Background: Anxiety and depression are major contributors to mental-health burden and frequently co-occur in clinical practice. In tele-mental health, routinely captured operational variables such as consultation duration, visit frequency, and follow-up cadence may provide clinical digital phenotypes that complement conventional symptom scales. This study aimed to characterize anxiety-depression comorbidity in a large real-world tele-mental health cohort and to determine whether symptom severity was associated with distinct patterns of healthcare utilization. Methods: We conducted a retrospective real-world study of 3467 patients followed in psychiatry and psychology teleconsultations. Patients were classified as anxiety only, depression only, comorbid anxiety-depression, or neither. Symptom severity was categorized as mild, moderate, or severe using validated questionnaire-based measures; to improve comparability across instruments, scores were additionally harmonized using z-score normalization. Associations between anxiety and depression severity within the comorbid subgroup were examined using a chi-square framework. Telehealth utilization endpoints included consultation duration, number of consultations, and inter-visit interval, analysed overall and stratified by sex, age group, and symptom severity. Results: Anxiety and/or depression were present in 61.7% of the cohort (2140/3467), and anxiety-depression comorbidity accounted for 43.8% of all patients (1520/3467), indicating substantial real-world overlap. Within comorbid cases, anxiety and depression severity were strongly coupled, with depression severity varying systematically across anxiety severity strata (chi-square p = 9.88 × 10^-102). Compared with isolated anxiety or depression, comorbidity was associated with a more intensive healthcare-utilization profile, characterized by a higher mean number of consultations and shorter inter-visit intervals. Among comorbid patients, females showed greater longitudinal service use than males, with more visits and closer follow-up. Resource use also varied according to symptom burden, mainly in depression, supporting a graded relationship between clinical severity and operational care demand. Conclusions: In this large real-world tele-mental health cohort, anxiety-depression comorbidity was highly prevalent, clinically structured, and associated with distinct and measurable resource-use signatures. These findings highlight the novelty and practical value of integrating symptom severity with operational telehealth data to derive pragmatic digital phenotypes of care intensity. Such phenotypes may support risk stratification, triage, follow-up scheduling, and capacity planning in tele-mental health, with potential translational relevance for broader mental healthcare systems. However, these findings should be considered descriptive and hypothesis-generating and warrant further longitudinal validation in other clinical settings.

Background: Fatigue is a highly disabling symptom in multiple sclerosis and is strongly associated with reduced health-related quality of life (HRQoL). However, whether distinct fatigue dimensions show differential associations with specific HRQoL domains remains unclear. This study investigated the relationship between physical, cognitive, and psychosocial fatigue and SF-36 outcomes in people with relapsing-remitting multiple sclerosis (RRMS). Methods: Forty-four people with RRMS were included in this cross-sectional study. Participants were classified as fatigued or non-fatigued according to the Modified Fatigue Impact Scale (MFIS) total score cut-off. Group differences in SF-36 domains were examined using ANCOVAs adjusted for age, sex, disease duration, and disability, with additional sensitivity analyses adjusting for depressive symptoms. Partial Spearman correlations assessed associations between MFIS subscales and SF-36 domains across the whole sample, controlling for demographic and clinical covariates. Results: Eighteen participants were classified as fatigued and 26 as non-fatigued. Fatigued participants showed significantly lower scores across all SF-36 domains. After additional adjustment for depressive symptoms, differences remained significant for Physical Functioning, Role Physical, General Health, Vitality, Social Functioning, and Role Emotional. Physical fatigue was inversely associated with several HRQoL domains, including physical, social, vitality, general health, and mental health-related outcomes. Psychosocial fatigue was associated with poorer Physical Functioning, Role Physical, Bodily Pain, and Social Functioning. Cognitive fatigue was not significantly associated with any SF-36 domain. Conclusions: Physical and psychosocial fatigue appear to be the main fatigue dimensions associated with HRQoL impairment in RRMS. Dimension-specific fatigue assessment may help identify more individualized targets for patient-centered management.

