BACKGROUND Foreign body (FB) ingestion is a common problem in children. In a report of adult FB ingestion, 56% of cases involved individuals with mental illness; the most common foreign bodies were batteries (23%), drug-filled balloons for intervention (17%), razor blades (16%), and others. Standard management of an accidentally swallowed button battery (BB) is radiographic evaluation followed by natural passage through the gastrointestinal tract after traversing the esophagus and stomach. Although cases of BB retention in Meckel's diverticulum have been documented, no reports have described retention in a colonic diverticulum. CASE REPORT An 88-year-old woman with Alzheimer's disease presented with retention of a BB in an ascending colonic diverticulum. Multi-detector computed tomography images showed a radiopaque foreign body near the duodenal bulb. Based on the diagnosis of an ingested BB in the duodenal bulb, emergency upper gastrointestinal endoscopy was performed 2 h after admission. However, an abdominal radiograph obtained after admission showed that the BB had migrated into the right colon. Colonoscopy performed the same day revealed that the BB had entered an ascending colonic diverticulum, from which it was successfully removed. To our knowledge, this is the first reported case of BB retention in a colonic diverticulum. CONCLUSIONS Retention of a BB in the colonic diverticulum, which poses a risk of perforation, should be considered in patients undergoing colonoscopy for suspected foreign body ingestion.

Despite the well-established need to increase access to HIV testing and prevention services among people with serious mental illness, little is known about the determinants of implementation of these services in behavioral health organizations. This multi-method study was conducted in King County, Washington, an EHE priority jurisdiction. A quantitative survey of 16 county behavioral health organizations explored the HIV testing and prevention services currently offered. Three organizations that viewed HIV testing and prevention services as very important or essential for their clients participated in in-depth qualitative interviews; 21 staff, providers, and leaders were interviewed about barriers and facilitators to on-site HIV testing and prescription or referral for Pre-exposure prophylaxis (PrEP). We used a rapid deductive qualitative analysis approach guided by the Consolidated Framework for Implementation Research (CFIR) 2.0. Commonly identified facilitators were organizational culture and a non-judgmental approach to care, frequent contact and long-standing relationships with clients, and a mission to provide holistic care. Commonly identified barriers were lack of resources and trained staff, infrastructure challenges (inability to bill services, weak referral pathways), higher priorities for services (including testing for Hepatitis C and sexually transmitted infections), and lack of knowledge and information. Lack of trained staff and the complexity of the service were more often perceived as barriers to providing PrEP on-site than HIV testing. Opportunities to build capacity were also identified, and included training, implementing universal testing, and expanding partnerships with other organizations to provide HIV testing and prevention services on-site at the behavioral health organization.

The determinants of chronic diseases are complex, and we demonstrated how lifestyle-related factors interact with physiological factors to influence the risk of healthspan termination (HST).

This prospective cohort study include 217,412 UK Biobank participants aged 37 to 73. Multivariate-adjusted Cox regression models assessed individual associations between physiological and lifestyle-related factors with HST. Weighted Quantile Sum (WQS) regression models examined the relative importance of each risk factor and their cumulative effects on HST. Structural Equation Modeling (SEM) was conducted to clarify pathways linking lifestyle, physiological factors, and HST.

We observed statistically significant associations between lifestyle-related and physiological factors with HST. WQS models also indicates that unhealthy lifestyle (OR = 2.77; 95% CI: 2.65-2.89; P < 0.01) and physiological factors (OR = 3.27; 95% CI: 3.06-3.50; P < 0.01) substantially increased risk of HST. Path analysis revealed that healthspan was positively correlated with biomarker (r = 0.03; P < 0.01), sleep behavior (r = 0.14; P < 0.01), and lifestyle (r = 0.16; P < 0.01), but negatively correlated with mental health (r = -0.13; P < 0.01).

Lifestyle-related factors interact with physiological factors through multiple pathways, influencing the risk of a shortened healthspan.

