To explore patients’ awareness levels of palliative care (PC) and how this awareness shapes their preferences regarding the timing and approach for discussing it.

The study, conducted at a prominent institution specializing in oncology care, enrolled women aged 18–75 years who had been diagnosed with breast cancer. Patients completed guiding questions: Do you know what PC is?, When is the most appropriate time and the most appropriate way to discuss PC?. The interviews were conducted exclusively via video call and were recorded, transcribed, and then deleted.

The study involved 61 participants, averaging 49 years old. Almost half (47.5%) had completed high school. Qualitative data analysis revealed 9 thematic categories. Regarding the first question, 2 divergent categories emerged: care for life and threatening treatment. For the second question, opinions diverged into 4 categories: At an early stage, mid-course of the disease, as late as possible, and no time at all. For the third question, 3 categories emerged: communication and support, care setting and environment, and improving the PC experience.

This study reveals diverse perspectives on patients’ awareness and preferences for discussing PC, challenging the misconception that it’s only for end-of-life (EOL) situations. Comprehending PC influences when and how patients discuss it. If tied solely to EOL scenarios, discussions may be delayed. Conversely, understanding its role in enhancing advance support encourages earlier conversations. Limited awareness might delay talks, while informed patients actively contribute to shared decision-making. Some patients prefered early involvement, others find mid-treatment discussions stress-relieving. Community support, quiet environments, and accessible resources, underscoring the importance of a calm, empathetic approach, emphasizing the importance of understanding its role in advance support and providing valuable implications for enhancing patient care practices, theories, and policies.

High-risk Human Papillomavirus (HPV) infections are a leading cause of cervical diseases among Han Chinese women of reproductive age. Despite studies like Mai et al. (2021) addressing HPV prevalence in Southern China, awareness remains low, especially in Southwest China. Our study addresses this gap.

This hospital-based, retrospective study analyzes the prevalence of high-risk HPV and its association with cervical intraepithelial neoplasia (CIN) among Han Chinese women of reproductive age in Southwest China.

Data were collected from 724 women undergoing routine health exams from December 2022 to April 2023. A total of 102 women with high-risk HPV infections were identified. A survey assessed HPV awareness, CIN incidence, and socio-demographic factors influencing awareness.

Of the 724 women, 102 (14.1%) were diagnosed with high-risk HPV, with HPV-16 being the most common subtype (22.5%). Awareness was significantly lower among unmarried women (OR: 6.632, p = 0.047), those with high school education or less (OR: 20.571, p = 0.003), and rural residents (OR: 19.483, p = 0.020). HPV-16 was detected in 54.55% of women with high-grade CIN.

There is an urgent need for targeted education and HPV vaccination in Southwest China, particularly for women with lower education, rural residents, and older individuals. Subtype-specific strategies are essential for preventing and managing CIN.

To determine the level of awareness of health technology assessment (HTA) and its predictors among clinical year medical students in public universities in Klang Valley, Malaysia.

A cross-sectional study using the stratified random sampling method was conducted among clinical year medical students in four public universities in Klang Valley, Malaysia. Data on the level of awareness of HTA and its associated factors were collected using a self-administered online questionnaire. Descriptive, bivariate, and multivariate analyses were performed using IBM SPSS version 27 to determine the level of awareness of HTA and its predictors.

Majority (69 percent) of participants had a low level of awareness of HTA. The predictors of high-level awareness of HTA were attitude toward HTA (adjusted odds ratio (AOR) = 7.417, 95 percent confidence interval (CI): 3.491, 15.758), peer interaction on HTA (AOR = 0.320, 95 percent CI: 0.115, 0.888), and previous training on HTA (AOR = 4.849, 95 percent CI: 1.096, 21.444).

Most future doctors in public universities exhibit a low awareness of HTA. This study highlights the interplay between attitudes toward HTA, peer interaction, and previous training as influential predictors of HTA awareness. An integrated and comprehensive educational approach is recommended to cultivate a positive attitude and harness the positive aspects of peer interaction while mitigating the potential negative impact of misconceptions. Emphasizing early exposure to HTA concepts through structured programs is crucial for empowering the upcoming generation of healthcare professionals, enabling them to navigate HTA complexities and contribute to evidence-based healthcare practices in Malaysia and beyond.

Since seminal work by Sherrington, the term interoception refers to the ability to sense modifications of internal bodily states as opposed to the ability to sense stimuli coming from outside the body itself. Despite conceptual changes regarding the afferent signals subserving this type of inner perception, the core of this definition is still valid and widely accepted. The critical contribution of internal state perception to self-regulation as well as higher-order cognitive processes has led to the development of psychometric and observational measures trying to capture individual interoceptive skills, focusing especially on the ability to orient attention to internal sensations. Nonetheless, despite growing interest in interoceptive attention (IAtt), little is known about neurofunctional correlates of our ability to redirect attention to internal sensations and consciously process them, as well as on potential objective biomarkers of IAtt performance.

