Beginning in March 2020, the COVID-19 pandemic and response, which included physical distancing and stay-at-home orders, disrupted daily life in the United States. Compared with the rate in 2019, a 31% increase in the proportion of mental health-related emergency department (ED) visits occurred among adolescents aged 12-17 years in 2020 (1). In June 2020, 25% of surveyed adults aged 18-24 years reported experiencing suicidal ideation related to the pandemic in the past 30 days (2). More recent patterns of ED visits for suspected suicide attempts among these age groups are unclear. Using data from the National Syndromic Surveillance Program (NSSP),* CDC examined trends in ED visits for suspected suicide attempts † during January 1, 2019-May 15, 2021, among persons aged 12-25 years, by sex, and at three distinct phases of the COVID-19 pandemic. Compared with the corresponding period in 2019, persons aged 12-25 years made fewer ED visits for suspected suicide attempts during March 29-April 25, 2020. However, by early May 2020, ED visit counts for suspected suicide attempts began increasing among adolescents aged 12-17 years, especially among girls. During July 26-August 22, 2020, the mean weekly number of ED visits for suspected suicide attempts among girls aged 12-17 years was 26.2% higher than during the same period a year earlier; during February 21-March 20, 2021, mean weekly ED visit counts for suspected suicide attempts were 50.6% higher among girls aged 12-17 years compared with the same period in 2019. Suicide prevention measures focused on young persons call for a comprehensive approach, that is adapted during times of infrastructure disruption, involving multisectoral partnerships (e.g., public health, mental health, schools, and families) and implementation of evidence-based

On February 18, 2022, this report was posted as an MMWR Early Release on the MMWR website (https://www.cdc.gov/mmwr).In 2021, a national emergency* for children's mental health was declared by several pediatric health organizations, and the U.S. Surgeon General released an advisory † on mental health among youths. These actions resulted from ongoing concerns about children's mental health in the United States, which was exacerbated by the COVID-19 pandemic (1,2). During March-October 2020, among all emergency department (ED) visits, the proportion of mental health-related visits increased by 24% among U.S. children aged 5-11 years and 31% among adolescents aged 12-17 years, compared with 2019 (2). CDC examined changes in U.S. pediatric ED visits for overall mental health conditions (MHCs) and ED visits associated with specific MHCs (depression; anxiety; disruptive behavioral and impulse-control disorders; attention-deficit/hyperactivity disorder; trauma and stressor-related disorders; bipolar disorders; eating disorders; tic disorders; and obsessive-compulsive disorders [OCD]) during 2019 through January 2022 among children and adolescents aged 0-17 years, overall and by sex and age. After declines in weekly visits associated with MHCs among those aged 0-17 years during 2020, weekly numbers of ED visits for MHCs overall and for specific MHCs varied by age and sex during 2021 and January 2022, when compared with corresponding weeks in 2019. Among adolescent females aged 12-17 years, weekly visits increased for two of nine MHCs during 2020 (eating disorders and tic disorders), for four of nine MHCs during 2021 (depression, eating disorders, tic disorders, and OCD), and for five of nine MHCs during January 2022 (anxiety, trauma and stressor-related disorders, eating disorders, tic disorders, and OCD), and overall MHC visits during January 2022, compared with 2019. Early identification and expanded evidence-based prevention and intervention strategies are critical to improving children's and adolescents' * https://www.aap.org/en/advocacy/child-and-adolescent-healthy-mentaldevelopment/aap-aacap-cha-declaration-of-a-national-emergency-inchild-and-adolescent-mental-health/ † https://www.hhs.gov/sites/default/files/surgeon-general-youth-mental-healthadvisory.pdf

is a collaboration among CDC, local, and state health departments, and federal, academic, and private sector partners. https://www.cdc.gov/nssp/index.html † To reduce artifactual impact from changes in reporting patterns, analyses were restricted to facilities with a coefficient of variation ≤40 and average weekly informative discharge diagnosis ≥75% complete with consistent discharge diagnosis code formatting throughout 2019-2022. Visits from 1,674 facilities from 41 states were eligible to be included in the study. All facilities from three counties in California (El Dorado, Plumas, and Yosemite),

On July 16, 2021, this report was posted as an MMWR Early Release on the MMWR website (https://www.cdc.gov/mmwr).Record high temperatures are occurring more frequently in the United States, and climate change is causing heat waves to become more intense (1), directly impacting human health, including heat-related illnesses and deaths. On average, approximately 700 heat-related deaths occur in the United States each year (2). In the northwestern United States, increasing temperatures are projected to cause significant adverse health effects in the coming years (3). During June 25-30, 2021, most of Oregon and Washington were under a National Weather Service excessive heat warning.* Hot conditions persisted in parts of Oregon, Washington, or Idaho through at least July 14, 2021. The record-breaking heat had the largest impact in Oregon and Washington, especially the Portland metropolitan area, with temperatures reaching 116°F (46.7°C), which is 42°F (5.6°C) hotter than the average daily maximum June temperature.Data from the National Syndromic Surveillance Program (NSSP) † were analyzed to examine patterns in heat-related illness emergency department (ED) visits during the June 2021 heat wave and the month preceding it in the northwestern United States. Heat-related ED visits were analyzed for U.S. Department of Health and Human Services (HHS) Region 10, which includes Alaska, Idaho, Oregon, and Washington, during May 1-June 30 in 2019 and 2021. ED visits were compared with those in the rest of the nation and to corresponding months in 2019; comparison data from 2019 were selected to diminish potential confounding effects of COVID-19 on ED visit trends in 2020, such as changes in health care seeking behavior. Heat-related illness ED visits were identified using a combination of free text describing the patient's reason for visit (chief complaint) and administrative discharge diagnoses indicating exposure to high ambient temperature. To account for changes in facilities sharing data with * https://www.weather.gov/ † NSSP is a collaboration between CDC, local and state health departments, federal agencies, health care facilities, independent clinical laboratories, and a university-affiliated research center. NSSP receives data from 71% of nonfederal emergency departments (EDs) nationwide, although <50% of ED facilities from California, Hawaii, Iowa, Ohio, Minnesota, and Oklahoma currently participate in NSSP. Among all visit data received by NSSP, 78% are reported within 24 hours of the clinical encounter. NSSP collects ED visit information (chief complaint and administrative discharge diagnosis) and patient demographic details such as age, gender, race, and ethnicity. Diagnosis information is collected using the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) and (ICD-9-CM), and Systematized Nomenclature of Medicine (SNOMED) codes.

