The miR-9-5p/CXCL11 pathway is a key target of hydrogen sulfide-mediated inhibition of neuroinflammation in hypoxic ischemic brain injury

We previously showed that hydrogen sulfide(H2S)has a neuroprotective effect in the context of hypoxic ischemic brain injury in neonatal mice.However,the precise mechanism underlying the role of H2S in this situation remains unclear.In this study,we used a neonatal mouse model of hypoxic ischemic brain injury and a lipopolysaccharide-stimulated BV2 cell model and found that treatment with L-cysteine,a H2S precursor,attenuated the cerebral infarction and cerebral atrophy induced by hypoxia and ischemia and increased the expression of miR-9-5p and cystathionineβsynthase(a major H2S synthetase in the brain)in the prefrontal cortex.We also found that an miR-9-5p inhibitor blocked the expression of cystathionineβsynthase in the prefrontal cortex in mice with brain injury caused by hypoxia and ischemia.Furthermore,miR-9-5p overexpression increased cystathionine-β-synthase and H2S expression in the injured prefrontal cortex of mice with hypoxic ischemic brain injury.L-cysteine decreased the expression of CXCL11,an miR-9-5p target gene,in the prefrontal cortex of the mouse model and in lipopolysaccharide-stimulated BV-2 cells and increased the levels of proinflammatory cytokines BNIP3,FSTL1,SOCS2 and SOCS5,while treatment with an miR-9-5p inhibitor reversed these changes.These findings suggest that H2S can reduce neuroinflammation in a neonatal mouse model of hypoxic ischemic brain injury through regulating the miR-9-5p/CXCL11 axis and restoringβ-synthase expression,thereby playing a role in reducing neuroinflammation in hypoxic ischemic brain injury.

Randomized trial estimating effects of hypnosis versus progressive muscle relaxation on medical students’test anxiety and attentional bias

BACKGROUND Test anxiety is prevalent among medical students and leads to impaired academic performance.Test-related attentional bias has been identified as an important maintaining factor in test-anxious individuals.AIM To evaluate whether hypnosis and progressive muscle relaxation(PMR)could modify medical college students’test anxiety and attentional bias.METHODS A total of 598 medical students were screened.The participants were divided into higher and lower test anxiety groups according to their scores on the test anxiety scale(TAS).Ninety medical college students with high TAS score were randomly assigned to a hypnosis or PMR group.Another 45 students with low TAS score were included,forming a baseline control group.The intervention was conducted weekly for 6 wk,and each session lasted approximately 30 min.The total intervention time and the number of intervention sessions for the hypnosis and PMR groups were equal.Data were collected at the pretest,posttest,and 2-mo follow-up.RESULTS Hypnosis group participants had a significantly lower TAS score at posttest(t=-21.827,P<0.001)and at follow-up(t=-14.824,P<0.001),compared to that at pretest.PMR group participants also had a significantly lower TAS score at posttest(t=-10.777,P<0.001)and at follow-up(t=-7.444,P<0.001),compared to that at pretest.At the posttest level,the hypnosis group had a significantly lower TAS score than the PMR group(t=-3.664,P<0.001).At the follow-up level,the hypnosis group also had a significantly lower TAS score than the PMR group(t=-2.943,P=0.004).Clinically significant improvement was found in both the hypnosis and PMR groups(hypnosis=64.0%;PMR=62.22%).Hypnosis was more effective than PMR in reducing test anxiety among medical college students.Hypnosis could modify attentional bias toward threatening stimuli,but PMR could not.CONCLUSION These results suggest that attentional bias plays an important role in test anxiety treatment.

Population aging, medicalization of death and death education in China

Wuhan University,the development of death education in China has a history of more than 30 years.But it has lacked the clout it deserves in China.However,in recent years,death education has begun to attract more and more attention from the medical community.Various lectures and pieces of training related to death education held by the government and medical institutions,as well as related academic salons,seminars,workshops and“Death Cafes”held by the people have appeared and become popular.Death education has been developed in China for more than 30 years,why has it suddenly become popular and even popular in recent years?This has an important relationship with China’s aging population and the medicalization of death.

