Universal suicide risk screening in pediatric primary care settings is lacking, despite the endorsement of this practice by several national organizations. This study explores barriers to and facilitators of implementing universal suicide risk screening in pediatric primary care clinics, with a focus on clinics that had not yet adopted this practice.

We conducted a qualitative study consisting of semi-structured interviews with primary care clinicians and support staff involved in suicide risk screening, risk assessment, and disposition planning. Participants were recruited from 15 pediatric clinics in the Midwestern United States. Interviews were audio-recorded, transcribed verbatim, and analyzed using thematic analysis.

From 55 interviews we identified barriers at three levels: clinic, provider, and patient. Clinic-level barriers included time, workflow, and staffing. Provider-level barriers included lack of training/self-efficacy, frustration at not being able to offer solutions, and burnout. Patient-level barriers included irritation with repetitiveness of screening questions, concerns about honesty and openness, parent/caregiver buy-in, and discomfort and stigma discussing the topic of suicide. Facilitators included perceived value and effectiveness of screening, comfort with screening, clinic buy-in, a team approach to care, providing privacy, and providing context. Suggestions to enhance these suicide prevention practices were also described.

Overall, clinicians and support staff reported seeing value in implementing suicide risk screening in pediatric primary care. Our findings underscore the importance of reducing barriers and enhancing facilitators associated with implementing suicide risk screening, risk assessment, and disposition planning to expand suicide prevention efforts to more youths.

The effects of armed conflict on children are devastating, with more than 520 million children and adolescents residing in conflict zones worldwide. Armed conflicts not only cause death and destruction but also lead to widespread displacement, exposing children to physical injuries, sexual violence, family separation, food insecurity, and disruption of essential services like education and health care. All pediatricians and health care providers play crucial roles in addressing the complex challenges faced by children in these settings. Pediatric professionals are called to advocate for policy reforms, ensure culturally appropriate, sensitive, and trauma-informed care and community support, and engage in research to mitigate short- and long-term harm and promote resilience. Strategic interventions include ensuring access to health care and mental health services, safeguarding education, and providing bereavement and psychosocial support during and after resettlement. In doing so, pediatricians can help protect children's rights and foster a future where every child, regardless of conflict, has the opportunity to thrive.

The COVID-19 pandemic caused major disruptions to health care, affecting the delivery of HIV care and prevention services. We aimed to determine the impact of the pandemic on HIV testing rates in medical settings across regions and racial and ethnic populations in the USA.

In this retrospective cohort study, we used data from the National Clinical Cohort Collaborative (N3C) from Jan 1, 2018, to Dec 31, 2022, of individuals aged 15-64 years with active health-care records. In this dataset, COVID-19 cases were matched (1:2) to COVID-negative controls on the basis of age, sex, and race and ethnicity within each site. We used interrupted time-series analyses to estimate changes in the monthly HIV testing rate, measured as the number of individuals tested per 10 000 people in four geographical regions (midwest, northeast, south, and west) among four racial and ethnic groups (White [non-Hispanic], Black [non-Hispanic], Hispanic, other). We estimated these changes in three time periods: prepandemic (January, 2018, to February, 2020), early pandemic (March, 2020, to August, 2020), and late pandemic (September, 2020, to December, 2022).

9 704 278 individuals were included and had a mean age of 41·2 years (SD 13·5). 5 667 609 (58·4%) of 9 704 278 individuals were female and 4 036 669 (41·6%) were male. Most individuals were White, followed by other, Black, and Hispanic, with notable geographical differences in racial and ethnic composition. Prepandemic, HIV testing rates were relatively stable, although levels varied by region and racial and ethnic group. The impact on testing rates differed substantially during the early and late pandemic, with the west experiencing the sharpest and most prolonged decline (-30·94 per 10 000 people, 95% CI -42·29 to -19·59). Among racial and ethnic groups, the Black population showed the greatest reduction in testing at the onset of the pandemic across all four regions, and specifically in the northeast, which decreased by 53·09 per 10 000 people (95% CI -73·43 to -32·77). The decline was more modest among White individuals at the national level (-13·55 per 10 000 people, -20·27 to -6·84) and no racial or ethnic groups showed a significant decline in the south. Testing rates rebounded to varying degrees during the late pandemic.

