Pulmonary arteriovenous malformations (PAVMs) are a recognised cause of progressive cyanosis following bidirectional superior cavopulmonary anastomosis (BDG). The role of antegrade pulmonary blood flow (APBF) in preventing PAVM formation remains controversial. While preserved APBF may improve oxygen saturation and pulmonary artery growth, its protective effect against PAVMs is uncertain. Increasing evidence suggests that exclusion of hepatic venous blood from the pulmonary circulation, rather than absence of pulsatile flow, may be the primary mechanism underlying PAVM development. Therefore, management of APBF after BDG should be individualized.

This retrospective observational study included children with univentricular physiology who underwent BDG before 4 years of age with a minimum follow-up of two years. Patients were divided into two groups based on the presence or interruption of APBF. Clinical data, oxygen saturation, echocardiographic findings, pulmonary artery dimensions, and imaging evidence of PAVMs were analysed using computed tomography angiography and/or cardiac catheterisation. Outcomes were compared between groups.

Sixty patients were included. PAVMs occurred in 26.7% of patients with interrupted APBF and 23.3% with preserved APBF (p = 0.766). Oxygen saturation was higher in the preserved APBF group but not statistically significant. Pulmonary artery dimensions and pressures were comparable, and all patients remained suitable for Fontan completion. Cyanosis was more frequent in the APBF-interrupted group.

Preserved APBF improves oxygen saturation but does not reduce PAVM incidence. Hepatic venous exclusion appears to be the primary determinant of PAVM development, supporting individualized surgical decision-making.

We aimed to evaluate patient and clinician experiences of advance care planning (ACP) conversations facilitated by an ACP nurse coordinator (ACP-NC).

We used a sequential mixed-methods approach that included a patient survey, patient interviews, and clinician interviews at a family medicine clinic. Patients were invited into the study if they had reached a stable point in their ACP decision-making conversations with the ACP-NC or PCP (i.e. their goals and preferences were considered settled at the time) and were not imminently dying. Invitations to complete a survey were sent within 2 weeks of patients completing their ACP conversations. Patient interviewees were purposefully selected to vary on key attributes such as age, gender, and number of ACP conversations. An iterative sampling strategy was used for both patient and clinician interviews.

Ninety-three patients completed the survey, and 10 patients were interviewed. Six clinicians were interviewed. Sixty percent of patient respondents reported being very comfortable having ACP conversations. At the time of the survey, 79% had completed or revised their existing advance directive. The professional groups that patients most preferred to engage with, regarding ACP, were their primary care provider (87%), ACP-NC (70%), and palliative care specialist (61%). Patient interviews indicated that participants appreciated being referred to the ACP-NC within the clinic, describing her as a motivator and generous with her time, which facilitated thoughtful discussion of preferences and wishes. Clinician interviews identified limited time as a key barrier to conducting ACP conversations and saw a dedicated ACP-NC as a major benefit to allow patients to spend more time having these important conversations.

Patients were open to engaging in ACP discussions. Integrating an ACP-NC within primary care teams may represent an acceptable and effective approach to promote the early initiation of ACP in primary care settings.

Individuals with severe mental illness (SMI) have increased risk of physical comorbidities, linked to worse outcomes such as greater psychopathology, frailty, and neurocognitive impairment. Mechanisms underlying this burden remain unclear. This study examined whether frailty and psychopathology predict evening chronotype, especially in SMI with comorbidities.

A longitudinal study assessed 165 participants at two time points over one year: schizophrenia (n = 30), bipolar disorder (n = 42), major depressive disorder (n = 35), and healthy controls (n = 58). The SMI group (n = 107) was divided into SMI with comorbidities (SMI-C; n = 47) and without (SMI; n = 60). Measures included psychopathology, frailty, chronotype, neurocognitive and functional performance, and hematological biomarkers.

