An internet-based platform with a low-calorie dietary intervention improves cardiometabolic risk factors in overweight and obese people in China: Half-year follow-up results of a randomized controlled trial

AIM

To explore the effectiveness of the Metawell programme on cardiometabolic risk factors in China, which combines meal replacement biscuits, a wireless scale, and a mobile phone application.

METHODS

In this two-arm, parallel-design randomized study, 220 participants were randomly assigned to an intervention (n = 110) and a control (n = 110) group. Participants in the intervention group were instructed to use meal replacement products and scales for weight loss and monitoring, whereas participants in the control group received printed materials containing a sample diet and face-to-face weight loss education at enrolment. The trial lasted 6 months, including a weight loss period in Months 1-3 and a weight maintenance period in Months 3-6. Generalized estimating equations were used to compare differences between the two groups.

RESULTS

The median (interquartile range) ages of the intervention and control groups were 32.00 (28.00, 39.00) years and 33.00 (28.25, 41.00) years, with body mass indices of 28.20 (26.30, 30.95) kg/m2 and 27.70 (26.02, 29.70) kg/m2, respectively. Participants in the intervention group experienced significantly greater decreases in waist circumference, hip circumference, triglycerides, total cholesterol: high-density lipoprotein cholesterol ratio, fasting blood glucose, fasting insulin, and homeostatic model assessment of insulin resistance index compared to the control group (p < 0.01). Among participants who did not regain weight during the maintenance period after weight loss, the reductions in systolic and diastolic blood pressure were significantly greater in the intervention group than in the control group (p < 0.05).

CONCLUSIONS

The Metawell programme of caloric restriction and remote monitoring can be adapted to overweight and obese people in China to reduce their cardiometabolic risk factors. Furthermore, there was a better improvement in blood pressure in participants who maintained the effects of weight loss.

Plasma DNA methylation detection for early screening, diagnosis, and monitoring of esophageal adenocarcinoma and squamous cell carcinoma

BACKGROUND

The early diagnosis rate of esophageal cancer (EC), one of the most prevalent digestive tract cancers worldwide, remains low.

AIM

To investigate the utility of plasma SHOX2, SEPTIN9, EPO, and RNF180 methylation in the clinical diagnosis and monitoring of EC.

METHODS

Plasma samples were collected from 210 patients at Hubei Cancer Hospital, and TaqMan polymerase chain reaction was employed to detect plasma SHOX2, SEPTIN9, RNF180, and EPO methylation. The area under the curve was used to estimate their diagnostic value for EC. Cox and logistic regression analyses were used to estimate the independent screening risk factors for patients with EC.

RESULTS

The sensitivity and specificity of combined assessment of plasma SHOX2, SEPTIN9, RNF180, and EPO methylation for adenocarcinoma, squamous cell carcinoma (SCC), and EC detection were 66.67% and 86.27%, 77.40% and 85.29%, and 76.19% and 86.27%, respectively; the area under the curve values for diagnosing adenocarcinoma, SCC, and EC were 0.737 [95% confidence interval (CI): 0.584–0.89], 0.824 (95%CI: 0.775–0.891), and 0.864 (95%CI: 0.809–0.92), respectively.

CONCLUSION

According to our findings, plasma SHOX2, SEPTIN9, RNF180, and EPO methylation exhibits appreciated sensitivity for diagnosing EC. The precise measurement of plasma SHOX2, SEPTIN9, RNF180, and EPO methylation can improve EC diagnosis and therapy efficacy monitoring.

Estimating epidemic trajectories of SARS-CoV-2 and influenza A virus based on wastewater monitoring and a novel machine learning algorithm

The COVID-19 pandemic has altered the circulation of non-SARS-CoV-2 respiratory viruses. In this study, we carried out wastewater surveillance of SARS-CoV-2 and influenza A virus (IAV) in three key port cities in China through real-time quantitative PCR (RT-qPCR). Next, a novel machine learning algorithm (MLA) based on Gaussian model and random forest model was used to predict the epidemic trajectories of SARS-CoV-2 and IAV. The results showed that from February 2023 to January 2024, three port cities experienced two waves of SARS-CoV-2 infection, which peaked in late-May and late-August 2023, respectively. Two waves of IAV were observed in the spring and winter of 2023, respectively with considerable variations in terms of onset/offset date and duration. Furthermore, we employed MLA to extract the key features of epidemic trajectories of SARS-CoV-2 and IAV from February 3rd, to October 15th, 2023, and thereby predicted the epidemic trends of SARS-CoV-2 and IAV from October 16th, 2023 to April 22nd, 2024, which showed high consistency with the observed values. These collective findings offer an important understanding of SARS-CoV-2 and IAV epidemics, suggesting that wastewater surveillance together with MLA emerges as a powerful tool for risk assessment of respiratory viral diseases and improving public health preparedness.

Developing and validating intracity spatiotemporal air quality health index in eastern China

BACKGROUND

Recently pilot published city-level air quality health index (AQHI) provides a useful tool for communicating short-term health risks of ambient air pollution, but fails to account for intracity spatial heterogeneity in exposure and associated population health impacts. This study aims to develop the intracity spatiotemporal AQHI (ST-AQHI) via refined air pollution-related health risk assessments.

METHODS

A three-stage analysis was conducted through integrating province-wide death surveillance data and high-resolution gridded estimates of air pollution and climate factors spanning 2016-2019 in Jiangsu Province, eastern China. First, an individual-level case-crossover design was employed to quantify the short-term risk of nonaccidental mortality associated with residential exposure to individual pollutant (i.e., PM2.5, NO2, O3, and SO2). Second, we accumulated and scaled the excess risks arising from multiple pollutants to formulate daily gridded ST-AQHI estimates at 0.1° × 0.1°, dividing exposure-related risks into low (0-3), moderate (4-6), high (7-9), and extreme high (10+) levels. Finally, the effectiveness of ST-AQHI as composite risk communication was validated through checking the dose-response associations of individual ST-AQHI exposure with deaths from nonaccidental and major cardiopulmonary causes via repeating case-crossover analyses.

RESULTS

We analyzed a total of 1,905,209 nonaccidental death cases, comprising 785,567 from circulatory diseases and 247,336 from respiratory diseases. In the first-stage analysis, for each 10-μg/m3 rise in PM2.5, NO2, O3, and SO2 exposure at lag-01 day, population risk of nonaccidental death was increased by 0.8% (95% confidence interval: 0.7%, 0.9%), 1.9% (1.7%, 2.0%), 0.4% (0.3%, 0.5%), and 4.1% (3.7%, 4.5%), respectively. Spatiotemporal distribution of ST-AQHI exhibited a consistent declining trend throughout the study period (2016-2019), with annual average ST-AQHI decreasing from 5.2 ± 1.3 to 4.0 ± 1.0 and high-risk days dropping from 15.8% (58 days) to 1.6% (6 days). Exposure associated health risks showed great intracity- and between-city heterogeneities. In the validation analysis, ST-AQHI demonstrated approximately linear, threshold-free associations with multiple death events from nonaccidental and major cardiopulmonary causes, suggesting excellent performance in predicting exposure-related health risks. Specifically, each 1-unit rise in ST-AQHI was significantly associated with an excess risk of 2.0% (1.8%, 2.1%) for nonaccidental mortality, 2.3% (2.1%, 2.6%) for overall circulatory mortality, and 2.7% (2.3%, 3.1%) for overall respiratory mortality, as well as 1.7%-3.0% for major cardiopulmonary sub-causes.

