Atrial fibrillation (AF) is associated with substantial symptom burden and reduced quality of life. Although physical activity is recommended, sustained engagement remains challenging. Behaviorally informed, nurse-led interventions may support long-term adherence in outpatient cardiopulmonary care.

To evaluate the effects of a nurse-led, COM-B-based walking intervention on quality of life (primary outcome), symptom severity, AF burden, and physical activity in patients with persistent or permanent AF.

In this randomized trial, 78 patients were randomized (39/group); 75 with complete longitudinal data (37 intervention, 38 control) were analyzed. The 12-week intervention combined COM-B-based nurse education, pedometer-supported walking (≥30 min, ≥3 days/week), and weekly calls. Outcomes were assessed at baseline, week 4, and week 12 using repeated-measures analyses. SF-36 domains used Bonferroni α = 0.00,625.

After Bonferroni adjustment, significant group × time effects were observed for physical functioning, emotional role limitations, vitality/energy, social functioning, and bodily pain, whereas physical role limitations, mental health, and general health did not meet the adjusted threshold. Symptom severity showed a significant group × time interaction (F = 23.258, p < 0.001, ηp² = 0.242); the unadjusted week-12 between-group mean difference was -5.14 (SE = 1.25, 95% CI -7.64 to -2.64). AF burden did not differ by group over time (p = 0.767).

The primary analysis showed significant group × time effects in five of eight SF-36 domains, not across all domains. Nurse-led support may facilitate subjective symptom management when measured AF burden is unchanged; larger, longer trials are needed.

NCT05189691.

Emerging evidence has reported associations between more negative views on aging and poorer performance on cognitive tasks. However, findings have been inconsistent. Gender differences and the cognitive status of participants may help explain these discrepancies. This study therefore investigated (a) the associations of gender, presence of mild cognitive impairment (MCI), and their interaction with expectations regarding aging (ERA, a measure assessing views on aging); and (b) the associations between subjective and objective cognitive measures and ERA in cognitively normal (CN) individuals and those with MCI. We report cross-sectional data from the Personality and Total Health Through Life Project (PATH), comprising 1,562 participants (48% females, M age = 75.06 (SD = 1.50), age range = 72-79). ERA were assessed using the 12-item ERA scale, covering global ERA and domain-specific expectations related to physical health, mental health, and cognitive function. Objectively-assessed global cognition, memory, working memory, and processing speed, and subjective memory complaints were assessed using standardized neuropsychological test batteries. Multiple linear regression models were estimated. Among CN participants, women reported more positive ERA than men (β = 4.42, p < .001). Participants with MCI exhibited lower ERA than CN individuals (β = -6.05, p < .001). Subjective memory complaints were associated with lower ERA both in CN (β = -5.38, p < .001) and MCI (β = -8.85, p < .01) participants. Findings support an association between greater current cognition and more positive ERA. Interventions promoting brain health could benefit from a component fostering positive ERA. For individuals experiencing cognitive decline, future research may evaluate strategies that encourage the maintenance of realistic, yet optimistic aging perceptions.

to identify interventions aimed at improving the mental health of family caregivers, whether or not focused on health literacy and health gains.

this systematic review was conducted in accordance with the Joanna Briggs Institute guidelines and involved searches in nine databases. Primary studies published in English, Spanish, and Portuguese were included if they developed, tested, or implemented programmes designed to promote positive mental health among caregivers aged 18 years and older.

seven original studies were included, comprising randomised controlled trials, quasi-experimental studies, mixed-methods studies, and pilot studies conducted across different countries. The interventions ranged from home visits and problem-solving techniques to online psychoeducational courses and caregiver training programmes. Significant improvements were observed in depression, anxiety, caregiver burden, and positive mental health, alongside a significant increase in caregivers' skills and knowledge.

this review demonstrates that educational and psychosocial approaches contribute positively to improving the mental health of informal caregivers.

Insomnia with objective short sleep duration has been reported to be associated with cardiometabolic comorbidities. We aimed to investigate the association between insomnia symptoms with objective or self-reported sleep duration and mortality in a general population sample.

From the Wisconsin Sleep Cohort, 373 participants with insomnia symptoms and 394 participants without insomnia symptoms with a median follow-up duration of 8 years were included. Insomnia symptoms were defined as the presence of difficulty in falling sleep, maintaining sleep or early awakening for more than 5 times/month. Objective short sleep duration was defined as total sleep time < 6 hours based on polysomnography. Self-reported short sleep duration was defined as < 7 hours.

Insomnia symptoms with objective short sleep duration were associated with a 2.6-fold higher risk of all-cause mortality (hazard ratio [HR]=2.57, 95% confidence interval [95%CI]=1.12-5.89) compared to participants without insomnia symptoms and normal sleep duration (>6 hours) after controlling for confounders. Furthermore, participants with insomnia symptoms and normal sleep duration or with objective short sleep duration but without insomnia symptoms were not associated with increased risk of all-cause mortality. Finally, insomnia symptoms with self-reported short sleep duration were not associated with risk of all-cause mortality.

