Suicidal acts may cluster in time and space and lead to community concerns about further imitative suicidal episodes. Although suicide clusters have been researched in previous studies, less is known about the clustering of non-fatal suicidal behaviour (self-harm). Furthermore, most previous studies used crude temporal and spatial information, e.g., numbers aggregated by month and residence area, for cluster detection analysis. This study aimed to (i) identify space–time clusters of self-harm and suicide using daily incidence data and exact address and (ii) investigate the characteristics of cluster-related suicidal acts.

Data on emergency department presentations for self-harm and suicide deaths in Taipei City and New Taipei City, Taiwan, were used in this study. In all-age and age-specific analyses, self-harm and suicide clusters were identified using space–time permutation scan statistics. A cut-off of 0.10 for the p value was used to identify possible clusters. Logistic regression was used to investigate the characteristics associated with cluster-related episodes.

A total of 5,291 self-harm episodes and 1,406 suicides in Taipei City (2004–2006) and 20,531 self-harm episodes and 2,329 suicides in New Taipei City (2012–2016) were included in the analysis. In the two cities, two self-harm clusters (n [number of self-harm episodes or suicide deaths in the cluster] = 4 and 8 in Taipei City), four suicide clusters (n = 3 in Taipei City and n = 4, 11 and 4 in New Taipei City) and two self-harm and suicide combined clusters (n = 4 in Taipei City and n = 8 in New Taipei City) were identified. Space–time clusters of self-harm, suicide, and self-harm and suicide combined accounted for 0.05%, 0.59%, and 0.08% of the respective groups of suicidal acts. Cluster-related episodes of self-harm and suicide were more likely to be male (adjusted odds ratio [aOR] = 2.22, 95% confidence interval [CI] 1.26, 3.89) and young people aged 10–29 years (aOR = 2.72, 95% CI 1.43, 5.21) than their cluster-unrelated counterparts.

Space–time clusters of self-harm, suicide, and self-harm and suicide combined accounted for a relatively small proportion of suicidal acts and were associated with some sex/age characteristics. Focusing on suicide deaths alone may underestimate the size of some clusters and/or lead to some clusters being overlooked. Future research could consider combining self-harm and suicide data and use social connection information to investigate possible clusters of suicidal acts.

Dynamic interpersonal therapy (DIT) is a brief, structured psychodynamic psychotherapy with demonstrated efficacy in treating major depressive disorder (MDD). The aim of the study was to determine whether DIT is an acceptable and efficacious treatment for MDD patients in China.

Patients were randomized to 16-week treatments with either DIT plus antidepressant medication (DIT + ADM; n = 66), general supportive therapy plus antidepressant medication (GST + ADM; n = 75) or antidepressant medication alone (ADM; n = 70). The Hamilton Depression Rating Scale (HAMD) administered by blind raters was the primary efficacy measure. Assessments were completed during the acute 16-week treatment and up to 12-month posttreatment.

The group × time interaction was significant for the primary outcome HAMD (F = 2.900, df1 = 10, df2 = 774.72, p = 0.001) in the acute treatment phase. Pairwise comparisons showed a benefit of DIT + ADM over ADM at weeks 12 [least-squares (LS) mean difference = −3.161, p = 0.007] and 16 (LS mean difference = −3.237, p = 0.004). Because of the unexpected high attrition during the posttreatment follow-up phase, analyses of follow-up data were considered exploratory. Differences between DIT + ADM and ADM remained significant at the 1-, 6-, and 12-month follow-up (ps range from 0.001 to 0.027). DIT + ADM had no advantage over GST + ADM during the acute treatment phase. However, at the 12-month follow-up, patients who received DIT remained less depressed.

Acute treatment with DIT or GST in combination with ADM was similarly efficacious in reducing depressive symptoms and yielded a better outcome than ADM alone. DIT may provide MDD patients with long-term benefits in symptom improvement but results must be viewed with caution.

Mental disorders, including depression, obsessive compulsive disorder (OCD), and schizophrenia, share a common neuropathy of disturbed large-scale coordinated brain maturation. However, high-interindividual heterogeneity hinders the identification of shared and distinct patterns of brain network abnormalities across mental disorders. This study aimed to identify shared and distinct patterns of altered structural covariance across mental disorders.

