Effects of cumulative COVID-19 cases on mental health:Evidence from multi-country survey

BACKGROUND Depression and anxiety were both ranked among the top 25 leading causes of global burden of diseases in 2019 prior to the coronavirus disease 2019(COVID-19)pandemic.The pandemic affected,and in many cases threatened,the health and lives of millions of people across the globe and within the first year,global prevalence of anxiety and depression increased by 25%with the greatest influx in places highly affected by COVID-19.AIM To explore the psychological impact of the pandemic and resultant restrictions in different countries using an opportunistic sample and online questionnaire in different phases of the pandemic.METHODS A repeated,cross-sectional online international survey of adults,16 years and above,was carried out in 10 countries(United Kingdom,India,Canada,Bangladesh,Ukraine,Hong Kong,Pakistan,Egypt,Bahrain,Saudi Arabia).The online questionnaire was based on published approaches to understand the psychological impact of COVID-19 and the resultant restrictions.Five standardised measures were included to explore levels of depression[patient health questionnaire(PHQ-9)],anxiety[generalized anxiety disorder(GAD)assessment],impact of trauma[the impact of events scale-revised(IES-R)],loneliness(a brief loneliness scale),and social support(The Multidimensional Scale of Perceived Social support).RESULTS There were two rounds of the online survey in 10 countries with 42866 participants in Round 1 and 92260 in Round 2.The largest number of participants recruited from the United Kingdom(112985 overall).The majority of participants reported receiving no support from mental health services throughout the pandemic.This study found that the daily cumulative COVID-19 cases had a statistically significant effect on PHQ-9,GAD-7,and IES-R scores.These scores significantly increased in the second round of surveys with the ordinary least squares regression results with regression discontinuity design specification(to control lockdown effects)confirming these results.The study findings imply that participants’mental health worsened with high cumulative COVID-19 cases.CONCLUSION Whist we are still living through the impact of COVID-19,this paper focuses on its impact on mental health,discusses the possible consequences and future implications.This study revealed that daily cumulative COVID-19 cases have a significant impact on depression,anxiety,and trauma.Increasing cumulative cases influenced and impacted education,employment,socialization and finances,to name but a few.Building a database of global evidence will allow for future planning of pandemics,particularly the impact on mental health of populations considering the cultural differences.

Hepatocardiorenal syndrome in liver cirrhosis:Recognition of a new entity?

Emerging evidence and perspectives have pointed towards the heart playing an important role in hepatorenal syndrome(HRS),outside of conventional understanding that liver cirrhosis is traditionally considered the sole origin of a cascade of pathophysiological mechanisms directly affecting the kidneys in this context.In the absence of established heart disease,cirrhotic cardiomyopathy may occur more frequently in those with liver cirrhosis and kidney disease.It is a specific form of cardiac dysfunction characterized by blunted contractile responsiveness to stress stimuli and altered diastolic relaxation with electrophysiological abnormalities.Despite the clinical description of these potential cardiac-related complications of the liver,the role of the heart has traditionally been an overlooked aspect of circulatory dysfunction in HRS.Yet from a physiological sense,temporality(prior onset)of cardiorenal interactions in HRS and positive effects stemming from portosystemic shunting demonstrated an important role of the heart in the development and progression of kidney dysfunction in cirrhotic patients.In this review,we discuss current concepts surrounding how the heart may influence the development and progression of HRS,and the role of systemic inflammation and endothelial dysfunction causing circulatory dysfunction within this setting.The temporality of heart and kidney dysfunction in HRS will be discussed.For a subgroup of patients who receive portosystemic shunting,the dynamics of cardiorenal interactions following treatment is reviewed.Continued research to determine the unknowns in this topic is anticipated,hopefully to further clarify the intricacies surrounding the liver-heart-kidney connection and improve strategies for management.

