Inflammatory bowel diseases (IBD) have been associated with adverse outcomes during pregnancy, with guidelines developed to inform clinical practice. This study reviewed adherence to guidelines amongst different healthcare providers caring for individuals with IBD during pregnancy.

A retrospective multi-centre study of individuals with IBD who received antenatal IBD care at three Australian tertiary units from 2023 to 2025 was undertaken. Clinical documentation for each pregnancy was reviewed against nine process indicators derived from the European Crohn's and Colitis Guidelines on Sexuality, Fertility, Pregnancy and Lactation [1]. The primary outcome was the proportion of process indicators followed by speciality per pregnancy.

Forty-three pregnancies amongst 43 individuals were included; 19 (44.2%) had ulcerative colitis. Twenty-six pregnancies (60.5%) were to individuals on biologic therapy for IBD at time of conception. Gastroenterologists met a median 6/9 (67%) process indicators, Obstetrics/Maternofetal Medicine specialists met a median 3/9 (33%) process indicators, and Other Specialists (combined) met a median 1/9 (11%) process indicators per pregnancy. The number of clinic visits and proportion of process indicators followed correlated positively. Adherence to preconception counselling, mental health assessment, and venous thromboembolism risk assessment was particularly poor, completed by Gastroenterology in 39.5, 34.9 and 4.7% of cases, respectively, compared to 4.7, 25.6 and 46.5% of cases by obstetric care providers.

Uptake of guideline recommendations for antenatal IBD management was variable between different speciality providers in this study of patients with moderate-to-severe IBD. Uptake of recommendations may be improved by increasing access to multidisciplinary care and frequent clinical contact. Whether improvements in adherence with process indicators translates to improved clinical outcomes warrants further evaluation in IBD pregnancy.

Remote technologies for cochlear implant (CI) service provision promises to increase access to personalised, efficient, effective, and equitable CI services. Evaluating remote services using relevant outcome measures improves evidence available to make informed decisions about patient care. The objective of this study was to identify a core outcome domain set (CODS) for remote CI services.

A three-round two-group online crossover Delphi review. Participants rated, and in the final round, ranked outcome domains (n = 57) in three supra-domains previously identified by a systematic review and three online workshops. The study is registered on the Core Outcome Measures in Effectiveness Trials website.

CI users (n = 114) and professionals (n = 77) from Australia, the UK, and the USA.

Domains identified across both groups were: Usability, Reliability, and Accessibility of the remote service to the client (Service supra-domain); Device Integrity and Status, Speech Discrimination, and Device Use (Clinical supra-domain); and Participation Restriction, Hearing-Related Quality of Life, Client Device Satisfaction, and Mental Health and Wellbeing (Patient supra-domain).

The substantial mismatch between the ranking of Clinical and Patient outcome domains between CI users and professionals suggests important differences in perspectives. Mutual education is essential to ensure needs are mutually understood and met.

Psychiatric comorbidities, including anxiety and depression, are increased in individuals with eosinophilic gastrointestinal disorder (EGID) compared with the general population. However, there are no established guidelines for screening and evaluating mental health disorders, and screening practices are unclear. We e-mailed an anonymous Web-based survey to members of the American Academy of Allergy, Asthma & Immunology and the Consortium of Eosinophilic Gastrointestinal Disease Researchers to examine mental health screening practices among clinicians caring for patients with EGIDs in the United States. Literature examining the association between mental health disorders and EGID was reviewed, best practices for anxiety and depression screening were discussed, and recommendations for implementing successful screening programs were formulated. Most survey respondents (62%; n = 31 of 50) indicated screening for anxiety and depression was important; however, only 18.6% (n = 11 of 59) conducted screening as part of standard clinical care for these patients. The most cited barriers to screening included a lack of time, limited expertise, and inadequate screening resources. This report provides recommendations and resources to facilitate the implementation of anxiety and depression screening in patients with EGIDs.

To identify patient and attendance characteristics that predict persistent high use of emergency departments (EDs) in England and to quantify the relationship between these factors and the duration an individual remains a high user.

