The risk of cognitive decline and dementia following cardiovascular disease (CVD) events is well recognized. However, it remains unclear whether cognitive changes observed after such events reflect a process that begins prior to the event itself. To compare the cognitive trajectories of older adults preceding an incident CVD event with those of a matched control group without an event. Data for this nested case-control study were obtained from a prospective cohort of older, community-dwelling individuals (aged ≥65 years) in Australia and the US with no history of CVD at the time of study enrollment in the Aspirin in Reducing Events in the Elderly (ASPREE) randomized clinical trial and the extension (ASPREE-XT) observational study. The ASPREE trial was conducted between March 2010 and December 2014, with follow-up to June 2017. The ongoing ASPREE-XT trial continued annual follow-up; this study reports data through December 2022. Case patients with an adjudicated CVD event, including fatal coronary heart disease (CHD), nonfatal myocardial infarction (MI), fatal or nonfatal stroke, and hospitalization for heart failure (HHF), were matched by age, sex, and educational attainment to control participants without a CVD event. Data were analyzed from June to December 2024. Cognitive function as assessed by the Modified Mini-Mental State Examination, the Hopkins Verbal Learning Test-Revised, the Symbol Digit Modalities Test, and the Controlled Oral Word Association Test. Linear mixed-effects models were used to estimate the trajectories of cognitive function among case patients with a CVD event and control participants. Over 11 years, 1934 CVD events occurred among 19 114 participants. In this analysis, 1887 of 1934 case patients (97.6%) with adjudicated CVD events were matched to 7548 control participants (N = 9435; overall median age, 75.7 years [IQR, 72.4-80.0 years]; 4970 males [52.7%]). Individuals with incident CVD events had lower cognitive function, starting at between 3 and 8 years before the event, compared with those without CVD. Faster declines in global cognition (β, -0.19 [95% CI, -0.33 to -0.06]), episodic memory (β, -0.04 [-0.11 to -0.03]), processing speed (β, -0.28 [95% CI, -0.48 to -0.07]), and verbal fluency (β, -0.15 [95% CI, -0.27 to -0.04]) in the years prior to the CVD event were also observed compared with control participants. Composite global cognition (β, -0.11 [95% CI, -0.17 to -0.06]) and executive function scores (β, -0.07 [95% CI, -0.11 to -0.03]), but not memory, also declined faster. Similar cognitive trajectories were observed for fatal CHD, stroke, and HHF; however, this pattern was not observed for nonfatal MI, in which case patients and control participants showed comparable trends. In this case-control study of community-dwelling older adults, deterioration in cognitive function was prominent prior to CVD events, suggesting that this decline may be associated with subsequent CVD events. These findings may help inform future research aimed at understanding the association between cognitive change and CVD.

Psychiatric disorders are a major global public health concern, highlighting the urgent need for policies to mitigate their impact, especially for at-risk populations. To investigate the association of the Brazilian conditional cash transfer program (Bolsa Familia Program [BFP]) with psychiatric disorder hospitalizations and availability of community mental health service. This cohort study was conducted during an 8-year period using linked social and health data from the 100 Million Brazilian Cohort. The participants were all individuals who were registered at CadÚnico between January 1, 2008, and December 31, 2015. Statistical analyses were conducted between August 12, 2025, and January 31, 2026. Participation in the BFP. All psychiatric disorder hospitalizations registered on the Hospital Information System according to International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) as psychiatric disorders, except for substance use disorders. A total of 38 572 143 individuals (mean [SD] age, 21.66 [22.06] years; 20 661 009 [54%] female and 17 911 134 [44%] male; 188 033 [0.49%] Asian, 2 238 344 [5.80%] Black, 280 859 [0.73%] Indigenous, 22 123 435 [57.36%] Pardo [includes individuals with Black or mixed ancestry, including European, African, and Indigenous heritage], and 12 749 758 [33.05%] White) were included in the analysis. A total of 56 646 individuals (0.1%) had a psychiatric disorder hospitalization during the study period. Individuals who received a cash transfer from the BFP had a 23% lower risk of psychiatric disorders hospitalization (hazard ratio [HR], 0.77; 95% CI, 0.76-0.79). The association was stronger among Pardo (HR, 0.72; 95% CI, 0.69-0.74) and Black (HR, 0.78; 95% CI, 0.72-0.85) individuals who lived in the poorest municipalities (HR, 0.67; 95% CI, 0.63-0.71) regardless community mental health care. In this cohort study of the 100 Million Brazilian Cohort, a national cash transfer program was associated with lower risk of psychiatric hospitalizations, especially among at-risk populations who experience health inequalities.

