The "Cone of Gaze" (CoG), a measure of the range of gaze angles that one perceives to be looking at them, has been proposed as a biobehavioural marker of psychiatric disorders characterised by symptoms in the social domain, such as social anxiety disorder. However, the evidence remains inconsistent and its mechanisms unclear. Here, we combine meta-analysis and well-powered experimental replications to investigate: 1) individual differences in the CoG between those with and without social anxiety; 2) within-subjects differences in the CoG in response to faces with angry versus neutral expressions; and 3) the interaction between these factors. The meta-analyses revealed significantly wider CoG for socially anxious versus non-anxious individuals (representing 10 studies and 403 participants), and wider CoG for angry versus neutral expressions (9 studies, 523 participants). However, the existing evidence was sparse, highly heterogeneous and often involved small samples. Our experiments (N = 514) did not replicate the effect of social anxiety or emotional expression on CoG. Our integrated approach, combining meta-analyses with experimental replications and extensions, provides a rigorous framework for assessing the robustness and clinical relevance of gaze perception effects. We highlight the need for larger, more transparent datasets to accurately estimate CoG effects and other putative markers to assess their translational potential.
Around one in four people with stroke will have a recurrent stroke. The risk can be reduced through medication and lifestyle changes, but many have poor risk factor control post-stroke. There is no nationally recognised model of care for stroke secondary prevention, and inadequate secondary prevention may be a complex problem that cannot be effectively dealt with by addressing various contributing factors independently. We sought to understand implementation and research priorities to address gaps in stroke secondary prevention in Australia. An online roundtable and four follow-up small group discussions were conducted between March and April 2023. Participants were people with lived experience of stroke, researchers, health professionals and representatives from stroke advocacy organisations and the Australian federal government. Participants were given pre-discussion questions on stroke secondary prevention priorities, barriers and enablers. Moderated discussion invited reflection on system-level connections between priorities and shared understanding of diverse perspectives, rather than consensus-building. Discussions were recorded, transcribed and analysed following Braun and Clarke's thematic analysis methodology. In the roundtable and small-group discussions, 25 people participated (68% women). Most priorities related to the inductive theme, 'models of care', including programmes, interventions and health system settings. Perceived barriers and enablers related to the following inductive themes: 'coordination', 'resourcing', and the 'research translation pipeline'. Identified priorities were heterogeneous and extensive. Tensions existed between some priorities, but others were shared by participants. Our roundtable identified a range of priorities for stroke secondary prevention, coming from diverse perspectives. Stroke secondary prevention is a complex problem with interacting system elements that make improvement challenging. A model of care for stroke secondary prevention in Australia is needed that accounts for this complexity while building upon shared priorities. This project embedded people with lived experience of stroke. This included three people with lived experience of stroke, or of being a carer for a person with stroke, who took part in the initial roundtable and provided valuable contributions in discussions of implementation and research priorities for secondary stroke prevention. These participants also helped to prepare this manuscript, providing helpful feedback to ensure that priorities, barriers and enablers for secondary stroke prevention from a lived experience perspective were centred.
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We examined whether the effects of a brief, guided mindful meditation (MM) exercise on aggression perpetration differed based on an individual's baseline ability to nonjudgmentally observe the present moment (i.e., dispositional mindfulness). One hundred two college students (56.1% women; 78.9% White) completed the Mindful Attention Awareness Scale (MAAS) and were randomly assigned to either a one-time 15-minute audio-guided meditation, mindful condition, or control condition before completing a shock-based laboratory aggression paradigm involving provocation by an ostensible opponent. All participants were coded as having either high or low levels of dispositional mindfulness based on a mean split of their MAAS score. Results indicated that participants with high levels of dispositional mindfulness displayed significantly less aggression in the MM condition relative to the control condition (d = .64). In contrast, participants with low levels of dispositional mindfulness displayed more aggression in the mindful condition relative to the control condition (d = .45), although this effect was not statistically significant. These findings suggest that individuals' baseline ability to nonjudgmentally observe the present moment has important implications for determining who may and may not benefit from audio-guided MM as a brief intervention for aggression.
