To examine primary care (PC) and mental health (MH) telehealth utilization and satisfaction across 9 high-income countries and identify associated demographic and clinical factors.

We conducted a cross-sectional analysis of the Commonwealth Fund International Health Policy Survey, which was fielded from March through August 2023 and surveyed nationally representative samples of adults aged 18 years or older in Australia, Canada, France, Germany, the Netherlands, New Zealand, Sweden, Switzerland, the United Kingdom, and the United States. Analysis from December 2024 to November 2025 included 17,160 of 21,341 respondents after exclusions. Survey-weighted multivariable logistic regression assessed PC and MH telehealth use and satisfaction.

Overall, an estimated 25.6% used PC telehealth and 9.0% used MH telehealth (weighted estimates). Primary care telehealth use ranged from 6.6% (Germany) to 39.7% (Australia) and was associated with female gender (adjusted odds ratio [aOR], 1.47; 95% CI, 1.34-1.63), higher education (aOR, 1.56; 95% CI, 1.40-1.74), above-average income (aOR, 1.28; 95% CI, 1.15-1.43), and chronic conditions (aOR, 1.75; 95% CI, 1.55-1.97). The odds of Mental health telehealth use decreased with age (aOR for ≥65 vs 18-24 years, 0.23; 95% CI, 0.16-0.33) and were not associated with income. Among users, 80.4% were satisfied with PC and 77.6% with MH telehealth. Older adults (≥65 years) using MH telehealth reported higher satisfaction odds than 18-24 years (aOR, 2.79; 95% CI, 1.20-6.47).

Telehealth adoption varied substantially by country and service type. Income disparities in PC telehealth and low adoption but high satisfaction among older MH telehealth users suggest that targeted and age-friendly implementation strategies are needed.

Child maltreatment has lasting adverse effects on both physical and mental health and is associated with reduced quality of life. In Colombia, this problem remains highly prevalent. Childhood maltreatment has been identified as a risk factor for multiple chronic conditions, including cardiovascular disease, autoimmune disorders, cancer, and stress-related psychiatric disorders such as major depressive disorder. Early-life exposure to chronic stress is associated with immunological alterations, including increased production of pro-inflammatory cytokines, and the development of a chronic low-grade inflammatory state. Against this background, we investigated the association between a history of childhood maltreatment, systemic low-grade inflammation, and the distribution of leukocyte populations exhibiting features of senescence in patients with breast cancer.

We included 20 women diagnosed with breast cancer, who completed the Childhood Trauma Questionnaire-Short Form (CTQ-SF). Peripheral blood was collected to isolate plasma and PBMCs. Plasma cytokines were measured using a Cytometric Bead Array. Markers of immune senescence and exhaustion in monocytes, NK cells, and T cells were analyzed by flow cytometry.

The CTQ-SF assessment revealed a high prevalence of severe-to-extreme childhood maltreatment, with 40% of participants reporting severe physical abuse, 35% severe emotional abuse, and 40% severe physical neglect. Immunologically, CM + patients exhibited significantly higher TNF-α levels and significantly reduced HLA-DR expression on intermediate monocytes compared with CM- patients.

This exploratory pilot study suggests that childhood maltreatment may be associated with an altered inflammatory profile in breast cancer patients. Larger prospective studies are warranted to confirm these findings and determine their clinical significance.

Although loneliness is prevalent and significantly impacts society globally, its neural and genetic bases remain poorly understood. The thalamus, which receives sensory information from the environment, may have a more significant role in social interactions than previously recognized. Here, we integrate neuroimaging and genetic approaches to characterize structural differences within the thalamus associated with loneliness.

We obtained thalamic nuclei volumes on brain scans from 45,834 individuals (age range: 45-82 years) in the UK Biobank and grouped them into 6 anatomical groups. We investigated effects of loneliness and social isolation using self-reported data. Then, we performed a genome-wide association study (GWAS) analysis on the genetic overlap between thalamic volumes and loneliness.

The volumes of the whole thalamus and its medial, lateral, and posterior nuclei are significantly reduced in individuals with loneliness compared with those who do not feel lonely. Loneliness with frequent social contact is associated with smaller volumes, whereas social isolation without loneliness shows no such reduction in thalamus volumes. Leveraging data from GWASs on thalamic volumes (n = 30,114) and loneliness (n = 370,342) in the UK Biobank, we identified shared loci between thalamus structure and loneliness.

Our findings support the emerging view that the thalamus plays important roles in social interactions and in the experience of loneliness.

Internet-based interventions for perinatal depression reduce depressive symptoms in new and expectant mothers. However, modifiers of their effects, and prognostic factors of adherence, are unknown.

To assess modifiers of effectiveness and deterioration, and prognostic factors of adherence in internet-based interventions for perinatal depression.

Systematic searches were conducted in three bibliographic databases on February 7, 2025. Two independent researchers identified randomized controlled trials (RCTs) of internet-based interventions for perinatal depression. We conducted conventional and two-stage individual participant data meta-analysis (IPDMA).

