This study examined the associations of anxiety, insomnia, and psychological resilience with health-related quality of life (HRQoL) among maintenance dialysis patients and explored potential mediating roles. In this cross-sectional study, 207 adult patients undergoing maintenance dialysis were recruited. HRQoL was assessed using the Short Form-36 Health Survey (SF-36), generating Physical Component Summary (PCS) and Mental Component Summary (MCS) scores. Anxiety, insomnia, and psychological resilience were measured using the Generalized Anxiety Disorder-7 (GAD-7), Athens Insomnia Scale (AIS), and 25-item Connor-Davidson Resilience Scale (CD-RISC-25), respectively. Multivariable linear regression and bootstrap-based mediation analyses were conducted. Furthermore, subgroup analyses were conducted to examine the robustness of the results.Higher anxiety and insomnia scores were independently associated with lower PCS and MCS, whereas resilience was positively associated with both components. Each one-point increase in anxiety score was associated with a 1.61-point decrease in PCS and a 1.15-point decrease in MCS; corresponding decreases for insomnia were 1.01 and 0.91 points. Psychological resilience partially mediated the association between anxiety and HRQoL (23.46% for PCS; 30.37% for MCS), but no significant mediation was observed for insomnia. Subgroup analyses showed consistent associations for insomnia, while the anxiety-HRQoL relationship was modified by smoking status and diabetes. Anxiety and insomnia are independently associated with impaired HRQoL in dialysis patients. Psychological resilience partially explains the adverse impact of anxiety, but not insomnia, suggesting distinct patterns of association and potential targets for tailored psychosocial interventions.

Rates of youth vaping have become a major concern over the past decade with worries about impacts of vaping on neurodevelopment, mental health, transition to cigarettes, and unknown long-term physical sequelae. In 2023, the American Academy of Pediatrics (AAP)'s updated tobacco care guidelines encouraged primary care providers to consider using nicotine replacement therapy (NRT) products to help support youth vaping and tobacco cessation. This study sought to explore the determinants to using NRT products for youth vaping cessation per AAP recommendations amongst primary care providers in an urban, safety-net health system where use of NRT for youth was limited.

This study used a mixed-methods case study design guided by the Practical, Robust Implementation and Sustainability Model (PRISM). Nine primary care providers caring for patients aged 12-17 completed key informant interviews and a modified version of the PRISM Contextual Survey Instrument (PRISM-CSI) between May and July 2025. Qualitative analysis was done using a rapid matrix approach and quantitative analysis was descriptive in nature. Themes/subthemes and mean PRISM-CSI item scores were integrated to generate final mixed meta-inferences.

5 themes with 13 subthemes emerged from qualitative analysis. In quantitative analysis, all PRISM-CSI item mean scores were rated as either neutral (2.50-3.49 on 1-5 rated ordinal scale) or positive (≥3.50). A total of 14 meta-inferences were generated from integration of qualitative and quantitative results, showing that AAP guidelines on NRT were considered acceptable and met an important need, but contextual determinants important to implementation included addressing time/work demands, provider training, confidentiality, insurance coverage/affordability, managing follow up, youth perceptions of harms and treatment preferences, perceived limited concurrent public health/policy intervention, and bolstering existing practice change infrastructure.

AAP guidelines on NRT were considered reasonable by providers interviewed and surveyed in this study while acknowledging specific contextual determinants for successful implementation. Providers also felt it was important to strengthen ongoing public health and policy efforts to address youth vaping in addition to clinical intervention. This study provides insight into the translation of efforts such as the AAP guidelines in a specific healthcare system to address a pressing health issue for youth.

Common mental health conditions are increasing in England, with growing severity and unmet need. Evidence shows that mental wellbeing is strongly shaped by wider social determinants such as income, housing, employment, and relationships. Conventional clinical approaches may not adequately address these underlying factors, highlighting the need for preventative, community-based solutions.

This paper describes the community involvement and engagement (CEI) approach used to develop CoSign, a digital signposting tool designed to help individuals identify social determinants contributing to mental distress and access appropriate community support.

The development of CoSign incorporated CEI throughout the research process, guided by the INVOLVE research-cycle framework and the IAP2 Spectrum of Public Participation. A total of 29 stakeholders-including healthcare professionals, voluntary sector representatives, policymakers, and individuals with lived experience-contributed through workshops, consultations, and collaborative activities. Engagement focused on shaping the tool's design, content, accessibility, and implementation considerations.

