BMC Medicine最新文献

{"title":"How to tackle inequities in bereavement support for ethnically diverse communities: a national qualitative study using experience-based co-design.","authors":"Lucy E Selman, Jenny Birchall, Emily Fisher, Adejoke O Oluyase, Nikel-Shaniece Hector-Jack, Toslima Khatun, Rukia Saleem, Naureen Khan, Shirin Shahid, Riffat Mahmood, Gurpreet Grewal-Santini, Monika Afolabi, Candice Wang, Sarah Ng, Rashmi Kumar, Katherine Bristowe, Herbert Dunhill, Zoebia Islam, Jonathan Koffman, Gurch Randhawa, Emily Harrop, Catriona R Mayland, Sabrina Bajwah","doi":"10.1186/s12916-026-05254-4","DOIUrl":"https://doi.org/10.1186/s12916-026-05254-4","url":null,"abstract":"<p><strong>Background: </strong>High-income countries globally are becoming increasingly diverse. People from ethnically diverse communities experience inequities in accessing bereavement support, but evidence to inform equitable provision remains limited. We aimed to determine how formal bereavement support services can better serve ethnically diverse communities by identifying barriers to and facilitators of equitable access, defining key components of culturally safe and appropriate bereavement care, and developing a logic model and recommendations for equitable bereavement support.</p><p><strong>Methods: </strong>Multi-phase national qualitative study, drawing on experience-based co-design principles. We conducted interviews (n = 53) and focus groups (n = 9) with 121 bereaved people from 13 ethnically diverse backgrounds, interviews with 23 bereavement support providers across 12 services, four online co-design workshops with bereaved people and stakeholders (n = 53), and a hybrid workshop to refine recommendations (n = 29 stakeholders). Recruitment and data collection prioritised cultural safety and an asset-based approach. Directed thematic analysis was informed by Levesque et al.'s access to healthcare framework.</p><p><strong>Results: </strong>Barriers to equitable bereavement support arose across the access pathway but were concentrated mainly within bereavement support organisations and the wider bereavement support system. Racism and intersectionality were cross-cutting themes, influencing whether bereaved people could identify, trust, reach and engage with support. Key barriers included poor signposting and referral, long waiting lists, limited staff diversity, language barriers, weak organisational commitment to equity, precarious funding, and white-centred, individualised models of grief support. Participants identified culturally safe and equitable care as requiring anti-racist practice, sustained community partnership, provision of support in trusted settings and community languages, holistic and flexible provision, and greater investment in grassroots services designed and delivered by ethnically diverse communities. The logic model and recommendations identify system-wide actions needed to address barriers and support equitable access.</p><p><strong>Conclusions: </strong>Inequitable access to bereavement support for ethnically diverse communities is rooted primarily in the design, organisation and cultural orientation of services and the wider bereavement support system. Improving equity will require sustained investment in community-led provision, accountability mechanisms, and genuine partnership with ethnically diverse communities. Findings from this robust multi-perspective study provide actionable recommendations to reform bereavement support across high- and middle-income settings.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"24 1","pages":""},"PeriodicalIF":8.7,"publicationDate":"2026-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149227243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"'People need to be a bit more understanding that my body is wrecked': A qualitative exploration of inpatient hospital care for people living with multiple long-term conditions.","authors":"Sue Bellass, Thomas Scharf, Miles D Witham, Lynsey Threlfall, Chris Plummer, Avan A Sayer, Rachel Cooper","doi":"10.1186/s12916-026-05181-4","DOIUrl":"10.1186/s12916-026-05181-4","url":null,"abstract":"<p><strong>Background: </strong>Living with multiple long-term conditions (MLTC) is becoming increasingly common with far-reaching consequences for individuals and healthcare systems. People with MLTC often face complex care pathways through health systems - especially hospitals, which are largely configured for specialist treatment of single conditions - yet evidence on people with MLTC's lived experience in the hospital setting is limited. This study aimed to understand the hospital care experiences of people living with MLTC who had recently had an inpatient stay.</p><p><strong>Methods: </strong>People with MLTC who had experienced an inpatient stay in hospital within the previous six months were recruited via three hospitals in England and via patient networks. Semi-structured one-to-one interviews were conducted with each participant, focussing on their experiences of care from admission to discharge. An inductive thematic analysis was undertaken.