Karolinska Institutet

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Depression in old age often has a poor clinical course, although there is substantial variability in depressive symptom trajectories. We aimed to characterise old-age depressive symptom trajectories, assess their multifactorial correlates, and their impact on mortality. We used cohort data from 2118 dementia-free community-dwelling adults aged ≥60years participating in the Swedish National study on Aging and Care in Kungsholmen (SNAC-K). Depressive symptoms were evaluated using the Montgomery-Åsberg Depression Rating Scale at baseline and 1-3 follow-ups over 9years. Sociodemographic (age, sex, marital status, socioeconomic status), psychosocial (social connections and support), clinical (multimorbidity), and functional (gait speed; cognitive impairment) factors at baseline were considered as trajectory correlates. Generalised growth mixture models and multinomial logit models estimated depression trajectories and their correlates. Cox proportional hazard models estimated all-cause mortality risk. Three trajectory classes emerged: low, increasing, and U-shaped trajectories of depressive symptoms. Compared to the low trajectory, socioeconomic status involving high financial strain and poor social support was more common in the increasing and U-shaped trajectories. Slow gait speed was linked to higher odds of increasing depressive symptoms, while greater multimorbidity was associated with the U-shaped trajectory. The increasing and U-shaped trajectories were associated with higher mortality risk, and the association for increasing was robust to the adjustment of covariates. Depressive symptom trajectories in late life are heterogeneous and linked to diverse socio-economic, clinical, and functional factors, some of which are trajectory-specific. Given its association with mortality, older people should be carefully monitored for depressive symptomatology.

This repeated cross-sectional study examined trends and behavioral correlates of excessive screen time among Swedish adolescents across 2017, 2020 and 2023. Specifically, this study examined 1) temporal trends of variables used, 2) correlates of pooled screen time, and 3) correlates of specific screen modalities (gaming, social media, and film/TV viewing). Data were collected from n=8,300 upper secondary school students in Jönköping County (n=2,319 in 2017; n=3,056 in 2020; n=2,925 in 2023). Measures used included risk behaviors (e.g., alcohol, smoking), physical activity, psychosocial trust, exposure to violence and victimization, sleep duration, psychosomatic symptoms, absenteeism and living arrangement. General linear models (GLM; UNIANOVA) were conducted, adjusting for relevant covariates. Alcohol use, smoking, shorter sleep duration, higher psychosomatic symptoms, and school absenteeism were associated with higher pooled screen time, whereas physical activity, female gender, and living with both parents were associated with lower pooled screen time. Across modality-specific analyses, shorter sleep duration, lower physical activity, living without both parents, and school absenteeism were consistently associated with higher screen use across gaming, social media, and film/TV viewing, while substance-use and gender associations varied by modality. Sleep, physical activity, family structure, and school absenteeism appear to be robust correlates across screen modalities, supporting the importance of targeting these factors in adolescent health promotion and digital media guidance. These findings highlight the need for parents, researchers, and health professionals to pay closer attention to adolescents' digital media use.

In January 2026, the new Dietary Guidelines for Americans were released, generating substantial international debate. Unlike previous editions, these guidelines were not primarily based on the report of the Dietary Guidelines Advisory Committee but on an independent scientific review, a process that raised concerns regarding transparency and potential conflicts of interest. This article critically examines the main recommendations of the new Dietary Guidelines for Americans, with particular emphasis on their implications for metabolic, cardiovascular, and kidney health. While the guidelines appropriately emphasize the reduction of ultra-processed food consumption and the promotion of minimally processed foods, several inconsistencies with contemporary scientific evidence are identified. Key concerns include the use of an outdated inverted food pyramid, a strong emphasis on high-protein intake (1.2–1.6 g/kg/day) predominantly from animal sources, and an internal contradiction between recommended protein intake and limits on saturated fat consumption. The proposed dietary pattern may also inadequately support gut microbiota health due to relatively low recommendations for fruits, vegetables, and whole grains. These issues may also be relevant to nephrology, given the growing popularity of high-protein diets and their potential renal implications. Overall, while the guidelines contain positive elements, their scientific coherence and alignment with established evidence-based dietary patterns remain questionable, potentially limiting their effectiveness as a public health tool.

• Stakeholders identified five themes for home-based stroke rehabilitation. • Patient involvement and staff competence were both rated feasible and important. • The physical home environment and social networks were rated as important, yet less feasible to implement. • A gap was found between policy ambitions and real-world rehabilitation delivery. • Concept mapping enabled stakeholder-driven priorities in care development. Despite growing emphasis on home-based rehabilitation following stroke, there remains limited understanding of how to effectively tailor services to individual needs. This study employed concept mapping to explore diverse stakeholder perspectives on adapting home-based rehabilitation to better support the recovery process after stroke. Through this mixed-methods participatory approach, we engaged 89 stakeholders, including stroke survivors, significant others, healthcare professionals, managers, and architects. Participants generated, sorted, and rated statements about what matters most in home-based stroke rehabilitation. A hierarchical cluster analysis was conducted to organize the data into concepts. Five clusters were identified: 1) social support at home and beyond; 2) professional competence; 3) supportive home environment; 4) teamwork and resources; and 5) patient involvement. Patient involvement was rated highest for importance and feasibility, followed by professional competence. Specifically, stakeholders emphasized that rehabilitation should feel meaningful and be tailored to the patient's needs. No generated ideas from the cluster “supportive home environment” were found in the go-zone, and adapting rehabilitation to diverse home environments was recognized as crucial but hard to implement. The findings underscore the need for individualized, context-sensitive approaches and suggest that strengthening professional competence, particularly in navigating diverse environments and engaging support networks, will be essential to translating person-centered principles into everyday rehabilitation practice.

