To describe contact with nature and analyze its relationship with perceived stress and health-related quality of life (HRQoL) in the adult population of a rural region.

Cross-sectional observational study.

Primary care, rural region in the province of Guadalajara (Spain).

Adults (aged 18-70), selected by random sampling stratified by sex and age. People with physical, cognitive, or language limitations were excluded.

Perceived stress (PSS-14), HRQoL (SF-12v2: physical (PCS) and mental (MCS) components) and contact with nature (access, frequency, and visual exposure). Sociodemographic, clinical and socioeconomic variables were also collected. Descriptive, bivariate (Chi-square, Student's t-test/ANOVA or Mann-Whitney U test/Kruskal-Wallis) and multivariate analysis using multiple linear regression and MANOVA.

208 participants were analyzed. The mean PSS score was 20.6 (SD=7.8). Stress was lower in people who were more physically active, had contact with natural environments and visual exposure to nature from home or during commutes. The mean PCS score was 44.8 (SD=9.6) and the MCS score was 51.2 (SD=10.4). Used of open natural environments was independently associated with higher CSF (B=2.10; p=0.004), and the presence of plants in the home with a higher CSM scores (B=3.76; p=0.024).

In the rural adult population, contact with nature is associated with lower levels of perceived stress and better HRQoL, supporting its consideration as a health asset in primary care.

Community health workers (CHW) programs are effective at reducing hospitalizations, improving mental health, and supporting health-promoting behaviors. Research suggests awareness and use of CHW services remain uneven across communities nationally. This study describes awareness, use and satisfaction with a city-wide CHW program among racial/ethnic minority individuals in Philadelphia. Data come from a web-based health survey conducted February-March 2024. Participants reported sociodemographic characteristics, health conditions, barriers to social resources, and awareness and use of the city's CHW program. Among 522 participants, the majority were Black (55.4%), women (70.1%), with mean age 39 years. Less than half (44.6%) were aware of the CHW program; of those, 30.5% (13.6% of whole sample) had used it. Among users, 80.3% reported being satisfied with services. In multivariate models, Asian, Hispanic/Latine, privately insured, unemployed, those without barriers to social resources, those with chronic conditions, and West Philadelphia residents had lower odds of awareness. Education, income, and anxiety symptoms were not associated with program awareness. Awareness and use of this CHW program is low to moderate among key populations in Philadelphia. Given variations in awareness, scale-up of CHW programs should include evaluation of program reach, especially to individuals who are not employed and have chronic health conditions.

Hippocampal pattern separation is a neural operation supporting mnemonic discrimination of highly similar memories by orthogonalizing neural inputs into nonoverlapping representations. In humans, pattern separation is thought to support the specificity of episodic memories. Recent neuroimaging studies suggest that the hippocampus can also access and manipulate semantic information. However, it is unclear whether the hippocampus can pattern separate highly similar semantic representations. Here, we tested multiple neural and behavioral signatures of pattern separation using high-resolution functional MRI during a well-established memory discrimination task where we manipulated semantic similarity in a multidimensional conceptual space using word-embeddings. Thirty young adults (Mage = 21.1, 16 females) saw adjective-noun phrases (e.g., "exotic zoo") that were later repeated exactly as before or modified with semantically similar adjectives (e.g., "strange zoo"). Crucially, we presented exact and modified repeats both during an incidental encoding and a two-choice recognition phase, where mnemonic discrimination was assessed. Consistent with pattern separation, we found attenuated repetition suppression for modified repeats in repetition sensitive clusters of the hippocampal head, which was evident at both high and low levels of similarity with no difference between two a priori defined similarity bins. In addition, within participants, the neural signature of pattern separation was associated with mnemonic discrimination at recognition. Finally, clusters sensitive to repetitions during encoding differentiated lures from foils at recognition. These results suggest that hippocampal pattern separation is triggered by fine-grained differences in meaning and supports the creation of highly specific representations of memories overlapping in semantic memory.

Kratom (Mitragyna speciosa) is increasingly used by U.S. adults for pain management, mental health symptoms, and substance withdrawal, yet remains minimally regulated and poorly integrated into clinical guidance. This scoping review characterized patterns and motivations for kratom use, associated health outcomes, and regulatory and social factors shaping access and perception among U.S. adults.

