Stigma among healthcare professionals may lead to poor quality of healthcare services for patients with mental illness. This study conducts a network meta-analysis to estimate the relative efficacy ...between different types of anti-stigma interventions for healthcare professionals.
Network meta-analysis.
The attitudes and behavior intension of healthcare professionals toward mental illness.
A total of 18 studies (22 trials) from 9 countries are included in the analysis. In the network meta-analysis, rank probabilities show interventions with indirect contact plus lecture (SUCRA = 81.5%), direct contact plus problem-based learning workshop (SUCRA = 77.4%), and indirect contact (SUCRA = 72.2%) having the highest probability of being ranked first, second, and third, respectively.
Our findings suggest that education combining social contact is the most effective anti-stigma intervention, which can be implemented in clinical practices to help reduce this stigma and improve healthcare services for patients with mental illness.
Abstract Background Prior research has identified the mediating effect of physical activity in the relationship between self-perceptions of aging and physical health. However, this impact on mental ...health is unknown, and the influence of environmental contexts proposed by ecological models in this regard remains largely unexplored. Therefore, this study aimed to investigate the role of physical activity in the relationship between self-perceptions of aging and depressive symptoms in older adults, and compare the impact across four levels of neighborhood walkability. Methods A sample of 1,055 community-dwelling older adults aged 65 or above was obtained through random-digit-dialing computer-assisted telephone interviewing. The individual’s neighborhood walkability was calculated using Walk Score®, and categorized into four levels: car-dependent, somewhat walkable, very walkable, and walker’s paradise. Partial least squares structural equation modelling was employed. Results We found that more positive self-perceptions of aging were associated with fewer depressive symptoms and a mediation effect of physical activity in this relationship. Among the four levels of neighborhood walkability, the mediation effect of physical activity was only statistically significant in the lowest level (car-dependent). The findings supported our hypotheses regarding the mediating effect of self-perceptions of aging on depressive symptoms via physical activity. Neighborhood walkability might potentially influence the mediating role of physical activity. Conclusions This study emphasizes key areas on intervention programs and policy formulation to promote mental health in older adults.
Mental-illness-related stigma not only exists in the public but also in healthcare systems. Healthcare providers (HCPs) who have stigmatizing attitudes or behaviors might be thought of as a key ...barrier to mental health service use, and influence the quality of healthcare. Although cumulative projects have been conducted to reduce stigma related to mental illness among HCPs around the world, little is known about whether the attitudes of HCPs toward mental illness have changed over time. Research on this topic is mixed with respect to whether attitudes of HCPs toward mental illness have become more or less positive. The aim of the current study was to help clarify this issue using a cross-temporal meta-analysis of scores on the Social Distance Scale (SDS), Opinions about Mental Illness (OMI), and Community Attitudes towards Mental Illness (CAMI) measures among health care professionals and students (
= 15,653) from 1966 to 2016. Our results indicated that both social distance (
= -0.32,
< 0.001) and attitudes (
= 0.43,
= 0.007) of HCPs toward mental illness have become increasingly positive over time. These findings provide empirical evidence to support that the anti-stigma programs and courses have positive effects on HCPs and can inform future anti-stigma programs focusing on improving the attitudes of HCPs toward mental illness, thereby improving the quality of healthcare provided.
Although the recently developed mental health literacy scale showed significant score differences between general population and mental health professionals, to this date there is no published scale ...intended to specifically assess mental health literacy (MHL) in healthcare students. This study constructed a 26-item scale-based measure to assess multiple components of MHL and associated psychometric properties in a sample of medical and public health students of 11 universities in Taiwan.
The development and validation of the scale comprised three phases: measure development, pilot testing (n = 32), and psychometric properties examination (n = 1294).
26 items were generated for five factors: maintenance of positive mental health, recognition of mental illness, attitude to mental illness stigma, help-seeking efficacy, and help-seeking attitude. The scale demonstrated good content validity, internal consistency, and construct validity (factorial validity, convergent validity, discriminant validity, and known groups validity).
The findings suggest that the Mental Health Literacy Scale for Healthcare Students (MHLS-HS) is a valid, reliable, and practical tool for identifying MHL gaps in medical and public health students. It has the potential to inform remedial curricular interventions for educators and evaluate intervention effectiveness.
To assess risks of postpartum hypertension and diabetes mellitus (DM) for women with hypertension during pregnancy (HDP) with and without gestational DM (GDM).
