Access to nature is found to have significant mental and physical health benefits, but there is minimal evidence of the potential impact on patients, staff and relatives from intensive care.

It is the purpose of this paper to explore a case series of 2 patients from an intensive care in the United Kingdom (UK), utilising a garden space for end-of-life care and rehabilitation practices.

In the first case, care at end-of-life is explored from a relative and staff perspective. The second case explored the impact of utilisation of a garden space for the care of a patient with multi-drug-resistant organisms in intensive care.

Feedback from the first case explored that, despite the sadness of the end-of-life experience, the intensive care garden space provided a positive environment for all respondents. Four main themes emerged: environmental influence, personalisation and privacy, communication and perception of care of the patient and relative. The second case explored the positive impact of environmental conditions to control and manage the spread of complex drug-resistant pathogens, and the role of the interdisciplinary team to facilitate the management of complex delirium.

The utilisation of a garden room and fresh air space in both cases was found to optimise patient, relative, staff experience and in case 2 it was used successfully to support delirium management and rehabilitation experience.

Utilisation of a nature-based environment can impact positively patient, relative and staff experience of critical care, with careful attention to risk assessment and safety. However more clinical research is required to further explore the phenomenon.

PurposeOnline directories play an important apomediary role in shaping how older adults find and compare potential providers. However, little is known about how this type of health information represents older adult needs and aging-related mental health expertise. This study examines how mental health professionals represent older adults and age-related care in their Psychology Today profiles.MethodsWe conducted a mixed-methods content analysis of 281 Psychology Today provider profiles across 8 U.S. cities. We used frequency counts and descriptive statistics to characterize provider attributes and areas of expertise. Using thematic analysis, we examined how providers describe their approach to serving older adults and aging-related mental health care. Quantitative findings informed and contextualized the qualitative analysis.ResultsWe identified one overarching theme "Older Adults at the Limits of Apomediated Visibility" and four subthemes: "Absent Narratives of Aging," "Token Mentions of Older Adults", "Misaligned Descriptions of Expertise", and "Generalist Framings Obscure Age-Specific Care". These results suggest that apomediary signals of relevance may not consistently match substantive descriptions of provider expertise in older adult mental health care.ConclusionsFindings reveal gaps between platform filters and profile narratives that may undermine the directory's apomediary role, making "older adult" care appear searchable while obscuring the age-relevant information older adults need to make informed health decisions. Better alignment between structured search criteria and narrative self-representation would strengthen informed decision-making and advance equitable access to age-responsive mental health services.

Are there distinct symptom clusters in women with endometriosis and adenomyosis, and how do these clusters predict quality of life?

Latent class analyses of 22 438 women with endometriosis identified four symptom phenotypes, including high pain-gastrointestinal and psychological-neurological clusters; adenomyosis cases were concentrated in high‑pain classes without a minimal‑symptom group, and high‑burden phenotypes had poorer quality of life.

Endometriosis and adenomyosis are heterogeneous conditions with diagnostic delays of 4-11 years. The classification based on surgical findings and imaging fails to capture the complex, systemic symptom combinations that affect patients' quality of life (QoL).

Large-scale cross-sectional cohort study using data from the United States-based All of Us Research Program (Controlled Tier v8; May 2018-October 2023).

The dataset included 22 438 women with electronic health records (EHR) and/or self-reported endometriosis. Four Latent Class Analyses (LCA) were performed on different patient groups: (i) the full endometriosis cohort (n = 22 438); (ii) an age-corrected subset restricted to premenopausal women (aged 18-45; n = 5542) to minimize menopausal confounding; and two subgroups derived from the age-corrected cohort to test whether concomitant adenomyosis defines distinct symptomatic phenotypes: (iii) clinically confirmed endometriosis without adenomyosis (n = 1797) and (iv) adenomyosis with endometriosis (n = 643). LCA was performed using 19 self-reported and EHR-derived symptoms and comorbidities (e.g. chronic pelvic pain, migraine, depression, gastrointestinal symptoms) to identify patient subgroups. Multinomial logistic regression assessed sociodemographic (age, BMI, deprivation index) and clinical predictors (hormonal contraceptive use, surgical history) of class membership. The association between latent classes and QoL outcomes was evaluated using data from the 'Overall Health' and 'Health Care Access and Utilization' surveys. Data are available via the All of Us Researcher Workbench (https://workbench.allofus.org).

Latent class analysis of clinically confirmed endometriosis identified four distinct symptom phenotypes, most notably a severe 'High Pain & Gastrointestinal with Mood Symptoms' (High) cluster and a unique 'Predominantly Psychological/Neurological' cluster that challenges traditional gynecological-focused diagnostic frameworks. Patients with adenomyosis exhibited a distinct profile with two high-pain symptom classes and the absence of a fully asymptomatic group, indicating a higher overall disease burden. Membership in the High class was significantly associated with lower general health scores, reduced social satisfaction, and increased barriers to healthcare access.

