Clinical characteristics of unvaccinated or incompletely vaccinated children with neurological manifestations due to SARS-CoV-2 Omicron infection.

Omicron generally causes milder disease than previous strains of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), especially in fully vaccinated individuals. However, incompletely vaccinated children may develop Omicron-related complications such as those affecting the central nervous system. To characterize the spectrum of clinical manifestations of neuro-COVID and to identify potential biomarkers associated with clinical outcomes, we recruited 15 children hospitalized for Omicron-related neurological manifestations in three hospitals in Hong Kong (9 boys and 6 girls aged 1-13 years). All were unvaccinated or incompletely vaccinated. Fourteen (93.3%) were admitted for convulsion, including benign febrile seizure (n = 7), complex febrile seizure (n = 2), seizure with fever (n = 3), and recurrent breakthrough seizure (n = 2), and the remaining nonconvulsive patient developed encephalopathic state with impaired consciousness. None of the seven children with benign febrile seizure and six of eight children with other neurological manifestations had residual deficits at 9-month follow-up. SARS-CoV-2 RNA was undetectable in the cerebrospinal fluid (CSF) specimens of seven patients who underwent lumbar puncture. Spike-and-wave/sharp waves affecting the frontal lobes were detected in four of seven (57.1%) patients who underwent electroencephalogram. Children with Omicron-related neurological manifestations had significantly higher blood levels of IL-6 (p < 0.001) and CHI3L1 (p = 0.022) than healthy controls, and higher CSF levels of IL-6 (p = 0.002) than children with non-COVID-19-related febrile illnesses. Higher CSF-to-blood ratios of IL-8 and CHI3L1 were associated with longer length of stay, whereas higher ratios of IL-6 and IL-8 were associated with higher blood tau level. The role of CSF:blood ratio of IL-6, IL-8, and CHI3L1 as prognostic markers for neuro-COVID should be further evaluated.

Changes in Tobacco Use in the Early Phase of Coronavirus Disease 2019 Pandemic in Hong Kong: A Qualitative Study.

INTRODUCTION: Changes in tobacco use and related personal and environmental factors amid the coronavirus disease 2019 (COVID-19) pandemic can be captured by qualitative studies, but they are few in non-Western populations. AIMS AND METHODS: We assessed the perceived links between tobacco use and COVID-19, and changes in the use of cigarettes, electronic cigarettes (ECs), and heated tobacco products (HTPs) in the early phase of the pandemic in Hong Kong, where lockdown was not implemented. Semi-structured telephone interviews were conducted from January to June 2021 in 95 participants (36 EC users, 28 HTP users, and 32 exclusive cigarette users). Transcriptions were coded using deductive and inductive approaches, and factors for changes were nested in the social-ecological model. RESULTS: Two-thirds of participants perceived their infection susceptibility was the same as never tobacco users, and 44.2% perceived more severe COVID-19 disease if infected. Amid the pandemic, tobacco use decreased overall but increased indoors for all three products. Increased tobacco use was mostly attributed to increased emotional distress, while decreases were attributed to various personal (health concerns) and environmental factors (e.g., COVID-19 regulations). Perceived convenience and lower costs were reasons for increased EC use. Limited access to HTPs was compensated by cigarette use. CONCLUSIONS: Many participants were unaware of the potential harm of tobacco use on COVID-19. Overall tobacco use decreased due to COVID-19 regulations, which may not be sustainable post-pandemic. Indoor consumption increased, supporting a comprehensive smoke-free policy that covers private indoor areas. Better cessation services targeting EC, HTP, and cigarette use are needed. IMPLICATIONS: Smokers need better awareness of the risk of tobacco use on COVID-19. Smoking cessation services can be improved by offering brief advice, strengthening advocacy against secondhand smoke, and covering EC and HTP use, highlighting their potential harms to users and others, and their risk of addiction and relapse to cigarette use.

Cigarettes, heated tobacco products and dual use: exhaled carbon monoxide, saliva cotinine and total tobacco consumed by Hong Kong tobacco users.

