Cognitive impairment is a common non-motor symptom in Parkinson's disease (PD) that can potentially occur at any disease stage (Aarsland et al., 2021). Compared to cognitively normal patients, PD patients that develop mild cognitive impairment (MCI) show greater levels of atrophy (Mak et al., 2015). Greater baseline white matter hyperintensity (WMH) burden is also linked to more severe future cognitive deficits in PD patients (Dadar et al., 2018). Here, we assess the longitudinal changes in gray matter (GM) atrophy and WMH burden in PD patients that develop MCI compared to those that remain cognitively normal.

Imaging and clinical data were obtained from the Parkinson's Progression Markers Initiative (PPMI) study (Marek et al., 2018). Deformation-based morphometry (DBM) maps and WMH segmentations were extracted using T1w images in 312 PD (559 timepoints) using an in-house pipeline (Lajoie et al. 2025) and BISON (Dadar et al., 2021), respectively. A series of linear mixed-effects models were used to assess the differences in the longitudinal trajectories of the brain measures (DBM and WMHs) between the patients that developed MCI compared to those that remained stable using an interaction term between conversion_status and time from baseline visit as the variable of interest. The models included MoCA score at baseline, sex, and age at the baseline as covariates. False Discovery Rate (FDR) method was applied for multiple comparisons correction (Benjamini and Hochberg, 1995).

All included PD patients were cognitively normal at baseline and had 6 years of follow-up assessments available for cognitive status. During these 6 years, 47 patients developed MCI, while 265 remained cognitively normal. Figures 1A-B show the t-statistic maps of the regions that showed significantly greater rates of longitudinal atrophy, ventricular expansion, and WMH progression in patients that developed MCI compared against those that remained cognitively healthy following FDR correction. The observed differences for both atrophy and WMHs were the strongest in bilateral frontal regions as well as the accumbens areas (Table 1).

Our results suggest that PD patients that develop MCI experience greater levels of pathology in both gray and white matter brain regions in the frontal lobes.

The introduction and scale-up of HIV treatment and prevention programmes have resulted in steady declines in orphanhood prevalence in sub-Saharan Africa, but orphanhood incidence and its associated factors are less understood. We aimed to describe the incidence and prevalence of orphanhood after HIV treatment and prevention programmes became available in Rakai, Uganda.

In this population-based cohort study, we used data from all children and adolescents younger than 18 years with censused parents residing in 28 continuously surveyed Rakai Community Cohort Study (RCCS) communities from 1995 to 2022 (N=92 441), to calculate maternal, paternal, and double orphanhood prevalence by census round. Orphanhood incidence was estimated by use of a non-parametric hierarchical Bayesian model over time among children whose parents were alive during their first census interview and who were censused at least twice without missing more than two consecutive census visits (N=54 411). Poisson regression models estimated incidence rate ratios of orphanhood and 95% CIs by time period (pre-antiretroviral therapy [ART; 1995-2003], ART partial availability [2004-14], and ART full availability [2015-22]), age at orphanhood, and socioeconomic status of the household. Population attributable fractions of incident orphanhood due to parents' HIV-positive status were estimated among those with surveyed parents who were tested for HIV.

Orphanhood prevalence declined considerably over the study period, with steepest declines after ART became available; from 21·5% (3421 of 15 941 individuals) in 2003-04 to 6·3% (1449 of 23 082 individuals) in 2020-22. In adolescents aged 15-17 years, orphanhood prevalence declined from 49·4% (1057 of 2138) in 2002-03 to 14·4% (526 of 3661 individuals) in 2020-22. Incidence rates declined sharply; double orphanhood declined from 5·13 (95% CI 4·02-6·45) per 1000 person-years in 2003-04 to 0·68 (0·42-1·05) per 1000 person-years in 2020-22. The proportion of new cases of orphanhood attributed to parental HIV status declined from 67% in 2004 to 11% in 2022 for paternal orphanhood and from 71% to 12% for maternal orphanhood.

