A network model of depressive and anxiety symptoms: a statistical evaluation.

BACKGROUND: Although network analysis studies of psychiatric syndromes have increased in recent years, most have emphasized centrality symptoms and robust edges. Broadening the focus to include bridge symptoms within a systematic review could help to elucidate symptoms having the strongest links in network models of psychiatric syndromes. We conducted this systematic review and statistical evaluation of network analyses on depressive and anxiety symptoms to identify the most central symptoms and bridge symptoms, as well as the most robust edge indices of networks. METHODS: A systematic literature search was performed in PubMed, PsycINFO, Web of Science, and EMBASE databases from their inception to May 25, 2022. To determine the most influential symptoms and connections, we analyzed centrality and bridge centrality rankings and aggregated the most robust symptom connections into a summary network. After determining the most central symptoms and bridge symptoms across network models, heterogeneity across studies was examined using linear logistic regression. RESULTS: Thirty-three studies with 78,721 participants were included in this systematic review. Seventeen studies with 23 cross-sectional networks based on the Patient Health Questionnaire (PHQ) and Generalized Anxiety Disorder (GAD-7) assessments of clinical and community samples were examined using centrality scores. Twelve cross-sectional networks based on the PHQ and GAD-7 assessments were examined using bridge centrality scores. We found substantial variability between study samples and network features. 'Sad mood', 'Uncontrollable worry', and 'Worrying too much' were the most central symptoms, while 'Sad mood', 'Restlessness', and 'Motor disturbance' were the most frequent bridge centrality symptoms. In addition, the connection between 'Sleep' and 'Fatigue' was the most frequent edge for the depressive and anxiety symptoms network model. CONCLUSION: Central symptoms, bridge symptoms and robust edges identified in this systematic review can be viewed as potential intervention targets. We also identified gaps in the literature and future directions for network analysis of comorbid depression and anxiety.

The prevalence of poor sleep quality in the general population in China: a meta-analysis of epidemiological studies.

BACKGROUND: The high prevalence of poor sleep quality (PSQ) in the general population leads to negative health outcomes. Since estimates of PSQ prevalence in the Chinese general population vary widely, this meta-analysis aimed to refine these estimates and to identify moderating factors. METHODS: A comprehensive literature search was undertaken in both international (PubMed, PsycINFO, Web of Science, and EMBASE) and Chinese (Wanfang, and the China National Knowledge Infrastructure databases) databases from inception to 23 November 2023. Studies were required to have used standard scales such as the Chinese version of the Pittsburgh Sleep Quality Index (PSQI). The pooled prevalence of PSQ and 95% confidence intervals (CIs) were calculated using a random-effects model. Subgroup and meta-regression analyses were performed to identify sources of heterogeneity. RESULTS: In 32 studies with a combined 376,824 participants, the pooled prevalence of PSQ was 19.0% (95% CI 15.8-22.8%; range 6.6-43.6%). Across 22 studies that reported PSQI data, the pooled mean score was 4.32 (95%CI 3.82-4.81; SD = 0.502). The pooled mean sleep duration across 8 studies was 7.62 (95% CI 7.23-8.00; SD = 0.194) hours. Subgroup analyses showed that lower education (Q = 4.12, P = 0.042), living in less developed regions (Q = 60.28, P < 0.001), and lower PSQI cutoff values (Q = 9.80, P = 0.007) were significantly associated with PSQ. Meta-regression analyses showed that study quality was inversely associated with estimated PSQ prevalence (ß = - 0.442, P = 0.004). LIMITATIONS: Although measures such as subgroup and meta-regression analyses were performed, substantial heterogeneity remained. Information related to sleep quality, such as comorbid physical diseases or psychiatric disorders, substance use, occupational types, and employment status, were not reported in most studies. CONCLUSION: One in five people in the general population of China may have PSQ and people with lower education or living in western regions may be more susceptible.

Pain trajectories and their associations with cognition among older adults: a 10-year cohort study from network perspective.

