A predictive model for readmission within 1-year post-discharge in patients with schizophrenia.

BACKGROUND: Schizophrenia is a pervasive and severe mental disorder characterized by significant disability and high rates of recurrence. The persistently high rates of readmission after discharge present a serious challenge and source of stress in treating this population. Early identification of this risk is critical for implementing targeted interventions. The present study aimed to develop an easy-to-use predictive instrument for identifying the risk of readmission within 1-year post-discharge among schizophrenia patients in China. METHODS: A prediction model, based on static factors, was developed using data from 247 schizophrenia inpatients admitted to the Mental Health Center in Wuxi, China, from July 1 to December 31, 2020. For internal validation, an additional 106 patients were included. Multivariate Cox regression was applied to identify independent predictors and to create a nomogram for predicting the likelihood of readmission within 1-year post-discharge. The model's performance in terms of discrimination and calibration was evaluated using bootstrapping with 1000 resamples. RESULTS: Multivariate cox regression demonstrated that involuntary admission (adjusted hazard ratio [aHR] 4.35, 95% confidence interval [CI] 2.13-8.86), repeat admissions (aHR 3.49, 95% CI 2.08-5.85), the prescription of antipsychotic polypharmacy (aHR 2.16, 95% CI 1.34-3.48), and a course of disease ≥ 20 years (aHR 1.80, 95% CI 1.04-3.12) were independent predictors for the readmission of schizophrenia patients within 1-year post-discharge. The area under the curve (AUC) and concordance index (C-index) of the nomogram constructed from these four factors were 0.820 and 0.780 in the training set, and 0.846 and 0.796 for the validation set, respectively. Furthermore, the calibration curves of the nomogram for both the training and validation sets closely approximated the ideal diagonal line. Additionally, decision curve analyses (DCAs) demonstrated a significantly better net benefit with this model. CONCLUSIONS: A nomogram, developed using pre-discharge static factors, was designed to predict the likelihood of readmission within 1-year post-discharge for patients with schizophrenia. This tool may offer clinicians an accurate and effective way for the timely prediction and early management of psychiatric readmissions.

Psychosocial crisis intervention for coronavirus disease 2019 patients and healthcare workers. / æ–°åž‹å† çŠ¶ç— æ¯’è‚ºç‚Žæ‚£è€ å’ŒåŒ»åŠ¡äººå‘˜çš„å¿ƒç†ç¤¾ä¼šå±æœºå¹²é¢„ï¼ˆè‹±æ–‡ï¼‰.

OBJECTIVES: Shelter hospital was an alternative way to provide large-scale medical isolation and treatment for people with mild coronavirus disease 2019 (COVID-19). Due to various reasons, patients admitted to the large shelter hospital was reported high level of psychological distress, so did the healthcare workers. This study aims to introduce a comprehensive and multifaceted psychosocial crisis intervention model. METHODS: The psychosocial crisis intervention model was provided to 200 patients and 240 healthcare workers in Wuhan Wuchang shelter hospital. Patient volunteers and organized peer support, client-centered culturally sensitive supportive care, timely delivery of scientific information about COVID-19 and its complications, mental health knowledge acquisition of non-psychiatric healthcare workers, group activities, counseling and education, virtualization of psychological intervention, consultation and liaison were exhibited respectively in the model. Pre-service survey was done in 38 patients and 49 healthcare workers using the Generalized Anxiety Disorder 7-item (GAD-7) scale, the Patient Health Questionnaire 2-item (PHQ-2) scale, and the Primary Care PTSD screen for the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (PC-PTSD-5). Forty-eight healthcare workers gave feedback after the intervention. RESULTS: The psychosocial crisis intervention model was successfully implemented by 10 mental health professionals and was well-accepted by both patients and healthcare workers in the shelter hospital. In pre-service survey, 15.8% of 38 patients were with anxiety, 55.3% were with stress, and 15.8% were with depression; 16.3% of 49 healthcare workers were with anxiety, 26.5% were with stress, and 22.4% were with depression. In post-service survey, 62.5% of 48 healthcare workers thought it was very practical, 37.5% thought more practical; 37.5% of them thought it was very helpful to relief anxiety and insomnia, and 27.1% thought much helpful; 37.5% of them thought it was very helpful to recognize patients with anxiety and insomnia, and 29.2% thought much helpful; 35.4% of them thought it was very helpful to deal with patients' anxiety and insomnia, and 37.5% thought much helpful. CONCLUSIONS: Psychological crisis intervention is feasible, acceptable, and associated with positive outcomes. Future tastings of this model in larger population and different settings are warranted.

