Tetralogy of Fallot is the most common cyanotic CHD and is ideally repaired during infancy. However, delayed diagnosis and limited access to congenital cardiac care may result in presentation during adolescence or adulthood. This study evaluated outcomes of tetralogy of Fallot repair in patients aged ≥ 13 years.

This retrospective cohort study included patients aged ≥ 13 years undergoing primary tetralogy of Fallot repair between June 2016 and June 2025. Demographic, operative, and post-operative data, including early mortality and reintervention, were analysed.

Ninety-four patients underwent repair at a median age of 15 years (interquartile range: 3) and weight of 36.5 kg (interquartile range: 12.2). Pre-operative coil embolisation of aortopulmonary collaterals was required in 26.6%. Mean cardiopulmonary bypass and aortic cross-clamp times were 114.8 ± 49.8 and 82.4 ± 35.6 minutes, respectively. Mean ventilation duration was 7.7 ± 7.1 hours, ICU stay 3.9 ± 1.0 days, and post-operative hospital stay 4.6 ± 1.3 days. Transannular patch repair was performed in 65 patients (69%), while 29 (31%) underwent pulmonary valve-preserving repair, with comparable early outcomes. Thirty-day mortality was 1.06%, and reintervention occurred in 2.1% during a mean follow-up of 38.4 months.

Primary repair of tetralogy of Fallot in late-presenting adolescents and adults can be performed with low early mortality and acceptable morbidity. Careful pre-operative assessment, including identification and management of significant aortopulmonary collaterals, and individualised right ventricular outflow tract reconstruction are important components of management. These findings support definitive repair in appropriately selected late-presenting patients.

To investigate whether socioeconomic deprivation is associated with residual or recurrent cholesteatoma following primary mastoidectomy.

A retrospective cohort study included all patients undergoing primary mastoidectomy for cholesteatoma in National Health Service Tayside between 2012 and 2020. Socioeconomic status was assessed using the Scottish Index of Multiple Deprivation 2020 and divided into quintiles. Patients were stratified into paediatric (≤16 years) and adult (>16 years) groups. Recurrence/residual rates across Scottish Index of Multiple Deprivation quintiles were compared using Fisher’s exact tests, and time to recurrence was analysed using Kaplan–Meier survival curves.

One hundred eighty-four patients were included (59 children, 125 adults). Recurrence/residual occurred in 39 per cent of children and 24 per cent of adults. In children, higher deprivation was significantly associated with risk of recurrence/residual disease (p = 0.0013). No significant association was observed in adults.

Socioeconomic deprivation is linked to higher recurrence/residual in children, highlighting disparities in postoperative outcomes and the importance of targeted follow-up.

Metabolic syndrome (MetS) is linked to later-life cognitive decline and brain aging, but early detection of vulnerability in midlife remains challenging. This study applied two methods to detect subtle changes in midlife adults with MetS: (1) latent profile analysis (LPA) to identify cognitive performance patterns and (2) an MRI-derived brain-predicted age metric to assess structural brain aging.

Participants were cognitively unimpaired, community-dwelling adults from prior studies on metabolic and brain health (N = 230; ages 40 – 65). MetS status was assigned using clinical criteria based on cardiovascular indicators and medical history. Cognitive test scores, adjusted for age, sex, and education, were analyzed using LPA, identifying four cognitive subgroups: High Memory, Low Executive, Global Average, and Low Memory. T1-weighted MRI scans were processed with brainageR to compute brain-predicted age difference (PAD). Analyses were conducted in R using chi-square tests, ANCOVA, regression, and nonparametric methods, with appropriate covariates and effect size estimates.

MetS prevalence differed across cognitive profiles (χ2 = 10.99, p = .012, V = 0.22), with higher rates in the Low Memory and Global Average groups than in the High Memory group. Individuals without MetS had younger brain ages than those with MetS (p = 0.003, η2 = 0.03). Only elevated triglycerides were associated with greater PAD (p = 0.012, η2 = 0.02). A Johnson–Neyman analysis showed the MetS–PAD association was significant between ages 40.0 and 54.6. PAD did not differ by cognitive profile.