Advances in Zika virus vaccines and therapeutics:A systematic review

Zika virus(ZIKV)is the causative agent of a viral infection that causes neurological complications in newborns and adults worldwide.Its wide transmission route and alarming spread rates are of great concern to the scientific community.Numerous trials have been conducted to develop treatment options for ZIKV infection.This review highlights the latest developments in the fields of vaccinology and pharmaceuticals developments for ZIKV infection.A systematic and comprehensive approach was used to gather relevant and up-to-date data so that inferences could be made about the gaps in therapeutic development.The results indicate that several therapeutic interventions are being tested against ZIKV infection,such as DNA vaccines,subunit vaccines,live-attenuated vaccines,virus-vector-based vaccines,inactivated vaccines,virus-like particles,and mRNA-based vaccines.In addition,approved anti-ZIKV drugs that can reduce the global burden are discussed.Although many vaccine candidates for ZIKV are at different stages of development,none of them have received Food and Drug Authority approval for use up to now.The issue of side effects associated with these drugs in vulnerable newborns and pregnant women is a major obstacle in the therapeutic pathway.

Recent advances on vaccines against malaria: A review

This review aims to summarize the currently viable vaccine strategies including the approved vaccines and the those in trials for next-generation malaria vaccines.Data on malaria vaccine development was collected through a comprehensive review.The literature search was performed using databases including Google Scholar,PubMed,NIH,and Web of Science.Various novel approaches of vaccination are being developed,including those based on radiation-attenuated strategies,monoclonal antibodies,targeted immunogenic peptides,RNA and DNA vaccines,nanoparticle-based vaccines,protein-based vaccination protocols,and whole organism-based vaccination strategies.Trials on RTS,S have entered phase Ⅲtesting,and those based on blood-stage vaccines and vaccines to interrupt malarial transmission have advanced to higher stages of trials.Mathematical modeling,combined drug and vaccine strategies,mass drug administration,polyvalent vaccine formulations,and targeted vaccination campaigns is playing an important role in malarial prevention.Furthermore,assessing coverage,accessibility,acceptability,deployment,compilation,and adherence to specific vaccination strategies in endemic regions is essential for vaccination drives against malaria.

Development of an experimental method for well-controlled blast induced traumatic limb fracture in rats

Heterotopic ossification(HO)is a consequence of traumatic bone and tissue damage,which occurs in 65%of military casualties with blast-associated amputations.However,the mechanisms behind blast-induced HO remain unclear.Animal models are used to study blast-induced HO,but developing such models is challenging,particularly in how to use a pure blast wave(primary blast)to induce limb fracture that then requires an amputation.Several studies,including our recent study,have developed platforms to induce limb fractures in rats with blast loading or a mixture of blast and impact loading.However,these models are limited by the survivability of the animal and repeatability of the model.In this study,we developed an improved platform,aiming to improve the animal's survivability and injury repeatability as well as focusing on primary blast only.The platform exposed only one limb of the rat to a blast wave while providing proper protection to the rest of the rat's body.We obtained very consistent fracture outcome in the tibia(location and pattern)in cadaveric rats with a large range of size and weight.Importantly,the rats did not obviously move during the test,where movement is a potential cause of uncontrolled injury.We further conducted parametric studies by varying the features of the design of the platform.These factors,such as how the limb is fixed and how the cavity through which the limb is placed is sealed,significantly affect the resulting injury.This platform and test setups enable well-controlled limb fracture induced directly by pure blast wave,which is the fundamental step towards a complete in vivo animal model for blast-induced HO induced by primary blast alone,excluding secondary and tertiary blast injury.In addition,the platform design and the findings presented here,particularly regarding the proper protection of the animal,have implications for future studies investigating localized blast injuries,such as blast induced brain and lung injuries.

Prevalence of obesity,determinants,and its association with hyperglycaemia among community dwelling older adolescents in India

