Comparing suicide completion rates in bipolar I versus bipolar II disorder: A systematic review and meta-analysis.

BACKGROUND: Bipolar disorder (BD) has a high disease burden and the highest mortality risk in BD comes from suicide. Bipolar disorder type II (BD-II) has been described as a milder form of bipolar disorder; however, extant literature is inconsistent with this description and instead describe illness burden and notably suicidality comparable to persons with bipolar I disorder (BD-I). Towards quantifying the hazard of BD-II, herein we aim via systematic review and meta-analysis to evaluate the rates of completed suicide in BD-I and BD-II. METHOD: We conducted a literature search on PubMed, OVID (Embase, Medline) and PsychINFO databases from inception to June 30th, 2023, according to PRISMA guidelines. Articles were selected based on the predetermined eligibility criteria. A meta-analysis was performed, comparing the risk of completed suicide between individuals diagnosed with BD-I to BD-II. RESULTS: Four out of eight studies reported higher suicide completion rates in persons living with BD-II when compared to persons living with BD-I; however, two of the studies reported non-significance. Two studies reported significantly higher suicide completion rates for BD-I than BD-II. The pooled odds ratio of BD-II suicide rates to BD-I was 1.00 [95 % CI = 0.75, 1.34]. LIMITATIONS: The overarching limitation is the small number of studies and heterogeneity of studies that report on suicide completion in BD-I and BD-II. CONCLUSION: Our study underscores the severity of BD-II, with a risk for suicide not dissimilar from BD-I. The greater propensity to depression, comorbidity and rapid-cycling course reported in BD-II are contributing factors to the significant mortality hazard in BD-II.

Altered functional connectivity subserving expressed emotion environments in schizophrenia: An fNIRS study.

Living in high-expressed emotion (EE) environments, characterized by critical, hostile, or over-involved family attitudes, has been linked to increased relapse rates among individuals with schizophrenia (SZ). In our previous work (Wang et al., 2023), we conducted the first feasibility study of using functional near-infrared spectroscopy (fNIRS) with our developed EE stimuli to examine cortical hemodynamics in SZ. To better understand the neural mechanisms underlying EE environmental factors in SZ, we extended our investigation by employing functional connectivity (FC) analysis with a graph theory approach to fNIRS signals. Relative to healthy controls (N=40), individuals with SZ (N=37) exhibited altered connectivity across the medial prefrontal cortex (mPFC), left ventrolateral prefrontal cortex (vlPFC), and left superior temporal gyrus (STG) while exposed to EE environments. Notably, while individuals with SZ were exposed to high-EE environments, (i) reduced connectivity was observed in these brain regions and (ii) the left vlPFC-STG coupling was found to be associated with the negative symptom severity. Taken together, our FC findings suggest individuals with SZ experience a more extensive disruption in neural functioning and coordination, particularly indicating an increased susceptibility to high-EE environments. This further supports the potential utility of integrating fNIRS with the created EE stimuli for assessing EE environmental influences, paving the way for more targeted therapeutic interventions.

Programmed cell death factor 4-mediated hippocampal synaptic plasticity is involved in early life stress and susceptibility to depression.

Early life stress (ELS) increases the risk of depression later in life. Programmed cell death factor 4 (PDCD4), an apoptosis-related molecule, extensively participates in tumorigenesis and inflammatory diseases. However, its involvement in a person's susceptibility to ELS-related depression is unknown. To examine the effects and underlying mechanisms of PDCD4 on ELS vulnerability, we used a "two-hit" stress mouse model: an intraperitoneal injection of lipopolysaccharide (LPS) into neonatal mice was performed on postnatal days 7-9 (P7-P9) and inescapable foot shock (IFS) administration in adolescent was used as a later-life challenge. Our study shows that compared with mice that were only exposed to the LPS or IFS, the "two-hit" stress mice developed more severe depression/anxiety-like behaviors and social disability. We detected the levels of PDCD4 in the hippocampus of adolescent mice and found that they were significantly increased in "two-hit" stress mice. The results of immunohistochemical staining and Sholl analysis showed that the number of microglia in the hippocampus of "two-hit" stress mice significantly increased, with morphological changes, shortened branches, and decreased numbers. However, knocking down PDCD4 can prevent the number and morphological changes of microglia induced by ELS. In addition, we confirmed through the Golgi staining and immunohistochemical staining results that knocking down PDCD4 can ameliorate ELS-induced synaptic plasticity damage. Mechanically, the knockdown of PDCD4 exerts neuroprotective effects, possibly via the mediation of BDNF/AKT/CREB signaling. Combined, these results suggest that PDCD4 may play an important role in the ELS-induced susceptibility to depression and, thus, may become a therapeutic target for depressive disorders.

