Enhanced clinical assessment of hematologic malignancies through routine paired tumor and normal sequencing.

Genomic profiling of hematologic malignancies has augmented our understanding of variants that contribute to disease pathogenesis and supported development of prognostic models that inform disease management in the clinic. Tumor only sequencing assays are limited in their ability to identify definitive somatic variants, which can lead to ambiguity in clinical reporting and patient management. Here, we describe the MSK-IMPACT Heme cohort, a comprehensive data set of somatic alterations from paired tumor and normal DNA using a hybridization capture-based next generation sequencing platform. We highlight patterns of mutations, copy number alterations, and mutation signatures in a broad set of myeloid and lymphoid neoplasms. We also demonstrate the power of appropriate matching to make definitive somatic calls, including in patients who have undergone allogeneic stem cell transplant. We expect that this resource will further spur research into the pathobiology and clinical utility of clinical sequencing for patients with hematologic neoplasms.

Resource saving and carbon footprint reduction potential of urban symbiosis strategy in express packaging waste recycling network.

The booming express delivery industry corresponds to the environmental challenges caused by massive express packaging waste (EPW). An efficient logistics network is necessary link to support EPW recycling. This study, therefore, designed a circular symbiosis network for EPW recycling based on urban symbiosis strategy. The treatment of EPW in this network includes reuse, recycling and replacing. An optimization model with multi-depot collaboration combining material flow analysis and optimization methods was developed and a hybrid non-dominated sorting genetic algorithm-II (NSGA-II) was designed as technical support for designing the circular symbiosis network while quantitatively assessing the economic and environmental benefits of the network. The results show that the designed circular symbiosis option has better resource saving and carbon footprint reduction potential than both the business as usual option and circular symbiosis option without service collaboration. In practice, the proposed circular symbiosis network can save EPW recycling costs and reduce carbon footprint. This study provides a practical guideline for the application of urban symbiosis strategies to help urban green governance and the sustainable development of express companies.

Water-Energy-Carbon Nexus: Greenhouse Gas Emissions from Integrated Urban Drainage Systems in China.

Greenhouse gas (GHG) emissions from integrated urban drainage systems (IUDSs), including sewer, wastewater treatment plants (WWTPs), and receiving water systems, have not yet been integrated due to the lack of modeling tools. Here, we updated the computable general equilibrium-based System Dynamics and Water Environmental Model (CGE-SyDWEM), a recently developed model simulating the water-energy-carbon nexus at the watershed level, to calculate the direct and indirect (electricity use and external) GHG emissions from IUDSs considering carbon mitigation strategies and water engineering practices. The updated CGE-SyDWEM was applied to an estuary watershed in Shenzhen, the fourth largest city in China. With increasing socio-economic development and water infrastructure systems upgrading, GHG emissions are projected to increase from 129.2 (95% CI: 95.9-162.5) kt in 2007 to 190.7 (144.8-236.6) kt in 2025, with 89% from WWTPs (direct: 17%; electricity use: 65%; and external: 7%), 10% from the sewer (direct: 1% and electricity use: 9%) and 1% from receiving waters (direct). Carbon mitigation can reduce GHG emissions by 7% and emission intensity by 6% by 2025, with 63% contributed by external emission reduction from chemical uses. The integrated model can aid water, energy, and carbon decision-makers in finding cost-effective solutions for water and energy security in the future.

Research progress on source, risk assessment, and management of emerging pollutants in drinking water.

With the extensive production and use of various chemicals, emerging pollutants including environmental endocrine disrupting chemicals, perfluoro chemicals, antibiotics, and microplastics have been continuously entering the environment, and spread to water through multiple pathways. The pollution of these emerging pollutants raised continuous concerns for the safety of drinking water, threating the ecological environment and human health. In combination with international research progress, we discussed in detail about pollution, source, and risk assessment of emerging pollutants in drinking water. We further suggested and prospected the challenge of environmental management of emerging pollutants. This review could promote the public's understanding of emerging pollutants, and provide theoretical support for risk prevention and treatment of emerging pollutants in drinking water.

