Competency-based education is widely endorsed in health professions education (CBHPE) as an outcomes-focused approach to ensuring that all graduates demonstrate the competencies needed to improve patient and population health. Despite adoption of outcomes frameworks, accreditation requirements, and CBHPE tactics, interventions remain siloed within programs and training levels rather than spanning the education to practice continuum. Consequently, learners and teachers experience fragmented educational journeys that can fall short of addressing each learner's needs for continuous learning and growth. To advance efforts toward a CBHPE continuum, this systems-informed conceptual analysis uses a systems thinking perspective to analyze leverage points, places within complex systems where small, strategic interventions can cause large-scale, lasting changes. Drawing on Meadows' framework for understanding leverage points in complex systems, we examined barriers and opportunities to achieve a continuum and present five theoretically informed, literature-based, and expert-derived recommendations for transformation. Our analysis revealed that strategic intervention points, including paradigm shifts from 'time-served' to 'competence-demonstrated' readiness, structural changes through cross-continuum governance alignment, and process modifications via shared competency language and data systems, enable meaningful transformation beyond surface-level adjustments. Key recommendations include: (1) restructuring system architecture to enable seamless learner progression through competency committees and joint governance bodies; (2) shifting mental models to normalize time-variable progression and reconceptualize assessment as growth-supporting; (3) implementing high-impact approaches to assessment with longitudinal learner analytics; (4) changing rules and incentives to reward competency achievement; and (5) establishing continuous data-driven feedback systems. Understanding these leverage points informs targeted approaches, enabling a cohesive, coordinated, learner-centered CBHPE continuum.

Veteran issues in the United States often figure prominently in policy debates and media coverage surrounding psychedelic substances, such as psilocybin mushrooms and ibogaine. This is partially driven by the need to improve access and efficacy of treatments for mental health conditions, especially conditions (such as posttraumatic stress disorder) that are more common among veterans than nonveterans. In this study, the authors present new data from the 2025 RAND Psychedelics Survey. The study focuses on the use of specific psychedelic substances and policy preferences among U.S. veterans and compares them with nonveterans. The study also includes data on veterans' willingness to try these substances and their attitudes about U.S. Department of Veterans Affairs (VA) policies on certain psychedelics.

Mental health problems among older adults are an important and underrecognized public health concern in India. Depression, anxiety, and stress in later life are influenced by demographic, social, behavioural, and clinical factors, and identifying their independent predictors is essential for designing targeted preventive strategies.

This study aims to estimate the burden of depression, anxiety, and stress among older adults in rural North India and to identify independent predictors of depression, anxiety, and stress symptoms.

A community-based cross-sectional study was conducted among 384 older adults aged 60 years and above residing in rural districts of North India. Participants were selected through multistage random sampling from three rural blocks, and door-to-door household interviews were carried out. Data were collected using a pretested semi-structured questionnaire. Depression, anxiety, and stress were assessed using the Depression, Anxiety, and Stress Scale (DASS-21). Bivariate analysis was performed using the chi-square test, followed by multivariable binary logistic regression to identify factors independently associated with depression, anxiety, and stress.

The sample included 53.4% males and 46.6% females. Most participants were aged 60-65 years (64.3%), 64.1% were illiterate, 65.9% were married, and 60.9% belonged to lower socioeconomic strata. In this study, depression was present in 98 participants (25.5%), anxiety in 134 participants (34.9%), and stress in 100 participants (26.0%). This study also demonstrated strong positive correlations between depression, anxiety, and stress scores. Depression showed a strong positive correlation with anxiety (ρ = 0.865, p < 0.001) and stress (ρ = 0.852, p < 0.001). The strongest correlation was observed between anxiety and stress scores (ρ = 0.835, p < 0.001). In the final multivariable models, sleep difficulty, social isolation, chronic morbidity, and physical inactivity emerged as factors independently associated with psychological distress.

Psychological distress is common among older adults in rural districts of North India, and sleep difficulty, chronic morbidity, social isolation, and physical inactivity are key predictors. Community-based geriatric mental health programs should incorporate routine screening for these factors and link high-risk older adults to primary care and social support services.

