The perspectives of healthcare professionals in mental health settings on stigma and recovery - A qualitative inquiry.

BACKGROUND: Mental health stigma is one of the most prominent barriers to recovery, and it is widely known that stigma may manifest differentially in different cultures. Healthcare professionals working closely with persons with mental illnesses (PMI) may provide important insights towards stigma that are otherwise unattainable from caregivers and consumers. However, there is a dearth of literature on healthcare professionals' perspectives on this topic. Thus, this study uses a multilevel approach to explore how stigma affects recovery from the perspectives of healthcare professionals that work closely with PMI in Singapore. METHODS: Semi-structured interviews were conducted with a total of 17 healthcare professionals who were working in mental health settings in Singapore. Participants were recruited via direct email invitation or through snowball sampling. Data collected was analysed with the inductive thematic analysis method. All coding and inter-rater analyses were performed with NVivo. RESULTS: The current study themes identified stigma-related factors that influence PMI's recovery from the perspectives of healthcare professionals working closely with PMI. These factors were organised into three overarching themes in a multilevel structure. The three themes were classified as Micro Factors (e.g., internalised stigma), Meso Factors (e.g., discrimination of people associated with the stigmatised group), and Macro Factors (e.g., structural stigma and stigma within healthcare settings). CONCLUSIONS: The findings of this study gave us a greater understanding of how stigma influences recovery in Singapore, which could be used to guide the development and implementation of future policies and strategies to promote recovery. Importantly, our results suggest that improving mental health literacy, addressing cultural misgivings towards mental illness, implementing recovery-oriented practices, and making insurance more accessible for PMI could mitigate the deleterious impact that stigma has on recovery.

Delays in Time-To-Antibiotics for Young Febrile Infants With Serious Bacterial Infections: A Prospective Single-Center Study.

Introduction: Fear of missed serious bacterial infections (SBIs) results in many febrile young infants receiving antibiotics. We aimed to compare the time to antibiotics between infants with SBIs and those without. Materials and Methods: We recruited febrile infants ≤ 90 days old seen in the emergency department (ED) between December 2017 and April 2021. SBI was defined as (1) urinary tract infection, (2) bacteremia or (3) bacterial meningitis. We compared the total time (median with interquartile range, IQR) from ED arrival to infusion of antibiotics, divided into (i) time from triage to decision for antibiotics and (ii) time from decision for antibiotics to administration of antibiotics. Results: We analyzed 81 and 266 infants with and without SBIs. Median age of those with and without SBIs were 44 (IQR 19-72) and 29 (IQR 7-56) days, respectively (p = 0.002). All infants with SBIs and 168/266 (63.2%) infants without SBIs received antibiotics. Among 249 infants who received antibiotics, the median total time from ED arrival to infusion of antibiotics was 277.0 (IQR 236.0-385.0) mins for infants with SBIs and 304.5 (IQR 238.5-404.0) mins for those without (p = 0.561). The median time to decision for antibiotics was 156.0 (IQR 115.0-255.0) mins and 144.0 (IQR 105.5-211.0) mins, respectively (p = 0.175). Following decision for antibiotics, infants with SBIs received antibiotics much faster compared to those without [107.0 (IQR 83.0-168.0) vs. 141.0 (94.0-209.5) mins, p = 0.017]. Conclusion: There was no difference in total time taken to antibiotics between infants with SBIs and without SBIs. Both recognition and administration delays were observed. While all infants with SBIs were adequately treated, more than half of the infants without SBIs received unnecessary antibiotics. This highlights the challenge in managing young febrile infants at initial presentation, and demonstrates the need to examine various aspects of care to improve the overall timeliness to antibiotics.

Strategies to Reduce Mental Illness Stigma: Perspectives of People with Lived Experience and Caregivers.