BACKGROUND: Independent studies on exhaled carbon monoxide (CO) and saliva cotinine levels in regular heated tobacco product (HTP) users, and how they compare with conventional cigarette (CC) smokers, are lacking. METHODS: A total of 3294 current users of CCs, HTPs or electronic cigarettes (ECs) from a household survey and a smoking hotspot survey were classified into seven groups: exclusive users of CCs, HTPs, ECs; dual users of CCs and HTPs, CCs and ECs, HTPs and ECs; and triple users. We measured exhaled CO level using the piCo Smokerlyzer (n=780) and saliva cotinine using NicAlert cotinine test strips (n=620). Among the seven groups, the differences in (1) CO and cotinine levels were examined using Kruskal-Wallis test, and (2) the average daily tobacco consumption in the past 30 days was examined using multivariable linear regression. RESULTS: Both exclusive and dual users of CCs had a higher CO level than exclusive HTP or EC users (p<0.05). Exhaled CO levels were similar between HTP and EC users, as were saliva cotinine levels among the seven groups. Compared with exclusive CC users, those who also used HTPs or ECs smoked fewer CCs (CCs+HTPs: adjusted coefficient -2.79, 95% CI -3.90 to -1.69; CCs+ECs: -1.34, 95% CI -2.34 to -0.34), but consumed more tobacco sticks equivalent in total (2.79 (95% CI 1.61 to 3.96); 1.95 (95% CI 0.79 to 3.12)). CONCLUSIONS: HTP or EC use showed lower exhaled CO but similar saliva cotinine levels compared with CC use. Dual users of CCs and HTPs/ECs smoked fewer CCs than exclusive CC users, but consumed more tobacco in total.

Needs and experiences of cancer care in patients' perspectives among the lesbian, gay, bisexual, transgender and queer community: a systematic review.

Individuals within the Lesbian, Gay, Bisexual, Transgender and Queer (LGBTQ) community who are diagnosed with cancer experience inequitable treatment in healthcare systems worldwide, resulting in dissatisfaction, communication challenges with healthcare providers, and a deep sense of disappointment. Stigma, discrimination, and perceived homophobia further heighten the risk of psychological and attitudinal disorders, including depression and suicidal tendencies, among LGBTQ cancer patients. To comprehensively assess the discrimination faced by LGBTQ cancer patients and gain deeper insights into their needs and experiences, we conducted a systematic review following PRISMA guidelines. We searched for relevant articles using specific keywords in reputable databases such as PubMed, Google Scholar, and PsycINFO. We rigorously evaluated article quality using the CASP (Critical Appraisal Skills Programme) checklist. From a total of 75 eligible studies, we carefully selected 14 studies, specifically examining LGBTQ cancer patients who were currently undergoing or had previously undergone cancer treatment. The studies revealed various factors, including unmet needs related to anxiety and depression, instances of discrimination, disparities in care, and inadequate support systems. A majority of patients expressed dissatisfaction with their cancer care and continued to encounter discrimination and disparities throughout their treatment journeys. Consequently, this led to heightened levels of anxiety, stress, depression, and negative perceptions of healthcare providers. Based on these findings, we recommend providing specialized training to social workers and healthcare providers. This training will equip them with the necessary skills and knowledge to deliver culturally sensitive care tailored to the unique needs of LGBTQ cancer patients. By addressing discrimination, reducing disparities, and fostering an inclusive environment, healthcare professionals can strive to ensure that LGBTQ cancer patients receive the care they deserve.

Exposure to e-cigarette advertising, attitudes, and use susceptibility in adolescents who had never used e-cigarettes or cigarettes.

