Reminder through mobile messaging application improves outpatient attendance and medication adherence among patients with depression: An open-label randomised controlled trial

INTRODUCTION

Non-attendance and medication adherence are longstanding concerns in psychiatric outpatient settings. This study aimed to determine effectiveness of reminders using mobile messaging applications (messaging apps) in improving outpatient attendance and medication adherence among patients with depression.

METHODS

This was a parallel, open-label randomised controlled trial with participants recruited from psychiatric outpatient services of a teaching hospital in Kuala Lumpur and a secondary hospital in Melaka. Adults (≥18 years) diagnosed with major depressive disorder; capable of reading and understanding English or Bahasa Malaysia; prescribed with at least one antidepressant and owns a smart phone were subsequently randomly assigned (1:1) to receive treatment reminders (intervention) or standard treatment without reminders (control), using a computergenerated randomisation programme. The intervention group received two reminder categories: Outpatient appointment reminders (a day before appointment); and medication reminders (weekly basis). Participants were followed-up over two months. We utilised Montgomery- Asberg Depression Rating Scale (MADRS) to measure the severity of depression; and Brief Adherence Rating Scale (BARS) to assess medication adherence. Primary outcomes were outpatient attendance rates and medication adherence assessed at two months. Secondary outcomes included changes in depression severity within each group at two months; comparison of changes in depression severity between both groups; preferences of participants towards treatment reminders, and reasons for non-attendance among participants. This trial was registered with the National Medical Research Registry, NMRR-19-3466-52001.

RESULTS

Between February and April 2020, 183 participants were randomised to each group, of whom 179 reached study endpoint (91 [98.9%] of 92 in intervention group and 88 [96.7%] of 91 in control group). All recruited participants (n=183) were analysed using intention-to-treat approach. At two months, intervention group has significantly higher outpatient attendance rates (76.8%) than control group (56.4%) (p=0.002), and reported higher medical adherence percentage (mean difference 23.1, [95%CI 0.4, 35.8]; p<0.001). There was also significant difference in the MADRS score change between both groups (mean difference 3.4, [95%CI 0.4, 6.3]; p=0.025). Treatment reminders preferences among participants varied; forgetfulness was the most commonly reported reason (53%) for missing outpatient appointments.

CONCLUSION

Reminders through mobile messaging applications significantly improved outpatient attendance and medication adherence among patients with depression. Our findings support the use of messaging apps for treatment reminders in psychiatric outpatient settings. However, concerns regarding confidentiality require careful measures to be taken.

Prevention of ventilator-associated pneumonia

Ventilator-associated pneumonia is the commonest, yet mostly preventable, infection in mechanically ventilated patients. Successful control of ventilator-associated pneumonia can save hospitalisation cost, and is possible by using a multidisciplinary clinical and administrative approach. The ventilator-associated pneumonia rate should be expressed as the number of ventilator-associated pneumonia days per 1000 ventilator days to take into account the device-utilisation duration for meaningful comparison. Various strategies address the issue, including general infection control measures, body positioning, intubation and mechanical ventilation, oral and gastro-intestinal tract, endotracheal tube, airway pressure, cuff pressure, selective digestive and/or oropharyngeal decontamination, and probiotic or early antibiotic treatment, as well as overall administration at a policy level. The rationale and controversy of these approaches are discussed in this article. The authors suggest that all units treating mechanically ventilated patients should have a ventilator-associated pneumonia prevention protocol in place, and ventilator-associated pneumonia should be seriously considered as a key performance indicator in local intensive care units.

Optical and magneto-optical anisotropies in large-area two-dimensional Co antidots film

In this work, we investigate the plasmon-induced optical and magneto-optical anisotropies in the large-area square-ordered Co antidots film. It shows that both the outline of reflectivity spectrum and Kerr spectrum are significantly modified by surface plasmon polarition (SPP) resonances. Moreover, the magnitude of Kerr angle reaches to about 10 minutes at the azimuthal angle 45°, which is over 3 times of that of pure Co film. These phenomena are attributed to the SPP resonances with different diffraction orders of reciprocal lattice vectors.

