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.

Non-communicable diseases (NCDs) increasingly affect adolescents, particularly in low- and middle-income countries. Seven key lifestyle behaviours, alcohol and tobacco use, consumption of JUNCS foods (junk, ultra-processed, nutritionally inappropriate, caffeinated/coloured/carbonated foods/beverages, sugar-sweetened beverages); physical inactivity; inadequate sleep; excessive screen time; and stress, collectively termed the 'Big-7 Behavioural Risk Determinants', contribute to NCD onset in adolescence and persistence into adulthood.

To determine the effectiveness of the AdoHealth e-wellness initiative in reducing the Big-7 Behavioural Risk Determinants among school-going adolescents aged 14-17 years, measured as change from baseline at 6 and 12 months post-intervention compared with control schools.

This multisite, open-label, superiority cluster randomised controlled trial will include 180 high and senior secondary schools (Classes 9-12, ages 14-17 years; including public and private) in SAS Nagar (Mohali), Punjab, India, randomly assigned in a 1:1 ratio to intervention or control groups, stratified by school location (urban/rural) and school type (government/private). Participants will be recruited by trained field investigators. Eligible participants are students aged 14-17 years enrolled in participating schools, with written parental consent and adolescent assent; students with serious health conditions or planned school transfer will be excluded. The intervention comprises e-modules (10-15 min each) on the Big-7 Behavioural Risk Determinants, delivered via classroom smartboards with facilitator support, over 8 weekly sessions. A pilot phase will be conducted in one school (approximately 100 adolescents) prior to full-scale implementation. Behavioural and biochemical assessments using standardised tools will be conducted at baseline, 6 months, and 12 months post-intervention. Safety monitoring includes adverse event reporting and referral for psychological support as needed. The planned sample size is 18,000 students (9000 per arm across 90 clusters each). The primary endpoint is the change in the 'Big-7 Behavioural Risk Determinants' at 12 months post-intervention, while secondary endpoints include intermediate behavioural changes, biochemical risk markers, and overall well-being.

This study aims to evaluate the feasibility and potential effectiveness of school-based e-wellness interventions targeting multiple health behaviours simultaneously. If successful, findings may contribute to early NCD prevention strategies and inform policy development for adolescent health promotion programs in low- and middle-income countries.

Trial registration: Clinical Trials Registry of India (CTRI), CTRI/2025/01/079797. Registered on January 30, 2025. https://ctri.nic.in/Clinicaltrials/rmaindet.php?trialid=121397&EncHid=98502.11769&modid=1&compid=19. First participant recruitment commenced on August 16, 2025.

In Malaysia, one third of the adult population suffer from hypertension and literature reported poor sleep quality led to cardiovascular events. However, little study was conducted to look at the gender-specific differences in sleep quality among hypertensive patients. This study aimed to examine gender difference in sleep quality and its associated factors among hypertensive population in a primary care clinic.

This was a cross-sectional study conducted from December 2023 to February 2024 using systematic approach with validated questionnaires (PSQI, DASS-21, STOP-BANG). Multiple logistic regression and Firth's penalized regression (to address sparse data/complete separation) were used to identify the determinants of poor sleep among different gender hypertensive patients.

Three hundred thirty-five participants (62.9% female, mean age 58 years) were recruited in this study. Prevalence of poor sleep among male and female were 91.1% and 84.8% respectively. In the multivariable analysis for men, a lack of regular physical exercise (< 150 min/week) was identified as the sole significant predictor of poor sleep (aOR 6.278, p = 0.040). Among women, poor sleep was significantly associated with anxiety symptoms (aOR 11.486; 95% CI: 1.37-96.21; p = 0.024) and income, where those in the B40 (bottom 40% income) and T20 (top 20% income) groups had higher odds of poor sleep compared to the M40 group (aOR 3.46; 95% CI: 1.23-9.72; p = 0.019).

These findings highlight gender-specific determinants of sleep disturbances among those with hypertension, suggesting tailored interventions addressing physical inactivity for men and socioeconomic support or anxiety management for women to improve sleep quality.

Despite advancements in treatment, diabetic foot ulcers (DFU) are challenging to heal, and the comparative efficacy of debridement strategies is poorly understood. This study assessed the effectiveness and ranked debridement methods for DFU based on wound size reduction (WSR). We conducted a Bayesian network meta-analysis (BNMA) of randomised trials, including individuals with diabetic foot ulcers. PubMed, Embase, Scopus, Web of Science, and Cochrane were examined till August 2025. Seven debridement approaches were compared with each other and with standard wound care (SWC); trial arms were classified by the primary debridement method, with routine wound care co-interventions permitted. We estimated mean differences with 95% credible intervals, ranked treatments using the Surface Under the Cumulative Ranking curve (SUCRA) (0%-100%; higher scores indicate a greater likelihood of best effect), and assessed risk of bias and certainty of evidence using GRADE. Twenty-two RCTs (n = 1148) were incorporated. Biological debridement showed the largest reduction in WSR (MD 29.6%, 95% CrI -4.4 to 64.1), and enzymatic debridement (MD 21.8%, -11.5 to 55.6). Sensitivity analyses supported biological debridement over surgical and SWC, and enzymatic debridement over autolytic debridement. Across all interventions, SUCRA ranked autolytic (85%) and mechanical (75%) highest, whereas the largest estimated WSR were observed with biological and enzymatic debridement. Overall, certainty of evidence was low, although a few comparisons were rated as moderate certainty. Biological and enzymatic debridement seem to be the most successful for decreasing DFU size. However, SUCRA preferred autolytic and mechanical techniques. Evidence is scarce, endorsing personalised care and comprehensive multicenter trials.

The cardiometabolic index (CMI), a combination of lipid parameters and measures of adiposity, has been shown to be associated with a variety of metabolic disorders. However, its relationship with depression in diabetic individuals remains unexplored. This study aims to investigate the association between CMI and depression among adults with diabetes and determine whether a threshold effect exists in this relationship. We analyzed data from 3069 adults with diabetes in the National Health and Nutrition Examination Survey 2005 to 2018. Depression was defined as a Patient Health Questionnaire-9 score ≥ 10. Survey-weighted logistic regression models were used to examine the association between CMI and depression. Generalized additive models assessed nonlinearity, and 2-piecewise linear regression identified inflection points. In addition, sensitivity analyses were performed to determine the stability of our findings. The prevalence of depression was 11.5% among diabetic participants. A significant positive association was observed between CMI and depression (odds ratio [OR]: 1.21, 95% confidence interval [CI]: 1.02 to 1.43, P = .032) in adjusted models. Compared to participants in the lowest CMI quartile, those in the highest quartile had more than double the odds of depression (OR: 2.24, 95% CI: 1.42 to 3.53, P < .001). Two-piecewise logistic regression confirmed a threshold at CMI = 1.66. Below this threshold, each unit increase in CMI was significantly associated with higher depression risk (OR: 2.23, 95% CI: 1.36 to 3.68, P = .001), while above this threshold, no significant association was detected (OR: 0.91, 95% CI: 0.62 to 1.35, P = .649). Among U.S. adults with diabetes, a higher CMI correlates with increased odds of depression in a nonlinear fashion, with risk saturation at approximately CMI 1.66. Addressing dyslipidaemia and controlling lipid levels may lower the risk of depression in patients with diabetes.