The vaccination against COVID-19 is being carried out, and observing the aging process and changes in the face of the pandemic in the older adults, studies are needed to better understand these changes. The purpose of this study was to compare immune response, inflammation, physical-functional performance, and gait at one and nine months after the fourth dose of the COVID-19 vaccine between physically active and insufficiently active older adults. Prospective cohort study. Thirty older adults were evaluated and divided into two groups: the Experimental Group ‒ physically active (EG, n = 15) and the Control Group ‒ insufficiently active (CG, n = 15). Assessments were baseline, one and nine months, post-vaccination and regular exercise practice. Immunological and inflammatory markers and physical-functional variables: questionnaires (FRAQ, Baecke), physical tests (Step Test, Floor Transfer Test, Timed Up and Go, six-minute walk test, hand grip strength), and gait analysis using a pressure platform. The EG showed increased IgA and decreased IgG levels over time. Regarding inflammation, EG demonstrated modulation of the inflammatory response, characterized by increased IL-10 levels, significant changes in IL-12p70 and IP-10 concentrations, and improved pro-/anti-inflammatory cytokine ratios (e.g., IL-6/IL-10), indicating a more regulated immune profile. Additionally, EG improved physical performance in the Step Test, Floor Transfer Test, and six-minute walking test, along with reduced plantar load in the midfoot and rearfoot regions. In contrast, the CG showed reductions in IL-10 and IP-10 levels over time, without consistent improvement in inflammatory modulation or physical-functional performance. In inter-group comparisons at nine months, EG exhibited higher IL-10 levels and a more favorable pro-/anti-inflammatory balance compared with CG, suggesting a controlled and effective immune activation following vaccination. The practice of regular physical exercise was associated with more favorable immune, inflammatory, physical-functional, and gait outcomes at one and nine months after the fourth dose of the COVID-19 vaccine in physically active older adults compared with insufficiently active peers. These findings suggest that long-term regular physical exercise was associated with modulation of the immune-inflammatory profile, marked by a balanced increase in both Th1-associated cytokines (IL-12p70, IP-10) and the regulatory cytokine IL-10 and increased IgA levels and a reduction in IgG over time, suggesting a controlled and effective immune activation following vaccination against COVID-19 and regular exercise practice compared with CG (insufficiently active) and better physical-functional performance with reduction plantar overloading during gait.
Individuals with chronic pain have increased risk of suicide, however, few receive suicide prevention interventions. Problem-solving therapy is an evidence-based treatment for chronic pain that seeks to improve problem-solving ability, an executive function associated with suicide risk and related outcomes. The goal of this pilot randomized controlled trial was to estimate if problem-solving therapy improves problem-solving ability and other outcomes for Veterans with chronic pain and moderate suicide risk (n = 44). Veterans were randomized to receive 12-weeks of video delivered problem-solving therapy or supportive psychotherapy. At post-treatment, problem-solving therapy was estimated to result in a greater increase in problem-solving ability (Cohen's d = 0.33, small effect) and a greater reduction in perceived burdensomeness (Cohen's d = 0.60, large effect), compared to supportive psychotherapy. These between-group differences were estimated to be maintained for problem-solving ability (Cohen's d = 0.94, large effect) and perceived burdensomeness (Cohen's d = 0.45, medium effect) at 6-month follow-up. It was estimated that problem-solving therapy did not have a differential effect on thwarted belongingness compared to supportive psychotherapy. In exploratory analysis, problem-solving therapy was estimated to reduce suicide ideation intensity, suicide ideation frequency, and suicide coping at post-treatment, however, in between-group analysis, only suicide ideation frequency was estimated to be reduced as compared to supportive psychotherapy. Results for the exploratory pain outcomes were mixed. This study suggests problem-solving therapy may improve problem-solving ability and reduce feelings of perceived burdensomeness. A fully powered clinical trial is needed to confirm these results and to determine if problem-solving therapy reduces suicide risk and improves pain outcomes.
