Optimal dementia risk reduction strategies benefit from sufficient public knowledge of risk factors and risk perception, but current public awareness is uncertain.

In a systematic literature review on public knowledge and perception of dementia risk factors, we searched relevant databases for original research articles until 2024. When possible, we pooled study results using random effects meta-analysis, and explored sources of heterogeneity through meta-regression. Qualitative studies and studies about risk perception were analysed using narrative synthesis.

Of 4996 articles screened, 155 were eligible for inclusion. Of these, 125 reported on knowledge of risk factors and 50 on risk perception, jointly providing data from 164,644 participants in 41 countries across 6 continents. Recognition of the 28 queried risk and protective factors was moderate, somewhat higher for lifestyle factors (medians: 38.5-71.5%) than for cardiovascular (9.9-66.9%) and environmental (25.4-44.4%) factors, but with large heterogeneity across queried factors. With the exception of physical activity (71.5%, IQR:46.9-88.3%), social isolation (66.6% [23.7-84.0%]) and traumatic brain injury (65.0% [18.0-76.7%]), recognition of all established modifiable risk factors for dementia from prespecified lists was below 50%, lowest for education (19.5% [7.8-54.9%]), air pollution (25.4% [16.3-41.0%]), and obesity (30.4% [27.0-43.0%]). Recall of risk factors (7 studies) was markedly lower than recognition. Meta-regression analyses showed no consistent differences by year of publication, or by participants' age, gender, and educational attainment. Among 23 qualitative studies, limited knowledge emerged particularly regarding dementia-specific risk factors like hearing loss. Perceived risk was measured inconsistently across studies, but was generally moderate to high, along with notable worry about dementia in a large part of the older population.

Knowledge of dementia risk and protective factors in the general population remains limited. These findings call for population-level interventions, including educational campaigns, to enhance preventive strategies.

Depression and anxiety are common in chronic eye diseases, and the psychological implications of symptomatic vitreous opacities (SVO) remain underexplored. This systematic review synthesized current evidence on the psychological burden of SVOs and the extent to which interventions confer psychological benefit.

Although SVOs typically occur with normal visual acuity, many patients with vision-degrading myodesopsia (VDM) report significant distress, impaired well-being, and measurable degradation of contrast sensitivity. Understanding the magnitude of this burden and the potential psychological benefits of available treatments is important for clinical decision-making and patient counseling.

In June 2025, Medline, Embase, and the Cochrane Library were searched. Eligible studies assessed outcomes related to mental health, depression, anxiety, personality, quality of life, coping, and/or patient experiences or perceptions of vitreous opacities or their treatment. The protocol was prospectively registered in PROSPERO (CRD420251243887). The primary outcome was psychological burden relative to healthy controls; secondary outcomes included psychological changes following Nd:YAG vitreolysis or pars plana vitrectomy. Given substantial heterogeneity in study design and psychological instruments, findings were synthesized descriptively.

Thirteen studies met inclusion criteria, encompassing 635 patients aged 18-88 years across Europe, Asia, and the Americas. Across study designs, individuals with SVO reported significantly higher levels of depression, anxiety, and perceived stress than healthy controls, despite preserved visual acuity. Standardized instruments (NEI-VFQ, PHQ-9, CES-D, HADS, Zung SDS, GAD-7, STAI, PSS-10) consistently showed elevated psychological symptom scores and lower mental health-related quality-of-life scores. Personality assessments (BFI) revealed greater neuroticism and lower extraversion in patients with SVO. Interventional studies with Nd:YAG laser vitreolysis and pars plana vitrectomy demonstrated improvements in vision-related QoL and psychological well-being.

SVOs commonly present with a psychological overlay that affects emotional well-being. Our findings raise the possibility of a visual somatization component in psychologically vulnerable individuals, whereby vitreous changes may contribute to heightened anxiety or distress. Recognizing that traditional clinical metrics such as visual acuity may underestimate functional impairment supports the need for psychological screening, patient-centered counseling, and integration of validated floater-specific outcome measures alongside psychological endpoints.