</p><p><strong>Results: </strong>A total of 44 people (mean age 68.4 years, 23 women) who reported living with between 2 and 11 long-term conditions, the majority of whom (96%) reported that their most recent hospital stay was unplanned, participated in the study. Three themes were constructed from the interview data, reflecting perceptions at individual, interpersonal and organisational levels. Participants' experiences were shaped by internalised narratives of hospital care, where care was expected to be focussed primarily on single conditions within a resource-constrained environment. Relationally, the degree of alignment between clinician and patient knowledge on conditions was a key contributor to whether hospital care was experienced positively or negatively, and participants' perceptions of organisational constraints to holistic care gave insights into their views on system-level barriers shaping the provision of care for MLTC in the hospital setting.</p><p><strong>Conclusions: </strong>Experiences of inpatient hospital care for people with MLTC are complex, diverse and shaped by expectations of care in a specialist setting configured to provide care for single conditions. Healthcare professionals should incorporate patients' experiential expertise into decision-making processes through consultation with people with lived experience of MLTC. Redesigning hospital services to provide holistic care will require flexibility to respond to the wide spectrum of MLTC experiences.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"24 1","pages":""},"PeriodicalIF":8.7,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13673762/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Front-line decision-making: a thematic analysis of interviews with hospital staff on referrals, admissions, and care for people with multiple long-term conditions.","authors":"Sara Pretorius, Sue Bellass, Rachel Cooper, Felicity Evison, Suzy Gallier, Nicola Howe, Elizabeth Sapey, Amelia Sheppard, Jana Suklan, Avan A Sayer, Miles D Witham, On Behalf Of The Admission Research Collaborative","doi":"10.1186/s12916-026-05236-6","DOIUrl":"10.1186/s12916-026-05236-6","url":null,"abstract":"<p><strong>Background: </strong>Multiple long-term conditions (MLTC) are increasingly common and present challenges for hospital healthcare professionals (HCPs) making decisions about admissions, referrals, and care management in the context of a single-organ oriented health system. This qualitative study examined how HCPs in emergency and acute hospital settings make such decisions for people living with MLTC, exploring factors that influence clinical judgement and how HCPs respond to these challenges.</p><p><strong>Methods: </strong>HCPs involved in making decisions about care for people living with MLTC presenting to hospital were recruited via National Health Service (NHS) research delivery networks and professional contacts, using purposive and snowball sampling. Semi-structured individual interviews were conducted, focusing on how HCPs make decisions regarding the care of people living with MLTC and factors influencing such decisions. Reflexive thematic analysis was undertaken. Themes relating to influences on decision-making were organised using the Social Ecological Model (SEM).</p><p><strong>Results: </strong>We interviewed 40 HCPs working in NHS emergency departments and acute assessment units across multiple regions, specialties and roles. Seven themes were constructed and organised into two overarching categories. The first category 'Factors Influencing Decision-Making' included the themes the complex patient, professional expertise and identity, system pressures and inflexible structures. These themes were mapped to the SEM, demonstrating influences across individual and environmental levels. The second category 'Adaptive Decision-Making Strategies' included the themes Mitigating risk and Relying on heuristics capturing how HCPs navigate the uncertainty created by these influences. The theme, Relational care, operated between categories, illustrating how relationships both shape what decisions are possible (interpersonal level of SEM) and provide a means of navigating uncertainty.</p><p><strong>Conclusions: </strong>Clinical decision-making for people living with MLTC in emergency and acute settings is shaped by uncertainty arising from the interaction of factors operating across individual, interpersonal and environmental levels. To manage this uncertainty, staff employ a range of adaptive strategies. However, participants described this level of compensatory work as challenging and potentially insufficient on its own. Supporting decision-making and reducing reliance on adaptive responses may benefit from system‑level change, including improved community care, enhanced generalist expertise, opportunities for relational decision-making, better continuity and shared ownership of care, and flexible care pathways.