The role of pharmacists in disasters has been increasingly acknowledged, yet their responsibilities and core competencies for effective disaster management remain insufficiently defined, limiting their engagement. As pharmacists’ roles in clinical care expand, their involvement in disaster situations has similarly evolved. However, conventional pharmacy education in Taiwan currently lacks comprehensive training in disaster management. This study aims to elucidate pharmacists’ roles in disaster management and identify essential competencies, proposing a framework for advancing disaster-related education for pharmacists.

A qualitative study was conducted through semi-structured interviews from July 2024 to November 2024 with senior pharmacists from the Pharmaceutical Society of Taiwan, the Federation of Taiwan Pharmacists Association, and healthcare professionals from five disaster medical assistance teams. Participants were purposively selected, and the interviews explored pharmacists’ roles and required competencies in disaster contexts. Data were transcribed and analyzed via thematic analysis, with a second researcher contributing to enhance reliability. Preliminary findings were reviewed by participants to ensure validity.

Theoretical saturation was achieved after interviewing 15 participants. Nine categories of roles and their respective competencies were identified: understanding of disasters, self management, clinical pharmacy, pharmaceutical management, first-aid skills, psychological support, medical assistance, teamwork, and policy-making. These were consolidated into four key themes: basic disaster knowledge, pharmaceutical care in disasters, healthcare extension, and disaster management. These themes form a progressive structure for pharmacists’ education in disaster management, grounded in their professional expertise. It begins with the application and enhancement of existing knowledge based on an understanding of disasters and extends to other healthcare related services, ultimately progressing to disaster management.

The study identified the professional roles of pharmacists in disaster management, encompassing nine core competencies. This framework provides a basis for defining training objectives and structuring disaster preparedness programs for pharmacists.

Post-traumatic stress disorder (PTSD) may shorten life expectancy, but evidence for Asian populations and cause-specific mortality remains limited. The aim of this study is to investigate the association between PTSD and mortality risk in an Asian population.

We used Taiwan’s National Health Insurance Research Database (2000–2022) to assemble a cohort of 28,777 individuals with incident PTSD and 115,108 age- and sex-matched unexposed individuals, plus a sibling cohort of 13,305 affected patients and 22,030 unaffected siblings. Cox models estimated adjusted hazard ratios (AHRs) for all-cause, unnatural-cause (suicide and accidents) and natural-cause mortality, with progressive adjustment for sociodemographic factors, comorbidity and familial confounding. Subgroup analyses addressed five psychiatric comorbidities, sex and age (youth, adulthood and older adults).

Over a mean follow-up of 8 years, PTSD was associated with excess all-cause mortality (AHR = 1.32, 95% CI 1.24–1.41) driven by markedly increased unnatural deaths (AHR = 5.93, 5.13–6.85), especially suicide (AHR = 10.36, 8.41–12.76) and accidental deaths (AHR = 2.18, 1.67–2.86). Natural-cause mortality showed no consistent increase (AHR = 0.91, 0.85–0.98). In sibling analyses, excess risks persisted for all-cause (AHR = 2.48, 2.04–3.01), unnatural deaths (AHR = 4.76, 3.58–6.34) and suicide mortality (AHR = 7.90, 5.21–11.97), but not for accidents or natural causes. The risk patterns were similar across different psychiatric comorbidity strata and genders; suicide and unnatural-cause excess remained evident in all age groups.

PTSD was associated with elevated premature death risk in Taiwan, primarily through suicide and unnatural causes. Integrating targeted suicide-prevention into PTSD care pathways may be essential to reducing this avoidable mortality burden.

Most children recover from mild traumatic brain injury (mTBI), but some experience persistent neurocognitive effects. Understanding is limited due to methodological differences and a lack of pre-injury data. The study aimed to assess changes in neurocognitive outcomes in children following mTBI compared to orthopedic injury (OI) and non-injured (NI) controls, while accounting for pre-injury functioning.

Data were drawn from the Adolescent Brain and Cognitive Development (ABCD) study, a prospective longitudinal cohort. The sample included children with mTBI between the 1-year and 2-year follow-ups (n = 83), identified by parent report of head injury with memory loss or loss of consciousness, compared to children who experienced OI within the same period (n = 231) and an NI control group (n = 218). Changes in neurocognitive outcomes from baseline to the 2-year follow-up between groups (mTBI vs. OI; mTBI vs. NI) were estimated using linear mixed-effects models, accounting for demographic, behavioral, genetic, and white matter microstructural covariates.

At baseline prior to injury, the mTBI group demonstrated better performance on picture vocabulary and crystallized composite scores than the OI group. At post-injury, after adjusting for pre-injury baseline differences, children who sustained an mTBI were no different in any measure of neurocognitive outcomes compared to OI and NI controls.