BACKGROUND: Few studies have examined the associations between pain trajectories and cognitive function in older adults. This study explored the associations between pain trajectories and different cognitive domains in older adults from a network perspective. METHODS: Data on pain trajectories were derived from the Health and Retirement Study between 2010 and 2020 using latent class growth analyses. Measurements of key cognition domains, including memory, attention, calculation, orientation and language, were included. Linear regression and network analysis were performed to evaluate the associations between different pain trajectories and cognition. RESULTS: A total of 9,551 older adults were included in this study and three trajectories of pain were identified. After controlling for the covariates, persistent severe pain trajectory was associated with poorer overall cognition, memory and calculation ability when compared to mild or non-persistent pain trajectory. In the pain and cognition network model, memory (expected influence (EI) = 0.62), language (EI = 0.58) and calculation (EI = 0.41) were the most central domains. CONCLUSIONS: Pain trajectories appeared stable over time among older adults in this study. Severity of persistent pain was an important risk factor for poor cognition, especially in relation to memory and calculation domains. Interventions targeting memory, language and calculation domains might be useful in addressing cognitive decline in older adults with persistent pain.

COVID-19 and Sleep Problems: A Perspective from Bibliometric Analysis.

OBJECTIVES: The Coronavirus Disease 2019 (COVID-19) pandemic and the containment measures for COVID-19 have affected sleep quality in the population. This study explored sleep-related research from a bibliometric perspective to provide an overview of the research outputs in this field. METHODS: Original and review articles were retrieved from the Web of Science Core Collection (WOSCC) database from December 2019 to 7 Aug 2023. R package "bibliometrix" was used to summarize the number of articles of authors, institutions, and countries; count the citations of the articles, and generate a Three-Fields Plot. VOSviewer software was applied to visualize the collaboration network among authors and institutions, and to conduct a co-occurrence analysis of keywords. RESULTS: A total of 4,499 articles on COVID-19 and sleep, and 25,883 articles on non-COVID-19 and sleep were included. Sleep related articles were mainly published by authors from China, the USA, and Italy. For COVID-19 and sleep research, Huazhong University of Science was the most productive institution. The Psychiatry Research was the most influential journal across the different subject categories of this field. "Mental health", "anxiety", and "depression" were the most common keywords, while "sleep quality" and "quality of life" were the likely topic areas in terms of future research directions. CONCLUSIONS: Our findings provide a comprehensive perspective for researchers to understand the wider landscape of both COVID-19 and non-COVID-19 sleep-related research area.

Prevalence of insomnia and its association with quality of life in caregivers of psychiatric inpatients during the COVID-19 pandemic: a network analysis.

BACKGROUND: Studies on sleep problems among caregivers of psychiatric patients, especially during the COVID-19 pandemic, are limited. This study examined the prevalence and correlates of insomnia symptoms (insomnia hereafter) among caregivers of psychiatric inpatients during the COVID-19 pandemic as well as the association with quality of life (QoL) from a network analysis perspective. METHODS: A multi-center cross-sectional study was conducted on caregivers of inpatients across seven tertiary psychiatric hospitals and psychiatric units of general hospitals. Network analysis explored the structure of insomnia using the R program. The centrality index of "Expected influence" was used to identify central symptoms in the network, and the "flow" function was adopted to identify specific symptoms that were directly associated with QoL. RESULTS: A total of 1,101 caregivers were included. The overall prevalence of insomnia was 18.9% (n = 208; 95% CI = 16.7-21.3%). Severe depressive (OR = 1.185; P < 0.001) and anxiety symptoms (OR = 1.099; P = 0.003), and severe fatigue (OR = 1.320; P < 0.001) were associated with more severe insomnia. The most central nodes included ISI2 ("Sleep maintenance"), ISI7 ("Distress caused by the sleep difficulties") and ISI1 ("Severity of sleep onset"), while "Sleep dissatisfaction" (ISI4), "Distress caused by the sleep difficulties" (ISI7) and "Interference with daytime functioning" (ISI5) had the strongest negative associations with QoL. CONCLUSION: The insomnia prevalence was high among caregivers of psychiatric inpatients during the COVID-19 pandemic, particularly in those with depression, anxiety and fatigue. Considering the negative impact of insomnia on QoL, effective interventions that address insomnia and alteration of sleep dissatisfaction should be developed.

Hikikomori: A perspective from bibliometric analysis.