BACKGROUND: Tobacco advertisements have been banned in Hong Kong, but low intensity e-cigarette (EC) advertising can still be found in various media outlets. We investigated the associations between exposure to EC advertising and susceptibility to EC use in adolescents who had never used cigarettes or ECs, with potential mediation by attitudes towards ECs and the tobacco industry. METHODS: The School-based Smoking Survey 2016/17 assessed exposure to EC advertising in the past 30 days, attitudes towards ECs and the tobacco industry, susceptibility to EC use, and other covariates. Generalised linear mixed models and multiple mediation analysis methods were used in data analyses. RESULTS: Among 7082 students (mean age 14.9 years), 28.8% reported exposure to EC advertising. Exposure was associated with being uncertain about the harm of EC use, being tolerant towards ECs, believing the tobacco industry is respectable, and being susceptible to EC use; the magnitudes of these associations increased with the number of types of advertising exposed (0, 1, and ≥ 2) (all p-values < 0.01). These attitudinal factors were in turn associated with EC use susceptibility (all p-values < 0.001). The perception that tobacco companies make youth smoke was not associated with the advertising exposure or EC use susceptibility. Of the total effects of EC advertising on use susceptibility, only 16.6% were mediated by attitudinal factors: perceived harm (3.1%), attitudes towards ECs (8.2%), and attitudes towards the tobacco industry (4.9%). CONCLUSIONS: Even exposure to low intensity EC advertising was associated with susceptibility to EC use in adolescents who had never used cigarettes or ECs. The association was weakly mediated by tolerant attitudes towards ECs and the tobacco industry. The government should reinforce the regulations on EC advertising to protect adolescent health.

Tobacco Industry Denormalization Beliefs in Hong Kong Adolescents.

BACKGROUND: Tobacco industry denormalization (TID) seeks to expose the industry's misconducts. Research on TID beliefs, meaning negative attitudes toward the tobacco industry (TI), may inform TID programs, but was limited to western populations. We investigated TID beliefs and their association with smoking and sociodemographic characteristics in Hong Kong adolescents. METHODS: In a school-based cross-sectional survey of 14214 students (mean age 15.0 years, 51.5% boys), TID beliefs were assessed by two questions: (1) whether the TI was respectable and (2) whether the TI tried to get youth to smoke, each with four options from "definitely no" to "definitely yes." Smoking susceptibility and behaviors were also assessed. Sociodemographic characteristics included age, sex, perceived family affluence, highest parental education, numbers of co-residing smokers, and school-level smoking prevalence. RESULTS: Of all students, 77.6% considered the TI not respectable and 56.6% believed that the TI tried to get youth to smoke. Stronger TID beliefs were inversely associated with smoking susceptibility and behaviors. For example, students considering the TI definitely not respectable (vs. definitely yes) were 56% (95% confidence intervals [CI] = 45% to 66%), 49% (95% CI = 41% to 56%), and 53% (95% CI = 36% to 65%) less likely to be susceptible to smoking (among never-smokers) and be ever- and current smokers, respectively. Of all correlates examined, only younger age and having no co-residing smoker were associated with TID beliefs. CONCLUSIONS: Substantial proportions of Hong Kong adolescents did not hold TID beliefs, but those who did were less likely to smoke. Our results suggest that TID programs may help reduce adolescent smoking. IMPLICATIONS: The TI's misconducts and responsibility for the tobacco epidemic were not well known by Hong Kong adolescents. TID beliefs in this population were inversely associated with smoking. These findings suggest that TID programs in local adolescents may be of value. The investigation into the correlates of TID beliefs found that socioeconomic status and school-level smoking prevalence were not associated with TID beliefs. This suggests that local TID programs targeting adolescents in general, for example, mass-media campaigns, may be more appropriate than those targeting particular schools or selected groups of adolescents.

Secondhand Smoke From Multiple Sources, Thirdhand Smoke and Respiratory Symptoms in Hong Kong Adolescents.