Postgraduate students are six times more susceptible to mental health challenges than the general adult population, making it imperative to identify effective initiatives to support them. This is particularly relevant for master's and doctorate students undertaking distance-learning programmes as this is a dimension of the student experience that remains unexplored. Meditation practices such as those included in Mindfulness and Heartfulness programmes have been shown to improve university students' mental health and wellbeing even when delivered via videoconferencing. However, the efficacy of these approaches remains under-investigated among distance learning postgraduates.

This study aims to explore the impact of an online synchronous Mindfulness-based intervention (MBI) compared to a Heartfulness-based intervention (HBI) on distance-learning postgraduate students' mental health and wellbeing using randomised controlled trial (RCT) design.

The MBI included guided meditations, emphasizing present moment focus through breathwork and body scan exercises, compassion and non-judgmental observations. The HBI included a heart-focused form of silent meditation, with additional mental exercises aimed to facilitate the clearing and release of impressions. Weekly live online instructor-led group sessions facilitated access across 17 countries on six continents. In an initially powered RCT using block randomisation, N = 73 UK-based and international postgraduate students from King's College London (KCL) were allocated to either HBI (n = 37) or MBI (n = 36). 61 (80% female) completed validated questionnaires at baseline (T1), after 8-week intervention (T2) and at twelve-week follow-up (T3) through intention-to-treat (ITT) analysis. Significance was assessed through repeated-measures ANOVA, supplemented by mixed-effects modeling to assess robustness.

In line with hypotheses, the group × time interaction was not statistically significant for primary outcomes, providing no indication of differential change between interventions. Both MBI and HBI were associated with significant improvements in stress, anxiety, depressive symptoms and wellbeing in postgraduates over time, established through secondary within-group outcomes at T2. At T3, improvements were maintained for wellbeing and stress through ITT analysis. Anxiety reductions were sustained only through Per-Protocol (PP) analysis at T3.

These findings are consistent with comparable effects. Both HBI and MBI may be beneficial as preventative and transdiagnostic approaches for postgraduate students' mental health and wellbeing, at scale, and remotely with a global reach.

Prenatal exercise has established health benefits, yet adherence remains low, and the role of the exercise environment in shaping psychological experience during pregnancy is unclear. This study aimed to examine the associations of the prenatal exercise environment with exercise experience and psychological distress, with particular attention to the proposed affective and cognitive pathways within the Prenatal Exercise Environment Dual-pathway framework.

In this cross-sectional study, 361 pregnant women were recruited through multicenter convenience sampling from medical centers in five regions of China. The researcher-developed Prenatal Exercise Environment and Experience Questionnaire underwent preliminary psychometric evaluation in the current sample, followed by structural equation modeling with 5,000 bootstrap resamples and machine-learning analyses.

The prenatal exercise environment was positively associated with positive affective state (β = 0.328, p < 0.001) and exercise enjoyment (β = 0.270, p < 0.001) and negatively associated with repetitive negative thinking (β = -0.297, p < 0.001). Positive affective state was positively associated with exercise enjoyment (β = 0.143, p = 0.007), whereas repetitive negative thinking was negatively associated with exercise enjoyment (β = -0.216, p < 0.001). Exercise enjoyment was inversely associated with psychological distress (β = -0.253, p < 0.001). The model explained 21.8% of the variance in exercise enjoyment but only 6.4% in psychological distress, indicating limited explanatory power for the latter. Exploratory machine learning identified the sensory and physical environment as the strongest predictor of weekly Thermic Effect of Activity.

Prenatal exercise environments influence psychological outcomes through dual affective and cognitive pathways. Improving environmental quality and reducing negative cognition may enhance exercise engagement and mental well-being during pregnancy.

