Innovation is needed for the growing number of patients with chronic obstructive pulmonary disease (COPD). Pulmonary rehabilitation (PR) is effective in improving exercise tolerance and quality of life, but these benefits do not appear to be sustained. This highlights the need for cost effective methods to maintain benefits on completion of therapy. The findings of a large trial from the UK are reported.

A two-center randomized controlled trial of patients discharged from PR compared the costs and benefits of PR maintenance with standard care. National Health Service (NHS) resource use, personal expenditure, and societal costs were recorded over one year, and bottom-up costing was undertaken for the PR maintenance program. Changes in health-related quality of life were recorded using the EQ-5D-5L, and differences were compared with the level identified as significant for COPD. A cost utility analysis was undertaken from an NHS perspective; uncertainties in cost and outcome data were incorporated into a sensitivity analysis. Cost-effectiveness ratios and cost-effectiveness acceptability curves (CEACs) were computed.

The study included 116 patients who had finished PR within the last four weeks. The economic analysis showed that mean healthcare costs per patient for PR maintenance were approximately GBP139.72 (EUR165.57) lower than for usual care. The observed 0.118 advantage in mean quality-adjusted life-years (QALYs) (p<0.05) was above the threshold (0.051) for COPD significance. CEACs indicated there was a 97 percent chance of achieving GBP20,000 (EUR23,699.80) per QALY (NICE acceptance level ≤GBP30,000 (EUR35,549.70). Patient and societal costs increased this percentage. It was estimated that if patients with COPD completed a maintenance program following PR, the NHS could save up to GBP28.6 million (EUR33.89 million).

Our findings confirm that a structured PR maintenance program is highly cost effective in extending the benefits of short-term PR. The trial, undertaken during COVID, also signals the potential for emerging digital innovations to provide future transformative change in delivering self-management programs to sustain health and reduce NHS costs for people living with chronic conditions.

The Korean Basketball League(KBL) holds an annual draft to allow teams to select new players, mostly graduates from the elite college basketball teams even though some are from high school teams. In sports games, many factors might influence the success of an athlete. In addition to possessing excellent physical and technical factors, success in a sports game is also influenced by remarkable psychological factors. Several studies reported that elite sports players can control their anxiety during competition, which may lead to better performance. In particular, the temperament and characteristics of players have been regarded as crucial determinants of the player’s performance and goal. In this regard, numerous studies suggest that personality is considered to be an important predictor of long-term success in professional sports

Based on previous reports and studies, we hypothesized that physical status, temperament and characteristics, and neurocognitive functions of basketball players could predict the result of KBL draft selection. Especially, temperament and characteristics were associated with the result of KBL selection. The basketball performances including average scores and average rebound were associated with emotional perception and mental rotation.

We recruited the number of 44 college elite basketball players(KBL selection, n=17; Non-KBL selection, n=27), and the number of 35 age-matched healthy comparison subjects who major in sports education in college. All participants were assessed with the Temperament and Character Inventory(TCI), Sports Anxiety Scales(SAS), Beck Depression Inventory(BDI), Perceived Stress Scale (PSS-10), Trail Making Test(TMT), and Computerized Neuro-cognitive Test(CNT) for Emotional Perception and Mental Rotation.

Current results showed that physical status, temperament and characteristics, and Neurocognitive functions of college basketball players could predict the KBL draft selection. Among temperament and characteristics, novelty seeking and reward dependence were associated with KBL draft selection. The basketball performances including average scores and average rebound were associated with emotional perception and mental rotation.

In order to be a good basketball player for a long time, it was confirmed that temperamental factors and Neurocognitive factors were very closely related. Furthermore, it is also judged that these results can be used as basic data to predict potential professional basketball players.

None Declared

In South Korea, all men at the age of 18 or older are required to serve at military for a certain period as an obligation. These recruits should be able to withstand psychological stress and pressures of rapid adaptation of the unique and new environment in military. The number of military recruits facing adaptation issues has been on the rise, necessitating an evaluation for active service. In our previous study (Park et al., in press 2023), we classified the military recruits with mental issues according to latent profile analysis (LPA) and examined the treatment response during six months.

In this study, we further examined clinical characteristics over the next six months.

Ninety-two participants were analyzed with LPA using MMPI-2 clinical profiles in the previous study. The three classes were identified: mild maladjustment (Class 1, n=14), neurotic depression and anxiety (Class 2, n=36), high vulnerability and hypervigilance (Class 3, n=42). At 12 months, Clinical Global Impression-Severity and Global Assessment of Functioning were assessed to test their long-term changes.