Sex differences in the cannabinoid regulation of energy homeostasis

This review highlights the progress made thus far in characterizing the behavioral and cellular mechanisms through which cannabinoids regulate energy homeostasis. We performed microstructural analysis of feeding behavior in gonadectomized guinea pigs and gonadally intact, transgenic CB1 receptor knockout mice to determine how cannabinoids affect circadian rhythms in food intake and meal pattern. We also implanted data loggers into the abdominal cavity to correlate the appetite-modulating properties of cannabinoids with changes in core body temperature. We then coupled the effects on feeding behavior and temperature regulation with synaptic changes in the hypothalamic feeding circuitry via whole-cell patch clamp electrophysiological recording from neurons in the arcuate nucleus (ARC), in order to gain a more global perspective on the cannabinoid modulation of energy homeostasis. We observed marked sex differences in cannabinoid effects on food intake and core body temperature--with male guinea pigs exhibiting a comparatively greater sensitivity to the hyperphagia and hypophagia, as well as the hypothermia and hyperthermia, produced by CB1 receptor agonists and antagonists, respectively. In addition, male but not female CB1 receptor knockout mice show a diminished nocturnal food intake and average daily body weight relative to their wildtype littermate controls. The disparity in the CB1 receptor-mediated hyperphagia is paralleled by sex differences in the cellular effects of cannabinoids at anorexigenic, guinea pig proopiomelanocortin (POMC) synapses. Postsynaptically, cannabinoids potentiate an A-type K+ current (I(A)) in POMC neurons from female guinea pigs, whereas in males the activation of an inwardly rectifying K+ current is observed. Presynaptically, while cannabinoids inhibit glutamatergic input onto POMC neurons in males and females to similar degrees, males are more refractory to the cannabinoid-induced inhibition of convergent GABAergic input than females. These data reveal pervasive sex differences in the cannabinoid regulation of energy homeostasis that are consistent with changes in the excitability of POMC neurons.

Lipoprotein multigene families in Mycoplasma pneumoniae

In this study, reverse transcriptase PCR was employed to construct a transcriptional profile of Mycoplasma pneumoniae lipoprotein genes contained in six multigene families. Most genes were found to be expressed. Many truncated lipoprotein genes were expressed, often polycistronically with other truncated genes, indicating that these genes may still be functional.

Chemical synthesis and magnetic properties of well-coupled FePt/Fe composite nanotubes

A simple two-step hydrogen reduction method was used to synthesize FePt/Fe composite nanotubes. As the first step, L1(0) FePt nanotubes were prepared by heating a porous alumina template loaded with an alcohol solution of a Fe chloride and Pt chloride mixture in flowing hydrogen at 670 degrees C. Then, FePt/Fe composite nanotubes were obtained by reducing the alcohol solution of the Fe chloride within the formed FePt nanotubes at a lower temperature, namely 470 degrees C. Through changing the concentrations of initial alcohol solutions, the FePt:Fe atomic ratios of the composite nanotubes were easily adjusted and the magnetic properties were tuned accordingly. For (FePt)(100-x)/Fe(x) composite nanotubes with x ranging between 0 and 26 at.%, the hard and soft phases were well coupled and the coercivity was tunable over a large range (1.27-2.73 T). Furthermore, the marked interdiffusion between Fe and FePt, which usually exists in FePt-based composites fabricated by using conventional methods, was not observed in the formed composite nanotubes. This indicates the two-step hydrogen reduction method to be a promising route for synthesizing nanocomposites which are difficult to fabricate by using conventional methods due to the interdiffusion between different phases.

