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Clozapine treatment increases the risk of agranulocytosis, but findings on the epidemiology of agranulocytosis have been inconsistent. This meta-analysis examined the prevalence of agranulocytosis and related death in clozapine-treated patients. A literature search in the international (PubMed, PsycINFO, and EMBASE) and Chinese (WanFang, Chinese National Knowledge Infrastructure, and Sinomed) databases was conducted. Prevalence estimates of agranulocytosis and related death in clozapine-treated patients were synthesized with the Comprehensive Meta-Analysis program using the random-effects model. Thirty-six studies with 260 948 clozapine-treated patients published between 1984 and 2018 were included in the meta-analysis. The overall prevalence of agranulocytosis and death caused by agranulocytosis were 0.4% (95% CI 0.3-0.6%) and 0.05% (95% CI 0.03-0.09%), respectively. The prevalence of agranulocytosis was moderated by sample size, study quality, year of publication, and that of data collection. The prevalence of clozapine-associated agranulocytosis is low. Agranulocytosis-related death appears rare.

PurposePast suicide attempts (SA) are a major contributor to suicide. The prevalence of SA in pregnant and postpartum women varied significantly across studies. Therefore, this meta-analysis was conducted to examine the prevalence of SA and its mediating factors in this population.MethodsRelevant articles published in PubMed, EMBASE, Web of Science, PsycINFO, Medline complete, Chinese National Knowledge Infrastructure database (CNKI), Chinese Wanfang and Chongqing VIP database were systematically searched from inception to March 28, 2019. Titles, abstracts and full texts were reviewed independently by three researchers. Studies were included if they reported data on SA prevalence or provided relevant data that enabled the calculation of SA prevalence. Data were extracted by two researchers and checked by one senior researcher. The random-effects model was used to analyze data by the CMA 2.0 and Stata 12.0, with the high degree of statistical heterogeneity present. The primary outcomes were prevalence of SA with 95% CI during pregnancy and during the first-year postpartum.ResultsFourteen studies covering 6,406,245 pregnant and postpartum women were included. The pooled prevalence of SA was 680 per 100,000 (95% confidence interval 0.10–4.69%) during pregnancy and 210 per 100,000 (95% confidence interval 0.01–3.21%) during the first-year postpartum. Data source was significantly associated with prevalence of SA in the subgroup analysis (pregnancy, p < 0.001; the first-year postpartum, p = 0.013).ConclusionThe prevalence of SA is not high in pregnant and postpartum women. Due to the potential loss of life and negative impact of SA on health outcomes, however, careful screening and effective preventive measures should be implemented for this population.

PurposePoor sleep quality is common in medical students and is associated with a number of negative health outcomes. However, the prevalence estimates of poor sleep quality in medical students vary widely across studies. We thus conducted a meta-analysis of the prevalence of poor sleep quality and its mediating factors in medical students.MethodsA systematic literature search of PubMed, EMBASE, Web of Science, PsycINFO, and Medline Complete was performed. The random-effects model was used to analyze the pooled prevalence of poor sleep quality and its 95% confidence intervals (CIs).ResultsA total of 57 studies with 25,735 medical students were included. The pooled prevalence of poor sleep quality was 52.7% (95% CI: 45.3% to 60.1%) using the Pittsburgh Sleep Quality Index (PSQI). The pooled mean total PSQI score across 41 studies with available data was 6.1 (95% CI: 5.6 to 6.5). Subgroup analyses found that PSQI cutoff value and study region were associated with the prevalence of poor sleep quality (P = 0.0003 VS. P = 0.005). Across the continents, poor sleep quality was most common in Europe, followed by the Americas, Africa, Asia, and Oceania. Meta-regression analyses found that smaller sample size (slope = − 0.0001, P = 0.009) was significantly associated with higher prevalence of poor sleep quality.ConclusionsPoor sleep quality is common among medical students, especially in Europe and the Americas continets. Due to the negative health outcomes, regular screening of poor sleep quality and effective interventions are needed for medical students.

