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Behavioral treatments are recognized as evidence-based approaches for treatment of urinary incontinence (UI) in women. However, many women do not have in-person access to qualified providers, which has led to the emergence of remote methods of delivery for behavioral treatment. The purpose of this study was to identify salient features of participants' experiences with two modalities for remote delivery of behavioral treatment for UI within a pragmatic randomized trial. Individual qualitative interviews were conducted to explore the views and experiences of women Veterans who completed behavioral treatment delivered by a mobile health application (MyHealtheBladder, MHB) or video visit via VA Video Connect (VVC). The study was conducted at 3 Southeast VA healthcare systems (April 2020 - September 2023). MHB consisted of 56 self-administered daily sessions delivered remotely over 8 weeks. VVC consisted of a single session with a specialized UI provider. After the first 8 weeks, women identified as non-responders (based on self-reported symptom improvement) were randomized to an additional VVC session or no session. A hybrid qualitative content analysis integrating deductive and inductive methods was conducted to identify the most frequently occurring and highly emphasized topics. Of the 188 women Veterans who completed the first 8-week treatment, 41 completed the interview. Participants focused on three topics: (1) encountering technical and logistical issues in access and use; (2) interacting with the program content; and (3) finding motivation, encouragement, and inspiration. Participants in both arms of the study spoke of the importance of the structure and process of content presentation, emphasizing mechanisms for reminders, review and feedback. They also valued the woman Veterans' UI stories and provider verbal and nonverbal expressions of care and support as sources of motivation and encouragement. MHB participants reported far fewer challenges with accessing information compared to their VVC counterparts. Future mobile health programs should incorporate mechanisms for smooth navigation of MHB and timely provider feedback, as well as strategies to ensure patients can access VVC and are prepared for participation in ways that optimize their engagement with the behavioral treatment program.

Based on findings from human atherosclerotic arteries and mouse arterial injury models, where ZHX2 expression is significantly downregulated, this study identifies ZHX2 as a critical inhibitor of pathological vascular remodeling. Functionally, local adenoviral overexpression of ZHX2 in vivo attenuates neointima formation in a mouse carotid artery ligation model, while in vitro experiments demonstrate that ZHX2 impedes the proliferation and migration of primary Vascular Smooth Muscle Cells (VSMCs). Mechanistically, integrated RNA-seq and ChIP-seq analyses reveal that ZHX2 transcriptionally regulates GADD45G, directly binding to its promoter and activating its transcription. The essential role of this pathway is confirmed by the finding that knockdown of GADD45G counteracts the inhibitory effects of ZHX2 overexpression on VSMC proliferation, migration, and neointima formation. Consequently, the ZHX2/GADD45G signaling axis is highlighted as a potential regulatory pathway in injury-associated neointimal remodeling.

Brucellosis is a zoonotic disease, which can cause systemic infections involving multiple organs. In musculoskeletal diseases, spondylitis is the most common complication of brucellosis, mainly affecting the lumbar and thoracic vertebrae, and rarely involving the cervical vertebrae. Brucellosis-induced cervical spondyloarthritis represents a severe and rare clinical manifestation of brucellosis, potentially leading to permanent damage and neurological dysfunction. This case report involves a 66-years-old male with a rare case of cervical spondylitis caused by Brucella. The diagnosis was based on the patient's epidemiological history, laboratory tests, and imaging examinations. After triple therapy with doxycycline, rifampicin, and ceftriaxone for the treatment of brucellosis, the patient's symptoms improved. Early diagnosis and treatment of spondylitis caused by Brucella are very important for the prognosis of patients.

