Postoperative nausea and vomiting (PONV) after orthognathic surgery is a serious postoperative complication. The cholinergic receptor muscarinic 3 (CHRM3) rs2165870 and tachykinin receptor 1 (TACR1) rs3755468 single-nucleotide polymorphisms (SNPs) have been reported to be involved in PONV. We evaluated the impact of these SNPs on PONV in a Japanese population who underwent orthognathic surgery under PONV prophylaxis with the 5-hydroxytryptamine (serotonin) receptor 3A receptor antagonist ondansetron. In 121 patients, dexamethasone was administered after intubation, followed by ondansetron before the end of surgery. An 11-point numeric rating scale (NRS) score for PONV (0-2 h or 2-24 h after anesthesia endpoint [a.a.e.]) and the presence or absence of metoclopramide administration (0-2 h or 2-24 h a.a.e.) were evaluated. If patients complained of PONV and had an NRS score ≥ 4, then metoclopramide was administered intravenously for PONV rescue. Patients were genotyped for the CHRM3 rs2165870 and TACR1 rs3755468 SNPs, followed by the statistical analysis of associations between these SNPs and phenotypes. AA carriers of CHRM3 rs2165870 received metoclopramide at a significantly higher rate (P = 2.48 × 10^- 2) and had higher NRS scores (P = 3.40 × 10^- 2) under a diminished influence of ondansetron than GG and GA carriers. CC carriers of TACR1 rs3755468 had significantly higher NRS scores under the sufficient influence of ondansetron than CT and TT carriers (P = 9.97 × 10^- 3). Numeric rating scale scores showed a significant interaction between "time" (the effect of ondansetron) and "genotype" (two-way analysis of variance, P = 4.39 × 10^- 2). AA carriers of CHRM3 rs2165870 were significantly associated with "time" (P = 3.26 × 10^- 2), and CC carriers of TACR1 rs3755468 were not (P > 0.05). These results suggest that ondansetron significantly affects nausea that is associated with CHRM3, whereas it has a minimal effect on nausea that is associated with TACR1. This indicates that nausea that is associated with CHRM3 is qualitatively different from nausea that is associated with TACR1. Ondansetron mainly exerts its effects outside the blood-brain barrier, which may lead to differential impacts on nausea that is associated with CHRM3 and TACR1. These findings may provide future directions for tailor-made preventive measures against PONV that depend on high-risk genotypes of the CHRM3 rs2165870 and TACR1 rs3755468 SNPs.

Sexual and gender minorities (SGM) experience among the largest mental health disparities of any population. One driver has been the lack of evidence-based practices (EBPs) addressing the distinct mechanisms underlying SGM's risk. LGBTQ-affirmative cognitive-behavioral therapy (CBT) is among the only EBPs specifically for SGM mental health. LGBTQ community centers represent an ideal implementation setting for LGBTQ-affirmative CBT given their wide reach. Although direct training of mental health providers at LGBTQ community centers by experts has been shown to improve providers' LGBTQ-affirmative CBT skills, it is unclear how such training should be optimally delivered. This paper describes the protocol of a trial that seeks to compare the effectiveness of three training strategies for implementing LGBTQ-affirmative CBT, identify center-level moderators of implementation success, and examine the impact of the three strategies on client mental health through theory-informed organizational and provider mechanisms.

This hybrid type III effectiveness-implementation trial will randomize 90 centers to receive one of three additive strategies for implementing LGBTQ-affirmative CBT: [1] a suite of self-paced digital learning materials (Materials Only condition); [2] these materials plus weekly live webinar training for 12 weeks (Direct Training condition); or [3] the above plus one year of supervision from a local supervisor who will receive expert consultation in a train-the-trainer format (Local Supervision condition). The primary outcome will be provider fidelity assessed via simulated practice. Implementation determinants (e.g., center resources, provider/client characteristics), mediators (e.g., implementation climate, provider self-efficacy), and other outcomes (e.g., intervention adaptation, sustainment) will be captured using a mixed-methods design. Clinical effectiveness outcomes (i.e., client mental and behavioral health symptoms) will be assessed through client surveys among a subset of 15 centers.

