Anxiety, depression, insomnia, and PTSD among college students after optimizing the COVID-19 response in China

BACKGROUND

The number of COVID-19 infections has increased sharply and quickly after optimizing the COVID-19 response in China. In the context of this population-size infection, college students' psychological response is yet to be understood.

METHODS

A cross-sectional study was designed to investigate anxiety, depression, insomnia, and post-traumatic stress disorder (PTSD) symptoms among college students from December 31, 2022, to January 7, 2023. The questionnaire included the Generalized Anxiety Disorder 7 (GAD-7), Patient Health Questionnaire 9 (PHQ-9), Insomnia Severity Index (ISI), Impact of Event Scale (IES-R), and self-designed questionnaire.

RESULTS

Of the 22,624 respondents, the self-reported prevalence of anxiety, depression, insomnia, PTSD, and any of the four psychological symptoms appeared as 12.7 %, 25.8 %, 11.6 %, 7.9 %, and 29.7 %, respectively. The self-reported COVID-19 infection rate was 80.2 %. Changes in the place for learning, longer time online, not recovering after infection, a higher proportion of family member infection, insufficient drug reserve, worry about sequela after infection, future studies, or employment contributed to a higher risk of anxiety/depression/insomnia symptoms or PTSD symptoms. Multinomial logistic regression showed that those who spent more extended time on the Internet, recovered after infection, and had insufficient drug reserves were less likely to have PTSD than anxiety/depression/insomnia symptoms.

LIMITATIONS

The study was a non-probability sampling survey.

CONCLUSIONS

Anxiety, depression, insomnia, and PTSD were common psychological symptoms among college students when infection went through a large-scale population. This study highlights the importance of continuing to care for the psychological symptoms of college students, especially timely responses to their concerns related to the epidemic situation and COVID-19 infection.

Association of infant Rib and Alp1 surface protein N-terminal domain immunoglobulin G and invasive Group B Streptococcal disease in young infants

BACKGROUND

Vaccine development for Group B Streptococcus (GBS), a common cause of invasive disease in early-infancy and adverse pregnancy outcomes, include exploring widely-expressed GBS surface proteins as vaccine epitopes. We investigated the association between natural infant serum IgG against the RibN and Alp1N domains and risk of invasive GBS disease caused by isolates expressing these proteins.

METHODS

We analyzed maternal and infant serum samples from GBS disease cases and infants born to GBS-colonized women controls. Bayesian modelling was used to calculate the GBS homotypic IgG concentration associated with risk reduction of invasive disease in the infant.

RESULTS

PCR-based typing of 85 GBS invasive isolates showed 46 and 24 possessing the gene for Rib and Alp1, respectively. These were matched to 46 and 36 infant controls whose mothers were colonized with GBS expressing Rib and Alp1, respectively. RibN IgG geometric mean concentrations (GMC) were lower in cases than controls among infants (0.01; 95 %CI: 0.01-0.02 vs 0.04; 95 %CI: 0.03-0.06; p < 0.001), no significant difference was found between maternal RibN IgG GMC in cases compared to controls. Alp1N IgG GMC was also lower in infant cases (0.02; 95 %CI: 0.01-0.03) than controls (0.05; 95 %CI: 0.04-0.07; p < 0.001); albeit not so in mothers. An infant IgG threshold ≥ 0.428 and ≥ 0.112 µg/mL was associated with 90 % risk reduction of invasive GBS disease due to Rib and Alp1 expressing strains, respectively.

DISCUSSION

Lower serum RibN and Alp1N IgG GMC were evident in infants with invasive GBS disease compared with controls born to women colonized with GBS expressing the homotypic protein. These data support the evaluation of Alp family proteins as potential vaccine candidates against invasive GBS disease.

Correlates of stigma for patients with breast cancer: a systematic review and meta-analysis

OBJECTIVE

This study was conducted to examine the factors associated with stigma in breast cancer women.

METHODS

PubMed, Embase, the Cochrane Library, Web of Science, and two Chinese electronic databases were electronically searched to identify eligible studies that reported the correlates of stigma for patients with breast cancer from inception to July 2022. Two researchers independently performed literature screening, data extraction, and risk of bias assessment. R4.1.1 software was used for statistical analysis.

