Chronic obstructive pulmonary disease (COPD) is a leading cause of global morbidity and mortality. Emerging evidence suggests disparities in COPD outcomes between rural and urban populations, but no prior review has synthesised these differences globally. Five databases (Medline, Embase, Emcare, CINAHL and Cochrane Central) were searched in May 2025. Eligible peer-reviewed studies directly compared rural and urban populations in at least one of four measures of COPD burden: prevalence, symptom burden, exacerbations or mortality. Study quality was assessed and narrative synthesis was conducted due to heterogeneity in outcome measures. Of 1339 screened studies, 32 met inclusion criteria, spanning 13 countries. COPD prevalence was higher rurally in 83% (15/18) of studies, with 11/15 demonstrating statistical significance. This pattern was consistent across geographical distributions. Total exacerbation rates were higher rurally in 60% (3/5) of studies, although hospitalisations varied significantly. 50% (6/12) of studies reported higher hospitalisation rates in urban areas and 5/12 studies reporting higher rates in rural areas. 86% (6/7) of studies demonstrated higher mortality rurally and symptom burden was higher amongst rural residents in 67% (4/6) of studies; however, the majority of these were conducted in the USA. This review highlights consistent rural-urban inequalities in COPD prevalence and outcomes, reflecting the impact of healthcare inequities, socioeconomic deprivation and environmental exposures on COPD burden in rural areas. Targeted interventions promoting equitable healthcare access, health education, transition to cleaner fuels and rural access to smoking cessation and pulmonary rehabilitation services are essential to mitigate these disparities and improve outcomes in rural populations.

Ventilator-induced lung injury continues to limit outcomes in patients with acute respiratory failure despite established lung-protective strategies.Mechanical power, the rate of energy transfer from the ventilator to the respiratory system, has emerged as an integrative index of ventilator-induced stress. Experimental studies indicate that cumulative and dissipated energy, rather than isolated pressures or volumes, drive lung injury. Observational and registry data consistently link higher mechanical power with increased mortality in acute respiratory distress syndrome and mixed intensive care unit populations, with thresholds of ∼16-18 J·min^-1 associated with increased risk. Normalised indices (e.g. mechanical power per predicted body weight or per compliance) often outperform absolute mechanical power as predictors of outcome. Strategies to minimise mechanical power include individualised positive end-expiratory pressure titration, driving pressure limitation, and an optimised respiratory rate. Complementing traditional physiological analysis, this review highlights the emerging role of technological integration, specifically closed-loop ventilation and artificial intelligence-driven prediction models, as essential tools to bridge the gap between theoretical mechanical power concepts and bedside application.Mechanical power provides a unifying physiological framework that integrates volume, pressure, flow and frequency into a single descriptive measure of ventilatory load. While higher mechanical power is consistently associated with worse outcomes, current evidence does not support titrating ventilation to pre-defined numerical power thresholds, and prospective randomised trials are required to determine whether mechanical power-informed strategies improve patient-centred outcomes. Mechanical power should therefore be regarded as a contextual physiological descriptor rather than a standalone therapeutic target.

In the United States, post-COVID-19, Mental and Behavioral Health (MBH) related Emergency Department (ED) visits, specifically for young adults, have increased. This article presents a review of 29 peer-reviewed articles on technological ED interventions to improve the safety and care experiences of patients with MBH conditions. The key findings indicate improved MBH identification for patients, improved access to care with telepsychiatry, enhanced communication through standardized documentation and alerts, and high acceptability of crisis management interventions. Further research needs to be conducted to enhance intervention design, acceptability, and adoption of screening, remote consultation, and crisis management interventions, and reduce staff documentation workload.