In Taiwan, as a super-aging society, older women face unique challenges that affect their health and quality of life (QoL). The present 1-year longitudinal study was conducted to examine changes in physical and psychosocial health and the relationship between these factors and QoL from March 2023 to June 2024. Women (N = 114) aged over 60 years completed baseline assessments, which included demographic information and evaluations using standardized scales, and 48 completed the follow-ups conducted 1 year later. Findings showed a significant decline in QoL, particularly among those aged 75+ years (effect size = 0.630). Self-directed ageism, frailty, physical resilience, and depression were identified as critical associated factors affecting QoL. These results highlight the importance of developing tailored strategies for young-older (60-74 years) and old-older individuals (75+ years), focusing on preserving physical abilities, managing chronic illnesses, and enhancing psychosocial health, particularly for older women to improve their overall well-being and reduce societal caregiving costs. Ageism, Frailty, Physical Resilience, and Depression: The Associated Factors of Active Aging Among Older WomenA study was conducted to address the challenges faced by older women in Taiwan, particularly regarding healthy and active aging amid rising caregiving costs linked to chronic diseases and declining physical abilities. Older women aged over 60 years old were recruited for a longitudinal study, assessing their physical and psychosocial health at baseline and again after 1 year using standardized questionnaires. The study examined the factors associated with quality of life (QoL) among 48 older women over a 1-year period. The findings showed a significant decline in QoL, especially among those aged 76 to 90 years, with self-directed ageism, frailty, physical resilience, and depression identified as key factors contributing to lower QoL. The findings emphasize the necessity of tailored strategies for different age groups to formulate targeted interventions aimed at enhancing and sustaining health. For the young-older adults (aged below 75 years), the focus should be on preserving physical abilities through interventions that promote active aging and resilience, thereby supporting physical fitness and preventing frailty. In contrast, for old-older adults (aged 75 years or older), comprehensive health support is essential, including accessible services for managing chronic illnesses and addressing frailty issues. In addition, it is important to offer specialized resources to enhance psychosocial health and cognitive function, along with resilience training programs to equip older adults with effective coping mechanisms for stress.

Sepsis-associated acute kidney injury (SA-AKI) raises mortality risk, while the independent links of pre-existing diabetes mellitus (DM) and in-hospital glycemic status to SA-AKI remain unclear. This study explored their correlations with early SA-AKI among sepsis patients. This multicenter retrospective cohort enrolled 6,974 pathogen-positive adult sepsis patients admitted to ICUs from 2023 to 2026. We used pre-existing DM as the primary exposure and time-weighted average glucose as the secondary marker. Multiple adjustment methods including propensity score matching (PSM) and inverse probability weighting (IPW) were adopted to reduce confounding bias. After enrolling 6,947 septic ICU patients, multivariate logistic regression identified pre-existing DM as an independent risk factor for early SA-AKI (adjusted OR&#x202f;=&#x202f;2.54, 95% CI 2.25-2.86, p <&#x202f;0.001). The protective glycemic range was 6-11&#x202f;mmol/L for diabetic patients (adjusted OR&#x202f;=&#x202f;0.88, 95% CI 0.78-0.98, p =&#x202f;0.025) and 8-13&#x202f;mmol/L for non-diabetic patients (adjusted OR&#x202f;=&#x202f;0.55, 95% CI 0.48-0.62, p <&#x202f;0.001). PSM, IPW and doubly robust estimation all validated these consistent associations. Abnormal glucose showed weak predictive power for SA-AKI (AUC 0.60-0.61). Higher time-weighted glucose correlated with advanced AKI stages and increased in-hospital mortality in mild-to-moderate SA-AKI patients. Diabetic SA-AKI patients had higher proportions of stage 1 and stage 3 AKI without significant difference in overall in-hospital mortality compared with non-diabetic counterparts. Matched SA-AKI patients suffered longer ICU/hospital stays, more organ support use and higher hospital mortality. Common pathogenic organisms had higher detection rates in SA-AKI cases. Pre-existing DM was positively correlated with early SA-AKI. Targeted in-hospital glycemic intervals were linked to lower SA-AKI risk, which supports individualized glucose monitoring for sepsis patients.