RESULTS

Twenty articles including 4161 patients were included in the systematic review and meta-analysis. Results showed that breast cancer stigma was positively correlated with working status, type of surgery, resignation coping, depression, ambivalence over emotional expression, and delayed help-seeking behavior and negatively correlated with age, education, income, quality of life, social support, confrontation coping, psychological adaptation, self-efficacy, and self-esteem. Descriptive analysis showed that breast cancer stigma was positively correlated with intrusive thoughts, body image, anxiety, and self-perceived burden but negatively correlated with a sense of coherence, personal acceptance of the disease, sleep quality, cancer screening attendance and doctor's empathy.

CONCLUSION

Many demographic, disease-related, and psychosocial variables are related to breast cancer stigma. Our view can serve as a basis for health care professionals to develop health promotion and prevention strategies for patients with breast cancer.

Predictors and correlates of emotionalism across acquired and progressive neurological conditions: A systematic review

Emotionalism can develop following a range of neurological disorders; however the aetiology of emotionalism is still unclear. To identify anatomical, neuropsychological and psychological predictors and correlates of emotionalism across neurological disorders: stroke, Parkinson's disease, multiple sclerosis, traumatic brain injury, Alzheimer's disease, vascular dementia and amyotrophic lateral sclerosis. To explore if these predictors and correlates of emotionalism differ across neurological disorders. A comprehensive systematic search was completed of four databases: MEDLINE, CINAHL Complete, PsycINFO and EMBASE. Methodological quality was assessed using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies and each study was graded according to the level of evidence using the Scottish Intercollegiate Guidelines Network. Fifty papers (participants N = 1922) were included. 25 studies were rated as "Fair," 21 "Good" and 4 "Poor." The review identified predictors and correlates found in several neurological disorder such as bulbar networks, serotonergic pathways, genetics and female gender. Multiple studies across diseases (stroke, MS, ALS) indicate emotionalism is associated with cognitive impairment, especially frontal deficits. Due to the disproportionate number of studies identified across neurological disorders, it is difficult to draw definitive answers. Further research is required across neurological disorders to explore similarities and differences in anatomical, neuropsychological and psychological predictors and correlates.

Repetitive negative thinking: transdiagnostic correlate and risk factor for mental disorders? A proof-of-concept study in German soldiers before and after deployment to Afghanistan

BACKGROUND AND OBJECTIVES

Disorder-specific forms of Repetitive Negative Thinking (RNT) are associated with multiple diagnostic categories, indicating a transdiagnostic nature. Few studies examined content-independent RNT processes across groups of diagnosed mental disorders. Moreover, theory describes RNT processes as critically involved in the etiology of mental disorders, empirical evidence however is scarce. We first tested the transdiagnostic nature by examining levels of RNT across groups of internalizing and externalizing mental disorders compared to healthy individuals and explored RNT levels in a comorbid disorder-group. Second, we examined whether RNT predicts incident psychopathology.

METHODS

In a sample of German soldiers (n = 425) scheduled for deployment in Afghanistan, we compared RNT levels between diagnosed groups with alcohol use disorders, anxiety disorders and healthy individuals cross-sectionally. Exploratory analyses were conducted comparing a comorbid disorder-group to healthy individuals and to both single-disorder-groups. Longitudinally, we examined the predictive value of pre-deployment RNT levels for incident psychopathology after deployment (n = 167). RNT was measured using the Perseverative Thinking Questionnaire (PTQ), DSM-IV diagnoses were assessed using the standardized Composite International Diagnostic Interview (CIDI).

RESULTS

Cross-sectional comparisons revealed that soldiers with alcohol use disorders and anxiety disorders showed significantly higher degrees of RNT compared to healthy soldiers. RNT levels in those with comorbid disorders were significantly higher compared to healthy soldiers but also compared to both single-disorder-groups. Longitudinal analyses revealed that higher levels of RNT prior to deployment were associated with a higher risk to have any incidental mental disorder after deployment. This however is only attributable to individuals with a PTQ score above a cut-off of 15.

CONCLUSIONS

Findings provide evidence for RNT as a transdiagnostic correlate and a vulnerability factor for the development of mental disorders.

Correlates of stigma for patients with cancer: a systematic review and meta-analysis

OBJECTIVE

The systematic review and meta-analysis was performed to summarize the available evidence and identify the correlates of cancer stigma.

METHODS

PubMed, EMBASE, Web of Science, the Cochrane Library, and PsycINFO were electronically searched to identify eligible studies about correlates of stigma for patients with cancer. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of included studies. A meta-analysis was performed using the statistical program R.

