Many children and young people (CYP) with significant mental health difficulties face barriers to accessing care from mental health services, impacting their clinical outcomes and recovery. Sociodemographic and socioeconomic factors may contribute to inequalities in access and outcomes.

To investigate the roles of sociodemographic, socioeconomic and clinical factors in influencing access to services, receipt of clinical care or diagnoses and clinical outcomes.

Using data from a large, nationally representative, randomised controlled trial in England (STADIA), 1225 children aged 5–17 years and with emotional difficulties referred to child and adolescent mental health services (CAMHS) were followed up over 18 months post-referral to investigate predictors of referral acceptance, receipt of care and their clinical outcomes.

Older CYP (for each 1-year increase in age, odds ratio 1.07, 95% CI: 1.02, 1.11) and those living in the least deprived neighbourhoods (deprivation index, least versus most deprived quintile: odds ratio 1.60, 95% CI: 1.05, 2.43) were more likely to have their referral accepted by CAMHS. Clinical severity (i.e. scoring above cut-off for symptoms and/or impact) was not associated with receipt of a clinical diagnosis or treatment/intervention. At 12-month post-referral, 61% met mental health ‘caseness’ criteria (v. 67% at baseline). CYP living in less deprived neighbourhoods had better clinical outcomes at 12-month follow-up (least versus most deprived quintile: odds ratio 0.49, 95% CI: 0.30, 0.81, for meeting caseness criteria, i.e. the presence of clinically significant symptoms and impairment). Females were more likely than males to have clinically significant levels of depression at 12-month follow-up (odds ratio 1.77, 95% CI: 1.28, 2.45).

There appear to be sociodemographic and socioeconomic inequalities in access to care and outcomes for clinically referred CYP with emotional mental health difficulties, with limited improvements in clinical outcomes 1 year following referral to CAMHS. CYP living in more deprived areas and younger children appear less likely to receive help, hampering earlier intervention efforts even in help-seeking populations.

The positive valence systems (PVS) domain, a key focus of the Research Domains Criteria framework, divides reward-related processes into three constructs: reward responsiveness, reward learning, and reward valuation. Difficulties with several of these reward constructs have been reported in people with mood-psychosis spectrum disorders. This study aims to examine how performance on tasks corresponding to these three constructs covaries, and how performance relates to mood and psychotic symptoms in adults with mood-psychosis spectrum disorders, those at familial risk, and controls.

Data from two studies (N = 278 and N = 332) were analyzed, which both included people with a psychotic disorder or bipolar disorder (patients), their first-degree relatives (FDRs), and controls. PVS constructs were measured using the Multi-Armed Bandit Task, Effort-Expenditure for Rewards Task, and Monetary Incentive Delay Task. Depression, mania, and psychosis symptoms were measured with self-report and interview instruments. Confirmatory factor analysis was used to examine covariation, and path analysis to test associations with symptoms.

The three reward constructs showed weak (nonsignificant) covariance in all groups. There were a few impairments in reward-related performance in patients or FDRs, none that survived multiple-comparison correction. There were no associations between symptoms and performance on the PVS constructs after multiple comparisons correction.

The findings showed no evidence that performance on any of the three PVS constructs could constitute an endophenotype of mood-psychosis spectrum disorders. We recommend future research examining the contribution of specific cognitive skills to reward-related behavior, and to sources of heterogeneity in reward functioning within the patient group.

To compare long-term vestibular function in cochlear implant recipients with enlarged vestibular aqueduct and those without inner-ear malformations.

A comparative analysis was conducted on 53 cochlear implant recipients (27 with enlarged vestibular aqueduct, 26 with no inner-ear malformations). Vestibular function was assessed using caloric testing, vestibular-evoked myogenic potential, the video head impulse test and age-appropriate symptom questionnaires.

Enlarged vestibular aqueduct patients demonstrated significantly better preservation of otolithic function post-implantation, with higher cervical vestibular-evoked myogenic potential response rates (56 vs 12 per cent, p = 0.001). Caloric testing showed similar vestibular dysfunction across both groups. Both cohorts exhibited significant asymmetry between implanted and non-implanted ears.

Cochlear implantation impairs vestibular function regardless of cochlear morphology, affecting both otolithic and low-frequency semicircular canal function. However, better saccular function preservation in enlarged vestibular aqueduct patients suggests unique vestibular adaptation, with implications for counselling and rehabilitation.

This pilot study describes the design and field evaluation of web-based pre-deployment medical screening and health monitoring by the Urban Search and Rescue (US&R) branch of the Federal Emergency Management Agency (FEMA).

A review of US&R medical officers’ (MOFR) and task force physicians’ workflow identified web-based solutions. A Microsoft Forms tool (Microsoft Corporation, Redmond, Washington, USA) was utilized for pre-deployment medical screening. A web-based dashboard was developed for reporting task force daily Injury and Illness Logs, submission tracking, and syndromic surveillance.

The pre-deployment medical screening tool was completed by 100% of Incident Support Team (IST) members and took less than 4 minutes to complete. A post-deployment survey revealed that the new process was more efficient for the IST members and for the MOFRs in comparison to an in-person screen. Task force daily compliance with web-based Injury and Illness Log reporting was 84%. Successful syndromic surveillance was demonstrated and assisted in maintaining operational readiness. All tools were noted to be intuitive to use and were more efficient compared to prior workflows despite no advanced training in their use.

Web-based medical screening, reporting, and surveillance tools can be successfully implemented with high reporting adherence and improved workflow efficiency without prior training.

