The contribution of children to viral spread in schools is still debated. We conducted a systematic review and meta-analysis of studies to investigate SARS-CoV-2 transmission in the school setting. Literature searches on 15 May 2021 yielded a total of 1088 publications, including screening, contact tracing, and seroprevalence studies. MOOSE guidelines were followed, and data were analyzed using random-effects models. From screening studies involving more than 120,000 subjects, we estimated 0.31% (95% confidence interval (CI) 0.05-0.81) SARS-CoV-2 point prevalence in schools. Contact tracing studies, involving a total of 112,622 contacts of children and adults, showed that onward viral transmission was limited (2.54%, 95% CI 0.76-5.31). Young index cases were found to be 74% significantly less likely than adults to favor viral spread (odds ratio (OR) 0.26, 95% CI 0.11-0.63) and less susceptible to infection (OR 0.60; 95% CI 0.25-1.47). Lastly, from seroprevalence studies, with a total of 17,879 subjects involved, we estimated that children were 43% significantly less likely than adults to test positive for antibodies (OR 0.57, 95% CI 0.49-0.68). These findings may not applied to the Omicron phase, we further planned a randomized controlled trial to verify these results.

Advances in childhood cancer management have substantially improved the burden of these neoplasms over the past 40 years, particularly in high-income countries. This study aimed to monitor recent trends in America and Australasia using mortality data from the World Health Organization. Trends in childhood cancer mortality continued to decline in high-income countries by approximately 2% to 3% per year in Japan, Korea, and Australia, and 1% to 2% in North America. Only a few Latin American countries showed favorable trends, including Argentina, Chile, and Mexico, whereas other countries with limited resources still lagged behind.

Despite the high prevalence of hypochondriasis in primary care settings, there are relatively few pharmacotherapy trials in hypochondriasis. Ongoing controversy about nosology of hypochondriasis and lack of work demonstrating specific neurobiological alterations in hypochondriasis may contribute to this. There have been several open label trials of selective serotonin reuptake inhibitors (SSRIs) and serotonin-2A antagonist/reuptake inhibitors (SARIs) for the treatment of hypochondriasis, and more recently two randomized controlled trials (RCTs). Taken together, there is a small body of evidence to support the efficacy of SSRIs in the treatment of hypochondriasis. Further RCTs are needed to confirm efficacy, determine effectiveness of treatments in primary care settings, address influence of comorbidity and other potential predictors of outcome, and compare pharmacotherapy to psychotherapy. Keywords: Hypochondriasis, neurobiology, open label trial, pharmacotherapy, randomized clinical trial, selective serotonin reuptake inhibitors.

Because of their global clinical utility, phonemic fluency tests are frequently incorporated into neuropsychological assessment batteries. However, in heterogeneous societies their use is complicated by the lack of careful attention to using letters of equivalent difficulty across languages, and the paucity of norms stratified by relevant sociodemographic variables. In accordance with the International Test Commission's guidelines for adaptation of test material in multilingual contexts, this study provides (1) an internationally replicable methodological template for selecting appropriate letter sets; (2) empirical evidence to substantiate the equivalence of a letter set across three languages; (3) a template for evaluating the relative impact of sociodemographic variables on phonemic fluency; and (4) appropriately stratified norms for the letter set SBL (English and Afrikaans) / IBL (Xhosa) in a sample (N = 512) of urban participants (7–25 years with 1–17 years of education) from the Cape Town region of the Western Cape province of South Africa.

<p>Supplementary Figure 2: Pooled adjusted odds ratios (ORs) and corresponding 95% confidence intervals (CIs) for the association between intake of proton-pump inhibitors and gastric cancer, by smoking status and alcohol drinking status.</p>

Anxiety and related disorders are the most prevalent mental disorders in the general population. There is a strong bidirectional association between anxiety and related disorders and co-occurring general medical conditions. The co-occurrence of anxiety and related disorders and general medical conditions is associated with significant impairment, morbidity and economic costs. At the same time, recognition of anxiety and related disorders in people with medical illness may be challenging when comorbid with physical illness due in part to overlap in symptomatology. Furthermore, there is a relatively limited evidence base of randomized controlled trials in this population. Additional work is needed to improve screening for anxiety and related disorders in medical illness, to enhance diagnosis and assessment, and to optimize treatment.