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Protocol standardisation is widely used to improve the quality and consistency of acute stroke reperfusion, but evidence from routine public hospital practice remains limited, particularly on whether gains are sustained during later periods of service stress. We evaluated changes in access to and timeliness of intravenous thrombolysis after cluster-wide protocol standardisation in a Hong Kong public hospital cluster and examined whether these performance domains changed during a later Omicron-related service shock. In this interrupted time-series study, we analysed acute ischaemic stroke care in the Kowloon West Cluster, Hong Kong, from 1 January 2017 to 31 December 2024. Prespecified breakpoints were implementation of a unified reperfusion protocol in July 2019 and the Omicron-related service shock in February 2022. Primary monthly outcomes were intravenous thrombolysis rate, median door-to-needle time, and the proportion treated within 60&#x2009;minutes. Secondary process outcomes were door-to-computed tomography time and imaging-to-needle interval. Secondary quarterly patient-centred outcomes were early neurological improvement at 24&#x2009;hours and 3-month functional outcome measured using the modified Rankin Scale. Protocol implementation was associated with an immediate increase in intravenous thrombolysis access. Median door-to-needle time showed a more complex pattern, with an immediate worsening after protocol implementation followed by a favourable post-implementation trend. The proportion treated within 60&#x2009;minutes improved after protocol implementation. During the Omicron period, thrombolysis access remained stable, but treatment timeliness deteriorated progressively. Decomposition of the reperfusion pathway suggested that this later erosion was driven mainly by prolongation of the downstream imaging-to-needle interval rather than by deterioration in initial imaging access. Early neurological improvement showed post-protocol improvement but attenuated during sustained service stress. Favourable 3-month functional outcome remained broadly stable, with sensitivity analyses yielding similar estimates despite declining follow-up completeness in the post-shock period. Cluster-wide protocol standardisation was associated with improved access to intravenous thrombolysis and a mixed pattern in treatment timeliness. Implementation effects on timeliness were not linear and included early disruption, subsequent improvement, and later deterioration during prolonged service stress. Preserved treatment access should not be assumed to indicate preserved treatment speed. Quality evaluation of acute stroke services should distinguish access from timeliness and use pathway-level measurement to identify workflow segments most vulnerable to disruption.

Everyday discrimination is a pervasive social stressor that has been linked to adverse health outcomes and contributes to persistent health inequities in the United States. Understanding contemporary patterns of discrimination across racial and ethnic groups remains an important public health priority. Our study examined racial and ethnic differences in multiple forms of everyday discrimination among U.S. adults. Data were drawn from the 2023 National Health Interview Survey, a national U.S. sample of non-institutionalized adults aged&#x2009;&#x2265;&#x2009;18 years. The analytic sample included 28,797 adults who identified as White, Black, Hispanic, or Asian. Everyday discrimination was measured using the Everyday Discrimination Scale. Separate multiple logistic regression models were estimated to assess associations between race and ethnicity and five discrimination measures, adjusted for covariates. Both Black and Asian adults had higher odds of reporting multiple forms of everyday discrimination compared to White adults. Black adults exhibited elevated odds across all five measures, particularly being perceived as threatening (OR&#x2009;=&#x2009;2.25, 95% CI: 2.02-2.51). Similarly, Asian adults had higher odds of reporting discrimination, particularly poorer service (OR&#x2009;=&#x2009;1.83, 95% CI: 1.60-2.10). In contrast, Hispanic adults demonstrated a mixed pattern, including lower odds of reporting disrespect (OR&#x2009;=&#x2009;0.88, 95% CI: 0.81-0.96), but higher odds of reporting poorer service (OR&#x2009;=&#x2009;1.24, 95% CI: 1.13-1.36). Racial and ethnic differences in everyday discrimination varied across measures, with consistently higher odds among Black and Asian adults and more variable patterns among Hispanic adults, highlighting the importance of addressing discrimination across social contexts.

Primary aldosteronism (PA) frequently coexists with obstructive sleep apnea (OSA), and this comorbidity is associated with increased cardiometabolic risk. Although both PA and OSA have been individually linked to gut microbiome alterations, it remains unclear which layer of gut microbiome-associated variation best reflects clinical heterogeneity in PA with coexisting OSA. In this prospective observational study, we performed shotgun metagenomic sequencing and untargeted fecal metabolomic profiling in 29 adults with clinically confirmed PA, who were stratified according to OSA severity (G1-G4) based on overnight polysomnography. Microbial gene richness, taxonomic composition, functional potential based on KEGG annotation, and antibiotic resistance gene profiles were analyzed using standardized bioinformatic workflows. Metabolomic variation was assessed using multivariate analysis, pathway enrichment, and additional exploratory analyses incorporating apnea-hypopnea index (AHI) as a continuous variable. Multiple-testing correction was applied to metabolite-level comparisons. Global gut microbial gene richness, alpha diversity, beta diversity, and broad functional profiles did not show strong group-level separation across OSA severity strata. Additional analyses using AHI as a continuous variable similarly showed no significant association between AHI and overall gene richness or alpha diversity indices. Nevertheless, selective genera showed exploratory associations with AHI, suggesting that localized taxonomic signals may occur despite relative stability of global community structure. Antibiotic resistance gene profiles showed marked inter-individual variability without clear group-level separation, although ARO richness showed an exploratory inverse association with AHI. In contrast, fecal metabolomic profiling revealed nominal phenotype-associated differences, including trehalose-related metabolites and FAHFA species that showed inverse exploratory associations with AHI. However, no individual metabolite remained significant after global Benjamini-Hochberg false discovery rate correction. In PA with coexisting OSA, gut microbiome-associated heterogeneity appears to be more readily reflected by selected taxonomic and metabolic signals than by global microbial diversity or broad functional potential. However, given the small sample size, limited control of clinical and lifestyle confounders, and lack of metabolite-level significance after global FDR correction, these findings should be interpreted as exploratory and hypothesis-generating. Larger controlled cohorts incorporating PA subtype, medication exposure, dietary assessment, and longitudinal validation are needed.