Nationwide retrospective cohort study using a Cox proportional hazards model with random effects.

EDs across England, using linked national healthcare datasets including hospital admissions, General Practice (GP) prescribing data and mortality records from January 2016 to December 2019.

The total national dataset comprised approximately 150 million ED attendances by 30 million adult patients (aged>18). From this, a random sample of 5 million individuals was analysed. In the 2017 calendar year, 1 766 208 individuals attended the ED, of which 91 034 (5.2%) met the criteria for high use (defined as five or more attendances within a 12-month period).

The primary outcome was the length of time an individual remained in the 'high user' status. Predictors were measured using HRs to determine the likelihood of transitioning out of high-user status (where an HR<1.00 indicates a longer duration of high use).

Several factors significantly predicted prolonged high-user status. Strong predictors (expressed as HRs) included: use of hypnotics and anxiolytics (HR=0.64), antipsychotics (HR=0.67), opioid analgesics (HR=0.73) and non-opioid analgesics (HR=0.74), being a 'burst' attender (HR=0.55), social deprivation (HR=0.81), leaving the department after refusing treatment (HR=0.77), leaving before being treated (HR=0.86) and having 'nothing abnormal detected' during the visit (HR=0.88).

Persistent high ED use is strongly associated with prescriptions for analgesics and mental health medications, as well as specific attendance behaviours like 'burst' patterns and leaving without treatment. These findings suggest that healthcare providers should prioritise proactive care plans, enhanced mental health support and specialised pain management strategies to intervene before patients become long-term frequent users. Further research into the efficacy of these specific interventions for 'burst' attenders is warranted.

Mental health and well-being are urgent priorities across circumpolar regions, where suicide and psychological distress contribute substantially to premature mortality and disability. Indigenous communities in Arctic and sub-Arctic settings continue to face profound inequities linked to colonisation and intergenerational trauma, while also advancing wellness frameworks grounded in cultural continuity, language, land and self-determination. Progress in mental health promotion and suicide prevention depends on timely, consistent and culturally relevant population-level information. Yet mental health surveillance remains fragmented, and the literature has not been comprehensively mapped to describe how public health surveillance systems are designed, governed, implemented and used in Indigenous contexts. This review aims to inform culturally grounded mental health and wellness surveillance in circumpolar Indigenous contexts. This will be achieved by mapping how public health surveillance systems involving Indigenous Peoples are designed, governed, implemented and used, and identifying transferable lessons for circumpolar monitoring.

This scoping review will follow the Joanna Briggs Institute methodology for scoping reviews and will be reported using Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. Using a Population-Concept-Context framework, we will include peer-reviewed and grey literature published in the past 20 years (English and Scandinavian languages) describing public health surveillance systems implemented with, by or for Indigenous communities. This will cover the period of January 2006 to August 2026. Mental health, suicide, substance use and wellness-related systems will be prioritised. Searches will be conducted in MEDLINE, Embase and APA PsycInfo, complemented by targeted grey literature searching of relevant organisational and government sources. A health sciences librarian will execute all database searches and export results for screening. One reviewer will conduct the grey literature searches, documenting search dates, sources and retrieval decisions. Two reviewers will independently screen all records retrieved and extract data using a structured charting tool capturing system characteristics, governance and data stewardship, ethics, implementation considerations, uses of surveillance information and circumpolar relevance. Findings will be summarised descriptively and synthesised using inductive content analysis to identify recurring constructs, patterns and evidence gaps. The review is anticipated to commence in August 2026 and to be completed by September 2027.

Ethics approval is not required for this review of publicly available literature. Results will be disseminated through peer-reviewed publication, presentations to relevant Indigenous and public health partners, and knowledge products tailored to circumpolar surveillance planning.

Antenatal depression is a significant yet under-recognised global public health concern that affects a substantial proportion of women in Ethiopia. This study aimed to examine the magnitude, trajectory and determinants of depressive symptoms among pregnant women.

A prospective longitudinal study design was conducted between April 2023 and February 2024.