Introduction: Reports on involuntary tobacco smoke exposure in children have focused mostly on secondhand smoke (SHS) from smoking inside the home. We studied the separate and combined prevalence of SHS exposure from multiple sources and thirdhand smoke (THS) and the associations with respiratory symptoms in Hong Kong adolescents. Methods: In 2010-2011, 61 810 Secondary 1 (US Grade 7) to seven students reported their smoking status, respiratory symptoms, and exposure to four sources of tobacco smoke in the past 7 days. Weighted prevalence of exposure was calculated. Associations with respiratory symptoms were analyzed in 50 762 never smokers using logistic regression. Results: Tobacco smoke exposure at home was 23.2% considering SHS exposure from inside the home, but increased to 33.2% including SHS from neighbors and 36.2% further including THS. Including SHS outside home (55.3%), 63.3% of adolescents were exposed to SHS anywhere or THS at home. In never smokers, SHS from each source and THS at home were linearly associated with respiratory symptoms. Exposure to more sources yielded stronger associations with respiratory symptoms (p for trend<.001). The adjusted odds ratios (95% CI) were 1.04 (0.97-1.11), 1.12 (1.03-1.22), 1.40 (1.26-1.56) and 1.99 (1.74-2.28) for 1, 2, 3, and 4 sources, respectively. Conclusions: Although Hong Kong's smoking prevalence is among the lowest in the developed world, over 60% of its adolescents were involuntarily exposed to tobacco smoke from one or more sources with a linear association with respiratory symptoms in never smokers. More stringent policies are needed to protect adolescents from tobacco smoke. Implications: In a high-density urban setting, involuntary exposure to tobacco smoke in adolescents can be much higher than the smoking prevalence of the general population, especially if SHS exposure from multiple sources and THS are also considered. Such exposures have important health implications as demonstrated by their linear associations with respiratory symptoms. Tobacco control measures effective in reducing smoking prevalence may have little effect in reducing adolescent exposure to tobacco smoke, especially in the private home, in which other public health strategies are urgently needed.

Associations of unhappiness with sociodemographic factors and unhealthy behaviours in Chinese adolescents.

Background: Evidence on the effects of lack of physical exercise, alcohol drinking and smoking on happiness is limited and inconsistent. We examined the associations of unhappiness with sociodemographic factors and these unhealthy behaviours in Chinese adolescents. In a school-based survey in 2012-13 in Hong Kong, 45 857 secondary school students (mean age 14.8 years, 54.0% boys) reported their happiness level (not happy at all/not very happy/happy/very happy), frequency of physical exercise, alcohol drinking status, smoking status and sociodemographic factors. A main and a sensitivity analysis examined the associations of unhappiness with the study factors, treating unhappiness as a binary (combining 'not happy at all' and 'not very happy') and a four-level ordered variable, respectively. The main and the sensitivity analysis both showed that unhappiness was associated with older age, very poor families, non-intact families, more co-residing smokers, lack of physical exercise and alcohol drinking; current smokers were unhappier than never and ex-smokers; unhappiness also increased significantly with the number of unhealthy behaviours ( P for trend < 0.001). In Chinese adolescents, unhappiness levels were higher in those who had a very poor family, a non-intact family and more co-residing smokers, and in those who were physically inactive, drank alcohol and smoked.

Open-Label Study of Absorption and Clearance of 1% Voriconazole Eye Drops.

Twenty participants undergoing elective cataract surgery received 1% voriconazole eye drops (1 drop per eye) either 20, 40, 60, or 80 min before surgery. Median voriconazole concentrations of 1.9 to 3.2 mg/liter in aqueous humor samples were attained over the first 80 min, which were higher than in vitro MIC90 values for typical fungi that cause keratitis.

Electronic cigarette use among adolescents: a cross-sectional study in Hong Kong.

BACKGROUND: Little is known about electronic cigarette (e-cigarette) use among Chinese adolescents. We examined the prevalence of current (past 30-day) e-cigarette use and its associated factors in a large sample of adolescents in Hong Kong. METHODS: We analyzed data of the School-based Survey on Smoking among Students 2012/13 from a representative sample of 45,857 secondary school students (mean age: 14.8 ± 1.9). We conducted chi-square tests and t-test to compare current e-cigarette use by covariates. We used multivariable logistic regression to examine the association between current e-cigarette use and demographic variables, parental smoking, peer smoking, knowledge about the harm of cigarette smoking, attitudes toward cigarette smoking, cigarette smoking status, use of other tobacco products, and alcohol consumption. RESULTS: Overall, 1.1% of students reported current e-cigarette use. Of e-cigarette users, 11.7% were never-cigarette smokers, 15.8% were experimental cigarette smokers, 39.3% were former cigarette smokers, and 33.2% were current cigarette smokers. Current e-cigarette use was associated with male sex, poor knowledge about the harm of smoking, cigarette smoking, use of other tobacco products, and alcohol consumption. CONCLUSIONS: Surveillance and intervention efforts should address a wide range of tobacco products, including e-cigarettes. Tobacco cessation programs should also address alcohol use collectively. Policies prohibiting e-cigarette sales to minors may help prevent e-cigarette uptake among adolescents.

