Cognitive neuroscience research often relies on convenience sampling of participants, which can result in biased sample demographics and an under-representation of older adults. There is a need to identify more effective routes to widen participation among older adults and to explore age-related differences in the motivators and barriers to research involvement. This mixed methods study combined qualitative data from two focus groups, conducted with N = 11 healthy older adults aged 55-73, and an online questionnaire completed by N = 336 adults aged 18-88. Analysis of the focus group discussions identified 3 main themes that were most important to older adults: a) The importance of receiving transparent information about the aims, procedures and safety of the study, b) Distinguishing between medical and non-medical research, and c) Contributing to the "collective good". The questionnaire echoed that altruism, and the prospect of scientific discovery, are increasingly important motivators with advancing age, whereas financial incentives become less important. Older adults have more free time to participate, are less deterred by the prospect of pain, and express more trust in researchers than younger people. Attitudes towards different imaging methods (MRI, EEG, NIBS and Eye tracking) varied, with fewest negative emotions for eye-tracking and most for non-invasive brain stimulation, but positive attitudes generally increased and negative attitudes reduced with age. These findings can inform age-tailored recruitment strategies to improve diversity in neuroimaging research. Improving communication, addressing practical barriers, and framing studies in a meaningful context may help increase participation among groups who are traditionally underrepresented in neuroimaging research.
Chronic pain is a leading global cause of disability. There is evidence supporting the efficacy of virtual reality (VR) interventions for improving pain and function in patients with chronic pain. However, use of VR in physiotherapy practice remains limited. This study examined the pre-implementation barriers and facilitators experienced by physiotherapists working in Germany when implementing VR for chronic pain management in outpatient settings. Physiotherapists participating in a VR implementation study were interviewed using semi-structured interviews. The interviews were transcribed and analyzed using qualitative content analysis. The identified barriers and facilitators were categorized into domains of the Theoretical Domains Framework. Based on the interviews with nine physiotherapists, the pre-implementation key barriers included environmental barriers, such as time limitations and lack of insurance reimbursement, knowledge barriers in relation to chronic pain management and VR content, professional role barriers, such as VR being perceived as outside the scope of physiotherapy and decision-making barriers, such as patient selection. The primary facilitators were environmental opportunities, such as VR being a unique asset of the practice or a dedicated area for VR therapy. Additional facilitators included positive expectations for the rehabilitation process and the belief that VR is an opportunity of growth for physiotherapy as a profession. Physiotherapists recognize the therapeutic potential of VR, but anticipate significant implementation challenges related to environmental restrictions, knowledge gaps, and professional role conflicts. However, they also identified potential facilitators, such as VR's unique assets for practices and its benefits for patient empowerment and professional advancement. Successful adoption requires multifaceted strategies that address reimbursement policies, provide enhanced training in areas such as pain neuroscience and VR applications, and facilitate workflow integration. Future research should validate these findings across diverse healthcare systems to support the integration of VR in chronic pain care. The study was registered with the German Clinical Trials Register on April 14, 2023 (ID: DRKS00030862).
This study focuses on detecting mental performance from EEG signals. It provides both classification and explanation results. For this purpose, we developed a new feature extraction method called Different Pattern (DiffPat) within an Explainable Feature Engineering (XFE) framework. The proposed approach utilizes an EEG mental performance dataset. The DiffPat algorithm extracts the differences between EEG channels in order to improve the efficiency of the feature extraction process. To develop the identified features into a more accurate set of features, the iterative Neighborhood Component Analysis (INCA) feature selection method was utilized iteratively. After selecting the features with INCA, the K-Nearest Neighbor (KNN) classifier was used to classify the features. AI-based explainable results utilizing XAI methods in conjunction with Directed Lobish (DLob) symbolic language were generated to produce cortical connectome diagrams and interpretive sentences that describe the relationship between the brain's neural networks. The DiffPat-driven model achieved 84.48% accuracy with leave-one-subject-out (LOSO) cross-validation, which serves as the primary subject-independent performance estimate. A complementary subject-aware 10-fold cross-validation, where all segments of each subject were confined to a single fold, yielded 99.87% accuracy. The DiffPat-based XFE model can explain the results and provides an advance in both feature engineering and neuroscience. Because the model can both classify and explain the results, it has strong potential for mental performance analysis and other EEG applications.
