Ruben Peralta

Mental health integration into primary care is increasingly recognized as a healthcare priority because mental disorders commonly coexist with chronic physical illnesses and can affect clinical outcomes, quality of life, healthcare utilization, and costs. This chapter reviews the principles, implementation strategies, and clinical significance of incorporating mental health services into routine primary care. It examines common conditions encountered in primary care, including depression, anxiety disorders, stress-related disorders, and substance use disorders, and summarizes evidence-informed approaches to screening, assessment, treatment, referral, and follow-up. The chapter also discusses collaborative care models, multidisciplinary teams, and digital mental health technologies that may improve access, continuity, and patient engagement. Major implementation challenges include stigma, healthcare disparities, workforce shortages, organizational barriers, policy limitations, and ethical concerns. Finally, emerging developments in person-centered integrated behavioral healthcare, precision psychiatry, and digital innovation are considered as potential approaches for strengthening comprehensive, accessible, and equitable primary healthcare systems.

Background: Trauma surgeons face a challenge in the management of high-grade pancreatic injuries (HGPIs), as optimal strategies remain controversial. HGPIs are uncommon and difficult to manage due to dynamic trauma physiology and complications from the injury and management. We aimed to evaluate HGPI presentations, management, and outcomes. Methods: This retrospective study included 13 patients with HGPIs (American Association for the Surgery of Trauma [AAST] grade III–V) who underwent interventions between 2017 and 2024. Results: There were 13 cases with HGPIs (five Grade III, four Grade IV, and four Grade V). Liver injury was the most common associated organ injury (61.5%), followed by splenic injury (46.2%). Distal pancreatectomy was the most frequently performed operation, with either concomitant splenectomy (53.8%) or spleen preservation (23.1%). Severe postoperative infection was observed in this cohort, with sepsis occurring in 69.2% of patients and peripancreatic collections noted in 76.9% and intra-abdominal infection in 61.5%. Other postoperative complications included ileus (61.5%), pancreatic fistula (30.8%), and diabetes (15.4%). Conclusions: This case series demonstrates that high-grade pancreatic injuries are associated with substantial morbidity, along with prolonged hospitalization. A higher Abbreviated Injury Scale (AIS) among HGPIs is associated with greater overall injury severity and higher rates of major complications. Clinicians should consider prioritizing early drainage procedures, particularly in Grade IV and V injuries. Multicenter and larger-sample-size studies are required.

Introduction: Blast‐ and penetrating‐mechanism traumatic brain injury (TBI) is increasingly prevalent in settings affected by conflict and explosive violence, including among local casualties in environments where neurosurgical infrastructure, advanced imaging, and critical care resources may be limited or absent. No protocols or guidelines comprehensively address the full spectrum of TBI from blast and penetrating mechanisms across variable resource levels. Methods: The Explosive Weapons Trauma Care Collective (EXTRACCT) conducted a targeted narrative literature review across key clinical domains, including initial assessment, hemodynamic and airway management, medical treatment of intracranial hypertension, noninvasive neuromonitoring, surgical decision‐making, and interfacility transport. Searches were performed in PubMed and supplemented by military, penetrating and trauma system clinical practice guidelines (Joint Trauma System, Brain Trauma Foundation, TCCC). Evidence was synthesized by a multidisciplinary authorship team and consensus was achieved through iterative expert review, following the AGREE II framework. Results: This document provides stratified recommendations across variable resource contexts. Key recommendations include: early physiological stabilization with avoidance of hypotension and hypoxia; structured neurological assessment using postresuscitation GCS and pupillometry; noncontrast head CT as the primary imaging modality, with CT angiography for penetrating TBI and high‐risk blunt mechanisms; hyperosmolar therapy as first‐line treatment for intracranial hypertension; evidence‐based sedation, analgesia, and neuromuscular blockade protocols; noninvasive multimodal neuromonitoring when invasive ICP monitoring is unavailable; surgical thresholds for decompressive craniectomy and craniotomy; and standardized transport protocols to minimize secondary brain injury during interfacility transfer. Conclusions: This document addresses a critical gap in context‐appropriate blast‐TBI management for settings with variable resource availability. Strict control of basic physiological parameters, structured clinical decision‐making, and early transfer to neurosurgical care remain the primary determinants of outcome in resource‐limited environments.

Rib nonunion with malunion and heterotopic ossification (HO) is a rare complication of rib fractures. It is associated with significant morbidity and quality-of-life impairments owing to pain. Management is complex and requires a multidisciplinary approach involving surgery and appropriate multimodal pain management strategies, including systemic and locoregional interventions. We report a case of rib fracture nonunion with malunion and HO formation resulting in significant disability, successfully managed with surgical intervention and chronic pain management strategies employing radiofrequency ablation.

