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Untreated anger and aggression in youth confer heightened risk for subsequent psychosocial problems. However, engaging youth in treatment for anger can be difficult given barriers to accessing care and high rates of attrition. This study examined whether learning relaxation skills and practicing them using a videogame, whose operation was contingent upon keeping heart rate close to baseline levels, could help children learn to manage anger and aggression. Youth ages 7-17 with elevated levels of anger (N = 39) were randomized to receive the active video game condition or a control game that displayed heart rate but did not stop the game if heart rate became elevated. Youth underwent baseline screening, 6 treatment sessions, and follow-up assessments at 2-weeks and 3-months. Compared to the control condition, children in the active condition demonstrated significantly greater improvements in clinician-rated aggression severity (d = 1.48) and youth-rated emotion dysregulation (d = 3.46) at 2-weeks post-treatment. The active group maintained these improvements at 3-month follow-up, but no longer significantly differed from the control group. Intervention effects were nonsignificant for parent-reported emotion dysregulation and aggression. In addition, the intervention group youth, but not control group, experienced increased time with heart rate below baseline over the course of the 6 sessions. Findings suggest a promising brief intervention for reducing aggression and emotion dysregulation in children while they are waiting for longer-term outpatient therapy. Clinical Trial Registration Number: NCT03270813., Competing Interests: Compliance with Ethical Standards. Competing Interests: The authors have no relevant financial or non-financial interests to disclose. The authors are not affiliated with and have no financial interests in Neuromotion or Mightier. Ethical Approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional review board at Massachusetts General Hospital and conducted in accordance with the ethical standards of the American Psychological Association. Informed Consent: Informed consent was obtained from parents of all individual participants included in the study and assent was obtained from all child and adolescent participants., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Dynapenic abdominal obesity (DAO) may be associated with an increased risk of disability. However, to date, this has not been investigated in low- and middle-income countries (LMICs), while the mediators are largely unknown., Aims: Therefore, we aimed to investigate the association between DAO and activities of daily living (ADL) disability, and to identify potential mediators among older adults from six LMICs., Methods: Cross-sectional, nationally representative data from the WHO Study on global AGEing and adult health were analyzed. Data on 20,198 adults aged ≥ 60 years were analyzed [mean (SD) age 69.3 (13.1) years; 54.1% females]. Dynapenia was defined as handgrip strength of < 26 kg for men and < 16 kg for women. Abdominal obesity was defined as waist circumference of > 88 cm for women and > 102 cm for men. DAO was defined as having both dynapenia and abdominal obesity. Disability was defined as severe or extreme difficulty in conducting at least one of six types of ADL. Multivariable logistic regression and mediation analysis were conducted., Results: Compared to no dynapenia and no abdominal obesity, DAO was significantly associated with 2.08 (95%CI = 1.37-3.17) times higher odds for ADL disability Mediation analysis showed that diabetes (mediated percentage 4.7%), hypertension (7.2%), and angina (7.7%) were significant mediators in the association between DAO and ADL disability., Conclusions: DAO was associated with increased odds for ADL disability among older adults from LMICs. Future longitudinal studies are warranted to assess temporal associations, and whether addressing or preventing DAO can impact on future occurrence of disability., (© 2024. The Author(s).)

Background: Cataracts may increase risk for falls but studies on this topic from low- and middle-income countries (LMICs) are scarce. Therefore, we examined the cross-sectional association between self-reported visual symptoms (suggesting cataract) and self-reported injurious falls in nationally representative samples of adults aged ≥ 65 years from five LMICs (China, Ghana, India, Mexico, and Russia)., Methods: Data from the WHO Study on global AGEing and adult health (SAGE) were analysed. Self-reported information on past 12-month fall-related injury and cataract based on symptoms were collected. Multivariable logistic regression and meta-analyses were conducted to assess associations., Results: Data on 13,101 people aged ≥ 65 years were analysed [mean (SD) age 72.5 (11.3) years; 45.2% males]. The overall prevalence of self-reported fall-related injury and visual symptoms (suggesting cataract) were 4.9% and 29.4%, respectively. There was a positive association between self-reported visual symptoms (suggesting cataract) and fall-related injury (i.e., OR > 1) in all five countries but statistical significance was reached in three: China (OR = 1.60; 95% CI = 1.08-2.35), India (OR = 1.96; 95% CI = 1.15-3.35), and Russia (OR = 3.58; 95% CI = 2.06-6.24). The pooled OR including all five countries based on a meta-analysis was OR = 1.88 (95% CI = 1.32-2.68)., Conclusions: Self-reported visual symptoms (suggesting cataract) were associated with higher odds for self-reported injurious falls among older adults in LMICs. Expanding availability of cataract surgery in LMICs may also have the additional benefit of reducing falls among older people., (© 2024. The Author(s), under exclusive licence to The Royal College of Ophthalmologists.)

Objectives: Mild cognitive impairment (MCI) is a unique indicator of underlying distress that may be strongly associated with suicide risk. Despite this, to date, no study has examined the association between MCI and suicidal ideation. Therefore, the present study aimed to examine the association between MCI and suicidal ideation among adults aged ≥65 years from 6 low- and middle-income countries (LMICs; China, Ghana, India, Mexico, Russia, and South Africa)., Methods: Cross-sectional, nationally representative data from the World Health Organization's Study on Global Ageing and Adult Health were analyzed. MCI was defined using the National Institute on Aging-Alzheimer's Association criteria. Self-reported information on past 12-month suicidal ideation was collected. Multivariable logistic regression and meta-analysis were conducted to assess associations., Results: Data on 13,623 individuals aged ≥65 years were analyzed. The prevalence of suicidal ideation ranged from 0.5% in China to 6.0% in India, whereas the range of the prevalence of MCI was 9.7% (Ghana) to 26.4% (China). After adjustment for potential confounders, MCI was significantly associated with 1.66 (95% confidence interval [95% CI] = 1.12-2.46) times higher odds for suicidal ideation., Discussion: Mild cognitive impairment was significantly associated with higher odds for suicidal ideation among older adults in LMICs. Future longitudinal studies from LMICs are necessary to assess whether MCI is a risk factor for suicidal ideation., (© The Author(s) 2024. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Introduction: This study aimed to investigate the association between handgrip strength and suicidal ideation in representative samples of adults aged ≥50 years from six LMICs (China, Ghana, India, Mexico, Russia, and South Africa)., Methods: Cross-sectional, community-based data from the World Health Organization's Study on Global Aging and Adult Health were analyzed. Handgrip strength quintiles by sex were created based on the average value of two handgrip measurements of the dominant hand. Self-reported information on past 12-month suicidal ideation was collected. Multivariable logistic regression analysis was conducted to assess associations., Results: Data on 34,129 individuals were analyzed [mean (SD) age 62.4 (16.0) years; age range 50-114 years; 52.1% females]. After adjustment for potential confounders, in the overall sample, compared to the handgrip strength quintile with the highest values [Quintile 1 (Q1)], Q2, Q3, Q4, and Q5 were associated with significant 2.15 (95% CI = 1.05-4.39), 2.78 (95% CI = 1.06-7.32), 3.53 (95% CI = 1.68-7.42), and 6.79 (95% CI = 2.80-16.48) times higher odds for suicidal ideation., Conclusions: Lower handgrip strength was significantly and dose-dependently associated with higher odds for suicidal ideation in adults aged ≥50 years from LMICs. Future longitudinal studies are needed to understand the underlying mechanisms, and whether increasing general muscular strength and physical function may lead to reduction in suicidal ideation., (© 2024 The Authors. Suicide and Life‐Threatening Behavior published by Wiley Periodicals LLC on behalf of American Association of Suicidology.)

Carbonated soft-drink consumption is detrimental to multiple facets of adolescent health. However, little is known about temporal trends in carbonated soft-drink consumption among adolescents, particularly in non-Western countries. Therefore, we aimed to examine this trend in representative samples of school-going adolescents from eighteen countries in Africa, Asia and the Americas. Cross-sectional data from the Global School-based Student Health Survey 2009-2017 were analysed. Carbonated soft-drink consumption referred to drinking carbonated soft-drinks at least once per day in the past 30 d. The prevalence of carbonated soft-drink consumption was calculated for each survey, and crude linear trends were assessed by linear regression models. Data on 74 055 students aged 12-15 years were analysed (mean age 13·9 (sd 1·0) years; 49·2 % boys). The overall mean prevalence of carbonated soft-drink consumption was 42·1 %. Of the eighteen countries included in the study, significant decreasing, increasing and stable trends of carbonated soft-drink consumption were observed in seven, two and nine countries, respectively. The most drastic decrease was observed in Kuwait between 2011 (74·4 %) and 2015 (51·7 %). Even in countries with significant decreasing trends, the decrease was rather modest, while some countries with stable trends had very high prevalence across time (e.g. Suriname 80·5 % in 2009 and 79·4 % in 2016). The prevalence of carbonated soft-drink consumption was high in all countries included in the present analysis, despite decreasing trends being observed in some. Public health initiatives to reduce the consumption of carbonated soft-drink consumption among adolescents are urgently required.

