The aim of this study was to investigate the effects of central vestibular dysfunction on physical functionality and cognitive function in individuals with multiple sclerosis (MS).

Fifty-two fully ambulatory individuals with MS (Expanded Disability Status Scale [EDSS] ≤ 4) were included and divided into two groups: those with central vestibular involvement (Group 1; n = 25) and those without (Group 2; n = 27). Central vestibular involvement was assessed using videonystagmography. Physical and cognitive functions were evaluated in all participants using the Glittre Activities of Daily Living (ADL) test, Godin Leisure-Time Exercise Questionnaire (GLTEQ), and the physical dimension of the MSQoL-54 for physical functionality, and the BICAMS, Trail Making Test (TMT), Word List Generation test and the cognitive dimension of the MSQoL-54 for cognitive function.

According to the physical functionality assessment results, the time required to complete the Glittre ADL test was longer in group 1 than in group 2 (p = 0.01). The score for the physical dimension of the MSQoL-54 was lower in group 1 (p = 0.045). In the BICAMS Symbol Digit Modalities Test, Group 1 scored lower than Group 2 (p = 0.013). A significant difference between the groups was also observed in the time taken to complete the TMT (p = 0.017). Additionally, Group 1 exhibited lower scores on the cognitive dimension of the MSQoL-54 (p = 0.012).

Physical functionality and specific cognitive domains differed between MS participants with and without central vestibular involvement. It should be considered that vestibular dysfunction may adversely impact cognitive and physical functionality, even in low-moderate disability level.

To study (1) the differences in dietary climate impact between sociodemographic groups, (2) the differences in food consumption and macronutrient intake as absolute amounts and in relation to energy intake by dietary climate impact level and (3) food groups as contributors of dietary climate impact.

Food consumption and energy and macronutrient intakes were calculated based on two non-consecutive 24-hour dietary recalls. Dietary climate impact was calculated using national coefficients produced with life cycle assessment. Regression analysis was used to test the mean differences between sociodemographic groups and sex-specific dietary climate impact tertiles.

Finnish national food consumption survey FinDiet 2017.

In total, 565 men and 682 women (age 18–74) after exclusion of energy under-reporters.

The mean daily dietary climate impact was higher in men than in women (5·6 v. 4·0 kg CO2eq) and in younger age group (18–44 years) than in older age group (65–74 years). The association of food consumption and dietary climate impact was mainly different for food consumption as absolute amounts (g/d) and in relation to energy (g/MJ). In relation to energy, the consumption of animal-based foods was higher and plant-based foods lower in the highest dietary climate impact tertile compared with the lowest tertile. Red and processed meat was a major contributor to dietary climate impact.

Our study emphasises the importance of considering food consumption and nutrient intake both as absolute amounts and in relation to energy intake. Our findings support the advantages of plant-based diets in being both healthier and more climate-friendly.

Noonan syndrome is characterised by typical facial features, short stature, CHDs, and other comorbidities, which are caused by germline mutations in genes coding for components of the Ras-mitogen-activated protein kinase pathway. Noonan syndrome is an inherited disease involving multiple systems, but ventricular arrhythmia in Noonan syndrome is rarely reported.

Here we report a 15-year-old patient with leucine zipperlike transcription regulator 1-associated Noonan syndrome, who has CHD (left ventricular hypertrophy with left ventricular outflow tract obstruction), ventricular arrhythmia, bundle branch block, pectus excavatum, costal eversion, scoliosis, myopia, growth retardation, hearing loss, chest tightness, and fatigue. Chest tightness and fatigue are the main reasons for admission of the patient. The patient was treated with spironolactone, empagliflozin, tolasemide, potassium chloride, and bisoprolol. One month after treatment, the patient has no more chest tightness or fatigue. Genetic testing revealed that the patient had a novel heterozygous variant c.313delT (p.trp105Glyfs * 42) mutation in the leucine zipperlike transcription regulator 1. We provide a review of the literature of leucine zipperlike transcription regulator 1 mutations and find that ventricular arrhythmias have been reported in leucine zipperlike transcription regulator 1-related Noonan syndrome.

Our findings expand on the Noonan syndrome phenotype and suggest that mutations in the leucine zipperlike transcription regulator 1 gene are involved in ventricular arrhythmia.

While prenatal exposure to tobacco has been associated with adolescent suicide attempt, little is known about the mechanisms explaining this association. This study aims to explore the mediating roles of internalizing symptoms, externalizing behaviors, and peer problems across childhood in the association between prenatal exposure to tobacco and adolescent suicide attempt.

We analyzed data from N = 8,861 participants from the Millennium Cohort Study followed from ages 9 months to 17 years. Binary logistic regression models were used to investigate the total association between exposure to tobacco in pregnancy and suicide attempt, and mediation analyses were conducted using structural equation models to investigate the direct and indirect associations.

In models adjusted for key covariates, we found a significant association between prenatal tobacco exposure and increased risk of adolescent suicide attempts (odds ratio = 2.08, 95% confidence interval = [1.68, 2.56]), partly mediated through internalizing problems, externalizing behaviors, and peer problems from ages 3 to 14 years (accounting for 37% of the total association, that is, 16%, 12%, and 9%, respectively).

