In sub-Saharan Africa, young women face disproportionate challenges transitioning from school to employment, with high rates of those not in education, employment or training (NEET). Structural barriers-including unequal gender norms, early marriage and unpaid labour-limit their economic participation. The Campaign for Female Education (CAMFED) Livelihoods programme supports young women's transition from school to independent adulthood through mentoring, life skills, business and agricultural training and access to financial resources.

This study will evaluate the impact, process and mechanisms of change, and cost-benefit of CAMFED Livelihoods programme in Tanzania and Zimbabwe (2024-2027), focusing on outcomes related to economic activity, empowerment, leadership, mental health, subjective well-being and sexual and reproductive health among adolescent and young women (aged 15-24 years).

We will conduct a mixed-method, longitudinal evaluation across five districts in Tanzania and three districts in Zimbabwe. The quantitative component includes a pre-post cohort with a comparison group in Tanzania (n=1520) and a single-cohort design in Zimbabwe (n=500), with data collected at baseline, midline and endline. Primary outcomes are NEET status and leadership, complemented by measures of well-being, empowerment and health. The qualitative component will explore mechanisms of change and programme delivery. A cost-benefit analysis will estimate social and economic returns using a provider perspective. Youth researchers will be engaged to enhance participatory learning.

We have received ethics approvals from the London School of Hygiene and Tropical Medicine (31266), the National Health Research Ethics Committee (6732) in Tanzania and the Medical Research Council of Zimbabwe (MRCZ/A/3239) in Zimbabwe. Results of this study will be published in peer-reviewed academic journals and shared with policymakers, study participants and the other stakeholders in Tanzania and Zimbabwe.

Many older people experience Mild Cognitive Impairment (MCI), which may compromise the effectiveness of health promotion programmes.

We explored engagement with behaviour change among participants scoring 18-25 on the Montreal Cognitive Assessment receiving HomeHealth, a health promotion intervention supporting older adults with mild frailty to maintain independence in England ().

Of the 46 semistructured process evaluation interviews, 29 participants scored in the MCI range, purposively selected for demographic characteristics and degrees of cognitive impairment and the seven support workers.

Thematic analysis resulted in three themes: Navigating the impact of MCI; Addressing memory as a goal in the intervention; and Adapting Behaviour Change Interventions for MCI. Participants had varied opinions about whether their memory was problematic and whether anything could be done to help. Many reported not discussing memory concerns with support workers. Barriers to engagement in behaviour change included limited social support and not acknowledging memory problems. Facilitators included setting goals which increased or were linked to existing health behaviours, using reminders/prompts and actively involving family members.

Implementing these facilitators into existing and new health promotion interventions delivered to older adults, with suspected but unacknowledged MCI, could overcome the current barriers people with MCI face when trying to engage and benefit from interventions.

ISRCTN54268283.

In Bangladesh, as well as throughout the world, children's screen time has significantly increased. Children spend a lot of time on the internet and digital screens for entertainment, education, and communication, which has increased their daily screen time. However, the potential detrimental impacts of excessive screen time on children's mental, physical, and social health have drawn attention.

This study aimed to explore the effect of high exposure to screens on the health and mental well-being of school-going children and adolescents in Dhaka, Bangladesh.

This cross-sectional descriptive study was conducted from July 2022 to June 2024. A total of 420 school-going children and adolescents aged 6 to 14 years were enrolled from 3 English-language and 3 Bangla-language schools in Dhaka using a stratified random sampling technique. Anthropometric measurements, a semistructured questionnaire, and the Pittsburgh Sleep Quality Index, the Development and Well-Being Assessment scale, and the Strengths and Difficulties Questionnaire, all of which were validated in Bangla, were used to gather data. We considered students who were exposed to screens for less than 2 hours a day as the low-exposure group and those who were exposed for more than 2 hours a day as the high-exposure group.

A total of 83.3% (350/420) of the students were in the high-exposure group, and their average screen time per day was 4.6 (SD 2.3) hours. Eye problems were reported by 35.7% (150/420) of the students, and a significant difference was found between the low- and high-exposure groups. In total, 96% (144/150) of the students with eye problems were from the high-exposure group, whereas 4% (6/150) were from the low-exposure group. Headaches were reported by 80% (336/420) of the students, and they were common in the high-exposure group (279/336, 83%). Moreover, students from the high-exposure group had a short duration and poor quality of sleep (mean 7.3, SD 1.4 hours), which was statistically significant. Furthermore, obesity was more predominant in the high-exposure group (P<.001). Our study revealed that, overall, 31% (130/420) of the students had at least one mental health problem and 9.8% (41/420) had more than one mental health problem using the Development and Well-Being Assessment scale, and mental health problems were greater in the high-exposure group than the low-exposure group. Although behavioral problems such as conduct issues (119/420, 28.3%) and peer difficulties (121/420, 28.8%) were observed among the participants, no statistically significant difference was found between the 2 groups.