<p>Supplementary Table 4: Pooled adjusted odds ratios (ORs) and corresponding 95% confidence intervals (CIs) for the association between intake of proton-pump inhibitors and gastric cancer from the leave-one-out meta-analysis.</p>

Much attention has been paid to revisions of psychiatric classification systems. Nevertheless, there remains significant dissatisfaction with the nosology. From a neuroscience perspective, diagnostic criteria have failed to incorporate neurobiological data, and a focus on “circuit-based behavioral dimensions” 1 will improve diagnosis. From a more critical perspective, given that psychiatric disorders do not represent valid disease entities 1, diagnosis merely medicalizes problems in living. These specific debates echo larger debates about classification in medicine, in which many emphasize notions of disease, arguing that clinicians must be scientists who understand physiology, while others emphasize the experience of illness, stating that clinicians must be humanists who understand suffering 2. An integrative medicine and psychiatry arguably recognizes each of these aspects of being a good diagnostician and researcher 3, 4. From an integrative perspective, ongoing work on nosological systems is needed to optimize diagnostic validity and utility. To the extent that the RDoC framework leads to research that allows such progress, it should be supported. However, I worry that many DSM-5 and ICD-11 critics may have unduly high expectations of diagnostic systems. Insofar as the RDoC framework sets unrealistic goals for nosology, caution is needed. Along these lines, I would emphasize the following points. First, a clear goal of medical and psychiatric classification is clinical utility, which is only partly related to underlying pathophysiology. In medicine, the diagnosis of a syndrome, such as cardiac failure, may provide little information about precise etiology, but nevertheless may help guide treatment 5. In psychiatry, many entities are syndromic. While syndromes may have multiple causes, blurry boundaries, and absent biomarkers, they also are clinically useful. It may be counterargued that much of medicine focuses on specific etiologically-based entities, e.g., viral pneumonia. Psychiatry too has specific diseases, such as psychosis due to neurosyphilis. But these exceptions prove the rule; many diagnoses in medicine and psychiatry reflect the fact that patients present with variegate symptoms underpinned by multiple mechanisms 6. Some cases of hypertension, headache, and depression are due to single gene variants or other circumscribed pathophysiologies; the majority reflect multiple influences. Second, given that multiple mechanisms play a role in producing psychiatric signs and symptoms, foregrounding any particular diagnostic validator, such as “circuit-based behavioral dimensions”, has both pros and cons. Science has progressed from Hippocrates's account of the “humors” to theories of the neurocircuitry basis of positive and negative valence, but it is possible that, a century from now, circuitry concepts will be considered rudimentary. On the other hand, the construct of depression, which is based on several other validators, may continue to resonate with eons of clinical descriptions. DSM-5 distinguishes between anxiety and obsessive-compulsive related disorders partly on the basis of the different neurocircuitry underpinning these conditions. But there are also strong arguments for lumping these disorders on the basis of considerations such as response to serotonin reuptake inhibitors and cognitive-behavioural treatments 7. We need to accept that diagnostic systems cannot “carve nature at her joints”. Rather, facts and values need to be continually re-assessed, to try optimize classifications. Third, given the multiple mechanisms underlying psychiatric complaints, and the many considerations relevant to treatment decisions, we should be cautious in our expectation that diagnostic criteria or thresholds will ultimately be based on behavioral dimensions or biological markers. Simple assessments, such as blood pressure measurement or mental status examination in medicine and psychiatry, can provide important information. Still, such information is partial. In medicine and psychiatry, deciding on whether and how to intervene necessarily requires a complex assessment of a range of factors, including understanding the function of symptoms, their social context, and the risks versus benefits of treatment. One set of factors sometimes neglected by critics of nosology emerges from a public health perspective. Psychiatric classifications focus on individual disorders, where underlying “endophenotypes” may be relevant. However, it may be as important to address “exophenotypes”, i.e., societal phenomena, such as interpersonal violence, that crucially contribute to the burden of disease 8. Furthermore, decisions about thresholds for psychiatric intervention may need to include not only facts about underlying neurobiological mechanisms, but also considerations such as the cost-effectiveness of particular interventions. Given that the RDoC framework encourages research on a broad range of phenomena and mechanisms, it is hard to be overly critical. By adopting a translational approach that encompasses different levels of investigation, RDoC may well contribute to advancing personalized medicine. Still, we need to be cautious of medical strawmen, such as the physician who relies solely on laboratory tests to determine diagnoses, or the public health practitioner who eradicates pathogens using simple interventions such as hand-washing. No matter how many dollars we pour into behavioral neuroscience, we may have to accept that there are few diagnostic biomarkers for psychiatric disorders, and few mosquito nets to combat them 9. Indeed, given the complexity of medicine, psychiatry provides a number of approaches worth emulating. Thus, a physician faced with a patient with headache should be able, after a careful history and examination, to diagnose a particular headache syndrome (indeed, headache classification takes a DSM-like approach ( 10). Then, based on neuroscience knowledge, as well as a range of other considerations, one or another intervention may be chosen. Similarly, a physician faced with a complex public health problem, such as substance abuse, knows that the causes are complex, that a range of responses are needed (and that, as in much of psychiatry, there is no mosquito net). For the foreseeable future, an integrative approach to psychiatric diagnosis and research ought to incorporate DSM/ICD, RDoC, and a broad range of other constructs.