Now that LGBTQ-affirmative CBT has shown efficacy across several trials and generated high demand, research is needed to determine nationwide implementation strategies. This study will identify optimal means through which to implement this treatment innovation in the US's large network of LGBTQ community centers, thereby producing generalizable guidance for EBP implementation across low-resource settings nationwide in which mental health disparities populations are likely to seek treatment.

NCT05890404 (05/25/2023), https://clinicaltrials.gov/study/NCT05890404 .

Disorders of consciousness are characterized by severe impairments in arousal and awareness. Deep brain stimulation is a potential treatment, but outcomes vary-possibly due to differences in patient characteristics, electrode placement, or the specific brain network engaged. We describe 40 patients with disorders of consciousness undergoing deep brain stimulation targeting the thalamic centromedian-parafascicular complex. Improvements in consciousness are associated with better-preserved gray matter, particularly in the striatum. Electric field modeling reveals that stimulation is most effective when it extends below the centromedian nucleus, engaging the inferior parafascicular nucleus and the adjacent ventral tegmental tract-a pathway that connects the brainstem and hypothalamus and runs along the midbrain-thalamus border. External validation analyzed show that effective stimulation engages a brain network overlapping with disrupted patterns of brain activity observed in two independent cohorts with impaired consciousness: one with arousal-impairing stroke lesions and the other with awareness-impairing seizures. Together, these findings advance the field by informing patient selection, refining stimulation targets, and identifying a brain network linked to recovery that may have broader therapeutic relevance across consciousness-impairing conditions.

Japan's maternal mortality rate and perinatal mortality rate have shown one of the world's most significant declines, positioning Japan at the global forefront of the lowest levels. The nearly logarithmic annual decline in maternal and perinatal mortality rates suggests that, in addition to advances in medicine and healthcare, various types of care for mothers and newborns have played a crucial role in this achievement.

From the period of World War II to the postwar era, up to around 1980, and then every decade thereafter, the events and movements surrounding perinatal healthcare in each era were examined from the perspectives of epidemiology, medical/healthcare advancements, and institutional/policy trends.