Cognitive reserve (CR) is a protective factor in first-episode psychosis (FEP), influencing cognitive, clinical, and functional outcomes. CR is shaped by a combination of genetic, clinical, and environmental factors, yet the extent of their respective contributions remains unclear. This study investigates the influence of polygenic risk scores (PRS), clinical and environmental variables on CR in FEP.

A cohort of 174 individuals with non-affective FEP, aged 25.5 (SD=5.3), was analyzed. CR was assessed using a socio-behavioral proxy. PRS for educational attainment (PRSEA), intelligence (PRSIQ), cognitive performance (PRSCP), occupational attainment (PRSOA), physical activity (PRSPA), and schizophrenia (PRSSZ) were calculated. Age at onset, socioeconomic status, birth weight, and family history of psychosis were considered. Multiple regression models were employed to evaluate the impact of the different predictors on CR.

PRSEA (p=0.002), age at onset (p=5.32x10-5), and family history of psychosis (p=0.001) emerged as the strongest contributors to CR. Higher PRSEA was associated with higher levels of CR, while earlier age at onset and positive family history were associated with lower CR. The model incorporating environmental, clinical, and genetic variables explained 17.7% of the variance in CR, and the one without PRS explained 13.5%. The inclusion of PRSEA in the model improved the explanatory power (Δadj.R2=0.042) and predictive accuracy (ΔRMSE=−0.288).

These findings highlight the role of precision psychiatry in better understanding CR. Early identification of individuals with earlier onset, family history of psychosis, and lower genetic predisposition to educational attainment may help characterize those with lower CR.

Patients with Parkinson’s disease (PD) suffer from interrelated motor and non-motor symptoms. While most research focuses on motor improvement, this study investigated whether targeting mood via sequential bilateral dorsolateral prefrontal cortex (DLPFC) tDCS could favorably affect motor function in patients maintaining a stable medication ‘ON’ state. Additionally, we employed wearable smart devices to objectively evaluate real-world changes in daily activity and sleep patterns, complementing traditional clinician-rated scales.

PD patients with mild-to-moderate depressive symptoms were enrolled. All participants completed a 7-day baseline monitoring period using a smart band. Participants received ten sessions of bilateral tDCS targeting the DLPFC (anode F3, cathode F4) at 2 mA for 30 minutes, three times a week. Clinical assessments and smart band monitoring were repeated during the final week of treatment. Pre–post changes and correlations were analyzed while controlling for potential confounders.

Following tDCS, it was significant improvements in K-MADRS, STAI, AS, UPDRS part III, and PDQ-39. Smart device data showed a significant increase in daily step counts after treatment, while changes in physical activity time and sleep duration were not significant. Changes in step count were strongly correlated with improvements in apathy, and this relationship remained significant after confounding variables (rho = –0.76, p < 0.001).

Bilateral DLPFC tDCS significantly improved mood and motor function in patients with PD. Smart band data further showed an increase in daily step counts after the intervention, with reductions in apathy. These findings suggest that tDCS may enhance goal-directed behavior by modulating mood-related pathways, highlighting apathy as an important therapeutic target in PD.

An intrauterine device (IUD) is a highly effective long-acting and reversible contraceptive method widely available around the world and safe for nearly all women. However, very few women in Southwestern Ethiopia use.

To identify factors influencing an intention to use the intrauterine device among family planning users in Southwestern, Ethiopia.

A facility-based cross-sectional study was conducted among 784 modern family planning users from 15th October to 15th November 2020. An interviewer-administered questionnaire was used. Estimates were generated using logistic regression model.

Thirty percent intended to use IUD. The most commonly cited reasons for their lack of an intention to use IUD were fear of side effects, lack of knowledge, and husband disapproval. Being able to read and write (AOR = 3.33 [95% C.I. 1.48, 7.49]) compared to those unable to read and write; Being rich (AOR = 1.69 [95% C.I. 1.02, 2.82]) compared to the poor; being knowledgeable about IUD (AOR = 2.74 [95% C.I. [1.67, 4.51]); having higher reproductive health autonomy (AOR = 1.53 [95% C.I. [1.09, 2.16]) were found to be significant factors influencing women’s intention to use an IUD.

Nearly one-third of women who attend health facilities are currently using contraception reported an intention to use an IUD in the future. Public health interventions should focus on the cited reasons reaching all the community in need, and give priority for women who unable read and write, and lowest wealth status. Further interventional studies were recommended to determine effective interventions to increase women’s intention to use intrauterine device.

Inconsistent findings persist across resting-state functional imaging studies of regional brain alterations in postpartum depression (PPD), while connections to transcriptional profiles and neurotransmitter systems remain largely uncharacterized.

We performed a whole-brain voxel-wise meta-analysis of resting-state functional imaging studies comparing PPD patients and healthy controls using SDM-PSI software. JuSpace toolbox analyzed atlas-based nuclear imaging-derived neurotransmitter maps, and transcriptional data were sourced from the Allen Human Brain Atlas.

Our systematic review identified 12 functional imaging studies (475 PPD patients, 504 controls). Patients with PPD displayed increased resting-state functional activity in the left inferior occipital gyrus and left precuneus as well as decreased resting-state functional activity in the right amygdala and left precentral gyrus. These functional alterations spatially overlapped with serotonergic, dopaminergic, and VAChT systems. Transcriptional analysis revealed PPD-related gene enrichments in ion channel function (transmembrane transport, gated/passive channels) and channel complexes.

The meta-analysis revealed functional alterations within the DMN, limbic, and primary sensorimotor systems in PPD patients. These changes were linked to neurotransmitter alterations and genetic modulations underlying brain dysfunction. Collectively, these findings advance mechanistic understanding of PPD pathophysiology.