X11/Mint genes control polarized localization of axonal membrane proteins in vivo.

Mislocalization of axonal proteins can result in misassembly and/or miswiring of neural circuits, causing disease. To date, only a handful of genes that control polarized localization of axonal membrane proteins have been identified. Here we report that Drosophila X11/Mint proteins are required for targeting several proteins, including human amyloid precursor protein (APP) and Drosophila APP-like protein (APPL), to axonal membranes and for their exclusion from dendrites of the mushroom body in Drosophila, a brain structure involved in learning and memory. Axonal localization of APP is mediated by an endocytic motif, and loss of X11/Mint results in a dramatic increase in cell-surface levels of APPL, especially on dendrites. Mutations in genes required for endocytosis show similar mislocalization of these proteins to dendrites, and strongly enhance defects seen in X11/Mint mutants. These results suggest that X11/Mint-dependent endocytosis in dendrites may serve to promote the axonal localization of membrane proteins. Since X11/Mint binds to APP, and abnormal trafficking of APP contributes to Alzheimer's disease, deregulation of X11/Mint may be important for Alzheimer's disease pathogenesis.

Societal discrimination and mental health among transgender athletes: a systematic review and Meta-analysis.

BACKGROUND: Discrimination and inequality have been identified as significant problems faced by transgender individuals in sports participation. However, uncertainties remain regarding the effectiveness of interventions aimed at promoting equality. OBJECTIVES: This systematic review and meta-analysis aimed to examine the experiences of transgender athletes in sports, focusing on mental health issues and factors contributing to inequality among transgender and other sexual minorities. METHODS: The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and searched 10 electronic databases, including PubMed, Google Scholar, and Web of Science, to identify eligible studies published between 2005 and 2022. The search yielded 1430 articles, of which only 12 studies met the inclusion criteria for this review. RESULTS: The meta-analysis of the 12 studies included in this review revealed that transgender athletes faced social discrimination and inequality in sports participation, resulting in mental health problems and higher rates of suicide. From a cohort of 21,565 participants in the studies, 7152 (33%) were subjected to discrimination in sports participation and healthcare, with a rate of 0.61 (95% confidence interval [CI]: 0.35, 0.81). However, transgender athletes who felt welcomed and embraced by their respective teams accounted for 0.39 (95% CI: 0.19, 0.65). These results indicated significant differences between how transgender athletes are treated in healthcare settings and when participating in sports. CONCLUSION: The study findings underscore the need for policies, cultural research, and interventions to address discrimination and inequality faced by transgender athletes in sports participation. Promoting equality and safeguarding the rights of transgender athletes can mitigate the risk of mental health problems and increase physical activity among sexual minorities.

Investigating the Interrelationships Among Mental Health, Substance Use Disorders, and Suicidal Ideation Among Lesbian, Gay, and Bisexual Adults in the United States: Population-Based Statewide Survey Study.