The COVID-19 pandemic disrupted primary care delivery and may have exacerbated disparities in chronic disease management, particularly for diabetes mellitus. This study sought to investigate how living in areas with low access to primary care providers (PCP) affected the delivery of diabetes care during the pandemic. This is a retrospective longitudinal study using the Panel 24 of the Medical Expenditure Panel Survey data merged with the 2019 County Health Rankings data to classify areas by PCP availability (low vs. high). Dependent variables included measures of care processes (e.g., number of HbA1c tests), quality (e.g., diet modification) and outcomes (e.g., eye complications). Multivariable models were adjusted for demographics, insurance status and COVID-19 diagnosis. HbA1c testing, foot examinations and retinal examinations decreased during the pandemic for both groups, with much more pronounced declines in low PCP density areas. The largest change occurred in the frequency of attending group classes, dropping nearly 80% in low PCP areas. Individuals in low PCP areas were more likely to initiate oral diabetes medications (as opposed to insulin) compared with those in high PCP areas (0.84% vs. 0.28%, p&#x2009;=&#x2009;0.015). Older age was associated with new diabetes (HR&#x2009;=&#x2009;1.05) and new kidney disease (HR&#x2009;=&#x2009;1.04), but less likely to start diet modification (HR&#x2009;=&#x2009;0.99). Being female (HR&#x2009;=&#x2009;0.69) and non-Hispanic whites (HR&#x2009;=&#x2009;0.60) were associated with a lower likelihood of diabetes incidents. These findings highlight the importance of preparing public health responses for future events that limit access to routine care, particularly for individuals with or at risk of diabetes. Strengthening both in-person and virtual primary care services is critical to reducing gaps in chronic disease management and to supporting ongoing PCP follow-up.

Cardiorespiratory fitness (CRF) is a powerful predictor of current and future health across all age groups. Recognising CRF's ability to screen health-related outcomes is essential for supporting its use in clinical practice. The aim was to evaluate the health-related diagnostic and prognostic accuracy of CRF using an overview of systematic reviews. Five bibliographic databases (MEDLINE, Embase, Scopus, CINAHL and SPORTDiscus) were searched from January 2002 to April 2025 to identify systematic reviews with meta-analyses that reported on the health-related diagnostic and prognostic accuracy of CRF. The results were presented using forest plots, with the certainty of evidence assessed by a modified Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. Of the 10,796 papers identified, six systematic reviews with meta-analyses (n&#x2009;=&#x2009;31,171 observations) were included. Of these, five examined cardiovascular disease, events, or risk, and one examined mitochondrial disorders. CRF was measured objectively or estimated by exercise as maximum or peak oxygen consumption, ventilatory efficiency or fluctuation, or exercise performance or tolerance. All included reviews were graded as having low to critically low quality. CRF demonstrated high prognostic accuracy for predicting severe cardiovascular events in adults with heart failure, with moderate certainty (diagnostic odds ratio [dOR] 4.1-8.1; area under the curve of a summary receiver operating characteristic curve [SROC AUC] 0.73-0.77), and moderate-to-high diagnostic accuracy for detecting coronary artery disease in adults with type 2 diabetes or with suspected coronary artery disease with very low certainty (dOR 2.3-7.6; SROC AUC 0.66-0.79), mitochondrial disorders among adults with high certainty (dOR 18.1-26.6; SROC AUC 0.70-0.83), and cardiovascular disease risk among apparently healthy children and adolescents with low certainty (dOR 3.6-5.7; SROC AUC 0.64-0.71). CRF detects cardiovascular disease and mitochondrial disorders and predicts cardiovascular events among adults with chronic conditions and detects cardiovascular risk among apparently healthy children; however, the certainty of evidence ranged from very low to high certainty due to methodological limitations. Further research is needed to generate high-quality diagnostic evidence for CRF across diverse health outcomes and age groups in the general population. PROSPERO CRD42022370149.

