Parental prenatal mood and anxiety disorders (PMADs) are linked to child neurodevelopmental disorders (NDDs), but evaluations of the magnitude and mechanisms of this association are limited. This study estimates the strength of the association and whether it is impacted by genetic and environmental factors.

A systematic search of PubMed, CENTRAL, PsycINFO, OVID, and Google Scholar was performed for articles published from January 1988 to September 2025. Of 2,420 articles screened, 74 met the inclusion criteria. Meta-analyses were conducted on 21 studies, and 53 were included in the narrative synthesis. We conducted random-effects meta-analyses, along with tests for heterogeneity (I2) and publication bias (Egger’s test). The review followed PRISMA and MOOSE guidelines.

Maternal PMADs were associated with a significantly increased risk of attention-deficit/hyperactivity disorder (ADHD; odds ratio [OR] 1.91, 95% confidence interval [CI] 1.45–2.52) and autism spectrum disorder (ASD; OR 1.75, 95% CI 1.43–2.14) in children. Paternal PMADs were also associated with the risk of NDDs, with combined odds for ASD and ADHD (OR = 1.23, 95% CI 1.14–1.33). Several studies suggested that the link between parental PMADs and offspring NDDs might be impacted by both genetic and environmental factors, including the impact of ongoing parental depression on child behavior.

Parental PMADs are associated with increased risk of NDDs in children. These findings likely reflect a combination of inherited liability and environmental processes; clarifying mechanisms will require genetically informed designs. Regardless of mechanism, offering optional, family-centered developmental support may help promote child well-being in families where a parent is experiencing PMADs.

Depressive symptoms are closely associated with cognitive decline and risk of incident dementia, and plasma biomarkers may play a significant role in this relationship. We aimed to investigate the influence of plasma biomarkers and explore the underlying mechanisms.

This study included 1,658 dementia-free community residents recruited in 2009–2011 from the Shanghai Aging Study. At baseline, we assayed plasma phosphorylated tau 217 (p-tau217) and neurofilament light chain (NfL), and assessed depressive symptoms using the Center for Epidemiologic Studies Depression scale. Cox regression models were performed to estimate the risks of incident dementia and Alzheimer’s disease (AD) during the 5-year follow-up. Parallel and serial mediation models were applied to investigate whether plasma p-tau217 and NfL mediated the relationship between depressive symptoms and cognitive decline.

Older adults with depressive symptoms had higher risks of dementia and AD, especially among those with higher concentrations of baseline plasma p-tau217/NfL. Sex-specific analysis revealed that depressive symptoms combined with high plasma NfL increased AD risk in men (hazard ratio, HR [95% confidence interval, CI] = 5.89 [2.01, 17.27], p = 0.001), whereas women with depressive symptoms and high plasma p-tau217 showed higher AD risk (HR [95%CI] = 6.07 [2.82, 13.09], p < 0.001). Parallel mediation analysis revealed that plasma p-tau217/NfL mediated the relationship between depressive symptoms and cognitive decline, respectively. Additionally, serial mediation analysis found p-tau217 precedes NfL within the mediating pathway (β = 0.403, bootstrap 95% CI: 0.347, 0.452).

Plasma p-tau217 and NfL could individually or jointly mediate the relationship between depressive symptoms and cognitive decline.

CHD are structural cardiac anomalies which are a leading cause of childhood mortality and morbidity in India and have multifactorial aetiology. Compromised socioeconomic status augments several environmental stressors and is shown to have a positive association with CHD in offspring. The presented study is an institution-based case-control study to explore the same with CHD as the primary outcome.

A total of 2064 paediatric patients (1760 CHD cases and 304 controls with structurally normal hearts) were analysed. Demographic and socioeconomic status parameters were recorded using the Kuppuswamy scale. Statistical associations were examined using chi-square tests and odds ratios.

Majority of all patients belonged to the upper-lower class. No significant association was found between socioeconomic status and CHD (p = 0.18). However, rural residence was significantly associated with a higher risk of CHD (χ2 = 16.09, p = 0.0011; OR vs. urban = 1.59). A significant association was found between maternal education and CHD prevalence (χ2 = 20.9, p = 0.0001), with uneducated mothers having higher odds of children with CHD. Joint family structure also showed higher odds of having a child with CHD (OR = 1.75, p < 0.001).