While Class 1 and 2 significantly improved over 6 months, Class 3 showed little or no improvement even with more medications in our previous study. During the 6-month follow-up period, 50% of Class 1, 38.9% of Class 2, and 41.5% of Class 3 were dropped. It was during this period that their level of military service was decided. Class 1 and 2 which showed marked improvement up to initial 6 months, did not demonstrate substantial further improvement during follow-up period with a considerable portion stopped visiting hospital. Subjects in Class 3, who showed little or no improvement during initial 6 months, demonstrated continued improvement in this study, although their symptoms still appeared relatively severe.

This study suggests clinical implications for treatment plan and intervention of each subgroup classified based on MMPI-2 clinical profiles of military recruits who might show maladjustment to serve. The long-term continuous treatment for Class 3 patients will be needed, even after exemption from active duty.

None Declared

he present study investigates irritable bowel syndrome in mental health professionals and the characteristics of psychosocial factors that affect this.

The present study selected an irritable bowel syndrome group among 291 mental health professionals based on the Rome III criteria, and investigated demographic variables. The Hospital Anxiety Depression Scale (HADS), Psychosocial Well-being Index (PWI), and Korean Occupational Stress Scale (KOSS) were used to evaluate psychosocial factors. An independent t-test and chi-square test were used to determine differences between the groups, and a logistic regression analysis was used to determine the odds ratio (OR) of IBS based on occupational stress. SPSS 21.0 (IBM Statistical Package for the Social Sciences 21.0) was utilized for all statistics.

Differences in demographic variables based on IBS group were not statistically significant. Depressive symptoms (t = -4.767, p<0.001) and anxiety (t = -4.068, p<0.001) were higher in the IBS group, and psychosocial well-being was lower (t = 2.288, p<0.05). The OR of IBS based on depressive symptoms was 5.737 (95% CI = 2.24–14.69). There were significant differences in occupational stress based on IBS within the subordinate domains of physical environment (t = -3.160, p<0.01), job demand (t = -3.273, p<0.01), interpersonal conflict (t = -2.295, p<0.05), job security (t = -3.005, p<0.01), and lack of reward (t = -2.046, p<0.05). The OR of IBS based on the subordinate domains of occupational stress was 3.708 (95% CI = 1.20-11.41) in physical environment, and 3.759 (95% CI = 1.33-10.56) in job demand.

The results of the present study verify that psychosocial factors in mental health professionals have a close correlation with IBS. Accordingly, improvements in both IBS symptoms and quality of life should occur through proactive intervention in these variables.

None Declared

A large and accumulating body of evidence shows that loneliness is detrimental for various health and well-being outcomes. However, less is known about potentially modifiable factors that lead to decreased loneliness.

We used data from the Health and Retirement Study to prospectively evaluate a wide array of candidate predictors of subsequent loneliness. Importantly, we examined if changes in 69 physical-, behavioral-, and psychosocial-health factors (from t0;2006/2008 to t1;2010/2012) were associated with subsequent loneliness 4 years later (t2;2014/2016).

Adjusting for a large range of covariates, changes in certain health behaviors (e.g. increased physical activity), physical health factors (e.g. fewer functioning limitations), psychological factors (e.g. increased purpose in life, decreased depression), and social factors (e.g. greater number of close friends) were associated with less subsequent loneliness.

Our findings suggest that subjective ratings of physical and psychological health and perceived social environment (e.g. chronic pain, self-rated health, purpose in life, anxiety, neighborhood cohesion) are more strongly associated with subsequent loneliness. Yet, objective ratings (e.g. specific chronic health conditions, living status) show less evidence of associations with subsequent loneliness. The current study identified potentially modifiable predictors of subsequent loneliness that may be important targets for interventions aimed at reducing loneliness.

In South Korea, all men at the age of 18 or older are required to serve at military for a certain period as an obligation. These recruits should be able to withstand psychological stress and pressures of rapid adaptation of the unique and new environment in military.

The current study attempted to identify distinct subgroups of patients referred for military service suitability and further to investigate whether there is a difference in clinical features such as treatment responsiveness and prognosis among those subgroups.