The findings highlight the importance of accounting for pre-injury differences when evaluating neurocognitive outcomes following pediatric mTBI. Neurocognitive differences within a year post-injury may be more related to pre-existing individual factors rather than the injury itself, underscoring the need for a comprehensive approach in studying pediatric mTBI.

Euthymic bipolar disorder (euBD) patients exhibit deficits in neurocognitive and social cognitive functioning compared to healthy controls (HCs). Our prior research has shown that the excitatory/inhibitory (E/I) imbalance in the default mode network (DMN) is linked to executive function in euBD. Neurocognitive impairments are associated with social cognition deficits in individuals with mental disorders. Given this connection, this study posits E/I imbalance within the DMN is associated with social cognition, with executive function as a mediator.

Seventy-five HCs and 49 euBD individuals were recruited. Using the emotion recognition task, Diagnostic Analysis of Nonverbal Accuracy 2-Taiwan version (DANVA-2-TW) and cognitive flexibility task, Wisconsin Card Sorting Test (WCST), we assessed emotion recognition and prefrontal function. Proton magnetic resonance spectroscopy (1H-MRS) measured metabolites in the posterior cingulate cortex (PCC) and medial prefrontal cortex/anterior cingulate cortex (mPFC/ACC), quantifying excitatory glutamate+glutamine (Glx) and inhibitory GABA to calculate the E/I ratio.

euBD patients showed poorer emotion recognition (p = 0.020) and poorer cognitive flexibility (fewer WCST categories completed, p = 0.002). A negative association was found between emotion recognition and the E/I ratio in the mPFC/ACC of the BD patients (r = −0.30, p = 0.034), which was significantly mediated by cognitive flexibility (Z = −2.657, p = 0.007).

The BD patients demonstrate deficits in emotion recognition, linked to an altered E/I balance in the prefrontal cortex, and the cognitive flexibility, a key aspect of executive function, mediates the impact of the E/I ratio on emotion recognition accuracy in euBD patients.

Schizophrenia is associated with a reduced average lifespan due to accelerated ageing. Early studies have predominantly focused on the global brain age gap, limiting our understanding of region-specific ageing. Moreover, the relationship between accelerated ageing and schizophrenia disease progression has not been directly examined.

Our aim was to investigate the cortical spatiotemporal patterns in ageing and disease progression in schizophrenia.

Using multi-site, resting-state functional magnetic resonance imaging data, we analysed intrinsic activity fluctuations in 2353 healthy controls and 546 subjects with schizophrenia. We assessed normative models of ageing trajectories in brain activities in healthy controls, and examined the developmental trajectory of deviations from normative reference ranges with disease progression in schizophrenia.

The ageing trajectories of both groups demonstrated spatiotemporal variability unfolding along the sensorimotor–association cortical axis, characterised by a rapid decline in transmodal association cortices at younger ages and followed by an accelerated decline in primary cortices at older ages. However, schizophrenia exhibited a more rapid rate of decline across the entire cerebral cortex, particularly during the short-duration stage. Further analysis revealed that the spatial variability of disease-induced ageing deviations persisted along the sensorimotor–association cortical axis throughout disease progression. The premature involvement of neurotransmitter systems, including dopamine and serotonin, may underlie accelerated ageing.

Our work uncovers regional ageing trajectories organised along the sensorimotor–association cortical axis, and provides new insights into the mechanisms of atypical ageing and disease progression in schizophrenia.

Perimenopausal women often experience physiological and psychological decline due to the effects of oestrogen fluctuations and the decline of ovarian function, leading to significantly increased depression rates, decreases in the quality of life and mental health issues. Studies have shown that the gut microbiota exerts anti-perimenopausal depression (PMD) effects via the microbiota-gut-brain (MGB) axis, the mechanisms of which may be related to inflammation. In this review, we discuss the effects and mechanisms of gut microbiota in PMD and provide new insights for future PMD treatment.

This review elaborates on the role of MGB axis in PMD from different aspects of inflammation, including gut microbiota metabolites, inflammatory signaling pathways, and clinical applications.

Disorders of gut microbiota and decreased levels of gut microbiota metabolites (short-chain fatty acids, monoamine neurotransmitters) may cause PMD. The mechanism of intestinal microbiota-mediated inflammation may be related to TLR4/NF-κB pathway, NOD-like receptor protein 3 (NLRP3) inflammasome pathway and JAK-STAT pathway. At the same time, it was found that gut microbiota (probiotics, prebiotics, etc.) had good therapeutic potential in the treatment of PMD.

