It is ambiguous whether a higher dose of linaclotide provides higher efficacy for chronic constipation (CC) patients. The meta-analysis aimed to assess the efficacy and safety of linaclotide doses ranging from 62.5  A comprehensive search was conducted, and STATA16 software was used for data analysis. p < 0.001), the low-dose group , the medium-dose group , and high-dose group . Bayesian analysis showed the high-dose group obtained the maximum CSBM responder rate : 3.22–7.79; probability rank = 0.87) indirectly compared with extremely low-dose, low-dose, and medium-dose groups. However, no significant difference presented in the CSBM responder rate by pairwise comparisons of the different dose groups. Additionally, no more any adverse events occurred in the higher linaclotide dose group  indirectly compared with other dose groups.  Seven studies with 4,107 patients were eligible. A significantly enhanced number of completely spontaneous bowel movement (CSBM) responders were found in the extremely low-dose group (OR: 2.94; 95% CI: 1.98–4.34;  High dose of linaclotide could be more effective and safer for CC patients, which need more trials to confirm in the future. Chronic constipation (CC) may be primary  or secondary to several disorders or medications. CC is characterized by various bowel symptoms, including infrequent bowel movement, hard stools, excessive straining to defecate, a sense of anorectal blockage, anal digitation, and a sense of incomplete evacuation. The most widely used diagnostic criteria of CC are the Rome criteria, and the latest is Rome IV, created in 2016 [CC negatively affects the quality of life, comparable with chronic diseases, such as chronic obstructive pulmonary disease, diabetes, and depression , 3. In cThere are many choices available for the treatment of CC, including changes in defecation habits, increase in fiber intake, and several drugs, such as laxatives and systemically active agents. However, up to 50% of patients report that they are not completely satisfied with current treatment due to inefficient relief from constipation, the side effects of drugs , the lack of predictability of laxative action, and partial improvement of the quality of life .Escherichia coli ST toxin, interacts with the guanylate cyclase C (GC-C) located in the enterocyte apical membrane. Activation of the GC-C receptor results in cyclic GMP production that induces the secretion of fluids and electrolytes into the lumen, accelerates colonic transit, and relieves constipation [μg and 290 μg has demonstrated an adequate level of safety and efficacy in two large RCTs conducted on CC patients [μg dose was approved for CC treatment in adults. A linaclotide dosage of 290 μg once per day is considered safe and effective for IBC-C patients in the USA [μg linaclotide resulted in a higher monthly responder rate in a global assessment of relief from IBS symptoms, responder rate of completely spontaneous bowel movement (CSBM), and responder rate of abdominal pain or discomfort relief than those with placebo [μg may be appropriate for IBS-C patients. Similarly, there is ambiguity on whether a high dose of linaclotide provides higher efficacy for CC patients. Therefore, in this study, we aimed to assess the effect and safety of different doses of linaclotide for the treatment of CC.Linaclotide, a peptide homolog of tipation . Many sttipation –17. Nevepatients . However the USA –21. Howe placebo , which iThis meta-analysis was conducted following PRISMA guidelines. A comprehensive search of the PubMed, the Cochrane Library, and the Embase was performed using the search terms: linaclotide and chronic constipation.Randomized controlled trial (RCT)Participants had to be diagnosed with CCParticipants had to be treated using linaclotideThe language had to be EnglishParticipants were diagnosed with IBS-CIncomplete dataThe publication was a letter, comment, editorial, or case reportThe detailed selection process is summarized in the PRISMA flow diagram. Two authors (Jiao Yang and YanChang Lei) independently identified the full-text manuscripts of these studies based on the inclusion criteria and conducted data extraction for the primary and secondary endpoints. Conflicts were resolved by discussion. The primary endpoint was the number of CSBM responders. The secondary endpoints were the number of spontaneous bowel movement (SBM) responders, the number of responders of the global assessment of relief, the number of responders of abnormal bowel habits improvement, and the number of responders of abdominal symptoms relief. The definition of a CSBM/SBM responder was a patient who had reported at least 3 CSBMs/SBMs and an increase of 1 or more CSBMs/SBMs from the baseline at each evaluation point. Responders for global assessment of relief of CC symptoms, abnormal bowel habits improvement, and abdominal symptoms relief were defined as patients with a score of 1 or 2 at each evaluation point.μg, 72 μg, or 75 μg of linaclotide. The low-dose group of patients received 145 μg or 150 μg of linaclotide. The medium-dose group of patients received 290 μg or 300 μg, and the high-dose group received 500 μg or 600 μg of linaclotide.Moreover, the baseline characteristics, such as country, number of centers, diagnostic criteria for CC, the total number of patients, the proportion of female patients, dose of linaclotide, duration, and outcomes, of the randomized controlled trials were recorded. The extremely low-dose group of patients received 62.5 I2 or p statistics. If I2 > 50% or p < 0.1, indicating heterogeneity, the random-effects model was used. Otherwise, the fixed-effects model was applied. Publication bias was assessed by funnel plots and Begg's test. The quality of the eligible studies was evaluated by Cochrane's risk of bias tool (RevMan 5.3 software) including random sequence generation, allocation concealment, blinding of participants and personnel, blinding of the outcomes assessment, incomplete outcome data, selective reporting, and other biases. In addition, R software (3.6.3) with GEMTC and RJAGS packages was utilized to perform Bayesian analysis to rank the optimal dose of linaclotide [th and 97.5%th percentiles.STATA 16 software was used to perform the statistical analyses. All outcomes were dichotomous variables. The risk ratio (RR), odds ratio (OR), and 95% confidence intervals (CI) were calculated. Additionally, heterogeneity was analyzed using aclotide , 24. Theaclotide . 95% creThe Grading of Recommendation Assessment, Development, and Evaluation approach (GRADE) was applied to assess the quality of the evidence associated with the meta-analysis primary outcomes results.Seven studies , 25–30 aThe quality of all eligible studies was evaluated using the risk of bias tool of the Cochrane collaboration network. Random sequence generation, allocation concealment, blinding of participants and personnel, blinding of outcome assessment, and incomplete outcome data were found to be low risk. Selective reporting and other biases showed an unclear risk of bias, as shown in I2 = 27.9% or p=0.216). The number of CSBM responders was significantly higher in the linaclotide group than the placebo group . Then, a stratified analysis was conducted between patients administered different doses of linaclotide and the placebo. The number of CSBM responders in the extremely low-dose group , low-dose group , medium-dose group , and high-dose group  was higher than that of the placebo, as shown in Seven RCTs reported on the number of CSBM responders in the linaclotide group and placebo group. The fixed-effects model was used because no significant heterogeneity was found , as given in Four studies conducted on 1,123 patients reported on the number of SBM responders. p=0.156), as given in The low-dose group and the medium-dose group were further analyzed. We applied the fixed-effects model because the level of heterogeneity was not significant and found that the efficacy was comparable with the number of SBM responders between the low-dose group and medium-dose group , as given in p=0.626) was not significant, as given in A total of 3,837 patients reported the incidence of responders in the