In England, 18% of children and young people (CYP) experience clinical levels of mental health difficulties. CYP who are involved in children's social care, either receiving in-home care (i.e. child protection plans; CPP) or out-of-home care (i.e. children looked after; CLA), may experience higher prevlance than peers. Less is known about actual contacts with mental health services. This study aimed to provide an account of the contacts with mental health services for children with and without CPP and CLA, and reasons for referral.

Data were extracted from NHS Digital for all CYP in England in contact (e.g. through referral, appointment, support) with mental health services between April 2016 and March 2021, and included sociodemographic information, CPP or CLA status and referral reason.

In total, 1,984,827 CYP were in contact with mental health services. The most common referral reasons were anxiety (13%), 'in crisis' (10%) and depression (7%). Contacts tended to increase each year for all groups. Overall, CPP and CLA were between 2 and 3 times more likely to be in contact with mental health services compared to peers. However, this represented between 9% and 18% of CPP and CLA.

The findings suggest that there are wide discrepancies between mental health needs and contacts with services. CPP and CLA have particularly high levels of unmet need. While these data indicate escalating demand, service contacts have not increased significantly, suggesting an increased threshold for access in a stretched clinical service.

This article is a structured narrative review that synthesizes empirical findings and expert consensus and provides policy guidance to outline implementation pathways for integrating Yoga into mainstream healthcare systems, with India as a case example. Yoga is an ancient health practice traditionally used as a holistic approach to health management and wellbeing. However, the acceptance of Yoga as an evidence-based practice in the modern healthcare delivery requires systematic reassessment for its implementation within the healthcare system to make healthcare more affordable, improve prevention, rehabilitation, and resilience thus reduce strain on medical resources. In this review, we have organized the literature review and practical insights around three core themes: stakeholder configurations and governance, economic and quality management, and implementation strategies and evaluation to develop an actionable framework for an optimal care system responsive to patients' needs and adaptable to different community settings. This article has incorporated peer-reviewed studies on the effectiveness of Yoga, its implementation in mainstream healthcare, along with relevant publicly available policy, accreditation, and practice standard sources, to emphasize constructs of implementation science and evidence-based practice. The review identifies a know-do gap between growing evidence for Yoga and its system-level adoption, proposing a staged framework that integrates stakeholder engagement, economic evaluation, quality management, and monitoring to support evidence-based implementation. We propose a comprehensive, context-sensitive model that combines traditional wisdom with contemporary behavioral, clinical, and systems-based approaches. By embedding Yoga within an implementation science framework, we advocate for its role as a mainstream, evidence-informed system. Adoption of Yoga as a therapeutic and preventive modality can be accelerated through standardized protocols, transparent evaluation and regulation, and tripartite governance among state actors, healthcare institutions, and Yoga professionals; however, the feasibility hinges on context-sensitive financial support, stakeholder management, and workforce development.

Uterine fibroids are the most common gynecologic tumors. Despite their non-cancerous nature, they pose significant symptoms that can impact women's quality of life and mental health. Black women have the highest incidence of uterine fibroids, with a lifetime risk of about 80%. Allostatic load reflects the cumulative biological consequences of chronic stress arising from environmental and social exposures, including low socioeconomic status, microaggression, and racial discrimination. Disproportionately prevalent among Black women, allostatic load is associated with adverse health outcomes across multiple organ systems, and emerging epidemiological evidence suggests a plausible association with uterine fibroids. This review examines how allostatic load is measured and its effects on the body's regulatory systems, including neuroendocrine, immune, and metabolic pathways. Importantly, allostatic load is presented here as a hypothesis-generating integrative framework rather than an established causal mechanism. This review also explores the epidemiological and biological evidence linking chronic stress to uterine fibroids, with particular attention to the potential role this framework plays in contributing to racial disparities in fibroid burden among Black women. A distinction is drawn between the biological embedding of chronic stress (allostatic load), structural determinants of health (socioeconomic status, healthcare access), and interpersonal factors (clinician bias, institutional mistrust)-each representing complementary but conceptually distinct contributors to observed disparities. In addition, this review discusses the potential impact of stress, lifestyle factors, and genetic predisposition on fibroid development, and recommends preventive strategies encompassing both public health and individual-level interventions.

Tuberculosis (TB) remains a major global health challenge, particularly in low-income settings where structural inequities hinder early diagnosis and care. Ethiopia, one of the 30 high TB-burden countries, continues to experience marked geographic disparities. Understanding knowledge, attitudes, and practices (KAP) among affected populations is essential to inform context-specific interventions supporting the End TB Strategy.

A cross-sectional KAP survey was conducted in Woliso District (Oromia Region, Ethiopia) between April 2023 and December 2024, including 152 TB index cases and 326 household contacts. A structured, interviewer-administered questionnaire assessed knowledge of TB symptoms, transmission, diagnosis, and perceived barriers to care. Categorical variables were compared using Chi-square or Fisher's exact test, and continuous variables with Mann-Whitney test.

