The global distribution and the risk prediction of relapsing fever group Borrelia: a data review with modelling analysis.

BACKGROUND: The recent discovery of emerging relapsing fever group Borrelia (RFGB) species, such as Borrelia miyamotoi, poses a growing threat to public health. However, the global distribution and associated risk burden of these species remain uncertain. We aimed to map the diversity, distribution, and potential infection risk of RFGB. METHODS: We searched PubMed, Web of Science, GenBank, CNKI, and eLibrary from Jan 1, 1874, to Dec 31, 2022, for published articles without language restriction to extract distribution data for RFGB detection in vectors, animals, and humans, and clinical information about human patients. Only articles documenting RFGB infection events were included in this study, and data for RFGB detection in vectors, animals, or humans were composed into a dataset. We used three machine learning algorithms (boosted regression trees, random forest, and least absolute shrinkage and selection operator logistic regression) to assess the environmental, ecoclimatic, biological, and socioeconomic factors associated with the occurrence of four major RFGB species: Borrelia miyamotoi, Borrelia lonestari, Borrelia crocidurae, and Borrelia hermsii; and mapped their worldwide risk level. FINDINGS: We retrieved 13 959 unique studies, among which 697 met the selection criteria and were used for data extraction. 29 RFGB species have been recorded worldwide, of which 27 have been identified from 63 tick species, 12 from 61 wild animals, and ten from domestic animals. 16 RFGB species caused human infection, with a cumulative count of 26 583 cases reported from Jan 1, 1874, to Dec 31, 2022. Borrelia recurrentis (17 084 cases) and Borrelia persica (2045 cases) accounted for the highest proportion of human infection. B miyamotoi showed the widest distribution among all RFGB, with a predicted environmentally suitable area of 6·92 million km2, followed by B lonestari (1·69 million km2), B crocidurae (1·67 million km2), and B hermsii (1·48 million km2). The habitat suitability index of vector ticks and climatic factors, such as the annual mean temperature, have the most significant effect among all predictive models for the geographical distribution of the four major RFGB species. INTERPRETATION: The predicted high-risk regions are considerably larger than in previous reports. Identification, surveillance, and diagnosis of RFGB infections should be prioritised in high-risk areas, especially within low-income regions. FUNDING: National Key Research and Development Program of China.

Risk factors assessment and a Bayesian network model for predicting ischemic stroke in patients with cardiac myxoma.

Objective: This study aims to identify relevant risk factors, assess the interactions between variables, and establish a predictive model for ischemic stroke (IS) in patients with cardiac myxoma (CM) using the Bayesian network (BN) approach. Methods: Data of patients with CM were collected from three tertiary comprehensive hospitals in Beijing from January 2002 to January 2022. Age, sex, medical history, and information related to CM were extracted from the electronic medical record system. The BN model was constructed using the tabu search algorithm, and the conditional probability of each node was calculated using the maximum likelihood estimation method. The probability of each node of the network and the interrelationship between IS and its related factors were qualitatively and quantitatively analyzed. A receiver operating characteristic (ROC) curve was also plotted. Sensitivity, specificity, and area under the curve (AUC) values were calculated and compared between the BN and logistic regression models to evaluate the efficiency of the predictive model. Results: A total of 416 patients with CM were enrolled in this study, including 61 with and 355 without IS. The BN model found that cardiac symptoms, systemic embolic symptoms, platelet counts, and tumor with high mobility were directly associated with the occurrence of IS in patients with CM. The BN model for predicting CM-IS achieved higher scores on AUC {0.706 [95% confidence interval (CI), 0.639-0.773]} vs. [0.697 (95% CI, 0.629-0.766)] and sensitivity (99.44% vs. 98.87%), but lower scores on accuracies (85.82% vs. 86.06%) and specificity (6.56% vs. 11.48%) than the logistic regression model. Conclusion: Cardiac symptoms, systemic embolic symptoms, platelet counts, and tumor with high mobility are candidate predictors of IS in patients with CM. The BN model was superior or at least non-inferior to the traditional logistic regression model, and hence is potentially useful for early IS detection, diagnosis, and prevention in clinical practice.

