Community Needs Assessment for a Professional University Health Counselling Course in Cambodia

Developing health and counselling professionals remains an important part of supporting mental health services in Cambodia.This paper aims to identify how the key stakeholders and mental health experts in Cambodia consider how a university level health counselling course could contribute to addressing the needs/treatment gap for mental health services in Cambodia.In order to do this,the study consists of semi-structured interviews with stakeholders,community needs assessment,and community resource mapping.The data were drawn from 15 NGOs,various profit and not-for-profit organizations as well as two key government stakeholders.The participants were invited to take part in a stakeholders/expert semi-structured interview that lasted between 30-60 minutes at the participants’organizations.The findings revealed that all participants believe that a university level health counseling course was crucial in Cambodia to address pressing mental health issues in the country.Most participants believed that a graduate or post-graduate level program such as a B.A.or M.A.was necessary to train qualified counsellors.The program should be internationally benchmarked,with a Cambodian context.Topics should include psychopathology,professional ethics and competencies,counselling theories and interventions,trauma treatment,as well as emotional intelligence and addiction.Other topics might need to include parenting,support system for suicidal patients,self-care,staff wellbeing programs,and school counselor programs.

A Review of Grief Counselling Practices for Family Members of Oncology Patients in Hospice Care

In cancer patients, especially terminal patients, the family members of the patients will develop more serious sadness and find it difficult to face death rationally, which affects the quality of life and activities. Because of this, in the clinical treatment of oncology patients, strengthening hospice care for family members, doing a good job of death education, assisting them to face and participate in the clinical treatment of oncology in a positive way, and avoiding excessive grief can simultaneously improve the quality of life of patients and their families.

Contraceptive Continuation, Pregnancy and Abortion Rate Two Years after Post Abortion Counselling

Objectives: To estimate the contraceptive use rate, pregnancy and abortion rate two years after post abortion counselling. Methods: In this current paper we conducted a cross-sectional study from September to December 2011 among women who participated of original randomized trial. In this study 118 women who had been allocated in the group that received the personalized contraceptive counselling and 103 women who had been allocated in the group that received standard counselling service were contacted by phone. The analyzed variables were the use of contraceptive methods, reasons for not using them, satisfaction in used method, and occurrence of pregnancy and abortion. Results: The pregnancy rate was lower in the personalized counselling group (p = 0.022), whereas abortion (p = 0.543) and contraceptive use rate (p = 0.270) had no difference between groups. The overall contraceptive use rate was high in both groups and the injectable method use rate was higher in personalized counselling group (p?= 0.004). Conclusions: Two years after the intervention the pregnancy rate was lower in personalized counselling group. The contraceptive use rate had no difference between the groups, except for the injectable which the use rate was higher in the personalized counselling group. These results could be encouraging because the intervention improved the uptake of one of the long-acting methods of contraception.

Reasons for non-compliance among patients treated under Revised National Tuberculosis Control Programme(RNTCP) and their treatment outcome after structured counselling

Objective:To judge for reasons of interrupting the treatment as told by patient himself/herself and see for adherence to therapy and treatment outcome after counselling.Methods:All patients with history of interrupting the treatment presenting to chest OPD were included in this study.Counselling was done by medical officer on first interaction and by health care worker(as guidance of medical officer) subsequently.Reasons for interrupting the treatment were noted.Patients and their relatives were counselled about the urgent need for strict adherence to therapy with special focus on reasons for which that particular patient had defaulted.Results:Total 56 patients were included in the study during First Quarter of year 2007.Treatment outcomes of 40 patients were available.6 out of them had interrupted the treatment(15%)(National figures;19%and Maharashtra: 21%),13 patients died during the treatment(5 of them were Cat 2 defaulters).Multiple reasons for interrupting the treatment were present.Most common reasons were alcoholism and feeling of relief with treatment (46.4%).Conclusion:There is an urgent need for stressing upon counselling during Revised National Tuberculosis Control Programme(RNTCP) sensitization and training.Medical officers can play an important role in reducing the defaulter rate by counselling of patient and their relatives.

