Environmental disruption alters circadian clock gene expression, increasing the risk of adverse cardiac events and suggesting cardiomyocyte-specific circadian responses to external stimuli. Analyses of previously reported transcriptomic data revealed increased expression of Titin-cap (Tcap) in adult compared to embryonic myocytes and identified myosin light chain 2 (Myl2) as clock-controlled. Given cardiac sarcomeric roles of the encoded proteins, we hypothesized that extracellular cues driving postnatal cardiac maturation and hypertrophy influence time-of-day Tcap and Myl2 expression. Tcap induction was concomitant with neonatal myocyte binucleation, fetal gene suppression, and increased heart weight during the early phase of cardiac growth. Since norepinephrine stimulates β-adrenergic and α-adrenergic receptors, the latter driving clock-controlled transcriptional remodeling, phase‑response curves of the β‑adrenergic agonist isoproterenol (ISO) following α-adrenergic stimulation with phenylephrine (PE) were performed on neonatal rat ventricular myocytes (NRVM), revealing periodic myocyte hypertrophy and TCAP protein expression. PE entrenched ISO-mediated Tcap suppression, to which oscillatory Per2 and Myl2 transcription was impervious. Differential NRVM culture density revealed biomass-dependent changes in Per2 and Tcap transcription and hypertrophy timing. Hypoxia initiated myocyte atrophy and Bmal1-dependent Tcap transcription, reflected in decreased heart weight and increased Tcap expression in hypoxic neonatal rat hearts. Tcap depletion impaired Bmal1 and fetal hypertrophic gene expression, compromised hypoxia-mediated Myl2 transcriptional suppression, and aggravated hypoxia-induced atrophy. In summary, Tcap and Myl2 are circadian genes differentially influenced by environmental factors, including adrenergic stimulation, paracrine signaling, and O₂ tension during postnatal cardiac maturation. These findings have implications for the distinct regulation of myocyte growth and maturation, by external cues during the postnatal period.

A growing number of studies suggest that exposure to particulate matters with aerodynamic diameters < 2.5 μm (PM_2.5) below air quality standards still increases the risk of death from cardiovascular disease (CVD), and the risk of death from ischemic heart disease (IHD) and stroke, the largest cause of CVD death. The aim of this study was to investigate the effect of PM_2.5 exposure at lower levels on years of life lost (YLL) and potential life expectancy benefits for IHD and stroke. We investigated the relationship between daily PM_2.5 and YLL for IHD and stroke using a generalized additive model (GAM) based on Poisson distribution. Furthermore, we extended our analysis to estimate the Potential Gain in Life Expectancy (PGLE) and the Attributable Fraction (AF) under the current Chinese air quality standards and more stringent World Health Organization (WHO) air quality guidelines. Findings reveal that for each 10 µg/m³ increase in PM_2.5, YLL rose by 1.69 years for IHD and 1.34 years for stroke, with the most significant effects observed on the day of exposure for IHD and three days post-exposure for stroke. The impact was more pronounced among women and those aged ≥ 65 years. If PM_2.5 levels met the 2021 WHO air quality guidelines, PGLE of 0.22 years for IHD and 0.16 years for stroke could be achieved. The study highlights the need for stricter PM_2.5 control measures to enhance cardiovascular health and reduce mortality, even in regions with relatively low pollution levels.

The health impacts of compound environmental exposures, particularly the joint effects of low temperature and air pollution, remain insufficiently understood.

This study aimed to evaluate the independent and joint effects of apparent low temperature (AT) and PM_2.5 on cardiovascular emergency ambulance calls (EACs). Methods: Daily cardiovascular emergency ambulance calls (EACs), meteorological, and air pollution data in Shijiazhuang, China (2014-2023) were analyzed. AT was calculated using the Steadman formulation. Distributed lag non-linear models (DLNM) were applied to assess lagged effects, while joint exposure models and relative excess risk due to interaction (RERI) were used to evaluate joint effects and interactions.

