Background Depression is common among older women and is shaped by various social, economic, and health-related factors. In Kerala, the rapidly aging population and distinct socio-cultural context may influence the prevalence and risk patterns of depression among elderly women. Literature on depression among older women in Kerala is limited. This study assessed the prevalence and determinants of depression among older women in Thiruvananthapuram District, Kerala, India. Methods A community-based cross-sectional study was conducted among 480 women aged ≥60 years, selected through multistage cluster sampling. Depression was assessed using the Patient Health Questionnaire (PHQ)-9, and severity was dichotomized as moderately severe or severe (PHQ-9 score ≥15) versus mild or moderate (PHQ-9 score <15). Log-binomial models were used to estimate unadjusted prevalence ratios (UPR), and multivariable Poisson regression was applied to obtain adjusted prevalence ratios (APR) with 95% confidence intervals (CI). Results The prevalence of moderately severe or severe depression was 35.8% (n=172, 95% CI: 31.3-40.1). In the multivariable analysis, urban residence (APR=2.83; 95% CI: 2.08-3.86, p<0.001), unmarried status (APR=1.44; 95% CI: 1.15-1.79, p=0.001), presence of chronic morbidity (APR=1.46; 95% CI: 1.10-1.94, p=0.010), and sleep disturbance (APR=1.39; 95% CI: 1.10-1.96, p=0.009) were significantly associated with a higher likelihood of experiencing moderately severe or severe forms of depression. Conclusion Over one-third of older women reported moderately severe or severe depression. These findings highlight the need for community-based screening and targeted mental health interventions focusing on urban residents, unmarried individuals, patients with other chronic conditions, and those with sleep disturbances.

National trends indicate that drug-related deaths among Veterans have been increasing from 2010 to 2019. The present study involves a recent analysis of drug mortality data for a single large Veterans Affairs (VA) Healthcare System. The aims of the study included (1) the identification of VA patients with drug-related deaths, (2) patient characteristics and service utilization patterns of VA patients with drug-related deaths, and (3) the evaluation of existing internal tracking systems for monitoring drug-related deaths.

This retrospective study matched VA enrollment records to San Diego County Medical Examiner (ME) data from January 2019 to June 2023. The records of individuals who died of a drug-related overdose in San Diego County were matched to VA medical records. Chart reviews were conducted to evaluate the extent to which intentional and accidental overdose events were documented in electronic medical records, and to examine demographic and clinical characteristics and healthcare utilization in Veterans who died by overdose.

From January 2019 to June 2023 there were a total of 140 drug overdose deaths, 91.4 % were accidental (n = 128) and 8.6 % were intentional (n = 12). Prior to ME data matching, VA records captured 9.6 % of accidental drug overdoses (n = 15) and 100 % of intentional drug overdoses (n = 12). Fentanyl or fentanyl analogs were involved in 37.1 % (n = 52) of intentional and unintentional drug overdose deaths with the combination of fentanyl and methamphetamine being the next most specific common cause of death (n = 30; 21.4 %). In terms of VA healthcare utilization, in the year prior to their death, 63.6 % of Veterans accessed care. Among those 89 VA patients, they most commonly utilized the emergency department (75 %) and primary care (56.2 %). Among the 20 % of Veterans with opioid use disorder (OUD), in the year prior to their death, 39.3 % were dispensed a prescription for naloxone and 35.7 % were dispensed a medication for OUD.

Comparing VA records to county ME records revealed that VA records missed over 80 % of drug-related overdose deaths-4 out of every 5 deaths. While accurate for intentional overdoses, accidental overdoses-which comprise the vast majority of drug overdose deaths-were missing over 90 % of the time. Given that drug toxicology results were consistent with county trends, this suggests that VA records severely underestimate drug overdose deaths. Approximately two-thirds of VA patients who died of drug overdose access VA and most were seen in the emergency department and over half in primary care-identifying these as important intervention targets for overdose prevention. Given the gaps in capturing drug overdose deaths, other healthcare systems looking to prevent overdose deaths, and especially other VA systems, may want to consider adopting similar methods to better capture and understand factors that impact drug overdose deaths among their patient populations.

Accurate assessment of an individual's diet is vital to study the effect of diet on health. Image-based methods, which use images as input, may improve the reliability of dietary assessment. We developed an iOS application that uses computer vision to identify food from images. This study aimed to assess the accuracy of energy intake (EI_app) estimates from the application by comparing them to estimated energy expenditure (EE) and to the EI estimates from a validated dietary assessment tool, the 24-h recall (EI_recall). Participants were recruited from a randomised controlled trial called He Rourou Whai Painga. Participants recorded all intake over 7 d using the application, which provided a mean daily EI; this was compared to the EI estimated by two 24-h recalls. The EI from the application and the recalls were compared to EE, estimated using indirect calorimetry and wrist-worn accelerometry. EI estimates from the application and the 24-h recalls were lower than EE, with a mean bias of -1814 kJ (95% CI -3012 to -615, p = 0.005) and -1715 kJ (95% CI -3237 to -193, p = 0.029), respectively. The mean bias between EI from the application and the 24-h recall was 783 kJ (95% CI -875 to 2441, p = 0.33). This suggests that the EI estimates from the application are comparable to the 24-h recall method, a validated and widely used tool in nutritional research.

