Cardiac hypertrophy refers to the compensatory response of the heart to various physiological or pathological stimuli in order to maintain its function. Let-7e-5p has been reported to be upregulated in patients with cardiac hypertrophy.

This study aimed to investigate the role of let-7e-5p in the progression of cardiac hypertrophy using animal and cell models.

Peripheral blood was collected from patients with cardiac hypertrophy and healthy controls to detect let-7e-5p expression via reverse transcription quantitative polymerase chain reaction (RT-qPCR). An aortic banding (AB)-induced cardiac hypertrophy rat model was established to explore let-7e-5p expression in vivo. Antagomir let-7e-5p was used to investigate the effects of let-7e-5p silencing on cardiac hypertrophy progression in an AB-induced rat model. Angiotensin II (Ang II) was used to induce hypertrophy in H9c2 rat cardiomyocytes in vitro. The downstream regulatory mechanism of let-7e-5p was investigated in H9c2 cells.

We first examined and verified that let-7e-5p was upregulated in blood samples from patients with hypertrophic cardiomyopathy (HCM) compared to healthy controls and showed good diagnostic performance according to receiver operating characteristic (ROC) analysis. In vivo, let-7e-5p was overexpressed in the heart tissues of AB-induced cardiac hypertrophy rats. Let-7e-5p deficiency alleviated AB surgery-induced cardiac hypertrophy in rat models. In vitro, let-7e-5p expression was higher in Ang II-induced H9c2 rat cardiomyocytes. Let-7e-5p inhibition reversed the Ang II-induced increase in cardiomyocyte size and the upregulation of ANP, BNP, and β-MHC expression, whereas let-7e-5p overexpression showed the opposite effects. Mechanistically, limb-bud and heart (LBH) was identified as a target of let-7e-5p, and LBH overexpression reversed the promotive effects of let-7e-5p on hypertrophy in Ang II-treated H9c2 cells. IGF-PI3K-AKT signaling was activated in Ang II-treated H9c2 cells, and let-7e-5p silencing suppressed its activation by targeting LBH. The IGF1R inhibitor PQ401 reversed the enhancement of H9c2 hypertrophy induced by let-7e-5p upregulation or LBH silencing.

Let-7e-5p promotes cardiac hypertrophy by targeting LBH and regulating the IGF-PI3K-AKT signaling pathway, which may provide novel insights into targeted therapy.

HIV-related stigma diminishes efforts to contain the HIV epidemic, as it compromises testing and access to quality services. Various HIV prevention and control measures have been put in place, including antiretroviral medications. However, HIV-related stigma still compromises human rights for people with HIV. We used the social ecological model to examine HIV-related stigma in a cross-sectional and multinational sample of 1,598 people with HIV. We found moderate HIV-related stigma, mainly related to concerns about HIV status disclosure and negative attitudes of the public. Overall HIV-related stigma and its dimensions were associated with factors at the individual, community, and structural levels of the social ecological model, with patterns of association depending on a given dimension of HIV stigma and contextual factors. The findings suggest that efforts to address HIV-related stigma need a comprehensive approach that considers not only people with HIV but also their immediate and distal social ecological environment.

Alcohol use is a leading cause of premature mortality in the US. Despite public health recommendations and insurance coverage mandates, alcohol screening and brief intervention (ASBI) in primary care remains underused.

To estimate the population-level impact of expanded ASBI delivery on alcohol use and potential years of life lost (YLL) from major alcohol-related causes of death in US adults through 2030, by sex, race and ethnicity, and educational attainment as a proxy for socioeconomic status.

This was a decision analytical study that used a dynamic individual-level microsimulation model of nationally representative of US adults (age ≥18 years) from 2000 to 2030 and considered sociodemographic variables, alcohol use, and mortality risks.

Four expansion scenarios increasing the annual number of eligible individuals receiving ASBI from 2025 to 2030: scenario 1, expanding alcohol screening (AS) only; scenario 2, expanding brief intervention (BI) by 4 million; scenario 3, expanding BI by 8 million; and scenario 4, universal ASBI delivery. Scenarios were compared with a no-expansion counterfactual assuming historical trends.

Prevalence of hazardous alcohol use (>20 or >40 g of alcohol per day for women and men) and YLL per 100 000 before age 75 years from 5 key alcohol-related causes of death (alcohol use disorder, liver disease and cirrhosis, motor vehicle injuries, other unintentional injuries, and suicide) in 2030.

The analysis of the microsimulation model found that scenario 3 (additional 8 million BI) and scenario 4 (universal ASBI) had the strongest impact on alcohol use and mortality, and were projected to reduce annual alcohol-related YLL per 100 000 by -51.3 (95% credible interval [CrI], -73.2 to -32.8) and -68.9 (CrI, -102.2 to -44.8) among men, respectively, and -34.1 (CrI, -54.5 to -16.1) and -52.0 (CrI, -75.0 to -30.2) among women, respectively, by 2030. In scenario 4, the gap in YLL from causes associated with alcohol use between low and high education narrowed by -3.5% (-64.5 YLL per 100 000; 95% CrI, -106.3 to -35.9) among men and -4.9% (-31.4 YLL per 100 000; 95% CrI, -56.2 to -12.4) among women.

