Objective: This study aims to assess research trends in the association between schizophrenia and autoimmune diseases, systematically review their relationship, and evaluate the credibility of existing evidence. Methods: Bibliometric analysis was conducted using the bibliometrix package in R, along with VOSviewer and CiteSpace. Relevant systematic reviews and meta-analyses were retrieved from six databases: PubMed, Web of Science, Embase, CINAHL, PsycINFO, and the Cochrane Library. Summary risk estimates were recalculated using the DerSimonian and Laird method under a random-effects model, and the credibility of the evidence was assessed. Results: The bibliometric analysis found that "meta-analysis" has become a frequently used keyword and may be a focal point for future research. The umbrella review included 17 articles, containing 24 report data points from 12 quantitative reviews. Results indicated that 9 reports assessed the relationship between schizophrenia and autoimmune diseases. Schizophrenia was significantly associated with autoimmune neurological disorders (RR = 1.42; 95 % CI = 1.18-1.72), providing suggestive evidence. Seven reports evaluated the impact of schizophrenia on autoimmune diseases, showing highly suggestive evidence that schizophrenia patients had a pooled relative risk of 2.22 (95 % CI = 1.95-2.52) for psoriasis. Eight reports assessed the impact of autoimmune diseases on schizophrenia, with bullous pemphigoid patients showing significantly higher schizophrenia prevalence (OR = 2.63; 95 % CI = 2.03-3.39). Conclusions: This study synthesizes evidence of varying levels, highlighting the association between schizophrenia and autoimmune diseases. It offers new insights for future exploration, fosters interdisciplinary collaboration, and provides valuable implications for public health policy development.

Background: Given trends towards greater life expectancy, there is an increasing need to promote healthy ageing and add quality and value to older adults' lives, however the evidence regarding the effects on overall health and wellbeing has not been synthesised. Active lifestyles may provide diverse health and wellbeing benefits for older adults in terms of maintaining or improving their physical, psychological, and social functions. This systematic review evaluates whether and how different types of interventions within community-based settings could benefit specific aspects of older adults' health and wellbeing. Methods: PubMed, PsycINFO, Scopus and Web of Science were systematically searched in January 2022 for experimental studies (including randomised controlled trials, non-randomised controlled trials, and quasi-experimental studies) exploring health and wellbeing benefits of community-based activities in older adults. A total of 12,707 sources were identified through database searches with 183 retained for full screening. Final inclusion was based on the following eligibility criteria: (1) participants were generally healthy and predominantly independent community-dwelling older adults aged 60 and above; (2) interventions were based in real-world settings, e.g., dance, art and technology classes, etc. held in publicly-accessible facilities; (3) pre-/post-interventions assessed at least one outcome in physical health, psychological wellbeing or social connections; (4) control groups were used, including passive and active control groups or groups that received a different type of intervention; (5) experimental studies followed a quantitative research design. Study quality was systematically assessed, and a comprehensive narrative synthesis of the findings was conducted. Results: Of the 183 studies screened, 56 were included in the final review. Among the 33 predominantly physical interventions, 31 demonstrated positive effects. Of the 16 predominantly mental interventions, 14 reported benefits. All seven predominantly social interventions reported positive effects. Discussion: The benefits of real-world interventions were reported across a range of outcomes, particularly in terms of reducing depression or anxiety, or improving physical functioning, sleep quality and social participation. However, heterogeneity in interventions, sample design, duration and dosage suggest that more research is needed to support the effects of duration and dosage of intervention exposure. As real-world interventions more closely resemble the way in which older people engage in activities, evidence of their effectiveness in promoting health and wellbeing should inform preventative healthcare provision and policymaking.

