Patients undergoing interventional treatment (e.g., TAVR) are predominantly older adults characterized by frailty and multiple comorbidities. While exercise-based cardiac rehabilitation is beneficial, existing guidelines are often generalized, with limited structured protocols specifically tailored to the safety needs and physical limitations of this vulnerable population.

To construct an evidence-based, expert consensus protocol for exercise rehabilitation specifically tailored for older adults after interventional treatment for valvular heart disease.

A systematic literature review and evidence synthesis were conducted, followed by two rounds of modified Delphi consultations with 17 multidisciplinary experts from six provinces in China. Authority coefficients (Cr) were calculated to assess expert validity, and consensus was evaluated using Kendall's W and coefficients of variation.

Expert engagement was high, with response rates of 77.3% and 100% in the two rounds, and high authority (Cr > 0.7). Consensus was achieved across feasibility, appropriateness, and effectiveness (Kendall's W, P < 0.05). The final protocol comprises 8 dimensions and 36 items. Key geriatric-focused features include preoperative frailty and fall risk assessments, staged low-intensity prehabilitation, and culturally adapted home-based exercises (e.g., Tai Chi/Baduanjin) to support safety and adherence. A multi-level safety-oriented framework was developed, incorporating risk stratification, individualized low-intensity exercise prescription, continuous physiological monitoring, and structured follow-up during rehabilitation.

This consensus-based protocol addresses the needs of older valve intervention patients by integrating safety monitoring with individualized, progressive exercise prescriptions. It provides a practical, safety-oriented framework for healthcare professionals to implement early mobilization and home-based rehabilitation, ultimately supporting functional recovery in high-risk elderly patients.

Cognitive decline has been reported after coronary artery revascularization, but whether it reflects procedure-specific effects or the burden of underlying vascular disease remains uncertain.

To determine whether incident dementia risk differs according to coronary revascularization strategy among older adults with acute coronary syndrome (ACS).

We conducted a longitudinal cohort study among adults aged ≥65 years hospitalized for ACS between 2010 and 2020 (n = 25,176). Patients underwent percutaneous coronary intervention (n = 8,043), coronary artery bypass grafting (n = 797), or received no revascularization (n = 16,336). A second comparator cohort included patients with stable coronary artery disease (CAD) without revascularization (n = 154,299). The primary outcome was incident dementia identified using validated International Classification of Diseases codes after a 1-year washout. Propensity-matched analyses used Cox models accounting for the competing risk of death.

Revascularized patients were younger (74.8 ± 6.9 vs 77.1 ± 8.2 years), more often male (66.2% vs 54.0%), and had lower Elixhauser multimorbidity scores (4.6 ± 2.8 vs 5.4 ± 3.0, all P < 0.001). Over a median 4.8 years of follow-up, 9.0% of ACS patients developed dementia. Revascularization was not associated with increased dementia risk compared with ACS without revascularization (sub-hazard ratio: 1.05; 95% CI: 0.95-1.17) or stable CAD. Dementia risk was also similar between percutaneous coronary intervention and coronary artery bypass grafting.

We found that among older adults with ACS, coronary revascularization was not statistically significantly associated with increased dementia risk compared with no revascularization or stable CAD. These findings reflect the hypothesis that the majority of dementia risk is potentially driven more by cumulative vascular and systemic factors than by procedure-specific neurotoxicity.

Frailty is a known predictor of adverse outcomes in aortic valve replacement. However, its impact on the broader population with valvular heart disease (VHD) remains less explored.

This study aimed to evaluate the prevalence of frailty across major VHD subtypes and investigate the association between frailty and adverse clinical events.

A total of 2,147 elderly patients with severe VHD from the China-DVD2 Study underwent the frailty assessment using the Fried, Fried+, Essential Frailty Toolset, and a simplified 4-item score. The primary outcome was a 1-year all-cause death, whereas the secondary outcome was 1-year all-cause death and heart failure hospitalization.