Purpose: There is a scarcity of literature on temporal trends in physical fighting and physical attacks among the global adolescent population. Therefore, we aimed to examine these trends in a nationally representative sample of school-going adolescents aged 12-15 years from 30 countries in Africa, Asia, and the Americas, for which temporal trends of physical fighting and physical attacks are largely unknown., Methods: Cross-sectional data from the Global School-based Student Health Survey 2003-2017 were analyzed. Self-reported data on past 12-month physical fights and physical attacks were collected. For each survey, the prevalence and 95% confidence interval of physical fights and physical attacks were calculated. Linear regression models were used to examine crude linear trends., Results: Data on 190,493 students aged 12-15 years were analyzed [mean (standard deviation) age 13.7 (1.0) years; 48.9% boys]. The mean prevalence of past 12-month physical fight and physical attack was 36.5% and 37.2%, respectively. Significant decreasing trends in physical fights were observed in 16/30 countries, while significant increasing trends were found in 2/30 countries. For physical attacks, significant decreasing and increasing trends were observed in 13/26 and 1/26 countries, respectively. The remaining countries showed stable trends., Discussion: It is encouraging that decreasing trends in physical fighting and physical attacks were observed across a large number of countries. However, stable trends were also common, while increasing trends also existed, suggesting that global efforts to address adolescent violence are still required., (Copyright © 2023 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

The potential of physical activity in preventing mental health issues has garnered interest among health professionals. We conducted a systematic umbrella review of evidence supporting the relationship between physical activity and the prevention of mental health complications. Our findings revealed a significant association between higher physical activity levels and reduced risk of depression (OR = 0.77, 95% CI 0.72 - 0.82). This association was consistent across various age groups, sex, and geographical regions. Interestingly, low and moderate-intensity physical activity showed the most significant protective effects against depression (low-intensity: OR = 0.81, 95% CI: 0.75-0.56; moderate-intensity: OR = 0.79, 95% CI: 0.72-0.87). Our analysis also showed significant associations between higher physical activity levels and prevention of anxiety disorders (OR = 0.71, 95% CI: 0.61-0.82). However, the evidence regarding the association between physical activity and psychosis/schizophrenia risk was less clear. These findings underscore the physical activity's potential as a preventative measure against mental health complications, highlighting the importance of promoting physical activity in mental health interventions., Competing Interests: Declaration of Competing Interest The authors declare that there is no conflict of interests., (Copyright © 2024. Published by Elsevier Ltd.)

Background: Magnetic resonance-guided focused ultrasound (MRgFUS) for treatment of essential tremor (ET) traditionally targets the ventral intermediate (Vim) nucleus. Recent strategies include a secondary lesion to the posterior subthalamic area (PSA)., Objective: The aim was to compare lesion characteristics, tremor improvement, and adverse events (AE) between patients in whom satisfactory tremor suppression was achieved with lesioning of the Vim alone and patients who required additional lesioning of the PSA., Methods: Retrospective analysis of data collected from ET patients treated with MRgFUS at St Vincent's Hospital Sydney was performed. Clinical Rating Scale for Tremor (CRST), hand tremor score (HTS), and Quality of Life in Essential Tremor Questionnaire (QUEST) were collected pre- and posttreatment in addition to the prevalence of AEs. The lesion coordinates and overlap with the dentatorubrothalamic tract (DRTT) were evaluated using magnetic resonance imaging., Results: Twenty-one patients were treated in Vim only, and 14 were treated with dual Vim-PSA lesions. Clinical data were available for 29 of the 35 patients (19 single target and 10 dual target). At follow-up (mean: 18.80 months) HTS, CRST, and QUEST in single-target patients improved by 57.97% (P < 0.001), 36.71% (P < 0.001), and 58.26% (P < 0.001), whereas dual-target patients improved by 68.34% (P < 0.001), 35.37% (P < 0.003), and 46.97% (P < 0.005), respectively. The Vim lesion of dual-target patients was further anterior relative to the posterior commissure (PC) (7.84 mm), compared with single-target patients (6.92 mm), with less DRTT involvement (14.85% vs. 23.21%). Dual-target patients exhibited a greater proportion of patients with acute motor AEs (100% vs. 58%); however, motor AE prevalence was similar in both groups at long-term follow-up (33% vs. 38%)., Conclusion: Posterior placement of lesions targeting the Vim may confer greater tremor suppression. The addition of a PSA lesion, in patients with inadequate tremor control despite Vim lesioning, had a trend toward better long-term tremor suppression; however, this approach was associated with greater prevalence of gait disturbance in the short term., (© 2024 The Authors. Movement Disorders Clinical Practice published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.)

Objective: To investigate the prevalence and trends of essential study design elements in preclinical urological studies, as well as key factors that may improve methodological rigour, as the demand for methodological rigour in preclinical studies is increasing since research reproducibility and transparency in the medico-scientific field are being questioned., Methods and Results: PubMed was searched to include preclinical urological studies published between July 2007 to June 2021. A total of 3768 articles met the inclusion criteria. Data on study design elements and animal models used were collected. Citation density was also examined as a surrogate marker of study influence. We performed an analysis of the prevalence of seven critical study design elements and temporal patterns over 14 years. Randomisation was reported in 50.0%, blinding in 15.0%, sample size estimation in 1.0%, inclusion of both sexes in 6.3%, statistical analysis in 97.1%, housing and husbandry in 47.7%, and inclusion/exclusion criteria in 5.0%. Temporal analysis showed that the implementation of these study design elements has increased, except for inclusion of both sexes and inclusion/exclusion criteria. Reporting study design elements were associated with increased citation density in randomisation and statistical analysis., Conclusions: The risk of bias is prevalent in 14-year publications describing preclinical urological research, and the quality of methodological rigour is barely related to the citation density of the article. Yet five study design elements (randomisation, blinding, sample size estimation, statistical analysis, and housing and husbandry) proposed by both the National Institutes of Health and Animal Research: Reporting of In Vivo Experiments guidelines have been either well reported or are being well reported over time., Systematic Review Registration: PROSPERO CRD42022233125., (© 2023 BJU International.)