To create a public digital database centered on adult traumatic brachial plexus injury (TBPI). TBPI mainly affects young males, usually involved in motorcycle accidents, often leading to severe motor and sensory impairment in the affected upper limb. This initiative aimed at encouraging data sharing and reuse. Managing data from TBPI may enable the identification of functional markers associated with clinical improvement in individuals with TBPI and foster the development of new investigative tools to elucidate its mechanisms. Detailed electronic questionnaires were designed to collect epidemiological, physical, and clinical data. The free software Neuroscience Experiments System (NES) was employed to support data storage and management. Hence, data from 170 Brazilian adult individuals with TBPI with varying degrees of functional impairment were collected. The Unified Admission Assessment (Q44071_unified-admission-assessment) was devised to register the first evaluation by the TBPI research group. The Unified Follow-up Assessment (Q92510_unified-follow-up-assessment) was created to register subsequent follow-up visits. The Unified Surgical Evaluation (Q61802_unified-surgical-evaluation) was designed to record the surgical procedures used for brachial plexus reconstruction. Data collection occurred between 2014 and 2020.
Repetitive transcranial magnetic stimulation (rTMS) is widely used to modulate brain activity and treat neurological and psychiatric disorders, yet how diverse stimulation protocols shape cortical function-and whether they share common principles-remains unclear. We combined resting-state fMRI acquired before and after single-session rTMS across nine distinct protocols targeting specific cortical regions to comprehensively map changes in the local amplitude of hemodynamic fluctuations. We found that after-effects co-varied across protocols, with similarity patterns constrained by structural and functional connectivity. Strikingly, a shared spatial pattern emerged across all protocols, closely aligned with the brain's sensory-association hierarchy. Both shared and protocol-specific effects exhibited significant correspondence with the distribution of neurotransmitter systems. Mapping to the Neurosynth cognitive atlas revealed many-to-many correspondences between rTMS effects and cognitive domains, primarily driven by stimulation of parietal and motor regions. These rTMS-induced changes also overlapped with functional abnormalities in major depressive disorder and Parkinson's disease, highlighting the parietal cortex as a potential transdiagnostic target. Key results were independently replicated in two datasets of multi-session rTMS. These findings reveal a unified organizational framework for rTMS after-effects, grounded in cortical hierarchy, neurochemistry, and cognitive activations, offering potential guidance for neuromodulations of brain disorders.
Emerging research suggests a link between attention deficit hyperactivity disorder (ADHD) and central sensitization (CS), a condition characterized by heightened sensitivity to pain and sensory stimuli. This study aimed to measure the severity of CS symptoms in children with ADHD and in their parents; compare results with those of a neurotypical group; and explore associations between CS symptoms and pain intensity as well as potential familial patterns. Participants included 37 children with ADHD (mean age = 11.54 years; 62.2% male) and 29 neurotypical children (mean age = 13.07 years; 58.6% male). Children completed the Central Sensitization Inventory (CSI) - Child and Adolescent Version and rated their pain intensity at the time of assessment and over the past week. One parent per child completed the adult version of the CSI. Children with ADHD reported significantly higher CSI-indexed CS symptom scores than those in the comparison group (p < 0.001). In categorical analyses, neurotypical children were significantly more likely to fall into the subclinical (lowest symptom) CS range (adjusted p < 0.005). Children with ADHD also reported significantly greater pain intensity both currently (p = 0.016) and over the past week (p = 0.003). Stronger correlations between CSI-indexed CS and self-reported pain were observed in the ADHD group, particularly for current pain (ρ = 0.66, p = 0.002). Parents of children with ADHD also had elevated CS scores (p = 0.003), with the majority falling in the severe range. A moderate correlation between parent and child CSI-indexed CS scores was observed across the entire sample (ρ = 0.47, p = 0.002), while a strong correlation between parents' CS scores and their own medical conditions was found only in the ADHD group (ρ = 0.66, p = 0.002). Children with ADHD, and their parents, reported elevated CSI-indexed CS symptoms and pain intensity, suggesting that CS symptoms may represent a clinically relevant feature in some ADHD presentations. These findings support the value of considering sensory and pain-related assessments in ADHD evaluations and highlight the need for further research into potential mechanisms and integrative interventions that may improve outcomes and reduce functional impairment in pediatric neuropsychiatric conditions. Not applicable.
