Learning Health Systems (LHS) integrate research, clinical expertise, and patient data to continuously improve health care. Although community engagement is central to LHS, existing literature has largely focused on data infrastructure, clinical improvement, and system learning, with limited attention to meaningful patient and public involvement (PPI) in community-based care. This review aimed to identify facilitators and barriers to such involvement in the development of LHS in community health services.

We conducted a scoping review in line with the JBI methodology and searched MEDLINE (Ovid), CINAHL, Embase, PsycINFO, Scopus, Web of Science, and Google Scholar. Reference lists were searched using forward and backward citation. The date of the last search was August 10, 2026. We excluded studies conducted in acute or hospital settings and conference proceedings. Two reviewers independently screened and extracted data using Covidence, and NVivo was used to synthesize the outcomes.

We identified 12 studies published between 2017 and 2025, most conducted in the United States (75%). Studies included diverse populations such as older adults, individuals with chronic disease survivors, LGBTQ+ individuals in cancer survivorship care, and stroke survivors. Patient and public involvement ranged from consultation and interviews to partnership and co-design, while shared governance or co-led models were uncommon. Barriers to meaningful involvement included mistrust in healthcare systems, structural inequities, fragmented care pathways, poor communication, limited infrastructure, lack of sustainable engagement support, and power imbalances that contributed to tokenistic participation. Facilitators included trust-building, mutual respect, community partnerships, culturally responsive engagement, co-design approaches, and supportive organizational leadership. Strategies to enhance engagement included care coordination tools, telehealth, inclusive recruitment practices, bidirectional feedback systems, knowledge translation initiatives, and patient and family participation in decision-making and service design.

This review highlights that meaningful patient and public involvement in Learning Health Systems depends not only on technical infrastructure, but also on relational, organizational, and structural conditions that support equitable participation. Findings suggest that community-based LHS development requires sustained investment in trust-building, shared decision-making, inclusive governance, and long-term engagement strategies. Future research should examine how participatory approaches influence equity, governance, service improvement, and long-term Learning Health System outcomes.

Starting a career in veterinary medicine represents a major life transition, accompanied by substantial professional and personal challenges. The study aimed to assess job satisfaction, psychosocial demands, and working conditions of veterinarians during their first year in their profession, and to identify the factors associated with commitment and job satisfaction. Early-career veterinarians in Germany, Austria, and Switzerland were surveyed using an online questionnaire that included the Copenhagen Psychosocial Questionnaire III. Multifactorial regression models were calculated to reveal the associations of (a) demographics and working conditions and (b) psychosocial demands with commitment and job satisfaction.

Responses from 196 participants were included in the analysis. The majority of participants (n=118; 76%) were engaged in clinical practice, predominantly in the small animal sector. Half of the respondents already participated in emergency services, and another 17% planned to do so in the near future. Most respondents reported overtime work. Compared with the German COPSOQ standard sample, early-career veterinarians reported lower levels of role conflicts and higher levels of job satisfaction, commitment to the workplace, and sense of community at work. At the same time, dissolution (work-life boundary blurring) was higher than in the German standard sample. Job satisfaction and commitment were primarily associated with the availability of a supervising veterinarian, perceived quality of leadership, support at work, and feedback. Interestingly, neither quantitative demands (amount of work related to time) nor emotional demands (emotionally distressing work situations) were significantly associated with commitment to the workplace or job satisfaction.

The results indicate that early-career veterinarians are highly motivated and satisfied with their work but strongly benefit from adequate supervision, feedback, and organizational support.

Adolescent motherhood is a complex public health and social challenge, particularly in low- and middle-income countries where cultural norms and policy frameworks intersect. Teen mothers often enter parenthood without adequate emotional readiness, social support, or access to youth-friendly healthcare. Self-efficacy, defined as an individual's belief in their ability to manage and succeed in specific tasks, is crucial for empowering adolescent mothers to navigate postpartum challenges, improve parenting outcomes, and maintain mental well-being. In Iran, existing adolescent and maternal health policies are limited and often fail to adequately address the unique needs of this population. These gaps increase their vulnerability to mental health challenges, poor parenting outcomes, and long-term socioeconomic and psychosocial disadvantages. The aim of this study is to analyze the multi-level challenges faced by adolescent mothers in the postpartum period, drawing on the perspectives of key stakeholders, including adolescent mothers, their families, policymakers, and health service providers, and to co-create policy recommendations that integrate self-efficacy-oriented strategies into Iran's maternal health system.

