Functioning, recognized as the third health indicator and a key metric for rehabilitation, can be assessed by measuring capacity and performance.

To quantify the prevalence of disability and cognitive impairment in individuals aged 50+ and evaluate the reliability and clinical relevance of capacity and performance qualifiers in the activity and participation domains of the international classification of functioning checklist (ICF checklist).

A cross-sectional study was conducted in a population from rural and urban areas of Aragón (Spain), including 1707 participants. Disability and cognitive impairment were assessed using the WHO Disability Assessment Schedule 12-item version (WHODAS 12) and mini-mental state examination. A randomly selected subsample (n = 129) underwent a detailed functional evaluation. The ICF checklist was used to compare capacity and performance, analyzing their agreement and differences.

Disability was present in 50.6% of participants. Severe or total disability was most prevalent in general tasks/demands (10.1%) and domestic life (7.1%), reflecting significant daily functioning limitations. The largest capacity-performance discrepancies were in domestic life, self-care, and learning, indicating key intervention areas. Notably, 40.5% of participants had lower performance in domestic life, followed by learning/knowledge (28%) and mobility (17%). Conversely, performance exceeded capacity in community living (13.3%) and personal relationships (5.5%), highlighting the influence of environmental factors.

Disability is highly prevalent in adults aged 50+, notably affecting daily functioning. Gaps between ability and performance indicate environmental barriers, especially at home and in learning contexts. Improved outcomes in social domains suggest enabling conditions. Findings support the ICF checklist's clinical value and advocate for integrating environmental factors into disability care.

Female infertility causes considerable emotional distress for affected women, negatively influencing their quality of life (QOL) and marital stability. This study aimed to identify factors influencing QOL and marital distress among Omani women attending a fertility clinic.

This cross-sectional study included Omani women seeking infertility treatment at Sultan Qaboos University Hospital, Muscat, Oman, from November 2022 to February 2023 and assessed QOL using the World Health Organization QOL-Brief (WHOQOL-BREF) and marital adjustment using the Arabic Revised-Dyadic Adjustment Scale.

A total of 150 women were included in this study. The mean WHOQOL-BREF Version score was 69.40 ± 11.03, with mental health scoring the lowest and social relationships the highest. Primary infertility was reported by 58% and most participants were over 35 years old and unemployed. Mental health QOL was positively associated with polygynous marriages and younger age. The marital adjustment was negatively correlated with younger age at marriage and disparities in spousal education levels.

These findings highlight the need for targeted psychological support to improve the QOL and marital dynamics of Omani women undergoing infertility treatment.

Physical activity is essential for preventing cognitive decline, stroke and dementia in older adults. A new cardiovascular diagnosis offers a critical window for positive lifestyle changes. However, sustaining physical activity behavior change remains challenging and the underlying mechanisms are poorly understood. To identify the neural, behavioral, and contextual determinants of long-term physical activity change after a new cardiovascular diagnosis, we applied support vector machine learning to predict 4-year trajectories of both self-reported and accelerometer-derived moderate-to-vigorous physical activity in 295 cognitively unimpaired older adults from the UK Biobank, testing three models that incorporated baseline: (i) demographic, cognitive, and contextual factors, (ii) baseline resting-state functional connectivity alone, and (iii) combined multimodal features across all predictors. The combined multimodal model had the highest predictive power (r = 0.28, P = 0.001). Key predictors included greenspace access, social support, executive function and between-network functional connectivity within the default mode, and frontoparietal control networks. These findings underscore the importance of behavioral factors and social determinants of health and uncover neural mechanisms that may support lifestyle modifications. In addition to furthering our understanding of the mechanisms underlying successful physical activity behavior change, these findings help to guide the design of interventions and health policy with the ultimate goal of preventing cardiovascular disease burden and late-life cognitive decline.

People with borderline personality disorder (BPD) are high utilisers of acute psychiatric services (i.e., psychiatric emergency and inpatient services). Yet, people with BPD often encounter significant stigma in these settings, which can result in demoralisation and reluctance to seek further care. Peer support services are increasingly adopted to align mental health services with recovery-oriented principles. This study aimed to understand the perceived acceptability, opportunities and challenges of integrating peer support for people with BPD in acute psychiatric services. We invited people with lived experience (i.e., people with symptoms of BPD and their loved ones) and mental health professionals who provide care for people with BPD to participate in an online survey. We received 41 quantitative responses and 25 responses to open-ended questions. Peer support was rated as important by people with lived experience and providers. Themes extracted via thematic analysis from the open-text responses considered how peer support would (or would not) meet patients' needs, including: feeling seen, heard and understood; fostering a sense of connection and belonging; reducing negative or stigmatising experiences; accessing instrumental and informational support; experiencing a sense of psychological safety; and enhancing a sense of hope. Most responses saw peer support as well matched to these needs; however, some expressed possible implementation challenges, including staffing consistency, role confusion and incompatibility of crisis stabilisation versus recovery goals. Overall, results underscored the potential of peer support to enhance alignment with recovery-oriented practice, which is an organisational priority for many mental health services.