Purpose: Adolescent alcohol consumption is detrimental to multiple facets of health. However, there is a scarcity of data available on time trends in adolescents' alcohol consumption particularly from non-Western countries and low- and middle-income countries. Thus, we examined the temporal trend of alcohol use in a large representative sample of school-going adolescents aged 12-15 years from 22 countries in Africa, Asia, and the Americas., Methods: Data from the Global School-based Student Health Survey were analyzed. Alcohol consumption referred to consuming alcohol on at least one day in the past 30 days. Crude linear trends of past 30-day alcohol consumption by country were assessed by linear regression models., Results: Data on 135,426 adolescents aged 12-15 years were analyzed [mean (standard deviation) age 13.8 (1.0) years; 52.0% females]. The overall mean prevalence of past 30-day alcohol consumption was 14.1%. Of the 22 countries included in the study, increasing, decreasing, and stable trends were observed in 3, 8, and 11 countries, respectively. Specifically, significant increases were observed in Benin between 2009 (16.1%) and 2016 (38.6%), Myanmar between 2007 (0.9%) and 2016 (3.6%), and Vanuatu between 2011 (7.6%) and 2016 (12.2%). The most drastic decrease was observed in Samoa between 2011 (34.5%) and 2017 (9.8%), but the rate of decrease was modest in most countries., Discussion: Among school-going adolescents, decreasing trends in alcohol consumption were more common than increasing trends, but the rate of decrease was limited in most countries, suggesting that more global action is required to curb adolescent alcohol consumption., (Copyright © 2023 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Perceived loneliness in adolescence is associated with a plethora of adverse outcomes. However, data on its temporal trends are scarce. Therefore, we aimed to examine the temporal trend of perceived loneliness among school-going adolescents aged 12-15 years from 28 countries in Africa, Asia, and the Americas, where temporal trends of loneliness are largely unknown., Methods: Cross-sectional data from the Global School-based Student Health Survey 2003-2017 were analyzed. Perceived loneliness referred to feeling lonely most of the time or always in the past 12 months. Crude linear trends of perceived loneliness by country were assessed by linear regression models., Results: Data on 180,087 adolescents aged 12-15 years were analyzed [Mean (SD) age 13.7 (1.0) years; 51.4 % females]. The overall prevalence of perceived loneliness was 10.7 %. Among the 28 countries included in the study, significant increasing and decreasing trends were observed in six counties each, with stable trends found in 16 countries. The most drastic increase and decrease were observed in Egypt between 2006 (7.9 %) and 2011 (14.3 %), and in Samoa between 2011 (23.3 %) and 2017 (8.0 %), respectively. Stable trends with high prevalence across time were also common., Conclusion: Our data suggest that perceived loneliness among adolescents is a global phenomenon, which has seen little improvement if any in recent years. It would be prudent to implement nationwide policies to combat loneliness globally., Competing Interests: Declaration of competing interest None., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: The current literature comparing outcomes after a unilateral magnetic resonance image-guided focused ultrasound (MRgFUS) thalamotomy between tremor syndromes is limited and remains a possible preoperative factor that could help predict the long-term outcomes., Objective: The aim was to report on the outcomes between different tremor syndromes after a unilateral MRgFUS thalamotomy., Methods: A total of 66 patients underwent a unilateral MRgFUS thalamotomy for tremor between November 2018 and May 2020 at St Vincent's Hospital Sydney. Each patient's tremor syndrome was classified prior to treatment. Clinical assessments, including the hand tremor score (HTS) and Quality of Life in Essential Tremor Questionnaire (QUEST), were performed at baseline and predefined intervals to 36 months., Results: A total of 63 patients, comprising 30 essential tremor (ET), 24 dystonic tremor (DT), and 9 Parkinson's disease tremor (PDT) patients, returned for at least one follow-up. In the ET patients, at 24 months there was a 61% improvement in HTS and 50% improvement in QUEST compared to baseline. This is in comparison to PDT patients, where an initial benefit in HTS and QUEST was observed, which waned at each follow-up, remaining significant only up until 12 months. In the DT patients, similar results were observed to the ET patients: at 24 months there was a 61% improvement in HTS and 43% improvement in QUEST compared to baseline., Conclusion: These results support the use of unilateral MRgFUS thalamotomy for the treatment of DT, which appears to have a similar expected outcome to patients diagnosed with ET. Patients with PDT should be warned that there is a risk of treatment failure. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society., (© 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.)

Background: There is a scarcity of studies examining the longitudinal relationship between dynapenic abdominal obesity (DAO; ie, impairment in muscle strength and high waist circumference) and future fall risk. Therefore, we aimed to investigate the prospective association between DAO at baseline and falls occurring during 2 years of follow-up in a nationally representative sample of middle-aged and older individuals from Ireland., Methods: Data from 2 consecutive waves of the Irish Longitudinal Study on Ageing survey were analyzed. Dynapenia was defined as handgrip strength of <26 kg for men and <16 kg for women. Abdominal obesity was defined as a waist circumference of >88 cm for women and >102 cm for men. DAO was assessed at Wave 1 (2009-2011) and was defined as having both dynapenia and abdominal obesity. Falls occurring between Wave 1 and Wave 2 (2012-2013) were self-reported. Multivariable logistic regression analysis was conducted., Results: Data on 5 275 individuals aged ≥50 years were analyzed (mean [standard deviation {SD}] age 63.2 [8.9] years; 48.8% males). After adjustment for potential confounders, compared to no dynapenia and no abdominal obesity at baseline, DAO was significantly associated with 1.47 (95% confidence interval [CI]: 1.14-1.89) times higher odds for falls at 2-year follow-up. Dynapenia alone (odds ratio [OR] = 1.08; 95% CI: 0.84-1.40) and abdominal obesity alone (OR = 1.09; 95% CI: 0.91-1.29) were not significantly associated with falls at follow-up., Conclusions: DAO increased the risk for falls among middle-aged and older adults in Ireland. Interventions to prevent or reverse DAO may be beneficial for fall reduction., (© The Author(s) 2023. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: There is a scarcity of studies on the association between physical multimorbidity and lower levels of physical activity among older adults from low- and middle-income countries, while the potential mediating variables in this association are largely unknown., Methods: Cross-sectional, community-based, nationally representative data from the World Health Organization Study on global AGEing and adult health were analyzed. Data on 11 chronic physical conditions were collected. Scoring <150 minutes of moderate- to high-intensity physical activity per week was considered low physical activity. Multivariable logistic regression and mediation analysis were done to assess associations and quality of life measures which might influence these associations., Results: Data on 14,585 people aged ≥65 years were analyzed (mean [SD] age 72.6 (11.5) y, maximum age 114 y; 55.0% women). After adjustment for potential confounders, compared with no chronic conditions, ≥3 conditions were associated with a significant 1.59 to 2.42 times higher odds for low physical activity. Finally, mobility mediated the largest proportion of the association between ≥3 chronic physical conditions and low physical activity (mediated percentage 50.7%), followed by activities of daily living disability (30.7%), cognition (24.0%), affect (23.6%), and pain/discomfort (22.0%)., Conclusions: Physical multimorbidity was associated with higher odds for low physical activity among older adults residing in low- and middle-income countries. Mobility, disability, cognition, affect, and pain/discomfort explained the largest proportion of this association. Given the universal benefits of regular and sustained participation in physical activity, it would be prudent to implement interventions among older people with physical multimorbidity to increase levels of physical activity. Future studies should assess the impact of addressing the identified potential mediators among people with multimorbidity on physical activity levels.

Background: Outdoor air pollution has been reported to be associated with frailty (including slow gait speed) in older adults. However, to date, no literature exists on the association between indoor air pollution (eg, unclean cooking fuel use) and gait speed. Therefore, we aimed to examine the cross-sectional association between unclean cooking fuel use and gait speed in a sample of older adults from 6 low- and middle-income countries (China, Ghana, India, Mexico, Russia, and South Africa)., Methods: Cross-sectional, nationally representative data from the World Health Organization Study on global AGEing and adult health were analyzed. Unclean cooking fuel use referred to the use of kerosene/paraffin, coal/charcoal, wood, agriculture/crop, animal dung, and shrubs/grass based on self-report. Slow gait speed referred to the slowest quintile based on height, age, and sex-stratified values. Multivariable logistic regression and meta-analysis were done to assess associations., Results: Data on 14 585 individuals aged ≥65 years were analyzed (mean [standard deviation] age 72.6 [11.4] years; 45.0% males). Unclean cooking fuel use (vs clean cooking fuel use) was significantly associated with higher odds for slow gait speed (odds ratio = 1.45; 95% confidence interval: 1.14-1.85) based on a meta-analysis using country-wise estimates. The level of between-country heterogeneity was very low (I2 = 0%)., Conclusions: Unclean cooking fuel use was associated with slower gait speed among older adults. Future studies of longitudinal design are warranted to provide insight into the underlying mechanisms and possible causality., (© The Author(s) 2023. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Introduction: MRI-guided focused ultrasound (MRgFUS) thalamotomy provides an exciting development in the field of minimally invasive stereotactic neurosurgery. Current treatment options for focal hand dystonia are limited, with potentially more effective invasive stereotactic interventions, such as deep brain stimulation or lesional therapies, rarely used. The advent of minimally invasive brain lesioning provides a potentially safe and effective treatment approach with a recent pilot study establishing MRgFUS Vo-complex thalamotomy as an effective treatment option for focal hand dystonia. In this study, we undertake an open-label clinical trial to further establish MRgFUS Vo-complex thalamotomy as an effective treatment for focal hand dystonia with greater attention paid to potential motor costs associated with this treatment. To elucidate pathophysiology of dystonia and treatment mechanisms, neurophysiological and MRI analysis will be performed longitudinally to explore the hypothesis that neuroplastic and structural changes that may underlie this treatment benefit., Methods and Analysis: A total of 10 participants will be recruited into this open-label clinical trial. All participants will undergo clinical, kinemetric, neurophysiological and radiological testing at baseline, followed by repeated measures at predesignated time points post MRgFUS Vo-complex thalamotomy. Further, to identify any underlying structural or neurophysiological abnormalities present in individuals with focal hand dystonia, 10 age and gender matched control participants will be recruited to undergo comparative investigation. These results will be compared with the intervention participants both at baseline and at 12 months to assess for normalisation of these abnormalities, if present., Ethics and Dissemination: This trial was reviewed and approved by the St Vincent's Health Network Sydney Human Research Ethics Committee (2022/ETH00778). Study results will be published in peer-reviewed journals and presented at both national and international conferences., Trial Registration Number: CTRN12622000775718., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Modern management of MS targets No Evidence of Disease Activity (NEDA): no clinical relapses, no magnetic resonance imaging (MRI) disease activity and no disability worsening. While MRI is the principal tool available to neurologists for monitoring clinically silent MS disease activity and, where appropriate, escalating treatment, standard radiology reports are qualitative and may be insensitive to the development of new or enlarging lesions. Existing quantitative neuroimaging tools lack adequate clinical validation. In 397 multi-center MRI scan pairs acquired in routine practice, we demonstrate superior case-level sensitivity of a clinically integrated AI-based tool over standard radiology reports (93.3% vs 58.3%), relative to a consensus ground truth, with minimal loss of specificity. We also demonstrate equivalence of the AI-tool with a core clinical trial imaging lab for lesion activity and quantitative brain volumetric measures, including percentage brain volume loss (PBVC), an accepted biomarker of neurodegeneration in MS (mean PBVC -0.32% vs -0.36%, respectively), whereas even severe atrophy (>0.8% loss) was not appreciated in radiology reports. Finally, the AI-tool additionally embeds a clinically meaningful, experiential comparator that returns a relevant MS patient centile for lesion burden, revealing, in our cohort, inconsistencies in qualitative descriptors used in radiology reports. AI-based image quantitation enhances the accuracy of, and value-adds to, qualitative radiology reporting. Scaled deployment of these tools will open a path to precision management for patients with MS., (© 2023. Springer Nature Limited.)

