Through the comparison of responses of normal volunteers, assessment of autonomic function under abnormal clinical conditions focused on the detection of dysautonomia involving both the parasympathetic and adrenergic limbs in patients with Chagas heart disease, post-cardiac surgery, chronic heart failure, mitral valve prolapse, and hyperthyroidism. In particular, the autonomic impairment observed in Chagas disease patients involved predominantly the parasympathetic control of heart rate at the sinus node level, and the adrenergic innervation at the myocardial ventricular level. The autonomic derangements observed in Chagas cardiomyopathy patients have only recently been explored in terms of their prognostic relevance, and their potential clinical implications for therapeutic purposes remain to be investigated. Over the last nearly seven decades, our laboratory has accumulated significant expertise using several tests described above to evaluate autonomic control of heart rate, now focusing on various pathophysiological clinical conditions. The effect of endurance physical training and of aging was mostly focused on studies of normal volunteers whose responses at baseline served as controls to be compared during tests employed in individuals with some morbid clinical conditions. By far, the pathophysiology of Chagas heart disease involving the autonomic nervous system was the most predominant subject studied in our laboratory, since the early studies in the 1960s until the late studies just recently published in international journals (Central Illustration). Other pathological conditions focused on our studies were mitral valve prolapse, heart failure, post-cardiac surgery, and hyperthyroidism.

Incident atrial fibrillation (AF) is common following kidney transplantation (KTx) and is associated with worse clinical outcomes. Artificial intelligence electrocardiography (AI-ECG) algorithms have demonstrated efficacy in predicting risk of new-onset AF in the general population, however their prognostic value in KTx recipients is relatively unknown.

Retrospective analysis was conducted on KTx recipients without AF, with at least one pre-transplant ECG between 2011 and 2021 across three tertiary centers in the United States (Mayo Clinic sites in Minnesota, Arizona, and Florida). A previously validated AI-ECG algorithm estimated the probability of incident AF for each patient. Based on AI-ECG probabilities, patients were categorized into high and low risk groups, with the optimal AI-ECG score cut-off determined. The incidence of new-onset AF, allograft failure, and mortality were compared between groups.

Overall, 6246 patients (age 53.5 ± 13.8 years; 58.9% male) were included. Pre-transplant AI-ECG probability of AF ≥5% was the optimal cutoff for high risk of incident AF (sensitivity 72%, specificity 62%). High risk scores were associated with true new-onset AF at 30 days (aHR 2.89, 95%CI 2.05-4.09, p<0.001), three years (aHR 2.54, 95%CI 1.99-3.26, p<0.001), and five years post-transplant (aHR 2.48, 95%CI 1.99-3.09, p<0.001). High risk AI-ECG scores were also associated with increased mortality (aHR 1.56, 95%CI 1.30-1.88, p<0.001) and overall allograft failure (aHR 1.50, 95%CI 1.30-1.75, p<0.001) through five year follow-up.

This pre-transplant AI-ECG parameter identified patients at increased risk of new-onset AF post-KTx and provided prognostic utility. Overall, this easy to obtain tool allows for risk stratification of patients who may benefit from closer monitoring, targeted risk factor modification, and early intervention.

Volemic control is essential for maintaining tissue perfusion and fluid homeostasis, with cardiorenal and endothelial mediators regulating intravascular composition, often impaired in pathological states. Notably, intestinal epithelial cells are highly sensitive to volume fluctuations, resulting in changes in intestinal permeability that may not be detected by current diagnostic methods. This review offers a comprehensive description of the main mediators involved in volemic regulation, their impact on intestinal morphofunctionality, and specific details regarding epithelial cells. Additionally, key biomarkers - especially lactulose/mannitol - for assessing intestinal barrier disruption are highlighted, and a novel approach is proposed using liquid chromatography-mass spectrometry to investigate gut alterations in heart failure and exercise-induced stress, which are silent and neglected conditions with significant repercussions on intestinal barrier function.

In South Africa, an estimated 62% of female sex workers (FSW) are living with HIV. Oral HIV pre-exposure prophylaxis (PrEP) is effective, but FSWs' PrEP use typically declines rapidly post-initiation in service settings. We examined a pilot individualized case management (ICM) intervention aiming to increase PrEP adherence and persistence among cisgender FSW initiating PrEP in eThekwini, South Africa. To assess pathways of intervention influence and potential effectiveness, we characterize the support participants received from the case manager (CM) and the ways in which it influenced their PrEP adherence and persistence.

