Children in the US are disproportionately affected by disasters. However, pediatric-specific disaster medicine research remains limited, underscoring an urgent need for a pediatric-focused disaster medicine research agenda for the US to improve outcomes and preparedness for future events.

To describe an expert consensus-driven research agenda that will help guide the field of pediatric disaster medicine during the next decade.

On the basis of the findings from a previously conducted scoping review of published pediatric disaster research, this consensus statement convened a panel of 48 pediatric health care and disaster medicine subject matter experts in a Delphi process conducted between July 1 and July 17, 2024, to establish a pediatric disaster research agenda. Expert input was leveraged to enable participants to refine their responses based on feedback until consensus was achieved through 3 rounds of surveys, discussions, and voting. A deductive approach to the transcripts of these Delphi sessions was performed to enhance the quantitative results from the voting rounds surrounding the high priority, uncertain consensus results. This process identified key research areas and determined a prioritized consensus research agenda for pediatric disaster medicine.

Consensus agenda of pediatric disaster medicine research priorities.

A total of 48 subject matter experts from 28 different institutions representing 26 US states participated in the modified Delphi process. A total of 106 research questions were generated from the gaps in the literature, and the Delphi panelists contributed an additional 155 research questions or areas, resulting in a total of 261 research questions or research areas. These questions were categorized into 20 subtopics across 5 main topics: preparedness, mitigation and prevention, response, recovery, and education. The panel prioritized 5 subtopics as high priority, high consensus: capacity and capability, community involvement, health equity considerations, mental health needs, and technology. The panel identified 5 additional high priority, high consensus subtopic areas (disaster-specific metrics, disaster research infrastructure, disaster research methodology, infectious disease, and natural disasters) that did not meet the criteria for inclusion.

This consensus statement using a modified Delphi Process established a national consensus-driven research agenda for pediatric disaster medicine, providing a roadmap for future research initiatives. By addressing identified gaps in research for disaster preparedness and response for children, this US-based agenda guides future research, enhances evidence-based practices, and ultimately improves the health and safety of pediatric populations during disasters.

Suicide helplines increasingly employ chat services to aid those in urgent need, but the wording and structure of text-driven exchanges may affect their effectiveness.

Given the association of cognitive distortions with depression and anxiety, this study investigated their prevalence in the language of individuals seeking help from the Dutch 113 suicide helpline.

We observed the prevalence of cognitive distortions for both help seekers and counselors in a large volume of chat sessions (N=71,148) of the Dutch 113 suicide chat helpline using natural language processing. The results were compared to 2 large collections of online text data from Dutch social media and web content.

We found that nearly all types of cognitive distortions are more prevalent in the language of help seekers compared to the control group of helpline counselors. Distortions of the personalizing, emotional reasoning, and mental filtering types were, respectively, 20.22, 7.87, and 4.53 times more prevalent among help seekers, revealing a distinct pattern of thought and language among individuals affected by suicidality.

Our results raise the prospect of improving the effectiveness of online therapeutic interventions that target cognitive distortions through lexical analysis that detects the cognitive and lexical markers of suicidality.

Myasthenia gravis (MG) is an autoimmune neuromuscular disorder characterized by muscle weakness and fatigue due to autoantibodies impairing neuromuscular transmission. With a global prevalence of 40-180 per million, Taiwan has seen a rise in MG cases from 4476 in 2013 to 5752 in 2019, with generalized MG (GMG) prevalence increasing significantly, whereas GMG patients incur substantially higher medical costs and resource utilization compared to non-MG patients. To standardize MG management, the Society formed an expert committee of 37 MG specialists and a patient representative, tasked with developing evidence-based guidelines. The committee, organized into 11 thematic subgroups, conducted a systematic review of literature from 2015 to 2024 and employed a Modified Delphi method to achieve consensus on clinical guidance statements. Recommendations cover diagnosis (e.g., antibody testing and electrophysiological tests), treatment (e.g. thymectomy, steroids, and novel biologics), and management of specific MG subtypes, including ocular, early- and late-onset, muscle-specific tyrosine kinase-related, and refractory MG, as well as myasthenic crisis and neonatal MG. The guidelines emphasize early diagnosis, integrated management of comorbidities, and long-term care strategies, including patient support and tailored exercise programs. These consensus statements aim to enhance care quality, improve patient outcomes, and guide future research and pharmaceutical development in Taiwan's medical community.

Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is an autoimmune disorder characterized by psychiatric manifestations, seizures, and dyskinesias. Neuronal intranuclear inclusion disease (NIID) presents heterogeneously with dementia, neuropathy, and episodic encephalitis-like events, typically showing bilateral corticomedullary hyperintensities on diffusion-weighted imaging (DWI). The simultaneous occurrence of these conditions is extremely uncommon, complicating diagnosis due to overlapping clinical and radiological features. We report the case of a 68-year-old female with a history of atrial fibrillation and hyperthyroidism who presented with urinary tract infection, followed by acute consciousness disturbance, left arm paresis, and pyrexia. Initial antibiotic therapy resolved symptoms, but recurrent neurological deficits ensued. Diagnostic evaluation confirmed the presence of both anti-NMDAR encephalitis, evidenced by positive serum antibodies, and NIID, supported by abnormal GGC repeat expansions in the NOTCH2NLC gene and intranuclear inclusions on skin biopsy. Brain magnetic resonance imaging demonstrated unusual unilateral cortical ribboning and corticomedullary lesions on DWI. Therapy with corticosteroids and intravenous immunoglobulin resulted in significant improvement; however, subsequent workup revealed colorectal adenocarcinoma. This case highlights the diagnostic complexity and management challenges by the rare concurrence of anti-NMDAR encephalitis and NIID.

Stroke is a leading cause of mortality and disability in Taiwan, necessitating a comprehensive understanding of its long-term impacts.

This study aims to investigate the prevalence, risk factors, and progression of poststroke disabilities across motor, swallowing, cognitive, emotional, epilepsy, and quality-of-life domains.

This multicenter, prospective cohort study will recruit 2000 acute ischemic and hemorrhagic stroke patients from 14 major hospitals in Taiwan. Assessments will be conducted at baseline, 3 months, and 12 months poststroke using validated tools, questionnaires, imaging, and blood biomarkers (ClinicalTrials registered no: NCT06772194).

Key outcomes include motor function recovery, prevalence of dysphagia, cognitive impairment, poststroke depression, and epilepsy, as well as quality-of-life measures. Advanced imaging techniques and biomarker analyses, including genome-wide association studies, will explore predictors of disability and recovery.

This study seeks to address gaps in stroke recovery research by integrating clinical and biological data to enhance personalized stroke management. T-PODS is expected to inform strategies for reducing disability and improving long-term outcomes for stroke survivors in Taiwan, contributing to the global effort to optimize stroke care and rehabilitation.

Deficiency of adenosine deaminase 2 (DADA2) is a rare autosomal recessive autoinflammatory disorder manifesting with variable clinical features, including systemic inflammation, vasculopathy, and recurrent ischemic or hemorrhagic strokes. Recurrent strokes have been well-established as part of the spectrum of DADA2 in keeping with the presentation of our patient. However, movement disorders in DADA2 have not been well-described. We report a case presenting with childhood-onset recurrent febrile illness, recurrent ischemic strokes, progressive generalized dystonia, intellectual disability and vasculitic rash. Neuroimaging revealed old pontine and bilateral thalamic infarcts while blood investigations revealed elevated inflammatory markers, pancytopenia and immunodeficiency. This case highlights the importance of recognizing DADA2 as a potentially treatable cause of early-onset stroke and movement disorder, emphasizing the need for timely diagnosis and targeted therapy.

The Philippine Package of Essential Noncommunicable Disease Interventions (PhilPEN) was introduced by the Department of Health through AO 2012-0029. This is anchored to WHO PEN, a prioritized set of cost-effective interventions that can be carried out to provide an acceptable standard of care at the primary health care level, even in low-resource settings. The study aims to evaluate the availability and adequacy of primary health care facilities in providing the PhilPEN package of interventions using the WHO assessment tool.

