While child developmental checks are universally recommended, engagement with developmental surveillance programmes is low globally. To address this policy to practice gap, this study examined the diagnostic accuracy of the 'Watch Me Grow' Integrated (WMG-I) digital developmental screening and ongoing surveillance approach.

This sub-study examined diagnostic accuracy of the WMG-I digital approach compared with routine assessment (service as usual (SaU)) in a prospective sample.

Parents of 16-to-35-month-old children attending 40 general practices (randomised to WMG-I or SaU) in culturally diverse metropolitan New South Wales and Queensland, Australia, participating in a longitudinal cluster randomised controlled trial. Parents in the WMG-I group completed the WMG-I digital weblink, including a primary screener and automated secondary screener (if concerns were reported). On completion, results and recommendations were transmitted to the parent and general practitioner (GP) allowing discussion and further assessment. This was compared with SaU GP assessment. Once engaged, based on child's date of birth, WMG-I sends automated reminders to take the check again at the next recommended ages, thereby allowing ongoing developmental monitoring/surveillance.

All children with identified concerns and a 10% systematic sample without concerns received a reference standard assessment using the Mullen Scale of Early Learning, Autism Diagnostic Observation Schedule and Vineland Adaptive Behaviour Scale. The primary outcome was diagnostic accuracy of WMG-I compared with SAU on the reference standard assessments.

Of the 655 children in the study at age 2 years, 151 children received reference standard assessment. There was a statistically significant difference in the diagnostic accuracy, with 93.9% sensitivity in the WMG-I group (95% CI 88.1% to 99.7%) and 75.9% (95% CI 57.2% to 94%) in the SaU group (p=0.035); specificity was 71.4% (95% CI 54.7% to 88.1%) and 66.7% (95% CI 44.9% to 88.4%) (p=0.743), respectively.

Universal digital surveillance programmes such as WMG-I can enhance time and service efficiency to accurately identify developmental needs. Leveraging routine primary care contact such as immunisation visits to administer WMG-I digital offers a scalable solution for increasing the uptake of developmental surveillance at a population level internationally.

ANZCTR12621000680864.

Early childbearing has significant adverse effects on the health and socio-economic well-being of young people globally. While some interventions have addressed the challenges faced by young parents, no study has systematically mapped initiatives aimed at improving the health and socio-economic well-being of young parents in Africa. This scoping review aimed to map and summarise existing interventions meant to improve the well-being of young parents in Africa, examining their approaches, geographical distribution, key outcomes and impacts to inform future policy and programme decisions.

Our study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) standards and was guided by the Joanna Briggs Institute methodological framework for scoping review.

We conducted a systematic search across PubMed, Science Direct, JSTOR, African Journals Online, Education Resources Information Center and Google Scholar for peer-reviewed articles published between 1 January 2000 and 31 December 2024.

We included peer-reviewed studies such as randomised controlled trials, non-randomised studies, mixed methods studies and qualitative evaluations focusing on young mothers and fathers aged 10-24 years in Africa, reporting interventions targeting their health and socio-economic well-being and published in English or French. We excluded non-peer-reviewed studies, studies conducted outside of Africa, those focusing on parents older than 24 years, publications written in languages other than English or French as well as grey literature materials.

Three independent reviewers screened all articles' abstracts and titles using Rayyan software. Then these three reviewers independently conducted a full-text review for the prequalified articles using the prespecified inclusion criteria. Findings were summarised in tables and synthesised qualitatively.

Our review included 13 peer-reviewed studies, namely randomised controlled trials (2), quasi-experimental (7), mixed-methods (2) and qualitative studies (2). The studies were conducted in seven African countries, primarily in Kenya (5) and exclusively targeted young mothers (10-24 years), while neglecting young fathers. Most interventions focused on health outcomes, particularly mental and sexual and reproductive health. Few addressed economic (financial independence, livelihoods), social (communication, decision-making) or educational (school continuation, performance) outcomes. The interventions demonstrated positive impacts across multiple domains, including mental health, education, sexual/reproductive health access, social skills (communication, decision-making) and economic empowerment (financial independence, living conditions) among young mothers.

The evidence base for interventions targeting African young parents' well-being is limited in volume, geographical spread, evaluation rigour and focus on young fathers. The findings underscore the need for more robust research to identify effective interventions for this population.

