Although multimodal rehabilitation programs are effective for substance use disorders and widely used, addiction is still a global socioeconomic problem. Providing practical strategies, such as the HeartMath intervention for managing stress at the moment, helps mitigate the physical, emotional, and psychological impacts associated with substance use disorder, promotes resilience, and enhances treatment motivation.

To investigate the effects of the nurse-led HeartMath Training Program on resilience, emotional adjustment, and treatment motivation among patients with substance use disorder.

A randomized controlled trial (RCT) was used to carry out this study. This study was conducted at the inpatient unit for patients with addiction at Elmaa'mora Hospital for Psychiatric Medicine in Alexandria, Egypt. The subjects were 130 patients with substance use disorders (65 in each group). Researchers used three tools to collect the necessary data: Tool I Resilience Scale, Tool II Brief Adjustment Scale-6, and Tool III Treatment Motivation Questionnaire.

The difference in resilience, emotional adjustment, and treatment motivation between the study and control groups after the Nurse-Led HeartMath training intervention was statistically significant.

The HeartMath Training Program is efficacious in improving resilience and emotional adjustment among patients with substance use disorder and increasing their treatment motivation.

ClinicalTrials.gov identifier: NCT06437366.

Population aging has led to accelerated decline in pulmonary function, rising prevalence of depressive symptoms, and cognitive impairment, posing significant public health challenges. Although epidemiological evidence links poorer pulmonary function to subsequent cognitive decline, the pathways driving this relationship are not fully understood. We therefore investigated whether depressive symptoms mediate this relationship in older Chinese adults.

Data were drawn from the China Health and Retirement Longitudinal Study (CHARLS), including 2,320 participants aged 60 years and older. Pulmonary function was measured using peak expiratory flow (PEF). Depressive symptoms were assessed with the 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10). Cognitive function was evaluated through tests of episodic memory and mental intactness. Mediation analysis was conducted using Baron and Kenny's framework, and bootstrap analysis with 1,000 resamples was performed to assess direct and indirect effects. Sensitivity analyses ensured result robustness.

Spearman correlation analysis showed that PEF was positively correlated with cognitive function (r = 0.20, P < 0.001) and negatively correlated with depressive symptoms (r = -0.15, P < 0.001). After adjusting for confounders, multivariate linear regression analysis indicated that baseline PEF was positively associated with subsequent cognitive function (β = 0.131, P < 0.001) and negatively associated with depressive symptoms (β = -0.064, P < 0.001). The mediation effect of depressive symptoms accounted for 9.1% of the total effect regarding baseline pulmonary function on cognitive function.

Depressive symptoms partially mediate the relationship between pulmonary function and cognitive function in older adults. These findings emphasize the need for mental health interventions to mitigate cognitive decline linked to reduced pulmonary function.

Multiple sclerosis (MS) is a chronic, progressive, and neurodegenerative disease affecting more than 2.8 million people globally. Mobility impairments are among the most significant challenges faced by people with MS, leading to physical inactivity, deconditioning, and disability progression (for some, even irreversible disability). This negatively impacts mental health, social participation, and quality of life while placing a considerable economic burden on society. Exercise can improve mobility and mitigate disability progression, but facility-based options are often inaccessible, especially for those in remote areas. Telerehabilitation offers a promising alternative, but current systems are limited by complexity and hardware requirements.

The PLATINUMS (Implementation of an Advanced Telerehabilitation Solution for People With Multiple Sclerosis) project proposes an AI-driven telerehabilitation system to deliver accessible, cost-effective, and home-based exercise therapy for people with MS.

