TDuring COVID-19 pandemic, it was noticed that it was students who were mostly affected by the changes that aroused because of the pandemic. The interesting part is whether students’ well-being could be associated with their fields of study as well as coping strategies.

In this study, we aimed to assess 1) the mental health of students from nine countries with a particular focus on depression, anxiety, and stress levels and their fields of study, 2) the major coping strategies of students after one year of the COVID-19 pandemic.

We conducted an anonymous online cross-sectional survey on 12th April – 1st June 2021 that was distributed among the students from Poland, Mexico, Egypt, India, Pakistan, China, Vietnam, Philippines, and Bangladesh. To measure the emotional distress, we used the Depression, Anxiety, and Stress Scale-21 (DASS-21), and to identify the major coping strategies of students - the Brief-COPE.

We gathered 7219 responses from students studying five major studies: medical studies (N=2821), social sciences (N=1471), technical sciences (N=891), artistic/humanistic studies (N=1094), sciences (N=942). The greatest intensity of depression (M=18.29±13.83; moderate intensity), anxiety (M=13.13±11.37; moderate intensity ), and stress (M=17.86±12.94; mild intensity) was observed among sciences students. Medical students presented the lowest intensity of all three components - depression (M=13.31±12.45; mild intensity), anxiety (M=10.37±10.57; moderate intensity), and stress (M=13.65±11.94; mild intensity). Students of all fields primarily used acceptance and self-distraction as their coping mechanisms, while the least commonly used were self-blame, denial, and substance use. The group of coping mechanisms the most frequently used was ‘emotional focus’. Medical students statistically less often used avoidant coping strategies compared to other fields of study. Substance use was only one coping mechanism that did not statistically differ between students of different fields of study. Behavioral disengagement presented the highest correlation with depression (r=0.54), anxiety (r=0.48), and stress (r=0.47) while religion presented the lowest positive correlation with depression (r=0.07), anxiety (r=0.14), and stress (r=0.11).

1) The greatest intensity of depression, anxiety, and stress was observed among sciences students, while the lowest intensity of those components was found among students studying medicine.

2) Not using avoidant coping strategies might be associated with lower intensity of all DASS components among students.

3) Behavioral disengagement might be strongly associated with greater intensity of depression, anxiety, and stress among students.

4) There was no coping mechanism that provided the alleviation of emotional distress in all the fields of studies of students.

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Major Depressive Disorder (MDD) is one of the most common mental illnesses worldwide and is strongly associated with suicidality. Commonly used treatments for MDD with suicidality include crisis intervention, oral antidepressants (although risk of suicidal behavior is high among non-responders and during the first 10-14 days of the treatment) benzodiazepines and lithium. Although several interventions addressing suicidality exist, only few studies have characterized in detail patients with MDD and suicidality, including treatment, clinical course and outcomes. Patient Characteristics, Validity of Clinical Diagnoses and Outcomes Associated with Suicidality in Inpatients with Symptoms of Depression (OASIS-D)-study is an investigator-initiated trial funded by Janssen-Cilag GmbH.

For population 1 out of 3 OASIS-D populations, to assess the sub-population of patients with suicidality and its correlates in hospitalized individuals with MDD.

The ongoing OASIS-D study consecutively examines hospitalized patients at 8 German psychiatric university hospitals treated as part of routine clinical care. A sub-group of patients with persistent suicidality after >48 hours post-hospitalization are assessed in detail and a sub-group of those are followed for 6 months to assess course and treatment of suicidality associated with MDD. The present analysis focuses on a preplanned interim analysis of the overall hospitalized population with MDD.

Of 2,049 inpatients (age=42.5±15.9 years, females=53.2%), 68.0% had severe MDD without psychosis and 21.2% had moderately severe MDD, with 16.7% having treatment-resistant MDD. Most inpatients referred themselves (49.4%), followed by referrals by outpatient care providers (14.6%), inpatient care providers (9.0%), family/friends (8.5%), and ambulance (6.8%). Of these admissions, 43.1% represented a psychiatric emergency, with suicidality being the reason in 35.9%. Altogether, 72.4% had at least current passive suicidal ideation (SI, lifetime=87.2%), including passive SI (25.1%), active SI without plan (15.5%), active SI with plan (14.2%), and active SI with plan+intent (14.1%), while 11.5% had attempted suicide ≤2 weeks before admission (lifetime=28.7%). Drug-induced mental and behavioral disorders (19.6%) were the most frequent comorbid disorders, followed by personality disorders (8.2%). Upon admission, 64.5% were receiving psychiatric medications, including antidepressants (46.7%), second-generation antipsychotics (23.0%), anxiolytics (11.4%) antiepileptics (6.0%), and lithium (2.8%). Altogether, 9.8% reported nonadherence to medications within 6 months of admission.

