Efficacy of an e-Learning Module on Endocrine Disruptors for Family Medicine Residents: Matched Before-And-After Cohort Study

<strong>Background:</strong> Environmental factors account for 23% of global deaths and 25% of chronic diseases. In France, the Fourth National Environmental Health Plan prioritizes training health professionals in environmental health. Endocrine-disrupting chemicals (EDCs) are chemical substances that interfere with hormonal systems, contributing to a range of health effects. In 2024, the Primary Care and Environmental Health (PCEH) program at the University of Montpellier–Nîmes introduced an innovative e-learning module on EDCs for first-year family medicine residents. <strong>Objective:</strong> This study aimed to evaluate the impact of the PCEH e-learning module on participants’ satisfaction, knowledge, and self-reported behaviors regarding EDCs in household environments. <strong>Methods:</strong> This monocentric, matched before-and-after cohort study included all first-year family medicine residents at the University of Montpellier–Nîmes. The module, developed collaboratively by clinicians and educators, integrated interactive images, artificial intelligence–generated virtual rooms, short educational videos, games, and flash cards. Participants were assessed using pretraining and posttraining questionnaires administered immediately before and after the module. These questionnaires evaluated satisfaction (using a 5-point Likert scale), knowledge (using binary “yes” or “no” questions), and behaviors (using a 5-point Likert scale). Statistical analyses included the McNemar test for paired categorical variables and paired 2-tailed <i>t</i> tests for continuous variables, with a significance threshold set at a <i>P</i> value of less than .05. <strong>Results:</strong> This study aimed to evaluate the impact of an e-learning module on knowledge and behaviors related to endocrine disruptors. Our findings show significant improvements across all measured domains. Of 148 eligible residents, 78 (52.7%) completed both assessments over a 17-day period. Overall satisfaction was high (mean 4.0/5, SD 0.9), with positive ratings for the e-learning format (mean 4.1/5, SD 1.0) and module duration (mean 4.2/5, SD 1.0). Knowledge improved significantly, with a mean 55.56 (SD 13.54) increase in correct identification of EDCs across all substances (<i>P</i>&lt;.001). Self-reported behaviors improved by an average of 2.13 points (95% CI 1.71-2.56) on the 5-point scale (<i>P</i>&lt;.001), exceeding those reported in previous PCEH modules. Secondary outcomes showed high posttraining identification of at-risk populations and exposure locations, although recognition of some substances (eg, alkylphenols and phenoxyethanol) remained low. <strong>Conclusions:</strong> This innovative e-learning module significantly improved residents’ knowledge and preventive behaviors related to EDCs. These findings support the integration of environmental health training into medical curricula and highlight the potential of scalable e-learning interventions to strengthen preventive competencies in primary care.

Experiences of People With Poorly Controlled Type 2 Diabetes Using Telemonitoring: Qualitative Study Embedded in a Feasibility Trial

Background: Telemonitoring has been shown to improve glycemic control in type 2 diabetes, but the optimal design for effectively integrating self-management education remains unclear. Including patient feedback in the design process can enhance usability, increase engagement, and improve the feasibility and effectiveness of the intervention in real-world settings. Objective: This study aims to explore participants’ experiences and the acceptability of 2 different telemonitoring intervention designs and trial procedures used in a feasibility trial among people with non–insulin-dependent type 2 diabetes. Methods: Using a qualitative research design, semistructured interviews were conducted with participants who had completed the telemonitoring intervention. The interviews were analyzed using the thematic approach outlined by Braun and Clarke. Results: A total of 12 participants were interviewed. Four major themes emerged from the analysis: (1) acceptance of and experience with telemonitoring and devices, (2) structure and flow of the intervention, (3) relationship with and support from health care professionals, and (4) learning to live with diabetes. Participants found the devices easy to use, particularly self-monitoring of blood glucose, which was perceived as highly relevant and informative. Technical challenges were primarily related to the activity tracker and initial device setup. The measurement schedule supported self-management, though some participants found it inflexible and difficult to integrate into daily life. Continuous communication with health care professionals was highly valued and fostered trust. Participants reported increased insight into the relationship between lifestyle behaviors and blood glucose levels, which motivated healthier dietary choices and increased physical activity. Participants described that telemonitoring enhanced their understanding of diabetes and supported their engagement in self-management, although preferences for measurement types and frequency varied. Conclusions: Participants reported overall satisfaction, attributing it to structured monitoring and consultations with health care professionals that supported self-management. Blood glucose, physical activity, and diet were considered the most relevant data types. Tailoring the intervention to user priorities and improving the usability of devices and the intervention structure may increase engagement and motivation. Integrating continuous glucose monitoring may further reduce the burden associated with self-monitoring in future telemonitoring interventions for people with type 2 diabetes.
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<![CDATA[Award-winning psychiatrist Steven Moffic, MD, urges psychiatry to elevate social, spiritual, and moral care, tackling burnout, tech, and ecological ethics.]]>

