Over 20% of Europe's population is chronically exposed to transport noise levels considered detrimental to health, yet evidence on its impact on children's mental health remains limited. We aimed to investigate the effect of different sources of residential noise exposure on children's emotional and behavioural difficulties.

In this birth cohort study, data from the nationally representative French ELFE cohort were analysed from birth to age 10 years (2011-22). We excluded children with missing data on the study's exposures from age 2 months to 5·5 years and on outcome variables at age 10·5 years, twins, children in foster care, and children with profound hearing impairment. Residential exposure to road traffic, aircraft, and railway noise was assessed at age 2 months, 3·5 years, and 5·5 years using GeoClimate and NoiseModelling open-source software and public geographical, traffic, and noise map data. Children's mental health was assessed using the parent-reported Strengths and Difficulties Questionnaire at age 10·5 years. We applied marginal structural models with inverse probability weighting to estimate the effect of time-varying noise exposure through childhood.

Of the 7914 children included, 4044 (51·1%) were male and 3870 (48·9%) were female. At age 2 months, 2480 (31·3%) children were exposed to low levels (<55 A-weighted decibels [dB(A)]) of road traffic noise exposure, 2772 (35·0%) were exposed to medium levels (55-<60 dB[A]), and 2662 (33·6%) were exposed to high levels (≥60 dB[A]). Persistent exposure to high levels of road traffic noise (≥60 dB[A] across childhood) was associated with higher levels of internalising symptoms at age 10·5 years (adjusted regression coefficient β=0·38, 95% CI 0·14 to 0·63; p=0·003), particularly emotional symptoms (β=0·20, 0·02 to 0·37; p=0·026) and peer relationship problems (β=0·19, 0·06 to 0·32; p=0·009). No significant effects were detected for high exposure to road traffic noise at age 3·5 years. At age 2 months, 161 (2·0%) children were exposed to railway noise of 50 dB(A) or higher. Exposure to railway noise (at least once to ≥50 dB[A] during childhood) was associated with lower levels of internalising symptoms (β=-0·61, 95% CI -1·10 to -0·12; p=0·008), although this association was no longer significant after correction for multiple testing. Exposure to aircraft noise was low, with 185 (2·3%) children exposed to 50 dB(A) or higher at age 2 months, and no significant associations were observed between exposure to aircraft noise and children's emotional and behavioural difficulties.

Although residual confounding cannot be entirely excluded, our results support the need for policies aimed at reducing residential road traffic noise. They require replication in other large-scale cohorts and further investigation of the underlying mechanisms is needed.

None.

Effective communication is crucial for high-quality health care, but systemic barriers still disrupt patient-provider interactions. Research shows that communication failures are a major reason for preventable medical errors. These issues are linked to around 30% of malpractice claims and over 1744 deaths each year in the United States. In addition, hospitals lose about US $12 billion each year because of miscommunication. Despite the critical nature of this issue, the literature remains fragmented. Most studies focus on specific communication problems rather than examining how these barriers work together in patient-provider settings.

This scoping review aims to map the literature thoroughly to (1) identify and categorize key types of communication barriers, (2) evaluate their impacts on patient experience, clinical decision-making, and health outcomes, and (3) examine intervention strategies designed to mitigate these challenges. The findings aim to inform the development of adaptive, technology-enabled solutions to improve patient-provider communication in increasingly diverse and digitally integrated health care settings.

A scoping review was conducted in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines across four databases: PubMed, IEEE Xplore, CINAHL, and Current Contents Connect. This covered the period from January 1, 2004, to April 30, 2026. The search focused on peer-reviewed, English papers that examined language barriers, cultural barriers, psychological barriers, and mental model differences in clinical settings.

From an initial set of 6233 records, 253 studies met our stringent inclusion criteria. This review divides communication barriers into four categories: linguistic, cultural, psychological, and mental model differences. It highlights four key findings. First, there has been a notable increase in scholarly interest in communication barriers over the last decade, showing greater awareness in clinical fields. Second, although the four barriers have been known, little is known about the specific communication habits or physiological signs defining each barrier. Third, while researchers have linked individual barriers to adverse outcomes, evidence shows that various barriers often happen at the same time. This creates a combined effect that increases patient distress. Fourth, despite the introduction of promising solutions such as interpreter services, cultural training, and AI tools, a lack of basic knowledge about real-time indicators slows the development of intelligent systems.

Unlike previous reviews, which typically examine single communication barriers, this scoping review offers a new approach by mapping how linguistic, cultural, psychological, and cognitive barriers intersect. It provides a unified framework that connects these complex communication failures to specific technological solutions. In practice, this guides the combining of AI tools with real-time physiological monitoring to develop adaptive, patient-centered communication strategies. Ultimately, incorporating these responsive technologies into clinical practice is crucial for lowering medical errors, addressing health disparities, and ensuring fair, patient-centered care.

