Depression during pregnancy is an important public health concern, with national recommendations calling for universal screening throughout prenatal care. However, recent analysis within the Sanford Health system (2011-2021) found that depression during pregnancy was diagnosed in 11.20% of all pregnancies but in only 4.55% of Black pregnancies, suggesting underdiagnosis in this population. This study aims to identify barriers to effective prenatal depression screening for Black women and assess potential solutions to improve provider practices and patient outcomes. This qualitative study will involve up to 25 semi-structured informational interviews with prenatal care providers within the Sanford Health system. Providers will be recruited via email using a voluntary participation approach. Interviews will last 15-20 minutes and be conducted in person or via phone in a private setting. Recruitment will continue until thematic saturation, anticipated within 12-25 interviews. We anticipate identifying several recurring themes representing provider-perceived barriers to screening for depressive symptoms during Black pregnancy. Based on preliminary literature and project rationale, expected themes may include time constraints in clinical workflow, limited training in culturally sensitive screening, differences in patient-provider communication, provider uncertainty regarding follow-up procedures, and perceived stigma surrounding mental health. Additional themes may reflect systemic, cultural, or institutional gaps that influence screening practices across clinics. Identifying provider-perceived barriers will inform targeted recommendations for improving depression screening during Black pregnancy within the Great Plains region. Insights from this study may guide development of provider training initiatives, workflow modifications, and system-level supports that promote equitable mental health screening. Ultimately, this work aims to support earlier identification and treatment of depression, reduce disparities in prenatal care, and strengthen culturally responsive practices within regional health systems.

Obesity affects over 40% of adults in the U.S., and bariatric surgery, particularly Roux-en-Y gastric bypass (RYGB), is among the most effective treatments for sustained weight loss and comorbidity reduction. However, emerging evidence has linked bariatric surgery to an increased risk of alcohol use disorder (AUD), particularly in the years following surgery.

To review the evidence surrounding the incidence, timing, mechanisms, and risk factors associated with AUD following bariatric surgery, with an emphasis on RYGB.

A comprehensive review of the literature examining postoperative rates of AUD among bariatric surgery patients was conducted, highlighting trends, mechanisms, and subpopulations at risk.

RYGB is associated with a significantly increased risk of developing AUD, with incidence rising notably 2-8 years postoperatively. Risk factors include younger age, male gender, preoperative substance use, poor mental health, low social support, and undergoing RYGB rather than other surgical procedures. The delayed increase in AUD appears to result from both physiological changes such as faster alcohol absorption and higher peak blood alcohol levels and psychological factors like addiction transfer. Additionally, bariatric surgery increases risks for alcohol-related liver disease and psychiatric hospitalization related to alcohol misuse.

AUD is a significant long-term risk following RYGB, warranting routine preoperative screening, patient education, and long-term postoperative monitoring. Use of validated screening tools and provision of behavioral health support are critical to mitigate this risk and ensure optimal long-term outcomes for bariatric surgery patients.

This comprehensive register-based study examines fatal at-fault crashes of motor vehicle drivers with alcohol and other substance findings. We categorized substances with possible impact on driving into three categories: alcohol, medicines without addiction potential, and other substances, including illegal substances and medications with addiction potential. We analyzed the differences in crash circumstances and risk factors using odds ratios (ORs), comparing at-fault drivers with different substance combinations to those who were non-impaired.

Our material comprises crash data from the Finnish Road Accident (FRA) database in 2019-2022. Multidisciplinary Road Traffic Accident Investigation Teams (RAITs) investigate all fatal crashes in depth, and the Finnish Crash Data Institute (OTI) maintains the FRA database. RAITs have access to all police records, including medico-legal autopsy findings and toxicological data from virtually all deceased drivers.During the study period, there were 750 at-fault motor vehicle drivers of fatal crashes. Our final study material consisted of all data with information on alcohol and other substance findings, including 234 drivers with substance findings, and 446 non-impaired drivers.