global assessment of relief. More patients reported as responders in the global assessment of relief in the linaclotide group than those in the placebo group , as given in p=0.23), as given in Three trials reported on responders of abnormal bowel habits improvement as an outcome. More patients in the linaclotide group presented abnormal bowel habits improvement than those in the placebo group , as given in p < 0.001), as given in Five trials conducted on 2,307 patients reported on the number of responders of abdominal symptoms relief. More patients in the linaclotide group reported as responders of abdominal symptoms relief than those in the placebo group , gastrointestinal disorders , diarrhea , and infections  than those in the placebo group, as given in Patients in the linaclotide group presented with more any AEs  indirectly compared with other dose groups, as shown in A funnel plot and Begg's test were used to evaluate the publication bias, and no significant publication bias was presented for these outcomes , as shown in The eligible studies were RCTs, and the level of evidence using GRADE instruments was high. In total, these studies provided a moderate to high level of evidence of the CSBM responder rate in Supplementary Materials .The effects of different doses of linaclotide on CC have been assessed, resulting in confusing outcomes for clinicians. Therefore, we conducted a meta-analysis to evaluate whether a high dose of linaclotide would present more benefits for patients with CC. Up to date, this is the first meta-analysis to assess the efficacy of different doses of linaclotide. In this study, we found that the efficacy of each linaclotide dose was better than that of the placebo and was tolerable for patients with CC. Furthermore, the high dose of linaclotide was more efficacious and resulted in no more adverse events in patients with CC by indirect comparison with other dose of linaclotide.μg daily) and IBS-C (290 μg daily) in 2012 [μg dose of linaclotide was approved by the FDA for treating chronic idiopathic constipation [μg or a placebo and found no dose-dependent increase in CSBMs, SBMs, stool consistency, and straining in patients with IBS-C [Linaclotide, which targets GC-C receptors on the lumen of the intestinal epithelium, has been approved by the US Food and Drug Administration (FDA) for the treatment of chronic constipation , abdominal bowel habits improvement (OR: 3.73), and abdominal symptoms relief (OR: 2.76), compared with those administered the placebo. For the low dose and medium dose of linaclotide groups, the global assessment of relief responder rate was 45.70% and 46.79%, respectively, indicating that a higher dose of linaclotide provided no significant improvement in the global assessment of relief. The responder rate of abdominal bowel habits improvement and abdominal symptoms relief was 32.29% and 27.27%, and 56.83% and 58.76% between the low and medium dose of linaclotide groups, respectively, and showed no statistical significance. These results can be explained by the effect of linaclotide in reducing visceral sensitivity, as proven using rodent models of visceral pain . These bμg group, and linaclotide 145 μg group, respectively [μg with no detectable change in serum levels [The most common adverse events of linaclotide are diarrhea and gastrointestinal disorders. Here, we reported the incidence of any AEs, gastrointestinal disorders, diarrhea, and infections in patients with linaclotide were all higher than those with the placebo. Most AEs were mild or moderate. Only one eligible study reported on diarrhea that resulted from the discontinuation of 0, 2.4%, and 3.2% of patients in the placebo, linaclotide 72 ectively . We analm levels . Howeverm levels  which isThere are some limitations to this study. First, the number of eligible studies was small. Second, most studies were conducted in the United States or Japan. There was a lack of data from China and European countries. The dose of linaclotide may be different for patients of different genetic backgrounds. Third, the dose of linaclotide for different dose groups was not a single value but was a category. Fourth, efficacy parameters, such as the change in mean CSBM/SBM frequency, change in mean stool form score, and improvement of health-related quality of life, were lacking due to the unavailability of relevant data, which may change the conclusion. Finally, the definition of CC used in our study is broad and included certain secondary factors, such as medications. Therefore, there may be some discrepancies in the efficacy of different linaclotide doses between primary CC and secondary CC.In conclusion, high dose of linaclotide could be more effective and safer for CC patients which need more trials to confirm in the future.


We aim to develop a deep neural network model to differentiate pneumonia-type lung carcinoma from pneumonia based on chest CT scanning and evaluate its performance.  We retrospectively analyzed 131 patients diagnosed with pneumonia-type lung carcinoma and 171 patients with pneumonia treated in Beijing Hospital from October 2019 to February 2021. The average age was 68 (±15) years old, and the proportion of men (162/302) was slightly more than that of women (140/302). In this study, a deep learning based model UNet was applied to extract lesion areas from chest CT images. Lesion areas were extracted and classified by a designed spatial attention mechanism network. The model AUC and diagnostic accuracy were analyzed based on the results of the model. We analyzed the accuracy rate, sensitivity, and specificity and compared the results of the model to the junior and senior radiologists and radiologists based on the model. P < 0.05). Based on the lesion texture diversity and the lesion boundary ambiguity, the algorithm produced false-positive samples (13.51%).  The model has a good efficiency in detecting pneumonia-like lesions (6.31 seconds/case). The model accuracy rate, sensitivity, and specificity were 74.20%, 60.37%, and 89.36%, respectively. The junior radiologist's accuracy rate, sensitivity, and specificity were 61.00%, 48.08%, and 75.00%, respectively. The senior radiologist's accuracy rate, sensitivity, and specificity were 65.00%, 51.92%, and 79.17%, respectively. The results of junior radiologists based on the model were improved . The results of senior radiologists based on the model were also improved  and the diagnostic accuracy of which was statistically higher than other groups ( This deep learning model could detect pneumonia-type lung carcinoma and differentiate it from pneumonia accurately and efficiently. Lung cancer is the most common malignant tumor in the pulmonary disease, with about 1.8 million patients worldwide . Lung caRecently, computed tomography has been continuously developing. HRCT, the MPR function of MSCT, energy spectrum CT quantitative analysis, and dual-source CT dual-energy technology have been applied in the differential diagnosis of PTLC and pneumonia. They provided more information for CT diagnosis, thus enlarged the application scope of CT and improved diagnostic accuracy. Meanwhile, deep learning technology has achieved great success in medical imaging due to the powerful feature extraction ability –11. SpecThe institutional ethics committee approved this retrospective study. The need to obtain written informed consent for participation was waived.Chest CT images from 302 patients from October 2019 to February 2021 were included in this study, comprising 171 patients with pneumonia and 131 patients with PTLC. Among them, there were 162 males and 140 females with an average age of 68.Inclusion criteria: patients with pneumonia-type lung cancer or pneumonia diagnosed by CT were included. The image quality of CT was good. Exclusion criteria: cases with poor image quality affecting observation.All eligible patients underwent laboratory examination, routine pathological examination, or anti-inflammatory therapy.The chest CT image with pneumonia and PTLC were randomly selected from October 2019 to February 2021 and randomly divided into a training set and a test set at a ratio of 2 : 1. The training dataset