While socioeconomic status alone was not significantly associated with CHD in this cohort—likely due to universal free care at our institute—maternal education, rural residence and family structure emerged as critical determinants. These findings highlight the need for targeted public health initiatives focusing on maternal literacy, rural healthcare access, and awareness programmes to improve early CHD diagnosis and outcomes. Further population-based research is needed to elucidate socioeconomic status-CHD associations at a broader level.

To understand how the Go Wish Cards Game (GWCG) can support the expression of values, wishes, and preferences at the end of life among women living with advanced breast and/or gynecological cancer.

This descriptive qualitative study was conducted as part of a larger randomized clinical trial. Participants were recruited from a leading cancer center in Brazil and invited to sort the GWCG cards into three categories: “very important,” “somewhat important,” and “not important.” The 10 cards rated as “very important” were discussed individually to explore their meanings. At the end of the session, participants were asked: “What did it mean for you to play the cards?” Narratives associated with the “very important” cards were analyzed using content analysis based on Bardin’s methodological framework.

Thirty-three women completed the GWCG. Participants described the game as a meaningful opportunity for reflection, communication, and expression of personal values and end-of-life wishes. Discussions of the “very important” cards elicited narratives focused on trust-based relationships, emotional and spiritual support, dignity, and relief from suffering. The most frequently selected cards included wishes such as “to have a doctor I trust and nurses who care about me” and “to have my family and friends with me,” reflecting shared priorities across narratives. Values and wishes were organized into three overarching dimensions: emotional and existential connections; dignity and autonomy; and care and comfort at the end of life. The GWCG was perceived as a valuable tool for facilitating the expression of biopsychosocial and spiritual values.

The findings indicate that the GWCG supports reflection and the articulation of end-of-life values, wishes, and priorities, particularly those related to dignity, autonomy, comfort, and emotional connection. The tool shows potential to promote meaningful conversations and care aligned with what gives purpose and meaning to women living with advanced cancer.

This study aims to evaluate differences in healthcare utilization among patients with ischemic stroke in metropolitan versus non-metropolitan Manitoba.

This study is a population-level analysis using the Discharge Abstract Database from Manitoba. The database includes all patients who received care in a Manitoba facility for ischemic stroke between April 2019 and March 2023. Data were collected on patient demographics, comorbidities and geographical location of stroke presentation (metropolitan Winnipeg vs non-metropolitan). Outcomes included length of stay (LOS), treatment, discharge disposition and mortality. Regression analysis was performed to analyze outcomes, adjusting for age, sex and comorbidities.

3704 (71.6%) patients were admitted in Winnipeg, and 1471 (28.4%) patients were admitted in non-metropolitan Manitoba. Patients presenting to Winnipeg were younger (mean age 72.3 vs 74.3 years) and had higher rates of atrial fibrillation, hypertension, diabetes, chronic kidney disease and heart failure. Patients presenting to Winnipeg had a shorter LOS (16.1 days vs 18.4 days, coefficient 0.05, 95% CI −4.54 to −1.27), had higher rates of intravenous thrombolysis (adjOR 5.13, 95% CI 3.85–6.84), were less likely to be discharged home (39.8% vs 57.5%, adjOR 0.47, 95% CI 0.41–0.53) and were more likely to be transferred for inpatient stroke rehabilitation (adjOR 3.46, 95% CI 2.64–4.54). There were no differences in in-hospital mortality. There was a higher incidence of stroke in Winnipeg compared to non-metropolitan Manitoba (F-statistic 23.84, p = 0.0028).

This study illustrates differences in healthcare utilization outcomes between patients living in metropolitan Winnipeg versus non-metropolitan Manitoba presenting with ischemic stroke.

This study aimed at investigating the clinical, individual, and systemic factors influencing paediatricians’ and family physicians’ clinical decision-making process in the vaccination of children during infection from the physician’s perspective.

A qualitative study through semi-structured in-depth interviews was conducted among 10 paediatricians and 10 family physicians working in Ankara, Türkiye. The audio-recorded interviews were translated into written texts, and the obtained data was analysed using the thematic analysis method proposed by Braun and Clarke.

Four main themes were identified in of thematic analysis: (I) Impact of clinical conditions on vaccination decisions, (II) attitudes of families and their communication processes with physicians, (III) impact of practice settings and institutional factors, and (IV) vaccine postponement and compensation approaches. It was observed that the decision-making processes of the paediatricians were mainly based on the clinical evaluation criteria, while family physicians considered the expectations of the families and institutional conditions. Also, the importance of establishing effective communication with vaccine-hesitant families has been emphasized by both groups of physicians.