FSW initiating PrEP through a non-governmental key populations program (n = 29) participated in the pilot ICM sessions for 12 weeks, as well as semi-structured, in-depth interviews (IDIs) at baseline, month 1, and month 3. We triangulated the IDIs with CM observation notes and PrEP program refill data through month 4. We coded textual data thematically, and produced narrative summaries and time-ordered matrices to summarize themes, assess changes over time, and compare participants who continued versus discontinued PrEP by month 4. We employed the "capability, opportunity, and motivation - behavior (COM-B)" system in interpreting the pathways through which the CM's support influenced participants' PrEP adherence and persistence and considering potential intervention enhancements.

The CM provided emotional, instrumental, and informational support that positively influenced participants' PrEP use capability, opportunity, and motivation. She bolstered participants' PrEP use capability by providing reminder tools and information to manage side effects and dispel misunderstanding; opportunity by helping strategize covert PrEP use in the face of stigma, and directly resolving pill access problems stemming from mobility and housing insecurity; and motivation by providing care and accompaniment. Experiences of care, accompaniment, and other emotional support from the CM were deeply felt in context of sex work stigma, and more prominent in the narratives of participants continuing PrEP at month 4 (20/29; 69%) versus those who discontinued. Still, 31% (9/29) of participants discontinued PrEP, and key influential forms of CM support required her ongoing presence.

Findings suggest both pathways of potential ICM effectiveness and impact and sustainability shortfalls, calling for larger-scale evaluation and complementary structural approaches, such as those bolstering FSW social cohesion and tackling socio-economic barriers.

Adolescent mental health outcomes are often poorer in rural areas of Australia, and most adolescents do not seek help, highlighting a critical gap in understanding help-seeking behaviours. This study examined mental health help-seeking patterns and associated factors among rural Australian adolescents.

Data from Wave 8 of the Longitudinal Study of Australian Children, including 4,837 adolescents aged 14-19 years, were analysed. The prevalence of help-seeking overall and by remoteness, as defined by the Australian Bureau of Statistics were estimated. Cluster-adjusted multiple logistic regression models were used to examine factors associated with help-seeking behaviours.

Help-seeking behaviours were generally lower among adolescents from rural areas compared to their urban counterparts. Seeking face-to-face mental health professional help was significantly less common in outer regional and remote areas (7.72%, 95% CI: 5.39-10.93) compared to urban areas (12.20%, 10.97-13.54). Furthermore, males reported significantly lower professional help-seeking behaviours (2.76%, 1.33-5.63) than females (13.53%, 9.08-19.70) in outer regional and remote areas. Similar sex disparities were observed in non-face-to-face (e.g., internet, phone) help-seeking. The most common predictors of help-seeking behaviours were ongoing anxiety or depression and good parent-child relationships. Other statistically significant predictors included suicidal thoughts and behaviours, single-parent family, community participation, social media exposure and drug use. Two predictors (i.e., financial hardship for formal help-seeking and community engagement for informal help-seeking) varied statistically significantly between rural and urban settings.

Strategies to address lower prevalence of mental health help seeking among rural male adolescents in Australia should be sensitive to context-specific barriers and designed to meet their unique needs. Adolescent-focused digital interventions and strengthened family and community engagement are vital to ensuring equitable access to mental health services for adolescents in rural Australia.

Physical activity (PA) has positive effects on physical and mental health. Nevertheless, two thirds of individuals with major depressive disorders (MDD) do not meet PA recommendations. Furthermore, MDD is associated with increased cardiovascular risk and autonomic nervous system dysfunction. This depression-related dysfunction is expressed by low heart rate variability (HRV). In contrast, regular PA has been shown to improve autonomic regulation over time as indicated by higher HRV values.

The overarching aim of this umbrella review is to examine the complex interrelationship and mutual influence between MDD, PA, and HRV. We aim to answer the following questions: (I) How does PA affect depressive symptoms? (II) How are HRV and MDD related? (III) How does PA affect HRV?

Medline, Embase, PsycINFO, SPORTDiscus, and Epistemonikos were searched for systematic reviews and meta-analyses from their inception until 5 July 2024. Reviews were included if they presented the effects of PA interventions on depression severity in individuals with MDD for part I, if they showed the differences in HRV parameters between healthy individuals and individuals with MDD for part II, and if they presented the effects of PA interventions on HRV parameters in healthy individuals for part III. The quality of the included reviews was assessed by Assessing the Methodological Quality of Systematic Reviews (AMSTAR 2) criteria.