Scale-up of ART in this Ugandan setting drove substantive declines in orphanhood incidence. Yet, a considerable burden of orphanhood persisted in 2022, particularly among adolescents. To consolidate these gains, sustained investment and adaptation of HIV programmes are crucial to mitigate the ongoing risk of orphanhood for this vulnerable population.

National Institute of Allergy and Infectious Diseases, National Institute of Child Health and Development, Gates Foundation, National Institute of Mental Health, and National Institutes of Health Fogarty International Center.

Cannabis is the most used illicit substance during pregnancy in the United States. While cannabis legislation is associated with prevalence and access to care, its relationship with treatment completion among pregnant women is unclear. This study examined the association between cannabis legalization and treatment completion among pregnant women admitted for cannabis use from 2020 to 2022.

This retrospective cross-sectional analysis used data from the Treatment Episode Data Set-Discharge (TEDS-D) to analyze treatment completion among pregnant women aged 12 or older who were admitted for cannabis use (n = 13,088) across states with fully legalized, partially legalized (medical use only), or illegal cannabis policies. Multivariable-adjusted logistic regression was used to assess the association between legalization status and treatment completion, with subgroup analyses by treatment setting and referral source.

Among pregnant women admitted for cannabis use, 28.3 % completed treatment. Compared to states where cannabis remained illegal, those in states with fully legalized cannabis had significantly lower odds of treatment completion (adjusted odds ratio [AOR], 0.33 [95 % confidence interval, 0.27-0.41]), with a similar trend in states with partial legalization (AOR, 0.33 [0.28-0.40]). The negative association between cannabis legislation and treatment completion was more pronounced in outpatient settings than in residential programs, and stronger among court/other referrals than among voluntary referrals.

Cannabis legalization may be negatively associated with treatment completion among pregnant women admitted for cannabis use. Further research is needed to identify policy-related barriers and develop evidence-based interventions that improve treatment engagement and retention in this vulnerable population.

To characterize stigma dimensions, social, and related behavioral circumstances in people living with HIV (PLWHs) seeking care, using natural language processing methods applied to a large collection of electronic health record (EHR) clinical notes from a large integrated health system in the southeast United States.

We identified a cohort of PLWHs from the University of Florida (UF) Health Integrated Data Repository and performed topic modeling analysis using Latent Dirichlet Allocation (LDA) to uncover stigma-related dimensions and related social and behavioral contexts. Domain experts created a seed list of HIV-related stigma keywords, then applied a snowball strategy to iteratively review notes for additional terms until saturation was reached. To identify more target topics, we tested three keyword-based filtering strategies. The detected topics were evaluated using three widely used metrics and manually reviewed by specialists. Word frequency analysis was used to highlight the prevalent terms associated with each topic. In addition, we conducted topic variation analysis among subgroups to examine differences across age- and sex-specific demographics.

We identified 9,140 PLWHs at UF Health and collected 2.9 million clinical notes. Through the iterative keyword approach, we generated a list of 91 keywords associated with HIV-related stigma. Topic modeling on sentences containing at least one keyword uncovered a wide range of topic themes associated with HIV-related stigma, social, and related behaviors circumstances, including "Mental Health Concern and Stigma", "Social Support and Engagement", "Limited Healthcare Access and Severe Illness", "Missed Appointments and HIV Care Monitoring", "Treatment Refusal and Isolation", "Intimate Partner Violence and Relationship Concerns", "Fear of Falling and Physical Health Concerns", "Substance Abuse", and "Food Insecurity and Resource Scarcity". Topic variation analysis across sex and age subgroups revealed no substantial difference between males and females; however, there were differences were observed among different ages. For example, "Fear of Falling and Physical Health Concerns" was notably more prevalent among older adults.

Extracting and understanding the HIV-related stigma and associated social and behavioral circumstances from EHR clinical notes enables scalable, time-efficient assessment and overcoming the limitations of traditional questionnaires. Findings from this research provide actionable insights to inform patient care and interventions to improve HIV-care outcomes.

