To assess the knowledge and attitudes of clinical and non-clinical healthcare workers related to climate change and health in Tanzania and to explore their roles in supporting sustainable healthcare practices. Multicentre, cross-sectional survey. Private healthcare facilities across multiple levels of care in Tanzania. Healthcare workers employed at participating private healthcare facilities. A total of 216 respondents completed the survey, including both clinical (65.7%) and non-clinical (34.3%) staff. Primary outcomes included healthcare workers' knowledge and attitudes regarding climate change and health, as well as their awareness of the healthcare sector's role in environmental degradation. Secondary outcomes included barriers to workplace climate action and existing engagement in environmentally sustainable healthcare practices. Over 90% of respondents recognised climate change as a significant health threat, and nearly 80% acknowledged that healthcare facilities contribute to environmental impacts. Major barriers to sustainable practices included low awareness among colleagues, budget constraints and a perceived lack of institutional or leadership support. Reported actions included responsible energy use, waste and water management and participation in climate-related education and awareness initiatives. Participants also described contributing to sustainable healthcare practices through lower-carbon clinical approaches, environmentally conscious procurement and cross-disciplinary collaboration. Healthcare workers in private healthcare facilities in Tanzania demonstrate strong awareness of climate change and motivation to support sustainability efforts. However, institutional and structural barriers limit implementation. Efforts to advance sustainable healthcare systems should focus on strengthening organisational support, increasing awareness and enabling healthcare workers to translate knowledge into action.
Studies have discussed the relation between pet ownership and several health outcomes, but the evidence remains inconclusive. It is suggested that factors related to the owner, the animal, and the human-animal relationship might explain general associations in findings. This study investigates differences in health, social support, life satisfaction, loneliness, and psychological well-being by pet ownership and regular animal contact status. It explores whether these outcomes are associated with attachment to the animal, perceived socio-emotional support from the animal, the animal species, and the amount of animal contact and how these variables relate to each other. We investigated data from a representative survey of 2,328 Swiss participants. We used health behaviour, health status, healthcare use, social support, life satisfaction, loneliness, and psychological well-being to conduct regression analyses, with pet ownership, human-animal contact, attachment to the animal, socio-emotional support from the animal, and the animal species as the predictors, while controlling for socio-demographic variables. Pet owners reported a slightly lower health status and a slightly higher frequency of unhealthy behaviour. We found no difference in healthcare use, loneliness, life satisfaction, psychological well-being, or the amount of human social support between pet owners and non-pet owners. People with regular animal contact did not differ in health status, health behaviour, healthcare use, loneliness, life satisfaction, psychological well-being, or human social support compared to people with no regular animal contact. Attachment to the animal and the animal species were not related to health, loneliness, life satisfaction, and psychological well-being, while socio-emotional support from the animal and the amount of animal contact were sometimes associated. Moreover, we found that attachment to and socio-emotional support from the animal were higher in females, in relation to dogs, and when people spent more time with the animal. We found little evidence for a general association between pet ownership or regular animal contact and human health and well-being. However, relationship-related factors, including socio-emotional support from the animal and the amount of contact with the animal, were sometimes associated with well-being. Moreover, the quality of the human-animal relationship depended on different factors, such as the amount of spent time with the animal or animal species. These findings suggest that associations between pet ownership and human health and well-being depend on characteristics of the owner, the animal and the human-animal relationship itself. Our study shows that pet ownership is a complex construct and should be conceptualised multidimensionally to understand its possible positive or negative associations with health outcomes.
Pediatric migrant health has been identified by the World Health Organization as a critical area for interdisciplinary research to improve care for children and adolescents with migration experience. Nevertheless, research agendas have rarely been shaped systematically by individuals with lived and professional experience, limiting relevance and impact. To identify and prioritize the most important unanswered research questions in pediatric migrant health in Europe through a structured, participatory priority-setting process. This multiphase survey study (April 2024 to June 2025), led by migrants and clinicians using the James Lind Alliance participatory priority-setting methodology, comprised 2 online consultations informed by Delphi procedures and a final in-person consensus workshop using a modified nominal group technique. Participants residing in multiple European countries included migrant caregivers, former migrant children and adolescents, health care workers in pediatric migrant health, and double experts with combined lived and professional experience. They were recruited via professional networks, community organizations, and open calls. The final in-person consensus workshop convened in Basel, Switzerland, in June 2025. The primary outcome was a ranked list of the top 10 unanswered research priorities in pediatric migrant health based on participant-generated questions and consensus methods. In consultation 1, 256 participants (156 [61.0%] with lived migration experience; 25 countries of residence, 41 countries of origin; 115 aged <35 years [44.9%], 138 aged ≥35 years [53.9%]; 158 female [61.7%]) submitted 1589 questions and comments, which were consolidated into 53 unanswered summary questions after qualitative content analysis and evidence checking. In consultation 2, rankings from 576 participants (214 [37.2%] with lived migration experience; 31 countries of residence, 50 countries of origin; 193 aged ≤35 years [33.5%], 364 aged ≥35 years [63.2%]; 412 female [71.5%]) yielded a short list of 25 questions. During the final consensus workshop, participants selected the top 10 research priorities. The 3 highest ranked priorities focused on universal access to health care, the health impact of racism and discrimination, and barriers to accessing care. Remaining priorities addressed health effects of migration, social determinants of health, needs of at-risk groups (including unaccompanied or undocumented minors and children with medical complexities), professional language support, training of health care workers, and family involvement in care. The research priorities identified in this survey study could provide a roadmap for future multidisciplinary and participatory research to improve health equity for pediatric migrants in Europe.
