A longer duration of untreated illness (DUI) has been associated with poorer outcomes across several mental disorders; however, few studies have investigated DUI in anxiety disorders, particularly in generalized anxiety disorder (GAD). This study aimed to identify sociodemographic and clinical factors associated with a longer DUI in GAD.

We conducted a cross-sectional, multicenter study, retrospectively reviewing the medical records of GAD patients from three mental health services. Sociodemographic and clinical variables were extracted for analysis. One-way analyses of variance and Pearson’s correlations were used to examine the relationship between DUI and categorical and quantitative variables, respectively. A multivariate linear regression model was then conducted to identify variables independently associated with DUI.

The total sample included 243 patients; the mean DUI was 30.92 (±65.25) months. In the final model, a longer DUI was associated with an earlier age at onset (B = −0.428; p = 0.023), a longer duration of illness (B = −0.431; p < 0.001), and the presence of multiple side effects (B = 55.778; p < 0.001). There was a trend toward statistical significance for the association between a longer DUI and multiple medical comorbidities (B = 13.122; p = 0.076).

Our findings suggest that reducing the time between the onset of GAD and the initiation of appropriate pharmacological treatment may improve clinical outcomes, mitigating the risk of a chronic course of illness. Further studies are needed to elucidate the role of DUI as a prognostic factor in GAD.

Exercises are an essential component of preparedness and should be used to enhance capability and contribute to continuous improvement. An exercise can be as simple as a planning group discussing an emergency plan or as complex as a major multi-agency event involving several organizations and participants. This study aims to identify and conceptualize quality indicators (QIs) influencing prehospital disaster exercises across structure, conduct, and outcome.

This research was conducted through a systematic review and searching of the databases of PubMed, Scopus, Web of Science, and Google Scholar. Thematic content analysis was used for data analysis. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used for systematic search, and the Critical Appraisal Skills Program (CASP) was used for quality assessment of the final extracted articles.

From an initial set of 3,083 articles, 10 high-quality studies were included for analysis. The quality indicators influencing prehospital disaster exercises were analyzed into 3 themes, 8 categories, and 21 subcategories. The primary themes and related main categories included: Exercise structure QIs (knowledge promotion and cognitive skills, supply of exercise hardware and software requirements and resources desirable management), Exercise conduct QIs (practical proficiency in essential skills and decision-making capacity), and Exercise outcome QIs (evaluation and reporting of exercise, promotion of managerial capabilities and competencies, and development of psychological capabilities).

The findings of this research present a knowledge framework that can help exercise planners in prehospital settings in designing scientifically sound and standardized exercises aimed at enhancing disaster response processes. Furthermore, the implementation and evaluation of both discussion-based and operation-based disaster exercises informed by these identified quality indicators can foster the development of knowledge and promote behavioral change among prehospital staff, and facilitate a standardized response to emergencies and disasters.

Frailty is associated with adverse outcomes among patients with head and neck cancers. We evaluated the awareness of frailty among Irish head and neck healthcare professionals.

A cross-sectional survey was distributed to Irish multidisciplinary head and neck healthcare professionals.

Eighty responses were received with varying clinical experience. Seventy-nine (99 per cent) participants believed frailty could influence: post-treatment functional outcomes (77 [96 per cent]), overall survival (72 [90 per cent]) and treatment related toxicity among head and neck cancer patients. Eighteen (23 per cent) participants had used frailty in practice. A lack of awareness / training (68 [85 per cent]) and time / practical constraints (62 [78 per cent]) were the main barriers identified to the utilisation of frailty in practice.

Irish head and neck healthcare professionals are aware of frailty and believe it may be of benefit in clinical practice. Barriers to incorporation of frailty in head and neck care included a lack of training, time or resources.

Veterans Affairs Medical Centers offer multiple weight-loss treatments, including a comprehensive lifestyle intervention program (i.e., MOVE!), anti-obesity medications (AOMs) and bariatric surgery. Yet, most eligible veterans do not receive these treatments.

To describe the design, rationale, and planned evaluation of a comprehensive Weight Management and Metabolic Health program (WMMHP), consisting of (1) weight-focused visits with physicians or pharmacists trained in obesity medicine; (2) patient-centered use of available weight-loss treatments; and (3) coordinated, team-based care.