Anterior cruciate ligament reconstruction is a constantly evolving procedure, and we continue to push the limits to improve outcomes for our patients. As rates of reinjury continue to be higher than we desire, we have consistently sought methods to improve postoperative outcomes and reduce the rates of revision surgeries. The rebirth of lateral extra-articular augmentation procedures has given us a strong tool to leverage to achieve these goals. It is essential that we continue to appreciate the price of this progress and fully understand the risks of augmenting our existing surgical techniques. Finding the optimal patients on whom to utilize these techniques is the key to balancing our success in this challenging patient population.
Sedation is commonly used in intensive care units (ICUs), but there is limited evidence about how staff members make sense of their sedation practice or what influences their use of sedation. The aim of this study was to report qualitative case study findings that compare ICU sedation practice and staff perspectives in Australia and the UK, with the aim of informing international practice and policy. A qualitative case study approach was applied in one general ICU in Australia and one in the UK. Between November 2021 and February 2023, nurses, doctors, and allied health professionals were recruited. Data were collected through focus groups, participant observation, clinical notes review, and semistructured interviews. A cross-case analysis was completed using reflexive thematic analysis. In Australia, 43 ICU staff members participated; in the UK, 91 ICU staff members participated. Twenty-four patients were observed, and their notes were reviewed. Two focus groups, 18 interviews, and over 300 observation hours were completed. The cross-case analysis identified similarities and differences in sedation practice between the ICUs. Each unit had differences in sedation reduction and contrasting daily routines influencing sedation use. In both units, key drivers of decision-making were similar, namely the physical layout, perceptions of moral distress, and safety concerns. This paper presents an in-depth exploration of the sedation practices and perspectives of healthcare professionals working in an ICU in Australia and a similar ICU in the UK. Through the cross-case analysis, we have shown the importance of attending to the physical layout of ICUs and understanding the concerns of staff about safety and the moral dimensions of their practice when aspiring to implement best sedation practice. Furthermore, we have revealed that similar ICUs in different countries take different approaches to sedation reduction, highlighting the need for greater international exchange on this crucial area of ICU practice.
Little research has investigated how autistic individuals make sense of their experiences with socializing and interacting with others in postsecondary education. Autistic students are also dissatisfied with insufficient social interventions and the lack of autistic input in the design of such support. This study investigated the lived experiences of social interaction and related support in autistic postsecondary students. We conducted interviews with eight Chinese autistic students currently enrolled in a university or college in Hong Kong. Analysis using an interpretative phenomenological analysis approach identified four themes, including (1) their attempts and motivation to connect and socialize, which was often felt ineffective and exhausting; (2) the internal negotiation and delicate balance between masking and unmasking; (3) the crucial role of both formal and informal supports in coping with social and emotional challenges; and (4) social support and interventions needed to include diverse strategies ranging from skills building to neurodiversity-informed practices that respond to individual preferences and contexts. This study reveals cultural nuances in social preferences and masking that are not found in Western-dominant literature, which can inform more culturally responsive conceptualizations of interventions that enhance social experiences and promote authenticity.Lay AbstractAutistic students in university often face social challenges that affect their well-being, learning, and ability to connect with others. These struggles are not always well understood. By listening to their personal experiences, we can better support them in ways that they desire and create more inclusive environments. The study aimed to understand how autistic college or university students in Hong Kong experience social interaction and the support they receive. It focused on their personal stories to explore what helps or hinders their ability to interact and socialize with others. We interviewed eight autistic students in Cantonese Chinese. They shared their thoughts and feelings about their social lives and the support they received. The researcher analyzed these interviews to find unique meanings in each participant and the common themes and patterns among their experiences. The study found four main themes. First, socializing is challenging but meaningful. Second, many students masked their autistic traits and found it exhausting, but they also valued the importance and benefits of doing it. Third, support from peers, teachers, and professionals helps them cope. Fourth, social interventions and support should be personalized and should value their preferences and perspectives. The study highlights that masking can be both harmful and helpful, depending on the situation and culture. Our results also show that autistic students want to be themselves but often feel pressured to fit in. These insights challenge the idea that all support should focus on changing autistic behavior, while also supporting the need for autistic students to learn to change and adapt to society.
