Loneliness is a rising public health concern among older Japanese adults. We aimed to construct a predictive model for loneliness onset among older adults and evaluate its predictive performance.

A total of 4050 participants responded to our survey (mean follow-up period: 3.1 [range, 2.8-3.3] years). Of these, 1806 older adults (age ≥ 65 years) who were not lonely at baseline were included. Loneliness was assessed using the UCLA Loneliness Scale (Version 3). A score of ≥ 44 indicated the presence of loneliness at follow-up. Predictive models for the onset of loneliness were developed using 12 machine-learning algorithms. Discrimination was assessed using the area under the receiver operating characteristic curve (AUC) with 95% confidence intervals (CIs). Sensitivity analyses examined the contribution of baseline UCLA-LS information, model stability, and class imbalance handling.

In total, 421 respondents (23.3%) reported loneliness at follow-up. The XGBoost model achieved the highest AUC of 0.740 (0.705-0.776), with an accuracy of 0.631, sensitivity of 0.806, and specificity of 0.577. SHAP analysis indicated that baseline UCLA-LS items were among the most influential predictors. When all baseline UCLA-LS items were excluded, the test AUC decreased to 0.635. Ten-fold cross-validation showed a mean AUC of 0.742 ± 0.065 for the full XGBoost model.

XGBoost showed moderate discrimination for predicting 3-year loneliness onset. However, baseline UCLA-LS information contributed substantially to model performance, and external predictors alone showed modest discriminative ability. Further refinement and external validation are needed before implementation.

Young people living with HIV (YPLH) in Ghana aged 10-24 face elevated barriers to effective HIV management due to structural, social, and economic challenges. These barriers, including poverty, social stigma, gendered inequities, and limited social and household support, disrupt medication adherence and access to healthcare. Inadequate adherence contributes to increased viral loads, reduced HIV knowledge and acceptance, and ongoing transmission. Despite this vulnerability, the lived experiences of YPLH in Ghana and the strategies they use to navigate these barriers remain underexplored. Using a qualitative design, semi-structured interviews were conducted with young people (n = 18) aged 16-25, and data were analyzed using inductive thematic analysis to identify key barriers and coping strategies. Findings reveal that barriers to HIV management are embedded in daily life and shaped by psychosocial, financial, and gendered constraints. Women experienced more frequent and compounded barriers than men, particularly related to stigma, domestic expectations, and economic dependence. Across participants, challenges related to mental and physical health, financial insecurity, stigma, and time demands disrupted engagement with care. Despite these challenges, participants demonstrated resilience and agency, describing adaptive strategies such as reliance on peer and community resources, selective disclosure, and creative approaches to managing medication. These findings highlight the persistent barriers faced by YPLH and their capacity to develop resourceful, peer-informed strategies. Centering lived experiences and coping practices, this study emphasizes the importance of HIV care approaches that strengthen personal skills, foster socially supportive care environments, and address broader structural determinants through gender-responsive, multisectoral programming beyond clinical settings.

Strong evidence supports the integration of physical activity (PA) promotion in psychotherapy. As mental healthcare practitioners with expertise in behaviour change, psychologists are well-placed to promote PA as an adjunctive psychological intervention. This scoping review aimed to systematically synthesise evidence on psychologists' PA promotion practices, including their knowledge, confidence and past training on promoting PA. This scoping review mapped psychologists' barriers and facilitators to the 14 domains of the Theoretical Domains Framework. Systematic searches were conducted, with 11 studies meeting the inclusion criteria. Among the studies measuring the frequency of psychologists' PA promotion (n = 9), most (67%) reported that >50% of psychologists promote PA with clients. Studies reporting on psychologists' PA promotion training experiences (n=4) found that almost two-thirds of psychologists have not received any formal training in PA promotion. The domains most identified as barriers to PA promotion were 'social influences' and 'skills', whilst the domains most identified as facilitators to PA promotion were 'beliefs about consequences' and 'beliefs about capabilities'. Given that PA promotion in psychotherapy is an effective intervention, but psychologists lack formal training in this area, tailored training may benefit psychologists' capabilities and clinical practice to promote PA safely and effectively.

Naloxone is an opioid overdose reversal drug that is available for free without a prescription via participating community pharmacies in Australia.

