Workforce situation of the Chinese mental health care system: results from a cross-sectional study.

BACKGROUND: High-quality mental health services can improve outcomes for people with mental health problems and abate the burden of mental disorders. We sought to identify the challenges the country's mental health system currently faces and the human resource situation related to psychological services and to provide recommendations on how the mental health workforce situation could be addressed in China. METHODS: This study used a cross-sectional survey design. A web-based questionnaire approach and a convenience sampling method were adopted. It was carried out from September 2020 to January 2021 in China, and we finally included 3824 participants in the analysis. Descriptive statistical analysis of the characteristics of the study sample was performed. The risk factors for competence in psychological counseling/psychotherapy were assessed using multiple linear regression analysis. RESULTS: Workforce related to psychotherapy is scarce in China, especially in Western China and community mental health sectors. Psychiatrists (39.1%) and nurses (38.9%) were the main service providers of psychotherapy in psychiatric hospitals, and clinical psychologists (6.9%) and counsellors (5.0%) were seriously scarce in mental health care sectors. A total of 74.2% of respondents had no systematic psychological training, and 68.4 and 69.2% of them had no self-experience and professional supervision, respectively. Compared with clinical psychologists and counselors, psychiatrists and nurses had less training. Systematic psychological training (ß = - 0.88), self-experience (ß = - 0.59) and professional supervision (ß = - 1.26) significantly influenced psychotherapy capacity (P<0.001). CONCLUSIONS: Sustained effort will be required to provide a high-quality, equitably distributed psychotherapy workforce in China, despite challenges for community mental health sectors and western China being likely to continue for some time. Because mental illness is implicated in so many burgeoning social ills, addressing this shortfall could have wide-ranging benefits.

The psychological impact of COVID-19 on Chinese healthcare workers: a systematic review and meta-analysis.

PURPOSE: This study aimed at investigating five dimensions of the psychological impact (post-traumatic stress symptoms (PTSS), anxiety, depression, sleep disturbance or profession-related burnout) of COVID-19 on healthcare workers (HCW) in China. METHODS: Studies that evaluated at least one of the five target dimensions of the psychological impact of COVID-19 on HCW in China were included. Studies with no data of our interest were excluded. Relevant Databases were searched from inception up to June 10, 2020. Preprint articles were also included. The methodological quality was assessed using the checklist recommended by AHRQ. Both the rate of prevalence and the severity of symptoms were pooled. The protocol was registered in PROSPERO (CRD42020197126) on July 09, 2020. RESULTS: We included 44 studies with a total of 65,706 HCW participants. Pooled prevalence rates of moderate to severe PTSS, anxiety, depression, and sleep disturbances were 27% (95% CI 16%-38%), 17% (13-21%), 15% (13-16%), and 15% (7-23%), respectively; while the prevalence of mild to severe level of PTSS, anxiety, and depression was estimated as 31% (25-37%), 37% (32-42%) and 39% (25-52%). Due to the lack of data, no analysis of profession-related burnout was pooled. Subgroup analyses indicated higher prevalence of moderate to severe psychological impact in frontline HCW, female HCW, nurses, and HCW in Wuhan. CONCLUSION: About a third of HCW in China showed at least one dimension of psychological symptoms during the COVID-19 pandemic, whereas the prevalence of moderate and severe syndromes was relatively low. Studies on profession-related burnout, long-term impact, and the post-stress growth are still needed.

Correlation Characteristics of Electrical Conductivity of Surface Waters with the Fluorescence Excitation-Emission Matrix Spectroscopy-Parallel Factor Components of Dissolved Organic Matter.

Fluorescence excitation-emission matrix spectroscopy (EEMs) has become a very popular technique in characterization of aquatic dissolved organic matter (DOM) coupled with a parallel factor (PARAFAC) model, denoted as (EEMs-PARAFAC). This research addresses the poorly researched relationship correlation between dissolved ions and fluorescence in a natural water environment. The relationship between the EEMs-PARAFAC components and ionic composition was studied in freshwater lakes, rivers, and seawater from locations in China. The natural water environment is different from a simulated environment having a fixed ionic composition. We used electrical conductivity (EC) to reflect the ionic strength as an indicator to evaluate the relationship in a series of water bodies. Results show that the EC generally had a positive correlation with DOM in natural water environment, but no correlation was found with water from the highly saline Yellow Sea. The Chaohu Lake samples contained one component having a significant negative correlation with EC, i.e., r > 0.6, p < 0.05, while other surface waters contained components having both positive and negative correlations (r > 0.5, p < 0.05). The negative correlation with EC also highlighted that humic acid-like components and protein-like materials (c1-c3) were positively correlated with DOM, while the protein-like component (c4) was negatively correlated with DOM. The EC equation proposed provided a good fit with the EC values of surface waters. The use of EC would be a useful and rapid method for analyzing the variation in the fluorescence component and its effect on water quality. This study highlights the need to account for variation in EC when assessing EEMs-PARAFAC of natural waters.

