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Emotional experience and change in psychodynamic inpatient psychotherapyObjectives: The subject of the present study is the recording of emotional experience and its change through inpatient psychodynamic psychotherapy, taking into account the factors of age, gender, and traumatic experiences in childhood and adolescence. Methods: The following standardized instruments were used on the clinical sample of 971 patients (413 inpatient, 558 day clinic patients) at the beginning and at the end of the treatment: Questionnaire for the Assessment of Emotional Experience and Emotion Regulation (EER), Childhood-Trauma-Questionnaire (CTQ), Inventory of Interpersonal Problems (IIP), Helping Alliance Questionnaire (HAQ), Symptom-Check-List (SCL-90-R). Results: The mean duration of treatment was 66.8 days (SD = 14.1; range 30-96). Younger patients and polytraumatized patients showed a higher expression of negative emotions. At the end of treatment, the whole group of patients showed a change in emotional experience, especially a strong decrease in passive-negative emotions and a decrease in psychological distress. Age represented a significant factor influencing emotional change. Discussion: The results underline the importance of emotional change as a prerequisite for treatment success and confirm the effectiveness of inpatient psychodynamic treatment. A further differentiation of the patients with regard to their emotional responsiveness seems to make sense with regard to the suitability of the therapeutic offers.

Anomalous self-experiences (ASE) are suggested as a phenotypic core feature of schizophrenia spectrum disorders and present in at risk samples as well. In our study, we investigated the relation between ASE and clinical high risk state for psychosis (CHRP) against the background of further influencing factors like childhood trauma and general psychopathology.126 help-seeking adolescents were included. CHR-P patients were identified using the Structured Interview for Psychosis-Risk Syndromes (SIPS). ASE were assessed with the Inventory of Psychotic-like Anomalous Self-Experiences (IPASE). Childhood trauma, depression and anxiety were assessed with well-established questionnaires (CTQ; PHQ-9; GAD-7).CHR-P subgroup (n = 50, 39.7%) show significantly higher scores in IPASE total (t (81.07) = -5.150, p = .000) and CTQ total (t (85.95) = -2.75, p = .007) in comparison with the non CHR-P subgroup. Logistic regression analysis confirmed that IPASE total could predict CHR-P status (OR 1.03, 95% CI 1.01-1.04, p = .000). Furthermore, CTQ total and IPASE total show moderate to strong positive correlation (r = 0.44, p .001) as well as CTQ total with both IPASE subdomains Cognition (r = 0.404, p .001) and Self- Awareness (r = 0.443, p .001).The CHR-P subgroup shows significantly more ASE than the non CHR-P subgroup. Further, ASE predicted CHR-P status. Our results indicated that ASE could play a considerable role in the identification of high risk for developing schizophrenia spectrum disorder and could complement CHR-P testing. Importantly, it seems that ASE may be related to exposure to childhood trauma.

Objective Young adults putting off marriage and having less children have become recent trends in many modern societies. Yet less is known about the psychological factors underlying the drastically low marriage and fertility rates. We hypothesized that childhood maltreatment experience may have a negative association with one’s marriage and childbearing intention.Methods A total of 1,004 college students (mean age of 20.8±2.3 years, 56.1% female) completed self-questionnaires including sociodemographic information, marriage and childbearing intention, Patient Health Questionnaire 9 (PHQ-9), and Childhood Trauma Questionnaire (CTQ). Multivariable logistic regression analyses were conducted to evaluate the effect of childhood trauma on marriage and childbearing intentions after controlling for sociodemographic variables and depression.Results 29.7% had no intention to get married and 40.4% had no intention to have children in the future. The prevalence of physical, sexual, and emotional abuse was 33.1%, 18.5%, and 22.3%, respectively. Multivariable logistic regression analyses revealed that female (p

OBJECTIVE The pathways underlying the early life adversity and cardiovascular reactivity association remain unclear. The current study examined the role of current depressive symptoms on this relationship. METHODS Mediation analyses were conducted using data from 639 participants drawn from the Midlife Development in the United States (MIDUS II) Biomarker Project. Responses were derived from the Childhood Trauma Questionnaire [CTQ] and Center for Epidemiologic Studies Depression Scale [CES-D]). Participants had their systolic and diastolic blood pressure (SBP, DBP) and heart rate (HR) monitored throughout a standardized stress testing protocol. RESULTS The association between early life adversity and reactivity was mediated by current depressive symptoms; all adversity factors were linked to higher levels of current depressive symptoms, which in turn, were associated with lower cardiovascular reactivity. For emotional abuse, this was noted for SBP (β = -.06, 95% CI [-.13,-.01]; and DBP: β = - .04, [-.07,-.01]), physical abuse (SBP: β = -.05, [-.11,-.01]; DBP: β = -.03, [-.06,-.01]), sexual abuse (SBP: β = -.04, [-.09,-.01]; DBP: β = -.02, [-.05,-.01]), emotional neglect (SBP: β = -.04, [-.09,-.01]; DBP: β = -.02, [-.05,-.01]), physical neglect (SBP: β = -.09, [-.17,-.02]; DBP: β = -.05, [-.09,-.02]) and total CTQ (SBP: β = -.02, [-.03,-.00]; DBP: β = -.01, [-.02,-.00]). CONCLUSIONS The present findings extend research and demonstrate that depression is an underlying mechanism linking early life adversity and blunted cardiovascular reactivity.

Empirical studies have identified deficits in cognitive and affective theory of mind (ToM) in patients with borderline personality disorder (BPD), but results remain heterogeneous and not much is known about the role of childhood trauma. The current study assessed cognitive and affective ToM in 80 patients with BPD and 41 healthy controls in a false-belief cartoon task. Childhood trauma was measured with the Childhood Trauma Questionnaire (CTQ). Patients with BPD responded slower in all experimental conditions in false-belief situations, but not when false beliefs were resolved; made more errors in the cognitive ToM condition; and reported worse affective states more often in and after false-belief situations. No significant correlations between ToM and childhood trauma could be found. The current study revealed deficits in cognitive and affective ToM in patients with BPD that may be related to a more negative affective state raised by the false-belief stories.

The aim of this study was to investigate the relationships among childhood trauma, dissociative experiences, and internet gaming disorder (IGD) in young adults diagnosed with attention deficit hyperactivity disorder (ADHD) and age- and gender-matched controls. Forty participants diagnosed with ADHD at a university hospital psychiatric outpatient clinic and 40 healthy controls completed a test battery that included a sociodemographic form as well as the Adult ADHD Severity Rating Scale (ASRS), Childhood Trauma Questionnaire (CTQ), Dissociative Experiences Scale (DES), Somatoform Dissociation Questionnaire (SDQ), and Internet Gaming Disorder Scale - Short Form (IGDS9-SF). The CTQ (t = -4.61, p

Every manufacturing company will strive to create the best quality products. This is also done by PT. CMSM, a steel company, is producing corrugated zinc products. In several production periods, the defective product values were still found that exceeded the tolerance limit value set at 0.5% in corrugated zinc products. These problems are, of course, very detrimental to the company, so it’s essential to control the quality of corrugated zinc products. This study aimed to determine the factors that cause product defects, propose plans to improve product quality, and provide managerial recommendations based on Six Sigma analysis. Data collection techniques are carried out through observation, interviews, and documentation. Based on the study results, it is known that DPO is 0.000885 and DPMO is 884.6028. At this time, the company is at the level of 4.64 sigma with CTQ (Critical to Quality) folded zinc sheet, cut size is not according to standard, thickness is not according to standard, uneven coating layer and perforated zinc sheet. Based on the analysis, five factors cause product defects: humans, machines, methods, materials, and the environment. To improve quality, the company should improve their quality control through 5W + 1H analysis, namely by providing training to employees, periodic machine maintenance and ensuring that the SOPs that have been made are implemented correctly and adequately. Keywords: six sigma, DMAIC, product defect, quality control, manufacturing

