There has been significant progress in understanding neurosarcoidosis (NS) as a distinct disorder, which encompasses a heterogeneous group of clinical and radiological alterations which can affect patients with systemic sarcoidosis or manifest isolated.

The healthcare challenges posed by NS and sarcoidosis in general extend beyond their physical symptoms and can include a variety of psychosocial factors, therefore the recognition of main neuropsychiatric symptoms can be useful to approach patients with NS. Methods: For this purpose, databases such as Pubmed, Medline and Pubmed Central (PMC) have been searched.

A correct diagnosis of NS is established by the combination of clinical picture, imaging features and the histopathological finding of non-caseating and non-necrotizing granulomas. After analyzing the current literature, there is a need for specific, case-control, cohort and clinical trials on the psychiatric manifestations of sarcoidosis, because the evaluation of psychological distress (in terms of emotional suffering e.g. anxiety or depression) is often underestimated.

Exploring the neuropsychiatric manifestations of sarcoidosis is useful to raise awareness of this condition among clinicians and to establish a holistic management, which includes both physical and psychological aspects.

Ageing significantly contributes to osteoarthritis (OA) and metabolic syndrome (MetS) pathogenesis, yet the underlying mechanisms remain unknown. This study aimed to identify ageing-related biomarkers in OA patients with MetS. OA and MetS datasets and ageing-related genes (ARGs) were retrieved from public databases. The limma package was used to identify differentially expressed genes (DEGs), and weighted gene coexpression network analysis (WGCNA) screened gene modules, and machine learning algorithms, such as random forest (RF), support vector machine (SVM), generalised linear model (GLM), and extreme gradient boosting (XGB), were employed. The nomogram and receiver operating characteristic (ROC) curve assess the diagnostic value, and CIBERSORT analysed immune cell infiltration. We identified 20 intersecting genes among DEGs of OA, key module genes of MetS, and ARGs. By comparing the accuracy of the four machine learning models for disease prediction, the SVM model, which includes CEBPB, PTEN, ARPC1B, PIK3R1, and CDC42, was selected. These hub ARGs not only demonstrated strong diagnostic values based on nomogram data but also exhibited a significant correlation with immune cell infiltration. Building on these findings, we have identified five hub ARGs that are associated with immune cell infiltration and have constructed a nomogram aimed at early diagnosing OA patients with MetS.

Osteoarthritis (OA) is a prevalent degenerative joint disease characterized by progressive cartilage loss, inflammation, and joint dysfunction. With profound effects on joint function and quality of life, OA imposes a substantial socio-economic burden. As of now, OA remains incurable, lacking approved medications, regenerative therapies, or procedures that can halt the progressive destruction of the joint. Intraarticular (IA) injections have emerged as a cornerstone in the management of knee OA, offering localized minimally invasive therapeutic options. Traditional IA therapies, including corticosteroids and hyaluronic acid (HA), primarily aim to reduce pain but lack regenerative capacity. Biologic IA therapies for knee OA including autologous blood-derived products like platelet-rich plasma (PRP), bone marrow aspirate concentrate (BMAC) and mesenchymal stromal cells (MSCs) have become more commonly used. Finally, newer IA therapies such as fibroblast growth factor 18 and gene therapy are being investigated. In this review, we highlight the current evidence around IA injections for the treatment of knee OA.

Major depression disorder (MDD) is a common illness that severely limits psychosocial functioning and diminishes quality of life, particularly in young adults. Thus, it is imperial to identify MDD youth patients efficiently. This study aims to determine whether differential activation (DA) oriented recognizers can work efficiently.

This study collected heart rate variability (HRV) data and demographic information from 50 youth patients diagnosed with MDD and 53 healthy control participants. We developed six datasets, comprising baseline, stress, rest, differential activation period, Difference values between rest and stress period and combined dataset. From the provided data sets, we have developed machine learning models and also deep learning models. We then proceed to compare the performance metrics.

Models that utilized DA period and integration data sets exhibited superior performance compared to others. The deep learning model based on Long Short-Term Memory model we developed demonstrated the highest performance among all the models in each data set. Specifically, in the integration dataset, the model attained a mean cross-validation accuracy of 0.806 (95 % Confidential Interval (CI) 0.785-0.827), with a mean Area under Receiver Operating Characteristic Curve of 0.805 (95 % CI 0.784-0.826) and a mean Area under the Precision-Recall Curve of 0.863 (95 % CI 0.848-0.878).

The combination of DA theory and HRV record provides a new insight and also an efficient way for youth MDD identification.

Many individuals with depression explore complementary and alternative medicine, including spiritual healing. This pilot randomized controlled trial (RCT) aimed to assess the feasibility of a study that integrated spiritual healing with standard care versus standard care alone for adults with moderate depression.

In this pilot RCT with two parallel groups, 28 adult patients with depression were randomized to receive either spiritual healing alongside usual care (n = 14) or usual care alone (n = 14). The healing session was highly individualized. The healer positioned her hands over various areas of the client's body (head, chest, knee, hip, and feet) intending to adjust the energy flow within the client. Outcomes were measured by changes in the Beck Depression Inventory for Primary Care (BDI) scores pre-and post-intervention. Participants' experiences with spiritual healing were explored through a process evaluation. .

The BDI scores captured significant changes in depression severity, with the intervention group showing the greatest mean difference from baseline (BDI 23.0) to week 16 (BDI 14.9), compared to the control group which worsened from baseline (BDI 24.2) to week 16 (BDI 26.7). In addition, participants expressed satisfaction with the study components and procedures, and all completed the questionnaires at designated times. Recruiting from clinical practice proved suboptimal due to conflicts with primary care physicians' schedules leading to fewer participants in the study than planned. Measures to minimize loss to follow-up were effective.

Spiritual healing may be a beneficial option for individuals who suffer from moderate depression. The participants in this study were satisfied with the spiritual healing treatment, and adherence rates were high. Future RCTs should consider recruiting participants through different avenues to enhance research feasibility to alleviate the burden on family care physicians' offices.

Elevated night resting heart rate (HR) has been associated with increased depression severity, yet the underlying mechanisms remain elusive. This study aimed to investigate the mediating role of sleep disturbance and the influence of anxiety on the relationship between night resting HR and depression severity.

This is a secondary data analysis of data collected in the Remote Assessment of Disease and Relapse (RADAR) Major Depressive Disorder (MDD) longitudinal mobile health study, encompassing 461 participants (1774 observations) across three national centers (Netherlands, Spain, and the UK). Depression severity, anxiety, and sleep disturbance were assessed every three months. Night resting HR parameters in the 2 weeks preceding assessments were measured using a wrist-worn Fitbit device. Linear mixed models and causal mediation analysis were employed to examine the impact of sleep disturbance and anxiety on night resting HR on depression severity. Covariates included age, sex, BMI, smoking, alcohol consumption, antidepressant use, and comorbidities with other medical conditions.

Higher night resting HR was linked to subsequent depressive severity, through the mediation of sleep disturbance. Anxiety contributed to an exacerbated level of sleep disturbance, subsequently intensifying depression severity. Anxiety exhibited no direct effect on night resting HR.