The mental health of medical students has been widely discussed, with studies reporting a high prevalence of mental health issues, including depression, anxiety, suicidal ideation and burnout. Yet, few have explored the relationship between material, social and health deprivation and these outcomes in medical students, despite the higher risk of psychological disorders when exposed to precarious living conditions. Our study aimed to explore longitudinal associations between experiencing deprivation and mental health outcomes among Swiss medical students while adjusting for protective factors. Data were collected from hour-long online surveys at two time points (November-December 2022 and November-December 2023) of an open cohort study of medical students from the University of Lausanne, Switzerland (UNIL). Data were analysed using hierarchical multiple regression models. This study was carried out by Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois (CHUV)) and the Centre for Primary Care and Public Health, UNIL. Our sample included medical students enrolled in any year of medical school studies, excluding those enrolled as part of an exchange programme. At time points T3 and T4, there were, respectively, 1941 and 1267 eligible students for participation; the final sample consisted of 631 medical students having participated at both time points (67.5% female, mean age 22.11). Deprivation was evaluated with the Deprivation in Primary Care Questionnaire (DIPCare-Q) index. Mental health variables included depression symptoms, anxiety symptoms, suicidal ideations and burnout symptoms (emotional exhaustion, cynicism, academic efficacy). Protective factors included coping skills (emotion-focused, problem-focused and help-seeking) and social support (practical and emotional support). In our final regression model, controlling for demographics (ie, age, gender, year of study and mother tongue), protective factors and baseline mental health scores, a higher overall baseline deprivation index was predictive of increased depression (β=0.14, p<0.001) and anxiety (β=0.06, p=0.046) symptoms over time, but not for suicidal ideation or burnout symptoms. Results demonstrated a significant association between deprivation and mental health longitudinally. Findings suggested that social support was protective from an increase in suicidal ideations over time. The implementation of interventions that provide material and social support may help promote improved mental health and health equity among medical students.
Engaging in respectful, evidence-based dialogue on controversial public health issues is an essential competency in undergraduate public health education, where future professionals must be able to navigate sensitive topics with diverse interest holders. In the current political context, however, such discussions can be challenging for students, underscoring the need for structured educational approaches that develop skills in critical examination, debate, and constructive communication. This study evaluates the impact of participation in PHC3603 Critical Issues in Public Health on students' confidence in their ability to engage in productive conversations on controversial public health topics, including with individuals holding differing viewpoints. Study participants included undergraduate students enrolled in PHC3603 in the Fall 2023 semester (n = 64). PHC3603 is an undergraduate course that utilizes multiple learning modalities, collaborative learning, and the creation of a welcoming class environment to help students develop the array of skills needed to meaningfully engage in productive discourse on challenging topics. Students completed a self-reflective survey in the first and last week of the course that included fourteen Likert-type and two open-ended items. Mixed-methods analysis was completed using Wilcoxon signed-rank tests and inductive qualitative content analysis. Findings demonstrate significant increases in students' perceived confidence on all quantitative measures. Qualitative findings complemented the quantitative results by illustrating students' enhanced confidence in engaging in structured discussions on controversial public health topics, including improved abilities in argument construction, critical appraisal of evidence, and application of the ARE framework. Students also reported gains in socio-emotional competencies, such as open-mindedness, empathy, active listening, and maintaining respectful and composed dialogue during challenging discussions. Findings highlight effective strategies for improving student confidence in engaging in reasoned discourse around controversial public health topics and offers evidence on effective methods for implementation in higher education. Findings further present an opportunity to increase awareness of the importance of developing student confidence and skills related to engaging in productive, evidence-based conversations on divisive public health issues.
