CURRENT ISSUE

ABSTRACT: Background: Adult men experience a disproportionate burden of mental health morbidity yet consistently demonstrate lower rates of help-seeking compared with women. Barriers such as stigma, limited mental health literacy, and masculine norms often prevent early recognition of distress and engagement with support, contributing to prolonged difficulties and poorer outcomes. Behavioural health education interventions have been proposed as a means to address these upstream barriers. 
Objective: This systematic review and meta-analysis evaluated the effectiveness of behavioural health education interventions in improving mental health help-seeking among adult men. 
Methods: Following PRISMA 2020, we searched PubMed, ScienceDirect, and Dimensions AI for studies published from 2015 to 2025 for intervention studies with adult men aged ≥18 years. Ten studies were included and synthesised narratively. Risk of bias was assessed using RoB 2 and ROBINS-I. A random-effects meta-analysis was conducted on three RCTs reporting help-seeking intentions using the Generic Inverse Variance method, with effects expressed as Standardised Mean Differences (SMD) and 95% CIs. 
Findings: Narratively, interventions most consistently improved mental health awareness, stigma reduction, emotional openness, and help-seeking intentions. Evidence of direct behavioural change was limited. The pooled meta-analysis showed no statistically significant effect on help-seeking intentions (SMD = 0.02, 95% CI −0.19 to 0.24; p = 0.85; I² = 79%). Sensitivity analysis using a fixed-effect model yielded a small significant effect (SMD = 0.08, 95% CI 0.00 to 0.17). 
Conclusion: Behavioural health education interventions may improve psychological factors associated with help-seeking among adult men, particularly awareness, stigma-related outcomes, and readiness to seek support. However, the meta-analysis found no statistically significant pooled effect on help-seeking intentions, with substantial heterogeneity indicating variation according to intervention type, population characteristics, and delivery context.

ABSTRACT: Background : Transcatheter closure is an established treatment option for selected perimembranous ventricular septal defects (VSDs). Because of the close anatomical relationship of the perimembranous septum to the tricuspid valve, aortic valve, and conduction system, residual shunting and device–valve interactions remain important considerations during follow-up.
Case Presentation : A 14-year-old boy was referred in 2026 with progressive exertional dyspnea and occasional chest discomfort. Four years earlier, on February 5, 2022, he had undergone transcatheter closure of a perimembranous VSD at another institution using a 6/6-mm Amplatzer Duct Occluder II (ADO II). The available procedural record documented catheter-based VSD crossing, device deployment, and immediate transesophageal echocardiographic assessment before release, with satisfactory device position reported. The original catheterization laboratory fluoroscopic, angiographic, and echocardiographic images were unavailable for retrospective review. Follow-up echocardiography in 2023 and 2024 demonstrated a persistent residual VSD of approximately 5 mm without significant tricuspid regurgitation (TR) or pulmonary hypertension, and surgical closure had been advised. In 2025, the patient developed mild exertional dyspnea, which progressed to New York Heart Association (NYHA) functional class II symptoms by 2026. Preoperative transthoracic echocardiography demonstrated a 6–7-mm residual perimembranous VSD inferior to the device, with predominantly left-to-right flow and a peak Doppler gradient of approximately 87 mmHg. Ventricular systolic function was preserved, without significant TR or pulmonary hypertension. Following multidisciplinary assessment, surgery was undertaken because of the persistent residual defect, previous recommendations for definitive closure, evolving symptoms, and the anatomical relationship of the device to the tricuspid septal leaflet, with repeat transcatheter intervention considered limited and of uncertain feasibility. Surgical exploration demonstrated the ADO II between the tricuspid septal leaflet and the right-ventricular aspect of the interventricular septum, with adherence to the septal leaflet and localized leaflet distortion. The leaflet was structurally intact. The device was carefully explanted, the residual VSD was directly closed, and the distorted tricuspid septal leaflet was repaired. Intraoperative transesophageal echocardiography demonstrated complete VSD closure and satisfactory tricuspid leaflet coaptation with mild TR. At 6-month follow-up, the patient had no dyspnea or breathing difficulty, with persistent VSD closure, preserved ventricular function, and stable mild TR.
Conclusion : This case documents a late operative device–tricuspid anatomical relationship following ADO II closure of a perimembranous VSD. The principal finding was the location of the device between the tricuspid septal leaflet and the right-ventricular aspect of the interventricular septum, with leaflet adherence and localized distortion despite the absence of significant preoperative TR. Because the original implantation imaging was unavailable, the timing and mechanism of this relationship cannot be established. Furthermore, the restrictive residual VSD, preserved ventricular function, and absence of pulmonary hypertension or major ventricular volume loading do not establish the residual shunt as the direct cause of the patient's exertional symptoms. Surgical exploration permitted simultaneous device explantation, definitive VSD closure, and restoration of tricuspid leaflet coaptation, with satisfactory short-term outcome.