Digital mental health interventions (DMHIs) offer a potential solution to bridge the considerable treatment gap in mental health service delivery. Our objectives were to qualitatively examine barriers, facilitators, attitudes, and preferences toward DMHIs among patients with severe mental illness (SMI) and their caregivers.

In-depth interviews were conducted with remitted patients with schizophrenia or bipolar disorder and their caregivers. A semi-structured interview guide with open-ended questions and prompts was used. Interview sessions were audio-recorded and transcribed verbatim. Descriptive open coding was done. Generated inductive codes were arranged first into categories and then into themes.

Twelve patients with SMI and 12 caregivers were interviewed. Key barriers to the use of DMHIs were perceived ineffectiveness of technology-assisted consults (compared to in-person visits), perceived adverse effects, inadequate digital literacy, cognitive barriers such as forgetting details during teleconsultations, and concerns about confidentiality. Key facilitators included convenience, wide reach and availability, willingness to adapt, shared access to devices in households, and the potential of DHMIs to increase awareness about mental illness. Attitudes toward DMHIs were ambivalent, with concerns about technology-mediated clinical interactions but openness to personalized service delivery through technology, such as medication and appointment reminders, and toll-free contact numbers for emergencies. They also emphasized the importance of raising awareness about mental illness through DMHIs.

Patients with SMI and their caregivers identified significant structural and individual barriers to the use of DMHIs. We suggest that DMHIs for this group should be co-designed to address their needs and concerns, thereby enhancing uptake.

Alberta Family Integrated Care^TM (AB-FICare^TM) is a standardized, theory-driven model that integrates parents as primary caregivers in neonatal intensive care units (NICUs); however, its clinical effectiveness, implementation determinants, and cross-setting applicability require systematic synthesis. This narrative review aims to evaluate the evidence on AB-FICare^TM in Level II NICUs, focusing on neonatal and parental outcomes, implementation barriers and facilitators, and transferability to healthcare systems with distinct organizational and cultural contexts. Following SANRA guidelines, we systematically searched PubMed, Embase, Web of Science, and the Cochrane Library for studies published between January 2020 and June 2026. Ten reports from a single Canadian cluster randomized controlled trial met the inclusion criteria. The findings demonstrate that AB-FICare^TM significantly reduced the adjusted length of stay by 2.55 days (95% CI: -4.44 to -0.66, P = 0.02) without increasing readmissions or emergency visits, and improved parental experiences, specifically enhancing trust, engagement, and discharge readiness. However, exclusive human milk feeding at 2 months was lower in the AB-FICare^TM group (aOR = 0.51, 95% CI: 0.31-0.83, P = 0.01). Neurodevelopmental outcomes were mixed; while there was a signal for reduced communication delay at 6-24 months, this was not replicated at 18 months, whereas maternal parenting stress consistently predicted developmental delay (aORs > 1.03, P < 0.01). Key implementation facilitators included receptive organizational culture and stakeholder engagement, whereas barriers encompassed training burden and competing institutional priorities. Based on these findings, we propose that AB-FICare^TM implementation should move from one-size-fits-all adoption toward context-sensitive adaptation, integrating robust lactation support, post-discharge mental health services, and system-level coordination into a comprehensive framework covering NICU stay through community-based follow-up. Future research should prioritize long-term neurodevelopmental follow-up, formal cost-effectiveness analyses adhering to CHEERS standards, and multi-site validation across diverse healthcare settings to establish the generalizability and sustainability of AB-FICare^TM benefits beyond the Canadian context.

Hemophilia is a rare hereditary bleeding disorder characterized by a deficiency of clotting factor, resulting in an increased bleeding tendency. Historically, people living with hemophilia (plwh) were advised to avoid physical activity (PA) due to injury risk. Today, improved treatment options enable plwh more self-determined lifestyles. Moreover, medical perspectives on PA have shifted underlining the benefits of regular engagement in PA for physical and mental health. Nevertheless, youth and young adults living with hemophilia (yyalwh) show comparatively low exercise capacity and lack in sport-specific motor performance. Research on experiences and perspectives of plwh regarding participation in PA remains limited. Therefore, this qualitative focus group study aims to explore perceived barriers and facilitators to participation in PA among yyalwh.

Seven focus groups were conducted with 28 participants aged 14-30 years with different types and severities of hemophilia. Data were analyzed using a structuring qualitative content analysis approach. Factors perceived as supporting participation were categorized as facilitators, whereas factors perceived as hindering participation were categorized as barriers.

Five main categories related to participation were identified across multiple levels: individual, social, environmental, policy, and societal. Barriers and facilitators were found across all levels and interacted with each other. The social level emerged as particularly influential. Support from family members, doctors, and teachers was described as a key facilitator, while explicit restrictions negatively affected engagement. The societal level also proved to be highly relevant, since it interacts with the other levels and reflects ableist narratives that yyalwh face in everyday life.

