Despite rapid advances in neuroscience, Black scientists remain persistently underrepresented across training and career stages, reflecting structural inequities in mentorship, funding, and access to professional networks. These disparities limit not only individual career trajectories but also the formation of a strong scientific identity, thereby constraining the field's capacity for innovation and global impact. In this perspective, we examine equitable mentorship as a critical tool for improving representation, retention, and scientific productivity in neuroscience. We define equitable mentorship as intentional, culturally responsive, and structurally supported guidance that extends beyond technical training to include career navigation, identity-affirming support, and access to networks. Drawing on evidence from the literature and personal experiences with mentorship models such as the Black in Neuro Mentorship Program, we highlight the value of collective, affinity-based, and cross-institutional approaches that distribute mentorship labor, foster belonging, and reduce the disproportionate burden placed on Black faculty and trainees. We argue that mentorship should be recognized as essential infrastructure for the neuroscience enterprise and call for institutional investment in structured, compensated mentorship programs to support Black neuroscientists and build a more equitable and innovative global workforce.
New brain-heart clinical practice guidelines recommend provision of patient decision aids (PtDAs) to support people with or at risk of brain and heart conditions. We aimed to identify and appraise the quality of PtDAs addressing brain-heart conditions and their consideration of health equity. We conducted an online environmental scan to identify publicly available PtDAs. Two reviewers independently searched, extracted data, and appraised their quality using International Patient Decision Aid Standards (IPDAS) criteria, the Patient Education Materials Assessment Tool (PEMAT), and the PROGRESS-Plus framework for health equity. Of 2549 resources identified, 51 PtDAs were eligible. Nine addressed a combined brain-heart decision, 36 addressed primarily cardiovascular conditions with brain implications, and 6 addressed primarily brain conditions with heart implications. Few focused on brain-heart conditions concomitantly. None addressed dementia, and only one addressed depression as a primary condition with cardiovascular risk addressed as a secondary consideration. The mean IPDAS essential criteria score was 5.8 of 7 (SD 1.5, range 1-7). For PEMAT-P (for printable materials), 91% PtDAs achieved an adequate understandability rating (≥ 70%), and 56% achieved an adequate actionability rating (≥ 70%). The most frequently reported PROGRESS-Plus healthy equity items were age (80%), gender/sex (45%), and socioeconomic status (39%). Brain-heart guidelines recommend PtDA use, but our environmental scan highlighted the need for more of these important interventions. Few PtDAs focused on brain and heart conditions concomitantly, none addressed dementia, and only one addressed depression, which frequently coexist with cardiac conditions. PtDAs also lacked actionable guidance within an equity-informed framework to support quality decisions and decision-making processes for all. Les nouvelles recommandations cliniques relatives aux troubles cérébraux et cardiaques préconisent l'utilisation d'outils d'aide à la décision des patients (OAD) pour accompagner les personnes atteintes ou exposées à des risques de troubles cérébraux et cardiaques. Notre objectif était d'identifier et d'évaluer la qualité de ces OAD traitant des troubles sur l'axe cœur-cerveau, ainsi que la manière dont ils prennent en compte l'équité en matière de santé. Nous avons mené une analyse contextuelle en ligne afin d’identifier les OAD accessibles au public. Deux évaluateurs ont, de manière indépendante, effectué des recherches, extrait des données et évalué leur qualité à l’aide des critères des normes internationales des aides à la décision destinées aux patients (IPDAS), de l’outil d’évaluation des supports d’information destinés aux patients (PEMAT) et du cadre PROGRESS-Plus pour l’équité en matière de santé. Sur les 2 549 ressources identifiées, 51 OAD étaient éligibles. Neuf traitaient d’une décision combinée sur l'axe cœur-cerveau, 36 traitaient