To assess whether participants from a transtheoretical model-based intervention maintained increases in fruit and vegetables (FV) intake 48 months after baseline.

Randomised controlled community trial.

A Brazilian primary health care service.

Primary health care service users. The control group (CG) received usual care, and the intervention group (IG) received usual care and a 7-month collective intervention to promote FV intake. We analysed individuals with positive changes 12 months after baseline (baseline intake <400 g/d with any increase at 12 months or baseline intake ≥400 g which remained ≥400 g at 12 months, n 2·232). Outcomes were FV intakes at 36 and 48 months after baseline compared to previous intakes to identify maintenance. We used generalised estimating equations models to assess time and intervention effects in follow-up intake.

Participants were mostly adult women. We identified decreases of 54.4 g/d in fruit intake and 38.5 g/d in vegetable intake at 36 months and increases of 6.9 g/d in fruit intake and 23.4 g/d in vegetable intake at 48 months. According to adjusted models, at 36 months, CG and IG participants presented similar decreases in FV intakes, which means initial changes in the IG were not maintained. At 48 months, small increases in intakes were also similar between IG and CG.

Intervention participants did not maintain initial changes on FV intake in the long term, and boosters might be necessary to maintain initial increases.

The symptoms of psychotic disorders do not exist in isolation, but interact with one another as part of a dynamic network. For example, hallucinations may worsen mood, which may exacerbate hallucinations, creating self-reinforcing cycles. These symptom interactions have been shown to lead to the onset and maintenance of disorders. Effective treatments should therefore not only reduce overall symptom severity, but also disrupt these pathological interactions. Although antipsychotics are known to reduce symptom burden, their effects on the dynamic architecture of symptom networks remain unclear.

This study aims to characterise how 6 weeks of antipsychotic treatment alters the structure of temporal symptom networks in schizophrenia.

Data were pooled from 8 randomised controlled trials evaluating the efficacy of paliperidone over 6 weeks, in 2508 participants with schizophrenia spectrum disorders. Twenty symptoms assessed across four time points were modelled using a panel graphical vector autoregression approach. Temporal networks were estimated for treatment and placebo groups. Network-level and symptom-level connectivity were compared using resampling-based permutation tests.

Antipsychotic treatment was associated with significantly lower global symptom network connectivity than placebo treatment (18.92 v. 26.52; S = 7.60; p < 0.001). Specific inter-symptom connections were attenuated, most notably a reduced influence of ‘lack of spontaneity’ on other symptoms (0.97 v. 1.74; p < 0.001).

Antipsychotic treatment not only decreases symptom severity, but also disrupts dynamic interdependencies among symptoms. These findings suggest that effective treatment weakens maladaptive symptom coupling, offering new insights into the mechanisms of clinical improvement and potential targets for intervention.

Millions of Ukrainians displaced since 2022 experience high rates of depression, anxiety and distress, with major barriers to in-person mental healthcare. Immersive avatar-based virtual reality environments may offer scalable psychosocial support while preserving key therapeutic elements.

To evaluate the efficacy of avatar-based virtual reality support groups versus in-person support groups and a waitlist control among Ukrainian refugees in Romania.

In this 3-arm randomised controlled trial, 156 participants were assigned to avatar virtual reality groups, in-person support groups or a waitlist control. Assessments were conducted at baseline, mid-intervention, post-intervention and at 3-month follow-up. Primary analyses used clustered intention-to-treat longitudinal mixed models with cluster-robust standard errors. Complementary baseline-adjusted analysis of covariance and sensitivity analyses were also performed.

Most between-group comparisons favoured the interventions but many lacked statistical significance, probably owing to attrition and clustering. In-person groups showed the strongest benefits, in particular, they were associated with greater perceived social support versus waitlist at post-intervention and reduced anxiety in end-point analyses. Avatar virtual reality effects were smaller and non-significant. Effects were largely attenuated at follow-up. Sensitivity analyses excluding participants with high levels of baseline trauma identified stronger treatment effects.

In-person support groups demonstrated the strongest short-term psychosocial benefits, especially for perceived social support. Delivery of the avatar virtual reality intervention proved feasible, but the intervention did not show consistent superiority or equivalence to in-person groups. The findings support further refinement of immersive interventions with improved retention strategies and trauma-sensitive adaptations, particularly across populations with varying digital familiarity.

