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With the World Health Organization (WHO) estimating 720,000 deaths from suicide each year, the phenomenon of suicide is a priority in public health policy. International policy frameworks highlight the need to adopt biopsychosocial perspectives in order to understand the phenomenon of suicide; however, in practice, it is noted that social components play a minor role in policy design, with a preference for a biopsychological and clinical approach. This paper seeks to answer the question: Does Spanish public policy on suicide prevention operationalize the biopsychosocial model of suicide in its strategic implementation? To answer this question, a documentary analysis of public policies is carried out using the READ method. Current suicide policies in force in Spain are examined at three levels: transnational framework documents, national policies, and regional public policies. In the 15 policies analyzed, a lexicometric analysis is combined with a thematic qualitative policy analysis. The results show that, as one moves down to policies closer to the population, a gap emerges between the discursive use of the biopsychosocial model and its practical application. It is concluded that at the transnational and national policy levels, the biopsychosocial model predominates in the understanding of suicide, while in Spain’s autonomous communities, the psychobiological approach tends to be prioritized over social causes. This has an impact on the types of measures proposed, which have limited intersectional scope, a narrow view of the community-based approach, and prioritize healthcare resources to address the phenomenon of suicide.

Aims and background: The sleep-wake cycle and sleep consolidation are essential to children's growth and development.There is a paucity of studies on the sleep characteristics and the effect of electronic media on them in healthy Indian infants and toddlers.The objectives were to assess the sleep characteristics of healthy Indian infants and toddlers and to examine the impact of electronic media on them.Materials and methods: This was a cross-sectional study at a tertiary center in India, among healthy children aged 3-36 months.Those with concurrent illness (e.g., gastroenteritis, respiratory illness) were excluded.A Hindi version of the Revised Brief Infant Sleep Questionnaire (BISQ-R) was used to assess sleep patterns.Results: A total of 100 children were enrolled during the study period; their median (IQR) age was 12.1 (3.5, 18) months, with most of them being males (74%).The median (IQR) total sleep duration was 11 (10.0,13.3) hours.Electronic media exposure was noted in 83 (83%) children.Of them, 27 (32.5%)children were exposed to ≥1 hour/day.There was no significant difference in sleep duration, night awakenings, or wakefulness between media-exposed and media-unexposed groups in children.Similarly, there was no significant effect of media exposure on sleep characteristics.Conclusion: Sleep duration in infants and toddlers was below the international recommendation.A majority of children had exposure to electronic media, and one-third had exposure of at least 1 hour.Approximately three-fourths of parents didn't perceive the child's sleep problems.Clinical significance: There is an urgent need to routinely evaluate sleep characteristics in infants and toddlers and to increase awareness of sleep hygiene and media exposure among parents.

Purpose: The COVID-19 pandemic has increased the workload of medical personnel providing patient care, particularly inpatient nurses. Field interviews with nurses at hospitals in Bandung City indicated increased fatigue and sleepiness during the new normal adaptation period. This study aimed to measure mental workload and sleepiness among inpatient nurses in Bandung City. Methodology: A total of 275 inpatient nurses participated by completing the National Aeronautics and Space Administration Task Load Index (NASA-TLX) questionnaire to assess mental workload and the Karolinska Sleepiness Scale (KSS) to measure sleepiness. Results: Mental workload among inpatient nurses ranged from high to very high, with scores between 76.93 ± 13.18 and 81.36 ± 13.53. Hospital characteristics, gender, age, and marital status were identified as factors associated with excessive mental workload. KSS scores indicated that nurses were in the very alert to alert range after completing their duties. Furthermore, 60.73% of nurses experienced very high mental workload, while 68.73% were classified as very alert. Conclusion: The findings indicate the need for hospital management to improve working conditions through better shift scheduling, resource allocation, and equitable distribution of staff support facilities to address the needs of inpatient nurses. Originality: This study examines mental workload and sleepiness simultaneously among inpatient nurses in Bandung City and identifies factors associated with excessive mental workload, providing a basis for improving hospital workforce management during the new normal adaptation period.