The median age was 72.8 years (43.5% female). Frailty prevalence ranged from 16.8% to 39.3% and prefrailty from 50.9% to 64.5%, depending on the assessment tool. Among the evaluated scales, the simplified frailty score was the most consistent association with adverse outcomes (adjusted HR: 1.50 [95% CI: 1.25-1.81] for all-cause mortality; 1.53 [95% CI: 1.32-1.77] for the composite outcome). These associations were preserved across the exploratory subgroups and specific VHD subtypes. Adding frailty score to the European System for Cardiac Operative Risk Evaluation II improved risk stratification for all-cause mortality (C-statistic: 0.715 vs 0.668; likelihood ratio test P < 0.001) and the composite outcome (0.722 vs 0.688; likelihood ratio test P < 0.001).

Frailty is highly prevalent and independently associated with poor prognosis in severe VHD. The simplified 4-item frailty score offers a practical and incrementally valuable tool for enhancing risk stratification in routine clinical practice.

Opioid diversion-the unauthorized redirection of prescription opioids-is a growing global concern with significant public health implications. While diversion can occur at many points in the supply chain, instances involving healthcare professionals (HCPs) are particularly complex, as they often occur within clinical settings and most often involve self-medication, substance use disorders among healthcare professionals, or peer dynamics. These cases raise not only legal and professional concerns but also profound ethical dilemmas. To date, the ethical perspectives of HCPs in relation to opioid diversion have been underexplored. This multinational qualitative study aims to investigate how HCPs experience and navigate ethical conflicts related to opioid diversion in clinical contexts. The study focuses on the lived experiences and moral reasoning of HCPs who encounter diversion, either among colleagues or in relation to their own practice. It seeks to explore and identify barriers to seeking help and accessing harm reduction, and to understand how these challenges vary across different healthcare systems.

Semi-structured interviews will be conducted with HCPs working in clinical settings where opioids are used. A fictional scenario involving suspected diversion among peers will be used to encourage reflective discussion. This approach is intended to minimize social desirability bias and potential legal concerns in comparison to assessing experienced diversion. The interview guide is structured around the five steps of ethical analysis as outlined by Marckmann, supporting a theory-informed exploration of individual and systemic dilemmas. Data will be analyzed using reflexive thematic analysis (RTA), allowing for nuanced insights into both explicit reasoning and latent moral constructs. Recruitment of HCPs takes place in hospital departments characterized by frequent opioid use. The study protocol is intended for international implementation to support cross-national comparative analysis.

This study will generate a deeper understanding of the ethical tensions HCPs face in the context of opioid diversion. By identifying structural and cultural drivers behind moral distress, the findings may help address stigma and inform the development of ethically guided harm reduction strategies as well as supportive structures for HCPs. The cross-national comparative perspective aims to contribute to an international framework for reducing opioid-related harm in healthcare.

Benzodiazepines (BZDs) are associated with dependence, tolerance, withdrawal, and various adverse effects, and switching to other drug classes is often recommended. Although non-BZD hypnotics are reported in package inserts to have similar but less frequent adverse events, real-world patients often have complex psychiatric and medical backgrounds, and the actual frequency of subjective adverse events may differ substantially from that reported in package inserts. This study aimed to elucidate subjective symptoms potentially related to psychotropic medications using real-world patient data.

This prospective cohort study included patients at the Akebono Clinic who were taking a single hypnotic agent. A total of 314 patients were analyzed. Insomnia severity was assessed using the Athens Insomnia Scale, and 11 self-reported adverse events were evaluated.

The frequency of insomnia was 72% for non-BZDs, 52% for BZDs, and 70% for dual orexin receptor antagonists (DORAs) (significantly lower for BZDs; p = 0.0036). Among the 11 self-reported symptoms, two items (thirst and nightmares) were reported as "always" or "often" by more than 10% of patients; three items (constipation, head heaviness/headache, and abnormal behavior during sleep) by 5%-10%; and four items (lightheadedness, vertigo, abdominal pain, and tremor) by 3%-5%. There were no differences in adverse-event frequencies among non-BZDs, BZDs, and DORAs. Multivariate analyses showed that adverse events were associated with female sex, age < 60 years, and schizophrenia, depression, and anxiety disorders, but not with hypnotic drug classes.