Mental health problems in adolescents are increasing. Universal school-based interventions may play an important preventative role.

The aim of the Approaches for Well-being and Mental Health Literacy: Research in Education (AWARE) trial was to evaluate two universal, school-based interventions that previously yielded evidence of impact in other countries: Youth Aware of Mental Health (YAM) and The Mental Health and High School Curriculum Guide (The Guide).

AWARE was a multi-school, parallel group, cluster randomised controlled trial in English secondary schools. Schools were allocated on a 1:1:1 ratio to one of two interventions or a usual practice control group, balanced on current levels of mental health provision within schools, school location, deprivation and urbanicity. Eligible participants were pupils in schools across England in Year 9 (aged 13–14 years) at baseline. The statistician, quantitative data analyst and economist were masked. Primary outcomes were depressive symptoms measured with the Short Mood and Feelings Questionnaire for YAM and intended help-seeking, measured with the General Help Seeking Questionnaire for The Guide (both at 3–6 months).

153 schools were randomised, including 12 166 pupils (NYAM = 4028 pupils, Nguide = 3997 pupils, Ncontrol = 4141 pupils). We found that for YAM vs control (N = 5516) there was no improvement in depressive symptoms s.m.d. = 0.02; 95% CI –0.05 to 0.10), and for The Guide vs control (N = 5409) we found increased intended help-seeking compared with the control group (s.m.d. = 0.10; 95% CI 0.02 to 0.19). A notable minority of schools were unable to deliver YAM because of challenges in implementing it. Increased depressive symptoms scores were observed in both intervention conditions, compared with control at the longer-term follow-up.

The findings indicate that participating in The Guide is effective at improving intended help-seeking. However, due to the increases in depressive symptoms associated with each intervention at the long-term follow-up, further investigation of the potential negative impacts of these programmes is advised before further rollout in English schools.

Trial registration number: ISRCTN17631228.

Post-migration stressors can exacerbate post-traumatic stress disorder (PTSD) and reduce treatment effectiveness among refugees. Evidence for integrated care models in high-income settings remains limited.

To compare treatment as usual (TAU) with an add-on integrated care intervention for unemployed refugees with PTSD.

We conducted a two-arm, parallel-group superiority trial with 1:1 randomisation to TAU or TAU with an add-on integrated care intervention, delivered at a specialised out-patient clinic in Denmark (ClinicalTrials.gov NCT04244864). TAU included sessions with a psychologist and physician over 8–12 months. The integrated care intervention also included structured collaboration with employment services. The primary outcome was functioning, using the 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS) interview. Secondary outcomes included symptoms, quality of life and post-migration stressors. Analyses followed the intention-to-treat principle, using analysis of covariance and linear regression with multiple imputations.

The study included 195 patients in treatment from 2020 to 2025. No difference was observed in WHODAS score between groups pre- to post-treatment (mean difference 0.30, 95% CI −2.40 to 3.00; P = 0.825). Similarly, no differences were found for secondary or exploratory outcomes, and overall change was limited. However, the integrated care group had a lower rate of early dropout (P = 0.042) and higher level of treatment satisfaction (P = 0.035).

Integrated care was feasible but not superior to TAU in improving outcomes for refugees with longstanding symptoms and unemployment. Future research should examine how the timing and intensity of integrated care interventions influence outcomes, including earlier implementation and adequate support for refugees with longstanding and complex needs.

This study aimed to assess whether intra-operative autologous platelet-rich fibrin glue accelerates nasal mucosal healing after septoplasty.

Prospective, randomised controlled trial of 100 adults undergoing septoplasty, randomised to platelet-rich fibrin glue (n = 50) or standard surgery (n = 50). Primary outcome: endoscopic healing via modified Lund–Kennedy score. Secondary outcomes: Visual Analog Scale pain, crusting, Nasal Obstruction Symptom Evaluation scores and complications.

Platelet-rich fibrin glue significantly accelerated epithelialisation at one week (2.72 vs. 3.46, p = 0.028) and two weeks (1.49 vs. 2.17, p = 0.006). Pain, crusting and Nasal Obstruction Symptom Evaluation scores improved significantly in the platelet-rich fibrin glue group during early follow-up (p < 0.05). No significant differences were observed between groups at four or 12 weeks. Complication rates were low and comparable.

