Coercion in Psychiatry: Exploring the Subjective Experience of Coercion Among Patients in Five Portuguese Psychiatric Departments.

The subjective experience of coercion may have a more significant impact on clinical outcomes than formal coercive measures. This study aimed to investigate the subjective experience of coercion among patients on admission in Portuguese psychiatric departments by assessing their perceived coercion, procedural justice, and negative pressures during admission. The study also investigated whether this subjective experience of coercion changed with time during admission, and the predictors of this change. Validated instruments, including the McArthur Admission Experience Survey (AES) and the Client Assessment of Treatment Scale, were used to collect information from 208 adults admitted to five public psychiatric inpatient departments in rural and urban regions of Portugal. About a third (32.24%, n = 49) of the sample had a legal involuntary admission status, while more than a third of them perceived their admission to be involuntary (40.13%, n = 61). The subjective experience of coercion was significantly higher among people who perceived their admission to be involuntary compared to people who perceived their admission to be voluntary (Median = 10, IQR = 5.5 vs. Median = 3, IQR = 6; p < 0.001). Satisfaction with their care was significantly inversely correlated with the subjective experience of coercion (p < 0.01). The changes in the subjective experience of coercion at the second assessment were predicted by the perceived admission status rather than the legal admission status, and the initial procedural justice (p < 0.05). The study findings highlight the importance of improving procedural justice in psychiatric admissions, regardless of the legal status of admission.

Central venous catheter-related right atrial thrombus in oncology patients: a case series of cardiovascular magnetic resonance studies.

Background: Patients with cancer are at an increased risk of thrombus formation, often identified on routine echocardiogram in the right atrium. The 2022 ESC Guidelines on Cardio-oncology emphasize cardiac magnetic resonance (CMR) as the gold standard for thrombus identification. Case summary: We present a case series of seven patients who underwent CMR due to right atrial mass suspected to result from central venous catheter-related right atrial thrombus. In all cases, CMR enabled accurate diagnosis of a thrombus. It also allowed to assess complete or partial resolution of the thrombi following anticoagulation on follow-up studies. Discussion: The presence of a central venous catheter is recognized as a risk factor for thrombus formation, particularly when inappropriately advanced into the right atrium. The integration of CMR into the diagnostic pathway enabled precise thrombus identification and guidance for treatment in this population with a complex balance between cancer-related thrombotic and haemorrhagic risks.

Responding to the needs of survivors of intimate partner violence in Lithuania: perceptions of mental health and social care professionals.

Around eight-out-of-ten survivors of domestic violence in Lithuania are women, and of those, eight-out-of-ten suffer violence specifically from their intimate partners (IPV). Women who experience IPV are at higher risk of having mental health conditions. This study aims to explore the perspectives of mental health and social care professionals regarding the provision of mental health support to IPV survivors in Lithuania. Four focus groups were conducted among 29 service providers from across the country. Audio-recordings were transcribed verbatim and analyzed thematically using MAXQDA software. The five main themes derived from the analysis reveal: 1) low levels of IPV awareness among IPV survivors who seek support with their mental health; 2) a lack of specialized training among professionals as a barrier to effective support; 3) a low prioritization on the national level; 4) little inter-sectoral collaboration which undermines the complexity of needed responses; 5) broader systemic problems. The provision of mental health support to IPV survivors lacks the recognition that IPV is gender-based violence and a major public (mental) health problem. The complexity of needed services is absent. Further research needs to explore the utilization of mental health services by IPV survivors and their perceptions concerning it.

Impact of passive ultrasonic irrigation on the outcome of non-surgical root canal treatment: a systematic review and meta-analysis of randomized clinical trials.