This umbrella review included 90 reviews. Part I shows that various types of PA are effective in reducing symptoms of depression in individuals with MDD. In addition, there is a similar reduction with PA compared with pharmacological treatment. Part II demonstrates that time-based and frequency-based HRV values are lower in individuals with MDD than in healthy individuals. Part III shows that different types of PA can improve time-based, frequency-based and nonlinear HRV parameters in healthy individuals.

This comprehensive umbrella review demonstrates the importance of PA to reduce symptoms of depression and to have a positive impact on autonomic function. Further studies suggest that PA can also improve HRV in individuals with MDD. In the future, randomized controlled trials should be conducted to examine which types and forms of PA are effective in positively affecting HRV in individuals with MDD according to standardized parameters in the area of HRV and depression severity.

The protocol for this umbrella review was a priori registered with PROSPERO: CRD42021278665.

Forced displacement and migration are on the rise worldwide. Asylum seeking and refugee minors (ASRM) are particularly exposed to risk factors for mental health problems. Yet, there is a lack of comprehensive data on the prevalence of specific mental health problems as well as applied screening and follow-up care in Germany.

Using the online platform REDCap, we conducted the cross-sectional SAVE-KID survey among health and social care professionals (HSCP) working with ASRM in Germany (n = 201; 44% medical doctors, 38% social workers) to assess the estimated mental health burden among ASRM, the conducted screening measures, and provided mental health care as well as the extent to which communication problems affect care for ASRM.

Here we show, that on average, 21% of ASRM are reported with one or more listed mental health problem. Only 37% receive follow-up. Less than 24% of participants conduct mental health screening by informal questions, interviews, trained staff or questionnaires. 84% of participants report frequent communication problems. Most used aids are online tools or relatives' translations.

SAVE-KID describes an imbalance between the occurrence of and screening for mental health problems among ASRM. Comprehensive, systematic detection of mental health problems remains challenging due to communication problems, lack of specialized staff and diagnostic tools as well as follow-up care structures.

Social media is a significant source of information for post-secondary students, who are usually at the age at which many common mental disorders first express themselves. Social media can have a role in the way post-secondary students identify and act on mental health issues.

Explore how the use of social media influences post-secondary students' adoption of mental health labels.

We included empirical studies on mental health labelling in the context of social media use among post-secondary students published in English between January 1995 and April 2025.

The review includes references from five databases: Scopus, PubMed, Ovid MEDLINE (to access APA PsycINFO), Web of Science and ProQuest Global Dissertations and Theses. Based on the included studies from the initial search, we built a complementary search strategy using Research Rabbit artificial intelligence.

We present a table listing characteristics of the studies and brief summaries of their findings. A narrative synthesis compiled the information from each study to answer the research questions.

The search identified 7551 references and 1099 additional records from Research Rabbit. 11 studies published since 2011 met the inclusion criteria with qualitative, mixed methods and quantitative designs, without major quality concerns. Approaches to measuring social media exposure varied, including platform reports of user activity and self-reported indicators. Individuals adopted labels themselves or received labels from peers or researchers. Most research focused on self-presentation and symptom disclosure rather than labelling itself. The accuracy of self-diagnosis was higher for common disorders and lower for complex conditions such as mania or panic disorders. Labelling varied across social media platforms. Online interaction revealed issues that students were reluctant to share face-to-face. Label use appeared to influence help-seeking and peer support, with effects shaped by social stigma.

The adoption of mental health labels via social media among post-secondary students remains largely unexplored. The concept of labelling and its operationalisation vary across research. Future studies should provide more formal definitions, investigate mechanisms driving labelling and assess its potential effects on human health.

Mental health and substance use problems among people released from prison contribute substantially to premature mortality and emergency services demand. Understanding of mental health and substance use-related health service contacts prior to these severe and costly outcomes is limited. We assessed mental health and substance use-related contact with multiple services, comparing rates of contact among people released from prison to a matched general population sample who had not recently been in prison.

To compare rates of health service contacts for mental health and substance use between people released from prison and a matched general population sample.

We conducted a retrospective cohort study using linked administrative data with nationwide coverage. The cohort contained all people released from any Scottish prison in 2015 (exposed group), and a random general population sample matched (ratio 1:5) on sex, age, postcode and deprivation indices, who had no imprisonment in the 5 years prior (unexposed group). We linked individual-level administrative healthcare (prescriptions, outpatient, inpatient, emergency/unscheduled care: 2010-2020), prison (admissions, releases: 2010-2020) and deaths records (2015-2020). We estimated adjusted incidence rate ratios (aIRRs) with 95% CIs using fixed-effects Poisson regression with cluster-robust standard errors, controlling for time-in-community, pre-index mental health and substance use-related health service contacts, and comorbidities. We stratified models by mental health (MH), substance use (SU) and dual diagnosis (attributable to both MH and SU).