Emergency physicians frequently care for patients with serious or terminal illnesses, yet they often lack formal palliative care training. Our primary objective was to develop a structured, multimodal palliative care curriculum for emergency medicine (EM) residents and evaluate whether this curriculum improved residents' knowledge, comfort level, and perceived application of skills to care for patients with chronic or terminal illness in the emergency department (ED). Our secondary objective was to determine whether EM residents found palliative care education important and to identify which educational modalities are most effective for acquiring palliative care knowledge and skills. We implemented an eight-hour multimodal curriculum for EM residents at a single, large Level I trauma center (four hours of didactics, a three-hour simulated patient communication skills lab, and one hour of high-fidelity simulation). Our primary outcome was pre- and post-intervention surveys (12 questions) that assessed perceived knowledge, comfort, and skill application on five-point Likert scales. We analyzed paired responses using the Wilcoxon signed-rank test, with a P value of < .05 considered statistically significant. Effect size was calculated using Cohen d. Our secondary outcome measure was a post-intervention survey (six questions) that assessed participants' opinions on the effectiveness of the different educational methods. There was a 100% response rate among 41 residents from all postgraduate years 1-3. Significant improvements (P < .001) were observed in residents' self-reported abilities across all domains with large effect sizes. Median scores and interquartile ranges increased for conducting goals-of-care discussions (4 [3-4] vs 4 [4-5]), interpreting advance directives (3 [2-4] vs 4 [4-4]), managing end-of-life symptoms (3 [2-3] vs 4 [3-4]), communicating bad news (3 [2-4] vs 4 [4-4]), and coordinating with palliative or hospice teams (2 [2-3] v. 4 [4-4]). All educational modalities were rated effective, with simulation and small-group sessions preferred over lectures. A structured, multimodal palliative care curriculum significantly enhanced EM residents' perceived preparedness to manage patients with palliative care needs. Embedding didactic and simulation-based palliative training in EM residencies is both feasible and impactful, addressing critical gaps in palliative competencies and aligning with national best-practice guidelines.

Frequently visited community pharmacies can serve as sites for additional healthcare, including screenings for unknown conditions. Our implementation-oriented pilot study sought to evaluate the proportions of older adults that followed-up with their primary healthcare provider about a positive cardiac arrhythmia, weakness, or cognitive impairment screening performed in a community pharmacy. A cross-sectional design was used and screenings occurred at a well-visited community pharmacy inside a clinic. Possible cardiac arrhythmias were identified with a mobile electrocardiogram. Weakness status was examined with a hydraulic handgrip dynamometer. A paper-and-pencil based cognitive assessment determined cognitive impairment status. Participants screening positive were advised to visit their healthcare provider, and follow-up for determining if such visits occurred was performed approximately 3-months later. Of the 106 participants, 51 were referred to their healthcare provider for any positive screening. At follow-up, 12 (23.5%) participants reported visiting their primary healthcare provider about the positive screening performed at the community pharmacy. Our implementation-oriented pilot study showed promise for kindling healthcare provider follow-up regarding positive screenings performed at a community pharmacy. Conducting such screenings may reengage patients with their primary healthcare providers when appropriate, and support the identification of unknown conditions.