In January 2023, British Columbia (BC) became the first Canadian province to implement a legally sanctioned drug decriminalization policy, removing criminal penalties for adults possessing 2.5 g or less of opioids, cocaine, methamphetamine, and MDMA. Introduced as a three-year pilot, it aimed to reframe substance use as a public health issue, reduce stigma, and improve health and social service engagement. Criminal penalties were reintroduced for drug possession in most public spaces in May 2024, and the pilot ended in January 2026. Its termination has been interpreted as policy failure; this review aimed to examine how the pilot was implemented in practice and to identify factors that shaped its operationalization and early implementation-relevant outcomes.

We conducted a systematic review with narrative synthesis of peer-reviewed literature examining implementation-relevant aspects of BC's decriminalization pilot. Six databases were searched (January-February 2026) for studies published May 31, 2022-February 1, 2026. The protocol was registered in PROSPERO (CRD420251271694).

Twenty-seven studies were included. Four cross-cutting implementation barriers were identified: pilot design features, public and cross-sector communication gaps, limited frontline training, and insufficient funding and infrastructure. Design features included the 2.5 g possession threshold, misalignment with real-world drug use patterns; the three-year timeframe, which constrained system-level effects; and the May 2024 amendment, which introduced additional instability. The pilot was implemented without commensurate investment in harm reduction, treatment, or housing infrastructure, within already constrained systems.

BC's decriminalization pilot suggests the effects of legal reform are shaped by implementation context. Early outcomes may reflect design features, institutional readiness, and system capacity rather than legal change alone; longer-term impacts remain uncertain. Future reforms should align legal change with coordinated implementation, operational guidance, public communication, and adequate service infrastructure.

Older adults face a substantial burden of common mental disorders, yet they are less likely to seek professional help compared to younger adults. In Chinese contexts, collectivist values and stigma may further deter help-seeking. Social norms are central to the theory of planned behavior (TPB) and nudge theory, suggesting that norm-based messages, especially those that are visually engaging, could strengthen perceived social approval and subsequent help-seeking intentions.

This study aims to evaluate the effectiveness of co-designed norm-based nudges, delivered in descriptive (descriptive norm nudge) or pictorial forms (pictorial norm nudge), in improving subjective norms and intentions to seek mental health help among older adults, compared to an information-only control.

This 3-arm randomized controlled trial (1:1:1) recruits adults aged ≥60 years via community partners in Hong Kong. Participants receive daily texting for 14 days and are allocated to the pictorial norm nudge (descriptive text combined with pictorial cultural games that evoke social support), the descriptive norm nudge (descriptive text only), or the control (mental health service information) groups. Assessments are conducted at baseline (T0), after intervention (T1), and at a 3-month follow-up (T2). Primary outcomes are subjective norms and help-seeking intentions, measured using the Chinese version of the TPB questionnaire. Secondary outcomes include perceived behavioral control, help-seeking attitudes, perceived barriers, depression, anxiety, and loneliness. A 2-level linear mixed model will be used in intention-to-treat analyses to examine the intervention's effectiveness.

The study grant was awarded in June 2023, with recruitment of participants to the randomized controlled trial starting in December 2024 and concluding in June 2026. As of June 30, 2026, a total of 532 eligible participants had completed the baseline assessment. Among them, 470 (88.34%) completed the postintervention, and 408 (76.69%) completed the 3-month follow-up assessment assessments. Data collection and follow-ups are ongoing. A full report of the findings is expected by October 2026, with publication anticipated in early 2027.

This study will provide critical insights into the feasibility and effectiveness of brief, co-designed nudges for promoting mental health help-seeking intentions. If effective, this approach will offer a scalable, culturally adaptive, and low-intensity strategy to improve mental health service use among older adults.

Severe and enduring mental health problems (SEMHP) in youth often fall outside traditional diagnostic classifications, which may lead to insufficient assessment of these youth's characteristics in classification-based psychiatry practice. Therefore, the objective of this study is to explore how current diagnostic practices in child-and-adolescent psychiatry address specific characteristics of youth with SEMHP by mapping the diagnostic process. Moreover, we aim to identify facilitators and barriers to effective assessment of specific SEMHP-characteristics by analysing stakeholders' perspectives.

The exploration involved: 1) mapping the diagnostic processes (e.g., steps, tools) used in a CAP facility in the Netherlands by conducting semi-structured preparatory interviews with eight professionals in CAP in July-September 2023, and 2) qualitative analysis of stakeholder experiences to understand how SEMHP-characteristics are assessed, and what factors facilitate or hinder adequate assessment of these SEMHP-specific characteristics through focus groups. Separate focus groups with ten clinicians (n = 5, n = 5), eight youth (n = 5, n = 3) and five caregivers (n = 5) were conducted, using a semi-structured topic guide in December 2023 till May 2024. Data was analysed using reflexive thematic analysis to unravel barriers and facilitators in SEMHP-assessment.

