There are substantial barriers to initiate advance care planning (ACP) for persons with chronic-progressive disease in primary care settings. Some challenges may be disease-specific, such as communicating in case of cognitive impairment. This study assessed and compared the initiation of ACP in primary care with persons with dementia, Parkinson’s disease, cancer, organ failure and stroke.

Longitudinal study linking data from a database of Dutch general practices’ electronic health records with national administrative databases managed by Statistics Netherlands.

Data from general practice records of 199 034 community-dwelling persons with chronic-progressive disease diagnosed between 2008 and 2016.

Incidence rate ratio (IRR) of recorded ACP planning conversations per 1000 person-years in persons with a diagnosis of dementia, Parkinson’s disease, organ failure, cancer or stroke, compared with persons without the particular diagnosis. Poisson regression and competing risk analysis were performed, adjusted for age, gender, migration background, living situation, frailty index and income, also for disease subsamples.

In adjusted analyses, the rate of first ACP conversation for persons with organ failure was the lowest (IRR 0.70 (95% CI 0.68 to 0.73)). Persons with cancer had the highest rate (IRR 1.75 (95% CI 1.68 to 1.83)). Within the subsample of persons with organ failure, the subsample of persons with dementia and the subsample of stroke, a comorbid diagnosis of cancer increased the probability of ACP. Further, for those with organ failure or cancer, comorbid dementia decreased the probability of ACP.

Considering the complexity of initiating ACP for persons with organ failure or dementia, general practitioners should prioritise offering it to them and their family caregivers. Policy initiatives should stimulate the implementation of ACP for people with chronic-progressive disease.

While previous studies have shown an association between anti-Mullerian hormone (AMH) levels and endometriosis, there are limited data on the relationship between AMH levels and age among women with endometriosis.

The present study aimed to investigate the associations between age and AMH levels in women with and without endometriosis.

A cross-sectional, population-based study using data from the ongoing Tehran Lipid and Glucose Study.

A total of 1005 eligible reproductive-age women were selected. These participants were categorised into two groups: women with confirmed endometriosis (n=305) and controls (n=700).

None.

Association between AMH levels and age among women with endometriosis and healthy controls, using linear, quadratic and segmented regression analyses.

A total of 1005 women aged 18–48 years participated in the study, including 305 (30.3%) with endometriosis and 700 (69.7%) healthy controls. Women with endometriosis had significantly lower AMH levels compared with healthy controls (1.99±1.42 vs 2.30±1.61 ng/mL; p=0.029). In healthy controls, an increase of 1 year was associated with –0.15 ng/mL of AMH (95% CI: –0.17 to –0.14). Segmented regression identified a threshold at 27 years (1.92), with a sharper decline below this age (slope: –0.35, 95% CI: –0.47 to –0.23; p

Our study showed that women with endometriosis had significantly lower AMH levels compared with healthy controls and did not demonstrate the age-related threshold observed in the control group, where AMH levels declined more sharply before 27 years of age. These findings suggest that endometriosis may alter the typical pattern of AMH, indicating that clinicians should interpret AMH levels with caution in this population. Further research is needed to validate these results in other populations and explore alternative biomarkers or strategies for more accurately assessing ovarian reserve in women with endometriosis.

Breast cancer is the most common form of cancer in women. A considerable number of women with breast cancer who have been treated with chemotherapy subsequently develop neurological symptoms such as concentration and memory difficulties (also known as ‘chemobrain’). Currently, there are no validated therapeutic approaches available to treat these symptoms. Cognitive training holds the potential to counteract cognitive impairment. Combining cognitive training with concurrent transcranial direct current stimulation (tDCS) could enhance and maintain the effects of this training, potentially providing a new approach to treat post-chemotherapy subjective cognitive impairment (PCSCI). With this study, we aim to investigate the effects of multi-session tDCS over the left dorsolateral prefrontal cortex in combination with cognitive training on cognition and quality of life in women with PCSCI.

The Neuromod-PCSCI trial is a monocentric, randomised, double-blind, placebo-controlled study. Fifty-two women with PCSCI after breast cancer therapy will receive a 3-week tDCS-assisted cognitive training with anodal tDCS over the left dorsolateral prefrontal cortex (target intervention), compared with cognitive training plus sham tDCS (control intervention). Cognitive training will consist of a letter updating task. Primary outcome will be the performance in an untrained task (n-back task) after training. In addition, feasibility, safety and tolerability, as well as quality of life and performance in additional untrained tasks will be investigated. A follow-up visit will be performed 1 month after intervention to assess possible long-term effects. In an exploratory approach, structural and functional MRI will be acquired before the intervention and at post-intervention to identify possible neural predictors for successful intervention.

Ethical approval was granted by the ethics committee of the University Medicine Greifswald (BB236/20). Results will be available through publications in peer-reviewed journals and presentations at national and international conferences.

ClinicalTrials.gov; NCT04817566, registered on 26 March 2021.

Guideline-directed medical therapy (GDMT) for heart failure (HF) reduces adverse events, but is underused. Global barriers to GDMT optimisation include low frequency of visits, clinician inertia and poor patient knowledge, which may be mitigated by digital health interventions (DHI). In Brazil, low digital literacy and reduced access to technology may compromise these potential DHI’s beneficial effects. Our objective is to develop and test the effectiveness of a DHI to optimise GDMT in patients recently hospitalised for HF in the Brazilian public health system (Sistema Único de Saúde (SUS)).

This is a randomised, controlled, multicentre, parallel-group, clinical trial in which 154 patients being discharged from an HF-related hospitalisation will be randomised. Inclusion criteria are ≥18 years of age, reduced ejection fraction HF (EF

This study was approved by the Universidade Federal de Minas Gerais. Recruitment started in November 2023, and patients involved will sign an informed consent form. Results will be presented at scientific meetings and published in scientific journals in 2025, and will be disclosed in social media and presented to public health stakeholders.

Universal Trial Number U1111-1295-1864 Brazilian Clinical Trials Registry (https://ensaiosclinicos.gov.br/rg/RBR-10vpf9bm).