Cognitive profiles and brain-predicted age metrics identify early vulnerability in midlife MetS, underscoring the importance of early intervention.

Few studies have examined attention-deficit/hyperactivity disorder (ADHD) symptoms in middle- and older-aged adults. We aim to examine the phenotypic expression of ADHD symptoms in these age groups.

This study comprised a random sample (N = 1,562) from the US Health and Retirement Study 2016, a representative US sample aged 50 years and over. ADHD symptoms were assessed based on the Adult ADHD Self-Report Scale.

In the primary analysis, 10 competing confirmatory factor analytic models of ADHD symptoms in middle- and older-aged adults were compared. The best-fitting model was hierarchical with a general ADHD factor at the apex and underneath symptom factors of inattention, hyperactivity, and impulsivity (ꭓ2 = 319.34, df = 91.71, P = 0.00, TLI = 0.98, CFI = 0.96, RMSEA = 0.04, 95% CI = 0.04–0.05). In complementary analyses, this model was a satisfactory fit to the data: (1) in individuals without a history of cognitive impairment or dementia, and when the general ADHD factor was specified to load on (2) cognitive function, (3) depressive symptoms (which showed adequate fit), and (4) ADHD polygenic scores, (5) in middle- and older-aged adults, and (6) when weighted to represent the US population.

These results imply a hierarchical representation of ADHD symptoms in middle- and older-aged adults consisting of a general factor at the apex with neurocognitive and genetic correlates and underneath symptom factors of inattention, hyperactivity, and impulsivity. Collectively, this model offers a novel framework to study the mechanisms of ADHD symptoms in middle- and older-aged adults and points to treatment targets.

To describe motor, respiratory and quality of life changes in a mixed cohort of adults with spinal muscular atrophy (SMA) from a single tertiary rehabilitation center in Canada and to report preliminary psychometric evidence of a nationally recommended core outcome set over 12 months.

This real-world, mixed-treatment cohort, exploratory, single-site, prospective observational study followed fifteen adults with SMA over 12 months. Participants completed the Spinal Muscular Atrophy Recommended Toolkit (SMART), which consists of eight outcome measures (OM) assessed at baseline and 12 months. Concurrent and predictive validity were assessed using Spearman’s Correlation Coefficient (SCC). Longitudinal change and sensitivity to change were evaluated using the Wilcoxon signed-rank test and standardized response mean.

Ten participants were receiving disease-modifying treatments. None of the OMs demonstrated statistically significant changes over 12 months. Respiratory and motor function measures are independently clustered into two clusters. Only the Children’s Hospital of Philadelphia – Adult Test of Neuromuscular Disorders (CHOP-ATEND) exhibited high sensitivity to change. Forced vital capacity (FVC) >2 L or peak cough flow (PCF) >200 L/min corresponds with ceiling effects of the Revised Upper Limb Module (RULM) and SMA Functional Rating Scale (SMAFRS).

This exploratory study identified two collinear clusters between SMART OMs, suggesting measurement redundancy. SMART OMs did not demonstrate significant changes over 12 months in this small mixed-treatment cohort. Developing new OMs that are valid, reliable and responsive, and optimizing OM selection will reduce clinic and patient burden, and improve clinical utility in a real-world setting.

This study aimed to evaluate the general practitioner (GP) referral pathway for adult attention deficit hyperactivity disorder (ADHD) devised by the Irish Health Service Executive’s (HSE) National Clinical Programme for Adult ADHD (NCPAA). Primary objectives were to (i) quantify GP referrals to community mental health teams (CMHTs) for adult ADHD screening, (ii) measure workload on CMHTs related to screening adult ADHD referrals without comorbid mental health problems, and (iii) quantify access to adult ADHD screening through CMHTs and subsequent assessment and treatment access through specialist adult ADHD teams.

