Demanded interdisciplinary subjects for integration in medical education program from the point of view of graduated medical physicians and senior medical students: a nationwide mixed qualitative-quantitative study from Iran.

INTRODUCTION: This study aimed to detect interdisciplinary subjects for integration into the medical education program of Iran. METHODS: A qualitative-quantitative method was used. Firstly, interdisciplinary subjects demanded by medical graduates and senior medical students were defined by qualitative study. In the second stage, questionnaire was developed which based on the findings of qualitative stage, experts' opinion and reviewing of the national general guide of professional ethics for medical practitioners. Questionnaire consisted of demographic, occupational and thirteen interdisciplinary items. These items consisted of social determinants of health, social and economic consequences of disease, social prescribing, physicians' social responsibility, role of gender, racial, ethnic, social and economic issues in approach to patients, role of logic and mathematics in clinical decision-making, philosophy of medicine, maintaining work-life balance, self-anger management, national laws of medicine, religious law in medical practice, health system structure, and teamwork principles. Level and importance of knowledge and self-assessed educational needs were asked about each item. In the third stage, a national online survey was conducted. SPSS 25 was used for statistics. RESULTS: By content analysis of data in qualitative stage, 36 sub-themes and 7 themes were extracted. In the quantitative part, 3580 subjects from 41 medical universities across Iran participated in this study. 2896 (80.9%) were medical graduates and 684 (19.1%) were senior medical students. Overall, knowledge about interdisciplinary items was low to intermediate, while high to very high knowledge ranged from maximally 38.7% about socioeconomic consequences of disease to minimally 17.2% about social prescribing. Participants gave the most importance to the having knowledge about self-anger management (88.3%), maintaining work-life balance (87.2%) and social determinants of health (85.8%), respectively. However, national laws of medicine (77.6%), maintaining work-life balance (75.4%) and self-anger management (74%) were the first top three educational demands by participants. CONCLUSION: This study revealed a low to moderate level of knowledge about interdisciplinary topics among both graduated medical physicians and senior medical students. These groups showed a strong demand and tendency to know and to be educated about these topics. These findings underscore the urgency for educational reforms to meet the interdisciplinary needs of medical professionals in Iran.

Design of double Z-scheme Ag-Ag3O4/CuO-CuFe2O4 magnetic nanophotocatalyst via starch-templated microwave-combustion hybrid precipitation method and modified with corona-plasma: Remediation of dye contaminants.

Herein, the novel double Z-scheme Ag-Ag3O4/CuO-CuFe2O4 magnetic nanophotocatalyst with nanosphere-on-nanosheet-like morphology was synthesized via the corona-plasma-assisted starch-templated microwave-combustion-precipitation method to remove the dye pollutants. The CuO-CuFe2O4 meso/macroporous nanophotocatalyst was synthesized using a one-pot-stage combustion-microwave process with/without starch as a hard-template. Subsequently, surface modification was carried out by DC corona-plasma discharge technology at various voltages, namely 500, 1000 and 1500 V. Then, the Ag3O4 photocatalyst was deposited on the CuO-CuFe2O4 fabricated with starch-hard-template and treated with 1000 V corona-plasma (denoted as: Ag-Ag3O4/CuO-CuFe2O4 (Starch) 1000 P). The properties of the synthesized nanophotocatalysts were analyzed using various techniques, including X-ray diffraction (XRD), Diffuse reflectance spectroscopy (DRS), Transmission electron microscopy (TEM), Field emission scanning electron microscopy (FESEM), Brunauer-Emmett-Teller and Barrett-Joyner-Halenda (BET-BJH), Vibrating Sample Manetometer (VSM), and Photoluminescence (PL). The XRD analysis corroborated the presence of CuO, CuFe2O4 and Ag3O4 in the structure of all samples. The BET-BJH analysis indicates that the specific surface area of the Ag-Ag3O4/CuO-CuFe2O4 (Starch) 1000 P nanophotocatalyst as the best sample is 2 m2/g, higher than other samples. Additionally, the DRS analysis revealed that the band gap of the Ag-Ag3O4/CuO-CuFe2O4 (Starch) 1000 P nanophotocatalyst is about 1.68 eV with the surface plasmon resonance. The performance of the ternary heterostructured Ag-Ag3O4/CuO-CuFe2O4 (Starch) 1000 P nanophotocatalyst was 96.2% and 89.1% in the degradation of the crystal violet (10 mg/L) and acid orange 7 (10 mg/L), respectively, proving its outstanding degradation capacity.