principalement de troubles cardiovasculaires ayant des implications cérébrales, et 6 traitaient principalement de troubles cérébraux ayant des implications cardiaques. Peu d'entre elles se concentraient simultanément sur les affections cœur-cerveau. Aucune ne traitait de la démence, et une seule traitait de la dépression en tant que trouble principal, le risque cardiovasculaire étant abordé comme une considération secondaire. Le score moyen des critères essentiels de l'IPDAS était de 5,8/7 (écart-type 1,5, intervalle 1-7). Pour le PEMAT-P (pour des documents imprimables), 91 % des OAD ont obtenu une note de compréhensibilité adéquate (≥ 70 %) et 56 % une note d'applicabilité adéquate (≥ 70 %). Les éléments de l'échelle PROGRESS-Plus relatifs à l'équité en matière de santé les plus fréquemment rapportés étaient l'âge (80 %), le genre/sexe (45 %) et le statut socio-économique (39 %). Les lignes directrices relatives à l’axe cœur-cerveau recommandent l'utilisation des OAD, mais notre analyse contextuelle a mis en évidence la nécessité de multiplier ces interventions importantes. Peu d'OAD se concentraient simultanément sur les troubles cérébraux et cardiaques, aucun ne traitait de la démence et un seul abordait la dépression, qui coexistent fréquemment avec les troubles cardiaques. Les OAD manquaient également de conseils concrets s'inscrivant dans un cadre tenant compte de l'équité pour soutenir des décisions et une prise de décision de qualité.
暂无摘要（点击查看详情）
Despite national efforts to improve research inclusion, people from underserved communities remain underrepresented in dementia trials. Barriers occur at the point of initial engagement and also within the participation pathway itself, as the structure and burden of early screening procedures can discourage continuation. ACCESS D (Advancing Community Collaboration and Engagement Strategies in Dementia) aims to address these challenges by testing a community-based model that combines co-produced engagement events, low-burden research participation, and real-time support from the South Central Ambulance Service (SCAS), a trusted, community-visible National Health Service (NHS) healthcare workforce serving the counties of Hampshire, Oxfordshire, Buckinghamshire and Berkshire in Southern England, UK. ACCESS D is a 12-month mixed-methods feasibility study recruiting 100 adults aged 50-90 years with either (1) a diagnosis of mild cognitive impairment or dementia or (2) a self- or proxy-reported memory concern affecting daily life. The study will deliver between 12-18 co-produced community outreach events in non-clinical settings, supported by SCAS research paramedics and nurses. Following written (paper or digital) informed consent, participants will complete a core questionnaire and may optionally take part in one or more low-burden research opportunities designed to provide supported, first-hand experience of dementia research. Feasibility outcomes, including pathway progression and opt-in to future dementia research contact, will be descriptively summarised and stratified using National Institute of Health and Care Research (NIHR) INCLUDE-aligned underserved characteristics. Qualitative interviews and focus groups with participants and staff will examine acceptability, perceived value, barriers and enablers and implementation learning, analysed using thematic analysis and integrated with quantitative findings. The study has received a favourable opinion from the Southwest-Frenchay Research Ethics Committee and Health Research Authority approval (IRAS 361074). Findings will be disseminated via peer-reviewed publications, conference presentations and co-produced lay outputs for community partners and participants. These outputs will be accompanied by an implementation toolkit for research teams and a visual summary for potential participants.
Artificial intelligence is being embedded in clinical trial infrastructure, shaping who is identified, stratified, and analysed. Opaque models risk amplifying existing disparities in the evidence base. We argue that embedded transparency, the structural integration of ex ante interpretability, demographic auditability, documented uncertainty handling, and stakeholder-relative explanation, is a necessary, though not sufficient, condition for equitable AI-enabled trials, and propose governance recommendations actionable across regulatory regimes.