BACKGROUND: Reducing the stigma surrounding mental illness is a global public health priority. Traditionally, anti-stigma campaigns were led by mental health professionals/organisations and had an emphasis on increasing mental health literacy. More recently, it has been argued that people with lived experience have much to contribute in terms of extending and strengthening these efforts. The purpose of this paper was to elicit views and suggestions from people with lived experience (PWLE) as well as from informal caregivers of people with mental health conditions, on effective strategies to combat the stigma surrounding mental illness. METHODS: Six focus group discussions (FGDs) were carried out with PWLE recruited at outpatient services at the Institute of Mental Health, Singapore, and five FGDs were carried out with informal caregivers who responded to advertisements for the study between March and November 2018. In all, the sample comprised 42 PWLE and 31 caregivers. All the FGDs were transcribed verbatim and were analysed using thematic analysis. A pragmatic approach was adopted for the study, and the researchers did not assume any particular philosophical orientation. RESULTS: Four overarching themes depicting strategies to combat stigma were identified through thematic analysis. They were (1) raising mental health awareness, (2) social contact, (3) advocacy by influential figures or groups, and (4) the legislation of anti-discriminatory laws. CONCLUSIONS: These strategies were in line with approaches that have been used internationally to disrupt the process of stigma. Our study has further identified nuanced details on how these strategies can be carried out as well as possible areas of priority in the Singapore landscape.

A Qualitative Exploration of the Views of Policymakers and Policy Advisors on the Impact of Mental Health Stigma on the Development and Implementation of Mental Health Policy in Singapore.

Few studies have examined the views of policy makers regarding the impact of mental health stigma on the development and implementation of mental health policies. This study aimed to address this knowledge gap by exploring policymakers' and policy advisors' perspectives regarding the impact of mental health stigma on the development and implementation of mental health programmes, strategies, and services in Singapore. In all 13 participants were recruited for the study comprising practicing policymakers, senior staff of organisations involved in implementing the various mental health programmes, and policy advisors. Data was collected through semi-structured interviews, which were transcribed verbatim and analysed using reflexive thematic analysis. Data analysis revealed three superordinate themes related to challenges experienced by the policymakers/advisors when dealing with mental health policy and implementation of programmes. These themes included stigma as a barrier to mental health treatment, community-level barriers to mental health recovery, and mental health being a neglected need. Policymakers/advisors demonstrated an in-depth and nuanced understanding of the barriers (consequent to stigma) to mental healthcare delivery and access. Policymakers/advisors were able to associate the themes related to the stigma towards mental illness with help-seeking barriers based on personal experiences, knowledge, and insight gained through the implementation of mental health programmes and initiatives.

Preliminary development of a bystander intervention scale for depression and the examination of socio-demographic correlates amongst Singapore university students.

BACKGROUND: Despite peer involvement having a positive impact on help-seeking behavior, there is a lack of a scale quantifying the possibility of an individual intervening upon noticing peers who show signs of depression. The aims of this study were to (1) develop a bystander intervention scale for depression that assesses the likelihood of university students intervening when a peer shows signs of depression based on the theory of bystander intervention, (2) identify the underlying factors contributing to the behavior, and (3) explore the socio-demographic correlates of the scale. METHODS: The proposed scale, the Bystander Intervention Scale for Depression (BISD), is a 17-item self-reported questionnaire that was developed based on existing bystander intervention theory and inputs from mental health experts. Data was collected as part of a larger study to evaluate the effectiveness of an anti-stigma intervention amongst university students from a local university. A total of 392 participants were recruited. Exploratory factor analyses were performed to identify the underlying factor structure. Multiple linear regressions were conducted to explore the socio-demographic correlates of the scale. RESULT: Four key factors were identified for the proposed scale: (1) Awareness of depression among peers; (2) Vigilance towards possible symptoms of depression; (3) Knowledge on how to intervene; (4) Acceptance of responsibility to intervene. Having experience in the mental health field was associated with all factors while having family members or friends with mental illness was associated with all factors except for knowledge on how to intervene. Students of older age were associated with higher vigilance towards possible symptoms of depression and knowledge on how to intervene. Those of non-Chinese ethnicity were associated with acceptance of responsibility to intervene. CONCLUSION: This study provides a preliminary tool to assess bystander intervention in depression amongst university students. This study identifies sub-groups of the student population that require more education to intervene with depressed peers and also informs the development of future strategies.

Recognition of Depression and Help-Seeking Preference Among University Students in Singapore: An Evaluation of the Impact of Advancing Research to Eliminate Mental Illness Stigma an Education and Contact Intervention.

