Abstract Stroke remains a leading cause of disability and mortality worldwide, disproportionately affecting older adults. Advances in acute stroke management have reduced mortality but led to a growing population of survivors living with long-term disability. The burden and impact of stroke extend beyond neurological impairment. Physically, older survivors experience functional decline, loss of independence in activities of daily living, and heightened need for environmental or institutional support. Psychologically and socially, stroke survivors face high rates of depression, anxiety, apathy, and fatigue, compounded by social isolation and caregiver burden. Spiritual distress is common yet often overlooked, particularly among those previously active in their faith communities who struggle with meaning, guilt, and disengagement after disability. Current care models require a more structured approach to whole-person care in stroke recovery that recognizes and addresses the physical, psychological, social, and spiritual/existential dimensions of well-being. Multidimensional validated assessment tools are needed to assess and promptly identify challenges to holistic recovery for stroke survivors. Multidisciplinary teams including physicians, nurses, rehabilitation specialists, psychologists, social workers, chaplains, and palliative care providers are essential to address the full range of patient and caregiver needs while potentially addressing long-term disability, enhancing quality of life, and preserving dignity for stroke survivors and their caregivers. By implementing such approaches, healthcare systems can more effectively meet the complex needs of this vulnerable population.

Since 1997 the Building Trades National Medical Screening Program (BTMed) has offered medical exams to construction workers employed in US nuclear weapons facilities. The process consists of two steps: (1) a detailed work history interview; and (2) a medical exam. Some participants only completed the work history interview, and we compared their mortality experience to those who also completed medical exams. We compared the mortality of 3470 work-history-only participants to 23,452 participants who completed both the work history interview and medical exams and, of these, 1720 who additionally participated in lung cancer screening. We used Cox proportional hazard and Poisson regression models to estimate hazard ratios and risk ratios while controlling for potential confounders. Medical exam participants experienced a reduction in mortality risk of 28% for all causes combined; 27% for all respiratory diseases combined; 37% for chronic obstructive pulmonary disease; 30% for cardiovascular diseases combined; 32% for all cancers combined; 36% for lung cancer; and 53% for colorectal cancer. The more medical exams they undertook the greater the mortality risk reduction (25%, 29%, and 43% for one, two, and three medical exams, respectively), demonstrating a clear trend. BTMed has prevented approximately 2911 premature deaths among our participants through 2021 and added 35,178 years of life, an average of 1.5 years per participant, at a cost of $2757 per year of life saved. Secondary prevention in occupational high-risk groups is very effective. Continued surveillance beyond retirement age is important to reduce mortality.

Pentylenetetrazol (PTZ) kindling is a widely used model for inducing epileptogenesis and evaluating long-term seizure susceptibility differences among animals. This model is typically performed by chronic, repetitive exposures to a constant subconvulsive PTZ dose. However, the effectiveness of the commonly used dose (35 mg/kg) varies among different animal groups due to factors such as species, age, sex, and genetic background. This study characterizes a novel kindling approach, the PTZ Dose Escalation (PTZ-DE) model, which assesses chronic seizure threshold with enhanced sensitivity by empirically determining the minimally effective dose to induce PTZ kindling for specific experimental conditions. The efficacy and validity of the PTZ-DE model were compared to the standard PTZ kindling approach. First, the characteristic increase in chronic seizure response was compared between PTZ-DE and the standard model across animal characteristics (strain, sex). Next, the PTZ-DE model's validity was assessed by determining whether PTZ-DE could replicate the increased chronic seizure susceptibility previously reported using the standard approach after traumatic brain injury (TBI). Lastly, the PTZ-DE model's effectiveness in detecting seizure differences was measured in a condition (glyburide treatment) where alterations to chronic seizure susceptibility were not detected with standard kindling. This study observed that, compared to the standard model, the PTZ-DE model corrects for background differences in PTZ susceptibility, replicates known alterations in chronic seizure thresholds, and uncovers changes in seizure threshold previously unidentified by the standard approach. The PTZ-DE model may be a superior approach for discovering new pathological mechanisms of epileptogenesis and for developing targeted therapies for seizure management.

We briefly review the literature on cognitive behavioral therapy for menopause, characterizing these interventions within their proper social cognitive context, and situating them within the broader research literature on cognitive behavioral therapy approaches. Furthermore, we highlight critical knowledge gaps and underscore the need for targeted next steps in research. Unlike menopause hormone therapy, traditional cognitive behavioral therapy for menopause protocols are not necessarily designed to reduce the frequency or severity of vasomotor symptoms (e.g. hot flashes/night sweats). They do, however, reduce the functional impact of (i.e. hot flash-related interference) and psychological distress associated with (i.e. hot flash-related distress) vasomotor symptoms. Generalization effects, including concomitant improvements in mood, sleep, and overall quality of life, are common. The paucity of studies that examine the efficacy and effectiveness of these interventions for women with mental health conditions, however, has left a critical knowledge gap that warrants attention. Cognitive behavioral therapy for menopause is an evidence-based treatment for the reduction of psychological symptoms associated with vasomotor symptoms. This treatment should not be misconstrued as the nonpharmacologic equivalent of menopause hormone therapy, and further research is needed to determine how and when this treatment is helpful to women with mental health conditions.