Neuropsychiatric symptoms are prevalent in Parkinson's disease (PD) but remain incompletely characterized, particularly concerning sex-specific differences and the comparative performance of diagnostic tools. This study aimed to provide a comprehensive neuropsychiatric profile of a Taiwanese PD cohort, evaluate the diagnostic sensitivity of various assessment tools, and explore correlations with clinical features. We enrolled 92 PD patients and 57 healthy controls. Participants underwent a comprehensive assessment battery, including motor scales, cognitive measures, and mood inventories. Diagnoses of dementia and depression were established using standard criteria. Diagnostic tool performance was evaluated by calculating the sensitivity and specificity, and relationships between variables were assessed using Spearman correlation. Dementia was identified in 34.8% and depression in 28.3% of PD patients. Female patients had lower scores on the Mini-Mental State Examination (MMSE) (25.18 vs. 28.08, p = 0.003) and Montreal Cognitive Assessment (MoCA) (21.18 vs. 25.79, p = 0.001), and higher scores on the Hamilton Depression Rating Scale (HAM-D) (6.68 vs. 5.02, p = 0.046) and Neuropsychiatric Inventory (NPI) (3.95 vs. 1.79, p = 0.018) compared with male patients. For dementia diagnosis, the clinician-rated MMSE and MoCA demonstrated sensitivities exceeding 90%, whereas the caregiver-rated Clinical Dementia Rating (CDR) had a sensitivity of only 25%. For depression, the clinician-rated HAM-D (88.5% sensitivity) outperformed the self-reported Beck's Depression Inventory II (BDI-II) (65.4% sensitivity). Most neuropsychiatric assessments were significantly correlated with age, disease duration, and motor severity. These findings highlight a considerable neuropsychiatric burden in PD, with a distinct female-predominant vulnerability in cognitive and affective domains. The superior performance of clinician-administered assessments emphasizes their value in improving diagnostic certainty. These results support the routine, comprehensive, and sex-specific neuropsychiatric evaluations in the clinical management of PD.
Dengue fever remains a major and expanding public health threat in tropical regions, with outbreaks increasingly affecting fragile and conflict-affected settings. In Sudan, the ongoing armed conflict has compounded vulnerabilities, limited healthcare access, and amplified the importance of community-level prevention and awareness. We conducted a community-based, multi-center cross-sectional study to assess knowledge, attitudes, and practices (KAP) related to dengue fever prevention and control during the 2025 outbreak in Sudan. A total of 459 adult participants from seven outbreak-affected states were recruited using an online, convenience-based sampling approach. Due to reliance on online platforms, the sample is predominantly composed of young, educated individuals; this limitation is acknowledged explicitly. Data were collected using a validated KAP questionnaire. Participants were classified as having 'Good Knowledge' if they scored ≥ 60% (12/20) on the knowledge section, and 'Positive Attitude' if they scored ≥ 60% on the attitude section. Good Practice was defined as a score ≥ 5 out of 9. Data were analyzed using descriptive statistics, chi-square tests, independent t-tests, and binary logistic regression for multivariate analysis. Statistical significance was set at p ≤ 0.05. Overall awareness of the dengue outbreak was high (96.5%). The majority of participants demonstrated good knowledge (96.5%), positive attitudes (99.8%), and good preventive practices (91.3%). However, substantial misconceptions persisted, particularly regarding transmission: 77.3% of respondents incorrectly believed dengue could be spread through contaminated food or water. Knowledge and practice scores were significantly associated with age, gender, and educational level, with older adults, males, and individuals with lower formal education exhibiting poorer outcomes. Attitudes toward dengue prevention were uniformly positive across all demographic groups (p > 0.05). Despite high overall KAP levels, critical knowledge gaps and demographic disparities threaten effective dengue prevention during outbreaks. Targeted, demographic-specific educational interventions addressing misconceptions about transmission and vector behavior are urgently needed to strengthen community-based control efforts, particularly in conflict-affected settings such as Sudan. Future research should prioritize in-person sampling strategies to ensure adequate representation of older adults and individuals with lower levels of formal education.