BACKGROUND Globally,obesity and diabetes mellitus(DM)are emergent public health concerns in the adolescent population.India,home to the largest adolescent population and the second largest diabetes cohort is experiencing rapid but unplanned urbanization,with accompanying unhealthy nutritional transition,and sedentary lifestyle.AIM To determine prevalence and determinants of obesity and hyperglycaemia and their association among community-dwelling older adolescents(15-19 years)in India.METHODS This cross-sectional analysis from the national family health survey-5 included data of 258028 adolescents aged 15-19 across India(2019-2021).The survey employed stratified two-stage sampling,with systematic random sampling in rural and urban areas.Statistical analysis included descriptive statistics,bivariate,and multivariable logistic regression,employing generalized linear models.RESULTS The weighted prevalence of DM was 1.09%including 0.77%[95%confidence interval(CI):0.72-0.83]previously diagnosed and 0.32%(95%CI:0.29-0.35)newly diagnosed cases detected on survey screening.On adjusted analysis,increasing age,higher education levels,higher wealth index,and overweight/obesity were the factors significantly associated with presence of DM.Only 61%of the adolescents with previously diagnosed DM were on anti-diabetes treatment.The weighted prevalence of overweight/obesity among older adolescents was 6.9%with significantly higher odds in the male sex,having higher educational levels,urban residence,and those with a higher wealth index.CONCLUSION Nearly one in hundred older adolescents in India have diabetes,with one in three undiagnosed.Strengthening DM screening and treatment access among adolescents through public health programs is urgently warranted.

Catatonia:A deep dive into its unfathomable depths

This editorial addresses catatonia,a complex neuropsychiatric syndrome characterised by a spectrum of psychomotor disturbances.The editorial seeks to clarify the ambiguous aspects of catatonia,integrating recent research findings,including global studies and diagnostic advancements.It discusses catatonia’s clinical manifestations,prevalence,and associated psychiatric and medical conditions,with particular emphasis on its frequent co-occurrence with schizophrenia and mood disorders.The prevalence of catatonia,which varies across psychiatric populations,is illustrated by a significant study conducted in Nelson Mandela Bay,South Africa.This study provides valuable insights into the effectiveness of the Bush-Francis Screening Instrument compared to the Diagnostic and Statistical Manual 5 criteria in diagnosing catatonia.The editorial evaluates treatment approaches,primarily focusing on benzodiazepines and electroconvulsive therapy,and discusses emerging therapeutic strategies.It underscores the importance of robust diagnostic frameworks and early intervention in managing catatonia,as recommended by the latest evidence-based consensus guideline.Furthermore,it suggests future research directions,particularly in exploring the neurobiological and genetic factors of catatonia,to enhance our understanding and improve treatment outcomes.This editorial succinctly aims to demystify catatonia and provide valuable insights for clinicians and researchers in mental health care.

Tree: Reducing the use of restrictive practices on psychiatric wards through virtual reality immersive technology training

BACKGROUND Restrictive practices(RPs)are defined by measures linked to physical and chemical restraints to reduce the movement or control behaviours during any emergency.Seclusion is an equal part of RPs intended to isolate and reduce the sensory stimulation to safeguard the patient and those within the vicinity.Using interventions by way of virtual reality(VR)could assist with reducing the need for RPs as it could help reduce anxiety or agitation by way of placing users into realistic and immersive environments.This could also aid staff to and change current RPs.AIM To assess the feasibility and effectiveness of using a VR platform to provide reduction in RP training.METHODS A randomised controlled feasibility study,accompanied by evaluations at 1 month and 6 months,was conducted within inpatient psychiatric wards at Southern Health National Health Service Foundation Trust,United Kingdom.Virti VR scenarios were used on VR headsets to provide training on reducing RPs in 3 inpatient psychiatric wards.Outcome measures included general self-efficacy scale,generalised anxiety disorder assessment 7(GAD-7),Burnout Assessment Tool 12,the Everyday Discrimination Scale,and the Compassionate Engagement and Action Scale.RESULTS Findings revealed statistically significant differences between the VR and treatment as usual groups,in the Everyday Discrimination Scale items Q8 and Q9:P=0.023 and P=0.040 respectively,indicating higher levels of perceived discrimination in the VR group.There were no significant differences between groups in terms of general self-efficacy,generalised anxiety disorder assessment 9,and Burnout Assessment Tool 12 scores.A significant difference was observed within the VR group for compassionate engagement from others(P=0.005)over time.Most respondents recorded System Usability Scale scores above 70,with an average score of 71.79.There was a significant reduction in rates of RPs in the VR group vs treatment as usual group with a fluctuating variability observed in the VR group likely due to external factors not captured in the study.CONCLUSION Ongoing advancement of VR technology enables the possibility of creating scenarios and simulations tailored to healthcare environments that empower staff by providing more comprehensive and effective training for handling situations.

