bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effectiveness, Acceptability and Safety of Pharmaceutical Management for Combat-Related PTSD in Adults Based on Systematic Review of Twenty-Two Randomized Controlled Trials
Authors: Yan Jin-Zhu , Liu Jia-Ling , Li Xiao-Zheng , Zhang Zhi-Xin , Liu Run-Ben , Zhang Chao , Gong Qin-Qin 
Published: January 2022

Objective: This study assessed the efficacy, acceptability, and safety of pharmaceutical management for combat-related post-traumatic stress disorder (PTSD) to provide a clinical decision-making basis for clinicians.Method: A comprehensive search was conducted using Ovid MEDLINE, Ovid EMBASE, Cochrane Library, Scopus, ScienceDirect, and Web of Science for randomized controlled trails (RCTs), which reported pharmaceutical management and placobo for adults with combat-related PTSD, that were published until April 21, 2021. The effectiveness, acceptability, and adverse events (AEs), were designed as interested outcomes. The change in total symptoms of combat-related PTSD according to the clinician rating scale was defined as primary outcome, and the others were defined as secondary outcomes.Results: Twenty-two RCTs with 1,221 patients were involved. Compared with placebo, overall active comparators had statistical differences for all outcomes, including the change in total symptoms of combat-related PTSD [SMD = −0.36, 95%CI (−0.62,−0.09)], depression [SMD = −0.28, 95%CI (−0.45,−0.10)], anxiety [SMD = −0.44, 95%CI (−0.64,−0.23)], re-experience [SMD = −0.33, 95%CI (−0.52,−0.13)], avoidance [SMD = −0.24, 95%CI (−0.43,−0.05)], and hyper-arousal [SMD = −0.26, 95%CI (−0.48,−0.03)]. Compared with the placebo, in terms of acceptability, overall active comparators did not significantly decrease all-cause discontinuance rates [RR = 0.97, 95%CI (0.78,1.20)], and the significance decreased due to AEs [RR = 2.42, 95%CI (1.41,4.13)]. Nevertheless, overall there was no statistically significant difference for overall AEs, including somnolence, sedation, dizziness, paresthesia, anxiety, blurred vision, generalized anxiety disorder, and sleep disturbance. All funnel plots were symmetrical and no publication bias was found.Conclusion: Active drugs, especially amitriptyline, imipramine, and quetiapine, had a positive effect on the improvement of combat-related PTSD symptoms. Despite there being no significant increase in the AEs of the active drugs, the fact that the discontinuation rates of these drugs, including risperidone, imipramine, and topiramate, were increased deserves attention. Furthermore, as active drugs were effective across ethnic groups and battlefields, active drug regimens were revealed to be more appropriate for treating people with symptoms of extreme severe PTSD (≥80) or PTSD that is at least 8 weeks old. In addition, current evidence was from adults under 60 years of age and male combat-related PTSD. Whether this evidence can be extended to other populations of combat-related PTSD needs to be confirmed by subsequent high-quality, large-sample studies.
Brain Connectivity and Symptom Changes After Transcranial Magnetic Stimulation in Patients With Borderline Personality Disorder
Authors: Sverak Tomas , Linhartova Pavla , Gajdos Martin , Kuhn Matyas , Latalova Adela , Lamos Martin , Ustohal Libor , Kasparek Tomas 
Published: January 2022

