Youth mental health concerns are rising and often present as internalizing or externalizing behaviors that can lead to a host of negative academic, social, and health outcomes, especially for marginalized students. Despite the growing mental health needs, many youth face barriers to accessing traditional mental health care, highlighting the importance of school-based mental health services.

This paper contributes to understanding Multitiered Systems of Support (MTSS), an evidence-based framework, by reviewing its application within the school context and opportunities to increase students' equitable access to mental health supports.

This paper provides recommendations for evidence-based screening measures and some evidence-based prevention and intervention services that can be utilized and delivered in schools. Implications for how workforce diversity, professional development, and supportive policies can strengthen MTSS implementation by promoting inclusive, trauma-informed care and fostering collaboration among schools, families, and communities to enhance student well-being and equity are also reviewed.

School-based mental health services that utilize MTSS and center equity are imperative for addressing the rising mental health concerns among youth.

Independent audits of medical large language models have concentrated on models that answer unsafely rather than those that decline safe questions. In June 2026, Anthropic released Claude Fable 5 with a safeguard that detects requests related to cybersecurity, biology, or chemistry and reroutes them to a fallback model, Claude Opus 4.8. The developer states that this safeguard is deliberately conservative and affects fewer than 5% of sessions. Whether that figure holds for consumer health questions, many containing dense biomedical vocabulary, was unknown.

This study measured how often Claude Fable 5 routed consumer health questions to its fallback model and whether routing varied by clinical domain and framing.

In this observational, point-in-time audit, the first 500 unique prompts in alphabetical order from the HealthSearchQA benchmark (3173 prompts) were each entered once into Claude Fable 5 through the web interface, in a new session with no system prompt and default settings, from June 9 to 12, 2026. Two reviewers independently coded each response as routed to fallback upfront or not routed upfront, with a third adjudicating disagreements. Midgeneration truncation due to a safety interruption was recorded separately. Prompts were labeled by clinical domain, question type, and sensitivity. Rates were reported with Wilson 95% CIs and compared using chi-square tests. Gemini 2.5 Flash served as an independent comparator.

Reviewers agreed on 474 of 500 responses (94.8%; Cohen κ=0.90; 95% CI 0.86-0.94). Fable 5 routed 243 (48.6%; 95% CI 44.2%-53.0%) prompts to the fallback. Of the 257 not routed upfront, 236 (91.8%; 95% CI 87.8%-94.6%) were fully answered and 21 (8.2%; 95% CI 5.4%-12.2%) were truncated midgeneration. Fallback routing varied by clinical domain (χ²₁₀=59.5; P<.001), from 88.9% (32/36; 95% CI 74.7%-95.6%) for oncology and 79.3% (23/29; 95% CI 61.6%-90.2%) for reproductive and obstetric prompts to 26.3% (5/19; 95% CI 11.8%-48.8%) for mental and behavioral health. It also varied by question type (χ²₃=61.9; P<.001): 63.1% (101/160; 95% CI 55.4%-70.2%) for prognosis or severity, 49.6% (137/276; 95% CI 43.8%-55.5%) for definition, and 1.8% (1/55; 95% CI 0.3%-9.6%) for diagnosis or treatment. Gemini answered 89.7% (218/243; 95% CI 85.3%-92.9%) of routed prompts and declined 19% (95/500; 95% CI 15.8%-22.7%) overall. Standardization to the full 3173-prompt question-type and domain compositions yielded fallback rates of 48.8% and 47.5%, respectively.

Claude Fable 5 routed nearly half of these benchmark consumer health prompts away from the primary model, and routing was associated with clinical domain, question category, and disease vocabulary. Because benignness was not independently adjudicated, wording covaried with clinical content, and the fallback model's subsequent answer was not recorded, these findings describe routing and truncation rather than user-facing refusal or a causal classifier feature. Fallback routing is a measurable safety property that audits should report alongside answer quality.

Postpartum post-traumatic stress disorder acts as an invisible scar, eroding maternal mental health and exerting long-term effects on infant development. Existing screening methods have limitations, hindering early prevention. Predictive models offer a promising approach for early identification of postpartum post-traumatic stress disorder. This study aims to establish a current evidence baseline and outline future directions through a systematic review and meta-analysis.

