Dementia is a life-limiting condition, and a palliative care approach can improve both quality of life and quality of care for people living-and dying-with dementia. Research has consistently shown that, compared with other terminal conditions such as cancer, dementia is under-recognised and under-treated within palliative care systems. Considerable attention has been paid to this overall under-representation; however, further inequities exist within palliative dementia care research and practice itself. This position paper draws on an in-depth conversation with a person living alone with Alzheimer's disease and vascular dementia, alongside a critical engagement with existing literature. Using lived experience as a starting point, we identify two untapped dimensions of palliative dementia care: (1) barriers in palliative care conversations when a person with dementia attends clinical appointments unaccompanied; and (2) intersectional disadvantage arising from dementia, living alone, and health and social care systems that overly rely on informal carers or supporters. These contribute to exclusionary research practices that marginalise people living with dementia without close care partners. While the involvement of carers and supporters in shared decision-making should be encouraged when they are present, high-quality palliative care and research must not depend on their presence and should be equally accessible to people living with dementia who attend services alone. We argue that addressing this neglected area requires the meaningful involvement of people with lived experience in shaping both research agendas and clinical practice.

Mental health difficulties are highly prevalent worldwide. Digital mental health tools (DMHTs) have been developed to increase accessibility to mental healthcare for people who may struggle to access care due to cost, location or stigma. As the views of stakeholders are important in understanding the potential barriers to and facilitators of DMHT implementation, the aims of this review were to critically appraise and synthesise qualitative findings relating to the perceptions and/or experiences of healthcare professionals (HCPs) on the use of digital mental health tools in clinical practice.

A systematic search of mixed-method and qualitative studies was performed using five databases. Eligible studies were quality-assessed. Data were analysed using inductive thematic synthesis.

Fifteen studies were identified and reviewed. Four main themes (alongside eight subthemes) were developed from the data of 604 HCPs: 1) DMHTs should augment - not replace - face-to-face clinical care; 2) Considerations and caveats to use in clinical practice; 3) Using DMHTs to enhance clinical care; and 4) Perceived barriers and concerns.

HCPs strongly endorsed the view that DMHTs offer increased access to care, however, concerns about their therapeutic quality, risk management, and workload burden persist. Context-sensitive implementation and proper infrastructure are essential for successful integration into mental health services.

https://www.crd.york.ac.uk/prospero/, identifier CRD42020188879.

Currently, myopia affects approximately 1,406 million individuals, representing 22.9% of the global population. Emerging technologies are transforming eye care by providing innovative approaches to address the global challenge of myopia progression. Despite advancements in myopia control strategies, a comprehensive evaluation of the global landscape of emerging technologies remains an urgent priority.

The article search was conducted across PubMed, Scopus, PsycInfo, Web of science and Google Scholar databases. Titles, abstracts, and full texts were screened for inclusion independently by all authors, with discrepancies resolved through discussion. The findings are reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) extension for Scoping Reviews checklist.

A total of 28 articles were included in this scoping review. The majority of the included were randomized clinical trials (n = 10, 35.7%), with most conducted in China (n = 10, 35.7%). The study populations predominantly consisted of individuals less than 17 years of age. Several studies reported that Defocus Incorporated Multiple Segments (DIMS) spectacle lenses demonstrated outshining efficacy in controlling axial length growth and reducing myopia progression compared to alternative interventions.

This scoping review identifies emerging technologies show potential in managing myopia progression, further research is needed to determine their long-term safety profiles, optimize treatment protocols, and address regional disparities in access to these options.

Psoriasis and metabolic dysfunction-associated fatty liver disease (MAFLD) share pathological features such as chronic inflammation, immune dysregulation, and metabolic disturbance. Increasing evidence suggests biological crosstalk between the two conditions, offering new insights into their shared mechanisms and comanagement. Early-stage MAFLD, characterized by hepatic steatosis without evident inflammation or fibrosis, provides a crucial window for intervention. This study aimed to identify early diagnostic biomarkers linking psoriasis and MAFLD.

Transcriptomic datasets of psoriasis and MAFLD were retrieved from the Gene Expression Omnibus (GEO) database. Weighted gene co-expression network analysis (WGCNA) was used to identify MAFLD-related modules. Shared genes were obtained by intersecting module genes with differentially expressed genes (DEGs) from psoriasis datasets. Machine learning algorithms, including random forest (RF), least absolute shrinkage and selection operator (LASSO), and support vector machine (SVM), were applied to identify hub genes. Diagnostic performance was evaluated using receiver operating characteristic (ROC) analysis, immune infiltration assessment, Spearman correlation, and experimental validation in psoriasis and MAFLD mouse models.

