Atrial fibrillation (AF) and heart failure (HF) frequently coexist and worsen one another's outcomes. To investigate shared molecular mechanisms, we compared atrial gene regulatory networks (GRNs) in the mouse Tbx5 conditional knockout (Tbx5 cKO) AF model and the transverse aortic constriction (TAC) HF model. Here we show highly correlated changes in atrial transcriptional and genomic profiles, including downregulated atrial Tbx5 expression in both mouse and human HF. More than 100 transcription factor genes were coordinately dysregulated in the atria of the Tbx5 cKO and TAC models. The wild-type atrial TBX5-driven GRN, including Klf15, a repressor of cardiomyocyte hypertrophy, was disrupted in Tbx5 cKO and TAC models. Conversely, a disease-specific network featuring Sox9 emerged in activated fibroblasts of Tbx5 cKO and TAC models. Our results identify coordinated disruption of TBX5-dependent atrial gene regulation in AF and HF, suggesting that a shared genomic injury response may underlie the reciprocal risk between these conditions.

Suicide rates among Veterans were over 70% higher than non-Veterans in 2022, and nearly 60% had not recently used the Veterans Health Administration (VHA). Veterans have unique experiences and healthcare needs. VHA provides military culturally competent suicide prevention care to Veterans. There is a lack of research demonstrating that community agencies are adequately prepared to provide military culturally competent care, when appropriate.

The purpose of this analysis was to understand organizational readiness and gaps related to providing military culturally competent Veteran suicide prevention programming in community agencies.

Semistructured qualitative interviews were conducted with 24 Veteran-serving community agencies to assess each organization's interactions with and navigation of VHA and care coordination, suicide prevention policies, procedures, and quality improvement, staff training on suicide prevention and military cultural competency, Veteran status screening procedures, crisis line dissemination, and suicide prevention metric tracking.

Organizations lack awareness of their role in Veteran suicide prevention, and lack of readiness to implement comprehensive and military culturally competent Veteran suicide prevention programming. Salient implementation needs included: screening for Veteran status, collection of metrics, military cultural competency and suicide prevention training, Veterans Crisis Line dissemination, suicide prevention policies and standardized operating procedures, and care coordination between community agencies and VHA.

Findings suggest a need to bolster intraorganizational readiness to provide comprehensive and tailored suicide prevention programming to Veterans receiving care in the community with the aim of strengthening a community-wide safety net to reduce Veteran suicide deaths.

Increasing migration and population ageing pose growing challenges for dementia diagnosis in culturally and linguistically diverse (CALD) populations. This study evaluated changes in diagnostic practices in an Italian Centre for Cognitive Disorders and Dementia following implementation of the ImmiDem project and culturally adapted cognitive tools.

A retrospective observational study was conducted including all CALD patients assessed between 2016 and 2024. Collected data included demographic and linguistic characteristics, country of origin, type of cognitive assessment, and use of standard versus cross-cultural tools. Diagnostic practices were compared between T1 (2016-2020) and T2 (2021-2024), corresponding to ImmiDem implementation.

A total of 163 CALD patients (4.2% of referrals) were identified, with a marked increase in T2 (+ 180%). Mean age was 65.2 ± 13.8 years; 35.2% had low education. Patients originated from 46 countries and spoke 26 languages, with no significant demographic differences between T1 and T2. Cognitive screening was performed in 81.6% and extensive testing in 33.1%. Use of cultural mediators and cross-cultural tools rose significantly in T2. Importantly, diagnoses in T2 more frequently involved milder cognitive impairment, likely reflecting earlier referral and the increasing use of more sensitive cross-cultural cognitive assessment tools. The Rowland Universal Dementia Assessment Scale (RUDAS) showed weaker correlations with age and education than the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA), with generally good concordance across tools.

Referrals of CALD patients increased substantially, with earlier detection of cognitive impairment and wider use of culturally appropriate assessment. Persistent gaps in validated tools and cultural competence highlight the need for further multicentre prospective studies to support equitable diagnostic practices.

Peripartum depression (PPD) has a global prevalence of 20% significantly impacting societies. Yet, existing treatments face barriers for its uptake. This study examined the acceptability of a remotely supervised home-based transcranial direct current stimulation (tDCS) solution combined with a CBT-based app (the FLOW Neuroscience solution) for PPD, among women (experts by experience; EEs) and healthcare professionals (HPs). Fifteen EEs and 14 HPs participated in focus groups informed by the Theoretical Framework of Acceptability. Narratives were iteratively refined, using the template analysis method. Participants were overall positive about the treatment considering it supports patients' autonomy, freedom of choice and a universally accessible perinatal mental health care system. However, they also highlighted several concerns, such as the limitations of exclusively remote/virtual and bot-lead interventions which, on the one hand, may address fear of stigma about perinatal mental health, but on the other may also increase loneliness in depressed patients. Additionally, participants emphasized the need for effective communication strategies to build trust over health innovation and recommended the integration of home-based remotely supervised tDCS treatments combined with a CBT-based app into existing care models. Our findings suggest that while the FLOW solution addresses existing gaps in PPD it also presents some limitations. Here we provide user-centered actionable insights into the adjustment of this innovative, home-based solution to enhance access and engagement in PPD care.

To evaluate the early effectiveness of total talar replacement (TTR) with personalized three-dimensional (3D)-printed titanium talus prostheses in the treatment of steroid-induced talar avascular necrosis (TAN).