Our findings underscore the mediating role of sleep disturbance in the effect of night resting HR on depression severity, and anxiety on depression severity. This insight has potential implications for early identification of indicators signalling worsening depression symptoms, enabling clinicians to initiate timely and responsive treatment measures.

The relationship between depression and cardiovascular disease (CVD) in individuals with prediabetes, its relative importance compared with traditional risk factors and whether genetic risk modifies this association remain unclear.

To explore the potential interactive effects of controlling traditional risk factors and depression on CVD, and to assess how depression compares with traditional risk factors in terms of its relative contribution to CVD risk in individuals with prediabetes.

We analysed a prospective cohort of 42,020 individuals from the UK Biobank, all free of prevalent CVD. Depression was determined using multiple sources to accurately assess the exposure. The five traditional risk factors considered were sleep duration, smoking, blood pressure (BP), low-density lipoprotein (LDL) cholesterol and renal function. We used Cox proportional hazards regression models to examine the associations between depression, risk factor control and CVD events.

Over a median follow-up of 13.1 years, 5865 individuals developed CVD, including 4764 cases of coronary heart disease and 1415 strokes. Compared with controlling 4-5 risk factors, both depression and controlling 0-1 risk factor significantly increased the risk of CVD in individuals with prediabetes. The corresponding multivariable-adjusted hazard ratios (95% CI) for CVD were 1.18 (1.09-1.28) and 1.44 (1.29-1.60), respectively. Depression ranked second in predicting CVD among the selected risk factors. A synergistic effect between depression and risk factor control was observed for CVD, with a relative excess risk due to interaction of 0.16 (0.06-0.26). Furthermore, these associations were independent of the genetic susceptibility to CVD.

Among individuals with prediabetes, both depression and suboptimal control of traditional risk factors are associated with an increased risk of CVD, independent of genetic susceptibility.

Work-related musculoskeletal disorders (WMSDs) are commonplace in industry and a host of qualitative and quantitative approaches have been used to assuage the problem, including wearable sensors and biomechanical endurance models, both of which were used in the present study. Six endurance models (consumed endurance, new improved consumed endurance and the exponential and power Frey Law and Avin general and shoulder models) with four alternative maximum torque (Torquemax) quantification methods, including a novel approach to generate Torquemax, were compared. The proposed approach to quantify Torquemax, in combination with the new improved consumed endurance model produced the lowest root mean square errors (RMSE), and indicated improved performance compared to the literature. The mean RMSE was reduced from 41.08s to 19.11s for all subjects, from 26.13s to 12.16s for males, and 51.28s to 24.45s for females using the proposed method. R2 for 25% and 45% standardised intensity dynamic tasks were .459 and .314 respectively, P < .01. This research provided an optimised and individualised endurance prediction approach for loaded dynamic movements which can be applied to industry tasks and may lead to reduced upper-limb strains, and potentially WMSDs.

Major Depressive Disorder (MDD) and Bipolar Disorder (BD) are two common psychiatric disorders that have a substantial influence on people's mental health and quality of life. The identification of regulatory networks and potential drugs for both disorders enhances our understanding of these conditions and facilitates the development of targeted and effective therapies.

This study employed network-based methods to identify gene regulatory networks and potential therapeutics for Major Depressive Disorder (MDD) and Bipolar Disorder (BD). We identified intersecting genes, predicted miRNAs and transcription factors, and constructed the TF-miRNA-hub gene network. Modules, enrichment analysis, and motifs were identified, and potential drugs targeting disease-associated genes were discovered using the DSigDB from the Enricher database.

We identified five common hub genes (AKT1, IL1B, IL6, MAPK3, TNF) in MDD and BD protein-protein interaction networks. Our analysis revealed three microRNAs (hsa-let-7d-5p, hsa-let-7a-5p, hsa-mir-34a-5p) and two transcription factors (NFKB1, RELA) targeting these hub genes, which are also involved in various disorders and pathways, including cancer, hepatitis B, and the TNF signalling pathway. Notably, we identified 10 potential drug candidates targeting these hubs, providing valuable insights into MDD and BD's molecular mechanisms and potential therapeutic targets.

Further experimental validation required to confirm the computational predictions.

The findings emphasize the importance of regulatory network motifs discovery in understanding the disorders-dynamics and therapeutics. These results provide the ground work for developing the common targeted interventions for MDD and BD.

Clinical predictors of treatment-resistant depression could improve treatment strategies. Depressive symptom profiles at baseline are potential outcome predictors, but little evidence is available, and sex-specific profiles have been scarcely investigated.

Baseline symptom scores of 1294 patients with major depressive disorder were assessed by the Montgomery-Åsberg depression rating scale (MADRS) as part of a multicenter study by the "Group for the Studies of Resistant Depression". Treatment outcomes were assessed according to the MADRS after ≥4 weeks of naturalistic treatment. We tested if individual MADRS item scores at baseline were associated with treatment outcome in the whole sample and in sex-stratified subgroups.

A specific baseline symptom profile was associated with non-response in the whole sample. In particular, apparent and reported sadness, reduced sleep, lassitude, inability to feel, and pessimistic thoughts were the only MADRS items that scored higher at baseline in patients with subsequent lack of response. In the sex-stratified analysis, females showed a similar profile overall, however they showed higher baseline levels of inner tension, inability to feel, and pessimistic thoughts compared to males, and these symptoms were associated with lack of response in females but not in males. Neurovegetative symptoms were poorly predictive. Overall baseline severity related to poor response.

This is a post-hoc analysis. The naturalistic design of the study with a retrospective assessment is potential limitations.

A specific baseline symptom profile characterized by higher sadness, reduced sleep and anhedonic features may be indicative of poor treatment outcome. Females showed a distinctive baseline profile associated with poor response.

Chronic kidney disease (CKD) is a global health concern and an independent risk factor for cardiovascular disease. Despite optimal treatments, mortality remains high among CKD patients. This meta-analysis aimed to assess the balance between the cardiovascular benefits and the bleeding risks associated with the use of low-dose aspirin in patients with CKD stages 3-5.

Randomized controlled trials (RCTs) regarding the use of low-dose aspirin for cardiovascular primary prevention for patients with CKD were searched in PubMed, Embase, and the Cochrane Library. The Cochrane Collaboration RoB 2.0 tool was used to assess the risk of bias of RCTs. Major adverse cardiovascular events (MACE), including cardiovascular mortality, nonfatal myocardial infarction, and nonfatal stroke, along with other related outcomes, was calculated using a random-effects model to determine hazard ratios and relative risks (RRs). A subgroup analysis was stratified by estimated glomerular filtration rate (eGFR) levels to assess the differential effects of the treatment on patients with varying degrees of kidney function impairment.

Five long-term RCTs were identified through systematic searches. Among them, 2 were at low risk, 2 had bias concerns, and 1 was at high risk. Aspirin significantly reduced the risk of MACE (RR, 0.76; 95% CI, 0.62-0.94), cardiovascular mortality (RR, 0.60; 95% CI, 0.43-0.85) and all-cause mortality (RR, 0.78; 95% CI, 0.63-0.96) in patients with CKD stages 3-5 compared to those not taking aspirin. When eGFR < 45 mL/min per 1.73 m2, the use of aspirin was associated with a significant reduction in the risk of myocardial infarction (RR, 0.47; 95% CI, 0.23-0.96) and cardiovascular mortality (RR, 0.47; 95% CI, 0.24-0.92). However, aspirin increased the risk of major bleeding in patients with CKD stages 3-5 compared to those not taking aspirin (RR, 1.50; 95% CI, 1.12, 2.02).