Risk of VMAT2 inhibitors on suicidality and parkinsonism: report utilizing the United States Food and Drug Administration adverse event reporting system.

Prescription of vesicular monoamine transporter 2 (VMAT2) inhibitors, valbenazine, deutetrabenazine, and tetrabenazine, is becoming increasingly common in persons treated with antipsychotics. Reported suicidality and parkinsonism are safety concerns with VMAT2 inhibitors. Herein, we aim to evaluate the aforementioned safety outcomes using the FDA Adverse Event Reporting System. Reporting odds ratios (RORs) and lower limits of 95% confidence intervals of information components (IC025) were calculated to quantify VMAT2 inhibitor-associated adverse events. Acetaminophen was the reference agent. Suicidal ideation was significantly associated with VMAT2 inhibitors, with RORs ranging from 2.38 to 10.67 and IC025 ranging from 0.73 to 2.39. Increased odds of suicidal behavior was observed with tetrabenazine (ROR 3.011, IC025 0.0087), but not deutetrabenazine or valbenazine. Decreased odds of suicide attempts and completed suicide were observed with VMAT2 inhibitors, with RORs ranging from 0.011 to 0.10 (all IC025 < 0). Increased odds of parkinsonism were reported for all VMAT2 inhibitors, with RORs and IC025 ranging from 19.49 to 25.37 and 1.66 to 2.93, respectively. The mixed results with VMAT2 inhibitor-associated suicidality and parkinsonism do not establish causal relationships. The parameters of suicidality may be explained by underlying psychiatric disorders.

Effects of cannabidiol and Δ9-tetrahydrocannabinol on cytochrome P450 enzymes: a systematic review.

Due to legal, political, and cultural changes, the use of cannabis has rapidly increased in recent years. Research has demonstrated that the cannabinoids cannabidiol (CBD) and Δ9-tetrahydrocannabinol (THC) inhibit and induce cytochrome P450 (CYP450) enzymes. The objective of this review is to evaluate the effect of CBD and THC on the activity of CYP450 enzymes and the implications for drug-drug interactions (DDIs) with psychotropic agents that are CYP substrates. A systematic search was conducted using PubMed, Scopus, Scientific Electronic Library Online (SciELO) and PsychINFO. Search terms included 'cannabidiol', 'tetrahydrocannabinol', and 'cytochrome P450'. A total of seven studies evaluating the interaction of THC and CBD with CYP450 enzymes and psychotropic drugs were included. Both preclinical and clinical studies were included. Results from the included studies indicate that both CBD and THC inhibit several CYP450 enzymes including, but not limited to, CYP1A2, CYP3C19, and CYP2B6. While there are a few known CYP450 enzymes that are induced by THC and CBD, the induction of CYP450 enzymes is an understudied area of research and lacks clinical data. The inhibitory effects observed by CBD and THC on CYP450 enzymes vary in magnitude and may decrease the metabolism of psychotropic agents, cause changes in plasma levels of psychotropic medications, and increase adverse effects. Our findings clearly present interactions between THC and CBD and several CYP450 enzymes, providing clinicians evidence of a high risk of DDIs for patients who consume both cannabis and psychotropic medication. However, more clinical research is necessary before results are applied to clinical settings.

Evaluation of activities and instrumental activities of daily living and correlated factors of traumatic brain injury patients in Vietnam.