A cross-sectional survey was conducted in 25 randomly selected primary health care facilities in Metro Manila. Data were collected through structured interviews with facility staff and direct observation using a standardized questionnaire aligned with PhilPEN and WHO PEN guidelines. The tool assessed PhilPEN inputs (infrastructure, human resources, basic tools and equipment, essential medicines, record-keeping, financing) and services (risk assessment and screening, early diagnosis and monitoring, treatment and follow-up, counseling, referral of patients).

All facilities met the basic standards for infrastructure, human resources, record keeping, and financing. However, only 40% had all essential medicines, and just 16% had complete tools, including urine ketone/protein test strips. Risk assessment and patient counseling were consistently implemented, but early diagnosis and follow-up services were inconsistent due to training and supply gaps.

Primary health care centers in Metro Manila demonstrate partial readiness for PhilPEN implementation. Gaps in tools, medicines, and protocol availability should be addressed to optimize NCD service delivery.

Patient-reported experience measures (PREMs) provide valuable insights into care quality from the patient's perspective and are particularly relevant for chronic conditions such as type 2 diabetes mellitus (T2DM). However, evidence on their implementation in primary care settings of low- and middle-income countries (LMIC) remains limited.

This study explored barriers and facilitators to implementing a diabetes-specific PREM in routine outpatient care in a district-level hospital setting in northern Thailand, to inform strategies for its feasible and sustainable use in similar resource-constrained settings.

A qualitative study was conducted using in-depth interviews and a group interview with patients aged 20 years and older living with T2DM, healthcare providers, and the hospital executive team. A total of 25 participants were purposively selected from a hospital-based non-communicable disease (NCD) clinic. Data were collected using a semi-structured interview guide informed by the Consolidated Framework for Implementation Research (CFIR) and analysed using inductive thematic analysis. Patient demographic data were analysed descriptively.

Among the 19 patients included, the mean age was 59.7 years (SD = 11.9), with a range of educational and occupational backgrounds. Thematic analysis revealed three overarching themes influencing PREM implementation: patient-related factors, instrument characteristics, and contextual and implementation factors. Key facilitators included patients' perceived value of the PREM, trust in healthcare providers, and supportive organizational structures that enable workflow integration and staff allocation. Major barriers were limited literacy, functional constraints among older adults, and challenges related to instrument wording, format preferences, and insufficient resources for staff assistance.

Addressing these factors through tailored questionnaires, flexible administration, and institutional commitment can support the routine collection of patient-reported experiences, strengthen patient-centred care, and inform implementation strategies in similar primary care settings across Southeast Asia.

With the global population aging, this study aimed to estimate the prevalence of healthy aging and its associated factors in China.

This cross-sectional study was conducted in Henan Province, China, in 2023. A multi-stage, stratified, probability-proportional-to-size (PPS) sampling method was employed to enroll 9,180 community-dwelling older adults aged ≥60 years. Healthy aging was defined as "no major chronic diseases," "no disability," "high cognitive function," "high physical function," and "active social engagement." The weighted prevalence of healthy aging was evaluated. Weighted Poisson regression models were used to estimate the prevalence ratios (PRs) for the association between sociodemographic/lifestyle factors and healthy aging.

The overall weighted prevalence of healthy aging was 6.1%. The weighted prevalence of no major chronic diseases, no disability, high cognitive function, high physical function, and active social engagement was 23.7, 82.2, 42.4, 39.0, and 71.8%, respectively. The PR of healthy aging was inversely associated with age (PR = 0.65 in those aged 70-79 years and PR = 0.30 in those aged ≥80 years). Older adults residing in urban areas had a higher PR of healthy aging than those in rural areas (PR = 1.44, 95% CI 1.30-1.59). Higher education, higher income, alcohol consumption, and physical activity were all positively associated with healthy aging (p < 0.05).

The prevalence of healthy aging among community-dwelling older adults in Henan Province was low. Fewer than half of the participants were free from major diseases or maintained high cognitive and physical function. Promoting healthy aging requires a multifaceted approach that integrates healthcare, economic, and educational initiatives. Particular attention should be given to female individuals, rural residents, individuals with lower education and income levels, and individuals who are divorced, widowed, cohabiting, or living alone.