To evaluate if there is an association between periodontal diseases (gingivitis and periodontitis) and adverse childhood experiences (ACEs) and further to evaluate the association between ACEs and tooth loss as the number of missing teeth has been recognised as a surrogate measure of periodontitis DATA SOURCES: Following comprehensive electronic (Pubmed, Web of Science, Scopus and PsycInfo) and manual literature searches until August 2024, the studies that measured ACEs and reported periodontal disease or tooth loss were included. Two independent reviewers assessed the risk of Bias of the included studies using Effective Public Health Practice Project Quality Assessment tool (EPHPP). A meta-analysis was performed using SPSS version 28 with a random effect model to pool odd's ratios and leave-one-out sensitivity analysis. Further meta regression was conducted to examine if gender moderated these associations.

Two reviewers screened 956 titles and abstracts, included 9 studies (108,609 participants) in the systematic review and 8 studies in the meta-analysis. The overall effect size for the association between ACEs and periodontal disease outcomes was 2.41 (95% CI 1.42 - 3.39, p<0.001), and for tooth loss was 2.01 (95% CI1.25-2.76, p<0.001) such that individuals exposed to childhood trauma were twice as likely to have periodontal disease or tooth loss compared to individuals not exposed to childhood trauma.

This meta-analysis found a low-quality evidence for association between ACEs and indicators of periodontal diseases. However, future studies should use longitudinal study designs and investigate the underlying mechanisms to clarify causal relationships and identify intervention opportunities.

Individuals exposed to Adverse Childhood Experiences (ACEs) are likely to have periodontal disease or tooth loss compared to individuals not exposed to ACEs. Further it is important to collaborate with mental health professionals for effective comprehensive patient management.

Temporal interference (TI) stimulation offers a noninvasive neuromodulation technique for targeting deep brain structures while sparing overlying cortical tissue. While early applications have validated TI's capacity to engage subcortical targets such as the hippocampus and striatum, the frequency-dependent mechanisms governing its efficacy remain poorly understood. This is particularly critical for the nucleus accumbens (NAc), a key hub in reward circuitry where invasive deep brain stimulation (DBS) typically operates at high frequencies (∼130 Hz).

In this study, we investigated whether TI stimulation induces frequency-specific modulation of NAc activity and its functional coupling with the prefrontal cortex. Using a within-subject, counter-balanced design, we applied individualized NAc-targeting TI stimulation at three distinct envelope frequencies (5 Hz, 40 Hz, and 130 Hz) in 24 healthy adults. Resting-state functional MRI was acquired pre- and post-stimulation.

Results revealed a distinct dissociation between local and circuit-level effects: TI stimulation induced no statistically significant changes in local spontaneous activity within the NAc across any frequency condition. In contrast, 130 Hz stimulation selectively reduced functional connectivity between the NAc and the medial prefrontal cortex (mPFC), whereas 5 Hz and 40 Hz conditions produced no such effect. Notably, despite the absence of significant group-level local modulation, the magnitude of individual NAc activity reduction under 130 Hz stimulation was significantly correlated with the extent of NAc-mPFC decoupling (r = -0.53). Exploratory analyses further revealed increased activity in the adjacent dorsal striatum (right putamen), consistent with a conduction-block model at the target core.

These findings suggest that high-frequency TI mimics the network-disrupting effects of high-frequency DBS, offering evidence that TI can noninvasively modulate deep reward circuits in a parameter-specific manner for potential clinical application.

Epilepsy is a chronic neurological disorder that frequently leads to physical injuries during seizures, posing both clinical and psychosocial challenges for affected individuals. This study aimed to investigate the frequency, types, severity, and anatomical distribution of injuries among patients with epilepsy, and to assess their impact on Quality of Life (QoL).

