This systematic review and meta-analysis aimed to quantify the magnitude of placebo and nocebo effects in pharmacological trials for OCRDs and identify clinical and methodological moderators influencing these effects.

A comprehensive literature search was conducted across multiple databases and clinical trial registries up to May 2025. Randomised, placebo-controlled trials involving pharmacological interventions for OCRDs were included. The primary outcomes were placebo effect size and placebo response rate; secondary outcomes included nocebo response rate and side effect profile. Data were extracted independently and meta-analysed using random effects models. Meta-regression was performed to assess moderators of placebo response.

Fifteen eligible trials (N = 640; placebo N = 341) were included. The pooled placebo effect size was moderate (SMC = −0.63; 95% CI −0.77 to −0.48), with low heterogeneity (I2 = 4.73%). The placebo response rate was 21%, and the nocebo response rate was 18%. Despite testing a broad range of potential moderators, including clinical characteristics, methodological design, and medication class, no significant predictors of placebo effect size were identified. Side effects were reported in nearly one-third of placebo recipients, underscoring the relevance of nocebo effects.

Placebo and nocebo responses are noteworthy in trials for OCRDs and may influence perceived treatment efficacy. Variability in placebo responses is not well explained by currently measurable moderators. Further research is needed to explore neurobiological, psychological, and methodological contributors to expectancy effects in OCRD pharmacotherapy trials.

The present study investigated the management of predominant negative symptoms in hospitalized patients and assess the impact of targeted pharmacological and psychological interventions.

This longitudinal, prospective, multicenter cohort study was conducted across multiple hospitals in Slovakia, focusing on inpatients, with assessments at admission and discharge. Eligible participants were hospitalized adults (18–65) diagnosed with schizophrenia and predominant negative symptoms. Treatment effectiveness was measured using the modified Short Assessment of Negative Domain, Self-evaluation of Negative Symptoms, Personal and Social Performance, and Clinical Global Impression scales. Means changes and effect sizes were calculated from baseline to final assessment. Differences in the perception of negative symptoms between patients and doctors were examined.

At discharge, patients showed significant improvements in symptom severity and functioning on all scales. Primary and secondary negative symptoms significantly decreased, especially those linked to positive and affective symptoms. Functioning improved, with fewer severe impairments in daily life. Most patients were on antipsychotic polytherapy throughout hospitalization, with around 85% receiving multiple antipsychotics at admission and at discharge. Non-pharmacological interventions were also widely used, with nearly nine out of ten patients receiving at least one such therapy during hospitalization.

Negative symptoms in schizophrenia pose a major treatment challenge, leading to functional impairment and poor quality of life. While positive symptoms often trigger hospitalizations, negative symptoms have a lasting impact on prognosis. Results suggest both D3-receptor–targeted pharmacotherapy, particularly cariprazine, and integrated non-pharmacological interventions may contribute to meaningful improvements in negative symptoms during hospital care.

The COVID-19 pandemic caused unprecedented operational stress on hospital-based antimicrobial stewardship programs (ASP). We utilized a systems engineering framework to characterize multi-level systems challenges to and strategies for resilient, hospital-based antimicrobial stewardship (AMS) during the COVID-19 pandemic.

Using a national data set, we identified hospitals that had significant COVID-19 burden. We conducted semi-structured interviews with pharmacists, physicians and quality leaders involved in ASPs during the pandemic at those hospitals. Interview guides were developed using the Systems Engineering Initiative for Patient Safety (SEIPS) framework. Transcribed interviews were analyzed using deductive content analysis.

We interviewed 37 participants from 22 different healthcare systems across the country. Challenges to resilient ASP included physician employment model; limited AMS resources; staff shortages due to illness; shift in priorities; increased workload; remote work; and therapeutic momentum. Preexisting strategies to promote resilient AMS included system-wide AMS; decentralized AMS; excellent interprofessional relationships; strong culture of AMS and embracing incremental change. Real-time response strategies included ability to prioritize well; consistency with AMS work; being flexible and adopting change; intensifying infectious disease engagement; dedication to the profession; and reliance on automated tools and technology.

Using a systems engineering informed qualitative approach, participants identified many modifiable challenges to AMS resiliency. Given the unfortunate reality that infectious disease pandemics and periods of operational stress are likely to occur in the future, we recommend that healthcare system leadership utilize the preexisting and real-time response strategies identified in this manuscript as a roadmap to ASP preparedness and a more proactive future response.

