Many adults are insufficiently active, posing a threat to public health. Research shows steep declines in physical activity during the emerging adulthood period. Psychological and socioenvironmental factors have been shown to be independently associated with engaging in physical activity. However, few studies have examined the cross-domain interactions between psychological and socioenvironmental factors on physical activity in real time. Real-time data collection methods can be leveraged alongside traditional nomothetic methods to gain a more comprehensive understanding of how physical activity is affected by dynamic changes to one's unique psychological and contextual state within a day.

This paper describes the protocol for a study aiming to examine independent and interactive associations between psychological and contextual factors and real-time physical activity in emerging adults. Ecological momentary assessment (EMA) and device-based monitoring of physical activity will be used.

The SCOPE (Studying COntextual and Psychological predictors of physical activity among Emerging adults) study will use an intensive longitudinal study design. A total of 124 emerging adults will be recruited, completing 2 waves of data collection consisting of an online survey followed by 7 days of EMAs 6 months apart. EMA surveys will be administered using the Pathverse smartphone app, and physical activity will be assessed using a Fitbit Versa 4 activity monitor.

The study was approved by the research ethics board at the University of Waterloo in November 2025. Recruitment and enrollment began in December 2025, and complete T1 data from 69 participants have been collected as of February 2026. It is expected that T1 data collection will be completed by April 2026, and T2 data collection will occur between June and October 2026. Data analysis on T1 data is expected to begin in May 2026. We anticipate results to be published in fall 2027.

Exploring real-time associations between psychological and socioenvironmental factors and physical activity will provide a more comprehensive understanding of the dynamic barriers and facilitators influencing individuals' engagement in physical activity in their everyday lives. The outcomes of this work will help advance existing theories on behavioral choice and effort minimization and inform the development of decision rules for adaptive interventions that are tailored to individuals' unique and current context.

Undergraduate students, including those preparing for health professions, report high rates of psychological distress and underuse of traditional counseling services. Credit-bearing wellness courses that combine psychoeducation with experiential learning may offer a scalable, curriculum-based approach to supporting student well-being.

This qualitative study explored how undergraduate students described personal growth, coping, and lifestyle changes following participation in experiential wellness courses.

An anonymous postcourse online survey captured open-ended responses from students enrolled across 6 wellness course sections. The courses emphasized stress physiology, evidence-based coping strategies, and weekly experiential assignments. Narrative responses from 110 participants were analyzed inductively using the reflexive thematic analysis developed by Braun and Clarke within a constructivist-interpretivist paradigm.

A total of six themes were identified: (1) healthy habits and practical lifestyle change; (2) stress management skills and mental health techniques; (3) self-reflection, awareness, and personal growth; (4) relevance and immediate applicability; (5) peer connection and discussion-based learning; and (6) course structure and opportunities for improvement. Students described adopting new coping strategies, developing greater self-awareness, and perceiving course content as relevant and applicable to their daily lives.

Students described experiential wellness courses as supportive of coping, self-awareness, and behavior change. These findings provide insight into how students engage with and interpret course-based wellness education. Curriculum-integrated approaches may represent a complementary strategy to support student well-being. Future research should examine these approaches across diverse populations and over time.

Integrating mental health care into well-attended health services, such as maternal-child health (MCH), offers a promising approach to increasing access to mental health care. To inform integration, we assessed the current approach to screening and treatment of perinatal mood and anxiety disorders (PMAD) in MCH facilities in Western Kenya. We conducted a cross-sectional survey among the facility managers ("in-charges") at 20 MCH facilities in Western Kenya. Trained data collectors administered questionnaires to assess facility infrastructure and human resources, perinatal mental health screening, psychological interventions, psychiatric medication availability, and level of perinatal mental health integration into standard MCH services. Across 20 MCH facilities, the majority were located in rural areas (16,80%), 2 peri-urban (10%), and 2 urban (10%). Facilities had a median of 37.5 medical staff (IQR: 31.0, 45.5); the most common cadre was nurses (median: 9.0, IQR: 6.0, 12.5). Under half of the facilities (8, 40%) screened for PMAD using a validated tool and documented results; most (19, 95%) reported diagnosing PMAD (not necessarily through a systematic approach), yet only half (10, 53%) documented the diagnosis. The most common psychotherapy reported across the sites was supportive counseling (15, 75%). Some facilities offered evidence-based psychotherapies (e.g., cognitive behavioral therapy, problem-solving therapy, etc.), but did not report on training, supervision or guidance from the evidence-based intervention manual. Across all facilities, the availability of mental health medications was limited. Only (12, 60%) had any antidepressant available, (16, 80%) had antiepileptics, (9, 45%) had antipsychotics, and (2, 10%) had mood stabilizers available. Mental health services in MCH clinics in Western Kenya are currently not offered in a structured and systematic manner to effectively alleviate PMAD. Available infrastructure and human resources offer an opportunity to integrate an evidence-based treatment model to improve perinatal mental health in the MCH clinics in Western Kenya.

