Quality of life in patients with schizophrenia: A 2-year cohort study in primary mental health care in rural China.

Objective: Quality of life (QoL) has been always an important way to evaluate the outcomes of schizophrenia, but there have been few previous longitudinal studies and few in middle-income countries. This study aimed to explore the QoL in Chinese patients with schizophrenia treated in primary mental health care and the risk factors of QoL over time. Methods: Patients with schizophrenia treated in primary mental health care in rural/regional areas in Luoding, Guangdong, PR China, were evaluated with an extended questionnaire including the Chinese version of the World Health Organization Quality of Life (WHOQOL-BREF) at baseline and 2-year follow-up. Bivariate and multivariate analyses were conducted including Generalized Estimated Equation analyses (GEE). Results: Four hundred and ninety-one patients with schizophrenia in primary care completed the 2-year follow up evaluation. The QoL physical, environmental, and social relationships domains showed improvement after the 2-year period, but the psychological domain did not. GEE results showed that earlier age of onset, older age, being employed, being unmarried, the thicker waist circumference, less use of clozapine or other SGAs, fewer hospitalizations, more frequent insomnia, more severe depressive and negative symptoms as well as worse treatment insight were independently associated with poor QoL in patients with schizophrenia. Conclusion: According to our results, to improve the quality of life of patients with schizophrenia in primary care, we should pay more attention to the treatment of depression, negative and insomnia symptoms of schizophrenia, the choice and dosage of antipsychotic medication and improvement in the treatment compliance. The combined use of educational and behavioral strategies may improve treatment adherence.

A Non-Isocyanate Route to Poly(Ether Urethane): Synthesis and Effect of Chemical Structures of Hard Segment.

A series of non-isocyanate poly(ether urethane) (PEU) were prepared by an environmentally friendly route based on dimethyl carbonate, diols and a polyether. The effect of the chemical structure of polyurethane hard segments on the properties of this kind of PEU was systematically investigated in this work. Polyurethane hard segments with different structures were first prepared from hexamethylene di-carbamate (BHC) and different diols (butanediol, hexanediol, octanediol and decanediol). Subsequently, a series of non-isocyanate PEU were obtained by polycondensation of the polyurethane hard segments with the polyether soft segments (PTMG2000). The PEU were characterized by GPC, FT-IR, 1H NMR, DSC, WAXD, SAXS, AFM and tensile testing. The results show that the urea groups generated by the side reaction affect the degree of crystallization of hard segments by influencing the hydrogen bonding of the hard segments molecular chains. The degree of hard segment crystallization, in turn, affects the thermal and mechanical properties of the polymer. The urea group content is related to the carbon chain length of the diol used for the synthesis of hard segments. When butanediol is applied to synthesize hard segment, the hard segment of the resulting PEU is unable to crystallize. Therefore, the tensile strength and modulus of elasticity of butanediol-based PEU is lowest among three, though it possesses the highest urea group content. When longer octanediol or decanediol is applied to synthesize the hard segment, the hard segments in the resulting polyether-based polyurethane are crystallizable and the resulting PEU possesses higher tensile strength.

Risk factors for violent behaviors in patients with schizophrenia: 2-year follow-up study in primary mental health care in China.

Objective: The consequences and impact of violent behavior in schizophrenia are often serious, and identification of risk factors is of great importance to achieve early identification and effective management. Methods: This follow-up study sampled adult patients with schizophrenia in primary mental health care in a rural area of southern China, in which 491 participants completed a comprehensive questionnaire at baseline and the 2-year follow-up. Sociodemographic, clinical and psychological assessment data were collected from all participants. Paired sample T-Tests and the McNemar Test were performed to examine changes over the follow-up period. Generalized Estimating Equations (GEE) were used to analyze the risk factors for violent behavior. Results: The results showed that about two in five community-dwelling patients with schizophrenia reported violent behavior in the past year. At follow-up, participants were significantly less employed, had more times of hospitalization, more psychotropic medication, and severer depressive symptoms, but had better health-related quality of life than at baseline. Use of clozapine and better insight into medication decreased the possibility of violent behavior, while more severe positive symptoms, insomnia, as well as use of second-generation antipsychotics other than clozapine, antidepressants and mood stabilizers increased the possibility of violent behavior. Conclusions: Risk evaluation, prevention and management of violence in patients with schizophrenia are demanded in primary mental health care.

Mannose modified zwitterionic polyester-conjugated second near-infrared organic fluorophore for targeted photothermal therapy.