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"24 1","pages":""},"PeriodicalIF":8.7,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13673829/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bayesian probabilistic statements for communicating clinical trial results.","authors":"Orestis Efthimiou, Konstantina Chalkou, George Cm Siontis, Urs Fischer, Thomas Perneger, Georgia Salanti, Angèle Gayet-Ageron","doi":"10.1186/s12916-026-05208-w","DOIUrl":"10.1186/s12916-026-05208-w","url":null,"abstract":"<p><strong>Background: </strong>Clinical trials are often analyzed using frequentist methods and results are interpreted according to their statistical significance. However, p-values and effect measures such as odds or hazard ratios are poorly understood by researchers and policymakers, and even less by patients and clinicians. Moreover, communicating uncertainty around treatment effects is challenging. Probabilistic statements from Bayesian analyses (e.g., the probability that a drug is more effective than placebo) offer an intuitive way to convey results and uncertainty, may provide insight, and support clinical decision-making. We aimed to (i) empirically evaluate the utility of probabilistic statements by re-analyzing data from previously published trials using Bayesian methods, and (ii) provide instructional examples of how probabilistic statements can be used to communicate and interpret results from clinical trials.</p><p><strong>Methods: </strong>We analyzed data on primary outcomes obtained from trials previously published in leading medical journals, using Bayesian methods. We included 169 primary outcomes from 130 negative trials (p-values > 0.05) across various medical fields, and 234 outcomes from 225 positive trials (p-value < 0.05) in oncology. We used uninformative priors for illustration, supplementing them with skeptical priors in sensitivity analyses. We estimated the probabilities that active treatments were more effective or safe than controls, for each outcome. We also estimated probabilities that the treatment effects were above specific thresholds for clinical significance. We described three of the included trials in more detail and additionally analyzed one trial in neurology as didactical case studies, to illustrate the use of probabilistic statements.</p><p><strong>Results: </strong>So-called negative studies may sometimes yield clinically relevant evidence of an effect: in 26/169 (15%) cases we found > 90% probability that the experimental treatment is better than control; for 12/169 (7%) of them, this probability was > 95%. Conversely, positive trials may not always show evidence of clinically meaningful effects: in 25/234 (11%) of the positive oncology trials, there was less than 50% probability that treatment reduces hazards by 20% or more. Our case studies illustrate how to use probabilistic statements in medical decision making in practice.</p><p><strong>Conclusions: </strong>Relying on statistical significance without considering clinical importance can mislead decision-making and potentially harm patients. Probabilistic statements from Bayesian analyses can complement traditional approaches to communicating clinical trial results.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"24 1","pages":""},"PeriodicalIF":8.7,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13651341/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149134993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Longitudinal associations between loneliness and outcomes of Common Mental Disorders (CMDs): A systematic review and meta-analysis.","authors":"Theodora Stefanidou, Siying Li, Kinga Lagan, Gamze Evlat, Hannah Gray, Jasmine Harju-Seppänen, Amber Jarvis, Millie O'Sullivan, Shivangi Talwar, Gemma Lewis, Joshua E J Buckman, Alexandra Pitman, Sonia Johnson, Brynmor Lloyd-Evans","doi":"10.1186/s12916-026-05252-6","DOIUrl":"10.1186/s12916-026-05252-6","url":null,"abstract":"<p><strong>Background: </strong>Loneliness has been increasingly associated with poor mental health outcomes, yet its prognostic role in people with Common Mental Disorders (CMDs) remains unclear. This systematic review aimed to examine whether loneliness is longitudinally associated with mental health outcomes in individuals with CMDs, regardless of treatment status.</p><p><strong>Methods: </strong>We searched PsycINFO, MEDLINE, Embase and CINAHL from inception to October 2025 for longitudinal studies examining associations between baseline loneliness and CMD outcomes at follow-up. Eligible studies included adults aged 16+ with CMDs. We conducted a narrative synthesis and where appropriate, random-effects meta-analyses for binary depression outcomes reflecting unfavourable course (recurrence, persistence, or non-remission). Study quality was assessed using the Newcastle-Ottawa Scale, and certainty of evidence was evaluated using GRADE. The protocol was registered with PROSPERO (registration number: CRD42023410401).</p><p><strong>Results: </strong>We included 22 studies, of which the majority focused on depression-related outcomes (operationalised as symptom severity, recurrence, persistence, remission, and service utilisation). Our narrative synthesis showed consistent associations between higher baseline loneliness and poorer depression-related outcomes at follow-up in people with CMDs across clinical, community, and treatment settings. Meta-analysis of four studies (all in older adults with depression) showed that individuals reporting loneliness at baseline had over three times the odds of poor depression outcomes at follow-up compared with those not lonely (pooled adjusted OR 3.26, 95% CI [2.26-4.70], p < 0.001). This finding should be interpreted with caution, as only one of the four studies adjusted for baseline depressive symptom severity. The few studies capturing suicidal ideation, anxiety, and mixed CMD outcomes found limited and inconsistent evidence. The GRADE certainty of evidence was high for depression outcomes, low for suicidal ideation and anxiety outcomes, and very low for mixed CMD outcomes.