Our findings support that insomnia with objective short sleep duration is the more severe insomnia phenotype. Objective short sleep duration appears to be a valid marker of the biological severity of insomnia.

Long-term blood pressure variability (BPV) is associated with cognitive decline, yet the underlying mechanisms have not been fully elucidated.

To investigate the associations between long-term BPV and hippocampal subfield volume and cognitive function and to assess the mediation effect of hippocampal subfield volume.

Prospective.

One thousand three hundred sixty-six adults attended at least 3 surveys between 2006 and 2020 as part of the Kailuan Study.

3T; 3D T1-weighted sequence (T1WI).

Cognitive function was evaluated by Montreal Cognitive Assessment (MoCA) at the last (7th) survey visit and brain MRI acquired. The hippocampus was segmented into 12 subfields via FreeSurfer software: molecular layer, cornu ammonis (CA)1, CA2-3, CA4, subiculum, presubiculum, parasubiculum, hippocampal amygdalar transition area (HATA), dentate gyrus (DG), fimbria, hippocampal tail, and hippocampal fissure. BPV was defined as the standard deviation of manual blood pressure (BP) readings acquired at each survey visit. Associations between BPV, hippocampal subfield volume, and cognitive function were assessed.

Associations were evaluated using generalized linear models. To explore whether hippocampal subfield volume mediated the association between BPV and cognitive function, mediation analysis was employed.

Higher systolic BPV (SBPV) was significantly associated with lower volumes in CA1, CA2-3, molecular layer, and HATA (β = -8.99, -3.15, -7.18, and -1.27, respectively). Elevated diastolic BPV (DBPV) was significantly associated with lower molecular layer volume (β = -5.71). SBPV and DBPV were significantly negatively associated with MoCA scores (β = -0.24 and -0.20, respectively). Decreased volumes in the molecular layer, CA4, CA2-3, CA1, subiculum, DG, fimbria, and hippocampal tail were significantly associated with lower MoCA scores (β = -0.32, -0.29, -0.25, -0.28, -0.26, -0.31, -0.53, and -0.26, respectively). The association between SBPV and MoCA scores was mediated by molecular layer volume (proportion: 9.45%).

Elevated BPV was associated with hippocampal subfield atrophy and cognitive decline. The association between SBPV and cognitive decline appears to be mediated by molecular layer volume.

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Skin NTDs cause mental ill health, primarily through social stigma and discrimination, overburdening services and undermining elimination efforts. A holistic One Health (OH) approach is essential for NTD elimination, but evidence and operational guidance lack. This scoping review documents the current state of integration of mental health and OH-based skin-NTD programmes. It forms part of a series of reviews on the role of OH in skin NTDs, led by the WHO skin NTD working groups.

We searched four peer-reviewed databases for terms related to skin NTDs, OH, mental health and social determinants of health (SDH). Peer-reviewed articles exploring all four concepts were eligible, with no language/geographical/time constraints. Grey literature, conference abstracts and non-peer-reviewed materials were excluded. Abstract screening and extraction was supported by ASreview and NotebookLM. Outcomes related to mental health, OH/SDH and skin NTDs were analysed and charted, using a descriptive thematic analysis approach.

Twenty-two papers were included; predominantly quantitative studies in Africa, focused on cutaneous leishmaniasis (CL), with few intervention studies. Mental health was typically explored as a downstream effect (primarily stigma and distress), with limited use of validated instruments. Few studies meaningfully embedded OH approaches, including cross-sectoral collaboration and changes were rarely attributed to climate change. A theoretical framework for the multi-directional and intersectional relationship between mental health, SDH and OH is presented.

The underlying mechanisms of mental health remain poorly characterised, with a lack of integrated OH thinking. Exposure to skin NTDs is generally due to lack of agency and choice. Evidence on the role of household economic conditions and climate change in relation to mental health and skin NTDs lacks. Participatory research has a critical role to play in co-designing nuanced OH-informed interventions, but it is critical that we build on identified synergies within existing frameworks, including person-centred care and syndemics.

Gaming disorder is recognised in ICD-11 as an addictive disorder associated with persistent gaming leading to functional impairment. While many video games include monetised features such as microtransactions and other in-game purchases, financial harms are rarely examined as a potential negative consequence. The present study examined associations between higher versus lower risk of gaming disorder and two financial outcomes: game-related overspending and financial harm.

Data were from the International Gaming Study 2024, a cross-sectional survey of 1,522 adult regular gamers from Australia (n = 303), China (n = 314), Indonesia (n = 300), Netherlands (n = 303) and the United States (n = 302). Gaming disorder was screened using the Gaming Disorder Identification Test (GADIT), with participants classified into higher-risk (≥5) versus lower-risk (<5) groups.

