Determining cut-off values and predictors for the Snaith-Hamilton Pleasure Scale: comparison between clinical and school settings.

BACKGROUND: Few previous studies have established Snaith-Hamilton Pleasure Scale (SHAPS) cut-off values using receiver operating characteristic curve analysis and applied these values to compare predictors of anhedonia between clinical and nonclinical groups. AIMS: To determine the optimal cut-off values for the SHAPS and use them to identify predictors of anhedonia in clinical and nonclinical groups in Taiwan. METHOD: This cross-sectional and correlational study used convenience sampling to recruit 160 patients from three hospitals and 412 students from two universities in northern Taiwan. Data analysis included receiver operating characteristic curve, univariate and multivariate analyses. RESULTS: The optimal SHAPS cut-off values were 29.5 and 23.5 for the clinical and nonclinical groups, respectively. Moreover, two-stage analysis revealed that participants in the clinical group who perceived themselves as nondepressed, and participants in the nonclinical group who did not skip classes and whose fathers exhibited higher levels of care and protection were less likely to attain the cut-off values. Conversely, participants in the nonclinical group who reported lower academic satisfaction and were unwilling to seek help from family or friends were more likely to attain the cut-off values. CONCLUSIONS: Our findings highlight the importance of optimal cut-off values in screening for depression risk within clinical and nonclinical groups. Accordingly, the development of comprehensive, individualised programmes to monitor variation trends in SHAPS scores and relevant predictors of anhedonia across different target populations is crucial.

Antenatal depression across trimesters as a risk for postpartum depression and estimation of the fraction of postpartum depression attributable to antenatal depression: A systematic review and meta-analysis of cohort studies.

OBJECTIVE: This meta-analysis aimed at estimating the prevalence of postpartum depression (PPD) at different postpartum timepoints in women with antenatal depression (AD) in the three trimesters. We also examined the association between AD and PPD, and estimated the population attributable fraction of PPD to AD. METHODS: This systematic review and meta-analysis identified cohort studies that determined the prevalence of PPD in women who had AD, and those that examined the association between AD and PPD from PubMed, Embase, MEDLINE, CINAHL and PsycINFO. Articles were appraised using the modified Newcastle Ottawa Scale and data were analyzed using Comprehensive Meta-Analysis. RESULTS: Eighty-eight (88) cohort studies with a combined sample size of 1,042,448 perinatal women contributed to the meta-analysis. About 37% pregnant women who had AD, later had PPD. Those with AD had four times higher odds of developing PPD (OR: 4.58; 95% CI = 3.52-5.96). The odds of having PPD were higher when AD was observed in the first or third trimester compared to the second trimester. About 12.8% of PPD cases were attributable to AD. CONCLUSION: The findings should inform future clinical guidelines on the screening, the frequency of screening, and follow-up care in maternal-mental health.

Prevalence of sleep disturbance among adolescents with substance use: a systematic review and meta-analysis.

PURPOSE: Sleep disturbance has become a major challenge among adolescents worldwide. Substance use is among the most common factors contributing to sleep disturbance. This systematic review and meta-analysis examined the prevalence and categories of sleep disturbance among adolescents with substance use. METHODS: We comprehensively searched for relevant studies published in the following databases from inception to August 2022: CINHAL (via EBSCOhost), PubMed, Scopus, Ovid Medline, Embase, ProQuest, and Web of Science. Data analysis was performed using Comprehensive Meta-Analysis version 3 software. We used a random-effects model to pool prevalence rates with 95% confidence intervals (CIs). Forest plots and p values for the Cochran Q statistic were used to evaluate heterogeneity among studies. Subgroup and meta-regression analyses were performed to compare the groups and identify the sources of heterogeneity. RESULTS: We examined 18 studies that reported insomnia, hypersomnolence, sleep-related breathing disorders as sleep disturbances among adolescents with the use of alcohol, smoking, marijuana, and coffee. The total sample was 124,554. The overall prevalence rate of sleep disturbance was 29% (95% CI: 0.201-0.403). Subgroup analysis revealed that the prevalence rates of insomnia and hypersomnolence were higher among alcohol users (31%; 95% CI: 0.100-0.654) and smokers (46%; 95% CI: 0.232-0.700). The study design and method of assessment groups were the significant moderators that showed the source of variation in the included studies. CONCLUSION: Sleep disturbance is highly prevalent among adolescents with substance use. Insomnia and hypersomnolence are more prevalent among alcohol users and smokers, respectively. On the basis of our findings, health-care providers can develop effective targeted interventions to reduce substance use, prevent sleep disturbance, and promote healthy sleep habits among adolescents.