</p><p><strong>Conclusions: </strong>Loneliness is consistently associated with poorer subsequent depression outcomes in people with CMDs, particularly depressive disorders. These findings suggest loneliness may represent an important prognostic factor in depression and warrant further evaluation in intervention studies. Further high-quality longitudinal research is needed to clarify whether-and under what conditions-loneliness affects outcomes for other CMDs and treatment effectiveness.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"24 1","pages":""},"PeriodicalIF":8.7,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13670620/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of green health prescribing and nature-based interventions in primary care and community settings for older adults: a systematic review of health, wellbeing and social outcomes.","authors":"Furqan Butt, Jeremiah Donoghue, Cameron Ley, Naila Dracup, Sophie Staniszewska, Lena Al-Khudairy, Tilli M Smith, Nadia Corp, Jo Parsons, Helen Frost, Amy Grove, Yen-Fu Chen, Danielle A van der Windt","doi":"10.1186/s12916-026-05194-z","DOIUrl":"https://doi.org/10.1186/s12916-026-05194-z","url":null,"abstract":"<p><strong>Background: </strong>Green Health Prescribing involves health and care professionals prescribing structured, nature-based interventions, such as gardening, walking in green spaces, or cultural activities outdoors. With population ageing and increasing pressure on healthcare systems, Green Health Prescribing has been proposed as a potentially cost-effective approach to support healthy ageing in older adults with long-term conditions. This review summarises evidence on the effectiveness of Green Health Prescribing and related nature-based interventions for older adults.</p><p><strong>Methods: </strong>A systematic review was conducted of intervention studies reporting the effectiveness of Green Health Prescribing and nature-based interventions for adults aged 50 years and over in primary or community care settings. Eligible designs included randomised trials, other comparative designs, and before-after studies. Searches up to October 2024 were performed in major medical, psychological, social science, and environmental databases, alongside grey literature sources. Study selection, data extraction, and quality appraisal were undertaken independently by at least two reviewers. Quantitative findings were synthesised narratively using a Grading of Recommendations, Assessment, Development and Evaluation-informed approach, with reporting guided by established systematic review standards. Patient and provider input informed the design and interpretation of findings.</p><p><strong>Results: </strong>Twenty-one studies, including 11 randomised trials, evaluated interventions among older adults living in the community or residential care. Interventions included activities in nature, exercise in green spaces, indoor gardening, and horticultural therapy. Many studies reported improvements in at least one health or wellbeing outcome; however, statistically significant effects compared with control conditions were uncommon. Evidence suggested potential benefits for quality of life, mental health, physical function, fatigue, loneliness, and social connectedness, but findings were inconsistent. Overall certainty of evidence was low or very low, largely because of small sample sizes, risk of bias, and limited replication across outcomes.</p><p><strong>Conclusions: </strong>Evidence supporting the effectiveness of Green Health Prescribing and nature-based interventions for older adults remains limited. Given continued policy priority and funding for green space prescribing, high-quality pragmatic trials and implementation studies are needed, particularly among older adults, to robustly assess health outcomes, cost-effectiveness, and healthcare resource use in routine practice for Green Health Prescribing as a referral option in primary and community care.</p><p><strong>Systematic review registration: </strong>CRD42025603199.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"24 1","pages":""},"PeriodicalIF":8.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13631981/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neuropsychiatric outcomes after montelukast versus inhaled corticosteroids in pediatric asthma: a pooled birth cohort study.","authors":"Xue-Feng Jiao, Francine M Ducharme, Lisiane Freitas Leal, Cristina Longo, Odile Sheehy, Florentia Kaguelidou, Anick Bérard","doi":"10.1186/s12916-026-05235-7","DOIUrl":"https://doi.org/10.1186/s12916-026-05235-7","url":null,"abstract":"<p><strong>Background: </strong>The evidence regarding montelukast‑associated neuropsychiatric adverse events in children with asthma is controversial and inconclusive. We sought to further examine the association between use of montelukast and the risk of neuropsychiatric events in children with asthma.</p><p><strong>Methods: </strong>We conducted a pooled analysis of two birth cohorts: the AMerican PREGNANcy-Mother-Child CohorT (AM-PREGNANT) from the US, and the Quebec Pregnancy Cohort (QPC) from Canada. We included children aged 1 to < 18 years with the first incident diagnosis of asthma after birth and whose initial asthma controller therapy was either montelukast monotherapy or inhaled corticosteroids (ICS) monotherapy. The primary outcomes were sleep disorders and attention-deficit/hyperactivity disorder (ADHD), while secondary outcomes included mood disorders, anxiety disorders, and oppositional defiant and conduct disorders. We used Cox proportional hazards regressions, adjusting for potential confounders, to quantify the associations in each birth cohort independently. A random effects Meta-analysis was used to pool outcome-specific results if heterogeneity was acceptable.