While all examined SEMHP-characteristics in this study were addressed in the diagnostic process, still participants reported feeling unseen or misunderstood during the assessments. Participants identified factors that hindered and facilitated the diagnostic assessment including distrust in systems, masking behaviour of youth, lack of time and generational differences in recent societal developments such as social media.

Our study highlights stakeholder-identified barriers, revealing a shared perception of disconnect within the diagnostic process. This disconnect refers to a mismatch between clinical assessments and the lived experiences of youth and caregivers, in which they feel unheard, share less and experience being overlooked. Overcoming barriers requires viewing diagnostics as a relational process, where, in addition to gathering information, the focus in on building a therapeutic relationship, prioritising youth's story and emphasising individual understanding.

Patient navigation is a critical component of health care delivery, facilitating connections with appropriate services. A new era of virtual navigation systems has emerged, with systems that can be accessed through websites or smartphone apps. However, it is unknown which features of these novel systems impact patient outcomes.

The objective of this scoping review is to understand the current landscape of existing virtual navigation systems. In this review, we will determine the features of these systems, as well as the patient outcomes and accessibility barriers associated with them that have been reported in the literature.

This review will follow the guidelines for scoping reviews outlined by the Joanna Briggs Institute methodology. This will include systems that provide recommendations for health care, mental health and addiction services, and social services. This will include systems designed for patients, caregivers, and/or care providers. A search strategy will be used to locate both published and unpublished literature. The databases to be searched include PubMed, PsycINFO (ProQuest), Cochrane Library, Web of Science Core Collection (Clarivate), Cumulative Index of Nursing and Allied Health Literature (EBSCO), ScienceDirect, IEEE Xplore, and ACM Digital Library. Papers will be screened and selected, and data will be extracted by 2 independent members of the research team. The extracted data will primarily focus on outcomes and features of the virtual navigation systems. This will include the information they ask of users and the content and format of the information on services they provide.

Funding for this project was received in May 2024. As of June 2026, abstract and full-text screening have been completed, data extraction is underway, and data analysis has not begun yet. Our search resulted in the retrieval of 14,461 studies that were eligible for screening. We anticipate that the full scoping review manuscript will be prepared for submission by winter 2027. Results will be presented in tabular format and accompanied by a narrative summary.

This review will synthesize the current literature on virtual navigation systems that aim to connect patients to appropriate health care services. By identifying trends and gaps, this review will provide critical information for the development of new and innovative systems that can support health care and public health systems.

Depression carries the highest burden of mental health-related disability in the United States. Approximately 13% of military veterans report elevated rates of depression. Despite the availability of evidence-based treatments for depression, nearly 50% of veterans in need of mental health care remain untreated. Internet-based interventions show promise in reducing this gap; however, there are currently no standard self-guided internet-based interventions for depressive symptoms in veterans. Deprexis is one such intervention that leverages cognitive behavioral therapy to target depressive symptoms.

This pilot study evaluated the feasibility, acceptability, and preliminary effectiveness of Deprexis, a fully self-guided internet-based intervention for depression, in US military veterans with mild to severe depressive symptoms.

This open-label pilot trial recruited 19 veterans with mild to severe depression (mean age 55.5, SD 8.2 y; baseline Quick Inventory of Depressive Symptomatology-Self-Report [QIDS-SR]: mean 16.2, SD 4.1) for an 8-week course of Deprexis, with self-report assessments at baseline, posttreatment (8 wk), and follow-up (16 wk). Primary outcomes included depressive symptoms (QIDS-SR), functional disability (World Health Organization Disability Assessment Schedule 2.0), and symptom-related disability (Sheehan Disability Scale). Feasibility was assessed through recruitment and retention rates, and acceptability was measured using validated questionnaires (Credibility and Expectancy Questionnaire and Client Satisfaction Questionnaire). Multilevel models examined change over time, with effect sizes calculated using pooled SDs from unconditional models.

Recruitment and retention targets were met, with 15 out of 19 (79%) participants meeting the adherence criteria (ie, ≥60 min of active program use). Of these, 14 participants completed posttreatment questionnaires and were included in the completer analyses. The program received a positive acceptability rating: of the 18 participants who completed follow-up assessments, 78% (n=14) rated services as good or excellent and 72% (n=13) were satisfied with the amount of help received. No safety concerns were reported. Among completers (n=14), QIDS-SR scores decreased from baseline to posttreatment (estimate -2.22, SE 1.44; P=.14; d=-0.54, 95% CI -1.07 to 0.13) and follow-up (estimate -2.85, SE 1.19; P=.02; d=-0.70, 95% CI -1.21 to -0.08) with moderate-to-large effect sizes. Effect sizes were similar in the total sample. Functioning (World Health Organization Disability Assessment Schedule 2.0) improved among completers at follow-up (estimate -8.09, SE 3.80; P=.045; d=-0.41, 95% CI -0.96 to -0.05). Disability (Sheehan Disability Scale) did not significantly improve from baseline to posttreatment or follow-up.