A total of 82,714 EACs were included. Apparent low temperature was significantly associated with increased risk of cardiovascular EACs, with delayed effects. Most joint exposure scenarios further elevated risks, with the strongest cumulative effect observed under the P1T3 scenario (RR = 1.146, 95% CI: 1.088-1.207). Subgroup analyses showed higher susceptibility among males, older adults, and patients with hypertension. Both synergistic and antagonistic interactions were identified.

Combined exposure to apparent low temperature and PM_2.5 significantly increases the risk of cardiovascular emergency ambulance calls, with complex lagged and heterogeneous effects. These findings provide important epidemiological evidence for understanding compound environmental risks and underscore the need to incorporate multi-factor environmental exposures into public health early warning and intervention strategies.

Extant diagnostic and screening tools struggle to accommodate the diverse features of autism spectrum disorder (ASD) while balancing psychometric properties with respondent burden. Bifactor multidimensional item response theory (MIRT)-based computerized adaptive testing (CAT) can increase accuracy and accessibility of diagnostic assessments.

To develop, calibrate, and validate the CAT-Autism tool for children and adolescents.

This diagnostic study used National Institute of Mental Health Data Archive data available February 2024 from neurodevelopmental studies including children and adolescents with item-level responses for measures relevant to domains related to autism phenotype features. Based on reported scores from clinical assessments or measures, individuals were grouped by diagnosis as neurotypical and ASD (all levels of severity). Data were analyzed from February 2024 to February 2026.

Valid CAT-based estimates in 10 subdomains (restricted to those in sample completing 200 items or more) compared with full item-bank scores; predictive performance was evaluated in discrimination, calibration, and clinical utility analyses against clinician-assigned diagnostic status.

A total of 490 questions to parents and caregivers were considered for potential item bank inclusion. The final sample included 10 309 children and adolescents for calibration (mean [SD] age, 9.3 [6.4] years; 7716 male [74.9%]); 2055 children and adolescents diagnosed as neurotypical (19.9%) and 8254 with ASD (80.1%). Of 490 items, 424 fit the bifactor structure with loadings higher than 0.3 on the primary dimension (ASD). Correlation between observed and estimated item-category proportions was r = 0.98, indicating exceptional fit of the model to the data. With age and sex included as external predictors, the CAT-Autism model yielded outstanding diagnostic predictive accuracy for differentiating neurotypical from ASD results with an AUC of 0.95 (95% CI, 0.92-0.98) for 1-to-5-year-olds and 0.94 (95% CI, 0.92-0.97) for 6-to-18-year-olds. Correlation between full item-bank scores and CAT scores (mean, 13 items; range, 6-45 items) was r = 0.95 for 1-to-5-year-olds and r = 0.94 for 6-to-18-year-olds.

In this development and validation of our prediction model, CAT-Autism surpassed full item-bank scores with an average of 13 questions; these findings demonstrated that adaptively administering a small, statistically optimal subset of items can yield comparable (or better) results while reducing respondent burden. Next steps will be to test implementation parameters and confirm efficacy of CAT-Autism in clinical and community settings.