To investigate Australian community pharmacists' knowledge, attitudes, practices, and provision of naloxone and overdose prevention, and identify barriers to and correlates of naloxone provision.

Data were collected between January and April 2025 via an anonymous, cross-sectional questionnaire among Australian community pharmacists who were recruited using a randomised representative sampling approach. Data pertaining to pharmacy and pharmacist-related characteristics, pharmacists' knowledge and attitudes towards naloxone, overdose prevention, and provision of naloxone, including barriers to provision, were captured. Multivariable logistic regression was conducted to determine the pharmacy (including jurisdiction, geographic location, pharmacy type, and provision of other harm reduction services) and pharmacist (including gender, years of experience, knowledge of, and attitudes towards naloxone and overdose prevention) characteristics associated with stocking naloxone.

Of the 730 pharmacists who completed the online questionnaire, approximately three-quarters (n = 534, 73.2%) stocked naloxone. Most pharmacists had positive attitudes towards naloxone (85%), and good or excellent self-reported knowledge (81%) of naloxone and overdose prevention. Logistic regression analyses revealed that pharmacies that had significantly greater odds of stocking naloxone were located in Australia's least populous states/territories (Australian Capital Territory, Northern Territory, Tasmania, South Australia) (aOR: 2.32; 95% CIs 1.17-4.61) and Queensland (aOR: 2.12; 95% CIs 1.17-3.83), provided Opioid Agonist Treatment (aOR: 2.77; 95% CIs 1.82-4.24), and had pharmacists with good or excellent knowledge of naloxone (aOR: 4.43, CIs 2.75-7.12; aOR: 6.19, CIs 3.53-10.84 respectively) and very positive attitudes towards naloxone supply (aOR: 2.29, 95% CIs 1.23-5.25). Lack of time to develop, implement and/or sustain the program (59.4%) and lack of training among pharmacy staff (44.6%) were identified as key barriers among the minority of pharmacists that did not stock naloxone.

A large proportion of community pharmacies in Australia stocked naloxone, with variability across states/territories. While pharmacists' attitudes and knowledge were positive overall, there remains scope to increase provision of adequate education and targeted support to strengthen community pharmacies' harm reduction capacity and provide equitable access.

This paper aims to understand the status quo of structural empowerment of clinical nurses and analyze its influencing factors to provide references for optimizing nursing management. A cross-sectional survey of 333 clinical nurses was conducted using the Chinese version of the Conditions for Work Effectiveness Questionnaire-II (CWEQ-II) for Medical Staff and the Psychological Capital Scale. The total score of clinical nurses' structural empowerment was (57.45 ± 9.28), and the average score of structural empowerment was (3.02 ± 0.49). Multiple linear regression analysis showed that marital status, highest educational background, position, employment method, and mental health training experience were the main influencing factors of nurses' structural empowerment level (P < .05). Correlation analysis showed that the total score of structural empowerment was significantly positively correlated with the total score of psychological capital (r = 0.449, P < .001). The level of structural empowerment of clinical nurses is at a moderate level and is affected by many factors. Medical institutions and nursing managers should take effective improvement measures according to its influencing factors to improve the level of structural empowerment of clinical nurses, optimize nursing management, and help the development of the nursing career.

Although severe depression and suicidal ideation among adolescents could be driven by excessive academic competition, research on this problem is still insufficient. Therefore, this study aims to analyze the relationship between academic achievement, depression, and suicidal ideation based on large-scale data. This study utilized data from the nationwide Korea Youth Risk Behavior Web-based Survey conducted from 2006 to 2022, investigating a total of 1,138,802 adolescents. Weighted proportions with 95% confidence intervals (CIs) and crude numbers and percentages were utilized to analyze and present the results in various formats. To accurately assess the association of academic achievement with depression and suicidal ideation, weighted odds ratios and their 95% CIs were calculated using weighted logistic regression analysis. Compared to students with high academic achievement, those with moderate achievement showed a 1.12 (95% CI = 1.11-1.13) times higher risk of depression, while those with low achievement had a 1.54 (1.52-1.56) times higher risk. Similarly, students with low academic achievement had a 1.49 (95% CI = 1.47-1.51) times higher risk of suicidal ideation. The prevalence of both depression and suicidal ideation decreased before the coronavirus disease 2019 pandemic but steadily increased during the pandemic. Females experienced higher rates of depression in each academic achievement group (high: weighted odds ratio = 1.49 [95% CI = 1.46-1.52]; middle: 1.59 [1.56-1.63]; low: 1.72 [1.69-1.75]) and suicidal ideation (high: 1.60 [1.57-1.64]; middle: 1.63 [1.59-1.68]; low: 1.82 [1.78-1.86]) than males. This study suggests that academic achievement can be associated with depression and suicidal ideation. Therefore, implementing mental health and educational programs targeting students with lower academic achievement may be crucial.