This study employed a multi-phase, mixed-methods approach, with the primary focus on qualitative interviews and Delphi assessment. Semi-structured interviews were conducted with 21 policymakers and health service providers, as well as in-depth interviews with 23 adolescent mothers, to explore their perspectives on postpartum challenges and empowerment strategies. The study also drew on a previously conducted literature review as part of the broader research project to identify evidence-based strategies for supporting adolescent mothers. A Delphi panel, comprising national experts from the health, education, psychology, and social sectors, was subsequently convened to assess, validate, and refine policy recommendations. Thematic analysis of the qualitative interview data, in combination with insights from the literature review, guided the development of a culturally sensitive and context-specific policy framework, ensuring that the recommendations were evidence-informed and practically relevant to Iran's maternal health system.

The findings revealed that adolescent mothers face complex, multi-dimensional challenges across individual, familial, structural, and policy levels. Improving adolescent maternal health in Iran requires a comprehensive, multi-level approach that integrates adolescent-friendly care into national policies. Empowerment-focused interventions and family-community engagement are vital to enhance postpartum self-efficacy and reduce stigma. Strengthening healthcare provider training and creating youth-friendly services will improve care quality and accessibility. Effective intersectoral collaboration and robust monitoring systems are essential for sustained impact. Continued research will support evidence-based policy refinement and better outcomes for adolescent mothers.

This study calls for culturally tailored, evidence-based interventions, improved provider skills, and strong community support. Policies must address both psychosocial and clinical needs of adolescent mothers simultaneously, with continuous monitoring and support for applied research to ensure effectiveness and ongoing improvements in the health outcomes of this at-risk group.

Understanding how daily environmental exposures influence the human brain and mental health is increasingly important in the context of global urbanization and climate change. Previous studies have focused primarily on long-term environmental factors or isolated features like green space and air quality, neglecting the interaction between multiple exposures encountered in everyday life. This protocol paper describes the study design and dataset of the Day2Day Environment project, an ongoing study investigating how real-world, day-to-day environmental variability affects brain structure, function, and well-being.

This dense longitudinal study collects multimodal data from 30 participants over 25 testing sessions, including neuroimaging and tracking of physiological, behavioral, and environmental variables. Using wearable devices, geographic ecological momentary assessments, and GPS-based geospatial tracking, we collect data on air quality, noise, light exposure, physical activity, stress, cognition, and affect. Neuroimaging measures include T1- and T2*-weighted images during rest and tasks, quantitative multi-parameter mapping, high-resolution proton density imaging of the hippocampus, and diffusion tensor imaging sequences.

The Day2Day Environment dataset offers a unique opportunity to study short-term neuroplasticity in response to the dynamic interplay between multiple environmental exposures. Furthermore, the diversity of measurements in this dataset may be valuable for addressing research questions beyond environmental neuroscience.

Climate change poses significant risks to physical and psychological health, particularly among vulnerable groups such as pregnant women. Awareness of climate-related threats can influence anxiety levels as well as coping mechanisms such as hope. This study aims to evaluate the effects of climate change education on pregnant women's awareness, anxiety, and hope.

This randomized controlled pretest-posttest experimental study was conducted with 154 pregnant women who attended a public hospital in Istanbul between September 2025 and January 2026. Participants were randomly assigned to either the intervention group (n = 77) or the control group (n = 77). The intervention group received a 60-minute face-to-face training session focusing on climate change and pregnancy, whereas no intervention was applied to the control group. Data were collected before the intervention and four weeks afterward using the Climate Change Worry Scale, the Climate Change Awareness Scale, and the Climate Change Hope Scale. The data were analyzed using descriptive statistics (such as frequency, percentage, and mean), parametric tests (independent samples t-test and ANOVA).

The mean age of participants in the intervention group was 28.49 ± 6.55 years, while it was 27.99 ± 6.85 years in the control group. No significant differences were found between the groups in terms of individual and obstetric characteristics (p > 0.05). Following the intervention, significant increases were observed in climate change anxiety, awareness, and hope levels in the intervention group (p < 0.001). In contrast, the control group showed decreases in anxiety and hope levels, while awareness demonstrated only a limited increase (p < 0.05). Between-group comparisons revealed that posttest scores were significantly higher in the intervention group (p < 0.05). Repeated measures ANOVA indicated a significant interaction between group and time for all variables (p < 0.001). Effect sizes were found to be large (d = 1.30-2.20), indicating a strong impact of the intervention.

The findings of this study demonstrate that climate change education is an effective intervention that significantly influences awareness, anxiety, and hope levels among pregnant women. These results suggest that structured educational programs for pregnant women may serve as a valuable tool in enhancing environmental awareness and supporting psychological well-being.

NCT07403513, www.

gov . Registered on January 29, 2026.

This study aimed to compare emotional and behavioral problems in the offspring of parents with schizophrenia, the offspring of parents with bipolar disorder, and healthy controls using the Child Behavior Checklist for ages 6-18 years (CBCL/6-18).