Machine learning-based comparison of factors influencing estimated glomerular filtration rate in Chinese women with or without nonalcoholic fatty liver

BACKGROUND The prevalence of non-alcoholic fatty liver(NAFLD)has increased recently.Subjects with NAFLD are known to have higher chance for renal function impairment.Many past studies used traditional multiple linear regression(MLR)to identify risk factors for decreased estimated glomerular filtration rate(eGFR).However,medical research is increasingly relying on emerging machine learning(Mach-L)methods.The present study enrolled healthy women to identify factors affecting eGFR in subjects with and without NAFLD(NAFLD+,NAFLD-)and to rank their importance.AIM To uses three different Mach-L methods to identify key impact factors for eGFR in healthy women with and without NAFLD.METHODS A total of 65535 healthy female study participants were enrolled from the Taiwan MJ cohort,accounting for 32 independent variables including demographic,biochemistry and lifestyle parameters(independent variables),while eGFR was used as the dependent variable.Aside from MLR,three Mach-L methods were applied,including stochastic gradient boosting,eXtreme gradient boosting and elastic net.Errors of estimation were used to define method accuracy,where smaller degree of error indicated better model performance.RESULTS Income,albumin,eGFR,High density lipoprotein-Cholesterol,phosphorus,forced expiratory volume in one second(FEV1),and sleep time were all lower in the NAFLD+group,while other factors were all significantly higher except for smoking area.Mach-L had lower estimation errors,thus outperforming MLR.In Model 1,age,uric acid(UA),FEV1,plasma calcium level(Ca),plasma albumin level(Alb)and T-bilirubin were the most important factors in the NAFLD+group,as opposed to age,UA,FEV1,Alb,lactic dehydrogenase(LDH)and Ca for the NAFLD-group.Given the importance percentage was much higher than the 2nd important factor,we built Model 2 by removing age.CONCLUSION The eGFR were lower in the NAFLD+group compared to the NAFLD-group,with age being was the most important impact factor in both groups of healthy Chinese women,followed by LDH,UA,FEV1 and Alb.However,for the NAFLD-group,TSH and SBP were the 5th and 6th most important factors,as opposed to Ca and BF in the NAFLD+group.

Post Mid-Staffordshire Inquiries Reaction, in and about the National Health Service (NHS), England. The Missing Pieces: Organizational, Care and Virtue Ethics Perspectives

The release of the Mid Staffordshire hospital report otherwise called the Francis report once again ignited the debate about the issue of abuse of especially vulnerable patients, while navigating the care pathway as inpatients in hospitals;within the National health service (NHS), England. Once more the official reaction from the NHS directorate is more “standards” to monitor failed standards in patient care. Of interest in the official responses so far, are the unheard voices addressing the issue of healthcare and organizational ethics concerns that need revisiting. This article seeks to revisit practice, systems and care issues leading to incidents of the type of the Staffordshire abuses, and the important but yet unheralded place of organizational and care ethics in helping to curb such abuses from re-occurring.

Mental health impact of the Middle East respiratory syndrome,SARS,and COVID-19:A comparative systematic review and metaanalysis

