Few primary care patients with hazardous drinking initiate or engage in alcohol care. We conducted a formative evaluation of an intervention, Connect to Care (C2C), designed to support patients with hazardous drinking and mental health symptoms in initiating alcohol care.

C2C's acceptability and barriers and facilitators to its use in the primary care setting were explored.

Participants were enrolled in a pilot randomized controlled trial of C2C. Participants assigned to the C2C condition were selected to participate in a qualitative interview at the completion of their 3-month follow-up. Template analysis was used to analyze qualitative data.

We interviewed 20 primary care patients (90% male) with a positive screen for hazardous drinking and depression and/or PTSD symptoms.

Participants described four ways that C2C was helpful: Using a menu, the coach helped educate participants on their alcohol care options; participants' felt that the coach was non-judgmental, caring, and genuinely interested in helping them learn about their care options and link them to their preferred option; participants' appreciated the flexibility of how and when C2C was offered which facilitated engagement; and it was some participants' perception that C2C helped them reduce both their alcohol use and mental health symptoms. However, some patients reported that the length of C2C sessions, repetitive information provided by the coach, and not wanting to change their drinking habits as barriers to C2C session attendance.

This qualitative study highlights helpful components, potential barriers to session attendance, and potential adaptations to C2C informed by primary care patients participating in a pilot RCT of this strengths-based intervention. The findings could help inform implementation of C2C in the primary care setting.

To evaluate the agreement of the 2-item (PHQ-2) and 8-item (PHQ-8) Patient Health Questionnaires compared to the PHQ-9 and clinical diagnosis for depression screening in Brazilian adults, and to examine associated sociodemographic and behavioral factors. We analyzed cross-sectional data from 148,733 participants in the 2013 and 2019 Brazilian National Health Surveys. ROC curve analyses identified optimal cutoffs for PHQ-8 and PHQ-2 against the PHQ-9 (≥ 10) and clinical indicators. Logistic regression and Ratio of Odds Ratios (ROR) compared associations across screening tools and self-reported diagnosis. The PHQ-8 (cutoff ≥ 10) showed near-perfect agreement with the PHQ-9 (AUC = 0.982). For the PHQ-2, a ≥ 3 cutoff optimized specificity (96.4%) and overall agreement (94.7%), with an AUC of 0.877. Optimal cutoffs against clinical indicators shifted lower (≥ 4 for PHQ-8; ≥ 1 for PHQ-2). Both brief versions identified associations profiles consistent with the PHQ-9 (e.g., higher odds in women, low-income individuals, and those with chronic diseases). However, ROR analyses revealed a significant healthcare gap: higher income and advancing age strongly predicted formal diagnosis, while Black/Brown populations and those with poor health were significantly underrepresented clinically compared to symptom screening. All scales showed strong reliability (α, ω > 0.85), including the PHQ-2 (r = 0.55; ρ_sb = 0.71). The PHQ-8 is a psychometrically equivalent alternative to the PHQ-9 in Brazil, and the PHQ-2 is a reliable, ultra-brief tool ideal for rapid, large-scale population screening. While these scales accurately capture symptom burden, the observed discrepancies with formal diagnosis highlight significant systemic barriers to mental healthcare access for vulnerable subgroups.

Current screening tools for harmful alcohol consumption have fallen out of step with recent guidance on the health risks of alcohol. To address this gap, the Canadian Research Initiative in Substance Matters updated the screening recommendations for high-risk drinking and alcohol use disorder (AUD) in the 2023 national clinical practice guideline.

Following a systematic review of literature published between Jan. 1, 2013, and Feb. 24, 2023, that examined screening tools for high-risk drinking and AUD, the updated recommendations were developed by a multidisciplinary national committee, which included people with lived and living experience. We scored the recommendations and certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation tool. We used the Appraisal of Guidelines for Research and Evaluation II instrument and the Guidelines International Network's principles for disclosure of interests and management of conflicts to ensure the update met international standards for transparency, high quality, and methodological rigour.

Acknowledging that time constraints are the most commonly reported barrier to universal alcohol screening, we developed 5 recommendations involving a simple screening method, to identify and address both unhealthy alcohol consumption and more serious problems related to alcohol. The recommendations include asking all patients about alcohol consumption and providing educational support to all those who drink above Canada's Guidance on Alcohol and Health's low-risk threshold. We propose a simple screening algorithm to optimize and tailor further intervention, including when to assess for possible AUD.