Background: People with severe mental illness (SMI) have a higher prevalence of several chronic physical health conditions, and the prevalence of physical multimorbidity is expected to rise. The aim of this study was to assess the strength of the association between SMI and physical multimorbidity., Study Selection and Analysis: We systematically searched PubMed/Medline, Scopus, Embase, Web of Science, PsycINFO and the behavioural sciences collection databases, from inception to 31 January 2023, for studies that investigated the association between SMI and physical multimorbidity. Humans of any age either clinically diagnosed and/or currently receiving treatment for SMI, specified as schizophrenia (and related psychotic disorders), bipolar disorder and psychotic depression, were eligible. Data from studies selected for inclusion were converted into ORs, with a subsequent meta-analysis conducted., Findings: We included 19 studies with a total of 194 123 patients with SMI with different diagnoses and drawn from the general population. The pooled OR for physical multimorbidity in people with versus without SMI was 1.84 (95% CI 1.33 to 2.54), with the analysis indicating a high level of heterogeneity (98.38%). The other 15 studies included in the systematic review for which it was not possible to conduct a meta-analysis showed strong associations between SMI and physical multimorbidity., Conclusions: The current evidence highlights the link between SMI and physical multimorbidity. A multidisciplinary approach is now urgent to develop the best models of services tailored to patients with SMI with physical multimorbidities to improve physical, mental and social outcomes. PROSPERO registration number CRD42023395165., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. Published by BMJ.)

Food insecurity may be a risk factor for depression in adolescents. However, data on this topic from low- and middle-income countries (LMICs) are scarce, despite food insecurity being most common in LMICs. Therefore, we aimed to examine the association between food-insecurity and depressive symptoms among school-going adolescents from 22 LMICs. Cross-sectional data from the Global school-based Student Health Survey were analyzed. Self-report measures assessed past 12-month depressive symptoms and past 30-day food insecurity (hunger). Multivariable logistic regression and meta-analysis were conducted to assess associations. Data on 48,401 adolescents aged 12-15 years were analyzed [mean (SD) age 13.8 (0.9) years; 51.4 % females]. The prevalence of depressive symptoms was 29.3 %, and those of moderate and severe food insecurity were 45.0 and 6.3 %, respectively. After adjustment for potential confounders, compared to no food insecurity, the pooled OR (95 %CI) of moderate and severe food insecurity were 1.36 (1.30-1.42) and 1.81 (1.67-1.97), respectively. The level of between-country heterogeneity was low. Food insecurity was associated with significantly higher odds for depressive symptoms among adolescents in LMICs. Policies to address food insecurity may also help prevent depression in this population, pending future longitudinal research., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023. Published by Elsevier B.V.)

Purpose: People with eating disorders may be at increased risk for physical health problems, but there are no data on the relationship between eating disorders and physical multimorbidity (i.e., ≥ 2 physical conditions) and its potential mediators. Thus, we investigated this association in a representative sample of adults from the UK, and quantified the extent to which this can be explained by various psychological and physical conditions, and lifestyle factors., Methods: Cross-sectional data of the 2007 Adult Psychiatric Morbidity Survey were analyzed. Questions from the five-item SCOFF screening instrument were used to identify possible eating disorder. Respondents were asked about 20 physical health conditions. Multivariable logistic regression and mediation analysis were conducted., Results: Data on 7403 individuals aged ≥ 16 years were analyzed [mean (SD) age 46.3 (18.6) years; 48.6% males]. After adjustment, possible eating disorder was associated with 2.11 (95%CI = 1.67-2.67) times higher odds for physical multimorbidity. Anxiety disorder explained the largest proportion this association (mediated percentage 26.3%), followed by insomnia (21.8%), perceived stress (13.4%), depression (13.1%), obesity (13.0%), and alcohol dependence (4.3%)., Conclusion: Future longitudinal studies are warranted to understand potential causality and the underlying mechanisms in the association between eating disorder and multimorbidity, and whether addressing the identified potential mediators in people with eating disorders can reduce multimorbidity., (© 2023. Springer Nature Switzerland AG.)

Purpose: Bullying victimization among adolescents is a major public health concern. However, multicountry studies investigating temporal trends of bullying victimization among adolescents are scarce, especially from a global perspective. Thus, we aimed to examine the temporal trends of bullying victimization among school-going adolescents between 2003 and 2017 in 29 countries from Africa (n = 5), Asia (n = 18), and the Americas (n = 6)., Methods: Data on 191,228 students aged 12-15 years [mean (standard deviation) age 13.7 (1.0) years; 48.9% boys] who participated in the Global School-based Student Health Survey were analyzed. Bullying victimization was based on self-report and referred to being bullied at least once in the past 30 days. The prevalence (95% confidence interval) of bullying victimization was calculated for each survey. Crude linear trends in bullying victimization were examined by linear regression models., Results: The mean prevalence of bullying victimization across all surveys was 39.4%. There was a large variation in the trends of bullying victimization across countries with a significant increasing and decreasing trend being observed in 6 and 13 countries, respectively. Myanmar, Egypt, and the Philippines showed the sharpest increase. The decrease was modest in most countries which showed a decreasing trend. The remaining countries showed stable trends (n = 10) but some countries such as Seychelles showed consistently high prevalence over time (i.e., ≥ 50%)., Discussion: Decreasing trends of bullying victimization were more common than increasing or stable trends in our study including adolescents from 29 countries. However, a high prevalence of bullying was observed in most countries, and thus, further global efforts to combat bullying victimization are necessary., (Copyright © 2023 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: Skull density ratio (SDR) influences the permeability of the skull to the ultrasound waves used in magnetic resonance-guided focused ultrasound (MRgFUS) for the treatment of tremor. SDR values vary across the skull and the mean value is known to be predictive of sonication thermal increase. The aim of this investigation was to explore the effects of the SDR distribution on clinical outcomes following treatment with MRgFUS., Methods: Data from 61 patients with essential or dystonic tremor treated with MRgFUS targeting the ventral intermediate nucleus (Vim) were retrospectively analyzed. Tremor suppression was assessed using the Clinical Rating Scale for Tremor (CRST) and hand tremor score (HTS). Vim ablation volume was measured on the T1-weighted MR image acquired both at 1 day and 12 months after treatment. The numerical distribution of SDR values measured for each element in the ultrasound transducer was quantified by calculating the mean, standard deviation, skewness, entropy, and kurtosis of the SDR histogram. The effect of the SDR metrics on change in CRST and HTS was examined using a linear mixed-effects model. Additionally, the effect of the regional distribution of SDR values was explored in an element-wise analysis between patients with above- and below-average tremor suppression., Results: A significant positive effect was found between SDR kurtosis and improvement in CRST (β = 0.33, p = 0.004) and HTS (β = 0.38, p < 0.001). The effect was found to be significant at 1 month posttreatment (CRST: β = 0.415, p = 0.008; HTS: β = 0.369, p = 0.016), and at the most recent clinical follow-up (CRST: β = 0.395, p < 0.001; HTS: β = 0.386, p < 0.001). One hundred seventy-one significant elements were identified in the element-wise analysis. The mean percentage difference from the mean SDR in these elements was associated with improvement in CRST (β = 0.27, p < 0.008) and HTS (β = 0.27, p < 0.015). Higher SDR kurtosis was associated with increased lesion volume at 12 months (p = 0.040) and less reduction in volume relative to the day-1 lesion volume (p = 0.007)., Conclusions: Greater SDR kurtosis was associated with larger, more stable lesions at 12 months posttreatment and increased tremor suppression at long-term follow-up. SDR kurtosis may provide a more meaningful prognostic factor than the mean SDR.

