Substate-level analysis reveals geographical variation in COVID-19 epidemiology and facilitates improvement of prevention efforts with greater granularity.

We analyzed daily confirmed COVID-19 case count in West Virginia and its 9 regions (March 19, 2020-March 9, 2023). Nonparametric bootstrapping and a Poisson-distributed multiplier of 4 were applied to account for irregular and under-reporting. We used the R package EpiEstim to estimate the time-varying reproduction number Rt with 7-day-sliding-windows (2020-2023) and non-overlapping-time-windows between 5 policy changes (2020 only). Poisson regression was used to estimate the incidence rate ratio (IRR) between each region and West Virginia (2020, 2021, and 2022).

Statewide Rt fluctuated over the study period, with the highest in March 2020 (close to 2) and the lowest Rt (<1) seen in June 2020. The Stay-at-home Order, Face Mask Mandate, and Virtual Learning Resumes saw 38.7% (95% credible interval [CrI]: 21.9%-57.5%), 10.6% (95% CrI, 3.2%-18.9%), and 9.4% (95% CrI, 3.2%-15.4%) corresponding decreases in Rt statewide. All regions experienced incidence rates different from the state. The IRRs ranged from 0.32 (95% CI, 0.32-0.33) (Northern region) to 1.90 (95% CI, 1.87-1.94) (Wood-Jackson region) in 2020.

Policies reducing human contacts, e.g., Stay-at-home Order and Virtual Learning Resumes, effectively reduced transmission statewide.

Dirofilaria repens is the primary etiological agent of human dirofilariosis in the Old World, with Italy reporting the highest number of cases in Europe. This study describes two new cases of D. repens infection in humans, in southern Italy, where canine dirofilariosis is endemic. The first case involved a 33-year-old man from Caserta (Campania, Southern Italy) who presented with a subcutaneous mass on the upper eyelid. Surgical excision revealed an immature female D. repens worm measuring 14 cm, lacking microfilariae in both the uterus and peripheral blood. The second case was a 67-year-old man from Pozzuoli (Metropolitan City of Naples, Southern Italy) with an oval-shaped nodule in the left frontal scalp region. A live gravid female D. repens worm measuring 15–16 cm was extracted, also without microfilariae in the peripheral blood and no male worm detected. PCR sequencing confirmed a 100% match with D. repens. Both patients tested positive for D. repens antibodies by IgG ELISA. These cases underscore the continuous spread of human dirofilariosis in southern Italy and highlight diagnostic challenges due to variable clinical presentations. The discovery of a gravid female without microfilaremia suggests complexities in the parasite’s life cycle in humans, challenging the notion of humans as strict dead-end hosts. Given the rising prevalence in both humans and dogs, a comprehensive epidemiological study is recommended. Inclusion of dirofilariosis in the national surveillance system for notifiable diseases would improve case identification and tracking, aiding in better monitoring and control of this zoonotic infection.

Emerging evidence suggests a co-occurrence of attention-deficit hyperactivity disorder (ADHD) and immune response-related conditions. However, it is unclear whether there is a causal relationship between ADHD and immune response.

We investigated the associations between ADHD traits, common variant genetic liability to ADHD, and serum C-reactive protein (CRP) levels in childhood and adulthood, using data from the Avon Longitudinal Study of Parent and Children. Genetic correlation was estimated using linkage-disequilibrium score regression. Two-sample Mendelian randomization (MR) was conducted to test potential causal effects of ADHD genetic liability on serum CRP as an indicator of systemic inflammation, as well as the genetically proxied levels of specific plasma cytokines.

There was little evidence to suggest association between ADHD and CRP in childhood and adulthood. ADHD genetic liability was associated with a higher serum CRP at ages 9 (β = 0.02, 95% confidence interval [CI] = 0, 0.03), 15 (β = 0.04; 95% CI = 0.02, 0.06), and 24 years (β = 0.03; 95% CI = 0.01, 0.05). There was evidence of genetic correlations between ADHD and CRP ( {r}_g ${r}_g$ = 0.27; 95% CI = 0.19, 0.35). Evidence of a bidirectional effect of genetic liability to ADHD and CRP was found by two-sample MR (ADHD-CRP: βIVW= 0.04, 95% CI = 0.01, 0.07; CRP-ADHD: ORIVW = 1.09, 95% CI = 1.01, 1.17).

Further work is necessary to understand the biological pathways linking ADHD genetic liability and CRP and gain insights into understanding how they might contribute in the links between ADHD and later-life adverse physical and mental health outcomes.

Developing integrated mental health services focused on the needs of children and young people is a key policy goal in England. The THRIVE Framework and its implementation programme, i-THRIVE, are widely used in England. This study examines experiences of staff using i-THRIVE, estimates its effectiveness, and assesses how local system working relationships influence programme success.

