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The mental health risk factors for primary healthcare workers (PHWs) following the Coronavirus Disease 2019 pandemic and the differences by urbanicity remain unclear. In this study, we aimed to identify key factors of anxiety and depression among PHWs in urban and rural settings in China.
Methods
This cross-sectional study was conducted in all 31 provinces in mainland China, between 1 May and 31 October 2022. A total of 3,769 PHWs, including family physicians, nurses, public health professionals, pharmacists, and other medical staff, were recruited from 44 urban community health service centers and 27 rural township hospitals. The Bayesian Additive Regression Tree model was employed to identify risk factors of anxiety and depression.
Results
Among 3,769 PHWs, 1,006 (26.7%) worked in urban areas and 2,763 (73.3%) in rural areas. Occupational satisfaction significantly influenced anxiety in both urban and rural practitioners. For urban PHWs, living with family (odds ratio (OR): 0.42, 95% confidence interval (CI): 0.28–0.62) and self-rated health (fair: OR: 0.31, 95% CI: 0.23–0.42; good: OR: 0.13, 95% CI: 0.09–0.20) were key factors of anxiety. For rural PHWs, after-work exercise (rarely: OR: 0.28, 95% CI: 0.11–0.76; frequently: OR: 0.15, 95% CI: 0.05–0.44) played a critical role. Depression was associated with after-work exercise, self-rated health, and occupational satisfaction for all PHWs. Additionally, living with family (OR: 0.51, 95% CI: 0.34–0.75) and organizational support satisfaction (satisfied: OR: 0.28, 95% CI: 0.19–0.42) were significant for urban practitioners.
Conclusions
Risk factors such as occupational satisfaction, health, and family relations significantly influence PHW mental health in China, with notable differences by urbanicity. Tailored mental health interventions are recommended to address urban–rural disparities.
Volunteering is playing an increasingly bigger role in social services and schools both in Western settings and in the Hong Kong Chinese context. The demand for volunteers in the sector of social services is continually increasing (Sherr 2008). Little is known about the willingness of secondary school students to participate in future volunteering in Hong Kong. This study attempts to explore the phenomenon of youth volunteering through the theory of planned behavior and Personal and Social Responsibility, and identifies prior experience in community service as a main predictor of the willingness of the students to participate in future volunteering. A total of 1046 students from seven secondary schools in Hong Kong completed a structured questionnaire. Social workers, teachers, and volunteer managers could benefit from this study as they could foster students’ willingness to volunteer after graduation by actively engaging them in community service programs early on in a specific time in their life.
It is well known that measuring the noneconomic outcomes produced by social economy organizations is fairly difficult and complex. Usually, social economy organizations feature participatory and democratic decision-making processes that help create social capital and relational goods, and they are interested in social integration; accordingly, they tend to create an organizational culture that encourages their workers to contribute to local communities. Therefore, the hypothesis that the increased activities of social economy organizations have a causal effect on the subjective well-being of the people living near those organizations is highly plausible. In this paper, we estimate the causal effect and attempt to test the hypothesis statistically by using a dataset called the “Seoul Survey,” which provides observations on the subjective well-being of 45,496 citizens living in Seoul and the size of social economy organizations. Controlling for variables at the district level and the appropriate socioeconomic characteristics of each individual in the dataset, we find that the size of social organizations is highly significant.
HIV civil society advocacy in Vietnam is shaped by a unique fusion of historic and contemporary influences, resulting in nuanced ways in which advocacy is practised. In this study, we interviewed representatives from civil society, the Government of Vietnam, international NGOs, multilateral and research organisations and commercial consultancies to identify the influences on advocacy practice today. Aspects of Confucianism, Buddhism, Communism and changes to international funding were all identified as shaping HIV civil society policy advocacy practice directed towards government. These influences have resulted in a strong respect for hierarchy, non-confrontational and collaborative working relationships between civil society and the government, decision-making by consensus and changes in advocacy practice corresponding to fluctuations in international funding. This study shows how, as civil society continues to develop its role in the HIV sector in Vietnam, it is critical to understand these complex influences so that program designers, funders and evaluators can appropriately support HIV civil society policy advocacy.
The assessment of a technology’s innovativeness, which indicates its capacity to transform practice, is crucial for strategic planning in health care. However, clear assessment criteria are often lacking. This abstract presents the early experience of the Agency for Care Effectiveness with the UK Government’s Medical Technology Innovation Classification Framework to identify innovative medical technologies (MedTechs) anticipated to disrupt clinical practice in Singapore.