We systematically searched ten databases-PubMed, Web of Science, Embase, Cochrane Library, PsycINFO, CINAHL, Scopus, and three Chinese databases (CNKI, Wanfang, CBM)-from inception to August 12, 2025. Studies developing and/or validating multivariable prediction models for post-traumatic stress disorder within 12 months postpartum were included. The PROBAST tool was used to assess risk of bias and applicability. Random-effects models were employed for meta-analysis of validated model performance (AUC, sensitivity, specificity).

Seventeen studies involving 17,236 participants were included. The pooled AUC was 0.84 (95% CI: 0.80-0.88), with a pooled sensitivity of 0.77 and specificity of 0.82. Frequently identified predictors included mode of delivery, level of social support, pregnancy complications, and fear of childbirth. Considerable heterogeneity was observed (I² = 89.7%), and calibration and external validation were insufficiently reported.

This review demonstrates that prediction models for postpartum post-traumatic stress disorder show promising predictive accuracy and development potential. However, methodological flaws and high heterogeneity constrain their generalizability. Future research should adhere to TRIPOD guidelines, conduct large-sample, multi-center external validations, and strengthen calibration and clinical utility assessments. Such efforts could help translate prediction models into clinically usable tools, shifting the healthcare paradigm from reactive symptom management to proactive, individualized risk prevention, thereby reducing maternal trauma and optimizing family outcomes.

Purpose: Studies have demonstrated that medication and diagnostic imaging (DI) use and, more broadly, health care resource utilization, are not necessarily concordant with clinical practice guidelines. However, these studies did not evaluate the concurrent presence of clinical manifestations. This study therefore aimed to investigate the association between medication intake and DI, and health outcomes including pain, disability, physical, and mental health-related quality of life in people with chronic whiplash-associated disorders (WADs). We also aimed to evaluate whether medication intake and DI use differed based on specific presenting clinical manifestations (pain classification category [nociceptive, nociplastic, or neuropathic], psychologic features, pain cognitions, and sleep). Method: This cross-sectional study investigated people attending a multidisciplinary chronic pain centre in Calgary, Canada, between October 2019 and December 2021 who attended for evaluation of chronic symptoms arising from a motor vehicle collision. Participants completed a series of questionnaires that evaluated various health domains (pain intensity/interference; disability; physical and mental health-related quality of life; depression, anxiety, and stress; post-traumatic stress; pain catastrophizing; and sleep) at intake, and anonymized results were entered into a registry database with their informed consent. Results: Different classes of medication intake, use of multiple medications, receiving CT, ultrasound, or MRI scans and multiple DI utilization were associated with worse health outcomes. Increased medication intake was also associated with increased DI utilization. In concert, these results suggest that increased health care resource utilization was associated with worse health outcomes - both physically and psychologically - in chronic WAD. Conclusions: Our results indicate that medication intake and DI were not matched to clinical manifestations, and thus further education of health care providers is warranted to assist with appropriate health care resource utilization. These results also suggest that chronic WAD guidelines are required inclusive of recommendations for appropriate utilization of medication and referral for DI.

Transgender and gender non-conforming (TGNC) individuals are under-represented in inflammatory bowel disease (IBD) research, and little is known about their diagnostic experiences, disease burden, mental health comorbidity, or quality of life (QoL). We therefore aimed to characterise clinical features, diagnostic timelines, comorbidity, and QoL among TGNC people with IBD and to contextualise key outcomes using a matched cisgender cohort.

We conducted a nationwide cohort study within the IBD BioResource population. Using questionnaires and linked BioResource data, we collected information on demographics, clinical history, gender-affirming care, comorbidity, and QoL. TGNC participants were matched to cisgender controls by sex and age category for a contextual and exploratory comparison. Analyses were performed using regression models.

Thirty-nine TGNC participants responded (46.2% Crohn's disease, 43.6% ulcerative colitis, 10.3% IBD-unclassified). Median time from symptom onset to diagnosis was 10.5 months (interquartile range 6.0-18.0), 62.3% reported prior hospitalisation and 28.2% prior IBD surgery. Psychiatric comorbidity was frequent (79%). Gender-affirming hormone therapy was reported in 30.7% and prior gender-affirming surgery in 17.9%. Matched analyses demonstrated a trend towards longer diagnostic delays and higher rates of hospitalisation and IBD-related surgery in TGNC participants. Psychiatric comorbidity was significantly higher (79.5% vs 56.8%, p=0.033). QoL impairment was substantial and broadly comparable between groups.

