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Hypopharyngeal multichannel intraluminal impedance-pH (HMII-pH) technology incorporating 2 trans-upper esophageal sphincter impedance channels has been developed to detect pharyngeal reflux. We used the HMII-pH technique to validate the candidate pharyngeal acid reflux (PAR) episodes based on the dual-pH tracings and determined the interobserver reproducibility.We conducted a cross-sectional study in tertiary centers in Taiwan. Ninety patients with suspected laryngopharyngeal reflux and 28 healthy volunteers underwent HMII-pH test when off acid suppressants. Candidate PAR episodes were characterized by pharyngeal pH drops of at least 2 units and reaching a nadir pH of 5 within 30 seconds during esophageal acidification. Two experts manually independently identified candidate PAR episodes based on the dual-pH tracings. By reviewing the HMII-pH tracings, HMII-pH-proven PAR episodes were subsequently confirmed. The consensus reviews of HMII-pH-proven PAR episodes were considered to be the reference standard diagnosis. The interobserver reproducibility was assessed.A total of 105 candidate PAR episodes were identified. Among them 84 (80.0%; 95% CI, 71.0-87.0%) were HMII-pH-proven PAR episodes (82 in 16 patients and 2 in 1 healthy subject). Patients tended to have more HMII-pH-proven PAR episodes than healthy controls (median and percentile values [25th, 75th, and 95th percentiles]: 0 [0, 0, 3] vs 0 [0, 0, 0],Our preliminary data showed that 80.0% (71.0-87.0%) of the proposed candidate PAR episodes were HMII-pH-proven PAR episodes, among which the interobserver reproducibility was good.

Background Youth suicide rates have increased markedly in some countries. This study aimed to estimate the population-attributable risk of psychiatric disorders associated with suicide among Taiwanese youth aged 10–24 years. Methods Data were obtained from the National Death Registry and National Health Insurance (NHI) claims database between 2007 and 2019. Youth who died by suicide were included, and comparisons, 1:10 matched by age and sex, were randomly selected from the Registry for NHI beneficiaries. We used multivariable logistic regression to estimate suicide odds ratios for psychiatric disorders. The population-attributable fractions (PAF) were calculated for each psychiatric disorder. Results A total of 2345 youth suicide and 23 450 comparisons were included. Overall, 44.8% of suicides had a psychiatric disorder, while only 7.9% of the comparisons had a psychiatric disorder. The combined PAF for all psychiatric disorders was 55.9%. The top three psychiatric conditions of the largest PAFs were major depressive disorder, dysthymia, and sleep disorder. In the analysis stratified by sex, the combined PAF was 45.5% for males and 69.2% for females. The PAF among young adults aged 20–24 years (57.0%) was higher than among adolescents aged 10–19 years (48.0%). Conclusions Our findings of high PAF from major depressive disorder, dysthymia, and sleep disorder to youth suicides suggest that youth suicide prevention that focuses on detecting and treating mental illness may usefully target these disorders.

Functional somatic syndromes (such as chronic fatigue syndrome, fibromyalgia, irritable bowel syndrome) are often comorbid. Whether these syndromes are distinct constructs and whether they have different psychological features are interesting questions. We perform a cluster analysis based on a nationwide survey in Taiwan to answer these questions.A score of at least 5 on the Patient Health Questionnaire-15 (PHQ-15, measuring somatic symptoms) indicated somatic syndromes and the data of 550 subjects were included. According to the gastrointestinal, pain-fatigue and cardiovascular subdimension scores of the PHQ-15, we performed a two-step cluster analysis. The demographic data and the cluster scores of the Health Anxiety Questionnaire and the Patient Health Questionnaire-4 (measuring depression and anxiety) were compared. Multinomial logistic and multiple linear regression analyses were used to clarify the associations between clusters/somatic symptoms and demographics/psychological features.Four clusters were generated and named according to their somatic features: "high gastrointestinal symptoms", "high pain-fatigue and comorbid somatic symptoms", "middle to high pain-fatigue symptoms" and "high cardiovascular symptoms". The high pain-fatigue and comorbid somatic symptom cluster had the highest levels of extent to which symptoms interfere with a person's life, depression and anxiety. The high cardiovascular symptom cluster was featured by high excessive worry over health and illness and low educational level. The high gastrointestinal symptom cluster had relatively low psychopathologies.The results of this population-based analysis supported the existence of distinct somatic syndromes that are not parts of a single whole somatic syndrome and have different psychological features.

Abstract. Background: The differences in emotional reactions toward media reports of celebrity suicides between distressed and non-distressed individuals have rarely been explored. Aim: We aimed to explore differences in reaction patterns to the news coverage of a celebrity’s suicide between distressed and nondistressed individuals in Taiwan. Method: We conducted an Internet survey to assess the impact of the news coverage of a celebrity’s suicide. A series of χ2 tests, Spearman’s rank correlations, and logistic regression analyses were performed to compare the differences in emotional involvement and psychological impact after exposure to suicide news between distressed and nondistressed individuals. Results: A total of 1,258 Internet users responded to the survey (236 men and 1,020 women). Compared with nondistressed individuals, distressed individuals ( n = 537) were more likely to feel suicidal (11% vs. 2%, p < .001) after reading the news. They were less willing to seek help when in need (62% vs. 77%, p < .001). All the variables remained significant after adjustment for sociodemographic variables in regression analyses. Limitations: The Internet-based survey may suffer from selection bias. Conclusion: Extensive media reporting of suicide stories has a profound impact on readers, particularly on vulnerable groups. Responsible reporting of suicide incidents is crucial for suicide prevention.

