People living with spinal cord injuries and disorders (SCI/D) are at heightened risk for depression, anxiety, and post-traumatic stress disorder, yet frequently encounter barriers to mental health care. Lesbian, gay, bisexual, transgender, queer individuals and those with related identities (LGBTQ+) also experience elevated mental health disparities and marginalization in clinical settings. As no prior studies have assessed the mental health of LGBTQ+ people with SCI/D, this study sought to examine how members of this population describe their mental health needs, including barriers and facilitators to fulfilling them.

Qualitative, exploratory study using rapid directed content analysis.

Community-based sample across the US.

Thirty-two LGBTQ+ adults with SCI/D.

Semi-structured interviews.

Interviews addressing mental health needs.

Participants emphasized the need for affirming clinical and social support that addressed their LGBTQ+ identities and disability experiences. They stressed the importance of providers who saw them as individuals through an intersectional lens. Competence with both LGBTQ+ and SCI/D issues was considered essential. Providers who were members of the LGBTQ+ and/or SCI/D communities were valued for their relatability and deeper understanding. Participants also requested therapeutic support groups that addressed both LGBTQ+ and SCI/D concerns. Social support from friends, partners, families (i.e. chosen, legal, and/or biological), and communities was also crucial. Peers with shared lived experiences provided companionship as well as invaluable emotional, informational, and tangible support.

LGBTQ+ adults living with SCI/D identified affirming clinical care and social support as critical to their mental health. Findings highlight the importance of developing intersectional, person-centered clinical and social resources that meet this unique population's needs holistically.

We explored the epidemiological evidence on the prevalence of mental health symptoms among current and former elite athletes as well as among their entourage members.

A systematic review and meta-analysis were conducted in PubMed, PsycINFO, SportDiscus and Scopus to retrieve original quantitative studies that (i) were written in English, (ii) were conducted exclusively among current or former elite athletes and/or their entourage members, and (iii) presented prevalence rates of mental health symptoms.

In total, 72 studies were included, focusing on self-reported mental health symptoms (not on clinically diagnosed mental health disorders). Meta-analyses comprising 2596 to 10,927 current elite athletes showed that the prevalence of mental health symptoms ranged from 4% for drug misuse to 33% for distress. Meta-analyses comprising 2070 to 3405 former elite athletes showed that the prevalence of mental health symptoms ranged from 12% for depression to 28% for alcohol misuse. Because of the considerable heterogeneity among the included studies, the pooled prevalence estimates from these meta-analyses should be interpreted cautiously, as they summarize highly heterogeneous populations. Mental health symptoms were found to also be common among entourage members, with prevalence rates ranging from 5% for depression or anxiety to 53% for alcohol misuse in high-performance staff (including coaches) and reaching up to 36-58% for burnout in healthcare professionals working during the Paralympic games.

Showing considerable heterogeneity across included studies, our systematic review and meta-analysis established that mental health symptoms are commonly reported by current and former elite athletes, as well as by their high-performance staff (including coaches) and medical staff. This warrants the implementation of various tailored resources, such as mental health literacy, screening programs and the availability of interdisciplinary medical and psychological support.

The COVID-19 pandemic compelled higher education to resort to e-learning, posing new challenges to the teaching/learning of pharmacy students worldwide. While digital learning provided flexibility, diverse technological infrastructure and institutional availability of resources greatly influenced the student experience. This scoping review aims to assess the perceptions relating to the pivot to e-learning among pharmacy students in the League of Arab States due to the COVID-19 pandemic and how the shift affected student engagement, learning outcomes, and institutional preparedness. Following PRISMA-ScR guidelines, a comprehensive search across ten databases was conducted to identify relevant studies published between January 2020 and December 2025. Forty studies satisfied the inclusion criteria. Pharmacy students in this region responded to the transition to e-learning in diverse ways. While most appreciated the convenience of online modalities, several challenges were consistently enumerated. These were limited technological infrastructure, reduced interpersonal interaction, and disruption of hands-on practical training. Blended learning approaches were largely favored, particularly for their ability to marry online theoretical instruction with face-to-face experiential learning. Reliability and validity issues of internet-based tests were felt by both faculty and students. Stress and mental health problems among students surfaced. Student complaints in general depicted pharmacy education's need for pedagogic reform, better infrastructure, and student mental health services during e-learning. Areas identified from this review are instructional technology infrastructure improvement, adopting a blended learning strategy, and the need to consider the mental health of students learning at a distance.

