Assessment of maximal heart rate is used in clinical practice to determine the degree of beta-blockade during exercise and periods of adrenergic stress. When direct measurement is not possible, indirect methods utilising heart rate prediction equations are commonly used, but their validity in children has been challenged.

Retrospective data on 109 healthy children (male 63, 58%; mean age 11.00 ± 3.09) undergoing routine exercise testing were analysed. Measured maximal heart rate was compared with estimates obtained from twenty-two prediction equations.

All prediction equations overestimated maximal heart rate in males. In females, two equations underpredicted (Fairbarn and Heinzmann-Filho et al.), whilst the remaining equations overpredicted. The equations that predicted most accurately differed between males (Fairbarn) and females (Whyte (males). The prediction equation used commonly in clinical practice, Fox (220-age), overestimated significantly in males and females (p = < 0.001). A moderate positive correlation with age and maximal heart rate was seen in males only (r = 0.3195, p = 0.0107).

This study shows that adult age regression equations do not accurately predict childhood maximal heart rate as determined by exercise testing. An inability to accurately predict maximal heart rate could have important implications for both childhood exercise prescription and the safe monitoring of pharmacological therapy that limits exertional heart rate response in children with inherited arrhythmic syndromes. In the absence of direct measurement of maximal heart rate, alternative paediatric-specific prediction methods should be developed to ensure appropriate estimation of childhood maximal heart rate.

Suicide is one of the leading causes of maternal mortality in high-income countries. Suicide prevention policy calls for maternity care providers to actively explore potential risk factors and self-reported suicidal intent with perinatal women. However, longitudinal research establishing the prevalence of suicidal intent and associated risk factors with representative cohorts of perinatal women in the UK is lacking.

This secondary analysis aimed to determine the prevalence of suicidal intent in pregnancy and postpartum, and examine factors associated with suicidal intent.

A total of 2210 women completed self-report assessments in early, mid- and late pregnancy and early postpartum. Suicidal intent was measured with the item ‘I have made plans to end my life’ (Clinical Outcomes in Routine Evaluation-10). Other variables included anxiety (Generalised Anxiety Disorder-7, Stirling Antenatal Anxiety Scale), depression (Whooley Questions), health status (EuroQoL EQ-5D-5L), mental health history, and sociodemographic and pregnancy variables.

Suicidal intent was indicated by 72 participants (3.26%, 95% CI 2.56–4.09) on at least one occasion. Suicidal intent was significantly associated with having negative feelings about pregnancy (odds ratio 3.63, 95% CI 1.99–6.63), unplanned pregnancy (odds ratio 2.03, 95% CI 1.25–3.30), previous and current mental health problems (odds ratio 3.70 95% CI 2.19–6.25), symptoms causing daily difficulties (odds ratio 5.94 95% CI 3.32–10.66) and being of Asian (odds ratio 2.62, 95% CI 1.44–4.77) or mixed ethnicity (odds ratio 3.43, 95% CI 1.49–7.93). Poor physical health in early pregnancy was also associated with suicidal intent (t = 6.37, d.f. = 2108, p < 0.001).

These findings indicate that daily difficulties associated with mental health, and negative feelings about pregnancy are important and underexplored risk factors for experiencing suicidal intent. The findings also corroborate previous research indicating that previous and existing mental health problems and ethnicity are significant risk factors.

People with diabetes have increased risk of depression that further worsens clinical outcome. However, occurrence of depression among patients with diabetes exposed to antidiabetes agents is under-studied. We investigated whether antidiabetes agents would decrease the risk of depression in people with diabetes.

This population-based cohort study identified 686,522 patients with incident type-2 diabetes between 2002-2021 in Hong-Kong who were exposed to any antidiabetes agents, using territory-wide medical-record database of public-healthcare services. Associations of exposure to antidiabetes agents and risk of first-diagnosed depression were examined by Cox proportional-hazards models for each individual agent. An array of covariates, including age, sex, calendar-year period, catchment-area, pre-existing physical/psychiatric-comorbidities, average HbA1c-level, diabetic-complications, cardiovascular/lipid-lowering medications, and presence of other antidiabetes agents under investigation was adjusted. Three sets of sensitivity-analyses were conducted by (a) restricting to patients with cumulative drug-exposure ≥90 days and ≥180 days, (b) monotherapy, and (c) incorporating commonly-used non-antidiabetic medications as exposure variables.

Lower risk of new-onset depression was associated with exposure to any antidiabetes agents (HR 0.42, 95%CI 0.39-0.45) compared with no exposure in patients with incident type-2 diabetes. Lower depression risk was associated with exposure to metformin (0.61[0.57-0.66]) compared with no antidiabetes agents, and to pioglitazone (0.25[0.10-0.63]), linagliptin (0.26[0.13-0.52]), and insulin (0.63[0.55-0.72]). Sensitivity-analyses affirmed that lower depression risk was associated with metformin and insulin.