AIMS: Hikikomori is a common phenomenon reported in Japan and many other countries. However, the broad trends of the research publications on hikikomori are unclear. Therefore, this study examined the patterns of research on hikikomori using bibliometric analysis. METHODS: Relevant publications were searched in Web of Science. Bibliometric analyses were performed with CiteSpace, R and VOSviewer. RESULTS: In total, 297 publications on hikikomori met the eligibility criteria. The International Journal of Social Psychiatry (IF = 10.461) published the most papers (K = 17, or 5.7%) on hikikomori. Takahiro A. Kato from Kyushu University (41; 13.8%; H-index = 18) was the most influential author, while Takahiro A. Kato (total link strength [TLS]: 235), Alan R. Teo (TLS: 157), and Masaru Tateno (TLS: 153) separately had the strongest research collaboration with other researchers. Of all countries that published on hikikomori, Japan had the highest number of publications (K = 91). The keywords "United States" and "psychiatric diagnosis" received the most attention between 2013 and 2015, whereas "health" and "autism spectrum disorder" received the most attention in 2021 and 2022. CONCLUSIONS: Peer-reviewed research publications on hikikomori are growing rapidly and the research trends in this field are also changing.

Traditional Chinese medicine-based integrated health interventions for depression: A systematic review and meta-analysis.

BACKGROUND: Some traditional Chinese medicine (TCM)-based integrated health interventions have been used for depression, but pooled efficacy remains unknown. AIMS AND OBJECTIVES: This study aimed to systematically evaluate the efficacy of TCM-based integrated health interventions for relieving depression. DESIGN: Systematic review and meta-analysis. METHODS: A comprehensive literature search was conducted on 17 databases from inception up to June 2022. Randomised controlled trials (RCTs) that examined an integrated health intervention based on TCM theory for depression were included. The risk of bias was assessed using the second version of the Cochrane risk-of-bias tool for randomised trials, and the quality of evidence was evaluated using the Grading of Recommendations, Assessment, Development and Evaluation system. RESULTS: Eighteen RCTs with a total of 1448 depressed participants were included. Health care providers, mainly nurses (14 studies), implemented TCM-based integrated health interventions. The pooled results showed that TCM-based integrated health interventions had larger effects on reducing depressive symptoms (15 studies; standardised mean difference = -2.05; 95% CI: -2.74, -1.37; p < .00001) compared with usual care at posttreatment but showed no significant difference contrasted to cognitive behavioural therapy (two studies, p = .31). However, the overall evidence was low. CONCLUSIONS: The meta-analysis results indicated that TCM-based integrated health interventions were effective in reducing depression. However, the results should be interpreted with caution because of the low quality of the included studies. Future RCTs with rigorous designs should be conducted to provide robust evidence of the efficacy of TCM-based integrated health interventions in treating depression. RELEVANCE TO CLINICAL PRACTICE: TCM-based integrated health interventions might be a potentially effective alternative for depression. Nurses could play an important role in designing and providing TCM-based integrated nursing interventions for patients with depression. NO PATIENT OR PUBLIC CONTRIBUTION: This is a systematic review and meta-analysis based on data from previous studies.

Use of the 33-Item Hypomania Checklist (HCL-33) to Distinguish Bipolar Disorder From Major Depressive Disorder in Older Adults.

BACKGROUND: Bipolar disorder (BD) is often misdiagnosed as major depressive disorder (MDD) in older patients. This study examined the psychometric properties of the 33-item Hypomania Checklist (HCL-33) and its accuracy to differentiate BD from MDD among older adults. METHOD: A total of 215 depressed older patients were recruited; 107 were diagnosed with BD (71 with BD-type I and 36 with BD-type II) and 108 with MDD. Principal components analysis (PCA) was used to explore the factor structure of the HCL-33. Cronbach's alpha was calculated to test the internal consistency. Intra-class correlation coefficient (ICC) was used to measure test-retest reliability. The receiver operating characteristic (ROC) analysis was used to generate the optimal cut-off value to differentiate between BD and MDD. RESULTS: Two factors were identified in the PCA analysis accounting for 33.9% of the total variance. The Cronbach's alpha value for the HCL-33 was 0.912, with 0.922 for factor I and 0.664 for factor II. The test-retest reliability was excellent (ICC: 0.891). The optimal cut-off of the HCL-33 total score for discriminating between MDD and BD was 14, with a sensitivity of 88.8% and specificity of 82.4%. CONCLUSION: The HCL-33 had satisfactory reliability and validity and could be used to distinguish BD from MDD in older adults.

