People who engage in both self-harm and violence (‘dual harm’) in prison cause widespread disruption to prison services. Whilst the behavioural profile of such individuals is gaining attention, there is very little research which explores their life histories and how these contextualise their dual harm. This study qualitatively explored how five young men in a medium secure prison in England with a history of dual harm (in the community, prison, or both) made sense of their life experiences and engagement in dual harm behaviours. Participants were interviewed using an in-depth life story interview protocol. A narrative analysis identified three themes: ‘Beginning: Making sense of a traumatic childhood’, ‘Middle: Exploring challenges during late adolescence’ and ‘End: Who I am now, and who I must be’. These themes, grounded in life experiences and associated meaning, offer valuable insights into the underpinnings of dual harm behaviours and direction for interventions addressing dual harm in prisons. The paper concludes with a discussion of key implications and directions for future research and practice in relation to the support and management of people who dual harm in custody.
HPV vaccines, 20 years on
Nature Medicine, Published online: 20 May 2026; doi:10.1038/s41591-026-04374-x
Women are now at the very center of the global cancer control agenda, but there are major challenges ahead.
<![CDATA[Learn how to spot bipolar mixed features, avoid antidepressant pitfalls, and choose evidence-based antipsychotics.]]>
Aspects of Quality of Life in Interstitial Lung Disease: Pilot Observational Cross-Sectional Study in a Single Center
Background: Quality of life (QOL) is an important aspect of every chronic disease, including interstitial lung disease (ILD). QOL is perceived as a significant patient-centered outcome. Objective: This study aims to identify factors correlating with different aspects of QOL in patients with various ILDs. Methods: We recruited 57 participants hospitalized in a tertiary care clinical center to this pilot observational cross-sectional study. These included 22 patients with idiopathic interstitial pneumonia (IIP), 19 patients with connective tissue disease–associated ILD (CTD-ILD), and 16 patients with interstitial pneumonia with autoimmune features (IPAF). The Saint George’s Respiratory Questionnaire (SGRQ) and World Health Organization Quality of Life Questionnaire (WHOQOL-BREF) were used to assess QOL, and the Hospital Anxiety and Depression Scale – Modified Version (HADS-M) and Patient Health Questionnaire – 9 (PHQ-9) were used to evaluate depression severity. Functional parameters including forced vital capacity (FVC), forced expiratory volume in 1 second (FEV), transfer lung capacity for carbon monoxide (TLCO), and 6-minute walk distance (6MWD) were assessed. Assessment of QOL was a secondary outcome measure in a multicenter prospective study aimed at determining the characteristics of Polish patients with interstitial pneumonia with autoimmune features. Results: In each study group, positive correlations existed between the WHOQOL-BREF physical domain score and FEV % predicted value (=.001) and TLCO % predicted value (=.03). Regardless of diagnosis, higher depression, anxiety, and aggression scores (ie, worse mental health) correlated negatively with multiple domains of QOL measured using the WHOQOL-BREF. Predictors of QOL aspects varied in each study group. In the IPAF group, the TLCO % predicted value was a predictor of QOL expressed as the SGRQ total score (=.005). In the CTD-ILD group, short 6MWD (<.001) and high HADS-M aggression score (=.01) correlated with low QOL (expressed as a high SGRQ total score). In the IIP group, 6MWD (=.002) and PHQ-9 scores (<.001) were predictors for SGRQ symptoms score. Gender-based differences were revealed: In all study groups, men had higher scores in the psychological, social, and environmental domains of the WHOQOL-BREF, indicating better QOL, without a statistically significant difference in the physical domain scores between genders. Diagnosis-based differences in the psychological aspects of QOL were also revealed: The QOL psychological domain scores were significantly lower in the CTD-ILD and IPAF groups than in the IIP group, indicating worse QOL (=.01). Conclusions: QOL is a multifaceted issue with various factors impacting its assessment. 