Introduction: Intracranial hemorrhage (ICH) is a potentially life-threatening medical event that requires expedited diagnosis with computed tomography (CT). Automated medical imaging triaging tools can rapidly bring scans containing critical abnormalities, such as ICH, to the attention of radiologists and clinicians. Here, we retrospectively investigated the real-world performance of VeriScout ™ , an artificial intelligence-based CT hemorrhage detection and triage tool., Methods: Ground truth for the presence or absence of ICH was iteratively determined by expert consensus in an unselected dataset of 527 consecutively acquired non-contrast head CT scans, which were sub-grouped according to the presence of artefact, post-operative features and referral source. The performance of VeriScout ™ was compared with the ground truths for all groups., Results: VeriScout ™ detected hemorrhage with a sensitivity of 0.92 (CI 0.84-0.96) and a specificity of 0.96 (CI 0.94-0.98) in the global dataset, exceeding the sensitivity of general radiologists (0.88) with only a minor relative decrement in specificity (0.98). Crucially, the AI tool detected 13/14 cases of subarachnoid hemorrhage, a potentially fatal condition that is often missed in emergency department settings. There was no decrement in the performance of VeriScout ™ in scans containing artefact or postoperative change. Using an integrated informatics platform, VeriScout ™ was deployed into the existing radiology workflow. Detected hemorrhage cases were flagged in the hospital radiology information system (RIS) and relevant, annotated, preview images made available in the picture archiving and communications system (PACS) within 10 min., Conclusion: AI-based radiology worklist prioritization for critical abnormalities, such as ICH, may enhance patient care without adding to radiologist or clinician burden., Competing Interests: DW, CS and CW are part-time employees at the Sydney Neuroimaging Analysis Centre (SNAC). MB has received institutional support for research, speaking and/or participation in advisory boards for Biogen, Merck, Novartis, Roche, and Sanofi Genzyme, and is a research consultant to RxPx and research director for the SNAC. YB and TD are consulting radiologists for SNAC. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Wang, Jin, Shieh, Ng, Pham, Dugal, Barnett, Winoto, Wang and Barnett.)

Background: Inadequate fruit and vegetable intake may be associated with cognitive decline but its association with mild cognitive impairment (MCI; a preclinical stage of dementia) is largely unknown. Therefore, we examined the association of fruit and vegetable consumption with MCI among middle-aged and older adults from low- and middle-income countries (LMICs)., Methods: Cross-sectional, nationally representative data from the WHO Study on global AGEing and adult health were analyzed. MCI was defined using the National Institute on Aging-Alzheimer's Association criteria. Quintiles of vegetable and fruit consumption were created based on the number of servings consumed on a typical day. Multivariable logistic regression analysis was conducted., Results: Data on 32 715 individuals aged ≥50 years were analyzed (mean [standard deviation] age 62.1 [15.6] years; 51.7% females). Greater fruit consumption was dose-dependently associated with lower odds for MCI. For example, the highest quintile (vs lowest) had 47% lower odds for MCI (odds ratio [OR] = 0.53; 95% confidence interval [CI] = 0.43-0.66). For vegetable consumption, compared to the lowest quintile, the second to fourth quintiles had significant 38%-44% lower odds for MCI but there was no significant difference for the highest quintile (OR = 0.82; 95% CI = 0.59-1.15)., Conclusions: Higher fruit and vegetable consumption was associated with lower odds for MCI among middle-aged and older adults from LMICs, but no significant differences were found between the highest and lowest quintiles of vegetable consumption. Future longitudinal studies are required to explore these findings in more depth, and mechanistic studies are required to elucidate on the observed possible U-shaped association between vegetable consumption and MCI., (© The Author(s) 2023. Published by Oxford University Press on behalf of The Gerontological Society of America. 
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(1) Background: Temporal trends of food insecurity among adolescents are largely unknown. Therefore, we aimed to examine this trend among school-going adolescents aged 12-15 years from 31 countries in Africa, Asia, and the Americas. (2) Methods: Data from the Global School-based Student Health Survey 2003-2017 were analyzed in 193,388 students [mean (SD) age: 13.7 (1.0) years; 49.0% boys]. The prevalence and 95%CI of moderate (rarely/sometimes hungry), severe (most of the time/always hungry), and any (moderate or severe) food insecurity (past 30-day) was calculated for each survey. Crude linear trends in food insecurity were assessed by linear regression models. (3) Results: The mean prevalence of any food insecurity was 52.2% (moderate 46.5%; severe 5.7%). Significant increasing and decreasing trends of any food insecurity were found in seven countries each. A sizeable decrease and increase were observed in Benin (71.2% in 2009 to 49.2% in 2016) and Mauritius (25.0% in 2011 to 43.6% in 2017), respectively. Severe food insecurity increased in countries such as Vanuatu (4.9% in 2011 to 8.4% in 2016) and Mauritius (3.5% in 2011 to 8.2% in 2017). The rate of decrease was modest in most countries with a significant decreasing trend, while many countries with stable trends showed consistently high prevalence of food insecurity. (4) Conclusion: Global action is urgently required to address food insecurity among adolescents, as our data show that achieving the United Nations Sustainable Development Goal 2 to end hunger and all forms of malnutrition by 2030 would be difficult without strong global commitment.

Objectives: We aimed to examine the relationship of pain with suicidal ideation and suicide attempts with depressive symptoms among adults aged ≥50 years from six low- and middle-income countries (LMICs) (China, Ghana, India, Mexico, Russia, and South Africa)., Methods: Cross-sectional, community-based, nationally representative data from the WHO Study on global AGEing and adult health were analyzed. Self-reported information on past 12-month suicidal ideation and suicide attempts among people with depressive symptoms was collected. Pain was assessed with the question "Overall in the last 30 days, how much of bodily aches or pain did you have?" With answer options: "none", "mild", "moderate", "severe/extreme". Multivariable logistic regression was done to assess associations., Results: Data on 34,129 adults aged ≥50 years (mean [SD] age 62.4 [16.0] years; males 47.9%) were analyzed. Compared to no pain, mild, moderate, and severe/extreme pain were associated with 2.83 (95% CI = 1.51-5.28), 4.01 (95% CI = 2.38-6.76), and 12.26 (95% CI = 6.44-23.36) times higher odds for suicidal ideation. For suicide attempt, only severe/extreme pain was associated with significantly increased odds (OR = 4.68; 95% CI = 1.67-13.08)., Conclusions: In this large sample of older adults from multiple LMICs, pain was strongly associated with suicidal thoughts and suicide attempts with depressive symptoms. Future studies should assess whether addressing pain among older people in LMICs may lead to reduction in suicidal thoughts and behaviors., (© 2023 The Authors. International Journal of Geriatric Psychiatry published by John Wiley & Sons Ltd.)

Background: Previous studies on the association between pain and cognitive decline or impairment have yielded mixed results, while studies from low- and middle-income countries (LMICs) or specifically on mild cognitive impairment (MCI) are scarce. Thus, we investigated the association between pain and MCI in LMICs and quantified the extent to which perceived stress, sleep/energy problems, and mobility limitations explain the pain/MCI relationship., Methods: Data analysis of cross-sectional data from six LMICs from the Study on Global Ageing and Adult Health (SAGE) were performed. MCI was based on the National Institute on Aging-Alzheimer's Association criteria. "Overall in the last 30 days, how much of bodily aches or pain did you have?" was the question utilized to assess pain. Associations were examined by multivariable logistic regression analysis and meta-analysis., Results: Data on 32,715 individuals aged 50 years and over were analysed [mean (SD) age 62.1 (15.6) years; 51.7% females]. In the overall sample, compared to no pain, mild, moderate, and severe/extreme pain were dose-dependently associated with 1.36 (95% CI = 1.18-1.55), 2.15 (95% CI = 1.77-2.62), and 3.01 (95% CI = 2.36-3.85) times higher odds for MCI, respectively. Mediation analysis showed that perceived stress, sleep/energy problems, and mobility limitations explained 10.4%, 30.6%, and 51.5% of the association between severe/extreme pain and MCI., Conclusions: Among middle-aged to older adults from six LMICs, pain was associated with MCI dose-dependently, and sleep problems and mobility limitations were identified as potential mediators. These findings raise the possibility of pain as a modifiable risk factor for developing MCI., (© 2023. The Author(s).)