Background Achieving early glycemic control in adolescents with diabetes is associated with improved short- and long-term health outcomes. The aim of this study was to examine the relationship between eating attitudes and glycemic control, as well as the factors associated with eating attitudes and glycemic control, in adolescents with diabetes. Methods This descriptive cross-sectional study included 143 adolescents with diabetes, aged 10–19 years, who attended a research hospital between February and April 2024. The data were collected using a Descriptive Information Form, Eating Attitudes Test (EAT) and an information form questioning the values of some metabolic variables. Results The mean age of the participants was 14 ± 2.3 years and 49.7% had diabetes between 1–5 years. The mean total score of the EAT scale was 16.62 ± 8.30. The mean score of the “Dieting” subscale of the EAT scale was 10.39 ± 5.58, the mean score of the “Bulimia food preoccupation” subscale was 2.33 ± 3.03 and the mean score of the “Oral Control” subscale was 3.79 ± 3.08. There was no significant difference between the mean EAT total score and glycemic control. Conclusions The mean EAT-26 total score was below the commonly used cutoff score, and no significant association was found between EAT-26 scores and HbA1c. Differences in EAT-26 total and subscale scores were observed according to selected demographic and clinical characteristics, including BMI, treatment modality, and treatment adherence. These findings describe self-reported eating attitudes in the study sample and support the inclusion of eating-related assessment within the holistic care of adolescents with Type 1 DM.

Background Most person-centered research on exercise motivation has identified static profiles, leaving unclear how motivational configurations change over time, what psychological experiences are associated with those changes, and whether transitions predict subsequent exercise. This study examined the short-term mobility of exercise-regulation profiles, psychological-need predictors of specific transitions, and their prospective associations with later leisure-time exercise. Methods A three-wave prospective study followed 1,780 students from six Chinese colleges at approximately 4-week intervals. Exercise regulation, exercise-specific psychological need satisfaction and frustration, and leisure-time exercise were assessed at each wave. Continuous-indicator latent transition analysis identified longitudinal motivational profiles and transition probabilities. Posterior-probability-weighted models examined origin-wave need satisfaction and frustration as predictors of eligible transitions and tested whether first-interval transitions were associated with final-wave exercise after prior exercise was considered. Results Six profiles were retained: amotivated–controlled, low-regulation, mixed intrinsic–controlled, identified-dominant, intrinsic-dominant, and high autonomous–introjected. Overall profile stability was substantial but incomplete, with 76.9 and 73.8% of posterior transition mass remaining on the stability diagonal across the two intervals. The largest off-diagonal transition was from low regulation to high autonomous–introjected motivation (18.0 and 20.1%). After Holm correction, greater need satisfaction was associated with lower odds of moving from intrinsic-dominant or high autonomous–introjected motivation to low regulation (odds ratios = 0.47–0.49), whereas greater need frustration was associated with lower odds of moving from low regulation to identified- or intrinsic-dominant profiles (odds ratios = 0.41–0.62). In models controlling baseline exercise, movement from amotivated–controlled or low regulation to high autonomous–introjected motivation was associated with greater subsequent exercise, whereas several transitions toward less internalized configurations were associated with lower exercise. After additional adjustment for exercise measured at the transition endpoint, only the low-regulation-to-high autonomous–introjected transition remained significant. Conclusion Exercise motivation was substantially stable yet meaningfully mobile over short periods. Psychological-need experiences were associated with specific, origin-dependent motivational transitions, and selected transitions prospectively differentiated later exercise behavior. The findings support a dynamic and state-dependent view of exercise motivation and suggest that the psychological conditions relevant to maintaining internalized motivation may differ from those involved in moving out of low regulation.

