Centre for Health Technology and Services Research

Background/Objectives: The presence of postmortem pink teeth is a phenomenon occasionally observed during forensic autopsies. This phenomenon has been typically associated with deaths involving drowning, asphyxiation, trauma, or electrocution. However, the recent literature suggests that it is nonspecific. Despite being recognized in forensic literature for decades, its pathophysiology, prevalence, and forensic relevance remain controversial. The existing evidence is scattered and primarily based on case reports, narrative reviews, or isolated observations. This scoping review aims to systematically map the available scientific evidence on the phenomenon of postmortem pink teeth and its potential role in determining the cause of death within the context of forensic medicine. Methods: This review was conducted following the Joanna Briggs Institute (JBI) methodology for scoping reviews and reported according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Results: A comprehensive search was carried out across multiple databases to identify studies addressing the occurrence, mechanisms, and forensic interpretation of pink teeth in postmortem examinations. After application of the inclusion and exclusion criteria, the search allowed for the selection of 12 publications (case reports and observational studies). Conclusions: Collected data from the selected studies allowed us to conclude that PTP is a nonspecific taphonomic artifact, lacking diagnostic value in determining the cause of death. Mapping the current evidence on pink teeth contributed to a better understanding of this phenomenon and its lack of forensic significance, promoting more informed decision-making in postmortem assessments.

Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most prevalent and highly impacting neurodevelopmental disorders worldwide. Beyond its complexity, it’s a childhood-onset condition influenced by both genetic and environmental factors. Among these, nutrition has emerged as a relevant modifiable factor, yet most studies have focused on isolated nutrients, overlooking dietary complex interplay. This study addresses that gap using a data-driven nutrient pattern approach. To identify nutrient patterns in children with ADHD and explore their association with behavioural symptoms. In this case–control study, 76 children aged 6–10 years (ADHD: n = 43, Neurotypical, n = 33) were included. Nutritional intake was assessed using 3-day food diaries and Principal Component Analysis (PCA) was applied to 24 total energy intakeadjusted dietary nutrients. Multivariable regression models assessed associations between nutrient patterns, individual nutrients, and ADHD-related symptoms measured by Child Behaviour Questionnaire (CBCL) and Conners’ Parent Rating Scale-Revised: Short Form (CPRS-R:S). Seven major nutrient patterns were identified, explaining 76.7% of the total variance. Although no group-level differences in overall patterns reached statistical significance, the Antioxidant–Mineral factor showed a near-significant lower score in the ADHD group (p = 0.077). Children with ADHD consumed significantly less Monounsaturated fats (MUFAs) (p = 0.003), Polyunsaturated fats (PUFAs) (p = 0.010), and vitamin C (p = 0.014). Vitamin A and selenium emerged as key nutrients associated with behavioral and emotional symptoms, and ADHD severity. Our findings suggest that children with ADHD may have lower intake of antioxidant-rich micronutrients and healthy fats, with implications for symptom severity. These results underscore the potential role for nutrition-based strategies in the clinical management of ADHD.

Background/Objectives: Endocrine therapy (ET) is a common treatment for hormone-dependent breast cancer and is associated with a significant reduction in recurrence and mortality rates. However, the decision to initiate endocrine therapy is a critical and often distressing juncture for patients. The need to weigh its survival benefits against the potential burden of side effects, including mood changes, pain, muscle stiffness, and fatigue, can render this decision-making phase a source of significant distress. The present systematic review aimed to identify and synthesize the sociodemographic and psychosocial predictors of the decision-making process related to ET adherence among women with breast cancer. Methods: A systematic literature search was conducted in three electronic databases—PubMed Central, ProQuest, and Scopus—to identify studies examining the association between sociodemographic and psychosocial factors and the decision-making process regarding ET among women with breast cancer. Inclusion criteria encompassed cross-sectional studies published between 2000 and 2025. Data were extracted and analyzed to identify recurring predictors across studies. The findings were synthesized through a narrative synthesis. Results: Twelve cross-sectional studies met the inclusion criteria, comprising a total of 8510 women diagnosed with breast cancer and undergoing ET. Ten studies (83%) identified sociodemographic variables—such as age, marital status, educational level, and ethnicity—as significant predictors of decision-making. Moreover, nine studies (75%) reported psychosocial factors, including quality of life (QoL), fear of progression, infertility concerns, and social support, as influential in the decision to initiate or continue ET. Specifically, the decision to adhere to ET is generally supported by younger age, higher education, better perceived quality of life, and greater social support. Conversely, it is hindered by lower income, lower education, fertility concerns related to marital status, and diminished quality of life. Conclusions: The findings of this review indicate that both sociodemographic and psychosocial factors play key roles in shaping women’s decisions regarding adherence to ET. Understanding these predictors can facilitate decision-making and inform the development of targeted interventions aimed at improving treatment adherence and supporting patient-centered care in breast cancer treatment. The focus on decision-making processes, rather than on adherence rates, is what distinguishes this review from other systematic reviews.