Proactive referral, defined as a strategy to connect smokers with smoking cessation programs under the responsibility of healthcare professionals, is effective in increasing the uptake of such programs. A feasibility study in a health check-up setting of the Brief Tobacco Intervention with Proactive Referral (BTI-PR), our smoker-level implementation strategy for smoking cessation treatment (SCT), revealed that the BTI-PR could be delivered to 85.7% of smokers as intended by healthcare professionals following provider-level guidance on implementation, which included educational sessions and the provision of materials. The present study aimed to estimate smoker uptake of SCT following a multifaceted, provider-level implementation strategy in Japanese real-world health check-up settings. This single-arm, multi-center, uncontrolled hybrid type 3 effectiveness-implementation study is focused on providing stakeholders with the evidence necessary to support adoption of the BTI-PR together with its provider-level implementation strategy. The BTI-PR is a smoker-level implementation strategy for SCT which acts by motivating smokers to schedule an online SCT appointment by themselves. The provider-level implementation strategy consists of eight components: (a) conduct a training session, (b) provide a guide on the BTI-PR, (c) provide a checksheet for the BTI-PR, (d) provide a flyer on the online SCT, (e) conduct a kickoff meeting and request to discuss pre-specifiable matters, (f) schedule a pre-implementation phase, (g) request holding a review meeting and report, and (h) conduct a plenary meeting to share local knowledge. Primary outcome is the penetration of online SCT, namely the proportion of smokers eligible for the BTI-PR who attend the first session of the online SCT within 3 months after receiving the BTI-PR. Data collection was completed in February 2026. A total of 24 healthcare professionals who received the provider-level implementation strategy delivered the BTI-PR to smokers to explore the primary outcome. The final analyses were commenced in March 2026. This study is expected to support the adoption of proactive referral together with an implementation strategy in health check-up settings, although causal inference remains limited. The findings will contribute to the implementation of effective smoking cessation support into preventive health services. https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000064502; UMIN-CTR, number UMIN000056447.
Specialized outpatient palliative care (SOPC) provides home-based care for terminally ill patients and is associated with improved quality of life and prolonged survival. Due to its decentralized structure and growing demand, SOPC is a key target for digital transformation. Telehealth, mobile health, and AI offer considerable potential benefits but also present challenges, particularly with regard to user acceptance. Although both children and adults receive SOPC under the German statutory health insurance system, services differ in terms of patient characteristics, duration of care, and geographic coverage. Moreover, there is limited knowledge regarding the extent to which digital health applications are transferable across different areas of palliative care. This study assesses the extent to which needs and concerns regarding digitalization in SOPC for children are transferable to adult SOPC, using the PalliDoc Mobile app as a case example. Two adult SOPC teams using the PalliDoc Mobile app (a pediatric-origin mobile app) were surveyed between March 2022 and March 2025 using an embedded mixed methods design to assess digitalization needs and concerns. Therefore, a focus group study took place in the respective offices of the included teams. Twenty-five members from both teams, who were recruited via the personal network of the authors, participated, representing urban and rural care areas in Germany. Using an open-ended interview guide, the needs and concerns were first discussed with all participating members of each team. In a second step, the participants were allocated to profession-specific subgroups to further explore and prioritize the identified needs using a quantitative voting format. The focus group discussions were analyzed using qualitative content analysis, while the analysis of the prioritization votes was performed using descriptive statistics. The triangulation of qualitative and quantitative findings revealed a total of 13 needs within the examined care teams for adults, with functions focusing on voice control being the highest priority (n=8 positive votes and no negative votes for voice input; n=6 positive votes and no negative votes for voice output). Additionally, functions relating to digitization and organizational tasks were viewed as predominantly helpful. Unlike in pediatrics, telehealth functions like video contacts, telemetry, and electronic patient-reported outcome measures are neither used here now nor intended to be used in the future. The identified concerns predominantly addressed the potential risk of AI-assisted documentation (n=2 positive votes and n=7 negative votes) altering or distorting health care professionals' perception of information related to patients. Cross-setting telehealth applications may work, but they are no "plug-and-play solution." Needs and concerns in each setting should be addressed to guarantee customized services.
Monitoring of population mental health is now considered to play a vital role in health, risk factor and demographic surveillance systems across the globe. Adopting a public mental health perspective on monitoring and surveillance requires us to consider the entire spectrum of mental health, which broadly ranges from positive mental health and well-being to severe mental disorders, including at-risk populations. This population mental health approach has become the mainstay of public mental health provision in many European countries but there is a dearth of research on this issue in Germany in the past 20 years and fundamental conceptual and methodological issues remain to be addressed at both the national and international levels. The Mannheim incidence and inception cohort study is a recently established two-arm population-based incidence (arm 1) and inception cohort (arm 2) study in the catchment area of Mannheim, Germany. In the incidence-arm, case ascertainment of incident cases is carried out for the years of 2024 and 2025 based on clinical assessment via structured clinical interviews and retrospective case record evaluation. In the inception cohort arm, we recruit and follow an epidemiologically characterised population-based cohort of individuals (1) without symptoms (ie, stage 0), (2) meeting the criteria for non-specific psychological distress (ie, stage 1 a) or (3) a Clinical High At-Risk Mental State for severe mental disorder (ie, stage 1b) at baseline and up to four follow-up assessments every 6 months. Assessments include clinical interviews, self-report measures and ecological momentary assessment.Poisson regression will be conducted to quantify variation in incident rates by age, sex and migrant/ethnic minority group status. In the inception cohort arm, we will perform maximum likelihood estimation of hazard rates to estimate rates of transition from earlier stages to later stages. Latent class analysis will be used to identify empirically-based clinical stages to test convergence with contemporary staging models. The study has received ethical approval from the local ethics committee (Medical Faculty Mannheim, Heidelberg University, 585-21). Results will be published in peer-reviewed journals, presented at academic conferences and disseminated through (social) media to address a broader public audience.