Assessing the effectiveness of internetbased interventions for mental health outcomes:an umbrella review

Internet-based interventions(IBIs)for behavioural health have been prevalent for over two decades,and a growing proportion of individuals with mental health concerns prefer these emerging digital alternatives.However,the effectiveness and acceptability of IBIs for various mental health disorders continue to be subject to scholarly debate.We performed an umbrella review of meta-analyses(MAs),conducting literature searches in PubMed,Web of Science,Embase,Cochrane and Ovid Medline from their inception to 17 January 2023.A total of 87MAs,reporting on 1683 randomised controlled trials and 295589 patients,were included.The results indicated that IBIs had a moderate effect on anxiety disorder(standardised mean difference(SMD)=0.53,95%CI 0.44 to 0.62)and post-traumatic stress disorder(PTSD)(SMD=0.63,95%CI 0.38 to 0.89).In contrast,the efficacy on depression(SMD=0.45,95%CI 0.39 to 0.52),addiction(SMD=0.23,95%CI 0.16 to 0.31),suicidal ideation(SMD=0.23,95%CI 0.16 to 0.30),stress(SMD=0.41,95%CI 0.33 to 0.48)and obsessive-compulsive disorder(SMD=0.47,95%CI 0.22 to 0.73)was relatively small.However,no significant effects were observed for personality disorders(SMD=0.07,95%CI-0.13 to 0.26).Our findings suggest a significant association between IBIs and improved mental health outcomes,with particular effectiveness noted in treating anxiety disorders and PTSD.However,it is noteworthy that the effectiveness of IBIs was impacted by high dropout rates during treatment.Furthermore,our results indicated that guided IBIs proved to be more effective than unguided ones,playing a positive role in reducing dropout rates and enhancing patient adherence rates.

Hydrogen sulfide reduces oxidative stress in Huntington's disease via Nrf2

The pathophysiology of Huntington's disease involves high levels of the neurotoxin quinolinic acid. Quinolinic acid accumulation results in oxidative stress, which leads to neurotoxicity. However, the molecular and cellular mechanisms by which quinolinic acid contributes to Huntington's disease pathology remain unknown. In this study, we established in vitro and in vivo models of Huntington's disease by administering quinolinic acid to the PC12 neuronal cell line and the striatum of mice, respectively. We observed a decrease in the levels of hydrogen sulfide in both PC12 cells and mouse serum, which was accompanied by down-regulation of cystathionine β-synthase, an enzyme responsible for hydrogen sulfide production. However, treatment with NaHS(a hydrogen sulfide donor) increased hydrogen sulfide levels in the neurons and in mouse serum, as well as cystathionine β-synthase expression in the neurons and the mouse striatum, while also improving oxidative imbalance and mitochondrial dysfunction in PC12 cells and the mouse striatum. These beneficial effects correlated with upregulation of nuclear factor erythroid 2-related factor 2 expression. Finally, treatment with the nuclear factor erythroid 2-related factor 2inhibitor ML385 reversed the beneficial impact of exogenous hydrogen sulfide on quinolinic acid-induced oxidative stress. Taken together, our findings show that hydrogen sulfide reduces oxidative stress in Huntington's disease by activating nuclear factor erythroid 2-related factor 2,suggesting that hydrogen sulfide is a novel neuroprotective drug candidate for treating patients with Huntington's disease.

Neuroprotective effect of pretreatment with ganoderma lucidum in cerebral ischemia/reperfusion injury in rat hippocampus

Ganoderma lucidum is a traditional Chinese medicine, which has been shown to have both an-tioxidative and anti-inflammatory effects, and noticeably decreases both the infarct area and neuronal apoptosis of the ischemic cortex. This study aimed to investigate the protective effects and mechanisms of pretreatment with ganoderma lucidum （by intragastric administration） in cerebral ischemia/reperfusion injury in rats. Our results showed that pretreatment with ganoderma lucidum for 3 and 7 days reduced neuronal loss in the hippocampus, diminished the content of malondialdehyde in the hippocampus and serum, decreased the levels of tumor necrosis factor-a and interleukin-8 in the hippocampus, and increased the activity of superoxide dismutase in the hippocampus and serum. These results suggest that pretreatment with ganoderma lucidum was protective against cerebral ischemia/reperfusion injury through its anti-oxidative and an-tiinflammatory actions.