CONCLUSIONS

ST-AQHI developed in this study performed well in predicting intracity spatiotemporal heterogeneity of death risks related to multiple air pollutants, and may hold significant practical importance in communicating air pollution-related health risks to the public at the community scales.

Enhanced predictability and interpretability of COVID-19 severity based on SARS-CoV-2 genomic diversity: a comprehensive study encompassing four years of data

Despite the end of the global Coronavirus Disease 2019 (COVID-19) pandemic, the risk factors for COVID-19 severity continue to be a pivotal area of research. Specifically, studying the impact of the genomic diversity of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) on COVID-19 severity is crucial for predicting severe outcomes. Therefore, this study aimed to investigate the impact of the SARS-CoV-2 genome sequence, genotype, patient age, gender, and vaccination status on the severity of COVID-19, and to develop accurate and robust prediction models. The training set (n = 12,038), primary testing set (n = 4,006), and secondary testing set (n = 2,845) consist of SARS-CoV-2 genome sequences with patient information, which were obtained from Global Initiative on Sharing all Individual Data (GISAID) spanning over four years. Four machine learning methods were employed to construct prediction models. By extracting SARS-CoV-2 genomic features, optimizing model parameters, and integrating models, this study improved the prediction accuracy. Furthermore, Shapley Additive exPlanes (SHAP) was applied to analyze the interpretability of the model and to identify risk factors, providing insights for the management of severe cases. The proposed ensemble model achieved an F-score of 88.842% and an Area Under the Curve (AUC) of 0.956 on the global testing dataset. In addition to factors such as patient age, gender, and vaccination status, over 40 amino acid site mutation characteristics were identified to have a significant impact on the severity of COVID-19. This work has the potential to facilitate the early identification of COVID-19 patients with high risks of severe illness, thus effectively reducing the rates of severe cases and mortality.

Global burden of zoonotic infectious diseases of poverty, 1990-2021

BACKGROUND

The zoonotic infectious diseases of poverty (zIDPs) are a group of diseases contributing to global poverty, with significant impacts on a substantial population. This study aims to describe the global, regional, and national burden of zIDPs-schistosomiasis, cystic echinococcosis, cysticercosis, and food-borne trematodiases (FBTs)-to support policy making and resource allocation for their control and elimination.

METHODS

Data of zIDPs from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 were retrieved from 1990 to 2021. The age-standardized prevalence rate (ASPR), age-standardized mortality rate (ASMR), and age-standardized disability-adjusted life-year (DALY) rate were described and the estimated annual percentage changes (EAPCs) were calculated to quantify their burden and temporal trends. Spearman correlation analysis was conducted to examine the relationship between age-standardized rates and Socio-demographic Index (SDI).

RESULTS

In 2021, these zIDPs exhibited a certain level of ASPRs and age-standardized DALY rates, while maintaining relatively low ASMRs. Noticeably, schistosomiasis presented the highest ASPR of 1914.299 (95% UI: 1378.920, 2510.853 per 100,000 population) and an age-standardized DALY rate of 21.895 (95% UI: 12.937, 37.278 per 100,000 population) among the zIDPs. The tapestry of burden-woven predominantly through low and lower-middle SDI regions-stretched across Africa, Latin America, and parts of Asia. From 1990 to 2021, a kaleidoscopic shift was observed globally as ASPRs, ASMRs, and age-standardized DALY rates declined significantly, as reflected by the EAPC values. Negative correlations were observed between the ASPRs, ASMRs, age-standardized DALY rates of schistosomiasis (r value = - 0.610, - 0.622 and - 0.610), cystic echinococcosis (- 0.676 of ASMR, - 0.550 of age-standardized DALYs), cysticercosis (- 0.420, - 0.797 and - 0.591) and the SDI. In contrast, a slight positive correlation was noted between the ASPR, age-standardized DALY rates of FBTs and SDI with r value of 0.221 and 0.213, respectively.

CONCLUSION

The burden of zIDPs declined across almost all endemic regions from 1990 to 2021, yet still predominated in low and low-middle SDI regions. Substantial challenges exist to achieve the goal of control and elimination of zIDPs, and integrated approaches based on One Health need to be strengthened to improve health outcomes.

Transmission of multidrug-resistant tuberculosis in Jiangxi, China, and associated risk factors

In order to effectively combat the urgent threat of multidrug-resistant tuberculosis (MDR-TB), it is imperative to gain a comprehensive understanding of the drug-resistant profiles, transmission dynamics, and associated risk factors. Our study encompassed a population-based retrospective analysis with 130 MDR-TB patients from 2018 to 2021. The research methodology incorporated whole-genome sequencing, drug susceptibility testing , and logistic regression analysis to discern the risk factors of genomic clustering linked to recent transmission. The findings from phenotypic drug resistance assessments revealed notable resistance rates: ethambutol at 62.3% (81/130), streptomycin at 72.3% (94/130), levofloxacin at 51.5% (67/130), and moxifloxacin at 50.0% (65/130). Furthermore, among all patients, 38 individuals (29.23%, 38/130) were found to be part of 17 clusters, indicating instances of recent MDR-TB transmission. The genomic clustering patients were deeply investigated. Lineage 2.2.1 was established as the primary sub-lineage (86.15%, 112/130), followed by lineage 4 (9.23%, 12/130). Moreover, the logistic regression analysis underscored that unemployment, farming occupations, and prior TB treatment were identified as significant risk factors for recent transmission.

IMPORTANCE

The high prevalence of multidrug-resistant tuberculosis (MDR-TB) in Jiangxi Province highlights the importance of understanding the genetic background and drug resistance patterns of these strains. This knowledge is crucial for developing effective control methods. Furthermore, in light of the significance of preventing transmission among tuberculosis patients, whole-genome sequencing was utilized to investigate the recent transmission of MDR-TB and identify associated risk factors. The findings revealed that individuals in the farming sector, those who are unemployed, and patients with a history of tuberculosis treatment are at elevated risk. Consequently, targeted public interventions for these at-risk groups are imperative.

Stability assessment of housekeeping genes for qRT-PCR in Yersinia enterocolitica cultured at 22°C and 37°C