Poor sleep quality is associated with negative health outcomes and high treatment burden. This study investigated the prevalence of poor sleep quality and its socio-demographic correlates among older adults in Hebei province, which is a predominantly agricultural region of China. A large-scale cross-sectional epidemiological survey was conducted from April to August 2016. The study used a multistage, stratified, cluster random sampling method. Sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI). A total of 3,911 participants were included. The prevalence of poor sleep quality (defined as PSQI > 7) was 21.0% (95% CI 19.7–22.2%), with 22.3% (95% CI 20.9–23.8%) in rural areas and 15.9% (95% CI 13.4–18.4%) in urban areas. Multivariable logistic regression analyses found that female gender (P < 0.001, OR 2.4, 95% CI 2.00–2.82), rural areas (P = 0.002, OR 1.5, 95% CI 1.14–1.86), presence of major medical conditions (P < 0.001, OR 2.4, 95% CI 2.02–2.96) and family history of psychiatric disorders (P < 0.001, OR 2.7, 95% CI 1.60–4.39) were independently associated with higher risk of poor sleep quality. Poor sleep quality was common among older adults in Hebei province of China. Regular assessment of sleep quality and accessible sleep treatments for older population should be provided in agricultural areas of China.

Major depressive disorder (MDD) is a common psychiatric disorder in China, but its reported treatment rate varies largely across different studies. The objective of this meta-analysis was to determine the pooled treatment rate for people with MDD in China and its associated factors. Both English (PubMed, Cochrane Library, PsycINFO, Web of Science) and Chinese (Chinese National Knowledge Infrastructure, WanFang and SinoMed) databases were searched from their commencement date to November 13, 2018. Epidemiological studies that reported the treatment rate of MDD were included and synthesized using a random effects model. Fifteen studies covering 609,054 participants were included. The pooled treatment rate for MDD in China was 19.5% (95% CI: 10.7%–28.4%). Among the 15 studies, 9 reported the number of patients who received treatments in psychiatric hospitals with a pooled treatment rate of 5.2% (95% CI: 2.8%–7.5%). Meta-regression found that study quality (β = 0.131, P = 0.028) and male gender (β = 0.006, P = 0.039) were significantly associated with a higher treatment rate for MDD. In China, the treatment rate for MDD, particularly in psychiatric hospitals, was low. Effective public education and increasing access to mental health services will probably increase the number of people seeking and receiving treatment.

This is a meta-analysis of randomized controlled trials (RCTs) comparing cognitive behaviour therapy for insomnia (CBT-I) monotherapy with active control treatment for insomnia in patients with medical or psychiatric comorbidities. Both international (PubMed, EMBASE, PsycINFO, Cochrane Library) and Chinese (WanFang, and CNKI) databases were systematically searched. The random effects model was used. Thirteen RCTs comparing CBT-I (n = 441) and active controls (n = 412) groups were included. CBT-I group showed significant advantage over active controls at post-treatment assessment in terms of Insomnia Severity Index (ISI; SMD = -0.74), sleep onset latency (SMD = -0.36), wake after sleep onset (SMD = -0.21), sleep quality (SMD = 0.56), Pittsburgh sleep quality index total scores (PSQI; SMD = -0.76) and the total score of dysfunctional beliefs and attitudes about sleep scale (DBAS; SMD = -1.09). Subgroup analyses revealed significant improvement in sleep onset latency in patients with psychiatric disorders (SMD = -0.45), while significant reduction of number of wakeup after sleep onset was found in patients with medical conditions (SMD = -0.31). This meta-analysis found that CBT-I monotherapy had greater efficacy than other active control treatment for insomnia in patients with medical or psychiatric comorbidities.

