This study explored clinicians' perceptions of the barriers that immigrant, refugee, and ethnically diverse populations face in accessing mental health (MH) care in Canada, the challenges clinicians encounter in service delivery, and their recommendations for improving access and quality of care.

Guided by a practice-based research approach, a qualitative descriptive approach was used, employing semi-structured interviews and thematic analysis. The study was conducted across community-based MH organizations in multiple Canadian provinces within primary and community care settings. Nineteen MH clinicians, including social workers, psychotherapists, and counselors were purposively sampled. Eligible participants were currently employed in MH roles and had direct experience working with diverse populations; there were no formal exclusion criteria.

Clinicians identified two overarching categories of barriers: logistical challenges (such as long wait times, cost, and limited access to multilingual services) and cultural/social barriers (including stigma, cultural mismatch, and mistrust of Western MH models). Clinicians also reported institutional challenges, such as limited training and resources for culturally responsive care. Recommendations focused on enhancing cultural responsiveness, increasing clinician education, and implementing system-level changes to reduce structural inequities.

Clinician insights highlight the need for more accessible, equitable, and culturally responsive MH services for diverse populations in Canada. These findings have implications for future research, clinician training, and policy reform.

Cardiovascular (CV) disease is the leading cause of death among U.S. women, yet women have a limited understanding of their CV-related morbidity and mortality risks. Provider-, system-, and patient-level barriers point to a need for multi-level evidence-based strategies to facilitate CV risk reduction. Supported by the Replicating Effective Programs implementation strategy, we implemented a CV Toolkit in primary care clinics for women Veterans. The objective was to evaluate the effect of CV Toolkit implementation on participation in behavior change programs that target CV risk reduction.

In partnership with the Veterans Health Administration (VA) Office of Women's Health and National Center for Health Promotion and Disease Prevention, we conducted an implementation trial of a CV Toolkit at five geographically diverse VA sites between March 2017-March 2020. Using a non-randomized stepped wedge design, we evaluated the effect of CV Toolkit implementation on participation in the VA MOVE! weight management program, and on participation in health promotion and disease prevention (HPDP) programs (coaching, facilitated groups, etc.) and/or complementary integrative health (CIH) programs (yoga, meditation, etc.). We utilized a three-level (patient, site, time) non-linear fixed effect model with stratification by age (65 and older versus younger). Patient participation, utilization, and demographics were extracted from VA administrative data for all women with at least one primary care visit at a participating site from December 2016-March 2020 (n = 6009).

Women were on average 46 years old; 49% were white, 32% Black, 17% Hispanic; and over a third had CV risk factors and/or mental health diagnoses. For women 65 years and older (n = 540), active toolkit implementation was associated with increased odds of MOVE! participation (OR = 1.09; 95% CI:1.030-1.152) compared to when the toolkit was not active either within or between sites. Women younger than 65 (n = 5469) had increased odds of using HPDP/CIH programs during active toolkit implementation (OR = 1.01; 95% CI:1.002-1.022).

A multilevel intervention and implementation strategy were associated with improved patient-level outcomes-a rarity in implementation trials. Precision implementation may offer important next steps in understanding causality and further specifying how implementation strategies can optimize clinical and implementation outcomes.

Clinical Trials.gov, NCT02991534. Registered 12-09-2016, https://clinicaltrials.gov/study/NCT02991534?cond=NCT02991534&rank=1.

Goal setting is one of the most commonly used strategies for increasing exercise and physical activity, and is a core aspect of the scope of practice for many exercise and health practitioners. Despite its widespread use, recent research has highlighted a need to reconsider traditional practice and re-evaluate the theoretical and empirical basis of goal setting in exercise and physical activity promotion. The issues identified in traditional approaches to goal setting in exercise and physical activity include oversimplification, misapplication of theory and over-reliance on the SMART acronym (e.g., Specific, Measurable, Achievable, Realistic, Time-bound goals) rather than more rigorous evidence-based approaches. Therefore, this expert statement, on behalf of Exercise and Sports Science Australia, reviews theory and empirical evidence on goal setting, and provides practical recommendations for exercise and health practitioners when supporting clients to set goals. To move beyond the issues highlighted in traditional approaches to goal setting, it is necessary to go 'back to basics' and consider the foundations of goal setting. In turn, we outline: the goal-setting process; the structure of goals; moderating factors that determine whether/when certain types of goal should be set; and outcomes of goals, including risks and pitfalls. We provide corresponding practical recommendations to assist exercise and health practitioners in setting goals with clients. This expert statement seeks to help practitioners avoid the issues highlighted in traditional approaches to goal setting in exercise and physical activity, and set more suitable and evidence-based goals with clients instead.