Abstract. Background: Few studies have investigated whether means accessibility is related to the spatial distribution of suicide. Aims: To examine the hypothesis that indicators of the accessibility to specific suicide methods were associated with method-specific suicide rates in Taipei City, Taiwan. Method: Smoothed standardized mortality ratios for method-specific suicide rates across 432 neighborhoods and their associations with means accessibility indicators were estimated using Bayesian hierarchical models. Results: The proportion of single-person households, indicating the ease of burning charcoal in the home, was associated with charcoal-burning suicide rates (adjusted rate ratio [aRR] = 1.13, 95% credible interval [CrI] = 1.03–1.25). The proportion of households living on the sixth floor or above, indicating easy access to high places, was associated with jumping suicide rates (aRR = 1.16, 95% CrI, 1.04–1.29). Neighborhoods’ adjacency to rivers, indicating easy access to water, showed no statistical evidence of an association with drowning suicide rates (aRR = 1.27, 95% CrI = 0.92–1.69). Hanging and overall suicide rates showed no associations with any of these three accessibility indicators. Limitations: This is an ecological study; associations between means accessibility and suicide cannot be directly inferred as causal. Conclusion: The findings have implications for identifying high-risk groups for charcoal-burning suicide (e.g., vulnerable individuals living alone) and preventing jumping suicides by increasing the safety of high buildings.

Objective: We investigated recent trends in youth suicide and their associations with societal and psychological factors in Taiwan. Methods: Suicide data (1971–2019) for 10–24 year olds were extracted from Taiwan’s national cause-of-death data files. We investigated changes in trends in youth suicide rates, societal factors (gross domestic product per capita, Gini index, overall and youth unemployment rates, divorce rates in people aged 40–59 years [i.e. the age of most 15–24 year olds’ parents] and Internet use rates) and psychological distress indicators (youth self-harm rates and the prevalence of worry-related insomnia, and suicide ideation, plan and attempt) using joinpoint regression and graphic examinations. The associations of these factors with youth suicide rates were examined using Prais–Winsten regression. Results: Suicide rates in Taiwan’s 10–24 year olds changed from a downward trend (2005–2014) to an upward trend in 2014 and increased 11.5% (95% confidence interval = [5.2%, 18.1%]) annually between 2014 and 2019. There was also an upturn in divorce rates among females aged 40–59 years in 2014 and self-harm rates among 15- to 24-year-old youth in 2013. The prevalence of self-reported insomnia and suicide ideation, plan and attempt in youth started to increase from 2013 to 2016. In the regression analysis, Internet use, female divorce rates and youth self-harm rates were positively associated with youth suicide rates. Conclusion: Suicide rates and the prevalence of suicidal behaviors began to increase in Taiwanese youth in the 2010s. These increases may be associated with concurrent rises in parental divorce rates, Internet use and poor sleep. Further research is needed to examine the mechanisms underlying recent increases in youth suicide risk.

In this work, we used reflexive Banach spaces to study the differential variational—hemivariational inequality problems with constraints. We established a sequence of perturbed differential variational–hemivariational inequality problems with perturbed constraints and penalty coefficients. Then, for each perturbed inequality, we proved the unique solvability and convergence of the solutions to the problems. Following that, we proposed a mathematical model for a viscoelastic rod in unilateral contact equilibrium, where the unknowns were the displacement field and the history of the deformation. We used the abstract penalty method in the analysis of this inequality and provided the corresponding mechanical interpretations.

There is limited literature analyzing the outcome of human poisoning with methomyl and cypermethrin pesticide mixture. Between 2002 and 2018, a total of 63 patients intoxicated with methomyl, cypermethrin, or their pesticide mixture were treated at Chang Gung Memorial Hospital. The patients were categorized into three groups based on the type of pesticide, as methomyl (n = 10), cypermethrin (n = 31), or methomyl and cypermethrin (n = 22). Demographic, clinical, laboratory, and mortality data were obtained for analysis. The patients were aged 54.9 ± 18.9 years. Following ingestion, the patients experienced a wide range of clinical symptoms, including aspiration pneumonia (50.8%), acute respiratory failure (41.3%), acute kidney injury (33.3%), multiple organ failure (19.0%), emesis (19.0%), acute hepatitis (12.7%), diarrhea (7.9%), seizures (4.8%), lacrimation (4.8%), etc. After analysis, it was found that patients with methomyl and cypermethrin poisoning suffered higher incidences of acute respiratory failure (p < 0.001), aspiration pneumonia (p = 0.004), acute kidney injury (p = 0.011), and multiple organ failure (p < 0.001) than the other groups. Laboratory analyses revealed that patients with methomyl and cypermethrin poisoning had a higher creatinine level (p = 0.011), white blood cell count (p < 0.001), and neutrophil count (p = 0.019) than the other groups. A total of seven (11.1%) patients died. The average duration of hospitalization was 9.8 ± 10.0 days. In a multivariate logistic regression model, it was revealed that methomyl pesticide (p = 0.045) or methomyl and cypermethrin pesticide mixture (p = 0.013) were significant risk factors for acute respiratory failure. Nevertheless, no mortality risk factor could be identified. Therefore, the analytical results suggest that methomyl pesticide is the major contributor to the toxicity of methomyl and cypermethrin pesticide mixture poisoning. More research is needed.