RESULTS

Thirty-one studies involving a total of 7114 patients were included in the systematic review and meta-analysis. The results of the meta-analysis showed that cancer stigma shared positive associations with male gender, symptoms, depression, anxiety, body image loss, self-blame, social constraint, intrusive thoughts, and ambivalence over emotional expression, and negative associations with income, NK cell subsets, QOL, self-esteem, self-efficacy, cancer screening attendance, doctor's empathy, and medical satisfaction. The results of the descriptive analysis indicated that cancer stigma was positively associated with self-perception of aging, anger, internal attributions, stressful life events, self-perceived burden, and sleep dysfunction, while negatively associated with patient-provider communication and sleep quality.

CONCLUSION

Healthcare staff should pay attention to the identified correlates of cancer stigma. The results of our research can inform the design of interventions to reduce stigma and to improve clinical outcomes in people with cancer.

Progression-free survival is a suboptimal predictor for overall survival among metastatic solid tumour clinical trials

BACKGROUND

The use of overall survival (OS) as the gold standard primary end-point (PEP) in metastatic oncologic randomised controlled trials (RCTs) has declined in favour of progression-free survival (PFS) without a complete understanding of the degree to which PFS reliably predicts for OS.

METHODS

Using ClinicalTrials.gov, we identified 1239 phase III oncologic RCTs, 260 of which were metastatic solid tumour trials with a superiority-design investigating a therapeutic intervention by using either a PFS or OS PEP. Each individual trial was reviewed to quantify RCT design factors and disease-related outcomes.

RESULTS

A total of 172,133 patients were enrolled from the year 1999 to 2015 in RCTs that used PFS (56.2%, 146/260) or OS (43.8%, 114/260) as the PEP. PFS trials were more likely to restrict patient eligibility by using molecular criteria (15.1% versus 4.4%, p = 0.005) use targeted therapy (80.1% versus 67.5%, p = 0.048), accrue fewer patients (median 495 versus 619, p = 0.03), and successfully meet the trial PEP (66.9% versus 33.3%, p < 0.0001). On multiple binary logistic regression analysis, factors that predicted for PFS or OS PEP trial success included choice of PFS PEP (p < 0.0001), molecular profile restriction (p = 0.02) and single agent therapy (p = 0.02). Notably, there was only a 38% (31/82) conversion rate of positive PFS-to-OS benefit; lack of industry sponsorship predicted for PFS-to-OS signal conversion (80.0% without industry sponsorship versus 35.1% with industry sponsorship, p = 0.045).

CONCLUSIONS

A PFS PEP has suboptimal positive predictive value for OS among phase III metastatic solid tumour RCTs. Regulatory agency decisions should be judicious in using PFS results as the primary basis for approval.

Prevalence and correlates of depressive symptoms among Chinese patients with cataracts treated in tertiary general hospitals

Background

Previous studies recruited unrepresentative samples of Chinese patients with cataract and reported a wide range of prevalence of depressive symptoms in this patient population (18.0–89.7%). The present study determined the prevalence and correlates of depressive symptoms among a consecutive sample of Chinese patients with cataract treated in tertiary general hospitals.

Methods

A total of 339 patients with cataract were consecutively selected from ophthalmology departments of two large general hospitals in Wuhan, China. Depressive symptoms were assessed with the Chinese Hospital Anxiety and Depression Scale. Logistic regression was used to identify factors that were associated with depression.

Results

The prevalence of depressive symptoms was 23.9% (95% CI [19.4–28.4]%) among patients with cataract. Correlates for depressive symptoms include an education level of primary school and below (OR = 1.93, P = 0.038), marital status of “others” (OR =3.15, P < 0.001), poor family economic status (OR = 2.26, P = 0.010), nuclear cataract (OR =4.32, P < 0.001), and mixed cataract (OR = 2.76, P = 0.017).

Conclusions

Depressive symptoms are common among Chinese patients with cataract treated in large general hospitals. Patients who are poorly educated, have a marital status other than “married”, have poor family economic status, and suffer from nuclear and mixed cataracts are at greater risk for depressive symptoms.