This study aimed to develop and validate a questionnaire that investigates sugar-related eating behaviour, excessive consumption, and addictive-like eating. This questionnaire was validated using a rigorous process assessing content validity, face validity, reliability testing, feasibility testing, and construct validity. Spearman's correlation coefficients and Cronbach's alpha were used to assess reliability. Feasibility testing was used to further validate and confirm the scoring/categorisation of 'low', 'medium', and 'high' scorers for use in future research. Exploratory factor analysis and reliability analysis were used to determine underlying latent factors and assess construct validity. Content validity was assessed by health professionals (n = 16), face validity was assessed by the lay public who had no expertise in nutrition or addiction (n = 20). Reliability (n = 54), repeat reliability (n = 50), and feasibility (n = 113) testing were assessed with a sample from the lay public. Spearman's correlation coefficients were in the range of 0.58-0.91 and were statistically significant (P < 0.001), indicating good temporal stability within the questionnaire. Cronbach's alpha coefficients were in the range of 0.62-0.93, indicating good internal consistency. Feasibility testing confirmed the use of calculating an 'average total score' from the data set and splitting the data set into tertiles: low, medium, and high scorers. Exploratory factor analysis confirmed three latent factors: F1: Compulsive Eating; F2: Comfort Eating; and F3: Withdrawal. Results suggest the questionnaire is highly reliable and was successfully validated. This questionnaire can be used in research to investigate problematic and addictive-like eating behaviour and its effects on ill health.

Poor sleep has been associated with mental health concerns such as anxiety and depression. Prior evidence suggests that smartphone use may be a factor in poor sleep and mental ill-health in young adults, though most studies have relied on self-reported measures of smartphone use and sleep, which can be unreliable. This study used objective and subjective measures to examine the relationship between time spent using smartphones, sleep duration, quality, regularity, and symptoms of depression and anxiety in a sample of self-selected poor sleepers.

Participants (N = 99; 70.7% female) wore an actigraph for 2 weeks to assess their habitual nightly sleep duration and regularity. Their average daily smartphone screen use was collected over 1 week with a smartphone application. Standardized questionnaires were used to assess sleep quality and mental health symptoms.

No statistically significant associations were found between objective smartphone screen use and any sleep or mental health variables. Sleep disturbance, sleep-related daytime impairment, anxiety, and depression were positively correlated. However, regression models identified that only sleep-related daytime impairment explained unique variance in anxiety and depression when adjusted for sleep disturbance and duration, gender, age, and screen time.

Specific timing of smartphone screen use (e.g., evening use) and/or application content were not collected as part of this study.

These results conflict with prior evidence demonstrating negative relationships between self-reported smartphone screen use, sleep, and mental health. Further research incorporating objective measurement of smartphone screen use, focusing on critical periods for sleep, may provide a more nuanced picture of this relationship. Results also demonstrate the differing roles of night-time sleep disturbance and daytime sleep-related impairment in mental health. Trial Registration: Australian New Zealand Clinical Trials Registry number: ACTRN12621000132842.

To examine disability-related disparities in participation in national health screenings in South Korea and to determine how these gaps vary by disability severity, type, and socio-economic factors.

A trend analysis of screening participation from 2012 to 2020 and multivariable logistic regression for 2019-2020 were conducted using the National Health Insurance Service database, linking eligibility, health screening, and disability registration data. The cohort comprised 10,413,089 adults aged ≥40 years (20% population sample). Annual screening uptake was the outcome; predictors included disability status, severity, type, employment, sex, income, insurance, and region.

Screening uptake rose overall between 2012 and 2020 yet remained lower for people with disabilities, particularly those with severe physical, visual, communication, mental, developmental, epilepsy, and internal disabilities. Age-sex standardization and socio-economic adjustment attenuated but did not remove gaps. Employment narrowed disparities, whereas women with disabilities faced wider gaps than men.

Despite nationwide gains, disability-related inequities in preventive screening persist, amplified by severe impairment, unemployment, and female gender. Policies should prioritize accessible facilities, targeted outreach, and socio-economic support to ensure equitable screening for people with disabilities.

