It remains unclear which individuals with subthreshold depression benefit most from psychological intervention, and what long-term effects this has on symptom deterioration, response and remission.

To synthesise psychological intervention benefits in adults with subthreshold depression up to 2 years, and explore participant-level effect-modifiers.

Randomised trials comparing psychological intervention with inactive control were identified via systematic search. Authors were contacted to obtain individual participant data (IPD), analysed using Bayesian one-stage meta-analysis. Treatment–covariate interactions were added to examine moderators. Hierarchical-additive models were used to explore treatment benefits conditional on baseline Patient Health Questionnaire 9 (PHQ-9) values.

IPD of 10 671 individuals (50 studies) could be included. We found significant effects on depressive symptom severity up to 12 months (standardised mean-difference [s.m.d.] = −0.48 to −0.27). Effects could not be ascertained up to 24 months (s.m.d. = −0.18). Similar findings emerged for 50% symptom reduction (relative risk = 1.27–2.79), reliable improvement (relative risk = 1.38–3.17), deterioration (relative risk = 0.67–0.54) and close-to-symptom-free status (relative risk = 1.41–2.80). Among participant-level moderators, only initial depression and anxiety severity were highly credible (P > 0.99). Predicted treatment benefits decreased with lower symptom severity but remained minimally important even for very mild symptoms (s.m.d. = −0.33 for PHQ-9 = 5).

Psychological intervention reduces the symptom burden in individuals with subthreshold depression up to 1 year, and protects against symptom deterioration. Benefits up to 2 years are less certain. We find strong support for intervention in subthreshold depression, particularly with PHQ-9 scores ≥ 10. For very mild symptoms, scalable treatments could be an attractive option.

American diets are increasingly based on ultra-processed foods (UPF). Current research, particularly on socio-economic differentials, is lacking. This study aimed to provide an updated examination of US household purchases of UPF and how this differs by race–ethnicity, household income and household education.

The NielsenIQ Consumer Panel 2020 was utilised for analysis. Each food and beverage product purchased by US households was assigned a level of processing under the Nova level of processing classification system. The volume of UPF purchased overall and by food group was determined for each Nova processing group and examined by race–ethnicity, education and income. Results were stratified by race–ethnicity within each income group. A P value < 0·0001 was considered significant.

This study analysed data from the Nielsen IQ Consumer Panel 2020 which recorded household food purchases in the USA.

The Nielsen IQ Homescan Consumer Panel is a nationally representative longitudinal survey of around 35 000 and 60 000 US households.

Of 33 054 687 products purchased by 59 939 US households in 2020, 48 % of foods and 38 % of beverages were considered UPF. Categories with the highest proportion of purchases deriving from UPF included carbonated soft drinks (90 %), mixed dishes and soups (81 %) and sweets and snacks (71 %). Slightly higher but statistically significant proportions of UPF purchases occurred in the lowest income and education groups and among non-Hispanic whites.

It is concerning that household purchases of UPF in the USA are high. Policies that reduce consumption of UPF may help reduce diet-related health inequalities.

To understand healthcare workers’ (HCWs) beliefs and practices toward blood culture (BCx) use.

Cross-sectional electronic survey and semi-structured interviews.

Academic hospitals in the United States.

HCWs involved in BCx ordering and collection in adult intensive care units (ICU) and wards.

We administered an anonymous electronic survey to HCWs and conducted semi-structured interviews with unit staff and quality improvement (QI) leaders in these institutions to understand their perspectives regarding BCx stewardship between February and November 2023.

Of 314 HCWs who responded to the survey, most (67.4%) were physicians and were involved in BCx ordering (82.3%). Most survey respondents reported that clinicians had a low threshold to culture patients for fever (84.4%) and agreed they could safely reduce the number of BCx obtained in their units (65%). However, only half of them believed BCx was overused. Although most made BCx decisions as a team (74.1%), a minority reported these team discussions occurred daily (42.4%). A third of respondents reported not usually collecting the correct volume per BCx bottle, half were unaware of the improved sensitivity of 2 BCx sets, and most were unsure of the nationally recommended BCx contamination threshold (87.5%). Knowledge regarding the utility of BCx for common infections was limited.

HCWs’ understanding of best collection practices and yield of BCx was limited.

This study explores the perspectives of Irish Travellers, an ethnic minority group in Ireland, on the service improvements needed to implement culturally appropriate recovery approaches in mental health services.

A community-based participatory research approach was employed. Seventeen Traveller peer researchers conducted thirteen qualitative participatory workshops and five individual interviews across Ireland. Eighty-seven adult members of the Traveller community (83% female, mean age = 33, 56.3% not in education or employment) were recruited through convenience sampling. Participatory thematic analysis was employed.