Yersinia enterocolitica, a species within the genus Yersinia, thrives optimally at 22-25°C but can also grow at the mammalian core body temperature of 37°C. This dual temperature adaptability necessitates establishing both temperature conditions in research to examine the effects on various biological processes. In quantitative real-time PCR (qRT-PCR) assays, the selection of appropriate housekeeping genes is vital for data accuracy. Nevertheless, the lack of alternatives and information often leads to the default use of the 16S rRNA gene despite potential limitations. This investigation sourced 16 potential reference genes through a comprehensive review of the literature and transcriptome sequencing data analysis. We validated the expression stability of these genes via qRT-PCR across 12 Y. enterocolitica strains, representing the four prevalent serotypes O:3, O:5,27, O:8, and O:9, isolated from diarrheal patient stool samples. This approach aimed to minimize the impact of serotype heterogeneity. After acquiring Cq values, gene stability was evaluated using four established algorithms-ΔCq, geNorm, NormFinder, and BestKeeper-and subsequently synthesized into a consolidated ranking through the Robust Rank Aggregation (RRA) method. Our study suggests that the genes glnS, nuoB, glmS, gyrB, dnaK, and thrS maintain consistent expression across varying culture temperatures, supporting their candidacy as robust housekeeping genes. We advise against the exclusive use of 16S rRNA for this purpose. Should tradition prevail in its utilization, it must be employed with discernment, preferably alongside one or two of the housekeeping genes identified in this study as internal controls.IMPORTANCEIn our study, we focused on identifying stable reference genes for quantitative real-time PCR (qRT-PCR) experiments on Y. enterocolitica cultured at different temperatures (22°C and 37°C). After thoroughly evaluating 16 candidate genes, we identified six genes-glnS, nuoB, glmS, gyrB, dnaK, and thrS-as exhibiting stable expression across these temperature conditions, making them ideal reference genes for Y. enterocolitica studies. This discovery is crucial for ensuring the accuracy and reliability of qRT-PCR data, as the choice of appropriate reference genes is key to normalizing expression data and minimizing experimental variability. Importantly, our research extended beyond bioinformatics analysis by incorporating validation with clinical strains, bridging the gap between theoretical predictions and practical application. This approach not only underscores the robustness and reliability of our findings but also directly addresses the critical need for experimental validation in the field. By providing a set of validated, stably expressed reference genes, our work offers valuable guidance for designing experiments involving Y. enterocolitica, enhancing the reliability of research outcomes, and advancing our understanding of this significant pathogen.

Analysis of the gut microbiota and fecal metabolites in people living with HIV

The gut microbiome has a pivotal function in human immunodeficiency virus (HIV). However, the associated alterations in the gut microbiome-host interaction are unknown. Herein, we aimed to investigate the gut microbiota and fecal metabolites in people living with HIV (PLWH). We collected stool samples from 70 PLWH and 34 healthy controls (HCs) and carried out 16S rRNA gene sequencing and analyzed the metabolites using liquid chromatography-mass spectrometry. Firmicutes, Proteobacteria, Actinobacteriota, and Bacteroidota were the most abundant phyla in both groups. Among genera, the level of Escherichia-Shigella was upregulated significantly in the PLWH group, whereas in the HC group, Bacteroides spp. were upregulated. Prediction of microbial function indicated significant reductions in alanine, aspartate, glutamate, and histidine metabolism. Furthermore, a comparison of the fecal metabolites between the HC and PLWH groups identified 38 differentially abundant metabolites in four differentially enriched human metabolic pathways. According to Spearman correlation analysis, there are close relationships between four differentially abundant microbiota members and five differentially abundant fecal metabolites, which might influence particular human metabolic pathways. Our findings provide a basis for further experimental investigation of the contribution of the gut microbiota and its associated metabolites to HIV/AIDS, providing a novel perspective for the further study of HIV/AIDS.IMPORTANCEGrowing evidence demonstrates that the gut microbiota is associated with HIV. This study investigated changes in the gut microbiota and fecal metabolites in PLWH. We identified 38 differentially abundant metabolites in four differentially enriched human metabolic pathways. Moreover, close relationships were noted between the four differentially abundant microbiota members and five differentially abundant fecal metabolites, which might influence particular human metabolic pathways. Thus, to benefit PLWH, potential pathobionts could be reduced (e.g., g_Enterococcus); probiotics could be increased (e.g., g_Faecalibacterium and g_Agathobacter); or certain metabolites (e.g., N-acetyl-L-phenylalanine and trehalose) could be reduced by changes in diet or the use of nutritional supplements. Our results provide insights into the interaction between the gut microbiota and the host, identifying possible targets that might be beneficial for PLWH.

Wastewater-based intestinal protozoa monitoring in Shanghai, China

Intestinal protozoa Cryptosporidium spp., Giardia duodenalis, and Enterocytozoon bieneusi have been implicated in serious waterborne outbreaks worldwide. Wastewater-based epidemiology (WBE) is a promising approach for evaluating the disease prevalence in a catchment population in that it monitors the contamination level of the intestinal pathogens in wastewater. We collected 48 urban wastewater samples (24 from influents and 24 from effluents) from the Yangpu Wastewater Treatment Plant (YPWTP) in Shanghai, China. We identified Cryptosporidium spp., G. duodenalis, and E. bieneusi by nested polymerase chain reaction (PCR) amplification. Cryptosporidium hominis and subtype IdA14 were identified in two samples by analyzing the sequences of small subunit ribosomal RNA (SSU rRNA) and 60-kDa glycoprotein (gp60) genes, respectively. The G. duodenalis sub-assemblage AII (n = 8) and assemblage C (n = 4) in 12 samples were determined by analyzing triosephosphate isomerase (tpi) gene sequences. The E. bieneusi genotype A was identified in one sample by analyzing the sequence of the internal transcribed spacer (ITS) region of the rRNA gene. These findings suggest that improving wastewater treatment and monitoring the virility of pathogens in effluents is critical. We observed similar prevalence and genotypes/subtypes of the three intestinal protozoa in our wastewater samples as those reported in previous studies, providing evidence that WBE can be used as an effective epidemic management tool.IMPORTANCECryptosporidium spp., Giardia duodenalis, and Enterocytozoon bieneusi are common intestinal protozoa causing diarrhea. The infective oocysts, cysts, and spores released in feces can survive in different environments, including multiple types of water bodies. Humans can acquire these intestinal protozoan infections via the fecal-oral route as in waterborne transmission. Wastewater-based epidemiology can rapidly and reliably detect and monitor the emergence and spread of waterborne diseases. We detected Cryptosporidium spp., G. duodenalis, and E. bieneusi in a wastewater treatment plant in Shanghai, China, reflecting the occurrence and genetic characterizations of the three intestinal pathogens from community members served by the wastewater treatment plant.

Identification of virus epitopes and reactive T-cell receptors from memory T cells without peptide synthesis

Identifying epitopes and their corresponding T-cell receptor (TCR) sequences is crucial in the face of rapidly mutating viruses. Peptide synthesis is often required to confirm the exact epitope sequences, which is time-consuming and expensive. In this study, we introduce a scalable workflow to identify the exact sequences of virus epitopes and reactive TCRs targeting the epitopes from memory T cells. Following the narrowing down of epitopes to specific regions via the tandem minigene (TMG) system, our workflow incorporates the utilization of peptide-major histocompatibility complex-displaying yeasts (pMHC-displaying yeasts) to rapidly screen immunogenic epitopes' precise sequences, obviating the necessity for the chemical synthesis of peptides. Focusing on SARS-CoV-2, we identify the precise sequences of reactive TCRs, targeting conserved epitopes across the Coronaviridae family, from the blood of COVID-19-recovered individuals over 8 months. Notably, we reveal that at least 75% (6/8) of the tested donors harbor T cells targeting a shared epitope, KTFPPTEPK, derived from the N protein. Furthermore, several identified TCRs exhibit cross-reactivity to mutant epitopes, suggesting a potential mechanism for sustained T-cell responses against emerging SARS-CoV-2 variants.

