Dental aesthetics self-perception can influence self-confidence and psychosocial well-being, but evidence from Pakistan remains limited. This study examined dental aesthetic self-perception, smile satisfaction, and associated factors among adults in Karachi, Pakistan.

This cross-sectional study was conducted at Liaquat College of Medicine and Dentistry (LCMD) in Karachi from November 2, 2022, to March 21, 2023. Adults residing in Karachi were recruited through an online convenience sample, with the questionnaire link distributed by email and social media platforms.

Eight hundred fifty-four individuals participated in the study, comprising 276 males (32.3%) and 578 females (67.7%). Overall, 62.8% of participants were satisfied with their smile, whereas 318 (37.2%) expressed dissatisfaction. A total of 595 (69.7%) agreed that a smile can affect mental, emotional, and social well-being, and 665 (77.9%) believed that smiling alleviates stress. Most respondents (542, 63.4%) agreed that tooth color influences the attractiveness of a smile. Additionally, 335 (39.2%) reported always or sometimes avoiding smiling in photographs. Reported reasons included irregular tooth size or shape (25.4%), yellow or stained teeth (22.7%), misaligned teeth (16.1%), gaps between teeth (8.3%), and other reasons (20%). Gender analysis indicated that more females believed a smile influences their cognitive, emotional, and social well-being (p = 0.032) and the influence of tooth color on attractiveness of a smile (p = 0.034). Binary logistic regression found no significant associations between sociodemographic variables and smile satisfaction.

Overall, 62.8% of participants were satisfied with their smiles, and the measured sociodemographic variables were not significantly associated with smile satisfaction. Most participants believed that smiling reduces stress, enhances personality, and reflects confidence. Further studies using probability-based sampling and formally validated instruments are needed to identify clinical, psychological, and contextual factors associated with smile satisfaction.

Dementia affects over 57 million people worldwide. UK and international policy position personalised, conversation-based care planning as central to post-diagnostic support. However, delivery in primary care is inconsistent, and many practitioners lack dementia-specific communication training. Existing evidence focuses on single roles or settings, leaving a gap in understanding how communication operates across the primary care workforce.

To identify what helps and hinders effective communication for integrated dementia care planning and determine the support and training needs of the wider primary care workforce.

Semi-structured interviews - 11 people with dementia, 13 family carers, and 19 primary care practitioners from diverse roles, exploring experiences of care planning conversations. Reflexive thematic analysis.

Three themes were developed, progressing from micro-level communication practices (Theme 1: Beyond the tick-box), through triadic dynamics (Theme 2: Balancing voices in the conversation), to organisational influences (Theme 3: From silos to meaningful shared care planning). Time and Conversation as intervention cut across all themes, shaping trust and disclosure. Participants reported reliance on tick box approaches, inconsistent preparation, and uncertainty about care plan purpose and ownership. Non-clinical roles were commonly viewed as well placed to support meaningful conversations, but were often described as constrained by unclear remit and weak integration.

A persistent gap remains between policy ambitions and everyday practice. Time-pressured, checklist-driven encounters and fragmented systems undermine shared decision-making. The expanded primary care workforce offers untapped potential to address these gaps, but this requires clearer roles, formal integration, and targeted investment in communicative skills.

The unregulated drug supply in Canada increasingly contains benzodiazepines, particularly those not approved for medical use, raising concerns about toxicity risk, especially when combined with opioids. Therefore, we aimed to describe trends in benzodiazepine-related toxicity deaths and compare their characteristics and circumstances by benzodiazepine type.

We conducted a descriptive cross-sectional study of accidental benzodiazepine-related toxicity deaths in Ontario between January 1, 2018 and June 30, 2022, using linked administrative healthcare at ICES including coroner's investigation records from the Drug and Drug/Alcohol Related Death Database. We measured monthly crude rates of benzodiazepine toxicity deaths and summarized characteristics (age, sex, region of residence, etc.) and circumstances (number and types of substances involved, healthcare encounters for toxicities and substance use disorders, etc.) of decedents and compared these by benzodiazepine type (approved vs. not approved for medical use in Canada).