was then further subdivided into the training and internal validation (10% of the sample). Independent test sets were not used for training and internal validation. The patient demographic and disease statistics are given in Tables The chest CT image was obtained with equipment from different manufacturers by using standard imaging protocols. Chest CT scan field from the thoracic inlet to the base of the lungs. Protocols are as follows: scanning slice thickness, 5 mm; image matrix, 512 × 512; FOV, 400 mm; reconstruction parameter setting: slice thickness, 1.0 mm; layer spacing, 1.0 mm; observation window parameters: lung window width, 1500 HU, window position, −600 HU; mediastinum window width, 400 HU; window level, 35 HU.First, a segmentation model based on UNet  was desiIn the stage of lesion classification, we designed a classification network with the spatial attention mechanism . In the The attention mechanism made the network focus on important parts of the image during feature extraction. The information contained in the image was rich and diverse. The indiscriminate reference of all the information in the image would make the features complicated and confusing. The attention mechanism ensured that only the key features in the image were extracted by assigning different weights to the image features of different regions, resulting in decreased cost of network convergence and improved accuracy.A junior radiologist with 3–5 years of work experience and a senior chest imaging specialist with more than ten years of work experience independently read out the images without referring to the deep learning model. The location of pneumonia-like lesions was marked; the lesion features were selected; the qualitative diagnosis was made; the number of image layers was recorded based on the location of the lesions.The chest CT images of 100 patients were imported into the model for automatic recognition, labeling, and diagnosis.Two weeks after the radiologist completed the independent readout of the images, the junior and senior radiologists used the deep learning model to assist the reading and recorded the diagnostic accuracy of pneumonia-like lesions detected.Two chest radiologists with more than ten years of experience, respectively, marked the chest CT images of 302 patients. The diagnostic results of the lesion were identified and recorded. The consensual results were combined with the results of pathology and laboratory tests as the reference standard for genuine positivity.P < 0.05.The performance of our trained deep learning model was evaluated using an independent test set that was not involved in the training process. The test set consisted of 100 examination images, which were randomly selected from 302 data. Unrestricted response receiver operating characteristic (ROC) curve was used to analyze and test the performance of the deep learning model to comprehensively reflect the performance of the model in terms of false-positive rate and detection rate. The area under the curve was calculated using a 95% confidence interval (CI).With the assistance of the deep learning model, the differences in the diagnostic accuracy of pneumonia-like lesions among the five groups were compared among the doctors with low seniority, the doctors with high seniority, the deep learning model, and the combined deep learning model of the doctors with high and low seniority, respectively. The chi-square test was used to make pairwise comparison between groups.SPSS 20.0  was used to input, organize, and analyze the data. Levels of significant are shown as P=0.55) and the independent testing dataset . There was no significant difference in age between the two groups.P < 0.01)   was obta < 0.01) . The modThe details of junior radiologists, senior radiologists, deep learning model, and radiologist based on the model of overall reading pneumonia sample number of correct diagnosis, correct diagnosis score , false-positive diagnostic score , sensitivity, specific, positive predictive value, and negative predictive value are given in P < 0.05). The corresponding diagnostic accuracy rates of each group were 61%, 65%, 74%, 76%, and 78%, respectively, as given in P=0.558), model and senior radiologists (P=0.167), model and senior radiologist based on the model (P=0.774), model and junior radiologist based on model (P=0.508), and junior radiologist based on model and senior radiologist (P=0.088). There were statistically significant differences in the diagnostic accuracy between any two following groups, including the model and the junior radiologist, the junior radiologist based on the model and the junior radiologist, the senior radiologist based on the model and the junior radiologist, and the senior radiologist based on model and the senior radiologist .Comparison of diagnostic accuracy of pneumonia-like disease among junior radiologists, senior radiologists, model, and radiologist based on model . The diaPTLC is a special manifestation of peripheral lung cancer, which mainly manifested as lung lobe, segment, and ground glass density in imaging finding. The clinical manifestations are cough, expectoration, fever, and other symptoms, lack of specificity, with similar imaging to “pneumonia,” which can be easily misdiagnosed as pneumonia and other diseases. As a result, patients cannot receive effective treatment in the first time, directly threatening the follow-up treatment and life –24. ClinIn recent years, imaging technology in China has developed rapidly, and high-precision CT and PET/CT have become increasingly popular, which is of great help to distinguish between PTLC with different pathological basis and focal pneumonia. In a study, patients with pneumonia-type lung cancer received chest-enhanced CT, single-phase PET/CT, and dual-phase 18F-FDG PET/CT, respectively. The study found that chest enhanced CT combined with dual-phase F-FDG PET/CT had the highest diagnostic accuracy (91.1%). The accuracy of chest enhanced CT alone was the lowest (27.4%), proving that chest enhanced CT combined with dual-phase 18F-FDG PET/CT has an exact diagnostic effect. However, it is still misdiagnosed to a certain extent to assess benign and malignant lesions based on the 18F-FDG glucose metabolism . This exWith the rise of machine learning in recent years, some works have been focused on the field of pneumonia image processing. For example, a convolutional neural network was used to distinguish between pneumonia patients and healthy controls . BesidesHowever, this study has some limitations. There is a lot of overlap in the response of the lungs to various injuries, as well as in the presentation of many lung diseases. There is no way to distinguish all lung diseases based solely on the appearance of the chest CT image. At present, it is generally believed at home and abroad that the final results of computer-aided diagnosis should still be confirmed by the radiologists, so we suggest a multidisciplinary approach. In addition, although a large amount of data were collected for this study, the test set and the training set came from the same hospital. Finally, there is still room for improvement in the encoding of features. The feature extraction method based on convolution cannot pay attention to the global feature distribution of the lesion. The transformer  structurIn conclusion, a machine learning method based on the convolutional network model was used to distinguish PTLC and pneumonia in this study. The results showed that the model has good performance and high reliability, and the diagnostic accuracy is significantly higher than simple chest CT. Meanwhile, compared with traditional examination methods, this method reduce radiation, economic, and psychological burden for patients. Therefore, this method has prospect for clinical application. However, this model has some deficiencies. In the future, we will collect more cases, increase the sample size, subdivide the pathological types, optimize the model, and apply the updated algorithm. We hope to develop a mature deep learning model to differentiate PTLC and pneumonia from the chest CT image more accurately and provide reference for treatment.


