The Generalized Anxiety Disorder 7-Item Scale (GAD-7) is a brief self-reported measure for screening for anxiety symptoms. However, the evidence about its cross-cultural validity is fragmentary and usually focused on specific settings. Therefore, we aimed to critically review and synthesize the existing evidence about the cross-cultural validity of the GAD-7.

We conducted a systematic review of studies assessing the cross-cultural validity of the GAD-7 in following the PRISMA guidelines. Additionally, the quality of the studies was assessed following the COSMIN guidelines, and the quality of the evidence was assessed with the GRADE. Data were synthesized narratively.

Out of 1,965 unique records, 9 unique studies were deemed eligible for the COSMIN appraisal and the narrative synthesis (total sample: 11,894, 53.7% females and 20 different cultural groups). Most studies (7) had adequate quality and showed evidenced of the unitary structure of the GAD-7 across cultural groups. In 4 studies also assessing possible cultural bias, the effect on the general score was deemed negligible.

The evidence about the cross-cultural validity of the GAD-7 is very limited. Although more research is needed, the evidence available shows that the GAD-7 could be a cross-culturally valid tool for the assessment of anxiety symptoms in clinical contexts and epidemiological studies. Until new high-quality evidence will be available, these results would constitute a key first step for supporting the use of the GAD-7 in multi-cultural clinical settings and to inform clinical, public health and global health decision making in relation to anxiety.

Fenestration in the Fontan procedure was introduced to improve early postoperative outcomes by reducing systemic venous pressure and augmenting preload to the systemic ventricle. It is believed to decrease pleural drainage, shorten hospital stay, and reduce complications. However, fenestration may result in systemic desaturation and carries a potential risk of paradoxical thromboembolism. The benefits of routine fenestration remain controversial. This study aimed to evaluate whether adding a fenestration influences early postoperative outcomes.

Between March 2024 and November 2025, 52 patients underwent Fontan completion at our institution. Forty patients met the inclusion criteria and were prospectively divided into two equal groups: non-fenestrated (Group 1, n = 20) and fenestrated (Group 2, n = 20). Twelve patients were excluded due to a primary Fontan procedure, elevated pulmonary vascular resistance, increased transpulmonary gradient, or significant branch pulmonary artery distortion. Demographic and perioperative parameters, including ventilation duration, inotrope duration, chest drain duration and volume, ICU stay, and total hospital stay, were analysed.

Baseline demographic and intraoperative variables were comparable between groups. Duration of mechanical ventilation, ICU stay, total chest drainage, and cardiopulmonary bypass time were similar. Chest drain duration was shorter in the fenestrated group (8.1 ± 4.2 vs. 10.2 ± 5.3 days), but this difference was not statistically significant (p = 0.173). Discharge oxygen saturation was significantly lower in the fenestrated group (88.9 ± 5.6% vs. 93.3 ± 3.5%; p = 0.0072).

In the present cohort, fenestration was not associated with a statistically significant improvement in most early perioperative outcomes. Larger studies are needed to define its role.

Formal thought disorder (FTD), characterized by disruptions in the flow and form of thought, is a core feature of psychosis. But its measurement is fragmented across numerous rating scales, leading to its continued neglect in both research and clinical practice. To determine if different FTD scales measure the same underlying construct, we need to assess the degree to which the content of commonly used FTD scales overlaps with each other.

We conducted a systematic review to identify all standardized, clinician-rated scales used to measure FTD in psychotic disorders. From this set, we extracted individual items and derived a consensus list of 56 discrete FTD phenomena. Two independent clinical experts conducted item-to-item mapping for every scale item onto these FTD phenomena. Content overlap between scales was quantified using Jaccard Similarity Index (JSI). We determined the overall coverage achieved via several combinations of FTD scales.

The 15 scales, comprising 207 items, showed weak content overlap. The mean JSI across all scale pairs was low, and no single phenomenon featured across all scales. While some core FTD phenomena (e.g. ‘incoherence’, ‘poor speech content’, ‘drifting-off’) were represented in many scales, 20% of all identified features were idiosyncratic, appearing in only one scale.

Existing FTD rating scales capture a wide but heterogeneous array of symptoms with poor content overlap. This lack of harmonization challenges the comparability of mechanistic and interventional studies. We highlight the need for a consensus-based, standardized measurement of FTD and provide a comprehensive checklist to advance the research and clinical practice.

Specialised knowledge in adult congenital heart disease is crucial but often lacking, particularly in resource-limited settings. The Global Conversations in Adult Congenital Heart Disease webinar series was initiated to provide accessible, global education via virtual platforms.

This study evaluates the attendance patterns, participant demographics, knowledge outcomes, and audience feedback of the Global Conversations in Adult Congenital Heart Disease webinar series, analysing 19 monthly sessions conducted from October 2023 to April 2025.

Registration data, session viewership, and total series reach were recorded. Demographics were collected per session. Pre- and post-session quizzes were used to assess changes in knowledge; scores from these independent groups were compared using the Mann–Whitney U test. Post-webinar surveys collected improvement suggestions.