Prevalence and factors associated with anxiety and depression among community-dwelling older adults in Hunan, China: a cross-sectional study.

BACKGROUND: Older adults' psychological health is a public health issue that cannot be ignored, especially when these psychological health problems and related factors change across different social backgrounds because of rapid changes in traditions and family structures and the epidemic responses after the outbreak of COVID-19 in China. The aim of our study is to determine the prevalence of anxiety and depression and their associated factors among community-dwelling older adults in China. METHODS: A cross-sectional study was conducted from March to May 2021 with 1173 participants aged 65 years or above from three communities in Hunan Province, China who were selected using convenience sampling. A structured questionnaire including sociodemographic characteristics, clinical characteristics, the Social Support Rating Scale (SSRS), the 7-Item Generalized Anxiety Disorder scale (GAD-7), and the Patient Health Questionnaire-9 Item (PHQ-9) was used to collect relevant demographic and clinical data and to measure social support status, anxiety symptoms, and depressive symptoms, respectively. Bivariate analyses were conducted to explore the difference in anxiety and depression based on samples' different characteristics. The multivariable logistic regression analysis was performed to test for significant predictors of anxiety and depression. RESULTS: The prevalence of anxiety and depression were 32.74% and 37.34%, respectively. Multivariable logistic regression analysis revealed that being female, being unemployed before retirement age, lacking physical activity, having physical pain, and having three or more comorbidities were significant predictors for anxiety. Subjective social support and support utilization were significant protective factors. Regarding depression, religion, lacking physical activity, having physical pain, having three or more comorbidities were found to be significant predictors. Support utilization was a significant protective factor. CONCLUSIONS: The study group showed a high prevalence of anxiety and depression. Gender, employment status, physical activity, physical pain, comorbidities, and social support were associated with psychological health problems of older adults. These findings suggest that governments should focus on the psychological health problems of older adults by raising community awareness of issues related to older adults' psychological health. They should also screen for anxiety and depression among high-risk groups and encourage individuals to seek supportive counseling.

Night shifts, insomnia, anxiety, and depression among Chinese nurses during the COVID-19 pandemic remission period: A network approach.

Background: The outbreak of the COVID-19 pandemic imposed a heavy workload on nurses with more frequent night shifts, which led to higher levels of insomnia, depression, and anxiety among nurses. The study aimed to describe the symptom-symptom interaction of depression, anxiety, and insomnia among nurses and to evaluate the impact of night shifts on mental distress via a network model. Methods: We recruited 4,188 nurses from six hospitals in December 2020. We used the Insomnia Severity Index, Patient Health Questionnaire-9, and Generalized Anxiety Disorder Scale-7 to assess insomnia, depression, and anxiety, respectively. We used the gaussian graphical model to estimate the network. Index expected influence and bridge expected influence was adapted to identify the central and bridge symptoms within the network. We assessed the impact of night shifts on mental distress and compared the network structure based on COVID-19 frontline experience. Results: The prevalence of depression, anxiety, and insomnia was 59, 46, and 55%, respectively. Nurses with night shifts were at a higher risk for the three mental disorders. "Sleep maintenance" was the central symptom. "Fatigue," "Motor," "Restlessness," and "Feeling afraid" were bridge symptoms. Night shifts were strongly associated with sleep onset trouble. COVID-19 frontline experience did not affect the network structure. Conclusion: "Sleep maintenance," "Fatigue," "Motor," and "Restlessness" were important in maintaining the symptom network of anxiety, depression, and insomnia in nurses. Further interventions should prioritize these symptoms.