Objective: Although pesticide poisonings occur worldwide, most high-income countries have not been severely affected. Japan is a key exception, with pesticide suicides becoming a major public health concern in the 1980s. We here report the epidemiology of lethal pesticide poisoning in Japan in relation to its pesticide regulation and agricultural output.Methods: We obtained data on pesticide registration and sales from the Japan Plant Protection Association’s annual Pesticide Handbook, national Food and Agricultural Materials Inspection Center, and Food and Agriculture Organization of the United Nations. Data on deaths due to pesticide poisoning and population were obtained from Vital Statistics of Japan. We reviewed the registration status and hazard classification of pesticides in Japan and analysed the relationships between the use/sales, pesticides fatalities, and agricultural output.Results: Five hundred and twenty-nine pesticide active ingredients are currently registered in Japan, including four WHO hazard class IB organophosphorus and carbamate insecticides. Paraquat was registered in 1962 as a liquid SL20 formulation. In 1986, restrictions were imposed on its sale/use and a 4.3% paraquat ion/4.1% diquat ion combination product registered by ICI. There were 221 pesticide poisoning fatalities in 2019, down from 2,648 in 1986, a 92% reduction over 33 years. Self-poisoning was responsible for most pesticide deaths in both 1985 (2,013/2,476, 81.3%) and 2019 (146/221, 66.1%). Pesticide poisoning made up 8.6% of all suicides in 1985, down to 0.7% in 2019. Unintentional deaths also all fell by 83.8%, from 463 to 75. These reductions were associated with reduced sales of both OP/carbamate insecticides and paraquat/diquat but no apparent change in agricultural output across a broad range of crops.Conclusions: Reduced use of highly hazardous pesticides and lowered concentration formulations in Japan was associated with major decreases in all deaths from pesticide poisoning and the proportion of all suicides due to pesticide ingestion.

There is growing awareness that nature-based solutions (NBS) prevent negative effects and secure ecosystem services. However, the potential of NBS to provide intended benefits has not been rigorously assessed. Water, food, and energy (WFE) are essential for human well-being. This study highlights the importance of NBS in terms of water, food, and energy. A set of on-site NBS that includes permeable pavements, plant microbial fuel cells, bio-filtration basins, and rain gardens is used to determine the contribution of NBS to the environmental and economic development of urban environments. The results of this study show that NBSs benefit an urban environment in terms of water treatment, stormwater retention, food production and energy generation, carbon sequestration, pollination, sedimentation retention, and cultural services dimension. This research highlights an urgent need for the integration of water, food, and energy plans to ensure that NBSs contribute to the environment and for the conservation of ecosystem services.

INTRODUCTION Routine HIV testing is expected to facilitate early diagnosis and treatment. Nevertheless, to date, limited data are available on the presumed benefit of early detection with improved outcomes through routine HIV testing. METHODS This study was based on the Taiwan national HIV/AIDS registry, with follow-up data validated through December 31, 2014. Outcomes of people diagnosed with HIV infection through the routine (routinely offered in specific settings, opt-out) versus through nonroutine (individual risk-based) testing were compared. The main outcomes of the study were late diagnosis, HIV-related mortality, and all-cause mortality. Individuals were matched by year of HIV diagnosis and adjusted for age, sex, transmission routes, and SES. Analyses were conducted in 2019-2020. RESULTS This study included all 28,674 people diagnosed with HIV infection during 1986-2014 (8,431 [29%] by routine testing, 18,305 [64%] by individual risk-based testing) with a mean follow-up time of 6.2 years. Routine testing was associated with an 80% lower likelihood of late HIV diagnosis (AOR=0.20, 95% CI=0.18, 0.23, p

In this paper, under some new appropriate conditions imposed on the parameters and mappings involved in the proximal mapping associated with a general H-monotone operator, its Lipschitz continuity is proved and an estimate of its Lipschitz constant is computed. The main contribution of this work is the establishment of a new equivalence relationship between the graph convergence of a sequence of general strongly H-monotone mappings and their associated proximal mappings, respectively, to a given general strongly H-monotone mapping and its associated proximal mapping by using the notions of graph convergence and proximal mapping concerning a general strongly H-monotone mapping. By employing the concept of proximal mapping relating to general strongly H-monotone mapping, some iterative algorithms are proposed, and as an application of the obtained equivalence relationship mentioned above, a convergence theorem for approximating a common element of the set of solutions of a system of generalized variational inclusions involving general strongly H-monotone mappings and the set of fixed points of an ({an},{bn},ϕ)-total uniformly L-Lipschitzian mapping is proved. It is significant to emphasize that our results are new and improve and generalize many known corresponding results.

The purpose of this paper is to study the convergence theorems in $\operatorname{CAT} (\kappa )$ CAT ( κ ) spaces with $k > 0$ k > 0 for total asymptotically nonexpansive mappings which are essentially wider than nonexpansive mappings, asymptotically nonexpansive mapping, and asymptotically nonexpansive mappings in the intermediate sense. Our results generalize, unify, and improve several comparable results in the existing literature.

Backgrounds Socioeconomic factors influence suicide risk but a systematic understanding of the role of financial hardship is unclear. We examined whether financial hardship had cumulative or contemporaneous impacts on suicide ideation and any gender and age differences in a large Korean sample. Methods Data of 67,728 observations from 14,321 individuals were extracted from seven waves of Korean Welfare Panel Study. The association of financial hardship at baseline and its change over two years with suicide ideation was investigated using generalized estimation equation to account for repeated measurements within an individual, adjusting for other socioeconomic factors. Results Financial hardship was associated with suicide ideation but the magnitude of association varied across age and gender groups. Specifically, the impact of financial hardship was persistent over two years presenting a cumulative effect among men aged 50-64 years and ≥65 years; e.g., adjusted OR (adjusted odds ratio) = 3.87, 95 % CI = 2.71–5.54 for emergent hardship group vs adjusted OR = 4.22, 95 %CI = 3.00–5.93 for persistent group in those aged ≥65 years. Financial hardship increased the risk of suicide ideation incrementally with age, although the pattern was less clear among women. Limitations Financial hardship was identified as having changing nature, though it was assumed to occur over two years. Conclusion In general, financial hardship plays a role in amplifying suicide ideation in a contemporaneous way but also in a cumulative way, predominantly among late-middle-aged and elderly men. Monitoring and intervention for financial hardship would be a promising strategy for suicide prevention.

