Probucol mitigates high-fat diet-induced cognitive and social impairments by regulating brain redox and insulin resistance.

Probucol has been utilized as a cholesterol-lowering drug with antioxidative properties. However, the impact and fundamental mechanisms of probucol in obesity-related cognitive decline are unclear. In this study, male C57BL/6J mice were allocated to a normal chow diet (NCD) group or a high-fat diet (HFD) group, followed by administration of probucol to half of the mice on the HFD regimen. Subsequently, the mice were subjected to a series of behavioral assessments, alongside the measurement of metabolic and redox parameters. Notably, probucol treatment effectively alleviates cognitive and social impairments induced by HFD in mice, while exhibiting no discernible influence on mood-related behaviors. Notably, the beneficial effects of probucol arise independently of rectifying obesity or restoring systemic glucose and lipid homeostasis, as evidenced by the lack of changes in body weight, serum cholesterol levels, blood glucose, hyperinsulinemia, systemic insulin resistance, and oxidative stress. Instead, probucol could regulate the levels of nitric oxide and superoxide-generating proteins, and it could specifically alleviate HFD-induced hippocampal insulin resistance. These findings shed light on the potential role of probucol in modulating obesity-related cognitive decline and urge reevaluation of the underlying mechanisms by which probucol exerts its beneficial effects.

The Uptake and Distribution Evidence of Nano- and Microplastics in vivo after a Single High Dose of Oral Exposure.

Objective: Tissue uptake and distribution of nano-/microplastics was studied at a single high dose by gavage in vivo. Methods: Fluorescent microspheres (100 nm, 3 µm, and 10 µm) were given once at a dose of 200 mg/(kg∙body weight). The fluorescence intensity (FI) in observed organs was measured using the IVIS Spectrum at 0.5, 1, 2, and 4 h after administration. Histopathology was performed to corroborate these findings. Results: In the 100 nm group, the FI of the stomach and small intestine were highest at 0.5 h, and the FI of the large intestine, excrement, lung, kidney, liver, and skeletal muscles were highest at 4 h compared with the control group ( P < 0.05). In the 3 µm group, the FI only increased in the lung at 2 h ( P < 0.05). In the 10 µm group, the FI increased in the large intestine and excrement at 2 h, and in the kidney at 4 h ( P < 0.05). The presence of nano-/microplastics in tissues was further verified by histopathology. The peak time of nanoplastic absorption in blood was confirmed. Conclusion: Nanoplastics translocated rapidly to observed organs/tissues through blood circulation; however, only small amounts of MPs could penetrate the organs.

Autonomous Internet of Things (IoT) Data Reduction Based on Adaptive Threshold.

With the development of intelligent IoT applications, vast amounts of data are generated by various volume sensors. These sensor data need to be reduced at the sensor and then reconstructed later to save bandwidth and energy. As the reduced data increase, the reconstructed data become less accurate. Usually, the trade-off between reduction rate and reconstruction accuracy is controlled by the reduction threshold, which is calculated by experiments based on historical data. Considering the dynamic nature of IoT, a fixed threshold cannot balance the reduction rate with the reconstruction accuracy adaptively. Aiming to dynamically balance the reduction rate with the reconstruction accuracy, an autonomous IoT data reduction method based on an adaptive threshold is proposed. During data reduction, concept drift detection is performed to capture IoT dynamic changes and trigger threshold adjustment. During data reconstruction, a data trend is added to improve reconstruction accuracy. The effectiveness of the proposed method is demonstrated by comparing the proposed method with the basic Kalman filtering algorithm, LMS algorithm, and PIP algorithm on stationary and nonstationary datasets. Compared with not applying the adaptive threshold, on average, there is an 11.7% improvement in accuracy for the same reduction rate or a 17.3% improvement in reduction rate for the same accuracy.

Electrostatically Powered Multimode Liquid Crystalline Elastomer Actuators.

Soft actuators based on liquid crystalline elastomers (LCEs) are captivating significant interest because of their unique properties combining the programmable liquid crystalline molecular order and elasticity of polymeric materials. For practical applications, the ability to perform multimodal shape changes in a single LCE actuator at a subsecond level is a bottleneck. Here, we fabricate a monodomain LCE powered by electrostatic force, which enables fast multidirectional bending, oscillation, rotation, and complex actuation with a high degree of freedom. By tuning the dielectric constant and resistivity in LCE gels, a complete cycle of oscillation and rotation only takes 0.1 s. In addition, monodomain actuators exhibit anisotropic actuation behaviors that promise a more complex deployment in a potential electromechanical system. The presented study will pave the way for electrostatically controllable isothermal manipulation for a fast and multimode soft actuator.

