Urbanization and digitalization are contributing to reductions in the physical activity of adolescent individuals. Daily step count is an increasingly accessible and widely used metric for quantifying physical activity, yet little is known about how it is associated with mental health, academic performance, and brain health in adolescents.

To investigate the association of daily step count and future mental health and academic performance in adolescents, and whether differences in brain structure mediate these associations.

This cohort study used data from participants in the Adolescent Brain Cognitive Development (ABCD) Study (release 5.1), a large-scale, longitudinal investigation designed to comprehensively characterize psychological and neurobiological development from late childhood to adolescence. The ABCD Study was conducted across 21 sites across the US, providing a diverse and geographically distributed sample. Participants were adolescent individuals with valid daily step count data and usable neuroimaging data collected between November 2018 to November 2020. Data were analyzed from May 2025 to August 2026.

Pedometer-based measurements of average daily step count over the previous 3 weeks.

Linear mixed models examined associations of daily step count with mental health, academic performance, and brain structure, and assessed how these associations varied between different step count categories. Using structural equation modeling, step-count-associated brain morphology was examined to determine whether it statistically mediated the association between physical activity and mental health, and/or academic outcomes 1 year later. Dose-response associations were also examined.

This study included 5515 adolescent participants (2640 [47.9%] female; mean [SD] age 11.93 [0.65] years) using step counters. Higher step count was associated with lower total mental health problems (B [SE], -0.080 [0.015]; t = -5.497; P < .001) and greater cortical thickness in the paracentral (B [SE], 0.057 [0.016]; t = 3.621; P < .001) and rostral anterior cingulate (B[SE], 0.052 [0.016]; t = 3.319; P = .001) regions. Further analyses showed a significant dose-response association, with progressively lower mental health problems across higher step categories compared with the under 5000-step group. Mediation analyses revealed that greater paracentral thickness statistically mediated the association between higher daily step count and fewer mental health problems 1 year later.

In this cohort study, higher daily step counts were associated with structural differences in the brains of adolescents, which were in turn associated with better mental outcomes prospectively. Beneficial associations for mental health appeared to accrue continuously across the observed range, with no evidence of a threshold or plateau, highlighting that every step counts and the potential value of promoting daily steps in adolescents.

CGM is increasingly recommended for non-insulin-treated type 2 diabetes according to the ADA Standards of Care 2026. However, its clinical benefit in high-quality standard care remains limited. This study evaluated whether addition of the digital therapeutic glucura, which delivers personalised lifestyle intervention and self-management guidance, improves glycaemic outcomes beyond CGM and standard care.

The study was a 6-month, multicentre, open-label RCT conducted at 24 sites in Germany (ID: DRKS00032537). Adults (≥18 years) with non-insulin-treated type 2 diabetes (HbA_1c 53-97 mmol/mol [7.0-11.0%], BMI≥25 kg/m²) receiving standard care were randomly assigned (1:1) by centralised stratified block randomisation to glucura or a control app. Participants and study personnel were not masked to group assignment. Both groups used intermittent CGM every 3 months during the study. CGM sensors were not used prior to the study. The primary endpoint was the change in HbA_1c from baseline to 6 months. Secondary outcomes included weight change and patient-centric measures.

Of 327 randomised participants (intervention: n=165; control: n=162), 320 were analysed (ITT population). The standalone CGM control group improved HbA_1c levels by 3.3 mmol/mol (0.30 percentage points); however, the intervention group showed greater reductions of 8.7 mmol/mol (0.80 percentage points) with an adjusted difference of -5 mmol/mol (-0.46 percentage points; 95% CI -7, -3 mmol/mol; p=0.00003). Within the intervention group, more participants achieved HbA_1c targets (<53 mmol/mol [<7.0%]: 55% vs 31%, OR 3.38, exploratory p=0.0002; <48 mmol/mol [<6.5%]: 27% vs 7%, OR 6.63, exploratory p=0.0001). The mean weight loss was also greater in the intervention group (4.11% vs 1.79%, p<0.0001). Significant improvements in mental health and diabetes-related distress were also observed. The positive effects were consistent across all subgroups. No device-related serious adverse events were observed.