To clarify the mechanism of semicarbazide-modified α-lactalbumin (SEM-LA)-mediated cytotoxicity, we investigated its effect on human U937 leukemia cells and MCF-7 breast cancer cells in the current study. SEM-LA induced apoptosis in U937 cells, which showed increased NOX4 expression, procaspase-8 degradation, and t-Bid production. FADD depletion inhibited SEM-LA-elicited caspase-8 activation, t-Bid production, and cell death, indicating that SEM-LA activated death receptor-mediated apoptosis in U937 cells. SEM-LA stimulated Ca2+-mediated Akt activation, which in turn increased Sp1- and p300-mediated NOX4 transcription. The upregulation of NOX4 expression promoted ROS-mediated p38 MAPK phosphorylation, leading to protein phosphatase 2A (PP2A)-regulated tristetraprolin (TTP) degradation. Remarkably, TTP downregulation increased the stability of TNF-α mRNA, resulting in the upregulation of TNF-α protein expression. Abolishment of Ca2+-NOX4-ROS axis-mediated p38 MAPK activation attenuated SEM-LA-induced TNF-α upregulation and protected U937 cells from SEM-LA-mediated cytotoxicity. The restoration of TTP expression alleviated the effect of TNF-α upregulation and cell death induced by SEM-LA. Altogether, the data in this study demonstrate that SEM-LA activates TNF-α-mediated apoptosis in U937 cells through the NOX4/p38 MAPK/PP2A axis. We think that a similar pathway can also explain the death of MCF-7 human breast cancer cells after SEM-LA treatment.

Abstract. Background: Debunking suicide misconceptions is an important suicide prevention measure. Few studies on suicide misconceptions and their correlates have been conducted in East Asia, where suicide is known to be more permissible. Aims: We investigated the prevalence and associated characteristics of suicide misconceptions in Taiwan. Whether holding suicide misconceptions was associated with reduced support for governmental suicide prevention measures was also assessed. Method: A dual-frame nationally representative telephone survey combining landlines and mobiles was conducted with 1,087 respondents. Logistic regression analyses were used to examine factors associated with suicide misconceptions. Results: Nearly 82% of the respondents held at least one type of suicide misconceptions. The most commonly held misconception was “Talking about suicide would encourage suicide” (49.5%), followed by “People who talk about suicide do not mean to do it” (47.3%) and “Most suicides happen suddenly without any warning” (46.5%). Suicide misconceptions were more common in younger people, divorced/widowed individuals, and those with lower educational attainment. Individuals with suicide misconceptions were less likely to support governmental investments in suicide prevention. Limitations: Causality could not be inferred from the cross-sectional study. Conclusions: Suicide misconceptions are prevalent in Taiwan. Debunking suicide misconceptions should be an integral part of national suicide prevention strategies.

We evaluated the effects of breathing Pseudotsuga menziesii (P. menziesii) and Lavandula angustifolia (L. angustifolia) essential oils (EOs) during a horticultural activity on older adults. A total number of 92 older adult (71.2 ± 7.7 years old) participants were guided through a leaf printing procedure. In the meantime, water vapor and EOs were diffused in an orderly manner. The heart rate variability-related parameters as well as the brain waves were recorded. In addition, we also collected data for the State–Trait Anxiety Inventory-State (STAI-S) questionnaires before and after the whole indoor natural activity program. The physiological parameters including standard deviation of normal to normal intervals, normalized high frequency (nHF), and high alpha wave increased while the normalized low frequency (nLF), the ratio of LF-to-HF power, high beta wave, and gamma wave decreased following the breathing of P. menziesii and L. angustifolia EOs. These changes indicated a relaxing effect of breathing both EOs during a horticultural activity on older adults. Our results demonstrated a beneficial effect of P. menziesii EO which is as good as a well-known relaxant L. angustifolia EO. This notion was supported by the results of STAI-S. Here we developed an indoor natural activity program for older adults to promote physical and mental health.

We evaluated the effects of breathing

This paper is devoted to the study of a class of generalized nonexpansive mappings called generalized nearly asymptotically nonexpansive mappings and to show that it properly includes the class of nearly asymptotically nonexpansive mappings. We investigate the problem of approximating a common element of the set of solutions of a system of generalized nonlinear variational-like inclusions involvingP-η-accretive mappings and of the set of fixed points of a generalized nearly asymptotically nonexpansive mapping. To this end, we suggest a new iterative algorithm with mixed errors. As an application of the obtained equivalence, we prove the strong convergence and stability of the sequence generated by the proposed iterative algorithm to a common point of the two sets mentioned above.

