Objective: To develop and conduct preliminary testing of the reliability and validity of the Healthcare Worker (HCW) Culture of Support Scale (COS), intended to assess health worker perceptions of institutional support resources and organizational culture related to their well-being. Methods: A cross-sectional survey was conducted with 533 HCWs from ambulatory clinic and rural hospital settings. The survey included validated measures and newly developed items. Exploratory and confirmatory factor analyses (EFA/CFA) were employed to determine the factor structure. Internal consistency and construct validity were assessed using Cronbach alpha and correlation with mental health outcomes. Results: The COS demonstrated a robust three-factor structure: 1) Organizational Support (Cronbach alpha = 0.83), 2) Access to Peer Support (Cronbach alpha = 0.92), and 3) Availability of Support (Cronbach alpha = 0.97), accounting for 84.9% of variance. Cronbach alpha for the overall scale was 0.94. CFA confirmed excellent model fit (RMSEA = .049, CFI = .992). Higher COS scores correlated with lower burnout (r = -.47, p < .001) and anxiety (r = -.35, p < .001), and greater resilience (r = .30, p < .001). Conclusion: Preliminary evidence suggests that the COS is a reliable and valid measure of HCWs' perceptions of organizational support for worker well-being. This scale and the three subscales can provide healthcare institutions with a way to evaluate organizational initiatives to enhance worker well-being and workforce resilience. Further testing is recommended in diverse settings. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The Health Resources and Services Administration (HRSA), U.S. Department of Health and Human Services (HHS) provided financial support for this publication. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethics committee/IRB of The Johns Hopkins University School of Medicine gave ethical approval for this work I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors

We present Mx. A, a 35-year-old nonbinary patient with a complex psychiatric history, including major depressive disorder with psychotic features, attention deficit hyperactivity disorder, and posttraumatic stress disorder, who developed tardive dyskinesia following stimulant (amphetamine/dextroamphetamine) initiation, which improved significantly after discontinuing the stimulant and switching to quetiapine. The case highlights the challenges of managing tardive dyskinesia in patients with overlapping psychiatric conditions and polypharmacy, emphasizing the role of stimulants in exacerbating movement disorders. A review of stimulant-induced movement disorders underscores their association with tics, dyskinesia, and tardive dyskinesia, particularly in attention deficit hyperactivity disorder populations. We discuss treatment strategies, including Vesicular monoamine transporter 2 inhibitors (e.g., valbenazine), antipsychotic switches (e.g., clozapine, quetiapine), and adjunctive therapies (e.g., vitamin E). The report advocates vigilant monitoring, early intervention, and individualized approaches for tardive dyskinesia in high-risk patients.

IntroductionHealthcare workers’ well-being is of utmost importance given persistent high rates of burnout, which also affects quality of care. Minority healthcare workers (MHCW) face unique challenges including structural racism and discrimination. There is limited data on interventions addressing the psychological well-being of MHCW. Thus, this systematic review aims to identify interventions specifically designed to support MHCW well-being, and to compare measures of well-being between minority and non-minority healthcare workers.MethodsWe searched multiple electronic databases. Two independent reviewers conducted literature screening and extraction. The Mixed Methods Assessment Tool (MMAT) or Joanna Briggs Institute (JBI) criteria were utilized to assess the methodological quality of studies, based on the study design. Total scores as percentages of criteria met were used to determine overall quality as low (<40%), moderate (40-80%), or high (>80%). For conflicts, consensus was reached through discussion. Meta-analysis was not possible due to heterogeneity of study designs.ResultsA total of 3,816 records were screened and 43 were included in the review. The majority of included studies (76.7%) were of moderate quality. There were no randomized control trials and only one study included a well-being intervention designed specifically for MHCW. Most (67.4%) were quantitative-descriptive studies that compared well-being measures between minority and non-minority identifying healthcare workers. Common themes identified were burnout, job retention, job satisfaction, discrimination, and diversity. There were conflicting results regarding burnout rates in MHCW vs non-minority workers with some studies citing protective resilience and lower burnout while others reported greater burnout due to compounding systemic factors.DiscussionOur findings illuminate a lack of MHCW-specific well-being programs. The conflicting findings of MHCW well-being do not eliminate the need for supports among this population. Given the distinct experiences of MHCW, the development of policies surrounding diversity and inclusion, mental health services, and cultural competency should be considered. Understanding the barriers faced by MHCW can improve both well-being among the healthcare workforce and patient care.