Overwhelming evidence found that adolescents with mild traumatic brain injury (mTBI) exhibit structural brain alterations. The influence of mTBI on the adolescents' structural covariance networks (SCNs) remains unexplored.

In this study, data from the Adolescent Brain Cognitive Development Study were adopted, comprising 450 adolescents with mTBI and 450 matched controls for clinical behavior analysis. After structural magnetic resonance imaging quality control, 415 adolescents with mTBI and 404 matched controls were finally included in the SCNs analysis. The SCNs were established using cortical thickness (CT) and cortical surface area (CSA), with group differences assessed via nonparametric permutation tests.

The results demonstrated that adolescents with mTBI suffered from impaired cognitive function, including worse working memory, processing speed, and sleep quality. Furthermore, adolescents with mTBI demonstrated both reduced CSA and CT in the executive control network (ECN), including the superior parietal lobule, anterior cingulate cortex, superior frontal gyrus, and insula. In addition, network nodal metrics in these regions also showed abnormalities.

These findings might suggest that impaired executive function is associated with aberrant SCNs of hubs in ECN in adolescents with mTBI.

Prioritising malaria vaccine targets requires understanding immunity to genetically and structurally diverse parasite antigens, influencing antibody measurements and durability. We measured total IgG levels to 25 Plasmodium falciparum antigens and assessed their association with protection and antigen features. Antibodies were quantified in two longitudinal cohorts of Papua New Guinean children (5-14 years; n=647) experiencing high or moderate transmission. Associations between antibody levels and time to first clinical malaria episode were evaluated using Cox regression and Bayesian antibody-kinetics models, incorporating antigen genetic diversity and structural properties. In high-transmission settings, antibody levels were elevated and stable, with the strongest protection observed for conserved, low-diversity antigens dominated by the 3D7-reference-matching haplotypes and enriched for intrinsically disordered and alpha-helical regions. In moderate transmission, antibody levels were variable, decayed over time, and reflected recent exposure. These findings identify antigen diversity as a key modifier of malaria immunity and underscore the importance of antigen features.

To identify latent classes of socio-contextual vulnerability among postpartum women and to examine whether these classes differed in postpartum depressive symptomatology and self-reported postpartum depression diagnosis. A total of 1308 women residing in Spain who had given birth within the previous 24 months participated in this cross-sectional online study. Latent class analysis (LCA) was conducted based on socio-demographic, caregiving, contextual, obstetric, and prior clinical-history indicators, including employment status, educational attainment, caregiving support, area of residence, age, partnership status, primiparity, postpartum time, and previous depression history. Differences between classes in EPDS screening positivity and self-reported postpartum depression diagnosis were subsequently explored. A 2-class model with better fit, parsimony, and interpretability was selected. The identified classes were characterized as Class 1: Higher socio-contextual vulnerability (27.5%) and Class 2: Lower socio-contextual vulnerability (72.5%). Relative to Class 2, Class 1 showed lower probabilities of employment (0.443 vs. 0.926) and higher education (0.482 vs. 0.833), together with higher probabilities of low caregiving support (0.392 vs. 0.132), unemployment (0.271 vs. 0.029), caregiving or home duties (0.248 vs. 0.038), younger age (0.666 vs. 0.443), and rural residence (0.288 vs. 0.122). Women in the higher socio-contextual vulnerability class showed a higher probability of EPDS screening positivity (0.632 vs. 0.551; OR = 1.401, 95% CI [1.163, 1.672]) and a somewhat higher probability of self-reported postpartum depression diagnosis (0.143 vs. 0.116). The findings suggest that postpartum depressive symptomatology is embedded within broader socio-contextual conditions and support the importance of incorporating socio-contextual indicators into postpartum mental health screening and prevention strategies.