Identifying differential trajectories and predictors for depressive symptoms in adolescents using latent class growth analysis: A population-based cohort study.

INTRODUCTION: This study investigated the differential trajectories and relevant determinants of depressive symptoms in adolescents by following cohorts that included junior, senior, and vocational high school adolescents, over a 3-year period in Taiwan. METHODS: Longitudinal data were obtained from 575 adolescents who participated in the Taiwan Adolescent to Adult Longitudinal Study. Data analysis included latent class growth with time-varying covariate, univariate, and multivariate analysis. RESULTS: A three-class ("low but increasing trajectory," "moderate and stable trajectory," and "high but decreasing trajectory") model fit the data of the cohort. Our findings indicated that 29%, 38%, and 33% of the adolescents were in the low but increasing, moderate and stable, and high but decreasing trajectories, respectively. After confounders were controlled for, bullying experiences were identified as a risk factor for depressive symptoms. The protective factors against depressive symptoms included resilience and peer and social support. CONCLUSIONS: The transitions between different educational stages critically influence the depressive symptoms of adolescents, and the adolescents follow different depressive trajectories, that have different etiology. Therefore, identifying adolescents at high risk for depression and designing student-centered intervention programs through individualized and multidimensional assessment of depressive symptoms are crucial for adolescents.

Relationship between traits and sleep quality of hospitalized elderly patients and sleep quality of family caregivers.

AIM: To understand whether the sleep quality of the caregivers of elderly inpatients is associated with their own characteristics and with the characteristics or sleep quality of the elderly inpatients. DESIGN: A cross-sectional study design that recruited participants from September to December 2020 was adopted, in which 106 pairs of elderly inpatients and caregivers were recruited. METHODS: Data collected from the elderly inpatients included demographic characteristics as well as the numerical rating scale (NRS) score, Charlson Comorbidity Index (CCI), Geriatric Depression Scale Short Form (GDS-SF) score, and Pittsburgh Sleep Quality Index (PSQI). Caregiver data included demographic characteristics and PSQI. RESULTS: In the regression analysis of caregiver characteristics and caregiver sleep quality, only caregiver age and the relationship between caregiver and inpatient (other vs. spouse) were correlated with caregiver sleep quality. In the regression analysis of elderly inpatient characteristics, caregiver characteristics, and caregiver sleep quality, only the PSQI of elderly inpatients and the relationship between caregiver and inpatient (other vs. spouse) were correlated with caregiver sleep quality. PATIENT OR PUBLIC CONTRIBUTION: Poor caregiver sleep quality was more likely to manifest when the elderly inpatients had poor sleep quality, when the caregivers themselves were older, and when the caregiver was the inpatient's spouse.

Psychometric Validation of the Indonesian Version of Children's Revised Impact of Event Scale 13.

A psychometric evaluation of the Children's Revised Impact of Event Scale 13 (CRIES-13), which measures the posttraumatic stress disorder (PTSD) symptoms in children and adolescents caused by the coronavirus disease 2019 (COVID-19) pandemic, was conducted. We aimed to cross-culturally adapt and test the psychometric qualities of the CRIES-13 that was applied to Indonesian adolescents exposed to COVID-19 risk across gender groups. A cross-sectional study was conducted at a junior high school in Yogyakarta, Indonesia, in May 2022; 346 Indonesian adolescents aged 12 to 18 years completed the Indonesian version of the CRIES-13. The factorial validity results supported the scale's three-factor structure (intrusion, avoidance, and arousal), which satisfied all parameter index requirements and exhibited a favorable level of internal consistency reliability. Excellent results were obtained across genders for the four-level measurement of invariance (i.e., configural, metric, scalar, and full invariance), and they met the recommended criteria. Our Cronbach's alphas and composite reliability ratings were high (>0.7), indicating a strong correlation and reliability of the items for measuring each construct. We strongly support the use of the Indonesian CRIES-13, which was demonstrated to be valid and reliable for an adolescent population.

Coping with the Experience of Bad Sleep and Fatigue Associated with the Nursing Clinical Practicum.

