Effectiveness of enhancing contact model on reducing family caregiving burden and improving psychological wellbeing among caregivers of persons with schizophrenia in rural China.

BACKGROUND: It is unclear whether the enhancing contact model (ECM) intervention is effective in reducing family caregiving burden and improving hope and quality of life (QOL) among family caregivers of persons with schizophrenia (FCPWS). METHODS: We conducted a cluster randomized controlled trial in FCPWS in eight rural townships in Xinjin, Chengdu, China. In total, 253 FCPWS were randomly allocated to the ECM, psychoeducational family intervention (PFI), or treatment as usual (TAU) group. FCPWS in three groups were assessed caregiving burden, QOL and state of hope at baseline (T0), post-intervention (T1), 3-month (T2), and 9-month (T3) follow-up, respectively. RESULTS: Compared with participants in the TAU group, participants in the ECM group had statistically significantly lower caregiving burden scores both at T1 and T2 (p = 0.0059 and 0.0257, respectively). Compared with participants in the TAU group, participants in the PFI group had statistically significantly higher QOL scores in T1 (p = 0.0406), while participants in the ECM group had statistically significantly higher QOL scores in T3 (p = 0.0240). Participants in both ECM and PFI groups had statistically significantly higher hope scores than those in the TAU group at T1 (p = 0.0160 and 0.0486, respectively). CONCLUSIONS: This is the first study to explore the effectiveness of ECM on reducing family caregiving burden and improving hope and QOL in rural China. The results indicate the ECM intervention, a comprehensive and multifaceted intervention, is more effective than the PFI in various aspects of mental wellbeing among FCPWS. Future research needs to confirm ECM's effectiveness in various population.

COVID-19 vaccinations: The unknowns, challenges, and hopes.

The entire world has been suffering from the coronavirus disease 2019 (COVID-19) pandemic since March 11, 2020. More than a year later, the COVID-19 vaccination brought hope to control this viral pandemic. Here, we review the unknowns of the COVID-19 vaccination, such as its longevity, asymptomatic spread, long-term side effects, and its efficacy on immunocompromised patients. In addition, we discuss challenges associated with the COVID-19 vaccination, such as the global access and distribution of vaccine doses, adherence to hygiene guidelines after vaccination, the emergence of novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants, and vaccine resistance. Despite all these challenges and the fact that the end of the COVID-19 pandemic is still unclear, vaccines have brought great hope for the world, with several reports indicating a significant decline in the risk of COVID19-related infection and hospitalizations.

Association Between Community Contextual Factors and Stigma of Mental Illness in South Korea: a Multilevel Analysis.

This study examined the association of subjective and objective community contextual factors with stigma of mental illness in a sample of users of community mental health services centers in South Korea. Five hundred thirty-two persons with MI were surveyed on perceived stigma and experienced stigma, and on two subjective measures of community characteristics-perceived disorder and perceived collective efficacy of their neighborhood. Objective community indicators at the neighborhood level were collected from a government administrative data base. Multilevel statistical analysis was conducted to identify the effects of individual-level characteristics and community-level objective indicators on stigma. Perceived neighborhood disorder was associated with both perceived stigma and experienced stigma. Perceived collective efficacy was associated with perceived stigma but not experienced stigma. The proportion of persons with disabilities in the neighborhood, an objective community indicator, was associated with experienced stigma. Mental health practitioners and policy planners need to examine the relevance of neighborhood characteristics in the design of policy and practice interventions in order to enhance the social inclusion of persons with MI.

Sources of social support and community integration among persons with serious mental illnesses in Korea.

BACKGROUND: Community integration is an important component of recovery for persons with serious mental illnesses (SMI). However, persons with SMI often experience barriers in using community resources, participating in community activities, and developing interactions with neighbors and other community members. AIMS: This study examines the association between different sources of social support, including family, friends and mental health services providers, and three dimensions of community integration. METHOD: A sample of 399 persons with SMI was interviewed from community-based mental health service agencies in South Korea. RESULTS: Family support and friendship support positively influenced all three aspects of community integration. More support from mental health professionals was associated with increased perceived accessibility to community resources but decreased involvement in community activities. CONCLUSION: Recommendations are made in supporting the role of natural networks and in advocating for a consumer-centered approach to service delivery.