Non-suicidal self-injury is a serious health problem among patients with depression or bipolar disorder. However, few studies within the Chinese context have investigated the prevalence of NSSI and its risk factors in above populations. The purpose of this study was to investigate the prevalence of non-suicidal self-injury and its risk factors in patients with depression or bipolar disorder in China.Mage = 29.71; SDage = 11.95) with depression or bipolar disorder from two psychiatric hospitals in Beijing, China. A General Demographic Data Form, the Non-suicidal Self-injury Questionnaire(NSSI-Q), Impulsivity Item and the Adverse Childhood Experiences-International Questionnaire(ACE-IQ) were completed by all patients.The final sample comprised of 394 inpatients(P<0.05).Of the 394 patients examined, 245(62.2%) of this sample reported NSSI in past year. Of the 245 patients with NSSI, 135(55.1%) were diagnosed with depression and 110(44.9%) were diagnosed with bipolar disorder. The most common methods of NSSI for female was “pinching”(23.1%) and “scratching”(22.8%), while for male it was “hiting hard objects”(12.7%). By multivariate regression analysis, young age, unemployment, a higher monthly family income, single, impulsivity, long duration of illness and ACEs were risk factors for NSSI in patients with depression and bipolar disorder(Our study points to the fact that there was an unfortunate message about the prevalence of NSSI among patients with depression or bipolar disorder in China. It is necessary not only to raise the awareness of NSSI in families and society, but also to formulate targeted assessment and intervention. Moreover, future research should not only focus on individuals being hospitalized, but should be representative of individuals treated at home or in the community because there are no national statistics on NSSI among such patients in China. Non-suicidal self-injury(NSSI) is generally defined as “the direct, deliberate destruction of one’s own body tissue without the intention of suicidal intent” , includiEstimated prevalence of NSSI vary widely as due to a number of factors including the time since last episode of NSSI, the number of NSSI episodes to be recognized, research tools, as well as different study areas and populations . Benjet 9- THC/CBD balance [NSSI leads to a variety of serious consequences, including physical injury , negativ balance , which m balance . However balance .Whereas studies from other countries have investigated the prevalence of NSSI and risk factors of NSSI , 25, 26,The participants for this cross-sectional study consisted of patients who were hospitalized at one of the two Chinese biggest psychiatric hospitals in Beijing, China, between September 2019 and May 2020. Inclusion criteria were: 1) The patients who were aged 18 to 60 years old were interviewed by two or more psychiatrists and met the diagnostic of depression or bipolar disorder according to the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10); 2) The patients were clinically stable(an increase in drug dosage not more than 50% in the 3 months before this investigation ); 3) TheFrom September 2019 to May 2020, 412 adult patients were eligible for our study. Of these patients, 16 cases were excluded from the analysis because of the unwillingness to continue to participate in study. The final sample consisted of 394 patients, with a a response rate of 95.63%. Before entering our study, we explained the purpose, content and procedure of this study to the patients, and promised that the study results would only be used for academic research. Patients voluntarily decide whether to participate in the study or not. If they agree to participate, they will sign a written informed consent. Moreover, patients have the right to decide whether to continue during the study. The questionnaire information was collected face-to-face, one-on-one, by trained researchers in a quiet room in the ward after being given a verbal and written explanation of the study and having acquired informed consent. And the questionnaire was completed by themselves. If the respondents have questions about the questionnaire, the researchers can help them understand by informing them of the original intention of the question in a non-judgmental way. Additionally, the quality control procedures in the research process are also very important. Measures were taken for quality assurance, such as intensive researcher training, detailed field explanations, continuous feedback and independent supervision of supervisors and field researchers. The questionnaire was collected and checked whether there were any missing items by the researcher on the spot after completion. The study was performed according to the Declaration of Helsinki and approved by the Research Ethics Board of Peking Union Medical College (2019–18-K7).A General Demographic Data Form by self-designed was employed to collect basic information of each patient, including sex, age, marital status, employment status, monthly family income, residence, educational level of patients and their parent, left-behind experience, substance abuse experience, family type, family structure, and the clinical features of patients for the borderline personality disorder assessment module was computed, indicating very good internal consistency of the section. After removing the impulsivity item, the value does not change, indicating that the item has high reliability [Impulsivity was measured by the question: “Most of time in your life, no matter what the situation was, no matter who you were with, have you often done things impulsively?” Respondents who answered affirmatively were defined in this study as impulsive. For the assessment of impulsivity, it is derived from the borderline personality disorder assessment module using the edule-IV . We canniability . Good coiability .ACEs were assessed using the Adverse Childhood Experiences International Questionnaire(ACE-IQ) developed by the World Health Organization , which cP < 0.05). In addition, based on clinical experiences and literature review, it was found that the sex was closely related to the occurrence of NSSI [P<0.05 for both directions. All statistical analyses were performed in SPSS for Windows, Version 23.0.Descriptive statistics for all the variables were first conducted using percentages for the categorical variables. Mean, standard deviation, and range were computed for continuous variables. The prevalence of NSSI was examined and presented in terms of frequency and the proportion of those encountering it(%). Social-demographic characteristics, impulsivity and ACEs of participants between NSSI group(Depression-NSSI group/Bipolar Disorder-NSSI group) and Non-NSSI group were compared by using Chi-squared tests. After running Chi-squared tests for each putative risk factor between groups Table , we incl of NSSI . TherefoSD = 11.95). Male and female patients did not differ in age. The response rate was 95.63%. Sixteen patients who were eligible for inclusion in this study declined to continue in the study. No patients returned incomplete or not analyzable questionnaires.The sample composed of 394 adult patients, with a mean age of 29.71 years were 29.71 years, and they were from north China(65.5%), northeast China(7.9%), etc., most of them were female(69.8%). The majority of the respondents(65.2%) had finished university or above and 53.6% of the respondents were unemployed. In addition, the monthly family income of 161 participants exceeded 1000 dollars. More than half of the respondents(61.7%) were single and from urban areas(65.7%). 99(25.1%) and 76(19.3%) respondents had left-behind experience and substance abuse experience respectively. The educational level of the parents of the respondents was mostly university or above, especially father(35.3%). Two hundred eighteen participants(55.33%) were from the nuclear family. The number of participants from single child family(50.5%) and those from multiple children family(49.5%) accounted for about half each. Clinical diagnoses of the patients were depression(52.8%) and bipolar disorder(47.2%), of whom the majority were within 3 years of illness(58.1%) and within 1–3 times of recurrence(44.2%). 