Nursing students experience anxiety during clinical practicum, which may interfere with their learning of clinical practice. This study explored the practicum anxiety symptom experience of clinical nursing students. The methodology was mixed research design consist of questionnaire and a qualitative research design following a grounded theory approach. Research data were gathered via theoretical sampling from 37 female college nursing students practicing in a Central Taiwan hospital and analyzed using the content analysis method. The mean age of the subjects was 20.7 ± 1.35 years old. The practicum-related anxiety symptom experience was made up of core dimensions associated with the nursing clinical practicum, such as bad sleep and fatigue, and covered six themes. Students first encountered anxiety-inducing situations in the clinical setting, and then they began coping through self-adaptation and teachers' help. In cases of coping failure, students began to have a bad sleep in the night and then felt tired and fatigued all day. These themes became a repeating cycle during the clinical practicum. This conceptual model shows that students experienced bad sleep and fatigue as a result of anxiety symptoms during the clinical practicum. Bad sleep and fatigue are critical anxiety symptoms for nursing students in clinical practice. Nursing teachers should pay attention to bad sleep and fatigue in nursing students and help students to improve their mental and physical health.

Longitudinal Effects of a Combined Program of Pelvic Floor Muscle Training and Yoga on Genitourinary Symptoms in Asian Women of Older Age: A Randomized Experimental Study.

This parallel-two-group randomized experimental study including a supervised group and an unsupervised group examined the longitudinal effects of pelvic floor muscle training (PFMT) combined with yoga on genitourinary symptoms and the health-related quality of life (HRQOL), and compared practice adherence rates of the two groups. A sample of women experiencing ≥1 genitourinary symptom(s) were recruited and assigned to a supervised group or an unsupervised group. The supervised group attended supervised group practice sessions and performed at-home practice of PFMT and yoga. The unsupervised group performed at-home practice of PFMT and yoga. Information was collected at five time points (n = 91). Generalized estimating equation procedures were used to examine the intervention effects. An independent t-test was conducted to compare the practice adherence rates. Both groups' genitourinary symptoms and HRQOL significantly improved over time. The supervised group displayed greater improvements in genitourinary symptoms and HRQOL and better adherence than did the unsupervised group.

Effects of yoga on menopausal symptoms and sleep quality across menopause statuses: A randomized controlled trial.

This randomized controlled trial investigated the effects of yoga on menopausal symptoms and sleep quality across menopause statuses. Participants were randomly assigned to either the intervention or control group (n = 104 each), and those in the intervention group practiced yoga for 20 weeks. The participants completed the following questionnaires: the Depression, Anxiety, and Stress Scale; Multidimensional Scale of Perceived Social Support; Menopause Rating Scale; and Pittsburgh Sleep Quality Index. The results revealed that yoga effectively decreased menopausal symptoms, with the strongest effects noted in postmenopausal women (mean ± standard deviation: 14.98 ± 7.10), followed by perimenopausal women (6.11 ± 2.07). Yoga significantly improved sleep quality in postmenopausal and perimenopausal women after controlling for social support, depression, anxiety, stress, and menopausal symptoms (p < 0.001). However, yoga did not affect sleep quality in premenopausal women. Overall sleep quality significantly improved in postmenopausal and perimenopausal women. Our data indicate that yoga can help decrease menopausal symptoms, particularly in perimenopausal and postmenopausal women, and improve their health.

Predictors of HIV testing among youth aged 15-24 years in The Gambia.