Stakeholder input informed key aspects of CoSign, including the identification of relevant domains of need, refinement of language to improve accessibility, and the structure of the user experience. Practical considerations, such as service capacity, inclusivity, and potential barriers to engagement, were highlighted and addressed. The resulting web-based tool enables users to self-identify areas of social need and receive tailored signposting to community resources. CEI enhanced the relevance, acceptability, and usability of the tool.

Meaningful community involvement is essential in developing accessible, preventative mental health tools grounded in real-world needs. However, challenges such as limited resources, stakeholder fatigue, and equity in participation must be managed. The CoSign project demonstrates the value of CEI while underscoring the importance of flexible, context-sensitive approaches to engagement.

Virtual Reality (VR) is increasingly adopted in higher education, offering immersive learning experiences that bridge theoretical knowledge and practical application. However, its integration is influenced by organizational dynamics and individual motivations, requiring a deeper understanding of these factors to optimize its potential.

This qualitative study employed thematic analysis of semi-structured interviews with four educators from health and social care programmes at three universities and one educator from a police education programme. Participants shared their experiences integrating VR into curricula, focusing on leadership, collaboration, training, and resource allocation. Data were analysed using Braun and Clarke's reflexive thematic analysis, supported by F4 Analysis software, to identify key themes related to VR adoption and implementation.

Six themes emerged, highlighting both enablers and barriers to VR adoption. Leadership support and motivated early adopters were critical for initial implementation, but challenges included high costs, inadequate training, and limited alignment with curricula. Collaboration, both internally and with external partners, facilitated tailored VR content but required sustained effort and resources. Participants also noted that VR provided opportunities to enhance student preparedness for real-world scenarios, although its perceived complexity occasionally hindered broader acceptance. Despite variability in institutional readiness, a common need for ongoing professional development and strategic planning was evident.

The findings underscore that successful VR integration in education relies on aligning technological innovations with pedagogical design and institutional strategies. Leadership support, robust collaboration, and sustained training are pivotal for overcoming barriers. These preliminary, hypothesis-generating insights point to factors that institutions may wish to consider when adopting VR, while underscoring the need to balance enthusiasm with critical evaluation.

Individuals diagnosed with schizophrenia spectrum disorders (SSDs) face a multitude of challenges in their lifetime including complex symptomatology, co-morbid health concerns, profound levels of stigmatization, and diminished access to quality care. Additionally, they are often the victims of unjust systemic biases and discrimination when they are able to engage with the healthcare system. This confluence of injustices leads to disparate physical and mental health outcomes for this vulnerable population. Globally, schizophrenia affects over 24 million, many of whom are experiencing healthcare disparities posing a significant public health concern. Dance/movement therapy (DMT) is an equitable healthcare provision situated in a strengths-based and trauma-informed psychotherapeutic framework. Dance/movement therapy can support the symptomatic needs of SSDs including alternate reality orientations, thought and behavioral disorganization, and diminished interpersonal engagement.

We present an intrinsic case report nested within a larger randomized controlled trial that implemented a convergent parallel mixed method design. Data were collected simultaneously; however, initially analyzed individually first, then merged. Pre- and post-intervention quantitative data were collected through the Brief Psychiatric Rating Scale (BPRS). Qualitative data were collected post-intervention through semi-structured individual interviews.

This intrinsic case report examines the experience of a 37-year-old African American cisgender male, with high symptom acuity of schizoaffective disorder, who engaged in a single-session DMT intervention.

Following the intervention, the participant exhibited a decrease in symptomatology as evidenced by the BPRS in total scores as well as subscales of psychological distress, positive symptoms, negative symptoms, and resistance. Moreover, following the DMT session the participant expressed having had a transformative experience, feeling like a contributing member of the group process. He also reported feeling a sense of pride, and experiencing the ability to engage in healthy relationships, and noted shared and meaningful experiences in his group process.

Community-driven, non-verbal treatment options such as DMT, can provide opportunities for individuals with symptom acuity of SSDs. Future research should explore the potential for DMT, an inclusive and equitable treatment option, to support individuals with SSDs.

Healthcare-associated infections (HAIs) remain a persistent patient safety problem in acute hospital settings globally, with suboptimal personal protective equipment (PPE) compliance among nursing staff identified as a modifiable contributing factor. In Saudi Arabia, compliance rates are reported as low as 65%, yet the psychological and behavioural determinants have not been systematically examined using validated theoretical frameworks. The Integrated Behavioural Model (IBM) offers a theoretically grounded approach to understanding the cognitive, normative, and control-related factors shaping health-related intentions. To identify and quantify the attitudinal, normative, and perceived control factors influencing nurses' intentions to comply with PPE guidelines in two acute care hospitals in northern Saudi Arabia, using a phased mixed-methods design informed by the IBM.