In non-insulin-treated type 2 diabetes, CGM plus standard care yielded less metabolic benefit than CGM combined with glucura. The combination of glucura and CGM also translated into improvements beyond glycaemic management. Trial registration German Clinical Trials Register DRKS00032537 Funding The study was funded by Perfood Laboratories GmbH.

BackgroundGiven the rapidly aging population in the United States and preferences to age-in-place, demand for direct care workers in the home will increase. Yet, it is unclear whether labor supply will meet demand, particularly in rural areas.ObjectiveTo describe differences in home care worker supply and demand by rurality and temporal trends between 2015 and 2024.MethodsRepeated cross-sectional description of the supply of care workers serving adults 65 and older with functional impairments in the United States using 2015-2024 American Community Survey data.ResultsFrom 2015 to 2024, the national supply of home care workers increased by 6.0% (95% CI: [2.6%, 9.4%]). Relative supply in metropolitan areas increased 7.3% (95% CI: [3.6%, 11.0%]) and decreased in rural areas by -10.3% (95% CI: [-19.7%, -1.0%]). While potential demand for care increased in both rural and metropolitan areas over this period, the number of care workers increased only in urban areas.

The computational burden of individual-level genetically regulated gene expression (GReX) imputation has risen sharply with the growth of human mega-biobanks and the rapid expansion of transcriptomic imputation models across tissues and single-cell hierarchies. Existing tools were not designed for this setting and require complex, memory-intensive workflows that are poorly matched to shared and cloud-based compute environments, where runtime, memory, and I/O directly determine cost and throughput. GROMTools is an open-source C ++ engine with an R interface that exploits sparse prediction weights, streams PLINK2 genotypes, and writes compact binary outputs for scalable individual-level GReX imputation.

In UK Biobank (UKB), benchmarks on chromosome 1 across 50,000-450,000 individuals, 388,017 variants, and 11,724 gene-model pairs from 32 single-nucleus transcriptome imputation models, GROMTools produced near-identical predictions to PrediXcan and PLINK2, with minimum Pearson correlation >0.999 and maximum RMSE <0.001 across all of the imputed genes, while reducing CPU time by about 100-fold and peak memory by about 33-fold. These gains make routine biobank-scale individual-level GReX imputation practical and cost-efficient on standard CPU infrastructure.

GROMTools is freely available at https://github.com/voloudakislab/gromtools under the GPL v3 license. Documentation is available at https://voloudakislab.github.io/gromtools/ .All scripts used for data quality control and benchmarking, together with log files and a snapshot of the GROMTools code version used for all of our analyses, are archived at DOI:https://zenodo.org/records/21926165.

Supplementary data are available at Bioinformatics online.

Patients with high need and high costs (HNHCs) are frequent users of emergency departments (EDs), and some of their visits may be avoidable with better access to primary care. A better understanding of the reasons for ED use of HNHC patients can inform cost containment and quality improvement efforts. Our goal was to identify reasons for ED visits based on categories of services received by HNHC patients during the visit and to examine the likely role of different categories of primary care providers (PCPs) in reducing potentially preventable visits. We used the 2018 California Medicaid enrollment and claims data for HNHC patients with at least 1 PCP visit and 1 ED visit followed by discharge. These patients generated 539,798 ED visits. We conducted latent class analysis to classify visits and logistic regressions to examine associations between PCP type, visit, and patient characteristics with ED classes. We identified 6 classes of ED visits and considered 2 as acute care and 4 as nonacute care classes. The latter included a large class of ED visits (51%) by patients who received the fewest procedures. Patients within this group were more likely to have chronic and mental health conditions, weekend ED visits, live in rural locations, and attend group practices and health centers funded by the Health Resources and Services Administration. Our findings suggest that expanding after-hours services, providing medical emergency hotlines, and delivering comprehensive services within primary care may help circumvent costly and frequent nonacute ED visits among HNHC patients.