The study "The psychological and physical health and well-being of New Zealand contemporary Veterans" represents one of the few large population studies conducted on contemporary Veterans in New Zealand. Included in this survey was an open-ended question allowing respondents to articulate their thoughts, opinions, or feedback on the Veteran experience. Responses were analyzed using qualitative content analysis framework informed by Mayring's (2022) eight-step content analysis process. A hybrid deductive-inductive approach was used to generate sub-themes from participants' responses, which were categorized under the World Health Organization's four domains of well-being (psychological, social, environmental, and physical). In this study, responses from 1,037 Veterans were analyzed and put into 22 sub-themes and four overarching themes. While many participants expressed positive gains due to their military service, challenges in psychological, social, environmental, and physical well-being were evident. Positive outcomes included gaining educational achievements, career skills, and personal growth and development. Challenges included issues such as posttraumatic stress disorder, depression, anxiety, moral injury, identity confusion, internalized stigma, stereotyping, the strain of demanding work on family life, hearing loss, musculoskeletal problems, and concerns regarding toxic chemical exposure. Veterans face challenges in all four domains of well-being. Despite encountering difficulties, there is a reluctance or social stigma associated with Veterans seeking help for their well-being concerns, compounding the challenges they face. Additionally, Veterans perceive a need for more accessible and effective support services. Transitioning from military to civilian life presents practical and emotional challenges that often impact Veterans’ sense of identity, health, family relationships, and social acceptance. Many Veterans struggle to reintegrate with their families and face difficulties accessing civilian support services that may not fully understand their unique needs. For this reason, collecting direct feedback from Veterans effectively captures both the barriers and supports for a successful transition. In this study, 1,037 New Zealand Veterans shared their experiences — both the positive outcomes, like gaining new skills, education, and personal growth, and the challenges. Veterans reported issues such as mental health struggles, identity conflicts, family strain, hearing loss, and concerns about exposure to harmful chemicals. Despite these well-being challenges across all areas of life, many Veterans hesitate to seek help because of social stigma or personal reluctance. Veterans strongly expressed the need for better, more accessible support services to ease the transition process. L’étude intitulée The psychological and physical health and well-being of New Zealand contemporary Veterans représente l’une des quelques grandes enquêtes en population réalisées auprès des vétéran.e.s contemporain.e.s de la Nouvelle-Zélande. Une question ouverte en faisait partie, afin que les répondant.e.s puissent exprimer leurs réflexions, leurs opinions ou leurs commentaires sur l’expérience des vétéran.e.s. Les réponses ont été évaluées d’après un cadre d’analyse de contenu qualitatif éclairé par le processus d’analyse de contenu en huit étapes de Mayring (2022). Une approche déductive-inductive hybride a permis de produire des sous-thèmes à partir des réponses des participant.e.s, classées en vertu des quatre domaines de bien-être (psychologique, social, environnemental et physique) de l’Organisation mondiale de la Santé. Dans cette étude, les réponses de 1 037 vétéran.e.s ont été analysées et réparties en 22 sous-thèmes et quatre thèmes principaux. De nombreux participants ont exprimé avoir acquis des gains grâce à leur service militaire, mais éprouvaient des difficultés évidentes en matière de bien-être psychologique, social, environnemental et physique. Les résultats positifs incluaient le niveau d’instruction, les compétences professionnelles ainsi que la croissance et le développement personnels. Les difficultés incluaient des problèmes comme le trouble de stress post-traumatique, la dépression, l’anxiété, les blessures morales, la confusion d’identité, la stigmatisation internalisée, le stéréotypage, le fardeau d’un travail exigeant sur la vie familiale, la perte auditive, les problèmes musculosquelettiques et les préoccupations découlant de l’exposition à des produits chimiques toxiques. Les vétéran.e.s font face à des défis dans les quatre domaines du bien-être. Pourtant, une réticence ou une stigmatisation sociale est associée aux vétéran.e.s qui réclament de l’aide pour leur mal-être, laquelle s’ajoute à leurs difficultés. De plus, les vétéran.e.s affirment avoir besoin de services de soutien plus efficaces et plus accessibles. La transition de la vie militaire à la vie civile comporte des difficultés pratiques et affectives qui ont souvent des effets sur le sentiment d’identité, la santé, les relations familiales et l’acceptation sociale des vétéran.e.s. De nombreux.ses vétéran.e.s éprouvent de la difficulté à réintégrer leur famille et à accéder à des services de soutien civils qui ne comprennent peut-être pas pleinement leurs besoins particuliers. Pour cette raison, la collecte de commentaires directement auprès des vétéran.e.s saisit avec efficacité à la fois les obstacles et les mesures de soutien à une transition réussie. Dans cette étude, 1 037 vétéran.e.s néo-zélandais.e.s ont confié leurs expériences, c’est-à-dire autant les résultats positifs, comme l’acquisition de nouvelles compétences, l’instruction et la croissance personnelle, que les difficultés. Les vétéran.e.s ont confié éprouver des difficultés comme des problèmes de santé mentale, des conflits d’identité, des tensions familiales, une perte auditive et des craintes d’exposition à des produits chimiques néfastes. Malgré ces enjeux liés à leur bien-être dans tous les aspects de leur vie, de nombreux.se vétéran.e.s hésitent à demander de l’aide à cause de la stigmatisation sociale ou d’une réticence personnelle. Les vétéran.e.s ont exprimé fortement la nécessité de disposer de meilleurs services de soutien, plus accessibles, pour faciliter le processus de transition.
