搜索结果：Behaviour research and therapy

Audit and feedback (A&F) is a widely used strategy to improve professional practice. This is supported by prior Cochrane reviews and behavioural theories describing how healthcare professionals are prompted to modify their practice when given data showing that their clinical practice is inconsistent with a desirable target. Yet there remains uncertainty regarding the effects of A&F on improving healthcare practice and the characteristics of A&F that lead to a greater impact. To assess the effects of A&F on the practice of healthcare professionals and to examine factors that may explain variation in the effectiveness of A&F. With the Cochrane Effective Practice and Organisation of Care (EPOC) group information scientist, we updated our search strategy to include studies published from 2010 to June 2020. Search updates were performed on 28 February 2019 and 11 June 2020. We searched MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCO), the Cochrane Library, clinicaltrials.gov (all dates to June 2020), WHO ICTRP (all dates to February Week 3 2019, no information available in 2020 due to COVID-19 pandemic). An updated search and duplicate screen was completed on February 14, 2022; studies that met inclusion criteria are included in the 'Studies awaiting classification' section. Randomised trials, including cluster-trials and cross-over and factorial designs, featuring A&F (defined as measurement of clinical performance over a specified period of time (audit) and provision of the resulting data to clinicians or clinical teams (feedback)) in any trial arm that reported objectively measured health professional practice outcomes. For this updated review, we re-extracted data for each study arm, including theory-informed variables regarding how the A&F was conducted and behaviour change techniques for each intervention, as well as study-level characteristics including risk of bias. For each study, we extracted outcome data for every healthcare professional practice targeted by A&F. All data were extracted by a minimum of two independent review authors. For studies with dichotomous outcomes that included arms with and without A&F, we calculated risk differences (RDs) (absolute difference between arms in proportion of desired practice completed) and also odds ratios (ORs). We synthesised the median RDs and interquartile ranges (IQRs) across all trials. We then conducted meta-analyses, accounting for multiple outcomes from a given study and weighted by effective sample size, using reported (or imputed, when necessary) intra-cluster correlation coefficients. Next, we explored the role of baseline performance, co-interventions, targeted behaviour, and study design factors on the estimated effects of A&F. Finally, we conducted exploratory meta-regressions to test preselected variables that might be associated with A&F effect size: characteristics of the audit (number of indicators, aggregation of data); delivery of the feedback (multi-modal format, local champion, nature of comparator, repeated delivery); and components supporting action (facilitation, provision of specific plans for improvement, co-development of action plans). We included 292 studies with 678 arms; 133 (46%) had a low risk of bias, 41 (14%) unclear, and 113 (39%) had a high risk of bias. There were 26 (9%) studies conducted in low- or middle-income countries. In most studies (237, 81%), the recipients of A&F were physicians. Professional practices most commonly targeted in the studies were prescribing (138 studies, 47%) and test-ordering (103 studies, 35%). Most studies featured multifaceted interventions: the most common co-interventions were clinician education (377 study arms, 56%) and reminders (100 study arms, 15%). Forty-eight unique behaviour change techniques were identified within the study arms (mean 5.2, standard deviation 2.8, range 1 to 29). Synthesis of 558 dichotomous outcomes measuring professional practices from 177 studies testing A&F versus control revealed a median absolute improvement in desired practice of 2.7%, with an IQR of 0.0 to 8.6. Meta-analyses of these studies, accounting for multiple outcomes from the same study and weighting by effective sample size accounting for clustering, found a mean absolute increase in desired practice of 6.2% (95% confidence interval (CI) 4.1 to 8.2; moderate-certainty evidence) and an OR of 1.47 (95% CI 1.31 to 1.64; moderate-certainty evidence). Effects were similar for pre-planned subgroup analyses focused on prescribing and test-ordering outcomes. Lower baseline performance and increased number of co-interventions were both associated with larger intervention effects. Meta-regressions comparing the presence versus absence of specific A&F components to explore heterogeneity, accounting for baseline performance and number of co-interventions, suggested that A&F effects were greater with individual-recipient-level data rather than team-level data, comparing performance to top-peers or a benchmark, involving a local champion with whom the recipient had a relationship, using interactive modalities rather than just didactic or just written format, and with facilitation to support engagement, and action plans to improve performance. The meta-regressions did not find significant effects with the number of indicators in the audit, comparison to average performance of all peers, or co-development of action plans. Contrary to expectations, repeated delivery was associated with lower effect size. Direct comparisons from head-to-head trials support the use of peer-comparisons versus no comparison at all and the use of design elements in feedback that facilitate the identification and action of high-priority clinical items. A&F can be effective in improving professional practice, but effects vary in size. A&F is most often delivered along with co-interventions which can contribute additive effects. A&F may be most effective when designed to help recipients prioritise and take action on high-priority clinical issues and with the following characteristics: 1. targets important performance metrics where health professionals have substantial room for improvement (audit); 2. measures the individual recipient's practice, rather than their team or organisation (audit); 3. involves a local champion with an existing relationship with the recipient (feedback); 4. includes multiple, interactive modalities such as verbal and written (feedback); 5. compares performance to top peers or a benchmark (feedback); 6. facilitates engagement with the feedback (action); 7. features an actionable plan with specific advice for improvement (action). These conclusions require further confirmatory research; future research should focus on discerning ways to optimise the effectiveness of A&F interventions.

