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Aims: This study aims to identify factors associated with mental health literacy (mental health knowledge and attitudes towards mental health and help-seeking behaviours), depression and anxiety amongst adolescents, and test the hypothesised model by examining the interrelationships between these outcomes., Design: Cross-sectional descriptive quantitative research., Methods: Using convenient sampling, 615 adolescents from four public schools completed online questionnaires measuring mental health literacy, depression, and anxiety. The data were analysed using Pearson correlation, multiple linear regression, and structural equation modelling (SEM)., Results: Individual factors (e.g., gender, physical health and past traumatic experiences), family factors (e.g., parental criticism and family support) and school/community factors (e.g., academic pressure and safety) were associated with mental health outcomes. SEM revealed an association between higher mental health knowledge and better attitudes towards mental health and help-seeking behaviours but did not show a significant association with depression and anxiety., Conclusions: Findings emphasise the need for holistic and culturally safe approaches to address adolescent mental health in Indonesia., Implications: Future research should focus on developing and evaluating tailored mental health interventions in Indonesia that address individual, family, school, and community factors. These interventions should target the interrelated aspects of mental health literacy, depression, and anxiety identified in this study. Key areas for intervention include enhancing self-esteem, promoting help-seeking behaviours, supporting spirituality, managing long-term conditions, improving sleep hygiene, encouraging physical activity, teaching stress management techniques, fostering diversity, managing trauma, and combating discrimination. A comprehensive approach to adolescent mental well-being should integrate parental involvement, peer support systems, community engagement initiatives, and mental health literacy education., Impact: This research informs future interventions such as school-based programs, family-oriented campaigns, and community initiatives to support adolescent mental health, potentially influencing policy decisions, and resource allocation in mental health services., Reporting Method: STROBE guidelines., Patient or Public Contribution: No direct patient or public contribution., (© 2025 John Wiley & Sons Ltd.)

Background: Medicaid expansion via the Affordable Care Act, more recent legislation and Medicaid 1115 waivers offer opportunity to increase health care access among individuals involved in the carceral system. Effective enrollment of new beneficiaries and temporary suspension and reactivation of existing Medicaid benefits upon release is key to the success of these efforts. This study aims to characterize how jails, prisons and Medicaid agencies are implementing Medicaid suspension and enrollment programs and identifies barriers and facilitators to implementation., Methods: We conducted 19 semi-structured interviews with 36 multi-state leaders in carceral facilities, Medicaid agencies, local health departments and national policy experts from 2020 to 2021. Interviews covered 4 domains: (1) the role of policy in influencing carceral and reentry Medicaid practices, (2) implementation strategies to suspend and enroll incarcerated individuals into Medicaid, (3) barriers and facilitators to successful implementation, and (4) variation in implementation between jails and prisons., Results: Participants identified logistical challenges with suspension and enrollment, including limited infrastructure for data sharing between carceral facilities and Medicaid agencies, burdensome bureaucratic requirements, and challenges with Medicaid renewal, particularly in the jail environment. They offered opportunities to overcome barriers, such as the creation of specialized incarcerated Medicaid benefit categories and provision of in-reach services via managed care organizations. Participants also called for improvements to Medicaid reactivation processes, as even when facilities successfully suspended benefits, individuals faced significant challenges and delays reactivating benefits upon release. Participants also called for further loosening of the Medicaid Inmate Exclusion Policy., Discussion: Findings highlight the need to update data sharing infrastructure, which will be critical to the implementation of the 1115 waivers, as carceral facilities will be subject to Medicaid billing and reporting requirements. In addition to investing in the ability to newly enroll and suspend Medicaid benefits, attention towards improving timely reactivation practices is needed, particularly given the highly elevated risk of mortality immediately after release. Participants calls for further reforms to the Medicaid Inmate Exclusion Policy are consistent with proposed legislation., Conclusions: Findings can critically inform the successful implementation of Medicaid-based reforms to improve the health of incarcerated and formerly incarcerated people., Competing Interests: Declarations. Ethics approval and consent to participate: Research protocols were approved by the Johns Hopkins Bloomberg School of Public Health Institutional Review Board. Consent for publication: N/A Competing interests: The authors declare that they have no competing interests., (© 2024. The Author(s).)

