Late-onset depression (LOD) and subthreshold depressive symptoms (SDS) have been associated with cerebral small vessel disease (SVD), but the evidence regarding pre-stroke depression remains limited. This study examined the frequency of DSM-5 LOD and SDS prior to the first non-embolic lacunar stroke.

Fifty-eight patients (mean age 62.2 ± 8.2 years; 41.4% female) with a first lacunar ischemic stroke underwent MRI (T1, T2, FLAIR sequences) and psychiatric evaluation using the MINI, with data from caregivers and medical records. Patients were classified as having LOD (D), SDS (S), combined (S/D), or none (nD/S). Statistical analyses included Mann-Whitney U and Fisher's Exact tests.

Of the total sample, 63.8% (n = 37) exhibited LOD or SDS, with reported onset on average 5-7 years prior to stroke (mean onset age: 55.5 years). Females exhibited higher prevalence of depressive symptoms (87.5% vs. 47.1%, p = 0.001). Hypertension (75.7%) and dyslipidemia (62.2%) were the most common vascular risk factors. No patient had manic or hypomanic episodes.

Premorbid depressive symptoms were common and may precede the clinical manifestation of cerebrovascular disease. Given the retrospective and observational design, these findings should be regarded as hypothesis-generating rather than causal. Prospective longitudinal studies incorporating quantitative SVD imaging markers are required.

The psychological and social consequences of recurring exposure to Violent Video Games (VVGs) are a concerning issue of global health interest. Prolonged engagement with VVGs can lead to addiction, desensitizing adolescents to real-world violence and impairing their empathy. This desensitization may trigger various forms of aggression and result in emotional blunting.

This study aims to assess the mediation pathways between violent video gaming, desensitization, aggression, and blunted emotional reactions among adolescents using gaming addiction as a moderator.

A descriptive, correlational, multi-group study was conducted among 501 randomly selected adolescents. The moderation and mediation analysis was used to identify the direct and indirect pathways linking the study variables.

Adolescents with problematic videogaming (31.9%, n = 160) reported significantly higher scores in violent gaming, aggression, desensitization, and emotional blunting than non-problematic (p < .001). Adolescents with problematic videogaming, violent gaming directly predicted aggression (β =0.60, p < .001), whereas non-problematic adolescents demonstrated emotion-mediated pathways through desensitization (β = 0.29, p < .001). Despite different mechanisms, both groups exhibited comparable total effects on emotional blunting.

Adolescents with problematic videogaming exhibited higher levels of aggression, desensitization, and emotional blunting compared to non-problematic peers. The moderated mediation analysis revealed that addiction influences the pathways connecting engagement with VVGs to emotional blunting, as problematic gamers showed a direct pathway from VVGs to aggression, whereas non-problematic gamers followed an emotion-mediated pathway to aggression through desensitization.

Pediatric nurses should incorporate screening for gaming behavior into adolescent psychosocial assessments. Adolescents with problematic videogaming require targeted behavioral interventions to manage aggression, while adolescents with non-problematic videogaming benefit from preventive emotional regulation and media literacy programs.

Postpartum depression (PPD) is one of the most common challenges following childbirth. Left unaddressed, PPD can have enduring consequences for both the birthing individual and child. There is a growing emphasis on promoting resilience to mitigate PPD. In addition, cortisol, the body's primary stress hormone, plays a central role in pregnancy, and disruptions in its regulation have been implicated in perinatal mood disturbances. This study investigated whether optimism, a resilience resource, moderates the association between prenatal hair cortisol concentration (HCC) and PPD symptoms.

Participants included 128 individuals, followed from pregnancy to 6 months postpartum. Optimism and HCC were measured during pregnancy, and depression was measured during pregnancy, at 2 weeks postpartum, and 6 months postpartum. The main and interactive effects of HCC and optimism on PPD were assessed using multiple linear regression.

