Universal Health Coverage (UHC) is the cornerstone of equitable health systems and service delivery. Achieving UHC requires both "whole of government" and "whole of society" approaches that are vital for building resilient health systems that promote physical and mental wellness for all communities. In this paper, we review several theories of stakeholder engagement (SE) and argue that meaningful SE - as opposed to stakeholder management - is essential for fostering early participation and democratic decision-making in the transformation of health systems towards UHC. We recommend several key steps to promote early and inclusive SE that actively solicit input from diverse community members, establish open platforms for dialogue, and leverage the expertise and resources of various sectors. By creating a collaborative environment that includes each individual, whether an educator, policymaker, family member, or business leader, amongst others, we can advance the goals of UHC and build health systems that benefit everyone.

Population aging poses significant public health challenges, particularly in maintaining physical and mental wellbeing among older adults. Square dance, a culturally embedded group exercise in China, may offer a practical strategy to enhance functional, psychological, and social health in community-dwelling older adults.

A 12-week single-blind randomized controlled trial was conducted among 150 older adults (60-79 years), randomly allocated to a Square Dance Intervention Group (n = 75) or a Health Education Control Group (n = 75). The intervention comprised three 60-min sessions weekly. Assessments were conducted at baseline, Week 6, and Week 12. Outcomes included aerobic endurance (6MWT), balance (TUG), flexibility, blood pressure, depressive and anxiety symptoms (GDS-15, GAD-7), wellbeing (WHO-5), and quality of life (SF-12). Intention-to-treat mixed-effects models were used for analysis.

Compared with controls, the intervention group achieved significantly greater improvements in 6MWT (+41.5 m), TUG (-1.05 s), flexibility (+3.2 cm), systolic (-3.8 mmHg) and diastolic blood pressure (-2.4 mmHg). Depressive symptoms (-1.5 points), anxiety (-1.2 points), WHO-5 (+3.8 points), and SF-12 PCS/MCS (+3.1 and +3.4 points) also improved significantly. Adherence was high (87%), with no serious adverse events reported.

The findings provide strong evidence that a culturally relevant group-based square dance program enhances functional capacity, emotional wellbeing, cardiovascular health, and overall quality of life in older adults. Its high feasibility, safety, and acceptability suggest strong potential for widespread community implementation as a low-cost healthy aging strategy.

Miscarriage is a prevalent and distressing experience that profoundly impacts both women's and men's psychological wellbeing and relationship dynamics. This study investigated the lived experiences, coping strategies, and relationship dynamics of women and men following miscarriage in Kampala district. The study used a qualitative approach, particularly a phenomenological research design. It employed a purposive sampling technique to select 12 participants who had experienced at least one miscarriage at least 1 month before data collection. The sample included women aged 24-38 years and men aged 28-50 years. Data were collected using in-depth interviews and analyzed following Virginia Braun and Victoria Clarke's six-phase approach to thematic analysis. The study findings showed that the lived experiences of participants were characterized by an emotional rollercoaster involving denial and sadness, trauma, and a loss of identity. Participant experiences were also marked by a search for an explanation and the pressure to align grief with cultural gender expectations. To navigate this aftermath, participants' coping strategies included mutual partner support, religion, the pursuit of a replacement baby, and the presence of other children. Furthermore, the experience transformed relationship dynamics; while some couples figured it out together, strengthening their bond, others faced emotional distance and a damaging blame game, outcomes often influenced by the state of the relationship prior to the loss. The study findings highlighted the psychological, social, spiritual, and emotional impact of miscarriage for both women and men. Therefore, there is a need for comprehensive and culturally sensitive support for individuals navigating the aftermath of miscarriage.

DNA methylation of the ELOVL2 (Elongation of Very Long Chain Fatty Acids Protein 2) promoter is one of the most robust molecular biomarkers for chronological age; however, whether ELOVL2 plays a functional role in brain aging and immunosenescence, and whether the APOE genotype modulates these effects, has not been fully explored. This study investigated the associations among ELOVL2 methylation, APOE genotype, and neurophysiological changes in the brain, as well as indicators of immunosenescence of peripheral blood T cells during aging.