The COVID-19 pandemic, particularly early on, caused substantial disruptions in HIV testing rates across the USA, with pronounced racial, ethnic, and regional disparities. These findings highlight the need for targeted interventions to mitigate the impact of public health emergencies on communities disproportionately affected by pre-existing health inequities, including expanding mobile testing units, supporting community-based outreach, and investing in culturally responsive care to improve access to testing during future public health disruptions.

National Institutes of Health, National Institute of Mental Health, and National Institute on Drug Abuse.

Presentar los resultados estatales de salud y nutrición obtenidos mediante la Encuesta Nacional de Salud y Nutrición Continua 2020-2024 (Ensanut Continua 2020-2024). Material y métodos. La Ensanut Continua es una serie de encuestas anuales, probabilísticas, estratificadas y por conglomerados, con representatividad nacional, regional, urbana, rural y estatal. Se integraron cinco rondas (2020-2024) con más de 50 000 hogares y 53 600 adultos encuestados. Se unificaron bases mediante ponderadores ajustados y análisis con diseño complejo para estimar 145 indicadores de salud y nutrición.

Se obtuvieron estimaciones estatales válidas y comparables sobre inseguridad alimentaria e hídrica, acceso a servicios de salud, nutrición infantil y adulta, enfermedades crónicas, salud mental, envejecimiento y actividad física. Las prevalencias mostraron heterogeneidad territorial y social, reflejando brechas en cobertura y bienestar. Conclusión. La Ensanut Continua 2020-2024 fortalece el monitoreo nacional y estatal de la salud y nutrición, proporcionando evidencia clave para la planeación, implementación y evaluación de políticas públicas en México.

Postpartum depression (PPD) is a common mental health issue that negatively impacts maternal well-being and infant development. The COVID-19 pandemic has exacerbated depression risk among postpartum women due to added stressors from the crisis. This study aimed to assess PPD prevalence during the pandemic and identify associated factors. The study was conducted at Hanoi Obstetrics and Gynecology Hospital from May 2023 to December 2023. This cross-sectional study selected 223 postpartum women via convenience sampling. Data collection utilized online surveys and phone interviews. The Edinburgh Postnatal Depression Scale (EPDS) gauged depression levels, analyzed using Stata 16.0. Descriptive statistics and logistic regression explored relationships between PPD and contributing factors. Among participants, 22.0% scored 9-11 on EPDS, indicating mild depression; 5.8% were high-risk (EPDS 12-13), and 8.5% had PPD (EPDS > 14). The study identified links between PPD and poor sleep, COVID-19 anxiety, and limited social support. PPD remains a critical concern during COVID-19, with factors like sleep quality, pandemic-related anxiety, and social support influencing depression risk. Early screening and psychological interventions are crucial to mitigate PPD's impact on maternal and infant health post-pandemic.

Synaptic dysfunction is a candidate mechanism in psychotic disorders, yet the precise underlying substrates remain elusive. We investigated how combining in vivo electroencephalography (EEG) and in vitro human cortical spheroid (hCS)-based methods can further our understanding of psychosis pathophysiology during fetal stages of neurodevelopment. Ten individuals with schizophrenia (SZ) or bipolar disorder (BD; 5 males and 5 females) and five controls (CTRL; 3 males and 2 females) underwent EEG assessments, including long-term potentiation (LTP)-like cortical plasticity and mismatch negativity (MMN). hCS were generated from induced pluripotent stem cells of all participants, and immunohistochemistry, Seahorse bioenergetics and patch-clamp recordings were performed. EEG-based LTP-like plasticity was reduced in individuals with SZ and BD. Basal respiration was decreased in BD hCS and VGLUT1 levels were reduced in both SZ and BD hCS. There was a positive association between EEG-based LTP-like plasticity and hCS basal respiration which survived correction. Our data provide further support for roles of mitochondrial and glutamatergic impairments in the synaptic dysfunction of psychosis and demonstrate the potential of combining EEG- and hCS-based methods for early development mechanistic studies of brain disorders.