The All of Us is a United States-based research program, and the findings should be replicated in other independent cohorts to confirm generalizability across other geographical regions. The cross-sectional design limits causal inference regarding QoL outcomes. Also, the analyses rely on a mix of diagnostic approaches, including surgical and non-surgical clinical and self-reported diagnoses, which is both a strength and a limitation. The 'Minimal Symptom Burden' class may reflect under-documentation of symptoms in clinical records rather than a true lack of symptoms, and the High class may reflect to patients who have higher multimorbidity, hence have more hospital visits.

These results support a shift toward personalized, interdisciplinary management of endometriosis that addresses mental health and gastrointestinal symptoms alongside pelvic pain. The identification of a 'Predominantly Psychological/Neurological' cluster suggests that young women presenting with non-classical symptoms (anxiety, migraine, depression) could be screened for endometriosis to reduce diagnostic delays and improve life-course potential.

D.K. was supported by a 'Ramón y Cajal' fellowship from the Spanish Ministry of Science and Innovation (RYC2024-050099-I). O.G. was supported by a postdoctoral award from the Amy P Goldman Foundation.

I.F. is the co-founder and co-owner of Sur180 Therapeutics, which is developing a novel treatment for endometriosis, and the Chief Scientific Officer of Nura Health, which is developing a non-invasive diagnostic solution for the disease. I.F. has received ARPA-H grant no. ARPA-H-ICHUB-24-101-1035 as Principal Investigator, consulting fees from Nura Health and Sur180 Therapeutics, and stock and share options in both companies. I.F. is also the inventor on patents for 'Compositions and methods for treating endometriosis' (US10695341 and US10729693) and serves as an unpaid Board Member of the World Endometriosis Society and the Fundación Puertorriqueña de Pacientes con Endometriosis (ENDOPR). H.S.T. received speaker fees from Gedeon Richter, a grant from AbbVie through Yale University, consulting fees from Regeneron, and is a co-inventor on Yale's endometriosis biomarkers and treatments (including US11993816B2, US10982282B2, and US12286629B2). He also serves on the boards of the Environmental Health Trust and Environment and Human Health.

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Persistent emotion lability and impulsive behavior in bipolar disorder (BD) are thought to be due to impaired affective cognitive control. Neural synchrony via theta-gamma phase-amplitude coupling (PAC) in the prefrontal cortex facilitates cognitive control and is impaired in BD. This pilot study aimed to investigate the feasibility and efficacy of transcranial alternating current stimulation (tACS) in targeting the neural coordination (i.e., theta-gamma PAC) of cognitive control in a double-blind, randomized, controlled crossover trial.

Participants (N = 18) with BD completed an emotional Go/No-Go task during six 5-min stimulation blocks interleaved with 2-min resting blocks. Participants received active- and sham-stimulation 1 week apart; sham comprised a ramp up/down at the beginning and end of the block to mimic stimulation sensations. Tolerability was measured using a side effect questionnaire after active and sham stimulation. Behavioral measures of discriminability (d') and reaction time during the task, and EEG measures of theta-power and theta-gamma PAC during the interleaved resting states were compared for active versus sham.

Active did not differ from sham stimulation on any side effects (all p's > 0.11). Effect sizes when comparing discriminability, theta-power, and PAC across active versus sham were small but showed a consistent pattern of improvement in the active relative to the sham condition.

This pilot study showed that 30-min tACS is tolerable to BD patients and demonstrated preliminary promise in enhancing affective cognitive control. Future studies should determine the optimal dosage to produce more substantial and enduring effects.

ClinicalTrials: NCT05480124.

In developing countries, many organizations are attempting to implement interventions to improve adolescent mental, sexual, and reproductive health (ASRH). A key challenge in these efforts is the efficient utilization of available resources. However, there is a considerable lack of efficiency studies, particularly in high resource-constrained settings such as Niger. Addressing this gap, the present study assessed the delivery of adolescent mental, sexual, and reproductive health services in Niger, while evaluating the technical efficiency and its determinants within public health facilities providing adolescent sexual and reproductive health services.

A cross-sectional survey was conducted at 160 rural and urban health facilities in Niamey and Maradi, from May 31 to June 24, 2022. Descriptive frequency analysis assessed the availability of mental and sexual/reproductive health services. Stochastic frontier analysis (translog function) measured technical efficiency, while fractional logit regression identified influencing factors.

