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Little is known about how sociodemographic and clinical factors affect the caregiving burden of persons with schizophrenia (PwSs) with transition in primary caregivers.
Aims
This study aimed to examine the predictive effects of sociodemographic and clinical factors on the caregiving burden of PwSs with and without caregiver transition from 1994 to 2015 in rural China.
Method
Using panel data, 206 dyads of PwSs and their primary caregivers were investigated in both 1994 and 2015. The generalised linear model approach was used to examine the predictive effects of sociodemographic factors, severity of symptoms and changes in social functioning on the caregiving burden with and without caregiver transition.
Results
The percentages of families with and without caregiver transition were 38.8% and 61.2%, respectively. Among families without caregiver transition, a heavier burden was significantly related to a larger family size and more severe symptoms in PwSs. Deteriorated functioning of ‘social activities outside the household’ and improved functioning of ‘activity in the household’ were protective factors against a heavy caregiving burden. Among families with caregiver transition, younger age, improved marital functioning, deteriorated self-care functioning, and better functioning of ‘social interest or concern’ were significant risk factors for caregiving burden.
Conclusions
The effects of sociodemographic and clinical correlates on the caregiving burden were different among families with and without caregiver transition. It is crucial to explore the caregiver arrangement of PwSs and the risk factors for burden over time, which will facilitate culture-specific family interventions, community-based mental health services and recovery.
Reconstructing the history of elite communication in ancient China benefits from additional archaeological evidence. We combine textual analysis with new human stable carbon and nitrogen isotope data from two Chu burials in the Jingzhou area to reveal significant dietary differences among Chu nobles of the middle Warring States period (c. 350 BC). This research provides important new information on the close interaction between the aristocratic families of the Qin and Chu.
In this paper, we present explicit and computable error bounds for the asymptotic expansions of the Hermite polynomials with Plancherel–Rotach scale. Three cases, depending on whether the scaled variable lies in the outer or oscillatory interval, or it is the turning point, are considered separately. We introduce the ‘branch cut’ technique to express the error terms as integrals on the contour taken as the one-sided limit of curves approaching the branch cut. This new technique enables us to derive simple error bounds in terms of elementary functions. We also provide recursive procedures for the computation of the coefficients appearing in the asymptotic expansions.
This study examined the pattern of medical utilization and the distribution of comorbidities shortly before death among adolescents who died from suicide and compared these data with those of living controls.
Methods
From Taiwan's National Health Insurance Research Database, this study identified adolescents aged 10–19 years who died from suicide (n = 935) between 1 January 2000, and 31 December 2016, by linking each patient with the national mortality database. The researchers conducted a nested case–control study through risk set sampling, and for each case, 20 age- and sex-matched controls (n = 18 700) were selected from the general population. The researchers applied conditional logistic regression to investigate differences in medical utilization and physical and psychiatric comorbidities between cases and controls.
Results
Cases had a higher proportion of contact with the psychiatric department but a similar proportion of contact with any non-psychiatric medical department within 1 year before suicide compared with controls. There were 18.6% of adolescent suicide victims who only had contacted with a psychiatric department 3 months before suicide. Moreover, cases had a higher proportion of contact with non-psychiatric services within 3 months before suicide, particularly with emergency, surgery, and internal medicine departments. Cases had higher risks of several psychiatric disorders and physical illnesses, including heart diseases, pneumonia, and ulcer disease, than did controls.
Conclusions
The findings of increased medical utilization and higher risks of physical and psychiatric comorbidities in adolescent suicide victims are crucial for developing specific interventions to prevent suicide in this population.
Cognitive impairment is common in late-life depression, which may increase Alzheimer disease (AD) risk. Therefore, we aimed to investigate whether late-life major depressive disorder (MDD) has worse cognition and increases the characteristic AD neuropathology. Furthermore, we carried out a comparison between treatment-resistant depression (TRD) and non-TRD. We hypothesized that patients with late-life depression and TRD may have increased β-amyloid (Aβ) deposits in brain regions responsible for global cognition.
Methods
We recruited 81 subjects, including 54 MDD patients (27 TRD and 27 non-TRD) and 27 matched healthy controls (HCs). Neurocognitive tasks were examined, including Mini-Mental State Examination and Montreal Cognitive Assessment to detect global cognitive functions. PET with Pittsburgh compound-B and fluorodeoxyglucose were used to capture brain Aβ pathology and glucose use, respectively, in some patients.
