Youth and adults with muscular dystrophy (MD) face sexual and reproductive healthcare barriers shaped by the physical, social, and emotional impacts of a progressive neuromuscular condition. Despite sexual health being central to well-being, it remains understudied, as the needs of disabled individuals are often overlooked due to misconceptions and false narratives of disinterest. To address this gap, we conducted semi-structured interviews with thirty adults with various MD types, exploring their sexual and reproductive healthcare experiences. Using a hybrid inductive-deductive thematic analysis, we identified six themes related to barriers in care: patient discomfort discussing sexual health and insecurity about disability or inexperience; provider discomfort and overemphasis on medical puberty; lack of private, confidential time with providers; unaddressed fertility and reproductive concerns; provider invalidation or assumptions about sexual or romantic interest; and reliance on self-education from pornography or online sources. We also identified six themes for actionable improvements: patients desired increased provider-initiated conversations; practical sexual health information including hygiene and self-care; dating and relationship guidance; mental health support and resources to counter negative media messages; education on safe options for sexual fulfillment; and community and peer connection resources. Overall, participants expressed a strong desire for proactive, confidential, and affirming care addressing the full spectrum of sexual health needs while integrating mental health and peer support. Findings highlight the urgent need for inclusive, accessible, and holistic sexual and reproductive healthcare tailored to the lived experiences of people with MD.

Intolerance of uncertainty (IU) - a dispositional inability to react effectively to uncertain situations - has been increasingly conceptualized as a transdiagnostic risk factor for internalizing problems such as generalized anxiety and depression. However, evidence for its temporal role in the development of these conditions remains limited, particularly in adolescents, a group at heightened risk for psychopathology.

A total of 5,291 adolescents (46.2% boys; M age = 14.40 ± 1.56, range = 10-18 years) completed self-report measures of IU, generalized anxiety and depressive symptoms at baseline, 6 months and 12 months. Linear and logistic regression analyses examined whether baseline IU predicted subsequent symptom severity and elevated (above-cut-off) symptom levels over time.

Higher baseline IU significantly predicted increases in generalized anxiety and depressive symptoms, as well as higher odds of elevated generalized anxiety and depressive symptom levels at both 6- and 12-month follow-ups, even after adjusting for baseline symptom severity or baseline elevated symptom status. Baseline IU also predicted the new-onset and persistence of elevated symptoms across both intervals. Stratified analyses revealed developmental and sex differences: IU's predictive effects were strongest in early adolescence for girls and in middle-to-late adolescence for boys.

IU emerged as a transdiagnostic longitudinal predictor of generalized anxiety and depressive symptoms in adolescents, supporting its value as an early screening marker of vulnerability. Interventions targeting IU may offer an effective strategy for reducing broad internalizing risk during this critical developmental period.

Individuals with hereditary cancer syndromes often experience unique psychosocial challenges that may not be fully addressed in routine clinical care. Support with communicating genetic risk to family, coordinating complex medical care, and managing distress may enhance emotional well-being and improve engagement in recommended cancer prevention strategies. Incorporating social work services into gynecologic hereditary cancer care may address these unmet needs and promote a more comprehensive, patient-centered care model.

From April through September 2024, all patients with hereditary cancer syndromes followed at a gynecologic oncology clinic were offered referral to a genetics social worker. For patients who accepted, the social worker documented their primary areas of interest. Uptake of social work services was examined in relation to patient demographics and clinical characteristics.

Among 124 patients offered referrals, 102 (82.3%) accepted. New patients to the gynecologic oncology clinic were significantly more likely to engage with social work services vs. established patients (91.2% vs. 74.6%, p = 0.02). No other variables were associated with interest in social work. Among those who engaged with the social worker, the most frequently requested domains of assistance included mental health resources (36.9%), support groups (35.4%), family testing (32.3%), and care coordination (30.8%).

Integration of social work services into gynecologic hereditary cancer care resulted in high patient engagement. The strongest uptake was observed among new patients, underscoring the importance of providing early access to support. Overall, patients expressed substantial interest in mental health resources, support groups, family testing, and care-coordination assistance, highlighting critical areas for enhanced care delivery.

The ongoing conflict in Ukraine has created a severe humanitarian crisis, disproportionately affecting vulnerable populations such as children with chronic conditions. We set out to determine information about mental health in children with epilepsy in Ukraine affected by the conflict.