When adolescents face both Internet addiction and mood symptoms: A cross-sectional study of comorbidity and its predictors

This study aimed to determine the prevalence of comorbid Internet addiction (IA) and mood symptoms and to identify common and unique risk profiles for individual and comorbid mental health problems among adolescents. A total of 2272 high school students in Changchun, China, were included in a cross-sectional study. Participants were asked to complete paper-based questionnaires on sociodemographic characteristics, lifestyle factors, Internet use, parent-child relationships, IA, and mood symptoms. Multivariate logistic regressions were used to compare the risk profiles for IA, mood symptoms, and their comorbidity. The Bonferroni correction was used for multiple tests. Students who were girls, were current smokers, had more than 1.5 h sleep deprivation per day on weekdays, used the Internet for more than 30 and 240 min per day on weekdays and weekends, respectively, used social networking sites more than 6 times per day, were Internet gamers, and/or reported poor parent-child relationships reported higher rates of comorbid IA and mood symptoms. Adolescents exposed to more of these correlates would have a higher risk of IA, mood symptoms, and their comorbidity. Public strategies for the prevention of mental illnesses should expand their capacity to identify and limit the co-occurrence of IA and mood symptoms.

Prevalence and factors associated with underweight, overweight and obesity among women of reproductive age in India

INTRODUCTION

Although the prevalence of underweight is declining among Indian women, the prevalence of overweight/obesity is increasing. This study examined the prevalence and factors associated with underweight and overweight/obesity among reproductive-aged (i.e., 15-49 years) women in India.

METHODS

This cross-sectional study analyzed data from the 2015-16 National Family Health Survey. The Asian and World Health Organization (WHO) recommended cutoffs for body mass index (BMI) were used to categorize body weight. The Asian and WHO BMI cutoffs for combined overweight/obesity were ≥ 23 and ≥ 25 kg/m2, respectively. Both recommendations had the same cutoff for underweight, < 18.5 kg/m2. After prevalence estimation, logistic regression was applied to investigate associated factors.

RESULTS

Among 647,168 women, the median age and BMI was 30 years and 21.0 kg/m2, respectively. Based on the Asian cutoffs, the overall prevalence of underweight was 22.9%, overweight was 22.6%, and obesity was 10.7%, compared to 15.5% overweight and 5.1% obesity as per WHO cutoffs. The prevalence and odds of underweight were higher among young, nulliparous, contraceptive non-user, never-married, Hindu, backward castes, less educated, less wealthy, and rural women. According to both cutoffs, women who were older, ever-pregnant, ever-married, Muslims, castes other than backwards, highly educated, wealthy, and living in urban regions had higher prevalence and odds of overweight/obesity.

CONCLUSION

The prevalence of both non-normal weight categories (i.e., underweight and overweight/obesity) was high. A large proportion of women are possibly at higher risks of cardiovascular and reproductive adverse events due to these double nutrition burdens. Implementing large-scale interventions based on these results is essential to address these issues.

Depressive symptoms in Chinese male inpatients with schizophrenia: Prevalence and clinical correlates

Depression is common in patients with schizophrenia and associated with serious consequences. However, previous studies have mixed findings on characteristics of depression in schizophrenia, partly because of the use of depressive symptom scales that are not specific to schizophrenia. This study examined the prevalence and correlates of depressive symptoms in Chinese patients with schizophrenia. A consecutive sample of 349 male inpatients with schizophrenia was recruited from the largest psychiatric specialty hospital in south-central China. Depressive symptoms and psychopathology of patients were assessed with the Calgary Depression Scale for Schizophrenia and the Positive and Negative Symptom Scale, respectively. Extrapyramidal side effects (EPSs) were assessed with the Simpson Angus Scale, the Barnes Akathisia Rating Scale, and the Abnormal Involuntary Movement Scale. Demographic and other clinical data were also collected. Depressive symptoms were present in 41.8% of male schizophrenia inpatients. Multiple logistic regression analysis revealed that early age at onset (OR [95%CI] = 1.12 [1.01,1.27], p = 0.049), more severe negative symptoms (OR [95%CI] = 1.05 [1.01,1.09], p = 0.034), more severe general psychopathological symptoms (OR [95%CI] = 1.06 [1.01,1.12], p = 0.041), akathisia (OR [95%CI] = 2.87 [1.45,5.69], p = 0.003), and dyskinesia (OR [95%CI] = 3.93 [1.36,11.33], p = 0.011) were significantly associated with depression. Appropriate antipsychotic medication treatment and reducing EPSs of antipsychotics may help prevent or relieve depression of patients with schizophrenia.

Consistent condom use and its correlates among female sex workers at hair salons: a cross-sectional study in Zhejiang province, China

Background

This study investigated condom use among female sex workers (FSWs) at hair salons during commercial sexual interactions over 1 month. We explored the associations of such use with various sexual behaviours, HIV/STI risk perception and related knowledge, self-efficacy regarding condom use, exposure to behavioural interventions, and other factors. This type of information has not been reported in China and is critical for designing and modifying programs aimed at preventing HIV/STI transmission in this group of FSWs and their clients.

