A fundamental challenge for people with severe mental illness (SMI) is how to deal with cognitive impairments, which are common in this population and limit daily functioning. Cognitive remediation (CR) is a psychological intervention that targets these cognitive impairments to improve everyday functioning. However, reduced neural plasticity in people with SMI might hinder newly learned cognitive skills to sustain. Transcranial Direct Current Stimulation (tDCS) can promote this neural plasticity, which could enhance learning and result in longer-lasting improvements in cognitive and daily functioning. This study aimed to investigate the acceptability of the combination of CR and tDCS for people with severe mental illness who live in residential psychiatric facilities.

We interviewed participants of the ongoing HEADDSET pilot trial. In this pragmatic, randomized, controlled pilot trial, participants (individuals with SMI, 18 years or older, living in psychiatric facilities) received CR in combination with concurrent active tDCS (n = 13) or sham tDCS (n = 13) twice weekly for 16 weeks (32 sessions in total). We invited participants who finished the trial’s training period (n = 16) to participate in the interviews. According to the Theoretical Framework of Acceptability (Sekhon et al., 2017), we assessed seven components of acceptability: Affective attitude, burden, intervention coherence, ethicality, opportunity costs, perceived effectiveness, and self-efficacy.

Twelve of the 16 participants participated in the interviews: seven completers (attended at least 20 of the 32 sessions; M = 22.7, range = 20-25) and five non-completers (M = 11.6, range = 9-15). The reasons for not completing the protocol were mainly unrelated to the training (i.e., prolonged illness, substance abuse, personal circumstances). Only one participant did not complete the training because of its intensity. Independent of whether participants completed the intervention, they were positive about the training. They reported that they liked the CR program CIRCuiTS, that participating in the training was not a burden and that, in their opinion, the training could help others. Moreover, all participants observed improvement in their cognitive functioning, and six individuals (three completers and three non-completers) observed improvements in their everyday life (e.g., fewer problems with doing groceries, being more organized, and being able to concentrate and read a book). Overall, the participants would recommend the training to others. Non-completers of the intervention would recommend the CR with tDCS, while completers neither recommended nor advised against the addition of tDCS. Participants who understood and could explain how the training works reported more improvements in daily life, were better at formulating their treatment goals, and stated that the treatment goals were more relevant to them compared to the participants who were unable to do so.

The combined intervention of CR and tDCS was acceptable to individuals with severe mental illness, the participation in the training was no burden to both completers and non-completers, and participants reported personal benefits for their cognitive functioning and everyday life. Future studies should investigate the effectiveness of the intervention in larger randomized controlled trials.

To investigate the prevalence and predictors of expressed breast-milk feeding in healthy full-term infants and its association with total duration of breast-milk feeding.

Prospective cohort study.

In-patient postnatal units of four public hospitals in Hong Kong.

A total of 2450 mother–infant pairs were recruited in 2006–2007 and 2011–2012 and followed up prospectively for 12 months or until breast-milk feeding had stopped.

Across the first 6 months postpartum, the rate of exclusive expressed breast-milk feeding ranged from 5·1 to 8·0 % in 2006–2007 and from 18·0 to 19·8 % in 2011–2012. Factors associated with higher rate of exclusive expressed breast-milk feeding included supplementation with infant formula, lack of previous breast-milk feeding experience, having a planned caesarean section delivery and returning to work postpartum. Exclusive expressed breast-milk feeding was associated with an increased risk of early breast-milk feeding cessation when compared with direct feeding at the breast. The hazard ratio (95 % CI) ranged from 1·25 (1·04, 1·51) to 1·91 (1·34, 2·73) across the first 6 months.

Mothers of healthy term infants should be encouraged and supported to feed directly at the breast. Exclusive expressed breast-milk feeding should be recommended only when medically necessary and not as a substitute for feeding directly at the breast. Further research is required to explore mothers’ reasons for exclusive expressed breast-milk feeding and to identify the health outcomes associated with this practice.

To investigate the effect of public hospitals in Hong Kong not accepting free infant formula from manufacturers on in-hospital formula supplementation rates and breast-feeding duration.

Prospective cohort study.

In-patient postnatal units of four public hospitals in Hong Kong.

Two cohorts of breast-feeding mother–infant pairs (n 2560). Cohort 1 (n 1320) was recruited before implementation of the policy to stop accepting free infant formula and cohort 2 (n 1240) was recruited after policy implementation. Participants were followed prospectively for 12 months or until they stopped breast-feeding.

The mean number of formula supplements given to infants in the first 24 h was 2·70 (sd 3·11) in cohort 1 and 1·17 (sd 1·94) in cohort 2 (P<0·001). The proportion of infants who were exclusively breast-fed during the hospital stay increased from 17·7 % in cohort 1 to 41·3 % in cohort 2 (P<0·001) and the risk of breast-feeding cessation was significantly lower in cohort 2 (hazard ratio=0·81; 95 % CI 0·73, 0·90). Participants who non-exclusively breast-fed during the hospital stay had a significantly higher risk of stopping any or exclusive breast-feeding. Higher levels of formula supplementation also increased the risk of breast-feeding cessation in a dose–response pattern.

After implementation of a hospital policy to pay market price for infant formula, rates of in-hospital formula supplementation were reduced and the rates of in-hospital exclusive breast-feeding and breast-feeding duration increased.

We describe the internal cerebral vein (ICV) sign, which is a hypo-opacification of the ICV on computed tomogram angiography (CTA) as a new marker of increased cerebral blood transit-time in ipsilateral internal carotid artery occlusions (ICAO).

A retrospective analysis of 153 patients with acute unilateral M1 middle cerebral artery (MCA) occlusions ± ICAOs was performed. The degree of contrast opacification of the ICV on the ipsilesional side was compared to that of the unaffected side.

Of 153 patients in our study, 135 had M1 MCA occlusions ± intra-cranial ICAO (M1±iICAO) and 18 had isolated extracranial ICAO (eICAO). In the patients with proximal M1±iICAO, 57/65 (87.1%) showed the ICV sign. Of the 8 patients without the ICV sign in this group, 6 had prominent lenticulostriate arteries arising from the non-occluded M1 segment, 1 had a recurrent artery of Huebner, and 1 had filling of distal ICA/M1 segment through prominent Circle of Willis collaterals. For the 70 patients with isolated distal M1±iICAO, 7/70 (10%) showed the ICV sign, with all 7 showing occluded lenticulostriate arteries. Of the patients with eICAO, 8/18 showed the ICV sign, all 8 with the ICV sign had poor Circle of Willis collaterals.

The ICV sign correlates well with presence of proximal M1±iICAO in patients with either occluded lenticulostriate arteries or poor Circle of Willis collaterals. In patients with eICAO, the sign correlates with reduced Circle of Willis collaterals and may be a marker of increased ipsilateral cerebral blood transit time.