Results
MDD patients performed worse in Montreal Cognitive Assessment (p = 0.003) and had more Aβ deposits than HCs across the brain (family-wise error-corrected p < 0.001), with the most significant finding in the left middle frontal gyrus. Significant negative correlations between global cognition and prefrontal Aβ deposits existed in MDD patients, whereas positive correlations were noted in HCs. TRD patients had significantly more deposits in the left-sided brain regions (corrected p < 0.001). The findings were not explained by APOE genotypes. No between-group fluorodeoxyglucose difference was detected.
Conclusions
Late-life depression, particularly TRD, had increased brain Aβ deposits and showed vulnerability to Aβ deposits. A detrimental role of Aβ deposits in global cognition in patients with late-onset or non-late-onset MDD supported the theory that late-life MDD could be a risk factor for AD.
Nutritional Risk Screening index is a standard tool to assess nutritional risk, but epidemiological data are scarce on controlling nutritional status (CONUT) as a prognostic marker in acute haemorrhagic stroke (AHS). We aimed to explore whether the CONUT may predict a 3-month functional outcome in AHS. In total, 349 Chinese patients with incident AHS were consecutively recruited, and their malnutrition risks were determined using a high CONUT score of ≥ 2. The cohort patients were divided into high-CONUT (≥ 2) and low-CONUT (< 2) groups, and primary outcomes were a poor functional prognosis defined as the modified Rankin Scale (mRS) score of ≥ 3 at post-discharge for 3 months. Odds ratios (OR) with 95 % confidence intervals (CI) for the poor functional prognosis at post-discharge were estimated by using a logistic analysis with additional adjustments for unbalanced variables between the high-CONUT and low-CONUT groups. A total of 328 patients (60·38 ± 12·83 years; 66·77 % male) completed the mRS assessment at post-discharge for 3 months, with 172 patients at malnutrition risk at admission and 104 patients with a poor prognosis. The levels of total cholesterol and total lymphocyte counts were significantly lower in high-CONUT patients than low-CONUT patients (P = 0·012 and < 0·001, respectively). At 3-month post discharge, there was a greater risk for the poor outcome in the high-CONUT compared with the low-CONUT patients at admission (OR: 2·32, 95 % CI: 1·28, 4·17). High-CONUT scores independently predict a 3-month poor prognosis in AHS, which helps to identify those who need additional nutritional managements.
The condition of partial anomalous origin of a branch pulmonary artery from the descending aorta could be found in several diseases and should be carefully differentiated. We report an unusual case of anomalous systemic arterial supply to normal basal segments of the left lower lung and another case of intralobar pulmonary sequestration. These two cases were treated successfully by transarterial embolisation using the Amplatzer Vascular Plug. We also set up a diagnostic algorithm to differentiate these diseases from anomalous systemic arterial supply to the pulmonary region. It is possible to make the correct diagnosis using the step-by-step diagnostic algorithm and careful interpretation of chest computed tomography angiography.
Enterprises evolve continuously, usually gradually, but sometimes rapidly in the face of disruptive events. The purpose of this study is to analyze the transformation process of the design consultancy in the face of challenges presented by advanced technology, economic change, and systemic shifts by applying selected methods and tools from the ARIES (Architecting Innovative Enterprise Strategy) framework. The study uses IDEO as an example to discuss the organizational structure of design consultancies, and describes how IDEO has evolved in the context of change. This study illustrates some emerging challenges that the design consulting industry is facing now and will face in the future, and how these challenges will affect organizational culture and structure, the design consulting process, the recruiting criteria, and the designers, as well as envisioning possible paths for the future of design consultancy.
While the external infiltration of water has been identified from modern geothermal and/or fossil hydrothermal systems through stable isotopes, the physicochemical boundary conditions like the initial oxygen isotopes of water $( {{\rm \delta }^{ 18}{\rm O}_{\rm W}^{\rm i} } ) $ and rock as well as alteration temperature were implicitly presumed or empirically estimated by the conventional forward modelling. In terms of a novel procedure proposed to deal with partial re-equilibration of oxygen isotopes between constituent minerals and water, the externally infiltrated meteoric and magmatic water are theoretically inverted from the early Cretaceous post-collisional granitoid and intruded Triassic gneissic country rock across the Dabie orogen in central-eastern China. The meteoric water with a $ {{\rm \delta }^{ 18}{\rm O}_{\rm W}^{\rm i} } $ value of −11.01 ‰ was externally infiltrated with a granitoid and thermodynamically re-equilibrated with rock-forming minerals at 140°C with a minimum water/rock (W/R)o ratio around 1.10 for an open system. The lifetime of this meteoric hydrothermal system is kinetically constrained less than 0.7 million years (Myr) via modelling of surface reaction oxygen exchange. A gneissic country rock, however, was externally infiltrated by a magmatic water with $ {{\rm \delta }^{ 18}{\rm O}_{\rm W}^{\rm i} } $ value of 4.21 ‰ at 340°C with a (W/R)o ratio of 1.23, and this magmatic hydrothermal system could last no more than 12 thousand years (Kyr) to rapidly re-equilibrate with rock-forming minerals. Nevertheless, the external infiltration of water can be theoretically inverted with oxygen isotopes of re-equilibrated rock-forming minerals, and the ancient hydrothermal systems driven by magmatism or metamorphism within continental orogens worldwide can be reliably quantified.