Scotland.

We linked records for 8313 people released from prison, and 41 213 matched individuals. Mental health and substance use-related contact rates were significantly higher for people released from prison across all services, and particularly for emergency and unscheduled care. aIRRs for ambulance contacts were MH=7.75 (95% CI 5.76 to 10.42), SU=7.58 (95% CI 5.71 to 10.08), dual diagnosis=8.28 (95% CI 6.50 to 10.55); and accident and emergency department contacts were MH=4.88 (95% CI 3.78 to 6.29) and SU=7.98 (95% CI 5.71 to 11.17). aIRRs for community prescriptions were MH=1.80 (95% CI 1.67 to 1.94), SU=5.95 (95% CI 4.83 to 7.32), dual diagnosis=5.33 (95% CI 3.70 to 7.68); drug and alcohol services were 7.13 (95% CI 6.00 to 8.48); and outpatient attendances were 2.61 (95% CI 2.17 to 3.16). aIRRs for 24-hour unscheduled telephone support were MH=7.63 (95% CI 4.93 to 11.83) and SU=8.29 (95% CI 3.99 to 17.22); and out-of-hours general practice were MH=5.14 (95% CI 3.66 to 7.22), SU=5.89 (95% CI 3.11 to 11.14) and dual diagnosis=8.85 (95% CI 2.94 to 26.63). aIRRs for general/acute hospital admissions and day cases were MH=2.97 (95% CI 1.43 to 6.16), SU=7.85 (95% CI 4.42 to 13.91), dual diagnosis=13.11 (95% CI 7.95 to 21.61); and for psychiatric admissions were MH=3.62 (95% CI 2.39 to 5.49), SU=10.74 (95% CI 6.12 to 18.84) and dual diagnosis=7.74 (95% CI 4.30 to 13.94).

Improved post-release mental health and substance use care is vital for individual and public health. Despite elevated rates of contact with community mental health and substance use services, people released from prison have disproportionately high rates of contact with emergency and unscheduled care services. This suggests that early support is either inadequate or not accessed by those in greatest need.Policymakers and service providers should consider investment in tailored transitional and post-release intervention at individual and population level, to improve health and thus prevent later high-cost service use and avoidable mortality. Our results also suggest high-quality care must be available and accessible beyond the immediate post-release period to permit sustained engagement or engagement at a later date.

Mobile health (mHealth) technologies have become increasingly popular for monitoring mental health symptoms and lifestyle behaviours, and are largely reported to be feasible and acceptable to users. However, to date, the efficacy of such technologies to improve perinatal mental health outcomes has been mixed. Within the perinatal context, much of this work has been done in the context of postpartum depression, stemming from electronic health records as well as cohort studies. There is, however, a dearth of studies focusing on depression in pregnancy, and machine learning-based clinical decision support systems remain underexplored. The HappyMums application has been developed to meet this need, and its use across Europe will be tested in this study.

A total of 1000 pregnant people currently suffering from, or at risk of, antenatal depression will be recruited across six countries. All participants will be between 13 and 28 weeks' gestation and will be given access to the new purposefully developed HappyMums mobile application, to use from enrolment until 2 months postpartum. The application leverages passively collected data from smartphone sensors relating to physical activity and behaviour, as well as requiring active engagement from the user to complete mental health questionnaires and 'game-like' activities. Digital data types will be combined with traditional mental health measurement methods, such as standardised questionnaires and interviews, to develop novel predictive models capable of identifying mental health trajectories in women at risk of developing antenatal depression and to test the app's utility for use as personalised risk prediction and depression identification tool. The primary outcome of this study is to determine what proportion of users will continue to use the mobile application and engage with its tasks and activities at least weekly, while secondary exploratory outcomes include assessing usability of the app and testing the predictive ability of a novel machine learning-based model. These outcomes will, for the first time, be assessed by integrating active as well as passive data.

Ethical approval has been granted by local research ethics committees in each recruiting centre. At King's College London (leading the clinical study), the study was reviewed by the East of England-Essex Research Ethics Committee and granted favourable opinion (REC reference 24/EE/0129). All other sites collecting participant data have the study approved for local delivery. Findings relating to the primary and secondary outcomes will be submitted for publication in open access, peer-reviewed journals, as well as presentations at conferences as symposia or posters. Findings will be made available to a non-specialist audience through open access digital mental health magazines and promotion on social media.

NCT06578845.