Higher optimism during pregnancy was associated with lower PPD symptoms at both 2 weeks and 6 months postpartum. Higher HCC during pregnancy was associated with lower PPD symptoms only at 2 weeks postpartum. A significant optimism×HCC interaction emerged at 6 months postpartum, indicating that the association between HCC and depressive symptoms differed by optimism level. Among individuals with low optimism, lower HCC was associated with greater depressive symptoms, whereas among those with high optimism, HCC showed little relation to depressive symptoms.

Findings underscore the value of integrating psychological and physiological perspectives on perinatal mental health and suggest that optimism may serve as a protective factor against the long-term impact of physiological stress on PPD.

Pulmonary hypertension (PH) and diabetes frequently coexist, and metabolic dysregulation plays a role in PH pathogenesis. While preclinical studies indicate that certain antidiabetic therapies may beneficially impact the pulmonary vasculature and right heart function in PH, clinical data remain limited. We conducted a retrospective cohort study of veterans with PH and diabetes using Veterans Health Affairs data (2003-2015). The associations between exposure to antidiabetic medications at the time of PH diagnosis and survival were analyzed using Cox proportional hazards regression. We identified 41,670 veterans with PH and diabetes, largely older men (median age 69, 97% male). Average survival from PH diagnosis was 3.5 years. After adjustment for demographics, comorbid conditions, renal function, and hemoglobin A1c, metformin and thiazolidinedione (TZD) exposure were associated with lower mortality (HR 0.828, 95% CI 0.799-0.857 and HR 0.838, 95% CI 0.793-0.885, respectively). Conversely, insulin use was associated with higher mortality. These associations remained consistent across multiple analytical approaches and were independent of baseline hemoglobin A1c levels. Interactions were observed between drug effects and both renal function and PH comorbidities, with metformin's protective effect enhanced in patients with lower eGFR but attenuated in those with lung disease. In conclusion, metformin and TZD use were associated with improved survival in veterans with PH and diabetes, while insulin use was associated with reduced survival. These findings suggest that metabolic modulation may represent a viable therapeutic strategy in PH, though could be context dependent. Prospective trials are needed to evaluate therapeutic approaches targeting the metabolic pathobiology of PH.

The aim of this study was to develop a machine learning-based stratification model to identify high-risk individuals for sarcopenia among patients with chronic lung disease (CLD), thereby facilitating early personalised management of this complication.

We included 1833 complete patient records with CLD diagnoses from the China Health and Retirement Longitudinal Study dataset, comprising 388 sarcopenia cases and 1445 non-sarcopenia controls. 17 variables were collected, including demographic characteristics (age, gender, waist circumference, education level), lifestyle factors and chronic comorbidities. Data were split into training and test sets (7:3 ratio). Variables were screened using Least Absolute Shrinkage and Selection Operator (LASSO) regression, and six machine learning algorithms were employed to construct and validate stratification models, with performance evaluated through multiple metrics. Temporal validation (n=1205) and SHapley Additive exPlanations analysis ensured robustness and interpretability.

All six machine learning algorithms demonstrated excellent performance in both the training and test sets, as evidenced by receiver operating characteristic curve analysis. Among them, eXtreme Gradient Boosting achieved the highest overall performance (area under the curve=0.93). The feature importance analysis identified waist circumference, age and gender as the three most significant predictors of sarcopenia in patients with CLD.

This study developed an interpretable machine learning-based risk stratification model for sarcopenia in patients with CLD. The model may serve as a novel clinical tool to support early personalised interventions and improve patient prognosis.

Preclinical evidence suggests beta blockers may reduce cartilage degradation and delay knee osteoarthritis (OA) progression. While beta blockers are widely used in patients with hypertension, their potential role in preventing total knee arthroplasty (TKA) is unclear. Therefore, we assessed the association between beta blocker use and TKA in knee OA patients with hypertension.