This cross-sectional controlled study was conducted in the Child and Adolescent Psychiatry Outpatient Clinic of Karabük Training and Research Hospital. The sample included 62 children and adolescents aged 6-18 years: 21 offspring of parents with schizophrenia, 20 offspring of parents with bipolar disorder, and 21 healthy controls. Parental diagnoses were established according to the criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and confirmed with the Structured Clinical Interview for DSM-5. Emotional and behavioral problems were assessed using CBCL/6-18 T-scores. Group comparisons were performed using one-way analysis of variance and chi-square tests, with Bonferroni correction applied for multiple CBCL comparisons. Multivariable linear regression analysis was used to identify factors independently associated with total problems scores.

The groups did not differ significantly in age, sex, or educational status. Compared with healthy controls, both clinical groups had higher rates of previous child psychiatry visits and less favorable family-related sociodemographic characteristics. After Bonferroni correction, significant group differences remained for withdrawn/depressed, anxious/depressed, internalizing problems, aggressive behavior, externalizing problems, social problems, attention problems, and total problems. In these domains, both offspring groups scored significantly higher than controls, whereas the schizophrenia and bipolar disorder groups did not significantly differ from one another. In adjusted regression analysis, both schizophrenia-group status and bipolar-disorder-group status remained independently associated with higher total problems scores.

Offspring of parents with schizophrenia or bipolar disorder show elevated emotional and behavioral problems compared with healthy controls, supporting the importance of early screening and family-oriented preventive interventions.

Chronic fatigue syndrome (CFS) is a complex disorder characterized by persistent fatigue, sleep disturbance, and cognitive impairment. It substantially impairs both physical and mental health. Tai Chi, a traditional Chinese mind-body exercise, may improve symptoms in patients with CFS. However, its neural mechanisms remain unclear. This study investigated the effects of Tai Chi on spontaneous brain activity in patients with CFS using resting-state functional magnetic resonance imaging (rs-fMRI) and amplitude of low-frequency fluctuations (ALFF).

Sixty patients with CFS were randomly assigned in a 1:1 ratio to either a Tai Chi group or a health education group; 57 participants completed both fMRI scans and fatigue assessments and were included in the complete-case analysis. Both groups underwent a 12-week intervention consisting of three 60-min sessions per week. Adherence was monitored using weekly logs. Fatigue severity was assessed before and after the intervention using the Multidimensional Fatigue Inventory (MFI-20). Resting-state fMRI data were acquired at both time points. Preprocessing included motion correction, normalization to Montreal Neurological Institute space, and spatial smoothing. ALFF was calculated to quantify regional spontaneous neural activity. Correlation analyses were performed to assess associations between changes in ALFF and MFI-20 scores. Harms were monitored throughout the intervention period.

Fifty-seven participants were included in the complete-case analysis (Tai Chi, n = 29; health education, n = 28). Compared with health education, Tai Chi produced greater reductions in MFI-20 total score from baseline to week 12 (between-group change difference, -9.50 points; 95% CI, -12.31 to -6.70; Cohen's d = -1.83; P < 0.001). Greater improvements were also observed in overall fatigue, physical fatigue, mental fatigue, activity reduction, and interest reduction, with between-group differences ranging from -1.26 to -2.44 points. In imaging analyses, Tai Chi was associated with increased ALFF in prefrontal, hippocampal/striatal, and supplementary motor regions and decreased ALFF in occipital and temporal regions, using voxel-level P < 0.001 and cluster-level family-wise error correction. Exploratory brain-behavior analyses showed that increases in ALFF in the left medial superior frontal gyrus and left dorsolateral superior frontal gyrus were associated with greater reductions in MFI-20 scores, whereas decreases in ALFF in the left inferior occipital gyrus were associated with fatigue improvement. No falls, injuries, severe post-exertional malaise, or intervention-related medical events were reported through weekly participant logs or supervised-session monitoring.

A 12-week Tai Chi intervention was associated with greater fatigue improvement than health education and with region-specific changes in resting-state spontaneous brain activity in patients with CFS. Tai Chi was associated with reduced fatigue and altered spontaneous brain activity in prefrontal, hippocampal, motor, and sensory-related regions in patients with CFS. These findings suggest that Tai Chi may modulate fatigue-related brain function, which may contribute to improvements in fatigue severity. Future studies should replicate and extend existing network-level findings using prespecified, adequately powered connectivity and mediation analyses with active exercise comparators and longer-term follow-up.

https://www.chictr.org.cn/showproj.html?proj=223860, ChiCTR2400082268; March 26, 2024.

Since the end of the 20th century, mental health research has been increasingly driven by the hope of uncovering the neurobiological roots of mental illness. Despite progress in this area, significant therapeutic breakthroughs - especially for complex conditions such as schizophrenia - remain limited. It is unclear whether these research priorities truly align with the needs and experiences of those affected. Greater involvement of people with lived experience in shaping research questions and processes could enhance the clinical relevance of research and lead to more effective, patient-centered interventions.