Postpartum depression (PPD) is a common childbirth complication that impairs the mother-infant relationship and contributes to long-term developmental challenges among children. Although PPD treatment reduces depressive symptoms, it is not necessarily sufficient to improve maternal-infant interaction. In addition, several barriers preclude timely access to care including mental health stigma, limited specialized providers, and challenges with navigating the healthcare system and securing necessary childcare and transportation. Our team developed a 12-session patient- and clinician-facing digital platform, MommaConnect that combines evidence-based therapies-- Mother Baby Interaction Therapy and Interpersonal Psychotherapy-- to improve PPD symptoms and mother-infant interaction, address barriers to care, and provide support between therapy sessions. The purpose of this article is to describe the translation of our in-person approach to treating PPD and improving mother-baby interaction to our MommaConnect digital platform that integrates core psychotherapy components into a user-centered platform.

Our methods were guided by the PRECEDE-PROCEED Model and three stages of a nine-stage digital platform development process. In stage 1, we conducted focus groups to understand the needs of postpartum mothers who had experienced PPD and in-depth interviews to understand the concerns of perinatal mental health clinicians. We analyzed the qualitative data with thematic content analysis. In stage 2, we used component mapping to translate treatment modalities into the digital platform. Finally in stage 3, we used co-design, prototyping, and user-interface design to build the MommaConnect prototype.

Results from the focus groups identified four themes including (1) barriers to accessing care, (2) preferences and needs in mental health care delivery, (3) feedback on the MommaConnect App, and (4) broader challenges and experiences. The in-depth interviews with the clinicians resulted in six themes including (1) assessment and early intervention, (2) barriers to care, (3) role of technology in treatment, (4) building a therapeutic alliance, (5) community and social support, and (6) addressing comorbid conditions. Additionally, the team translated the in-person treatment modality to a 12-session format and designed the current version of the MommaConnect prototype, which has both patient-facing and clinician-facing components.

MommaConnect offers an innovative, accessible approach that combines Mother Baby Interaction Therapy and Interpersonal Psychotherapy to treat PPD and improve the quality of mother-infant interaction. Its digital adaptation provides a treatment platform for mothers and clinicians to work together in real time and communicate between sessions. MommaConnect may expand access, reduce barriers to care, and inform the broader translation of evidence-based behavioral interventions into scalable, technology-enabled formats. This work has the potential to transform access to perinatal mental health care, improve maternal and infant outcomes, and reduce the long-term sequelae associated with untreated PPD and disrupted early relational experiences for infants.

Mental health conditions such as depression, anxiety, and post-traumatic stress disorder (PTSD) are highly prevalent among forcibly displaced populations. Prevalence rates of common mental health conditions have been studied in refugee groups. However, research is sparse regarding the heterogeneity of psychiatric symptoms and quality of life (QoL) profiles among individuals with recent displacement experiences.

The current study employed Latent Profile Analysis (LPA) to identify profiles of psychopathology and QoL in a sample of 510 recently arrived refugees in Sweden. The associations of profile membership with socio-demographic factors were thereafter investigated.

Three distinct profiles were identified: a severe psychopathology/low QoL profile (36.27%), a PTSD-dominant/preserved QoL profile (33.14%) and a mild psychopathology/high QoL profile (30.59%). Nationality and residence status were moderately associated with profile membership. Individuals with Afghan nationality were over-represented, and those with Syrian nationality under-represented, in the severe psychopathology/low QoL profile. This association is likely explained by residence status: 82% of individuals in the severe psychopathology/low QoL profile lacked a residence permit, with only 3.6% of Afghans having received a residence permit, compared to 59.1% of Syrians.

The results underscore the heterogeneity of psychopathological symptoms and QoL in individuals with recent displacement experiences, as well as a significant influence of contextual factors like residence status on their mental health and QoL. These findings may have implications for informing psychological treatments and migration policies.

Fear of falling (FOF) is a phenomenon prevalent among older adults associated with adverse outcomes, including reduced mental and physical health, decreased quality of life, and an overall reduction in social participation. Based on cross-sectional and longitudinal studies, recent reviews have provided information on the prevalence of FOF and its association with different health outcomes. To gain a deeper understanding of factors relevant to interventions to prevent or reduce FOF, this review goes beyond previous evidence syntheses by focusing on psychosocial factors that are longitudinally associated with FOF. The objective of the review is to provide an overview on evidence levels of psychosocial factors assumed to be longitudinally associated with FOF.