Improvement of Care Cascade for Hypertension and Diabetes in Rural China: Protocol for an Implementation Study

The management of hypertension and diabetes poses significant challenges to China's healthcare system, necessitating seamless patient progression through screening, diagnosis, management, and control. Utilizing the care cascade model, this study aims to systematically identify patient drop-offs and devise strategies to address healthcare delivery bottlenecks for hypertension and diabetes in rural China. This study consists of three phases. In Phase 1, qualitative interviews are conducted to explore healthcare experiences and identify determinants across the care cascade. Phase 2 involves systematically assessing barriers identified in Phase 1 and collaborating with local stakeholders using intervention mapping and co-design to generate interventions and implementation strategies. Phase 3 is a cluster randomized controlled trial involving 48 villages, randomly assigned in a 1:1 ratio, to compare changes in hypertension and diabetes care. Intervention villages will implement interventions developed in Phase 2 for 1 year, while control villages will continue with usual care. Primary outcomes include between-group differences in achieving blood pressure and glycemic targets, along with service and implementation outcomes. This study aims to identify the stage with the largest patient retention gap in the care cascade and develop intervention strategies through participatory co-design with practitioners, emphasizing feasible, low-cost approaches. The pragmatic cluster RCT will assess strategy effectiveness, offering valuable insights for practical interventions to enhance hypertension and diabetes care in rural settings, potentially shaping impactful programs and improving healthcare outcomes. Trial Registration: ClinicalTrials.gov. identifier: NCT06141278.

Interaction Effects Between Low Self-Control and Meaning in Life on Internet Gaming Disorder Symptoms and Functioning in Chinese Adolescents: Cross-Sectional Latent Moderated Structural Equation Modeling Study

BACKGROUND

Internet gaming disorder (IGD) is an emerging behavioral addiction with mental health implications among adolescents. Low self-control is an established risk factor of IGD. Few studies have, however, examined the moderating role of meaning in life (MIL) on the relationships between low self-control and IGD symptoms and functioning.

OBJECTIVE

This study aimed to examine the effects of low self-control and MIL and their interaction effects on IGD symptoms and family and school functioning in a structural equation model.

METHODS

A sample of 2064 adolescents (967, 46.9% male; mean age 14.6 years) was recruited by multistage cluster random sampling from 5 middle schools in Sichuan, China, in 2022. The participants completed a self-report questionnaire with validated measures on low self-control, presence of MIL, search for MIL, IGD symptoms, school commitment, and family functioning. Construct validity, measurement invariance, and structural invariance of the measures were evaluated by confirmatory factor analysis across sex. Structural equation modeling was conducted to examine the indirect effects of low self-control and MIL on family and school functioning through IGD symptoms. Latent moderated structural equation modeling was performed to examine the interaction effects between low self-control and MIL on IGD symptoms, school commitment, and family functioning.

RESULTS

All scales showed satisfactory model fit and scalar measurement invariance by sex. Males showed significantly greater IGD symptoms and lower levels of self-control (Cohen d=0.25-1.20, P<.001) than females. IGD symptoms were significantly and positively associated with impulsivity (β=.20, P=.01), temper (β=.25, P<.001), and search for meaning (β=.11, P=.048) and significantly and negatively associated with presence of meaning (β=-.21, P<.001). Presence of MIL and impulsivity showed a significant and negative interaction effect (β=-.11, SE .05; P=.03) on IGD symptoms. The positive effect of impulsivity on IGD symptoms was stronger among adolescents with low presence of MIL than those with high presence of MIL. Temper showed significant and positive interaction effects with presence of MIL (β=.08, SE .04; P=.03) and search for MIL (β=.08, SE .04; P=.04) on family functioning. The negative effects of temper on family functioning were stronger among adolescents with low levels of MIL than among those with high levels of MIL.

CONCLUSIONS

This study provides the first findings on the interaction effects between low self-control and presence of MIL and search for MIL on IGD symptoms and functioning among a large sample of adolescents in rural China. The results have implications for targeted interventions to help male adolescents with lower self-control and presence of meaning.

Genomic surveillance of Canadian airport wastewater samples allows early detection of emerging SARS-CoV-2 lineages

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has shown wastewater (WW) surveillance to be an effective means of tracking the emergence of viral lineages which arrive by many routes of transmission including via transportation hubs. In the Canadian province of Ontario, numerous municipal wastewater treatment plants (WWTPs) participate in WW surveillance of infectious disease targets such as SARS-CoV-2 by qPCR and whole genome sequencing (WGS). The Greater Toronto Airports Authority (GTAA), operator of Toronto Pearson International Airport (Toronto Pearson), has been participating in WW surveillance since January 2022. As a major international airport in Canada and the largest national hub, this airport is an ideal location for tracking globally emerging SARS-CoV-2 variants of concern (VOCs). In this study, WW collected from Toronto Pearson's two terminals and pooled aircraft sewage was processed for WGS using a tiled-amplicon approach targeting the SARS-CoV-2 virus genome. Data generated was analyzed to monitor trends of SARS-CoV-2 lineage frequencies. Initial detections of emerging lineages were compared between Toronto Pearson WW samples, municipal WW samples collected from the surrounding regions, and Ontario clinical data as published by Public Health Ontario. Results enabled the early detection of VOCs and individual mutations emerging in Ontario. On average, the emergence of novel lineages at the airport preceded clinical detections by 1-4 weeks, and up to 16 weeks in one case. This project illustrates the efficacy of WW surveillance at transitory transportation hubs and sets an example that could be applied to other viruses as part of a pandemic preparedness strategy and to provide monitoring on a mass scale.

Climate heterogeneity, season variation, and sexual dimorphism modulate the association between MHC II diversity and parasite variation in striped hamster

Parasite-mediated selection is widely believed to play a crucial role in maintaining the diversity of the major histocompatibility complex (MHC) genes, which is thought to be maintained through heterozygote advantage, rare-allele advantage, and fluctuating selection. However, the relationship between parasite pressure and MHC diversity has yielded inconsistent findings. These inconsistencies may arise from the influence of environmental factors and individual variations in traits on host-parasite interactions. To address these issues, our study extensively investigated populations of striped hamsters inhabiting regions characterized by environmental heterogeneity. The primary objective was to examine the universality of parasite-mediated selection mechanisms. Our observations revealed the presence of multiple parasite infections, accompanied by spatial and temporal variations in parasite communities and infection patterns among individual hamsters. Specifically, the temperature was found to influence all four parasite indices, while the presence of gamasid mites and parasite richness decreased with increasing precipitation. We also noted significant seasonal variation in parasite dynamics. Moreover, a significant sexual dimorphism was observed with males exhibiting a considerably higher parasite burden compared to their female counterparts. Lastly, we identified the maintenance of MHC polymorphism in striped hamsters as being driven by the heterozygote advantage and fluctuating selection mechanisms. This study underscores the significance of ecological processes in comprehending host-parasite systems and highlights the necessity of considering environmental factors and individual traits when elucidating the mechanisms underlying MHC diversity mediated by parasites.

Current Updates on Variants of SARS-CoV- 2: Systematic Review

Background

Coronavirus disease 2019 is caused by the severe acute respiratory syndrome coronavirus 2, which has become a pandemic. Severe acute respiratory syndrome coronavirus 2 is an enveloped, unsegmented, positive-sense, single-stranded RNA virus that belongs to the family Coronaviridae.

Aim

The objective of this review is to conduct a qualitative analysis of the current updates on epidemiology, evolution, and vaccine variants for SARS-CoV-2.

Method

The search strategy was done from the database based on the PRISMA criteria for qualitative analysis of this review. Literature on variants of severe acute respiratory syndrome coronavirus 2, published in English in the last 5 years (2019-2023), were included. From 179 a total of 105 articles were reviewed, searched, and retrieved from the electronic databases PubMed. The search was done using keywords like COVID-19, SARS-CoV-2, variants, mutations, and vaccines, and articles were managed using EndNote X8 software. The scope of view for this review was the course of the pandemic by emerging variants and how man is struggling to overcome this sudden pandemic through vaccines. The narrative skeleton was constructed based on the article's scope of view.