Sleep Disturbances and Their Association With Quality of Life in Older Psychiatric Patients During the COVID-19 Pandemic.

AIMS: The negative effect of the COVID-19 pandemic on sleep quality of clinically stable psychiatric patients is unknown. This study examined the prevalence of sleep disturbances and their association with quality of life (QOL) in clinically stable older psychiatric patients during the COVID-19 pandemic. METHODS: This multicenter, cross-sectional study involved older patients attending maintenance treatment at outpatient departments of four major psychiatric hospitals in China. Patients' socio-demographic and clinical characteristics were collected. Sleep disturbances, depressive symptoms, and QOL were assessed with the Insomnia Severity Index, the 9-item Patient Health Questionnaire, and 2 items of the World Health Organization Quality of Life-Brief version, respectively. Binary logistic regression analysis was conducted to examine the independent associations of socio-demographic and clinical variables with sleep disturbances, while the association between sleep disturbances and QOL was explored with analysis of covariance. RESULTS: A total of 941 patients were recruited. The prevalence of sleep disturbances was 57.1% (95% CI: 53.9-60.2%). Analysis of covariance revealed that QOL was significantly lower in patients with sleep disturbances compared to those without. Multivariate logistic regression analysis showed that sleep disturbances were positively and independently associated with more severe depressive symptoms (OR = 1.32, 95% CI: 1.26-1.37). Compared to patients with major depressive disorder, those with other psychiatric diagnoses had a significantly higher prevalence of sleep disturbances (OR = 1.44, 95% CI: 1.00-2.08). CONCLUSION: Sleep disturbances were common among clinically stable older psychiatric patients during the COVID-19 pandemic. Considering the negative association with QOL, this subpopulation needs regular assessment and timely treatment to reduce their sleep disturbances and improve their QOL.

Network Analysis of Depression, Anxiety, Posttraumatic Stress Symptoms, Insomnia, Pain, and Fatigue in Clinically Stable Older Patients With Psychiatric Disorders During the COVID-19 Outbreak.

OBJECTIVES: The Coronavirus Disease 2019 (COVID-19) pandemic has profound negative effects on the mental health of clinically stable older patients with psychiatric disorders. This study examined the influential nodes of psychiatric problems and their associations in this population using network analysis. METHODS: Clinically stable older patients with psychiatric disorders were consecutively recruited from four major psychiatric hospitals in China from May 22 to July 15, 2020. Depressive and anxiety syndromes (depression and anxiety hereafter), insomnia, posttraumatic stress symptoms (PTSS), pain, and fatigue were measured using the Patient Health Questionnaire, General Anxiety Disorder, Insomnia Severity Index, Posttraumatic Stress Disorder Checklist - Civilian Version, and Numeric Rating Scales for pain and fatigue, respectively. RESULTS: A total of 1063 participants were included. The network analysis revealed that depression was the most influential node followed by anxiety as indicated by the centrality index of strength. In contrast, the edge connecting depression and anxiety was the strongest edge, followed by the edge connecting depression and insomnia, and the edge connecting depression and fatigue as indicated by edge-weights. The network structure was invariant by gender based on the network structure invariance test (M = .14, P = .20) and global strength invariance tests (S = .08, P = .30). CONCLUSIONS: Attention should be paid to depression and its associations with anxiety, insomnia, and fatigue in the screening and treatment of mental health problems in clinically stable older psychiatric patients affected by the COVID-19 pandemic.

Prevalence of Suicidality and its Association with Quality of Life in Older Patients with Clinically Stable Psychiatric Disorders in China During the COVID-19 Pandemic.

