Narrowband ultraviolet B (NBUVB) phototherapy is an established treatment for vitiligo. However, real-world practices vary significantly, particularly in dosing strategies, maintenance schedules, and the use of minimal erythema dose (MED) testing, impacting treatment outcomes. To assess NBUVB phototherapy practices among Indian dermatologists, evaluate patient characteristics and treatment outcomes, and identify variations in clinical protocols. An online, questionnaire-based survey was conducted among 80 Indian dermatologists who responded actively using NBUVB. The questionnaire was validated through expert review, pilot testing, and reliability assessment before deployment. Validation included content validation by three senior dermatologists with more than 15 years of phototherapy experience to ensure item relevance and clarity. A pilot test among 10 dermatologists confirmed internal consistency. Data were analyzed using descriptive statistics. Among 80 respondents (response rate of 5%), 65% had >10 years' experience. Most respondents (52.5%) used only NBUVB whole-body units, while others employed combination or targeted phototherapy devices. MED testing was performed by only 30%, typically using visual test dose methods; 70% used empirical starting doses. A 200 mJ/cm² starting dose was most common (60%). Maintenance therapy was administered every 1-2 weeks in 75%. Early clinical improvement was observed after 10-20 sessions, and >50% re-pigmentation in vitiligo occurred after 50-70 sessions in 85%. Acral vitiligo showed a mixed response, with poor or limited response in 60% of cases. Mild erythema (80%) and burning (60%) were the most reported side effects. The study is limited by self-reported data, possible recall bias, and lack of detail on MED testing procedures. There is marked variability in NBUVB protocols among Indian dermatologists. Emphasizing standardized guidelines and MED-based personalized dosing could improve therapeutic outcomes and patient safety in vitiligo management.

Reproductive Planning and Preconception Counseling in Kidney Disease (REPKID):A Cross-Sectional Survey.

Qualitative research offers key insights into enablers and obstacles of healthcare-seeking behavior, and the credibility of findings depends on methodological quality. This study aims to critically appraise the methodological quality of existing qualitative studies on delayed medical consultation in obstructive sleep apnea (OSA) patients, thereby identifying common limitations and offering recommendations for future improvements. A systematic search was conducted in EMBASE, MEDLINE, and CENTRAL databases, covering literature from inception to February 2026. Inclusion criteria were qualitative studies (e.g., phenomenological, ethnographic, or grounded theory paradigms) on medical consultation delays in adult OSA patients, excluding single-case studies or narrative reports with very small samples. Two reviewers independently assessed studies against five dimensions, with disagreements resolved by discussion. Three studies were included, from which eight methodological issues were identified: (1) potential "survivorship bias" from including only diagnosed patients; (2) recall bias in retrospective designs; (3) insufficient consideration of the role of comorbidities in the healthcare-seeking process; (4) unclear directionality between cognitive factors and delayed behavior; (5) lack of in-depth analysis of deviant cases; (6) oversimplified view of family/friend support; (7) insufficient transparency in reporting interview guides and data saturation; and (8) absence of researcher reflexivity during data collection and analysis. Current qualitative studies on delayed medical consultation in OSA patients have several methodological flaws that may affect their validity. Future research should prioritize prospective, community-based studies targeting high-risk OSA populations not yet seeking medical help, and comprehensively document the entire trajectory of their medical consultation delay. This will enhance research rigor and provide clearer guidance for developing more actionable intervention strategies.