Intermediate-risk papillary thyroid carcinoma (PTC) accounts for 40%-60% of newly diagnosed PTC and comprises a heterogeneous group with variable recurrence risk. The benefit of postoperative radioactive iodine (RAI) remains uncertain. To describe features, response-to-therapy outcomes, and ATA 2025 recurrence-risk redistribution in patients with ATA 2015 intermediate-risk PTC managed without adjuvant RAI. Retrospective cohort study. Adults (≥ 18 years) with ATA 2015 intermediate-risk PTC treated with total thyroidectomy (TT) or thyroid lobectomy (TL), with/without lymph node dissection, and followed for ≥ 1 year were included. Omission of postoperative RAI was based on histopathology, cervical ultrasound (US), serum thyroglobulin (Tg), and anti-thyroglobulin antibodies (TgAb) measured within 6 months postoperatively. TL patients required negative US. TT patients required negative US plus Tg < 1 ng/mL if TgAb-negative, or stable/declining TgAb if positive. Response to therapy was assessed using ATA 2015 dynamic risk stratification and reassessed with ATA 2025 criteria. Ninety-nine patients were included; 84 (84.8%) were women, the mean age was 40.2 ± 13.3 years, and the median follow-up was 4.8 years. Microscopic extrathyroidal extension was present in 51 (51.5%), lymph node metastases in 37 (37.4%), and extranodal extension in 4 (4.0%). By ATA 2015, 67 (67.7%) had an excellent response and 32 (32.3%) an indeterminate response; no incomplete responses or structural recurrences occurred. ATA 2025 reclassified 3 (3.0%) as low risk, 39 (39.4%) as low-intermediate, 52 (52.5%) as high-intermediate, and 5 (5.1%) as high risk. Selected intermediate-risk PTC patients managed without adjuvant RAI had excellent mid-term outcomes, supporting a risk-adapted de-escalation strategy.
Understanding how gene-flow and selection interact across environmental gradients is essential for assessing population resilience and evaluating the deep-refugia potential of mesophotic habitats under rapid climate change. In the context of depth, genetic connectivity patterns have been documented for broadcast-spawning species, but that of brooding marine invertebrates remains largely unexplored, leaving the role of mesophotic habitats as potential refugia uncertain. Here, we investigated the genetic structure of the brooder sponge Ircinia variabilis across shallow and mesophotic habitats in the Eastern Mediterranean and across shallow sites spanning multiple Mediterranean basins (i.e., Mallorca, Ionian-Sea and Israel). By quantifying depth and distance-related connectivity, and assessing the relative roles of neutral processes and temperature-driven selection, we evaluated the genetic connectivity of I. variabilis and the potential of mesophotic habitats to function as refugia. Using ddRADseq, we obtained 957 SNPs, to characterize gene-flow patterns, genetic structure, and environmental influences on differentiation. Ircinia variabilis exhibited pronounced vertical and geographic genetic structure, consistent with limited larval dispersal. Notably, Ionian-Sea populations were genetically closer to Mallorca than to the geographically closer Israeli populations, suggesting influence of oceanographic barriers. Analyses of selection-associated loci indicate that environmental variability contributes to population divergence, supporting local adaptation. Along the Israeli coast, pronounced differentiation between shallow and mesophotic populations highlights depth as a key axis of evolutionary divergence. Limited vertical connectivity challenges a central assumption of the deep refugia hypothesis, suggesting mesophotic populations may not sustain shallow populations under climate change.