Objective: To investigate the alignment of self-harm ideation ratings with clinical assessments of suicidality in postpartum women diagnosed with unipolar and bipolar depression and the impact of trauma and psychiatric diagnosis on this alignment. Methods: Data from the largest postpartum depression screening study (n=10,000) in the US were examined in this secondary analysis. Inclusion criteria were a positive depression screen (Edinburgh Postnatal Depression Scale [EPDS] ≥10), a psychiatric diagnosis (Structured Clinical Interview for DSM-IV), and a suicidality assessment derived from the Structured Interview Guide for the Hamilton Depression Rating Scale with Atypical Depression Supplement (SIGH-ADS). Trauma exposure, including both childhood and adult physical and sexual abuse, was measured using 4 yes/no questions from the Dissociative Disorders Interview Schedule. Associations between key variables were examined using independent samples t tests, analysis of variance, χ² tests, or Fisher exact tests. Nonparametric tests were used for skewed continuous data. To assess the consistency between the EPDS and SIGH-ADS scales, Cohen κ statistics were used, with weighted κ applied to severity ratings and simple κ for binary categorizations. Results: Among 1,155 screen-positive postpartum women (68% White, 25.5% African American, 6.6% other; mean age 27.93 years), 21% endorsed self-harm ideation and 10.1% reported suicidality. Compared to those with unipolar depression, women with bipolar disorder had more than twice the odds of suicidality (odds ratio [OR] 2.77, 95% CI, 1.86 to 4.13, P<.001) and nearly 4 times the odds (OR 3.92, 95% CI, 1.18 to 13.00, P<.001) of not self-reporting self-harm ideation. Overall concordance between self-report (EPDS10) and clinical evaluation (SIGH-ADS11) was 78.6% (κ=0.28, 95% CI, 0.21 to 0.34, fair agreement) but varied significantly by diagnosis (P<.001), with lower concordance in the bipolar group (67.3%; κ=0.21) compared to the unipolar group (80.4%; κ=0.31). In the high-risk bipolar disorder group, concordance was no longer statistically significant, indicating poor alignment between self-report and clinical evaluation for these patients. Trauma was strongly associated with suicidality and a bipolar diagnosis. Conclusion: The EPDS does not consistently detect suicidality in perinatal bipolar patients, with our study showing only slight and nonsignificant agreement with clinical assessment in this high-risk group. Given that risk can change quickly in postpartum bipolar patients, timely and frequent clinical assessments are needed to identify high-risk individuals. Tracking and integrating routine bipolar disorder screening and trauma assessments in perinatal care may enhance early identification of suicide risk and improve maternal mental health outcomes.

The COVID-19 pandemic negatively affected sexual and reproductive health and rights (SRHR) and increased unwanted pregnancies among young people, yet scant evidence documents SRH service-access trajectories and experiences of young people living with HIV during this time. We conducted a remote study, comprised of qualitative Facebook and telephonic data collection with adolescents living with HIV and young parents in South Africa (n = 41, ages 16-29) in 2020/2021. Following this, we conducted in-depth research through calls, WhatsApp and Facebook to explore narratives of two young people living with perinatally-acquired HIV who accessed SRH services and became parents during COVID-19 lockdowns. We engage a narrative approach to illustrate the trajectories of these two young people - documenting their biopsychosocial lives and experiences accessing SRH services - with attention to personal, structural and relational factors. Findings illustrate their agency while detailing gaps in provisions that significantly affected their health and well-being. This study applies practice theory, exploring how gendered, relational, social and geographic factors shaped young people's experiences and SRH. Despite being well-acquainted with the biomedical technologies and relationships governing their care, they struggled to navigate an altered health landscape. Findings document how they were subject to narratives of individual responsibility for their SRH amidst system-level shortcomings. Results highlight significant gaps in service provision and an imperative to enhance the material conditions for young parents living with HIV in South Africa. They underscore the need for resilient, shock-responsive health and social protection systems to maintain continuous SRH services for adolescents living with HIV during crises.

To investigate hemodynamic and blood oxygen metabolism and their associations with disease progression, dopaminergic transporter (DAT) activity, and glucose uptake in patients with Parkinson's disease (PD).

This cross-sectional study included 73 patients with PD (mean age: 61.10 years) and 67 healthy controls (mean age: 58.99 years). Oxygen metabolism parameters-deoxygenated hemoglobin (Cdeoxy), oxygen extraction fraction (OEFrel), deoxygenated cerebral blood volume (dCBV), and R2* were measured using qMRI. DAT availability and glucose metabolism were assessed using PET with [18F]FP-CIT and [18F]FDG, respectively. Regional analyses were conducted using standardized brain atlases.

Compared with the controls patients with PD exhibited elevated Cdeoxy, OEFrel, and R2* in the substantia nigra, whereas Cdeoxy and dCBV levels were reduced in the bilateral caudate nucleus and frontal cortex (p < 0.05). The Hoehn-Yahr (H-Y) 2.5-3 subgroup exhibited higher levels of Cdeoxy and OEFrel in the left putamen than the H-Y 1-2 subgroup (p < 0.05). In the H-Y 1-2 subgroup, Cdeoxy, OEFrel, and R2* correlated with UPDRS scores in the substantia nigra and red nucleus (p < 0.05). In advanced stages (H-Y stages 2.5-3), significant correlations were observed in the striatal structures/the left dorsolateral putamen/posterior right caudate (p < 0.05). OEFrel and R2* values were positively correlated with glucose metabolism in the left putamen and right caudate. (p < 0.05).

qMRI demonstrated alterations in hemodynamics and oxygen metabolism in patients with PD, particularly within the nigrostriatal system, suggesting that metabolic indicators could serve as supplementary biomarkers for diagnosing and monitoring the progression of PD.

