the total sample, 44% of patients did not consider lifestyle a risk factor for breast or ovarian cancer, and 33% did not consider genetic cancer testing to be a potential facilitator for lifestyle changes. Patients at higher cancer risk from modifiable risk factors are partly less informed about hereditary cancer, though sociodemographics also contributed substantially.

Age-related spinal sagittal malalignment is commonly attributed to factors such as disc degeneration, osteoporotic vertebral fractures, and paraspinal muscle degeneration. These factors often coexist, making it challenging to discern their relative contributions to spinal malalignment in the elderly population. Understanding these contributions is crucial for both prevention and treatment strategies for spinal deformities in aging individuals. A cross-sectional analysis was conducted within the second survey of the Wakayama Spine Study (2012-2013). A total of 952 participants were recruited, and 794 (239 men, 555 women; mean age, 63.5 ± 13.1 years) were eligible for magnetic resonance imaging (MRI) and standing radiographic evaluation of spinal alignment. Primary outcome measures included the C7 sagittal vertical axis (SVA), pelvic incidence (PI), and pelvic tilt (PT) from standing lateral radiographs. Secondary outcomes included MRI-based assessments of disc degeneration using the Pfirrmann classification, vertebral fractures via the semi-quantitative (SQ) method, and paraspinal muscle fatty infiltration ratio at the L1/L2 level. Spinal sagittal malalignment was defined as C7 SVA ≥ 50mm. Statistical analyses, including logistic regression, were performed to identify significant factors associated with spinal malalignment. Spinal sagittal malalignment was observed in 98 participants (12%), with 53 (55%) reporting low back pain in the past month. Significant factors associated with sagittal malalignment included age ≥ 70 years (odds ratio [OR], 2.48; 95% confidence interval [CI], 1.33-4.69), PT ≥ 18.7° (OR, 3.12; 95% CI, 1.77-5.63), vertebral fracture (morphometric fracture index ≥ 4; OR, 2.01; 95% CI, 1.15-3.51), and paraspinal muscle fatty infiltration ratio ≥ 10.6% (OR, 4.98; 95% CI, 2.74-9.27). Paraspinal muscle fatty infiltration was the most significant factor associated with spinal malalignment in the general population. Among the identified risk factors, paraspinal muscle degeneration is potentially reversible, underscoring its importance in postural correction strategies and surgical planning. These findings suggest that interventions targeting muscle quality may be crucial in managing spinal malalignment in elderly individuals.

Disclosure: F. Spall: None. A. Spall: None. K. Alexander: None. S. Syed: None.INTRODUCTION: Hypothyroidism is closely linked to anemia, as thyroid hormones are essential in regulating erythropoiesis. The mechanisms behind this include decreased erythropoietin production, disrupted iron metabolism, and impaired bone marrow function, all of which contribute to anemia in hypothyroid patients. Recognizing this connection is crucial for accurately diagnosing and managing anemia in individuals with thyroid dysfunction. CASE REPORT: A 35-year-old Spanish male with a history of post-surgical hypothyroidism following a thyroidectomy at age 7, and ongoing levothyroxine supplementation, presented with multiple episodes of hematemesis. On arrival, he exhibited hypothermia and hypotension. Although he had been on levothyroxine, he had missed his medication for the past month due to insurance issues. Initial vital signs showed a temperature of 94.8°F, blood pressure of 90/46 mmHg, heart rate of 52 bpm, and oxygen saturation of 95% on room air. Lab results revealed a hemoglobin of 5.1 g/dL, consistent with normocytic anemia, along with a platelet count of 172 and normal coagulation parameters (PT 14.7, PTT 20.3, fibrinogen 214). TFTs showed a markedly elevated TSH of 309.9 µU/mL and a low free T4 of 0.29 ng/dL. On examination, the patient appeared lethargic and was admitted to the ICU for management of acute blood loss anemia and hemorrhagic shock secondary to severe hypothyroidism, requiring vasopressor support. Treatment included packed red blood cells (PRBCs), hydrocortisone, levothyroxine supplementation, and vasopressors. Hydrocortisone was discontinued after normal morning cortisol levels excluded adrenal insufficiency. Myxedema coma was deemed unlikely due to preserved mental status, no edema, and resolution of hypothermia. Levothyroxine was administered, resulting in a gradual improvement in TSH levels. Testing for acquired von Willebrand factor (vWF) disease, which can be associated with hypothyroidism, returned negative results. Although the initial vWF test was negative, it’s important to note that lab results may take time to appear. The patient’s anemia was likely due to impaired thyroid hormone production affecting erythropoiesis and red blood cell production. CONCLUSIONS: This case highlights the substantial impact of severe hypothyroidism on anemia and emphasizes the importance of considering thyroid dysfunction in the differential diagnosis of treatment-resistant anemia. Early diagnosis and proper levothyroxine supplementation are essential for effective management.Presentation: Monday, July 14, 2025