Studies examining associations between psychosocial factors (predictors) and FOF (outcome) longitudinally were included. Cochrane CENTRAL, Embase, Scopus, and Web of Science were searched up to October 25, 2025. An ordinal rating scheme was used for data synthesis to assess beyond sociodemographic variables and other psychosocial factors. A modified version of the Newcastle-Ottawa scale was employed to evaluate study quality.

Sixteen studies (n at baseline: 255-9,060) with a total of 30,724 participants reported longitudinal associations of 14 psychosocial factors with FOF. Higher depressive symptoms, anxiety, negative affect, and symptom burden, lower social activity, social participation, emotional support, and feeling older were linked to higher FOF. The relationship between depressive symptoms and higher FOF showed the most robust evidence, with six studies finding evidence for incremental validity of depressive symptoms beyond sociodemographic variables and other psychosocial factors. In contrast, higher self-efficacy, positive affect, social support, and social cohesion were associated with lower FOF. In some cases, the magnitude of associations was reduced when controlling for other variables.

The evidence base remained weak for psychosocial factors other than depressive symptoms. Further longitudinal research is needed on the role of psychosocial factors for FOF. Such studies enlarge the evidence base for factors identified in this review and should include additional factors (e.g., loneliness). Our findings highlight the need for further research on the relationship between depressive symptoms and FOF for the development of effective interventions.

Pre-registration ID: https://doi.org/10.17605/OSF.IO/X5ZGR.

Endometriosis is a chronic systemic disease affecting ~10% of women, yet its genetic basis and molecular mechanisms remain poorly understood. Hence, here we conducted a genome-wide association study of endometriosis and adenomyosis in ~1.4 million women, including 105,869 cases, aiming to expand loci discovery across ancestries, dissect symptom-specific effects and integrate multi-omic data. We identified 80 genomic regions associated with endometriosis risk, including 37 new loci, of which 5 are also associated with adenomyosis. We identified putative causal variants underlying over 50 of these associations. Transcriptomic, epigenetic and proteomic analyses across tissues linked endometriosis risk to pathways involved in cell differentiation, immune and hormonal regulation, tissue remodeling and inflammation. Drug-repurposing analyses highlighted potential treatments currently used for breast cancer, contraception and preterm birth prevention. Endometriosis polygenic risk interacted with abdominal pain, anxiety, migraine and nausea. This study advances understanding of genetic risk factors for endometriosis and provides molecular support for several hypotheses on its pathogenesis.

Transition-metal-catalyzed carbene transfer reactions are powerful tools in organic synthesis, yet they traditionally rely on diazo compounds, which raise stability and safety concerns. While alternative precursors have emerged, a general, redox-neutral, and atom-economical platform for metallocarbenes generation remains a persistent challenge. Herein, we introduce carboxamide-functionalized BCBs as versatile carbene precursors that undergo catalyst-controlled chemodivergent reactions. Under nickel catalysis, cyclopropanation of multisubstituted alkenes proceeds via an acceptor-type Ni-carbene, affording azabicyclo[n.1.0] architectures bearing up to three contiguous stereocenters with excellent diastereocontrol. In contrast, copper catalysis promotes efficient and chemoselective formal C(sp²)─H insertion to access allyl oxindoles. Both protocols exhibit broad substrate scope, high functional group tolerance, and exceptional atom economy, and their synthetic utility is highlighted through the preparation of core structures of bioactive compounds. Computational and experimental studies reveal that Ni-carbene generation proceeds via a stepwise dual C─C cleavage, contrasting with the concerted dual cleavage and subsequent electrophilic aromatic substitution manifold established for the copper system.