Travellers’ ideas about improvements in mental healthcare involve practitioners in creating a trusting environment, increasing representation of Travellers within mental healthcare staff and working in partnership with Traveller service users to co-produce strategies that are owned by the community. Study participants emphasised the importance of Traveller cultural awareness, strengthening trauma-informed care, and embedding an ethos of cultural humility within mainstream services. The findings indicate the need for increased collaboration between mental health service providers and non-mental health agencies, and a reorientation of care towards empowering Traveller service users to achieve their social aspirations and building a positive self-identity.

This study demonstrates that implementing a recovery approach for Travellers requires a reorientation of services, in line with Travellers’ definition of culturally appropriate mental healthcare. This study calls for an expanded mandate for mental health services beyond individual care and towards intersectoral action in addressing the social determinants of Travellers’ mental health. This will help to shape an equitable and inclusive healthcare setting that promotes Travellers’ mental health and recovery.

In response to the COVID-19 pandemic, we rapidly implemented a plasma coordination center, within two months, to support transfusion for two outpatient randomized controlled trials. The center design was based on an investigational drug services model and a Food and Drug Administration-compliant database to manage blood product inventory and trial safety.

A core investigational team adapted a cloud-based platform to randomize patient assignments and track inventory distribution of control plasma and high-titer COVID-19 convalescent plasma of different blood groups from 29 donor collection centers directly to blood banks serving 26 transfusion sites.

We performed 1,351 transfusions in 16 months. The transparency of the digital inventory at each site was critical to facilitate qualification, randomization, and overnight shipments of blood group-compatible plasma for transfusions into trial participants. While inventory challenges were heightened with COVID-19 convalescent plasma, the cloud-based system, and the flexible approach of the plasma coordination center staff across the blood bank network enabled decentralized procurement and distribution of investigational products to maintain inventory thresholds and overcome local supply chain restraints at the sites.

The rapid creation of a plasma coordination center for outpatient transfusions is infrequent in the academic setting. Distributing more than 3,100 plasma units to blood banks charged with managing investigational inventory across the U.S. in a decentralized manner posed operational and regulatory challenges while providing opportunities for the plasma coordination center to contribute to research of global importance. This program can serve as a template in subsequent public health emergencies.

Head and neck squamous cell carcinomas (HNSCCs) are aggressive tumours lacking a standardised timeline for treatment initiation post-diagnosis. Delays beyond 60 days are linked to poorer outcomes and higher recurrence risk.

A retrospective review was conducted on patients over 18 with HNSCC treated with (chemo)radiation at a rural tertiary care centre (September 2020–2022). Data on patient demographics, oncologic characteristics, treatment details and delay causes were analysed using SPSS.

Out of 93 patients, 35.5% experienced treatment initiation delays (TTIs) over 60 days. Median TTI was 73 days for delayed cases, compared to 41.5 days otherwise. No significant differences in demographics or cancer characteristics were observed between groups. The primary reasons for the delay were care coordination (69.7%) and patient factors (18.2%). AJCC cancer stage showed a trend towards longer delays in advanced stages.

One-third of patients faced delayed TTI, primarily due to care coordination and lack of social support. These findings highlight the need for improved multidisciplinary communication and patient support mechanisms, suggesting potential areas for quality improvement in HNSCC treatment management.

In Europe, associations between different types of nonparental care and internalizing and externalizing behaviors in children have not been adequately explored (Gialamas, A et al. J Epiemiol Community Health. 2015). Internalizing and externalizing symptoms in childhood can have lifetime repercussions, thus understanding their risk factors and the potentially protective role of family policies is highly relevant.

To explore the associations between different types of nonparental care prior to primary school and internalizing and externalizing behaviors across young adolescence.

Six parent-offspring prospective birth cohort studies across five European countries within the EU Child Cohort Network (EUCCN) were included in the study. A two-stage individual participant data (IPD) meta-analysis on complete cases was performed. Linear regression models (one for each age group: 5-6 years, 7-9 years, 10-13 years) were applied in each cohort separately and then cohort-specific coefficients and standard errors were combined using random-effects (restricted estimate maximum likelihood (REMD) meta-analysis to attain overall effect estimates. Data were then stratified by socioeconomic position and sex.