Overall, participation in PA and sports among yyalwh is shaped by complex interrelations of barriers and facilitators across these levels. The findings may contribute to raising awareness of these dynamics and highlight the importance of involving yyalwh early in self-determined decision-making processes.

Scrotal content pain (SCP) is a clinically significant condition that can substantially impair quality of life. The causes of SCP are heterogeneous and may include urologic, neuropathic, musculoskeletal, vascular, inflammatory, referred, and psychosocial contributors. In some patients, dysfunction of the lower abdominal wall, inguinal canal, or pelvic floor may contribute to regional nerve irritation and persistent pain. The objective of this retrospective case series was to describe pain and quality-of-life outcomes following a multimodal physiotherapy protocol in men with persistent SCP.

 Twenty-eight men with persistent SCP, with a mean age of 42.1 years (95% CI, 36.3 to 47.9), who completed the four-week protocol and had complete baseline and post-treatment outcome data were included. The protocol consisted of four weekly sessions of class IV laser therapy, dry needling, pulsed electromagnetic field therapy, manual therapy, progressive therapeutic exercise, and daily oral tadalafil. Pain was measured before and after each session using a 10-cm visual analog scale (VAS). Physical and mental health were assessed before treatment and after the final session using the Patient-Reported Outcomes Measurement Information System (PROMIS) Global-10. Available follow-up data were reviewed for symptom recurrence and additional treatment.

Mean VAS pain decreased from 8.0 cm (95% CI, 7.8 to 8.2) before the first treatment session to 3.0 cm (95% CI, 2.6 to 3.4) immediately after the first session and to 0.8 cm (95% CI, 0.4 to 1.1) after the fourth session. PROMIS Global-10 Physical Health scores increased from 40.6 to 51.7, and Mental Health scores increased from 46.7 to 51.1. At three to six months, 25 patients were contacted, and none reported pain recurrence requiring additional treatment. At six to 12 months, 22 patients were contacted, of whom four reported recurrence that interfered with activities of daily living (ADL) and underwent additional treatment.

In this retrospective case series, completion of a four-week multimodal protocol was associated with substantial short-term reductions in self-reported pain and improvements in global physical and mental health in men with persistent SCP. Because the study lacked a control group, included multiple concurrent interventions, and had incomplete long-term follow-up, causality, component-specific effects, and treatment durability cannot be established. Prospective controlled studies are warranted.

People living with HIV/AIDS and violence-related trauma histories (PLWH/T) may have unmet mental health needs due to high rates of mental disorders coupled with mental health provider shortages, as well as other barriers to care. Our prior work with PLWH/T in Metro Atlanta revealed a desire for peer-delivered mental health and psychosocial support (MHPSS) services, such as peer mentorship/navigation, peer support groups, cognitive behavioral therapy, and Psychological First Aid/Mental Health First Aid.

In the present qualitative study, we assessed the feasibility of implementing or expanding these interventions through interviews with health care workers (HCWs) at Ryan White-funded clinics (RWCs) using the Consolidated Framework for Implementation Research to guide data collection and analysis.

Key barriers included structural characteristics (i.e., staffing limitations), lack of available resources (e.g., funding), and engaging innovation deliverers and innovation recipients. Key facilitators included financing (e.g., grants), need, and access to knowledge & information (e.g., training).

Overall, RWC HCWs perceived these interventions to be feasible to implement/expand. Future research should assess cost-effectiveness and explore pathways of mobilizing peers to deliver MHPSS interventions to PLWH/T.

This cross-sectional study aims to screen for depression and suicidal thoughts, as well as identify associated factors, among female trail runners. An online survey was used, collecting participants' sociodemographic data, trail running habits, medical indicators, and screening for depression (using the PHQ-9) and suicidal thoughts (using Q9 of the PHQ-9). A total of 318 female trail runners answered the survey. Depression was defined as PHQ-9 ≥ 10, and suicidal ideation was assessed using item 9 of the PHQ-9. Statistical analyses included chi-square tests and multivariate logistic regression to identify factors associated with a positive screening for depression and suicidal thoughts. A total of 18.9% participants had a positive PHQ-9 score, screening positive for major depression. Factors associated with a positive screening for depression were unemployment (p = 0.004), younger age groups (p = 0.033), trail running fewer than 3 years (p = 0.002) and never having been pregnant or given birth (p = 0.013). Unemployment was the only independent risk factor for depression (p = 0.005). More than 3 years of trail running (p = 0.013) and parity ≥ 1 (p = 0.036) were independent protective factors for depression. Overall, 7.9% participants answered "yes" to question 9 (Q9) of the PHQ-9, indicating the presence of suicidal ideations. Factors associated with a positive screening for suicidal thoughts were weekly training distance >50 km (p = 0.020), previous diagnosis of an eating disorder (p < 0.001) and never having been pregnant (p = 0.008) or given birth (p = 0.033). We present novel data on depression and suicidal thoughts in female trail runners. Nearly 1 in 5 female trail runners screened positive for depression and nearly 1 in 13 screened positive for suicidal thoughts. This highlights the importance of creating awareness for mental health and providing education and access to appropriate support.