Purpose: The primary aim of this study was to investigate how speech-language pathologists (SLPs) from Estonia, Finland, and Lithuania rate the significance of different features for diagnosing childhood apraxia of speech (CAS) in their languages., Method: An online survey was conducted among 197 Estonian, Finnish, and Lithuanian SLPs who have worked with children with CAS. The SLPs were asked to rate the significance of 63 features for CAS diagnosis in their respective language. Cross-linguistic patterns in diagnostic features were examined with simple correspondence analysis (SCA) and via descriptive statistics., Results: The ratings revealed six to seven diagnostic features that were considered very significant for CAS diagnosis by the majority of respondents in each country. The SCA highlighted differences between Lithuanian SLPs and Estonian and Finnish SLPs. Some possible language-specific associations were noted, such as palatalization errors for Lithuanian and Estonian and diphthong distortions for Estonian. The respondents from all countries rated highly those features that can easily be applied to most languages (e.g., groping) and gave lower ratings to features that may be influenced by the linguistic structure of different languages (e.g., word stress errors)., Conclusions: Overall, SLPs provided high ratings to CAS features that occur universally across languages, whereas features specific to languages, such as prosody-related errors, were not as highly rated. Several language-specific features were highlighted, providing direction for future research and emphasizing the importance of language-specific considerations in CAS research and diagnosis.

The tumor immune microenvironment (TiME) of human central nervous system (CNS) tumors remains to be comprehensively deciphered. Here, we employed flow cytometry and RNA sequencing analysis for a deep data-driven dissection of a diverse TiME and to uncover noncanonical immune cell types in human CNS tumors by using seven tumors from five patients. Myeloid subsets comprised classical microglia, monocyte-derived macrophages, neutrophils, and two noncanonical myeloid subsets: CD3 + myeloids and CD19 + myeloids. T lymphocyte subsets included double-negative (CD4 - CD8 - ) T cells (DNTs). Noncanonical myeloids and DNTs were explored on independent datasets, suggesting that our DNT phenotype represents γδ T cells. Noncanonical myeloids were validated using orthogonal methods across 73 patients from three independent datasets. While the proportions of classical myeloids agreed with reported malignancy type-associated TiMEs, unexpectedly high lymphocyte frequencies were detected in gliosarcoma, which also showed a unique expression pattern of immune-related genes. Our findings highlight the potential of data-driven approaches in resolving CNS TiME to reveal the mosaic of immune cell types constituting TiME, warranting the need for future studies on the nonclassical immune cell subsets., Competing Interests: Declarations. Conflict of interest: The authors declare no competing interests. Ethical approval: The study was performed in accordance with the principles of the Declaration of Helsinki. This prospective study was reviewed and approved by The Regional Ethics Committee of Pirkanmaa Hospital District, currently named as the Ethics Committee of the Wellbeing Services County of Pirkanmaa, with the reference of the approval number R14024. Consent to participate: All patients provided informed consent to the use of tumor material for the applications used in this study. Consent to publish: All the participants of this study provided informed consent for publication of their data according to the legislation and good practice., (© 2024. The Author(s).)