The PLATINUMS project begins with working package (WP) 1, focusing on obtaining ethical approval and recruiting staff. Following this, WP2 involves a 4-week system feasibility and usability study (n=40) to assess and refine the digital platform. WP3 comprises a validity study (n=60) to evaluate remote mobility tests via the system, such as the Short Physical Performance Battery (SPPB), functional reach, and sit-to-stand tests, to ensure their reliability for use in WP4, the feasibility multicenter randomized controlled trial (RCT). The 10-week multicenter feasibility RCT will be conducted in MS centers across Denmark, Ireland, Israel, and Italy, with 96 participants varying in disability levels. The primary objective is to evaluate the efficacy of the AI-powered telerehabilitation system on mobility outcomes compared to usual care. Finally, WP5 will assess the cost-effectiveness of the telerehabilitation system by analyzing implementation costs, adherence, and use of health care. The PLATINUMS project aims to revolutionize exercise therapy for people with MS by demonstrating the feasibility, validity, and preliminary efficacy of the AI-driven telerehabilitation system. This approach addresses barriers such as accessibility, privacy, and standardization while promoting patient and therapist acceptance.

Funding for the PLATINUMS project was obtained in February 2024. WP2 data collection began in April 2025 across 4 European sites. WP3 is scheduled to launch in July 2025, with WP4 (the feasibility RCT) planned for January 2026. Initial WP2 results are expected by October 2025, with first publications anticipated in mid-2026.

The PLATINUMS project is expected to generate critical insights into the feasibility, usability, and preliminary efficacy of an AI-based telerehabilitation system for people with MS. By leveraging widely available technology and real-time feedback, the system addresses key barriers to traditional rehabilitation. Findings from this protocol may inform future large-scale trials and support the broader implementation of digital health solutions in neurological rehabilitation.

PRR1-10.2196/75983.

Adherence to the Mediterranean diet (MedDiet) has been linked to better physical and mental health outcomes. However, its relationship with health-related quality of life (HRQoL) in children and adolescents has not been quantitatively assessed. To examine the association between adherence to the MedDiet and HRQoL in children and adolescents through a systematic review and meta-analysis of observational studies. PubMed, Scopus, Web of Science, and Cochrane Library were searched from inception through November 1, 2024. Observational studies assessing the association between MedDiet adherence and HRQoL in participants aged ≤ 19 years. Only studies using validated tools for both exposure and outcome were included. Two reviewers independently extracted data and assessed study quality using the National Heart, Lung, and Blood Institute tool. A random-effects model with a restricted maximum likelihood estimator was applied. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. The primary outcome was the Spearman's correlation coefficient (r) between MedDiet adherence and HRQoL. Twenty-four studies (n = 28,692; weighted mean age = 12.6 years) from ten countries were included. Higher adherence to the MedDiet was associated with better HRQoL (r = 0.22; 95% confidence interval [CI], 0.13 to 0.30; p < 0.001), although effect sizes were modest and heterogeneity was high (inconsistency index [I²] = 99.8%). Subgroup and sensitivity analyses confirmed the robustness of findings across HRQoL domains (e.g., physical, emotional, school-related). Studies with unadjusted models reported stronger associations than those with covariate-adjusted models.

Greater adherence to the MedDiet is modestly associated with higher HRQoL in children and adolescents. These findings support dietary interventions as a component of youth well-being strategies, although further longitudinal and interventional research is needed.

• The Mediterranean diet (MedDiet) has been associated with various physical and mental health benefits in children and adolescents, including lower obesity risk and better academic performance. • Previous reviews have suggested a positive relationship between MedDiet adherence and health-related quality of life (HRQoL), but no meta-analysis had quantified this association.

• This is the first meta-analysis to quantitatively assess the association between MedDiet adherence and HRQoL in youth, including data from 24 studies and nearly 29,000 participants. • Higher adherence to the MedDiet was modestly but consistently associated with better HRQoL across physical, emotional, social, school-related, and parental domains, despite high heterogeneity.