This is a quality improvement program implemented within the VA Ann Arbor Healthcare System. WMMHP eligibility criteria include body mass index (BMI) ≥ 30 kg/m2 or BMI ≥ 27 kg/m2 and ≥ 1 weight-related condition and participation in the MOVE! program. We plan to conduct an 18-month retrospective program evaluation using a propensity-matched cohort analysis to estimate the added benefit of WMMHP vs. MOVE! alone. The primary outcome will be mean change in weight at 18 months after baseline. Secondary outcomes will include mean weight loss at 6, 12, and 24 months, percentage of patients achieving thresholds of ≥ 5%, ≥ 10%, and ≥ 15% weight loss, initial prescriptions for and refilled prescriptions as a measure of adherence to AOMs, and referrals to, engagement with, and completion of bariatric surgery. We will also examine between-group differences in health system resource utilization.

The WMMHP is an innovative approach to improving treatment and outcomes for veterans with overweight and obesity. If effective, its components may inform obesity care delivery in VA and non-VA settings.

To map the spread of research on legumes, including beans, peas and other pulses; to identify research gaps and opportunities relating to the use of legumes for improved human nutrition, health and environmental outcomes; and to develop a novel method for clarifying research priorities.

Prospective mapping review, identifying and mapping ongoing research (2019–2023) across the value chain.

UK.

Academic research studies in three databases.

Fifty ongoing research projects were identified, revealing a focus on the two ends of the value chain: production (twenty-one projects) and consumption (twenty-one projects). Only four projects encompassed the entire value chain from producer to consumer. Research on production includes the role of legumes in crop rotations for soil health and reduced fertiliser use, productivity interventions and improved breeds. Research on consumption includes dietary and health outcomes, predominantly cardiometabolic impacts, and legumes as an alternative protein source. Few projects focused on the middle of the value chain (four projects on product development) with none focused on processing, food service or retail.

Further interdisciplinary projects, linking producers to consumers and with a greater focus on middle-chain actors, are needed. The food processing/manufacturing, food service and retail sectors hold significant power in food systems practice and governance. They play a crucial role in transitioning to a healthier and more sustainable food system. Understanding the drivers and barriers for these food systems actors in increasing production and consumption of beans, peas and pulses is required to inform future food policy and practice.

The growing frequency of global disasters highlighted the need to integrate technology into disaster management. This systematic review describes the global landscape of mobile phone technologies for natural hazard-induced disaster prevention, preparedness, response, and recovery.

A systematic review was conducted by searching databases, including Embase and MEDLINE, for studies published in English between 2000 and March 2024 that examined mobile applications for disaster management.

The review included 26 studies covering 77 mobile apps across 14 countries. Most apps were privately owned (78.26%), supported multiple disaster phases (41.56%), and favored the Android platform (46.67%), with GPS being the most common technology (15.58%). Apps primarily targeted the general public (63.64%) and focused on earthquakes (32.47%) and hurricanes (31.17%). Despite their potential, adoption remains low; only 11.33% (6 apps) exceeded 1 million downloads, while 33.96% failed to surpass 1,000 downloads.

This review highlights significant gaps in the development, adoption, and impact of disaster management apps, especially in high-risk regions. Future efforts must focus on enhancing accessibility, addressing user needs, expanding features, and fostering stakeholder collaboration to improve the effectiveness of mobile technologies in disaster preparedness, response, and recovery.

Auditory verbal hallucinations (AVH) in schizophrenia spectrum disorders (SSDs) may arise from misattributed inner speech. However, it is unclear if inner speech frequency and phenomenology differ in schizophrenia-spectrum voice-hearers compared with healthy individuals, and how different inner speech varieties relate to AVH and affect. Using experience sampling methodology (ESM), this study examined the moment-to-moment dynamics between inner speech varieties, AVH, and affect.

Participants completed 6 days of ESM on an electronic device, responding to 10 daily prompts on inner speech varieties (i.e. dialogic, evaluative, other people, condensed, and positive), AVH, and affect. Responses from 32 individuals with SSDs with current AVH (‘SSD’) and 34 healthy controls (‘HC’) were analyzed using linear mixed modeling.

SSD reported significantly more inner speech moments and higher momentary intensity of evaluative, other people, condensed, and positive inner speech compared with HC, but not for dialogic inner speech. Within SSD, higher momentary intensities of dialogic, evaluative, other people, and condensed inner speech were associated with higher AVH levels. Momentary negative affect (NA) moderated the association between evaluative inner speech and AVH, with a stronger association at higher NA levels.