These findings suggest that interventions targeting mental health symptoms and peer problems may maximize suicide prevention efforts among children who were prenatally exposed to tobacco, thus potentially reducing the long-term risk of suicide attempt.

Informed consent is a cornerstone of ethical research, but the lack of widely accepted standards for the key information (KI) section in informed consent documents (ICDs) creates challenges in institutional review board (IRB) reviews and participant comprehension. This study explored the use of GPT-4o, a large language model (collectively, AI), to generate standardized KI sections.

An AI tool was developed to interpret and generate KI content from ICDs. The evaluation involved a multi-phased process where IRB subject matter experts, principal investigators (PIs), and IRB reviewers assessed the AI output for accuracy, differentiation between standard care and research, appropriate information prioritization, and structural coherence.

Iterative refinements improved the AI’s accuracy and clarity, with initial assessments highlighting factual errors that decreased over time. Many PIs found the AI-generated sections comparable to their own and expressed a high likelihood of using the tool for future drafts. Blinded evaluations by IRB reviewers highlighted the AI tool’s strengths in describing study benefits and maintaining readability. However, the findings underscore the need for further improvements, particularly in ensuring accurate risk descriptions, to enhance regulatory compliance and IRB reviewer confidence.

The AI tool shows promise in enhancing the consistency and efficiency of KI section drafting in ICDs. However, it requires ongoing refinement and human oversight to fully comply with regulatory and institutional standards. Collaboration between AI and human experts is essential to maximize benefits while maintaining high ethical and accuracy standards in informed consent processes.

This study aimed to report a 10-year single-centre experience of cochlear implantation in children with CHARGE syndrome (manifests as coloboma, heart defects, atresia of the choanae, growth retardation and genital and ear anomalies) and evaluate surgical strategies and outcomes.

Children with CHARGE syndrome who underwent cochlear implantation between 2014 and 2024 were retrospectively reviewed. Patient characteristics and post-operative auditory outcomes were analysed.

Six patients (nine ears) were included. Most had airway anomalies, one-third required post-operative intensive care. Temporal bone malformations were present in 78 per cent of ears. Standard posterior tympanotomy was feasible in one-third; the remainder required transcanal or combined approaches. Full-electrode insertion was achieved in all ears. Median follow-up was 3.4 years; aided thresholds ranged 25 to 50 dB hearing level. Three patients developed reliable open-set speech perception, two achieved closed-set recognition and one demonstrated environmental sound awareness.

Cochlear implantation provides meaningful auditory benefit in selected children with CHARGE syndrome. Pre-operative cochlear nerve imaging, flexible surgical planning and coordinated peri-operative airway management are essential.

In children with tetralogy of Fallot and associated right ventricular outflow tract obstruction, right ventricular outflow tract stenting has emerged as a viable alternative to surgical shunting, particularly in high-risk patients who are unsuitable for early definitive repair.

This prospective and retrospective observational study involved 55 symptomatic children with Fallot-type physiology who underwent right ventricular outflow tract stenting over a 30-month period at a tertiary-care centre in India. Data from pre-procedural imaging, intraoperative parameters, and post-procedural outcomes were analysed. The primary endpoints were improvement in systemic oxygen saturation and pulmonary artery growth. Secondary endpoints included complication rates, ICU stay duration, and factors associated with procedural failure.

The median age at intervention was 11 months. All patients presented with cyanosis, and 80% had documented cyanotic spells. The right internal jugular vein was used for vascular access in 75% of cases. A significant improvement was observed in systemic oxygen saturation (from 67.8 to 87.1%, p < 0.001), along with an increase in pulmonary artery Z-scores. Complications included pulmonary oedema (47%), stent migration (7.2%), and new-onset tricuspid regurgitation (26.9%). The procedure had a success rate of 83.6%. Although no significant predictors of failure or prolonged ICU stay were identified, furosemide use was associated with a longer recovery time.

Right ventricular outflow tract stenting serves as a safe, effective, and reproducible palliative option in selected neonates with Fallot physiology. It facilitates improved systemic oxygenation and promotes pulmonary artery development, thereby serving as a bridge to definitive surgical repair.

The study aims to explain the challenges experienced by Emergency Medical Services workers in a massive disaster due to resource scarcity.

In this qualitative study, in-depth interviews were conducted with 14 Emergency Medical Services workers in the region within the first 72 hours of the Kahramanmaraş Earthquakes. Participants were determined by snowball sampling method, and data were collected using a semi-structured interview form. Collected data were evaluated using descriptive and content analysis methods.

When the data were analyzed, the difficulties experienced by the participants were covered in two main themes and eight sub-themes. The main themes were physical and managerial challenges, and the sub-themes were nutrition, shelter and adverse weather conditions, hygiene, safety, sleep shortage and exhaustion, operational, logistics and transportation, communication and coordination.