Result

From the parent severe acute respiratory syndrome coronavirus 2, many variants emerged during the course of this pandemic. They are mainly categorized into two variants: variants of interest and variants of concern based on the impact on public health. The World Health Organization leveled five variants: Alpha (strain B.1.1.7), Beta (strain B.1.351), Gamma (strain P.1), Delta (strain B.1.617.2), and Omicron (B.1.1.529).

Conclusions

It is crucial to stay informed about the latest developments in the understanding of SARS-CoV-2 variants, as new variants can emerge and impact the course of the pandemic. Health authorities and researchers continuously have to monitor and study these variants to assess their characteristics, transmissibility, severity, and the effectiveness of vaccines against them. One has to always refer to the latest information from reputable health journals or organizations for the most up-to-date and accurate details on COVID-19 variants.

Sufficient sleep and physical activity can relieve the effects of long-term exposure to particulate matter on depressive symptoms among 0.31 million children and adolescents from 103 counties in China

BACKGROUND

Although long-term exposures to air pollutants have been linked to mental disorders, existing studies remain limited and inconsistent. We investigated the relationship between exposure to particulate matter (PM) and depressive symptoms, as well as the potential role of sleep duration and physical activity.

METHOD

Using the surveillance data (2019 to 2022) of common diseases and risk factors among 312,390 students aged 10-25 years, logistic regression, generalized liner model (GLM) and restricted cubic spline (RCS) were employed to investigate the relationship between long-term exposure to PM and depressive symptoms.

RESULT

Significant associations were found between PM1 (OR = 1.21, 95 % CI: 1.12-1.32), PM2.5 (OR = 1.24, 95 % CI: 1.19-1.38), and PM10 (OR = 1.87, 95 % CI: 1.69-2.07) and increased risks of depressive symptoms. Sleep duration and physical activity relieved these associations. The odds ratios (ORs) of PM1, PM2.5, and PM10 on depressive symptoms were lower in group with sufficient sleep (1.02 vs. 1.49, 1.20 vs. 1.80, 2.15 vs. 2.23), lower in group with high level MVPA (1.13 vs. 1.48, 1.14 vs. 1.58, 1.85 vs. 2.38), and lower in group with high level outdoor activity (1.19 vs. 1.55, 1.23 vs. 1.63, 1.83 vs. 2.72).

LIMITATIONS

Conclusions about causality remain speculative because of the cross-sectional design.

CONCLUSION

Sufficient sleep duration and outdoor activity may mitigate the decline in mental health among adults in developing countries caused by long-term exposure to PM. This contribution enhanced our understanding of the mechanisms linking air pollution to mental health.

A novel high-risk model identified by epithelial-mesenchymal transition predicts prognosis and radioresistance in rectal cancer

Many studies have shown that tumor cells that survive radiotherapy are more likely to metastasize, but the underlying mechanism remains unclear. Here we aimed to identify epithelial-mesenchymal transition (EMT)-related key genes, which associated with prognosis and radiosensitivity in rectal cancer. First, we obtained differentially expressed genes by analyzing the RNA expression profiles of rectal cancer retrieved from The Cancer Genome Atlas database, EMT-related genes, and radiotherapy-related databases, respectively. Then, Lasso and Cox regression analyses were used to establish an EMT-related prognosis model (EMTPM) based on the identified independent protective factor Fibulin5 (FBLN5) and independent risk gene EHMT2. The high-EMTPM group exhibited significantly poorer prognosis. Then, we evaluated the signature in an external clinical validation cohort. Through in vivo experiments, we further demonstrated that EMTPM effectively distinguishes radioresistant from radiosensitive patients with rectal cancer. Moreover, individuals in the high-EMTPM group showed increased expression of immune checkpoints compared to their counterparts. Finally, pan-cancer analysis of the EMTPM model also indicated its potential for predicting the prognosis of lung squamous cell carcinoma and breast cancer patients undergoing radiotherapy. In summary, we established a novel predictive model for rectal cancer prognosis and radioresistance based on FBLN5 and EHMT2 expressions, and suggested that immune microenvironment may be involved in the process of radioresistance. This predictive model could be used to select management strategies for rectal cancer.

COVID-19 Outcomes Among Hematopoietic Cell Transplant and Chimeric Antigen Receptor T-Cell Recipients in the Era of SARS-CoV-2 Omicron Variants and COVID-19 Therapeutics

Recipients of cellular therapies, including hematopoietic cell transplant (HCT) and chimeric antigen receptor T-cell (CART) therapy, are at risk for poor outcomes from coronavirus disease 2019 (COVID-19). There are limited data describing outcomes among patients in the pre- and early post-cellular therapy period during the Omicron era when multiple antiviral therapeutics were widely available. The objective of this study is to describe COVID-19 treatment and outcomes in patients diagnosed with COVID-19 during the pre- or early post-cellular therapy period. This is a single-center retrospective cohort study of adult HCT and CART recipients diagnosed with COVID-19 in the pre- and early post-cellular therapy period who tested positive for COVID-19 at our cancer center between January 1, 2022 and March 1, 2023. Primary outcomes were 30-day COVID-19-related hospitalization and death. A secondary outcome was development of persistent COVID-19, defined by a positive SARS-CoV-2 polymerase chain reaction (PCR) 31 to 90 days after COVID-19 diagnosis. Among 65 patients included, 52 (80%) received at least one COVID-19 therapeutic. The most common treatment after initial COVID-19 diagnosis was nirmatrelvir/ritonavir (29%), followed by monoclonal antibody therapy (26%) and remdesivir (11%). Of the 64 patients with at least 30 days of follow-up, 8 (12%) had at least one COVID-19-related hospitalization and one patient died, though cause of death was not due to COVID-19. Of the 8 patients hospitalized for COVID-19, one had severe disease and 7 had mild or moderate infection. Persistent COVID-19 was observed in 13/65 (20%) patients, with 4 patients requiring additional antiviral therapy. Three pre-cellular therapy patients had delays in receiving cellular therapy due to persistent COVID-19. During the Omicron era, rates of 30-day COVID-19-related hospitalization and death were relatively low in this cohort of pre- and early post-HCT and CART recipients, the majority of whom received treatment with at least one antiviral agent. Persistent COVID-19 occurred in 1 in 5 patients in the peri-cellular therapy period and led to cellular therapy treatment delays in several patients, highlighting the need for new COVID-19 treatment strategies.

Retrotransposon SINEs in age-related diseases: Mechanisms and therapeutic implications

Retrotransposons are self-replicating genomic elements that move from one genomic location to another using a "copy-and-paste" method involving RNA intermediaries. One family of retrotransposon that has garnered considerable attention for its association with age-related diseases and anti-aging interventions is the short interspersed nuclear elements (SINEs). This review summarizes current knowledge on the roles of SINEs in aging processes and therapies. To underscore the significant research on the involvement of SINEs in aging-related diseases, we commence by outlining compelling evidence on the classification and mechanism, highlighting implications in age-related phenomena. The intricate relationship between SINEs and diseases such as neurodegenerative disorders, heart failure, high blood pressure, atherosclerosis, type 2 diabetes mellitus, osteoporosis, visual system dysfunctions, and cancer is explored, emphasizing their roles in various age-related diseases. Recent investigations into the anti-aging potential of SINE-targeted treatments are examined, with particular attention to how SINE antisense RNA mitigate age-related alterations at the cellular and molecular levels, offering insights into potential therapeutic targets for age-related pathologies. This review aims to compile the most recent advances on the multifaceted roles of SINE retrotransposons in age-related diseases and anti-aging interventions, providing valuable insights into underlying mechanisms and therapeutic avenues for promoting healthy aging.