Emission characteristics, risk assessment and scale effective control of VOCs from automobile repair industry in Beijing.

Automobile repair is regarded as a typical domestic source of VOCs in China characterized by numerous sites, wide dispersion and intermittent VOCs emissions. It is of great importance to study and control VOCs from such activities. In this research, emission characteristics, risk assessment and scale effective control of VOCs from automobile repair in Beijing were studied. Results showed that coating spraying and baking were the main processes of VOCs and the major species determined were mostly oxygen-containing VOCs and aromatic hydrocarbons in the case of solvent-based coating usage. Meanwhile, alkanes were determined and accounted for 40 % of total VOCs emissions during the water-based coating spraying and baking. Generally, the total determined VOCs during the automobile repair processes were 1.06-1.27 mg/m3 and 2.93-53.46 mg/m3 for the usage of water-based and solvent-based paint, respectively. Health risk assessments indicated that the residents in the region about 30 m high within a radius of 20 m around the automobile repair plants might suffer from both serious non-carcinogenic and carcinogenic risk threats in the case of solvent-based coating usage in that the values of total hazard index (HI) represented by dichloropropane and acrolein were higher than 1 and the value of lifetime cancer risk (LCR) represented by dichloroethane was higher than 10-5. Besides, those in the region about 30 m high and within a wider radius of 340 m might suffer from carcinogenic risk threat with a certain probability (LCR > 10-6) no matter either solvent-based or water-based coatings were used. As for the scale control of VOCs from automobile repair, independent adsorption by activated carbon combined with mobile regeneration by catalytic combustion was also proposed as an efficient way.

Basic research investment, innovation capability improvement, and economic growth efficiency.

This study explores the relationship between the proportion of basic research investment in R&D expenditure and regional economic growth efficiency and its influence path. A panel of data from 31 China's provincial was analysed by the fixed-effects model over 2009 to 2019. Empirical results highlight that: (1) the increase in the proportion of basic research investment has a significant promoting effect on regional economic growth efficiency, but it presents an "inverted U-shaped" impact path. Meanwhile, the threshold effect model test results reveal that basic research investment plays a more significant role in promotion when the per capita income level exceeds a certain threshold. (2) The test results of the mediating effect model indicate that the improvement of the level of human capital is the intermediate channel through which the investment in basic research affects regional economic growth efficiency, while the mediating effect of the increase of knowledge storage on the process of the investment in basic research affecting regional economic growth efficiency is not supported by data. Potential policy measures are discussed.

Epidemiology of imported infectious diseases, China, 2014-18.

BACKGROUND: The frequent movement of population between countries brings an increasing number of travel-related infections. This study aims to define the spectrum and dynamics of imported infections observed from international travel in the Chinese mainland. METHODS: Sick travellers were screened by inbound sentinel surveillance and post-travel clinic visits from 2014 to 18. The infections were classified as respiratory, gastrointestinal, vector-borne, blood/sexually transmitted and mucocutaneous. The analysed variables included the place of origin of the travellers (Chinese or foreign) and the time when travel-related infection was present (at the time of return, during travel and post-travel visits to the clinic). RESULTS: In total, 58 677 cases were identified amongst 1 409 265 253 travellers, with an incidence of 41.64/million, comprising during-travel incidence of 27.44/million and a post-travel incidence of 14.20/million. Respiratory infections constituted the highest proportion of illnesses during travel (81.19%, 31 393 of 38 667), which mainly came from Asian countries and tourists; with influenza virus and rhinovirus infections being mainly diagnosed. Vector-borne diseases constituted the highest proportion of post-travel illnesses (98.14%, 19 638 of 20 010), which were mainly diagnosed from African countries and labourers; with malaria and dengue fever being mainly diagnosed. The differential infection spectrum varied in terms of the traveller's demography, travel destination and travel purpose. As such, a higher proportion of foreign travellers had blood/sexually transmitted diseases (89.85%, 2832 of 3152), while Chinese citizens had a higher prevalence of vector-borne diseases (85.98%, 19 247 of 22 387) and gastrointestinal diseases (79.36%, 1115 of 1405). The highest incidence rate was observed amongst travellers arriving from Africa, while the lowest was observed amongst travellers arriving from Europe. CONCLUSIONS: The findings might help in preparing recommendations for travellers and also aid in primary care or other clinics that prepare travellers before trips abroad. The findings will also help to identify locations and the associated types of infections that might require attention.