To evaluate the value of linked electronic health records (EHRs) for measuring stroke care quality in England before and after the COVID-19 pandemic, focusing on metrics not routinely captured: stroke incidence, dispensing of secondary prevention medications and a proxy of disability-time spent at home after stroke ('home-time'). Prospective cohort study using national linked datasets. England-wide health data linkage including the Sentinel Stroke National Audit Programme (SSNAP), primary and secondary care, dispensed medications and mortality records, accessed via National Health Service (NHS) England's Secure Data Environment. 425 675 adults with a first stroke between 1 January 2020 and 31 December 2023; data were available for 304 210 in primary care, 279 825 in hospital admissions, 220 470 in SSNAP and 59 465 in death records. Annual stroke incidence; first-year medication dispensing rates for antiplatelets, anticoagulants, antihypertensives and lipid-lowering agents (with a 1-month washout period) and home-time at 180 days post stroke. Stroke ascertainment was highest when combining all sources, with 10.8% of non-fatal ischaemic strokes recorded exclusively in primary care and 19.4% of fatal strokes identified solely through death records. Standardised annual stroke incidence rose from 227.6 (95% CI 226.1 to 229.0) to 244.8 (95% CI 243.4 to 246.3) per 100 000 over the study period including the COVID-19 pandemic. During the COVID-19 lockdown, non-fatal stroke recordings decreased while stroke-related deaths rose, indicating that recording quality was sensitive to shifts in healthcare-seeking behaviour during the pandemic. Among people with ischaemic stroke, 89.1% received an antiplatelet or anticoagulant, 44.5% an antihypertensive and 80.5% a lipid-lowering therapy. For haemorrhagic stroke, these proportions were: for anticoagulants 13.5%, antiplatelets 13.2%, antihypertensives 46.6% and lipid lowering 41.1%. Medication dispensing for stroke prevention declined with increasing age and comorbidity, but varied little by ethnicity, region or pandemic period. Mean home-time within 180 days of stroke was 166.6 (95% CI 166.4 to 166) days, decreasing with greater age (141.4 days for 90 years or older (95% CI 140.7 to 142.1)), deprivation (166.4 days (95% CI 166.1 to 166.6) for most deprived quintile) and stroke severity (137.4 days for National Institutes of Health Stroke Scale (NIHSS) score on arrival over 22 (95% CI 135.8 to 139.1)) and increasing with years from the COVID-19 pandemic 2023 (169.3 days (95% CI 169.0 to 169.5) vs 2020 164.4 days (95% CI 164.1 to 164.7)). Standardised stroke incidence increased significantly over the study period, highlighting a growing public health burden that persisted despite disruptions due to the pandemic although variation in case ascertainment and stroke coding practices was observed. While secondary prevention coverage for antiplatelets and lipids was high, lower rates of dispensing of antihypertensives, particularly in older and comorbid populations, potentially signal a target for improvement. Home-time represents a sensitive, person-centred outcome that exposes disparities linked to socioeconomic deprivation and clinical severity that can be used to enhance routine stroke audits. These findings justify the expansion of linked EHR infrastructure and the modernisation of governance frameworks to enable the longitudinal evaluation of care quality beyond the COVID-19 era.

This study evaluated the effectiveness of a group intervention combining cognitive behavioural therapy for insomnia (CBT-I) and imagery rehearsal therapy (IRT) for nightmares, delivered to current and former military and law-enforcement personnel with post-traumatic stress disorder (PTSD) at an outpatient operational stress injury clinic. This study further investigated the interrelationships among changes in insomnia, nightmares and PTSD symptoms during treatment. Sixty outpatients (78% male, 50.7&#xa0;&#xb1;&#xa0;7.3 years) attended 10 weekly 2-h sessions of CBT-I/IRT and completed daily sleep diaries as well as pre-/post-intervention questionnaires assessing the severity of insomnia, nightmares, and PTSD, sleep-related beliefs, ruminations, and life satisfaction. From baseline to post-intervention, significant reductions were observed in insomnia severity, nightmare distress and frequency, PTSD severity, dysfunctional beliefs about sleep, and insomnia-related ruminations, while life satisfaction increased (all p&#xa0;<&#xa0;.05). Sleep-diary indices improved following CBT-I/IRT, including shorter sleep onset latency (t(37)&#xa0;=&#xa0;5.0, p&#xa0;=&#xa0;&#x2264;.001), longer total sleep time (t(37)&#xa0;=&#xa0;-1.7, p&#xa0;=&#xa0;.049), less wake after sleep onset (t(37)&#xa0;=&#xa0;1.8, p&#xa0;=&#xa0;.037), and higher sleep efficiency (t(37)&#xa0;=&#xa0;-5.1, p&#xa0;&#x2264;&#xa0;.001). A positive correlation was identified between the degree of improvements in insomnia severity and nightmare distress (r(46)&#xa0;=&#xa0;.41, p&#xa0;=&#xa0;.004). Improvements in insomnia severity (r(48)&#xa0;=&#xa0;.35, p&#xa0;=&#xa0;.013) and in nightmare distress (r(46)&#xa0;=&#xa0;.36, p&#xa0;=&#xa0;.012) both correlated with improvements in PTSD. This study supports the real-world effectiveness of CBT-I/IRT for addressing sleep disturbances, trauma-related symptoms, sleep-related cognitions and life satisfaction in people with PTSD. The multidimensional symptom improvements highlight the value of jointly addressing insomnia and nightmares in trauma-exposed populations and support wider implementation of CBT-I/IRT among service members.