Subjects were male patients aged 18 to 28 years who visited the department of psychiatry at the University Hospital for evaluating mental health problems related to military service. We conducted a latent profile analysis (LPA) using 10 clinical scales of MMPI-2 as an indicator variable to investigate the subgroups of subjects. The clinical state of subjects was assessed with CGI-S and GAF scale for three time point (0, 3, and 6 month).

The results showed that the best fitting model corresponded to a three-class model: each class was named ‘Class 1: mild maladjustment’, ‘Class 2: neurotic depression and anxiety’, and ‘Class 3: highly vulnerable and hypervigilant’ respectively. Subsequent analysis was also carried out to identify changes in clinical symptoms and functional level across treatment time of each subgroup identified in LPA. We demonstrated that the three subgroups displayed differential characteristics in treatment responsiveness and clinical course evaluated by CGI-S and GAF over a treatment period of 6 months. Three subgroups indicated significant differences in the number of medications prescribed as well. Class 3 had more antidepressants and anxiolytics on use than Class 1 and 2. Antipsychotic agents and a combination of three antidepressants were prescribed more frequently in Class 3 than in Class 1 and 2.

While Class 1 and 2 significantly improved over 6 months, Class 3 showed little or no improvement in our clinical parameters even with more medications. This study has a clinical significance that it has classified qualitatively different subgroups within the sample by conducting LPA with clinical profiles of MMPI-2 and provides a basis for comprehensively understanding their differentiated clinical features. This study suggests clinical implications for treatment plan and intervention of each subgroup classified based on MMPI-2 clinical profiles of military recruits who might show maladjustment to serve.

None Declared

Suicide is a complex problem in which individual, family social factors are interrelated. The 1997 Asian financial crisis caused a major economic crisis in Korea, and Korea received bailout support from the International Monetary Funds(IMF) from December 23, 1997 to August 23, 1997.

This study aimed to investigate the relationship between the suicide rate of children and adolescents who grew up during this economic crisis in Korea.

Suicide rates are calculated according to gender, region, and age of 5 years (10-14 years old, 15-19 years old, 20-24 years old) using suicide death data from the Korea National Statistical Office from 2000 to 2017. The cohort of interest in the study is the group that was in childhood and early adolescence between 1997-2000 and corresponds to 1986-1995 in terms of birth year. Cohorts are divided into 1986-1989 (G1), 1990-1992 (G2), and 1993-1995 (G3) according to birth year. These groups were 8-14 years old for G1 and 5-10 years old for G2, 2-7 years old for G3 during 1997-2000, during the economic crisis. The Age-Period-Cohort analysis and linear mixed-effects regression models are used and the moderating effect on region and age is also analyzed.

The 10-24 year-old suicide rate was higher in males than females, in older age groups, earlier in birth years in the birth cohort, and in rural than urban areas. Suicide rates between the ages of 20-24 years were particularly high among men living in rural areas. During the national economic crisis, the suicide rate was higher among adolescents than preschoolers (G3 < G1) (p<0.001), and this trend was observed for both men and women. However, the main effect of the cohort was not observed at a statistically significant level.

The national economic crisis has a negative impact on the mental health of children and adolescents, and it is more negative for adolescents than for children, which can increase the suicide rate between the ages of 20-24.

None Declared

Rapid diagnostic tests (RDTs) are increasingly being implemented as antimicrobial stewardship tools to facilitate antibiotic modification and reduce complications related to their overutilization. We measured the clinical impact of a phenotypic RDT with antimicrobial stewardship (AMS) in the setting of gram-negative bacteremia.

In this single-center retrospective cohort study, we evaluated adult patients with gram-negative bacteremia who received at least 72 hours of an antibiotic.

The primary outcome was the duration of empiric antibiotic therapy for gram-negative bacteremia. Secondary outcomes included time-to-directed therapy, proportion of modifications, hospital length of stay (LOS), and subsequent infection with a multidrug-resistant organism (MDRO) or C. difficile infection (CDI).

The duration of empiric antibiotics decreased in the RDT+AMS group (4 days vs 2 days; P < .01). Time to directed therapy decreased from 75.0 to 27.9 hours (P < .01).

The clinical outcomes of LOS, MDRO, and CDI were reduced. The phenotypic RDT demonstrated an improvement in stewardship measures and clinical outcomes.

This study aimed to analyse the temporal and spatial trends in the burden of anxiety disorders and major depressive disorder related to bullying victimisation on global, regional and country scales.