Methods
ACE’s horizon scanning methodologies were employed to identify innovative MedTechs, based on innovation programs of regulatory bodies, such as the United States Food and Drug Administration breakthrough device designation. The UK Framework was applied, using only the technology aspects (novelty) and not the implementation elements (expected shift in clinical practice) to assess the novelty of MedTechs. Three evaluators independently classified each MedTech as incremental (exists within healthcare system), transformative (novel application of existing technology), or disruptive (first-in-class) based on desktop research. The usability of the classifications was assessed through user experience and inter-rater agreement, with consensus reached for most disagreements.
Results
Among 228 innovative MedTechs identified based on regulatory body designations, pre-consensus inter-rater agreement was 76 percent across innovation categories, with higher consistency (89%) for incremental innovations but lower agreement (64%) for transformative and disruptive categories. The inconsistencies stemmed from limited understanding of the use of MedTechs and their expected shift in local clinical practice. Following consensus, 42 percent were classified as incremental and 58 percent as transformative or disruptive. To enhance future usability, transformative and disruptive technologies were combined into a single highly innovative category to expedite categorization. Highly innovative technologies were then prioritized for local clinician input.
Conclusions
The UK Framework offers a valuable approach to assess the level of innovativeness of MedTechs. By combining transformative and disruptive technologies into a highly innovative category, ACE could expediently prioritize impactful MedTechs to inform the system on upcoming innovations with disruptive potential. This fit-for-purpose approach could offer resource-constrained health technology assessment bodies a means to assess the innovativeness of MedTechs.
This study systematically evaluates the effects of probiotic interventions on gut microbiota and clinical outcomes in diabetic patients to determine the optimal target population and conditions for effective use, with an emphasis on precision treatment. A comprehensive search was performed across PubMed, Web of Science, Cochrane Library, Embase, China National Knowledge Internet (CNKI), and Wanfang databases until April 2024. Randomized controlled trials (RCTs) assessing probiotics as adjunctive therapy for diabetes were included. The control group received standard care, and the intervention group received probiotics alongside standard care. Data were managed with Endnote and Excel, and analyses were conducted using Revman 5.3 and Stata 16. Twelve RCTs involving 1,113 participants were included. Probiotics significantly increased fecal Lactobacillus (standardized mean difference (SMD) 1.42, P < 0.0001, I2 = 95%) and Bifidobacterium levels (SMD 1.27, P < 0.0001, I² = 90%) and reduced fasting plasma glucose (SMD -0.35, P = 0.004). Subgroup analysis showed that shorter intervention durations (≤3 months) improved FPG, HbA1c, and Bifidobacterium levels, while younger patients (≤60 years) experienced the most significant improvements in Bifidobacterium levels. In conclusion, probiotics improve gut microbiota and clinical outcomes in diabetic patients, with intervention duration and patient age as key factors influencing treatment effectiveness.
Let $S_g$ denote the genus g closed orientable surface. A coherent filling pair of simple closed curves, $(\alpha,\beta)$ in $S_g$, is a filling pair that has its geometric intersection number equal to the absolute value of its algebraic intersection number. A minimally intersecting filling pair, $(\alpha,\beta)$ in $S_g$, is one whose intersection number is the minimal among all filling pairs of $S_g$. In this paper, we give a simple geometric procedure for constructing minimally intersecting coherent filling pairs on $S_g, \ g \geq 3,$ from the starting point of a coherent filling pair of curves on a torus. Coherent filling pairs have a natural correspondence to square-tiled surfaces, or origamis, and we discuss the origami obtained from the construction.
The famous Sidorenko’s conjecture asserts that for every bipartite graph $H$, the number of homomorphisms from $H$ to a graph $G$ with given edge density is minimised when $G$ is pseudorandom. We prove that for any graph $H$, a graph obtained from replacing edges of $H$ by generalised theta graphs consisting of even paths satisfies Sidorenko’s conjecture, provided a certain divisibility condition on the number of paths. To achieve this, we prove unconditionally that bipartite graphs obtained from replacing each edge of a complete graph with a generalised theta graph satisfy Sidorenko’s conjecture, which extends a result of Conlon, Kim, Lee and Lee [J. Lond. Math. Soc., 2018].