The study was conducted in Adama Town and the East Shewa Zone of the Oromia Region, Ethiopia. A total of 933 pregnant women who visited the health facility for their first ANC visit were recruited and followed throughout their pregnancy.

Antenatal depressive symptoms were measured using the Patient Health Questionnaire-9 through face-to-face interviews and monthly phone calls. The trajectory and determinants of antenatal depressive symptoms were assessed using group-based trajectory modelling and generalised estimating equations.

The study found that overall, 30.5% of participants experienced antenatal depressive symptoms, with a lower prevalence at the first measurement point (24.2%) and higher prevalence at the second measurement point (36.9%). Antenatal depressive symptoms were higher during the first trimester (35.6%) compared with the second (19.8%) and third (13.2%) at baseline, and the pattern was consistent across the monthly follow-up period. Moreover, 11.6% of pregnant women had a trajectory of mild-to-moderate depressive symptoms over time. Factors included being currently married (adjusted OR (aOR) 0.53; 95% CI 0.28 to 0.98), having an unintended pregnancy (aOR 1.29; 95% CI 1.03 to 1.62), experiencing intimate partner violence (aOR 2.43; 95% CI 1.67 to 3.56), experiencing at least one pregnancy danger sign (aOR 2.60; 95% CI 2.22 to 3.04), having a history of at least one pregnancy complication (aOR 1.87; 95% CI 1.53 to 2.29), being in the first trimester (aOR 1.45; 95% CI 1.09 to 1.93), having poorer self-reported health (aOR 1.66; 95% CI 1.40 to 1.97) and moderate to low health-related quality of life (aOR 2.43; 95% CI 1.78 to 3.32) were associated with antenatal depressive symptoms.

Nearly one-third of pregnant women had antenatal depressive symptoms, and one in 10 demonstrated steadily increased depressive symptoms over time. The high burden of antenatal depressive symptoms and their association with preventable social and pregnancy-related factors underscore the need for comprehensive antenatal care services that incorporate mental health screening, psychosocial support and interventions addressing intimate partner violence and pregnancy-related complications.

Preterm birth risk prediction currently relies on previous history, with those classified as intermediate-risk or high-risk being offered cervical length measurements. However, most preterm births occur in women considered low-risk. The majority of low-risk women are first-time mothers (nulliparous women) and therefore, typically do not receive cervical length measurements. Evidence from outside the UK suggests that cervical length screening and treatment with progesterone in low-risk women can prevent preterm birth. However, little is known about the acceptability and feasibility of introducing cervical length screening in low-risk nulliparous women in the UK National Health Service (NHS). This study aims to provide this evidence to inform decision-making for cervical length screening (NIHR PGfAR 207290).

A study consisting of two theoretically informed qualitative work packages will explore the perspectives and experiences of women, healthcare professionals and other relevant stakeholders regarding cervical length screening for low-risk nulliparous women. Data will be collected through a combination of semistructured interviews and focus groups with approximately 50 healthcare professionals and 50 women and an online survey.Women will be purposively sampled from community groups and maternity units. Healthcare professionals and providers will be identified through purposive and snowball sampling from maternity units and healthcare and other relevant organisations including those involved in the planning and commissioning of antenatal services. All interviews and focus groups will be audio-recorded and transcribed verbatim. Posters advertising the study will be displayed in maternity units and community centres. Data collection began in September 2025 and is due to end in December 2026. Data will first be analysed inductively and then deductively using the Behaviour Change Wheel, Theoretical Domains Framework and the Feasibility Framework.

Ethical approval was granted by the Health Research Authority (IRAS 349196) and NHS Research Ethics Committee (25/NW/0252) as well as the University of Birmingham (RG_25-018). Findings will be shared with service users and healthcare providers through peer-reviewed publications and conferences. Results will also be reported to the UK National Screening Committee to inform recommendations on national adoption.

"Micropatterns" refer to brief bouts of nonexercise physical activity (<3 min) embedded in daily routines. Evidence suggests that 4 to 6 daily bouts are associated with significant cardiovascular benefits and may offer an accessible alternative for socioeconomically diverse populations who face barriers to structured exercise. This qualitative codesign study aimed to work with socioeconomically diverse community members in Scotland and Australia to explore context-specific perspectives and experiences of micropatterns and codesign a scalable digital smartphone intervention.

