Evaluate the different kinds of DPR described in the literature and propose an abduction-based model of the Servant DPR, in which patients are protagonists in their treatment.

Pubmed literature review of the last forty years with the keyword ‘physician-patient relations’.

While nursing care advanced in its professional efficacy through Watson's human care and through the leader servant model, the DPR models demonstrated that the doctors are lost in their posture, even feeling as abused heroes. Models that include the patient in decision-making and that value the patient as a person (PCC) promise a revolution in the medical realm. Nevertheless, the PCC model is not enough to heal the DPR itself, because the role of the doctor must be changed to adapt to the relationship, otherwise, the PCC by itself can increase the burden upon the doctor. Doctors with a role of remunerated servant (not slave), like any other professional who delivers a service with excellence, focusing in the main actor, the patient, can heal the DPR.

The Servant DPR gives a positive counter transference, increasing the doctor's motivation and giving him back the sense of purpose in medicine, increasing the health system's effectiveness.

The authors have not supplied their declaration of competing interest.

The last two decades increase in early detection and diagnosing children with autism spectrum disorders (ASD) has challenged child and youth habilitation centers to offer the best and most appropriate treatment and support.

To evaluate an ongoing Comprehensive Intensive Early Intervention (CIEI) program for children with ASD based on principles of behaviour learning and developmental science, implemented in the child's natural setting.

The change in autism symptoms among children participating in CIEI (intervention group, n = 67) was compared with children who received traditional habilitation services only (comparison group, n = 27). Symptom changes were measured as evaluation-ADOS-R-scores, total-, severity-, and module-adjusted-scores (ADOS-MAS), minus the corresponding baseline-scores, divided by the time between baseline and evaluation, and estimated using ANOVA adjusting for confounders. The ADOS-MAS were developed to allow improved communicative functions to be counted in the overall symptom improvement.

Children in both study groups improved their autism symptoms as measured with the ADOS-MAS, and the improvement was statistically significantly larger among children without any developmental delay (P < .001). When adjustments were made for developmental delay, there was a statistically significant larger improvement of ADOS-MAS among children in the intervention group than in the comparison group (P = 0.047). Similar results were found for ADOS-R-total and ADOS-severity scores (P = 0.023 and P = 0.060. respectively).

The results of the current study indicate that the CIEI program significantly improve social and communicative skills among children with autism, and that children with developmental delay could benefit to a similar degree as other children.

The authors have not supplied their declaration of competing interest.

Bulimia nervosa (BN) is characterized by dysregulated eating behaviour and present data suggest adipokines may regulate food intake. We investigated a possible association between BN and adipokine levels and hypothesized that plasma (P)-adiponectin would be elevated and P-leptin and P-leptin-adiponectin-ratio would be reduced in women with BN.

The study was designed as a cross-sectional study with a longitudinal arm for patients with BN. Plasma-adiponectin and leptin was measured in 148 female patients seeking psychiatric ambulatory care and 45 female controls. Fifteen patients were diagnosed with BN and the remaining with other affective and anxiety disorders. P-adiponectin and P-leptin levels were compared between patients with BN, patients without BN and controls. At follow-up 1–2 years later, adipokines were reassessed in patients with BN and the Eating Disorder Examination Questionnaire was used to assess symptom severity.

P-adiponectin was elevated in patients with BN at baseline and at follow-up when compared to patients without BN and controls (P < 0.004 and < 0.008 respectively). The difference remained significant after controlling for body mass index. P-adiponectin was correlated to symptom severity at follow-up in patients with BN without morbid obesity (ρ = 0.72, P < 0.04). P-leptin-adiponectin-ratio was significantly lower in patients with BN compared to controls (P < 0.04) and P-leptin non-significantly lower.

Findings indicate a stable elevation of P-adiponectin in women with BN. P-adiponectin at follow-up correlates to eating disorder symptom severity in patients without morbid obesity, indicating that P-adiponectin should be further investigated as a possible potential prognostic biomarker for BN.

Video games are among the most popular leisure time activities. While majority of gamers play in a healthy manner, a minority shows gaming disorder (GD) symptoms and experiences detrimenting effects in their lives. Even though gaming time is moderately associated with gaming disorder symtoms, research suggests that it is not a reliable predictor by itself.

The aim of the present study is to explore whether depression symptoms, self-esteem, attention-deficit/hyperactivity disorder (ADHD) and escapism (when gaming is motivated by the avoidance of everyday problems) moderate the association between gaming time and GD symptoms and whether this is different for boys and girls.