We examined 72 non-demented volunteers aged 20-88 years, stratified by APOE genotype (41 APOE-, 31 APOE+). ELOVL2 methylation levels were measured via bisulfite conversion and pyrosequencing. Participants underwent cognitive screening, auditory P3 event-related potential (ERP) recordings, and resting-state MRI functional connectivity (rsFC) assessments. In a subgroup of 18 healthy subjects, we examined peripheral blood T-cell subsets and analyzed the association of CD3⁺HLA-DR⁺ T cells with ELOVL2 methylation and neurophysiological characteristics.

ELOVL2 CpG promoter methylation (chr 6:11044880. GRCh37) was associated with P3 ERP latency in both the overall sample and APOE4+ carriers, remaining significant even after adjusting for age; however, this association was not significant in APOE4- individuals. DNA methylation of ELOVL2 was inversely correlated with fMRI rsFC in the salience-, and memory-related, and central autonomic networks, indicating disrupted connectivity within these networks. An increased proportion of CD3⁺ cells expressing the immune activation marker HLA-DR was correlated with elevated ELOVL2 methylation level and with decreased fMRI rsFC in brain networks, including circuits related to the DMN medial prefrontal cortex, amygdala, and cerebellum.

The results imply a close link between ELOVL2 methylation, inflammaging and brain dysfunction, which is modulated by APOE4+ genotype.

Background: Research has demonstrated the effectiveness of a mobile app-delivered Acceptance and Commitment Therapy (IACT) programme for individuals with posttraumatic stress disorder (PTSD) in their PTSD symptoms. However, there are still few studies on its mediating mechanism.Objective: This secondary analysis aimed to examine whether six components of psychological flexibility - acceptance, present-moment awareness, self-as-context, cognitive defusion, valued living, and committed action - mediate the effects of an IACT programme for individuals with PTSD.Method: Data were obtained from a randomized controlled trial in which participants were assigned to an IACT condition (n = 78) or a waitlist control (WL; n = 67). Using a latent growth curve modelling approach with bias-corrected bootstrapped confidence intervals, changes in PTSD symptoms and psychological flexibility components were assessed at baseline (T1) and following each of six intervention modules (T2-T7).Results: Relative to WL, the IACT group showed significantly greater improvements in both PTSD symptoms and all six flexibility components. Mediation analyses revealed that four processes - acceptance, self-as-context, cognitive defusion, and committed action - fully mediated the intervention's effects on PTSD outcomes, whereas valued living and present-moment awareness served as partial mediators.Conclusions: These findings suggest that enhancing these components of psychological flexibility may be crucial for effective IACT treatment of PTSD.

Sleep is essential for adolescents’ physical and psychological development. Sleep problems are common among adolescents with psychiatric disorders, but research on the prevalence of specific sleep disorders herein is lacking.

To examine the prevalence of sleep disorders in adolescents with psychiatric disorders and to explore its relationship with sleep-hygiene-behaviors.

In a cross-sectional pilot-study, 50 adolescents (16-24 years) receiving care at a specialized mental health institution completed the Holland Sleep Disorders Questionnaire and the Adolescent Sleep Hygiene Scale. The prevalence of sleep disorders and differences in sleep-hygiene-behaviors between adolescents with and without sleep disorder(s) were analyzed using cross-tabulations, <span class="CharOverride-4">&chi;</span>&sup2;-, and t-tests.

68% of adolescents scored above cut-off for at least one sleep disorder, and 54% for two or more. Insomnia disorder (60%) and circadian rhythm sleep-wake disorders (44%) were most prevalent. Comorbidity of multiple sleep disorders was high. Adolescents with sleep disorders reported significantly poorer sleep-hygiene, particularly pertaining substance use and pre-sleep emotional arousal.

Sleep disorders are highly prevalent among adolescents with psychiatric disorders and are associated with poorer sleep-hygiene. Early detection and sleep disorder treatment, along with improving sleep-hygiene-behaviors, might be essential for healthy sleep quality and better/faster psychiatric recovery in adolescents.

In forensic mental health care, clients who terminate treatment prematurely are at increased risk of recidivism. Most drop out during the initial treatment phase. Understanding factors associated with the timing of dropout may help clinicians adjust interventions in time and maximize treatment benefit.

To examine the extent to which the central eight criminogenic risk factors predict the timing of dropout (early, middle, or late) among adults receiving outpatient forensic treatment.