Patients with type-2 diabetes with exposure to several antidiabetes agents is at decreased risk of new-onset depression. Further research is warranted to clarify the depression-reducing mechanisms of antidiabetes agents in this vulnerable population.

The modified endoscopic Lothrop (Draf III) procedure requires reliable mucosal coverage of the exposed bone within the frontal neo-ostium to prevent post-operative restenosis. Free mucosal grafts are effective but difficult to secure due to limited access and absent anchoring sites. We describe a novel use of bioabsorbable steroid-eluting implants as a pragmatic approach to achieve mucosal graft fixation.

Following completion of a Draf III frontal sinusotomy, a PROPEL™ implant is deployed over a free mucosal graft within the frontal neo-ostium. Endoscopic assessment is performed at standard post-operative intervals.

In our experience, the technique provides mechanical stabilisation and local steroid delivery and is associated with visually satisfactory graft apposition and mucosalisation in the post-operative period.

The use of bioabsorbable steroid-eluting implants offers a practical and complementary endoscopic adjunct in patients undergoing Draf III frontal sinus surgery, supporting graft fixation and contributing to improved long-term neo-ostium patency.

Negative metacognitive bias, underestimating one’s abilities, is consistently linked to psychopathology, yet prior work has often collapsed anxiety/stress and depression or examined depression alone. We tested the unique associations of depression, anxiety/stress, and posttraumatic stress disorder (PTSD) with metacognitive bias in post-9/11 veterans.

Veterans from the Translational Research Center for TBI and Stress Disorders (TRACTS, N = 601; 90% male; M age = 34.31) completed 21-item Depression, Anxiety, and Stress Scale (depression, anxiety/stress), CAPS-IV (PTSD), WHODAS-II Understanding/Communicating (self-reported cognition), and an objective cognition composite (assessment of executive function, memory, and attention). Bias was computed as self-report minus objective cognition. A subsample (n = 239) repeated testing ∼2 years later.

At time 1, more negative metacognitive bias was associated with greater anxiety/stress (r = −.41), depressive (r = −.37), and PTSD symptoms (r = −.31) (all ps < .001). In a simultaneous model, anxiety/stress (β = −.29 p < .001) and depressive symptoms (β = −.12, p = .045) explained unique variance though PTSD symptoms did not (β = −.03, p = .524). Longitudinally, changes in bias were uniquely predicted by symptom changes in anxiety/stress (β = −.33, p < .001) and PTSD (β = −.16, p = .001), but not depression (β = −.10, p = .137).

Across cross-sectional and longitudinal models, anxiety/stress emerged as the most consistent correlate of metacognitive bias, with weaker contributions from depression and PTSD. These findings highlight the importance of assessing the self-report versus objective cognition gap and the need to further understand the temporal relationship between anxiety/stress and metacognitive bias.

An increasing number of children and adolescents are prescribed second-generation antipsychotic medications, which may lead to cardiometabolic or other physical health impairments. It is unknown whether lifestyle interventions can prevent or manage these adverse effects.

To evaluate the effectiveness of lifestyle interventions for preventing or managing cardiometabolic risks and other adverse physical health outcomes in this population.

Four bibliographic databases were searched up to February 2024. Randomised controlled trials reporting a physical health outcome of children or adolescents (aged 6–17 years) taking antipsychotics and participating in a lifestyle intervention compared with treatment as usual (TAU) were eligible for inclusion. The Cochrane Risk of Bias 2 tool was used to assess risk of bias. Data were synthesised via a random-effects meta-analysis and narrative synthesis.

Four studies with a total of 370 participants were included. Most (75%) had a high risk of bias. Lifestyle interventions resulted in moderate but statistically non-significant reductions in participants’ body mass index (standard mean difference −0.70, 95% CI: −1.70 to 0.31) compared with TAU. Some studies reported improvements in other physical health outcomes favouring the intervention, although findings were inconsistent and varied across different measures. Reporting of secondary indicators of physical health, including participant or family health behaviours, was limited.

The effectiveness of lifestyle interventions for preventing or managing the cardiometabolic risk and other adverse physical health outcomes in this population is unclear due to the limited number of available trials, small samples and high risk of bias. Larger trials are needed.

Posttraumatic stress disorder (PTSD) has been associated with advanced epigenetic age cross-sectionally, but the association between these variables over time is unclear. This study conducted meta-analyses to test whether new-onset PTSD diagnosis and changes in PTSD symptom severity over time were associated with changes in two metrics of epigenetic aging over two time points.

We conducted meta-analyses of the association between change in PTSD diagnosis and symptom severity and change in epigenetic age acceleration/deceleration (age-adjusted DNA methylation age residuals as per the Horvath and GrimAge metrics) using data from 7 military and civilian cohorts participating in the Psychiatric Genomics Consortium PTSD Epigenetics Workgroup (total N = 1,367).