Association of pre-existing depression and anxiety with Omicron variant infection

Pre-existing psychiatric disorders were linked to an increased susceptibility to COVID-19 during the initial outbreak of the pandemic, while evidence during Omicron prevalence is lacking. Leveraging data from two prospective cohorts in China, we identified incident Omicron infections between January 2023 and April 2023. Participants with a self-reported history or self-rated symptoms of depression or anxiety before the Omicron pandemic were considered the exposed group, whereas the others were considered unexposed. We employed multivariate logistic regression models to examine the association of pre-existing depression or anxiety with the risk of any or severe Omicron infection indexed by medical interventions or severe symptoms. Further, we stratified the analyses by polygenic risk scores (PRSs) for COVID-19 and repeated the analyses using the UK Biobank data. We included 10,802 individuals from the Chinese cohorts (mean age = 51.1 years, 45.6% male), among whom 7841 (72.6%) were identified as cases of Omicron infection. No association was found between any pre-existing depression or anxiety and the overall risk of Omicron infection (odds ratio [OR] =1.04, 95% confidence interval [CI] 0.95-1.14). However, positive associations were noted for severe Omicron infection, either as infections requiring medical interventions (1.26, 1.02-1.54) or with severe symptoms (≥3: 1.73, 1.51-1.97). We obtained comparable estimates when stratified by COVID-19 PRS level. Additionally, using clustering method, we identified eight distinct symptom patterns and found associations between pre-existing depression or anxiety and the patterns characterized by multiple or complex severe symptoms including cough and taste and smell decline (ORs = 1.42-2.35). The results of the UK Biobank analyses corroborated findings of the Chinese cohorts. In conclusion, pre-existing depression and anxiety was not associated with the risk of Omicron infection overall but an elevated risk of severe Omicron infection, supporting the continued efforts on monitoring and possible early intervention in this high-risk population during Omicron prevalence.

Associations between cooking method of food and type 2 diabetes risk: A prospective analysis focusing on cooking method transitioning

Cooking process for food significantly impacts household air and increases exposure to endocrine disruptors such as acrylamide, consequently affecting human health. In the past 30 years, the transformation of cooking methods to high-temperature thermal processing has occurred widely in China. Yet the transition of cooking methods on the onset of type 2 diabetes (T2D) remains unclear, which may hinder health-based Sustainable Development Goals. We aimed to estimate the associations between dietary intake with different cooking methods and T2D risk. We included 14,745 participants (>20 y) from the China Health and Nutrition Survey (1991-2015). Food consumption was calculated using three consecutive 24-h dietary recalls combined with both individual participant level and household food inventory. Cooking methods, including boiling, steaming, baking, griddling, stir-frying, deep-frying, and raw eating, were also recorded. The consumption of baked/griddled and deep-fried foods was positively associated with 39% and 35% higher of T2D risk by comparing the highest with the lowest category of food consumption, respectively. The use of unhealthy cooking methods for processing foods including baked/griddled and deep-fried foods was attributable for 15 million T2D cases of the total T2D burden in 2011, resulting in a medical cost of $2.7 billion and was expected to be attributable for 39 million T2D cases in 2030, producing a medical cost of $223.8 billion. Replacing one serving of deep-fried foods and baked/griddle foods with boiled/steamed foods was related to 50% and 20% lower risk of T2D, respectively. Our findings recommend healthy driven cooking methods for daily diet for nourishing sustainable T2D prevention in China.

Rapid and extensive SARS-CoV-2 Omicron variant infection wave revealed by wastewater surveillance in Shenzhen following the lifting of a strict COVID-19 strategy

Wastewater-based epidemiology (WBE) has emerged as a promising tool for monitoring the spread of COVID-19, as SARS-CoV-2 can be shed in the faeces of infected individuals, even in the absence of symptoms. This study aimed to optimize a prediction model for estimating COVID-19 infection rates based on SARS-CoV-2 RNA concentrations in wastewater, and reveal the infection trends and variant diversification in Shenzhen, China following the lifting of a strict COVID-19 strategy. Faecal samples (n = 4337) from 1204 SARS-CoV-2 infected individuals hospitalized in a designated hospital were analysed to obtain Omicron variant-specific faecal shedding dynamics. Wastewater samples from 6 wastewater treatment plants (WWTPs) and 9 pump stations, covering 3.55 million people, were monitored for SARS-CoV-2 RNA concentrations and variant abundance. We found that the viral load in wastewater increased rapidly in December 2022 in the two districts, demonstrating a sharp peak in COVID-19 infections in late-December 2022, mainly caused by Omicron subvariants BA.5.2.48 and BF.7.14. The prediction model, based on the mass balance between total viral load in wastewater and individual faecal viral shedding, revealed a surge in the cumulative infection rate from <0.1 % to over 70 % within three weeks after the strict COVID-19 strategy was lifted. Additionally, 39 cryptic SARS-CoV-2 variants were identified in wastewater, in addition to those detected through clinical surveillance. These findings demonstrate the effectiveness of WBE in providing comprehensive and efficient assessments of COVID-19 infection rates and identifying cryptic variants, highlighting its potential for monitoring emerging pathogens with faecal shedding.

Factors Associated With Intended Utilization of Home-Based Long-Term Care Among Older Adults in China: The Moderating Effect of Community Support

OBJECTIVES

Guided by Andersen's behavioral model, the objectives of this study were to (a) examine the associations between individual factors and the intended utilization of home-based long-term care (LTC) services among older adults in China and (b) explore the influence of community support, if any, on these associations.

METHODS

Using a multistage random sampling approach, we recruited 1,064 older adults in Chengdu, China. Hierarchical regression was employed to investigate the direct effects of individual predictors and community support on the intended use of home-based LTC services. The moderating effect of community support was examined using the Hayes Process.

RESULTS

Two predisposing (i.e., being old and unmarried), 4 enabling (i.e., living alone, having fewer children, and receiving less family and peer support), and 6 need factors (i.e., having more chronic illnesses; decreased performance in instrumental activities of daily living; higher levels of depression, anxiety, loneliness; and a lower self-image of aging), and low community support were significantly associated with increased intended utilization of home-based LTC. In addition, community support moderated the effects of family support (B = -0.20, p < .001), peer support (B = -0.20, p < .001), self-image of aging (B = -0.39, p < .001), depression (B = -0.34, p < .001), and loneliness (B = -0.48, p < .001) on the intended utilization of home-based LTC services.

DISCUSSION

Policy-makers and practitioners should consider delivering tailored services for older adults and involve the community in the context of enhancing home-based LTC services.

Sex-specific effects of maternal blood pressure on newborn telomere length: A prospective study

OBJECTIVE

To investigate the relationship between maternal blood pressure (BP) and neonatal cord blood telomere length (TL) during pregnancy, and to clarify the sensitive period.