Diabetes mellitus is a global health challenge requiring sustained self-management. Evidence highlights the role of families in supporting adults with diabetes mellitus, yet many interventions fail to adopt structured, theory-informed, and family-centred approaches. To address this gap, the psychoeducational intervention "Juntos com a Família + Capazes" (Together with Family + Capable) was developed within the Medical Research Council Framework for Complex Interventions, integrating empirical evidence, theoretical models, and stakeholder input. This study conducted a pre-intervention conceptual validation, exploring perspectives of healthcare professionals, adults with Type 1 and Type 2 diabetes mellitus, and family members on its structure, content, and feasibility. A qualitative descriptive design was applied. Focus groups interviews with healthcare professionals, adults with diabetes mellitus, and family members, were guided by a semi-structured interview guide. Sessions were audio-recorded, transcribed, and analysed using deductive qualitative content analysis with independent manual coding and consensus discussions. Three focus groups were held (n = 19): two with healthcare professionals and one with adults with diabetes and family members, separated due to participant availability and feasibility constraints. Participants critically reflected on the pre-implementation conceptual design of the programme, described as a six-month intervention with a six-month follow-up, structured into seven modules and delivered flexibly across 7-12 sessions. They endorsed the overall structure and content while suggesting refinements to module sequencing and module titles. Participatory strategies, tailored motivational phone calls, and strong family involvement were considered essential for engagement, sustained behavioural change, and feasibility. Analysis revealed both convergent themes and stakeholder-specific perspectives, integrating clinical expertise with lived experience. The "Juntos com a Família + Capazes" programme was conceptually validated, prior to implementation, as a family-centred, theory-informed, and adaptable intervention for adults with diabetes mellitus and their families. This pre-implementation phase enables refinements to content, sequencing, language, and delivery strategies, strengthening cultural relevance, acceptability, and feasibility. Conducting conceptual validation before piloting ensured that both clinical expertise and lived experiences shaped the intervention, highlighting the value of focus groups in identifying adjustments that enhance its real-world applicability. Future research should evaluate its effectiveness, sustainability, and scalability across healthcare contexts.

Abstract Background Increased intake of ultra-processed food (UPF) links to higher risk of inflammatory bowel disease (IBD)1, while its biological mechanism remains unclear. Our previous work implied gene-diet interaction modulates the risk of IBD, especially in those with higher IBD susceptibility2,3. This study is to unveil UPF’s effect on IBD via circulating metabolites, localize key component, and explore its mechanism linking UPF to IBD. Methods We aim to find the mechanism of UPF on incident IBD through key metabolite and related gene. Analyses involved two parts: a. construct UPF metabolic signature in UK Biobank (UKB) discovery cohort (n = 10,229), with internal (n = 91,306) and external validation (Whitehall II [WHII], n = 7,893); b. identify and validate key metabolite in UPF-IBD association and its mechanism in Western and Eastern (n = 752) cohorts. UPF metabolic signature was developed by elastic net regression of metabolites (assayed by high-throughput metabolomic platforms) on UPF intake (measured by repeated dietary recalls). We applied Cox regression to assess the metabolic signature on IBD risk. Weighted gene co-expression network analysis (WGCNA) was used to identify metabolite clusters in the signature. We combined linear model, elastic net regression, survival analysis, mediation analysis, and WGCNA to identify key metabolites. Further validation was performed in an Eastern multi-center cohort, ONE-IBD. Mendelian randomisation (MR), colocalization, and gene-environment (G-E) interaction analyses were used to address potential causality and genetic locus (Fig 1). Results A UPF metabolic signature of 73 metabolites was constructed (Fig 2A) and validated in UKB and WHII (Spearman ρ: 0.20-0.25). More pronounced UPF metabolic signature was associated with higher risk of IBD and CD (IBD: HRper SD=1.72, 95% CI 1.32-2.24; CD: HRper SD=2.65, 95% CI 1.57-4.48 Fig 2B). WGCNA revealed a cluster rich in fatty acids inversely associated with CD (HRper SD=0.66, 95% CI 0.45-0.98, Fig 2C), in which docosahexaenoic acid (DHA) was pinpointed as key metabolite (mediated proportion=12.5%, Fig 2D-E). External validation in ONE-IBD supported DHA as the metabolite most strongly associated with UPF and CD (Fig 2F). MR and colocalization revealed rs174546 in FADS1 gene as a shared variant linking DHA with CD (Fig 2G-H). G-E analysis showed UPF’s effect on CD was pronounced in individuals with FADS1 variant (T allele carriers, linking to lower DHA), while metabolic signature’s effect on CD was weakened, stressing the central role of metabolites (Fig 2I). Conclusion Our study reveals the critical role of metabolites linking UPF and IBD risk, especially in CD, with consistent evidence identifying DHA and FADS1 gene as personalised targets in IBD precision prevention.

