The majority of households in high‐income countries have access to safely managed drinking water, but a significant number do not trust or use their tap water. Much remains unknown about the perceptions and behaviors of millions of people who opt to not drink tap water that meets national guidelines. Given that tap water avoidance is associated with myriad adversities and bottled water generates enormous amounts of waste, information about the drivers of trust in tap water is critical. Therefore, we investigated drinking water perceptions and behaviors in 2020–21 in Evanston, Illinois, a mid‐size city on Lake Michigan whose water quality meets or exceeds federal guidelines. In collaboration with a local environmental organization and a university, we conducted community‐based participatory research that included surveys (n = 756) and in‐depth interviews (n = 52) with a convenience sample of residents. Most (92.6%) respondents reported primarily consuming tap water. 81.2% of survey respondents (n = 749) thought their tap water was safer than or as safe as bottled water. Those who drank primarily bottled water (7.4%) were more likely to identify as Black, Indigenous, People of Color (BIPOC) or unhoused. BIPOC individuals had 3.4 times the odds of distrusting tap water than white respondents and men were 44% less likely to distrust tap water than women. Adverse experiences with water and low trust in government were also associated with lower trust in tap water safety. These findings suggest that outreach be targeted toward these groups to ensure widespread access to safe and trusted tap water.

Subarachnoid hemorrhage (SAH) is a devastating form of stroke that disproportionately affects younger individuals and often results in long-term disability, even among those who achieve favorable outcomes on traditional clinical scales. This scoping review uses the PRISMA-ScR protocol to evaluate independent studies from 1980 to 2025 and synthesizes current evidence on sleep and cognitive dysfunction in SAH survivors, highlighting their prevalence, impact, and gaps in assessment and management. A total of 2243 publications were screened across three databases (PubMed, EMBASE, and Web of Science), which resulted in 115 studies analyzed for review. Sleep disturbances—including insomnia, hypersomnia, and sleep apnea—are common across all phases of recovery and are closely linked to fatigue, mood disorders, and impaired cognitive function. Cognitive deficits, particularly in memory, executive function, and attention, persist in most survivors and are significant barriers to return to work and reintegration. Despite their clinical relevance, these domains are underrepresented in SAH research and inadequately captured by standard outcome measures such as the modified Rankin Scale. Compared to moderate-to-severe traumatic brain injury (TBI), the SAH literature lacks standardized assessment tools, longitudinal data, and interventional studies. Neuroinflammation may underlie both sleep and cognitive sequelae, offering a potential therapeutic target. This review underscores the need for patient-centered outcome measures, integrated sleep and cognitive assessments, and targeted interventions to improve long-term brain health in SAH survivors.

Background: While trauma’s impact on health and well-being is increasingly emphasized in outpatient and pediatric settings, less is known about how a patient’s history of trauma, especially healthcare-related trauma (“medical trauma”), may shape experiences of safety, trust, and distress on a general internal medicine inpatient service. Objective: We sought to understand how recently hospitalized adults experience safety, trust, and distress during hospitalization, and how resident physicians and interdisciplinary care team members perceive barriers to delivering trauma-informed care. Design: We conducted a qualitative study among recently hospitalized patients, internal medicine residents, and interdisciplinary care team members. Patients completed semi-structured interviews that explored recent hospitalization experiences and perceptions of distress, safety, and trust. Resident physician and interdisciplinary care team members participated in focus groups to explore experiences caring for patients with trauma histories. Patients were screened for adverse childhood experiences (ACEs) using the Philadelphia ACEs survey. Transcripts were analyzed using a quasi-inductive descriptive approach. Results: A total of 10 patients with high ACEs, 10 internal medicine residents, and 10 interdisciplinary care team members (5 nurses, 4 social workers, and 1 chaplain) participated. Patients highlighted medical trauma (healthcare-related experiences that resulted in prolonged emotional or psychological distress) as a relevant traumatic experience while seeking medical care. Three themes emerged describing how hospitalization could re-activate or compound existing medical trauma: (1) Hospital treatments sometimes retraumatized patients, especially those with prior medical trauma; (2) perceived bias influenced encounters for patients and challenged clinicians’ responses; and (3) missed inquiry about prior medical trauma and clinicians’ uncertainty about broaching it limited emotionally safe communication. Conclusions: Medical trauma is an important and impactful phenomenon, often reinforced through routine care. Embedding trauma-informed strategies, such as screening for prior trauma, reviewing documentation for bias, and trauma-informed communication, may help reduce medical trauma and strengthen trust in inpatient general medicine care.

Background : Low 6-mercaptopurine (6-MP) adherence (<95%) is associated with increased relapse in pediatric acute lymphoblastic leukemia (ALL). Stronger habit has been associated with higher adherence. Our objective was to examine the relationship of 6-MP adherence to habit strength and health-related quality of life (HRQOL) in children with ALL. Methods : A single-center, cross-sectional study of 52 participants: 11 patients (mean age 16±4, 45% Female) and 41 parents/caregivers (age 37±5, 80% Female). Participants completed Visual Analogue Scale (VAS _dose ), Patient Reported Outcomes Measurement Information System (PROMIS) Medication Adherence Scale (PMAS), Self-Regulated Habit Index (SRHI), and PROMIS HRQoL measures. Descriptive statistics and spearman’s rho correlations were used. Eleven semi-structured interviews of participants were conducted and analyzed using Grounded Theory and thematic analysis. Results : Overall, 81% (42/52) of participants reported high 6-MP adherence (VAS _dose ≥95%): patients 91% (10/11) and parents 78% (32/41). Higher adherence was correlated with better peer relationship scores (r _s =0.34, P =0.03). No significant correlation was found between adherence and habit strength. Reported facilitators for higher 6-MP included reminders, care team communications, developing personalized tools, experience with medication administration, self-efficacy, and access to social support. On the other hand, financial burden, scheduling conflicts, and medication access were common barriers cited by participants. Conclusions : One-fifth of participants reported low 6-MP adherence, and habit strength wasn’t associated with adherence rates. Variability of 6-MP routines over treatment may prohibit automaticity. Behavioral interventions aimed at promoting habit formation could address barriers to 6-MP adherence and improve health outcomes in pediatric ALL.

Pregnancy involves major cardiovascular adaptations, yet its long-term impact on maternal brain health remains poorly understood. The American Heart Association’s Life’s Simple 7 (LS7) and Life’s Essential 8 (LE8) are validated tools to assess cardiovascular and brain health, but their use in obstetric populations is limited. Following PRISMA-ScR guidelines, we searched three databases (2010–2024) for studies assessing ≥ 1 LS7/LE8 component during pregnancy with mid- or later-life cognitive or dementia outcomes; narrative synthesis and meta-analyses were conducted where feasible. Of 3940 screened abstracts, 30 studies met the inclusion criteria. Most examined hypertensive disorders of pregnancy (HDP), few assessed diabetes independently, and none evaluated the full LS7/LE8 construct. Meta-analyses showed that HDP was associated with increased risk of all-cause dementia (HR 1.34; 95% CI 1.11–1.62) and vascular dementia (HR 1.76; 95% CI 1.03–3.00; n = 3 studies), but not Alzheimer’s disease (HR 1.22; 95% CI 0.96–1.56). Although LS7/LE8 are established frameworks for cardiovascular and brain health, their application during pregnancy remains limited. Integrating LE8 into obstetric care may enable earlier identification of individuals at risk for later-life cognitive decline and inform strategies to promote maternal brain health across the lifespan.