Voxelated opto-physically unclonable functions via irreplicable wrinkles.

The increased prevalence of the Internet of Things (IoT) and the integration of digital technology into our daily lives have given rise to heightened security risks and the need for more robust security measures. In response to these challenges, physical unclonable functions (PUFs) have emerged as promising solution, offering a highly secure method to generate unpredictable and unique random digital values by leveraging inherent physical characteristics. However, traditional PUFs implementations often require complex hardware and circuitry, which can add to the cost and complexity of the system. We present a novel approach using a random wrinkles PUF (rw-PUF) based on an optically anisotropic, facile, simple, and cost-effective material. These wrinkles contain randomly oriented liquid crystal molecules, resulting in a two-dimensional retardation map corresponding to a complex birefringence pattern. Additionally, our proposed technique allows for customization based on specific requirements using a spatial light modulator, enabling fast fabrication. The random wrinkles PUF has the capability to store multiple data sets within a single PUF without the need for physical alterations. Furthermore, we introduce a concept called 'polyhedron authentication,' which utilizes three-dimensional information storage in a voxelated random wrinkles PUF. This approach demonstrates the feasibility of implementing high-level security technology by leveraging the unique properties of the rw-PUF.

Obesity is positively Associated with Depression in Older Adults: Role of Systemic Inflammation.

Objective: We aimed to explore the association between obesity and depression and the role of systemic inflammation in older adults. Methods: Adults ≥ 65 years old ( n = 1,973) were interviewed at baseline in 2018 and 1,459 were followed up in 2021. General and abdominal obesity were assessed, and serum C-reactive protein (CRP) levels were measured at baseline. Depression status was assessed at baseline and at follow-up. Logistic regression was used to analyze the relationship between obesity and the incidence of depression and worsening of depressive symptoms, as well as the relationship between obesity and CRP levels. The associations of CRP levels with the geriatric depression scale, as well as with its three dimensions, were investigated using multiple linear regressions. Results: General obesity was associated with worsening depression symptoms and incident depression, with an odds ratio ( OR) [95% confidence interval ( CI)] of 1.53 (1.13-2.12) and 1.80 (1.23-2.63), especially among old male subjects, with OR (95% CI) of 2.12 (1.25-3.58) and 2.24 (1.22-4.11), respectively; however, no significant relationship was observed between abdominal obesity and depression. In addition, general obesity was associated with high levels of CRP, with OR (95% CI) of 2.58 (1.75-3.81), especially in subjects free of depression at baseline, with OR (95% CI) of 3.15 (1.97-5.04), and CRP levels were positively correlated with a score of specific dimension (life satisfaction) of depression, P < 0.05. Conclusion: General obesity, rather than abdominal obesity, was associated with worsening depressive symptoms and incident depression, which can be partly explained by the systemic inflammatory response, and the impact of obesity on depression should be taken more seriously in the older male population.

Morbihan disease misdiagnosed as senile blepharoptosis and successfully treated with short-term minocycline and ketotifen: A case report.

BACKGROUND: Morbihan disease is a rare skin condition with diagnostic and therapeutic challenges. Facial nonpitting erythematous edema is usually considered to be a characteristic manifestation and diagnostic clue for the Morbihan disease. Treatment of Morbihan disease remains a dilemma due to its long course, poor response, and high recurrence rate. CASE SUMMARY: We report the case of a 69-year-old man with Morbihan disease. The patient presented ptosis as the first and main symptom. There was no obvious edema or other skin lesions. The patient was misdiagnosed with senile blepharoptosis based on eyelid performance and no treatment was administered to him. After continuous progressive asthenia of eye-opening and ptosis for more than one year, a skin biopsy was recommended. Histopathological analysis showed edema in the dermis, lymphatic hyperplasia and dilatation, and perivascular lymphocytic infiltration. An obvious increase in toluidine blue-stained mast cells was observed. The patient was finally diagnosed with Morbihan disease. Minocycline and ketotifen were prescribed based on the increase of mast cells in skin tissue slices. The patient experienced rapid relief seven days later and complete remission after 40 d from the commencement of the treatment. CONCLUSION: Ptosis without obvious swelling could be the only or main clinical manifestation of Morbihan disease in rare conditions. An increase of mast cells was an important therapeutic clue to the rapid and remarkable efficiency of the combination therapy of minocycline and antihistamine.