Infertility in China: Culture, society and a need for fertility counselling

With a high rate of infertility, it is important to understand the context of fertility and family planning in China, to inform the necessity of supportive care. A literature review was undertaken to explore the societal constructs informing perspectives of childbearing, family planning and infertility, alongside Chinese considerations of fertility treatments, including assisted reproductive technologies and fertility counselling. In China, childbearing attitudes and behaviours are shaped by tensions between traditional cultural values of the filial piety originating from Confucianism, the history of strict family planning policy, the recent termination of one-child policy and the socioeconomic circumstance. For infertile Chinese individuals, the inability to meet these childbearing expectations gives rise to significant pressure and consequent psychological distress, particularly depressive symptoms. Demographic factors such as gender, education, income and geographical location have been found to influence prevalence and degree of depression in infertile Chinese men and women. These difficulties are compounded by barriers of cultural acceptance, legislative restrictions and availability of resources for alternative options such as adoption and surrogacy. It is important that these fertility sociocultural factors are taken into consideration when assisting Chinese patients to access and utilise fertility treatment services.

Impact of Nutritional Counselling on Nutritional Status of Postmenopausal Women

The aim of the study was to assess the impact of nutrition counselling on food intake and anthropometric measurements in postmenopausal women. Sixty postmenopausal women were selected from two villages of Sangrur district and were divided into two groups—Group I (Control) and Group II (Experimental) containing 30 subjects each. Subjects of Group II were imparted nutrition counselling (NC) regarding benefits of Aloe vera and its use in diet in individual and group contacts once in a week, for a period of three months. Aloe vera plants were also distributed to be used in their diets. Dietary intake of subjects for 3 consecutive days by 24 hr recall method was recorded before and after nutrition counselling. The average daily nutrient intake of diets was calculated by using Diet Cal. Anthropometric parameters were calculated before and after counselling. Dietary survey revealed that intake of cereals, fats/oil and sugar/jaggery decreased significantly (p ≤ 0.05) whereas intake of green leafy vegetable, other vegetables and fruits increase significantly (p ≤ 0.01) after counselling. A significant decrease in energy, carbohydrate, fat and significant increase intake in iron, calcium, potassium, Vitamin C and β-carotene content was observed. A significant reduction was observed for weight, body mass index (BMI), mid upper arm circumference (MUAC), triceps skinfold thickness (TSFT) and waist hip ratio (WHR) by 4.9%, 3.98%, 2.9% and 2.17% respectively, while random blood sugar (RBS), systolic blood pressure (SBP) and diastolic blood pressure (DBP) decreased by 25.21%, 13.74% and 8.03% after counselling. After nutrition counselling subjects adopted good nutritional practices and use of Aloe vera leaves in diets which improved their health status of postmenopausal women.

The Effectiveness of Clinical Colloquium Established by the “Drawing Recall” Technique in University Counselling Services for Student Mental Health

An experimental assessment of the effectiveness of university counselling was conducted through the “Stress Drawing Recall” Technique applied before and after a clinical colloquium with 70 university students of both genders, aged 18 - 35 years, who had requested this service. Another 70 students waiting to undergo the colloquium were interviewed as a control group. Two parallel series of drawings depicting personal stress situations were collected and, after evaluation by three expert judges in “double-blind” conditions, led to establishing five forms of development of the graphic language from the first to second drawing, defined as follows: a) distension, with a reduction in stress indicators and increase in comfort indicators;b) explicit representation of conflict resolution;c) appearance of new elements, with persisting conflict;d) increase in stress indicators;e) invariant or equivalent repetition of the stress drawing. Results showed that students who underwent the clinical colloquium (experimental group) changed their stress drawings mainly in the direction of distension and conflict resolution, while the control group had more invariant or equivalent repetition of the stress situation (?= 62.77;p < 0.001). The events depicted in the stress drawings were divided into three categories: a) limited short-term stressful situations due to mainly external agents;b) externally induced stressful situations with intense emotional resonance;c) wide-ranging long-lasting stressful situations with great involvement of the self. The participants were divided into: a) very anxious subjects;b) averagely anxious subjects;c) not very anxious subjects, on the basis of their scores on two questionnaires: the MPI (1959) and the STAI (1970). There is a correspondence between the subjects’ level of conflict and extension of the depicted stress. This confirms the usefulness of the Stress Drawing Recall Technique in psychological counselling.

