Task shifting and task sharing are strategies for redistributing healthcare responsibilities to optimise healthcare services. The World Health Organization (2008) framed 'shifting' as the delegation of tasks from higher- to lower-qualified workers, while subsequent scholarship characterised 'sharing' as collaborative, team-based redistribution. However, the two approaches are often used interchangeably in literature and by practitioners. Drawing on interviews and observations across 16 Indian organisations working in primary healthcare, mental health, and emergency medical services, we identified two types of operational ambiguities: organisations simultaneously employed both strategies for different tasks within the same service and also demonstrated practices that did not match their design intent or initial appearances. Based on these, we reiterate the importance of classifying task redistribution (Shifting OR Sharing) at individual task levels, consistent with the task-specific wording of conventional definitions, and additionally propose a new operational criterion: whether the delegating provider is functionally present or absent during task execution. We suggest revised working definitions incorporating this criterion as a hypothesis for prospective testing, and invite the global health community to validate these for clearer implementation, evaluation, and policy.

The educational alliance describes a framework for the trusting relationship between trainee and supervisor as they engage in meaningful, effective feedback. This framework emphasizes interpersonal relationships, shared goals, and agreement on actionable steps to achieve these goals. In this theory-informed conceptual analysis, the authors propose that the educational alliance logically extends to support and enhance competency-based medical education and health professions education, collectively known as competency-based health professions education (CBHPE). Authors describe how key features of the educational alliance align with the five core components of CBHPE: outcome-based competencies, sequenced progression, tailored learning experiences, competency-focused instruction, and programmatic assessment - by facilitating individualized learning that is centered on the trainee-supervisor relationship. Relevant theories that support the effective implementation of the educational alliance in CBHPE to advance learning include growth mindset and self-regulated learning theories. Authors present specific actionable recommendations regarding trainee and supervisor roles and responsibilities within an educational alliance for creating shared mental models, building relationships, engaging in team training, and attending to ethical considerations, including conflicts of interest and using data for the determination of trainee competency and advancement. Additionally, the authors introduce an Educational Agreement applicable to all training levels, designed to foster, guide, and strengthen the educational alliance. The Agreement is intended to be voluntary, co-constructed, and may be adapted to local contexts. Finally, the authors identify areas for future empirical examination through research on the educational alliance in CBHPE programs.

Peer mentorship by individuals with lived experience is increasingly recognized as supporting recovery after severe injury. Yet evidence on its role in hospital-based rehabilitation remains limited, particularly in cases of severe war-related physical injury during ongoing military conflict. This study examines the benefits and barriers of peer mentorship within the Israel Defense Forces Casualties Affairs Unit, which trains previously injured veterans to accompany newly injured soldiers during hospitalization in healthcare settings as part of their reserve duty.

The study employed a qualitative design, comprising 41 in-depth interviews: 21 with severely injured soldiers (with amputations, traumatic brain injury, spinal cord injury, burns, polytrauma) who were assigned peer mentors, and 20 with parent-caregivers. Interviews underwent linguistic and thematic analyses.

Peer mentorship was found to support recovery across three domains: functional (independent functioning, exercising rights, community participation), social-emotional (fostering hope, belonging, trust, and mediation of re-entering the public space), and cognitive (autonomous choice, insight, identity reconstruction, and developing an effective mindset when interacting with others). Barriers were also identified across three domains: technical-functional (matching and timing issues), emotional (managing rejection, shattering the illusion of full recovery, appearance-related avoidance), and cognitive (discrepancies in worldviews).

Integrating peer mentorship into the post-acute continuum of care facilitates recovery of severely injured soldiers and their families but requires careful implementation. Healthcare systems and rehabilitation units may integrate peer mentorship as part of their comprehensive support framework. The study's significance lies in the need to develop diverse responses for war casualties following military conflicts worldwide.

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.