Manual contouring (MC) is time-consuming work in radiotherapy planning for rectal cancer. Artificial intelligence (AI) can reduce the time required for clinical target volume (CTV) and organs-at-risk (OARs) delineation. In this study, we evaluated the quality of auto-segmented CTVs and OARs.

Dose-planning data were collected from ten patients who underwent preoperative radiotherapy for locally advanced rectal cancer in 2024. Auto-segmented structures from the AI-Rad and Contour+ software tools were added. Constructed AI-CTVs, based on Contour+ segmentations and AI-OARs, i.e., bladder, femoral heads and bowel bag, by both AI tools, were compared to their MC counterparts by use of quantitative metrics, volumetric/surface Dice similarity coefficients (vDSC/sDSC) and maximum/average Hausdorff distance (HD/aHD). The constructed AI-CTVs and MC counterparts were graded by two radiotherapists with two qualitative methods.

The median vDSC, sDSC, HD and aHD values of our constructed AI-CTVs compared with the MC-CTVs were 0.86, 0.61, 23.19 and 0.62 mm, respectively. For both AI tools, the agreement in the OAR metrics was overall good but less similar for the bowel bag. The qualitative evaluations of the AI-CTVs, compared to the MC-CTVs, were in clear favour of the MC-CTVs. The cranial-anterior nodal levels were anatomical areas with poorer coverage, where the contouring guidelines differed.

The quality of our constructed AI-CTVs was inferior to the MC-CTVs. Thus, the auto-segmentation methods need further development on this aspect for use in the clinical setting. In contrast, the agreement of the quantitative metrics for the OARs was overall good, except for the bowel bag.

This study aimed to translate the Family Appraisal of Caregiving Questionnaire for Palliative Care (FACQ-PC) into Turkish and to examine its psychometric properties.

After completing the necessary translation stages, 190 participants (109 women and 81 men) with a mean age of 43.63 years (SD = 11.83), who provided care to individuals requiring palliative care, were recruited using convenience sampling. Participants completed the Sociodemographic Information Form, FACQ-PC, Burden Interview, Positive and Negative Affect Scale, and Palliative Performance Scale. Subsequently, reliability and validity analyses were conducted on the collected data.

Reliability analyses included internal consistency coefficients and test–retest reliability. Cronbach’s alpha coefficients were 0.88 for the negative outcome’s subscale, 0.90 for the positive caregiving appraisal subscale, and 0.82 for the family well-being subscale. Pearson’s correlation coefficients for test–retest reliability were 0.95, 0.87, and 0.94 for the negative outcomes, positive caregiving appraisal, and family well-being subscales, respectively. Validity analyses revealed a 3-factor structure similar to that of the Polish version but different from that of the original version. Based on factor loadings, two items were removed from the scale, resulting in a final 23-item version. Examination of the factor loadings revealed that these 2 items did not load onto any factor.

The reliability and validity analyses indicated that the Turkish version is a reliable and valid measurement tool for research and clinical applications. This tool is recommended for addressing the challenges faced by primary care physicians, health-care professionals working in home health and palliative care units, as well as family members and relatives who provide palliative care to patients.

Food insecurity (FI) prevalence has increased globally, including in the USA, and disproportionately affects certain subgroups (e.g. women). Both food-related and non-food-related sociopolitical indicators may impact FI rates; however, these associations are underexplored. This study assessed select state-level sociopolitical indicators among states with higher and lower FI rates compared to the national average.

Cross-sectional

US

We identified twenty-five states representing lower (n 18) and higher (n 7) FI prevalence compared to the 2021–2023 US average (12·2 %) and used national data sources to characterise sixteen sociopolitical indicators (selected via prior review) across three categories: (1) proximal to FI (related to food access/income/resources), (2) inequality (contributing to disparities) and (3) tobacco/alcohol/cannabis regulation (may exacerbate/perpetuate financial constraints). We described each indicator and explored their associations (using t tests or Fisher’s tests) with state FI status (high v. low).

For proximal indicators, low-FI (v. high-FI) states had greater food environment scores, nutrition assistance programme participation, minimum wage and insured individuals. For inequality indicators, low-FI (v. high-FI) states had narrower gender wage gaps, greater racial equity and more protective policies for sexual/gender minority populations and abortion rights. For substance-related indicators, low-FI (v. high-FI) states had higher cigarette taxes and were more likely to have comprehensive smoke-free laws, legalised non-medical cannabis and provisions for expunging/pardoning prior cannabis-related convictions.

Low-FI states had more sociopolitical indicators aimed at improving food access, financial resources, equality and substance use-related regulations. Findings highlight the importance of adopting a holistic, sustainable, multilevel approach to effectively address the broader determinants of FI.

