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BACKGROUND: Suicide remains one of the leading causes of death among adolescents. Although recent studies have suggested a strong association between auditory hallucinations and suicidal behaviors, little is known regarding the association between suicidal behaviors and visual hallucinations, which are also common among adolescent psychiatric patients. METHOD: A cross-sectional study of all first-time patients aged 10-15 years was conducted at three child and adolescent psychiatric outpatient facilities in Kanagawa Prefecture, Japan, from April 2015 to March 2018. Self-reported questionnaires were administered to evaluate auditory and visual hallucinations, suicide planning, and suicide attempts within the two weeks prior to the first visit. Our logistic regression model included three covariates (sex, age, and presence of major depressive episode) for adjustments. Among the 1285 respondents, 37 who had moderate or severe intellectual disability were excluded, leaving 1248 for analysis. RESULTS: Among the 1069 patients who completed questionnaire items on hallucinations, 230 (21.5%) experienced auditory or visual hallucinations. After controlling for all confounders, visual hallucinations, but not auditory hallucinations, were significantly associated with increased odds of suicide planning (odds ratio [OR] 2.5, 95% confidence interval [CI] 1.5-4.1). In contrast, auditory hallucinations, but not visual hallucinations, were significantly associated with increased odds of suicide attempts (OR 2.8, 95% CI 1.3-6.1). No interaction effects were observed between suicidal behaviors and auditory or visual hallucinations. CONCLUSIONS: Clinicians should consider the prevalence of both auditory and visual hallucinations among young adolescent patients, with emphasis on auditory hallucinations, given their association with suicide attempts.
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Transtorno Depressivo Maior , Ideação Suicida , Adolescente , Criança , Estudos Transversais , Alucinações/epidemiologia , Alucinações/psicologia , Humanos , Japão/epidemiologia , Pacientes AmbulatoriaisRESUMO
AIM: Although treatment guidelines for pharmacological therapy for schizophrenia and major depressive disorder have been issued by the Japanese Societies of Neuropsychopharmacology and Mood Disorders, these guidelines have not been well applied by psychiatrists throughout the nation. To address this issue, we developed the 'Effectiveness of Guidelines for Dissemination and Education in Psychiatric Treatment (EGUIDE)' integrated education programs for psychiatrists to disseminate the clinical guidelines. Additionally, we conducted a systematic efficacy evaluation of the programs. METHODS: Four hundred thirteen out of 461 psychiatrists attended two 1-day educational programs based on the treatment guidelines for schizophrenia and major depressive disorder from October 2016 to March 2018. We measured the participants' clinical knowledge of the treatment guidelines using self-completed questionnaires administered before and after the program to assess the effectiveness of the programs for improving knowledge. We also examined the relation between the participants' demographics and their clinical knowledge scores. RESULTS: The clinical knowledge scores for both guidelines were significantly improved after the program. There was no correlation between clinical knowledge and participant demographics for the program on schizophrenia; however, a weak positive correlation was found between clinical knowledge and the years of professional experience for the program on major depressive disorder. CONCLUSION: Our results provide evidence that educational programs on the clinical practices recommended in guidelines for schizophrenia and major depressive disorder might effectively improve participants' clinical knowledge of the guidelines. These data are encouraging to facilitate the standardization of clinical practices for psychiatric disorders.
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Transtorno Depressivo Maior/tratamento farmacológico , Educação Médica Continuada , Conhecimentos, Atitudes e Prática em Saúde , Guias de Prática Clínica como Assunto/normas , Avaliação de Programas e Projetos de Saúde , Psiquiatria/educação , Esquizofrenia/tratamento farmacológico , Adulto , Humanos , Disseminação de InformaçãoRESUMO
BACKGROUND: IL-17F is involved in the pathogenesis of several inflammatory diseases, including asthma and COPD. However, the effects of steroids on the function of IL-17F signaling mechanisms are largely unknown. One of the transcription elongation factors, positive transcription elongation factor b (P-TEFb) composed of cyclin T1 and cyclin-dependent kinase 9 (CDK9), is known as a novel checkpoint regulator of gene expression via bromodomain-containing protein 4 (Brd4). METHODS: Human airway smooth muscle cells were stimulated with IL-17F and the expression of IL-8 was evaluated by real-time PCR and ELISA. Next, the phosphorylation of CDK9 was determined by Western blotting. The CDK9 inhibitor and short interfering RNAs (siRNAs) targeting Brd4, cyclin T1, and CDK9 were used to identify the effect on IL-17F-induced IL-8 expression. Finally, the effect of steroids and its signaling were evaluated. RESULTS: IL-17F markedly induced the transcription of the IL-8 gene and the expression of the protein. Pretreatment of CDK9 inhibitor and transfection of siRNAs targeting CDK9 markedly abrogated IL-17F-induced IL-8 production. Transfection of siRNAs targeting Brd4 and cyclin T1 diminished IL-17F-induced phosphorylation of CDK9 and IL-8 production. Moreover, budesonide decreased CDK9 phosphorylation and markedly inhibited IL-17F-induced IL-8 production. CONCLUSIONS: This is the first report that P-TEFb is involved in IL-17F-induced IL-8 expression and that steroids diminish it via the inhibition of CDK9 phosphorylation. IL-17F and P-TEFb might be novel therapeutic targets for airway inflammatory diseases.