Cancer resistance has been the huge challenge to clinical treatment. A photothermal therapy of second near-infrared (NIR-II) organic dye small molecule has been used to conquer the cancer resistance. However, the available NIR-II dye lacks selectivity and spreads throughout the body. It has toxicity and indiscriminate burn injuries normal cells and tissues during therapy. Hence, to improve the therapeutic outcomes, herein, for the first time, we report the mannose-modified zwitterionic nanoparticles loading IR1048 dye, aiming to overcome cancer cellular resistance. The targeting molecule mannose has been applied to modify zwitterionic polyester, and the obtained polyester is employed to load IR1048 to prolong the circulation time in the blood and improve the stability of loaded dye, due to the good cytocompatibility of polyester and the antifouling properties of zwitterions. In vitro experimental results show that the pH-responsive targeted nanoparticles display satisfactory photophysical properties, prominent photothermal conversion efficiency (44.07%), excellent photothermal stability, negligible cytotoxicity for normal cells and strong photothermal toxicity to drug-resistant cancer cells. Moreover, due to the mannose targeting effect, cancer cells can endocytose the nanoparticles effectively. All these results demonstrate potential application of this alternative hyperthermal delivery system with remote-controllable photothermal therapy of tumor for accurate diagnosis by NIR-II fluorescence imaging.

Nondestructive Strategy to Effectively Enhance the Interfacial Adhesion of PBO/Epoxy Composites.

Low interfacial adhesion seriously limits the wide application of PBO fiber in composites. To solve this problem, a novel hierarchical reinforcement strategy was developed by introducing epoxy sizing, nanoreinforcement of amino-functionalized silicon dioxide (SiO2-NH2), and an interfacial compatibilizer of 2,6-bis(2-hydroxy-4-aminophenyl) benzobisoxazole (HABO) onto poly(p-phenylene benzobisoxazole) (PBO) fibers via a facile dip-coating approach. SiO2-NH2 and HABO were uniformly dispersed in epoxy sizing, forming an active interface layer. On this basis, wettability, surface roughness of the PBO fiber, and compatibility with the resin matrix were significantly improved, which gave 88.4 and 40.4% enhancement in the interfacial shear strength and interlaminar shear strength of the corresponding composites, respectively. Moreover, it should be noted that the outstanding mechanical and thermal properties of the PBO fiber were not impaired during the sizing treatment. In summary, our work provides an effective and damage-free approach to improve the interfacial adhesion of PBO/epoxy composites.

Psychotropic medication treatment patterns in community-dwelling schizophrenia in China: comparisons between rural and urban areas.

BACKGROUND: To date no study has compared more specifically the psychotropic medication treatment patterns for patients with schizophrenia living in community between rural and urban areas. This study examined the rural-urban differences of the use of psychotropic drugs among community-dwelling individuals with schizophrenia in China. METHOD: Data on 993 community-dwelling patients with schizophrenia (n = 479 in rural area and n = 514 urban area) were collected by interviews during 2013-2014, and 2015-2016 according to the diagnosis of DSM-IV or ICD-10. Data on patients' socio-demographic and clinical characteristics, prescriptions of psychotropic drugs were collected using a standardized protocol and data acquisition procedure. RESULTS: Multivariate analyses revealed that in comparison with the rural counterparts, the patients from the urban area were significantly more frequently prescribed antipsychotic polypharmacy, clozapine, and benzodiazepines, but the patients from the rural area had more frequently prescribed anticholinergics. CONCLUSIONS: Substantial variations in psychotropic medication treatment patterns for patients with schizophrenia living in community were found between rural and urban areas in China. Common use of antipsychotic polypharmacy, clozapine and benzodiazepines in urban area, and anticholinergics in rural area need to be further addressed.

Antipsychotic-Free Status in Community-Dwelling Patients With Schizophrenia in China: Comparisons Within and Between Rural and Urban Areas.

OBJECTIVE: To date, no study has specifically compared antipsychotic-free patients with schizophrenia living in the community between rural and urban areas. This study examined the rural-urban differences among antipsychotic-free community-dwelling individuals with schizophrenia in China. METHODS: Data on 1,365 community-dwelling patients with schizophrenia (n = 742 in a rural area and n = 623 in an urban area) with diagnoses according to DSM-IV or ICD-10 were collected by interviews during 2013-2014 and 2015-2016. Data on patients' sociodemographic and clinical characteristics, prescriptions of psychotropic drugs, and antipsychotic treatment status were recorded using a standardized protocol and data collection procedure. RESULTS: The prevalence of antipsychotic-free status in the total sample (N = 1,365) was 27.3%; the proportion of antipsychotic-free patients was significantly lower (17.5%) in the urban area (17.5%) than in the rural area (35.4%; χ² = 55.03, P < .001). Binary logistic regression analysis revealed that antipsychotic-free patients, whether from the urban area or the rural area, were older (P = .001, odds ratio [OR] = 0.95 in urban; P = .006, OR = 0.97 in rural) and had poorer attitude toward medication treatment (P < .001, OR = 1.21 in urban; P < .001, OR = 1.31 in rural). Antipsychotic-free patients from the urban area also had fewer admissions, lower education level, and greater likelihood of living by themselves. Antipsychotic-free patients from the rural area also had worse insight into the disease, fewer anxiety symptoms, more prominent positive symptoms, and lower body mass index and were more likely to be women. CONCLUSIONS: Antipsychotic-free status was more common in community-dwelling patients with schizophrenia in the rural area than in the urban area. Older age and poorer attitude toward medication treatment were common features of antipsychotic-free patients. There were correspondingly different risk factors for antipsychotic-free status between rural and urban areas. Building a positive medication treatment attitude is an important strategy for establishing medication adherence in older, community-dwelling patients with schizophrenia.