BACKGROUND Over the last few decades,3 pathogenic pandemics have impacted the global population;severe acute respiratory syndrome coronavirus(SARS-CoV),Middle East respiratory syndrome coronavirus(MERS-CoV)and SARS-CoV-2.The global disease burden has attributed to millions of deaths and morbidities,with the majority being attributed to SARS-CoV-2.As such,the evaluation of the mental health(MH)impact across healthcare professionals(HCPs),patients and the general public would be an important facet to evaluate to better understand short,medium and long-term exposures.AIM To identify and report:(1)MH conditions commonly observed across all 3 pandemics;(2)Impact of MH outcomes across HCPs,patients and the general public associated with all 3 pandemics;and(3)The prevalence of the MH impact and clinical epidemiological significance.METHODS A systematic methodology was developed and published on PROSPERO(CRD42021228697).The databases PubMed,EMBASE,ScienceDirect and the Cochrane Central Register of Controlled Trials were used as part of the data extraction process,and publications from January 1,1990 to August 1,2021 were searched.MeSH terms and keywords used included Mood disorders,PTSD,Anxiety,Depression,Psychological stress,Psychosis,Bipolar,Mental Health,Unipolar,Self-harm,BAME,Psychiatry disorders and Psychological distress.The terms were expanded with a‘snowballing’method.Cox-regression and the Monte-Carlo simulation method was used in addition to I2 and Egger’s tests to determine heterogeneity and publication bias.RESULTS In comparison to MERS and SARS-CoV,it is evident SAR-CoV-2 has an ongoing MH impact,with emphasis on depression,anxiety and post-traumatic stress disorder.CONCLUSION It was evident MH studies during MERS and SARS-CoV was limited in comparison to SARS-CoV-2,with much emphasis on reporting symptoms of depression,anxiety,stress and sleep disturbances.The lack of comprehensive studies conducted during previous pandemics have introduced limitations to the“know-how”for clinicians and researchers to better support patients and deliver care with limited healthcare resources.

Occupational Exposure of Healthcare Workers during COVID-19 Field Surveillance Activities in South India: A Cross-Sectional Qualitative Study

Context: Health Care Workers (HCWs) involved in field-level activities are exposed to COVID-19 which puts them under physical and psychological stress. Aim: The objective of this study was to understand the perception of the health care workers regarding their occupational exposure to COVID-19, including the safety measures used during field surveillance activities. Settings and Design: This cross-sectional study was conducted from June 2020 to July 2020 among the health care workers involved in COVID-19 field containment activities in two south Indian states—Telangana and Tamil Nadu. Methods and Material: Respondents were purposively sampled based on their involvement in the COVID-19 field level activities. Sixteen In-Depth Interviewees (IDIs) were conducted telephonically with medical officers, district epidemiologists, community health workers, sanitary workers, emergency medical technicians, and ambulance coordinators. Statistical Analysis Used: IDIs were analyzed using manual thematic analysis. Results: Seven themes and sub-themes emerged: awareness and training, occupational exposure to COVID-19 and duration, safety measures, occupational burnout, social stigma, psychological violence, and facilitating factors. Respondents felt a high level of occupational exposure to COVID-19 in addition to increased workload and stress due to fear of infection, shortage of workforce, denial of week off, psychological violence, and social stigma which affected them deeply. Support from supervisors and family, and measures ensuring the safety of women were facilitating factors to cope with the situation. Conclusions: It is important to safeguard the general and mental health of field-level health workers involved in COVID-19 activities, to keep their morale high during the continuing pandemic.

Impact of lockdown relaxation and implementation of the facecovering policy on mental health: A United Kingdom COVID-19 study

BACKGROUND Pandemic mitigation policies,such as lockdown,are known to impact on mental health of individuals.Compulsory face covering under relaxed lockdown restrictions gives assurance of less transmission of airborne infection and has the potential to improve mental health of individuals affected by restrictions.AIM To examine the association of the lockdown relaxation and the implementation of the face covering policy on the mental health of the general population and subgroups in the United Kingdom using interrupted time series model.METHODS Using a web-based cross-sectional survey of 28890 United Kingdom adults carried out during May 1,2020 to July 31,2020,changes in mental health status using generalised anxiety disorder(GAD-7),and impact of events scale-revised(IES-R)scales are examined,at the dates of the first lockdown relaxation(July 4,2020)and the subsequent introduction of face covering(July 24,2020)in United Kingdom.A sharp regression discontinuity design is used to check discontinuities in mental health outcomes at policy-change dates.RESULTS Average GAD-7 scores of participants were 5.6,5.6 and 4.3 during the lockdown period,the lockdown relaxation phase and the phase of compulsory face covering,respectively,with lower scores indicating lower anxiety levels.Corresponding scores for IES-R were 17.3,16.8 and 13.4,with lower scores indicating less distress.Easing lockdown measures and subsequent introduction of face covering,on average,reduced GAD-7 by 0.513(95%CI:0.913-0.112)and 1.148(95%CI:1.800-0.496),respectively.Corresponding reductions in IES-R were 2.620(95%CI:4.279-0.961)and 3.449(95%CI:5.725-1.172).These imply that both lockdown relaxation and compulsory face-covering have a positive association with mental health scores(GAD-7 and IES-R).CONCLUSION The differential impact of lockdown and relaxation on the mental health of population sub-groups is evident in this study with future implications for policy.Introduction of face covering in public places had a stronger positive association with mental health than lockdown relaxation.

