Objective: To explore danish adolescents' experiences of Family-Based Treatment (FBT) for anorexia nervosa (AN). Method: Individual semi-structured interviews were conducted with 15 adolescents (13 females, mean age 15.8 years) at the end of treatment and analysed via inductive reflexive thematic analysis. Result: Three overarching themes were generated through analysis: Losing Control - Gaining Freedom captured adolescents' initial distress at relinquishing responsibility for renourishment to parents, later experienced as liberating, as parental oversight countered AN and restored agency. The Difficult Trust reflected how AN itself complicated trust, with adolescents feeling that others did not always believe or trust them. From Conflict to Closeness described evolving parent-child relationships, showing that early conflicts gave way to strengthened bonds, particularly with the parent who assumed primary responsibility, as collaborative engagement fostered improved communication and mutual understanding. Overall, early distress coexisted with long-term gains in autonomy and familial closeness. Conclusion: By the end of treatment, adolescents came to recognize the rationale and value of parental responsibility for renourishment in FBT, reporting that it facilitated recovery while strengthening relationships. The findings emphasize the importance of trust, safe therapeutic spaces, and active involvement from both parents, and highlight a need for targeted adaptations for transitional-age youth.

Electroconvulsive therapy (ECT) is an effective intervention for treatment-resistant depression (TRD). Although prior studies have identified cerebellar functional alterations following ECT, cerebellar-cerebral functional connectivity (FC) changes remain insufficiently explored.

Cerebellar seeds were defined based on prior connectivity studies, targeting cerebellar regions functionally coupled with executive, default-mode, and affective-limbic networks. Seed-based cerebellar-cerebral FC analyses were conducted using neuroimaging data from 72 patients with TRD (52 of whom completed post-ECT assessment) and 63 healthy controls (HCs). Correlation analyses assessed clinical associations, and support vector regression was applied to predict treatment response using baseline FC. Neuroimaging-transcriptomic association analyses were conducted to identify gene expression patterns correlated with post-ECT FC alterations.

Compared to HCs, patients with TRD exhibited decreased cerebellar connectivity with the sensorimotor network (SMN) and the default-mode network (DMN). Following ECT, TRD patients showed significant alleviation of depressive symptoms, which was accompanied by a marked increase in cerebellar-DMN connectivity. Enhanced FCs between the left Crus II_Exec2 and the bilateral medial superior frontal gyrus were positively correlated with Hamilton Depression Rating Scale (HAMD) score reduction (r = 0.343, P = 0.026). Additionally, baseline FC of the left Crus II_Exec2 significantly predicted HAMD reduction (r = 0.412, P < 0.001). Neuroimaging-transcription association analysis revealed these FC alterations were associated with normative gene patterns enriched in synaptic signaling, ion channel, and chromatin remodeling.

TRD is associated with reduced cerebellar-SMN and cerebellar-DMN connectivity. ECT may enhance cerebellar-DMN connectivity, potentially contributing to antidepressant effects.

Substance use disorders are associated with an elevated risk of self-harm. Currently, clinical and structured assessment of self-harm risk typically relies on evidence from the general population samples. The aim of this study was to develop a risk model for self-harm that incorporates predictors specific to individuals with substance use disorders.

Using national registers, we identified a population-based cohort of 449 720 individuals with substance use disorders in Sweden between 2006 and 2020. We tested independence and strength of a range of socio-demographic and clinical factors, obtained through linkage of population-based registers, with a Cox proportional hazards model, and estimated the risk of self-harm. For the risk model, 361 120 individuals were allocated to the development sample and 88 600 to external validation based on different geographical regions. We assessed self-harm risk over five predetermined follow-up periods-within 7 days, 1 month, 3 months, 6 months and 12 months-following a healthcare contact for substance use disorders.

In the development sample, self-harm rates ranged from 0.6% to 3.5%, and in the validation sample from 0.5% to 3.6%. Ten risk factors were retained in the final risk model. Strongest associations with subsequent self-harm were for clinical factors: previous self-harm [hazard ratio (HR) = 3.17, 95% confidence interval (CI) = 3.08-3.26] and comorbidity of mental disorders (HR = 2.63, 95% CI = 2.50-2.72). Recent psychotropic medication use, including antidepressant (HR = 1.29, 95% CI = 1.23-1.38) and antipsychotic treatments (HR = 1.34, 95% CI = 1.24-1.44), was associated with increased risk, even after adjusting for psychiatric comorbidity, likely reflecting greater clinical severity and complexity. Across follow-up periods, performance was good in terms of discrimination, with area under the curve (AUCs) ranging from 0.73 (95% CI = 0.71-0.76) to 0.79 (95% CI = 0.78-0.80). In relation to calibration, expected-to-observed risk ratios were 1.00 to 1.04 and Brier scores 0.01 to 0.04 across follow-up periods. We used the model to generate a simple web-based risk calculator [Oxford Self-hArM after substance use disorders (OxSAMS)].