Eighteen studies were eligible, and data from nine (n = 1094 participants) were pooled in IPDMA. We found evidence of a difference in post-treatment depressive symptoms between participants in the internet-based intervention and controls (SMD = 0.29 [95%CI: 0.03-0.54], small effect size), increase in response (RR = 1.97 [95%CI: 1.57-2.47]) and remission (RR = 1.73 [95%CI: 1.38-2.18]). The interventions were effective for anxiety symptoms (SMD = 0.26 [95%CI: 0.11-0.40]) but not for reliable deterioration (OR = 0.80 [95%CI: 0.49-1.32]). No modifiers of effectiveness or deterioration, or prognostic factors of adherence were identified. Baseline depressive symptoms and comorbid anxiety were prognostic factors for higher depressive symptoms at post-treatment.

Internet-based interventions for perinatal depression are effective for depressive and anxiety symptoms in new and expectant mothers. They may be offered to patients regardless of their age, education, relationship status, employment, baseline depressive or anxiety symptoms, previous treatment, number of children, or ethnic minority status, if they wish to follow them. RCTs should collect more information on factors relevant to the perinatal period, such as partner's mental health and pregnancy complications.

Open Science Framework (https://osf.io/98tms).

In the exploration of psychopathology, the most discussed anecdote which always remained contradictory was the notion of 'functional vs biological' perspective of psychopathology. With the same anecdote, the present study attempted to reflect the clarity on the issue by taking a paradigmatic move in exploring the psychopathology with the help of Brain Fingerprinting Technique (BFT). BFT computes a mathematical and statistical algorithm for determination of information through presentation of stimuli. This presentation of stimuli leads to generation of P300-MERMER brainwave to determine the information. The same argument of real vs virtual experiential contexts pertaining to certain psychiatric conditions was applied in the present study. With the help of data analysis, it was proven that no biological evidence of fingerprinting with respect to delusional beliefs, perception of auditory stimuli in hallucinatory behaviour and real loss of information in case of dissociative amnesia was observed in the brain. Rather, in first two conditions the mathematical and statistical algorithm computed 'information absent' and in third condition it computed as 'information present' respectively. The above observations helped in substantiating the diagnoses of the patients with scientific sanctity and physiological correlates. The present study could be able to expand the horizon of applications of BFT in few of the psychiatric conditions such as delusional disorders, hallucinatory behaviours, and dissociative amnesia.

Bariatric surgery (BS) is an effective long-term weight management option for individuals with type 1 diabetes (T1D) and obesity. However, the long-term effects of BS on glycemic control and cardiovascular (CV) risk factors in individuals with T1D remain unclear, and few studies have directly compared BS outcomes with a matched cohort receiving standard diabetes care.

To evaluate the impact of BS on weight, insulin requirements, glycemic control, and CV risk factors in individuals with T1D and obesity, compared to standard diabetes care.

Joslin Diabetes Center, Boston, MA, United States.

This was a retrospective cohort study of 20 adults (mean age 41 ± 10 years) with T1D and obesity who underwent BS (Roux-en-Y gastric bypass 75%, sleeve gastrectomy 15%, and laparoscopic gastric banding 10%). A matched cohort (1:1 ratio) of 20 adults receiving standard diabetes care (mean age 43 ± 12 years) was selected. Baseline characteristics included similar body weight, diabetes duration, and glycemic control. Data on body weight, hemoglobin A1C, insulin use, lipid profile, and blood pressure were collected at baseline and after 3 years.

After 3 years, the BS cohort experienced weight loss of 33.5 ± 2.6 kg (28.1 ± 2.2%), while the standard care group gained 2.6 ± 2.8 kg (2.2 ± 2.4%, P < .0001). Hemoglobin A1C and low-density lipoprotein cholesterol levels remained unchanged in both groups. However, the BS group showed a reduction in insulin dose, weight-adjusted insulin requirements, triglycerides, systolic blood pressure, and antihypertensive medications. High-density lipoprotein cholesterol increased in the BS group compared to the standard care cohort.

BS reduces body weight, insulin requirements, and several CV risk factors in individuals with T1D and obesity, although it does not improve long-term glycemic control. Further prospective randomized clinical trials are needed to confirm these findings.

Cardiovascular disease became the leading cause of death among Hispanic individuals in the United States in 2022. Hispanic adults experience a disproportionate burden of cardiometabolic risk factors, including obesity, diabetes, and dyslipidemia. Hispanic populations are highly heterogeneous, with substantial variations in genetic ancestry and sociocultural influences that shape cardiovascular disease risk and outcomes. The "Hispanic paradox," describing lower cardiovascular disease mortality despite higher risk factor burden, is increasingly recognized as an oversimplification that does not apply uniformly across Hispanic heritage groups, sexes, or disease types. Disaggregated data reveal substantial differences in risk profiles and disease burden among Hispanic heritage groups, emphasizing the limitations of treating this population as a monolithic unit. Recent evidence demonstrates widening disparities in hypertension control, obesity, diabetes, and metabolic diseases among Hispanic populations, threatening this prior mortality advantage. Advancing cardiovascular and equitable health will require developing a deeper understanding of the unique drivers of cardiovascular disease within diverse Hispanic communities, addressing barriers such as language and insurance access, and implementing culturally tailored interventions and policies. This scientific statement summarizes current cardiovascular disease epidemiology in Hispanic populations, emphasizing heritage group variation and social and structural determinants of health, and presents strategies to improve prevention and healthcare delivery. Key priorities for advancing cardiovascular health in Hispanic adults include expanding disaggregated data collection, increasing representation in research, and ensuring equitable implementation of precision medicine approaches, including genomics, multi-omics, and artificial intelligence, while addressing environmental exposures, psychosocial stressors, and policy-related drivers of risk in order to achieve the American Heart Association's 2028 Impact Goals to advancing health and hope for everyone, everywhere.