Low-dose aspirin provided significant benefits in preventing MACE, cardiovascular mortality and all-cause mortality in patients with CKD stages 3-5, particularly in preventing myocardial infarction, and cardiovascular mortality in those with an eGFR < 45 mL/min per 1.73 m2. However, the risk of major bleeding tended to increase as the eGFR decreased. For patient populations with a high risk of bleeding, it is necessary to re-evaluate the appropriateness of aspirin use.

There is limited research on the relationship between the triglyceride-to-high-density lipoprotein cholesterol (TG/HDL-C) ratio and outcomes in new-onset heart failure (HF). Therefore, this study aimed to explore the association between TG/HDL-C ratio and clinical outcomes in these patients.

A retrospective cohort of 614 adults with new-onset HF hospitalized at The First Affiliated Hospital of Nanchang University between July 2021 and December 2022 was analyzed. The primary endpoint was major adverse cardiovascular events (MACE), defined as cardiovascular (CV) death and HF rehospitalizations within 12 months after discharge. Kaplan-Meier (K-M) curves, restricted cubic spline (RCS) analysis, and Cox regression evaluated the association between TG/HDL-C ratio and MACE risk.

Patients were divided into four quartiles (Quartile 1, 2,3 and 4) based on their TG/HDL-C ratios. The mean age was 68.94 ± 14.34 years, with 59.12% male. The mean left ventricular ejection fraction (LVEF) was 46.59 ± 10.89%, with 45.11% having an LVEF ≤ 40%. During the 12-month follow-up, 156 patients experienced MACE, comprising 18 CV deaths and 138 HF rehospitalizations. The Quartile 4 group had the highest MACE risk incidence compared to other groups (P < 0.001). K-M analysis confirmed that the Quartile 4 group was associated with an increased cumulative incidence of MACE, HF rehospitalization, and CV death (all P < 0.001). RCS analysis revealed a positive nonlinear relationship between the TG/HDL-C ratio and MACE risk (P for nonlinear = 0.026), with a sharp risk increase above a ratio of 1.08. After adjustment, TG/HDL-C ratio was independently associated with MACE (HR: 1.44, 95% CI: 1.29-1.60). Compared to Quartile 1, adjusted HRs were significantly higher in Quartiles 2, 3, and 4 (all P < 0.005).

The TG/HDL-C ratio is independently associated with 12-month MACE risk in new-onset HF patients. It may serve as a simple, cost-effective marker to improve early risk stratification and guide closer monitoring and tailored management in this high-risk population.

Individuals with headache choose over-the-counter (OTC) medications to relieve pain and associated symptoms. This real-world evidence study investigated the effect of three OTC headache treatments on headache intensity and the associated impairment of cognitive and functional parameters in headache sufferers in Germany, Brazil, and Japan.

This prospective, multinational, observational eDiary-based study included adults experiencing headache for ≥ 6 months, with ≥ 2 headache episodes per month requiring treatment and using one of the three OTC headache treatments (Germany: ibuprofen 400 mg + caffeine 100 mg; Brazil: dipyrone 1 g; Japan: ibuprofen 100 mg + caffeine 40 mg). The primary endpoint was change in headache intensity (11-point numeric rating scale [NRS]) from baseline (headache onset) to 2 h post-treatment. Secondary endpoints were association between NRS scores for headache intensity and for cognitive and functional parameters and change in these parameters from baseline to 2 h post-treatment.

Of the 32,623 individuals screened, 1239 were enrolled in the study, with 607 having their first headache episode treated using one of the OTC treatments. Baseline demographics and characteristics were similar across the cohorts. At 2 h post-treatment, headache intensity significantly improved, with the mean change from baseline being 3.4 (3.1, 3.7, 95% confidence interval), 4.2 (3.9, 4.5), and 3.0 (2.7, 3.3) for German, Brazilian, and Japanese cohorts, respectively. Improvement was observed in all cognitive and functional parameters. The NRS score for headache intensity significantly predicted NRS scores of all cognitive and functional parameters (P < 0.0001).

The study shows that headache intensity significantly affects cognitive and functional aspects, as well as overall quality of life, for sufferers globally. It confirms the effectiveness of OTC medications and suggests using headache intensity as a self-assessment tool for symptom severity, highlighting the need for new parameters in the OTC domain to improve public health benefits.

Within the last decade, system and policy-level changes have driven substantial shifts in heart failure (HF) care from hospital to home, requiring greater support from informal care partners. What has not been examined is the state of the care partner science by person and system-level domains using qualitative studies to understand impact across multiple person and system levels.

(1) Identify by person and system levels and domain what is known about informal care partners and (2) Identify gaps in the caregiving science and suggest ways to move forward.

This secondary analysis of a large HF systematic review is guided by the National Institute on Minority Health and Health Disparities and MIRACLE frameworks and uses meta-synthesis techniques with critical realist approaches to synthesize and interpret the themes across papers.

Using data from 46 papers and 1695 care partners, we identified patterns occurring across 6 domains (biological, behavioral, affective, physical/built environment, sociocultural environment, and healthcare system) and on 4 levels (individual, interpersonal, community, and societal). Existing research predominantly addressed affective and behavioral domains, followed by health system and sociocultural domains. Few studies focused on biological and physical/built environment domains, leaving large gaps in what is known about caregiving at the cellular (biological) and societal (community and societal) levels.

HF caregiving continues to be studied at a very rudimentary level. This synthesis also reveals critical gaps in what is known about caregiving within the physical/built environment domain and at the community and societal levels.

To critically discuss the rationale for the use of drugs approved for idiopathic pulmonary fibrosis (IPF) to treat occupational interstitial lung diseases (OILDs).

Although IPF and OILDs share several clinical, radiological and probably pathogenetic features, currently, OILDs do not have a standard of care. In recent years, our knowledge and understanding of ILDs has improved substantially. Recently, the progressive pulmonary fibrosis (PPF) phenotype, which refers to non-IPF fibrotic ILDs that progress despite appropriate treatment, has been defined. OILDs may also be progressive. Nintedanib, initially approved for treatment of IPF, is also approved in patients with PPF. On the other hand, pirfenidone is approved in IPF but not in PPF, due to the lack of robust evidence of efficacy in this patient subset.

OILDs are a large and highly heterogeneous group of conditions without a proper standard of care. Nintedanib may slow functional decline and disease progression in progressive OILDs, and new clinical trials are ongoing.

This study aimed to analyze the efficiency of oral health resource allocation in public medical institutions in Yunnan Province at the end of the 13th Five-Year Plan period in China. The findings will provide a theoretical basis for the government and health administration departments to formulate regional medical and health plans and adjust policies and systems. Additionally, tailored recommendations will be proposed to optimize the allocation of oral health resources in public medical institutions in Yunnan Province and enhance resource utilization efficiency.

