Nuclei segmentation with point annotations from pathology images via self-supervised learning and co-training.

Nuclei segmentation is a crucial task for whole slide image analysis in digital pathology. Generally, the segmentation performance of fully-supervised learning heavily depends on the amount and quality of the annotated data. However, it is time-consuming and expensive for professional pathologists to provide accurate pixel-level ground truth, while it is much easier to get coarse labels such as point annotations. In this paper, we propose a weakly-supervised learning method for nuclei segmentation that only requires point annotations for training. First, coarse pixel-level labels are derived from the point annotations based on the Voronoi diagram and the k-means clustering method to avoid overfitting. Second, a co-training strategy with an exponential moving average method is designed to refine the incomplete supervision of the coarse labels. Third, a self-supervised visual representation learning method is tailored for nuclei segmentation of pathology images that transforms the hematoxylin component images into the H&E stained images to gain better understanding of the relationship between the nuclei and cytoplasm. We comprehensively evaluate the proposed method using two public datasets. Both visual and quantitative results demonstrate the superiority of our method to the state-of-the-art methods, and its competitive performance compared to the fully-supervised methods. Codes are available at https://github.com/hust-linyi/SC-Net.

Cultural adaptation of trauma-focused cognitive behavioral therapy for trauma-affected children in China.

OBJECTIVE: Trauma-focused cognitive behavioral therapy (TF-CBT) developed in the United States is one of the most widely used interventions for children with posttraumatic stress disorder. However, little information was provided about the cultural adaptation process when it was used in other countries. It was seldom adopted in East Asia. Furthermore, few studies adapted TF-CBT as a school-based intervention. This study was aimed at exploring the cultural fitness of TF-CBT in China and documenting the adaptation process. METHOD: In the present study, feedback from stakeholders, including seven mental health practitioners, ten caregivers, eight school staffs, and forty-five children, was collected through focus groups or individual interviews. The adaptations were made for TF-CBT based on these people's feedback. RESULTS: The results showed that it was necessary to make adaptations of TF-CBT. Even though most of the core components were culturally appropriate, some culturally specific factors were found, including the resistance to parental involvement, the lack of children's intentions and abilities to seek support, the difficulty in children's cognitive coping, and the strong stigmatization toward TF-CBT in communities. The present study made corresponding adaptations. It developed an adapted version of intervention "power up children's psychological immunity" based on TF-CBT. The new version of intervention included seven group sessions and three to five individual sessions. CONCLUSION: Cultural adaptation is crucial to promote the acceptance of TF-CBT among stakeholders, including trauma-affected children, caregivers, school principals, class teachers, and mental health practitioners. The adapted intervention may promote the implementation of it in China. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A study on predicting the length of hospital stay for Chinese patients with ischemic stroke based on the XGBoost algorithm.

BACKGROUND: The incidence of stroke is a challenge in China, as stroke imposes a heavy burden on families, national health services, social services, and the economy. The length of hospital stay (LOS) is an essential indicator of utilization of medical services and is usually used to assess the efficiency of hospital management and patient quality of care. This study established a prediction model based on a machine learning algorithm to predict ischemic stroke patients' LOS. METHODS: A total of 18,195 ischemic stroke patients' electronic medical records and 28 attributes were extracted from electronic medical records in a large comprehensive hospital in China. The prediction of LOS was regarded as a multi classification problem, and LOS was divided into three categories: 1-7 days, 8-14 days and more than 14 days. After preprocessing the data and feature selection, the XGBoost algorithm was used to build a machine learning model. Ten fold cross-validation was used for model validation. The accuracy (ACC), recall rate (RE) and F1 measure were used to evaluate the performance of the prediction model of LOS of ischemic stroke patients. Finally, the XGBoost algorithm was used to identify and remove irrelevant features by ranking all attributes based on feature importance. RESULTS: Compared with the naive Bayesian algorithm, logistic region algorithm, decision tree classifier algorithm and ADaBoost classifier algorithm, the XGBoot algorithm has higher ACC, RE and F1 measure. The average ACC, RE and F1 measure were 0.89, 0.89 and 0.89 under the 10-fold cross-validation. According to the analysis of the importance of features, the LOS of ischemic stroke patients was affected by demographic characteristics, past medical history, admission examination features, and operation characteristics. Finally, the features in terms of hemiplegia aphasia, MRS, NIHSS, TIA, Operation or not, coma index etc. were found to be the top features in importance in predicting the LOS of ischemic stroke patients. CONCLUSIONS: The XGBoost algorithm was an appropriate machine learning method for predicting the LOS of patients with ischemic stroke. Based on the prediction model, an intelligent medical management prediction system could be developed to predict the LOS based on ischemic stroke patients' electronic medical records.

