Symptoms of depression, anxiety and anger are common amongst parents and are associated with increased risk of offspring mental health problems and differences in child brain development. Many parents do not access treatment, in part due to expense, wait times, and stigma. Increasing access to treatment may improve quality of life for parents and their children. eHealth and peer-supported interventions may offer accessible and effective treatment avenues for parents of young children. The primary aim of this non-inferiority trial is to estimate the effect of the Building Emotional Awareness and Mental Health (BEAM) intervention, a digital and peer-supported mental health and parenting program, administered by trained peer paraprofessionals, on parental depression, anxiety and anger symptoms relative to a treatment-as-usual (TAU) waitlist control group. The secondary aims are to compare child internalizing and externalizing behaviours between BEAM and TAU groups to estimate the effect of the BEAM program on child behavioural outcomes. The final aim is to estimate differences in child structural and functional brain connectivity 6 months post intervention between the BEAM and TAU control groups.

A two-arm, single-blinded, parallel groups randomized controlled trial (RCT) with a 1:1 allocation ratio and repeated measures will be conducted in Western Canada. Parents and primary caregivers (aged 18 +) who self-report moderate to severe symptoms of anger, anxiety, or depression at time of enrolment and reside in the provinces of British Columbia or Alberta, Canada, will be eligible to participate from the larger Pregnancy During the Pandemic (PdP) cohort and invited to enrol. PdP research coordinator will distribute invitations to individuals who previously consented to be contacted for future studies and meet eligibility criteria. Parents will also be recruited from the community through social media advertisements to reach a total sample of 240 participants. Assessments will be conducted at baseline (T1), post-intervention (T2), and 6 months post treatment (T3) and will include self-report questionnaires, and neuroimaging.

Findings from this study will provide data on the potential efficacy of the BEAM program in supporting parental mental health, child well-being, and neurodevelopment. Results may inform future large-scale trials and may guide the development of accessible, community-based interventions aimed at improving family mental health and child developmental outcomes.

This trial was registered on ClinicalTrials.gov on September 20, 2023. The first planned enrolment date was April 24, 2024. The registration number is NCT06046989. https://clinicaltrials.gov/study/NCT06046989.

This study explored the lived experiences of African Australian consumers and their perspectives on the role of spirituality, religion and culture in shaping mental health and engagement with mental health services. A qualitative phenomenological design informed by transcultural nursing perspectives was used. Semi-structured interviews were conducted with 15 African Australian participants aged 18-25 years from diverse African backgrounds, including Zimbabwe (n = 2), Ethiopia (n = 3), South Sudan (n = 5), Somalia (n = 4) and Ghana (n = 1). Interviews were audio-recorded and transcribed verbatim. The data were analysed using Colaizzi's phenomenological method of analysis, which involved identifying significant statements, formulating meanings, clustering themes and developing an exhaustive description of participants' experiences and interpretations of mental health within cultural and spiritual contexts. Three interconnected themes were identified: living between two worlds, seeking healing beyond medication and breaking the silence. Participants described migration-related stress, disrupted social networks and tensions between collectivist cultural expectations and individual identity as contributing to psychological distress. At the same time, spirituality, religious practices and culturally grounded community networks were identified as important coping resources that fostered resilience and social support. Participants reported mixed experiences with formal mental health services, noting that biomedical approaches often overlooked cultural and spiritual dimensions of wellbeing, while culturally responsive care enhanced trust and engagement. The findings highlight the importance of culturally and spiritually responsive mental health care to improve service engagement and support the wellbeing of African Australian communities.

Beta-thalassaemia major (BTM) is a chronic hemoglobinopathy associated with a substantial psychosocial burden. Reported rates of anxiety in BTM vary widely, hindering service planning and intervention design. We performed a systematic review and meta-analysis to estimate the pooled prevalence of anxiety in patients with BTM.

A comprehensive search of PubMed/MEDLINE, Scopus and Web of Science (studies from 2005 to 30 April 2025) identified observational studies reporting anxiety prevalence in BTM. Pooled prevalence and 95% confidence intervals (CIs) were calculated using random-effects meta-analysis (Stata v16), with heterogeneity quantified by I².

From 726 records, 10 studies met inclusion criteria (total N ≈ 11,385). The pooled prevalence of anxiety symptoms in BTM was 33.0% (95% CI: 22.0-44.0); however, given extreme between-study heterogeneity (I² ≈ 98%), this estimate should be interpreted with substantial caution. Prevalence varied by instrument (DASS-21: 56.0%, higher than other tools), and by region (Middle East 38.0% vs. Europe 31.0% and United States 21.0%). By severity, pooled estimates were: mild 18.0%, moderate 11.0% and severe 11.0%.

Elevated anxiety symptoms, detected predominantly via screening instruments rather than formal clinical diagnosis, were identified in an estimated one-third of BTM patients; this figure should be interpreted cautiously given extreme between-study heterogeneity. Given this substantial burden, routine psychological screening and integration of mental-health interventions into thalassaemia care pathways are recommended.