Hearing loss (HL) imposes a substantial burden on families and society and is the largest modifiable risk factor for dementia. As a practical and non-invasive approach to managing HL, hearing aid use has been associated with a reduced risk of incident dementia and global cognitive decline. However, high-level evidence on the cognitive benefits of hearing aids among those at high dementia risk is scarce and adherence to hearing aid use remains challenging. Our study aims to explore whether a family-supported hearing aid use behaviour intervention, guided by the integrated framework of self-determination theory, technology acceptance model and family social support theory, can improve cognitive function in Chinese older adults with both HL and mild cognitive impairment (MCI). This study is a two-arm, single-blinded, randomised controlled trial. A total of 150 participants with HL and MCI will be randomly assigned in a 1:1 ratio to either an intervention group (hearing aid use and family intervention) or a control group (hearing aid use and regular health education). All interventions will last for 4 months. Hearing aid use will be delivered by professional audiologists, while family caregivers will deliver the behavioural intervention at home after receiving standardised training from researchers and guidance through structured manuals. Furthermore, family caregivers will be guided through a WeChat group to address unresolved issues related to hearing aid maintenance and intervention skills. The primary outcome is cognitive function measured by the Montreal Cognitive Assessment-Hearing Impairment at baseline and follow-up. Secondary outcomes include adherence score to hearing aid use measured by daily duration and weekly frequency, hearing aid use skills, motivation, activities of daily life, quality of life, depressive symptoms, subjective cognitive decline, social support, self-efficacy, healthcare utilisation, autonomy support and caregiver burden. The study was approved by the Institutional Review Board of Peking University. Research findings will be published in peer-reviewed journals and at national and international conferences. ChiCTR2400091791.

Individuals with chronic pain have increased risk of suicide, however, few receive suicide prevention interventions. Problem-solving therapy is an evidence-based treatment for chronic pain that seeks to improve problem-solving ability, an executive function associated with suicide risk and related outcomes. The goal of this pilot randomized controlled trial was to estimate if problem-solving therapy improves problem-solving ability and other outcomes for Veterans with chronic pain and moderate suicide risk (n&#xa0;=&#xa0;44). Veterans were randomized to receive 12-weeks of video delivered problem-solving therapy or supportive psychotherapy. At post-treatment, problem-solving therapy was estimated to result in a greater increase in problem-solving ability (Cohen's d&#xa0;=&#xa0;0.33, small effect) and a greater reduction in perceived burdensomeness (Cohen's d&#xa0;=&#xa0;0.60, large effect), compared to supportive psychotherapy. These between-group differences were estimated to be maintained for problem-solving ability (Cohen's d&#xa0;=&#xa0;0.94, large effect) and perceived burdensomeness (Cohen's d&#xa0;=&#xa0;0.45, medium effect) at 6-month follow-up. It was estimated that problem-solving therapy did not have a differential effect on thwarted belongingness compared to supportive psychotherapy. In exploratory analysis, problem-solving therapy was estimated to reduce suicide ideation intensity, suicide ideation frequency, and suicide coping at post-treatment, however, in between-group analysis, only suicide ideation frequency was estimated to be reduced as compared to supportive psychotherapy. Results for the exploratory pain outcomes were mixed. This study suggests problem-solving therapy may improve problem-solving ability and reduce feelings of perceived burdensomeness. A fully powered clinical trial is needed to confirm these results and to determine if problem-solving therapy reduces suicide risk and improves pain outcomes.

Emotion regulation capacity in adolescence is predictive of improved adult mental health and functioning. In the absence of access to functional coping skills, suicidal ideation can be understood as an attempt at emotion regulation. Dialectical Behavioural Therapy adapted for adolescents (DBT-A) targets suicidal ideation directly, partly through teaching of coping skills. Although prior studies have demonstrated DBT-A's effectiveness in reducing suicidal thoughts and behaviour, such studies lack long-term follow-up and often rely on self-reports at single time-points, reducing the capacity to capture variations over time. To examine whether having received DBT-A in adolescence was associated with differences in suicidal ideation, negative affect and coping skills use measured in daily life, 12.4 years after treatment. Adolescents (N&#xa0;=&#xa0;54) who participated in an RCT of DBT-A vs. Enhanced Usual Care (EUC), were followed up 12.4 years later and provided bihourly real-time reports of positive and negative affect, suicidal ideation and use of coping skills collected six times daily for seven consecutive days through the use of mobile phones. Mixed effect models were used to investigate treatment group differences longitudinally and generalized linear models to examine group differences in suicidal ideation occurrence. Concurrent Major Depression or Borderline Personality Disorder (BPD) as well as time measures were included as potential moderators. https://clinicaltrials.gov/study/NCT04298190. To have received DBT-A was associated with lower odds (OR&#xa0;=&#xa0;.16, 95&#xa0;%CI: .02 - .89) of reporting any suicidal ideation, independently of concurrent BPD or Major Depression. There were statistically significant within-person interaction effects on negative affect by use of specific coping skills depending on treatment condition. Only participants who received EUC reported higher levels of negative affect after having used more cognitive coping skills. Participants in both groups reported higher levels of negative affect after having used a breathing exercise, and this effect was significantly higher in the DBT-A group. Young adults who received DBT-A as adolescents had lower probability of reporting suicidal ideation 12.4 years after treatment, independently of concurrent psychiatric morbidity. In addition, the relationship between negative affect and use of coping skills was different in participants who had received DBT-A vs EUC. These findings suggest that DBT-A in adolescence has a long-term impact on suicidal ideation and coping skills use over a decade later.