CRD42023464828.

Depression, anxiety, and stress-related difficulties represent a major global health burden. Online psychological therapy has emerged as a promising approach to increasing access to care, yet evidence from routine, real-world clinical settings, particularly for services delivered without standardized treatment protocols, remains limited.

This study aimed to describe symptom change and patient-reported satisfaction associated with routine online psychological therapy delivered within an insurance-based care setting.

A retrospective observational service evaluation was conducted using deidentified routine care data. Clients aged 15 years and older who initiated online psychological therapy and completed baseline and end-of-treatment assessments on all 3 outcome measures were included. Symptoms of depression, anxiety, and perceived stress were measured using the 9-item Patient Health Questionnaire (PHQ-9), 7-item Generalized Anxiety Disorder (GAD-7), and 10-item Perceived Stress Scale (PSS-10), respectively. Changes in symptoms were examined using paired sample t tests, within-sample effect sizes (Cohen d and Cohen d_z with 95% CIs), and reliable change indices. Robustness was assessed with therapist-clustered mixed models and attrition sensitivity analyses. A ≥50% reduction in symptom scores was reported as a descriptive response criterion. Patient satisfaction was assessed with single-item ratings at the end-of-treatment assessment.

A total of 1221 clients were included. Clients completed a mean of 4.7 (SD 1.67) therapy sessions over an average treatment duration of 62.7 (SD 40.4) days. Significant reductions with large within-sample effect sizes were observed for depression (Cohen d=1.25, 95% CI 1.17-1.32), anxiety (Cohen d=1.49, 95% CI 1.41-1.57), and perceived stress (Cohen d=1.46, 95% CI 1.38-1.54). A ≥50% symptom reduction was observed in 60.7% (741/1220) of clients for depression, 67.5% (824/1221) for anxiety, and 30.8% (376/1221) for perceived stress. At the end-of-treatment assessment, 80.7% (985/1221) scored below the clinical cutoff for depression (PHQ-9<10) and 79.2% (967/1221) for anxiety (GAD-7<8). Reliable improvement was observed in 56% (688/1221) to 65% (794/1221) of clients, with deterioration below 2% on all measures. Mean patient-reported satisfaction scores ranged from 8.55 (SD 1.71) to 8.96 (SD 1.45) on a 10-point scale, and mean recommendation likelihood was 8.61 (SD 1.88). Therapist-level intraclass correlation coefficients were ≤0.029; effect sizes were 1.27-1.50 under inverse-probability weighting and 0.41-0.50 under zero-change imputation for baseline-screened clients without end-of-treatment assessments.

Routine online psychological therapy delivered within an insurance-based care setting was associated with substantial pre-post symptom reductions, high proportions of clients meeting a descriptive ≥50% reduction criterion and showing reliable improvement, and high patient-reported satisfaction. Because the evaluation used an uncontrolled pre-post design restricted to clients with paired assessments, observed changes cannot be attributed causally to treatment. High satisfaction among responding clients is consistent with acceptability of the model to those clients; feasibility was not formally assessed, and inferences about comparative effectiveness require controlled designs.

Malnutrition is highly prevalent amongst psychiatric inpatients, with prevalence reaching up to 42.5%. Geriatric-psychiatric inpatients, in particular, face complex nutritional barriers distinct from typical hospital malnutrition. To date, there is limited guidance on adapting mealtime assistance strategies to the complex needs of geriatric-psychiatric inpatients.

A systematized narrative review aligned with SANRA was conducted to develop a mealtime assistance framework. Personal and institutional challenges in geriatric-psychiatric care were identified, followed by a review of successful mealtime practices from various inpatient settings, and then key elements were modified to fit the unique needs of the target population.

Personal challenges to addressing malnutrition in geriatric psychiatric care include medication-induced appetite and taste changes, apathy, low motivation, and altered circadian rhythm patterns. Institutional barriers include overly rigid organizational approaches, deficits in staff knowledge relating to evidence-based nutrition, competing staff priorities and a predominant focus on pharmacotherapy, which may cause approaches to physical health and nutritional status to be inadequate. Key nutritional interventions from the literature include improving the mealtime environment through protected mealtimes and auditory optimization, enhancing human interaction between staff and patients, implementing a 'train-the-trainer' model, and using oral nutritional supplements and food fortification. Key adaptations to address specific challenges in this population include flexible mealtime scheduling to accommodate disrupted routines, specialized staff training in patient empathy and mutual reciprocity, and the use of sealed packaging for oral nutrition supplements to address paranoia.