OBJECTIVE: This systematic review aimed to assess the impact of Passive Ultrasonic Irrigation on the periapical healing rate of primary root canal treatment compared to conventional syringe irrigation. METHODS: Registered a priori in the PROSPERO database, this review was conducted by two independent reviewers who performed an electronic search up to December 2023. The search included databases such as MEDLINE (PubMed), Scopus, Web of Science, Embase, LILACS, and the Cochrane Library, as well as grey literature. We included randomized clinical trials (RCTs) that focused on patients undergoing primary root canal treatments. The study compared intervention groups using PUI with control groups that did not use activation techniques. Periapical healing was assessed over follow-up periods of at least six months, utilizing either periapical radiographs or cone-beam computed tomography. To synthesize the findings, a meta-analysis and trial sequence analysis were conducted, employing the Relative Risk as the measure of effect, with a 95% confidence interval. The GRADE approach was utilized to assess the certainty of the evidence. RESULTS: The meta-analysis incorporated three RCTs, involving 474 patients (501 teeth). The analysis revealed that PUI led to a higher rate of periapical healing compared to CSI (Relative Risk: 1.10; 95% Confidence Interval: 1.01-1.21, I² = 0%), with moderate certainty of evidence. CONCLUSIONS: Despite the limited number of high-quality RCTs, the findings showed a positive impact of PUI on periapical healing rates in primary root canal treatments, in comparison to CSI. REGISTER: CRD42021290894.

Effects of high-intensity interval training on subjective sleep quality and daytime sleepiness in patients with obstructive sleep apnea: A secondary analysis from a randomized controlled trial.

This study aimed to verify the effect of 12 weeks of HIIT on the perceived sleep quality and excessive daytime sleepiness in patients with obstructive sleep apnea (OSA). For this, a secondary analysis of a randomized controlled trial, including 36 adults with moderate-severe OSA (19 males; 52.2 ± 9.8 years; body mass index = 34.2 ± 5.8; AHI = 42.0 ± 22.9 e/h) was performed. Participants were randomly assigned to HIIT [5 periods of 4 min of walking or running on a treadmill at 90-95 % of maximum heart rate (HRmax) interspersed with 3 min of walking at 50-55 % of HRmax performed three times per week for 12 weeks] or a control group (CG; stretching exercises performed two times per week for 12 weeks). Specific domains of subjective sleep quality and EDS were assessed at baseline and post 12 weeks. Generalized estimated equation were used to verify between groups and times differences. There were no group × time interactions for the domains sleep duration (0.416), sleep efficiency (0.198), sleep disturbance (0.523), and sleep medications (0.915). However, significant group × time interactions were observed for global sleep score (0.022), and for the domains sleep quality (0.001), sleep latency (0.029), and daytime dysfunction (0.012). In addition, there was a significant group × time interaction for EDS (HIIT = -3.4 ± 0.9; CG change = -1.0 ± 1.0; p = 0.023). Thus, in patients with OSA, 12 weeks of HIIT improves perceived sleep quality and daytime sleepiness.

Internet Gaming Disorder and the Incidence of Suicide-Related Ideation and Behaviors in College Students.

OBJECTIVES: The longitudinal associations between DSM-5 Internet Gaming Disorder (IGD) and suicide-related ideation and behaviors have not been explored. In this study, we therefore seek to examine the association between baseline IGD and incident suicide ideation, plans, and attempts. METHODS: This is a prospective cohort study of 2586 Mexican college students followed up from September 2018 to June 2022. We estimated hazards ratios modeling incidence of suicide ideation, plans, and attempts by fitting proportional hazards Cox models with person-time scaled in years. RESULTS: Among 2140 students without suicide ideation at baseline, there were 467 incident cases in 3987.6 person-years; ideation incidence rates were 179 cases per 1000 person-years among students with IGD and 114 cases per 1000 person-years among those without IGD. Incidence rates for suicide plans were 67 and 39 per 1000 among IGD and non-IGD students, and 15 and 10 per 1000, respectively for attempts. After controlling for age, sex, and mood, anxiety, and substance use disorders, IGD was associated with an 83% increased risk of suicide ideation. Although incidence rate estimates for plans and attempts were higher among students with IGD, results were not statistically significant. CONCLUSIONS: This study helps to raise awareness of the increased risk of at least suicidal ideation in people experiencing IGD. Clinicians treating patients with IGD may encounter complaints of suicide ideation over time, and even reports of suicidal behavior that should not be disregarded. Identifying these patients and treating/referring them for underlying suicidality should form part of IGD treatment.

Genome-wide association analyses identify 95 risk loci and provide insights into the neurobiology of post-traumatic stress disorder.