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Brônquios/metabolismo , Interleucina-17/fisiologia , Miócitos de Músculo Liso/metabolismo , Fator B de Elongação Transcricional Positiva/fisiologia , Transdução de Sinais/fisiologia , Brônquios/citologia , Budesonida/farmacologia , Células Cultivadas , Ciclina T/antagonistas & inibidores , Quinase 9 Dependente de Ciclina/antagonistas & inibidores , Quinase 9 Dependente de Ciclina/metabolismo , Humanos , Interleucina-8/biossíntese , Interleucina-8/genética , NF-kappa B/antagonistas & inibidores , FosforilaçãoRESUMO
The effectivity of cryo-scanning transmission electron microscopy-electron energy loss spectroscopy was demonstrated for nanoscale analysis of the cross-section of the Cu/polyimide interface. The nanoscale Cu/Cu2O/CuO layer structure at the interface was clearly observed for the first time. In addition, a Cu atom was identified, embedded in the polyimide matrix, and the average valence of diffusing Cu atoms or nanoclusters was determined using (cryo-)scanning transmission electron microscopy-electron energy loss spectroscopy. On the basis of these results, we have proposed a mechanism for the diffusion of Cu atoms in polyimide. To the best of our knowledge, this is the first report of the observation of a metal atom embedded in an insulating amorphous polymer.
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CONTEXT: Children and adolescents with intellectual disability often have various mental disorders and behaviour problems. Despite the limited evidence on the efficacy and safety of psychotropic medication use to children and adolescents with intellectual disability, clinicians often prescribes psychotropic medications for the management of problem behaviours. OBJECTIVE: We aimed to clarify the psychotropic prescribing practices for children and adolescents with intellectual disability. DESIGN: We conducted a 1-year cohort study of patients with intellectual disability aged 3-17 years using a large health insurance claims database in Japan. OUTCOME MEASURES: Psychotropic prescription, prescription duration, polypharmacy, and average dosage. RESULTS: Of 2,035 patients, the most prevalently prescribed psychotropic medications were antipsychotics (12.5%), anxiolytics/hypnotics (12.4%), stimulants (4.8%), mood stabilizers (2.4%), and antidepressants (1.8%). The prescription prevalences of anxiolytic/hypnotic and antipsychotics increased with age. Patients aged 6 years or older had around 2-fold higher prescription duration of antipsychotics (median duration of over 300 days per year) than those aged 3 to 5 years. The likelihood of polypharmacy and excessive dosage (defined as chlorpromazine equivalents of >300 mg/day) of antipsychotics increased with age. CONCLUSION: We observed a higher prescription prevalences of anxiolytics/hypnotics and antipsychotics and a longer prescription duration of antipsychotics in the present study than those in previous studies. Our results suggest a need for developing clinical practice guidelines for the management of problem behaviours among children and adolescents with intellectual disability.