Bereavement is associated with an increased risk of mental illness. The COVID-19 pandemic caused excess mortality, and may have exacerbated the mental health impact of bereavement due to social restrictions and reduced healthcare access. Using Swedish national register data, this study aimed to compare the risk of mental illness following bereavement before (2018-2019) and during (2020-2021) the pandemic, exploring how the pandemic might have modified the psychological impact of bereavement and identifying high-risk groups.We conducted a nationwide matched cohort study including (1) 3,840,845 individuals (349,168 bereaved) before the pandemic, and (2) 5,132,988 individuals (466,636 bereaved) during the pandemic. Mental illness was defined as the first occurrence of any psychiatric diagnosis or suicidal behavior during each period. Multivariable Cox regression was used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs). We found that bereaved individuals had a significantly higher risk of mental illness compared to non-bereaved individuals in both periods (before pandemic: HR 1.42, 95%CI 1.34-1.49; during pandemic: HR 1.34, 95%CI 1.28-1.39). Bereaved individuals younger than 30 years had markedly higher risks of psychiatric disorders in the pre-pandemic period compared to the pandemic period. Higher risks of incident psychiatric disorders were observed for loss of a child or spouse, compared to loss of a sibling or parent, as well as for loss due to accident or suicide as compared to other causes. Furthermore, bereavement due to COVID-19 was associated with an increased risk of mental illness during the pandemic period (HR 1.38, 95% CI 1.21-1.59). In conclusion, bereavement was consistently associated with an increased risk of mental illness, before and during COVID-19 pandemic, although young individuals (<30 years) seemed more affected before the pandemic. However, further research in settings with a different pandemic burden and/or mitigation strategies is needed to assess the generalizability of our findings beyond Sweden.

Mental health (MH) disorders are highly prevalent among university students, with multi-level impacts. Although campus-based mental health services (CBMHS) are available, awareness and utilisation rates remain low. This study examined the awareness and utilisation of CBMHS among Zimbabwean tertiary students, including the barriers, facilitators, and preferences that influence their access to services. This descriptive cross-sectional study recruited 1070 students from five tertiary institutions in Harare, Zimbabwe. Participants completed questionnaires evaluating awareness, utilisation, preferences, and barriers to accessing CBMHS. Data were analysed using descriptive statistics and multivariate logistic regression. The mean age of the participants was 21.7 (SD = 2.7) years. 76.5% of students were aware of CBMHS. Awareness of MH services was associated with familial history of MH conditions [AOR = 1.35 (95% CI: 1.05; 1.83), p = .05] and personal experience of a MH condition [AOR = 0.71 (95% CI: 0.52; 0.97), p = .030]. Only 16.5% of students had utilised CBMHS. High utility of CBMHS was associated with drug and substance use [AOR = 2.388 (95% CI: 1.227; 4.644), p = 0.01], availability of a psychologist [AOR = 1.69 (95% CI: 1.10; 2.59), p = .017] and availability of campus-wide MH workshops [AOR = 1.62 (95% CI: 1.00; 2.60), p = .049]. Key barriers to MH service utilisation included lack of resident/institutional MH service providers [AOR = 2.02 (95% CI: 1.16; 3.51), p = .013], past MH experiences [AOR = 1.53 (95% CI: 1.16; 2.02), p = .002], and friend's history of MH condition [AOR = 1.44 (95% CI: 1.11; 1.86), p = .006]. Students preferred self-help services, individual therapy, and psychologists for MH support. Universities should promote MH awareness through effective awareness campaigns and workshops, provide tailored services that align with the students' preferences, and ultimately create a supportive environment that fosters students' overall MH service utilisation and well-being.