BACKGROUND Adolescents are a high-risk group for non-suicidal self-injury (NSSI), which seriously affects their physical and mental health. This study aimed to explore the risk factors for depressive adolescents with NSSI. METHODS A total of 153 adolescents with depression were divided into the NSSI group (n=65) and non-NSSI group (n=88) according to the criteria stipulated by Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). The Beck scale for suicidal ideation (BSS), adolescent self-rating life events checklist (ASLEC), family adaptability and cohesion evaluation scale II-Chinese version (FACES II-CV), childhood trauma questionnaire short form (CTQ SF), and multidimensional scale of perceived social support (MSPSS) were applied to evaluate suicidal ideation, frequency and intensity of stressful life events, family functions, childhood trauma, and perceived support, respectively. We applied two-dimensional logistic regression to identify risk factors for NSSI. RESULTS Female gender ratio, suicidal ideation, and attempted suicide were significantly higher in the NSSI group than in the non-NSSI group (all P

HIV-associated neurocognitive disorders (HAND) present a challenge in South Africa where the burden of HIV infection is highest. Identification of biological correlates of HAND is required to improve diagnosis and inform interventions. Telomeres maintain genomic integrity and their shortening is a marker of biological aging sensitive to environmental influences. This study examined relative telomere length (rTL) as a predictor of cognitive function in the context of HIV and childhood trauma (CT), a risk factor for HAND. Two hundred and eighty-six women completed a neurocognitive assessment battery and the Childhood Trauma Questionnaire – Short Form (CTQ). Quantitative polymerase chain reaction for amplification of telomeric repeats and the reference gene human beta-globin was used to calculate rTL. Neurocognitive and rTL assessments were repeated at one year in 110 participants. Cross-sectional and longitudinal data were assessed using linear and mixed models, respectively. Participants with HIV (n = 135 in cross-sectional and n = 62 in longitudinal study groups) reported more severe CT and had shorter baseline rTL compared to seronegative controls. Participants without HIV had a greater one-year decline in rTL. Global cognitive and attention/working memory scores declined in participants with HIV. Our data indicate that baseline rTL in the context of CT and HIV did not predict decline in cognitive scores. HIV-associated pathophysiological processes driving cognitive decline may also engage mechanisms that protect against telomere shortening. The results highlight the importance of examining biological correlates in longitudinal studies.

XYZ is a company engaged in fabrication. Quality is very important for the company because it can affect customer satisfaction. In the production process there are still defect problems found on the top side of the structural construction and it affects the quality of the part. The failure rate on the topside product has a 5:28% percentage exceeds the standards set by the company which is 2%. Based on the percentage of defects that have been obtained, the problem can be solved by fishbone analysis and FMEA. In the first stage using CTQ which aims to identify failures that occur and determine quality characteristics. The next step after identifying the failure that occurred can be calculated DPMO and Sigma Level. After getting the DPMO value and the Sigma level, identification of the root causes of the failure occurred. The causes of problems that have been analyzed using fishbone analysis can be solved using FMEA. Keywords : DPMO, Tingkat Sigma, Fishbone analysis, FMEA

Childhood trauma is one of the most prominent risk factors in developing major depressive disorder (MDD) and may lead to unfavorable outcomes of pharmacotherapy and psychotherapy in MDD. While how it modulates the treatment outcome of the repetitive transcranial magnetic stimulation (rTMS) and how sex difference may play a role in mediating this relationship remain unknown. To evaluate this question, 51 (37 women) MDD patients were treated with 10 Hz rTMS to the left dorsolateral prefrontal cortex (lDLPFC). The experience of childhood trauma was quantified by the Childhood Traumatic Questionnaire (CTQ). The depressive severity was assessed by Hamilton Depression Scale (HAMD) and Beck Depression Inventory (BDI) as the primary and secondary assessments. Beck Hopelessness Scale (BHS) and Hamilton Anxiety Scale (HAMA) were also assessed for further confirmation. Thirty-six (70.6%) participants showed a response including 17 (33.3%) achieving remission to the rTMS treatment. The alleviation of depressive symptoms was negatively correlated with the CTQ scores, specifically in women but not men, in subjective BDI and BHS, but not objective HAMD or HAMA. We demonstrate that childhood trauma negatively affects the subjective perception of rTMS-lDLPFC treatment outcomes in female MDD patients. This highlights the importance of measuring childhood trauma-related symptoms in routine clinical rTMS treatment, as they may impact perceived efficacy.

Background Childhood adversity is a global health problem affecting 25–50% of children worldwide. Few prior studies have examined the underlying neurochemistry of adversity in adolescents. This cross-sectional study examined spectroscopic markers of trauma in a cohort of adolescents with major depressive disorder (MDD) and healthy controls. We hypothesized that historical adversity would have a negative relationship with spectroscopic measures of glutamate metabolites in anterior cingulate cortex. Methods Adolescent participants (aged 13–21) underwent a semi-structured diagnostic interview and clinical assessment, which included the self-report Childhood Trauma Questionnaire (CTQ), a 28-item assessment of childhood adversity. Proton magnetic resonance spectroscopy (1H-MRS) scans at 3 Tesla of an anterior cingulate cortex (ACC) voxel (8 cm3) encompassing both hemispheres were collected using a 2-dimensional J-averaged sequence to assess N-acetylaspartate (NAA), Glx (glutamate+glutamine) and [NAA]/[Glx] concentrations. Generalized linear models assessed the relationships between CTQ scores and metabolite levels in ACC. Results Thirty-nine participants (17 healthy controls, 22 depressed participants) underwent 1H-MRS and completed the CTQ measures. There were decrements in [NAA]/[Glx] ratio in the ACC of participants with childhood adversity while no significant relationship between CTQ total score and any of the ACC metabolites was found in the combined sample. Exploratory results revealed a positive association between Glx levels and CTQ scores in depressed participants. Conversely the [NAA]/[Glx] ratio had a negative association with total CTQ scores in the depressed participants. Emotional Abuse Scale showed a significant negative relationship with [NAA]/[Glx] ratio in the combined sample when adjusted for depression severity. Conclusions Our findings suggest that childhood adversity may impact brain neurochemical profiles. Further longitudinal studies should examine neurochemical correlates of childhood adversity throughout development and in populations with other psychiatric disorders.

Posttraumatic stress symptoms (PTSS) are associated with both childhood physical abuse (CPA) and antisocial (AS) traits, yet their potential as mediators of the CPA-AS traits link is understudied and the specific roles of individual symptom clusters in this relation is unknown. The current study aimed to examine the mediational role of PTSS in the relation between CPA and AS traits in a sample of low-income African American women with histories of intimate partner violence (IPV). It was hypothesized that avoidance would emerge as a significant mediator, whereas reexperiencing, numbing, and hyperarousal would not. Participants (N = 150) were recruited from a level-1 trauma public hospital and evaluated as part of a randomized controlled trial of a group therapy intervention for low-income, African American women suicide attempters with histories of IPV. The Childhood Trauma Questionnaire (CTQ), Posttraumatic Diagnostic Scale (PDS), and International Personality Disorder Examination-Screening Questionnaire (IPDE-SQ) were used to measure variables of interest. Using bootstrapping analyses, a parallel mediation model compared PTSS clusters as potential mediators of the CPA-AS traits relation, controlling for IPV. When reexperiencing, avoidance, numbing, and hyperarousal were entered simultaneously as potential mediators, only avoidance emerged as a significant mediator of the CPA-AS traits link. Avoidance symptoms may play a unique role in the link between early experiences of CPA and later AS traits among multiply traumatized African American women. Findings have implications for understanding AS traits in the context of early life trauma and suggest that targeting specific PTSS clusters (e.g., avoidance) may improve treatment outcomes for women in this population.