The clinical data of 11 patients with steroid-induced TAN who met the selection criteria between June 2022 and June 2024 were retrospectively analyzed. There were 8 males and 3 females with an average age of 51 years ranging from 26 to 67 years. The duration of hormone use ranged from 12 to 36 months, with an average of 19.6 months. The TTR treatment was performed with the personalized 3D-printed titanium alloy talus prosthesis. Radiographic evaluation was performed preoperatively and at last follow-up to assess prosthesis-related conditions, including loosening, subsidence, and adjacent joint degeneration. Clinical outcomes were assessed using the visual analogue scale (VAS) score, American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, Ankle Osteoarthritis Scale (AOS), 36-Item Short Form Survey (SF-36) [including physical health score (PCS) and mental health score (MCS)], and ankle range of motion (ROM) to assess functional recovery.

All surgeries were completed successfully. The operation time was 40-60 minutes (mean, 51 minutes), and intraoperative blood loss was 5-20 mL (mean, 10 mL). All incisions healed by first intention without early complications such as infection, skin necrosis, hematoma, neurovascular injury, or deep vein thrombosis. All 11 patients were followed 15-33 months (mean, 22.8 months). One superficial wound infection occurred at 2 weeks postoperatively and resolved after conservative treatment. No prosthetic joint infection, loosening, subsidence, adjacent joint degeneration, or reoperation was observed. At last follow-up, the VAS score, AOFAS ankle-hindfoot score, AOS score, PCS score, and MCS score improved significantly when compared with preoperative ones ( P<0.05), whereas ankle ROM showed no significant difference ( P>0.05).

Personalized 3D-printed titanium talus prostheses effectively relieve pain and improve ankle function and quality of life in patients with steroid-induced TAN, providing a viable joint-preserving treatment option.

To explore the lived experiences of perimenopause/menopause among Ghanaian women.

Qualitative study using in-depth, semi-structured interviews.

Community and hospital based settings across Ghana, where women's lives are largely shaped by informal trade, caregiving, and gendered work roles.

Perimenopausal, menopausal, and post-menopausal women aged between 18 and 99 years that provided informed consent.

A qualitative methodology was used based on a topics guide that was developed following an evidence synthesis, patient-public involvement and expert opinions. Interviews explored experiences linked to symptoms, healthcare access, coping strategies, work-life balance, and societal perceptions. Data were analysed using Braun and Clarke's six-phase reflexive thematic analysis to identify key patterns and meanings.

Experiences and perceptions of menopause, including symptom burden, coping mechanisms, and barriers to care.

Six interconnected themes were identified. Menopause intensified occupational and economic strain, with symptoms disrupting income generation and caregiving. Psychological burden and emotional disruption were widespread, often concealed due to stigma. Physical and somatic symptoms significantly impaired daily functioning. Barriers to healthcare included limited awareness, fragmented services, and low prioritisation of menopause. Women adopted coping and resilience strategies, such as herbal remedies and social withdrawal. Outlook, migration, and intergenerational lessons shaped planning for future generations.

Menopause in Ghana is a neglected occupational and sociocultural health issue. Integrating menopause care into chronic disease and mental health services, improving access, and enhancing workplace protections are critical.

The Circle of Security-Parenting (COS-P) group intervention has demonstrated efficacy in reducing maternal perinatal mental health difficulty (PMHD) symptoms in some contexts. The Circle of Security Intervention (COSI) study, a multisite, individually randomised, single-blind, parallel-arm controlled trial, was conducted in England to assess the clinical effectiveness of COS-P in reducing perinatal psychopathology, parenting and infant development, as well as its acceptability among the National Health Service (NHS) participants and staff. The main aim of this work is to estimate the cost-utility of COS-P plus treatment as usual (TAU) relative to TAU among mothers and birthing parents receiving NHS perinatal mental health services (PMHS) in England.

A within-trial economic evaluation was performed comparing COS-P plus TAU with TAU alone, using data from the COSI trial, which employed a 2:1 randomisation ratio. Analyses were conducted from both NHS and personal social services (PSS) and societal perspectives. A 12-month time horizon was used, consistent with the final trial follow-up.

Secondary care NHS perinatal health services across multiple centres in England.

A total of 371 mothers and birthing parents with PMHD were randomised and had complete economic outcome data; 248 received COS-P plus TAU and 123 received TAU alone. Participants were eligible if they were receiving NHS PMHS; exclusion criteria were defined in the trial protocol.

Participants in the intervention arm received the COS-P group programme in addition to TAU. The control group received TAU alone.

The primary economic outcome was quality-adjusted life years (QALYs) over 12 months, derived from the 5-level EuroQol five-dimensional (EQ-5D-5L) questionnaire - responses. Costs were estimated from NHS and PSS as well as societal perspectives, including healthcare utilisation and productivity losses due to work absence.

Compared with TAU, COS-P was associated with higher costs from both NHS and PSS (£180.58; 95% CI -£1075 to £1436) and societal (£72.94; 95% CI -£1473 to £1619) perspectives. COS-P was marginally less effective in terms of QALYs (-0.01; 95% CI -0.06 to 0.05). Probabilistic sensitivity analyses indicated substantial uncertainty around cost and effectiveness estimates.

On average, COS-P was associated with higher costs and did not demonstrate improvements in health-related quality of life compared with TAU alone. Given the uncertainty surrounding the estimates, further research is warranted to explore potential longer term economic and clinical impacts of COS-P in perinatal mental health settings.

SRCTN18308962.