Effectiveness of a school-based, lay counselor-delivered cognitive behavioral therapy for Chinese children with posttraumatic stress symptoms: a randomized controlled trial.

Background: Improving children's access to mental health services need more innovative solutions, especially in low- and middle-income countries. School-based psychosocial interventions delivered by lay counselors may be an efficient way to improve children's access to mental health services. But few studies were conducted to examine the effectiveness of these interventions. Therefore, this study is to evaluate the effectiveness of trauma-focused cognitive behavioral therapy (TF-CBT) in a group format delivered by lay counselors to children with trauma-related symptoms in China. Methods: A total of 234 children (aged 9-12 years) with full or subthreshold posttraumatic stress disorder (PTSD) were randomly assigned to group-based TF-CBT or treatment as usual (TAU). In the intervention group, 118 children received 10-12 sessions of group-based TF-CBT delivered by lay counselors for 9 consecutive weeks. In the TAU group, 116 children received the usual school services provided by psychology teachers. The primary outcome was the reduction in PTSD severity, which was assessed with the UCLA PTSD reaction index for DSM-5 (PTSD-RI-5). The secondary outcomes included the reduction in PTSD severity and the remission of PTSD, both of which were measured with the PTSD checklist-5 (PCL-5). Secondary outcomes also included the reduction in depression severity and the reduction in generalized anxiety severity. Blinded assessments were collected at baseline, posttreatment (primary endpoint), and 3-month follow-up. This trial is registered with Chinese Clinical Trial Registry, ChiCTR1900027131. Findings: At posttreatment, the intervention group scored significantly lower than the TAU group on PTSD-RI-5 PTSD (30.98 vs. 39.22; adjusted mean difference [AMD], -7.35; 95% CI, -11.66 to -3.04), PCL-5 PTSD (28.78 vs. 38.04; AMD, -8.49; 95% CI, -13.23 to -3.75), depression (5.52 vs. 7.96; AMD, -1.63; 95% CI, -2.50 to -0.76), and generalized anxiety (7.23 vs. 8.64; AMD, -1.21; 95% CI, -2.20 to -0.23). The remission of PCL-5 PTSD was also significantly higher in the intervention group (42.86% vs. 13.54%, χ 2  = 13.10, P < 0.001). These two groups showed a similar level of symptoms at the 3-month follow-up. Interpretation: The group-based TF-CBT can significantly alleviate PTSD, depression, and generalized anxiety right after treatment in Chinese children who suffer from different types of trauma. But the long-term effects of this intervention need to be further tested. This intervention can be delivered by trained lay counselors in low- and middle-income countries. Funding: None.

Comparative efficacy for different age groups of psychological or psychosocial treatments on post-traumatic stress disorder: protocol for systematic review, meta-analysis and meta-regression analysis.