The Adolescent Brain Cognitive Development (ABCD) Study has substantially advanced developmental neuroscience through its large scale and open-science framework. This review synthesizes the study's significant statistical and methodological contributions over its first ten years, organized around the pillars of population neuroscience, longitudinal modeling, and causal inference. We first examine how ABCD's population-based design has prompted a reconsideration of how effect sizes are interpreted, helping to establish new benchmarks for distinguishing stable, biologically relevant signals from trivial associations in large-N contexts. We detail the computational innovations required to process high-dimensional data at scale, specifically highlighting new analytic tools like the Fast and Efficient Mixed Effects Algorithm (FEMA) framework for mass-univariate modeling and advanced strategies for managing selective attrition and missing data in large-scale longitudinal cohorts. In the domain of longitudinal and multilevel modeling, we discuss the transition from traditional cross-lagged designs to sophisticated frameworks - such as random-intercept cross-lagged panel models, latent growth curves, and parallel process models - that disentangle within-person developmental trajectories from stable between-person traits. We further highlight the study's role in advancing causal inference in observational research through "G-methods", marginal structural models, and quasi-experimental family-based designs. Finally, we explore how ABCD serves as a critical bridge for cross-cohort generalizability and lifespan validation using datasets like the UK Biobank. By contributing to new standards for reproducibility and methodological rigor, the ABCD Study has helped move neuroscience toward a "big data" era, providing a comprehensive statistical foundation for understanding the complex interplay between biology and environment during the transition to adulthood.
Neurological disorders affect more than 3.4 billion people worldwide and are now the leading cause of disability globally. Despite remarkable advances in neuroscience, substantial inequities remain in access to prevention, diagnosis, treatment, and rehabilitation. World Brain Day 2026 adopts the theme "Brain Health: Access for All", calling for coordinated global action to reduce these disparities. The campaign recognises that equitable access to brain healthcare is essential to achieving healthier individuals, stronger communities, and more resilient health systems. It emphasises prevention across the life course, earlier diagnosis, community-based care, workforce development, and advocacy to improve neurological outcomes worldwide. Built around five core pillars and five strategic priorities, World Brain Day 2026 provides a practical framework for governments, healthcare professionals, researchers, patient organisations, and communities to work together towards equitable access to brain health. The campaign reinforces a simple but urgent message: access delayed is potentially access, and brain health, denied.
Cognitive development is associated with diet, activity, sleep, metabolic health, and socioeconomic status. However, evidence remains limited, as most studies have focused on clinical groups or single factors. We examined the combined associations of these variables with cognitive function in school-aged children from the general population. We evaluated 170 school-aged children from a population-based cohort (mean age 6.33 ± 0.03 years; 49% female). Children were evaluated after an overnight fast (>8 h), and anthropometric, metabolic, and socioeconomic variables were evaluated. Diet and physical activity were assessed using validated questionnaires (Vioque FFQ and enKid). Cognitive function was assessed using NEPSY-II and TONI-2 subsets. Correlation and regression analyses were performed. Cognitive function was positively associated with Mediterranean diet adherence, sleep duration, socioeconomic status, and negatively associated with ultra-processed food intake, TV viewing, and metabolic markers including insulin resistance (HOMA-IR), C-reactive protein, and gamma-glutamyltransferase (all p < 0.05). Multivariate analyses showed that Mediterranean diet adherence (OR 2.18, 95%CI 1.08-4.40), economic status (OR 2.50, 95%CI 1.13-5.49), sleep duration (OR 2.90, 95%CI 1.42-5.92), and HOMA-IR (OR 0.47, 95%CI 0.23-0.96) as independently associated with cognitive outcomes, particularly in attention, language, and memory. Lifestyle factors and socioeconomic conditions are independently associated with cognitive function in children. Key message: Diet, sleep, metabolic health, and socioeconomic status are associated with cognitive function in school-aged children. Novelty: Simultaneously examines multiple factors associated with cognition in school-aged children from a population-based cohort. Impact on cognition: Mediterranean diet adherence, sleep duration, and metabolic health were positively associated with several cognitive domains, including attention, language, and memory. Practical use: Highlights the potential relevance of healthy lifestyles and social equity in relation to cognitive development. Broader significance: Highlights the multifactorial nature of cognitive development in children.