Objective: The objective of this review is to assess and synthesize the available qualitative evidence on health professionals' experiences in screening for postpartum depression (PPD). Introduction: PPD is a significant public health problem. Clinical screening is essential to develop appropriate interventions to meet the needs of women and their families. The findings of this review have important implications for decision-making and policy development for continuous professional development programs that promote evidence-based PPD screening. Inclusion criteria: This review considered studies that explore the experiences of health professionals who screen for PPD in any geographic location at any health care facility, scenario, or setting. The review focused on qualitative data, including methods such as phenomenology, grounded theory, ethnography, action research, and feminist research. Methods: The review followed a 3-step search strategy in line with JBI methodology for systematic reviews of qualitative evidence. The databases searched included PubMed, CINAHL (EBSCOhost), Embase (Elsevier), Scopus, LILACS (BVS), ScienceDirect (Elsevier), PsycINFO (Ovid), Index Psi Journals (BVS-PSI), and PePsic (IPUSP). Unpublished studies were searched for in Google Scholar, Cybertesis, Dart-E, EthOS, and Open Access Theses and Dissertations (OATD). Two independent reviewers evaluated the included studies for methodological quality and extracted data using the JBI data extraction and synthesis tools. Studies published in English, Portuguese, and Spanish from database inception until October 2023 were included. Results: Twenty-four qualitative studies from 14 countries across 5 continents involving 392 health professionals were included. A total of 113 findings were extracted and grouped into 5 categories: i) education and training; ii) responsibility of PPD screening, referral, and follow-up: role of the job and work overload; iii) screening, referral, and follow-up; iv) disclosure, judgment, culture; v) and health system structure. Two synthesized findings evolved from these categories: i) The need for training and ongoing education, professional role, professional practice, and ways of caring in screening postpartum women for depressive symptoms; ii) External barriers, facilitating factors, and health system issues. Conclusions: Health professionals' experiences caring for women and families concerning PPD are influenced by their culture, practices, training, and worldview. Regular workshops and practical training sessions that emphasize the development of PPD-screening skills, particularly in recognizing subtle signs of depression and conducting culturally sensitive assessments, could be highly effective for health professionals. Policymakers should collaborate with health care professionals to develop and implement policies tailored to different contexts and cultures. Providing educational subsidies and ensuring monitoring and follow-up after PPD screening are fundamental for the sustainability of PPD screening and management.

网络化心理干预近年来逐渐应用于改善丧亲人群的心理健康状况,系统考察其干预效果及其调节因素有助于指导临床实践。这项研究通过文献检索与筛选,选取了47个丧亲人群网络化心理干预研究,其中19项随机对照试验满足了元分析标准(N=1222),元分析共包括68个效应值。结果发现,干预对总体心理健康的效应达到显著的中等水平(g=0.54; 95%CI=[0.39, 0.70]);具体而言,干预对病理性哀伤(g=0.56; 95%CI=[0.39, 0.74])、抑郁(g=0.51; 95%CI=[0.36, 0.67])和创伤后应激(g=0.63; 95%CI=[0.45, 0.81])症状的改善都达到显著的中等效果。在改善总体心理健康水平方面,未使用意义建构、干预次数大于或等于10次和给予治疗反馈的网络化心理干预效果更好,干预频率为一周多于一次的干预效果要好于一周一次。但是,理论取向、干预过程中是否包含暴露练习、认知重构和行为激活的干预策略、是否设置提醒以及脱落率的高低均不存在调节作用。本研究说明网络化心理干预对改善丧亲人群的心理健康状况效果较为理想,并且在不同条件下网络化心理干预具有不同的效果。

This scoping review provides a broad overview of the existing literature on economic evaluations of preventive, screening, and treatment programmes for peripartum depression (PPD). PPD is one of the leading causes of disease-related disability among women. However, PPD often goes undiagnosed and untreated, with as many as half of cases not being identified. We followed the PICO-P (publication type) structure. Databases were searched from inception until 30 June 2023. The intervention stage in the studies was classified as prevention, screening, treatment, screening and treatment, and prevention and treatment. The health economics methods of the studies were divided into cost-effectiveness analysis, cost-utility analysis, cost-benefit analysis, cost-minimisation analysis, return of investment, and multiple. Ultimately, 38 studies were included for extraction and evaluation. Several interventions for PPD may be cost effective, including peer support, psychological therapies, and screening strategies using tools like the Edinburgh Postnatal Depression Scale (EPDS). However, study limitations include heterogeneity across studies, methodological limitations, and limited generalisability to diverse populations. The cost-effectiveness results of PPD interventions may differ across different health systems, partly due to differences in the amount and distribution of resources available. By implementing suggested policy recommendations, policymakers can significantly improve the identification, treatment, and prevention of PPD, ultimately improving the health and well-being of mothers, children, and families.

