Acute Depression Research Articles

Depression in the Face of Racism: A Socio-Psychological Analysis of Chimamanda Ngozi Adichie ’s Short Story “The Thing Around Your Neck

The short story “The Thing Around Your Neck” by Chimamanda Ngozi Adichie encapsulates the escapade of a migrant American Visa Lottery winner from Nigeria. A poor Nigerian, her image of America used to be influenced by some socio-cultural stereotypes promoted by Hollywood and various types of political and commercial media institutions. Soon, she finds no truth in what she used to believe about America as an economic heaven. She learns about America’s immoral give-and-take policy from her surrogate uncle who makes sexual advances towards her. She finds higher education extremely expensive and engages in the rat race to support herself as a waitress at a restaurant, a part-time student, and a breadwinner for her family in Nigeria. Constantly subjected to acute depression and loneliness, she feels stifled and suffocated in bed every night. Thanks to her white American lover, she recovers from it. Yet, so sensitive in mind, her body reacts to even the slightest emotional disappointment by getting frozen and irresponsive. Often, her dark complexion proves highly detrimental to her happiness as a black American. Although she is accepted by her lover’s parents, in her daily life, she experiences insults from both blacks and whites she meets in the streets. Such realities appear dark and negative and repulse her faith in the so-called sophistication of the American people. However, by the time she decides to visit Nigeria to commiserate with her mother bereaved by her father’s demise, her white American lover proves to be an inseparable tour de force.

Reliability of Anxiety Stress Irritability Behavioral Changes (Asib) – Neuro Psychosomatic Scale in the Post - Covid 19 Population

The Corona Virus Disease (COVID-19) has lead to universal psychosocial impact by causing mass hysteria, economic burden and financial losses. Mass fear of COVID-19, also called as “coronaphobia”, has generated a plethora of psychiatric problems all over the society. Disease itself multiplied by forced quarantine to combat COVID-19 applied by nationwide lockdowns can produce acute panic, anxiety, obsessive behaviors, hoarding, paranoia, and depression, and post-traumatic stress disorder (PTSD) in the long run. The ASIB neuro psychosomatic scale for post COVID - 19 patients is basically designed to evaluate the level of neuro psychosomatic impairments caused by COVID – 19.

Molecular mechanisms of quetiapine bidirectional regulation of bipolar depression and mania based on network pharmacology and molecular docking: Evidence from computational biology

BackgroundQuetiapine monotherapy is recommended as the first-line option for acute mania and acute bipolar depression. However, the mechanism of action of quetiapine is unclear. Network pharmacology and molecular docking were employed to determine the molecular mechanisms of quetiapine bidirectional regulation of bipolar depression and mania. MethodsPutative target genes for quetiapine were collected from the GeneCard, SwissTargetPrediction, and DrugBank databases. Targets for bipolar depression and bipolar mania were identified from the DisGeNET and GeneCards databases. A protein-protein interaction (PPI) network was generated using the String database and imported into Cytoscape. DAVID and the Bioinformatics platform were employed to perform the Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses of the top 15 core targets. The drug-pathway-target-disease network was constructed using Cytoscape. Finally, molecular docking was performed to evaluate the interactions between quetiapine and potential targets. ResultsTargets for quetiapine actions against bipolar depression (126 targets) and bipolar mania (81 targets) were identified. Based on PPI and KEGG pathway analyses, quetiapine may affect bipolar depression by targeting the MAPK and PI3K/AKT insulin signaling pathways via BDNF, INS, EGFR, IGF1, and NGF, and it may affect bipolar mania by targeting the neuroactive ligand-receptor interaction signaling pathway via HTR1A, HTR1B, HTR2A, DRD2, and GRIN2B. Molecular docking revealed good binding affinity between quetiapine and potential targets. LimitationsPharmacological experiments should be conducted to verify and further explore these results. ConclusionsOur findings suggest that quetiapine affects bipolar depression and bipolar mania through distinct biological core targets, and thus through different mechanisms. Furthermore, our results provide a theoretical basis for the clinical use of quetiapine and possible directions for new drug development.