Both sustained attention (SA) and executive functioning (EF) are critical for adaptive behavior and compromised across a range of psychiatric disorders, yet their etiological relationships remain underexplored. Here, we report the first multivariate characterization of molecular genetic influences on SA (vigilance, lapse recovery cost, lapse propensity) and EF (processing speed, response selection, working memory). In collaboration with 23andMe, we report previously unpublished genome-wide association studies of these phenotypes in a single cohort of more than 20,000 individuals enriched for diagnoses of major depressive disorder and bipolar disorder. We used Genomic Structural Equation Modeling to formally model patterns of genetic covariance among these task-based measures of cognition, and their relationships with other cognitive, clinical, and imaging-derived phenotypes. We identified two distinct latent genetic factors: one influencing EF and one influencing SA. Both the EF and SA factors were genetically correlated with cognitive and clinical phenotypes, with each latent factor uniquely linked to liability for psychiatric disorders, including attention-deficit/hyperactivity disorder. However, genetic correlations with imaging-derived neuroanatomical phenotypes were modest and non-significant after correction for multiple comparisons. Collectively, these results provide an initial multivariate genetic characterization of SA and EF, though replication in larger and more diverse samples will be important. They suggest that genetic influences on sustained attention are generally distinct from those that influence executive function. The EF and SA factors show distinct patterns of genetic overlap with multiple cognitive and psychiatric outcomes, underscoring the need for more granular cognitive phenotyping to generate new insights into the genetic architecture of cognition and the etiology of psychopathology.
Current guidelines acknowledge the importance of both microsurgical and neuroendovascular expertise in the treatment of cerebrovascular disease. To achieve optimal care for these patients, it is becoming increasingly evident that procedural volumes impact patient outcomes. This is demonstrated across various cerebrovascular diseases.In this literature review, we demonstrate the association of volume with patient outcomes across multiple cerebrovascular disease states and interventions. Microsurgical aneurysm clipping remains essential even with the rise of endovascular therapy and mortality and patient-safety indicator events are clearly lower at high-volume centers for both ruptured and unruptured aneurysms. Likewise, patients undergoing surgery for cerebrovascular malformations and carotid endarterectomy have significantly better outcomes in high-volume centers by high-volume surgeons. Studies of mechanical thrombectomy and carotid stenting reinforce the association between higher procedural volumes, decreased mortality, and improved outcomes across various intervention modalities. The integration of neurocritical care has further improved outcomes, with specialized units demonstrating reduced mortality rates and lengths of stay.Modern cerebrovascular and stroke care necessitates comprehensive care by experienced providers in high-volume centers to optimize patient outcomes for both hemorrhagic and ischemic cerebrovascular disease. The relationship between higher institutional and provider case volumes and better patient outcomes is clearly delineated in the literature. Maintaining high-volume standards for endovascular and microsurgical cerebrovascular care can help ensure high-quality care across centers.
Histology education relies on the visual interpretation of microscopic structures and requires repeated practice for effective learning. Advances in educational technology, particularly virtual microscopy, have created new opportunities for improving histology education. During the COVID-19 pandemic, online learning approaches became essential alternatives to traditional laboratory-based teaching. This study aimed to compare the effects of the eHistoLab web application and conventional e-lecturing on students' learning outcomes and perceptions in histology education among medical sciences students in Iran. This quasi-experimental study used a two-group pre-test/post-test design. A total of 100 medical, dentistry, and pharmacy students enrolled in a histology course at Smart University of Medical Sciences (SMUMS), Iran, during the summer semester of 2023 participated in the study. Participants were randomly assigned into two groups. One group received instruction through e-lecturing, while the other group was taught using the eHistoLab web application, a bilingual virtual microscopy platform providing access to high-resolution histological slides, image magnification, search functions, and interactive communication with instructors. Learning outcomes were assessed using pre- and post-tests, and data were analyzed using paired and independent t-tests in SPSS version 24. The findings revealed that 50% of students preferred virtual microscopy alone for learning histology, while 30% preferred a combination of methods, and 20% preferred e-lecturing alone. Regarding educational resources, 58% of students preferred the eHistoLab application, whereas 26% preferred textbooks and 16% preferred recorded e-lectures. Meantime, 62% of students preferred the eHistoLab tool in terms of motivation for learning histology, whereas 30% preferred the combined approach and 8% favored recorded e-lectures. Moreover, the results indicated that the post-test scores in the group taught with the eHistoLab web application were significantly higher than those in the e-lecturing group (P < 0.001). The findings of this study suggest that the eHistoLab web application improved students' learning outcomes and was positively perceived as a learning tool in histology education. Virtual microscopy may therefore serve as a useful complementary approach to lecture-based histology teaching.