Teamwork and communication are critical to reducing medical error, particularly in complex surgical procedures such as vascularized composite allotransplantation (VCA). Although cadaveric rehearsals are used to prepare for VCA, their effect on team development and operative outcomes remains unstudied. We therefore sought to evaluate the evolution of teamwork and its impact on operative outcomes in preparation for the first successful combined full-face and bilateral hand transplant. Cadaveric rehearsals were conducted in preparation for a combined full-face and bilateral hand transplant. As a quality improvement effort, teams followed surgical checklists and were assessed for teamwork using the Clinical Teamwork Scale (CTS) and the Oxford Non-Technical Skills (NOTECHS) tool. Face- and hand-specific scores and dissection times were recorded at each rehearsal to guide debriefings and refine subsequent sessions until transplantation. Eleven cadaveric rehearsals were conducted with 9 surgical teams, each including at least 3 surgeons, 2 nurses, and 1 research fellow. Overall mean CTS scores improved significantly from baseline to transplantation for both face and hand teams, with notable gains in teamwork, communication, situational awareness, and decision-making. Linear regression showed significant positive associations between rehearsal number and scores in most CTS and NOTECHS domains. Total dissection time significantly decreased from 411 minutes at baseline to 273 minutes at the final rehearsal (P = 0.004). Teamwork and dissection time significantly improved during 11 cadaveric rehearsals, culminating in the first successful face and bilateral hand transplant. A comprehensive, team-based approach is essential to the success of VCA.
Understanding how Americans think about public health and the role of government institutions is crucial for informing effective health communication in a polarized political climate. We deployed an open-ended national survey of 1004 adults in October 2025 to assess public perceptions of these topics. Respondents associated the term "public health" with health for everyone (44%) and health of everyone (23%), alongside healthcare (20%) and other themes. The most common perceived government benefit was facilitating access to healthcare (39%)-particularly by addressing cost (16%). Among perceived government harms, more Republicans than Democrats cited overregulation (16% vs 8%, P < 0.01), limiting personal freedoms (16% vs 6%, P < 0.001), and inefficiency (10% vs 4%, P < 0.01); more Democrats than Republicans mentioned dismissing science (7% vs 2%, P < 0.01) and defunding (7% vs 2%, P = 0.02). Weighted analyses yielded minimal substantive differences from unweighted findings. Findings reveal both cross-partisan common ground in term associations and divergent concerns regarding government action. Public health messaging should leverage shared priorities and acknowledge partisan concerns about government roles.
Despite longstanding recognition of sex as a biological variable, its integration into biomedical research remains inconsistent. Numerous publishers have introduced policies to improve reporting and inclusion of sex and gender, including Nature, which requires authors to complete a Life Science Reporting Summary documenting sex inclusion. Here, we evaluated the effectiveness of these policies by examining sex inclusion and reporting practices in all original research articles involving humans, vertebrates, or cell lines published in Nature in 2025 (N = 513). Nearly two-thirds of articles included both sexes (62.7%); however, inclusion was often nominal. Of these articles reporting inclusion of both sexes, 33% did not maintain inclusion across experiments, used markedly unbalanced sex ratios (≥ 2:1), or alternated between male- and female-only experiments. Another 45.5% of these articles reporting inclusion of both sexes did not report sample size by sex, so it cannot be ascertained whether sex inclusion was maintained across experiments or balanced by sex. Single-sex studies accounted for approximately one-fifth of articles. While male-only and female-only studies occurred at similar overall rates, male-only studies were more than four times more likely to address conditions affecting both sexes while female-only studies were more likely to address sex-specific conditions (e.g., ovarian cancer). Notably, the policies aimed at improving reporting and inclusion also did not increase analysis by sex; only 7% of articles explicitly analyzed sex as a discovery variable for at least some analyses. These findings suggest that transparency-focused reporting summaries alone are insufficient to ensure sex inclusion and/or meaningful analytical integration of sex (i.e., direct comparison of sexes, rather than using sex as a covariate). As a leading biomedical journal, Nature plays a central role in shaping research norms; without stronger editorial expectations, reporting requirements risk reinforcing male-default assumptions rather than advancing rigor and generalizability. Biological sex can influence how diseases develop and how treatments work. For this reason, researchers are increasingly encouraged to include both males and females in their studies. Many scientific journals now have policies to improve how sex is considered and reported. In this study, we looked at whether these policies are working by reviewing all research articles published in Nature in 2025. We found that nearly two-thirds of studies said they included males and females. However, this inclusion was often incomplete or unclear. In many cases, researchers did not consistently include both sexes throughout all experiments, used uneven numbers of males and females, or switched between studying only males or only females. Nearly half of the studies that claimed to include both sexes did not provide enough detail to confirm how many males and females were used. About one in five studies used only one sex. Studies using only males were much more likely to focus on conditions that affect everyone, while studies using only females were more likely to focus on female-specific conditions. Importantly, very few studies (7%) compared results between males and females to see if there were meaningful differences. Overall, our findings suggest that current reporting requirements are not enough to ensure that sex is properly included, reported, and analyzed in research. Stronger expectations are needed to improve the quality and usefulness of scientific findings for everyone.