</p><p><strong>Results: </strong>In AM-PREGNANT, 85,322 asthmatic children were included, with 21,534 in the montelukast monotherapy group and 63,788 in the ICS monotherapy group. In QPC, 11,854 asthmatic children were included, with 373 in the montelukast monotherapy group and 11,481 in the ICS monotherapy group. Use of montelukast was significantly associated with increased risks of ADHD (pooled adjusted hazard ration [HR], 1.40; 95% confidence interval [CI], 1.19-1.66) and oppositional defiant and conduct disorders (adjusted HR, 1.43; 95% CI, 1.13-1.82) compared to ICS; however, AM-PREGNANT and QPC yielded inconsistent findings regarding sleep disorders. In the subgroup analyses, use of montelukast was significantly associated with an increased risk of sleep disorders in the controlled and partly controlled asthma subgroup and in children who had not used oral corticosteroids during follow-up time when compared to ICS. There were no significant between-group differences with regards to mood disorders or anxiety disorders.</p><p><strong>Conclusions: </strong>Among children newly diagnosed with asthma, use of montelukast is associated with increased risks of ADHD and oppositional defiant and conduct disorders compared to ICS; among those with newly diagnosed controlled, partly controlled, or non-severe asthma, use of montelukast is associated with an increased risk of sleep disorders compared to ICS.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"24 1","pages":""},"PeriodicalIF":8.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13632352/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors influencing access to green health prescribing in primary care for older adults - a qualitative systematic review.","authors":"Jeremiah Donoghue, Furqan Butt, Cameron Ley, Naila Dracup, Sophie Staniszewska, Lena Al-Khudairy, Tilli M Smith, Nadia Corp, Jo Parsons, Helen Frost, Amy Grove, Yen-Fu Chen, Danielle A van der Windt","doi":"10.1186/s12916-026-05195-y","DOIUrl":"https://doi.org/10.1186/s12916-026-05195-y","url":null,"abstract":"<p><strong>Background: </strong>Green health prescribing (GHP) refers to nature-based interventions (NBIs) prescribed by a clinician or qualified health or social care professional. Given the ageing global population and increasing care needs posing severe challenges for healthcare systems, GHP has emerged as a potentially effective and efficient scheme to support healthy ageing in older people living with long-term conditions. This evidence review aimed to identify the barriers and enablers to access, uptake, implementation and delivery of GHP and associated NBIs.</p><p><strong>Methods: </strong>We undertook a systematic review of qualitative evidence exploring the barriers and enablers of GHP and engagement with NBIs. Searches from 2000 up to October 2024 were conducted in Medline, PsycINFO, ASSIA (Applied Social Sciences Index and Abstracts), GreenFILE, Web of Science and Dimensions and Overton and Google. Study selection (based on a priori-defined eligibility criteria), data extraction, and quality appraisal were conducted independently by two reviewers and discrepancies were resolved by a third reviewer. Qualitative data were extracted from each article, and we conducted an inductive thematic synthesis of data. We followed reporting guidance from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), the Enhancing transparency in reporting the synthesis of qualitative research (ENTREQ) and GRIPP2 for patient and public involvement and engagement (PPI-E).</p><p><strong>Results: </strong>Ten overarching factors were identified from 25 included studies representing barriers and enablers of access to or implementation of GHP and NBIs. Key barriers included challenges in programme accessibility, gaps in service provision and healthcare professionals' knowledge, prescriber hesitancy, limited organisational capacity, socioeconomic disparities, and limited evidence of effectiveness. Enablers included accessibility of green spaces, positive experiences in social engagement and connecting to nature and provider's enthusiasm and commitment.</p><p><strong>Conclusions: </strong>Our findings explore factors that can directly influence access and engagement of older people with NBIs, and organisational capacity of service providers and prescribers. To realise the full potential of GHP in supporting healthy ageing and reducing health inequalities, future efforts should prioritise accessible programme design, invest in community provision infrastructure, and improve the integration within primary and community care settings.</p><p><strong>Systematic review registration: </strong>CRD42025603199.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"24 1","pages":""},"PeriodicalIF":8.