Disclosure: A. Al-Thunaibat: None. L.L. Ponce Rosas: None. K. Sanu: None. A. Abualnil: None. J.S. Martins Torrontegui: None. C. Penaherrera: None.Introduction: The use of testosterone has become increasingly prevalent in recent years, both through medical prescriptions and non-medical, unauthorized channels. While testosterone is primarily prescribed for the management of hypogonadism, it is also widely misused by athletes and bodybuilders to enhance muscle mass and physical performance due to its anabolic effects. Herein, we presented a case of PE and DVT secondary to testosterone use in a patient with no other risk factors for venous thromboembolism (VTE). Case Presentation: A 45-year-old male with a medical history of HTN, primary hypogonadism, polycythemia secondary to testosterone supplement, asthma, and OSA on CPAP presented to the ED with progressive shortness of breath. He had been on testosterone replacement therapy (TRT) for over seven years. Due to polycythemia, he was advised to undergo therapeutic phlebotomy twice monthly but had been non-compliant for the past month. On presentation, laboratory results showed Hgb 17.8 g/dL, HCT 55%, RBC 6.6 million/μL, WBC 20,000/μL, and troponin 70 ng/L. ABG values 7.40/27/53/17, and total testosterone level was 1004 ng/dL. CT chest with IV contrast revealed massive bilateral pulmonary emboli with right heart strain. Lower extremity doppler ultrasound demonstrated a DVT in the right posterior tibial vein. The patient underwent catheter-directed thrombolysis via EKOS procedure and was subsequently transitioned to a DOAC. Given the diagnosis of VTE, TRT was discontinued permanently. Discussion: Testosterone has well-documented erythropoietic effects, which can contribute to erythrocytosis (HCT > 54%) and increased blood viscosity, thereby raising the risk of VTE. According to the Endocrine Society guidelines, TRT should be withheld if HCT exceeds 54%, and to be resumed only after HCT returns to the normal range, typically at a lower dose. Additionally, therapeutic phlebotomy—in which one unit of blood (500 mL) is removed at regular intervals—is an effective strategy for managing testosterone-induced erythrocytosis. Per the American Urological Association guidelines, total testosterone and CBC should be measured every 6-12 months during therapy. Conclusion: Erythrocytosis is a well-recognized adverse effect of TRT, requiring regular monitoring of CBC and serum testosterone levels. If HCT exceeds 54%, the TRT dose should be adjusted or temporarily discontinued, and therapeutic phlebotomy may be considered to reduce the risk of VTE.Presentation: Sunday, July 13, 2025

People increasingly use conversational AI for support and companionship. Yet, current discourse on AI companions reveals a stark divide: some scholars argue that feeling connected to AI is impossible due to AI’s inability to experience emotions, while others contend that AI’s ability to provide the illusion of emotions is enough. Across two experiments (one pre-registered; Total N = 1274), we investigated whether accounting for individual differences in anthropomorphism could help bridge these two perspectives. Participants completed a measure of anthropomorphism and were then randomly assigned to discuss their past month through a conversation with a chatbot (chatbot condition) or by journaling (control condition) and then completed a measure of social connection. Our results suggest that for some individuals, AI’s artificial nature may pose an insurmountable barrier to meaningful connection; for others, however, this artificiality may be a minor obstacle, easily overcome by a tendency to anthropomorphize.Supplementary InformationThe online version contains supplementary material available at 10.1038/s41598-025-19212-2.

