BackgroundDementia care units offer specialized inpatient psychiatric treatment for persons living with dementia (PLWD). Given increasing numbers of PLWD and limited availability of dementia care units, it is crucial to clarify how these units can be used most efficiently.MethodsThe sample included data from 75 unique inpatient psychiatric hospitalizations for PLWD. Data were collected via retrospective chart review. Mixed random and fixed effects longitudinal analyses were run to identify significant predictors of length of psychiatric hospitalization.ResultsPredictors showing significant association included a change in living environment at time of discharge; an ED send out/admission to a general medical hospital; legal pursuits; and diagnostic evaluations pursued during the psychiatric hospitalization.ConclusionsDementia care units are effective in reducing neuropsychiatric symptoms for PLWD. This study highlights avenues for optimization of this care environment to allow for the maximum number of PLWD to receive specialized dementia care treatment.

Mental health courts (MHCs) are a growing component of the U.S. criminal justice system's response to individuals with mental illness. Yet, key aspects of contemporary MHC practices, such as eligibility criteria, assessment of risk-need-responsivity principles, integration of trauma-informed care, use of sanctions and incentives, and access to community resources, remain understudied. In response, we conducted a survey study of 70 U.S. adult MHCs to explore these domains. Our findings indicate broadened eligibility criteria, with increases in acceptance of violent offenses and greater inclusion of non-traditional primary diagnoses (e.g., developmental disabilities and traumatic brain injuries). Fewer than a quarter of respondents reported bilingual MHC staff and translated program materials. Most MHCs employed at least one risk assessment tool. Just over 90% of MHCs included jail sanctions on their menu of options, with the majority incarcerating participants for 6 days or less on average. Tailored sanctions and incentives were perceived as being most effective, but expansion of available incentives is hindered by lack of funding. MHCs identified housing, inpatient psychiatric units, and co-occurring disorders resources as the most needed resources for participants. Our findings highlight the differences across MHCs that persist across jurisdictions.

Difficulties in emotion regulation are recognized as transdiagnostic processes that contribute to psychological vulnerability, particularly under prolonged adversity such as long-term unemployment. This pilot study assessed the effectiveness of structured emotion regulation training in reducing psychological distress and promoting adaptive regulation strategies among individuals facing prolonged unemployment. Seventy-five adults were randomized to an intervention group (n = 30), which received Affect Regulation Training (ART), or a waitlist control group (n = 45). Participants completed validated self-report measures pre- and post-intervention, including the Beck Depression Inventory (BDI-II), Outcome Questionnaire (OQ-45.2), Psychological Well-Being Scale (PWBS), Positive and Negative Affect Schedule (PANAS), Difficulties in Emotion Regulation Scale (DERS), and Cognitive Emotion Regulation Questionnaire (CERQ). Compared with the waitlist control group, the intervention group showed reductions in depressive symptoms and psychological distress, along with improvements in emotion regulation and psychological well-being. These findings support the feasibility and preliminary efficacy of ART in vulnerable populations. This pilot trial provides initial evidence that an intervention targeting emotion regulation can enhance psychological functioning in individuals facing long-term unemployment. While further studies with larger, more diverse samples and longer-term follow-ups are needed, the present preliminary results point to the potential of ART as a scalable, low-intensity, transdiagnostic approach.

Pediatric firearm injuries represent a leading cause of morbidity and mortality in the USA, yet clinical care models for youth with firearm injuries remain fragmented and unstandardized. Unlike other serious pediatric conditions such as asthma and cancer, which benefit from established interdisciplinary care pathways, firearm injuries are often treated as isolated events without structured follow-up or coordinated support systems. This absence of standardized clinical guidelines reflects broader systemic biases in how these injuries are perceived and managed within health care. Drawing on the Injury Equity Framework and established chronic disease management models, we propose comprehensive, trauma-informed clinical guidelines for pediatric firearm injury care spanning primary, secondary, and tertiary prevention. These guidelines emphasize universal firearm safety screening integrated into routine pediatric visits, standardized protocols for acute trauma care with automatic interdisciplinary team activation, and structured longitudinal follow-up addressing medical, behavioral health, and social needs. By comparing current fragmented approaches to evidence-based care pathways used in asthma and cancer management, we identify critical gaps in continuity and comprehensiveness of firearm injury care and offer specific, actionable recommendations to close these gaps.

Comorbidities between mental disorders and irritable bowel syndrome (IBS) have been widely reported, yet associations between mental wellbeing and IBS, particularly regarding underlying genetic modification and proteomic signatures, remain underexplored.

This prospective cohort study analyzed 75,842 IBS-free participants aiming to investigate the prospective association between mental wellbeing and the risk of IBS in UK Biobank. Mental wellbeing was assessed through life satisfaction, positive affect, neuroticism, and depressive/anxiety symptoms. Cox models evaluate the hazard ratio (HR) for mental wellbeing and plasma proteome in relation to incident IBS during follow-up. Proteomic profiling identified mental wellbeing-associated proteins, with pathway enrichment analysis revealing biological mechanisms. Mediation and Mendelian randomization analyses further examine intermediate pathways and causality.

