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PubMed2026

Suicide in rural South Africa before and during COVID-19: evidence from forensic mortuary data in Limpopo Province.

Suicide is a growing public health concern in South Africa, with rural provinces such as Limpopo facing heightened vulnerability due to limited mental health services and socio-economic inequalities. Evidence on the impact of COVID-19 on suicide in rural contexts remains limited. This study examined suicide trends in Limpopo Province and changes associated with the COVID-19 period. A retrospective interrupted time series analysis was conducted using forensic mortality data from 1 January 2019 to 31 December 2021, allowing assessment of pre-existing trends and changes following COVID-19 lockdowns. Among 5770 unnatural deaths, 957 were suicides. The proportion of suicides increased from 29.5% in 2019 to 36.9% in 2021. Suicides predominantly occurred among males and young adults, with hanging accounting for over 90% of deaths throughout. Interrupted time series analysis revealed a significant downward trend in suicide cases during the strict national lockdown (Alert Level 5), with a 31% reduction in incidence (IRR = 0.69, 95% CI: 0.49-0.98). Less restrictive lockdown levels showed no significant effects. Suicide mortality increased prior to COVID-19, with a subsequent decline during the strictest lockdown period. Stable demographic patterns and methods highlight persistent vulnerabilities and the need for sustained suicide-prevention strategies beyond pandemic.

Humans↗
PubMed2026

Healing from within: A randomized controlled trial of a novel expressive writing intervention among trans and gender expansive adults.

Transgender and gender expansive (TGE) populations in the United States experience high rates of mental health disparities. High rates of depressive and anxiety symptoms have been linked to a host of stigma-related stressors and exacerbated by decreased access to competent and affirming formalized health care supports, particularly in the face of legislation aiming to curb access. As a result, intervention strategies that can be made widely available, accessed at no cost, and address these stressors to improve mental health and well-being are needed. This study presents findings from a self-administered online mental health intervention, titled Reflections to (re)Claim an Affirmed Identity to Improve Mental Health (RECLAIM), which used an expressive writing approach to address internalized anti-TGE stigma to reduce depressive and anxiety symptoms and improve perceived community connectedness. In this randomized controlled trial, 115 TGE community adults were assigned to one of three study conditions: two RECLAIM interventions and one expressive writing active control group. Analysis of between-group effects found that all three groups experienced similar levels of improvement in mental health over time, while within-group effects of time by condition demonstrated some notable differences in the overall trajectory of treatment or control effects. Overall, results of this randomized controlled trial provide preliminary empirical support for the efficacy of RECLAIM in reducing depressive and anxiety symptoms and internalized anti-TGE stigma and improving community connectedness. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Humans↗
PubMed2025

Mediators of the Association Between a Parent's Experience of Trauma and Their Children's Well-Being: A Systematic Review.

At present, our understanding of trauma's complexity is underdeveloped, particularly with regard to intergenerational effects. In this paper, we review peer-reviewed literature on parental trauma and child well-being, focusing on mediating factors. We conducted a global systematic review of longitudinal, observational studies assessing mediators between a parent's traumatic exposure and their children's well-being. The primary outcome of the review was quantitative measures of child well-being (physical and psycho-social) assessed when the child was 18 years or under. We considered the following experiences as trauma exposures: intimate partner violence, rape, sexual assault, victimization during violent crime, childhood abuse, and exposure to direct, immediate threats to personal survival during war, political unrest, natural disasters, and sudden, critical injury/illness. Thirty-two studies met our inclusion criteria. The two most common mediator categories were caregiver mental health (n = 13) and parenting behavior (n = 10). Other studies measured aspects of the parent-child relationship (n = 9), maternal stress factors (n = 5), parental physical health (n = 2), and child-level factors (n = 6) as mediators. Almost all included studies (n = 28) detected a mediation effect. The majority of studies (n = 21) cited robust theoretical frameworks to support their mediator and outcome choices. Studies varied in quality, but most used appropriate, formal mediation analyses. Several study designs could be enhanced by methods to improve precision and reduce bias. Currently, there is little consistency in how similar constructs are measured between mediation studies. We did not locate any studies in low-income countries, and few studies examined aspects of family dynamics, physical health, environmental characteristics, or paternal factors.

