Ischemic stroke triggers complex multicellular responses across neurons, glia, and the neurovascular unit, but the temporal coordination among these cell types remains incompletely understood. In this study, we integrated five publicly available mouse single-cell RNA sequencing datasets spanning the acute, subacute, and recovery phases after middle cerebral artery occlusion (MCAO), together with complementary rat single-nucleus RNA-seq data, to establish a time-resolved transcriptomic framework of post-ischemic brain repair.

Integrative single-cell analysis identified candidate multicellular communication patterns linking microglia, astrocytes, oligodendrocyte lineage cells, endothelial cells, and neurons during post-ischemic remodeling. Microglia exhibited an early transition from inflammatory activation toward lipid metabolic and neuroprotective programs. Astrocytes shifted from injury-associated reactive states to reparative phenotypes and emerged as central coordinators of intercellular communication. Oligodendrocyte progenitor cells activated maturation programs associated with remyelination, while the neurovascular unit underwent coordinated remodeling characterized by dynamic signaling interactions among astrocytes, microglia, endothelial cells, and neurons. Selected glial and neurovascular signaling patterns were also detectable in the complementary rat snRNA-seq data.

Our analysis suggests that post-ischemic brain repair involves time-associated multicellular programs integrating inflammation resolution, astrocyte-mediated repair, oligodendrocyte maturation, and neurovascular remodeling. These findings provide a hypothesis-generating transcriptomic framework for understanding stage-associated brain repair after ischemic stroke and may inform the development of time-aware therapeutic strategies targeting cell-state transitions and intercellular communication.

Anaemia is among the most prevalent comorbidities in heart failure with preserved ejection fraction (HFpEF), but pooled prognostic estimates predate the contemporary left ventricular ejection fraction (LVEF) ≥50% definition and combine legacy with contemporary cohorts. We quantified the association between World Health Organization (WHO)-defined anaemia and all-cause mortality in HFpEF and tested whether it persists under the stricter ejection-fraction threshold.

Following PRISMA 2020 (PROSPERO CRD420251361160), we searched five databases from inception to 2026 and included cohort studies reporting an adjusted hazard ratio (aHR) for binary WHO-defined anaemia vs all-cause mortality in an ejection fraction-stratified HFpEF population; every estimate was verified against its primary source and screening was duplicated (κ = 1.00 after adjudication). Of 6123 records, 20 studies were included; 17 (109 909 patients; anaemia prevalence 26%-70%; follow-up 12-72 months) contributed to two pre-specified co-primary pools analysed with Paule-Mandel random-effects models and Hartung-Knapp-Sidik-Jonkman variance correction: a legacy pool (LVEF ≥40%, k = 17) and a contemporary pool (LVEF ≥50%, k = 12). Anaemia was associated with higher all-cause mortality in both: aHR 1.49 (95% CI 1.35-1.66; 95% prediction interval (PI) 1.07-2.09; I2 = 85%) in the ≥40% pool and 1.41 (1.26-1.57; PI 1.06-1.87; I2 = 83%) in the ≥50% pool, both PIs excluding the null. The estimate was stable across 12 pre-specified sensitivity analyses (range 1.45-1.52) with no influential study. Across four Bayesian priors, the posterior median aHR was 1.39-1.49 with posterior probability of harm ≥.999, and a robust Bayesian model-average that entertains null, homogeneity, and publication-bias models returned aHR 1.41 (95% credible interval 1.17-1.58). Although small-study effects were detected (Egger P = .03), the bias-corrected estimate was essentially unchanged (PEESE aHR 1.39). A per-1 g/dL lower-haemoglobin dose-response meta-analysis (k = 6) yielded aHR 1.17 (1.08-1.27). The accrued sample exceeded the diversity-adjusted required information size, and GRADE certainty was moderate under the prognostic-factor framework.

WHO-defined anaemia is independently associated with a ∼40-50% higher all-cause mortality in HFpEF, preserved under the contemporary LVEF ≥50% definition and robust to extensive sensitivity, Bayesian, and bias-correction analyses. These findings support incorporating anaemia into HFpEF risk assessment and motivate mortality-powered trials in rigorously defined HFpEF, while not implying that anaemia correction improves outcomes.

PROSPERO CRD420251361160.

Work-related stress has been widely associated with an increased risk of various mental disorders and poor mental well-being. The fast-growing mobile health services industry has provided new opportunities for workplace mental health.

This randomized controlled trial examined the effectiveness of Neurum (Neurum Limited), a smartphone-based intervention tool featuring ecological momentary assessments and interventions that aims to reduce workplace stress in real-time and real-world settings.

