In England, National Health Service (NHS) memory services provide most dementia diagnostic and immediate post-diagnostic care. We aimed to co-design and conduct a survey regarding diagnostic and post-diagnostic care, and perceived readiness for new treatments.

We invited all memory services in England to complete the survey. We compared services by provider type, investigating whether service characteristics (provider type, rurality, region, referral rates, staffing mix, accreditation) were associated with diagnosis rates and psychological therapy provision.

139/188 (73.9%) memory services participated, 130 (93.5%) provided by mental health/community and 9 (6.5%) by acute trusts. We estimated that English memory services receive 192,418 referrals/year, 98.7% to mental health/community trust services. In these services, the median annual referral rate per Full Time Equivalent (FTE) staff was 100.8 (Interquartile range: 56.7-132.8). Of FTE memory service staff, 14.0% (9.0-19.0%) were doctors. Acute trust-based services reported fewer referrals (45.8, 21.1-99.5) and had more doctors (33.0%, 23.0-43.0% FTE). More acute trust services felt ready to prescribe dementia Disease Modifying Treatments (N = 8 [88.9%]) than mental health/community services (N = 50, [41.7%]), while fewer acute trusts offered post-diagnostic psychological therapy routinely (N = 5 [55.6%]) vs. (N = 100 [77.5%]) in community services. NHS region (β = 0.70 [95% Confidence interval (CI): 0.08, 1.32]) and rurality (β = 2.14, [95% CI: 1.32, 2.96]) predicted lower diagnostic rates; regions with highest dementia diagnosis rates (67%+) had more memory service staff relative to the local aged 65 + population size.

We identified marked geographical inequalities. People in regions with less resourced memory services and rural areas had less access to timely diagnosis and care.

People living with osteoporosis can experience worse mental health and quality of life (QoL), including pain and psychological distress than those without. Psychological stress and poor mental health are associated with an increased risk of osteoporosis (OP). We conducted a systematic review and meta-analysis of randomised controlled trials investigating the effect of exercise on mental health, QoL and pain in people living with OP. A systematic review and meta-analysis was conducted following PRISMA guidelines (PROSPERO: CRD42023440020). Inclusion criteria were randomised controlled trials investigating exercise in people diagnosed with OP, including QoL, mental health, and/or pain outcomes. Exclusion criteria were non-human studies or studies not translatable into English. An electronic search of the literature was performed from inception to December 2025 in PubMed, EMBASE, PsycINFO, CINAHL, Scopus, and Web of Science. Bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist. The Consensus on Exercise Reporting Template was used to assess reporting quality. Three authors independently extracted data into Microsoft Excel. Data were analysed using Cochrane Review Manager Web (version 9.4.1), including mean differences (MD) and standardised mean differences (SMD) using a random-effects inverse variance model. Moderator analyses assessed modality, intensity, duration, frequency, setting, participant age, the presence of fracture (%), the nature of fracture and the osteoporosis diagnosis (postmenopausal or other). Certainty and quality of evidence were assessed using the GRADE approach. Twenty-three trials (n = 2120, mean age 67.1 ± 5.98yrs, 95.1% female) were included: five resistance training, six balance training, six combined resistance and balance training, three multi-modality, two Clinical Pilates, one aquatic, one combined aerobic, strength and Yi Jin Jing. A total of 1135 participants underwent exercise (low-high intensity, 2-7 times weekly) for 19 ± 12 weeks targeting upper, lower and full body, with seventeen studies reporting progression. Exercise improved mental health (SMD 0.53 [0.25, 0.81], p = 0.0002, moderate certainty evidence), QoL (SMD 0.62 [0.29, 0.95], p = 0.0003, moderate certainty evidence) pain (SMD 0.36 [0.17, 0.55], p = 0.0002, low certainty evidence), and pain at rest MD - 1.69 [- 2.38, - 0.99], p < 0.00001, moderate certainty evidence). Clinical Pilates was most effective for mental health (p = 0.006), QoL (p < 0.00001) and pain (p = 0.01). For mental health, the largest effect was seen with interventions performed three times per week for 4-11 weeks. Reporting quality varied (CERT, mean 11.1 ± 3.4, range 5-18), as did bias, with concerns regarding evidence certainty, internal validity and statistical conclusion validity bias. Exercise improves mental health, QoL, and pain. Pilates appeared most effective for all outcomes; however, resistance training was also effective for both QoL and pain. Further high-quality research following standardised reporting guidelines is needed for people living with osteoporosis. KEY POINTS: • Exercise improves mental health, quality of life and pain for people living with osteoporosis. Pilates was most effective, while resistance training also showed an effect for quality of life and pain outcomes. Further high-quality research is needed for people living with osteoporosis and poor mental health.