Mechanisms of action and advances in application of music therapy in improving cognitive impairment based on the theory of neuroplasticity

As global population aging accelerates, preventing and treating cognitive impairment has become a major public health priority. Music therapy is a safe, well-tolerated non-pharmacological intervention with substantial potential to improve cognitive function. This review synthesizes the neurologic music therapy (NMT) framework, encompassing techniques targeting attention, memory, and executive function, delivered through both active and receptive approaches. Clinical investigations indicate that music therapy may improve cognition and neuropsychiatric symptoms in Alzheimer’s disease (AD), vascular cognitive impairment (VCI), Parkinson’s disease–related cognitive impairment, mild cognitive impairment (MCI), and traumatic brain injury (TBI); however, effects appear to vary by intervention duration and disease stage. This narrative review aims to provide a theoretical foundation and practical guidance for the non-pharmacological intervention of cognitive impairment by collating evidence on the neuroplasticity theoretical foundations, technical systems, and clinical applications of music therapy.

Microglial regulation of synaptic plasticity in transsynaptic degeneration of glaucoma

Glaucoma is a heterogeneous group of irreversible and blinding optic neuropathies caused by multiple factors. It is clinically characterized by progressive loss of visual field and decline in visual acuity, ultimately culminating in complete blindness. Hallmark pathological features include progressive degeneration of retinal ganglion cells and atrophy of the optic nerve. Importantly, the pathological process of glaucoma extends far beyond the eyeball, involving transsynaptic degeneration across the entire visual pathway. Microglia, as the principal immune regulators of the central nervous system, serve as the earliest sensors and effectors in the pathogenesis of glaucoma. By modulating synaptic plasticity, microglia contribute to synaptic loss and the disruption of neural circuits. They also play essential roles in maintaining neural tissue homeostasis. This review summarizes current evidence and underlying mechanisms of bidirectional transsynaptic degeneration in glaucoma. It highlights that targeting microglial functional homeostasis, particularly their regulation of synaptic plasticity, may be a promising strategy to mitigate glaucoma-associated transsynaptic degeneration and promote central neuroprotection.

Transient multidomain functional improvement in advanced Alzheimer’s disease following high-dose psilocybin-containing mushroom administration: a case report

BackgroundAdvanced Alzheimer’s disease (AD) is generally regarded as a stage of irreversible functional decline. Psilocybin is known to transiently alter large-scale brain network dynamics and to induce plasticity-related mechanisms in preclinical models, yet clinical data in advanced dementia remain lacking.Case presentationWe report the case of an octogenarian Japanese-American woman with a 10-year history of Alzheimer’s disease, including 5 years of marked hypofunction and predominantly monosyllabic speech. Baseline features included chronic urinary incontinence, executive dysfunction, dysphagia, dependent mobility, flat affect, and severe reduction in spontaneous communication. The patient received 5 g of orally administered psilocybin-containing mushrooms (Enigma strain). The acute phase was marked by autonomic activation, clinically suspected hyperthermia, profuse sweating, and a prolonged deep sleep-like state. Approximately 19 h post-administration, spontaneous autobiographical speech emerged. Over subsequent days and weeks, functional improvements included restoration of urinary continence, improved ambulation, autonomous dressing, increased emotional responsiveness, sustained social interaction, contextual memory retrieval, preserved working memory for social context, and spontaneous conversational engagement.ConclusionThis case documents transient multidomain functional improvement in advanced Alzheimer’s disease following psilocybin administration. The findings do not imply disease reversal but suggest that residual functional capacity may persist in late-stage neurodegeneration and may become transiently accessible under specific neuromodulatory conditions.