Background/Objectives: Sexualized drug use (SDU) and chemsex have emerged as a growing public health concern globally, reflecting complex intersections between sexual practices, psychoactive substance use, and structural vulnerabilities. In Brazil, however, evidence on healthcare access among individuals who engage in SDU/chemsex remains limited and fragmented. This scoping review aimed to map and analyze the available literature on healthcare access in this population, identifying barriers, facilitators, and gaps in care. Methods: The review followed the Arksey and O'Malley framework and Joanna Briggs Institute recommendations, with searches conducted in six databases (MEDLINE/PubMed, Embase, Scopus, SciELO, LILACS, and PsycINFO) for studies published between 2014 and 2025. Results: Eleven studies met the inclusion criteria, predominantly quantitative and concentrated in large urban centers. Findings indicate that healthcare access is shaped by persistent structural and symbolic barriers, including stigma, discrimination, fear of disclosure, and limited professional preparedness. Care remains largely centered on human immunodeficiency virus (HIV) and sexually transmitted infections (STIs) services, with insufficient integration of primary care, mental health, and substance use services, contributing to fragmented care. Significant gaps were identified, including the underrepresentation of women, transgender, and non-binary populations, and the absence of studies focusing on healthcare professionals. Conclusions: Substance use patterns reflect both global trends and local specificities, particularly the prominence of alcohol and cocaine in Brazil. This review provides the first synthesis of Brazilian evidence on chemsex from a healthcare access perspective. The findings highlight critical inequities and support the need for integrated, stigma-free, and context-sensitive care within the Brazilian Unified Health System. Based on these findings, the VIP-SDU/Chemsex Model is proposed as a multilevel framework to explain how structural, symbolic, and programmatic factors shape access and health outcomes.

As global populations grow and technology advances, daily life is increasingly shaped by digital systems such as computers and smart devices. However, prolonged device use has contributed to increasing physical and mental health concerns, particularly those associated with poor sitting posture. Posture-related strain is frequently overlooked and contributes to musculoskeletal discomfort, including back, neck, shoulder, and wrist pain, and may also be associated with sleep disturbances and elevated stress levels. To the best of our knowledge and based on the existing literature, this is the first study to introduce a machine learning-based framework for advanced muscle strain severity classification using Internet of Things (IoT) devices that integrates posture monitoring and muscle strain detection into a unified low-cost framework ($23 hardware cost). The primary objective of this work is accurate classification of muscle strain severity, while real-time alerts serve as a secondary ergonomic feedback mechanism. Specifically, this study makes four major contributions. First, we created a novel dataset through real-time acquisition of electromyography (EMG) and posture signals from participants in hospital and industrial environments, capturing diverse muscle strain patterns validated against clinical assessment procedures. Second, we designed a two-part hardware architecture consisting of posture detection (PD) and strain detection (SD) modules using a NodeMCU ESP8266, HC-SR04 ultrasonic sensor, EMG sensor, and buzzer for real-time physiological monitoring, incorporating EMG-specific preprocessing including band-pass filtering, rectification, and RMS smoothing. Third, we proposed and evaluated a hybrid machine learning framework integrating Vision Transformer (ViT) and XGBoost to classify strain severity into three study-specific categories: baseline (EMG RMS < 40 µV), compensatory strain (40-59 µV), and overload (≥60 µV). These categories were used as reproducible severity proxies for machine learning annotation and should not be interpreted as universal biomarkers of structural tissue damage. Finally, the proposed framework achieved a classification accuracy of 99.0% (95% CI: 98.5-99.5%) with an inference latency of 15.2 ms.