Traumatic brain injury (TBI) is among the leading causes of death in Vietnam. Survivors of TBI suffer from functional and cognitive deficits. Understanding that Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs) are crucial in measuring the treatment and health-related quality of life among patients with TBI. This study aims to evaluate ADLs and IADLs among the TBI population in Vietnam and determine the correlated factors to these two indices. A cross-sectional study was conducted on 212 patients with TBI in Vietnam from February to September 2020. ADLs and IADLs scales were applied. Depression, quality of sleep, and social support scales were used. Multivariate Tobit regression was adopted to identify factors associated with ADLs and IADLs. Patients who received first aid had higher ADLs scores than those who had not, by a statistical difference with a p value = 0.04. The mean ADLs score was 5.4 (SD = 1.4). The mean score of IADLs was 7.3 (SD = 1.7). Female patients (Mean = 7.6, SD = 1.1) performed better in IADLs than male patients (Mean = 7.1, SD = 1.9). Both ADLs and IADLs were affected strongly by depression and Injury Severity scores (p < 0.01), whereas IADLs were significantly correlated to caregiver types and quality of sleep (p < 0.01). Family support was observed as a negatively correlated factor to IADLs. Findings from the study provided evidence for authorities to adjust the health strategies among patients with TBI. Proper prehospital care, a basic low-cost hospital care model, and mental health counseling services should be considered when developing health interventions in Vietnam.

Preferences for childbirth delivery and pain relief methods among pregnant women in Vietnam.

Background: Understanding childbirth delivery and pain relief method preferences is important as a part of the shared decision-making process between pregnant women and health professionals. This study aimed to examine the preferences for childbirth delivery modes and pain relief methods and factors related to these preferences among pregnant women in Vietnam. Methods: A cross-sectional survey on pregnant women was conducted in two obstetrics hospitals in Vietnam. Face-to-face interviews using a structured questionnaire were performed to collect information about sociodemographic characteristics, pregnancy characteristics, preferences for different childbirth delivery modes, and pain relief methods. Multivariate logistic regression was employed for determining associated factors with the preferences. Results: Of 576 pregnant women, 34% of participants preferred cesarean section. Most of the sample did not have any preferences for specific pharmacological pain relief methods (70.1%), while support from partner/relatives was the most preferable non-pharmacological method (61.3%), following by water birth (11.1%) and acupuncture (9.9%). Desire to have another baby, relatives' experience, selection date of birth, and instrumental social support were major drivers of the cesarean section selection. This preference was an important factor in the preference for pharmacological pain relief. Meanwhile, high levels of informational and emotional support were associated with non-pharmacological method preference. Conclusion: This study highlighted a high preference rate for cesarean section in urban pregnant women in Vietnam. Holistic approaches from family, health facility, and policy should be performed to diminish the cesarean rate preference and promote the use of non-pharmacological pain relief methods during birth.

Early life stress enhances the susceptibility to depression and interferes with neuroplasticity in the hippocampus of adolescent mice via regulating miR-34c-5p/SYT1 axis.

Early life events are major risk factors for the onset of depression and have long-term effects on the neurobiological changes and behavioral development of rodents. However, little is known about the specific mechanisms of early life adversity in the susceptibility to subsequent stress exposure in adolescence. This study characterized the effect of maternal separation (MS), an animal model of early life adversity, on the behavioral responses to restraint stress in mice during adolescence and investigated the molecular mechanism underlying behavioral vulnerability to chronic stress induced by MS. Our results showed that MS exposure could further reinforce the depressive vulnerability to restraint stress in adolescent mice. In addition, miR-34c-5p expression was obviously up-regulated in the hippocampi of MS mice at postnatal day (P) 14 and P42. Further, synaptotagmin-1 (SYT1) was deemed as a target gene candidate of miR-34c-5p on the basis of dual luciferase assay. It was found that the downregulation of miR-34c-5p expression in the hippocampi of MS mice could ameliorate dysfunction of synaptic plasticity by targeting molecule SYT1, effects which were accompanied by alleviation of depressive and anxious behaviors in these mice. The results demonstrated that the miR-34c-5p/SYT1 pathway was involved in the susceptibility to depression induced by MS via regulating neuroplasticity in the hippocampi of mice.