Background Predicted increases in suicide were not generally observed in the early months of the COVID-19 pandemic. However, the picture may be changing and patterns might vary across demographic groups. We aimed to provide a timely, granular picture of the pandemic's impact on suicides globally. Methods We identified suicide data from official public-sector sources for countries/areas-within-countries, searching websites and academic literature and contacting data custodians and authors as necessary. We sent our first data request on 22nd June 2021 and stopped collecting data on 31st October 2021. We used interrupted time series (ITS) analyses to model the association between the pandemic's emergence and total suicides and suicides by sex-, age-and sex-by-age in each country/area-within-country. We compared the observed and expected numbers of suicides in the pandemic's first nine and first 10-15 months and used meta-regression to explore sources of variation. Findings We sourced data from 33 countries (24 high-income, six upper-middle-income, three lower-middle-income; 25 with whole-country data, 12 with data for area(s)-within-the-country, four with both). There was no evidence of greater-than-expected numbers of suicides in the majority of countries/areas-within-countries in any analysis; more commonly, there was evidence of lower-than-expected numbers. Certain sex, age and sex-by-age groups stood out as potentially concerning, but these were not consistent across countries/areas-within-countries. In the meta-regression, different patterns were not explained by countries' COVID-19 mortality rate, stringency of public health response, economic support level, or presence of a national suicide prevention strategy. Nor were they explained by countries' income level, although the meta-regression only included data from high-income and upper-middle-income countries, and there were suggestions from the ITS analyses that lower-middle-income countries fared less well. Interpretation Although there are some countries/areas-within-countries where overall suicide numbers and numbers for certain sex- and age-based groups are greater-than-expected, these countries/areas-within-countries are in the minority. Any upward movement in suicide numbers in any place or group is concerning, and we need to remain alert to and respond to changes as the pandemic and its mental health and economic consequences continue. Copyright (C) 2022 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Made available in DSpace on 2022-04-28T19:40:08Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-07-01 Background: The COVID-19 pandemic is having profound mental health consequences for many people. Concerns have been expressed that, at their most extreme, these consequences could manifest as increased suicide rates. We aimed to assess the early effect of the COVID-19 pandemic on suicide rates around the world. Methods: We sourced real-time suicide data from countries or areas within countries through a systematic internet search and recourse to our networks and the published literature. Between Sept 1 and Nov 1, 2020, we searched the official websites of these countries’ ministries of health, police agencies, and government-run statistics agencies or equivalents, using the translated search terms “suicide” and “cause of death”, before broadening the search in an attempt to identify data through other public sources. Data were included from a given country or area if they came from an official government source and were available at a monthly level from at least Jan 1, 2019, to July 31, 2020. Our internet searches were restricted to countries with more than 3 million residents for pragmatic reasons, but we relaxed this rule for countries identified through the literature and our networks. Areas within countries could also be included with populations of less than 3 million. We used an interrupted time-series analysis to model the trend in monthly suicides before COVID-19 (from at least Jan 1, 2019, to March 31, 2020) in each country or area within a country, comparing the expected number of suicides derived from the model with the observed number of suicides in the early months of the pandemic (from April 1 to July 31, 2020, in the primary analysis). Findings: We sourced data from 21 countries (16 high-income and five upper-middle-income countries), including whole-country data in ten countries and data for various areas in 11 countries). Rate ratios (RRs) and 95% CIs based on the observed versus expected numbers of suicides showed no evidence of a significant increase in risk of suicide since the pandemic began in any country or area. There was statistical evidence of a decrease in suicide compared with the expected number in 12 countries or areas: New South Wales, Australia (RR 0·81 [95% CI 0·72–0·91]); Alberta, Canada (0·80 [0·68–0·93]); British Columbia, Canada (0·76 [0·66–0·87]); Chile (0·85 [0·78–0·94]); Leipzig, Germany (0·49 [0·32–0·74]); Japan (0·94 [0·91–0·96]); New Zealand (0·79 [0·68–0·91]); South Korea (0·94 [0·92–0·97]); California, USA (0·90 [0·85–0·95]); Illinois (Cook County), USA (0·79 [0·67–0·93]); Texas (four counties), USA (0·82 [0·68–0·98]); and Ecuador (0·74 [0·67–0·82]). Interpretation: This is the first study to examine suicides occurring in the context of the COVID-19 pandemic in multiple countries. In high-income and upper-middle-income countries, suicide numbers have remained largely unchanged or declined in the early months of the pandemic compared with the expected levels based on the pre-pandemic period. We need to remain vigilant and be poised to respond if the situation changes as the longer-term mental health and economic effects of the pandemic unfold. Funding: None. Centre for Mental Health Melbourne School of Population and Global Health University of Melbourne Swansea University Medical School Translational Health Research Institute Western Sydney University Ministry of Public Health Department of Health Promotion National Confidential Inquiry into Suicide and Safety in Mental Health University of Manchester Centre for Mental Health and Safety and National Institute for Health Research Patient Safety Translational Research Centre University of Manchester School of Public Health National Suicide Research Foundation University College Cork Australian Institute for Suicide Research and Prevention School of Applied Psychology Griffith University Institute for Life Course Health Research Department of Global Health Stellenbosch University Working Group on Prevention of Suicide and Depression at Public Health Council Department of Psychiatry Blekinge Hospital Botucatu Medical School Universidade Estadual Paulista Instituto Nacional de Psiquiatría Ramon de la Fuente Muñiz University of Rochester Medical Center Region Friuli Venezia Giulia Central Health Directorate Outpatient and Inpatient Care Service Department of Medicine University of Udine Institute of Health Behaviors and Community Sciences College of Public Health National Taiwan University Thames Valley Local Criminal Justice Board Department of Psychiatry Psychotherapy and Psychosomatics Medical University of Innsbruck Center for Outcomes Research and Evaluation Yale School of Medicine Coroners Court of Victoria Danish Research Institute for Suicide Prevention Department of Mental Health Johns Hopkins School of Public Health Centre for Mental Health Research Australian National University Brigham and Women's Hospital Department of Emergency Medicine School of Population Health University of Auckland Magistrates Court of Tasmania (Coronial Division) Bureau of Vital Records and Statistics Louisiana Office of Public Health Ministry of Public Health Undersecretary of Health Services Research Department, 113 Suicide Prevention Departments of Psychiatry and Epidemiology Columbia University Medical Center/New York State Psychiatric Institute Centre for Suicide Research University of Oxford Louisiana Department of Health Greater Manchester Mental Health NHS Foundation Trust Department of Psychiatry Aga Khan University KU Leuven Center for Contextual Psychiatry Population Health Sciences Bristol Medical School University of Bristol South Asian Clinical Toxicology Research Collaboration Faculty of Medicine University of Peradeniya World Health Organization Country Office for Nepal Karolinska Institutet Bekhterev National Medical Research Center of Psychiatry and Neurology Pavlov First Saint Petersburg State Medical University Unit Suicide Research and Mental Health Promotion Department of Social and Preventive Medicine Center for Public Health Medical University of Vienna Department of Child and Adolescent Psychiatry Medical University of Vienna School of Psychology University of Nottingham Self-Harm Research Group School of Psychology University of Nottingham Mental Health Centre Copenhagen Department of Psychiatry and Psychotherapy Klinikum Klagenfurt am Wörthersee Suicidal Behaviour Research Lab University of Glasgow Preventing Deaths from Poisoning Research Group University of Edinburgh Usher Institute University of Edinburgh Suicide Research and Prevention Center Shanghai Mental Health Center Shanghai Jiao Tong University School of Medicine Departments of Psychiatry and Epidemiology Columbia University Department of Child and Adolescent Psychiatry and Psychotherapy University of Ulm Psychosocial Services in Vienna National Centre for Suicide Research and Prevention Institute of Clinical Medicine University of Oslo Department of Child and Adolescent Psychiatry Psychotherapy and Psychosomatics University Hospital Leipzig Department of Psychiatry and Psychotherapeutic Medicine Landeskrankenhaus Villach Department of Psychiatry Psychosomatic Medicine and Psychotherapy University Hospital Frankfurt Department of Borderline Disorders and Psychotherapy Bekhterev National Medical Research Center of Psychiatry and Neurology Saint Petersburg State University Department of Psychiatry Health Authority Frankfurt am Main Department of Addictive Disorders Psychiatry and Psychotherapy LVR-Klinik Köln Department of Psychiatry Psychosomatic Medicine and Psychotherapy Goethe-University Organizational-Scientific Department Bekhterev National Medical Research Center of Psychiatry and Neurology Department of Psychiatry University of Toronto Department of Psychiatry Sunnybrook Health Sciences Centre Waseda University Faculty of Political Science and Economics Sneha—Suicide Prevention Centre Voluntary Health Services Department of Community Medicine Faculty of Medicine and Allied Sciences Rajarata University of Sri Lanka Department of Psychiatry Sackler School of Medicine Tel Aviv University and Geha Mental Health Center Division of Molecular Imaging and Neuropathology New York State Psychiatric Institute and Department of Psychiatry Columbia University National Institute of Health Research Biomedical Research Centre University Hospitals Bristol and Weston NHS Foundation Trust University of Bristol Department for Psychiatry University Psychiatric Hospital Vrapče School of Medicine University of Zagreb Botucatu Medical School Universidade Estadual Paulista

