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Mental health conditions account for 18% of years lived with disability worldwide. 1-in-6 adults are affected in England, with most mental health conditions beginning in childhood and adolescence. Mental distress and ill health are unequally distributed in the UK, with strong associations with wider determinants of health, and higher prevalence among systemically disadvantaged groups. Currently, there is a lack of evidence to inform effective and timely policymaking for primary prevention in the UK. In recognition of these challenges, a national Population Mental Health (PMH) Consortium was established, as part of Population Health Improvement UK (PHIUK). PHIUK is a national research network which works to transform health and reduce inequalities through change at the population level. Our aim is to establish an interdisciplinary PMH Consortium, focussing on upstream determinants and the prevention of risks and onset of mental health conditions through interdisciplinary stakeholder engagement, to create new opportunities for population-based improvement of mental health in the UK.The PMH Consortium brings together leading interdisciplinary representation in population mental health, spanning from sciences to the arts, across the UK. Membership includes six academic institutions, third sector organisations, lived experience expertise, and strong links with national bodies to ensure integrated cross-national and regional policy impact. The PMH Consortium comprises four cross-cutting platforms (Partners in policy, implementation, and lived experience; Data, linkages, and causal inference; Narrowing inequalities; Training and capacity building) and three challenge areas (Children and young people's mental health; Prevention of suicide and self-harm; Multiple long-term conditions) which are highly integrated and interdependent. The work will be underpinned by a Theory of Change across an initial four-year life cycle. This paper describes the aim, objectives, and approach of the PMH Consortium, as well as anticipated challenges and strengths. The goal of the PMH Consortium is to develop a model for population mental health research and policy translation that is both scalable and sustainable. It is critical to ensure continued impact and viability beyond the initial four years, contributing to the prevention of mental health conditions in the UK, with personal, economic, social, and health benefits.
Children with autism spectrum disorder (ASD) frequently exhibit selective eating behaviors characterized by food refusal and limited dietary variety, which can lead to nutritional deficiencies and impaired family functioning. This study evaluated the effectiveness of the Schmetterling Nutritional Behavior Intervention (NBI) Program, a creative behavioral intervention integrating established behavioral strategies with innovative components, including imitation chaining, shaping, and therapist-guided exoskeleton modeling. Three children (YW, RA, and JK) diagnosed with autism spectrum disorder (ASD) participated in a single-case experimental design. The study employed the Childhood Autism Rating Scale, 2nd Edition (CARS-2) assessing autism symptom severity, while the Child Eating Behavior Questionnaire (CEBQ) measured changes in eating behavior. Substantial increases in food acceptance were observed across all participants, with the highest improvements in food responsiveness, enjoyment of food, and food fussiness. Tau-U analysis revealed large and significant intervention effects for both therapist-implemented and parent-implemented sessions. Although CARS-2 scores remained within the 'severe' classification range, notable percentage reductions suggested clinically relevant improvements in core autism symptoms. These findings support the Schmetterling NBI Program as an individualized, evidence-based approach to enhancing dietary diversity and reducing maladaptive feeding behaviors in children with ASD. Children with autism spectrum disorder (ASD) commonly demonstrate selective eating patterns, including food refusal and restricted dietary repertoire, which may contribute to nutritional deficits and compromised family dynamics. This investigation examined the efficacy of the Schmetterling Nutritional Behavior Intervention (NBI) Program, a novel behavioral intervention that synthesizes established behavioral methodologies with innovative components such as imitation, shaping procedures, and therapist-guided training. Utilizing a single-case experimental design, three children diagnosed with ASD (YW, RA, and JK) were assessed with the Childhood Autism Rating Scale, Second Edition (CARS-2) to evaluate autism symptom severity, and the Child Eating Behavior Questionnaire (CEBQ) to measure alterations in feeding behavior. Results indicated substantial improvements in food acceptance across all participants, with pronounced enhancements in food responsiveness, enjoyment of food, and reductions in food fussiness. Tau-U statistical analysis demonstrated large and significant intervention effects for both therapist-administered and parent-implemented sessions. Although CARS-2 scores remained within the severe classification range, notable percentage reductions indicated clinically meaningful improvements in core autism symptomatology. These findings support the Schmetterling NBI Program as an individualized, evidence-based intervention for promoting dietary diversity and reducing maladaptive feeding behavior among children with ASD. Replicating our preliminary findings in a larger sample and finding evidence-based tailored interventions for children with ASD pose important challenges for future research.