Emotional urgency predicts bipolar symptoms, severity, and suicide attempt better than non-emotional impulsivity: a cross-sectional study.

Introduction: Emotional urgency is an emotion-based subdimension of trait impulsivity that is more clinically relevant to psychopathology and disorders of emotion dysfunction than non-emotional subdimensions (i.e., lack of perseverance, sensation seeking, lack of premeditation). However, few studies have examined the relative effects of emotional urgency in bipolar disorder. This cross-sectional study aimed to establish the clinical relevance of emotional urgency in bipolar disorders by (1) explicating clinically relevant correlates of emotional urgency and (2) comparing its effects against non-emotional impulsivity subdimensions. Methods and results: A total of 150 individuals with bipolar disorder were recruited between October 2021 and January 2023. Zero-order correlations found that emotional urgency had the greatest effect on bipolar symptoms (r = 0.37 to 0.44). Multiple two-step hierarchical regression models showed that (1) positive urgency predicted past manic symptomology and dysfunction severity (b = 1.94, p < 0.001 and 0.35 p < 0.05, respectively), (2) negative urgency predicted current depression severity, and (3) non-emotional facets of impulsivity had smaller effects on bipolar symptoms and dysfunction by contrast, and were non-significant factors in the final step of all regression models (b < 0.30, ns); Those who had a history of attempted suicide had significantly greater levels of emotional urgency (Cohen's d = -0.63). Discussion: Notwithstanding the study's limitations, our findings expand status quo knowledge beyond the perennial relationship between non-emotion-based impulsivity and bipolar disorder and its implications.

Economic burden and financial vulnerability of injuries among the elderly in Vietnam.

Falls are a leading cause of death among elderly people. However, research on the cost of fall-related injuries is limited in Vietnam. We estimated treatment costs and associated factors among 405 elderly patients in Thai Binh hospitals. Costs were estimated through self-reported data on medical and non-medical expenses. Logistic regression and GLM were used to identify payment and affordability factors. Inpatient and outpatient care costs for fall-related injuries were US$98.06 and US$8.53, respectively. 11.85% of participants couldn't pay for treatment. Payment ability and cost decline were linked to family income, medical history, and hospital stay length. Elderly with fall-related injuries in Vietnam experienced high costs and severe health issues. Primary healthcare services and communication campaigns should be strengthened to reduce disease burden and develop effective fall injury prevention strategies.

Preference and willingness to pay for reproductive health services among adults in Urban-Rural transition settings of a developing country: evidence from a cross-sectional study in a rural district of Hanoi, Vietnam.

BACKGROUND: Since the introduction of fee-for-service models in public hospitals and the legalization of private health services in Vietnam in 1989, the price of reproductive health services has risen. These changes have exacerbated inequities in accessing reproductive health services. This study examines potential disparities in willingness to pay for reproductive health services among adults in a rural district of Hanoi. METHODS: A cross-sectional study was conducted at 9 communes in Thanh Oai district, a rural district of Hanoi, Vietnam, in July 2019. Face-to-face interviews were conducted using a structured questionnaire to collect self-reported data. The contingent valuation was used to examine willingness to pay for reproductive health services with a starting price of 2 million VND (~ US$86.2, July 2019 exchange rate), which is the average price of all RHS in public facilities in Vietnam. Multiple Logistic regression and Multiple Interval regression models were used to identify factors associated with willingness to pay and the amount that people were willing to pay for reproductive health services. RESULTS: Among 883 participants, this study found 59.1% of them willing to pay for reproductive health services at an average maximum amount of US$36.2, significantly less than the current average price of US$86.2. Occupation, number of sex partners, perception towards the necessity of reproductive health services, and prior use of reproductive health services were found to significantly influence willingness to pay for reproductive health services, while age, income level, gender, occupation, perception towards the necessity of reproductive health services and prior use of reproductive health services were reportedly correlated with the amount participants were willing to pay for reproductive health services. CONCLUSION: Lower willingness to pay for reproductive health services compared to the current prices (US$36.2 vs. US$86.2) is likely related to an overall low awareness of the necessity of reproductive health services, and future education campaigns should specifically target those from lower-income backgrounds. Financial subsidization should also be provided, especially for those from the low-income group, to ensure equitable access to reproductive health services. Given the heterogeneity of reproductive health services, further studies should examine the willingness to pay for each type of service independently.