Inefficiencies within the structures, processes, and resources associated with mental health and psychosocial support (MHPSS) can lead to adverse individual and collective health outcomes among disaster survivors. Therefore, accurately identifying the barriers to implementing these interventions is essential for strengthening the disaster response system. This study aimed to explore and extract the key challenges and recommendations related to MHPSS in disasters within the national health system in Iran. This study was conducted in December 2024 using a qualitative research design and a directed content analysis approach. Participants consisted of 20 experts in mental health, disaster management, and health policy, selected through purposive sampling. Data were collected via semi-structured, in-depth interviews, and the trustworthiness of the findings was ensured using Lincoln and Guba's criteria. Nine major challenge domains were identified. At the macro governance level, a limited recognition of the importance of MHPSS and insufficient attention to the long-term psychosocial consequences of disasters were reported. Within the domains of organization and coordination, the absence of a unified command and the presence of parallel activities across agencies were identified. Structural constraints included the lack of formally approved organizational structures, inadequate infrastructure, and the absence of a clear framework for the management and integration of volunteers. In the area of human resources, key challenges comprised a shortage of psychiatrists, misalignment between workforce capacity and assigned responsibilities, and insufficient attention to the motivation and welfare of responders. Training and research gaps were noted, including insufficient pre-disasters training and limited context-specific applied research. In addition, ineffective risk communication and limited consideration of cultural and social dimensions were identified as prominent obstacles to delivering effective MHPSS interventions. MHPSS in disasters is confronted with complex and intersectoral challenges, the resolution of which requires a coordinated and evidence-informed approach. Enhancing policymakers' awareness, ensuring sustainable financial resources, developing needs based training programs, leveraging local human resources, and incorporating cultural considerations can substantially improve the effectiveness of MHPSS services during crises and provide a foundation for future policymaking and planning in the health system.
Gait speed is included in the World Falls Guidelines (WFG) fall risk algorithm, yet its ability to discriminate fallers from non-fallers remains unclear. This individual participant data meta-analysis examined the discriminative ability of the WFG-recommended cut point (<0.8m/s) and the performance of a higher cut point (<1.0m/s) for predicting falls in community-dwelling older adults and clinical populations at elevated risk of falls. Individual data from 28 studies with a quantitative measure of gait speed and at least three months of prospectively reported falls were analysed using modified Poisson regression and negative binomial regression, followed by random-effects meta-analyses. Eight studies involving community-dwelling older adults (n = 3,627) and twenty studies involving clinical populations (n = 3,981) were included. Walking at <0.8m/s was associated with increased risk of falling (Relative Risk: 1.27 (95%CI 1.17 - 1.38)) and fall rate (Incidence Rate Ratio: 1.54 (95%CI 1.34 - 1.77)). Diagnostic accuracy was modest (58%, specificity 77%, sensitivity 35%), with consistent findings across planned subgroup analyses for population, fall history, and sex. Analyses using the <1.0m/s cut point produced similar effect sizes and accuracy metrics but identified a larger proportion of fallers in both community-dwelling (30.1% vs. 8.7%) and clinical populations (66.9% vs. 46.0%) compared to the <0.8m/s cut point. Slower gait speed is associated with an increased risk and rate of falling across both population groups, but discriminative accuracy is low. While the <0.8m/s threshold shows consistent associations, a <1.0m/s cut point may be more clinically useful in community-dwelling and clinical settings because it identifies more fallers.