The major events in each era are outlined as follows: Until around 1980: After World War II, in 1948, several laws were enacted to protect mothers and fetuses, including the Maternal and Child Health Handbook, in 1966. The number of births experienced a baby boom for about 10 years following 1945, peaking in 1973. Birthplaces shifted from home deliveries to medical facilities, with doctors becoming the primary birth attendants. Academically, the Japan Association of Obstetricians and Gynecologists (JAOG) for Maternal Protection and the Japan Society of Obstetrics and Gynecology (JSOG) were established in 1949. In the medical field, neonatal intensive care units (NICUs) were introduced and neonatal transport systems became well-established by the 1970s. In 1976, the limit of viability was revised from under 28 weeks of gestation to under 24 weeks. The late 1970s saw the fetal heart rate monitoring, the heartbeat detection using Doppler ultrasound and the ultrasound imaging techniques. 1980s: The perinatal medicine became well established, leading to hold The Japan Society of Perinatal Medicine. For fetal management, the fields of fetal diagnosis and fetal treatment entered their early stages with the widespread use of fetal heart rate monitoring and ultrasound imaging. In neonatal care, neonatal transport systems to NICU facilities were enhanced. A major breakthrough in this field was the discovery and widespread use of pulmonary surfactant. Two key concepts that emerged and advanced during this period were maternal transport systems and the Perinatal Maternal and Child Center initiative. In 1987, cases of hepatitis caused by non-heat-treated coagulation products became a major issue. As a result, informed consent affecting mothers and fetuses became a significant point of discussion. The Obstetrics and Gynecology Specialist system was introduced, along with the regular publication of Training Notes for Obstetricians and Gynecologists and Glossary of Obstetrics and Gynecology Terms. As a result of these efforts, both the perinatal mortality rate and the maternal mortality rate were reduced by approximately half over the course of 10 years. 1990s: In 1991, the limit of viability was revised to 22 weeks of gestation. In terms of maternal care, nutritional management guidelines for general pregnant women were introduced. In fetal medicine, major topics included the administration of steroids to the mother to promote fetal lung maturation, as well as direct fetal treatments such as shunt procedures and needle aspirations. In neonatal care, inhaled nitric oxide therapy and extracorporeal membrane oxygenation treatment became more widely adopted. Following the Great Hanshin-Awaji Earthquake, in 1995, led to the development of the Disaster Medical Assistance Team and the establishment of Perinatal Maternal and Child Medical Center. In 1996, the Maternal Protection Law was enacted, and the Japan Council for Quality Health Care (JCQHC) was founded to standardize medical care. Asia & Oceania Federation of Obstetrics & Gynecology Journal and Journal of Obstetrics and Gynecology Research were launched as English-language academic journals. 2000s: Japan's perinatal mortality rate became the lowest in the world, but the maternal mortality rate was still struggling. Obstetric care changed significantly after an obstetrician was arrested for causing a maternal death during a cesarean section. The JSOG and the JAOG developed practice guidelines describing standard obstetric diagnosis and treatments, and the JCQHC established the Japan Obstetric Compensation System for Cerebral Palsy. In addition, a project to report on maternal deaths by JAOG was also launched, and the combination of these measures led to form a framework of professional autonomy for obstetricians. During this period, brain hypothermic therapy for brain injury was developed. 2010s: The Great East Japan Earthquake in 2011 led to major changes in disaster medical planning. This included the introduction of training programs for disaster medical coordinators and the development of disaster-time pediatric and perinatal liaisons. To enhance medical safety, JAOG launched an incidental case reporting system in 2004. Additionally, in 2010, a maternal mortality reporting system was introduced, followed by the maternal severe complications reporting system in 2021. The Japan Council for Implementation of Maternal Emergency Life-Saving System was established, along with the Japan Association for Labor Analgesia, a collaborative council for academic societies and organizations related to painless delivery. Suicide as a significant cause of maternal death led to the establishment of the "Mother and Child Mental Forum" academic conference, which later evolved into the Mental Health Care for Mother & Child training program. In the field of prenatal testing, non-invasive prenatal testing was introduced as a clinical research initiative. From 2020 onward: The year 2020 began with the global outbreak of COVID-19. Until 2023, numerous issues arose due to repeated pandemics, including delivery methods and locations for COVID-positive pregnant women, standard precautions during labor, mother-infant separation after birth, vaccination, so on. JSOG and JAOG worked together to address these challenges. The most pressing issue in the perinatal field is the declining birth rate. Alongside an aging workforce of physicians and a shortage of successors, the decrease in new obstetric clinic openings has become a major concern. By 2024, the decrease in the number of full-time obstetricians and the overtime work limits in Medical Care Act are making it necessary to reconsider the structure of obstetric medical services. Japan's perinatal care system, which has maintained the highest global standards, now stands at a major crossroads.

Researchers (clinicians), academic societies, and professional organizations, centered on the mother and child, have collaborated with support from the government, making progress and building the current safe pregnancy and childbirth management system. However, significant issues remain that need urgent attention, including regulations on overtime work, securing obstetrician numbers, the rapid decline in childbirth facilities, and the functional collapse of perinatal maternal-child healthcare centers. These are critical challenges that must be addressed promptly.

Obsessive-compulsive personality disorder (OCPD) is a common psychopathological condition that generally causes a significant maladjustment in affected individuals. Despite its prevalence, there are no univocal and defined guidelines for the treatment of this condition, and the literature evidence on this topic is scant and controversial.

This narrative review synthesizes clinical trials, case reports, and experimental proposals for OCPD treatment in the light of the most recent neurobiological models. We aimed to review current therapeutic evidence for the disorder and evaluate their effectiveness, proposing potential rationales to guide future strategies.