Effectiveness of early essential newborn care implementation in four counties of western China.

BACKGROUND: Neonatal survival is a public health concern globally. However, the regional disparity in neonatal mortality between rural counties of western China and urban areas of eastern provinces remains high. Early essential newborn care (EENC), recommended by World Health Organization, refers to a set of cost-effective interventions to improve neonatal health and development outcomes. In this study, we aimed to explore the effectiveness of EENC implementation in four counties of western China. METHODS: Pre- and post-intervention investigations were conducted in four selected EENC intervention counties and four control counties of four western provinces of China, from June to August 2017 and from December 2020 to April 2021 respectively. A mixed quantitative and qualitative approach was used for data collection and analysis. Data on the coverage of EENC practices were collected via a post-intervention face-to-face questionnaire survey with postpartum mothers before hospital discharge. Hospital-reported data on neonatal health indicators were obtained through mail surveys in both investigations. We also performed semi-structured interviews with policymakers, health staff and postpartum mothers to understand their perceptions about the usefulness of EENC implementation. RESULTS: Overall, 599 mother-newborn pairs in the intervention group and 699 pairs in the control group participated in the post-intervention survey. Controlling for the confounding factor of province, the proportion of newborns receiving EENC interventions was higher in the intervention group than in the control group (P < 0.05). Intervention groups in four provinces had higher coverage of: any skin-to-skin contact (99.50% vs. 49.07%); early breastfeeding initiation (within 60 min of birth) (90.84% vs. 80.35%); no medicine applied to the umbilical cord (98.50% vs. 9.73%); routine eye care (93.16% vs. 8.73%); and vitamin K1 administration (98.33% vs. 88.98%). EENC implementation was associated with decreased risk of neonatal diarrhea (OR: 0.326, 95% CI: 0.123, 0.865) and eye infection (OR: 0.147, 95% CI: 0.045, 0.483). Policymakers, health staff and postpartum mothers expressed satisfaction with the EENC interventions, noting a willingness among staff and policymakers to implement and sustain these interventions; the promotion of these interventions within hospital policy; the positive emotions experienced by postpartum mothers; perceived improvements in health; and improvements in support for health workers. CONCLUSION: EENC-recommended core practices (except kangaroo mother care) have been successfully introduced in pilot hospitals. The efficacy of EENC implementation should be highly recognized to accelerate the progress towards its national roll out.

Burden of Prostate Cancer in China, 1990-2019: Findings From the 2019 Global Burden of Disease Study.

Our study is the first to illustrate the age and geographic distribution differences in the epidemiology of prostate cancer from 1990 to 2019 in China. Prostate cancer (PC) is a malignant tumor derived from prostate epithelial cells and is one of the most commonly diagnosed cancers in men. In recent years, the global incidence and the annual deaths number of PC showed a continuous increase, which has caused a huge disease burden on human health. In terms of the global average, the incidence and mortality of PC in China are relatively low. However, the age-standardized incidence rate of PC was 17.3/100,000 in 2019 in China, with a 95.2% rise compared to 1990, while the global growth rate of incidence rate over the same period is 13.2%. This showed that the development trend of PC in China is not optimistic. There are few precise studies on the epidemiology of PC in China. After the general analysis strategy used in the Global Burden of Diseases, Injuries and Risk Factors Study (GBD) 2019, we elaborated on the incidence, mortality, and disability-adjusted life-years (DALYs) and the corresponding age-standardized rate of the Chinese PC population from 1990 to 2019 according to different ages and provinces. We used joinpoint regression analysis to estimate the incidence and mortality trends. Our analysis shows that elderly people over 80 are still the main focus of incidence and death. The epidemiology and disease burden of PC of different provinces in China show obvious regional differences, and some certain provinces such as HongKong, Macao, and Zhejiang should be paid more attention. More targeted and effective strategies should be developed to reduce the burden of PC in China.

Health Inequalities of STEMI Care Before Implementation of a New Regional Network: A Prefecture-Level Analysis of Social Determinants of Healthcare in Yunnan, China.