Background: Burnout among healthcare workers (HCWs) threatens workforce stability and patient care, particularly in rural hospitals where staff shortages, limited resources, and professional isolation amplify stress. Peer support interventions have demonstrated promise in urban centers, but their feasibility and impact in rural settings remain underexplored. Methods: We implemented and evaluated the Johns Hopkins RISE (Resilience in Stressful Events) peer support program across two rural hospital systems in the Mid-Atlantic United States. Using pre- and post-implementation surveys, we assessed anxiety (GAD-7), burnout (Maslach Burnout Inventory), resilience (CD-RISC), and perceptions of organizational culture of well-being. Linear and logistic regression models adjusted for age, site, and employment duration were used to evaluate outcomes over time. Results: A total of 868 respondents participated across three time points. Burnout and anxiety declined modestly post-implementation, while resilience improved initially but was not sustained at 2-year follow-up. Older employees demonstrated lower anxiety and burnout, while mid-career employees (3-10 years of employment) reported significantly higher distress. Importantly, access to peer support and perceived availability of supportive resources improved significantly over time, reflecting growing program integration. Conclusions: RISE was adapted successfully in rural hospital settings, with evidence of reduced burnout, lower anxiety, and increased perceived access to peer support. While resilience gains were not sustained, results suggest that a peer support program tailored to each organization can mitigate workforce distress in rural health systems. Addressing implementation and contextual barriers and sustaining organizational commitment are important for long-term impact. Expanding peer support to rural hospitals may improve workforce retention and care delivery in underserved communities.

Wars have enormous negative mental health consequences for the civilians involved. This is particularly true for the recent Israel-Hamas war in Gaza. We present an analysis of the current humanitarian situation in Gaza, its dire mental health impact, and highlight the critical silence of medical and mental health professional organizations on this public health disaster.

Roughly one in five adults who meet criteria for long covid present with objective or subjective cognitive dysfunction or elevated symptoms of depression or anxiety lasting ≥12 weeks from an acute covid illness. These neuropsychiatric sequelae have considerable functional consequences at the level of the individual, society, and the broader economy. Neuropsychiatric long covid symptoms are thought to be causally diverse, and a range of risk factors as well as biological, psychological, and environmental mechanisms have been hypothesized to contribute to symptom development and persistence. When present, objective cognitive deficits tend to be modest for most individuals, with some evidence suggesting increased risk of dysfunction and decline specifically for older adults with a history of severe acute illness. Longitudinal data suggest a delayed emergence of psychiatric symptoms may occur in the weeks and months after an acute covid illness. Emerging research points to the early recovery period as a potential window of opportunity for intervention to alter patient trajectories, though evidence based treatment remains lacking.

Introduction: COVID-19 has amplified existing challenges to healthcare in rural areas, including a lack of access to care, increased staff turnover, and poor staff morale. Although there was increased awareness about healthcare workers’ stress and burnout during the COVID-19 pandemic, most of the support interventions tended to be in urban healthcare centers. Given the unique challenges rural healthcare workers face, we sought to systematically identify the types of interventions specifically designed and utilized to support the well-being of healthcare workers practicing in rural settings. Methods: We conducted a comprehensive search of the literature through electronic databases (Medline, Embase, PsycINFO, Web of Science, CINAHL, Emerald, SCOPUS databases, Google Scholar, ProQuest Dissertations and Theses Global, American Doctoral Dissertations, Open Access Theses and Dissertations) to identify quantitative, qualitative, and mixed methods studies describing supportive interventions for rural healthcare workers with well-being-related outcomes. We used the Effective Public Health Practice Project (EPHPP), Mixed Methods Assessment Tool (MMAT) and Joanna Briggs Institute (JBI) Critical Appraisal Checklist to evaluate the study quality. Results: Out of 1583 identified records, 25 studies were included in the analysis. The studies described a wide range of supportive interventions and outcomes. The overall quality of the studies was weak to moderate. None of the studies were randomized, and only six included controls. The included interventions had high acceptance by rural healthcare workers. Quantitative and qualitative themes identified shared decision-making, effective supervision, and proactive cultural change as the most fruitful interventions. Financial interventions alone were not effective. Most of the studies were either unfunded or were funded internally by the institutions. Conclusions: Support interventions for healthcare workers, especially second-victim support programs, are underutilized in rural settings.