Inclusive adapted physical activity and parasport programs support physical and psychosocial well-being of children experiencing disability. Easter Seals offers opportunities for children of all abilities to engage in physical activity through introductory parasports. Our evaluation aimed to understand caregiver's perspectives on quality participation in Easter Seals programs. We collected quantitative and qualitative data through surveys followed by semi-structured interviews to further explore survey data findings. Survey data were analyzed using descriptive statistics and interviews using reflexive thematic analysis. Surveys highlighted caregiver-perceived participant satisfaction and a caregiver-perceived positive impact of programs on participants' physical and psychosocial well-being. Five themes were generated: (1) caregiver support and dedication, (2) meaningful participation, (3) mastery of skills, (4) thriving alongside peers, and (5) hopes for the future. Findings illustrate the importance of thoughtfully designed programs, focused on quality participation, for children experiencing disability and their families.
The study was conducted to evaluate the effects of Ayres sensory integration therapy versus conservative treatment in autism spectrum disorder. In a prospective randomised controlled trial, we assessed pre- and post-intervention scores of both the intervention group (A) that took ASI and the control group (B) that received conservative treatment-only behaviour therapy, speech therapy, and educational activities of children with Autism Spectrum Disorder (ASD) -using sensory profile from Jan 2024 to July 2024. Thirty diagnosed ASD cases, age range 2-8 years, were randomly enrolled in both groups (n=15/group) at the RICCER Institute of Faisalabad. The intervention group (A) was noted to be significantly better in mean change as compared with the control group (B). Independent and paired t-test results showed significant relationship between ASI intervention group (A) and sensory integration dysfunction, while non-significant relationship between sensory integration dysfunction and conservative group (B) treatment (p> 0.05). Ayres Sensory Integration, an Occupational Therapy Approach, was significantly effective in developing socialisation, self-care, and aim accomplishment in comparison to conservative treatment in ASD.
Obesity is a multifactorial endocrine disease. Novel hormone receptor modulators are now available for its treatment. This does not mean, however, that obesity can be managed or cured by pharmacotherapy alone. Multidimensional support and scaffolding are required to attain and sustain optimal outcomes with drug therapy. In this communication, we provide a systematic coverage of the various aspects of support that are needed. We term them metapharmacologic, as they extend beyond the realm of conventional pharmacology. These include biomedical (medical, endocrine, pharmacotherapeutic), lifestyle (nutrition, physical activity), and psychosocial (psychological, social, systemic) optimization.
This observational follow-up study investigated whether early parent-administered physiotherapy during the neonatal period was associated with motor outcomes in childhood, and compared these outcomes between two preterm groups and a term-born control group. This is a follow-up of a pragmatic randomised controlled trial that initially included 153 infants born very preterm (≤32 weeks' gestation), randomised to either early parent-administered physiotherapy or standard care, between 34 and 37 weeks' gestation. At 7-10 years, motor outcomes were assessed in 92 children (intervention, n = 43; standard care, n = 49) and in 83 term-born controls. The primary outcome was the Movement Assessment Battery for Children-Second Edition (MABC-2). Group differences were analysed using linear mixed models adjusted for age, sex, and parental education. Odds ratios (ORs) were calculated for scores ≤5th and ≤ 15th percentiles to estimate the likelihood of having or being at risk for movement difficulties. Mean MABC-2 total score was 9.0 (SD3.0) in the intervention group, 9.6 (SD3.0) in the standard care group, and 10.8 (SD2.9) in the control group. Adjusted mean difference between the intervention and the standard care groups did not differ but both the intervention and standard care groups had lower scores than the control group (-1.2; 95% CI: -2.3 to -0.2 and -0.6; 95% CI: -1.6 to 0.3, respectively). Adjusted ORs for scoring ≤5th or ≤15th percentile did not differ in either preterm group compared with the control group. At 7-10 years, motor outcomes did not differ between children born very preterm who received three-week parent-administered physiotherapy and those who received standard care during the neonatal period. However, both preterm groups had lower motor scores than term-born peers.