Mobile behavioral health crisis response services, staffed by clinicians and specialists, can support individuals experiencing urgent mental health or substance use issues. While Medicaid coverage for these services since 2021 has supported growth in their availability, research on family caregivers' experiences with mobile crisis services remains limited. Family caregivers often participate in encounters with crisis services when the person in crisis cannot seek help independently due to their symptoms. This study aimed to explore family members' experiences with a mobile crisis program in the US using qualitative methods. The study examined an expanding, county-level mobile crisis program designed according to SAMHSA guidelines and Medicaid-qualifying standards, staffed by clinicians and peer support workers. We used qualitative methods to understand family caregiver experiences with these services. Data was collected through in-depth interviews with family caregivers (N = 11), the primary source for this analysis, and ethnographic field observations of mobile crisis response teams (N = 29 observation days), which provided contextual information about service delivery and family involvement during crisis. Transcripts and field notes were analyzed for recurrent themes. Family members expressed feeling isolation and being overwhelmed while managing loved ones' constant care. Many worried that without their support, loved ones would face homelessness and worsened mental health. Families identified the mobile crisis service as a substantial improvement over the other options they could turn to for help. They reported that crisis services alleviated isolation, appreciated providers who understood home dynamics, and found comfort in having a safe and responsive resource to call when needed. Families identified the availability mental health responders as a source of relief both during and after crisis episodes. Understanding how features of crisis response service are experienced by family caregivers can inform impact studies by highlighting potential mechanisms of effectiveness.

Nature-based interventions (NBIs) have been identified to support a recovery-oriented approach for people experiencing mental health issues. However, there is still limited knowledge related to how mental health service users experience their recovery process when engaged in NBIs.

To explore and explain how mental health service users experience the process of personal recovery from participating in a newly developed NBI.

The study was conducted using constructivist grounded theory and included 20 participants. The NBI, including equine-assisted therapy, was delivered in groups at a farm-based rehabilitation centre. Purposeful sampling was used, and in-depth interviews were performed on site. Data were analysed in an iterative, comparative process. During the analysis, NVIVO 14 was used to organise and manage the data systematically.

The grounded theory of the core concept 'A process of embodied recovery', described the participants' experiences of personal recovery during the NBI and included three concepts: 'Experiencing interconnection' through transactions with the environment, 'Processing inner connection' through reflection and 'Feeling intra-connected' through integration of self and body as a whole in everyday life.

The NBI provides positive multisensory experiences to support personal recovery among mental health service users. The findings hold significant implications for the advancement of recovery-oriented services in mental health care, including occupational therapy.

Advocates of a public health approach to psychoactive substances need actionable evidence. In several countries, multidisciplinary groups have used multi-criteria decision analysis (MCDA) to generate harm scores and rankings for commonly used psychoactive substances; however, these did not fully reflect substances' prevalence of use. Public health policy decisions around psychoactive substances should be informed by population-level outcomes, which are driven by use prevalence.

Led by a policy practitioner, a multidisciplinary group from across Canada conducted a MCDA of harms caused by 16 commonly used psychoactive substances. To make the analysis more relevant to public health policy, we adapted it to account for not only the severity of harms associated with a substance, but also prevalence of use. This adaptation was applied across harm criteria.

Adapting MCDA this way allowed for the generation of harm scores that represent total population-level harm caused by each substance rather than individual-level harm. As a result, they provide clear evidence of the relative population-level harm caused by different substances. This evidence can inform prioritization of public health efforts and be used by policy practitioners advocating for a public health approach to substances.

Adapting MCDA to reflect population-level outcomes is a practical innovation for public health policy and practice. Prevalence-adjusted MCDA produces evidence that is well aligned with how public health policy decisions are made and evaluated, and may be applicable to other public health issues characterized by multiple data sources and competing policy objectives.

This study explores older adults' perceptions of the ageing experience in Trinidad and Tobago, and gains insight into their self-perceptions of ageing. A concurrent mixed-methods approach was utilized, targeting older adults living in Trinidad or Tobago. For this paper, only the qualitative component of the study will be discussed. Thirty-eight (38) participants engaged in six focus group discussions about their physical, mental, and social health and ageing experiences. The focus groups were audio-recorded and transcribed verbatim. The data were analyzed with MAXQDA software and themes found. Participants lived experiences were garnered from various aspects of their lives, including personal matters and cultural and societal influences with major themes such as ageism and disrespect, undesirable cultural norms, and fear of crime. Most themes reflected positive perceptions, including positive outlook on ageing, positive perceptions of one's health, enjoying retirement, satisfaction with available resources, and spirituality/religion. Negative experiences focused on the health system and in navigating financial challenges. The findings of our study show the need for a change in the framing of age and ageing at both the individual and societal level and shows the relevance of continued societal participation and adequate health care among older adults for a healthy ageing society. Multilevel and multisector efforts are required to reduce everyday ageism and promote positive beliefs, practices, and policies related to aging and older adults.