Background: The SMHS 2016 revealed that young adults in Singapore had the highest 12-month prevalence of mental disorders, with depression being the most prevalent condition. Additionally, the study found that those with higher education were less likely to seek treatment. The recognition of mental illness and knowledge of where to seek help has been found to influence one's ability to seek timely psychological help. This study thus aims to evaluate the effects of ARTEMIS, an education and contact intervention on university students' recognition of depression and help-seeking preference. Methods: A total of 390 university students were recruited over a period of 6-months (October 2018 to April 2019). Students had to attend a one-off intervention which comprised a lecture on depression and personal contact with a person with lived experience of mental illness. Recognition of depression and help-seeking preference were assessed using a vignette approach, at pre- and post-intervention as well as at 3-month follow-up. Results: The intervention was effective at improving student's recognition of depression and this effect was sustained at 3-months follow-up. The intervention was also effective in shifting student's help-seeking preference, although the effects were not sustained at 3-month follow-up. Having a close friend or family with mental illness was associated with better recognition, and being able to correctly recognize depression was linked to a preference to seek psychiatric over non-psychiatric help. Conclusion: This study elucidated the efficacy of a knowledge-contact-based intervention in improving university students' recognition of depression and help-seeking preference. However, while the benefits on recognition of depression is more enduring, it is more transient for help-seeking beliefs, and booster sessions may be needed to improve the long-term effectiveness of the intervention on help-seeking preference. Lastly, to investigate the generalizability of this study's findings, future studies could replicate the current one across other non-self-selected samples, such as by integrating the intervention as part of student's orientation.

Advancing research to eliminate mental illness stigma: an interventional study to improve community attitudes towards depression among University students in Singapore.

BACKGROUND: After decades of anti-stigma initiatives, the Advancing Research To Eliminate Mental Illness Stigma (ARTEMIS) intervention study is one of the first in Singapore to evaluate the effects of an anti-stigma intervention on attitudes towards depression in university students. METHODS: 390 university students from a local university in Singapore were voluntarily recruited for the study. The ARTEMIS intervention comprises an educational and social contact component, as well as a question and answer (Q&A) session with experts in the area of mental health. The Community Attitudes towards Mental Illness (CAMI) scale was administered at baseline, post-intervention and at 3-months follow-up. A confirmatory factor analysis (CFA) was conducted. RESULTS: The CFA identified a 3-factor model for the CAMI with a decent fit (RMSEA = 0.06, CFI = 0.93, TLI = 0.93, SRMR = 0.06). Favourable shifts in attitudes across the factors were observed immediately after the intervention (p <  0.001). Gender (ß = - 1.19, 95% CI: - 2.10, - 0.27, p = 0.01) and nationality (ß = - 1.23, 95% CI: - 2.35, - 0.11, p = 0.03) were identified as significant correlates for the community mental health ideology (CMHI) factor. Linear effects indicated that having a close social contact with mental illness observed a smaller decrease in authoritarianism scores from pre- to post-intervention (ß = 0.85, 95% CI: 0.18, 1.53, p = 0.01); whereas quadratic effects found a greater decrease in scores from post-intervention to after 3-months for benevolence (ß = - 0.34, 95% CI: - 0.52, - 0.16, p <  0.001) and CMHI (ß = - 0.22, 95% CI: - 0.45, - 0.002, p = 0.048). CONCLUSION: The anti-stigma intervention shows promising short-term results across the CAMI dimensions even after adjusting for sociodemographic correlates. However, the intervention did not observe the sustained attitude shifts after 3-months. Recommendations for future anti-stigma interventions were also considered.

Measurement properties of Pain Catastrophizing Scale in patients with knee osteoarthritis.

OBJECTIVES: Pain catastrophizing impacts symptoms and outcomes for knee osteoarthritis (OA). We evaluated the internal consistency, content, construct and structure validity of the Pain Catastrophizing Scale (PCS) in patients with knee OA. METHODS: We evaluated content validity of PCS via cognitive interviews. We then recruited patients with knee OA enlisted for knee replacement (KR) surgery in a Singapore tertiary referral hospital for cross-sectional validation evaluation of PCS. Data was collected 2 weeks prior to KR. Analyses was guided by the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) framework for internal consistency, construct validity and structure validity. RESULTS: Adequate content validity was confirmed from 10 patients in cognitive interviews. 675 (70.4% female, mean (standard deviation, SD) age = 65.52 (6.84) years) were included (91.7% total KR, 8.3% unicompartmental KR) in the cross-sectional study. The mean (SD) PCS score was 12.65 (10.55), with 0.14% and 8.63% ceiling and floor effects, respectively. PCS demonstrates high internal consistency (Cronbach's alpha = 0.94). Construct validity was demonstrated by fulfilment of seven out of seven (100%) a priori hypotheses. PCS was strongly correlated with anxiety and depression, and moderately correlated with physical functioning and mental health domains of the short form 36 health survey (SF-36). Sensitivity analyses between Chinese and non-Chinese subgroups are generally consistent. From confirmatory factor analysis, the PCS model showed good fit for a second-order, three-factor structure (CFI = 0.965, TLI = 0.950, SRMR = 0.031). CONCLUSIONS: This study supports internal consistency, construct validity and structural validity of PCS as a measure of pain catastrophizing in knee OA patients. Key points • The PCS is validated for measuring pain catastrophizing in knee OA patients, for evaluation of possible link to post-KR surgery satisfaction outcomes and other purposes.