Maternal mortality and morbidity in the United States remain substantially higher than in other high-income countries. Evidence suggests that exposure to chronic stress and social and environmental adversity contributes to maternal health risk through interconnected biological, psychological, and structural pathways. While these associations are documented, the molecular mechanisms linking adversity to maternal health outcomes remain poorly defined. This protocol describes a five-year, prospective, explanatory sequential mixed-methods cohort study (N = 200) designed to map how multilevel stress exposures influence biological and clinical outcomes among urban postpartum women. The study integrates geocoded neighborhood-level data, longitudinal electronic health records, and comprehensive interviewer-administered surveys assessing trauma, social support, and mental health. To identify the biological pathways of adversity, we employ multi-omics profiling of peripheral blood mononuclear cells-including DNA methylation, chromatin accessibility, and histone modification-alongside inflammatory and steroid hormone assays. Statistical frameworks, including Exposome-Wide Association Studies and spatial mediation modeling, will evaluate the interplay between socio-ecological stressors and molecular signatures during the postpartum period. Findings will advance understanding of the biological embedding of adversity and inform multilevel interventions to improve maternal health outcomes.

Spinal cord injury (SCI) causes persistent physical and psychological impairments and is associated with reduced quality of life. Telemedicine may improve rehabilitation access and follow-up care, but its effectiveness across multiple outcome domains in SCI remains uncertain.

This study aimed to evaluate the effects of telemedicine interventions on psychological health, quality of life, sleep, functional independence, and participation, and pain intensity in individuals with SCI.

We searched PubMed, Web of Science, Embase, Ovid MEDLINE, and Cochrane CENTRAL until 17 February 2026. We included English-language randomized controlled trials (RCTs) of telemedicine interventions in individuals with SCI. Two reviewers independently screened studies, extracted data, and assessed risk of bias using the Risk of Bias 2 (RoB 2; Cochrane) tool. Random-effects meta-analyses used the Hartung-Knapp-Sidik-Jonkman method with restricted maximum likelihood estimation of between-study variance. Effects were summarized as standardized mean differences (SMD) or mean differences (MD) with 95% CIs. For main meta-analyses, 95% prediction intervals were reported when at least 5 studies were available, but not for analyses with fewer than 5 studies or for subgroup meta-analyses. Certainty of evidence was assessed using GRADE (Grading of Recommendations Assessment, Development, and Evaluation).

We included 33 studies (35 reports). Telemedicine improved the World Health Organization Quality of Life-BREF (WHOQOL-BREF) social domain (MD 3.27, 95% CI 0.64 to 5.89; P=.03) and sleep quality at 3 months (MD -2.24, 95% CI -3.82 to -0.67; P=.04). Depressive symptoms also improved in the >3-≤6 months follow-up subgroup (SMD -0.31, 95% CI -0.57 to -0.04; P=.03). Overall effects for depressive symptoms were not significant (SMD -0.11, 95% CI -0.26 to 0.05; prediction interval -0.37 to 0.15; P=.16; I²=36.3%), while findings for anxiety, other WHOQOL-BREF domains, sleep quality at 1 month, functional outcomes, and pain intensity generally favored telemedicine but did not reach statistical significance. Approximately half of the studies were rated as low risk overall on RoB 2, with most remaining studies rated as having some concerns and a smaller subset rated as high risk. GRADE certainty was high for the >3-≤6-month depressive-symptoms subgroup, moderate for the WHOQOL-BREF social domain, Pittsburgh Sleep Quality Index (PSQI), and Spinal Cord Independence Measure (SCIM), and low for depressive symptoms overall, anxiety, and pain intensity.

Telemedicine may improve selected outcomes in SCI, with the most consistent evidence for social aspects of quality of life, sleep after sustained intervention exposure, and a more favorable effect on depressive symptoms in midterm follow-up subgroup analyses. These results suggest telemedicine as a practical adjunct for extending SCI rehabilitation access and continuity. Further trials should focus on optimizing intervention components, intensity, and patient targeting.

Stuttering is a neurodevelopmental disorder that typically emerges in childhood and may persist into adulthood. The current study hypothesized that adults with persistent stuttering who received active anodal transcranial direct current stimulation (tDCS) over the left inferior frontal gyrus would demonstrate significantly greater improvements in speech fluency compared to those who received sham stimulation.