A substantial number of patients develop cognitive dysfunction after contracting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), significantly contributing to long-coronavirus disease (COVID) morbidity. Despite the urgent and overwhelming clinical need, there are currently no proven interventions to treat post-COVID cognitive dysfunction (PCCD). Psychostimulants like methylphenidate may enhance both noradrenergic and dopaminergic pathways in mesolimbic and pre-frontal areas, thus improving memory and cognition. We present a case series of six patients who were treated at the Johns Hopkins Post-Acute COVID-19 Team (PACT) clinic for PCCD with methylphenidate 5 - 20 mg in the context of routine clinical care and followed for 4 to 8 weeks. Baseline and post-treatment outcomes included subjective cognitive dysfunction and objective performance on a battery devised to measure cognitive dysfunction in long-COVID patients. Three out of the six patients reported subjective improvement with methylphenidate, one patient described it as "notable" and another as "marked" improvement in memory and concentration. We also found significant pre-treatment subjective complaints of cognitive dysfunction; however, formal cognitive assessment scores were not severely impaired. A statistically significant difference in pre and post scores, favoring intervention, was found for the following cognitive assessments: Hopkins verbal learning test (HVLT) immediate recall, HVLT delayed recall and category-cued verbal fluency. The current series demonstrates promising neurocognitive effects of methylphenidate for long-COVID cognitive impairment, particularly in recall and verbal fluency domains.

The blood-brain barrier (BBB) presents a significant challenge in delivering medications to the brain, impeding direct targeting of specific brain regions in humans. Currently, effective methods for overcoming this protective barrier are limited. Targeted drug delivery to the brain from the nose has been utilized successfully, albeit the delivered dose of medication directly to the brain predominantly depends on circulation. One promising strategy involves guiding magnetic nanoparticles through the cribriform plate from the nose to the brain. Unlike other areas, the nose and circumventricular organs provide a less restrictive pathway where the BBB is permeable. The concept of guiding the diffusion of magnetic nanoparticles through the cribriform plate appears feasible in theory. However, the complexity of such a delivery system necessitates a heuristic approach for practical implementation. In our recent study, we attempted to guide the diffusion of fluorescent magnetic nanoparticles using neodymium magnets in different media and animal brain tissues. Although, we did not successfully demonstrate this method of delivery with simplistic approach, we argue that an interprofessional effort is essential to tackle this mode of drug delivery by passing the challenges posed by the BBB and to innovate targeted drug delivery solutions for the brain. By leveraging diverse perspectives and specialized knowledge, we can advance towards more effective therapies that harness the potential of magnetic nanoparticle technology for neurological treatments. Keywords: magnetic nanoparticles, targeted drug delivery, nasal drug delivery, bypass blood brain barrier, olfactory epithelium

Working in correctional facilities is inherently stressful, and correctional workers have a high rate of anxiety, depression, PTSD, and professional burnout. Correctional workers faced an unprecedented set of challenges during the COVID-19 pandemic, exacerbating an already dire situation. There has been a relative shortage of studies evaluating effective interventions for the psychological consequences of working in correctional facilities. Well-being and mental health Interventions for correctional workers should be embedded in a general framework of support, reducing occupational risk factors, improving mental well-being by developing a positive work environment, improving mental health literacy, and identifying and treating mental health issues. The backbone of the correctional system is its workforce and the mental health and well-being of correctional workers are of paramount importance in an effective correctional system.

