Antipsychotics used to treat severe mental illness (SMI) markedly raise the risk of metabolic syndrome. Early weight gain predicts worse outcomes, making timely intervention vital, particularly within the first 6 months, when the most weight loss is achievable. This meta-analysis evaluated non-pharmacological weight/body mass index (BMI) management interventions during the first 6 months of their usein people receiving antipsychotics for SMI, to identify effective components with the aim of preventing long-term metabolic complications. Systematic searches of five databases (to October 2024) yielded 1483 studies; 8 (643 participants) met inclusion criteria. Interventions included exercise, nutrition, education, monitoring and psychological input, delivered individually or in groups. Meta-analysis showed significant weight (-1.93 kg) and BMI (-1.12 kg/m2) reductions. Group-based, multi-component programmes with psychological input were most effective. Group-based, multi-component interventions that include a psychological element produced the greatest reductions in weight and BMI. Future research should focus on refining and embedding psychologically informed, multi-component group programmes into routine psychiatric care to optimise long-term physical health outcomes.

Infection of backyard and poultry with low pathogenicity avian influenza LPAI A(H5N2) viruses has occurred in Mexico since 1994, and the first human infection caused by this influenza virus was detected in 2024. Since its emergence in the Americas, frequent reassortments between high pathogenicity avian influenza HPAI A(H5N1) and LPAI viruses has occurred. In September 2025, the Instituto Nacional de Enfermedades Respiratorias of Mexico City identified an unsubtypeable influenza A virus infection in a young adult patient later determined to be a reassortant HPAI (H5N2) virus with a clade 2.3.4.4b HA. We analyzed clinical and epidemiologic data from this patient. Respiratory samples were tested for influenza RT-qPCR assays. Genomic sequence and phylogenetics analyses were performed to provisionally assign a new genotype to the novel HPAI A(H5N2) reassortant virus. The patient presented with fever and tachypnea, later developed hemoptysis and thoracic pain, with oxygen saturation decreasing to 70%. CT scan showed bilateral ground-glass opacities consistent with diffuse alveolar hemorrhage and zones consistent with consolidation. Clinical improvement was observed and the patient was discharged. Through viral complete genome analysis, we identified an HPAI A(H5N2) virus with genes from both clade 2.3.4.4b A(H5N1) viruses similar to those detected in North America during 2022-2023 and genes from the LPAI A(H5N2) viruses detected in Mexico during 2024. This is the first ever laboratory-confirmed human infection caused by an HPAI A(H5N2) virus infection, suggesting a new genotype provisionally classified as B3.14. The relationship of the virus with the severity of illness remains unknown.

High prescription drug costs are a pressing national concern and contribute to medication nonadherence and poor health outcomes. The Inflation Reduction Act (IRA) introduced sweeping reforms to improve medication affordability, but their potential impact on medication adherence is unknown. To evaluate the association of the IRA's 2024 prescription drug provisions with cost-related medication nonadherence as well as health care-related financial strain. This quasi-experimental difference-in-differences analysis used data from the 2021-2024 National Health Interview Survey. Adults aged 62 to 67 years who were enrolled in Medicare Part D (intervention) or private insurance (comparator) were included. Individuals with incomes 135% or less of the federal poverty level, dually enrolled in Medicaid, and who currently used insulin were excluded from the primary analysis because preexisting protections limited their out-of-pocket spending in Medicare. The IRA's prescription drug provisions were enacted on January 1, 2024, including (1) elimination of the 5% coinsurance requirement for catastrophic coverage that effectively capped out-of-pocket drug costs to approximately $3300 per year and (2) expansion of full low-income subsidies. The primary outcome was cost-related medication nonadherence. The secondary outcome was health care-related financial strain. The study population included 1454 Medicare beneficiaries (weighted mean [SD] age, 66.1 [0.8] years; 53.1% female) and 3797 privately insured comparators (weighted mean [SD] age, 63.3 [1.2] years; 50.7% female). Prior to the 2024 IRA reforms, trends in cost-related medication nonadherence were parallel between the 2 groups. Following implementation of the IRA's 2024 provisions, cost-related medication nonadherence declined among Medicare beneficiaries relative to comparators (adjusted difference-in-differences estimate, -4.9 percentage points [pp]; 95% CI, -8.8 to -1.0 pp). Among Medicare beneficiaries with multiple chronic conditions, the decline was more pronounced (adjusted difference-in-differences estimate, -7.8 pp; 95% CI, -12.9 to -2.8 pp). These findings were robust across multiple sensitivity analyses as well as secondary analyses using Medicare beneficiaries with incomes 135% or less of the federal poverty level and dually enrolled in Medicaid as an alternative comparator group. In contrast, there were no meaningful differential changes observed for health care-related financial strain (adjusted difference-in-differences estimate, -2.6 pp; 95% CI, -10.1 to 5.0 pp). In this difference-in-differences analysis, the IRA's 2024 prescription drug provisions were associated with a reduction in cost-related medication nonadherence among eligible Medicare beneficiaries in their first year. These early improvements may have important implications for chronic disease management and downstream clinical outcomes.