Toward sustainable development goals in gender inequality: an analysis of gender preferences among urban pregnant women in a Southeast Asian country.

BACKGROUND: Gender-biased discrimination and preferences are global phenomena, particularly son preferences. However, updated evidence about this issue in Vietnam has not yet been provided. Therefore, this study aimed to examine the gender preferences among pregnant women and identify associated factors of such preferences. METHODS: A cross-sectional survey was conducted in two hospitals in Vietnam with 732 pregnant women. Gender preferences for their child were asked, along with socio-demographic (e.g., education, occupation) and pregnancy characteristics (e.g., pressure to have a son, gender of first child, the importance to have a son of family members, and information sources on pregnancy care) by using face-to-face interviews and a structured questionnaire. Multinomial logistic regression was performed to determine factors associated with gender preferences. RESULTS: About 51.9% of the participants had no gender preference, while, among those who had a gender preference, 26.5% preferred sons, and 21.6% preferred daughters. Only 6.2% had pressure to have a son. Having the first child who was female (OR = 4.16, 95%CI = 1.54-11.25), having the pressure to have a son (OR = 6.77, 95%CI = 2.06-22.26), and higher self-perceived importance to have a son (OR = 3.05, 95%CI = 1.85-5.02) were positively associated with son preference. Otherwise, women having partners with high school education or above (OR = 2.04, 95%CI = 1.06-3.91), living with parents-in-law (OR = 2.33; 95%CI = 1.25-4.34), the higher number of pregnancies, and a higher degree of importance in having a son regarding parents-in-law (OR = 2.15, 95%CI = 1.38-3.35) associated with higher odds of preferring daughter. CONCLUSION: This study showed that gender preference was common among pregnant women, but the pressure to have a son was low. Further education programs and legal institutions should be implemented to improve gender inequality and gender preference in society.

Impact of interventions on the quality of life of cancer patients: a systematic review and meta-analysis of longitudinal research.

The impact of cancer interventions has been conducted in several research due to the significant burden of this non-communicable disease. The interventions that played an important role in the improvement of the patient's quality of life (QoL) and health-related quality of life (HRQL) can be classified into two main groups: pharmaceutical and non-pharmacological methods. However, studies so far often analyze a specific group of interventions for specific types of cancer. Thus, in this systematic review and meta-analysis, we synthesized the overall impact of cancer interventions on patients' quality of life in several cancers.In this research, we followed the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) to search the longitudinal original research on the Web of Science (WOS) database. After that, the Newcastle-Ottawa Scale (NOS) and Jadad Scale were used to assess the quality of non-randomized control trials and randomized control trials, respectively. Then, the characteristics of the included studies were described in the six main fields table and the random effect model with robust estimation was applied to analyze the impact of interventions on the health utility of patients.From the database, 122 longitudinal original research were included in the meta-regression, with most of them having high or fair quality. The European Organization for the research and treatment of cancer scale for quality of life (EORTC-QLQ) was the most used health utility measurement at 65.15%. In the adjusted effect models, the Visual Analogue Scale (VAS) had significant statistics in all models when we compared it with the EQ-5D Scale (p < 0.05) and several types of cancer such as breast, lung, and prostate cancer had significant statistics when comparing with hematological cancer in the model types of cancer (p < 0.01). Moreover, radiotherapy, screening, and a combination of chemotherapy and best supportive care also had significant statistics (p < 0.01) in the model of interventions when compared with radiotherapy applied only. Our research can suggest a vital combination of both pharmaceutical and non-pharmacological interventions to improve the quality of life of some common types of cancer patients.

Social and Economic Impacts of COVID-19 Among Health Professionals in Vietnam: Status and Associations with Quality of Life and Sleep Quality.