ObjectivesRepetitive transcranial magnetic stimulation (rTMS) is an innovative method in the treatment of borderline personality disorder (BPD). We hypothesized that prefrontal rTMS in patients with BPD leads to improved BPD symptoms and that these effects are associated with brain connectivity changes.MethodsFourteen patients with BPD received 15 sessions of individually navigated prefrontal rTMS over the right dorsolateral prefrontal cortex. Clinical effects were measured by the Borderline Symptom List 23, UPPS-P, the Difficulties in Emotion Regulation Scale (DERS), the Zung Self-Rating Anxiety Scale (SAS), and the Montgomery and Åsberg Depression Rating Scale (MADRS). Effects of rTMS on brain connectivity were observed with a seed correlation analysis on resting-state fMRI and with a beta series correlation analysis on Go/No Go tasks during fMRI. Assessments were made before and immediately after the treatment.ResultsThe assessments after rTMS showed significant reductions in two subscales of UPPS-P, and in DERS, SAS, and MADRS. The brain connectivity analysis revealed significant decreases in amygdala and insula connectivity with nodes of the posterior default mode network (pDMN; precuneus, posterior cingulate cortex, parietal lobules). Connectivity changes were observed both in the resting state and during inhibition. The decrease of amygdala-pDMN connectivity was positively correlated with reduced depression and lack of premeditation after rTMS.ConclusionsDespite the study limitations (open single-arm study in a small sample), our findings suggest a possible neural mechanism of rTMS effect in BPD, reduced amygdala connectivity with the pDMN network, which was positively associated with symptom reduction.
The Impact of the COVID-19 Pandemic on Forensic Mental Health Services and Clinical Outcomes: A Longitudinal Study
Authors: Puzzo Ignazio , Aldridge-Waddon Luke , Stokes Nicholas , Rainbird Jordan , Kumari Veena 
Published: January 2022

BackgroundThe COVID-19 pandemic has had a substantial impact on forensic mental health service provision and implementation. This study aimed to provide an analysis of the impact of COVID-19 related restrictions on routine outcomes within a large forensic mental health service in London, UK.MethodWe conducted a longitudinal cohort study using data collected routinely prior to the COVID-19 pandemic (April 2018–March 2020) and then stages thereafter (March 2020–March 2021; analyzed as March–May 2020, June–September 2020, October–December 2020, January–March 2021). We used causal impact models (Bayesian structural time-series) to examine the effect of COVID-19 related changes on routine outcomes related to service provision and implementation.ResultsThere was an overall increase in long-term segregation (LTS) hours during the pandemic; 140%, (95% Cl 107, 171%) during Lockdown 1; 113%, (159% Cl 127, 192%) during post-Lockdown 1; 45% (95% Cl 23, 68%) during Lockdown 2 and, finally, 90% (95% Cl 63, 113%) during Lockdown 3. The most negative outcomes were evident during Lockdown 3. Incidents of violence were significantly more frequent during Lockdown 3 than would have been predicted based on pre-pandemic data, including physical assaults to service users (206%, 95% CI 57%, 346%), non-physical assaults to service users (206%, 95% CI 53%, 339%), and self-harm (71%, 95% CI 0.4%, 135%). Use of enforced medication also increased during Lockdown 3 (317%, 95% CI 175%, 456%).ConclusionThe pandemic and its related restrictions negatively affected some service outcomes. This resulted in increased incidents of violence and increased use of restrictive interventions, beyond what would have been expected had the pandemic not occurred.
Reliability and Validity of General Health Questionnaire-12 in Chinese Dental Healthcare Workers During the COVID-19 Pandemic
Authors: Zhong Xiaogang , Jin Xin , Yan Li , Yang Lu , Long Huiqing , Wang Jing , Wang Haiyang , Liu Yiyun , Pu Juncai , Xie Peng , Ji Ping 
Published: January 2022

BackgroundThe General Health Questionnaire-12 (GHQ-12) is a widely used instrument to assess mental health status. However, little is known about its applicability in Chinese healthcare workers. This study aimed to evaluate the reliability and validity of the GHQ-12 in Chinese dental healthcare workers.MethodsDental healthcare workers participated in the first occupational survey in China conducted by the Chongqing Stomatological Association from February 2021 to March 2021 by filling out GHQ-12. The reliability and validity of GHQ-12 were then tested.ResultsA total of 3,020 valid electronic questionnaires were acquired. The positive detection rate of self-reported mental health status was 23.80% (719/3,020). The Cronbach's α coefficient of the GHQ-12 was 0.892, and the Cronbach's α coefficient was 0.877–0.888 after the deletion of individual items, and the split-half reliability was 0.843. The correlation coefficient between the item-total score ranged from 0.465 to 0.762 (P&lt;0.05). The exploratory factor analysis found 2 common factors with a factor load of 0.564–0.818. The confirmatory factor analysis showed that the factor load on the specified items was 0.480–0.790.ConclusionsThe two-factor model of GHQ-12 featured good reliability and validity, which could be used to assess the mental health status of Chinese dental healthcare workers.
Focusing on Comorbidity—A Novel Meta-Analytic Approach and Protocol to Disentangle the Specific Neuroanatomy of Co-occurring Mental Disorders
Authors: Fortea Lydia , Albajes-Eizagirre Anton , Yao Yuan-Wei , Soler Edu , Verdolini Norma , Hauson Alexander O. , Fortea Adriana , Madero Santiago , Solanes Aleix , Wollman Scott C. , Serra-Blasco Maria , Wise Toby , Lukito Steve , Picó-Pérez Maria , Carlisi Christina , Zhang JinTao , Pan PingLei , Farré-Colomés Álvar , Arnone Danilo , Kempton Matthew J. , Soriano-Mas Carles , Rubia Katya , Norman Luke , Fusar-Poli Paolo , Mataix-Cols David , Valentí Marc , Via Esther , Cardoner Narcis , Solmi Marco , Shin Jae I. , Vieta Eduard , Radua Joaquim 
Published: January 2022

