The Inter-Relationships Between Depressive Symptoms and Suicidality Among Macau Residents After the "Relatively Static Management" COVID-19 Strategy: A Perspective of Network Analysis.

Background: Suicidality is a global public health problem which has increased considerably during the coronavirus disease 2019 (COVID-19) pandemic. This study examined the inter-relationships between depressive symptoms and suicidality using network analysis among Macau residents after the "relatively static management" COVID-19 strategy. Methods: An assessment of suicidal ideation (SI), suicide plan (SP), suicide attempt (SA) and depressive symptoms was conducted with the use of individual binary response items (yes/no) and Patient Health Questionnaire (PHQ-9). In the network analysis, central and bridge symptoms were identified in the network through "Expected Influence" and "Bridge Expected Influence", and specific symptoms that were directly associated with suicidality were identified via the flow function. Network Comparison Tests (NCT) were conducted to examine the gender differences in network characteristics. Results: The study sample included a total of 1008 Macau residents. The prevalence of depressive symptoms and suicidality were 62.50% (95% CI = 59.4-65.5%) and 8.9% (95% CI = 7.2-10.9%), respectively. A network analysis of the sample identified SI ("Suicidal ideation") as the most central symptom, followed by SP ("Suicide plan") and PHQ4 ("Fatigue"). SI ("Suicidal ideation") and PHQ6 ("Guilt") were bridge nodes connecting depressive symptoms and suicidality. A flow network revealed that the strongest connection was between S ("Suicidality") and PHQ6 ("Guilt"), followed by S ("Suicidality") and PHQ 7 ("Concentration"), and S ("Suicidality") and PHQ3 ("Sleep"). Conclusion: The findings indicated that reduction of specific depressive symptoms and suicidal thoughts may be relevant in decreasing suicidality among adults. Further, suicide assessment and prevention measures should address the central and bridge symptoms identified in this study.

Interactive changes in depression and loneliness symptoms prior to and during the COVID-19 pandemic: A longitudinal network analysis.

OBJECTIVES: Depression and loneliness co-occur frequently. This study examined interactive changes between depression and loneliness among older adults prior to and during the COVID-19 pandemic from a longitudinal network perspective. METHODS: This network study was based on data from three waves (2016-2017, 2018-2019, and 2020) of the English Longitudinal Study of Ageing (ELSA). Depression and loneliness were measured with the eight-item version of the Center for Epidemiologic Studies Depression Scale (CESD-8) and three item version of the University of California Los Angeles (UCLA) Loneliness Scale, respectively. A network model was constructed using an Ising Model while network differences were assessed using a Network Comparison Test. Central symptoms were identified via Expected Influence (EI). RESULTS: A total of 4,293 older adults were included in this study. The prevalence and network of depression and loneliness did not change significantly between the baseline and pre-pandemic assessments but increased significantly from the pre-pandemic assessment to during COVID-19 assessment. The central symptom with the strongest increase from pre-pandemic to pandemic assessments was "Inability to get going" (CESD8) and the edge with the highest increase across depression-loneliness symptom communities was "Lack companionship" (UCLA1) - "Inability to get going" (CESD8). Finally, "Feeling depressed" (CESD1) and "Everything was an effort" (CESD2) were the most central symptoms over the three assessment periods. CONCLUSIONS: The COVID-19 pandemic was associated with significant changes in the depression-loneliness network model. The most changed symptoms and edges could be treatment targets for reducing the risk of depression and loneliness in older adults.

Prevalence and network structure of post-traumatic stress symptoms and their association with suicidality among Chinese mental health professionals immediately following the end of China's Dynamic Zero-COVID Policy: a national survey.

