Structural brain alterations have been observed in individuals with phenylketonuria (PKU); however, the potential impact of PKU on brain aging remains unexplored. This study investigated brain age in adults with early-treated classical PKU compared to healthy controls. Thirty early-treated adults with classical PKU (age 19-48 years) and 59 age-, sex-, and education-comparable healthy controls underwent structural magnetic resonance imaging (MRI), cognitive and mood assessment, and blood sampling. Brain age was estimated using machine learning models trained to predict brain age from MRI-derived features across the full brain, cortical lobes, or subcortical regions. The brain age gap (BAG)-the difference between brain age and chronological age-was calculated. In addition, white matter lesion load was rated in patients. While patients with PKU showed differences in BAG for four out of eight brain age estimates, only the BAG in the insula was significantly higher in PKU than controls after correcting for multiple comparisons (p_uncor = 0.006, η² = 0.07). The cingulate BAG was positively associated with concurrent and historical Phe levels (r_s = 0.41-0.69, p_uncor < 0.05) and with white matter lesion load (r_s = 0.40, p_uncor = 0.034). Further, subcortical and cingulate BAG were linked to cognitive performance (r_s = -0.41-0.38, p_uncor < 0.05). These correlations did not survive FDR-correction. In conclusion, the elevated insular BAG in adults with early-treated PKU may reflect atypical brain development due to cumulative effects of early-life or lifelong metabolic disturbances. Longitudinal studies are warranted to elucidate brain aging trajectories and their cognitive implications in PKU.

Social risk screening is a significant expansion of clinical care that raises a complexity of challenges for healthcare providers and patients alike.

To understand the experience of responding to social risk screens among patients with mental health needs, how they prioritize health-related social needs when seeking care, and the impact of social risk screening on the patient-health system relationship.

Qualitative study; one-on-one key informant interviews.

Primary care patients at an academic urban safety-net hospital in Boston, MA.

Primary data were collected via qualitative interviews with patients who presented at primary care with a mental health concern (e.g., depression, anxiety) in the past 1-3 months and completed a social risk screening from December 2020 to August 2021. Interviews were held via Zoom in English, audio-recorded and transcribed. Interviews focused on patients' experience of being screened for social risks and needs, their conceptualizations of social risk domains (e.g., housing, food, transportation, etc.), and the importance of these needs relative to medical care access. A deductive analysis using the Information-Motivation-Behavioral Skills model was applied to identify themes.

A total of 148 individuals were approached with 30 participating in semi-structured interviews (20.3% recruitment rate): 19 (63%) participants self-identified as female and 14 (47%) as Black/African American. Data revealed that asking patients about their social needs further emphasizes their already vulnerable position when seeking medical care, particularly when addressing mental health concerns. Patients stated that they were reluctant to disclose future health-related social needs when prior reported needs were not supported or addressed.

When patients reported prior instances of sharing health-related social needs where those needs went unaddressed, instances of "double loss" occurred, leading to potential distrust in the medical system. It is important that health systems implement effective referral processes and have adequate resources to address patient disclosed needs, especially for at-risk patient populations.

The 2-1-1 information and referral system connects vulnerable populations to essential services during public health emergencies. However, there is limited evidence examining the specific needs of unhoused populations during these events. This study examines associations between temperature variations, tropical cyclones, and service utilization patterns among unhoused populations using 2-1-1 call data from southern Louisiana (2014-2023). Analyzing over 20,000 calls, predominantly in urban areas (65%), we employed negative binomial regression, distributed lag non-linear modeling (DLNM), and natural language processing to uncover patterns in help-seeking behavior during temperature variations and tropical cyclones. Negative binomial models demonstrate declines in 2-1-1 utilization both during cyclone events (IRR: 0.77, CI: 0.60-0.99) and in the recovery period (IRR: 0.86, CI: 0.76-0.97). Significant associations were observed across the temperature distribution with both the coldest (D1, IRR: = 1.22, 95% CI = 1.08-1.38) and warmest (D10, IRR = 1.21, 95% CI = 1.06-1.38) temperature deciles, indicating increased call volume at the coldest and warmest temperatures compared to moderate temperatures. DLNM results corroborated a U-shaped association at temperature extremes, though effects were predominantly significant only at the coldest temperatures. Computational text analysis of call narratives revealed that mental health mentions increased significantly with temperature (from 19.4% in coldest conditions to 30.5% in warmest conditions), but decreased during cyclone periods (from 29.1% in non-cyclone conditions to 15.5-20.2% during various cyclone phases). While 2-1-1 data captures only those with phone access and service awareness, potentially underrepresenting the most marginalized, these findings provide actionable insights into help-seeking patterns among service-connected (e.g., 2-1-1) unhoused populations during and following extreme weather events.

This study aimed to determine the prevalence of mild cognitive impairment (MCI) and cognitive impairment (CI) in patients undergoing haemodialysis (HD) and to identify physical function characteristics associated with these conditions.

A cross-sectional study was conducted among 147 outpatients receiving HD. MCI was evaluated using the Japanese version of the Montreal Cognitive Assessment (MoCA-J), and CI was assessed using the Mini-Mental State Examination (MMSE). Patients were classified into three groups: normal (MMSE ≥ 24 and MoCA-J ≥ 26), MCI (MMSE ≥ 24 and MoCA-J < 26) and CI (MMSE < 24). Patient characteristics and physical function were compared among groups. Multivariate analysis was conducted using analysis of covariance adjusted for age, sex, dialysis vintage and body mass index.