Hate-motivated behaviour (HMB) is a growing public health issue. These behaviours can range from hate crimes to microaggressions and have been associated with wide-ranging consequences.

The current study aimed to explore the relationship between specific adverse childhood experiences (ACEs) and HMB perpetration.

Participants (n = 447) completed an online cross-sectional survey assessing demographic factors, ACEs and HMB perpetration.

Individuals who experienced ACEs were more likely to report engaging in HMB than those who did not experience negative life events during childhood. Abuse, neglect and living with a family member with substance abuse and/or mental health issues were all associated with HMB perpetration.

This study provides a more nuanced understanding of the link between experiences during childhood and HMB later in life, by highlighting that specific ACEs were more strongly associated with engaging in these behaviours. Future research should seek to replicate these findings and examine the mechanisms underpinning these relationships.

Under China’s dual economic structure of urban and rural areas, rural regions face issues such as low socioeconomic status, inadequate healthcare resources, and neglect of mental health, leading to a higher prevalence of depression among middle-aged and older adults (above 45 years) in this area.

This prospective cohort study used data from 6,183 rural Chinese middle-aged and older adults in the China Health and Retirement Longitudinal Study (CHARLS, 2018–2020). A random forest model was developed to predict 3-year incidents of depressive symptoms. Independent risk factors were identified via chi-square tests followed by binary logistic regression (Odds Ratios [ORs] and 95% Confidence Intervals [CIs] reported for significant variables, p < 0.05). The model’s performance and clinical utility were assessed using standard metrics and Decision Curve Analysis (DCA). SHapley Additive exPlanations (SHAP) values determine the individual feature impact on predictions. A subgroup analysis also compared depression-related characteristics in middle-aged (45–59 years) versus older adults (≥ 60 years) with incident depressive symptoms.

Over a 3-year follow-up, 1,629 (26.35%) participants developed incident depressive symptoms. A Random Forest model, optimized using Recursive Feature Elimination (RF-RFE), which selected 28 key predictors from an initial 33. After threshold adjustment (optimal threshold = 0.43) to maximize the F1-score, the model achieved an accuracy of 0.736, precision of 0.499, recall of 0.607, F1-score of 0.548, and an AUC of 0.776 (95% CI: 0.763–0.788). The mean Brier score was 0.163 ± 0.006. DCA confirmed its clinical utility. Key protective factors identified via logistic regression included being male, higher education, and internet access. Conversely, increased age, poor self-rated health, lower life satisfaction, and functional limitations were significant risk factors for incident depressive symptoms.

The random forest model demonstrates moderate predictive ability to estimate the risk of depressive symptoms in individuals aged 45 and above in rural China over the next 3 years. It offers a potentially valuable screening tool for rural regions with low mental health awareness and high depression prevalence, enabling more targeted interventions and prevention strategies.

The online version contains supplementary material available at 10.1186/s40359-025-03513-2.

Improving the inclusion of under-served groups in clinical trials is increasingly being seen as a priority area for research funders and regulators. Adults who lack capacity to make an informed decision about taking part in trials are recognised as an under-served group. Researchers struggle to navigate the complex ethical, legal, and methodological issues surrounding trials involving adults lacking capacity to consent, leading to frequent exclusion of this population. Researchers have identified a need for greater knowledge about designing and conducting trials involving this population. Building on the CONSULT research programme, we developed stakeholder-informed training to help researchers design more inclusive trials.

The CONSULT e-learning was developed in collaboration with a group of researchers with topic expertise and a lay advisory group with lived experience. It was developed over four phases: (1) establishing researchers' training needs using an online survey; (2) developing the e-learning content including illustrative case studies, videos, and links to resources and further reading; (3) iterative piloting and refining of the content; (4) dissemination of the e-learning and initial evaluation. A set of informational materials about the e-learning were also developed.

Informed by the stakeholder survey (n = 82), the CONSULT e-learning consists of four key modules covering the legal and ethical frameworks, consent and consultation processes, and methodological considerations, with the key role of public involvement threaded throughout. It was launched at a webinar (December 2024), with a post-webinar survey (n = 29) showing an increase in awareness about the importance of including adults lacking capacity in trials where they are a relevant population. Researchers also signalled their commitment to changing their research practice, suggesting that the e-learning has a role in facilitating greater inclusion of this under-served population in trials. The CONSULT e-learning is available online: www.capacityconsentresearch.com/training .

Alongside tools such as the INCLUDE Impaired Capacity to Consent Framework, the CONSULT e-learning course aims to support researchers to develop the knowledge and skills needed to design and conduct higher-quality trials that are more inclusive of adults who lack capacity to consent. Further engagement, including with funders who increasingly require inclusion as a condition of funding, is needed.