A total of 201 working adults were recruited for a 4-week smartphone-based intervention that incorporated cognitive behavioral therapy, mindfulness exercises, and self-regulation exercises delivered on Neurum. A simple randomization procedure was used. Participants in the intervention group were encouraged to log mood journals, complete mental health exercises, and provide user feedback whenever applicable. The key outcome was measured by the Depression, Anxiety, and Stress Scale-21 items (DASS-21; Cronbach α=0.87).

The intervention group consisted of 102 participants, while the control group consisted of 99 participants. More participants dropped out from the intervention group (n=21) than from the control group (n=2; χ²₁=18.259; P<.001). The final sample consisted of 178 participants (male: 85/178, 47.8%; female: 93/178, 52.2%; mean age of 34.65, SD 7.67 y). Analyses revealed that after the 4-week intervention, the DASS-21 scores decreased in the intervention group (mean difference [MD]_{post-pre intervention}=-14.518) but increased in the control group (MD_{post-pre intervention}=3.319; F_1,176=59.358, P<.001; η²=0.252). This effect was largely led by stress reduction (F_1,176=64.679, P<.001; for the intervention group, MD_{post-pre intervention}=-6.692, while for the control group, MD_{post-pre intervention}=2.000). On average, participants completed 6.27 (SD 9.4) exercises and provided 9.74 (SD 18.2) mood journal logs, with a daily engagement of 4.95 (SD 6.89) minutes. However, the associations between the changes in DASS-21 scores and the numbers of exercises or mood journal logs did not reach statistical significance.

This study primarily established the effectiveness of Neurum in alleviating depression, anxiety, and stress symptoms in noninstitutionalized working adults, with a satisfactory user retention rate. Despite potential health-related culture differences, Neurum contributed to evidence-based digital health in nonclinical settings for timely needs and general accessibility as an alternative to traditional, face-to-face, and high-cost mental health services. Future directions involving a personalized approach in online mental health services were discussed.

This youth participatory action (YPAR) research study sought to document developmental processes relevant to body-image and mental health in the lives of young people. Eighteen youth (ages 14 to 22) from three regions of the United States participated in online photovoice sessions. Data sources included journal reflections, photographs with narratives, and facilitator notes. Youth selected topics of focus and engaged in collaborative analysis. Three themes emerged: navigating Eurocentric body norms, strengths and challenges of youth development, and well-being in emerging adulthood. Participant photos and journals reflected internalized expectations about bodies and emphasized the importance of connection, community, and creative expression. Photovoice can engage in dialogue and reflection relevant to their emerging adulthood. Findings highlight the importance of youth-led storytelling in research and arts-based practice.

Problematic internet use (PIU) is an important public health concern among college students because of its associations with adverse psychological, social, and academic outcomes. Stressful life events may contribute to PIU, but previous studies have mainly relied on linear models and have rarely examined nonlinear, threshold, or plateau effects while accounting for sociodemographic and lifestyle factors.

This study aimed to examine the linear and nonlinear dose-response associations between stressful life-event scores and probable PIU among Chinese college students, and to determine whether these associations remained after adjustment for potential confounders.

This cross-sectional study used convenience sampling to recruit students from 8 higher education institutions, including comprehensive universities, medical universities, and vocational colleges, in Shanghai, Jiangsu, and Zhejiang, China, between March 1 and June 30, 2025. Stressful life events during the preceding 12 months were assessed using the 26-item Adolescent Self-Rating Life Events Checklist (ASLEC). Probable PIU was screened using the 8-item Internet Addiction Diagnostic Questionnaire (IADQ), with a score of 5 and above indicating probable PIU. Descriptive statistics, independent-samples 2-tailed t tests, chi-square tests, multivariable logistic regression, and restricted cubic spline (RCS) analyses were conducted. The primary analyses used a complete-case sample of 2805 participants.

Among the 2805 participants, 436 (15.5%, 95% CI 14.3%-16.9%) met the screening criterion for probable PIU. Participants with probable PIU had higher mean ASLEC scores than those without probable PIU (30.26, SD 28.10 vs 17.75, SD 20.84; P<.001). In the fully adjusted model, each 1-point increase in the ASLEC score was associated with 2% higher odds of probable PIU (adjusted odds ratio 1.02, 95% CI 1.01-1.02; P<.001). RCS analysis showed significant overall and nonlinear associations (both P<.001). The estimated odds changed little below a score of approximately 14, increased markedly between approximately 14 and 60, and appeared to plateau above 60. Because relatively few participants scored above 60, estimates in this range were less precise.