Effects of social networks on physical health among people with serious mental illness.

This study examined the effects of social network characteristics on physical health among people with serious mental illness using social transactions that are reciprocal, and the combination of objective and subjective health measures. The sample consisted of a probability sample of 231 adults with serious mental illness who resided in permanent supportive housing in Philadelphia, Pennsylvania. Path analyses were conducted to examine the relationships between social network characteristics and two aspects of medical comorbidity, objective health and subjective health. Bivariate statistics showed that individuals with medical comorbidity were more likely to have contact with their network members and had a higher level of reciprocal positive tangible support when compared to those who did not have medical comorbidity. The results of the path analyses revealed that none of the social network characteristics were associated with better physical health. The lack of a significant relationship between social networks and better physical health is contrary to prior research findings. However, this is the first study to include both types of social transactions simultaneously as predictors of better physical health for individuals with serious mental illness. A longitudinal study would provide more insight into the temporal relationship of social networks and physical health conditions of people with serious mental illness. Furthermore, the transactional nature of social relationships, particularly for those with mental health issues, requires greater exploration.

Inert Transition Metal Ion Complexes in Organic Synthesis: Protection and Activation.

Single-crystal X-ray diffraction studies for a variety of metal ion complexes of functionalised sarcophagines (sarcophagine=sar=3,6,10,13,16,19-hexa-azabicyclo[6.6.6]icosane) have further confirmed not only that the form of the metal ion/sar unit is unique for each metal, albeit with a sensitivity of the conformation to the associated counter anions, but also that for any given metal and ligand substituent, the dimensions (bond lengths and angles) of the complex and the substituent at the secondary nitrogen centres do not differ significantly from those of the isolated components. Despite this, where the substituent contains reactive sites, the reactivity differs markedly from that of their form in an uncoordinated substrate. Rationalisations are offered for these differences, in part through the use of Hirshfeld surface analysis of the intermolecular interactions. The kinetic inertness of the complexes means that the metal ions can be considered to act as regioselective protecting groups.

Predictors of health services utilization among persons with psychiatric disabilities engaged in supported independent housing.

OBJECTIVE: Persons with psychiatric disabilities are at greater risk for medical comorbidity, and prior research suggests these persons may underutilize health services. In response, this study examined the impact of engagement in psychiatric rehabilitation services, including case management, on utilization of general health services among persons with psychiatric disabilities engaged in supported housing, while controlling for demographic and clinical characteristics. METHODS: Poisson regression analyses were used to examine the impact of socio-demographic, clinical, and service characteristics on reported utilization of general health services in the past year. RESULTS: Findings indicated supported housing residents receiving case management coupled with weekly contact with residential support services visited a general health practitioner more frequently than those with less support services. CONCLUSIONS AND IMPLICATIONS: Study results suggest psychiatric rehabilitation services provided to persons in the context of safe and affordable housing may represent an important mechanism for enabling persons with psychiatric disorders to access needed medical care.

Mental health-related stigma and attitudes toward patient care among providers of mental health services in a rural Chinese county.

BACKGROUND AND AIMS: The increasing prevalence of mental illness and low treatment rate presents a pressing public health issue in China. Pervasive stigma is a significant barrier to mental health recovery and community inclusion. In particular, stigmatizing or supportive attitudes held by healthcare providers could either perpetuate or mitigate self-stigma of people with mental illness. Moreover, mental health resources are unevenly distributed in China, with most of them concentrated in urban centers and provincial capitals. This study explores healthcare providers' attitudes toward mental illness and the challenges they faced at work in a rural Chinese county. METHOD: Four focus groups were conducted with 36 healthcare providers from a three-tier mental healthcare system in a rural county in southwestern China. Focus group discussions were recorded and transcribed verbatim. The team employed a conventional content analysis approach for data analysis. All transcripts were double-coded by three bilingual team members who are native Chinese speakers. Coding discrepancies were resolved by consensus. RESULTS: Healthcare providers recruited from the county, township, and village levels varied in educational background, professional qualification, and experience of working with people with mental illness. Five thematic categories identified across four groups include (1) barriers to mental healthcare delivery, (2) keys to mental health recovery, (3) providers' attitudes toward providing care, (4) providers' perception toward patients and family members, and (5) providers' perception of training needs. CONCLUSIONS: This is a unique study that included healthcare providers from a three-tier healthcare system. Findings signal the importance of understanding healthcare practitioners' experiences and views to inform the design of training initiatives in rural or low-resource communities.