This study evaluated the implementation and operational viability of the LGU Malay Mental Health Ordinance using the seven-component Project EMBRACE framework. The study addressed a local evidence gap by examining not only whether ordinance activities were implemented but also whether the workforce, referral, infrastructure, monitoring, and partnership conditions required for sustained delivery were present. A convergent parallel mixed-methods design was used. Quantitative data were obtained from 50 program implementers through a validated researcher-developed questionnaire (Cronbach's alpha = 0.962), while qualitative data were collected through Focus Group Discussions with 10 adult mental health service clients from Mainland Malay and Boracay Island. Means and standard deviations summarized five-point viability ratings, and qualitative transcripts were thematically analyzed; the two strands were integrated by comparing convergent, complementary, and divergent findings. The ordinance obtained an overall viable assessment, but component results were uneven. Wellness of Daily Living (M = 3.75), Mental Disorder (M = 3.65), Substance Abuse and Other Forms of Addiction (M = 3.72), and Provision of Services for Mental, Neurologic, and Substance Disorders (M = 3.45) were rated Viable. Extreme Life Experience (M = 3.11), Neurologic Disorders (M = 3.37), and Enhancement of Mental Health Facilities and Partnerships (M = 3.29) were Moderately Viable. Service-user accounts generally supported these patterns and highlighted limited specialist access, psychosocial workforce gaps, dependence on external referrals, and infrastructure constraints. The findings indicate that Malay has established a functional community mental health foundation, but long-term viability requires prioritized investment in crisis-response personnel, neurologic referral capacity, facilities, formal partnerships, continuity-of-care mechanisms, and integrated monitoring.

Autoimmune conditions may affect wellbeing through symptoms, treatment demands, uncertainty and disruption to daily activities. This cross-sectional study examined subjective psychological wellbeing among adults living with autoimmune conditions and its association with illness-related factors. The project reports data from 21 participants. Wellbeing was measured using the World Health Organization Five Well-Being Index (WHO-5), scored from 0 to 100, alongside a researcher-developed illness-impact questionnaire. The reported mean WHO-5 score was 31.05 (SD = 21.61; median = 32; range = 0?88). Illness duration was not significantly associated with wellbeing (r = .043, p = .857; n = 20). Greater perceived severity (ρ = -.587, p = .005), treatment burden (ρ = -.519, p = .016) and interference with daily activities (ρ = -.754, p < .001) were associated with lower wellbeing. The gender comparison was not statistically significant (U = 53.0, p = .299). These preliminary results require verification against the anonymized dataset. The small, mixed-diagnosis sample and cross-sectional design limit generalizability and causal interpretation.

Background Yoga is a multidimensional mind–body practice, yet little is known about whether the weekly practice frequency of its individual components is differentially associated with subjective wellbeing (SWB). This study examined the associations between the weekly practice frequency of asana, pranayama, relaxation, and meditation and SWB among Hungarian yoga practitioners. Methods A cross-sectional online survey based on convenience snowball sampling was conducted in April–May 2021, during the COVID-19 pandemic, among 379 adult yoga practitioners (44.31 ± 10.12 years). SWB was assessed using the World Health Organization-Five Wellbeing Index (WHO-5). Associations between participant characteristics and SWB were examined using one-way ANOVA and Pearson’s correlations. Separate ANCOVA models examined associations between the weekly practice frequency of each yoga component and SWB after adjustment for place of residence, other physical exercise, yoga practice duration, and yoga expertise (Holm–Bonferroni corrected). Independent associations were examined using multiple linear regression, with a dummy-coded sensitivity analysis. Results Place of residence, yoga expertise, other physical exercise, and, weakly, yoga practice duration were associated with SWB. After adjustment, all four yoga components remained significantly associated with higher SWB (corrected p ≤ 0.029), with medium effect sizes for asana (ηp 2 = 0.070) and meditation (ηp 2 = 0.061) and small effect sizes for pranayama (ηp 2 = 0.050) and relaxation (ηp 2 = 0.024). Daily practice was consistently associated with the highest SWB. The regression model explained only 12.9% of the variance in SWB (Cohen’s f 2 = 0.15), and only asana ( B = 0.69, 95% CI [0.22, 1.17]) and meditation frequency ( B = 0.61, 95% CI [0.21, 1.00]) remained independently associated with SWB, as supported by the sensitivity analysis. Conclusion In this predominantly female, highly educated convenience sample, more frequent weekly practice of all four yoga components was associated with higher SWB. However, after accounting for participant characteristics, yoga experience, and the overlap among components, only asana and meditation frequency remained independently associated with SWB. These associations were small, and most of the variance in SWB remained unexplained. Given the cross-sectional design, causal conclusions cannot be drawn and generalization should be cautious; longitudinal and intervention studies of individual yoga components are needed.