Adolescent polysubstance use: Time for a new public health approach Ronan Fleury and Mary Cannon discuss the growing trend of polysubstance use among adolescents and highlight the need for a new public health strategy that reflects the complexities of adolescent substance use. Adolescent substance use is no longer a single-substance issue. Increasingly, young people use alcohol, nicotine, and cannabis together, a pattern that research shows is both common and harmful. In a recent Irish school survey, 7.5% of 15–16-year-olds reported using all three substances within the past month (Fleury et al., 2025). This trend challenges long-standing public health frameworks that still approach substance use in isolation, leaving us with definitions, policies, and interventions that lag behind lived reality. Clinical trials and neuroscience studies have historically excluded people who use multiple substances (Hakkararinen et al, 2019). The result is evidence that does not reflect reality. We end up with prevention strategies and clinical interventions that are not only mismatched but sometimes irrelevant to the populations most in need.

College students are known to frequently engage in alcohol consumption, and are at risk for developing dangerous drinking patterns (e.g., binge drinking). Since imposter syndrome occurs at high rates among undergraduate students, it is reasonable to assume that college students may experience its negative effects, such as anxiety and depression. Given the relation of anxiety and depression to worse drinking outcomes, imposter syndrome may also be related to greater drinking and related problems. Yet, this is the first known study to test whether imposter syndrome is related to drinking behaviors. 376 (87% female) undergraduates recruited through our psychology department research participant pool with current (past 3-month) alcohol use completed an online survey. Imposter syndrome was statistically significantly related to anxiety, depression, coping-motivated drinking, peak estimated blood alcohol content (eBAC), drinking frequency, and alcohol-related problems. Imposter syndrome, via the serial effects of depression and coping motives, was significantly indirectly related to eBAC, drinking frequency, and alcohol-related problems. Similarly, via the serial effects of anxiety and coping motives, imposter syndrome was significantly indirectly related to eBAC, drinking frequency, and alcohol-related problems. The results of this study can inform treatment and prevention efforts by suggesting that imposter syndrome may be an important yet thus far neglected target for interventions. The present study provides novel insight by identifying that imposter syndrome is related to worse alcohol outcomes and that these relations occur via negative affect and coping-motivated drinking.

The role of petting zoo animals in the dissemination of disease has been widely studied, yet understanding the potential reservoir of antimicrobial resistance (AMR) in these centres has not been explored in the United Kingdom (UK). To understand the carriage of AMR pathogens within petting zoos, this study aimed to identify AMR in E. coli and Staphylococcus intermedius group (SIG) isolated from faeces and skin, respectively, including selective cultures for ESBL-E. coli and methicillin-resistant staphylococci. Faecal samples and skin swabs were collected from 166 petted mammals across eight UK centres to recover E. coli and coagulase-positive staphylococci (CoPS), respectively, through enrichment culture methods, plating onto non-selective (tryptone bile-x agar, mannitol salt agar) and selective media (ESBL ChromID, mannitol salt agar with 6 mg/L oxacillin). Antimicrobial susceptibility was assessed using Kirby-Bauer disc diffusion, covering eight classes of antimicrobials. Antimicrobial usage records from the past 12-months were obtained from 7/8 centres. Overall, 145/166 faecal samples yielded 223 E. coli isolates, with an overall AMR prevalence of 42.6%. Thirteen E. coli isolates (from 8.5% of animals) were classified as multidrug-resistant. ESBL-producing E. coli were detected in 5/166 faecal samples. From 166 skin swabs, 84 yielded CoPS isolates, with S. aureus (n = 70), SIG (n = 13) and S. hyicus (n = 1) identified. Overall, 25.3% of SIG isolates exhibited resistance to at least one antimicrobial. Antimicrobial usage correlated positively with AMR prevalence for E. coli (p < 0.001), though was not associated with multidrug-resistance. This study demonstrates for the first time the presence of AMR within bacteria isolated from UK petting zoo animals, highlighting this reservoir of AMR bacteria.