28.7% of participants reported impulsivity, and the vast majority of participants(93.4%) reported ACEs.The final sample comprised 245 adult patients accompanied with NSSI(62.2%) and 149 adult patients unaccompanied with NSSI(37.8%). Among 245 participants with NSSI, 135(55.1%) were diagnosed with depression and 110(44.9%) were diagnosed with bipolar disorder. Moreover, 57(14.4%) had engaged in one type of NSSI and 188(47.6%) had attempted more than one type of NSSI, respectively. “Deliberately pinching oneself”(23.1%) was the most common way of NSSI for female, while “Deliberately hiting hard objects such as walls, tables, windows and floors with fists”(12.7%) was the most common way of NSSI for male, as detailed in Fig.P < 0.05), as presented in Table We also compared the demographics and clinical features of patients in the Depression-NSSI group, Bipolar Disorder-NSSI group and the Non-NSSI group to explore the relationships. Chi-square test showed that age, employments status, marital status, monthly family income, substance abuse experience, duration of illness, times of recurrence, impulsivity and ACEs were statistically different between the three groups, unemployment, have a higher monthly family income and have a history of ACEs, as presented in Table As revealed in Table OR = 0.254 and OR = 0.326; using 18 ~ 30 years old group as the reference category). Next, low risks for NSSI remained associated with married status, no impulsivity  and no ACEs group. Finally, duration of illness for more than 10 years were more likely to have NSSI than those less than 3 years, as presented in Table By comparing patients between BD-NSSI group and Non-NSSI group, 5 variables - age, marital status, impulsivity, ACEs and duration of illness - emerged as significant correlates of NSSI in patients with bipolar disorder. More specifically, in patients with bipolar disorder, the incidence of NSSI was significantly lower in 31 ~ 45 and 46 ~ 60 years old group in a Canadian study among clinical populations . EquallyP>0.05), which are contrary to Tang’s study [It has been suggested that demographic characteristics and clinical features should be considered when interpreting results of any NSSI research . Contrar’s study . On the ’s study . Whether’s study . This maP>0.05), which was partially inconsistent with Escelsior’s findings [To our surprise, statistical significance between substance abuse experience and the incidence of NSSI in patients with depression and bipolar disorder was not found had a higher risk of NSSI, which is consistent with Preyde’s findings that NSSI is more prevalent in young patients with psychiatric disorders due to their difficulty in emotional regulation, adaptive ability and interpersonal relationships . Next, tIn this present study, marital status is one of the important factors affecting NSSI of patients with bipolar disorder, that is, single patients are more likely to engaged in NSSI, which has been repeatedly emphasized in previous studies –56. It iIn recent years, several studies found that individuals reporting ACEs were tied up with NSSI , 62, whiThis study investigated the prevalence of NSSI and its risk factors among patients with depression and bipolar disorder in China. Primarily, we have obtained the not encouraging prevalence to arouse the attention of domestic medical staff, relevant scholars and the public. That is to say, the coping strategies for NSSI should not be confined to hospitals but extended to the communities and families. Then, by comparing the demographic data, impulsivity and ACEs between groups, the relevant influencing factors were found, which can provide support for the exploration of prevention, treatment and etiology of this group. Eventually, the risk factors for NSSI was identified by multivariate regression analysis. Except for the assessment of general demographic data, assessment procedures of mental health may need to include an assessment of impulsivity and ACEs to more fully evaluate NSSI. A combination of the risk factors mentioned above and diagnosis of depression or bipolar disorder among patients who conduct NSSI can also alert medical staff to develop targeted interventions aimed at helping these patients and their families with emotion regulation skills so as to cope with past negative experiences and consequently improve their mental health and well-being. From an academic point of view, this study further confirmed the correlations between NSSI and some factors in patients with depression and bipolar disorder, further supported the conclusions of some scholars. This study also offered new thought for scholars of various contries to guide them to carry out more scientific and targeted research. Notably, future studies should focus on the origin of NSSI as opposed to its characteristics, in order for professionals to be able to prevent the issue.Several limitations of the current study need to be acknowledged. Initially, the participants included were patients in two hospitals in Beijing. As the capital of China, Beijing will attract patients from all over the country, the samples are mainly Beijing native. Considering that China is a vast country with diversified social economy, the source of sample would limits the generalizability of these findings to other cities and rural areas of China. Second, we employed retrospective self-report questionnaires, and there is no independent confirmation, which might mean our data were not sufficiently objective. Participants may forget, suppress or even identify with their experiences as they grow older and more experienced. Therefore, these data may be affected by bias to some extent. Third, an exploration of testing the directionality of the relationships is not allowed in the present study because of the design of cross-sectional. There may be a great deal of analyses and the possibility that some of the correlations were obtained by chance. Taking into account these limitations, additional studies are needed to investigate the NSSI and tease apart the association between NSSI and some factors in order to determine how generalizable the results of this study would be to other psychiatric hospitals from diffirent regions in China. Such studies should employ a large sample, multicenter, longitudinal design, and adopt tools other than self-report questionnaire. And we should remain cautious in drawing causal inferences regarding the relationship between NSSI and some factors.Despite these limitations, the current study examined the prevalence of NSSI and its risk factors in patients with depression and bipolar disorder based on data from a sample of two psychiatric hospitals in Beijing. Our study reported that NSSI was experienced by a significant number of patients with depression or bipolar disorder, and NSSI were associated with some factors, including age, employment status, marital status, impulsivity, etc. NSSI not only affects the physical and mental health of the patients, but also places an insupportable burden on the family and society. Some implications for public policy were manifested in this study. The risk of NSSI in patients with depression and bipolar disorder, especially who are young, unemployment, from family with high monthly income, single, impulsive, and have long duration of illness, ACEs should be assessed. Awareness of NSSI should be improved in the family and society. Likewise, training for health care workers and educators are needed, to help them identify and intervene as early as possible . It is n