6MWD, TLCO predicted value, and worse functional ability might specifically impact QoL in ILD. Mental health is an important aspect of QOL in the ILD population, as patients with a chronic, potentially life-limiting disease may be more prone to developing depression or anxiety. Assessment of QOL should be taken into account in clinical decision-making and research on chronic diseases, as this patient-related outcome may impact therapeutic decisions and patient compliance. Trial Registration: ClinicalTrials.gov NCT03870828; https://clinicaltrials.gov/study/NCT03870828
Multigesture Electromyographic Control Complexity in Upper Limb Prostheses Actuated via Single Sensor Input Contraction Magnitude: Qualitative Study for Evaluating Performance and Cognitive Load
<strong>Background:</strong> Lack of functionality is one factor that contributes to prosthetic rejection rates. Electromyographic upper limb prostheses are controlled through muscle contractions in the user’s residual limb. The incorporation of multigesture controls into a novel, in-house developed upper limb prosthesis requires users to differentiate between the strengths of muscle contractions to trigger programmed gestures. Little research exists on the limitations of expanding device capabilities. This expansion may lead to a decline in accuracy and perceived usability or an increase in training time and cognitive workload. <strong>Objective:</strong> This study aimed to determine the feasibility of implementing multiple gestures when learning electromyographic controls during a single training session. <strong>Methods:</strong> Participants with full upper extremity control were fitted with a Flex Controller, a surface electromyography device that measures muscle contraction. Contractions were visualized as peaks and calibrated through an adjustable scale on a tablet. A training app was developed in-house to test novice users on an electromyography control system. Users interacted with 1, 3, or 5 zones on the screen. Each horizontal zone represented a threshold required to trigger a distinct gesture on the prosthesis. The cohorts were labeled A1 (n=9), A2 (n=10), A3 (n=9), and B1 (n=26). Every participant completed 3 trials per arm, and each trial consisted of 15 randomized cues. Each cue was represented by a green color change, with 1 point earned after a successful peak. Collected outcomes included performance, the System Usability Scale, and the National Aeronautics and Space Administration Task Load Index. <strong>Results:</strong> Scores decreased significantly as zones increased (Kruskal-Wallis H<sub>3</sub>=24.9, <i>P</i><.001). The mean scores were 15.0 (SD 0.0) for 1 zone, 9.1 (SD 1.1) for 3 zones, and 5.5 (SD 1.1) for 5 zones. Perceived usability, measured by System Usability Scale, showed modest omnibus difference across cohorts (Kruskal-Wallis H<sub>3</sub>=5.22, <i>P</i>=.16); however, a pairwise comparison showed the 5-gesture cohort rated usability lower than the progressive cohort (2-tailed Welch t<sub>11</sub>=–2.19, <i>P</i>=.05). The 5-gesture cohort rated the system lowest (mean 63.3, SD 16.2). Cognitive workload, assessed through the National Aeronautics and Space Administration Task Load Index, increased with the number of gestures. The performance subscale showed a significant omnibus difference across cohorts (Kruskal-Wallis H<sub>3</sub>=21.4, <i>P</i><.001). Mean performance subscale scores were 84.4 (SD 14.7) for the single-gesture condition, 30.6 (SD 21.7) for the 5-gesture condition, and 44.2 (SD 21.2) for the progressive cohort, reflecting increasing perceived difficulty with more gestures. The sample size for quantitative analysis was 54. <strong>Conclusions:</strong> These findings support the implementation of progressive training for 3 gestures. Usability perceptions were the highest among the more complicated progressive cohort, which is likely related to perceived improvement. Progressively learning 3 gestures enables a balance between device capability, user intention, perceived usability, and cognitive workload.