The impact of the disaster on the residents of the city of Derna, Libya, psychologically, behaviorally, and intellectually

"The current research aims to determine whether disasters have an impact on the residents of the city of Derna in Libya psychologically, behaviorally, and intellectually. It also aims to investigate whether there are differences in the psychological, behavioral, and intellectual impact of disasters based on variables such as gender, age, extent of material damage, loss of a family member, and place of residence. The researcher followed a descriptive-analytical approach, and to achieve the research objectives, the researcher used two tools for collecting information and data: interviews and observations. The research community consisted of all residents of the city of Derna in eastern Libya, totaling 175,297. The sample consisted of 411 individuals, including 231 males and 180 females, selected using non-random sampling methods (purposive, quota, and accidental). The researcher arrived at a number of results, the most important being that disasters have psychological, behavioral, and intellectual effects that are evident among the research sample, such as acute psychological depression, aggressive behaviors, and difficulty in thinking. Additionally, there were differences between males and females in their response to disasters in favor of females due to the nature of females being emotionally sensitive and physically weaker. Furthermore, differences were also found among the research sample in the impact of disasters based on age, with children being more affected and more prone to behavioral disorders and psychological diseases, followed by the elderly over 60 years old. The rest of the age groups were less affected compared to children and the elderly. The research results also indicated that those who lost one or more family members and had their homes and properties damaged were more affected and sadder compared to other sample individuals whose properties were not damaged and who did not lose anyone. Finally, the results showed differences in the impact of disasters on the residents of the city of Derna in Libya psychologically, behaviorally, and intellectually based on their place of residence. The impact was greater on those living in the city center and on Sea Street because they suffered greater damage compared to those living in the east and west of the city.

Incidence of mental health conditions following pediatric hospital admissions: analysis of a national database.

Despite increasing survival of children following hospitalization, hospitalization may increase iatrogenic risk for mental health (MH) disorders, including acute stress, post-traumatic stress, anxiety, or depression. Using a population-based retrospective cohort study, we assessed the rates of new MH diagnoses during the 12 months after hospitalization, including the moderating effects of ICU exposure. This was a retrospective case control study using the Truven Health Analytics insurance database. Inclusion criteria included children aged 3-21 years, insurance enrollment for >12 months before and after hospital admission. We excluded children with hospitalization 2 years prior to index hospitalization and those with prior MH diagnoses. We extracted admission type, ICD-10 codes, demographic, clinical, and service coordination variables from the database. We established age- and sex-matched cohorts of non-hospitalized children. The primary outcome was a new MH diagnosis. Multivariable regression methods examined the risk of incident MH disorder(s) between hospitalized and non-hospitalized children. Among hospitalized children, we further assessed effect modification from ICU (vs. non-ICU) stay, admission year, length of stay, medical complexity, and geographic region. New MH diagnoses occurred among 19,418 (7%) hospitalized children, 3,336 (8%) ICU-hospitalized children and 28,209 (5%) matched healthy controls. The most common MH diagnoses were anxiety (2.5%), depression (1.9%), and stress/trauma (2.2%) disorders. Hospitalization increased the odds of new MH diagnoses by 12.3% (OR: 1.123, 95% CI: 1.079-1.17) and ICU-hospitalization increased these odds by 63% (OR: 1.63, 95% CI: 1.483-1.79) as compared to matched, non-hospitalized children. Children with non-complex chronic diseases (OR: 2.91, 95% CI: 2.84-2.977) and complex chronic diseases (OR: 5.16, 95% CI: 5.032-5.289) had a substantially higher risk for new MH diagnoses after hospitalization compared to patients with acute illnesses. Pediatric hospitalization is associated with higher, long-term risk of new mental health diagnoses, and ICU hospitalization further increases that risk within 12 months of the acute episode. Acute care hospitalization confers iatrogenic risks that warrant long-term mental and behavioral health follow-up.

Correlates to Improvement in Sleep Duration in Acute Mania and Depression.

Correlates to Improvement in Sleep Duration in Acute Mania and Depression.

Management of bipolar disorder in South Africa: National Department of Health essential medicine selection and treatment algorithms