Correction to: Psychological and somatic distress in Chinese outpatients at general hospitals: a cross-sectional study.

[This corrects the article DOI: 10.1186/s12991-017-0158-y.].

Operationalization of diagnostic criteria of DSM-5 somatic symptom disorders.

BACKGROUND: The aim of this study was to test the operationalization of DSM-5 somatic symptom disorder (SSD) psychological criteria among Chinese general hospital outpatients. METHODS: This multicenter, cross-sectional study enrolled 491 patients from 10 general hospital outpatient departments. The structured clinical "interview about cognitive, affective, and behavioral features associated with somatic complaints" was used to operationalize the SSD criteria B. For comparison, DSM-IV somatoform disorders were assessed with the Mini International Neuropsychiatric Interview plus. Cohen's к scores were given to illustrate the agreement of the diagnoses. RESULTS: A three-structure model of the interview, within which items were classified as respectively assessing the cognitive (B1), affective (B2), and behavioral (B3) features, was examined. According to percentages of screening-positive persons and the receiver operator characteristic (ROC) analysis, a cut-off point of 2 was recommended for each subscale of the interview. With the operationalization, the frequency of DSM-5 SSD was estimated as 36.5% in our sample, and that of DSM-IV somatoform disorders was 8.2%. The agreement between them was small (Cohen's к = 0.152). Comparisons of sociodemographic features of SSD patients with different severity levels (mild, moderate, severe) showed that mild SSD patients were better-off in terms of financial and employment status, and that the severity subtypes were congruent with the level of depression, anxiety, quality of life impairment, and the frequency of doctor visits. CONCLUSIONS: The operationalization of the diagnosis and severity specifications of SSD was valid, but the diagnostic agreement between DSM-5 SSD and DSM-IV somatoform disorders was small. The interpretation the SSD criteria should be made cautiously, so that the diagnosis would not became over-inclusive.

Psychological and somatic distress in Chinese outpatients at general hospitals: a cross-sectional study.

BACKGROUND: Our study aimed (1) to describe the proportion of psychological distress among Chinese outpatients at general hospitals, (2) to compare cognitive and behavioral characteristics of patients with different distress patterns, and (3) to investigate the discriminant function of the analyzed variables in indicating the affinity towards the different distress patterns. METHODS: This multicenter cross-sectional study was conducted at ten outpatient departments at Chinese general hospitals. The somatic symptom severity scale (PHQ-15), the nine-item depression scale (PHQ-9), and the seven-item anxiety scale (GAD-7) were employed to classify patients in terms of four distress patterns. RESULTS: A total of 491 patients were enrolled. Among them, the proportion of patients with high psychological distress was significantly higher within those with high somatic distress (74.5% vs. 25.5%, p < .001). Patients with psychological distress alone and mixed distress were significantly younger and with lower monthly family income, while the proportion of female patients (80.9%) was highest in the somatic distress group. Patients with mixed distress had the most negative cognitive and behavioral characteristics [highest health anxiety (5.0 ± 1.9), lowest sense of coherence (35.5 ± 10.0), the worst doctor-patient relationship from both patients' (36.0 ± 7.3) and doctors' perspectives (23.3 ± 7.0)], as well as most impaired quality of life (41.6 ± 7.4 and 31.9 ± 10.3). In addition, compared with patients with somatic distress alone, those with psychological distress alone had lower sense of coherence, worse doctor-patient relationship, and more impaired mental quality of life, but less doctor visits. Discriminant analysis showed that gender, mental quality of life, health anxiety, sense of coherence, and frequent doctor visits were significant indicators in identifying patients with different distress patterns. CONCLUSIONS: Our study found that (1) psychological distress was not rare in the Chinese general hospital outpatients, especially in those with high somatic distress; (2) patients with psychological distress alone sought less help from doctors, despite their severe psychosocial impairment; and (3) gender, health anxiety, sense of coherence, mental quality of life, and frequent doctor visits could help to identify different distress patterns.