Humans↗
PubMed2026

Exploring Implementation of Cantonese Radio Broadcasting as a Mental Health Promotion Initiative for Linguistically Isolated Immigrants.

Digital-first public health efforts often miss linguistically isolated immigrant communities because of structural barriers and stigma. Ethnic legacy media can reach these groups, but keeping programs funded and operational over the long term is frequently difficult. This Practice Note examines a Cantonese-language radio health program in "Los Angeles County" that ran 128 live broadcasts across a full 12-year Chinese zodiac cycle. Instead of a top-down clinical model, the show endured by acting as an informal community navigation hub. We examine two recurring administrative frictions: anonymous off-air calls about urgent economic needs (e.g., hotel job referrals) and on-air audience corrections of mispronounced medical terms. We argue these interactions should be seen not as disruptions but as measurable indicators of structural trust that sustain programs. We offer practical guidance for recruiting undergraduates to expand reach via ethnic print newspapers, using peer-recovery milestones to amplify impact. The note concludes with a pragmatic blueprint for health educators to manage professional boundaries, preserve commercial-clinical separation, and uphold cultural safety in isolated communities.

Chinese American health↗
PubMed2026

Effect of a pharmacist-led mHealth app on adherence, quality of life, and glycaemic control in diabetes: A multicentre RCT.

AIMS: To evaluate whether CareAide&#xae;, a pharmacist-driven mHealth application, improves medication adherence, health-related quality of life (HRQoL), and glycaemic control in diabetes mellitus using structural equation modelling. METHODS: Pre-specified secondary analysis of the type 2 diabetes mellitus cohort from a 6-month multicentre open-label randomised controlled trial (N&#xa0;=&#xa0;663) across three Malaysian hospitals. Adherence was assessed by MMAS-8 (subjective) and Proportion of Days Covered (PDC; pharmacy-verified). HRQoL was measured by AQoL-6D and EQ-5D-5&#xa0;L. Structural equation modelling (SEM), Necessary Condition Analysis, and Importance-Performance Map Analysis (cIPMA) were applied. RESULTS: CareAide&#xae; produced large adherence gains (MMAS-8: 7.31 vs 5.55, d&#xa0;=&#xa0;1.64; PDC&#xa0;&#x2265;&#xa0;80%: 81.6% vs 33.0%; both p&#xa0;<&#xa0;0.001). Early 3-month adherence was the strongest predictor of sustained 6-month adherence in both models (&#x3b2; std&#xa0;=&#xa0;0.567 and 0.688; p&#xa0;<&#xa0;0.001). AQoL-6D utility improved significantly (0.669 vs 0.618; d&#xa0;=&#xa0;0.353, p&#xa0;<&#xa0;0.001), driven by coping (d&#xa0;=&#xa0;0.447) and relationships (d&#xa0;=&#xa0;0.254) domains. HRQoL did not mediate adherence; gains were a direct independent benefit. The intervention effect on HbA1c was not statistically significant in the PDC-based SEM model (&#x3b2;&#xa0;=&#xa0;&#xa0;-&#xa0;0.333, p&#xa0;=&#xa0;0.065); a group difference was, however, supported by baseline-adjusted ANCOVA (&#x3b2;&#xa0;=&#xa0;&#xa0;-&#xa0;0.41%, p&#xa0;=&#xa0;0.002), and the complete-case comparison was non-significant (p&#xa0;=&#xa0;0.153), so glycaemic findings warrant cautious interpretation. cIPMA identified the intervention as the primary optimisation target. CONCLUSIONS: CareAide&#xae; significantly improves medication adherence and psychosocial quality of life. Evidence for glycaemic benefit came from baseline-adjusted analysis (ANCOVA), though findings should be interpreted with caution given incomplete HbA1c data at one site. The first three months are the most critical period for pharmacist support. In this dataset, PDC appeared more sensitive than MMAS-8 to the HbA1c signal within 6&#xa0;months, but this finding requires confirmation in longer studies with more complete HbA1c data. TRIAL REGISTRATION: ClinicalTrials.gov NCT06068309.