Chronic pain represents heritable conditions linked to suicide death. It has been suggested that a shared genetic predisposition may contribute to this relationship, but there has not yet been a comprehensive assessment of genetic and clinical overlaps of different types of chronic pain with suicide death. Here, we integrated whole-genome sequencing and electronic health records from 986 unrelated individuals of European ancestry who died by suicide in the Utah Suicide Mortality Research Study and 415 ancestrally-matched population controls selected for absence of disease. Polygenic scores (PGSs) for seven distinct types of chronic pain were calculated and tested in the suicide cohort. We observed significant positive associations of PGSs for multisite chronic pain (PGS_MCP) and chronic widespread pain (PGS_CWP) with suicide mortality. Sex-stratified analyses showed elevations in both males and females. Pain diagnosis-stratified analyses revealed associations with suicide death regardless of chronic pain diagnoses. Follow-up tests of PGSs for more specific pain conditions showed additional associations with suicide death for: 1) monoarticular arthritis, 2) back pain, and 3) chronic inflammatory demyelinating polyneuropathy across all suicide death individuals, and 4) irritable bowel syndrome within males only. In a multiple logistic regression test of all chronic pain PGSs associating suicide death status, four types of pain remained uniquely associated with suicide death, highlighting distinct subgroups within suicide death: some attributed to MCP and CWP, and others associated with monoarticular arthritis or chronic inflammatory demyelinating polyneuropathy. This cohort study reports associations between suicide death and PGSs from various pain conditions, regardless of sex or chronic pain diagnosis, suggesting that combining genetic and clinical risk factors may better identify genetic overlap, causal directions, and/or specific gene pathways.

Ankylosing spondylitis (AS) is strongly associated with the human leukocyte antigen B27 (HLA-B27), yet how this genetic risk factor interacts with the gut microbiome remains unclear. We integrated fecal gut microbiota analysis, untargeted metabolomics, and clinical phenotyping in 88 participants, including HLA-B27-positive patients with AS (n = 28), HLA-B27-positive healthy controls (n = 30), and HLA-B27-negative healthy controls (n = 30). HLA-B27 positivity, particularly in AS, was associated with marked alterations in gut microbial composition and metabolic profiles, with forty bacterial species showing progressive disease-related shifts across cohorts. Integrated pathway and metabolomic analyses identified three amino acid-related pathways consistently disrupted in AS: tryptophan metabolism, cysteine metabolism, and pyruvate-centered biosynthesis of branched-chain amino acids, ornithine, and lysine. Correlation network analyses linking differential taxa, metabolites, and clinical indices revealed previously unrecognized microbial and metabolic signatures that robustly distinguished AS from both control groups. To explore causality, fecal microbiota transplantation (FMT) from clinical donors into antibiotic-treated mice recapitulated key disease-relevant features, including impaired intestinal barrier function, systemic inflammation, trabecular bone loss, and polarization of macrophages toward a proinflammatory M1 phenotype. Mechanistic validation identified cinnabarinic acid as a critical microbial-derived metabolite that suppresses M1 macrophage polarization via activation of the aryl hydrocarbon receptor (AhR) pathway and confers protection in the FMT model. Together, these findings support a model in which HLA-B27-associated gut dysbiosis and metabolic reprogramming promote AS pathogenesis through macrophage-mediated inflammation and osteocatabolic signaling, highlighting microbial-metabolic pathways as potential therapeutic targets.

Dementia is a major global cause of death, with cases projected to rise from 57.4 million in 2019 to 152.8 million by 2050. As the disease progresses, individuals experience growing frailty, complex health needs and multiple comorbidities, requiring comprehensive support to maintain quality of care. Non-pharmacological physical interventions, targeting either the physical body or immediate environment, may help address these needs, especially in advanced dementia nearing end of life.

To map, appraise and synthesise evidence on the effectiveness of physical interventions for people with dementia nearing end of life.

An umbrella review of systematic reviews on physical interventions, part of a broader palliative dementia care series.

MEDLINE, Epistemonikos and ASSIA were searched for systematic reviews from 1980 to May 2024 involving people with dementia, carers or staff in health and social care settings. Physical interventions were defined as non-pharmacological approaches focusing on the body or physical environment.

From 6052 records, 13 reviews met the inclusion criteria. Interventions grouped into two categories: (1) nutrition and hydration (including enteral feeding) and (2) physical activities (including exercise, massage and approaches to reduce care resistance). Evidence quality was generally low, with no conclusive findings on effectiveness. Most interventions addressed well-being and function, with limited evidence for carer support, holistic assessment or medical management.

Research has primarily targeted well-being and functional outcomes, leaving key gaps in carer support and holistic management, warranting further investigation.

PROSPERO CRD42020162887.