A novel transdiagnostic blended Ecological Momentary Intervention (EMI) for improving self-esteem in youth who experienced childhood adversity has shown beneficial effects. However, evidence on the cost-effectiveness of SELFIE and EMIs overall is lacking.

In this RCT-based economic evaluation, participants aged 12–26 years with low self-esteem (<26 on the Rosenberg Self-Esteem Scale [RSES]) and experienced childhood adversity were recruited from specialized mental health services and the general population and randomly allocated to CAU (control condition) or CAU + SELFIE (experimental condition). The Trimbos/iMTA Questionnaire for Costs Associated with Psychiatric Illness (TiC-P), the RSES, and EQ-5D-5L were assessed at baseline, post-intervention, and 6-, 18-, and 24-month follow-up. Incremental cost-effectiveness (ICER) and cost-utility (ICUR) ratios, and acceptability curves, were generated. Sensitivity and subgroup analyses assessed robustness.

From a societal perspective, the ICER presented €1,219 per improved point of self-esteem, and the ICUR presented €53,986 per QALY gained. The probability of cost-effectiveness was 26% at a willingness-to-pay (WTP) threshold of €20,000/QALY and 49% at €50,000/QALY. At €50,000/QALY, the probability of cost-effectiveness was 77% from a healthcare perspective (ICUR €15,671/QALY gained) and 87% for participants recruited from specialized mental health services (ICUR €–14,567/QALY gained).

At the societal level, the SELFIE intervention exceeded the WTP threshold. Tests for robustness showed higher probabilities of cost-effectiveness from a healthcare perspective, likely reflecting the absence of educational productivity loss costs in the societal perspective, and in youth recruited from specialized mental health services. The innovative field of blended EMIs yields encouraging first results, urging more cost-effectiveness research.

Children born with single-ventricle heart disease face a myriad of medical comorbidities, psychological risks, and quality of life challenges as they age. Parent perspectives on their care from diagnosis through development are critical to understand best ways and times to intervene to promote child and family adjustment to illness.

Parents of children with status post-Fontan procedure were recruited to complete an electronic qualitative survey exploring parent perspectives of care. Grounded theory was utilised to analyse the data and identify themes and subthemes.

Twenty-four parents completed the survey, describing their experience from diagnosis through the early years of treatment and into childhood and adolescence. Seven core themes were identified: survival and hope, parent stress and support, early stress and development, quality of life, increased independence, connection to the team, and communication. Initially, parents shared early worry regarding survival as they learned more about the condition and underwent surgeries. Later, parents supported their child’s development and balanced ongoing hypervigilance with promotion of normalcy in their child’s life. Quality of life and behavioural health concerns emerged amongst other medical comorbidities, and parents emphasised the need for both child and parent support in navigating family life with this illness.

Parent perspectives highlighted the importance of family-centred, multidisciplinary care models that integrate medical subspeciality and psychosocial services for holistic care of children born with single-ventricle heart disease. Implications for care across development and interventions for children and parents are discussed.

Functional neurological disorder (FND) is a common and disabling neuropsychiatric condition in which women comprise approximately 75% of cases. This paper examines whether the gender imbalance seen in FND is unique among neurological and psychiatric conditions and explores the biological, psychological, and social contributors to this disparity.

A narrative review was conducted using MEDLINE, PsycINFO, and Web of Science. Gender ratios were compared across depression, anxiety, post-traumatic stress disorder, schizophrenia, eating disorders, Parkinson’s disease, and multiple sclerosis. Evidence regarding sex hormones, early life trauma, gender-based social determinants, and diagnostic biases were synthesized thematically.

Amongst the psychiatric and neurological conditions reviewed, FND shows a pronounced female predominance (approximately 3:1), placing it amongst the most gender imbalanced disorders in our sample, with only eating disorders showing a larger female predominance. Biological factors (particularly the influence of estrogen and progesterone on stress reactivity, neuronal excitability, and agency), may heighten female vulnerability. Social determinants (increased exposure to trauma, socioeconomic inequality, and gender norms) further contribute to this risk. FND shares clinical and demographic similarities with other internalizing disorders and conditions linked to dissociation and trauma. The literature suggests FND emerges from a bidirectional interaction between gonadal hormones and psychosocial stressors.

The marked gender imbalance in FND arises from the interplay of biological vulnerability and gendered social adversity. Understanding these intersecting influences is essential for reducing stigma and guiding future research, diagnosis, and treatment. The findings support the need for a gender-sensitive, biopsychosocial approach to FND care, and investigation.

C-reactive protein (CRP) has been studied in relation to bipolar disorder (BD) and suicidality independently. Although suicide risk is elevated in youth with BD, little is known about the association of CRP with suicidality in this population.

211 youth participated, including 23 BD with lifetime suicide attempts (BDSA), 45 BD with lifetime non-suicidal self-injury (NSSI; BDNSSI), 39 BD without lifetime suicide attempt or NSSI (BDNo-SA/NSSI), and 104 healthy controls (HC). Suicide attempts and NSSI were assessed systematically. Fasting blood samples yielded CRP levels. Primary analyses controlled for age, sex, and body mass index percentile.