This study is innovative in applying RCS analysis to characterize the nonlinear dose-response association between stressful life-event scores and probable PIU. Unlike previous studies based mainly on conventional linear models, it identified potential inflection points at approximate scores of 14 and 60 and provided a more detailed account of how the odds of probable PIU varied across exposure levels. These findings extend the existing evidence and may provide preliminary information for developing tiered screening, stress-management support, and referral pathways in university mental health services. However, the identified values are exploratory statistical points rather than validated clinical cutoffs. Longitudinal and intervention studies are needed to confirm their practical use and determine whether stress-reduction and coping-focused interventions can reduce the onset or persistence of probable PIU.

To evaluate the performance and consistency of Large Language Models (LLMs) in core systematic review (SR) tasks and to introduce open-source tools for automated batch processing that provide decision rationales.

We assessed GPT-4o, Kimi-K2, DeepSeek-V3, and DeepSeek-R1 on five SR tasks: title/abstract screening (3550 records), full-text screening (233 texts), data extraction (112 RCTs), Risk of Bias (ROB) assessment (112 RCTs), and AMSTAR-2 assessment (20 SRs). Each model was evaluated twice to measure consistency. All outputs required supporting rationales and verbatim evidence.

LLMs demonstrated proficiency across tasks, with generally high intra-model but lower inter-model consistency. In screening, models showed lower precision (0.27-0.40) but high recall (0.83-0.91) and specificity (0.83-0.91). DeepSeek-R1 and DeepSeek-V3 excelled in title/abstract and full-text screening, respectively. Data extraction accuracy was similar across models (0.78-0.82). Kimi-K2 achieved the highest ROB F1 score (0.71). AMSTAR-2 assessments were generally acceptable.

While effective, LLMs showed variable performance across SR tasks. The mandatory output of rationales and evidence enhances transparency and allows for human verification of AI decisions.

We provide a suite of automated tools for key SR tasks. By leveraging these tools to validate model outputs rather than starting manually, reviewers can significantly improve workflow efficiency while maintaining methodological rigour.

As digital technologies become increasingly integrated into psychological practice, the demand for competencies in digital clinical psychology is growing. Although competency frameworks for digital clinical practice exist, validated instruments to assess these competencies remain scarce. In Sweden, psychology master's students are now being offered digital psychology courses, increasing the need for instruments to measure intended improvements in knowledge and abilities. Using AI to assist with translation procedures can facilitate the adaptation of existing instruments to new national and cultural contexts.

This study aims to test an AI-assisted procedure for the translation and contextual adaptation of the Digital Competencies for Applied Psychological Practitioners (DCAPP) scale into Swedish and to examine the psychometric properties of the translated version in a sample of psychology master's students in Sweden, including a pilot test of the instrument's responsiveness to changes in knowledge and abilities among students attending a digital psychology course.

An AI-assisted adaptation procedure, using ChatGPT and DeepL, was used to translate the DCAPP from English to Swedish. The Swedish version was distributed to psychology master's students during their eighth semester, including those attending an elective digital psychology course. Twenty-four of 55 master's students completed the baseline questionnaire. Of the 14 students enrolled in the digital psychology course, 13 completed the baseline questionnaire and 9 completed the follow-up assessment. Item descriptives, internal consistency, and responsiveness to change were calculated for the scale.

The AI-assisted translation procedure resulted in a translated version of the scale with both high quality and semantic similarity ratings. The Swedish DCAPP demonstrated excellent internal consistency for the total score (α=.96) and also for Knowledge (α=.93) and Abilities (α=.96) subscales. It demonstrated acceptable item distributions, with item-total correlations above 0.30 (range: 0.53-0.87), and mean interitem correlations for the subscales were acceptable but indicated potential item redundancy (Knowledge r=0.48; Abilities r=0.61). Although skewness and kurtosis values were mostly acceptable, pronounced floor effects were observed in both subscales. A statistically significant increase in students' competency ratings was observed at post test (P<.001), suggesting preliminary sensitivity to change.

Using an AI-assisted adaptation procedure to support translation is feasible. The Swedish DCAPP showed promising psychometric properties and preliminary evidence of responsiveness to change. Floor effects may have been due to students' limited digital competencies. Although initial results are promising, further research with larger samples is needed before the psychometric validity of the Swedish DCAPP can be confirmed.

Although awareness of the mental health needs of minor-attracted persons (MAPs) is growing, barriers continue to limit their access to care, and evidence on what influences their help-seeking behavior remains limited. Addressing this gap calls for public health strategies that enhance the prevention of child sexual abuse through healthcare provision for MAPs. This review aims to map the barriers and facilitators to help-seeking in this population to inform policies that improve healthcare access.