Background. Bipolar disorder (BD) is a severe mental illness associated with multimorbidity, psychosocial disability and significant public health issues. However, guideline heterogeneity clouds therapeutic decisions, particularly in relapse prevention. Polypharmacy and poor health outcomes are common. For low- and middle-income countries, deciding which medicines to procure and how to treat BD in an integrated manner remains elusive. Although South Africa (SA) is committed to universal health coverage, the estimated treatment gap for mental disorders in the public health sector is 91%. An Essential Medicines List (EML) enables equitable access to medicines, while Standard Treatment Guidelines (STGs) facilitate rational prescribing and quality care. Objectives. To describe the medicine selection process for the treatment of BD in the SA public health sector, and the treatment algorithms developed to guide integrated care. Methods. Evidence-based medicine principles, stakeholder consultation and consensus decision-making were used. The existing (2015) BD guideline and stakeholder comments were reviewed by a ministerially appointed expert review committee, following which a research question with eligibility criteria was formed, and rapid systematic evidence synthesis conducted. PubMed and Cochrane databases were searched for systematic reviews of randomised controlled trials and observational studies of acute and maintenance treatment in BD, with an additional PubMed search for primary research. Quality of the systematic reviews was appraised using the 11-item assessment of multiple systematic reviews. After costing to ensure affordability, final recommendations were made to the National EML Committee (NEMLC) using the strength of recommendation taxonomy classification. Following approval by the NEMLC, proposed medicines were incorporated into the 2019 National Department of Health Adult Hospital STGs. As the STGs are updated every 3 years, stakeholder input was sought in 2021 and 2023, with no changes to the medicine selection. Results. Seven systematic reviews and one observational study were included in the evidence synthesis. Six medicines were selected as essential for maintenance treatment: lithium, valproate, lamotrigine, olanzapine, quetiapine and clozapine. While risperidone and benzodiazepines were retained for acute mania, carbamazepine and fluoxetine were removed from acute depression. Treatment algorithms for predominantly manic and depressive courses of illness were constructed to encourage person-centred care, aiming for euthymia, individual functioning and relapse prevention. Conclusion. Evidence-based medicine principles enabled the NEMLC to select a range of essential medicines for the management of BD in a middle-income country. Local monitoring and evaluation are needed to inform future editions of the STGs and EML.

Risk Factors for Respiratory Depression Associated with Tramadol Based on the Global Pharmacovigilance Database (VigiBase).

Tramadol, a weak μ-opioid receptor agonist, has been used worldwide for pain management. It is considered to have a favorable safety profile without serious adverse events; however, safety issues of respiratory depression were proposed by regulatory governments. We aimed to examine the risk and contributing factors associated with tramadol-related respiratory depression using a real-world database, VigiBase. Disproportionality analysis of tramadol and tramadol/paracetamol was performed using proportional reporting ratios, reporting odds ratios, and information components for all drugs and opioids. Factors related to respiratory depression, including sex, age, presence of abuse, death, and various concomitant medications, were evaluated. Among 140,721 tramadol reports, respiratory depression was reported in 1126 cases, 81.3% of which were deemed serious. Five adverse events were detected as signals of tramadol-related acute central respiratory depression (ACRD) in 882 reports. A higher proportion of ACRD cases in children and adolescents was observed than all adverse events cases of tramadol. Concomitant users of CYP2D6 inhibitors, opioids, benzodiazepines, and anti-depressant drugs showed a higher proportion in ACRD cases than non-ACRD cases. ACRD was related to drug abuse and death. This pharmacovigilance study, using VigiBase, confirmed a high risk of respiratory depression (a serious, potentially fatal adverse event) secondary to the use of tramadol, especially in pediatric patients, drug abusers, or during concomitant use of opioids, benzodiazepines, or antidepressants.

Epidemiological Association of Parental Substance Use History and Mental Health Disorders in Central Morocco

This cross-sectional study investigated the prevalence of substance use disorders and explored associations between parental substance use disorder history and mental health disorders among psychiatric hospital inpatients in central Morocco. A total of 723 participants were included in the study. Data were collected using a structured questionnaire and medical records, covering psychiatric diagnoses, sociodemographic characteristics, substance use disorders among patients and their parents, as well as the patient's psychiatric history and length of hospital stay. Participants were divided into two groups: those with parental history of substance use disorders (PSUD) and those without. Patients' mean ages were 34.40 years (± 11) and 35.5 years (± 12), respectively. The prevalence of substance use was notably high among participants, with cannabis use being the most prevalent (90.6%). Educational level was associated with PSUD, with participants having no formal education showing a higher likelihood of having parents with SUD (unadjusted odds ratio, UOR = 2.11, 95% CI = 1.1 to 4.03). Polysubstance use was also associated with the PSUD group (UOR = 2.42, 95% CI = 1.73 to 3.40). Regarding psychiatric disorders, one in five patients in the PSUD group had schizophrenia (21.35%), followed by acute psychotic episodes (20.5%), depression (20.29%), and anorexia (8.24%). The study revealed a high overall prevalence of substance use among participants with mental health disorder, highlighting the significance of parental SUD history as a predictor for patients' mental health disorders. This suggests the need for special attention and preventive measures. [ Psychiatr Ann . 2024;54(2):e56–e66.]