Illness Attribution of Outpatients with Multiple Somatic Symptoms in Peking Union Medical College Hospital.

Objective To explore the characteristics of illness attribution of outpatients with multiple somatic symptoms in Peking Union Medical College Hospital. Methods It was a cross-sectional study conducted from March to October,2012. A total of 150 outpatients were recruited from the departments of Gastroenterology,Traditional Chinese Medicine and Psychological Medicine by convenience sampling. Somatic symptom scale of the Patient Health Questionnaire (PHQ-15) was used to screening each patient in the waiting list. With the cut-off value of 10,patients were divided into the somatic symptom positive (SOM+) group and somatic symptom negative (SOM-) group. Sociodemographic characteristics were compared between these two groups. All the subjects completed interviews including questions about illness attribution. All the answers of illness attribution were concluded into three major groups as physical factors,situational factors and psychological factors. Results The proportion of female was significantly higher in SOM+ group than in SOM-group (69.3% vs. 53.3%;χ2=4.048,P=0.044). In SOM+ group,significantly more patients contributed their illness to psychological factors (64.0% vs. 45.0%;χ2=5.273,P=0.022). There was no significantly difference between SOM+ group and SOM-group on the phenomenon of multiple illness attribution (41.0% vs. 32.0%;χ2=1.407,P=0.236). However,in the Department of Gastroenterology,there were significantly more outpatients in SOM+ group with multiple illness attribution (60.0% vs. 32.0%;χ2=3.945,P=0.047).Conclusions The outpatients in general hospital with multiple somatic symptoms are more likely to contribute their illness to psychological factors. The phenomenon of multiple illness attribution is common among patients. Clinicians should increase their awareness and knowledge of illness attribution,so as to provide better holistic health services.

[A clinical study of functional dyspepsia and mental disorder co-morbidity].

OBJECTIVE: To investigate the co-morbid state of mental disorder in patients with functional dyspepsia (FD) in a tertiary general hospital in China and explore the risk factors of the co-morbidity of FD and major depressive disorder (MDD). METHODS: This study was designed as a bilateral evaluation and structural psychiatric interview. Patients with FD and newly diagnosed outpatients with MDD in gastrointestinal and psychological departments were enrolled. FD was defined by Rome III criteria. The questionnaires including symptoms of FGIDs Roma III, the composite international diagnostic interview (CIDI 3.0) Chinese version, the Hamilton depression/anxiety rating scale (HAMD/HAMA), Montgomery-Asberg depression scale (MADRS) were involved in this study. All patients were administered by well trained physicians and investigators in face to face interview. RESULTS: A total of 69 patients have completed the valid questionnaires and interview, among whom 42 met FD criteria (FD group) and 27 with FD co-morbid MDD (co-morbid group). Male to female ratios were 17:25 and 10:17, the mean age (42.1 ± 13.3) and (43.1 ± 15.3) years respectively. The life-long co-morbidity of FD and MDD was 39.1% (27/69), while 31.9% (22/69) patients with FD were accompanied with other mental disorders rather than MDD. Patients in FD co-morbid MDD group had significantly more severe depression than those in FD group with HAMD-17 score 21.6±8.0 and 14.5 ± 7.6, HAMA score 21.2 ± 9.0 and 14.9 ± 7.5 respectively (all P<0.01). Logistic regression analysis showed that high score of MADRS and complication with functional anorectal disorder may be the risk factors of FD co-morbid MDD [OR(95% CI) 1.12(1.06-1.19) and 7.07(1.12-44.53)]. CONCLUSIONS: The co-morbidity rate of FD with MDD in our hospital is high. In addition to MDD, other mental disorders also need to be paid attention in FD patients. FD co-morbid MDD patients suffered more severe depression and anxiety. The high score of MADRS and complication with functional anorectal disorder seem to be the risk factors of co-morbidity of FD and MDD.

[Survey on the barriers in providing the mental health services to the suicide attempters in ED].

