In recent years, the promotion of multidisciplinary care and the heightened focus on patients' physical and mental well-being have sparked increased research interest in the mental health burden associated with ophthalmic diseases. In response, we assembled a multidisciplinary team of ophthalmologists, psychiatrists, neurobiologists, and computer scientists to create a systematic and forward-looking overview aimed at guiding future research in both fundamentals of life sciences and brain-computer interface as well as clinical practice. This overview centers on mood disorders, the most prevalent psychiatric conditions among this population. We integrate evidence on the neural, humoral, and inflammatory mechanisms that connect eye disease to mood dysregulation, while also detailing the ocular manifestations typical of mood-disordered patients, including their unique features and underlying mechanisms. Furthermore, we catalog current and emerging ophthalmic and psychiatric diagnostic tools and therapeutic strategies. Finally, we propose a comprehensive multidisciplinary framework for screening, treatment, patient education, and long-term follow-up, providing researchers and clinicians with an evidence-based resource for integrated care.

Executive functioning (EF) challenges are common among autistic youth and persist throughout childhood and adolescence; they have been linked to important outcomes, including poorer mental health, adaptive skills, and overall quality of life. Despite the significance of EF in autism, few studies have examined the trajectory of EF challenges longitudinally, and those that have are constrained by small sample sizes, limited age ranges, and a focus on global EF at the expense of specific EF subdomains.

This study examines the trajectory of parent-reported EF flexibility, working memory, and inhibition challenges in autistic youth from early childhood to young adulthood and their relationship to parent-reported aggression, anxiety, and depression symptoms. Leveraging a longitudinal sample of 313 participants (age range = 2-25, 79 females, mean age at first visit = 9.5 ± 4.6 years, age range at first visit 2.6-23.1 years; mean FSIQ = 103.3, FSIQ range 52-159; mean number of visits per participant = 2.3, range 2-9) across 941 observations, multilevel growth curve modeling was used to examine the trajectory of EF challenges and their relationship to mental health across time.

We found that EF challenges persist in autistic people from 2 to 25 years old, regardless of cognitive ability and parent education level. Although symptoms of aggression decline with age, depression symptoms increase with age in this sample of autistic people. Notably, autistic females are at unique risk for increasing anxiety in adolescence. Flexibility challenges in particular predict mental health outcomes across anxiety, depression, and aggression symptoms.

These data demonstrate the enduring nature of EF challenges among autistic people during childhood and into young adulthood, as well as their influence on mental health. EF and flexibility, in particular, are potent and persistent yet malleable predictors of key outcomes, making them important targets for intervention.

Bone-derived cytokines have been implicated in glucose metabolism, but their role in type 1 diabetes mellitus (T1DM) is unclear. We investigated alterations in bone turnover markers (BTMs) and their associations with β-cell function and autoimmunity in T1DM.

This cross-sectional study enrolled 369 T1DM individuals and 150 matched controls. Serum BTMs, fasting C-peptide (FCP), HbA1c, glucose, and islet-autoimmune profile were measured. Analyses included group comparisons, linear regression, and Locally Estimated Scatterplot Smoothing (LOESS) to visualize the relationships of FCP and osteocalcin (OC) with disease duration. A logistic-regression model incorporating OC was developed to assess β-cell failure in participants at early stage of established T1DM.

Serum BTMs were significantly lower in T1DM versus controls, and lowest in the low-FCP subgroup. Only log_e-transformed OC (ln[OC]) remained independently associated with log_e-transformed FCP (ln[FCP]) after adjustment (β = 0.38, P = 0.036). LOESS modelling revealed biphasic FCP decline (rapid within 2 years, then slow), while OC rose initially, peaking at 2 years before declining. The positive ln[OC]-ln[FCP] association was significant only within 5 years post-diagnosis. In this early stage, OC also correlated with regulatory T cells frequency (r = 0.319, P = 0.009). A model combining OC, body mass index, duration, insulin dose, age, and glucose discriminated severe β-cell failure with an AUC of 0.83 (95% confidence interval: 0.77-0.89).

In early-established T1DM, OC independently associates with preserved β-cell function. Higher OC levels were accompanied by better β-cell function and an expanded regulatory T-cell pool, suggesting a potential role in the islet immune microenvironment.