A number of articles have heralded the use of artificial intelligence (AI) agents to serve as a replacement for human psychotherapists. Despite the rapid advancements in the use of both rule-based and generative AI programs in the recent past, an overall review shows only small impacts on certain mental health symptoms, particularly depression, and then only in the short-term. Significant strides forward, both in terms of technology and the development of answers to ethical questions regarding AI's use in psychotherapy, must be seen before the use of such systems becomes widespread or regularly recommended to replace human mental health clinicians.
This study investigates the effectiveness of various text representation methods in distinguishing between AI-generated and human-written content, using a corpus of 1000 Italian essays. Four techniques were employed for text representation: Text Features, Most Frequent Words (MFWs), Correspondence Analysis (CA), and a fine-tuned Large Language Model (LLM). Machine learning models, including Random Forests, Elastic-net, and Support Vector Machine, were applied to these representations. The study achieved high classification accuracy, with Text Features performing exceptionally well. However, adversarial tactics revealed vulnerabilities in models based on Text Features and MFWs, while approaches based on CA and LLM demonstrated greater resilience. CA in particular proved to be the best compromise between parsimony in the number of predictors, accuracy and robustness to targeted text-modification attacks. The research also focused on the explainability of the results, highlighting significant differences between AI- and human-written texts, including sentence structure and lexical choices. Ethical considerations, particularly in educational settings, were emphasized, along with the need for further cross-linguistic studies and diverse domain datasets. This research provides valuable insights into the challenges and potential solutions in AI text detection, emphasising the importance of balancing accuracy with interpretability and robustness against adversarial attacks.
Microglial activation contributes to the neuroinflammatory response in amyotrophic lateral sclerosis. Soluble triggering receptor expressed on myeloid cells 2 (sTREM2) reflects microglial activity in several neurodegenerative disorders, but its role in amyotrophic lateral sclerosis remains unclear. We evaluated plasma sTREM2 as a marker of microglial activation in amyotrophic lateral sclerosis (ALS) and compared its diagnostic performance with established blood biomarkers of neurodegeneration. Plasma sTREM2, neurofilament light chain (NfL), phosphorylated tau181 (Ptau181), and glial fibrillary acidic protein (GFAP) were measured in 100 patients with ALS, 30 healthy controls, and 30 disease mimics. Group differences were assessed using general linear models adjusted for age and sex. Associations with clinical variables and inflammatory markers were tested using Spearman correlation, and diagnostic performance was evaluated using receiver operating characteristic curves. Plasma sTREM2 differed across groups (p = 0.016), with higher levels in ALS compared with healthy controls (p = 0.013) and in mimics compared with healthy controls (p = 0.007), but no difference between ALS and mimics (p = 0.394). Discrimination between ALS and controls was modest (area under the curve 0.677), with no discrimination between ALS and mimics (area under the curve 0.512). No association was found between sTREM2 and disease severity or inflammatory markers (all p > 0.10). Plasma sTREM2 increases in ALS but lacks diagnostic specificity and clinical associations, supporting its role as a nonspecific marker of neuroimmune activation rather than a biomarker of disease-related neurodegeneration.
