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Objectives: To evaluate the effectiveness of integrated models of mental healthcare in enhancing clinical outcomes, quality of life, satisfaction with care and health service delivery outcomes in young people aged 12–25 years. A secondary objective was to identify common components of integrated mental health interventions. Methods: A systematic review and meta-analysis of studies published 2001–2023 that assessed clinical or health service use outcomes of integrated care, relative to treatment as usual, for any mental health condition in 12–25 years old accessing community-based care. Results: Of 11,444 titles identified, 15 studies met inclusion criteria and 6 studies were entered in the meta-analysis. Pooled effect size found integrated care was associated with a greater reduction in depressive symptoms relative to treatment as usual at 4–6 months (standardised mean difference = −0.260, 95% confidence interval = [−0.39, −0.13], p = 0.001). Of the seven studies reporting access or engagement, all reported higher rates of both in the intervention arm. The most frequent components of integration were use of a multidisciplinary team (13/15 studies), shared treatment planning (11/15) and workforce training in the model (14/15). Conclusions: Integrated models of mental healthcare are associated with a small, but significant, increase in effectiveness for depressive symptoms relative to treatment as usual. Given integrated care may increase access and engagement, future research should focus on assessing the impact of integrated care in a wider range of settings and outcomes, including clinical and functional recovery, satisfaction with care and system-level outcomes such as cost-effectiveness. [ABSTRACT FROM AUTHOR]

Aims Peri-procedural myocardial infarction (PMI) after percutaneous coronary intervention (PCI) has been shown to be associated with worse clinical outcomes. We aimed to investigate the value of coronary plaque characteristics and physiologic disease patterns (focal vs. diffuse) assessed by coronary computed tomography angiography (CTA) in predicting PMI and adverse events. Methods and results Three hundred fifty-nine patients with normal pre-PCI high-sensitivity cardiac troponin T (hs-cTnT) underwent CTA before PCI were analysed. The high-risk plaque characteristics (HRPC) were assessed on CTA. The physiologic disease pattern was characterized using CTA fractional flow reserve-derived pullback pressure gradients (FFRCT PPG). PMI was defined as an increase in hs-cTnT to >5 times the upper limit of normal after PCI. The major adverse cardiovascular events (MACE) were a composite of cardiac death, spontaneous myocardial infarction, and target vessel revascularization. The presence of ≥3 HRPC in the target lesions [odds ratio (OR) 2.21, 95% confidence interval (CI) 1.29–3.80, P = 0.004] and low FFRCT PPG (OR 1.23, 95% CI 1.02–1.52, P = 0.028) were independent predictors of PMI. In a four-group classification according to HRPC and FFRCT PPG, patients with ≥3 HRPC and low FFRCT PPG had the highest risk of MACE (19.3%; overall P = 0.001). Moreover, the presence of ≥3 HRPC and low FFRCT PPG was an independent predictor of MACE and showed incremental prognostic value compared with a model with clinical risk factors alone [ C index = 0.78 vs. 0.60, P = 0.005, net reclassification index = 0.21 (95% CI: 0.04–0.48), P = 0.020]. Conclusions Coronary CTA can evaluate plaque characteristics and physiologic disease patterns simultaneously, which plays an important role for risk stratification before PCI. [ABSTRACT FROM AUTHOR]

Mental health disorders are responsible for 125.3 million disability-adjusted life years (DALYs) lost globally, with depression in adolescents rising faster than in adults. In total, more than 90% of the 1.2 billion adolescents in the world live in low- and middle-income countries (LMICs). Despite the rise in teenage marriage and pregnancy in LMICs, there is a paucity of research on the role of pregnancy as a risk factor for adolescent mental health, and the role of spousal connectedness as a potential protective factor. This study aims to address this gap. A total of 2408 currently married adolescent (aged 15–19 years) women from the Bangladesh Adolescent Health and Wellbeing Survey 2019–2020 were analysed. Multivariable models were used to assess the factors associated with depression symptoms and major depressive disorder (MDD). The prevalence of moderate/severe depressive symptoms or MDD among adolescents was 14.6%, well ahead of south Asian levels. The odds of having moderate/severe depressive symptoms (adjusted odds ratio [AOR]=1.94, 95% confidence interval [CI] 1.37–2.76) or MDD (AOR=1.63, 95%CI 1.18–2.25) were higher in pregnant adolescent women than in non-pregnant adolescent women. A closer relationship with one's husband reduced the risk of developing moderate/severe depressive symptoms (AOR=0.90, 95% CI 0.84–0.96) or MDD (AOR=0.91, 95% CI 0.86–0.97). Pregnancy and connectedness had no statistically significant interaction effect on depression. There is an urgent need for affordable and scalable interventions to reduce the risk of mental health morbidity in pregnant adolescent women especially in low- and middle-income countries. [ABSTRACT FROM AUTHOR]