Aims: Digital counselling has gained paramount importance for coronary artery disease (CAD) patients' treatment in recent years. It has been shown to provide a multitude of benefits, including improved risk factors and enhanced lifestyles. No previous reviews have emphasized the interactiveness of digital counselling. Consequently, the aim of this review is to determine whether interactive two-way digital counselling can provide effective secondary prevention as alternative or adjunct care compared with usual care, where patients visit a cardiac clinic and obtain verbal information and written recommendations of the risk factors without a digital intervention., Methods and Results: Studies that implemented digital interventions in patient counselling among CAD patients were identified by searching 10 electronic databases at the end of August 2022 and updated on 15 December 2023. The Joanna Briggs Institution (JBI) protocol was used for screening, quality assessment, data extraction, and meta-analysis. In total, 15 papers were identified that reported the effect of interactive digital counselling on risk factors and lifestyle changes in CAD patients. The results of the meta-analyses had neutral pre-defined outcomes and did not show any effect on cardiovascular risk factors or lifestyle changes., Conclusion: There is a need for better descriptions of the content and delivery of interactive digital interventions in studies. In the future, digital interventions should be designed not only to focus on patient, but to incorporate social support, peer groups, and interactive tools on a digital platform. Social support has proved to be important in terms of adherence to treatment., Registration: PROSPERO CRD42021247315., Competing Interests: Conflict of interest: none declared., (© The Author(s) 2025. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Mantle cell lymphoma is a rare type of B-cell lymphoma, which is considered incurable yet treatable. In recent years, the treatment options of mantle cell lymphoma have multiplied, and the focus of treatment is expected to shift from traditional chemoimmunotherapy toward precision medicine. However, this development is hindered by the high costs of targeted therapies. To provide a baseline for future assessment of costs and benefits of new and emerging MCL treatments, we established a predictive simulated model of lifetime treatment trajectories based on a retrospective cohort of chemoimmunotherapy era patients diagnosed and treated between the year 2000 and 2020., (© 2025 John Wiley & Sons Ltd.)

The brain develops most rapidly during pregnancy and early neonatal months. While prior electrophysiological studies have shown that aperiodic brain activity undergoes changes across infancy to adulthood, the role of gestational duration in aperiodic and periodic activity remains unknown. In this study, we aimed to bridge this gap by examining the associations between gestational duration and aperiodic and periodic activity in the EEG power spectrum in both neonates and toddlers. This cross-sectional study involved EEG data from 73 neonates (postnatal age 1-5 days, 40 females) and 56 toddlers (postnatal age of 2.9-3.2 years, 28 females) from the FinnBrain Birth Cohort Study. EEG power spectra were parameterized to aperiodic and periodic components using the SpecParam tool. We tested the associations between gestational duration as well as postnatal age and SpecParam parameters in neonates and toddlers while including birth weight and child sex as covariates. For neonates, multilevel models were employed, considering different data acquisitions (sleep and auditory paradigm + sleep), while in toddlers, regression models were used as only data from the auditory paradigm was available. We found that longer gestational duration was associated with a steeper power spectrum across EEG frequencies both in neonates and toddlers. Effect was especially strong in toddlers (β = 0.45, p = 0.004), while in neonates, it remained nearly statistically significant (p = 0.061). In neonates, a quadratic association between gestational duration and beta center frequency (12.5-30 Hz) was found. In toddlers, beta center frequencies were overall higher in females compared to males. Offset (calculated as the power of the aperiodic curve at 2.5 Hz) and theta center frequency had negative associations with postnatal age in neonates, but not in toddlers. Our results suggest that gestational duration may have significant and relatively long-lasting effects on brain physiology. The possible behavioral and cognitive consequences of these changes are enticing topics for future research., (© 2025 The Author(s). Human Brain Mapping published by Wiley Periodicals LLC.)

