To investigate how unintended pregnancy (UP) is associated with the occurrence of mental health (MH) problems one year later among womxn, while also considering pregnancy outcome (abortion/continuation), co-occurring risks and protective factors. We examine this in the Dutch context, given available abortion care up to 24 weeks gestation and high diversity in people's pregnancy intentions. We hypothesized that MH problems are more prevalent among those whose pregnancy was more unintended.

Data from the Dutch BluePrInt study included both womxn who had an abortion (AB, n = 152) and who continued their UP (CT, n = 212). They filled out an online survey shortly after their abortion (AB) or around 14 weeks gestation (CT), and at follow-up one year later. Key variables included pregnancy intendedness (continuously measured), anxiety/depression symptoms (measured with a screening tool based on the CIDI), social- and partner support, abuse experiences, UP-related variables (difficulty deciding, uncertainty, pressure, and negative emotions) and socioeconomic position.

26.5% developed MH symptoms one year after their UP, with no significant differences between AB and CT groups. Pregnancy intendedness and -outcome (abortion vs. continuation), as well as their interaction, were not related to MH symptoms one year later. Previous MH was the strongest predictor of MH risks (OR: 3.54), while perceived social support from family/friends was associated with a lower risk (OR: 0.66).

In a context where abortion care is available, pregnancy intendedness and -outcome do not increase people's risks of MH symptoms one year after experiencing an UP. Instead, previous MH and support from family/friends are important for MH after experiencing an UP. Positioning UP as inherently problematic is not warranted. Policy and practice should center people's lived reproductive experiences and care needs.

Exploring responses to everyday conflict scenarios is important for understanding the development of aggressive behavior in children and for clinical practice. Current research suggests that simulations within virtual reality (VR) improve traditional approaches. We expanded this research by developing a VR-based assessment (VR test) comprising three ambiguous and three hostile peer-related conflict scenarios. This pilot study examined the test's feasibility and psychometric properties in 8-12-year-old boys, including a clinical sample with aggressive behavior problems (n = 42) and a non-clinical sample (n = 40). During the VR test, behavioral responses were observed and social information processing (SIP) explored. Additionally, we collected reports of peer-related aggression and disruptive behavior symptoms from parents, children, and teachers. Good feasibility of the test was demonstrated by various indicators (e.g., session duration, appeal, immersion). Internal consistencies of the aggressive behavioral response and SIP scales suggested mostly good reliability of the VR test scales. Intercorrelations between scale scores indicated partial overlaps (r = .28-.84). Discriminant validity of the VR test scenarios was demonstrated by higher scale scores for hostile than for ambiguous scenarios and higher scores for ambiguous scenarios compared to a neutral scenario (all p < .001). Differences between the clinical and non-clinical sample revealed discriminant validity of VR test scales (d = 0.57-1.76). With a few exceptions, correlations of the VR test scales with multi-informant ratings indicated convergent validity (r = .02-.71). Overall, these findings suggest feasibility and provide initial evidence of adequate psychometric properties. Further research is needed to ensure psychometric robustness and utility. Study registration: https://www.drks.de/ (Number = DRKS00032850, registration date = 2024/01/30, retrospectively registered).

Treatment expectations are central to psychotherapy outcomes but are typically assessed as a unidimensional construct focusing on anticipated improvement. This study investigated whether expectations of improvement, worsening, and side effects, as measured by the Generic Rating Scale for Previous Treatment Experiences, Treatment Expectations, and Treatment Effects (GEEE), represent distinct dimensions in psychotherapy. We examined three samples differing in treatment context and symptom burden: patients currently in psychotherapy (N = 102), prescreened patients awaiting psychotherapy (N = 83), and a community sample of former psychotherapy patients who reported current mental health problems (N = 219). Across all groups, expectations of improvement were distinct from expectations of worsening and side effects, whereas the latter two showed moderate overlap. Improvement expectations correlated strongly with the Credibility/Expectancy Questionnaire (CEQ), while worsening and side effect expectations did not, indicating discriminant validity. In the psychotherapy sample, depressive symptoms were negatively associated with improvement expectations and positively with worsening and side effect expectations. The findings support the GEEE as a brief and multidimensional tool that extends beyond existing measures by capturing both positive and negative facets of treatment expectations. Differentiating these domains may help identify patients at risk of disengagement and inform tailored interventions to foster more adaptive expectation profiles in psychotherapy.

To determine whether the onset of physical health problems/sensory impairments is associated with incident challenging behaviours.