Studies on post-traumatic stress symptoms (PTSS) among mental health professionals (MHPs) are limited, particularly since restrictions due to coronavirus disease (COVID-19) have been lifted such as the recent termination of China's Dynamic Zero-COVID Policy. The current study filled this gap by exploring the prevalence, correlates, and network structure of PTSS as well as its association with suicidality from a network analysis perspective. A cross-sectional, national survey was conducted using a convenience sampling method on MHPs between January 22 and February 10, 2023. PTSS were assessed using the Post-Traumatic Stress Disorder Checklist-Civilian version, while suicidality was assessed using standardized questions related to ideation, plans, and attempts. Univariate and multivariate analyses examined correlates of PTSS. Network analysis explored the structure of PTSS and suicidality. The centrality index of "Expected influence" was used to identify the most central symptoms in the network, reflecting the relative importance of each node in the network. The "flow" function was adopted to identify specific symptoms that were directly associated with suicidality. A total of 10,647 MHPs were included. The overall rates of PTSS and suicidality were 6.7% (n = 715; 95% CI = 6.2-7.2%) and 7.7% (n = 821; 95% CI = 7.2-8.2%), respectively. Being married (OR = 1.523; P < 0.001), quarantine experience (OR = 1.288; P < 0.001), suicidality (OR = 3.750; P < 0.001) and more severe depressive symptoms (OR = 1.229; P < 0.001) were correlates of more PTSS. Additionally, higher economic status (e.g., good vs. poor: OR = 0.324; P = 0.001) and health status (e.g., good vs. poor: OR = 0.456; P < 0.001) were correlates of reduced PTSS. PCL6 ("Avoiding thoughts"; EI = 1.189), PCL7 ("Avoiding reminders"; EI = 1.157), and PCL11 ("Feeling emotionally numb"; EI = 1.074) had the highest centrality, while PCL12 ("Negative belief"), PCL 16 ("Hypervigilance") and PCL 14 ("Irritability") had the strongest direct, positive associations with suicidality. A high prevalence of lingering PTSS was found among MHPs immediately after China's "Dynamic Zero-COVID Policy" was terminated. Avoidance and hyper-arousal symptoms should be monitored among at-risk MHPs after the COVID-19 pandemic and serve as potential targets for the prevention and treatment of PTSS in this population.

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.

Depression and anxiety among Macau residents during the COVID-19 outbreak: A network analysis perspective.

Background: The 2019 novel coronavirus disease (COVID-19) outbreak affected people's lifestyles and increased their risk for depressive and anxiety symptoms (depression and anxiety, respectively hereafter). We assessed depression and anxiety in residents of Macau during "the 6.18 COVID-19 outbreak" period and explored inter-connections of different symptoms from the perspective of network analysis. Methods: In this cross-sectional study, 1,008 Macau residents completed an online survey comprising the nine-item Patient Health Questionnaire (PHQ-9) and seven-item Generalized Anxiety Disorder Scale (GAD-7) to measure depression and anxiety, respectively. Central and bridge symptoms of the depression-anxiety network model were evaluated based on Expected Influence (EI) statistics, while a bootstrap procedure was used to test the stability and accuracy of the network model. Results: Descriptive analyses indicated the prevalence of depression was 62.5% [95% confidence interval (CI) = 59.47-65.44%], the prevalence of anxiety was 50.2% [95%CI = 47.12-53.28%], and 45.1% [95%CI = 42.09-48.22%] of participants experienced comorbid depression and anxiety. "Nervousness-Uncontrollable worry" (GADC) (EI = 1.15), "Irritability" (GAD6) (EI = 1.03), and "Excessive worry" (GAD3) (EI = 1.02) were the most central symptoms, while "Irritability" (GAD6) (bridge EI = 0.43), "restlessness" (GAD5) (bridge EI = 0.35), and "Sad Mood" (PHQ2) (bridge EI = 0.30) were key bridge symptoms that emerged in the network model. Conclusion: Nearly half of residents in Macau experienced comorbid depression and anxiety during the 6.18 COVID-19 outbreak. Central and bridge symptoms identified in this network analysis are plausible, specific targets for treatment and prevention of comorbid depression and anxiety related to this outbreak.

Depression and quality of life among Macau residents in the 2022 COVID-19 pandemic wave from the perspective of network analysis.