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Deficiência Intelectual/tratamento farmacológico , Psicotrópicos/uso terapêutico , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Bases de Dados Factuais , Combinação de Medicamentos , Feminino , Humanos , Seguro Saúde , MasculinoRESUMO
OBJECTIVE: Interleukin (IL)-32 is a novel cytokine and is involved in the pathogenesis of various inflammatory diseases, including asthma and COPD. However, the regulatory mechanisms of IL-32 expression and its precise pathogenic role remain to be defined. Given that viral infections are known to potentially cause and exacerbate airway inflammation, in this study, we investigated the expression of IL-32 induced by synthetic double-stranded (ds) RNA, and its signaling mechanisms involved. METHODS: Bronchial epithelial cells were stimulated with synthetic dsRNA poly I:C. The levels of IL-32 expression were analyzed using real-time PCR and ELISA. The involvement of transforming growth factor ß-activated kinase 1 (TAK1) and a subunit of nuclear factor-κB (NF-κB), p65 was determined by western blot analyses. TAK1 inhibitor, 5Z-7-Oxozeaenol and NF-κB inhibitor, BAY 11-7082 were added to the culture to identify key signaling events leading to the expression of IL-32. Finally, the effect of short interfering RNAs (siRNAs) targeting TAK1 and p65 was investigated. RESULTS: dsRNA significantly induced IL-32 gene and protein expression, concomitant with activation of TAK1 and p65. Pretreatment of 5Z-7-Oxozeaenol diminished dsRNA-induced phosphorylation of NF-κB. Both 5Z-7-Oxozeaenol and BAY 11-7082 significantly abrogated dsRNA-induced IL-32 production. Moreover, transfection of the cells with siRNAs targeting TAK1 and p65 inhibited the expression of IL-32. CONCLUSIONS: The expression of IL-32 is induced by dsRNA via the TAK1-NF-κB signaling pathway in bronchial epithelial cells. IL-32 is involved in the pathogenesis of airway inflammation, and may be a novel therapeutic target for airway inflammatory diseases.
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Brônquios/metabolismo , Células Epiteliais/metabolismo , Interleucinas/metabolismo , RNA de Cadeia Dupla/metabolismo , Brônquios/efeitos dos fármacos , Células Cultivadas , Células Epiteliais/efeitos dos fármacos , Humanos , Proteínas I-kappa B/metabolismo , Lactonas/farmacologia , MAP Quinase Quinase Quinases/metabolismo , NF-kappa B/metabolismo , Nitrilas/farmacologia , Fosforilação/efeitos dos fármacos , Fosforilação/fisiologia , Pneumonia/metabolismo , Resorcinóis/farmacologia , Transdução de Sinais/efeitos dos fármacos , Transdução de Sinais/fisiologia , Sulfonas/farmacologia , Fator de Transcrição RelA/metabolismoRESUMO
BACKGROUND: We aimed to examine trends in the use of psychotropic medications among elderly outpatients with dementia in Japan between 2002 and 2010. METHODS: We used data from the 2002-2010 Survey of Medical Care Activities in Public Health Insurance (SMCA-PHI), a nationally representative cross-sectional survey of claims data for the month of June in every year. We included ambulatory care visits by patients aged 65 years or older who were prescribed cholinesterase inhibitors (n = 15,591), and identified use of any psychotropic medications during the survey month. RESULTS: In 20082010, the most prevalently prescribed psychotropic medications to patients with dementia were sedatives-hypnotics (27.3%), antipsychotics (21.3%), antidepressants (11.4%), and mood-stabilizers(2.8%). Between 20022004 and 20082010, use of second-generation antipsychotics increased from 4.9%to 11.2%, while use of first-generation antipsychotics decreased from 17.4% to 12.1% [corrected].These numbers resulted in a 1.1-fold increase in the adjusted prevalence of the overall use of antipsychotics. Quetiapine and risperidone use showed a 4.8- and 1.8-fold increase, respectively, while haloperidol use showed a 2.3-fold decrease. CONCLUSIONS: Despite safety warnings against the use of antipsychotics for patients with dementia in several countries, our study revealed a slight increase in the extensive use of off-label antipsychotics over time in Japan. This finding indicates an urgent need for evaluation of the efficacy of antipsychotics for the approved treatment of severe agitation, aggression, and psychosis associated with dementia. Moreover, psychosocial interventions and antipsychotic withdrawal strategies are needed in order to reduce the overall prevalence of antipsychotic use.