Living with a stigmatizing skin disease may hinder normative development during emerging adulthood. The present study aimed to examine indirect effects of internalized stigma in the relationship between social stigma and psychosocial adjustment among young adults with visible chronic skin diseases. Indicators of psychosocial adjustment spanned several domains: mental health (depression, anxiety, quality of life), physical health (somatic symptoms), intimacy and health behaviour (physical activity).

This cross-sectional study recruited young adult patients with chronic skin disease from an outpatient dermatology clinic. Data were obtained through self-report, electronic medical records and a physical exam.

Young adults (N = 195, M_age = 28.06 years; 49% female) with psoriasis (55%), atopic dermatitis (23%) or hidradenitis suppurativa (22%) self-reported sociodemographic information and measures for social stigma (PSQ), internalized stigma (WBIS-adapted) and psychosocial adjustment (PHQ-9, GAD-7, DLQI, SSS-8, DIS, days of physical activity per week). Bootstrapped mediation analyses tested indirect effects of internalized stigma on the relationship of social stigma and each psychosocial adjustment outcome, controlling for covariates.

Indirect effects of internalized stigma on the relationship of social stigma with each outcome were significant (p's < .01, R² = .10 to .64).

Findings indicated that stigma has implications for many areas of functioning and well-being, highlighting how emerging adulthood contextualizes the experience of living with the stigma of visible skin disease. Internalized stigma was a major driving force, serving as a potential target for clinical and psychoeducational interventions to improve the well-being of young adults with chronic visible skin disease.

The objective of this study was to describe the demographic, clinical, cognitive, and functional characteristics of acquired brain injury patients, analyze complications, and evaluate inpatient rehabilitation outcomes.

Retrospective review of 50 acquired brain injury patients undergoing multidisciplinary inpatient rehabilitation (2019-2024). Glasgow Coma Scale, post-traumatic amnesia, cognitive scales (Mini-Mental State Examination, Montreal Cognitive Assessment, Rancho Los Amigos), Functional Ambulation Scale, and complications were assessed.

Traumatic etiology comprised 76% of cases; 72% were severe (Glasgow Coma Scale 3-8). Prolonged post-traumatic amnesia (>24 h) was significantly associated with severe injury (p<0.001). Spasticity (64%), contractures (42%), speech disorders (42%), and dysphagia (34%) were most prevalent. Functional Ambulation Scale score 0 decreased from 58 to 42% post-rehabilitation; Functional Ambulation Scale 3-5 increased from 24 to 46% (Wilcoxon signed-rank test, p<0.001).

Structured multidisciplinary rehabilitation was associated with measurable functional gains in acquired brain injury patients despite severe deficits and frequent complications; however, the absence of a control group precludes causal conclusions.

The aim of this study was to compare functional shoulder performance and fatigue among young adults with forward head posture, forward head posture with scapular dyskinesis (forward head posture+scapular dyskinesia), and healthy controls.

This cross-sectional study included 85 young adults aged 18-25 years, allocated to three groups: forward head posture+scapular dyskinesia (n=25), forward head posture (n=30), and control (n=30). Forward head posture was assessed using the craniovertebral angle, scapular dyskinesia with the Lateral Scapular Slide Test, functional shoulder performance with Timed Functional Arm and Shoulder Test, and fatigue with the Chalder Fatigue Scale.