INTRODUCTION: It remains unknown whether psychological or psychosocial treatments for post-traumatic stress disorder (PTSD) have comparable effects across the life span. This study aims at comparing the effects of psychological/psychosocial treatments for PTSD between different age groups of youth, early-middle adults and late adults. METHODS AND ANALYSIS: A systematic search will be conducted among thirteen electronic databases, including Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, PsycINFO, EMBASE, ERIC, PubMed, SCOPUS, Web of Science, Published International Literature on Traumatic Stress, China National Knowledge Infrastructure Database, the Wanfang database, the Chinese Scientific Journal Database (VIP Database) and ProQuest Dissertations and Theses, from inception to 15 May 2022. Electronic searches will be supplemented by a comprehensive grey literature search in Conference proceedings and trial registries. Randomised controlled trials (RCTs) comparing psychological or psychosocial treatments for PTSD with control conditions in all age groups will be included. The primary outcome is the between-treatments efficacy for PTSD that refers to the outcomes of the RCTs included in the meta-analysis. Effect sizes will be calculated for all comparisons and pooled with a fixed effects model or a random effects model. Differences in the efficacy of psychological/psychosocial therapies for PTSD across the age groups will be examined by stratified analyses and meta-regression analyses. ETHICS AND DISSEMINATION: Data used in this study will be anonymised. These data will not be used for other purposes than research. Authors who supply the data will be acknowledged. The authors declare that no conflicts of interest exist. The findings of this study will be disseminated through briefing reports, publications and presentations. TRIAL REGISTRATION NUMBER: CRD42022334305.

Barriers and facilitators to implementing evidence based mental health practice in primary schools / 中国学校卫生

Objective@#To explore the facilitators and barriers of the implementation of evidence based mental health practice, in order to provide practical experience for promoting the development of evidence based mental health services in primary schools in China.@*Methods@#Semi structured interviews were conducted with 4 education bureau managers, 8 school administrators, 7 classroom teachers, and 7 treatment providers after providing evidence based practice in 10 primary schools in Henan Province, China. Data was analyzed using thematic analysis.@*Results@#Evidence based practice in primary schools faced multiple factors at the macro level, school level, and individual level. A total of 8 facilitators and 9 barriers were extracted. Among these factors, some factors were particularly striking. These included the "exclusion" of teacher title evaluation system, time conflict between practice and school schedule, stigmatization of mental health and mismatch between perceived effectiveness of services and expectations.@*Conclusion@#Evidence based mental health practice is feasible in Chinese schools. The implementation process needs to take full account of macro, school and individual multi level factors to move evidence based mental health services from theory and data to practice in China.

The acceptability, feasibility, and preliminary effectiveness of group cognitive behavioral therapy for Chinese children with posttraumatic stress disorder: A pilot randomized controlled trial.

OBJECTIVE: The psychological need for traumatized children is huge in China. However, evidence-based treatments designed for Chinese children are scarce. This study aimed to test the feasibility and preliminary effectiveness of a cognitive-behavioral program (Power up Children's Psychological Immunity; PCPI) in Chinese children. METHOD: A total of 87 children with posttraumatic stress disorder (PTSD) symptoms in grades 3 to 5 were randomly allocated (1:1) to the PCPI group or the treatment as usual (TAU) group. The feasibility was assessed by participant adherence, satisfaction, and acceptability. The severity of PTSD, depression and anxiety were assessed at pre- and posttreatment and the 3-month follow-up. RESULTS: A high level of satisfaction (81.82%) and retention rate of each session (more than 93.33%) were found. Qualitative feedback reported a high level of acceptance. At posttreatment, the PCPI group had lower mean scores than the TAU group for PTSD (adjusted mean difference [AMD], -6.18; 95% CI, -12.21 to -.14; p = .048), and anxiety (AMD, -2.05; 95% CI, -3.81 to -.28; p = .026). However, little change was found from posttreatment to 3-month follow-up. CONCLUSION: The findings indicated that the school-based group PCPI intervention was feasible and acceptable. Further evaluation is needed to examine its effectiveness in a larger sample size. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

COVID-19 Screening in Chest X-Ray Images Using Lung Region Priors.