Alcohol was clearly the most prevalent substance, used by 75% of the drivers with substance findings. The mean alcohol concentration in alcohol-only cases was 1.64‰, and in cases with alcohol and other substances, 1.45‰. Drivers with substance findings were much more likely to have prior DUI offenses (OR = 21.9 [10.6-45.0]). Moreover, drivers using substances other than alcohol had even higher odds of previous DUIs (OR = 31.9 [13.5-75.3]). Drivers with alcohol findings were more likely <25 years old compared to non-impaired drivers (OR = 2.10 [1.31-3.37]). Drivers with substance findings had higher odds of causing a crash while speeding compared to non-impaired drivers (for example, speeding at least 30 km/h: OR = 5.88 [4.00-8.62]). We found no statistically significant differences between drivers who had used alcohol alone and those who had used alcohol and other substances.

Alcohol with high concentrations dominated among at-fault drivers with substance findings in fatal road traffic crashes. Substance use co-occurred with other forms of risk taking such as speeding. Young drivers were overrepresented among drivers with alcohol findings. Despite new illegal substances and increasing drug use, alcohol still has a major impact on fatal crashes. This means that traditional measures for tackling DUI problems still apply but we must be open for new innovations, too.

Sleep is multidimensional, and it remains unclear which aspects are most relevant to cognition and dementia risk. We aimed to apply a data-driven approach to identify clusters of sleep variables that reflect meaningful sleep composites and examined their association with cognition and dementia risk.

This was a prospective observational cohort study that used data from the Sleep and Dementia Consortium, comprising 5 US population-based cohorts. Participants aged ≥45 and ≥60 years were included in the cognitive and dementia analyses, respectively. All were free of dementia and stroke at baseline. Participants had methodologically consistent, home-based polysomnography, self-report habitual sleep, neuropsychological assessments, and dementia risk surveillance. A cluster around latent variables analysis was used to derive 9 latent sleep composites from 44 sleep metrics. Global cognitive composite z scores were derived from principal component analysis. Linear regression models assessed associations between sleep composites and cognitive performance. Cox proportional hazard models assessed associations between sleep composites and incident dementia. Results were considered statistically significant if p < 0.05.

The pooled cognitive analysis included 5,958 participants (mean ± SD age 70 ± 11 years, 32% female). The incident dementia analysis included 5,471 participants (74 ± 12 years, 31% female). There were 1,134 incident dementia cases (median follow-up time of 5-19 years). Nine sleep composites were identified, together explaining 49% of the total variance in the original 44 sleep metrics: Sleep quantity and efficiency, sleep fragmentation, light non-rapid eye movement (NREM) predominance, N3 predominance, spindle number and duration, REM sleep bouts, respiratory disturbances, slow oscillation-spindle coupling, and spindle amplitude. Of these, composites reflecting greater sleep quantity and efficiency (i.e., longer and more consolidated sleep; pooled β per one-unit change in composite, 0.03; 95% CI 0.004-0.06; p = 0.033) and stronger slow oscillation-spindle coupling (pooled β, 0.04; 95% CI 0.003-0.07; p = 0.039) were associated with better global cognition. However, no significant associations were identified between the 9 sleep composites and dementia risk.

Sleep composites were not significantly associated with dementia risk. However, longer, more consolidated sleep and stronger slow oscillation-spindle coupling were associated with cognitive performance. These composites may be useful in guiding further investigations of sleep-brain health relationships.