Aged↗
PubMed2026

Public health, public protest: The role of health burdens and healthcare access in protest mobilisation.

Health and politics are intertwined, yet few studies have examined the association between health and protest. This study examined whether population health burdens were associated with protest incidence and whether healthcare access modified these associations. Analysis was based on an unbalanced 2004-2023 country-year panel, combining protest counts from ACLED with rates for 22 GBD causes. Mixed-effects negative-binomial models estimated incidence-rate ratios (IRRs) with interactions for healthcare access (&#xb1;1 SD). Two-way fixed-effects Poisson models were estimated as a benchmark to distinguish cross-national associations from within-country dynamics. Health burdens were systematically, but heterogeneously, associated with protest. Rates for several non-communicable burdens were associated with protest, notably musculoskeletal disorders (IRR 1.72, 95% CI 1.37-2.15), neoplasms (1.24, 1.06-1.44), substance-use disorders (1.32, 1.12-1.56) and HIV/AIDS and other STIs (1.24, 1.12-1.38). Higher healthcare access generally attenuated health-protest associations. Fixed-effects models confirmed several associations (e.g. HIV/AIDS, neoplasms) but revealed that others (e.g. maternal/neonatal disorders, enteric infections) were driven primarily by cross-national differences. Population health burdens were associated with cross-national variation in protest mobilisation. Chronic, non-communicable burdens were associated with heightened protest, whereas poverty-linked and early-life burdens were associated with lower mobilisation. Healthcare access was associated with attenuation of these relationships.

Humans↗
PubMed2026

Behaviourally informed text message reminders to increase cervical screening attendance in people with severe mental illness: the OPTIMISE pilot randomised controlled trial.

OBJECTIVES: This study assessed the feasibility of both the delivery and evaluation of 'enhanced' (behaviourally informed) text message reminders containing links to existing co-designed resources supporting decision-making for people with severe mental illness (SMI) regarding attendance of cervical screening. DESIGN: A pilot randomised controlled trial (RCT). SETTING: 13 General Practice (GP) practices in London were recruited. PARTICIPANTS: GP practices identified people with SMI aged 24-64 years who were overdue cervical screening. Target sample size was 120 participants (60 per arm) based on existing guidance for pilot trials. INTERVENTION: In March 2025, participants were randomised (1:1) to receive either the enhanced (intervention) or the standard (control) SMS reminder. PRIMARY AND SECONDARY OUTCOME MEASURES: 18 weeks later, feasibility outcomes were collected (primary outcomes) and data analysis for a definitive RCT was rehearsed (secondary outcome). RESULTS: Of the 150 participants across 13 GP practices that were randomised (n=75 per arm), 132 (88%) texts delivered (intervention n=64/75 (85%), control n=68/75 (91%)). 10 practices (76.9%) provided follow-up data for 102 participants (intervention n=50, control n=52). Five participants (intervention n=4, control n=1) attended screening within the trial period. Participant survey response rate was low (9/132 (7%), intervention n=5, control n=4). Both SMS messages were low cost, with the intervention SMS a 50% higher cost to deliver (7.5p vs 5p per SMS). Primary feasibility measures of recruitment rate of GP practices (27%), retention of GP practices (77%) and participants (100%), SMS delivery (88%) and data completeness (64%) indicated viability, although survey response rate (7%) did not. CONCLUSIONS: Achieving adequate recruitment and retention, data completeness and comparable groups is viable with some amendments, although an alternative method is required to assess fidelity. Behaviourally informed SMS reminders are feasible to deliver to people with SMI, although it is uncertain if the extra resources are accessed and used. With changes to data collection, a definitive trial could be feasible. Given the low observed cervical screening attendance, additional intervention is needed for this group. TRIAL REGISTRATION NUMBER: ISRCTN12558681.