Few policies have focused specifically on the growing burden of Non-Communicable Diseases (NCD) in Low- and Middle-Income Countries (LMIC). Health policy formulation plays a vital role in the allocation of resources to implement effective interventions and reforms; hence, a nuanced understanding of the health policy formulation process is essential. However, there is limited evidence about the process through which NCD policies were formulated in Nepal. This study used Kingdon's multiple streams framework to explore how NCDs were recognized and prioritized, how policy alternatives were decided, how policy windows were opened, and which contextual factors influenced the policy formulation process. A qualitative case study approach was applied to gain a comprehensive understanding of the formulation of major NCD-related policies in Nepal. Semi-structured interviews were conducted with 12 key stakeholders, and policy documents were analyzed using framework analysis. The NCDs were gradually recognized and prioritized through the convergence of global and local evidence, sustained advocacy, and international commitments. Policymakers encountered several challenges, such as competing health priorities, the chronic nature of NCDs, donor preferences for communicable diseases, financial constraints, and multisectoral complexities of NCDs. The Package of Essential Non-communicable diseases (PEN) interventions were adopted as a policy alternative, informed by global evidence, World Health Organization (WHO) recommendations, and lessons from other countries. While coordinated efforts by stakeholders brought the problem, policy and politics streams together, the role of policy entrepreneurs was found to be less relevant in Nepal's context. The findings highlight the need to consider external influences while conducting similar studies in LMICs. Further research is needed on strategies to address persistent structural and financial challenges in NCD policy formulation.

Metabolic dysfunction-associated steatotic liver disease (MASLD) and Type 2 Diabetes (T2D) are components of insulin resistance, but the prevalence of MASLD at the diagnosis of youth-onset T2D is unknown. We aimed to describe the prevalence of alanine aminotransferase (ALT) elevation, a biomarker for MASLD, in youth-onset T2D at diagnosis and after one year and investigate factors associated with ALT elevation.

A single-centre retrospective cohort study was conducted of patients (age ≤ 21 years) diagnosed with T2D between 1/1/2010 and 31/12/2021, with ALT available at diagnosis. ALT elevation was defined as being greater than 1.5 times the upper range of normal based on patient sex.

In the cohort (n = 438), 58% of patients had ALT elevation at T2D diagnosis. Hispanic patients had higher odds of ALT elevation than non-Hispanic Black patients (p < 0.001), and lower HbA1c at diagnosis was associated with higher odds of ALT elevation (p < 0.001). Among patients followed for one year (n = 141), the prevalence of ALT elevation decreased from 65% to 47%. ALT at diagnosis was not associated with a change in Haemoglobin A1C (HbA1c) from diagnosis to one year of follow-up, nor was HbA1c at diagnosis associated with a change in ALT.

ALT elevation is common at T2D diagnosis in youth. HbA1c is negatively associated with ALT elevation at diagnosis, but ALT and HbA1c at diagnosis did not impact the change in the corresponding marker at one year. The prevalence of elevated ALT varies between groups, and analysis of disease course within subpopulations is pertinent.

Cost pressures and limited access challenge the sustainability of Finnish primary care. Multidisciplinary team (MDT) models have been introduced, but evidence on cost and quality in Nordic settings remains limited.

To describe healthcare costs and glycaemic control in primary care centres implementing an MDT model versus usual care.

This quasi-experimental study included 11,124 patients from five intervention and three control health centres in Espoo, Finland. The MDT model redistributed tasks between nurses and physicians, emphasising remote consultations and proactive management. Retrospective data from primary and secondary care electronic health records (2021-2023) were analysed. Outcomes were annual per-patient costs (€) and the proportion of type 2 diabetes patients with HbA1c >53 mmol/mol. Differences over time were examined using regression models.

Baseline costs (2021) were similar between groups. Costs increased in both groups, but by 2023 combined per-patient costs were lower in MDT centres (4902 €) than in controls (6213 €). Primary care costs decreased slightly in intervention centres and increased in controls. Secondary care costs rose in both groups, with a steeper increase observed in control centres. Intervention centres showed a shift toward nurse-led and remote contacts with fewer physician visits. Glycaemic control remained stable in both groups. No clear differences were observed in continuity of care or avoidable hospital admissions.

MDT implementation was associated with lower cost growth over three years without compromising glycaemic control.