Sigma power and sleep spindles are key elements of Non-Rapid Eye Movement (NREM) sleep. They reflect anatomical and physiological properties of brain circuits, are linked with various behavioral outcomes in typically development (TD) children, and undergo significant modifications during development. Furthermore, recent studies have highlighted the potential of NREM sigma power and sleep spindles as early neurophysiological markers for autism spectrum disability (ASD). Here, we conducted polysomnography (PSG)/EEG recordings during afternoon naps on 50 children aged between 2 and 6 years, diagnosed with ASD or TD. EEG recordings from 19 scalp leads were analyzed, focusing on sigma power and sleep spindle parameters. EEG analyses revealed significant differences in power spectral density between ASD and TD children, particularly in the sigma band and adjacent alpha and beta bands, with increased power localized to anterior EEG leads in ASD children. Higher spindle amplitude and integrated spindle activity (ISA) were found in the ASD group, especially in frontal regions. Additional frequency-specific analyses (10-12 Hz, 12-14 Hz, 14-16 Hz) confirmed significant differences in spindle amplitude and distribution patterns, emphasizing the role of brain regions that are detectable from anterior EEG leads in ASD-related sleep abnormalities. No significant differences were found in spindle density, duration, or frequency outside specific clusters. These findings indicate that some sleep spindle parameters, particularly in frontal areas, are altered in ASD. The study highlights the feasibility of using afternoon nap PSG as a practical and effective method to detect these abnormalities in clinical settings. Future research should investigate the developmental trajectory of spindles in ASD and their potential role as neurophysiological biomarkers, offering valuable insights for diagnosis and prognosis.

Surgical menopause, the removal of both ovaries prior to natural menopause, may impact short-and long-term physical and emotional health. An increasingly common cause of surgical menopause is risk-reducing salpingo-oophorectomy (RRSO) in those at high inherited risk of ovarian cancer. The WHAM (What Happens After Menopause?) study is the largest prospective controlled study of RRSO. It measured the effect of RRSO compared to controls on physical and mental health over 2 years, and the potential modifying effects of menopausal hormone therapy (MHT). WHAM consists of 104 premenopausal women with BRCA1/2 pathogenic variants undergoing RRSO and 102 age-matched comparators who retained their ovaries. Outcomes including sexual function, vasomotor symptoms, cognition, mood, cardiometabolic health and bone health were measured between baseline and 24 months. MHT uptake after RRSO and the impact of MHT on these outcomes were assessed. Findings of WHAM have been published in more than ten manuscripts. Key findings include that RRSO adversely affects sexual function, sleep, and mood compared to comparison women. After RRSO, vasomotor symptoms (VMS) are generally mild, peak at 3 months, and do not worsen by 24 months. MHT reduces but does not resolve VMS. Loss of bone density was observed at 24 months and was partially mitigated by MHT. Cardiometabolic health and cognition were largely maintained at 24 months. This manuscript summarises the published findings of WHAM. These unique data will enhance evidence-based care in surgical menopause and will support shared decision-making around RRSO, ensuring rapid translation of new evidence into clinical practice. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry: registration no: ACTRN12615000082505; anzctr.org.au.

The National Institute of Health (NIH) Undiagnosed Diseases Program (UDP) is an NIH project with the goal of providing both a comprehensive diagnosis and a better understanding of the many mechanisms of disease for patients with rare and undiagnosed conditions. Patients accepted to the program receive a careful review of their medical records and a tailored inpatient evaluation at the NIH Clinical Center in Bethesda, MD. For the pediatric population, systematic neurodevelopmental phenotypic evaluations are included. Here we report neurodevelopmental phenotyping data on pediatric participants enrolled in the NIH UDP from 2009 to 2019, with genetic findings reported through 2025. Results for 219 pediatric participants included a high rate of intellectual disability, with 27% of the sample in the severe-to-profound range. The phenotype often included multisystemic involvement, with motor impairments as well as vision and hearing concerns. For the 46% for whom a genetic diagnosis was made, there was greater impairment, including more severe intellectual disability and more frequent motor impairments as well as minimal verbal status. This study documented that severe neurodevelopmental impairments are frequently present in the unique pediatric undiagnosed patients enrolled in NIH UDP; the diagnosis of a genetic condition was associated with greater impairment.

Most mental health difficulties have their onset in early adolescence. Increasingly, community based primary care is recognised as a critical pathway to early intervention. Despite encouraging initial evaluations, there is an ongoing need for evidence of the outcomes of primary care youth mental health programmes delivered at scale. This brief report examines reliable improvements in psychological distress and user satisfaction data from a national primary care youth mental health programme in the sustainment phase of implementation.

This report takes a multi-methods approach to routine evaluation data. Young people (aged 12-25; N = 8,721) completed Clinical Outcomes Routine Evaluation (CORE-10 and YP-CORE) pre- and post-treatment. Clinical cut offs and a reliable change index (based on established guidelines) were used to report rates of reliable improvement. The analysis examined differences in outcomes based on age, gender, and clinical need. Satisfaction was measured using the youth service satisfaction survey (N = 4,267). Natural language processing techniques were employed to objectively analyse qualitative user feedback.