Data were from the 2019 Global Burden of Disease (GBD) Study. We assessed the global disability-adjusted life years (DALYs, per 100 000 population) of anxiety disorders and major depressive disorder attributable to bullying victimisation by age, sex and geographical location. The percentage changes in age-standardised rates of DALYs were used to quantify temporal trends, and the annual rate changes across 204 countries and territories were used to present spatial trends. Furthermore, we examined the relationship between the sociodemographic index (SDI) and the burden of anxiety disorders as well as major depressive disorder attributable to bullying victimisation and its spatial and temporal characteristics globally.

From 1990 to 2019, the global DALY rates of anxiety disorders and major depressive disorder attributable to bullying victimisation increased by 23.31 and 26.60%, respectively, with 27.27 and 29.07% for females and 18.88 and 23.84% for males. Across the 21 GBD regions, the highest age-standardised rates of bullying victimisation-related DALYs for anxiety disorders were in North Africa and the Middle East and for major depressive disorder in High-income North America. From 1990 to 2019, the region with the largest percentage increase in the rates of DALYs was High-income North America (54.66% for anxiety disorders and 105.88% for major depressive disorder), whereas the region with the slowest growth rate or largest percentage decline was East Asia (1.71% for anxiety disorders and −25.37% for major depressive disorder). In terms of SDI, this study found overall upward trends of bullying-related mental disorders in areas regardless of the SDI levels, although there were temporary downward trends in some stages of certain areas.

The number and rates of DALYs of anxiety disorders and major depressive disorder attributable to bullying victimisation increased from 1990 to 2019. Effective strategies to eliminate bullying victimisation in children and adolescents are needed to reduce the burden of anxiety disorders and major depressive disorder. Considering the large variations in the burden by SDI and geographic location, future protective actions should be developed based on the specific cultural contexts, development status and regional characteristics of each country.

Adolescence is a period of life when dietary patterns and nutrient intakes may greatly influence adult fatness. This study assesses the tracking of energy and nutrient intakes of Ho Chi Minh City adolescents over 5 years. It explores the possible relationships between energy and the percentage of energy from macronutrients with BMI.

Height, weight, time spent on physical activity, screen time and dietary intakes were collected annually between 2004 and 2009 among 752 junior high school students with a mean age of 11·87 years at baseline. The tracking was investigated using correlation coefficients and weighted kappa statistics (k) for repeated measurements. Mixed effect models were used to investigate the association between energy intakes and percentage energy from macronutrients with BMI.

There were increases in the mean BMI annually, but greater in boys than in girls. Correlation coefficients (0·2 < r < 0·4) between participants’ intakes at baseline and 5-year follow-up suggest moderate tracking. Extended kappa values were lowest for energy from carbohydrate (CHO) in both girls and boys (k = 0·18 & 0·24, respectively), and highest for protein in girls (k = 0·47) and fat in boys (k = 0·48). The multilevel models showed the following variables significantly correlated with BMI: CHO, fat, percentage of energy from CHO, fat, time spent for moderate to vigorous physical activity, screen time, age and sex.

The poor to fair tracking observed in this cohort suggests that individual dietary patterns exhibited in the first year are unlikely to predict energy and nutrient intakes in the fifth year.

Emotional dysregulation (ED) is a common characteristic of both attention deficit hyperactivity disorder (ADHD) and major depressive disorder (MDD), especially in adolescents. However, whether ADHD and MDD may share the specific ED-related neural networks remains unknown.

In total, 43 adolescents with clinical ED (22 adolescents with ADHD and 21 with MDD) were recruited; in addition, 29 sex- and age-matched healthy controls (HCs) were included. Resting-state functional connectivity (RSFC) analysis, voxel-based morphometry, and diffusion tensor imaging analysis were performed for each patient. In addition, we determined the significant regions of interest in patients with ED due to ADHD and MDD as compared with HCs and tested their correlations with clinical rating scale scores.

Compared with HCs, patients with ED had greater RSFC in the cerebellum and supramarginal gyrus (SMG), especially between vermis VI and the SMG in the attention networks, and lower RSFC between the right supplementary motor area and right lateral parietal area. Lower gray matter (GM) volume in the SMG was also found. RSFC was significantly correlated with clinical rating scale scores for all patients with ED due to ADHD or MDD. GM change was correlated with ED and MDD rating scale scores.

The cerebellum and attention networks might play major roles in ED pathophysiology in adolescents with ADHD and MDD. Increased connectivity of the vermis to the SMG serves as a possible underlying neural network.