Patients’ mHealth Apps Usage and Data Privacy, Security, and Confidentiality Concerns: Exploratory Study
Background: The Technology Adoption Model (TAM) offers a potential framework for elucidating the relationships between data privacy or security concerns and behavioral intention, perceived usefulness (PU), and perceived ease of use (PEOU) of mobile health (mHealth) apps, particularly for patients’ self-care management. In Saudi Arabia, limited information is available on these pertinent research areas despite the government’s relentless efforts to bolster the use of mHealth apps. Objective: This study applies the TAM and the psychosociocultural framework to explore the influence of patients’ data privacy and security concerns on the PU, PEOU, and behavioral intention to use mHealth apps for self-care management in Saudi Arabia. Methods: A cross-sectional study was conducted by recruiting patients using mHealth apps for self-care from various provinces in Saudi Arabia. Research instruments were developed based on the components of 2 theories: the psychosociocultural framework and TAM, which were then piloted, validated, and distributed to participants via Google Forms. Linear regression models were performed to test the hypothesized relationships. Results: Overall, 567 patients using mHealth apps participated in the study. Slightly more than one-third (217/567, 38.2%; range 35.6%‐41.4%) of the participants expressed a high level of concern regarding data privacy, confidentiality, and security, with significant predictors being female gender, higher educational qualifications, and younger age groups (<46 years). About 18% to 25% of the variance in PU, PEOU, and behavioral intention to use mHealth apps was explained by the tested factors. Patients were more likely to have higher PU following a unit decrease in data confidentiality (=.31; =.01) and security concerns (=.47; =.01). The PEOU of mHealth apps increased as users demonstrated less concern regarding data privacy (=.18; =.001), confidentiality (=.24; <.001), and security (=.43; =.02). Likewise, behavioral intention to use mHealth apps also increased significantly following a reduction in respondents’ concerns toward data privacy (=.18; =.02), confidentiality (=.24; =.03), and security issues (=.36; =.01). Conclusions: Specific demographic factors and concerns regarding data security and privacy influence patients’ PU, PEOU, and behavioral intention to use mHealth apps for self-care management. Targeting the age-, education-, and gender-based differences regarding the usage of mHealth apps. Health care providers and policymakers may consider age-, education-, and gender-based differences when developing strategies to improve the adoption of mHealth apps among the Saudi patient population.
Feasibility of Videoconference-Based Cognitive Behavioral Therapy for Somatic Symptom Disorder: Single-Arm Pilot Trial
Background: Somatic symptom disorder (SSD) is a mental disorder marked by persistent somatic symptoms and maladaptive health-related thoughts, feelings, or behaviors. Cognitive behavioral therapy has been shown to be effective in treating SSD, reducing patients’ somatic symptoms, depressive symptoms, and anxiety symptoms. However, challenges remain—including limited access to treatment. Videoconference-based cognitive behavioral therapy (vCBT) has emerged as a promising approach, offering flexible and tailored treatment while addressing the shortage of medical resources and potentially reducing patient dropout. Objective: This study examined the feasibility of vCBT for patients with SSD and explored secondary outcomes related to the physical component of health-related quality of life (HRQOL) as assessed using the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) physical component summary (PCS) score and other exploratory clinical outcomes. Methods: This single-arm pilot trial evaluated feasibility as the primary outcome assessed via recruitment rate, retention rate, session completion rate, and safety. Ten participants with SSD were enrolled, and all received 6 weekly 50-minute vCBT sessions. Secondary outcomes included physical HRQOL (SF-36 PCS) as the key secondary outcome, as well as mental HRQOL, depressive symptoms, somatic symptom severity, anxiety symptoms, health anxiety, pain, insomnia, and generic HRQOL. These outcomes were measured at the preintervention (week 0) and postintervention (week 6) time points and 1-month follow-up (week 10) and were analyzed using 2-sided paired tests. Results: All feasibility criteria were met, with