Mediating effect of workplace violence on the relationship between empathy and professional identity among nursing students.

Background: Studies have reported that empathy had a positive effect on professional identity (PI) in nursing students. However, little was known about the mechanism underlying this relationship between empathy and professional identity in nursing students. Objective: The purpose of this study was to analyze in depth the mediating effect of workplace violence (WVP) between empathy and professional identity in nursing students. Methods: A total of 405 nursing students participated and were investigated using the Chinese version of the Jefferson Scale of Empathy-Health Professional (JSE-HP), the scale of professional identity about nursing students, and the workplace violence Incident Survey in this study. Hierarchical regression was used to analyze the mediating effect of workplace violence on the relationship between empathy and professional identity among nursing students. Results: The score of nursing students' professional identity was 103.69 ± 17.79. Workplace violence had a significant negative correlation with empathy (r = -0.449, P < 0.001) and professional identity (r = -0.330, P < 0.001). Workplace violence accounted for 14.59% of the total mediating effect on the relationship between empathy and professional identity for nursing students. Conclusions: In this study, the level of professional identity of nursing students was low. Workplace violence had a partially significantly mediating effect on the relationship between empathy and professional identity. Maybe, it was suggested that nursing students' professional identity might be improved and driven by a decrease in workplace violence. Targeted interventions at reducing nursing students' workplace violence should be developed and implemented. In addition, nursing managers and educators should be aware of the importance of empathy and improve professional identity in nursing students.

A network analysis of anxiety and depression symptoms among Chinese nurses in the late stage of the COVID-19 pandemic.

Background: Nurses are at high risk for depression and anxiety symptoms after the outbreak of the COVID-19 pandemic. We aimed to assess the network structure of anxiety and depression symptoms among Chinese nurses in the late stage of this pandemic. Method: A total of 6,183 nurses were recruited across China from Oct 2020 to Apr 2021 through snowball sampling. We used Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder scale-7 (GAD-7) to assess depression and anxiety, respectively. We used the Ising model to estimate the network. The index "expected influence" and "bridge expected influence" were applied to determine the central symptoms and bridge symptoms of the anxiety-depression network. We tested the stability and accuracy of the network via the case-dropping procedure and non-parametric bootstrapping procedure. Result: The network had excellent stability and accuracy. Central symptoms included "restlessness", "trouble relaxing", "sad mood", and "uncontrollable worry". "Restlessness", "nervous", and "suicidal thoughts" served as bridge symptoms. Conclusion: Restlessness emerged as the strongest central and bridge symptom in the anxiety-depression network of nurses. Intervention on depression and anxiety symptoms in nurses should prioritize this symptom.

Effects of Disease-Related Knowledge on Illness Perception and Psychological Status of Patients With COVID-19 in Hunan, China.

OBJECTIVE: The aim of this study was to assess the current status of disease-related knowledge and to analyze the relationship among the general condition, illness perception, and psychological status of patients with coronavirus disease 2019 (COVID-19). METHODS: A hospital-based cross-sectional study was conducted on 118 patients using convenience sampling. The general questionnaire, disease-related knowledge questionnaire of COVID-19, Illness Perception Questionnaire (IPQ), and Profile of Mood States (POMS) were used to measure the current status of participants. RESULTS: The overall average score of the disease-related knowledge of patients with COVID-19 was (79.19 ± 14.25), the self-care situation was positively correlated with knowledge of prevention and control (r = 0.265; P = 0.004) and total score of disease-related knowledge (r = 0.206; P = 0.025); the degree of anxiety was negatively correlated with the knowledge of diagnosis and treatment (r = -0.182; P = 0.049). The score of disease-related knowledge was negatively correlated with negative cognition (volatility, consequences, emotional statements) and negative emotions (tension, fatigue, depression) (P < 0.05); positively correlated with positive cognition (disease coherence) and positive emotion (self-esteem) (P < 0.05). CONCLUSIONS: It was recommended that we should pay more attention to the elderly and low-income groups, and increase the knowledge about diagnosis and treatment of COVID-19 and self-care in the future health education for patients.