Methods

Our data were derived from a large cross-sectional study conducted among low-tier FSWs in 21 counties within Zhejiang province, China. Data were collected from September to November 2013.Bivariable and multiple logistic regression analyses were used to identify factors associated with self-reported consistent condom use among FSWs working at hair salons.

Results

Of 1682 FSWs working at hair salons, 50.5% consistently used condom with clients during the previous month. Multivariable analysis revealed that condom use for commercial sex, consistent vaginal douching after commercial sex, adopting contraceptive measures, high scores on perceived self-efficacy regarding condom use, and exposure to interventions were associated with self-reported consistent condom use; early initiation of commercial sex, experiences with oral sex, rarely/sometimes/often using oral contraceptives, and having seen a doctor were associated with not using condoms.

Conclusions

Commercial sex is not effectively protected, and behavioural interventions targeting FSWs should take into account the various factors that are correlated to condom use.

Correlates of tummy time in infants aged 0-12 months old: A systematic review

BACKGROUND

Tummy time, defined as an infant being placed on their stomach whilst they are awake and supervised, has been shown to have a positive effect on infant development and head shape. Tummy time can be influenced by a number of factors. Using a social ecological model, categories of potential variables can be examined to determine their influence on behaviours such as tummy time. The purpose of this systematic review was to examine potential correlates of tummy time in infants from birth to 12 months old.

METHODS

Electronic databases were originally searched between March to December 2016. Included studies needed to be peer-reviewed, written in English, and meet a priori study criteria. The population was apparently healthy infants aged from birth to 12 months old. The article needed to contain an objective or subjective measure of tummy time as a dependent variable and examine the association between a demographic, psychological, behavioral, and/or environmental variable and tummy time. For this study, tummy time could include the ability of the infant to move whilst being positioned on their stomach, for example, the infant's ability to roll from back to front, or lift their head when lying on their stomach (prone positioning ability), or the capacity, time spent, age started, or parent attitudes/behaviours regarding the infant being placed on their stomach. The outcomes were the relationships between potential correlates and tummy time. Risk of bias was assessed at the individual study level using the Cochrane risk of bias assessment for observational studies.

RESULTS

15 articles representing 2372 unique participants from 7 countries were included. Correlates that were positively correlated with tummy time were age, prone sleeping, spending greater than 15minutes whilst awake in tummy time when 2 months old, amount of time in the bath, order of achievement of prone extension and prone on elbow positions and parents/carers setting aside time for tummy time. Risk of bias of the included studies ranged from low to high.

CONCLUSIONS

Specific demographic, environmental and behavioral variables were found to be positively and negatively associated with tummy time. This evidence could assist future research regarding interventions to promote tummy time, enhance motor development, increase infant physical activity and contribute to future tummy time recommendations for parents and health care providers.

Changes in depressive symptoms and correlates in HIV+ people at An Hoa Clinic in Ho Chi Minh City, Vietnam

BACKGROUND

Understanding of depression among Vietnamese people living with HIV (PLWH) is limited. This longitudinal study examines changes in depressive symptoms and identifies its correlates among people living with HIV under antiretroviral therapy at An Hoa Clinic.

METHODS

People living with HIV ≥18 years and undergoing antiretroviral therapy for ≥3 months were eligible. Those at final AIDS stage, too ill, or illiterate were excluded due to their inability to complete the self-administered questionnaire. One researcher was present in the clinic for a month inviting PLWH to participate. Data were collected from 242 PLWH at baseline (T1) and 234 after three months (T2). Depressive symptoms was measured by the Center for Epidemiologic Studies Depression Scale (CESD). Social relationship was measured using questions created by World Health Organization. Generalized Estimating Equations were used examining changes in depressive symptoms with CESD cut-off <16/≥16 (mild depression) and cut-off <23/≥23 (major depression).

RESULTS

Model 1 (CESD cut-off <16/≥16) showed that participants were not more likely to have depressive symptoms at T2 compared to T1 (OR = 1.15, p > 0.05). Those with a co-morbidity were more likely to have depressive symptoms than those without a co-morbidity (OR = 1.76, p < 0.05). Those with higher social relationship scores were less likely to have depressive symptoms than those with lower scores (OR = 0.76, p < 0.001). Model 2 (CESD cut-off <23/≥23) showed that participants were more likely to have major depressive symptoms at T2 compared to T1 (OR = 1.6, p < 0.01) and those with higher social relationship score were less likely to have major depressive symptoms than those with lower scores (OR = 0.73, p < 0.001).