OBJECTIVE: The purpose of this study was to explore the barriers existing in medical settings behind the phenomenon that few suicide attempters were provided by mental health services when they got treatment in the general hospital ED. METHODS: An anonymous and voluntary survey was administered among two groups: ED physicians and psychiatrists. Two tertiary general hospitals and one psychiatric hospital were chosen through convenience sampling. Suicide Behavior Attitude Questionnaire and a self-made questionnaire to evaluate barriers were used. RESULTS: The response rate was 68.7% for ED physicians, and 87.0% for psychiatrists. ED physicians generally scored unfavorably than psychiatrists on many items in SBAQ (P < 0.001), but on the item about whether the suicide attempters should have access to mental health services, the median of the scores = 10 for both group (P = 0.059), meaning highly agree. Some consistent barriers could be summarized from the self-made questionnaire. CONCLUSIONS: The majority of ED physicians in general hospitals still hold some misunderstanding about the suicide attempters, but they fully agree that the suicide attempters should have access to mental health services. The barriers for psychiatrists are clear.The barriers for ED physicians are complicated but workable.

[Fluorescence enhancement effect of silver nanoparticles with different surface modifiers and sizes].

Silver nanoparticles were prepared by chemical method using citricacid trisodiumsalt (Ag-CTS) and polyvinylpyrrolidone (Ag-PVP) as surface modifiers, respectively. When Ag-CTS or Ag-PVP nanoparticles were added into methyl orange (MO) solution, the enhanced-fluorescence of S1-->S0 and quenched-fluorescence of S2-->S0 were simultaneously observed. However, for the solution containing Ag-PVP, the red-shift of fluorescence peak of S1-->S0 was observed and the extents of the enhanced-fluorescence of S1-->S0 and quenched-fluorescence of S2-->S) are higher than those of the solution containing Ag-CTS. With the increase in reaction time the fluorescence intensity of S1-->S0 increased gradually in the solution containing Ag-CTS nanoparticles and no change was observed in the solution containing Ag-PVP nanoparticles. The lower the MO concentration, the higher the fluorescence intensity ratio of S1-->S0. The results indicated that the silver nanoparticles with different surface modifiers affect the metal-enhanced fluorescence by impacting the distance between the methyl orange and silver nanoparticles. The size of silver nanoparticles affects the metal-enhanced fluorescence due to the difference in the surface plasma resonance properties.

Development and validation of a nomogram for tracheotomy decannulation in individuals in a persistent vegetative state: A multicentre study.

BACKGROUND: Decannulation for people in a persistent vegetative state (PVS) is challenging and relevant predictors of successful decannulation have yet to be identified. OBJECTIVE: This study aimed to explore the predictors of tracheostomy decannulation outcomes in individuals in PVS and to develop a nomogram. METHOD: In 2022, 872 people with tracheostomy in PVS were retrospectively enrolled and their data was randomly divided into a training set and a validation set in a 7:3 ratio. Univariate and multivariate regression analyses were performed on the training set to explore the influencing factors for decannulation and nomogram development. Internal validation was performed using 5-fold cross-validation. External validation was performed using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA) on both the training and validation sets. RESULT: Data from 610 to 262 individuals were used for the training and validation sets, respectively. The multivariate regression analysis found that duration of tracheostomy tube placement≥30 days (Odds Ratio [OR] 0.216, 95 % CI 0.151-0.310), pulmonary infection (OR 0.528, 95 %CI 0.366-0.761), hypoproteinemia (OR 0.669, 95 % CI 0.463-0.967), no passive standing training (OR 0.372, 95 % CI 0.253-0.547), abnormal swallowing reflex (OR 0.276, 95 % CI 0.116-0.656), mechanical ventilation (OR 0.658, 95 % CI 0.461-0.940), intensive care unit (ICU) duration>4 weeks (OR 0.517, 95 % CI 0.332-0.805), duration of endotracheal tube (OR 0.855, 95 % CI 0.803-0.907), older age (OR 0.981, 95 % CI 0.966-0.996) were risk factors for decannulation failure. Conversely, peroral feeding (OR 1.684, 95 % CI 1.178-2.406), passive standing training≥60 min (OR 1.687, 95 % CI 1.072-2.656), private caregiver (OR 1.944, 95 % CI 1.350-2.799) and ICU duration<2 weeks (OR 1.758, 95 % CI 1.173-2.634) were protective factors conducive to successful decannulation. The 5-fold cross-validation revealed a mean area under the curve of 0.744. The ROC curve C-indexes for the training and validation sets were 0.784 and 0.768, respectively, and the model exhibited good stability and accuracy. The DCA revealed a net benefit when the risk threshold was between 0 and 0.4. CONCLUSION: The nomogram can help adjust the treatment and reduce decannulation failure. REGISTRATION: Clinical registration is not mandatory for retrospective studies.