Early screening of COVID-19 is essential for pandemic control, and thus to relieve stress on the health care system. Lung segmentation from chest X-ray (CXR) is a promising method for early diagnoses of pulmonary diseases. Recently, deep learning has achieved great success in supervised lung segmentation. However, how to effectively utilize the lung region in screening COVID-19 still remains a challenge due to domain shift and lack of manual pixel-level annotations. We hereby propose a multi-appearance COVID-19 screening framework by using lung region priors derived from CXR images. Firstly, we propose a multi-scale adversarial domain adaptation network (MS-AdaNet) to boost the cross-domain lung segmentation task as the prior knowledge to the classification network. Then, we construct a multi-appearance network (MA-Net), which is composed of three sub-networks to realize multi-appearance feature extraction and fusion using lung region priors. At last, we can obtain prediction results from normal, viral pneumonia, and COVID-19 using the proposed MA-Net. We extend the proposed MS-AdaNet for lung segmentation task on three different public CXR datasets. The results suggest that the MS-AdaNet outperforms contrastive methods in cross-domain lung segmentation. Moreover, experiments reveal that the proposed MA-Net achieves accuracy of 98.83 % and F1-score of 98.71 % on COVID-19 screening. The results indicate that the proposed MA-Net can obtain significant performance on COVID-19 screening.

Validation of posttraumatic stress disorder (PTSD) and complex PTSD in Chinese children as per the ICD-11 proposals using the International trauma questionnaire.

Background: Given that the validity of applying complex posttraumatic stress disorder (CPTSD) in nonclinical children remains unclear. Objectives: The current study aimed to explore the factor structure, discriminant validity, and risk factors of ICD-11 posttraumatic stress disorder (PTSD) and CPTSD using the International Trauma Questionnaire. Methods: A total of 3478 trauma-exposed Chinese children aged 9-12 years were included in this study. All participants were assessed for PTSD and CPTSD using the International Trauma Questionnaire (ITQ). Confirmatory factor analysis (CFA) was conducted to explore the factor structure of CPTSD in a sample of Chinese children. Latent class analysis (LCA) was employed to evaluate the discriminant validity of CPTSD symptoms. Multinomial logistic regression analyses determined associations between the different classes and traumatic events. Results: The CFA results showed that the first-order six-factor model was identified as the best-fitting model in Chinese children aged 9-12 years. Four different classes, CPTSD symptoms, PTSD symptoms, disturbances in self-organization (DSO) symptoms, and a low symptom class were found by LCA. Both prolonged interpersonal trauma and other types of trauma were risk factors for the CPTSD class and the PTSD class. Conclusions: The results of this study partially support the factorial validity and strongly support the discriminant validity of the ICD-11 proposals for PTSD and CPTSD in Chinese children, supporting the conceptualization of PTSD and CPTSD as sibling diagnoses based on the ICD-11. However, findings suggest the need for careful consideration of identified trauma types in the ICD-11 proposals.

Antecedentes: Dado que la validez de aplicar el diagnóstico de Trastorno de estrés postraumático complejo (TEPT-C) en población infantil no clínica es incierto.Objetivos: el presente estudio está dirigido a explorar la estructura de factores, validez de discriminación y factores de riesgo del TEPT y TEPT-C de la CIE-11 usando el Cuestionario Internacional de Trauma.Método: Un total de 3478 niños chinos expuestos a un evento traumático de 9 a 12 años de edad fueron incluidos en este estudio. Todos los participantes fueron evaluados para TEPT y TEPT-C usando el Cuestionario Internacional de Trauma (ITQ por sus siglas en inglés). Se realizó un análisis factorial confirmatorio (CFA por sus siglas en inglés) para explorar la estructura factorial del TEPT-C en una muestra de niños chinos. Se realizó un análisis de clases latentes (LCA) para evaluar la validez de discriminación de los síntomas de TEPT-C. Se realizó una regresión logística multinomial para determinar la asociación entre las diferentes clases y los eventos traumáticos.Resultados: Los resultados del CFA mostraron que el modelo de seis-factores de primer-orden fue identificado como el modelo más acertado en niños chinos de 9 a 12 años de edad. El LCA encontró cuatro clases diferentes, síntomas de TEPT-C, síntomas de TEPT, alteraciones en la auto-organización (DSO por sus siglas en inglés) y una clase de síntomas baja. Tanto el trauma interpersonal prolongado y otros tipos de trauma fueron factores de riesgo para las clases de TEPT y de TEPT-C.Conclusiones: Los resultados de este estudio apoyan parcialmente la validez factorial y apoyan contundentemente la validez discriminatoria de las propuestas del CIE-11 para TEPT y TEPT-C en niños chinos, apoyando la conceptualización del TEPT y el TEPT-C como diagnósticos hermanos basados en el CIE-11. Sin embargo, los hallazgos sugieren la necesidad de una consideración cuidadosa de los tipos de trauma identificados en las propuestas del CIE-11.

