The excitation–inhibition (E/I) imbalance is a major pathological characteristic of major depressive disorder (MDD). However, whether/how electroconvulsive therapy (ECT) modulates neuronal homeostasis or E/I balance in MDD and its molecular basis is still largely unknown.

In this study, longitudinal rs-fMRI data from 46 patients with MDD receiving ECT and 46 healthy controls were included. The Hurst index was used to characterize the E/I balance, and mixed-effects model was constructed to assess the interactive effects of ECT on the Hurst index and functional connectivity (FC). Moreover, spatial correlation analyses were conducted by integrating cortical myelination pattern, glucose metabolism distribution, neurotransmitter density maps, and transcriptomic data to reveal the underlying molecular basis.

ECT significantly reduces the Hurst index in the middle cingulate cortex (MCC) and induces functional decoupling between the MCC and the posterior cingulate cortex. Furthermore, changes in the Hurst index were closely associated with cortical myelination, glucose metabolism, and the distribution maps of dopamine and histamine. Spatial transcriptomic association analysis revealed that genes regulating the effects of ECT on Hurst index or FC are specifically enriched in cell types such as excitatory neurons, astrocytes, and oligodendrocytes, and are primarily involved in biological processes including synaptic signal transduction, neuronal projection regulation, and glutamatergic synapses.

These findings suggest that ECT may regulate the processes of myelin remodelling through neurons and glial cells by influencing the expression levels of relevant genes, thereby modulating the E/I balance and functional network activity in a synergistic manner to improve depressive symptoms.

To systematically identify and prioritize age- and sex-specific modifiable risk factors for incident depression, and to characterize integrated risk patterns to pinpoint high-risk populations across different life stages.

Using data from 428,078 participants in a cohort, incident depression was identified using hospital records. Cox proportional hazards models were applied to assess age- (the middle-aged, quinquagenarian and the elderly) and sex-specific (females and males) associations between modifiable risk factors and depression incidence. Population-attributable fractions (PAFs) prioritized predominant factors, and self-organizing maps (SOMs) visualized integrated risk patterns. Mendelian randomization (MR) analyses examined potential causal associations between top-ranked factors and depression risk.

During a mean follow-up of 13.11 years, 15,106 (3.53%) participants developed depression. Hazard ratios for modifiable factors were similar between sexes but varied by age. Generally, the overall PAFs decreased with age (PAF of 83.47% in the middle-aged, 82.96% in the quinquagenarian and 76.77% in the elderly). Health-related factors consistently showed the highest PAFs (33.46–38.12%) across all age subgroups and females, driven by weak grip strength (12.60–18.09%) and unhealthy body mass index (6.94–7.80%). Socioeconomic factors ranked first in males (24.55%), with unemployment contributing the most (9.27%). Lifestyle factors ranked second in younger groups and females, led by poor sleep quality and smoking. Environmental exposure and social support were the last two risk profiles across all subgroups, jointly contributing to about 12% of PAF. SOM integrated patterns predominated by less social support and low socioeconomic status increased depression risk up to 4.37-fold. Potential causal associations between the top five risk factors and depression were observed by MR analyses.

Health condition, socioeconomic status and lifestyle factors demonstrated stronger associations and greater PAFs for depression among relatively younger adults, pinpointing the importance of targeting these impactful factors from an earlier age.

Prior observational studies have reported conflicting results regarding whether antidepressant treatment reduces long-term dementia risk, likely due to confounding by indication and reverse causation. We aimed to investigate the association between baseline antidepressant use and incident dementia, incorporating cognitive and neuroimaging outcomes.

We conducted a prospective cohort study using UK Biobank participants free of dementia at baseline. Antidepressant use was self-reported at baseline (2006–2010). Incident dementia was identified through linked electronic health records until December 19, 2022. Cox proportional hazards models estimated hazard ratios (HRs) for all-cause dementia, Alzheimer’s disease (AD), and vascular dementia (VD), adjusting for sociodemographic, lifestyle, health-related, antidepressant indication factors, and co-medication of other anticholinergics. In subsamples, cognitive performance (n = 57,330) and structural brain imaging (n = 42,276) were examined as intermediate outcomes.