BackgroundIn mental health, comorbidities are the norm rather than the exception. However, current meta-analytic methods for summarizing the neural correlates of mental disorders do not consider comorbidities, reducing them to a source of noise and bias rather than benefitting from their valuable information.ObjectivesWe describe and validate a novel neuroimaging meta-analytic approach that focuses on comorbidities. In addition, we present the protocol for a meta-analysis of all major mental disorders and their comorbidities.MethodsThe novel approach consists of a modification of Seed-based d Mapping—with Permutation of Subject Images (SDM-PSI) in which the linear models have no intercept. As in previous SDM meta-analyses, the dependent variable is the brain anatomical difference between patients and controls in a voxel. However, there is no primary disorder, and the independent variables are the percentages of patients with each disorder and each pair of potentially comorbid disorders. We use simulations to validate and provide an example of this novel approach, which correctly disentangled the abnormalities associated with each disorder and comorbidity. We then describe a protocol for conducting the new meta-analysis of all major mental disorders and their comorbidities. Specifically, we will include all voxel-based morphometry (VBM) studies of mental disorders for which a meta-analysis has already been published, including at least 10 studies. We will use the novel approach to analyze all included studies in two separate single linear models, one for children/adolescents and one for adults.DiscussionThe novel approach is a valid method to focus on comorbidities. The meta-analysis will yield a comprehensive atlas of the neuroanatomy of all major mental disorders and their comorbidities, which we hope might help develop potential diagnostic and therapeutic tools.
COVID-19 Variability Within European Countries Sourced From ECDC Data. Is Variability Explained by Specific Country Policies?
Authors: Ruano-Ravina Alberto , López-Vizcaíno Esther , Candal-Pedreira Cristina , Santiago-Pérez María Isolina , Pérez-Ríos Mónica 
Published: January 2022

BackgroundEurope has had a large variability in COVID-19 incidence between and within countries, particularly after June 2020. We aim to assess the variability between European countries and regions located in a given country.MethodsWe used ECDC information including countries having 7 regions or more. The metric used to assess the regional variability within a country was the intercuartilic range in a weekly basis for 32 weeks between June 29th 2020 and February 1st 2021. We also calculated each country's overall variability across the 32 weeks using the distances from the regional curves of the 14-day incidence rates to the corresponding national curve, using the L2 metric for functional data. We afterwards standardised this metric to a scale from 0 to 100 points. We repeated the calculations excluding island regions.ResultsThe variability between and within countries was large. Slovenia, Spain and Portugal have the greatest variability. Spain and Slovenia held also the top three places for the greatest number of weeks (Spain for 19 weeks and Slovenia for 10) with the highest variability. For variability among the incidence curves across the 32-week period, Slovenia, Portugal and Spain ranked first in functional variability, when all the regions were analysed but also when the island regions were excluded.ConclusionsThese differences might be due to how countries tackled the epidemiological situation. The persistent variability in COVID-19 incidence between regions of a given country suggests that governmental action may have an important role in applying epidemiological control measures.
Experiences of Urinary Incontinence Management in Older Women: A Qualitative Study
Authors: Javanmardifard Sorur , Gheibizadeh Mahin , Shirazi Fatemeh , Zarea Kourosh , Ghodsbin Fariba 
Published: January 2022