Daily Encounters of Mental Illness Stigma and Individual Strategies to Reduce Stigma - Perspectives of People With Mental Illness.

INTRODUCTION: A qualitative evaluation of mental illness stigma experienced by people with mental illness (PMI) is currently lacking in Singapore. This study aims to employ qualitative methods to identify the common encounters of mental illness stigma experienced by PMI in Singapore and uncover their individual strategies and efforts to reduce mental illness stigma. METHODS: This study is part of a larger research project that explores the concept of mental illness stigma among different stakeholders in Singapore. Focus group discussions (FGDs) were conducted with 42 PMI to collect qualitative data on their experience with mental illness stigma, including encounters of stigma and individual strategies to reduce stigma. The inductive thematic analysis method was employed to analyze the data. RESULTS: The eight emergent themes associated with encountering stigma in PMI's everyday life were categorized into two over-arching themes, public stigma (i.e., negative beliefs and attitudes, subjected to contemptuous treatment, social exclusion, over-scrutinizing, and receiving excessive care and concern) and structural stigma (i.e., the requirement to declare psychiatric conditions during job interviews, excluded from consideration after the declaration, and requirement of medical endorsements for employment). Four themes regarding PMI's individual strategies to reduce stigma were also identified (i.e., non-disclosure of condition, standing up for themselves, individual efforts in raising awareness, improving themselves, and living life as per normal). LIMITATIONS: Participants may be influenced by social desirability bias due to the presence of other participants in an FGD setting. Also, those who agreed to participate in the study may possess strong views or beliefs about mental illness stigma and may therefore be inherently different from those who refused to participate. CONCLUSION: Our findings on instances of public and structural stigma encountered by PMI in Singapore can guide policymakers with the development of future policies and strategies to reduce mental illness stigma in the Singapore society. Furthermore, our study also identified individual strategies that PMI employed to reduce mental illness stigma. However, the effectiveness of these strategies was unclear and little is known of their effect on PMI themselves. Hence, there is a need for future studies to examine these strategies.

The potential impact of an anti-stigma intervention on mental health help-seeking attitudes among university students.

BACKGROUND: The reluctance of young adults to seek mental health treatment has been attributed to poor mental health literacy, stigma, preference for self-reliance and concerns about confidentiality. The purpose of this study was to examine the potential impact of an anti-stigma intervention that includes education about depression, information about help-seeking as well as contact with a person with lived experience, on help seeking attitudes. METHODS: A pre-post study design was employed. Changes in help-seeking attitudes were measured using the Inventory of Attitudes towards Seeking Mental Health Services (IASMHS) immediately post-intervention and after 3 months. Sociodemographic data, information on past experiences in the mental health field and contact with people with mental illness were collated. Three hundred ninety university students enrolled in the study. Linear mixed models were used to examine the effects of the intervention. RESULTS: Scores on all subscales of the IASMHS, Psychological Openness (PO), Help-seeking Propensity (HP) and Indifference to Stigma improved significantly post-intervention and at 3-month follow-up compared to pre-intervention, with HP demonstrating the highest effect size. However, a significant decline was observed on all three scales at 3-month follow-up compared to post-intervention. Gender, having friends/family with mental illness, and previous experience in the mental health field moderated the intervention effects for the PO and HP subscales. CONCLUSION: The study showed that the brief anti-stigma intervention was associated with improvements in help-seeking attitudes among university students with differential effects among certain sub-groups. As the beneficial outcomes appeared to decrease over time, booster sessions or opportunities to participate in mental health-related activities post-intervention may be required to maintain the desired changes in help-seeking attitudes.