Malaria is a life-threatening disease caused and spread by female Anopheles mosquitoes. It is a global health concern, especially in tropical areas, where the WHO Africa region published 94% of malaria cases and 95% of deaths related to malaria in children under 5 years old. In Rwanda, malaria continues to affect the population, where rural communities are at risk. This narrative review has the purpose of showcasing the university student contribution to advancing malaria eradication in Rwanda. The narrative review acquired secondary data accessed from different peer-reviewed journals, Google Scholar, WHO databases, and other sources, to understand the contributions of everyone in fighting and preventing malaria. There are positive outputs when university students apply their education, outreach, awareness campaigns, and community training toward malaria prevention. People understood that they had to implement those practices learned from student outreaches in ending malaria, and also the improvement in health facilities was adopted to combat malaria, as seen in the country's Malaria Strategic Plan (MSP), which was extended from 2013 to 2020 and reduced malaria cases by 75% and deaths by 50% in Rwanda. It showed that when there is improved awareness and education and also volunteering of young people through information dissemination, the distribution of long-lasting insecticidal nets can eradicate malaria. Also, we have seen that the improved technology developed by university students has designed a mobile application that provides real-time malaria surveillance data. Despite their interests in researching innovation and advocacy, they faced many hurdles that prevented them from contributing fully, like limited resources, funding, lack of connections, and insufficient education and skills about malaria. That is why university students need more knowledge and other requirements to advocate fully for achieving WHO and the country's strategic plan toward malaria eradication. University students have shown their contributions to malaria control in Rwanda through changes in community behaviors and working with other health workers. Even if there are barriers, students' engagement expresses sustainable outputs and is an advance to the country's strategic plan for malaria eradication in 2030.
Contact lens (CL) wear may induce changes to the tear film, leading to sensations of ocular dryness and CL discomfort, key reasons for CL discontinuation. CL care solutions can help address underlying mechanisms of CL discomfort, improving wear experience. We report outcomes of an in-home use test of Biotrue® Hydration Plus Multi-Purpose Solution (BHP MPS; Bausch + Lomb, Rochester, NY, USA), which is formulated to maintain ocular surface homeostasis and improve CL comfort. In this IRB-approved, real-world survey study, adult soft CL users used BHP MPS for 7 days before completing a survey rating their experience (agreement/disagreement for attributes including CL cleanliness, comfort [including during extended screen use], prevention of CL dryness, perception of CL hydration, gentleness on eyes, and likelihood to recommend to others). A power analysis estimated sample size for 80% statistical power. Responses were analyzed with 2-sided exact binomial tests for agreement in >50% of responses (significance level α=0.05). Participants (N=435) were demographically balanced (mean age 42.5 years; 52.9% female). Over 60% of participants reported baseline CL dryness and tired eyes; 8.0% were likely to discontinue CL wear. At the end of the trial period, 98.9% were satisfied with how their CLs felt. Individual responses were significantly >50% for all attributes (p<0.05), including 91.7% agreeing that BHP MPS positively impacted CL comfort (and helped to keep CLs feeling clean [96.8%], keep CLs comfortable so that eyes do not feel tired [93.1%], maintain CL comfort [94.7%], prevent CL dryness [93.6%], maintain comfort with extended screen use [92.0%], and maintain hydration [94.7%] while being gentle on eyes [96.6%]); 94.0% would recommend BHP MPS to other CL wearers. No adverse events were reported. BHP MPS demonstrated strong performance across all key criteria evaluated in this real-world cohort of soft CL wearers for improved CL wear experience. Comfort is important to keep people wearing their contact lenses, but some people stop wearing them because their eyes feel