TGNC individuals with IBD demonstrated a high burden of psychiatric comorbidity and signals of longer diagnostic timelines and poorer disease control compared with cisgender peers. These findings highlight potential disparities across IBD care pathways and underscore the need for larger, dedicated studies.

Mounting evidence suggests overlapping pathology across Alzheimer's disease (AD), dementia with Lewy bodies (DLB), and Parkinson's disease (PD), yet its extent and clinical implications remain unclear.

Cerebrospinal fluid (CSF) amyloid beta (Aβ)42/40, phosphorylated tau 181 (p-tau181), neurofilament light chain (NfL), and total α-synuclein were centrally measured using fully-automated Elecsys immunoassays in 347 participants (European Platform for Neurodegenerative Diseases [EPND] cohort) and compared between groups. Associations of amyloid and tau positivity with cognitive and motor function were evaluated.

Compared to controls, amyloid and tau levels were abnormal in DLB, but not in PD. Amyloid and tau positivity in DLB were associated with worse global cognitive outcomes, but not with motor performance. NfL levels were elevated across diseases, and total α-synuclein levels were associated with tau positivity.

AD pathology is observed in DLB, and related to worse cognition, but it is less observed in PD. CSF NfL captures non-disease-specific processes, whereas CSF total α-synuclein likely reflects CSF tau positivity. Results can help patient management in clinical practice and trials.

Integrated youth mental healthcare is an approach that has evolved in response to the global escalation of young people's poor mental health, and the failure of current mental health systems and models to improve this situation. Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ+) young people have disproportionately high rates of poor mental health compared with their cisgender, heterosexual peers, but there is a dearth of research examining how best to integrate mental healthcare for LGBTQ+ youth.

To identify differences in the discursive construction of LGBTQ+ identity, youth, and mental health between LGBTQ+-specific youth mental health services and mainstream services and how these differences may facilitate or limit the integration of mental healthcare.

We conducted a qualitative secondary analysis using Foucauldian discourse analysis, a method that centralises power and knowledge, to examine the discourses used to construct LGBTQ+ identity, youth, and mental health across four different mental health services. Using epistemic injustice as a theoretical framework, we analysed interviews with LGBTQ+ young people and staff (n = 30).

Mainstream discourses of LGBTQ+ youth mental health concentrate on risks, trauma, and harm, and reinforce a passive, pathologised, and patronised subject position for LGBTQ+ youth. In contrast, we identified three counter-discourses in LGBTQ+-specific mental health services: Knowing and telling, Resisting pathology, and Capability. These counter-discourses allowed for wider, transformative possibilities for LGBTQ+ youth subjectivities and mental wellbeing.

Existing models of integrated youth mental healthcare privilege a clinical, developmental, and universal approach that does not consider justice or the oppressive power systems implicated in LGBTQ+ young people's mental healthcare. Without addressing in/justice, there will remain fundamental irreconcilable differences that will forfeit effective and inclusive systems of mental healthcare for LGBTQ+ young people.

Digital therapeutics for mental health often face low patient engagement, which limits their clinical impact. Interventions that deliver treatment using a video game medium may improve engagement and therapeutic efficacy, but the potential emergence of gaming-related problems remains a safety question and a concern among clinical stakeholders. We examined whether long-term adjunctive use of the video game therapeutic Meliora was associated with changes in gaming-related problems in a three-arm randomized controlled trial. Participants were adults with interview-confirmed major depressive disorder without significant gaming or gambling problems at baseline. The intention-to-treat cohort (n = 1001) had a mean age of 33.4 years (SD 9.3), and 64% were female. From baseline to post-intervention (week 12), Game Addiction Scale (GAS-7) scores decreased in the Meliora group (mean change, -0.63 points; 95% CI, -0.91 to -0.34; dz = -0.24; Holm-adjusted p < 0.001), whereas no change was observed in the Sham group, which used a highly similar video game therapeutic (mean change, -0.02 points; 95% CI, -0.25 to 0.28; dz = -0.01; Holm-adjusted p = 0.900). Between-group analyses showed more negative GAS-7 change in the Meliora group than in the Sham group (adjusted mean difference, -0.19 points; 95% CI, -0.30 to -0.08; d = -0.13; Holm-adjusted p = 0.001), indicating a relatively greater reduction with Meliora, whereas changes were similar between the Meliora and TAU groups (adjusted mean difference = 0.04 points; 95% CI, -0.08 to 0.15; d = 0.03; Holm-adjusted p = 0.509). Intervention usage time, experienced immersion, and their interaction were not significantly associated with changes in GAS-7 scores in either the Meliora or Sham group. Using a ≥ 25% deterioration threshold, deterioration occurred in 10.4% of participants in the Meliora group, 15.3% in the Sham group, and 9.8% in the TAU group, with no statistically significant between-group differences. Complementary per-protocol analyses among participants with greater intervention exposure were consistent with the ITT findings. These findings provide no evidence that long-term use of a video game therapeutic was associated with increased gaming-related problems in appropriately screened patients using interventions with safeguards against excessive use.

