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Background: Congenital infections included in the TORCH complex remain an important cause of fetal and neonatal morbidity and mortality, being associated with miscarriage, intrauterine growth restriction, congenital malformations, neurological impairment, and long-term developmental sequelae. Prenatal serological screening may contribute to the early identification of maternal infections and facilitate preventive and therapeutic interventions. However, data regarding the utilization of TORCH screening and associated socio-demographic determinants in Romania remain limited. Objective: This study aimed to evaluate the self-reported uptake of prenatal serological testing for one or more infections included in the TORCH complex, particularly Toxoplasma gondii, rubella virus, cytomegalovirus (CMV), herpes simplex virus (HSV), and syphilis, and to identify socio-demographic, obstetrical, and prenatal care-related factors associated with TORCH testing among pregnant women in Romania. Materials and Methods: A cross-sectional observational study was conducted using an online self-administered questionnaire completed by 1301 pregnant women from Romania. Data collection was performed between August 2022 and March 2023 through digital platforms, including social media and pregnancy-related forums. The primary outcome was self-reported performance of serological testing for at least one TORCH-related infection during pregnancy. Associations between explanatory variables and TORCH testing were evaluated using chi-square tests and multivariable binary logistic regression models. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated. Results: Overall, 75.6% of participants reported undergoing serological testing for at least one infection included in the TORCH complex during pregnancy, while 49.3% reported a complete TORCH panel. The most frequently reported investigations were for Toxoplasma gondii (92.8%) and rubella virus (89.9%), whereas HSV testing was less commonly reported (42.5%). Lower educational level was the strongest independent factor associated with reduced likelihood of TORCH testing (adjusted OR = 0.08; 95% CI: 0.03–0.19; p < 0.001) (adjusted OR—aOR). Unemployment status (aOR = 0.70; 95% CI: 0.50–0.99; p = 0.045) and multiparity (aOR = 0.62; 95% CI: 0.49–0.77; p < 0.001) were also associated with lower testing uptake. In contrast, participation in prenatal education programs was associated with increased likelihood of TORCH testing (aOR = 1.37; 95% CI: 1.04–1.80; p = 0.024). The number of prenatal consultations was not independently associated with testing uptake. Conclusions: The uptake of prenatal serological screening for congenital infections (assessed using an expanded Romanian panel that includes hepatitis B and HIV in addition to the classical TORCH agents) in Romania appears to be influenced predominantly by socio-educational and behavioral factors rather than by the quantitative utilization of prenatal care services alone. Given the online recruitment strategy and the predominantly urban and highly educated sample, the reported uptake rates may overestimate population-level coverage. Significant inequalities in access to preventive prenatal investigations were observed, particularly among women with lower educational and socio-economic status. Strengthening prenatal education programs and improving equitable access to standardized prenatal screening may contribute to optimizing congenital infection prevention and maternal–fetal health outcomes. Full article

We explored the epidemiological evidence on the prevalence of mental health symptoms among current and former elite athletes as well as among their entourage members. Methods: A systematic review and meta-analysis were conducted in PubMed, PsycINFO, SportDiscus and Scopus to retrieve original quantitative studies that (i) were written in English, (ii) were conducted exclusively among current or former elite athletes and/or their entourage members, and (iii) presented prevalence rates of mental health symptoms. Results: In total, 72 studies were included, focusing on self-reported mental health symptoms (not on clinically diagnosed mental health disorders). Meta-analyses comprising 2596 to 10,927 current elite athletes showed that the prevalence of mental health symptoms ranged from 4% for drug misuse to 33% for distress. Meta-analyses comprising 2070 to 3405 former elite athletes showed that the prevalence of mental health symptoms ranged from 12% for depression to 28% for alcohol misuse. Because of the considerable heterogeneity among the included studies, the pooled prevalence estimates from these meta-analyses should be interpreted cautiously, as they summarize highly heterogeneous populations. Mental health symptoms were found to also be common among entourage members, with prevalence rates ranging from 5% for depression or anxiety to 53% for alcohol misuse in high-performance staff (including coaches) and reaching up to 36–58% for burnout in healthcare professionals working during the Paralympic games. Conclusions: Showing considerable heterogeneity across included studies, our systematic review and meta-analysis established that mental health symptoms are commonly reported by current and former elite athletes, as well as by their high-performance staff (including coaches) and medical staff. This warrants the implementation of various tailored resources, such as mental health literacy, screening programs and the availability of interdisciplinary medical and psychological support. Full article