Implementing mealtime interventions tailored explicitly to the geriatric psychiatric inpatient population is vital for addressing malnutrition and improving both physical and mental health outcomes. This review provides a novel, setting-specific mealtime assistance framework for this uniquely vulnerable population, making testing and cost-effectiveness analysis an important priority for future research.

Artificial intelligence (AI) technologies are increasingly integrated into health contexts and may facilitate health management and healthcare support. However, not all populations may benefit equally from advances in AI health applications, especially those with disadvantaged social status.

This study examined sociodemographic disparities in AI use for health among adults in Mainland China and explored how social positions may intersect in shaping AI use for health.

A nationally representative online sample of Chinese adults (N = 1200) completed questionnaire items assessing six forms of AI use for health and sociodemographic variables, including sex, age, income, education, and insurance coverage.

Participants reported low to moderate overall AI use for health. Higher income was associated with greater use of AI-powered wearable health reports, AI-assisted hospital care, and AI-based tools for mental health, but lower use of AI-based medical consultation chatbots. Having commercial health insurance was consistently positively associated with various AI health use, whereas having rural cooperative insurance was not associated with AI use behaviors. In addition, age significantly interacted with both income and insurance status in predicting overall AI use for health.

Findings suggest that AI health use in Mainland China varies across sociodemographic groups and may reflect broader inequalities in healthcare access and resources.

Pregnancy is a vital developmental stage during which anxiety, depressive symptoms, and suicide risk may emerge or intensify. Although their prevalence is well documented, there remains a need to identify associated clinical and social risk factors, particularly in contemporary and diverse contexts.

To estimate the prevalence of anxiety symptoms, depressive symptoms, and suicide risk among pregnant women, and to analyze associated sociodemographic, obstetric, and psychosocial factors.

We conducted an observational, analytical, cross-sectional study with a sample of 1775 pregnant women. Emotional symptoms were assessed using the GAD scale, the Beck Depression Inventory, and the suicide module of the MINI. Spearman correlation analyses and binary logistic regression (univariate and multivariate) were performed to identify significant associations.

A total of 60.7% of participants presented anxiety symptoms, 39% depressive symptoms, and 11.2% suicide risk. Multivariate factors associated with a higher likelihood of emotional distress included personal or family history of mental health problems (anxietyOR 2.30 and depressionOR 4.15), low social support (anxietyOR 2.25 and depressionOR 3.83), unstable romantic relationships (anxietyOR 2.03 and depressionOR 2.54), recent access to psychological care (anxietyOR 4.69 and depressionOR 4.15) and substance use (depressionOR 1.69). Suicide risk was additionally associated with migrant background (OR 3.24) and high-risk pregnancy (OR 1.81). Nulliparity showed a protective effect against depressive symptoms (OR 0.56).

The findings reveal a substantial emotional burden during pregnancy and underscore the central role of psychosocial determinants. Systematic perinatal mental health screening-including direct assessment of suicide risk-is recommended, along with interventions that integrate a biopsychosocial approach sensitive to the cultural and relational context of pregnant women.

The introduction of designated registered nurse (RN) prescribing in Australia creates an opportunity to strengthen RNs' role in adult attention-deficit/hyperactivity disorder (ADHD) care. Adult ADHD is a lifelong neurodevelopmental condition that may require ongoing medication review, monitoring, psychoeducation, and coordinated support. Access to ADHD medication has traditionally relied on specialist psychiatric assessment, creating barriers related to cost, waiting times, rurality, socioeconomic disadvantage, and fragmented primary care. Mental health RNs are well placed to address these gaps through collaborative prescribing models. Their expertise includes therapeutic engagement, mental state and functional assessment, risk identification, medicines monitoring, consumer partnership, and care coordination. These capabilities support treatment review, adverse-effect monitoring, continuity of care, and management of comorbid mental health concerns. However, current reforms do not clearly define the role of specialist mental health RNs in ADHD care or provide profession-specific guidance, decision-support tools, and ADHD education pathways. This article argues that mental health RN prescribers can improve access, continuity, safety, and equity. It calls for policy, education, and governance frameworks that embed RNs within collaborative ADHD service models.