Culturally adapted and lay-delivered cognitive behaviour therapy for older adults with depressive symptoms in rural China: a pilot trial.

BACKGROUND: Late-life depression issues in developing countries are challenging because of understaffing in mental health. Cognitive behavioural therapy (CBT) is effective for treating depression. AIM: This pilot trial examined the adherence and effectiveness of an eight-session adapted CBT delivered by trained lay health workers for older adults with depressive symptoms living in rural areas of China, compared with the usual care. METHOD: Fifty with screen-positive depression were randomly assigned to the CBT arm or the care as usual (CAU) arm. The primary outcomes were the session completion of older adults and changes in depressive symptoms, assessed using the Geriatric Depression Scale (GDS). RESULTS: The majority (19/24) of participants in the CBT arm completed all sessions. Mixed-effect linear regression showed that the CBT reduced more GDS scores over time compared with CAU. CONCLUSION: Lay-delivered culturally adapted CBT is potentially effective for screen-positive late-life depression.

The effect of smoke-free legislation on the mortality rate of acute myocardial infarction: a meta-analysis.

BACKGROUND: Several studies have demonstrated that smoke-free legislation is associated with a reduced risk of mortality from acute myocardial infarction (AMI). This study aimed to examine and quantify the potential effect of smoke-free legislation on AMI mortality rate in different countries. METHODS: Studies were identified using a systematic search of the scientific literature from electronic databases, including PubMed, Web of Science, ScienceDirect, Embase, Google Scholar, and China National Knowledge Infrastructure (CNKI), from their inception through September 30, 2017. A random effects model was employed to estimate the overall effects of smoke-free legislation on the AMI mortality rate. Subgroup analysis was performed to explore the possible causes of heterogeneity in risk estimates based on sex and age. The results of meta-analysis after excluding the studies with a high risk of bias were reported in this study. RESULTS: A total of 10 eligible studies with 16 estimates of effect size were included in this meta-analysis. Significant heterogeneity in the risk estimates was identified (overall I2 = 94.6%, p < 0.001). Therefore, a random effects model was utilized to estimate the overall effect of smoke-free legislation. There was an 8% decline in AMI mortality after introducing smoke-free legislation (RR = 0.92, 95% confidence interval (CI): 0.90-0.94). The results of subgroup analyses showed that smoke-free legislation was significantly associated with lower rates of mortality for the following 5 diagnostic subgroups: smoke-free in workplaces, restaurants and bars (RR = 0.92, 95% CI: 0.90-0.95), smaller sample size (RR = 0.92, 95% CI: 0.89-0.95), study location in Europe (RR = 0.90, 95% CI: 0.85-0.94), regional study area (RR = 0.92, 95% CI: 0.89-0.94), and no previous local smoke-free legislation (RR = 0.91, 95% CI: 0.90-0.93). However, there was not much difference in AMI mortality rates after the legislation between the longer (RR = 0.92, 95% CI: 0.86-0.98) and shorter follow-up duration subgroups (RR = 0.92, 95% CI: 0.89-0.94). CONCLUSION: Smoke-free legislation could significantly reduce the AMI mortality rate by 8%. The reduction in the AMI mortality rate was more significant in studies with more comprehensive laws, without prior smoke-free bans, with a smaller sample size, at the regional level, and with a location in Europe.