Background: The rapid evolution of large language models (LLMs), such as Bidirectional Encoder Representations from Transformers (BERT; Google) and GPT (OpenAI), has introduced significant advancements in natural language processing. These models are increasingly integrated into various applications, including mental health support. However, the credibility of LLMs in providing reliable and explainable mental health information and support remains underexplored. Objective: This scoping review systematically maps the factors influencing the credibility of LLMs in mental health support, including reliability, explainability, and ethical considerations. The review is expected to offer critical insights for practitioners, researchers, and policy makers, guiding future research and policy development. These findings will contribute to the responsible integration of LLMs into mental health care, with a focus on maintaining ethical standards and user trust. Methods: This review follows PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines and the Joanna Briggs Institute (JBI) methodology. Eligibility criteria include studies that apply transformer-based generative language models in mental health support, such as BERT and GPT. Sources include PsycINFO, MEDLINE via PubMed, Web of Science, IEEE Xplore, and ACM Digital Library. A systematic search of studies from 2019 onward will be conducted and updated until October 2024. Data will be synthesized qualitatively. The Population, Concept, and Context framework will guide the inclusion criteria. Two independent reviewers will screen and extract data, resolving discrepancies through discussion. Data will be synthesized and presented descriptively. Results: As of September 2024, this study is currently in progress, with the systematic search completed and the screening phase ongoing. We expect to complete data extraction by early November 2024 and synthesis by late November 2024. Conclusions: This scoping review will map the current evidence on the credibility of LLMs in mental health support. It will identify factors influencing the reliability, explainability, and ethical considerations of these models, providing insights for practitioners, researchers, policy makers, and users. These findings will fill a critical gap in the literature and inform future research, practice, and policy development, ensuring the responsible integration of LLMs in mental health services. International registered report identifier (irrid): DERR1-10.2196/62865.

目的 基于症状自评量表（symptom checklist 90,SCL-90）结果，探究中国潜艇部队官兵心理健康状况影响因素及其发展变化趋势。方法 利用Review Manager 5.3软件对中国知网（CNKI）、维普（VIP）、万方（Wanfang）等数据库自建库以来关于中国潜艇部队官兵SCL-90相关调查研究进行整理分析，根据不同影响因素进行系统评价。结果 共纳入9篇文献、20个组别，潜艇部队官兵共1 395人。潜艇部队官兵航后航前心理状况差异meta分析结果显示，潜艇部队官兵航后相较于航前的9个SCL-90因子平均效应量均为正值，其中躯体化、强迫、人际敏感、抑郁、焦虑、敌对、恐怖及精神病的差异均有统计学意义（均P0.05）；核潜艇和常规潜艇心理状况差异meta亚组分析结果显示，核潜艇部队官兵总体的SCL-90因子相较于2016年军人常模的平均效应量均为正值，且躯体化、强迫、人际敏感、抑郁、焦虑、恐怖、偏执及精神病性的差异均有统计学意义（均P0.05）。常规潜艇官兵各...

Background: In the World Health Organization (WHO) geographical region of South-East Asia, the mental health burden of adolescents appears high. Addressing this burden requires development of mental health policies consistent with international standards to assist governance, resource allocation and delivery of mental healthcare effectively. The aim was to identify current national mental health policies/plans/programs/legislation in South-East Asia, assess compliance with international standards and review inclusion of adolescents in these documents. Methods: Searches were conducted on WHO MiNDbank, official government websites, Google and Google Scholar. Documents were compiled and screened, data were extracted and evaluated following WHO Guidelines on Monitoring and Evaluation of Mental Health Policies and Plans. Frequencies of checklist and sub scores were calculated. Data were narratively synthesised. Findings: Fourteen mental health policies/plans/programs/legislation from 8 countries met inclusion criteria. Maldivian and Bangladeshi documents complied the greatest with WHO guidelines. All 8 countries considered adolescents to some extent in their documents. Only Indian documents consulted child health groups during policy development. Intra/Inter sectoral collaboration with child health divisions was highlighted in documents from Sri Lanka, Bangladesh, India and Maldives. Interpretation: Most South-East Asian nations had developed separate national mental health governance documents. However, their incorporation of adolescent mental health is rare and compliance with international standards were inconsistent. Binding mental health legislation separate from health legislation; inclusion of adolescents; addressing resource constraints; and guidelines for mental health policy development catered to low-and-middle-income countries are all essential to address the complex mental health needs of South-East Asian adolescents.