uncomfortable and dry over time. For reusable contact lenses especially, the choice of lens cleaning and care solution is important to help keep lenses feeling comfortable. Biotrue® Hydration Plus Multi-Purpose Solution (BHP MPS; Bausch + Lomb, Rochester, NY, USA) is a unique contact lens solution with ingredients that help clean and remove spots off the lenses, which may help keep the eye healthy and help the contact lenses feel more comfortable. The BHP MPS ingredients were chosen based on scientific research and advice from experts. This study looked at how using BHP MPS in daily life made people feel. The study included 435 people who regularly wore reusable contact lenses. Overall, these people agreed that BHP MPS helped keep their contact lenses clean and comfortable, was gentle on their eyes, and stopped their lenses from feeling dry, even if they were using a screen, like a computer, for a long time. Nearly everyone in the study agreed they would recommend BHP MPS to others who wear contact lenses. This study showed that BHP MPS can help reusable contact lens wearers, improving the way people’s eyes feel. This real-life study is important because it builds on what we already know about BHP MPS from other studies and helps people who wear contact lenses and their eye care doctors choose the right contact lens solution to use.
Respiratory syncytial virus (RSV) is an important respiratory pathogen among older adults and those with chronic conditions. Two systematic literature reviews identified the impacts of chronic conditions on RSV infection outcomes in adults, and how immunological changes alter RSV infection susceptibility in older individuals. Searches using MEDLINE/Embase identified relevant papers published between 1 January 1990, and 2 August 2023. Of 4,699 records, 212 were selected. Inclusion criteria were based on relevant comorbidities, outcomes, and study methodologies. The prevalence of severe RSV-associated disease, hospitalization risk, and mortality increased with age. Contributing factors for increased RSV infection susceptibility and morbidity in adults included immunosenescence, age-related physiological function decay, and presence of certain chronic conditions. Mechanisms underlying increased RSV susceptibility in those with chronic conditions included epithelial damage, inflammation, and direct or indirect myocardial damage. Vaccines for the prevention of RSV-associated lower respiratory disease in older adults have potential to prevent substantial morbidity and mortality. Immunosenescence and chronic medical conditions increase susceptibility of adults to RSV, yet knowledge gaps remain regarding RSV pathogenesis in chronic conditions. Recently approved RSV vaccines support preventive strategies for these individuals.The protocol for this study is PROSPERO registered (identifier: CRD42021293292). The purpose of this article is to bring together information on why older adults and those with chronic conditions are at increased risk of severe infection caused by a virus called respiratory syncytial virus (RSV). Almost everyone is infected by this virus before the age of 3 and re-infections happen repeatedly throughout life. Older adults experience worse symptoms from this virus than younger adults and are more likely to need hospital care and eventually die when they get sick from RSV. RSV can also interfere with the ability to work, to do household chores, and quality of life. Changes in the immune system and age-related deterioration in older adults can impair their ability to mount an adequate and protective immune response to various infectious agents, including RSV, and make them more vulnerable to severe disease. Adults with chronic conditions are also more likely to get severe disease from RSV due to their immune system not working as it should and damage to tissues in the lungs and heart. Three vaccines have recently been approved for use in multiple countries across the world, which have been shown to protect against respiratory illnesses caused by RSV, reducing the risk of developing such illnesses by more than 80% in the first season after vaccination. Unlike influenza vaccines, which are given each year, it is anticipated the RSV vaccine may be protective for multiple RSV seasons. National guidelines in several countries recommend vaccination against RSV in older adults, especially those with chronic conditions.