BACKGROUND: As one of the most serious types of coronary heart disease, ST-elevation myocardial infarction (STEMI) faces huge challenges in the equal management and care of patients due to its life-threatening and time-critical condition. Health inequalities such as sex and age differences in STEMI care have been reported from developed countries. However, limited outcomes have been investigated and the major drivers of inequality are still unclear, especially in under-developed areas. This study aimed to explore the major drivers of health inequalities in STEMI care before implementation of a new regional network in the south-west of China. METHODS: Prefecture-level data of STEMI patients before the implementation of a regional network were analysed retrospectively. Drivers of inequality were identified from six social determinants of health, namely area of residence, ethnicity, sex, age, education and occupation. Outcomes of STEMI care included timely presentation, reperfusion therapy, timely reperfusion therapy, heart failure, inpatient mortality, length of hospital stay, hospital costs, and various intervals of ischaemic time. RESULTS: A total of 376 STEMI patients in the research area before implementation of the STEMI network were included. Compared with urban residents, rural patients were significantly less likely to have timely presentation (odds ratio [OR]=0.47, 95% CI: 0.28-0.80, P=.004) and timely reperfusion therapy (OR=0.32, 95% CI: 0.14-0.70, P=.005). Rural residents were less likely to present to hospital promptly than urban residents (HR=0.65, 95% CI=0.52-0.82, P<.001). In the first 3 hours of percutaneous coronary intervention (PCI) reperfusion delay and first 6 hours of total ischaemic time, rural patients had a significantly lower probability to receive prompt PCI (hazard ratio [HR]=0.40, 95% CI: 0.29-0.54, P<.001) and reperfusion therapy (HR=0.37, 95% CI: 0.25-0.56, P<.001) compared to urban patients. CONCLUSION: Rural residents were a major vulnerable group before implementation of the regional STEMI network. No obvious inequalities in ethnicity, sex, age, education or occupation existed in STEMI care in Chuxiong Prefecture of China.

Assessment on water resources carrying capacity in karst areas by using an innovative DPESBRM concept model and cloud model.

The shortage of water resources in karst areas is mainly caused by the development of karst landforms, poor availability of water resources and the difficulty of utilization. To reasonably evaluate water resources carrying capacity (WRCC) of karst areas, based on characteristics of urban water resources utilization in karst areas, this study put forward DPESBRM (Driver-Pressure-Engineering water shortage-State-Ecological basis-Response-Management) concept model the first time to build an urban evaluation index system of WRCC in karst areas. Based on this index system and in allusion to uncertainties that exist during the evaluation process, a cloud model is used to represent index weights and perform comprehensive evaluation calculations, which fully considers the randomness and ambiguity of evaluation objects. WRCC from 2009 to 2018 were evaluated and were classified as five grades (Serious overload - Overload - Critical - Weak carrying capacity - Strong carrying capacity). Results proved that WRCC had improved year after year, gradually changing from a serious overload state in 2009 to a strong carrying capacity state in 2018. 2009 and 2016 were classified as I grade (serious overload). 2010 and 2011 were classified as II grade (overload). 2012, 2013 and 2015 were classified as IV grade (weak bearing capacity). 2014, 2017 and 2018 were classified as V grade (strong bearing capacity). Cloud model assessment results are compared with that of TOPSIS method, and assessment results are basically unanimous. It shows that the established WRCC evaluation method based on cloud model in this study is reasonable and feasible. Population density, urbanization rate and per capital water consumption are important driving factors affecting WRCC. Hence, strengthening the construction of water conservancy facilities, optimizing the water consumption structure, improving the efficiency of industrial water use, reducing per capital water consumption, and narrowing urban water supply and demand gap are important measures to ensure WRCC.

Assessment and determinants of global outcomes among 445 mass-casualty burn survivors: A 2-year retrospective cohort study in Taiwan.