Potato-on-rod like of Z-scheme plasmon Ag2CrO4-Ag2Mo2O7 heterojunction nanophotocatalyst with high stability and accelerated photo-degradation evolution of organic contaminants.

The shocking increase of resistant dye pollutants in the environment and their harmful effects has become a potential threat to the ecosystem. In the current work, the novel and highly efficient potato-on-rod-like Z-scheme plasmon Ag2CrO4-Ag2Mo2O7 heterojunction nano-photocatalyst was synthesized by precipitation method to photodegrade different organic dyes under artificial sunlight. The required analysises were carried out to characterize nanophotocatalysts. FESEM and TEM results showed the placement way of potato-like Ag2CrO4 between/on rod-like Ag2Mo2O7 which was leading to suitable structure and surface morphology. Besides, the morphology observations released the meso-/macroporous potato-on-rod like architecture self-assembled by nanoparticles. DRS analysis also confirmed two band gap energies of 2.55 and 1.72 eV in Ag2CrO4-Ag2Mo2O7 (3:1) resulting from forming a heterojunction structure and the plasmon Ag. Ag2CrO4-Ag2Mo2O7 (3:1) nanophotocatalyst exhibited the most remarkable activity in the photodegradation of 10 mg/L 2-naphthol orange (97.8%), 10 mg/L rhodamine B (99.7%), 10 mg/L crystal violet (98.9%), and 10 mg/L methyl orange (56.1%) with a catalyst dosage of 0.1 gr for about 90 min. The appropriate energy band gap, the formation of the heterostructure, the presence of meso (0.0038 cm3/g) and macro (0.0044 cm3/g) holes, and pore diameter at about 17.2 nm based on BET-BJH analysis that facilitated the penetration of pollutant molecules, increased pollutant adsorption and demonstrated stunning capability of efficient light harvesting, the reason was electron-hole pairs recombination rate reduction. Moreover, the fabricated samples showed tremendous catalyst constancy and reusability even after the fourth run. Results have shown the remarkable photocatalytic activity under visible light and provide an environment-friendly and green strategy to overcome the challenges of organic pollutants present in aqueous solutions.

Determining the existence of the foramen of Huschke in patients with temporomandibular joint disorders using cone beam computed tomography: retrospective cohort study.

BACKGROUND: Foramen of Huschke has been presented as an unusual developmental defect in anteroinferior aspect of external auditory canal. It can be associated with significant otologic complications. The purpose of this study was to determine the association between existence of foramen of Huschke and temporomandibular joint disorders in Cone Beam Computed Tomography (CBCT) images. METHODS: Of an initial sample of 465 patients, we retrospectively evaluated the CBCT images of 118 individuals with clinical signs and symptoms of temporomandibular joint disorders as case group and 256 individuals as control group. The presence, size and localization of foramen of Huschke were assessed in the axial and corrected sagittal images. The sex and age distribution were determined. Fisher's exact test, T-test and Pearson's Chi-square were applied to assess the relationship between foramen of Huschke and temporomandibular joint disorders in the case and control groups considering age and sex. RESULTS: The foramen of Huschke prevalence was slightly higher in patients with temporomandibular joint disorders (3.4%) than patients without temporomandibular joint disorders (0.8%). However, the difference was not statistically significant (P = 0.082). foramen of Huschke was found in five females and one male. There was no significant difference between case and control groups considering the age of patients with foramen of Huschke (P = 0.683). There was no significant difference between the case and control groups, considering the right and left ears in distribution of foramen of Huschke (P = 0.099) (P = 0.183). CONCLUSIONS: Higher prevalence of foramen of Huschke in patients with temporomandibular joint disorders may suggest possible mechanism for temporomandibular joint disorders development that can be affected by presence of foramen of Huschke.

