Literature Collection

BACKGROUND: Effective mental health primary prevention and early detection strategies targeting perinatal mental healthcare settings are vital. Poor maternal mental health places the developing foetus at risk of lasting cognitive, developmental, behavioural, physical, and mental health problems. Indigenous women endure unacceptably poor mental health compared to all other Australians and disproportionately poorer maternal and infant health outcomes. Mounting evidence demonstrates that screening practices with Indigenous women are neither effective nor acceptable. Improved understanding of their perinatal experiences is necessary for optimizing successful screening and early intervention. Achieving this depends on adopting culturally safe research methodologies. METHODOLOGY: Decolonizing translational research methodologies are described. Perspectives of Australian Indigenous peoples were centred on leadership in decision-making throughout the study. This included designing the research structure, actively participating throughout implementation, and devising solutions. Methods included community participatory action research, codesign, and yarning with data analysis applied through the cultural lenses of Indigenous investigators to inform culturally meaningful outcomes. DISCUSSION: The Indigenous community leadership and control, maintained throughout this research, have been critical. Allowing time for extensive community collaboration, fostering mutual trust, establishing strong engagement with all stakeholders and genuine power sharing has been integral to successfully translating research outcomes into practice. The codesign process ensured that innovative strengths-based solutions addressed the identified screening barriers. This process resulted in culturally sound web-based perinatal mental health and well-being assessment with embedded potential for widespread cultural adaptability.

BACKGROUND: Deep brain stimulation (DBS) has been successfully used for the treatment of circuitopathies including movement, anxiety, and behavioral disorders. The hypothalamus is a crucial integration center for many peripheral and central pathways relating to cardiovascular, metabolic, and behavioral functions and constitutes a potential target for neuromodulation in treatment-refractory conditions. To conduct a systematic review, investigating hypothalamic targets in DBS, their indications, and the primary clinical findings. METHODS: PubMed, Scopus, and Web of Science databases were searched in accordance with the PRISMA guideline to identify papers published in English studying DBS of the hypothalamus in humans. RESULTS: After screening 3,148 papers, 34 studies consisting of 412 patients published over two decades were included in the final review. Hypothalamic DBS was indicated in refractory headaches (n = 238, 57.8%), aggressive behavior (n = 100, 24.3%), mild Alzheimer's disease (n = 58, 14.1%), trigeminal neuralgia in multiple sclerosis (n = 5, 1.2%), Prader-Willi syndrome (n = 4, 0.97%), and atypical facial pain (n = 3, 0.73%). The posterior hypothalamus was the most common DBS target site across 30 studies (88.2%). 262 (63.6%) participants were males, and 110 (26.7%) were females. 303 (73.5%) patients were adults whereas 33 (8.0%) were pediatrics. The lowest mean age of participants was 15.25 ± 4.6 years for chronic refractory aggressiveness, and the highest was 68.5 ± 7.9 years in Alzheimer's disease patients. The mean duration of the disease ranged from 2.2 ± 1.7 (mild Alzheimer's disease) to 19.8 ± 10.1 years (refractory headaches). 213 (51.7%) patients across 29 studies (85.3%) reported symptom improvements which ranged from 23.1% to 100%. 25 (73.5%) studies reported complications, most of which were associated with higher voltage stimulations. CONCLUSIONS: DBS of the hypothalamus is feasible in selected patients with various refractory conditions ranging from headaches to aggression in both pediatric and adult populations. Future large-scale studies with long-term follow-up are required to validate the safety and efficacy data and extend these findings.