Objectives: This study aimed to investigate the longitudinal associations between breakfast consumption, sleep duration and depressive symptoms among adolescents. Methods: The baseline survey (T1) was conducted from November to December 2019 using a multi-stage stratified cluster sampling method among secondary school students in Shanghai, China. The follow-up survey was conducted about one and a half years later (T2). A total of 2502 adolescents were included in the final analysis. Depressive symptoms were evaluated using the Chinese version of the Patient Health Questionnaire-2 (PHQ-2-C). Breakfast consumption frequency and sleep duration in the past week were self-reported. A cross-lagged model was constructed to examine the longitudinal associations between breakfast consumption, sleep duration and depressive symptoms. Results: The results showed that the prevalence of depressive symptoms and insufficient sleep increased from 15.31% and 89.53% at T1 to 18.47% and 92.89% at T2, respectively. The rate of daily breakfast consumption decreased from 81.10% to 76.06%. The cross-lagged model showed that daily breakfast consumption could significantly predict depressive symptoms (β = −0.109, SE = 0.030, p < 0.001) and sleep duration (β = 0.070, SE = 0.028, p = 0.013). Sleep duration could predict depressive symptoms (β = −0.076, SE = 0.022, p < 0.001) and vice versa (β = −0.039, SE = 0.018, p = 0.028). Conclusions: The rate of daily breakfast consumption among adolescents decreased, alongside the prevalence of depressive symptoms and insufficient sleep increased. Daily breakfast consumption predicted depressive symptoms and sleep duration, whereas depressive symptoms and sleep duration may have a bidirectional association. Full article

Smartwatches are commonly used IoT wearable devices, which contain sensors that can support the data management process of smartwatch data. This process is essential for providing data-based insights that can motivate users to achieve their physical activity (PA) and health goals. However, there is a lack of understanding of users’ perceptions of the health-related value they derive from smartwatches and of user self-tracking behaviour within a PA context. This self-tracking behaviour is also known as Self-Quantification Behaviour (SQB), which is the process of data preparation, collection, integration, reflection, and action. SQB could be affected by the functions provided by the smartwatch device, which vary by manufacturer, brand and model. The paper aims to investigate user perceptions of SQB and its association with their perceived value of smartwatches. A survey was conducted with professional office workers from South Africa who use smartwatches. The findings highlighted that the respondents enjoyed collecting and engaging with their PA data and that SQB significantly affected all four value constructs: Perceived Usefulness, Pleasure, Goal Pursuit Motivation, and Social Value. Social value, in terms of data sharing and user lifestyle, was the least well-rated. The findings contribute to an enhanced understanding of smartwatches and users’ perceived value of self-quantifying behaviour in the context of PA, thereby ultimately improving the smartwatch usage experience and motivating users to exercise more. Full article

Background: Telehealth acceptance for chronic low back pain (CLBP) remains unclear. It may depend on patients’ knowledge, attitudes, barriers, and health factors. This study assessed telehealth physical therapy’s acceptability for CLBP by examining willingness, knowledge, attitudes, and barriers, and comparing willingness among healthcare professionals. Methods: This study included 309 adults with CLBP. The Telemedicine Perception Questionnaire (TMPQ) assesses perceptions and barriers. Participants rated telehealth willingness and completed the PROMIS-29 for health factors. The descriptive statistics summarized the characteristics. The Friedman test was used to compare professional willingness, t-tests were used to examine sex differences, Pearson’s correlation was used to assess PROMIS-29 and telehealth willingness, and multivariate regression was used to identify the related variables. Results: The participants had an average age of 26.06 years, and 90% were female. Willingness varied (p < 0.001), being highest among dietitians (3.86 ± 1.15), lowest in physical therapists (3.52 ± 1.13). Males reported more telehealth barriers (p = 0.043), and females had higher anxiety, depression, fatigue, and pain scores (p < 0.05). Willingness to use telehealth physical therapy correlated with physical function (r = 0.319). The knowledge score was most strongly correlated with physical function (r = 0.368). Regression analysis showed that knowledge (B = 0.057, p = 0.011) and attitude (B = 0.063, p < 0.001) predicted greater telehealth willingness, with the model explaining moderate proportion of the variance in willingness to use telehealth physical therapy (R² = 0.381; adjusted R² = 0.370). Conclusions: Telehealth physical therapy was moderately acceptable in adults with CLBP. Knowledge and acceptance increased the willingness to use telehealth services. Higher knowledge of telehealth and more positive attitudes were associated with a greater willingness to use telehealth physical therapy. These findings suggest that patient education and clear orientation to telehealth procedures may support readiness for telehealth-based physical therapy. However, the strong predominance of female participants (90%) and the self-selected online sample should be considered when interpreting the findings, as these factors may limit generalizability to the broader CLBP population. Full article