A scoping review was conducted following Joanna Briggs Institute (JBI) methodology and Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-SCR) guidelines. Searches of PubMed/MEDLINE, Embase, CENTRAL, and the Cochrane Library identified peer-reviewed studies published between 2015 and 2025. Studies involving U.S. adults that examined kratom use patterns, health outcomes, or regulatory and social factors were included. Screening and data extraction were conducted using Covidence, and qualitative content analysis was used to identify key themes and research gaps.

Of 1,887 records identified, 43 studies met inclusion criteria. Most studies were cross-sectional, with sample sizes ranging from small laboratory cohorts to nationally representative surveys. Common motivations for kratom use included pain relief, self-treatment of mental health conditions, mitigation of substance withdrawal, and enhancement of energy or mood. Reported outcomes were primarily behavioral and psychological, including polysubstance use, cravings, tolerance, and perceived symptom improvement, alongside physical effects such as gastrointestinal symptoms and withdrawal. Regulatory factors included legal variability, limited federal oversight, inconsistent product labeling, marketing practices, and stigma.

Kratom use among U.S. adults reflects unmet healthcare needs within a fragmented regulatory environment. Coordinated regulation, improved clinical education, standardized surveillance, and stigma-reduction efforts are needed to mitigate harm and support informed decision-making.

Numerous neurocognitive and behavioral deficits in adolescents with acquired brain injury have been associated with impairments in executive functions. Nevertheless, many adolescents do not receive targeted rehabilitation. One of the most validated interventions addressing executive dysfunction in this population is the web-based Teen Online Problem Solving (TOPS) program, developed in the United States in the early 2000s. This study aimed to evaluate the feasibility of the Italian version of TOPS (I-TOPS) in its first implementation in Italy, compared with an active control wellness intervention in adolescents aged 11-19 years. Data on the feasibility of both the training and the study design and procedures are reported from the randomized controlled trial conducted to assess feasibility prior to a full evaluation of efficacy. Forty-two adolescents participated, 21 allocated to I-TOPS and 21 to the wellness intervention. Overall willingness to participate in the study, assessed before randomization across the full sample, was moderate (61.73%). The I-TOPS group, but not the wellness group, demonstrated adequate training adherence, training satisfaction and participation rates. No technological issues hindering program completion, accessibility difficulties with the web-based platform or significant loss to follow-up among participants who completed the training were reported in either group. However, challenges in collecting outcome measures on parent functioning due to refusal were observed in both groups. Adherence to the planned assessment timeline was satisfactory but not fully met. In sum, the findings suggest that I-TOPS represents a feasible approach that is subjectively perceived as useful and engaging by adolescents with acquired brain injury and their families. Nevertheless, the moderate acceptance rate in the study and the potential stigma associated with reporting mental health concerns among some parents may limit the generalizability of the findings. These factors should be taken into account when planning efficacy studies. This study was registered at ClinicalTrials.gov (NCT05169788).

Delayed cancer diagnosis leads to poorer outcomes. Unintended weight loss (UWL) is a nonspecific symptom associated with cancer and other serious conditions, which can make it complex to identify the underlying cause. Clinical decision support systems (CDSSs) can provide evidence-based recommendations to facilitate timely investigation and diagnosis.

This study aimed to pilot the implementation of a CDSS for improving early cancer detection in primary care patients with UWL.

Five practices reviewed patients identified by the UWL CDSS. Staff were interviewed on the acceptability and feasibility of the CDSS. Interviews were analyzed thematically using 2 relevant frameworks: the acceptability of health care interventions and the sociotechnical model for evaluation of digital interventions framework. Clinical audits assessed the correct identification of UWL, follow-up rates, and patient characteristics.