Wildfires are projected to increase in frequency and severity, yet their mental health consequences, particularly the social factors associated with vulnerability, are not well understood. To estimate the association between wildfire exposure and psychological distress and to assess the social factors that modify this association. In this longitudinal survey study, a probability-based internet panel of Los Angeles County residents in California was surveyed monthly, before and after the January 2025 wildfires, generating prefire measures of social vulnerability, postfire measures of wildfire impact, and prefire and postfire mental health assessments. Residence in an evacuation warning or order zone during the January 2025 wildfires, based on respondents' residential census tracts. Psychological distress was measured monthly using the validated 4-item Patient Health Questionnaire (PHQ-4; range, 0-12, with higher scores indicating greater distress); subscales assessed anxiety and depression. Two-way fixed-effects (TWFE) models with respondent and month-year fixed effects were used to estimate wildfire-associated mental health changes. The analytic sample included 1510 adults (mean [SD] age, 47.2 [15.5] years; 924 [61.2%] female) and 31 632 respondent-month observations spanning October 1, 2023, through December 31, 2025; at wildfire onset, 143 (9.5%) were residing in an evacuation order or warning zone. TWFE models interacting wildfire onset with evacuation zone residence indicated that evacuation zone residents experienced a 0.28-point greater increase in PHQ-4 score (β [SE] = 0.28 [0.09]; P = .002) after wildfire onset. This association showed no significant attenuation over the 11-month follow-up and was concentrated among individuals with household incomes below $100 000, extreme housing cost burden, prefire psychological distress, or limited instrumental social support. Subscale analyses suggest that the increase in PHQ-4 scores was associated primarily with increases in anxiety; after wildfire onset, evacuation zone residents exhibited greater increases in both anxiety (β [SE] = 0.17 [0.05]; P = .002) and depression (β [SE] = 0.12 [0.05]; P = .02), but only anxiety increased significantly from its prefire baseline. In this longitudinal survey study of Los Angeles County residents, residential exposure to the January 2025 wildfires was associated with increased psychological distress, but only among individuals with preexisting psychosocial or economic vulnerabilities. Policies that strengthen housing security and instrumental support networks may reduce wildfire-related mental health burdens.
Mental health conditions are prevalent during adolescence, but access to early evidence-based treatments remains limited. Scalable, online, theory-based transdiagnostic interventions delivered in primary care have the potential to reduce this treatment gap, but the effectiveness remains unknown. The objective is to investigate whether an online transdiagnostic emotion regulation treatment for adolescents with mental health conditions is superior to an active control treatment. This single-blind, randomised clinical superiority trial will evaluate the effectiveness and cost-effectiveness of an online transdiagnostic emotion regulation treatment for adolescents with mental health conditions within primary care in Sweden. We aim to include 388 participants (adolescents aged 12-17 years with mental health conditions and their parents), recruited through primary care and self-referral. Patients will be randomised to either an online transdiagnostic emotion regulation treatment or an active control treatment. Participants will receive 6 weeks of therapist-guided online transdiagnostic emotion regulation treatment or an active control treatment consisting of 6 weeks of online supportive treatment. Parents will participate in parallel with their adolescents in both conditions and will receive an online parent course. The primary outcome, assessed by blinded assessors, will be clinical global symptom severity measured with the Clinical Global Impressions-Severity scale. Treatment effectiveness will be evaluated through blinded assessment and self-assessment at primary endpoint (immediately after treatment) and 3 months after treatment. In addition, a health economic evaluation will be conducted. The study will be undertaken between October 2023 and July 2026. The study has obtained ethical approval from the Swedish Ethical Review Authority. Findings will be disseminated in peer-reviewed publications and presented at scientific conferences. NCT06067165.