ABSTRACT Earlier studies have documented psychoactive substance use and nicotine exposure among commercial drivers in Ghana. However, those studies relied solely on self-reported questionnaires, which are prone to recall and response bias. This study aimed to provide a more accurate estimate by using a chromatographic immunoassay urine drug test. This exploratory cross-sectional study was conducted between January and August 2024 in the Tamale metropolitan area of Ghana. The study included 70 consenting commercial drivers aged from 26 to 78 years. Sociodemographic, anthropometric and occupational factors were collected using a semi-structured questionnaire. Urine samples were then obtained from the participants and tested for Amphetamine (AMP), Barbiturates (BAR), Benzodiazepines (BZO), Cocaine (COC), Tetrahydrocannabinol (THC), Morphine (MOP), Opiates (OPI), nicotine exposure using Cotinine (COT), Tramadol (TML), and Tricyclic Antidepressants (TCA) using the 10-panel Multi-Drug One Step chromatographic immunoassay test kit. The total urine prevalence of psychoactive substances and nicotine exposure was 61.4%, consisting of COT (37.1%), THC (24.3%), BZO (11.4%), Tramadol (5.7%) and AMP (2.9%). While the self-reported smoking prevalence was 10%, the urine cotinine prevalence was 37.1%. In addition, 14(20%) of the urine samples tested positive for two substances. Contrary to expectations, commercial drivers with no history of accident were more likely to test positive for TML [AOR = 8.667(95%CI: 1.025–73.249)], or two substances [AOR = 5.000(95%CI: 1.051–23.789)]. The urine samples of commercial drivers tested positive for psychoactive substances and nicotine exposure. However, positivity for a psychoactive substance or nicotine exposure may not be associated with a history of road traffic accidents. Further studies are recommended.

Timely diagnosis remains a major challenge in oral cancer, with more than half of cases diagnosed at advanced stages. Although the patient interval has been suggested as a key component of the diagnostic pathway, its relative contribution and temporal evolution remain insufficiently characterized. This study aimed to quantify diagnostic and treatment intervals in oral cancer and to evaluate the relative contribution of the patient interval using the Aarhus Statement framework, comparing current data with a historical cohort recruited a decade earlier in North-Western Spain. A hospital-based ambispective observational study was conducted including consecutive incident cases of histologically confirmed oral squamous cell carcinoma diagnosed in 2025 at a tertiary referral center. Time intervals from first symptom to treatment initiation were defined according to the Aarhus Statement. Recall bias was minimized through triangulation of patient interviews, relatives' reports, and clinical records. Median intervals and interquartile ranges were calculated, and comparisons were performed with a historical cohort recruited in 2015 under identical methodological criteria. Ratios between intervals were estimated to assess the relative contribution of the patient interval. The median patient interval decreased slightly in 2025 compared with 2015 (25 vs. 31.5 days). Primary care and diagnostic intervals were shorter, whereas specialist and pre-treatment intervals increased. The total pre-treatment interval remained stable between cohorts. Ratio analyses showed that the patient interval represented a limited proportion of the total diagnostic and treatment pathway, with no significant temporal differences. Temporal changes in the oral cancer pathway were heterogeneous, suggesting a redistribution of delays toward later intervals of care. The patient interval was not the main contributor to overall time to treatment, highlighting the need for system-level strategies targeting specialist assessment and treatment initiation phases.

ABSTRACT Objectives To examine the impact of Covid-19 on women regarding alcohol use, and experience of receiving relevant services. Methods Demographic and clinical characteristics of all women attending an alcohol use disorder community service in England over a 6-month period were compared to those of men. A subset of 10 women was interviewed using a semi-structured interview. Triangulation criteria included age, parenthood and childcare responsibilities. Results There were no demographic or clinical differences between women and men. Increased mental health difficulties, burden of motherhood and loss of social role were precipitating factors for drinking escalation during the pandemic. Known factors such as fear of stigma, fear of involvement of social services and partner’s negative influence were barriers to seeking treatment. Conversely self-recognition of alcohol problematic use or support from family motivated individuals to seeking treatment. Conclusions Despite the limitation of small sample and risk of recall bias this study indicates that a personalized and sensitive approach may help to break down stigma and fear of social services and promote engagement with services. Early recognition and support for mental health problems and improved collaboration between mental health and alcohol services might improve engagement into treatment and reduce impact on women and their families.