An observational cohort design was used to retrospectively analyse ADHD-related referral data collected by clinical staff across 11 Irish CMHTs, and three specialist adult ADHD teams from January to December 2023.

There was high variability in adult ADHD referrals to CMHTs, ranging from 14 to 122 over one year. There was also high variability in the number of referrals seen by CMHTs, ranging from 9 to 82. From 304 referrals seen across 11 CMHTs, 25.3% required initial treatment for another mental health condition. Specialist adult ADHD teams received 3–4 times more referrals than they were able to assess during this timeframe.

The NCPAA has provided crucial services for adults with ADHD in Ireland. However, an increase in neurodiversity awareness and demand for services suggests that a range of referral pathways depending on complexity level may be required. Alternative models are proposed, which require allocation of resources and training through primary care, secondary mental health services and specialist teams.

To document the evolution of subjective cognitive functioning over four years in adults hospitalized after traumatic brain injury (TBI), comparing mild and moderate-severe TBI, and accounting for sociodemographic and clinical factors.

This secondary analysis of a longitudinal observational cohort study includes 222 adult participants hospitalized following a TBI (mean age = 41 ± 15 years; 29% women; 65% mild, 35% moderate-severe TBI). Data were collected via in-person/telephone interview and self-report questionnaires administered 4, 8, 12, 24, 36, and 48 months post-TBI. The primary outcome measure for subjective cognitive functioning was the Medical Outcomes Study Cognitive Functioning Scale (MOS-COG).

Mixed model analyses revealed a significant Time effect, with post hoc tests showing a better perceived cognitive functioning on the MOS-COG at 4 months than at 24 and 36 months after TBI. The TBI severity effect and TBI severity*Time interaction were not significant. Secondary effects revealed that poorer subjective cognitive functioning was associated with higher levels of symptoms of depression, anxiety, insomnia, and fatigue, and lower quality of life. Overall, the MOS-Cog score was about one standard deviation below the normative mean, suggesting greater cognitive complaints than in the general population, regardless of injury severity.

The results suggest that subjective cognitive functioning is poorer than normative values and fairly stable over four years after TBI, with a slight decrease between 4 and 24–36 months, and is similar between mild and moderate-severe TBI.

To gather and analyse information from the literature concerning the management of otitis media with effusion in adults.

A review of the English-language literature from 1970 to the present.

Ventilation tubes have been the standard treatment for otitis media with effusion in adults, but examination of the results of published studies shows that they are associated with disappointing outcomes and significant complications, notably intermittent or chronic discharge, particularly in cases associated with nasopharyngeal carcinoma. Balloon dilatation of the Eustachian tube, intratympanic steroid therapy and cortical mastoidectomy appear to be possible alternatives.

A rethink of the management of otitis media with effusion in adults is needed, together with further research. For cases not associated with nasopharyngeal carcinoma, intratympanic steroid therapy appears to be a promising option.

To understand the dietary patterns of adults and explore their association with iodine nutritional levels and thyroid function in adults.

We randomly collected 5 ml of adult urine samples and measured urinary iodine concentration (UIC) by cerium arsenate-catalysed spectrophotometry. A serum sample of 5 ml was collected for the determination of free triiodothyronine, free thyroxine and thyrotropin, and diet-related information was collected through a FFQ. Dietary patterns were extracted by principal component analysis, and the relationship between dietary patterns and iodine nutrition levels and thyroid function was explored.

A cross-sectional study involving adults in Xinjiang, China, was conducted.

A total of 435 adults were enrolled in the study.