Acute phase mediator interleukin-6 and depression, work-related stress among young people (25-44 years old)

Aim. To study the association of interleukin-6 (IL-6) levels with depression and stress at work among young people (25-44 years old) in Novosibirsk.Material and methods. A random representative sample of young people (25-44 years old) in Novosibirsk was surveyed (975 people of both sexes; response rate, 71%) in 2013-2016 on the basis of Research Institute of Internal and Preventive Medicine — branch of the Institute of Cytology and Genetics (FWNR-2024-0002). All respondents signed informed consent. The World Health Organization MONICA-Psychosocial (MOPSY) scale was used to assess depression. Work-related stress was determined using the Karasek’s scale included in the program protocol. Quantitative determination of IL-6 was carried out in the laboratory of clinical biochemical and hormonal studies of therapeutic diseases of the Research Institute of Internal and Preventive Medicine — branch of the Institute of Cytology and Genetics.Results. High level of depression among people of both sexes aged 25-44 years were 11,9% (among men — 8,5%, among women — 14,6%). The level of IL-6 was higher in individuals of both sexes with high level of depression — 1,33 [0,72;3,92] pg/ml than without depression — 1,16 [0,63;2,37] pg/ml) (p=0,002). In women with high level of depression, IL-6 value was higher (1,31 [0,72;3,86] pg/ml) than in those without depression (1 [0,53;2,03] pg/ml) or a moderate depression — 1,06 [0,58;2,14] pg/ml, (p=0,002). The level of IL-6 was higher among people of both sexes who had changed occupation within the last 12 months (1,4 [0,67;3,58] pg/ml) than among those who had no changes — 1,12 [0,63;2,04] pg/ml. Among participants who assessed their work responsibility as very high, the median levels of serum IL-6 were higher (1,7 [0,72;5,48] pg/ml), than among people with high work load (1,37 [0,58;5,18] pg/ml), as well as with a moderate (1,21 [0,63;2,5] pg/ml) and a slight (1,09 [0,63;1,98] pg/ml) work load.Conclusion. A significantly higher level of IL-6 was found in depression and workplace stress among young people (25-44 years old) compared to people without depression and not experiencing workplace stress.

Persistence of amygdala hyperactivity to subliminal negative emotion processing in the long-term course of depression

Biased emotion processing has been suggested to underlie the etiology and maintenance of depression. Neuroimaging studies have shown mood-congruent alterations in amygdala activity in patients with acute depression, even during early, automatic stages of emotion processing. However, due to a lack of prospective studies over periods longer than 8 weeks, it is unclear whether these neurofunctional abnormalities represent a persistent correlate of depression even in remission. In this prospective case-control study, we aimed to examine brain functional correlates of automatic emotion processing in the long-term course of depression. In a naturalistic design, n = 57 patients with acute major depressive disorder (MDD) and n = 37 healthy controls (HC) were assessed with functional magnetic resonance imaging (fMRI) at baseline and after 2 years. Patients were divided into two subgroups according to their course of illness during the study period (n = 37 relapse, n = 20 no-relapse). During fMRI, participants underwent an affective priming task that assessed emotion processing of subliminally presented sad and happy compared to neutral face stimuli. A group × time × condition (3 × 2 × 2) ANOVA was performed for the amygdala as region-of-interest (ROI). At baseline, there was a significant group × condition interaction, resulting from amygdala hyperactivity to sad primes in patients with MDD compared to HC, whereas no difference between groups emerged for happy primes. In both patient subgroups, amygdala hyperactivity to sad primes persisted after 2 years, regardless of relapse or remission at follow-up. The results suggest that amygdala hyperactivity during automatic processing of negative stimuli persists during remission and represents a trait rather than a state marker of depression. Enduring neurofunctional abnormalities may reflect a consequence of or a vulnerability to depression.

High rate of negligence induced burns in children: A rising cause for concern of the world's burn community