A Scoping Review on Cue Reactivity in Methamphetamine Use Disorder.

The experience of craving via exposure to drug-related cues often leads to relapse in drug users. This study consolidated existing empirical evidences of cue reactivity to methamphetamine to provide an overview of current literature and to inform the directions for future research. The best practice methodological framework for conducting scoping review by Arkey and O'Malley was adopted. Studies that have used a cue paradigm or reported on cue reactivity in persons with a history of methamphetamine use were included. Databases such as Medline, EMBASE, PsycINFO and CINAHL were searched using key terms, in addition to citation check and hand search. The search resulted in a total of 32 original research articles published between 2006 to 2020. Three main themes with regard to cue reactivity were identified and synthesized: (1) effects of cue exposure, (2) individual factors associated with cue reactivity, and (3) strategies that modulate craving or reactivity to cues. Exposure to methamphetamine-associated cues elicits significant craving and other autonomic reactivity. Evidence suggests that drug cue reactivity is strongly associated with indices of drug use and other individual-specific factors. Future studies should focus on high quality studies to support evidence-based interventions for reducing cue reactivity and to examine cue reactivity as an outcome measure.

Mental illness stigma's reasons and determinants (MISReaD) among Singapore's lay public - a qualitative inquiry.

BACKGROUND: Mental illnesses pose a significant burden worldwide. Furthermore, the treatment gap for mental disorders is large. A contributor to this treatment gap is the perceived stigma towards mental illness. Besides impeding one's help-seeking intentions, stigma also impairs persons with mental illness (PMI) in other aspects of their life. Studies have found that stigma may manifest differentially under different cultural contexts. Thus, this study seeks to elucidate the determinants of stigma towards PMI among lay public in Singapore using a qualitative approach. METHODS: A total of 9 focus group discussions (FGD) were conducted with 63 participants consisting of lay public Singaporeans who were neither students or professionals in the mental health field, nor had they ever been diagnosed with a mental illness. Topics discussed during the FGD were related to the stigma of mental illness. Data collected were analyzed with inductive thematic analysis method. A codebook was derived through an iterative process, and data was coded by 4 different coders. Both coding and inter-rater analysis were performed with NVivo V.11. RESULTS: In total, 11 themes for the determinants of stigma were identified and conceptualized into a socioecological model. The socioecological model comprised 4 levels of themes: 1) Individual level beliefs (fear towards PMI, perceiving PMI to be burdensome, dismissing mental illness as not a real condition), 2) Interpersonal influences (upbringing that instills stigma, intergroup bias, perceived inability to handle interactions with PMI), 3) Local cultural values (elitist mindset among Singaporeans, Chinese culture of "face", Islamic beliefs about spiritual possession and reaction towards PMI), and 4) Shared societal culture (negative portrayal by media, Asian values). CONCLUSIONS: The findings of this study improved our understanding of the various reasons why stigma exists in Singapore. The themes identified in this study concur with that of studies conducted overseas, as some determinants of stigma such as fear towards PMI are quite ubiquitous. Specifically, the themes elitist mindset among Singaporeans and perceived inability to handle interactions with PMI were unique to this study. It is highly recommended that future anti-stigma campaigns in Singapore should incorporate the findings of this study to ensure cultural misgivings and beliefs are addressed adequately.

Causal beliefs of mental illness and its impact on help-seeking attitudes: a cross-sectional study among university students in Singapore.

OBJECTIVES: A considerable proportion of those who suffer from mental illnesses in Singapore do not seek any form of professional help. The reluctance to seek professional help could be due to misconceptions about the causes of mental illnesses. Research has shown that help-seeking attitudes can predict actual service use. As young adults are most at risk of developing mental illnesses, this study aims to elucidate the impact of causal beliefs about mental illness on help-seeking attitudes among university students in Singapore. DESIGN: Prior to attending an anti-stigma intervention, data on the Causal Beliefs about Mental Illness, Inventory of Attitudes towards Seeking Mental Health services and questions pertaining to sociodemographic background were collected from participants using a self-administered questionnaire. Multiple linear regressions were performed to examine the relationship between causal beliefs and help-seeking, as well as their sociodemographic correlates. SETTINGS: A university in Singapore. PARTICIPANTS: 390 students who were studying in a University in Singapore. RESULTS: Younger age was associated with higher scores on psychosocial attribution, while prior social contact with individuals with mental illness was significantly associated with lower scores on personality attribution. With regard to help-seeking attitudes; being a male and personality attribution were significantly associated with lower scores on 'Psychological Openness' and 'Indifference to Stigma', while psychosocial attribution was significantly associated with higher scores on 'Help-seeking Propensity'. Having prior social contact also predicted higher 'Psychological Openness', while being in Year 2 and 3 predicted lower scores on 'Indifference to Stigma'. CONCLUSION: Findings from this study suggest that help-seeking attitudes might be influenced by causal beliefs, with personality attribution being the most impairing. Hence, to reduce the wide treatment gap in Singapore, anti-stigma interventions targeting young people could focus on addressing beliefs that attribute mental illness to the personality of the individual.