IntroductionOlder women have various experiences regarding the management of urinary incontinence depending on the societies they live in and their cultural backgrounds. The present study aimed to determine older women's experiences in urinary incontinence management.MethodsThe present qualitative study employed a conventional content analysis approach and was conducted in Iran from 2019 to 2020. In this research, the data were collected through face-to-face unstructured in-depth interviews with 22 older women suffering from urinary incontinence selected via purposeful sampling. The interviews were continued until reaching the data saturation point. Data analysis was performed simultaneously with data collection. The interviews were recorded, transcribed, and analyzed through Graneheim and Lundman style content analysis, and data management was done using the MAXQDA software. In order to achieve the accuracy and validity of the study, the Four-Dimensions Criteria (FDC) by Lincoln and Guba, namely credibility, dependability, conformability, and transformability, were considered and used.ResultsThis study was conducted on 22 older women suffering from urinary incontinence with the mean age of 66.54 ± 5.76 years. The acquired data were put in four main categories of “resilience” with three subcategories, “change in lifestyle” with six subcategories, “attempt for treatment of the condition” with three subcategories, and “receiving support” with two subcategories.ConclusionThe study results indicated that the older women suffering from urinary incontinence were resilient against the condition, had changed their lifestyles to manage the condition, and sought treatment. In addition, receiving support from the family and the society played a significant role in the follow-up and management of the condition. The present study findings can help healthcare team members focus on urinary incontinence, design care programs for older women with this condition, and improve their quality of life. Furthermore, focusing on young and middle-aged women's health, providing them with the necessary training for taking care of the genitourinary system, and raising their awareness for preventing urinary incontinence during old ages can be helpful. Moreover, increasing the healthcare team's sensitivity and following the patients up can help diagnose, manage, and treat the condition before exerting adverse impacts on their quality of life.
Stratification of Health Professional Education and Its Funding Disparities: Evidence From China During the Period of 1998–2017
Authors: Gao Wenjuan , Li Wenzhuo , Zang Yue , Zhong Yuxin , Wu Hongbin 
Published: January 2022

Background: The finance of health professional education (HPE) is of immense importance for effective and sustainable health systems, yet relevant empirical research was scarce due to the lack of financial data. The study aimed to bridge the gap by presenting the scenario of finance for health professional institutions (HPIs) of different tiers in China and exploring how the stratification of institutions affected their funding disparities.Methods: The study employed data collected from the Ministry of Education in China, and selected the HPIs mainly based on the World Directory of Medical Schools. The funding levels and disparities of China's HPIs during the period (1998–2017) were analyzed with descriptive statistics, and the indicators of funding per institution and funding per student were both considered. The average funding in HPIs was presented by tiers, and the Gini coefficient and Theil index were employed to describe the differences in financing among HPIs over the span.Results: The study found that the number of HPIs has kept growing over the past two decades, with both the funding per institution and the funding per student increasing steadily. Specifically, the average funding per institution of the three tiers increased by 31.5 times, 13.4 times, and 10.5 times separately, with the first-tier universities having an absolute advantage compared to lower tiers. As for the financing disparities among HPIs, the Gini coefficient of the funding per institution maintained to be over 0.5, with the third-tier institutions scoring the highest, while the Gini coefficient of the funding per student all ranged approximately from 0.2 to 0.3. Through the decomposition of the inequalities measured by the Theil index, the share of the between-tier difference in per-institution funding grew from 29.7 in 1998 to 77.9% in 2017.Conclusions: The funding disparities between tiers of HPIs in China gradually became more accentuated, with the top-tier institutions taking up the largest share. Although the stratified development in HPE has posed a challenge to the unified quality assurance of medical personnel training, it may also be regarded as an effective pathway for developing countries like China to achieve stable development in health professional education.
Cost-Efficiency Analysis of the Improved Web-Based Planning, Budgeting, and Reporting System (PlanRep) in Tanzania
Authors: Ruhago George M. , Kapologwe Ntuli A. , Ngalesoni Frida N. , Kengia James T. , Kibusi Stephen M. , Kalolo Albino , Kitali Erick J. , Mtatifikolo James D. , Masuha Sutte R. , Kikula Amani , Mtei Gemini 
Published: January 2022