AIMS: The pattern of suicidality in older patients with psychiatric disorders during the COVID-19 pandemic is not clear. This study examined the prevalence of suicidality and its association with quality of life (QOL) among older clinically stable patients with psychiatric disorders during the COVID-19 pandemic. METHODS: A multicenter, cross-sectional study was conducted from May 22 to July 15, 2020, among four major tertiary psychiatric hospitals in China. Suicidality was assessed by asking 3 standardized questions. Depressive symptoms, pain, and QOL were assessed with the 9-item Patient Health Questionnaire (PHQ-9), the numeric pain rating scale (NPRS), and the World Health Organization Quality of Life Questionnaire-brief version, respectively. RESULTS: A total of 1063 clinically stable patients participated and completed the assessment. The prevalence of suicidality was 11.8% (95% CI: 9.9%-13.7%) during the COVID-19 pandemic. Multiple logistic regression analysis revealed that poor treatment adherence (P = .009, OR = 1.86, 95% CI: 1.17-2.96) and perceived illness worsening during the COVID-19 outbreak (P = .02, OR = 2.07, 95% CI: 1.15-3.73), being diagnosed with major depressive disorder (P < .001, OR = 2.79, 95% CI: 1.68-4.64), PHQ-9 total score (P < .001, OR = 1.20, 95% CI: 1.15-1.24) and NPRS total score (P = .002, OR = 1.17, 95% CI: 1.06-1.29) were associated with higher risk of suicidality. After controlling for covariates, older psychiatric patients with suicidality had lower QOL compared to those without (F(1, 1063) =16.5, P<.001). CONCLUSIONS: Suicidality was common in older patients with clinically stable psychiatric disorders during the COVID-19 pandemic. Considering its negative impact on QOL and personal suffering, routine screening and preventive suicide measures should be implemented for older psychiatric patients.

Worldwide prevalence of mild cognitive impairment among community dwellers aged 50 years and older: a meta-analysis and systematic review of epidemiology studies.

BACKGROUND: Mild cognitive impairment (MCI) is the preclinical and transitional stage between healthy ageing and dementia that may be a potential 'target' for interventions designed to delay progression to dementia. In this systematic review and meta-analysis, we assessed the prevalence of MCI worldwide in community-dwelling adults aged 50 years and older. METHODS: PubMed, Web of Science, Embase and PsycINFO database searches were conducted from their respective inception dates to 1 September 2021. Data on the overall prevalence of MCI were synthesised using random effects models. RESULTS: A total of 66 articles covering 242,804 participants fulfilled study criteria for inclusion. The overall prevalence of MCI was 15.56% (95%CI: 13.24-18.03%). Prevalence rates of amnestic MCI and non-amnestic MCI were 10.03% (95%CI: 7.98-12.27%) and 8.72% (95%CI: 6.78-10.89%), respectively. The prevalence of MCI increased with age and decreased with education level. Subgroup and meta-regression analyses revealed that region of study site and male gender proportion per sample were significant correlates of MCI prevalence. CONCLUSION: The global prevalence of MCI among community dwellers is over 15% and is affected by age, gender, education level and region of study sites. Assessment and interventions targeting MCI within at-risk population subgroups should be considered toward the prevention of dementia.

Perceptions of patient aggression in psychiatric hospitals: a qualitative study using focus groups with nurses, patients, and informal caregivers.

BACKGROUND: Aggression in psychiatric hospitals has been of interest to researchers. Information on how different stakeholders perceive patient aggression remains equivocal. Even less is known about possible similarities or differences in stakeholders' perceptions of how aggressive behaviour is understood, managed and prevented in psychiatric hospitals. We aimed to explore multiple viewpoints on patient aggression, its possible causes and outcomes, and development ideas for prevention and management. METHODS: A qualitative design was adopted. The data were collected using focus group interviews. A thematic approach was used for interpretation. The data were collected on 15 adult wards in two inpatient psychiatric settings in Hong Kong. Participants were nurses working on the psychiatric inpatient wards, patients admitted to the wards, and informal caregivers visiting inpatient wards (N = 94). RESULTS: Commonalities between all groups were found on how patient aggression is perceived, and why it occurs. Patients and especially nurses described how patient aggression occurred with no clear reason or forewarning and how patients were physically controlled or restricted after aggressive events. Only nurses and patients expressed experiencing physical burden, while all groups considered psychological burden to be a consequence of aggression. All groups proposed that helpful attitudes among nurses, better communication, structural changes, and better self-management skills would prevent patient aggression. Risk assessment was proposed only by nurses and patients, while safety measures were proposed by nurses and informal caregivers only. The use of restrictive interventions to manage aggressive events was proposed by all groups. CONCLUSIONS: Despite the complex diversity of perspectives in different stakeholder groups regarding patient aggression, the findings highlighted that it is possible to achieve some mutual understanding of aggression in psychiatric hospitals and identify areas to be developed. Staffs' attitudes and skills for engagement and communication with patients and informal caregivers should be improved. There is also still room to develop the therapeutic environment and culture toward meaningful activities during the treatment period.