BACKGROUND: Worldwide, an estimated 38.0 million people lived with the human immunodeficiency virus in 2019, and 3.4 million young people aged 15~24 years were living with HIV. Sub-Saharan Africa carries a significant HIV burden with West and Central Africa most affected with HIV. Among the young people living with HIV in West and Central Africa, an estimated 810,000 were aged 15~24 years. This study aimed to assess predictors that influence the uptake of HIV testing among youth aged 15~24 years in The Gambia. METHODS: The 2013 Gambia Demographic and Health Survey data for youth aged 15~24 years was used. The Andersen behavioral model of health service use guided this study. A cross-sectional study design was used on 6194 subjects, among which 4730 were female. The analysis employed Chi-squared tests and hierarchical logistic regression. RESULTS: Less than one-quarter of the youth 1404 (22.6%) had ever been tested for HIV. Young people aged 20~24 years (adjusted odds ratio (aOR): 1.98), who were females (aOR: 1.13), married youth (aOR: 3.89), with a primary (aOR: 1.23), secondary or higher education (aOR: 1.46), and who were from the Jola/Karoninka ethnic group (aOR: 1.81), had higher odds of having been tested for HIV. Those with adequate HIV knowledge and those who were sexually active and had aged at first sex ≥15 years (aOR: 3.99) and those <15 years (aOR: 3.96) were more likely to have been tested for HIV compared to those who never had sex. CONCLUSION: This study underscores the low level of model testing on HIV testing among youth (15~24 years) in The Gambia. Using Anderson's Model of Health Service Utilization, the predisposing factors (socio-demographic and HIV knowledge) and the need-for-care factors (sexual risk behaviors) predict healthcare utilization services (HIV testing) in our study; however, only socio-demographic model explained most of the variance in HIV testing. The low effect of model testing could be related to the limited number of major variables selected for HIV knowledge and sexual risk behavior models. Thus, consideration for more variables is required for future studies.

The Long-Term Efficacy Study of Multiple Allogeneic Canine Adipose Tissue-Derived Mesenchymal Stem Cells Transplantations Combined With Surgery in Four Dogs With Lumbosacral Spinal Cord Injury.

Severe lumbosacral pain, paraparesis or paraplegia, and urinary incontinence are common but frustrating problems in dogs with lumbosacral spinal cord injury (SCI). The surgical interventions including stabilization and decompression may not restore satisfying neurological functions in severe SCI. Adipose tissue-derived mesenchymal stem cells (Ad-MSCs) show benefits in immunomodulation, anti-inflammation, and promotion of axonal growth and remyelination, and also display efficacy in several diseases in veterinary medicine. In this report, four dogs presented with fracture of sacrum vertebrae or fracture of seventh lumbar and lumbosacral displacement after road traffic accidents. The clinical signs include lumbosacral pain (4/4), paraparesis (3/4), paraplegia (1/4), and urinary incontinence (4/4). All dogs were treated by surgical decompression with or without stabilization 1 to 7 weeks after trauma. Allogeneic canine Ad-MSCs (cAd-MSCs) were injected locally on nerve roots through the surgical region in all dogs. One dose of intravenous transplantation and 4 doses of local transplantation were also performed within 8 weeks after the surgery separately. All dogs showed significant neurological improvements with normal ambulatory ability (4/4) and urinary control (3/4) 3 months after the surgery and the first cAd-MSCs transplantation. No side effect was related to multiple cAd-MSCs transplantations during 6 months monitoring in all dogs. In conclusion, multiple cAd-MSCs transplantations could be a recommended treatment combined with surgery in dogs with lumbosacral SCI.

Does parenting style moderate the relationship between parent-youth sexual risk communication and premarital sexual debut among in-school youth in Eswatini?

BACKGROUND: Based on propositions of the contextual model of parenting style, we examined whether there is a relationship between parent-youth sexual risk communication (PYSRC) and premarital sexual debut, and whether this relationship is moderated by the parenting style. METHODS: A cross-sectional study design was employed, and data were collected using a self-reported questionnaire from 462 youth (211 boys and 251 girls) aged 15-24 years in senior grades of three public high schools (two rural and one urban) in Eswatini (formerly Swaziland). A hierarchical binary regression analysis was conducted to examine the association between PYSRC and premarital sexual debut, and to test whether parenting style moderates this relationship. RESULTS: The mean age of participants was 18.9 (±1.85) years, and a slight majority were females (54.3%). About 35.9% of participants reported having had sex (i.e., premarital sexual debut). After adjusting for age, gender, living arrangement, school location, and peer sexual activity, neither PYSRC (adjusted odds ratio [AOR] = 1.01, 95% confidence interval [CI]: 1.00, 1.03) nor parenting style (AOR = 0.81, 95% CI: 0.64, 1.04) significantly predicted premarital sexual debut in the sample. Likewise, parenting style did not significantly moderate the relationship between PYSRC and premarital sexual debut (AOR = 1.01, 95% CI: 1.00, 1.02). CONCLUSION: Contrary to propositions of the contextual model of parenting style, in this study, parenting style (authoritativeness) did not moderate the studied relationship, indicating the need for more studies to test the applicability of the contextual model of parenting style in African settings.