Among 461,464 participants, 33,721 (7.3%) reported baseline antidepressant use. Over a mean follow-up of 13.4 years, 7,922 (1.7%) developed incident dementia. Baseline antidepressant use was associated with higher risks of all-cause dementia (adjusted HR: 1.47, 95% CI 1.36–1.60), AD (1.53, 1.36–1.73), and VD (1.44, 1.23–1.70). Users performed worse on fluid intelligence and prospective memory tasks and showed lower total and gray matter volume, regional reductions in the hippocampal gray matter and basal nucleus, and greater white matter hyperintensity volume.

Baseline antidepressant use was linked to a higher risk of dementia, poorer cognitive performance, and adverse brain structural changes. These findings underscore the importance of judicious prescribing, regular cognitive monitoring, and consideration of non-pharmacological approaches in clinical care.

Although home is frequently the preferred place of death, little is known regarding how home healthcare (HHC) influences this outcome for people with dementia (PWD), particularly within Asian contexts. This study investigates the impact of HHC and its 2016 “Integrated Home-Based Medical Care” reform on home death in Taiwan, explicitly accounting for the cultural phenomenon of “impending death discharge.”

This nationwide retrospective cohort study utilized Taiwan’s National Health Insurance Research Database. We identified PWD decedents from 2011 to 2022 and conducted a nested case–control analysis. Cases (home deaths) and controls (hospital deaths) were matched 1:1 using propensity scores to balance demographics and health status. HHC models included pre-2016 primary HHC, post-2016 primary HHC, and the reformed “HBPC Plus” (Home-Based Primary Care Plus). The outcome was adjusted to include patients discharged terminally to die at home, reflecting distinctive cultural practices.

Among 209,468 decedents, 95,594 were selected after matching. Overall, HHC use was associated with higher odds of home death (adjusted odds ratio [aOR]: 1.17; 95% CI: 1.13–1.21). The reformed HBPC Plus program showed the strongest association compared to pre-2016 primary HHC (aOR: 1.63; 95% CI: 1.34–1.98). Crucially, this association strengthened further when accounting for impending death discharge (aOR: 1.82; 95% CI: 1.40–2.35). Higher visit frequency and services from hospital-based teams were also significantly linked to home death.

HHC significantly increases the likelihood of home death among PWD in culturally influenced contexts. The 2016 reform, particularly the HBPC Plus program, proved highly effective. Policy components like flexible visit frequencies and enhanced hospital–physician coordination appear vital for supporting end-of-life care at home, offering key insights for policy planning in aging societies.

Cognitive impairment in first-episode schizophrenia (FES) is a major contributor to functional decline, but antipsychotics provide limited cognitive improvement, and few repetitive transcranial magnetic stimulation (rTMS) studies have targeted the orbitofrontal cortex (OFC). This study investigated whether right OFC rTMS enhances specific cognitive functions in FES and its relationship with symptom reduction.

Ninety drug-naive FES patients were enrolled, with 48 receiving active right OFC rTMS and 42 sham stimulation for 20 sessions over 8 weeks, while all patients took olanzapine (10–20 mg/day). Cognitive function was assessed using the Chinese version of the MATRICS Consensus Cognitive Battery (MCCB) at baseline and week 4, and psychotic symptoms were rated with the Positive and Negative Syndrome Scale (PANSS).

Repeated-measures analysis of variance (RMANOVA) demonstrated a significant Time×Group interaction for visuospatial memory (assessed via the Brief Visuospatial Memory Test-Revised, BVMT; F = 5.079, df = 1, 83, p = 0.027, η2 = 0.058). Post hoc tests revealed significant BVMT improvement in the active group (p < 0.001) but not in the sham group (p = 0.312). In the active group, improvements in BVMT and Neuropsychological Assessment Battery (NAB) scores were significantly correlated with lower PANSS total scores after Bonferroni correction.

These findings indicate that right OFC rTMS improves specific cognitive functions in FES, with cognitive benefits associated with symptom alleviation, supporting the right OFC as a promising target for cognitive intervention in FES.

Emergency medical technicians (EMTs) often perform patient-handling tasks in emergency settings, posing a high risk of occupational injury. The prevalence of Work-Related Musculoskeletal Disorders (WRMSD) among EMTs has been underestimated due to the lower reporting rate of WRMSD events in Taiwan. This study employed a nationwide safety manual handling survey by integrating the health belief model (HBM) and the transtheoretical model (TTM) to examine behavioral factors influencing the adoption of safety manual handling skills among EMTs.