Long-Term Health Consequences Among Wenchuan Earthquake Adult Survivors: Implications of a Framework for Postearthquake Reconstruction.

The objective of this study was to examine the longitudinal health consequences of the Wenchuan earthquake. Based on descriptive analyses of national-level data and multivariate analyses on a six-wave repeated cross-sectional survey, the findings suggested that after 8 years health risks remained high among earthquake-affected survivors; however, a process of recovery existed. To conceptualize these findings, in this study, we proposed a three-stage recovery model in which the postdisaster health status was divided into three stages: acute, stagnant, and adaptive. At each stage, the health risk varied, and over time, associations between health outcomes and protective factors varied. The three-stage recovery model identified the trends of long-term health consequences among adult earthquake survivors and provided guidance for postdisaster reconstruction in China on the basis of protective factors analyses.

Risk factors associated with pain among community adults in Northwest China.

Objectives: We aimed to investigate the prevalence of and risk factors associated with pain and to compare the correlation between depression and sleep quality and pain among adults in Northwest China, where health care resources are limited. Methods: In total, 7,602 subjects (age ≥40 years) participated in this survey. Using the Brief Pain Inventory-Chinese version, we evaluated the overall pain among respondents, including pain sites, pain intensity, and its interference in daily life. In addition, depression symptoms were measured using the Center for Epidemiologic Studies Depression Scale Chinese edition. Furthermore, the subjective sleep quality among participants was assessed using the Pittsburgh Sleep Quality Index. Results: Approximately 25.2% of the participants experienced pain, and 41.7% of those perceived the worst pain they had experienced as severe pain. Chronic disease exhibited the most robust correlation with severe pain, followed by poor sleep quality. Furthermore, the correlation between depression and pain was found only in the population with severe pain. Conclusion: The study reveals that pain affects a large proportion of Chinese adults, especially females, living in rural areas, having lower incomes, unemployed, and suffering from poor health status or mental illness. Furthermore, this study suggests we should have a screen and intervention for depression and poor sleep quality among pain suffers, which will be helpful for pain management in Northwest China.

Applications of the Chinese version of the primary care PTSD screen for DSM-5 (PC-PTSD-5) for children.

BACKGROUND: Effective screening is important for public mental health services. Although the primary care PTSD screen for DSM-5 (PC-PTSD-5) is useful in screening for post-traumatic stress disorder (PTSD) in adults, its reliability and validity for use in children remain unclear. This study aimed to examine the performance characteristics of the Chinese PC-PTSD-5 for children in children aged 8 to 16 years. METHODS: 4,022 rural children from Grades 4 to 9 in China were included in this study. All participants were assessed for PTSD using the Chinese PC-PTSD-5 for children and the PTSD Checklist for DSM-5 (PCL-5), and assessed for anxiety using the Chinese version of the State Anxiety Scale for Children (CSAS-C), and for depression using the Children's Depression Inventory - Short Form (CDI-S). The performance characteristics of the PC-PTSD-5 for children were evaluated using receiver operating characteristic analyses. RESULTS: The mean scores on the PCL-5 and the PC-PTSD-5 were 17.45 (SD = 14.78) and 1.78 (SD = 1.33), respectively. There was a significant correlation between the PC-PTSD-5 and PCL-5 (r = 0.54, p < 0.001), and small but significant correlations of the PC-PTSD-5 with the CSAS-C (r = 0.31, p < 0.001) and CDI-S (r = 0.27, p < 0.001). In this study, 2 and 3 were both found to be acceptable cutoff values. A cutoff value of 2 yielded a sensitivity of 0.87 and a specificity of 0.52, while a cutoff of 3 had sensitivity = 0.57, and specificity = 0.77. LIMITATIONS: A clinical interview was not used to validated diagnostic findings. CONCLUSIONS: The reliability and validity of the Chinese PC-PTSD-5 were statistically acceptable for screening for probable PTSD in children. Additionally, the Chinese PC-PTSD-5 had a favorable sensitivity at a cut off 2 and a favorable specificity at a cut off 3, based on PCL-5 results.