This study aims to critically re-evaluate classical definitions of physical fitness proposed by leading institutions such as the American College of Sports Medicine (ACSM), the World Health Organization (WHO), and the National Academy of Sports Medicine (NASM). Despite their physiological robustness, these definitions no longer capture the multidimensional determinants of human functionality in modern life. The paper introduces a multidimensional fitness paradigm that reframes fitness as a biopsychosocio-emotional capacity integrating physical, mental, social, occupational, and digital dimensions. A narrative critical review of transdisciplinary literature was conducted across the fields of behavioral science, social epidemiology, occupational health, and digital medicine. Conceptual, methodological, and operational gaps in existing frameworks were identified and critically appraised. Drawing from the biopsychosocial model, self-determination theory, behavior change frameworks (COM-B), and digital ethics literature, the study synthesized theoretical foundations and proposed measurable indicators for five interacting dimensions of fitness. Cross-cutting themes such as equity, ethics, data governance, and cultural variability were analyzed to ensure applicability across diverse populations. The review reveals that traditional physiological metrics-such as cardiorespiratory endurance, strength, and body composition-are necessary but insufficient to account for overall human functioning. Evidence demonstrates that cognitive control, emotion regulation, social connectedness, occupational balance, and digital literacy substantially influence wellbeing, resilience, and sustainable performance. The proposed multidimensional model operationalizes fitness through integrated indicators and suggests a validation roadmap encompassing reliability, validity, feasibility, and fairness. Furthermore, illustrative applications in clinical, workplace, and municipal contexts demonstrate how multidimensional fitness can guide personalized interventions and policy innovations. The multidimensional fitness paradigm expands the conceptual boundaries of fitness from a purely physiological construct to an integrative biopsychosocio-digital framework. By embedding ethical, cultural, and technological considerations, it offers a roadmap for 21st-century health promotion and sustainable performance. The study concludes with a 10-point research and policy agenda emphasizing equity, data ethics, and cross-sectoral integration, positioning fitness as both a scientific construct and a societal compass for human flourishing. The framework is presented as a conceptual proposal: its structure, indicators, and applications remain to be empirically validated.

The adverse effects of night shift work on the physical and mental health of nurses have been widely documented. However, little is known about whether these psychological experiences persist after nurses cease working night shifts or whether some of these experiences subsequently manifest as intrusive memories.

To explore the characteristics of the delayed manifestation of night shift-related intrusive memories and the associated experiences among non-shift nurses with a history of night shift work.

A descriptive qualitative study design was employed using a descriptive phenomenological approach. Fifteen non-shift nurses with a history of night shift work who were currently working fixed day shifts at a Grade III Class A hospital in Shandong Province were recruited for semi-structured interviews. Colaizzi's seven-step method was used for data analysis. The findings were reported in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) guideline.

Among nurses who reported night shift-related intrusive experiences after the cessation of night shift duties, these experiences may persist for months or even years and may be reactivated by specific situational cues, accompanied by emotional responses. Four themes were identified: Night Shift-Related Psychosocial Stressors; Characteristics of Night Shift-Related Intrusive Memories; Contextual Cues and Persistent Experiences Following Night Shift Work; and Coping and Meaning Reconstruction After Night Shift Experiences.

Among nurses who reported night shift-related intrusive experiences after the cessation of night shift duties, these experiences were characterized by delayed onset, involuntary recurrence, and situational dependence. These findings highlight the importance of recognizing the psychological experiences of nurses with a history of night shift work and suggest the need for appropriate occupational mental health support and adaptation strategies.

In the context of high awareness but low utilization of university counseling services, an important question is whether university mental health support may still carry psychological significance when actual service use remains limited. Drawing on social support theory and stigma theory, this study extends the understanding of university mental health support beyond a utilization-based perspective by examining whether students' perceptions of university mental health support are associated with mental health through perceived stigma. Using survey data from 642 university students in China, this study developed an analytical model examining the associations among perceived institutional support, perceived stigma, and mental health outcomes. The results showed that perceived institutional support was positively associated with mental health and negatively associated with perceived stigma. In addition, perceived stigma was negatively associated with mental health and statistically accounted for part of the observed association between perceived institutional support and mental health, suggesting an indirect association consistent with the proposed theoretical model. These findings suggest that the potential value of university mental health support may extend beyond actual counseling utilization. Rather, students' perceptions of institutional recognition, accessibility, and acceptance of psychological support may represent an important aspect of the campus mental health environment. This perspective is particularly relevant within the Chinese higher education context, where concerns about social evaluation and stigma may influence students' willingness to acknowledge psychological difficulties and seek support. This study contributes to the literature by moving beyond a utilization-based framework and highlighting the potential contextual significance of perceived institutional support in relation to stigma and mental health. Practically, the findings suggest that Chinese universities may consider not only service availability but also students' perceptions of institutional support when evaluating campus mental health environments.