Growing engagement with digital spaces among children and adolescents increases the risk of negative online experiences (NOE). This study examined the prevalence, risk factors, and reporting barriers for NOE among youth with mental health and neurodevelopmental conditions. A cross-sectional, mixed-methods study between January and July 2023 was conducted using a community-based sample from the Child Mind Institute's Healthy Brain Network. A total of 1,009 youth aged 9 to 15 years (58.4% male; mean age = 11.79 years, SD = 1.71 years) completed a quantitative survey. A subsample (n = 109) participated in a qualitative follow-up involving a 3-day moderated online bulletin board. Of the 1,009 participants, 26.6% experienced NOE in the previous year, with 68.7% reporting multiple incidents; however, 80% did not report them. Factor analyses identified 3 key reporting barriers: reporting process, reporting policy, and emotional barriers. Social aptitude, mental health symptoms, and parenting style predicted youths' likelihood of encountering NOE and key reporting barriers. Qualitative findings indicated that reporting decisions involved assessing malice, perpetrator intent, and NOE type; ambiguity in these areas contributed to reporting uncertainty. This study highlights the gap between the high prevalence and low reporting rates of NOE among youth with mental health and neurodevelopmental conditions. Identified demographic, clinical, and family factors were associated with increased risk of experiencing NOE and the 3 reporting barriers. Findings underscore the need for targeted, developmentally appropriate strategies involving policymakers, technology developers, clinicians, and educators to support safer online environments for at-risk youth. • Educate children and families about online reporting processes using developmentally appropriate, clear, and accessible language.• Encourage parents to adopt consistent, supportive involvement in their children's online activities, as positive parenting was associated with lower risk and reporting barriers.• Address emotional barriers by normalizing help-seeking, validating fears of embarrassment or retaliation, and connecting youth with safe peer or adult support.• Collaborate with schools and digital platforms to advocate for user-friendly reporting tools and resources tailored to younger or more vulnerable users. Children with mental health conditions often face bullying or harassment online. This cross-sectional study of over 1,000 youths examined negative online experiences and reporting patterns. Despite negative online experiences being common, few youths reported them. Barriers included not knowing how to report, doubting action would be taken, and feeling strong emotions. These findings may guide families, schools, clinicians, and technology companies in creating safer online spaces.
Free voluntary counselling and testing (VCT) interventions improve access to HIV and sexually transmitted infections prevention, particularly for underserved populations. Financial barriers are widely recognised as a key deterrent to testing uptake in vulnerable populations. In 2023, Zurich (Switzerland) introduced a pilot programme offering free VCT for young people and low-income residents. This study explores healthcare professionals' (HCPs) experiences with implementing the programme, with a focus on perceived benefits, barriers and opportunities for improvement. We conducted a qualitative descriptive study based on semistructured interviews with HCPs. Two clinics participating in a city-wide pilot programme providing free counselling and testing in Zurich, Switzerland. 12 HCPs (60% response rate) from the two participating clinics were interviewed. HCPs' perceived benefits of the programme, barriers to uptake, underserved populations and recommendations for improvement. HCPs viewed the programme as an effective entry point into sexual healthcare for young people and first-time testers, particularly due to the removal of financial barriers. Counselling was seen as its most important component, promoting knowledge-sharing and early engagement in preventative healthcare. While the programme successfully reached well-informed, highly educated individuals, key high-risk groups, including vocational students, conservative individuals, asylum seekers and those under 18, remained underserved. Reported barriers included stigma, misinformation and long appointment waiting times. HCPs recommended improved outreach to vocational schools, more inclusive educational materials and mobile testing initiatives to improve accessibility. HCPs consider free VCT programmes a critical tool for equitable access to sexual healthcare. However, to maximise their reach and impact, targeted, context-sensitive strategies are needed to engage underserved and high-risk populations more effectively.
Sexual and reproductive health and rights (SRHR) education is particularly important in wartime Ukraine, where young people face disrupted access to services, persistent socio-cultural taboos, and increased vulnerability related to conflict. However, little is known about how Ukrainian students and future professionals understand and make sense of SRHR. This study explored how SRHR was conceptualised in pre-course written responses and articulated in post-course focus group reflections, and how these framings related to students' future professional readiness in wartime Ukraine. A qualitative exploratory design was used. Data comprised pre-course open-ended responses (n = 15) and post-course focus group discussions (three groups; n = 16) from voluntary participants of the same international SRHR course. The two datasets were analysed using framework analysis and treated as complementary qualitative sources rather than as matched individual-level pre-post data. Pre-course written responses showed that students mostly understood SRHR in biomedical and informational terms, focusing on reproductive health, contraception, sexually transmitted infections, and access to medical services. In post-course focus group reflections, SRHR was discussed more broadly, with attention to psychological, social, ethical, institutional, and rights-based dimensions: students reflected on professional responsibility, youth-friendly services, structural barriers, and the importance of SRHR in the context of war. Transformative learning-based SRHR education provided a useful context for broader reflection on sexual and reproductive health and rights among future professionals. Integrating such courses into higher education may support professional reflection and preparedness for SRHR-related practice during war and post-war recovery in Ukraine.
Background: The COVID-19 pandemic heightened exposure to potentially traumatic events (PTEs), such as severe illness or the loss of a loved one. Its prolonged nature may have influenced how mental health symptoms evolved.Objective: This study examined changes in posttraumatic stress symptoms (PTSS) and mental wellbeing over time and identified factors contributing to differences in these outcomes.Method: Panel survey data were collected from Dutch youth and adults between March 2022 and June 2024. Participants reported PTEs during the pandemic and whether they still felt affected by these events. PTSS were measured with the PCL-5, anchored to their most distressing event. Mental wellbeing was assessed using the MHI-5. Mixed-effects models examined how risk factors influence severity of PTSS and mental wellbeing. Qualitative analysis of an open-ended question provided insight into the influence of the COVID-19 pandemic on how participants' coped with PTEs.Results: 5,782 observations (of 3,445 individuals) were analysed. PTSS declined slightly over time, but personal vulnerability factors were more strongly associated with PTSS than event-related factors. For mental wellbeing, only personal vulnerability factors were significant covariates. Thematic analysis of the open question revealed four main themes: lack of social contact and support, (interference with) mourning rituals, fear and uncertainty surrounding infection, and renewed appreciation for life and relationships with others.Conclusions: Our findings indicate that personal vulnerability factors and the broader pandemic context, which disrupted normal social coping mechanisms, played a prominent role in the aftermath of pandemic-related trauma. In future public health crises, policies should aim to maintain social connectedness and emotional support to promote psychological recovery. Posttraumatic stress symptoms declined slightly over time in Dutch youth and adults exposed to pandemic-related traumatic events.Personal vulnerability factors showed stronger associations with posttraumatic stress symptoms and mental wellbeing than event-related factors.The pandemic disrupted normal coping processes by hindering social support, mourning rituals, and increasing fear and uncertainty.
