This study aimed to develop and validate a questionnaire that investigates sugar-related eating behaviour, excessive consumption, and addictive-like eating. This questionnaire was validated using a rigorous process assessing content validity, face validity, reliability testing, feasibility testing, and construct validity. Spearman’s correlation coefficients and Cronbach’s alpha were used to assess reliability. Feasibility testing was used to further validate and confirm the scoring/categorisation of ‘low’, ‘medium’, and ‘high’ scorers for use in future research. Exploratory factor analysis and reliability analysis were used to determine underlying latent factors and assess construct validity. Content validity was assessed by health professionals (n = 16), face validity was assessed by the lay public who had no expertise in nutrition or addiction (n = 20). Reliability (n = 54), repeat reliability (n = 50), and feasibility (n = 113) testing were assessed with a sample from the lay public. Spearman’s correlation coefficients were in the range of 0.58–0.91 and were statistically significant (P < 0.001), indicating good temporal stability within the questionnaire. Cronbach’s alpha coefficients were in the range of 0.62–0.93, indicating good internal consistency. Feasibility testing confirmed the use of calculating an ‘average total score’ from the data set and splitting the data set into tertiles: low, medium, and high scorers. Exploratory factor analysis confirmed three latent factors: F1: Compulsive Eating; F2: Comfort Eating; and F3: Withdrawal. Results suggest the questionnaire is highly reliable and was successfully validated. This questionnaire can be used in research to investigate problematic and addictive-like eating behaviour and its effects on ill health.

Information on registered primary healthcare diagnoses from the Register of Primary Health Care Visits (RPV) is used to allocate healthcare funding in Finland. Our aim was to analyse the diagnosis rate trajectories in the RPV and, through that, assess the equitable development of funding. We extracted national- and regional-level diagnosis numbers from the RPV. Joinpoint regression analysis with Model 1 (overall trend) and Model 2 (potential changes in trend) was used to assess diagnosis rate trajectories from 2018 to 2024. Model 1 demonstrated that the number of registered primary healthcare diagnoses has increased between 2018 and 2024, but the growth has not been uniform across all trajectories. Model 2 showed significant differences in the diagnosis rate trajectories between regions and diagnostic groups. There were significant discrepancies in the registration of primary care diagnoses. Reducing these discrepancies by standardizing diagnosis registration practices is necessary to ensure equitable healthcare funding.

Acute effects of a daily dose of red wine may cause deterioration of visual function; however, there is limited information on healthy individuals. This study aims to investigate acute effects of daily red wine consumption on visual function and retinal microvasculature in healthy young adults through a randomised self-controlled design and to explore the molecular mechanisms using an animal model. In healthy young adults’ study, twenty-seven adults with follow-up at baseline, 0·5 h and 2 h after consuming 300 ml of either red wine or water underwent blood biochemistry, visual function, morphology and blood flow of retinal and choroidal vasculatures, and cerebral blood flow (CBF) evaluation. Acute red wine consumption caused abnormal changes in retinal function (multifocal visual electrophysiology) that preceded changes in vision. Macular vessel diameter index (VDI) increased significantly at 0·5 h but decreased significantly at 2 h, despite increased regional CBF following red wine consumption, which was consistent with increased choroidal thickness and decreased retinal thickness. Animal experiments conducted on Brown Norway rats demonstrated a significant decrease in retinal VDI and vessel area density (VAD) associated with increased reactive oxygen species production following red wine administration, as well as decreased endothelial nitric oxide synthase (eNOS) and increased endothelin-1 (ET-1) levels in the retina. Consequently, red wine consumption caused abnormal changes in retinal function and microvascular constriction in healthy young adults, and an animal model suggested that the underlying mechanism may involve the regulation of eNOS and ET-1 levels in the retina. These findings imply the potential detrimental effects of drinking habits on individuals with retinal ischaemic diseases.

Family meals are positively associated with healthier diets among children and parents. We aimed to deepen the understanding of these relationships by exploring the associations between shared meals and dietary quality among children, fathers and mothers. A subset of parent-child dyads (296 children aged 3–6 years, 103 fathers, 293 mothers) from the DAGIS Intervention baseline assessment was included in this cross-sectional study. The parents reported how often they shared meals with the child and filled in a food frequency questionnaire assessing their child’s and their own food consumption. A Healthy Food Intake Index (HFII) describing dietary quality was calculated for all family members. We used linear regression to investigate the associations between shared meals and the HFII of the children, fathers and mothers. Models were adjusted for child’s age and gender, parent’s age and educational level and number of children in the household. Children whose fathers reported less frequently sharing a weekend lunch with the child had a lower HFII (B estimate –1·58, 95 % CI –2·66, –0·50). The association remained close to statistical significance with adjustments (B estimate –0·99, 95 % CI –2·17, 0·19). A less frequently shared weekend lunch was also borderline significantly associated with lower HFII among the fathers (adjusted model, B estimate –1·13, 95 % CI –2·30, 0·04). Fathers should be encouraged to share meals with their family, since it might have a role in the dietary quality of both children and fathers. Future studies should recognise fathers as important contributors to a healthy home food environment.

