No abstract

The impact of the COVID-19 pandemic on clinically stable older patients with psychiatric disorders is unclear. This study examined the prevalence of depressive and anxiety symptoms, and their associations with quality of life (QOL) in clinically stable older patients with psychiatric disorders during the COVID-19 pandemic. This was a multicenter, cross-sectional study. Depressive and anxiety symptoms, insomnia, pain, and QOL were assessed with standardized instruments. A total of 1063 patients were included. The prevalence of depressive and anxiety symptoms, and combined depressive and anxiety symptoms were 62.3% (95%CI = 59.4–65.2%), 52.4% (95%CI = 49.3–55.4%), and 45.9% (95%CI = 42.9–48.9%), respectively. Patients with depressive and anxiety symptoms had significantly lower QOL than those without (P < 0.01). Binary logistic regression analyses revealed that having depressive symptoms was positively associated with more severe insomnia (OR = 1.29, P < 0.01) and pain (OR = 1.14, P < 0.01), and was negatively associated with other psychiatric diagnoses (except for major depressive disorder, schizophrenia, and organic mental disorder; OR = 0.50, P < 0.01), while having anxiety symptoms was positively associated with severe physical diseases (OR = 1.57, P = 0.02), poor adherence to treatment (OR = 1.50, P < 0.01), and more severe insomnia (OR = 1.15, P < 0.01) and pain (OR = 1.11, P < 0.01). Having combined depression and anxiety symptoms was positively associated with poor adherence to treatment (OR = 1.42, P = 0.02) and more severe insomnia (OR = 1.19, P < 0.01) and pain (OR = 1.15, P < 0.01), and was negatively associated with the diagnosis of schizophrenia (OR = 0.50, P = 0.04) and others (OR = 0.53, P < 0.01). Depressive and anxiety symptoms were common in clinically stable older patients with psychiatric disorders during the COVID-19 pandemic. Considering the negative impact of these symptoms on QOL, regular screening and appropriate treatment are recommended for this population.

This report describes the genetic characterization of 297 wild-type measles viruses that were isolated in 24 provinces of China between 1995 and 2003. Phylogenetic analysis of the N gene sequences showed that all of the isolates belonged to genotype H1 except 3 isolates, which were genotype A. The nucleotide sequence and predicted amino acid homologies of the 294-genotype H1 strains were 94.7%-100% and 93.3%-100%, respectively. The genotype H1 isolates were divided into 2 clusters, which differed by approximately 2.9% at the nucleotide level. Viruses from both clusters were distributed throughout China with no apparent geographic restriction and multiple co-circulating lineages were present in many provinces. Even though other measles genotypes have been detected in countries that border China, this report shows that genotype H1 is widely distributed throughout the country and that China has a single, endemic genotype. This important baseline data will help to monitor the progress of measles control in China.

ObjectivesTo establish whether sham acupuncture (SA) or placebo acupuncture (PA) is more efficacious for reducing low back pain (LBP) than other routine treatments and to discuss whether SA or PA is appropriate for randomized controlled trials of acupuncture for LBP.MethodsSix databases were searched on 31 May 2017. We included only randomized controlled trials of adults with LBP and lower back myofascial pain syndrome. The studies had at least two control arms: a sham-controlled acupuncture arm and a routine care or waiting list arm (people who did not receive acupuncture until the end of treatment). Trials were combined using meta-analysis methods when the data allowed statistical pooling. Pooled effect sizes were calculated by random effects models.ResultsThis review identified 7 trials (1768 participants); all were included in the meta-analysis. We found statistically significant differences in pain reduction post-intervention between SA or PA and routine care or a waiting list, with a standardized mean difference of −0.36 (95% CI −0.54 to −0.18; I2 statistic=16%; participants=624; studies=6) for the Visual Analog Scale and −0.35 (95% CI −0.49 to −0.20; I2 statistic=0%; participants=736; studies=1) for the Chronic Pain Grade Scale; however, no significant difference was observed between SA or PA and routine care or no treatment for post-intervention function.ConclusionCompared with routine care or a waiting list, SA or PA was more efficacious for pain relief post-intervention. Concluding that SA or PA is appropriate for acupuncture research would be premature. Guidelines evaluating SA or PA control methods are needed to determine the specific effect of acupuncture over placebo.

Background: To investigate the multidimensional difficulties in accessing a definitive diagnosis of adult rare diseases and the associated impact factors in China. Methods: A total of 1010 adult rare disease patients from the 2018 China Rare Disease Survey were used for analysis. The Structural Equation Models examined the interrelationships among five accessibility indicators and the effects of three sets of impact factors. Results: (1) Accessibility: 72.97% of patients were misdiagnosed; they waited an average of 4.30 years and visited 2.97 hospitals before the definitive diagnosis; 67.13% were diagnosed outside the home city and traveled an average of 562 km. (2) Interrelationships among accessibility indicators: the experience of misdiagnosis significantly increased diagnosis delay and the number of hospitals visited, but had no significant effect on healthcare utilization across cities. (3) Impact factors: the rarity of disease only increased the number of hospitals visited and residence–hospital distance; high-quality healthcare distribution was key in determining accessibility; the older, disabled, poor, and less-educated individuals, and those in Central/West China were disadvantaged. Conclusion: The socioeconomic dimension of difficulties in accessing a definitive diagnosis of rare diseases should be attended, especially the uneven distribution of high-quality healthcare and those disadvantaged patients. More systematic rare disease surveys are needed in the future.