Rising cancer incidence and survival rates have led to an unprecedented demand for psychosocial care. Yet, limited financial and practical resources present a barrier to the provision of evidence-based care. Clinical practice guidelines (CPGs) are well-positioned to enhance the quality and efficiency of psychosocial oncology care; however, little is known about their use and perceptions in the field. The present study explored the use and perceptions of CPGs among 172 Canadian psychosocial oncology clinicians via a cross-sectional, online survey. Findings revealed substantial variation in awareness, with over 20% of participants reporting no familiarity with CPGs, and low to moderate use of CPGs (M = 2.97, SD = 2.96) among users. Key barriers included a lack of formal training, limited applicability to local contexts, and systemic constraints such as high workloads. Conversely, participants highly endorsed facilitators, including accessible training programs, relevant tools/interventions, and greater institutional and community engagement. Clinician perspectives are paramount to the dissemination and implementation of psychosocial oncology CPGs. Our findings suggest that successful implementation requires broader accessibility, widespread adaptation, and greater community engagement. By addressing these systemic constraints, CPGs may be better positioned to bridge the gap between evidence and real-world service provision.

This study examines the coping strategies used by refugee women who have survived gender-based violence (GBV) across multiple stages of migration. Drawing on interviews with 50 urban refugee women in Nairobi, Kenya, the study explores how coping processes shift or remain consistent throughout the migration trajectory using the migration process framework. Although GBV is widespread among forcibly displaced women globally, limited research has investigated how survivors appraise and manage the stress of these experiences over time and within changing displacement contexts. Guided by Lazarus and Folkman's transactional theory of stress and coping, the analysis identifies a wide range of strategies. Emotion-focused approaches include caring for children, acceptance, crying, religiosity, silence, avoidance, and self-care. Problem-focused strategies encompass social and community support; reliance on marital or partner relationships; access to medical and mental health services; participation in skills training; support from host communities; and efforts to adapt economically and culturally. Data were collected through quota and snowball sampling and analyzed using thematic analysis. Findings show that coping is a dynamic, context-dependent process shaped by women's agency alongside the social and structural resources available at each displacement phase. Survivors continuously recalibrated their coping approaches in response to evolving risks, opportunities, and support systems. The study underscores the need for culturally grounded, phase-specific interventions that strengthen emotional resilience while expanding practical support for refugee women affected by GBV. Such interventions should address both immediate psychosocial needs and the broader structural conditions that shape women's capacity to cope throughout their displacement journeys.

Posttraumatic stress (PTSD) and substance use disorder (SUD) treatment research has been hampered by heterogeneous measures, inconsistent reporting, and sensitive data governance constraints that limit data synthesis and clinical translation. This manuscript describes how integrating FAIR (Findable, Accessible, Interoperable, Reusable) principles and FACT (Fairness, Accuracy, Confidentiality, Transparency) concepts can strengthen PTSD-SUD data science, with Project Harmony as an applied example.

We identify key barriers to evidence accumulation in PTSD-SUD clinical trials and map FAIR+FACT-aligned practices across the research lifecycle (data acquisition, harmonization, analysis, sharing, and dissemination). We then illustrate implementation strategies using procedures from Project Harmony's (PH) individual participant data meta-analysis (IPD-MA), including common data element (CDE) labeling, interoperable harmonization pipelines, documentation of analytic decisions, and governance-informed access controls.

We identify priority points where FAIR+FACT alignment improves reproducibility and validity while reducing participant risk, particularly for populations vulnerable to confidentiality harms and stigma. The PH case example demonstrates feasibility of rigorous harmonization and measurement-equivalence approaches at scale and shows how transparent, provenance-preserving workflows can support comparative effectiveness analyses across diverse trials.

FAIR+FACT integration offers a practical framework for advancing trustworthy PTSD-SUD treatment evidence. We provide specific recommendations for investigators, clinical trial networks, and funders/policymakers to institutionalize FAIR+FACT requirements and resource the personnel and infrastructure needed for ethical, reusable PTSD-SUD datasets. Routine adoption of interoperable metadata standards, rigorous documentation and code sharing, and trauma-informed governance can accelerate guideline development, strengthen policy relevance, and improve clinical decision-making for individuals with comorbid PTSD and SUD.