African swine fever (ASF) is a highly contagious animal disease caused by African swine fever virus (ASFV). It is listed by the World Organization for Animal Health (WOAH) as an animal disease subject to statutory reporting. ASFV, a large, enveloped double-stranded DNA virus with high genomic complexity, exhibits a case fatality rate of up to 100%, posing a significant threat to the global pig industry and food safety. To date, the absence of a safe commercial ASFV vaccine primarily stems from challenges in identifying immunogenic viral antigens, insufficient characterization of ASFV pathogenesis, and limited understanding of the virus’s immune evasion mechanisms. Here, we review the pathogenic characteristics (morphological structure, clinical symptoms, and epidemiological characteristics), molecular biological characteristics, and infection mechanism of ASFV, as well as the immune response mechanism, vaccine research, and the latest information on ASFV in other areas. This review will be in favour of understanding the current state of knowledge of ASF and developing effective vaccines to control this disease.
Timely dissemination of clinical trial results is essential to advance knowledge, guide practice, and improve outcomes, yet many trials remain unpublished, limiting impact. We examine what drives publication and timelines across three major clinical domains.
Methods:
We analyzed study design and factors associated with dissemination of interventional trials, focusing on cardiovascular disease (CVD), cancer, and COVID-19. A total of 10,785 trials (CVD: 5929; cancer: 4210; COVID-19: 646) were linked to PubMed publications using National Clinical Trial identifiers. Study design, operational, and transparency-related features were assessed as predictors of time to publication, defined as the interval from study completion to first publication, using Cox proportional hazards model.
Results:
COVID-19 trials had the highest publication rate (49.6%), followed by CVD (42.3%) and cancer (32.9%), likely reflecting pandemic-related prioritization. Faster publication was associated with larger enrollment, more sites, result posting, randomization, DMC presence, and higher blinding levels (all p < 0.05). Slower publication was linked to supportive care or diagnostic trials (CVD), basic science (cancer), and later COVID-19 trial completion. In subgroups, U.S. facility presence (CVD) and phase 3 design (cancer) predicted faster publication, while healthy volunteer inclusion (CVD) predicted slower publication. Among DMC trials, more secondary outcomes were linked to faster publication across all disease areas.
Conclusions:
Key study design and operational factors consistently predict whether and when trials are published. Strengthening methodological rigor, result reporting, and multi-site collaboration may accelerate timely dissemination into peer-reviewed literature.
While depressive symptoms are common during menopausal transition, the relationship between the two remains unclear. Therefore, this study aimed to examine the longitudinal changes in depressive symptoms among middle-aged Korean women and identify those with elevated and worsening symptoms during this period.
Methods
A total of 1,178 participants who underwent comprehensive health examinations at Kangbuk Samsung Hospital in Korea were followed for a median of 10.8 years (IQR, 9.2–11.6; maximum, 12.7), including all women who reached natural menopause during follow-up, with only data prior to HRT initiation included. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D), and menopausal stages were classified according to the STRAW + 10 criteria and final menstrual period (FMP). Linear mixed-effects models and group-based trajectory modelling (GBTM) were applied to evaluate longitudinal changes in depressive symptoms and to identify distinct trajectories in the severity and stability of depressive symptoms.
Results
The age-adjusted prevalence of CES-D ≥ 16 was 11.0%, 11.5%, 11.2% and 12.4%, with corresponding mean scores of 6.7, 6.6, 6.9 and 7.1 across stages. After adjusting for time-varying age and covariates, menopausal stage transitions were not significantly associated with higher levels of depressive symptoms, whether analysed as continuous or binary variables. For binary CES-D (≥16), the estimated coefficients (95% CI) were 0.10 (–0.20 to 0.41) for early transition, 0.09 (–0.21 to 0.39) for late transition and 0.26 (–0.09 to 0.61) for post-menopause. Similarly, time relative to the FMP (–11 to +9 years) showed no significant association with depressive symptoms. GBTM identified three distinct trajectories: most participants (75.5%) maintained consistently low depressive symptoms throughout the transition, whereas 5.8% showed worsening symptoms. Poor sleep quality (OR 5.83, 95% CI 3.25 to 10.45) and moderate-to-severe vasomotor symptoms (OR 2.95, 95% CI 1.30 to 6.70) were significantly associated with the worsening trajectory. Suicidal ideation was higher in this group (45.4% at baseline, increasing to 70.5% at follow-up).
Conclusions
Most women maintained low depressive symptoms during the menopausal transition; however, a subset experienced worsening symptoms linked to menopause-related physical symptoms. Medical visits for menopause-related symptoms may provide opportunities for screening depressive symptoms in higher-risk women, though the screening effectiveness requires further evaluation.