Cancer-related fatigue (CRF) is common in men with prostate cancer (PC). Physical activity is helpful in reducing CRF; however, it is unclear if reducing sedentary behaviour (SB) improves CRF. Technology-based interventions, wearable technology (WEAR) and online educational workshops (EDU), have shown to increase physical activity and affect health behaviour; however, their impact on CRF are less clear. The aim of this pilot study was to determine the feasibility of a pilot randomized controlled trial of technology-based interventions to reduce SB and improve CRF. Participants were adult males with PC, currently sedentary (<150&#xa0;min per week of activity), fluent in English, and had a computer with internet access. Participants were randomized in a 2x2 factorial design (WEAR only, EDU only, WEAR&#xa0;+&#xa0;EDU, and control). Feasibility metrics included consent rate, retention rate, adherence, and study acceptability. Assessments consisted of Functional Assessment of Cancer Therapy - Fatigue (FACT-F) (Minimal Clinically Important Difference (MCID)&#xa0;=&#xa0;3), Sit-Q-7d (MCID&#xa0;=&#xa0;1.9), Accelerometry, Functional Assessment of Cancer Therapy - General (FACT-G) and Patient Health Questionnaire (PHQ-9). Descriptive statistics were used for feasibility outcomes and a constrained longitudinal data analysis was used for efficacy outcomes. Twenty-one participants, mean age of 67 (SD 8.7) years and mainly retired (52.4%), were recruited. Neither consent rate (28/231, 12.1%) nor retention rate (11/21, 52.4%) met feasibility targets; however, there was moderate intervention adherence (3/5, 60%). Trends of reduced SB and CRF were seen in participants who used a WEAR device. Average effects across times for fatigue (FACT-F) were 3.8 (95% CI -5.4, 12.9) for WEAR and -1.1 (-10.4, 8.3) for EDU. Effects on SB (Sit-Q-7d) were 2.3 (-2.8, 7.4) for WEAR and -1.0 (-5.7, 3.7) for EDU. Although consent and retention rates were low, participants found the study acceptable and were adherent. Unfortunately, the study was not large enough to precisely estimate treatment effects. Future studies should continue to evaluate WEAR and EDU, using strategies to increase recruitment and retention. Clinicians should encourage cancer survivors to reduce SB, increase physical activity through education and wearable devices.

Treatment intensification with androgen receptor pathway inhibitors (ARPIs) and/or docetaxel in addition to androgen deprivation therapy (ADT) improves survival for men with metastatic hormone-sensitive prostate cancer (mHSPC), yet real-world uptake has historically been low. We conducted a population-based retrospective cohort study of Ontario men aged &#x2265;66 years diagnosed with de novo mHSPC between 2014 and 2022 using linked administrative health data, defining treatment intensification as initiation of an ARPI and/or docetaxel with ADT within six months of diagnosis. Quarterly intensification rates were modeled using autoregressive integrated moving average (ARIMA) time-series methods with nonlinear trend specifications, and competing models were compared using information criteria, out-of-sample hold-out forecast accuracy, and long-horizon extrapolation behaviour to project uptake through 2030. Among 6099 men, 24% received treatment intensification, with quarterly intensification rates increasing from 3% in 2014 to 56% in 2022. A restricted cubic spline ARIMA model (ARIMA(1,0,1) + RCS3) was selected as the primary base-case forecast because it showed superior out-of-sample hold-out accuracy and more tempered long-horizon extrapolation. The cubic specification was retained as an upper-bound scenario, reflecting the possibility of continued aggressive momentum in treatment adoption. Both specifications captured a marked inflection after 2020 that temporally coincided with guideline updates and funding expansions. Near-term base-case projections (through 2026) suggest continued growth in intensification toward 80-85%, with the upper-bound scenario approaching saturation more quickly. Projections beyond 2026 are exploratory and presented for methodological completeness, given the eight-year horizon relative to a nine-year observation window and the widening prediction intervals at extended horizons. Despite substantial growth over time, treatment intensification remains incomplete in routine practice. These findings are temporally consistent with the impact of policy and funding changes on the adoption of evidence-based therapy and underscore the need for ongoing implementation efforts to address persistent clinical and system-level barriers to equitable access.

