Older civilian hostages are often framed as vulnerable, yet little age-specific evidence describes how they cope during captivity. This qualitative study examined coping strategies among Israeli older adults abducted by Hamas and interpreted findings through gerontological lenses.

Sesmi-structured interviews were conducted with 13 older adults (mean age = 79.15; 12 women) approximately one year after release. Data were analyzed using a phenomenological approach to capture the lived experience of captivity.

Six themes captured coping as a flexible configuration of practices. Participants described emotion regulation through shutdown, crying, and mental quieting. Agency was preserved through bodily self-care, time structuring, writing, and cognitive tasks. Internal occupation through music, games, and autobiographical imagination supported continuity. When held with others, participants sustained interpersonal bonds through conversation, humor, storytelling, imaginative travel, mutual care, and leadership. Spiritual frameworks supported hope and meaning. Coping was not uniformly adaptive: some responses reflected ambivalent meaning-making and pointed to limits of coping, including reframing deprivation as shared suffering, guilt, perceived abandonment, and eroded trust.

Findings extend the literature by showing that later-life coping under external constraint involves preserving identity, relying on meaningful bonds, and shifting toward internal control. Results highlight vulnerability and strength, suggesting coping is active, socially embedded, and shaped by age-related meanings, while also revealing moral strain and ruptures in trust. Specifically, life stories and internal cognitive resources serve as survival mechanisms, transforming passive endurance into active engagement. These findings emphasize age-sensitive frameworks for understanding trauma and resilience among older populations in extreme situations.

Genetic variants that increase the risk for complex diseases persist in human populations, despite adverse effects on health and longevity. Life-history theory predicts that such alleles can be maintained by trade-offs arising from pleiotropy, yet direct genomic evidence has been limited. We asked whether disease-associated variants persist because they enhance reproduction, despite costs to health and lifespan. By analysing genome-wide data across 62 diseases, longevity and fertility, we show that disease-risk alleles are, on average, associated with reduced longevity and increased fertility. Moreover, the subset of alleles that increase both fertility and disease risk appear to have been favoured by natural selection over the past 50,000 years. Using Mendelian randomization, we detect a causal effect of genetic liability to disease on longevity, but no robust evidence for a causal effect on fertility; importantly, these estimates remain stable after adjusting for socioeconomic factors. At the individual level, we compared offspring numbers between affected and unaffected individuals with high polygenic disease risk. For most diseases, affected individuals had more children than unaffected ones. But for early-onset diseases, the pattern reverses, indicating reproductive costs of early morbidity. Together, these results support antagonistic pleiotropy and help explain the persistence of disease-risk alleles in human populations.

Circadian disruption affects multiple aspects of human health, but the genetic architecture of individual susceptibility remains unclear. We examined the genetics of the Circadian Imbalance Index (CII), an additive 0-5 score combining evening chronotype, short/long sleep, high neuroticism, atypical caffeinated coffee intake, and low vitamin D.

We ran a genome-wide association study (GWAS) of CII in 312,935 European-ancestry UK Biobank participants, compared signals with component-specific and leave-one-component-out (LOCO) GWASs, and tested sex and shift work interactions. CII polygenic score (PRS) PheWAS analyses were evaluated in Mass General Brigham Biobank (N = 50,908) and All of US (N = 98,182), with component-weighted PRS sensitivity analyses. Replication was assessed in Nurses' Health Study II women (N = 11,344). We estimated genetic correlations and performed bidirectional two-sample Mendelian randomisation (MR) with MR-Egger, weighted median and LOCO sensitivity analyses.

We identified 27 loci mapping to 72 genes, including genes with reported links to circadian regulation or circadian-related pathways, such as CALCA, DHCR7, KDM5A, HAL, and CRX. Five genes (EPHB1, SERPING1, C12orf74, PLEKHG7, and EEA1) were observed in the CII analysis but not in component-specific analyses. LOCO analyses indicated that the CII genetic signal was not reducible to any single component. The CII PRS was associated with metabolic and psychiatric phenotypes. CII was genetically correlated with insomnia, mood swings, body mass index, type 2 diabetes, coronary artery disease, and myocardial infarction. MR analyses provided suggestive directional evidence, strongest for reverse associations of mood swings and coronary artery disease with CII.