High shear in situ exfoliation of 2D gallium oxide sheets from centrifugally derived thin films of liquid gallium.

A diversity of two-dimensional nanomaterials has recently emerged with recent attention turning to the post-transition metal elements, in particular material derived from liquid metals and eutectic melts below 330 °C where processing is more flexible and in the temperature regime suitable for industry. This has been explored for liquid gallium using an angled vortex fluidic device (VFD) to fabricate ultrathin gallium oxide (Ga2O3) sheets under continuous flow conditions. We have established the nanosheets to form highly insulating material and have electrocatalytic activity for hydrogen evolution, with a Tafel slope of 39 mV dec-1 revealing promoting effects of the surface oxidation (passivation layer).

Life Support Course for Nurses: beyond competency training.

The Life Support Course for Nurses (LSCN) equips nurses with the resuscitation skills needed to be first responders in in-hospital cardiac arrests. Previous published articles on the LSCN were mainly focused on the development of the LSCN in Singapore, as well as nurses' confidence level, defibrillation experience and outcomes, the perceived barriers faced by nurses and the usefulness of the course. This paper highlights the importance of two key learning methodologies in the LSCN: deep learning and reflection.

The mediating role of knowledge on the contact and stigma of mental illness in Hong Kong.

BACKGROUND: Although knowledge is a crucial component in contact theory delineating how prejudice changes toward out-groups with stigmatized conditions, little is known about the mediating role of knowledge on contact, stigmatizing attitudes, and behaviors toward mental illness. AIM: This study aimed to examine the mechanism underlie contact and stigma change by knowledge. METHODS: A total of 366 participants including family members (FM), mental health providers (MHP), and community residents (CR) recruited across communities in Hong Kong and completed measures of contact level, contact quantity, contact quality, mental health related knowledge, prejudice, and discriminatory behaviors. Structural equation modeling was adopted to test the association among the key variables. RESULTS: Higher level of contact was significantly correlated with better knowledge, less prejudice, and less discriminatory behaviors. Knowledge was directly and negatively correlated with prejudicial attitudes but was not significantly related to discriminatory behaviors. Furthermore, lower levels of prejudice were associated with less discriminatory behaviors. CONCLUSION: Enhancement of contact may increase understanding toward people with mental illness (PMI) and diminish stigmatizing attitudes and behaviors. Although prejudicial attitudes may be reduced by broadening mental health knowledge, increasing knowledge only might not ameliorate discriminatory behaviors. Future research should test mediators on contact and stigma by using longitudinal data.

Peer-to-peer contact, social support and self-stigma among people with severe mental illness in Hong Kong.

BACKGROUND: Self-stigma exerts a range of adversities for persons with severe mental illness (SMI), however, little is known about the association between peer contact, social support and self-stigma. AIMS: This study aimed to explore the mediating role of social support on the relationship between peer contact and self-stigma among persons with SMI in Hong Kong. METHODS: A total of 159 persons with SMI (schizophrenia and mood disorder) in community service centres participated in the study through completing a survey on self-stigma, social functioning, social support, perception of peer contact and mass media. Logistic regression was utilised to explore the influencing factors of self-stigma among the participants. RESULTS: The results showed that 81.1% of participants reported moderate to severe levels of self-stigma. Self-stigma was significantly associated with diverse factors (e.g. social functioning). Importantly, positive peer contact was significantly associated with lower self-stigma of persons with SMI. Social support acted as a mediator between peer contact and self-stigma. CONCLUSION: The results of this study suggest that contact-based interventions, such as enhancing positive peer-to-peer contact, should be conducted for reducing self-stigma among persons with SMI.