SSDs with current AVH experience more frequent inner speech and exhibit a distinct phenomenological profile compared with healthy individuals. Several inner speech varieties are associated with AVH severity momentarily, supporting the hypothesis that inner speech contributes to AVH at the phenomenological level. This study highlights the emotional state as an important moderator of the inner speech–AVH relationship and as a potential therapeutic target.

To synthesize the available experimental study evidence to estimate the effects of ketamine on suicide ideation (SI) in high-risk individuals.

We conducted a systematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Double-blind randomized controlled trials and open-label studies investigating the safety and effectiveness of ketamine on SI published up to October 2025 were identified. Data were pooled using random-effects meta-analysis. The main outcome was standardized mean difference on SI in high-risk individuals. Secondary outcomes were the percentage of adverse events and the moderator effects.

We identified 21 studies with a total of 927 participants meeting our inclusion criteria. The pooled effect size for the reduction of SI after ketamine treatment was significant and clinically meaningful (large effect size of −1.40, 95% confidence interval: −2.15 to −0.66, P < 0.001, low–quality evidence). Dissociation (38.8%, P = 0.014), nausea (31.6%, P < 0.001), dizziness (24.7%, P = 0.003), headache (22.0%, P = 0.011) and anxiety (15.8%, P < 0.001) were the frequently reported adverse events. Moderator analyses indicated that the effect was higher in younger individuals and those with severe SI.

Our findings highlight the effectiveness of ketamine in reducing SI in high-risk individuals, especially younger individuals and those with severe ideation. Nonetheless, additional research is required to better understand optimal dosing regimens and the potential long-term effects of ketamine treatment.

To investigate whether taste perception of two artificial sweeteners—aspartame and neohesperidin dihydrochalcone (NHDC)—is causally associated with the risk of site-specific cancers.

A two-sample Mendelian randomisation (MR) study.

Genetic instruments for taste perception (6 for aspartame; 13 for NHDC) were obtained from a genome-wide association study (GWAS) of Australian adolescents, and cancer outcome data were sourced from publicly available GWAS datasets.

Genetic data for taste perception from 1757 Australian adolescents and genetic data for cancers from large-scale GWAS cohorts, including UK Biobank (n 500 000) and FinnGen (n 500 000).

A one sd increase in the genetically predicted perceived intensity of NHDC was associated with an increased risk of male genital cancer (OR = 1·11, 95 % CI: 1·04, 1·19) and prostate cancer (OR = 1·03, 95 % CI: 1·01, 1·08) based on FinnGen data. These associations persisted after multivariable MR adjustment for glucose and aspartame perception but were not replicated in the UK Biobank. A weak protective association between aspartame perception and cervical cancer (OR = 0·998, 95 % CI: 0·997, 0·999) was observed, but this attenuated to null in sensitivity analyses.

This study found no compelling evidence that perception of aspartame or NHDC during adolescence causally influences later-life cancer risk. The findings highlight the importance of evaluating individual artificial sweeteners separately in future research examining potential health effects.

Ocrelizumab (OCR) and rituximab (RTX) are anti-CD20 monoclonal antibodies (CD20Mabs) used in the treatment of relapsing multiple sclerosis (RMS). While both are effective at reducing relapses and new MRI lesions in clinical trials, real-world data on discontinuation rates and reasons for stopping therapy are limited.

This observational retrospective chart review included patients from two MS clinics in British Columbia, Canada. RMS patients treated with at least one infusion of OCR or RTX between January 2017 and March 2023 were included. Primary outcomes were reasons for discontinuation and discontinuation rates, with a secondary outcome of time to discontinuation.

In total, 881 RMS patients were included, with 478 on OCR and 403 on RTX. A total of 16.9% of patients on OCR and 14.9% on RTX discontinued therapy over 1643 and 694 patient-years, respectively (p = 0.46). Reasons for discontinuation included: side effects (33.3%), insurance coverage (17.0%) and clinical or radiological disease activity (11.3%). Discontinuation rates at 12, 24 and 36 months were 3.5%, 8.2% and 12.5% for OCR, and 6.4%, 14.8% and 22.2% for RTX, respectively (p = 0.0089). Median time to discontinuation was 21 months on OCR and 11.5 months on RTX (p < 0.0001). On Cox regression analysis, treatment with RTX was the only variable associated with discontinuation (hazard ratio 1.72, 95% CI 1.20–2.45).

Discontinuation rates of CD20Mabs were low, and the most common reason for stopping was side effects. Although not designed for comparison, our study suggests RMS patients may persist longer on OCR than RTX.