Intravenous and/or subcutaneous immunoglobulins (IVIg/SCIg) are used as immunoglobulin replacement therapy (IgRT) in primary and secondary immunodeficiencies (PID/SID) and as immunomodulatory therapy in immune-mediated diseases. Despite empiric immunoglobulin G (IgG) target concentrations in PID, dosing remains variable and suboptimal, particularly in immune-mediated diseases lacking clear IgG target concentrations. Population pharmacokinetic (popPK) and pharmacodynamic (PD) modelling may clarify interindividual variability and support individualised dosing. Recent developments extend beyond PID, emphasising the importance of integrated PK-PD approaches to optimise IgG therapy. This review aimed to provide a comprehensive overview of popPK(-PD) models describing polyclonal IgG therapy, and to emphasise the added value of PK-PD in understanding drug behaviour. A systematic literature search was conducted in Embase, MEDLINE, and Web of Science from inception to August 2025. Studies describing popPK(-PD) models for exogenous polyclonal IVIg and/or SCIg administration in humans were included. In total, 14 studies were included. While most popPK models focus on PID (N&#x2009;=&#x2009;10), an increasing number address immune-mediated diseases. Immunoglobulin G pharmacokinetics are typically described using two-compartment models with first-order kinetics, using body weight (BW) as a common covariate for clearance and volume of distribution. Endogenous IgG is often incorporated as a fixed PK parameter; however, this may not adequately capture interindividual variability and potential effects of Ig treatment on IgG concentrations. Two popPK-PD models link IgG concentrations to clinical outcomes in immune-mediated diseases. In contrast, such models are currently lacking for PID. Simulations showed consistent predicted IgG concentrations following SCIg in PID, while IVIg models in PID showed more variability. PopPK models have advanced understanding of IgG PK and its variability between patients and treatment regimens. These models provide a powerful framework to support individualised dosing strategies, thereby potentially reducing reliance on empirical, trial-and-error dosing approaches. However, clear target concentrations are lacking and must be established for individual patients. Models may be further optimised by incorporating essential Neonatal Fc receptor (FcRn) mechanisms using physiology-based pharmacokinetic (PBPK) or semi-mechanistic models. In conclusion, current models are useful to predict IgG concentrations across diseases during Ig treatment; however, a clearer relationship with PD is required. Hence, these findings can guide clinical trial design for tailored dosing regimens.

Malaria is a significant public health issue in sub-Saharan Africa, especially in Apac District, Uganda, where it greatly affects children under five. Despite its high rates of morbidity and mortality, there is limited understanding of how communities manage malaria and seek treatment. This study aimed to identify the factors that influence treatment-seeking behaviour among caretakers of young children in Apac District. A cross-sectional analytical study was conducted using quantitative methods, with data collected from 240 households through simple random sampling. Caregivers completed structured questionnaires, and Cox proportional hazards regression analysis was performed in R to examine the socio-economic, demographic, and behavioural factors influencing the time taken by caretakers to seek malaria treatment for their children. All caregivers sought treatment for their children and out of the 240 caregivers, (70%) are female. The Cox proportional hazards model identified key factors affecting treatment-seeking time: secondary education significantly increased the likelihood of time for treatment seeking (HR&#x2009;=&#x2009;1.67, p&#x2009;=&#x2009;0.044). Significant delays were associated with no medicine at the hospital (HR&#x2009;=&#x2009;0.61, p&#x2009;=&#x2009;0.001) and financial constraints (HR&#x2009;=&#x2009;0.49, p&#x2009;<&#x2009;0.001). To ensure timely malaria treatment for young children, it is crucial to improve drug supply at hospitals and through Village Health Teams, and to educate caregivers on early treatment. Expanding education financing and promoting NGO involvement in caregiver education are essential. Efficient medicine distribution and caregiver education on prompt treatment are key to improving health outcomes for children under five.

Unmet social needs (including housing, transport and social inclusion) contribute substantially to health outcomes, especially for people with long-term health conditions such as multiple sclerosis (MS). Whether assessment of unmet social needs occurs in MS clinical care is unclear. This study aims to (1) understand current practices, (2) identify barriers and enablers to social needs assessments in MS care, and (3) explore the feasibility of social needs screening tools. This qualitative descriptive study comprised focus groups and interviews with clinicians, carers and people with MS in Australia. We inductively and deductively coded transcripts and used applied thematic analysis to identify themes, using COM-B (Capability, Opportunity, Motivation, Behaviour) and Feasibility frameworks. We collected data from 19 participants (11 clinicians and 8 lived-experience participants). Participants reported inconsistent and unstructured social needs assessment in MS care. Barriers aligned with capability (lack of referral pathway knowledge), opportunity (resources) and motivation (belief in abilities, evidence of value and scepticism). Enablers aligned with capability (clinician rapport and self-advocacy), opportunity (care coordination and self-paced assessment), and motivation (mutual desire for positive patient outcomes). A social needs screening tool was considered acceptable, conditional on adequate resourcing and/or design to ensure identified needs can be addressed. Findings from this qualitative descriptive study suggest that the current integration of social care in MS healthcare in Australia is inadequate. We identified opportunities to develop and test a screening tool and supporting referral resources to identify and address unmet social needs in MS patients. Better integrated social and healthcare represents a promising avenue for improving comprehensive MS management.