PURPOSE: To study outcomes among survivors of the mass-casualty powder explosion on 27 June 2015, at Formosa Fun Coast Waterpark, New Taipei City, Taiwan. METHODS: Using retrospective data on Taiwanese survivors, we analyzed prehospital management, burns assessment and prognosis, functional recovery, and medical costs, followed-up through 30 June 2017. We related outcomes to burn extent, categorized according to the percentages of total body surface area with second/third-degree burns (%TBSA) or autologous split-thickness skin grafts (%STSG), and an investigational scale: f{SASG} = (%TBSA + %STSG)/2, stratified by %STSG. Analyses included casualty dispersal, comparisons between %TBSA, %STSG and f{SASG}, and their relationships with length of hospitalization, times to rehabilitation and social/school re-entry, physical/mental disability, and medical costs. We also investigated how burn scars restricting joint mobility affected rehabilitation duration. RESULTS: 445 hospitalized casualties (excluding 16 foreigners, 23 with 0% TBSA and 15 fatalities) aged 12-38 years, had mean TBSA of 41.1%. Hospitalization and functional recovery durations correlated with %TBSA, %STSG and f{SASG} - mean length of stay per %TBSA was 1.5 days; more numerous burn scar contractures prolonged rehabilitation. Females had worse burns than males, longer hospitalization and rehabilitation, and later school/social re-entry; at follow-up, 62.3% versus 37.7% had disabilities and 57.7% versus 42.3% suffered mental trauma (all p ≤ 0.001). Disabilities affecting 225/227 people were skin-related; 34 were severely disabled but 193 had mild/moderate impairments. The prevalence of stress-related and mood disorders increased with burn extent. Treatment costs (mean USD-equivalents ∼$48,977/patient, ∼$1192/%TBSA) increased with burn severity; however, the highest %TBSA, %STSG and f{SASG} categories accounted for <10% of total costs, whereas TBSA 41-80% accounted for 73.2%. CONCLUSIONS: Besides %TBSA, skin-graft requirements and burn scar contractures are complementary determinants of medium/long-term outcomes. We recommend further elucidation of factors that influence burn survivors' recovery, long-term physical and mental well-being, and quality of life.

Budget impact analysis of osteoporosis medications for primary prevention of fractures in Taiwan.

INTRODUCTION: Taiwan's national health insurance currently only covers the use of osteoporosis drugs for the secondary prevention of fractures and does not provide coverage for primary prevention. The purpose of this study is to develop a model for analyzing the budgetary impact of the use of osteoporosis medications of primary prevention. METHODS: The budget impact model in this study is the "actual medication cost" minus the "medical expenses for all types of fractures that can be avoided by taking osteoporosis medications." We developed six possible insurance payment plans for primary prevention based on the age of the patients and T-scores and performed eleven steps to estimate the budget impact of each payment plan. RESULTS: The results of this study indicated that there may be 71,220 (T-score ≤ - 3.0, 75 + y/o) to 157,515 (T-score ≤ - 2.5, 65 + y/o) people using the drugs, and the budget impact may be US$26.28-58.98 million in 2019. However, the payment plans may avoid 492-766 fracture events and save medical expenditures for fracture treatment by US$1.30-2.02 million. The average costs for primary prevention within a year will be US$53,386-77,006. CONCLUSION: The budget impact of using osteoporosis medications to primary prevention of fractures is significant, but it can be compensated due to savings in fracture treatment costs.

Burden of melanoma in China, 1990-2017: Findings from the 2017 global burden of disease study.

Melanoma is an aggressive form of skin cancer, and a worldwide problem with increasing incidence. Little is known about the burden of melanoma in the Chinese population. We evaluated temporal trends and geographic variation in melanoma-associated burden, to narrow an important knowledge gap concerning the consequences of this disorder across time, provinces in China. After the general analytic strategy used in the 2017 Global Burden of Disease study, we analyzed the incidence, mortality, prevalence and disability-adjusted life-years (DALYs) of melanoma, by age, sex and geography from 1990 to 2017. Levels in melanoma burden were assessed for 33 province-level administrative units between 1990 and 2017. We used joinpoint regression analysis to estimate the slope of incidence and mortality trends. The age-standardized incidence rate of melanoma was 0.9 per 100,000 in 2017, with a 110.3% rise compared to 1990. Although the age-standardized DALYs rate (per 100,000) decreased from 9.1 in 1990 to 7.6 in 2017, it showed an upward trend from 2007 to 2017. The DALYs rate increased steadily with age for females while increased and peaked at 55-59 years for males. The incidence of melanoma was higher in the clustered eastern provinces than western provinces, while the DALYs showed a pattern in opposite direction. In China, there has been a substantial increase in the burden of melanoma over the last decade, representing an ongoing challenge in Chinese population. More targeted strategies should be developed for elderly population, especially for females, to reduce the melanoma burden throughout China, particularly the western provinces.