This qualitative study explores the perspectives of peer support workers and researchers with lived experience in mental health research on the context of schizophrenia. We conducted semistructured interviews with 12 peer support workers and one researcher with lived experience. To contextualise and illustrate the findings, selected perspectives from 13 additional interviews with patients with schizophrenia are included. Interviews were analysed using qualitative content analysis according to Kuckartz.

Three central categories were identified: (1) Perception of mental health research: Participants valued both neurobiological and social approaches to research equally. They acknowledged certain advances; however, these developments were viewed as gradual and still inadequate. (2) Participation in research: Participants strongly demanded greater involvement of people with lived experience in all research stages. (3) Manner of research: Participants expressed a strong desire for user-set priorities, dissatisfaction with current research topics, perceived marginalisation, structural issues such as publication bias (e.g. favouring large randomised controlled trials over qualitative studies) and a lack of funding.

Overall, the findings highlight the importance of incorporating lived experience in all stages of mental health research. More inclusive approaches are viewed as essential for improving research and care.

As the population of persons living with HIV (PLWH) ages, the Peruvian National HIV, STI and Hepatitis Program (NHSTIHP) faces the question of how best to provide care for non-communicable diseases (NCDs) among PLWH. Using a qualitative approach, this study explores the barriers and facilitators of providing NCD care to PLWH in Peru through the perspective of NHSTIHP physicians and coordinators. HIV regional program coordinators and physicians affiliated with Peru's NHSTIHP were recruited for individual in-depth interviews from the Program's physician and coordinator registry and by peer referral. Interviews continued until thematic saturation was reached in both groups. The emerging themes were visualized using an adapted socioecological framework. All regional coordinators who volunteered (N = 25) were interviewed. Physicians were sampled to ensure variability in training background and region, and 14 physicians were interviewed to reach thematic saturation. Barriers and facilitators discussed by both groups were organized into major themes following a socioecological model: patient, provider, local clinic/hospital, regional, and national health system. Peru-specific themes identified included: concern about practicing outside of one's specialty ("intrusismo"), patient trust, the role of HIV coordinators and insurance, and the importance of national clinical practice guidelines. This study highlights the complex interplay between patient, provider, local, regional, and national factors that influence delivery of care to PLWH in Peru. Addressing the barriers will require co-creation of resource-adaptable national HIV guidelines, with the participation of providers, program coordinators, and patients. These guidelines should encompass not only NCD management and educational resources for HIV providers and patients, but also processes and implementation pathways. This will require coordination between existing NCD and HIV health programs, and generation of epidemiologic data on NCD in PLWH to optimize resource allocation.

Adverse Childhood Experiences (ACEs) are established life-course determinants of adult health, yet evidence linking ACEs to multimorbidity in sub-Saharan Africa remains limited. Nigeria is undergoing rapid demographic and epidemiological transitions characterized by population ageing and a rising burden of non-communicable diseases (NCDs). This study examined whether cumulative ACE exposure predicts multimorbidity among older adults in North-Central Nigeria.

A cross-sectional study was conducted among 734 adults aged ≥60 years in Niger State, Nigeria. ACE exposure before age 18 was assessed using the Adverse Childhood Experiences International Questionnaire (ACE-IQ) across 13 domains. Multimorbidity was defined as the presence of two or more chronic conditions (NICE criteria) from a list of 24 conditions and analyzed both as a count and dichotomized (≥3 vs. < 3 conditions). Descriptive statistics summarized participant characteristics. Chi-square tests examined bivariate associations. Hierarchical logistic regression models estimated adjusted odds ratios (ORs) and 95% confidence intervals (CIs) to determine independent predictors of multimorbidity.

High cumulative ACE exposure was observed, with 68.4% reporting ≥4 ACEs. Multimorbidity was common: 38.4% reported three or more chronic conditions. ACE exposure was strongly associated with multimorbidity (χ² = 116.07, p < 0.001). In unadjusted analysis, participants reporting ≥4 ACEs had significantly higher odds of multimorbidity (OR = 67.14; 95% CI: 9.25-487.04). After adjusting for socio-demographic covariates, cumulative ACE exposure remained an independent predictor (OR = 15.58; 95% CI: 1.33-182.21). Advanced age (≥80 years) and living in three-generation households were also independently associated with multimorbidity.

Cumulative childhood adversity significantly predicts multimorbidity among older Nigerian adults, demonstrating a clear dose-response relationship. These findings underscore the importance of life-course approaches and trauma-informed strategies in public health policy. Early identification and prevention of childhood adversity may contribute to reducing the long-term burden of multimorbidity in low- and middle-income settings.