BackgroundThe pathogenesis and prognosis of multiple sclerosis (MS) is an area of active medical research. Dietary and biochemical parameters such as serum 25-dihydroxycholecalciferol, magnesium, and potassium play a role in disease progression. This study aimed to compare the nutritional status and biochemical profile of patients with and without MS.MethodologyThis case-control study included a total of 112 participants (56 in the control group and 56 in the MS group). The participants’ socioeconomic and demographic profiles, nutritional status, and biochemical details were all gathered using history, patient files, and records. The effect of these parameters on the presence of MS was evaluated using a decision tree model. Student’s t-test and Mann-Whitney U test were performed to compare these parameters.ResultsA decision tree model was developed with an accuracy rate of 86.52%. The vitamin and mineral intake of the groups showed significant statistical differences (p = 0.001). The differences were important in terms of biochemical parameters, especially serum levels of 25-dihydroxycholecalciferol and potassium.ConclusionsThe key parameters that varied between MS patients and the control group, according to the constructed decision tree, were serum levels of 25-dihydroxycholecalciferol, magnesium, calcium, potassium, and carbohydrate intake. Nutritional measures against MS can be taken based on the decision tree. Multiple sclerosis (MS) is a steadily progressing disorder of the central nervous system marked by demyelinating brain and spinal cord regions . The exaThere is no proven cure for MS as there is much to be researched regarding the disease etiology, pathogenesis, and treatment. Multiple therapies including immunomodulators and steroids have been proven to ameliorate the attack episodes and to enhance the quality of life among patients suffering from MS . A studyThis descriptive case-control study was conducted at the Government Khawaja Muhammad Safdar Medical College and Allied Institutions, Sialkot, Pakistan from January 2019 to January 2020. In terms of nutritional status and biochemical data, two groups of patients were compared. The cases included patients who had the outcome of interest, i.e., MS and those without MS. The participants’ socioeconomic status and demographic profiles, as well as their nutritional status, were determined based on the responses obtained from surveys conducted during face-to-face interviews. The biochemical information was collected from the participants’ blood samples.The study included patients who were willing to participate, aged between 18 and 65 years, having no illness other than MS, and did not alter their eating patterns after being diagnosed with MS. A total of 196 patients met the above-mentioned inclusion criteria. To ensure the validity of biochemical analyses, patients who had not taken any disease-modifying medications, mineral supplementation, and corticosteroids in the last three months were included. The total number of patients who met these criteria was 56 . A list of patient names who applied to the hospital’s internal medicine or endocrinology outpatient clinics during the study period was compiled to form the control group. Individuals aged between 18 and 65 years who did not have any chronic health conditions were identified and asked to participate in the current study as volunteers. To conduct sex-adjusted analyses, an equal number of male and female  participants were selected as controls.Participants’ general characteristics, health status, and eating habits were studied. Participants were asked to share their average daily intake of the most commonly consumed nutrients through a well-organized survey. The program Ebispro for Windows was used to test the average 24-hour retrospective food intake records of the study participants. The participants’ energy and nutrient intake were measured. A total of 33 food and beverage-related questions were used to collect data on daily average food intake. Participants were asked how often they would eat those foods and beverages daily. The total daily energy intake, as well as macro and micronutrient intake, were calculated based on the responses.For the summer and winter seasons, the reference values for 25-dihydroxycholecalciferol were set at 20-120 ng/mL and 10-60 ng/mL, respectively, based on the hospital’s laboratory requirements. The Beckman Coulter AU-5800  unit was used to calculate all parameters except serum 25-dihydroxycholecalciferol. The level of 25-dihydroxycholecalciferol in the blood was measured using the chemiluminescence immunoassay method on a Beckman Coulter Dlx-800. The spectrophotometry method was used to evaluate serum Ca, Mg, and inorganic phosphate levels, while the ion-selective electrode method was used to determine serum K levels. Spectrophotometric methods were used to quantify lipid profile values. The serum levels of alanine aminotransferase, aspartate aminotransferase, and alkaline phosphatase were measured using a kinetic spectrophotometric tool, while immunoturbidimetric methods were used to measure inflammatory markers like C-reactive protein.Shapiro-Wilk normality tests were used to assess the normality of the data. The Chi-square test was used to evaluate whether there was a relationship between the variables. The variations between MS patients and healthy people in terms of socioeconomic and demographic factors, nutritional status, and biochemical information were demonstrated using a decision tree model. The statistical significance standard for all tests was set at 0.05. Rapid Miner Studio version 8.2 was used to build the decision tree model. SPSS Statistics for Windows, version 25.0  was used to perform all statistical calculations.The frequency analysis showing the socioeconomic and demographic characteristics of the participants is shown in Table The average daily energy, macronutrient, and micronutrient intake of the control and MS groups were compared to see whether there were statistically significant differences. In this study, descriptive statistics, as well as comparisons of participants’ nutritional status, were presented. Between the control and MS groups, there were no statistically significant differences in percentage lipid, carbohydrate, protein, cholesterol, calcium, phosphorus, vitamin B2, vitamin B12, and zinc intake . However, there were significant statistical variations between the control and MS groups’ measured carbohydrate, lipid, potassium, vitamin B1, and B6 intake. In general, the control group had higher energy and nutrient intake than the MS group.Participants’ biochemical data were collected to look at the potential discrepancies between the control and MS groups. Descriptive statistics, as well as references to the biochemical data of the participants, were shown. There were statistically significant differences in serum levels of calcium, magnesium, potassium, vitamin D, and low-density lipoprotein between the groups. The difference was particularly noticeable in serum levels of 25-dihydroxycholecalciferol and potassium. The serum 25-dihydroxycholecalciferol level was slightly lower (8.9 ± 4.0 ng/mL) in the MS group than the control group (18.9 ± 11.0 ng/mL). Similarly, the MS group had a slightly lower mean serum potassium level than the control group .A decision tree model was developed to compare the threshold values of certain parameters in healthy people and MS patients based on nutritional status and biochemical information obtained from the participants. The built tree was difficult to investigate as there were so many features gathered from the participants. Therefore, a forward selection approach was used to determine the best subset of features for simplifying the tree. The five characteristics that made up the decision tree that produced the best classification results were serum levels of vitamin D, magnesium, calcium, and potassium, and carbohydrate intake.Following the arrows from the top to bottom and paying attention to the feature’s limit values helps in the interpretation of the tree. In this study, 29 participants had a