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Existing reviews on mental health disparities between deaf and hard‐of‐hearing (DHH) and hearing populations have focused predominantly on children, adolescents, or older adults, leaving a gap for working-age adults. We conducted a systematic review comparing the prevalence, incidence, and severity of any DSM-5-TR or ICD-11 mental disorder between DHH and hearing adults aged 18–60 years. We aimed to quantify disparities and examine disorder-specific patterns to inform future research, policy, and service development.
Methods
On 13 December 2025, we searched Ovid Medline, Embase, APA PsycINFO and Web of Science. We included analytical observational studies involving DHH and hearing adults aged 18–60 years, reporting mental disorder prevalence, incidence, or severity. Two researchers independently extracted data, and risk of bias (RoB) was assessed using the modified CLARITY tool. We narratively synthesised findings by aggregating outcomes at the study level using two approaches: summary and majority of the effect directions within a study. Subgroup syntheses examined outcome type, study RoB, age group and mental disorder category.
Results
Sixty studies (n = 8 578 466) met inclusion. In the summary-direction synthesis, 58.3% (35/60) of studies reported higher mental disorder outcomes for DHH adults, 21.7% (13/60) found no difference and 20.0% (12/60) had mixed findings; none indicated lower mental disorder outcomes for DHH. Under the majority-direction approach, 65.0% (39/60) showed higher mental disorder outcomes and 35.0% (21/60) no difference. These patterns were consistent across prevalence (62.8–72.1% higher) and severity (61.1% higher). Studies with higher RoB more often reported higher mental disorder outcomes (66.7–72.2%) than lower-RoB studies (54.8–61.9%), though both mirrored the overall synthesis. Effects were similar across younger (61.9–71.4%) and older adult samples (61.1–66.7% higher). Disorder-specific syntheses identified psychotic disorders, post-traumatic stress disorder and suicidal outcomes as having the strongest disparities (≥72.2% higher), followed by general mental disorders, anxiety and depression. Fewer than five studies examined each of the other disorders, thereby limiting conclusions for these disorders.
Conclusions
Most available evidence indicates that the prevalence and severity of mental disorders are higher among DHH adults aged 18–60 years than among hearing adults, with limited evidence on incidence. No studies reported lower aggregated mental disorder outcomes for DHH adults. Addressing these disparities requires targeted intervention research, supported by population-based, longitudinal and (quasi-)experimental studies including comprehensive reporting of participant characteristics. This will inform more tailored interventions, improve screening and ultimately contribute to better mental health and quality of life for DHH adults.
Polyethylene liners dropped onto operating room floors rapidly acquire bacterial contamination, including clinically important pathogens. In a randomized bench study, sterile chlorhexidine–alcohol and povidone-iodine immersion significantly reduced bioburden compared with ethanol or no intervention. When replacement is not feasible, chlorhexidine or iodine is preferable.
Counting the number of isomers of a chemical molecule is one of the formative problems of graph theory. However, recent progress has been slow, and the problem has largely been ignored in modern network science. Here we provide an introduction to the mathematics of counting network structures and then use it to derive results for two new classes of molecules. In contrast to previously studied examples, these classes take additional chemical complexity into account and thus require the use of multivariate generating functions. The results illustrate the elegance of counting theory, highlighting it as an important tool that should receive more attention in network science.
The US Centers for Disease Control and Prevention (CDC) has listed vaccination as one the top 10 public health achievements,1 and vaccines have led to a tremendous reduction in deaths due to vaccine-preventable disease in the United States alone.2 There are over 22 million persons employed in healthcare in the United States, making healthcare personnel (HCP) an important population to target for vaccination efforts. Promoting vaccination for HCP as defined by the CDC is likely to become even more essential given the rising incidence in the United States of vaccine-preventable diseases such as measles and pertussis.3
Limited studies have conducted a comprehensive investigation on the impact of China’s birth policy change on the mental health among women of childbearing age. This study aimed to explore the potential impact of China’s Universal two-child policy on depressive symptoms among women of childbearing age, based on national-representative, longitudinal survey data.
Methods
Data we employed in this study were derived from the China Family Panel Study (CFPS) for the waves of 2012, 2014, 2016, 2018 and 2020. We included 7481 currently married females (17079 for pooled sample) aged 20–40 years. Depressive symptoms were assessed using the Kessler 6 Rating Scale (K6) and the Center for Epidemiologic Studies Depression Scale (CES-D). All scores were standardized for analysis. We employ the difference-in-difference model to investigate the association between the implementation of the Universal Two-child Policy (UTP) and women’s depressive symptoms.
Results
Women in the exposed group, after implementing UTP, had a standardized score of depressive symptoms 0.10 higher (95% CI: 0.03–0.16, p = 0.007) than during the pre-intervention period after controlling for multiple covariates. They also faced a higher risk of having moderate or severe depressive symptoms (OR = 1.45, 95% CI: 1.12–1.87, p = 0.004). The stratified analysis revealed that the negative impact of UTP on mental health was pronounced among women with advanced age, low education, medium family income, only male offspring before UTP, and no new birth after UTP.