To co-create with rangatahi (young people) evidence-based eating and wellbeing guidelines for young people in Aotearoa New Zealand (NZ), informed by mātauranga Māori (traditional Māori knowledge).

Rangatahi collaborated with Māori and non-Māori experts to review existing health guidelines covering sustainable eating, physical activity, screen time, sleep and mental wellbeing and develop their own set of guidelines. Peer feedback on the draft guidelines was used to produce the final guidelines. The process integrated scientific evidence with mātauranga Māori, following tikanga Māori (Māori custom) to ensure a culturally centred process.

Wānanga (learning workshops) were held at a local marae (traditional meeting house), and feedback presentations were held in four secondary schools in Hawke’s Bay, NZ.

Seventeen rangatahi from four schools with high Māori student enrolment participated in the wānanga, and ninety-four students provided peer feedback through surveys.

The rangatahi created ten eating and ten wellbeing guideline messages. These messages were invitational (beginning ‘Let’s try to…’) acknowledging the challenging journey for many rangatahi from current to recommended behaviours. Only one quantification (8–10 h of sleep) was included. Three eating and three physical activity guidelines incorporated the concepts of ‘mauri’ (life force). The guidelines addressed contemporary issues including sustainable eating, ultra-processed foods, social dimensions of eating and physical activity, screen time and cyberbullying. They also emphasised respect, rights and responsibilities, concluding with a motivational whakatauki (proverb) about aspirations.

Innovative, relevant and contemporary eating and wellbeing guidelines have been successfully co-created by rangatahi Māori for all young people across NZ.

To evaluate food marketing techniques used in Canadian recreation and sport facilities and assess the healthfulness of foods and beverages marketed by the techniques.

Cross-sectional content analysis of photographed food marketing instances coded for marketing techniques according to Health Canada’s Monitoring Protocol, developed for monitoring food marketing techniques across settings, supplemented with new inductively identified codes and sport-related marketing techniques. Healthfulness was classified as ‘of concern’ or ‘not of concern’ according to cut-offs of sodium, sugar and saturated fat established by Health Canada.

Recreation and sport facilities in Canada

134 facilities with 2576 food marketing instances

91·4 % of food marketing instances included at least one general marketing technique. Branded infrastructure, displays and furniture was the most prevalent (87·9 %) and appeared with another technique half of the time. Sport-related marketing appeared in 12·2 % of marketing instances, with most referring to sponsors. Most (86·5 %) marketing instances were ‘of concern’. Food marketing instances with sport-related marketing (97·6 %) were significantly more likely to be ‘of concern’ than without sport-related marketing (84·6 %) (χ2 = 20·54, P < 0·001). Three new indicators – appeals to taste, appeals to emotion, and cross-channel references – captured persuasive elements not addressed by the current monitoring protocol.

This study highlights the presence of food branding and the use of sport-related marketing to promote unhealthy products/brands in recreation and sports facilities. Monitoring protocols may underestimate exposure to persuasive food marketing by overlooking subtle, symbolic and cross-channel techniques. Future research can be improved by including subtle techniques and reinforced messages across marketing channels.

There is increasing evidence on the effectiveness of prevention bundles against non-ventilator hospital-acquired pneumonia (nvHAP), but detailed reports on their implementation are lacking. This study aims to describe and structure the implementation activities undertaken in a single-center multimodal intervention that achieved a 31% reduction in nvHAP incidence.

Longitudinal descriptive qualitative study.

Nine medical and surgical departments of a Swiss university hospital.

Healthcare professionals and implementation teams in study departments.

We collected longitudinal data on implementation activities using (1) implementation activity logs, (2) drop-in interviews and observations, (3) “action plan meetings,” (4) focus groups, and (5) unstructured recall sessions among the project team. Data were deductively coded using the “Expert Recommendations for Implementing Change” taxonomy, specified using Proctor et al.’s “Recommendations for specifying and reporting implementation strategies” and mapped to the “Exploration, Preparation, Implementation, Sustainment” framework phases.

A total of 174 activities were undertaken. Activities varied by implementation phase, most frequently involving “evaluative and iterative strategies,” “develop stakeholder interrelationship strategies” and “training and education of stakeholders” during Exploration, Preparation, and Implementation, respectively. During Implementation, 54% of activities were initiated by department nurses, and 27% were initiated by the institutional implementation team. Activities included interdisciplinary kick-off events, education in various formats, posters, informational stickers for patients, provision of new equipment (e.g., toothbrushes), and electronic medical records order sets.