Shared and distinct aberrations in frontal-striatal system functional patterns among patients with irritable bowel syndrome and major depressive disorder.

BACKGROUND: Considering the high comorbidity, shared risk factors, and genetic pathways between irritable bowel syndrome (IBS) and major depressive disorder (MDD), we hypothesized that there would be both shared and disorder-specific alterations in brain function. METHODS: A total of 39 IBS patients, 39 MDD patients, and 40 healthy controls (HCs) were enrolled and matched for sex, age, and educational level. All subjects underwent resting-state functional MRI. The clinical variables of anxiety, depression, gastrointestinal symptoms and alexithymia were recorded. The 12 subregions of the striatum were employed as seeds to assess their functional connectivity (FC) with every voxel throughout the whole brain. RESULTS: Compared to HC, IBS and MDD patients exhibited aberrant frontal-striatal circuitry. We observed a common decrease in FC between the dorsal striatum and regions of the hippocampus, sensorimotor cortex, and prefrontal cortex (PFC) in both IBS and MDD patients. Patients with IBS exhibited disorder-specific decreases in FC within the striatum, along with reduced connectivity between the ventral striatum and sensorimotor cortex. In contrast, MDD patients showed disorder-specific hyperconnectivity in the medial PFC-limbic system. Receiver operating characteristic curve analysis showed that frontal-striatal FC values could serve as transdiagnostic markers of IBS and MDD. Within the IBS group, striatal connectivity was not only negatively associated with weekly abdominal pain days but also negatively correlated with the levels of anxiety and alexithymia. CONCLUSIONS: This exploratory analysis indicated that patients with IBS and MDD exhibited both shared and disorder-specific frontal-striatal circuit impairments, potentially explaining both comorbidity and distinct phenotypes.

How stroke-related dysphagia relates to quality of life: the mediating role of nutritional status and psychological disorders, and the moderating effect of enteral nutrition mode.

Background: Although stroke-related dysphagia has been shown to influence quality of life (QOL), the underlying mechanisms have yet to be uncovered. Objective: This study aims to investigate the mediating role of nutritional status and psychological disorders in the relationship between stroke-related dysphagia and QOL in stroke patients and explore the moderating effect of enteral nutrition mode. Methods: In 2022, A questionnaire survey using stratified random sampling was conducted on 5,322 stroke patients with dysphagia, including Functional Oral Intake Scale (FOIS), Swallowing Quality of Life Questionnaire, Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder-7 (GAD-7) to assess dysphagia, QOL and psychological disorders, respectively, for each participant. Records of serum albumin, Hemoglobin, Total serum protein, serum prealbumin and Body mass index were enrolled to assess nutritional status. Results: FOIS demonstrated a significant positive predictive effect on QOL. Nutritional status and psychological disorders (PHQ-9 and GAD-7) mediated the relationship between FOIS and QOL. Nutritional status-psychological disorders showed a chain mediation effect in the relationship between FOIS and QOL. The moderating effect of enteral nutrition mode was observed. Conclusion: The mediating role of nutritional status and psychological disorders with moderating effect of enteral nutrition mode in the relationship between dysphagia and QOL in stroke patients was found.

Comparison of different hydroxyapatite composites for bone tissue repair: In vitro and in vivo analyses.

Objectives: The material used for bone tissue repair needs to be simultaneously osteoconductive, osteoinductive, and osteogenic. To overcome this problem, researchers combine hydroxyapatite (HA) with natural materials to improve properties. This paper compares the effects of angiogenesis and osteogenesis with different composites through in vivo experiments and characterization analysis. Materials and Methods: Chitosan/nHA (CS/nHA) and sodium alginate/nHA (SA/nHA) microspheres were synthesized via reverse-phase emulsification crosslinking and analyzed using scanning electron microscopy (SEM), energy dispersion spectroscopy (EDS), and X-ray diffraction (XRD). Implanted into mouse thigh muscles, their angiogenic and osteogenic potentials were assessed after 8 and 12 weeks through various staining methods and immunohistochemistry. Results: The mean vascular density (MVD) of CS/nHA, CaP/nHA, and SA/nHA groups was (134.92±35.30) n/mm2, (159.09±22.14) n/mm2, (160.31±42.23) n/mm2 at 12 weeks, respectively. The MVD of the CaP/nHA and SA/nHA groups were significantly higher than that of the CS/nHA group. The collagen volume fractions (CVF) were 34.13%, 51.53%, and 54.96% in the CS/nHA, CaP/nHA, and SA/nHA groups, respectively. In addition, the positive expression area ratios of OPN and CD31 in the CaP/nHA and SA/nHA groups were also significantly higher than those in the CS/nHA group. Conclusion: The ability of SA/nHA composite microspheres in osteogenesis and angiogenesis is clearly superior to that of the CS/nHA group and is comparable to that of CaP/nHA, which has superior osteogenesis ability, indicating that SA/nHA composite microspheres have greater application prospects in bone tissue engineering.