Quality of DOTS Adherence Counselling among Hospitalized Tuberculosis Patients

Setting: Non-adherence to tuberculosis treatment is a risk factor for multidrug-resistant tuberculosis (MDR-TB). In 2015, 480,000 cases of MDR-TB were notified worldwide, leading to 250,000 deaths. Aim: The quality of the Directly Observed Treatment (DOT) adherence counselling among patients with drug resistant and sensitive was assessed. Methods: A hospital based crossectional analytical study was conducted at the national TB hospital in Windhoek among patients with MDR-TB and drug susceptible TB (DS-TB). The quality of adherence counselling was assessed against the WHO counselling guidelines using an interviewer-administered questionnaire. Quality was measured by completeness, duration and frequency of the adherence counselling sessions or program as well as patient satisfaction and preferences. Quantitative and qualitative data were by descriptive statistics in SPSS v23 and thematic analysis respectively. Results: Of the 50 patients, 60% were male, 76% were aged Conclusions: The quality of DOT adherence counselling among hospitalized TB patients is sub-optimal. There is need for a standard operating procedure and guidelines for effective adherence counselling among TB patients to optimize treatment outcomes.

Assessment of Knowledge and Attitudes of Expectant Mothers towards HIV Screening and Counselling at Jachie-Pramso in the Ashanti Region of Ghana

Background: The prevention of mother to child transmission (PMTCT) of human immunodeficiency virus (HIV) is paramount in safeguarding the lives of unborn children and young babies. The study sought to examine the knowledge and attitudes of expectant mothers towards HIV screening and testing in the Jachie-Pramso Community of the Ashanti Region. Methods: The study adopted a descriptive survey approach as its research design. The population of the study comprised 158 expectant mothers who were registered and attended regular antenatal care sessions at the community hospital. The census approach to sampling was adopted for the study. A structured questionnaire was used as the tool for data collection. Chi-square and descriptive statistics were used to analyse the data. Results: The findings from the study indicated that awareness level of HIV and its related issues were high among expectant mothers. It was also found that attitude of healthcare workers, community members and sexual partners are the main factors that prevent expectant mothers from patronising voluntary counselling and testing (VCT) services. It was generally, recommended that intensive educational programmes be instituted to sensitize both healthcare workers and the general public on discriminative behaviours. Conclusion: Most of the expectant mothers have knowledge of HIV and attitudes of the expectant mothers towards VCT of HIV were positive. The healthcare facility and its professionals may consider training the expectant mothers so they can act as snow-ballers in the dissemination of relevant health education and coerce other expectant mothers in the community to participate in the VCT and HIV programmes.

The Role of Physical Counselling in Patients with Type 2 Diabetes Mellitus: A Systematic Review

Context: Physical exercise is a key component of treatment and management of people with Type 2 Diabetes, but the role of strategies and interventions to increase and promote physical activity is unclear. Objective: To conduct a systematic review of intervention studies assessing the effects of physical activity counselling on health outcomes in subjects with type 2 diabetes mellitus. Data sources: The Cochrane Library, MEDLINE, EMBASE, CINAHL, LILACS, ClinicalTrials.gov databases were used for the literature search. Data Selection: Studies that assessed the effects of interventions mainly based on physical activity counselling strategies, on physical activity level and glycosylated hemoglobin (HbA1c) were included in the review. Data Extraction: Two independent reviewers extracted the data. Data Synthesis: A total of 23 studies out of 1425 retrieved from databases search, were included in the review. The global number of subjects included in the selected studies was 9913, and the mean age of participants was 58.8 (±8.2) years (min = 46.3;max = 73.6). The most part of the studies (19) reported values of physical activity level;13 of them (68.4%) found a significant effect after the counselling intervention, while 6 (31.6%) did not found significant changes. Among the 17 studies reporting data on HbA1c 9 (52.9%) described a significant decrease in the counselling intervention group, while 7 (41.2%) did not find any statistically significant change and 1 (5.9%) reported a significant HbA1c reduction in the comparison group rather than the counselling group. Conclusions: The results presented in this systematic review seem to affirm the usefulness of physical counselling interventions on physical activity and HbA1c, however the lack of homogeneity in the intervention protocols and the contrasting results limit the comprehension of the usefulness of such an approach in patient with type 2 diabetes.