a recruitment rate of 83.3% (10/12), a retention rate of 100% (10/10), a session completion rate of 100% (10/10), and no adverse events reported. The SF-36 PCS score improved by 4.99 points at the postintervention time point, representing a large within-group effect (Cohen =0.99, 95% CI 0.21‐1.74). Medium to large improvements were also observed in mental HRQOL, depressive symptoms, anxiety symptoms, health anxiety, pain, insomnia, and generic HRQOL, and most of these improvements were observed at the 1-month follow-up. Conclusions: Our findings indicate that vCBT is a feasible and safe approach for SSD, with findings suggesting acceptability and preliminary evidence of effectiveness. Trial Registration: University Hospital Medical Information Network Clinical Trials Registry UMIN000046138; https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000052664
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Development, Feasibility, Acceptability, and Usability of an Artificial Intelligence–Powered Chatbot (Suzy) to Support Patients in Substance Use Disorder Recovery: Multiphase Study
<strong>Background:</strong> Substance use disorder (SUD) remains a major public health crisis in the United States, with significant challenges in treatment access, retention, and workforce capacity. SUD care teams, including addiction medicine physicians and peer recovery coaches (PRCs), support patients receiving SUD treatment but face heavy workloads and burnout. Artificial intelligence (AI) innovations, particularly large language model (LLM)–based chatbots, may extend PRC support and provide patients with on-demand recovery support between clinic visits and PRC contacts. However, evidence on their development, feasibility, acceptability, and usability in addiction services remains limited. <strong>Objective:</strong> This study describes the development, feasibility, acceptability, and usability of an AI-powered health coaching chatbot (Suzy) designed to support patients in SUD recovery. <strong>Methods:</strong> A total of 2 clinicians, 5 researchers, and 2 technology developers led a small, multiphase pilot study. In the formative phase, they conducted focus groups and qualitative in-depth interviews with 12 health care professionals and 8 patients with substance use histories to specify chatbot functions and develop a rule-based chatbot. In phase 2, they conducted usability testing of the rule-based chatbot with 8 patients who reported substance use and completed standardized tasks, surveys, and qualitative interviews. Measures included the System Usability Scale (SUS), Net Promoter Score (NPS), and Single Ease of Use Question (SEQ). In phase 3, they developed an LLM-based chatbot co-designed and fine-tuned with PRCs and other SUD experts. <strong>Results:</strong> Rule-based chatbot functions included craving management, appointment reminders, resource referrals, care team contacts, and goal setting. Usability task testing supported feasibility. In this small pilot sample, quantitative and qualitative feedback indicated acceptability and usability, with an average SUS score of 93 (benchmark 68), an NPS of 63 (benchmark 35), and a mean SEQ score of 6.5/7. Patients valued Suzy’s approachable, nonjudgmental language and features that promoted accountability, self-monitoring, and 24/7 availability, while emphasizing that chatbots should supplement but not replace human support. The LLM-based chatbot development emphasized information accuracy, safety escalation protocols to mitigate risks of inappropriate chatbot responses, human-in-the-loop features, and expanded conversational flexibility and personal tailoring. <strong>Conclusions:</strong> In this pilot study, a rule-based chatbot designed to support SUD care demonstrated feasibility, usability, and acceptability. LLM-based chatbot development required more robust safety and emergency reporting features, while offering more patient-responsive conversational functions. By providing on-demand coaching, referrals, and reminders, Suzy may extend the reach of care teams, alleviate provider burden, and enhance patient engagement. Additional work is needed to understand how to best integrate Suzy into patients’ recovery journeys to ensure human support remains accessible and prioritized. LLM evaluation was based on expert testing and safety review. Clinical effectiveness, including the impact on substance use, was not evaluated. Next steps include evaluating the LLM chatbot in real-world settings with larger samples and assessing its efficacy in reducing substance use.