Mental health impact on Black,Asian and Minority Ethnic populations with preterm birth:A systematic review and meta-analysis

BACKGROUND Preterm birth(PTB)is one of the main causes of neonatal deaths globally,with approximately 15million infants are born preterm.Women from the Black,Asian,and Minority Ethnic(BAME)populations maybe at higher risk of PTB,therefore,the mental health impact on mothers experiencing a PTB is particularly important,within the BAME populations.AIM To determine the prevalence of mental health conditions among BAME women with PTB as well as the methods of mental health assessments used to characterise the mental health outcomes.METHODS A systematic methodology was developed and published as a protocol in PROSPERO(CRD420-20210863).Multiple databases were used to extract relevant data.I2 and Egger's tests were used to detect the heterogeneity and publication bias.A trim and fill method was used to demonstrate the influence of publication bias and the credibility of conclusions.RESULTS Thirty-nine studies met the eligibility criteria from a possible 3526.The prevalence rates of depression among PTB-BAME mothers were significantly higher than full-term mothers with a standardized mean difference of 1.5 and a 95%confidence interval(CI)29%-74%.The subgroup analysis indicated depressive symptoms to be time sensitive.Women within the very PTB category demonstrated a significantly higher prevalence of depression than those categorised as non-very PTB.The prevalence rates of anxiety and stress among PTB-BAME mothers were significantly higher than in full-term mothers(odds ratio of 88%and 60%with a CI of 42%-149%and 24%-106%,respectively).CONCLUSION BAME women with PTB suffer with mental health conditions.Many studies did not report on specific mental health outcomes for BAME populations.Therefore,the impact of PTB is not accurately represented in this population,and thus could negatively influence the quality of maternity services they receive.

Roles of biochemistry data, lifestyle, and inflammation in identifying abnormal renal function in old Chinese

BACKGROUND The incidence of chronic kidney disease(CKD)has dramatically increased in recent years,with significant impacts on patient mortality rates.Previous studies have identified multiple risk factors for CKD,but they mostly relied on the use of traditional statistical methods such as logistic regression and only focused on a few risk factors.AIM To determine factors that can be used to identify subjects with a low estimated glomerular filtration rate(L-eGFR<60 mL/min per 1.73 m^(2))in a cohort of 1236 Chinese people aged over 65.METHODS Twenty risk factors were divided into three models.Model 1 consisted of demographic and biochemistry data.Model 2 added lifestyle data to Model 1,and Model 3 added inflammatory markers to Model 2.Five machine learning methods were used:Multivariate adaptive regression splines,eXtreme Gradient Boosting,stochastic gradient boosting,Light Gradient Boosting Machine,and Categorical Features+Gradient Boosting.Evaluation criteria included accuracy,sensitivity,specificity,area under the receiver operating characteristic curve(AUC),F-1 score,and balanced accuracy.RESULTS A trend of increasing AUC of each was observed from Model 1 to Model 3 and reached statistical significance.Model 3 selected uric acid as the most important risk factor,followed by age,hemoglobin(Hb),body mass index(BMI),sport hours,and systolic blood pressure(SBP).CONCLUSION Among all the risk factors including demographic,biochemistry,and lifestyle risk factors,along with inflammation markers,UA is the most important risk factor to identify L-eGFR,followed by age,Hb,BMI,sport hours,and SBP in a cohort of elderly Chinese people.