This evaluation uses a quasi-experimental design (10 implementation and 10 comparison sites.) Measurements included staff surveys and assessment of ‘THRIVE-like’ features of each site. Additional site-level characteristics were collected from health system reports. The effect of i-THRIVE was evaluated using a four-group propensity-score-weighted difference-in-differences model; the moderating effect of system working relationships was evaluated with a difference-in-difference-in-differences model.

Implementation site staff were more likely to report using THRIVE and more knowledgeable of THRIVE principles than comparison site staff. The mean improvement of fidelity scores among i-THRIVE sites was 16.7, and 8.8 among comparison sites; the weighted model did not find a statistically significant difference. However, results show that strong working relationships in the local system significantly enhance the effectiveness of i-THRIVE. Sites with highly effective working relationships showed a notable improvement in ‘THRIVE-like’ features, with an average increase of 16.41 points (95% confidence interval: 1.69–31.13, P-value: 0.031) over comparison sites. Sites with ineffective working relationships did not benefit from i-THRIVE (−2.76, 95% confidence interval: − 18.25–12.73, P-value: 0.708).

The findings underscore the importance of working relationship effectiveness in the successful adoption and implementation of multi-agency health policies like i-THRIVE.

Myocardial bridge contributes to chest pain, often accompanied by non-specific complaints.

Our study aims to determine somatic symptom disorder (SSD) prevalence in patients with myocardial bridge, investigating associated clinical and psychological features.

In this prospective cross-sectional study, we enrolled 1357 participants (337 with and 1020 without myocardial bridge) from Shanghai Renji Hospital. The Somatic Symptom Scale-China questionnaire was used to assess SSD. Depressive and anxiety disorders were assessed by the Patient Health Questionnaire-9 (PHQ-9) and Generalised Anxiety Disorder-7 (GAD-7).

The prevalence of SSD in the myocardial bridge group was 63.2%, higher than the group without myocardial bridge (53.8%). Patients with myocardial bridge were at an increased risk of SSD (odds ratio 1.362, 95% CI 1.026–1.809; P = 0.033). There were no differences in the mean PHQ-9 scores (3.2 ± 3.4 v. 3.2 ± 4.1; P = 0.751) or GAD-7 scores (2.5 ± 3.0 v. 2.3 ± 3.7; P = 0.143) between the two groups. Among patients with myocardial bridge, gender was the only independent risk factor for SSD. Women were 3.119 times more likely to experience SSD compared with men (95% CI 1.537–6.329; P = 0.002).

Our findings emphasise the high prevalence and severity of SSD among patients with myocardial bridge. The screening for SSD should be of particular concern, especially among female patients.

Weight misperception has been reported as a common problem in high-income countries, but there is a paucity of high-quality empirical evidence in low- and middle-income countries, especially among children and adolescents. This study estimates the prevalence of weight misperception and investigates changes over time among children and adolescents in China, as well as identifies factors that may affect this weight misperception.

The China Health and Nutrition Survey, which is a repeated, representative cross-sectional study employing multistage random cluster processes.

A Chinese national survey across fifteen provinces and municipal cities.

Data from children and adolescents aged 6–16 years from six consecutive waves between 2000 and 2015 were included.

The final sample totalled 7110 children and adolescents. The overall prevalence of weight misperception was largely stable between 2000 and 2015 (range: 34·1–37·3 %). Sex and age groups were associated with weight misperception, with boys and younger participants more likely to misperceive their weight status. In addition, dieting and being physically active or inactive were associated with increased rates of weight misperception.

Weight misperception is common among youth in China and is unequally shared with several subpopulations at increased risk. Researchers and health promoters are called to recognise weight misperception when addressing overweight and obesity countermeasures, and more tailored public health initiatives are warranted to more effectively reach those with weight misperceptions.

This study examines more than 5.8 million bed days of data from private and National Health Service care providers who contribute to the Mental Health Services Monthly Statistics in the UK. The use of oral chemical restraint is compared with provider size, and the relative use of oral chemical restraint as opposed to seclusion is investigated.

The data-set has large amounts of missing data. The use of oral chemical restraint is proportional to provider size in terms of bed days. Analysis of those providers who reliably submit data demonstrates patterns of reported use of oral chemical restraint versus use of seclusion.

Further research is required into the institutional characteristics that are correlated with increased use of oral chemical restraint. Efforts to investigate the use of restrictive interventions in mental health settings are frustrated by inconsistent reporting.

Despite a global decline in suicide rates, the USA has witnessed a concerning rise in suicide mortality over the past two decades.

This study aims to elucidate the changing patterns of suicide mortality in the USA from 1999 to 2019, with a particular focus on gender and racial differences.

We utilised national mortality data for causes of suicide (X60–X84, Y87.0) from the Centers for Disease Control and Prevention for 1999–2019. The age–period–cohort analysis was conducted to explore the effects of age, period and birth cohort effects on suicide mortality by gender and race.