Introduction: Nurses' well-being at work (WAW) is important for overall health care outcomes. Nurses often navigate complex roles, contending with time constraints, ethical challenges and societal undervaluation, underscoring the necessity of addressing their WAW., Methods: The aim of this systematic review was to analyse the interventions that potentially improve nurses' WAW in care settings for older people. The ultimate goal is to provide an understanding of this field and advance the development of WAW interventions. We performed a systematic review which was registered in PROSPERO and conducted according to PRISMA guideline. We conducted a comprehensive literature search across five scientific databases and one platform in February 2023., Results: Out of 5975 records, we included 21 full-text articles in the review. Interventions were typically complex and focused on (a) nurses' health, (b) nursing care, (c) care facilities and (d) management. Interventions resulted in a range of outcomes on the (a) physical, (b) psychosocial and (c) environmental dimensions of WAW, with most interventions leading to positive outcomes, albeit with instances of negative and neutral results., Conclusions: Interventions focusing on nurses' health or care facilities can be promising to improve WAW of nurses working in care settings for older people. Interventions aimed at improving the WAW have focused on various aspects. Despite the mainly positive outcomes, some interventions can also compromise nurses' WAW., Implications for Practice: Strategies and interventions aimed at improving nurses' WAW are needed in practice as nurses' WAW is crucial in recruiting to and retaining nurses in care settings for older people. Promoting WAW also contributes to the quality of care for older people and the provision of ethically high-quality health services., Trial Registration: The review protocol was registered in the International Prospective Register of Systematic Reviews, PROSPERO (CRD42023399478)., (© 2024 The Author(s). International Journal of Older People Nursing published by John Wiley & Sons Ltd.)

Background: Smoking is a known risk for sudden cardiac death (SCD) in the general population. However, its significance in patients with acute coronary syndrome (ACS), a condition that also elevates the risk of SCD, is disputable., Methods: A total of 9704 consecutive ACS patients with available smoking data were included in the analysis. Comprehensive patient data were obtained from the Mass Data in Detection and Prevention of Serious Adverse Events in Cardiovascular Disease research database. A composite endpoint of SCD, SCD aborted by successful resuscitation and accurate implantable cardioverter defibrillator therapy to otherwise potentially fatal ventricular fibrillation/ventricular tachycardia was used. Univariate, age- and sex-adjusted, and a multivariate fine-gray competing risk regression with adjustment to traditional risk factors was conducted., Results: Median follow-up time was 6.8 years (IQR, 4.1-10.2), and 454 (4.7%) SCD cases were identified. At the baseline, 23.7% ( N  = 2444) were active smokers, and 20.8% ( N  = 2146) were ex-smokers. In the multivariate model, active smokers had an elevated risk of 1.79 (95% CI, 1.41-2.27; P  < 0.001) for future SCD. Ex-smokers had no elevated risk for SCD in fine-gray subdistribution hazard. Also, active smokers were notably younger (mean age 58.7 years) than non- or ex-smokers (71.1 years and 68.9 years, respectively, P  < 0.001 for both comparisons)., Conclusion: Active smokers had a 79% higher risk of SCD when compared with nonsmokers. Smoking cessation should be heavily encouraged after ACS. Also, a person's smoking status should be considered in further studies developing SCD and implantable cardioverter defibrillator-benefit risk scores., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Macrophages are a highly plastic cell type that adopt distinct subtypes and functional states depending on environmental cues. These functional states can vary widely, with distinct macrophages capable of displaying opposing functions. We sought to understand how macrophage subtypes that exist on two ends of a spectrum influence the function of other cells. We used a coculture system with primary human macrophages to probe the effects of macrophage subtypes on breast cancer cell proliferation. Our studies revealed a surprising phenotype in which both macrophage subtypes inhibited cancer cell proliferation compared with cancer cells alone. Of particular interest, using two different proliferation assays with two different breast cancer cell lines, we showed that differentiating macrophages into a "protumor" subtype inhibited breast cancer cell proliferation. These findings are inconsistent with the prevailing interpretation that "protumor" macrophages promote cancer cell proliferation and suggest a re-evaluation of how these interpretations are made.