Bedtime smart device usage and accelerometer-measured sleep outcomes in children and adolescents.

PURPOSE: We analyzed the association between bedtime smart device usage habits and accelerometer-measured sleep outcomes (total sleeping time, sleep efficiency, and wake after sleep onset) in Hong Kong children and adolescents aged 8-14. METHODS: A total of 467 students in Hong Kong participated in this study from 2016 to 2017. They self-reported their bedtime smart device usage habits. The primary caregiver of each participant was also invited to complete a self-administered questionnaire about the family's social-economic status and bedtime smart device usage habits. An ActiGraph GT3X accelerometer was used to assess participants' 7-day sleep outcomes. RESULTS: The mean age of the participants was 10.3 (SD 1.9), and 54% were girls. Among the participants, 27% (n = 139) used a smart device before sleep, and 33% (n = 170) kept the smart device on before sleep. In total, 27% (n = 128) placed the smart device within reach before sleep, 23% (n = 107) would wake up when notifications were received, and 25% (n = 117) immediately checked the device after being awakened by a notification. Multiple regression controlling for age, sex, socio-economic status, and other confounders showed that those who woke up after receiving a notification had a statistically longer sleeping time (19.7 min, 95% CI: 0.3, 39.1, p = 0.046), lower sleep efficiency (- 0.71%, 95% CI - 1.40, - 0.02, p = 0.04), and a longer wake after sleep onset (2.6 min, 95% CI: 0.1, 5.1, p = 0.045) than those who did not. Nonetheless, all primary caregivers' bedtime smart device habits were insignificantly associated with all sleep outcomes of their children. CONCLUSION: Those who woke up after receiving smart device notifications had lower sleep efficiency and longer wake after sleep onset than those who did not, and they compensated for their sleep loss by lengthening their total sleep time.

Prevalence of Depressive Symptoms Among Pregnant and Postpartum Women in China During the COVID-19 Pandemic.

OBJECTIVE: According to recent studies, the COVID-19 pandemic has been associated with an increased risk of mental health problems across many subpopulations including pregnant and postnatal women. This study examined the prevalence and correlates of depressive symptoms (depression hereafter) in Chinese pregnant and postpartum women during the COVID-19 pandemic. METHODS: This was a multicenter, cross-sectional study comprising 1309 pregnant and postpartum women across 12 provinces in China during the COVID-19 pandemic. Depression was assessed using the nine-item Patient Health Questionnaire. Univariate analyses and multivariate logistic regression analyses were conducted. RESULTS: The prevalence of depression in pregnant and postpartum women was 27.43% (95% confidence interval [CI] = 25.01%-29.85%). Women who were worried about themselves or their babies being infected with COVID-19 (odds ratio [OR] = 2.562, 95% CI = 1.670-3.929), and those who had delayed regular medical checkups (OR = 2.434, 95% CI = 1.580-3.750) were at higher risk of depression. Compared with those living in central and western parts of China, women living in northern (OR = 0.513, 95% CI = 0.326-0.807) and southeastern parts of China (OR = 0.626, 95% CI = 0.463-0.846) were less likely to have depression. CONCLUSIONS: The COVID-19 pandemic was associated with an increased likelihood of mental health problems among pregnant and postnatal women. Over a quarter of the pregnant and postpartum women in China had depression during the COVID-19 pandemic. Considering the negative health impact of depression, preventive measures, regular mental health screening, and medical checkups are needed with the goal to reduce the risk of depression in this vulnerable population during a pandemic.

Oral health in patients with dementia: A meta-analysis of comparative and observational studies.