One of the most important causes of death in burn patients is burn [1-10]. Accurate evaluation, timely diagnosis, and proper treatment of burn patients can reduce their mortality rate [11-21]. On the other hand, one of the most important causes of injury among children aged 1 to 15 is burns [22]. Usually, children and teenagers are more vulnerable in burn injuries than other age groups [23]. Severe burns can affect children's health both in the acute stage of burns and in the later stages of their lives [24]. Burns in children often occur due to injuries caused by hot liquids. The mechanism of burns among children can be due to exploratory behaviors without understanding the dangers in the environment [25]. Most burn injuries are due to accidental causes, but in some cases, it can be due to negligence in children [22]. It is difficult to distinguish whether the burn was accidental or caused by negligence [24]. Burn hospitalizations and deaths due to negligent burns are more than accidental burns. The interesting point is that some cases of children's burn injuries can be due to misbehavior and negligence that were not diagnosed at the time of admission. Identifying these people is important because preventive efforts by health care teams for children are necessary [22]. Hence, most negligence induced burns in children are preventable because negligence and carelessness are the main causes of burns in them [24]. The consequences of negligence induced burns in children can have physical, mental, and emotional effects on children and their families [23]. Burn scars often persist after healing and lead to functional and aesthetic problems [24]. On the other hand, psychological care after burns should be considered; because, children experience a high level of acute stress, anxiety, and depression after burns, and hospitalization can be scary for children [23]. The negative consequences of negligence induced burns in children in the long term can lead to chronic diseases in childhood and even adulthood. Therefore, special attention should be paid to the timely prevention, diagnosis, and treatment of negligence induced burns in children [22]. However, previous evidence regarding negligence induced burns in children is very limited. Hence, one study showed that 56% of burns in children were due to negligence [24].

Efficacy of ketamine and thiopentone sodium with modified electroconvulsive therapy in depressive disorder: An observational study

Background: The first-line treatment for people with acute mania, mood disorders, severe depression, and catatonia is electroconvulsive therapy (ECT). The goal of anesthesia during ECT is to cause unconsciousness, and the drugs administered should not have any effect on seizures. Because all anesthetics have some ability to change seizures, the kind of anesthetic used in modified ECT becomes crucial. This study aimed to assess the hemodynamic profile during modified ECT and the effects of ketamine and thiopentone sodium on seizure duration. Aims and Objectives: The aim of the study was to compare the outcome of ECT, such as hemodynamics, improvement in depression, and duration of seizure, with ketamine versus thiopentone sodium in depressive disorder. Materials and Methods: A prospective observational study was conducted with 50 randomly selected depression patients after obtaining permission from the Institutional Ethics Committee and consent from the patients and attendants from June 2021 to November 2022. All 50 cases were equally divided into group K and group T. To obtain the data, a predesigned, semi-structured questionnaire was used along with the Hamilton rating scale for depression and ECT. The Chi-square test was used to measure the association between two categorical variables. A P < 0.05 was considered statistically significant. Results: The mean heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, and saturation of peripheral oxygen are higher in group K than in group T, and the mean difference was significant between group K and group T. Groups had a statistically significant association with increased secretions, nausea and vomiting, and headache, but not with gender, ASA grade, and number of ECT sessions. Conclusion: Compared to ketamine, thiopentone sodium was found to have minimal hemodynamic derangements, a decrease in seizure duration, and side effects.

Sexual dysfunction in bipolar depression: Gender differences.

To find sexual dysfunction in acute-phase bipolar depression patients and subsequently characterize the gender-wise differences in sexual functioning. A cross-sectional, descriptive, observational, purposeful, and hospital-based study was done with 45 patients (age range: 18-59 years) with moderate to severe acute phase bipolar depression (HAM-D scores >18). The domain-wise (Pleasure, Desire/Frequency Desire/Interest, Arousal/Excitement, and Orgasm/Completion) sexual functioning was assessed by the Change in Sexual Functioning Questionnaire (CSFQ-14) (≤41 for females, ≤47 for males as a cut-off for dysfunction). This study is registered in the CTRI (Clinical Trials Registry India, Number: CTRI-2021-07-035182). The prevalence of sexual dysfunction was 91% of bipolar disorder patients with more male participants (53.3%) compared to females (46.7%). The mean HAM-D score for the study sample was 27.93 ± 8.035. The female gender had more dysfunctional scores in desire/frequency (t = 2.229, P = 0.031), desire/interest (t = 2.448, P = 0.019), orgasm/completion (t = 2.974, P = 0.005), and overall total CSFQ (t = 2.946, P = 0.005). The odds of sexual dysfunction were significant given a one-unit increase in suicidal ideation in the index episode (adjusted OR = 1.222, 95% CI: 1.004-1.488, P = .049). Acute-phase bipolar patients have very high sexual dysfunction rates. Females have both global and specific sexual response cycle deficits in comparison to acute phase bipolar depressed males. Future trials shall amuse neurobiology grounded, more individualistic sexual rehabilitation-based interventional paradigms, and longitudinal research models in acute phase bipolar depression.

Examining the Role of GLU/GABA to GLN Metabolic Cycle in the Pathogenesis of Post-Stroke Depressive Disorder and Insomnia.