Neglected tropical diseases disproportionately affect underserved populations, with snakebite envenoming (SBE) remaining one of the most overlooked, despite its significant global burden. Digital health applications (DHAs) offer potential to improve prevention, care, and resource management, especially when integrated into digital health interventions. However, despite growing interest, evidence and structured evaluations are limited, making it difficult to assess their impact without a clear overview of existing tools. This scoping review aims to provide the first comprehensive mapping of DHAs for SBE, highlighting their potential to strengthen the World Health Organization (WHO) strategy while underscoring the urgent need for structured evaluation, improved quality, and strategic integration to enhance prevention, treatment, and coordination efforts. This review followed the Joanna Briggs Institute and PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines, with a protocol registered on the Open Science Framework. We searched the PubMed database, app stores, and Google for DHAs between September 24 and 26, 2024, addressing snakebite prevention or treatment. To be included, the DHA had to be accessible via the recorded link, contain a description with snakebite-related features (eg, identification, first aid, and treatment), and allow user interaction. Descriptions had to appear in abstracts, app store listings, or website text. Results were grouped by type (mobile- or web-based) and by WHO region. Furthermore, we examined the 2 most common features: first aid and snake identification. First aid content was benchmarked against global guidelines, while identification methods were categorized, and selected artificial intelligence (AI)-based identification apps were exploratively tested using images of medically significant snakes. A total of 52 eligible results were included, of which 94.2% (49/52) were mobile apps and 5.8% (3/52) were web-based. Regional focus varied, with most apps targeting South-East Asia (n=11, 21.2%), the Americas (n=9, 17.3%), and the Western Pacific (n=5, 9.6%). However, these numbers largely reflect concentration in just a few countries, namely India (n=10, 19.2%), the United States (n=5, 9.6%), and Australia (n=5, 9.6%). The most frequent feature was snake identification support, for example, through photo upload and algorithm-based recognition. However, AI-driven identification often lacked clarity and performed inconsistently in testing. First aid guidance was also common, but only a handful of apps offered comprehensive, evidence-based advice, while others omitted key steps or recommended unsafe practices. This review provides the first structured evaluation of DHAs for SBE and offers a reproducible framework for assessing digital solutions across neglected tropical diseases. By highlighting key gaps and proposing a foundation for integration into national strategies, it supports the development of equitable, evidence-based digital health innovation in underserved areas.

Tau protein abnormalities are more detrimental to neurocognitive function and behaviour than amyloid plaque formation in patients affected by Alzheimer's Disease (AD) - the most common cause of dementia worldwide. Pathologically, tau misfolding, neurofibrillary tangle formation, hyper phosphorylation, and dissociation from microtubules lead to synaptic dysfunction and neuron death. With this understanding, tau is now a major therapeutic target; there is a growing research effort to assess immunotherapy, kinase inhibitors, and tau aggregation inhibitors, and evidence suggests that combination therapies may have synergistic effects. Although there are many challenges remaining, including poor late-stage trial efficacy and limited therapeutic access through the blood-brain barrier, the preliminary results from early preclinical and clinical studies suggest that tau pathology can be reduced and neuronal function improved. Additionally, RNA interference, antisense oligonucleotides, and other gene-based therapies are under investigation. Overall, tau-directed treatments show promise for the treatment of AD, with particular optimism about improvements in delivery systems and combination therapies that will lead to substantial therapeutic benefits and improved quality of life for patients with AD.

Timely medical follow-up after a diagnosis of cognitive impairment, such as mild cognitive impairment (MCI) or dementia, is imperative for initiating appropriate medical treatment and accessing comprehensive care management and psychosocial support. However, many community-dwelling older adults who receive a positive case-finding result default on their medical follow-up appointments. This persistent challenge undermines early detection and active case-finding efforts and increases the risk of early institutionalization. Understanding the determinants is important for developing effective interventions in community-based case-finding. This qualitative study aimed to explore the barriers and facilitators influencing medical help-seeking behavior among community-dwelling individuals in Singapore diagnosed with MCI or dementia following a positive case-finding result. The COM-B (capability, opportunity, motivation-behavior) framework of the Behavior Change Wheel (BCW) was used to systematically identify these determinants. Using maximum variation sampling based on age, gender, ethnicity, living arrangement, relationship with caregiver, prior memory concerns, and whether participants had sought medical follow-up after their cognitive impairment diagnosis, we conducted 21 unique household semistructured interviews with 26 individuals (comprising 5 participant-caregiver dyads of MCI, 6 participants diagnosed with MCI, 1 caregiver of a participant with MCI, and 9 caregivers of participants diagnosed with dementia). These participants were a subset of individuals and caregivers recruited from a community-based study validating an artificial intelligence (AI)-based dementia case-finding tool. Interviews were audio-recorded, transcribed verbatim, and analyzed using the framework analysis method. Two authors (SRL and XX) performed inductive coding before mapping to COM-B, with subsequent discussion and review by the remaining authors. The COM-B components informed the selection of the relevant intervention functions from the BCW. Barriers to medical help-seeking behavior after cognitive impairment diagnosis included physical impairments, low health literacy to navigate the health care processes, inaccurate disease knowledge, complicated health care processes, inadequate physical infrastructure to navigate health care organizations, oversimplified cultural representation of dementia, perceived inaccuracy of the case-finding tool, and lay beliefs about seeking medical care when sick. Facilitators included adopting strategies to track medical appointments, a case-finding result letter as a cue for action, caregivers with profamily workplace policies, and valuing proactive medical disease management. Notably, social capital, (in)ability to recognize symptoms, and strong affective states triggered by the case-finding results were both barriers and enablers. These findings highlight a complex interplay of individual, social, and structural determinants influencing medical help-seeking behavior following a cognitive impairment diagnosis. Rather than a linear trajectory, medical help-seeking is shaped by a dynamic interplay across the COM-B domains. Drawing on these findings, we developed a set of comprehensive and actionable recommendations grounded in the BCW intervention functions to support timely medical follow-up after a cognitive impairment diagnosis. To maximize their impact, these recommendations should be collaboratively refined and evaluated with stakeholders using the acceptability, practicability, effectiveness, affordability, side effects, and equity (APEASE) criteria.