Depression is a major global cause of disability, and depressive symptoms are highly prevalent and increasing among Chinese university students. Mounting evidence confirms that inflammation plays a key role in the pathogenesis of depression, and dietary inflammatory potential regulates systemic inflammation to influence depressive symptom development. However, existing research is limited by cross-sectional designs, recall bias from self-reported dietary surveys, and a lack of long-term prospective cohort evidence on the diet-inflammation-mental health pathway in Chinese university students. This study aimed to examine the longitudinal association between Dietary Inflammatory Index (DII) and the incidence of depressive symptoms in Chinese university students, and to explore subgroup differences by family relationship and socioeconomic status. A 3-year longitudinal prospective cohort study was conducted among 5314 students from a university in Shanghai, China. Eligible participants met the criteria of ≥86 days of annual campus cafeteria dining and at least 1 breakfast, lunch, and dinner in campus canteens per quarter; students with abnormal monthly energy intake, excessive food consumption, or incomplete 3-year dietary/psychological data were excluded. Dietary data were continuously collected via the Intelligent Ordering System (IOS) from April 2020 to March 2023 to calculate DII scores. Depressive symptoms were annually assessed using the Beck Depression Inventory-II from March 2021 to March 2023. Mixed-effects logistic regression (α=.05) was used to analyze the association, with subgroup analyses stratified by family relationship and poverty status. The baseline prevalence of depressive symptoms was 10.75% (571/5314; male: 261/2679, 9.74%; female: 310/2635, 11.76%). After adjusting for covariates, compared with the highest DII quartile (most proinflammatory diet), lower DII quartiles (more anti-inflammatory or low proinflammatory diets) were associated with a reduced risk of incident depressive symptoms in participants without depressive symptoms at baseline: Q1 (odds ratio [OR] 0.27, 95% CI 0.16-0.47), Q2 (OR 0.52, 95% CI 0.33-0.84), and Q3 (OR 0.26, 95% CI 0.16-0.42). Subgroup analyses showed this protective effect was only significant in students with harmonious family relationships and non-poverty-stricken students; no significant association between DII and depressive symptom improvement was found in participants with baseline depressive symptoms. This study is among the first to prospectively examine dietary inflammatory potential and depressive symptoms in university students using long-term objective dietary monitoring. Unlike studies relying on self-reported dietary surveys, this study used an automated and precise campus-based IOS to continuously capture real-world dietary behaviors over 3 years. The findings indicate that sustained anti-inflammatory dietary patterns are associated with a lower risk of depressive symptoms among Chinese university students, although this protective effect was weaker in students experiencing family discord or socioeconomic disadvantage. These findings provide new longitudinal evidence for the diet-inflammation-mental health relationship and support integrated campus interventions combining dietary guidance with psychosocial support.

Myopia is a global public health concern, especially among children and adolescents. This exploratory study aimed to develop a myopia risk prediction model for Tibetan adolescents using interpretable machine learning, while explicitly acknowledging the methodological limitations of non-cycloplegic refraction and self-reported data. We included 735 Tibetan adolescents. An XGBoost algorithm was used to build a binary classification model, with the SHAP method applied for feature interpretation. Data were split into 80% training and 20% test sets to analyze associations between behavioral, demographic factors, and myopia risk. Myopia was defined using non-cycloplegic autorefraction (uncorrected visual acuity < 5.0 [logMAR 0.0] and spherical equivalent ≤ - 0.50 D). In children aged 9-15 years, non-cycloplegic autorefraction is known to overestimate myopia due to accommodative tone, leading to outcome misclassification. Moreover, behavioral exposures were self-reported by children, introducing recall and desirability bias. Consequently, all findings are purely hypothesis-generating and require validation using cycloplegic refraction and objective exposure measures. Statistical analyses included independent samples t-tests, Mann-Whitney Utests, chi-square tests, and binary logistic regression. Older age was significantly associated with higher myopia risk (OR = 1.200, 95% CI: 1.069-1.347, P = 0.002). Male sex (OR = 0.583, 95% CI:0.427-0.796) and boarding at school (OR = 0.419, 95% CI: 0.250-0.702) were associated with lower myopia prevalence. Behavioral associated factors included irregular breakfast habits (OR = 2.882), reduced frequency of classroom seat rotation, and longer daily after-school study time. Machine learning analysis identified learning behaviors (seat rotation, study time, grade) as the most important predictors, followed by lifestyle factors (breakfast habits, screen time). However, due to the absence of cycloplegia and the cross-sectional design, these associations may be biased and should not be interpreted causally. In this exploratory cross-sectional study with major methodological limitations, several behavioral and demographic factors were associated with myopia status among Tibetan adolescents. The findings do not establish causality and are not suitable for clinical or public health recommendations. Future research must employ cycloplegic refraction, objective exposure monitoring (e.g., wearable light sensors, school records), and longitudinal designs before any reliable conclusions can be drawn.

