Recent Submissions
Item type: Item , The interrelationship between small Duct PSC and Large Duct PSC: diagnostic challenges, genetic insights, and prognostic implications; a narrative review(Springer Nature Link, 2025-10) Nishad, N.; Niriella, M.A.; De Silva, A.P.; Butler, K.; Subramanian. S.; Thoufeeq. M.H.PURPOSE OF REVIEW To understand the pathogenesis, genetic associations, and the relationship of small-duct primary sclerosing cholangitis (sdPSC) with large-duct primary sclerosing cholangitis (ldPSC) and with IBD. Can early detection of sdPSC influence the progression to more severe forms and improve patient outcomes? RECENT FINDINGS sdPSC affects intra-hepatic ducts and lacks the cholangiographic features of ldPSC. Diagnosis of sdPSC requires a liver biopsy. sdPSC is less common and has a more favourable prognosis. While both sdPSC and ldPSC share histopathological similarities, sdPSC changes are subtle. Genetically, sdPSC is linked to HLA-DRB113:01 and B08, whereas ldPSC is more associated with HLA-B08. About 25% of sdPSC cases may progress to ldPSC. sdPSC has a lower risk of colorectal cancer and cholangiocarcinoma. SUMMARY sdPSC is genetically different from ldPSC, but the histology appears similar. Differentiating between sdPSC and ldPSC is essential for management, with annual colonoscopy recommended for PSC-IBD patients. sdPSC patients with concomitant IBD might represent precursors to classic large duct PSC. In contrast, those without IBD may represent a different cholangiopathy, warranting further investigation.Item type: Item , Predictive Accuracy of Clinicians Estimates of Death and Recovery after Acute Intracerebral Hemorrhage: Pre-Specified Analysis in INTERACT3 Study(Basel ; New York : Karger, 2025-10) Ouyang, M.; Ma, L.; Chen, X.; Wang, X.; Billot, L.; Li, Q.; Malavera, A.; Li, X.; Venturelli, P.M.; De Silva, A.; Nguyen, T.H.; Wahab, K.W.; Pandian, J.D.; Wasay, M.; Pontes-Neto, O.M.; Abanto, C.; Arauz, A.; You, C.; Hu, X.; Song, L.; Anderson, C.SINTRODUCTION: Accurately predicting a patient's prognosis is an important component of decision-making in intracerebral hemorrhage (ICH). We aimed to determine clinicians' ability to predict survival, functional recovery, and return to premorbid activities in patients with ICH. METHODS: Pre-specified secondary analysis of the third intensive care bundle with blood pressure reduction in acute cerebral hemorrhage trial (INTERACT3), an international, multicenter, stepped-wedge cluster randomized controlled trial. Clinician perspectives on prognosis were collected at hospital admission and Day 7 (or before discharge). Prognosis questions were the likelihood of (i) survival at 48 h and 6 months, (ii) favorable functional outcome (recovery walking and self-care), and (iii) return to usual activities at 6 months. Clinician predictions were compared with actual outcomes. RESULTS: Most clinician participants were from neurosurgery (75%) with a median of 8 working years (IQR 5-14) of experience. Of the 6,305 randomized patients who survived 48 h, 213 (3.4%) were predicted to die (positive predictive value [PPV] 0.99, 95% confidence interval [CI] 0.99-0.99). Of 5,435 patients who survived 6 months, 209 (3.8%) were predicted to die (PPV 0.93, 95% CI: 0.92-0.93). Predictions on the favorable functional outcome (PPV 0.54, 95% CI: 0.52-0.56) and satisfied ability to return to usual activities (PPV 0.50, 95% CI: 0.49-0.52) were poor. Prediction accuracy varied by working years and region of practice. CONCLUSIONS: In patients with ICH, clinician estimates of death are very good but conversely they are poor in predicting higher levels of functional recovery and activities.Item type: Item , Policies on using artificial intelligence adopted by journals in psychiatry and mental health(European Science Editing 51, 2025-10) Baminiwatta, A.; Costa, C.; Weerasinghe, D.; Arafat, S.M.Y.; Lund, B.D.BACKGROUND: The integration of artificial intelligence (AI) tools in academic publishing is expanding rapidly, raising concerns about authorship, transparency, and editorial standards. Although organisations such as Committee on Publication Ethics and International Council of Medical Journal Editors have proposed guidelines on the use of AI, the extent to which they have been adopted by journals in psychiatry and mental health remains unclear. OBJECTIVES: To examine the adoption and content of AI policies in psychiatry and mental health journals indexed in SCImago and to determine whether higher-quartile journals are more likely to include policies related to AI. METHODS: Policies related to AI in the guidelines for authors and reviewers were examined for two groups of