Do social support and community engagement act as mechanisms in the association between neighbourhood income inequality and the mental health of mothers in Calgary,Canada? A mediation analysis

PurposeAccording to the social determinants of health framework, income inequality is a potential risk factor for adverse mental health. However, few studies have explored the mechanisms suspected to mediate this relationship. The current study addresses this gap through a mediation analysis to determine if social support and community engagement act as mediators linking neighbourhood income inequality to maternal anxiety and depressive symptoms within a cohort of new mothers living in the City of Calgary, Canada.MethodsData collected at three years postpartum from mothers belonging to the All Our Families (AOF) cohort were used in the current study. Maternal data were collected between 2012 and 2015 and linked to neighbourhood socioeconomic data from the 2006 Canadian Census. Income inequality was measured using Gini coefficients derived from 2006 after-tax census data. Generalized structural equation models were used to quantify the associations between income inequality and mental health symptoms, and to assess the potential direct and indirect mediating effects of maternal social support and community engagement.ResultsIncome inequality was not significantly associated with higher depressive symptoms (β = 0.32, 95%CI = −0.067, 0.70), anxiety symptoms (β = 0.11, 95%CI = −0.39, 0.60), or lower social support. Income inequality was not associated with community engagement. For the depression models, higher social support was significantly associated with lower depressive symptoms (β = −0.13, 95%CI = −0.15, −0.097), while community engagement was not significantly associated with depressive symptoms (β = 0.059, 95%CI = −0.15, 0.27). Similarly, for the anxiety models, lower anxiety symptoms were significantly associated with higher levels of social support (β = −0.17, 95%CI = −0.20, −0.13) but not with higher levels of community engagement (β = 0.14, 95%CI = −0.14, 0.41).ConclusionThe current study did not find clear evidence for social support or community engagement mediating the relationship between neighbourhood income inequality and maternal mental health. Future investigations should employ a broader longitudinal approach to capture changes in income inequality, potential mediators, and mental health symptomatology over time.     

Electroacupuncture and acupuncture in the treatment of anxiety - A double blinded randomized parallel clinical trial

BackgroundThe estimated number of people living with anxiety disorders worldwide is around 264 million and is estimated to have worsened with the recent pandemic of COVID-19. Acupuncture has shown to have excellent therapeutic effects in reducing anxiety.DesignDouble-blinded randomized controlled clinical trial with 56 participants (21–82 years) with anxiety diagnosed by 3 different anxiety scales (BAI, GAD-7 and OASIS). A 30-min acupuncture session was applied once a week for 10 weeks.AimsEvaluate the effectiveness of acupuncture and electroacupuncture in the treatment of anxiety to verify if: (1) People with high anxiety report reduced scores after 5 and 10 sessions; (2) Salivary cortisol levels accompanied the reduced scores; (3) Electroacupuncture treatment is more effective than acupuncture; (4) the treatments is independent of anxiolytic medication.MethodsVolunteers were randomized into 3 groups (control, acupuncture, and electroacupuncture). The results were analyzed by anxiety scales and salivary cortisol tests.ResultsThe findings show an improvement in anxiety, assessed by BAI, GAD-7 and OASIS, after the 5th session of acupuncture (p < 0.05) and electroacupuncture (p < 0.05) and the 10th session for both techniques (p < 0.001). The salivary cortisol values measured in the morning followed this pattern (p < 0.05), although the reduction of the night cortisol values was not statistically significant. Electroacupuncture and acupuncture show similar efficacy. The positive effect after the treatments is independent of anxiolytic medication (p < 0.001).ConclusionAcupuncture and electroacupuncture are effective in treating anxiety on their own or as adjuncts to pharmacological therapy.Trial registration numberNºP445-08/2017 (Unidade de Investigação em Ciências da Saúde);     