CRP levels differed across groups (F3,204 = 3.40, p = 0.02, ηp2 = 0.05). In post hoc analyses, CRP levels were significantly higher among BDSA (3.44 ± 6.42 mg/L) vs HC (0.81 ± 0.90 mg/L; p < 0.01) and BDNo-SA/NSSI (1.42 ± 3.31 mg/L; p = 0.01) groups; however, no difference was seen with the BDNSSI group (1.83 ± 2.22 mg/L; p = 0.12). Between-group differences in CRP levels persisted in independent sensitivity analyses controlling for current mood symptoms, lifetime mania score, lifetime smoking, and medications, but not with lifetime depression score.

Suicide attempts among youth with BD are associated with elevated CRP. Given accessibility of CRP testing, the present findings have potential clinical implications. Larger, longitudinal studies with repeated measures are needed to examine time-varying associations between CRP and suicide risk among youth with BD.

The Regulation (EU) 2021/2282 on Health Technology Assessment (HTAR), which applies as of January 2025, introduces the Joint Clinical Assessment (JCA) for selected health technologies and establishes a stakeholder network. This study aims to evaluate the expected impact of the implementation of the HTAR from a multi-stakeholder perspective, using Italy as a case study.

A scoping literature review was performed according to the PRISMA guidelines to inform the development of an interview guide. Target participants included Italian stakeholder representatives with an interest in the HTAR. One-on-one semi-structured interviews were conducted virtually at the end of 2024. The questions were categorized into three main topics: expected benefits and opportunities; foreseen risks or challenges; recommended actions. The interviews were transcribed verbatim and analyzed using thematic content analysis techniques.

Thirteen participants included representatives from national and regional HTA bodies, health technology developers’ associations, health professional associations, patient organizations, and HTA experts. The JCA is expected to enhance the quality of clinical assessment and to result in faster and more equitable access to health innovations. However, the timing will depend on the extent to which Member States require complementary analyses. Health technology developers benefit from submitting a single JCA dossier, but often cope with limited evidence and short-term deadlines. The interviewees recommended harmonizing evidence standards, investing in HTA education and training, and fostering strategic stakeholder collaborations.

The process of harmonization induced by the HTAR is beneficial to standardize clinical assessment at the EU level, but needs to reconcile different stakeholder perspectives.

Hospices represent the cornerstone of modern palliative services. However, population-level data on hospice utilization and characteristics of patients dying in hospice remain limited to examine national temporal trends in hospice deaths in Italy from 2011 to 2022, with a focus on the underlying causes of death.

We performed a nationwide, population-based retrospective study using official mortality data from the Italian National Institute of Statistics. All deaths registered in Italy between 2011 and 2022 were included. Hospice deaths were identified as those occurring in licensed hospice facilities.

Hospice beds increased from 1,681 in 2011 to 3,419 in 2022, while hospice deaths more than doubled from 19,179 (3.2% of all deaths) to 43,972 (6.2%). The mean age of hospice deaths rose from 74.0 to 76.6 years. Among patients dying in hospice, neoplasms remained the leading cause of death but declined from 87.0% in 2011 to 73.8% in 2022, while cardiovascular deaths increased from 6.2% to 9.5%, neurological from 1.2% to 3.4%, and respiratory from 1.0% to 2.5%. The proportion of national neoplasm deaths occurring in hospice reached approximately 20% in 2022. Similarly, the proportion of non-neoplasm hospice deaths tripled (0.6–2.1%).

Between 2011 and 2022, hospice deaths in Italy more than doubled, reflecting substantial progress in expanding access to palliative care. The gradual increase in non-neoplasm hospice deaths suggests a shift toward greater inclusivity, although neoplasm remains predominant.

Human papillomavirus (HPV), particularly high-risk types such as HPV 16 and 18, is a major cause of cervical cancer and other cancers. Despite the United Kingdom’s (UK’s) commitment to cervical cancer elimination by 2040, participation in HPV screening is declining, disproportionately affecting underserved groups, including those experiencing poverty, people from minoritized racial, ethnic, gender, or sexual identity groups, and people living with HIV.

We conducted a mixed-methods study to explore awareness, barriers, and facilitators to HPV self-sampling from clinician and public perspectives. A multi-stakeholder survey (n = 105) and two online focus groups with clinicians (n = 4) and members of the public (n = 5) were undertaken.

Survey respondents identified accuracy, cost-free availability, ease of use, accessibility, clear instructions, and adequate follow-up as critical test features. Participants emphasized that disability, cultural context, language, and socioeconomic status strongly influence barriers and facilitators to uptake. Focus groups provided contextual depth, illustrating how privacy, logistical and emotional impacts, and supportive follow-up pathways shaped acceptability and trust. Clinicians highlighted the need for integration into healthcare infrastructure to maintain trust and ensure support. Public participants recommended community-driven engagement, including multilingual instructions and tailored communication to encourage adoption among diverse groups. Concerns were raised about unintended consequences, such as anxiety following asymptomatic HPV diagnoses and challenges in managing clinical pathways after positive results. Suggestions included leveraging community organizations to reduce hesitancy.

Findings highlight policy and implementation considerations for embedding HPV self-sampling within care pathways to improve uptake and reduce inequalities.