The transition from military-to-civilian life is associated with challenges including shifts in identity and employment, reestablishment of family and personal relationships, and financial hardship. To better support transition, it is important to explore the perspectives of those who have transitioned from the Australian Defence Force (ADF) into civilian life. Thus, the study aims to explore how occupational participation during military service influences the experience of transitioning to civilian life.

A narrative inquiry methodology with two phases of interviews was used to collect data from 12 former serving Australian Defence Force members. Thematic analysis was used to interpret the data.

The first author is a former ADF member. The second interview was intended to check and enhance participant participation in the study. There was no further consumer and community involvement.

Two themes were developed. (1) Being in the 'bubble' described how occupational participation is experienced in military service. The military bubble created occupational imbalance and was heavily reliant on work and devoid of leisure. (2) 'The bubble pops and the real-world begins' describes how the loss of the military occupations including peers and the collective culture, challenged their occupational participation in civilian life. Most participants sought to establish occupational balance, to varying degrees of success.

Imbalanced occupational participation during military service can hinder the transition to civilian life. Supporting this shift requires strategies that promote engagement in community and leisure activities. Future research should focus on how to support occupational participation in civilian roles and activities to facilitate smoother transitions.

Adherence to treatment guidelines for agitation in dementia is suboptimal and inconsistent. We designed and evaluated an Integrated Care Pathway (ICP) for the management of agitation in dementia.

This was a double-blind randomized controlled trial at 12 inpatient units and long-term-care homes (LTCHs) across Canada. Participants were randomized 1:1 to the ICP or treatment-as-usual (TAU). Primary outcomes were Cohen Mansfield Agitation Inventory (CMAI) and psychotropic polypharmacy at 12 weeks.

We randomized 185 participants (93 inpatients, 92 in LTCHs). For CMAI, there were no significant time-by-treatment-group interactions among inpatients (F_{4, 299.3} = 1.7, p = 0.14) or LTCH residents (F_{4, 296.0} = 0.87, p = 0.48). For polypharmacy, there were significant time-by-treatmentgroup interactions among both inpatients ( χ 7 2 = 15.3, p = 0.032) and LTCH residents ( χ 7 2 = 30.0, p < 0.001), with lower rates of polypharmacy in the ICP group at certain time points, but not at week 12.

Standardizing care for agitation in dementia may result in lesser polypharmacy without affecting efficacy. Future studies should assess the ICP in the broader community and outpatients.

Abortion is a common reproductive healthcare process that is often stigmatised. Research on abortion stigma has grown significantly since the last major review over a decade ago, and there is a pressing need for an updated, comprehensive systematic review. The purpose of this review is to examine the extent and subjective experiences of abortion stigma among those seeking an abortion in high-income countries. We aim to explore the theoretical conceptualisations of abortion stigma in relevant studies. We conducted a mixed-method systematic review following the JBI and PRISMA guidelines. PubMed, CINHAL, PsychINFO, LIVIVO, and the Cochrane Library were searched for peer-reviewed articles. Quantitative studies were summarised narratively. Qualitative studies were synthesised using the JBI meta-aggregative approach. We included 41 qualitative, nine quantitative, and three mixed methods studies. Most studies lacked a substantial theoretical conceptualisation of abortion stigma. Quantitative studies reported prevalence rates of perceived abortion stigma ranging from 37% to 60%, suggesting that stigma remains a common experience among abortion seekers. Findings also indicate associations between abortion stigma and various sociodemographic factors (e.g., religion, race, age), as well as adverse mental health outcomes. In the qualitative studies, people seeking abortion care reported experiencing and anticipating judgment from healthcare professionals, anti-abortion activists, and their close social circle. Their experiences also centered on the internalisation of shame and guilt. Some studies highlighted the mitigating effect of social support. Longitudinal and mixed methods approaches with consistent assessment would be useful to better understand the developmental pathways of abortion stigma. This understanding is necessary to provide individual and structural support for people seeking abortion care.