A Dew-Condensation Sensor Exploiting Local Variations in the Relative Refractive Index on the Dew-Friendly Surface of a Waveguide.

We propose a sensor technology for detecting dew condensation, which exploits a variation in the relative refractive index on the dew-friendly surface of an optical waveguide. The dew-condensation sensor is composed of a laser, waveguide, medium (i.e., filling material for the waveguide), and photodiode. The formation of dewdrops on the waveguide surface causes local increases in the relative refractive index accompanied by the transmission of the incident light rays, hence reducing the light intensity inside the waveguide. In particular, the dew-friendly surface of the waveguide is obtained by filling the interior of the waveguide with liquid H2O, i.e., water. A geometric design for the sensor was first carried out considering the curvature of the waveguide and the incident angles of the light rays. Moreover, the optical suitability of waveguide media with various absolute refractive indices, i.e., water, air, oil, and glass, were evaluated through simulation tests. In actual experiments, the sensor with the water-filled waveguide displayed a wider gap between the measured photocurrent levels under conditions with and without dew, than those with the air- and glass-filled waveguides, as a result of the relatively high specific heat of the water. The sensor with the water-filled waveguide exhibited excellent accuracy and repeatability as well.

Genetic Algorithm-Based Online-Partitioning BranchyNet for Accelerating Edge Inference.

In order to effectively apply BranchyNet, a DNN with multiple early-exit branches, in edge intelligent applications, one way is to divide and distribute the inference task of a BranchyNet into a group of robots, drones, vehicles, and other intelligent edge devices. Unlike most existing works trying to select a particular branch to partition and deploy, this paper proposes a genetic algorithm (GA)-based online partitioning approach that splits the whole BranchyNet with all its branches. For this purpose, it establishes a new calculation approach based on the weighted average for estimating total execution time of a given BranchyNet and a two-layer chromosome GA by distinguishing partitioning and deployment during the evolution in GA. The experiment results show that the proposed algorithm can not only result in shorter execution time and lower device-average energy cost but also needs less time to obtain an optimal deployment plan. Such short running time enables the proposed algorithm to generate an optimal deployment plan online, which dynamically meets the actual requirements in deploying an intelligent application in the edge.

Evidence on Invasion of Blood, Adipose Tissues, Nervous System and Reproductive System of Mice After a Single Oral Exposure: Nanoplastics versus Microplastics.

Objective: This study was designed to provide the evidences on the toxicokinetics of microplastics (MPs) and nanoplastics (NPs) in the bodies of mammals. Methods: 100 nm, 3 µm, and 10 µm fluorescent polystyrene (PS) beads were administered to mice once by gavage at a dose of 200 mg/kg body weight. The levels and change of fluorescence intensity in samples of blood, subcutaneous fat, perirenal fat, peritesticular fat, cerebrum, cerebellum, testis, and epididymis were measured at 0.5, 1, 2, and 4 h after administration using an IVIS Spectrum small-animal imaging system. Histological examination, confocal laser scanning, and transmission electron microscope were performed to corroborate the findings. Results: After confirming fluorescent dye leaching and impact of pH value, increased levels of fluorescence intensity in blood, all adipose tissues examined, cerebrum, cerebellum, and testis were measured in the 100 nm group, but not in the 3 and 10 µm groups except in the cerebellum and testis at 4 h for the 3 µm PS beads. The presence of PS beads was further corroborated. Conclusion: After a single oral exposure, NPs are absorbed rapidly in the blood, accumulate in adipose tissues, and penetrate the blood-brain/testis barriers. As expected, the toxicokinetics of MPs is significantly size-dependent in mammals.

Exposure to microplastics in the upper respiratory tract of indoor and outdoor workers.