BACKGROUND: Mental health disparities have been documented among lesbian, gay, and bisexual (LGB) adults in the United States. Substance use disorders and suicidal ideation have been identified as important health concerns for this population. However, the interrelationships among these factors are not well understood. OBJECTIVE: This study aims to investigate the interrelationships among mental health, substance use disorders, and suicidal ideation among LGB adults in the United States using a population-based statewide survey. METHODS: Our study was an observational cross-sectional analysis, and the data for this study were collected from a sample of LGB adults who participated in the statewide survey. The survey collected information on mental health, substance use disorders, and suicidal ideation using validated measures. Descriptive statistics and inferential data analysis were conducted to explore the interrelationships among these factors. RESULTS: The results showed that LGB adults who reported higher levels of depression and drug abuse and dependence also reported higher levels of suicidal tendency and mental illness. Inferential data analysis using χ2 tests revealed significant differences in depression score (χ22=458.241; P<.001), drug abuse and dependence score (χ22=226.946; P<.001), suicidal tendency score (χ22=67.795; P<.001), and mental illness score (χ22=363.722; P<.001) among the 3 sexual identity groups. Inferential data analysis showed significant associations between sexual identity and mental health outcomes, with bisexual individuals reporting the highest levels of depression, drug abuse and dependence, suicidal tendency, and mental illness. CONCLUSIONS: This study provides important insights into the interrelationships among mental health, substance use disorders, and suicidal ideation among LGB adults in the United States. The findings underscore the need for targeted interventions and research aimed at addressing the mental health needs of sexual minority populations. Future research should aim to better understand the underlying mechanisms driving these disparities and develop culturally sensitive and tailored interventions that meet the unique needs of LGB individuals. Reducing stigma and discrimination against sexual minority populations is also crucial to improving their mental health outcomes.

Prediction of pyramidal tract side effect threshold by intra-operative electromyography in subthalamic nucleus deep brain stimulation for patients with Parkinson's disease under general anaesthesia.

Introduction: In DBS for patients with PD, STN is the most common DBS target with the sweet point located dorsal ipsilaterally adjacent to the pyramidal tract. During awake DBS lead implantation, macrostimulation is performed to test the clinical effects and side effects especially the pyramidal tract side effect (PTSE) threshold. A too low PTSE threshold will compromise the therapeutic stimulation window. When DBS lead implantation is performed under general anaesthesia (GA), there is a lack of real time feedback regarding the PTSE. In this study, we evaluated the macrostimulation-induced PTSE by electromyography (EMG) during DBS surgery under GA. Our aim is to investigate the prediction of post-operative programming PTSE threshold using EMG-based PTSE threshold, and its potential application to guide intra-operative lead implantation. Methods: 44 patients with advanced PD received STN DBS under GA were studied. Intra-operative macrostimulation via EMG was assessed from the contralateral upper limb. EMG signal activation was defined as the amplitude doubling or greater than the base line. In the first programming session at one month post-operation, the PTSE threshold was documented. All patients were followed up for one year to assess clinical outcome. Results: All 44 cases (88 sides) demonstrated activations of limb EMG via increasing amplitude of macrostimulation the contralateral STN under GA. Revision tracts were explored in 7 patients due to a low EMG activation threshold (<= 2.5 mA). The mean intraoperative EMG-based PTSE threshold was 4.3 mA (SD 1.2 mA, Range 2.0-8.0 mA), programming PTSE threshold was 3.7 mA (SD 0.8 mA, Range 2.0-6.5 mA). Linear regression showed that EMG-based PTSE threshold was a statistically significant predictor variable for the programming PTSE threshold (p value <0.001). At one year, the mean improvement of UPDRS Part III score at medication-off/DBS-on was 54.0% (SD 12.7%) and the levodopa equivalent dose (LED) reduction was 59.5% (SD 23.5%). Conclusion: During STN DBS lead implantation under GA, PTSE threshold can be tested by EMG through macrostimulation. It can provide real-time information on the laterality of the trajectory and serves as reference to guide intra-operative DBS lead placement.

Mitigating Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia: Ameliorating Sexual Function and Psychological Well-Being in Older Men.

This study aimed to investigate the prevalence of lower urinary tract symptoms (LUTS) in older men (N= 3056) with benign prostatic hyperplasia (BPH) and its effects on their sexual function and mental health. Descriptive, correlation, and regression analyses were used to explore the relationships between prostate and lower urinary tract health and psychological well-being. Better prostate and lower urinary tract health positively affected psychological well-being, and sexual function also had a positive influence. LUTS have an adverse impact on sexual function and mental health. Early intervention is crucial for mitigating the negative impact of LUTS on the quality of life in older men. Addressing prostate and lower urinary tract health issues through appropriate interventions may improve psychological well-being. Health care professionals must consider the adverse effects of BPH and LUTS on sexual function and mental health, and implement interventions to enhance the overall quality of life in older men.