Background: In the summer of 2022, Macau experienced a surge of COVID-19 infections (the 618 COVID-19 wave), which had serious effects on mental health and quality of life (QoL). However, there is scant research on mental health problems and QoL among Macau residents during the 618 COVID-19 wave. This study examined the network structure of depressive symptoms (hereafter depression), and the interconnection between different depressive symptoms and QoL among Macau residents during this period. Method: A cross-sectional study was conducted between 26th July and 9th September 2022. Depressive symptoms were measured with the 9-item Patient Health Questionnaire (PHQ-9), while the global QoL was measured with the two items of the World Health Organization Quality of Life-brief version (WHOQOL-BREF). Correlates of depression were explored using univariate and multivariate analyses. The association between depression and QoL was investigated using analysis of covariance (ANCOVA). Network analysis was used to evaluate the structure of depression. The centrality index "Expected Influence" (EI) was used to identify the most central symptoms and the flow function was used to identify depressive symptoms that had a direct bearing on QoL. Results: A total 1,008 participants were included in this study. The overall prevalence of depression was 62.5% (n = 630; 95% CI = 60.00-65.00%). Having depression was significantly associated with younger age (OR = 0.970; p < 0.001), anxiety (OR = 1.515; p < 0.001), fatigue (OR = 1.338; p < 0.001), and economic loss (OR = 1.933; p = 0.026). Participants with depression had lower QoL F (1, 1,008) =5.538, p = 0.019). The most central symptoms included PHQ2 ("Sad Mood") (EI: 1.044), PHQ4 ("Fatigue") (EI: 1.016), and PHQ6 ("Guilt") (EI: 0.975) in the depression network model, while PHQ4 ("Fatigue"), PHQ9 ("Suicide"), and PHQ6 ("Guilt") had strong negative associations with QoL. Conclusion: Depression was common among Macao residents during the 618 COVID-19 wave. Given the negative impact of depression on QoL, interventions targeting central symptoms identified in the network model (e.g., cognitive behavioral therapy) should be developed and implemented for Macau residents with depression.

Prevalence of insomnia and its association with quality of life among Macau residents shortly after the summer 2022 COVID-19 outbreak: A network analysis perspective.

Background: The latest wave of the coronavirus disease 2019 (COVID-19) pandemic in Macau began on 18 June 2022 and was more serious than previous waves. Ensuing disruption from the wave is likely to have had a variety of negative mental health consequences for Macau residents including increased risk for insomnia. This study investigated the prevalence and correlates of insomnia among Macau residents during this wave as well as its association with quality of life (QoL) from a network analysis perspective. Methods: A cross-sectional study was conducted between 26 July and 9 September 2022. Univariate and multivariate analyses explored correlates of insomnia. Analysis of covariance (ANCOVA) examined the relationship between insomnia and QoL. Network analysis assessed the structure of insomnia including "Expected influence" to identify central symptoms in the network, and the flow function to identify specific symptoms that were directly associated with QoL. Network stability was examined using a case-dropping bootstrap procedure. Results: A total of 1,008 Macau residents were included in this study. The overall prevalence of insomnia was 49.0% (n = 494; 95% CI = 45.9-52.1%). A binary logistic regression analysis indicated people with insomnia were more likely to report depression (OR = 1.237; P < 0.001) and anxiety symptoms (OR = 1.119; P < 0.001), as well as being quarantined during the COVID-19 pandemic (OR = 1.172; P = 0.034). An ANCOVA found people with insomnia had lower QoL (F(1,1,008) = 17.45, P < 0.001). "Sleep maintenance" (ISI2), "Distress caused by the sleep difficulties" (ISI7) and "Interference with daytime functioning" (ISI5) were the most central symptoms in the insomnia network model, while "Sleep dissatisfaction" (ISI4), "Interference with daytime functioning" (ISI5), and "Distress caused by the sleep difficulties" (ISI7) had the strongest negative associations with QoL. Conclusion: The high prevalence of insomnia among Macau residents during the COVID-19 pandemic warrants attention. Being quarantined during the pandemic and having psychiatric problems were correlates of insomnia. Future research should target central symptoms and symptoms linked to QoL observed in our network models to improve insomnia and QoL.