MGB axis mediated inflammation may play an important role in PMD. The application of gut microbiota in the treatment of PMD patients has profound clinical transformation value, but a lot of efforts are still needed.

Social determinants of health (SDHs) exert a significant influence on various health outcomes and disparities. This study aimed to explore the associations between combined SDHs and mortality, as well as adverse health outcomes among adults with depression.

The research included 48,897 participants with depression from the UK Biobank and 7,771 from the US National Health and Nutrition Examination Survey (NHANES). By calculating combined SDH scores based on 14 SDHs in the UK Biobank and 9 in the US NHANES, participants were categorized into favourable, medium and unfavourable SDH groups through tertiles. Cox regression models were used to evaluate the impact of combined SDHs on mortality (all-cause, cardiovascular disease [CVD] and cancer) in both cohorts, as well as incidences of CVD, cancer and dementia in the UK Biobank.

In the fully adjusted models, compared to the favourable SDH group, the hazard ratios for all-cause mortality were 1.81 (95% CI: 1.60–2.04) in the unfavourable SDH group in the UK Biobank cohort; 1.61 (95% CI: 1.31–1.98) in the medium SDH group and 2.19 (95% CI: 1.78–2.68) in the unfavourable SDH group in the US NHANES cohort. Moreover, higher levels of unfavourable SDHs were associated with increased mortality risk from CVD and cancer. Regarding disease incidence, they were significantly linked to higher incidences of CVD and dementia but not cancer in the UK Biobank.

Combined unfavourable SDHs were associated with elevated risks of mortality and adverse health outcomes among adults with depression, which suggested that assessing the combined impact of SDHs could serve as a key strategy in preventing and managing depression, ultimately helping to reduce the burden of disease.

Establishing appropriate action–outcome associations can allow animals and humans to control behavior and the environment in a goal-directed manner. Deficits in instrumental learning in psychosis have been widely reported in past studies, but the results remain elusive.

To explore the consistent neural representations of instrumental learning in functional magnetic resonance imaging (fMRI) in individuals with psychosis, a total of 18 studies (458 individuals with psychosis and 454 controls) were included in our coordinate-based meta-analysis.

Patients with psychosis presented increased activation in the left middle occipital gyrus, insula, and lingual and postcentral gyri; decreased activation in cortico-striato-thalamo-cortical (CSTC) networks, including the dorsal striatum, insula, thalamus, middle cingulate cortex, posterior cingulate cortex, dorsolateral, orbital, and medial prefrontal cortices (DLPFC, OFC, and mPFC), cerebellum, and associated sensory areas, during instrumental learning. Moreover, mPFC hypoactivation was negatively associated with the percentage of first-generation antipsychotic users, and insula hyperactivation was negatively associated with the percentage of medicated individuals.

Our study revealed that the CSTC circuit could facilitate action-based reward learning in psychosis and may help explain the neuropathological mechanisms underlying these deficits in this disorder.

As cities like Beijing expand rapidly, green and blue spaces (GBS)—essential for ecosystem services (ESs) such as clean air, flood control, and recreation—are increasingly threatened. This 20-year study examines how urban expansion and policy interventions have shaped Beijing’s GBS. While green initiatives have increased natural areas, unchecked urban sprawl has fragmented these spaces, reducing their environmental benefits. Satellite data and urban planning analyses underscore a key lesson: maintaining well-connected natural zones is critical for urban resilience. These findings are broadly applicable for rapidly growing cities globally, urging urban planners to integrate ecological conservation with development, and to safeguard healthy environments and vibrant communities.

This study quantifies the spatiotemporal dynamics of urban GBS in Beijing, evaluating their essential role in delivering ESs and strengthening urban resilience. Although China has achieved substantial progress in urban greening, the ecological impacts of rapid urbanization on GBS configuration and connectivity have not been comprehensively quantified. Using an integrated analytical framework combining principal component analysis and multiple linear regression, we reveal how urban development strategies have shaped GBS dynamics over two decades. A spatially explicit analysis, utilizing geographically weighted regression, further elucidates the heterogeneous relationships among the normalized difference vegetation index, human footprint index, and ESs delivery capacity. Notably, socioeconomic incentives and green infrastructure governance—especially objective indicators such as forest, garden, and greenspace area—have effectively driven GBS expansion. However, urban expansion has led to pronounced fragmentation of peri-urban GBS, suggesting potential degradation of their ecosystem service support functions. These findings emphasize the need for adaptive GBS management strategies that balance ecological conservation with sustainable urban growth in rapidly developing cities.

Urban growth fragments green and blue spaces, reducing vital ecosystem services. Balancing conservation with development is essential for sustainable cities.