The relationship between fear severity and satisfaction after vaginal delivery was examined with a focus on its association with epidural analgesia. Postpartum cross-sectional questionnaire survey was conducted among 201 healthy women after vaginal delivery in Japan. The participants completed the Japanese Wijma Delivery Experience Questionnaire (JW-DEQ) Version B and the short version of the Childbirth Experience Self-Rating Scale, and were grouped by use of epidural analgesia and/or fear severity. Data were analyzed using Spearman correlation, Mann-Whitney U, and chi-square tests. No significant association between fear and satisfaction was found in the women without epidural analgesia. The proportion of women with severe fear of childbirth, defined as a JW-DEQ Version B score ≥ 85, was 39%. In the postpartum-recalled severe fear group, epidural analgesia was associated not only with higher overall satisfaction but also higher scores in its sub-factors: "labor pain coping" and "trust in medical staff". In contrast, epidural analgesia was associated only with "labor pain coping" score in the light fear group. Epidural analgesia induced higher childbirth satisfaction among women with severe fear. Although this study is limited by its cross-sectional design, potential recall bias, and the focus on a specific patient population, which may affect the generalizability of the findings, the factors of "labor pain coping" and "trust in medical staff " seem to be important to avoid fear of childbirth for giving childbirth satisfaction.

Intrinsic links between obsessive-compulsive symptoms and other psychopathological symptoms: A network analysis of clinical and community populations.

ABSTRACT Mild and moderate severity health impacts of hot weather remain largely unmonitored. We piloted a participatory surveillance system for monitoring heat-related health impacts. FluTracking Australia volunteers in Sydney and Melbourne were invited to enrol in HeatTracking. For those who agreed to participate, a weekly survey collecting self-reported heat-related symptoms was sent for 9 weeks of the 2024/2025 Australian summer. Almost 20% of the invitees enrolled, resulting in 1,735 participants (61% female, 48% aged >64 years). Retention and adherence to survey completion were high. Heat-related health impacts were reported by 11.7%–21.0% of participants each week, and 0.7–3.0% of people with heat-related symptoms sought medical care. Factors associated with heat-related health impacts included older age, female sex, high apparent temperature, living in rental accommodation, high number of hours feeling too hot due to physical activity, and having a recent history of heat-related health impacts. Overall participant satisfaction was high with 93.1% of 610 who provided feedback indicating they would participate again. Future HeatTracking iterations should seek to minimise recall bias while capturing more precise timing and location of exposure, as well as a broader range of symptoms, preventive behaviours, and productivity impacts. A participatory surveillance approach to monitoring heat-related health impacts appears feasible.