Sexsomnia is an arousal disorder in which abnormal sexual behaviors and experiences (such as masturbation, sexual intercourse, loud sexual vocalizations) are manifested during NREM sleep and are followed by amnesia upon awakening from these episodes. Both behavioral and pharmacological interventions are available for management of these manifestations, but no clinical trials have been performed to determine their effectiveness or guide clinical management. The aim of this review and case report is to describe the effectiveness of Cognitive Behavioral Therapy for sexsomnia (CBT-S) in a 27-year-old male whose chief complaint was sexual behavior 2 to 3 nights per week. The initial clinical assessment yielded diagnoses of sexsomnia, insufficient sleep syndrome, and snoring. The components of CBT-S used in this case included sleep extension, sleep hygiene, and relaxation therapy (diaphragmatic breathing with autogenic training) employing client-centered Motivational Interviewing. The patient reported no recurrence of sexsomnia events during the first month of therapy, but experienced 1 recurrence between the third and sixth months of follow-up, which was likely triggered by sleep deprivation and following alcohol consumption. No further recurrence of sexsomnia events was reported while maintaining adequate adherence to therapy. As is the case for insomnia, CBT represents a viable therapeutic option for the management of sexsomnia.

Children with moderate acute malnutrition (MAM) have an increased risk of iron deficiency, anaemia and death from infectious diseases. The iron-regulating hormone hepcidin is increased in inflammation and may be important in regulating iron metabolism in children with MAM. Asymptomatic malaria has previously been associated with elevated s-hepcidin. We assessed the association between inflammation, iron status, anthropometry and malaria and serum hepcidin (s-hepcidin) and evaluated the effect of food supplementation on s-hepcidin in a secondary analysis in 1019 children with MAM from a randomised intervention trial in Burkina Faso. Children received 12 weeks of supplementation of 500 kcal/d as either corn–soy blend (CSB) or lipid-based nutritional supplements (LNS). S-hepcidin was measured at baseline and after 12 weeks. At baseline, correlates of s-hepcidin were determined using Tobit regression. The effect of supplementation was determined using mixed effects Tobit regression. Children with iron deficiency had 82 % (95 % CI 76, 87) lower s-hepcidin than those without, whereas children with acute infection and inflammation had elevated s-hepcidin. Children with symptomatic malaria had 103 % (95 % CI 32, 210) higher s-hepcidin than afebrile children without detectable malaria, while children with recent or asymptomatic malaria had 51 % (95 % CI 35, 63) lower s-hepcidin. S-hepcidin increased 61 % (95 % CI 38, 87) after 12 weeks of food supplementation with 22 % higher (95 % CI 2, 45) concentration in those who received LNS compared with CSB. Expectedly, morbidity and inflammation were associated with higher, and iron deficiency with lower, s-hepcidin. Further studies are needed to corroborate the finding of decreased s-hepcidin in malnourished children with asymptomatic malaria.

Low-dimensional representation and clustering of network data are tasks of great interest across various fields. Latent position models are routinely used for this purpose by assuming that each node has a location in a low-dimensional latent space and by enabling node clustering. However, these models fall short through their inability to simultaneously determine the latent space dimension and number of clusters. Here we introduce the latent shrinkage position cluster model (LSPCM), which addresses this limitation. The LSPCM posits an infinite-dimensional latent space and assumes a Bayesian nonparametric shrinkage prior on the latent positions’ variance parameters resulting in higher dimensions having increasingly smaller variances, aiding the identification of dimensions with non-negligible variance. Further, the LSPCM assumes the latent positions follow a sparse finite Gaussian mixture model, allowing for automatic inference on the number of clusters related to non-empty mixture components. As a result, the LSPCM simultaneously infers the effective dimension of the latent space and the number of clusters, eliminating the need to fit and compare multiple models. The performance of the LSPCM is assessed via simulation studies and demonstrated through application to two real Twitter network datasets from sporting and political contexts. Open-source software is available to facilitate widespread use of the LSPCM.