Intra-operative platelet-rich fibrin glue accelerates early mucosal healing and reduces post-operative morbidity during first two weeks after septoplasty without increasing complications. These benefits are confined to early recovery, with equivalent long-term outcomes.

The effectiveness of food advertising restrictions may be limited by the allowance of brand advertising. This study investigated the impact of brand advertising on cognitive, affective and behavioural intention outcomes for food products high in fat, salt and/or sugar (HFSS).

Online randomised controlled trial. Participants were randomly allocated to one of three groups: HFSS brand advertisements, non-HFSS brand advertisements or non-food brand advertisements (control). Eight images of brand advertisements were individually presented via an online research platform. The primary outcomes were purchase intention and craving, measured using 100-point slider scales. Secondary outcomes were brand recognition, recall and product associations. Generalised linear models examined craving and purchase intention for HFSS foods. Group differences in brand recognition, recall and product associations were tested using Kruskal–Wallis and ANOVA.

Online.

UK adults (N 191) aged 18–87 (M = 47; sd = 16·15).

The mean composite purchase intention score for the HFSS group (234·89) was not significantly different (p > 0·05) from coefficients for non-HFSS (−51·91) and non-food groups (31·21). Similarly, no significant group differences were found for cravings. The HFSS group was significantly more likely to recognise, recall and associate more products with viewed brands, compared to non-HFSS and non-food groups (ps < 0·01).

Exposure to HFSS brand advertising triggered recognition, recall and product associations with viewed brands. However, this did not translate into increased craving or purchase intention for HFSS foods. Future research should examine the effects of brand advertising in real-world settings.

Most antidepressants do not independently treat impaired cognition associated with major depressive disorder (MDD). Elevated brain cortisol levels are associated with both MDD and cognitive impairment. Emestedastat is a brain-penetrant, intracellular cortisol synthesis inhibitor.

The XanaCIDD trial aimed to determine whether emestedastat 10 mg could improve both cognitive impairment and depression in a population with persistent MDD and cognitive impairment.

Participants had a diagnosis of MDD, with persistent depression (Hamilton Rating Scale for Depression-17 ≥17) and cognitive impairment (coding test ≤0.5 s.d. of normal). Randomised treatment (1:1) was continued for 6 weeks (week 6), with 4 weeks’ blinded follow-up (week 10). The primary end-point was cognition (composite of attention/working memory) at week 6. Depression end-points included Montgomery–Åsberg Depression Rating Scale (MADRS) and Patient Global Impression of Severity (PGI-S). Analyses used a mixed model for repeated measures (cognitive impairment and MADRS one-sided tests, others two-sided) and Cohen’s d effect size. No adjustments were made for multiple comparisons.

A total of 165 participants were enrolled and treated: 134 (81%) were on background antidepressants, 62% were female, mean prior number of MDD episodes was 10 and mean coding z-score was −1.47. There was no benefit on the primary cognitive end-point at week 6 (p = 0.17 favouring placebo), with the cognitive composite improving markedly in both groups without correlation to depressive symptoms or baseline characteristics (R2 ≤ 0.02). The trend towards benefit on the prespecified secondary depression end-point, MADRS, began at week 6 and was maximal at week 10 (2.7 points, Cohen’s d 0.43, p = 0.05). A trend towards potential emestedastat benefit in PGI-S scores was also maximal at week 10 (p = 0.12). Mild–moderate transaminase elevations were seen in 10% of emestedastat participants (≤2 times normal in 7 of 8 cases, 1 discontinuation) versus 1% of the placebo group.

There was no benefit of emestedastat on the primary end-point of cognitive impairment and a large placebo effect, without correlation of cognitive impairment to depression changes or baseline characteristics. Trends towards potential antidepressant activity suggest that emestedastat may be a novel antidepressant worthy of further investigation.

Price promotions influence food choices and are disproportionately applied to foods high in fat, sugar and salt (HFSS), consumption of which is a known contributor to poor diet and diet-related non-communicable diseases. This study evaluates the effectiveness of (1) restricting price promotions of HFSS products and (2) allowing such promotions but restricting communications regarding them in changing purchasing behaviours.

Between-subjects randomised controlled trial with three arms: (1) reduced price, labelled a price promotion (‘Usual Practice’); (2) reduced price, not labelled a price promotion (‘No Communication’) and (3) standard price (‘No Promotion’). Participants selected food and drinks for 2 d in a one-off shop, without restrictions on the number of items to purchase or the budget, at a simulated online supermarket. We measured total energy (kcal) in basket, total cost, total number of items, energy density (kcal/100 g) and proportion of the basket that was HFSS.