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13632392/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severity of depression and anxiety symptoms is reflected in physiological and behavioral metrics collected from a consumer-grade wearable ring.","authors":"Saeid Azadifar, Alireza Sameh, Laura Nauha, Mikko Kärmeniemi, Maisa Niemelä, Vahid Farrahi","doi":"10.1186/s12916-026-05276-y","DOIUrl":"10.1186/s12916-026-05276-y","url":null,"abstract":"<p><strong>Background: </strong>Modern wearable devices generate a multitude of digital metrics, which can be used to measure human function in health and disease. This study investigated whether and how digital metrics generated from a consumer-grade smart ring were different in individuals with varying severity of depression and anxiety symptoms in a large population-based cohort.</p><p><strong>Methods: </strong>Cross-sectional data were obtained from the Northern Finland Birth Cohort 1986 when participants were 33-35 years of age. Participants were asked to wear the Oura Ring for two weeks, which provided digital measures of sleep architecture, nocturnal heart rate (HR), nocturnal heart rate variability indexed by the root mean square of successive differences between normal heartbeats (RMSSD), and minute-by-minute movement intensity. Participants with at least one weekday and a weekend day with no less than 15 h of wear time were included. Two screening tools were used to assess depression and anxiety symptoms. Symptoms of anxiety were assessed using the Generalized Anxiety Disorder 7-item scale (GAD-7) and symptoms of depression and anxiety using Hopkins Symptom Checklist-25 (HSCL-25). Participants were grouped into no, mild, and moderate-to-severe anxiety symptom groups based on GAD-7, and with and without depression and anxiety symptoms based on HSCL-25. Time-series data were visualized, and statistical differences between groups were assessed using one-way ANCOVA followed by Tukey's post hoc test.</p><p><strong>Results: </strong>A total of 1,290 participants provided enough valid data and were included. Participants with moderate-to-severe anxiety assessed by GAD-7 and with depression and anxiety symptoms assessed by HSCL-25 exhibited lower percentage of rapid eye movement (REM) and deep sleep, and increased light sleep compared with the group without depression and anxiety. These two groups also showed higher HR, lower RMSSD during sleep, and lower levels of physical activity during the day. The differences between mild anxiety group with no and moderate-to-severe anxiety groups were overall less apparent on average.</p><p><strong>Conclusions: </strong>Findings suggest that severity of depression and anxiety can be reflected in behavioral and physiological metrics generated by a consumer-grade wearable ring. These findings suggest that they may be a promising tool for enhancing symptoms tracking and informing personalized care strategies.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"24 1","pages":""},"PeriodicalIF":8.7,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13625339/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to: Debate in relation to \"Ultra‑processed foods and human health: the main thesis and the evidence\".","authors":"Leandro F M Rezende, Maria Laura da Costa Louzada, Euridice Martinez-Steele, Geoffrey Cannon, Renata B Levy, Patricia C Jaime, Carlos A Monteiro","doi":"10.1186/s12916-026-05217-9","DOIUrl":"10.1186/s12916-026-05217-9","url":null,"abstract":"<p><p>This response addresses criticisms by Ibsen and colleagues regarding the definition of ultra-processed foods (UPFs) by Nova, proposed mechanisms linking UPFs to health outcomes, and the choice of comparators in epidemiological studies. We argue that these critiques partially reflect a misunderstanding of Nova and how evidence on UPF has been generated. Nova classifies foods into four groups by the extent and purpose of industrial processing, not nutrient composition. Epidemiological studies primarily examine the health effects of the worldwide increasing exposure to the ultra-processed dietary pattern, capturing real-world dietary displacement of the first three Nova groups, the basis of traditional healthy diets, by UPFs. The focus on specific food nutrient imbalances has informed important policies. However, this approach is insufficient to explain or orient actions to reverse the worldwide rise in diet-related chronic diseases, because they fail to address the underlying industrial food system. The ultra-processed dietary pattern is characterized by the systematic co-occurrence of nutrient and non-nutrient harmful attributes, including altered food matrices, excessive energy density, hyper-palatability, additives for which there is evidence of harm, and industrial contaminants. Heterogeneity within this pattern does not invalidate it as a dietary exposure, just as variability within the Mediterranean diet does not preclude its epidemiological and policy relevance. The same applies to the claims that mechanisms linking UPFs to health outcomes are non-specific. Similarly, critiques of inappropriate comparators conflate analyses of individual foods and dietary patterns. Given the scale, consistency, and breadth of the evidence, actions to reduce overall UPF consumption are justified and overdue.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"24 1","pages":""},"PeriodicalIF":8.7,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13621495/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149073203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}