Although no guidelines are available for OCPD, given the paucity of controlled studies, a possibility to overcome this gap might rely on identifying among the currently available and emerging therapies those that may appear most promising for improving the outcome of the disorder and suggesting novel therapeutic targets. In this way, this paper might represent a sort of 'call to action' to the scientific deepening of the mode of action of those treatments that could be of help to improve the detrimental quality of life of OCPD patients.

Medications for opioid use disorder (MOUD) can reduce opioid use and overdose deaths. This study examined whether the Communities That HEAL (CTH) intervention increased MOUD initiation, retention, and linkage. The HEALing Communities Study was a multi-site, 2-arm, parallel, community-level, cluster-randomized, unblinded, wait-list controlled trial conducted in 67 communities (n = 34 intervention, n = 33 control). Using Prescription Drug Monitoring Programs and Medicaid claims data, we compared mean community-level rates of MOUD outcomes during the 1-year comparison period (July 2021-June 2022) for: (a) MOUD receipt at least once; (b) continuous MOUD receipt for 180 days; and (c) MOUD linkage within 31 days following an opioid-related emergency department or hospital encounter. For intervention and control communities, adjusted rates of receiving MOUD at least once were 578 (95 % CI: 562, 594) and 596 (95 % CI: 572, 621) per 1000 Medicaid enrollees, respectively [adjusted Relative Rate (aRR)= 0.97 (95 % CI: 0.93, 1.01)]. Adjusted rates of receiving MOUD for 180 consecutive days (retention) were 614 (95 % CI: 595, 634) and 620 (95 % CI: 603, 638) per 1000 Medicaid enrollees receiving MOUD at least once for intervention and control communities, respectively [aRR= 0.99 (95 % CI: 0.95, 1.04)]. The adjusted rate of linkage was 280 (95 % CI: 254, 310) and 252 (95 % CI: 226, 281) per 1000 encounters for intervention and control communities, respectively [aRR= 1.11 (95 % CI: 0.96, 1.28). Compared to control communities, communities that received the CTH intervention did not demonstrate higher rates of MOUD use, retention, or linkage. Additional efforts are needed to improve uptake and sustained use of MOUD. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04111939.

Over the last two and a half decades, there has been a surge of research into adverse childhood experiences (ACEs). ACEs have been found to be a significant predictor of mental health outcomes in adulthood, and researchers have begun to explore the relationship between ACEs and mental health outcomes in athletes. However, to the best of the authors' knowledge, no study has directly compared the mental health of student-athletes to non-student-athletes in the context of exposure to ACEs. In the present study, we compared psychological outcomes observed in college students (123 student-athletes and 149 non-student-athletes) on two mental health variables-depressive symptoms and difficulties in emotion regulation-at one university in the U.S. Results indicated that exposure to ACEs had a significant effect on both depressive symptoms and difficulties in emotion regulation, while student-athlete status only had a significant effect on depressive symptoms. There was no significant interaction effect between exposure to ACEs and student-athlete status. This pattern of main effects and an absence of an interaction effect remained even when the psychological trait of hardiness was controlled for. The implications and limitations of these results will be discussed.