Objective To investigate the key factors influencing the implementation of long-acting injection-promoting policies and propose effective improving paths.Methods Qualitative interviews were carried out for stakeholders involved in the promotion of long-acting injections,based on the consolidated framework for implementation research.Additionally,countermeasures for identified barriers were proposed based on expert recommendations for implementation changes.Results A total of 46 health administrators,healthcare workers,and patients in Beijing were interviewed.The study identified several barriers in the strength and quality of evidence,adaptability,relative advantage,complexity and cost,patient needs and resources,external collaboration,external policies and incentives,organizational structural characteristics,and self-efficacy.Conclusions From the perspectives and experiences of stakeholders,the promotion of long-acting injections has shown initial success but still faces multiple obstacles.It is recommended that efforts should be made to coordinate and adapt policies,improve and incentivize relative organizations,and continuously strengthen the advocacy and education for individuals.

Background Anxiety and depressive symptoms are common during pregnancy, influencing obstetric outcomes. This cross-sectional study primarily aimed to assess the prevalence of anxiety and depressive symptoms in pregnancy and their association with obstetric outcomes. Another objective of the study was to determine the association of maternity social support and partner support during pregnancy with the final obstetric outcomes. Methods During the first phase (antenatal) of the study, anxiety, depressive symptoms, maternity social support, and partner support were assessed using structures and validated questionnaires, i.e., Generalized Anxiety Disorder scale (GAD-7), Edinburgh Postnatal Depression Scale, Maternity Social Support Scale, and Partner Support Scale, respectively. During phase II (post-partum), details on the mode of delivery, gender of the baby, gestational age at delivery, birth weight, and any complication(s) during delivery were noted. Results Out of a total of 104 study participants, anxiety and depressive symptoms were present in 17.3% (n=18) and 26.0% (n=27), respectively. The risk of low birth weight was increased with clinically significant antenatal anxiety symptoms (χ2 = 7.566, p=0.010) and depressive symptoms (χ2=4.323, p=0.038). A strong association was found between fetal maturity and maternity social support (χ2=26.269, p≤0.001). Conclusions The study results highlight the importance of routine mental health screening during pregnancy and timely interventions to improve maternal and neonatal outcomes.

This case report describes a rare instance of local anesthetic systemic toxicity (LAST) following subcutaneous lidocaine administration for a minor surgical procedure. A 70-year-old male patient developed agitation, dysarthria, and quadriparesis postoperatively, with subsequent investigations revealing a pneumothorax but no major neurological or vascular compromise. The diagnosis of LAST was made after exclusion of other causes. The patient recovered fully within hours without any specific management. This case underscores the need for improved awareness of LAST among non-anesthesiology clinicians and emphasizes preventive strategies for local anesthetic use.

The opportunities of health and happiness are unequally distributed. Multiple triggers lead to social exclusion and can result in homelessness. Efforts are still failing to counter health inequity. Our ethnographic research explores the social pathways of citizens deprived of a home. How can we sustainably promote fair opportunities for all?

Urgent information needs prompted field research among Dutch homeless service users. In semi-structured interviews, we collected information on health and needs. A transdiagnostic, generic strategy is used. Our focus is on the three themes of recovery (meaning, symptoms, and the social dimension), and their evolution over time. From a human rights perspective, the study examines the interactions between homeless service users and their environments. Case descriptions are added for a better understanding of dynamics.

The dual snowball sampling resulted in a representative sample of Dutch homeless service users in 2015-2017 (16 facilities, 436 users). The health and needs patterns reveal many interrelations of multiple needs. The user-system interactions uncover a systemic failure to match vital needs of the neediest. The interactions over time expose how social decline occurs and identify opportunities for improvement. The survival strategies show that stress often generates communication barriers, conflict, alienation and neglect. This has a negative impact on the self-image, (in)formal networks and place of users in society. A "deadlocked case" from a local experiment demonstrates how community relations can overcome modern system obstacles, while creating stable conditions for growth.