BackgroundReducing opioid use is challenging due to limited evidence-based weaning methods and a lack of interventions to mitigate withdrawal symptoms. An emerging intervention using transcutaneous auricular neurostimulation (tAN) is being developed to reduce opioid withdrawal symptoms, but its mechanisms of action are not yet well understood. This is a clinical trial performed to investigate the mechanisms of tAN in managing pain and opioid withdrawal during opioid taper in adults with chronic pain.MethodsThis is a single-site, randomized, double-blind, and sham-controlled superiority framework trial during an inpatient opioid taper for participants on long-term opioid therapy for chronic pain. Participants are recruited for an inpatient stay at a large, academic medical center in the United States. Included participants are adults between 18 and 75 years of age who have the presence of pain more than half of the days in the past 6 months, are prescribed opioid medication, have a willingness to taper the opioid dose by at least 10%, and have a urine drug screen positive for the prescribed opioid but negative for illicit drugs and nonprescribed opioids. Participants are excluded with a condition affecting their safety of participation (e.g., epileptic seizures, current suicidal ideation, current abuse of illicit drugs or alcohol, pregnancy), a condition that precludes fMRI assessment (implanted medical device, claustrophobia), or a status affecting pain medication intake (e.g., surgery in the past month, opioid prescription dose > 200 morphine milligram equivalents per day, history of neurological diseases or traumatic brain injury, active treatment for cancer).Participants are randomized to receive either active tAN (n = 20) or sham tAN (n = 20). Both groups undergo a mild-to-moderate opioid taper on day 1 and are maintained at the reduced level for 4 days under inpatient medical supervision. The primary outcome measure, brain functional magnetic resonance imaging (fMRI), is used to measure BOLD signals and resting functional connectivity (z-value) of pain networks. Secondary outcome measures are self- and clinician-observed opioid withdrawal scales, behavioral assessment questionnaires, and quantitative sensory testing (QST) data.The first subject enrollment was completed from July 25 to 28, 2023. The total enrollment count was set to 40 with two arms of equal ratios. Randomization stratification by gender at birth was performed. The study physician, intervention-providing staff member, and outcome-assessing study coordinator each perform recruitment, and each is blinded to treatment group assignment.Safety and harm measures of opioid withdrawal will be assessed with the Clinical and Subject-reported Opiate Withdrawal Scores. Vital signs will be assessed three times per day, and adverse events will be recorded and reported as necessary.DiscussionUnderstanding the mechanisms of action of tAN will lead to the development of more effective future non-pharmacologic treatments in mitigating withdrawal while gradually tapering participants off prescription opioid management.Trial registrationClinicaltrials.gov, NCT05555485. Registered on 15 September 2022.

Assessing violation of local cannabis delivery bans prior to enactment of California's Senate Bill 1186.

Perceived racism-based police violence and substance use among black and hispanic emerging adults: Evidence from a national sample

Objective: Cannabis use has been increasing among the Hispanic/Latinx population in the United States (US). Little research has expressly focused on culturally relevant factors related to cannabis use processes and problems among this group. The present investigation sought to help bridge this gap and test the main and interactive effects of perceived ethnic discrimination and negative emotional reactivity to minority stress in terms of cannabis use processes, including perceived barriers for cannabis reduction, cannabis use problems, and cannabis use motives, among Hispanic/Latinx adults in the US. Method: Participants were recruited through Qualtrics Panels and included 521 adults who engaged in current (past month) cannabis use (Mage = 36.52 years, SD = 10.26; 55.1% male). Results: In adjusted models, for perceived barriers for cannabis reduction and cessation as well as cannabis use problems, both perceived ethnic discrimination and negative emotional reactivity to minority stress were independently associated with higher odds of endorsement. For cannabis use motives, negative emotional reactivity to minority stress was positively associated with enhancement, social, coping, and expansion motives, whereas perceived ethnic discrimination was a contributor to conformity motives; effects ranged from small to medium. No interactive effects emerged as statistically significant. Conclusions: The current findings suggest that among the U.S. Hispanic/Latinx population, screening and intervening upon perceived ethnic discrimination and negative emotional reactivity to minority stress may help mitigate challenges with the continued use of cannabis.