The efficacy assessment of convalescent plasma therapy for COVID-19 patients: a multi-center case series.

Convalescent plasma (CP) transfusion has been indicated as a promising therapy in the treatment for other emerging viral infections. However, the quality control of CP and individual variation in patients in different studies make it rather difficult to evaluate the efficacy and risk of CP therapy for coronavirus disease 2019 (COVID-19). We aimed to explore the potential efficacy of CP therapy, and to assess the possible factors associated with its efficacy. We enrolled eight critical or severe COVID-19 patients from four centers. Each patient was transfused with 200-400 mL of CP from seven recovered donors. The primary indicators for clinical efficacy assessment were the changes of clinical symptoms, laboratory parameters, and radiological image after CP transfusion. CP donors had a wide range of antibody levels measured by serology tests which were to some degree correlated with the neutralizing antibody (NAb) level. No adverse events were observed during and after CP transfusion. Following CP transfusion, six out of eight patients showed improved oxygen support status; chest CT indicated varying degrees of absorption of pulmonary lesions in six patients within 8 days; the viral load was decreased to a negative level in five patients who had the previous viremia; other laboratory parameters also tended to improve, including increased lymphocyte counts, decreased C-reactive protein, procalcitonin, and indicators for liver function. The clinical efficacy might be associated with CP transfusion time, transfused dose, and the NAb levels of CP. This study indicated that CP might be a potential therapy for severe patients with COVID-19.

Ecological risk assessment of heavy metals in fish from the Dianchi Lake, China using the integrated biomarker response approach.

This study used the integrated biomarker response (IBR) index approach to assess the ecological risks of heavy metals in different regions of Dianchi Lake, combined with active monitoring and passive monitoring. The contents of five heavy metals (Cu, As, Cd, Hg, and Pb) and six biomarkers (acetylcholinesterase, sodium-potassium ATPase, metallothionein, superoxide dismutase, glutathione peroxidase, and malondialdehyde) in the muscles of crucians (Carassius auratus) were measured to calculate the IBR value. The results indicate that the contents of heavy metal in the fish under active monitoring and passive monitoring were rather low and did not exceed the National Food Safety Standards of China. The IBR value of day 14 of active monitoring correlated with the heavy metal Cd content in the fish, suggesting a potential risk of Cd pollution in the aquatic environment of Dianchi Lake. The IBR values obtained for different regions of the lake on day 14 can be arranged in the following order: West S3 (9.24) > East S1 (3.97) > South S2 (2.39) > North S4 (0.36). These results suggest a potential risk of heavy metal contamination in the western part of Dianchi Lake.

Access to Direct-Acting Antiviral Treatment for Hepatitis C Virus Among Veterans With Serious Mental Illness.

OBJECTIVE: This study examined whether serious mental illness is associated with initiating and with completing sofosbuvir-based treatment for hepatitis C virus (HCV) among veterans who started treatment after the Veterans Health Administration (VHA) received expanded funding for HCV care. METHODS: Administrative health care data from fiscal years 2016-2017 revealed 4,288 treatment-naïve patients with HCV, of whom 1,311 had initiated sofosbuvir-based treatment. Dependent variables were initiation and completion of ≥8 weeks of sofosbuvir treatment. Associations with serious mental illness were estimated with adjusted odds ratios from multivariable logistic regression analyses. RESULTS: No statistically significant differences were found in the proportion of veterans with and veterans without serious mental illness who initiated (p=0.628) or completed ≥8 weeks (p=0.301) of sofosbuvir treatment. CONCLUSIONS: Veterans with and without serious mental illness initiated and completed sofosbuvir treatment at similar rates. The VA should continue to provide equitable access to HCV treatments and support medication adherence.