Objective: To investigate the relationship between orthorexia dimensions, specifically healthy orthorexia (HeOr) and orthorexia nervosa (OrNe), and hematological inflammatory markers.Methods: This cross-sectional, analytical study included 218 healthy volunteers (73.9% male, median age: 25.0 years) who were evaluated between February 2026 and April 2026.Sociodemographic profiles and the Teruel Orthorexia Scale scores were obtained.Complete blood count parameters and inflammatory indices, including the monocyte-to-lymphocyte ratio (MLR) and systemic inflammation response index (SIRI), were analyzed.Results: HeOr scores demonstrated significant negative correlations with white blood cell count (r = -0.163,P = 0.016), neutrophil count (r = -0.160,P = 0.019), monocyte count (r = -0.244,P < 0.001), platelet count (r = -0.168,P = 0.013), MLR (r = -0.134,P = 0.049), and SIRI (r = -0.185,P = 0.006).Conversely, OrNe scores exhibited a significant negative correlation only with monocyte count (r = -0.171,P = 0.012) and showed no significant associations with other hematological parameters or systemic inflammatory indices.Conclusion: Individuals with higher HeOr tendencies display a healthier systemic inflammatory profile, likely reflecting beneficial dietary choices.Despite being characterized by more rigid cognitions and behaviors toward healthy eating, OrNe tendencies do not manifest a healthier inflammatory profile.

Background Cumulative exposure to adverse childhood experiences (ACEs) is associated with an increased risk of substance use, overdose, and suicide. Rural children are more likely to experience most ACEs. There is limited literature contextualizing rural individuals’ experiences with ACEs. Public Health 3.0 calls for multisector partner engagement to generate collective impact. The purpose of this study was to evaluate rural providers’ perspectives on challenges and recommendations for ACEs mitigation in their community from a cross-sector context. Participants and setting Participants were 74 providers enrolled in an online ACEs training. Participants lived and/or worked in five rural Missouri counties with high drug overdose death rates. Methods This was a conventional content analysis of written responses to structured discussion prompts from three training modules. Analysis included familiarization, inductive identification of major codes, and refinement of codes, followed by independent coding by two authors until consensus, and reporting major patterns. Artificial intelligence supported preliminary code development. An adapted Sequential Intercept Model (SIM) framework organized challenges and recommendations by setting. Results Results included personal stories about how ACEs impacted their communities through overdose, suicide, homelessness, unemployment, and adverse health effects. Settings included schools, government, healthcare, daycares, criminal justice, Extension, fire departments, libraries, and nonprofits. Participants recommended expanding the ACEs definition to include satanic abuse, bullying, incest, war, genocide, military family stressors, and death of a loved one. Intervention recommendations included whole-family interventions, community-wide training, trauma-informed training, expanded access to treatment, classes in prison/jails, and fostering positive childhood experiences. Conclusion Community voice is necessary to contextualize setting-specific insights that inform development of upstream interventions appropriate for and tailored to the community. Participants identified both strategies that could be incorporated into everyday practice—including empathy, listening, providing judgment-free and safe spaces, providing food for children experiencing hunger, encouraging positive childhood experiences, mentoring, and connecting individuals with resources for food, shelter, clothing, and mental health—and broader structural changes that may require policy-level action. The adapted SIM organizes these concepts.

It has also taken over a century for science to fully realize that oxytocin is far more than a “female reproductive hormone.” Both the measurement and interpretation of the biochemical and functional properties of oxytocin have raised controversy and remain works in progress. However, oxytocin is now recognized as a pleiotropic molecule that sits at the center of an extended system which includes vasopressin, the autonomic nervous system, the immune system and more. This larger system affects essentially every bodily function and helps to coordinate these with social context, the history of each individual and perhaps the existence of humans as a species. Together these support survival, reproduction and wellbeing, allowing mammals to manage and benefit from various forms of hormetic challenge. Here we suggest that oxytocin, viewed as a system, in turn acts as a keystone capable of connecting mammalian regulatory physiology to the benefits of social connection.