Maternal Experiences of Parenting Young Children While Battling Breast Cancer in Taiwan.

BACKGROUND: Western mothers with breast cancer find themselves struggling with parenting responsibilities. Because parenting is culturally shaped, literature on ill mothers' experiences of parenting young children from a collectivist culture is limited. OBJECTIVE: The aim of this study was to examine Taiwanese mothers' experiences of and cultural practices embedded in parenting young children while in treatment for breast cancer. METHODS: Sixteen mothers with at least 1 child younger than 12 years were recruited from a breast cancer organization in Taiwan. Data were collected from November 2016 to June 2017 via a semistructured individual interview and analyzed using a content analysis technique. RESULTS: Five themes, namely, "maternal limited disclosure, complementary with children's tacit knowledge," "the scar is no longer a scar but a symbol for intimate bonding," "issues of maternal absence for young children and school-aged children," "the power of 'We are a family'," and "to live a simple life and to live for one's self," elucidate how cultural beliefs and practices shape maternal parenting experiences during treatment of breast cancer. CONCLUSIONS: The findings illustrate how Taiwanese mothers interpret their illness, contextualize illness-related messages in daily life, and maintain family ties while coping with breast cancer. The will to maintain the family's integrity, including the extended family, can empower mothers throughout the trajectory. IMPLICATIONS FOR PRACTICE: Ill mothers may benefit from nurses' guidance on daily routines and cultural practices that they can exploit to frame illness messages for their children. Maternal efforts to change their outlook on life, vocalize their needs, and become more assertive should be acknowledged and supported.

Swallowing exercises for head and neck cancer patients: A systematic review and meta-analysis of randomized control trials.

BACKGROUND: Extensive surgery and chemo/radiation therapy (C/RT) to manage head and neck cancer (HNC) patients affects their ability to swallow food and liquids, risk of aspiration and greatly influences their quality of life (QOL). OBJECTIVES: Ascertain the effectiveness of swallowing exercises on improving swallowing function, performance status, mouth opening, risk of aspiration/penetration and QOL in HNC patients. DESIGN: Systematic review and meta-analysis of randomized controlled trials DATA SOURCES: PubMed, Ovid-Medline, Embase, Cochrane Library, CINAHL and Web of Science and included all available RCTs. REVIEW METHODS: We followed the PRISMA guidelines and standard methods for conducting a systematic review and meta-analysis. Comprehensive Meta-analysis 3.0 using the random effects model was used for data analysis. RESULTS: In total, 19 RCTs with 1100 participants were identified and included in the current review. Swallowing exercises had significant small effect on swallowing function 0.33 (95%CI = 0.00-0.65) and moderate effect on mouth opening 0.60 (95%CI = 0.21-0.99) immediately after intervention and small effect at 6-month follow-up 0.46 (95%CI = 0.11-0.81). However, non-significant effects were observed on risk of aspiration/penetration, performance status and all domains of QOL. CONCLUSION: Swallowing exercises demonstrated effectiveness in improving swallowing function and mouth opening in HNC patients undergoing multimodal treatment. This is the first comprehensive systematic review and meta-analysis of RCTs to assess the effect of swallowing exercises in HNC patients undergoing multimodal treatment. Nurses can play an important role in assisting the delivery of oropharyngeal swallowing exercises including jaw exercises, tongue exercises and swallowing maneuvers with assistance and guidance from speech pathologists to help improve HNC complications and QOL for HNC survivors.

Determining Factors Affecting Nurses' Acceptance of a Care Plan System Using a Modified Technology Acceptance Model 3: Structural Equation Model With Cross-Sectional Data.