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To explore and map the literature on referral pathway gaps and improvement strategies in primary healthcare (PHC) to secondary healthcare (SHC) referrals, and to categorise both gaps and improvements using the Quintuple Aim framework for healthcare improvement-a model encompassing patient experience, population health, costs, provider well-being and health equity. Scoping review guided by Arksey and O'Malley's framework, refined by the Joanna Briggs Institute and reported following the Preferred Reporting Items for Systematic Review and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) guidelines. PubMed, CINAHL and Scopus were searched for publications from January 2013 to May 2024. Peer-reviewed, English-language studies reporting on improvements to PHC-to-SHC referral processes. Studies were eligible if they examined referrals initiated by primary care physicians (population) addressed interventions or improvements targeting referral gaps (concept) in PHC settings (context). Studies focused exclusively on secondary care perspectives, non-English publications and those outside the 2013-2024&#x2009;date range were excluded. Data were charted using a standardised form based on a Population-Concept-Context framework. Data extraction was partially supported by the artificial intelligence-based platform Elicit, with systematic verification against source articles. Referral gaps and improvements were mapped to the five Quintuple Aim domains using structured analytical columns applied to each included study, then synthesised narratively. 85 studies were included. Analysis revealed recurring referral pathway gaps across five stages (patient assessment, information transfer, coordination, specialty access and feedback), negatively impacting all five Quintuple Aim domains. Eight categories of improvements were identified (eg, educational initiatives, electronic referral systems, structured templates, decision support tools). These improvements frequently enhanced referral efficiency; however, evidence of impact on provider well-being and health equity was limited. Referral improvements can enhance efficiency, but evidence of impact on provider well-being and health equity remains sparse. Future research should prioritise equity-focused designs and address administrative burden and resource constraints to achieve full Quintuple Aim alignment. Open Science Framework (https://osf.io/87htv/).

Microglia, the resident immune cells of the central nervous system (CNS), maintain brain homeostasis and respond to pathological insults. Microglial dysfunction has been implicated in the pathogenesis of several neurodegenerative diseases, including Alzheimer's disease, Parkinson's disease, and multiple sclerosis. Impaired lysosomal function, particularly defective lysosomal acidification, leads to the accumulation of undegraded material, thereby promoting neuroinflammation and neuronal damage. This review examines the mechanisms governing lysosomal acidification in microglia and evaluates its potential as both a therapeutic target and a prognostic biomarker in neurodegenerative diseases. The literature on microglial lysosomal acidification, lysosomal pH regulation, autophagy, and neurodegeneration was searched in PubMed, Scopus, and Web of Science. Relevant mechanistic, preclinical, and translational studies were critically appraised and synthesized. Lysosomal acidification is increasingly recognized as a key regulator of microglial function and homeostasis. Defective acidification, driven by dysregulation of the vacuolar H+-ATPase (V-ATPase) proton pump, TFEB/TFE3 signaling pathways, and lysosomal ion channels such as TRPML1 and TMEM175, impairs autophagic flux and substrate degradation, facilitating the accumulation of neurotoxic aggregates including amyloid-&#x3b2; and &#x3b1;-synuclein. Emerging evidence suggests that the degree of microglial lysosomal acidification may serve as a prognostic biomarker for disease progression and therapeutic response. Restoration or enhancement of lysosomal acidification through pharmacological modulation of lysosomal pH, activation of autophagy, or targeting of key regulatory pathways has been shown to re-establish microglial homeostasis, attenuate neuroinflammation, and confer neuroprotection in preclinical models. Restoration of microglial lysosomal acidification represents a promising therapeutic strategy for neurodegenerative diseases. A deeper understanding of the molecular mechanisms regulating lysosomal acidification in microglia may facilitate the identification of novel biomarkers and therapeutic targets, ultimately contributing to the development of innovative interventions for neurodegenerative disorders.

Few studies have investigated the association between cardiovascular health (CVH) and thyroid dysfunction, and the modifying role of depression or anxiety remains unclear. This longitudinal study included 360,332 UK Biobank participants without thyroid disease at baseline and with complete CVH scores. We examined the associations between CVH and the risks of hyperthyroidism and hypothyroidism using Cox proportional hazards regression models, quantified the relative contributions of CVH components using weighted quantile sum regression, and evaluated the mediating role of inflammatory markers. Furthermore, we investigated the modifying effects of depression and anxiety on these associations. A multi-state model was used to explore disease trajectories. During a median follow-up of 12.53 years, 1,533 and 7,542 participants developed hyperthyroidism and hypothyroidism, respectively. After multivariable adjustment, each 5-point increase in CVH score was associated with a 7% (95% confidence interval [CI], 4% to 9%) lower risk of hyperthyroidism and an 8% (95% CI, 7% to 9%) lower risk of hypothyroidism. A high CVH score was associated with a 50% (95% CI, 37% to 60%) lower risk of hyperthyroidism and a 45% (95% CI, 38% to 50%) lower risk of hypothyroidism. Among the CVH components, obesity and tobacco exposure contributed most to disease risk. Inflammatory markers partially mediated these associations. Depression and anxiety modified the association between CVH and hypothyroidism, and CVH showed a protective effect across the disease trajectories. Maintaining favorable CVH was associated with a lower risk of thyroid dysfunction, particularly among individuals with good mental health.