The vitamin D and parathyroid pathways are intrinsically linked to the regulation of calcium levels within a physiological range. Type 1 Diabetic patients are in turn theoretically impacted by these factors due to insulin's dependence on calcium for its function. This paper investigates the relationship between Type 1 Diabetes Mellitus, vitamin D deficiency, and parathyroid hormone levels in the pediatric population.

This is a cross-sectional study with 102 participants aged 3-18 years old who were selected from Salama and Cerner patient databases at Al Jalila Children's Specialty Hospital (Dubai Health). Inclusion criteria for selection were based on participants' Type 1 Diabetes Mellitus status and Hemoglobin A1c levels. Furthermore, other factors such as phosphate levels, calcium levels, and comorbidities were collected.

The prevalence of vitamin D insufficiency was 73.3%, with 63.2% of patients reporting normal parathyroid hormone levels. There was no significant correlation between vitamin D and parathyroid hormone levels (χ = 7.7, p = 0.103). Of the diabetic patients with insufficient vitamin D levels and normal parathyroid hormone levels, 83.3% had normal calcium levels (χ = 22.986, p = 0.028). There was no significant correlation between vitamin D, parathyroid hormone, and other factors such as phosphate levels, vitamin D supplementation, and comorbidities.

Type 1 Diabetes pediatric patients exhibited the ability to regulate calcium homeostasis through parathyroid hormone regulation despite having insufficient vitamin D levels. However, such compensatory mechanisms may manifest as long-term complications without early intervention. Further investigations should be conducted to investigate the causal pathways.

Hyperbaric oxygen therapy (HBOT) is an established adjunctive treatment for selected diabetic foot ulcers, although evidence regarding its effectiveness remains heterogeneous. We conducted a retrospective, single-center, observational study of adult diabetic patients receiving HBOT (2.5 ATA, 100% oxygen) for a lower-limb wound at the only hyperbaric center in Guadeloupe, a French Caribbean territory, between January 2020 and June 2023. Among 257 patients treated with HBOT, 71 diabetic patients met inclusion criteria (mean age 63.1 ± 12.7 years; 69% male). Peripheral arterial disease and osteitis were highly prevalent, while the proportion of current smokers (7.9%) was notably lower than in previously published HBOT cohorts, a distinctive feature of this population. HBOT was considered a last resort, after failure of prolonged conventional therapy, in 63% of patients, likely contributing to the modest six-month healing rate of 34% (18/53 evaluable patients) and 19% rate of major amputation occurring during or after HBOT. Patients referred through the multidisciplinary Diabetic Foot Care Unit had fewer major amputations despite older age and greater vascular burden, though this comparison may reflect referral-related selection bias. No candidate factor, including glycemic control, referral pathway, or delay to HBOT, reached statistical significance in univariable analysis. This descriptive, single-arm finding cannot establish HBOT efficacy but is consistent with a role for HBOT within coordinated multidisciplinary diabetic foot care, highlighting the importance of earlier referral and optimised patient selection.

Diabetic retinopathy (DR) is a condition that progressively affects the microvasculature, commonly seen in individuals with diabetes, which is a leading cause of visual impairment across the globe. Approximately one-third of people with diabetes will eventually develop DR, and it remains a public health issue because the retinal damage is irreversible if the disease continues to go undiagnosed and untreated. Although various screening methods exist, including fundus photography and optical coherence tomography (OCT), they are often limited as a result of availability and expertise required for diagnosis and management. Recent advancements in artificial intelligence (AI) are transforming DR screening and diagnosis. AI has demonstrated the potential to automate retinal image evaluation with accuracies that, in some studies, approach or exceed existing standards of care; however, reported performance varies across algorithms, datasets, and clinical settings, highlighting the need for cautious interpretation and further validation in diverse populations. Machine learning (ML) & deep learning (DL) models, particularly convolutional neural networks (CNNs), have been found to have excellent performance in identifying DR-related abnormalities, including mild, moderate, and severe DR, and diabetic macular edema, at sensitivities and specificities exceeding traditional screening. AI tools under various names, such as IDx-DR, EyeArt, and Google's AI algorithm, are quick and price-effective tests using an AI solution for early diagnosis of DR in either developed or developing economies. In addition, AI can also support predictive analytics, risk stratification, and treatment decision-making, so that ophthalmologists can provide patients with better management options. Importantly, AI also comes with its own challenges, such as data harmonization and regulatory approval for deploying AI in clinical care. This review will focus on the existing literature on the applications of AI in diagnosing and management of DR and will outline the importance of this innovation.