A man in his 60s presented with acute hypoxaemic respiratory failure secondary to post-COVID-19 fibrotic pneumonia, requiring 3 L/min oxygen therapy (peripheral oxygen saturation (SpO2) 75%), peripheral cyanosis, modified Borg Dyspnoea Scale score 4 and exertional desaturation. An 8-week physiotherapy protocol progressed from diaphragmatic breathing/gravity-assisted postures (days 1-3) through segmental percussion/proprioceptive neuromuscular facilitation (day 4 to week 2), short-lever/long-lever upper limb exercises (weeks 3-4), to trunk mobility/ambulation (weeks 5-8). Outcomes included oxygen weaning to 0.5 L/min, SpO2 94% on room air, Borg score 1 and 50 m unsupported ambulation. The interventions enhanced secretion clearance, alveolar recruitment and ventilation-perfusion matching via titration matched to clinical stability (SpO2 ≥90% phase thresholds). This demonstrates the role of structured physiotherapy in resource-limited settings for post-COVID-19 recovery.
Radiometal-based radiopharmaceuticals have become central to the advancement of molecular imaging and targeted radionuclide therapy, offering powerful tools for the diagnosis and treatment of diseases affecting the brain. The unique chemical versatility of radiometals - encompassing a broad range of coordination chemistries, physical half-lives, and emission properties - combined with an expanding repertoire of targeting biomolecules enables highly tunable and increasingly modular imaging and therapeutic platforms. In particular, positron emission tomography (PET) using radiometal-labelled tracers provides sensitive, quantitative, and non-invasive assessment of molecular processes in vivo, while radiometal-based therapeutic agents enable the selective delivery of cytotoxic radiation to diseased tissue. This review examines recent progress in the application of radiometal-based radiopharmaceuticals for brain disorders, with a focus on neuro-oncology - including primary brain tumours and brain metastases - as well as neurodegenerative diseases such as Alzheimer's disease and Parkinsons disease. Key challenges unique to brain applications are discussed, including the restrictive nature of the blood-brain barrier, heterogeneous target expression, and off-target biodistribution. Recent advances in chelator development, emerging antigen targets, alternative routes of administration, and strategies to improve brain delivery are highlighted. While imaging agents continue to lead therapeutic development in this space, reflecting the need for accurate disease characterisation, recent progress underscores the potential of radiometal-based therapies for brain disease. In particular, immunoPET has emerged as a powerful tool for evaluating target expression, biodistribution, and treatment response. Collectively, these developments position radiometal-based radiopharmaceuticals as a promising and evolving platform enabling personalised treatment strategies for neurological disorders.
Plantar fasciitis (PF) is a common cause of plantar heel pain leading to functional limitation and reduced quality of life. While extracorporeal shock wave therapy (ESWT) is a well-established treatment option, the additional benefit of kinesio taping (KT) as an adjunct modality remains unclear. This study aimed to evaluate the short-term effects of combining KT with ESWT on pain and foot function in patients with PF.  Methods: This retrospective comparative study included 116 patients (54 in the KT+ESWT group and 62 in the ESWT-only group) with clinically diagnosed unilateral PF persisting for at least 3 months. Pain and functional status were assessed using the Visual Analog Scale (VAS), Roles and Maudsley Score (RMS), and Foot Function Index (FFI) subscales (pain, disability, and activity restriction) before and after a 3-week treatment period. Between-group differences were evaluated using analysis of covariance (ANCOVA) adjusted for baseline scores and demographic variables. Effect sizes were reported using partial eta-squared (η2) and post-hoc power analysis confirmed adequate study power.  Results: Both treatment groups demonstrated significant improvements from baseline to post-treatment in VAS, RMS, and FFI subscales (all P < .001). After adjustment for baseline scores, the KT+ESWT group showed significantly greater improvement than the ESWT group across all outcome measures (adjusted P < .001 for VAS, RMS, FFI-Pain, FFI-Disability, and FFI-Activity restriction). The observed effect sizes were large (η2 = 0.165-0.280), and the reduction in VAS pain exceeded the minimally clinically important difference, indicating clinically meaningful improvement.  Conclusion: The combined application of KT with ESWT resulted in superior short-term improvements in pain and foot function compared with ESWT alone in patients with PF. The complementary effects of KT in reducing plantar fascia load and enhancing proprioceptive control may augment ESWT's established regenerative and analgesic benefits. Given its simplicity, low cost, and accessibility, KT may be considered a practical adjunct to ESWT in clinical rehabilitation settings. However, as the follow-up period was limited to 3 weeks, the long-term durability of treatment effects remains uncertain. Future randomized controlled trials with extended follow-up are needed to validate these findings.    Cite this article as: Çelik G, Sarı MH, Doğan ŞK, Bal A. Short-term effects of combined kinesio taping and extracorporeal shock wave therapy in patients with plantar fasciitis. Acta Orthop Traumatol Turc. 2026; 60(2), 0640, doi: 10.5152/j.aott.2026.25640.