Prevalence of poor sleep quality in COVID-19 patients: a systematic review and meta-analysis.

Objective: The coronavirus disease (COVID-19) and the public health responses were associated with a huge health burden, which could influence sleep quality. This meta-analysis and systematic review examined the prevalence of poor sleep quality in COVID-19 patients. Methods: PubMed, Web of Science, Embase, and PsycINFO were systematically searched from their respective inception to October 27, 2022. Prevalence rates of poor sleep were analyzed using a random effects model. Results: Totally, 24 epidemiological and 12 comparative studies with 8,146 COVID-19 patients and 5,787 healthy controls were included. The pooled prevalence of poor sleep quality based on the included studies was 65.0% (95%CI: 59.56-70.44%, I2 = 97.6%). COVID-19 patients had a higher risk of poor sleep quality compared to healthy controls (OR = 1.73, 95% CI: 1.30-2.30, p < 0.01, I2 = 78.1%) based on the 12 comparative studies. Subgroup analysis revealed that COVID-19 patients in low-income countries (p = 0.011) and in studies using a lower Pittsburgh Sleep Quality Index score cut-off (p < 0.001) were more likely to have poor sleep quality. Meta-regression analyses revealed that being female (p = 0.044), older (p < 0.001) and married (p = 0.009) were significantly correlated with a higher risk of poor sleep quality while quality score (p = 0.014) were negatively correlated with the prevalence of poor sleep quality in COVID-19 patients. Conclusion: Poor sleep quality was found to be very common in COVID-19 patients. Considering the negative effects of poor sleep quality on daily life, sleep quality should be routinely assessed and appropriately addressed in COVID-19 patients.

The backbone symptoms of depression: a network analysis after the initial wave of the COVID-19 pandemic in Macao.

Background: The coronavirus disease 2019 (COVID-19) pandemic disrupted the working lives of Macau residents, possibly leading to mental health issues such as depression. The pandemic served as the context for this investigation of the network structure of depressive symptoms in a community sample. This study aimed to identify the backbone symptoms of depression and to propose an intervention target. Methods: This study recruited a convenience sample of 975 Macao residents between 20th August and 9th November 2020. In an electronic survey, depressive symptoms were assessed with the Patient Health Questionnaire-9 (PHQ-9). Symptom relationships and centrality indices were identified using directed and undirected network estimation methods. The undirected network was constructed using the extended Bayesian information criterion (EBIC) model, and the directed network was constructed using the Triangulated Maximally Filtered Graph (TMFG) method. The stability of the centrality indices was evaluated by a case-dropping bootstrap procedure. Wilcoxon signed rank tests of the centrality indices were used to assess whether the network structure was invariant between age and gender groups. Results: Loss of energy, psychomotor problems, and guilt feelings were the symptoms with the highest centrality indices, indicating that these three symptoms were backbone symptoms of depression. The directed graph showed that loss of energy had the highest number of outward projections to other symptoms. The network structure remained stable after randomly dropping 50% of the study sample, and the network structure was invariant by age and gender groups. Conclusion: Loss of energy, psychomotor problems and guilt feelings constituted the three backbone symptoms during the pandemic. Based on centrality and relative influence, loss of energy could be targeted by increasing opportunities for physical activity.

Sleep disturbance and its association with quality of life among psychiatric nurses in China.