In the immunization of infected children, decision-making is shaped in addition to medical facts in relation to the parental attitude, organizational factors within health institutions, and personal experiences of medical staff. Decisions of paediatricians are largely grounded in medical facts, whereas family practitioners assess that social and organizational factors are of higher importance. Improved adherence to medical guidelines and communication competencies of medical professionals can contribute towards medical practice consistency.

Patients with non-English language preference (NELP) face significant barriers to safe and effective communication in palliative and supportive care. These barriers compromise quality, delay care, and heighten the risk of unmet psychosocial needs, particularly when compounded by health literacy concerns and limited access to translated resources.

We describe two Spanish-speaking patients with advanced cancer whose inpatient and outpatient supportive care was complicated by language barriers, leading to communication gaps, including symptom misinterpretation and inadequate family discharge education. These factors contributed to significant distress and safety risks.

Interdisciplinary interventions, including professional interpreter use, bilingual supportive care psychology, teach-back education, medication relabeling in Spanish, and culturally tailored communication, helped restore trust, alleviate suffering, and align care with patient and family values. In one case, a lack of validated Spanish versions of the Edmonton Symptom Assessment System within the electronic medical record (EMR) hindered symptom self-reporting and safety. Following multiple requests, the EMR team initiated development of a Spanish-language template to facilitate future integration.

Structural gaps in language accessibility compound distress, reduce autonomy, and threaten safety. These cases underscore that interpreter services alone are insufficient. Integrating validated multilingual tools into EMRs, standardizing translated discharge instructions, and expanding access to in-person interpreters are critical steps toward equitable care. Institutionalizing linguistically responsive systems is essential for ensuring safety, equity, and dignity in palliative care for patients with NELP.

Many European countries independently conduct horizon scanning activities. However, the costs, time, and resources required can be prohibitive. To address this, the International Horizon Scanning Initiative (IHSI) was launched in 2019. IHSI aims to facilitate decision-makers and payers in negotiating fair prices and preparing for potentially disruptive pharmaceuticals. IHSI developed the Joint Horizon Scanning Database, a repository of pharmaceuticals expected to enter the European market, and initiated a series of High Impact Reports (HIRs) to highlight pharmaceuticals that have the potential to significantly impact healthcare systems. This paper outlines the development of key performance indicators (KPIs) that can be used to evaluate IHSI’s work.

In close collaboration with representatives from IHSI member countries and its Executive Committee, the following KPIs were developed: “Number of IHSI member countries”, “Embedding of IHSI in national health technology assessment procedures”, “Database coverage”, “Data completeness”, “Data timeliness”, “Accuracy of identifying disruptive pharmaceuticals”, “Accuracy of identifying non-disruptive pharmaceuticals”, “Use of HIRs in preparing for disruption to the healthcare system”, and “Use of HIRs in price negotiations and financial arrangements”. Among these, “Accuracy of identifying disruptive pharmaceuticals” was considered most important, followed by “Data timeliness” and “Data completeness”. Additionally, based on consultations with nonmember countries, strategies for improvement were identified should the KPIs reveal areas for improvement. These include involving patients in the selection of pharmaceuticals and conducting reputation surveys alongside measuring KPIs. While the KPIs and strategies for improvement are specific to IHSI, they can be tailored to support other (international) horizon scanning initiatives.

To explore the feasibility and effect of video-assisted minimally invasive surgery for combined heart valvular diseases through an intercostal incision.

From July 2022 to April 2025, a total of 50 video-assisted minimally invasive combined heart valve surgeries were performed in the Department of Cardiovascular Surgery of the First Affiliated Hospital of Anhui Medical University. Combined heart valve procedures include mitral and tricuspid valve surgery and mitral and aortic valve surgery, as well as large atrial septal defect repair combined with mitral and tricuspid valve surgery. The 4th right intercostal incision along the anterior axillary line was set as the primary access for the surgical procedure of combined mitral and tricuspid valves. The 3rd intercostal incision next to the sternum was set as the primary access for the surgical procedure of combined aortic and mitral valves. The 4th right intercostal incision along the midclavicular line was set as the primary access for the surgical procedure of combined mitral and tricuspid valves concomitant with a large defect of the atrial septal. The perioperative data of patients was collected.