METHODS

We conducted a prospective cohort study with 621 mother-newborn pairs from the Guangxi Zhuang Birth Cohort (GZBC) in China. Multiple informant models, restricted cubic spline regression (RCS) models, and quantile regression models were conducted to analyze the correlation between maternal BP and neonatal TL.

RESULTS

Maternal diastolic blood pressure (DBP) was inversely related to neonatal cord blood TL in the second trimester (P = 0.015) and the third trimester (P = 0.011). There was a male-specific relationship between maternal BP and neonatal TL. A 1 mmHg increment in maternal systolic blood pressure (SBP) and DBP during the second trimester was related with 0.42% (95% CI: -0.80%, -0.04%) and 0.61% (95% CI: -1.13%, -0.09%) shorter TL in male newborns, respectively. Per unit increase of maternal DBP during the third trimester was related with 0.54% (95% CI: -1.03%, -0.05%) shorter TL in male newborns. Pregnant women with hypertensive disease of pregnancy (HDP) had male offspring with shorter TL (P = 0.003). However, no significant relationships were found in female newborns (P = 0.570).

CONCLUSION

Maternal BP during pregnancy is inversely correlated with male neonatal TL and the second and third trimesters are sensitive windows.

Microbial biosurfactant-mediated green synthesis of zinc oxide nanoparticles (ZnO NPs) and exploring their role in enhancing chickpea and rice seed germination

Malnutrition is one of the greatest challenges faced by humanity, which may be addressed by improving crop productivity to ensure food security. However, extensive use of synthetic fertilizers can lead to soil fertility degradation. This study highlights the potential of combining nanotechnology with biotechnology to enhance the germination rates of commercially important crop seeds. Bacterial biosurfactant extracted from a newly isolated Klebsiella sp. strain RGUDBI03 was used as a reducing and capping agent for the synthesis of zinc oxide nanoparticles (ZnO NPs) through a simple method. Extensive characterization of ZnO NPs through electron microscopic analysis showed well-dispersed, homogeneous NPs with a size range of 2-10 nm. High-resolution transmission electron microscopy (HR-TEM) images also revealed molecular fringes of 0.26 nm in single crystal ZnO NPs, with approximately 50% of the NPs exhibiting a size range of 2-4 nm. X-ray diffraction (XRD) results of ZnO NPs indicated the presence of (100), (002), (101), (102), (200), and (112) planes, confirming their crystalline nature. The presence of C = C-H, C = C, C-H, and C = C groups in both the bacterial biosurfactant and ZnO NPs, as depicted by Fourier-transform infrared spectroscopy (FTIR) spectra, confirmed the function of the biosurfactant as a reducing and capping agent. The nano-primed chickpea (Cicer arietinum) and rice (Oryza sativa) seeds showed an increase in water uptake rate, 89% and 92% respectively, compared to the control (73% and 44%), leading to an enhanced germination rate of 98% and 76%, compared to their respective controls (80% and 30%) under optimized conditions. Additionally, the nano-primed seeds exhibited higher levels of α-amylase activity in both seeds (0.37 mg/g for chickpea and 2.49 mg/g for rice) compared to the control. Notably, the ZnO NP priming solution exhibited no cytotoxicity on red blood cells and earthworms (Eudrilus eugeniae), indicating their non-cytotoxic and eco-friendly nature for future field trials.

Evolving molecular HIV clusters revealed genotype-specific dynamics in Guangzhou, China (2008-2020)

OBJECTIVES

This study investigated the genotype-specific dynamics of molecular HIV clusters (MHCs) in Guangzhou, China, aiming to enhance HIV control.

METHODS

HIV pol sequences from people with HIV (PWH) in Guangzhou (2008-2020) were obtained for genotyping and molecular network creation. MHCs were identified and categorized into three types: emerging, growing, or stable. Clustering rates, proportions of cluster types, and members within each type were calculated and their trends were assessed using joinpoint regression.

RESULTS

Among 8395 PWH, the most prevalent HIV-1 genotypes were CRF07_BC (39.7%) and CRF01_AE (32.6%). The genotype composition has been stable since 2012 (Ps > 0.05). The overall clustering rate was 43.3%, with significant variations across genotypes (P < 0.001), indicating genotype-specific transmission fitness. Significant declines in overall and genotype-specific clustering rates toward the end of 2020 (Ps < 0.05), potentially offer support for HIV control efforts in reducing local infections. The continuously increasing proportions of stable clusters and the gradually decreasing proportions of emerging and growing clusters (either Ps < 0.05 or Ps > 0.05) suggest a trend toward stable molecular network structure. However, growing clusters exhibited CRF55_01B, CRF07_BC, and CRF59_01B dominance that indicate their priority for interventions.

CONCLUSION

The evolving MHCs highlight the genotype-specific cluster dynamics, providing fresh insights for enhanced prevention and control strategies.

Prediabetes and cardiovascular risk factors: the effectiveness of a guided self-determination counselling approach in primary health care, a randomized controlled trial

BACKGROUND

Identify individuals who are at risk of Type 2 diabetes, who also are at a greater risk of developing cardiovascular disease is important. The rapid worldwide increase in diabetes prevalence call for Primary Health Care to find feasible prevention strategies, to reduce patient risk factors and promote lifestyle changes. Aim of this randomized controlled trial was to investigate how a nurse-lead Guided Self-Determination counselling approach can assist people at risk of type 2 diabetes to lower their coronary heart disease risk.

METHODS

In this randomized controlled study, 81 people at risk of developing type 2 diabetes were assigned into an intervention group (n = 39) receiving Guided Self-Determination counselling from Primary Health Care nurses over three months and a control group (n = 42) that received a diet leaflet only. Measurements included the Finnish Diabetes Risk Score questionnaire and biological measurements of Hemoglobin A1c protein, Body Mass Index, fasting blood glucose, Blood pressure, Cholesterol, High-density lipoprotein, and triglycerides, at baseline (time1), 6 (time2) and 9 months (time 3).

RESULTS

A total of 56 participants, equal number in intervention and control groups, completed all measurements. A significant difference between the intervention and control groups, in coronary heart disease risk was not found at 6 nor 9-months. However, within-group data demonstrated that 55.4% of the participants had lower coronary heart disease risk in the next ten years at the 9-month measurement. Indicating an overall 18% relative risk reduction of coronary heart disease risk by participating in the trial, with the number needed to treat for one to lower their risk to be nine. Within the intervention group a significant difference was found between time 1 and 3 in lower body mass index (p = 0.046), hemoglobin A1c level (p = 0.018) and diastolic blood pressure (p = 0.03).

CONCLUSIONS

Although unable to show significant group differences in change of coronary heart disease risk by this 12-weeks intervention, the process of regular measurements and the guided self-determination counselling seem to be beneficial for within-group measures and the overall reduction of coronary heart disease risk factors.

TRIAL REGISTRATION

This study is a part of the registered study 'Effectiveness of Nurse-coordinated Follow-Up Programme in Primary Care for People at Risk of T2DM' at www.

CLINICALTRIALS

gov (NCT04688359) (accessed on 30 December 2020).

Pertussis upsurge, age shift and vaccine escape post-COVID-19 caused by ptxP3 macrolide-resistant Bordetella pertussis MT28 clone in China

OBJECTIVES

China has experienced a notable upsurge in pertussis cases post-COVID-19, alongside an age shift to older children, increased vaccine escape, and a notable rise in the prevalence of macrolide-resistant Bordetella pertussis. Here, we present a genomic epidemiological investigation of these events.