Telemedical interventions have been shown to reduce mortality and morbidity and improve the quality of life of chronic heart failure (CHF) patients. During the Covid-19 pandemic remote coaching gained further importance; however, it is not clear if Covid-19-specific telecoaching has a long-lasting impact on behaviour change. Patients were pre-existing participants in a combined tele-monitoring and telecoaching programme for CHF. A total of 419 patients were assessed with a standardised questionnaire immediately before and three weeks after a COVID-19-specific telecoaching in April 2020, as well as eight months later. The aim of the study was to observe changes in knowledge and behaviour regarding COVID-19 risk reduction measures, number of medical contacts and self-perceived health risk over time following the telecoaching module. After telecoaching, patients spontaneously recalled significantly more COVID-19-specific risk reduction measures rising from an average of 2.1 items prior to coaching to 2.5 at short- and long-term follow-up (p&#x2009;=&#x2009;0.0002). The number of self-reported medical contacts were significantly lower at short-term than at long-term follow-up (30% vs. 42%, p&#x2009;=&#x2009;0.0060 family doctor, 5% vs. 12%, p&#x2009;=&#x2009;0.0014 hospital). CHF patients perceived themselves as low risk for a severe COVID-19 infection, and this perception did not change after telecoaching. No difference in social isolation or concern over time were noted. Our longitudinal observational study suggests a possible effect of a single COVID-19-specific telecoaching module on knowledge about the disease and complying with risk reduction measures, which seems to persist over time. These results should be interpreted with caution in the context of increasing public awareness and public health campaigns.

Dopaminergic medication used in disorders like Parkinson's disease (PD) and restless legs syndrome can cause impulsive-compulsive behaviour (ICB), often with strong negative effects on patients' quality of life. This narrative review presents translational evidence on iatrogenic ICB, taking findings from epidemiological, clinical, neuroimaging and preclinical studies into consideration. Epidemiological and clinical studies find dopamine agonists with high D2/3-selectivity to be most strongly linked to ICB. Their effect on ICB has often been shown to be dose-dependent, but the impact of combining different dopaminergic drugs or applying extended-release formulations is less clear. Intervention studies support tapering or replacing dopamine agonists for ICB reduction, whereas no efficacious pharmacotherapy has been identified for ICB treatment specifically. Adequate animal models for mimicking different types of ICB are available, and point, in line with human neuroimaging studies, towards an involvement of striatum and prefrontal cortex in iatrogenic ICB. Overall, complementary research designs have led to profound evidence regarding the occurrence of ICB in PD and establishing methods transferable to other, less-studied patient populations. A combined approach integrating insights from human studies and animal models could contribute to developing dopaminergic drugs with lower ICB risk but also specific pharmacotherapies for impulsivity or compulsivity in the future. Diseases like Parkinson's disease and restless legs syndrome are treated with drugs that affect dopamine activity in the brain. As a side effect, these drugs can lead to a lower impulse control, manifested, for example, as gambling disorder or hypersexuality. This article summarises research on these side effects, collected through a variety of scientific methods. The drug type with the highest risk for behavioural side effects has been identified, but many details remain unclear, especially in patients with other disorders than Parkinson's disease. Results from both human brain imaging and animal models start to reveal brain pathways involved.