Background Eating-related behavioural factors may contribute to the complexity of glycaemic management in type 2 diabetes mellitus (T2DM), but their relationships with treatment context remain insufficiently understood. This study examined hedonic hunger and eating-disorder symptom dimensions in relation to glycaemic control across different treatment regimens in adults with T2DM. Methods This cross-sectional study included 203 adults with T2DM attending an outpatient diet clinic in southeastern Turkey between March and September 2025. Participants were receiving oral antidiabetic medication only ( n = 108), insulin only ( n = 32), or combined oral medication plus insulin therapy ( n = 63). Hedonic hunger was assessed using the Power of Food Scale (PFS), and eating-disorder symptom dimensions using the 13-item Eating Disorder Examination Questionnaire–Short Form (EDE-Q-13). Anthropometric measurements, 24-h dietary recall data, fasting plasma glucose (FPG), and glycated haemoglobin (HbA1c) were obtained. Hierarchical linear regression was used to examine factors associated with HbA1c. Results HbA1c differed substantially across treatment groups and was highest in the insulin-only group ( p < 0.001). Several PFS subscales and EDE-Q-13 symptom dimensions also differed between groups, although their effect sizes were small. Selected PFS dimensions were weakly positively correlated with glycaemic indicators, whereas the EDE-Q-13 eating-restraint subscale and total score showed weak inverse correlations with HbA1c. In the fully adjusted model, insulin-only and combination therapy were associated with higher HbA1c compared with oral medication only, while body mass index (BMI) was inversely associated with HbA1c. Neither the PFS food available subscale nor the EDE-Q-13 total score remained independently associated with HbA1c. The final model explained 27.2% of the variance in HbA1c (adjusted r 2 = 0.230). Conclusion Treatment context was more strongly related to glycaemic status than the behavioural measures assessed, although modest differences in hedonic hunger and eating-disorder symptom dimensions were evident across treatment regimens. These findings suggest that eating-related behavioural characteristics may provide complementary information in nutritional assessment and should be interpreted alongside the broader clinical context of T2DM management.

Background Psychedelic retreats are increasingly used to promote wellbeing outside clinical settings, yet the psychological processes associated with sustained improvements in wellbeing remain poorly understood. From a public mental health perspective, identifying mechanisms that support positive mental health beyond symptom reduction is of growing importance. Methods This naturalistic longitudinal study followed 173 participants attending guided psilocybin retreats conducted within a structured framework of preparation, dosing, and integration. Mental wellbeing was reported before the retreat and across a 12-month follow-up period. Longitudinal changes were examined using linear mixed-effects models. Mediation analyses investigated whether changes in connectedness, neuroticism (anxiety facet), spiritual transcendence, and absorption were associated with changes in wellbeing. Mystical-type experiences were examined as potential predictors of these psychological changes. Results Participants reported substantial and sustained improvements in mental wellbeing over 12 months, moving from levels below Swedish population norms at baseline toward comparable levels at follow-up. Connectedness showed the strongest statistical association with improvements in wellbeing and accounted for the largest proportion of variance in wellbeing change, followed by reductions in the anxiety facet of neuroticism and absorption. Spiritual transcendence was associated with wellbeing improvements when examined separately but did not retain unique effects in the multiple mediation model. More intense mystical-type experiences predicted greater increases in connectedness, spirituality, and absorption, as well as greater reductions in neuroticism (trait anxiety). The association between mystical experiences and wellbeing was substantially attenuated when connectedness was included in the model, suggesting that connectedness may act as a candidate mediator linking mystical-type experiences to longer-term wellbeing, though the observational design precludes causal inference. Conclusions These findings extend prior work on psychedelic-assisted therapy to naturalistic retreat settings, suggesting that connectedness may represent a key psychological process linking psychedelic retreat experiences to sustained improvements in mental wellbeing. From a public mental health perspective, the results highlight the potential importance of social and relational factors in promoting wellbeing beyond the treatment of mental illness. Future controlled studies are needed to clarify the relative contributions of psychedelic, social, and contextual components.