Evaluation of a culturally adapted cognitive behavior therapy-based,third-wave therapy manual

BACKGROUND Recommendations for psychotherapy have evolved over the years,with cognitive behavioral therapy(CBT)taking precedence since its inception within clinical guidelines in the United Kingdom and United States.The use of CBT for severe mental illness is now more common globally.AIM To investigate the feasibility and acceptability of a culturally adapted,CBT-based,third-wave therapy manual using the Comprehend,Cope,and Connect approach with individuals from a diverse population presenting to primary and secondary healthcare services.METHODS A pilot study was used to assess the feasibility and acceptability of the manualised intervention.Outcome measures were evaluated at baseline,post-intervention and 12 wk-follow up.32 participants with mental health conditions aged 20-53 years were recruited.Assessments were completed at three time points,using Clinical Outcomes in Routine Evaluation(CORE),Hospital Anxiety and Depression Scale(HADS),Bradford Somatic Inventory and World Health Organization Disability Assessment Schedule 2.0(WHODAS).The Patient Experience Questionnaire was completed post-treatment.RESULTS Repeated measures of analysis of variance associated with HADS depression,F(2,36)=12.81,P<0.001,partialη^(2)=0.42 and HADS anxiety scores,F(2,26)=9.93,P<0.001,partialη^(2)=0.36;CORE total score and WHODAS both showed significant effect F(1.25,18.72)=14.98,P<0.001,partialη^(2)=0.5.and F(1.29,14.18)=6.73,P<0.001,partialη^(2)=0.38 respectively.CONCLUSION These results indicate the effectiveness and acceptability of the culturally adapted,CBT-based,third-wave therapy manual intervention among minoritized groups with moderate effect sizes.Satisfaction levels and acceptability were highly rated.The viability and cost-effectiveness of this approach should be explored further to support universal implementation across healthcare systems.

Heart rate response and recovery during exercise predict future delirium risk——A prospective cohort study in middle-to older-aged adults

Background:Delirium is a neurocognitive disorder characterized by an abrupt decline in attention,awareness,and cognition after surgical/illness-induced stressors on the brain.There is now an increasing focus on how cardiovascular health interacts with neurocognitive disorders given their overlapping risk factors and links to subsequent dementia and mortality.One common indicator for cardiovascular health is the heart rate response/recovery(HRR)to exercise,but how this relates to future delirium is unknown.Methods:Electrocardiogram data were examined in 38,740 middle-to older-aged UK Biobank participants(mean age=58.1 years,range:40-72 years;47.3%males)who completed a standardized submaximal exercise stress test(15-s baseline,6-min exercise,and 1-min recovery)and required hospitalization during follow-up.An HRR index was derived as the product of the heart rate(HR)responses during exercise(peak/resting HRs)and recovery(peak/recovery HRs)and categorized into low/average/high groups as the bottom quartile/middle 2 quartiles/top quartile,respectively.Associations between 3 HRR groups and new-onset delirium were investigated using Cox proportional hazards models and a2-year landmark analysis to minimize reverse causation.Sociodemographic factors,lifestyle factors/physical activity,cardiovascular risk,comorbidities,cognition,and maximal workload achieved were included as covariates.Results:During a median follow-up period of 11 years,348 participants(9/1000)newly developed delirium.Compared with the high HRR group(16/1000),the risk for delirium was almost doubled in those with low HRR(hazard ratio=1.90,95%)confidence interval(95%CI):1.30-2.79,p=0.001)and average HRR(hazard ratio=1.54,95%CI:1.07-2.22,p=0.020)).Low HRR was equivalent to being 6 years older,a current smoker,or>3 additional cardiovascular disease risks.Results were robust in sensitivity analysis,but the risk appeared larger in those with better cognition and when only postoperative delirium was considered(n=147;hazard ratio=2.66,95%CI:1.46-4.85,p=0.001).Conclusion:HRR during submaximal exercise is associated with future risk for delirium.Given that HRR is potentially modifiable,it may prove useful for neurological risk stratification alongside traditional cardiovascular risk factors.