Recurrent Respiratory Papillomatosis (RRP) is caused by human papillomavirus (HPV) types 6 and 11, and afflicts children (Jo-RRP, Juvenile-onset RRP) and adults (Ao-RRP, adult-onset RRP). The study objective was to describe the disease burden of RRP from three patient-relevant perspectives: economic, clinical, and humanistic.

A retrospective descriptive analysis of responses to questionnaires captured within a linked Coordination of Rare Diseases (CoRDS) and the Recurrent Respiratory Papillomatosis Foundation (RRPF) (CoRDS/RRPF) patient registries from May 1, 2019, to July 31, 2023 was performed. Categorical variables were summarized using counts and proportions and continuous variables were summarized using means (standard deviations) and medians (interquartile ranges).

Responses from 122 participants, 55% (67/122) Jo-RRP and 45% (55/122) Ao-RRP, were included. Forty-one percent (41/99) traveled more than 100 miles round trip to receive specialty care, and 61% (52/85) spent > 5% of their family income to pay for care. RRP resulted in increased absences from school [94% (17/18) for participants aged < 22] and work [85.5% (65/76) for participants aged > 22]. Moreover, 64.9% (48/74) of respondents perceived that RRP negatively impacted their careers. Feelings of isolation (70%) and depression (45.1%) were common, but less than 25% of respondents reported seeking mental health assistance.

RRP leads to clinical, financial, and psychosocial burdens. Increased public awareness regarding HPV infection of the airway is needed, as this disease is preventable through HPV vaccination.

Disparities in the quality of mental healthcare services for majoritized versus minoritized clients are pronounced, while therapists draw on intuition and wider societal ideologies rather than professional training to confront the question of how to address clients' cultural identities and backgrounds in psychotherapy. This signals a gap between theoretical calls for cultural sensitivity and the practical implementation of culturally responsive care. The current study explores how psychotherapists deal with the dilemma of how to conceptualize, address, and discuss 'culture' in their practice. Drawing on a critical social-psychological framework for discourse analysis, we analyzed 31 semi-structured interviews with psychotherapists in Flanders, Belgium, and present the discursive patterns they articulated on culture and therapeutic conversations interpreted as related to culture. Therapists construct the importance of these conversations and position themselves while perpetuating wider societal discourse on cultural diversity in their clinical practice, drawing from five different repertoires: an action hesitancy repertoire, an experience as expertise repertoire, a paternalistic repertoire, a self-evidence repertoire, and a de-culturalization repertoire. Each repertoire has specific strengths and pitfalls for effective therapy with minoritized clients. As therapists are primary authorities in diagnosis and treatment, their practices greatly impact care quality and have the potential to either uphold or challenge existing disparities in mental healthcare.

Some patients with chronic pancreatitis (CP) experience nociplastic pain due to central nervous system dysregulation, yet its recognition is limited by the lack of bedside tools. Self-reported body maps are used to assess pain widespreadedness and to differentiate pain mechanisms in chronic pain patients, but their utility in CP is unclear. This study aimed to determine whether pain widespreadedness, measured via a body map, is associated with features of nociplastic pain in CP.

We conducted a cross-sectional analysis of adults with definite CP enrolled in a single-center longitudinal cohort. Pain widespreadedness was assessed using the Michigan Body Map and categorized by the number of painful regions (0-7) and by presence of localized versus widespread (≥3 regions) pain. Clinical features of nociplastic pain were measured using validated psychometric and pain surveys. Group comparisons were performed with multivariable regression models adjusted for demographics, comorbidities, and CP characteristics.

Among 110 participants (mean age 54 years, 52% male), 93% reported abdominal pain. Of those with abdominal pain, 64% had widespread pain. Increasing number of painful regions and widespread pain (versus localized) were independently associated with higher pain severity, pain interference and neuropathic pain scores, as well as more fatigue, impaired physical functioning, greater chronic overlapping pain conditions, and poorer physical and mental health.