The CII captures a polygenic composite susceptibility signal associated with cardiometabolic and mood outcomes, with suggestive evidence of directional relationships.

European Research Council Advanced Grant CLOCKrisk (101053225).

Depression is a multifactorial disorder with significant global health impact. Neuroimaging advances have provided insights into neural mechanisms underlying depression, while gut microbiome alterations have been linked to brain structure and function. This review summarizes evidence on the association between gut microbiome variability and brain structural and functional changes in Major Depressive Disorder (MDD) and Bipolar Depression (BD).

A bibliographic search was conducted on PubMed, Scopus and Web of Science for original studies investigating correlations between gut microbiome and brain structure and function.

Three studies investigated probiotic interventions in MDD, showing significant associations with increased gray matter volume (GMV) in the calcarine sulcus, reduced putamen and hippocampal activation, and altered fronto-limbic functional connectivity, especially within the precuneus and superior parietal lobule. Also, observational studies in MDD showed that specific microbial taxa or alpha diversity were positively correlated with limbic and basal ganglia GMV, whereas other taxa negatively correlated with frontal connectivity or GMV in regions involved in memory, somatosensory integration, and emotional regulation. Finally, although no interventional studies were available for BD, the available observational studies in this disorder exhibited gut-brain imbalance associations with immune activation and prefrontal dysfunction, with gut microbes linked to neuroactive metabolites correlated with altered connectivity in thalamus, striatum, and language and limbic regions.

From the available literature emerged that gut microbiome variations seem to be associated with brain structural and functional alterations in both MDD and BD, with preliminary evidence also suggesting significant neurobiological effects of probiotics in MDD. Nonetheless, further studies are needed to confirm the role of gut microbiome modulation as part of personalized approaches.

Sub-Saharan Africa (SSA) has 1.3 billion people, 2.1 billion by 2050; the life expectancy has increased so the burden of non-communicable diseases (NCD) has almost reached that of communicable diseases. In SSA NCD neurological diseases rank at the top: stroke is a leading cause of death, and there are more than 20 million persons with epilepsy (PWE); 75% PWE lack proper treatment. Hospitals are few and under-resourced with a persistent neurologist shortage, hence the majority of neurologic patients seek care at primary care level: improving access to care for neurologic diseases at primary care level is a strategic objective of the WHO-Intersectoral Global Action Plan. HIV, highly prevalent in SSA, increases the burden of neurologic conditions and the United Nations-WHO called to integrate HIV and NCD-neurologic diseases at HIV primary care centres. At this level much of the care to neurologic patients is delivered by non-physician clinicians (NPC) whose education in neurology is insufficient. The Italian Society of Neurology (SIN) established a partnership with the DREAM program, a sub-Saharan Africa primary care program treating chronic diseases as HIV and other diseases since 2002, whose successful intervention model can be applied to epilepsy and other neurologic conditions. So far, the partnership trained more than 430 local healthcare workers, over 2,800 people with epilepsy receive regular care at 14 DREAM centers, more than 4,000 epilepsy teleconsultations have been performed by Italian neurologists along with more than 1,200 electroencephalograms reports thanks to a tele-neurology platform. In addition, SIN started an education course to young Italian neurologists to provide them knowledge and tools on SSA primary care, a step forward to build a globalized neurology.

Stroke is a major public health concern in sub-Saharan Africa, including Ghana. Although its clinical and demographic risk factors are well established globally, nationally representative evidence on stroke prevalence and associated factors in Ghana remains limited. Also, previous research using WHO SAGE Wave 1 data has examined stroke prevalence and associated factors among older adults in Ghana; however, important methodological gaps remain, particularly regarding the explicit consideration of the complex survey design and unobserved cluster-level heterogeneity.

This study examined the prevalence and risk factors of stroke among adults in Ghana.