Objective: The risk of repetition of deliberate self-harm peaks in the first 7 days after a deliberate self-harm episode. However, thus far no studies have examined the risk factors for repeating deliberate self-harm during this short-term period. We aimed to investigate the effects of socio-demographic factors, self-harm method and mental health factors in adolescents (10–19 years old) and young adults (20–29 years old). Methods: We used data linkage of population-wide administrative records from hospital inpatients and emergency departments to identify all the deliberate self-harm–related episodes that occurred in adolescents and young adults in Western Australia from 2000 to 2011. Logistic regression with generalised estimating equations was used for the analyses. Results: The incidence of repeating deliberate self-harm within the first 7 days after an index episode was 6% (403/6,768) in adolescents and 8% (842/10,198) in young adults. Socio-demographic risk factors included female gender and socioeconomic disadvantage. Compared with non-poisoning, self-poisoning predicted increased risk of having a repeated deliberate self-harm episode in males, but not in females. Borderline personality, impulse-control and substance use disorders diagnosed within one week before and one week after an index deliberate self-harm episode conferred the highest risk, followed by depressive and anxiety disorders. Having a preceding deliberate self-harm episode up to 7 days before an index episode was a strong predictor for the future repetition of a deliberate self-harm episode. Conclusion: Having a repeated deliberate self-harm episode within the first 7 days was related to a wide range of factors present at an index deliberate self-harm episode including socio-demographic characteristics, deliberate self-harm method and co-existing psychiatric conditions. These factors can inform risk assessments tailored to adolescents and young adults respectively to reduce the repetition of deliberate self-harm within a short but critical period, potentially contributing to reduce the repetition of deliberate self-harm in the long term. [ABSTRACT FROM AUTHOR]

MRI Assessment of Ablation-Induced Scarring in Atrial Fibrillation Background There is limited knowledge on the extent and location of scarring that results from catheter ablation and its role in suppressing atrial fibrillation (AF). We examined the effect of atrial fibrosis and ablation-induced scarring on catheter ablation outcomes in AF. Methods We conducted a prospective multicenter study that enrolled 329 AF patients presenting for catheter ablation. Delayed enhancement magnetic resonance imaging (DE-MRI) of the left atrium was obtained preablation. Scarring was evaluated in 177 patients with a DE-MRI scan obtained 90 days postablation. We evaluated residual fibrosis, defined as preablation atrial fibrosis not covered by ablation scar. The primary outcome was freedom from recurrent atrial arrhythmia. Results In the analysis cohort of 177 patients, preablation fibrosis was 18.7 ± 8.7% of the atrial wall. Ablation aimed at pulmonary vein (PV) isolation was performed in 163 patients (92.1%). Ablation-induced scar averaged 10.6 ± 4.4% of the atrial wall. Scarring completely encircled all 4 PVs only in 12 patients (7.3%). Residual fibrosis was calculated at 15.8 ± 8.0%. At 325 days follow-up, 35% of patients experienced recurrent arrhythmia. Multivariable Cox proportional hazards models demonstrated that baseline atrial fibrosis (HR and 95% CIs) (1.09 [1.06-1.12], P < 0.001) and residual fibrosis (1.09 [1.05-1.13], P < 0.001) were associated with atrial arrhythmia recurrence, while PV encirclement and overall scar were not. Conclusions Catheter ablation of AF targeting PVs rarely achieves permanent encircling scar in the intended areas. Overall atrial fibrosis present at baseline and residual fibrosis uncovered by ablation scar are associated with recurrent arrhythmia. [ABSTRACT FROM AUTHOR]