Simulated online supermarket.

Adults representative of the UK population (n 9004).

There were no significant differences in energy in baskets between groups, after controlling for age, sex, household income, ethnicity and deprivation. No significant differences were found between groups’ baskets for total cost, energy density or proportion HFSS. Participants in the ‘Usual Practice’ group selected significantly more items than the ‘No Promotion’ group (11·4 v. 11·1; P = 0·003).

No significant effects of restricting price promotions, or communications of them, were found for purchasing behaviours in a simulated online supermarket. Further price-based interventions, especially in real-world settings, are needed to provide robust policy recommendations.

Functional neurological disorder (FND) is characterised by disabling motor, sensory and/or seizure symptoms. Contemporary models highlight the possible involvement of altered affective and autonomic regulation and interoceptive processing in FND. However, accessible, mechanism-informed interventions remain limited.

This study sought to examine the feasibility, acceptability and possible benefits of tailored somatic yoga for people with FND, aiming to directly target altered emotional and bodily regulation in this group.

This single-site, two-arm randomised feasibility trial allocated adults with FND to 6 weeks of either somatic yoga (weekly remote sessions plus home practice manual) or a music-based relaxation control. Feasibility outcomes included recruitment, retention, adherence and acceptability. Secondary outcomes, assessed at baseline, week 3, week 6 and 3-month follow-up, included FND symptom burden, psychological symptoms (anxiety, depression, dissociation), general functioning, health-related quality-of-life, interoceptive awareness and autonomic symptoms.

Seventy-six enquiries were received. Thirty participants consented (100%), 27 were randomised (90%), 23 commenced the trial (77%) and 21 completed it (70%). Recruitment and retention targets were met, with 100% retention in the yoga arm. Adherence was high across both groups, although digital logging of home practice posed usability challenges. Exploratory analyses indicated large effect sizes for self-reported FND symptom improvement and interoceptive awareness in the yoga group, with effects sustained at follow-up.

Individually delivered somatic yoga was found to be feasible, acceptable and safe for people with FND. Our results also suggest potential benefits of somatic yoga for FND symptom improvement and interoceptive awareness, supporting progression to a fully powered trial.

People with schizophrenia spectrum disorders (SSDs) experience high rates of obesity and metabolic dysfunction, contributing substantially to excess morbidity and mortality. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) such as semaglutide and tirzepatide have demonstrated substantial efficacy for weight and glycaemic outcomes in the general population, but evidence in people with SSDs remains limited.

To synthesise all placebo-controlled, randomised controlled trials (RCTs) examining semaglutide and/or tirzepatide in people with SSDs.

A preregistered systematic review and meta-analysis of RCTs examining the efficacy and safety of semaglutide and/or tirzepatide in adults with SSDs was conducted. Outcomes and adverse events were pooled using random-effects meta-analysis. Certainty of evidence was assessed using the GRADE criteria.

Three trials (n = 258) met inclusion criteria, examining semaglutide dosages of 1.0–2.0 mg over 26–36 weeks. No trials examining tirzepatide were found. Semaglutide significantly reduced body weight (−11.32 kg; 95% CI −15.35 to −7.29), body mass index (−3.58 kg/m2; 95% CI −4.86 to −2.30), haemoglobin A1c (−0.37%; 95% CI −0.51 to −0.22) and fasting glucose (−0.54 mmol/L; 95% CI −0.94 to −0.13). In adverse event analyses, semaglutide was associated with increased risks of abdominal pain (risk ratio 2.93; 95% CI 1.13–7.60), vomiting (risk ratio 2.57; 95% CI 1.39–4.77) and constipation (risk ratio 3.23; 95% CI 1.14–9.18). There was no evidence of increased risk of serious adverse events.

Semaglutide produces clinically meaningful improvements in weight and glycaemic outcomes in people with SSDs, with an adverse event profile consistent with known gastrointestinal effects of GLP-1 RAs in the general population. These findings support semaglutide as a promising adjunctive metabolic intervention in this population, although larger and longer trials, specifically those testing tirzepatide, are needed to better characterise heterogeneity of effects and long-term safety of these promising pharmacological treatments.