The study involved a series of codesign workshops in each country. Participants were nonexercising adults aged 30+ (n = 20 in Scotland and n = 34 in Australia). Workshops drew on the behavior change wheel to explore facilitators and barriers to micropatterns and codesign the intervention. Data were analyzed using thematic framework analysis.

Participants identified a range of barriers (eg, aging and physical decline) and facilitators (eg, valuing health benefits) to engaging in micropatterns. Four modifiable factors were identified: a lack of knowledge and awareness, perceptions about energy and effort, concerns about ability and safety, and low mood and poor mental health. Participants identified 13 intervention components utilizing 6 intervention functions (eg, education, persuasion, and training), and a program theory was developed. To deliver the change mechanism, participants emphasized the importance of inclusive educational content and digital accessibility.

This study demonstrated the theoretically grounded development of a smartphone intervention to promote micropatterns among socioeconomically diverse communities. Future research is required to test the feasibility of the intervention while ensuring digital accessibility and the availability of social support.

Behavioral Activation (BA) is an evidence-based treatment for depression that researchers have adapted for peer delivery to improve access to maternal mental health care. However, little research has examined how peer-delivered BA should be adapted for mothers with substance use disorder (SUD) histories. Building on prior qualitative work with mothers in recovery, this study used Experience-Based Co-Design (EBCD) to adapt the peer-delivered BA intervention Alma in partnership with peer support specialists (PSS) with lived recovery experience.

Using an EBCD framework, the study team conducted a two-phase adaptation study. In Phase 1, four PSS completed all six Alma meetings as participants and engaged in structured co-design meetings after each meeting. In Phase 2, five additional PSS completed Alma training and provided feedback on the proposed adaptations. Analyses used reflexive thematic analysis to examine co-design meeting transcripts, facilitator field notes, and open-ended survey responses.

Six themes emerged. PSS recommended tailoring recovery-specific language according to stage of recovery, integrating recovery concepts into existing BA tools, incorporating mid-week accountability check-ins, expanding opportunities for peer connection, emphasizing participant choice and consent, and providing structured supervision for PSS. Participants consistently viewed Alma as acceptable and relevant for mothers navigating SUD and recovery.

Findings provide an empirically grounded framework for adapting peer-delivered BA interventions for mothers with SUD histories and highlight the value of engaging PSS as co-design partners. A subsequent pilot study of the adapted Alma program will evaluate these adaptations.

Sleep is a vital biological function, and impaired sleep can lead to a range of problems, including poor health and wellbeing. Poor sleep and higher rates of sleep-related problems and difficulties are often reported by autistic people of all ages, however, these experiences and problems have seldom been studied in diagnosed autistic populations in midlife and old age.

This study used data from the first wave of the AgeWellAutism cohort, from a sample of 265 autistic and 167 age- and gender-matched non-autistic adults aged 40-93 years (mean = ∼60 years; ∼50% female). Participants completed widely used and standardised measures of sleep quality and mental health symptoms.

The autistic group reported significantly greater sleep problems than the non-autistic group, with poorer overall sleep across all domains (all p < 0.001), with autistic women reporting greatest difficulties. The largest differences between groups were observed in sleep disturbances and daytime dysfunction (χ² = 101.8 and 95.1, respectively, both p < 0.001). These differences remained significant after controlling for age and symptoms of anxiety, depression and PTSD. Across both groups, poorer sleep was associated with older age and higher levels of anxiety, depression and PTSD symptoms, with a stronger association between sleep problems and anxiety symptoms in the autistic group.

Consistent with prior autism trait-based research in the general population, middle-aged and older autistic adults report more extensive sleep problems and worse sleep quality than non-autistic adults. Sleep problems were associated with older age and poorer mental health. Though the study is cross-sectional, the findings highlight the need to explore causal links through intervention. Addressing anxiety, and mental health problems more broadly, may improve sleep quality in ageing autistic populations.