journals, all indexed under Psychiatry and Mental Health in SCImago in November-December 2024. The two groups were (1) a stratified random sample of 200 journals (50 per quartile) chosen from a total of 578 journals and (2) 25 top-ranked journals in psychiatry and mental health. RESULTS: Among the first group, 78 (39%) journals included policies related to AI in their guidelines or instructions for authors and reviewers, the number being greater in top-quartile journals (56% in Q1 versus 20% in Q4; χ² = 14, P = .003). Of the 78 journals, 69 (88.5%) disallowed AI tools as named authors, an equal number mandated disclosure of the use of AI, and 58 (74.4%) emphasised author accountability. Peer review policies mostly prohibited AI use (n = 47); AI-assisted copy editing was permitted in 56 journals; and policies on AI-generated images varied. None reported using AI detection tools. Among the top 25 journals, 16 (64%) included policies related to AI; all prohibited authorship to AI and required disclosure; and one reported using AI detection tools. CONCLUSION: Despite the rising use of AI in publishing, most psychiatry and mental health journals, especially the lower-quartile journals, lack policies on such use. Wider adoption and standardisation of policies related to AI are crucial to ensure research integrity and credibility.Item type: Item , Cultural Adaptation of Mindfulness from a Japanese Perspective(Springer Nature Link, 2025-10) Hamamura, T.; Maung, M.; Baminiwatta,A.; Chan, C.S.; Chih, H.; Kanetsuki, M.; Gumulya, M.; Gilbey, S.; Mazzucchelli, T.Item type: Item , Burden of 375 diseases and injuries, risk-attributable burden of 88 risk factors, and healthy life expectancy in 204 countries and territories, including 660 subnational locations, 1990-2023: a systematic analysis for the Global Burden of Disease Study 2023(London : J. Onwhyn, 2025-10) GBD 2023 Disease and Injury and Risk Factor Collaborators including Mettananda, C.; Mettananda, S.; Chandradasa, M.BACKGROUND: For more than three decades, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) has provided a framework to quantify health loss due to diseases, injuries, and associated risk factors. This paper presents GBD 2023 findings on disease and injury burden and risk-attributable health loss, offering a global audit of the state of world health to inform public health priorities. This work captures the evolving landscape of health metrics across age groups, sexes, and locations, while reflecting on the remaining post-COVID-19 challenges to achieving our collective global health ambitions. METHODS: The GBD 2023 combined analysis estimated years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) for 375 diseases and injuries, and risk-attributable burden associated with 88 modifiable risk factors. Of the more than 310 000 total data sources used for all GBD 2023 (about 30% of which were new to this estimation round), more than 120 000 sources were used for estimation of disease and injury burden and 59 000 for risk factor estimation, and included vital registration systems, surveys, disease registries, and published scientific literature. Data were analysed using previously established modelling approaches, such as disease modelling meta-regression version 2.1 (DisMod-MR 2.1) and comparative risk assessment methods. Diseases and injuries were categorised into four levels on the basis of the established GBD cause hierarchy, as were risk factors using the GBD risk hierarchy. Estimates stratified by age, sex, location, and year from 1990 to 2023 were focused on disease-specific time trends over the 2010-23 period and presented as counts (to three significant figures) and age-standardised rates per 100 000 person-years (to one decimal place). For each measure, 95% uncertainty intervals [UIs] were calculated with the 2·5th and 97·5th percentile ordered values from a 250-draw distribution. FINDINGS: Total numbers of global DALYs grew 6·1% (95% UI 4·0-8·1), from 2·64 billion (2·46-2·86) in 2010 to 2·80 billion (2·57-3·08) in 2023, but age-standardised DALY rates, which account for population growth and ageing, decreased by 12·6% (11·0-14·1), revealing large long-term health improvements. Non-communicable diseases (NCDs) contributed 1·45 billion (1·31-1·61) global DALYs in 2010, increasing to 1·80 billion (1·63-2·03) in 2023, alongside a concurrent 4·1% (1·9-6·3) reduction in age-standardised rates. Based on DALY counts, the leading level 3 NCDs in 2023 were ischaemic heart disease (193 million [176-209] DALYs), stroke (157 million [141-172]), and diabetes (90·2 million [75·2-107]), with the largest increases in age-standardised rates since 2010 