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, seven databases were searched without date restrictions, yielding 583 records. Of these, seven studies met the inclusion criteria and were included in the review. Data were charted and analyzed thematically.

Although the included studies provided valuable data, they exhibited methodological limitations that are discussed in the review. Four main barriers were identified (1): structural, including limited resources and fear of mandatory reporting (2); financial constraints (3); social, such as stigma from harmful media portrayals; and (4) individual, such as feelings of shame. Facilitators spanned three dimensions (1): structural, such as anonymous online platforms and specialized clinical training (2); social, such as anti-stigma campaigns, and (3) individual, including recognizing one's attraction as problematic.

These findings reveal a profound disconnect between MAPs' support needs and current healthcare capacity to provide accessible, non-stigmatizing care. Notable gaps remain regarding female and non-Western MAPs, longitudinal help-seeking trajectories, and interventions targeting psychological distress. Online communities and media emerged as paradoxical forces, capable of reinforcing isolation and stigma while also serving as low-threshold entry points into care. Addressing these barriers requires a multilevel approach combining structural reforms, clinical training, digital interventions, and anti-stigma campaigns, alongside policies that distinguish offending from non-offending MAPs to balance public safety with accessible, ethical care.

Mental health disorders represent a growing global challenge, particularly in low- and middle-income countries, where women are disproportionately affected by social and structural inequalities. Although women's empowerment has been increasingly recognized as a strategy to improve physical health, its relationship with mental health remains less well understood.

This study examined the association between women's empowerment and mental health symptoms among ever-married women in Bangladesh.

A cross-sectional analysis was conducted using data from the 2022 Bangladesh Demographic and Health Survey. Women's empowerment was measured using the Survey-Based Women's Empowerment (SWPER) Global index across 3 domains: attitudes toward violence, social independence, and decision-making. Associations between empowerment domains and depressive symptoms, anxiety, and any mental health symptoms were assessed using multivariable logistic regression.

Empowerment in the attitudes toward violence domain was significantly associated with mental health outcomes. Women with low empowerment in this domain had higher odds of depression (adjusted odds ratio [aOR] 1.81, 95% CI 1.16-2.81), anxiety (aOR 1.46, 95% CI 1.10-1.94), and any mental health symptoms (aOR 1.63, 95% CI 1.27-2.10). No significant associations were found for the social independence or decision-making domains.

Higher empowerment in the "attitudes toward violence" domain was associated with a lower prevalence of common mental health symptoms, suggesting that addressing gender-based violence norms may improve women's mental health in Bangladesh.

Mental health-related stigma is a barrier to access to mental health services. This mixed-methods pre-post pilot feasibility study aimed to adapt and pilot-test a multi-level anti-stigma intervention across three levels of the health system to assess its feasibility and potential to reduce mental health-related stigma in Nepal. Contact-based interventions integrating people with lived experience in mental health and stigma training packages were adapted and implemented, targeting female community health volunteers (n = 19), primary healthcare workers (n = 9), and psychiatrists and psychiatric nurses (n = 9). Stigma-related knowledge, attitudes, and competency were measured pre- and post-training with follow-up at 3 and 6 months. Qualitative interviews were conducted with 43 participants across levels. In INDIGO Local, knowledge score increased from 20.43 (95% CI: 20.0-20.9) at pre-training to 25.11 (95% CI: 23.83-26.17) at six months. In INDIGO Primary, the intended behavior increased from 16.67 (95% CI: 14.73-19.27) at pre-training to 18.88 (95% CI: 17.69-20.31) at post-training, while SDS mean score decreased from 39.26 to 20.62. The PCP's helpful behavior increased, and harmful behavior decreased. The knowledge and OSCE mean score in INDIGO READ-MH increased from 12.67 (95% CI: 10.36 -14.97) at baseline to 14.67 (95% CI: 13.28-16.05) at the post-training and from 2 (95% CI: 1.62-2.38) at pre-training to 9 (95% CI: 7.56-10.44) at post- training, respectively. The ASTAD subscale increased at three months, except for motivation and work satisfaction, which decreased at post-training. Qualitative data highlighted the positive attitudinal shift following the interventions, with strong emphasis on PWLE involvement. Overall, the providers perceived the training as feasible and appropriate within Nepal's health system. However, whilst they reported more positive perceptions towards persons with mental health conditions following the interventions, they also identified barriers to effective mental health care, such as insufficient availability of medicines, limited human resources, or separate counseling rooms.