This Bayesian network meta-analysis evaluates the comparative efficacy of cognitive interventions on cognitive function in elderly individuals with cognitive impairment.

Randomized controlled trials examining the effects of cognitive interventions on cognitive function in older adults aged 60 years and above with cognitive impairment were searched in the Cochrane Library, PubMed, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), China Biomedical Literature Service System (SinoMed), VIP Database, and Wanfang Data. The search covered the period from database inception to August 2025. Two researchers independently performed study selection, data extraction, and risk-of-bias assessment using the Cochrane risk-of-bias tool. RevMan 5.4 was used for risk-of-bias visualization, Stata 16.0 was used to construct the evidence network plots, and Bayesian network meta-analysis was conducted using the gemtc package in R version 4.5.2.

This meta-analysis incorporated 35 randomized controlled trials (RCTs), encompassing a total of 2,316 patients. Eight distinct cognitive intervention modalities were evaluated. Regarding the Mini-Mental State Examination (MMSE) scores, surface under the cumulative ranking curve (SUCRA) analysis revealed the following probability ranking for efficacy: computerized cognitive training (CCT; SUCRA = 81.08%), non-invasive brain stimulation (NIBS; SUCRA = 73.87%), cognitive stimulation therapy (CST; SUCRA = 67.24%), serious games (SUCRA = 65.64%), memory training (SUCRA = 61.79%), integrated cognitive training (SUCRA = 51.87%), virtual reality (VR; SUCRA = 27.02%), usual care (SUCRA = 14.38%), and olfactory training (OT; SUCRA = 7.10%). League table comparisons further demonstrated statistically significant improvements in MMSE scores compared to control groups for several interventions: CCT (mean difference [MD] = 2.14, 95% CI: 0.90 to 3.39), integrated cognitive training (MD = 1.28, 95% CI: 0.24 to 2.31), CST (MD = 1.70, 95% CI: 0.80 to 2.65), and serious games (MD = 1.67, 95% CI: 0.23 to 3.13). For the Montreal Cognitive Assessment (MoCA) scores, the SUCRA ranking was: memory training (SUCRA = 70.92%), CST (SUCRA = 70.63%), CCT (SUCRA = 69.71%), integrated cognitive training (SUCRA = 60.27%), virtual reality (VR; SUCRA = 48.24%), serious games (SUCRA = 46.16%), NIBS (SUCRA = 29.93%), and usual care (SUCRA = 4.15%). Significant enhancements in MoCA scores versus control were observed for: CCT (MD = 3.13, 95% CI: 1.79 to 4.50), integrated cognitive training (MD = 2.81, 95% CI: 1.41 to 4.28), and CST (MD = 3.26, 95% CI: 1.16 to 5.50).

Current evidence suggests that CCT, CST, memory training, and NIBS may be more effective interventions for improving cognitive function in elderly individuals with cognitive impairment.

Nurses frequently encounter demanding clinical environments that require effective coping to maintain performance and well-being. Psychological resilience has been recognized as a key personal resource that enables nurses to adapt to occupational stress. However, organizational factors, such as nurses' perceptions of strategic planning, may also shape how resilience translates into effective coping strategies.

This study aimed to examine the mediating role of strategic planning perception in the relationship between psychological resilience and coping strategies among nursing staff.

A quantitative cross-sectional correlational design was employed. A nonprobability convenience sample of 379 nurses working at Qena University Hospital, Egypt, participated in the study. Data were collected using the Strategic Plan Perception Scale, the Connor-Davidson Resilience Scale (CD-RISC-10), and the Coping Strategies Inventory Short Form (CSI-SF). Structural equation modeling (SEM) with path analysis was performed using SPSS and AMOS Version 23 to test the hypothesized mediation model while controlling for demographic and work-related variables. Bootstrapped confidence intervals were used to assess the significance of indirect effects.