Nurses should incorporate routine anxiety screening with validated tools (e.g., HADS, DASS-21) into thalassaemia and transfusion care, assess body image and stigma concerns, provide culturally sensitive family education and refer patients exceeding clinical thresholds to mental health professionals. Embedding structured psychosocial support within thalassaemia services is essential for holistic BTM care.

As this study was a review of previously published literature, there was no involvement from patients or the public in the design, conduct, reporting or dissemination of research.

The protocol of this study is registered in PROSPERO with ID: CRD420251238275.

Postpartum depression (PPD) is a common mental health disorder after childbirth. Although microbiome research in PPD has mainly focused on the gut, the role of skin microbiota remains unclear. We used Mendelian randomization (MR) to assess potential causal associations between skin microbiota and PPD. A bidirectional 2-sample MR analysis used genome-wide association study (GWAS) summary statistics. Genetic instruments for skin microbial features were obtained from a published skin microbiota GWAS, and PPD data were derived from 67,205 mothers (7604 cases, 59,601 controls). Instruments were selected at P <1 × 10-5, linkage disequilibrium-clumped, harmonized, and filtered for weak instruments (F statistic <10). Because this microbiome threshold is exploratory, Benjamini-Hochberg false discovery rate correction was applied within taxonomic levels. The inverse-variance weighted method was primary, complemented by weighted median and mode-based methods. Heterogeneity, pleiotropy, and outliers were assessed using Cochran Q, MR-Egger intercept, and MR-PRESSO. Three skin microbial taxa showed nominal associations with PPD. Higher genetically predicted Acinetobacter on the dorsal forearm (dry skin; 9 single nucleotide polymorphisms [SNPs]; mean F = 22.12) and Proteobacteria in the antecubital fossa (moist skin; 6 SNPs; mean F = 23.44) were associated with increased PPD risk, whereas Betaproteobacteria in the antecubital fossa (11 SNPs; mean F = 21.54) was associated with decreased risk. Associations were directionally consistent, with no substantial heterogeneity or horizontal pleiotropy. After multiple-testing assessment, the findings were exploratory rather than definitive. Reverse MR did not support an effect of PPD on the identified skin microbiota. This MR study provides exploratory genetic evidence linking specific skin microbial features to PPD risk. The findings extend microbiota-related hypotheses beyond the gut microbiome but require validation in larger microbiome GWAS datasets, longitudinal cohorts, and mechanistic studies before clinical or causal conclusions are drawn.

Children's and adolescents' mental health and cognitive development are shaped by complex environmental exposures across their life-course. The exposome framework provides an integrative approach to assess the interlinkages. While sleep is a prerequisite for mental and cognitive health, its role as an underlying pathway remains unclear. This review aims to map and contextualize the evidence on whether sleep mediates or moderates associations between the exposome and mental health, well-being, or cognitive outcomes in individuals aged 0-21 years.

Following PRISMA-ScR guidelines, we conducted a scoping review of peer-reviewed studies published in English from 2000 to January 2025. Scopus and PsycINFO were searched, supplemented by reference screening and cohort-based searches. Two reviewers independently screened records and charted data, which were synthesised narratively.

Twelve studies examined the full causal chain from multiple environmental exposures to mental health or cognitive outcomes via sleep, with 34 additional studies addressing specific partial pathways. Most studies were cross-sectional and conducted in high-income countries. Sleep was primarily assessed using self- or parent-reported measures. Evidence suggested that sleep may mediate or moderate associations between the exposome and mental health or cognitive outcomes, however, longitudinal evidence remains notably limited. The diversity of exposures and domains points to the effect being a result of multiple exposures emphasising the importance of an exposome perspective within early life exposures and outcomes.

Sleep represents an important pathway linking the exposome to mental health and cognitive development, however longitudinal, child-centred exposome research remains scarce.

Developmental programming, a permanent adaptation of the fetus/neonate to maternal environmental signals, underlies many adult physiological and psychiatric disorders. Prenatal stress induced by the synthetic glucocorticoid dexamethasone has been shown to increase anxiety- and depressive-like behaviors and lead to hyperreactive neuroendocrine and autonomic nervous system (ANS) responses to stress in adult female offspring. Prenatal stressors can also cause maternal immune activation (MIA), impact mood/stress circuitry, and program neural development. One way to engage molecular immune signals is to activate toll-like receptors (TLRs). Developmental changes have been seen following gestational exposure to lipopolysaccharide (LPS; TLR4), poly I:C (TLR3), and, most recently, TLR7 agonists resiquimod (RQ) or imiquimod (IMQ). Studies have identified changes in ANS function that may be tied to blood-brain barrier (BBB) changes in the paraventricular nucleus of the hypothalamus (PVN) that coincide with anxiety- /depressive-like behaviors that manifest after fetal programming. These adult dysfunctions are a consequence of prenatal stressors and may have a common underlying mechanism related to the dysregulation of communication between the PVN and critical ANS centers in the brainstem. Studies in humans indicate that brainstem loci may be important centers of ANS regulation that can be targeted to attenuate major depressive disorder (MDD) symptoms in adults. Furthermore, data suggest that select immune and BBB characteristics in PVN and autonomic nuclei in the brainstem are critical targets for future studies, aligning with the hypothesis that immune signaling plays a major role in the development and expression of psychiatric disorders. The overarching goal of this review is to outline the cellular and physiological pathways by which prenatal stressors, mainly synthetic glucocorticoid exposure and MIA, produce long-term, sex-biased programming of adult behavior and ANS function relevant to physiological and psychiatric disorders.