The delivery of miR-21a-5p by extracellular vesicles induces microglial polarization via the STAT3 pathway following hypoxia-ischemia in neonatal mice

Extracellular vesicles(EVs)from mesenchymal stromal cells(MSCs)have previously been shown to protect against brain injury caused by hypoxia-ischemia(HI).The neuroprotective effects have been found to relate to the anti-inflammatory effects of EVs.However,the underlying mechanisms have not previously been determined.In this study,we induced oxygen-glucose deprivation in BV-2 cells(a microglia cell line),which mimics HI in vitro,and found that treatment with MSCs-EVs increased the cell viability.The treatment was also found to reduce the expression of pro-inflammatory cytokines,induce the polarization of microglia towards the M2 phenotype,and suppress the phosphorylation of selective signal transducer and activator of transcription 3(STAT3)in the microglia.These results were also obtained in vivo using neonatal mice with induced HI.We investigated the potential role of miR-21a-5p in mediating these effects,as it is the most highly expressed miRNA in MSCs-EVs and interacts with the STAT3 pathway.We found that treatment with MSCs-EVs increased the levels of miR-21a-5p in BV-2 cells,which had been lowered following oxygen-glucose deprivation.When the level of miR-21a-5p in the MSCs-EVs was reduced,the effects on microglial polarization and STAT3 phosphorylation were reduced,for both the in vitro and in vivo HI models.These results indicate that MSCs-EVs attenuate HI brain injury in neonatal mice by shuttling miR-21a-5p,which induces microglial M2 polarization by targeting STAT3.

Science Letters:Crossover randomized controlled trial of the electronic version of the Chinese SF-36

Objectives:to verify the feasibility and reliability of the electronic version of Chinese SF-36 based on the Quality-of-Life-Recorder. Design: A crossover randomized controlled trial, comparing a paper-based and an electronic version of the Chinese SF-36, was conducted. According to generated random numbers, interviewees were asked to fill out either the electronic version or the paper version first. The second version was filled in after a pause of at least 10 min. Settings and participants: One group of 100 medical students at the School of Medicine of Zhejiang University and the other group of 50 outpatients at a clinic for general practice in Hangzhou City (China) were eventually recruited in this study. Results: The acceptance of the electronic version was good (60% of medical students and 84% of outpatients preferred the electronic version). At the level of eight-scale scores, the mean-difference for each scale (except for general health) between the two versions was less than 5%. At the level of 36 questions, the percentage of "exact agreement" ranged within 64%～99%; the percentage of "global agreement" ranged within 72%～99%; 77% of the kappa coefficients demonstrated "good/excellent agreement" and 23% of the kappa coefficients demonstrated "medium agreement". Conclusion: This study, for the first time, can provide empirical basis for the confirmation of the feasibility and reliability of the electronic version of the Chinese SF-36 and may provide an impulse towards widespread deployment of the Quality-of-Life-Recorder in Chinese populations.

Menopause and cognitive impairment:A narrative review of current knowledge

A severe impairment of cognitive function characterizes dementia.Mild cognitive impairment represents a transition between normal cognition and dementia.The frequency of cognitive changes is higher in women than in men.Based on this fact,hormonal factors likely contribute to cognitive decline.In this sense,cognitive complaints are more common near menopause,a phase marked by a decrease in hormone levels,especially estrogen.Additionally,a tendency toward worsened cognitive performance has been reported in women during menopause.Vasomotor symptoms(hot flashes,sweating,and dizziness),vaginal dryness,irritability and forgetfulness are common and associated with a progressive decrease in ovarian function and a subsequent reduction in the serum estrogen concentration.Hormone therapy(HT),based on estrogen with or without progestogen,is the treatment of choice to relieve menopausal symptoms.The studies conducted to date have reported conflicting results regarding the effects of HT on cognition.This article reviews the main aspects of menopause and cognition,including the neuroprotective role of estrogen and the relationship between menopausal symptoms and cognitive function.We present and discuss the findings of the central observational and interventional studies on HT and cognition.

