Child maltreatment is strongly linked to depression, yet comparisons across maltreatment forms have been inconsistent. Prior meta-analyses mostly used single-level models and combined studies assessing different subsets of maltreatment forms, introducing statistical dependence and between-samples confounds that can distort cross-form comparisons.

We synthesized data from 12 eligible meta-analytic reviews (those assessing at least emotional, physical, and sexual abuse, and providing effect size data), extracting 563 effect sizes from 217 depression risk studies and 501 effect sizes from 157 depression severity studies. Meta-analyses used two-level random-effects multilevel models, accounting for within-study dependence. Initial analyses compared all abuse forms plus emotional and physical neglect. Subsequent analyses compared just abuse forms either from samples assessing all three (‘complete-abuse’ samples) or only one or two (‘incomplete-abuse’ samples), which addressed between-samples confounds.

Effect sizes for different maltreatment forms were strongly correlated within studies (median rs ≈ .46–.48), confirming statistical dependence. Across all analytic layers, emotional abuse showed the strongest association with depression, and sexual abuse the weakest. In complete-abuse studies – the most internally comparable designs – a clear hierarchy emerged: emotional abuse > physical abuse > sexual abuse for both risk and severity. Incomplete-abuse studies obscured these differences.

By modeling effect size dependence and reducing between-samples confounds, this study provides clearer evidence that emotional maltreatment – particularly emotional abuse – is most strongly linked to depression. These findings underscore the need for greater clinical and prevention focus on emotional forms of maltreatment.

Transition from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS) is poorly managed, with discontinuity of care commonplace, leading to poorer outcomes, while evidence-based interventions to improve transition are scarce. This study is a secondary analysis of the MILESTONE trial, aiming to determine whether managed transition increases the proportion of young people who appropriately transition from CAMHS to AMHS.

The MILESTONE trial was a multicenter, two-arm, cluster-randomized controlled trial across eight countries at 40 CAMHS sites to compare usual care (UC) to managed transition (MT). MT consisted of training, identification, and assessment of transition readiness and appropriateness. Eligible participants were receiving CAMHS care, IQ ⩾ 70 and within 1 year of their service transition boundary. CAMHS sites were randomized 2:1 between UC and MT. The main outcome was whether participants were receiving care from AMHS at 15 months follow up.

The MILESTONE study included 793 participants, 552 receiving UC and 241 receiving MT. In the MT group, 24.9% transitioned to AMHS at 15 months compared to 14.2% in the UC group (p = 0.002), and appropriate transitions (in those with a need for transition at baseline or ongoing clinical need at 15 months) were 32.3% in the MT group compared to 16.4% in the UC group (p < 0.001).

A higher proportion of the MT group transitioned to AMHS at 15 months, and there was a higher proportion of appropriate transitions compared to UC. Clinicians and services should consider the incorporation of MT into routine clinical care.

Negative metacognitive bias, underestimating one’s abilities, is consistently linked to psychopathology, yet prior work has often collapsed anxiety/stress and depression or examined depression alone. We tested the unique associations of depression, anxiety/stress, and posttraumatic stress disorder (PTSD) with metacognitive bias in post-9/11 veterans.

Veterans from the Translational Research Center for TBI and Stress Disorders (TRACTS, N = 601; 90% male; M age = 34.31) completed 21-item Depression, Anxiety, and Stress Scale (depression, anxiety/stress), CAPS-IV (PTSD), WHODAS-II Understanding/Communicating (self-reported cognition), and an objective cognition composite (assessment of executive function, memory, and attention). Bias was computed as self-report minus objective cognition. A subsample (n = 239) repeated testing ∼2 years later.

At time 1, more negative metacognitive bias was associated with greater anxiety/stress (r = −.41), depressive (r = −.37), and PTSD symptoms (r = −.31) (all ps < .001). In a simultaneous model, anxiety/stress (β = −.29 p < .001) and depressive symptoms (β = −.12, p = .045) explained unique variance though PTSD symptoms did not (β = −.03, p = .524). Longitudinally, changes in bias were uniquely predicted by symptom changes in anxiety/stress (β = −.33, p < .001) and PTSD (β = −.16, p = .001), but not depression (β = −.10, p = .137).

Across cross-sectional and longitudinal models, anxiety/stress emerged as the most consistent correlate of metacognitive bias, with weaker contributions from depression and PTSD. These findings highlight the importance of assessing the self-report versus objective cognition gap and the need to further understand the temporal relationship between anxiety/stress and metacognitive bias.