Domestic violence and associated factors during COVID-19 epidemic: an online population-based study in Iran.

BACKGROUND: The novel coronavirus disease 2019 has severely affected communities around the world. Fear and stress of being infected, along with pressure caused by lockdown, prevention protocols, and the economic downturn, increased tension among people, which consequently led to the rise of domestic violence (DV). Therefore, this study was conducted to determine the rate of change in DV and its associated factors during the COVID-19 epidemic in Shiraz, Iran. METHODS: In this cross-sectional study, 653 individuals with the age of over 15 years from Shiraz were participated through snowball sampling and filled out an online questionnaire through the WhatsApp platform. A 51-item, self-administered and multidimensional (knowledge, attitude, and practice) questionnaire was designed and assessed 653 participants. The gathered data was analyzed using SPSS software (version 25), and variables with a p-value of less than 0.05 were considered statistically significant. RESULTS: In this study, 64.2% of the respondents were within the age range of 31-50 years, and 72.6% of the subjects were female. Furthermore, 73.8 and 73.0% of the individuals were married and educated for over 12 years, respectively. The DV increased by 37.5% during the quarantine period, compared to before the pandemic. The emotional type was the most common type of violence; the sexual type was the least frequent. Multivariate analysis indicated that infection with COVID-19, drug use, high level of co-living observation of anti-COVID prevention protocols, and lower level of physical activity during the quarantine period had a positive and significant association with the occurrence of DV. CONCLUSION: Based on the obtained results, it is required to implement effective harm-reduction policies and measures in the community due to the increasing rate of DV during the COVID-19 epidemic.

Joint Optimization of Energy Consumption and Data Transmission in Smart Body Area Networks.

In Wireless Body Area Networks (BAN), energy consumption, energy harvesting, and data communication are the three most important issues. In this paper, we develop an optimal allocation algorithm (OAA) for sensor devices, which are carried by or implanted in human body, harvest energy from their surroundings, and are powered by batteries. Based on the optimal allocation algorithm that uses a two-timescale Lyapunov optimization approach, we design a framework for joint optimization of network service cost and network utility to study energy, communication, and allocation management at the network edge. Then, we formulate the utility maximization problem of network service cost management based on the framework. Specifically, we use OAA, which does not require prior knowledge of energy harvesting to decompose the problem into three subproblems: battery management, data collection amount control and transmission energy consumption control. We solve these through OAA to achieve three main goals: (1) balancing the cost of energy consumption and the cost of data transmission on the premise of minimizing the service cost of the devices; (2) keeping the balance of energy consumption and energy collection under the condition of stable queue; and (3) maximizing network utility of the device. The simulation results show that the proposed algorithm can actually optimize the network performance.

Influence of Simvastatin as Augmentative Therapy in the Treatment of Generalized Anxiety Disorder: A Pilot Randomized, Placebo-Controlled Study.