Subjective adverse events in patients taking hypnotics occurred more frequently than those reported in package inserts, indicating a clear discrepancy between controlled trial data and real-world clinical experience. Because adverse events were more strongly associated with patient characteristics-such as psychiatric comorbidities, physical conditions, and concomitant medications-than with hypnotic drug class, routine assessment of subjective symptoms through interviews or questionnaires is essential in clinical practice.

Hospital stays are often associated with emotional strain, influenced by environmental, procedural, and communication factors. While supportive interventions hold promise for improving patient well-being, understanding the lived experiences and needs of patients is essential for designing effective, patient-centered solutions. This study seeks to explore these factors to inform future strategies for enhancing emotional support during hospital stays.

A 2023 cross-sectional survey at the Department of Radiology and Nuclear Medicine at the University Hospital Mannheim was conducted as an exploratory assessment to characterize patient-reported emotional stressors and care experiences during hospitalization. The survey employed a mixed-methods approach. The data was analyzed using descriptive and inferential statistics, with qualitative responses coded for thematic patterns.

The survey revealed that prolonged waiting times (>1 hour, 74% of participants) and communication problems were associated with lower self-reported mental well-being (mean score dropped from 4.45 to 3.57 out of 5, p<0.001). Language barriers and organizational inefficiencies exacerbated distress, while staff empathy and social visits improved well-being. Prior to procedures, the most common stated emotions by participants were apprehension (68% therapeutic procedure and 58% diagnostic procedure) and anxiety (47% therapeutic, 21% diagnostic), with these emotions shifting to confidence (78% therapeutic, 57% diagnostic) and hope (44% therapeutic, 43% diagnostic) post-procedure.

Communication delays and procedural anxiety are important contributors to emotional distress during hospitalization. These findings delineate empirically grounded stress domains that may guide structured investigation of supportive intervention strategies. By integrating such innovations alongside the irreplaceable value of human-centered care, future research can build on these insights to create holistic, patient-tailored solutions. Co-design with patients and clinicians, followed by rigorous validation, will be key to unlocking this potential.

The course of psychotic disorders typically involves relapses. Early warning signs vary between individuals and are difficult to detect in clinical practice, especially in outpatient settings. Speech provides a quantitative clinical marker for detecting such early warning signs. The EU Horizon project TRUSTING (A TRUSTworthy speech-based AI monitoring system for the prediction of relapse in individuals with schizophrenia) aims to develop and evaluate a speech-based monitoring system for predicting imminent psychotic relapses. The study will examine the potential for prospective relapse prediction, and feasibility and usability of the monitoring system.

In this multicentre observational study, n=240 remitted and at-risk-of-relapse adults with psychotic disorders and a comparison group with n=120 healthy participants (matched by age and sex) will be examined at six sites and in six different languages (German, French, Dutch, English, Czech and Turkish). The follow-up period is 6 months. The TRUSTING smartphone app will be used to collect weekly voice recordings through speech tasks; information on medication adherence, substance use, mood, anxiety and sleep quality; and motor data from a tapping task. Primary endpoints encompass model performance for relapse prediction, user adherence, transcription quality, usability of recordings and overall system usability. The primary analysis of user adherence, transcription quality, usability of recordings and overall system usability will be an unadjusted description of the respective proportions using 95% Wilson confidence intervals. Regarding relapse prediction, the predictive value of the risk estimates for relapse occurrence will be assessed using the area under the receiver operating characteristic curve. Exploratory analysis will be performed on potential speech-based markers associated with relapse risk.

This study has been approved by swissethics (Business Administration System for Ethics Committees number: 2025-01177). Findings from this project will be disseminated through peer-reviewed journal publications and presentations at relevant scientific conferences, as well as at public events related to mental health.

ClinicalTrials.gov ID: NCT07397975.