A prolific amount of data regarding maternal sensitivity and child development outcomes comes from high income, industrialised western contexts. Sparse attention has been paid to characterising patterns or unique expressions of sensitivity as an independent topic of study globally with a glaring dearth of comparative data from LMICs including sub-Saharan Africa. We aimed to detail maternal sensitivity within the dyadic interaction between mother and her 42-month-old child (n = 130) in a peri-urban low socioeconomic context as part of the Drakenstein Child Health Study. Ten-minute videoed interactions were coded using the Emotional Availability Scale. We found no report of psychometric properties and applicability of the EA in our context, therefore confirmatory followed by exploratory factor analysis on the four maternal subscales was conducted. EFA using scree plot and parallel analysis extracted a 3 factor model that better fit our data than the original four. Factor 1-Sensitive Engagement, Factor 2-Non-Hostile Supportive Engagement and Factor 3-Non-Intrusive Engagement aligned theoretically with the original maternal subscales. The new Sensitive Engagement subscale accounted for 25% cohort variance and mothers showed varied distribution over five categories ranging from Highly Sensitive to Highly Insensitive. Cumulatively, 59% of total variance is explained by 3 factors - Factor 2-22% and Factor 3-12%. Significantly, our cohort shows remarkably resilient sensitivity patterns and behaviours considering the extremely harsh and challenging environments in which they must raise children.

Studies have reported that autistic individuals are diagnosed with major depressive disorder (depression) at rates significantly higher than their non-autistic peers. While studies have shown that Black autistic individuals may be particularly vulnerable to experiencing depression, few studies have examined rates of lifetime depression diagnosis and symptom burden within this population in comparison to other racial groups, in particular White autistic individuals. This study addresses this gap by comparing demographic differences and mental health diagnosis, symptoms, and service use for Black and White autistic adults with and without a lifetime depression diagnosis, offering insights to guide future research and clinical practice to address the mental health needs of autistic individuals. Data were drawn from the Relationships, Employment, Autonomy, and Life Satisfaction (REALS) study, which includes self-reported history of mental health diagnoses, as well as measures of current anxiety and depression symptoms. Bivariate analyses were conducted to examine demographic, mental health service use, and clinical differences among an age- and income-matched sample of Black and White autistic participants, stratified by whether they had received a depression diagnosis in their lifetime (past and/or current). The study included 179 autistic adults (93 Black, 86 White). Black autistic adults with a lifetime depression diagnosis had higher income, education, and employment rates than those without a lifetime depression diagnosis. White participants showed no such differences. Further, Black participants reported similarly high current depression symptoms and anxiety, regardless of whether they had a depression diagnosis or not. That is, Black autistic adults without a lifetime depression diagnosis report experiencing comparable levels of current depressive symptoms as those with a lifetime depression diagnosis, which for both groups fall near clinical cutoffs. Findings underscore the need for more nuanced mental health services that address the complex needs of autistic adults, particularly Black individuals who remain underrepresented in autism research. The similarly high anxiety and depression symptom levels across Black autistic adults with and without a lifetime depression diagnosis suggest that those with depression and who have access to mental health services may not find that such services fully address ongoing distress. The elevated rates of co-occurring mental health conditions among those with a history of depression point to the importance of integrated, intersectional approaches to care that consider both racial identity and neurodivergence.

Girls with predispositions for disordered eating (DE) may select into weight-conscious peer groups (i.e. peer groups that emphasize body weight/shape). However, factors driving selection into these peer groups remain unknown, as genetic and/or environmental predisposition to DE may lead girls to select weight-conscious peers. To explore what may drive selection, the present study investigated whether genetic or shared environmental influences underlie associations between DE and exposure to weight-conscious peers and whether effects differ by pubertal status.

Participants included 833 female twins (ages 8-15) from the Michigan State University Twin Registry. Bivariate twin models were conducted to explore etiologic overlap between DE and exposure to weight-conscious peers. Separate models were run for pre-early pubertal girls and mid-late pubertal girls given past research demonstrates differences in genetic and environmental contributions underlying eating pathology by pubertal status.