Data was collected from a representative sample of 5th grade students of public education institutions in Budapest. Sample selection was carried out by one-step sampling stratified for school type, district, and maintainer; the sampling unit was the class. Data from 2126 students were analyzed (49.3% male, mean age 10.7 years, SD=0.54).

Depression symptoms moderated the association between gaming time and GD symtoms in both genders. For those with higher depression symptoms the aforementioned association was stronger. Furthermore, self-esteem had a moderator effect only among girls, while escapism motivation and ADHD only among boys. In these cases, the association between gaming time and GD symptoms was stronger among those with lower self-esteem, and higher ADHD and escapism scores.

Results suggest that gaming time is more strongly connected to GD symptoms in certain conditions, but its predictive value is limited even in those cases.

Funding statement: This study was supported by the Hungarian National Research, Development and Innovation Office (KKP126835). Orsolya Király was supported by the János Bolyai Research Scholarship of the Hungarian Academy of Sciences and by the ÚNKP-21-5

Parental self-efficacy indicates how effectively parents can manage their parenting responsibility and acts as a predictor of the behavioral and emotional adjustments of children.

Current study was conducted to examine the influencing factors on parental self-efficacy of 2–6 year old children's mothers.

The present study is a descriptive-post hoc study. 350 mothers were selected from 15 kindergartens of 3 area of Tehran, by multistage sampling method. They completed Rosenberg's self-esteem scale (Rosenberg, 1986), Parental Bonding Questionnaire (Parker et al., 1983), Parenting stress Index (Abiding, 1995), Sources of Social support scale (Koeske & Koeske, 2002), Maternal efficacy Questionnaire (Teti & Gelfand, 1991) and Preschool Behavior Checklist (McGuire & Richman, 1986). Stepwise regression analysis showed that parenting stress, children behavioral problems, mother's self-esteem and parental distress subscale from parenting stress index, in four steps, could explain 32% of variance in maternal self-efficacy.

Parental stress, children's behavioral problems and mother's self esteem are important factors in maternal self-efficacy. Therefore, interventions regarding mentioned factors, can enhance maternal self-efficacy and prevent maladjustments related to mothers and children.

The potential impact of the COVID-19 pandemic on suicidal behavior has generated predictions anticipating an increase in suicidal tendencies. The aim of this research is to study its influence on the incidence of hospital-treated suicide attempts throughout the year 2020 in Oviedo, Spain.

Data were collected on all patients admitted to the emergency department of Central University Hospital of Asturias in Oviedo for attempted suicide during 2020. Incidence rates were calculated for three lockdown periods. Suicide attempt trends in 2020 were compared with a non-COVID-19 year (2009) to avoid seasonal variations bias. Chi-square and Fisher’s exact tests were performed. The influence of COVID-19 incidence in Oviedo was analyzed using Spearman’s correlation coefficient.

The cumulative incidence rate of attempted suicide per 100,000 person-years was 136.33 (pre-lockdown), 115.15 (lockdown), and 90.25 (post-lockdown) in adults (over 19 years old), and 43.63 (pre-lockdown), 32.72 (lockdown), and 72.72 (post-lockdown) in adolescents (10–19 years old). No association was found with COVID-19 incidence rates (Spearman’s rho −0.222; p = 0.113). Comparing the years 2020 and 2009, statistically significant differences were observed in adolescents (Fisher’s exact test; p = 0.024), but no differences were observed in adults (chi-square test = 3.0401; p = 0.218).

Hospital-treated suicide rates attempted during the COVID-19 outbreak in Oviedo, Spain showed a similar trend compared with a non-COVID-19 year. In contrast, the number of adolescents hospital-treated for attempted suicide increased during lockdown, suggesting more vulnerability to COVID-19 restrictions after the initial lockdown period in this age group.

Parenting behaviors and discipline play a critical role in children's socialization and self regulation skills.

To investigate whether parental practices, especially punitive discipline, are associated with adolescents’ bullying behavior at school.

This is a community based sample with 247 adolescents from five public schools, between 10 and 15 years of age. Bullying was measured by a self-administered instrument Brazilian modified version of the Olweus Bully Victim Questionnaire. The Dimensions of Discipline Inventory Parental - Child Report measured parental practices. Parental practices were analyzed using two main subtypes: power assertive/punitive (psychological aggression, corporal punishment, deprivation of privileges, and penalty tasks) and inductive (explaining, rewarding and monitoring). Associations between parental practices and bullying were controlled for potential confounders such as age, sex, and whether the parental figure was biological in a logistic regression analysis.