Reward processing deficits are prominent in major depressive disorder (MDD) and contribute to appetitive phenotypes: hyperphagic (HyperMDD) and hypophagic (HypoMDD). However, few studies have examined neurobiological processes underlying these phenotypes, and whether they stem from aberrant responsivity specific to food or rewards more broadly. This study probed group differences in functional connectivity during anticipation and outcome phases of food vs. monetary rewards across appetitive MDD phenotypes. 14 unmedicated HyperMDDs, 20 unmedicated HypoMDDs, and 36 healthy controls completed food and monetary incentive delay tasks while undergoing fMRI. Psychophysiological interaction analyses examined functional connectivity changes during relevant task conditions/reward processing components: anticipation, successful reward outcome, and failed reward outcomes. Findings revealed dissociable patterns of fronto-striatal and salience network connectivity during anticipatory reward processing among groups, reflecting differential top-down control of food versus monetary cues. HypoMDD was associated with heightened connectivity to food cues and negative connectivity to monetary cues, while HyperMDD exhibited the opposite patterns. MDD groups also differed in connectivity during reward outcome: HypoMDD demonstrated increased functional connectivity for successful food outcome and reduced functional connectivity for successful money outcome whereas HyperMDD demonstrated reduced connectivity during successful food outcome and increased connectivity during successful money reward outcome. For failed reward outcomes, only HyperMDD demonstrated reduced connectivity for failed food outcomes, and increased connectivity for failed money outcomes. These findings suggest that appetitive MDD phenotypes are distinguished by opposing circuitry profiles that bias responsivity toward food versus monetary rewards, patterns that may help guide the development of phenotype- and reward-specific interventions.
Major depressive disorder (MDD) is a biologically heterogeneous condition, with a subset of patients exhibiting elevated inflammatory markers associated with greater symptom burden and lower responsiveness to antidepressants. Treatment outcomes with repetitive transcranial magnetic stimulation (rTMS) are also highly variable, and inflammation may impair neuroplasticity, thereby modulating treatment efficacy. This exploratory study investigated whether baseline inflammatory protein signatures could influence the response to intermittent theta burst stimulation (iTBS). Using the Olink® Target 96 Inflammation panel, baseline inflammatory protein levels were analyzed in 54 patients with moderate-to-severe depression (baseline MADRS ≥20) undergoing iTBS treatment. K-means clustering identified two subgroups: Cluster 1 (n = 28) and Cluster 2 (n = 26). Cluster 2 showed the highest proportion of responders, whereas Cluster 1 showed the lowest. The clusters did not differ significantly in age, sex, medication status, randomization arm, or body mass index. Differential protein expression was assessed using volcano plots with false discovery rate (FDR) correction. Pathway enrichment analyses using Kyoto Encyclopedia of Genes and Genomes (KEGG) and Reactome databases identified biological processes associated with the clustering solution. Volcano analysis identified 10 differentially expressed proteins between clusters (FDR < 0.05 and |ΔNPX| ≥ 1). Enrichment analyses implicated cytokine-cytokine receptor interaction, chemokine signaling, and interleukin signaling pathways as characteristic of the lower-response subgroup. These findings indicate that baseline inflammatory signatures may help differentiate responsiveness to iTBS in moderate-to-severe depression, supporting future pathway investigations as a potential strategy for personalized psychiatry.