Adolescents in low-resource settings hold positive attitudes toward sexual and reproductive health (SRH) services, yet fail to use them. This study presents a theoretical reinterpretation of mixed-methods data (N = 408 adolescents, aged 13-19) from Uganda's Busoga region, through Festinger's Cognitive Dissonance Theory. Quantitative findings showed health-seeking attitudes predicted SRH service utilization (β = 0.910, p < .001) and future intentions (β = 1.976, p < .001), but 52% of adolescents had no SRH service contact in past year, and mean uptake scores remained below 2.0 on a 5-point scale. Qualitative analysis of focus group discussions identified three dissonance-reduction strategies: avoidance of health facilities, rationalization through misinformation, and selective information-seeking from peers. The reinterpretation proposes four intervention strategies: barrier reduction, community norm campaigns, cues to action with immediate access, and targeted messaging for working and rural adolescents. Addressing psychological discomfort and structural barriers may help close the attitude-behaviour gap.
Behavioural interventions remain the cornerstone of evidence-based practice for addressing the core symptoms of autism spectrum disorder (ASD). The Skill Training Program for Parents with ASD Children (STPAC) is a group intervention programme for parents and the first parent-mediated intervention programme developed by Chinese clinical practitioners. This study was conducted to evaluate the feasibility and effectiveness of STPAC within the context of routine child healthcare services in China. This is a real-world, multi-site implementation study employed a single-arm, pre-post design. Between July 2023 and June 2025, 128 families of toddlers (aged 18-54 months) with suspected or diagnosed ASD were enrolled from two child healthcare settings. Participants received the 8-week, group-based parent training programme, which integrated didactic lessons, video modelling and individualised coaching. Outcomes were assessed at baseline and post-intervention using parent-reported measures: the Knowledge of Autism Intervention Questionnaire (KAIQ), the Communication and Symbolic Behavior Scales Developmental Profile (CSBS DP) and the Parenting Stress Index-Short Form (PSI-SF). Statistical analysis included paired-samples t-tests to evaluate within-group changes, with effect sizes (Cohen's d) calculated to quantify the magnitude of improvement. Parental knowledge of autism intervention strategies increased substantially (mean improvement=6.26 points, p<0.001; d=1.17). Child communication and symbolic skills also improved, with the CSBS DP total score rising from 35.30 to 40.88 (p<0.001; d=0.99), representing an overall improvement rate of 85.7%. Furthermore, parenting stress decreased from clinically significant to normal levels (mean reduction=3.70 points, p=0.005). The intervention was equally effective across diverse family demographics, and baseline child communication ability was the strongest predictor of post-intervention gains. Despite an attrition rate of approximately 30%, STPAC demonstrated feasibility as a parent-mediated intervention delivered by trained local clinicians within routine child healthcare settings. Participation in the programme was associated with improvements in parental knowledge, child social communication and parenting stress. These findings provide preliminary evidence supporting the potential of STPAC to expand access to early ASD intervention, though confirmation in a randomised controlled trial is warranted.