Status quo and influencing factors for anxiety, depression, and insomnia among 4 237 nurses in Hunan Province. / 湖南省4 237åæŠ¤å£«ç„¦è™‘ã€æŠ‘éƒã€å¤±çœ çŽ°çŠ¶åŠå½±å“å› ç´ .

OBJECTIVES: Public health emergencies have caused significant psychological burden on nurse and affect their mental health. After the coronavirus disease 2019 pandemic, the nurse's mental health has been paid much attention. This study aims to investigate status and influencing factors for anxiety, depression, and insomnia in nurses during the normalized epidemic period, and to further compare the risk of anxiety, depression, and insomnia among nurses at different levels of hospitals between front-line epidemic nurses and other nurses so as to provide a basis for mental health work, nursing management, and relevant study in hospital. METHODS: A total of 4 237 nurses from all levels of hospitals in Hunan Province participated in the survey in December 2020. A self-designed anonymous questionnaire was used in this study. Anxiety, depression, and insomnia were assessed using Generalized Anxiety Disorder-7 items (GAD-7), Patient Health Questionnaire-9 items (PHQ-9), and Insomnia Severity Index (ISI), respectively. Descriptive statistical analysis was used to evaluate nurses' anxiety, depression, and insomnia; t-test, analysis of variance, and multiple linear stepwise regression analysis were used to analyze the influencing factors of nurses' anxiety, depression, and insomnia. RESULTS: The scores of GAD-7 among 4 237 nurses were 4.44±4.20, with 10.3% of them experienced moderate to severe level anxiety. The scores of PHQ-9 were 6.03±4.76, with 17.5% of them experienced moderate to severe level depressive symptom. The scores of ISI were 8.37±5.42, with 12.3% of them experienced moderate to severe insomnia. There were significant differences in GAD-7, PHQ-9, and ISI scores among different groups of hospital levels, gender, professional title, position, education level, night shifts, and family monthly income (all P<0.05). Marital status, whether to participate in the front-line, and whether to participate in psychology training groups were not associated with anxiety, depression, and insomnia (all P>0.05). Gender, hospital level, professional title, educational background, more night shifts, and family monthly income were the influencing factors for the GAD-7 and PHQ-9 scores. Gender, length of service, position, hospital level, educational background, night shifts in the last year, and family monthly income were the influencing factors for ISI score. CONCLUSIONS: There is no difference in the scores of the GAD-7, PHQ-9, and ISI between nurses whether to participate in the front-line, indicating that series of measures for front-line medical staff are effective in China.Meanwhile, some nurses experienced anxiety, depression, and insomnia, and attention should be paid to nurses with low position, more night shifts, lower-level hospitals, and families with low income. It is recommended that management policies, psychological support, and human resource protection should be given to relieve the pressure and maintain the mental health of nurses. At the same time, it is necessary to make mental health knowledge training as a routine training when responding to public health emergencies.

Promoting resilience and lower stress in nurses and improving inpatient experience through emotional intelligence training in China: A randomized controlled trial.