Selective binding of imidazolium cations in building multi-component layers.

Addition of 1-alkyl-3-methylimidazolium (C(n)-mim) cations 3-5 to a mixture of bis-phosphonium cation 2 and sodium p-sulfonatocalix[4]arene (1) in the presence of lanthanide ions results in the selective binding of an imidazolium cation into the cavity of the calixarene. The result is a multi-layered solid material with an inherently flexible interplay of the components. Incorporating ethyl-, n-butyl- or n-hexyl-mim cations into the multi-layers results in significant perturbation of the structure, the most striking effect is the tilting of the plane of the bowl-shaped calixarene relative to the plane of the multi-layer, with tilt angles of 7.2, 28.9 and 65.5 degrees , respectively. The lanthanide ions facilitate complexation, but are not incorporated into the structures and, in all cases, the calixarene takes on a 5- charge, with one of the lower-rim phenolic groups deprotonated. ROESY NMR experiments and other (1)H NMR spectroscopy studies establish the formation of 1:1 supermolecules of C(n)-mim and calixarene, regardless of the ratio of the two components, and indicate that the supermolecules undergo rapid exchange on the NMR spectroscopy timescale.

Conceptualizing community: the experience of mental health consumers.

In this article we describe a focus group study of the perspectives of diverse groups of mental health consumers on the concept of community. We identify the core domains that constitute the notion of community, and commonalities and differences in the perception of community along the lines of ethnicity and sexual orientation/gender identity. Seven focus groups were conducted with a total of 62 participants. Transcripts were analyzed using the grounded theory approach.Two domains-togetherness and community acceptance-emerged as common to four types of communities that were most frequently mentioned in the focus group discussion. Our findings show that identities other than those associated with mental illness and the role of service user are critical to the understanding of the psychological sense of community among persons with psychiatric disabilities. We suggest that mental health providers empower consumers to expand their "personal communities" beyond that of mental health clients using their diverse identities, and design interventions for addressing the stigma emanating from identities that are discriminated against by the wider society.

Face-Saving and Depressive Symptoms Among U.S. Chinese Older Adults.

Face-saving represents a unique culturally salient construct among Chinese. However, our understanding regarding its relationship with psychological distress in this population remains limited. The objective of this cross-sectional study is to examine (1) the relationship between face-saving and depressive symptoms among U.S. Chinese older adults; and (2) whether face-saving mediates the relationship between acculturation and depressive symptoms. Data were from the Population Study of Chinese Elderly in Chicago (N = 3132), the largest epidemiologic study of Chinese older adults in Western countries. The relationship between face-saving and self-reported depressive symptoms was investigated by step-wise multivariable linear regression models. The Sobel test was used to test the mediating effect of face-saving. U.S. Chinese older adults with higher face-saving values experienced greater levels of depressive symptoms (B = 0.05, p < 0.001) than those with lower face-saving values, even after sociodemographic factors, health characteristics, and social support were accounted for. The mediation effect of face-saving was not statistically significant. The study findings underscore the significance of a unique cultural factor, specifically face-saving, in understanding U.S. Chinese older adults' experience of depressive symptoms. Depression screening and treatment programs should pay attention to face-saving issues among U.S. Chinese older adults. Future studies need to incorporate cultural factors in mental health research in diverse populations.

Psychiatric Diagnoses and Treatment Preceding Schizophrenia in Adolescents Aged 9-17 Years.

