We aimed to describe the characteristics of children and young people referred to social prescribing across the UK and understand what social prescribing looks like for these young people. Additionally, we aimed to explore whether access to and experiences of social prescribing vary with age and have changed from 2017 to 2025. Overall, we aimed to identify whether social prescribing reduces or exacerbates health inequalities among children and young people, and whether this has changed over time.

Analysis of social prescribing electronic health records.

Social prescribing hubs and services across the UK that use Access Elemental (a cloud-based social prescribing platform).

52 585 individuals referred to social prescribing in 2017-2025 aged 4-25 years (mean=20.04 years, SD=4.71), of whom 57% were female, 39% male, <2% were in other gender groups and 3% did not disclose their gender.

We summarised young people's characteristics (age, gender, country, urban area, area deprivation, referral route, reason for referral) and the care pathway received (case status, number type and length of contacts, onward signposting and interventions) using descriptive statistics. We then used unadjusted linear, logistic, multinomial logistic and negative binomial regression models to describe whether these factors differed by age and over time.

Most individuals were aged 18 and over, 91% lived in urban areas and 58% lived in the top three most deprived deciles of the UK. Most were referred by general practitioners or other allied health workers (79%) and mental health was the leading reason for referral (44%). The typical pathway included 4.64 social prescribing contacts (SD=7.70) totalling 66 min (SD=108), with 34% receiving an onward referral to community support. The average age of those referred to social prescribing increased over time.

Our findings indicate that relatively few children under 18 were referred to social prescribing and this disparity may be increasing. It was promising that children and young people referred to social prescribing were more likely to live in deprived areas. However, given current findings, more work is needed to increase the reach of social prescribing for children and young people across the UK.

To update estimates of the health and financial burden of adverse childhood experiences (ACEs) in England and Wales and generate estimates for English regions.

Population attributable fractions (PAFs) for ACEs were calculated for risks and causes of ill-health using data from 10 randomly stratified cross-sectional ACE studies. PAFs were applied to disability-adjusted life years (DALYs) for England, Wales and English regions for 2023, with financial costs estimated using UK statistical life year values (societal willingness to pay).

Households in England and Wales.

28 449 residents aged ≥18 years.

PAFs for ACE exposure categories (1 ACE, 2-3 ACEs and ≥4 ACEs) for four health risks (smoking, high alcohol use, drug use and high body mass index (BMI)) and seven causes of ill health (violence, mental illness, cancer, type 2 diabetes, heart disease, respiratory disease and stroke). Annual estimated DALYs and financial costs attributable to ACEs.

Relative risks for all outcomes increased with ACEs, with risk ratios for ≥4 ACEs ranging from 1.063 (95% CI 1.000 to 1.129, p=0.048) for high BMI to 9.147 (95% CI 7.062 to 11.847, p<0.001) for drug use. For health risks, PAFs for ACEs were highest for drug use (Wales 60.3% and England 56.7%), while ACE-attributable costs were highest for smoking (Wales £1.8 billion and England £22.7 billion). For causes of ill health, PAFs for ACEs were highest for violence (Wales 49.2% and England 46.2%), and costs were highest for mental illness (Wales £1.8 billion and England £37.8 billion). Across all outcomes (accounting for duplication by excluding DALYs for causes linked to the four health risks), total ACE-attributable costs were £7.8 billion for Wales and £115.6 billion for England; costs for English regions ranged from £6.3 billion (North East England) to £18.0 billion (South East England).

Findings highlight the substantial financial burden of ACEs across England and Wales and provide important information to inform regional activity. There is an urgent and economically justified need for action to prevent ACEs and support those affected by them to reduce the health and economic burden of poor-quality childhoods.

Reporting diversity characteristics is required for more inclusive, equitable and policy-relevant research.

To evaluate the reporting of diversity characteristics in publications using a large mental healthcare electronic health record (EHR)-derived research data resource, and to compare reporting of these characteristics in publications with their availabilities in the underlying dataset.

Cross-sectional review of Clinical Record Interactive Search (CRIS)-derived publications and assessment of diversity characteristic availability within the underlying EHR-derived database.