Internet gaming disorder (IGD) is associated with abnormal functional connectivity (FC) in brain networks. However, findings from resting-state functional magnetic resonance imaging studies are highly inconsistent, likely due to individual heterogeneity in IGD-related neural alterations-a feature commonly observed in other psychiatric disorders but understudied in IGD. We applied normative modeling to nucleus accumbens (NAcc) seed-to-voxel resting-state FC to derive individualized deviation (Z) maps for 173 IGD participants relative to age- and sex-adjusted normative ranges from 232 healthy controls. We then performed exploratory unsupervised clustering of network-level deviation features across three sample data, three atlas templates, and two clustering algorithms, selecting the optimal number of clusters using the silhouette criterion. IGD showed marked heterogeneity in FC deviations: voxel-level deviations were largely idiosyncratic in both spatial distribution and direction. When deviations were summarized at the network level, clustering consistently selected a two-cluster solution across data, atlases, and algorithms, separating a majority "low-deviation" stratum from a smaller "high-deviation" stratum. IGD is characterized by pronounced individual variability in FC deviations. Network-level deviations yield a robust higher- vs. lower-deviation stratification, although the present findings do not support interpreting this pattern as evidence for discrete subtypes. The present study highlights the utility of individualized deviation mapping beyond conventional case-control analyses for characterizing heterogeneity in IGD.
The purpose of this study was to measure the effect of motivational interviewing on both reducing internet addiction and digital game addiction in adolescents. A parallel-group randomised controlled trial was adopted. The study population consisted of ninth-grade (14-15 years of age) high school students in a city in Turkiye. The study was completed by 88 participants (experimental: 44; control: 44). The data were collected using a Personal Information Form, the Young Internet Addiction Test, and the Digital Game Addiction Scale. The experimental group received a preparatory session and five weekly motivational interviewing sessions. Instruments were administered to both groups before (pre-test) and after the intervention (post-test), and at follow-up tests 3 and 6 months after the final session. The data were analysed using the two-way mixed design and the Bonferroni Comparison Test. The mean scores of internet addiction and digital game addiction decreased significantly after the motivational interviewing in the experimental group compared to the control group (p < 0.001) in both the post-test and follow-up tests. The present study concluded that motivational interviewing may be associated with reductions in mitigating symptoms of internet addiction and digital game addiction behaviours among adolescents. Motivational interviewing could be implemented to reduce internet addiction and digital game addiction behaviours. Trial registration: The study was registered on a clinical trial database (NCT06721702). The study started on December 11, 2023 (actual date on which the first participant was enrolled). • Internet addiction and digital game addiction are two increasingly important problems among adolescents. • Digital games and online activities negatively affect adolescents' physical, social, and psychological health. • Motivational interviewing was an effective technique to reduce online gaming and internet addiction. • A motivational interviewing program comprising at least six sessions could be implemented to promote behavioural change in adolescents.
This study examined the prevalence of post-traumatic stress disorder (PTSD) diagnoses among pregnant women who delivered in hospitals in the United States between 2016 and 2020, and explored associations with adverse pregnancy outcomes, hospital length of stay, and hospital costs. This cross-sectional study utilised survey-weighted data from the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) to estimate sample characteristics and prevalence trends. Logistic regression models were used to analyse associations between PTSD and adverse pregnancy outcomes. Length of hospital stay and hospital costs were examined using negative binomial and generalised linear models with log link and gamma distribution, respectively. PTSD prevalence increased from 236.3 to 545.8 per 100,000 delivery hospitalisations between 2016 and 2020 (p < 0.001; average annual percentage change [AAPC] 23.0%). PTSD was associated with a higher prevalence of comorbidity, increased odds of preterm delivery (adjusted odds ratio [aOR] 1.13; 95% CI 1.08-1.18), and increased odds of fetal growth restriction (aOR 1.09; 95% CI 1.01-1.17, p = 0.03). Longer hospital stays and higher costs were also observed among women with PTSD. These findings highlight a rising prevalence of PTSD among pregnant women who delivered in hospitals in the United States over the study period. PTSD was associated with higher prevalence of comorbidity, and increased length of stay and hospital cost. Further research is warranted to investigate the reasons behind the trend, and to clarify the temporal relationship between prenatal PTSD and adverse pregnancy outcomes.