A growing body of literature has suggested that the perimenopause and the early postmenopausal years are associated with an increased risk of experiencing symptoms of depression and the development of first-onset and recurrent episodes of major depressive disorder. Multiple risk factors have been identified, including stressful life events and lower socioeconomic status, as well as early life adversity. The objective of the current study was to characterize the influence of early life childhood maltreatment and incident depression among women experiencing bothersome menopausal symptoms. Participants were recruited from two university-affiliated specialty clinics caring for women with bothersome menopausal symptoms. Assessments included the Childhood Trauma Questionnaire (CTQ), the Center for Epidemiological Studies - Depression (CES-D) scale and the Greene Climacteric Scale. Findings from this cross-sectional study indicate that adverse childhood experiences, as measured using the CTQ, were highly prevalent among women seeking care for bothersome menopausal symptoms (66%). Further, a greater score on the CTQ was significantly associated with higher CES-D scores, as well as with a greater burden of menopausal symptoms, after adjusting for confounding. Our findings lend support to the growing body of literature suggesting that early life stress affects mental health well into adulthood.

Introduction and Objectives Since different PET/CT (Positron Emission Tomography/Computed Tomography) scanners give different qualitative readings, a program for clinical trial qualification (CTQ) is mandatory to guarantee a reliable and reproducible use of PET/CT in prospective multi-centre clinical trials. Within this work we will show the results carried out in performing CTQ in Spain. Materials and Methods We set up, under the auspices of Grupo Espanol de Linfomas/Trasplante Autologo de Medula Osea (GELTAMO), a CTQ program consisting of the acquisition and analysis of 18 F uniformity and image quality phantoms for the reduction of inter-scanner variability (ISV). The ISV was estimated on background activity concentration (BAC) and sphere to background ratio (SBR) and defined as their 95% confidence level. Results Twenty-six out of 27 (96%) scanners fulfilled the CTQ requirements. The CTQ was fulfilled at the first round in 27% of the cases, while in 38%, 15% and 20%, two, three or more than three iterations, were required, respectively. The mean CTQ time was (1.8 ± 1.4) months (range: 0.3–4.6). The ISV in BAC and SBR were 20.3% and 67.7%. Conclusions The CTQ proven to be a reliable tool to reduce ISV. This enabled to set-up clinical trials in which PET/CT was used to evaluate different clinical endpoints.

espanolIntroduccion y objetivos Dado que los diferentes escaneres de PET/TC (tomografia por emision de positrones/tomografia computarizada) dan lecturas cualitativas diferentes, es obligatorio un programa de cualificacion de ensayos clinicos (CTQ) para garantizar un uso fiable y reproducible de la PET/TC en ensayos clinicos prospectivos multicentricos. Dentro de este trabajo mostraremos los resultados en la realizacion de CTQ en Espana. Materiales y metodos Hemos puesto en marcha, bajo los auspicios del Grupo Espanol de Linfomas/Trasplante Autologo de Medula Osea (GELTAMO), un programa de CTQ que consiste en la adquisicion y analisis de fantomas de uniformidad 18F y calidad de imagen para la reduccion de la variabilidad interescaner (ISV). La ISV se estimo sobre la concentracion de actividad de fondo (BAC) y la relacion esfera a fondo (SBR) y se definio como su intervalo de confianza (IC) del 95%. Resultados Veintiseis de los 27 escaneres (96%) cumplieron los requisitos de la CTQ. El CTQ se cumplio en la primera ronda en el 27% de los casos, mientras que en el 38%, 15% y 20% se requirieron dos, tres o mas de tres iteraciones, respectivamente. El tiempo medio de la CTQ fue de 1,8 ± 1,4 meses (rango: 0,3-4,6). El ISV en BAC y SBR fue 20,3 y 67,7%. Conclusiones El CTQ demostro ser una herramienta fiable para reducir la ISV. Esto permitio poner en marcha ensayos clinicos en los que se utilizo la PET/TC para evaluar diferentes criterios de valoracion clinica. EnglishIntroduction and objectives Since different PET/CT (Positron Emission Tomography/Computed Tomography) scanners give different qualitative readings, a program for clinical trial qualification (CTQ) is mandatory to guarantee a reliable and reproducible use of PET/CT in prospective multi-centre clinical trials. Within this work we will show the results carried out in performing CTQ in Spain. Materials and methods We set up, under the auspices of Grupo Espanol de Linfomas/Trasplante Autologo de Medula Osea (GELTAMO), a CTQ program consisting of the acquisition and analysis of 18F uniformity and image quality phantoms for the reduction of inter-scanner variability (ISV). The ISV was estimated on background activity concentration (BAC) and sphere to background ratio (SBR) and defined as their 95% confidence level. Results Twenty-six out of 27 (96%) scanners fulfilled the CTQ requirements. The CTQ was fulfilled at the first round in 27% of the cases, while in 38%, 15% and 20%, two, three or more than three iterations, were required, respectively. The mean CTQ time was (1.8 ± 1.4) months (range: 0.3-4.6). The ISV in BAC and SBR were 20.3% and 67.7%. Conclusions The CTQ proven to be a reliable tool to reduce ISV. This enabled to set-up clinical trials in which PET/CT was used to evaluate different clinical endpoints.

Objectives: This study is to find the correlation among BDNF metabolism, early trauma, and current stress status of OCD patients. As well as to study the BDNF metabolism-stress related pathological mechanism in OCD development. Methods: A total of 140 participants were recruited in this study, including 64 drug-naive OCD patients (OCDs) and 76 healthy controls (HCs). The clinical data of the subjects were measured using YBOCS, CTQ, and PSS. The plasma mBDNF and proBDNF values were measured by ELISA while the M/P ratio was calculated. Results: The mBDNF, proBDNF plasma levels, and M/P ratio of unmedicated OCD individuals decreased evidently comparing with HCs. Also, positive associations were found between PSS and CTQ and between CTQ and M/P ratio. The negative correlation included proBDNF and PSS as well as proBDNF and CTQ. Intermediary analysis generated by SPSS has showed that the perceived stress played a complete mediating role between early trauma and plasma M/P ratio levels, and the mediating effect was 0.043 in non-medication OCD patients. Conclusions: Findings from this study suggested that early trauma experience and stress state work together in regulating BDNF metabolism level in OCD patients. The nucleus accumbens and reward loop are also pivotal in the pathogenesis of OCD.

TPKU PP.Tebuireng's business is engaged in school uniforms. The results of previous research, it was found that there were seven Critical to Quality (CTQ). The seven CTQs are button attachment, accessories installation, untidy stitching, loose overlock, uniform stain, slanted pocket, and sloping belt. Based on these findings, the objective of the activity is transforming knowledge to develop the quality of school uniform using the six sigma method. The six sigma method is improving quality, aiming 3-4 defects per million products or services. The results of the service activities have been delivery of material and the application of the six sigma method. The six sigma method stages include define, measure, analyze, improve, control. The results of the define application by check sheet, identified seven CTQs. The application of measure is 2.95 sigma level, is equivalent to 74,830 defective in a million productions. The analyze application with pareto and causal diagram shows two types of CTQ. That have dominant causes of defects, namely untidy seams and uniform stains. The implementation of improve is based on the analyze stage results. Implementation of control by means of documentation, disseminate all relevant sections. As a step to improve the performance of the next process.

Childhood trauma as well as severe events occurring later in life have been associated with the development of major depressive disorder (MDD). However, the interaction of early and later occurring adverse events in patients with MDD is understudied. This study aims to disentangle this interaction by investigating the effects on two of the main stress-response systems of the body, the hypothalamic–pituitaryadrenal (HPA-) axis and the immune system in depressed patients. The function of the HPA-axis was assessed by measuring FKBP5, SGK1 and NR3C1 mRNA-expression in peripheral blood after an in vivo glucocorticoid receptor (GR) challenge with 1.5 mg dexamethasone in 150 depressed in-patients (47.4% females). Childhood trauma was evaluated using the Childhood Trauma Questionnaire (CTQ), severe life events occurring one year prior to hospital admission were assessed with the List of Threatening Experiences (LTE). Multiple childhood traumata, i.e. ≥ 3, were present in 68 (45.5%) patients, 59 (39.3%) experienced ≥ 3 severe recent life events. The history of ≥ 3 severe recent life events was associated with an impaired GR-induction of SGK1 (F = 10.455; df = 1; p = 0.002) and FKBP5 mRNA expression (F = 8.720; df = 1; p = 0.004), and with elevated measures of the immune system such as CRP and lymphocyte count. In addition, severe recent life events were associated with a substantially impaired treatment response to antidepressants (F = 7.456; df = 1; p = 0.008). These effects could not be observed in relation to childhood trauma. Severe life events occurring prior to MDD development substantially impaired the stress-response systems and the response to treatment with antidepressants. This finding may indicate the need to employ additional treatment options such as psychotherapy right at the beginning of treatment or immune-modulating approaches.