This systematic review examined the associations of dietary factors such as nutrients, food intake, dietary patterns and dietary biomarkers with structural and functional brain MRI biomarkers, focusing on macrostructural, microstructural, lesion and perfusion measures, and functional activity/connectivity. Articles published in English were systematically searched in PubMed, Embase and PsycInfo up to 19 July 2024. A total of thirty-eight prospective cohort studies (twenty-three cross-sectional and fifteen longitudinal analyses) and thirteen intervention studies were included. Cross-sectional analyses revealed heterogenous associations: baked fish correlated with larger hippocampal volumes (β = 0·21), while oily fish, dairy products and tofu adversely related to ventricle grade. Pro-inflammatory dietary patterns were positively associated with silent infarct risk (DII Q4 v. Q1, OR = 1·77), whereas anti-inflammatory patterns tended to favour brain preservation. Longitudinal studies demonstrated more consistent protective associations: green tea consumption (+100 mL/d) reduced hippocampal atrophy by 0·024%/year, prudent dietary patterns preserved +203 mm3 left hippocampal volume over 4 years and higher plasma carotenoids decreased medial temporal lobe loss by 0·02 cm3/year. However, null findings were common across multiple dietary factors. Interventions showed limited structural benefits (effective in only two of six studies), while polyphenol-rich supplements more consistently improved cerebral perfusion and functional connectivity. Longitudinal and intervention studies demonstrated more consistent patterns than cross-sectional analyses; however, current evidence remains limited for clinical translation. Findings from cross-sectional analyses, despite being from prospective cohorts, require careful interpretation. Further replication across diverse populations and standardised long-term studies are needed before translating these associations into clinical practice.
Judges in Vietnam have increasingly been called upon by the state and society to resolve new social and economic problems. However, the expansion of judicial authority presents a problem for Vietnam’s authoritarian government, which wants courts that can resolve social problems without challenging state interests. This study draws on empirical research to explore whether judges in Vietnam’s authoritarian polity can harness legal reasoning to extend their authority. It uses a novel theoretical framework based on systems theory to understand how judges determine who is entitled to benefit from the law, which norms are appropriate to particular cases, and how such norms might direct them to reach decisions. Data from case studies and interviews with judges reveal that courts in Vietnam are increasingly using legal reasoning to manage the interaction between legal and extralegal norms, which is a decision-making process with the potential to expand judicial authority over socially significant disputes.
The 48-item Negative Physical Self Scale (NPSS; Chen, Jackson, & Huang, 2006) was created to assess general and specific physical appearance concerns relevant to Chinese cultural contexts. The NPSS can be administered to adolescents and/or adults and is free to use in any setting. In this chapter, we discuss the development of the NPSS and then summarize research evaluating its psychometrics. Specifically, the NPSS been found to have a five-factor structure comprising concerns with fatness, stature, facial appearance, and general appearance within exploratory and confirmatory factor analyses that is invariant across samples of mainland Chinese women and men. Furthermore, specific NPSS dimensions have internal consistency reliability, test-retest reliability, convergent validity, discriminant validity and predictive validity support. Subsequently, this chapter presents the NPSS items in their entirety, instructions for administration, the item response scale, and the scoring procedure. Finally, we provide logistics of use - including permissions, copyright, and contact information - for readers.
Singapore conducted its second nationwide mental health literacy survey in 2023, following the first survey in 2015.
Aims
This study aimed to ascertain the population’s beliefs about the helpfulness of treatments for mental illnesses in Singapore, and assessed changes over an 8-year period.
Method
A nationally representative cohort (n = 4195, aged 18–67 years) was interviewed between September 2022 and February 2024, which replicated the methods of the 2015 survey (n = 3006, aged 18–65 years). Using a vignette-based approach, 3002 respondents rated the perceived helpfulness of 28 treatment options for alcohol abuse, dementia, depression, obsessive–compulsive disorder (OCD) and schizophrenia as either ‘helpful’ or ‘harmful’. Weighted prevalence, stratified by vignettes and logistic regressions, were performed.
Results
Counselling was most frequently rated as being helpful for alcohol use disorder (94.0%) and depression (95.2%), while seeing a psychiatrist was most frequently rated helpful for schizophrenia (93.0%), dementia (85.1%) and OCD (91.6%). Across all vignettes, informal help sources, including family (80.8%) and friends (74.7%), were considered less helpful than mental health professionals, except for ‘counselling over the phone’ (58.8%) and ’seeing a general practitioner’ (69.8%). Participants in 2023 were significantly more likely to endorse psychologists, counsellors and phone counselling as being helpful than in 2015. Face-to-face help was considered more helpful than over-the-phone professional help, highlighting the continued need for a personal touch in mental health services.
Conclusions
Overall, there has been an improvement in the perception of the helpfulness of mental health professionals, but targeted interventions to improve the perception of mental health services by general practitioners and institutions are essential.