Mass casualty events (MCE), such as campus shootings, can severely impact the mental health of students, faculty, and staff. This study examined the psychological effects of an MCE at a minority-serving institution and explored how sense of belonging, cardiorespiratory fitness, and treatment preferences influenced recovery. To measure the impact of the MCE on mental health an anonymous survey was administered four to five months post-MCE to university students, faculty and staff. Within the survey, participants were asked to retrospectively report their depression (PHQ-9) and anxiety (GAD-7) symptoms as they recalled them two weeks prior to the MCE, and as they experienced them in the two weeks preceding survey completion. The survey also included current measures of sense of belonging (SBS), perceived discrimination (PEDQ), estimated cardiorespiratory fitness (eCRF), and intervention preference to cope with the impacts of the MCE. Participants reported significant perceived increases in PHQ-9 and GAD-7 scores from the pre-MCE recall to current time-periods. Increases in depression (PHQ-9 scores) from pre-MCE to recent recall were larger among respondents with lower pre-MCE anxiety (GAD-7 scores), higher perceived discrimination (PEDQ), and those currently receiving treatment for anxiety or depression; respondents not receiving treatment showed no significant change. Among students, lower belonging scores were associated with greater increases in depression. Neither belonging nor perceived discrimination were strongly linked to individual variables, indicating their multifactorial nature. Most participants reported a preference to learning about alternative interventions such as exercise or meditation over pursuing university counseling services.

BackgroundWomen in Africa experience a disproportionate burden of HIV, with their life trajectories shaped by its health and social impacts. The variation is based on present psychosocial barriers and the stigma and discrimination they experience. These differences determine their life course approaches, shaping their health outcomes, mental health service engagement, and overall well-being.ObjectiveThis qualitative study aimed to explore and describe the life space and life-span issues for women living with HIV to establish the policies that may support and explain women's health-related quality of life.DesignAn interpretative phenomenological design was followed in order to gain an in-depth understanding of the life courses of women living with HIV.MethodsData were collected between December 2023 and May 2024. Semi-structured interviews were conducted in rural Matabeleland South Province with twenty (20) purposively sampled women living with HIV (aged 20-65) to explore their experiences and how HIV determines their life approaches. The Interpretive Phenomenological Analysis framework was employed for data analysis.ResultsThe findings indicated that women experience (i) Loss of control and planning, (ii) Deterioration in the quality of relationships, and (iii) limited access to education, training, and work. The younger women are the ones who are severely affected, as their daily activities and social roles tend to be disrupted while living in a state of social and economic insecurity. The only support received is from the peers who are also living with HIV in the form of a support group.ConclusionFindings indicate the need for continuous psychosocial and financial support of young women living with HIV. Moreover, there should be a renewed emphasis on adherence to policies that promote non-discrimination.

Preterm (<37 weeks), early-term (37-38 weeks), or post-term (42 weeks) birth may elevate the risk of mental, neurodevelopmental, and cardiopulmonary disease in adulthood, potentially impacting work capacity.

We examined the association between gestational age and early disability pension (DP) among 228 572 Finnish individuals born between 1 January 1987 and 30 September 1990. We identified the first DP decision from ages 16 to ∼32 years (2003-20) by using linked birth and DP records, including timing and diagnosis. Adjusted hazard ratios (HRs) with 95% confidence intervals were estimated by using Cox regression, with full-term birth (39-41 weeks) as the reference.

A total of 9224 individuals (4.0%) received DPs. Adjusted for sex and birth year, the HRs for DP by gestational age groups of 23-31, 32-33, 34-36, 37-38, and 42 weeks were 5.20 (4.52-5.99), 2.47 (2.04-3.00), 1.55 (1.41-1.70), 1.22 (1.16-1.29), and 1.12 (1.01-1.25). Among preterm adults, the most common diagnoses included cerebral palsy, intellectual disability, depression, and schizophrenia. For early-term and post-term adults, depression and schizophrenia were the most frequent.

Preterm, early-term, and post-term births were associated with early DPs, with slightly different diagnostic profiles. The risk was highest among those born very preterm (<32 weeks). High-quality perinatological care is crucial regarding future careers and societal costs.

Wildfires are projected to increase in frequency and severity, yet their mental health consequences, particularly the social factors associated with vulnerability, are not well understood.

To estimate the association between wildfire exposure and psychological distress and to assess the social factors that modify this association.

In this longitudinal survey study, a probability-based internet panel of Los Angeles County residents in California was surveyed monthly, before and after the January 2025 wildfires, generating prefire measures of social vulnerability, postfire measures of wildfire impact, and prefire and postfire mental health assessments.