BACKGROUND: Preliminary evidence is promising regarding the anxiolytic effects of statins in animal models of anxiety. Hence, this study aimed to evaluate the efficacy of simvastatin augmentation versus placebo in the treatment of patients with generalized anxiety disorder (GAD) with residual symptoms despite treatment with selective serotonin reuptake inhibitors (SSRIs). METHODS: A double-blind, 8-week controlled trial was conducted from August 2018 to December 2019 in an outpatient psychiatry clinic in Hamadan, Iran. A total of 138 patients with a diagnosis of GAD were assessed for eligibility. Of them, 84 patients who met the study criteria were randomly assigned either to the adjuvant simvastatin (20 mg/day) or to the placebo group. Standard medication consisting of SSRIs was consistent 2 months prior to and during the study. The severity of anxiety symptoms for each patient was assessed based on the Hamilton Anxiety Rating Scale (HAM-A) score at baseline, week 4, and week 8 after treatment. Additionally, blood lipid values were assessed at baseline and on completion of the study. RESULTS: Thirty-three out of 42 patients in the intervention group and 35 out of 42 patients in the control group completed the 8 weeks of the study period. Compared to the placebo group, in the simvastatin group cholesterol, triglycerides, and low-density lipoprotein significantly decreased, and high-density lipoprotein significantly increased over time. General linear model analysis demonstrated that although over time a higher decrease in mean HAM-A scores was observed in the intervention group compared to the control group, this difference was not statistically significant (p = 0.11). In addition, at the end of the study, the number of responders and remitters was comparable in the two groups. CONCLUSIONS: The results from this clinical study did not support the potential efficacy of adjunctive simvastatin in the treatment of patients with GAD. Thus, large-scale and long-term clinical trials are required to more accurately assess the potential efficacy of statins in the treatment of patients with anxiety disorders.

Phase Transition in Modified Newtonian Dynamics (MONDian) Self-Gravitating Systems.

We study the statistical mechanics of binary systems under the gravitational interaction of the Modified Newtonian Dynamics (MOND) in three-dimensional space. Considering the binary systems in the microcanonical and canonical ensembles, we show that in the microcanonical systems, unlike the Newtonian gravity, there is a sharp phase transition, with a high-temperature homogeneous phase and a low-temperature clumped binary one. Defining an order parameter in the canonical systems, we find a smoother phase transition and identify the corresponding critical temperature in terms of the physical parameters of the binary system.

Bacterial staphylokinase as a promising third-generation drug in the treatment for vascular occlusion.

Vascular occlusion is one of the major causes of mortality and morbidity. Blood vessel blockage can lead to thrombotic complications such as myocardial infarction, stroke, deep venous thrombosis, peripheral occlusive disease, and pulmonary embolism. Thrombolytic therapy currently aims to rectify this through the administration of recombinant tissue plasminogen activator. Research is underway to design an ideal thrombolytic drug with the lowest risk. Despite the potent clot lysis achievable using approved thrombolytic drugs such as alteplase, reteplase, streptokinase, tenecteplase, and some other fibrinolytic agents, there are some drawbacks, such as high production cost, systemic bleeding, intracranial hemorrhage, vessel re-occlusion by platelet-rich and retracted secondary clots, and non-fibrin specificity. In comparison, bacterial staphylokinase, is a new, small-size plasminogen activator, unlike bacterial streptokinase, it hinders the systemic degradation of fibrinogen and reduces the risk of severe hemorrhage. A fibrin-bound plasmin-staphylokinase complex shows high resistance to a2-antiplasmin-related inhibition. Staphylokinase has the potential to be considered as a promising thrombolytic agent with properties of cost-effective production and the least side effects.

Sunlight-activated 3D-mesoporous-flowerlike Cl-Br bismuth oxides nanosheet solid solution: In situ EG-thermal-sonication synthesis with excellent photodecomposition of ciprofloxacin.

In this research, a group of BiOX (Cl:Br) nanosheet solid solution with various Cl/Br molar ratios have been fabricated using a facile one-pot in-situ thermal-sonication method. The crystal phases structure, elemental composition, morphology, specific surface area and optical features of as-synthesized photocatalyst were explored by XRD, EDX, FESEM, HRTEM, AFM, BET-BJH, and DRS techniques. The photocatalytic activity of nanophotocatalysts was investigated by photodegradation of ciprofloxacin as a model pharmaceutical pollutant under simulated solar light illumination. The scavenging effect was studied by using tTriethanolamine and 2-propanol to evaluate the roles of holes and hydroxyl radicals as main active species. All the samples showed higher photocatalytic activity compared to pristine BiOCl and BiOBr. Among the solid solutions, BiOX (Cl:Br = 1:3)-U sample exhibited excellent photocatalytic performance by 100% degradation efficiency of ciprofloxacin within 120 min. The outstanding photocatalytic activity of BiOX (Cl:Br = 1:3)-U might be ascribed to the large specific surface area, suitable morphology and band gap, effective separation of the photo-generated electron-hole pairs and the existence of the meso-size pores in structure. Moreover, results demonstrated that the presence of ultrasound irradiations and generated microjets during the synthesis step could appreciably improve the photocatalytic performance. After 4 cycles, there was no significant change in photocatalytic activity that confirms the high stability of BiOX (Cl:Br = 1:3)-U mesoporous nanophotocatalyst. Besides, the influence of operating parameters on the degradation efficiency and the possible photocatalytic mechanism was examined.