BACKGROUND: Emotional intelligence training relieves stress and promotes resilience among nurses. Previous studies have not sufficiently explored the effect of emotional intelligence training among nurses on the experience of inpatients under their care. OBJECTIVE: To explore the effects of emotional intelligence training on emotional intelligence, resilience, and perceived stress among nurses and examine how training affects inpatient experience. DESIGN: Randomized controlled trial. SETTING: A tertiary general hospital in Changsha, China. PARTICIPANTS: A total of 103 nurses were randomly selected from 20 wards. METHODS: The wards were randomized into two groups. The intervention group (n = 53 nurses) received emotional intelligence training in two phases: Phase I-system training phase, twice a week for one month; Phase II-a consolidated learning phase, once a week for 11 months. The control group (n = 50) received daily briefings in meetings between head nurses, which were held regularly to discuss specific problems. There was no emotional intelligence training conducted with the control group. Data were collected at baseline and after the intervention. RESULTS: Emotional intelligence training improved emotional intelligence, resilience, and stress in the intervention group. The control group scored lower on the Wong and Law's Emotional Intelligence Scale and all subscales, showed stability in the scores on the Connor-Davidson Resilience Scale and its subscales, and very little change in stress scores. Repeated measures analysis of variance showed significantly greater beneficial changes in the intervention group on all but the optimism subscale. There were suggestive differences in the predicted direction between the emotional intelligence training wards and the control wards at post-test on the patient experience scale and the four subscales. CONCLUSION: Our study suggests that emotional intelligence training improves emotional intelligence, resilience, and stress among nurses and leads to improvements in inpatient experience. Emotional intelligence training should be part of nurse education to improve the quality of care nurses provide and their ability to work without increased stress.

Readiness for Hospital Discharge of Adult Patients with Major Depressive Disorder in China: A Cross-Sectional Study.

PURPOSE: Being ready for discharge is vital to successful hospital-to-home transitions. However, despite a wealth of evidence on its effectiveness, little is known about readiness for hospital discharge (RHD) in adult patients with major depressive disorder (MDD) and its influencing factors. In this study, we investigated the patient-reported RHD and its influencing factors among Chinese adult patients with MDD. PATIENTS AND METHODS: In this cross-sectional design study, 230 adult patients with MDD were recruited according to the inclusion and exclusion criteria, 6 were excluded due to incomplete questionnaires, finally 224 patients were included in our study. Data were collected from March to September 2019 in a tertiary general hospital in Hunan Province (China). The general information, RHD, quality of discharge teaching and level of depression were assessed by using questionnaires. Univariate analysis and ordinal logistic regression analysis were performed to explore the influencing factors of RHD. RESULTS: The RHD score was 7.37 ± 1.40, and 36.2% of participants were not ready for discharge. The score of quality of discharge teaching scale (QDTS) was 6.36 ± 1.89, the dimension of delivery scored highest, followed by content-needed and content-received. The proportions of patients with no, mild, moderate, moderately severe and severe depression were 12.5%, 27.7%, 25.0%, 25.4% and 9.4%, respectively. The following factors were associated with RHD: the level of depression (OR=0.66), the content-received dimension of QDTS (OR=1.16), education level (OR=1.24), work status (OR=1.76) and length of hospitalization (OR=0.53). CONCLUSION: The RHD among participants was at a moderate level. It is strongly suggested to take the assessment of RHD as a routine process. High education level, employment and the content-received dimension of QDTS were protective factors of participants' RHD, and long-term hospitalization, the high level of depression were its risk factors.

The Difficulties and Mental Health Intervention Need of Doctors and Nurses in Biological Emergencies: A Qualitative Study.