An increasing number of indications are emerging for point-of-care ultrasound to diagnose and treat musculoskeletal complaints. Low cost, dynamic imaging, immediate results, and added advantage of portability have made ultrasound an important imaging modality in urgent care, emergency department (ED), and other musculoskeletal care clinics. This article reviews the use of musculoskeletal ultrasound to help evaluate articular and periarticular structures to evaluate for mechanical injuries and inflammatory arthritis., Competing Interests: Disclosure A.L. Day: Royalties from Springer International for Manual of Musculoskeletal Ultrasound Textbook. M.J. Kohler, Royalties from Springer International for Musculoskeletal Ultrasound in Rheumatology Review Textbook; Janssen/Johnson and Johnson-Medical Advisory Board; Setpoint Medical-Research PI; Novartis-Medical Advisory Board. E. Chew and L. Nazarian: No disclosures., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Primary hyperparathyroidism predominately affects women who are postmenopausal and causes complications, including fragility fractures. Its treatment is parathyroidectomy, which is associated with low complication and >95% cure rates. Considering fractures are associated with premature death, we aimed to determine whether the surgical management of individuals with biochemical diagnosis of primary hyperparathyroidism was associated with a reduction in fracture risk., Methods: In this population-based cohort study, we used administrative health databases to identify adults ≥18 year old who were biochemically diagnosed with primary hyperparathyroidism between 2007 and 2016 in Ontario. Patients were included if their calcium was ≥2.6 mmol/L (≥10.42 mg/dL) with a concurrent parathyroid hormone of ≥2.2 pmol/L (≥20.75 pg/mL). We followed patients and compared the incidence of fractures between those with and without parathyroidectomy. To control for potential confounding, we used inverse probability of treatment weighting to estimate the average treatment effect in the treated. Fine-Gray competing risk regression models were used to determine the association between surgery and time to fracture., Results: In a cohort of 28,059 with a biochemical diagnosis of primary hyperparathyroidism, the mean age (standard deviation) was 65 years (14.2 years), and 75% (n = 21,139) were female. Only 12.6% (n = 3,523) underwent parathyroidectomy. Weighted fracture cumulative incidence at 12 years postdiagnosis was 10.17% (n = 182) in surgical patients and 14.04% (n = 2,004) in nonsurgical patients. Parathyroidectomy prevented 1 fracture for every 26 surgeries performed (weighted risk difference, 3.87%, 95% confidence interval, 0.96%-6.62%) and reduced the hazard of fracture by 22% (weighted hazard ratio, 0.78; 95% confidence interval, 0.64-0.95)., Conclusion: In a large, publicly funded health system, parathyroidectomy significantly reduced the short- and long-term risk of fragility fractures in patients with primary hyperparathyroidism., Competing Interests: Conflict of Interest/Disclosure The authors have no conflicts of interests or disclosures to report., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Maternal immune activation (MIA) during pregnancy is implicated in offspring psychiatric disorders. However, it is unknown to what extent MIA affects neurodevelopment, particularly cerebrocortical anatomy, in the general population, and whether effects differ by sex. The current study used vertex-wise statistics to examine the association between maternal prenatal CRP, an archetypal systemic inflammatory marker, and offspring cortical thickness, surface area, and volume, in 2635 mother-child dyads (5.4-26.5 years) from three population-based cohorts, and one clinical cohort enriched for presence of inflammation markers. Maternal CRP within a normal physiological range (<10 mg/L) exhibited sex-specific quadratic associations with cortical morphological measures in 2 regions in males and 1 region in females at childhood. Elevated (>10 mg/L) CRP was associated with regional cortical morphology in females and in a pooled sample of sexes. Overall, MIA is associated with cortical development in a regional and sex-specific manner in studies spanning childhood to adulthood., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Recent research has highlighted the deficiencies and variations in the digital competences of social services and healthcare personnel. Yet there is a shortage of data regarding how the personnel use digital devices and solutions and their attitudes towards digitalisation. Hence, a systematic investigation into digital devices and solutions in healthcare is warranted., Objectives: This study aimed to analyse the similarities and differences in digital competences and organisational support among healthcare personnel, focusing on using digital applications and services. The primary research question was to investigate what kinds of digital competence profiles are identifiable through social services and healthcare personnel self-assessments., Methods: The survey was conducted in the Wellbeing Services County of Central Finland at the end of 2023. It utilised validated self-assessment methods and garnered 