A sequential mixed-methods design was employed. Phase 1 comprised 14 semi-structured interviews with nurses; content analysis generated items for a purpose-built survey. Phase 2 involved administering the survey to a randomly selected sample of 289 nurses, with 279 completing it (response rate 96.5%). Internal consistency (Cronbach's alpha 0.92) and test-retest reliability (ICC > 0.80) were established. Multiple regression analyses identified significant predictors of compliance intention.

The overall IBM model accounted for 62.3% of variance in nurses' intentions to comply (R² =0.623, p < 0.001). Attitudes were the strongest predictor (indirect β = 0.405, p < 0.001; direct β = 0.229, p < 0.001), followed by subjective norms (direct β = 0.174, p < 0.001) and perceived behavioural control (indirect PBC β = 0.137, p = 0.002). Mean scores showed strong positive attitudes (5.7/7.0) and subjective norms (5.5/7.0), but notably lower perceived behavioural control (3.5/7.0), signaling a critical gap between intention and perceived ability.

These findings suggest that while nurses report strong foundational motivation, the institutional environment may substantially constrain their capacity to act on these intentions. Targeted interventions may benefit from addressing systemic barriers, such as supply chains and clinical guidance, alongside rather than instead of attitude-focused approaches.

UK South Asian populations are at high risk of physical and mental health multimorbidity, which means they live with multiple long-term conditions. The life course emergence of multimorbidity, its underlying aetiology, and consequences for future health and mortality have yet to be studied in this population.

We studied Internalising (depression, anxiety, somatoform disorders) and Cardiometabolic (hypertension, obesity, type 2 diabetes, chronic kidney disease, dyslipidaemia) MultiMorbidity (ICM-MM): the lifetime occurrence of ≥1 internalising mental health condition AND ≥1 cardiometabolic condition in a longitudinal cohort of Genes and Health study participants with linked genetic and health data from 1st April 1997-24th November 2024. We used multi-state models to investigate trajectories in ICM-MM and risk of major cardiovascular or renal events (CVR) or non-CVR death. We used flexible parametric models to estimate baseline hazards for health state transitions, adjusting for sociodemographic factors, a polygenic risk score (PRS) for ICM-MM (ICM-MMPRS), and describe 10-year simulated health state probabilities. Over 10.2 years median follow-up of 23,554 British Bangladeshi and Pakistani participants (median baseline age 31.1 years, 12,934 [54.9%] women), 3,159 (13.4%) developed ICM-MM; 1,522 (6.5%) CVR; and there were 103 (0.4%) non-CVR deaths. Women were less likely to remain healthy, with higher probability of developing internalising conditions and subsequent ICM-MM, but lower risk of CVR than men. Younger age was associated with higher risk of developing internalising conditions. Bangladeshi ethnicity, higher deprivation, and smoking were all associated with higher probability of ICM-MM. 10-year CVR risk was highest for people who developed ICM-MM via the trajectory cardiometabolic-to-internalising (versus internalising-to-cardiometabolic) in mid-life (age 40). Higher ICM-MMPRS was associated with higher probability of ICM-MM via cardiometabolic conditions rather than internalising conditions. Our findings are based on routinely collected electronic health records from East London, which incompletely capture individual-level and time-varying risk factors, remission or recovery, and may not reflect British Bangladeshi and British Pakistani communities across the UK. The PRS was derived largely from GWAS of European ancestry populations, which may limit its transferability to this cohort.

The burden of multimorbidity is high in British Bangladeshi and British Pakistani populations. Young Bangladeshi women are at high risk of ICM-MM, while men are at higher risk of CVR. Detection and intervention strategies for physical and mental health multimorbidity should be targeted early in the lifecourse, for those at highest risk.

Rheumatologic diseases significantly impact health-related quality of life (HRQoL), affecting physical, mental, and social well-being and pose unique challenges due to their wide range of symptoms. Patient-reported outcomes (PROs) provide valuable insights into how these diseases influence different dimensions of HRQoL, supporting personalized healthcare approaches.

In this cross-sectional study, we examined HRQoL in 213 patients with rheumatologic diseases, including, among others, rheumatoid arthritis, localized pain disorders, connective tissue diseases, and rarer conditions such as vasculitis, using the EQ5D-5L and the Patient-Reported Outcomes Measurement Information System (PROMIS^®) as well as Pain and HRQoL specific PROs. We provided PROMIS health domain scores of key health aspects such as physical function, fatigue, pain interference, and social participation. Additionally, we compared HRQoL and PROMIS domain scores with a German general population reference sample and conducted exploratory comparisons across the three most frequent principal diagnosis groups: systemic sclerosis, rheumatoid arthritis, and vasculitis. Moreover, we investigated which patient-reported health domains were most strongly associated with HRQoL in these diseases. Penalized regression models with elastic net regularization were used to identify stable predictors of HRQoL, followed by a pooled linear regression model for interpretation.