Neuroprotective mechanism of L-cysteine after subarachnoid hemorrhage

Hydrogen sulfide,which can be generated in the central nervous system from the sulfhydryl-containing amino acid,L-cysteine,by cystathionine-β-synthase,may exert protective effects in experimental subarachnoid hemorrhage;however,the mechanism underlying this effect is unknown.This study explored the mechanism using a subarachnoid hemorrhage rat model induced by an endovascular perforation technique.Rats were treated with an intraperitoneal injection of 100 mM L-cysteine(30μL)30 minutes after subarachnoid hemorrhage.At 48 hours after subarachnoid hemorrhage,hematoxylin-eosin staining was used to detect changes in prefrontal cortex cells.L-cysteine significantly reduced cell edema.Neurological function was assessed using a modified Garcia score.Brain water content was measured by the wet-dry method.L-cysteine significantly reduced neurological deficits and cerebral edema after subarachnoid hemorrhage.Immunofluorescence was used to detect the number of activated microglia.Reverse transcription-polymerase chain reaction(RT-PCR)was used to detect the levels of interleukin 1β and CD86 mRNA in the prefrontal cortex.L-cysteine inhibited microglial activation in the prefrontal cortex and reduced the mRNA levels of interleukin 1βand CD86.RT-PCR and western blot analysis of the complement system showed that L-cysteine reduced expression of the complement factors,C1q,C3αand its receptor C3aR1,and the deposition of C1q in the prefrontal cortex.Dihydroethidium staining was applied to detect changes in reactive oxygen species,and immunohistochemistry was used to detect the number of NRF2-and HO-1-positive cells.L-cysteine reduced the level of reactive oxygen species in the prefrontal cortex and the number of NRF2-and HO-1-positive cells.Western blot assays and immunohistochemistry were used to detect the protein levels of CHOP and GRP78 in the prefrontal cortex and the number of CHOP-and GRP78-positive cells.L-cysteine reduced CHOP and GRP78 levels and the number of CHOP-and GRP78-positive cells.The cystathionine-β-synthase inhibitor,aminooxyacetic acid,significantly reversed the above neuroprotective effects of L-cysteine.Taken together,L-cysteine can play a neuroprotective role by regulating neuroinflammation,complement deposition,oxidative stress and endoplasmic reticulum stress.The study was approved by the Animals Ethics Committee of Shandong University,China on February 22,2016(approval No.LL-201602022).

Applicability Evaluation of Simplified Cognitive Behavioral Therapy

背景:我们在国内较早开展并研发了针对焦虑症的结构化认知行为治疗操作手册,本研究在前期研究基础上对简化认知行为治疗的适宜性进行评价。目的:通过多中心临床对照实验,评价简化认知行为治疗(Simplified Cognitive Behavioral Therapy,SCBT)的适宜性。方法:通过来自不同级别的精神卫生专科医疗机构和综合医院精神科等多个中心,对广泛性焦虑患者进行SCBT的临床对照研究,分为3组:SCBT组,SCBT+药物组和药物组。比较三组脱落率,接受SCBT患者对治疗满意度以及治疗师对SCBT评价。结果:(1)三组脱落率差异没有统计学意义。(2)接受SCBT的两组患者仅在治疗时间和次数上差异有统计学意义,SCBT组比SCBT+药物组患者治疗满意度高。(3)18名SCBT实施人员均认为操作手册内容容易理解、易于操作,并到达治疗目标。结论:SCBT对广泛性焦虑患者适宜性较强,有望成为在不同级别医疗机构应用推广的心理治疗方法。

Development of a psychosocial functioning questionnaire for patients with major depressive disorder

Background The importance of psychosocial functioning in the assessment,diagnosis and treatment of major depressive disorder(MDD)is widely recognised.However,there is a lack of effective scales to assess psychosocial functioning in patients with MDD.Aims To develop a professional questionnaire to evaluate the psychosocial functioning of patients with MDD.Methods Using a literature review,an open-ended questionnaire survey,and patient interviews,a theoretical model of psychosocial functioning was constructed,and an initial questionnaire was formed which included four dimensions.After two rounds of testing,using items analysis and exploratory factor analysis,a finalized questionnaire was created.There were 460 patients with MDD selected from six psychiatric hospitals for formal testing using a convenience sampling method.Forty patients were randomly selected and retested one week later to evaluate the test-retest reliability of the scale.The Patient Health Questionnaire-9(PHQ-9),Short Form of Quality of Life Enjoyment and Satisfaction Questionnaire(Q-LES Q SF),Sheehan Disability Scale(SDS),and Dysfunctional Attitudes Scale(DAS)provided major standards to check the criterion validity of this questionnaire.Correlation analysis,confirmatory factor analysis,and internal consistency reliability testing were used to examine other psychometric characteristics of the finalized questionnaire.Results The Psychosocial Functioning Questionnaire(PFQ)for patients with MDD included three dimensions:psychological cognitive functioning,subjective well-being,and social functioning,with a total of 18 items.The overall internal consistency reliability of the questionnaire was 0.957,and the test-retest reliability was 0.840.Confirmatory factor analysis showed that the model fitted well:Goodness of Fit Index(GFI)=0.888;Root Mean SquareError of Approximation(RMSEA)=0.085.The total score of PFQ was significantly correlated with the total score of PHQ-9,DAS,SDS and Q-LES Q SF(|r|=0.599-0.870,p<0.001).Conclusions The Psychosocial Functioning Questionnaire has good reliability and validity.It can be used to measure the psychosocial functioning of patients with MDD.