Ethnic disparities in prevalence and clustering of cardiovascular disease risk factors in rural Southwest China.

BACKGROUND: This study examines how prevalence and clustering of cardiovascular disease (CVD) risk factors differ by ethnicity and socioeconomic status (SES) among rural southwest Chinese adults. METHODS: A cross-sectional survey of 7027 adults aged ≥35 years of Han and four ethnic minority group descent (Na Xi, Li Shu, Dai, and Jing Po) was used to derive prevalence of tobacco smoking and exposure to secondhand smoke (SHS) as well as alcohol consumption and physical activity data. Anthropometric measurements were also taken, including height, weight, and waist and hip circumference, as well as blood pressure (BP) and fasting blood glucose (FBG) measurements. RESULTS: Current smoking and drinking status were the top two CVD risk factors in the study population. Dai ethnic minority participants had the highest prevalence of hypertension, obesity, and central obesity, whereas Jing Po ethnic minority participants had the highest prevalence of current smoking status, SHS exposure, and current drinking status (P < 0.01). Han participants had the highest prevalence of diabetes and physical inactivity (P < 0.01). 11.1% of all participants did not have any of the studied CVD risk factors, while 68.6% of Han, 60.2% of Na Xi, 50.7% of Li Shu, 82.2% of Dai, and 73.0% of Jing Po participants had clustering of two or more CVD risk factors. Prevalence of CVD risk factor clusters increased with age (P < 0.01). Males and individuals with lower education levels and lower annual household income were more likely to have CVD risk factors than their counterparts (P < 0.01). CONCLUSION: Clustering of CVD risk factors is common in rural southwest China. Ethnicity and individual SES significantly impact prevalence of CVD risk factors and their clustering.

Soil contamination with antibiotics in a typical peri-urban area in eastern China: Seasonal variation, risk assessment, and microbial responses.

The prevalence and persistence of antibiotics in soils has become an emerging environmental issue and an increasing threat to soil security and global public health. The problem is more severe in areas undergoing rapid urbanization; however, the ecological risks of antibiotics, seasonal variability, and associated soil microbial responses in peri-urban soils have not been well-explored. The seasonal soil sampling campaigns were conducted in a typical peri-urban watershed in eastern China to investigate distribution of antibiotics. The results demonstrated higher mean concentrations of most antibiotic compounds in winter than in summer in peri-urban soils. The seasonal variations of norfloxacin, enrofloxacin, and ciprofloxacin were more significant than those of other antibiotics, due to their higher migration ability and bioavailability. An ecological risk assessment demonstrated that chlortetracycline, ciprofloxacin, doxycycline, and ofloxacin can pose high risks to soil microorganisms. Furthermore, the coexistence of multiple antibiotics obviously poses higher risks than individual compounds. A redundancy analysis demonstrated that tetracyclines mainly showed negative correlations with Firmicutes and Chloroflexi, and quinolones showed obviously negative correlations with Acidobacteria, Gemmatimonadetes, and Nitrospirae, suggesting potential inhibition from antibiotics on biological activities or biodegradation processes. However, the persistence of antibiotics in soil results in a significant decrease in bacterial diversity and a change in dominant species. Our results provide an overview of the seasonal variability of antibiotics and the associated effects on bacterial communities in peri-urban soils. The results can provide scientific guidance on decreasing soil contamination with antibiotics to enhance soil security in similar areas.

Health risk assessment of heavy metals in Cyprinus carpio (Cyprinidae) from the upper Mekong River.