Of 60 patients identified by the CDSS as potentially having UWL, 36 (60%) had true UWL. Among the misclassified cases, most patients (16/55, 30%) were intentionally trying to lose weight; this intention was documented as free text in the clinical notes for 98% (58/60) of patients and in a structured field for only 20% of patients. Of the 36 patients, 5 (14%) were actively recalled by their practices for further follow-up; the others (31/36, 86%) were not recalled, as most were deemed already under appropriate follow-up. By 6 months, 94% (34/36) of the cohort had received follow-up care regardless of whether they had been formally recalled. One-third (12/36, 33%) of patients had no additional symptoms, while 36% (13/36) had recorded additional abdominal symptoms. Mental health conditions accounted for 19% of diagnoses linked to UWL consultation. Practice staff were generally receptive to the UWL CDSS concept. It was particularly appreciated by practices with strong quality improvement processes and prior CDSS experience. A high proportion of misclassified patients, poor workflow integration, and conflicting patients' agendas were cited as implementation barriers.

Our study revealed challenges and potential benefits of implementing a CDSS for identifying patients with UWL at risk of cancer in primary care. While integration issues and misclassification of patients were noted, high rates of follow-up care were observed regardless of the CDSS. These high follow-up rates prompt consideration of whether they reflect Australian primary care and whether a CDSS with these characteristics is the most appropriate approach to support early cancer detection. Future research should focus on improving CDSS integration with existing workflows, enhancing correct identification through access to clinical notes and the use of more sophisticated digital methods (eg, AI). These findings highlight the potential of CDSS in improving patient care and the complexities involved in their successful implementation.

Comorbid anxiety and depression in patients with multiple sclerosis (MS) are common, conferring a greater risk of poorer outcomes and increased health care costs. Few MS services include scalable treatment pathways for psychological distress.

This study aims to conduct a real-world longitudinal study evaluating the implementation and potential effectiveness of an integrated pathway involving digital screening for psychological distress and COMPASS-MS, a therapist-guided digital cognitive behavioral therapy tailored to the challenges of living with MS.

This is a mixed methods, observational, real-world, longitudinal study being conducted in the United Kingdom. Routine mental health screening in the MS clinic will identify patients experiencing distress (using predefined clinical cutoffs), who will be assessed for eligibility for psychological treatment, including the COMPASS-MS program. Participants will receive COMPASS-MS online over approximately 12 weeks (including up to six 30-min therapist sessions). The implementation, reach, and adoption of the treatment pathway within a specialist MS service will be assessed using aggregate data on the uptake of mental health screening, eligibility, and consent rates for COMPASS-MS, as well as the number of COMPASS-MS sessions completed. Interviews with patients and health care professionals will primarily assess the scalability and potential or actual barriers and facilitators of the new pathway. Potential effectiveness will be assessed using participant questionnaires at preintervention and 12 weeks postintervention. The primary effectiveness outcome will be pre-post changes in distress (Patient Health Questionnaire Anxiety and Depression Scale scores). Quantitative data will be summarized using descriptive statistics and mixed effects models. Qualitative data will be analyzed using reflexive thematic and framework analysis.

Recruitment of both patients and health care professionals began in June 2024. For patients, recruitment was completed as of September 2025, including 82 participants. For health care professionals and stakeholders, as of September 2025, 7 had consented and completed interviews, and 13 more were expected to be recruited by August 2026. Data analysis has not yet started; however, quantitative results are expected by September 2026.

The study findings will inform treatment pathways that can be incorporated into MS clinics and highlight adaptations or implementation protocols required to increase future scalability and effectiveness.

Therapist-guided internet-delivered cognitive behavioral therapy (guided iCBT) is increasingly implemented in routine mental health care to expand access to evidence-based treatments. Although the clinical effectiveness and patient acceptability of guided iCBT for common mental health disorders are well established, less is known about how introducing such digitally mediated interventions reshapes therapists' everyday work practices and professional roles. Existing research has primarily focused on treatment outcomes, service uptake, and organizational implementation challenges, leaving therapists' lived professional experiences and role enactment in routine practice underexplored.

This study aimed to explore how the introduction of guided iCBT in routine clinical practice influences mental health care professionals' perceptions and enactment of their professional roles, and to examine how these roles are shaped by interactions between technology and health care professionals.

We conducted an exploratory qualitative study using semistructured interviews and observations with 31 health care professionals who delivered guided iCBT in specialized mental health care settings between January and December 2022. Participants were recruited through purposive and snowball sampling, and data were analyzed using reflexive thematic analysis. The study was theoretically informed by actor-network theory and sociological perspectives on professional roles, enabling a sociotechnical interpretation of how professional work is shaped through interactions between human and nonhuman actors.