The overall median urinary iodine of the 435 respondents was 219·73 μg/l. The dietary patterns were PCA1 (staple food pattern), PCA2 (fruit, vegetable and meat pattern), PCA3 (fish, shrimp and legume pattern) and PCA4 (dairy-based protein pattern). The correlation analyses showed that PCA1 and PCA3 were positively correlated with the UIC. The results of the multivariable analysis showed that PCA1, Q1, Q2 and Q3 were associated with an increased risk of iodine deficiency compared with Q4 ((OR): 260·41 (95 % CI: 20·16, 663·70)), 59·89 (5·64, 335·81), and 2·01 (0·15, 26·16), respectively). In PCA2, Q3 was associated with an increased risk of iodine deficiency compared with Q4 (OR: 0·16 (0·05, 0·53)). In PCA3, Q3 was associated with an increased risk of iodine deficiency compared with Q4 (OR: 0·23 (0·06, 0·90)). In PCA4, Q1 was associated with an increased risk of iodine deficiency compared with Q4 (OR: 31·30 (4·88, 200·64)).

This study demonstrated that of the four dietary patterns, the least dependent staple food pattern (Q1) had a higher risk of iodine deficiency compared with the most dependent staple food pattern (Q4). However, the current evidence on the effect of dietary patterns on thyroid function needs to be validated by further longitudinal studies that include long-term follow-up, larger sample sizes and repeated measures.

To evaluate whether changes in starch intake (in terms of amount and food sources) were associated with increments in dental caries among adults.

This is an 11-year longitudinal study (2000–2011) with duplicate assessments for all variables. A 128-item FFQ was used to estimate intake of starch (g/d) and six starch-rich food groups (potatoes, potato products, roots and tubers, pasta, wholegrains and legumes). Dental caries was assessed through clinical examinations and summarised using the number of decayed, missing and filled teeth (DMFT score). The relationship between quintiles of starch intake and DMFT score was tested in linear hybrid models adjusting for confounders.

Northern and Southern regions of Finland.

922 adults, aged 30–88 years.

Mean starch intake was 127·6 (sd: 47·8) g/d at baseline and 120·7 (55·8) g/d at follow-up. Mean DMFT score was 21·7 (6·4) and 22·4 (6·2) at baseline and follow-up. Starch intake was inversely associated with DMFT score cross-sectionally (rate ratio for highest v. lowest quintile of intake: –2·73, 95 % CI –4·64, –0·82) but not longitudinally (0·32, 95 % CI –0·12, 0·76). By food sources, the intakes of pasta (–2·77, 95 % CI –4·21, –1·32) and wholegrains (–1·91, 95 % CI –3·38, –0·45) were negatively associated with DMFT score cross-sectionally but not longitudinally (0·03, 95 % CI –0·33, 0·39 and –0·10, 95 % CI –0·44, 0·24, respectively).

Changes in the amount and sources of starch intake were not associated with changes in dental caries. Further studies should be conducted in different settings and age groups while focusing on starch digestibility and specific sources of starch.

Depression is strongly associated with risk for suicidal behaviors. However, depression is a highly heterogeneous condition (i.e. there are more than 200 combinations of DSM-5-TR depressive symptoms to correspond to a depression diagnosis). Limited research to date has taken an empirical approach to see how people cluster together based on their classification of depressive symptoms and whether people in certain classes are more likely to report suicide outcomes than other classes. This analysis leverages the National Survey on Drug Use and Health and examines classes of depressive symptoms to explore differences in suicide-related outcomes by class among adults endorsing depressive symptoms (n = 41 969).

We used latent class analysis (LCA) to identify classes of individuals’ DSM-5 depressive symptoms presentation and then explored differences in suicide-related outcomes (i.e. suicide plans, suicide attempts) by the resulting classes.

A four-class model was determined to optimize the fit criteria. Class 3 (high depressive symptoms) had significantly greater rates of suicide-related outcomes, followed by class 1 (high depressed mood and moderate worthlessness), with classes 4 and 2 having significantly lower rates of suicide-related outcomes.

The use of LCA provided valuable findings on the importance of leveraging both a multi-faceted assessment of depressive symptoms to identify cases where a high number of depressive symptoms are endorsed, and review of the specific symptoms endorsed. Worthlessness, in particular, may be of particular value to focus on within the context of suicide prevention.