The purposes of this research are to quantify the concentration of heavy metals (Zn, Cu, As, Pb, Cd, and Hg) in the water and fish tissues of common carp (Cyprinus carpio) in the upper Mekong River and to thereby elucidate the potential dietary health risks from fish consumption of local residents. Surface water and fish tissues (gill, muscle, liver, and intestine) from four representative sample areas (influence by a cascade of four dams) along the river were analyzed for heavy metal concentrations. Results revealed that the levels of heavy metals in fish were tissue-dependent. The highest Cu and As levels were found in the liver; the highest Zn and Pb levels occurred in the intestine, and the highest Hg level was found in the muscle. The total target hazard quotient (THQ) value for residents is > 1 for long-term fish consumption, and local residents are, therefore, exposed to a significant health risk. Results from the current study provide an overall understanding of the spatial and tissue distribution of heavy metals in water and fish body along the upper Mekong River under the influence of cascade dams and highlight the potential health risk of As for the local residents of long-term fish consumption.

Identification of Copy Number Variants from SNP Arrays Using PennCNV.

High-resolution single-nucleotide polymorphism (SNP) genotyping arrays offer a sensitive and affordable method for genome-wide detection of copy number variants (CNVs). PennCNV is a hidden Markov model (HMM)-based CNV caller for SNP arrays, first released 10 years ago. A typical CNV calling procedure using PennCNV includes preparation of input files, CNV calling, filtering CNV calls, CNV annotation, and CNV visualization. Here we describe several protocols for CNV calling using PennCNV, together with descriptions on several recent improvements to the software tool.

Physical activity and chronic diseases among older people in a mid-size city in China: a longitudinal investigation of bipolar effects.

BACKGROUND: While previous studies have shown that regular physical activity can delay the onset of certain chronic diseases; less is known about the changes in physical activity practices following chronic disease diagnoses. China is experiencing a rapid aging transition, with physical activity an important routine in many older people's lives. This study utilizes the Health Belief Model to better understand the bidirectional relationships and bipolar effects between physical activity and chronic disease burden in Huainan City, a mid-sized city in China. METHODS: Longitudinal health survey data (2010-2015) from annual clinic visits for 3198 older people were obtained from a local hospital, representing 97% of the older population in three contiguous neighborhoods in Huainan City. The chronic diseases studied included obesity, hypertension, diabetes, hyperlipidemia, cardiovascular diseases, liver and biliary system diseases, and poor kidney function. Multilevel logistic regression was used to examine differences in physical activity levels across socio-demographic groups. Cox proportional hazards models were used to examine the impacts of physical activity practice levels on chronic disease onsets. Logistic regression was used to estimate the effects of chronic disease diagnosis on physical activity practice levels. RESULTS: The prevalence of chronic diseases increased with increasing age, among men, and those with a lower education. Older people who were physically active experienced a later onset of chronic disease compared to their sedentary counterparts, particularly for obesity and diabetes. Following diagnosis of a chronic disease, physically active older people were more likely to increase their physical activity levels, while sedentary older people were less likely to initiate physical activity, demonstrating bipolar health trajectory effects. CONCLUSIONS: Health disparities among older people may widen as the sedentary experience earlier onsets of chronic diseases and worse health trajectories, compared to physically active people. Future health education communication and programmatic interventions should focus on sedentary and less healthy older populations to encourage healthy aging. These lessons from China may be applied to other countries also experiencing an increasing aging population.

An Assessment of the Impact of Land Thermal Infrared Observation on Regional Weather Forecasts Using Two Different Data Assimilation Approaches.

