Schizophrenia is a serious long-term psychotic disorder marked by positive and negative symptoms, severe behavioral problems and cognitive function deficits. The cause of this disorder is not ...completely clear, but is suggested to be multifactorial, involving both inherited and environmental factors. Since human brain regulates all behaviour, studies have focused on identifying changes in neurobiology and biochemistry of brain in schizophrenia. Brain is the most lipid rich organ (approximately 50% of brain dry weight). Total brain lipids is constituted of more than 60% of phospholipids, in which docosahexaenoic acid (DHA, 22:6n-3) is the most abundant (more than 40%) polyunsaturated fatty acid (PUFA) in brain membrane phospholipids. Results from numerous studies have shown significant decreases of PUFAs, in particular, DHA in peripheral blood (plasma and erythrocyte membranes) as well as brain of schizophrenia patients at different developmental phases of the disorder. PUFA deficiency has been associated to psychotic symptoms and cognitive deficits in schizophrenia. These findings have led to a number of clinical trials examining whether dietary omega-3 fatty acid supplementation could improve the course of illness in patients with schizophrenia. Results are inconsistent. Some report beneficial whereas others show not effective. The discrepancy can be attributed to the heterogeneity of patient population.
In this review, results from recent experimental and clinical studies, which focus on illustrating the role of PUFAs in the development of schizophrenia were examined. The rationale why omega-3 supplementation was beneficial on symptoms (presented by subscales of the positive and negative symptom scale (PANSS), and cognitive functions in certain patients but not others was reviewed. The potential mechanisms underlying the beneficial effects were discussed.
Omega-3 fatty acid supplementation reduced the conversion rate to psychosis and improved both positive and negative symptoms and global functions in adolescents at ultra-high risk for psychosis. Omega-3 fatty acid supplementation could also improve negative symptoms and global functions in the first-episode patients with schizophrenia, but improve mainly total or general PANSS subscales in chronic patients. Patients with low PUFA (particularly DHA) baseline in blood were more responsive to the omega-3 fatty acid intervention.
Omega-3 supplementation is more effective in reducing psychotic symptom severity in young adults or adolescents in the prodromal phase of schizophrenia who have low omega-3 baseline. Omega-3 supplementation was more effective in patients with low PUFA baseline. It suggests that patients with predefined lipid levels might benefit from lipid treatments, but more controlled clinical trials are warranted.
Patient and visitor violence (PVV), the most prevalent source of workplace violence, is largely ignored, underreported, and a persistent problem in emergency departments. It is associated with ...physical injuries, psychological distress, and occupational stress in nurses. A randomized controlled trial was conducted in Taiwan from January to December 2020. This study aimed to test the efficacy of an integrated Workplace Violence Prevention and Management Training Program on PVV in 75 emergency department (ED) nurses from a hospital. Cluster sampling was used because the policy of subdivision strategy was enforced during the COVID-19 pandemic. ED nurses received either the intervention or 1-hour in-service class. Data were collected from questionnaires. Data were analyzed mainly by the repeated measure analysis of variance and generalized estimating equations. The intervention had positive effects on developing stronger goal commitment, improving occupational coping self-efficacy, increasing confidence in ability to deal with violent situations, and modifying attitudes toward the causes and management of PVV in ED nurses (p < 0.05). The marginal R2 of the generalized estimating equation model for goal commitment, occupational coping self-efficacy, confidence, attitudes toward aggression in ED and aggressive behavior variables was high as 0.54 (p < 0.001), 0.45 (p < 0.001), 0.58 (p < 0.001), 0.29 (p < 0.05), and 0.72 (p < 0.001), respectively. These study models could effectively predict changes in the mean values. The benefit was driven by the effect of the intervention in ED nurses. Thus, the intervention, when applied in conjunction with routine in-service class, could exert synergistic improvements on outcomes measured in nurses.
Background
This study investigated the determinants and use of Taiwan's long‐term care (LTC) Plan Version 2.0 (LTC 2.0) services by persons with dementia (PWDs) and their caregivers.
Methods
In ...total, 1268 PWD–caregiver dyads were enrolled for analysis from a national dementia registry. Andersen's Behavioral Model of Health Services Use was used to investigate the association of LTC service use with several factors, namely the demographic data of PWDs and their caregivers, migrant caregiver employment, monthly household income, caregiver burden as determined by the Zarit Burden Interview (ZBI), Mini‐Mental State Examination score, Clinical Dementia Rating scores, neuropsychiatric inventory scores for the behavioral and psychological symptoms of dementia, and PWDs' activities of daily living (ADLs).