Twenty-nine shared genes were identified and found to be enriched in immune and metabolic pathways. Six hub genes-ADRB2, WNT5A, S100A9, FAM110C, S100A12, and TUBB6-were selected through integrated machine learning analysis and experimental validation. These genes exhibited high diagnostic accuracy and significant correlations with disease severity and immune cell infiltration.

This study identified six hub genes-ADRB2, WNT5A, S100A9, FAM110C, S100A12, and TUBB6-as potential cross-disease biomarkers for the comorbidity of psoriasis and MAFLD, and these genes are significantly associated with disease severity. These findings provide new targets for early diagnosis and potential treatment strategies for the comorbidity.

Living in socioeconomically deprived areas has been linked to poorer health outcomes, with older adults potentially more vulnerable due to cumulative environmental exposure. This study examined the association between neighbourhood socioeconomic deprivation and cognitive decline among older adults in Porto, Portugal.

We used data from 486 participants aged ≥50 years in the EPIPorto cohort, each with at least two cognitive assessments between 2005 and 2018. Neighbourhood deprivation was measured using the Portuguese European Deprivation Index; cognitive function was assessed with the Mini-Mental State Examination. Missing data were addressed using multivariate imputation (mice package), and associations were estimated via linear mixed-effects models (lme4 package).

The average cognitive decline was -0.60 points between assessments (95% CI: -0.82 to -0.37). In unadjusted models, higher neighbourhood deprivation was associated with faster decline (β = -0.18; 95% CI: -0.29 to -0.06), but this was not significant after adjustment (β = 0.00; 95% CI: -0.11-0.12). Greater decline was significantly associated with older age, female sex, and lower education.

Findings highlight the role of individual sociodemographic factors but indicate no significant association with neighbourhood deprivation.

Undocumented immigrants are a highly vulnerable population, frequently exposed to violence and trauma in their country of origin, along the migration journey, and in the host country. This study investigates which factors experienced before, during, and after migration influence the development of post-traumatic stress disorder (PTSD). It also investigates whether PTSD relates to high-risk health behaviors in France.

We relied on a survey representative of undocumented immigrants attending facilities providing assistance to vulnerable populations in Paris and Bordeaux (France). Analyses relied on several multivariate probit models (N = 1,060).

Overall, 54.1% of respondents experienced at least one traumatic event, and 17.2% currently suffer from PTSD. Factors associated with an increase probability to develop PTSD are: coming to France for safety reasons (before migration), entering France without appropriate documentation (during migration), food insecurity and poor housing conditions (after migration). PTSD is also associated with an increase probability to engage in high-risk alcohol consumption.

Although pre-migration factors cannot be addressed by destination-country policies, our findings suggest that interventions targeting deprivation may help reducing PTSD and substance use among undocumented immigrants.

Policy Points The One Big Beautiful Bill Act (OBBBA) may impose the largest coverage losses in US history, causing the number uninsured to rise by 55% in the coming decade. We examined four prior coverage contractions-Reagan-era Medicaid cuts, the 2005 TennCare disenrollment, 2019 Arkansas work requirements, and the Medicaid Unwinding-to shed light on the OBBBA's impacts. These suggest that most who lose Medicaid do not find alternative coverage, and that states are unlikely to compensate for federal cuts, findings that run counter to some assumptions adopted by the Congressional Budget Office in predicting the impacts of Medicaid cuts. Studies of coverage contractions complement data from coverage expansions in predicting worse health care access, household finances, and health for needy individuals due to the OBBBA. Studies also suggest that the magnitude of harms from contractions may exceed that suggested by expansions.

The so-called One Big Beautiful Bill Act signed into law by President Trump on July 4, 2025 will cut $1 trillion from federal health care programs over the coming decade and cause 10 million individuals to become uninsured according to the Congressional Budget Office. Most analyses of the bill's impacts have assumed they would be the inverse of those documented from previous coverage expansions. An examination of past coverage cuts might yield additional insights into the probable impacts of this legislation on the medical care and health of the needy.

We reviewed studies of four prior large scale coverage contractions: Reagan-era Medicaid cuts, the 2005 Tenncare Disenrollment, the 2019 implementation of work requirements in Arkansas, and the postpandemic "Unwinding" of Medicaid.