Recent studies have shown the unique value of satellite-observed land surface thermal infrared (TIR) information (e.g., skin temperature) and the feasibility of assimilating land surface temperature (LST) into land surface models (LSMs) to improve the simulation of land-atmosphere water and energy exchanges. In this study, two different types of LST assimilation techniques are implemented and the benefits from the techniques are compared. One of the techniques is to directly assimilate LST using ensemble Kalman filter (EnKF) data assimilation (DA) utilities. The other is to use the Atmosphere-Land Exchange Inversion model (ALEXI) as an "observation operator" that converts LST retrievals into the soil moisture (SM) proxy based on the ratio of actual to potential evapotranspiration (fPET), which is then assimilated into an LSM. While most current studies have shown some success in both directly the assimilating LST and assimilating ALEXI SM proxy into offline LSMs, the potential impact of the assimilation of TIR information through coupled numerical weather prediction (NWP) models is unclear. In this study, a semi-coupled Land Information System (LIS) and Weather Research and Forecast (WRF) system is employed to assess the impact of the two different techniques for assimilating the TIR observations from NOAA GOES satellites on WRF model forecasts. The NASA LIS, equipped with a variety of LSMs and advanced data assimilation tools (e.g., the ensemble Kalman Filter (EnKF)), takes atmospheric forcing data from the WRF model run, generates updated initial land surface conditions with the assimilation of either LST- or TIR-based SM and returns them to WRF for initializing the forecasts. The WRF forecasts using the daily updated initializations with the TIR data assimilation are evaluated against ground weather observations and re-analysis products. It is found that WRF forecasts with the LST-based SM assimilation have better agreement with the ground weather observations than those with the direct LST assimilation or without the land TIR data assimilation.

Consumer satisfaction with antipsychotic medication-monitoring appointments: the role of consumer-prescriber communication patterns.

OBJECTIVE: The study was designed to explore patterns of prescriber communication behaviors as they relate to consumer satisfaction among a serious mental illness sample. METHODS: Recordings from 175 antipsychotic medication-monitoring appointments between veterans with psychiatric disorders and their prescribers were coded using the Roter Interaction Analysis System (RIAS) for communication behavioral patterns. RESULTS: The frequency of prescriber communication behaviors (i.e., facilitation, rapport, procedural, psychosocial, biomedical, and total utterances) did not reliably predict consumer satisfaction. The ratio of prescriber to consumer utterances did predict consumer satisfaction. CONCLUSIONS: Consistent with client-centered care theory, antipsychotic medication consumers were more satisfied with their encounters when their prescriber did not dominate the conversation. PRACTICE IMPLICATIONS: Therefore, one potential recommendation from these findings could be for medication prescribers to spend more of their time listening to, rather than speaking with, their SMI consumers.

Great Disparity in Photoluminesence Quantum Yields of Colloidal CsPbBr3 Nanocrystals with Varied Shape: The Effect of Crystal Lattice Strain.

Understanding the big discrepancy in the photoluminesence quantum yields (PLQYs) of nanoscale colloidal materials with varied morphologies is of great significance to its property optimization and functional application. Using different shaped CsPbBr3 nanocrystals with the same fabrication processes as model, quantitative synchrotron radiation X-ray diffraction analysis reveals the increasing trend in lattice strain values of the nanocrystals: nanocube, nanoplate, nanowire. Furthermore, transient spectroscopic measurements reveal the same trend in the defect quantities of these nanocrystals. These experimental results unambiguously point out that large lattice strain existing in CsPbBr3 nanoparticles induces more crystal defects and thus decreases the PLQY, implying that lattice strain is a key factor other than the surface defect to dominate the PLQY of colloidal photoluminesence materials.

Heterogeneous water supply affects growth and benefits of clonal integration between co-existing invasive and native Hydrocotyle species.