The present investigation scrutinizes the prevailing distribution of oral health resources within public institutions situated in Yunnan Province, marking the culmination of the 13th Five-Year Plan era. Employing cross-sectional analysis, the study utilizes conventional BCC and CCR models of Data Envelopment Analysis (DEA), alongside the super-efficiency SBM model, to assess the efficacy of resource allocation across 16 prefectures (or cities) within the province.

In the conventional model analysis, the average technical efficiency (TE) of oral health resource allocation in 16 prefectures (or cities) of Yunnan Province at the end of the 13th Five-Year Plan was 0.867, with an average pure technical efficiency (PTE) of 0.914 and an average scale efficiency (SE) of 0.950. Out of the 16 decision-making entities, 2 exhibit effectiveness according to DEA standards, 2 demonstrate weak effectiveness, while 9 manifest ineffectiveness. In the SBM super-efficiency model analysis, the TE of the whole province was 0.820, accompanied by an average PTE of 1.110 and an average SE of 0.863. Five prefectures (or cities) attained super-efficiency effectiveness, with Kunming City (the provincial capital of Yunnan) distinguishing itself notably owing to substantial disparities in PTE (3.840) and SE (0.293).

On the whole, the efficacy in leveraging oral health resources within public medical institutions throughout Yunnan Province was deemed relatively commendable. Nonetheless, notable disparities among prefectures (or cities) persisted, characterized by an excessive concentration of premium resources. Ineffective resource utilization coexisted with inadequate distribution. It is recommended to customize the distribution of oral health resources in each area according to local conditions, facilitate the decentralization of premium resources, and enhance the capacity of oral medical services.

Gut microbiome is implicated in the onset and progression of major depressive disorder (MDD), but the dynamic alterations of depressive symptoms, gut microbiome, and fecal metabolome across different stages of stress exposure remain unclear. Here, we modified the chronic social defeat stress (CSDS) model to evaluate mice subjected to social defeat stress for 1, 4, 7, and 10 days. Behavioral tests, 16S rRNA, metagenomics, and fecal metabolomics were conducted to investigate the impact of stress exposure on behaviors, gut microbiota and fecal metabolites. We observed that depressive-like behaviors, such as anhedonia and social avoidance, worsened significantly as stress exposure increased. The microbial composition, function, and fecal metabolites exhibited distinct separations across the different social defeat stress groups. Mediation analysis identified key bacteria, such as Lachnospiraceae_UCG-001 and Bacteroidetes, and fecal metabolites like valeric acid and N-acetylaspartate. In our clinical depression cohort, we confirmed that fecal valeric acid levels, were significantly lower in depressive-like mice and MDD patients, correlating closely with stress exposure and anhedonia in mice. Further analysis of serum and brain metabolites in mice revealed sustained changes of N-acetylaspartate abundance in fecal, serum, and cortical samples following increasing stress exposure. Together, this study elucidated the characteristics of depressive-like behaviors, gut microbiome, and fecal metabolome across various social defeat stress exposure, and identified key bacteria and fecal metabolites potentially involved in modulating social defeat stress response and depressive-like behaviors, providing new insights into the pathogenesis and intervention of depression.

Depression is a major public health issue, increasing the risk of comorbidities. Some people with depression experience cognitive dysfunction, which can persist even after symptomatic recovery. British South Asians are at greater risk of developing depression and are less likely to seek treatment. It is important to understand their experience of subjective cognitive dysfunction in depression and how best to support them.

This study explored subjective experience of cognitive dysfunction during recurrent depression, in a sample of 12 British South Asians aged between 45 and 60 years.

We conducted semi-structured interviews to explore cognitive dysfunction during recurrent depression. We analysed the data using thematic analysis.

Difficulties in attention and concentration resulted in lower quality of social relationships, including not feeling present and social isolation. Learning new information was difficult, thus impacting productivity. Participants found it difficult to engage in enjoyable activities that promoted brain health. The emotional, physical and spiritual impact negatively impacted on quality of life.

Cognitive strategies used in therapies could improve brain health and functional recovery in people living with depression.

Mental health nurses play a pivotal role in providing culturally appropriate information and strategies for managing cognitive dysfunction in recurrent depression.

Identifying anatomy causally involved in psychosis could inform therapeutic neuromodulation targets for schizophrenia.

To assess whether lesions that cause secondary psychosis have functional connections to a common brain circuit.

This case-control study mapped functional connections of published cases of lesions causing secondary psychosis compared with control lesions unassociated with psychosis. Published cases of lesion-induced psychosis were analyzed in a computational laboratory. Participants had documented brain lesions associated with new-onset psychotic symptoms without a history of psychosis. Control cases included 1156 patients with lesions not associated with psychosis. Generalizability across lesional datasets was assessed using an independent cohort of 181 patients with brain lesions who subsequently underwent neurobehavioral testing. Data were analyzed from June 2022 to April 2024.

Lesions causing secondary psychosis.

Psychosis or no psychosis.

A total of 153 lesions from published cases were determined to be causal of psychosis, 42 of which were described as schizophrenia or schizophrenia-like (71 [46%] patients were male, 82 [54%] female; mean [SD] age, 50.0 [20.8] years). Lesions that caused secondary psychosis mapped to a common brain circuit defined by functional connectivity to the posterior subiculum of the hippocampus (84% functional overlap, family-wise error [FWE] rate corrected P < 5 × 10-5). At a lower statistical threshold (>75% overlap, FWE-corrected P < 5 × 10-4), this circuit included the ventral tegmental area, retrosplenial cortex, lobule IX and dentate nucleus of the cerebellum, and the mediodorsal and midline nuclei of the thalamus. This circuit was consistent when derived from schizophrenia-like cases (spatial r = 0.98). We repeated these analyses after excluding lesions intersecting the hippocampus (n = 47) and found a consistent functional connectivity profile (spatial r = 0.98) with the posterior subiculum remaining the center of connectivity (>75% overlap, FWE-corrected P < 5 × 10-5), demonstrating a circuit-level effect. In an independent observational cohort of patients with penetrating head trauma (n = 181), lesions associated with symptoms of psychosis exhibited significantly similar connectivity profiles to the lesion-derived psychosis circuit (suspiciousness, P = .03; unusual thought content, P = .046). Voxels in the rostromedial prefrontal cortex are highly correlated with this psychosis circuit (spatial r = 0.82), suggesting the rostromedial prefrontal cortex as a promising transcranial magnetic stimulation target for psychosis.

Lesions that cause secondary psychosis affect a common brain circuit in the hippocampus. These results can help inform therapeutic neuromodulation targeting.

Acute myocardial infarction (AMI) is a major cause of death in cardiovascular patients. SOCS3's protective role in cardiac I/R-I is being explored, and miRNAs, particularly miRNA-148a-3p, are suspected to target SOCS3. To elucidate the role of miRNA-148a-3p targeting lipid metabolism gene SOCS3 in cardiac ischemia-reperfusion injury (I/R-I) in rats.