This study included 36 volunteers who were asked to complete a heart-beat counting task (HCT), a common IAtt task. During both resting-state and HCT, central electrophysiological (EEG, 32 electrodes) and cardiovascular activity (ECG, I lead) were recorded. eLORETA was used to estimate both task-related and resting-state intracortical sources of EEG signals. Statistical non-parametric mapping (SnPM) was used to draw and investigate contrast statistical maps between rest- and task-related cortical current density.

Contrast analyses comparing HCT and resting revealed higher Alpha frequency current density estimates during the task, with primary cortical seed in the right parahippocampal gyrus. Regression analyses of the relationship between IAtt scores and task-related changes in intracortical current density during HCT revealed a positive relationship for the Beta frequency bands with primary cortical seeds in the cingulate gyrus and insula.

Findings add to available literature by further specifying the electrophysiological signature of interoceptive attentiveness, and suggest specific electrophysiological markers as objective measures of individual IAtt skills.

Disruptions to mind-wandering are common across neuropsychiatric disorders. Whilst the large-scale brain networks associated with mind-wandering are increasingly well understood, we know very little about what neurobiological mechanisms trigger a mind-wandering episode and sustain the mind-wandering brain state. From a clinical perspective, we aimed to understand dysfunctional mind-wandering in neuropsychiatric diseases of ageing: frontotemporal dementia, Alzheimer’s disease and Parkinson’s disease. We also tested the hypothesis that mind-wandering relates to visual hallucinations in Parkinson’s disease. From a theoretical perspective, we advance the hypothesis that the hippocampal sharp wave-ripple is a compelling candidate for a brain state that can trigger mind-wandering episodes. The occurrence of the sharp wave-ripple is heavily dependent on hippocampal neuromodulatory tone. Neuromodulatory systems that regulate the sharp wave-ripple may be crucial for understanding the disruption to mind-wandering in neuropsychiatric disease.

We developed a thought-sampling task to probe mind-wandering in neuropsychiatric diseases of ageing. To explore brain patterns related to mind-wandering, we used multi-modal neuroimaging (i.e., resting state and structural scans). In separate studies, we applied these techniques in frontotemporal dementia and Alzheimer’s disease; and in Parkinson’s patients with and without visual hallucinations.

We showed reduced mind-wandering in frontotemporal dementia, associated with functional and structural changes across the default network. In Parkinson’s disease, we also found a reduction in mind-wandering compared with healthy controls. However, in patients with visual hallucinations, mind-wandering was preserved and associated with increased connectivity between the default network and early visual regions.

Together, disrupted mind-wandering occurs in neuropsychiatric diseases of ageing. It may contribute to some of the more recognisable symptoms in these conditions, including apathy and hallucinations. These findings also provide a unique clinical validation of current brain network models of mind-wandering that have been developed in healthy populations. Neuromodulatory influences over mind-wandering have implications for treating impairments in this process across neuropsychiatric conditions.

As the population continues to age at a rapid pace, an important question that has been raised by clinicians and researchers alike, is “how can we preserve our cognitive abilities as older adults?” Cognitive reserve (CR) is thought to account for inter-individual differences in the cognitive trajectories of older people experiencing similar levels of brain pathology. Being a hypothetical construct, CR cannot be measured directly and therefore, must be operationalized through a combination of demographic and lifestyle variables. While there is sufficient empirical evidence supporting the relationship between individual CR proxies and cognitive functioning, few studies to date have explored which CR proxy is most important in predicting aspects of late-life cognitive functioning and whether composite measure of CR accurately predict cognitive functioning, above and beyond variables traditionally associated with late-life cognitive ability (e.g., age, gender, cardiovascular risk, depression). The present cross-sectional study sought to examine the relationship between three well-established CR proxies—educational attainment, mental workplace demands, crystallized intelligence—and baseline neuropsychological functioning in a clinical sample of older adults without dementia.

Using archival data from 248 older adult patients seen at geriatric specialist hospital in Ontario, Canada, we examined the cumulative and independent effects of educational attainment (years of formal education), mental workplace demands (mean analyst rating for 10 O*NET variables measuring cognitively complex work activities), and crystallized intelligence (score on WASI-I Vocabulary subtest) on performance across several neuropsychological tests assessing i.) verbal memory, ii.) visual memory, iii.) attention, concentration, and working memory, iv.) executive functioning, v.) visuospatial processing, and vi.) language. Composite scores for all six cognitive domains were calculated by averaging converted z-scores on domain-specific tests of neuropsychological functioning. A series of regression models were then constructed to evaluate the relationship between CR and late-life cognitive functioning. To determine the relative importance of each CR proxy, a follow-up relative weight analysis (RWA) was performed for each regression model.