Six Sigma has become a leading business improvement methodology which has been successfully applied in a wide range of businesses. In so doing, companies focus on systematically creating value and reducing and removing waste (the lean element of the approach) whilst employing Six Sigma to focus on and to eradicate the Critical to Quality (CTQ) issues that affect an organization. The research strategy of this paper is survey method and primary data was gathered from supply chain and quality enhancement departments of selected Six Sigma companies n Karachi, Pakistan through structured questionnaires. This paper indicates that the performance of the company becomes highly reliable, reduced cost, eliminate wastages, and improve quality by the adaption of Six-Sigma practices. The study also reported that the continuous improvement is also playing a mediating role when we consider Company’s performance as dependent variable and cost reduction, Quality betterment and eliminate wastages as independent variables.

Religiosity and spirituality (R/S) are increasingly recognized as significant aspects in the evaluation of depressed patients. Limited research, however, has investigated the impact of R/S on outcomes of more severe or chronic depressed patients. The present study investigated the impact of different religiosity dimensions in tertiary care Brazilian depressed patients over suicide risk scores measured at baseline and remission of depressive symptoms in a 6-month prospective follow-up. In 277 individuals interviewed, 226 presented a diagnosis of depressive episode and 192 were assessed in the follow-up. Religiosity was evaluated using the Duke University Religion Index, comprising three dimensions of religiosity (organizational religiosity, non-organizational religiosity, intrinsic religiosity). Other potential predictors of outcomes included the Childhood Trauma Questionnaire (CTQ), Maudsley Staging of illness (MSM), Medical Outcomes Study Social Support Survey (MOS), World Health Organization Spirituality, Religiousness and Personal Beliefs instrument (WHOQOL-SRPB) and Hamilton Depression Scale (HAM-D). Results showed that almost half (46.1%) of the patients reported previous suicide attempts. Linear regression models identified that religious attendance (t-statistic -2.17, P=0.03), intrinsic religiosity (t-statistic -2.42, P=0.01) and WHOQOL-SRPB (t-statistic -3.67, P=0.00) were inversely correlated to suicide risk scores. In a prospective follow-up 16.7 % of patients (n=32/192) achieved remission of depressive symptoms (HAM-D scores ≤7). Religious attendance (OR 1.83, P=0.02) was identified as the main predictor of remission. Findings reinforce the importance of attending to religiosity/spirituality in order to improve outcomes and promote the recovery especially among severely depressed patients with increased suicide risk.

Background Accumulating evidence has converged to suggest that childhood trauma may contribute to bipolar disorder (BD). This study aimed to investigate the patterns of childhood trauma among patients with bipolar I (BD-I) and bipolar II (BD-II) disorders, according to DSM-IV and in contrast with healthy volunteers. We also explored whether the relationship between childhood trauma and onset of bipolar disorder is mediated by immature defense mechanisms. Methods Participants were patients with BD-I (n=44) and BD-II (n = 42), and healthy controls (HCs, n = 43). Childhood traumatic experiences and defense mechanisms were assessed by the Childhood Trauma Questionnaire (CTQ) and the Defense Style Questionnaire (DSQ), respectively. Results BD patients experienced more severe childhood trauma than HCs. Physical neglect sub-score and total score of the CTQ had both direct and indirect effects on the diagnosis of BD-I, and an immature defense style mediated the indirect effects. The diagnosis of BD-II was mainly related to the physical neglect and emotional abuse subs-core and total score of the CTQ, as mediated by the immature defense mechanisms. BD-I and BD-II significantly differed in the emotional abuse sub-score of the CTQ. Conclusions Physical neglect sub-score and total score of the CTQ were associated with the diagnosis of BD (both BD-I and BD-II), as mediated by an immature defense style. Furthermore, emotional abuse might be an important risk factor for BD-II compared to BD-I. These findings may inform risk reduction and psychosocial intervention strategies to prevent and treat patients with bipolar disorders.

During the past decade, research on the link between childhood emotional maltreatment and adulthood romantic relationship well-being has been accumulating, but there still lacks a systematic, quantitative evaluation of existing research. This three-level, meta-analysis aimed to fill this gap. Reports were included if they examined the link between early emotional maltreatment and adulthood romantic relationship well-being, presented statistics needed to calculate at least one bivariate effect size, written in English, and published/written before January 1, 2020. We retrieved 201 effect sizes from 23 reports. Early emotional maltreatment (aggregated across forms) was negatively (yet modestly) associated with later romantic relationship well-being (aggregated across dimensions; r = −.143, 95% confidence interval [−.173, −.114], p < .001). This association did not vary as a function of maltreatment form but differed across relationship well-being dimensions, such that the effect was stronger for the negative than for the positive relationship outcomes. We also found that (a) the actor effect was larger than the partner effect, (b) the effect was stronger in studies using Childhood Trauma Questionnaire (CTQ) than in studies not using CTQ, (c) whether using established measures of relationship well-being did not alter the effect, (d) the absolute magnitude of effect was negatively associated with methodological rigor of effect, and (e) the effect did not vary as functions of publication type, whether the sample was a college student sample, or union status, and was not related to the mean of union duration. Last, the limitations of existing research, avenues for future inquiries, and implications for practice were noted.

Objective : The purpose of this study was to analyze the symptoms of depression, anxiety, and childhood trauma in functional gastrointestinal disorder (FGID) patients who visited the brain-gut axis clinic. Methods The study participants included 99 individuals who were diagnosed with FGID by gastroenterologists, 88 individuals who had no FGID but showed symptoms of FGID based on the Rome criteria, and 79 individuals who did not show any symptoms or were diagnosed with FGID. Symptoms of depression, anxiety, and childhood trauma were evaluated by the Korean version of Beck-depression inventory-II (K-BDI-II), Korean version of Beck anxiety inventory (K-BAI), and Korean version of childhood trauma questionnaire (K-CTQ), respectively. Results The BDI score, BAI score, and CTQ score were significantly different between the groups. The group also had higher odds for developing anxiety as compared to the control group (odds ratio [OR] = 10.215, 95% confidence intervals [CI]: 2.49-41.76). Additionally, the FGID group had higher odds for developing symptoms of depression (OR = 5.554, 95% CI: 2.06-14.97) and experiencing physical violence (OR = 3.128, 95% CI: 1.53-6.38) than the non-FGID group. Conclusion This study showed that FGID patients were more likely to have symptoms of depression, severe anxiety, and childhood trauma, which were the risk factors of FGID.

Background Childhood trauma is associated with major depressive disorder (MDD) and bipolar disorder (BD) in adults. However, no meta-analysis was performed on the prevalence of different types of childhood trauma in adults with affective disorders, using the Childhood Trauma Questionnaire (CTQ). Methods Four databases were used to search articles regarding the prevalence of childhood emotional abuse (CEA), childhood physical abuse (CPA), childhood sexual abuse (CSA), childhood physical neglect (CPN), and childhood emotional neglect (CEN) in patients with MDD and BD using the CTQ. Results A total of 17 and 11 articles were found analyzing patients with MDD and BD, respectively. A pooled prevalence rate of 33.0% and 30.0% for CEA, 17.0% and 18.0% for CPA, 19.0% and 22.0% for CSA, 37.0% and 31.0% for CEN, and 31% and 30.0% for CPN was found in patients with MDD and BD respectively. A difference in 95% confidence interval in the CSA rate between men and women was found in patients with MDD in the gender subgroup and in the rate of some types of childhood trauma in the continent subgroup in both patient types. Limitations A limited number of articles were included in some continents, thus, the heterogeneity in the meta-analysis was generally high. Conclusion The prevalence of CEA, CEN, and CPN in patients with affective disorders was relatively high, whereas that of CPA and CSA was relatively low. These childhood traumas might be affected by continent and gender.