Out of 1,956 registrants from 89 countries, 54.6% attended the sessions, representing 1,068 participants from 64 nations: mainly Colombia (30.9%), Peru (18%), the USA (14.1%), and Mexico (9.9%). Median quiz scores improved from 50% pre-session (n = 120) to 100% post-session (n = 108), a statistically significant gain (p = 0.035). Notably, 29% had no prior adult congenital heart disease education. Most post-webinar survey respondents rated case presentations and discussions as excellent (75.0%) or good (20.1%). Qualitative feedback suggested areas for improvement included audiovisual quality, audience engagement, content delivery, and language accessibility.

The Global Conversations in Adult Congenital Heart Disease webinar series successfully engaged a diverse international audience and showed significant differences in quiz scores between pre- and post-session independent groups, demonstrating the potential benefit and feasibility of virtual education in bridging gaps in adult congenital heart disease training, particularly in resource-limited countries.

To evaluate factors associated with positive LTBI screening among HCWs and predictors of treatment initiation and completion across hospital sites in Ireland.

Multicentre retrospective cohort study.

Five hospital sites in Ireland.

N = 755 healthcare workers (HCWs).

Evaluation of latent tuberculosis infection (LTBI) by interferon gamma release assay in HCWs from high-incidence countries during 2023, identified via occupational health records. IGRA positivity rates, linkage to treatment and treatment outcomes were recorded. Demographic and occupational factors associated with these outcomes were investigated.

There were n = 755 HCWs from high-incidence TB countries identified via occupational health records eligible for LTBI screening. 719 underwent IGRA testing, of whom 93 (13%) were positive. Age > 50 was associated with IGRA positivity (OR 5.71; 95% CI 1.79–18.17; P = .003). In addition to these n = 93 HCWs, two additional sites provided treatment outcomes for n = 164 HCWs, and a further n = 58 IGRA-positive HCWs were referred to Site 1. Among these 313 IGRA-positive HCWs, 50% initiated therapy, with substantial variation across sites (27%–88%). Multivariable analysis showed study site, but not demographic factors, predicted treatment initiation (P < .001). Common reasons for non-initiation included treatment refusal and non-attendance. Treatment completion was high (82%) and was not associated with study site.

LTBI prevalence among HCWs in Ireland was lower than international estimates. While treatment initiation was low, completion was high. Treatment initiation varied by site, driven by institutional rather than individual factors. A standardised national programmatic approach is needed for HCWs within the LTBI cascade of care.

In September 2024, Lebanon experienced an unprecedented mass casualty incident involving the simultaneous detonation of thousands of weaponized pager devices. This systematic review characterizes the resulting injury patterns, surgical burden, and disaster-response lessons to help inform future preparedness and response strategies.

PubMed, Embase, Scopus, and Web of Science were searched for studies on casualties from the pager explosions. A random-effects meta-analysis estimated pooled prevalence of injuries by body region.

Sixteen articles met inclusion criteria overall, comprising seven studies in the clinical synthesis and nine articles in the qualitative disaster-response synthesis. A consistent injury pattern predominantly affected the hands, face, and eyes. Specialty-specific cohorts demonstrated severe ocular destruction, frequent hand amputation, and a substantial operative burden. In the two comparable hospital-based cohorts eligible for meta-analysis, upper extremity injuries were most common (pooled prevalence 84%; 95% CI: 73–91%; I2 = 0%). The incident exposed critical weaknesses in triage, communication, and specialty surge capacity.

The 2024 pager explosions produced a novel injury signature distinct from conventional blast trauma. These findings, while based on limited case series, underscore the urgent need for health care systems to develop flexible, adaptive disaster plans that can respond to the unique threats of unconventional warfare.

This study examined the behavioral characteristics of psychiatric inpatients following disasters.

Data were collected from 2 psychiatric hospitals in Japan, 1 affected by the Northern Osaka Earthquake (magnitude 6.1, seismic intensity 6) on June 18, 2018, and the other impacted by torrential rainstorms (total rainfall reaching 1800 mm; 224 fatalities, 8 missing) between June 28 and July 8, 2018. Focus group interviews were conducted with 24 nursing staff members from each hospital, divided into 8 groups.

A total of 158 inpatient behaviors were identified and organized into 19 themes. To delineate behavioral patterns, these behaviors were interpreted as adaptive (53.1%), maladaptive (22.2%), or unclassifiable (24.7%). Among maladaptive behaviors requiring prioritized care, 56.8% were associated with psychiatric disorders, while 43.2% reflected general disaster-related reactions.

Psychiatric inpatients demonstrated adaptive responses alongside typical disaster-related behaviors, with some behaviors attributable to underlying psychiatric conditions. Post-disaster care for psychiatric inpatients should emphasize strategies that support adaptability and protection. Additionally, targeted care for maladaptive behaviors specific to psychiatric conditions and vigilant observation of patients who do not display overtly agitated behaviors are critical.

Parkinson’s disease (PD) is a neurodegenerative disorder characterized by neuron loss and abnormal protein trafficking. Dysregulation of vesicle-mediated transport contributes to pathogenesis, but its diagnostic value and immune associations are unclear.