In decision analytical model expanding ASBI delivery in primary care was projected to reduce premature mortality and may represent an important strategy for improving population health. Substantial expansion had measurable but modest potential to narrow socioeconomic inequalities in premature mortality from causes of death associated with alcohol use.

Prolonged wait times for outpatient psychiatric care are a persistent problem across health systems and have been exacerbated following the COVID-19 pandemic, particularly in community hospital settings with limited specialist capacity. Purpose. To describe and evaluate a psychiatrist-led telephone consultation triage pathway designed to optimize specialist time and reduce outpatient psychiatry wait times. A quality improvement initiative was implemented in November 2022 at a Canadian community hospital. A structured triage process was applied to all outpatient psychiatry referrals, with selected lower-complexity referrals redirected to alternative pathways or addressed through psychiatrist-led telephone consultations with primary care providers. Service-level metrics were examined descriptively. Between November 2022 and May 2023, 687 outpatient psychiatry referrals were reviewed. Of these, 495 (72%) were accepted for psychiatric assessment and 192 (28%) were redirected. Following implementation, psychiatrist-led telephone consultations increased from approximately one per month to 12-15 per month. Compared with standard 90-minute psychiatric assessments, telephone consultations averaged approximately 10 min. Average outpatient wait times decreased from approximately 10 months prior to implementation to approximately 6 weeks during the post-implementation period. A structured psychiatrist-led telephone consultation triage pathway was associated with improved access to outpatient psychiatric care in a community hospital setting. This pragmatic, low-cost approach may be relevant to other services facing similar post-pandemic pressures.

Older adults often turn to faith leaders for mental health support, yet many faith leaders have not received adequate training to provide this support. This study examined whether an online training course, Mental Health and Aging for Faith Leaders, can increase faith leaders' self-assessed competency related to mental health in older adults and prepare them to provide initial support to older adults with mental health concerns. This study also examined how the course might influence faith leaders' self-identified changes in practices. A total of 44 faith leaders from two cohorts completed the online course. Faith leaders showed a statistically significant increase in self-assessed competency with a large effect size (p < .001, Cohen's d > .80). Faith leaders also described wanting to make changes on the individual, interpersonal, organizational, and societal levels based on their training experience. Expanding access to this training will prepare more faith leaders to support older adult mental health. Future research should include participants with more religious diversity and explore ways to assist faith leaders as they turn their knowledge into action.

This pilot study evaluated the feasibility of hospital-based identification and preparation for a personalised, multidisciplinary tapering programme for long-term hypnosedative use in older adults with insomnia, focusing on implementation processes and patient-reported barriers rather than clinical efficacy.

This single-centre, prospective, interventional pilot study was conducted at Ghent University Hospital (Belgium). Patients aged ≥70 years using ≥1 hypnosedative for insomnia for ≥90 consecutive days were screened. Eligible participants received either a reimbursed tapering scheme or an individual tapering plan which was initiated after discharge. Both were developed collaboratively with the patient, hospital physicians, clinical pharmacist, general practitioner, and community pharmacist. Follow-up telephone interviews at four and twelve weeks assessed tapering adherence, self-reported barriers, fall incidents, and sleep quality.

Among 2860 screened patients, 30 were included (median age 77 years; 50% Male; 93.3% polypharmacy). At 12 weeks, 23.1% were actively tapering, and 19.2% had fully discontinued hypnosedatives. The most frequently reported barriers involved reflective motivation (62.9%), including (fear of) worsening sleep and deterioration in physical or mental health. Social opportunity barriers (22.8%) included limited support from healthcare professionals. Structural barriers included missing prescriptions and incomplete discharge instructions.

Deprescribing hypnosedatives in older patients within a hospital setting is complex and challenged by low recruitment, motivational, social, and structural barriers. Multidisciplinary strategies, education, and integrated care pathways are essential to enhance implementation. Policy measures, including broader reimbursement and shared electronic medication records could further facilitate safe deprescribing interventions.

To describe and benchmark the structure and service components of multidisciplinary cerebral palsy (CP) programs in North America.

This was a cross-sectional descriptive benchmarking study utilizing a convenience sample from North American member sites within the Cerebral Palsy Research Network. Structured presentations on care delivery with standardized extraction included: programmatic structure; clinical flow; data collection and program improvement; and service offerings. Site investigators confirmed accuracy of each center's extracted data. Free-text responses provided further context. Frequencies of the various aspects of service provision were calculated.

Eleven sites participated. Service delivery frequency was identified as foundational (present universally), core (present at 8-10 participating sites), or specialty (present at seven or fewer sites). Universal services included tone and orthotic management, access to therapies and equipment, orthopedic surveillance and surgery, neurosurgical procedures, and gait analysis. Specialty services included transition, adult, mental health, and reproductive care.