This article presents a new integrated multiresolution framework for quality prediction and process monitoring in complex batch operations: MR-QP&PM. For quality prediction, the proposed framework uses a multiresolution soft sensor that identifies the Critical to Quality (CTQ) variables and optimizes their resolution. This later tuning dimension has been overlooked in previous works and has a significant impact on the predictive accuracy of soft sensors, especially for batch processes. To complement the soft sensor and effectively assess the validity of its predictions and whether the process is operating under normal operating conditions (NOC), a monitoring scheme with multiresolution adaptability is applied. In case a fault is detected, MR-QP&PM is capable to discern whether the fault is CTQ and possibly estimate its impact. MR-QP&PM was tested and compared with current benchmark methods using several batch testing systems, including the well-known PENSIM simulator, where its superior predictive performance and detection ability was demonstrated. A critical analysis of when the quality predictions of MR-QP&PM can and cannot be trusted is also made, in order to set the boundaries where the proposed methodology can be safely applied.

BackgroundChildhood adversity is reliably associated with immune alterations in adulthood, including increases in inflammatory processes. However, relatively few studies have investigated these associations in clinical populations such as cancer patients who are at risk for negative immune-related health outcomes. The current study tested the hypothesis that childhood maltreatment would be associated with alterations in immune-related gene expression in monocytes from women with breast cancer.MethodsWomen (n=86) were recruited after diagnosis with early-stage breast cancer but before onset of adjuvant therapy with radiation, chemotherapy, and/or endocrine therapy. Participants completed questionnaires to assess childhood maltreatment (Childhood Trauma Questionnaire; CTQ) and depressive symptoms (Center for Epidemiologic Studies Depression Scale; CES-D) and provided blood samples for immune assessment. CD14+monocytes were isolated for RNA extraction and gene expression analyses.ResultsBased on responses to the CTQ, 28% of participants were classified as experiencing physical and/or emotional abuse or neglect and 7% as experiencing sexual abuse. Genome-wide transcriptional profiling of isolated monocytes identified 202 gene transcripts that differed in average expression level by>25% over the range of maltreatment exposure. Bioinformatics analyses of those gene transcripts identified a significantly greater prevalence of NF-κB-binding motifs within the promoters of up-regulated vs. down-regulated genes (p=.028) in women exposed to childhood maltreatment, indicating greater inflammatory signaling. Parallel analyses of Type I interferon signaling also indicated greater prevalence of Interferon Response Factor (IRF)-related binding sites in women with a childhood maltreatment history (p=.020). Results remained significant in analyses controlling for current depression; however, NF-κB and IRF-related gene expression was higher in women with both maltreatment exposure and current depression.ConclusionsIn women recently diagnosed with early-stage breast cancer, childhood maltreatment was associated with increases in the classical NF-kB-related pro-inflammatory signaling pathway and with increases in the Type I interferon system. These results suggest a broad pattern of chronic immunologic activation in breast cancer patients with a history of childhood maltreatment, particularly those who are currently experiencing clinically significant depressive symptoms. These findings have implications for the long-term health and well-being of maltreatment exposed breast cancer patients.

The experience of childhood maltreatment has a far-reaching negative impact on physical and mental health. In particular, it can lead to two typical mental symptoms: depression and anxiety. Based on the broaden-and-build theory of positive emotion, this study proposed emotional intelligence as a mediating variable, and constructed a structure equation model in order to explore the mediating effect of emotional intelligence on the relationship between childhood maltreatment and depression/anxiety. We randomly recruited 811 Chinese college students as participants and asked them to complete the Childhood Trauma Questionnaire (CTQ), the Symptom Checklist 90 Scale (SCL-90) and the Wong and Law Emotional Intelligence Scale (WLEIS). The results showed that emotional intelligence plays a significant role in mediating the effects of childhood maltreatment on depression and anxiety, which laid a theoretical foundation for improving the mental health level of childhood maltreatment groups by improving their emotional intelligence.

Family studies can provide a wealth of information regarding risk factors in psychological disorders. No studies have compared the trauma experiences and coping strategies of problem gamblers with those of their first-degree relatives. Therefore, in this study, childhood trauma and coping strategies were investigated among participants with gambling disorder, their first-degree biological relatives, and community controls. Participants completed diagnostic interviews and symptom severity assessments. Participants also completed the Childhood Trauma Questionnaire (CTQ) which assesses history of abuse and neglect, and the Coping Inventory for Stressful Situations (CISS) which assesses task, emotion, and avoidance oriented coping strategies. Analysis of variance showed that there was a significant effect for group, but not gender, on the CTQ. Multivariate analysis of variance revealed a significant effect for group on coping style. Post-hoc tests showed that probands and relatives were less likely to use task-oriented coping compared to controls, but probands and relatives did not differ from each other on task-oriented coping. Mediation analysis showed that task-oriented coping did not mediate the relation between childhood trauma and gambling severity. By using a family study design, this study was able for the first time to delineate familial and disease-specific effects associated with childhood trauma and coping strategies in gambling disorder.

It is known that childhood maltreatment and problematic eating behaviors are higher in bariatric surgery patients compared to over- and normal-weight persons. The aim of the study is to investigate the relationship between childhood maltreatment and problematic eating behaviors such as restraint, eating concern, weight concern, shape concern, and emotional eating in bariatric surgery patients. 112 consecutive obese individuals seeking bariatric surgery at a University Hospital were administered asset of scales, including Childhood Trauma Questionnaire (CTQ), Dutch Eating Behavior Questionnaire-Emotional Eating subscale (DEBQ-E), and Eating Disorder Examination-Questionnaire (EDE-Q) and sociodemographic form, cross-sectionally. After descriptive statistics, a regression analysis was conducted to understand the relationships of CTQ scores with EDE-Q total, and subscale scores and DEBQ-E. In the Pearson correlation analysis, a statistically significant positive correlation was found between CTQ total score with EDE-Q total score and all subscales scores. In linear regression analyses, it was found that emotional abuse (β = 0.39, p = 0.02) and physical abuse (β = 0.36, p = 0.01) predicted increased DEBQ-E scores. In addition, sexual abuse was found to significantly predict weight concern (β = 0.26, p = 0.04) and shape concern (β = 0.31, p = 0.01). Our findings showed that the dynamics of problematic eating behaviors may differ depending on the type of childhood trauma. Psychiatric evaluation of bariatric surgery patients is important in understanding the relationship between childhood maltreatment and problematic eating behaviors. Level V, cross-sectional descriptive study.

BackgroundThe general understanding of the ‘vulnerability–stress model’ of mental disorders neglects the modifying impact of resilience-increasing factors such as coping ability.AimsProbing a conceptual framework integrating both adverse events and coping factors in an extended ‘vulnerability–stress–coping model’ of mental disorders, the effects of functional neuropeptide S receptor gene (NPSR1) variation (G), early adversity (E) and coping factors (C) on anxiety were addressed in a three-dimensional G × E × C model.MethodIn two independent samples of healthy probands (discovery: n = 1403; replication: n = 630), the interaction of NPSR1 rs324981, childhood trauma (Childhood Trauma Questionnaire, CTQ) and general self-efficacy as a measure of coping ability (General Self-Efficacy Scale, GSE) on trait anxiety (State-Trait Anxiety Inventory) was investigated via hierarchical multiple regression analyses.ResultsIn both samples, trait anxiety differed as a function of NPSR1 genotype, CTQ and GSE score (discovery: β = 0.129, P = 3.938 × 10−8; replication: β = 0.102, P = 0.020). In A allele carriers, the relationship between childhood trauma and anxiety was moderated by general self-efficacy: higher self-efficacy and childhood trauma resulted in low anxiety scores, and lower self-efficacy and childhood trauma in higher anxiety levels. In turn, TT homozygotes displayed increased anxiety as a function of childhood adversity unaffected by general self-efficacy.ConclusionsFunctional NPSR1 variation and childhood trauma are suggested as prime moderators in the vulnerability–stress model of anxiety, further modified by the protective effect of self-efficacy. This G × E × C approach – introducing coping as an additional dimension further shaping a G × E risk constellation, thus suggesting a three-dimensional ‘vulnerability–stress–coping model’ of mental disorders – might inform targeted preventive or therapeutic interventions strengthening coping ability to promote resilient functioning.