When a biological public health event breaks out, due to the characteristics of their work, doctors and nurses must face risks directly when the situation is unknown. Their difficulties and psychological pressure are unimaginable. However, few studies have investigated the difficulties encountered by those doctors and nurses and their requirements for psychological interventions. This study aimed to explore the difficulties and psychological intervention needs of doctors and nurses during the new biological public health events in China in 2019. We carried out a qualitative study using a phenomenological approach. We used convenience sampling to identify participants who provided direct care and treatment for patients with biological events such as coronavirus disease 2019 (COVID-19). They participated in semi-structured, in-depth face-to-face interviews. The interviews were transcribed and analyzed using Colaizzi's seven-step method. Analysis of this study was divided into the difficulties encountered by doctors and nurses and their mental health need. The difficulties encountered by doctors and nurses included four themes: being worried about the impact on others, lack of knowledge and skills, difficult patients, being socially isolated, and the feeling of uncertainty. The mental health need was summarized into two parts, needs expressed by doctors and nurses and needs observed by researchers. Doctors and nurses mostly did not feel that they needed any psychological support, but the researchers noticed several signs of stress or potential mental health problems among interviewees. Doctors and nurses faced significant complex and multidimensional difficulties. Many denied needing psychological support, even though the researchers noted signs that it might be helpful. Interventions and support strategies that involve mental health promotion activities should consider individual needs related to doctors and nurses' situation.

Psychosocial Experiences of Front-Line Nurses Working During the COVID-19 Pandemic in Hubei, China: A Qualitative Study.

BACKGROUND: A large number of nurses across China joined the anti-coronavirus disease 2019 (COVID-19) front-line in Hubei province, where the local healthcare system faced unprecedented challenges in the early 2020. Few studies have reported the psychological experiences of nurses from other regions who voluntarily participated in the response to the COVID-19 pandemic in Hubei province. AIM: To describe the psychological experiences of nurses who were involved in the anti-COVID-19 pandemic battle in Hubei province from January to April 2020. METHODS: This was a qualitative descriptive study using purposive and snowball sampling strategies for participant recruitment. Twenty-four nurses were approached and twenty-one of them completed telephone interviews in April 2020. The interviews took an average of 75 min (range 34-140 min). Data were analyzed thematically after verbatim transcription of the interviews. RESULTS: Our analysis generated three primary themes: (I) Contexts; (II) Psychological responses; and (III) Coping strategies (most participants identified suitable coping strategies including relaxing activities and seeking social support). Participants' psychological responses varied in four phases of the journey through the experience: (i) initiation phase: obligations and concerns/fears; (ii) transition phase: from overwhelmed to increased confidence; (iii) adaptation phase: a sense of achievement and exhaustion; and (iv) completion phase: professional and personal growth. CONCLUSION: Nurses had concerns, fears, and faced challenges working on the COVID-19 front-line. However, they were motivated by a strong sense of professional commitment. Most nurses successfully achieved personal and professional growth as they identified a range of coping strategies. Future research is needed to explore the long-term impact of the COVID-19 related working experiences on these nurses.

Manual lymphatic drainage for lymphedema in patients after breast cancer surgery: A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Studies have shown that manual lymphatic drainage (MLD) has a beneficial effect on lymphedema related to breast cancer surgery. However, whether MLD reduces the risk of lymphedema is still debated. The purpose of this systematic review and meta-analysis was to summarize the current evidence to assess the effectiveness of MLD in preventing and treating lymphedema in patients after breast cancer surgery. METHODS: From inception to May 2019, PubMed, EMBASE, and Cochrane Library databases were systematically searched without language restriction. We included randomized controlled trials (RCTs) that compared the treatment and prevention effect of MLD with a control group on lymphedema in breast cancer patients. A random-effects model was used for all analyses. RESULTS: A total of 17 RCTs involving 1911 patients were included. A meta-analysis of 8 RCTs, including 338 patients, revealed that MLD did not significantly reduce lymphedema compared with the control group (standardized mean difference (SMD): -0.09, 95% confidence interval (CI): [-0.85 to 0.67]). Subgroup analysis was basically consistent with the main analysis according to the research region, the publication year, the sample size, the type of surgery, the statistical analysis method, the mean age, and the intervention time. However, we found that MLD could significantly reduce lymphedema in patients under the age of 60 years (SMD: -1.77, 95% CI: [-2.23 to -1.31]) and an intervention time of 1 month (SMD: -1.77, 95% CI: [-2.23 to -1.30]). Meanwhile, 4 RCTs including, 1364 patients, revealed that MLD could not significantly prevent the risk of lymphedema (risk ratio (RR): 0.61, 95% CI: [0.29-1.26]) for patients having breast cancer surgery. CONCLUSIONS: Overall, this meta-analysis of 12 RCTs showed that MLD cannot significantly reduce or prevent lymphedema in patients after breast cancer surgery. However, well-designed RCTs with a larger sample size are required, especially in patients under the age of 60 years or an intervention time of 1 month.