Psychological resilience showed a significant positive association with coping strategies (β = 0.312, p < 0.001) and strategic planning perception (β = 0.521, p < 0.001). Strategic planning perception was also positively associated with coping strategies (β = 0.213, p < 0.001). Mediation analysis revealed that strategic planning perception partially mediated the relationship between psychological resilience and coping strategies (indirect effect = 0.181, 95% CI [0.016, 0.088], p < 0.001), with the indirect effect accounting for approximately 37% of the total effect.

Strategic planning perception was identified as an organizational mechanism associated with the relationship between psychological resilience and coping strategies among nursing staff. Both individual psychological resources and organizational planning processes were found to be related to nurses' responses to workplace stress. These findings suggest that integrated approaches simultaneously strengthening personal resilience and enhancing organizational communication and participatory planning may be beneficial.

Nursing leaders may consider strengthening resilience development initiatives and promoting transparent and participatory strategic planning processes. Enhancing nurses' understanding and involvement in organizational planning may be associated with adaptive coping and contribute to workforce resilience. Future longitudinal research is needed to establish causal relationships and evaluate the effectiveness of integrated interventions targeting both personal and organizational resources.

Systems thinking has been promoted to address complex public health challenges involving fragmented systems, multi-sectoral governance, and interacting social determinants of health. However, its application in real-world public health interventions and the conditions influencing implementation remain understudied. This systematic review examines how systems thinking has been operationalized in public health interventions, identifies key facilitators and barriers to implementation, and interprets these findings in relation to broader public health practice and ongoing health system reforms in Saudi Arabia.

We conducted a systematic review (2013-2025; final search November 2025) using PubMed, Scopus, Web of Science, CINAHL, and PsycINFO. Studies applying systems thinking in population- or community-level public health interventions with implementation findings were included; conceptual and non-intervention studies were excluded. Data on approaches, frameworks, facilitators, and barriers were extracted and narratively synthesized. Quality was appraised using the MMAT (2018). The review was registered (PROSPERO; registration number CRD420251267775).

Of 948 records identified, fifteen studies met the inclusion criteria, spanning communicable and non-communicable disease interventions across high-, middle-, and low-income countries. Systems thinking approaches included learning health systems, systems analysis and improvement approaches, community-based system dynamics, causal loop diagramming, and whole-system or multi-sectoral designs. Systems thinking was embedded within implementation processes, including iterative learning cycles, participatory system mapping, and quality improvement mechanisms. Key facilitators included stakeholder engagement and co-production, integration within existing health system structures, incremental capacity building, and leadership support. Barriers included challenges translating systems concepts into actionable interventions, workforce constraints, fragmented or non-interoperable data systems, rigid governance arrangements, and external disruptions such as COVID-19. Study designs were predominantly qualitative or mixed methods, with heterogeneity in evaluation approaches and limited long-term outcome assessment.

Systems thinking in public health is applied mainly as an implementation-embedded practice rather than an analytical tool. Its effectiveness depends on participatory processes, adaptive learning, and supportive governance and data systems. These findings provide practical insights for health system reform contexts, including Saudi Arabia, where systems thinking can support integrated and adaptive public health interventions.

Attention-Deficit/Hyperactivity Disorder (ADHD) is a prevalent neurodevelopmental disorder that persists in adulthood, affecting academic performance and daily functioning. Despite its significance, limited research has explored the prevalence of ADHD-like symptoms among university students in Egypt. This study aims to estimate the prevalence of ADHD Symptoms among Egyptian university students and identify associated factors. A cross-sectional study was conducted using an online self-administered questionnaire among students aged ≥ 18 years or older from various Egyptian universities. The Adult ADHD Self-Report Scale (ASRS) was used to assess ADHD symptoms. A non-probability convenience sampling technique was applied, and multivariable logistic regression was performed to determine associated risks of ADHD positivity. A total of 3,136 responses were collected, with 2,383 valid responses included in the final analysis. The estimated prevalence of ADHD SYMPTOMS was 37.9% (95% CI: 36.0%-39.9%), obesity (OR = 2.09, 95% CI: 1.14-3.95, p = 0.019), smoking (OR = 1.93, 95% CI: 1.25-3.01, p = 0.003), sleep disorders (OR = 2.12, 95% CI: 1.77-2.55, p < 0.001), childhood trauma (OR = 1.42, 95% CI: 1.18-1.71, p < 0.001), and history of mental health conditions (OR = 1.71, 95% CI: 1.34-2.18, p < 0.001). Regular exercise was associated with lower odds of ADHD (OR = 0.55, 95% CI: 0.44-0.70, p < 0.001). Prevalence of ADHD-like symptoms among Egyptian university students is notably high, with multiple lifestyle and psychosocial factors showing significant associations with its occurrence. These findings highlight the need for increased awareness, early screening, and targeted interventions to support affected students. Future research should further investigate the cultural and educational influences on ADHD in Egypt.