410The most interesting feature of our case was that of the mother's underlying autoimmune disorder, ulcerative colitis. A number of studies, including several from Europe and Japan, have emphasized antecedent Camp?/~o6oc~r~'e/M~ enteritis as a frequent antecedent infection that may lead to development of Guillain-Barre syndrome.&dquo;-&dquo; Although it is possible that mother could have been infected during pregnancy with Campylobacterjejuni, leading to an exacerbation of ulcerative colitis in the 7th month of gestation, we were unable to demonstrate the presence of this infection.The negative cytomegalovirus antibody immunoglobulin G titer made a preceding cytomegalovirus infection in this infant unlikely. There was maternal serologic evidence after delivery of a past infection with Epstein-Barr virus. It is, therefore, possible that this could have been the antecedent illness, but this cannot be proven by the above data.This brings us to the consideration of the possible relationship of mother's ulcerative colitis or immunologic status to this infant's polyneuropathy. It is conceivable that circulatory autoantibodies to specific enteric structural proteins in ulcerative colitis can cross the placenta. A common amino acid sequence could result in a prominent inflammatory response to peripheral nerve myelin (&dquo;molecular mimicry&dquo;19). However, why the infant's and not the mother's peripheral nerve myelin would be susceptible is unclear. We were only able to find five cases of Guillain-Barr6 syndrome associated with ulcerative colitis.2o,zS ummary . This patient then represents the second documented case in the English medical literature with the diagnosis of in utero-acquired Guillain-Barr6 syndrome with complete recovery and the first neonatal case to fulfill all of the electrophysiologic criteria for Guillain-Barr6 syndrome. This case stresses the good overall prognosis of this disorder when it presents in the neonate and the need to consider Guillain-Barr6 syndrome in the differential diagnosis of generalized hypotonia of infancy, particularly in the setting of a maternal autoimmune disorder.

Four patients with Down's syndrome suffered compression of the spinal cord secondary to atlantoaxial dislocation. All four developed inability to walk and quadriparesis, with signs of cervical myelopathy. It is important to recognize this potentially fatal complication of the syndrome. Immediate immobilization of the neck, followed by cervical roentgenograms, should be done in any patient with Down's syndrome who presents with neck pain, torticollis, urinary incontinence, or loss of ambulation. Surgical repair with fusion of the first and second cervical vertebrae can be carried out later.

BackgroundCriminology research has traditionally investigated sociodemographic predictors of crime, such as sex, race, age, and socioeconomic status. However, evidence suggests that short-term fluctuations in crime often vary more than long-term trends, which sociodemographic factors cannot explain. This has redirected researchers to explore how environmental factors, such as meteorological variables, influence criminal behavior. In this study we investigate the association between daily ambient temperature and homicide incidence in South Africa, a country with one of the highest homicide rates in the world.MethodsMortality data was from South Africa’s civil registration system and includes all recorded deaths in the country from 1997 to 2013 (17 years). Daily temperature was from the National Oceanographic and Atmospheric Association of the United States and South Africa’s Agricultural Research Council. Data were analyzed using a time-stratified case-crossover design with conditional logistic regression. We delineated cases as either “definite” (ICD-10 codes X85-Y09, n = 68,356) or “probable” homicides (ICD-10 codes W25-W26, W32-W34, W50, Y22-Y24, Y28-Y29, n = 177,873). Case periods were defined as the day on which a death occurred. Control periods were selected using a day-of-week match within the same month and district. Analyses investigated same-day and lagged effects of maximum, mean and minimum temperature.ResultsA one-degree Celsius increase in same-day maximum temperature – our a priori metric of choice – was associated with a 1.5% (1.3–1.8%) increase in definite homicides and a 1.2% (1.1–1.3%) increase in total (definite + probable) homicides. Significant (p < 0.05) positive associations were also observed when applying other temperature metrics (mean, minimum) and lags (1, 0–1). The shape of the association did not display any clear non-linearities. There was no evidence of confounding by public holidays or air pollution.ConclusionsThis study suggests a positive association between daily ambient temperature and homicide in South Africa. This temperature-health relationship may be of particular concern in the context of climate change. The ability to include meteorological variables as a predictor of criminal activity and violent behavior could prove valuable in resource allocation for crime prevention efforts.

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