Significant between-group differences were found for dominant-side, non-dominant-side, and total Timed Functional Arm and Shoulder Test scores (p<0.001). The forward head posture+scapular dyskinesia group had lower dominant-side and total Timed Functional Arm and Shoulder Test scores than the both forward head posture and control groups (p=0.040, p<0.001, and p=0.031, p<0.001, respectively), while both postural disorder groups had lower non-dominant-side Timed Functional Arm and Shoulder Test scores than controls (forward head posture+scapular dyskinesia: p<0.001; forward head posture: p=0.003). Total and physical fatigue scores were higher in both the forward head posture+scapular dyskinesia and forward head posture groups than in controls (total fatigue: p=0.010 and p=0.011; physical fatigue: both p=0.019), whereas mental fatigue did not differ significantly among the groups (p=0.163).

Functional shoulder performance was lower in the forward head posture and forward head posture+scapular dyskinesia groups than in the controls, with the lowest scores in the forward head posture+scapular dyskinesia group. Total and physical fatigue were higher in both postural disorder groups, whereas mental fatigue did not differ between groups.

to examine the association between burnout and sociodemographic, occupational, and health-related factors among Brazilian Military Police officers.

cross-sectional study conducted between November and December 2024 with 1,028 participants. Burnout was assessed using the Burnout Assessment Tool, with descriptive and inferential analyses.

most participants were men (81.9%) and Brown (pardo) (49.6%); mean age was 41.9 ± 6.5 years. Burnout ranged from moderate to very high in 75.4%. Age, years of service, and physical inactivity were negatively correlated with burnout. Scores were significantly higher among women, White participants, those with a college degree, fixed shifts, physical inactivity, long-term medication use, prior psychological care, and addiction.

burnout reflects an imbalance between high job demands and limited institutional resources, consistent with the Job Demands-Resources model. Findings underscore the need for interdisciplinary policies, healthy workplaces, and mental health care aligned with SDGs 3 and 8, reinforcing nursing's strategic role.

This analysis aimed to examine past 20-year prevalence trends of multiple mental health outcomes by age and sex, using repeated cross-sectional survey data from the Canadian household population.

Age- and sex-stratified bootstrap-weighted prevalence estimates were calculated from available Canadian Community Health Survey datasets between 2002 and 2024. Categorizations for age included adolescents and young adults (12-29 years), middle-aged adults (30-64 years) and older adults (65+ years). Mental health outcomes included self-reported professionally diagnosed mood and anxiety disorder, depression survey scales (Composite International Diagnostic Interview Short Form for Major Depression /9-item brief Patient Health Questionnaire) and fair/poor self-perceived mental health. Stratified prevalence estimates from each year were combined and assessed for heterogeneity using random-effects meta-analysis. In the instance of heterogeneity, meta-regression models were applied to generate predicted prevalence trends over time for each mental health outcome, by age and sex categories.

The prevalence of all mental health outcomes increased from 2002/2003 to 2024, in all age groups of both sexes. For example, in adolescent and young adult males, the weighted prevalence of diagnosed mood disorder increased from 2.37% (95% confidence interval [CI]: 2.03, 2.78) in 2003 to 12.58% (95% CI: 10.37, 15.19) in 2024, while prevalence in females of this age group increased from 5.23% (95% CI: 4.76, 5.74) in 2003 to 21.49% (95% CI: 18.97, 24.24) in 2024. Generally, young males saw the greatest relative increases in prevalence, while young females had the greatest absolute increases. Middle-aged and older adults also saw notable increases in their prevalence of poor mental health. Quadratic survey year terms were statistically significant in meta-regression analysis for all outcomes, age and sex groups (excluding mood disorder trends in65+-year-old adults), suggesting curvilinear trends. Male age categories showed more similar trends over time when compared to age-specific estimates of females.

The broad identification of increasing prevalence across various outcomes, age and sex groups has not been highlighted by prior research. Though prevalence increases in young females remain distinct, this finding aligns with previous literature. Consistency of trend patterns between diverse mental health outcomes indicates that multiple dimensions of mental health may be changing similarly over time. Future analyses are critical in understanding the potential factors contributing to these trends and should look to include broad population samples, rather than limiting analyses to specific age/sex groups.