Results
Among the studied family caregivers, 81.4% did not use LTC resources. A multivariable logistic analysis revealed that aberrant motor behaviors (odd ratio OR = 1.31, 95% confidence interval CI = 1.10–1.56, p = 0.003), dysfunction in ADLs (OR = 1.06, 95% CI = 1.02–1.10, p = 0.002), higher ZBI scores (OR = 1.02, 95% CI = 1.01–1.03, p = 0.004), not residing with family members (OR = 1.88, 95% CI = 1.32–2.66, p < 0.001), and not employing a migrant caregiver (OR = 4.41, 95% CI = 2.59–7.51, p < 0.001) were the factors most significantly associated with LTC service use.
Conclusion
Factors such as whether PWDs live alone, specific neuropsychiatric symptoms, and impaired function should be considered in future policy amendments to provide required activities and care resources for PWDs and their caregivers.
Key points
This study investigated the determinants and use of long‐term care (LTC) service by persons with dementia (PWDs) and their caregivers.
PWDs who used LTC services had more severe neuropsychiatric symptoms (NPSs), poorer cognitive function, and inferior ability to engage in activities of daily living (ADLs) and placed a greater burden on their caregivers.
More aberrant motor behaviors, greater ADL limitations, greater caregiver burden, not residing with family members, and not employing migrant caregivers were the factors most significantly associated with LTC service use.
These factors should be considered in future policy amendments to provide care resources for PWDs and meet the needs of PWDs and their caregivers.
Abstract
The Wnt signaling pathway is intricately connected with bone mass regulation in humans and rodent models. We designed an antibody-based platform that generates potent and selective Wnt ...mimetics. Using this platform, we engineer bi-specific Wnt mimetics that target Frizzled and low-density lipoprotein receptor-related proteins and evaluate their effects on bone accrual in murine models. These synthetic Wnt agonists induce rapid and robust bone building effects, and correct bone mass deficiency and bone defects in various disease models, including osteoporosis, aging, and long bone fracture. Furthermore, when these Wnt agonists are combined with antiresorptive bisphosphonates or anti-sclerostin antibody therapies, additional bone accrual/maintenance effects are observed compared to monotherapy, which could benefit individuals with severe and/or acute bone-building deficiencies. Our data support the continued development of Wnt mimetics for the treatment of diseases of low bone mineral density, including osteoporosis.
Determining the number of clusters, which is usually approved by domain experts or evaluated by clustering validity indexes, is an important issue in clustering analysis. This study discusses the ...effectiveness of clustering validity indexes for centroid-based partitional clustering algorithms. Most general-purpose clustering validity indexes take the minimum/maximum distance between a pair of data objects, a pair of cluster centroids, or an object and a centroid as an important evaluation factor; however, they may present unstable results, especially when two centroids are allocated closely. To alleviate this problem, a new clustering validity index, which is termed the Wu-and-Li index (WLI), is proposed in this paper. Our proposed WLI partially allows, to some extent, the existence of closely allocated centroids in the clustering results by considering not only the minimum but the median distances between a pair of centroids as well; therefore possessing better stability. The performances of WLI and some existing clustering validity indexes are evaluated and compared by running the fuzzy c-means algorithm for clustering various types of datasets, including artificial datasets, UCI datasets, and images. Experimental results have shown that WLI has the more accurate and satisfactory performance than other indexes.
Nurses received the highest rate of workplace violence due to their close interaction with clients and the nature of their work. There have been relatively few qualitative studies focus on nurses' ...perceptions of and experiences with the antecedents, dilemma and repercussions of the patient and visitor violence (PVV), leaving a considerable evidence gap. The aim of this study was to explore nurses' experience of PVV in emergency department, the impact of PVV on quality of care, and supports needed after exposure to such incidents. We conducted semi-structured interviews with a purposive and snowball sample of nurses, and analyzed the content of the interview transcripts. A total of 10 nurses were approached and agreed to participate. Those participants ranged in age from 24 to 41 years old, eight female and two male nurses, and the majority of them (80%) held a university Bachelor degree in nursing. The average time in nursing practice was 7.2 years. We conceptualized five analytical themes, which comprised: (1) multifaceted triggers and causes of PVV; (2) experiences following PVV; (3) tangled up in thoughts and struggle with the professional role; (4) self-reflexivity and adjustment; and, (5) needs of organizational efforts and support following PVV. This paper provides compelling reasons to look beyond solely evaluating the existence of workplace, and considering the perceived professional inefficacy, impacts of being threatened or assaulted in nurses. There are also urgent needs in provision of prevention and management of workplace training programs to ensure the high-quality nursing care.