Post-traumatic stress disorder (PTSD) genetics are characterized by lower discoverability than most other psychiatric disorders. The contribution to biological understanding from previous genetic studies has thus been limited. We performed a multi-ancestry meta-analysis of genome-wide association studies across 1,222,882 individuals of European ancestry (137,136 cases) and 58,051 admixed individuals with African and Native American ancestry (13,624 cases). We identified 95 genome-wide significant loci (80 new). Convergent multi-omic approaches identified 43 potential causal genes, broadly classified as neurotransmitter and ion channel synaptic modulators (for example, GRIA1, GRM8 and CACNA1E), developmental, axon guidance and transcription factors (for example, FOXP2, EFNA5 and DCC), synaptic structure and function genes (for example, PCLO, NCAM1 and PDE4B) and endocrine or immune regulators (for example, ESR1, TRAF3 and TANK). Additional top genes influence stress, immune, fear and threat-related processes, previously hypothesized to underlie PTSD neurobiology. These findings strengthen our understanding of neurobiological systems relevant to PTSD pathophysiology, while also opening new areas for investigation.

Epidemiological profile of luxations injuries with or without dental fractures in permanent teeth: A 10-years retrospective study.

BACKGROUND/AIM: This study assessed the epidemiology of luxation injuries with or without dental fractures in patients attending the outpatient clinic of a Brazilian dental school over the past decade. MATERIAL AND METHODS: We reviewed clinical records from a specialized center for dental trauma care in Brazil, focusing on patients who experienced at least one traumatic dental injury (TDI) in a permanent tooth between 2012 and 2022. The extracted data included sex, age, etiology, time between trauma occurrence and the search for initial care, TDI classification, and the need for endodontic treatment. The statistical analysis involved Pearson's chi-squared and Fisher's exact tests at a 5% significance level. RESULTS: The 366 analyzed clinical records included 166 patients (350 teeth) with luxation injuries. Men (n = 102) showed a higher prevalence of luxation injuries than women (n = 64). Extrusive luxation prevailed (n = 99 patients and 208 teeth). Patients with luxation injuries sought care promptly after dental trauma incidents (p = .02) and demonstrated a higher incidence of endodontic treatment (p < .0001) than those without luxation injuries. Lateral luxation was notably associated with traffic accidents (p < .0001). The combination of luxation injuries and tooth fractures did not correlate with a higher need for endodontic treatment (p > .05). CONCLUSIONS: Age and trauma etiology seemed to have influenced the epidemiological profile of luxation injuries. Additionally, these injuries affected the time to seek initial care and the need for endodontic treatment.

The multimodality cell segmentation challenge: toward universal solutions.

Cell segmentation is a critical step for quantitative single-cell analysis in microscopy images. Existing cell segmentation methods are often tailored to specific modalities or require manual interventions to specify hyper-parameters in different experimental settings. Here, we present a multimodality cell segmentation benchmark, comprising more than 1,500 labeled images derived from more than 50 diverse biological experiments. The top participants developed a Transformer-based deep-learning algorithm that not only exceeds existing methods but can also be applied to diverse microscopy images across imaging platforms and tissue types without manual parameter adjustments. This benchmark and the improved algorithm offer promising avenues for more accurate and versatile cell analysis in microscopy imaging.

New-onset diabetes after kidney transplantation: Assessing urinary Wilm's tumor-1 protein to predict renal allograft dysfunction.