Background Sleep duration is an important component of healthy aging, yet gender differences in short and long sleep among older adults remain insufficiently understood. This study aimed to examine gender differences in sleep duration among Chinese older adults and quantify the contributions of socioeconomic, behavioral, functional, and health-related factors to these differences. Methods Data were obtained from 9,590 adults aged ≥65 years who participated in the 2018 wave of the Chinese Longitudinal Healthy Longevity Survey. Sleep duration was self-reported and categorized as short (<6 h), normal (6–8 h), or long (>8 h). Multinomial logistic regression was used to identify factors associated with short and long sleep, with weighted analyses and Poisson regression performed as sensitivity analyses. Separate Fairlie decomposition analyses were conducted for short and long sleep to quantify the contributions of observed characteristics to gender differences. Results Overall, 44.95% of participants had abnormal sleep duration, with a higher prevalence among women than men (46.87% vs. 42.66%, p < 0.001). Compared with men, women had a higher relative risk of short sleep (RRR = 1.399, 95% CI: 1.204–1.625) but a lower relative risk of long sleep (RRR = 0.856, 95% CI: 0.754–0.972). The association with short sleep remained significant in the weighted analysis (RRR = 1.530, 95% CI: 1.210–1.935), whereas the gender difference in long sleep was attenuated (RRR = 0.821, 95% CI: 0.661–1.021). For short sleep, observed characteristics explained 21.65% of the gender disparity. Education (22.75%), depressive symptoms (11.07%), IADL limitation (6.02%), and self-assessed health (4.82%) contributed positively to the disparity, whereas smoking status (−22.57%), drinking status (−12.45%), and exercise (−4.87%) partially offset it. The gender difference in long sleep was negligible, with substantial offsetting contributions across factors. Conclusion Gender differences in sleep duration among Chinese older adults were primarily concentrated in short sleep, with women experiencing a higher risk. Socioeconomic, behavioral, psychological, and functional characteristics contributed to this disparity, although most of the short-sleep difference remained unexplained. Gender-sensitive interventions addressing educational disadvantage, depressive symptoms, functional limitations, and health behaviors may help reduce inequalities in sleep duration among older adults.

Background: Patients with pulmonary tuberculosis (TB) undergoing treatment may experience poor sleep quality and fatigue, potentially affecting daily activities and quality of life. Objective: This study aimed to examine the relationship between sleep quality and fatigue levels among patients with pulmonary TB undergoing treatment. Methods: This observational analytic study employed a cross-sectional design. The study was conducted in April 2026 at Primary Health Center X, Deli Serdang Regency, Indonesia, involving 21 participants selected through total sampling. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), while fatigue was measured using the Fatigue Severity Scale (FSS). Spearman's correlation test was planned with a significance level of α = 0.05. Results: According to the data presented in the manuscript, 14 participants (66.7%) had poor sleep quality, while 7 participants (33.3%) had good sleep quality. Moderate fatigue was the most frequent category, reported in 8 participants (38.1%), followed by severe fatigue in 7 participants (33.3%) and mild fatigue in 6 participants (28.6%). Cross-tabulation indicated that all participants classified as having severe fatigue belonged to the poor sleep quality group. Conclusion: The descriptive findings suggest a tendency toward greater fatigue among patients with poor sleep quality. However, the statistical significance of this relationship remains unconfirmed pending verification of the analysis using individual participant data

Introduction: During the first year of the COVID-19 pandemic, the global prevalence of anxiety and depression rose by about 25%, with women and young people most affected. Now that the emergency phase is over, it is necessary to know the mental health status of university students' families, a group that is rarely measured directly. Objective: To describe the levels of anxiety, depression and perceived stress among nursing students and their family members, and to explore their relationship with age, gender, socioeconomic stratum and religion. Methods: Quantitative, descriptive, cross-sectional study with non-probability convenience sampling. Thirty-nine people aged 17 to 79 took part: third-semester nursing students at Universidad Metropolitana de Barranquilla and their family members. The GAD-7, the PHQ-9 and the 10-item Perceived Stress Scale (PSS-10) were administered. Associations were tested with the chi-square test and, because of the small cell counts, with an exact test estimated by Monte Carlo simulation.Results: Of the participants, 67% were women, 31% were aged 17 to 25, 49% belonged to socioeconomic stratum 2 and 87% were Catholic. Absence of symptoms and mild levels predominated. Mild anxiety was the most frequent category among those aged 17 to 25 (66.7%), and 25% of those aged 44 to 52 had severe anxiety. The chi-square test suggested an association between age and anxiety (p = 0.046), but the exact test did not confirm it (p = 0.080). No other variable was significantly associated with anxiety, depression or stress. Conclusions: Participants mostly showed mild or no symptoms, with no significant differences by sociodemographic variables. The cross-sectional design and the sample size do not allow these levels to be attributed to the pandemic, but the cases of severe anxiety and moderately severe depression among middle-aged family members warrant follow-up of family mental health in the post-pandemic period.