The South London and Maudsley (SLaM) National Health Service (NHS) Foundation Trust Biomedical Research Centre Case Register, accessed via the CRIS platform, representing secondary mental healthcare delivered to a geographic catchment area covering four boroughs in south London.

All CRIS-derived publications were reviewed to ascertain reporting of protected characteristics, as defined in the UK Equality Act 2010, alongside additional diversity-related characteristics. The availability of each characteristic within CRIS was assessed from records available up to 15 April 2026. Descriptive statistics were used to summarise reporting and data availability.

A total of 362 publications were evaluated. The mean number of diversity characteristics reported per publication was 4.0, and no publication reported more than 10 characteristics. Age (89.3%), sex (87.3%) and ethnicity (80.4%) were the most frequently reported characteristics. Socioeconomic status was reported in 42.5% of publications, while marriage and civil partnership (35.0%) and disability (27.0%) were reported in a smaller proportion of studies. All remaining characteristics were reported in less than 10% of publications.Data availability within CRIS was highest for sex (99.9%) and age (99.8%), followed by socioeconomic status, geographic location and homelessness (all 97.5%) and ethnicity (86.5%). However, several characteristics were reported far less frequently than they were available in the dataset, particularly geographic location (6.6% reported despite 97.5% availability) and homelessness (5.8% reported despite 97.5% availability).

Reporting of diversity characteristics in this case study for EHR-based mental health research was uneven and did not fully reflect availability in the source data. While age, sex and ethnicity are commonly reported, several other protected and diversity-related characteristics are rarely used by researchers despite their availability, and other characteristics remain challenging to capture. As routine EHR-derived datasets increasingly inform mental health research and policy, greater attention to recording, accessibility and reporting of diversity characteristics is required to support more inclusive and representative research.

The thalamus is a core node of the basal ganglia-thalamocortical circuit implicated in Parkinson's disease (PD) and depression. This study examined associations among thalamic volume ratio (TVR), nigrostriatal dopaminergic degeneration, and depressive symptoms in PD.

We included 170 PD patients with 4‑year follow‑up data from a prospective cohort. TVR was derived from automated thalamic segmentation; depressive symptoms were assessed using the Geriatric Depression Scale (GDS), and dopamine transporter (DAT) availability was quantified. Multivariable regression, linear mixed‑effects models, mediation, and ordinal logistic regression sensitivity analyses were performed.

TVR correlated positively with caudate (r = 0.249, p = 0.001), putamen (r = 0.197, p = 0.010), and anterior putamen (r = 0.230, p = 0.003) DAT availability, but inversely with GDS at Years 1-4 (p < 0.05), not at baseline. After FDR adjustment, TVR remained independently associated with GDS at Year 2 (β = -0.655, p = 0.006, q = 0.036), but the association at Year 1 did not survive correction (β = -0.445, p = 0.037, q = 0.100). A significant TVR‑by‑time interaction emerged (β = -0.163, p = 0.008), suggesting that lower TVR was associated with a steeper increase in GDS scores over time. Mediation analyses demonstrated significant indirect effects of caudate DAT on GDS at Years 1 and 2, with direct effects marginal at Year 1 (β = -0.840, p = 0.050) and significant at Year 2 (β = -1.181, p = 0.017), indicating partial mediation.

TVR may represent an imaging correlate of dopaminergic dysfunction and depressive progression in PD, with a mediating pathway linking caudate degeneration, thalamic alterations, and depressive symptoms. Independent validation is warranted.

Patient portal messaging connects patients with their healthcare teams but is underused by Spanish-speaking patients.

Evaluate content and use patterns of portal messaging among Spanish-speaking patients to inform future implementation strategies to increase portal messaging.

We evaluated messaging use patterns among a random sample of adults with an EHR-designated Spanish language preference across three diverse healthcare systems in Texas: an academic medical center, a public safety-net institution, and a regional, integrated community health system. Eligible participants initiated ≥1 medical advice request conversation via the portal between April 5, 2021-April 4, 2022. We thematically coded messages to capture characteristics including message sender and receiver role, language, topic, conversation length, and concordance.