Subject-level structural covariance aberrance in patients with mental disorders was investigated using individualized differential structural covariance network. This method inferred structural covariance aberrance at the individual level by measuring the degree of structural covariance in patients deviating from matched healthy controls (HCs). T1-weighted anatomical images of 513 participants (105, 98, 190 participants with depression, OCD and schizophrenia, respectively, and 130 age- and sex-matched HCs) were acquired and analyzed.

Patients with mental disorders exhibited notable heterogeneity in terms of altered edges, which were otherwise obscured by group-level analysis. The three disorders shared high difference variability in edges attached to the frontal network and the subcortical-cerebellum network, and they also exhibited disease-specific variability distributions. Despite notable variability, patients with the same disorder shared disease-specific groups of altered edges. Specifically, depression was characterized by altered edges attached to the subcortical-cerebellum network; OCD, by altered edges linking the subcortical-cerebellum and motor networks; and schizophrenia, by altered edges related to the frontal network.

These results have potential implications for understanding heterogeneity and facilitating personalized diagnosis and interventions for mental disorders.

To assess the accuracy of the Varian PerfectPitch six-degree-of-freedom (6DOF) robotic couch by using a Varian SRS QA phantom.

The stereotactic radiosurgery (SRS) phantom has five tungsten carbide BBs each with 7·5 mm in diameter arranged with the known geometry. Optical surface images and cone beam CT (CBCT) images of the phantom were taken at different pitch, roll and rotation angles. The pitch, roll, and rotation angles were varied from −3 to 3 degrees by inputs from the linac console. A total of 39 Vision RT images with different rotation angle combinations were collected, and the Vision RT software was used to determine the rotation angles and translational shifts from those images. Eight CBCT images at most allowed rotational angles were analysed by in-house software. The software took the coordinates of the voxel of the maximum CT number inside a 7·5-mm sphere surrounding one BB to be the measured position of this BB. Expected BB positions at different rotation angles were determined by multiplying measured BB positions at zero pitch and roll values by a rotation matrix. Applying the rotation matrix to 5 BB positions yielded 15 equations. A linear least square method was used for regression analysis to approximate the solutions of those equations.

Of the eight calculations from CBCT images, the maximum rotation angle differences (degree) were 0·10 for pitch, 0·15 for roll and 0·09 for yaw. The maximum translation differences were 0·3 mm in the left–right direction, 0·5 mm in the anterior–posterior direction and 0·4 mm in the superior–inferior direction.

The uncertainties of the 6-DOF couch were examined with the methods of optical surface imaging and CBCT imaging of the SRS QA phantom. The rotational errors were less than 0·2 degree, and the isocentre shifts were less than 0·8 mm.

Evidence on the long-term comparative effectiveness of posttraumatic stress disorder (PTSD) psychotherapies in adults remains unknown. Therefore, we performed an extensive network meta-analysis of randomised controlled trials (RCTs) to determine the comparative effectiveness of psychotherapies for people diagnosed with PTSD.

A comprehensive search was conducted in Cochrane library, Embase, Medline-OVID, PubMed, Scopus, and Psych-Info until March 2021. Studies on the effectiveness of cognitive processing therapy (CPT), cognitive therapy (CT), eye movement desensitisation reprocessing (EMDR), narrative exposure therapy (NET), prolonged exposure (PE), cognitive behavioural therapy (CBT), present-centred therapy (PCT), brief eclectic psychotherapies (BEP), psychodynamic therapy (PDT) or combination therapies compared to no treatment (NT) or treatment as usual (TAU) in adults with PTSD were included. Frequentist and Bayesian approaches were used for analysis in R-software.

We included 98 RCTs with 5567 participants from 18 897 studies. CPT, EMDR, CT, NET, PE, CBT, and PCT were significant to reduce PTSD symptoms (SMD range: −1.53 to −0.75; Certainty: very low to high) at immediate post-treatment and ranked accordingly. Longitudinal analysis found EMDR (1.02) and CPT (0.85) as the significant therapies with large effect size in short-term and long-term follow-up, respectively. NET and CPT showed higher proportion of loss of PTSD diagnosis (RR range: 5.51–3.45) while there were no significant psychotherapies for retention rate compared to NT.