Humans↗
PubMed2026

Nourishing collaboration: interdisciplinary nutrition education for health care professionals.

Nutrition education remains insufficient in many health care professional training programs despite the central role of diet in the prevention and management of chronic disease. Contemporary nutrition science increasingly recognizes that dietary behaviors and health outcomes are shaped by complex interactions among biological, behavioral, environmental, and food system factors. This perspective proposes an interdisciplinary framework for nutrition education that integrates the complementary expertise of physicians, dietitians, chefs, and farmers. By bridging clinical care, nutrition science, culinary practice, and agricultural systems, such an approach may strengthen the translation of evidence into practice, improve nutrition-related competencies among health care professionals, and ultimately enhance population health outcomes.

Humans↗
PubMed2026

Multidisciplinary mHealth Rehabilitation for Patients With Abdominal Cancer Who Are Receiving Chemoradiotherapy: Randomized Phase II Trial.

BACKGROUND: Concurrent chemoradiotherapy (CCRT) for abdominal cancer frequently induces muscle loss, weight loss, and malnutrition. OBJECTIVE: This exploratory randomized phase II trial evaluated whether a multidisciplinary, mobile health (mHealth)-based multimodal rehabilitation program could preserve handgrip strength and muscle mass in patients with abdominal cancer undergoing CCRT. METHODS: In this prospective, multicenter, randomized, open-label phase II trial (NCT05325554), 111 eligible patients with abdominal malignancies scheduled for CCRT were randomly assigned (1:1) to receive either multidisciplinary mHealth rehabilitation care (MRC; n=57) or standard care (SC; n=54). The MRC program was delivered by a dedicated multidisciplinary team using the AiNST mHealth platform and wearable heart rate monitors. The primary end point was handgrip strength at the end of CCRT (analyzed with analysis of covariance adjusting for baseline). Secondary end points were exploratory and analyzed without multiplicity adjustment; sensitivity analysis using false discovery rate (FDR) correction was performed. RESULTS: Between February 2022 and April 2023, 111 patients were enrolled. Adherence was high (n=93, 83.9% achieved exercise targets). After adjusting for baseline handgrip strength, the MRC group had significantly higher handgrip strength at the end of CCRT than the SC group (adjusted mean difference 4.87 kg, 95% CI 3.36-6.38; P<.001). Exploratory analyses of secondary end points (without multiplicity adjustment) showed that the MRC group also had better preservation of body weight (P=.005), skeletal muscle mass (P<.001), serum albumin (P=.009), prealbumin (P=.02), and lower rates of hematological toxicity (P<.05), as well as improved psychological status (distress thermometer [DT] and Hospital Anxiety and Depression Scale [HADS]) and nutritional scores (Nutritional Risk Screening 2002 [NRS-2002] and Patient-Generated Subjective Global Assessment [PG-SGA]) at the end of CCRT (all P<.05). All nominally significant secondary end points remained significant after FDR correction (q<.05). These findings are preliminary and should be interpreted with caution due to the open-label design, population heterogeneity, and exploratory secondary analyses. CONCLUSIONS: In this exploratory phase II trial, a multidisciplinary, mHealth-based multimodal rehabilitation program was associated with better preservation of handgrip strength, muscle mass, and nutritional status, as well as lower rates of certain treatment toxicities, compared with SC. However, definitive conclusions are limited by the open-label design, heterogeneity of tumor types, and short follow-up. Larger, blinded phase III trials are needed to confirm these findings.

Humans↗
PubMed2026

Changes in hemoglobin levels and cardiometabolic health in adults with metabolic syndrome - a secondary outcome analysis of a six-month randomized controlled trial.