Experience of Drug Abusers Participating in Community-Based Drug Rehabilitation Services Provided by the Counselling Centres for Psychotropic Substance Abusers (CCPSAs) in Hong Kong

Despite the official statistics showing that the number of drug users has been declining, the problem of drug abuse remains serious in Hong Kong. This problem is evidenced by the trend of hidden and prolonged drug abuse. The recovery of drug abusers is an important process, because the misuse of drugs can cause many bio-psycho-social complications. Therefore, 11 Counselling Centres for Psychotropic Substance Abusers (CCPSAs) in different districts in Hong Kong play an important role on those drug abusers [1]. As a core community-based drug rehabilitation service in Hong Kong, studies about CCPSAs are limited. This study uses a descriptive qualitative approach to explore the experience of drug abusers participating in community-based drug rehabilitation services provided by CCPSAs. Five CCPSA users, who utilized the services for more than two months, participated in the semi-structured face-to-face interviews. Data collected were then analysed by thematic analysis, and five themes were generated: 1) receiving supportive counselling service in CCPSAs, 2) revealing variance towards nonmandatory services in CCPSAs, 3) encountering intrapersonal conflicts when participating in CCPSAs, 4) expanding social network through integration in group activities and 5) wishing to be a companion to other drug abusers. Findings of this study provide valuable insights towards services modification and the enhancement of drug rehabilitation and drug abusers’ wellbeing over the collaboration of healthcare workers, services providers and the media. However, this study has some limitations, and it presents suggestions for future research.

Enhanced Adherence Counselling, Support Groups and Viral Load Suppression amongst HIV-Positive Adolescents in a Tertiary Health Care Facility in Cameroon

Background: Globally, HIV viral load suppression rate, which is an indirect measure of the efficacy of antiretroviral (ART) medication, is 47% and 52% in Africa. In Cameroon, the viral load (VL) suppression rate is 44.7% and poor adherence is widely documented as being responsible for the large gap in VL Suppression. Enhanced adherence counselling (EAC) sessions, and enrolment and participation in support groups are specific interventions to improve ART adherence and improve viral load suppression. Purpose: This study assesses the uptake and contribution of support groups and EAC sessions in the management of adolescents with unsuppressed VL results at Centre Hospitalier d’Essos, Yaounde. Methods: A retrospective correlational quantitative patient files review was conducted for 138 files of HIV positive adolescents aged between 10 - 19 years with HIV VL above 1000 copies/ml enrolled in care between January 2009 and December 2019. Data from the questionnaire was entered into CSPRO version 7.4. and analyzed by using SPSS version 25.0. Results: A total of 138 participants (75 females and 63 males) with a mean age of 15 ± 3 years were included in our study. Sixty-nine (50%) participants were in World Health Organization (WHO) stage I;32.6% were in Stage II;13.0% and 4.3% were in stages III and IV, respectively. Thirty (21.7%) had a history of tuberculosis and 76% of the adolescents were being cared for primarily by their parents. The charts of the adolescents revealed that there was an association between completion of EAC sessions in adolescents with unsuppressed VL and eventual VL suppression (R.R = 2.5;CI 0.848 - 6.162;p = 0.033). However, there was no significant association between support group enrolment and active participation, and eventual VL Suppression. Furthermore, combining EAC and support group interventions was strongly associated with eventual VL Suppression in this group of initially unsuppressed adolescents (R.R = 7.5;C.I 2.544 - 22.360;p Conclusion: Suppression rates were good after completion of EAC sessions and participation in support group enrolment for adolescents with a high VL. As we move towards having 95% of ART-treated adolescents achieve and maintain viral suppression, there is a need to reinforce EAC sessions and support group enrolment in ART clinics targeting this priority group.

Intensive Lifestyle Counselling Intervention: Preventing Maternal Risk for Gestational Diabetes Mellitus