PURPOSE: New-onset diabetes after transplantation (NODAT) is a frequent metabolic complication associated with podocyte damage and renal allograft dysfunction. Thus, Wilm's tumor-1 (WT-1) protein, as a podocyte marker, holds promise as an option to evaluate renal allograft dysfunction in NODAT. Therefore, the study aimed to investigate urinary WT-1 levels in NODAT patients during the first year after kidney transplantation (KTx). MATERIALS AND METHODS: KTx patients were categorized into non-NODAT and NODAT groups. Fasting blood glucose, glycated hemoglobin (HbA1c), urinary albumin/creatinine ratio (ACR), serum creatinine, estimated glomerular filtration rate (eGFR), and urinary WT-1 were measured at 3, 6, 9, and 12-months post-KTx. RESULTS: The NODAT group manifested elevated levels of blood glucose and HbA1c during the first year post-KTx. Also, exhibited elevations in ACR and serum creatinine levels at 6, 9, and 12-months post-KTx when compared to non-NODAT group. Conversely, eGFR values in the NODAT group demonstrated significant declines at 3, 6, and 9-months post-KTx relative to non-NODAT. Furthermore, NODAT group exhibited a median annual eGFR of 47 â€‹mL/min/1.73 â€‹m2. Urinary WT-1 levels at 3, 6, 9, and 12-months post-KTx were significantly higher in the NODAT group compared to non-NODAT. Additionally, noteworthy positive correlations were identified between urinary WT-1 and HbA1c levels, along with significant negative correlations between urinary WT-1 and eGFR at the 3, 6, 9, and 12-months post-KTx. CONCLUSION: The increased urinary WT-1 levels from 3-months post-KTx in NODAT patients may indicate the first sign of podocyte injury, predicting a renal allograft dysfunction in these patients.

Prevalence and acceptability of psychological and/or economic intimate partner violence, and utilization of mental health services by its survivors in Lithuania.

BACKGROUND: Lithuania has one of the highest averages in the European Union when it comes to psychological and/or economic intimate partner violence (PE-IPV). IPV survivors are several times more likely to have mental health conditions than those without IPV experiences. The aim of this article is to study the prevalence, characteristics and attitudes of PE-IPV survivors in Lithuania, and the predictors of them accessing mental health services. METHODS: A cross-sectional study based on a national survey representative of the adult population. The survey was implemented by a third-party independent market research company employing an online survey panel. Logistic regression models were used in the analysis. RESULTS: Almost 50% of women in Lithuania experience PE-IPV. Females are significantly more likely to experience it than males. The vast majority of women find PE-IPV unacceptable; however, only one-third of survivors seek any type of help. Only one-tenth approach mental health services, with divorcees being at higher odds of doing so. CONCLUSIONS: Further research is needed to explore predictors and contextual factors of why IPV survivors seek mental healthcare, or not. Policy implications include the need to eliminate IPV and mental health stigma; develop accessible mental health services and effective treatment approaches.

Mental health conditions and utilisation of mental health services by survivors of physical intimate partner violence in Portugal: Results from the WHO world mental health survey.

The aim of this article is to study mental health conditions among survivors of severe physical intimate partner violence (IPV) and their utilisation of mental health services. This study is an integrated part of the World Mental Health Survey Initiative-Portugal, for which data was collected from a nationally representative adult sample using well-validated scales. Logistic regression models were used in the analysis. The most common statistically significant mental health conditions among IPV survivors were suicide ideation, PTSD, major depressive episode, and generalised anxiety disorder. More than one in three survivors developed PTSD. Suicide ideation was likely to occur after first experiencing IPV. Almost a half of survivors received specialised mental health treatment; in most cases, delivered by a psychiatrist. Over 60 % addressed their mental health issues consulting general physicians or other healthcare professionals. Those who experienced family violence in childhood had greater odds of also experiencing IPV; survivors of IPV with this experience were more likely to receive mental health treatment. The need to promote greater awareness and competencies of not only mental health professionals but also of general physicians and other healthcare professionals to provide support more effectively to survivors of any type of IPV deserves to be emphasised.

Hospitalisations and fatality due to respiratory diseases according to a national database in Brazil: a longitudinal study.

BACKGROUND: Respiratory diseases (RDs) cause millions of hospitalisations and deaths worldwide, resulting in economic and social impacts. Strategies for health promotion and disease prevention based on the epidemiological profile of the population may reduce hospital costs. AIM: To characterise hospitalisations and deaths due to RDs in Brazilian adults above 20 years old between 2008 and 2021. METHODS: This ecological study used secondary data of hospitalisations and deaths due to RDs from the Hospital Information System of the Brazilian Unified Health System between 2008 and 2021. Data were grouped according to region, age group and sex. The period was divided into first (2008-2011), second (2012-2015) and third (2016-2019) quadrennia and one biennium (2020-2021), and all data were analysed using the GraphPad Prism; statistical significance was set at p<0.05. RESULTS: A total of 9 502 378 hospitalisations due to RDs were registered between 2008 and 2021. The south and southeast regions presented the highest hospitalisation and fatality rate, respectively, in the age group ≥80 years with no significant differences between sexes. Also, RDs caused 1 170 504 deaths, with a national fatality rate of 12.32%. CONCLUSION: RDs affected the Brazilian population and impaired the health system, especially the hospital environment. The south/southeast regions were the most affected, and the ageing process contributed to the increased incidence of RDs.