Alzheimer's disease and related dementias (ADRD) are frequently associated with behavioral and psychological symptoms of dementia (BPSD), which complicate care, increase medication exposure and cognitive iatrogenic risk. The mobile team for ADRD (MTAD) provides therapeutic recommendations for acute cases following home interventions. This study evaluated the theoretical impact of MTAD medication recommendations on medication exposure in community-dwelling older patients with neurocognitive disorders (NCD) and BPSD. This retrospective single-center study included older patients with NCDs visited by MTAD. Medication exposure was evaluated theoretically, assuming full implementation of MTAD medication recommendations, based on medication number, prevalence of potentially inappropriate medications (PIMs) identified using the EU(7)-PIM list, and sedative/anticholinergic burden quantified by the Drug Burden Index (DBI). MTAD medication recommendations were classified. Among 246 patients (mean age 83.9 years), MTAD recommendations would result in a significant reduction in PIMs per patient (0.91 versus 0.79, p < 0.001), with a significant increase in the overall and sedative DBI (0.55 versus 0.74, p < 0.001; 0.46 versus 0.65, p < 0.001, respectively), and number of prescribed medications (6.5 versus 6.9, p < 0.001), without change in the anticholinergic DBI (0.25 versus 0.26, p = 0.206). A total of 337 recommendations were issued, mainly additions (51%) and discontinuations (23%), primarily targeting psychotropics. The theoretical implementation of MTAD recommendations for older patients with BPSD could reduce exposure to PIMs and may lead to an increased use of sedatives. However, further efforts are needed to optimize somatic treatments and minimize iatrogenic risks through comprehensive medication reviews.
While the central dogma outlines DNA-to-protein information flow, existing gene regulators mainly target transcription. Here, we developed the λN-Guided RNA Targeting System (λGRTS), a CRISPR-independent platform enhancing mammalian mRNA translation via specific translation-guiding RNAs (tgRNAs). λGRTS integrates λN (high-affinity BoxB binder), mutated eIF4E1 (ablated non-specific 5' cap binding, retains TIC recruitment), and auxiliary factors (HuR for dsRNA stabilization, PABP and RRM2-RRM3 for mRNA closed loops). Optimized 22-nt tgRNAs (targeting 58 bp upstream of mRNA ATG in 5' UTR) and NES-tagged proteins maximized efficacy. λGRTS outperformed dCasRX (smaller ~ 50 kDa vs. ~ 150 kDa, single tgRNA vs. crRNA-tracrRNA), boosting functional proteins (e.g., GFP). It activated P53/PTEN, suppressing GBM cell proliferation, inducing G1 arrest, and reducing invasion in vitro. In vivo, lentiviral λGRTS inhibited orthotopic GBM in nude mice, extended survival by approximately 35-40 days, with IHC confirming P53/PTEN upregulation. Mass spectrometry showed no off-target effects. Cross-species tests (human, mouse, bovine cells) validated broad applicability via conserved eIF4E1. λGRTS offers a specific, safe translation-centric tool for gene regulation and oncology research.
The Indiana Complex Care Coordination Collaborative (IC4) is a statewide model of care coordination design to enhance the quality of medical care for children with medical complexity (CMC) by training and embedding nurse care coordinators in primary care practices. This study examines the impact of IC4 care coordinators on caregivers' and patients' quality of medical care, access to medical and community resources, care workload, and the quality of life of caregivers and CMC. Caregivers of CMC (n = 13) completed one-hour semi-structured interviews focused on met/unmet needs, quality of medical care, co-developed shared plan of care, caregiver/patient quality of life, caregiver workload, and medical home experience. Using NVIVO, researchers used a codebook to conduct an inductive thematic analysis of the interview transcripts. The thematic analysis was revealed five overarching themes: (1) central role of the care coordinator, (2) proactive and personalized support, (3) care across the lifespan, (4) emotional support, and (5) navigating healthcare systems. Caregivers reported that they considered their care coordinator a trusted health professional who can advocate for them with other health professionals. Families appreciated that the shared plan of care created with the care coordinator can be easily disseminated to other healthcare and service professionals, as well as other family members, and helps the patients and families be seen as individuals, not just as a medical record. Care coordination can address unmet needs and greatly improve the quality of and access to care received by CMCs and their families. Unanimously, caregivers report the substantial instrumental, informational, and emotional support care coordinators (CCs) provide to access medical systems, resources, planning, and reduce patient care workload. Additionally, several caregivers reported substantial social support from the CC. However, several caregivers still reported feelings of loneliness and difficulties engaging with families without CMC.