Neuropathic pain (NP) is a complex chronic pain condition arising from a lesion or disease of the somatosensory nervous system, presenting significant clinical challenges with limited therapeutic efficacy from conventional pharmacological interventions. Massage, as a specific form of manual therapy, is a pivotal therapeutic modality in traditional Chinese medicine (TCM) and has been increasingly adopted for the management of NP due to its noninvasive nature and favorable safety profile. Recent advances in clinical and basic research indicate that massage not only effectively mitigates pain symptoms and ameliorates functional impairment and emotional disturbances but also exerts analgesic effects by modulating inflammatory responses, regulating ion channel function, controlling synaptic plasticity at the spinal level, and inducing brain functional remodeling. This review synthesizes and critically evaluates current evidence regarding the application of massage for NP, integrating findings from both animal studies and clinical trials. It systematically analyzes potential molecular and cellular mechanisms, including the HMGB1/NF-κB pathway, mechanosensitive Piezo channels, the astrocytic NDRG2/GLT-1 pathway, and the default mode network (DMN). By critically synthesizing the underlying mechanisms of massage, this review aims to provide a theoretical basis for clinical promotion and mechanistic research, thereby advancing the development of comprehensive, potentially disease-modifying therapeutic strategies for NP.
Persistent mobility limitations after inpatient rehabilitation are common in older adults with cognitive impairment (CI). Home-based exercise interventions can improve locomotor capacity during this vulnerable period; however, evidence that they improve real-world mobility is scarce. To investigate the effects of a home-based exercise programme combined with physical activity (PA) promotion on real-world digital mobility outcomes (DMOs). Single-centre, double-blind, randomised, placebo-controlled trial. Community. 104 community-dwelling older adults with CI (82.3 ± 6.0 years; 75% women; Mini-Mental State Examination score 23.2 ± 2.4) recently discharged from inpatient geriatric rehabilitation. The intervention group received a 12-week home-based exercise programme combined with behavioural change techniques to promote PA; the control group received a 12-week non-specific home-based placebo motor activity programme. DMOs related to walking amount, pattern and pace were measured over 48 h at baseline, post-intervention and after a 12-week follow-up using a single body-fixed sensor and validated processing algorithms. Post-intervention, small statistically significant improvements favouring the intervention group were observed in walking pattern and pace outcomes, including longer walking bout (WB) duration, higher walking speed and longer stride length in shorter (10-30 s) WBs, and higher 90th percentile walking speed in WBs >10 s. These improvements were not sustained at the 12-week follow-up. No between-group differences were found for walking amount. The post-discharge home-based exercise programme combined with PA promotion showed small, short-term improvements in selected real-world walking pattern and pace outcomes in older adults with CI after inpatient rehabilitation; however, these effects were no longer evident at follow-up, and walking amount did not increase.