In adjusted logistic models, membership in the higher-risk group was strongly associated with overspending (OR = 5.36, 95% CI: 3.31-8.69) and financial harm (OR = 7.76, 95% CI: 4.88-12.35). More specifically, among participants in the higher-risk group 80.2% reported overspending and 77.8% reported financial harm compared to 42.6 and 30.6% in the lower-risk group. Odds of financial harms were higher in China and Indonesia than in Australia, while odds in the United States and Netherlands did not differ significantly from Australia.

Financial harms from gaming are common and most pronounced among individuals at higher risk of gaming disorder but are not limited to this group. These findings highlight the need for greater awareness of the risk for gaming-related financial harm, alongside strengthened consumer protection measures.

Recent changes to the National Institute for Health and Care Excellence (NICE) guidelines combined with an update to the implementation advice from the Scottish Dental Clinical Effectiveness Programme (SDCEP) have resulted in significant changes to the advice given to dentists concerning the prevention of infective endocarditis (IE). In contrast to a previous NICE recommendation against the use of AP for IE prevention, dentists are now recommended to offer antibiotic prophylaxis (AP) to all individuals at high-risk of IE before extractions or oral surgery procedures, and to consider AP for high-risk individuals undergoing any other at-risk dental procedures that involve manipulation of the gingival or periapical region of the teeth.Most UK cardiologists, cardiothoracic surgeons and infectious disease specialists (alongside many National Health Service trusts, several of which incorporate dental schools and hospitals) follow the European Society for Cardiology (ESC) guidelines. Awareness of the changes made by NICE and SDCEP, and the similarities and differences between their updated recommendations and the ESC guidelines, is therefore essential.

Prolonged delay between the onset of the first episode of psychosis (FEP) and initiation of treatment is common in lower- and middle-income countries (LMICs), including Pakistan. This qualitative study explored perspectives of young persons with FEP, carers, healthcare professionals, and traditional and spiritual healers (TSHs) on drivers of delayed diagnosis and treatment of FEP, to suggest interventions aimed at addressing factors contributing to prolonged duration of untreated psychosis (DUP) in Pakistan and similar contexts.

We conducted a qualitative study in Peshawar, Pakistan using focused ethnography as a research design. We first conducted focused ethnography using participant observation with 15 TSHs. Subsequently, data was collected through semi-structured interviews (n = 26) and focus group discussions (n = 6) with FEP individuals (age 14-25), their carers, and healthcare professionals. We used framework analysis, combining inductive and deductive thematic approaches to analyse the data.

Three themes emerged from the analysis in relation to care pathways in psychosis: (1) moral-spiritual explanations legitimise spiritual healings; (2) stigma renders psychiatric disclosure socially risky; and (3) structural exclusion of inaccessibility of mental health from primary care.

Psychosis remains untreated for a prolonged time as families navigate a moral-spiritual landscape that makes TSHs the only legitimate healers, stigma makes psychiatric disclosure a threat to family honour, and absent or dismissive services make biomedical care unreachable. Engagement with TSHs represents an underutilised opportunity to develop collaborative care models that reduce the duration of untreated psychosis.

Sports and exercise medicine (SEM) is increasingly recognized as a multidisciplinary specialty that contributes to the prevention of non-communicable diseases, enhancing rehabilitation, and optimizing athlete performance. In Ghana, SEM education is emerging, yet its effectiveness depends on clinical training through preceptorship. This study explored SEM preceptors' perspectives on their roles, challenges, institutional support, and motivational factors.

A qualitative descriptive design underpinned by an interpretivist epistemology, was employed. Seventeen SEM preceptors were purposively recruited from hospitals, clinics, and academic institutions affiliated with the University of Health and Allied Sciences. Data were collected through interviews and analyzed thematically following Braun and Clarke's framework. Reflexivity, member checking, and audit trails were applied to enhance trustworthiness.

Four major themes emerged: (1) conceptualization of SEM as preventive, rehabilitative, and complementary medicine; (2) challenges in clinical training including resource limitations, lack of formal training, and supervisory difficulties; (3) minimal institutional support, with weak coordination and calls for incentives and capacity building; and (4) motivational factors, where strong intrinsic drivers such as passion for teaching and student engagement were counterbalanced by extrinsic challenges including financial strain and inadequate resources.

In conclusion, SEM preceptors in Ghana are knowledgeable and intrinsically motivated, yet systemic barriers constrain their effectiveness. Strengthening institutional frameworks, investing in resources, and embedding experiential learning principles are essential to enhance SEM education. Incentivizing preceptors through recognition and financial support will sustain engagement and align SEM training with national health priorities.