Impact of mandatory masking amid the COVID-19 pandemic on outdoor smoking: an interrupted time-series analysis of a 33-month unobtrusive observational study.

Background: Mask-wearing in outdoor public places in Hong Kong was mandated on 29 July 2020, amid the COVID-19 pandemic. We aimed to evaluate the impact of mandatory masking with no exemption for smoking on outdoor smoking. Methods: We conducted 253 unobtrusive observations at 10 outdoor smoking hotspots in 33 months from July 2019 to March 2022 and counted smokers and non-smoking pedestrians in fixed boundaries. We conducted interrupted time-series analyses on the monthly mean volume of smokers (persons per hour) using generalized linear models. The independent variables were as follows: time since the first observation, implementation of the mask regulation, time since the regulation, seasonality, and waves 1-5 outbreaks. We checked the robustness of the association using the daily mean volume of smokers as the dependent variable. Two sensitivity analyses were conducted to include the hotspot location or the number of all pedestrians as an offset. Results: Monthly outdoor smoking decreased immediately after the regulation (incidence rate ratio [IRR]: 0.505, 95% confidence interval [CI]: 0.374 to 0.680, P < 0.001). Daily smoking analysis and the two sensitivity analyses supported the results. However, monthly outdoor smoking increased by 11% since the regulation (IRR: 1.110, 95% CI: 1.074 to 1.147, P < 0.001). An exception was observed at the most severe wave 5 outbreak when monthly outdoor smoking decreased (IRR: 0.415, 95% CI: 0.327 to 0.525, P < 0.001). Conclusion: Outdoor smoking fell immediately after mandatory masking, rebounded to pre-pandemic levels, and decreased again at the most severe wave 5.

Mental Health of Children With Special Educational Needs and the Return to In-Person Learning After the COVID-19 Pandemic.

Importance: There is limited evidence on whether the quality of life and behavior of children with special educational needs (SEN) have improved or worsened since schools reopened after COVID-19-related school closures. Objective: To describe the changes in the mental well-being of children and adolescents with SEN during the initial 6 months of resuming in-person learning after COVID-19-related school closures. Design, Setting, and Participants: This repeated cross-sectional study reported data from surveys completed by parents and caregivers of children and adolescents aged 3 to 18 years with SEN studying at special schools in Hong Kong. The first cohort was obtained during COVID-19-related school closure in April 2020 (wave 1) and the second cohort was obtained 6 months after school resumption with data collection between July and October 2021 (wave 2). Data analysis occurred from January to June 2022. Exposure: Diagnosis of a disability or disorder that required school-based special educational programming. Main Outcomes and Measures: Children's emotional and behavioral difficulties (measured with the Strengths and Difficulties Questionnaire [SDQ]), quality of life (measured with the Pediatric Quality of Life Inventory [PedsQL]), lifestyle habits, parental stress, and parental well-being (measured with the PedsQL Family Impact Module) were assessed. Cross-sectional comparisons of well-being between the 2 waves were conducted using analysis of covariance, and multiple regression analysis was performed to identify factors associated with mental health outcomes in wave 2. Results: In wave 1, a total of 456 parents and caregivers of children with SEN (mean [SD] age, 7.44 [3.98] years; 315 boys [69.1%]; 141 girls [30.9%]) responded to the surveys. In wave 2, 519 parents and caregivers of children with SEN (mean [SD] age, 8.16 [4.47] years; 365 boys [70.3%]; 154 girls [29.7%]) responded. After school resumption, preschoolers aged 3 to 5 years with SEN had significantly fewer emotional difficulties (mean [SD] SDQ score, 3.26 [2.39] vs 2.68 [2.03]; standardized mean difference [SMD] = 0.26; 95% CI, 0.07-0.46; Bonferroni-corrected P = .04) and conduct difficulties (mean [SD] SDQ score, 2.88 [1.89] vs 2.41 [1.91]; SMD = 0.25; 95% CI, 0.05-0.44; Bonferroni-corrected P = .01), whereas adolescents had more conduct difficulties (mean [SD] SDQ score, 1.62 [1.50] vs 2.37 [3.02]; SMD = 0.41; 95% CI, 0.13-0.70; Bonferroni-corrected P = .049). The overall quality of life of school-aged children with SEN aged 6 to 11 years worsened after school resumption (mean [SD] PedsQL score, 67.52 [17.45] vs 60.57 [16.52]; SMD = 0.41; 95% CI, 0.19-0.62; Bonferroni-corrected P = .002). Conclusions and Relevance: The findings of this repeated cross-sectional study suggest that preschoolers with SEN had improved emotional and behavioral functioning when school resumed after COVID-19-related closures. School-aged children with SEN, adolescents with SEN, and children with intellectual disabilities were at risk of reduced quality of life, indicating that additional support should be offered to vulnerable groups as they return to schools.