Over 89% of surveyed health facilities in Maradi and Niamey reported providing sexual and reproductive health services to adolescents. Conversely, the availability of mental health services was limited, with only 10% of facilities offering such support in these regions. Stochastic estimation revealed an average technical efficiency score of 45.2% (95%CI: 0.410-0.49). Notably, higher-than-average efficiency scores were observed among facilities managed by male personnel.

The findings highlight significant gaps in the provision of mental health services, underscoring the need for targeted interventions. Training health personnel to effectively manage adolescents with mental health disorders is recommended. The comparatively low technical efficiency score suggests room for improvement; establishing well-equipped and functional pharmacies with relevant sexual and reproductive health products may contribute to enhanced performance in health service delivery.

Healthcare professionals often implement quality improvement (QI) initiatives but lack training to implement and sustain QI initiatives. Leading Healthcare Improvement (LHI) is a course that combines principles from change management, team science, and leadership effectiveness into an implementation strategy to enable clinicians to lead sustainable change.

LHI is a 6-session, 4-month interactive training. Learners work on an active QI project throughout the course. A Wilcoxon signed-rank test was conducted to evaluate pre- and post-course changes in learners' self-reported confidence across five QI competencies.

Veterans Healthcare Administration clinicians and fellows completed the LHI pre- (n = 111) and post-course (n = 74) evaluations with 70 responding to both evaluations. The 70 learners self-reported significantly increased confidence after the training in each of the QI competencies: communicating urgency (W = 56, p < 0.001), developing and leading interprofessional teams (W = 48, p < 0.001), creating and communicating project vision (W = 54, p < 0.001), developing strategies to remove barriers (W = 60, p < 0.001), and communicating project impacts to leadership (W = 62, p < 0.001).

LHI is an implementation strategy curriculum intended to support healthcare professionals in leading system-level changes. Its emphasis on key partner influence, interprofessional teamwork, and real-time project application may help address gaps in existing training and has the potential to strengthen capacity for sustained healthcare improvement.

The factors influencing the oral microbiome during childhood and adolescence remain under-explored at the population level. Furthermore, details on how the oral microbiome differs with age, varies between individuals of different ethnicities, or is associated with socioeconomic factors and diet in children and adolescents are almost entirely unknown. Saliva samples and detailed demographic, health, diet and socioeconomic data were collected from children and adolescents that attended the Ontario Science Centre (Toronto, Canada) and were enrolled in the Spit for Science cohort. We characterised the bacterial microbiota of 4812 samples using 16S rRNA gene sequencing to make this the largest population cohort of the paediatric oral microbiome to date.

Exploration of limited participant genotyping information and more than 50 variables encompassing the demographics, health, diet, socioeconomic status and living environment of participants revealed that almost all of the investigated variables were associated with overall community structure and/or the abundance of specific bacterial genera. However, most of these associations were modest (R² < 0.01) and the correlation between genetic relatedness and salivary bacteriome similarity was weak (R² = -0.014), while the strongest determinants of oral bacteriome composition were shared family/household environment (R² = 0.61 in the subset of participants from multi-child households), age (R² = 0.014) and ethnicity (R² = 0.01). We show that older children and adolescents have higher richness but lower evenness than younger children, suggesting that their oral bacteriome changes as they are exposed to more influences outside the home, and that the oral bacteriome is more consistent with more core taxa among children and adolescents than adults. We also find that diet variables related to the frequency of sugar consumption have the largest impact on the oral bacteriome of children and adolescents, and that microbial differences attributed to ethnicity and diet are likely intertwined.

This study provides an atlas of the demographic, health and lifestyle factors that are associated with the salivary bacteriome of children and adolescents. These findings highlight the complex interplay between social, environmental, and biological factors in shaping the developing oral microbiome and underscore the importance of inclusive, demographically diverse cohorts in microbiome research. This presents a reference for the variables that are important to account for in paediatric oral microbiome studies. Video Abstract.

The diagnostic term, autism spectrum disorder, encompasses the full range of impairments associated with the autism spectrum, a significant change from earlier DSM definitions that identified various subtypes of autism. However, the majority of autism-related research and cultural representations in recent years has focused on autistic individuals with strong language and cognitive abilities. In 2021, the administrative term Profound Autism (PA) was proposed by a Lancet Commission to draw attention to autistic people whose impairments require lifelong, round-the-clock care. The initial definition of PA included a minimum age and requiring 24/7 access to an adult to ensure safety, and suggested considering IQ, and verbal ability when defining this group. However, researchers have subsequently utilized widely varying criteria in studies of this group, producing results that are difficult to compare and limit the potential for the identification of this group to advance knowledge about their strengths and needs.

To address the need for studies that use comparable samples and increase clarity in communication and interpretation of results, we carried out a systematic, multi-stage Delphi consensus study with over 70 participants who identified as researchers, caregivers, autistic individuals, and clinicians, to measure consensus on components of a research definition of PA. A series of questions was developed for the primary domains of interest.