暂无摘要（点击查看详情）
The ongoing opioid overdose crisis disproportionately affects minority communities, highlighting the urgent need for community-based addiction research to better understand and address this public health issue. Community-academic partnerships are a key strategy to engage these communities in addiction research. Here we describe the Health Advocates In-Reach and Research (HAIR) initiative, a collaboration between the University of Maryland and the National Institute on Drug Abuse Intramural Research Program. We tested whether barbershops, a trusted community venue, can support hair collection for fentanyl toxicology and a stress biomarker (cortisol) to inform equitable overdose prevention. Within the HAIR initiative, community barbers/stylists and academic partners co-designed an anonymized, barbershop-based hair collection pilot project. Prespecified objectives were to (1) build trust between researchers and community members, (2) evaluate feasibility (successful collection and laboratory assay completion) and acceptability, (3) quantify fentanyl in hair, (4) quantify hair cortisol, and (5) explore associations between fentanyl detection and cortisol. Liquid chromatography-mass spectrometry (LC/MS) assays for quantitative analysis were developed and applied. Forty samples were collected from predominantly Black (85%), non-Hispanic (77.5%), male (95%) patrons. Cortisol concentrations were successfully measured in 36 of the 40 samples, ranging from 3.36 to 104.00 pg/mg. Fentanyl was detected in 13 of the 40 samples, specifically four in quantifiable amounts (10.20-171.00 pg/mg) and nine samples containing trace amounts below the limit of quantification. An ordinary least squares regression model suggested that fentanyl presence may be predictive of increased cortisol after controlling for demographic variables. This association did not reach statistical significance (p = .065), likely due to limited statistical power from the small sample size. This pilot study presents a promising community-based translational research model to advance addiction implementation science. Barbershops represent a feasible, acceptable setting for community-based hair toxicology and stress biomarker collection, enabling the identification of otherwise unrecognized exposure and stress signals within high-burden populations. This practice-ready workflow could augment local overdose strategies, linking on-site findings to naloxone distribution and rapid Medications for Opioid Use Disorder (MOUD) navigation, and merits evaluation in larger hybrid implementation science studies.
There is an application for artificial intelligence (AI) to augment medical education. The aim of this study was to incorporate AI-powered cameras to quantify the learning curve and performance metrics associated with external ventricular drain (EVD) placement. Fourteen participants, comprising medical students and neurosurgical residents, were recorded performing an EVD on a trainer head. Five panoramic cameras were installed within the simulation suite. The model employed convolutional neural networks to track anatomical landmarks and assess task completion. Quantification of the learning curve was achieved by aggregating scores across three phases: preparation, insertion, and closing. Additional metrics included fluidity, a proxy for surgical finesse. The model successfully itemized parameters that characterize EVD placement. The study demonstrated a clear learning curve in EVD placement. The overall scores were 64.4/126 (51.1%), 99.6/126 (79%), and 113/126 (89.7%) for the students, junior residents, and senior residents ( p  < 0.0001). Significant improvements were observed in the preparation, insertion, and closing phases. The mean scores for preparation were 16.4/37 (44.3%), 25.6/37 (69.2), and 30.5/37 (82.4) for the students, junior residents, and senior residents ( p  < 0.0001). The mean scores for insertion were 26.2/44 (59.5%), 37.8/44 (85.9%), and 38.5/44 (87.5%) for the students, junior residents, and senior residents ( p  = 0.026). The mean scores during closing were 13/25 (52%), 22.2/25 (88.8%), and 25/25 (100%) for the students, junior residents, and senior residents ( p  = 0.0034). Fluidity improved significantly with training level ( p  = 0.0006). Our platform effectively quantified the learning curve associated with EVD placement, underscoring the importance of objective feedback and AI's potential to facilitate skill acquisition.