From insurance data of 15- to ...44-year-old women with pregnancy in 2000-2011, we established an HDP/GDM cohort (n=1270), an HDP/non-GDM cohort (n=5077), and a comparison cohort without either disorder (n=12,594), frequency matched by age and year of pregnancy. Postpartum hypertension and DM were assessed before 2012.
The postpartum hypertension incidence increased with age in all cohorts, with overall rates of 13.1, 8.82, and 0.79 per 1000 person-years in the HDP/GDM, HDP/non-GDM, and comparison cohorts, respectively. The adjusted hazard ratios (aHRs) of hypertension were 16.8 (95% CI, 11.8-24.1) for the HDP/GDM cohort and 11.2 (95% CI, 8.19-15.2) for the HDP/non-GDM cohort relative to the comparison cohort. The corresponding incident DM rates were 41.9 and 8.06 vs 2.55 per 1000 person-years in the 3 cohorts, respectively, with aHRs of 16.2 (95% CI, 13.2-19.9) for the HDP/GDM cohort and 3.15 (95% CI, 2.55-3.89) for the HDP/non-GDM cohort relative to the comparison cohort. Incident DM in the HDP/GDM cohort was 44% greater in 15- to 29-year-old women vs 40- to 44-year-old women (49.1 vs 34.2 per 1000 person-years), with aHRs of 39.2 (95% CI, 24.5-62.7) and 5.52 (95% CI, 2.92-10.4), respectively, relative to comparisons of respective age groups.
Subsequent hypertension and DM risks are greater in women with HDP/GDM than in women with HDP only compared with women without these complications. Younger women with HDP/GDM should be particularly cautious.
Using regression modeling analysis to investigate the breakpoints of the trends in survival-without-major-neonatal-morbidities (MNM) or -without-neurodevelopmental- impairment (NDI) by year and ...gestational age (GA) in preterm infants.
We enrolled 2237 preterm infants (GA < 32 weeks) in Tainan, Taiwan. The trends in survival-without-MNM or -without-NDI by year (1995–2016) and GA (23–31 weeks), and the epochs and GA ranges with distinct changes were examined. Adjusted rate ratios (aRR) (95% confidence interval CI) were calculated using the rates in infants born at 23 weeks in 1995 as the reference.
For yearly trend, there were three epochs (1995–2000, 2001–2006, 2007–2016) with distinct changes in the rates of survival-without-MNM (aRR 95% CI 1.07 1.02–1.12, 1.04 1.02–1.07, 1.02 1.01–1.04) and -without-NDI (1.03 1.02–1.07, 1.02 1.01–1.04, 1.01 0.98–1.04). For GA trend, the three GA ranges with different increases in the rates of survival-without-MNM were 23+0-26+6 (1.60 1.31–1.94), 27+0-28+6 (1.24 1.14–1.34) and 29+0-31+6 weeks (1.17 1.02–1.34), while those in the rates of survival-without-NDI were 23+0-25+6 (1.14 1.03–1.25), 26+0-28+6 (1.06 1.02–1.12) and 29+0-31+6 weeks (1.04 1.02–1.07). The trends in survival-without-MNM and -without-NDI increased over years in infants with GA 25–31 but not < 25 weeks.
The yearly trends in survival-without-MNM and -without-NDI had steady increases from 1995 to 2016 with distinct changes in three epochs, and the GA trends also increased with different rates per week in three GA ranges. Infants with GA < 25 weeks did not improve on the rates of survival-without-MNM or -without-NDI per year from 1995 to 2016.
Gastric subepithelial tumors are usually asymptomatic and observed incidentally during endoscopic examination. Although most of these tumors are considered benign, some have a potential for malignant ...transformation, particularly those originating from the muscularis propria layer. For this type of tumor, surgical resection is the standard treatment of choice. With recent advent of endoscopic resection techniques and devices, endoscopic submucosal dissection (ESD) has been considered as an alternative way of treatment. The aim of this study is to demonstrate the feasibility of a modified ESD technique with enucleation for removal of gastric subepithelial tumors originating from the muscularis propria layer, and to evaluate its efficacy and safety.
From November 2009 to May 2011, a total of 16 patients received a modified ESD with enucleation for their subepithelial tumors. All tumors were smaller than 5 cm and originated from the muscularis propria layer of the stomach, as shown by endoscopic ultrasonography (EUS). The procedure was conducted with an insulated-tip knife 2. Patient's demographics, tumor size and pathological diagnosis, procedure time, procedure-related complication, and treatment outcome were reviewed.