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Antidepressivos/uso terapêutico , Antipsicóticos/uso terapêutico , Inibidores da Colinesterase/uso terapêutico , Demência/tratamento farmacológico , Agitação Psicomotora/tratamento farmacológico , Psicotrópicos/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Demência/complicações , Feminino , Humanos , Hipnóticos e Sedativos/uso terapêutico , Japão , Masculino , Uso Off-Label , PsicofarmacologiaAssuntos
Terapia Cognitivo-Comportamental/estatística & dados numéricos , Transtorno Depressivo Maior/terapia , Prescrições de Medicamentos/estatística & dados numéricos , Eletroconvulsoterapia/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde , Hospitais/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Estudos Transversais , Pesquisa sobre Serviços de Saúde , Humanos , Japão , Polimedicação , Indicadores de Qualidade em Assistência à Saúde , Estudos RetrospectivosRESUMO
UNLABELLED: Context: Despite evidence of an increase in the number of young patients receiving mental health treatment, most psychotropic medications have not been approved for the treatment of children and adolescents by the Ministry of Health, Labour and Welfare. There is little data available on psychotropic medication use in children and adolescents in Japan. OBJECTIVE: To establish the prevalence of psychotropic medications and multiclass psychotropic polypharmacy in outpatients aged 18 years or younger in Japan between 2002 and 2010. DESIGN: We used the national insurance claims database from the 2002-2010 Survey of Medical Care Activities in Public Health Insurance in Japan. OUTCOME MEASURES: Prevalence of psychotropic prescription and psychotropic polypharmacy. RESULTS: Our study dataset comprised 233,399 outpatient visits. Among patients aged 6-12 years between 2002-2004 and 2008-2010, there was a significant increase in the prevalence of ADHD medications (Odds Ratio [OR] 1.84; 95% Confidence Interval [CI] 1.33, 2.56) and antipsychotics (OR 1.58 95% CI 1.06, 2.34), and a significant decrease in the prevalence of sedative-hypnotics (OR 0.67; 95% CI 0.46, 0.99). Among patients aged 13-18 years, there was a significant increase in the prevalence of ADHD medications (OR 2.49; 95% CI 1.34, 4.62), anti-psychotics (OR 1.43 ; 95% CI 1.20, 1.70), and antidepressants (OR 1.37; 95% CI 1.09, 1.72). Medications that were most frequently involved used in combination of two or more psychotropic agents were mood stabilizer (93%), followed by antidepressants (77%), sedative-hypnotics (62%), antipsychotics (61%), and ADHD medications (17%). CONCLUSION: Our study revealed an increase in the use of off-label antipsychotics and antidepressants among children and adolescents. Therefore, there is an urgent need for clinical trials to evaluate the efficacy of psychotropic medications for use in children and adolescents, and the development of a clinical database to monitor the associated long-term risks and benefits.
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Uso de Medicamentos/estatística & dados numéricos , Transtornos Mentais/tratamento farmacológico , Psicotrópicos/uso terapêutico , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Seguro Saúde , Masculino , Fatores de TempoRESUMO
We performed molecular dynamics simulations of carbon nanotube (CNT) to elucidate the growth process in the floating catalyst chemical vapor deposition method (FCCVD). FCCVD has two features: a nanometer-sized cementite (Fe 3 C) particle whose melting point is depressed because of the larger surface-to-volume ratio and tensile strain between the growing CNT and the catalyst. The simulations, including these effects, demonstrated that the number of 6-membered rings of the (6,4) chiral CNT constantly increased at a speed of 1 mm / s at 1273 K , whereas those of the armchair and zigzag CNTs were stopped in the simulations and only reached half of the numbers for chiral CNT. Both the temperature and CNT chirality significantly affected CNT growth under tensile strain.
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AIMS: It has been recommended that for patients with schizophrenia, antipsychotics should be prescribed simply, using an optimal dose. However, pro re nata (p.r.n., meaning to use on an as-needed basis) antipsychotics may increase the risk of excessive dosing (defined as mean chlorpromazine-equivalent doses above 1000 mg) and polypharmacy (combination use of different antipsychotics). This study aimed to investigate the increased risk caused by p.r.n. antipsychotics. METHOD: The subjects included 413 patients with schizophrenia from 17 acute psychiatric wards in nine hospitals. Over a 24-h period on a survey day, data on regular medication and the use of p.r.n. were collected. The analysis focused on p.r.n. antipsychotics in agitated patients. We used McNemar's test to evaluate differences in the proportions of patients prescribed antipsychotics with excessive dosing or polypharmacy before (i.e., regular medication only) and after prescribed p.r.n. antipsychotics were added to regular medication (i.e., regular medication plus p.r.n. antipsychotics). RESULTS: Of 413 patients, 312 (75.5%) were prescribed p.r.n. for agitated status. Of those, 281 (90.1%) were prescribed p.r.n. antipsychotics. The total doses were significantly higher and more compounded in case patients prescribed p.r.n. antipsychotics than in those who were not. Seventeen patients (4.1%) were actually administered p.r.n. antipsychotics. Their total medication, including p.r.n. on the current day, represented excessive dosing or polypharmacy of antipsychotics. CONCLUSION: The use of p.r.n. antipsychotics may cause hidden excessive dosing and polypharmacy. Our results indicate the importance of careful monitoring of p.r.n. antipsychotics to agitated patients with schizophrenia.