Based on representation in our cohort, we propose a checklist of foundational, core, and specialty features as benchmarks for individual CP programs. Although additional work is needed to assess widespread consensus, applicability, and utility, our findings provide a preliminary framework for standardizing service delivery for centers striving to provide comprehensive CP care.

Individuals experiencing structural vulnerabilities experience greater rates of serious illness and face barriers to accessing healthcare, including advance care planning. However, evidence to understand relevant barriers, facilitators, and effective interventions for advance care planning engagement among different structurally vulnerable populations remains fragmented.

To inform advance care planning interventions for structurally vulnerable patients by reviewing: barriers and facilitators to advance care planning; and advance care planning interventions.

Scoping review.

We searched MEDLINE, Embase, CINAHL, and PsycINFO for studies published between January 2003 and October 2024. Eligible studies examined advance care planning for those experiencing housing instability, poverty, racialization of Black or Indigenous race, serious mental illness, or substance use disorders.

From 70 included articles, 13 barriers, 13 facilitators, and 6 targets of intervention were identified. Barriers and facilitators were commonly experienced between multiple structurally vulnerable populations. The most common barriers include low advance care planning literacy, discomfort with conversations around mortality, personal, cultural and/or spiritual beliefs, and familial and social isolation. Common facilitators include trusted provider relationships, provider training and empowerment, social support, and tailored advance care planning content and delivery. We identified 27 interventions, most commonly involving advance care planning education and outreach or guided advance care planning.

Structurally vulnerable patients share many barriers and facilitators to advance care planning, which can inform interventions for underserved populations. Interventions targeting advance care planning education and outreach or guided advance care planning show promise if providers can incorporate advance care planning facilitators.

In the UK, media reporting has highlighted the impact of high infant formula prices upon parent wellbeing and feeding practices. We explored this issue through surveys (n = 261) and interviews (n = 20) with parents who were struggling to afford infant formula, and surveys (n = 137) and interviews (n = 21) with stakeholders in infant feeding, parenting and food insecurity. Almost all parents and stakeholders identified a detrimental impact upon parental mental and physical health, relationships, social and emotional wellbeing. Parents described feeling shame, anxiety and sadness, compounded if mothers wanted to breastfeed but could not. Some continued to breastfeed through pain whilst others stopped because they worried their diet was insufficient. To afford milk some parents reported restricting their own food or heating, returning to work early and getting into debt. Almost half sourced formula, including opened products, from social media marketplaces (46.0%) or bought formulas marketed for older babies (45.2%). Over a third (39.1%) reported using an unsafe feeding practice, including using leftover formula for a feed later (28.7%), reducing sterilisation (21.5%), and watering down feeds (13.8%). Many realised these were not recommended practices and felt guilty and anxious. Although a third were supported by Healthy/Best Start allowance, many families did not qualify for benefits or financial support and often had two working parents. Reduced maternity pay, high childcare costs and the broader cost-of-living crisis, affected affordability. Our data highlight an urgent need for intervention, including enhanced emergency provision pathways, stronger controls on formula marketing, infant formula price regulation, and enhanced breastfeeding support.

Opioid use disorder (OUD) remains a significant public health concern in Saudi Arabia; however, recent evidence describing patient characteristics and treatment outcomes in inpatient settings is limited. The objective of this study was to describe the demographic, clinical, and treatment profiles of inpatients with OUD and assess early post-discharge outcomes, following buprenorphine-based therapy.

This descriptive cross-sectional chart review was conducted at the Eradah Mental Health Complex in Riyadh, Saudi Arabia. Medical records of 22 male inpatients admitted between April and September 2024 with confirmed OUD alone or in combination with other substances were reviewed. Extracted data included socio-demographics, substance use history, comorbidities, withdrawal symptoms, treatment regimens, prevalence of polysubstance use, treatment types, discharge status, and six-month relapse or readmission rates.

The mean age of patients was 38.3 years. Most were Saudi nationals (n=13, 59.1%) and unemployed (n=19, 86.4%). Heroin was the most commonly used opioid (n=14, 63.6%). Polysubstance use was highly prevalent (n=20, 90.9%), with methamphetamine/amphetamine reported in 45.5% of patients (n=10). Withdrawal symptoms occurred in 68.2% of patients (n=15), with the most common being insomnia (n=10, 66.7%), muscle aches (n=8, 53.3%), and sweating (n=6, 46.7%). Medical comorbidities were documented in 45.5% (n=10). Buprenorphine/naloxone induction followed by transition to weekly long-acting injectable buprenorphine was the most common regimen (n=12, 54.5%). Planned discharges were documented in 63.6% of patients (n=14), while six-month readmissions occurred in 27.3% (n=6). Loss to follow-up was recorded in 22.7% (n=5).

This inpatient cohort showed frequent polysubstance use, medical comorbidity, non-employment, and prior treatment exposure. Buprenorphine-based opioid agonist therapy (OAT) was commonly used, including long-acting injectable formulations, but observed associations with discharge pathways are preliminary and should not be interpreted as causal or as evidence of treatment effectiveness. Larger multicenter studies with standardized follow-up are needed.