Health technology management (HTM) involves systems designed to ensure the safe, effective, and cost-effective use of health technologies following reimbursement. This study examines the recommendations of Ireland’s Health Service Executive-Drugs Group (HSE-DG), exploring the characteristics and patterns of positive or conditional positive recommendations and HTM-related requirements.

We reviewed the minutes of HSE-DG meetings between January 2018 and December 2023. Data on medicines reviewed during this period were extracted into Microsoft Excel and analyzed narratively.

Over the study period, the HSE-DG reviewed 192 medicines (including new medicines and new indications for existing medicines), of which 157 received positive (115) or conditional positive recommendations (42). Of these, thirty-three were subject to HTM conditions, typically involving a managed access protocol or a specific reimbursement application process. Due to inconsistent reporting of key information, quantitative analysis was not feasible. However, common characteristics among HTM-linked recommendations emerged. These included submissions for reimbursement targeting a subset of the licensed population (45.5 percent vs. 5.6 percent in non-HTM cases), designation as orphan medicines (39.4 percent vs. 29.8 percent), and having both first-in-class and new chemical entity designations (75.8 percent vs. 47.6 percent).

Findings indicate an increasing trend toward positive/conditional positive reimbursement recommendations with HTM in the Irish setting, with an average of 21 percent of positive/conditional positive recommendations over the study period contingent on HTM. More granular and consistent reporting of key indicators would enable the determination of characteristics associated with reimbursement recommendations with HTM.

Early economic evaluations (EEE) can evaluate the economic potential of new innovative healthcare solutions. We present a methodological framework for EEE in bipolar disorder and use eLi12 as an illustrative case, a new method to estimate 12-h lithium blood levels when blood sampling deviates from the 12-h timing, enabling more flexibility for patients and better data on 12-h lithium levels.

A decision-analytic model evaluated the costs and consequences of eLi12 for the treatment of bipolar disorder from a Danish national healthcare payer perspective, assessing the minimum efficacy threshold where eLi12 would be considered cost-effective compared with standard of care. The primary outcome was net monetary benefit (NMB), and we estimated quality-adjusted life-years (QALYs) assuming a willingness-to-pay threshold of €67,000/QALY gained. Costs associated with bipolar disorder and lithium treatment (e.g. hospitalisations, suicides, lost productivity, implementation costs) were estimated from literature, Danish registries, and expert opinion.

Assuming 28,000 patients with bipolar disorder whereof 10,000 are treated with lithium, a 2.5% reduction in number of hospitalisations and suicides are sufficient for eLi12 to be considered cost-effective within one year of implementation. When using a longer time horizon, allowing more savings to be included and thus considering a smaller improvement to be sufficient, less than 1% improvement by using eLi12 would be sufficient within a three-year time horizon.

EEE can evaluate the health economic potential of new innovative methods, supporting early investment decisions and guiding research. eLi12 can have significant healthcare savings, emphasising the relevance of studying clinical implementation.

Out-of-hospital cardiac arrest (OHCA) remains a major cause of mortality world-wide. Early bystander cardiopulmonary resuscitation (CPR) is a critical determinant of survival; however, many witnessed arrests are managed by untrained laypersons. Dispatcher-assisted CPR (DA-CPR) increases bystander intervention rates, but telephone-based guidance limits real-time assessment of compression quality. Video-assisted CPR (V-CPR) may overcome these limitations by enabling visual feedback and demonstration-based guidance.

The aim of this study was to evaluate whether video call-assisted dispatcher guidance incorporating simultaneous real-time demonstration improves CPR performance quality compared with voice call-assisted guidance in untrained laypersons during a simulated adult OHCA scenario.

This prospective, randomized, single-blind, manikin-based trial included 85 university students without prior CPR training. Participants were randomized to telephone-assisted CPR (T-CPR; n = 40) or video-assisted CPR (V-CPR; n = 45). All participants performed standardized hands-only CPR for five minutes following dispatcher instructions. In the V-CPR group, the dispatcher simultaneously demonstrated CPR on a manikin during the video call. The primary outcome was the composite CPR Quality Score generated by the manikin feedback system. Secondary exploratory outcomes included compression depth, compression rate, interruption time, and Emergency Medical Services (EMS)-related time intervals. Robust regression analysis adjusted for age, sex, dominant hand, height, and weight was performed.

