Lockdown during the pandemic has had significant impacts on public mental health. Previous studies suggest an increase in self-harm and suicide in children and adolescents. There has been little research on the roles of stringent lockdown.

To investigate the mediating and predictive roles of lockdown policy stringency measures in self-harm and emergency psychiatric presentations.

This was a retrospective cohort study. We analysed data of 2073 psychiatric emergency presentations of children and adolescents from 23 hospital catchment areas in ten countries, in March to April 2019 and 2020.

Lockdown measure stringency mediated the reduction in psychiatric emergency presentations (incidence rate ratio of the natural indirect effect [IRRNIE] = 0.41, 95% CI [0.35, 0.48]) and self-harm presentations (IRRNIE = 0.49, 95% CI [0.39, 0.60]) in 2020 compared with 2019. Self-harm presentations among male and looked after children were likely to increase in parallel with lockdown stringency. Self-harm presentations precipitated by social isolation increased with stringency, whereas school pressure and rows with a friend became less likely precipitants. Children from more deprived neighbourhoods were less likely to present to emergency departments when lockdown became more stringent,

Lockdown may produce differential effects among children and adolescents who self-harm. Development in community or remote mental health services is crucial to offset potential barriers to access to emergency psychiatric care, especially for the most deprived youths. Governments should aim to reduce unnecessary fear of help-seeking and keep lockdown as short as possible. Underlying mediation mechanisms of stringent measures and potential psychosocial inequalities warrant further research.

Wearable Digital Health Technologies (WDHTs) can support and enhance self-management by giving individuals with chronic conditions more control over their health, safety and wellbeing. Involving patients early on in the design of these technologies facilitates the development of person-centered products. It may increase the potential uptake of (and adherence to) any intervention they are designed to deliver. This research aims to elicit chronic kidney disease (CKD) patients’ preferences for WDHTs that may help patients manage their conditions.

We used discrete choice experiments (DCE) to elicit preferences for WDHTs characterized by their generalizable characteristics. The study design was informed by a multi-stage mixed-method approach (MSMMA). This included a review of the published literature, focus group interviews and one-to-one interactions with CKD patients to identify relevant characteristics (that is, attributes and levels) associated with wearable DHTs. We collected the data from 113 patients (age ≥18 years) with stage 3 or above CKD. The analysis started with a conventional multinomial logit model and was extended by investigating heterogeneity in preferences via latent class models.

Our MSMMA yielded ten potential attributes for consideration in a choice task. The final list included five attributes, cross-checked and validated by the research team, and patient representatives. The most preferred attributes of WDHTs were device appearance, format and type of information provided, and mode of engagement with patients. Respondents preferred a discreet device, which offered options that individuals could choose from and provided medical information.

We show how to use MSMMA to elicit user preferences in (and to inform the) early stages of the development of WDHTs. Individuals with CKD preferred specific characteristics that would make them more likely to engage with the self-management support WDHT. Our results provide valuable insights that can be used to inform the development of different WDHTs for different segments of the CKD patients population, moving away from a one-size-fits-all provision and resulting in population health gains.

The coronavirus disease 2019 (COVID-19) pandemic has led to significant strain on front-line healthcare workers.

In this multicentre study, we compared the psychological outcomes during the COVID-19 pandemic in various countries in the Asia-Pacific region and identified factors associated with adverse psychological outcomes.

From 29 April to 4 June 2020, the study recruited healthcare workers from major healthcare institutions in five countries in the Asia-Pacific region. A self-administrated survey that collected information on prior medical conditions, presence of symptoms, and scores on the Depression Anxiety Stress Scales and the Impact of Events Scale-Revised were used. The prevalence of depression, anxiety, stress and post-traumatic stress disorder (PTSD) relating to COVID-19 was compared, and multivariable logistic regression identified independent factors associated with adverse psychological outcomes within each country.

A total of 1146 participants from India, Indonesia, Singapore, Malaysia and Vietnam were studied. Despite having the lowest volume of cases, Vietnam displayed the highest prevalence of PTSD. In contrast, Singapore reported the highest case volume, but had a lower prevalence of depression and anxiety. In the multivariable analysis, we found that non-medically trained personnel, the presence of physical symptoms and presence of prior medical conditions were independent predictors across the participating countries.

This study highlights that the varied prevalence of psychological adversity among healthcare workers is independent of the burden of COVID-19 cases within each country. Early psychological interventions may be beneficial for the vulnerable groups of healthcare workers with presence of physical symptoms, prior medical conditions and those who are not medically trained.

Using a cross sectional study design 1366/1401 women in their 3rd trimester of pregnancy were screened for depression using the Self-Rating Questionnaire (SRQ) and the Edinburgh Postnatal Depression Scale (EPDS). These instruments are validated, available in Urdu and have been used in the pre and postnatal period in Pakistan. The life events checklist was used to measure social stress and the Brief Disability Questionnaire (BDQ) for disability.