Background/Objectives: Hwa-byung (HB) is a culture-bound syndrome characterized by prolonged suppression of anger and somatic complaints. No evidence-based digital therapeutic (DTx) has been developed for HB. We evaluated the feasibility, user experience (UX), and preliminary clinical effects of an acceptance and commitment therapy-based DTx, Hwa-free, for HB. Methods: Adults aged 19–80 years diagnosed with HB were enrolled in a four-week app-based intervention with assessments at Weeks 0, 2, 4, and 8. The primary outcome was UX via a 22-item survey at Week 4. Secondary outcomes included HB scales, depression, anxiety, anger, psychological flexibility, and health-related quality of life. Results: Of 45 screened, 30 were enrolled; 28 constituted the modified intention-to-treat population. Mean app use was 20.3 ± 7.8 days (72.6% adherence). All adverse events were assessed as probably or definitely unrelated to the intervention. UX positive response rates exceeded 80% across video content (82.8–89.7%), HB self-assessment (86.2%), meditation (86.2%), and in-app guidance (85.7%). Within-group changes at Week 4 were observed in 11 of 18 clinical scales, including HB Symptom Scale (Δ = −9.8, d = −0.92), Beck Depression Inventory-II (Δ = −13.3, d = −1.11), and state anger (Δ = −7.8, d = −0.96); these are uncontrolled pre–post changes not attributable to the intervention. The HB screening-positive rate declined from 100% at baseline to 55.6% at Week 8. Conclusions: Hwa-free demonstrated adequate feasibility, acceptable UX, and preliminary within-group symptom changes. A fully powered randomized controlled trial is warranted. Full article

Introduction: Community-based day center programs may support healthy ageing by promoting functional ability, mental well-being, and social participation among older adults, but real-world evidence from Latin America remains limited. Objective: We aimed to examine changes in functional status, mental health, and quality of life among older adults participating in the CEDIAM program in the Maule Region of Chile in 2022 and 2023. Methods: Pre–post observational study using routinely collected data from 15 CEDIAM centers. The 2022 and 2023 datasets were analyzed as independent cohorts. Functional status was assessed with the Barthel Index, the Lawton and Brody scale, and the Timed Up and Go test; mental health with the Mini-Mental State Examination and the 15-item Geriatric Depression Scale; and quality of life with the EuroQol-5D visual analogue scale. Paired comparisons, category-transition analyses, and multivariable logistic regression models of improvement were performed. Results: Baseline samples included 894 participants in 2022 and 897 in 2023. In 2022, all continuous outcomes improved significantly (all p ≤ 0.001). In 2023, the Barthel Index, the Timed Up and Go test, and the Geriatric Depression Scale improved (all p < 0.0001), and the EuroQol-5D visual analogue scale also improved (p < 0.01), whereas the Lawton and Brody scale (p = 0.204) and the Mini-Mental State Examination (p = 0.725) did not. Category-transition analyses showed significant improvements in basic activities of daily living and mobility in both cohorts (both p < 0.001), while significant categorical changes in instrumental activities of daily living, global cognition, depressive symptoms, and self-rated quality of life were observed only in 2022 (all p ≤ 0.01). Rural residence was associated with higher odds of improvement in basic activities of daily living (OR 1.62, 95% CI 1.17–2.25; p = 0.004), whereas age ≥75 years was associated with lower odds of improvement in depressive symptoms (OR 0.56, 95% CI 0.41–0.76; p < 0.001) and self-rated quality of life (OR 0.65, 95% CI 0.45–0.94; p = 0.023). Conclusions: Participation in CEDIAM was associated with favorable changes, particularly in basic functional status and mobility, although responses varied across outcomes and participant subgroups. Full article