Individuals with rheumatic diseases had significantly lower HRQoL than the general population (EQ-5D-5L VAS mean: 55.4 versus 73.2). PROMIS T-scores indicated markedly reduced Physical Function (M = 36.5, SD = 9.6) and elevated pain interference (M = 61.7, SD = 9.2). Penalized regression analyses identified Physical Function, Fatigue, Ability to Participate in Social Roles and Activities as stable predictors of EQ-5D-5L VAS. Higher Physical Function and Social Participation were associated with higher HRQoL, whereas higher Fatigue was associated with lower HRQoL.

These results highlight the importance of PROs in understanding the patient experience in rheumatologic disease and identifying individual needs. Routine assessment of HRQoL domains may help recognize unmet needs and support individualized care in rheumatology.

Repetitive transcranial magnetic stimulation (rTMS) is an effective treatment for major depressive disorder (MDD). There has been recent growth in rTMS research focusing on parameter optimization, including accelerated treatment schedules and controllable pulse parameter stimulation; these advancements have the potential to improve accessibility and clinical outcomes. As such, the aim of this pilot study was to assess the safety and preliminary clinical efficacy of a rapid, one-day treatment protocol of rectangular pulse rTMS, in adults with MDD.

Patients with MDD aged between 22 and 85 years presenting to a community rTMS clinic were enrolled in an open-label trial. A one-day treatment using rectangular pulse 10 Hz rTMS was offered. The treatment course consisted of three sessions of a biphasic rectangular pulse 19-minute rTMS protocol, delivering a total of 9000 pulses with a 60-minute interval between sessions. Clinical scales were administered at baseline, at the end of the treatment day, after 24 hours, and seven days later. Clinic data were used to report on additional outcomes from 30, 60, and 90 days post treatment.

A total of 55 patients were enrolled in the trial and 53 started treatment. Results revealed a decrease in score on the Montgomery Åsberg Depression Rating Scale of 25.5 ± 5.4 (representing a percentage reduction of 72.0% ± 13.4%) from baseline to seven days post treatment. In addition, 32 of 53 (60.4%) patients met the criteria for clinical remission, whereas 47 of 53 (88.7%) patients met the criteria for clinical response, seven days post treatment. Naturalistic clinic data showed that the antidepressant effect may persist for up to 90 days post treatment, with 41 of 53 (77.4%) patients maintaining a clinically significant response and 20 of 53 (37.7%) patients remaining in clinical remission.

Our preliminary findings suggest that a brief, one-day course of rectangular pulse rTMS may produce meaningful and sustained reductions in clinical depressive symptoms. Larger, blinded, randomized control trials with trained and impartial raters are needed to confirm these findings.

To study rates of psychiatric diagnoses and psychotropic medication prescription among US military-affiliated adolescents and young adults (AYA) with polycystic ovary syndrome (PCOS).

This retrospective matched cohort study included US military-affiliated AYA (aged 15-21 years) enrolled in TRICARE Prime for at least 6 months during the surveillance period (January 2016 to October 2023). Military-affiliated AYA were grouped into three categories: individuals diagnosed with PCOS (N = 6,911), age-matched individuals with no diagnosed PCOS symptoms (N = 35,814), and individuals with diagnosed symptoms suggestive of PCOS (N = 2,136). The presence of a psychiatric diagnoses and prescriptions for psychotropic medications were obtained via the International Classification of Diseases, 10th Revision, Clinical Modification codes and National Drug codes, respectively.

AYA with diagnosed PCOS had higher odds of having a psychiatric diagnosis and being prescribed a psychotropic medication compared to an age-matched comparison group (psychiatric diagnosis odds ratio [OR] = 2.48 [2.35-2.62], medication OR = 2.14 [2.03-2.25]) and individuals with symptoms suggestive of PCOS (psychiatric diagnosis OR = 1.11 [1.003-1.23], medication OR = 1.16 [1.05-1.28]).

The odds of psychiatric comorbidities and psychotropic medication prescription were more than twice as high as among US military-affiliated AYA with PCOS. More research is needed to determine whether health-care utilization and military-related factors impact mental health outcomes among AYA with PCOS. Additionally, tailored, multidisciplinary mental health services for AYA with PCOS are needed.