We conducted a nested case-control study using a nationally representative sample of Medicare beneficiaries with newly diagnosed knee OA and prevalent hypertension from 2011 to 2020. Beneficiaries who underwent TKA were defined as cases, while those without TKA were defined as controls. Cases and controls were matched at a 1:4 ratio based on pre-specified criteria using incident density sampling. We measured binary (exposed/unexposed) and cumulative exposure of beta blockers during 6 months before TKA using total standardized daily doses (TSDD) for each patient, categorized as unexposed (0), < 1-200, 201-400, 401-600, 601-900, > 900. Confounding was addressed using propensity score adjustment and stratification for the binary exposure and direct covariate adjustment for cumulative exposure in conditional logistic regression models.

We included 30 338 beneficiaries with TKA and 106 145 matched controls. The mean age (SD) was 74.4 (5.5) years, and 67.1% were women in both groups. There was no significant association between beta blocker use and odds of TKA (adjusted OR [aOR] 1.01; 95% CI, 0.97-1.02) compared with unexposed individuals. Smilarly, no cumulative exposure category was associated with TKA risk (TSDD: < 1-200 [aOR, 1.01; 95% CI,0.97-1.04]; TSDD: 201-400 [aOR 1.00; 95% CI, 0.96-1.05]; TSDD: 401-600 [aOR, 1.02; 95% CI, 0.96-1.08]; TSDD: 601-900 [aOR 0.94; 95% CI, 0.87-1.00]; and, TSDD: > 900 [aOR 0.99; 95% CI, 0.91-1.08]), compared with the unexposed group.

We found no evidence to support that beta blocker exposure reduces the likelihood of TKA.

Long-term outcomes of work rehabilitation for individuals on extended sick leave due to common mental disorders or chronic musculoskeletal pain remain insufficiently studied. This randomized controlled trial evaluated the long-term effects on work disability and cost-effectiveness over eight years, and health outcomes over ten years, comparing (1) unimodal Acceptance and Commitment Therapy (ACT) and (2) multidisciplinary assessment and treatment program including ACT (TEAM) with standard care (Control).

Work disability days were analysed using ordered beta regression, and health outcomes were assessed using mixed models for repeated measures. Results are presented as estimated marginal means.

Both intervention groups demonstrated lower model-predicted median work disability days at all time points compared to Control, but the differences were only statistically significant for the TEAM group at years four, seven, and eight. Both ACT and TEAM interventions showed superior effects on psychiatric symptom reduction relative to Control at one- and two-years follow-up.

The findings highlight the importance of extended follow-up to fully capture the effects of rehabilitation efforts. The results support the consideration of both rehabilitation models for women with prolonged work disability, with the choice between them potentially guided by available resources, individual patient complexity, and a stepwise approach to care.

The study was retrospectively registered at the Clinicaltrials.gov Register Platform on November 15, 2017 (ID NCT03343457).

Evidence-based parenting programmes are widely used to prevent violence against children and improve parenting and mental health. Despite hundreds of randomised trials, little is known about their outcomes when delivered at scale within routine delivery. This study assesses the WHO-endorsed and UNICEF-endorsed Parenting for Lifelong Health programme for caregivers and adolescents, delivered through non-governmental organisation and government in Botswana, the Democratic Republic of the Congo, Eswatini, South Africa, South Sudan, Tanzania, Zambia and Zimbabwe, with support from the President's Emergency Plan for AIDS Relief (PEPFAR), the United States Agency for International Development (USAID) and the European Union.

Pre-post surveys for caregivers and adolescents were integrated into service data collection between 2016 and 2022. Abbreviated standardised measures of physical abuse, emotional abuse, approval of corporal punishment, positive involved parenting, monitoring/supervision, caregiver depressive symptoms, parenting stress and adolescent depressive symptoms and externalising behaviour were used. Individual country scores were analysed separately for caregivers and adolescents using generalised linear mixed-effects models, and cross-country data were combined using a random-effects meta-analytic model.