Intimate partner violence (IPV) and depressive symptoms are major public health concerns during the preconception, prenatal, and postpartum periods and are shaped by both interpersonal and structural conditions, including economic hardship and food insecurity. State-level Supplemental Nutrition Assistance Program (SNAP) eligibility policies, including eliminating the SNAP asset test and increasing the SNAP income limit under broad-based categorical eligibility (BBCE), influence access to food assistance and may be associated with maternal well-being.

We conducted a repeated cross-sectional analysis of data from 66,677 women with lower income in the 2016-2020 Pregnancy Risk Assessment Monitoring System. We categorized states as having two BBCE policies, one BBCE policy, or no BBCE policies, reflecting more expansive SNAP eligibility. We conducted log-binomial regression with generalized estimating equations to calculate adjusted prevalence ratios (PRs) and 95% confidence intervals (CIs), estimating associations of state BBCE policies with preconception and prenatal physical IPV and postpartum depressive symptoms.

Compared to women in states with no BBCE policies, those in states with both BBCE policies had a lower prevalence of preconception and prenatal physical IPV (PR: 0.79, 95% CI: 0.66-0.94) and postpartum depressive symptoms (PR: 0.83, 95% CI: 0.75-0.93). Estimates for states with one BBCE policy were smaller and less precise but also suggested a decreased prevalence of preconception and prenatal physical IPV and postpartum depressive symptoms compared to states with no BBCE policies (PR = 0.80, 95% CI: 0.64-1.00; PR = 0.91, 95% CI: 0.81-1.03, respectively).

Results suggest that structural conditions shaping access to economic resources may represent a pathway through which risk for IPV and maternal mental health challenges can be prevented.

Chronic nausea is commonly associated with disorders of gut-brain interaction (DGBI). Pediatric functional nausea (FN) is defined as predominant nausea generally unrelated to meals. It is unclear if FN is a distinct entity or clustered with pain-associated DGBI. This multi-center study aimed to investigate the burden and comorbidities of FN and compare it to other DGBI.

Patients ages 8-21 years with DGBI were enrolled in a cross-sectional, multi-center observational registry across seven outpatient gastroenterology clinics and classified by Rome IV criteria. FN was compared to non-FN DGBI using validated symptom surveys: (1) Nausea Severity Scale (NSS), (2) Abdominal Pain Index (API), (3) PROMIS Global Health Scale (GHS), (4) PROMIS Pediatric Anxiety, (5) PROMIS Pediatric Depression, (6) Children's Somatization Inventory (CSI), and (7) Functional Disability Inventory (FDI).

292 subjects were analyzed. Fifty (17%) met FN criteria, of which 72% were female. Eighty-four and 32% of FN patients also met criteria for functional dyspepsia (FD) post-prandial distress subtype and irritable bowel syndrome (IBS), respectively. FN versus non-FN reported greater abdominal pain (p = 0.008), anxiety (p = 0.007) and depression (p = 0.002). FN versus IBS more commonly had long-term nausea and abdominal pain (p = 0.011, p = 0.014), postural dizziness (p = 0.034), migraines (p < 0.001), lower global health (p = 0.003), along with greater anxiety (p < 0.001) and depression (p < 0.001).

Children who meet formal FN criteria do not have isolated nausea. FN overlaps highly with pain-associated DGBI, and nearly all FN patients report abdominal pain. FN is coupled with extra-intestinal symptoms, mental health comorbidities, and poor global health.