Background/Objectives: Emotional eating (EE) is an emerging public health concern among university students, a population exposed to heightened academic demands, psychosocial stressors, and lifestyle changes that may promote maladaptive coping behaviors. EE has been linked to psychological distress, particularly depressive and anxiety symptoms, as well as sociodemographic, lifestyle, and anthropometric factors; however, findings remain heterogeneous and insufficiently integrated within comprehensive analytical frameworks. This study aimed to examine the association between EE and depressive and anxiety symptoms in university students, while assessing the independent contributions of sociodemographic, academic, lifestyle, and anthropometric determinants. Methods: A cross-sectional survey was performed among 1279 university students from 10 regions in Greece. Sociodemographic, academic, lifestyle, and anthropometric data were collected using validated instruments and standardized procedures. Depressive and anxiety symptoms were assessed by the use of the Beck Depression Inventory-II (BDI-II) and the six-item State-Trait Anxiety Inventory (STAI-6), respectively. EE was evaluated utilizing the EE subscale of the Three-Factor Eating Questionnaire-Revised 18 (TFEQ-R18). Multivariable ordinal logistic regression models were applied to examine independent associations. Results: In fully adjusted models, depressive and anxiety symptoms were the strongest correlates of higher EE levels, each associated with more than twofold increased odds. Female sex, Greek nationality, rural residence, enrollment in biomedical sciences, later academic years, and regular smoking were also positively associated with EE. Higher physical activity was inversely associated with EE levels. Overweight, obesity, and increased waist circumference and waist-to-hip ratio were consistently linked to higher EE, with several associations exceeding twofold increased odds. Conclusions: EE in university students is strongly associated with psychological distress and clusters with adverse lifestyle and anthropometric characteristics. These findings support the need for integrated interventions targeting mental health, lifestyle behaviors, and obesity-related risk factors. Longitudinal studies are warranted to clarify causal pathways and underlying mechanisms.

Background: Anxiety and depression are major contributors to mental-health burden and frequently co-occur in clinical practice. In tele-mental health, routinely captured operational variables such as consultation duration, visit frequency, and follow-up cadence may provide clinical digital phenotypes that complement conventional symptom scales. This study aimed to characterize anxiety-depression comorbidity in a large real-world tele-mental health cohort and to determine whether symptom severity was associated with distinct patterns of healthcare utilization. Methods: We conducted a retrospective real-world study of 3467 patients followed in psychiatry and psychology teleconsultations. Patients were classified as anxiety only, depression only, comorbid anxiety-depression, or neither. Symptom severity was categorized as mild, moderate, or severe using validated questionnaire-based measures; to improve comparability across instruments, scores were additionally harmonized using z-score normalization. Associations between anxiety and depression severity within the comorbid subgroup were examined using a chi-square framework. Telehealth utilization endpoints included consultation duration, number of consultations, and inter-visit interval, analysed overall and stratified by sex, age group, and symptom severity. Results: Anxiety and/or depression were present in 61.7% of the cohort (2140/3467), and anxiety-depression comorbidity accounted for 43.8% of all patients (1520/3467), indicating substantial real-world overlap. Within comorbid cases, anxiety and depression severity were strongly coupled, with depression severity varying systematically across anxiety severity strata (chi-square p = 9.88 × 10^-102). Compared with isolated anxiety or depression, comorbidity was associated with a more intensive healthcare-utilization profile, characterized by a higher mean number of consultations and shorter inter-visit intervals. Among comorbid patients, females showed greater longitudinal service use than males, with more visits and closer follow-up. Resource use also varied according to symptom burden, mainly in depression, supporting a graded relationship between clinical severity and operational care demand. Conclusions: In this large real-world tele-mental health cohort, anxiety-depression comorbidity was highly prevalent, clinically structured, and associated with distinct and measurable resource-use signatures. These findings highlight the novelty and practical value of integrating symptom severity with operational telehealth data to derive pragmatic digital phenotypes of care intensity. Such phenotypes may support risk stratification, triage, follow-up scheduling, and capacity planning in tele-mental health, with potential translational relevance for broader mental healthcare systems. However, these findings should be considered descriptive and hypothesis-generating and warrant further longitudinal validation in other clinical settings.