Social, economic, and legislative factors and global road traffic fatalities.

BACKGROUND: Road traffic fatalities (RTF) is the 8th cause of mortality around the world. At the end of the Decade of Action, it would be of utmost importance to revisit our knowledge on the determinants of RTF. The aim of this study is to assess factors related to RTF at global level. METHODS: We used road safety development index which accounts for the interactions between system, human and products to assess the RTF in 115 and 113 countries in 2013 and 2016, respectively. To analyze data, three statistical procedures (linear regression, classification and regression trees, and multivariate adaptive regression splines) were employed. RESULTS: Classification and regression trees has the best performance amongst all others followed by multivariate adaptive regression splines for 2013 and 2016 data set with an R2 around 0.83. Results show that any increase in human development index was associated with RTF reduction. Comparing RTF data of 2013 and 2016, 8 countries experienced a change of more than 30%, which demonstrated a significant relationship with GINI index (named after Corrado Gini). Considering the three components of human development index, it is revealed that education explained most of RTF variation in classification and regression trees model followed by income and life expectancy. CONCLUSION: Policymakers should consider road collisions as a socio-economic issue. In this regard, they can make provisions to reduce RTF in the long run by focusing on enhancing the three components of human development index, mainly education. However, there is a need to investigate the causation pathway among these three components with RTF with different time-trend procedures.

Effect of Rivastigmine (Acetyl Cholinesterase Inhibitor) versus Placebo on Manic Episodes in Patients with Bipolar Disorders: Results from a Double Blind, Randomized, Placebo-Controlled Clinical Trial.

BACKGROUND: To treat patients with bipolar disorders (BPD) during the acute phase, the standard procedure is to administer lithium or sodium valproate. To further optimize treatment, acetylcholinesterase inhibitors such as donepezil and galantamine have gained increased interest, though with conflicting results. In the present randomized, double-blind, placebo-controlled clinical trial, we investigated whether, and to what extent, adjuvant rivastigmine might improve symptoms of mania in patients with BPD during the acute manic phase. METHODS: A total of 70 patients with BPD in an acute state of mania (mean age 33.8 years; 24% females) took part in this study. After a thorough clinical interview, standard treatment consisted of 20mg/kg/day of sodium valproate; next, patients were randomly assigned either to the adjuvant rivastigmine or to the placebo condition. The study duration was 24 days. The dose of rivastigmine was 1.5 mg for the first 7 days and 3 mg from day 8 to day 24. Experts blind to the patients' study condition rated patients' mania scores, symptom severity, and symptom improvements at baseline (except symptom improvements) and 4, 8, 12, and 24 days after the beginning of this study. RESULTS: Symptoms of mania improved over time, but more so in the adjuvant rivastigmine compared to the placebo condition. Greater improvements were observed from day 8 on. CONCLUSIONS: The pattern of results from the present randomized, placebo-controlled, double-blind study suggests that adjuvant rivastigmine, a cholinesterase inhibitor, improved symptoms of mania among a larger sample of inpatients with BPD and in the acute manic state. However, the improvements were modest, and the results should be replicated and above all balanced against side effects.

Influence of adjuvant Coenzyme Q10 on inflammatory and oxidative stress biomarkers in patients with bipolar disorders during the depressive episode.