Objectives: The present study aimed to investigate the association between asthma and work absence in a large sample of US working adults, while controlling for several sociodemographic and health characteristics. Methods: This study used data from the 2019 Health and Functional Capacity Survey of the RAND American Life Panel (ALP). Work absence corresponded to the number of days of absence from work for health-related reasons in the past 12 months. Current asthma was self-reported and was included in the analyses as a dichotomous variable. Control variables included sex, age, ethnicity, marital status, education, occupation, annual family income, health insurance, and number of chronic physical or psychiatric conditions. Finally, the association between asthma and work absence was analyzed using logistic regression models. Results: This study included 1,323 adults aged 22-65 years (53.1% males; mean [SD] age 43.1 [11.7] years). Individuals with asthma were more likely to report at least one (81.5% versus 56.8%, p -value<0.001) or three days of absence (56.9% versus 31.3%, p -value=0.003) from work in the past 12 months than those without asthma. These findings were corroborated in the regression analyses, as asthma was positively and significantly associated with work absence after adjusting for all control variables (at least one day of absence: OR=3.24, 95% CI=1.44-7.29; at least three days of absence: OR=2.61, 95% CI=1.26-5.40). Conclusions: This US study of working adults showed that asthma was a risk factor for work absence. Further research is warranted to better understand the factors predisposing to work absence in the asthma population.

Objectives: Magnetic resonance-guided focussed ultrasound (MRgFUS) is an incisionless ablative procedure, widely used for treatment of Parkinsonian and Essential Tremor (ET). Enhanced understanding of the patient- and treatment-specific factors that influence sustained long-term tremor suppression could help clinicians achieve superior outcomes via improved patient screening and treatment strategy., Methods: We retrospectively analysed data from 31 subjects with ET, treated with MRgFUS at a single centre. Tremor severity was assessed with parts A, B and C of the Clinical Rating Scale for Tremor (CRST) as well as the combined CRST. Tremor in the dominant and non-dominant hand was assessed with Hand Tremor Scores (HTS), derived from the CRST. Pre- and post-treatment imaging data were analysed to determine ablation volume overlap with automated thalamic segmentations, and the dentatorubrothalamic tract (DRTT) and compared with percentage change in CRST and HTS following treatment., Results: Tremor symptoms were significantly reduced following treatment. Combined pre-treatment CRST (mean: 60.7 ± 17.3) and HTS (mean: 19.2 ± 5.7) improved by an average of 45.5 and 62.6%, respectively. Percentage change in CRST was found to be significantly negatively associated with age (β = -0.375, p  = 0.015), and SDR standard deviation (SDR SD ; β = -0.324, p  = 0.006), and positively associated with ablation overlap with the posterior DRTT (β = 0.535, p  < 0.001). Percentage HTS improvement in the dominant hand decreased significantly with older age (β = -0.576, p  < 0.01)., Conclusion: Our results suggest that increased lesioning of the posterior region of the DRTT could result in greater improvements in combined CRST and non-dominant hand HTS, and that subjects with lower SDR standard deviation tended to experience greater improvement in combined CRST., Competing Interests: KK declares that he was the recipient of funding in the form of a PhD scholarship from GE Healthcare Australia. MB reports research support from Biogen, Novartis, Sanofi-Genzyme, Merck, Alexion and Bristol Myers Squibb and advisory board consulting fees from Novartis and Autobahn Therapeutics. MB is the Director of Research (Honorary), Sydney Neuroimaging Analysis Centre, and ad-hoc consultant, RxMx. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Kyle, Maller, Barnett, Jonker, Barnett, D’Souza, Calamante, Maamary, Peters, Wang and Tisch.)

Purpose: Multimorbidity (i.e., ≥ 2 chronic conditions) poses a challenge for health systems and governments, globally. Several studies have found inverse associations between multimorbidity and quality of life (QoL). However, there is a paucity of studies from low- and middle-income countries (LMICs), especially among the older population, as well as studies examining mediating factors in this association. Thus, the present study aimed to explore the associations, and mediating factors, between multimorbidity and QoL among older adults in LMICs., Methods: Cross-sectional nationally representative data from the Study on Global Ageing and Adult Health were analyzed. A total of 11 chronic conditions were assessed. QoL was assessed with the 8-item WHO QoL instrument (range 0-100) with higher scores representing better QoL. Multivariable linear regression and mediation analyses were conducted to assess associations., Results: The final sample consisted of 34,129 adults aged ≥ 50 years [mean (SD) age 62.4 (16.0) years; age range 50-114 years; 52.0% females]. Compared to no chronic conditions, 2 (b-coefficient - 5.89; 95% CI - 6.83, - 4.95), 3 (- 8.35; - 9.63, - 7.06), 4 (- 10.87; - 12.37, - 9.36), and ≥ 5 (- 13.48; - 15.91, - 11.06) chronic conditions were significantly associated with lower QoL, dose-dependently. The mediation analysis showed that mobility (47.9%) explained the largest proportion of the association between multimorbidity and QoL, followed by pain/discomfort (43.5%), sleep/energy (35.0%), negative affect (31.9%), cognition (20.2%), self-care (17.0%), and interpersonal activities (12.0%)., Conclusion: A greater number of chronic conditions was associated with lower QoL dose-dependently among older adults in LMICs. Public health and medical practitioners should aim to address the identified mediators to improve QoL in patients with multimorbidity., (© 2022. The Author(s).)

Background and Aim: We aimed to capture the breadth of health outcomes that have been associated with the presence of Urinary Incontinence (UI) and systematically assess the quality, strength, and credibility of these associations through an umbrella review and integrated meta-analyses., Methods: We assessed meta-analyses of observational studies based on random-effect summary effect sizes and their p-values, 95% prediction intervals, heterogeneity, small-study effects, and excess significance. We graded the evidence from convincing (Class I) to weak (Class IV)., Results and Discussion: From 3172 articles returned in search of the literature, 9 systematic reviews were included with a total of 41 outcomes. Overall, 37 out of the 41 outcomes reported nominally significant summary results (p < 0.05), with 22 associations surviving the application of a more stringent p-value (p < 10 -6 ). UI was associated with worse scores than controls in female sexual function (Class II), while it was also associated with a higher prevalence of depression (odds ratio [OR] = 1.815; 95% confidence interval [CI]: 1.551-2.124), and anxiety (OR = 1.498; 95% CI: 1.273-1.762) (Class IV). UI was associated with poorer quality of life (QoL), higher rate of mortality (hazard ratio = 2.392; 95% CI: 2.053-2.787) an increase in falls, frailty, pressure ulcers, diabetes, arthritis, and fecal incontinence (Class IV)., Conclusions: UI is associated with female sexual dysfunction, with highly suggestive evidence. However, the evidence of other adverse outcomes including depression, anxiety, poorer QoL, higher mortality, falls, pressure ulcers, diabetes, arthritis, fecal incontinence, and frailty is only weak. A multidimensional approach should be taken in managing UI in the clinical setting., (© 2023. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

In the context of an emerging Japanese encephalitis outbreak within Australia, we describe a novel locally acquired case in New South Wales. A man in his 70s had rapidly progressive, fatal meningoencephalitis, diagnosed as caused by Japanese encephalitis virus by RNA-based metagenomic next-generation sequencing performed on postmortem brain tissue.

Background: Body weight may be a risk factor for anxiety; however, there is a scarcity of studies on this association in older adults especially from low and middle income countries (LMICs). Therefore, we investigated the association between body mass index (BMI) and anxiety symptoms among adults aged ≥ 50 years from 6 LMICs., Methods: Cross-sectional, community-based, nationally representative data from the World Health Organization (WHO) Study on global AGEing and adult health (SAGE) were analyzed. The BMI was based on measured weight and height and was categorized as: < 18.5 kg/m 2 (underweight), 18.5-24.9 kg/m 2 (normal weight), 25.0-29.9 kg/m 2 (overweight), 30.0-34.9 kg/m 2 (obesity class I), 35.0-39.9 kg/m 2 (obesity class II), and ≥ 40 kg/m 2 (obesity class III). Anxiety symptoms referred to severe/extreme problems with worry or anxiety in the past 30 days. Multivariable logistic regression analysis was conducted., Results: Data on 34,129 individuals aged ≥ 50 years (mean age 62.4 years, SD 16.0 years; 52.1% female) were analyzed. Overall, compared to normal weight, only underweight was significantly associated with anxiety symptoms (odds ratio, OR = 1.56; 95% confidence interval, CI = 1.26-1.95). Obesity class III (vs. normal weight) was associated with significantly increased odds for anxiety symptoms (OR = 4.15; 95%CI = 1.49-11.59) only among males., Conclusion: In this large representative sample of older adults from LMICs, underweight was associated with anxiety symptoms in males and females. Class III obesity was associated with anxiety symptoms only in males. Future studies to shed light on the reason why severe obesity was associated with anxiety symptoms only among males in LMICs are needed., (© 2021. Springer-Verlag GmbH Austria, part of Springer Nature.)