A new video standard called High Efficiency Video Coding (HEVC) has been recently finalized. In comparison with the H.264/AVC video coding standard, HEVC further improves the video coding rate distortion (RD) performance, but at the price of significant increase in its encoding complexity, especially in its motion estimation (ME) due to large block sizes and complicated block partition. To reduce the ME complexity in HEVC while maintaining its RD performance, in this paper we first formulate ME at the integer pixel level as a statistical inference problem and then propose a confidence interval-based ME (CIME) method. The proposed CIME method can be applied either on top of the existing fast search implemented in HEVC or on its own to replace the existing fast search implemented in HEVC. Experiments show that for the low-delay main test configuration of HEVC: 1) when applied on top of the existing fast search in HEVC, the proposed CIME method further reduces, on average, the integer-level ME time by 70% with only 1.0% increase in bit rate while maintaining the same reconstruction quality in PSNR and 2) when applied on its own to replace the existing fast search implemented in HEVC, the proposed CIME method achieves performance comparable with that of the fast search in HEVC reference software and better than that of the dynamic system fast algorithm proposed recently in the literature. [ABSTRACT FROM AUTHOR]

Objective: To investigate the association between alcohol consumption and incidence of sleep disorder.Methods: PubMed, EMBASE and OVID were searched systematically until March 2020 for cohort studies quantitatively investigating the effect of alcohol on incident sleep disorder. We conducted a random-effects meta-analysis to calculate the summary ORs (odds ratios) and 95 %CIs (confidence intervals) on the incidence of sleep disorder in relation to alcohol consumption.Results: The pooled analysis of eleven included cohort studies demonstrated that general drinking was significantly associated with incidence of sleep disorder (OR:1.37, 95 %CI:1.22,1.54,I² = 0.0 %) while heavy drinking was not (OR:1.22, 95 %CI:0.94,1.60, I² = 81.1 %). (general drinking (women <24 g/day; men <48 g/day; < 4 times/week), heavy drinking (women ≥24 g/day; men ≥48 g/day; ≥ 4times/week)).Conclusions: Findings from the present systematic review and meta-analyses showed that there was no evidence that alcohol consumption diminished sleep problems, and some evidence that general drinking might increase the sleep problems, but further study is necessary. [ABSTRACT FROM AUTHOR]

We report 5-year efficacy and safety outcomes from CheckMate 9LA in patients with metastatic non-small cell lung cancer (mNSCLC) and exploratory analyses in key patient subgroups. Adults with stage IV/recurrent NSCLC and no sensitizing EGFR/ALK alterations were randomized to receive nivolumab plus ipilimumab with chemotherapy (n = 361) or chemotherapy (n = 358). Outcomes were assessed in all randomized patients and subgroups. With 57.3 months' minimum follow-up, patients continued to derive overall survival (OS) benefit with nivolumab plus ipilimumab with chemotherapy over chemotherapy (HR, 0.73; 95% CI, 0.62–0.85; 5-year OS rates, 18% vs. 11%), regardless of tumor programmed death ligand 1 (PD-L1) expression (PD-L1 < 1%, 22% vs. 8%; PD-L1 ≥ 1%, 18% vs. 11%), histology (squamous, 18% vs. 7%; non-squamous, 19% vs. 12%), or presence of baseline brain metastases (20% vs. 6%). Five-year duration of response (DOR) rates were 19% versus 8% with nivolumab plus ipilimumab with chemotherapy versus chemotherapy, with consistent benefit across subgroups. Patients who discontinued nivolumab plus ipilimumab with chemotherapy due to treatment-related adverse events had a 5-year OS rate of 37%. Five-year progression-free survival and DOR rates in 5-year survivors were 55% versus 38% and 59% versus 46%, respectively. No new safety signals were observed in 5-year survivors, regardless of the number of ipilimumab doses received. This 5-year update supports the long-term, durable OS benefit and improved 5-year survivorship with nivolumab plus ipilimumab with chemotherapy over chemotherapy in patients with mNSCLC, regardless of tumor PD-L1 expression or histology. NCT03215706 • NIVO + IPI + chemo provided long-term, durable clinical benefit in metastatic NSCLC. • Magnitude of benefit was higher in PD-L1 < 1% or squamous histology subgroups. • NIVO + IPI + chemo improved efficacy outcomes in patients with brain metastases. • Treatment discontinuation due to TRAEs had no negative impact on efficacy. • In 5-y survivors, safety profile was consistent regardless of the no. of IPI doses. [ABSTRACT FROM AUTHOR]