Trans young people face systemic barriers to physical activity participation and experience disproportionately higher rates of physical and mental health challenges compared with their cisgender peers, yet evidence-based exercise interventions tailored to this population remain limited. This study evaluated a 12-week structured, group-based, gender-affirming exercise programme for trans youth aged 12 to 24 years in Western Australia, recruited through a specialist paediatric gender diversity service and community-based health and well-being services. Using a nonrandomised effectiveness-implementation hybrid design, the study assessed both the real-world implementation outcomes and health-related effectiveness of the programme, which was collaboratively designed with trans young people, families, and health professionals and grounded in international physical activity guidelines. Twenty participants enrolled, with 18 completing postprogramme assessments. Quantitative analysis revealed modest improvements in muscular strength, endurance, power, aerobic recovery, and well-being from baseline to 12 weeks, alongside high acceptability, appropriateness, feasibility, fidelity, and retention rates. Qualitative analysis identified themes relating to pathways to participation, connection through shared experience, supportive facilitation, and perceived physical and psychological benefits. This study adds to the limited evidence base by demonstrating that gender-affirming exercise programmes are both feasible and acceptable across clinical and community settings. Findings support the broader integration of exercise into gender-affirming health care, with implications for the design of inclusive health services and physical activity policies that address the specific needs of trans youth.

Schizophrenia is a common and severe mental condition with onset usually in late adolescence and young adulthood. Schizophrenia is caused by a combination of multiple genetic and environmental factors with significant neurodevelopmental implications. Advances in the clinical management of schizophrenia include biological and non-biological treatments. Drug interventions can ameliorate positive symptoms and prevent the progression of disease due to relapses. Non-biological approaches such as psychosocial and cognitive interventions can help functional improvement, relapse prevention, and early stage psychosis management, and new interventions such as neuromodulation and digital health interventions are still under investigation. Despite these advances, novel therapeutic strategies, particularly drugs, are hampered by a biologically heterogeneous population of patients with schizophrenia, a condition defined only by clinical operational criteria. Reconsidering the construct of schizophrenia from the viewpoint of mechanism driven precision medicine will be important, with stratification of patients on the basis of their biological characteristics. The first step towards this goal is to accumulate objective biomarkers for schizophrenia. On the basis of the framework of precision medicine, further advancement in the management of schizophrenia is expected.

Asthma is frequently accompanied by depression, yet whether vitamin D deficiency increases depression risk remains unclear.

To examine the association between serum 25-hydroxyvitamin D (25(OH)D) and depression in adults with asthma, with particular attention to the role of overweight/obesity, and to explore potential mechanisms using genetic and transcriptomic evidence.

Using NHANES 2007-2018 and 2021-2023, logistic regression was applied to assess associations between 25(OH)D strata and depression with stratification by BMI. Two-sample Mendelian randomization (MR) tested causal relationships among 25(OH)D, asthma, depression, and BMI. Transcriptomic differentially expressed genes were integrated with disease-related genes for pathway enrichment.

A total of 4,890 adults with asthma were included. Lower 25(OH)D levels showed a graded association with depression risk. Compared with sufficient 25(OH)D(≥75nmol/L), insufficiency (50-74.9 nmol/L), mild deficiency (25-49.9 nmol/L), and severe deficiency (<25 nmol/L) were associated with approximately 40%, 73%, and 97% higher risks of depression (all P < 0.05). This association was observed only in the overweight/obese subgroup (OR = 1.46, 95% CI: 1.15-1.86),P-interaction=0.285. MR analyses did not support a genetic causal effect of 25(OH)D on asthma or depression, whereas BMI showed positive causal effects on both. Transcriptomic analysis identified 69 core candidate genes. enriched in the Th17/neutrophil axis.

Vitamin D deficiency was associated with higher odds of depression in asthma, reaching significance only in the overweight/obese subgroup, although the interaction was not significant. This association may involve the Th17/neutrophil inflammatory axis rather than direct genetic causality, supporting attention to vitamin D status and mental health in patients with asthma who are overweight/obese.