Little is known regarding the extent to which the barriers separating brain subcompartments lead to differential drug transport into these subcompartments and whether such differences impact the behavioral effects of drugs. Against this background, here we have adopted electrochemical aptamer-based (EAB) sensors, a seconds-resolved, in vivo molecular measurement tool, to two tasks. First, we have measured the pharmacokinetics associated with the anesthetic procaine crossing the blood-brain-barrier into the solid tissue of the hippocampus and crossing the blood-cerebrospinal fluid barrier into the lateral ventricle. Second, we have determined the extent to which procaine concentrations in these two subcompartments correlate with the behavioral response the drug elicits. Performing these studies, we find that, whereas the drug's elimination kinetics are effectively indistinguishable between the two subcompartments, penetration into the hippocampus is statistically significantly slower than into the lateral ventricle. The relationships between drug concentration and the resulting behavioral effect also differ significantly between the two subcompartments, with the correlation between concentration and drug-induced suppression of ambulatory behavior being stronger in the hippocampus than in the lateral ventricle. This difference presumably arises because hippocampal concentrations more accurately reflect procaine exposure at the drug's site of action.
To identify which features best differentiate Sjögren's-related from non-Sjögren's related dry eye disease (DED) using machine-learning models. A retrospective study was conducted on 324 individuals with DED based on Dry Eye Workshop-II criteria, including 162 with and 162 without Sjögren's disease (SjD). One eye per subject was randomly selected. Demographics, Ocular Surface Disease Index (OSDI), and clinical signs were collected. A symptom-sign discordance score was calculated (range - 1 to + 1), positive values indicated greater symptom burden relative to signs, and negative values indicated greater clinical signs relative to symptoms. Multiple machine learning models were developed, and the one with the highest accuracy was selected as optimal. Feature importance, Weight of Evidence (WoE), and Information Value (IV) were computed for the top five predictors in the optimal model. The mean age was 47.4 years, and 82% of individuals were female. Compared to the non-SjD group, those with SjD had lower OSDI scores (31.8 vs. 44.6, p < 0.001) despite higher ocular surface staining (OSS) (Oxford IV 5.5% vs. 4.9, p = 0.015), shorter non-invasive tear break-up time (NIBUT) (8.6 vs. 10.6 s), lower Schirmer values (7.5 vs. 14.4 mm), and a higher rate of positive InflammaDry tests (73.4% vs. 25.3%, p < 0.001). Discordance scores for OSS (- 0.34 vs. +0.09, p < 0.001), NIBUT (- 0.60 vs. -0.39, p < 0.001), and Schirmer (- 0.46 vs. -0.39, p = 0.003) were more negative in the SjD compared to the non-SjD group, indicating that objective signs exceeded symptoms across all three metrics in the SjD group. The optimal model (accuracy = 0.96) identified the most predictive features of SjD-related DED as a positive InflammaDry test (WoE: 1.034, IV: 0.45), OSS discordance (score < - 0.5) (WoE: 1.376, IV: 0.42), NIBUT discordance (score < - 0.5) (WoE: 2.079, IV: 0.22), Schirmer test < 5 mm/5 min (WoE: 1.007, IV: 0.18), and Schirmer discordance (score < - 0.5) (WoE: 0.746, IV: 0.09). SjD-related DED is characterized by ocular surface inflammation, symptom-sign discordance with signs outweighing symptoms, and a Schirmer test < 5 mm/5 min.