Sex differences in the cannabinoid modulation of an A-type K+ current in neurons of the mammalian hypothalamus

Cannabinoids regulate biological processes governed by the hypothalamus including, but not limited to, energy homeostasis and reproduction. The present study sought to determine whether cannabinoids modulate A-type K(+) currents (I(A)) in neurons of the hypothalamic arcuate nucleus (ARC). Whole cell patch-clamp recordings were performed in slices through the ARC prepared from castrated female and male guinea pigs. Forty percent of guinea pig ARC neurons exhibited a transient outward current that was antagonized by high (mM) concentrations of 4-aminopyridine and (100 nM) rHeteropodatoxin-2. Five of these neurons also were immunopositive for both beta-endorphin and the Kv4.2 channel subunit. Bath application of the CB1 receptor agonists WIN 55,212-2 (1 microM) or ACEA (1 microM) selectively induced a rightward shift in the inactivation curve for the I(A), significantly increasing the half-maximal voltage without affecting the peak current magnitude, in neurons from female but not male animals. The CB1 receptor antagonist AM251 (1 microM) reversed this action. Collectively, these data reveal that guinea pig ARC neurons, including proopiomelanocortin neurons, express a prominent I(A) that is positively modulated by cannabinoids in a sex-specific way by altering the voltage dependence of its inactivation. The resultant inhibitory effect on this neuronal population may shed some insight into the mechanism(s) by which cannabinoids influence hypothalamic function.

Mothers' perspectives on the quality of postpartum care in Central Shanghai, China

OBJECTIVES

To investigate mothers' perspectives on the quality of postpartum care services in central Shanghai, China.

DESIGN

Semi-structured interviews.

SETTING

Two maternal and child health posts in two subdistricts in LW District, Central Shanghai, China.

STUDY PARTICIPANTS

Fifty postpartum mothers who attended the maternal and child health posts in the two subdistricts in LW District, Central Shanghai, China.

MAIN OUTCOME MEASURES

Mothers' perceived quality and adequacy of postpartum services.

RESULTS

A majority of the mothers (90%; n = 45) were primiparas (first time mothers). Half did not consider the postpartum services to be of high quality. They defined high quality as 'full satisfaction of the mother and the child'. Their perception of quality was influenced by their concern about child care, an area in which they expressed the need for further improvement.

CONCLUSION

Mothers indicated that to improve quality of services further, greater emphasis should be placed on: (1) health education on childcare; (2) more time allocation for discussion with health workers during their postpartum home visits so their questions and concerns could be addressed effectively; (3) access to health workers in times of need rather than during officially prescribed home visits; and (4) provision of continuous training for maternal and child health workers with respect to childcare. The findings will be relevant to health workers and policy makers involved in planning and implementation of maternal and child health services in similar urban settings in developing countries.

Effects of antecedent order and semantic context on Chinese pronoun resolution

Three reading time experiments were conducted in order to examine the relative contributions of order of antecedents and semantic context to the resolution of temporarily ambiguous Chinese pronouns. These pronouns were ambiguous because each of them was preceded by two antecedents, both of which were likely candidates for coreference. The identity of the pronoun was revealed by subsequent disambiguating information that constrained the pronoun to one particular interpretation. Experiment 1 showed that reading of the disambiguating phrase was slower when the phrase confined the pronoun to the second rather than to the first antecedent. Experiment 2 produced the same effect of antecedent order (first vs. second antecedent) regardless of whether the target antecedent was an action-performing or an action-receiving entity. In Experiment 3, the order effect was eliminated by a biasing modifier inserted immediately before the pronoun. These results indicate that in a semantically neutral environment, the first-appearing antecedent is the preferred candidate for coreferencing the ambiguous Chinese pronoun. The interaction between order of antecedents and semantic context (in the form of preposed biasing modifiers) suggests that the initial comprehension of Chinese pronouns depends as much on contextual as on structural factors.

Role of flagellins from A and B loci in flagella formation of Halobacterium salinarum

Haloarchaeal flagella are composed of a number of distinct flagellin proteins, specified by genes in two separate operons (A and B). The roles of these flagellins were assessed by studying mutants of H. salinarum with insertions in either the A or the B operon. Cells of the flgA- mutant produced abnormally short, curved flagella that were distributed all over the cell surface. The flgA2- strain produced straight flagella, mainly found at the poles. The flgB- mutant had flagella of the same size and spiral shape as wild-type cells, but these cells also showed unusual outgrowths, which appeared to be sacs filled with basal body-like structures. In broth cultures of this mutant, the medium accumulated flagella with basal body-like structures at their ends.