Several systematic reviews support nature-based interventions (NBIs) as a mechanism of enhancing mental health and wellbeing. However, the available evidence for the effectiveness of these interventions is fragmentary and mixed. The heterogeneity of existing evidence and significant fragmentation of knowledge within the field make it difficult to draw firm conclusions regarding the effectiveness of NBIs. This can only limit the development of interventions to support personal and planetary wellbeing, potentially resulting in ineffective and ill-targeted investment decisions. These concerns have hindered the translation of research evidence into practice and guidelines are urgently required to assist researchers, practitioners and policymakers in developing interventions to promote environmental stewardship and meet the health needs of diverse communities. A higher-order or meta-level synthesis is required to make sense of this evidence. This umbrella review synthesises evidence on the barriers and enablers to nature-based interventions through a summative review of existing published systematic reviews and meta-analyses. A systematic search in PsycINFO, PubMed, Greenfile, Web of Science, Embase, Scopus, Academic Search Complete (EBSCO), Environment Complete (EBSCO), Cochrane Library, CINAHL, Health Policy Reference Centre and Google Scholar was performed. This is a mixed method review, and systematic reviews with both quantitative and qualitative data synthesis were included. 64 systematic reviews were included in the synthesis. The descriptive data, extracted from each study, forms an overview of the characteristics of available evidence on nature-based interventions. A narrative synthesis is used to present the potential factors influencing the outcomes of NBIs. The risk of bias of the systematic reviews was assessed using a 16-item Assessment of Multiple Systematic Reviews 2 (AMSTAR2) checklist. Directions for future research, potential quality needs and recommendations for future research, policymaking, and practice are discusssed.

Objectives: This study aimed to evaluate the effectiveness of interventions in reducing loneliness among community-dwelling older adults. Design: A network meta-analysis (NMA) and systematic review. Setting and participants: Interventional studies were included if they contained original quantitative data on interventions to reduce loneliness among community-dwelling older adults. Qualitative studies were included if they contained views on loneliness coping strategies or intervention evaluation. Methods: Six English databases and 3 Chinese databases were searched for studies published before August 2023. We extracted mean and standard deviation for the NMA to examine the overall effectiveness and efficacy of different interventions on loneliness. Thematic analysis was used to derive perspectives on coping strategies to mitigate loneliness. Results: Forty-six quantitative studies with 6049 participants and 40 qualitative studies with 1095 participants were included in the analysis. The pooled effect size was large and significant [standardized mean difference (SMD), -0.95; 95% CI, -1.32 to -0.58; P < .001], indicating a strong effect of interventions in reducing loneliness. Subgroup analyses revealed significant differences in effect sizes by study region and health risk. Results of the NMA suggested interventions seem to be most effective when having psychosocial interventions as the content, a combination of individual and group as the delivery mode, and a mixture of face-to-face and online methods as the contact mode. Findings of the qualitative synthesis revealed 2 main dimensions of activities for reducing loneliness, including delivery modes (individual or group or combination) and settings (indoor or outdoor or combination). Strategies for coping with loneliness at the social, cognitive, and behavioral levels were also identified. Conclusions and implications: The present study identified the most effective components of loneliness interventions in reducing loneliness among older adults. Findings offer important insights for practice and policy-making on potential strategies that can be used to reduce loneliness among community-dwelling older adults.