We aimed to examine the relationship between the quality of macronutrients consumed at dinner versus breakfast and their effects on body composition among Iranian adults. A cross-sectional study was conducted among 450 Iranian adults (aged 20-59). Anthropometric and body composition measures, including BMI, body fat percentage, fat-free mass, muscle mass, and waist-to-hip ratio, were assessed. Dietary data were collected using three 24-hour recalls, categorizing macronutrient quality (carbohydrates, fats, and proteins). ANCOVA was used to compare anthropometric and body composition measures across macronutrient tertiles for dinner versus breakfast. Non-linear associations were analyzed using restricted cubic splines. According to our findings, higher-quality carbohydrate intake at dinner versus breakfast showed a significant inverted U-shaped association with BMI. Conversely, saturated fat intake at dinner versus breakfast increased BMI in a U-shaped relationship, while linearly reducing muscle mass and fat-free mass. Unsaturated fat intake at dinner compared to breakfast showed a U-shaped association with BMI. Moreover, animal protein intake at dinner versus breakfast slightly increased muscle mass and fat-free mass in a reverse U-shaped pattern. However, higher plant protein intake at dinner versus breakfast reduced BMI linearly and decreased fat-free mass and muscle mass. Higher intake of high-quality carbohydrates, unsaturated fats, and plant-based proteins at dinner versus breakfast may improve body composition, while increased consumption of saturated fats and animal proteins at dinner versus breakfast may worsen central adiposity and BMI.
The relationship between autonomic nervous system function, indexed by heart rate (HR) and heart rate variability (HRV), and the oxidant-antioxidant defense system in obsessive-compulsive disorder (OCD) remains poorly understood. This study investigated the association between autonomic reactivity and salivary antioxidant capacity (AOC) in patients with OCD under cognitive-emotional load. Thirty-one patients with OCD and twenty-nine healthy controls (HC) underwent a cognitive-emotional antisaccade task. Saliva samples for AOC analysis and electrocardiogram (ECG) recordings were collected before and after the task. Participants were stratified into high- and low-HR subgroups based on baseline levels. The OCD group demonstrated significantly lower baseline AOC and a blunted AOC response to the task compared to HC, whose AOC increased significantly. Crucially, stratification by baseline HR revealed a physiologically distinct OCD subtype. OCD patients with low baseline HR exhibited a maladaptive profile, showing a decrease in AOC and a significant increase in normalized low-frequency power (LFnu). In contrast, OCD patients with high baseline HR showed an AOC increase comparable to that of healthy controls. Overall, the OCD group also demonstrated a more pronounced increase in very low-frequency power (VLF) and higher overall LFnu, indicating generalized sympathetic predominance. These findings point to a physiologically distinct OCD phenotype defined by low baseline HR, impaired antioxidant response, and sympathetic hyperreactivity under stress, and suggest that baseline HR may serve as a candidate biomarker of a more severe, maladaptive form of OCD with compromised compensatory mechanisms linking autonomic regulation and antioxidant defense. CLINICAL TRIAL NUMBER: Not applicable.
Calcitonin gene-related peptide monoclonal antibodies (CGRP mAbs) are effective migraine-specific preventive therapies; however, access remains limited in many low- and middle-income countries (LMICs). In such settings, oral migraine preventive medications (OMPMs) continue to serve as the foundation of preventive care. The association between baseline preventive regimens and real-world escalation to CGRP mAbs has not been well characterized. We conducted a single-center retrospective cohort study of adults with migraine attending a university-based headache clinic in Thailand between January 2021 and December 2023. Participants with at least one baseline OMPM, no prior CGRP mAb exposure, and at least 6 months of follow-up were included. Multivariable Cox proportional hazards models, adjusted for age, sex, and migraine subtype, were used to examine associations between baseline OMPM classes and CGRP mAb initiation. A secondary analysis evaluated factors associated with discontinuation of baseline OMPMs. Among 80 participants, 16 (20.0%) initiated CGRP mAbs over 11,554 person-days of follow-up, with a median time to initiation of 44.5 days. Baseline use of beta-blockers (BBs) or tricyclic antidepressants (TCAs) was independently associated with a lower likelihood of CGRP mAb initiation (BB: adjusted hazard ratio [aHR] 0.17, 95% CI 0.04-0.66; TCA: aHR 0.12, 95% CI 0.02-0.57). In secondary analyses, baseline BB use was also associated with greater persistence with preventive therapy (aHR for discontinuation 0.24, 95% CI 0.09-0.64). Baseline oral preventive regimens were associated with differing likelihoods of switching to CGRP mAbs in this LMIC setting. Optimizing oral preventive treatment strategies remains essential in settings where access to CGRP-targeted therapies is limited, either due to unavailability or lack of reimbursement.