Water deficit during the growing season is a major factor limiting vegetable production. Therefore, saving water used for vegetable production by applying regulated deficit irrigation (RDI) can be a strategy to reduce water supply. The effects of different RDI levels from irrigation systems on vegetable yields, yield components, water use, and water use efficiency (WUE) of maize, lettuce, and garland chrysanthemum were investigated in a pot experiment. Plants were subjected to four irrigation levels, as follows: full irrigation as a control (RDI-100), 70% of full irrigation (RDI-70), 50% of full irrigation (RDI-50), and 30% of full irrigation (RDI-30). The WUE values of maize and lettuce were significantly higher with RDI-30 than other treatments, yet a significant reduction of WUE in garland chrysanthemum was detected compared to other treatments. There were significant correlations of WUEi with WUEyield and WUEbiomass in maize plants, indicating that WUEi can be a useful nondestructive estimator of yields and biomass contents in maize. Moreover, a significant correlation between WUEi and WUEyield in lettuce plants was observed. This index was correlated with economic production, and can be used to assess fresh weights and as an index of the irrigated water content. These results for evaluating water deficits in plants used nondestructive measurements that are applicable to large-scale water management of vegetable plants, thereby enabling scarce water resources to be conserved.

The goal of this paper is to introduce a new class of parametric elliptical variational-hemivariational inequality problems together with parametric inverse problems. We show the existence of solut...

Background Taiwan has implemented a national health insurance system since 1995 with high coverage and utilization rate. However, the health care system in Taiwan is facing immense challenges due to rapid population ageing. We have evaluated the landscape of population health by revisiting the results of GBD 2017 study. Methods Taiwan vital registration data (1980–2016) and Taiwan national health insurance database (2016) were used. We also conducted benchmarking comparisons with selected countries in East Asia from 1990 to 2017. Results The age-standardized disability-adjusted life-year (DALY) rates decreased by one-quarter from 1990 to 2017; however, progress was relatively slow compared to the comparator countries and has been stagnant recently. The Social-demographic Index (SDI) level in Taiwan in 2017 was 0.86, which is similar to Japan, Singapore, and South Korea in 2017, while the SDI level of China in 2017 was similar to that of Taiwan (0.69) in 1990. Although Taiwan's SDI reached the same level as those in Japan, Singapore, and South Korea in 2017, modifiable risk factors still contributed to nearly half of Taiwan's total disease burden. Five leading risk factors (high fasting plasma glucose, high body-mass index, alcohol use, illicit drug use, and impaired kidney function) accounted for a higher DALY rate in Taiwan than comparator countries in 2017. Conclusion Taiwan made marked progress in health from 1990 to 2017. However, interventions targeted on major modifiable disease risk factors should be prioritized to realize the full potential of heath improvement in the process of rapid socioeconomic development.