643 responses from social services and healthcare professionals. Data analysis involved quantitative cluster analysis for grouping participants and qualitative content analysis for describing the clusters., Results: The study resulted in a final model of seven clusters that presented distinct digital competence profiles with relatively even sizes. These clusters represented the different aspects of digital usage among social services and healthcare professionals. They could be categorised into three overarching profiles: 1) Motivated digital experts, 2) Burdened digital users and 3) Frustrated survivors. Motivated digital experts comprised up almost half of the respondents (45.1%). Still, the findings also facilitated identifying of a small group of Frustrated survivors (7.5%) who represented burdened and stressed digital users., Conclusions: The results indicate significant variances in digital competence profiles among employees. Social services and healthcare personnel perceive the opportunities and challenges associated with digital applications and services differently. Further detailed research into the disparities between digital competence profiles is necessary, particularly regarding the types of support that benefit different profiles the most., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Aim(s): To provide an introduction to the Good Nursing Care Scale (GNCS) and systematically review the application of the scale in health research., Design: Systematic review., Methods: Empirical studies published in English or Finnish in peer-reviewed journals or as a summary of a PhD thesis where the scale was used for data collection amongst patients were included. Analysis was made by using descriptive statistics, narrative analysis, and evaluation of psychometric properties., Data Sources: PubMed, CINAHL, Cochrane, and Scopus in October 2023., Results: A total of 26 full-text studies and summaries of PhD theses were included in the review. The GNCS has been developed systematically, and the theoretical structure has remained stable. The studies indicate a high level of patient-centered quality of nursing care. Validity and reliability evaluation and reporting were systematic in the studies and mainly indicate sufficient level. Variations between countries are not large, supporting the international use of the GNCS., Conclusions: Patient-centered quality of nursing care is predominantly at high levels. However, systematic evaluation is needed to provide longitudinal data. For that purpose, the GNCS is one potential instrument., Implications for the Profession and Patient Care: Support for the use of existing, tested instruments is encouraged to provide critical ideas for the future needs of nurse practitioners, managers, teachers and researchers., Impact: This paper impacts researchers interested in systematic evaluation of the patient-centered quality of nursing care and for practitioners taking care of patients. For researchers, it introduces a relevant instrument, the GNCS, for analysing the quality or for comparing the quality with other instruments. For practitioners, it produces evidence of the usability of the GNCS., Reporting Method: PRISMA guided the systematic review, and the COSMIN guideline was used for quality appraisal of included studies., Patient or Public Contribution: No Patient or Public contribution., (© 2024 The Author(s). Journal of Clinical Nursing published by John Wiley & Sons Ltd.)

Seasonality can influence many physiological traits requiring optimal energetic capacity for life-history stage transitions. In Atlantic salmon, high-energy status is essential for the initiation of maturation. Earlier studies have linked a genomic region encoding vgll3 to maturation age, potentially mediated via body condition. Vgll3 has also been shown to act as an inhibitor of adipogenesis in mice. Here we investigate the influence of season and vgll3 genotypes associating with early (EE) and late (LL) maturation on lipid profiles in the muscle and liver of juvenile Atlantic salmon. We reared Atlantic salmon for two years from fertilization and sampled muscle and liver during the spring and autumn of the second year (at which time some males were sexually mature). We found no seasonal or genotype effect in the muscle lipid profiles of immature males or females. However, in the liver we detected a triacylglycerol enrichment and a genotype specific direction of change in membrane lipids, phosphatidylcholine and phosphatidylethanolamine, from spring to autumn. Specifically, from spring to autumn membrane lipid concentrations increased in vgll3*EE individuals but decreased in vgll3*LL individuals. This could be explained by 1) a seasonally more stable capacity of endoplasmic reticulum (ER) functions in vgll3*EE individuals compared to vgll3*LL individuals or 2) vgll3*LL individuals storing larger lipid droplets from spring to autumn in the liver compared to vgll3*EE individuals at the expense of ER capacity. This genotype specific seasonal direction of change in membrane lipid concentrations provides more indirect evidence of a potential mechanism linking vgll3 with lipid metabolism and storage., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)