Mental health outcomes in 213 Ukrainian children with epilepsy during the conflict were screened using standardized instruments for post-traumatic stress disorder (PTSD; Harvard Trauma Questionnaire), anxiety (7 item Generalized Anxiety Disorder module, GAD-7), depression (Patient Health Questionnaire-9, PHQ-9), and epilepsy severity (Global Assessment of Severity of Epilepsy scale, GASE). Data were collected between February and June 2023 through self- or proxy-completed surveys.

Participants (14.6%) screened positive for PTSD symptoms, with girls significantly more affected than boys. A high proportion screened positive for symptoms of anxiety and depression, with 22% in the range for severe anxiety and 55% in the moderate-to-severe depression range. Epilepsy severity strongly correlated with mental health burden. Access to care was severely disrupted: 76% reported difficulty obtaining antiseizure medications, and 51% struggled to access medical services, contributing to increased seizure frequency in 56% of cases. Regression analyses identified epilepsy severity and barriers to medical care as key predictors of adverse mental health outcomes.

These findings underscore the compounded impact of war and chronic illness on children's psychological well-being and highlight the urgent need for trauma-informed, multilevel interventions, and improved access to health care for this vulnerable population.

This case report presents the case of a 25-year-old woman who developed ketamine addiction following a single sub-anaesthetic dose of intranasal ketamine in a pilot study investigating intranasal racemic ketamine for acute suicidality. She had a history of depression, obsessive-compulsive disorder, autism spectrum disorder and anorexia nervosa, and she had sporadically used alcohol and cannabis. Following the intervention, she reported a transient reduction in suicidal ideation but later sought illicit ketamine to recreate its calming effects on intrusive thoughts. Subsequently she also started abusing cocaine and 3-methylmethcathinone (3-MMC). Within weeks she had escalated to daily use, which led to financial distress, housing instability and a suicide attempt when access was cut off. Although she initially ceased use, she later relapsed into ketamine and cocaine addiction. This case highlights the addictive risk of ketamine, even in controlled settings. Given ketamine's rising use in psychiatric treatment, careful screening, monitoring and awareness of addiction potential are essential. Future research should evaluate patient-specific risk factors and dosing strategies to minimise abuse liability.

Psychological stress is increasingly recognized as an important modifier of asthma severity and control. However, objective clinical data on asthma outcomes during prolonged armed conflict remain limited. This study aimed to evaluate changes in anxiety, depression, lung function, and asthma control among patients with persistent asthma living in a frontline region of Ukraine during periods of differing military intensity, and to examine their associations with clinical parameters and access to controller therapy.

This prospective observational study included 49 adults with persistent asthma and 21 healthy controls examined twice between May-June and September-October 2024 at a regional hospital in Sumy, Ukraine. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS). Asthma-related outcomes included forced expiratory volume in 1 s (FEV₁), Asthma Control Test (ACT) scores, blood eosinophils, and total IgE levels. Statistical analysis was performed using IBM SPSS Statistics 30.0. Pearson correlation analysis was applied to assess relationships between psychological and clinical variables. Binary logistic regression was used to identify factors associated with poor asthma control (ACT < 20), with anxiety and depression entered as continuous predictors and access to baseline therapy as a binary variable.

Psychological distress increased significantly in both asthma patients and healthy individuals during the period of intensified hostilities. In patients with asthma, worsening security conditions were accompanied by significant declines in FEV₁ and ACT scores (p < 0.001), whereas eosinophil counts and total IgE levels remained unchanged. Anxiety was negatively correlated with both FEV₁ and ACT across study periods, while depression showed no significant correlations with clinical indices. Logistic regression revealed that higher anxiety levels were independently associated with poor asthma control in May-June (OR = 1.563, 95% CI 1.012-2.412) and September-October 2024 (OR = 1.539, 95% CI 1.032-2.294). Depression was not significantly related to asthma control at either time point. Limited access to baseline therapy in September-October was associated with increased odds of poor asthma control, but this did not reach statistical significance (OR = 2.889, 95% CI 0.60-13.83).

Prolonged exposure to wartime stress was associated with progressive psychological deterioration and worsening asthma control. Anxiety - already evident after 2 years of conflict - emerged as a consistent determinant of impaired asthma outcomes, whereas depressive symptoms showed no independent association. These findings highlight the importance of integrating mental health screening into asthma management strategies in conflict-affected regions.