The aim of this study was to determine the presence of microplastics (MPs) in the upper respiratory tract of indoor and outdoor workers, to assess the type and the extent of contamination. Sputum and nasal lavage fluid were collected, and plastic particles were quantitatively analyzed by polarizing microscopy and a laser direct infrared chemical imaging system. The polarized light microscopy results showed that suspicious MPs were found in the nasal lavage and sputum of both couriers and office staff, and the abundance of MPs in the nasal lavage of office staff was significantly higher than in couriers (P < 0.0001). The chemical imaging results showed that polycarbonate (24.2%) and polyvinylchloride (PVC) (23.0%) were the predominant plastic materials in the sputum of couriers, while polyamide (PA) (25.3%) and polyethylene (22.9%) were dominant in the nasal lavage fluid. The sputum and nasal lavage fluid of office staff were both dominated by PVC (39.1% and 41.1%, respectively) and PA (24.8% and 31.6%, respectively). Therefore, this study revealed that microplastic pollution was found in the respiratory tract of both indoor and outdoor workers, but the distribution of MP particles differed between the two populations.

Lanthanum tin oxide-modified sensor electrode for the rapid detection of environmentally hazardous insecticide carbaryl in soil, water, and vegetable samples.

The growing population and global food demands have encouraged the use of pesticides to increase agricultural yields; however, the irrational use of pesticides threatens human health and the environment. Carbaryl (CRBL) is the most widespread insecticide and severely affects soil, water systems, and human health. Thus, it is crucial to monitor CRBL residues in the environment and vegetable samples. This study reports the rapid and sensitive electrochemical detection of CRBL based on a pyrochlore-type lanthanum tin oxide (LSO) nanoparticles (NPs)-modified screen-printed carbon electrode (SPCE). A low-temperature hydrothermal method was employed to prepare the LSO NPs. The structural properties of the LSO NPs were characterized by X-ray diffraction, Raman, and X-ray photoelectron spectroscopy analyses. The LSO NPs/SPCE demonstrated good electroanalytical performance for CRBL detection, with a low detection limit of 0.4 nM (0.08 µg/L) and a sensitivity of 1.05 µA/(µM cm2). Furthermore, the LSO NPs/SPCE exhibited high selectivity among highly interfering carbamate and organophosphorus pesticides, which share similar mechanisms of action. Additionally, the LSO NPs/SPCE sensor achieved > 90% recovery for the detection of CRBL in soil, water, and vegetable samples, thus verifying its suitability for the rapid detection of CRBL.

High microwave responsivity Co-Bi25FeO40 in synergistic activation of peroxydisulfate for high efficiency pollutants degradation and disinfection: Mechanism of enhanced electron transfer.

Cobalt doped Bi25FeO40 was used as a heterogeneous catalyst in microwave (MW) co-activation of peroxydisulfate (PDS) system for organic contaminant purification and disinfection simultaneously. Due to low charge-transfer resistance and fast electron migration, Co-Bi25FeO40 showed superior catalytic efficiencies for activation PDS to degrade over 92.0% of bisphenol A (BPA) with the initial concentrations ranging from 40 mg/L to 120 mg/L in 5.0 min. The non-radical oxidation pathway via electron transfer regime on the surface of Co-Bi25FeO40 was the dominant reactive species in the reaction system. Benefit from the energy transfer and cross-coupling reactions of microwave, the Co-Bi25FeO40/MW/PDS system can generate abundant reactive sites to facilitate the formation of more surface-bonding complexes. Microwave energy can be absorbed by Co-Bi25FeO40 catalysts to promote activation of PDS and production of nanobubbles. The generated nanobubbles increase the temperature of the local solution to promote the reaction. The Co-Bi25FeO40/MW/PDS system also exhibited excellent bactericidal capability for Escherichia coli (E.coli). The catalysts, oxidants and microwaves acted on E. coli to form physical, and oxidative pressure simultaneously, causing cell damaged and made bacterial death. This work provides prospects toward high-efficiency integration of contaminant purification and pathogenic microorganisms inactivation.

Deformable Photonic Crystals Based on Chiral Liquid Crystals with Thermal-Mediative Shape Memory Effect.

We propose a deformable photonic crystal that exhibits the thermal-mediative shape memory effect. The chiral liquid crystalline polymeric scaffold, which produces the structural colors from a helical twist of the liquid crystal director, is prepared through phase-stabilization of a reactive mesogen in a small molecular chiral liquid crystal (CLC), polymerization, and removal of the CLC. The prepolymer of polyurethane acrylate (PUA) is then infiltrated in the prepared scaffold and subsequently photo-polymerized to form a CLC-PUA composite film. Upon compression, this film shows the blue shift of the structural color and retains this color-shift as released from compression. As the temperature increases, the color is recovered to a pristine state. The concept proposed in this study will be useful for designing mechanochromic soft materials.