Our findings provide evidence for improving current guidelines and informing clinical decision-making for PTSD management. However, the best PTSD treatment plan should be tailored to patients' needs, characteristics, and clinician expertise.

PROSPERO CRD42020162143

Coronavirus disease (COVID-19) has spread worldwide due to high infectivity. The social sexual environment in rural areas of China and the weak basic medical facilities may affect the treatment and transmission of the disease. The aim of this study was to understand the knowledge, attitudes, and practices (KAP) related to COVID-19 among residents in rural areas experiencing the epidemic and the factors, to provide a basis for further epidemic prevention and control.

The COVID-19 KAP of rural residents in Hebei Province was collected by the snowball sampling method. The COVID-19 KAP questionnaire was distributed on social platforms such as WeChat and QQ through a network questionnaire.

The overall level of COVID-19 KAP in rural residents was good, but in terms of knowledge, the correct rate of isolation was 73.2%, the correct rates of 2 disinfection items were 72.3% and 77.4%, and the correct rate of hand-washing was 70.7%; 54.5% residents felt panic; 81.0% disinfected household items; and 84.9% washed their hands correctly. Residents still needed to strengthen these aspects. A binary logistic analysis showed that age, education, and participation in training were factors affecting the level of COVID-19 KAP.

This study found that rural residents had good levels of COVID-19 KAP, but there were gaps in specific issues that warrant attention. We advocate training on COVID-19 for rural residents.

Adult daughters concerned about getting breast cancer throughout their lives and required support because their mothers had breast cancer.

This article aims to examine the revised Information and Support Needs Questionnaire (ISNQ) and validate it in a Taiwanese community population comprising daughters of mothers with breast cancer.

Using convenience sampling, daughters of mothers with breast cancer were recruited and were separated into 2 samples (Sample 1, n = 102, and Sample 2, n = 118). First, we translated and modified the ISNQ to ensure cultural adaptation and formed ISNQ Chinese version (ISNQ-C). Second, we conducted an exploratory factor analysis using both samples to explore the ISNQ-C factor structure. Finally, we tested the criterion validity and known‐group validity of the ISNQ-C using Sample 2.

Thirty-two items addressing 5 factors were identified for the ISNQ‐C. Each factor had good internal consistency. The criterion validity was supported by significant correlations between the ISNQ‐C scores and scores on the impacts of an event, anxiety, and depression. Known‐group comparisons revealed that the group with deceased mothers reported significantly more unmet needs related to “releasing my anxiety” compared to the group where the mother was stable and undergoing regular follow-ups.

The ISNQ‐C demonstrated good reliability and validity in terms of assessing needs among daughters of mothers with breast cancer in Taiwan. Using this assessment tool before genetic counseling to target the individual needs of this population at risk for breast cancer would be helpful to provide personalized care.

The relationship of a diet low in fibre with mortality has not been evaluated. This study aims to assess the burden of non-communicable chronic diseases (NCD) attributable to a diet low in fibre globally from 1990 to 2019.

All data were from the Global Burden of Disease (GBD) Study 2019, in which the mortality, disability-adjusted life-years (DALY) and years lived with disability (YLD) were estimated with Bayesian geospatial regression using data at global, regional and country level acquired from an extensively systematic review.

All data sourced from the GBD Study 2019.

All age groups for both sexes.

The age-standardised mortality rates (ASMR) declined in most GBD regions; however, in Southern sub-Saharan Africa, the ASMR increased from 4·07 (95 % uncertainty interval (UI) (2·08, 6·34)) to 4·60 (95 % UI (2·59, 6·90)), and in Central sub-Saharan Africa, the ASMR increased from 7·46 (95 % UI (3·64, 11·90)) to 9·34 (95 % UI (4·69, 15·25)). Uptrends were observed in the age-standardised YLD rates attributable to a diet low in fibre in a number of GBD regions. The burden caused by diabetes mellitus increased in Central Asia, Southern sub-Saharan Africa and Eastern Europe.

The burdens of disease attributable to a diet low in fibre in Southern sub-Saharan Africa and Central sub-Saharan Africa and the age-standardised YLD rates in a number of GBD regions increased from 1990 to 2019. Therefore, greater efforts are needed to reduce the disease burden caused by a diet low in fibre.