Bipolar disorder (BPD) is a severe and chronic mental disease with high rates of social and functional disability. To explain the emergence and maintenance of BPD, increasing attention has been focused on dimensions of inflammation and oxidative stress (OTS). Coenzyme Q10 (CoQ10) is known for its anti-oxidant and anti-inflammatory effects; accordingly, the aim of the present study was to investigate, if compared to placebo, adjuvant CoQ10 might favorably impact on serum levels of inflammatory and OTS biomarkers in patients with BPD during their depressive phase. A total of 89 BPD patients, currently in a depressive episode were allocated by block randomization either to the adjuvant CoQ10 (200 mg/day) condition or to the placebo condition. At baseline and 8 weeks later at the end of the study, serum levels of total antioxidant capacity (TAC), total thiol groups (TTG), catalase activity (CAT), nitric oxide (NO), malondialdehyde (MDA), tumor necrosis factor-alpha (TNF-α), interlukin-6 (IL-6), and IL-10 were assessed. 69 patients completed the 8-week lasting study. Compared to baseline and to the placebo condition, serum levels of TTG and TAC significantly increased, and TNF-α, IL-10, and NO statistically decreased over time in the adjuvant CoQ10 condition. No statistically significant changes were observed for CAT, MDA, and IL-6. The pattern of results suggests that compared to placebo and over a time lapse of 8 weeks, adjuvant CoQ10 favorably impacted on OTS and inflammatory biomarkers in patients with BPD during the depressive episode. Thus, CoQ10 might be considered a safe and effective strategy for treatment of patients with BPD during their depressive phase.

Mechanochemical Synthesis of CuO/MgAl2O4 and MgFe2O4 Spinels for Vanillin Production from Isoeugenol and Vanillyl Alcohol.

CuO/MgAl2O4 and CuO/MgFe2O4 catalysts were successfully synthesized with the use of spinel supports by a very simple and low-cost mechanochemical method. High-speed ball-milling was used to synthesize these catalyst supports for the first time. Materials were subsequently characterized by using XRD, FESEM, TEM, EDS-Dot mapping, XPS, BET-BJH, and Magnetic Susceptibility to investigate the physical-chemical characteristics of the catalysts. Acidity evaluation results indicated that the catalyst with the Mg-Al spinel support had more acid sites. XRD results showed a successful synthesis of the catalysts with large crystal sizes. Both catalysts were used in isoeugenol oxidation and vanillyl alcohol to vanillin reactions, with the CuO/MgAl2O4 showing optimum results. This catalyst provided 67% conversion (74% selectivity) after 2 h and this value improved to 81% (selectivity 100%) with the second reaction after 8 h. The CuO/MgFe2O4 catalyst in the first reaction after five hours revealed 53% conversion (47% selectivity) and after eight hours with the second reaction, the conversion value improved to 64% (100% selectivity). In terms of reusability, CuO/MgAl2O4 showed better results than the CuO/MgFe2O4 catalyst, for both reactions.

Evaluating the Effect of Coenzyme Q10 Augmentation on Treatment of Bipolar Depression: A Double-Blind Controlled Clinical Trial.

BACKGROUND: Bipolar disorder (BPD) is a chronic and recurrent mood disorder characterized by episodes of mania, hypomania, and major depression. Based on available evidence, mitochondrial dysfunction, oxidative stress, and inflammation have important roles in the pathophysiology of bipolar depression. More specifically, it seems that coenzyme Q10 (CoQ10), a mitochondrial modulator, as well as an antioxidant and anti-inflammatory agent, might be effective in modulating these pathophysiological pathways. Accordingly, the aim of this study was to investigate whether and to what extent, compared with placebo, adjuvant CoQ10 might improve symptoms of depression in patients with BPD. METHODS: A total of 69 patients with BPD with a current depressive episode were randomly assigned either to the adjuvant CoQ10 (200 mg/d) or to the placebo group. Standard medication consisting of mood stabilizers and antidepressants was consistent 2 months prior and during the study. Depression severity for each patient was assessed based on the Montgomery-Asberg Depression Rating Scale scores at baseline, fourth week, and eighth week of the study. RESULTS: Symptoms of depression decreased over time in both groups. Compared with the placebo group, adjuvant CoQ10 to a standard medication improved symptoms of depression after 8 weeks of treatment. In addition, at the end of the study, it turned out that more responders were observed in the CoQ10 group, compared with the placebo group. CoQ10 had minimal adverse effects and was well tolerated. CONCLUSIONS: The present pattern of results suggests that among patients with BPD, compared with placebo, adjuvant CoQ10 probably because of its antioxidant and anti-inflammatory properties can improve symptoms of depression over a period of 8 weeks.