Conclusion
We observed that the implementation of the UTP was associated with increased depressive symptoms among married women of childbearing age in China, with significant heterogeneity across different sociodemographic groups. Greater attention should be paid to the complex psychological conditions of women of childbearing age when adjusting fertility policies, which is crucial to prevent women from suffering poor mental health and to advance high-quality development in population health.
There is growing public health interest in ultra-processed foods (UPF), but limited research exploring consumers’ perceptions of these foods in the United States. We aimed to characterise consumers’ beliefs about UPF, the association between perceived food processing and perceived food healthfulness and alignment between consumers’ perceptions and objective measures of food processing and healthfulness.
Design:
In a cross-sectional survey, participants answered questions regarding their beliefs about UPF. They rated the healthfulness and processing levels of a random selection of ten out of forty possible foods. We used descriptive statistics to examine participant beliefs about UPF. We used linear regression models to test associations between perceived processing and perceived healthfulness and between objective and perceived measures of food healthfulness and processing.
Setting:
We fielded an online survey in the USA in November 2023.
Participants:
This study included US adults aged ≥ 18 years (n 4455).
Results:
Fifty-four percent of participants correctly identified UPF as ‘Food products submitted to a series of industrial processing’ and 52 % correctly identified UPF as, ‘Food products that contain artificial ingredients’. However, one-third of participants believed UPF were genetically modified products. While foods with higher perceived processing tended to have lower perceived healthfulness and individuals perceived UPF as more processed and less healthful than minimally processed foods, healthfulness perceptions better aligned with Food Compass 2.0, a measure that integrates food processing and nutrient-profile.
Conclusions:
Educational and policy efforts (e.g. food labeling) are needed to help consumers distinguish UPF and holistically assess the healthfulness of foods and beverages.
This study aimed to assess the oral health status of individuals with schizophrenia and explore its association with behavioural and pharmacological factors, with particular focus on long-term antipsychotic treatment and cumulative anticholinergic burden.
Methods
A total of 153 adults with schizophrenia (18–65 years) from the Mental Health Network of Bizkaia (Spain), all under antipsychotic treatment for ≥12 months, were evaluated and compared with 153 controls from the general population. Data on socio-demographic variables, tobacco use and oral hygiene habits were collected. Oral health was assessed using the Decayed, Missing and Filled Teeth (DMFT) index and the Community Periodontal Index of Treatment Needs (CPITN). Unstimulated salivary flow was measured, and subjective xerostomia symptoms were recorded. Cumulative anticholinergic burden was estimated using the Drug Burden Index, considering both psychotropic and non-psychotropic medications. The association between dental health and clinical, behavioural and pharmacological variables was analysed in patients with schizophrenia.
Results
Patients with schizophrenia exhibited significantly poorer oral health than controls, with higher mean DMFT scores (15.3 vs. 10.9; p < 0.001) and more advanced periodontal disease indicated by CPITN. Salivary hypofunction (<0.45 ml/min) was present in 31% of patients versus 12% of controls. In addition, high to very high anticholinergic burden was present in 71.9% of patients with schizophrenia, compared to only 3.3% of controls. In patients with schizophrenia, multivariate analyses identified the following as significant predictors of worse dental status (DMFT): age; smoking; female sex; illness duration; reduced salivary flow; poor tooth brushing; and anticholinergic burden. For periodontal health (CPITN), however, no variable was identified as a significant predictor of high-risk periodontal status.
Conclusions
Oral health is substantially compromised in individuals with schizophrenia, reflecting a multifactorial interplay of behavioural, systemic and pharmacological factors. Both cumulative anticholinergic burden and reduced salivary flow independently contribute to poorer dental health, while periodontal disease appears to result from more complex influences not fully captured with studied variables. These findings underscore the importance of proactive clinical strategies, including regular dental assessments, targeted oral hygiene interventions, interdisciplinary collaboration between mental health and dental care providers and careful review of psychopharmacological regimens to minimize unnecessary anticholinergic exposure. Such integrated approaches are essential to preserve oral health, enhance quality of life and improve long-term outcomes in this vulnerable population.