BackgroundAlthough United States (US) correctional workers (correctional officers and health care workers at correctional institutions) have experienced unprecedented stress during the COVID-19 pandemic, to date, there are no systematic data on the mental health impact of COVID-19 on correctional workers.ObjectiveTo determine the perceived mental health burden of the COVID-19 pandemic on correctional workers and to explore the relationship between workers' mental health, social demographics, and environmental/work factors. In particular, the study sought to examine if occupational role (correctional officers vs. health care workers) or sex were associated with mental health status.MethodsThis cross-sectional survey was conducted in 78 correctional sites in Pennsylvania, Maryland, West Virginia and New York from November 1 to December 1, 2020. There were 589 participants, including 103 correctional officers and 486 health care workers employed at the correctional facilities. Measurements included the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Adult PROMIS Short Form v.1.0—Sleep Disturbance, Impact of Event Scale-Revised, Maslach Burnout Inventory 2-item, and Connor-Davidson Resilience Scale 2-item.ResultsApproximately 48% of healthcare workers and 32% of correctional officers reported mild to severe depressive symptoms, 37% reported mild to severe anxiety symptoms, 47% of healthcare workers and 57% of correctional officers reported symptoms of burnout, and 50% of healthcare workers and 45% of correctional officers reported post-traumatic stress symptoms. Approximately 18% of healthcare workers and 11% of correctional officers reports mild to moderate sleep disturbance. Health care workers had significantly higher depression and sleep disturbance scores than did correctional officers, while correctional officers had significantly higher burnout scores. Female correctional workers scored significantly higher on anxiety than their male counterparts. Increased workload, workplace conflict, younger age of employees, trust in institutional isolation practices, and lower work position were associated with increased burnout. Despite experiencing high mental health burden, correctional workers showed high resilience (60%).ConclusionWe found a high level of psychological symptoms among health care workers in correctional settings, and this population may experience unique challenges, risks and protective factors relative to other health care workers outside of correctional settings. Understanding these factors is essential for developing effective interventions for correctional workers.

We applaud Wietlisbach and colleagues for highlighting the silver lining in the dark clouds of the COVID-19 pandemic.1 Their qualitative study based on 4 internal medicine (IM) residency programs in the Northeast United States suggests that IM residents adjusted quickly to the disruption and changes brought on by COVID-19 and focused on resiliency and well-being during the pandemic. Our own experience at a large IM residency program at Johns Hopkins Bayview Medical Center suggested that, although COVID-19 had a predominantly negative effect on the well-being of the residents, it also presented an incredible learning opportunity. Forty IM residents were contacted as part of a larger survey to monitor the stress and well-being of staff during COVID-19 at Johns Hopkins Bayview Medical Center between October and December 2020, out of which 18 (45%) completed the survey. Survey measures included Patient Health Questionnaire-2, Generalized Anxiety Disorder-7, and modified Maslach Burnout Inventory. In addition, residents were asked about the satisfaction of their educational experience.Survey results showed that 17% of the residents had significant depressive symptoms and sleep disturbances, while 25% endorsed moderate to severe anxiety symptoms. More than 70% residents felt burned out, and 22% indicated that they felt burned out and callous toward their work on a daily basis. Ninety-four percent of residents indicated that their training was significantly impacted by COVID-19. Sixty-seven percent had to miss their didactic training due to work demands. Thirty-three percent had to change their core or elective rotations. On the positive side, 50% of the residents indicated that they learned new skills during COVID-19 that contributed to their professional growth. Some of the comments from residents were: “Now on call as an intern,” “Taking on more shifts on my scheduled days off,” “Type of cases seen are limited by COVID,” “Zoom didactic sessions are not as effective as in person,” and “Less mentorship and teaching from upper residents and faculty.”In contrast to the Wietlisbach study, our survey suggests that the residents were less enthusiastic about the technological innovations in didactics and training and longed to go back to the pre-COVID-19 normal. However, we also found a strong focus of resiliency by the residents, with 61% of the sample scoring >6 on the 2-item Connor-Davidson Resilience Scale. We agree with Wietlisbach and colleagues that COVID-19 can be a catalyst in the transformation of graduate medical education.2