The mean age of participants was 69.7 ± 11.8 years, 63.9% were male, and the mean HD vintage was 6.0 ± 6.9 years. Based on cognitive testing, 50 patients (34%) were classified as normal, 59 (40%) as MCI and 38 (26%) as CI. Compared with the normal group, the CI group exhibited significantly lower physical function, including grip strength, Short Physical Performance Battery scores, and usual gait speed. Similarly, physical function in the CI group was significantly poorer than in the MCI group. However, no significant differences in physical function were observed in physical function between the normal and MCI groups.

MCI and CI were prevalent among HD patients, affecting 40% and 26%, respectively. Patients with CI demonstrated a marked decline in physical function than those who were cognitively normal or had MCI.

Violence against women is a critical global health issue, with especially high prevalence rates in informal settlements in low-income countries. Over one billion people live in informal settlements. In Kenyan settlements, lifetime rates of intimate partner violence (IPV) reach up to 85%, and are closely linked to common mental health disorders. Despite urgent need, access to IPV and mental health services is scarce. Low-cost interventions like Problem Management Plus (PM+)-a World Health Organization intervention designed to reduce psychological distress-and Wings of Hope (WINGS)-a screening, brief intervention, and referral to treatment intervention-deliverable by non-specialists in healthcare and community settings could provide an effective strategy to address this need, but their combined effectiveness has not been tested. We conducted a pilot randomized controlled trial of an adapted, combined IPV and mental health intervention (WINGS + PM+) compared to PM + only among 260 women recruited from two public health clinics in Nairobi informal settlements. Screening, assessment, and intervention were facilitated by community health promoters. The feasibility trial achieved 93.5% retention at six months, excellent session completion, and nearly universal participant satisfaction, with no study-related adverse events. We also analyzed primary and secondary IPV and mental health outcomes, including depression, anxiety, and post-traumatic stress. Both intervention arms showed significant reductions in IPV and improvements in mental health over six months. Leveraging existing community health promoter and public health networks proved essential, underscoring the promise of scaling up these interventions to fill critical gaps in services in resource-limited settings.

Leprosy remains a public health challenge in India, with many individuals continuing to experience physical disability, stigma, and psychosocial burden despite being cured. While co-occurrence of individual comorbidities such as diabetes and depression has been reported, the prevalence and patterns of multimorbidity among persons affected by leprosy remain poorly documented.

We conducted a mixed-methods study across six tertiary referral hospitals of The Leprosy Mission in India during 2021-2022. Quantitative data were extracted from electronic medical records of 10,428 adults affected by leprosy, including clinical details, random blood sugar, haemoglobin, cataract assessment, and wellbeing status measured using the WHO-5 index. Multimorbidity was defined as the presence of ≥2 conditions in addition to leprosy. Logistic regression was used to identify associated factors. Qualitative data were collected through focus group discussions (FGDs) with 16 persons affected by leprosy and 14 healthcare providers and analyzed thematically.

Leprosy alone was present in 81.9% of participants, while 16.4% had one additional condition, and 1.7% experienced multimorbidity. Diabetes was the most frequent comorbidity (9.3%), followed by poor wellbeing (5.6%) and cataract (1.5%). Increasing age, male gender, and disability were significantly associated with multimorbidity. FGDs revealed limited awareness of multimorbidity, challenges in accessing integrated care, financial barriers, and absence of flexible guidelines for management.

Although relatively uncommon (1.7%), multimorbidity among persons with leprosy poses substantial challenges. Diabetes, mental health concerns, and malnutrition highlight the need for integrated, person-centred care models. Strengthening primary healthcare, enhancing screening, and developing multimorbidity-sensitive guidelines are essential to improve outcomes, reduce stigma, and promote holistic wellbeing in this marginalized population.

Parenting responsibilities can be particularly challenging for patients receiving mental health services, often resulting in a range of negative impacts on children. Incorporating a family-focused approach into the usual care of parents with mental illness has been recommended to promote patient recovery while supporting the well-being of children and the entire family unit. This study aimed to document the family-focused practices undertaken by psychiatrists working with parents who have a mental illness and to explore potential facilitators and barriers to these practices.

A sequential explanatory mixed-method design was used, combining an online survey and individual interviews. Family-focused practices were reported by 27 psychiatrists through the French version of the Family-Focused Mental Health Practice Questionnaire. Follow-up qualitative individual interviews were conducted with 5 psychiatrists. Item-by-item analysis of the quantitative data was performed, followed by a thematic analysis of the qualitative data, integrating findings from both sources.

Although psychiatrists acknowledge their patients' parenting role, most are reluctant to provide further support. Key barriers to family-focused practice include the predominantly individual-focused nature of psychiatric care, stigma, consent issues, and limited collaboration between adult and child services. Facilitators include psychiatrists' professional autonomy, personal experience, and confidence in conducting family meetings.

Psychiatrists can play a pivotal role in identifying, acknowledging, and providing appropriate support to parents with mental illness and their families, including children. Developing comprehensive guidelines and targeted training is essential to equip psychiatrists with effective strategies for addressing parenting challenges in patients with complex mental health issues. Additionally, psychoeducational resources for children should be incorporated. Implementing these initiatives may lead to more compassionate, targeted care and improved outcomes for parents and their families.