Psilocybin-assisted therapy (PAT) shows promise for treating PTSD in adults but hasn't been studied in U.S. military Veterans, who face higher symptom severity and suicide risk. This open-label pilot trial evaluated the safety and feasibility of PAT in Veterans with severe, treatment-resistant PTSD. The clinical trial was pre-registered at ClinicalTrials.gov (NCT05554094). The eligibility criteria were that participants be U.S. military Veterans aged 21-64 with a DSM 5 diagnosis of PTSD for at least six months, and a Clinician-Administered PTSD Scale for DSM 5 (CAPS-5) total severity score ≥35. PTSD was also required to be treatment-resistant. Clinical outcomes were assessed at the Center for Psychedelic Drug Research and Education in Columbus, OH. Twelve participants received eight hours of therapy followed by two psilocybin dosing sessions at 15 mg and 25 mg, spaced 2-3 weeks apart, of synthetic psilocybin, along with approximately eight hours of post-psilocybin therapy. Follow-up occurred at four weeks post-second dosing. The primary endpoints were safety (i.e., the type, severity, frequency of adverse events) and suicidal ideation/behavior (as measured by the Columbia Suicide Severity Rating Scale (CSSR-S)) from baseline to 1-month post-second psilocybin administration. The secondary endpoints were PTSD symptom severity rated by a clinician and the participant. Exploratory analyses included the impact of psychotherapy and expectancy on PTSD symptom severity. Of the 668 participants who completed the online pre-screener, 13 consented and enrolled, 1 withdrew before the first dosing session, and 12 fulfilled the study requirements. No serious adverse events occurred; non-serious adverse events included headaches, anxiety, and dizziness. There was no increase in suicidal ideation or behavior during the trial, and heart rate and blood pressure remained within safe limits during the psilocybin sessions. There was a large (d = 2.30) and significant (p < 0.001) reduction (mean difference = 27.5, 95% CI: 19.9 to 35.1) in clinician-rated PTSD symptoms from baseline through 1-month follow-up, with 75% having a treatment response and in remission from PTSD. While expectancy did not predict changes in PTSD symptoms, pre-dosing symptom change during the preparation phase of treatment did. Clinician adherence ratings were 98% across all study visits. Findings reveal that PAT is safe, well-tolerated, and shows preliminary clinical improvement for PTSD, suggesting that PAT may offer therapeutic relief for Veterans with severe treatment-resistant PTSD. This study explored whether psilocybin-assisted therapy (PAT), a therapeutic approach being studied for the treatment of several mental health conditions, could help U.S. military Veterans with severe treatment-resistant posttraumatic stress disorder. Veterans completed therapy sessions before and after receiving two doses of psilocybin. Researchers monitored safety and changes in PTSD symptoms for one month after treatment. No serious safety problems occurred, and most side effects were mild, such as headaches or brief anxiety. Veterans showed large improvements in PTSD symptoms, and many no longer met criteria for PTSD after one month. These results suggest PAT may offer meaningful relief for Veterans who have not found help through standard treatments. More research with larger groups is needed to confirm these results.
The family-centred care (FCC) is a model that emphasises the active participation of family members in patient care decisions, fostering collaboration and recognising families as vital partners in the healthcare journey, with evidence linking it to improved neonatal outcomes and parental satisfaction. In Nigeria, where neonatal mortality remains among the highest globally, evidence on FCC integration, particularly from the perspectives of both parents and health workers, is scarce. To explore the enablers and challenges of FCC for preterm newborns in a tertiary neonatal unit in Northern Nigeria, drawing on the lived experiences of parents and nurses. We conducted a qualitative study in the neonatal intensive care unit of Federal Teaching Hospital Gombe, Nigeria, between April 2023 and April 2024. Purposive sampling recruited parents of preterm infants who had been discharged and neonatal nurses. Three focus group discussions (FGDs) with 20 parents and one FGD with 14 nurses were held. Sessions were conducted in English and Hausa, transcribed, translated where necessary and analysed thematically using Braun and Clarke's framework with NVivo V.10 software. Parents identified enablers such as the intrinsic value they derived, supportive structure and confidence/readiness to care for the baby. Challenges included the burden and stress associated with FCC, culture and attitude as well as role negotiation within the unit. Nurses highlighted enablers including job satisfaction and reduced workload, but expressed concerns over parental interference and resistance to change. The findings underscore the dynamic interplay of facility, staff and family factors in shaping FCC implementation. FCC is acceptable and valued by parents in our neonatal setting, with important implications for neonatal policy and service delivery. Implementation of FCC is strongly influenced by the interaction of individual, institutional and community-level factors that shape parental engagement and experience.
There is limited research comparing patient- and clinician-reported health-related quality of life (HRQOL) in patients with infections. To compare what patients with complicated urinary tract infections (UTIs) describe about their HRQOL with the perceptions of their treating clinicians. This qualitative study used semistructured interviews of hospitalized patients with complicated UTI and clinicians who cared for them for at least 2 days at 2 academic hospitals in the southeastern US. The interviews were conducted between February 7 and May 26, 2023, with the analysis completed between May 1, 2023, and September 3, 2024. The main outcome was how clinician perceptions and patient experiences and descriptions aligned and diverged for different aspects of patient HRQOL. Directed content matrix and team-based qualitative techniques were used to facilitate analysis and presentation. Interviews were conducted with 12 patients (median [IQR] age, 70 [60-78] years; 7 male [58.3%]) and 16 clinicians (median [IQR] age, 35 [31-43] years; 9 female [56.3%]). Four key concepts were identified: (1) the full range of impact of complicated UTI symptoms on patient functioning was not consistently recognized by clinicians, (2) clinicians' perceptions of HRQOL were influenced by patients' medical conditions and concerns about misattribution of symptoms to a UTI, (3) different terms and level of detail were used by patients and clinicians to describe HRQOL associated with complicated UTI, and (4) clinicians believe that HRQOL is important but approach their role in addressing HRQOL with varied experience and comfort. This qualitative study of patients and their treating clinicians found important differences in how patients and clinicians perceive and describe the impact of complicated UTI on patient HRQOL. Understanding how patient and clinician perceptions of HRQOL diverge may help with the design of patient-centered outcomes for clinical trials and identify areas for enhanced patient-clinician communication.