Executive function deficits are consistently associated with attention-deficit/hyperactivity disorder (ADHD), yet the expression of specific executive domains may differ across genders. Emotional regulation difficulties have been increasingly recognized as an important component of ADHD, particularly among adolescent girls, although evidence from large community-based samples remains limited. This study examined gender differences across executive function domains in adolescents, with particular emphasis on emotional regulation among those with elevated ADHD symptoms. A school-based cross-sectional study was conducted with 1,260 adolescents aged 11-18 years. Executive functioning was assessed using the Behavior Rating Inventory of Executive Function - Self Report (BRIEF-SR), and ADHD symptoms were measured with the Youth Self Report (YSR). Participants scoring in the clinical range on the YSR Attention Problems scale were classified as the high ADHD symptom group. A subsample underwent neurocognitive testing using the Stroop Color-Word Test and the Go/No-Go task. Group comparisons, correlational analyses, and interaction models were used to examine executive function domains and the influence of gender. ADHD symptoms were strongly associated with global executive dysfunction (r=0.703, p<0.001). Adolescents in the high ADHD symptom group showed substantially greater impairment across behavioral, emotional, and cognitive regulation domains compared with peers below the clinical threshold. A gender difference was observed specifically in the emotional regulation domain, with females reporting higher levels of impairment than males, while overall ADHD symptom scores did not differ significantly by gender. Neurocognitive testing in the subsample indicated longer reaction times in the incongruent condition of the Stroop task among adolescents with elevated ADHD symptoms. Emotional dysregulation appears to represent a particularly salient executive difficulty among female adolescents with elevated ADHD symptoms. These findings support the inclusion of emotional regulation measures in routine assessment and highlight the potential value of gender-sensitive approaches in the identification and intervention of adolescents with ADHD-related difficulties.
This paper offers an active inference narrative that considers discriminatory behaviour in relation to the cognitive concept of zones of bounded surprisal (ZBS). It is argued that narrow ZBS band-widths characterise the discriminatory minds of people who see themselves as an in-group. They tend not to be indignant or outspoken, but acquiescent when they witness poor behaviour of those whom otherwise they regard as members of their in-group. When such behaviour harms other people, its perpetrators have a very narrow ZBS band-width: one that likely is a characteristic of dehumanising minds. Because such perpetrators see themselves as members of an in-group with entitlement to control aspects of society, they humiliate or abuse out-groups to which they assign others, and have no compunction about violating their dignity or human rights. We briefly consider policies that could lessen the unwelcome social repercussions of the behaviour of people with discriminatory and dehumanising minds.
Recovery housing provides critical support for individuals with opioid use disorder (OUD), yet residents who use medications for OUD (MOUD) often face barriers to entry and long-term support. No existing validated instruments currently assess these barriers, which can differ by MOUD type and reflect both attitudinal stigma and logistical capacity within recovery housing settings. We developed and tested two parallel versions (Operator and Resident) of a novel tool, the Recovery Housing Barriers to Medications for Addiction Treatment (RHB-MAT) measure. Item generation was informed by literature review and structured input from current housing operators and residents, resulting in scales addressing attitudinal barriers (for both operators and residents) and capacity barriers (for operators) and MOUD type (buprenorphine, methadone, naltrexone). Surveys were administered to 145 recovery housing operators and 250 residents across the United States. Exploratory and confirmatory factor analyses were conducted to establish dimensionality. Internal consistency, and convergent, divergent, and concurrent criterion validity were examined using established measures of stigma and related constructs. Factor analyses supported a multidimensional structure, distinguishing attitudinal barriers across both groups and capacity barriers among operators. Internal consistency across scales was acceptable to strong (α = 0.74-0.92) across all but one subscale. Convergent validity was supported while divergent validity was less consistent. Concurrent criterion validity was generally demonstrated with associations between Operator RHB-MAT scores and their house's unique medication acceptance policies by MOUD type. Overall, residents evidenced higher attitudinal barrier scores than operators. The RHB-MAT represents the first validated measure of MOUD-related barriers in recovery housing, with tailored versions for both operators and residents. This tool can be used in research, policy, and practical quality improvement efforts to identify and address attitudinal and capacity-related barriers that impede access to evidence-based OUD treatment in recovery residences.