PURPOSE: The COVID-19 pandemic has transformed the way of life of many individuals, especially those working at the frontlines, such as healthcare workers. Our study aims to examine the impact of COVID-19 on the socio-economic status, quality of life, and sleep quality when Vietnam was experiencing the 4th wave of the COVID-19 pandemic. METHODS: A cross-sectional study was conducted on 604 healthcare workers using snowball sampling from October through to November 2021. Our study examined the impact of the government's COVID-19 prevention policy including personal protective measures (5K measures), directive 15, directive 16, and directive 16 plus. The EQ-5D-5L and EQ-VAS were used to measure health-related quality of life and a scale of 1 to 10 was used to rate sleep quality of healthcare workers. RESULTS: A total of 604 respondents, most people were female (57.9%), and working as civil servants (75.3%). Very few participants were able to increase their earnings during the pandemic. Participants who did not have monthly allowance amounts had the highest proportion (60.1%), followed by those under 2 million VND (21.2%). In the univariate regression model, people with high government policy scores tend to have lower quality of life and sleep quality scores. In addition, in the multivariable regression model, people with high scores on government policies tend to have lower quality of life (EQ-5D) scores. CONCLUSION: The COVID-19 prevention measures had a negative impact on quality of life, sleep quality, and daily demands of healthcare workers. These findings should help guide future policy implementations.

Factors correlated with neuropathic pain among industrial workers in Vietnam: a multi-site cross-sectional study.

Introduction: Neuropathic pain is a debilitating condition resulting from various etiologies such as diabetes, multiple sclerosis, and infection, and is associated with decreased quality of life, poor health outcomes, and increased economic burden. However, epidemiological studies on neuropathic pain have been largely limited in Vietnam. Methods: A cross-sectional study was conducted on adult Vietnamese industrial workers across three manufacturing plants. Demographic, socioeconomic, occupational and health data were collected. Prevalence of neuropathic pain was assessed using the Douleur Neuropathique 4 (DN4) scale. Regression modeling was utilized to identify predictors of pain. Results: Among 276 workers, 43.1 and 24.3% reported that they had suffered from spinal pain and osteoarthritis pain, respectively. In terms of work conditions, people maintaining constant posture when working from 30 to 60 min (OR = 3.15, 95% CI = 1.07; 9.29), or over 60 min (OR = 2.59; 95% CI = 1.12; 5.98) had a higher risk of suffering from spinal pain. People who worked in conditions lacking adequate lighting and with exposures to toxic chemicals were also likely to be suffering from osteoarthritis pain with OR = 4.26, 95% CI = 1.02; 17.74 and Coef. = 1.93; 95% CI = 1.49; 2.50, respectively. Regular health examinations and higher expenditure for healthcare were correlated with a lower prevalence of neuropathic pain. Discussion: These results may inform the adoption of pain screening and other programs that increase health care access for this population, as well as more stringent occupational health and safety standards.

Psychological impacts of COVID-19 on Vietnamese health workers over the prolonged restricted COVID-19 responses: a cross-sectional study.

OBJECTIVE: We assessed the psychological impact posed by COVID-19 and its associated factors on the healthcare workforce nationwide during the peak of Vietnam's fourth outbreak. DESIGN: A cross-sectional study. SETTING: Our study was conducted in 61 provinces of Vietnam. METHODS: A total of 2814 healthcare professionals in 61/63 provinces of Vietnam. An online questionnaire using Patient Health Questionnaire-9 (PHQ-9), Perceived Stress Scale-4 (PSS-4) and Generalised Anxiety Disorder-7 (GAD-7) scales was distributed randomly to a subgroup of 503 respondents. PRIMARY AND SECONDARY OUTCOME MEASURES: To determine the impact of COVID-19 on the psychological of health workers, we conducted analyses to test a primary hypothesis related to participants based on three main scales including PHQ-9, PSS-4 and GAD-7 scales. RESULTS: Nearly half (49.7%) of healthcare workers experienced mild depression symptoms, 34.0% underwent moderate anxiety symptoms and 49.3% reported high-stress levels. Respondents who had a monthly income below 5 million VND (~US$212) and had more than 3 days of duty per week had a higher score on the anxiety scales. Compared with medical doctors, nurses/midwives had lower PHQ-9 (Coef=-2.53; 95% CI=-3.71 to -1.36) and GAD-7 scores (Coef=-2.36; 95% CI=-3.56 L to -1.16). Increased workload and work time was the harmful factor that increase the PHQ-9, GAD-7 or PSS-4 scores. More than half (53.9%) of respondents stated no demand for mental healthcare services. CONCLUSIONS: Health workers who gained less financial rewards are reported to have higher levels of mental distress than others, implying the need for a raise in basic salary as well as compensation and encouragement schemes. To tackle hesitancy in seeking mental help, integrating online mental health therapy with e-health consultations via social media can be strategically implemented to augment service delivery, and simultaneously enhance the standard of mental health services.