With a 12.4-year follow-up period, 1,400 cases of incident IBS were documented. Better mental wellbeing mitigated IBS risk dose-dependently (low risk group: HR, 0.37; 95% confidence interval [CI]: 0.31-0.43). Higher life satisfaction (HR, 0.41; 95% CI: 0.30-0.56) and positive affect (HR, 0.50; 95% CI: 0.41-0.62) were inversely associated with IBS risk, whereas neuroticism (HR, 2.35; 95% CI: 1.92-2.88) and depressive/anxiety symptoms (HR, 3.09; 95% CI: 2.17-4.42) increased the risk. Findings remained consistent in across prevalent IBS and IBS subtypes. Mental wellbeing effects were independent of genetic predisposition. Mediation analyses revealed about 27% of protective effect of mental wellbeing were mediated through reduced depression and anxiety. Mendelian randomization supports causal protective effects of positive mental wellbeing on IBS. Proteomic profiling identified mental wellbeing-associated proteins mainly enriched in cytokine-cytokine receptor interactions. Chromogranin A and gastrin emerged as key protein biomarkers, showing significant associations with both mental wellbeing components and IBS risk.

Our study demonstrates that enhanced mental wellbeing confers substantial protection against IBS development, highlighting psychological interventions as potential primary prevention strategies.

Attention-deficit/hyperactivity disorder (ADHD) affects up to 10% of children, often presenting with emotional dysregulation (irritability, anger). The kynurenine pathway, by which the amino acid tryptophan is converted into both neuroprotective and neurotoxic metabolites, was investigated for its role in ADHD pathophysiology. The MADDY study was an 8-week, multi-site, randomized controlled trial of a multinutrient supplement versus placebo in children 6-12 years old with symptoms of ADHD and emotional dysregulation. Participants from two U.S. sites (n = 84) provided baseline and week 8 urinary samples, analyzed via liquid chromatography-mass spectrometry for neurotransmitter levels. Linear mixed-effects models assessed change over time for seven analytes. Missing values were imputed, and results adjusted for multiple comparisons. Baseline neurotransmitter concentrations were not different between treatment groups. Changes over time in the seven analytes were not different between treatment groups. Nine participants had neurotransmitter levels below the lower limit of detection and were imputed; demographic characteristics were not different between these and other participants. Eight weeks of multinutrient supplementation did not change concentrations of urinary tryptophan, serotonin, or kynurenines in this sample of children 6-12 years old with ADHD and emotional dysregulation.

The hexosamine biosynthesis pathway (HBP) is a nutrient-sensitive branch of glucose metabolism that produces UDP-GlcNAc, a central substrate for protein glycosylation. Growing evidence links altered HBP activity to breast cancer (BC) progression and treatment response. However, the strength of evidence differs across tumor subtypes and across experimental versus patient data. This review summarizes current clinical and preclinical evidence on how HBP enzymes and HBP-derived glycosylation contribute to BC biology. Across BC cohorts and experimental models, increased expression of key HBP components has been associated with aggressive features, while mechanistic studies show that HBP activity can support oncogenic signaling through elevated O-GlcNAcylation of regulatory proteins. Work in BC models further indicates that HBP-related changes influence proliferation, survival, epithelial-mesenchymal transition, migration, and invasion, and may interact with pathways such as PI3K/AKT/mTOR, Wnt/β-catenin, and YAP. Evidence discussed in this review also links HBP output to stress-adaptation programs, including DNA damage responses and ER protein-folding capacity via N-linked glycosylation, which can promote survival under nutrient or therapy stress. Therapeutic studies described here include direct and indirect strategies to reduce HBP output, such as targeting pathway enzymes, modulating O-GlcNAc cycling, and using hexosamine analogs designed to disrupt flux or glycan function; these approaches reduce growth and metastatic behavior in several preclinical settings, but specificity and normal-tissue tolerance remain key constraints. Overall, the literature supports HBP as a plausible metabolic contributor to BC progression, but stronger patient-linked validation is needed. Future work should prioritize subtype-resolved clinical studies and direct measures of pathway activity to guide biomarker development and therapeutic targeting.

The Mediterranean diet (MD) has been associated with better glycaemic control in children with type 1 diabetes mellitus (T1DM) and favourable microbiome profiles in healthy individuals. However, it remains unclear whether MD adherence is associated with glycaemic control via microbiome. This study examined the relationships among MD adherence, gut microbiome, and glycaemic control in adults with T1DM and assessed the microbiome's ability to predict clinical and dietary outcomes.

In a cross-sectional study of 253 adults with T1DM, dietary intake was assessed using the EPIC food frequency questionnaire, and MD adherence was measured using the rMED score. Participants were stratified by adherence level (low, medium, high). Glycaemic control was evaluated using HbA1c and CGM metrics. Shotgun metagenomic sequencing of stool samples (n = 103) assessed the gut microbiome. Statistical analyses included ANOVA, PERMANOVA, LEfSe, and machine learning modeling. Higher MD adherence was associated with lower HbA1c levels (7.1 % vs 7.7 %; p < 0.001), greater time in range (67.0 % vs 59.4 %; p-trend = 0.03), and higher HDL cholesterol (1.62 vs 1.39 mmol/L; p = 0.01). High MD adherence was linked to a greater abundance of bacterial species such as Faecalibacterium prausnitzii. Both high MD adherence and lower HbA1c were associated with distinct microbiome functional pathways. Microbiome-based machine learning models predicted dietary patterns and clinical metrics.

In adults with T1DM, greater MD adherence is associated with better glycaemic control and a favourable gut microbiome. Specific microbial pathways may underlie these associations. Integrating diet and microbiome data supports personalized care. The study was registered at ClinicalTrials.gov with the identifier NCT05936242.