Most young people presented in the clinical range, with almost two-thirds reporting moderate to severe distress. Statistically significant reductions in distress were observed with large effect sizes (d = 1.08-1.28). Young people in the clinical range demonstrated significantly higher rates of reliable improvement compared to those who presented in the healthy range. In line with similar evaluations, young adults were more likely to achieve improvement and report higher satisfaction. Sentiment analysis of satisfaction data indicated a strong skew towards positive sentiment, with trust, anticipation and joy being predominant. Qualitative feedback pointed to waiting times as an improvement area.

The absence of a control group limits our ability to evaluate the effectiveness of the service interventions. Nonetheless after a decade of service delivery, these results indicate that large scale national youth mental health programmes can achieve satisfaction and clinical outcomes in line with international standards. Further research is needed on the predictors of reliable change, differences across demographic groups and approaches to improving waiting times in primary care.

The use of community treatment orders (CTOs) has increased in many jurisdictions despite very limited evidence for their efficacy. In this context, it is important to investigate any differences in outcome by subgroup.

To investigate the variables associated with CTO placement and the impact of CTOs on admissions and bed-days over the following 12 months, including differences by diagnosis.

Cases and controls from a complete jurisdiction, the state of Queensland, Australia, were analysed. Administrative health data were matched by age, sex and time of hospital discharge (index date) with two controls per case subject to a CTO. Multivariate analyses were used to examine factors associated with CTOs, as well as the impact on admissions and bed-days over the 12 months after CTO placement. Registration: Australian and New Zealand Clinical Trials Registry (ACTRN12624000152527).

We identified 10 872 cases and 21 710 controls from January 2018 to December 2022 (total n = 32 582). CTO use was more likely in First Nations people (adjusted odds ratio = 1.14; 95% CI: 1.06-1.23), people from culturally diverse backgrounds (adjusted odds ratio = 1.45; 95% CI: 1.33-1.59) and those with a preferred language other than English (adjusted odds ratio = 1.21; 95% CI: 1.02-1.44). When all diagnostic groups were considered, there were no differences in subsequent admissions or bed-days between cases and controls. However, both re-admissions and bed-days were significantly reduced for CTO cases compared with controls in analyses restricted to non-affective psychoses (e.g. adjusted odds ratio = 0.77, 95% CI: 0.71-0.84 for re-admission).

Queenslanders from culturally or linguistically diverse backgrounds and First Nations peoples are more likely to be placed on CTOs. Targeting CTO use to people with non-affective psychosis would both address rising CTO rates and mean that people placed on these orders derive possible benefit. This has implications for both clinical practice and policy.

This study adopted a prospective longitudinal design to assess the utility of demographic and medical characteristics routinely available to emergency medicine clinicians to predict the development of posttraumatic stress disorder (PTSD) in children exposed to death or serious injury 2 months following emergency department (ED) attendance.

A sample of children (8-17 years; N = 231) were recruited from 4 EDs in the East of England between 2010 and 2013. Within 2 weeks of attendance, research nurses screened records for appropriate cases and recorded information on relevant variables from ED attendance notes. At 2 months, a research assistant carried out a structured clinical interview to assess their Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) PTSD symptoms. Univariate analyses were conducted to compare ED characteristics between children who developed PTSD and those who did not. Logistic regression models were used to identify variables associated with increased risk of PTSD.

Ten percent of children met the criteria for PTSD at 2 months. Systolic blood pressure, pulse, number of injuries, being subjected to interpersonal violence, and having a head injury were variables that distinguished PTSD and non-PTSD groups. Logistic regression models showed that being assaulted was predictive of PTSD (Odds ratio = 5.07, 95% CI [1.51, 17.00]); although these models had excellent specificity (0.96), the sensitivity was poor (0.30)-that is, there were a number of cases who developed PTSD but were not assaulted.

PTSD is a complication of exposure to death or injury that occurs in a significant minority of children. Children who are victims of interpersonal violence are more likely to develop the disorder.

A novel physio-marker, termed "cerebrovascular dynamics index" (CDI), was developed and evaluated in a multi-center National Institutes of Health (NIH)-funded study for improved diagnosis of mild cognitive impairment (MCI) and its transition to Alzheimer's disease (AD).

The CDI quantifies the regulation dynamics of cerebral perfusion and oxygenation (which adjust autonomously blood flow and oxygen delivery over time) through predictive dynamic modeling using relevant time-series data.

Cross-sectional results demonstrated excellent diagnostic performance of CDI in differentiating 90 MCI/AD patients from 77 controls (area under the curve (AUC) =  0.96), which surpassed the commonly used biomarker of amyloid positron emission tomography-standardized uptake value ratio (PET-SUVR) (AUC = 0.78) or cognitive screening tests of Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) (AUC = 0.91 and 0.92, respectively). The CDI can also be used for disease staging because it differentiated 56 MCI from 34 mild AD participants (AUC = 0.98).

These findings offer the promise of a high-performance diagnostic physio-marker for MCI and AD, which can be obtained in a comfortable, rapid, and automated manner in clinical settings.