The retention of patients under methadone maintenance treatment (MMT) is an indication for the effectiveness of the therapy. We aimed to explore the relation between mortality and the cumulative MMT duration.
Methods
A retrospective cohort analysis was performed using Taiwan Illicit Drug Issue Database (TIDID) and National Health Insurance Research Database (NHIRD) during 2012–2016. We included 9149 and 11 112 MMT patients as the short and long groups according to the length of their cumulative MMT duration, 1–364 and ⩾365 days, respectively. The risk of mortality was calculated by Cox proportional hazards regression model with time-dependent exposure to MMT, and the survival probability was plotted with the Kaplan-Meier curve.
Results
The mortality rates were 2.51 and 1.51 per 100 person-years in the short and long cumulative MMT duration groups, respectively. After adjusting for on or off MMT, age, sex, marital status, education level, maximum methadone dose, and comorbidities (human immunodeficiency virus, depression, hepatitis C virus, hepatitis B virus, alcoholic liver disease, and cardiovascular disease), the long group had a lower risk of death (hazard ratio = 0.67; 95% confidence interval 0.60–0.75) than the short group. Increased risk was observed in patients with advanced age, being male, unmarried, infected by HIV, HCV, and HBV, and diagnosed with depression, ALD, and CVD. Causes of death were frequently related to drug and injury.
Conclusions
Longer cumulative MMT duration is associated with lower all-cause and drug-related mortality rate.
Although poverty associated with severe mental illness (SMI) has been documented in many studies, little long-term evidence of social drift exists. This study aimed to unravel the poverty transitions among persons with SMI in a fast change community in China.
Methods
Two mental health surveys, using the International Classification of Disease (ICD-10), were conducted in the same six townships of Xinjin county, Chengdu, China in 1994 and 2015. A total of 308 persons with SMI identified in 1994 were followed up in 2015. The profiles of poverty transitions were identified and regression modelling methods were applied to determine the predictive factors of poverty transitions.
Results
The poverty rate of persons with SMI increased from 39.9% to 49.4% in 1994 and 2015. A larger proportion of them had fallen into poverty (27.3%) rather than moved out of it (17.8%). Those persons with SMI who had lost work ability, had physical illness and more severe mental disabilities in 1994, as well as those who had experienced negative changes on these factors were more likely to live in persistent poverty or fall into poverty. Higher education level and medical treatment were major protective factors of falling into poverty.
Conclusions
This study shows long-term evidence on the social drift of persons with SMI during the period of rapid social development in China. Further targeted poverty alleviation interventions should be crucial for improving treatment and mental recovery and alleviating poverty related to SMI.
The high overall plant-based diet index (PDI) is considered to protect against type 2 diabetes in the general population. However, whether the PDI affects gestational diabetes mellitus (GDM) risk among pregnant women is still unclear. We evaluated the association between PDI and GDM risk based on a Chinese large prospective cohort – the Tongji Maternal and Child Health Cohort. Dietary data were collected at 13–28 weeks of pregnancy by a validated semi-quantitative FFQ. The PDI was obtained by assigning plant food groups positive scores while assigning animal food groups reverse scores. GDM was diagnosed by a 75 g 2-h oral glucose tolerance test at 24–28 weeks of gestation. Logistic regression models were fitted to estimate OR of GDM, with associated 95 % CI, comparing women in different PDI quartiles. Among the total 2099 participants, 169 (8·1 %) were diagnosed with GDM. The PDI ranged from 21·0 to 52·0 with a median of 36·0 (interquartile range (IQR) 33·0–39·0). After adjusting for social-demographic characteristics and lifestyle factors etc., the participants with the highest quartile of PDI were associated with 57 % reduced odds of GDM compared with women in the lowest quartile of PDI (adjusted OR 0·43; 95 % CI 0·24, 0·77; Pfor trend = 0·005). An IQR increment in PDI was associated with 29 % decreased odds of GDM (adjusted OR 0·71; 95 % CI 0·56, 0·90). Findings suggest that adopting a plant-based diet during pregnancy could reduce GDM risk among Chinese women, which may be valuable for dietary counselling during pregnancy.