Tuberculosis (TB) remains a critical global health concern, with India contributing nearly one-fourth of the total global burden. Although significant progress has been made in diagnostic innovations and therapeutic strategies, the rising incidence of multidrug-resistant TB (MDR-TB), coupled with treatment-associated adverse effects, continues to hinder effective disease management. These challenges not only complicate therapeutic outcomes but also pose a substantial threat to global TB elimination efforts. These factors substantially impair health-related quality of life (HRQoL), affecting physical, psychological, social, and environmental domains. Yet, evidence from Indian tertiary care settings using standardized QoL tools remains limited. A holistic assessment that combines clinical, radiological, and microbiological findings with psychological and QoL measures is essential for capturing the full impact of TB on patients' lives. This study was designed to comprehensively evaluate the QoL among patients with TB by employing the WHOQOL-BREF instrument within a tertiary care hospital setting. Furthermore, it aimed to investigate the influence of key determinants, including sociodemographic characteristics, treatment regimens, therapy-induced adverse events, and drug resistance patterns on QoL across the physical, psychological, social, and environmental domains. A six-month observational study was performed at a tertiary care hospital, enrolling 220 TB patients aged 20 years and above. QoL was assessed using the WHOQOL-BREF questionnaire, which evaluates four domains: physical, psychological, social, and environmental. Data were collected and analyzed using SPSS version 26, applying descriptive statistical methods to summarize the findings. The Physical Health domain demonstrated the greatest impairment (mean score: 36.35 ± 5.34), followed by the Psychological (44.49 ± 9.30), Environmental (48.17 ± 9.59), and Social (52.95 ± 19.61) domains. QoL varied significantly across sociodemographic and clinical factors, including education, occupation, and income. While adverse drug reactions (ADRs) were commonly reported, they did not show a significant association with diminished QoL (p > 0.05). Conversely, patients with drug-resistant TB demonstrated markedly lower scores in the environmental domain (p = 0.024) as well as overall QoL (p = 0.001) when compared to individuals with drug-sensitive TB. TB profoundly affects patients' QoL, with the greatest burden observed in the physical and psychological domains. Lower socioeconomic status, limited education, and drug-resistant TB are key determinants of poorer QoL. Incorporating patient-centred care with integrated psychological support alongside routine clinical management may improve overall treatment outcomes and well-being.
To evaluate the feasibility, safety, and quality of life (QoL) in patients with advanced epithelial ovarian cancer (EOC) undergoing laparoscopic hyperthermic intraperitoneal chemotherapy (HIPEC) as consolidation therapy following standard primary management. Patients with stage III-IVA EOC without clinical evidence of disease (physical exam, imaging, and CA125) and within 12 weeks of completing primary chemotherapy and surgery were enrolled. Patients underwent a second look laparoscopy (SLL) with HIPEC administration (carboplatin 800 mg/m2 for 90 min). Patients were followed for 6 months postoperatively and assessed for adverse events (AEs) and QoL scores using FACT-O questionnaires. Ten consecutive patients were enrolled and completed SLL with carboplatin HIPEC (feasibility =100%). All patients experienced at least one grade 1 or 2 AE with most (91%) attributed to study treatment. Five patients (50%) experienced a grade 3 or 4 AE limited to myelosuppression (leukopenia, thrombocytopenia, and anemia). All AEs resolved within 6 weeks of the study intervention, and there were no study related deaths. Perioperative outcomes were favorable with no conversions to laparotomy, no blood transfusions, and no ICU admissions. QoL scores also improved from baseline (123) when assessed at the 3 (137)- and 6-month (137) postoperative time points. Our study showed consolidation laparoscopic HIPEC to be feasible, safe, and well tolerated in this patient population. The most common AEs were related to chemotherapy. In our study, laparoscopic HIPEC did not adversely affect patient-reported QoL scores. This investigational approach may represent another way to offer patients HIPEC during upfront treatment of advanced EOC.