342 women scored ≥ 12 on the EPDS giving an estimated AND prevalence of 25.6 %. The EPDS and SRQ scores showed a high positive correlation. A significantly higher percentage of depressed women experienced problems in marital relations, work, finances, housing and domestic violence. Depressed women had higher disability scores. 32% of the depressed and 14% of non depressed were unable to perform usual daily activities. 35% of depressed women stayed in bed due to illness as compared to only 16 % of non-depressed.

This study confirms a high prevalence of AND in less educated women, experiencing a large number of social difficulties.

Rehabilitation should help the mentally ill persons to strength their potentials and reduce the deficits in order to live successfully in community. First Croatian Outpatient Rehabilitation Center is organized in Psychiatric Hospital Vrapce. Its goal is to improve the quality of life in patients with psychotic disorders through a holistic rehabilitation program. The Rehabilitation Centre offers program provided by Multi-disciplinary team. Team evaluates each patient on individual bases and develops a realistic treatment/rehabilitation plan. The key of treatment is combination of case management and group treatment. Rehabilitation program includes a supportive individual therapy, provided by the coordinator and different group therapy (psychoeducation, anti-stigma program, family education, healthy life styles, social skill training, stress cooping and vocational training) and creative groups.

40 patients were evaluated in program in our Center according to frequency of visits and rehospitalisation. Also we followed up the family involvement, the number and types of groups which patients attend and contacts with case manager. The obtained data will be compared with BPRS score and the Satisfactory scale results.

It was evident that patients, who regularly contact their case managers, attend to more than one group and have family support, have the treatment better results on Satisfactory scale and BPRS score.

Community Rehabilitation Center offers highly individualized program which combines case management and group therapy in order to help patients with psychotic disorders to recover and live with higher quality standards in community and its long lasting benefits are expected in future.

Since April 2004, Government policy in England upholds that clinicians should send copies of their clinical letters to their patients. However, some argue that patients already have the right to access their records under the Data Protection Act, 1998. Others suggest it wiser not to provide a letter in certain circumstances. Little evidence is available examining the factors that impact on and underlie patients’ views in relation to this.

To inform professionals about patients’ views on receiving clinical letters.

To establish the proportion and characteristics of patients who would like to receive clinical letters and to elicit underlying reasons for decisions.

Subjects were randomly sampled from an outpatient clinic and data collected using an 11-item questionnaire, between October 2010 and July 2013.

The majority (60%) of patients wished to receive their clinical letter. Most (62%) favoured wanting to know about treatment primarily. Of those who did not wish to have a copy, greatest concerns were of loss in the post and ‘unnecessary paperwork’ (each 11%). This group of patients were characteristically male, aged 61-80, of asian ethnicity, unmarried and unemployed. Patients with a diagnosis of adult personality and behaviour (ICD-10 F60-69) were most likely to opt to receive their clinical letter.

Although the majority preferred to receive clinical letters, reasons for preferences varied widely. With an increasing drive towards greater transparency in the health service, approaches to enhancing patient involvement will need to be flexible to the individual to enable truly meaningful patient participation.

There has been a continued debate in the last decade about the possible role of polyunsaturated fatty acids especially omega-3 fatty acids in attention deficit hyperactivity disorder (ADHD) either as a causative factor - on deficiency - or as a treatment.

To compare omega-3 fatty acids status in children with ADHD to normal children and to study the efficacy of high dose supplementations of fatty acids on symptoms of ADHD.

40 children diagnosed with ADHD combined type and another 40 normally developing as a control group. All patients were subjected to Mini International Neuropsychiatric Interview for Children, IQ assessment,.Conners' Parent Rating Scale-Revised long version (CPRS-R-L), Vigil continuous performance test. The patients were prescribed omega-3 fatty acid supplement daily dose of 900 mg EPA and 600 mg DHA for 3 months. After end of the 3 months these children were assessed again using the Conners' parent rating scale-revised and Vigil continuous performance test.

Significantly lower levels of EPA and DHA in ADHD group compared to normal control inverse correlation between DHA on one side and Conner's ADHD index; inattentive subtest and total DSMIV indexed on the other side Conners’ ADHD index subscale there was a statistically significant improvement following the treatment.

Low levels of omega 3 may contribute to the symptoms of ADHD. Supplementing omega 3 in the treatment of ADHD could be a useful add on tratment specially in cases demonstrating low serum levels.

Alzheimer's disease (AD) shares Pathophysiological features with type 2 diabetes (T2D). The nuclear receptor peroxisome Proliferator- activated receptor GAMMA (PPARγ) is a ligand- activated transcription factor that regulates glucose and lipid metabolism and suppress inflammatory gene expression.

The potential therapeutic role of PPARγ on cognitive impairment and visuospatial memory in insulin resistance-induced AD using Pioglitazone; a PPARγ agonist.

AD was induced in 6 weeks old male rats by adding 6mg/L copper sulphate to drinking water for 8 weeks. Rats were randomly divided into 4 groups(n=10). (1) Normal control group on plain water, (2) AD control group, (3) Fructose drinking induced insulin resistance (IR) AD group, (4) Pioglitazone-treated group received orally (10mg/kg/day) at a volume of 2 ml/kg/day for the last 12 weeks of the 16 weeks period. Groups (3),(4) received 10% fructose solution in drinking water for 16 weeks after developing AD. Cognitive functions were assessed using discrimination index (DI) in object recognition test (ORT) and escape latency in Morris water maze(MWM) test. PPARγ was investigated for its role on γ-secretase and α secretes as well as glucose homeostasis.