The origins of individual differences in infant social attention are not yet well understood. Two prominent lines of research identified different predictors. One points to differences with varying experiences in parent-child interaction styles while another focuses on differences in infant temperament. There is a lack of research integrating these two approaches in a single sample. The goals of this study were to test whether mother-child interaction as well as infant temperament at the age of 6 months are able to predict later social attention at the age of 12 months and whether social attention at 12 months is associated with shy temperament at 18 months. Data from a longitudinal sample of 64 mother-child dyads from a mid-sized city in Germany were being investigated. Mother-child interaction was measured using the EAS. Infant temperament was assessed with the IBQR and the ECBQ. A habituation paradigm was employed to measure infant social attention at 12 months. Several regression models showed that infant involvement in mother-child interaction positively predicted social attention, while a fearful temperament negatively predicted social attention. Moreover, the observed interaction between infant involvement and fearfulness in the sample of emotional available mothers may indicate that fearful infants who are already able to search for help by involving their mothers do not show any disadvantages in social attention. Shy temperament at 18 months was not correlated with infant social attention. Overall, our results provide further evidence on the influence of both the social context as well as individual traits on social cognitive outcomes.
Understanding how women navigate induced abortion care pathways is critical to ensuring person-centred, quality reproductive health services. Evidence indicates that persistent abortion stigma, the lack of choices of abortion methods and respectful care during abortion remain a global challenge to reproductive healthcare. Yet there is minimal evidence regarding abortion care pathways. This study explored induced abortion care pathways in Addis Ababa healthcare facilities. We used a descriptive qualitative approach, adopting purposive sampling techniques to recruit women who sought induced abortion care from seven facilities. The data were collected from May to July 2024. In-depth semi-structured interviews with sixteen women were digitally recorded and transcribed into the local language before being translated into English. Data were coded, organised, and analysed using inductive thematic analysis. Five main themes and their corresponding subthemes were developed through data analysis. Themes were: (i) social and emotional support, (ii) moral and social meanings shaping abortion care, (iii) accessibility and service delivery, (iv) perceived competency of abortion providers, and (v) physical and emotional effects of abortion. Many women attended the clinic alone, without their families, and received no support. Women often sought care at clinics away from their community due to concerns related to fear of stigma and social pressure. This study found long waiting times to receive abortion care, a lack of medicine and ultrasound at some facilities and limited availability of second-trimester abortions. Women reported that many providers were welcoming and competent, while others reported poor communication, the use of medical jargon, and stigmatising behaviours. Participant reported pressure to accept methods they did not want during contraceptive counselling and fear of breaches in privacy and confidentiality. Participants also described physical symptoms such as bleeding and pain, and felt ashamed and upset after the abortion, which could be associated with negative experiences. Inadequate social support, abortion stigma, and barriers to accessing abortion services, such as long waiting times and insufficient resources, were identified as significant gaps. These findings emphasised the need to strengthen person-centred abortion care and address systemic and socio-cultural barriers that undermine the quality of care. Abortion care should be easy to access, fair for everyone, and respectful of women’s needs. Kind communication and emotional support during abortion enhance the quality of care. This study explored abortion care experiences in healthcare facilities in Addis Ababa.We spoke with women who came for abortion care. We conducted face-to-face interviews employing open-ended questions. We analysed the data by thoroughly reading and checking the information to identify common patterns in women’s experiences.Women had varied experiences of support. Some received strong support from family or friends, which made them feel less worried and more confident. Some went through the abortion procedure alone as they feared pressure or shame. Many women felt abortion was a “sin” or morally wrong, while others felt confident that they had made the best decision for their lives. Women reported waiting times and service availability as challenges to accessing quality care. In addition, negative experiences such as feeling judged and ignored, as well as poor communication from providers, are reported. Women explained physical symptoms such as bleeding, fatigue and emotional outcomes including anxiety, guilt and self-blame after abortion. At the same time, some felt relieved after the abortion and satisfied with the care received.This study found that women faced challenges such as stigma and judgment, long waiting times, and limited availability of abortion services in some places. Improving the quality of abortion care can help women feel supported, reduce emotional distress, and protect their health and dignity.