Background: AI is increasingly proposed as a tool to enhance disaster medicine through improved situational awareness, decision support, and resource coordination. However, the extent to which current research has progressed beyond methodological development toward integrated, operationally validated systems remains unclear. Objective: This review aimed to systematically map the scope, methods, validation strategies, and system integration of AI applications in disaster medicine and emergency health care systems. Methods: This scoping review was conducted in accordance with PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. The PubMed (MEDLINE), Scopus, IEEE Xplore, and Google Scholar databases were searched from inception to January 31, 2026. Studies describing AI applications in disaster medicine, emergency response, mass casualty care, or public health emergencies were eligible. Data were charted across the emergency domain, scenario type, AI function, study design, and validation level. Results: A total of 168 studies were included. Research activity was concentrated in the disaster response and rescue, and public health and pandemics domains, which together accounted for 64 (38.1%) studies. Most studies involved algorithm or model development (43/168, 25.6%) or system or tool development (33/168, 19.6%), whereas applied and observational studies were less common (15/168, 8.9%). Validation was predominantly internal or simulation-based; external validation was reported in 13 (7.7%) studies, and prospective real-world validation was reported in 2 (1.2%) studies. Human-centered, smart city, and mental health domains were consistently underrepresented. Conclusions: AI research in disaster medicine is expanding rapidly but remains fragmented and is at an early stage of translational maturity. Future progress will depend on system-level integration, rigorous real-world validation, and alignment with operational emergency workflows.

Background: Poor-grade aneurysmal subarachnoid hemorrhage (aSAH) remains associated with high mortality and severe disability, yet contemporary outcomes may differ substantially from historical estimates. We performed a systematic review and meta-analysis to evaluate long-term outcomes after poor-grade aSAH and assess temporal, geographic, and treatment-related factors associated with prognosis. Methods: PubMed/MEDLINE, Embase, Cochrane Central, Scopus, Web of Science, and Google Scholar were searched from inception through March 2026. Studies enrolling consecutive adults with poor-grade aSAH (World Federation of Neurosurgical Societies grades IV–V, Hunt–Hess grades IV–V, or equivalent) reporting mortality and/or functional outcomes at ≥3 months were included. To minimize survivorship bias, studies excluding untreated patients or patients dying before aneurysm treatment were excluded. Random-effects meta-analyses of proportions were performed using generalized linear mixed models. Prespecified subgroup analyses and exploratory meta-regression analyses evaluated temporal, geographic, and treatment-related factors associated with outcomes. Findings: Forty-two studies including 7,726 patients from 16 countries across 4 continents were included. The pooled favorable functional outcome rate was 27.2% (95% CI, 23.9%–30.8%), whereas pooled overall mortality was 53.3% (95% CI, 49.0%–57.5%). Pre- and post-treatment mortality were 25.9% and 33.9%, respectively. Aneurysm treatment rate was 72.0% (95% CI, 65.6%–77.7%). Favorable outcomes improved over time from 13.5% (95% CI, 7.0%-24.3%) in the 1980s to 33.7% in the 1990s but plateaued thereafter. In exploratory meta-regression analyses, higher aneurysm treatment rates were independently associated with improved favorable functional outcome (0.134 log-odds increase per 10% increase in treatment rate; p = 0.01) and lower mortality (-0.224 log-odds per 10% increase in treatment rate; p < .001). Publication year was associated with lower mortality (p = 0.03) but not favorable outcome. Geographic region, country income group, and the proportion of grade V patients were not independently associated with outcomes. Interpretation: Mortality after poor-grade aSAH remains high, but approximately one-third of patients achieved favorable outcome. Higher aneurysm treatment rates were independently associated with improved functional outcomes and lower mortality.

Exercise is increasingly recognized as a clinically relevant intervention for mental health, with benefits that extend beyond physical fitness to improve mood, cognition, stress regulation, and overall well-being. This chapter examines the psychological effects of exercise through an integrated framework that links neurobiological mechanisms with clinical applications. Exercise modulates key neurotransmitters, enhances neuroplasticity through brain-derived neurotrophic factor (BDNF), improves cerebral perfusion, regulates the hypothalamic-pituitary-adrenal (HPA) axis, and reduces systemic inflammation. It also promotes behavioral activation, self-efficacy, emotion regulation, sleep quality, and social engagement, all of which contribute to improved psychological health. Clinical evidence supports the use of exercise across a broad spectrum of conditions, including depression, anxiety disorders, stress-related disorders, cognitive decline, and severe mental illness, where it functions as a preventive, adjunctive, and rehabilitative intervention. Successful implementation requires individualized exercise prescription, recognition of patient-specific barriers, and integration within comprehensive mental health care. Although exercise should not replace established pharmacological or psychological treatments, it offers a scalable, cost-effective, and sustainable strategy that complements conventional therapies and supports whole-person care. Future research should focus on personalized exercise prescriptions, optimization of intervention characteristics, and integration with digital health technologies to enhance adherence, accessibility, and long-term mental health outcomes.

Open health data has the potential to expedite discovery, enhance the capability of responding to public health-related challenges, and empower patients, although it comes with significant risks related to privacy, re-identification, equity, and commercialization. This chapter is a synthesis chapter because it presents case-based evidence to analyze how the consequences of openness are governed. Among our representative analyses are national registries, pandemic data infrastructures, rare disease communities, and federated models. In these cases, there is a stable governance pattern that highlights the centrality of trust, proportionality, and equity. Based on this synthesis, we suggest strategies for the practical governance of institutions and policymakers to connect the main ethical principles with practical safeguards. Placing such approaches in the context of new data space structures and developing regulatory frameworks, such as the EU Data Governance Act and Data Act, helps to demarcate ways of responsible cross-border reuse. At the end of the chapter, an implementation roadmap is provided, which involves assessment, principle setting, piloting, scaling, and long-term cultural change, with the objective of accelerating science and care while preserving ethical integrity.