Prevalence and dynamic features of psychological issues among Chinese healthcare workers during the COVID-19 pandemic:a systematic review and cumulative meta-analysis

Background The COVID-19 pandemic has placed tremendous pressure on healthcare workers who are at the frontline in the battle against it,causing various forms of psychological distress.Aims To outline the prevalence and dynamic changing features of medical workers’psychological issues and to review the related national policies during the COVID-19 pandemic in China.Methods We systematically searched for studies on the psychological states of Chinese medical staff from 1 January 2020 to 8 May 2020.The aggregate prevalence of each psychological issue was calculated and plotted to observe the changes over time.Policies on psychological support for medical staff during the pandemic were reviewed to explore their link to the prevalence of psychological problems.Results In total,26 studies were included in this study.A total of 22062 medical workers were surveyed from 31 January to 27 February 2020.Medical staff exhibited a substantial prevalence of anxiety symptoms,depression symptoms,stress-related symptoms and sleep problems during the survey period,with aggregate prevalence rates of 27.0%,26.2%,42.1%and 34.5%,respectively.Cumulative meta-analyses revealed that the prevalence of psychological distress peaked at the beginning of the pandemic and subsequently exhibited a slow downward trend.Conclusion Chinese medical staff displayed significant psychological disturbance during the outbreak of the COVID-19 pandemic,which was especially severe at the early stage.Implementing supportive policies may help alleviate ongoing psychological problems in healthcare workers.

Effects of smartphone-based interventions and monitoring on bipolar disorder:A systematic review and meta-analysis

BACKGROUND Recently,there has been a range of studies about smartphone-based interventions and monitoring for reducing symptoms of bipolar disorder(BD).However,their efficacy for BD remains unclear.AIM To compare the effect of smartphone-based interventions and monitoring with control methods in treating patients with BD.METHODS A systematic literature search was performed on PubMed,Embase,Clinical trials,psycINFO,Web of Science,and Cochrane Library.Randomized clinical trials(RCTs)or single-group trials in which smartphone-based interventions and monitoring were compared with control methods or baseline in patients with symptoms of BD were included.Data were synthesized using a random-effects or a fixed-effects model to analyze the effects of psychological interventions and monitoring delivered via smartphone on psychiatric symptoms in patients with BD.The primary outcome measures were set for mania and depression symptoms.Subgroups were created to explore which aspects of smartphone interventions are relevant to the greater or lesser efficacy of treating symptoms.RESULTS We identified ten articles,including seven RCTs(985 participants)and three single-group trials(169 participants).Analysis of the between-group study showed that smartphone-based interventions were effective in reducing manic[g=-0.19,95%confidence interval(CI):-0.33 to-0.04,P=0.01]and depressive(g=-0.28,95%CI:-0.55 to-0.01,P<0.05)symptoms.In within-group analysis,smartphone-based interventions significantly reduced manic(g=0.17,95%CI:0.04 to 0.30,P<0.01)and depressive(g=0.48,95%CI:0.18 to 0.78)symptoms compared to the baseline.Nevertheless,smartphone-based monitoring systems significantly reduced manic(g=0.27,95%CI:0.02 to 0.51,P<0.05)but not depressive symptoms.Subgroup analysis indicated that the interventions with psychoeducation had positive effects on depressive(g=-0.62,95%CI:-0.81 to-0.43,P<0.01)and manic(g=-0.24,95%CI:-0.43 to-0.06,P=0.01)symptoms compared to the controlled conditions,while the interventions without psychoeducation did not(P>0.05).The contacts between therapists and patients that contributed to the implementation of psychological therapy reduced depression symptoms(g=-0.47,95%CI:-0.75 to-0.18,P=0.01).CONCLUSION Smartphone-based interventions and monitoring have a significant positive impact on depressive and manic symptoms of BD patients in between-group and within-group analysis.