Meta-analysis revealed that the interaction between Time 1 (T1) Horvath age residuals and new-onset PTSD over time was significantly associated with Horvath age residuals at T2 (meta β = 0.16, meta p = 0.02, p-adj = 0.03). The interaction between T1 Horvath age residuals and changes in PTSD symptom severity over time was significantly related to Horvath age residuals at T2 (meta β = 0.24, meta p = 0.05). No associations were observed for GrimAge residuals.

Results indicated that individuals who developed new-onset PTSD or showed increased PTSD symptom severity over time evidenced greater epigenetic age acceleration at follow-up than would be expected based on baseline age acceleration. This suggests that PTSD may accelerate biological aging over time and highlights the need for intervention studies to determine if PTSD treatment has a beneficial effect on the aging methylome.

The Early Minimally Invasive Removal of Intracerebral Hemorrhage (ENRICH) trial demonstrated that minimally invasive surgery to treat spontaneous lobar intracerebral hemorrhage (ICH) improved functional outcomes. We aimed to explore current management trends for spontaneous lobar ICH in Canada to assess practice patterns and determine whether further randomized controlled trials are needed to clarify the role of surgical intervention.

Neurologists, neurosurgeons, physiatrists and trainees in these specialties were invited to complete a 16-question survey exploring three areas: (1) current management for spontaneous lobar ICH at their institution, (2) perceived influence of ENRICH on their practice and (3) perceived need for additional clinical trial data. Standard descriptive statistics were used to report categorical variables. The χ2 test was used to compare responses across specialties and career stages.

The survey was sent to 433 physicians, and 101 (23.3%) responded. Sixty-eight percent of participants reported that prior to publication of the ENRICH trial, spontaneous lobar ICH was primarily managed conservatively, with surgery reserved for life-threatening situations. Forty-three percent of participants did not foresee a significant increase in surgical intervention at their institution. Of neurosurgical respondents, 33% remained hesitant to offer surgical intervention beyond lifesaving operations. Only 5% reported routinely using specifically designed technologies to evacuate ICH. Seventy percent reported that another randomized controlled trial comparing nonsurgical to surgical management for spontaneous lobar ICH is needed.

There is significant practice variability in the management of spontaneous lobar ICH across Canadian institutions, stressing the need for additional clinical trial data to determine the role of surgical intervention.

Anxiety affects around one in five women during pregnancy and after birth. However, there is no systematic information on the proportion of women with perinatal anxiety disorders who want or receive treatment.

To examine (a) the prevalence of anxiety disorders during pregnancy and after birth in a population-based sample, and (b) the proportion of women with anxiety disorders who want treatment and receive treatment.

This study conducted 403 diagnostic interviews in early pregnancy (n = 102), mid-pregnancy (n = 99), late pregnancy (n = 102) or postpartum (n = 100). Participants also completed self-report measures of previous/current mental health problems and desire for treatment at every time point.

The prevalence of anxiety disorders over all time points combined was 19.9% (95% CI 16.1–24.1), with greatest prevalence in early pregnancy (25.5%, 95% CI 17.4–35.1). The most prevalent disorders were obsessive–compulsive disorder (8.2%, 95% CI 5.7–11.3) and generalised anxiety disorder (5.7%, 95% CI 3.7–8.4). The majority of women with anxiety disorders did not want professional help or treatment (79.8%). Most women with anxiety disorders who did want treatment (20.2%) were receiving treatment. The majority of participants with anxiety disorders had a history of mental health problems (64.6%).

Prevalence rates overall are consistent with previous research, lending validity to the findings. However, findings challenge the assumption that everyone with a psychological disorder wants treatment. These findings highlight the importance of relationship-based care, where individual needs and contextual barriers to treatment can be explored.

To assess changes in caregiver practices for young children after integrating the Responsive Care and Early Learning (RCEL) Addendum package into nutrition services after 10 months of implementation.

We measured changes in RCEL practices through a pre- and post-intervention assessment comprising a household survey and observations. To implement the intervention, we trained health service staff and community volunteers to deliver RCEL counselling to caregivers of children 0–23 months of age through existing community and facility-level platforms.

Jalal-Abad and Batken regions in the Kyrgyz Republic.

Caregivers of children aged 0–23 months at baseline.

We found statistically significant increases in RCEL practices, availability of early learning opportunities in the home, decreases in parenting stress and improvements in complementary feeding practices after the intervention implementation period.

Findings show that delivery of RCEL counselling using the RCEL Addendum was associated with improved responsive care practices and early learning opportunities. We also found that integration of RCEL with infant and young child feeding counselling did not disrupt nutrition service delivery or negatively affect complementary feeding outcomes, but rather suggest synergistic benefits. Given the importance of providing holistic care to support optimal early childhood development, these findings provide new evidence on how to strengthen the delivery of nurturing care services in the Kyrgyz Republic.