Purpose: Food insecurity and multimoribidity (i.e., ≥ 2 chronic conditions) may be linked bidirectionally, but there are no studies on this topic from LMICs. Therefore, the aim of the present study was to examine the association between food insecurity and physical multimorbidity in a large representative sample of older adults from six LMICs., Methods: Cross-sectional, community-based data on adults aged ≥ 50 years from the World Health Organization's Study on Global AGEing and Adult Health (SAGE) conducted in China, Ghana, India, Mexico, Russia, and South Africa were analyzed. A total of 11 chronic physical conditions were assessed. Past 12 month food insecurity was assessed with two questions on frequency of eating less and hunger due to lack of food. Multivariable logistic regression analysis was conducted to assess the associations., Results: Data on 34,129 adults aged ≥ 50 years [mean (SD) age 62.4 (16.0) years; age range 50-114 years; 47.9% males] were analyzed. After adjustment for potential confounders, in the overall sample, compared to being food secure, moderate and severe food insecurity were associated with 1.29 (95% CI 1.06-1.56) and 1.56 (95% CI 1.13-2.16) times higher odds for multimorbidity, respectively CONCLUSION: Food insecurity was associated with greater odds for multimorbidity in older adults from LMICs. Addressing food insecurity in the general population may reduce risk for multimorbidity, while screening for food insecurity and addressing it among those with multimorbidity may lead to better clinical outcomes, pending future longitudinal research., (© 2022. The Author(s).)

Background: Whilst MRI guided Focused Ultrasound (MRgFUS) thalamotomy is an effective treatment option for tremor disorders, there are reports of tremor recurrence in patients with tremor dominant Parkinson's disease (PD). The mechanisms for tremor recurrence are unknown but likely relate to the duality of tremor network pathways with ramifications for subsequent treatment options., Cases: We report two cases of tremor dominant PD who experienced tremor recurrence following MRgFUS thalamotomy with subsequent successful subthalamic nucleus deep brain stimulation (DBS). Tremor scores were measured at baseline, 1- and 3-months post MRgFUS and at least 18 months post DBS in both patients. Both cases evidenced immediate improvement in tremor, after MRgFUS, followed by subsequent tremor recurrence. STN DBS resulted in almost complete long-term tremor alleviation in both cases., Conclusions: These cases demonstrate the efficacy and feasibility of STN DBS in patients with tremor dominant PD with tremor recurrence following MRgFUS thalamotomy. We discuss the dualism of tremor outflow pathways that may have implications for single target lesional therapies., (© 2023 International Parkinson and Movement Disorder Society.)

Objectives: The association between physical multimorbidity and suicidal ideation or suicide attempts among older adults from low- and middle-income countries (LMICs) is largely unknown. We aimed to assess this association as well as its mediators using nationally representative data from six LMICs., Methods: Cross-sectional, community-based data from the Study on Global Aging and Adult Health were analyzed. A total of 11 chronic physical conditions were assessed. Self-reported information on past 12-month suicidal ideation and suicide attempts was also collected. Multivariable logistic regression and mediation analyses were conducted., Results: The final sample consisted of 34,129 adults aged ≥50 years (mean [SD] age 62.4 (16.0) years; maximum age 114 years; 52.1% females). In the overall sample, physical multimorbidity was associated with increased odds for suicidal ideation (OR = 2.99; 95% CI = 2.06-4.34) and suicide attempts (OR = 2.79; 95% CI = 1.58-4.95), with the association being stronger in males than females. The association between multimorbidity and suicidal ideation or suicide attempts was largely mediated by pain/discomfort (mediated% 33.3%-44.2%), sleep/energy (28.2%-33.8%), and mobility limitations (26.6%-34.8%)., Conclusions: Physical multimorbidity among older adults in LMICs was associated with a substantially increased risk for suicidal ideation and suicide attempts. Addressing the identified mediators in people with physical multimorbidity may aid in the prevention of suicidal ideation and suicide attempts., (© 2023 The Authors. International Journal of Geriatric Psychiatry published by John Wiley & Sons Ltd.)

Introduction: Physical multimorbidity is plausibly linked to sarcopenia. However, to date, only a few studies exist on this topic, and none have examined this association in low- and middle-income countries (LMICs). Thus, we aimed to investigate the association between multimorbidity and sarcopenia in a sample of older adults from six LMICs (China, Ghana, India, Mexico, Russia, South Africa)., Methods: Cross-sectional, community-based data from the WHO Study on Global Ageing and Adult Health (SAGE) were analysed. Sarcopenia was defined as having low skeletal muscle mass (SMM) and weak handgrip strength, while severe sarcopenia was defined as having low SMM, weak handgrip strength, and slow gait speed. A total of 11 physical chronic conditions were assessed and multimorbidity referred to ≥2 chronic conditions. Multivariable logistic regression analysis was conducted., Results: Data on 14,585 adults aged ≥65 years were analysed (mean age 72.6 years, SD 11.5 years; 53.7% females). Adjusted estimates showed that compared to no chronic physical conditions, ≥2 conditions are significantly associated with 1.49 (95% CI = 1.02-2.19) and 2.52 (95% CI = 1.53-4.15) times higher odds for sarcopenia and severe sarcopenia, respectively., Conclusions: In this large sample of older adults from LMICs, physical multimorbidity was significantly associated with sarcopenia and severe sarcopenia. Our study results tentatively suggest that targeting those with multimorbidity may aid in the prevention of sarcopenia, pending future longitudinal research., (© 2022 S. Karger AG, Basel.)