This study aims to elucidate the potential links between the GLU/GABA to GLN metabolic cycle disruptions and the onset of depressive and insomnia disorders following a stroke. We particularly focus on understanding if these disorders share a common underlying pathogenic mechanism. We examined 63 patients with post-stroke insomnia, 62 patients with post-stroke depression, and 18 healthy individuals. The study involved assessing insomnia using the Acute Insomnia Scale (AIS) and depression using the Hamilton Depression Rating Scale. We measured serum concentrations of GLN, GLU, and GABA and analyzed their correlations with AIS and HAMD scores. Our results indicate no significant difference in the serum levels of GLN, GLU, and GABA between the post-stroke insomnia and depression groups. However, these levels were notably lower in both patient groups compared to the healthy control group. A negative correlation between AIS scores and GABA levels was observed in the post-stroke insomnia group, suggesting a potential link between GABAergic disturbances and insomnia. Conversely, no significant correlation was found between Hamilton Depression Rating Scale scores and the levels of GABA, GLU, or GLN in the post-stroke depression group. The study highlights that abnormalities in the GLU/GABA to GLN metabolic cycle, particularly the levels of GLN, GABA, and GAD, might be intricately linked to the pathogenesis of post-stroke insomnia and depression. Our findings suggest that GABAergic imbalances could be indicative of post-stroke insomnia, serving as potential biological markers for differential diagnosis in clinical settings. Further research is warranted to explore these relationships in greater depth, potentially leading to new diagnostic and therapeutic approaches for post-stroke neuropsychiatric disorders.

Prevalence and Time Trends of Oral Anticoagulant Utilization in Adults with Sickle Cell Disease

Background: Sickle cell disease (SCD) is an inherited red blood cell disorder, caused by a genetic mutation in the β-hemoglobin chain. SCD is associated with chronic activation of coagulation and an increased risk of venous thromboembolism (VTE). Although the American Society of Hematology guidelines recommend indefinite anticoagulation for unprovoked or recurrent provoked VTE, no guidance is given regarding choice of anticoagulant due to a paucity of data. Existing evidence on the use of anticoagulants in patients with SCD has been mostly focused on oral anticoagulants, was limited by small sample sizes, and did not clearly demonstrate the temporal utilization patterns. Real-world evidence on oral anticoagulant use in SCD from large population-based studies is largely lacking. This study examined the prevalence and time trends of oral anticoagulant utilization in patients with SCD in the United States (US). Methods: This retrospective, repeated cross-sectional study analyzed the Cerner Health Facts® database from January 1, 2011, to December 31, 2016, which captures longitudinal electronic medical records (EMR) of patient data from participating facilities in the US. To be included, patients were required to (1) have ≥ 1 inpatient or emergency department encounters with SCD, or 2 outpatient encounters that were 30 days apart in a calendar year from 2012 to 2016, (2) have ≥ 1 prescription records on the encounters with SCD, (3) aged ≥ 18 years at index, and (4) have ≥ 1 encounter with SCD in a year prior to the index. For patients with multiple encounters with SCD in the calendar year, we randomly selected one encounter with SCD and defined it as the index. In this design, a patient contributed only one observation per year but may contribute to multiple years of observations if meeting the selection criterion. The outcome was the use of anticoagulants, defined as any prescription drug encounter for an oral anticoagulant (Vitamin K antagonist [VKA]: warfarin; direct oral anticoagulants [DOACs]: apixaban, rivaroxaban, dabigatran, edoxaban) within a grace period of 7 days discharged from the index. The independent variable was each calendar year measured as dummy variables. Covariates were measured during the 12-month baseline period prior to the index, which included patient demographics, comorbidities and complications of SCD, and facility characteristics. Time trends on the proportions of eligible patients with anticoagulant use against the calendar years of the SCD diagnosis were plotted, and the significance on the crude trend was examined using Cochran-Armitage trend test. In the main analysis, a modified Poisson regression by using generalized estimating equations (GEEs) estimated the adjusted prevalence ratios (APRs) for the trends and covariates associated with any anticoagulant utilization. In subgroup analysis, we estimated the APRs of covariates for the use of DOACs versus VKA. Results: The cohort included 8,824 adult patients with SCD in 182 facilities using automated Cerner EMR system for the years 2012 to 2016. Prescription rates of all oral anticoagulants gradually increased from 2012 to 2014; the rates of VKA prescriptions substantially dropped from 11.1/1000 to 4.1/1000 persons between 2014 and 2016, whereas prescription rates of DOACs increased significantly from 12.0/1000 to 29.1/1000. Prevalence of VTE was stable at approximately 6.2/1000 to 7.5/1000 between 2012 and 2016. Prescription rates of DOACs were lower in patients with (versus without) VTE (6.1/1000 vs 7.3/1000), while a reversed prescription pattern was observed for VKA (VTE [yes vs no]: 4.4/1000 vs 1.8/1000). Controlling for covariates, our main analysis demonstrated that patients with a diagnosis of acute chest syndrome, pulmonary hypertension, and depression were 1.51, 2.30, and 1.57 times more likely to have oral anticoagulant prescription, respectively (all p <0.05). Subgroup analysis showed that having a diagnosis of VTE was associated with a decreased likelihood of DOACs prescription relative to VKA (APR= 0.75, 95%CI: 0.62-0.91). Conclusion: Prescription of oral anticoagulants in adults with SCD has significantly increased from 2012 to 2016 and the increase was dominated by DOACs. The treatment paradox of a lower relative rate of DOACs utilization versus VKA in adults with SCD requires more study to understand the reasons and additional clinical outcomes associated with the utilization patterns.