Between January 2018 and June 2022, 782 Ontarians died of benzodiazepine-related toxicity (median age of 40 years), of which 70.5% were male and 88.6% resided in Southern Ontario The rate of benzodiazepine toxicity death peaked in December 2020 (0.27 per 100,000; N = 40). Overall, 98.1% of benzodiazepine deaths involved another substance, most commonly opioids (91.2%). Moreover, one-fifth (22.6%) of decedents had experienced a hospital-treated substance toxicity in the year prior to death, and almost two-thirds (64.1%) had a healthcare encounter with a substance use disorder diagnosis in the prior five years.

Benzodiazepines remain an important contributor to substance-related mortality in Ontario, with nearly 800 benzodiazepine-related toxicity deaths observed over a four-and-a-half-year period. As almost all deaths involved multiple substances, most commonly opioids, harm reduction and treatment programs must adapt to the evolving needs of people who use drugs who may experience both intentional and unintentional benzodiazepine exposure.

Reliable and valid diagnostic interviews for preschool-age children are needed to identify children with externalizing behavior problems requiring treatment and thus prevent adverse outcomes. This study evaluated the psychometric properties of the semi-structured Clinical Parent Interview for Externalizing Disorders (ILF-EXTERNAL).

Data were collected from 211 children (3;0-6;11 years, 62% boys) who were screened for participation in a multicenter study on evidence-based stepped care treatments for preschool children with externalizing symptoms (ESCApreschool). The factor structure, interrater reliability, internal consistency, convergent validity, and divergent validity of the ILF-EXTERNAL were examined from a multi-rater perspective (clinicians, parents, preschool teachers).

A first-order factor model with four correlated factors showed acceptable model fit and allowed for straightforward interpretability. Interrater reliability estimates were fair or moderate to good [intraclass correlation coefficients(1,1) =  .52-.74]. Categorical diagnostic agreement was moderate (κ = .44-.52). The ILF-EXTERNAL scales exhibited acceptable to good internal consistencies (α ≥ .69, ω ≥ .72), except for the ADHD Functional Impairment scale (α = .65, ω = .68). Correlations between the ILF-EXTERNAL scale scores and the Externalizing Problems scale of the Child Behavior Checklist (CBCL/1½-5) ranged from  .38 to  .56, whereas correlations with the Internalizing Problems scale ranged from  .09 to  .37. Except for one subscale, all ILF-EXTERNAL subscales correlated more strongly with the Externalizing Problems scale than with the Internalizing Problems scale, providing support for convergent and divergent validity. Cross-informant correlations between clinician and parent ratings were higher (r = .46-.65) than between clinician and preschool teacher ratings (r = .05-.33).

The ILF-EXTERNAL shows sound psychometric properties in clinically referred preschool children with ADHD and/or ODD.

People with HIV on effective treatment can expect a normal life expectancy, though they may experience increased prevalence of other chronic health conditions. We assessed among people with HIV, non-HIV health care usage and variation by sociodemographic and lifestyle factors.

Positive Voices 2022 is a national UK questionnaire study of people with HIV (April 2022-March 2023). Participants self-reported on use of a range of health services. Associations of sociodemographic and lifestyle factors with five specific services were assessed using modified Poisson regression. Prevalence ratios(aPRs) adjusted for age, demographic group and year of HIV diagnosis and 95% confidence intervals [95%CIs] are given.