This study is aimed to evaluate the effectiveness of an intensive lifestyle counselling (ILC) designed to prevent gestational diabetes mellitus (GDM) among high risk mothers. A quasi-experimental trial was conducted in four selected health clinics (two clinics for intervention and two clinics for control) in Negeri Sembilan, Malaysia. Of the 320 subjects recruited, 148 respondents in the intervention group and 150 respondents in the control group had completed the study (response rate 93.1%). The intervention group was given a routine antenatal care (RC) and a package of structured ILC sessions on diet, physical activity (PA) and information on appropriate gestational weight gain (GWG) in five routine antenatal care visits until 39 weeks’ gestation. The controls received only the RC. Both groups are comparable for sociodemographic characteristics (p < 0.05). GDM incidence is higher in control group (16.7%) compared to intervention group (6.1%), p = 0.046. After controlling the covariates, the intervention group consistently showed protective for developing GDM, (aOR: 0.25, CI: 0.18 - 0.23, p = 0.003). The intervention group had significantly increased in PA (moderate intensity) mean score (660.3 ± 289.4 Met/min) compared to control group (571.36 ± 230.38 Met/min), F(1, 296) = 10.418, p < 0.001 and comply to dietary recommendation (50.7% in intervention versus 16.7% in control), p < 0.001. Total GWG significantly lesser in intervention (11.4 ± 2.5 Kg) than the control group (12.7 ± 2.9 Kg), p < 001. An ILC can reduce GDM incidence, by increasing PA, increase compliance to the dietary intake recommendation and lesser total GWG among high risk mothers.

Genetic counselling in post-genomic era-to be or not to be

With the surge of genetic tests and technologies, genetic counsellors are faced with the challenge of translating emerging scientific knowledge into practical information for patients, clinicians and public health policy makers. The new tests and technologies also are associated with new psychosocial and ethical considerations. New guidelines are needed for each new discovery of the genomic impact on phenotype, pathology and disease while "old" syndromes and "old" pathology, continue to require attention. In the new postHuman Genome Project era, genetic counsellors will be an integral part of translating genomic discoveries into beneficial impact on human disease, health care, and medical benefits. The needs for genetic counselling should be designed into genomic research at the onset. Genetic counsellors need to handle old while rapidly assimilating new information and the principal challenge is to be up to date and updated.

Low Level of Hepatitis B Surface Antigen Screening in a Tertiary Health Facility in Nigeria 2000-2014: Imperative for Provider Initiated Testing and Counselling for Hepatitis B Virus?

Introduction: Viral hepatitis is a major public health challenge that requires an urgent response. Reducing mortality requires major scale-up in prevention, testing and treatment access;coverage in HBV vaccination, testing and treatment is low and must accelerate massively to achieve the 2030 targets. Less than 1% of HBV-infected individuals are diagnosed in Sub-Sahara Africa, despite the availability of rapid tests with good diagnostic accuracy. Materials and Methods: This was retrospective cross sectional study conducted in Federal Teaching Hospital Gombe, in North East Nigeria. All children and adults who presented to the out-patient departments, and those that were admitted irrespective of their HIV and or Hepatitis C virus status and had Hepatitis B and/or Hepatitis B envelope antigen test were conducted between 2000 to 2015. All children and adults were tested using the Hospital standard for Hepatitis B surface antigen test strip. Results: Between 2000 and 2014, 739,456 children and adults were admitted and reviewed in the outpatient units of the Federal Teaching Hospital Gombe;there were 685,552 adults and 53,904 children. Children constituted 7.3% (53,904/739,456) of admissions and outpatient consultations. 2.8% (210/7570), 3.3% (773/23,783), 3.6% (1145/32,142), 5.2% (1694/33,043), 3.3% (986/29,216), 1.9% (661/3321), 0.1% (53/41,626), 0.2% (113/46,634), 2.6% (1418/54,423), 5.4% (3717/69,696), 3.7% (2332/62,086), 3.5% (3241/90,623), 3.2% (2881/89,398), 3.8% (2428/62,687), 2.8% (1835/63,208) of children and adults were tested for HBsAg in 2000, 2001, 20002, 2003, 2004, 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013 and 2014 respectively. 23,487 children and adults were tested for HBsAg with a cumulative testing rate of 3%. Overall 4465/23,487 children and adults were seropositive for HBsAg giving a cumulative prevalence of 19%. Conclusion: HBV screening in our health facility is very low. Massive scale up in awareness and HBV vaccination are required. Provider initiated testing and counseling for HBV in health facilities needs support for implementation in Health Facilities in Sub Saharan Africa.