People experiencing homelessness face up to 12 times higher mortality rates than the general population. People experiencing homelessness have multiple, unmet health and care needs, including poor physical and mental health, substance use disorder and lack of stable and safe housing, yet they do not find services accessible or tailored to their needs.

The aim of this study was to assess the feasibility of conducting a larger, definitive trial evaluating an integrated clinical pharmacist/homeless third-sector support (Pharmacy Homeless Outreach Engagement Non-medical Independent prescribing Rx) for people experiencing homelessness, in a community pharmacy setting.

Randomised, multicentre, open, parallel group external pilot trial with parallel economic and qualitative process evaluation.

People experiencing homelessness ≥ 18 years were recruited from community pharmacies in Glasgow and Birmingham, United Kingdom. Participants were randomised 1 : 1 to receive Pharmacy Homeless Outreach Engagement Non-medical Independent prescribing Rx intervention in addition to usual care or usual care only. The Pharmacy Homeless Outreach Engagement Non-medical Independent prescribing Rx intervention is a collaboration between National Health Service pharmacist independent prescribers and third-sector homelessness charity workers offering weekly community pharmacy and/or outreach-based consultations for people experiencing homelessness to address health (e.g. health screening, treatment and prescribing), housing and social needs (e.g. welfare benefits, housing support). A range of health, social and care outcomes were evaluated at baseline, 3 and 6 months from both usual-care and intervention participants. The primary outcome was to evaluate the feasibility of a subsequent definitive randomised controlled trial according to pre-specified progression criteria classified as green (go ahead), amber (minor amendment in procedures required for definitive trial) and red (substantial changes needed). These related to recruitment; retention; intervention adherence; and collection of clinical and social outcomes data, including emergency department visits, rough sleeping and criminal justice encounters.

Progression criteria were met (4 green and 1 amber) as follows: (1) recruitment (target 55% conversion rate): 100 people experiencing homelessness were recruited as planned from 5 community pharmacies, 100/183, that is, 55% eligible consented to participate - green; (2) retention (target 60%): 72 (72%) participants remained in the study at 6 months - green; (3) collection of routine healthcare utilisation data (target 60%): 91 (91%) had emergency department visit and mortality data available at 6 months - green; (4) completion of questionnaire booklet (target 60%): 72 (72%) completed the booklet at 6 months - green; (5) intervention adherence (target 60%). Twenty-six (53%) participants had over half of the planned weekly contacts with the Pharmacy Homeless Outreach Engagement Non-medical Independent prescribing Rx team - amber. Signals of improvements were observed, as there were fewer ambulance call-outs, fewer emergency department visits and hospitalisations; fewer nights slept rough; and improved health-related quality of life in Pharmacy Homeless Outreach Engagement Non-medical Independent prescribing Rx participants compared to the usual-care group at 6 months' follow-up. Qualitative interviews conducted with participants and stakeholders. Participants suggested the Pharmacy Homeless Outreach Engagement Non-medical Independent prescribing Rx intervention was characterised by holistic approach, comprehensiveness, consistency and care. Challenges identified included resource constraints, integration with existing services and concerns about long-term sustainability.

Pharmacy Homeless Outreach Engagement Non-medical Independent prescribing Rx community pharmacy pilot randomised controlled trial successfully achieved key progression criteria. If found to be effective and cost-effective in a subsequent definitive randomised controlled trial, it offers promise as an adaptable (United Kingdom and internationally) model of integrated care provision for people experiencing homelessness.

While small sample size limits generalisability of the, it fulfils the purpose of a pilot study. Temporary absence of intervention worker in one of the study settings constrained intervention delivery. Future trials should plan for contingency measures.

Future research should seek to test and evaluate care models integrating health and voluntary sector care for people experiencing homelessness in various settings, including community pharmacy, street outreach and temporary accommodations.

This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number NIHR133060.