Methicillin-resistant Staphylococcus aureus (MRSA), a leading cause of chronic and post-surgical wound infections, is a hard-to-treat pathogen. In this study, we isolated and characterized a lytic MRSA bacteriophage, vB_SauM-MUHD-1, and evaluated its therapeutic potential in a murine wound infection model. Among 107 clinical wound samples, MRSA was reported in 48.6% of cases. Phage vB_SauM-MUHD-1, isolated from sewage, demonstrated lytic activity against 70.6% of the tested MRSA isolates. The phage exhibited efficient replication kinetics and remained stable under physiologically relevant conditions. Whole-genome sequencing identified a ~ 134 kb dsDNA genome (~ 30.45% GC) lacking detectable lysogeny-associated, virulence, or antimicrobial-resistance genes. In a BALB/c excisional wound model infected with MRSA, topical phage treatment significantly reduced bacterial burden, accelerated wound closure, and improved clinical severity scores compared to untreated controls, performing comparably to phage-linezolid combination therapy and outperforming linezolid monotherapy in bacterial clearance. These findings support that our phage vB_SauM-MUHD-1 has potential for treating MRSA-infected wounds and should be further investigated for efficacy in more challenging chronic or biofilm-rich wound environments. KEY POINTS: • This study provides a newly kayvirus, strictly lytic anti-MRSA phage vB_SauM-MUHD-1. • Phage exhibited favorable replication kinetics, physical stability and genomic safety. • Topical phage therapy reduced bacterial burden and accelerated wound healing.
Prostate cancer (CaP) is a leading malignancy in men, frequently diagnosed at advanced stages where androgen deprivation therapy remains the standard treatment. Surgical castration, either subcapsular or total orchiectomy, offers a definitive and cost-effective approach to androgen deprivation therapy. This study systematically compares clinical and patient-reported outcomes between subcapsular and total orchiectomy in patients with advanced CaP. A systematic search was conducted in PubMed, Scopus, and Cochrane Library through July 2025. Eligible studies included men with advanced CaP undergoing subcapsular or total orchiectomy. Risk of bias was assessed using RoB 2 for randomized trials and Newcastle-Ottawa Scale for nonrandomized studies. Data were analyzed using RevMan, and certainty of evidence was evaluated using GRADE approach. Twelve studies involving 759 patients were included. Subcapsular orchiectomy was associated with significantly higher postoperative testosterone levels (mean difference = 4.03, 95% confidence intervals 2.78-5.28), higher prostate-specific antigen (PSA) levels (mean difference = 0.94; 95% CI 0.54-1.33), and greater treatment satisfaction (odds ratios = 3.78; 95% confidence intervals 1.98-7.19) compared to total orchiectomy. No significant differences were found in overall functional assessment of cancer therapy-prostate scores, including physical, social, emotional, and functional well-being domains, prostate cancer subscale, operative time, and luteinizing hormone levels. Subcapsular orchiectomy may provide less effective hormonal and PSA suppression but greater treatment satisfaction, with comparable quality of life outcomes and operative time compared with total orchiectomy, suggesting a trade-off between biochemical suppression and patient-centered benefits.
Police force recruits have a high musculoskeletal injury burden, which results in a substantial economic burden and can lead to attrition. The objective of this study was to identify and prioritise the strategies perceived as important and feasible to reduce the prevalence, incidence, and burden of injury in police force recruits. Mixed-methods concept mapping study. Forty-eight participants were recruited from four broad groups: police force recruits/officers; police force staff; health professionals; and research experts. Participants brainstormed statements in response to a prompt ("To prevent injury and/or reduce the impact of injury on law enforcement recruit training, I think it's important to….") before sorting and rating the statements/strategies for importance and feasibility. Descriptive statistics, multi-dimensional scaling, hierarchical cluster analysis, pattern matching and Welch's t-tests were applied. Ninety-six unique prevention strategies were identified (42 were above the grand mean for both importance and feasibility). Eight clusters appropriately represented all statements. From highest to lowest mean cluster importance these were: i) clearly communicate physical training program expectations and requirements; ii) prepare for, monitor and manage physical training load; iii) provide best practice injury identification, prevention and management; iv) educate recruits, staff and other stakeholders involved in academy training delivery; v) provide a supportive training environment that promotes health, wellbeing and injury reporting; vi) have experienced staff deliver training and use appropriate equipment; vii) deliver a comprehensive and holistic physical training program; and viii) have appropriate physical entry standards and requirements. We identified 42 strategies above the grand means for both importance and feasibility to reduce the burden of injury in police force recruits. These strategies can be implemented by recruits, staff delivering the training program, and/ or staff managing or governing the training program. Future research should refine how these strategies can be implemented in practice and policy.