OBJECTIVE: Our study aimed to examine psychiatric diagnoses and treatment preceding a schizophrenia diagnosis in adolescents, stratified by sex and race/ethnicity. METHODS: Using Medicaid physical and behavioral health and pharmacy claims data, we identified 1,459 adolescents who were aged 9-17 years and diagnosed with schizophrenia between January 2006 through June 2009. Psychiatric diagnosis, mental health service use including psychiatric hospitalization, residential treatment and outpatient therapy and psychotropic medication use preceding schizophrenia were identified. RESULTS: Forty-five percent of the adolescents were diagnosed with one or more psychiatric conditions. More than 40% of the adolescents were hospitalized or placed in a residential treatment facility for other psychiatric conditions preceding schizophrenia. Overall, 72% of the adolescents were prescribed with one or more psychotropic medications and 22% were prescribed with three or more psychotropic medications in the year prior to their first schizophrenia diagnosis. We found that sex and race/ethnicity influence preceding psychiatric conditions and psychiatric treatment use. CONCLUSIONS: Careful screening and evaluation to validate diagnoses is important as the presence of certain psychiatric morbidity is common among adolescents with schizophrenia during the prodromal period. Developing acceptable and accessible interventions that will reduce psychiatric hospitalization and residential treatment care and improve care connection for schizophrenia treatment is important to mitigate complexity in treatment for adolescents and reduce cost burden for families and the society. Integrating health claims data in the development of schizophrenia risk conversion models can be useful in effectively predicting ideal timing of tailored interventions for adolescents with preceding psychiatric conditions.

International Efforts to Save Healthcare Personnel during COVID-19.

Coronavirus disease 2019 (COVID-19) pandemic is a global challenge. Several governments of the world have decided to take drastic actions in order to combat the spread of the disease, including the closing of air, maritime and land borders, as an extreme measure of isolation of each country/region. However, such measures had not prevented the disease from spreading globally; as COVID-19 has already spread in almost all countries. This virus's main victims are the healthcare personnel (HCP), who are physically and psychologically affected. The HCP serves as the first line of defense against this pandemic, what if we faced a significant loss in their number? And what if our HCP was going through a deep dark depression? The condition would be terrifying not only for now but also in the future. This raises the need for an intensified International collaboration, that mainly supports the HCP. We are throwing by challenging moments, and it is clear that social distancing, cooperation, hygiene awareness and abide by the recommendation and help of all governments, as well as obtaining the support of international organizations could be an excellent tool for preventing an increase in the number of cases, principally in countries and regions were COVID-19 is in the early stage of the epidemic. However, this is not the final solution for the current pandemic. An intensified global program, which mainly supports the HCP, then considers the other aspects of the COVID19 pandemic might bring this pandemic to a peaceful end.

Correlates of Emergency Department Service Utilization Among U.S. Chinese Older Adults.

Older adults visit emergency departments (EDs) at a disproportionally higher rate than other age groups. Prior studies examining racial disparities in ED utilization focus on African Americans and Hispanics. There is a dearth of information on ED utilization patterns among older Asian Americans despite the evidence that ED expenditures in Asian Americans are comparable to that of Caucasians. To address this knowledge gap, we examined factors associated with ED service utilization in the largest Asian subgroup, U.S. Chinese older adults. Cross-sectional data from the Population Study of Chinese Elderly in Chicago (PINE) (N = 3,157) were used. Multivariate negative binomial regression analyses were conducted to examine significant factors associated with ED use. Higher education (rate ratio [RR] = 1.03, 95% confidence interval [CI] 1.00-1.05) and acculturation levels (RR = 1.02, CI 1.00-1.04), fewer people in the household (RR = 0.94, CI 0.88-0.99), health insurance coverage (RR = 1.34, CI 1.01-1.78), lower income (RR = 0.89, CI 0.80-0.99), poorer perceived health (RR = 0.67, CI 0.58-0.77), more functional limitations (RR = 1.09, CI 1.06-1.13) and depressive symptoms (RR = 1.04, CI 1.02-1.07), and a history of heart disease (RR = 2.28, CI 1.83-2.84), stroke (RR = 1.68, CI 1.20-2.35), cancer (RR = 1.86, CI 1.31-2.63), and hip fracture (RR = 1.42, CI 1.02-1.98) were associated with higher rates of ED visits. Our findings highlight several significant correlates of ED use in U.S. Chinese older adults. Culturally-appropriate interventions modifying these factors have the potential to decrease ED visits and improve care outcomes in this population.