BackgroundInformation systems offer unlimited potential for innovation and digitalization of management functions to facilitate citizen participation and improve accountability, transparency, and efficiency in government operations and service delivery. In line with this, for more than one decade, Tanzania implemented an integrated planning, budgeting, and reporting system (PlanRep) that was used to prepare plans and budgets at the local government authorities (LGAs) using a desktop application. In 2017, PlanRep was upgraded to a Web-based system to address several challenges, including poor coordination and high cost involved in the preparation of plans and budgets. However, operational evidence regarding the cost-efficiencies and benefits of shifting to Web-based PlanRep has not been explored. This study aims to address this gap by assessing efficiency gains (in terms of cost and time) of shifting to a Web-based PlanRep system as a tool for the preparation of LGA plans and budgets.MethodsThe study applied a retrospective before-and-after study design whereby quantitative data was used to assess the amount of time and the cost incurred by LGAs when preparing their budget 1 year before the introduction of PlanRep and 1 year after. Parallelly, qualitative data were collected through key informant interviews with selected LGA officials, Regional Secretariats (RSs), President's Office Regional Administration and Local Government (PORALG), and system end-users such as heads of health facilities and schools (primary and secondary). Secondary data was analyzed by comparing time and cost used before and after Web-based PlanRep, while thematic analysis was employed for qualitative data.ResultsThe analysis showed a 53% reduction (from USD 3.8 million in 2017/18 to USD 1.8 million in 2018/19) in the total costs LGAs incurred during planning and budgeting after introducing the Web-based PlanRep. The main efficiency gain was related to per diem costs. The analysis also showed significant time saving from an average of 87 days in 2017/18 to only 8 days in 2018/19. PlanRep system end-users also acknowledged that the introduction of Web-based PlanRep has significantly saved their time and costs in preparation of LGA plans and budget.ConclusionThe introduction of the Web-based planning, budgeting, and reporting systems has resulted in tremendous cost reduction, time savings, transparency, accountability, and workload reduction. The findings offer operational evidence to guide the implementation and scale up of similar systems in countries that share equivalent circumstances like Tanzania.
Anxiety and Depressive Symptoms in the New Life With COVID-19: A Comparative Cross-Sectional Study in Japan Rugby Top League Players
Authors: Ojio Yasutaka , Matsunaga Asami , Kawamura Shin , Horiguchi Masanori , Yoshitani Goro , Hatakeyama Kensuke , Amemiya Rei , Kanie Ayako , Fujii Chiyo 
Published: January 2022

Objectives: The primary objective is to compare the prevalence of mental health problems, including psychological distress, anxiety and depressive symptoms in Japan Rugby Top League players in the new life with COVID-19 with those evaluated before COVID-19.Methods: An observational comparative web-based cross-sectional study was employed for Japan Rugby Top League players. We compared the data from 220 Japanese and 7 foreign players during the new life with COVID-19 with the data from before COVID-19, which was obtained from 233 Japanese and 18 foreign players. We measured anxiety and depression symptoms with the validated Kessler-6, which has been widely used in clinical and research settings among different populations. To investigate the distribution of K6 score and whether there are discrete clusters or not, we conducted the two-step cluster analysis.Results: In the new life with COVID-19, 15.0% of players reported mild symptoms, which was significantly lower than the 32.3% of players before COVID-19. The prevalence of moderate and severe symptoms was 6.7 and 3.5%, respectively, in the group during the new life with the COVID-19, and 4.8 and 5.2% in the pre-COVID-19 group, with no significant difference. A two-step cluster analysis supported the existence of these two qualitatively different clusters in both groups.Conclusions: With the spread of new lifestyles related to COVID-19, some rugby players may have improved mental health status due to changes in their daily living environment. Such environmental adjustments alone may not have been sufficient to change the mental health status of others. Rugby players or their teams may require mental health professionals and systems that ensure rest, adjust the environment, and sustainably provide more professional care.