Drug prescribing in rural health facilities in China: implications for service quality and cost

Overuse of drugs in rural areas of China has led to a growing concern regarding service quality and cost. The study found evidence of high levels of drug use in some rural health facilities in comparison with a number of other developing countries. Such a result was significantly associated with the government policy of financing health care, regulation and monitoring of health services, and users' attitudes and behaviour. It underlines the need for measures to be taken in China to improve drug use in order to allow its population access to effective care at reasonable cost.

Bringing basic health care to the rural poor

In the 1960s and 1970s China provided a good model for financing and delivering rural health services in developing countries. Since the implementation of economic reforms which began in the 1980s, however, health services in poor areas have been showing signs of declining, with fewer people able to pay for the services they need. This article examines major problems of access to basic health care faced by the poor, and proposes a strategy for improving health service delivery in the poor areas.

The financing and organization of health services in poor rural China: a case study in Donglan County

The socio-economic reforms launched in China in the late 1970s led to rapid economic growth and, with it, health sector resources expanded rapidly. The rural health services have benefited from the policies of economic reform, but not in an optimal way, particularly in poor areas. This article uses a case study of a poor county--Donglan--to illustrate that the fiscal decentralization combined with the financial responsibility system have resulted in a weakening of financing and provision of rural health services in poor areas. The need for health facilities to generate revenue has had unfortunate consequences for the style of medical care, such as over-prescription. In addition, the collapse of the cooperative medical system and the weakening of the three-tier network of rural health care in Donglan have jeopardized preventive programs and threaten access to basic health care for the peasants, especially the poor. The study found evidence that preventive programs have deteriorated over the past years, the poor had financial difficulty in access to services, particularly hospital care, health facilities at township and village levels have been run down, and less training and supervision have been provided by upper-level health facilities. The article concludes with recommendations for a strategy for rebuilding and strengthening the three-tier network of rural health care, and for establishing a cooperative medical and health care scheme to ensure that the majority of peasants in Donglan can be guaranteed access to basic health services. Limited health resources will therefore be better used.

Trichomonas vaginalis and cervical cancer. A prospective study in China

The relationship between Trichomonas vaginalis infection and cervical cancer was investigated prospectively in a cohort of 16,797 women aged 25 years or more who were followed from 1974 to 1985 within the framework of a cervical screening program in Jingan, China. Personal interviews were conducted by trained interviewers when the women first entered the screening program. At initial screening, 421 (2.51%) women had a positive cytologic diagnosis of T. vaginalis infection. Ninety-nine incident cases of pathologically confirmed squamous cell carcinoma were identified from the cohort, with a total of 140,018 person-years of observation. T. vaginalis infection was found to contribute to the risk of cervical cancer, as determined by crude estimates and after adjustment for potential confounding effects. In a multiple proportional hazards model, the relative risk for cervical cancer was 3.3 (95% confidence interval: 1.5 to 7.4) among women with T. vaginalis infection. Furthermore, in the multivariate analysis, increased risk of cervical cancer was associated with the following factors: number of extramarital sexual partners of both the subjects and their spouses, cigarette smoking, and irregular menstruation. Having a large number of negative Pap smears was associated with lower risk. This study suggests that there might be an association between T. vaginalis infection and the risk of cervical cancer, but only 4 to 5% of cervical cancer in Chinese women may be attributable to T. vaginalis infection.

New internal structure of spider dragline silk revealed by atomic force microscopy

Atomic force microscopy was used to study the three-dimensional nanometer-scale structure of the dragline silk of Nephila clavipes from microtomed sections of the silk. Contrary to a previously proposed model of randomly distributed protein crystallites interspersed in amorphous regions, a highly organized skin-core structure of the fiber was observed. The skin appeared to be thin with no discernible distinct features. The core consists of pleated fibril-like structures, which are arranged in two concentric cylinders. Upon stretching, the pleats were smoothed out substantially. The mechanical properties of spider silk can quite straightforwardly be related to the newly observed structures.