A collaborative and coordinated multistage approach is essential to create effective and acceptable guidelines and policies for the optimum and positive use of digital screens for the children of Bangladesh. Further prospective studies on a larger scale can be conducted to determine the impacts of screen time on aspects of health.

Medical assistance in dying (MAiD) has been available across Canada since 2016 for patients with amyotrophic lateral sclerosis (ALS). We aimed to characterize MAiD use, identify associated factors, and compare survival and location of death in a Canadian ALS cohort.

We retrospectively reviewed patients with ALS followed at a Canadian multidisciplinary clinic who died between January 1, 2019 and December 31, 2024. Patient characteristics were described by MAiD status. Factors associated with MAiD utilization were evaluated using regression analyses, and survival and location of death were compared between patients who did and did not pursue MAiD.

Of 255 patients (median age 67 years [IQR 60-75]; 42% female), 55 (21.6%) underwent MAiD. Percutaneous endoscopic gastrostomy (PEG) use was inversely associated with MAiD utilization (OR 0.34, 95% CI 0.15-0.78), whereas demographic and disease characteristics were not associated with MAiD. Survival from diagnosis to death was shorter among patients who underwent MAiD (median 12 vs 14 months; p = 0.019), with no difference from symptom onset. Death at home was more frequent with MAiD (62% vs 35%; p < 0.001).

MAiD is a common end-of-life option in ALS, reflecting patient values and is associated with lower PEG use, shorter postdiagnosis survival, and more frequent death at home.

Cold-related illnesses (CRIs) are preventable yet often deadly. Using twenty-five years of data from the National Inpatient Sample (1998-2022), we assessed nationwide trends in CRI hospitalizations and concomitant alcohol use, substance use, and mental health disorders and housing insecurity. We identified 345,314 (weighted) CRI hospitalizations and found that age- and sex-adjusted rates tripled from 42.0 to 122.5 per 100,000 hospitalizations. CRI inpatients were more likely than others to die during hospitalization, live in high-poverty ZIP codes, be publicly insured or uninsured, and have behavioral health conditions and housing instability. These findings highlight the rising and unequal toll of CRIs in the context of social instability and increasingly severe cold events associated with climate change. Expanded access to behavioral health treatments, increased subsidies for home heating, investments in affordable and supportive housing and shelter capacity, and public health measures to increase resilience to extreme weather events could reduce CRI morbidity and mortality.

Problematic smartphone use among adolescents is a growing public health concern closely associated with psychological distress and loneliness. Effective, culturally grounded, school-based interventions are needed.

The aim of this study was to assess the effects of a 12-week program combining traditional social sports games and mental exercises on smartphone addiction, nomophobia, psychological distress, and loneliness in adolescents.

In this randomized controlled trial, 69 school-recruited Tunisian adolescents (aged 14-16 years) with clinically elevated smartphone addiction scores were assigned to an experimental group (n=36, 52.2%) or a control group (n=33, 47.8%). The experimental group received a 12-week intervention comprising 4 weekly sessions integrating traditional social sports games with mental exercises, whereas the control group continued standard physical education. Outcomes (smartphone addiction, nomophobia, psychological distress, and loneliness) were assessed at baseline and after the intervention using scales validated in Arabic.

Linear mixed-effects models adjusted for age, sex, and BMI revealed significant group × time interactions of moderate magnitude across all outcomes (P<.05 in all cases) favoring the experimental group. Adjusted postintervention comparisons confirmed significantly lower scores in the experimental group for smartphone addiction, nomophobia, psychological distress, and loneliness (P<.05 in all cases; partial ηp2=0.08-0.12). Mediation analysis indicated that reductions in loneliness accounted for 34.4% of the intervention's effect on smartphone addiction, consistent with partial mediation.

A culturally adapted, school-based intervention combining traditional social sports games and mental exercises significantly reduced problematic smartphone use and improved psychological well-being. The partial mediation through reduced loneliness highlights the critical role of social connectedness in adolescent digital health interventions.