To explore the implications of transitioning from traditional memory clinics to Brain Health Services (BHS) for older adults, and to advocate for a geriatric-informed, equitable, and function-oriented approach to brain health care. This perspective article draws on discussions within the EuGMS Brain Health and Dementia Specialist Interest Group and relevant literature to examine the implications of emerging Brain Health Services for older adults. The emergence of Brain Health Services represents a significant shift in cognitive healthcare, moving beyond traditional memory clinic models focussed primarily on dementia diagnosis and management towards prevention, risk reduction, and maintenance of cognitive function. Potential benefits include earlier engagement with cognitive care, multidomain lifestyle interventions, reduction of stigma surrounding dementia, and facilitation of access to emerging disease-modifying therapies. However, substantial challenges remain. Biomarker-driven approaches may overemphasise Alzheimer's disease-centric frameworks despite the high prevalence of mixed pathologies and complex comorbidity in older adults. Ethical concerns surrounding risk disclosure, inequitable access, and resource allocation are also considerable, particularly if services disproportionately benefit younger, healthier, or socioeconomically advantaged populations. Brain Health Services should be reframed through a gerontologically informed lens that prioritises function, independence, quality of life, and equitable access alongside prevention. Integration with comprehensive geriatric assessment and existing older persons' care pathways is essential. Future research should focus on pragmatic real-world evaluation, inclusive outcome measures, and personalised approaches that account for heterogeneity in ageing. Ultimately, the success of BHS will depend on their ability to support healthy ageing while remaining responsive to the lived realities and priorities of older adults.

To explore the relationship between physical function and depressive and anxiety symptoms among older adults, and to determine whether poorer physical function is associated with higher levels of depressive symptoms. This retrospective analysis included data from the comprehensive geriatric assessments of 491 patients aged &#x2265;65 years who visited the Geriatric Outpatient Clinic or were hospitalized at the Geriatric Department of Beijing Tongren Hospital between November 2021 and December 2023. After excluding cases with incomplete data, 443 participants were included in the final analysis. Physical function was assessed using grip strength, the Timed Up and Go Test (TUGT), 4-meter walk speed, the five-time sit-to-stand test, the three-posture test, and the Short Physical Performance Battery (SPPB). Depressive and anxiety symptoms were evaluated using the Self-Rating Depression Scale (SDS) and the Self-Rating Anxiety Scale (SAS). Correlations between physical function and depressive and anxiety symptoms were analyzed, and factors associated with depressive symptoms were examined. The prevalence of depressive and anxiety states was 15.6% and 12.0%, respectively. Participants with depressive symptoms had significantly lower SPPB scores compared with those without (5.83 &#xb1; 2.70 vs 8.68 &#xb1; 2.14, P < 0.05). SPPB scores were moderately negatively correlated with depressive symptoms (r = -0.404, P < 0.05). Logistic regression showed that higher SPPB scores were associated with lower odds of depressive symptoms (OR = 0.557, 95% CI: 0.411-0.754), whereas longer TUGT time (OR = 1.123, 95% CI: 1.018-1.238) and higher anxiety scores (OR = 1.273, 95% CI: 1.185-1.368) were associated with higher odds. ROC analysis showed that SPPB score was associated with depressive symptoms (AUC = 0.859), with sensitivity of 0.86 and specificity of 0.67 at the optimal cutoff of 8.5. TUGT and anxiety scores also showed associations with depressive symptoms (AUC = 0.844 and 0.891, respectively; both P < 0.05). Declining physical function was associated with depressive symptoms among older adults. Within comprehensive geriatric assessments (CGA), routine SPPB evaluation alongside depressive symptom monitoring may help identify vulnerable older individuals and maintain intrinsic capacity.