CONCLUSIONS

People living with HIV were not more likely to have depressive symptoms (<16/≥16) but were more likely to have major depressive symptoms (<23/≥23) at T2 vs. T1. Social relationship was found to be strongly associated with depressive symptoms. Associations between age, individual income status, and co-morbidity with depressive symptoms were not decisive. Gender, ethnicity, education, religion, marriage, household economy, and adherence were not correlates.

Physical activity levels and associated socio-demographic factors in Bangladeshi adults: a cross-sectional study

Background

Low level of physical activity (PA) has become an important public health problem even in low-income countries. The objectives of this study were to measure PA levels, determine the prevalence of low PA and identify socio-demographic factors associated with it in Bangladeshi adults.

Methods

Data from 792 (urban, 395; rural, 397) Bangladeshi adults (25–64 years) were included in this population-based cross-sectional study conducted in 2011. Global Physical Activity Questionnaire version 2 (GPAQ-2) was used to measure PA. The metabolic equivalent task (MET) in minutes per week was calculated to determine total PA. Participants were categorized into low, moderate and high PA groups. Logistic regression was used to assess socio-demographic factors associated with low level of PA.

Results

Median MET-minute of total PA per week was almost double in the rural area (1720) than the urban area (960). The overall prevalence of low PA was 50.3% (95% CI: 46.8–53.8), urban 59.5% (54.7–64.3) and rural 41.9% (37.0–46.8). Women in general were more inactive (women 63.1% [58.3–67.9], men 39.3% [34.6–44.0]). The main contributions to total PA were from work (urban 40.0%, rural 77.0%) and active commute (57.0%, 21.0%). Leisure-time PA represented a very small proportion (<3.0%). Multiple logistic regressions found a significant association of urban residence (OR = 2.2; 95% CI: 1.5–3.2), women (2.1; 1.4–3.9), oldest age group 55–64 years (15.6; 7.5–32.2) compared to youngest age group 25–34 years, graduation or further education (8.6; 4.1–17.7), and higher socio-economic class (2.4; 1.4–4.2) compared to poor with insufficient PA.

Conclusions

This study identifies low PA in a rural and urban population in Bangladesh and that further large-scale population studies are warranted.

Early Clinical Exposure as a Learning Tool to Teach Neuroanatomy for First Year MBBS Students

Context

Early clinical exposure (ECE) is one of the important tools to teach basic science to the MBBS students. It is one form of vertical integration between basic science and clinical subjects. This study is an effort at exploring the use of ECE as a motivational tool toward better learning in neuroanatomy for first year MBBS students.

Aim

This study aims to make the students interested and motivated to study neuroanatomy by using ECE as learning tool in neuroanatomy and to make the students enable to retain the knowledge of neuroanatomy more efficiently and correlate the knowledge of neuroanatomy with neuromedicine.

Settings and Design

This study was conducted in collaboration with the Departments of Anatomy, General Medicine and Medical Education Unit in the year 2016. This was cross-sectional study.

Subjects and Methods

One hundred and fifty students of 1^st Professional MBBS were subdivided into two groups. After preliminary classes on brain, brainstem, and spinal cord for both groups, conventional lecture classes were taken for Group A only on upper motor neuron (UMN) and lower motor neuron (LMN) paralysis, and only Group B visited General Medicine ward where HOD, General Medicine showed and examined patients of UMN paralysis and LMN paralysis, elicited different symptoms, and discussed different investigation. It was followed by assessment of all by problem-based multiple choice questions (MCQ) and short answer questions. Then, Group B attended lecture class on different cranial nerve palsy whereas Group A visited medicine ward. It was followed by assessment of both groups by problem-based MCQ and short answer questions. The performance was compared. Then, the feedback of the students on ECE was collected by means of reflection writing followed by administration of questionnaire. Then, the perception of teachers regarding ECE was recorded by focused group discussion.

Statistical Analysis Used

Student's t-test was used to compare the performance of both batches. Reflection writing and focus group discussion were analyzed qualitatively.

Results

There was a significant difference in Group A (P = 0.019) but no significant difference in Group B (P = 0.679). All the teachers opined that ECE was an efficient method but more time and interdepartmental collaboration were necessary.

Conclusions

Group A improved performance due to ECE but Group B maintained the motivational effect of it. Therefore, ECE can be used as an effective learning tool.