The rapid digitalization of healthcare is transforming medical care strategies. Individuals carrying (likely) pathogenic TP53 germline variants (P/LP TP53) require complex surveillance protocols. To support these individuals, we provided the adapted PatientConcept app to adults with a P/LP TP53 variant and their relatives. We analyzed the value of this adapted app for this cohort, as well as general aspects of Internet use, web-based healthcare options, mental and physical health, and fear of progression. (FOP). From a larger study consisting of 70 carriers and 43 relatives, 25 affected individuals and no relatives installed the app. App users tended to be younger and physically fitter but reported higher levels of psychological distress and FOP compared to non-users. Users rated their distress as high and expressed interest in an on-demand intervention tool offering concise information sessions. Overall, users were satisfied with the app, finding it useful and easy to understand, though they identified areas for improvement. Many app features were underutilized, indicating a need for further adaptation to the target group. Most users obtained medical information online, considering it helpful but often unreliable and difficult to evaluate. Nevertheless, app users felt confident in their ability to use the Internet for health-related search. Our study demonstrates the feasibility and acceptance of an app for individuals with LFS, supporting their surveillance and health behaviors.

While the adolescent use of traditional substances has shown a decline in recent years, the use of Novel Psychoactive Substances (NPS) is rising in popularity due to affordability and accessibility. Limited research exists on the risk profiles of adolescents who engage in NPS use. This study aimed to identify key predictors of NPS use among adolescents.

This study included 1605 adolescents from the K cohort of the Longitudinal Study of Australian Children. Adolescent NPS use was measured using self-reported lifetime use of synthetic cannabis and other NPS use. We employed Firth's penalized logistic regression to investigate predictors of NPS use among adolescents.

Among the 1605 adolescents included in the study, 64 (4.0%) reported using NPS. Lower weekday social media use was linked to reduced odds of NPS use. Lower parental monitoring was significantly associated with higher odds of NPS use. Alcohol use was linked to increased odds of NPS use. Additionally, higher externalizing behavior was associated with increased odds of NPS use.

The findings highlight the importance of early identification and intervention to reduce the risks of NPS use, emphasizing the role of positive parenting, adolescent mental health support, and evidence-based prevention policies.

Assistive technology in adaptive sports has become a transformative force for individuals with disabilities. It helps disabled athletes to overcome physical and cognitive barriers to participate in sports. This study presents a bibliometric analysis of assistive technology in adaptive sports to examine its development, key themes, and emerging trends. The analysis used data from 8,660 documents across 2,137 sources retrieved from the Scopus database from 1987 to 2025. The result shows that due to advancements in technology and increased awareness of inclusivity in sports, the research output grows exponentially after 2010. Among these research outputs, the most used theme was rehabilitation. The other emerging topics incorporated into adaptive sports are virtual reality, brain-computer interfaces, wearable technologies. Further, the co-occurrence network analysis reveals that there are strong interdisciplinary connections between rehabilitation, assistive technology, and physical activity. However, several areas remain unexplored such as digital health and telehealth applications in adaptive sports. Thus, bibliometric analysis provides a roadmap for future research by identifying critical trends and gaps. This study highlights the interdisciplinary collaboration and technological innovation in advancing accessibility and inclusivity for athletes with disabilities.

Prenatal alcohol exposure (PAE) increases the risk for serious adverse birth outcomes and long-term neurodevelopmental, physical, and mental health outcomes, known under the umbrella term of fetal alcohol spectrum disorders (FASD). Despite its well-documented adverse effects, PAE continues to be prevalent in the United States (U.S.), where an estimated 13.5% of women report alcohol consumption during pregnancy. Brief interventions to reduce PAE delivered during prenatal care have obtained mixed results, in part due to obstetricians' high workload and short prenatal care visits. To overcome this challenge and address the need, Safe Start is a clinical trial to evaluate the efficacy of a hybrid intervention to reduce alcohol-exposed pregnancies delivered on a digital platform and by prenatal care nurses.

