Individuals with mental health difficulties (MHD) have a substantial reduction in life expectancy compared to the general population. It is increasingly recognised that mental health services need to improve physical healthcare as a priority. Sexual health, including consideration of high-risk sexual behaviours, medication side effects, and challenges in romantic relationships, is a further important but under-recognised aspect of overall health. We discuss some of the current issues relating to physical and sexual health, with a particular focus on youth with MHD and how we might implement holistic care in Ireland. Prioritising the resourcing of these issues could facilitate the implementation of a Shared Model of Care as recommended in Ireland’s National Mental Health Policy, Sharing the Vision.

In a normal pregnancy, glucocorticoids (GC), such as cortisol, play an essential role in early heart development. GC concentrations surge in late gestation to facilitate the maturation of fetal systems in preparation for birth. However, pregnancy complications related to stress, lifestyle factors, disease, and commonly used antenatal care treatments (GC therapy and artificial reproductive technology) can lead to prematurely increased GC concentrations that are detrimental to the heart before it is mature enough to benefit. These findings underpin the hypothesis that GC play a double-edged role that benefits normal heart development but is potentially harmful when dysregulated. However, the mechanisms by which both physiological and pathological elevations in GC concentrations influence the fetal cardiometabolic pathways that lead to detrimental long-term cardiovascular outcomes remain unclear. This review will, firstly, describe how cortisol regulates different aspects of cardiac development and, secondly, compare findings from different animal models that have provided mechanistic insight into how excess cortisol/GC during pregnancy impacts cardiac health across the life course.

Mental health symptoms pose a significant vulnerability to stressful life events among currently married women, adversely impacting their overall well-being and quality of life. This study explores the spatial patterns and factors associated with anxiety, depressive symptoms and the co-occurrence of both symptoms among currently married women of reproductive age in Bangladesh. This study utilised data from 13,372 (weighted) currently married women aged 15–49 years in the Bangladesh Demographic and Health Survey (BDHS) 2022, which used a cross-sectional design. Multivariable logistic regression models determined the associated factors. Additionally, spatial distribution and hotspot analysis were conducted using ArcGIS version 10.8. The weighted prevalence of moderate to severe anxiety, depressive symptoms and co-occurrence of anxiety and depressive (CAD) symptoms among currently married women of reproductive age was 4.1% (95% confidence interval [CI]: 3.8%, 4.5%), 4.8% (95% CI: 4.7%, 5.4%) and 2.2% (95% CI: 2.1%, 2.6%), respectively. Clustering of anxiety symptoms (Moran’s I = 0.063, p < 0.001), depressive symptoms (I = 0.091, p < 0.001) and CAD symptoms (I = 0.082, p < 0.001) were observed, with hotspots in Rangpur, Sylhet and Chittagong regions. Logistics regression analysis shows that currently married women who were living in the Barishal, Khulna, Rangpur and Sylhet regions, who belong to households with a higher wealth index, who experienced high levels of intimate partner violence (IPV), have completed high school, who are sexually inactive and whose husbands are unemployed, were more likely to experience CAD symptoms. Additionally, currently married women of reproductive age, whose age was 25–34 years, who are labourers, whose pregnancies are terminated and who have ≥5 children ever born, are at a higher risk of having anxiety symptoms. Besides, currently married women aged 25–34 years and 35–44 years, who are underweight, were more likely to have depressive symptoms. The findings highlight a significant regional disparity in the burden of anxiety, depressive and CAD symptoms among currently married women of reproductive age in Bangladesh. These findings can help design site-specific programmes and actions for women in the hot spot areas of Rangpur, Sylhet and Chittagong.

There is substantial international variation in recommended vitamin C intake levels. In the United States, the recommendation is 90 mg/day for men and 75 mg/day for women, while in the United Kingdom (UK), the current recommendation – established in 1991 – is only 40 mg/day for adults. This UK level was based on the 1953 Sheffield study, which found that 10 mg/day prevents scurvy, with 40 mg/day chosen as the recommended level for yielding somewhat higher plasma levels. In this commentary, we argue that the UK recommendation overlooked key evidence available at the time. Specifically, at least six controlled trials published before 1991 reported benefits from vitamin C supplementation in participants whose baseline vitamin C intake was already 40 mg/day or higher. One randomized controlled trial, published in 1993, found benefits from vitamin C supplementation even at a baseline intake of about 500 mg/day; however, this trial involved ultramarathon runners, and the findings should not be broadly generalised. Nonetheless, such results challenge the assumption that 40 mg/day is universally adequate to maintain full health. We also highlight that the UK recommendations were narrowly focused on preventing dermatological symptoms of scurvy, despite strong evidence – even at the time – that vitamin C deficiency can also cause cardiac dysfunction and greater morbidity due to respiratory infections. We conclude that the current UK vitamin C recommendation should be re-evaluated in light of controlled trial evidence and broader clinical outcomes.