A retrospective file study was conducted among 1,110 adult clients who discontinued treatment prematurely. The central eight risk factors were assessed with the RAF-GGZ. Dropout subgroups were categorized based on treatment duration as early (0-4&nbsp;months), middle (4-6&nbsp;months), and late (&gt; 6&nbsp;months) dropout.

More severe family or relationship problems at the start of treatment were the only risk factor significantly associated with an increased likelihood of late dropout. No significant effects were found for the other central eight risk factors.

The central eight risk factors appear to have limited value for predicting the timing of dropout among forensic outpatients. Future research should focus on responsivity factors and treatment process variables to better understand and prevent premature termination.

Although telehealth outcomes have been widely studied, less is known about how providing telehealth influences therapists' subsequent in-person clinical practice. This qualitative study examined how marriage and family therapists (MFTs) described changes in their in-person work following telehealth experience. Forty-two MFTs completed an online survey including demographic items, a Likert-scale item assessing perceived impact on in-person services, and an open-ended prompt about changes noticed during in-person therapy. A subset completed follow-up virtual interviews. Data were analyzed using reflexive thematic analysis. Findings indicated that telehealth functioned as a formative professional experience, shaping in-person practice through heightened embodied attunement, increased observational precision, more intentional communication, expanded intervention flexibility, and refined clinical decision-making. Participants also reported enduring logistical changes related to scheduling, boundaries, and modality selection. Developmental stage influenced how these changes were integrated. Results suggest telehealth experience represents an important dimension of therapist development, with implications for training, supervision, and hybrid care.

Germany increasingly relies on an internationally recruited migrant workforce, like Vietnamese migrants, to address shortages in the mental healthcare sector. This cross-sectional study examined differences in the Professional Quality of Life (ProQOL), measured through the subscales burnout (BO), secondary traumatic stress (STS) and compassion satisfaction (CS), among Vietnamese migrant and non-migrant mental health professionals (N = 312) in Germany. Participants completed an online survey in German or Vietnamese including the ProQOL - 5 Scale, as well as sociodemographic and work-related variables. Multiple linear regression models identified salary across all subscales and psychiatric pre-conditions for BO and STS as significant predictors for ProQOL outcomes. Analyses of covariance compared adjusted group means across migration and gender. Vietnamese migrant professionals report significantly lower CS and higher STS compared to non-migrant professionals, while no significant migration-related differences were observed for BO. Considering gender, women exhibit significantly higher CS than men, whereas no significant gender differences emerged for BO or STS. No significant migration × gender interaction effects were found. Findings indicate migration background is associated with relevant differences in ProQOL among mental health staff in Germany, underscoring the need for targeted support, like an inclusive workplace culture and work-related social network. Further research should incorporate direct measures of migration-related stressors to better understand underlying mechanisms and longitudinal designs.

Substance use and suicidality are prevalent among individuals at ultra-high-risk (UHR) of psychosis, yet their relationship remains unclear. This systematic review synthesises evidence on the relationship between substance use and suicidality-comprising suicidal ideation, self-harm, suicide attempts, and suicide deaths-in the UHR population.

A pre-registered systematic review (PROSPERO: CRD42024614852) was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Systematic searches of Embase, Medline, PsycINFO, and Web of Science identified studies examining substance use and suicidality in individuals at UHR. Two reviewers independently extracted data and assessed quality using the Mixed Methods Appraisal Tool. Findings were narratively synthesised.

Twelve studies (13 papers; n = 2198) met inclusion criteria. Of 40 analyses, only 13 reported significant associations between substance use and suicidality, most of which were derived from a single study. Tobacco use showed the most consistent preliminary associations with suicidal ideation and self-harm. Alcohol and cannabis were linked to ideation and self-harm in some analyses, and cocaine to ideation only, particularly when continuous measures were used. In contrast, composite substance use variables were largely unrelated to suicide outcomes. Methodological quality varied, with major limitations including reliance on cross-sectional data and the use of dichotomous substance use outcomes.

At present, there is insufficient high-quality evidence to establish a reliable association between substance use and suicidality in individuals at UHR for psychosis. Rigorous longitudinal studies using validated, substance-specific measures are needed to better understand these relationships and inform risk assessment and early intervention.