Among 478 participants (median age 28 years [IQR 19-40]; 44.1% female), 69.5% lived in rural areas. The main barriers to timely diagnosis were absence of nearby TB diagnostic facilities (13.4%), poor road conditions (6.3%), health system delays (5.9%), and financial constraints for transportation (3.8%). Poor roads and transport costs were reported more often by rural residents (p < 0.05), while absence of nearby TB diagnostic facilities was reported most often by index cases and older subjects (p < 0.05). Recognition of cough lasting >2 weeks (84.3%) and night sweats (65.7%) was common, while hemoptysis (49.6%) and fever (16.1%) were less recognized. Awareness of sputum and X-ray diagnostics was 87.2%, higher among index cases (95.4% vs. 83.4%, p = 0.0005). Although 77.0% considered TB life-threatening, 52.2% believed it was transmissible only through close or bed-sharing contact (p < 0.0001 for rural vs. urban). Older age correlated with better knowledge across most domains (all p < 0.01). Overall, subjects living in rural area had higher scores about barriers for accessing TB care (p = 0.0004) and attitude on TB (p = 0.01), and lower score about knowledge on TB (p = 0.002).

While TB knowledge and attitudes were generally high, misconceptions about transmission and persistent structural barriers hinder access to timely diagnosis and care. Expanding community-based diagnostic capacity, improving rural infrastructure, and integrating social protection strategies are key to advancing Ethiopia's progress toward End TB targets.

Depressive symptoms (DSs) are highly prevalent among medical students and may adversely affect both student well-being and future healthcare quality. Although personality traits (PTs) are closely associated with mental health, the psychological processes underlying these associations remain incompletely understood. This study examined the associations between the five PT dimensions and DS and explored whether psychological capital (PsyCap) and perceived stress (PS) statistically mediated these associations.

A multicenter cross-sectional survey was conducted among 583 third-year undergraduate clinical medicine students from three medical universities in China. Standardized questionnaires were administered to assess PTs, PsyCap, PS, and DS. Correlation, regression, and sequential mediation analyses were performed.

Correlation analyses showed that neuroticism was negatively correlated with PsyCap and positively correlated with PS and DS, whereas extraversion, openness to experience, agreeableness, and conscientiousness demonstrated the opposite pattern (all p < 0.001). Regression analyses indicated that neuroticism, openness to experience, agreeableness, and conscientiousness were significantly associated with DS (β = 0.39, -0.14, -0.15, -0.10, respectively, all p < 0.001), whereas the direct association between extraversion and DS was not statistically significant (β = -0.05). Mediation analyses supported statistically significant indirect associations through PsyCap alone, PS alone, and the proposed sequential pathway through PsyCap and PS. Among the five PT dimensions, the association between extraversion and DS was primarily reflected through the indirect pathways.

The findings suggest that PTs may be associated with DS through psychological resources and stress appraisal. By integrating PsyCap and PS into a sequential mediation framework, this study provides an expanded perspective on the psychological processes linking PTs and DS among medical students. Given the cross-sectional design, the proposed mediation pathways should be interpreted as statistical associations rather than causal relationships. Future longitudinal and intervention studies are needed to further evaluate these associations.

The increasing prevalence of autism spectrum disorder (ASD) highlights the importance of understanding caregivers' experiences in accessing mental healthcare for their children, particularly given the demanding nature of supporting children with ASD in resource-constrained settings.

This study aimed to explore the experiences of caregivers of children with ASD when accessing mental healthcare services in South Africa.

This qualitative study was conducted at the Child and Adolescent Psychiatric Unit at Weskoppies Hospital, a tertiary-level hospital in Pretoria West, Gauteng province, South Africa.

This qualitative case study purposively sampled 15 caregivers of children with ASD at a tertiary psychiatric facility in South Africa. Data were gathered through in-depth interviews and analysed using a Grounded Theory-informed thematic analysis approach.

Five main themes emerged: (1) challenges in accessing mental health care services, (2) delays in screening and early diagnosis, (3) limited ongoing education and knowledge-sharing, (4) the need for emotional support and counselling, and (5) facilitating referrals to specialised schools and allied health care services.

The study identified significant barriers to mental health service utilisation, underscoring the urgent need for improved service accessibility, caregiver support and increased public awareness.

The findings advocate for strengthened mental healthcare access and targeted caregiver support for families of children with ASD in South Africa.

Organophosphate ester flame retardants and plasticizers (OPEs) have myriad uses in industry and consumer products. Increasing human exposure to OPEs has raised concerns about their potential effects on child neurodevelopment during the pregnancy. Objective: We investigated whether OPE urinary concentrations during pregnancy were associated with child's autism-related outcomes.

We included 4159 mother-child pairs from 15 cohorts in the NIH Environmental influences on Child Health Outcomes (ECHO) Consortium, with children born from 2006-2020 (median age [interquartile range]: 6 [4,10] years). Nine OPE biomarkers were measured in urine samples collected mid- to late pregnancy. Dilution-adjusted biomarkers were modeled continuously, categorically (high [>median], moderate [≤median], nondetect), or as detect/nondetect depending on their detection frequency. We assessed child autism-related traits via a) parent report on the Social Responsiveness Scale (SRS) and b) clinical autism diagnosis. We examined associations of OPEs with child outcomes, including modification by child sex, using generalized estimating equations to account for clustering by ECHO cohort.

