Radboud University Medical Center

Background Climate change places increasing pressure on health systems. They must both reduce their negative impact on the environment and strengthen resilience to climate-related risks. Objective To synthesize and map the evidence from systematic reviews on the scope and effectiveness of climate change mitigation and adaptation actions in health systems. Methods An umbrella review of systematic reviews examining health system responses to climate change was conducted. The review followed the Joanna Briggs Institute methodological guidelines and adhered to the PRISMA checklist. The included systematic reviews had to meet two overarching criteria: at least two databases were searched, and a predefined instrument was used to assess the quality or risk of bias of the included studies. Results Forty-six systematic reviews published between 2020 and 2026 were included, covering 1,175 individual studies. Most reviews (41/46) focused exclusively on mitigation strategies, with evidence concentrated around major greenhouse gas emission hotspots: surgical procedures; radiology; pharmaceuticals; solid waste; and transportation of patients and staff. Across these areas, some mitigation strategies were associated with environmental and economic co-benefits, although the underlying evidence was heterogeneous and often of low to moderate quality. In contrast, only a small number of reviews addressed climate adaptation and health system resilience. Conclusions Existing evidence provides practical guidance on effective climate mitigation actions. The limited number of systematic reviews on climate adaptation highlights a gap in the evidence base. Translating mitigation evidence into clinical guidelines and policies and strengthening research on adaptation could support more systematic climate action in health systems.

Creativity is increasingly recognized as a positive aspect among adults with ADHD and those with high ADHD scores, but evidence in youth is limited, particularly regarding product-based creativity. It also remains unclear whether higher creativity benefits the lower well-being typically associated with ADHD traits. This study investigated associations between ADHD traits and product-based creativity in children, as well as longitudinal associations with well-being. Data were sourced from the Twins Early Development Study, a population-based sample of twins. ADHD traits (age 8), product-based creativity (age 9, writing task), and well-being (age 16) of 1,170 children were assessed. Correlation and regression analyses were used to explore the associations of ADHD trait dimensions (inattentiveness and hyperactivity/impulsivity) with writing-based creativity. Moderation analyses were conducted to examine whether this writing-based creativity moderated the association between childhood ADHD traits and later well-being. Additionally, we conducted exploratory analyses on children meeting screening criteria for suspected ADHD. We observed a small negative correlation between inattentiveness and writing-based creativity, which remained significant after controlling for hyperactivity/impulsivity, sex, IQ, reading, and writing. The writing-based creativity did not moderate the negative association between ADHD traits and well-being, nor did we observe differences in well-being between high-creativity and low-creativity groups among children meeting screening criteria for suspected ADHD. Future research utilizing diverse creativity measures beyond writing tasks is warranted to explore the developmental relationship between ADHD traits, creativity, and well-being. Additionally, our results highlight that taking both a creativity-domain-specific and a lifespan perspective is needed when studying and understanding ADHD-related positive aspects.

The expanding therapeutic landscape for inflammatory skin diseases, combined with rising healthcare costs, has increased the need for a comprehensive method to assess and compare treatment performance in daily practice care. In this context, drug survival—the time a patient remains on a given treatment—has gained increasing attention in dermatology because it comprehensively reflects treatment effectiveness, safety, and patient and clinician preferences. However, methodological approaches and reporting practices vary considerably across drug survival studies in dermatology. In this article, we aim to provide an updated and comprehensive guide for clinical researchers on drug survival methodology, offering recommendations for performing, reporting, and interpreting drug survival analyses in a standardized manner, while highlighting best practices within dermatology. We provide guidance on fundamental concepts of drug survival analysis, including Kaplan–Meier curves, reporting standards, censoring, stratification, regression analyses, and sample size calculations. In addition, to further enhance the quality of analyses, we discuss advanced topics such as restricted mean survival time, competing risks, time-dependent effects and covariates, and meta-analyses of drug survival data. Key concepts will be illustrated using a synthetic dataset, comprising patients with psoriasis treated with biologics, complemented by references to published studies that clarify relevant methodological concepts and provide real-world dermatological examples.

The gut–brain axis represents a bidirectional communication system disrupted in obesity. Evidence suggests associations between gut microbiota composition and brain function and eating behaviour, as well as between dysregulated brain networks and dietary choices and metabolic regulation. In this review, we examine how obesity affects both components of this axis and explore physical activity as a modifiable factor related to microbial composition and brain network connectivity. We discuss compositional alterations in the gut microbiota associated with obesity, including reduced microbial diversity and altered short-chain fatty acid production. On the brain side, dysregulation of large-scale functional networks, particularly the salience network, central executive network, and default mode network, is linked to impaired inhibitory control and disinhibited eating patterns. Despite promising evidence connecting physical activity with improvements in both gut microbiota and brain connectivity, observational and interventional studies show inconsistencies regarding temporal dynamics and causal relationships. To examine these questions, we augment our review with longitudinal data from 702 participants assessed across three timepoints using random-intercept cross-lagged panel models, which distinguish stable individual differences from dynamic within-person variation. Our findings indicate temporal associations in which physical activity precedes shifts in connectivity in attention-related networks, which subsequently precede alterations in gut microbiota diversity, consistent with predominantly brain-to-gut temporal patterns with network specificity. Taken together, these results highlight a potential role of physical activity in modulating both brain connectivity and microbial composition, with possible relevance for obesity treatment.

This meta-analysis provided a comprehensive synthesis of research on the relationship between trait self-compassion (SC), operationalised by the Self-Compassion Scale (SCS), and symptoms of psychopathology, including depression, anxiety, PTSD, and eating disorders. Given that SC is a multifaceted construct, we examined it at the overall, dimensional (compassionate and uncompassionate self-responding; CS and UCS), and component levels (mindfulness, self-kindness, common humanity, self-judgement, over-identification and isolation) to identify distinct patterns of association. We analysed 256 studies (1106 effect sizes; N = 107,304) with a three-level approach to meta-analysis with restricted maximum likelihood estimation. Overall SC showed a strong negative association with psychopathology symptoms (r = −0.50). The UCS dimension (r = 0.49) was more strongly linked to psychopathology than the CS dimension (r = −0.31). The UCS dimension showed the strongest association with depression (r = 0.53) and anxiety (r = 0.49), followed by eating disorders (r = 0.44) and PTSD (r = 0.26), while the CS dimension showed its strongest association with depression (r = −0.35). At the component level, self-kindness was consistently linked to lower psychopathology across symptom domains, while mindfulness and common humanity had the strongest associations with lower PTSD symptoms. Over-identification and isolation showed stronger links to symptoms in non-clinical and medically vulnerable groups (all p < 0.05). Additionally, age, gender, ethnicity, and publication year did not significantly moderate these associations (all p > 0.05). Our findings demonstrated the transdiagnostic relevance of SC and emphasise the need to treat it as a multifaceted construct when examining its relationship with psychopathology. This study is not preregistered.