Modifiable clinical factors appear to have the strongest associations with increased risk of self-harm in people with substance use disorders. Structured tools, taking account of the different strengths of those factors, could inform clinical decision-making and provide a baseline assessment for training and research.

In a randomised open-label trial among hospitalised patients with atherosclerotic vascular disease, motivational smoking cessation counselling with proactive referral to community-based follow-up was more effective than brief cessation advice and written information, with 6-month continuous abstinence rates of 49.5% vs. 24.5%. This study aimed to estimate the cost-effectiveness of this intervention compared with brief cessation advice.

Economic evaluation alongside a multicentre, randomised open-label, blinded-endpoint trial with 1:1 randomisation.

Three secondary care hospitals in Norway. Recruitment took place from November 2021 to October 2023.

Hospitalised patients aged 18 years or older with established atherosclerotic vascular disease who reported smoking at least one cigarette daily before admission were eligible for participation, regardless of whether admission was planned or unplanned. A total of 221 patients were randomised. One participant withdrew informed consent and was excluded from all analyses, leaving 220 participants in the economic evaluation. The cohort comprised 40% women and the mean age was 65.2 years.

Intervention costs included staff training, materials and personnel time. Hospital costs during the 16-month follow-up were estimated using Diagnosis-Related Group cost weights. Survival beyond follow-up was extrapolated using national mortality data adjusted for age, sex and atherosclerotic vascular disease. Lifetime costs were estimated using mean costs from the final six months of follow-up. The primary economic outcome was net monetary benefit (NMB), calculated at a willingness-to-pay threshold of €38 346 per life-year gained. The incremental cost-effectiveness ratio was also estimated. Future costs and life-years were discounted at 4%. Uncertainty estimates (UE) were obtained using bootstrapping.

During the 16-month follow-up, five patients (4.6%) died in the intervention group and nine (8.1%) in the control group. Discounted life expectancy from baseline was 13.54 years in the intervention group and 12.47 years in the control group, corresponding to an incremental gain of 1.06 life-years (95% UE = -0.72 to 3.31). The incremental discounted lifetime cost was €3280 per patient (95% UE = -€19 457 to €26 436), resulting in an incremental cost-effectiveness ratio of €3094 per life-year gained. At a willingness-to-pay threshold of €38 346 per life-year gained, the NMB was €37 475 (95% UE = -€15 868 to €107 797) and the probability of the intervention being cost-effective was 90.5%.

Motivational smoking cessation counselling delivered during hospitalisation with proactive referral to community-based follow-up had a high probability of being cost-effective from a hospital perspective for patients with atherosclerotic vascular disease.

Altered intrinsic functional connectivity is a well-established marker of borderline personality disorder (BPD). However, recent research suggests that investigating brain dynamics may offer a more detailed perspective on the neural signatures of BPD-related symptoms.

Resting-state fMRI data were analyzed in female patients with BPD (n = 47) and healthy controls (n = 28) to derive dynamic functional network connectivity (dFNC) indices using both meta-state and cluster-state approaches. Between-group comparisons assessed BPD-related dFNC alterations, while dimensional analyses explored associations between network dynamics and distinct symptom dimensions.

Both meta-state and cluster-state analyses revealed strong associations between symptom dimensions and dynamic range and fluidity. Meta-state analysis indicated that greater emotion regulation difficulties corresponded to an expanded state repertoire, reflecting increased variability in large-scale network configurations. Cluster-state analysis showed that fewer state transitions were associated with heightened borderline symptom severity, greater childhood trauma exposure, and increased dissociative symptoms. Furthermore, childhood trauma and emotion regulation difficulties moderated the relationship between time spent in specific cluster-states and borderline symptom severity.

These findings suggest that reduced dynamic flexibility but increased dynamic range in large-scale brain networks may contribute to core BPD symptoms, particularly in early trauma, emotion dysregulation as well as borderline symptom severity. The results highlight the association between aberrant dFNC and BPD and contribute to a more detailed characterization of neural dynamics relevant to the disorder.

Gastric and gastroesophageal junction adenocarcinoma (GC/GEJC) poses a substantial clinical burden in China. This updated guideline introduces a refined human epidermal growth factor receptor 2 (HER2) classification system (high, intermediate, low, absent) to redefine patient stratification for targeted therapy. It integrates cutting-edge evidence on standardized detection-including immunohistochemistry, in situ hybridization, and liquid biopsy-to overcome spatial-temporal heterogeneity. Recent progress in the use of HER2-targeted agents, including monoclonal antibodies, antibody-drug conjugates, tyrosine kinase inhibitors, and bispecific antibodies, is systematically reviewed and presented to inform evidence-based clinical practice. These updates aim to optimize personalized HER2-targeted therapy and improve outcomes in GC/GEJC patients.