Background/Objectives: Falls are a major threat to healthy ageing and the preservation of independence, yet the risk of falls in older adults commonly arises from multiple interacting domains rather than a single factor. This longitudinal analysis assessed whether frailty, functional limitation, and balance performance were associated with future falls among older adults. Methods: This longitudinal analysis assessed older adults aged 65 years and older over a three-year follow-up interval, using baseline data collected in 2015 and follow-up falls data collected in 2018. Baseline health, functional, and physical performance measures were evaluated in relation to self-reported falls at follow-up. Candidate predictors comprised sociodemographic, health, functional, and physical performance variables. Univariable logistic regression, adjusted screening models, and a final complete-case multivariable logistic regression model were used. Results: The eligible analytic sample comprised 1932 participants, of whom 480 (24.8%) reported falls at follow-up. In adjusted analyses, greater frailty index, greater ADL limitation, female sex, shorter full-tandem balance time, depressive symptoms, and greater self-rated mobility severity were associated with higher odds of future falls. However, only frailty index, ADL limitation, full-tandem balance time, and female sex were retained in the final multivariable model. In the final multivariable model of 1451 participants, frailty index per 0.1-unit increase (OR 1.26, 95% CI 1.07–1.48), ADL limitation score per 1-point increase (OR 1.30, 95% CI 1.16–1.45), female sex (OR 1.62, 95% CI 1.17–2.25) and longer full-tandem balance time per 10 s increase (OR 0.89, 95% CI 0.82–0.96) remained associated with falls. The final model showed modest discrimination and acceptable apparent calibration. Conclusions: Higher frailty, greater ADL limitation, poorer tandem balance and female sex were associated with subsequent falls. These results reinforce the value of a multidomain approach to fall-risk assessment. Full article

(1) Background: Adolescence is a critical period for the development of health-related behaviors, including dietary habits and physical activity. This cross-sectional study examined the associations between participation in organized sports, nutrient intake, and body composition in a sample of Greek adolescents. (2) Methods: A total of 224 adolescents aged 12–18 years from schools in the Attica region, Greece, participated in the study. Physical activity and organized sports participation were assessed using a validated questionnaire. Body composition was estimated using bioelectrical impedance analysis, and dietary intake was evaluated using three-day self-reported food records analyzed with Cronometer^® nutrition analysis software. (3) Results: Boys had higher fat-free mass and basal metabolic rate and lower fat-mass percentage than girls. Organized sports participation was common and differed by sex, with boys reporting higher participation and greater adherence to physical activity recommendations than girls. Organized sports participation was associated with differences in selected nutrient intakes, particularly among late adolescents; however, several differences were attenuated when nutrient intake was standardized per 1000 kcal, suggesting that part of the observed pattern may reflect differences in total energy intake. (4) Conclusions: These cross-sectional findings suggest that age-defined adolescent stage and organized sports participation are associated with differences in sports involvement, body composition, and nutrient intake among Greek adolescents; however, causal relationships cannot be established, and the findings should be interpreted as associations. Full article

Objective: Childhood abuse and neglect can have lasting impacts on mental and physical health. These effects may be amplified in rural and/or under-resourced communities, resulting in heightened anxiety, depression, and physical health problems. This study tested associations between childhood abuse/neglect with self-reported physical symptoms, with depressive and anxiety symptoms serving as potential mediators in this association. Participants: Participants (N = 606) were undergraduate college students living in the southeastern United States. Methods: Participants completed measures assessing childhood abuse/neglect, anxiety and depressive symptoms, and self-rated health, pain, fatigue, and sleep quality. Results: Anxiety symptoms mediated the association between emotional, physical, and sexual abuse with all self-reported health outcomes. Depressive symptoms mediated associations between emotional and physical abuse with all health outcomes. Conclusions: Results highlight the importance of increasing treatment access among college-aged adults with abuse histories to help mitigate its long-term effects on physical and mental health as individuals age. Full article