We analyzed 883 patient-initiated conversations from 297 patients including n=1,557 messages sent by patients and n=1,123 sent to patients. Most (77.3%, 1,204/1,557) messages from patient accounts were initiated in English, and 26.7% (414/1,557) were written by a self-identified care partner. Messages were most frequently about prescriptions (40.0%, 353/883), appointments (26.6%, 235/883), and symptoms (21.5%, 190/883). Most conversations were brief, with 56.4% consisting of one (21.4%) or two (35.0%) messages. Nearly all messages sent by patient accounts received language concordant responses (94.9%, 976/1,028), although some patients and care partners used automated translation tools.

Spanish-speaking patients who use the patient portal usually message in English, and more than a quarter of messages are written by care partners. Vendors and health systems could increase portal messaging use among Spanish speaking patients via Spanish language portal configuration and educational resources, especially for those without access to an English-speaking care partner. The most common messaging topics (appointment scheduling and medication refill requests) have existing, but underused, discrete portal functions. Generative artificial intelligence (AI) solutions in Spanish could facilitate portal messaging triage and language concordant responses to Spanish speakers.

Human Cytomegalovirus is the most common congenital infection worldwide, yet recommended hygiene measures to prevent maternal infection are difficult to implement consistently during pregnancy.

Despite their effectiveness, adherence to hygiene recommendations remains suboptimal, suggesting a gap between recommendations and women's everyday realities.

This study aimed to assess the real‑world applicability of hygiene recommendations for the prevention of cytomegalovirus during pregnancy in French-speaking Switzerland and to explore perceived barriers to their implementation.

A mixed‑methods design was used. Quantitative data were drawn from two cross‑sectional surveys conducted among pregnant or postpartum women (n = 834) and perinatal healthcare professionals (n = 341) to identify recommendations perceived as difficult to apply. These findings informed semi‑structured interviews with 12 mothers of young children, which explored barriers and facilitators to adherence.

Quantitative analyses identified avoiding contact with children's bodily fluids and ensuring partner adherence as the most challenging recommendations. Qualitative findings confirmed these challenges and identified three key barriers: insufficient and unclear information, high mental load linked to caregiving responsibilities, and recommendations perceived as only partially feasible in everyday life. Participants emphasised the need for clearer, pragmatic guidance and shared family involvement to support implementation.

The findings highlight a misalignment between hygiene recommendations and women's experiences.

Cytomegalovirus prevention strategies should prioritise clearer and actionable recommendations, improved professional training, and family-centred communication that avoids overburdening pregnant women. Integrating digital tools, prenatal education, and public awareness initiatives may enhance adherence and support more equitable prevention.

Filicide is a rare but severe form of lethal violence against children. Although international research has identified several victim, offender, and contextual correlates, empirical evidence from Spain remains scarce and fragmented.

This study aimed to describe filicide cases adjudicated in Spain and to examine how they differ from other child homicide cases.

The sample comprised 197 victim-based cases of completed or attempted homicide or murder involving victims under 18 years of age, adjudicated by Spanish Provincial Courts between 2016 and 2025. Of these, 116 were filicide cases and 81 were non-filicide child homicide cases.

Judicial decisions were retrieved from the Spanish Judicial Documentation Centre. Information was extracted from the statement of proven facts and coded for victim, offender, and offense characteristics. Descriptive and bivariate analyses were conducted to compare filicide with other child homicide cases.

Filicide victims were substantially younger than victims of other child homicides (M = 4.69 vs. 12.66 years; Welch's t(119.41) = 9.90, p < .001, Cohen's d = 1.614). Filicide cases were also more likely to involve female offenders (χ²(2) = 57.43, p < .001, Cramer's V = 0.540), older first offenders (Welch's t(112.41) = 3.47, p < .001, Cohen's d = 0.588), completed offenses, murder classifications, and methods involving close interpersonal proximity or caregiving access.

Filicide in Spain presents a distinctive victim-offender profile within lethal violence against children. Prevention efforts should address child maltreatment, mental health crises, domestic violence, and caregiving breakdown, with particular attention to infants and young children.

Co-occurring substance use disorder (SUD) is common among patients with chronic pain prescribed long-term opioid therapy (LTOT); unfortunately, limited empirical data are available to guide treatment.