Selective killing of tumor cells in vitro by an immunotoxin composed of ricin and monoclonal antibody against Ia antigen

A monoclonal antibody (MAb-HB55) directed against a HLA class II antigen (Ia), was purified by DE-52 chromatography. The purified MAb contained less than 5% impure protein detected by SDS-PAGE. Ricin was conjugated with the MAb via a disulfide bond to construct an immunotoxin (ricin-HB55). The concentration causing fifty percent growth inhibition (IC50) was 2 x 10(-11)M for the Raji cells. In contrast, the IC50 for Molt-4 and K562 cells was 100 times higher than that for the Raji cells. B lymphocytes separated from peripheral blood lymphocytes by nylon wool were selectively killed by the conjugate, but T lymphocytes were not apparently affected. Our results demonstrate that the immunotoxin is selectively cytotoxic to Raji cells and B-cells, and may have potential for purging malignant cells from bone marrow of patients with B-cell leukemia and lymphoma.

Uptake of metabolites by germinating blastospores of Histoplasma capsulatum

The uptake of radioactive L-leucine, L-glutamic acid, and guanine was monitored during blastospore germination of Histoplasma capsulatum. Blastospores of H. capsulatum, grown in Salvin's medium at 37 degrees C for 48 h and shifted to 23 degrees C, germinated within 24 h. Metabolite uptake was faster in mycelial cells at 23 degrees C than it was in yeast cells at 37 degrees C. During the yeast to mold transition, the initial rate of uptake was first markedly depressed and then increased and achieved a level characteristic of the mycelial phase of growth. Estimates of macromolecular synthesis occurring during transitional morphological events might be influenced by these differences in the rate of uptake.

Metabolism, macromolecular synthesis, and nuclear behavior of Cryptococcus albidus at 37 C

The temperature-sensitive events which prevent Cryptococcus albidus from growing at 37 C were investigated. Cultures incubated at 37 C immediately after inoculation did not increase in optical density nor in cell numbers, and by 24 h 90% of cells in such cultures were deformed and dead. When cultures in log phase were shifted from 23 to 37 C the optical density increased but the cell numbers did not. Morphological observations revealed that the increase in turbidity at 37 C represented enlargement and distortion of cells without appreciable replication. Uptake and incorporation of (14)C-leucine were similar at 23 and 37 C. There was no difference in (14)CO(2) evolution from cells at either temperature. Uptake and incorporation of adenine-8-(14)C into RNA was slightly lower in cells incubated at 37 C. There was, however, a 60% reduction in incorporation of adenine-8-(14)C into DNA after 3 hr at 37 C. Nuclear staining revealed that nuclear migration did not occur in cells incubated at 37 C. Thus the data indicate that both adenine incorporation into DNA and nuclear migration prior to nuclear division by C. albidus are temperature sensitive.

Uptake and utilization of glutamic acid by Cryptococcus albidus

Cryptococcus albidus utilizes glutamate as a sole carbon source. The kinetics of uptake of this amino acid were studied. l-Glutamic acid was taken up by two saturable systems: a high affinity system with a Michaelis constant (K(m)) of 1.15 x 10(-5) M and a V(max) of 0.049 mumol per mg per h and a low affinity system with a K(m) of 2.5 x 10(-3) M and a V(max) of 3.61 mumol per mg per h. Both systems possessed characteristics of active transport which were dependent on temperature and pH and which required metabolic energy. Uptake was inhibited at 37 C but the temperature-sensitive step was reversible. Chemical fractionation of cells with 5% trichloroacetic acid showed that glutamic acid initially entered a soluble pool which decreased after 1 h as the amino acid was incorporated into the protein and nucleic acid fractions of the yeast. Some of the glutamate was completely oxidized and could be recovered as (14)CO(2). Therefore, the amino acid was also used as an energy source.