Parkinson's disease (PD) care remains profoundly unequal across and within countries, despite major advances in understanding and treatment. Drawing on PD specialists' personal stories of real-world experiences from diverse regions across Asia, Africa, and South America, this paper highlights the key barriers to equitable PD care and identifies pragmatic, scalable solutions. Across settings, several major barriers consistently emerge: a critical shortage and uneven distribution of trained specialists; geographic disparities limiting access to care; substantial financial barriers, particularly for comprehensive and advanced therapies; fragmented healthcare systems lacking integration and multidisciplinary support; and low public awareness and persistent stigma, leading to delayed diagnosis and treatment. Strategies to address these challenges include workforce development through training, mentorship, and international collaboration; bringing expertise and services closer to patients via outreach programs and the use of "simple" technologies such as telemedicine and mobile communication platforms; ensuring universal access to essential medications, particularly levodopa; integrating multidisciplinary care models; public awareness campaigns and support groups empowering patients and caregivers and reducing stigma; and embedding research into routine care. The experiences presented here illustrate that meaningful progress is achievable through pragmatic solutions, collaborative networks, and sustained commitment to patient-centered care. Working Towards Better Parkinson's Disease Care for All: Stories and Insights from Parkinson's Specialists across the GlobeParkinson's disease (PD) care is not equally available to everyone. Although there have been many advances in understanding and treating PD, many people around the world still struggle to get the care they need. This paper shares real-life experiences from Parkinson's doctors in Asia, Africa, and South America to better understand these challenges and explore practical solutions. Common problems seen across different countries include too few healthcare professionals with expertise in PD, especially outside major cities; difficulties travelling long distances to access care; the high cost of treatments; healthcare services that are not well connected or coordinated; and low public awareness of PD, which can lead to stigma and delays in diagnosis and treatment. Practical approaches to improve access to care include training more healthcare professionals, building local expertise through mentorship and international partnerships, and bringing services closer to patients through outreach clinics and simple technologies such as telemedicine and mobile messaging platforms. Ensuring access to essential medicines, especially levodopa, is also critical. Other important strategies include providing multidisciplinary care, raising public awareness, reducing stigma, and incorporating research into everyday clinical practice. The experiences described here illustrate that meaningful improvements in PD care are possible, even in limited-resource settings. Progress can be achieved through practical solutions, strong partnerships, and a continued focus on the needs of patients and their families.
Major depressive disorder is a leading cause of disability worldwide, with significant challenges in treatment response, adherence and functional recovery. Despite the availability of numerous antidepressants, a substantial proportion of patients fail to achieve remission with initial therapy, underscoring the need for effective first-line treatment options. Desvenlafaxine, a serotonin-noradrenaline reuptake inhibitor, has demonstrated efficacy and safety in major depressive disorder, while its pharmacokinetic properties result in minimal drug-drug interactions. This narrative review evaluates clinical evidence supporting the use of desvenlafaxine as a first-line treatment and examines patient subgroups that may benefit most from this antidepressant. A comprehensive literature review was conducted to evaluate the evidence on desvenlafaxine in the treatment of major depressive disorder. This was supplemented by clinical insights discussed during a virtual advisory board meeting held on 16 December, 2024, attended by the authors-psychiatrists from Italy, Germany, Spain, Ireland and Portugal-together with representatives from Neuraxpharm, who market desvenlafaxine. The available evidence suggests that desvenlafaxine offers early symptom relief, sustained efficacy across diverse major depressive disorder symptom clusters, and benefits for patients with anhedonia, fatigue, cognitive dysfunction and functional impairment. Its tolerability and safety profile, including a lower risk of weight gain and drug-drug interactions, contributes to its ease of use and improved adherence. Based on the authors' clinical consensus, desvenlafaxine may be particularly suitable for working-age adults, perimenopausal and menopausal women, those with general medical comorbidities or polypharmacy concerns, and individuals requiring an antidepressant with a broad mechanism of action. In addition, its predictable pharmacokinetics make it a practical choice in primary care settings. While most current guidelines typically recommend selective serotonin reuptake inhibitors as first-line treatment, the favourable tolerability profile and efficacy of desvenlafaxine across diverse symptom clusters may support its consideration as a first-line option in select patient populations. Depression is a common mental health condition that can seriously impact on a person’s daily life, work and relationships. Many people with depression struggle to find an effective treatment, and even when they do, side effects such as weight gain or sexual dysfunction can make it difficult to continue taking medication. Desvenlafaxine is a type of antidepressant known as a serotonin-noradrenaline reuptake inhibitor. It works by targeting two important chemical pathways in the brain—serotonin and noradrenaline—which help improve depressive symptoms. This article reviews the scientific evidence on how well desvenlafaxine works, how safe it is, and which patients may benefit most from it as a first-choice treatment for depression. This article is based on a review of the existing published literature and clinical insights from a meeting of psychiatry experts from different countries. The findings suggest that desvenlafaxine can provide relief from symptoms of depression early in treatment, is effective for patients with low energy, difficulty concentrating or lack of motivation, and is less likely than some other antidepressants to cause weight gain. Based on the available evidence and the experts’ experience, desvenlafaxine may be particularly useful for patients who take multiple medications as it has a lower risk of interactions with other drugs. While not suitable for everyone, desvenlafaxine may be a valuable option for many people with depression, particularly those who need quick symptom relief, actively employed adults, perimenopausal women, individuals with comorbid physical health conditions, and those who struggle with fatigue and cognitive problems.