Power assertive/punitive practices by either mother or father were significantly associated with bullying behavior by their children. Mothers who most used power assertion and punishment as discipline were 4.36 (CI95%: 1.87–10.16; p < .001) times more likely of having a child who bullies others at school. Inductive discipline was not overall associated with bullying (p > .05). Examining each specific parental method within power assertive/punitive discipline scale, mild forms of corporal punishment, such spanking, and psychological aggression either by mother or father, had the more consistent associations.

The results underscore the potential and promising importance of advising parents about appropriate discipline strategies in order to prevent bullying perpetration at school.

Jumping to conclusions (JTC) is a reasoning bias where individuals make hasty decisions based on insufficient data. It is commonly observed among patients with delusions and is a risk factor for developing delusions. Several task paradigms have been developed to test JTC, but their convergence in measuring JTC remains unexplored.

This is a pilot test to examine the consistencies between three JTC tasks with a student sample. The relationships between JTC and cognitive abilities were also explored.

Forty-six university students completed the Beads Task, Fish Task and Box Task, as well as assessment of memory, intellectual functioning, executive function, impulsivity and need for closure.

There was a moderate correlation between the beads task and fish task on various measures of JTC (draws to decision [DTD], r=.50, p<.01; confidence, r=.47, p<.01; dichotomous JTC bias, ×2=16.14, p<.001). There was a mild correlation between DTD on the fish task and box task (r=.30, p<.05). General intelligence was associated with DTD and JTC bias (but not confidence) on the beads and fish tasks. Confidence in decision was associated with a higher level of impulsivity and a lower level of set-shifting ability.

Despite differences in materials and design of the three probability-based tasks, results of JTC measured by the beads task and box task were individually consistent with the fish task, and were not correlated between the two. The data-gathering process and the confidence in decision are associated with different cognitive abilities. Further study including a clinical sample is needed.

Women during the postpartum period experience many physiological, psychological, and social changes. Quality of life (QOL) is a sense of well-being and arises from satisfaction or dissatisfaction with various aspects of life including health, employment, socioeconomic state, psychological-emotional state, and family.

The purpose of this study was to identify influence of childbirth experience and postpartum depression on QOL.

This is a descriptive cross-sectional study regarding 150 postpartum women receiving cares in the hospital of Sfax and examined during the first and the sixth week post-delivery. Data collection tools in this study were demographic questionnaire, Edinburgh Postnatal Depression Scale (EPDS), and world health organization quality of life-bref (WHOQOL-bref). Data were analyzed using SPSS.

The mean age of our sample (n = 150) was 29.61 years. During the sixth week study period, 126 of 150 were examined.

A personal psychiatric history of depression was found in 9.3% of cases.

The current pregnancy was undesired in 15.3% of cases.

The prevalence of postpartum depression in the first week was 14.7% and 19.8% in the sixth week after delivery.

The mean score of quality of life was 81.62 ± 9.09.

Scores of quality of life and all its dimensions were significantly lower in depressive women.

Because enormous changes develop in postpartum women, we suggest supportive measures for mother by her mother-in-law family, and caregivers to improve the QOL and health status of the mother and her child and to prevent postpartum depression.

The authors have not supplied their declaration of competing interest.

Bipolar disorder impacts negatively on the patient, the family as well as the society. It taxes the health care services due to a combination of the illness and associated medical as well as psychiatric comorbidities. Unfortunately, in Africa knowledge of the epidemiology and burden of bipolar disorders is based mainly on data from the United States and Europe.

To highlight the epidemiological, clinical, and economic burden of bipolar disorder in Africa.

A systematic review of publications from Africa relating to the burden of bipolar disorder was conducted, including studies on epidemiology, patient-related issues and costs.

Data from community surveys conducted in Nigeria and Ethiopia indicated a lifetime prevalence of 0.1% to 0.6% for bipolar disorder. A study from Egypt showed a misdiagnosis rate of up to 36.2%. In one study, 8.1% of the males and 5.4% of the females reported a previous suicide attempt, while another study showed that up to 60% of patients with bipolar disorder had at least one comorbidity. There were no reports on mortality and cost of illness.

Despite the heterogeneous methodologies, samples and dearth of adequate representative evidence from Africa, we have identified bipolar disorder as a major mental health issue. There still exists a dearth of evidence regarding the epidemiological, clinical, social, and economic burden of the disorder in Africa.