Among 4451 people with healthcare use data, 79.0% attended their GP service in the past year, and 54.9%, 46.2%, 21.0%, and 10.0% attended dental, sexual health, accident and emergency (A&E) and mental health services, respectively. Use varied across sociodemographic groups. Older people were less likely to use mental health and sexual health services, but more likely to use GP and dentists. Black African men, other heterosexual men and Black African women were significantly less likely to use mental health services: aPR 0.19 95%CI[0.09-0.43], aPR 0.49 95%CI[0.31-0.78] and aPR 0.48 95%CI[0.34-0.68] respectively, compared to gay/bisexual/other men-who-have-sex-with-men. Participants without money for basic needs were much more likely to use mental health services (aPR 3.41, 95%CI[2.54-4.59] versus enough money) and A&E (aPR 2.00, 95%CI[1.65-2.45]), but less likely to use dentists (aPR 0.84 95%CI[0.73-0.96]). Obesity, smoking and comorbidities were also associated with higher use of A&E and mental health services.

Healthcare service use among people with HIV varies across sociodemographic groups. Results suggest the need for interventions and policies to improve physical and mental health and access to timely care among people with socioeconomic disadvantage and to enable greater access to mental health services for Black African people.

The first generation of clinically approved amyloid-targeting treatments has changed the terms of debate in Alzheimer's disease. It is no longer persuasive to argue that amyloid removal is biologically irrelevant or clinically inert in early symptomatic Alzheimer's disease. Lecanemab and donanemab have both demonstrated statistically robust and clinically meaningful, albeit still modest, slowing of disease progression, thereby establishing disease modification as a realistic therapeutic objective rather than a speculative aspiration. At the same time, these agents have exposed the defining limitation of the current therapeutic concept: although clearly beneficial for some patients, the margin for benefit versus risk remains narrow, and its realization in routine care is operationally demanding and heavily dependent on careful patient selection and surveillance rather than on drug effect alone. The central task for the field is therefore no longer to prove that amyloid-targeting treatments can work, but to make them work more effectively, more safely, more targeted, and less burdensome. In current practice, most plausible gains in net clinical value will come from earlier and more precise patient selection, structured risk stratification using the APOE genotype and baseline magnetic resonance imaging status, strict management of vascular risk factors, intensified monitoring during the early hazard period, more personalized treatment exposure, and amyloid antibodies engineered for lower vascular toxicity, for example, using brain shuttle technology. Further, alternative routes of administration have the potential to reduce burden on patients, caregivers, and providers likewise. Real-world registries will be essential to define long-term safety, effectiveness, and treatment patterns outside clinical trial populations. Therefore, future improvement of amyloid-targeting treatments is likely to come from widening the therapeutic margin by drug engineering as well as precision implementation in real-world settings.

Maternal neonaticide (< 24 h), infanticide (< 1 year), and filicide (> 1 year and < 18 years) refer to the killing of a child by the mother; however, these acts differ substantially in their underlying sociodemographic, clinical, and criminological characteristics. As no previous study has examined these three groups together within a single comparative framework, this research is the first to simultaneously investigate maternal neonaticide, infanticide, and filicide in a large-scale sample to determine their distinct sociodemographic, clinical, and criminological variables.

Data were retrospectively obtained from cases who underwent forensic psychiatric evaluation at the Department of Psychiatric Observation and the 4th Specialized Board of the Council of Forensic Medicine (CFM) in Türkiye between June 1, 2014, and June 1, 2024.

Among 113 cases (28 neonaticide, 35 infanticide, and 50 filicide), women in the neonaticide group were significantly younger and more frequently single and had lower rates of documented psychiatric disorders. The most frequently recorded motive in this group was the child being unwanted. The infanticide group had significantly higher documented rates of severe psychiatric disorders and previous psychiatric treatment. Almost all women in the neonaticide and filicide groups were assessed as having full criminal responsibility, whereas 34.3% of those in the infanticide group were assessed as lacking criminal responsibility.

The findings suggest that maternal neonaticide, infanticide, and filicide are associated with different sociodemographic, psychiatric, and medicolegal patterns. Recognizing these differences may contribute to more informed forensic psychiatric evaluations and may help identify areas relevant to risk assessment and prevention.