ABSTRACT Objective Eating disorders (EDs) are severe and complex psychiatric illnesses, with adolescence and young adulthood representing particularly vulnerable periods for onset, relapse and disruptions in treatment. The transition from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS) is especially complex, raising concerns about continuity of care and support for young people and their families. The Transition for Eating Disorders Youth intervention (TEDYi) aims to address these challenges by developing a person‐centered, peer‐led intervention grounded in lived experience to facilitate smoother transitions across ED services. Method This study represents the second phase of TEDYi and employed an Experience‐Based Co‐Design (EBCD) methodology. EBCD integrates the perspectives of young people, carers, and mental health professionals to improve transition services collaboratively. We conducted seven co‐production workshops with 37 co‐designers and analysed the data using reflexive thematic analysis. Results Three key themes emerged: (1) Being there—the importance of ongoing, reliable support; (2) Exploring readiness—factors shaping preparedness for transition; and (3) Enhancing engagement—the role of accessible psychoeducation. Insights were further refined through two Steering Groups, which considered delivery format, setting, and intervention materials. Discussion Co‐designers valued EBCD for creating a safe space where young people and carers could openly share lived experiences and for fostering a sense of community with shared goals. They highlighted that lived experience interventions in EDs can foster more optimal outcomes while helping individuals feel recognized. These findings will inform the finalization of the TEDYi prototype and subsequent piloting across clinical sites.

Stigma experienced and/or conveyed by family members of individuals with mental health conditions may impact on their health and wellbeing, and on the quality of care and health outcomes of people with lived experience of mental illness. However, most of the research on stigma and mental illness has been on public attitudes and behaviors of patients rather than what is expressed by or experienced within families. We aimed to identify scales that assess stigma in the context of family life, and to evaluate their psychometric properties. A literature search across Web of Science, PsycINFO, Medline, Scopus, and ProQuest Social Science (up to August 2025) yielded 14 eligible studies, reported via PRISMA. None of the 14 scales directly or solely assesses family-context stigma, but includes dimensions of self or public stigma, especially related to schizophrenia, possibly neglecting other forms of severe mental illness (SMI). In addition, existing tools often overlook the full range of family relationships and diverse caregiving experiences. There is a need for measures that more adequately and comprehensively capture the often complex and nuanced experience of mental illness stigma within families.

Introduction Surgical peritoneal dialysis (PD) catheter implantation can be performed under various anesthetic strategies, evidence guiding the optimal approach regarding clinical safety and perioperative efficiency remains limited. This study evaluated perioperative outcomes and resource utilization in open surgical PD catheter implantation under general (GA) versus local/regional anesthesia (LA). Methods This retrospective single-center cohort study included all open surgical PD catheter implantations performed between 2010 and 2021. Clinical outcomes and perioperative workflow parameters were analyzed. Patients were stratified by anesthesia type (GA versus LA), comorbidities, and operating room (OR) isolation status related to multidrug-resistant organisms. Results A total of 508 procedures were included (419 GA, 89 LA). Patients undergoing LA were older and more comorbid, with 49.4% classified as ASA ≥ 4 versus 14.6% in the GA group. Surgical procedures were comparable. LA was associated with shorter OR and post-anesthesia care unit times and faster transfer to definitive care units, indicating more efficient perioperative management. Postoperative surgical complication rates were comparable. Prolonged intensive care treatment occurred more frequently in LA patients, likely reflecting higher baseline illness severity. In patients with ASA ≥ 4, LA showed a trend toward reduced intraoperative catecholamine use (47.7% versus 67.2%; p = 0.0697). In multivariable analyses adjusting for age, ASA score, and cardiopulmonary comorbidities, anesthetic strategy was not independently associated with major safety outcomes. Among patients requiring isolation, GA resulted in disproportionate OR occupancy, whereas LA facilitated more efficient workflow regardless of isolation status. Discussion LA is preferentially used in high-risk patients. After adjustment for baseline risk, its surgical safety is comparable to GA, while offering perioperative resource and organizational advantages. Tailoring anesthetic strategies to patient comorbidities and isolation requirements may improve perioperative workflow and resource utilization without compromising outcomes.