Previous gene-environment studies on depression have examined the interaction between FKBP5 gene and childhood trauma, but the results are inconsistent and few studies have focused on Asian adolescents. Psychological resilience may explain for the inconsistency. We examined the interaction between FKBP5 gene and childhood trauma on depressive symptoms in Chinese adolescents, and firstly explored the moderating role of resilience in the relationship.This study comprised 942 participants (448 males, 47.6%) randomly recruited from four senior schools in Wuhan, Hubei of China. Depressive symptoms, childhood trauma, and resilience were respectively evaluated by the Center for Epidemiological Studies Depression Scale (CES-D), the Childhood Trauma Questionnaire (CTQ) and the Connor-Davidson Resilience Scale (CD-RISC). Three potentially functional FKBP5 polymorphisms were selected for genotyping.Participants carrying minor alleles of FKBP5 polymorphisms (rs3800373, rs1360780, and rs4713916) and a haplotype derived from these variants displayed higher CES-D scores when exposed to childhood physical abuse after adjusting for demographic characteristics and resilience (all P 0.01). The three-way interactions of FKBP5 SNPs, physical abuse, and resilience on depressive symptoms all yielded statistical significance after adjusting for demographic characteristics (β = -0.282 to -0.236; all P 0.001).Cross-sectional design, self- reported measurements and limited genotyped FKBP5 polymorphisms.FKBP5 variants in combination with childhood physical abuse may increase more pronounced depressive symptoms among Chinese adolescents, while resilience plays a moderating role in the associations. Future research to examine the exact mechanism of resilience in these associations is needed.

Background Childhood maltreatment is a well-known risk factor for developing a more severe and complex form of bipolar disorders (BD). However, knowledge is scarce about the interactions between childhood maltreatment and underlying genetic vulnerability on the clinical expression of BD. Method We assigned a BD-polygenic risk score (BD-PRS), calculated from the Psychiatric Genomics Consortium, to each individual in a sample of 402 cases with BD. The lifetime clinical expression of BD was characterized using structured interviews and patients completed the Childhood Trauma Questionnaire (CTQ) to assess the severity of childhood maltreatment. Results Cases who reported more severe childhood maltreatment had a lower BD-PRS (rho = -0.12, P = .01), especially when considering emotional abuse (rho = -0.16, P = .001). An interaction between BD-PRS and childhood maltreatment was observed for the risk of rapid cycling (P = .01). No further interactions between BD-PRS and childhood maltreatment were observed for other clinical characteristics (age at onset, suicide attempts, number of mood episodes, mixed features, substance use disorders and psychotic symptoms). Conclusion Our study is the first to show that less genetic risk may be needed to develop a more unstable form of BD when exposed to childhood maltreatment. Our study supports childhood trauma as an independent risk factor for BD.

Background: A history of child abuse is common and has a significant impact in the clinical course of patients diagnosed with bipolar disorders (BD). Aims: To assess the frequency of child abuse experiences in patients BD type I and to evaluate its association with clinical course and cognitive functioning variables. Material and Methods: 117 patients with BD aged 45 ± 14 years (66% women) answered the Childhood Trauma Questionnaire (CTQ). The clinical course (illness onset, history of suicide attempts and number of hospitalizations) was obtained from medical records. Cognitive functioning was evaluated through social and non-social cognition tasks. Results: 64% of participants reported some type of child abuse. This variable was associated with an early onset of the disease (Odds ratio (OR) = 3.3; p < 0.02), increased risk of suicide attempts (OR = 2.4; p < 0.04) and specific disturbances in social cognitive tasks. Conclusions: Our study supports evidence of a common history of child abuse in patients with BD. Although child abuse predicts a worse clinical course, major clinical practice guidelines, as well as research designs, do not highlight this evidence.

Background Emotional memory is a critical amygdala-dependent cognitive function characterized by enhanced memory for emotional events coupled with retrograde amnesia. Our study aims to assess the influence of bipolar disorder (BD), trauma, and the number of mood episodes on emotional memory. Methods 53 subjects (33 euthymic patients with BD and 20 healthy controls) answered a clinical assessment, childhood trauma questionnaire (CTQ), and an emotional memory test composed of lists of nouns, including neutral words, one emotional (E), one preceding (E-1) and one following word (E + 1). We assessed for the influence of type, position, diagnosis, trauma, and number of mood episodes in word recall using generalized estimating equations. Results Controlling for neutral words, BD had a higher recall for E-1 (p = 0.038) and a trend for a higher recall of E (p = 0.055). There was no difference between patients with and without trauma. Patients with BD who suffered multiple mood episodes had a higher recall of E compared to patients with fewer episodes (p = 0.016). Limitations Cross-sectional design and small sample size. Conclusion Our results indicate dysfunction in emotional memory in patients with BD, particularly after multiple mood episodes. While we expected an impaired emotional memory, patients with BD showed an increased recall for emotional stimuli and events preceding them. Childhood trauma does not seem to interfere with emotional memory changes in patients with BD. Emotional memory enhancement seems to be a promising marker of progression in BD.

PT HPPM is a manufacturing company engaged in the automotive sector. The products produced include Automatic Transmission (ATM), Engine Valve (EV), Four Wheel Drive (4WD), and Stell Belt, which are marketed at home and abroad. In carrying out its production activities, PT HPPM has guidelines for controlling its products' quality to compete in the automotive industry, including ATM products with the MCVT (Medium Continuously Variable Transmission) model. The method used in the quality control analysis of this research is Six Sigma, a vision of quality improvement towards a target of 3,4 failures per million opportunities for every transaction of goods and services, Gasperz (2005). To apply the Six Sigma concept, a measurement method is needed to assist the implementation of Six Sigma in the company. There are five steps in this method's stages, namely DMAIC (Define, Measure, Analyze, Improve, Control). There are four potential Critical To Quality (CTQ) that cause the product to become defective or fail in the MCVT model, namely NG Leak, NG Gata, NG Circlip, and NG OPC. The highest defect is NG Leak defect, 127 units with a percentage of 45.68% of the total number of defects produced—then followed by defects NG Gata with 79 units with a percentage of 28.42%. Meanwhile, another defect is NG Circlip, with 62 units with a percentage of 22.30%, then NG OPC as many as ten units with a percentage of 3.60%. By using the Six Sigma method and the DMAIC step (Define, Measure, Analyze, Improve, Control), it can be seen that the quality of MCVT products in the Main Line 1 process is good, which is at the level of 4,876 sigma with 370 Defect Per Million Opportunity (DPMO). From the Define stage by mapping and identifying problems to find out the causes of defective products, the Measure Stage by calculating the stability of the poses using the SPC method to determine the Proportion, CL, UCL, and LCL and calculating the process capability to determine the sigma level value and the DPMO value. The Analyze stage identifies the source of the problem with the Fishbone Diagram, the Improve stage looks for solutions using the 5W1H method, then Control to maintain and maintain process improvements. The results showed a decrease in the DPMO value from 383 units to 370 and an increase in the sigma level value from 4,868 to 4,876. This shows that the company has been able to implement a good quality control system

This evaluation of the Carpal Tunnel Questionnaire (CTQ) was designed to establish the validity and flexibility of its potential use both within a primary and secondary care setting. The questionnaire was originally designed to predict the positive and negative outcome of Nerve Conduction Studies (NCS) in those patients with suspected Carpal Tunnel Syndrome (CTS). Prior to being seen by the hand specialist patients who had been referred with suspected CTS where asked to complete the CTQ. These questionnaires were coded and filed by the clinic nurse. The hand specialist then completed the questionnaire with the patient preceding NCS. Questionnaires were scored subsequent to the appointment. Results for the hand specialist completed questionnaire showed an 80% specificity and 92% sensitivity regarding the ability of the CTQ to predict a positive NCS using a pre-determine cut-off score. The patient completed questionnaire showed a 70.67% specificity and 72% sensitivity. Using receiver operating characteristics a threshold score could be determined to achieve 100% sensitivity/specificity for both questionnaires. This questionnaire provides a useful addition in the assessment of patients with suspected carpal tunnel syndrome and could be used in a range of clinical settings although the scoring cut-off may need to be adapted depending on whether the questionnaire was completed by the clinician or patient. Using the questionnaire in a clinical setting would reduce the requirement for NCS by 60%, this would offer significant time and cost savings.