Iodine is a component of thyroid hormones and essential for neurological development. To evaluate the iodine nutritional status of pregnant women residing in Veneto and the possible role of thyroglobulin (Tg) as a proxy. 528 pregnant women in the third trimester of pregnancy were consecutively enrolled in this cross-sectional study and were asked to provide an early-morning spot urine sample (for UI/Creat) and a blood sample (for thyroid function and Tg). They also completed a questionnaire. Infant anthropometric data at birth were obtained. Median UI/Creat was 112·8 μg/g. 34·1 % of women had a UI/Creat ≥ 150 μg/g. Iodised salt (IS) was used by 76·9 % of women, iodine-containing supplements (ICS) by 74·2 % and cow’s milk was regularly consumed by 46·0 %. At multivariable analysis, consumption of regular cow’s milk and ICS were significant predictors of UI/Creat ≥ 150 μg/g (OR 1·57, 95 % CI: 1·06, 2·32 and OR: 2·83, 95 % CI: 1·66, 4·82, respectively). The median Tg value was lower among the iodine-sufficient than among the iodine-deficient women (P = 0·005). At multiple linear regression analysis, Tg was among the factors associated with weight (β = –81·83, P < 0·001) and length (β = –0·3, P < 0·01) at birth, although weakly. Tg was a factor associated with pre-term delivery (OR: 1·52, 95 % CI: 1·20, 1·92). Regular use of cow’s milk and ICS is a factor associated with UI/Creat ≥ 150 μg/g. Tg was associated with iodine status and pregnancy outcomes, although it had only a modest discriminative ability for sufficiency.
High-energy, sugar-rich diets are associated with obesity and pancreatic disorders. We investigated the effects of consumption of a high-fat and high-fructose diet (HFFrD) on gene expression related to insulin synthesis, inflammation and apoptosis in pancreatic β-cells. Weaned Wistar rats were fed either a control diet (CD; 11 % kcal from fat and 0 % from fructose) or an HFFrD (48 % kcal from fat and 33 % from fructose) for 22 weeks; after a 6-h fast, animals were euthanised. Body weight and total fat were recorded. Serum analyses included: glucose, insulin, triacylglycerides (TAG), malondialdehyde (MDA), TNFα, IL-6, IL-10 and advanced glycation end-products (AGE). Pancreatic islets were analysed for gene expression linked to insulin synthesis, inflammation and apoptosis. Pancreatic assessments included TUNEL assay and immunohistochemistry. HFFrD increased body weight, total fat, MDA, insulin, homeostatic model assessment for insulin resistance, AGE, TAG and IL-6 concentrations in both sexes. Gene expression revealed sex-dependent differences: Glut2, Gck, Khk, Ins2 and the transcription factor Mafa were downregulated in males but upregulated in females. Pdx1 expression increased in females, whereas NeuroD1 increased in males. Pro-inflammatory markers (Il-1β, Il-6) increased in both sexes, whereas Il-10 decreased in males and increased in females. Bax/Bcl2 ratio decreased in males but increased in females; antioxidant and apoptotic markers Nrf2 and Casp3 increased in females. Endocannabinoid receptors (Cnr1, Cnr2) increased in both sexes. HFFrD altered the expression of genes involved in insulin synthesis, inflammation and apoptosis in a sex-specific manner. Compared with males, females showed lower vulnerability, possibly because of adaptive responses in insulin synthesis signalling influenced by sex hormones.
Supported decision-making is rapidly gaining attention as an alternative to guardianship and other forms of surrogate decision-making for people with cognitive disabilities. This article provides an overview of the legal status of supported decision-making in the United States, with particular attention to how states are recognizing supported decision-making in different legal contexts. It then explores how the law of supported decision-making applies to clinical research. It explains that although federal research regulations and guidance do not explicitly address formal supported decision-making, individuals may use supported decision-making to make decisions about participating in clinical research and researchers may be required to allow such use under federal laws that protect against disability discrimination. It then concludes by considering legal barriers to greater use of supported decision-making and how these barriers might be overcome.
In the Netherlands, around 750 children (0–21 year) die annually from potentially palliative conditions. The majority of these children reside at home, receiving care from hospital services and primary care. This study aims to examine general practice utilization for pediatric palliative care patients in the last 2 years of life.
Methods
A retrospective cohort study was performed using the routine healthcare database of the Julius General Practitioners’ Network. The main outcome for general practitioner (GP) utilization was the number of GP consultations for children in the last 3 months of life. Participants were included who were children (0–21 years), and deceased in the period 01-01-2013 to 31-12-2022 from an underlying chronic condition. Data were analyzed using descriptive statistics and tested for differences in provided care between children who died in hospital and who died at home.
Results
Forty-eight children from 32 GP practices met inclusion criteria. Median age was 10.0 years (interquartile range [IQR] 1.5–17.1). Common diagnoses were oncological (29%), congenital (29%), and metabolic conditions (23%). Ninety-six percent of children had contact with their GP in the last 3 months (median 7 consultations, IQR 3.0–10.0), i.e. 26 children who died in hospital had median 3.5 GP consultations compared to 20 children who died at home median 9.5 GP consultations (p < 0.001). Thirty-five percent of children were documented as being palliative, with 54% having some form of advance care planning discussions documented.
Significance of results
These results demonstrate that GPs are highly involved in providing pediatric palliative care. The palliative nature of these children and advance care planning discussions are not routinely documented and/or performed by GPs. Further insights into guidance that supports GPs, in collaboration with other healthcare professionals, in providing palliative care for children at home and their families are needed.