Children with CHDs are exposed to ionising radiation during diagnostic and interventional cardiac catheterisation procedures. Data regarding radiation doses a child is exposed to during these procedures are scarce. We aimed to investigate the radiation dose and other related parameters for paediatric cardiac catheterisation and propose these as local reference levels.

We collected radiation exposure data for all diagnostic and interventional cardiac catheterisation cases (excluding electrophysiology procedures) utilising fluoroscopy at “Anonymized for review” between January 1, 2021 and November 30, 2021. Direct measures of radiation usage, i.e. fluoroscopy time, dose-area product value, and air kerma, were reported for each case by the INNOVA 2100 manufactured by Wipro GE Healthcare. The absorbed radiation dose was measured using a Bhabha Atomic Research Centre dosimeter, which was placed directly on the patients’ chests. Differences in measures of radiation exposure across procedural and interventional types were tested using the normality of continuous data by Kolmogorov–Smirnov test. Spearman’s correlation coefficient was calculated when the data violated normality.

The overall median dose-area product, fluoroscopy time, air kerma, and absorbed dose measured using a Bhabha Atomic Research Centre dosimeter were 300 mg.m2, 10.5 mins, 37 mGy, and 2.4 mSv, respectively. We have further categorised the median exposure parameters into 5 age groups and propose them as local dose reference levels. There was a strong correlation between fluoroscopy time with the absorbed radiation dose (Rho = 0.942). Fluoroscopy time showed fair correlation with air kerma (Rho = 0.65) and dose-area product (Rho = 0.59). Absorbed radiation dose showed fair correlation with dose-area product ( Rho = 0.56).

Fluoroscopy time alone is not a sufficient metric to monitor radiation exposure. Even when fluoroscopy times were comparable, air kerma and dose-area product levels were quite different. Therefore, the local dose reference levels proposed can be used as a benchmark for future studies aimed at process optimisation and further reducing the radiation exposure in paediatric patients.

This study aimed to compare long-term audiological outcomes of diode laser stapedotomy, microdrill stapedotomy and combined potassium titanyl phosphate laser–microdrill stapedotomy, and to identify predictors of surgical success.

Surgical, audiological and complications data were collected. Surgical success was analysed via the measurement of post-operative air–bone gap, air conduction gain.

A total of 615 patients were included; median follow-up was 16 months (range 1–1319). Overall, the 94.3 per cent achieved surgical success (air–bone gap < 15 dB). Median air–bone gap closure was 5 dB (interquartile range: 2.50–8.12), and median air conduction gain was 27.5dB (interquartile range: 19.37–36.25).

Compared across techniques, success rates were similar; however, post-operative air–bone gap was significantly better with laser techniques than with microdrill alone (p = 0.016). Longer prostheses were associated with improved outcomes.

All the examined techniques showed excellent audiological results. Laser use was associated with better post-operative air–bone gap than stapedotomy with microdrill only.

Early placement of a ventricular access device (VAD) in premature post-hemorrhagic ventricular dilatation based on ventricular size criteria, coupled with an aggressive tapping regimen to control ventricular size, may improve developmental outcomes. As this treatment paradigm represents a significant departure from traditional care, we present results of an institutional quality improvement protocol implementation study focusing on safety and resource use for those seeking to implement a similar care pathway.

Infants treated under the new ventricular size-driven protocol were retrospectively compared to a historical cohort managed according to clinical symptomatology. Process and compliance measures related to protocol implementation were tracked, as were complications and measures of resource use.

Ventricular access device (VAD) placement occurred earlier and at a smaller ventricle size, but beyond the protocol-mandated timeframe. Although more resource-intensive than customary care, compliance with protocol-directed screening ultrasounds and VAD aspirations by trained clinicians was high. Intensive ultrasound surveillance altered the management of only one infant during their treatment course. An increased rate of complications related to earlier and more aggressive treatment in these fragile infants was not observed.