Background: Fatigue is a highly disabling symptom in multiple sclerosis and is strongly associated with reduced health-related quality of life (HRQoL). However, whether distinct fatigue dimensions show differential associations with specific HRQoL domains remains unclear. This study investigated the relationship between physical, cognitive, and psychosocial fatigue and SF-36 outcomes in people with relapsing-remitting multiple sclerosis (RRMS). Methods: Forty-four people with RRMS were included in this cross-sectional study. Participants were classified as fatigued or non-fatigued according to the Modified Fatigue Impact Scale (MFIS) total score cut-off. Group differences in SF-36 domains were examined using ANCOVAs adjusted for age, sex, disease duration, and disability, with additional sensitivity analyses adjusting for depressive symptoms. Partial Spearman correlations assessed associations between MFIS subscales and SF-36 domains across the whole sample, controlling for demographic and clinical covariates. Results: Eighteen participants were classified as fatigued and 26 as non-fatigued. Fatigued participants showed significantly lower scores across all SF-36 domains. After additional adjustment for depressive symptoms, differences remained significant for Physical Functioning, Role Physical, General Health, Vitality, Social Functioning, and Role Emotional. Physical fatigue was inversely associated with several HRQoL domains, including physical, social, vitality, general health, and mental health-related outcomes. Psychosocial fatigue was associated with poorer Physical Functioning, Role Physical, Bodily Pain, and Social Functioning. Cognitive fatigue was not significantly associated with any SF-36 domain. Conclusions: Physical and psychosocial fatigue appear to be the main fatigue dimensions associated with HRQoL impairment in RRMS. Dimension-specific fatigue assessment may help identify more individualized targets for patient-centered management.

Background/Objectives: Sexualized drug use (SDU) and chemsex have emerged as a growing public health concern globally, reflecting complex intersections between sexual practices, psychoactive substance use, and structural vulnerabilities. In Brazil, however, evidence on healthcare access among individuals who engage in SDU/chemsex remains limited and fragmented. This scoping review aimed to map and analyze the available literature on healthcare access in this population, identifying barriers, facilitators, and gaps in care. Methods: The review followed the Arksey and O'Malley framework and Joanna Briggs Institute recommendations, with searches conducted in six databases (MEDLINE/PubMed, Embase, Scopus, SciELO, LILACS, and PsycINFO) for studies published between 2014 and 2025. Results: Eleven studies met the inclusion criteria, predominantly quantitative and concentrated in large urban centers. Findings indicate that healthcare access is shaped by persistent structural and symbolic barriers, including stigma, discrimination, fear of disclosure, and limited professional preparedness. Care remains largely centered on human immunodeficiency virus (HIV) and sexually transmitted infections (STIs) services, with insufficient integration of primary care, mental health, and substance use services, contributing to fragmented care. Significant gaps were identified, including the underrepresentation of women, transgender, and non-binary populations, and the absence of studies focusing on healthcare professionals. Conclusions: Substance use patterns reflect both global trends and local specificities, particularly the prominence of alcohol and cocaine in Brazil. This review provides the first synthesis of Brazilian evidence on chemsex from a healthcare access perspective. The findings highlight critical inequities and support the need for integrated, stigma-free, and context-sensitive care within the Brazilian Unified Health System. Based on these findings, the VIP-SDU/Chemsex Model is proposed as a multilevel framework to explain how structural, symbolic, and programmatic factors shape access and health outcomes.