<p>Supplementary Table 2: Questionnaire items used to assess exposure for each study included in the analysis.</p>

<p>Supplementary Figure 1: Pooled adjusted odds ratios (ORs) and corresponding 95% confidence intervals (CIs) for the association between intake of proton-pump inhibitors and gastric cancer, stratified by H. pylori infection and socioeconomic status (SES).</p>

<div>AbstractBackground:<p>A potential association between proton-pump inhibitors (PPI) and gastric cancer remains undefined. Thus, we aimed to evaluate such association within the Stomach cancer Pooling (StoP) Project.</p>Methods:<p>Data from five case–control studies of the StoP Project were included (1,889 cases and 6,517 controls). We assessed the impact of different exposure definitions, specifically any reported use of PPIs and exposure definitions based on the duration of PPI intake. Additionally, we modeled the dose–response relationship between the cumulative duration of PPI intake and gastric cancer.</p>Results:<p>Significant associations between PPI intake and gastric cancer, both overall and in the stratified analyses, were limited to exposure definitions based on short durations of intake. The overall odds ratio (OR) for any reported PPI intake was 1.78 [95% confidence interval (CI): 0.76–4.14]. In the dose–response analysis, the ORs of gastric cancer were found to be higher for short durations of PPI intake (6 months: OR 3.26; 95% CI: 2.40–4.42; one year: OR 2.14; 95% CI: 1.69–2.70; 2 years: OR 1.50; 95% CI: 1.22–1.85; 3 years: OR 1.27; 95% CI: 1.03–1.56), with the association becoming not significant for durations longer than 3 years.</p>Conclusions:<p>Our findings suggest that the observed association between PPIs and gastric cancer might be mainly due to reverse causality.</p>Impact:<p>The results of this study suggest that PPIs are a safe therapeutic choice regarding their effect on the occurrence of gastric cancer.</p><p><i><a href="https://aacrjournals.org/cebp/article/doi/10.1158/1055-9965.EPI-23-0809" target="_blank">See related commentary by Richman and Leiman, p. 1127</a></i></p></div>