Protocol compliance was satisfactory and no safety issues were noted. Although VAD placement occurred sooner, a majority of infants received intervention outside of the mandated timeframe and at a ventricular size above the desired intervention threshold. Minimizing transfer delays from peripheral neonatal intensive care units and improving access to the operating room were identified as areas for improvement. It appears possible to decrease the frequency of ultrasound surveillance without compromising safety.

Severe mental disorders (SMDs) impose profound suffering on patients and heavy burdens on family caregivers, often resulting in abusive behaviors. This study aimed to examine the association between psychiatric symptom severity and caregiver abuse, and to assess whether caregiver tobacco dependence moderates this relationship.

A cross-sectional study included 763 patient–caregiver dyads in rural Shandong, China. Psychiatric symptom severity was measured using the 18-item Brief Psychiatric Rating Scale. Caregiver tobacco dependence was assessed using the Fagerström Test for Nicotine Dependence. Patients reported caregivers’ verbal/physical abuse in the past year. Ordered logistic regression and interaction terms tested associations and moderation.

Overall, 25.7% of caregivers engaged in verbal abuse and 14.9% in physical abuse. Psychiatric symptom severity was significantly associated with both verbal (OR = 1.018, 95% CI: 1.010–1.026) and physical abuse (OR = 1.015, 95% CI: 1.005–1.025). Caregivers with moderate to severe tobacco dependence were more likely to commit verbal (OR = 1.851, 95% CI: 1.136–3.016) and physical abuse (OR = 2.292, 95% CI: 1.287–4.079) than non-smokers. Moderate to severe tobacco dependence significantly amplified the association between psychiatric symptom severity and verbal abuse (interaction OR = 1.024, 95% CI: 1.002–1.046), but not physical abuse.

In rural China, greater psychiatric symptom severity among patients with SMDs is associated with increased frequency of both verbal and physical abuse by caregivers, particularly verbal abuse among those with moderate to severe tobacco dependence, underscoring the need for caregiver-targeted psychological support and tobacco cessation interventions.

Due to frailty, chronic health issues, limited mobility, dependence on assistive devices, and polypharmacy, the geriatric population is more susceptible to the adverse effects of earthquakes. The aim of this study was to determine the factors affecting the quality of life of older adults who experienced the Kahramanmaraş-centered earthquakes in Türkiye on February 6, 2023.

This cross-sectional interview-based study was conducted with 340 older adults who experienced the earthquakes on February 6, 2023, and visited outpatient departments in Gaziantep. Data were gathered using a demographic form, Modified Fried Frailty Index, and WHO Quality of Life Instrument for Older Adults.

Participants’ average age was 71.37 ± 6.56 years, and 56.6% were women. Among them, 20.9% lost a first-degree relative, 15.3% were injured, and 45.3% were displaced. WHOQOL-OLD scores differed significantly by age, marital status, education, chronic illness, polypharmacy, living arrangements, and frailty.

This study highlights the factors influencing the quality of life of older adults in Türkiye after an earthquake. Living with a spouse and having primary or secondary education improved quality of life, while chronic illnesses and displacement had negative impacts. These findings emphasize the importance of considering the specific needs of older adults in disaster preparedness and response.

Psychomotor disturbance has long been observed in major depressive disorder (MDD) and is thought to be a key indicator of illness course. However, dominant methods of measuring psychomotor disturbance, via self-report and clinician ratings, often lack objectivity and may be less sensitive to subtle psychomotor disturbances. Furthermore, the neural mechanisms of psychomotor disturbance in MDD remain unclear.

To address these gaps, we measured psychomotor agitation via a force variability paradigm and collected resting fMRI in 47 individuals with current MDD (cMDD) and 93 individuals with remitted MDD (rMDD). We then characterized whether resting-state cortico-cortical and cortico-subcortical connectivity related to force variability and depressive symptoms.

Behaviorally, individuals with cMDD exhibited greater force variability than rMDD individuals (t(138) = 3.01, p = 0.003, Cohen’s d = 0.25). Furthermore, greater force variability was associated with less visuomotor connectivity (r(130) = −0.23, p = 0.009, 95% CI [−0.38, −0.06]). Visuomotor connectivity was significantly reduced in cMDD relative to rMDD (t(130) = −2.77, p = 0.006, Cohen’s d = −0.24) and mediated the group difference in force variability (ACME β = −0.06, 95% CI [−0.16, −0.01], p = 0.04).