Despite unprecedented medical advances, global healthcare systems are failing to deliver universal, equitable and quality care. Many systems also have low resilience to surges in demand, are highly fragmented, or suffer from unsustainable funding models. The crisis of poor accessibility of healthcare services, which includes both lack of availability and unacceptably long waiting times, stems from systemic failures: inadequate provision of primary healthcare, suboptimal deployment of human and non-human healthcare assets, metric- and profit-centric models that exacerbate inequality, fragmented and siloed services, unsustainable costs and a reactive focus on treatment over prevention. Climate change and demographic shifts threaten to overwhelm already strained systems. In this discourse we argue that achieving the fundamental human right to healthcare requires a radical reconstitution of primary healthcare, centred on unlocking previously un- and under-exploited resources, capacities and productivity, governed by the principle of 'Networked Agency with a Safety Net'. We propose a holistic transformation that increases accessibility, resilience, integration, sustainability and, crucially, equity, centred on three synergistic pillars. First, a digital and patient-agency revolution, designed to radically increase access to, and the productivity of, primary healthcare. This involves creating self-care ecosystems such as Do-It-Yourself Digital Medical Centres and Home Clinics, supported by a National Clinical Informatics Centre. By enabling patients to manage routine care, this system frees highly trained healthcare professionals to focus on the complex clinical work that demands their full expertise. This enables and fosters patient empowerment while ensuring continuous clinical oversight (to prevent any misunderstanding: clinical oversight means that all clinical recommendations/decisions are made by healthcare professionals; patient agency involves inter alia implementing such recommendations/decisions). Second, acceleration of the strategic exploitation of microbial technologies-frugal, sustainable tools for diagnostics, prophylactics and therapies, including and especially mental health interventions, and environmental health (One Health). Third, a decisive shift towards disease prevention and health creation, integrating 'Health in All Policies', targeted comprehensive health education, and a comprehensive and systematic dismantling of healthcare accessibility barriers-such as transport impediments-and legacy forms of discrimination like restricted sexual/reproductive healthcare and failure to adequately care for the most chronically underserved, including the ageing population. This model is inherently sustainable and designed to drastically reduce the healthcare sector's carbon footprint and environmental impact through service consolidation, transport-oriented siting and green infrastructure. The measures constitute a technical upgrade and also a fundamental recasting of the primary healthcare system and mindset. This is also a moral imperative. Governments, while increasingly delegating service provision to commercial actors, hold a non-delegable duty of care. Fulfilling this duty necessitates a covenant that transitions healthcare from a market commodity to a publicly-accountable system sustainably designed for long-term resilience, equity and dignity. The roadmap we provide-encompassing governance, infrastructure, innovation and education-charts a course from crisis to a sustainable future where universal access to quality healthcare can finally be realised.

Integrated Youth Services (IYS) are increasingly implemented across Canada to address the intersecting mental, physical and social needs of young people, yet the integration of primary care within IYS remains under-documented. This article presents a qualitative, practice-based case study of Aire ouverte Montréal-Métro Berri, an urban IYS site where family physicians have been embedded as permanent members of a multidisciplinary team since 2022. Serving diverse youth aged 12-25 in a downtown context, this site offers an exemplar of integrating family medicine within a publicly funded youth service model. Drawing on an ongoing evaluation, the paper describes the implementation model, roles of family physicians and enabling organizational conditions, based on document analysis and perspectives from clinicians, managers and team members. Findings highlight how co-location, collaborative practices, shared care planning and flexible administrative arrangements supported the integration of family physicians. Reported impacts include timely access to primary and mental healthcare, improved care coordination, enhanced team capacity to manage risk and earlier engagement of youth who might otherwise not access services or access care through crisis-driven pathways. This case offers transferable insights into integrating family physicians within IYS, at a time of rapid national scaling and persistent challenges in youths' access to primary care.

Our case study presents insights from our experiences of "integrating" Indigenous ways of knowing and being into integrated youth services (IYS), a growing Canadian model for offering a range of services to youth aged 11-25. Huddle NorWest, one of Manitoba's IYS hubs, serves a diverse population of youth, with ∼30-40% identifying as Indigenous. Recognizing the importance of culturally safe care, Huddle NorWest seeks to understand the factors that contribute to Indigenous youths' comfort in accessing its services. Current engagement strategies include an on-site Indigenous Elder, culturally relevant programming such as beading and ribbon skirt making, and the integration of Indigenous art and teachings throughout the space. As part of its broader commitment to reconciliation, NorWest Co-op Community Health actively supports a Truth and Reconciliation Commission (TRC) Committee and has signed the Winnipeg Indigenous Accord, outlining a three-year action plan to align with the TRC's Calls to Action. Indigenous perspectives are embedded in the organization's governance and advisory structures since 2017, including community and youth advisory councils, half of whom identify as Indigenous. This work reflects an ongoing effort to build trust and provide culturally safe, inclusive services for Indigenous youth, and can inspire other urban IYS serving Indigenous youth.