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Antipsicóticos/efeitos adversos , Polimedicação , Agitação Psicomotora/psicologia , Esquizofrenia/tratamento farmacológico , Psicologia do Esquizofrênico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antipsicóticos/administração & dosagem , Antipsicóticos/uso terapêutico , Feminino , Inquéritos Epidemiológicos , Hospitais Psiquiátricos , Humanos , Classificação Internacional de Doenças , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Uso Indevido de Medicamentos sob Prescrição , Risco , Adulto JovemRESUMO
Proton exchange membranes with high proton conductivity and low crossover of fuel molecules are required to realize advanced fuel-cell technology. The selective transportation of protons, which occurs by blocking the transportation of fuel molecules across a proton exchange membrane, is crucial to suppress crossover while maintaining a high proton conductivity. In this study, a simple yet powerful method is proposed for optimizing the crossover-conductivity relationship by pasting sulfanilic-functionalized holey graphenes onto a Nafion membrane. The results show that the sulfanilic-functionalized holey graphenes supported by the membrane suppresses the crossover by 89% in methanol and 80% in formate compared with that in the self-assembled Nafion membrane; an ≈60% reduction is observed in the proton conductivity. This method exhibits the potential for application in advanced fuel cells that use methanol and formic acid as chemical fuels to achieve high energy efficiency.
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AIM: The aim of this study was to conduct a 5-h training programme on anger-focused emotional management for nurses and verify its effectiveness. DESIGN: The study used a one-group pretest-posttest design. METHODS: Participants (N = 283) attended a programme comprising lectures and exercises. The Japanese version of the Buss-Perry Aggression Questionnaire was administered pre-, post- and 3-month posttraining. Regression analyses were used to assess the effects of the programme by gender. RESULTS: For the total aggression score, the difference between the pre- and posttraining scores was -2.827 points and remained at -1.602 points 3-month posttraining. Physical aggression scores decreased posttraining, but the scores increased after 3 months. There were statistically significant gender differences in hostility scores; pre-training scores were slightly higher for men than for women and lower for men after 3 months. Total and physical aggression scores were higher for men than for women. The training programme decreased aggression, and the effect persisted after 3 months.
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Terapia de Controle da Ira , Enfermeiras e Enfermeiros , Masculino , Humanos , Feminino , Agressão/psicologia , Hostilidade , IraRESUMO
To realize a sustainable hydrogen economy, corrosion-resistant non-noble-metal catalysts are needed to replace noble-metal-based catalysts. The combination of passivation elements and catalytically active elements is crucial for simultaneously achieving high corrosion resistance and high catalytic activity. Herein, the self-selection/reconstruction characteristics of multi-element (nonary) alloys that can automatically redistribute suitable elements and rearrange surface structures under the target reaction conditions during the oxygen evolution reaction are investigated. The following synergetic effect (i.e., cocktail effect), among the elements Ti, Zr, Nb, and Mo, significantly contributes to passivation, whereas Cr, Co, Ni, Mn, and Fe enhance the catalytic activity. According to the practical water electrolysis experiments, the self-selected/reconstructed multi-element alloy demonstrates high performance under a similar condition with proton exchange membrane (PEM)-type water electrolysis without obvious degradation during stability tests. This verifies the resistance of the alloy to corrosion when used as an electrode under a practical PEM electrolysis condition.