End-stage kidney disease (ESKD) is a growing public health concern in Oman, with an increasing number of adults requiring hemodialysis and facing complex dietary restrictions. Adequate nutrition knowledge and nutrition literacy are essential for effective dietary self-management, yet their relationship with dietary adherence in the Omani hemodialysis population remains underexplored. To determine the level of dialysis-specific nutrition literacy among Omani adults with end-stage kidney disease undergoing hemodialysis and to identify socio-demographic and clinical factors that predict acceptable nutrition literacy in this population. A cross-sectional study was conducted among 140 adults with ESKD receiving hemodialysis in Oman. Data were collected using a structured, self-administered questionnaire comprising socio-demographic and clinical items, the Dialysis-Specific Nutrition Literacy Scale (DSNLS), the Dialysis-Related Diet Knowledge Questionnaire (DDKQ), and adherence/health-belief subscales (perceived benefits, barriers, seriousness, susceptibility, and self-efficacy). Descriptive statistics summarized sample characteristics and scale scores. Correlation analyses assessed relationships between nutrition literacy, diet knowledge, and adherence-related perceptions. Multiple logistic regression identified independent predictors of acceptable nutrition literacy. Participants had a mean age of 48.19 years and a mean dialysis duration of 5.46 years. Overall, 60.7% had acceptable dialysis-specific nutrition literacy and 39.3% had limited literacy. Dialysis-related diet knowledge was low in 10.7%, moderate in 46.4%, and high in 42.9% of participants. Perceived benefits of dietary adherence were high, whereas perceived barriers, seriousness, and susceptibility were moderate and self-efficacy was relatively low. Nutrition literacy was positively correlated with perceived benefits, seriousness, susceptibility, and self-efficacy, while diet knowledge showed weaker associations with these beliefs. In the logistic regression model, living in the city (OR = 0.17, p = 0.01) and having diabetes mellitus as a comorbidity (OR = 0.17, p = 0.01) were associated with lower odds of acceptable nutrition literacy, whereas higher hemoglobin levels (OR = 1.51, p = 0.04) and self-rated “very good” overall health (OR = 5.80, p = 0.03) were associated with higher odds. Most Omani adults on hemodialysis demonstrated acceptable nutrition literacy and at least moderate renal-diet knowledge, but a substantial subgroup had limited literacy and low self-efficacy for dietary adherence. Nutrition literacy was more strongly linked to adherence-related beliefs than factual knowledge alone and was influenced by place of residence, comorbid diabetes, hemoglobin level, and perceived health. These findings highlight the need for culturally tailored, literacy-sensitive nutrition education in Omani dialysis units, with particular attention to urban patients and those with diabetes, to strengthen self-efficacy, address perceived barriers, and ultimately improve dietary adherence and clinical outcomes. Full article

Background/Objectives: Major Depressive Disorder is a serious mental disorder that negatively affects an individual’s health and quality of life. The diagnosis of this disease is based on clinical interviews, questionnaires, and the patient’s self-reports. The objective of this study is to develop a biological diagnostic system based on the analysis of EEG signals and brain regions, rather than relying on self-reports. Methods: In this study, the EEG signals in the Multimodal Open Mental Disorder Analysis (MODMA) dataset were divided into six anatomical regions: prefrontal, frontal, central, parietal, temporal, and occipital. Empirical Wavelet Transform and Empirical Mode Decomposition methods were applied separately to the channels in each region, resulting in three IMF components. A total of 23 features, including statistical, nonlinear, spectral, and model-based (AR) features, were extracted from each IMF component. In addition to these features, asymmetry features between the left and right hemispheres were also included. Feature dimensions ranging from 10 to 40 were selected via the mRMR method, and the extracted feature sets were classified using SVM, k-NN, RUSBoost, Random Forest, and Meta-Ensemble machine learning models with Leave-One-Subject-Out (LOSO) validation. Results: According to the analysis results, the highest accuracy rate in Major Depressive Disorder (MDD) diagnosis was achieved by classifying features extracted from the frontal and prefrontal regions. The EMD signal processing method demonstrated superior performance compared to the EWT method. An accuracy rate of 98.11% was achieved using Random Forest and Meta-Ensemble models. Conclusions: In the proposed method, Explainable Artificial Intelligence (XAI) based SHAP analysis was applied to provide reliable and interpretable features for MDD diagnosis based on brain regional analysis. Full article

Young Black women face barriers to exercise and elevated cardiometabolic risk, yet resistance exercise (RE) remains underutilized despite its benefits. We evaluated the feasibility and acceptability of a 24-week culturally adapted RE intervention + text messages in young Black women. Participants were randomized to the motivational exercise group (MEG; n = 14) or the standard exercise group (SEG; n = 13). Both groups received 10 and 11 weeks of supervised (by a Black woman) and unsupervised RE. MEG received additional cultural adaptations and weekly discussions to build competence, autonomy, and self-regulation strategies + mobile support. Feasibility and acceptability were assessed via recruitment, consent, and retention rates, adherence, and thematic analysis of semi-structured interviews. Recruitment and consent rates were 97.2% and 100.0%, respectively. Retention rates were 93.3% (MEG) and 86.7% (SEG) at 12 weeks, and 93.3% and 80.0% at 24 weeks, respectively. Supervised adherence was 93.9% and 88.8% in MEG and SEG, and 14.3% and 15.4%, respectively, during unsupervised RE. Participants desired continued support and a more tailored mobile experience during unsupervised RE. Supervised RE with ethnically matched trainers was feasible and acceptable. Future interventions should incorporate mobile tools with tailored feedback and accountability strategies to sustain long-term RE to improve health outcomes in this population. Full article