Outcomes Among Hospitalized Patients with Acute Chest Syndrome and Concomitant Clinical Depression: A United States Population-Based Cohort Study

Background Acute chest syndrome is a life-threatening complication of sickle cell disease, seen in both children and adults. Hospitalization and immediate treatment are necessary to prevent morbidity and mortality. Clinical depression is quite prevalent in patients with sickle cell disease, and review of literature reveals association of depression with increased annual emergency department visits, hospitalizations, and blood transfusions in patients with sickle cell disease. Whether this leads to worse outcomes is yet to be ascertained. Methods We utilized the 2018-2020 National Inpatient Sample (NIS) Database in conducting a retrospective cohort study. We identified hospitalized patients with acute chest syndrome and concomitant clinical depression using appropriate ICD-10 CM codes. We stratified patients based on whether they had clinical depression during the hospitalization or not. A survey multivariable logistic and linear regression analysis was used to calculate adjusted odds ratios (OR) for the primary and secondary outcomes. A p value of <0.05 was considered statistically significant. The aim of this study is to investigate the outcomes among hospitalized patients with acute chest syndrome and comorbid clinical depression looking primarily at the in-hospital mortality and hospital length of stay (LOS). Results We identified a total of 5271 hospitalized patients with acute chest syndrome, of which 10.72% (565/5271) had comorbid clinical depression. The overall in-hospital mortality among those with acute chest syndrome was 3.70% (195/5271). Among those with clinical depression, the overall in-hospital mortality rate was not significantly higher at 5.31% (30/565) (p=0.385). Utilizing a stepwise survey multivariable logistic regression model that adjusted for patient and hospital level confounders, clinical depression among hospitalized patients with acute chest syndrome did not significantly increase the risk for in-hospital mortality (adjusted OR 1.39, 95% confidence interval [CI], 0.49-3.91; p=0.533) or prolong hospital LOS (median LOS 6 days versus 7 days, p=0.631) Conclusion Acute chest syndrome continues to be an important cause of hospital admissions in patients with sickle cell disease. Our analysis revealed that clinical depression is commonly encountered in this subset of patients. Clinical depression did not have a statistically significant impact on outcomes including increased in-hospital mortality or prolonged hospital LOS. Prospective studies with large sample sizes are needed to better understand these outcomes.

The Rising Influence of Mindfulness-Based Cognitive Therapy in Depression Treatment

Major depressive disorder is a common and recurring condition that necessitates ongoing advancements in treatment. The integration of mindfulness meditation and cognitive behavioural techniques in mindfulness-based cognitive therapy (MBCT) has shown promise as an effective approach. This review focuses on the current evidence regarding MBCT's efficacy in treating acute depression and preventing relapse. A comprehensive search was conducted across various databases to identify randomized controlled trials, systematic reviews, and meta-analyses from the last decade that evaluate MBCT. The results consistently indicate that MBCT is able to reduce current symptoms of depression and lower the risk of relapse to a similar extent as maintenance antidepressants. Additionally, neuroimaging studies have revealed functional changes in the brain that correlate with clinical improvements following MBCT. There is a growing trend towards expanding the delivery methods for MBCT, including online platforms and applications, while also optimizing traditional in-person settings. However, there are several limitations that need to be addressed. These include issues surrounding patient diversity, teaching quality, cost-effectiveness, and accessibility. To broaden the scope of MBCT and enhance its effectiveness in different care settings, further research on implementation is necessary. To summarize, MBCT has demonstrated consistent efficacy in treating major depression, but there is a need to continuously improve its accessibility and delivery methods as it becomes more widely available