The upsurge in the number of people affected by the COVID-19 is likely to lead to increased rates of emotional trauma and mental illnesses. This article systematically reviewed the available data on the benefits of interventions to reduce adverse mental health sequelae of infectious disease outbreaks, and to offer guidance for mental health service responses to infectious disease pandemic. PubMed, Web of Science, Embase, PsycINFO, WHO Global Research Database on infectious disease, and the preprint server medRxiv were searched. Of 4278 reports identified, 32 were included in this review. Most articles of psychological interventions were implemented to address the impact of COVID-19 pandemic, followed by Ebola, SARS, and MERS for multiple vulnerable populations. Increasing mental health literacy of the public is vital to prevent the mental health crisis under the COVID-19 pandemic. Group-based cognitive behavioral therapy, psychological first aid, community-based psychosocial arts program, and other culturally adapted interventions were reported as being effective against the mental health impacts of COVID-19, Ebola, and SARS. Culturally-adapted, cost-effective, and accessible strategies integrated into the public health emergency response and established medical systems at the local and national levels are likely to be an effective option to enhance mental health response capacity for the current and for future infectious disease outbreaks. Tele-mental healthcare services were key central components of stepped care for both infectious disease outbreak management and routine support; however, the usefulness and limitations of remote health delivery should also be recognized.
The accurate prediction of turbulent mixing induced by Rayleigh–Taylor (R–T), Richtmyer–Meshkov (R–M) and Kelvin–Helmholtz (K–H) instabilities is very important in understanding natural phenomena and improving engineering applications. In applications, the prediction of mixing with the Reynolds-averaged Navier–Stokes (RANS) equation remains the most widely used method. The RANS method involves two aspects, i.e. physical modelling and model coefficients. Generally, the latter is determined empirically; thus, there is a lack of universality. In this paper, inspired by the well-known Reynolds decomposition, we propose a methodology to determine the model coefficients with the following three steps: (i) preset a set of analytical RANS solutions by fully using the knowledge of mixing evolutions; (ii) simplify the differential RANS equations to algebraic equations by imposing the preset solutions to RANS equations; (iii) solve the algebraic equations approximately to give the values of the entire model coefficients. The specific application of this methodology in the widely used K–L mixing model shows that, using the same set of model coefficients determined from the current methodology, the K–L model successfully predicts the mixing evolutions in terms of different physical quantities (e.g. temporal scalings and spatial profiles), density ratios and problems (e.g. R–T, R–M, K–H and reshocked R–M mixings). It is possible to extend this methodology to other turbulence models characterised with self-similar evolutions, such as K-$\epsilon$ mixing models.
Little is known about the trend and predictors of 21-year mortality and suicide patterns in persons with schizophrenia.
Aims
To explore the trend and predictors of 21-year mortality and suicide in persons with schizophrenia in rural China.
Method
This longitudinal follow-up study included 510 persons with schizophrenia who were identified in a mental health survey of individuals (≥15 years old) in 1994 in six townships of Xinjin County, Chengdu, China, and followed up in three waves until 2015. Kaplan–Meier survival analysis and Cox hazard regressions were conducted.
Results
Of the 510 participants, 196 died (38.4% mortality) between 1994 and 2015; 13.8% of the deaths (n = 27) were due to suicide. Life expectancy was lower for men than for women (50.6 v. 58.5 years). Males consistently showed higher rates of mortality and suicide than females. Older participants had higher mortality (hazard ratio HR = 1.03, 95% CI 1.01–1.05) but lower suicide rates (HR = 0.95, 95% CI 0.93–0.98) than their younger counterparts. Poor family attitudes were associated with all-cause mortality and death due to other causes; no previous hospital admission and a history of suicide attempts independently predicted death by suicide.
Conclusions
Our findings suggest there is a high mortality and suicide rate in persons with schizophrenia in rural China, with different predictive factors for mortality and suicide. It is important to develop culture-specific, demographically tailored and community-based mental healthcare and to strengthen family intervention to improve the long-term outcome of persons with schizophrenia.
Little is known about poverty trends in people with severe mental illness (SMI) over a long time span, especially under conditions of fast socioeconomic development.
Aims
This study aims to unravel changes in household poverty levels among people with SMI in a fast-changing rural community in China.
Method
Two mental health surveys, using ICD-10, were conducted in the same six townships of Xinjin county, Chengdu, China. A total of 711 and 1042 people with SMI identified in 1994 and 2015, respectively, participated in the study. The Foster-Greer-Thorbecke poverty index was adopted to measure the changes in household poverty. These changes were decomposed into effects of growth and equity using a static decomposition method. Factors associated with household poverty in 1994 and 2015 were examined and compared by regression analyses.