Poverty is associated with the severity of common mental health disorders and increased physical comorbidities. However, its effects on severe mental illness (SMI), beyond increasing their incidence, are less understood, especially in low- and middle-income countries. We here examined the relationship between baseline household income and subsequent mental and physical health outcomes in a large cohort of individuals diagnosed with schizophrenia or bipolar disorder in Colombia. Retrospective cohort and case-control study using electronic health records from over 5 million Colombians. We identified individuals diagnosed with schizophrenia or bipolar disorder and their baseline household income. Mental health outcomes included third-line antipsychotic treatments (clozapine or antipsychotic polypharmacy) and psychiatric hospitalizations. Physical outcomes included diagnoses of hypertension, type 2 diabetes, and HbA1c levels, compared with rates in individuals without SMI. We included 12,216 (6,485 women) participants newly diagnosed with bipolar disorder or schizophrenia between 2019 and 2023. Compared to middle-income participants (between $700-1,750USD/month), patients on a low income (less than $700USD/month) were more likely to require third-line antipsychotic treatment (OR 1.84 [1.64, 2.08]) and psychiatric hospitalization (incidence rate ratio 1.30 [1.21, 1.41]). Low-income participants with SMI had hypertension and diabetes rates like middle-income participants without SMI who were 20years older. However, the combined effect of SMI and low income together posed a less-than-additive risk. Lower income was associated with higher HbA1c levels in diabetes, while a diagnosis of SMI was associated with lower levels. Low income at SMI onset is associated with worse mental and physical health outcomes.

Ebstein Anomaly Fetal Echocardiogram Parameters are Associated with Illness Severity on Admission to the Cardiac Intensive Care Unit.

Abstract Patients with severe mental illness are more likely to develop kidney disease and its complications compared to patients without severe mental illness. Once patients with mental illness develop end-stage kidney disease, supporting adherence is important but can be difficult in moments of acute psychosis when the patient objects to dialysis, particularly when considering the lack of dialysis-compatible psychiatric hospitals. In this case, a woman with a history of bipolar disease and end-stage kidney disease has a manic episode after discontinuing her antipsychotic medications and refuses dialysis owing to paranoid delusions. We argue that, due to the potential imminent harm to the patient in refusing dialysis when incapacitated due to severe mental illness, it is reasonable to pursue treatment over objection while waiting for return to capacity unless the surrogate decision maker does not believe it would be in line with the patient's values and beliefs. If there is no return to capacity after an agreed trial period and dialysis cannot be safely pursued outside of the hospital, the provider may ethically withdraw dialysis even contrary to the surrogate decision maker when continuing treatment may be limited by resources and overshadowed by harm to the patient. In this article, we will discuss how Rubin and Prager's criteria in deciding to treat over patient objection were used and their limitations in being able to quantifiably weigh each principle, as well as the ethical justifiability of withdrawal of dialysis should the patient continue to be decapacitated and unwilling to cooperate with dialysis.

Sleep disturbances are common in the early stages of psychosis and bipolar disorder and are increasingly regarded as transdiagnostic risk factors for symptom severity and suicidality. However, few studies have simultaneously examined both subjective and objective sleep changes during this early illness phase. This cross-sectional study included patients within 12 months of the onset of psychosis or bipolar disorder and matched healthy controls. Patients completed standardised questionnaires including the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Beck Depression Inventory (BDI), Mood Disorder Questionnaire (MDQ) and Prodromal Questionnaire-16 (PQ-16). Actigraphy was recorded for seven consecutive nights in both groups. Twenty patients (11 with psychosis, 9 with bipolar disorder) and 20 healthy controls were assessed. Most patients reported poor sleep quality (70%), depressive symptoms (60%) and suicidal thoughts (65%). Poor sleep quality was strongly linked to depressive symptoms (r = 0.76) and prodromal features (r = 0.69). Actigraphy showed reduced total sleep time in patients compared to controls (388 vs. 449 min) and longer sleep latency in bipolar patients than in those with psychosis (161 vs. 80 min). Sleep disturbances are common during the first year of psychosis and bipolar disorder. Subjective sleep issues are closely linked to depression, prodromal psychotic symptoms and suicidal thoughts, while actigraphy shows disorder-specific differences. Routine evaluation of both subjective and objective sleep may serve as early indicators of vulnerability and guide intervention strategies in severe mental illness.