As global populations grow and technology advances, daily life is increasingly shaped by digital systems such as computers and smart devices. However, prolonged device use has contributed to increasing physical and mental health concerns, particularly those associated with poor sitting posture. Posture-related strain is frequently overlooked and contributes to musculoskeletal discomfort, including back, neck, shoulder, and wrist pain, and may also be associated with sleep disturbances and elevated stress levels. To the best of our knowledge and based on the existing literature, this is the first study to introduce a machine learning-based framework for advanced muscle strain severity classification using Internet of Things (IoT) devices that integrates posture monitoring and muscle strain detection into a unified low-cost framework ($23 hardware cost). The primary objective of this work is accurate classification of muscle strain severity, while real-time alerts serve as a secondary ergonomic feedback mechanism. Specifically, this study makes four major contributions. First, we created a novel dataset through real-time acquisition of electromyography (EMG) and posture signals from participants in hospital and industrial environments, capturing diverse muscle strain patterns validated against clinical assessment procedures. Second, we designed a two-part hardware architecture consisting of posture detection (PD) and strain detection (SD) modules using a NodeMCU ESP8266, HC-SR04 ultrasonic sensor, EMG sensor, and buzzer for real-time physiological monitoring, incorporating EMG-specific preprocessing including band-pass filtering, rectification, and RMS smoothing. Third, we proposed and evaluated a hybrid machine learning framework integrating Vision Transformer (ViT) and XGBoost to classify strain severity into three study-specific categories: baseline (EMG RMS < 40 µV), compensatory strain (40-59 µV), and overload (≥60 µV). These categories were used as reproducible severity proxies for machine learning annotation and should not be interpreted as universal biomarkers of structural tissue damage. Finally, the proposed framework achieved a classification accuracy of 99.0% (95% CI: 98.5-99.5%) with an inference latency of 15.2 ms.

Rising cancer incidence and survival rates have led to an unprecedented demand for psychosocial care. Yet, limited financial and practical resources present a barrier to the provision of evidence-based care. Clinical practice guidelines (CPGs) are well-positioned to enhance the quality and efficiency of psychosocial oncology care; however, little is known about their use and perceptions in the field. The present study explored the use and perceptions of CPGs among 172 Canadian psychosocial oncology clinicians via a cross-sectional, online survey. Findings revealed substantial variation in awareness, with over 20% of participants reporting no familiarity with CPGs, and low to moderate use of CPGs (M = 2.97, SD = 2.96) among users. Key barriers included a lack of formal training, limited applicability to local contexts, and systemic constraints such as high workloads. Conversely, participants highly endorsed facilitators, including accessible training programs, relevant tools/interventions, and greater institutional and community engagement. Clinician perspectives are paramount to the dissemination and implementation of psychosocial oncology CPGs. Our findings suggest that successful implementation requires broader accessibility, widespread adaptation, and greater community engagement. By addressing these systemic constraints, CPGs may be better positioned to bridge the gap between evidence and real-world service provision.

This study examines the coping strategies used by refugee women who have survived gender-based violence (GBV) across multiple stages of migration. Drawing on interviews with 50 urban refugee women in Nairobi, Kenya, the study explores how coping processes shift or remain consistent throughout the migration trajectory using the migration process framework. Although GBV is widespread among forcibly displaced women globally, limited research has investigated how survivors appraise and manage the stress of these experiences over time and within changing displacement contexts. Guided by Lazarus and Folkman's transactional theory of stress and coping, the analysis identifies a wide range of strategies. Emotion-focused approaches include caring for children, acceptance, crying, religiosity, silence, avoidance, and self-care. Problem-focused strategies encompass social and community support; reliance on marital or partner relationships; access to medical and mental health services; participation in skills training; support from host communities; and efforts to adapt economically and culturally. Data were collected through quota and snowball sampling and analyzed using thematic analysis. Findings show that coping is a dynamic, context-dependent process shaped by women's agency alongside the social and structural resources available at each displacement phase. Survivors continuously recalibrated their coping approaches in response to evolving risks, opportunities, and support systems. The study underscores the need for culturally grounded, phase-specific interventions that strengthen emotional resilience while expanding practical support for refugee women affected by GBV. Such interventions should address both immediate psychosocial needs and the broader structural conditions that shape women's capacity to cope throughout their displacement journeys.