PPARγ level was significantly elevated in IR-induced rats. However, Pioglitazone treatment was associated with restoration of PPARγ level to approximately normal values. Moreover, IR produced significant reduction in DI and prolongation of escape latency. Activation of PPARγ through Pioglitazone showed significant improvement in IR-induced dysfunctions in cognitive function and visuospatial memory in ORT and MWM tasks.

PPARγ agonists have a therapeutic potential in AD

Determine the prevalence of sexual assault in an inpatient forensic population.

Find individual-biological-social factors that may be associated with sex offending.

A cross-sectional study of patients admitted to a Canadian forensic unit.

Sample of 23 patients (95.7% male), of whom 13% had committed a sex offense. All men, 17% had attempted a murder, 17% had committed a murder, 48% had commited an assault and 5% had commited a different type of crime. 61% of the sample were in the low socioeconomic class and 39% to the medium one. 35% were diagnosed with developmental delay and 30% with personality disorders.

A person that had committed a sexual offense crime was much older, compared to the rest of the forensic population (43.33 ± 17.67 vs. 30.80 ± 11.93 years). Moreover the average stay in the hospital was almost the double for the sexual offenders compared with rest of the sample (199.67 months vs. 89.35 months).

Among the sexual offenders the prevalences of the diagnoses of AXIS I were, 67% psychoses, 33% mood disorders and 67% substance abuse. However all the sexual offenders were diagnosed with a comorbidity different than those compared with those that were not sexual offenders (100% vs 20%, p=0.003)

Older population who commits a sexual offense have a longer average stay at forensic unit.

Increased presence of comorbidities, associated at main diagnosis in axis I and organic comorbidities, as well as different treatments used.

The cutaneous polymorphic eruption of pregnancy (PEP) is presented by skin lesions usually in the third trimester of gestation and about 13% of women also suffer from perinatal depression.

To determine the frequency of pruritic urticarial papules of gestation with and without perinatal depression.

To assess the maternal causes for polymorphic eruption of pregnancy (PEP) in patients with and without perinatal depression.

Cases and controls were matched on the grounds of maternal weight gain in gestation, hormonal changes, deficit in iron and zinc, dysregulation of hypothalamic pituitary axis, pre-maturity, pre-eclampsia, pre-term labour. Univariate and multivariate analysis, adjusting for important demographic factors and comorbodities was conducted to assess the relationship of PEP with and without perinatal depression in reduced and full models of ANOVA in regression analysis. (Reduced model Y = β0 + β1X1 + … and the full model Y = β0 + β1X1 + β2X2 + β3X3 + β4X4 + β5X5 + β6X6 + …)

Polymorphic eruption of pregnancy with perinatal depression was statistically significant in maternal weight gain in gestation [odds ratio (OR) 1.20; 95% (CI): 1.15–1.30], hormonal changes [(OR) 2.78; 95% (CI): 2.52–2.82], deficit in iron and zinc [(OR) 2.18; 95% (CI): 2.04–2.38], dysregulation of hypothalamic pituitary axis [(OR) 1.37; 95% (CI): 1.18–1.49] and was not statistically significant in pre-maturity, pre-eclampsia and pre-term labour in cases and controls.

Pruritic urticarial papules and plaques of gestation are commonly associated in patients with perinatal derpession.

The authors have not supplied their declaration of competing interest.

Central-line–associated bloodstream infections (CLABSI) cause morbidity and mortality in critically ill children. We examined novel and/or modifiable risk factors for CLABSI to identify new potential targets for infection prevention strategies.

This single-center retrospective matched case-control study of pediatric intensive care unit (PICU) patients was conducted in a 60-bed PICU from April 1, 2013, to December 31, 2017. Case patients were in the PICU, had a central venous catheter (CVC), and developed a CLABSI. Control patients were in the PICU for ≥2 days, had a CVC for ≥3 days, and did not develop a CLABSI. Cases and controls were matched 1:4 on age, number of complex chronic conditions, and hospital length of stay.

Overall, 72 CLABSIs were matched to 281 controls. Univariate analysis revealed 14 risk factors, and 4 remained significant in multivariable analysis: total number of central line accesses in the 3 days preceding CLABSI (80+ accesses: OR, 4.8; P = .01), acute behavioral health needs (OR, 3.2; P = .02), CVC duration >7 days (8–14 days: OR, 4.2; P = .01; 15–29 days: OR, 9.8; P < .01; 30–59 days: OR, 17.3; P < .01; 60–89 days: OR, 39.8; P < .01; 90+ days: OR, 4.9; P = .01), and hematologic/immunologic disease (OR, 1.5; P = .05).

Novel risk factors for CLABSI in PICU patients include acute behavioral health needs and >80 CVC accesses in the 3 days before CLABSI. Interventions focused on these factors may reduce CLABSIs in this high-risk population.