A cross-sectional study was conducted among frontline EMTs in Taiwan, including full-time and volunteer EMTs from fire departments in Taiwan. Data on individual characteristics, WRMSD experiences, six factors of measuring attitude toward safety handling, and behavioral change stages to adopting safety handling via a questionnaire were analyzed using descriptive statistics and multinomial logistic regression to determine the impact of each factor on adopting safe handling techniques.

A total of 761 participants completed the questionnaire. The lower back was the most frequent WRMSD body part among participants. The most frequent type of patient handling-related injuries was strain/sprain (88.4%). The patient handling-related injuries occurred within 5.3 years after career initiation in 76.9% of participants. The results also indicated that higher perceived benefits and lower perceived barriers increase the odds of being in all TTM stages. The cue to action level was also a predictor for investigating the likelihood of being in each stage of change compared to the reference category.

Promoting the adoption of safety handling skills is a long-term battle in improving occupational health and safety among EMTs. Perceived benefits, perceived barriers, and cues to action may be the critical factors for designing and implementing the interventions in the future. Future interventions should focus on letting EMTs understand the benefits and barriers of conducting safety manual handling and provide clear, real-world guidance.

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.

Significant changes in Taiwan’s psychiatric services over recent decades include expansion of community-based clinics and implementation of the Schizophrenia Pay-for-Performance programme.

This study aimed to assess the trend of the quality of healthcare for individuals with schizophrenia, using various indicators of the treatment process and outcomes between 2010 and 2019.

Individuals with schizophrenia were identified using Taiwan’s National Health Insurance claims database. The quality of healthcare for individuals with schizophrenia was assessed using treatment process and outcome indicators, including antipsychotic types, medication adherence, daily dose for antipsychotics and concurrent use of other psychotropic agents. Outcome indicators included all-cause mortality, suicide deaths, psychiatric hospitalisation, emergency department visits and employment status.

Antipsychotic medication usage has shifted towards second-generation antipsychotics (SGAs) and long-acting injectable antipsychotics (LAIs), with declines in first-generation antipsychotics. The percentage of medication adherence declined, while that of individuals with an adequate daily dose increased. Concurrently, anticholinergic and benzodiazepine use decreased while antidepressant and mood stabiliser use increased. Outcome indicators showed no significant change in all-cause mortality or suicide rates over time, but there were reductions in psychiatric hospitalisations and emergency department visits. Employment rates increased overall, particularly in urban areas.

The quality of healthcare for individuals with schizophrenia, as measured by treatment process and outcome indicators, improved alongside changes in Taiwan’s psychiatric services; however, causality cannot be inferred from our findings. Future research should evaluate the effectiveness of psychiatric service policies and continuously monitor healthcare quality to further enhance the lives of individuals with schizophrenia.

Antimicrobial resistance (AMR) is a global health crisis exacerbated by policies like China’s Volume-Based Procurement (VBP), which may inadvertently increase antimicrobial overuse. This study evaluates a clinical pharmacist-led Antimicrobial Stewardship (AMS) program with prospective audit for special-restricted antimicrobials under VBP.

A retrospective quasi-experimental interrupted time-series analysis compared pre-intervention (2022) and post-intervention (2023–2024) data at Tongji Hospital, a tertiary hospital in Wuhan, China. Key metrics included Antimicrobial Use Density (AUD), prescription rationality, antimicrobial costs, and multidrug-resistant infection rates.

The intervention significantly improved prescription appropriateness for special-restricted antimicrobials (80.24% vs. 93.83%, P < 0.005) and reduced AUD (47.87 vs. 34.25, P < 0.001). Total antimicrobial costs decreased by 41.26%, with a reduction in the incidence of multidrug-resistant infections from 0.084% to 0.062% (P < 0.05). Carbapenem use correlated with CRKP isolation rates (R = 0.62, P < 0.05). Clinical pharmacists rejected 10.24% of prescriptions, all accepted by physicians.

Pharmacist-led prospective audits optimize antimicrobial use under VBP, mitigate resistance risks, and reduce costs, while acknowledging that concurrent infection control measures may have contributed to these trends. This model may inform similar interventions in other institutions, particularly those in resource-limited settings.