Burden of headache disorders in China, 1990-2017: findings from the Global Burden of Disease Study 2017.

BACKGROUND: Headache has emerged as a global public health concern. However, little is known about the burden from headache disorders in China. The aim of this work was to quantify the spatial patterns and temporal trends of burden from headache disorders in China. METHODS: Following the general analytic strategy used in the 2017 Global Burden of Disease study, we analyzed the prevalence and years lived with disability (YLDs) of headache and its main subcategories, including migraine and tension-type headache (TTH), by age, sex, year and 33 province-level administrative units in China from 1990 to 2017. RESULTS: Almost 112.4 million individuals were estimated to have headache disorders in 1990 in China, which rose to 482.7 million in 2017. The all-age YLDs increased by 36.2% from 1990 to 2017. Migraine caused 5.5 million YLDs, much higher than TTH (1.1 million) in 2017. The age-standardized prevalence and YLDs rate of headache remained stable and high in 2017 compared with 1990, respectively. The proportion of total headache YLDs in all diseases increased from 1990 to 2017 by 5.4%. A female preponderance was observed for YLDs and the YLDs were mainly in people aged 20~54 years. CONCLUSIONS: Headache remains a huge health burden in China from 1990 to 2017, with prevalence and YLDs rates higher in eastern provinces than western provinces. The substantial increase in headache cases and YLDs represents an ongoing challenge in Chinese population. Our results can help shape and inform headache research and public policy throughout China, especially for females and middle-aged people.

Modeling the carbon-energy-water nexus in a rapidly urbanizing catchment: A general equilibrium assessment.

Energy and water systems are interdependent and have complex dynamic interactions with the socio-economic system and climate change. Few tools exist to aid decision-making regarding the management of water and energy resources at a watershed level. In this study, a Computable General Equilibrium (CGE) model and System Dynamics and Water Environmental Model (SyDWEM) were integrated (CGE-SyDWEM) to predict future energy use, CO2 emissions, economic growth, water resource stress, and water quality change in a rapidly urbanizing catchment in China. The effects of both the CO2 mitigation strategies and water engineering measures were evaluated. CO2 mitigation strategies have the potential to reduce 46% CO2 emissions and 41% energy use in 2025 compared with reference scenario. CO2 mitigation strategies are also found to be effective in promoting industrial structure adjustment by decreasing the output of energy- and water-intensive industries. Accordingly, it can alleviate local water stress and improve water environment, including a 4.1% reduction in both domestic water use and pollutant emissions, a 16.8% water demand reduction in the labor-intensive industry sector, and 4.2% and 4.4% decrease in BOD5 and NH3-N loads in all industrial sectors, respectively. It is necessary to implement water engineering measures to further alleviate water resource stress and improve water quality. This study improves the understanding of the feedbacks of CO2 abatement on water demand, pollutant discharges, and water quality improvement. The integrated model developed in this study can be used to aid energy, carbon, and water policy makers to understand the complicated synergistic effects of proposed CO2 mitigation strategies on water demand and pollution emissions, and to design more effective policies and measures to ensure energy and water security in the future.

A "Sit Less, Walk More" Workplace Intervention for Office Workers: Long-Term Efficacy of a Quasi-Experimental Study.