The experience of these prior coverage contractions complements evidence from analyses of coverage expansions in predicting that widespread insurance loss will lead to a reduction in care utilization, an increase in household financial strain, and worsened physical and mental health for low-income individuals. These coverage contractions additionally suggest that most who lose Medicaid coverage will not find alternative coverage; that work requirements will impose burdensome administrative costs on states; that states are unlikely to offset reductions in federal Medicaid funding with internal funds; and that the second-order effects of coverage losses may, in some instances, be greater (in magnitude) than the benefits seen after coverage expansions.

Cuts to federal health care programs will produce sharp contractions in public coverage that will worsen existing problems in US health care such as insurance churn, degrading care, and worsening health inequality. While states may take some steps to mitigate harmful impacts, better protection of the medically needy would require repeal of the legislation, while full protection would require universal, seamless coverage.

Severe mental illness (SMI) is associated with substantial barriers to competitive employment, including stigma, cognitive impairments, and limited social support. The Individual Placement and Support (IPS) model is an evidence-based intervention that provides individualized assistance for job search, placement, and retention. Although IPS has shown effectiveness in high-income countries, there is limited evidence regarding its feasibility and preliminary outcomes in low- and middle-income settings, particularly in Latin America.

This pilot randomized controlled trial will assess the feasibility of implementing the IPS model for adults with SMI in Jalisco, Mexico. We will recruit 120 participants who are actively seeking employment and randomly assign them to either the IPS intervention or a control group receiving standard employment services. The intervention includes tailored support from trained IPS Employment Specialists in resume building, interview preparation, job search, and follow-up after job placement. Primary feasibility outcomes include recruitment and retention rates, participant acceptance, implementation fidelity, and identification of contextual barriers and facilitators. Secondary outcomes will explore employment status at 12 months, financial well-being, and health-related outcomes.

Findings from this pilot study will contribute to addressing the current gap in implementation research on IPS in Latin America. Findings will offer preliminary insights into the feasibility, acceptability, and contextual adaptability of the model in a public mental health setting. These results are expected to guide the refinement of study procedures and support planning for a future definitive trial. Additionally, exploratory data on employment and quality of life outcomes may help identify relevant domains for further investigation.

ClinicalTrials.gov NCT06019247. Registered on August 31, 2023.

Regular physical activity confers substantial cardiovascular benefits, yet it may in rare cases precipitate sudden cardiac arrest (SCA) or sudden cardiac death (SCD) in predisposed individuals. Although preventive frameworks have largely targeted competitive athletes, the rapidly expanding population of recreational participants remains insufficiently addressed.

Recreational athletes have a low but significant incidence of SCA/SCD (0.02 to 13 per 100,000 person-years). Coronary artery disease is most common in middle-aged individuals, while inherited cardiomyopathies account for fewer cases.

Contemporary preparticipation evaluation for recreational athletes has shifted from universal electrocardiogram-based screening to a risk-stratified, individualized approach emphasizing cardiovascular assessment, symptom recognition, and selective testing based on exercise intensity. Digital and wearable technologies are under evaluation to support symptom-triggered assessment and cardiac rhythm documentation; however, their effectiveness for preventing sports-related SCA/SCD and their optimal clinical workflows remain unproven.

Risk-based, symptom-driven preparticipation evaluation enhances safety, reduces unnecessary testing, and promotes lifelong participation in recreational sports.

Military-civilian reintegration represents a multidimensional transition, with 47 to 75% of Veterans reporting reintegration challenges. Emerging research suggests that challenges related to purpose in life, social connection, and financial stability are associated with suicide risk and broader well-being outcomes among Veterans. Guided by a normative transitions theory framework integrating psychosocial challenges (M-CARM) and enrichment (ELS), this cross-sectional study examined reintegration among 410 post-9/11 Veterans. Secure housing loss and unmet mental health needs were associated with multiple reintegration outcomes including Genuine Relationships, Sense of Purpose, Resentment and Regret, and Mental Health. A higher VA disability rating was associated with lower Physical Health and Engaged Citizenship. Unmet mental health needs were inversely associated with seven of nine reintegration outcomes. These findings underscore the value of multidimensional assessment and highlight the importance of housing stability, mental health needs, and broader reintegration challenges. Longitudinal research is needed to clarify how psychosocial challenge and enrichment interact over time and how challenges and enrichment may inform reintegration support and suicide prevention efforts.