OBJECTIVE: Poor oral health is common in dementia, but findings of epidemiological studies have been inconsistent. This meta-analysis examined oral health in patients with dementia diagnosed according to standardized diagnostic criteria. METHODS: Six international databases (PubMed, EMBASE, PsycINFO, Medline, Cochrane Library, and Web of Science) were searched from their commencement date until 8 November 2018. Oral health was measured by the Remaining Teeth (RT) and Decayed, Missing, and Filled Teeth (DMFT) Index. The mean differences (MD) and 95% confidence intervals (CI) of DMFT Index total and component scores were calculated using a random-effect model. RESULTS: Twenty-four studies were included for analyses. The pooled DMFT Index was 23.48 (95% CI: 22.34, 24.62), while the pooled score for each component was 2.38 (95% CI: 1.56, 3.20) in decayed teeth (DT), 18.39 (95% CI: 15.92, 20.87) in missing teeth (MT), 2.29 (95% CI: 0.62, 3.95) in filled teeth (FT), and 11.59 (95% CI: 9.14, 14.05) in RT. Compared to controls, people with dementia had significantly a higher DMFT Index total score (MD = 3.80, 95% CI: 2.21, 5.39, p < 0.00,001), and significantly lower number of RT (MD = -3.15, 95% CI: -4.23, -2.06, p < 0.00,001). Subgroup analyses revealed that higher DMFT Index score was significantly associated with year of survey (>2010), study design (case-control study), percentage of females (≤54.3), and the Mini Mental State Examination score (≤18.2). Higher MT score was significantly associated with study design (cross-sectional study), and lower FT score was significantly associated with year of survey (>2010). CONCLUSIONS: Oral health was significantly poorer in people with dementia compared with controls. Regular screening and effective treatment should be implemented for this population.

COVID-19-related stigma and its sociodemographic correlates: a comparative study.

BACKGROUND: Coronavirus disease 2019 (COVID-19) is closely associated with physical and mental health problems; however, little is known about the severity of stigma caused by COVID-19 among its survivors. Thus, the aim of this study was to compare differences in stigma experiences of COVID-19 survivors versus healthy controls after the COVID-19 outbreak peak in China. METHODS: This cross-sectional study comprised 154 COVID-19 survivors and 194 healthy controls recruited through consecutive and convenience sampling methods, respectively. COVID-19 related stigma was measured by the Social Impact Scale (SIS). Stigma differences between the two groups were compared with analysis of covariance (ANCOVA) and a generalized linear model (GLM) was used to identify independent correlates of COVID-19-related stigma in this study. RESULTS: Compared with healthy controls, COVID-19 survivors reported more overall stigma (F(1,347) = 60.82, p < 0.001), and stigma in domains of social rejection (F(1,347) = 56.54, p < 0.001), financial insecurity (F(1,347) = 19.96, p < 0.001), internalized shame (F(1,347) = 71.40, p < 0.001) and social isolation (F(1,347) = 34.73, p < 0.001). Status as a COVID-19 survivor, having family members infected with COVID-19, being married, economic loss during the COVID-19 pandemic, and depressive symptoms were positively associated with higher overall stigma levels (all p values < 0.05). CONCLUSION: COVID-19-related stigma is commonly experienced among COVID-19 survivors even though the outbreak has been well-contained in China. Routine assessment of stigma experiences should be conducted on COVID-19 survivors and appropriate psychological assistance, public education, and anti-stigma campaigns and policies should be enforced to reduce stigma within this vulnerable subpopulation.

Prevalence of problematic Internet use and its association with quality of life among undergraduate nursing students in the later stage of COVID-19 pandemic era in China.