Our findings represent a crucial step toward clarifying the pathophysiology of psychomotor agitation in MDD. Specifically, altered visuomotor functional connectivity emerged as a candidate neural mechanism, highlighting a promising direction for future research on dysfunctional visually guided movements in MDD.

This study aimed to evaluate the impact of temporary housing challenges (THC) after the February 6, 2023, Türkiye earthquake on clinical follow-up non-adherence (CFNA), low-density lipoprotein cholesterol (LDL-C) target achievement, and major adverse cardiac events (MACE) in patients with myocardial infarction (MI).

A retrospective cohort of 283 MI patients undergoing coronary angiography and stenting between May 6 and November 6, 2023, was analyzed. Patients were divided into Group 1 (THC group: residing in container cities) and Group 2 (non-THC group: living in intact/usable homes). Initial laboratory parameters and 1-year MACE incidence were compared. In MACE-free patients, adherence to 5 scheduled face-to-face visits (week 1, months 1, 3, 6, and 12) and LDL-C goal achievement were evaluated. CFNA was defined as attending fewer than 3 visits. One-year lab results were also compared.

THC independently predicted CFNA (OR: 1.925, P = 0.019) and MACE (OR: 3.937, P = 0.006). Follow-up attendance was lower in Group 1 (week 1: 43.2% vs 69.9%, P <0.001; month 12: 82.2% vs 95.1%, P = 0.008). LDL-C target achievement was significantly lower (6.85% vs 31.07%, P <0.001).

THC adversely impacts clinical follow-up adherence and increases MACE rates. Addressing THC’s challenges is essential for improving post-disaster health care outcomes.

To assess the iodine status of pregnant women from disadvantaged groups in Kahramanmaraş Province 1 year after the earthquake, including factors affecting iodine status.

510 healthy pregnant women were included in the study. A questionnaire was given to pregnant women after the earthquake to assess changes in diet and other social factors. Thyroid function, autoantibodies, thyroglobulin, urinary iodine concentration (UIC), creatinine (Cr) levels, and ultrasound were measured. Thyroid ultrasound was also performed to assess thyroid volume.

The median UIC of the participants was 91.27 μg/g Cr (Q1-Q3 = 62.53-142.86). The rate of low iodine status (<150 μg/g Cr) was 77.3% and the incidence of goiter was 19.2%. After the earthquake, 69% of pregnant women lived in urban areas and 31% in rural areas. 11.8% of the areas where they lived were moderately damaged, 11.4% severely damaged, and 5.9% completely destroyed. 15.1% were still living in temporary shelters 1 year after the earthquake. The risk of low UIC was 2.2 times higher for those living in temporary shelters after the earthquake.

Temporary shelters after the earthquake were the main risk factor for low iodine status. We need to support these groups after disasters and reduce the number of people living in temporary shelters.

Stroke remains a leading cause of death in British Columbia (BC), Canada. Understanding whether mortality declines are driven by prevention (reduced incidence) or improved survival (treatment) can inform public health and acute care planning.

We conducted a population-based study of 123,075 stroke events from 2002 to 2022 among BC residents aged 35–110 years, using linked administrative datasets. We calculated age-standardized rates of stroke events, 30-day case fatality and mortality, stratifying the rates by sex, age, income and geography. Regression models estimated temporal changes and relative contributions of declining event rates and case fatality to mortality reductions.

Age-standardized stroke event rates declined by 33% in females (208–140 per 100,000) and 25% in males (248–187) but increased among adults aged 35–54 (+14% females, +27% males). Females experienced a higher burden of stroke events as pre-admission deaths, particularly among 85+. Case fatality fell by 22% in females (40–31 per 100 events) and 15% in males (37–32), with the greatest improvements in younger adults. Mortality declined by 53% in females (72–34 per 100,000) and 43% in males (72–41) primarily driven by declines in case fatality. Disparities by sex, income and geography persisted.