occurring for anxiety disorders (62·8% [34·0-107·5]), depressive disorders (26·3% [11·6-42·9]), and diabetes (14·9% [7·5-25·6]). Remarkable health gains were made for communicable, maternal, neonatal, and nutritional (CMNN) diseases, with DALYs falling from 874 million (837-917) in 2010 to 681 million (642-736) in 2023, and a 25·8% (22·6-28·7) reduction in age-standardised DALY rates. During the COVID-19 pandemic, DALYs due to CMNN diseases rose but returned to pre-pandemic levels by 2023. From 2010 to 2023, decreases in age-standardised rates for CMNN diseases were led by rate decreases of 49·1% (32·7-61·0) for diarrhoeal diseases, 42·9% (38·0-48·0) for HIV/AIDS, and 42·2% (23·6-56·6) for tuberculosis. Neonatal disorders and lower respiratory infections remained the leading level 3 CMNN causes globally in 2023, although both showed notable rate decreases from 2010, declining by 16·5% (10·6-22·0) and 24·8% (7·4-36·7), respectively. Injury-related age-standardised DALY rates decreased by 15·6% (10·7-19·8) over the same period. Differences in burden due to NCDs, CMNN diseases, and injuries persisted across age, sex, time, and location. Based on our risk analysis, nearly 50% (1·27 billion [1·18-1·38]) of the roughly 2·80 billion total global DALYs in 2023 were attributable to the 88 risk factors analysed in GBD. Globally, the five level 3 risk factors contributing the highest proportion of risk-attributable DALYs were high systolic blood pressure (SBP), particulate matter pollution, high fasting plasma glucose (FPG), smoking, and low birthweight and short gestation-with high SBP accounting for 8·4% (6·9-10·0) of total DALYs. Of the three overarching level 1 GBD risk factor categories-behavioural, metabolic, and environmental and occupational-risk-attributable DALYs rose between 2010 and 2023 only for metabolic risks, increasing by 30·7% (24·8-37·3); however, age-standardised DALY rates attributable to metabolic risks decreased by 6·7% (2·0-11·0) over the same period. For all but three of the 25 leading level 3 risk factors, age-standardised rates dropped between 2010 and 2023-eg, declining by 54·4% (38·7-65·3) for unsafe sanitation, 50·5% (33·3-63·1) for unsafe water source, and 45·2% (25·6-72·0) for no access to handwashing facility, and by 44·9% (37·3-53·5) for child growth failure. The three leading level 3 risk factors for which age-standardised attributable DALY rates rose were high BMI (10·5% [0·1 to 20·9]), drug use (8·4% [2·6 to 15·3]), and high FPG (6·2% [-2·7 to 15·6]; non-significant). INTERPRETATION: Our findings underscore the complex and dynamic nature of global health challenges. Since 2010, there have been large decreases in burden due to CMNN diseases and many environmental and behavioural risk factors, juxtaposed with sizeable increases in DALYs attributable to metabolic risk factors and NCDs in growing and ageing populations. This long-observed consequence of the global epidemiological transition was only temporarily interrupted by the COVID-19 pandemic. The substantially decreasing CMNN disease burden, despite the 2008 global financial crisis and pandemic-related disruptions, is one of the greatest collective public health successes known. However, these achievements are at risk of being reversed due to major cuts to development assistance for health globally, the effects of which will hit low-income countries with high burden the hardest. Without sustained investment in evidence-based interventions and policies, progress could stall or reverse, leading to widespread human costs and geopolitical instability. Moreover, the rising NCD burden necessitates intensified efforts to mitigate exposure to leading risk factors-eg, air pollution, smoking, and metabolic risks, such as high SBP, BMI, and FPG-including policies that promote food security, healthier diets, physical activity, and equitable and expanded access to potential treatments, such as GLP-1 receptor agonists. Decisive, coordinated action is needed to address long-standing yet growing health challenges, including depressive and anxiety disorders. Yet this can be only part of the solution. Our response to the NCD syndemic-the complex interaction of multiple health risks, social determinants, and systemic challenges-will define the future landscape of global health. To ensure human wellbeing, economic stability, and social equity, global action to sustain and advance health gains must prioritise reducing disparities by addressing socioeconomic and demographic determinants, ensuring equitable health-care access, tackling malnutrition, strengthening health systems, and improving vaccination coverage. We live in times of great opportunity.