Hypertension remains a leading global health challenge, particularly in low- and middle-income countries (LMICs), where limited health care infrastructure and resources restrict effective management. Community health workers (CHWs) are critical in delivering care in these settings, and when equipped with mobile health (mHealth) apps, they can greatly enhance chronic disease management. Involving CHWs in the design and development at all stages is essential for the success of such programs. However, relatively little research discusses CHW feedback on mHealth interventions.

This study aims to evaluate CHW feedback on a hypertension program using a novel tablet-based mHealth tool designed for CHW hypertension diagnosis and management in rural Guatemala.

We conducted a mixed-methods analysis as part of a pilot study in San Lucas Tolimán, Guatemala, involving 6 CHWs over a 6-month period. Quantitative data were collected using the System Usability Scale and Likert-scale surveys before and after study completion. Qualitative data were gathered through written surveys and focus group interviews conducted in Spanish by bilingual team members. These methods assessed the app's ease of use, workflow integration, and cultural appropriateness. CHWs provided detailed perspectives on technical challenges, training adequacy, and patient engagement, which guided iterative refinements to both the mHealth app and the hypertension management program.

The mHealth app was generally well-received. Average System Usability Scale scores exceeded 70, surpassing established usability thresholds. Likert scale data revealed CHWs found the app to be useful and easy to use, but identified training protocols as areas for improvement. Qualitative analysis of focus groups and written surveys revealed 3 dominant themes. First, CHWs identified practical short-term needs, including slower and more comprehensive training sessions, simplified medication dosing regimens to reduce pill burden, and streamlined survey questions to shorten patient visit times. Second, CHWs raised larger structural concerns, including retention challenges related to financial compensation and misalignment between required clinical data collection and the cultural appropriateness of certain app questions. Third, CHWs highlighted program benefits, including improved patient care and hypertension management, empowerment through educational tools, and increased pride and community trust associated with the program.

Our findings suggest that iteratively integrating user feedback into the development of mHealth interventions is key to improve usability, cultural appropriateness, and overall effectiveness of chronic disease management in resource-constrained settings. Due to the small number of CHW participants, as well as a reliance on self-reported perceptions, these findings should be interpreted as exploratory and hypothesis-generating rather than generalizable. This study contributes to the growing literature on mHealth apps for noncommunicable diseases in LMICs and provides insights into CHW experiences. Addressing the technical barriers and systemic challenges identified in this study can help improve future implementations of mHealth-enabled chronic disease programs in LMICs.

Metabolic dysfunction-associated steatotic liver disease has become a predominant cause of chronic liver disease worldwide and represents a major clinical management challenge owing to the scarcity of effective therapeutic interventions. However, the molecular mechanisms driving MASLD progression remain incompletely understood. Here, we identify hepatoma-derived growth factor (HDGF) as a key regulator that integrates lipogenesis with intrahepatic inflammation in MASLD pathogenesis. Hepatic HDGF deficiency profoundly protects mice from high-fat, high-sucrose diet-induced hepatic steatosis and inflammation. Mechanistically, HDGF promotes lipogenesis and hepatic steatosis by facilitating S6K1-dependent phosphorylation of STAT3 at Ser727. Consistently, pharmacological inhibition of STAT3 by S3I-201 abolishes HDGF-induced lipogenic gene expression and hepatic steatosis in mouse models. Importantly, phosphorylation of HDGF at Ser165 is essential for its exosomal secretion from hepatocytes, thereby triggering proinflammatory macrophage activation. In humans, both serum and hepatic levels of HDGF are elevated and positively correlated with MASLD progression. Together, these findings uncover a mechanism that couples hepatic lipogenesis to intrahepatic macrophage activation, driving both steatosis and inflammation in MASLD. Targeting the HDGF-STAT3 pathway and exosomal HDGF secretion may represent a potential therapeutic strategy for ameliorating metabolic dysfunction and hepatic inflammation in MASLD and related disorders.