The revised screening recommendations represent a timesaving and pragmatic approach intended to be a resource for universal screening for alcohol risks and problems. The recommendations streamline the process of identifying and addressing the health needs of those who consume alcohol in a hazardous way or may have more serious problems related to alcohol.

People with intellectual disabilities have the right to access mainstream healthcare services. However, research highlights barriers to accessing services and recommends reasonable adjustments to improve this.

Focus groups were held with 21 staff from adult mental health services, including the intellectual disability service in Somerset, UK, to identify barriers and solutions to improve access. Reflexive thematic analysis was used, and change ideas were generated.

Four themes were identified: service barriers to making reasonable adjustments, the need for adequate training, the need for joint working, and reasonable adjustments in practice. Staff reported awareness of adjustments but variable knowledge and confidence in implementing them. Participants highlighted service constraints and wanted increased flexibility, joint working, and clearer record keeping.

From the identified barriers, change ideas were developed and solutions proposed to improve service access. Future service improvements and research need to meaningfully involve people with intellectual disabilities.

The psychological impact of honor cultures and shame societies on the general population has not been examined through a diagnostic lens. Atimiaphobia is a newly recognized psychological condition characterized by an intense fear of losing honor or being labeled shameless, deeply rooted in honor cultures and shame societies. To assess this construct, the Atimiaphobia Scale (AtiPhoS) was developed and rigorously validated. The study was conducted in a series of four phases involving 1232 participants (M_age = 27 years; women = 48.9%). The validation of the AtiPhoS involved exploratory and confirmatory factor analyses along with convergent and predictive validity. The AtiPhoS, comprising 15 items (English) and four subscales (fear of being labeled shameless, fear of violating social norms, fear of public judgement, fear of losing self-respect and honor) demonstrated excellent reliability (α = 0.824; ICC = 0.989). The model fit indices, such as CFI (0.933), TLI (0.916), RMSEA (0.065), and SRMSR (0.044), showed strong validity. Convergent validity was demonstrated by the scale's significantly positive correlation with the Experience of Shame Scale (r = 0.377) and the anxiety sub-scale of the Depression, Anxiety, and Stress Scale (r = 0.262). The predictive validity of the AtiPhoS was established through its inverse predictive values for social intelligence (β = -0.229). A significant positive correlation was found between atimiaphobia and age. Women and married individuals exhibited significantly higher levels of atimiaphobia compared with men and unmarried individuals, respectively. The study provides compelling evidence that atimiaphobia is a distinct and measurable phenomenon, contributing to the broader understanding of cultural stressors related to honor and shame.

Suicide is a major public health issue. Efforts to prevent it must begin as soon as hospitalization. Brief mental health interventions and contacts are known to be effective. The HOPAIR study proposes an innovative combination of peer support intervention and the Hope Box tool, followed by a reminder postcard sent to suicidal individuals hospitalized in psychiatric crisis units at two research centers in Lyon. Focusing on the resources of those affected, hope, and recovery, this study highlights the work of peer support workers and advanced practice nurses while offering encouraging prospects in the field of suicide prevention.

The Psy-Belt program (brief psychiatric care linked to the local area), developed by the Nord-Ouest Val-d'Oise hospital with the support of the Île-de-France regional health agency, aims to improve access to outpatient psychiatric care. Positioned at the beginning of the care pathway, it offers rapid assessment and intensive short-term follow-up by psychiatrists and advanced practice nurses (APNs). Despite limited human resources, it illustrates an innovative organizational approach aimed at streamlining mental health care pathways in a region under pressure and takes full advantage of the new skills offered by the arrival of APNs in psychiatry.

In sub-Saharan Africa, young women face disproportionate challenges transitioning from school to employment, with high rates of those not in education, employment or training (NEET). Structural barriers-including unequal gender norms, early marriage and unpaid labour-limit their economic participation. The Campaign for Female Education (CAMFED) Livelihoods programme supports young women's transition from school to independent adulthood through mentoring, life skills, business and agricultural training and access to financial resources.

This study will evaluate the impact, process and mechanisms of change, and cost-benefit of CAMFED Livelihoods programme in Tanzania and Zimbabwe (2024-2027), focusing on outcomes related to economic activity, empowerment, leadership, mental health, subjective well-being and sexual and reproductive health among adolescent and young women (aged 15-24 years).