Results
The proportion of poor households, as measured by the headcount ratio, increased significantly from 29.8% in 1994 to 39.5% in 2015. Decomposition showed that poverty in households containing people with SMI had worsened because of a redistribution effect. Factors associated with household poverty had also changed during the study period. The patient's age, ability to work and family size were of paramount significance in 2015.
Conclusions
This study shows that the levels of poverty faced by households containing people with SMI has become more pressing with China's fast socioeconomic development. It calls for further integration of mental health recovery and targeted antipoverty interventions for people with SMI as a development priority.
Southern China is affected by multi-stage tectonic activities, with strong fold deformation, complex fault systems and poor shale gas preservation conditions. Here, we used shale samples from the lower Silurian Longmaxi shale in the complex tectonic area of Southern China, to study the relationship between differential structural deformation, and pore structure and adsorption capacity. According to the deformation mechanism of the shale, it is further divided into brittle-slip rheological deformation (BD) and ductile-slip rheological deformation (DD). The results show that all micro-fractures can be observed under scanning electron microscopy in deformed shale samples, but in shale samples with different types of rheological deformation, the micro-fractures have large differences in scale, fracture length and lateral connectivity. The micro-fractures developed in DD shales are small in scale and short in fracture length, but have strong local connectivity. In contrast, brittle minerals are more developed in BD shales, and interlayer shearing has formed micro-fractures with large fracture length and good lateral connectivity, which is beneficial for later fracturing. In these two types of deformed shales, pores in organic matter are rare, and sporadic organic pores have small pore size and poor connectivity. The total pore volume (1.8–2.4 × 10−2 cm3 g–1) of BD shale samples is higher than that of DD shale samples (0.8–1.6 × 10−2 cm3 g–1). There is a positive correlation between total pore volume and quartz content. In addition, the specific surface area (12–18 m2 g–1) of DD shale samples is larger than that of BD shale samples (6–12 m2 g–1).
A miniature dual-band bandpass filter with interlocked stepped-impedance resonators (SIRs) is presented in this paper, which was designed for the student design competition held in European Microwave Week 2019. This bandpass filter is required to have two concurrent passbands, namely, the first passband at 900–1000 MHz and the second passband at 1427–1518 MHz bands, which cover six designated bands in sub-6 GHz range of fifth generation (5G) New Radio Access Technology. Three stopbands are required at 500–850, 1050–1350, and 1600–2000 MHz, respectively. To achieve the best figure of merit, an interlocked configuration of two SIRs is proposed. One advantage is that the impedance ratio of the inter-locked SIR can be controlled to have two passbands at the required frequencies. Second, the coupling section of the interlocked SIR gives three transmission zeros distributed to every stopbands such that the stopband suppression are dramatically enhanced. The measured results show that the passband insertion losses are 2.16 dB at the first passband and 1.33 dB at the second passband, and the return losses are greater than 10 dB. The stopband suppression at the transmission zeros are greater than 38 dB. The circuit is very compact as 41.40 × 19.96 mm2, equivalent to $0.25 \times 0.12\,\lambda _g^2$.
In the current research, a 60-d experiment was conducted with the purpose of exploring the impacts of methionine (Met) on growth performance, muscle nutritive deposition, muscle fibre growth and type I collagen synthesis as well as the related signalling pathway. Six diets (iso-nitrogenous) differing in Met concentrations (2·54, 4·85, 7·43, 10·12, 12·40 and 15·11 g/kg diets) were fed to 540 grass carp (178·47 (SD 0·36) g). Results showed (P < 0·05) that compared with Met deficiency, optimal level of dietary Met (1) increased feed intake, feed efficiency, specific growth rate and percentage weight gain (PWG); (2) increased fish muscle protein, lipid and free amino acid contents and improved fish muscle fatty acid profile as well as increased protein content in part associated with the target of rapamycin complex 1 (TORC1)/S6K1 signalling pathway; (3) increased the frequency distribution of muscle fibre with >50 µm of diameter; (4) increased type I collagen synthesis partly related to the transforming growth factor-β1/Smads and CK2/TORC1 signalling pathways. In conclusion, dietary Met improved muscle growth, which might be due to the regulation of muscle nutritive deposition, muscle fibre growth and type I collagen synthesis-related signal molecules. Finally, according to PWG and muscle collagen content, the Met requirements for on-growing grass carp (178–626 g) were estimated to be 9·56 g/kg diet (33·26 g/kg protein of diet) and 9·28 g/kg diet (32·29 g/kg of dietary protein), respectively.