Shift work disorder and related influential factors among shift workers in China

BackgroundShift work may cause insomnia and sleepiness in individuals. The present study aimed to exam shift work disorder (SWD), and to investigate their associations with individual characteristics.MethodsA total of 1833 shift workers were assessed using the Pittsburg Sleep Quality Index, Epworth Sleepiness Scale (ESS), Composite Scale of Morningness (CSM), Circadian Type Inventory (CTI), Center for Epidemiologic Studies–Depression Scale (CES-D), Beck Anxiety Inventory (BAI) and other self-compiled socio-demographic questionnaires.ResultsIn the current sample, 17.1% shift workers have experienced insomnia symptoms, 20.9% were tested for daytime sleepiness, and 19.9% were categorized as having SWD. Logistics regressions revealed that history of mental disorders (OR = 2.04, 95% CI = 1.30–3.21), chronic physical illness (OR = 1.53, 95% CI = 1.17–1.99), CES-D scores (OR = 1.03, 95% CI = 1.02–1.05), BAI scores (OR = 1.04, 95% CI = 1.03–1.06), languid/vigorous tendencies (OR = 1.06, 95% CI = 1.03–1.10) were positively associated with the onset of SWD, while morningness (OR = 0.97, 95% CI = 0.94–0.99) decreased the odds of SWD onset.ConclusionsThese findings suggested that attention should be drawn to individuals with mental and chronic diseases in when scheduling work shifts. While SWD and its associates should be considered when providing psychological services to shift workers.     

医院-社区-家庭闭环式模式在老年糖尿病周围神经病变患者中的应用价值

【摘要】目的 探讨“医院-社区-家庭”闭环式管理模式在老年糖尿病周围神经病变（DPN）患者中的应用价值。方法 选取2017年6月～2019年6月我院收治的老年DPN患者96例，随机分为观察组与对照组，每组各48例。对照组采用常规护理，观察组采用医院-社区-家庭闭环式管理模式。比较两组患者治疗依从性、血糖控制、心理健康状况、周围神经病变情况以及神经传导速率。结果 干预后，观察组患者用药、饮食、血糖测量、健康行为等方面依从率均高于对照组（P＜0.05）；观察组空腹血糖、饭后2 h血糖、糖化血红蛋白均低于对照组（P＜0.05）；观察组SCL-90症状自评量表躯体化、人际关系敏感、抑郁、焦虑、敌对以及睡眠饮食情况得分均低于对照组（P＜0.05）；观察组密西根糖尿病周围神经病变量表（MDNS）和多伦多临床神经病变评分量表（TCSS）评分均低于对照组（P＜0.05）；观察组正中神经、腓总神经神经传导速度（SNCV）和运动神经传导速度（MNCV）均高于对照组（P＜0.05）。结论 对老年DPN患者应用医院-社区-家庭闭环式管理模式能有效提高患者自我管理效能，维持血糖平稳，缓解不良情绪以改善DPN病情。     

Prognostic impact of conservative surgery for pancreatic IPMNs

BackgroundThe extent of pancreatic resection for intraductal papillary mucinous neoplasms (IPMNs) remains an unresolved issue. The study aims at analyzing the prognostic impact of conservative surgery (CS) i.e. of pancreatoduodenectomy or distal pancreatectomy, versus total pancreatectomy (TP), for pancreatic IPMNs.MethodsWe retrospectively analyzed and compared data of patients who had undergone pancreatic resection for IPMNs at our center between November 2007 and April 2019. Patients were divided into two main groups based on the extent of surgery: TP-group and CS-group. Subsequently, the perioperative and the long-term outcomes were compared. Moreover, a sub-group analysis of patients with IPMN alone and patients with malignant IPMN, based on preoperative indications to surgery and post-operative histopathological findings, was also performed.ResultsFifty-three patients were included in the TP-group and 73 in the CS-group. In 50 (39.7%) cases the frozen section changed the pre-operative surgical planning, with an extension of the pancreatic resection, in 43 (34.1%) cases up to a total pancreatectomy. Twenty-six patients (20.6%) with low-grade dysplasia at the frozen section underwent CS, while twenty (15.8%) underwent TP. Comparing these two sub-groups no differences were found in surgical IPMN recurrence, nor progression. The rate of overall postoperative complications was 56.6% in the TP-group and 57.5% in the CS-group (p = 0.940). Fifteen patients (20.5%) developed diabetes in the CS-group.None of the patients treated with CS developed a surgical IPMN recurrence or progression during the follow-up period. Comparing OS and DFS of the two groups, we did not find any statistically significant difference (p = 0.619 and 0.315).ConclusionA timely CS can be considered an appropriate and valid strategy in the surgical treatment of the majority of pancreatic IPMNs, as it can avoid the serious long-term metabolic consequences of TP in patients with a long-life expectancy. On the contrary, TP remains mandatory in case of PDAC or high-risk features involving the entire gland.