Hypertension is a premier risk factor for index and recurrent strokes globally. However, knowledge of hypertension as a risk factor for stroke occurrence and subsequent adverse vascular events among recent stroke survivors in the sub-Saharan Africa is limited. To assess the level and determinants of knowledge on hypertension and risk of stroke among recent stroke survivors in Ghana. This is a cross-sectional survey conducted at enrollment of participants involved in the multi-center, phase III randomized trial titled Phone-based Intervention under Nurse Guidance after stroke II (PINGS-2) study. Recent stroke survivors within 1-2 months of stroke onset were recruited from 10 Ghanaian hospitals comprising of (five primary-level, two secondary-level, and three tertiary-level facilities) between 2020 and 2022. We assessed knowledge of hypertension and stroke using a validated 14-item questionnaire on hypertension and stroke. We analyzed data using univariate and multivariate analysis to determine the associations between sociodemographic variables and the knowledge on hypertension among recent stroke survivors. We enrolled 500 participants, mean (SD) age of 58 (12) years, 56.2% being males and 73.3% had ischemic stroke. Out of 14 questions, the mean (SD) score was 8 (3) with a range of 0 to 13. Four factors significantly associated with knowledge of hypertension with adjusted β (95%CI) were Islam religion -1.40 (-2.40 - -0.49), NIHSS score -0.15 (- 0.22 - -0.07) for each unit increase and body mass index 0.08 (0.03 - 0.13) for each kg/m2 increase and educational attainment with primary level, secondary, and tertiary educational level 1.10 (0.02 - 2.10), 1.60 (0.52 - 2.70), 2.40 (1.20 - 3.60) compared with no education. We found substantial deficiencies in the knowledge on hypertension among recent hypertensive stroke survivors in the Ghanaian population in this multicenter study. Educational interventions are urgently needed to address these knowledge gaps to minimize risk of adverse outcomes among stroke survivors in resource-limited settings.
Tuberculosis (TB) is the leading global cause of death from a single infectious agent. Recent reductions in global health funding have threatened TB control, making comprehensive assessment of TB, HIV-related TB, and drug-resistant TB burdens before these disruptions essential for shaping effective responses. The WHO End TB Strategy sets targets of a 95% reduction in TB deaths and a 90% reduction in TB incidence between 2015 and 2035. Using results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023, this study aims to assess the burden of TB and multidrug-resistant TB (MDR-TB) across 204 countries and territories, and to evaluate progress towards the WHO End TB incidence and mortality targets. We quantified TB mortality using the Cause of Death Ensemble modelling platform with global vital registration, surveillance, verbal autopsy, and minimally invasive tissue sampling data. For TB morbidity estimation, we simultaneously modelled incidence, prevalence, and mortality by age and sex using DisMod-MR 2.1. A population attributable fraction (PAF) approach was applied to stratify morbidity and mortality estimates by HIV and drug-resistance status. We also calculated disability-adjusted life-years (DALYs) as the sum of years of life lost and years lived with disability. For the risk factor analysis, a comparative risk assessment framework was used and PAFs were derived for alcohol use, smoking, and high fasting plasma glucose to determine the proportion of TB burden associated with these risk factors. In 2023, there were an estimated 9·11 million (95% uncertainty interval 8·04-10·3) incident cases of all-form TB, 1·22 million (0·98-1·49) deaths, and 54·6 million (43·8-65·5) DALYs globally. HIV-related TB comprised 781 000 (690 000-879 000) incident cases and 210 000 (142 000-279 000) deaths, contributing 11·0 million (7·56-14·3) DALYs. MDR-TB accounted for 466 000 (198 000-1 080 000) incident cases, 102 000 (31 700-238 000) deaths, and 3·96 million (1·31-9·01) DALYs. From 2015 to 2023, global all-form TB incidence rates declined by 19·2% (17·8-20·5) and deaths declined by 22·6% (4·7-35·7); declines were larger for drug-susceptible TB than for MDR-TB. Sub-Saharan Africa and south Asia had the highest mortality burdens in 2023; reductions in all-form TB incidence and mortality were uneven between 2000 and 2023, with limited progress in both measures in Latin America and the Caribbean. Removing smoking, alcohol use, and high fasting plasma glucose would reduce global TB deaths to 768 000 (592 000-970 000) and DALYs to 34·9 million (27·8-43·8) in 2023; MDR-TB deaths would decrease to 77 200 (23 400-183 000) and DALYs to 3·12 million (1·03-7·29). Global progress towards WHO End TB targets is disparate and fragile. Although many regions achieved meaningful gains, others have stagnated in recent years. The complexity of TB prevention is amplified by divergent MDR-TB trends, the persistent burden of HIV, and growing exposure to modifiable risk factors. Recent volatility in global health financing threatens to further destabilise this vulnerable epidemiological landscape; concerted action is urgently needed to temper disruptions and preserve progress. Gates Foundation.