The findings suggest that challenges in meeting the basic physical needs of Emergency Medical Services workers during massive disasters may reduce the overall effectiveness of response efforts. Ensuring their physical safety, particularly in large-scale earthquakes that cause severe structural damage, emerges as a persistent concern. Disaster preparedness efforts should more carefully consider the fragility and vulnerability of high-risk zones when developing national response plans.

Evidence regarding the effects of antipsychotic medication on cognitive functioning after a first-episode psychosis (FEP) remains inconclusive. This study examined whether dopamine D2 receptor occupancy, affinity, and antipsychotic dose are related to cognitive functioning in people in remission from FEP.

278 remitted FEP participants from the HAMLETT-trial were included. Cognitive functioning was assessed with the Brief Assessment of Cognition in Schizophrenia, 3–6 months after remission. D2 receptor occupancy was estimated based on antipsychotic type and dose. Antipsychotics were categorized into partial agonists, or antagonists with high or low D2 receptor affinity. Linear regression analyses were performed with inverse probability of treatment weighting to control for differences in characteristics between groups.

D2 receptor occupancy was negatively related to global cognition (β = −0.18), verbal fluency (β = −0.22), and attention and processing speed (β = −0.17, all p < 0.003). The interaction between daily dose and D2 receptor affinity category was significant for global cognition (p = 0.0046) and working memory (p = 0.0019), but not for verbal fluency after correction for multiple testing (p = 0.029). Interactions showed that higher daily dose was related to lower cognitive functioning, with significantly stronger negative effects in high-affinity antagonists compared to other antipsychotics.

The current findings underscore the importance of antipsychotic D2 receptor occupancy and affinity for cognitive functioning and suggest better cognitive functioning in users of partial agonists and low D2 receptor affinity antipsychotics. This can be important when selecting antipsychotics for individuals with FEP.

We examined whether point-of-sale warning posters, compared with control posters, reduced Guatemalan adolescents’ purchases of sugar-sweetened beverages (SSB) at school stores.

We used a difference-in-differences approach (4-week baseline and 4-week treatment). Our primary analysis compared two schools assigned to an intervention warning poster to one school that displayed a control poster. Based on purchase transaction data, the outcomes were volume of SSB, beverage kcal and sugar purchased per transaction.

Three private schools in Guatemala City, Guatemala.

Students between 12 and 18 years of age.

Our primary analysis found that the warning poster decreased the overall volume of SSB (in ounces) that adolescents purchased in the warning poster intervention schools (−2·27 oz. 95 % CI = (−2·70, −1·85)) compared with the control school. This reduction was driven by a decrease in SSB purchases (OR = 0·64, 95 % CI = (0·49, 0·86)). The warning posters were associated with a significant reduction in likelihood of purchasing a beverage with kilocalories (calories) (OR = 0·68, 95 % CI = (0·49, 0·92)). These changes were associated with a significant overall decrease in sugar purchased (−5·54 g 95 % CI = (−6·69, −4·39)). The posters were associated with a significant increase in non-SSB purchases in the intervention schools compared with the control school (OR = 1·53, 95 % CI = (1·16, 2·02)).

Our results suggest that messages that warn adolescents about the high-sugar content in SSB may be an effective, low-cost way to modestly reduce purchases of these drinks. These findings provide evidence to support national front-of-package labelling, currently being considered in Guatemala.

This study aimed to develop a transparent district-level Maternal and Child Health (MCH) index for Uttar Pradesh (UP), India, using a hybrid methodological framework integrating Analytic Hierarchy Process (AHP), Technique for Order Preference by Similarity to Ideal Solution (TOPSIS), and Geographic Information Systems (GIS), to support spatially targeted and equitable health planning.

MCH is a key indicator of equity and effectiveness within health systems, directly impacting the wellbeing of mothers and children. Despite global efforts, many low-and middle-income countries continue to face preventable maternal deaths and child illnesses. In Uttar Pradesh (UP), substantial inter–district disparities in MCH outcomes persist but are often masked by state-level averages, hindering targeted policy and resource allocation.

We applied a hybrid Multi-Criteria Decision-Making (MCDM) framework. AHP was used to assign weights to nine key MCH indicators covering antenatal care, skilled birth attendance, child immunization, and nutrition based on National Family Health Survey (NFHS-5, 2019–21) data across 75 districts. TOPSIS was then employed to rank districts by overall MCH performance. GIS was used to visualize spatial disparities and identify clusters of high and low performance.

The MCH Index revealed substantial spatial disparities across UP. Districts such as Barabanki, Mahamaya Nagar, and Unnao ranked highest, while eastern UP and Bundelkhand showed lower performance. AHP assigned the highest importance to skilled birth attendance (22%) and antenatal care visits (22%). TOPSIS rankings highlighted gaps in maternal health services in socioeconomically marginalized districts. GIS mapping identified clusters of vulnerability linked to infrastructure and poverty. The AHP-TOPSIS-GIS framework provides a replicable method for sub-state MCH assessment, enabling policymakers to prioritize underserved districts and reduce geographic health outcomes. The findings underscore the need for decentralized, equity-focused strategies tailored to local contexts. Future research should incorporate temporal changes and socio-environmental factors to strengthen planning and monitoring.