Objective To investigate the effect of repetitive transcranial magnetic stimulation(rTMS)combined with the cognitive behavioral therapy(CBT)on the rehabilitation efficacy of the patients with Par-kinson's disease complicating depression(dPD).Methods Seventy patients with dPD in the Nanning Munici-pal Fifth People's Hospital from February 2020 to February 2023 were selected as the study subjects and di-vided into the observation group and control group according to the random number table method,35 cases in each group.Three cases in the control group during the study period came off.The control group was given the rTMS treatment,while the observation group was treated by rTMS+CBT.The remission situations of de-pressive symptoms before treatment,in 4,16 weeks after treatment were compared between the two groups.The Hamilton Depression Scale(HAMD),Social Disability Screening Schedule(SDSS)and Automatic Think-ing Questionnaire(ATQ)were used to evaluate the improvement effect of depression degree,negative auto-matic thinking and social function.Results There were statistically significant differences in the treatment mode,time factor and the interaction between time and treatment mode in HAMD,SDSS and ATQ scores be-tween the two groups(P＜0.05).The one-way ANOVA results revealed that the HAMD,SDSS and ATQ scores in the two groups were in turn decreased with the treatment time extension(P＜0.05).The multivari-ate ANOVA analysis results demonstrated that the HAMD,SDSS and ATQ scores in 4,16 weeks after treat-ment in the observation group were lower than those in the control group(P＜0.05).Conclusion rTMS+CBT for treating dPD has significant anti-depression effect,improves the negative thinking and increases the social function.

INTRODUCTIONA significant percentage of paediatric emergency department (ED) attendances worldwide are nonurgent, adversely affecting patient outcomes and healthcare systems. This study aimed to understand the reasons behind nonurgent ED visits, in order to develop targeted and effective preventive interventions.

METHODSIn-depth interviews were conducted with 49 caregivers to identify the decision-making factors related to taking children to the ED of KK Women's and Children's Hospital, Singapore. Interviews were carried out in the emergency room of the hospital after the children had been diagnosed with nonurgent conditions by the attending physician. Interview transcripts were analysed based on grounded theory principles.

RESULTSThe demographics of our study cohort were representative of the target population. The main reasons given by the caregivers for attending paediatric EDs included perceived severity of the child's symptoms, availability of after-hours care, perceived advantage of a paediatric specialist hospital and mistrust of primary care physicians' ability to manage paediatric conditions. Insurance or welfare was a contributing factor for only a small portion of caregivers.

CONCLUSIONThe reasons provided by Singaporean caregivers for attending paediatric EDs were similar to those reported in studies conducted in Western countries. However, the former group had a unique understanding of the local healthcare system. The study's findings may be used to develop interventions to change the knowledge, attitudes and behaviours of caregivers in Singapore.

Adolescent ; Caregivers ; Child ; Child, Preschool ; Cohort Studies ; Craniocerebral Trauma ; therapy ; Decision Making ; Emergencies ; Emergency Medical Services ; Emergency Service, Hospital ; organization & administration ; Epistaxis ; therapy ; Fathers ; Female ; Hospitals, Pediatric ; Humans ; Infant ; Infant, Newborn ; Male ; Mothers ; Patient Acceptance of Health Care ; Pediatrics ; organization & administration ; Respiratory Tract Infections ; therapy ; Singapore