We investigated the impact of the COVID-19 pandemic on call volumes and call characteristics using data from a national crisis helpline. Data were extracted for 215,066 calls to Taiwan’s national suicide prevention hotline (January 2018–May 2020). We used negative binomial regression to investigate changes in the weekly number of calls during the early period of the COVID-19 outbreak (January 21, 2020–May 25, 2020), relative to that expected according to the pre-pandemic trend. The call characteristics during the pandemic period (February 18, 2020–May 31, 2020) were compared between COVID-19 related vs unrelated calls. Higher-than-expected call volumes started from the 6th week of the pandemic and reached a peak in the 14th week, which was 38% (rate ratio = 1.38, 95% confidence interval 1.26–1.51) higher than that expected based on the pre-pandemic trend. The higher-than-expected call volumes were mainly attributable to higher-than-expected calls from non-suicidal and male callers. Calls in which COVID-19 was mentioned (13.2%) were more likely to be from male and first-time callers, occur outside 12 am–6 am, last less than 5 min, and were less likely to be from callers who had previous suicide attempts, recent suicidal ideation or suicide plans or actions than COVID-19 unrelated calls. Callers who made COVID-19 related calls were more likely to request information than other callers. Crisis helplines should strategically adapt to the increased need and callers’ specific concerns related to the outbreak.

Background: The COVID-19 pandemic and its consequences may affect population mental health and suicide risk.Aims: To explore the experiences among suicidal individuals who made calls to a suicide prevention hotline and to identify factors and psychological responses that may influence suicide risk.Method: We identified 60 eligible recorded calls to Taiwan’s suicide prevention hotline (January 23-May 31, 2020) and analyzed the transcripts using the framework analysis.Findings: We identified three themes: (a) effects of the COVID-19 pandemic on society (impacts on local economies, the fear of contagion, and disruptions caused by outbreak control measures); (b) stress experienced by callers, including increased challenges (financial burden, restricted freedom of movement, interpersonal conflicts, feelings of uncertainty, and education/career interruption) and reduced support (reduced access to health services and social support); and (c) the callers’ psychological responses to stress, including anxiety, sleep disturbance, depression, loneliness, hopelessness, and entrapment, which may increase suicide risk.Limitations: Only the experiences among those who sought help by calling the hotline during the early months of the pandemic in 2020 were explored.Conclusion: Our findings revealed the potential process underlying the impact of the COVID-19 pandemic on suicide risk and have implications for prevention and intervention strategies.

Previous studies have shown that chemical modification may increase the activity of proteins or confer novel activity to proteins. Some studies have indicated that myoglobin (Mb) is cytotoxic; however, the underlying mechanisms remain unclear. In this study, we investigated whether chemical modification of the carboxyl group by semicarbazide could promote the Mb cytotoxicity in human leukemia U937 cells and the underlying mechanism of semicarbazide-modified myoglobin (SEM-Mb)-induced U937 cell death. The semicarbazide-modified Mb (SEM-Mb) induced U937 cell apoptosis via the production of cleaved caspase-8 and t-Bid, while silencing of FADD abolished this effect. These findings suggest that SEM-Mb can induce U937 cell death by activating the death receptor-mediated pathway. The SEM-Mb inhibited miR-99a expression, leading to increased NOX4 mRNA and protein expression, which promoted SIRT3 degradation, and, in turn, induced ROS-mediated p38 MAPK phosphorylation. Activated p38 MAPK stimulated miR-29a-dependent tristetraprolin (TTP) mRNA decay. Downregulation of TTP slowed TNF-α mRNA turnover, thereby increasing TNF-α protein expression. The SEM-Mb-induced decrease in cell viability and TNF-α upregulation were alleviated by abrogating the NOX4/SIRT3/ROS/p38 MAPK axis or ectopic expression of TTP. Taken together, our results demonstrated that the NOX4/SIRT3/p38 MAPK/TTP axis induces TNF-α-mediated apoptosis in U937 cells following SEM-Mb treatment. A pathway regulating p38 MAPK-mediated TNF-α expression also explains the cytotoxicity of SEM-Mb in the human leukemia cell lines HL-60, THP-1, K562, Jurkat, and ABT-199-resistant U937. Furthermore, these findings suggest that the carboxyl group-modified Mb is a potential structural template for the generation of tumoricidal proteins.

Avermectin pesticides are widely used in agriculture, and are thought to have low toxicity in humans. However, information on their toxicity after accidental or deliberate ingestion is limited.The aim of this study was to evaluate the clinical manifestations of avermectin pesticide ingestion and identify factors associated with severe outcomes (death, intubation, or sustained hypotension requiring inotrope therapy).This multicenter retrospective study included patients who visited the emergency departments of six teaching hospitals due to acute avermectin pesticide ingestion between January 2012 and May 2020. Patients who reported ingestion of any other pesticides, drugs, or substances were excluded.In total, 64 patients (median age, 72 years) were included: 60 had ingested emamectin pesticides, and 4 had ingested abamectin. Almost all (98%) were cases of self-harm. The most common presentation was drowsiness (47%), with a median Glasgow Coma Scale (GCS) score of 14, followed by shortness of breath (SOB)/dyspnea (33%) and nausea/vomiting (22%). Concurrent methanol exposure (Most patients who intentionally ingested avermectin pesticides required inpatient treatment. Forty-two percent needed ICU care and 31% had severe outcomes. A GCS score13 and SOB/dyspnea were independently associated with severe outcomes.