123 050 participants were included (93% retention, 57 908 adolescents (96% female), 56 423 caregivers at follow-up). In all-country meta-analyses, estimates showed reduced physical abuse (-65%; 95% CI 51% to 74%), emotional abuse (-59%; 95% CI 48% to 68%) and approval of corporal punishment (-55%; 95% CI 48% to 60%). Positive involved parenting increased (+52%; 95% CI 24% to 87%) and poor supervision/monitoring decreased (-48%; 95% CI 34% to 58%). Caregiver depressive symptoms (-25%; 95% CI 8% to 48%), parenting stress (-46%; 95% CI 41% to 52%), adolescent depressive symptoms (-22%; 95% CI 1% to 38%) and adolescent externalising behaviour problems (-43%; 95% CI 29% to 54%) all declined. There was heterogeneity in pre-intervention scores and extent of change between humanitarian and development settings, and between different target groups, but strong consistency across caregiver and adolescent reports.

In eight African countries, including humanitarian and pandemic-affected contexts, an evidence-based parenting programme showed consistent associations with reduced violence against adolescent girls and improved parenting and mental health.

Rapid, sensitive, and low-cost in vitro screening is vital for controlling Helicobacter pylori (H. pylori) infection and guiding eradication, yet remains challenging. Here we report a high sensitivity lateral flow immunoassay (LFIA) based on a multifunctional composite magnetic-fluorescent probe (MTQD-Ab) that enables accurate detection of H. pylori in stool with minimal pretreatment and supports two modes-rapid screening and precise quantification-tailored to different use scenarios. The probe features a core-shell-biorecognition architecture: a 200 nm Fe₃O₄ core for strong magnetic responsiveness, multilayer carboxylated quantum dots (QDs) for intense fluorescence, and specific antibodies on the outermost QD surface for rapid capture of H. pylori, providing dual signal amplification via magnetic enrichment and fluorescence enhancement. By functionally switching the MTQD-Ab nanolabel, the platform provides two modes: in the direct mode, sample dilution achieves a limit of detection (LOD) of 100 cells/mL within 15 min; in the enrichment mode, magnetic concentration of a 1 mL sample lowers the LOD to 10 cells/mL and eliminates potential hook effects, enabling accurate quantitation. Validation with 40 clinical stool samples demonstrated reliable accuracy and near PCR sensitivity while shortening total time from several hours to ~ 30 min and reducing cost, indicating strong potential for clinical application.

Stroke is the second leading cause of death and the third leading cause of disability worldwide, with global economic costs exceeding US $890 billion annually and a projected 50% rise in deaths between 2020 and 2050. So far, stroke has been addressed within the WHO Global NCD Action Plan 2023-2030 and the Intersectoral Global Action Plan on Epilepsy and Other Neurological Disorders 2022-2031, but until now no World Health Assembly resolution had been specifically dedicated to stroke.

To present the first World Health Organization (WHO) Resolution specifically dedicated to stroke (EB158/CONF./9), describe its content and significance, and analyse its implications for global public health.

This paper presents and analyses resolution EB158/CONF./9- "Reducing the burden of stroke: strengthening prevention, acute care, rehabilitation and health-system readiness"; as advanced by the WHO Executive Board at its 158th session on 3 February 2026 and recommended to the Seventy-ninth World Health Assembly for adoption.Key content of the resolution:In February 2026, the 158th session of the WHO Executive Board advanced the first WHO resolution dedicated to stroke, proposed by Egypt and co-sponsored by Chile, Georgia, Palestine, Paraguay and Tunisia, recommending its adoption at the Seventy-ninth World Health Assembly. The resolution frames stroke as a continuum of care and sets out 16 operative actions for Member States (OP1), organized under three categories: (1) primary interventions across the prevention spectrum; (2) acute care and rehabilitation; and (3) surveillance and data; all underpinned by a health‑system strengthening approach. A further eight requests to the Director-General (OP2) provide WHO's mandate to act, covering normative guidance, technical support, monitoring, research, medicines access, regional cooperation, and progress reporting.Public health implication:The resolution establishes a comprehensive stroke action plan across the full continuum of care. Its legacy will depend not on its adoption in Geneva but on whether political commitment is matched by sustained implementation, investment, robust monitoring, and accountability grounded in stroke-specific indicators.