serum 25-dihydroxycholecalciferol level of less than 15.40 ng/mL, a serum magnesium level of less than 2.29 mg, a serum calcium level of less than 9.56 mg/dL, and a potassium intake of less than 1,798.05 mg. The constructed tree, as a descriptive method, is ideal for comparing parameter differences between the control and MS groups. Physicians may be able to take dietary measures based on the tree’s descriptive findings. The tree is shown in Figure The textual representation of the decision tree is shown in Figure Unlike several previous studies that compared only serum 25-dihydroxycholecalciferol levels of MS patients and healthy people, the current research focused on building a decision tree model to reveal the threshold values of certain parameters in both healthy people and MS patients. This decision tree was used to assess the critical values for 25-dihydroxycholecalciferol serum levels, magnesium, calcium intake, and potassium and CHO intake. As stated in the study, MS has a wide range of clinical characteristics, topography of involvement, and natural history variations, as seen in the western and eastern hemispheres . The stuThe level of serum 25-dihydroxycholecalciferol, which is thought to be a key variable, varies between healthy people and MS patients. Because 25-dihydroxycholecalciferol levels are known to vary by season, different reference values for 25-dihydroxycholecalciferol were used in this study for winter and summer seasons. The 25-dihydroxycholecalciferol levels of the control and MS groups were substantially different during both summer and winter seasons . Due to the nearly identical number of patients in both groups who had their measurements taken in winter (or summer), the distinction was made without regard to the season. The MS group had slightly lower levels of serum 25-dihydroxycholecalciferol (8.87 ± 4.02 ng/mL) than the control group (18.86 ± 11.04 ng/mL).Similar results were obtained in other studies ,9. DeficMagnesium is needed for nerve transmission as well as neuromuscular conduction. It also protects against excessive excitation, which can lead to neuronal cell death, and has been linked to various neurological disorders . MagnesiThe serum calcium levels (9.14 ± 0.63 mg/dL) in the MS group were statistically significantly lower than the control group  in the current study. Similar results were found in another study . There mLow-carbohydrate diets are linked to increased ambulation and physical exercise in people with MS . CarbohyBy analyzing nutritional status and biochemical parameters of people with and without MS, the observations and findings of this study aimed to contribute to the literature in terms of MS recognition. A new research field was attempted to be developed on the determination of critical values for MS patients by providing a decision tree model. The constructed tree, as a descriptive method, is ideal for comparing parameter differences between the control and MS classes. The key parameters that vary between an MS patient and a healthy individual are serum levels of vitamin D, magnesium, calcium, potassium intake, and carbohydrate intake, according to the report. It is important to remember that the parameters used to construct the decision tree are not the cause of MS. The aim of this study was not to find a connection between the two events.Having a retrospective outlook and a single-centered study design account for a few limitations in our study. Further multicentric cohort studies will help to develop the casual association between the disease and nutritional parameters. However, the results of our study open up new questions regarding the relationship of nutritional and biochemical parameters with MS.The key parameters that varied between an MS patient and a healthy individual, according to the constructed decision tree, were serum levels of 25-dihydroxycholecalciferol, magnesium, calcium, and potassium, and carbohydrate intake. Nutritional measures against MS can be taken based on the results of this study. The discrepancies between MS patients and healthy individuals should be identified in terms of certain parameters in prospective cohort studies. The findings show that vitamin D, magnesium, and calcium levels in the blood are predicted to be lower in MS patients.


To investigate the prevalence of adjustment disorder (AD) among cancer patients and the acceptance of psychological treatment, in relation to sociodemographic, clinical, and psychological factors.N = 200) participated in this observational study. Patients completed the Hospital Anxiety and Depression Scale, Checklist Individual Strength, Distress Thermometer and problem list. Patients with increased risk on AD based on these questionnaires were scheduled for a diagnostic interview. Patients diagnosed with AD were invited to participate in a randomized controlled trial on the cost-effectiveness of psychological treatment. Participation in this trial was used as a proxy of acceptance of psychological treatment. Logistic regression analyses were used to investigate associated factors.Breast, prostate, and head and neck cancer patients of all stages and treatment modalities  and having a shorter time since diagnosis .Taking sensitivity analysis into account, the prevalence of AD among cancer patients is estimated at 13 to 15%, and is related to being employed and having a shorter time since diagnosis. The majority of cancer patients with AD accept psychological treatment. Cancer patients may experience psychological problems . One of In a meta-analysis of Mitchell et al. (2011) , the preConcerning the usage of psychological treatment, a previous meta-analysis of Brebach et al.  showed tIn summary, there is inconclusive or limited evidence of the prevalence of AD and the acceptance of psychological treatment for AD among cancer patients, as well as its associated factors. The aim of this study was to investigate (1) the prevalence of AD among cancer patients in relation to sociodemographic and clinical factors; (2) to investigate sociodemographic, clinical, and psychological factors associated with AD among cancer patients with an increased risk for AD; and (3) to investigate the acceptance of psychological treatment among patients with AD in relation to sociodemographic, clinical, and psychological factors. Factors associated with AD among cancer patients in general and cancer patients with an increased risk for AD were investigated separately, as patient-reported outcome measures (PROMS) are increasingly used in clinical practice to identify patients with psychological problems. Due to the design of this study, the association between psychological factors and prevalence of AD could only be investigated among patients with an increased risk for AD.This observational study recruited cancer patients from Amsterdam UMC, Canisius Wilhelmina Hospital and Radboudumc, the Netherlands, between September 2019 and January 2020. The study was part of a randomized controlled trial (RCT) on the effectiveness and cost-utility of tailored psychological treatment targeting cancer patients with AD . PatientRandom selections of patients were drawn by the Netherlands Cancer Registry (NCR) which registers all newly diagnosed cancer patients. Recruitment started among breast, prostate, and head and neck cancer patients. Due to the COVID-19 pandemic, patients with other cancer diagnoses could not be recruited. The (former) treating physician checked the eligibility of the patients. After confirming eligibility, a patient information letter with informed consent form was sent to the patient by mail. After consenting, the patient was asked to complete the study questionnaire measuring their risk for AD.Study procedures were approved by the Medical Ethical Committee of VUmc and followed the Dutch Medical Research Involving Human Subjects Act.The primary outcomes were prevalence of AD and acceptance of psychological treatment. Prevalence was measured through