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Shear-thickening fluids that absorb the impact energy of high-velocity projectiles are of great interest for aerospace and body-armor applications. In such a frame, we investigate transient states of neat and aqueous polyelectrolytes (PE) having low molecular weights and containing poly([2-(methacryloyloxy)ethyl]trimethylammonium) as polycations and poly(acrylamide-co-acrylic acid) as polyanions. We compare results with those of bulk water. We employ nonequilibrium molecular dynamics to simulate oscillatory shear, mainly in the linear viscoelastic regime. We find that neat PE exhibits properties of a viscoelastic solid, whereas water and the aqueous mixture of PE conform to viscoelastic liquids with Maxwellian behavior at low angular frequencies. Terminal relaxation times are â¼0.499 and â¼1.385 ps for water and the aqueous mixture of PE, respectively. At high angular frequencies, storage moduli show anomalous behaviors that correspond to transitions between shear thinning and shear thickening in complex shear viscosities. The change in potential energy with the increase of the angular frequency is mainly driven by intramolecular interactions for neat PE, whereas short-range Coulomb interactions are the major contributions for water and the aqueous mixture of PE. Upon observation of the molecular configurations, only the local polyionic structure in the aqueous mixture of PE shows improvement when increasing the angular frequency, whereas the rest remains barely affected. Thus, the water structure in the aqueous mixture of PE allows the storage of energy elastically through the hydrogen-bond network at large angular frequencies, whereas the mechanical contribution of polyions weakens and fully vanishes at the beginning of shear thinning, explaining the superimposed data with data of bulk water. Our method and findings set the path for future molecular simulations in the nonlinear viscoelastic regime with more complex underlying molecular mechanisms.
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Água , Conformação Molecular , Peso Molecular , Polieletrólitos , ViscosidadeRESUMO
ABSTRACT: Problematic Internet use (PIU) is common and likely to coexist with mental health problems among adolescents with school refusal behavior. To date, no study has revealed to what extent PIU relates to the daily burden compared with other mental health problems. This study has examined the association between daily difficulties and PIU among adolescents with school refusal behaviors.This cross-sectional study involved all first-visit patients, regardless of diagnosis, aged 10 to 18âyears at 2 child/adolescent psychiatric outpatient clinics in Yokohama City, Japan, from April 2016 to March 2018. The Questionnaire-Children with Difficulties (QCD) were obtained from parents. Simultaneously, the severity of PIU was evaluated using the Internet Addiction Test and depressive and anxiety symptoms were evaluated using the Patient Health Questionnaire-9 and General Anxiety Disorder-7 scale in the 2âweeks before the first-visit. From 684 first-visit patients, 227 with school refusal behaviors were enrolled in the study.PIU was observed in 40% of adolescents with school refusal behaviors. The QCD scores among patients with PIU were significantly lower than those in patients without PIU. Linear regression analysis revealed relationships between PIU and lower QCD scores throughout the day (except at night) and the total score of the day, after controlling for confounders such as depressive and anxiety symptoms.In conclusion, among adolescents with school refusal behaviors, PIU may affect their parent-assessed daily difficulties particularly experienced throughout the day.
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Comportamento do Adolescente , Comportamento Aditivo , Adolescente , Comportamento do Adolescente/psicologia , Comportamento Aditivo/epidemiologia , Criança , Estudos Transversais , Humanos , Uso da Internet , Instituições AcadêmicasRESUMO
Aim: Current clinical guidelines for attention-deficit/hyperactivity disorder (ADHD) put shared decision making (SDM) at the center of care. However, there remain challenges in SDM in ADHD management, particularly regarding the decision to continue or discontinue medication after ADHD remission in adult patients. We aimed to develop a decision aid (DA) for adult patients with ADHD regarding the continuation or discontinuation of their ongoing ADHD medications after they have attained remission. Method: We systematically developed a DA according to the International Patient Decision Aid Standard (IPDAS). First, we created a DA prototype using the results of our previous systematic review and meta-analysis that identified the consequences of continuing and discontinuing ADHD medications. Second, we administered a mixed-method questionnaire (alpha acceptability testing) to adult patients with ADHD and healthcare providers to improve the DA prototype and develop it into a final version that is acceptable for clinical settings. Results: Our DA consisted of ADHD description, the option to continue or discontinue ADHD medications, the advantages and disadvantages of the consequences, as well as value clarification exercises for each option. Patients (n = 20) reported that the DA had acceptable language (85%), adequate information (75%), and a well-balanced presentation (53%). Healthcare providers (n = 19) provided favorable feedback. The final DA met all six IPDAS requisite criteria. Conclusions: Our results could facilitate the SDM process between patients and healthcare providers on the continuation or discontinuation of ADHD medication following remission. Further studies should verify the effects of using the DA during the SDM process among patients across the age spectrum with ADHD and healthcare providers.
