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1.

Few studies have examined the views of policy makers regarding the impact of mental health stigma on the development and implementation of mental health policies. This study aimed to address this knowledge gap by exploring policymakers’ and policy advisors’ perspectives regarding the impact of mental health stigma on the development and implementation of mental health programmes, strategies, and services in Singapore. In all 13 participants were recruited for the study comprising practicing policymakers, senior staff of organisations involved in implementing the various mental health programmes, and policy advisors. Data was collected through semi-structured interviews, which were transcribed verbatim and analysed using reflexive thematic analysis. Data analysis revealed three superordinate themes related to challenges experienced by the policymakers/advisors when dealing with mental health policy and implementation of programmes. These themes included stigma as a barrier to mental health treatment, community-level barriers to mental health recovery, and mental health being a neglected need. Policymakers/advisors demonstrated an in-depth and nuanced understanding of the barriers (consequent to stigma) to mental healthcare delivery and access. Policymakers/advisors were able to associate the themes related to the stigma towards mental illness with help-seeking barriers based on personal experiences, knowledge, and insight gained through the implementation of mental health programmes and initiatives.

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Portilla-Fernández  Eliana  Hwang  Shih-Jen  Wilson  Rory  Maddock  Jane  Hill  W. David  Teumer  Alexander  Mishra  Pashupati P.  Brody  Jennifer A.  Joehanes  Roby  Ligthart  Symen  Ghanbari  Mohsen  Kavousi  Maryam  Roks  Anton J. M.  Danser  A. H. Jan  Levy  Daniel  Peters  Annette  Ghasemi  Sahar  Schminke  Ulf  Dörr  Marcus  Grabe  Hans J.  Lehtimäki  Terho  Kähönen  Mika  Hurme  Mikko A.  Bartz  Traci M.  Sotoodehnia  Nona  Bis  Joshua C.  Thiery  Joachim  Koenig  Wolfgang  Ong  Ken K.  Bell  Jordana T.  Meisinger  Christine  Wardlaw  Joanna M.  Starr  John M.  Seissler  Jochen  Then  Cornelia  Rathmann  Wolfgang  Ikram  M. Arfan  Psaty  Bruce M.  Raitakari  Olli T.  Völzke  Henry  Deary  Ian J.  Wong  Andrew  Waldenberger  Melanie  O’Donnell  Christopher J.  Dehghan  Abbas 《European journal of epidemiology》2021,36(11):1143-1155

Common carotid intima-media thickness (cIMT) is an index of subclinical atherosclerosis that is associated with ischemic stroke and coronary artery disease (CAD). We undertook a cross-sectional epigenome-wide association study (EWAS) of measures of cIMT in 6400 individuals. Mendelian randomization analysis was applied to investigate the potential causal role of DNA methylation in the link between atherosclerotic cardiovascular risk factors and cIMT or clinical cardiovascular disease. The CpG site cg05575921 was associated with cIMT (beta?=??0.0264, p value?=?3.5?×?10–8) in the discovery panel and was replicated in replication panel (beta?=??0.07, p value?=?0.005). This CpG is located at chr5:81649347 in the intron 3 of the aryl hydrocarbon receptor repressor gene (AHRR). Our results indicate that DNA methylation at cg05575921 might be in the pathway between smoking, cIMT and stroke. Moreover, in a region-based analysis, 34 differentially methylated regions (DMRs) were identified of which a DMR upstream of ALOX12 showed the strongest association with cIMT (p value?=?1.4?×?10–13). In conclusion, our study suggests that DNA methylation may play a role in the link between cardiovascular risk factors, cIMT and clinical cardiovascular disease.

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Journal of Public Health - The prevalence of breast cancer cases in Malaysia is 1 in every 20 women. Comprehending the risk factors and causation of breast cancer as well as enabling early...  相似文献   
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Bradbury  Peta  Cidem  Aylin  Mahmodi  Hadi  Davies  Janet M.  Spicer  Patrick T.  Prescott  Stuart W.  Kabakova  Irina  Ong  Hui Xin  Traini  Daniela 《Inflammation》2022,45(3):1209-1223
Inflammation - Grass pollens have been identified as mediators of respiratory distress, capable of exacerbating respiratory diseases including epidemic thunderstorm asthma (ETSA). It is...  相似文献   
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Objective

To perform a cost-effectiveness analysis of a multifactorial, tailored intervention to reduce falls among a heterogeneous group of high-risk elderly people.

Design

Randomized control trial.

Settings

Communities.

Participants

Adults aged at least 65 years (N=354) seen at the emergency department (ED) for a fall or fall-related injury and discharged home.

Interventions

The intervention group received a tailored program of physical therapy focused on progressive training in strength, balance, and gait for a period of 3 months. They also received screening and referrals for low vision, polypharmacy, and environmental hazards. The Short Physical Performance Battery (SPPB) test was assessed at regular intervals to allocate participants into either a home-based or group center-based program. The control group received usual care prescribed by a physician and educational materials on falls prevention.

Main Outcome Measures

The incremental cost-effectiveness ratio (ICER) over the 9-month study period based on intervention costs and utility in terms of quality-adjusted life years (QALYs) calculated from EuroQol-5D scores.

Results

The ICER was 120,667 Singapore dollars (S$) per QALY gained (S$362/0.003 QALYs), above benchmark values (S$70,000). However, the intervention was more effective and cost-saving among those with SPPB scores of greater than 6 at baseline, higher cognitive function, better vision and no more than 1 fall in the preceding 6 months. The intervention was also cost-effective among those with 0-1 critical comorbidities (S$22,646/QALY).

Conclusion

The intervention was, overall, not cost-effective, compared to usual care. However, the program was cost-effective among healthier subgroups, and even potentially cost-saving among individuals with sufficient reserve to benefit.  相似文献   
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World Journal of Surgery - Primary spontaneous pneumothorax (PSP) is a relatively common clinical entity with high incidence in the young population. Video-Assisted Thoracic Surgery (VATS)...  相似文献   
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