BACKGROUND: Lower hemoglobin (Hb) levels within the normal range have been associated with favorable metabolic traits in cross-sectional studies. This study investigated whether changes in Hb levels correlated with changes in physiological and cardiometabolic parameters during a six-month behavioral intervention in individuals with metabolic syndrome. METHODS: The&#xa0;six-month randomized controlled trial aimed to reduce sedentary behavior in adults with metabolic syndrome (n&#x2009;=&#x2009;64). Key measurements included fasting blood samples, insulin sensitivity during a hyperinsulinemic-euglycemic clamp, insulin-stimulated liver glucose uptake, liver fat content (LFC), indirect calorimetry, cardiorespiratory fitness, and cardiac function. Correlations&#xa0;between changes in these variables and changes in Hb levels at baseline, three, and six months were examined. RESULTS: Cross-sectionally, higher Hb levels correlated with&#xa0;lower insulin sensitivity (r=-0.35, p&#x2009;=&#x2009;0.005), higher resting O2 consumption (r&#x2009;=&#x2009;0.41, p&#x2009;<&#x2009;0.001), higher resting energy expenditure (r&#x2009;=&#x2009;0.49, p&#x2009;<&#x2009;0.001), higher LFC (r&#x2009;=&#x2009;0.40, p&#x2009;=&#x2009;0.011), and greater&#xa0;left ventricular wall thickness (r&#x2009;=&#x2009;0.42, p&#x2009;=&#x2009;0.001). The intervention did not significantly impact Hb levels, and changes in Hb levels did not correlate with most cardiometabolic changes. However, reduced Hb levels correlated with reduced fasting blood glucose (r&#x2009;=&#x2009;0.29, p&#x2009;=&#x2009;0.032), improved insulin sensitivity (r = -0.26, p&#x2009;=&#x2009;0.045), and increased cardiorespiratory fitness (r = -0.29, p&#x2009;=&#x2009;0.033). CONCLUSIONS: Changes in Hb levels did not consistently correlate with changes in cardiometabolic markers during&#xa0;the intervention. However, reductions in Hb levels may relate to improved insulin sensitivity and fitness. Along&#xa0;cross-sectional correlations, this may be clinically relevant for individuals with metabolic syndrome. Further studies are merited to clarify&#xa0;the role of Hb levels in this high-risk group.

Humans↗
PubMed2026

Dispositional optimism and open-label placebo responses in hair cortisol concentrations and psychological distress-A randomized controlled trial.

Open-label placebo (OLP) treatments show beneficial effects on various health-related outcomes, but studies investigating OLP effects on physiological measures remain scarce. This randomized controlled trial examined the effect of a 4-week OLP intervention on psychological distress and hair cortisol concentrations (HCC) in 202 healthy university students preparing for mandatory oral exams and whether dispositional optimism moderates the OLP effects. Participants were randomly assigned to an OLP or control group. Psychological distress was repeatedly assessed via negative affect, test anxiety, and subjective stress. HCC was measured before and within the intervention. Treatment expectations were additionally examined in interaction with optimism. Results show that OLPs significantly reduced psychological distress and HCC compared to the controls. Optimism moderated the OLP effect on HCC, with less optimistic individuals demonstrating the strongest reduction, independent of expectation. Optimism did not moderate OLP effects in psychological distress. However, the OLP effect on psychological distress depended on the three-way interaction of group, optimism, and expectation. The results suggest that OLPs alleviate the psychophysiological impact of a real-life stressor and indicate that optimism and expectation differently shape psychological and physiological OLP responses. These findings are discussed within the framework of the interactionist perspective.

Humans↗
PubMed2026

Digital health interventions for diabetes management in the eastern mediterranean region: A systematic review of types and effectiveness.