Young maternal age (24 years or below) is a well-documented risk factor for child maltreatment. Young pregnant women are more likely than older mothers to have experienced childhood trauma, potentially increasing their vulnerability to re-traumatization during pregnancy and perinatal care interactions. Re-traumatization may play a role in increased child maltreatment risk, underscoring the importance of incorporating trauma-informed care (TIC) approaches into maternity services for this population. However, the implementation and evaluation of TIC training in community-based perinatal maternity care settings remain limited. As favorable staff attitudes are critical for the successful adoption and sustainability of TIC, evaluating the impact of training on professional attitudes is essential. We aimed to develop and evaluate the effects of a TIC training program on community-based maternity staff attitudes toward TIC in the Tokyo metropolitan area. Fifty-nine community-based maternity care staff (public health nurses, social workers, psychologists, and administrators) participated. The two-day training program was delivered in two formats: online (September 2021) and face-to-face (May 2022). Across the two days, the program included 2 h and 50 min of didactic lectures and 2 h and 30 min of interactive group discussion. Content covered core TIC principles, trauma-related responses, applications in perinatal care, and strategies to promote sustainable trauma-informed practice. Participants completed the 35-item Attitudes Related to TIC scale (ARTIC-35) at pre-training, post-training, and six-month follow-up. Mixed-effects modeling was used to examine changes in ARTIC-35 scores over time. Participants were predominantly women (81.4%). The mean age was 42.5 years and most participants were public health nurses (42.4%), psychologists (25.4%), and social workers (23.7%). Mean ARTIC-35 scores increased significantly from pre-training (5.30, standard deviation = 0.55) to post-training (5.70, 0.59; adjusted coefficient β = 0.40, p < .001) and remained significantly higher at six-month follow-up (5.55, 0.66; β = 0.26, p < .001). Effect sizes were medium (Cohen's d = 0.72) immediately post-training and small to moderate (0.47) at six months. The training program was associated with significant and sustained improvements in staff attitudes toward TIC. Future research should examine whether favorable attitudinal changes contribute to improving TIC practice and preventing child maltreatment.
Approximately 5% to 7% of patients with stroke develop post-stroke epilepsy (PSE). There is limited published literature about frequency, characteristics and outcomes of post-stroke epilepsy in Saudi population. We determined the frequency, management and outcomes of post-stroke epilepsy in a Saudi cohort. After IRB approval, a retrospective chart-review was performed on patients admitted with stroke at King Abdulaziz Medical City, MNGHA, Riyadh between January 2016 and December 2020. PSE was defined as one or more seizures after the 7th day of incident stroke. The diagnosis was clinical, EEG was not required to make the diagnosis of PSE. Data was collected about demographic features, stroke characteristics, epilepsy management and outcomes. Data was analyzed using RStudio (R version 4.3.1.). Consecutive, nonrandom sampling technique was used and all patients were included from the study period. A total of 2985 patients were included, of whom 2596 (87.0%) had ischemic stroke, 389 (13.0%) had hemorrhagic stroke. PSE occurred in 164 (5.49%) patients. The median age was 66.0 years (IQR:55.5-76.5), 102 (62.2%) were men, and 157 (95.7%) were Saudis. In ischemic group, 129 (4.97%) had PSE, whereas 35 (8.99%) in hemorrhagic group (p = 0.001). The commonest type of seizures was generalized in 96 (58.5%), focal in 45 (27.4%), unclassified in 23 (14.0%). Twenty-six (16%) patients had status epilepticus. Epileptiform abnormalities were seen in 16 (9.8%) on electroencephalogram. Treatment was started in 151 (93.8%) after first seizure, levetiracetam was commonest 1st antiseizure medication (ASM) used in 133 (82.6%). Side effects were reported in 11 (6.9%) patients; behavioral changes in 9 (5.5%), irritability in 6 (3.7%) patients. Nineteen (11.8%) patients needed 2nd ASM, 10 (6.1%) needed 3rd ASM. Median (IQR) follow-up was 26.0 (13.0-48.0) months. At last follow up, 120 (87%) were seizure free. Post-stroke epilepsy was common in our cohort. The patients with hemorrhagic stroke were more likely to have post-stroke epilepsy compared to ischemic stroke. Generalized seizures were the commonest type of seizure. Most patients had good control at last follow up requiring only monotherapy.