Transcriptomic data from GEO datasets (GSE20141, GSE20163, GSE7621) were analyzed. Differentially expressed vesicle-mediated transport-related genes were identified. Machine learning algorithms (least absolute shrinkage and selection operator, random forest, extreme gradient boosting) were integrated to select robust diagnostic biomarkers. The diagnostic model was validated across independent datasets. Immune infiltration was evaluated, and non-negative matrix factorization (NMF) identified molecular subtypes.

Machine learning revealed TRAPPC13 and COPS5 as robust diagnostic biomarkers with high predictive accuracy. The diagnostic model demonstrated strong accuracy across multiple datasets and showed excellent calibration and clinical applicability. Immune analysis highlighted differences in CD8+ T-cell fraction and MHC class I signaling between PD and controls. NMF clustering identified two transcriptionally distinct PD subtypes with distinct pathways and immune signatures.

This analysis identified TRAPPC13 and COPS5 as novel vesicle transport-related diagnostic biomarkers for PD. These genes show strong diagnostic potential, and the two identified molecular subtypes offer new insights into PD pathogenesis and may guide personalized therapeutic strategies.

Providing care for children with life-limiting conditions(LLCs) is an emotionally challenging experience that often exposes caregivers, particularly mothers, to considerable risk of psychological distress. The purpose of this study was to examine the moderating effect of emotional dysregulation on the relationship between severity of anxiety and depressive symptoms and high caregiving intensity, controlling for sociodemographic characteristics among mothers caring for children diagnosed with life-limiting conditions.

Using a cross-sectional descriptive design, a convenience sample of 192 mothers caring for children with life-limiting conditions was recruited and filled out an online self-administered questionnaire. Data were collected using online self-administered questionnaires regarding the sociodemographic characteristics of mothers and their children, emotional regulation difficulties (DERS), and the levels of anxiety and depressive symptoms among the mothers (DASS-21).

The analysis showed that 21.4% and 7.8% of mothers had moderate and severe depressive symptoms, and 19.3% and 15.6% had moderate and severe anxiety symptoms, respectively. The analysis also showed that emotional dysregulation is associated with high levels of anxiety (β = 0.74, P < 0.001) and depression (β = 0.74, P < 0.001); however, there was no significant moderating effect.

Anxiety and depression are significant psychological distress among mothers caring for children with life-limiting conditions and can be aggravated by emotional dysregulation and caregiving burden. There is a need to integrate interdisciplinary teamwork and family-centered care to provide holistic care and offer early screening, detection, and emotional regulation-focused management programs for psychological distress at healthcare services that care for children with LLCs.

Medical assistance in dying (MAID) is a rapidly growing and evolving field. The provision of MAID in Canada has substantially outpaced the number of new providers. While challenges of provision have been well described, little is known about the sustainability of providing this care long term. To fill this gap, we aimed to determine if providing MAID is sustainable while identifying factors that impact provider wellbeing.

We developed a 20-item Likert scale-based questionnaire that focused on themes of sustainability. We performed descriptive analyses for each question and used Fisher’s exact and Kruskal–Wallis tests to assess differences across provider characteristics. The questionnaire was distributed via a network of MAID navigators and providers in Ontario, Canada.

In total, 38 responses were received from well-experienced clinicians in a variety of specialties. A total of 74% of respondents felt their MAID work was sustainable for the long term. Practitioners strongly enjoyed the work and reported little emotional toll and burnout. While some providers felt the compensation and training were sufficient, others felt it could be improved. Nearly all respondents had someone ethically and clinically knowledgeable about MAID they could go to for support.

Our questionnaire has shown clinicians who are well-experienced and connected to supports report very positive experiences providing MAID and view the work as sustainable. While existing literature and media often emphasize the challenges of MAID, the perspectives of providers highlight a positive experience.

Parents influence and shape children’s career choices through practical factors, including access to resources and emotional factors such as role modelling and support. Preliminary evidence suggests that this may be even more relevant in psychiatry.

To explore perspectives about parental professional influence toward or away from a career choice in psychiatry at two levels: (a) past influence on practising psychiatrists of their parents and (b) current influence on their own children.

Medical doctors working in child and adolescent psychiatry (n = 44) and their family members (n = 24) participated in a reflective online questionnaire. Data were analysed with qualitative thematic analysis.

We found three main themes for influence of parental profession on career choice of doctors working in psychiatry: balancing autonomy and guidance (i.e. explicit, implicit and role modelling), influence of the sociocultural background of the family (i.e. family values, shared interest and bringing work home) and lived experience of mental disorders. We found similar themes for the influence of doctors working in psychiatry on career choice of their children, but subthemes differed (i.e. recognition of absence of neutrality and effects of parent’s profession on the mental well-being of their children).

Themes covered socialisation (participating in culture of the profession) and subjectification (development of person behind the professional), and not as much on qualification (competencies professionals need to qualify). Clinicians can apply the results as a framework to strengthen their professional identity, their own role modelling within their families and during teaching. Clinician educators and students may apply them to well-informed decision-making about career choice.