In adults admitted for MDD, suicidality was common, representing a psychiatric emergency in 35.9% of patients. Usual-care treatments and outcomes of suicidality in hospitalized adults with MDD require further study.

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This study aimed to explore the utility of the eosinophil percentage in peripheral blood for guiding post-operative glucocorticoid therapy in patients with chronic rhinosinusitis with nasal polyps.

Forty-four patients with chronic rhinosinusitis with nasal polyps underwent functional endoscopic sinus surgery and were randomly divided into two groups. Patients in the standard treatment group used oral and nasal spray glucocorticoids. In the biomarker treatment group, patients with peripheral blood eosinophil percentage values less than 3.05 per cent did not receive glucocorticoid treatment, whereas patients with values 3.05 per cent or above were part of the standard treatment group. Visual Analogue Scale, Sino-Nasal Outcome Test-22 scores, endoscopic Lund–Kennedy scores, eosinophils, interleukin-5 and eosinophil cationic protein in peripheral blood, and nasal secretions were measured.

After functional endoscopic sinus surgery, the Visual Analogue Scale, Sino-Nasal Outcome Test-22 and Lund–Kennedy scores were significantly reduced in both groups; there were no significant differences in those indicators between the groups during the three follow-up visits.

Peripheral blood eosinophil percentage offers a potential biomarker to guide post-operative glucocorticoid therapy in patients with chronic rhinosinusitis with nasal polyps.

Cognitive impairments are well-established features of psychotic disorders and are present when individuals are at ultra-high risk for psychosis. However, few interventions target cognitive functioning in this population.

To investigate whether omega-3 polyunsaturated fatty acid (n−3 PUFA) supplementation improves cognitive functioning among individuals at ultra-high risk for psychosis.

Data (N = 225) from an international, multi-site, randomised controlled trial (NEURAPRO) were analysed. Participants were given omega-3 supplementation (eicosapentaenoic acid and docosahexaenoic acid) or placebo over 6 months. Cognitive functioning was assessed with the Brief Assessment of Cognition in Schizophrenia (BACS). Mixed two-way analyses of variance were computed to compare the change in cognitive performance between omega-3 supplementation and placebo over 6 months. An additional biomarker analysis explored whether change in erythrocyte n−3 PUFA levels predicted change in cognitive performance.

The placebo group showed a modest greater improvement over time than the omega-3 supplementation group for motor speed (ηp2 = 0.09) and BACS composite score (ηp2 = 0.21). After repeating the analyses without individuals who transitioned, motor speed was no longer significant (ηp2 = 0.02), but the composite score remained significant (ηp2 = 0.02). Change in erythrocyte n-3 PUFA levels did not predict change in cognitive performance over 6 months.

We found no evidence to support the use of omega-3 supplementation to improve cognitive functioning in ultra-high risk individuals. The biomarker analysis suggests that this finding is unlikely to be attributed to poor adherence or consumption of non-trial n−3 PUFAs.

As the incidence of gender incongruence (GI)/gender dysphoria (GD) rises yearly, public understanding of transgender is also increasing, whereas this improvement cannot be achieved without extensive transgender-related surveys. However, most of the surveys were only issued to people who identify themselves as transgender with the absence of medical confirmations in most situations. These result in a gap between transgender survey and diagnosed GI/GD.

This study aims to discover the gap between self-reported and diagnostically confirmed transgender and GI/GD individuals among students in China.

We chose two middle schools and one college from Changsha (a city in China) at random with a total of 2047 students. Among them, 1661 students gave us certain gender identify responses in which we categorized them into two types (cisgender and gender minorities). Professional psychiatrists then used ICD-11 and DSM-5 criteria to confirm whether the self-reported gender minorities could be diagnosed with GI/GD via phone or in person.