Creatine is a vital bioenergetic compound that remains largely overlooked within food systems despite its well-established role in human health and performance. Unlike creatinine – a downstream breakdown product of creatine metabolism commonly measured as a biomarker of kidney function – creatine functions as an energy buffer, facilitating the rapid regeneration of ATP in tissues with high metabolic demands such as skeletal muscle, brain and heart. Although a portion of daily creatine requirements is met through endogenous synthesis, dietary intake – primarily from animal-source foods – remains essential to maintain optimal physiological levels. Emerging evidence indicates that suboptimal creatine status, or creatine insufficiency, may be widespread, particularly among vegetarians, vegans, older adults, individuals with chronic illness and those with increased energy needs. This paper examines the evolving role of creatine across four domains: its natural occurrence in foods, incorporation into fortified food products, use as a dietary supplement and potential future classification as a pharmaceutical agent. Special emphasis is placed on differences in regulatory status, intended use, dosage, labelling and public health implications. In light of mounting evidence that creatine insufficiency may contribute to adverse outcomes – including impaired cognition, reduced muscular performance and vulnerability to stressors – integrating creatine into food policy and nutrition strategies represents a promising, scalable and preventive approach to improve population health.

Rural primary care providers report increasing rates of professional burnout, which can further exacerbate rural provider shortages and health disparities. From 2023 to 2025, the Project ECHO team at Penn State University developed and delivered an educational rural health telementoring program, collaboratively with stakeholders, to disseminate guideline-concordant care to rural primary care clinicians. The program focused on key rural topics and created a professional learning community aimed at decreasing participant burnout. Self-reported results of the pilot program’s participants (n = 106) demonstrate increased knowledge (p < .001) and reduced professional isolation. Future programing will expand data collection to explore longer-term impact.

This study evaluated the effect of different medium-chain to long-chain fatty acid (MCFA:LCFA, M:L) ratios on growth performance, intestinal function, antioxidant capacity and gut microbiota in piglets. A total of 250 piglets were randomly assigned to five groups with five replicates, each containing ten pigs. The diets, containing varying amounts of MCFA-rich coconut oil and LCFA-rich soyabean oil, resulted in M:L ratios of 0, 2·1, 4·2, 8·8 and 33·8 %. Results showed that both final body weight and average daily weight gain increased as the M:L ratio increased (P < 0·05), while the 8·8 % M:L ratio diet exhibited the lowest feed:gain ratio (P < 0·05). As the M:L ratio increased, the contents of superoxide dismutase and glutathione peroxidase were increased, and MDA was decreased in serum (P < 0·05). The 8·8 and 33·8 % M:L diets improved ileal and jejunal morphology (P < 0·05), as indicated by greater villus height and villus height:crypt depth ratios. Furthermore, increasing M:L ratios from 0 to 33·8 % increased expression of tight junction proteins occludin and ZO-1 in the jejunum (P < 0·05). The 33·8 % M:L ratio reduced microbial α-diversity (P < 0·05), while 8·8 % M:L diet significantly increased the abundance of beneficial bacteria (e.g. Lactobacilli, Prevotella) and decreased harmful bacteria (e.g. Escherichia-Shigella, Enterococcus) in the cecum (P < 0·05). In summary, our study found that 8·8 % of dietary M:L ratios significantly improved growth performance, likely through modulating intestinal function, antioxidant activity and gut microbial composition.

Functional referral systems are critical to primary health care and universal health coverage. Referral and counter-referral are key relational mechanisms to link communities to the care they need and primary care to secondary and multi-sectoral services. Many referral systems are fragmented, leading to inefficiencies, coverage gaps, and compromised continuity and quality of care. In June 2024, we conducted a scoping review of PubMed, Global Index Medicus and WHO publication databases to identify referral coordination and process initiatives at national, subnational, and local levels.

We classified reports from 181 papers into non-exclusive categories based on referral system design, operational elements, service delivery platform, and/or user group. Initiatives targeting referral system design included modelling, organization and assessment methodologies. Initiatives focusing on operational elements included networks and linkages, pathways and algorithms, e-referral systems and platforms, digital processes and tools, and facility-level processes and tools.

When classified by service delivery platform, community-level initiatives emphasized improved recognition, screening, diagnosis, and communication by community health workers and use of SMS text messaging or mHealth apps. At initiating facilities, reports focused on standardizing referral criteria and protocols and optimizing communication with referral facilities, including for real-time clinical decision-making to improve timely referral and to reduce under- and over-referral. Structured algorithms and pathways were key to minimize the time between referral, diagnosis, and treatment for time-sensitive conditions. At receiving facilities, actions included supporting initiating facility clinical decision-making prior to referral, prioritizing urgent cases, and consistent counter-referral and/or onward referral.

Findings are informing WHO guidance on two-way referral systems.