All patients underwent the video-assisted minimally invasive surgery completely. A total of 49 patients were discharged as expected except for only 1 older patient who was transferred into a local medical institution for extended rehabilitation due to delayed postoperative awakening. Postoperatively, excellent function of replaced prosthetic valves without paravalvular leaking has been confirmed. Moreover, there was no or less than mild regurgitation for repaired mitral and tricuspid valves. Also, postoperative complications, including III atrioventricular block, renal failure, and severe hypoxaemia, have not been found.

Video-assisted minimally invasive surgery for combined heart valves is safe and effective with a short-term satisfactory outcome.

Idiopathic infantile arterial calcification is a rare autosomal recessive disorder characterised by extensive calcification and proliferation of the intimal layer of the large and medium sized arteries.

The diagnosis is usually made at autopsy or in the neonatal period, when there is cardiac failure. Prenatal diagnosis is possible in the latter half of pregnancy when there are hyperechoic vessel walls, hypertrophied ventricular musculature, and nonimmune fetal hydrops. The number of cases diagnosed before birth is low.

This study presents a 27-week pregnant patient diagnosed with widespread calcification in the aorta and pulmonary arteries, severe pericardial effusion, and hydrops fetalis during fetal echocardiographic examination.

This case report reminds paediatric cardiologists, radiologists, and perinatologists that they should be familiar with widespread arterial calcification. It emphasises that idiopathic infantile arterial calcification, a very rare condition, should be considered among the etiologic factors when hydrops fetalis is detected on ultrasound.

Hospitals are at the front line of adopting new health technologies, yet decision-making is often hampered by insufficient evidence, limited context, and misaligned priorities. Hospital-based health technology assessment (HB-HTA) provides a structured mechanism to evaluate innovations at the institutional level. However, published accounts of HB-HTA implementation remain scarce, particularly in Asian contexts.

We describe Singapore General Hospital’s (SGH) approach to institutionalizing HB-HTA through a three-pronged strategy: (1) structured two-page narrative proposals to ensure clarity, rigor, and alignment with organizational priorities; (2) establishment of a dedicated HB-HTA team – the Impact Assessment, Program Evaluation, and Implementation Research team; and (3) targeted training programs to build capacity among clinical and managerial staff. Evaluation of the framework included formative feedback from proposers and senior leaders, surveys of participant satisfaction, and qualitative interviews.

Between 2023 and 2024, SGH piloted and scaled the HB-HTA framework, reviewing 15 proposals exceeding USD $40 million across domains, including artificial intelligence, robotics, diagnostics, and therapeutic devices. Training workshops engaged 55 participants with high Net Promoter Scores (≥50 percent), while surveys of senior leadership showed that 91 percent were satisfied or very satisfied with the process. Qualitative feedback highlighted improved strategic alignment, transparency, and confidence in decision-making.

SGH’s experience demonstrates that embedding HB-HTA requires deliberate organizational design, leadership commitment, and stakeholder engagement. By combining concise narrative proposals with independent in-house assessments, hospitals can strengthen governance, foster accountability, and support value-driven innovation. This model offers a practical roadmap for institutions seeking to formalize HB-HTA within their decision-making processes.

Ventricular perforation is a serious complication of percutaneous myocardial biopsy. Accurate orientation of the biopsy forceps toward the ventricular septum under fluoroscopy is essential to minimise this risk. However, in paediatric patients, variations in ventricular septal orientation complicate proper forceps alignment. No previous studies have addressed this variability in children.

We retrospectively analysed paediatric patients who underwent myocardial biopsy between January 2019 and June 2023. The angle of the ventricular septum relative to the sagittal plane was measured using cardiac CT. Biopsies were performed under fluoroscopic guidance, with individualised angles adjusted to align with the septum. Fluoroscopic images were used to calculate the angle between the biopsy forceps and the septum and the combined angle relative to the sagittal plane.

Sixteen patients underwent a total of 85 biopsies; only the first biopsy per patient was included in the analysis. The mean angle of the septum was 54.3° (range: 30.0–75.0°), the mean angle between forceps and septum was 21.3° (range: 3.5–53.4°), and the combined angle relative to the sagittal plane was 75.6° (range: 45.0–115.7°). No cases of ventricular perforation were observed.

Ventricular septal orientation varies significantly in paediatric patients. Individualised adjustment of fluoroscopic angles based on pre-procedural CT measurements allows accurate positioning of biopsy forceps and may reduce the risk of severe complications.