Vaccination in adults at-increased risk of herpes zoster in Canada: insights from a multidisciplinary panel consensus

Risk of herpes zoster (HZ) increases with age (notably at ≥50 years), with greater risk also apparent in immunocompromised populations. The use of the recombinant zoster vaccine (RZV) in adults aged ≥50 years is established in Canada. However, while licensed RZV use was expanded in 2021 to include individuals ≥18 years of age who are or will be at increased risk of HZ due to immunodeficiency or immunosuppression caused by known disease or therapy, there remains some uncertainty for clinicians regarding which patients should be offered vaccination. To assist decision-making, a Canadian multidisciplinary panel was convened to develop guidance on the use of RZV in at-risk adults aged ≥18 years through a consensus approach, defined as ≥75% of the experts rating their agreement. The panel concluded that RZV should be offered to all at-risk individuals aged ≥18 years who are or will be at increased risk of HZ due to disease or therapy, in line with the licensed indication. This includes those with chronic medical conditions at greater risk of HZ (e.g. COPD, diabetes). Decisions should be individualized based upon patient assessment and shared clinical decision-making. Where possible, the two-dose vaccine series should be given at the earliest opportunity. Findings from this expert consensus provide guidance on the use of RZV in individuals ≥18 years at increased risk of HZ. Our views complement updated national recommendations for immunocompromised patients issued in May 2025.

A lupeol derivative and other isolates with antiplasmodial activity from the stem root of Rauvolfia mannii Stapf. (Apocynaceae)

Rauvolfia mannii is a plant from western and eastern areas of African continent and is widely used in folk medicine for the treatment of various diseases including malaria. Herein, one previously undescribed acylated triterpene ( 1 ), together with five already published natural products ( 2 - 6 ) were removed from its roots. The chemical structures of these compounds were determined by spectroscopic and spectrometric means (NMR, HRESIMS, IR and UV). In addition to the isolated triterpenoids, components 5 and 6 are also newly reported from the genus Rauvolfia . Moreover, some constituents were further tested against the chloroquine-sensitive strain of P. falciparum (3D7). It has been found that 3 and 4 showed a moderate antiplasmodial activity with IC 50 values of 46.25 and 39.79 µM respectively.

Congenital cardiac surgical simulation: bridging global workforce gaps and optimizing outcomes

Reaching competency in congenital heart surgery (CHS) requires lengthy and rigorous training. Due to patient safety, time limitations, and procedural complexity, the intraoperative setting is not ideal for technical practice. Surgical simulation using synthetic, biological, or virtual models is an increasingly valuable educational tool for technical training and assessment. In particular, three-dimensional (3D) models are especially favorable in CHS education for its high-fidelity demonstration of congenital heart defects. In countries where there is a deficit of local cardiac surgical expertise, simple and inexpensive innovation, such as expanding hands-on technical training programs involving 3D-models and hybrid teaching, may partially address the lack of CHS training opportunities and the consequent unmet need for surgical management of pediatric heart disease.

The prevalence of patient-reported cognitive complaints and dementia risk factors in the audiology clinic

Hearing-dementia research mainly focuses on determining the causal direction of this association. Little is known about the prevalence of cognitive problems in a representative audiology patient population. To examine the occurrence of self-reported cognitive complaints (SCC) and dementia risk factors (RF) in an audiology patient population. Patients visiting audiology clinics ( n  = 1100, 51% female and avg. age 61yrs) were administered an online intake tool based on the International Classification of Functioning Disability and Health. Domains extracted for analyses were memory and concentration (SCC) and loneliness, depression, sleep and vision (dementia RF) and self-reported hearing problems (SHP). Prevalence rates and associations with demographic variables and SHP were examined. SCC were highly prevalent, with over half of the patients reporting memory or concentration problems. Regarding dementia RF, 68% reported sleeping problems and > 50% reported sadness, anxiety or depressed mood. SHP correlated significantly with self-reported memory problems, loneliness, and vision problems. This descriptive cohort-study suggests a high risk of cognitive issues within the audiology clinic population, indicated by the high prevalence of SCC and some dementia RF. Our findings underscore the importance of considering closer cooperation between care pathways like audiology and neurology and use of a holistic patient-centered approach.

An Unholy Alliance? The Influence of Negative Emotions Elicited by Media Reports on the Persuasiveness of Populist Communication

Emotions play a crucial role in the success of populist actors and movements. The present study investigates whether populist actors can profit from emotions elicited by media content. We assume that populist claims are more persuasive than non-populist claims when experiencing negative emotions toward an issue and that citizens with strong populist attitudes are particularly susceptible to this persuasive process. In a 2 × 2 experiment ( N  = 475), we tested whether emotionalized (vs. neutral) media reports foster the persuasiveness of populist (vs. non-populist) communication and whether populist attitudes moderate this effect. The results indicate that citizens with medium to strong populist attitudes experience stronger negative emotions in response to emotionalized media content and that negative emotions increase support for promoted policies and the promoting actor. However, persuasive effects were not limited to populist communication.

Is Bedtime Media Use Good or Bad? A Competitive Analysis Between the Sleep Displacement Hypothesis and the Media Recovery Hypothesis

Bedtime media use is often maligned in research and pop culture. However, the evidence for the relationship between bedtime media use and sleep for adults has been mixed – sometimes sleep quality is negatively affected by media use, sometimes it is positively affected. Competing explanations include the sleep displacement hypothesis (i.e. media use leads to later sleep onset, less total sleep, and lower sleep quality) and the media recovery hypothesis (i.e. media use helps reduce stress, and this relaxation helps people fall and stay asleep). Two retrospective diary studies test these competing hypotheses in an undergraduate sample ( n  = 200) and a general population U.S. adult sample ( n  = 202). Overall, results provide more support for the sleep displacement hypothesis than for the media recovery hypothesis. However, some evidence suggests potential for positive relationships between media use and sleep. More work is needed to explicate the complicated relationship between bedtime media use and sleep.