Current status of premature mortality from four non-communicable diseases and progress towards the Sustainable Development Goal target 3.4: a population-based study in northeast China, 2004-2017.

BACKGROUND AND AIM: According to the United Nations' Sustainable Development Goal (SDG) target 3.4, premature mortality from four non-communicable diseases (cardiovascular diseases, cancer, chronic respiratory diseases, and diabetes mellitus, collectively referred to as NCD4) should achieve a minimum decline of 33% in 2030 relative to 2015. This remains a challenge for China. This study aimed to evaluate the current status and progress towards this target in Liaoning Province, one of the three provinces in northeast China. METHODS: We calculated the premature mortality rates (PMRs) per year and average annual percentage changes (AAPCs) from NCD4 using mortality data between 2004 and 2017. The trend was analyzed in the whole population, as well as in subpopulations of gender (male/female) and inhabiting area (urban/rural). PMRs from NCD4 for 2030 were projected by fitting a linear regression based on the current trend, which was identified by a Joinpoint model. FINDINGS: In the whole population, only chronic respiratory diseases showed a significant decline (AAPC: - 6.5%, p < 0.05), while only cancer showed a significant increase (AAPC: + 1.3%, p < 0.05); taken together, NCD4 showed a significant increase (AAPC: + 0.6%, p < 0.05). In the subpopulations, while males showed a significant increase in NCD4 (AAPC: + 1.5%, p < 0.05), cardiovascular diseases (AAPC: + 1.7%, p < 0.05), cancer (AAPC: + 1.8%, p < 0.05), and diabetes mellitus (AAPC: + 4.2%, p < 0.05), females showed a significant decline in NCD4 (AAPC: - 1.2%, p < 0.05), cardiovascular diseases (AAPC: - 1.8%, p < 0.05), diabetes mellitus (AAPC: - 2.1%, p < 0.05), but showed a mild increase in cancer (AAPC: + 0.5%, p > 0.05). A comparative analysis of the projected PMRs for 2030 with the 2015 levels revealed that only chronic respiratory diseases are expected to achieve the SDG target 3.4, apart from in the urban male subpopulation. CONCLUSION: Except for chronic respiratory diseases, NCD4 cannot be expected to achieve the SDG target 3.4 in the whole population of Liaoning Province. Under these circumstances, special attention should be paid to reducing the risks of cancer and providing preventative interventions for men.

Combined Effects of Mother's, Father's and Teacher's Psychological Distress on Schoolchildren's Mental Health Symptoms.

PURPOSE: Few studies have assessed the individual and joint effects of the mother's, father's and teacher's mental health symptoms on schoolchildren's behavior and emotional well-being simultaneously in the same study. PATIENTS AND METHODS: A cross-sectional survey was conducted among 8488 Chinese schoolchildren aged 6-17 years in northeast China. The Strengths and Difficulties Questionnaire (SDQ) and General Health Questionnaire (GHQ) were used to measure the mental health of the students, their parents and the teacher in charge of the class, respectively. A total of 6173 students (72.73%) with full mental health information from all three caretakers were included in the final analysis. RESULTS: We found a significantly elevated risk of mental health symptoms in children when their mothers (odds ratios (OR)=2.30, 95% CI=1.93-2.73), fathers (OR=2.08, 95% CI=1.73-2.50) and teachers (OR=1.18, 95% CI=1.01-1.39) reported poorer mental health, and the risk increased significantly with the number of the caretakers with mental symptoms. A father with poor mental health has both direct and indirect effects on a child's emotional health, by worsening the influence of a mother's poor mental health. CONCLUSION: All three caretakers have a significant negative influence on schoolchildren's emotional well-being, in the order of mother > father > teacher. It is desirable to assess and manage students' mental health in the both the family and school contexts.

Design of an Electro-Stimulated Hydrogel Actuator System with Fast Flexible Folding Deformation under a Low Electric Field.