a two-phase approach including a screening procedure and a diagnostic interview.Patients were screened on their risk for AD using the Hospital Anxiety and Depression Scale (HADS), Distress Thermometer (DT), and problem list. The HADS is a psychometrically validated 14‐item self-report questionnaire that measures symptoms of anxiety (HADS-A) and depression (HADS-D) in the last week. Also, a total HADS (HADS-T) score can be calculated ranging from 0 (no distress) to 42 (severe distress) . The DT Patients with an increased risk for AD were invited for a diagnostic interview either by telephone or face-to-face. The interviews were carried out by trained psychologists, who were registered in the expert database of the Dutch Association for Psycho-oncology (NVPO) or under supervision of a registered psychologist. All psychologists followed an E-Learning program on diagnosis and treatment of AD, which included a reader, videos, and an online assessment , 17. ThePatients diagnosed with AD were invited by the psychologist to participate in an RCT in which patients received tailored psychological treatment immediately or after a period of 6 months . If a paTo investigate factors associated with AD and acceptance of psychological treatment, the HADS, DT and problem list, the Checklist Individual Strength (CIS) and questions on sociodemographic and clinical characteristics were used. HADS, DT, and problem list are described above. The CIS is a valid and reliable 20-item instrument to measure fatigue, concentration, motivation, and physical activity , 19. A hThe socio-demographic questions focused on sex , age (years), marital status (yes/no), education level (high/low), and employment status (yes/no). Clinical data (tumor stage (I–II/III–IIII), treatment (single/multiple treatment), and time since diagnosis (less/more than 5 years after diagnosis)) and social economic status (high/middle/low) were obtained from the NCR.T-test and chi-square test. In phase 2 (diagnostic interview), participants (those who completed the interview) and drop-outs (those with an increased risk but who did not complete the interview) were also compared. A p-value<0.05 was considered statistically significant.Quantitative analyses were performed using the IBM Statistical package for the Social Science version 26. Descriptive statistics were generated for all baseline characteristics and outcome measures. To investigate selective non-response in phase 1 (screening), respondents and non-respondents were compared using independent To estimate the prevalence of AD among patients, the number of patients diagnosed with AD was divided by the total number of participants that completed the screening survey minus the total number of drop-outs in phase 2. In addition, sensitivity analyses were performed in which drop-outs of phase 2 were (a) all expected to have AD, (b) partly expected to have AD , and (c) all expected to have no AD. To estimate usage of psychological treatment, the number of patients who agreed to participate in the RCT was divided by the total number of patients diagnosed with AD.p-value<0.05. Since the HADS, DT, and problem list were used to identify patients with an increased risk for AD, these variables were not entered in the logistic regression models on the prevalence of AD among all cancer patients.Possible factors associated with (1) the prevalence of AD among all patients and (2) the prevalence of AD among patients with increased risk and (3) the acceptance of a psychological treatment were investigated using forward logistic regression analyses. Variables were entered one-by-one into the logistic regression model using a N=200, 34%) and those who did not respond . Patients who responded were more often male, had a higher social economic status, and were more frequently diagnosed with prostate cancer and more often diagnosed with tumor stage I or II compared to patients who did not respond (Table N=200) are shown in Table Figure nd Table . CharactOf all 200 patients that completed the survey, 98 patients had an increased risk for AD (49%) and were invited for a diagnostic interview Figure . Of thesN=74), AD was significantly associated with employment status, time since diagnosis, and willingness to talk to an expert . The overall prevalence rate of AD was estimated at 13.1%. Sensitivity analyses in which the 24 patients who dropped out were all expected to have AD, partly expected to have AD, or all expected to have no AD, showed prevalence rates of 23.5%, 15.0%, and 11.5% respectively. Multivariate analysis showed that overall AD was significantly associated with employment status and time since diagnosis  Figure .Table 4VThis study investigated the prevalence of AD among cancer patients and the acceptance of psychological treatment for AD, in relation to sociodemographic, clinical, and psychological factors. Overall prevalence rate of AD was estimated at 13%. Being employed and being diagnosed less than 5 years prior to the study were significantly associated with AD. It was estimated that 65% of patients with AD were willing to accept psychological treatment. None of the investigated factors was associated with acceptance of psychological treatment.The prevalence rate of AD should be viewed within the light of the sensitivity analyses in which prevalence rates of 24%, 15%, and 12% were found. As there were no significant differences in sociodemographic, clinical, and psychological characteristics, except from willingness to talk to an expert, between patients with an increased risk for AD who did and did not participate in the diagnostic interview, we assume that scenario b  is most acceptable. Therefore, a prevalence rate of 13–15% is expected to be most plausible. The prevalence rate of 13–15% is in line with two previous studies reporting prevalence rates of 12% . The stuThe current study demonstrated that being employed, being diagnosed less than 5 years prior to the study, and being willing to talk to an expert are associated with AD, while sociodemographic factors as age, sex, education, and marital status, and clinical factors as cancer type, stage, and treatment were not. This is in contrast to previous studies reporting that being female, younger, unmarried, more highly educated, and diagnosed with a more advanced tumor stage are associated with AD . An explCancer patients who have to manage multiple tasks  may perceive cancer-related stressors as a higher burden compared to those with less tasks  and therefore may be more vulnerable for developing distress , 23 or pOf the 23 patients diagnosed with AD in our study, 65% were willing to participate in an RCT on the effectiveness and cost-utility of psychological treatment for AD, and accepted psychological treatment. This is in line with the results of the meta-analysis of Brebach et al.  who founA strength of our study is the two-step approach to diagnose AD. A limitation is that, due to the COVID-19 pandemic, we had to stop recruiting patients earlier than planned, which resulted in 200 patients with breast, prostate, and head and neck cancer instead of the planned 3000 patients with various types of cancer . The lowAs the prevalence of AD is substantial and acceptance of psychological treatment is high, implementation of screening procedures to identify patients with AD in routine care is recommended. However, effectiveness and cost-effectiveness of psychological treatment of AD remain to be answered. An ongoing RCT will provide more evidence . FurtherThe prevalence of AD among cancer patients is estimated at 13 to 15%. AD among all cancer patients was found to be significantly associated with being employed and shorter time since diagnosis. AD among cancer patients who participated in the diagnostic interview was found to be significantly associated with being employed, shorter time since diagnosis and willingness to talk to an expert. The majority of cancer patients with AD accept psychological treatment.