Objectives To analyze the prevalence and clinical features of depression, anxiety, depression and anxiety in Tibetan patients with epilepsy and to improve the diagnosis and treatment. Methods 102 patients with epilepsy, who had been admitted to the Department of Neurology of the People's Hospital of Tibet Autonomous Region from January 2017 to December 2017, were diagnosed according to the Chinese Standard Classification and Diagnostic Criteria for Mental Disorders (3rd Edition) (CCMD-3). The Hamilton depression scale (HAMD 24 items) and the Hamilton anxiety scale (HAMA 14 items) were used to measure depression and anxiety. Different genders, ages, durations, frequency of attacks, and seizures types were analyzed for depression, anxiety, depression and anxiety. Univariate analysis was used to screen the factors that may cause depression, anxiety, depression and anxiety in patients with epilepsy. Logistic regression was used to analyze the risk factors of depression, anxiety, depression and anxiety in patients with epilepsy. Results Among the 102 patients with epilepsy, 35 (34.31%) comorbid depression, 10 (9.80%) comorbid anxiety, and 54 (52.94%) comorbid depression and anxiety. Univariate analysis showed that there was a significantly statistical difference in the duration of the disease and the frequency of seizures in local patients with epilepsy (P<0.05). There was a statistically significant difference in the frequency of epileptic seizures and anxiety (P<0.05). Multivariate logistic regression analysis showed that the probability of anxiety in patients with a disease duration of ≤2 years was only 10.1% of those with a course >2 years [OR=0.101, 95%CI (0.012, 0.915), P<0.05]; and the frequency of seizures was not an risk factors for epileptic comorbid with anxiety (P>0.05). The rate of depression and anxiety in patients with seizure frequency >2 times per month was 4.853 times higher than that of patients with seizure frequency ≤2 times per month [OR=4.853, 95%CI (2.024, 11.634), P<0.05]. Conclusions Tibetan patients with epilepsy have a high prevalence of depression, anxiety, depression and anxiety. In the diagnosis and treatment, we should strengthen the understanding and provide the appropriate prevention and treatment to improve the diagnosis and treatment level.
Stepped wedge cluster randomized trials (SW-CRT) is a kind of cluster randomized controlled trial mainly applied in the field of public health policy that has emerged in recent years, which has gradually attracted the attention of workers in the field of health and wellness. At present, this trial method is not widely used at home and abroad, and there are various ways of sample size calculation and statistical analysis. This paper describes the principles, categories, and differences between SW-CRT and traditional randomized controlled trials, and outlines sample size calculation and statistical analysis methods. In general, SW-CRT is characterized by clustering, cross-design, and measurement of results at multiple time points. In terms of sample size calculation, it is necessary to distinguish between clusters with the same and different sizes, and commonly used sample size calculation procedures can be implemented in Stata, R, and SAS software, as well as in fixed online websites, including the "Steppedwedge" program, the "swCRTdesign" program, the "Swdpwr" program, the "CRTpowerdist" program, and the "Shiny CRT Calculator" tool and so on. Based on the design characteristics of SW-CRT, the researcher should also consider the confounding factors of time effects and repeated measurements of result. Therefore, the statistical analysis methods are often based on generalized linear mixed model (GLMM) and generalized estimating equations (GEE). However, most of the above models have been proposed based on cross-sectional studies, there is a lack of statistical methods for queue design and SW-CRT with transitional period now, and more comprehensive methodological exploration is still needed in the future.