Our goal was to examine the extent to which baseline SUD status was associated with changes in pain interference, pain intensity, and prescription opioid dose reduction.

The present results are a secondary analysis of a pragmatic multisite 12-month randomized comparative effectiveness trial.

Eligible patients included veterans who were receiving LTOT for treatment of chronic pain.

Participants were randomized to receive one of two interventions, both of which were based on the collaborative care model for chronic pain; the interventions differed by resource intensity and included an intensive interdisciplinary pain team or less resource intensive pharmacist collaborative management. For these analyses, the treatment conditions were collapsed and we examined the extent to which SUD status at baseline predicted treatment outcomes.

Primary outcomes were changes at 12 months in pain interference, pain intensity, and prescription opioid dose.

At baseline, 250 of 778 participants (32.1%) met criteria for potential SUD. Participants with potential SUD were younger and more likely to have co-occurring mental health diagnoses, compared to participants without SUD, though had no differences in pain interference, pain intensity, or prescription opioid dose. During treatment, participants in both the potential SUD and No SUD group had significant reductions in pain interference and pain intensity, as well as reductions in prescription opioid dose. In adjusted analyses, there was no difference between groups in change on any of these outcomes.

Participants with and without potential SUD experienced improvements in pain interference and pain intensity, and had reductions in prescription opioid dose. These results suggest SUD status does not inhibit treatment response to collaborative care interventions for chronic pain.

ClinicalTrials.gov: NCT03026790.

Aquaporin 4-positive neuromyelitis optica spectrum disorder (AQP4⁺ NMOSD) and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) are antibody-mediated inflammatory disorders of the CNS with distinct immunopathogenic, clinical and imaging profiles. MRI is fundamental for diagnosis, monitoring and treatment decisions in these disorders, yet challenges persist, including overlap of imaging features, variable lesion evolution and the absence of standardized acquisition protocols. In this Expert Recommendation on behalf of the Magnetic Resonance Imaging in Multiple Sclerosis (MAGNIMS) study group, we provide recommendations for the practical use of conventional and non-conventional MRI for diagnosis, monitoring and research in AQP4⁺ NMOSD and MOGAD. We consider characteristic conventional MRI findings, recommend standardized core and optional MRI sequences for standardized protocols, and offer guidance on the timing of MRI at different phases of disease. We highlight the role of MRI in assessing acute attacks, distinguishing between true relapses and pseudo-relapses, and evaluating post-attack recovery. We also outline the added value of non-conventional MRI techniques for probing microstructural damage, inflammatory activity and tissue repair. Finally, we address the diagnostic complexity of seronegative NMOSD and the need for novel imaging biomarkers to improve classification and treatment precision.

Preterm birth (PB) or its threat (TPB) can negatively affect paternal mental health, leading to increased worry. As specific paternal risk factors are understudied, this study aimed to identify psychological, maternal, and infant-related medical factors associated with paternal postpartum worry in the context of TPB and PB.

In this longitudinal study, 112 men were assessed during their partner's pregnancy (T1) and six weeks postpartum (T2). Trait anxiety, worry, and chronic stress were measured using the State-Trait Anxiety-Depression Inventory (STADI) and the Trier Inventory for Chronic Stress (TICS). Maternal and infant medical data were collected from clinical records and standardised self-reports. Participants were assigned to either a risk group (RG) with term birth (TB) or PB, or a control group (CG: no TPB, term birth). Multiple linear regression analyses were conducted to identify predictors of paternal worry.

Antepartum chronic stress predicted worry. Trait anxiety and obstetric factors, cervical insufficiency and preterm premature rupture of membranes, were significant predictors in RG-TB only. In the RG-PB, low infant birth weight showed a small but non-significant association with paternal worry.

Fathers exposed to TPB are at increased risk of postpartum worry, particularly with higher antepartum chronic stress, trait anxiety, and maternal complications, even when the infant is born at term. Chronic stress and trait anxiety, along with maternal complications and infant birth outcomes, contribute differentially to paternal worry. These findings highlight the importance of early support and stress prevention for fathers facing prenatal risk, regardless of birth outcome.