BACKGROUND: Sleep disturbance is associated with a number of negative adverse outcomes. This study examined the prevalence of sleep disturbance and its association with demographic and clinical characteristics and quality of life (QOL) in psychiatric nurses in China. METHODS: This is a multi-center, cross-sectional study involving 11 psychiatric hospitals in China. Three types of sleep disturbance (difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS) and early-morning awakening (EMA)) and QOL were measured by standardized questions or instruments. RESULTS: A total of 1,847 psychiatric nurses participated. The overall prevalence of at least one type of sleep disturbance was 71.5% (95% CI [69.3-73.5]); the prevalence of DIS, DMS and EMA was 58.5% (95% CI [56.2-60.8]), 53.7% (95% CI [51.4-56.0]) and 54.6% (95% CI [52.3-56.9]), respectively. Nurses with sleep disturbance had significantly lower QOL in physical (F (1, 1,846) = 219.12, P < 0.001), psychological (F (1, 1,846) = 72.18, P < 0.001), social (F (1, 1,846) = 37.57, P < 0.001) and environmental domains (F (1, 1,846) = 95.45, P < 0.001). Multivariable logistic regression analyses revealed that shift work (DIS, OR = 1.6, 95% CI [1.28-1.98]; DMS, OR = 1.2, 95% CI [1.001-1.54]; EMA, OR = 1.3, 95% CI [1.02-1.58]) and alcohol use (DIS, OR = 1.8, 95% CI [1.46-2.32]; DMS, OR = 1.8, 95% CI [1.43-2.23]; EMA, OR = 1.7, 95% CI [1.33-2.07]) were positively associated with sleep disturbance, while higher monthly income (DIS, OR = 0.5, 95% CI [0.38-0.75]; DMS, OR = 0.7, 95% CI [0.51-0.98]) was negatively associated with sleep disturbance. CONCLUSION: Sleep disturbance was common among nurses in psychiatric hospitals in China, particularly those on shifts and having alcohol use. Health authorities should develop effective measures to reduce risk of sleep disturbance in this population.

The Prevalence of Burnout and its Associations with Demographic Correlates and Quality of Life among Psychiatric Nurses in China.

This study examined the prevalence of burnout and its association with quality of life (QOL) among psychiatric nurses in China.Ten psychiatric hospitals were included. Burnout and QOL were measured using standardized instruments. Altogether, 1449 nurses completed the assessment. The mean scores of emotional exhaustion (EE), depersonalization (DP) and personal accomplishment (PA) were 11.87 (SD = 6.72), 6.98 (SD = 5.71) and 22.06 (SD = 8.67), respectively. Of the participants, 59.8% (95% CI: 57-62%) experienced burnout; with 23.3% (95% CI: 21-25%) in EE, 14.6% (95% CI: 13-16%) in DP and 45.1% (95% CI: 43-48%) in PA. Psychiatric nurses who reported burnout had lower QOL in social (F (1, 1448) = 86.20, P < 0.001), physical (F (1, 1448) = 170.46, P < 0.001), psychological (F (1, 1448) = 205.63, P < 0.001), and environmental (F (1, 1448) = 120.24, P < 0.001) domains. Multiple logistic regression analysis revealed that alcohol users (P = 0.04; OR = 1.29, 95%CI: 1.01-1.64 in model 1 and P = 0.03; OR = 1.32, 95%CI: 1.04-1.69 in model 2) were significantly more susceptible to burnout, while senior nurses (P = 0.007; OR = 0.70, 95%CI: 0.53-0.91) and nurses with longer work experience (P = 0.02; OR = 0.70, 95%CI: 0.53-0.91) were less likely to develop burnout. Burnout is common in psychiatric nurses in China. In light of its negative impact on health and QOL, there is an urgent need for regular screening as well as effective preventive measures and interventions to reduce burnout within this at-risk occupational group.

Internet addiction among adolescents in Macau and mainland China: prevalence, demographics and quality of life.