BackgroundSelf-injurious thoughts and behaviors (SITBs) increasingly prevalent among youth, with particularly high rates in China. Existing assessment tools often lack comprehensiveness or cultural adaptation. This study aimed to translate and validate the Self-Injurious Thoughts and Behaviors Interview-Revised (SITBI-R) for Chinese adolescents in clinical settings and evaluate its diagnostic accuracy against DSM-5 criteria and suicide risk assessment protocols.MethodsA total of 170 adolescents aged 12–19 years were recruited from two psychiatric hospitals. The Chinese version of SITBI-R (C-SITBI-R) was compared with established instruments including the M.I.N.I., self-report scales for non-suicidal self-injury assessment, and DSM-5 diagnostic criteria. Content validity, construct validity, test-retest reliability, interrater reliability, and diagnostic agreement were evaluated.ResultsThe C-SITBI-R exhibited excellent content validity (I-CVI = 1.00, S-CVI/UA = 1.00) and significant construct validity correlations with validation instruments. Perfect interrater agreement was achieved (all κ and ICC values = 1.00, p < 0.001), while test-retest reliability showed excellent consistency for lifetime presence and timing variables (κs = 0.78-1.00, ICCs = 0.93-1.00, p < 0.001), and moderate to strong agreement for past month frequencies of major SITBs (ICCs = 0.64–0.75, p < 0.001).High diagnostic consistency was observed with DSM-5 criteria for NSSI (κ = 1.00) and SBD (κ = 0.86), and M.I.N.I. suicide risk assessment (κ = 0.94).ConclusionsThe C-SITBI-R demonstrates strong psychometric properties and cultural adaptation for systematic assessment of SITBs among Chinese adolescents. Its strong diagnostic accuracy and clinical feasibility support its implementation in routine psychiatric practice for enhanced identification and management of at-risk youth.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12888-025-07443-6.

BackgroundMedication-overuse headache (MOH) is a significant secondary headache that interferes with existing primary headache conditions, yet it is often an overlooked condition. This study aimed to develop and validate a user-friendly self-administered questionnaire to screen for MOH, to enhance early detection, an essential first step in the MOH care cascade in Thailand.Materials and methodsA Thai-language Self-Screening Questionnaire of MOH (SSQ-MOH) was developed to screen for MOH based on the International Classification of Headache Disorders, 3rd edition (ICHD-3), the Leeds Dependence Questionnaire, and the Severity of Dependence Scale. The questionnaire underwent iterative refinement through expert consultation with four headache specialists, patient feedback, and linguistic adjustments. The final questionnaire was launched, and data were collected from headache patients attending the specialized tertiary Headache Clinics, King Chulalongkorn Memorial Hospital, Bangkok, Thailand. Items in the questionnaire were selected and optimized to maximize sensitivity and specificity, using the final diagnosis made by headache specialists according to ICHD-3 criteria as the gold standard. Performance analysis–including sensitivity, specificity, predictive values, and the area under the receiver operating characteristic curve (AUC-ROC)–was conducted for each item individually. A combination of items was selected based on their individual AUC-ROC values.ResultsAmong the 94 patients included (89.4% female; median [IQR] age: 38 [29.0–52.0] years), the most common primary headache disorder was migraine (87.2%, n = 82). MOH was diagnosed in 17 patients (18.1%). A combination of two items—“Q1: In the past month, have you experienced headache on at least 15 days?” and “Q2: In the past month, have you taken headache painkillers on at least 10 days?”—with both answered demonstrated the highest diagnostic accuracy, with a sensitivity of 88.3%, specificity of 90.9%, and an AUC-ROC of 0.90.ConclusionThe SSQ-MOH demonstrates high sensitivity and specificity in headache clinic settings, supporting its utility as an effective screening tool. Further validation in various clinical settings in Thailand and other languages is needed.Supplementary InformationThe online version contains supplementary material available at 10.1186/s10194-025-02184-z.