Separation of dye from aqueous solution by a new gravity compression and aeration system.

Filtration is one of the important technologies for separating suspended particles. Under the condition of gravity compression, the filtration density can be increased and the separation effect of suspended particles can be improved. Considering the complex composition and the difficulty in degrading dye in industrial wastewater, a gravity compression aeration system with a modified polyester fibre ball (denoted as MPFB) was evaluated for the separation of dye from water. Congo red azo dye solution (0-40 mg/L) was selected as the model treatment compound. The MPFB was prepared by adjusting the concentrations of alkali (Quality score 0-25%), ß-cyclodextrin (0∼80 g/L), reaction temperature (40-90°C), and silane coupler concentration (Concentration fractions 0-0.8%). We used Fourier transform infrared spectroscopy (FTIR), Scanning electron microscopy (SEM), and X-ray photoelectron spectroscopy (XPS) to characterise the MPFB. The separation was affected significantly by adsorption conditions such as MPFB dose and pH. The lower the MPFB dose, the higher the expected adsorption capacity. For the treatment of a dye solution at 500 mg/L, 100% removal was achieved with 48 g/L MPFB, at pH 8 during adsorption under non-circulation aeration. For 24 h of reaction, the system could reach the maximum adsorption capacity of 11.2 mg/g, which followed the pseudo-first order kinetics model and the intraparticle diffusion model. We discovered that circulation aeration provided the best adsorption and electrostatic and hydrogen bonding were the dominant components of adsorption. Overall, the system is a promising technology and has the potential to treat large volumes of dye wastewater.

Burnout, emotional distress and sleep quality among Chinese psychiatric healthcare workers during the COVID-19 pandemic: a follow-up study.

Background: Different from the very early stages of the COVID-19 pandemic, burnout and chronic mental health problems among health care workers (HCWs) has become a challenge. Research is lacking on the relationship between burnout, stress, emotional distress and sleep quality. Methods: The Chinese center has been involved in the Cope-Corona project since the second survey (T2). Named after the project, a total of three cross-sectional surveys were distributed: T2 (February 16-20, 2021), T3 (May 10-14, 2022), and T4 (December 20-24, 2022). Burnout, depression, anxiety, sleep quality, workplace factors and individual resources were measured. Using the T4 data, we conducted structural equation model (SEM) to examine the mediating role of burnout in predicting emotional distress and sleep quality. Results: 96, 124, and 270 HCWs were enrolled at T2, T3, and T4, respectively. In line with the epidemic trends, the level of perceived COVID-19 related risks was significantly higher at T4, while the feeling of health and safety decreased significantly. At T4, the percentages of participants with clinically significant levels of depression and anxiety symptoms were 18.9% (51/270) and 9.3% (25/270), respectively, while 30.4% (82/270) of them reported poor or very poor sleep quality. According to the SEM, individual resources and workplace factors mainly had an indirect effect in predicting depression and anxiety via burnout. However, neither burnout nor stress was a mediator or predictor of sleep quality. Instead, individual resources, positive workplace factors, and younger age had a direct effect in predicting good sleep quality. Conclusion: Measures designed to enhance workplace factors and individual resources should be implemented to improve psychosomatic wellbeing of HCWs.

The association between the romantic relationships of parents and offspring depressive symptoms: Mediating effects of offspring communication patterns and romantic relationships.

This study investigated a conceptual model by testing how parental romantic relationships influenced the depressive symptoms of grown-up children and whether the constructive communication patterns of grown-up children and romantic relationships played mediation effects within it. A total of 421 Chinese participants were enrolled in the study. The level of depressive symptoms, romantic relationship satisfaction and closeness, couple communication patterns, and parental romantic relationships were measured via self-report questionnaires. According to the results, the structural equation modeling analysis verified that the severity of participants' depressive symptoms was negatively associated with the parental romantic relationship and that the association was mediated by participants' constructive communication patterns and their own romantic relationships. Furthermore, compared with nondepressed participants, depressed participants were less satisfied with their parental romantic relationships, exhibited fewer constructive communication patterns, and were more distant and unsatisfied with current romantic relationships.