Abstract Background In addition to endoscopic evaluation, histologic assessment of mucosal healing in patients with Crohn’s disease (CD) may provide further insights into the inflammatory status of their disease. Upadacitinib (UPA) is an oral Janus kinase inhibitor approved for the treatment of moderately to severely active CD that has demonstrated significantly higher rates of endoscopic remission compared with placebo (PBO) in phase 3 induction and maintenance trials.1 This post hoc analysis evaluated histologic outcomes in patients with CD treated with UPA vs PBO from the phase 3 trials. Methods Clinical responders to 12 wks induction of UPA 45 mg (UPA45) once daily (QD; U-EXCEL, U-EXCEED) were rerandomised to UPA 15 mg (UPA15) QD, UPA 30 mg (UPA30) QD, or PBO for 52 wks during maintenance (U-ENDURE). Biopsy collection was optional, including 2 specimens from each of 5 intestinal segments obtained from the edge of ulcers or most inflamed mucosa during endoscopy at screening, wk 12 (induction), and wk 52 (maintenance). The worst biopsy fragment of each segment was scored by central readers, with the highest score for a given feature across segments. The proportion of patients achieving histologic remission by Colonic/Ileal Global Histology Activity Score (CGHAS/IGHAS score ≤2), histologic remission alternatively defined as complete absence of mucosal neutrophils [in epithelium and lamina propria] and no epithelial damage, erosions and ulcers, and endoscopic-histologic remission defined as achieving both endoscopic remission (SES-CD Total Score ≤4 and ≥2-point reduction versus baseline and no subscore >1 in any individual variable) and histologic remission per alternative definition was assessed at wks 12 and 52 among patients with abnormal histology at baseline. Adjusted treatment differences between UPA and PBO were assessed using the Cochran-Mantel-Haenszel test. Safety was not assessed in this analysis but was published previously.1 Results 122 (PBO) and 247 (UPA) patients had histology data available at baseline, of which 115 (PBO) and 231 (UPA) had abnormal histology. A greater proportion (%) of patients receiving UPA vs PBO achieved: histologic remission by CGHAS (wk12: PBO 8.4, UPA45 21.6; wk52: PBO 6.2, UPA15 19.6, UPA30 25.0) and IGHAS (wk12: PBO 10.8, UPA45 18.3; wk52: PBO 0.3, UPA15 9.9, UPA30 11.9; Fig 1), histologic remission by alternative definition (wk12: PBO 9.6, UPA45 21.0; wk52: PBO 1.3, UPA15 15.6, UPA30 16.9; Fig 2A), and endoscopic-histologic remission (wk12: PBO 2.6, UPA45 10.4; wk52: PBO 0, UPA15 13.8, UPA30 15.4; Fig 2B). Conclusion In patients with moderately to severely active CD, UPA demonstrated improved histologic and endoscopic-histologic remission rates at induction (wk 12) and maintenance (wk 52) compared to PBO. Reference: 1. Loftus, E.V. et al.N Engl J Med. Upadacitinib induction and maintenance therapy for Crohn’s disease. 2023; 388;1966-1980 Conflict of interest: Prof. Dr. Magro, Fernando: Has been a speaker and has received honoraria for services from AbbVie, Biogen, Falk, Ferring, Hospira, Laboratorios Vitoria, Merck, and Vifor. Jairath, Vipul: Received consulting/advisory board fees from AbbVie, Alimentiv, Arena, Asahi Kasei Pharma, Asieris, Astra Zeneca, Avoro Capital, Bristol Myers Squibb, Celltrion, Eli Lilly, Endpoint Health, Enthera, Ferring, Flagship Pioneering, Fresenius Kabi, Galapagos, Gilde Healthcare, GlaxoSmithKline, Genentech, Gilead, Innomar, JAMP, Janssen, Merck, Metacrine, Mylan, Pandion, Pendopharm, Pfizer, Protagonist, Prometheus Biosciences, Reistone Biopharma, Roche, Roivant, Sandoz, Scope Eyecare, Second Genome, Sorriso, Takeda, TD Securities, Teva, TopiVert, Ventyx, Vividion received speaker’s fees from AbbVie, Ferring, Bristol Myers Squibb, Galapagos, Janssen, Pfizer, Takeda, and Fresenius Kabi. Peyrin-Biroulet, Laurent: Received consulting fees from AbbVie, Abivax, Adacyte, Alimentiv, Alfasigma, Amgen, Apini, Applied Molecular Transport, Arena, Banook, BMS, Celltrion, Cytoki Pharma, Enthera, Ferring, Fresenius Kabi, Galapagos, Genentech, Gilead, GSK, IAG Image Analysis, Index, Inotrem, Iterative Health, Janssen, Lilly, LifeMine, Medac, Mopac, Morphic, MSD, Nordic Pharma, Novartis, Oncodesign Precision Medicine, ONO Pharma, OSE Immunotherapeutics, Par’ Immune, Pfizer, Prometheus, Roche, Roivant, Samsung, Sandoz, Sanofi, Sorriso, Spyre, Takeda, Teva, ThirtyfiveBio, Tillots, Vectivbio, Vedanta, and Ventyx. He has received lecture fees from AbbVie, Amgen, Arena, Biogen, Celltrion, Ferring, Galapagos, Genentech, Gilead, Iterative Health, Janssen, Lilly, Medac, MSD, Nordic Pharma, Pfizer, Sandoz, Takeda, and Tillots. van Haaren, Stijn: Employee of AbbVie and may own stock options Dubcenco, Elena: Employee of AbbVie and may own stock options Ogholikhan, Sina: Employee of AbbVie and may own stock options. Garrison, Andrew: Employee/contractor of AbbVie and may own AbbVie stock or options. Abraham, Bincy: Consultant for Abbvie, Johnson and Johnson, Pfizer, Takeda, Celltrion, Lilly, Sanofi and on the Speaker’s Bureau for Abbvie, Johnson and Johnson, Pfizer, Takeda, Lilly.