Depression, reduced leisure satisfaction, and impaired autonomic regulation are common among older adults living in nursing homes. Non-pharmacological interventions such as yoga are increasingly recognized for their potential to improve both mental and physical health. This study aimed to investigate the effects of recreational therapy-based yoga on depression, leisure time satisfaction, and heart rate variability (HRV) in individuals aged ≥ 65 years residing in a nursing home. A randomized controlled experimental design was used. The study included 36 participants (18 in the experimental group and 18 in the control group) aged ≥ 65 years. The experimental group participated in yoga sessions for 45-60 min, twice weekly for 10 weeks, while the control group received no intervention. Data were collected using a Personal Information Form, Geriatric Depression Scale-15, Leisure Time Satisfaction Scale, and the Polar H10 heart rate monitor to assess HRV parameters. Based on the results of normality and homogeneity tests, appropriate parametric (dependent and independent samples t-tests) and non-parametric tests (Wilcoxon signed-rank and Mann-Whitney U tests) were applied. Post-test results showed a significant decrease in depression levels, a notable improvement in leisure time satisfaction, and positive changes in HRV parameters in the experimental group compared to the control group. These findings suggest enhanced parasympathetic activity and emotional well-being in participants who engaged in yoga. Recreational therapy-based yoga may be an effective intervention for improving mental health, leisure satisfaction, and autonomic function among older adults in institutional settings. This low-cost, accessible approach holds promise as a complementary therapy for enhancing the quality of life in elderly populations.
This study investigates the degree of the perceived risk of intravenous thrombolysis in acute cerebral infarction among surrogate decision-makers and the factors influencing their propensity to make decisions about thrombolysis. An investigation was conducted on a cross-sectional basis. We recruited participants using a purposive sampling technique. All participants were recruited from the Advanced Stroke Centre in a tertiary care general hospital from January 2022 to December 2022. A total of 201 Surrogate Decision-Makers completed the survey. Using a self-designed questionnaire, the instrument of this survey contains three aspects of general information including risk perception level survey, propensity for thrombolysis, and consisting of 18 questions. Risk perception consists of three dimensions: economic risk perception, psychosocial risk perception, and physical functioning risk perception, and each dimension is scored in the range of 3-15 points. Higher scores indicate stronger risk perception. The mean risk perception score of acute ischemic stroke surrogate decision-makers was (11.26 ± 2.72). The average score of psychosocial risk perception was (10.71 ± 2.34); the score of physical function risk perception was (11.00 ± 2.37). The highest proportion of those choosing conservative treatment was 46.8%. The percentage of those willing to thrombolize was 27.4%, and those who were unsure about it was 25.9%. The degree of perceived economic risk, perceived psychosocial risk, and perceived physical function risk all had a significant negative effect on the propensity to make decisions about thrombolysis after excluding the confounding interference of different ages, education levels, and monthly per capita household income. This study found a significant effect of risk-perception of the surrogate decision-maker on treatment propensity. Healthcare professionals should pay attention to guiding surrogate decision-makers to establish correct disease perception and risk-perception through effective communication during thrombolysis communication in acute ischemic stroke to relieve their decision-making pressure, shorten decision-making time and reduce Door-to-Needle time to improve patient prognosis and increase the rate of thrombolytic therapy. This study is a questionnaire survey conducted by the investigator and no patient or public participation is required. The risk perception of surrogate decision-makers is likely to play an essential role in the decision-making process. However, increased risk perception and prolonged thrombolysis are due to a lack of knowledge about thrombolysis among surrogate decision-makers. Generalizing the need for intravenous thrombolysis may improve the rate of thrombolysis and thus provide clinical benefit to patients.