Background: The global immigrant population is increasing annually, and Asian immigrants have a substantial representation within the immigrant population. Due to a myriad of challenges such as acculturation, discrimination, language, and financial issues, immigrants are at high risk of mental health conditions. However, a large-scale mapping of the existing literature regarding these issues has yet to be completed.Objective: This study aimed to investigate the mental health conditions, help-seeking behaviours, and factors affecting mental health service utilization among East Asian immigrants residing in Western countries.Method: This study adopted the scoping review methodology based on the Joanna Briggs Institute framework. A comprehensive database search was conducted in May 2024 in PubMed, CINAHL, Embase, Cochrane, and Google Scholar. Search terms were developed based on participants, concept, context framework. The participants were East Asian immigrants and their families, and the concept of interest was mental health help-seeking behaviours and mental health service utilization. Regarding the context, studies targeting East Asian immigrants in Western countries were included. Data were summarized narratively and presented in a tabular and word cloud format.Results: Out of 1990 studies, 31 studies were included. East Asian immigrants often face mental health conditions, including depression, anxiety, and suicidal behaviours. They predominantly sought help from informal sources such as family, friends, religion, and complementary or alternative medicine, rather than from formal sources such as mental health clinics or healthcare professionals. Facilitators of seeking help included recognizing the need for professional help, experiencing severe symptoms, higher levels of acculturation, longer length of stay in the host country. Barriers included stigma, cultural beliefs, and language barriers.Conclusions: The review emphasizes the need for culturally tailored interventions to improve mental health outcomes in this vulnerable population. These results can guide future research and policymaking to address mental health disparities in immigrant communities.

Introduction Episodes of alienation and/or anomie in pharmacists have been reported in historical accounts since the 19th century. Alienation and anomie are distinct types of psychological or social ills where people are problematically separated from, or their skills and values are misaligned with, others and their environment. Alienation and/or anomie can be important precursors of many negative work experiences, including job dissatisfaction, burnout and/or intention to leave.Methods and analysis We aim to study alienation and/or anomie in pharmacists from across the globe, reviewing all types of methodological designs, published in peer-reviewed journals, including all primary qualitative, quantitative and/or mixed-method research studies. We will narratively describe any focuses, causes, associated factors and/or consequences of alienation and/or anomie. We will identify all published peer-reviewed research by searching seven electronic databases (MEDLINE, Embase, APA PsychINFO, CINAHL Plus, Cochrane Library, Web of Science Core Collection and Scopus) and Google Scholar in May 2024. Extensive hand and citation-searching will also take place. Two independent reviewers will identify eligible studies, conduct a critical appraisal of the study conduct, extract data and synthesise reported findings by narratively exploring relationships within and between studies. The synthesis will follow a hybrid thematic analysis. Initially, we will deductively structure the findings according to six themes from underpinning alienation and anomie theory: Care, Values, Meaning, Recognition, Autonomy and Shared Responsibility. This structure may thereafter be inductively adapted, by creating new additional themes, if required from the data. A GRADE Confidence in the Evidence from Reviews of the Qualitative research approach will be used to determine a confidence profile of each theme. A thematic map showing the links between themes will also be produced.Ethics and dissemination Ethical permission is not required, as this study uses data from published research. Dissemination will be through publication in peer-reviewed journals and conference presentations.PROSPERO registration number CRD42024536336.

Objectives HTA agencies vary significantly in their methodology, interpretation of clinical evidence and reporting of recommendations. This research builds on established frameworks for assessing HTA outcomes and proposes a novel approach towards characterising and comparing clinical issues raised by HTA agencies. Methods HTA data from Canada, England, Scotland, Sweden, Germany, and France were extracted from an internal HTA database (HTA-Hive), constructed using a validated and published framework for the assessment of HTA outcomes. Clinical issues are categorised into: magnitude of clinical benefit, long-term clinical evidence, study design, generalizability, potential adverse events, comparators, and indirect comparisons. A total of 786 HTA reports (spanning 2009-2024) were included in the study. A sentiment analysis model VADER using the nltk package in Python was applied to the uncertainties to assess sentiment severity across agencies. Results There were total of 3,272 clinical uncertainties in the sample. The most common clinical uncertainty raised related to magnitude of clinical benefit (22.6%), while issues relating to appropriateness of comparator were the least frequent (8.3%). TLV had the worst average sentiment (-0.024), it was significantly worse than HAS, INESSS, IQWiG and NICE (p<0.005). NICE had the most positive (0.20), significantly better than CADTH, HAS, SMC, and TLV. The average compound sentiment across all clinical uncertainties was 0.11. The category with the lowest average sentiment was adverse effects (-0.209) highest was clinical benefit (0.34). Sentiment scores were highly variable across manufacturers with more than 10 reports (0.015 – 0.205). Average sentiment was similar across orphan and non-orphan medicines (0.133 vs 0.107) and significantly higher for oncology drugs vs other drugs (0.185 vs 0.069). Conclusions Natural Language Processing (NLP) techniques can help shed light on the severity of clinical issues raised in the context of HTA, which tend to vary according to HTA agency, type of uncertainty, therapeutic area and disease area.