A retrospective, population-based cohort study using longitudinal data from primary care records. HRs were estimated using Cox proportional hazards models accounting for recurrent events and time-varying exposures.

UK primary care data sourced from the Clinical Practice Research Datalink (CPRD) Aurum and Gold databases, covering over 850 000 person-years between 2009 and 2019.

166 989 individuals with recorded intellectual disabilities were included in the cohort.

Incident identification of challenging behaviours before or after a recorded incident of physical health problems/sensory impairment. Physical health problems/sensory impairments assessed included constipation, epilepsy, pain, visual impairment, hearing impairment, bowel incontinence, urinary incontinence and sleep problems.

21.21% (n=35 415) of the cohort had challenging behaviour recorded at least once in primary care records over the 11-year study period, equating to an incidence rate of 0.10 per person-year. 40.9% of episodes of challenging behaviour were associated with an incident physical health problem/sensory impairment. All eight physical health problems/sensory impairments were significantly associated with higher HRs for challenging behaviours after full adjustment for demographic and mental health covariates. These associations held across multiple sensitivity analyses. The strongest associations were found for bowel incontinence (HR=2.24; 95% CI 2.01 to 2.50), urinary incontinence (HR=1.93; 95% CI 1.77 to 2.11), constipation (HR=1.89; 95% CI 1.74 to 2.05) and sleep problems (HR=1.74; 95% CI 1.58 to 1.90).

This is the first longitudinal study to establish a temporal association between the onset of physical health problems/sensory impairments and challenging behaviours in people with intellectual disabilities. These findings highlight the need for proactive identification and management of physical health problems/sensory impairments as part of assessment processes to prevent or reduce the impact of challenging behaviours.

Non-attendance to healthcare appointments among young people with long-term conditions (LTCs) presents significant challenges to continuity of care and clinical outcomes. Although factors associated with non-attendance have been explored in broader populations, there remains an evidence gap concerning the specific drivers among adolescents and young adults aged 10-24 years living with chronic physical or mental health conditions. This review aims to identify and synthesise factors associated with healthcare appointment non-attendance among young people with LTCs.

We will conduct a systematic review and narrative synthesis of peer-reviewed quantitative, qualitative and mixed-methods studies reporting factors associated with non-attendance among young people with LTCs. MEDLINE, Embase, PsycINFO, Scopus and CINAHL will be searched from database inception. Searches will be conducted in March 2026 and will include studies with no geographic restrictions, and with eligibility extended to any language where translated full text is available. Two reviewers will independently screen studies, extract data and assess risk of bias using the ROBINS-I (quantitative), Critical Appraisal skills programme (qualitative) or mixed-methods appraisal tool (mixed-methods). A narrative synthesis will be undertaken, grouping factors thematically and comparing findings by age subgroup, condition type (physical vs mental health) and socioeconomic/geographical context. Reporting will follow Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidance.

Ethical approval is not required as no primary data will be collected. Findings will be disseminated through peer-reviewed publication and relevant conference presentations.

CRD420251080477.

Delivery of interventions within student mental health services has undergone considerable digital transformation in recent years. Traditional face-to-face meetings are being substituted with autonomous digital tools with evident advantages in terms of accessibility and scalability. Despite an increasing array of digital options, there is also a growing recognition that digital tools offer limited effectiveness without some degree of human support. For example, for mental well-being, completely digitally delivered interventions show approximately half the effect sizes of interventions delivered in a traditional format. Blended forms of delivery that use both digital advantages and recognized effects of human contact are therefore promising. Hitherto, the effects of blended delivery have not been evaluated for mental well-being. Hence, investigating how digitalization in intervention delivery impacts intervention effects on mental well-being is important. This is especially relevant among emerging adults enrolled in higher education, going through a critical, transformative life phase.

This systematic review and meta-analysis will primarily aim to investigate differences in effect due to the degree of digitalization in the mode of delivery of interventions on mental well-being among higher education students.

This work will adhere to the Cochrane Collaboration methodology, and results will be reported according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A systematic literature search will be conducted across 9 databases (Scopus, MEDLINE, PubMed, PsycINFO, ERIC, CINAHL, Web of Science, Cochrane, and International Clinical Trials Registry Platform). The population, intervention, comparator, and outcome framework will inform both the search strategy and eligibility criteria. For inclusion, studies should be randomized controlled trials investigating the effect of individually delivered interventions on positive affect or life satisfaction among mentally healthy higher education students aged 18 to 29 years. Studies will be independently screened, and data will be extracted, including the standardized mean difference as the effect measure. Risk of bias assessment will be conducted using the Cochrane Risk of Bias 2 instrument. The Hartung-Knapp-Sidik-Jonkman method for random effects meta-analysis will be applied, and study biases will be analyzed by funnel-plot assessment and Egger test. Finally, certainty of evidence for positive affect and life satisfaction will be assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach. Results will be presented in a summary of findings table.