BACKGROUND: Health information technology is used in nursing practice worldwide, and holistic patient care planning can serve as a guide for nursing practice to ensure quality in patient-centered care. However, few studies have thoroughly analyzed users' acceptance of care plan systems to establish individual plans. OBJECTIVE: Based on the technology acceptance model 3 (TAM3), a user technology acceptance model was established to explore what determines the acceptance of care plan systems by users in clinical settings. METHODS: Cross-sectional quantitative data were obtained from 222 nurses at eight hospitals affiliated with public organizations in Taiwan. Using the modified TAM3, the collected data were employed to analyze the determinants of user acceptance of a care plan system through structural equation modeling (SEM). We also employed moderated multiple regression analysis and partial least squares-SEM to test the moderating effects. RESULTS: We verified all significant effects from the use of a care plan system among bivariate patterns in the modified TAM3, except for moderating effects. Our results revealed that the determinants of perceived usefulness and perceived ease of use significantly influenced perceived usefulness and perceived ease of use, respectively. The results also indicated that nurses' perceptions of subjective norm (path coefficient=.25, P<.001), perceived ease of use (path coefficient=.32, P<.001), and perceived usefulness (path coefficient=.31, P<.001) had significantly positive effects on their behavioral intention to use the care plan system, accounting for 69% of the total explained variance. CONCLUSIONS: By exploring nurses' acceptance of a care plan system, this study revealed relationships among the variables in TAM3. Our results confirm that the modified TAM3 is an innovative assessment instrument that can help managers understand nurses' acceptance of health information technology in nursing practice to enhance the adoption of health information technology.

Predictors of resilience among adolescent disaster survivors: A path analysis.

AIMS: To investigate a theoretical model of risk and protective factors to predict resilience among adolescent disaster survivors. DESIGN: A cross-sectional study. METHODS: Parent's consent and student's informed consent forms were distributed at seven schools in a postdisaster setting (Yogyakarta, Indonesia) between July-October 2017; those who agreed to participate had to complete the self-reported questionnaires. Demographic data were evaluated using descriptive statistical analyses and relationships among study variables were determined using a path analysis. RESULTS: Results of the model test analysis indicated that six of the seven the hypothesized paths were supported by data from our samples and demonstrated significance on the path coefficients (p < .01). One path coefficient on the association between posttraumatic stress disorder (PTSD) symptoms and resilience was found to be insignificant (ß = -0.002, p > .05). However, overall, our hypothesized model was retained, indicating empirical support and adequate model's fit indices for the theoretical model. CONCLUSIONS: Overall, the findings demonstrated the predictive roles of risk and protective factors in adolescent disaster survivors' resilience. IMPACT: Resilience is known to be an important concept in recovering from long-term impacts following a disaster in adolescent populations, but its risk and protective factors have not been adequately explored. We found that PTSD symptoms influenced how adolescent disaster survivors developed defensive coping, social support had an indirect effect on resilience through courageous coping and defensive coping acted as a mediator between PTSD symptoms and courageous coping. These findings can help mental health professionals (i.e., community mental health nurses) promote intervention strategies to enhance resilience through improving coping skills in adolescent populations exposed to a disaster.

Multidimensional Scale of Perceived Social Support in Indonesian adolescent disaster survivors: A psychometric evaluation.

BACKGROUND: Social support plays an important role in adolescents' mental health and well-being, and even more so for disaster survivors. To measure the level of social support, one needs an appropriate tool to produce valid and reliable results; therefore, we aimed to measure the invariance across gender groups, and analyze the construct validity and reliability of the Indonesian version of the Multidimensional Scale of Perceived Social Support (MSPSS), a social support measurement tool which was theoretically constructed and has been well validated in many countries with various cultures and backgrounds. METHODS: A school-based assessment was conducted in junior and senior high schools in a post-disaster setting in Yogyakarta Province, Indonesia. We analyzed 299 adolescent survivors of a volcanic eruption, aged 12~18 years who completed a 12-item Indonesian version of the MSPSS. RESULTS: The factorial validity confirmed the three-factor structure of the scale (Family, Friends, and Significant Others) which met all of the criteria of parameter indices and provided evidence of high internal consistency reliability. The three-level measurement of invariance, which consisted of configural, metric, and scalar invariance, also performed very well across gender groups with our data and corresponded to the recommended parameters. Our composite reliability values were all fine (>0.7) and indicated that the items in the same construct were strongly correlated and reliable. CONCLUSIONS: The Indonesian version of the MSPSS was shown to be a valid, reliable, theoretically constructed, and applicable instrument for adolescent disaster survivors.

The effectiveness of eye movement desensitization and reprocessing toward anxiety disorder: A meta-analysis of randomized controlled trials.