目的 系统评价思维导图在癌症患者术后健康教育中的应用效果。方法 检索PubMed、Web of Science、CINAHL、中国知网、万方知识服务平台、中国生物医学文献数据库中关于癌症患者思维导图式健康教育的随机对照试验，检索时限为建库至2024年3月。采用Cochrane 5.1.0文献质量评价标准对随机对照试验文献进行质量评价，采用Revman 5.4软件进行Meta分析。结果 共纳入21篇文献，包括1 850例患者。Meta分析结果表明，基于思维导图的健康教育可以减轻癌症患者术后的焦虑情绪[MD=-9.82,95%CI(-14.37,-5.27),P<0.01]、抑郁情绪[MD=-7.27,95%CI(-9.69,-4.85),P<0.01]、疼痛程度[MD=-1.03,95%CI(-1.75,-0.31),P<0.01],提高自我护理能力[MD=17.59,95%CI(15.22,19.95),P<0.01],缩短术后首次下床活动时间[MD=-12.51,95%CI(-16.76,-8.25),P<0.01],提高护理满意度[RR=1.23,95...

目的 系统评价自我表露干预对癌症患者心理健康的促进效果，为提高癌症患者的生存质量提供循证证据。方法检索中国知网、万方数据、维普网、中国生物医学文献数据库、PubMed、Web of Science、Embase、Cochrane协作网中关于自我表露干预措施应用于各类癌症患者中的随机对照试验(RCT)文献，检索时间为建库至2023年12月31日，并采用RevMan 5.3软件对检索到的文献进行Meta分析。结果 共纳入10篇文献，研究对象总计1 252例。Meta分析结果显示，自我表露干预不仅能够提高癌症患者的痛苦表露水平[MD=3.92,95%CI(1.25,6.58),P=0.004],还能降低癌症患者对疾病复发的恐惧水平[MD=-1.04,95%CI(-1.66,-0.41),P=0.001]和抑郁水平[MD=-1.27,95%CI(-2.29,-0.25),P=0.01]。结论 自我表露干预可以提高癌症患者的痛苦表露水平，降低患者的疾病复发恐惧水平和抑郁水平，促进癌症患者心理健康。但本研究纳入的文献差异性较大，故今后还需进一步开展高质量的大样本量的随机对照试验，验证自我表露干预的...

目的：采用贝叶斯网状Meta分析技术对非药物干预方式减轻ICU转出病人家属迁移应激水平的效果进行评价。方法：计算机系统检索中国知网（CNKI）、Web of Science(SCIE)、Cochrane Library、Embase等中英文数据库，搜集不同非药物干预方式对减轻ICU转出病人家属迁移应激的随机对照试验（RCT），检索时限均为建库至2023年6月。使用Stata 15软件进行网状Meta分析。结果：共纳入15项RCT，累计研究患者1 186例，涉及5种非药物干预方式。结果显示：英文FRSS评分方面，减轻照顾者迁移应激水平的干预措施效果排序为行为改变轮模式>ICU联络护士>迁移手册>综合护理>认知行为干预。汉化版FRSS评分方面，减轻照顾者迁移应激水平的干预措施效果排序为迁移手册>认知行为干预>结构化健康教育>综合护理。FCTI评分方面，减轻照顾者迁移应激水平的干预措施效果排序为行为改变轮模式>ICU联络护士>迁移手册>综合护理。STAI评分方面，减轻照顾者迁移应激水平的干预措施效果排序为ICU联络护士>迁移手...

