The effectiveness and safety of centralized early rehabilitation care for critically ill children with severe acquired brain injury: A retrospective cohort and implementation study.

BACKGROUND: Most children with neurocritical illness are at risk of physical, neurocognitive, and psychosocial sequelae and need centralized early rehabilitation care. OBJECTIVE: To identify the effectiveness and safety of centralized early rehabilitation care for children with severe acquired brain injury. METHODS: This is a mixed methods study-an implementation study and single-center retrospective cohort study with historical control. All children with severe acquired brain injury hospitalized in a specialized rehabilitation center in a comprehensive tertiary pediatric hospital between September 2016 and August 2020 were included. Patients treated in the centralized early rehabilitation unit were compared to historical controls dispersed in the normal inpatient rehabilitation ward. The effectiveness outcomes were measured by the Pediatric Cerebral Performance Category (PCPC) scale and the incidence of newly onset comorbidities. The safety outcomes were indicated by the mortality rate and the incidence of unexpected referrals. RESULTS: One hundred seventy-five patients were included. The delta PCPC scores of the first 4 weeks of inpatient rehabilitation in the intervention group were significantly lower than the control group (Z = -2.395, p = 0.017). The PCPC scores at 1 year in the intervention group were significantly reduced as compared to the control group (Z = -3.337, p = 0.001). The incidence of newly onset pneumonia/bronchitis was also decreased in the intervention group (χ2 = 4.517, p = 0.034). No death of patients was recorded, and there was no significant difference in unexpected referral rate between the two groups (χ2 = 0.374, p = 0.541). CONCLUSIONS: The centralized pediatrics early rehabilitation unit is effective and safe for children with severe acquired brain injury. Further multicenter prospective implementation studies on effectiveness, safety, and economic evaluation are needed.

Cross-sectional study of mental health related knowledge and attitudes among care assistant workers in Guangzhou, China.

BACKGROUND: Care assistant workers (CAWs) are a part of a new pattern of mental health care providers in China and play a significant role in bridging the human resource shortage. CAWs in China mainly include community cadres, community mental health staff, and community policemen. The mental health related knowledge and attitudes of CAWs could influence their mental health care delivery. This study aimed to assess mental health related knowledge and attitudes of CAWs in Guangzhou, China. METHODS: In November 2017, a study was conducted among 381 CAWs from four districts of Guangzhou, China. Participants were assessed using the Perceived Devaluation and Discrimination Scale (PDD), the Mental Health Knowledge Schedule (MAKS), and the Mental illness: Clinicians' Attitudes (MICA) Scale. Data were analyzed by descriptive statistics, ANOVA, Bonferroni corrections and multivariable linear regression. RESULTS: The mean scores (standard deviation) of PDD, MAKS and MICA were 36.45 (6.54), 22.72 (2.56), and 51.67 (7.88), respectively. Univariate analyses showed that the older CAWs, community policemen and those who were less willing to deliver care to people with mental illness had significant higher MICA scores when compared with other staff (P < 0.001). Multivariable linear regression showed that after controlling for key variables, care willingness and PDD total score were positively associated with the MICA total score (all P < 0.05), while attitudes on additional items were significant negatively with the MICA total score (all P < 0.01). CONCLUSION: These findings suggest negative attitudes towards people with mental disorders among CAWs are common, especially among older staff. Community policemen suggest that they applied stereotypes of "violent mentally ill" people to all people they deal with who have mental disorders. The results also indicate human rights are being paid some attention to now, but need to be further continually improved in the future. Strategies for improving such negative attitudes and reducing the perceived stigma and discrimination should be carried out towards particular staff groups in an anti-stigma programme in Guangzhou, China.

Effectiveness of an anti-stigma training on improving attitudes and decreasing discrimination towards people with mental disorders among care assistant workers in Guangzhou, China.

BACKGROUND: Care assistant workers as a new pattern of care providers in China play an important role in bridging the mental health treatment gap. Stigma and discrimination against people with mental disorders among care assistant workers is a barrier which adversely influences mental health service delivery. However, programs aimed at reducing stigma among care assistant workers are rare in China. METHODS: A total of 293 care assistant workers from four districts of Guangzhou, China were randomly divided into an intervention group (n = 139) and a control group (n = 154). The intervention group received anti-stigma training and the control group received traditional mental health training. Both trainings lasted for 3 h. Participants were measured before and after training using Perceived Devaluation and Discrimination Scale (PDD), Mental illness: Clinicians' Attitudes (MICA) and Mental Health Knowledge Schedule (MAKS). Data were analyzed by descriptive statistics, t-test, Chi square test or Fisher's exact test. Multilinear regression models were performed to calculate adjusted regression coefficient of the intervention on PPD, MAKS, and MICA. RESULTS: There were significant lower scores on PDD and MICA in the intervention group after training when compared with the control group (both P < 0.001). No significant difference was found on MAKS total score between the two groups after training (P = 0.118). Both groups had better correct identification of schizophrenia, depression and bipolar disorder before and after training. CONCLUSIONS: These findings suggest that anti-stigma training may be effective in reducing the perception of devaluation-discrimination against people with mental illness and decreasing the level of negative stigma-related mental health attitudes among care assistant workers.

Tracking the Evolution of Polymer Interface Films during the Process of Thermal Annealing at the Domain and Single Molecular Levels using Scanning Tunneling Microscopy.

Structural evolution of polymer (NTZ12) interface films during the process of annealing is revealed at the domain and single molecular levels using the statistical data measured from scanning tunneling microscopy images and through theoretical calculations. First, common features of the interface films are examined. Then, mean values of surface-occupied ratio, size and density of the domain are used to reveal the intrinsic derivation of the respective stages. Formation of new domains is triggered at 70 °C, but domain ripening is not activated. At 110 °C, the speed of formation of new domains is almost balanced by the consumption due to the ripening process. However, formation of new domains is reduced heavily at 150 °C but restarted at 190 °C. At the single molecular level, the ratio of the average length of linear to curved backbones is increased during annealing, whereas the ratios of the total length and the total number of linear to curved skeletons reaches a peak value at 150 °C. The two major conformations of curved backbones for all samples are 120° and 180° bending, but the ripening at 150 °C reduces 180° folding dramatically. Molecular dynamic simulations disclose the fast relaxing process of curved skeletons at high temperature.