Derived mRNA expression data GSE59867 from GEO, identified 558 lipid metabolism genes from KEGG and GSEA, and screened for differentially expressed genes in acute myocardial infarction (AMI). Predicted miRNA-148a-3p targeting SOCS3 using TargetScanHuman, validated binding via luciferase assay and 3'UTR mutation. Established a rat I/R-I model to assess miRNA-148a-3p and SOCS3 expression, and investigated SOCS3 regulation by miRNA-148a-3p overexpression. Analyzed expression of NF-κB p65, IL-1β, and TNF-α-related proteins, and evaluated cardiac hemodynamics post-SOCS3 regulation by miRNA-148a-3p.

In GSE59867, TSPO, SOCS3, LRP1, PLB1, CYP1B1, PPARG, ACSL1, and CYP27A1 were identified as differentially expressed lipid metabolism genes in AMI. The results of immune infiltration showed a close relationship between the differential lipid metabolism genes and the infiltration of immune cells such as macrophages and monocytes. The random forest algorithm identified SOCS3 as the key gene. The luciferase reporter gene demonstrated the participation of miRNA-148a-3p in the regulation of SOCS3 by binding to its 3'UTR. In vivo experiments revealed low expression of miRNA-148a-3p in myocardial I/R, while SOCS3 was highly expressed. Elevated miRNA-148a-3p expression led to a decrease in SOCS3, NF-κB p65, IL-1β, and TNF-α levels during cardiac I/R-I. Overexpression of miRNA-148a-3p enhanced the cardiac performance in rats experiencing cardiac I/R-I.

Overexpression of miRNA-148a-3p regulates NF-κB signaling pathway by targeting lipid metabolism gene SOCS3, reduces inflammatory response, and then reduces cardiac I/R-I in rats.

The cranio-cervical flexion test (CCFT) is used in clinical practice to measure the activation of deep cervical flexor muscles. However, the reliability of the test has not been conducted on an adequate sample size, specifically in individuals with non-specific chronic neck pain (CNP).

The aim of the present study is to investigate the intra- and inter-rater reliability, standard error of measurement (SEM), and minimal detectable change (MDC) of the CCFT in individuals with non-specific CNP.

A cross-sectional study of reliability conducted at the UFSCar. Fifty-one individuals (17 men and 31 women) with non-specific CNP and aged over 18 years participated in this study. The CCFT was assessed with the Stabilizer pressure biofeedback device. Two raters conducted the test over two days, with a 5-7-days interval and a 10-min rest between raters. The activation score was determined by the level at which the participant kept activation for 10 s in a single stage (22, 24, 26, 28 and 30 mmHg). Appropriate statistical analysis was performed to calculate the intraclass correlation coefficient (ICC), SEM and MDC.

Both intra-rater (ICC = 0.65; 95% CI = 0.46-0.78) and inter-rater reliability (ICC = 0.72; 95% CI = 0.55-0.83) were considered moderate. The SEM was 1.73 and 1.66 for intra-rater and inter-rater reliability, and the MDC was 4.81 to 4.60, respectively.

The results of the present study indicate that CCFT is a reliable test to evaluate the activation score in individuals with chronic neck pain.

Arthritis is an important cause of disability globally, with high prevalence in low- and middle-income countries. Although osteoarthritis is the most common type of arthritis, various types of nondegenerative arthritis are prevalent in low- and middle-income countries. Multiple imaging modalities, such as radiography, ultrasound, computed tomography, and magnetic resonance imaging, are helpful in diagnosing and prognosticating arthritis. Although imaging appearances can overlap between types of arthritis, specific imaging findings have been described for the different etiologies. Knowing these imaging findings, especially on radiographs and ultrasound in resource-constrained areas, can be helpful in managing arthritis effectively.

Candida is a common fungal pathogen in the oral cavity, with Candida albicans being the most prevalent species. Some studies report a correlation between Candida prevalence and dental caries experience in preschoolers, while others report no such association. This systematic review and meta-analysis aimed to evaluate the association of Candida-biome with Early Childhood Caries (ECC) in preschool children.

Seven databases were searched for studies evaluating the correlation between Candida and ECC in healthy preschool children under 71 months of age. Dual independent screening, data extraction, bias risk assessment, meta-analysis, and quality evaluation of evidence were conducted.

The review included 20 studies with 12 reporting a positive association between Candida prevalence and ECC. The prevalence of Candida albicans in ECC ranged from 60%-84% across sample sites. Certain specific species, including C. dubliniensis and atypical non-albicans Candida (NAC), were also associated with caries severity in preschoolers. The pooled odds ratio (OR) estimate was 7.98 (95%CI; 3.84-16.58) for Candida-biome in plaque samples (I² = 84%), and 9.42 (95%CI: 4.15- 21.40) for Candida-biome in saliva sample (I² = 50%). These results suggest that children with Candida-biome in plaque and saliva have higher odds of having ECC than caries-free children.

Children with Candida-biome in plaque and saliva samples have a higher risk of Early Childhood Caries, predominantly associated with Candida albicans. Standardised methodologies for evaluating and comparing data on Candida species and ECC are recommended for future studies.

Patients with heart failure exacerbation can present in a variety of ways, including sympathetic crashing acute pulmonary edema (SCAPE). Emergency physicians play a key role in the diagnosis and management of this condition.

This narrative review evaluates key evidence-based updates concerning the diagnosis and management of SCAPE for the emergency clinician.

SCAPE is a subset of acute heart failure, defined as a patient with sudden, severe pulmonary edema and hypertension, resulting respiratory distress, and hypoxemia. This is associated with significantly elevated afterload with fluid maldistribution into the pulmonary system. Evaluation and resuscitation should occur concurrently. Laboratory assessment, electrocardiogram, and imaging should be obtained. Point-of-care ultrasound is a rapid and reliable means of confirming pulmonary edema. Management focuses on respiratory support and vasodilator administration. Noninvasive positive pressure ventilation (NIPPV) with oxygen support is associated with reduced need for intubation, improved survival, and improved respiratory indices. If the patient does not improve or decompensates on NIPPV, endotracheal intubation is recommended. Rapid reduction in afterload is necessary, with the first-line medication including nitroglycerin. High-dose bolus nitroglycerin is safe and effective, followed by an infusion. If hypertension is refractory to NIPPV and high-dose nitroglycerin, other agents may be administered including clevidipine or nicardipine. Angiotensin-converting enzyme inhibitors such as enalaprilat are an option in those with normal renal function and resistant hypertension. Diuretics may be administered in those with evidence of systemic volume overload (e.g., cardiomegaly, peripheral edema, weight gain), but should not be routinely administered in patients with SCAPE in the absence of fluid overload. Caution is recommended in utilizing opioids and beta blockers in those with SCAPE.

An understanding of the current literature concerning SCAPE can assist emergency clinicians and improve the care of these patients.