Fifteen of the sixteen tumors were successful complete resection. The mean tumor size measured by EUS was 26.1 mm (range: 20-42 mm). The mean procedure time was 52 minutes (range: 30-120 minutes). Endoscopic features of the 4 tumors were pedunculated and 12 were sessile. Their immunohistochemical diagnosis was c-kit (+) stromal tumor in 14 patients and leiomyoma in 2 patients. There was no procedure-related perforation or overt bleeding. During a mean follow up duration of 14.8 months (range: 6-22 months), there was no tumor recurrence or metastasis.
Using a modified ESD with enucleation for treatment of gastric subepithelial tumors originating from the muscularis propria layer and larger than 2 cm, complete resection can be successfully performed without serious complication. It is a safe and effective alternative to surgical therapy for these tumors of 2 to 5 cm in size.
Background and Aim: Bleeding peptic ulcers can be due to Helicobacter pylori (H. pylori) infection, use of non‐steroidal anti‐inflammatory drugs (NSAIDs), or idiopathic causes. The aim of this ...prospective study was to identify the clinical outcomes of bleeding peptic ulcers related to different causes.
Methods: A total of 390 patients with bleeding ulcers were evaluated consecutively between June 2005 and August 2006. The diagnosis of H. pylori infection was made at index endoscopy, using histology and the rapid urease test. If both endoscopic diagnostic tests were not performed, a serological test was applied to detect the presence of H. pylori infection in a previously untreated patient. The prevalence and outcome of bleeding ulcers are related to H. pylori infection, NSAID use, and non‐H. pylori idiopathic causes. The outcome between patients who were admitted for ulcer bleeding (outpatient bleeder) and those who bled while hospitalized (in‐hospital bleeder) was also compared.
Results: NSAID ulcers were noted in 223 patients, H. pylori ulcers in 102, and non‐H. pylori idiopathic ulcers in 65. In total, 298 patients had outpatient bleeders, and 92 had in‐hospital bleeders. The overall 3‐day rebleeding rate was 11.8% and the mortality rate was 5.4%. Eighteen of the 21 mortality cases died of their underlying comorbid illness. Patients with non‐H. pylori idiopathic ulcers had a significantly higher mortality rate than NSAID and H. pylori ulcers (12.3% vs 4.5% vs 2.9%, P = 0.02). Patients with H. pylori ulcers had significantly favorable outcomes than patients with NSAID ulcers (less blood transfusion and a shorter hospital stay) and non‐H. pylori idiopathic ulcers (shorter hospital stay and a lower mortality). Patients with in‐hospital bleeders had an adverse outcome as compared to outpatient bleeders, including a 3‐day rebleeding rate (25.0% vs 7.7%, P < 0.0001), 30‐day rebleeding rate (32.6% vs 12.1%, P < 0.0001), and higher mortality rate (16.3% vs 2.0%, P < 0.0001).
Conclusion: This study emphasizes the role of non‐H. pylori idiopathic ulcers and in‐hospital bleeders as the determining high‐risk predictors for bleeding peptic ulcers.
To assess the efficacy of rapid urease test (RUT) in patients with bleeding ulcers, as well as the effects of visible blood in the stomach and short-term (<24 h) use of standard-dose proton pump ...inhibitor (PPI) on RUT sensitivity.
The sensitivity of RUT in the diagnosis of Helicobacter pylori in upper gastrointestinal bleeding has been reported with conflicting results.
This was a prospective case-control study evaluating 324 consecutive patients with bleeding peptic ulcers (study group) and 164 with uncomplicated ulcers (control group). The presence of H. pylori infection was determined by both RUT and histology. Prevalence of H. pylori infection and the RUT sensitivity in diagnosing the bacteria between study and control groups were conducted.
The prevalence of H. pylori infection in those with bleeding ulcers was significantly lower than that of controls (53.7% vs. 65.2%, P=0.015). The false-negative rate of RUT in the study group was significantly greater than that of the control group (16.7% vs. 5.6%, P=0.006), whereas the sensitivity rates in the study group with or without gastric blood were significantly lower than those of the controls (79.6% vs. 94.4%, P=0.005; 84.8% vs. 94.4%, P=0.019). There was no significant difference in RUT sensitivity between study group with or without visible gastric blood (P=0.41). The RUT sensitivity rate was also not significantly different between those treated with PPI and those without in patients with bleeding ulcers (82.7% vs. 85.7%, P=0.67).
This study shows that the sensitivity of RUT in patients with bleeding ulcers is reduced. The presence of blood in the stomach and the short-term use of standard-dose PPI do not affect the RUT sensitivity in bleeding ulcers.
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