Evidence for the role of health behaviour and lifestyle treatment (HBLT) on the effectiveness of glucagon-like peptide-1 receptor agonists (GLP-1RAs) in paediatric obesity is limited. To assess the role of HBLT on the effectiveness of GLP-1RAs in youth with obesity. Patients aged 8-18&#x2009;years with obesity (n&#x2009;=&#x2009;51) receiving liraglutide were retrospectively divided into continuers (ongoing liraglutide treatment), discontinuers, or switches to semaglutide or metabolic-bariatric surgery. All were offered multidisciplinary HBLT and consecutively allocated to either high-frequency (HF) HBLT (&#x2265;&#x2009;26 contact hours/year) or low-frequency obesity medication (OM)-specific HBLT (9 contacts of 0.5&#x2009;h/year). After 9.7&#x2009;&#xb1;&#x2009;6.6&#x2009;months, a BMI reduction of &#x2265;&#x2009;5% and &#x2265;&#x2009;10% was observed in 37.3% and 13.7%, respectively. Relative change in BMI was higher in continuers compared to discontinuers (-6.7%&#x2009;&#xb1;&#x2009;7.5% vs. -0.7%&#x2009;&#xb1;&#x2009;5.1%, p&#x2009;=&#x2009;0.03). Whereas 39.2% of patients continued liraglutide, 33.3% discontinued, mainly due to gastrointestinal symptoms. 27.4% of patients switched treatment to semaglutide or underwent surgery. Patients with combined HBLT and liraglutide had markedly higher odds of continuation (OR 18.5, 95% CI 2.0-929.8, p&#x2009;<&#x2009;0.01) and greater reductions in BMI, which was by trend higher with OM-HBLT compared to HF-HBLT (BMI change -6.9%&#x2009;&#xb1;&#x2009;7.2% vs. -4.0%&#x2009;&#xb1;&#x2009;6.6%). GLP-1RAs were effective in the real-world treatment of paediatric obesity. HBLT appears to be essential to increase persistence and efficacy of GLP-1RAs.

Although cognitive-behavioural therapy (CBT) with exposure is the first-line treatment for Social Anxiety Disorder (SAD), its efficacy is lower for SAD than for other anxiety disorders. One possible reason is that CBT may not effectively target the key maintaining features of SAD: persistent avoidance and heightened threat expectancy. Experimental research shows that individuals with elevated social anxiety exhibit generalised avoidance and persistent threat beliefs in conditioning paradigms, yet it remains unclear whether brief cognitive-behavioural (CB) strategies can modify these fear responses. Clarifying which components of fear responding, behavioural, cognitive, and physiological, are amenable to brief CB-based instruction is critical for identifying the mechanisms through which CBT with exposure facilitates change and for improving the precision of treatment. This study examined the effect of a brief CB instruction on behavioural avoidance, threat expectancy, and autonomic arousal in individuals with elevated social anxiety. Eighty-eight adults were assigned to a CB-informed instruction (n&#xa0;=&#xa0;44) or control instruction (n&#xa0;=&#xa0;44) condition while completing a four-phase Pavlovian Conditioning paradigm: threat acquisition, US-avoidance acquisition, US-avoidance extinction, and extinction test. Social anxiety was modelled dimensionally using SPIN scores. Behavioural avoidance, skin conductance response (SCR; autonomic arousal), and US-expectancy ratings (cognitive threat prediction) were assessed throughout. Results showed that, higher social anxiety was associated with greater avoidance and persistent threat responding. Further, among individuals with elevated social anxiety, the CB instruction was associated with reduced avoidance behaviours during US-avoidance extinction but did not alter SCRs or threat expectancy during extinction testing. These findings suggest that a brief CB instruction can attenuate maladaptive avoidance without corresponding changes in autonomic or cognitive threat responses for individuals with higher social anxiety. This dissociation provides a novel, mechanistic account of how brief cognitive-behavioural strategies selectively modify components of fear responding, offering valuable insights for the development of more targeted and effective exposure-based interventions for SAD.

Depression following spinal cord injury (D-SCI) refers to a depressive state that occurs in an individual after a major spinal cord injury (SCI), characterized mainly by low mood and reduced interest. This study aims to investigate the regulatory role of anti-HMGB1 antibody in the depressive-like behaviour of D-SCI rats and to explore its underlying mechanisms. A depression model was established in rats 5&#x2009;weeks after SCI. The expression of HMGB1 and ferroptosis markers (MDA, GSH and iron ion deposition) in the hippocampus were examined in both the sham group and the D-SCI group. Subsequently, D-SCI rats were treated with an anti-HMGB1 antibody, and the depression-like behaviours of each group were assessed using open field and sucrose preference tests. Ferroptosis levels in the hippocampus, as well as the expression of ferroptosis-related proteins (ACSL4, SLC7A11 and GPX4), were also investigated. The co-localization of HMGB1 and NeuN in the rat hippocampus was detected by immunofluorescence double staining. Furthermore, at the cellular level, the effect of the anti-HMGB1 antibody on Erastin-induced ferroptosis in rat hippocampal neurons was analysed. The results indicated that compared to the sham group, the levels of HMGB1 and ferroptosis in the hippocampus of rats in the D-SCI group were significantly elevated. Administering anti-HMGB1 antibody to D-SCI rats could significantly augment their activity distance, movement speed and sucrose preference rate, while also suppressing the ferroptosis level and the expression of ferroptosis-related proteins in the hippocampus. Moreover, HMGB1 and NeuN were co-expressed in the rat hippocampus. The results from primary rat hippocampal neurons indicated that anti-HMGB1 antibody could inhibit erastin-induced ferroptosis in rat hippocampal neurons. Taken together, anti-HMGB1 antibody therapy can ameliorate depressive behaviour in D-SCI rats; the possible mechanism may involve the inhibition of ferroptosis in hippocampal neurons.