During pre-early puberty, shared and non-shared environmental correlations accounted for the overlap between DE and weight-conscious peer group exposure. Furthermore, shared environmental and non-shared environmental influences underlying DE contributed to 33.3% and 20.0% of the individual differences in weight-conscious peer group membership, respectively. In mid-late puberty, the genetic and non-shared environmental correlations accounted for the overlap between DE and weight-conscious peer group exposure. Genetic and non-shared environmental influences underlying DE contributed to 37.5% and 19.4% of the variance in weight-conscious peer group membership, respectively.

While selection effects may exist across development, these effects may be driven by variance in DE due to shared environment in pre-early puberty and genes in mid-late puberty.

Socio-sexual assessment tools like the SSKAAT-R are valuable for sexual education programming and interventions with people with intellectual and developmental disabilities. Although studies have been conducted on the psychometric properties of the SSKAAT-R, less is known about how clinicians use the tool in practice with individuals. As part of a larger research project, this paper explores clinicians' experiences using the SSKAAT-R.

A total of 17 clinicians participated in semi-structured interviews. Themes were identified through Thematic Analysis.

Clinicians spoke to the versatility of the SSKAAT-R administration. Clinicians often used the SSKAAT-R to assess client vulnerability and risk. Clinicians also spoke to the importance of the attitudes section for understanding client beliefs, while the knowledge section helped identify strengths and skill gaps.

This study sheds light on how clinicians use the SSKAAT-R with individuals who have intellectual and developmental disabilities.

Australia's National Preventive Health Strategy (NPHS) explicitly highlights the important role of primary care in screening for and supporting behaviour change to help reach preventive health goals. Given osteopaths' position as primary care providers in Australia, their role in fulfilling the NPHS warrants consideration. In response, this study aims to investigate osteopaths' perceptions regarding their role in preventive health and their practice behaviours regarding the key priority areas outlined in the NPHS.

This online cross-sectional 63-item survey was completed by registered osteopaths practising in Australia. Data were descriptively analysed. Participants rated each determinant on a 7-point Likert scale ranging from 'no role at all' (1) to 'a very significant role' (7). Participants rated each determinant on a 7-point Likert scale ranging from 'no role at all' (1) to 'a very significant role' (7).

Participants (n = 220) identified all levels of preventive health as highly relevant for osteopathic practice, with the greatest relevance attributed to secondary prevention (Mean [M]: 6.2; Standard deviation [SD]: 1.2) and the lowest to quaternary prevention (M: 5.7; SD 1.6). When considering the seven priority preventive health topics outlined in the NPHS, participants reported most frequently screening for physical activity (M: 4.7; SD: 0.6) and least for immunisation status (M: 2.1; SD: 1.0). Participants rated patients explicitly asking them about changing their behaviour as having the greatest influence on their decision-making regarding discussing 'healthy eating' (M: 4.5; SD: 0.8), 'physical activity' (M: 4.4; SD: 0.9), 'mental health' (M: 4.4; SD: 0.9) and 'immunisation' (M: 3.8; SD: 1.3) with their patients. Participants reported being likely to undertake a range of actions in response to identifying patient need.

This study suggests osteopaths play a role in preventive health that may be broader than previously assumed yet is still not inclusive of the full range of behaviours required of health professionals if the Australian government is to fulfil the goals and objectives outlined in the NPHS. SO WHAT?: Government initiatives to implement the NPHS must ensure they are leveraging health professionals to their fullest potential.

To investigate the relationship between college adaptation, emotion regulation self-efficacy, and anxiety/depression among medical freshmen, and to analyze the mediating role of emotion regulation self-efficacy in the association between adaptation and mental health, providing evidence for targeted psychological interventions.

A cross-sectional study was conducted in November 2022 using a stratified cluster random sampling, involving 1866 medical freshmen from two colleges in Wuhu City, Anhui Province. The student adaptation to College Questionnaire, Self-Regulation of Emotion Self-Efficacy Scale, Generalized Anxiety Disorder-2, and Patient Health Questionnaire-2 were used to assess adaptation, emotion regulation self-efficacy, anxiety, and depression, respectively. Pearson correlations analysis was conducted to examine the associations between medical freshmen's college adaptation, emotion regulation self-efficacy, and anxiety/depression. Subsequently, bias-corrected Bootstrap mediation analysis(5000 resamples) was employed to test the mediating role of emotion regulation self-efficacy in the relationship between college adaptation and anxiety/depression.