There is a paucity of data on the mental health impact of the Coronavirus disease 2019 (COVID-19) pandemic on United States (US) healthcare workers (HCWs) after the first surge in the spring of 2020. To determine the impact of the pandemic on HCWs, and the relationship between HCW mental health and demographics, occupational factors, and COVID-19 concerns. Cross-sectional survey in an urban medical center (September–November 2020) in Baltimore, MD, in the United States. A total of 605 HCWs (physicians, nurse practitioners, nurses, physician assistants, patient care technicians, respiratory therapists, social workers, mental health therapists, and case managers). Measures of mental health (Patient Health Questionnaire-2, Generalized Anxiety Disorder-7, PROMIS Sleep Disturbance 4a, Impact of Event Scale-Revised, Maslach Burnout Inventory-2 item, Connor-Davidson Resilience Scale-2 item), demographics, occupational factors, and COVID-19 related concerns. Fifty-two percent of 1198 HCWs responded to the survey and 14.2% reported depression, 43.1% mild or higher anxiety, 31.6% sleep disturbance, 22.3% posttraumatic stress symptoms, 21.6% depersonalization, 46.0% emotional exhaustion, and 23.1% lower resilience. Relative to HCWs providing in-person care to COVID-19 infected patients none of their working days, those doing so all or most days were more likely to experience worse depression (adjusted odds ratio, 3.9; 95% CI, 1.3–11.7), anxiety (aOR, 3.0; 95% CI, 1.4–6.3), possible PTSD symptoms (aOR, 2.6; 95% CI, 1.1–5.8), and higher burnout (aOR, 2.6; 95% CI, 1.1–6.0). Worse mental health in several domains was associated with higher health fear (aORs ranged from 2.2 to 5.0), job stressors (aORs ranged from 1.9 to 4.0), perceived social stigma/avoidance (aORs ranged from 1.8 to 2.9), and workplace safety concerns (aORs ranged from 1.8 to 2.8). US HCWs experienced significant mental health symptoms eight months into the pandemic. More time spent providing in-person care to COVID-19-infected patients and greater COVID-19-related concerns were consistently associated with worse mental health.

Background and Objective: Frontline healthcare workers face unprecedented stress from the current SARS COV-2 (COVID-19) pandemic. Hospital systems need to develop support programs to help frontline staff deal with this stress. The purpose of this article is to describe a support program for front line healthcare workers. Methods: In this community case report, we describe a well-being support rounding program that was developed to deliver Psychological First Aid (PFA) to frontline healthcare workers in a large urban medical center to maintain their sense of psychological well-being and self-efficacy. A team of clinicians from the department of psychiatry, who were trained on the Johns Hopkins RAPID model (Reflective Listening, Assessment, Prioritization, Intervention, and Disposition) to provide PFA, were deployed throughout the hospital. These clinicians carried out daily well-being rounds from April to June during the peak of the pandemic. Results: Approximately 20% of the frontline staff members were going through an acute crisis and benefited from PFA. Anxiety, anger, exhaustion, economic worry, job insecurity, dehumanized interactions with patients due to Personal Protective Equipment (PPE), and stress of taking care of sick and dying patients without their families present, were the main themes identified by the staff. The deployed team used active listening, mindfulness, validation, reframing and other cognitive interventions to support staff. Conclusions: Our experience suggests that frontline staff are willing to engage with in-person, on-site support programs. Fostering resilience and self-efficacy through PFA is a useful model to provide emotional support to frontline healthcare workers during health crises.

A number of factors affect treatment adherence, including the therapeutic alliance, perceived perceived lack of control, risk of dependence on medications, stigma associated with medication use, and more.