Schematic presentation of ECM degradation induced by miR-21 in human degenerated NP cells. The binding of miR-21 to PTEN mRNA 3'-UTR can significantly downregulate PTEN expression, which leads to the ...sequential Akt and mTOR phosphorylation. Activated Akt/mTOR pathway strongly reduces autophagy levels in human degenerative NP cells, which in turn increases the expression of MMP-3 and MMP-9 and facilitates the degradation of Col II and aggrecan. P: phosphorylation.
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Intervertebral disc degeneration (IDD) is the most common cause leading to low back pain, a highly prevalent, costly and crippling condition worldwide. Overexpression of miR-21 has been shown to promote proliferation of nucleus pulposus (NP) cells. However, it remains unclear whether miR-21 can promote the degradation of type II collagen (Col II) and aggrecan, two main extracellular matrix components within the disc. Here, the miRNA microassay assay identified 29 differentially expressed miRNAs in NP tissues from IDD patients compared with healthy controls. Following qRT-PCR validation, miR-21 expression was significantly upregulated in degenerated NP tissues, and showed a positive correlation with disc degeneration grade. Through gain-of-function and loss-of-function studies in human NP cells, miR-21 was shown to inhibit autophagy and then upregulate the expression of matrix metalloproteinase (MMP)-3 and MMP-9, leading to increased degradation of Col II and aggrecan. Mechanistically, phosphatase and tensin homolog (PTEN) was identified as a direct target of miR-21, and activated PTEN/ Akt/mammalian target of rapamycin (mTOR) signaling pathway was involved in miR-21-induced autophagy inhibition and Col II and aggrecan breakdown. Taken together, these results suggest that miR-21 contributes to Col II and aggrecan catabolism by inhibiting autophagy via the PTEN/Akt/mTOR signaling pathway in human NP cells.
Patients with schizophrenia and repetitive violence express core impairments that encompass multiple domains. To date, there have been few interventions integrating neurocognition, social cognition, ...alexithymia, and emotion regulation together as an approach to manage repetitive violence. The aim of this open-label randomized controlled trial was to examine more comprehensively the effectiveness of a novel Integrated Cognitive Based Violence Intervention Program on management of repetitive violence in patients with schizophrenia (vSZ). Sixty recruited patients were aged ≥20 years, diagnosed with schizophrenia for >2 years, had repetitive violent behavior within one year, and were psychiatrically hospitalized. The vSZ patients were randomly allocated to two groups and received either the intervention or treatment as usual. The intervention module, consisting of all defined 11 cognitive and social cognitive domains as well as emotion regulation, which were grouped into four modules. The intervention placed emphasis on the patients’ behavioral problems or intrinsic conflicts in relation to repetitive violence. The results indicate a statistically significant trend toward reducing impulsivity, anger with resentment, physical aggression, suspicion, and hostility (p < 0.05). The intervention significantly alleviated the intensity of cognitive failure, improved the management of alexithymic features and attribution styles and errors, and fostered adequate decision-making styles and emotion regulation capacity (p < 0.05). The intervention, when applied in conjunction with psychiatric standard care, could exert synergistic effects on alexithymia and cognitive, clinical, and neurocognitive features of repetitive violence in schizophrenia. This intervention provided patients a more active role to manage their violent behavior with the involvement of alexithymia.
Moral cognition is an important and multidimensional, but often overlooked, determinant of violence. Very few interventions have systematically examined the role of moral reasoning, anger management ...and problem-solving together in violence. A randomized controlled trial was conducted to comprehensively evaluate the sustained effects of an integrated Moral Reasoning Development Intervention (MRDI) in the management of repetitive violence in schizophrenia. This study placed special emphasis on essential components related to moral reasoning and violence in patients with schizophrenia. Evaluations, including measures of violence, moral reasoning, ethical valuation and judgement, decision-making, conflict management style, and personality traits, were performed at baseline, end of intervention, and 1-month follow-up after intervention. We found that MRDI was superior to treatment-as-usual, in improving moral reasoning and related variables and violence outcomes (p < 0.05). In comparison with the treatment-as-usual group (n = 22), patients in the MRDI group (n = 21) showed improved levels of moral reasoning, with decreased levels of violent behaviors. The MRDI participants also experienced significantly greater improvements or changes (p < 0.05) in their ethical valuation and judgement, decision-making style and preferences, and conflict management style. Our findings provide important implications for risk assessment and violence management and prevention.
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