Despite neuroinflammation being an initially protective response made by the central nervous system (CNS), as it becomes chronic, it can lead to neuronal damage since the cytokines which are released by microglia potentialize cellular death due to excitotoxicity, and this, in turn, promotes the release of pro-inflammatory mediators, feeding this way a self-sustaining cycle of neuroinflammatory response, which favor subsequent neurodegeneration. Given the fact that until this moment, there are not any therapeutic alternatives able to stop the neurodegeneration, the objective of the present work was to evaluate the putative neuroprotector effect of taurine, a partial glycinergic ionotropic receptor agonist, and also a GABAA receptor agonist, in a neuroinflammation animal model. For this intent, the oral taurine administration was evaluated on mnemonic impairing caused by LPS induced neuroinflammation in male Wistar rats. Such effects were investigated on recent and late spatial long-term memory and aversive memory in the behavioural tasks Morris water maze (MWM) and context fear conditioning (CFC), respectively. In addition, we investigated the effect of orally administered taurine on hippocampal neuronal density and on hippocampal levels of TNF-α and IL-4. Taurine, when orally administered for 30 days, in the doses of 20 and 200 mg/kg, was able to reverse the mnemonic impairment caused by neuroinflammation on recent and remote spatial long-term memory, and in the dose of 200 mg/kg, it also was able to do the same on aversive long-term memory. In the doses of 20 and 200 mg/kg, taurine was also able to reverse the LPS-induced increase in hippocampal TNF-α levels. Taurine, when orally administered in a pathological context characterized by neuroinflammatory background, as it was induced in this work, can perform a dose-dependent neuroprotective effect, probably by acting in an excitotoxic scenario in which the activation of hyperpolarizing receptors can be welcomed.
Midlife obesity is a well-established risk factor for dementia, whereas late-life obesity has been associated with no increased risk, or even a reduced risk in some studies. However, the joint associations of obesity (body mass index ≥ 30 kg/m2) and metabolic health phenotypes (defined by the presence of hyperglycemia, hypertension and dyslipidemia) with dementia risk are less explored, particularly with regard to age- and sex-related differences. Therefore, we investigated how obesity and metabolic health phenotypes jointly associate with dementia risk and whether this risk differs between midlife (≤ 65 years) and late-life (> 65 years), and sex. We analysed data from 11,482 participants, aged 51 to 100 years, from the US Health and Retirement Study (HRS), and 13,068 participants, aged 45 to 90 years, from the Swedish Twin Registry (STR). Cox regression models were used to estimate dementia risk in relation to metabolically healthy obesity (MHO), metabolically unhealthy obesity (MUO), and metabolically unhealthy no obesity (MUNO), relative to metabolically healthy no obesity (reference). Models were adjusted for age, sex, smoking status, and education level. Analyses were stratified by midlife and late-life and conducted in the entire sample and separately by sex. Metabolically unhealthy status in midlife and late-life indicated increased dementia risk regardless of obesity status, reaching statistical significance for midlife MUNO in females in HRS (Hazard ratio (HR): 1.62, 95% confidence intervals (CI): 1.05-2.49) and in late-life MUNO for the full sample in STR (HR: 1.13, CI: 1.02-1.25) and males in the STR (HR: 1.22, CI: 1.04-1.42). The associations between MUO and dementia risk were not statistically significant, but trends suggested midlife MUO was associated with higher dementia risk. The associations between mid and late-life MHO with dementia risk were also not statistically significant, although the associations showed trends towards lower dementia risk. Being metabolically unhealthy, especially in midlife, may be associated with increased dementia risk, regardless of obesity status. Mid- and late-life MHO showed no increased risk and suggested potential inverse associations. These findings underscore the importance of evaluating dementia risk in the context of obesity, metabolic health, age and sex simultaneously.