Background and objectives Health literacy in adulthood plays a major role in an individual’s ability to use health information to benefit their health. Social determinants in early childhood initiate the development of health literacy through newborn brain development and oral language acquisition. Both of these processes are promoted by stimulation from everyday interactions with parents/caregivers at home and in the community. Unequal access to language-learning opportunities during early childhood represents a modifiable developmental and social determinant of later educational and health outcomes. There are inequities in these time-sensitive interactions—specifically language-learning opportunities—across families in the population, which are social determinants of early literacy, achievement in school, and later-life education, health, and economic and social well-being across the life span. This gap is most pronounced among children who grow up in poverty in the United States and internationally. The healthcare system in the United States effectively reaches to nearly all infants; however, language-learning opportunities are not a focus during well-child visits. The term “Language Nutrition” (LN) was coined in prior research to refer to these developmentally rich interactions known to support brain and language growth in children younger than preschool age. We developed Kansas City Brain Builders (KCBB) to address this inequity by promoting LN broadly among families and children in a community so that all children have a more equitable home language environment. The purpose of this study is to report longitudinal empirical findings on families and children related to the implementation of KCBB, a public health approach to community change, over 2 years. Methods The evaluation involved two parallel longitudinal studies: the Community study and the Family study. The Community study assessed the implementation of a KCBB multisectoral community partnership to promote LN-friendly changes in local programs, practices, and policies. The Family study involved longitudinal assessments of a sample of 83 English- and Spanish-speaking families with children younger than 36 months of age, evaluating the KCBB impacts on parental behaviors and child growth in language skills. Results KCBB led to a high level of documented program implementation and substantial LN promotion throughout the community. Repeated parent assessments indicated that participants had received LN messages from multiple community sectors over time, increased their knowledge of the importance of LN, and used LN through storybook reading, verbal responsiveness, and teaching behaviors during interactions with their children. Growth in children’s early language skills was significantly associated with the amount of LN they received. Discussion/Conclusion KCBB is one of the few multisectoral interventions designed to promote community-wide change targeting LN. It is a manualized intervention that can be replicated by other communities. This study employed three levels of measurement such that change could be evaluated in a theoretical framework of influence from community engagement to parental behavior and growth in child language skills. Findings provide preliminary evidence that a multisectoral community approach can achieve broad reach and is associated with changes in caregiver practices and child language growth. Larger, controlled, and replicated studies are needed to establish causal effects and determine whether such approaches reduce disparities in language-learning opportunities.

Introduction Transgender and gender diverse (TGD) older adults in the United States (U.S.) face barriers to accessing health information and resources they need to make informed healthcare decisions. More resources are needed to promote their agency and preparedness to navigate an increasingly complex healthcare system and sociopolitical landscape. The purpose of this study was to develop a testable web-based resource to support informed healthcare decision-making for TGD older adults. Methods This multimethod co-design study integrated a human-centered design approach that centered the perspectives of TGD older adults in the research process. In the prototyping and testing phases of the study, TGD adults and multidisciplinary professionals from across the U.S. were enrolled to co-develop a web-based resource with the research team during individual and paired interviews. Participants also completed a demographic questionnaire and a website usability survey. Thematic analysis of qualitative data was used to identify design themes, which guided iterative prototyping of the web-based resource. Quantitative data were analyzed descriptively. Complementary data from the usability survey and participant interviews were integrated in a joint display. Results A total of 27 participants, of whom 14 (52%) were TGD older adults, enrolled in the prototyping and testing phases. Analysis of qualitative data across both phases yielded five design themes that structured the development of a functional web-based resource: (1) Facilitating healthcare decisions through information and resources; (2) Organizing complex content with clarity and inclusivity; (3) Maintaining security, accessibility, and navigability; (4) Phasing rollout to communities and organizations; and (5) Planning for leadership, stewardship, and partnership. In the prototyping phase, three low- and mid-fidelity prototypes of a health information and resources website for TGD older adults were developed. In the testing phase, participants trialed a mid-fidelity prototype of the website, and their recommendations for improvements were integrated into a high-fidelity prototype for dissemination. Conclusion This study is one of few studies using participatory methods to engage TGD older adults in public health research. Through the development of a health information and resources website, this study demonstrates an innovative and feasible community-based co-design approach to addressing barriers affecting healthcare decision-making for TGD older adults.