(1) Background: The complication rates for nonagenarians receiving therapeutic endoscopic retrograde cholangiopancreatography (ERCP) remain poorly understood. We aimed to determine whether nonagenarians were at an increased risk of ERCP-related complications. (2) Methods: We performed a retrospective study on therapeutic ERCP in nonagenarians from 2011 to 2016 at Taichung Veterans General Hospital. A control group comprising patients aged 65 to 89 years was used to compare demographic data and the outcomes of therapeutic ERCP with the nonagenarians. The risk factors for complications were determined by logistic regression model. (3) Results: There were 35 nonagenarians and 111 patients in the control group. Overall, complication rates were not statistically different between the two groups. However, advanced age was an independent predictor of complications in the multivariate analysis (odds ratio [OR] = 1.06; 95% confidence interval [CI] = 1.01–1.12; p = 0.049). End stage renal disease (ESRD) was another independent predictor of complications (OR = 4.87; 95% CI = 1.11–21.36; p = 0.036). Post-ERCP pancreatitis and bleeding were more common in ESRD patients than patients without ESRD. (4) Conclusions: Although nonagenarians receiving ERCP did not have more complications compared to elderly patients younger than 90 years, advanced age and comorbidity still affect the outcome of therapeutic ERCP in the elderly patients.

Previous studies have demonstrated that Siegesbeckia orientalis (SO) has a suppressive effect on the growth and migration of endometrial and cervical cancer cells. The present study examined the effect of SO ethanolic extract (SOE) on the proliferation and migration of hepatocellular carcinoma (HCC) and examined the effects of SOE on non-cancerous cells using HaCaT keratinocytes as a model. The SOE effectively inhibited the proliferation of Hepa1-6 (IC50 = 282.4 μg/mL) and HepG2 (IC50 = 344.3 μg/mL) hepatoma cells, whereas it has less cytotoxic effect on HaCaT cells (IC50 = 892.4 μg/mL). The SOE treatment increased the generation of ROS in HCC, but decreased the expression of antioxidant enzymes such as superoxide dismutase, glutathione peroxidase and catalase. In contrast, it reduced intracellular ROS formation and upregulated the expression of the related antioxidant enzymes in the H2O2-stimulated HaCaT cells. The SOE intervention also down-regulated the anti-apoptotic Bcl-2 and the migration-related proteins including matrix metalloproteinases (MMPs) and β-catenin in the HCC, suggesting that SOE could promote HCC apoptosis and inhibit HCC migration. On the contrary, it reduced apoptosis and promoted the migration of the keratinocytes. Additionally, the SOE treatment significantly up-regulated the pro-inflammatory cytokines, including TNF-α, IL-6 and IL-1β, in Hepa1-6 and HepG2 cells. Conversely, it significantly decreased the expression of these cytokines in the H2O2-induced HaCaT cells. These findings indicated that SOE treatment can delay the progression of HCC by increasing oxidative stress, promoting inflammatory response, inducing cancer cell apoptosis and inhibiting their migration. It also has protective effects from pro-oxidant H2O2 in non-cancerous cells. Therefore, SOE may provide a potential treatment for liver cancer.

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The main aim of this paper is twofold. Our first objective is to study a new system of generalized multivalued variational-like inequalities in Banach spaces and to establish its equivalence with a system of fixed point problems utilizing the concept of P-η-proximal mapping. The obtained alternative equivalent formulation is used and a new iterative algorithm for finding its approximate solution is suggested. Under some appropriate assumptions imposed on the mappings and parameters involved in the system of generalized multivalued variational-like inequalities, the existence of solution for the system mentioned above is proved and the convergence analysis of the sequences generated by our proposed iterative algorithm is discussed. The second objective of this work is to investigate and analyze the notion M-η-proximal mapping defined in the literature. Taking into account of the assumptions considered for such a mapping, we prove that every M-η-proximal mapping is actually P-η-proximal and is not a new one. At the same time, some comments relating to some existing results are pointed out.

Background Suicides by carbon monoxide poisoning from burning charcoal increased markedly and contributed to a rise in overall suicides in Taiwan in the early 2000s. A previous study indicated short-term effectiveness on reducing suicides of a charcoal restriction programme, which involved voluntary actions from large chain retail stores to move charcoal bags from open shelves to locked cabinets starting from 1st May 2012, in New Taipei City, Taiwan. We investigated the longer-term effect of this programme. Methods We calculated quarterly age-standardised charcoal-burning and overall suicide rates in New Taipei City and two comparison cities in 2007-2017. Controlled interrupted time-series analysis was used to examine the effect of the charcoal restriction programme. Results There was no difference between the intervention and comparison cities in step changes in the rates (per 100,000) of charcoal-burning suicide (intervention minus comparison = -0.336, 95% confidence interval -1.173 to 0.502) and overall suicide (-0.270, -1.844 to 1.303) after the intervention, or changes in trends (slopes) in charcoal-burning suicide rates (0.007, -0.055 to 0.069) and overall suicide rates (0.049, -0.138 to 0.236) before and after the intervention. Limitations There was no legislative requirement to enforce the charcoal restriction. The programme was also restricted to a subset of retail stores. Conclusion The charcoal restriction programme in New Taipei City showed no effect on reducing charcoal-burning or overall suicides in the five years after its implementation. Future means restriction strategies for suicide prevention should optimise the programme sustainability, ensure the comprehensive means restriction, and monitor the long-term intervention effectiveness.