Influence of adjuvant detached mindfulness and stress management training compared to pharmacologic treatment in primiparae with postpartum depression.

Ten to 15% of mothers experience postpartum depression (PPD). If untreated, PPD may negatively affect mothers' and infants' mental health in the long term. Accordingly, effective treatments are required. In the present study, we investigated the effect of detached mindfulness (DM) and stress management training (SMT) as adjuvants, compared to pharmacologic treatment only, on symptoms of depression in women with PPD. Forty-five primiparae (mean age: M = 24.5 years) with diagnosed PPD and treated with an SSRI (citalopram; CIT) took part in the study. At baseline, they completed questionnaires covering socio-demographic data and symptoms of depression. Experts rated also symptoms of depression. Next, participants were randomly assigned to one of the following study conditions: adjuvant detached mindfulness (CIT+DM); adjuvant stress management training (CIT+SMT); control condition (CIT). Self- and experts' ratings were completed at the end of the study 8 weeks later, and again at 8 weeks follow-up. Symptoms of depression decreased significantly over time, but more so in the CIT+DM and CIT+SMT group, compared to the control condition. The pattern of results remained stable at follow-up. In primiparae with PPD and treated with a standard SSRI, adjuvant psychotherapeutic interventions led to significant and longer-lasting improvements.

Female Gender, Marital and Family Problems, and Feelings of Guilt Are Related to Self-Immolation Suicide Attempts.

BACKGROUND: Self-immolation (SI) is considered one of the most painful, dramatic, and at the same time most inexplicable methods of suicide, with a high social impact. Prevalence rates are particularly high in Iran, and in north-western Iran specifically. Here, we report sociodemographic, psychological, and psychiatric characteristics of patients attempting self-immolation (PSIs), compared to patients with accident burns (PABs). METHOD: Patients referred to the Burns Emergency Unit of the Besat Hospital (Hamadan, Iran) were enrolled in the present study between winter 2015 and summer 2016. After burn-related treatments and surgery, a thorough interview was undertaken covering sociodemographic characteristics, burn-related information, and psychiatric background. RESULTS: A total of 79 patients were enrolled. Among these, 19 (31.7%) had attempted suicide via SI. Compared to the PABs, the PSIs were predominantly females; they reported family and marital problems as the main triggers for SI. The psychiatric interviews indicated that PSIs often suffered from major depressive disorders, adjustment disorders, and bipolar disorders. The prevailing feelings reported were guilt and shame. A binary logistic regression showed that feelings of guilt and marital and family problems predicted SI. CONCLUSIONS: The prevalence of SI was surprisingly high. Marital and family conflicts as a proxy for highly distressing social interactions, along with female gender and feelings of guilt and shame were strongly associated with SI. Family and couple counseling specifically tailored to difficulties experienced by women might reduce the risk of SI.

Further Evidence of the Positive Influence of Repetitive Transcranial Magnetic Stimulation on Speech and Language in Patients with Aphasia after Stroke: Results from a Double-Blind Intervention with Sham Condition.