In total, 7.5% of the college students and 5.8% of the middle school students reported themselves as gender minorities. Although 29% of college students and 43.8% of middle school students did not cooperate with the subsequent psychiatric interviews, none of the self-reported gender minority students meet the GI/GD criteria of ICD-11/DSM-5.

The epidemiological investigation of transgender is heavily affected by the definition and the data sources. There is a huge heterogeneity between self-reported transgender and diagnosed GI/GD. Future transgender studies should strictly control inclusion criteria.

No significant relationships.

Patients with single ventricle CHD have significant morbidity and healthcare utilisation throughout their lifetime, including non-cardiac hospital admissions. Respiratory viral infections are the main cause of hospitalisation in children, but few data exist for single ventricle patients. We sought to identify how respiratory viral infections impact patients with single ventricle CHD and potential differences between Glenn and Fontan circulation.

We conducted a retrospective study of patients seen from 01/01/2011–12/31/2020. We identified patients with a history of single ventricle CHD and Glenn palliation, and a normoxic control group with isolated atrial septal defect requiring surgical closure. We compared viral-related clinical presentations, admissions, and admission characteristics.

A total of 312 patients were included (182 single ventricle, 130 atrial septal defect). Single ventricle patients were more likely than children with isolated atrial septal defect to be admitted with a respiratory virus (odds ratio 4.15 [2.30–7.46]), but there was no difference in mechanical ventilation or hospital length of stay (p = 0.4709). Single ventricle patients with Glenn circulation were more likely than those with Fontan circulation to present and be admitted (odds ratio 3.25 [1.62–6.52]), but there was no difference in ICU admission, mechanical ventilation, or hospital length of stay (p = 0.1516).

Respiratory viral infections are prevalent but uncomplicated in patients with single ventricle CHD. Viral-related presentations and admissions are more prevalent during the period of Glenn circulation compared to Fontan circulation; however, rate of mechanical ventilation and hospital length of stay are similar.

The aim of this study was to examine birth outcomes in areas affected by Hurricane Michael.

Vital statistics data of 2017–2019 were obtained from the state of Florida. Births occurring in the year before and after the date of Hurricane Michael (October 7, 2018) were used. Florida counties were divided into 3 categories reflecting extent of impact from Hurricane Michael. Birth outcomes including incidence of preterm birth (PTB), low birth weight (LBW), and small for gestational age (SGA) were also compared before and after Hurricane Michael. Spontaneous and indicated PTBs were distinguished based on previously published algorithms. Multiple regression was used to control for potential confounders.

Both LBW (aRR 1.19, 95% CI: 1.07, 1.32) and SGA (aRR 1.11, 95% CI: 1.01, 1.21) were higher in the year after Michael than the year before in the most-affected area; a similar effect was not seen in other areas. A stronger effect was seen for exposure in the first trimester or in the 2 months after Michael than in the second or third trimester.

Consistent with many previous studies, this study of Hurricane Michael found an effect on fetal growth.

Pulmonary arteriovenous malformations in single ventricle congenital heart disease are poorly understood. Previous studies investigating pulmonary arteriovenous malformations predominantly focus on patients with heterotaxy syndrome and interrupted inferior caval vein. It is unknown if development and resolution of pulmonary arteriovenous malformations are similar for patients with and without heterotaxy syndrome.

In this retrospective single-institution study, we identified patients with a history of single ventricle congenital heart disease and Fontan palliation. We then matched patients with heterotaxy syndrome (intact and interrupted inferior caval vein) and non-heterotaxy hypoplastic left heart syndrome. To compare development of pulmonary arteriovenous malformations, we identified the frequency of positive diagnoses pre-Fontan. To compare resolution of pulmonary arteriovenous malformations, we recorded oxygen saturation changes for 12 months following Fontan.

A total of 124 patients were included. Patients with heterotaxy and interrupted inferior caval vein were more likely to have a pre-Fontan contrast echocardiogram performed (p < 0.01) and more likely to be diagnosed with pulmonary arteriovenous malformations pre-Fontan (p < 0.01). There was no difference in oxygen saturation prior to Fontan, yet all patient groups had increased their oxygen saturations in the first year after Fontan discharge.

Pulmonary arteriovenous malformations are variably diagnosed prior to Fontan palliation; however, all study groups had increased oxygen saturations after Fontan discharge, potentially indicating resolution of pulmonary arteriovenous malformations in all groups. The prevalence of pulmonary arteriovenous malformations pre-Fontan is likely underestimated. A quantitative, systematic approach to diagnosis and follow-up of pulmonary arteriovenous malformations is needed to better understand susceptibility and pathophysiology.