Women attending obstetrics clinics for pregnancy confirmation or an initial prenatal care visit are screened for eligibility. To qualify, participants must be at least 18 years old; have a gestational age of less than 28 weeks; report any alcohol use in the past 30 days; and provide consent to participate. Recruited participants are randomized in 1:1 proportion to the Safe Start intervention plus usual prenatal care or usual prenatal care alone. Over three visits, participants receive two digitally- and three nurse-delivered sessions based on motivational enhancement principles. Sessions are scheduled during prenatal care appointments to minimize participant burden and increase retention. Using an intent-to-treat analysis, weighted generalized estimating equations will be used to evaluate the intervention's efficacy, relative to usual care, in enhancing the proportion of women with a laboratory-confirmed negative phosphatidylethanol, a biomarker for alcohol use, at each visit. Additional analyses will evaluate intervention effects on the prevalence of adverse birth outcomes (preterm birth and low birth weight).

This intervention is embedded within a prenatal care clinic in a large urban setting serving primarily low-income racially minoritized women. If efficacious, this theory-driven, rigorously tested intervention may represent a scalable strategy suitable for adoption in maternity care across the U.S. to reduce PAE and alcohol-related adverse birth outcomes, including FASD.

The study is registered on clinicaltrials.org; Clinical Trials Registration Number: NCT05766761; Registration Date: 2023-02-27.

Peer-provided services play a crucial role in healthcare delivery across health care issues. This study describes the process of implementing a peer navigation program called mentoring and peer support (MAPS) for individuals with serious mental illness (SMI) reentering the community after jail release.

In-depth interviews were conducted with four peer navigators, and the 12-item Working Alliance Inventory Scale was used to assess their perspectives on the program. Additionally, 25 administrative documents were reviewed to describe implementation processes. An applied thematic analysis was conducted using the Consolidated Framework for Implementation Research (CFIR).

Results from qualitative exit interviews, the Working Alliance Inventory survey, and administrative reviews indicate that the MAPS program was feasible, acceptable, and culturally appropriate. However, opinions on its effectiveness were mixed. Peer navigators faced challenges accessing clients in jail due to facility lockdowns and short staffing. They also encountered client skepticism, as some initially mistook them for law enforcement or probation officers. Maintaining post-release contact was difficult due to unreliable phone numbers and unstable housing. Recommendations include aligning jail release times with community service hours, diversifying participant incentives, and employing full-time peer navigators for greater flexibility.

Peer navigation programs like MAPS hold promise for enhancing mental health service linkage among reentering individuals. Stronger post-release support systems and clearer role definitions to mitigate client distrust would advance implementation. Findings from this study will inform implementation of an adequately powered randomized trial evaluating effectiveness and cost-effectiveness of the MAPS intervention.

Motor performance (MP) is essential for maintaining functional independence, particularly in later life. However, the relationship between MP and sleep quality, depressive symptoms, and their underlying brain substrates remains obscure. We employed four samples of younger/mid-to-older adults (n = 1,954) from the Human Connectome Project-Young Adult (HCP-YA), HCP-Aging (HCP-A), and enhanced Nathan Kline Institute-Rockland sample (eNKI-RS) to assess the replicability of our findings. Using canonical correlation analyses within a machine learning framework, we investigated the associations of sleep quality, depressive symptoms, and grey matter volume (GMV) with MP. In the combined model of the HCP-YA sample, a canonical variate of better sleep, mild, sub-clinical depressive symptoms, and altered GMV of several cortical (including precentral and fusiform gyrus), thalamus, and cerebellar brain regions was associated with a canonical variate of better MP (r = 0.2, SD = 0.05). This pattern was conceptually replicated in the young eNKI-RS sample (r = 0.25, SD = 0.13). In the HCP-A sample, a variate of better sleep quality, fewer depressive symptoms, and increased GMV was associated with a variate of MP (r = 0.18, SD = 0.1), but these findings did not replicate in the mid-to-older eNKI-RS sample (r = 0, SD = 0.12). Across all samples, variates of increased GMV were associated with variates of better MP, suggesting potential neuroanatomical underpinnings. We observed age-related variations in the multivariate associations between sleep quality, depressive symptoms, and GMV with MP.