This report offers valuable insights for future implementation efforts by providing a structured overview of the concrete implementation activities performed in a successful one-hospital multimodal nvHAP prevention project.

Large inequalities in fruit and vegetable consumption (FVC) persist, yet it remains unclear how intersecting factors such as socio-economic status, ethnicity and sex influence FVC in the UK. Using an intersectional framework allows us to explore complex realities and double burdens faced by certain population groups.

Cross-sectional data from the UK Household Longitudinal Study Wave 9 (2017–2018) were analyzed. FVC was measured as a binary variable, indicating whether individuals met the recommended five daily portions of fruits and vegetables (400 grams in total). An intersectional Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy was used, nesting participants into forty-eight social strata based on sex, ethnicity, age and educational level.

United Kingdom.

A total of 16 275 individuals from the UK Household Longitudinal Study sample were included, with one adult randomly selected per household.

Overall, 69·2 % of the sample did not meet the recommended daily FVC. Inequalities were predominantly explained by additive effects of sex, ethnicity, age and educational level. Men, individuals with lower educational levels, ethnic minority groups and younger participants were at higher risk of insufficient FVC, particularly those experiencing combinations of these factors.

Low FVC across the population, combined with strong additive effects of social determinants, underscore the need for proportionate universal interventions. Policies targeting improved access to fruits and vegetables across all neighbourhoods, especially those predominantly inhabited by individuals with lower educational levels, are warranted to reduce these inequalities.

To synthesise and quantify the association between household food insecurity (HFI) and various forms of malnutrition that include stunting, wasting, underweight, overnutrition and anaemia among Indonesian children under 5 years of age.

A systematic review and meta-analysis was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. The study included literature search, screening, data extraction, quality assessment using Joanna Briggs Institute (JBI) tools and meta-analysis using Review Manager 5.4.

Studies conducted in Indonesia, covering urban, rural and mixed settings across multiple provinces.

Children under 5 years of age residing in Indonesia, from households assessed for food insecurity using validated tools.

A total of thirty-two studies met the inclusion criteria, of which twenty-six were eligible for meta-analysis. HFI was significantly associated with higher odds of stunting (case–control: OR = 4·66; 95 % CI: 3·39, 6·40; P < 0·001; cross-sectional: OR = 4·61; 95 % CI: 4·17, 5·11; P < 0·001), wasting (OR = 1·92; 95 % CI: 1·60, 2·32; P < 0·001), underweight (OR = 5·26; 95 % CI: 2·12, 13·04; P < 0·001) and overnutrition (OR = 1·66; 95 % CI: 1·49, 1·85; P < 0·001). Children in food-secure households had significantly lower odds of anaemia (OR = 0·41; 95 % CI: 0·30, 0·58; P < 0·001).

HFI is strongly associated with multiple forms of malnutrition among Indonesian children under 5 years of age. These findings highlight the urgent need for integrated, nutrition-sensitive strategies that address food security to improve child health and reduce malnutrition in Indonesia.

Orthostatic hypotension (OH) is common in Parkinson disease and contributes to injury, fatigue and reduced quality of life. More efficient approaches to identify higher-risk patients are needed.

A cross-sectional, single-center study of consecutive people with Parkinson disease was conducted over three months. Linear models adjusted for age, sex and disease duration assessed associations of OH to patient-reported outcomes (autonomic symptoms, quality of life), medications and other clinical features. Receiver operating characteristic curves evaluated patient-reported outcomes as predictors of clinic-measured orthostatic hypotension.

Fifty-seven participants (mean age 69; 60% male) completed assessments. OH was present in 29 (50.9%), but only 3 were symptomatic. The Orthostatic Hypotension Questionnaire showed strong discrimination for OH (sensitivity 81%; specificity 73%). Supine-to-3-minute standing systolic blood pressure dropped most when measured within 1 hour of dopaminergic medication (−17.4 mmHg; 95% CI −30.4 to −4.4) or 1–2 hours (−17.2 mm Hg;−26.8 to −7.6) compared with 2–3 hours (+1.6 mm Hg; −10.0 to + 13.2) or more (−2.9 mmHg; −14.9 to + 9.1). Older age was associated with a greater diastolic blood pressure drop. Delayed OH was associated with worse patient-reported mobility.

Orthostatic hypotension was common and usually asymptomatic in this sample. Patient-reported outcomes showed good sensitivity for identifying those likely to have OH. Time since dopaminergic medication impacted the blood pressure drop, and the delayed onset of hypotension was associated with worse mobility-related quality of life. Brief questionnaires may help risk-stratify patients for assessment, counseling and treatment of orthostatic hypotension.