Evidence-based use of pharmacological interventions in bipolar disorder is of paramount clinical importance. We aimed to uncover precription sequences in a large cohort of patients from the first diagnosis of bipolar disorder. Using Danish nationwide registers, we identified individuals with a first-time hospital diagnosis of bipolar disorder between January 1st, 2001, and December 31st, 2016. Redemeed prescriptions of litihum, anticonvulsants, antipsychotics, and antidepressants from five years before to five years after diagnosis were retreived. The data were analysed with descriptive statistics, sunburst plots, and Cox proportioal hazard models. The full study population consisted of 19,927 individuals. Before diagnosis, antidepressants were the predominantly prescribed group (46.9 % as first drug). After diagnosis, a major trend towards mood stabilising strategies was observed. although only 18.7 % received lithiumas first prescription. In analyses stratified for illness phase, lithium was more frequently prescribed as first drug after depression than after hypomania/mania, in which antidepressants were used as first drug in 10-15 % of the cases. Treatment sequences were highly heterogeneous (2,459 distinct sequences for the 19,927 individuals under investigation). Lithium appeared to carry the overall highest risk of treatment shift. We conclude that in accordance with national and international guidelines, a diagnosis of bipolar disorder leads to a relevant change of treatment strategy towards mood stabilising drugs. However, lithium continues to be underused;antidepressants probably used too frequently, and treatment sequences are highly heterogeneous and not adjusted according to illness phase. These results point to a potential for optimising the real-world pharmacological management of bipolar disorder.

Oral health continues to be one of the most common and costly diseases in early childhood, and there is a need for further, innovative research.

We explored the ways naturally living parents (those who embody the "natural" within their parenting ideology and behavior) navigated and perceived their children's oral health.

Twelve participants who identified as being "naturally living parents" participated in semistructured interviews. Data were thematically analyzed, and findings were aligned to an omissions and commissions framework to exhibit the complexity of parent decision-making.

Parents performed distinct omissions, including omitting fluoride, sugar, and "toxins" to maintain their children's oral health. Parents talked about having a commitment to knowledge building to protect their children's oral health (e.g., ingredient label reading and increasing knowledge of "safe" ingredients). Findings also provide insight into how parents consider and trust health information and health care providers and ways they gather information relating to oral health.

Analysis indicated that although parents navigated both omissions and commissions, omissions were more overtly present. Compared to previous health research using this framework, omissions and commissions were not as clearly demarcated in relation to oral health. The results show that oral health is a complex interplay of omissions and commissions, and parents must navigate not only discrete elements that affect the oral health of their children but also how these are influenced by considerations including social well-being.Knowledge Transfer Statement:The study highlights the need for dentists and early childhood health professionals to consider the complex way some parents perceive, inform, and rationalize decisions regarding their children's oral health. There is a need for nuance when considering children's oral health and naturally living parenting, especially in relation to effectively communicating health information that fosters trust and is considerate of broader lifestyle and health factors.

Basic symptoms (BS) are subtle, self-experienced disturbances in mental processes. Cognitive, visual and acoustic BS were included in clinical-high risk criteria for psychosis (CHR-P). So far, their interplay has been studied only in Western samples and always in concert with other symptoms, such as (attenuated) psychotic symptoms. Thus, we studies the interrelation of the 56 BS assessed with the 'Schizophrenia Proneness Instrument, Adult version', in an Indonesian sample of CHR-P patients (N = 108) 16-30 years-of-age, 18.95 % male) according to BS criteria using network analysis. The used estimator partially correlates with the Gaussian graphical model (GGM) and graph module. Model selection uses regularization techniques by setting λ = 0.05. The most central and traversed nodes in the robust, stable network were visual disturbances-'near- and tele-vision', 'disturbances of the perception of straight lines/contours' and 'micropsia, macropsia'. Visual disturbances were also predominately involved in the 16 strongest edges, thereby linking strongly with alienation experiences. Contrary to networks in Western samples in that cognitive BS played a central and important role, subjective visual disturbances seem to play an important role in the possible emergence and maintenance of BS, in particular of alienation experiences, in Indonesian patients with CHR-P. Future studies should therefore study this potential role longitudinally along with their neurobio/cognitive underpinnings. Furthermore, it should be studies, if cognitive-behavioral therapy as suggested for alienation experiences may prevent progression and reduce symptom load.

Periodontitis is a ubiquitous chronic inflammatory disease affecting the supporting tissues of the teeth and is a major cause of multiple tooth loss. Despite being preventable, periodontitis and dental caries are responsible for more years lost to disability than any other human condition. The most severe form of periodontitis affects 1 billion individuals, and its prevalence is increasing globally. Periodontitis arises from a dysregulated and hyperactive inflammatory response to dysbiosis in the periodontal microbiome. This response has systemic effects associated with premature mortality and elevated risk of several systemic non-communicable diseases (NCDs), including atheromatous cardiovascular disease, type 2 diabetes and chronic kidney disease (CKD). This risk association between periodontitis and NCDs is independent of their shared common risk factors, suggesting that periodontitis is a non-traditional risk factor for NCDs such as CKD. As periodontitis progresses, the immune cells and mediators underpinning its pathophysiology leak into the systemic circulation through the ulcerated oral mucosal lining, inducing in a systemic inflammatory profile that closely mirrors that observed in patients with CKD. The relationship between periodontitis and CKD seems to be bi-directional, but large-scale intervention studies are required to clarify causality and could lead to new care pathways for managing each condition as an exposure for the other.

This was an observational study.

Assessing the global burden of disease for low back pain (LBP) using the 2021 GBD (Global Burden of Disease) database.

LBP is a leading cause of workforce loss and disability. With societal aging and changes in lifestyle and work habits, the incidence of LBP is expected to rise. This study comprehensively analyzes the epidemiological trends of global LBP from 1990 to 2021.

Data publicly available from the 2021 GBD study were utilized, and a systematic analysis was conducted to assess the global burden and epidemiological trends of LBP.

From 1990 to 2021, the age-standardized prevalence, incidence, and Years Lived with Disability (YLD) rates of LBP have slightly declined globally. However, the number of affected individuals, new cases, and YLD numbers have significantly increased, making LBP a leading cause of YLD in 2021. The number of affected individuals increases with age, peaking in both men and women between the ages of 50 and 54. Worldwide, women have a higher prevalence of LBP than men, and this increases with age, with both sexes reaching peak prevalence between 80 and 84 years in 2021. Overall, over the past 3 decades, age-standardized YLD rates have shown a positive correlation with the Socio-demographic Index (SDI). In terms of region and nation, Tropical Latin America and Kingdom of Sweden have seen the greatest increase in age-standardized prevalence rates from 1990 to 2021.

Globally, LBP remains a notable public health concern, carrying a consistently high burden. To alleviate the future impact of this disease, it is imperative to increase public awareness regarding its risk factors and to implement preventive measures.

Depression is an important public health issue. In the general adult population, about 6.7% are affected. Little data are available about endurance runners. We conducted a prospective survey study screening for depression using the Patient Health Questionnaire and investigating potential associated risk factors in endurance runners (≥ 21.1-42.2 km) and ultraendurance runners (≥ 42.2 km). Statistical analysis included descriptive statistics, predictive techniques, and regression analysis. A total of n = 601 runners participated (female n=222 and male n=379; mean age [SD]: 42.8 years [± 10.1]). Overall, 11.3% screened positive for major depression, particularly female runners compared to male runners (p=0.002) and endurance runners compared to ultraendurance runners (p=0.023). No significant differences were observed among performance levels (elite vs. nonelite). Mild depression was observed in 21.6% of runners. Factors associated with a higher risk for screening for major depression included age (p<0.001), particularly runners under the age of 28 years, previous self-reported history of depression (p<0.001), more frequent weekly workouts (4-5/wk; p=0.021), weeks lost to injury (p=0.022), and female sex (p=0.025). A third of endurance and ultraendurance runners screened positive for depression, highlighting the importance of creating awareness for mental health issues and potential screening for athletes and providing access to appropriate support services and education.