Introduction Childhood trauma (CT) is known to be a vulnerability factor for schizophrenia, but the specific impacts of different trauma subtypes on the prognosis of these patients remains unclear. Objective To assess the relationships between the occurrence of overall CT and its subtypes with factors with known prognostic impact on schizophrenia, such as age at onset of symptoms, global functioning, and cognitive impairment in a sample of Brazilian patients. Methods One hundred and five stable patients diagnosed with schizophrenia according to DSM-5 criteria were evaluated using the Independent Living Skills Survey (ILSS; self-report global functioning), Schizophrenia Cognition Rating Scale (SCoRS; subjective cognitive impairment), and Childhood Trauma Questionnaire scales (CTQ; perceived overall CT, emotional neglect, physical neglect, physical abuse, and emotional and sexual abuse). Statistical analysis was performed with multivariate linear regression. Results After controlling for educational level and age, subjective cognitive impairment was directly correlated with overall perceived CT occurrence, emotional abuse, and sexual abuse. Self-report global functioning was inversely correlated with perceived overall CT occurrence, emotional abuse, and sexual abuse. Emotional abuse and physical abuse were also inversely correlated with age at onset of symptoms. Conclusions CT can be related to more severe prognoses in schizophrenia, impacting on early onset of symptoms, lower global functioning, and greater cognitive impairment. Subtypes of trauma can be associated with different prognostic risks.

The rapid rate of growth of technology and information in the modern era today, encourages companies to further develop their thoughts and views to maximize the goals and objectives set. The Place to Practice Business Skills (TPKU), is a business engaged in the field of convection managed by Tebuireng Boarding School. One of the most widely used convection products is the school uniform. In producing school uniforms, convection also strives to continuously improve quality by pressing the number of defects in the product. Some things that need to be done are identifying the factors that cause disability using the Six Sigma method, calculate the quality of sigma, and propose appropriate actions to control the quality of school uniforms. Six sigma is a tool of quality improvement toward the 3,4 target of failure per a million opportunities for each production. So six sigma is one of the new methods in the field of quality management aimed at quality control and improvement. By using the six sigma method, it can be seen that there are seven types of defects (CTQ) that occur in school uniform products. The two most common types of defects are: seams that are not tidy with a percentage of 51.1% and stain on uniform of 28.4%. For the quality of school uniforms produced by Tebuireng Convection is still low ie 2.95 sigma with a product defect rate as much 74830 products in one million products (DPMO). From the application of these six sigma, it can be concluded that the proposed action to be done convection to reduce the level of product defects is to focus its supervision on improving employee performance, engine performance, applicable work standards, existing facilities and infrastructure, provide motivation to work, and improve time management well.

Objective: To evaluate the association between childhood trauma (CT) and serum levels of brain-derived neurotrophic factor (BDNF) and thiobarbituric acid-reactive substances (TBARS) during crack-cocaine withdrawal. Method: Thirty-three male crack-cocaine users were recruited at admission to a public addiction treatment unit. Serum BDNF and TBARS levels were evaluated at intake and discharge. Information about drug use was assessed by the Addiction Severity Index-6th Version (ASI-6); CT was reported throughout the Childhood Trauma Questionnaire (CTQ). CTQ scores were calculated based on a latent analysis model that divided the sample into low-, medium-, and high-level trauma groups. Results: There was a significant increase in BDNF levels from admission to discharge, which did not differ across CT subgroups. For TBARS levels, we found a significant time vs. trauma interaction (F2,28 = 6.357, p = 0.005,ηp 2 = 0.312). In participants with low trauma level, TBARS decreased, while in those with a high trauma level, TBARS increased during early withdrawal. Conclusion: TBARS levels showed opposite patterns of change in crack-cocaine withdrawal according to baseline CT. These results suggest that CT could be associated with more severe neurological impairment during withdrawal.

Performance evaluation matrix (PEM) has captured many scholars’ attention and has been widely used to a variety of industry fields to evaluate their efficiency performance. The data mainly come from the collection of questionnaires in which customers’ varied opinions are enquired; however, Likert scale will be modified to fuzzy linguistic scale due to some uncertainty aspect in the linguistic data. In contrast, the major flaw of some researches was that they failed to present a verification approach with statistical inference to confirm the effectiveness of the improvement. Regarding to the related issues, Chen et al. (2018a) use discrimination index in reliance section to establish fuzzy membership function; subsequently, they propose fuzzy hypothesis testing to locate critical-to-quality (CTQ) so as to make further improvement. Following the same logic, this paper uses the identical process to develop the fuzzy verification method of the improvement efficiency for CTQ. Finally, this paper puts forward a numerical example to demonstrate application of the proposed verification model. The result means that there is sufficient evidence showing that performance improvement is poor and non-effective. Thus, manager should adopt otherwise measures to improve. Obviously, the method proposed particularly highlights the reduction of sampling error, shies away from the complexity inherent in fuzzy semantic collection, overcomes the uncertainty in the collected data, and increases the reliability of evaluation method.

Objectives: The incidence of psychological and behavioral problems and depression among adolescents is increasing year by year, which has become an important public health problem. Alexithymia, as an important susceptible factor of adolescent depression, may continue to develop and strengthen under the stimulation of COVID-19-related stressors. However, no studies have focused on alexithymia in adolescent depression during the pandemic in China. This study aims to investigate the incidence and related factors of alexithymia in adolescent depression during the pandemic.Methods: Three hundred adolescent patients were enrolled from October 2020 to May 2021. The general demographic information of all participants was collected, and the clinical characteristics were assessed by the 20-item Toronto Alexithymia Scale (TAS-20), the Adolescent Self-Rating Life Events Check (ASLEC) List, the Childhood Trauma Questionnaire (CTQ), and the Positive and Negative Suicide Ideation (PANSI) Inventory.Results: The incidence of alexithymia was significantly higher among adolescents with depression (76.45%) during the pandemic. There were significant differences in school bullying, disease severity, ASLEC score, CTQ score and PANSI score between adolescents with and without alexithymia. In addition, learning stress, health and adaptation problems during the pandemic may be influential factors in alexithymia of adolescent depression (P < 0.05).Conclusions: According to the results, we found a high incidence of alexithymia in adolescent depression during the pandemic. More support and attention from families, schools and society is needed to develop preventive and targeted psychological interventions as early as possible.

Theory of mind (ToM) is an aspect of social cognition impaired in different addictive disorders, including opioid addiction. This study aimed at replicating ToM deficits in opioid dependent patients undergoing opioid maintenance treatment (OMT) and exploring the influence of substance use related variables, executive functions and childhood maltreatment on ToM in opioid dependent patients. 66 opioid dependent patients were tested using the Movie for Assessment of Social Cognition (MASC) and compared with the data of healthy controls. Furthermore, the opioid dependent patients underwent testing for executive functions and filled in the Childhood Trauma Questionnaire (CTQ). Performance on the MASC was significantly poorer in the opioid dependence group than in the control group, even when recent additional drug use and psychiatric comorbidities were controlled for. No correlations were found between ToM and substance use related factors. Aspects of ToM performance in opioid dependent patients correlated significantly with different EF domains. ToM correlated significantly with the CTQ scales for physical maltreatment. The results confirm impaired ToM in opioid dependent patients and highlight executive functions and childhood maltreatment as influential factors. The lack of associations between ToM and substance use related variables and the association with childhood maltreatment suggest that ToM impairments might be a risk factor predating substance abuse.