Residence in an evacuation warning or order zone during the January 2025 wildfires, based on respondents' residential census tracts.

Psychological distress was measured monthly using the validated 4-item Patient Health Questionnaire (PHQ-4; range, 0-12, with higher scores indicating greater distress); subscales assessed anxiety and depression. Two-way fixed-effects (TWFE) models with respondent and month-year fixed effects were used to estimate wildfire-associated mental health changes.

The analytic sample included 1510 adults (mean [SD] age, 47.2 [15.5] years; 924 [61.2%] female) and 31 632 respondent-month observations spanning October 1, 2023, through December 31, 2025; at wildfire onset, 143 (9.5%) were residing in an evacuation order or warning zone. TWFE models interacting wildfire onset with evacuation zone residence indicated that evacuation zone residents experienced a 0.28-point greater increase in PHQ-4 score (β [SE] = 0.28 [0.09]; P = .002) after wildfire onset. This association showed no significant attenuation over the 11-month follow-up and was concentrated among individuals with household incomes below $100 000, extreme housing cost burden, prefire psychological distress, or limited instrumental social support. Subscale analyses suggest that the increase in PHQ-4 scores was associated primarily with increases in anxiety; after wildfire onset, evacuation zone residents exhibited greater increases in both anxiety (β [SE] = 0.17 [0.05]; P = .002) and depression (β [SE] = 0.12 [0.05]; P = .02), but only anxiety increased significantly from its prefire baseline.

In this longitudinal survey study of Los Angeles County residents, residential exposure to the January 2025 wildfires was associated with increased psychological distress, but only among individuals with preexisting psychosocial or economic vulnerabilities. Policies that strengthen housing security and instrumental support networks may reduce wildfire-related mental health burdens.

Universal Health Coverage (UHC) is the cornerstone of equitable health systems and service delivery. Achieving UHC requires both "whole of government" and "whole of society" approaches that are vital for building resilient health systems that promote physical and mental wellness for all communities. In this paper, we review several theories of stakeholder engagement (SE) and argue that meaningful SE - as opposed to stakeholder management - is essential for fostering early participation and democratic decision-making in the transformation of health systems towards UHC. We recommend several key steps to promote early and inclusive SE that actively solicit input from diverse community members, establish open platforms for dialogue, and leverage the expertise and resources of various sectors. By creating a collaborative environment that includes each individual, whether an educator, policymaker, family member, or business leader, amongst others, we can advance the goals of UHC and build health systems that benefit everyone.

Population aging poses significant public health challenges, particularly in maintaining physical and mental wellbeing among older adults. Square dance, a culturally embedded group exercise in China, may offer a practical strategy to enhance functional, psychological, and social health in community-dwelling older adults.

A 12-week single-blind randomized controlled trial was conducted among 150 older adults (60-79 years), randomly allocated to a Square Dance Intervention Group (n = 75) or a Health Education Control Group (n = 75). The intervention comprised three 60-min sessions weekly. Assessments were conducted at baseline, Week 6, and Week 12. Outcomes included aerobic endurance (6MWT), balance (TUG), flexibility, blood pressure, depressive and anxiety symptoms (GDS-15, GAD-7), wellbeing (WHO-5), and quality of life (SF-12). Intention-to-treat mixed-effects models were used for analysis.

Compared with controls, the intervention group achieved significantly greater improvements in 6MWT (+41.5 m), TUG (-1.05 s), flexibility (+3.2 cm), systolic (-3.8 mmHg) and diastolic blood pressure (-2.4 mmHg). Depressive symptoms (-1.5 points), anxiety (-1.2 points), WHO-5 (+3.8 points), and SF-12 PCS/MCS (+3.1 and +3.4 points) also improved significantly. Adherence was high (87%), with no serious adverse events reported.

The findings provide strong evidence that a culturally relevant group-based square dance program enhances functional capacity, emotional wellbeing, cardiovascular health, and overall quality of life in older adults. Its high feasibility, safety, and acceptability suggest strong potential for widespread community implementation as a low-cost healthy aging strategy.