A randomized, double-blind, sham-controlled clinical trial was conducted to evaluate the efficacy of a combined therapeutic approach. Thirty adults diagnosed with moderate to severe stuttering (6 females, 24 males; M = 30.60 years, SD = 10.15) were randomly assigned to either an anodal tDCS group or a sham stimulation group. Participants in the anodal group received fluency shaping therapy concurrently with anodal transcranial direct current stimulation (2 mA), while those in the sham group underwent the same behavioral therapy alongside sham stimulation. The tDCS was targeted over the left inferior frontal gyrus. Each participant completed ten 20-minute sessions over five consecutive days. Speech fluency outcomes were measured pre- and post-intervention.

The anodal tDCS group demonstrated significantly greater reductions in %SS, NAT, and SR compared to the sham group across all post-intervention time points (p < .05). Regarding the OASES, no significant between-group differences were observed at any time point; however, both groups demonstrated significant within-group improvements from baseline to the 3-month follow-up.

These findings suggest that tDCS, when combined with behavioral fluency interventions, can enhance speech fluency in adults who stutter. tDCS may therefore serve as a promising adjunctive technique to augment the effectiveness of conventional fluency therapies.

Physical inactivity constitutes a pressing societal problem. To realize physical activity's (PA) potential as a key health resource, mechanisms of PA engagement need to be understood. Laboratory and interventional studies documented that exercise relates to affective well-being (AWB) and suggested that AWB may shape PA behaviour. Digitalization enabled the investigation of how PA relates to AWB in everyday life, but findings from individual studies are ambiguous. Here we compiled 67 datasets (55.2% of eligible records) including 321,345 smartphone-based AWB ratings and nearly 1,000,000 h of accelerometer-measured PA (N = 8,223 participants) until December 2023 to clarify the nature and extent of PA-AWB associations. One- and two-stage individual participant data meta-analyses reveal that momentary AWB is associated with both prior (within, r = 0.05, 99.2% confidence intervals (CI) 0.03 to 0.06; between, r = 0.08, 99.2% CI 0.04 to 0.12) and subsequent (within, r = 0.04, 99.2% CI 0.03 to 0.05; between, r = 0.08, 99.2% CI 0.04 to 0.13) short-term PA in everyday life. Within persons, PA displays a positive association with energetic arousal, positive affective states and valence, yet a negative relation to calmness. The practical effect sizes are comparable to other daily life activities, with energetic arousal evincing the strongest relation to PA. Considerable heterogeneity in associations across individuals can be partially explained by sociodemographic moderators. Between participants, PA relates to positive affective states. The results document the critical relevance of PA-AWB relations in everyday life. They can contribute to the revision and development of health behaviour models and establish a starting point to approach behavioural, physiological and neuronal mechanisms underlying PA-AWB associations.

Keratoconus is an ectatic corneal disorder, which requires regular monitoring for early detection of progression and prompt treatment with collagen cross-linking (CXL) to stabilise the condition. This conflicts with the demand on corneal specialists to review acute referrals into the corneal service, delaying diagnosis and treatment. In this study, we examined the outcomes of an Allied Health Professional (AHP)-led keratoconus service for routine workup, monitoring, performing CXL and follow-up thereafter.

Refraction, topography and CXL operative details were taken from electronic patient records. Statistical analysis was performed in R^® (R Foundation for Statistical Computing, Vienna, Austria). 82 eyes had CXL performed by a nurse practitioner (NP) and 42 eyes by ophthalmologists. Pre- and post-operative evaluation were done by optometrists.

In total, 271 eyes of 177 patients were included. 92 patients (128 eyes) were consented and underwent CXL. 85 patients (143 eyes) where CXL was not indicated, were monitored routinely. All patients had baseline refraction and topography. Patients were reviewed at 12 and 24 months. All had topography at every visit. 71/72 eyes (98.61%) had refraction at 12 months and 57/58 eyes (91.28%) had refraction at 24 months. Patients who were operated on by NP found improvements in visual acuity at 12 months and 24 months (p < 0.05, Mann-Whitney U Test).

The AHP-led keratoconus service delivered satisfactory outcomes and can be an efficient means of dealing with these patients, complementing specialist corneal services in the NHS.