Existing machine learning (ML) models for dementia detection typically use fixed prediction windows and often lack clinically informed variable selection and responsible AI principles, thereby limiting performance, generalisability and clinical trust. We aimed to develop a single clinically informed model capable of both diagnosing dementia and predicting its onset over flexible time horizons up to 10 years. We trained our ML model on the NACC Uniform Data Set using 20 inputs compatible with UK National Healthcare Service secondary-care workflows, including a HORIZON feature encoding months from baseline. We also integrated explainability and fairness analyses. Same-visit classification achieved sensitivity of 0.951 (95% confidence interval 0.947-0.954), specificity of 0.810 (0.805-0.814), a geometric mean (G-mean) of 0.877 (0.874-0.880) and an area under the receiver operating characteristic curve (AUC) of 0.959 (0.957-0.960). Across future horizons from 24 to 120 months, sensitivity/specificity ranged between 0.808/0.856 at 24 months and 0.833/0.706 at 120 months, while AUCs were 0.906 and 0.851. Compared with a Cox proportional hazards model, our flexible-horizon ML model achieved a higher G-mean at four of the five evaluated horizons and higher specificity from 48 months onwards, whereas Cox achieved greater sensitivity from 48 months onwards. Shapley additive explanations highlighted functional independence, prediction horizon and cognitive measures as influential. Exploratory subgroup analyses showed broadly similar balanced discrimination across sex, race and age groups, although sensitivity-specificity trade-offs varied. An interactive web application was also developed for demonstration and clinical feedback. These findings support the feasibility of flexible-horizon, clinically-informed and responsible ML-based decision support for dementia early detection; however, external validation, recalibration and prospective clinical evaluation are required before deployment.

Sickness absence due to common mental disorders is rising among healthcare staff, yet evidence on the impact of shift work remains inconsistent. This study examined the association between shift work and the risk of first-time medically certified sickness absence (>14 days) due to common mental disorders (CMDs) among nursing staff. This 11-year prospective cohort study included 25 120 nurses and nursing assistants employed for one year or more between 2008 and 2019 in Region Stockholm. Shift work data were obtained from an employee register, and CMD-related sickness absence (N = 2792) from the Swedish Social Insurance Agency, for the study period 2009-2020. Discrete-time proportional hazards models estimated hazard ratios, adjusted for demographic factors and profession. Shift work was assessed in the year preceding sickness absence. Lower hazard ratios (HRs) for sickness absence due to CMDs were found among shift workers with night shifts (HR 0.80, 95% CI 0.72-0.89) and among permanent night workers (HR 0.81, 95% CI 0.65-0.99), compared with day workers. Frequent night shifts (>121/year) were associated with a lower risk (HR 0.77, 95% CI 0.65-0.90) compared with non-night workers. Among non-night workers, frequent quick returns (>49/year) from afternoon shifts (defined as less than 11 hours between shifts) were associated with a lower HR (HR 0.72, 95% CI 0.56-0.92) compared with never having quick returns. Shift work among nursing staff was associated with a lower risk of sickness absence due to common mental disorders. This finding may reflect a selection of healthy individuals for night-shift work.

Canadians' mental health has deteriorated over the past decade, increasing MH-related conditions and ED use. Evidence indicates that EDs are ill-suited to managing complex MH needs, negatively affecting care quality and nurses' experiences. Nurses face challenges including fear of violence, limited MH training, and insufficient organizational support. This study aimed to explore nurses' experiences and identify factors that contribute to or hinder their ability to care for individuals with MH concerns in the ED. Using a focused ethnography approach, we collected data mainly through semi-structured interviews (n = 12), non-participant observations, and a review of clinical documents. We analyzed data iteratively using reflexive thematic analysis. Analysis was primarily deductive, guided by Bandura's social cognitive theory (SCT), while remaining open to inductive insights. Three interrelated themes emerged: nursing role under strain, structural challenges in EDs, and persistent stigmatization, reflecting an incompatible healthcare system that fails to meet patients' MH needs adequately and contributes to difficult, sometimes dangerous experiences for nurses. Systemic reorganization is needed to support MH care in EDs, particularly by improving access to specialized expertise, creating safer care environments, and developing targeted MH skills.