The H1N1 influenza, a highly contagious acute respiratory disease, causes a significant burden on public health, especially during the winter season when the number of cases surges. Emergency department nurses, who are on the frontline of patient care during this period, are exposed to high - stress situations, increasing their risk of developing post - traumatic stress disorder (PTSD). Understanding the status of PTSD among them and its influencing factors is crucial for safeguarding their mental health and ensuring quality healthcare. This study aims to investigate the status of post-traumatic stress disorder (PTSD) among emergency department nurses in multiple tertiary hospitals in Shanghai, China during the winter H1N1 influenza season and analyze its influencing factors. A cross - sectional study design was adopted from October 2023 to December 2023. A total of 116 emergency department nurses from multiple tertiary hospitals in Shanghai were selected as research subjects using cluster sampling during the peak period of winter H1N1 influenza. The Impact of Event Scale-Revised (IES-R), Maslach Burnout Inventory (MBI), Simplified Coping Style Questionnaire (SCSQ), Connor-Davidson Resilience Scale (CD-RISC), and Social Support Rating Scale (SSRS) were used for data collection. PTSD was defined as IES-R score ≥ 35, and participants were grouped as PTSD positive or negative. The relationship between PTSD and occupational burnout, coping styles, psychological resilience, and social support was analyzed. Among the 116 participants, the rate of PTSD positivity was 44.86% (48/107). The MBI scores in all dimensions were significantly higher in the PTSD positive group compared to the PTSD negative group. The positive coping scores in the SCSQ were lower in the positive group, while the negative coping scores were higher. The CD-RISC scores in all dimensions were significantly lower in the PTSD positive group, as were the SSRS scores in all dimensions. Higher emotional exhaustion was significantly associated with increased odds of PTSD (OR = 1.16), indicating that for each one-point increase in emotional exhaustion, the odds of PTSD increased by 16%. Greater reliance on negative coping strategies was also independently associated with PTSD (OR = 1.23). In contrast, higher levels of optimism (a resilience factor) and greater subjective social support were protective, significantly lowering the odds of PTSD (OR = 0.76 and OR = 0.70, respectively). The occurrence of PTSD among emergency department nurses during the winter H1N1 influenza season is considerable and closely related to occupational burnout, psychological resilience, coping styles, and social support. These findings highlight the urgent need for attention to this issue. However, this study has several limitations. The sample was only from top - tier hospitals in Shanghai during the winter influenza season, which may limit the generalizability of the findings. Also, relying on self-reported questionnaires may be subject to recall bias and self - reporting subjectivity.

The relationship between stress and breast cancer (BC) remains a topic of debate. We investigated the association between stress experienced within the past year and the risk of BC. Population-based incident case-control study of 600 newly diagnosed BC cases and 600 population controls (18-75 years) recruited in Isfahan, Iran between 2021 and 2023. Logistic regression model with short-term stress as main exposure was used to estimate odds ratios (ORs) and 95% confidence intervals (CI) after adjusting for confounders. Multiplicative interaction was tested between stress and menopausal status as well as other confounders. One-year stress level was significantly associated with BC risk. Compared with women reporting low stress levels, the odds of BC were higher among those with high stress levels in both the unadjusted model (OR = 3.10, 95%Cl: 2.45-3.92) and the fully adjusted model (OR = 3.38; 95%CI (2.56, 4.47)). Based on the statistical test for multiplicative interaction, the association appeared stronger among premenopausal women (adjusted OR = 4.88, 95% CI: 3.17-7.52) than among postmenopausal women (adjusted OR = 2.34, 95% CI: 1.53-3.58), with evidence of interaction by menopausal status (p for interaction = 0.018). Despite the inherent limitations of case-control studies, including potential recall and selection biases, the findings of the current study suggest that higher levels of stress experienced within the past year may be associated with an increased risk of breast cancer, particularly among premenopausal women. Further prospective studies are warranted to clarify the nature and direction of this association.

BackgroundOlder survivors of cancer face heightened risk of depression and anxiety related to cancer experiences, fear of recurrence, and aging-related difficulties. Conventional mental health monitoring approaches, such as clinical assessments and even electronic patient-reported outcomes, are limited by recall bias, patient burden, and infrequent data collection. Emerging patient-generated health data from wearables and smart home devices offer passive, low-burden, continuous monitoring, but their ability to capture mental health risks in older survivors of cancer remains unclear.ObjectiveThis study aims to explore whether patient-generated health data collected in the wild, either passively or actively, can classify older survivors of cancer as having or not having signs of anxiety and depression based on Patient Health Questionnaire-4 (PHQ-4) scores and to assess the potential added value of passive monitoring modalities, such as smart plugs.MethodsThis study recruited 41 older survivors of cancer (mean age 72.3, SD 6.81 years) from the LifeChamps project. Over a 12-week period, participants were monitored using an activity tracker to measure physical activity, sleep, and physiological metrics; a smart scale to capture weight and body composition; and a smart plug to track television use as a proxy for sedentary television viewing. Mental health status was self-reported via the PHQ-4 questionnaire in a mobile app. Machine learning models were trained to classify mental health risk based on features derived from each sensor modality, both independently and in combination.ResultsTree-based gradient boosting models showed good performance in classifying PHQ-4–defined mental health risk. The best-performing configuration, combining smart plug and smart scale features, achieved a mean F1-score of 0.77 (SD 0.15) and a mean area under the receiver operating characteristic curve (AUC) of 0.85 (SD 0.10) across 3 repeated train-test splits. Standalone smart plug models, based solely on passive television use patterns, achieved a mean F1-score of 0.66 (SD 0.04) and a mean AUC of 0.71 (SD 0.06), outperforming models that relied only on activity tracker data (mean F1 0.59, SD 0.2). Multimodal combinations tended to improve average performance but did not consistently yield large gains over the strongest single-modality configurations, likely reflecting adherence-related data loss for wearables and scales. Crucially, passive monitoring of television use patterns emerged as a promising behavioral proxy measure of mental health states.ConclusionsThis study pioneers the use of passively collected data (eg, smart plugs) for mental health monitoring in older survivors of cancer, demonstrating their potential. Smart plugs capture behavioral patterns without user burden, with reasonable standalone performance (mean AUC 0.71, SD 0.06), positioning them as a promising low-burden modality. Future work should validate findings in larger independent cohorts and in prospective clinical workflows. Such technologies could transform monitoring for vulnerable populations, enabling scalable, inclusive care while reducing health care burdens.