The SPACES feasibility trial: A co-produced physical activity intervention for people with severe mental illness

A dihydroxanthene-based ratiometric fluorescent probe for ultrasensitive and rapid detection of Hg2+ and its applications.

Determinant factors of mortality among patients diagnosed with relapsing fever in a resource-limited setting in Ethiopia.

Communication, Teamwork, and Culture: Creating Winning Teams to Support Optimal Childbirth Outcomes.

Malnutrition is a major public health problem in India. Approximately 80% of the world's undernourished children are concentrated in 20 countries. In India, nearly 60 million children are underweight. Children with malnutrition contribute more to paediatric intensive care unit (PICU) admissions, and their outcomes may be affected by the degree of malnutrition. Malnutrition is also a risk factor for both, increase in length of stay in the PICU and higher Paediatric Respiratory Severity Score (PRESS) scores, thus increasing the need for respiratory support. To assess the impact of the nutritional status of children admitted with respiratory illnesses on the duration of stay at the PICU in a tertiary care hospital catering to suburban population. A prospective descriptive study carried out over a period of 6 months analysed 49 children admitted with respiratory illness to PICU in a tertiary care hospital. All Data collected was entered in Excel sheet. All data analyses were performed using IBM Corp. IBM SPSS Statistics for Windows [computer software]. Version 21. Armonk, NY: IBM Corp.; 2012. During the study period, a total of 134 children were admitted to the PICU. Among them, 49 children (36.5%) were admitted due to respiratory tract infections, forming our study group. Based on the IAP weight-for-age growth charts, it was found that 30 (61.2%) of these children exhibited some degree of malnutrition. In our study, 63.3% of the study population were infants. The male gender was predominant (59.2%) in the demographic pattern. The mean hospital stay for all patients was 8.3 days. Mean hospital stay in malnourished patients was 10.85 days, whereas in normally nourished children, it was 4.33 days. The average duration of PICU stay was 4.46 days overall. For malnourished patients, the average stay in PICU was 5.82 days, compared to 2.29 days for patients with normal weight. A significant positive correlation (P < 0.05) was found between malnutrition and prolonged PICU stay, hospital stay and severity of PRESS score. The grade of malnutrition was associated with greater severity of respiratory illness and a longer length of stay in PICU and Hospital. The assessment of grades of malnutrition at the time of admission can predict the impact on the length of stay in PICU and hospital.

Sociocultural identification of migrant forensic psychiatric inpatients facing mandatory repatriation - a hospital ethnography.

Association between influenza A virus and SARS-CoV-2 infections and mood disorders.

Beyond survival: Early markers of poor outcome in pediatric trauma.

Family decision-making during access to surgical care for children: A qualitative analysis and conceptual framework.

Background and objectives Critically ill patients in intensive care units (ICUs) are vulnerable to ocular surface disorders due to impaired protective mechanisms, mechanical ventilation, sedation, and adverse environmental conditions. This study aimed to evaluate the prevalence and pattern of ocular surface alterations in ICU patients, identify associated risk factors, and determine microbial profiles in infective kerato-conjunctivitis. Methods An observational study was conducted on patients admitted in ICU for more than 72 h. Data on demographics, systemic diagnoses, ocular examinations, including Schirmer’s test for severity of dry eye, conjunctival swab cultures, and corneal status were collected and analysed. Results Of the 280 patients, with mean ICU stay of 12.6 + 5.1 days, 200 (71.4%) had corneal abnormalities. Keratitis/corneal ulcer was most common (n=88, 31.4%), followed by punctate keratopathy (n=58, 20.7%) and corneal erosion (n=54, 19.3%). Lagophthalmos (n=82, 29.3%) and severe dry eye were significantly associated with corneal pathology ( P&lt; 0.001). Common pathogens included Klebsiella sp. and Staphylococcus species. Longer ICU stay and higher severity of illness correlated with increased ocular morbidity. Poor GCS scores, dry eye severity, mechanical ventilation, and conjunctival status were also significant contributors. Interpretation and conclusions This study documents the high burden of ocular surface disordersin ICU patients and emphasises the need for routine ocular assessments and structured preventive protocols. Integrating simple eye care measures can mitigate visual complications and enhance overall ICU care quality.