Background: Food insecurity has involved more than 750 million individuals worldwide. The association of food insecurity with socio-economic factors is also undeniable demand more consideration. Food insecurity will become a global priority by 2030. This systematic review and meta-analysis examined current literature concerning the association between food insecurity and psychological distress. Methods: Relevant researches were identified by searching databases including PubMed, EMBASE, Scopus, and Web of Science, ProQuest, and Cochrane Library up to June 2024 without language limitation. Then a snowball search was conducted in the eligible studies. The quality assessment was made through Newcastle-Ottawa Scale. Results: Data were available from 44 cross-sectional articles for systematic review and 17 eligible articles for meta-analysis with 2,267,012 and 1,953,636 participants, respectively. Findings support the growing segment of literature on the association between food insecurity and psychological distress. The highly represented groups were households with low income. Psychological and diabetic distress was directly associated with food insecurity as it increased the odds of distress to 329% (OR: 3.29; 95% CI: 2.46-4.40). Sleep problems, anxiety, depression, lower life satisfaction, obesity, and a higher rate of smoking were among the secondary outcomes. Conclusion: Food insecurity was a common stressor that can have a negative impact on psychological well-being and even physical health. The findings should be considered in the public health and making policy-making process.

Background: It is estimated that half of Canadians have insufficient sleep, which over time is associated with poor physical and mental health. Currently, the only publicly funded option for the diagnosis of sleep disorders in Ontario is an in-person overnight sleep study, performed in a hospital or independent health facility (known as a level 1 polysomnography). Level 2 polysomnography has been proposed as an alternative that can be conducted at home for the diagnosis of suspected sleep disorders, if considered to have sufficient diagnostic accuracy. We conducted a health technology assessment of level 2 polysomnography for the diagnosis of suspected sleep disorders in adults and children, which included an evaluation of the test performance, cost-effectiveness, and budget impact of publicly funding level 2 polysomnography, and the experiences, preferences, and values of people with suspected sleep disorders. Methods: We performed a systematic literature search of the clinical evidence to identify diagnostic accuracy, test failures and subjective measures of patient preferences. We assessed the risk of bias of each included study (using the Quality Assessment of Diagnostic Accuracy Studies [QUADAS-2] tool) and the quality of the body of evidence (according to Grading of Recommendations Assessment, Development, and Evaluation [GRADE] Working Group criteria). We performed a systematic literature search of economic evidence and conducted a primary economic evaluation and budget impact analysis to determine the cost-effectiveness and additional costs of publicly funding level 2 polysomnography for adults and children with suspected sleep disorders in Ontario. To contextualize the potential value of using level 2 polysomnography, we spoke with people with sleep disorders. Results: We included 10 studies that reported on diagnostic accuracy and found level 2 polysomnography had sensitivity ranging between 0.76-1.0 and specificity ranging between 0.40-1.0 (GRADE: Moderate to Very low) when compared with level 1 polysomnography. Studies reported test failure rates from 0% to 20%, with errors present in both level 1 and level 2 tests conducted (GRADE: Very low). As well, some of these studies reported patients were found to have mixed opinions about their experiences, with more people preferring their experience with level 2 testing at home and having better quality of sleep compared with when they underwent level 1 testing (GRADE not conducted).Our primary economic evaluation showed that for adults with suspected sleep disorders, the new diagnostic pathway with level 2 polysomnography was equally effective (outcome: confirmed diagnosis at the end of the pathway) as the current practice diagnostic pathway with level 1 polysomnography. With the assumption of a lower technical fee for level 2 polysomnography, the new diagnostic pathway with level 2 polysomnography was less costly than the current practice diagnostic pathway (a saving of $27 per person with a wide 95% credible interval [95% CrI, -$137 to $121]), indicating that the results are highly uncertain. For children, a new diagnostic pathway with level 2 polysomnography was associated with additional costs (mean, $9.70; 95% CrI, -$125 to $190), and similarly, this estimate was highly uncertain.We estimated that the budget impact of publicly funding level 2 polysomnography for adults is uncertain and could range from savings of $22 million to additional costs of $43 million. Publicly funding a diagnostic pathway with level 2 polysomnography for children could result in additional costs of about $0.005 million over the next 5 years.People with whom we spoke reported that their sleep disorder negatively impacted their day-to-day lives, mental health, social and family relationships, and work. Participants who had experience with in-clinic (level 1) polysomnography described negative experiences they had at the clinic. Most people said they would prefer at-home (level 2) polysomnography over in-clinic (level 1) polysomnography, citing comfort and convenience as the main reasons; however, some people who have physical limitations preferred level 1 (in-clinic) polysomnography because they needed assistance to set up the equipment. Conclusions: Level 2 polysomnography may have good test performance for adults and children, with adequate diagnostic accuracy, compared with level 1 polysomnography. The economic analyses showed that level 2 polysomnography for adults with suspected sleep disorders could be potentially cost saving but there is high uncertainty in the cost-effectiveness results. Given very limited information, the cost-effectiveness of this technology is also highly uncertain for children and young adults with suspected sleep disorders. The budget impact of publicly funding level 2 polysomnography for adults could range from savings of $22 million to additional costs of $43 million. Publicly funding level 2 polysomnography in children would require additional costs of about $0.005 million over the next 5 years. A clearer understanding of uptake of the technology, test costs, and the implementation pathway for adopting the technology is needed to improve the certainty of the cost-effectiveness and budget impact estimates. People with sleep disorders highlighted how important getting a diagnosis had been in order to be able to seek proper treatment for their sleep disorder and improve their lives. For many people with suspected sleep disorders, undergoing a sleep study at home would be a more comfortable and convenient option than undergoing a sleep study in clinic.