Correlates of Disability in Asian Patients With Major Depressive Disorder

PURPOSE

To examine correlates of disability in Asian patients with major depressive disorder (MDD).

DESIGN AND METHODS

Participants were outpatients with DSM-IV MDD. Global disability and three disability domains (i.e., work/school, social life/leisure, and family/home life) were key outcomes. Several socio-demographic and clinical characteristics were determined for their associations with disability.

FINDINGS

The sample was 493 MDD patients. Apart from the number of hospitalizations, the global disability was significantly associated with depression severity, fatigue, physical health, and mental health. Several clinical but only few socio-demographic characteristics associated with the other three disability domains were similar.

PRACTICE IMPLICATIONS

Disability among Asian patients with MDD correlates with the severity of psychiatric symptoms and the hospitalizations due to depression. Socio-demographic characteristics have little impact on the overall disability.

Antibody persistence and serological protection among seasonal 2007 influenza A(H1N1) infected subjects: Results from the FLUREC cohort study

INTRODUCTION

Haemagglutination-inhibition (HI) antibody titer is a correlate of protection against influenza; its persistence after infection or vaccination is important to determining susceptibility to subsequent infection. Few studies, however, have reported longitudinal data regarding the magnitude and duration of HI protection following natural seasonal influenza A infection.

METHODS

Using French influenza cohort study data collected from 2008 to 2010, we investigated persistence of serological protection among subjects according to influenza-like illness (ILI) and laboratory-confirmed seasonal 2007 influenza A(H1N1) infection status at inclusion in 2008 (ILI-A(H1N1) positive, ILI-A(H1N1) negative, or no-ILI). Antibody titers against seasonal 2007 A(H1N1) were determined using the HI technique for sera. Regression models for interval-censored data were used to estimate geometric mean titers (GMT) for HI assays. A logistic regression model adjusted for age group (subjects <30, 30-50 and >50 years old) was used to quantify the association between HI titer and protection against infection.

RESULTS

Based on 310 total subjects, influenza A(H1N1) infection was confirmed in 39 of 115 ILI subjects at inclusion. GMT associated with 50% probability of protection among ILI subjects decreased with age group (subjects <30 yo: GMT of 40.8 was associated with 50% [95CI: 29.3%; 70.7%] probability of protection, subjects 30-50 yo: 26.8 [95CI: 34.4%; 65.6%] and subjects >50 yo: 8.9 [95CI: 15.3%; 84.7%]). GMT declined after the first annual study visit among ILI-A(H1N1) positive subjects but remained higher compared to inclusion at the 2010 study visit (41.5 [95CI: 34.8; 49.5], p=0.0157). GMT remained stable among ILI-A(H1N1) negative subjects (p=0.7502), but decreased among no-ILI subjects (p<0.0001).

CONCLUSION

Our results confirm the positive relationship between HI titer and probability of protection among naturally infected subjects, and provides evidence that protection associated with HI titer varies with age. This longitudinal analysis suggests the rise in HI titers following seasonal 2007 influenza A(H1N1) infection may persist into subsequent influenza seasons.

Prevalence and correlates of major depressive disorder among rural-to-urban migrant workers in Shenzhen, China

BACKGROUND

In China, rural-to-urban migrant workers (MWs) are a large and vulnerable population that may be at high risk for depression, but previous studies focused on depressive symptoms of MWs and no study has investigated the epidemiology of major depressive disorder (MDD). The objective of this study was to determine the prevalence and correlates of one-month and lifetime MDD among MWs in Shenzhen, China, and mental health services utilization of MWs with lifetime MDD.

METHODS

A total of 3031 MWs were recruited from 10 manufacturing factories and interviewed with the Chinese version of the Mini International Neuropsychiatric Interview.

RESULTS

The one-month and lifetime prevalence rates of MDD were 1.39% (95% CI: 0.97%, 1.80%) and 5.08% (95% CI: 4.30%, 5.86%), respectively. No significant gender and age-group differences were found in these rates. The risk factors for lifetime MDD included lower education, worse living condition, poorer self-perceived physical health, migration before adulthood, infrequently calling family members, and having done lots of jobs. Only 3.25% of the respondents with lifetime MDD had sought professional help prior to the interview.

LIMITATIONS

The MW sample was selected from manufacturing factories, we should be cautious in generalizing our findings to MWs of other industries.

CONCLUSIONS

Compared with the Chinese general population, MWs may have a similar prevalence of MDD, but the rate of lifetime mental health services use of MWs with lifetime MDD is extremely low. MDD is a major public health concern for this population. There is an urgent need to improve mental health services for MWs.