Depression leads to a significant societal burden worldwide, yet most individuals affected lack adequate care. Digital mental health treatments (DMHTs) offer evidence-based, accessible interventions via websites, text messaging, virtual reality, and mobile apps, among other technologies. Studies demonstrate DMHT effectiveness, often comparable to traditional therapies, with high treatment acceptability and satisfaction. Key challenges include poor engagement, high attrition, and limited integration into routine care. Despite these barriers, innovations such as human support, improved reimbursement practices, patient-treatment matching strategies, and emerging AI-driven tools promise to broaden DMHTs' impact and position these programs as a frontline treatment option for depression globally.
This study investigates how Chinese breast cancer survivors reconstruct damaged identities and negotiate cultural norms to build resilience within a specific socio-cultural context. Using narrative inquiry and a life-course perspective, in-depth interviews were conducted with 15 female breast cancer survivors in Beijing. The study employed thematic narrative analysis to identify cross-cutting patterns while preserving individual story integrity. Rigor was ensured through data saturation and member checking. Resilience is manifested as a transformative narrative practice across three dimensions: (1) body narrative, survivors transition from chaos narratives to quest narratives, reclaiming identities by ascribing meaning to physical scars; (2) relational narrative, survivors negotiate the tension between Confucian gender expectations and self-care, shifting from stoic endurance to accepting vulnerability; and (3) social narrative, survivors bridge the gap between "silent island" of isolation and collective empowerment by establishing narrative communities that challenge social stigma. These findings reveal a duality of resilience-constrained by cultural structures yet empowered with agency. This study proposes a tripartite social work interventions framework, recommending that social workers act as narrative witnesses, cultural mediators, and community architects. By integrating local cultural wisdom with narrative techniques, social workers can effectively facilitate identity reconstruction and the social integration of breast cancer survivors.
A central question in visual word recognition concerns whether orthographic and phonological codes are coordinated sequentially or in parallel during lexical access. Korean Hangul, an alpha-syllabic writing system with morphophonemic spelling principles, allows independent manipulation of orthographic and phonological syllable overlap. In a masked priming lexical decision task with EEG (N= 30), we contrasted orthographically identical primes (e.g., 식-식량), phonologically overlapping primes (e.g., 싱-식량), and unrelated primes. Event-related potentials and time-frequency representations (theta: 4-8 Hz, lower beta: 13-20 Hz, upper beta: 20-30 Hz) were analyzed to capture both evoked and oscillatory neural dynamics. Orthographic priming produced a cascade of facilitative effects: early fronto-central P200 enhancement (150-250 msec) with upper beta synchronization (30-290 msec), followed by centro-parietal N400 reduction (350-550 msec) with frontal theta suppression (400-730 msec), and behavioral facilitation. Phonological priming, by contrast, elicited an inhibitory behavioral effect and sustained lower beta activity over central regions (310-590 msec) but produced no early electrophysiological modulation, consistent with lexical competition. This spatiotemporal dissociation suggests that orthographic syllable processing can emerge at early stages and cascades into later lexical-level processing, whereas phonological syllable effects are confined to later processing stages. These findings provide support for a sequential or cascaded account of orthographic-phonological coordination, as predicted by dual-route models, while challenging strong forms of parallel activation, and suggest that the alpha-syllabic structure of Korean may enable a processing strategy in which orthographic parsing serves as an efficient entry route to the lexicon.