In this observational study, 126 adult patients diagnosed with epilepsy at a tertiary epilepsy referral center were prospectively analyzed. Sociodemographic, clinical, and trauma-related data were collected using structured questionnaires. Injury severity was categorized as major (requiring inpatient or surgical care) or minor (outpatient or no admission). The Short Form-36 (SF-36) questionnaire was administered to assess QoL. The relationship between QoL and trauma characteristics was examined to identify factors associated with reduced QoL.

Seizure-related physical injuries (SRPI) occurred in 56 patients (44.4%), most commonly involving the head (78.6%), followed by the shoulder, foot, and hand. Of these, 14% required inpatient or surgical treatment. Sixteen patients (29%) developed chronic sequelae, including persistent pain, deformities, or restricted motion. Patients with SRPI reported significantly lower SF-36 scores across all domains compared to those without injuries, with the largest declines observed in physical functioning, general health, and bodily pain. Within the injured group, patients with sequelae demonstrated markedly lower QoL scores, particularly in Physical Functioning (p = 0.024), Mental Health (p = 0.024), Social Functioning (p = 0.014), and General Health (p < 0.001).

Seizure-related physical injuries are common in epilepsy and significantly impair Quality of Life, especially when chronic sequelae develop. Preventive measures, early rehabilitation, and standardized injury management protocols are essential to reduce long-term disability and improve outcomes in this population.

This study aimed to assess the efficacy and safety of intensity-modulated radiotherapy (IMRT) combined with regorafenib with or without immune checkpoint inhibitors (ICIs) as a second- or later-line treatment for advanced hepatocellular carcinoma (HCC).

Patients diagnosed with advanced HCC who had received RT combined with concurrent or sequential regorafenib treatment or regorafenib plus ICIs after failures of at least one line of systemic treatment in a single center from April 2018 to August 2022 were retrospectively reviewed. Progression-free survival (PFS) was the primary endpoint, while overall survival (OS), objective response rate (ORR), disease control rate (DCR), and toxicity were the secondary endpoints.

Fifty patients were included, with 44 (88.0%) in BCLC stage C, 37 (74.0%) having portal vein tumor thrombosis (PVTT), and 12 (24.0%) with extrahepatic metastasis. Thirty-eight patients received conventional fractionated RT (56.4Gy/22-28f), while 12 received hyperfractionated RT (50Gy/5-10f). Twenty-six were treated concurrently with regorafenib and 24 sequentially. ICIs were applied in 34 patients. For the entire cohort, when measured from the start of RT initiation, the median PFS and OS were 10.9 months and not reached. The corresponding 2-year PFS and OS rates were 25.3% and 53.5%, respectively. When assessed from regorafenib initiation, the median PFS and OS were 5.9 months and not reached, with 2-year PFS and OS rates of 22.8% and 54.9%, respectively. For tumors in the RT field, the ORR was 74.0% (RECIST) and 92.0% (mRECIST). The most common grade 3 toxicities were hand-foot syndrome (16.0%), thrombocytopenia (8.0%), dermatitis (8.0%), and transaminase elevation (6.0%).

IMRT concurrently or sequentially combined with regorafenib with or without ICIs is an effective, well-tolerated, and promising regimen as second-line or further-line treatment in patients with advanced HCC.

With the burden of diabetes rising in Australia, it is important to understand the challenges for rurally based health practitioners to achieve credentialling as a diabetes educator.

This is particularly relevant in rural and remote Australia with the shortage of credentialled diabetes educators and the great burden of disease.

Participants were credentialled diabetes educators (25), health practitioners in the process of credentialling (5), health practitioners who did not complete credentialling (7), and diabetes education academics teaching the qualification required before credentialling (9).

Using qualitative research methods, relevant practitioners involved in credentialling were interviewed. The interviews explored hurdles for rural-based diabetes educators in achieving credentialling given the required clinical hours and the absence of available local mentors. Interviews were transcribed and thematic analysis followed established methods to ensure research rigour.