After two rounds of review and voting, 76% of the respondents agreed on a research definition of PA of: adaptive functioning well below age level, requiring adult supervision to ensure physical and mental health, safety and well-being, being at least 8 years old, diagnosed with ASD, and having severely impaired cognitive abilities (reflected by IQ score below 50) and/or not verbally communicating other than single words or fixed phrases used predominantly to have their basic needs met.

Variations in access to measurement tools, as well as access to services across the world, limit the utility of this definition outside research practices, and a response rate of 58% yielded a final round sample size of 78 that may underrepresent portions of the stakeholder community and was overwhelmingly composed of respondents from the United States.

Based on these findings, a new working research definition of profound autism is proposed. Adoption of this definition could improve comparability across research studies, enhance the impact and generalizability of results, and better target interventions and supports for this high-needs group.

Evidence on the health needs of UK veterans accessing primary care is limited. Electronic health records (EHRs) offer an opportunity to address this evidence gap if veterans are correctly identified. This study validated the identification of veterans in the Clinical Practice Research Datalink (CPRD) and assessed its feasibility for examining their health compared with non-veterans.

We conducted a matched cohort study in CPRD, the largest primary care database in the UK, identifying veterans using military-related codes in patients' EHRs. Each veteran was matched to one or two non-veterans on age, gender, practice, and index date. Validation was undertaken through general practitioner confirmation of veteran status. We compared demographics, risk factors and recorded health conditions using descriptive statistics. Poisson regressions assessed the association between veteran status and various physical and mental health conditions.

122,484 veterans and 244,573 matched non-veterans were identified. 95% were captured using definite military terms, and validation showed substantial agreement with GP records. Veterans had higher recorded prevalence across all conditions. The largest differences were observed for PTSD (adjusted prevalence ratio [aPR] 16.43, 95% CI 14.89-18.13), followed by Alzheimer's disease (aPR 2.74, 95% CI 2.56-2.92), alcohol use disorder (aPR 2.23, 95% CI 2.09-2.39), hearing loss (aPR 2.09, 95% CI 2.02-2.15), and osteoarthritis (aPR 1.98, 95% CI 1.93-2.03). Recorded prevalence was also higher among veterans for COPD (aPR 1.83, 95% CI 1.77-1.89), depression (aPR 1.83, 95% CI 1.79-1.87), prostate cancer (aPR 1.83, 95% CI 1.73-1.94), coronary heart disease (aPR 1.78, 95% CI 1.72-1.84), lower back pain (aPR 1.73, 95% CI 1.70-1.77), and myocardial infarction (aPR 1.65, 95% CI 1.56-1.75). Differences for anxiety and breast cancer were modest.

This study establishes a foundation for UK veterans' health research using primary care data. Provided that identification and recording of veteran status improve in NHS records, CPRD offers considerable potential to monitor veteran health trends, identify needs, and evaluate interventions at scale.

There are limited data on food insecurity among college students from different marginalized backgrounds, both in Vermont and other predominantly White spaces, and what their institutions could do to improve food security and other basic needs. Thus, the aims of this study were to 1) examine food insecurity prevalence and its correlates among underrepresented college students, 2) assess their reasons for using campus food pantries and strategies for improving access to culturally appropriate foods on campus, and 3) determine their perspectives regarding how their institutions can address their basic needs.

Using a mixed methods cross-sectional research design, a convenience sample of full-time students or trainees ages 18 and older enrolled at four institutions of higher education in Vermont, United States, were recruited through flyers, course announcements, newsletters, listservs, and social media posts. An online survey provided estimates of food insecurity, on-campus food pantry use, and participant perspectives on institutional strategies to address basic needs through open-ended questions. Food insecurity was assessed by the 10-item United States Department of Agriculture food security survey module. Descriptive statistics assessed frequencies and percentages along with means and standard deviations. Binary logistic regression was conducted to estimate the odds of food insecurity. Inductive coding was used to analyze qualitative data and identify emergent themes.

Around 40% of all participants experienced food insecurity in the past year, with higher odds observed in students aged ≥ 30, Pell Grant recipients, first-generation students, Black students, and those who used a food pantry. The most cited reason for using a campus food pantry was ease of getting to the pantry while lack of awareness was the most reported barrier. Over 50% of participants recommended gathering feedback from students about their preferences to improve access to culturally appropriate foods. Common themes from qualitative analyses included: food access support, safe and affordable housing access, mental health and healthcare access, financial aid access, reliable and affordable transportation access, non-financial academic support, and general support services.

Institutions should prioritize food assistance programs targeting college students and incorporate mental health care, housing support, and financial aid for comprehensive safety nets.