The mean age of participants was 20.13 (SD = 1.81) years, and 54.1% were female. The CPR Quality Score was significantly higher in the V-CPR group than in the T-CPR group (median difference −47; 95% CI, −60 to −36; P < .001). The V-CPR group demonstrated greater mean compression depth, higher proportions of compressions within recommended rate and depth ranges, and shorter interruption times between compressions. The T-CPR group showed shorter time from case recognition to EMS call, while the interval from dispatcher contact to CPR initiation was similar between groups. In multivariable robust regression analysis, allocation to the V-CPR group remained independently associated with higher CPR Quality Score and improved compression performance metrics.

Video call-assisted dispatcher guidance incorporating simultaneous real-time visual demonstration significantly improves CPR quality in untrained lay rescuers compared with voice-only guidance. These findings suggest that structured visual modeling integrated into DA-CPR systems may enhance bystander resuscitation performance and help bridge gaps in community CPR training.

The widespread use of explosive weapons in populated areas (EWIPA) has become a defining feature of modern conflict with devastating consequences for civilians. Practical guidance on sheltering during explosive attacks remains limited, inconsistent, and unevenly integrated with existing scientific and technical evidence. This study explored the landscape of shelter guidance through the perspectives of international humanitarian practitioners working in EWIPA contexts.

Semi-structured interviews were conducted with 10 practitioners from international humanitarian NGOs, Red Cross societies, and UN agencies engaged in risk education, emergency response, and conflict monitoring. Participants were purposively selected for operational experience in EWIPA-affected regions. Interviews explored 4 domains: guidance content, information sources, dissemination channels, and implementation challenges. Data were analyzed using a hybrid inductive-deductive approach.

Practitioners described various sheltering messages, from general cues like “find cover” to specific techniques including low-profile positioning. Most guidance drew on field experience rather than empirical research. Dissemination strategies varied by context. Challenges included message distortion, difficulty engaging high-risk groups, and absence of standardized recommendations.

Shelter guidance in EWIPA contexts is fragmented and only partially connected to the existing technical and scientific evidence base. Findings highlight the need for coordinated, context-specific, and evidence-informed approaches to strengthen civilian protection.

Stigma towards individuals with mental, neurodevelopmental, and neurological conditions is associated with problems accessing healthcare (e.g. schizophrenia) and gaining employment (e.g. epilepsy). In Ireland, stigma differs towards different conditions, with previous research showing that schizophrenia is viewed more negatively than bipolar disorder or autism. More detailed understanding of stigma in Ireland requires replication of these findings in a larger, population-representative sample.

1,232 participants around Ireland completed a survey examining knowledge, attitudes, and behaviours towards schizophrenia, bipolar disorder, autism, and epilepsy as a comparator. Knowledge, attitudes, and behaviours towards these groups were compared using cumulative link mixed models.

Perception of others’ stigma and participants’ own self-reported behaviour were more negative towards schizophrenia compared to any of the other groups. Familiarity with mental health issues was associated with more positive self-reported behaviour towards those with schizophrenia. This improvement in behaviour was mediated by reduced perception of danger of this group. In contrast, greater mental health knowledge had no such impact on behaviour. Bipolar disorder was the second-most negatively perceived condition, followed by autism and epilepsy.

These findings support our recent pilot study and provide further evidence that stigma differs towards different conditions in Ireland, with Irish people perceiving more negative societal attitudes, and self-reporting more negative behaviour, towards schizophrenia. The finding that familiarity with schizophrenia predicted more positive behaviour and that this was mediated by reduced perception of danger suggests targets for future anti-stigma interventions.

Postpartum depressive symptoms can vary substantially and probably reflect distinct subtypes. Understanding specific symptom patterns may help identify those at risk for later psychiatric care.

We aimed to identify subtypes of postpartum depressive symptoms and examine their associations with subsequent psychiatric care.

We conducted a cohort study using Danish nationwide health registers linked to population-based Edinburgh Postnatal Depression Scale (EPDS) scores from 2015 to 2021. Latent class analysis of EPDS responses identified subtypes among women with clinically relevant symptoms (EPDS ≥11), using a maternal background population as a reference group (EPDS <11). The outcome was psychiatric hospital contacts or redeemed psychotropic prescriptions within 1 year postpartum. We estimated standardised cumulative incidence rates and risk ratios using spline-based, time-to-event models.