Medical residency is a demanding training stage characterized by high levels of stress and burnout. As digital natives, current medical trainees (ie, residents) are frequent users of social media; however, little is known about how their personal (nonprofessional) use relates to burnout and social media addiction (SMA).

This study aims to characterize the prevalence of SMA among Chinese medical trainees and explore its complex relationships with social media use patterns, occupational burnout, and related risk and protective factors.

A nationwide cross-sectional survey was deployed through Wenjuanxing and disseminated via WeChat between August 29 and September 10, 2024. Data included demographics, physical and psychiatric health history, work variables (eg, training year and night shifts), personality traits, and social media use. SMA was assessed using the Bergen Social Media Addiction Scale. Logistic regression was performed to identify predictors of addiction, and mediation and moderation analyses were conducted to clarify the role of occupational burnout.

Of 3621 medical trainees, 211 (5.8%) met the criteria for SMA (Bergen Social Media Addiction Scale ≥24, indicating addiction). Second-year medical trainees reported the highest addiction prevalence (92/1159, 7.9%). Logistic regression analysis revealed that higher burnout (odds ratio [OR] 1.41, 95% CI 1.23-1.62; P<.001), longer daily use (OR 1.39, 95% CI 1.23-1.56; P<.001), physical health problems (OR 1.56, 95% CI 1.13-2.16; P=.006), and psychiatric history (OR 2.00, 95% CI 1.41-2.84; P<.001) significantly increased the odds of addiction, whereas conscientiousness was protective (OR 0.92, 95% CI 0.86-0.99; P=.02). Social media use showed significant U-shaped associations with burnout, physical health problems, psychiatric history, personality characteristics, and mental health outcomes. For example, medical trainees using social media 1 hour or less (104/404, 25.7% with psychiatric history) and more than 4 hours daily (97/419, 23.2% with psychiatric history) both had higher risk profiles than moderate users. Mediation analysis showed that occupational burnout explained 28.1% of the effect of psychiatric history and 29.6% of the effect of physical health problems on addiction risk.

This large-scale survey provides the first systematic characterization of SMA among Chinese medical trainees and elucidates its associated risks and protective factors. Burnout consistently emerged as a key and pervasive predictor of SMA, functioning both as an independent risk factor and as a mediator amplifying the impact of health-related vulnerabilities. Moreover, the findings highlight that both minimal and excessive daily social media use may signal distinct behavioral manifestations of distress, potentially reflecting different clinical phenotypes: digital disengagement under acute stress versus compulsive engagement driven by chronic burnout. Notably, while mental health symptoms exhibited U-shaped associations with usage, SMA risk increased progressively with daily duration. These results underscore the need for interventions that extend beyond simply monitoring usage duration, emphasizing strategies to reduce burnout and enhance the overall well-being of medical trainees.

Low physical activity (PA) is a well-established risk factor for major depressive disorder (MDD). However, the temporal dynamics of PA preceding an incident clinical diagnosis of MDD remain poorly characterized, particularly using long-term, objective measures collected in real-world settings.

This study aimed to characterize trajectories of wearable-measured PA during the year preceding incident MDD diagnosis and identify the timing of within-person changes.

We conducted a retrospective nested case-control study using linked electronic health record and wearable (Fitbit) data from the All of Us Research Program. Adults with at least 6 months of valid Fitbit PA data in the 12 months preceding diagnosis were included. Incident MDD cases were identified based on a first electronic health record-recorded diagnosis and matched to MDD-free controls on age, sex, BMI, and calendar time of diagnosis, with up to 4 controls per case. Daily steps and moderate to vigorous PA (MVPA) were aggregated into monthly averages. Linear mixed-effects models were used to compare prediagnostic PA trajectories between cases and controls over a retrospective time scale from -12 to 0 months. Among cases, within-person contrasts were used to identify when PA levels first showed statistically significant deviations relative to levels observed 12 months before diagnosis. Exploratory analyses assessed heterogeneity by demographic factors.