BACKGROUND: After a stroke, up to 20% of patients suffer from aphasia. The preferred treatment for stroke-related aphasia (SRA) is regular speech and language training (SLT). In the present study, we investigated to what extent adjuvant repetitive transcranial magnetic stimulation (rTMS) might enhance recovery. While there is growing evidence of the positive effect of adjuvant rTMS on aphasia, no study has yet been based on an Iranian sample. METHOD: A total of 12 patients (mean age: 55 years; right-handed; 7 women) underwent treatment for SRA 1 month after stroke. The standard treatment consisted of regular 45-min SLT sessions 5 times a week for 2 consecutive weeks. Additionally, patients were randomly assigned either to adjuvant rTMS (5 times a week for 30 min) or to a sham condition (5 times a week for 30 min). At baseline and after 2 weeks of intervention, the degree of aphasia was assessed with the Farsi version of the Western Aphasia Battery. rTMS was applied to the inferior posterior frontal gyrus of the right hemisphere. RESULTS: Speech and language improved over time, but more so in the rTMS than in the sham condition. Large effect sizes were observed for content, fluency, and the aphasia quotient; medium effect sizes were observed for command comprehension and repetition, while effect sizes were small for auditory comprehension and naming. CONCLUSIONS: Among patients with SRA, compared to a sham condition, adjuvant rTMS improved speech and language skills. The present results add to the accumulating evidence that rTMS as a neuromodulation technique has the capacity to enhance the effect of conventional SLT.

Early maladaptive schemas of emotional deprivation, social isolation, shame and abandonment are related to a history of suicide attempts among patients with major depressive disorders.

BACKGROUND: Patients with psychiatric disorders have an exceptionally high risk of completed or attempted suicide. This holds particularly true for patients with major depressive disorders. The aim of the present study was to explore whether patients with major depressive disorders (MDD) and a history of suicide attempts differed in their early maladaptive schemas from patients with MDD but without such a history or from healthy controls. METHOD: Ninety participants took part in the study. Of these, 30 were patients with MDD who had made a recent suicide attempt; 30 were patients with MDD but no suicide attempts, and 30 were gender- and age-matched healthy controls. Participants completed questionnaires covering socio-demographic characteristics and the Young Schema Questionnaire (YSQ- RE2R) to assess early maladaptive schemas. Experts rated patients' MDD with the Montgomery-Asberg Depression Rating Scale. RESULTS: Patients did not differ in experts' ratings of symptoms of depression. Compared to healthy controls, patients with MDD recorded higher scores on maladaptive schemas such as recognition seeking, negativity/pessimism, and insufficient self-control. Compared to patients without suicide attempts and healthy controls, those who had made a suicide attempt had higher scores on dimensions such as failure, mistrust, emotional inhibition, social isolation, and abandonment/instability. CONCLUSION: Compared to healthy controls, patients with MDD had more pronounced maladaptive schemas, but this was more marked in patients with a history of suicide attempts. The results suggest that suicide attempts and poorer psychological functioning are related.

Repetitive Transcranial Magnetic Stimulation Improved Symptoms of Obsessive-Compulsive Disorder, but Also Cognitive Performance: Results from a Randomized Clinical Trial with a Cross-Over Design and Sham Condition.

OBJECTIVE: There is some evidence that repetitive transcranial magnetic stimulation (rTMS) is an effective method of treating patients suffering from obsessive-compulsive disorder (OCD). Here, we tested the hypothesis that rTMS has a positive impact both on symptom severity and cognitive performance in such patients. Specifically, short-term verbal processing speed and flexibility were assessed. METHOD: Ten patients suffering from refractory OCD and treated with standard medication were randomly assigned either to a treatment-first or to a sham-first condition. At baseline and after 2 and 4 weeks, symptom severity (experts' ratings) and cognitive performance (auditory perception, visual perception, short-term memory, and processing speed) were assessed. After 2 weeks, the treatment condition switched to the sham condition, and the sham condition switched to the treatment condition. RESULTS: Under treatment but not under sham conditions, symptom severity reduced. Moreover, cognitive performance improved in parallel. CONCLUSIONS: rTMS is a safe and efficient treatment for patients suffering from refractory OCD; symptoms and cognitive performance improved in parallel.