Menstrual function is sensitive to inflammatory, endocrine, and psychosocial stressors that may transiently disrupt the hypothalamic-pituitary-ovarian axis. Although menstrual disturbances have been reported during the coronavirus disease 2019 (COVID-19) pandemic, large real-world data from Asian populations remain limited. We aimed to describe menstrual changes reported after COVID-19 infection and to identify potential vulnerability factors. We conducted a retrospective cross-sectional survey using an electronic questionnaire among reproductive-aged women who had experienced at least one menstrual cycle following laboratory-confirmed or self-tested COVID-19 infection between January and March 2023. Participants reported menstrual characteristics before and after infection. Multivariable logistic regression analyses were performed adjusting for age, age of menarche, abnormal uterine bleeding (AUB)-related disease, pre-existing menstrual irregularity, vaccination status, and fever. Among 884 participants, 662 (74.9%) reported at least one menstrual change after infection. Alterations most commonly involved cycle length (421/884, 47.6%), menstrual flow (369/884, 41.7%), and duration (261/884, 29.5%). Women with pre-existing irregular cycles were more likely to report post-infection changes than those with regular cycles. In adjusted analyses, pre-existing menstrual irregularity remained independently associated with reporting menstrual changes (adjusted OR 1.51, 95% CI 1.12-2.03). Menstrual disturbances were frequently reported following COVID-19 infection and showed substantial interindividual variability. These findings suggest that menstrual function may be vulnerable to acute systemic stress. Because the study was cross-sectional and based on self-reported outcomes, the findings should be interpreted as associative rather than causal and may have been influenced by recall or selection bias. Prospective longitudinal studies are warranted.

Hidradenitis suppurativa (HS) is a disease that impairs the quality of life (QoL), sexual functioning, and fertility of the patients. The relationship between disease characteristics and sexual function remains insufficiently characterized. The aim of this study is to evaluate the rate of sexual dysfunction among HS patients; and to evaluate its relationship to disease or patient characteristics. In this multi-centered cross-sectional study, patients were asked to complete a structured online questionnaire including demographics, disease characteristics, the Hidradenitis Suppurativa Self-Assessment Tool (HSSA), HS-specific Dermatology Life Quality Index (HS-DLQI), and validated sexual function instruments (International Index of Erectile Function-5 [IIEF-5] for males; Female Sexual Function Index [FSFI] for females). A total of 522 HS patients were included. Higher HSSA stages correlated positively with worse HS-DLQI scores (r = 0.258, p < 0.001). Lesions in the head/neck, inframammary, gluteal, and inguinal regions were associated with greater QoL impairment. Male patients had significantly lower IIEF scores and higher erectile dysfunction (ED) prevalence compared to controls; however, HS was not an independent risk factor for ED in multivariable analysis. Female patients had significantly lower total FSFI scores than controls, particularly in arousal, orgasm, satisfaction, and pain domains, whereas lubrication remained unaffected and desire scores were higher. Recall bias, the self-reported nature of questionnaires, and sociocultural barriers to discussing sexual health may have influenced results. HS significantly impairs quality of life, particularly with increasing disease severity and involvement of specific anatomical regions. HS is associated with impaired sexual function in both women and men, with a more pronounced and multifaceted impact observed in female patients. Effective pain and inflammation control may improve sexual outcomes, underscoring the importance of comprehensive, domain-specific assessment in HS management.