There is no consensus regarding the classification of optic neuritis, and precise diagnostic criteria are not available. This reality means that the diagnosis of disorders that have optic neuritis as the first manifestation can be challenging. Accurate diagnosis of optic neuritis at presentation can facilitate the timely treatment of individuals with multiple sclerosis, neuromyelitis optica spectrum disorder, or myelin oligodendrocyte glycoprotein antibody-associated disease. Epidemiological data show that, cumulatively, optic neuritis is most frequently caused by many conditions other than multiple sclerosis. Worldwide, the cause and management of optic neuritis varies with geographical location, treatment availability, and ethnic background. We have developed diagnostic criteria for optic neuritis and a classification of optic neuritis subgroups. Our diagnostic criteria are based on clinical features that permit a diagnosis of possible optic neuritis; further paraclinical tests, utilising brain, orbital, and retinal imaging, together with antibody and other protein biomarker data, can lead to a diagnosis of definite optic neuritis. Paraclinical tests can also be applied retrospectively on stored samples and historical brain or retinal scans, which will be useful for future validation studies. Our criteria have the potential to reduce the risk of misdiagnosis, provide information on optic neuritis disease course that can guide future treatment trial design, and enable physicians to judge the likelihood of a need for long-term pharmacological management, which might differ according to optic neuritis subgroups., Competing Interests: Declaration of interests AP received grant support for remyelination trials in multiple sclerosis to the Amsterdam University Medical Centre, Department of Neurology, MS Centre (RESTORE trial), and UCL, London RECOVER trial; received grant fees from Fight for Sight (nimodipine in optic neuritis trial); received royalties or licenses from Up-to-Date (Wolters Kluwer) for a book chapter; received speaker fees for the Heidelberg Academy; participates on advisory board for SC Zeiss OCTA Angi-Network, and the SC Novartis OCTiMS study; holds leadership roles for governing board IMSVISUAL; was chairman of ERN-EYE Neuro-ophthalmology (until Oct, 2020); is board member of National Dutch Neuro-ophthalmology Association; received equipment from OCTA from Zeiss (Plex Elite); and received medical writing support from Novartis for a manuscript (https://doi.org/10.1002/acn3.51473). CF received consulting fees from Invex Therapeutics; received speaker honoraria from University of Dunedin; and holds leadership as Director of Royal Australian and New Zealand College of Ophthalmologists. VB received personal fees as consultant for Gensight and Neurophoenix. PC obtained grants from Annexon, Biogen, Genentech; received royalties from Cambridge Press for an OCT book; received consulting fees from Disarm Therapeutics, Nervgen, Biogen, Avidea; received honoraria from NY Academy of Sciences; and received equipment from Myelin Repair Foundation, Academic CME, Neuraly, and Landos. FC received speaker honoraria from Alexion, Accure Therapeutics, and the Sumiara Foundation. RDe obtained consulting fees from Alexion. JdS received consulting fees from Biogen, Teva, BMS Celegen, Roche, Novartis, Janssen, Merck, Alexion, CSL Behring; and honoraria from Biogen, Teva, BMS Celegen, Roche, Novartis, Janssen, Merck, Alexion, and CSL Behring. JFR received consulting fees from Roche, and Sanofi. EF holds honoraria from Alexion, Genzyme, Biogen, Novartis, and Janssen. TF holds honoraria from Alexion. CFT received honoraria from Novartis; and received support for attending meetings and travel from Novartis and Teva. KF obtained grants from Ministry of Education, Science and Technology of Japan as well as the Ministry of Health, Welfare and Labor of Japan; received consulting fees from Alexion Chugai-Roche Mitsubishi Tanabe, Novartis, Biogen, Eisai, Takeda, Teijin, Viela Bio, UCB, Merck, Japan Tobacco Pharma, and Abbvie; received honoraria from Alexion, Chugai-Roche, Mitsubishi Tanabe, Novartis, Biogen, Eisai, Takeda, Asahi Kasei Medical, Teijin, and Bayer; participated on a data safety monitoring board or advisory board from Alexion, Chugai, Mitsubishi Tanabe, Novartis, Biogen, Eisai, Takeda, Asahi Kasei Medical, Teijin, UCB, and Viela Bio; and received medical writing support from Oxford PharmaGenesis and Apothecom. RG acquired personal fees for participation on data safety monitoring boards, and served on the advisory boards for Biogen, Hikma, Merck, Roche, and Sanofi as well as receiving a grant from Roche. FG received grants or contracts from Roche (NMO epidemiologic studies) and Novartis (MS epidemiologic studies); received honoraria from for lectures from Roche, Novartis, Stendhal, and Merck; received support for attending meetings from the European Charcot Foundation, and ECTRIMS; and reports leadership of FOCEM (Foro Centroamericano y del Caribe de la Esclerosis Múltiple y otras enfermedades desmielinizantes del Sistema Nervioso Central) and Academia Panameña de Medicina y Cirugía (both unpaid). MHab obtained honoraria from Biogen, Sanofi Genzyme, Merck, Bayer, Novartis, Pliva-Teva, Roche, and Zentiva; received support for attending meetings from Biogen, Sanofi Genzyme, Merck, Bayer, Novartis, Pliva-Teva, and Roche; and participated on advisory board for Biogen, Sanofi Genzyme, Merck, Bayer, Novartis, Pliva-Teva, and Roche. ZIl obtained grants or contracts from Biogen and Alexion; received honoraria from Biogen, Novartis, Roche, Merck, and Alexion; received payment for expert testimony from Roche; received support for attending meetings and travel from Biogen and Sanofi; and participated on a data safety monitoring board or advisory board from Biogen, Novartis, Merck, Sanofi, Roche, and Alexion. HJK received grants or contracts from National Research Foundation of Korea, Aprilbio, and Eisai; received consulting fees from Aprilbio, Daewoong, HanAll BioPharma, MDimune, Roche, Sanofi Genzyme, Teva-Handok, UCB, and Viela Bio; and received honoraria from Alexion, Biogen, Celltrion, Eisai, GC Pharma, Merck Serono, Novartis, Sanofi Genzyme, and Teva-Handok. RM received consulting fees from UCB, Alexion, Merck, Viela Bio, Novartis, and Roche; and participated on an advisory board for Viela Bio and Roche. FP obtained research support from Alexion; received grants or contracts from German Ministry for Research Support Recipient Charité Education and Research (BMBF), Deutsche Forschungsgemeinschaft (DFG), Einstein Foundation, Guthy Jackson Charitable Foundation, EU FP7 Framework Program, Biogen, Genzyme, Merck, Serono, Novartis, Bayer, Roche, Parexel, and Almirall; received honoraria from the Guthy Jackson Foundation, Bayer, Biogen, Merck Serono, Sanofi Genzyme, Novartis, Viela Bio, Roche, UCB, Mitsubishi Tanabe, and Celgene; received support for attending meetings from Guthy Jackson Foundation, Bayer, Biogen, Merck Serono, Sanofi Genzyme, Novartis, Alexion, Viela Bio, Roche, UCB, Mitsubishi Tanabe, and Celgene; participated on an advisory board for Celgene, Roche, UCB, Merck; and reports leadership as academic editor for Plos One, and associate editor for Neurology, Neuroimmunology, and Neuroinflammation. MBR received support for attending meeting from Novartis. BSD received consulting fees from Chiesi; received honoraria from Chiesi and Sanofi; received support for attending meetings from Bausch + Lomb; participated on an advisory board for Chiesi; and has stock options from Accure Therapeutics. DS received grants or contracts from National Institute of Neurological Disorders and Stroke (NINDS), National Institute of Mental Health (NIMH), American Academy of Neurology (AAN), National Institute of Aging (NIA), National Multiple Sclerosis Society (NMSS), and United States Department of State; and was a committee member for Multiple Sclerosis International Federation (MSIF) and American Neurological Association (ANA). AS received grants or contracts from the Turkish MS society, and Istanbul University Research Support Grants; received consulting fees from Roche, Merck Serono, Biogen, Gen Pharma of Türkiye, Sanofi Genzyme, and Novartis; received honoraria from Sanofi Genzyme, Novartis, Roche, and Teva; and received support for attending meetings from Sanofi Genzyme. VvP obtained grants or contracts from Biogen; received consulting fees from Biogen, Merck, Sanofi, BMS, Novartis, Janssen, Almirall, and Roche; received honoraria from Biogen, Merck, Sanofi, BMS, Novartis, Roche; and received support for attending meetings from Biogen, Roche, and Almirall. MPW received royalties from Springer Healthcare and Elsevier; received consulting fees from Biogen, Roche, Biologix, Novartis, BMS-Celgene, Imcyse, Merck Serono, Sanofi Aventis, IXICO, and Icometrix; received honoraria from Bayer, Biogen, Biologix, Genilac, Novartis, Medison, Merck Serono, Roche, Sanofi Aventis, and BMS-Celgene; and participated on a data safety monitoring board for VU University Medical Center. LB received consulting fees as editor for the Journal of Neuro-Ophthalmology. GTP is an Emeritus editor for Neuro-ophthalmology. All other authors declare no competing interests., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

There are clinical and radiological phenotypes characteristic of neurosarcoidosis. Histopathologic confirmation is preferred, however, biopsy is associated with a significant risk of morbidity when only eloquent neural structures are involved and where there is no systemic disease. We present a series of patients with isolated neurosarcoidosis and suggest circumstances where an empirical, closely monitored, trial of tumour-necrosis-factor-alpha inhibitor therapy can improve outcome and diagnostic confidence., Competing Interests: Declaration of Competing Interest None., (Copyright © 2022. Published by Elsevier B.V.)

Background: There is currently limited literature on the association between visual impairment and suicidal thoughts and behaviours, especially among older adults from low/middle-income countries (LMICs). Thus, we aimed to investigate the associations of objectively measured distance visual impairment with suicidal ideation and suicide attempts among adults aged ≥50 years from six LMICs and to identify potential mediators., Methods: Cross-sectional, community-based, nationally representative data from the WHO Study on global AGEing and adult health were analysed. Objective distance visual acuity was measured using the tumbling E logMAR chart, and vision impairment was categorised as none, mild, moderate and severe. Self-reported information on past 12-month suicidal ideation and suicide attempts was also collected. Multivariable logistic regression and mediation analysis were conducted., Results: Data on 34 129 individuals aged ≥50 years (mean (SD) age, 62.4 (16.0) years; 47.9% men) were analysed. After adjustment for potential confounders, compared with no visual impairment, severe visual impairment was significantly associated with suicidal ideation (OR=9.50; 95% CI=2.47 to 36.52). Moderate and severe visual impairment were significantly associated with a 2.22 (95% CI=1.14 to 4.35) and 11.50 (95% CI=1.44 to 91.88) times higher odds of suicide attempts, respectively. Disability, poor self-rated health, mobility and loneliness explained 14.0%, 9.3%, 7.2% and 6.3% of the association between moderate/severe visual impairment and suicide attempts, respectively., Conclusion: Interventions to reduce suicidal ideation and suicide attempts among older adults with visual impairment in LMICs are required, targeting identified mediators, while using tested strategies for suicide prevention per se in LMICs may yield beneficial outcomes., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)