Two-thirds of patients with CP had widespread pain assessed using a body map. This subgroup had more severe symptoms and features of nociplastic pain. This simple tool may facilitate targeted, mechanism-based pain management in CP.

Background: Advancing age is frequently associated with balance impairment, increased fall risk, and psychological distress, which together contribute to loss of independence and reduced quality of life. Yoga, as a mind-body practice, has the potential to enhance physical stability as well as mental well-being in older adults. Therefore, the objective of this study was to evaluate the effects of a structured yoga program on balance, fear of falling, mobility, and mental health outcomes among older adults. Methods: A quasi-experimental pretest-post-test study was conducted at Nagpur, India. A total of 64 eligible participants (65-85 years) were purposively assigned to a yoga intervention group (n = 32) or a waitlist control group (n = 32). The 12-week intervention comprised preparatory exercises, yoga postures, breathing practices, and meditation. Outcomes assessed at baseline and post-intervention included balance, fear of falling, mobility, depression, and anxiety. Results: Data from 50 participants (yoga: n = 26; control: n = 24) were analyzed. The yoga group showed significant improvements in balance (p < 0.001) and functional mobility (p < 0.001), with significant reductions in fear of falling (p = 0.009), anxiety (p = 0.0003), and depression (p = 0.004). In contrast, the control group exhibited deterioration in functional mobility (p = 0.001) and anxiety (p = 0.009), with no significant gains in other measures. Between-group comparisons confirmed significantly greater improvements in the yoga group across all outcomes. Conclusions: A 12-week yoga program was feasible and effective in improving balance, functional mobility, and mental health, while reducing fear of falling among older adults. Yoga may serve as a safe, non-pharmacological intervention to promote healthy aging in institutionalized populations. Trial registration: This study was prospectively registered with the Clinical Trial Registry of India (Registration No: CTRI/2023/10/058682; Registered on: 16 October 2023).

The rate of human brain growth is greatest in mid-to-late fetal gestation, corresponding to peak neuronal dendritogenesis. In pregnancies complicated by fetal growth restriction (FGR) caused by placental dysfunction, brain development is adversely impacted, with evidence of reduced total and hippocampal brain volume in childhood and cognitive deficits. The cellular basis for hippocampal maldevelopment and dysfunction in FGR is unknown. In this study we employed complementary preclinical and clinical investigations of hippocampal developmental trajectory in growth restricted neonates to address this knowledge gap. In the preclinical study (FGR n=18, control n=19), FGR was induced in fetal sheep via surgical induction of placental insufficiency at 89 days gestational age (dGA, term is 148dGA), and after near-term birth (136dGA), postnatal memory function was measured over four weeks. Neuronal dendritogenesis (dendrite length, branching, complexity) was assessed using Golgi-Cox staining of individual hippocampal Cornu Ammonis (CA)1 neurons at two neonatal timepoints, newborn age at 24 hours after birth and 4-weeks of age, to compare the trajectory of hippocampal neuron development in FGR and control lambs. Results show that, in control lambs, total dendrite length and branching of CA1 hippocampal neurons significantly increased between newborn age and 4-weeks. In FGR lamb brains, neither dendrite length or branching increased over this period, and dendrite deficits were worse in FGR lambs at 4-weeks, corresponding to reduced hippocampal area. In 4-week-old lambs, we observed a significant correlation between total dendrite length of CA1 neurons and memory function. Hippocampal growth trajectory and function deficits were corroborated in small for gestational age (SGA) infants born very preterm. Magnetic resonance imaging (MRI) was performed in very preterm infants in early life, and repeated at term equivalent age, showing that the trajectory of anterior hippocampal growth was significantly reduced in SGA infants (n=20) compared to appropriate for gestational age (AGA; n=139) infants. Within the SGA infant cohort, reduced anterior hippocampal volume was significantly associated with lower Bayley Cognitive Composite scores at 18 months corrected age, controlling for gestational age at birth and infant sex. Together, these findings demonstrate that the trajectory of hippocampal growth is significantly impaired in SGA/FGR infants, caused by disturbed neuronal dendritogenesis that is programmed by an adverse fetal environment and persists, or worsens, after birth. Results in the clinical cohort provide the critical link between programming of reduced dendritogenesis, hippocampal volume deficit and cognitive dysfunction in SGA infants.