The average age of the 1866 surveyed medical freshmen was(18.78±1.23) years old, with 727 males(39.0%) and 1139 females(61.0%). The prevalence rates of anxiety and depression were 11.68%(218/1866) and 12.33%(230/1866), respectively. The overall adaptation score of medical freshmen was 3.46±0.51, with the lowest score observed in learning adaptation(3.21±0.67). College adaptation demonstrated significantly negative correlations with anxiety/depression(r=-0.482 and-0.505, P<0.01), and positive associations with expressive positive emotion self-efficacy and regulatory negative emotion self-efficacy(r=0.412, r=0.467, both P<0.01). Positive emotion regulation efficacy and negative emotion management efficacy demonstrated significant negative correlations with anxiety scores(r=-0.205, r=-0.358) and depression scores(r=-0.246, r=-0.345), respectively(P<0.01). Mediation analysis demonstrated that regulatory negative emotion self-efficacy partially mediated the relationship between adaptation and anxiety(indirect effect β=-0.083, SE=0.013, 95%CI-0.109 to-0.059; proportion mediated: 16%) and depression(β=-0.068, SE=0.013, 95%CI-0.093 to-0.043; proportion mediated: 13%).

Medical freshmen's adaptation and emotion regulation self-efficacy are closely related to anxiety and depressive emotions. Adaptation can not only directly and negatively predict the levels of anxiety and depression, but also indirectly reduce psychological risks by enhancing the self-efficacy in managing negative emotions.

To investigate the relationship between childhood abuse experiences and depression and anxiety symptoms in Anhui medical college students, as well as the chain mediating role of mobile phone dependence and sleep quality.

Using cluster sampling, two schools-Anhui Medical College and Anqing Medical College selected first-year students as the subjects of the survey. Baseline and follow-up surveys were conducted in November-December 2019 and November-December 2020, including a total of 3662 students who completed both the baseline and the follow-up, among which there were 976 males and 2686 females. Childhood Trauma Questionnaire-28 Item Short Form, Self-rating Questionnaire for Adolescent Problematic Mobile Phone Use, Pittsburgh Sleep Quality Index, Sleep-Rating Depression Scale and Sleep-Rating Anxiety Scale were used to evaluate childhood abuse experiences, mobile phone dependence, sleep quality, depression and anxiety symptoms, respectively. The partial correlations analysis was used to analyze the association between variables. After adjusting for age, gender, urban and rural areas, single-child status, parental education level and family economic level, the chain mediating effect of mobile phone dependence and sleep quality on the association between childhood abuse experiences and depression and anxiety symptoms was examined by bootstrap program and PROCESS software.

The detection rates of depressive symptoms and anxiety symptoms are 8.49% and 9.48%, respectively. As the partial correlations analysis shows, after controlling for anxiety symptoms, childhood abuse experiences showed significant positive correlations with mobile phone dependence, sleep quality, and depression symptom(r=0.120, r=0.154, r=0.135, P<0.01). Mobile phone dependence was significantly positively correlated with sleep quality and depression symptoms(r=0.333, r=0.135, P<0.01), and sleep quality showed a significant positive correlation with depression symptoms(r=0.131, P<0.01). After controlling for depression symptoms, childhood abuse experiences showed significant positive correlations with mobile phone dependence(r=0.108), sleep quality(r=0.147), and anxiety symptom(r=0.092, P<0.01). Mobile phone dependence was significantly positively correlated with sleep quality and anxiety symptoms(r=0.323, r=0.047, P<0.01), and sleep quality showed a significant positive correlation with anxiety symptoms(r=0.100, P<0.01). After adjusting for gender, family location, only child status, parental education level, and family economic conditions, the mediation analysis result indicate that mobile phone dependence and sleep quality played a chain mediating role between childhood abuse experiences and depression and anxiety symptoms, with the mediation effect of 0.076(95%CI 0.061-0.091, P<0.01)and 0.062(95%CI 0.050-0.074, P<0.01)and the mediation effect proportions of 23.58% and 23.40%(P<0.01), respectively.

Childhood abuse experiences can increase the risk of depression and anxiety symptoms in medical college students, and can also indirectly raise the level of depression and anxiety symptoms through the chain mediating role of mobile phone dependence and sleep quality.