Advancing Research to Eliminate Mental Illness Stigma: The Design and Evaluation of a Single-Arm Intervention Among University Students in Singapore.

BACKGROUND: Anti-stigma interventions for school and college students have been studied in several countries, but to the best of our knowledge, this has not been addressed in Singapore. The current study was designed to address this lacuna and aimed to evaluate the effectiveness of an anti-stigma intervention focusing on depression among university students in Singapore. METHODS: A one-off intervention comprising education and personal contact with a person with lived experience of depression was carried out in nine consecutive sessions over 6 months (October 2018 to April 2019) among 390 university students. Knowledge of depression and extent of stigma toward mental illness were assessed pre- and post-intervention as well as at 3-month follow-up. RESULTS: The intervention was effective in improving depression knowledge (d = 1.09; p < 0.001), as well as reducing social distancing (d = 0.54; p < 0.001) and personal stigma (dangerous/undesirable: d = 0.60; p < 0.001 and weak not sick: d = 0.10; p < 0.033) pre- to post-intervention as well as pre- intervention to 3-month follow-up (p < 0.005). LIMITATIONS: While 3-month follow-up data indicates favorable medium-term impact on knowledge and stigma; the study lacks long-term follow-up to examine the impact of anti-stigma interventions across time. The data were collected through self-report measures; however, social desirability bias is possible despite the assurances of confidentiality. CONCLUSION: Given the impact of the intervention, there is a need to consider the feasibility, challenges, and enablers of implementation of such interventions into the curriculum of university students to ensure a broader and sustained outreach and stigma reduction.

Non-pharmacological interventions for methamphetamine use disorder: a systematic review.

BACKGROUND: Methamphetamine (METH) use is on the rise globally, with the number of treatment seekers increasing exponentially across the globe. Evidence-based therapies are needed to meet rising treatment needs. This systematic review intends to appraise the existing evidence to identify effective non-pharmaceutical approaches for the treatment of METH use disorder. METHODS: Five electronic bibliographic databases-Ovid (Medline), Embase, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Web of Science and PsycINFO- were searched to identify relevant studies that were published between January 1995 to February 2020. Studies were selected and assessed by two independent reviewers. A systematic review of data from both randomised control trials (RCT) and non-RCTs was conducted to appraise the evidence. RESULTS: A total of 44 studies were included in the review. Behavioural interventions, i.e. cognitive behavioural therapy (CBT), contingency management (CM), exercise, residential rehabilitation based therapies, repetitive transcranial magnetic stimulation (rTMS), and matrix model demonstrated treatment efficacy in promoting abstinence, reducing methamphetamine use or craving in the participants. While CM interventions showed the strongest evidence favouring the outcomes assessed, tailored CBT alone or with CM was also effective in the target population. CONCLUSIONS: Behavioural interventions should be considered as the first line of treatment for methamphetamine use disorder. Future studies should address the longevity of the effects, and limitations due to smaller sample sizes and high dropout rates to enable better assessment of evidence.

Association between sleep quality and domains of quality of life amongst patients with first episode psychosis.