Objective To explore the influence of childhood trauma and family alcohol use on male alcohol use disorder. Methods We conducted a case-control study using Childhood Trauma Questionnaire (CTQ) and a structured interview involving 129 men with alcohol use disorder and 129 healthy male volunteers. The two groups were compared in terms of childhood trauma, parental drinking behavior, and attitudes toward childhood drinking. Results Patients showed higher scores of CTQ than controls on childhood trauma experiences, including on the subscales of physical abuse, emotional abuse, sexual abuse, and emotional neglect. Higher proportions of patients than controls had fathers who drank seven or more times a week, and had mothers who were opposed to childhood drinking. Conversely, a smaller proportion of patients than controls had fathers who opposed childhood drinking. Patients were more likely than controls to have been induced to drink as children. Logistic regression analysis identified three risk factors for alcohol use disorder: induced drinking during childhood [odds ratio (OR) 6.09, 95% confidence interval (CI) 2.56–14.51], the father’s weekly alcohol consumption during the respondent’s childhood (OR 4.40, 95%CI 2.94–6.58) and history of smoking (OR 3.39, 95%CI 1.48–7.77). Conversely, more years of education were a protective factor against alcohol use disorder (OR 0.88, 95% CI 0.78–0.99). Conclusions Men whose fathers drank frequently during their childhood and were encouraged to drink may be at increased risk of alcohol use disorder in adulthood. In fact these factors of family alcohol use appear to increase risk of alcohol use disorder among adult men more than exposure to childhood trauma does.

Objectives Antidepressants are effective in the treatment of Major Depressive Disorder (MDD), while many patients fail to respond to antidepressants. Both 5-HT1A (HTR1A) and 5-HT1B (HTR1B) receptors play an important role in antidepressant activity. Meanwhile, DNA methylation is associated with MDD and antidepressant efficacy. In this study we investigate the influence of HTR1A and HTR1B methylation combined with stress/genotype on antidepressant efficacy. Methods A total of 291 MDD patients and 100 healthy controls received the Life Events Scale (LES) and the Childhood Trauma Questionnaire (CTQ) as stress assessment. Eight single nucleotide polymorphisms (SNPs) of HTR1A and HTR1B involved in antidepressant mechanisms were tested. Methylation status in 181 cytosine-phosphate-guanine (CpG) sites of HTR1A and HTR1B were assessed. All MDD patients were divided into response (RES) and non-response (NRES) after 2 weeks of antidepressant treatment. Logistic regression was conducted for interactions between methylation, NLES/CTQ score and genotype. Results Low HTR1A-2-143 methylation is connected with better antidepressant efficacy in subgroup. Low HTR1A-2-143 methylation combined with low CTQ score is related to better antidepressant efficacy. The interaction between high HTR1B methylation with the rs6298 AA/AG genotype affects better antidepressant efficacy. Conclusions HTR1A and HTR1B methylation combined with stress/genotype is associated with antidepressant efficacy. This article is protected by copyright. All rights reserved.

This paper is the first to conduct a cross-sector study of the literature review manuscripts published by analyzing online customer reviews of service sectors. We performed this meta-analysis across six different service sectors - healthcare, hotels, airlines, restaurants, online games, online food/grocery delivery containing over 32 million customer reviews using quality management tools and techniques, such as Juran's trilogy and critical to quality (CTQ). The results of our cross-sector analysis indicate that ‘staff’ and ‘service’ topics are mentioned in all the industries that we reviewed, while ‘environment’ and ‘parking space’ are critiqued in a majority of the service domains. Most customers feel that the ‘time orientation’ aspect of CTQ and quality improvement dimension of Juran's trilogy are being followed across all service areas under consideration. We propose several managerial implications based on our analysis to improve the service quality of the reviewed domains.

Background: Suicide is moderately heritable and also more common in those who report childhood abuse. Previously, it was found that allele A of GABRG2 (GABA A receptor subunit gamma2) polymorphism rs211034 was protective in a suicide attempt (SA). Hence, it was proposed that rs211034 may interact with childhood trauma to influence cognitive deficits related to SA or depression risk. Genetic variants may predict the benefits of certain cognitive treatments.Methods: A total of 52 individuals who had attempted suicide, 59 individuals with major depressive disorder (MDD) or bipolar depression who had not previously attempted suicide, and 90 healthy volunteers were subjected to the modified Suicide Stroop task and were clinically assessed using the Childhood Trauma Questionnaire (CTQ) and Hamilton Depression Scale-24 items (HAMD-24). rs211034 was genotyped using Sanger sequencing.Results: After correcting for covariates, depressed participants displayed longer reaction times for all emotional conditions, including suicide-related words, compared with healthy controls. Depressed suicide attempters displayed longer reaction times for negative words than depressed non-attempters. Depressed non-attempters displayed higher interference scores for negative words compared with healthy controls. There was an interaction between rs211034 risk allele and the effects of reported childhood sexual abuse (CSA) on reaction time for all emotional words and suicide-related words. Carriers of the rs211034 risk allele A exhibited shorter reaction times, but the protective effects of this allele were eliminated in those exposed to reported CSA.Conclusion: Only limited results were found regarding effects of a past suicide attempt on response times to emotional and suicide-related words, but there was an overall effect of major depression on slower response time. Protective genetic effects of the rs211034 A allele on this slowing were eliminated in those with a history of sexual abuse during childhood. Further research is needed to better characterize the mechanisms underlying the effects of childhood trauma on these genetic effects.

OBJECTIVE The present study was conducted to investigate the mediating role of interpersonal problems, contrast avoidance of worry, and emotional contrast avoidance in the relationship between childhood trauma and symptoms of generalized anxiety disorder (GAD). METHOD In this cross-sectional study, 457 individuals (with mean age of 31.5 ± 5.49 years old) with symptoms of GAD who had been referred to psychotherapy centers in Khorramabad City, Lorestan Province, Iran were included. The tools used for data collection were the Childhood Trauma Questionnaire (CTQ), the Brief Inventory of Interpersonal Problems-Circumplex (IIP-C), the Contrast Avoidance Questionnaire-Worry (CAQ-W), the Contrast Avoidance Questionnaire-General Emotion (CAQ-GE), and the GAD Questionnaire-7 (GAD-7). RESULTS The results showed that contrast avoidance of worry and interpersonal problems had a direct and significant effect on symptoms of GAD (p < .001), but childhood trauma and emotional contrast avoidance had no direct and significant effect on symptoms of GAD (p < .05), and also contrast avoidance of worry and interpersonal problems significantly mediated the relationship between childhood traumas and symptoms of GAD (CI [.01,.30]). CONCLUSION Generally, our results showed that the people who have had trauma experiences in childhood may face difficulties in interpersonal relationships later in life. While faced with unpleasant events triggering their negative emotions, these individuals tend to have worry in order to prolong and maintain a negative emotional state-thereby avoiding an unexpected negative emotional shift or contrast experience. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Purpose This study aimed to determine the relationship of childhood trauma experiences with cognitive distortions and sense of coherence in nursing students. Design and Methods This descriptive, correlational, and cross-sectional study was conducted with 359 nursing students. Data were collected using the Sociodemographic Information Form, Childhood Trauma Questionnaire (CTQ), Cognitive Distortions Scale (CDS), and Sense of Coherence (SOC). Findings A positive correlation between CTQ and CDS and a negative correlation between CTQ and SOC were determined (p < 0.05). It was concluded that the CTQ sexual abuse variable had a significant (p = 0.008) effect on the SOC meaningfulness subscale. Practice implications It is thought that it is essential to strengthen nursing students in terms of childhood traumatic experiences, and the sense of coherence will contribute positively to this situation.