OBJECTIVE: This study tested the maintenance outcomes of a 3-month Sit Less, Walk More (SLWM) workplace intervention for office workers compared with usual care at 12 months from the baseline. METHOD: A quasi-experimental study was conducted in two workplaces. The intervention group (n = 51) received multi-component intervention and the comparison group (n = 50) received newsletters only. The outcomes of the study (self-reported psychosocial, physical activity, sitting, and lost productivity; objectively measured cardiometabolic biomarkers) were compared at baseline, 3, and 12 months. RESULTS: Generalized estimating equations analyses found that the intervention group had significant improvements in self-regulation for sitting less and moving more (P = 0.017), walking (P = 0.003), weight (P = 0.013), waist circumference (P = 0.002), and insulin (P = 0.000) at 12 months compared with the comparison group. CONCLUSION: The SLWM intervention was effective in improving self-regulation, walking, and some cardiometabolic biomarkers in office workers.

Evaluation of perioperative prophylaxis with fosfomycin tromethamine in ureteroscopic stone removal: an investigator-driven prospective, multicenter, randomized, controlled study.

PURPOSE: To compare efficacy, safety, and cost-effectiveness of fosfomycin tromethamine with other standard-of-care antibiotics in patients undergoing ureteroscopic lithotripsy. METHODS: This study was a prospective, multicenter, randomized, controlled trial. Eligible patients scheduled for ureteroscopic lithotripsy were randomly assigned to receive either fosfomycin (fosfomycin group, N = 101 patients) or standard-of-care antibiotic therapy as prophylaxis (control group, N = 115 patients). The incidence of infectious complications and adverse events was analyzed between the two groups, as well as the cost-benefit analysis. RESULTS: The incidence of infections following lithotripsy was 3.0% in the fosfomycin group and 6.1% in the control group (p > 0.05). Only asymptomatic bacteriuria was reported in fosfomycin group. In the control group was reported asymptomatic bacteriuria (3.5%), fever (0.9%), bacteremia (0.9%), and genitourinary infection (0.9%). The rate of adverse events was very low, with no adverse event reported in the fosfomycin group and only one in the control group (forearm phlebitis). The average cost per patient of antibiotic therapy with fosfomycin was 151.45 ± 8.62 yuan (22.7 ± 1.3 USD), significantly lower compared to the average cost per patient of antibiotics used in the control group 305.10 ± 245.95 yuan (45.7 ± 36.9 USD; p < 0.001). CONCLUSIONS: Two oral doses of 3 g fosfomycin tromethamine showed good efficacy and safety and low cost in perioperative prophylaxis of infections following ureteroscopic stone removal.

Spirometric prediction equations and the relationship between metabolic syndrome and spirometric parameters from an island in Fujian, China.

BACKGROUND: We investigated risk factors for decreased lung function among Chinese island residents (≥30 years) to determine the relationship between metabolic syndrome (MS) and decreased lung function. METHODS: From October 17, 2011 to November 1, 2011, 2607 residents aged ≥30 years who lived on the Huangqi Peninsula of Fujian were enlisted by random cluster sampling. They completed a questionnaire designed according to the Burden of Obstructive Lung Disease (BOLD) questionnaire, and underwent physical examination, blood test, and lung function evaluation. We constructed spirometric prediction equations for forced vital capacity (FVC) and forced expiratory volume in one second (FEV1), determined the lower limits of normal for FVC, FEV1 and FEV1/FVC, and examined the relationship between lung function and MS. RESULTS: Prediction equations for normal island residents were as follows: FVC (L) = -0.023 × age (years) + 0.042 × height (cm) + 0.641 × weight (kg) - 3.607 (males); FVC (L) = -0.017 × age (years) + 0.030 × height (cm) + 0.009 × weight (kg) - 1.741 (females); FEV1 (L) = -0.023 × age (years) + 0.040 × height (cm) + 0.010 × weight (kg) - 2.999 (males); FEV1 (L) = -0.017 × age (years) + 0.026 × height (cm) + 0.007 × weight (kg) -1.135 (females). The odds ratio for MS for increased risk of decreased FVC was 4.623 (95%CI =3.626-5.894, P<0.001), and for increased risk of decreased FEV1 was 3.043 (95%CI =2.447-3.785, P<0.001). CONCLUSIONS: MS is a risk factor for decreased lung function in island residents ≥30 years old.