Stability of extemporaneously prepared 0.5-percent caspofungin eye drops: a potential cost-savings exercise.

While the successful use of topical caspofungin for patients has been reported, topical caspofungin is not commercially available and its stability is unknown, limiting its usefulness in treating fungal keratitis. Caspofungin (0.5%) eye drops were aseptically prepared, and the concentrations were measured using a validated high-performance liquid chromatography (HPLC) analysis. The preparations remained stable for 28 days under refrigerated condition but not at 25.0 °C. Our study supports the cost-saving use of caspofungin eye drops in the clinical setting.

Lumbar epidural blood patch: An effective treatment for intracranial hypotension.

Background: The literature has demonstrated the efficacy of lumbar epidural blood patch (LEBP) in the management of spontaneous intracranial hypotension (SIH). However, the underlying pathophysiology of such management remains unclear. In this study, we aim to evaluate the utility of LEBP injections in the management of SIH and develop a potential management algorithm used in the triage and management of SIH patients. Methods: We retrospectively examined the clinical case notes of 14 patients with SIH (age: 25-69 years) who were managed with LEBP injections during the year of 2016-2021. We evaluated the presenting symptoms of each selected patient and radiological findings as well as treatment outcomes. Our aim is to evaluate the effectiveness of LEBP in the treatment of SIH patients through follow-up clinical and imaging assessment. Results: About 93% of patients describe the presence of headache at presentation, while 43% describe it as being of an orthostatic nature. All patients demonstrated typical findings on magnetic resonance imaging brain. Treatment success assessed through symptomatic improvement and radiological resolution was found in 85% of our patients at a 2-month interval. Conclusion: LEBP injection is an effective method of management in patients with a diagnosis of SIH. It should be considered in all SIH patients irrespective of whether a "dural leak" can be localized through radiological investigations.

Digital competence as a protective factor against gaming addiction in children and adolescents: A cross-sectional study in Hong Kong.

Background: Digital competence can help children and adolescents engage with technology for acquiring new knowledge and for broadening social contact and support, while reducing the risk of inappropriate media use. This study investigated the effects of digital competence on the risk of gaming addiction among children and adolescents. We explored whether students with good digital competence were protected from the adverse effects of media use and the risk of gaming addiction. Methods: 1956 students (690 primary and 1266 secondary) completed a digital competence assessment and a self-report questionnaire on their mental health status, use of digital devices, and experiences of cyberbullying. Multiple regression analyses with further mediation and moderation analyses were performed to investigate the association of digital competence with gaming addiction and mental health in children and adolescents. Findings: Regression analyses showed that children and adolescents with better digital competence were less likely to develop gaming addiction (ß = -0.144, p < 0.0001) and experienced less cyberbullying behaviour as perpetrators (ß = -0.169, p < 0.0001) and as victims (ß = -0.121, p < 0.0001). Digital competence was found to mediate the relationship between digital device usage time and gaming addiction. Interpretation: Digital competence is associated with less gaming addiction and could potentially lead to better mental wellbeing by reducing the risks of gaming addiction and cyberbullying. Education that promotes digital competence is essential to maximize the benefits of media use, while reducing the potential adverse effects from the inappropriate use of digital devices. Funding: This study was supported by a grant from the Research Grants Council of the HKSAR Government (#T44-707/16N) under the Theme-based Research Scheme.