BACKGROUND AND OBJECTIVES: The prevalence of problematic Internet use (PIU) in the post-COVID-19 pandemic era is not known. This cross-sectional study aimed to determine the prevalence of PIU among baccalaureate nursing students (hereafter: nursing students) in the post-COVID-19 era. METHODS: A total of 1070 nursing students were consecutively invited to participate in this study from the nursing schools of five universities. PIU and quality of life (QOL) were assessed using the Internet Addiction Test (IAT) and the World Health Organization Quality of Life Scale Brief Version (WHOQOL-BREF), respectively. t Tests, χ2 , tests, and Kruskal-Wallis tests were used to compare basic demographic and clinical characteristics between participants with and without PIU. Binary logistic regression analysis was used to examine independent correlates. RESULTS: The prevalence of PIU was 23.3% (95% confidence interval [CI]: 20.7%-25.8%). Multiple logistic regression analysis revealed that second- (p = .024) and third-year (p = .012) students were more likely to suffer from PIU compared with first year students. Students with more severe depressive (p = .014) and anxiety symptoms (p = .011) were independently and significantly associated with more severe PIU. After controlling for covariates, nursing students with PIU had a lower overall QOL score (p = .002). CONCLUSION AND SCIENTIFIC SIGNIFICANCE: Problematic Internet use (PIU) was common among nursing students in the post-COVID-19 era. Considering the negative impact of PIU on QOL and academic performance, regular screening should be conducted and effective interventions implemented for nursing students with PIU. This was the first study on the prevalence of PIU among nursing students in the post-COVID-19 era. The findings of this study could help health professionals and education authorities to understand the patterns of PIU and its influence on QOL among nursing students and to allocate health resources and develop effective measures to reduce the risk of PIU in this population.

Are People With Chronic Diseases Satisfied With the Online Health Information Related to COVID-19 During the Pandemic?

PURPOSE: A deluge of fake news and misinformation about the coronavirus disease 2019 (COVID-19) on the Internet poses challenges for the public in their search for reliable and relevant health information for taking protective measures, especially among people with chronic diseases (PWCD). This study aimed to (a) understand the satisfaction level of the online information related to COVID-19 in people with and without chronic diseases; (b) explore information-searching behavior and digital health literacy in PWCD; and (3) identify the possible predictors of information satisfaction among PWCD. METHODS: This was a multicity, cross-sectional study using an online survey with a convenience sample of people who (a) were 15 years of age or older and (b) had access to the Internet in mainland China, Hong Kong, and Macau. FINDINGS: Four thousand four hundred and seventy-two subjects completed the survey, of whom less than 50% felt satisfied with the online information. About 20% of respondents (n = 882) were diagnosed with at least one chronic disease and reported a lower level of information satisfaction (p = .003) than the people without chronic diseases. The majority of the PWCD obtained their online health information from social media. Higher digital health literacy (adjusted odds ratio [OR] = 5.07), higher frequency of searches regarding symptoms of COVID-19 (adjusted OR = 2.07), higher perceived importance of quickly learning from the information searched (adjusted OR = 1.63), and lower frequency of searches on the topic of dealing with psychological stress (adjusted OR = 0.54) were found to be predictors of information satisfaction among PWCD. CONCLUSIONS: The majority of PWCD sought online information related to COVID-19 from social media, and their level of information satisfaction was significantly lower than among people without chronic diseases. Digital health literacy is a strong and significant predictor of information satisfaction. CLINICAL RELEVANCE: To support PWCD, we not only have to provide them with clear and accurate information, but also promote their digital health literacy so that they may seek, understand, and appraise health information from the Internet to make appropriate health-related judgments and decisions.

The Attitude towards Preventive Measures and Knowledge of COVID-19 Inpatients with Severe Mental Illness in Economically Underdeveloped Areas of China.

Patients with severe mental illnesses (SMI) were at high risk of infection during Coronavirus Diseases 2019 (COVID-19) pandemic. This study examined hospitalized SMI patients' attitude and knowledge towards the COVID-19 infection. A cross-sectional survey was conducted in five psychiatric hospitals located in Gansu province, the most economically underdeveloped area in China. Patients' attitude towards preventive measures and knowledge of COVID-19 were measured by a self-report questionnaire. A total of 925 hospitalized patients with SMI were recruited. Of them, 84.8% (95%CI: 82.4%-87.1%) had positive attitudes towards preventive measures of the COVID-19 outbreak. Being married (OR: 1.55, 95%CI: 1.05-2.30) and a higher educational level (OR: 1.63, 95%CI: 1.12-2.38) were independently associated with positive attitudes towards COVID-19 preventive measures, whereas higher educational level was associated with better knowledge of the COVID-19 outbreak (ß: 0.231, P < 0.001). Patients mainly received COVID-19 relevant knowledge from public media (58.9%), followed by their clinicians (33.2%). Most hospitalized SMI patients in economically underdeveloped areas in China showed positive attitudes towards COVID-19 preventive measures. However, public health education on COVID-19 relevant knowledge by mental health professionals was inadequate to reduce the risk of transmission and infection.