Expiratory muscle strength training (EMST) is a non-invasive, evidence-based treatment that is used to improve swallowing in head and neck cancer (HNC) survivors. This prospective, pilot implementation study evaluated the feasibility, acceptability, and potential clinical effectiveness of a novel student-led tele-EMST program for HNC survivors.

HNC survivors (n = 13) completed an eight-week tele-EMST program. Acceptability was measured using the Theoretical Framework of Acceptability Questionnaire (TFAQ) and the Telehealth Usability Questionnaire (TUQ). Feasibility was tracked weekly. Swallowing performance, airway clearance, and quality of life were evaluated using the Timed Water Swallow Test (TWST), peak expiratory flow rate (PEFR), and SWAL-QoL, respectively. Data were collected with REDCap. Descriptive and non-parametric statistics were performed.

Acceptability of the tele-EMST program was high, as evidenced by high ratings on the TUQ (mean: 88.1/100%, SD: 16.3) and significant improvement on the TFAQ (p < 0.05). Technical issues occurred in 24% of sessions but were all resolved. Swallowing performance (TWST, p < 0.05), self-reported dysphagia symptoms, and mental health scores (SWAL-QoL, p = 0.03; p = 0.02) significantly improved. No significant changes in PEFR were observed (p = 0.59).

The findings of this small pilot feasibility suggest that a student-led, tele-EMST program is a promising, scalable approach to reduce treatment inequities and support survivorship care for HNC survivors with dysphagia.

Addictive disorders remain important contributors to the overall burden of disease, and although many have established treatments, stimulant use disorders (StUDs) still lack effective management options. Neurostimulation techniques, such as Transcranial Magnetic Stimulation and Transcranial Direct Current Stimulation, have attracted addiction medicine researchers and clinicians, with many studies showing promise in reducing cravings and improving other clinical outcomes in participants, as well as modulating relevant brain areas. As a result, research output in this area is increasing rapidly. This narrative review aims to assess currently available research data on non-invasive neurostimulation techniques in patients with StUDs to inform future research requirements and clinical applications. This review was conducted using a comprehensive search strategy across PubMed, OVID Medline and PsycINFO databases, using terms including "stimulant use disorder*", "transcranial magnetic stimulation" and "craving*". The initial search was intentionally broad to effectively assess the breadth of literature on neurostimulation in addiction disorders generally, resulting in the return of 1317 sources. Search results were uploaded to Covidence and screened for inclusion. Upon narrowing the scope to isolate StUDs, 179 sources were included for full-text review, with 90 included for extraction. The most common outcome measure assessed was craving, with cognition, affective symptoms, sleep, and use patterns other frequently assessed measures. Overall, the results appear promising, with non-invasive neurostimulation variably improving cravings, cognition and affective outcomes in patients with StUDs. However, this review identified some limitations that require further research attention, including small sample sizes, short follow-up periods, protocol heterogeneity, and ill-representative samples.

Growing interest in developing bioethical evaluation models for public health, together with limited consensus on fundamental moral values, highlights the need for a framework to guide ethical decision-making in this field. The Nuffield model has been proposed as an alternative for addressing ethical conflicts at the population level, as it offers a more suitable approach to the complexities of behavioral-change interventions than traditional clinical bioethics. Consequently, methodological tools are needed to guide decision-makers. This study sought to design and validate an instrument for the ethical evaluation of public health policies involving behavioral change.

Scale development and validation content study.

Reflective equilibrium was used as the overarching methodological strategy for instrument development. A three-phase mixed-methods (qualitative-quantitative) process was conducted, which included semi-structured interviews and expert validation using the Delphi technique.

We developed an instrument for the bioethical evaluation of public health policies that include a behavioral-change component, comprising nine domains and 32 items. Two Delphi rounds were carried out for expert validation, followed by a pilot test that informed adjustments to the final version of the instrument.

The methodological approach enabled the construction of the instrument by contrasting and ensuring coherence among predefined domains and the theoretical frameworks analyzed. Through the application of reflective equilibrium, new domains, integrity, participation, and interculturality, emerged in addition to those identified in the literature, resulting in an instrument with a strong theoretical foundation and expert validation.