Between 1999 and 2019, the suicide rate and the number of suicides in the USA increased 33% and 62%, respectively. We discerned an emerging peak of suicide among young adult populations even as increases affected nearly all groups. Females have shown increasing period risk, which has exceeded that of males since 2011. Their cohort risk, which slowly increased and exceeded males in post-1959 cohorts, exhibited a steep J-shaped pattern, especially among those born after 1977. Although Americans of all races have experienced increased period risk since 2011, it was highest among American Indians and Alaska Natives by the end of the 20-year span. With the mortality risk increasing rapidly in all post-1959 cohorts, the risk showed an obvious cliff-shaped pattern among the Asian/Pacific Islander population born after 1989.

The shifting burden of suicide mortality towards younger populations, transcending gender and racial boundaries, underscores the need for the implementation of tailored public health strategies.

Selective serotonin reuptake inhibitors (SSRIs) have been associated with increased risk of osteoporosis, and sertraline may be more potent than citalopram in this regard. Here, target trial emulation was used to investigate whether sertraline, citalopram and escitalopram (the S-enantiomer of citalopram) differentially affect the risk of osteoporosis. Subsequently, it was examined whether SSRIs increase the risk of osteoporosis in a dose-response-like manner.

Danish nationwide registers were used to identify all individuals that initiated treatment for depression with sertraline, citalopram, or escitalopram between January 1, 2007, and March 1, 2019. These individuals were followed until development of osteoporosis, death, or end of follow-up. Cox proportional hazards regression was used to adjust for relevant baseline covariates to emulate randomised treatment allocation to compare the rate of osteoporosis for individuals treated with sertraline, citalopram or escitalopram. Subsequently, the cumulative dose of sertraline, citalopram, and escitalopram was calculated, and Cox proportional hazards regression was used to assess dose-response-like relationships with osteoporosis.

We identified 27,280, 65,529, and 17,703 individuals initiating treatment with sertraline, citalopram, and escitalopram, respectively. There was no material or statistically significant differential risk of osteoporosis between these groups (adjusted hazard rate ratio, aHRR = 0.98 for citalopram versus sertraline and aHRR = 0.94 for escitalopram versus sertraline). The results were not indicative of the SSRIs having a dose-response-like effect on osteoporosis risk.

Sertraline, citalopram and escitalopram do not appear to differentially affect the risk of osteoporosis. The lack of clear dose-response-like relationships suggest that they do not have a causal effect on osteoporosis risk.

Little is known about the dose and pattern of moderate-to-vigorous physical activity (MVPA) to prevent depression. We aimed to assess the prospective association of dose and pattern of accelerometer-derived MVPA with the risk of diagnosed depression.

We included 74,715 adults aged 40–69 years from the UK Biobank cohort who were free of severe disease at baseline and participated in accelerometer measurements (mean age 55.2 years [SD 7.8]; 58% women). MVPA at baseline was derived through 1-week wrist-worn accelerometry. Diagnosed depression was defined by hospitalization with ICD-10 codes F32.0-F32.A. Restricted cubic splines and Cox regression determined the prospective association of dose and pattern of MVPA with the risk of incident depression.

Over a median 7.9-year follow-up, there were 3,089 (4.1%) incident cases of depression. Higher doses of MVPA were curvilinearly associated with lower depression risk, with the largest minute-per-minute added benefits occurring between 5 (HR 0.99 [95% CI 0.96–0.99]) and 280 (HR 0.67 [95% CI 0.60–0.74]) minutes per week (reference: 0 MVPA minutes).

Regardless of pattern, higher doses of MVPA were associated with lower depression risk in a curvilinear manner, with the greatest incremental benefit per minute occurring during the first 4–5 h per week. Optimal benefits occurred around 15 h/week.

In 2016, the Ontario Ministry of Health and Long-Term Care implemented the Provincial Strategy for Epilepsy Care to increase epilepsy surgery use in Ontario, Canada. The objectives of this study were to assess whether the use of (1) epilepsy surgery, including (a) its receipt and (b) assessments for candidacy, and (2) other healthcare for epilepsy, including (a) neurological consultations, (b) emergency department (ED) visits and (c) hospital admissions, changed since its implementation.

We used linked health administrative data and an interrupted time series design. Annual cohorts were created for July 1st to June 30th of each year from 2007 to 2019, comprising patients with drug-resistant epilepsy eligible for publicly funded prescription drug coverage with no cancer history. We used segmented Poisson regression models to assess whether the annual rates of each outcome changed between the period before the Provincial Strategy was implemented (July 2007–June 2016) and the period after.

There was a level increase in the rate of epilepsy surgery of 48% (95% CI: 0%, 118%) and slope decreases in the rates of neurological consultations, ED visits and hospital admissions for epilepsy of 10% (95% CI: −15%, −5%), 10% (95% CI: −20%, 1%) and 7% (95% CI: −12%, −1%) per year, respectively, associated with the Provincial Strategy.

The Provincial Strategy may be associated with an increased rate of epilepsy surgery and reduced rates of other healthcare use for epilepsy. Other regions experiencing low epilepsy surgery rates may benefit from similar interventions.