This study aimed to make a direct comparison of four tumor burden-related prognostic systems in predicting prognoses in patients with colorectal liver metastasis (CRLM) undergoing hepatectomy. Clinicopathological and survival data of 197 consecutive CRLM patients were extracted from a public database. Clinical Risk Score-derived N1S5 (lesion number of 1 and the largest size of 5cm are cutoffs for risk stratification), tumor burden score (TBS), modified TBS (mTBS) and total tumor volume (TTV) were calculated, and patients were stratified to different risk groups. Kaplan-Meier plots were adopted to depict the survival probabilities. Cox regression analyses were performed to evaluate the association between these systems and overall survival (OS) and disease-free survival (DFS). N1S5 and TTV systems effectively stratified patients into distinct risk groups with significantly different OS and DFS (p<0.05), but TBS and mTBS did not. Multivariable Cox regression analysis demonstrated N1S5 and TTV as independent variables associated with OS (HRs: 1.43 to 1.97, 1.59 to 1.76, respectively) and DFS (HRs: 1.34 to 2.09, and 1.80 to 2.51, respectively) (p<0.05). Compared with the other three systems, TTV showed a relatively higher time-dependent area under the curve (median: 0.60) and C-index (median: 0.64) for predicting OS. N1S5 had the highest C-index (median: 0.63) for predicting DFS. Total tumor volume seems to be a robust and effective tool for risk stratification and prognosis prediction in CRLM patients undergoing liver resection. N1S5 may provide a pragmatic simplified alternative to total tumor volume for prognostic prediction.

Peanut and tree nut allergies are leading causes of food-induced anaphylaxis in children. We aimed to examine early introduction and allergic characteristics in children with suspected severe peanut and/or tree nut allergy. Children aged 3-16 years with suspected severe peanut and/or tree nut allergy were recruited from Tampere University Hospital, Finland. Eligibility was based on a history of anaphylaxis and/or elevated specific immunoglobulin E (sIgE) to high-risk allergenic components. Data were collected through structured, physician-led interviews with participants and their caregivers. The study included 103 children (mean age 7.2 ± 3.0 years), of whom 47.6% had a history of anaphylaxis. Early nut introduction (< 6 months) did not occur at all among the participants. Additionally, nut introduction before 12 months was rare (< 2%). Peanut and cashew were the most introduced nuts and the most frequent anaphylaxis triggers. Parental food allergy was significantly more common among children without anaphylaxis compared to those with confirmed anaphylaxis (38.5% vs. 18.4%; p = 0.035). Early nut introduction was absent among children with suspected severe nut allergy, regardless of anaphylaxis history. Parental food allergy was more prevalent in children without anaphylaxis, suggesting it is not a reliable predictor of severe allergic reactions.

Selective serotonin reuptake inhibitors (SSRIs) are the first-line treatment for depression and anxiety, yet response rates remain suboptimal. Clinically accessible predictors of treatment outcome are therefore needed to guide decision-making in routine care. In this analysis, we examined data from a prospective hospital-based cohort of 92 outpatients with depression who initiated escitalopram monotherapy guided by therapeutic drug monitoring. The objective was to determine whether early levels of perceived stress predict subsequent treatment outcomes. Psychometric assessments included the clinician-rated Hamilton Depression (HAMD) and Anxiety (HAMA) Rating Scales and the self-rated Perceived Stress Scale (PSS), collected at baseline, week four, and week eight. Treatment outcomes were defined as absolute and relative changes in HAMD and HAMA scores at week eight, as well as response (≥50% HAMD reduction) and remission (HAMD <8). The week-4 PSS score predicted improvement in depression symptoms at week eight across all measures, independent of demographics, baseline PSS, and symptom severity at baseline or week four. Patients with low week-4 PSS scores (PSS<16) had markedly higher remission rates (22/27) compared to those with high scores (PSS>25), where remission was rare (1/21). The week-4 PSS score was also associated with improvement in anxiety symptoms, although less robust after adjustment for concurrent anxiety severity. Early perceived stress may represent a promising and accessible predictor of SSRI treatment outcomes. As an exploratory analysis, these findings should be considered hypothesis-generating and require replication before clinical implementation. The PSS is adaptable for digital platforms and may support future remote monitoring.

Mitochondrial electron transport flavoprotein (ETF) insufficiency causes metabolic diseases known as a multiple acyl-CoA dehydrogenase deficiency (MADD). In contrast to muscle, ETFDH is a non-essential gene in acute lymphoblastic leukemia NALM6 cells, and its expression is reduced across human cancers. In various human cancer cell lines and mouse models, ETF insufficiency caused by decreased ETFDH expression limits flexibility of OXPHOS fuel utilisation but paradoxically increases bioenergetics and accelerates neoplastic growth via activation of the mTORC1/BCL-6/4E-BP1 axis. Collectively, these findings reveal that while ETF insufficiency is rare and has detrimental effects in non-malignant tissues, it is common in neoplasia, where ETFDH downregulation leads to bioenergetic and signaling reprogramming that accelerates neoplastic growth.