BACKGROUND: Eye Movement Desensitization and Reprocessing (EMDR) has been well established as an effective treatment for post-traumatic stress disorder (PTSD). However, PTSD has been re-categorized as part of trauma and stressor-related disorders instead of anxiety disorders. We conducted the first meta-analysis on Randomized Controlled Trials to evaluate the effectiveness of EMDR on reducing symptoms of anxiety disorders. METHODS: A manual and systematic search using various databases and reference lists of systematic review articles published up to December 2018 was conducted. The symptoms of anxiety, phobia, panic, traumatic feelings and behaviors/somatic symptoms were examined. Hedges' g effect sizes were computed, and random effect models were used for all analyses. RESULTS: A total of 17 trials with 647 participants were included in this meta-analysis. EMDR was associated with a significant reduction of anxiety (g = -0.71; 95% CI: -0.96 to -0.47), panic (g = -0.62; 95% CI: -1.10 to -0.14), phobia (g = -0.45; 95% CI: -0.81 to -0.08), behavioural/somatic symptoms (g = -0.40; 95% CI: -0.63 to -0.12), but not traumatic feelings (g = -0.48; 95% CI: -1.14 to -0.18). Subgroup analysis revealed greater effects of EMDR if compared to passive control. However, the effects were not significantly different based on the duration, number of therapy sessions, or the number of weekly sessions. CONCLUSIONS: Our meta-analysis indicates that EMDR is efficacious for reducing symptoms of anxiety, panic, phobia, and behavioural/somatic symptoms. Further research is needed to explore EMDR's long term efficacy on anxiety disorders.

Construction and evaluation of multidomain attention training to improve alertness attention, sustained attention, and visual-spatial attention in older adults with mild cognitive impairment: A randomized controlled trial.

OBJECTIVES: We aimed to analyze the effects of multidomain attention training on alertness, sustained attention, and visual-spatial attention in older adults with mild cognitive impairment (MCI). DESIGN: The design used in this study was a two-arm, parallel group, double-blind randomized controlled trial. SETTING AND PARTICIPANTS: The participants of the study were seventy-eight older adults with MCI (mean age: 79.5 ± 7.9 years) from retirement centers and community housing for the elderly. INTERVENTION: The participants were randomly assigned to an experimental group (multidomain attention training, n = 39) or an active control group (n = 39). Both groups underwent training sessions for 45 minutes three times per week for 6 weeks (18 sessions in total). MEASURES: The main efficacy indicator was alertness (Trail Making Test Part B), sustained attention (Digit Vigilance Test), and visual-spatial attention (Trail Making Test Part A). The secondary outcome indicators were other cognitive functions (Mini-Mental State Examination [MMSE] and Montreal Cognitive Assessment [MoCA] subscales). Measurements were obtained at pretest, posttest, and 3 and 6 months after training. RESULTS: The results were analyzed by a generalized estimating equation (GEE), which indicated that attention outcomes (alertness, sustained attention, and visual-spatial attention) of the experimental group did not improve after training. However, the experimental group displayed a significant improvement in the attention, memory, and orientation of MMSE and MoCA subscales over a period of 6 months and also showed superior results compared with the control group. CONCLUSIONS: Multidomain attention training demonstrated improved alertness and visual-spatial attention for posttest after 6 months. We also outline potential future advances in attention training for improving attention in older adults with MCI.

Determinants of breastfeeding practices among mothers in Malawi: a population-based survey.

BACKGROUND: High rates of early initiation and exclusive breastfeeding have been reported in Malawi, yet the underlying factors are unknown. Our objective is to examine the determinants of breastfeeding practices for mothers of infants less than 24 months old in Malawi. METHODS: A cross-sectional study was conducted using nationally representative data from the 2010 Malawi Demographic and Health Survey. Multivariate logistic regression analysis was used. RESULTS: Of 7282 women, 95.4% initiated breastfeeding within 1 hour after birth; thereafter 71.3% of women practiced exclusive breastfeeding, 6.1% predominantly breastfed, and 1.9% chose bottle feeding exclusively. The odds of early initiation were higher among women with frequent antenatal care visits and multiparous mothers. Similarly, frequent antenatal care visits and hospital delivery were positive determinants for exclusive breastfeeding. Infants at 6 months of age were more likely to predominantly breastfeed than they were at 1 month. The odds of bottle feeding were higher among women who were educated, who delivered at a hospital. CONCLUSIONS: Optimal breastfeeding practices are highly prevalent in Malawi. Health care practice emphasizing frequent antenatal care visits that provide breastfeeding education and breastfeeding support in hospital care after childbirth are important for sustaining breastfeeding.