This study examined how community environments influence loneliness and depression among older adults and whether they moderate their association. A two-stage approach guided by the Transactional Model of Stress and Coping and the Environmental Press-Competence Model was employed.

Data were drawn from a nationwide survey of adults aged 65 years or older (N=605). Community environments comprised service accessibility and opportunities for community engagement. In the first-stage loneliness model, community environment variables and covariates were included. In the second-stage depression model, loneliness and interactions between loneliness and each community dimensions were incorporated.

Service accessibility was negatively associated with loneliness and depression and moderated their association. Loneliness was positively associated with depression (β = 0.399, p < .001), and the interaction between loneliness and service accessibility was significant (β = -0.083, p < .05), indicating a buffering effect. Opportunities for community engagement were positively associated with loneliness and were not associated with depression, highlighting a distinction between the availability of opportunities for engagement and actual engagement.

Strengthening community infrastructure to ensure equitable access to social, health, and recreational services is vital for building age-friendly environments that reduce loneliness and support well-being of older adults.

People with severe mental illness demonstrate markedly reduced life expectancy, largely due to preventable cardiometabolic disease. This burden is particularly pronounced in compulsory forensic psychiatric care, where prolonged inpatient stays, restrictive environments, and long-term antipsychotic treatment contribute to high levels of sedentary behavior, unhealthy diet, tobacco use, and metabolic disturbances. Despite substantial cardiometabolic risk, individuals in forensic psychiatric settings are frequently excluded from preventive health research, resulting in limited evidence regarding the feasibility and acceptability of lifestyle interventions in this context. Recent international recommendations emphasize the need to integrate structured lifestyle interventions as core components of mental healthcare, including in secure and compulsory settings.

The FOR-HEALTH study aims to assess the feasibility and acceptability of an adapted Structured Health Dialogue intervention delivered in compulsory forensic psychiatric inpatient care. Secondary objectives are to describe cardiometabolic, lifestyle, and patient-reported outcomes to inform the design of a future definitive randomized controlled trial.

This randomized controlled feasibility trial evaluates an adapted version of Structured Health Dialogues, an evidence-based cardiovascular prevention model originally developed for Swedish primary care. Participants are randomized in a 1:1 ratio to receive either Structured Health Dialogues plus treatment as usual or treatment as usual alone. Structured Health Dialogues integrate a systematic assessment of lifestyle behaviors, biological risk markers, psychosocial stress, and heredity into an individualized visual risk profile, which forms the basis for a motivational, person-centered dialogue. The intervention is adapted to the forensic psychiatric context and delivered within a secure inpatient setting. Primary outcomes relate to feasibility, including recruitment, retention, intervention delivery, and acceptability. Secondary outcomes include exploratory changes in lifestyle behaviors, cardiometabolic risk markers, and patient-reported outcomes. A total of 50 participants (25 per group) will be recruited. The study has been approved by the Swedish Ethical Review Authority. The findings are expected to inform the design and implementation of a future definitive randomized controlled trial evaluating Structured Health Dialogues in forensic psychiatric inpatient care.

NCT07157813.

Our understanding of the genetic architecture of obesity is primarily based on studies of adults, with sparser data from childhood. Here, we conducted age-stratified genetic association studies against objectively measured (n = 62,276) or recalled childhood adiposity-related traits (n_eff = 599,924), identifying 624 common variants associated with childhood adiposity, with one-third having no concordant association with adult body mass index. Signals linked to the leptin-melanocortin pathway (BSX, GNAS, LEPR and PCSK1) and incretin signaling (GIPR and GLP1R) showed childhood-specific effects on adiposity. Single-nucleus RNA sequencing data identified childhood-specific adiposity-regulating cell populations in the arcuate nucleus and mammillary bodies, indicating neurocircuits that regulate adiposity specifically during childhood. Finally, sequencing in 479,615 individuals uncovered rare protein-coding variation in ADCY3, CALCR, MC4R, MRAP2, POMC and MYH13, exhibiting stronger associations in childhood than in adults. Our findings suggest that childhood provides a more sensitive window for the study of key endocrine and neuropeptide pathways that regulate energy balance.