Identification and characterization of the Plasmodium yoelii PyP140/RON4 protein, an orthologue of Toxoplasma gondii RON4, whose cysteine-rich domain does not protect against lethal parasite challenge infection.

Previously, we identified a Plasmodium yoelii YM 140-kDa merozoite protein, designated PyP140, which formed a complex with apical membrane antigen 1 (AMA1). Furthermore, we produced a nonprotective monoclonal antibody (MAb), 48F8, that immunoprecipitated metabolically labeled PyP140 and localized the protein to the merozoite's apical end and, less frequently, to the merozoite surface, as observed by immunofluorescence assay (IFA). Here, using MAb 48F8, we have identified the pyp140 gene by screening a P. yoelii lambda-Zap cDNA expression library. The pyp140 cDNA covers approximately 90% of the putative open reading frame (ORF) of PY02159 from the P. yoelii NL genome sequencing project. Analysis of the complete gene identified the presence of two introns. The ORF encodes a 102,407-Da protein with an amino-terminal signal sequence, a series of three unique types of repeats, and a cysteine-rich region. The binding site of MAb 48F8 was also identified. A BLAST search with the deduced amino acid sequence shows significant similarity with the Toxoplasma gondii RON4 protein and the Plasmodium falciparum RON4 protein, and the sequence is highly conserved in other Plasmodium species. We produced the cysteine-rich domain of PyP140/RON4 by using the Pichia pastoris expression system and characterized the recombinant protein biochemically and biophysically. BALB/c mice immunized with the protein formulated in oil-in-water adjuvants produced antibodies that recognize parasitized erythrocytes by IFA and native PyP140/RON4 by immunoblotting but failed to protect against a lethal P. yoelii YM infection. Our results show that PyP140/RON4 is located within the rhoptries or micronemes. It may associate in part with AMA1, but the conserved cysteine-rich domain does not appear to elicit inhibitory antibodies, a finding that is supported by the marked sequence conservation in this protein within Plasmodium spp., suggesting that it is not under immune pressure.

Selective binding of pyrene in subdomain IB of human serum albumin: Combining energy transfer spectroscopy and molecular modelling to understand protein binding flexibility.

The ability of human serum albumin (HSA) to bind medium-sized hydrophobic molecules is important for the distribution, metabolism, and efficacy of many drugs. Herein, the interaction between pyrene, a hydrophobic fluorescent probe, and HSA was thoroughly investigated using steady-state and time-resolved fluorescence techniques, ligand docking, and molecular dynamics (MD) simulations. A slight quenching of the fluorescence signal from Trp214 (the sole tryptophan residue in the protein) in the presence of pyrene was used to determine the ligand binding site in the protein, using Förster's resonance energy transfer (FRET) theory. The estimated FRET apparent distance between pyrene and Trp214 was 27Å, which was closely reproduced by the docking analysis (29Å) and MD simulation (32Å). The highest affinity site for pyrene was found to be in subdomain IB from the docking results. The calculated equilibrium structure of the complex using MD simulation shows that the ligand is largely stabilized by hydrophobic interaction with Phe165, Phe127, and the nonpolar moieties of Tyr138 and Tyr161. The fluorescence vibronic peak ratio I1/I3 of bound pyrene inside HSA indicates the presence of polar effect in the local environment of pyrene which is less than that of free pyrene in buffer. This was clarified by the MD simulation results in which an average of 5.7 water molecules were found within 0.5nm of pyrene in the binding site. Comparing the fluorescence signals and lifetimes of pyrene inside HSA to that free in buffer, the high tendency of pyrene to form dimer was almost completely suppressed inside HSA, indicating a high selectivity of the binding pocket toward pyrene monomer. The current results emphasize the ability of HSA, as a major carrier of several drugs and ligands in blood, to bind hydrophobic molecules in cavities other than subdomain IIA which is known to bind most hydrophobic drugs. This ability stems from the nature of the amino acids forming the binding sites of the protein that can easily adapt their shape to accommodate a variety of molecular structures.