The search was finalized in March 2026, generating 6603 records after duplicate removal. Study selection and data extraction were conducted during April 2026, resulting in 41 eligible studies. Risk of bias assessment, data analysis, and manuscript preparation are planned before submission for peer review in August 2026.

The principal findings of this study will highlight differences in effect due to the mode of delivery of interventions on mental well-being among higher education students. This will be relevant for the management of student mental health promotion services.

PROSPERO CRD420251131950; https://www.crd.york.ac.uk/PROSPERO/view/CRD420251131950.

PRR1-10.2196/88458.

Guided exercise is central to rehabilitation for chronic nonspecific low back pain. Telerehabilitation enables remote delivery of guided exercise, but its effectiveness vs other rehabilitation modalities remains uncertain.

This review systematically assessed the comparative efficacy of telerehabilitation, in-person rehabilitation (IPR), and usual care (UC) for improving pain, disability, kinesiophobia, and health-related quality of life in patients with chronic nonspecific low back pain. Telerehabilitation combined with artificial intelligence (TLRH-AI) was evaluated as an exploratory intervention because available evidence was limited.

Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines, we searched randomized controlled trials in PubMed, Cochrane Library, Web of Science, and Embase from inception to April 30, 2026. A Bayesian network meta-analysis was conducted using R (version 4.4.1). Interventions were ranked using surface under the cumulative ranking curve (SUCRA) values. Evidence certainty was assessed using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) framework. Findings were interpreted considering heterogeneity, risk of bias, inconsistency, and estimated prediction intervals.

Among 2491 records, 20 randomized controlled trials involving 1854 participants were included. For pain intensity, IPR showed the greatest benefit at 4 weeks (low-certainty evidence), telerehabilitation at 8 weeks (moderate-certainty evidence), and telerehabilitation ranked highest at 12 weeks (SUCRA 87.2%; moderate-certainty evidence). For the Oswestry Disability Index-based disability, IPR ranked highest at 4 weeks (SUCRA 98.2%; low-certainty evidence) and 12 weeks (SUCRA 86.7%; low-certainty evidence), whereas telerehabilitation ranked highest at 8 weeks (SUCRA 90.4%; high-certainty evidence). For the Roland-Morris Disability Questionnaire-based disability, IPR was among the more effective interventions (SUCRA 67.3%; low-certainty evidence). For kinesiophobia, IPR ranked highest (SUCRA 99%; low-certainty evidence). For health-related quality of life, telerehabilitation significantly improved the physical component summary score (mean difference 6.05, 95% credible interval [CrI] 2.89-9.22; moderate-certainty evidence), whereas IPR showed a nonsignificant trend toward an improved mental component summary score (mean difference 2.79, 95% CrI -1.61 to 7.17; low-certainty evidence). Evidence for TLRH-AI remained limited and descriptive, suggesting possible short-term benefits with low to very low certainty. No significant small-study effects or global inconsistency were detected, although potentially important local inconsistency was observed in the 4-week Oswestry Disability Index comparison between UC and IPR.

This review uniquely compared telerehabilitation, IPR, UC, and exploratory TLRH-AI within a Bayesian network meta-analysis. Unlike previous reviews focused mainly on telerehabilitation vs conventional care, it provides a comparative hierarchy across delivery models, follow-up windows, and outcomes while incorporating evidence certainty and heterogeneity. The findings support individualized rehabilitation selection. In practice, telerehabilitation may offer a scalable option for longer-term pain relief and physical function improvement, whereas IPR may remain important for supervised functional recovery and psychological support. TLRH-AI remains exploratory and should not guide clinical decision-making until adequately powered trials are available.

PROSPERO CRD420251146712; https://www.crd.york.ac.uk/PROSPERO/view/CRD420251146712.

Alcohol and tobacco use frequently co-occur and contribute significantly to the global burden of disease. Despite the well-established benefits of addressing both behaviors simultaneously, health care professionals often face substantial challenges in delivering integrated interventions, including limited time, training, and resources. Digital health interventions offer a promising avenue to directly support patients in reducing alcohol and tobacco use, while bypassing some of the barriers encountered in clinical settings. However, there is a lack of consensus on the key behavior change techniques (BCTs) that must be incorporated to ensure that interventions are evidence based and contextually appropriate, making them effective.