AIM: The purpose of this systematic review was to determine the levels and influencing factors of mental workload in intensive care unit nurses. BACKGROUND: Intensive care unit nurses have a high mental workload level. To our knowledge, no meta-analytic research investigating the levels of mental workload in intensive care unit nurses and related factors has yet been performed. DESIGN: This article is a systematic review and meta-analysis. METHODS: Eleven electronic databases were searched from the database setup dates until 31 December 2022. The research team independently conducted study selection, quality assessments, data extractions and analysis of all included studies. The PRISMA guideline was used to guide reportage of the systematic review and meta-analysis. RESULTS: Seventeen studies were included. In these studies, the pooled mean score of mental workload was 68.07 (95%CI:64.39-71.75). Furthermore, subgroup analyses indicated that intensive care unit nurses' mental workload differed significantly by countries, sample size and publication year. The mental workload influential factors considered were demographic, work-related and psychological factors. CONCLUSION: Hospital administrators should develop interventions to reduce mental workload to enhance the mental health of intensive care unit nurses and nursing care quality. Hospital managers should pay attention to the mental health of nurses and guide them to correctly relieve occupational stress and reduce mental workload.

目的 探讨健康教育对胰腺癌患者术后自我效能及心理状态的影响，以期为胰腺癌患者的术后康复管理提供参考和依据。方法 采用复合逻辑检索方式，以“Pancreatic cancer”、“Pancreatic Neoplasms”、“Self Efficacy”、“Randomized controlled trial”、“健康教育”、“胰腺癌”等为检索词，对PubMed、中国知网等数据库的相关文献进行检索，检索时间为建库起至2023年10月31号，并筛选胰腺癌患者术后实施健康教育的文献。采用Cochrane协作网的风险偏倚评估工具对Meta分析最终纳入的文献进行评价，Rev Man 5.3软件进行Meta分析，以u检验（Z test）来判断合并统计量间是否存在统计学意义，根据u值计算出P值，并以α=0.05作为检验水准。结果 最终纳入11篇文献进行Meta分析，患者自我效能感积极应对评分的合并结果显示，Z=34.82（P<0.001），差异有统计学意义。自我效能感消极应对评分的合并结果显示，Z=12.12（P<0.001），差异有统计学意义。患者心理功能评分的合并结果显示，标准化均...