Chronic airway diseases (CAD) including Chronic obstructive pulmonary diseases (COPD), persistent asthma (≥2weekly episodes) and bronchiectasis, exhibit overlapping extrapulmonary manifestations potentially affecting health-related quality-of-life (HRQOL). The study objective was to quantify HRQOL of CAD patients and identify impact of associated pulmonary and extrapulmonary manifestations.

Total 101 established CAD patients were recruited cross-sectionally (COPD, n=61, persistent asthma, n=30 and bronchiectasis, n=10). Patients completed spirometry, body composition (Dual-energy X-ray Absorptiometry), muscle function (isometric and isokinetic dynamometry), exercise capacity (6-minute walking distance,6MWD) and patient reported outcomes including physical activity, sleep and Hospital-Anxiety-and-Depression-Scale. HRQOL was assessed using EuroQol quality-of-life questionnaire and utility score (EQ-5D index) was stratified into tertiles to compare patient characteristics.

Mean age of participants was 60.9±12.8y, and 25.7% were female. Mean EQ-5D index was 0.658(95%CI: 0.596, 0.721), significantly lower than population norms and other chronic diseases including diabetes, cardiovascular diseases and rheumatoid heart disease (p<0.01). Participants in lowest EQ-5D tertile were older, had higher depression, lower 6MWD, lower handgrip and quadriceps muscle strength than other two tertiles, whereas anxiety was higher in both lowest and intermediate tertile compared to highest tertile(p<0.01). In adjusted regression model, age (AOR:1.187) depression (AOR:1.438), anxiety (AOR:1.266), and body fat (AOR:1.114) showed increased odds for poor EQ-5D index while in intermediate vs highest EQ-5D tertile, only age (AOR: 1.125) and anxiety (AOR:1.403) showed a significant association.

HRQOL is significantly lower in CAD compared to other chronic non-communicable diseases and significantly associated with extrapulmonary manifestations. Interventions targeting modifiable risk factors may aid in improving HRQOL in CAD.

Parkinson's disease (PD) remains underdiagnosed in Thailand, and its rising prevalence presents a growing challenge for the healthcare system. The previously validated CheckPD digital population screening platform has been implemented nationally in collaboration with the Thai Red Cross Society (TRCS) and the National Health Security Office (NHSO), enabling integration of digital PD risk screening into preventive health frameworks.

To evaluate the early phase of a national rollout of the CheckPD platform, focusing on population reach, adoption, predictive performance, exploratory usability, and implementation factors influencing scalability across diverse real-world settings.

This RE-AIM-guided implementation study in 10 Thai provinces assessed reach, adoption, completion, system performance and positive predictive value among neurologist-evaluated screen-positive participants. Preliminary usability was assessed in 30 post-screening completers using the SUS and UEQ-S. Supplementary implementation feedback was collected from Village Health Volunteers and public health officers.

Between January 2024 and October 2025, 13,381 out of 18,520 users completed screening across 10 provinces (completion rate: 72.3%). The mean SUS score was 83, with a 92% first-time task completion rate. Programme reach was achieved through multiple channels, including Village Health Volunteers (6,742 participants), community field campaigns (5,207), facilitated online training initiatives (3,448), and self-initiated app downloads (3,123). When compared with neurologists' diagnoses among 730 screen-positive participants who underwent evaluation, the screening demonstrated a positive predictive value of 81.23% (593/730; 95% CI 78.39%-84.07%). Key facilitators of implementation included TRCS endorsement and network support, community volunteer engagement, and user-centred app design. Exploratory multivariable logistic regression analysis identified educational attainment and geographic context as significant predictors of screening completion, with higher educational attainment and residence outside Bangkok associated with a higher likelihood of completing the screening workflow.

The CheckPD programme demonstrates that national-scale digital screening for neurological disorders is feasible in a low-to-middle-income country when embedded within trusted institutions, supported by community networks, and aligned with data protection standards. Thailand's experience provides an early, promising, and potentially scalable model for implementing population-level improvements in brain health by enabling earlier detection and assessment of individuals at risk, in alignment with the World Health Organization's Brain Health framework.

Climate change accelerates non-communicable diseases (NCDs) through cascading environmental disruptions and is attributed to driving increased NCD-related mortality. Yet this syndemic remains invisible and underfunded. We detail why addressing the climate-NCD intersection is critical for improving health.