The restoration of standing and walking after spinal cord injury (SCI) remains a top priority for individuals with paraplegia. Despite significant advancements in neuromodulation techniques, challenges such as limited selectivity and inconsistent outcomes highlight the need for innovative approaches. Intraspinal microstimulation (ISMS) has emerged as a promising method for restoring motor function as demonstrated in various preclinical models. This study aimed to investigate the functional neural networks within the ventral lumbar spinal cord of pigs. We explored 134 stimulation sites inside the spinal cord in 13 domestic pigs. Post-mortem magnetic resonance imaging (MRI) revealed the location of microelectrode tips inside the spinal cord. The recorded kinematics and electromyographical muscle activity associated with each microelectrode allowed the creation of a functional map of the neural networks activated with ISMS. In addition, we performed anatomical measurements of the lumbar spine and spinal column. Our results revealed a somatotopic organization of motor networks responsible for distinct movements and muscle activations. Differences in activation patterns were primarily observed along the rostrocaudal axis (P < 0.05), where specific stimulation sites were associated with unique movements and muscle responses. In contrast, no notable variations were seen along the mediolateral or dorsoventral directions. Knee extension (KE) was the most frequently observed movement, occurring in 78% of the stimulated sites in the lumbar enlargement, followed by extensor synergy (Ext Syn, 64%), hip flexion (HF, 50%), ankle flexion (AF, 50%), ankle extension (AE, 43%), and hip extension (HE, 43%). Stimulation along the rostrocaudal axis of the lumbar spinal cord elicited a sequence of movements, beginning with HF in the rostral region and transitioning to KE, AF, AE, and HE in the caudal region across animals. Stimulation in the rostral lumbar enlargement produced stronger normalized EMG signals exceeding 50% of the maximum in vastus lateralis (VL) compared to tibialis anterior (TA) gastrocnemius (GS), gluteus medius (GL), and biceps femoris (BF; P < 0.05). Co-activation, defined as simultaneous activity above 50% of normalized maximum EMG activity, occurred at 27.4% of stimulation sites, resulting in synergistic movements and joint stiffening. The resulting map of spinal cord motor networks is important for improving device design and the efficiency of neuroprosthetic interventions. While motor maps exist for other species, they are absent for domestic pigs, a critical model for preclinical testing of SCI treatments. The functional motor maps provided here serve as a foundation for designing and optimizing intraspinal interventions, advancing their translation to clinical application.

Resilience is recognized as a crucial psychological resource that enables individuals, particularly medical students, to cope with academic and emotional stress. Given the rising concern over students' mental health, this study aimed to investigate the relationship between resilience and psychological well-being among medical students.

A cross-sectional, analytical study was conducted from March to May 2025 among medical students at Kerman University of Medical Sciences. Participants (n = 385) completed standardized questionnaires assessing resilience (Connor-Davidson Resilience Scale, CD-RISC) and mental health (Symptom Checklist-90-Revised, SCL-90-R). Data were analyzed using Pearson correlation coefficients and Partial Least Squares Structural Equation Modeling (PLS-SEM) to test both direct and moderated relationships.

The mean resilience score was 83.42 out of 125 (SD = 12.35), indicating a moderate to high level of resilience. The mean Global Severity Index (GSI) for mental health was 1.37 out of 4 (SD = 0.71), suggesting mild psychological symptoms. Pearson correlations showed significant negative relationships between resilience and GSI (r = - 0.45, p < 0.001). PLS-SEM results confirmed that resilience may significantly predicted lower mental health symptoms (β = - 0.41, t = 9.14, p < 0.001). Among resilience dimensions, "perception of competence" and "trust in one's instincts" had the strongest effects. Marital status moderated this relationship (β = - 0.11, p = 0.01), indicating a possibly stronger protective effect for married students.

Resilience may play a protective role against psychological distress among medical students. Specific dimensions such as perceived competence and trust in one's instincts appear particularly influential. Strengthening resilience, especially through social support mechanisms, may serve as a valuable strategy in promoting student mental health and academic performance. It is recommended that universities implement targeted resilience-building programs, such as peer support groups and stress management workshops, to enhance students' psychological well-being.

Young people often face significant challenges accessing effective mental health support as they navigate through complex healthcare systems, education pathways, and social pressures. Understanding the service-level barriers they encounter is critical to improving mental health system design and delivery. While previous studies have examined individual barriers to mental healthcare access, few have adopted a cross-sectorial, youth-informed approach which captures the interrelated structural, institutional, and socio-cultural factors influencing young people’s mental health experiences.

Seventeen participants aged 18–24 years with lived experience of depression and/or anxiety participated in nine in-person focus groups and interviews in Perth. Reflexive thematic analysis was used to identify systemic barriers and facilitators to mental healthcare, with a particular focus on access, care coordination, therapeutic engagement, and service responsiveness.

Key themes included fragmented care pathways, inadequate provider follow-up, prolonged wait times, financial constraints, lack of youth-specific mental health training among clinicians, and limited therapeutic rapport. Participants also described inadequate mental health literacy within schools and persistent stigma in social and familial settings. These intersecting barriers hindered access, disrupted continuity of care, and undermined trust in the mental health system.

Findings highlight critical inefficiencies in mental health service delivery for young Australians. Policy responses should prioritise integrated care models, investment in multidisciplinary youth mental health hubs, improved school-based mental health literacy, and culturally inclusive anti-stigma initiatives to promote access, trust, and continuity of care.