Coffee is one of the most widely consumed beverages worldwide, with ongoing debate regarding its potential benefits and drawbacks for human health, particularly sleep quality. Simultaneously, dietary composition-especially a predominantly plant-based diet-has been linked to better health outcomes. This study aimed to investigate how coffee intake and dominant dietary components relate to sleep quality in physically active individuals, with consideration of additional lifestyle factors such as stress and emotional well-being.

A cross-sectional survey was administered online and via QR codes displayed in sports facilities. Physically active adults (N = 392) completed a standardized questionnaire assessing sleep quality, stress, physical activity, and demographic data. Factor analysis identified underlying dimensions of interest, which were then used in K-Means clustering to group participants with similar response patterns. Statistical analyses, including the Kruskal-Wallis test and Dunn's post-hoc comparisons, determined differences in dietary and coffee consumption habits across factors and clusters.

Four factors emerged from the analysis: Stress, Health, Relaxation, and Emotional Well-being. Higher stress levels strongly correlated with poor sleep quality, while coffee consumption alone was not statistically linked to stress or sleep problems. Respondents who consumed more than two cups of coffee daily often clustered into groups reporting higher health and emotional well-being. A predominantly plant-based diet was significantly associated with better overall health scores and lower stress. Clustering analysis revealed that participants with the healthiest behaviors (Cluster 2) tended to follow plant-rich diets and reported lower stress levels and better sleep outcomes.

In a physically active population, stress appears to be a more robust predictor of poor sleep quality than coffee consumption. Moderate coffee intake may even coincide with higher health and emotional well-being scores. The findings emphasize that coffee consumption does not adversely affect sleep quality, and in fact has a positive effect on emotional wellbeing and health.

Autism spectrum disorder (ASD) is a prevalent neurodevelopmental disorder. Parents of children with ASD often have a higher level of affiliate stigma, which impacts their physical and mental health, family relationships and social functions. Nowadays, a variety of assessment tools are available for measuring this stigma, but they have many limitations. This systematic review aims to critically appraise the measurement properties of instruments used to assess affiliate stigma in parents of children with autism and help researchers and healthcare professionals make more appropriate choices when using these tools.

This protocol adheres to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. We will search five English databases (ie, PubMed, Web of Science, ScienceDirect Online, Embase and Cochrane Library) and four Chinese databases (ie, SinoMed, China National Knowledge Infrastructure, Wanfang Database and VIP information) from the databases' inception to 30 September 2025. Eligible studies will evaluate instruments measuring affiliate stigma in parents of children with autism, including self-report and observer ratings. The psychometric properties assessed will include reliability, validity, responsiveness, interpretability and clinical utility. Only primary quantitative studies published in peer-reviewed journals will be included. The search will have no limitations on language or time. Two researchers will independently carry out data extraction and quality assessment, with disagreements resolved through consensus or a third researcher. The consensus-based standards for the selection of health measurement instruments risk of bias checklist and the Grading of Recommendations Assessment, Development and Evaluation approach will be used to evaluate each measure's methodological quality and overall strength of evidence.

As this research constitutes a systematic review of pre-existing published data, formal ethics committee approval is deemed unnecessary in accordance with international research ethics guidelines. The synthesised findings will be submitted for publication in a rigorously peer-reviewed academic journal and presented at pertinent scientific conferences to ensure transparent knowledge dissemination within the academic community.

CRD420251043478.

Parental emotional socialization (PES) has been recognized as a critical mechanism in parenting programs to enhance children's well-being, especially following adversity. However, few studies have examined the potential moderating effect of baseline PES levels. This study aimed to examine whether supportive and unsupportive PES can mediate the intervention effects of a parenting program on child adjustment (Aim 1), and whether baseline PES can moderate the effect (Aim 2). This study utilized data from two randomized controlled trials for post-deployed military families (N = 335, Mage = 8.25, 54% girls). Families were either assigned to in-person intervention condition (n = 226) or a treatment-as-usual condition (n = 109). Baseline-targeted moderation mediation (BTMM) models were conducted for mothers and fathers separately, with child age, child sex, child minority status, family household income, and deployment length included as covariates. The parenting program had an indirect effect on child internalizing and externalizing problems 1-year post-baseline through reduced maternal unsupportive PES at post-intervention, while no indirect effect was found through supportive PES. Additionally, baseline PES moderated the impact of the ADAPT program on maternal supportive and unsupportive PES post-intervention, such that mothers who reported less supportive PES or more unsupportive PES at baseline benefited more. No intervention effect was found through fathers' PES. The findings underscore the crucial role of baseline PES in shaping behavioral parenting intervention effectiveness. The study highlights that one size does not fit all and future research and practice should consider the diverse needs and responses of families, emphasizing the delivery of personalized interventions to best meet parents' needs and maximize support.