Revisiting the psychometric properties of the McArthur admission experience survey: Validating the Portuguese version using a bifactor approach.

Cultural factors play a significant role in shaping the perception of coercion during psychiatric admissions. The present study aimed to assess the psychometric properties of the Portuguese Admission Experience Survey(P-AES). The study employed a cross-sectional approach in five psychiatric departments in three regions of Portugal. A total of 208 patients participated in the survey. Reliability was assessed through internal consistency and test-retest procedures. Internal validity was analyzed using a two-parameter logistic item response model, exploring three models, including a bifactor model. Convergent validity was determined by correlating AES scores with the Coercion Ladder (CL), Client Assessment of Satisfaction (CAT), and Global Assessment of Functioning (GAF) scale. Discriminatory power was assessed by comparing scores between patients with voluntary and involuntary admission status. The P-AES demonstrated satisfactory internal consistency and test-retest reliability. The bifactor model exhibited superior fit compared to the one-factor and three-factor models. Correlations between P-AES and CL, as well as CAT scores, indicated good convergent validity. Additionally, P-AES scores were notably higher in patients with compulsory psychiatric hospital admission compared to those admitted voluntarily, confirming its discriminatory power. The bifactor model suggests that all three domains of the AES should be used to measure the subjective experience of coercion.

Outcome of curcumin-based photodynamic therapy in endodontic microsurgery: A case report.

INTRODUCTION: Persistent apical periodontitis after root canal treatment may require surgical retreatment when non-surgical options are ineffective or impractical due to anatomical challenges or iatrogenic errors. Endodontic microsurgery (EMS) is a precise technique that aims to overcome extraradicular biofilm and root morphology issues. Photodynamic therapy (PDT) is an emerging supplementary disinfection approach that utilizes a photosensitizer agent and light to eliminate microorganisms through oxidative reactions. REPORT: A 60-year-old male with persistent apical periodontitis in a left maxillary first molar underwent non-surgical root canal retreatment followed by surgical reintervention due to anatomical complexities. During surgery, PDT was performed using a novel curcumin-based photosensitizer agent. After the procedure, the tooth was retrofilled with bioceramic cement, and photobiomodulation was applied to enhance tissue healing. One year post-surgery, the patient exhibited complete periradicular repair and remained asymptomatic. DISCUSSION: EMS is considered a last resort to salvage an endodontically treated tooth and has shown moderate success rates. PDT has demonstrated promise in improving periapical healing and reducing microorganisms. In this case, curcumin, diluted with 2 % chlorhexidine gel, served as an effective photosensitizer agent with antimicrobial properties. Moreover, performing photobiomodulation aided in cell recovery and reduced postoperative discomfort. CONCLUSION: The proposed EMS treatment protocol with PDT using curcumin yielded positive outcomes in this case report. Further randomized clinical trials are necessary to assess the efficacy of this approach in EMS. Additionally, further research on curcumin-based photosensitizer agents encapsulated in nanoparticles and enhanced antimicrobial agents is recommended to refine this treatment protocol for routine use.

Use of coercion in mental healthcare services in Nigeria: Service providers' perspective.