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Previous cross-sectional studies have reported that adolescent patients with anorexia nervosa (AN) showed global gray matter volume (GMV) reductions at the acute phase which were restored at the weight-recovered phase, compared with healthy controls (HC). However, few studies have investigated white matter volume (WMV) or cortical thickness in the context of AN, and results have been inconsistent. Voxel-based morphometry analyses for GM and WM, and cortical thickness analyses for GM were conducted in 31 adolescent patients with AN (vs. 18 HC) in the acute phase, and 16 patients with AN (vs. 13 HC) in the follow-up weight-recovered phase, over an approximately 1-year follow-up interval. At the acute phase, the AN patients showed significant reductions of GMVs and cortical thickness in widespread brain regions, compared with HC. Significant WMV reductions were identified in the bilateral superior longitudinal fascicle, superior thalamic radiation, corona radiata, and fornix, pons, and medulla in the patients. At the weight-recovered phase, the AN patients showed a significant GMV reduction in the left hippocampus, and a WMV reduction in the pons, compared with the HC. There was no difference in cortical thickness between two groups at the weight-recovered phase. In conclusion, the widespread volumetric reductions in GM and WM, and reduced cortical thickness observed in AN patients in the acute phase were not evident in the follow-up weight-recovered phase. The volume reductions observed in the hippocampus and pons in the weight-recovered phase could potentially reflect delayed neurogenesis or recovery from starvation in the AN patients.
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Anorexia Nervosa , Substância Branca , Adolescente , Anorexia Nervosa/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Substância Cinzenta/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética/métodos , Substância Branca/diagnóstico por imagemRESUMO
The COVID-19 pandemic has been affecting the mental health of hospital workers. During the prolonged pandemic, hospital workers may experience much more severe psychological distress, leading to an increased risk of suicide. This study aimed to investigate changes in psychological effects on hospital workers over 12 months from the beginning of the pandemic and clarify factors associated with psychological distress and suicide-related ideation 1-year after the pandemic's beginning. These repeated, cross-sectional surveys collected demographic, mental health, and stress-related data from workers in 2 hospitals in Yokohama, Japan. The first survey, conducted in March-April 2020, contained the 12-item General Health Questionnaire (GHQ-12) assessing general distress and the Impact of Event Scale-Revised (IES-R) assessing event-related distress. In the second survey in March 2021, hospital workers at the same two hospitals were reassessed using the same questionnaire, and Item 9 of the Patient Health Questionnaire (PHQ-9) was added to assess their suicide-related ideation. The findings of the first and second surveys revealed that the average score of GHQ-12 (3.08 and 3.73, respectively), the IES-R total score (6.8 and 12.12, respectively), and the prevalence rates of severe general distress (35.0% and 44.0%, respectively) and severe event-related distress (7.0% and 17.1%, respectively) deteriorated. The second survey showed that 8.6% of the hospital workers were experiencing suicide-related ideation. Both the general and event-related distress were associated with suicide-related ideation. In these surveys, mental health outcomes among the hospital workers deteriorated over one year from the pandemic's beginning, and their severe psychological distress was the risk factor for the suicide-related ideation. Further studies are needed to compare the psychological effects on hospital workers during and after the prolonged pandemic and to explore appropriate measures to support hospital workers' mental health.
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COVID-19 , Angústia Psicológica , Suicídio , Humanos , COVID-19/epidemiologia , Pandemias , Estudos Transversais , Estresse Psicológico/epidemiologia , Estresse Psicológico/psicologia , Inquéritos e Questionários , HospitaisRESUMO
We report the one-step fabrication of aligned and high-quality carbon nanotubes (CNTs) using floating-catalyst chemical vapor deposition (FCCVD) with controlled fluidic properties assisted by a gas rectifier. The gas rectifier consists of one-dimensional straight channels for regulating the Reynolds number of the reaction gas. Our computational fluid dynamics simulation reveals that the narrow channels of the gas rectifier provide steady and accelerated laminar flow of the reaction gas. In addition, strong shear stress is induced near the side wall of the channels, resulting in the spontaneous formation of macroscopic CNT bundles aligned along the direction of the gas flow. After a wet-process using chlorosulfonic acid, the inter-tube voids inherently observed in as-grown CNT bundles are reduced from 16 to 0.3%. The resulting CNT fiber exhibits a tensile strength of 2.1 ± 0.1 N tex-1 with a Young's modulus of 39 ± 4 N tex-1 and an elongation of 6.3 ± 0.6%. FCCVD coupled with the strong shear stress of the reaction gas is an important pre-processing route for the fabrication of high-performance CNT fibers.