Despite abundant care and welfare facilities, many shelter users feel abandoned. Our rights-based ecosystem approach leads to the root causes of unfairness, inherent in the healthcare system and culture. The findings disclose that the resilience of Dutch society suffers (but can withstand) significant erosion. By extension, this applies to modern care systems in high-income countries. Fostering resilience requires meaningful social relationships that offer creative solutions. Exploring dynamics stimulates shared learning in safe and public spaces. Providing networks with concrete tools, the approach can foster a coherent, systematic commitment to enrich fair opportunities and pathways toward thriving.

Neurodevelopmental disorders have become global public health challenges, and early interventions have been proved to be effective in mitigating the problems and promoting the long-term functioning of people facing such challenges. These interventions had long been provided only by health professionals, but parents are now recognized for their capabilities. Parent-implemented early interventions are devised to equip parents with specialized knowledge and skills so that they can offer tailored training for their children. As these community-based interventions are designed to be implemented at home, they inevitably influence and are influenced by the family systems. While the family dynamics play a key role in determining the efficacy of the intervention, still little is known about the familial factors, as the focus on the existing literature is on the changes of the parent-child dyads. This research bridged this knowledge gap in implementation sciences by investigating how the family members who did not partake in the training reacted to the parent-implemented interventions (PIIs) at home.

A qualitative study was conducted between August 2023 and July 2024 in Hong Kong, examining the impacts of a localized version of the World Health Organization Caregiver Skills Training. In total, 22 respondents participated in five focus group discussions. Inductive reflexive thematic analysis was applied to construct codes, themes, and frameworks.

Four levels of responses-Level 0: Reject, Level 1: Support, Level 2: Attempt, and Level 3: Embrace-were identified, and these themes were on a continuum of families' involvement in the practice of PII. Factors that promoted or discouraged their involvement were discussed. Evidence has confirmed that PII had indirect impacts on family dynamics, and the responses of family members affected the intervention effectiveness and the mental health of the caregiver-participants.

This research responded to the call to improve public health evaluations. It moved beyond the linear changing processes in the intervention design, addressed the complexity of the social systems, and explicated the multidimensional changing processes in a family-the immediate context where parent-implemented early intervention was implemented. It contributed to build initial frameworks on the familial influences and support the future development of the intervention and research designs.

Background: The role of occupational therapy is to provide management for various conditions including neurological, musculoskeletal, and psychological disorders, with the aim of maximizing function and independency in daily occupations. According to the World Federation of Occupational Therapists (WFOT), occupational therapy is a client-centered health profession concerned with promoting health and well-being through occupation. In Saudi Arabia, there are escalating rates of chronic conditions, which create an increasing demand for occupational therapy services. Yet, occupational therapy practice frameworks, as well as areas of assessment and intervention, are not well explored within the context of Saudi Arabia. Purpose: The aim of this research is to identify the most common disorders that occupational therapists work with within Saudi Arabia and the approaches used for managing these disorders. Methods: This was a cross-sectional study. An electronic survey was distributed to 230 occupational therapists working in Saudi Arabia. The survey consisted of two sections; the first was on educational backgrounds, and the second section was about the common conditions encountered in a clinical setting and the treatment approaches applied. The interventions nominated by participants were mapped to the person-environment-occupation model and to the occupational therapy practice framework. Results: The overall response rate was 57%. Analysis of data of 131 participants revealed that neurological diseases (e.g., stroke, multiple sclerosis, and Parkinson's disease) were the most common conditions managed by occupational therapists (64.3%), while respiratory diseases had the lowest percentage (4.7%). With regard to intervention approaches, "therapeutic exercise" was the most commonly applied approach as was reported by 77.1% of the therapists, while "functional electrical stimulation" was the lowest chosen approach as it was applied by 19.8% of the therapists. Conclusion: Occupational therapists in Saudi Arabia manage a variety of conditions and apply a wide range of rehabilitation approaches, yet gaps still exist in providing a holistic approach. The study emphasizes the importance of redirecting the focus of occupational therapists to core concepts of maximizing functioning and occupational performance and using occupation as a mean and as an outcome of rehabilitation.