Major depressive disorder (MDD), bipolar disorder (BD), and schizophrenia (SCZ) are highly prevalent and disabling psychiatric conditions with increasing incidence, significantly affecting individuals' daily functioning, social relationships, and overall quality of life. Current diagnostic practices largely rely on clinical interviews and symptom-based rating scales, which are inherently subjective and time-consuming-posing major obstacles to large-scale screening.

To address this, we propose a novel multiscale spatiotemporal network fusion (MSNF) feature extraction method based on functional near-infrared spectroscopy (fNIRS) combined with the verbal fluency test (VFT). This method is designed to enable objective, efficient, and automated differentiation among multiple psychiatric disorders (MDD, BD, and SCZ), as well as between patient groups and healthy controls (HCs). Leveraging the practical advantages of fNIRS, including its portability, motion tolerance, and balanced spatiotemporal resolution, the proposed MSNF fuses temporal dynamics with graph-theoretical topology, capturing both local hemodynamic dynamics and hierarchy connectivity patterns.

In this study, a total of 414 participants were recruited, including individuals diagnosed with MDD, BD, SCZ, and HCs. Classification experiments using machine learning (ML) models demonstrate the proposed method's robustness and superior diagnostic performance in binary and multiclass settings, outperforming traditional unidimensional feature approaches. Additionally, group-level functional connectivity (FC) analyses reveal distinct neurobiological signatures among psychiatric groups.

These findings underscore the translational potential of MSNF-enhanced fNIRS as a scalable neuroimaging-based biomarker tool for early psychiatric screening and differential diagnosis.

Background Skull base chondrosarcomas are rare and locally aggressive tumors with heterogeneous biology accounting for 0.1-0.2% of all intracranial tumors. Dedifferentiated chondrosarcoma is an exceptionally uncommon and aggressive variant, seldom seen at the skull base. We report a recurrent clival chondrosarcoma with a small, dedifferentiated component, and an unusually long latency after initial treatment. Case Report A 66-year-old woman was referred with a recurrent progressive clival lesion, initially suspected to be a chordoma. She had undergone subtotal resection followed by single-fraction radiosurgery (25 Gy) 32 years earlier. Surveillance imaging demonstrated interval growth compared with imaging 5 years earlier, prompting repeat subtotal resection. Histopathology revealed a conventional chondrosarcoma with a dedifferentiated component comprising <5% of tumor area and an isocitrate dehydrogenase 1 (IDH1) R132 mutation. The patient declined adjuvant radiotherapy. Three years later, she developed worsening diplopia, new right oculomotor palsy, and headache with radiologic progression, prompting repeat subtotal resection. She currently awaits postoperative proton beam radiotherapy. Conclusion This case highlights a key diagnostic challenge of distinguishing chondrosarcoma from chordoma, and underscores the importance of meticulous histologic sampling to detect small dedifferentiated foci that may otherwise result in undergrading and undertreatment. The heterogeneity in clinical behavior observed across histopathological subtypes further underscores the necessity for grade/subtype-driven treatment regimens. Therefore, accurate subtype classification and molecular annotation may better inform treatment strategy and follow-up. Lastly, the rarity of dedifferentiated skull base chondrosarcoma reinforces the need for multicenter registries to further understand the behavior and vulnerabilities of this rare disease.