We will conduct a mixed-method, longitudinal evaluation across five districts in Tanzania and three districts in Zimbabwe. The quantitative component includes a pre-post cohort with a comparison group in Tanzania (n=1520) and a single-cohort design in Zimbabwe (n=500), with data collected at baseline, midline and endline. Primary outcomes are NEET status and leadership, complemented by measures of well-being, empowerment and health. The qualitative component will explore mechanisms of change and programme delivery. A cost-benefit analysis will estimate social and economic returns using a provider perspective. Youth researchers will be engaged to enhance participatory learning.

We have received ethics approvals from the London School of Hygiene and Tropical Medicine (31266), the National Health Research Ethics Committee (6732) in Tanzania and the Medical Research Council of Zimbabwe (MRCZ/A/3239) in Zimbabwe. Results of this study will be published in peer-reviewed academic journals and shared with policymakers, study participants and the other stakeholders in Tanzania and Zimbabwe.

Many older people experience Mild Cognitive Impairment (MCI), which may compromise the effectiveness of health promotion programmes.

We explored engagement with behaviour change among participants scoring 18-25 on the Montreal Cognitive Assessment receiving HomeHealth, a health promotion intervention supporting older adults with mild frailty to maintain independence in England ().

Of the 46 semistructured process evaluation interviews, 29 participants scored in the MCI range, purposively selected for demographic characteristics and degrees of cognitive impairment and the seven support workers.

Thematic analysis resulted in three themes: Navigating the impact of MCI; Addressing memory as a goal in the intervention; and Adapting Behaviour Change Interventions for MCI. Participants had varied opinions about whether their memory was problematic and whether anything could be done to help. Many reported not discussing memory concerns with support workers. Barriers to engagement in behaviour change included limited social support and not acknowledging memory problems. Facilitators included setting goals which increased or were linked to existing health behaviours, using reminders/prompts and actively involving family members.

Implementing these facilitators into existing and new health promotion interventions delivered to older adults, with suspected but unacknowledged MCI, could overcome the current barriers people with MCI face when trying to engage and benefit from interventions.

ISRCTN54268283.

In Bangladesh, as well as throughout the world, children's screen time has significantly increased. Children spend a lot of time on the internet and digital screens for entertainment, education, and communication, which has increased their daily screen time. However, the potential detrimental impacts of excessive screen time on children's mental, physical, and social health have drawn attention.

This study aimed to explore the effect of high exposure to screens on the health and mental well-being of school-going children and adolescents in Dhaka, Bangladesh.

This cross-sectional descriptive study was conducted from July 2022 to June 2024. A total of 420 school-going children and adolescents aged 6 to 14 years were enrolled from 3 English-language and 3 Bangla-language schools in Dhaka using a stratified random sampling technique. Anthropometric measurements, a semistructured questionnaire, and the Pittsburgh Sleep Quality Index, the Development and Well-Being Assessment scale, and the Strengths and Difficulties Questionnaire, all of which were validated in Bangla, were used to gather data. We considered students who were exposed to screens for less than 2 hours a day as the low-exposure group and those who were exposed for more than 2 hours a day as the high-exposure group.

A total of 83.3% (350/420) of the students were in the high-exposure group, and their average screen time per day was 4.6 (SD 2.3) hours. Eye problems were reported by 35.7% (150/420) of the students, and a significant difference was found between the low- and high-exposure groups. In total, 96% (144/150) of the students with eye problems were from the high-exposure group, whereas 4% (6/150) were from the low-exposure group. Headaches were reported by 80% (336/420) of the students, and they were common in the high-exposure group (279/336, 83%). Moreover, students from the high-exposure group had a short duration and poor quality of sleep (mean 7.3, SD 1.4 hours), which was statistically significant. Furthermore, obesity was more predominant in the high-exposure group (P<.001). Our study revealed that, overall, 31% (130/420) of the students had at least one mental health problem and 9.8% (41/420) had more than one mental health problem using the Development and Well-Being Assessment scale, and mental health problems were greater in the high-exposure group than the low-exposure group. Although behavioral problems such as conduct issues (119/420, 28.3%) and peer difficulties (121/420, 28.8%) were observed among the participants, no statistically significant difference was found between the 2 groups.

A collaborative and coordinated multistage approach is essential to create effective and acceptable guidelines and policies for the optimum and positive use of digital screens for the children of Bangladesh. Further prospective studies on a larger scale can be conducted to determine the impacts of screen time on aspects of health.