This pilot trial demonstrates that Deprexis is feasible and acceptable for veterans with mild to severe depression, with preliminary evidence of effectiveness for depressive symptoms. The delayed emergence of functional improvements and sustained gains at follow-up support the potential of this scalable intervention. The results provide a strong foundation for the ongoing randomized controlled trial.

This study explored substance use and harm reduction service utilization among rural lesbian, gay, and bisexual (LGB) individuals.

A survey explored substance use patterns, history of abuse and stigma, and treatment and support group utilization, with subsequent interviews providing contextual and thematic data. Participants were recruited January to July 2023 in southern Illinois. All completed the survey, and a subset were interviewed. Chi-square and independent samples t-test analyses were conducted on the quantitative data, and Interpretative Phenomenological Analysis was used for the interviews (n = 9).

LGB survey participants (n = 17) had similar rates of substance use versus their heterosexual peers (n = 128), but increased frequency of reported adverse childhood experiences (score of 6.71 vs. 3.69; p < 0.001) and post-traumatic stress disorder (score 3.65 vs. 2.44; p = 0.006). Thematically, substance use risk factors included homophobic/biphobic environment(s), childhood trauma/abuse, familial histories of abuse, and mental health disorders.

Barriers to treatment and harm reduction service utilization included stigma from clinic staff and police, addiction to treatment medication, long treatment waitlisting, and lack of rehabilitation services. Rural LGB individuals may experience substance use, mental health issues, homonegativity, adverse family histories, and harm reduction barriers, which is reflective of non-LGB rural people who use substances except for homonegativity.

Intensive care unit (ICU) survivors frequently experience symptoms of post-traumatic stress disorder (PTSD) and reduced health-related quality of life (HRQoL), yet evidence for effective post-ICU interventions in primary care remains limited. This secondary analysis of the PICTURE randomised controlled trial provides an in-depth evaluation of HRQoL trajectories and potential treatment mechanisms.

The analysis included 319 adult ICU survivors with at least moderate PTSD symptoms, randomised to a brief general practitioner (GP)-delivered narrative exposure intervention or enhanced usual care. Longitudinal mixed-effects models estimated treatment-by-time effects on HRQoL, based on EuroQol Five-Dimension Five-Level (EQ-5D-5L) index and visual analog scale (VAS), with mediation via PTSD symptom change assessed using structural equation modelling.

The mean baseline EQ index was 0.71 ± 0.27 and EQ VAS was 60.7 ± 19.4. Mixed-effects models showed a transient improvement in EQ VAS at 6 months in the intervention group (ß = 5.85; 95% CI 0.84-10.87), followed by a delayed improvement in the EQ index at 12 months (ß = 0.075; 95% CI 0.014-0.136). About one quarter of the 12-month EQ index effect was mediated by PTSD symptom reduction at 6 months. Domain-level analyses indicated greater improvement in anxiety/depression and mobility.

In ICU survivors with PTSD symptoms, a brief GP-delivered psychological intervention was associated with clinically meaningful improvements in health-related quality of life over 12 months, with effects emerging over time and only partly explained by PTSD symptom reduction.

ClinTrials.gov: NCT03315390 (Registration date: 2017-10-20); German Clinical Trials Register (DRKS): DRKS00012589 (Registration date: 2017-10-17).

Infertility negatively impacts mental health and quality of life, with social avoidance and distress (SAD) being a key but underrecognized issue. This study aims to analyze SAD risk factors in infertility patients.

A retrospective study of 205 infertility patients (October 2022-July 2025) was divided into SAD (n = 93) and non-SAD (n = 112) groups. LASSO regression and XGBoost identified key variables, followed by logistic regression and ROC analysis.

Significant differences (P < 0.05) were found in age, education, residence, income, infertility stigma scale (ISS), self-esteem scale (SES), cognitive dismantling scale (CD-RISC) and social relationship quality scale (SRQS) scores. Five common factors (age, ISS, SES, CD-RISC, SRQS) were identified. Logistic regression showed age (OR = 1.333) and ISS (OR = 1.101) as risk factors, while SES (OR = 0.726), CD-RISC (OR = 0.876) and SRQS (OR = 0.863) were protective (P < 0.05). AUC values ranged 0.694-0.723, showing only modest discriminative ability.

SAD in infertility patients is independently associated with age, ISS, SES, CD-RISC and SRQS scores, each with moderate predictive value. These findings support the application of the above indicators for early identification and risk assessment of SAD among infertile populations.