Individuation and the Feminine Soul: Study of Feminine Archetypal Images Carried out on Surgical Patients

This article is the result of a research carried out in a private hospital of Belo Horizonte, Brazil. The patient care model of the Mastology Department includes an interdisciplinary staff that aims for the comprehensive treatment of these surgical patients. The research is based on clinical approach, under the framework of Analytical Psychology. Feminine archetypal images are symbolically represented by the Main Goddesses of the Olympus. It is natural for one of these expressions to prevail throughout a woman’s life, or even in specific moments of her life, but it is important to recognize that all of them are part of the feminine soul. We can, therefore, define and understand the Goddesses from Greek Mythology symbolically as being representative of the various feminine psychogenic forces that are projected. In reality, they are internal images that can be used to help know and understand personal issues and changes that are necessary in a woman’s life, enabling personal growth and the possibility to identify herself with the more authentic elements of her being. In this work experience, the feminine force showed itself to be a force of creation, of expression and of overcoming.

Stress and Resources in Women Attending an Inpatient Prevention/Rehabilitation Measure for Parents: Secondary Analysis of Quality Assurance Data

Questionnaire data from two projects on the development of quality assurance instruments for an inpatient rehabilitation/prevention program for parents were used for a secondary analysis. In this analysis, the associations of gains in a psychosocial resource (parenting self-efficacy) and two types of stressors experienced by mothers at the start of treatment (parenting hassles, depressive symptoms) with general life satisfaction and satisfaction with health at the end of treatment were explored. Structural equation modeling was applied to data from N = 1724 female patients. Potential resource-stressor interactions were tested using the Latent Moderated Structural Equations approach. Results showed that parenting hassles were negatively associated with general life satisfaction and satisfaction with health while self-efficacy gains were weakly positively correlated with both variables. No interaction of parenting hassles and self-efficacy gains was found. Depressive symptoms were negatively associated with both satisfaction measures. In these models, self-efficacy gains were not substantially correlated with life satisfaction, but showed a small association with satisfaction with health. There was no significant interaction of depressive symptoms and self-efficacy gains. The findings imply that interventions for distressed mothers—as exemplarily illustrated by this inpatient setting—should focus on identifying and reducing initial stressors as these may continue to impair mothers’ subjective health despite gains in parenting-related resources.

A meta-analysis of risk factors for epilepsy after acute ischaemic stroke and the development of a predictive model

Objective:To screen risk factors for epilepsy after acute ischaemic stroke based on meta-analysis and cohort study and to establish a predictive model.Methods:Computer searches of MEDLINE,Embase,Cochrane library,Web of Scinence,PubMed,CNKI,and WanFang Data data were conducted to collect literature on epilepsy after in acute ischemic stroke,from database creation to September 1,2022.The RRs and their 95%confidence intervals(CI)for risk factors for post stroke epilepsy were extracted for each study,and pooled estimates of the RRs and 95%CIs for each study were generated using either a random-effects model or a fixed-effects model.Beta coefficients for each risk factor were calculated based on the combined RR and their corresponding 95%CIs.The beta coefficients were multiplied by 10 and rounded.Results:Ten articles were identified for final inclusion in this meta-analysis,with a total of 141948 cases and 3702 cases of post stroke epilepsy.The risk factors included in the final risk prediction model were infarct size(RR 4.67,95%CI 1.41~15.47;P=0.01),stroke recuRRence(RR 2.48,95%CI 2.01~3.05;P<0.00001),stroke etiology(RR 1.70,95%CI 1.34~2.15;P<0.00001),stroke severity(RR 1.70,95%CI 1.34~2.15;P<0.00001),and stroke risk.stroke severity(RR 1.53,95%CI 1.39~1.70;P<0.00001),NIHSS score(RR 2.91,95%CI 1.64~5.61;P=0.0003),early-onset epilepsy(RR 5.62,95%CI 5.08~6.22;P<0.00001),cortical lesions(RR 3.83.95%CI 2.23~6.58;P<0.00001),total anterior circulation infarction(RR 18.94,95%CI 10.38~34.57;P<0.00001),partial anterior circulation infarction(RR 4.39,95%CI 2.29~8.40;P<0.00001),cardiovascular events(RR 1.78,95%CI 1.59~1.99;P<0.00001).Conclusion:Based on a systematic review and meta-analysis,we developed a simple risk prediction model for late epilepsy in baseline ischemic stroke that integrates clinical risk factors,including infarct size,stroke recurrence,stroke etiology,stroke severity,NIHSS score,early onset epilepsy,cortical lesions,stroke subtype,and cardiovascular events.