To assess the effectiveness of a school-based oral health promotion program on dental caries of permanent dentition among Iraqi children.

A cluster randomised controlled trial was conducted with a parallel study group, comprising 8-10-year-old schoolchildren, 186 in each group. At the beginning of the study, subjects in the intervention group received oral health education and a single dose of 5% sodium fluoride varnish for all teeth surfaces while the control group only received oral health education. The primary outcome data in this study were caries increment and incidence after six months. The secondary outcome data was any change in oral health behaviors in the students of both groups after 3 months. The caries status was recorded according to International Caries Detection and Assessment System (ICDAS). Statistical analyses included the Chi-square test, McNemar test, independent t-test, simple and multiple logistic regression models.

Study participants included 372 children with no significant difference in baseline characteristics between intervention and control groups. An increase was evident in the mean scores of DMFS, DMFT, number of children with DMFT > 0, and DS > 0 for both control and intervention groups at six-month follow-up but this increase was significantly higher for the control than intervention group (P < .001). Among all variables included in the multiple logistic regression model, just being in the intervention group showed a significant effect in which children in the control group had a 4.2-fold (95% CI: 2.36-7.54) greater chance for developing new caries than children in the intervention group. There was a statistically significant increase in the percentage of children with favourable levels of behaviors between baseline and 3-month follow-up (P < .05, P < .001).

Providing access to oral health services such as oral examination, fluoride varnish application, and oral health education to reduce dental caries and improve oral health practices seems to be effective among primary schoolchildren.

There is increasing interest in fatigue in people with psychotic illnesses. This systematic review and meta-analysis reviewed the evidence concerning the prevalence of fatigue and associated factors in adults with psychotic illnesses.

Embase, PsycINFO, Medline and CINAHL were systematically searched for articles in English published between January 1946 to 9 October 2023. Inclusion criteria was 'fatigue' in adults (≥18 years old) with a confirmed ICD11 or DSM5 diagnosis of a psychotic disorder. Risk of bias was assessed with the JBI and the Newcastle-Ottawa Scale. Pooled proportions for fatigue with 95 % CI were calculated using random effects models. Heterogeneity was assessed using Cochran's Q and I2 statistic and Egger's tests were conducted for publication bias.

A total of 57 articles met the inclusion criteria and 7 articles (n = 1161 participants) were included for the meta-analysis of fatigue. Fatigue prevalence was 55 % (95 % CI: 37-71 %, I2 = 94 %). A sensitivity analysis of the 6 studies using a valid scale (n = 711 participants) found a fatigue proportion of 59 % (95 % CI: 41-76, I2 = 93 %). Eighteen studies (n = 4569 participants) were included for an analysis exploring the prevalence of antipsychotic-related fatigue, which was 20.5 % (95 % CI: 11-34 %). We found no significant difference in antipsychotic-related fatigue between studies using a valid scale (27 %, 95 % CI: 14-46, k = 7) and studies using a clinical interview (17 %, 95 % CI: 7-35 %, k = 11) p = 0.302. An Egger's test indicated no publication bias. Quality assessments for included studies revealed that 16 % were at low risk of bias, 9 % at high risk and 75 % at moderate risk. Reported associations with fatigue included sex, age, antipsychotics, distress and depression, sleep, and some negative symptoms.

Our study revealed that a majority of people with psychosis experience fatigue. Antipsychotics, sex, and functioning may contribute to tiredness symptoms, but further research is needed.

In 2023, the Azithromycin Prevention in Labor Use (A-PLUS) trial showed intrapartum azithromycin reduces maternal sepsis or death in women with planned vaginal delivery in low-resource settings, but whether it reduces maternal infection is unknown. We aimed to evaluate the effectiveness of intrapartum azithromycin in reducing maternal infection.

We performed a post-hoc analysis of the multicentre, facility-based, randomised, double-blind, placebo-controlled A-PLUS trial. This trial compared prophylactic intrapartum single oral dose of 2 g azithromycin versus placebo on maternal morbidity and mortality in low-resource settings in southeast Asia and Africa from Sept 9, 2020, to Aug 18, 2022. The trial enrolled women in labour at 28 weeks' gestation (or later) at eight sites in the Democratic Republic of the Congo, Kenya, Zambia, Bangladesh, India, Pakistan, and Guatemala and found that azithromycin reduced the incidence of maternal sepsis or death. The primary outcome of the present analysis was the incidence of any maternal infection in the azithromycin versus placebo groups, which was defined as one or more of these infections after randomisation: chorioamnionitis, endometritis, perineal or caesarean wound infection, abdominopelvic abscess, mastitis or breast abscess, and other infections. Any neonatal infection was also analysed. All analyses were by intention to treat in all those with data available for that outcome. Relative risks (RRs) and 95% CIs were estimated with a Poisson model adjusted for treatment group and site. Subgroup analyses included a two-way interaction test between intervention group and subgroup. A-PLUS was registered at ClinicalTrials.gov, number NCT03871491.

29 278 women were randomly assigned to groups: 14 590 to receive azithromycin, 14 688 to receive placebo. Baseline characteristics were similar between the azithromycin and placebo groups (43·3% vs 43·4% primiparous, 8·5% vs 8·7% high risk for infection). The presence of any maternal infection occurred less often in the azithromycin group (580 [4·0%] of 14 558) compared with the placebo group (824 [5·6%] of 14 661 women; RR 0·71, 95% CI 0·64-0·79, p<0·0001). Any neonatal infection did not differ between treatment groups. Adverse events were not detected.

Among women planning vaginal delivery, this analysis provides evidence indicating that intrapartum azithromycin is associated with a lower incidence of maternal infections than placebo.

The Eunice Kennedy Shriver National Institute of Child Health and Human Development and Bill and Melinda Gates Foundation via Foundation of National Institutes of Health.

For the French and Spanish translations of the abstract see Supplementary Materials section.

What is the association between exercise adherence and the effects of exercise on pain intensity and functional limitations in adults with chronic non-specific low back pain (CNSLBP)?

Systematic review with meta-analysis.

Adults with CNSLBP.

Randomised controlled trials of exercise compared with no exercise (eg, usual care, placebo/sham or another conservative treatment). Adherence to exercise must have been reported.

Pain intensity and functional limitations.

This study included 46 trials with 56 exercise groups. High exercise adherence (80 to 100%) was associated with reduced pain intensity (0 to 100 scale) (MD -14.32, 95% CI -18.61 to -10.03, low certainty) and functional limitations (0 to 100 scale) (MD -8.08, 95% CI -10.68 to -5.49, low certainty). Moderate exercise adherence (60 to 79%) was not associated with reduced pain intensity (MD -4.53, 95% CI -9.39 to 0.34, very low certainty) or functional limitations (MD -2.75, 95% CI -6.00 to 0.51, very low certainty). Low exercise adherence (< 59%) was associated with reduced pain intensity (MD -5.33, 95% CI -10.00 to -0.66, low certainty) and functional limitations (MD -4.43, 95% CI -7.14 to -1.72, moderate certainty). Compared with low adherence, additional differences in outcomes for moderate and high adherence were mostly negligible.