Reading fluency depends on rapid integration of print and speech, yet the spatiotemporal mechanisms supporting this integration in school aged children remain poorly understood. This study combined fMRI and EEG to examine AV integration (i.e., additive enhancement and congruency effects) during single- and multi-letter detection tasks in 7-10-year-old children (N = 56). Multiple neural indices were examined to capture complementary spatial and temporal aspects of AV integration. fMRI results revealed additive enhancement in bilateral STG and Heschl's gyrus, congruency effects in the left IFG and left STG and increased functional connectivity between left IFG and STG during incongruent trials. EEG showed convergent temporal dynamics, with AV-related enhancement in P200 amplitude (190-230 ms) and theta-band (4-7 Hz) power over left frontotemporal electrodes. Individual differences analyses showed that additive enhancement in left STG was associated with higher spelling (β = 0.28, p = 0.034). Congruency effects in left STG (β = 0.31, p = 0.018) and left IFG (β = 0.38, p = 0.004), as well as IFG-STG connectivity (β = 0.34, p = 0.011), were linked to higher reading efficiency. Larger P200 amplitude (β = 0.32, p = 0.015) and greater theta power (β = 0.31, p = 0.021; β = 0.28, p = 0.034) were associated with higher spelling and fluency, respectively. Findings delineate complementary sensory-convergence and conflict-monitoring pathways for print-speech integration and show that integrating spatial and temporal neural indices improves explanation of reading skills in school-aged children.
Australian Aboriginal people have evolved advanced relational knowledge systems for raising children and young people over thousands of years. Documentation of this knowledge within peer-reviewed literature is dispersed across a broad set of disciplines and sources that are mostly contextualised within Eurocentric frameworks. In this scoping review, we describe the literature on Australian Aboriginal Early Relational Knowledge Systems. Our aim is to describe how Australian Aboriginal approaches to relational wellbeing uniquely promote health and human development from pre-conception, to childhood, to adolescence and into parenting next generation offspring. We privilege Australian Indigenous authors as the holders of knowledge and limit our review to data sources led by Australian Indigenous people. A systematic search for relevant studies was conducted across four databases: MEDLINE, PsycINFO, Embase and CINAHL. This yielded 5,141 articles, of which 26 met criteria. A further 5 articles were identified through citation searching resulting in 31 included articles. We describe how Aboriginal children and young people develop relational security through engagement with multiple complex social systems within family and community, through interaction with Country, and across human and non-human elements, many features of which are missed in Western theories and Western interpretation of Aboriginal relational knowledge. Culturally valid and reliable assessment measures are urgently needed to accurately represent and monitor population relational health in Aboriginal children and young people.
To examine associations between physical activity (PA) characteristics and psychosocial outcomes - quality of life (QoL) and fear of hypoglycemia (FH) - in children, adolescents, and young adults with type 1 diabetes (T1D). In this cross-sectional study, 100 insulin pump-treated outpatients T1D completed 7-day PA logs capturing timing, type, intensity, and volume. QoL and FH were assessed using age-appropriate validated instruments. General linear models evaluated associations between PA characteristics and psychosocial outcomes, accounting for age group and, in sensitivity analyses, sex and HbA1c. In pooled analyses (N = 82 complete cases), age group was significantly associated with both QoL (p = 0.037) and FH (p < 0.001), with a large effect size observed for FH. In sensitivity analyses adjusting for sex and HbA1c, the age-group effect on FH remained robust, whereas associations with QoL were attenuated. Exercise timing was associated with FH (p = 0.047), with higher adjusted FH scores observed among individuals reporting evening exercise. However, pairwise comparisons were not significant after correction. No significant AgeGroup×Timing interactions were detected. Preferred exercise type and intensity were not independently associated with psychosocial outcomes. In sensitivity analyses adjusted for sex and HbA1c (N = 62), the age-group effect on FH remained robust, whereas timing showed borderline significance. Developmental stage appears to be a major determinant of fear of hypoglycemia in youths with T1D. Exercise timing may contribute modestly to perceived hypoglycemia risk, particularly for evening activity, although findings were attenuated after adjustment. These cross-sectional associations highlight the importance of developmentally tailored exercise counselling, while longitudinal studies are needed to clarify directionality.