Corticosteroids (CSs) are widely prescribed but can induce psychiatric adverse effects (depressive, manic, psychotic, and anxiety symptoms). This systematic review aimed to quantify the association between CS use and psychiatric symptoms and to explore potential moderators across clinical contexts. We conducted a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-guided systematic review and meta-analysis. MEDLINE and Embase were searched through 10 October, 2025, and 19 hand-searched records were also screened. We included observational studies in medical CS users and excluded sex steroids, neonatal exposure, prescription-only outcomes, purely objective outcomes, sleep/cognition/delirium-focused studies, CS deficiency, withdrawal, and studies confounded by co-medications; randomized controlled trials were excluded by design. Two reviewers screened studies, extracted data, and assessed risk of bias with the Newcastle-Ottawa Scale. Certainty of evidence for each pooled outcome was additionally evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Pairwise meta-analyses pooled standardized mean differences and odds ratios using random-effects models; I2 quantified heterogeneity. The acute phase was operationally defined as ≤ 8 weeks after CS initiation. An exploratory meta-regression across six studies (seven groups) examined dose, duration, cumulative dose, age, and sex. Seventy-three studies (total N = 3,759,659) were included (22 cross-sectional, 31 cohort, 12 pre-post, 2 case-control, 2 registry, and 4 prospective patient-as-own-control investigations comparing outcomes during on-CS vs off-CS periods). Compared with non-users, CS use was associated with higher depressive symptom scores (standardized mean difference = 0.92, 95% confidence interval [CI] 0.40-1.45; p < 0.001; I2 = 89%; seven studies; n = 1403; eight groups). During the operationally defined acute phase (≤ 8 weeks after CS initiation), manic symptoms were more frequent than depressive symptoms (six studies; n = 1086; odds ratio = 2.42, 95% CI 1.48-3.97; p < 0.001; I2 = 0%). A single-arm meta-analysis estimated psychotic symptoms in 2.4% of CS users (95% CI 0.76-7.26; six studies; n = 1206). Anxiety showed no significant association with CS use (standardized mean difference = 0.13, 95% CI - 0.24 to 0.51; p = 0.26; I2 = 7%; three studies; n = 1251). Overall study quality (Newcastle-Ottawa Scale) was generally moderate to high, whereas certainty of evidence according to GRADE was generally low to very low across pooled outcomes. The exploratory meta-regression suggested that higher daily dose and older age were associated with greater depressive severity; by contrast, cumulative dose, treatment duration, and sex showed no significant associations, and these moderator findings remain exploratory. Corticosteroid use is associated with more severe depressive symptoms, and manic symptoms may predominate during acute treatment; psychotic reactions are uncommon. Dose and age may modulate depressive severity, but these moderator findings should be interpreted cautiously. Routine monitoring for mood and psychotic changes, especially early after initiation and in higher-dose or older patients, is warranted. Corticosteroids are widely used medicines that control inflammation, yet they can also influence mental health. We analyzed 73 clinical studies of patients taking these drugs for physical illnesses. Overall, people who used corticosteroids reported more signs of depression than those who did not. During the first 8 weeks of treatment, manic episodes—characterized by abnormally elevated or irritable mood, decreased need for sleep, racing thoughts, impaired judgment, and sometimes risky behavior—were about 2.4 times more frequent than depressive symptoms. Severe reactions such as psychosis affected only a small proportion of patients (approximately 2%). When we looked for possible reasons, an exploratory meta-regression suggested that higher daily corticosteroid doses and older age may be linked to more severe depression, whereas total cumulative dose, treatment duration, and sex were not. These findings should be interpreted cautiously because they are based on a small number of studies and show between-study variability. We found no consistent evidence that corticosteroids raise anxiety. Taken together, these results suggest that clinicians should routinely ask patients about mood changes, especially during the first 8 weeks, and pay particular attention to older adults who are receiving higher daily doses, while balancing any possible mental side effects against the well-established physical benefits of corticosteroid therapy.