Neurocognitive and functional impairments were greater in SMI groups than controls (F = 10.3–31.4; p < 0.0001; η²p = 0.12–0.34). The SMI-C group showed worse frailty than controls at T1 (F = 4.3; p < 0.01; η²p = 0.05) and than SMI at T2 (F = 8.5; p < 0.0001; η²p = 0.12), and elevated MCV/MCH (F = 3.8–9.4; p < 0.05–0.0001; η²p = 0.04–0.11). Chronotype distribution did not differ. Frailty and psychopathology predicted chronotype in SMI (p < 0.05–0.01); in controls, frailty and performance did so (p < 0.05).

Psychopathological and hematological profiles are associated with chronotype and may help identify subgroups for chronobiology-informed interventions. These findings support more personalized treatment approaches.

Gambling disorder (GD) involves persistent risky choices despite losses, suggesting impaired impulse control. While static paradigms reveal inhibition deficits in GD, they cannot model dynamic risk-reward escalations during real gambling. This study aims to investigate whether GD involves impaired dynamic impulse control during escalating stakes and to dissociate contributions of subjective risk evaluation and trait impulsivity to this deficit.

Using a sequential gambling task with 83 male patients with GD and 62 matched healthy controls (HCs), this study investigated dynamic impulse control deficits under escalating stakes. We quantified dynamic impulse control via the reward–reaction time (RT) coupling for ‘continue’ choices (dynamic impulse control index [DICI]) using Bayesian modeling. Risk sensitivity and risk preference were derived from stop/continue decisions. Trait impulsivity was assessed with the Barratt Impulsiveness Scale (BIS-11). Regression analyses examined the modulation of DICI by risk sensitivity and trait impulsivity.

Patients with GD exhibited significantly attenuated DICI versus HCs, reflecting failure to increase deliberation with escalating stakes. Computational modeling revealed markedly reduced risk sensitivity in GD despite comparable risk preference. Critically, trait impulsivity positively modulated DICI in HCs but not in GD, indicating pathological decoupling. Risk sensitivity positively predicted DICI in both groups, though significantly weaker in GD.

These findings establish a triadic impairment in GD: (1) attenuated adaptive impulse control during escalation (impaired DICI), (2) deficient subjective risk weighting (reduced sensitivity), and (3) breakdown of impulsivity-based modulation of control. This reveals a dynamic, mechanism-focused pathology beyond static trait models.

Although home is frequently the preferred place of death, little is known regarding how home healthcare (HHC) influences this outcome for people with dementia (PWD), particularly within Asian contexts. This study investigates the impact of HHC and its 2016 “Integrated Home-Based Medical Care” reform on home death in Taiwan, explicitly accounting for the cultural phenomenon of “impending death discharge.”

This nationwide retrospective cohort study utilized Taiwan’s National Health Insurance Research Database. We identified PWD decedents from 2011 to 2022 and conducted a nested case–control analysis. Cases (home deaths) and controls (hospital deaths) were matched 1:1 using propensity scores to balance demographics and health status. HHC models included pre-2016 primary HHC, post-2016 primary HHC, and the reformed “HBPC Plus” (Home-Based Primary Care Plus). The outcome was adjusted to include patients discharged terminally to die at home, reflecting distinctive cultural practices.

Among 209,468 decedents, 95,594 were selected after matching. Overall, HHC use was associated with higher odds of home death (adjusted odds ratio [aOR]: 1.17; 95% CI: 1.13–1.21). The reformed HBPC Plus program showed the strongest association compared to pre-2016 primary HHC (aOR: 1.63; 95% CI: 1.34–1.98). Crucially, this association strengthened further when accounting for impending death discharge (aOR: 1.82; 95% CI: 1.40–2.35). Higher visit frequency and services from hospital-based teams were also significantly linked to home death.

HHC significantly increases the likelihood of home death among PWD in culturally influenced contexts. The 2016 reform, particularly the HBPC Plus program, proved highly effective. Policy components like flexible visit frequencies and enhanced hospital–physician coordination appear vital for supporting end-of-life care at home, offering key insights for policy planning in aging societies.

Adverse childhood experiences (ACEs) are associated with increased risk of psychotic-like experiences (PLEs), but the relationship between specific adversities and the persistence of PLEs in young people remains unclear. We examined associations between distinct ACEs and the persistence of PLEs until 24 years old.