Alcohol use disorder (AUD) is a chronic condition that impairs health and function. Cognitive behavioral therapy (CBT) is an evidence-based treatment traditionally delivered face-to-face. Recently, digital CBT delivered online has gained prominence because of access barriers and user preferences. Although many digital CBT studies have emerged, few systematic reviews have directly compared digital and face-to-face CBT in adults with AUD. This systematic review and meta-analysis aimed to evaluate their comparative effectiveness. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, a comprehensive search identified 25 randomized controlled trials (n = 2,065) comparing these formats. A random-effects meta-analysis evaluated pre- and post-effectiveness by calculating the standardized mean change using raw score standardization (SMCR). For drinking quantity, digital CBT showed a significant pre–post effect (SMCR = 1.21, 95% confidence interval [CI]: 0.38 to 2.04; p = 0.004). Face-to-face CBT showed no overall significant effect (SMCR = 0.69, 95% CI: −0.16 to 1.53; p = 0.110). However, subgroup analysis of face-to-face trials showed significance for active treatment (SMCR = 1.09), but a nonsignificant negative effect for relapse prevention (SMCR = −0.72). For drinking frequency, both interventions yielded statistically significant effects; however, face-to-face CBT demonstrated a stronger effect (SMCR = 1.02, 95% CI: 0.30 to 1.74; p = 0.006) than digital CBT (SMCR = 0.54, 95% CI: 0.29 to 0.79; p < 0.001). Forest plots were generated, and Begg’s test was used to assess publication bias.
Depression in individuals with type 2 diabetes mellitus (T2DM) is associated with worse clinical prognosis; however, evidence regarding the relationship between depression and hypoglycaemic risk remains limited and inconclusive.
Aim
Our study aimed to evaluate the association between depressive symptoms and hypoglycaemic events.
Method
Depressive symptoms were assessed in participants of the ACCORD-HRQL study at baseline and during follow-up visits at 12, 36 and 48 months using the nine-item Patient Health Questionnaire (PHQ-9). Symptom severity was categorised into three levels: none (0–4 points), mild (5–9 points) or moderate to severe (10–24 points). The primary outcomes included hypoglycaemia requiring any assistance (HAA) and hypoglycaemia requiring medical assistance (HMA).
Results
Over a median follow-up of 4.3 years, 220 individuals developed HAA (incidence rate: 27.0 per 1000 person-years) and 157 individuals experienced HMA (incidence rate: 18.8 per 1000 person-years). Depressive symptoms exhibited dynamic fluctuations during the study period, and participants with depression consistently demonstrated less effective glycaemic control compared to those without depression. However, each one-unit increase in PHQ-9 score was not associated with elevated risks of HAA (hazard ratio, 1.00; 95% CI, 0.97–1.03) or HMA (hazard ratio, 0.98; 95% CI, 0.95–1.02).
Conclusions
Depressive symptoms in individuals with T2DM are dynamic and correlate with suboptimal glycaemic control. However, no significant association was observed between depression severity and increased hypoglycaemic events. These findings highlight the importance of integrated clinical strategies for continuous mental health monitoring and glucose management in T2DM individuals.
Butachlor is a herbicide extensively employed in rice (Oryza sativa L.) cultivation but historically under-investigated for its toxicological impacts on terrestrial vegetation. This study examines the dose-dependent effects of butachlor on the germination and antioxidant defense mechanisms in the seeds of Asian tape grass [Vallisneria natans (Lour.) H. Hara], an important submerged plant species widely distributed in the agricultural ponds. In a hydroponic setup, seeds were exposed to four concentrations of butachlor (0, 20, 200, and 2,000 μg ai L−1), and cultivated under controlled light conditions to quantify germination rates and assess oxidative stress responses. Our findings showed that butachlor concentrations up to 20 μg L−1 had no effect on the germination rate of V. natans seeds, while germination rates decreased by 6.0% and 8.7% at 200 and 2,000 μg L−1, respectively. At 2,000 μg L−1, malondialdehyde (MDA) content increased by 5.7 nmol g−1 FW, and catalase (CAT) activity declined by 21%, indicating oxidative damage. Additionally, the antioxidants proline (Pro) and glutathione (GSH) were upregulated under 20 μg L−1 butachlor treatment after 12 h, contributing to reactive oxygen species (ROS) scavenging and cellular stability. This study highlights the nuanced interactions between butachlor exposure and the antioxidant defenses in V. natans, providing valuable insights into the ecological impacts of herbicide pollution. Understanding these interactions is crucial for development of sustainable agricultural practices and management of herbicide resistance in aquatic systems.