Improved survival is the main driver of declining stroke mortality in BC, particularly in recent years. Socioeconomic, sex and age disparities persist, warranting focused strategies to address inequities and the rising stroke burden among younger populations.

Neuropsychological assessments commonly include word list learning tasks to assess verbal memory and learning. The California Verbal Learning Test (CVLT) provides multiple outcome measures and information regarding strategies used to enhance the coding and retrieval of information. Despite its popularity, the CVLT has not yet been formally translated into Hebrew and adapted to the Israeli population.

The CVLT-III was adapted to Hebrew (CVLT-IIIHebrew), and normative data of healthy Hebrew-speaking adults living in Israel (age range: 20 – 65, education range: 9 – 20) were collected (N = 235).

CVLT-IIIHebrew core scores were influenced by age, education level, and, to a lesser extent, sex. Normative data for the Hebrew-speaking Israeli population were generated using an overlapping interval strategy, and regression models were used to evaluate the necessity of adjusting core scale scores for sociodemographic variables. Internal reliability was very high. Clinicians can employ an easy-to-use calculator for adjusting CVLT-IIIHebrew core scores.

The adapted CVLT-IIIHebrew provides a valuable tool for evaluating the verbal memory of Hebrew speakers. Caution, however, is warranted when assessing individuals with lower education levels, as the normative sample was relatively highly educated. This highlights the importance of expanding the normative sample to include a broader spectrum of educational levels and ages. Moreover, the inclusion of Israeli minority groups, currently unrepresented in this normative sample, is of importance.

Alterations in the central and peripheral energy metabolism are increasingly recognized as key pathophysiological processes in psychiatric disorders. We investigated mitochondrial respiration and density linked to cellular energy metabolism and oxidative DNA damage in borderline personality disorder (BPD).

This cross-sectional case–control study compared three groups matched for age and body mass index: women with acute BPD, remitted BPD, and female healthy controls (n = 32, 15, 29). Peripheral blood mononuclear cells were investigated for differences in mitochondrial respiration, density, and markers of oxidative DNA damage.

Participants with acute BPD showed significantly reduced and less efficient mitochondrial ATP production compared to both remitted individuals and controls. Mitochondrial coupling and respiration were inversely associated with oxidative DNA damage, although DNA damage levels did not differ significantly across diagnostic groups. Sensitivity analyses indicated that comorbid major depressive episodes and antidepressant use did not account for the results.

These findings indicate mitochondrial alterations accompany acute symptom severity in BPD and may improve with remission. Unraveling causes and consequences of mitochondrial downregulation and its interplay with DNA maintenance in the context of stress and psychopathology could contribute to novel models and treatment strategies in BPD and related severe psychiatric disorders.

The simultaneous existence of low-value health care and underutilization of high-value care are global problems. Health technology reassessment (HTR) aims to optimize the value for money of technologies already in use within health care. Identifying candidate interventions for HTR remains challenging. Therefore, we tested a novel method to identify candidate outpatient prescription drugs for HTR through practice variation.

We used administrative data for all publicly funded outpatient prescriptions dispensed to persons aged 65 or older in Alberta in 2023. Through quantitative comparison of funnel plots for Anatomic Therapeutic Chemical (ATC) classes at the fourth level stratified by prescriber specialty, variation in prescription dispensation rates between prescribers was used to estimate three outcomes: the number of prescribers affected, the number of patients affected, and the potential budgetary impact. We ranked combinations of ATC class and prescriber specialty in descending order for each outcome, with use above and below the mean considered separately.

We analyzed data on 17.5 million dispensations, encompassing more than 8,000 prescribers and approximately 600,000 patients. The top ATC class–prescriber specialty combinations for each outcome showed high similarity above and below control limits while exhibiting minimal overlap between outcomes.

Our method successfully identified ATC class–prescriber specialty combinations with marked variation in use, for potential advancement through the HTR process. Depending on the perspective of those undertaking HTR of prescription drugs, different outcomes may be useful in technology prioritization. To make the ATC class–prescriber specialty combinations actionable, future efforts should focus on exploring the patients affected.