Workplace factors can predict the stress levels of healthcare workers during the COVID-19 pandemic: First interim results of a multicenter follow-up study.

Background: Research is lacking on the long-term influence of workplace factors on the mental health of health care workers during the COVID-19 pandemic. Methods: We distributed two online surveys to health care workers between May and October 2020 (T1) and between February and April 2021 (T2). Perceived stress, coronavirus-related risks, and workplace factors were measured via self-report questionnaires at both time points. We conducted hierarchical linear regression to investigate the predictive factors for high stress. Results: A total of 2,110 participants from seven countries and 4,240 participants from nine countries were enrolled at T1 and T2, respectively. Among them, 612 participated in both surveys. We called this cohort T1 + T2. High stress was reported in 53.8 and 61.6% of participants at T1 and T2, respectively. In cohort T1 + T2, compared with the baseline, the level of stress rose significantly (6.0 ± 2.9 vs. 6.4 ± 3.1), as did health/safety in the workplace (3.9 ± 0.8 vs. 4.2 ± 0.7). Unfortunately, we did not detect any significant difference concerning support in the workplace. Among all factors at baseline, being older than 35 [ß (95% CI) = -0.92 (-1.45, -0.40)], support [-0.80 (-1.29, -0.32)], and health/safety in the workplace [-0.33 (-0.65, -0.01)] were independent protective factors, while a positive history of mental disorders [0.81 (0.26, 1.37)] and rejection in private life [0.86 (0.48, 1.25)] were risk factors for high stress at T2. Conclusion: To relieve the high stress of health care workers, organizational-level approaches should be implemented, especially measures designed to enhance support, health/safety in the workplace, and to reduce the rejection of the public.

Spindle-related brain activation in patients with insomnia disorder: An EEG-fMRI study.

Sleep spindles have been implicated in sleep protection, depression and anxiety. However, spindle-related brain imaging mechanism underpinning the deficient sleep protection and emotional regulation in insomnia disorder (ID) remains elusive. The aim of the current study is to investigate the relationship between spindle-related brain activations and sleep quality, symptoms of depression and anxiety in patients with ID. Participants (n = 46, 28 females, 18-60 years) were recruited through advertisements including 16 with ID, according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and 30 matched controls. Group differences in spindle-related brain activations were analyzed using multimodality data acquired with simultaneous electroencephalography and functional magnetic resonance imaging during sleep. Compared with controls, patients with ID showed significantly decreased bilateral spindle-related brain activations in the cingulate gyrus (familywise error corrected p ˂ 0.05, cluster size 4401 mm3). Activations in the cingulate gyrus were negatively correlated with Pittsburgh Sleep Quality Index scores (r = -0.404, p = 0.005) and Self-Rating Anxiety Scale scores (r = -0.364, p = 0.013), in the pooled sample. These findings underscore the key role of spindle-related brain activations in the cingulate gyrus in subjective sleep quality and emotional regulation in ID.

Application of a new HMW framework derived ANN model for optimization of aquatic dissolved organic matter removal by coagulation.

Removing dissolved organic matter (DOM) with polyaluminium chloride is one of the primary goals of drinking water treatment. In this study, a new HMW framework was proposed, which divided the factors affecting coagulation into three parts consisting of hydraulic condition (H), metal salt (M), and background water matrix (W). In this framework, H, M and W were assumed to be interacted with each other and combined to determine coagulation efficiency. We investigated the feasibility of the framework to determine the treatment efficiency through mathematical models. Results showed that non-linear artificial neural network (ANN) model was a better fit to the experimental data than the linear partial least squares (PLS) model: the ANN model could explain 76% of the total variations while the PLS could only explain 71%. The PLS did not follow the variations of observed values adequately. These experiments showed that the interaction between the HMW framework components were not simple linear relationships. The ANN model was able to optimize the composition of the HMW framework improving the efficiency of DOM removal through the components of HMW such as velocity gradient (G value), coagulant dosage, solution pH, and background water matrix. Overall, HMW framework is a new classification of factors affecting coagulation, leading to a better understanding of the coagulation process and sensitivity to influencing variables.