The diagnosis of neuroinfectious diseases, including Tuberculous Meningitis (TBM), viral encephalitis, Human Immunodeficiency Virus (HIV), and post COVID-19 neurological syndromes, remains challenging due to limited surveillance, non-specific symptoms, inadequate laboratory sensitivity, and restricted availability of high-quality CSF or tissue specimens. The critical need for early and precise diagnosis and the development of reliable, validated biomarkers highlight the importance of biospecimen-driven approaches that leverage CSF and other biobanked materials, as evidenced by the emerging literature. This review aims to summarize the need for biobanks, discuss sample preservation and tracking, examine quality control frameworks, and evaluate current advances, translational applications, and ongoing challenges of biobanking in neuroinfectious disease research. We extracted evidence from existing neuroinfection biobanks, reviewed global standards governing bio-specimen preservation and storage, and analyzed studies demonstrating how archived CSF, blood, and brain tissue have enabled pathogen characterization, biomarker discovery, and translational research. Our analysis shows that biobanked specimens have facilitated high-resolution pathogen genotyping, immune profiling, and identification of diagnostic and prognostic biomarkers, such as neuro-filament light chain (NfL) and CSF proteomic signatures. Strengthening biobanking infrastructure, harmonized governance, established FAIR-aligned data systems, and the integration of AI and digital analytics will help accelerate biomarker validation, drive diagnostic innovation, and ultimately improve clinical outcomes for patients worldwide.

Chronic cough is most commonly associated with respiratory or gastroesophageal disorders, whereas central nervous system etiologies are rare. Cerebellar tonsillar herniation is typically characterized by neurological manifestations, but cough as an isolated symptom is uncommon.

A 61-year-old woman presented with a one-year history of recurrent cough that worsened after eating or drinking. Initial respiratory, gastrointestinal, and allergic evaluations, including chest computed tomography (CT), laboratory testing, and bronchial challenge, were unremarkable. Multidisciplinary team assessment prompted a water swallow test, which showed coughing episodes, raising suspicion for central nervous system involvement. Subsequent magnetic resonance imaging revealed cerebellar tonsillar herniation with 10-mm descent below the foramen magnum. The patient underwent posterior fossa decompression with occipital-cervical fusion. Her cough resolved completely postoperatively, with sustained symptom remission at one-year follow-up.

Cerebellar tonsillar herniation may present solely with chronic cough, particularly when common etiologies have been excluded. Thorough clinical assessment, including simple bedside tools such as the water swallow test, and multidisciplinary evaluation can promote timely diagnosis. Cerebellar tonsillar herniation should be regarded as a potential etiologic factor in the differential diagnosis of chronic cough.

This study aims to evaluate the diagnostic performance of an artificial intelligence (AI) algorithm for detection, segmentation, and volumetric quantification of pneumoperitoneum on abdominal CT scans.

We developed and validated a deep learning-based model for automated pneumoperitoneum detection on CT. Multi-center CT imaging series from 2072 patients were collected and randomly divided into training and testing sets at an approximate 7:3 ratio. The external validation set included 214 emergency CT scans collected between April 2022 and December 2024. Diagnostic reports served as the reference standard. Primary outcome included the area under the curve (AUC), sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV). Quantitative agreement between AI and reference volumes was assessed using the intraclass correlation coefficient (ICC).

In the test set (n = 607), the model demonstrated excellent performance: sensitivity 91.4%, specificity 93.1%, and AUC 0.97 (95% CI: 0.95-0.99). In the external validation cohort (n = 214), the model maintained robust performance with sensitivity 84.3% (95% CI: 76.2-90.5%), specificity 89.6% (95% CI: 82.3-94.6%), accuracy 86.9% (81.6-91.2%), PPV 89.2% (95% CI: 81.8-94.3%), and NPV 84.8% (95% CI: 77.1-90.7%). After excluding cases with minimal free gas (<1 mL), the model's sensitivity improved to 96%. AI-derived volumes showed strong agreement with the reference standard (ICC 0.996, 95% CI: 0.994-0.997).

The AI model attained high diagnostic accuracy for pneumoperitoneum on abdominal CT scans, promising to expedite emergency workflows.

Question Reliable AI detection of pneumoperitoneum, particularly for small-volume free air, on emergency CT remains an unmet need for rapid and accurate emergency triage. Findings The AI model shows high sensitivity and specificity for clinically relevant pneumoperitoneum volumes, although trace-volume detection on CT scans remains challenging. Critical relevance statement This study evaluates the diagnostic performance and volume-dependent variability of an AI model for pneumoperitoneum detection on CT scans, with the potential to aid emergency radiology workflow prioritization and decision support, though prospective studies are needed to confirm clinical impact.