Using longitudinal data from participants in the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort with at least one PLE datapoint, we used group-based trajectory modeling to estimate longitudinal trajectories of PLEs from age 12–24. We examined their associations with bullying victimization, maltreatment, parental mental health problems, parental substance abuse, parental separation, and parental intimate partner violence prior to first PLE experiences.

Among 4,448 participants, a three-group trajectory model provided the best fit, revealing low, increasing and persistent PLE groups from ages 12–24. In fully adjusted multinomial logistic regression models, those exposed to bullying were more likely to belong to either the increasing (relative risk ratio [RRR]: 1.83, 95%CIs: 1.26–2.66) or high (RRR: 1.78, 95%CIs: 1.07–2.93) PLEs group than the low PLE group; those exposed to maltreatment were more likely to be in the increasing PLE group (RRR: 1.47, 95%CIs: 1.03–2.10). No other ACEs were associated with PLE trajectories.

Bullying was associated with persistent PLEs up to 24 years old, independent of other forms of childhood adversity, with timing-specific effects of maltreatment on increasing symptoms emerging later in adolescence. Findings provide further evidence for the importance of prioritizing bullying and maltreatment reduction as public health targets.

Various psychotherapies are available for individuals with obsessive–compulsive disorder (OCD). However, the comparative effectiveness and acceptability of these therapies remain unclear.

To examine the comparative effectiveness and acceptability of different psychotherapies for OCD.

A living database of psychological interventions for OCD was utilised, and randomised controlled trials comparing psychotherapies with each other/control groups were included. Pairwise and network meta-analyses were conducted using a random-effects model. Comparative standardised mean differences (SMDs) were pooled for effectiveness in reducing OCD symptom severity post-treatment. Relative risks were calculated for acceptability. Sensitivity analyses were conducted by repeating the main analyses while controlling for specific variables to test the robustness of the findings.

A total of 68 controlled trials (76 comparisons, 4019 patients) were included, involving 7 psychotherapeutic approaches. All psychotherapies were significantly more effective than both waitlist (SMD −1.40 to −0.96) and pill placebo (SMD −1.44 to −1.00). Except for mindfulness-based therapy, all approaches were more effective than both care-as-usual (SMD −0.98 to −0.67) and psychological placebo (SMD −0.95 to −0.63). Sensitivity analyses excluding outliers, studies with comorbidities, comparisons with waitlist controls and comparisons supported by only a single study, as well as analyses restricted to adults with OCD, yielded results consistent with the main analyses. When restricted to studies rated as low risk of bias, all therapies except mindfulness-based therapy and the inference-based approach remained significantly more effective than waitlist. No significant differences were found among psychotherapies regarding effectiveness and acceptability.

Psychotherapies are similarly effective and acceptable for treating OCD. However, these findings should be interpreted with caution due to limited statistical power, substantial heterogeneity and a high risk of bias across many included studies. More methodologically rigorous research is needed to validate and strengthen the current evidence base.

To develop regression-based normative data for a set of widely used neuropsychological tests and to provide a freely accessible normative data calculator for use in Buenos Aires, Argentina.

Participants were drawn from a large clinical dataset and selected to reflect preserved global cognition, intact memory performance, and functional independence. Regression-based norms were developed for the Rey Auditory Verbal Learning Test, Verbal Fluency, Trail Making Test, and Digit Span tasks. For each model, predictors included age, sex, and years of education, as well as polynomial terms and interaction effects; final models were obtained via stepwise backward elimination procedures. Model assumptions were evaluated, and predictive performance was estimated using 10-fold cross-validation.

393 participants met inclusion criteria. Age was negatively associated with verbal memory, fluency, and executive function, whereas higher educational attainment was associated with better performance. Women outperformed men in verbal memory and phonological fluency. Demographic variables explained between 2% and 23% of variance across tests. An open-access calculator was developed to facilitate individualized normative estimation in clinical settings.

This study provides locally developed, regression-based norms for neuropsychological assessment in Buenos Aires – Argentina, addressing the lack of culturally relevant norms and limitations of traditional methods.