Preliminary evidence indicates that natural disasters are associated with an increased risk for schizophrenia. With few longitudinal studies on earthquakes, this retrospective cohort study examined exposure to the 1976 Tangshan earthquake and the subsequent risk of schizophrenia. Population counts and visits to all nine psychiatric hospitals in Tangshan city were collected. We created three cohort groups by earthquake exposure: infant (August 1972 to July 1976 births), fetal (August 1976 to May 1977 births), and unexposed (June 1977 to May 1981 births). The cumulative incidence of schizophrenia in each cohort was calculated by dividing the number of schizophrenia patients by total births in the corresponding period. Altogether, 6424 schizophrenia patients were identified, with 2786 in the infant group, 663 in the fetal group, and 2975 in the unexposed group. The crude cumulative incidence of schizophrenia in the infant, fetal and unexposed groups were 7.64 (95% confidence interval [CI] = 7.36–7.92), 9.07 (95% CI = 8.38–9.76), and 7.40 (95% CI = 7.13–7.66) per thousand population respectively. Adjusted for mortality, the corresponding figures were 7.73 (95% CI = 7.44–8.01), 9.30 (95% CI = 8.60–10.01) and 7.44 (95% CI = 7.18–7.71) per thousand population respectively. The mortality-adjusted risk ratio (aRR) was 1.25 (95% CI = 1.15–1.36) between fetal and unexposed groups ( χ 2  = 27.31, P  < 0.001). Males exposed as infants did not differ from the unexposed in cumulative schizophrenia incidence. People with fetal exposure to the 1976 earthquake had 25% higher risk of developing schizophrenia compared to unexposed counterparts.

Depression is increasingly prevalent and burdensome globally, yet region-specific studies on culturally distinct populations remain limited. Hence, this study sought to fill this gap in knowledge by determining the prevalence of depressive symptoms in Teochew people and its associations with demographic characteristics, lifestyles and chronic diseases, highlighting depression within a culturally specific population. A large-scale regional survey was performed between September and December 2022 using a multistage stratified equal volume random sampling. Depressive symptoms were measured by the Patient Health Questionnaire-9 (PHQ-9). Univariable and multivariable logistic regression of the complex sampling method were used for statistical analysis. This study encompassed 8,256 Teochew participants with an 83.00% response rate. The prevalence of depression symptoms in the Teoswa region was 4.5% [95% confidence interval (95%CI):3.9–5.1%]and Shantou city had the highest prevalence rate [6.1% (95%CI:5.1–7.3%)]. Teochew people who were women, unmarried, overweight or obese, and had less frequent physical exercise, higher educational level, irregular diet rhythm were prone to depressive symptoms (all P  < 0.05). Teochew people with multimorbidity were susceptible to depressive symptoms [Odds ratio (OR):6.53, 95%CI:3.89–10.97; P  < 0.01]. The prevalence of depressive symptoms in the Teoswa region was relatively high but lower than figures in Guangdong province. Targeted interventions should be implemented to address depressive symptoms among high-risk groups in the Teoswa region.

Our previous studies have demonstrated that erectile function was preserved in aged transgenic rats （TGR） harboring the human tissue kallikrein 1 （hKLK1）, while the molecular level of hKLK1 on corporal fibrosis to inhibit age-related erectile dysfunction （ED） is poorly understood. Male wild-type Sprague-Dawley rats （WTR） and TGR harboring the hKLK1 gene were fed to 4- or 18-month-old and divided into three groups： young WTR （yWTR） as the control, aged WTR （aWTR）, and aged TGR （aTGR）. Erectile function of all rats was assessed by cavernous nerve electrostimulation method. Masson＇s trichrome staining was used to evaluate corporal fibrosis in the corpus cavernosum. We found that the erectile function of rats in the aWTR group was significantly lower than that of other two groups. Masson＇s trichrome staining revealed that compared with those of the yWTR and aTGR groups, the ratio of smooth muscle cell （SMC）/collagen （C） was significantly lower in the aWTR group. Immunohistochemistry and Western blotting analysis were performed, and results demonstrated that expression of a-SMA was lower, while expressions of transforming growth factor-β1 （TGF-β1）, RhoA, ROCK1, p-MYPT1, p-LIMK2, and p-cofilin were higher in the aWTR group compared with those in other two groups. However, LIMK2 and cofilin expressions did not differ among three groups. Taken together, these results indicated that the RhoA/ROCK1/LIMK/cofilin pathway may be involved in the corporal fibrosis caused by advanced age, and hKLK1 may reduce this corporal fibrosis by inhibiting the activation of this pathway to ameliorate age-related ED.