Participants described challenges, highlighting an inequitable credentialling process for rural health practitioners. Issues included the inadequacy of material explaining the credentialling process at the time of enrolment, challenges finding mentorship support and gaining sufficient clinical experience for credentialling in a rural context, issues with recording credentialling activities, challenges with distance, and finding available jobs due to the ambiguous scope of practice of credentialled diabetes educators, particularly for allied health professionals.

The findings inform potential improvements for diabetes educator credentialling and offer insights into how processes could be improved to support development of a strengthened rural and remote-based diabetes educator workforce.

Metabolically-dysfunction-associated steatohepatitis (MASH) is the progressive form of metabolic dysfunction-associated steatotic liver disease (MASLD) and is strongly linked to obesity and type 2 diabetes mellitus (T2D). Tirzepatide, a dual glucose-dependent insulinotropic polypeptide (GIP)/glucagon-like peptide-1 (GLP-1) receptor agonist, has emerged as a promising therapeutic option due to its profound metabolic effects and potential hepatic benefits. This study integrates bibliometric mapping with current clinical evidence to evaluate tirzepatide's role in MASLD/MASH.

A bibliometric search was conducted in the Web of Science Core Collection (2018-2025) using predefined keywords related to tirzepatide and metabolic liver disease. Twenty-five full-text publications-including randomized controlled trials, post hoc analyses, meta-analyses, mechanistic reviews, and international guidelines-were systematically reviewed. Co-occurrence networks were generated using VOSviewer.

Scientific output on tirzepatide and MASLD/MASH has increased rapidly since 2020, with thematic clusters centered on metabolic regulation, hepatic inflammation, and fibrosis. Clinical evidence shows that tirzepatide induces substantial weight loss, improves glycaemic control, and reduces hepatic biomarkers such as ALT, AST, K 18, and Pro C3. The SYNERGY-nonalcoholic steatohepatitis (NASH) trial demonstrated high rates of MASH resolution without fibrosis worsening and meaningful fibrosis regression at 52 weeks. Network meta-analyses position tirzepatide among the most effective therapies currently available. Recent EASL-EASD-EASO guidelines recommend tirzepatide for MASLD patients with obesity, T2D, or cardiometabolic risk.

Tirzepatide combines potent metabolic effects with significant hepatic improvements, positioning it as a promising therapy for MASLD/MASH. Although long-term and phase III data are still needed, current evidence supports tirzepatide as a key component of modern metabolic liver disease management.

Immunotherapy and targeted therapy can yield durable responses in metastatic cancer but introduce prognostic uncertainty and distress resembling that of patients with a limited life expectancy. Managing Cancer and Living Meaningfully (CALM) is a brief, flexible psychotherapy designed for advanced-stage patients and may also benefit treatment responders.

To qualitatively assess how patients with metastatic lung cancer or melanoma experience life after responding to immunotherapy or targeted therapy, and to capture their perspectives on receiving CALM psychotherapy.

Twenty-two patients with metastatic lung cancer or melanoma and a confirmed therapy response began CALM as part of a larger study in the Netherlands. One year later, 20 were alive; 17 agreed to a semi-structured interview. Two researchers independently conducted thematic analysis of the transcripts.

Four themes described becoming a responder: a twilight zone between health and illness, living in ongoing uncertainty, struggling to adapt, and a shift over time. Five themes emerged on CALM: a safe place to process cancer, resolving relational strain, navigating illness, being seen as a whole person, and an invitation to discuss mortality. Most participants found CALM helpful. They valued the invitation to address mortality, but felt ambivalent, acknowledging its importance yet lacking urgency unless progression loomed.

Treatment responders face a shifting identity and enduring uncertainty as they adjust to life after a response. CALM can offer a support framework for those who struggle to establish a new equilibrium. Nonetheless, addressing mortality remains challenging when the timing of disease progression is unpredictable.