Internet addiction (IA) is common among adolescents and significantly determined by sociocultural and economic factors. The aim of this study was to compare the prevalence of IA among adolescents between Macau and mainland China and also examine its association with quality of life. A total of 2892 secondary school students were included. Standardized instruments were used to measure IA, depressive symptoms and quality of life. The overall prevalence of IA was 23.7%, with 32.5% in Macau and 19.8% in mainland China. Students in Macau were more likely to suffer from IA than those in mainland China (OR = 2.15, p < 0.001). Correlates of IA included being in higher school grades, poor academic performance, and more severe depressive symptoms. Students with IA reported lower quality of life in physical, psychological, social, and environmental domains. IA is common among Chinese adolescents, particularly in Macau. Considering the negative impact of IA on health and quality of life, regular screening and effective interventions should be undertaken for young Internet users.

Prevalence of sexual harassment toward psychiatric nurses and its association with quality of life in China.

OBJECTIVE: This study aimed to examine the prevalence of sexual harassment (SH) toward Chinese psychiatric nurses and its association with quality of life (QOL). METHODS: A total of 2124 psychiatric nurses were consecutively recruited from 10 psychiatric hospitals distributed across 10 provinces of China; of them, 1,449 were included for analyses. Participants' socio-demographic characteristics, experiences of workplace SH in the past year, and QOL were recorded. RESULTS: Overall, 21.5% (n = 311) of participants reported SH, with 8.4% (n = 121) reporting once, 7.1% (n = 103) reporting twice and 6.0% (n = 87) reporting three times or more. Psychiatric nurses who experienced SH had lower QOL in physical, psychological, social, and environmental domains. Multiple logistic regression analysis found that nurses with shorter clinical experience were more likely to experience SH. CONCLUSIONS: Workplace SH toward psychiatric nurses is common in mental health treatment settings in China. Considering its deleterious impact on nurses' well-being and care quality, effective staff training on the management of SH and a zero tolerance policy against SH should be developed for this population.

Voluntary admissions for patients with schizophrenia: A systematic review and meta-analysis.

AIMS: Voluntary admission rates of schizophrenia vary widely across studies. In order to make the topic be informed by evidence, it is important to have accurate estimates. This meta-analysis examined the worldwide prevalence of voluntary admissions for patients with schizophrenia. METHOD: PubMed, EMBASE, PsycINFO, the Cochrane Library, Web of Science and Medline databases were systematically searched, from their commencement date until 19th November 2018. Meta-analysis of included studies was performed using the random-effects model. RESULTS: Thirty-five studies with 134,100 schizophrenia patients were included. The overall voluntary admission rate of schizophrenia was 61.9 % (95 %CI: 52.3 %-70.7 %), while the involuntary rate was 43.0 % (95 %CI: 34.8 %-51.7 %). Subgroup analyses revealed that patients in Europe had significantly higher voluntary admission rates, while their North American counterparts were more likely admitted involuntarily. Papers published prior to 2008 reported higher involuntary admission rates. Meta-regression analyses showed that higher male percentage and higher study quality were significantly associated with higher voluntary admission rate. CONCLUSION: Although the worldwide prevalence of voluntary admissions was higher than that of involuntary admissions, the latter was common for schizophrenia. With the continuing liberalization of mental health laws broadening community-based psychiatric services, the rate of voluntary psychiatric admissions is expected to further increase over time.

Prevalence of verbal and physical workplace violence against nurses in psychiatric hospitals in China.

OBJECTIVE: Workplace violence (WPV) is common in mental health services in China, but its multi-center prevalence measured using standardized rating scales has rarely been reported. This study aimed to explore the prevalence of verbal and physical violence against nurses working in psychiatric hospitals and examine its independent socio-demographic correlates in China. METHODS: This was a cross-sectional study conducted in 11 major psychiatric hospitals in China using a 9-item self-reported workplace violence scale. RESULTS: A total of 1906 psychiatric nurses were recruited to participate in this study. The one-year prevalence of verbal and/or physical workplace violence (WPV) was 84.2% (95% CI: 82.4-85.8). The prevalence rates of verbal abuse, threats and physical violence were 79.3% (95% CI: 77.4-81.1), 70.9% (95% CI: 68.8-73.0) and 57.9% (95% CI: 55.7-60.2), respectively. Multiple logistic regression analysis revealed that working in department of psychiatry (OR = 3.42, P < 0.001), having moderate (OR = 2.05, P = 0.009), severe (OR = 2.04, P = 0.015) or extremely severe (OR = 3.21, P < 0.001) anxiety level of WPV and working in hospitals with a WPV reporting system (OR = 1.88, P < 0.001) were significantly associated with WPV. CONCLUSION: WPV against nurses is a serious occupational and public health concern in Chinese psychiatric hospitals. Appropriate preventive measures should be undertaken to reduce the risk of WPV in healthcare settings.