Data were obtained from the World Health Organization's Study on Global AGEing and Adult Health (WHO SAGE, Wave 1), comprising 5,066 Ghanaian participants, including individuals aged 50 years and older and a comparative group aged 18-49 years. Descriptive statistics and chi-square tests were used to assess variable distributions and bivariate associations with stroke. Given the hierarchical and complex survey structure of the data, with individuals nested within primary sampling units (PSUs), survey multivariable logistic regression was applied to estimate adjusted associations, while Bayesian multilevel logistic regression models were fitted to account for cluster-level random variation and improve estimate stability. Analyses were conducted in R (v4.5.1) using the survey and R-INLA packages, with statistical significance set at p < 0.05.

The two models produced consistent findings, with the Bayesian multilevel model offering the most stable and precise estimates after accounting for cluster-level heterogeneity at the PSU level and the within-cluster dependence among sampled individuals. Cluster-level heterogeneity was negligible (ICC = 0.0001; 95% CrI: 0.0000-0.0005), indicating minimal residual variation in stroke across PSUs. The Bayesian multilevel logistic regression analysis identified several significant predictors of stroke. Individuals who had ever attended school had higher odds of stroke compared to those who had not (aOR = 1.48, 95% CrI: 1.00-2.21). Obesity (aOR = 1.68, 95% CrI: 1.05-2.70), arthritis (aOR = 1.74, 95% CrI: 1.08-2.79), diabetes (aOR = 2.67, 95% CrI: 1.53-4.66), and hypertension (aOR = 3.46, 95% CrI: 2.28-5.23) were all associated with increased odds of stroke. Participants aged 50 years and above also had higher odds compared to younger adults (aOR = 2.76, 95% CrI: 1.18-6.44), whereas engagement in vigorous work-related physical activity was associated with reduced odds of stroke (aOR = 0.60, 95% CrI: 0.38-0.95).

Public health strategies should emphasize physical activity, healthy diets, weight control, and improved management of chronic diseases. These efforts align with the sustainable development goal 3 (SDG 3); Good Health and Well-being, particularly Target 3.4, which aims to reduce premature mortality from non-communicable diseases through prevention and treatment by 2030.

Anaplastic lymphoma kinase (ALK) rearrangements are rare in lung squamous cell carcinoma (LSCC), with the clinical efficacy of ALK tyrosine kinase inhibitors (TKIs) in patients harboring uncommon ALK fusions remaining poorly characterized. We report here the first identification of a novel MTHFD1L-ALK fusion in a 63-year-old male with a heavy smoking history diagnosed with stage IIIC LSCC. The patient initially received induction therapy with the ALK TKI iruplinalkib, achieving a best response of stable disease (SD). Although subsequent chemoradiotherapy yielded a partial response (PR), disease progression occurred after four cycles of maintenance iruplinalkib, with a progression-free survival (PFS) of 8.28 months. Subsequent lorlatinib provided limited benefit, with disease progression at 5.3 months following treatment self-discontinuation. Retrospective immunohistochemical staining of ALK (D5F3) was negative despite the positive genomic finding. This case demonstrates limited clinical benefit from ALK inhibitors in LSCC with this novel fusion, expands the known mutational spectrum in non-small cell lung cancer (NSCLC), and underscores the critical importance of confirming novel fusions at the protein expression level through multimodal testing.

Periprosthetic knee fractures are rare but serious complications of total knee arthroplasty (TKA), the incidence of which is rising due to an aging population and rising TKA rates. They most commonly affect the distal femur, and these fractures are linked to factors such as osteoporosis and falls. Robotic-assisted TKA (RA-TKA) improves surgical precision but introduces risks, such as pin-site complications. This study aims to report the incidence rate of periprosthetic distal femur fractures after RA-TKA. This is a retrospective cohort study, which was conducted at single tertiary center. The study included 429 patients (503 knees) who underwent RA-TKA (2021-2025). Data were collected from electronic health records. Our study included 429 patients who underwent RA-TKA. The majority were aged 56-65 years (n = 216, 42.9%), and most were female (n = 396, 78.7%). The mean BMI of patients was 33.9 ± 5.2. Diabetes mellitus was the most prevalent comorbidity (n = 244, 48.5%) and renal disease was not significantly associated with periprosthetic knee fractures in exploratory analysis (p = 0.064). The incidence of periprosthetic fractures was 1.4% (n = 7), primarily due to mechanical falls (n = 5, 71.4%). This study showed that there is a low incidence of periprosthetic knee fractures following RA-TKA, and these fractures are primarily due to mechanical falls. While renal disease showed a borderline association, the study was underpowered to draw conclusions about risk factors, and negative findings should not be interpreted as evidence of no association. These findings primarily describe the incidence of periprosthetic fractures and support the need for continued postoperative vigilance following RA-TKA.