The analytic cohort included 4104 participants (n=829, 20.2% incident MDD cases and n=3275, 79.8% matched controls; n=3355, 81.7% women; median age 48.4, IQR 36.3-61.3 years). Compared with controls, individuals who developed MDD exhibited consistently lower overall PA and significant downward trajectories in both daily steps and MVPA during the year preceding diagnosis (global trajectory tests; P<.001 for both outcomes). Differences widened progressively over time, indicating accelerating declines as diagnosis approached. Among cases, statistically significant changes in daily step counts emerged approximately 4 months before diagnosis (-145, 95% CI -253 to -37 steps vs month -12; P=.02) and reached -428 (95% CI -531 to -326) steps at diagnosis (P<.001). Declines in MVPA emerged approximately 5 months before diagnosis (-2.48, 95% CI -4.32 to -0.64 minutes; P=.02) and reached -5.61 (95% CI -7.35 to -3.86) minutes at diagnosis (P<.001). Furthermore, exploratory analyses suggested heterogeneity in prediagnostic trajectories across demographic subgroups, including steeper declines among men, more pronounced reductions in activity intensity at older ages, and persistently lower activity levels with flatter trajectories among individuals with obesity.

Unlike prior studies lacking objective PA assessment before MDD diagnosis, this study linked wearable and clinical data to characterize long-term prediagnostic trajectories in real-world settings. We observed sustained within-person declines emerging 4 to 5 months before diagnosis, providing insights into temporal dynamics preceding clinical recognition. These findings suggest that wearable-based monitoring may offer scalable early signals for risk stratification, prevention, and intervention for MDD.

Large-scale online studies with healthy adults have documented consistent associations between transdiagnostic psychiatric traits and metacognitive biases. Here, analysis of existing and new large-scale datasets reveals that such correlations may be largely due to surface-level dimensions of questionnaire-filling behavior: systematic rating biases and inattentive responding. Specifically, a bias to report positive or negative values in self-report scales may generalize to confidence ratings, producing spurious correlations between the two. Additionally, systematic overconfidence among inattentive responders produces spurious positive correlations between confidence and the endorsement of rare symptoms. We show that previously identified transdiagnostic dimensions of "anxiety-depression" and "compulsivity and intrusive thought," both shown to correlate with decision confidence, map neatly onto these two biases of questionnaire-filling behavior. In a preregistered experiment, we further show that decision confidence and self-reported obsessive-compulsive tendencies are correlated with independent measures of inattentive and biased responding. Taken together, we find substantial influence of inattentive and biased responding over both self-report psychiatric measures and confidence ratings. When not accounted for, these factors can produce a mirage of apparent metacognitive alterations in mental health. We discuss concrete precautionary measures that are needed to control for these biases.

Curiosity plays a fundamental role in human learning, development, and motivation, and emerging evidence suggests that reduced curiosity is linked to poorer mental health outcomes, including depressive symptoms (DS). However, to date, the majority of curiosity research relies on self-report assessments and thus risks biased reporting. Virtual reality (VR), a novel tool increasingly used within mental health research and treatment, might represent a potent tool for offering ecologically valid insights into curiosity-driven behaviors while circumventing issues related to self-report assessments, including demand characteristics and recall bias.

The study aimed to enhance the assessment of curiosity by using a novel VR environment and to examine its relevance to DS. Specifically, we tested 2 hypotheses using a novel VR environment: first, that curiosity, as assessed through spontaneous exploratory interactions and behaviors in VR, positively correlates with self-reported curiosity, and second, that VR-based curiosity is inversely associated with DS.

This exploratory study used an observational design that included 100 volunteers. All participants completed self-reported assessments of DS and curiosity before engaging in a novel VR scenario. Although progression in the virtual environment required solving cognitive tasks, these were embedded as structural elements rather than framed as the primary objective. Instead, participants' free explorations and interactions with objects formed the basis for the 4 curiosity metrics used in this study. After VR exposure, participants completed a questionnaire assessing cybersickness symptoms.

Hypothesis 1 was not supported, as only one curiosity metric, namely object interactions, was positively associated with one aspect of curiosity relating to motivation to seek new knowledge and experiences. Further, diminishing significance after correction for multiple testing warranted caution. Results relating to hypothesis 2 indicated partial support, in that object interaction was significantly associated with DS while controlling for age, sex, and cybersickness levels. Sensitivity analyses showed no associations between object interactions and self-reported anxiety and stress symptoms.

VR may be a potent tool for assessing exploratory behaviors in a controlled, yet ecologically valid, environment that avoids issues related to self-report. However, whether such motivations translate to established curiosity constructs warrants further research. This study also provided preliminary insights into how assessing exploratory interactions in VR may be a promising avenue that could enhance the understanding of the etiology and assessment of DS-particularly its early stages.