Quality of Life in Family Caregivers of Adolescents with Depression in China: A Mixed-Method Study.

PURPOSE: In this study, we investigated quantitatively the quality of life (QoL) and its influencing factors among Chinese family caregivers who care for adolescents with depression (AWD) and we explored qualitatively their care-giving experiences. METHODS: The study was a mixed method with convergent parallel design. The sociodemographic characteristics, QoL, caregivers' burden, family functioning, positive and negative affects were assessed by using questionnaires on 240 family caregivers of AWD in China. Twelve of these family caregivers were interviewed by using a semi-structured guide to explore their care-giving experiences. RESULTS: The mean score among family caregivers of AWD for physical QoL was 65.18 and 59.42 for mental QoL, which was significantly lower than the Chinese norms for QoL. Multiple regression analysis demonstrated that course of disease of AWD, caregivers' educational qualification, family functioning, positive affect and care-giving burden accounted for 57% of the variance in physical QoL. Suicide history of AWD, caregivers' educational qualification, negative affect, positive affect, care-giving burden and family functioning accounted for 54% of the variance in mental QoL. Four major themes of the care-giving experiences emerged: lack of knowledge about depression, being overwhelmed emotionally with psychological burden, the devastating impact of illness on family, and the perceived benefits of care-giving. CONCLUSION: The QoL among family caregivers of AWD in China was low. It is necessary for health-care professionals to pay more attention to the QoL of family caregivers who care for AWD.

Effect of caregivers' expressed emotion on the care burden and rehospitalization rate of schizophrenia.

BACKGROUND: This study assessed the effect of expressed emotion (EE) among caregivers of schizophrenia patients on their care burden and the illness rehospitalization rate. SUBJECTS AND METHODS: A total of 64 schizophrenia patients hospitalized for the first time and their key caregivers were recruited. The Chinese version of the Camberwell Family Interview (CFI-CV) was used to evaluate the EE of the key caregivers. A family burden questionnaire was used to evaluate the care burden. The patients' rehospitalization rate and medication compliance were evaluated by the self-designated criteria. The data collection was carried out at the first meeting in the hospital, at 6 months and 12 months after hospital discharge by using the same instruments. RESULTS: The subjective stress burden and subjective demand burden scores were higher in caregivers before and after discharge with statistical difference between the various observation time points (P<0.05). Significant differences were observed in the rehospitalization rate between patients with high medication adherence and low medication adherence at 12 months (P<0.01) and between patients with high expressed emotion (HEE) and low expressed emotion (LEE; P<0.05). The rehospitalization rate in patients with HEE caregivers was higher than that in those with LEE caregivers. The subjective stress burden scores were statistically significant between HEE and LEE caregivers (P<0.05). CONCLUSION: HEE is a predictor of rehospitalization rate in schizophrenic patients. The burdens of care scores are high in caregivers of schizophrenic patients. The caregivers with HEE have a high score in burden of care compared with those with LEE.

Impact of diabetes on the risk of bedsore in patients undergoing surgery: an updated quantitative analysis of cohort studies.