Soft actuators have recently been widely studied due to their significant advantages including light weight, continuous deformability, high environment adaptability, and safe human-robot interactions. In this study, we designed electrically responsive poly(sodium 4-vinylbenzenesulfonate/2-hydroxyethylmethacrylate/acrylamide) (P(VBS/HEMA/AAm)) and poly(sodium 4-vinylbenzenesulfonate/2-hydroxyethyl methacrylate/acrylic acid) (P(VBS/HEMA/AAc)) hydrogels. A series of P(VBS/HEMA/AAm) and P(VBS/HEMA/AAc) hydrogels were prepared by adjusting the monomer composition and cross-linking density to systemically analyze various factors affecting the actuation of hydrogels under an electric field. All hydrogels exhibited more than 65% gel fraction and a high equilibrium water content (EWC) of more than 90%. The EWC of hydrogels gradually increased with decreasing cross-linker content and was also influenced by the monomer composition. The mechanical properties of hydrogels were proportional to the cross-linking density. Particularly, hydrogels showed bending deformation even at low voltages below 10 V, and the electrically responsive bending actuation of hydrogels can be modulated by cross-linking density, monomer composition, applied voltage, ion strength of the electrolyte solution, and geometrical parameters of the hydrogel. By controlling these factors, hydrogels showed a fast response with a bending of more than 100° within a minute. In addition, hydrogels did not show significant cytotoxicity in a biocompatibility test and exhibited more than 84% cell viability. These results indicate that P(VBS/HEMA/AAm) and P(VBS/HEMA/AAc) hydrogels with fast response properties even under a low electric field have the potential to be used in a wide range of soft actuator applications.

Design Optimization of Reconfigurable Liquid Crystal Patch Antenna.

In various fields such as the 5G antenna system and satellite communication system, there is a growing demand to develop a smart antenna with a frequency selective or beamforming function within a limited space. While antennas utilizing mechanical, electronic, and material characteristics are being studied, a method of having tunable frequency characteristics by applying a liquid crystal material with dielectric anisotropy to a planar patch antenna is proposed. In resonance mode, the design method for using only the minimum amount of expensive liquid crystals is systematically arranged while maximizing the amount of change in the operating frequency of the antenna by considering the electric field distribution on the surface of the patch antenna. Furthermore, to increase the dielectric anisotropy of the liquid crystal, the liquid crystal must be aligned. Simultaneously, in cases where the cell gap of the liquid crystal exceeds 100 µm, the alignment force is weakened. While compensating for this shortcoming, securing the radiation characteristics of the antenna is proposed, and simulations are performed.

High-Definition Optophysical Image Construction Using Mosaics of Pixelated Wrinkles.

Despite many efforts in structuring surfaces using mechanical instabilities, the practical application of these structures to advanced devices remains a challenging task due to the limited capability to control the local morphology. A platform that programs the orientation of mechanically anisotropic molecules is demonstrated; thus, the surface wrinkles, promoted by such instabilities, can be patterned in the desired manner. The optics based on a spatial light modulator assembles wrinkle pixels of a notably small dimension over a large area at fast fabrication speed. Furthermore, these pixelated wrinkles can be formed on curved geometries. The pixelated wrinkles can record images, which are naturally invisible, by mapping the gray level to the orientation of wrinkles. They can retrieve those images using the patterned optical phase retardation generated under the crossed polarizers. As a result, it is shown that the pixelated wrinkles enable new applications in optics such as image storage, informative labeling, and anti-counterfeiting.

Prevalence of mental health problems in Chinese schoolchildren: The influence of measuring impact score and combining information from multiple informants.

BACKGROUND: To measure the effects of using different combinations of multiple informants and the impact score on the estimated prevalence of mental health problems in Chinese schoolchildren. METHODS: Complete information on the Strengths and Difficulties Questionnaire (SDQ) were obtained from students (S), parents (P), and teachers (T) for 4986 schoolchildren (11-17 years-old). We used 3 criteria to determine the prevalence of mental health problems: SDQ cut-off value (previously established in the United Kingdom), SDQ cut-off value plus an impact score of 1 or more, or plus an impact score of 2 or more. A student was defined as having a mental health problem if any informant (S, P, or T) classified the child as 'abnormal'. We compared the prevalence of mental health problems determined from 1 informant, 2 informants, and 3 informants. RESULTS: The prevalence of overall mental health problems increased with rising number of informants, but decreased with increasing impact score. When the impact score was not considered, the prevalence was 8.2% to 14.2% when rated by 1 informant, 18.8% to 24.7% when rated by 2 informants, and 28.3% when rated by all 3 informants. Failure to measure the impact score led to a two to threefold greater estimate of the prevalence of mental health problems. CONCLUSIONS: The types, number, and combinations of multiple informants and use of the impact score must be considered when comparing the results of different studies. It is preferable to use multiple informants and have the impact score taken the impact into account to reflect the real burden of mental health burden in children and adolescent.