Lifestyle interventions are an important and viable approach for preventing cognitive deficits. However, the results of studies on alcohol, coffee and tea consumption in relation to cognitive decline have been divergent, likely due to confounds from dose–response effects. This meta-analysis aimed to find the dose–response relationship between alcohol, coffee or tea consumption and cognitive deficits.

Prospective cohort studies or nested case-control studies in a cohort investigating the risk factors of cognitive deficits were searched in PubMed, Embase, the Cochrane and Web of Science up to 4th June 2020. Two authors searched the databases and extracted the data independently. We also assessed the quality of the studies with the Newcastle-Ottawa scale. Stata 15.0 software was used to perform model estimation and plot the linear or nonlinear dose–response relationship graphs.

The search identified 29 prospective studies from America, Japan, China and some European countries. The dose–response relationships showed that compared to non-drinkers, low consumption (<11 g/day) of alcohol could reduce the risk of cognitive deficits or only dementias, but there was no significant effect of heavier drinking (>11 g/day). Low consumption of coffee reduced the risk of any cognitive deficit (<2.8 cups/day) or dementia (<2.3 cups/day). Green tea consumption was a significant protective factor for cognitive health (relative risk, 0.94; 95% confidence intervals, 0.92–0.97), with one cup of tea per day brings a 6% reduction in risk of cognitive deficits.

Light consumption of alcohol (<11 g/day) and coffee (<2.8 cups/day) was associated with reduced risk of cognitive deficits. Cognitive benefits of green tea consumption increased with the daily consumption.

Previous studies showed that persons with mental illness had poorer quality of life than persons with the other medical conditions. We developed a manualized treatment - Quality of Life Enhancement Program (QOLEP) based on literature review and clinical experiences. the contents of the program include 4 sessions of ‘occupational life scheduling’ and 4 sessions of ‘coping skills’ provided by an occupational therapist during a 4-week period (2 times/week) which each session lasts for one to two hours.

Twenty-one subjects were recruited from community mental health rehabilitation centers in northern Taiwan. They were randomly assigned to either treatment group (N=11) or control group (N=10). the subjects in the control group received general supportive therapy over the phone twice a week for 4 weeks. Both groups were evaluated at baseline and posttreatment. the mixed-effects linear model was applied to analyze the efficacy of the treatment.

The results showed that the subjects who participated in the QOLEP had significantly better physical QOL than that of control group (-9.66+4.24, p< .05). the suicidal ideation of the subjects for both groups decreased over time (2.64+3.16, p< .05). Most of the participants indicated that the activities were easily understood, helpful to them, and are willing to participate in the program again.

With the program developed based on concept of occupational engagement, we were able to demonstrate the efficacy of specific treatment on quality of life and used it as evidence to support future development in mental health area.

Attrition can pose significant barriers to treatment success of depression; its contributing factors and impacts on treatment outcome need further clarification. Current study aimed to describe patterns of treatment attrition, to examine associated demographic and clinical determinants and to test whether and how attrition affects outcome of depression in a national cohort of adults treated for depression.

All adult patients prescribed with antidepressants for depression (n=216,557) in 2003 were identified from the National Health Insurance Research Database in Taiwan. Based on individuals’ clinical visit and antidepressant prescription, three attrition types, i.e., non-attrition, returning attrition and non-returning attrition, and their demographic/disease characteristics were identified. The relationships between attrition type and remission outcome over an 18-month follow-up period were further explored.

Factors pertaining to disease characteristics (severity of depression, comorbidities, painful physical symptoms and past treatment history) and clinical practice (physician specialty and choice of antidepressants) were associated with attrition and remission outcome at 18-month follow-up. Patients remaining in treatment within the first three months were associated with higher odds of having sustained remission (OR=1.21; 99% CI: 1.16, 1.27) and lower odds of having relapses/recurrences (OR=0.20; 99% CI: 0.19, 0.21) over the 18-month period, compared to those returning attriters.

Early attrition has significant negative impacts on antidepressant treatment outcome; it hence needs to be minimized through shared decision-making, exchange of treatment preferences and proper patient-physician communication. Based on current understanding, further efforts to reduce early attrition are highly warranted.