Two overarching themes described how guided iCBT reconfigures therapeutic work. First, participants reported increased professional agency through enhanced flexibility and autonomy, including greater control over work schedules and opportunities to tailor standardized treatment elements to individual patients. Second, the therapist's role expanded beyond traditional clinical tasks, encompassing increased administrative responsibilities ("the administrative therapist") and expectations to actively promote and legitimize guided iCBT to patients ("the professional salesperson"). While guided iCBT enabled more flexible and individualized care, it also introduced new constraints through standardized protocols, digital platforms, and organizational expectations, resulting in professional discretion and authority being actively negotiated rather than simply reduced or maintained.

This study offers a practice-oriented, sociotechnical account of how guided iCBT is implemented in routine care. The findings show how therapists' roles are shaped by everyday clinical workflows, in which responsibility, decision-making, and clinical judgment are distributed among therapists, patients, digital platforms, treatment protocols, and organizational arrangements. The concept of distributed therapeutic authority offers a useful lens for understanding how therapeutic work is reorganized in digitally mediated care without implying a loss of professional expertise. Professional judgment remains central but is exercised in interaction with digital tools and standardized treatment structures. These findings underscore the importance of aligning digital systems, clinical routines, and professional roles when implementing guided iCBT to support both access to care and the quality of therapeutic practice.

Conventional household-based housing affordability measures assume equal burden-sharing, potentially diluting or obscuring health risks of individuals with disproportionate burdens. To examine the implications of this assumption in research and preventive policy, we investigated the respective associations of household and individual housing affordability with psychological distress.

Analyzing data from a web-based cross-sectional survey conducted in November 2025 (6619 Japanese adults), we assessed classification discordance between household and individual housing unaffordability (cost-to-income ratio ≥ 30%) and examined their associations with psychological distress (Kessler Psychological Distress Scale ≥5). Modified log Poisson regression estimated prevalence ratios by housing tenure, using multiple imputation.

Adjusted prevalence ratios (aPR) were similar for the household (1.15; 95% confidence interval [CI]: 1.05, 1.26) and individual (1.17; 95% CI: 1.06, 1.28) indicators. Stratification by housing tenure showed strong associations for both indicators among homeowners (both aPR = 1.33), whereas no significant associations were observed among renters. However, the household measure overlooked about a third of individuals with unaffordable housing.

While the assumption of equal burden-sharing appears to be sufficient for research, it may obscure specific vulnerabilities when used for screening. Preventive strategies could be refined by incorporating individual indicators to capture these hidden risks.

On 17 December 2024, a magnitude 7.3 earthquake struck the Pacific Island country of Vanuatu, affecting over 80 000 people and causing 14 deaths and 265 injuries. Facing limited specialist clinical capacity, increased patient load and strained facilities, Vanuatu's Ministry of Health requested support from emergency medical teams.

Vanuatu, highly disaster-prone and geographically dispersed, has a health system constrained by limited human resources and recent cyclone-related damage. The country's national emergency medical team, the Vanuatu Medical Assistance Team, was established in 2017 and plays a central role in health emergency response in the country.

Within 24 hours of the earthquake, the Vanuatu Medical Assistance Team was activated and established an Emergency Medical Team Coordination Cell within the national health emergency operations centre. National and international emergency medical teams from Australia, Fiji, Indonesia, Japan and New Zealand were deployed over the subsequent weeks and provided clinical, mental health and information management support. The World Health Organization's emergency medical team Minimum Data Set was implemented to monitor health trends and inform response actions.

Eight national and international emergency medical teams deployed alongside local health services. Together, they reported more than 5500 consultations to the Emergency Medical Team Coordination Cell, and a specialized team provided mental health and psychosocial support to 521 people. Minimum Data Set analysis showed a rapid decline in trauma-related presentations and detected increases in influenza-like illness, guiding the transition from emergency to recovery.

This response underscored the value of emergency medical teams following disasters, the importance of national leadership and coordination, and the significance of regional solidarity and partnerships. It also highlighted the importance of information management during emergencies and demonstrated potential innovations in this space.