Life course theory posits that adverse childhood experiences (ACEs) exert lasting influences on health. However, their associations with the social frailty trajectory remain understudied in middle and later life.

This study utilized data from the China Health and Retirement Longitudinal Study (2011-2020). The social frailty trajectory was identified using group-based trajectory modeling (GBTM), while latent class analysis (LCA) classified distinct ACE patterns. Logistic regression models examined the associations between ACEs and social frailty trajectory. Additionally, network analysis was conducted to identify central nodes.

This study comprised 10 730 participants. Four patterns of social frailty trajectory were identified, namely persistently low then rising, persistently moderate then rising, initially moderate-high then rapidly declining, and persistently high then rising. Greater exposure to total ACEs (RRR = 1.11 [95% CI: 1.04, 1.17]; RRR = 1.16 [95% CI: 1.07, 1.26]; RRR = 1.25 [95% CI: 1.17, 1.34]), threat-related ACEs (RRR = 1.08 [95% CI: 1.001, 1.16]; RRR = 1.13 [95% CI: 1.02, 1.26]; RRR = 1.23 [95% CI: 1.12, 1.34]), deprivation-related ACEs (RRR = 1.22 [95% CI: 1.09, 1.35]; RRR = 1.30 [95% CI: 1.11, 1.51]; RRR = 1.42 [95% CI: 1.25, 1.61]), and the LCA-derived "household mental illness" cluster (RRR = 1.58 [95% CI: 1.18, 2.11]; RRR = 1.85 [95% CI: 1.26, 2.71]; RRR = 2.20 [95% CI: 1.59, 3.05]) was significantly associated with three disadvantaged patterns of social frailty trajectories compared to the persistently low then rising pattern. Network analysis revealed "household violence," "physical abuse," "household mental illness," and "bullying" as the most central nodes.

These findings implicate public health policies that promote early-life adversity screening, mental health interventions, and social resilience programs to maintain social functioning among middle-aged and older adults.

BackgroundTransitioning to parenthood is stressful for relationships. Women with endometriosis face several health challenges, which may further strain their relationships when they become parents. However, it remains uncertain whether this transition compromises their relationships beyond what is observed in the general population.ObjectivesTo compare the risk of relationship dissolution, relationship satisfaction, anxiety, and depression between women with and without endometriosis.DesignLongitudinal population-based cohort study including 99,531 singleton pregnancies to 84,642 women.Methods1,476 pregnancies to women with self-reported endometriosis were compared to 98,064 pregnancies in women without endometriosis, using data from the Norwegian Mother, Father and Child Cohort Study (1999-2017). Women were followed up to 8 years postpartum. Adjusted risk ratios (aRR) with 95 % confidence intervals (CI) were calculated by multivariable log-binomial regression, adjusting for age, education and income.ResultsWe observed increasing trends of mothers not living with the biological father (12% at 8 years postpartum) and of relationship dissatisfaction (4.7% at 5 years postpartum), without significant differences in the risk of relationship dissolution (10% vs. 12%) or dissatisfaction (4.8% vs. 4.7%) between women with and without endometriosis. However, women with endometriosis had significantly higher risks of anxiety (aRR: 1.30, 95% CI: 1.06-1.58) and depression (aRR: 1.32, 95% CI: 1.16-1.50) at 8 years postpartum.ConclusionMothers with endometriosis did not exhibit increased relationship dissolution or dissatisfaction compared to those without, despite experiencing a greater mental health burden. While these findings are encouraging, they should not trivialize the potential impact of endometriosis on quality of life.