This position statement provides guidelines for health professionals who are considering online or direct-to-consumer genetic testing for their patients. It presents the major issues around online and direct-to-consumer (DTC) testing including how it is accessed, motivations for accessing testing and how to return these results. Online or DTC recommendations include: (1) DTC testing should only be done by individuals/consumers who are well informed, aware of the risks, benefits and limitations of testing, and able to consent for their DNA to be collected, analyzed and potentially stored. Where possible, individuals/consumers should also be aware of the alternative option of undertaking testing through healthcare professionals in a clinical context, and the benefits of this. (2) Decisions about having a child tested should be based on peer-reviewed, published evidence. Genomics testing for children should be within a clinical context where parents are informed, have access to clinical support and professional genetic counseling about this decision, as well as support for the range of results received. (3) Parents considering direct-to-consumer testing on their newborn are counselled, or given information, to encourage them to have standard government funded newborn bloodspot screening testing on their newborn. (4) When choosing an online genomic test, preference should be given to tests undertaken in accredited laboratories offering tests accredited with the Therapeutic Goods Administration. (5) Results obtained through methods other than direct analysis from a laboratory accredited to perform genomic testing to inform human health and wellbeing should be interpreted with caution. The HGSA recommends that such results must be confirmed in an accredited diagnostic laboratory prior to relying on them to inform options for treatment, surveillance or risk reduction, or before undertaking cascade testing in family members. (6) When individuals are concerned about their health, they should consult an appropriate healthcare professional to decide whether an online genomic test is appropriate and discuss how useful test results could be to make health-related decisions.

This case report details the diagnosis and surgical management of a 7 cm aortic root aneurysm occurring in a 12-year-old with cutis laxa type B, an extremely rare connective tissue disorder. Our patient underwent a Bentall procedure as primary treatment for the aneurysm and had a successful interventional treatment of a postoperative pseudoaneurysm.

Although many online-based dietary surveys have been developed in recent years, systems that easily survey the dietary balance based on the Japanese diet are insufficient. This study aimed to evaluate the relationship between dietary balance scores from an online survey system based on the Japanese Food Guide Spinning Top, and nutrient/food intake calculated using the weighing method from dietary records (DRs), as well as to assess the system’s utility and applicability. An online dietary balance survey and semi-weighted DR assessment with food photographs were conducted in Japanese participants (n = 34). Registered dietitians entered the balance scores into the system based on the participants’ food photographs, and the scores were calculated using the system. Significant positive correlations (p < 0.001) were found between the online dietary balance scores and nutrient/food intake from DRs; especially for ‘grain dishes’ and carbohydrates (r = 0.704); ‘vegetable dishes’ and the vegetable dish group (sum of potatoes, vegetables, mushrooms, and algae) (r = 0.774); ‘main dishes’ and protein (r = 0.661); ‘milk’ and the milk and milk products group (r = 0.744); and ‘fruits’ and the fruits group (r = 0.748). Bland–Altman analysis showed that the dietary balance scores obtained by this system tended to underestimate the intake compared with the weighing method. Although there are limitations to the accurate estimation of nutrient and food intake, the online dietary balance scores obtained from the online dietary balance survey system were useful for understanding the dietary balance in the Japanese diet.

The position paper ‘The development of services for treatment of personality disorder in Adult Mental Health Services’ was published by the College of Psychiatrists of Ireland Personality Disorder Special Interest Group (PDSIG) in 2021. Following this, we are advocating for the development of a national treatment strategy for personality disorders in Ireland. As part of this process, we have examined international evidence and best practice guidelines for establishing personality disorder services. Key recommendations from the literature include access to services, continuity of care, a multidisciplinary approach, tiered models of care, collaboration with service users, staff training and supervision, and delivery of evidence-based interventions. These recommendations should form the backbone of a national personality disorder strategy for Ireland.

Kids SIPsmartER is a school-based behavioural intervention for rural Appalachia middle school students with an integrated two-way short message service (SMS) strategy for caregivers. When tested in a cluster randomized controlled trial, the intervention led to significant improvements in sugar-sweetened beverage (SSB) consumption among students and caregivers. This study explores changes in secondary caregiver outcomes, including changes in caregiver SSB-related theory of planned behaviour constructs (affective attitudes, instrumental attitudes, subjective norms, perceived behavioural control, and intentions), parenting practices, and the home environment. Participants included 220 caregivers (93% female, 88% White, 95% non-Hispanic, mean age 40.6) in Virginia and West Virginia at baseline and 7 months post-intervention. Relative to control caregivers (n = 102), intervention caregivers (n = 118) showed statistically significant improvements in instrumental attitudes (Coef.= 0.53, 95% CI [0.04, 1.01], p = 0.033), behavioural intentions (Coef.=0.46, 95% CI [0.05, 0.88], p = 0.027), parenting practices (Coef. = 0.22, 95% CI [0.11, 0.33], p < 0.001), and total home SSB availability (Coef. = –0.25, 95% CI [–0.39, –0.11], p < 0.001), with specific improvements for sweetened juice drinks (Coef. = –0.18, 95% CI [–0.35, –0.01], p = 0.043) and regular soda/soft drinks (Coef. = –0.31, 95% CI [–0.55, –0.07], p = 0.010). In contrast, there were no significant between group changes for affective attitudes, subjective norms, or perceived behavioural control. Our findings highlight future research areas and fill gaps in intervention literature. This study is among the few to develop and evaluate a scalable, theory-based caregiver SMS component in a rural, school-based intervention. Combined with evidence that Kids SIPsmartER improved SSB behaviours, our results emphasize the potential of theory-guided SMS interventions to impact SSB-related outcomes.

Trial registration: Clincialtrials.gov: NCT03740113.