Elevated serum inflammatory markers are associated with neuropsychiatric symptoms. This process is potentially more intense in individuals with chronic comorbidities such as obesity, systemic arterial hypertension (SAH), and diabetes mellitus (DM). Such conditions already establish a basal inflammatory state, which can be aggravated by acute viral infections, such as COVID-19, worsening neuropsychiatric outcomes. Given this panorama, this cross-sectional study aimed to analyze the association between the presence of pre-existing comorbidities, elevated plasma C-reactive protein (CRP) levels, and symptoms of stress, anxiety, and depression in individuals previously infected by SARS-CoV-2. The research included 350 participants: 114 in the post-COVID-19 group and 236 in the control group. The post-COVID-19 group had a higher prevalence of comorbidities, notably obesity (17.9%; p = 0.044), DM (13.3%; p < 0.01), and SAH (22.1%; p = 0.024). Furthermore, serum CRP levels were significantly higher in the post-COVID-19 group (p = 0.014) and correlated significantly with all comorbidities. The post-COVID-19 group presented higher stress (p = 0.02) and severity of depressive symptoms (p = 0.034). Specifically, the presence of SAH and obesity was associated with a significant increase in stress levels, depression, and anxiety severity (p = 0.027). In conclusion, the results demonstrate that individuals with pre-existing comorbidities, besides being more prevalent in the post-COVID-19 group, exhibit a higher systemic inflammatory state (high CRP), associated with the exacerbation of neuropsychiatric symptoms.

Chronic inflammation plays a central role in the pathogenesis of type 2 diabetes mellitus (T2DM), with emerging evidence highlighting the regulatory role of sialic acid-binding immunoglobulin-like lectins (SIGLECs). The SIGLEC-14 null polymorphism, resulting in reduced pro-inflammatory signalling, may influence susceptibility to T2DM. This study aimed to investigate the association between the SIGLEC-14 deletion polymorphism and the risk of T2DM and its related complications in an Egyptian population.

A case-control study was conducted on 194 participants, including 94 T2DM patients and 100 matched healthy controls. Genotyping of SIGLEC-14, SIGLEC-5, and the SIGLEC-14/5 fusion gene was performed using polymerase chain reaction (PCR). Clinical, biochemical, and demographic parameters were assessed. Associations between genotypes, alleles, and disease risk were evaluated using the chi-square test and odds ratios (ORs) with 95% confidence intervals (CIs).

The WT/WT genotype was significantly more frequent in T2DM patients, whereas the NULL/NULL genotype was less prevalent (P = 0.01). Carriers of the NULL/NULL genotype showed significantly reduced odds of T2DM (OR = 0.105, 95% CI: 0.012-0.864, P = 0.01). The NULL allele was associated with a lower risk of T2DM (OR = 0.40, 95% CI: 0.22-0.71, P = 0.001). Dominant and recessive models confirmed this protective effect (P = 0.008 and P = 0.02, respectively). NULL allele carriers had significantly lower BMI (P = 0.001) and reduced total cholesterol and LDL levels (P ≤ 0.034). No significant association was found between the SIGLEC14 deletion polymorphism and diabetic complications (P > 0.05).

The SIGLEC14 null allele is associated with reduced susceptibility to T2DM, potentially through the modulation of inflammatory pathways, but does not significantly influence disease complications. These findings highlight the role of immune-regulatory genetic variants in T2DM pathogenesis.