Towards a better understanding of MS pain: a systematic review of potentially modifiable psychosocial factors

OBJECTIVE

Pain is a common symptom of Multiple Sclerosis (MS). Biomedical treatments achieve only modest reductions in pain severity suggesting that this approach may be too narrow. The aim of this systematic review was to assess evidence for associations between modifiable psychosocial factors and MS pain severity and pain interference and use this evidence to develop a preliminary biopsychosocial model of MS pain.

METHODS

Empirical studies of pain in MS utilising standardised pain severity and pain interference measures were included. Online databases (Cochrane, PsychInfo, EMBASE, CINAHL, Medline, Web of Science and World Cat) and reference sections of included articles were searched, and corresponding authors contacted to identify unpublished studies. Information about design, sample size, MS type, time since diagnosis, psychosocial and pain measures and key findings were extracted. Thirty-one studies were assessed for quality and a narrative synthesis was conducted.

RESULTS

Similar to primary chronic pain, most studies reported small to medium associations between several psychosocial factors and pain severity and interference. Pain catastrophizing showed consistently strong associations with pain interference. Preliminary findings revealed a strong correlation between pain acceptance and pain interference. However, fear-avoidance appeared less important in MS, and other forms of behavioural avoidance were not explored.

CONCLUSIONS

A preliminary model of MS pain outlining specific psychosocial factors is presented with a conceptual formulation from both traditional, and contextual, cognitive-behavioural perspectives. Pain catastrophizing, acceptance, and endurance, as opposed to fear avoidance, responses are highlighted as potentially important treatment targets in MS, and directions for future research are outlined.

Prevalence, correlates and recognition of depression in Chinese inpatients with cancer

OBJECTIVE

To determine the prevalence, correlates and recognition rates of depressive disorders (DDs) in Chinese inpatients with cancer.

METHODS

Four hundred and sixty cancer inpatients were recruited from the oncology ward of a university hospital in Beijing, China. Patients were interviewed with a Chinese version of the Mini International Neuropsychiatric Interview 5.0 by eight trained psychiatrists. Case records of inpatients with DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) DDs were reviewed to determine whether treating oncologists made a diagnosis of depression, prescribed antidepressant medications and/or recommended psychiatric consultation/referral.

RESULTS

The 1-month prevalence rates (95% confidence intervals) of DDs and major depressive disorder (MDD) were 25.9% (21.9%-29.9%) and 12.6% (9.6%-15.6%), respectively. In our multiple logistic regression analysis, being unmarried [odds ratio (OR)=1.41], cancer stage of metastasis (OR=2.35), time since cancer diagnosis ≤20 months (OR=2.05), frequent pain (OR=1.99~6.83) and being scored between two and four on the Eastern Cooperative Oncology Group Scale (OR=2.25~4.97) were independently associated with depression. Only 6.9% of patients with MDD were recognized by treating oncologists.

CONCLUSIONS

DDs are very common among Chinese inpatients with cancer. The high prevalence rate and low recognition rate of depression in cancer patients indicate a pressing need for routine screening, evaluation and treatment of depression in this patient population.

Human papillomavirus vaccine acceptability among parents of adolescent girls: obstacles and challenges in Mysore, India

OBJECTIVE

Worldwide, 530,000 women are diagnosed with cervical cancer and 275,000 die annually. India bears the greatest burden of the disease with 132,000 cases and 74,000 deaths yearly. Widespread uptake of human papillomavirus (HPV) vaccine could reduce incidence and mortality by two-thirds. This study explored obstacles and facilitators of parental acceptability of HPV vaccine.

METHODS

In 2010, questionnaires were sent home with a random sample of 800 girls attending 12 schools in Mysore city to be completed by a parent. Data were analyzed using multivariable logistic regression with generalized estimating equation to account for potential clustering by school.

RESULTS

Of the 797 completed surveys; 71% reported willingness to accept HPV vaccine for their daughters. The adjusted odds of acceptance was higher among participants who received recommendation from their parents, perceived cervical cancer as a serious disease, believed that HPV vaccine was safe, or felt that vaccination was a good way to protect against cervical cancer. Parents who had concerns about vaccine side-effects or thought that it would cause pain had lower odds of acceptance.

CONCLUSION

Future promotion of vaccine should emphasize safety of immunization and involve promotion to the extended family, so that they actively recommend immunization of young adolescent girls.