Background While many perinatal weight loss interventions focus on caloric restriction and physical activity, few address sleep despite its independent effects on weight, diet, and physical activity and the high prevalence of sleep disturbances among postpartum individuals. This study aims to inform the program production stage of intervention development for an integrated sleep, diet, and physical activity intervention by identifying behavior change priorities, barriers, and delivery preferences. Methods We conducted individual interviews with 20 postpartum individuals following a preinterview survey that was sent alongside a newsletter summarizing findings from an earlier phase of the study. The survey assessed the perceived importance and difficulty of intervention components related to sleep, diet, and physical activity. The interview guide was designed to (1) identify which behavioral domain participants viewed as most important to address first; (2) explore the perceived difficulty of changing each behavior; (3) determine which topics to adapt and include in the intervention; and (4) elicit reflections on the newsletter with earlier study findings. The survey responses were summarized descriptively, and the interviews were analyzed via qualitative content analysis to identify key themes. Results Five themes emerged. (1) The participants affirmed that the newsletter reflected their experiences but identified gaps related to mental health and partner/provider support. (2) Sleep is viewed as the most important behavior to change, with strong support for strategies targeting sleep efficiency, sleep routines, and sleep-related worry. (3) Sleep is also perceived as the most difficult behavior to change due to infant-related sleep disruptions, parental fatigue, and limited knowledge of effective strategies. (4) Participants offered differing views on where to begin-some preferred starting with sleep, others preferred starting with diet and physical activity, or an integrated approach. (5) Participants emphasized the need for support and accountability, including coaching, peer connection, and flexible tools. Conclusion The findings provide concrete guidance for tailoring intervention content, structure, and delivery to postpartum individuals' values, constraints, and readiness for change.

Children with special healthcare needs (CSHCN), especially those with mental health needs, often receive services from multiple service sectors, including schools. Thus, care coordination may play a critical role in access to mental health care for these children. This pooled cross-sectional study used multivariable logistic regression with data from the National Survey of Children's Health (2020-2023), focusing on a subsample of children with caregiver-reported mental health problems and need for mental healthcare. It estimates the prevalence of parent-reported need for and receipt of effective care coordination and provider communication with schools. It also measures the association between parent-reported receipt of these services with unmet need for mental healthcare. Most caregivers reported need for care coordination (51.3%) and provider communication with schools (60.7%). Among those with need, 48.3% reported not having their care coordination needs met, and 57.2% of families reported unmet need for provider communication with schools. The probability of reported unmet mental health needs was 12 percentage points lower when children had all needs for care coordination met and 10 points lower when providers communicated with schools. Results suggest that having care coordination needs met and provider communication with schools may play an important role in children accessing needed mental healthcare.

Postpartum depression (PPD) affects 10-15% of mothers annually, yet early identification remains challenging. We introduce ClinPreAI, a novel agentic AI system that autonomously designs, implements, and evaluates machine learning solutions for PPD risk prediction using multimodal electronic health record data. We analyzed data from 4,161 pregnant individuals at Texas Children's Hospital (2012-2025), extracting 27 structured clinical variables and social worker notes. The primary outcome was Edinburgh Postnatal Depression Scale (EPDS) score ≥10 (31.0% prevalence). ClinPreAI operates through five specialized modules that iteratively refine predictive models through autonomous experimentation. ClinPreAI demonstrated strong performance across modalities. On structured data, it achieved F1: 0.68 ± 0.03, outperforming traditional AutoML (F1: 0.64 ± 0.02) and commercial solutions (AWS Canvas F1: 0.54-0.55). On multimodal data, ClinPreAI achieved F1: 0.65 ± 0.04, matching custom LLM-XGBoost (F1: 0.65 ± 0.01) and outperforming zero-shot models (Claude Opus F1: 0.51-0.52). This represents the first application of agentic AI to perinatal mental health prediction. Our results demonstrate that autonomous AI agents can democratize sophisticated predictive modeling in clinical settings, particularly valuable where domain experts lack ML training. By automating experimentation and debugging, agentic systems lower barriers to developing robust clinical prediction tools while maintaining interpretability.

The authors sought to examine how psychotherapy use by U.S. adults changed beyond increases during the acute phase of the COVID-19 pandemic.

A nationally representative sample of U.S. noninstitutionalized, civilian adults (N=147,448) was drawn from the 2019-2023 National Health Interview Survey to describe psychotherapy use trends and compare patients' sociodemographic, insurance, and mental health characteristics between 2019-2020 and 2021-2023.

Between 2019 and 2023, psychotherapy use increased from 9.5% to 13.4%, whereas reports of delaying or not receiving psychotherapy because of cost increased from 5.2% to 6.6%. Among respondents who reported using psychotherapy, no significant differences were found in telehealth use and reports of delaying or not receiving psychotherapy because of cost.

The increase in adult psychotherapy use was sustained after the acute phase of the pandemic. With the increased demand for services, monitoring trends in psychotherapy access is vital.