Premature Termination of Treatment among Adults Attending Treatment for Eating Disorders: A Critical Review

The article presents a critical review regarding the premature termination of eating disorder’s treatment among inpatients and outpatients, with the aim of identifying—emotional, psychodynamic and family-related aspects involved. The search strategy used the following MeSH terms combined by Boolean operators: “eating disorders” AND “treatment” OR “patient dropouts” OR “drop-out/dropouts” OR “attrition” OR “premature termination” AND “empirical study” OR “qualitative research”, for on Medline/PUBMED, PsycINFO and EMBASE databases. This article follows the PRISMA Guidelines. A total of 26 studies composed this review, of which 24 were original research articles, 1 was a review and 1 a theoretical article. Only two articles applied qualitative methods analyzing categories of content obtained by in-depth interviews, three combine quantitative and qualitative methods and other three present qualitative analyses while discussing quantitative studies. Further qualitative studies should be carried out to clarify meanings of dropout, premature termination of treatment, and attrition. Different expectations held by patients and by therapeutic teams, and the interpersonal difficulties of these types of patients, stand out as difficulties in constructing “therapeutic alliances”, with impacts on dropout, premature termination and attrition rates.

Prevalence of Mental Disorders and Health Service Utilization among Individuals with Turkish Migration Backgrounds in Germany: A Study Protocol for an Epidemiological Investigation

Background: There is a lack of reliable epidemiological data on prevalence and comorbidity rates of mental disorders in the migrant population in Germany. Despite existing national and international data on the extent of psychosocial burdens in migrant populations the prevalence among the study population remains unclear. The aim of this study was to collect prevalence data for the largest migrant population in Germany-individuals with Turkish migration backgrounds—using a culturally and linguistically sensitive approach. Methods: The study employs a cross-sectional design. The multi-centre study (Hamburg, Berlin) is based on a sample of individuals with Turkish migration backgrounds living in the two cities stratified by age, gender, and education. The study programme consists of three phases: 1) a qualitative focus group to collect information on how to increase the participation rate of the target population as a minority group in Germany;2) a translation phase to create culture and linguistic sensitive versions of the assessment tools (e.g., the Composite International Diagnostic Interview (CIDI) for Turkish speaking individuals;and 3) a baseline community study to assess the lifetime, 12-month and four-week prevalence and comorbidity rates of mental disorder, health care utilization and help-seeking behaviour in individuals of Turkish migration backgrounds living in Germany. Discussion: The study provides important data on the lifetime prevalence of mental disorders and health care utilization of individuals with Turkish migration backgrounds. Furthermore, the study is an important step towards gaining a better understanding of potential barriers to participation, creating resources for difficult-to- reach minorities, and understanding the need for assessing mental disorders in migrant populations. These results can offer a starting point for the initiation of the necessary structural changes for mental health care services and policies for groups with migration backgrounds.

Talking about Height and Quality of Life: A Content-Analysis of Focus Group Discussions with Short-Statured Children and Their Parents in the US

Background: To understand what life is like for US children with a diagnosis of Growth Hormone Deficiency or Idiopathic Short Stature, the impact of short stature on Health related Quality of Life (HrQoL) was qualitatively examined and needs for care from the young patients and their parents perspective were identified. Methods: Focus group discussions with 26 American-English speaking and nine American-Spanish speaking children and their parents were conducted, transcribed verbatim and subsequently qualitatively analyzed by two independent raters, using an existing coding guideline, based on the multidimensional HrQoL concept and a special software (VERBI-Software MAXQDA 10). Results: A total of 1313 statements for the English-speaking and 447 statements for the Spanish-speaking families were categorized. In the US, the strongest frequency of mention was found for the HrQoL dimension “Social” across respondents, followed by “Treatment” and “Emotion”. Conclusion: Conducting and analyzing data generated from focus groups ensure that young patients’ experiences of disease are represented in the measure of outcomes for use in clinical trials and patient care.