The impact of contract service policy and doctor communication skills on rural patient-doctor trust relationship in the village clinics of three counties.

BACKGROUND: Trust is regarded as the cornerstone of the doctor-patient relationship in the world of medicine; it determines the decisions patients make when choosing doctors and influences patients' compliance with recommended treatments. In China, patient-doctor trust acts as a thermometer measuring harmony in the doctor-patient relationship. The objective of this study is to explore the relationship between the contract service and patient-doctor trust-building in 25 village clinics of rural China. METHOD: The research was carried out in village clinics in rural China. A simple random sampling method was used to choose clinics and subjects. Based on feasibility and financial support, we chose three counties as our study settings: Dafeng District, Jiangsu Province; Yinan County, Shandong Province; and Wufeng Tujia Autonomous County, Hubei Province. Twenty-five village clinics and 574 subjects were selected in the three areas from the contract service and patient list. Descriptive statistics, t-tests, MANOVA, SEM, and multiple regression statistical analysis were employed to analyze the data. RESULT: Statistical analysis showed that contract service directly and indirectly influenced patient-doctor trust-building in village clinics. The patient perception of doctor communication skills was a mediator in the relationship between contract service policy and patient-doctor trust-building. CONCLUSIONS: Building patient-doctor trust is important in developing and enhancing rural health. The policy of contract service plays a significant role in building relationships. Well-developed communication skills of doctors contribute to the implementation of the contract service policy and to establishing patient-doctor trust.

Performance of Between-study Heterogeneity Measures in the Cochrane Library.

The growth in comparative effectiveness research and evidence-based medicine has increased attention to systematic reviews and meta-analyses. Meta-analysis synthesizes and contrasts evidence from multiple independent studies to improve statistical efficiency and reduce bias. Assessing heterogeneity is critical for performing a meta-analysis and interpreting results. As a widely used heterogeneity measure, the I statistic quantifies the proportion of total variation across studies that is caused by real differences in effect size. The presence of outlying studies can seriously exaggerate the I statistic. Two alternative heterogeneity measures, the (Equation is included in full-text article.)and (Equation is included in full-text article.)have been recently proposed to reduce the impact of outlying studies. To evaluate these measures' performance empirically, we applied them to 20,599 meta-analyses in the Cochrane Library. We found that the (Equation is included in full-text article.)and (Equation is included in full-text article.)have strong agreement with the I, while they are more robust than the I when outlying studies appear.

Empirical Comparison of Publication Bias Tests in Meta-Analysis.

BACKGROUND: Decision makers rely on meta-analytic estimates to trade off benefits and harms. Publication bias impairs the validity and generalizability of such estimates. The performance of various statistical tests for publication bias has been largely compared using simulation studies and has not been systematically evaluated in empirical data. METHODS: This study compares seven commonly used publication bias tests (i.e., Begg's rank test, trim-and-fill, Egger's, Tang's, Macaskill's, Deeks', and Peters' regression tests) based on 28,655 meta-analyses available in the Cochrane Library. RESULTS: Egger's regression test detected publication bias more frequently than other tests (15.7% in meta-analyses of binary outcomes and 13.5% in meta-analyses of non-binary outcomes). The proportion of statistically significant publication bias tests was greater for larger meta-analyses, especially for Begg's rank test and the trim-and-fill method. The agreement among Tang's, Macaskill's, Deeks', and Peters' regression tests for binary outcomes was moderately strong (most κ's were around 0.6). Tang's and Deeks' tests had fairly similar performance (κ > 0.9). The agreement among Begg's rank test, the trim-and-fill method, and Egger's regression test was weak or moderate (κ < 0.5). CONCLUSIONS: Given the relatively low agreement between many publication bias tests, meta-analysts should not rely on a single test and may apply multiple tests with various assumptions. Non-statistical approaches to evaluating publication bias (e.g., searching clinical trials registries, records of drug approving agencies, and scientific conference proceedings) remain essential.