Treatment Engagement in Adolescents: The Associations of Sociodemographic Characteristics, Caregiver Perceived Barriers, and Clinical Impairment

To examine the associations between sociodemographic characteristics, perceived barriers to treatment, clinical impairment, and youth treatment engagement. Participants included 196 families (youth: ages 12 to 18; 64.3% cis-gender female; 23.5% Black, 60.7% White, and 12.2% Mixed/Other race; 41.3% Hispanic or Latinx ethnicity) recruited as part of a comparative effectiveness trial for adolescent anxiety and depression. Self-report measures of sociodemographic characteristics and caregiver perceived barriers were completed at intake. Youth clinical impairment was assessed at baseline via clinical interview. Measures of engagement were collected throughout treatment, including initiation status, session attendance, and termination status. Relationships were examined using analyses of variances and hierarchal linear and logistic modeling. Perceived barriers did not differ by sociodemographic characteristics. Greater perceived stressors and obstacles predicted fewer sessions attended and a lower likelihood of successful termination. Youth of caregivers with an advanced degree and those with caregivers who were employed part time attended more sessions and were more likely to initiate and terminate treatment successfully compared to youth with caregivers of a lower education level or student or unemployed status. At higher levels of youth clinical impairment, greater perceived treatment demands and issues predicted reduced likelihood of treatment initiation. Perceived barriers, sociodemographic characteristics, and clinical impairment were all associated with levels of engagement in the treatment process. Baseline and continued assessment of perceived and experienced barriers to treatment may promote individualized strategies for families identified as at-risk for reduced engagement.

Delayed cerebrospinal fluid removal is ineffective in treating intrathecal baclofen overdose

Adverse reactions of liquorice consumed in the diet: a 10-year retrospective study of poison centres in France

We aimed to describe the symptoms, patient demographics, and trends over time of adverse effects related to liquorice consumed in the diet reported to French poison centres. We performed a retrospective study of data from French poison centres of cases of adverse effects of liquorice consumed in the diet, with a high causality score, between 2012 and 2021 (10 years). Sixty-four cases were included. The annual number of cases ranged from three to nine, with no significant variation over the study period. Liquorice-induced reactions were very rare (0.008% of all cases with symptoms reported to French poison centres). The products consumed were non-alcoholic beverages (non-alcoholic pastis, liquorice-based Antésite ® , and liquorice syrup), alcoholic beverages of the pastis type (10.9%), confectionery containing liquorice (12.5%), confectionery made with liquorice extract only (9.4%), herbal teas (12.5%) and food supplements (4.7%). Consumption was commonly chronic (67.2%) and non-compliant (70.3%). Chronic users presented with symptoms suggestive of pseudohyperaldosteronism, the severity of which seemed to correlate with the amount of glycyrrhizin ingested. Severity was high in 43.8% of cases. When the outcome was known (56.3%), it was favourable in almost all cases (94.4%), often after inpatient care, particularly in an intensive care unit. One patient had sequelae due to a stroke, and one fatality was reported. Severe cases were observed with all types of products, except liquorice syrup and food supplements, and more frequently with beverages (pastis with or without alcohol, and Antésite ® ). Due to significant variability in response to glycyrrhizin, some patients presented signs and symptoms suggestive of pseudohyperaldosteronism such as hypokalaemia, salt and water retention, and hypertension despite consuming the product as directed. Liquorice-induced effects were rarely reported to French poison centres, but their severity was high. Most patients were adults with chronic and non-compliant consumption, especially of soft drinks, with a clinical presentation suggestive of pseudohyperaldosteronism.

Evaluation of the reproducibility and validity of the use of the causality assessment method for poisonings designed and applied by the French poison control centres

French poison control centres have developed and use a standardised causality assessment method based on a decision tree for poisoning cases involving a wide range of xenobiotics, which includes five ascending levels (I0–I4) and six determinants. This study was designed to evaluate inter-rater reliability and the validity of using this method. A reference group of toxicologists identified five categories of cases – based on the route of exposure with two circumstances for the oral route – recorded in the French National Database of Poisonings. The reference group assessed by consensus the level of causality of each randomly selected case as the reference level. Toxicologists from poison centres, not belonging to the reference group, were selected as raters. Inter-rater reliability was assessed using weighted Light’s kappa. The results of raters were compared against the reference to test the validity of the method. A subgroup analysis of inter-rater reliability was also performed according to rater experience, case category, and causality determinant. Nineteen raters reviewed the 86 cases selected by the reference group. Kappa was equal to 0.55 (moderate agreement). Sensitivity was 0.90 and specificity was 0.62 when comparing I0 versus I1–I4 classes. The agreement between raters increased with experience except for the most experienced group. Ocular route of exposure had the highest kappa (0.70) among the five case categories. Kappa for the causality determinants varied from 0.31 (exposure) to 0.54 (bibliographical references). The causality assessment of poisonings was carried out on real-life cases. Our results are close to those of studies on causality methods in pharmacovigilance and nutrivigilance, despite a wider scope of application. Causality assessment method employed by French poison control centres is useful, although coding of some determinants should be improved. Further refinement of the causality assessment method will also further enhance its utility.