Introduction: Previous research has suggested thiazolidinediones (TZDs) may be associated with certain solid tumors. We examined incidence rates over time for patients with solid tumors who received TZD treatment for diabetes. Methods: We identified medication use and diagnosis codes that were aggregated to phecode disease classifications derived from the nationwide Veterans Administration Health Record System from 2000 to 2021. We identified 148,139 patients who had ≥2 diabetes diagnoses and had no previous cancer diagnosis. Among these, 8981 subjects had ≥4 years of TZD exposure. We then identified subjects with ≥2 diagnosis codes for solid tumors including bladder (n = 3987), breast (n = 632), colorectal (n = 5139), esophageal (n = 482), glioma (n = 591), lung (n = 5142), melanoma (n = 1896), pancreatic (n = 726), prostate (n = 11,884), renal (n = 3145), testicular (n = 369), and thyroid (n = 513). We used multivariable Cox proportional hazards regressions to measure associations between TZD use and cancer incidence. TZD use was modeled as a time-varying covariate from the first to last prescription of TZD medication, and analyses were adjusted for age at diabetes diagnosis, self-reported race, self-reported ethnicity, sex, body mass index, and cancer site-specific polygenic risk scores. Results: Long-term (≥4 years) exposure to TZDs was significantly associated with increased risk of developing prostate cancer (HR = 1.24, p < 0.001) and decreased risk of developing lung (HR = 0.58, p < 0.001), bladder (HR = 0.51, p < 0.001), and renal cancer (HR = 0.75, p = 0.003). Conclusions: Decreased risk of developing several solid tumors (lung, bladder, and renal) indicate that TZDs may be strong candidates for drug repurposing strategies to manage these types of cancer. These results warrant replication attempts in external datasets. Full article

Background: Major depressive disorder, particularly in its treatment-resistant form, remains a leading cause of global disability. When pharmacotherapy and psychotherapy fail, neuromodulation techniques such as electroconvulsive therapy (ECT) and repetitive transcranial magnetic stimulation (rTMS) are increasingly utilized. However, variability in protocols and outcome reporting continues to generate uncertainty regarding their comparative benefits and safety profiles. Objective: To comprehensively map and synthesize the available evidence on the clinical benefits and adverse effects of ECT and rTMS in adults with major depressive disorder and treatment-resistant depression. Methods: A scoping review was conducted following PRISMA-Sc guidelines and registered in PROSPERO; PubMed–MEDLINE, Scopus, and the Virtual Health Library were searched from inception to October 2022. Observational and experimental studies evaluating ECT and or rTMS in adults with depressive disorders were included. Data were extracted on study design, population characteristics, stimulation parameters, clinical outcomes, and adverse effects. Methodological quality was assessed using National Heart, Lung, and Blood Institute tools. Results: A total of 165 studies comprising 10,701 participants were included. ECT and rTMS were consistently associated with clinically meaningful reductions in depressive symptom severity across heterogeneous protocols. ECT demonstrated the most robust response rates, particularly in treatment-resistant and severe depression, while rTMS showed substantial efficacy with a more favorable safety profile. Adverse effects were more frequent and severe with ECT, including transient cognitive disturbances and cardiovascular complications, whereas rTMS was predominantly associated with mild, self-limited side effects such as headache and scalp discomfort. Considerable heterogeneity in stimulation parameters and diagnostic subgroups was observed across studies. Conclusions: Both ECT and rTMS represent effective neuromodulation strategies for major depressive disorder and treatment-resistant depression. ECT remains the most potent intervention in highly refractory cases, whereas rTMS offers a less invasive alternative with strong tolerability. Standardization of stimulation protocols, biomarker-informed stratification, coadjuvancy analysis, and long-term controlled studies are necessary to refine clinical positioning and advance precision neuromodulation in depression care. Full article