After controlling for age, gender, cardiovascular risk, and depression, our composite measure of CR (average z-score of educational attainment, mental workplace demands, crystallized intelligence) proved to be a significant predictor across all domains of cognitive functioning. Of the six cognitive domains assessed, CR was the most important in predicting higher-order cognitive functions, such as working memory and executive functioning. Out of the three CR proxies, crystallized intelligence was the only CR proxy that significantly predicted performance across all six cognitive domains. RWA revealed that crystallized intelligence was the most important in predicting neuropsychological functioning, followed by educational attainment, and mental workplace demands.

Despite being closely related, all three CR proxies demonstrated differential effects on late-life cognitive functioning. Overall, our findings suggest that the effects of CR are not generalizable across all cognitive domains and appears to be somewhat dependent on the CR proxy used. This study supports the existing literature in demonstrating the robustness of crystallized intelligence as a CR proxy and provides preliminary evidence supporting the idea that tasks that require higher levels of cognitive processing are the most influenced by CR.

Trait mindfulness is associated with reduced stress and psychological well-being. However, evidence regarding its effects on cognitive function is mixed and certain facets of trait mindfulness are associated with higher negative affect (NA). This study investigated whether specific mindfulness skills were associated with cognitive performance and affective traits.

165 older adults from the Maine Aging Behavior Learning Enrichment (M-ABLE) Study completed the National Alzheimer’s Coordinating Center T-Cog battery, the Five Facet Mindfulness Questionnaire, and the Positive and Negative Affect Schedule-SF.

All five facets of trait mindfulness were associated with higher Positive Affect and lower NA, with the exception that Observation was not associated with trait NA. Partial correlations adjusting for age indicated that better episodic memory was associated with Observation, Describing, and Nonreactivity. Verbal fluency performance was associated with Observation, while Working Memory was associated with Nonjudgment. Executive Attention/Processing speed was associated with total mindfulness scores and showed a trend relationship with Nonreactivity.

Mindfulness skills showed specific patterns with affective traits and cognitive function. These findings suggest that the ability to maintain awareness, describe, and experience internal and external states without reacting to them may partly rely on episodic memory. Mindful awareness skills also may depend on frontal and language functions, while the ability to experience emotional states without reacting may require Executive Attention. Global mindfulness and a non-judgmental stance may require auditory attention. Alternatively, mindfulness skills may serve to enhance these functions. Hence, longitudinal research is needed to determine the directionality of these findings.

Mind-wandering—the spontaneous shift in attention away from the external task to internal thoughts (including daydreaming, fantasizing, rumination, and worrying)—is negatively associated with performance across a variety of tasks including the sustained attention to response task, the Stroop task, tasks of working memory, choice reaction time, visual search, as well as more ecologically related tasks like reading comprehension and mathematics. There has also been promising evidence suggesting a potential link between mind-wandering, functional connectivity of the canonical networks of the brain, and Alzheimer’s disease (AD). However, no study has directly examined the relationship between neural correlates of mind-wandering and AD pathogenesis. In prior work, our lab has identified a whole-brain, functional connectivity-based marker of mind-wandering—the mwCPM—which predicted response time variability in older adults. In this study, we sought to evaluate the ability of this mind wandering CPM, derived from response time variability, to predict CSF p-tau/Aß42 ratio in 289 older adults from the Alzheimer’s Disease Neuroimaging Initiative. We hypothesized that the combined mind-wandering model including functional connections that predict high mind-wandering and functional edges that predict stability in attention, would predict AD pathology.

Resting-state functional MRI data from 289 older adults (147 healthy older adults, 111 individuals with mild cognitive impairment, and 31 older adults with AD) from the Alzheimer’s Disease NeuroImaging Initiative was analyzed for the current study. Participants were only included in the analyses if they had resting-state fMRI data, CSF measures of amyloid beta and tau pathology, and performance on cognitive composites of global cognition, episodic memory, and executive functioning. Using the well-established methodology of connectome-based predictive modeling, the mind-wandering model was applied to the resting-state fMRI data to predict CSF-based biomarker levels of p-tau and Aß42. Moreover, we also examined if this mind-wandering model predicted individual differences in composite measures of global cognition, episodic memory, and executive functioning

The high mwCPM model successfully predicted measured CSF p-tau/Aß ratios (high model: p = .137, p = .0196), controlling for mean framewise displacement. However, the combined network and the low MW network were not significant (combined model: p = .0731, p = .216; low model: p = -.0027, p = .960). We next examined the association between connectivity strengths of the high mwCPM and cognitive functioning in the domains of general cognition, episodic memory, and executive functioning. Connectivity strength in the high mwCPM—functional edges that were associated with high behavioral variability—were negatively associated with all three cognitive composites (global cognition: r = -.239, p < .0001; episodic memory: r = -.208, p = < .0001; executive functioning: r = -.178, p < .0001).

This study provides the first empirical support for a link between a neuromarker of mind-wandering and AD pathophysiology. Moreover, mind-wandering also has downstream consequential effects for key domains of cognitive functioning in older adults. Interventions targeted at reducing mind-wandering, particularly before the onset of AD pathogenesis, may make a significant contribution to the prevention of AD-related cognitive decline.