Familial hypercholesterolemia is a common genetic disorder associated with premature cardiovascular disease. Genetic cascade screening is recommended but remains underused due to privacy laws that prevent clinicians from directly contacting at-risk relatives. To examine whether implementing a web-based communication platform in a patient-mediated genetic cascade screening program for familial hypercholesterolemia increases uptake compared with usual care. This open-label, multicenter, implementation randomized clinical trial (CATCH) was conducted between November 1, 2020, and October 31, 2023, at 7 cardiovascular prevention or lipid clinics across Switzerland, representing French-, German-, and Italian-speaking regions. Adults aged 16 years or older with genetically confirmed familial hypercholesterolemia and at least 1 eligible first-degree relative living in Switzerland participated. A total of 87 index patients with 359 eligible first-degree relatives were randomized by family cluster (1:1) to the intervention or usual care arm. A secure web-based platform allowing participants to send preprepared electronic messages (email or text) to their relatives, linking them directly to participating centers for genetic testing. The primary outcome was cascade screening uptake, defined as the proportion of eligible first-degree relatives undergoing genetic testing within 6 months. The secondary outcome was new cases identified. Among 221 adults screened across multiple families, 87 (39.4%) had genetically confirmed familia hypercholesterolemia (median [IQR] age, 49.2 [16.4-83.7] years; 46 [52.9%] female; median [IQR] highest low-density lipoprotein cholesterol, 289.58 [139.00-498.07] mg/dL); 43 were randomized to the usual care arm, and 44 were randomized to the intervention arm. Among the 359 eligible relatives (median family size, 4), 99 (27.6%) underwent genetic testing. Uptake was higher in the intervention arm (30.4%; 95% CI, 22.0%-40.4%) than in usual care arm (16.7%; 95% CI, 10.1%-26.3%), yielding an odds ratio of 2.18 (95% CI, 1.06-4.51; P = .03). New case identification was also greater (17.0% vs 8.1%; odds ratio, 2.32; 95% CI, 1.07-5.05; P = .03). Newly identified patients were often untreated or had modifiable risk factors. In this randomized clinical trial of patient-mediated genetic cascade screening supported by a web-based platform, participation in genetic testing and detection of familial hypercholesterolemia was increased compared with usual care. These results suggest that the use of digital communication tools enhanced the reach and effectiveness of genetic screening programs within privacy-regulated health systems. ClinicalTrials.gov Identifier: NCT04419090.

The COVID-19 pandemic and associated lockdowns resulted in changes to the way children learned, developed, and accessed health care. To evaluate changes in rates and rate trends of new neurodevelopmental diagnoses for children in Ontario, Canada, before, during, and after the COVID-19 pandemic. This population-based retrospective cohort study used administrative data from ICES to assess new neurodevelopmental diagnoses from March 14, 2015, to December 31, 2024, among 291 896 children aged 6 years or younger in Ontario. The COVID-19 pandemic period, defined as March 14, 2020, to November 30, 2022, and the postpandemic period, defined as December 1, 2022, to December 31, 2024. Monthly rate of new neurodevelopmental diagnoses per 1000 child-months, defined as the total number of children with a neurodevelopmental diagnosis divided by the total number of child-months. Interrupted time series analysis using data before, during, and after the pandemic was performed to evaluate changes in rate levels or slopes between study periods. A total of 291 896 children received a neurodevelopmental diagnosis during the study period. Of 1 481 844 children at risk, 130 418 received a diagnosis in the prepandemic period (mean [SD] age, 2.5 [1.6] years; 79 573 boys [61.0%]); of 1 115 791 children at risk, 86 383 received a diagnosis during the pandemic period (mean [SD] age, 2.4 [1.6] years; 52 943 boys [61.3%]); and of 1 014 792 children at risk, 75 095 received a diagnosis in the postpandemic period (mean [SD] age, 2.7 [1.6] years; 45 030 boys [60.0%]). In the prepandemic period, rates of neurodevelopmental diagnoses increased monthly (slope = 0.04; 95% CI, 0.03-0.05; P < .001). In the first month of the pandemic, rates of neurodevelopmental diagnoses decreased by 0.91 per 1000 child-months (95% CI, -1.56 to -0.25 per 1000 child-months; P = .01) compared with the expected rate in the absence of the pandemic. Rates recovered and remained stable, with no statistically significant differences in slopes between the prepandemic period and either during or after the pandemic. This population-based cohort study showed no significant differences in rates of new neurodevelopmental diagnoses among children aged 6 years or younger from prepandemic rates in the pandemic and postpandemic periods. The rapid deployment of virtual care may have helped maintain health care access, facilitating diagnoses during the pandemic and postpandemic periods.

Emergency departments (EDs) play a central role in the evaluation and treatment of sexually transmitted infections, particularly for patients with limited access to outpatient care. National guidelines recommend empiric treatment for Neisseria gonorrhea and Chlamydia trachomatis when clinical concern is present or follow-up cannot be ensured. However, there are limited data on how empiric treatment is applied across pregnancy status and patient demographics in the ED setting. To compare empiric treatment rates between pregnant and nonpregnant patients evaluated for N gonorrhea and C trachomatis infection in EDs and to examine demographic differences in empiric treatment within these groups. Repeated cross-sectional study using aggregate encounter-level data from Epic Cosmos, a national deidentified electronic health record database, from January 1, 2016, to December 31, 2024, of ED patients for whom N gonorrhea or C trachomatis testing was performed. Data were analyzed from January 21 to 25, 2026. Pregnancy status at the time of the ED encounter. The primary outcome was empiric treatment, defined as administration of a guideline-recommended antibiotic regimen for N gonorrhea or C trachomatis infection during the same ED encounter as the testing. Associations between patient characteristics and empiric treatment were estimated using unadjusted odds ratios with 95% CIs, calculated from aggregate counts. Among 4 904 343 ED encounters with N gonorrhea or C trachomatis testing, 49 419 of 454 048 pregnant patients (10.9%) and 1 699 393 of 4 450 295 nonpregnant patients (38.2%) received empiric treatment. Pregnant patients had substantially lower odds of empiric treatment than nonpregnant patients (odds ratio, 0.20; 95% CI, 0.20-0.20). For both pregnant and nonpregnant patients, empiric treatment was more common among younger patients, those with noncommercial insurance, and patients whose primary language was English. Differences by race and ethnicity were observed but varied by pregnancy status. These findings suggest that in a national ED sample, empiric treatment for patients tested for N gonorrhea and C trachomatis differed markedly by pregnancy status and across demographic characteristics. These differences may reflect a combination of guideline interpretation, communication, and structural barriers to follow-up rather than uniform clinician bias. Understanding how empiric treatment aligns with population-level risk and access to care may inform more equitable management of sexually transmitted infections in ED settings.