Background/Objectives: Postpartum depression (PPD) affects approximately 10-20% of women during and after pregnancy, posing significant risks to maternal health, infant development, and family dynamics. Identifying modifiable risk factors is essential for prevention. Emerging evidence suggests that vitamin D, a neuroactive steroid hormone involved in neurotransmitter synthesis, neuroinflammation regulation, and calcium homeostasis, may play a protective role against mood disorders, including PPD. Methods: The search was conducted through a comprehensive search of the PubMed, Scopus, and Web of Science databases using a combination of Medical Subject Headings (MeSH) and free-text terms including "vitamin D", "25-hydroxyvitamin D", "deficiency", "pregnancy", "postpartum", "depression", "antenatal depression", "maternal mental health", and "perinatal mood disorders". Results: Numerous observational studies and systematic review reports around the world reinforce the potential global relevance of vitamin D insufficiency. This study advances personalized and precision medicine approaches by emphasizing the importance of individualized screening for vitamin D deficiency during pregnancy and postpartum, enabling tailored interventions that could mitigate the risk of postpartum depression. Conclusions: In conclusion, while a definitive causal relationship between vitamin D deficiency and perinatal depression remains unproven, screening for vitamin D levels during pregnancy could serve as a low-risk intervention to support maternal mental health. Future research should focus on well designed, large-scale randomized trials and standardization of diagnostic criteria to clarify vitamin D's role in preventing perinatal depression. Recognizing vitamin D status as a modifiable biomarker allows for targeted nutritional and pharmacological strategies to optimize maternal mental health.

Adolescent well-being is influenced by emotional regulation and clarity, particularly in contexts of depression, stress, and anxiety.

This study explores how depression mediates the relationship between emotional regulation and well-being and whether emotional clarity moderates this interaction, providing a comprehensive model to understand adolescent mental health.

A cross-sectional study was conducted with 636 Chilean adolescents aged 10-18. Emotional clarity and regulation were assessed using the TMMS-24 scale, depression with the DASS-21 scale, and subjective well-being with the Personal Well-Being Index (PWI). Statistical analyses included descriptive statistics, Pearson correlations, and moderated mediation models (PROCESS Macro, Models 4 and 7).

Emotional regulation positively correlated with subjective well-being (r = 0.373, p < 0.01) and negatively with depression (r = -0.251, p < 0.01). Depression partially mediated the relationship between emotional regulation and well-being (B = 0.149, 95% CI [0.082, 0.225]), with regulation explaining 86.41% of the effect. Emotional clarity moderated the regulation-depression link, with higher clarity amplifying the protective impact of regulation (index = 0.008, 95% CI [0.0017, 0.0149]).

Emotional regulation and clarity are vital for adolescent well-being and enhance the protective role of regulation against depression. Interventions targeting both constructs could improve mental health outcomes in vulnerable populations.

The aged care sector faces significant challenges due to rising demand from aging populations and chronic diseases, in addition to workforce shortages, contributing to staff stress, burnout, and poor mental wellbeing. In this review, we synthesized quantitative studies on factors and interventions to improve the mental wellbeing of the aged care workforce across indicators and system levels.

Five academic databases (Medline, Embase, Scopus, PsycInfo, and CINAHL) were searched from January 2014 to May 2024, using keywords related to aged care, care workers, and mental wellbeing. Quantitative studies examining factors or outcomes of interventions related to staff wellbeing were included. Identified factors were classified as micro-, meso-, and macro-level using a combined inductive and deductive approach.

Eighty-nine studies were included: 64 (72%) identified significant factors, and 25 (28%) evaluated interventions aiming to improve workers' mental wellbeing. Almost half concentrated on nursing staff (n = 38, 43%), with others addressing direct care workers (n = 25, 28%) or aged care workers more broadly (n = 19, 21%). From the synthesis, a multi-level model of factors affecting aged care worker wellbeing was developed, comprising 11 themes and 39 sub-themes; 3 micro-level themes (1. personal factors, 2. work engagement, and 3. skills and abilities), 6 meso-level themes (4. job demands, 5. professional relations, 6. job control, 7. leadership, 8. professional development, and 9. workplace resources), and 2 macro-level themes (10. policy and regulation and 11. structure and governance). Among the 25 intervention studies, most entailed micro-level changes (n = 24, 96%), including relaxation, emotion regulation, and behavioral management education training.

Understanding system-level factors is a key to designing comprehensive improvement approaches. Our new model can help guide organizations in developing targeted strategies to promote mental wellbeing and strengthen care delivery. While individual-focused interventions have shown benefits, organizational and broader system-level strategies to improve mental wellbeing are pivotal for achieving sustainable change.