Exploratory systematic review and meta-analysis on period poverty

BACKGROUNDPeriod poverty is a global health and social issue that needs to be addressed.It has been reported that many females compromise their education,employment,and social commitments during their menstruation days due to a number of reasons,including lack of access to toilets or menstrual products.AIM To provide a comprehensive understanding on period poverty,including outcomes associated with menstruation.METHODS All observational and randomised clinical trials reporting menstruation challenges,menstrual poverty and menstrual products were included.Our search strategy included multiple electronic databases of PubMed,Web of Science,ScienceDirect,ProQuest and EMBASE.Studies published in a peer review journal in English between the 30th of April 1980 and the 30th of April 2022 were included.The Newcastle-Ottawa Scale was used to assess the risk of bias of the systematic included studies.Pooled odds ratios(ORs)together with 95%confidence intervals(CIs)are reported overall and for sub-groups.RESULTS A total of 80 studies were systematically selected,where 38 were included in the meta-analysis.Of the 38 studies,28 focused on children and young girls(i.e.,10-24 years old)and 10 included participants with a wider age range of 15-49 years.The prevalence of using disposable sanitary pads was 45%(95%CI:0.35-0.58).The prevalence of menstrual education pre-menarche was 68%(95%CI:0.56-0.82).The prevalence of good menstrual hygiene management(MHM)was 39%(95%CI:0.25-0.61).Women in rural areas(OR=0.30,95%CI:0.13-0.69)were 0.70 times less likely to have good MHM practices than those living in urban areas.CONCLUSION There was a lack of evidence,especially from low-and middle-income countries.Further research to better understand the scope and prevalence of period poverty should be considered.This will enable the development of improved policies to increase access to menstrual products and medical support where necessary.

两种牙本质粘接剂粘接界面的扫描电镜研究

目的 研究两种新型牙本质粘接剂 Prim e & Bond○RNT(PBNT)和 Prim e one Mirage TM(P- One)粘接界面的超微结构和粘接机理。方法 选用 15颗拔出的无龋人类磨牙 ,按牙本质粘接剂微拉伸强度测试标本预备法 ,将各试验牙预备成牙冠中部有一深约 5 m m的小槽隔开的两个粘接面 ,以分别接受两种粘接剂处理。粘接后的标本浸于 37℃的蒸馏水中 2 4 h后分成两组 : 组 (5颗牙 )直接进行扫描电镜观察和粘接强度测试 ; 组 (10颗牙 )则在扫描电镜观察和粘接强度测试前行 5℃和 5 5℃的冷热循环 2 4 0 0次。将两组牙齿标本修整、片切成厚约 0 .5 mm的哑铃状系列微型薄片 ,供扫描电镜观察和拉伸测试。结果 PBNT和 P- One各自的粘接界面均可见厚约 3～ 5μm的混合层和伸入牙本质小管内的树脂突及彼此交织成网的树脂突侧支。此两种粘接剂以及它们各自是否经过温度循环 ,粘接界面的 SEM形貌均无明显差异。结论 PBNT和 P- One均可产生良好的树脂浸润 。

我国部分精神科医生对赌博成瘾认知程度的调查

目的:为了调查我国精神科医生对赌博成瘾的认识、经验和态度,以便做好今后的教育或培训工作,为促进我国精神科医生对于赌博成瘾的认知而提出更多建设性的建议。方法:采用自行设计的问卷来调查我国部分地区精神科医生对赌博成瘾的认识、诊断和治疗经验、接受培训的经历及有关态度。结果:共收回有效问卷110份,其中45%的精神科医生在临床实践中没有见过赌博成瘾病人,见过者中有67%的人见过病人不超过5个。所有110名被调查者中只有1人接受过赌博成瘾治疗的教育/培训,尽管有83%的人愿意接受该障碍识别与治疗方面的培训。90%以上的被调查者能认识到赌博成瘾的不良后果,80%者同意该障碍是一个公共卫生问题并且为一种成瘾障碍,70%者同意该障碍易共患其他重要的精神障碍,但仅有41%者知道精神病人赌博问题发生率比一般人群高。36%者表示能够评估并诊断赌博障碍,同时,23%者表示能够治疗该障碍。缺少知识、培训、资源及政府的支持是妨碍精神科医生参与治疗该障碍的主要因素,这些因素也是导致赌博成瘾在精神卫生场所未被识别的主要原因。结论:大多数精神科医生对赌博成瘾仅有很少的认识,几乎没有人接受过这方面的教育/培训。我国大多数精神科医生不仅对赌博成瘾的临床经验很少,也没有能力诊治该障碍。