Diabetes is a major cause of morbidity for patients undergoing surgery and can increase the incidence of some postoperative complications such as bedsores. We conducted a meta-analysis of observational studies to examine whether patients with diabetes undergoing surgery had high risk of bedsore. We performed a systematic literature search in Pubmed, Embase and the Cochrane Library Central Register of Controlled Trials database from inception to November 2016. Studies were selected if they reported estimates of the relative risk (RR) for bedsore risk in postoperative diabetic patients compared with that of in non-diabetic patients. Random-effects meta-analysis was conducted to pool the estimates. A total of 16 studies with 24,112 individuals were included in our meta-analysis. The pooled RR of bedsore development for patients with diatetes was 1.77 (95% CI 1.45 to 2.16). The results of subgroup analyses were consistent when stratified by surgery type, study design, research region, sample size, inclusion period, analysis method and study quality. There was evidence of publication bias among studies and a sensitivity analysis using the Duval and Tweedie "trim-and-fill" method did not significantly alter the pooled results (adjusted RR 1.17, 95% CI 1.02 to 1.36).This meta-analysis provides indications that diabetic patients undergoing surgery could have a higher risk of developing bedsores. Further large-scale prospective trials should be implemented to comfirm the association.

Prevalence of aggression in hospitalized patients with schizophrenia in China: A meta-analysis.

INTRODUCTION: Aggression is a major concern in psychiatric inpatient care. Variations in study designs, settings, populations and data collection methods render comparisons of the prevalence of aggressive behavior in high-risk settings difficult. We proposed to estimate the pooled prevalence of aggression among inpatients with schizophrenia in China. METHODS: Reports on aggressive behaviour involving physical contact or risks of interpersonal violence, in schizophrenia in Chinese general psychiatric wards were retrieved by using computer-assisted searches and manual searches of the reference lists of the relevant literature. Statistical analyses were conducted using the Comprehensive Meta-Analysis V2 software. Potential sources of heterogeneity were analyzed with Cochrane's Q analysis. RESULTS: The search yielded 19 eligible studies involving a total of 3,941 schizophrenia patients. The prevalence of aggressive behavior in psychiatric wards ranged between 15.3% and 53.2%. The pooled prevalence of aggression was 35.4% (95% CI: 29.7%, 41.4%). The most commonly reported significant risk factors for aggression were positive psychotic symptoms: hostility or suspiciousness, 78.9% (15 studies); delusions, 63.2% (12 studies); disorganized behavior, 26.3% (5 studies); and auditory hallucinations, 10.5% (2 studies); together with: past history of aggression, 42.1% (8 studies); and involuntary admission, 10.5% (2 studies). CONCLUSIONS: Aggressive behaviour is common in Chinese inpatients with schizophrenia. The prevalence figures indicate the need to identify reliable clinical and illness predictors for aggression in inpatient psychiatric wards and to test investigations aimed at reducing aggressive episodes and their adverse outcomes.

[Aggression of Chinese inpatients with schizophrenia: a systematic literature review].

OBJECTIVE: To systematically review and analyze literature on episodes of aggression in psychiatric wards and to determine the coping and preventive strategies employed to deal with aggression of patients with schizophrenia. METHODS: We used the key words such as "schizophrenia" and "aggression" to collect literature citations, which were published between July 1997 and November 2011, by searching databases such as the Chinese Journal Full-text Database (CJFD). The literature reports of aggression by patients with schizophrenia were surveyed by computer-assisted searches, scanning of reference lists, and manual search of relevant journals. We analyzed the reports of episodes of aggression in psychiatric wards. RESULTS: Prevalence of aggression in psychiatric wards was reported to range from 9.1% (95% CI: 6.3 to 11.9) to 49.6% (95% CI: 41.1 to 58.1), with most reports in the range of 20% to 40% (mean 28.0%). The aggressive behavior often occurred in special groups and typically bore a close relationship with the patient's personal qualities, social environment, or psychiatric symptoms. The aggressive behaviors can be attributed to a lack of standardized assessments and intervention instruments. CONCLUSION: There is a high risk of aggression in Chinese inpatients with schizophrenia, and it is urgent to establish the scientific, standardized, operational systems for assessing and treating the aggression of these patients.