Association of Social Support and Medication Adherence in Chinese Patients with Type 2 Diabetes Mellitus.

The prevalence of diabetes is steadily increasing in China. When diabetes is uncontrolled, it generates dire consequences for health and well-being. Numerous studies have shown that health outcomes were associated with social support and medication adherence. Previous study confirmed that social support was associated with medication adherence in patients with heart failure, HIV diseases, and first-episode psychosis. However, the relationship between social support and medication adherence in patients with type 2 diabetes mellitus (T2DM) is remains unclear. This study aims to examine whether social support is associated with medication adherence in patients with T2DM. This study was conducted in the First Affiliated Hospital of the General Hospital of the People's Liberation Army (PLA). In Beijing, a systematic random sample of 412 patients with T2DM over 18 years was recruited at baseline, and demographic characteristics, clinical data and their assessment of social support were collected from medical records and self-reported questionnaires. 330 of these patients completed a self-report measure of medication adherence at the sixth month after baseline data collection. Regression analysis showed that social support presented a positive effect on medication adherence, additionally, support utilization and the subscale of social support exhibited a significantly strong influence on medication adherence in patients with T2DM. Although medication adherence was influenced by multiple factors, this finding confirmed that social support must be recognized as a core element in interventions aimed at improving in the management of patients with T2DM.

Suicidality associated with PTSD, depression, and disaster recovery status among adult survivors 8 years after the 2008 Wenchuan earthquake in China.

It has been eight years since the Wenchuan earthquake. We don't know how the lives of those affected by the disaster may remain blighted by its effects, or how many remain thus affected. The aim of the present study was to examine the relationship of disaster exposure, PTSD, depression and suicidal behaviors, using data from a cross-sectional survey conducted in earthquake-affected areas of China. 1369 participants were recruited from two different sites that were severely affected by the Wenchuan earthquake. The survey assessed suicidality (suicidal ideation, plans and attempts) and other mental health issues. Probable PTSD was assessed using the Impact of Event Scale-Revised (IES-R). The Center for Epidemiologic Studies Depression Scale (CES-D) Chinese edition was used to assess depressive symptoms. The results showed that 11.2% of participants felt that their lives had not yet recovered from the effects of the Wenchuan earthquake, even after eight years. Suicidal ideation, plans, and attempts were reported by 9.1%, 2.9%, and 3.3%, respectively, of the respondents. PTSD, depression, and perceived non-recovery were highly associated with suicidality. These results indicate that suicidality can be a long-term mental health sequela of disaster. Targeted, long-term suicide prevention programs for adult survivors should be further developed.

Medication Adherence Mediates the Association between Type D Personality and High HbA1c Level in Chinese Patients with Type 2 Diabetes Mellitus: A Six-Month Follow-Up Study.

Aims. To examine the association between Type D personality and HbA1c level and to explore the mediating role of medication adherence between them in patients with type 2 diabetes mellitus (T2DM). Methods. 330 patients went on to complete a self-report measure of medication adherence and the HbA1c tests. Chi-square test, T test, Ordinary Least Square Regression (OLS), and Recentered Influence Function Regression (RIF) were employed. Results. Patients with Type D personality had significantly higher HbA1c value (P < 0.01). When Type D personality was operationalized as a categorical variable, SI was associated with HbA1c (P < 0.01). When NA, SI, and their interaction term were entered into regression, all of them were no longer associated with HbA1c level (P > 0.1). On the other hand, when Type D personality was operationalized as a continuous variable, only SI trait was associated with HbA1c level (P < 0.01). When NA, SI, and NA × SI term together were entered into regression, only SI was not related to HbA1c level. Furthermore, medication adherence had a significant mediation effect between Type D personality and HbA1c, accounting for 54.43% of the total effect. Conclusion. Type D personality was associated with HbA1c in direct and indirect ways, and medication adherence acted as a mediator role.