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Along with the rapid increase in older adult population in South Korea, the management of dementia is becoming important. selleck inhibitor Higher dementia prevalence inevitably leads to an excessive burden on medical expenditure throughout one's life, so the catastrophic health expenditure for dementia should be protected in the aspect of both nation and family. Therefore, this study attempted to estimate the lifetime medical expenditures (LE) of older adults with dementia, and confirmed if the long-term care insurance (LTCI) is effective in reducing their medical expenses. The study analyzed LE of adults, aged over 70 years, using a cohort database and simulated the total LE per capita. In order to compare the differences in LE due to dementia, propensity score matching (PSM) was performed. As of 2015, the total LE per capita for older adults with dementia and without dementia was estimated to be 76,973 thousand won ($65,427) and 31,105 thousand won ($26,439). Older adults with dementia had 2.4 times more expenditure than those without dementia. In particular, the LE per capita for hospitalization of dementia patients was 63,945 thousand won ($54,353), which was about 5 times higher than LE per capita for outpatient treatment. In addition, as a result of confirming the political effectiveness of LTCI, the LE for older adults with dementia, who had not used the long-term care service (LTCS), was estimated to be about 85,769 thousand won ($72,904). Conversely, LTCS users were estimated to spend 70,487 thousand won ($59,914), which means that LTCS non-users spent about 22% more on total LE than LTCS users. Non-users spent about half of their LE after the age of 80. Based on these findings, this study confirmed that the LTCI system had the desired effect of reducing the total LE for older adults with dementia.
African-American mothers in the U.S. experience high rates of stress, placing them at risk for depression, anxiety, and preterm births, and their children at risk for poor social-emotional development later in childhood. Yet, few studies have developed and tested family-based interventions that target optimal management of stress in this population.

The current mixed methods study examined whether a six-week family-based intervention (e.g., cognitive behavioral stress management intervention component for mothers and mindfulness-based kindness curriculum for their children) was effective in improving psychosocial outcomes among low-income African-American mothers and increasing prosocial behaviors in their children.

Seventy-two mothers (28% pregnant, 72% postpartum) completed pre- and post-intervention assessments of stress, depression, anxiety, and self-efficacy for stress management. Prosocial behaviors for 38 of their children (3-10 years of age) were also assessed via mother's self-report and two observational child assessments of sharing and helping behaviors. Qualitative interviews at post-intervention and reunion focus groups (up to two years later) were also conducted.

Mothers showed significant reductions in perceived stress, depressive symptoms, and anxiety, as well as improved self-efficacy for stress management at post-intervention. Although observational assessments of children's sharing and helping behaviors did not change, mothers' qualitative responses indicated improvements in their child's prosocial behaviors at home. Qualitative responses also revealed unique stressors that mothers experienced, the short- and long-term impact of these interventions on mothers and their children, and program recommendations.

These results support the efficacy of family-based stress management interventions in this at-risk population.
These results support the efficacy of family-based stress management interventions in this at-risk population.
Stigma toward people with epilepsy (PWE) is common around the globe. Perceived stigma produced by mental or physical disorders may represent a significant risk factor for suicide.This study examines whether and how perceived stigma, unemployment and depression interact to influence suicidal risk in PWE.

A consecutive cohort of people with epilepsy (PWE) was recruited from the First Affiliated Hospital of Chongqing Medical University. Each patient completed the Stigma Scale for Epilepsy (SSE), the Neurological Disorders Depression Inventory for Epilepsy scale (NDDI-E) and the suicidality module of Mini-International Neuropsychiatric Interview(MINI) v.5.0.0. Spearman's correlation and moderated mediation analysis were used to examine the associations among perceived stigma, depression, unemployment and suicidal risk.

Perceived stigma was positively associated with depression severity and suicidal risk. Depression severity mediated the association between perceived stigma and suicidal risk. The indirect effect of perceived stigma on suicidal risk through depression severity was positively moderated by unemployment.

The effect of perceived stigma on suicidal risk can be explained by the mediation of depression severity, At the same time, getting out from the shadow of perceived stigma may help reducing suicidal risk in PWE. In addition, improving employment status of PWE may attenuate the indirect effect of perceived stigma on suicidal risk through depression severity.
The effect of perceived stigma on suicidal risk can be explained by the mediation of depression severity, At the same time, getting out from the shadow of perceived stigma may help reducing suicidal risk in PWE. In addition, improving employment status of PWE may attenuate the indirect effect of perceived stigma on suicidal risk through depression severity.In a 1-day old filly with a loud heart murmur, transthoracic echocardiography revealed right ventricular hypertrophy associated with severe pulmonary valvular stenosis and a transvalvular pressure gradient (between right ventricle and pulmonary artery) of 125 mmHg. Computed tomographic angiography confirmed the finding, with no evidence of other relevant concurrent abnormalities. Balloon valvuloplasty was performed using a single balloon technique. The foal recovered well from anaesthesia. Following the procedure, the right ventricle-pulmonary artery transvalvular gradient decreased to 38 mmHg. At follow up examinations after 1 month, 1 year and 2 years, the filly showed normal exercise capacity and echocardiography confirmed the persistent substantial improvement in the transvalvular outflow gradient.
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