Among 162 079 women, 11 847 (7.3%) had clinically relevant symptoms (EPDS ≥11). Five subtypes were identified: Mild-depressive (23%), Moderate-anxious (17%), Moderate-depressive (18%), Moderate-overwhelmed (31%) and Severe-depressive (11%). At 1 year, the standardised cumulative incidence of psychiatric care was 69.6 (95% CI, 61.4–79.0) per 1000 persons in the Mild-depressive subtype. Compared with this group, the adjusted risk ratio was 0.33 (95% CI, 0.28–0.38) in the background maternal population, between 1.11 (95% CI, 0.93–1.32) and 1.25 (95% CI, 1.06–1.48) across moderate subtypes and 2.37 (95% CI, 1.99–2.82) for the Severe-depressive subtype.

Distinct subtypes of postpartum depressive symptoms were associated with varying risks of subsequent psychiatric care, depending on both symptom severity and symptom type. These findings underscore the importance of systematic screening and tailored follow-up, even for women with mild to moderate symptoms.

Large language models (LLMs) are increasingly explored for healthcare-associated infection (HAI) surveillance, but their reliability in applying formal National Healthcare Safety Network (NHSN) definitions is not well characterized. This study evaluates GPT-5.1 Thinking’s accuracy and rationales in classifying NHSN-defined infections.

Seventy synthesized case vignettes containing complete, organized clinical data representing five NHSN infection types, including complex edge cases, were assessed using 2025 NHSN surveillance definitions. GPT-5.1 Thinking classified cases under three prompting strategies: standard, structured, and constrained. Quantitative accuracy metrics and qualitative inductive content analysis of rationales and failure modes were performed.

Overall accuracy across 210 classifications improved from 78.6% (standard prompt) to 88.6% (structured) and 95.7% (constrained). Performance was highest for infections with clear anatomical or radiographic criteria (surgical site infections [SSI], ventilator-associated pneumonia [VAP]) and lowest for infections involving complex exclusion rules (central line-associated bloodstream infection [CLABSI], Clostridioides difficile infection [CDI]). Constrained prompting enhanced adherence to NHSN rules but did not eliminate errors in hierarchical exclusions. Content analysis identified three recurrent failure categories: prioritization of clinical plausibility over surveillance logic, failure to apply quantitative and temporal thresholds, and errors in hierarchical source attribution.

GPT-5.1 Thinking shows potential to support infection surveillance under strict constraints but exhibits systematic limitations, including overreliance on clinical intuition and difficulty with complex exclusion pathways. Currently, LLMs are unsuitable for autonomous NHSN classification but may serve as supervised decision-support tools with robust human oversight. Further development is needed to enhance LLMs’ ability to synthesize surveillance definitions and complex situational characteristics critical for effective HAI surveillance, though fully autonomous deployment would require further validation. These findings are based on synthetic data that may differ from real-world clinical data in ways likely to overestimate the accuracy of these tools.

High altitude cerebral edema (HACE), a fatal terminal stage of acute mountain sickness (AMS), is triggered by rapid exposure to hypoxia at high altitudes. The pathophysiology of HACE is complex, involving multiple key processes including energy metabolism disorders, oxidative stress, blood-brain barrier (BBB) injury, and neuroinflammation, all of which interact to drive disease progression. Lactylation, a novel epigenetic regulatory mechanism discovered in 2019, provides a fresh perspective for HACE research.

This study integrates the latest research findings on the pathophysiology of HACE, lactate metabolism, and the role of lactylation in hypoxia-related diseases (such as cancer and ischemic-hypoxic diseases). It focuses on analyzing the potential molecular mechanisms of lactylation in HACE, including its regulation of the HIF-1α/NF-κB axis, inflammation, and metabolism, and discusses existing lactylation regulation strategies.

In HACE, hypoxia-driven glycolysis elevates lactate, promoting protein lactylation (e.g., NuRD complex in microglia, which is correlated with proinflammatory cytokines). Lactylation may regulate HIF-1α/NF-κB axis, inflammation, and metabolism in HACE pathogenesis. Currently, methods such as the inhibition of lactate dehydrogenase (LDH) /monocarboxylate transporters and the use of histone deacetylase inhibitors have been proven effective in regulating lactylation.

Lactylation is a key link connecting metabolic disorders and neuroinflammation in HACE. However, the dual role of lactate in neuroprotection and neuroinjury under hypoxic conditions still requires further exploration. Future research should focus on deciphering the molecular networks related to HACE and developing precise intervention strategies to provide new directions for HACE treatment.