Myoclonus in infancy is often benign; however, persistent or progressive forms may indicate an underlying neurologic disease, including genetic movement disorders such as myoclonus-dystonia syndrome, a rare genetic condition most often associated with pathogenic variants in the Epsilon-Sarcoglycan (SGCE) gene. Early-onset cases are particularly challenging due to overlap with benign, epileptic, and metabolic conditions.We report a six-year-old girl with myoclonus beginning at 12 months of age, involving her head, neck, and arms, and a delayed onset of mild dystonia at five years. Neurological examination, neuroimaging, electroencephalography, and metabolic investigations were unremarkable. Genetic testing identified a heterozygous pathogenic SGCE variant, confirming the diagnosis. Trials with zonisamide, carbamazepine, sodium valproate, and clonazepam were ineffective; however, motor and cognitive development remained within the average range. Behavioral and attentional difficulties emerged later in childhood.This case highlights the diagnostic challenges of early-onset SGCE myoclonus-dystonia presenting as isolated myoclonus. Genetic testing was essential for diagnosis, pharmacologic response was limited, and functional outcome remained favorable. The later emergence of behavioral symptoms underscores the need for long-term multidisciplinary follow-up.

• Families value having a professional who provides continuous and coordinated support, enhancing interprofessional collaboration. • Active listening, mutual respect, and follow-up support are crucial for successful interventions and meaningful family engagement. • Children’s involvement in intervention and progress assessment is encouraged through age-appropriate, play-based approaches. • Families benefit from flexible, collaboratively designed strategies that build skills (e.g., communication, problem-solving) and foster family resilience. This scoping review synthesizes the self-reported needs, preferences, and experiences of multi-challenged families with children regarding psychosocial support interventions. Using the Population–Concept–Context (PCC) framework and Arksey and O’Malley’s methodology, a systematic search was conducted in Scopus, PubMed, ProQuest, and ERIC for peer-reviewed studies from 2013 to 2025. Eligible studies focused on families facing multiple long-term difficulties with children up to 18 years old and explored family perspectives on psychosocial care. The review followed PRISMA-ScR guidelines for transparency and rigor. Ten studies met inclusion criteria. Thematic analysis identified insights across three domains: intervention content, delivery approaches, and intervention context and structure. Key findings highlight the importance of contextual factors, especially home-based care, valued for accessibility, personalization, and support of daily routines. Results emphasize the need for coordinated, flexible, strengths-based support that respects family agency and addresses contextual barriers. Engaging children directly with age-appropriate, playful methods enhances their participation and expression. Training families in assertiveness, communication, and problem-solving emerged as essential for empowerment and intervention success. These findings underscore aligning professional practices with the lived realities and voices of multi-challenged families. Future research should prioritize participatory methodologies involving both families and children in the co-design and evaluation of interventions to enhance relevance, responsiveness, and effectiveness.