Background Diabetes frequently co-occurs with depression, anxiety, and diabetes-related distress, and psychological status directly influences glycaemic control and the risk of complications. Traditional mental health assessment relies on subjective scales. With the growth of digital health, digital phenotyping offers a new paradigm for real-time, objective mental health monitoring and prediction. However, the pathways through which these technologies perform monitoring and prediction remain unclear. Objective This scoping review aimed to systematically map the application pathways of digital phenotyping for mental health monitoring and prediction in people with diabetes, and to use machine learning-assisted text mining to analyse the main research themes and hotspots, thereby informing the future development of individualised risk prediction models and monitoring systems. Methods A scoping review search was conducted in six English databases (PubMed, Embase, CINAHL, Web of Science, Scopus, and the Cochrane Library) and four Chinese databases (CNKI, Wanfang, VIP, and China Biomedical Literature Database[CBM]), covering studies published from database inception to 10 September 2026. The search strategy was built around terms related to diabetes, digital phenotyping, and mental health. Machine learning-assisted literature mining was used to identify thematic patterns in the included studies. The study selection process and overall workflow followed the PRISMA extension for scoping reviews (PRISMA-ScR). Results A total of 2,968 records were retrieved. After screening, 10 studies were included. The evidence indicated that digital phenotyping mainly enables real-time monitoring of mental health in people with diabetes through signals such as continuous glucose monitoring (CGM), passive smartphone sensing, voice, and ecological momentary assessment (EMA). Machine learning methods were widely used for risk prediction modelling, but most studies built models at the group level, with only a few adopting n -of-1 analysis or subgroup prediction to achieve individualised risk prediction. External validation of models was generally lacking, and no intervention studies were identified. Conclusions Preliminary evidence suggests that digital phenotyping has exploratory potential for mental health monitoring and prediction in people with diabetes, but research that genuinely achieves individualised risk prediction remains limited. Closed-loop monitoring-intervention design and multicentre external validation are the main directions for future research. Systematic Review Registration https://osf. io/6wsaj/ .

Background As global aging accelerates, age-related psychophysiological conditions have emerged as major public health concerns. Promoting and sustaining vitality, an inherent human capacity, is essential for healthy aging and long-term well-being. The Mindfulness-based Vitality Promotion (MVP) program is a mindfulness-based behavioral intervention designed to enhance physical and psychological vitality and support sustainable well-being. This study evaluated the feasibility and acceptability of the MVP program and explored preliminary pre–post changes in health-related outcomes among community-dwelling individuals in a lifelong learning setting. Methods This study employed a single-arm mixed-methods design. A total of 35 participants were recruited for this study. The MVP program was delivered over 8 weeks, with each session lasting 90 min. Quantitative data were collected through self-report questionnaires, and qualitative data were obtained via semi-structured interviews. Feasibility and acceptability were assessed based on program retention, session attendance, and participant satisfaction. Results Quantitative analysis revealed significant pre–post increases in integrative vitality and well-being, along with significant reductions in depression, fatigue, and anxiety. No statistically significant changes were observed in pain, sleep disturbance, digestive symptoms, anger, or mindfulness. Of the 35 enrolled participants, 31 completed the program (88.6%), with a mean attendance of 6.37 of eight sessions. Among the 30 satisfaction survey respondents, 28 (93.3%) indicated willingness to participate again and 30 (100%) indicated willingness to recommend the program to others. The qualitative analysis identified four major themes: (i) diverse life challenges and self-care needs, (ii) learning through experience, connection, and application, (iii) regaining balance and agency in life, and (iv) sustaining practice requires continued support. Conclusion Mixed-methods findings provide preliminary information regarding the feasibility and acceptability of the MVP program and indicate favorable pre–post changes in several self-reported health-related outcomes. The MVP program may represent a practical lifelong learning intervention with potential relevance for public health promotion. Further controlled studies are warranted to establish its efficacy. Trial registration The trial was first submitted to the Clinical Research Information Service, Republic of Korea (KCT0009961, https://cris.nih.go.kr/cris/search/detailSearch.do?seq=28524&search_page=L ), on October 8, 2024, before participant enrollment began, and registration was finalized on November 28, 2024.