Higher exercise adherence is associated with larger improvements in clinical outcomes in adults with CNSLBP, although overall differences are small compared with lower adherence. Other factors besides adherence between the trials and exercise programs could explain these results. Further research is needed to determine the causal effect of exercise adherence on outcomes in adults with CNSLBP.

PROSPERO CRD42023447355 and Open Science Framework https://osf.io/7p6dw/.

To determine the effectiveness of the McKenzie Method compared to any conservative interventions on pain and disability in patients with chronic low back pain (LBP) with directional preference (DP).

We searched six electronic databases up to September 2022. Eligible randomized controlled trials were those assessing the McKenzie Method delivered by credentialed therapists for chronic LBP with DP. Two reviewers independently selected studies, extracted data, assessed risk of bias with the revised Cochrane Risk of Bias 2.0 tool and certainty of evidence with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.

Five trials (n = 743) were included. There was low-certainty evidence that the McKenzie Method, compared to all other interventions combined, produced clinically important reductions in short-term pain (mean difference [MD] -1.11 points on a 10-point scale; 95% CI -1.83 to -0.40) and in intermediate-term disability (standardized mean difference [SMD] -0.53; 95% CI -0.97 to -0.09). Low-to-moderate certainty evidence showed that the McKenzie Method also resulted in clinically important improvements in short-term pain (MD -1.53; 95% CI -2.51 to -0.54) and disability (SMD -0.50; 95% CI -0.74 to -0.25) when compared specifically to other exercise approaches, and in intermediate-term pain (MD -2.10; 95% CI -2.94 to -1.26) and disability (SMD -1.01; 95% CI -1.58 to -0.43) as well as long-term disability (SMD -0,59; 95% CI -1.14 to -0.03) when compared to minimal intervention. Low-certainty evidence showed usually small, clinically unimportant effects in comparison to manual therapy.

We found low-to-moderate certainty evidence that the McKenzie Method was superior to all other interventions combined for up to 6 months for pain and up to 12 months for disability, with clinically important differences versus exercise in the short term and versus minimal interventions in the intermediate term. The only clinically important long-term effect was on disability compared to minimal intervention.

The global effort to strengthen rehabilitation in health systems has led many countries to adopt the World Health Organization (WHO) guide for action. However, there is limited literature on practical implementation examples. This case report details Rwanda's process of adopting the WHO guide, focusing on stakeholders' viewpoints.

A cross-sectional qualitative study was conducted among rehabilitation stakeholders who played a role in implementing the WHO guide to strengthen rehabilitation in the health system. A structured data collection questionnaire using a 5-point Likert Scale was administered and Key informants interviews were conducted. Interviews were recorded, transcribed, coded, categorized and thematically analyzed.

A total of 180 participants filled the questionnaire, while 32 key informants were interviewed. 7 themes and 13 sub-themes emerged from the results. Rwanda's successful adoption of the WHO guide to strengthen rehabilitation in its health system can be attributed to the country's commitment justified by existing policies, guidelines, and the existence of a disability movement, and this could be an inspiring model for other countries to follow.

This case report describes a successful adoption process for Rwanda that can be a practical example for other low-income countries, emphasizing active engagement from the central level to local stakeholders.

Substance use is a pressing public health concern in young Ethiopians, impacting their physical, psychosocial, and emotional well-being and productivity. However, there is a limited understanding of the prevalence and factors associated with substance use in this population both across Ethiopia and in the West Arsi zone specifically. This study investigates the prevalence of substance use and associated factors among young people in the West Arsi Zone, Ethiopia.

A community-based cross-sectional survey was conducted among 427 randomly selected young people aged 14-29 in the West Arsi zone of the Oromia region, Ethiopia. Data were collected using structured interviewer-administered questionnaires. Logistic regression analysis was performed to determine the association between the outcome and independent variables. Ethical approval was obtained from the University of Technology Sydney, Australia, and Madda Walabu University, Ethiopia.

A total of 424 participants were included in the analysis, giving a response rate of 99.3%. The overall lifetime prevalence of any substance use among the study participants was 48.1% (95% CI: 43.3%, 53.0%) and the prevalence of current substance use was 72.5% (95% CI: 65.9, 78.5). Among lifetime users, 76.5% reported chewing khat, 49.0% drinking alcohol, 33.3% using various forms of tobacco, and 23.0% using cannabis. Being male, having a single marital status, a family history of substance use, low perceived social support, and the presence of mental health conditions were associated with an increased likelihood of substance use.

About half of the study participants reported a history of use of at least one substance from alcohol, khat, tobacco, or cannabis in their lifetime, highlighting the need for appropriate focused interventions to help address the growing challenges of substance use amongst young people in Ethiopia.

Depression and/or anxiety can be persistent or recurrent significantly affecting a person's capacity to manage daily life, job, and school. The burden of depression and anxiety is rising from time to time, with serious consequences for overall health. Depression and anxiety are crippling conditions that can impact individuals of the whole community. Despite the high prevalence of depression and/or anxiety few studies were conducted that show the diagnosis levels of depression and/or anxiety in the community, particularly in Kenya. Therefore, this study aims to determine the prevalence of depression and/or anxiety and their determinant factors among adults in Kenya using data sourced from the 2022 Kenya Demographic and Health Survey.

The Kenya demographic and health survey of 2022 data were used for this secondary data analysis in 2024. The survey included age groups ranging from 15 to 49, with a total sample size of 16,901 participants. Multilevel analysis was used to determine the prevalence of depression and/or anxiety with determinant factors at the 95% CI.

The overall prevalence of depression and/or anxiety was 3.84% with a 95% CI of (3.56, 4.14). Of this, 2.85% have only depression, 1.97% have only anxiety disorders, and 0.98% have comorbid depression and anxiety. In multivariable multilevel logistic regression analysis sexually violated, having a chronic medical illness, being divorced and widowed, having a job, and being HIV positive were associated with depression and/or anxiety with a p-value of less than 0.05.

According to the findings of this study the prevalence of depression and/or anxiety was 3.84%. This finding poses a significant challenge for the community to perform their daily tasks. As a result, the healthcare systems of Kenya have to mitigate the burden of depression and/or anxiety. All the clients must be treated since they received a diagnosis as reported by the physician.

Dementia is a major public health concern, with its incidence rising as the population ages. Recent studies suggest links between childhood health, socioeconomic status, and later-life cognitive impairment and dementia, though findings remain inconclusive. This systematic review evaluates the influence of childhood health and socioeconomic status on cognitive impairment and dementia.

A systematic search conducted in MEDLINE, CiNAHL, and PsycINFO in December 2024 identified 44 studies matching our inclusion criteria. Findings are presented under five key themes: (1) childhood health, (2) childhood educational attainment, (3) family socioeconomic and educational factors, (4) childhood experiences, and (5) childhood reading habits and social interactions.

Our results highlight the need for further longitudinal studies to establish causal relationships between early-life risk factors and later cognitive decline. Policymakers should prioritize early childhood development programs that integrate health, nutrition, education, and social support to help mitigate cognitive impairment and dementia in later life.