The study of professional burnout in knowledge workers, taking into account gender and age characteristics

Introduction. Maladaptive mental states pose a threat both to the personal health of the employee and to the stability of the organization. Mental health workers often have states of depression, mental and chronic fatigue, occupational stress and emotional burnout. At the same time, burnout is one of the most dangerous conditions, especially at the beginning of its development — the employee, as a rule, is not aware of its symptoms. It is important to identify such manifestations in time and properly organize the employee support system. It is necessary to determine the factors contributing to the development of emotional burnout syndrome in various age and gender professional groups, taking into account individual psychological characteristics.
 The study aims to research burnout and its predictors in knowledge workers, taking into account their gender and age characteristics and the class of working conditions according to the intensity of the labor process.
 Materials and methods. The authors conducted an online study of maladaptive mental states and working conditions of knowledge workers in terms of the intensity of the labor process, including a set of hygienic and psychological methods.
 The study involved 468 employees aged 20-59 years: 133 men (42.1±9.7 years) and 335 women (39.3±8.7 years). The researchers conducted a hygienic assessment of labor stress factors according to the Manual R 2.2.2006-05. The authors used: "degree of chronic fatigue", questionnaire for evaluation of acute mental fatigue, labor stress questionnaire; Maslach burnout questionnaire with subsequent calculation of integral index of burnout according to Bekhterev Scientific Research Institute formula; Beck depression scale. The experts compared the studied indicators depending on gender, age group, class of working conditions according to the intensity of the labor process and calculated a linear regression model for the indicator "integral index of emotional burnout".
 Results. There are 13 professional groups of knowledge workers with different classes of working conditions depending on the intensity of the labor process, for which there are leading labor stressors. The authors revealed statistically significant differences in the studied indicators depending on gender, age group and class of working conditions in terms of the intensity of the labor process, they also identified significant predictors for the indicator "integral index of emotional burnout": age (β=–0.160, p=0.013), acute mental fatigue (β=0.432, p=0.000), depression (β=0.403, p=0.000), second (β=0.343, p=0.020) and third (β=0.432, p=0.000) in terms of stressors (adjusted R2=0.698).
 Conclusion. Ensuring the longevity of knowledge workers should be based on the preservation of their psycho-emotional health, which requires a special approach to the prevention of maladaptive mental states. When developing preventive measures, it is necessary to take into account, first of all, the age characteristics of the employee and the class of working conditions according to the intensity of the labor process, estimated according to the Manual P 2.2.2006-05, as well as the gender of the employee, the level of depression and mental fatigue, leading labor stressors. In order to prevent burnout, it is necessary to focus more on situational and organizational factors than on individual ones.
 Ethics. The authors have conducted the study in accordance with the Helsinki Declaration and approved by the Local Ethics Committee of the Izmerov Research Institute of Occupational Health, Protocol No. 4 of 04/14/2021.

An intelligent algorithm of amyloid plucks to timely fault-predicting and contending dependability in IoMT

The security problem and the demand for service availability create risky conditions for individuals connected to the Internet of Medical Things (IoMT) technology. They are vulnerable to passive and active attacks involving the sharing of malicious information and data theft. Researchers have attempted to address these issues but often overlooked the significant impact of service priority and fault prediction on their methods for improving efficiency. The characteristics are undeniable when it comes to demanding appropriate service and rectifying the negative effects caused by faulty devices in an IoMT application. This study analyzes the challenges associated with IoMT and proposes a model and a three-phase algorithm called RPD for role mapping and pattern detection (RPD). RPD has successfully overcome the challenges posed by recent algorithms in defining service priority for various IoMT applications. It is capable of accurately predicting the area of faulty components and detecting and predicting them. The algorithm's features emphasize its role in providing a dependable service based on application priority, improving efficiency in service dependability, and reducing the cost overheads of defective components. Our approach involves transferring the responsibilities of IoMT application nodes onto the vertices of a subgraph while also defining their relationships using its edges. This study is inspired by the behaviors of human brain cells in facing Alzheimer's, Parkinson's, and acute Depression. It aims to develop a graph that can effectively identify patterns for predicting the distribution of amyloid plaques, specifically GPR56, α, and β proteins. To achieve this, we utilize the RPD algorithm, which identifies related patterns in technology applications based on their service priority predicted faulty components and halts them through phagocyte operations. This work demonstrates notable improvements in energy efficiency, communication delay, and dependability compared to recent Q-learning methods, with enhancements ranging from approximately 57.3% to 59.8%, 17.8% to 19.3%, and 37% to 41%, respectively.