Effect of Video Counselling Versus Verbal Counselling on Patient's experience during phacoemulsification under topical anaesthesia

Purpose:To evaluate the impact of video and verbal counselling on patients'undergoing phacoemulsification under topical anaesthesia.Methods:This is a prospective randomized controlled trial conducted at Aravind Eye Care System,Pondicherry,India.All patients had a 15 min one-on-one verbal counselling covering surgical technique,implant options,anaesthesia and payment options one day prior to surgery.On the day of surgery,patients were randomized into two groups;in the first group,patients were provided with video counselling and in the second group,patients were given verbal counselling prior to undergoing phacoemulsification under topical anaesthesia.Measurements of blood pressure,heart rate,respiration rate,and the Likert-scale anxiety rating were collected at preoperative,perioperative,and postoperative time points.Results:A group of 186 patients(aged 45–70 years)were provided video counselling via portable iPad before firsttime phacoemulsification,and a second group of 186 patients underwent surgery with verbal counselling.Systolic and diastolic blood pressure measurements were lower in both the video and verbally counselled groups during the intraoperative time point.Furthermore,during the intraoperative period,123(66.1%)video counselled patients felt relaxed compared to 119(64%)patients who were provided verbal counselling(P?0.6636).Patient cooperation during surgery was excellent in 76(40.9%)video counselled patients and 67(36%)verbally counselled patients(P?0.3374).25.8%and 21%(P?0.2703)of patients experienced no pain during surgery in the video and verbal counselled groups respectively.Conclusions:Although measures such as pulse rate,respiratory rate and feelings of relaxation did not show significant differences among the two groups of video and verbal counselling,patients marked cooperation during surgery and furthermore,the level of anxiety is most reassuring.

Classification and genetic counselling for a novel splicing mutation of the MLH1 intron associated with Lynch syndrome in colorectal cancer

Background:Lynch-syndrome-associated cancer is caused by germline pathogenic mutations in mismatch repair genes.The major challenge to Lynch-syndrome screening is the interpretation of variants found by diagnostic testing.This study aimed to classify the MLH1 c.1989t5G>A mutation,which was previously reported as a variant of uncertain significance,to describe its clinical phenotypes and characteristics,to enable detailed genetic counselling.Methods:We reviewed the database of patients with Lynch-syndrome gene detection in our hospital.A novel variant of MLH1 c.1989t5G>A identified by next-generation sequencing was further investigated in this study.Immunohistochemical staining was carried out to assess the expression of MLH1 and PMS2 protein in tumour tissue.In silico analysis by Alamut software was used to predict the MLH1 c.1989t5G>A variant function.Reverse transcription-polymerase chain reaction and sequencing of RNA fromwhole bloodwere used to analyse the functional significance of this mutation.Results:Among affected family members in the suspected Lynch-syndrome pedigree,the patient suffered from late-stage colorectal cancer but had a good prognosis.We found the MLH1 c.1989t5G>A variant,which led to aberrant splicing and loss of MLH1 and PMS2 protein in the nuclei of tumour cells.An aberrant transcript was detectable and skipping of MLH1 exon 17 in carriers of MLH1 c.1989t5G>A was confirmed.Conclusions:MLH1 c.1989t5G>A was detected in a cancer family pedigree and identified as a pathological variant in patients with Lynch syndrome.Themutation spectrumof Lynch syndrome was enriched through enhanced genetic testing and close surveillancemight help future patients who are suspected of having Lynch syndrome to obtain a definitive early diagnosis.

Enhancing Identity Protection in Metaverse-Based Psychological Counseling System

Non-face-to-face psychological counseling systems rely on network technologies to anonymize information regard-ing client identity.However,these systems often face challenges concerning voice data leaks and the suboptimal communication of the client’s non-verbal expressions,such as facial cues,to the counselor.This study proposes a metaverse-based psychological counseling system designed to enhance client identity protection while ensuring efficient information delivery to counselors during non-face-to-face counseling.The proposed systemincorporates a voicemodulation function that instantlymodifies/masks the client’s voice to safeguard their identity.Additionally,it employs real-time client facial expression recognition using an ensemble of decision trees to mirror the client’s non-verbal expressions through their avatar in the metaverse environment.The system is adaptable for use on personal computers and smartphones,offering users the flexibility to access metaverse-based psychological counseling across diverse environments.The performance evaluation of the proposed system confirmed that the voice modulation and real-time facial expression replication consistently achieve an average speed of 48.32 frames per second or higher,even when tested on the least powerful smartphone configurations.Moreover,a total of 550 actual psychological counseling sessions were conducted,and the average satisfaction rating reached 4.46 on a 5-point scale.This indicates that clients experienced improved identity protection compared to conventional non-face-to-face metaverse counseling approaches.Additionally,the counselor successfully addressed the challenge of conveying non-verbal cues from clients who typically struggled with non-face-to-face psychological counseling.The proposed systemholds significant potential for applications in interactive discussions and educational activities in the metaverse.