AIM: The aim of this study was to systematically review and evaluate the types and effectiveness of digital health interventions used for diabetes management in the Eastern Mediterranean Region (EMRO). METHODS: This systematic review, conducted according to PRISMA guidelines, searched PubMed, Web of Science, and Scopus up to May 2025 to identify studies on digital interventions for diabetes management in EMRO countries. Methodological&#xa0;quality of the included studies was evaluated using the EPHPP tool, and findings were categorized by intervention type, outcome measures, and intervention effectiveness. RESULTS: A total of 46 studies were included, mainly from Iran and Saudi Arabia. Phone calls and SMS were the most common digital tools. Digital interventions significantly improved HbA1c, fasting blood sugar, and several behavioral outcomes such as physical activity, medication adherence, and self-efficacy, while effects on psychological outcomes were mixed. CONCLUSION: Digital health interventions, especially phone calls and SMS, effectively improve glycemic control and self-care behaviors, though their impact on psychological outcomes remains inconsistent.

Humans↗
PubMed2026

Neighborhood Hostility is Associated With the Relationship Between Park Proximity and Physical Activity Among Youth: National Evidence From Chile.

PURPOSE: Physical inactivity among youth is highly prevalent worldwide. Although proximity to parks and recreational facilities is generally associated with higher physical activity (PA), unsafe or hostile neighborhood environments may limit their use. This study examined whether neighborhood hostility moderates the association between access to recreational facilities and adherence to World Health Organization PA guidelines among Chilean youth. METHODS: This cross-sectional study analyzed data from the 2024 National Physical Activity and Sport Survey of Chile, including 3,477 urban participants stratified into childhood (5-10 years), early adolescence (11-13 years), and late adolescence (14-17 years). Built environment exposures included perceived access to recreational facilities, a cumulative neighborhood hostility score (0-5). Logistic regression models were stratified by age group and adjusted for covariates. Interaction terms assessed moderation by neighborhood hostility, and causal mediation analyses were performed. RESULTS: Adherence to World Health Organization guidelines was low (41.9% in childhood, 43.8% in early adolescence, and 43.9% in late adolescence). Greater distance to recreational facilities was associated with lower odds of meeting activity guidelines. Higher neighborhood hostility was independently associated with lower PA levels. Among adolescents, neighborhood hostility substantially attenuated the association between proximity and activity. Mediation analyses indicated partial mediation, with effective park utilization emerging as the strongest mechanism, accounting for 21.8% of the association (p < .001), followed by psychological motivation (11.9%). DISCUSSION: Proximity to recreational infrastructure alone is insufficient to promote PA in hostile neighborhoods. Policy approaches should integrate infrastructure provision with strategies addressing neighborhood safety and promoting active engagement.

Humans↗
PubMed2026

Co-location of services: an umbrella review to consider how primary care estates could be better used to support disadvantaged groups.

AIM: To examine how co-located community and health services in primary care could support disadvantaged groups. BACKGROUND: Co-locating services is thought to improve access, collaboration, and patient outcomes. There are thousands of primary care premises across the UK. At a time of stagnating or widening health inequalities, they present an ideal opportunity to support communities, especially in disadvantaged areas. METHOD: We conducted a systematic umbrella review. Articles were retrieved from Ovid MEDLINE and Ovid Embase with supplementary snowball and grey literature searches. Reviews of co-located services supporting disadvantaged groups in primary care between 2010 and February 2024 were included. Quality and risk of bias were assessed using the Joanna Briggs Institute checklist. Two reviewers assessed eligibility, extracted data and assessed quality. Outcomes relating to health, welfare, healthcare utilization, and activity and processes were assessed. Data were narratively synthesized using a convergent integrated approach. FINDINGS: 2626 studies were screened, supplemented by snowball and grey literatures searches. Thirteen reviews were included for synthesis. One review included meta-analysis. Three models of care were identified; legal advice, welfare advice, and complementary health care. Data were synthesized according to themes: access and engagement, quality of care, efficiency, improved health, and improved social factors. We found co-located services can improve access to care, engagement in treatment, and quality of care for disadvantaged groups. Improvements to social determinants of health and mental health and well-being outcomes were reported. Findings were inconsistent when considering the impact of co-location on efficiency. We conclude that co-located services in primary care have the potential to improve identification of people most in need and improve their access to high quality health care and social support. Policy makers and practitioners should maximize the use of primary care estates to support disadvantaged groups and communities.

Humans↗