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.

Alone, the Nine Item Avoidant/Restrictive Food Intake Disorder (ARFID) Screen (NIAS) only allows for ARFID-like symptom detection, potentially overestimating its prevalence. We aimed to investigate the prevalence of ARFID-like symptoms and DSM-5-compatible ARFID (based on medical chart review) in irritable bowel syndrome (IBS), and to compare characteristics associated with these definitions.

Adult patients with IBS according to Rome IV criteria, consulting in our tertiary care center between January 2024 and February 2025, were included. Patient data were collected using validated questionnaires, including NIAS-Fr. ARFID-like symptoms were defined as meeting the cut-off for at least one NIAS-Fr subscale (≥ 10 on "picky" or "fear," or ≥ 9 on "appetite"). A medical chart review using our center's clinical data warehouse was conducted for detecting medical impairment and eating disorder (ED) diagnosis. Patients with a positive NIAS-Fr, without ED, and with at least one medical/psychosocial impairment were considered to be in the "DSM-5 compatible ARFID" group. Univariate and multiple logistic regression analyses were conducted.

Among the 326 included patients, 47.5% had ARFID-like symptoms, and 33.4% met DSM-5-compatible criteria for ARFID. Functional dyspepsia (FD) was prevalent in 60.4% of patients. Depressive symptoms, somatic symptom severity, and FD were independently associated with having ARFID-like symptoms (Nagelkerke R² = 0.138). Depressive symptoms and IBS symptom severity were independently associated with DSM-5 compatible ARFID (Nagelkerke R² = 0.203).

ARFID-like symptoms were more prevalent than DSM-5-compatible ARFID in our population. Applying DSM-5-compatible criteria was associated with more severe gastrointestinal and depressive symptoms. Standardized DSM-5 ARFID assessment methods remain to be established.

Risk assessment and management are key elements of clinical practice in mental health. Existing literature on risk assessment in mental health has focused more on the predictive validity of tools and less on the clinical utility of tools in daily practice.

To explore risk assessment and management processes, and how clinicians use risk tools in daily practice, across a single health board.

This was a large mixed-methods study in a health authority responsible for the care of 1.3 million people covering a wide range of settings. Data collection involved multiple approaches including staff surveys, focus groups, non-participant observations of team meetings, case-file audits and reviews of incident reports.

Although risk was routinely discussed in team meetings, the risk tool was rarely used to inform decision-making. Barriers to meaningful use of the tool included time constraints, lack of training and perceived lack of relevance. Both staff and carers reported limited involvement of patients and families in risk assessment processes. Case-file audits showed high completion rates of the risk tool but little evidence that it influenced decision-making.

This study demonstrates a significant challenge for services, with clinical teams discussing risk but not using the mandated formulation-based risk tool to do so. This is set against the need for health authorities to demonstrate consistent standards in risk management across specialties and settings and to have a format that makes risk management plans easily available to clinicians unfamiliar with the patient. Further research is required to develop a method of recording risk mitigation strategies that is collaborative and can be easily completed in a clinical setting.

Mental health disorders are the primary driver of the global disease burden among young people, yet nationally representative data for Central Asia remains scarce. This study aimed to determine the prevalence and sociodemographic correlates of potential depression, anxiety, and suicidality among the young population in the Central Asian nation of Kazakhstan.

A cross-sectional analysis was conducted using data from the 2024 Kazakhstan Multiple Indicator Cluster Survey (MICS), a nationally representative, multi-stage probability sample. Potential depression and anxiety were screened using the PHQ-2 and GAD-2 instruments (cut-off ≥ 3), while suicidality was assessed via self-reported thoughts (past two weeks) or attempts (past 12 months). Weighted prevalence estimates were calculated, and modified Poisson regression models identified independent sociodemographic risk factors. Population attributable fractions (PAFs) were estimated to quantify the impact of associated risks.

We included 5,079 individuals aged 15-24 years. The weighted national prevalence was 1.70% (95%CI = 1.31-2.08) for potential depression, 1.59% (95%CI = 1.23-1.96) for potential anxiety, and 0.96% (95%CI = 0.65-1.27) for potential suicidality among the population aged 15-24 years. In adjusted analyses, female sex was the strongest predictor of both potential depression (adjusted risk ratio [aRR] = 2.72, 95%CI = 1.55-4.79) and anxiety (aRR = 2.80, 95%CI = 1.58-4.96). Non-Kazakh ethnicity was also significantly associated with an increased risk of depression (aRR = 1.88, 95%CI = 1.17-3.02) and anxiety (aRR = 1.99, 95%CI = 1.28-3.11). PAFs indicated that female sex accounted for 45.6% and 46.8% of the risk for depression and anxiety, respectively. No significant sociodemographic correlates were identified for suicidality.

These findings provide the first nationally representative benchmarks for youth mental health in Kazakhstan. While prevalence rates are lower than global averages, the marked disparities by sex and ethnicity highlight the need for targeted, culturally sensitive mental health interventions. Strengthening early detection and resource allocation for these vulnerable subgroups is essential to meet national and Sustainable Development Goal targets.

Intimate partner violence (IPV) is a major global public health issue that adversely affects women's physical, psychosocial, and reproductive health. Although individual characteristics have been widely studied, relational dynamics and intergenerational experiences of violence remain less explored, particularly in the Turkish context. Examining these factors together may contribute to a more comprehensive understanding of IPV and inform prevention strategies.

This study aimed to examine IPV exposure among women of reproductive age in Türkiye and to identify sociodemographic, partner-related, and relational factors associated with such exposure.

A descriptive, cross-sectional study was conducted between 15 November 2024 and 15 January 2025 with 453 women aged 18-49 years who had a current partner. Participants were recruited through snowball sampling via five social media platforms. Data were collected using a researcher-developed online questionnaire comprising sociodemographic and partner-related characteristics and a single-item measure of exposure to IPV. Statistical analyses included the chi-square test, the Mann-Whitney U test, and Firth penalized logistic regression to address sparse-data bias and quasi-complete separation. Multicollinearity was assessed using variance inflation factors. Internal validation was performed using bootstrap optimism correction (B = 500) and 10-fold cross-validation repeated 10 times. Statistical significance was set at p < .05.

Overall, 11.3% of participants reported IPV exposure. Firth penalized logistic regression showed that witnessing the partner's violent behavior toward others (OR = 94.42; 95% CI: 6.06-1471.46), low relationship satisfaction (OR = 24.71; 95% CI: 4.43-137.92), a history of family violence (OR = 15.48; 95% CI: 5.21-46.02), lower income relative to expenses (OR = 19.12; 95% CI: 4.93-74.14), and increasing age (OR = 1.27 per year; 95% CI: 1.17-1.38) were independently associated with IPV exposure. The model yielded a Nagelkerke R² of 0.746 and an optimism-corrected AUC of 0.966. Given the limited number of IPV events and the wide confidence intervals for several estimates, the magnitude of the observed associations should be interpreted cautiously.

IPV exposure in this study was associated with individual, relational, socioeconomic, and prior violence-related characteristics. The observed associations are consistent with a multilevel understanding of IPV and highlight the relevance of considering relational and family experiences alongside individual and socioeconomic characteristics in IPV prevention and assessment.