Synthesis and characterization of water-soluble chitosan grafted with hydrophilic aliphatic polyester.

Traditionally, hydrophobic aliphatic polyester has been employed to modify chitosan and organic soluble or swellable graft copolymers have been obtained. In this work, linear poly(butylene tartrate) (PBT) with hydrophilic pendant hydroxyl groups, which was synthesized by direct polycondensation of tartaric acid and butanediol under mild condition, was chosen to modify chitosan and synthesize PBT grafted chitosan (CS-g-PBT) with the mediation of 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide in aqueous solution of an ionic liquid. The chain length of the grafted PBT could be facilely controlled by varying the molecular weight of PBT. The chemical structures of CS-g-PBT were systematically characterized by 1H NMR, attenuated total reflectance Fourier transform infrared and wide-angle X-ray diffraction. The thermal properties were investigated by thermogravimetric analysis and differential scanning calorimetry. The water solubility of chitosan has been effectively improved after grafting with PBT and a water-soluble chitosan derivative has been synthesized. Meanwhile, the water solubility of grafts varies regularly with chain length of grafted PBT.

Modification of chitosan with monomethyl fumaric acid in an ionic liquid solution.

Antibacterial and antioxidant monomethyl fumaric acid (MFA) was selected to modify chitosan, using aqueous solution of an ionic liquid as a homogeneous and green reaction media. The chemical structures of resulting polymers were systematically characterized by (1)H NMR, diffusion ordered spectroscopy, solid (13)C NMR and wide-angle X-ray diffraction. The results show that two kinds of MFA modified chitosan materials with totally different chemical structures have been synthesized. One product was a MF-chitosan salt composed of chitosan cation and MFA anion, which was obtained with the mediation of 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide (EDC) and N-hydroxysuccinimide. The other one synthesized with the mediation of EDC was a MF-chitosan amide in which MFA and chitosan are covalently attached. Solubility of chitosan has been improved, and MF-chitosan salt can be readily dissolved in water. The antioxidant activity has been enhanced with the introduction of MFA, irrespective of the chemical structure.

Mental health and burnout in primary and secondary school teachers in the remote mountain areas of Guangdong Province in the People's Republic of China.

BACKGROUND: A growing number of studies have shown that education is a work context in which professionals (teachers) seem likely to suffer from burnout that may be associated with low levels of mental health. Although there is a demonstrated need to improve the mental health and burnout levels among teachers, little is known about their mental health status, particularly with respect to graduating class teachers in remote mountain areas with undeveloped economies. The purpose of this study was to survey mental health and burnout among graduating class teachers in remote mountain areas and to examine the influence of moderating variables. METHODS: We conducted a multilevel analysis of 590 graduating class teachers from 42 primary and secondary schools in remote mountain areas of Guangdong province in the People's Republic of China. The outcome variable of self-reported mental health was measured by the Symptom Checklist-90 (SCL-90), and burnout was measured by the Chinese Maslach Burnout Inventory for primary and secondary school teachers. RESULTS: The status of both mental health and burnout among the respondents was significantly more troubling than the national norm used as a reference (P<0.05 or P<0.01). Each factor in the SCL-90 had a significant correlation with burnout (P<0.01). All factors of the SCL-90 were entered into the regression equation for each dimension of burnout (P<0.01). The factor having the greatest impact on emotional exhaustion and depersonalization was anxiety (beta 0.187 and 0.178, respectively). The factor having the greatest impact on reduced personal accomplishment and intellectual burnout was somatization (beta -0.214 and 0.185, respectively). CONCLUSION: The current outlook for the status of mental health and burnout among teachers in remote mountain areas of Guangdong is not good. The level of mental health among these teachers is lower than the national average, and the level of burnout is higher. Mental health status has obvious effects on burnout among these teachers.

A novel and simple procedure to synthesize chitosan-graft-polycaprolactone in an ionic liquid.

An ionic liquid, 1-ethyl-3-methylimidazolium acetate (EMIMAc), was synthesized and employed as a homogeneous and green reaction media to prepare chitosan-graft-polycaprolactone (CS-g-PCL) via ring-opening polymerization, using stannous octoate (Sn(Oct)2) as a catalyst. The structures and compositions of copolymers could be facilely controlled by the reaction conditions and feed ratios. The grafting content of polycaprolactone (PCL) could reach as high as 630%. The chemical structures of the copolymers were systematically characterized by (1)H NMR, Fourier transform infrared spectroscopy (FTIR) and wide-angle X-ray diffraction (WAXD), while thermal properties were studied by thermogravimetric analysis (TGA) and differential scanning calorimetry (DSC). The thermal stability and glass transition temperature (Tg) of the graft copolymers vary regularly with the change of PCL grafting content.