Autism regression, defined by the loss of previously acquired social, communicative, and language skills, affects approximately 25%-30% of children on the autism spectrum, most commonly emerging between 12 months and 30 months of age. Once debated as a potential artifact of parental recall or observation bias, contemporary evidence-including home-video analyses and prospective sibling studies-establishes regression as a biologically grounded neurodevelopmental deviation rather than a psychogenic phenomenon. This review presents an integrated model of regression, conceptualizing it as a "neurobiological crisis" in which the convergence of physiological stressors unmasks latent genetic vulnerabilities during a critical period of brain reorganization. Central mechanistic pathways include excessive synaptic pruning, excitatory-inhibitory imbalance, neuroinflammation, mitochondrial dysfunction, and dysbiosis of the gut-brain axis. From a clinical perspective, the period immediately following skill loss represents a window of heightened neuroplasticity. Pediatricians are urged to move beyond a "wait-and-see" approach, adopting a dual-track strategy that combines rapid medical and genetic evaluation to exclude pathological mimics (e.g., Landau-Kleffner syndrome, metabolic disorders) and to initiate immediate intensive behavioral and developmental interventions. Leveraging naturalistic developmental and behavioral interventions, as well as and parent-mediated strategies, many children achieve a meaningful functional reacquisition of lost skills. Ultimately, this review advocates empowered realism, framing regression as a dynamic, modifiable process in which early identification, precision-guided assessment, and evidence-based intervention can optimize long-term developmental and adaptive outcomes.

Spousal loss is a major life event with profound mental health implications. Despite abundant research on the psychological well-being of widows, most studies rely on post-bereavement data, risking recall bias. Therefore, this study analysed data from the National Survey of the Japanese Elderly to enhance our understanding of the bereavement process. We observed the levels and trajectories of depressive symptoms before, during, and after spousal loss using the first seven waves of the survey from 1987 to 2006. The results showed a modest increase in symptoms prior to loss and a significant spike at bereavement, with no subsequent decline. Participants' age at loss moderated recovery, with later life bereavement being associated with quicker adjustment. These findings highlight the need to address mental health deterioration in later life and indicate age-related resilience with increasing age globally.

This study examined real-time, unobtrusive accounts of suicidal distress shared by online forum users and developed a process framework to advance understanding and inform prevention efforts. A large pro-choice suicide discussion forum (150,000+ users) was selected to capture and analyse contemporaneous accounts of the suicide process, offering real-time, anonymous and minimally filtered disclosures less influenced by recall bias than retrospective interviews. A directed qualitative content analysis was conducted on publicly available posts (N = 526) describing suicidal distress or behaviour, categorizing content into current states (e.g. ideation, action), associated emotions and motivations. The Cyclical Model of Suicide (CMS) emerged as a non-linear, bidirectional framework characterized by non-sequential state transitions and recurrent movement. The model includes six states (non-suicidal distress, suicidal ideation, ambivalence, resolution, suicide in progress and recovery), a Reversal mechanism (regression to prior states) and 'incident drivers' (triggering shifts to higher-distress states and contributing to recurrence and state-bypassing). This study offers four insights. First, it uses in-the-moment accounts to propose a process-oriented framework rather than relying on retrospective reports. Second, it highlights recurrence language, with users describing experiences as cyclical. Third, it captures Reversal as a short-term shift away from action. Finally, it emphasizes the use of anonymous pro-choice suicide online spaces for venting and support before suicidal desire crystallizes into intent, highlighting that many users may be turning to these platforms instead of traditional therapeutic settings.

Assessing alcohol consumption in an era of direct alcohol markers.