Two missense STK11 gene variations impaired LKB1/adenosine monophosphate-activated protein kinase signaling in Peutz-Jeghers syndrome

BACKGROUND Peutz-Jeghers syndrome(PJS)is a rare hereditary neoplastic disorder mainly associated with serine/threonine kinase 11(STK11/LKB1)gene mutations.Preimplantation genetic testing can protect a patient’s offspring from mutated genes;however,some variations in this gene have been interpreted as variants of uncertain significance(VUS),which complicate reproductive decision-making in genetic counseling.AIM To identify the pathogenicity of two missense variants and provide clinical guidance.METHODS Whole exome gene sequencing and Sanger sequencing were performed on the peripheral blood of patients with PJS treated at the Reproductive and Genetic Hospital of Citic-Xiangya.Software was employed to predict the protein structure,conservation,and pathogenicity of the two missense variation sites in patients with PJS.Additionally,plasmids were constructed and transfected into HeLa cells to observe cell growth.The differences in signal pathway expression between the variant group and the wild-type group were compared using western blot and immunohistochemistry.Statistical analysis was performed using one-way analysis of variance.P<0.05 was considered statistically significant.RESULTS We identified two missense STK11 gene VUS[c.889A>G(p.Arg297Gly)and c.733C>T(p.Leu245Phe)]in 9 unrelated PJS families who were seeking reproductive assistance.The two missense VUS were located in the catalytic domain of serine/threonine kinase,which is a key structure of the liver kinase B1(LKB1)protein.In vitro experiments showed that the phosphorylation levels of adenosine monophosphate-activated protein kinase(AMPK)at Thr172 and LKB1 at Ser428 were significantly higher in transfected variation-type cells than in wild-type cells.In addition,the two missense STK11 variants promoted the proliferation of HeLa cells.Subsequent immunohistochemical analysis showed that phosphorylated-AMPK(Thr172)expression was significantly lower in gastric,colonic,and uterine polyps from PJS patients with missense variations than in non-PJS patients.Our findings indicate that these two missense STK11 variants are likely pathogenic and inactivate the STK11 gene,causing it to lose its function of regulating downstream phosphorylated-AMPK(Thr172),which may lead to the development of PJS.The identification of the pathogenic mutations in these two clinically characterized PJS patients has been helpful in guiding them toward the most appropriate mode of pregnancy assistance.CONCLUSION These two missense variants can be interpreted as likely pathogenic variants that mediated the onset of PJS in the two patients.These findings not only offer insights for clinical decision-making,but also serve as a foundation for further research and reanalysis of missense VUS in rare diseases.

Improvement of the nutritional support management system for patients in intensive care units

BACKGROUND Nutritional support for patients hospitalized in the intensive care unit(ICU)is an important part of clinical treatment and care,but there are significant implementation difficulties.AIM To introduce a modified nutritional support management system for ICU patients based on closed-loop information management and psychological counseling.METHODS The division of functions,personnel training,system construction,development of an intelligent decision-making software system,quality control,and improvement of the whole process were carried out to systematically manage nutritional support for ICU patients.RESULTS Following the implementation of the whole process management system,the scores of ICU medical staff’s knowledge,attitudes/beliefs,and practices regarding nutritional support were comprehensively enhanced.The proportion of hospital bed-days of total enteral nutrition(EN)in ICU patients increased from 5.58%to 11.46%,and the proportion of EN plus parenteral nutrition increased from 42.71%to 47.07%.The rate of EN initiation within 48 h of ICU admission increased from 37.50%to 48.28%,and the EN compliance rate within 72 h elevated from 20.59%to 31.72%.After the implementation of the project,the Self-rating Anxiety Scale score decreased from 61.07±9.91 points to 52.03±9.02 points,the Self-rating Depression Scale score reduced from 62.47±10.50 points to 56.34±9.83 points,and the ICU stay decreased from 5.76±2.77 d to 5.10±2.12 d.CONCLUSION The nutritional support management system based on closed-loop information management and psychological counseling achieved remarkable results in clinical applications in ICU patients.