Impact of Restriction-Resumption Protocols on Mood and Anxiety in Healthy Adults: Randomized Controlled Trial
<strong>Background:</strong> Simple behavioral and cognitive actions can reduce symptoms of anxiety and depression. However, there is limited research investigating whether restricting those same actions increases symptoms and whether resuming those actions reduces symptoms. <strong>Objective:</strong> The primary aim was to examine the impact of restricting, then resuming (the “restriction-resumption protocol”), 5 groups of actions called the Things You Do (TYD), on symptoms of depression and anxiety. Participant satisfaction with life and perceptions of changes in behavior and mental health were also evaluated. <strong>Methods:</strong> In total, 70 adults were randomly allocated to an intervention group (IG) or a control group (CG). IG participants completed a 3-phase protocol over 8 weeks: a 2-week baseline period (phase A), 2 weeks of restricted TYD actions (phase B), and a 4-week resumption phase (phase C). CG participants were instructed to maintain their usual activities and routines. Primary outcomes included symptoms of depression (Patient Health Questionnaire–9), anxiety (Generalized Anxiety Disorder–7), and frequency of TYD actions. Secondary outcomes included satisfaction with life and perceived changes in mental well-being. Outcomes were measured weekly throughout the 8-week trial and again after the trial at week 9. <strong>Results:</strong> Scores on outcome measures did not differ between groups during phase A and after the trial. However, by the end of phase B, IG participants showed significantly increased symptoms of depression and anxiety compared to CG participants (<i>P</i>s<.001). Large within-group effect sizes were observed on the Patient Health Questionnaire–9 and Generalized Anxiety Disorder–7 from baseline to the end of phase B (Cohen <i>d</i>>1.8) and from phase B to after the trial (Cohen <i>d</i>>1.9). Changes in satisfaction with life and evaluations of mental health corresponded with symptom changes. <strong>Conclusions:</strong> These findings demonstrate a relationship between the frequency of performing specific actions and symptoms of depression and anxiety. The restriction-resumption protocol has the potential to increase our understanding of causal mechanisms underlying common mental disorders and may lead to the development of new models of prevention and treatment. <strong>Trial Registration:</strong> Australian and New Zealand Clinical Trials Registry ACTRN12624001491550; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=388828&isReview=true
Efficacy of a World Health Organization–Guided Self-Help Intervention for Reducing Psychological Distress in Afghan Refugees: Randomized Controlled Trial
Background: Common mental health disorders are highly prevalent among refugees. There is an urgent need to address the mental health burden in this population. Objective: This study tested the efficacy of an individually supported self-help stress-management intervention developed by the World Health Organization—Doing What Matters in Times of Stress (DWM)—in reducing psychological distress and improving functioning among refugees in Indonesia, a major transit country in the Asia-Pacific region. Methods: A single-blind randomized controlled trial with 303 Farsi-speaking refugees was conducted between June 2024 and June 2025. Participants with moderate to high psychological distress (Kessler Psychological Distress Scale [K10] score≥20) were randomly allocated to the facilitator-guided individual DWM condition (n=202) or a repeated assessment control condition (n=101). The primary outcome was psychological distress (K10 score) at the posttreatment assessment. Secondary outcomes were posttraumatic stress disorder symptoms, functional impairment, social functioning, and personally identified problems. Results: Intent-to-treat analysis indicated that participants in the DWM condition showed greater reductions in K10 scores than those in the repeated assessment control condition (posttreatment: =−.563, SE=0.124; <.001; Cohen =0.56; 1-month follow-up: =−.447, SE=0.140; =.002; Cohen =0.45). Similarly, those participants in the DWM condition reported greater improvements in posttraumatic stress disorder symptoms, well-being, social functioning, functional impairment, and personally identified psychological problems. No serious adverse events were reported. Conclusions: The findings provide the first evidence for the effectiveness of DWM in reducing psychological distress and improving overall functioning among urban refugees living in a transit setting. Individually supported self-help interventions such as DWM mayoffer an effective, feasible, and scalable approach to improving mental health for refugees. Trial Registration: ANZCTR ACTRN12624000609550; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=387637&isReview=true