The study aims to identify expert opinions on the most suitable and effective BCTs (reflecting both behavioral relevance and delivery feasibility) to be included in a 1-time, self-guided digital intervention intended to initiate behavior change and support alcohol reduction among people trying to quit smoking.

We conducted a 2-round modified Delphi study with 14 panelists with expertise in behavioral science, alcohol and tobacco treatment, and digital interventions. Panelists rated 20 BCTs identified in a previous rapid review using the acceptability, practicability, effectiveness, affordability, safety, and equity (APEASE) criteria. BCTs were deemed "appropriate" if at least 70% (n=10) of panelists agreed on all criteria.

Six BCTs were identified as appropriate for implementation: goal setting, action planning (individualized change plan), action planning (reduction strategies), feedback on behavior, reattribution, and pros and cons. These BCTs were considered effective for promoting behavior change through structured planning and personalized strategies. The panel reached partial consensus on several BCTs, while 8 BCTs were deemed inappropriate for a 1-time, unsupervised digital intervention.

The results of this study offer a consensus-based view, reflecting expert opinion on the perceived appropriateness and feasibility of the BCTs that should be included in a 1-time digital intervention to address co-occurring alcohol and tobacco use.

Accurate language data are essential for studying health inequities related to language barriers. Our objective was to understand the accuracy of language variables in home care and long-term care databases.

Descriptive cross-sectional study using linked health administrative data.

The study included adults (aged ≥20 years) in Ontario, Canada, who answered the Canadian Community Health Survey between 2011 and 2018 and had assessments in home care and long-term care databases.

We linked survey respondents to assessment data from home care databases [Resident Assessment Instrument-Home Care (RAI-HC) and International Resident Assessment Instrument (InterRAI)] or from the long-term care database [Continuing Care Reporting System (CCRS)]. The answer to "What is the language you speak most often at home?" was our reference standard, identified from the Canadian Community Health Survey. We reported the data accuracy and agreement levels for the language variables in the health care databases compared with our reference standard.

Among survey respondents, we identified 8532 individuals with assessments in RAI-HC, 10,690 in InterRAI, and 4667 in CCRS. The accuracy of identifying true language preference was 88% in RAI-HC, 79% in InterRAI, and 82% in CCRS. The RAI-HC language variables had a sensitivity of 72.0% (95% CI, 68.2-75.7) for identifying a non-English language, InterRAI variables had a sensitivity of 66.9% (95% CI, 63.6-70.2), and CCRS variables had a sensitivity of 68.1% (95% CI, 63.1-73.0). The specificity of these variables for identifying a non-English language was high across all 3 databases (98.4%, 98.6%, and 98.5%) and very high for the "needs interpreter" variable [99.7% (95% CI, 99.5-99.9)].

The accuracy of identifying true language preference was moderately sensitive and highly specific in home care and long-term care databases in Ontario, Canada. Our findings support the use of these variables to identify linguistic groups.

Climate change-related heatwaves and dust storms increasingly strain water, sanitation, and hygiene (WaSH) systems in displacement settings, yet little is known about how households manage water scarcity during acute climate events. Gendered roles and responsibilities in refugee camps may further influence how water scarcity is managed. This study examines how household water management practices intersect with psychosocial stress during extreme summer conditions in Zaatari Refugee Camp, Jordan.

We conducted a qualitative study using gender-stratified focus group discussions with adult Syrian refugees in Zaatari Refugee Camp. Semi-structured focus groups explored experiences of water access, household water management, and stress during summer heatwaves and dust storms. Data were analyzed using inductive thematic analysis with participatory validation involving refugee co-facilitators.

Participants described uneven WaSH system functioning driven by timing, pressure, and geographic location, alongside predictable summer reductions in water supply and increased demand during heatwaves and dust storms. Households and individuals employed creative water conservation strategies that were effective but amplified stress through sustained vigilance and restriction. Importantly, women more frequently reported responsibility for monitoring, rationing, and enforcing water use, alongside greater psychosocial strain, while men described episodic stress related to system failures or water procurement.

In displacement contexts, water scarcity functions as a chronic psychosocial stressor shaped by infrastructure, acute climate events, and gendered household responsibilities. Addressing water insecurity in protracted displacement settings requires integrated WaSH approaches that extend beyond infrastructure to include mental wellbeing, gender-responsive programming, and meaningful engagement of refugees as lived-experience experts in governance and intervention design.