There were 74 453 parent-offspring dyads to study children’s internalizing difficulties and 72 462 parent-offspring dyads to study children’s externalizing difficulties. Center-based care attendance was associated with lower levels of internalizing difficulties 5-6 years [-1.13 (95%CI:- 2.68, 0.42), p=0.15]; 7-9 years [-1.38 (95%CI:- 2.85, 0.10), p=0.07]; 10-13 years [-1.06 (95%CI:- 1.95, -0.17), p=0.02]. Children who attended other forms of nonparental care appeared to have higher levels of internalizing difficulties: 5-6 years [0.02 (95%CI:- 1.96, 2.01), p=0.98], 7-9 years [0.91 (95%CI:0.23, 1.58), p=0.009]; 10-13 years [0.52 (95%CI:- 0.23, 1.27), p=0.17]. Other forms of nonparental care (not including center-based care) had a positive association with externalizing symptoms : 5-6 years [2.45 (95%CI:0.35, 4.55), p=0.02]: 7-9 years [2.78 (95%CI: 0.60, 4.95), p=0.01];10-13 years [1.93 (95%CI:-0.45, 4.32), p=0.11]. We found some evidence of effect moderation by the child’s sex and socioeconomic position (SEP).

The results suggest that center-based care may protect children from developing internalizing behaviors, but other forms of nonparental care may put children at more risk of developing more internalizing and externalizing behaviors. Also, factors such as sex and SEP may interact with nonparental care in influencing externalizing behaviors.

None Declared

Many countries are currently expanding their paternity leave policies, which have positive effects on parental mental health.

We examined whether two weeks of paid paternity leave are associated with post-partum depression (PPD) in mothers and fathers at two months after the birth of their child.

Data originated from The Etude Longitudinale Française depuis l’Enfance (ELFE) cohort study. A total of 10 975 fathers and 13 075 mothers with reported information on paternity leave and PPD at two months were included in the statistical analyses. Logistic regression models, using survey-weighted data and adjusted for confounders using Inverse Probability Weights (IPW), yielded Odds Ratios.

Fathers had a median age of 32∙6 (inter-quartile range (IQR) 36∙9 – 22∙6 years), and mothers had a median age of 30∙5 years (IQR 34∙0 – 27∙1 years) at the time of the ELFE child’s birth. Fathers who took paternity leave had reduced odds of PPD [0∙74 (95% CI: 0∙70 -0∙78)] as well as fathers who intended to take paternity leave [0∙76 (95 CI%: 0∙70 – 0∙82)] compared to fathers who did not take paternity leave. Mothers had an increased likelihood of PPD at two months if their partners took paternity leave [1∙13 (95 CI%: 1∙05 – 1∙20)]. Fathers’ educational level, work contract type nor the number of children in the family were found to be interactions (p>0.25).

Taking and intending to take a two-week paid paternity leave is associated with lower odds of PPD in fathers. Mothers whose partners take paternity leave experience borderline higher odds of PPD at two months. Offering only a two-week paternity leave may protect fathers against PPD but does not significantly protect may increase mothers’ risk of against PPD onset.

None Declared

Previous studies have showed that the type of early childcare can be associated with child behavioural difficulties though results vary across countries.

To investigate the link between early childcare from birth to 3 years and child behavioural difficulties at age 5.5 years, in the French context.

In this study (n = 9,699), parents participating in the French ELFE birth cohort reported their child main childcare type used between birth and three years of age (centre-based (22.6%), childminder (43.6%), informal (8.2%) or parents only [25.7%)), and the child’s behaviour through the Strengths and Difficulties Questionnaire (SDQ) at age 5.5 years. Scores were calculated for each SDQ subscale as well as the total SDQ scores. Logistic regression analyses were carried out adjusting on socio-demographic, parents’ and child’s characteristics to evaluate the association between early childcare type and abnormal SDQ total score (>16) as well as subscale scores.

In the study population, 584 (6.02%) children had abnormal SDQ total score, and 1,104 (11.4%) in the emotional subscale, 573 (5.91%) in the peer relationship subscale, 1,433 (14.8%) in behavioural subscale, and 1,097 (11,3%) in the hyperactivity subscale. After adjusting, compared to children who were looked after by their parents only, those who were in centre-based childcare had a lower likelihood of having an abnormal SDQ total score (ORa = 0.76 [95% CI: 0.58 – 0.99]), while there was no significant difference for children who were in a childminder’s care (ORa = 0.94 [95% CI: 0.75 – 1.17]) or in an informal childcare (ORa = 1.18 [95% CI: 0.86 – 1.63]). In additional analyses, we found that compared to children in parental care only, children in centre-based childcare had a decreased likelihood of having abnormal internalising subscales scores: emotional subscale, (ORa = 0.81 [95% CI: 0.67 – 0.99]) and peer relationship subscale, (ORa = 0.79 [95% CI: 0.61 – 1.02]). All other associations were not significant except for the informal childcare which was associated to a higher likelihood of abnormal behavioural subscale (ORa = 1.29 [95% CI: 1.03 – 1.62]).

In the French ELFE cohort, early centre-based childcare was linked to lower likelihood of having internalising problems in children at age 5.5 years. Further studies should focus on the possible mecanisms of this association. Family and childhood policies should aim to make centre-based childcare accessible to more children.

None Declared