The use of contraception is a key component of sexual and reproductive health, yet Lebanon still faces barriers that hinder the effective and equitable use of contraceptives and related reproductive health services. We aimed to determine the prevalence of contraceptive use, unmet need for family planning, demand for family planning satisfied with modern methods, and determinants of contraceptive use and modern contraceptive use among adults in Lebanon. We performed a national cross-sectional telephone survey study among adult men and women of reproductive age in Lebanon from January 2024 to July 2024. Determinants included demographic-, socioeconomic-, and health-related variables. Primary outcomes were the utilisation of any contraception method, long-acting reversible contraception methods, modern methods, and natural methods. We fitted adjusted survey-weighted logistic regression models, stratified by sex, for each determinant/outcome pair, and reported odds ratios and 95% confidence intervals as analytical outcomes. We included 3146 sexually active adults of reproductive age (mean age of 38.2 years, 43.4% female, 35.8% non-Lebanese, and 14.3% with pregnancy intentions). The prevalence of contraceptive use was 58.0%, with 31.3% of respondents using modern methods, 10.3% using long-acting reversible contraceptives, and 26.7% using natural methods. In terms of sex differences, 32.7% of women and 36.4% of men had unmet need for family planning, while 37.5% and 33.9% had their demand satisfied with modern methods, respectively. Age, nationality, marital status, employment status, self-rated physical health, depression, and food insecurity were associated with contraceptive use. Our results offer updated national estimates of the prevalence of contraceptive use among adults in Lebanon and point to inequities in contraceptive use. There is a need to strengthen sexual and reproductive health policies, and to implement national interventions that promote the use of modern contraceptive methods for everyone in need, irrespective of age, sex, nationality, marital, or socioeconomic status.
Concern about rising greenhouse gas levels is increasing, and the healthcare sector represents a substantial contributor to global carbon footprints. As a result, the development of more sustainable oncology practices has become an urgent call to action. Since more than half of cancer patients receive radiation therapy (RT), understanding its potential environmental impact is essential. The aim of the present study is to estimate the carbon footprint produced by RT in the context of prostate cancer comparing moderate and extreme hypofractionated treatments. Activity data for 100 prostate cancer patients treated with Varian Trilogy linear accelerator system were collected. Half of them underwent moderate hypofractionated RT (26 fractions) and half extreme hypofractionated RT (5 fractions). For each patient, the RT-related carbon footprint was calculated and differences between the two schedules were analyzed. The median carbon footprint for a moderate and an extreme hypofractionated treatment was 972.55 kgCO2e and 402.85 kgCO2e, respectively. The carbon footprint of extreme hypofractionated treatments was statistically lower compared to moderate hypofractionated treatments (p < 0.00001). Assuming that everyone traveled in an average-sized petrol car, the carbon footprint for patient travel represented the primary source of the carbon footprint, accounting for 81.3% and 91.6% of the total carbon footprint. These initial findings highlight that the biggest contributor to RT carbon footprint was patient travel. This result suggests how the adoption of extreme hypofractionated treatments may represent a possible way to reduce RT carbon footprint.