Clinical efficacy and safety of Zuranolone (SAGE-217) in individuals with major depressive disorder.

Major depressive disorder (MDD) is a common mental disorder with a high rate of morbidity and mortality. Dysfunctional signaling of gamma-aminobutyric acid (GABA) has been implicated in some studies in the etiology of MDD. Zuranolone (SAGE-217) is a novel, oral neuroactive steroid and an investigational positive allosteric modulator of synaptic and extrasynaptic GABAA receptors. Herein, we aimed to evaluate the efficacy and safety of Zuranolone in individuals with MDD. We reviewed seven studies including 1662 participants with MDD. Zuranolone was investigated as an oral, once-daily, 14-day treatment course. The results of our synthesis indicate that the antidepressant effects of Zuranolone are rapid, clinically meaningful, and replicated across multiple randomized clinical trials. In addition to replicated efficacy, Zuranolone is associated with an acceptable level of treatment-emergent adverse events and discontinuation without serious adverse events. It is believed that Zuranolone's antidepressant effects arise from its ability to enhance inhibitory GABAergic signaling by increasing synaptic and extrasynaptic GABAA activity and regulation of GABAA receptor expression. Taken together, preliminary evidence suggests the potential for antidepressant effects of Zuranolone. Zuranolone has been approved by FDA for postpartum depression, and is showing efficacy in major depressive disorder. Future research vistas should seek to determine the durability of this treatment approach as well as its effects on domain-specific outcomes (e.g., anhedonia, circadian rhythm, arousal systems) along with application in other diagnostic entities (e.g., bipolar depression).

Prevalence and impacts of self-medication in a disadvantaged setting: the importance of multi-dimensional health interventions.

Background: Self-medication is recognized as an effective form of treatment and is increasingly encouraged to treat minor illnesses. However, misuse of self-medication leaves devastating impacts on human health and causes antimicrobial resistance. Using medication without a prescription among farmers could cause more severe effects on their health than non-farm workers since they suffer from several occupational hazards such as excessive exposure to pesticides. Methods: A cross-sectional study was conducted in 197 residents living in Moc Chau from August to September. A structured questionnaire and face-to-face were used to collecting data. The multivariate logistic model was applied to indicate associated factors with the self-medication. Results: The prevalence of self-medication among farmers was 67%. Pain relievers (66.7%) and antibiotics (32.5%) were the types of medicines that were the most commonly purchased and used without a medical prescription. Ethnics and health status also significantly affected the self-medication practice as well as the purchase and use of antibiotics. The distance to travel to a medical center and the dangerous or difficult travel, participants with arthritis or inpatient treatment had significantly associated with buying and using the medicine and antibiotics without the medical prescription of farmers. Conclusion: Our research highlights a considerably high prevalence of self-medication among farmers residing in the mountainous area of Vietnam. Individual factors such as ethnics, health status, distance to health centers, and dangerous or difficult travel were found to be related to the SM practice as well as the purchase and use of antibiotics. From that, the current study suggests interventions. For instance, official guidelines are needed to raise awareness and minimize the disadvantages of self-medication; and digital health technologies should be applied to reduce the gap in healthcare service between mountainous and other areas of Vietnam.