BACKGROUND: There is increasing advocacy to reduce coercive practices in mental healthcare. Little research has been done on the topic in developing countries. AIMS: To explore what mental health professionals in Nigeria think about coercion, why it is used, and what contextual factors influence its use in mental healthcare services. METHODS: Semi-structured interviews were carried out with 16 doctors and 14 nurses from two psychiatric hospitals in two regions of Nigeria. The audio-recorded interviews were analyzed thematically with the aid of MAXQDA software. RESULTS: Three broad categories relating to the perception of, reasons for, and barriers/facilitators to the use of coercion were derived. Coercion was viewed as being for the best interests of patients, a means to an end, and effective for achieving desired outcomes. Safety was both a reason to use a coercive measure and a deterrent to using specific coercive measures thought to be unsafe. The socio-cultural context, obsolete mental health legislation, staff shortages, and attitudes were factors influencing the use of coercion in mental healthcare. CONCLUSION: Coercion was perceived to be ultimately beneficial in mental health practice. There is need for a new mental health legislation and more resources for mental health care in Nigeria to address the problem of coercion.

Effect of EDTA Activation on Blood Clot Structure in Regenerative Endodontics: A Scanning Electron Microscopy Study.

INTRODUCTION: EDTA plays a crucial role in regenerative endodontic therapy (RET) because of its significant biological effects. However, EDTA is also recognized as the preferred anticoagulant for hematologic tests. Thus, this study aimed to assess the influence of different EDTA activation techniques on the morphology of blood clots after conditioning the root canal dentin. METHODS: Forty extracted human teeth were prepared to simulate immature teeth and divided into the following 5 groups: (1) saline solution (negative control), (2) EDTA 17% + saline solution (CNI), (3) CNI + ultrasonic activation, (4) CNI + Easy clean activation, and (5) CNI + XP-endo Finisher activation. After irrigation, the roots were cleaved, and the root canals were filled with human blood to clot formation. The morphology and density of erythrocytes, platelets, and the fibrin network were observed using a scanning electron microscope. The fibrin network density was classified using a 4-point scale. Data were analyzed using the Friedman test and the Kruskal-Wallis test with Bonferroni adjustment (α = 5%). RESULTS: All groups exhibited consistent blood clot morphology characterized by a high density of erythrocytes, platelets, and white blood cells throughout the entire length of the root canal. The negative control group showed statistically significant high scores of fibrin density compared with the CNI group in all root thirds (P < .05). However, there was no statistical difference in the scores for the fibrin network density between the groups irrigated with EDTA with and without activation (P > .05). CONCLUSIONS: EDTA may impair the fibrin network formation compared with the saline group. However, EDTA activation did not significantly change the effects on the blood clot in contact with the conditioned intraradicular dentin.

Advancements in non-invasive imaging of atherosclerosis: Future perspectives.

Atherosclerosis is a chronic inflammatory disease characterized by the buildup of plaques in arterial walls, leading to cardiovascular diseases and high morbidity and mortality rates worldwide. Non-invasive imaging techniques play a crucial role in evaluating patients with suspected or established atherosclerosis. However, there is a growing body of evidence suggesting the need to visualize the underlying processes of plaque progression and rupture to enhance risk stratification. This review explores recent advancements in non-invasive assessment of atherosclerosis, focusing on computed tomography, magnetic resonance imaging, and nuclear imaging. These advancements provide valuable insights into the assessment and management of atherosclerosis, potentially leading to better risk stratification and improved patient outcomes.

Zero Tolerance for Coercion? Historical, Cultural and Organisational Contexts for Effective Implementation of Coercion-Free Mental Health Services around the World.

Coercion of service users/patients when receiving care and treatment has been a serious dilemma for mental health services since at least the 18th century, and the debate about how best to minimise or even eradicate compulsion remains intense. Coercion is now, once again and rightly, at the top of the international policy agenda and the COST Action 'FOSTREN' is one example of a renewed commitment by service user advocates, practitioners and researchers to move forward in seriously addressing this problem. The focus of service improvement efforts has moved from pure innovation to practical implementation of effective interventions based on an understanding of the historical, cultural and political realities in which mental health services operate. These realities and their impact on the potential for change vary between countries across Europe and beyond. This article provides a novel overview by focusing on the historical, cultural and political contexts which relate to successful implementation primarily in Europe, North America and Australasia so that policy and practice in these and other regions can be adopted with an awareness of these potentially relevant factors. It also outlines some key aspects of current knowledge about the leading coercion-reduction interventions which might be considered when redesigning mental health services.