Development and validation of a nutritional and nursing risk assessment method for diabetic patients.

The present study aimed to develop and evaluate a nutritional and nursing risk assessment method for diabetic inpatients to improve healthcare and risk management. Diabetic inpatients diagnosed according to the World Health Organization guidelines, together with their nursing staff, were divided into two groups for nutritional and nursing risk assessment. Data from one group were used to establish the assessment method, and data from the other group were used to evaluate the reliability and effectiveness of the method. To establish the method, various risk variables in the nutritional and nursing processes were evaluated by logistic regression analysis; the score and probability of the risk variables were determined based on odds ratios. The overall nutritional and nursing risk for individual inpatients was then judged by the accumulated scores. The analysis showed that there were a number of risk factors, including age and body mass index. The risk was shown to increase with increasing score for the inpatients, and the χ2 test (P<0.01) was used to indicate a significant association. When the score was 50, the sensitivity and specificity of the method used to detect the nutritional and nursing risk were 88.3 and 66.5%, respectively, with predictive positive and negative rates of 12.83 and 98.53%, respectively. Therefore, the method is simple, cost-effective and fast; it can be used to screen a large number of patients by nursing staff and can also be used by patients themselves. Overall, the method is an effective and practicable nutritional and nursing risk assessment and educational tool.

Antineuronal antibodies and infectious pathogens in severe acute pediatric encephalitis.

The pathogenesis of acute encephalitis is divided into either direct infection or by immune-mediated inflammation, but the cause is still unknown. This retrospective study aimed to screen antineuronal antibodies in children with severe acute encephalitis. Thirty-four children (22 boys and 12 girls) underwent assessments such as antineuronal antibodies survey for autoimmune encephalitis and polymerase chain reaction/viral culture and antibody assays for all commonly recognized causes of infectious encephalitis. Sixteen (47.1%) were positive for autoantibodies, including antiglutamic acid decarboxylase antibodies in 16 and voltage-gated potassium channel complex antibodies in 1. Sixteen patients (47.1%) had presumed infectious etiologies, including 6 with influenza, 6 with Mycoplasma pneumoniae, 3 with enterovirus, and 1 with herpes simplex virus. In this study, influenza and Mycoplasma pneumoniae infection are the main presumed causes of severe acute encephalitis in children, although an immune-mediated mechanism may also play a role.

Socioeconomic and clinical characteristics associated with repeat suicide attempts among young people.

PURPOSE: Repeat suicidal behaviors in young people are a critical public health concern. The study investigates individual socioeconomic and episode-dependent clinical factors predicting repeat suicide attempts among youth by gender. METHODS: Using a retrospective cohort study, we identified a total of 4,094 male and 3,219 female youths who had the index suicide episode at the ages of 15-24 years from the 1996-2007 National Health Insurance Research Database in Taiwan. The recurrence of suicide attempt was assessed within 1 year after the index suicide. Information pertaining to suicide management and postsuicide treatment was obtained from healthcare records. Repeated event survival analyses were used to estimate episode-dependent risk of suicide attempt. RESULTS: The occurrence of repeat suicide attempts was more common in males, yet the phenomenon of risk aggravation appears more prominent in females. The estimate for peak hazard of the second repeat attempt was 2-fold higher than that of the first repeat event in males, and approximately 6-fold in females. Socioeconomic (e.g., labor market participation: adjusted Hazard Ratio [aHR] = 1.14, 95% CI = 1.01-1.28) and index suicide management characteristics (e.g., receiving treatment at clinic, aHR = 1.54, 95% CI = 1.19-1.99) were found to play important roles for repeat suicide attempts in males. For females, postsuicide treatment of mental disorders appears more influential. CONCLUSIONS: The relationships between socioeconomic and clinical factors with repeat suicide attempts in young people vary by gender. School/workplace-based post suicide attempt consultation and clinical management for youth may be planned and delivered on a gender-appropriate basis.