BACKGROUND: There is a lack of studies exploring associations between sleep and quality of life (QOL) among patients with schizophrenia who have limited exposure to antipsychotics and are in the early stage of their illness. Our study investigates the association of poor sleep quality and its components with domains of QOL amongst patients with first episode psychosis (FEP). METHODS: Data was utilized from a longitudinal study that examined sleep, smoking and alcohol use amongst patients with FEP who were enrolled in the Early Psychosis Intervention Programme (EPIP). The data were collected during the patients' baseline visit; i.e., within 3 months of admission into the EPIP. The Pittsburgh Sleep Quality Index (PSQI) was employed to examine sleep quality and its 7 components over the last month. The WHO quality of life-BREF was used to examine QOL and its 4 domains: physical health, psychological, social relationship, and environment. Clinical data such as Positive and Negative Syndrome Scale (PANSS) and Global Assessment of Functioning (GAF) scores were obtained from a clinical data base. Linear regression analyses were conducted to investigate the association between poor sleep quality and the domains of QOL. RESULTS: Amongst the 280 recruited patients, 62.9% suffered from poor sleep quality. Poor sleep quality was associated with significantly lower scores in all domains of QOL, despite controlling for socio-demographics and clinical variables. Respondents with higher scores in subjective sleep quality and daytime dysfunction were associated with lower scores in the physical health and social relationship domain. Furthermore, respondents with higher scores in subjective sleep quality, sleep latency and daytime dysfunction were associated with lower scores in the psychological domain of QOL. Finally, respondents with higher scores in subjective sleep quality were associated with lower scores in the environment domain of QOL. CONCLUSIONS: Our findings highlight the importance of monitoring sleep quality amongst patients with FEP to improve their QOL. Clinical programmes should also pay more attention to sleep components in order to maintain satisfactory QOL amongst patients with FEP. Future interventions should focus on improving the relevant sleep components to ensure better treatment outcomes.

Evaluation of Mobile Apps Targeted at Patients With Spondyloarthritis for Disease Monitoring: Systematic App Search.

BACKGROUND: There are many apps developed for patients with spondyloarthritis in the market, but their purpose and quality are not objectively evaluated. OBJECTIVE: The objective of this study was to identify and evaluate existing publicly available, high-quality apps that use validated measurement instruments for monitoring spondyloarthritis disease activity. METHODS: We conducted a review of apps available on the Apple App Store and the Google Play Store based on a combination of keywords and inclusion and exclusion criteria. Validated disease activity measurement instruments were identified. Data regarding app characteristics, including the presence of validated disease activity measurement, were extracted. The Mobile App Rating Scale (MARS) was used to review the apps for user experience. RESULTS: A total of 1253 apps were identified in the app stores, and 5 apps met the criteria and were further analyzed. Moreover, 2 apps (MySpA and Group for Research and Assessment of Psoriasis and Psoriatic Arthritis App) contained some of the validated disease activity monitoring instruments for specific spondyloarthritis subtypes. These 2 apps were also rated good on the MARS (with total mean scores ≥4 out of 5), whereas the other apps scored poorly in comparison. CONCLUSIONS: There are 2 high-quality spondyloarthritis disease activity monitoring apps publicly available, but they only target 2 spondyloarthritis subtypes-ankylosing spondylitis and psoriatic arthritis. There is a lack of high-quality apps that can measure disease activity for other spondyloarthritis subtypes, and no app that consolidates all validated disease activity instruments across subtypes was available.

AZD6244 (ARRY-142886) enhances the therapeutic efficacy of sorafenib in mouse models of gastric cancer.

Gastric cancer is a deadly disease for which current therapeutic options are extremely limited. Vascular endothelial growth factor receptors and platelet-derived growth factor receptors regulate gastric cancer cell proliferation, invasion, and tumor angiogenesis. In the present study, we report that sorafenib therapy effectively inhibited tumor growth and angiogenesis in tumor xenografts. These were associated with reduction in the phosphorylation of vascular endothelial growth factor receptor-2 Tyr951, c-Kit Tyr568/570, platelet-derived growth factor receptor-beta Tyr1021, and Akt Ser473 and Thr308, down-regulation of positive cell cycle regulators, increased apoptosis, and up-regulation of p27. Sorafenib treatment also caused up-regulation of p-c-Raf Ser338 and p-extracellular signal-regulated kinase (ERK) Thr202/Tyr204 in gastric cancer xenografts. The combination of sorafenib and MAP/ERK kinase inhibitor AZD6244 enhances the effectiveness of each compound alone. Potential effect of sorafenib/AZD6244 included increase in proapoptotic Bim. Our data show that MAP/ERK kinase inhibition enhances the antitumor activity of sorafenib in vivo, supporting a rationale for multitargeted suppression of the angiogenesis and ERK signaling network in gastric cancer therapy.