Sleep duration and self-rated health in Chinese university students.

PURPOSE: Little is known about the association between sleep duration and health status in Chinese university students. This study examined the association between sleep duration and self-rated health in university students in China. METHODS: Altogether, 2312 subjects (928 in Macao, 446 in Hong Kong, and 938 in mainland China) were recruited. Standardized measures of sleep and self-reported health were administered. Sleep duration was categorized in the following way: < 6 h/day, 6 to < 7 h/day, 7-9 h/day, and > 9 h/day. RESULTS: Overall, 71% of university students reported poor health, 53% slept 7-9 h/day, 14% slept less than 6 h/day, 32% slept 6 to < 7 h/day, and 1% slept > 9 h/day. Univariate analysis revealed that compared to students with medium sleep duration (7-9 h/day), those with short sleep duration (< 6 h/day and 6 to < 7 h/day) were more likely to report poor health. Multivariate logistic regression analysis found that after controlling for age, gender, body mass index, university location, being a single child, religious beliefs, interest in academic major, academic pressure, nursing major, pessimism about the future, and depression, sleep duration of less than 6 h/day (odds ratio (OR) 1.98, 95% confidence interval (CI) 1.34-2.92, p < 0.01) was independently and significantly associated with poor self-reported health. CONCLUSIONS: Poor health status is common in Chinese university students, which appears to be closely associated with short sleep duration. Further longitudinal studies are warranted to gain a better understanding of the interaction between sleep patterns and health status in university students.

Self-Reported and Interviewer-Rated Oral Health in Patients With Schizophrenia, Bipolar Disorder, and Major Depressive Disorder.

PURPOSE: To compare self-reported (SR) and interviewer-rated (IR) oral health between schizophrenia (SZ), bipolar disorder (BP), and major depressive disorder (MDD) patients. DESIGN AND METHODS: 356 patients with SZ, BP, or MDD underwent assessments of psychopathology, side effects, SR, and IR oral health status. FINDINGS: 118 patients (33.1%) reported poor oral health; the corresponding proportion was 36.4% in BP, 34.8% in SZ, and 25.5% in MD (p = .21). SR and IR oral health correlated only modestly (r = 0.17-0.36) in each group. PRACTICE IMPLICATIONS: Psychiatric patients need to be assessed for both SR and IR oral health.

Immunoinformatic evaluation of multiple epitope ensembles as vaccine candidates: E coli 536.

Epitope prediction is becoming a key tool for vaccine discovery. Prospective analysis of bacterial and viral genomes can identify antigenic epitopes encoded within individual genes that may act as effective vaccines against specific pathogens. Since B-cell epitope prediction remains unreliable, we concentrate on T-cell epitopes, peptides which bind with high affinity to Major Histacompatibility Complexes (MHC). In this report, we evaluate the veracity of identified T-cell epitope ensembles, as generated by a cascade of predictive algorithms (SignalP, Vaxijen, MHCPred, IDEB, EpiJen), as a candidate vaccine against the model pathogen uropathogenic gram negative bacteria Escherichia coli (E-coli) strain 536 (O6:K15:H31). An immunoinformatic approach was used to identify 23 epitopes within the E-coli proteome. These epitopes constitute the most promiscuous antigenic sequences that bind across more than one HLA allele with high affinity (IC50 < 50nM). The reliability of software programmes used, polymorphic nature of genes encoding MHC and what this means for population coverage of this potential vaccine are discussed.