Spatial patchiness and temporal variability in water availability are common in nature under global climate change, which can remarkably influence adaptive responses of clonal plants, i.e. clonal integration (translocating resources between connected ramets). However, little is known about the effects of spatial patchiness and temporal heterogeneity in water on growth and clonal integration between congeneric invasive and native Hydrocotyle species. In a greenhouse experiment, we subjected severed or no severed (intact) fragments of Hydrocotyle vulgaris, a highly invasive species in China, and its co-existing, native congener H. sibthorpioides to different spatial patchiness (homogeneous and patchy) and temporal interval (low and high interval) in water supply. Clonal integration had significant positive effects on growth of both species. In the homogeneous water conditions, clonal integration greatly improved the growth in fragments of both species under low interval in water. However, in the patchy water conditions, clonal integration significantly increased growth in both ramets and fragments of H. vulgaris under high interval in water. Therefore, spatial patchiness and temporal interval in water altered the effects of clonal integration of both species, especially for H. vulgaris. The adaptation of H. vulgaris might lead to invasive growth and potential spread under the global water variability.

Stigma: a Unique Source of Distress for Family Members of Individuals with Mental Illness.

To distinguish the impact of mental illness stigma from that of other negative caregiving experiences, this study examined the unique relationships between stigma and caregiver/family functioning. Adult relatives (n = 437) of individuals with mental illness completed questionnaires regarding caregiving experiences, distress, empowerment, and family functioning, as part of a larger study. Regression analyses examined the relationship between stigma and caregiver/family variables, while controlling for other negative caregiving experiences. Stigma was uniquely associated with caregiver distress, empowerment, and family functioning. Mental illness stigma is a potent source of distress for families and an important target of family services.

Type D personality is associated with delaying patients to medical assessment and poor quality of life among rectal cancer survivors.

OBJECTIVE: The aim of this research was to explore quality of life (QoL), mental health status, type D personality, symptom duration, and emergency admissions of Chinese rectal cancer patients as well as the relationship between these factors. METHODS: Type D personality was measured with the 14-item Type D Personality Scale (DS14). Mental health status was measured with the Hospital Anxiety and Depression Scale (HADS). The QoL outcomes were assessed longitudinally using the European Organization for Research and Treatment of Cancer QLQ-C30 and QLQ-CR38 questionnaires at the baseline and 6 months after diagnosis. RESULTS: Of the 852 survivors who responded (94 %), 187 (22 %) had a type D personality. The proportion of patients with duration of symptoms >1 month and being diagnosed after emergency admissions in type D group is significantly higher than that in non-type D group. At both of the time points, type D patients reported statistically significant lower scores on most of the functional scales, global health status/QoL scales, and worse symptom scores compared to patients without a type D personality. At the 6-month time point, a higher percentage of patients in the type D group demonstrated QoL deterioration. Clinically elevated levels of anxiety and depression were more prevalent in type D than in non-type D survivors. CONCLUSIONS: Type D personality was associated with poor QoL and mental health status among survivors of rectal cancer, even after adjustment for confounding background variables. Type D personality might be a general vulnerability factor to screen for subgroups at risk for longer symptom duration and emergency admissions in clinical practice.

A national assessment of the epidemiology of severe fever with thrombocytopenia syndrome, China.

First discovered in rural areas of middle-eastern China in 2009, severe fever with thrombocytopenia syndrome (SFTS) is an emerging tick-borne zoonosis affecting hundreds of cases reported in China each year. Using the national surveillance data from 2010 to 2013, we conducted this retrospective epidemiological study and risk assessment of SFTS in China. We found that the incidence of SFTS and its epidemic areas are continuing to grow, but the case fatality rate (CFR) has steadily decreased. SFTS most commonly affected elderly farmers who acquired infection between May and July in middle-eastern China. However, other epidemiological characteristics such as incidence, sex ratio, CFR, and seasonality differ substantially across the affected provinces, which seem to be consistent with local agricultural activities and the seasonal abundance of ticks. Spatial scan statistics detected three hot spots of SFTS that accounted for 69.1% of SFTS cases in China. There was a strong association of SFTS incidence with temporal changes in the climate within the clusters. Multivariate modeling identified climate conditions, elevation, forest coverage, cattle density, and the presence of Haemaphysalis longicornis ticks as independent risk factors in the distribution of SFTS, based on which a predicted risk map of the disease was derived.