Novel physio-marker (cerebrovascular dynamics index [CDI]) quantifies the regulation dynamics of cerebral perfusion.The CDI was shown to improve mild cognitive impairment/Alzheimer's disease (MCI/AD) diagnosis (area under the curve [AUC] >0.95) relative to existing markers.The CDI is obtained non-invasively, objectively, rapidly, and inexpensively.The CDI performance supports the key role of cerebrovascular dysfunction in AD.The CDI is obtained via dynamic modeling of hemodynamic/oxygenation time-series data.

Myxedema crisis is a life-threatening manifestation of severe, decompensated hypothyroidism. It often presents insidiously with altered mental status, hypothermia, hypotension, bradycardia, and hypoglycemia. Sheehan syndrome is a rare but important cause of hypopituitarism, resulting from ischemic necrosis of the anterior pituitary due to severe postpartum hemorrhage. The condition may remain undiagnosed for years, with subtle symptoms gradually progressing to full-blown endocrine crises during physiological stress. We report the case of a 48-year-old woman who presented with sudden unconsciousness, hypotension, bradycardia, hypoglycemia, and hyponatremia. Her obstetric history revealed massive postpartum hemorrhage 15 years back, followed by failure of lactation and secondary amenorrhea. Physical examination revealed madarosis. Laboratory investigations confirmed central hypothyroidism and secondary adrenal insufficiency. Magnetic resonance imaging (MRI) of brain showed an empty sella turcica, supporting the diagnosis of Sheehan syndrome. She was managed with intravenous hydrocortisone and replacement dose of levothyroxine. Considering the clinical deterioration after initial improvement, levothyroxine 500 μg loading dose was given, suspecting myxedema coma, which lead to gradual improvement of sensorium and hemodynamic status. This case highlights the importance of considering myxedema coma in women with Sheehan syndrome, especially in the setting of an unexplained altered sensorium even after hydrocortisone supplementation.

Suicide remains a major public health concern, although most individuals who experience suicidal thoughts and ideations have contacted primary care shortly before committing suicide. This systematic review highlights the importance of suicide risk screening and prevention interventions in primary care contexts. Nevertheless, despite the different primary care practices being widely employed in the screening of different mental health concerns, including depression, most individuals feel unprepared or uncomfortable with screening for suicide risk. Therefore, the objective of this study is to systematically examine and synthesize existing evidence on the relationship between suicide-related outcomes (including suicidal ideation, suicide attempts, and suicide deaths) and primary care outpatient visits, with particular emphasis on the impact of mental health screening and intervention practices implemented within these settings. To attain the objective, a systematic search was conducted in PubMed, Google Scholar, Web of Science, Scopus, and Embase for peer-reviewed studies published between 2010 and 2025. Studies were included if they examined suicide-related outcomes (ideation, attempts, or death) in relation to primary care visits and incorporated data on mental health screening or interventions in these settings. Two reviewers independently screened articles, extracted data, and assessed methodological quality using standardized tools. Due to study heterogeneity, a narrative synthesis was used. Thus, of the 15 studies meeting inclusion criteria, most reported that a significant proportion of individuals who died by suicide had contact with primary care providers within one year before death. However, the implementation of mental health screening or suicide risk assessments during these visits was inconsistent. Studies that incorporated structured screening tools or brief interventions within primary care showed a potential reduction in suicide-related outcomes, although evidence quality varied. Primary care outpatient visits represent a pivotal point for suicide prevention. Enhanced integration of mental health screening and intervention practices in these settings may improve early detection and reduce suicide risk. Further high-quality, longitudinal research is needed to establish effective strategies for routine suicide prevention in primary care.

Prison population around the globe tends be among the most marginalized population groups. Many of these persons struggle with numerous health problems, primarily with infectious diseases and mental disorders. Our goal was to analyse morbidity of prisoners compared to age- and gender-matched controls.

Case-control study based on administrative data of healthcare utilisation in Hungary between 2017 and 2019.

Patient numbers by ICD-10 chapters and tabulation lists of diagnosis (morbidity groups) were obtained from the government-funded single payer health insurance institute. Convicts were compared to controls matched by age and gender in a 5:1 ratio.

The leading causes of healthcare utilisation of prisoners compared to controls by ICD-10 chapters were mental and behavioural disorders and external causes of morbidity, but the relative risk of healthcare use due to infectious diseases was not elevated. When investigating data at a more detailed level, that is, by morbidity groups, the relative risk of healthcare utilisation due to 19 out of a total of 299 morbidity groups was significantly, more than 3 times higher among prisoners compared to controls, and the first five highest relative risks were all due to external causes of injury.

The leading causes of morbidity among persons in prisons based on health care utilisation seems to be somewhat different from morbidity patterns identified by other methods such as clinical interviews, screening or estimations. Causes of health care utilisation both at ICD chapter and morbidity group-level is one of several relevant indicators of the health care needs of prison populations that uncovers the groups of most severe maladies among them. However, other sources of data should also be taken into account for the development of effective preventive and rehabilitative interventions. Follow-up of prisoner patients treated in health care would also be recommended to aid rehabilitation.