Compared with nondetectable concentrations, high exposure to bis-(butoxyethyl) phosphate (BBOEP) was associated with higher autistic trait scores (adj-β 0.97, 95% confidence interval [CI]: 0.42, 1.52) and greater odds of autism diagnosis (adjusted odds ratio [adj-OR]: 1.27, 95% CI: 1.07, 1.50). Bis-(1-chloro-2-propyl) phosphate (BCPP) showed associations with autistic trait scores (BCPP adj-β for high exposure vs nondetect: 0.34, 95% CI: -0.46, 1.13; BCPP adj-β for moderate exposure vs nondetect: 0.72, 95% CI: 0.24, 1.20). High exposure to bis-(2-chloroethyl) phosphate (BCETP) was associated with lower odds of autism diagnosis (adj-OR: 0.76, 95% CI: 0.60, 0.95). Other OPEs showed no associations in adjusted models. Associations between BBOEP and higher autistic trait scores were stronger in males than females.

Prenatal exposure to OPEs, specifically BCPP and BBOEP, may be associated with a higher risk of autism diagnosis and related traits in childhood.

The treatment needs of elderly people can be complex because of reduced mobility, compromised physical and mental states amongst others. These complexities can be pronounced in those with systemic diseases and those on medications that compound oral conditions e.g. Xerostomia. This makes oral hygiene and treatment more difficult. Despite their increased need, the uptake of dental care by elderly people is characteristically poor and unmet needs may be high6. Barriers to the uptake of care include a lack of perceived need, concerns about availability, cost and fear of cost, fear of treatment and anxiety about Dentist characteristics.

This cross-sectional study sampled 500 elderly patients, aged 65 to 91, attending clinics in selected healthcare centers in Oyo State, Nigeria. A multistage sampling technique was used, and data was gathered through structured interviewer-administered questionnaires and a modified WHO clinical assessment form to assess oral health status. Data was analyzed using SPSS version 23, with summary statistics like frequency tables and means. Chi-square tests were employed to examine associations between variables, with significance set at P < 0.05.Data collection was conducted daily, with verification and supervision to ensure accuracy. Occasional re-examination of random patients was done to maintain consistency among examiners.

The results showed a mean age of 74 ± 10 years, with 51% female participants. A mean DMFT score of 5 and a CPITN score of 2 indicated significant dental care needs. However, only 8.6% of the elderly participants had accessed dental care in the past 12 months. Financial constraints, fear of pain, and anxiety about dental instruments were some of the major factors preventing the elderly from seeking care.

The study concluded that despite available public-sector dental services, financial and personal barriers contributed to unmet oral health needs among the elderly.

Spinal cord injury (SCI) imposes substantial long-term physical, psychological, as well as financial burdens on patients in Iran, where high out-of-pocket (OOP) payments remain a major barrier to care. This study examined inequalities in healthcare utilization and OOP expenditures among patients with paraplegia and tetraplegia.

This cross-sectional analyzed data from the 2023 International Spinal Cord Injury Survey for Iran, including 191 patients from the Guilan Province. Data on healthcare utilization and OOP spending for consultations, rehabilitation, medications, diagnostics, mental health, and inpatient services were analyzed. Inequality was assessed using Gini and concentration indices, and further explored through decomposition analysis and recentered influence function regression.

Inpatient care accounted for the highest OOP cost (US$516.27/month), followed by rehabilitation (US$178.65/month). Mental health services were the least utilized and most inequitable, with a concentration index of 0.49, indicating pro-rich access. Education, marital status, and place of residence significantly influenced the disparities, with rural and less-educated patients experiencing greater barriers.

Patients with SCI in Iran face substantial financial inequities, and wealthier groups enjoy greater access to essential services. Policy reforms aimed at expanding insurance coverage, decentralizing rehabilitation, and subsidizing high-cost care are urgently required to promote equitable healthcare access and improve outcomes.

The Offender Personality Disorder (OPD) Pathway for England and Wales provides specialist services to men and women with complex mental health needs, which are linked to serious and harmful offending. However, criteria for accessing such services have relied on practitioner judgement and screening items developed for use with men. Within the context of a policy and practice task and finish group, this study examined existing processes and an array of routinely monitored items with the aim of developing a gender-responsive identification tool for women's entry to the OPD Pathway that would withstand the test of time.

A two-part exploratory study of cross-sectional secondary data drawn from a Ministry of Justice database of all women on licence or in custody at the time of access (June 2019) was conducted. Binary logistic regression modelling of extant identification processes was carried out. Proposed alternative items indicating key characteristics that may more appropriately represent the psychological needs profiles of women on the OPD Pathway were modelled and consulted on.

A tool consisting of 16 items that demonstrated good predictive utility in screening outcome was established. This practical and automatable tool was rolled out for use across probation and prison services.

This revised screening tool appeared more gender-sensitive than previous approaches to identifying women for OPD involvement while approximately maintaining the female OPD caseload figures.