METHODS

We performed a retrospective observational study using culture-positive B pertussis isolated in Shanghai, China, from 2016 to 2024. We analysed strain and pertussis epidemiology dynamics by integrating whole-genome sequencing of 723 strains with antimicrobial susceptibility, transcriptomic profile, and clinical data. We compared the genome sequences of Shanghai strains with 6450 Chinese and global strains.

RESULTS

From pre-COVID-19 (before December 2019) to post-COVID-19, patients shifted from predominantly infants (90%, 397/442) to a higher proportion of infections in older children (infant: 16%, 132/844), with the share of vaccinated individuals surging from 31% (107/340) to 88% (664/756). The macrolide-resistant Bordetella pertussis prevalence increased from 60% (267/447) to 98% (830/845). The emergence and expansion of a ptxP3-lineage macrolide-resistant clone, MR-MT28, which is uniquely capable of causing substantial infections among older children and vaccinated individuals, was temporally strongly associated with the pertussis upsurge and epidemiological transition. Although MR-MT28 showed increased expression of genes encoding pertussis toxin, it was associated with significantly milder clinical symptoms and a lower hospitalization rate. MR-MT28 likely originated in China around 2016, after acquiring several key mutations, including a novel prn150 allele, and has been detected across multiple regions in China. In addition, 26% (50/195) of MR-MT28 has evolved into predicted Pertactin (PRN)-deficient strains, with an IS481 insertion being the predominant mechanism.

DISCUSSION

We report that the post-COVID-19 upsurge of pertussis in China is associated with ptxP3-MR-MT28, and provide evidence that pathogen evolution is likely the primary factor driving + pertussis upsurge, age shift, and vaccine escape. MR-MT28 poses a high risk of global spread and warrants global surveillance.

Decreased prevalence of alcohol use and related sociodemographic factors in an urban district of Shanghai, China: Evidence from three cross-sectional surveys (2010-2021)

BACKGROUND

Alcohol use contributes considerably to the global impact of disease. However, limited research has been conducted recently to explore the changes in the prevalence of alcohol use, especially in urban Shanghai, China.

OBJECTIVES

To estimate the prevalence changes of alcohol use and explore related sociodemographic factors among urban residents of Xuhui district, Shanghai, China.

METHODS

Using a multistage probability proportionate-to-size sampling method, three waves of household investigations via a structured questionnaire were conducted in Xuhui district, Shanghai, China, between 2010 and 2021. Data were collected by face-to-face interviews among residents aged 15 or older who responded to the 2010, 2015, and 2021 Health Status and Health Service Utilization Survey. Age and sex standardized prevalence of alcohol use was calculated, and the linear trend was tested using logistic regression models. Multilevel mixed-effects logistic regression models with robust covariance matrix estimators were used to estimate related factors of alcohol use.

RESULTS

A total of 24 552 participants aged 15-109 years were included. The standardized overall prevalence of current regular alcohol use statistically declined from 8.8 % in 2010 to 5.5 % in 2021. This decreasing trend was statistically significant, especially among men aged 30-59 and ≥ 75 years old. However, the prevalence of overall alcohol use, regardless of frequency, increased from 19.6 % in 2015 to 24.0 % in 2021. Multivariate regression analysis showed that men had a significantly higher likelihood of regular alcohol use than women. Also, age was positively related to regular alcohol use, while education level was negatively related to this behavior.

CONCLUSIONS

Alcohol use was still common, although a significant decreasing trend in the prevalence of regular alcohol use was observed overall, in this study population. The findings call for strengthened health education and alcohol control in the context of the harmful effects of alcohol use at any level.

Unraveling the impact of ORF3a Q57H mutation on SARS-CoV-2: insights from molecular dynamics

ORF3a is a conserved accessory protein of SARS-CoV-2, linked to viral infection and pathogenesis, with acquired mutations at various locations. Previous studies have shown that the occurrence of the Q57H mutation is higher in comparison to other positions in ORF3a. This mutation is known to induce conformational changes, yet the extent of structural alteration and its role in the viral adaptation process remain unknown. Here we performed molecular dynamics (MD) simulations of wt-ORF3a, Q57H, and Q57A mutants to analyze structural changes caused by mutations compared to the native protein. The MD analysis revealed that Q57H and Q57A mutants show significant structural changes in the dimer conformation than the wt-ORF3a. This dimer conformer narrows down the ion channel cavity, which reduces Na + or K + permeability leading to decrease the antigenic response that can help the virus to escape the host immune system. Non-bonding interaction analysis shows the Q57H mutant has more interacting residues, resulting in more stability within dimer conformation than the wt-ORF3a and Q57A. Moreover, both mutant dimers (Q57H and Q57A) form a novel salt-bridge interaction at the same position between A:Asp142 and B:Lys61, whereas such an interaction is absent in the wt-ORF3a dimer. We have also noticed that the TM3 domain's flexibility in Q57H is increased because of strong inter-domain interactions of TM1 and TM2 within the dimer conformation. These unusual interactions and flexibility of Q57H mutant can have significant impacts on the SARS-CoV-2 adaptations, virulence, transmission, and immune system evasion. Our findings are consistent with the previous experimental data and provided details information on the structural perturbation in ORF3a caused by mutations, which can help better understand the structural change at the molecular level as well as the reason for the high virulence properties of this variant.Communicated by Ramaswamy H. Sarma.

The effectiveness of language nursing intervention on mental health in children with poor language skills

BACKGROUND

Mental health issues in adulthood often start in childhood, so it's important to identify these issues early and find ways to manage them. To our knowledge, no study was found that evaluated the long-term effects of language nursing intervention on mental health in children with poor language skills. This study, therefore, aimed to evaluate the long-term impact of a language nursing intervention on the mental health of children with poor language skills.

METHODS

We estimated poor language skills prevalence in 3-4-year-old children who were planning to enter kindergartens in Hunan, China. After selecting these children, we divided them into two experimental and control groups. The experimental group received a nursing intervention related to language skills for eight months. After eight months, the language skills of both groups were re-evaluated. Then, in the follow-up evaluation, the mental health of these children was evaluated at the ages of 9-10 years. Univariate and multivariate regression models adjusted with sampling weights were used to estimate the correlation of mental health and risk factors.

RESULTS

The language skills of the experimental group increased significantly compared to before the protocol (from 87.4±10.87 to 98.08±7.13; p = 0.001). At the end of the eight-month nursing intervention, the language skills of the experimental group were significantly higher than the control group (98.08±7.13 in experimental group and 87.51±9.59 in control group; p = 0.001). In multivariate analysis, single-parent family and not participating in the nursing protocol related to language skills at the age of 3-4 years were related to high symptoms of depression, anxiety and stress symptoms (single-parent family: for depression symptoms, OR = 1.28, 95% CI = 0.88-1.42; for stress symptoms, OR = 1.31, 95% CI = 0.79-2.74 and for anxiety symptoms, OR = 1.42, 95% CI = 0.97-2.44; not participating in the nursing protocol related to language skills at the age of 3-4 years: for depression symptoms, OR = 2.98, 95% CI = 1.80-5.19; for stress symptoms, OR = 1.88, 95% CI = 1.23-2.01 and for anxiety symptoms, OR = 2.67, 95% CI = 1.51-3.77; p<0.05).

CONCLUSION

The current study showed the effectiveness of this intervention on both language skills and mental health of children with poor language skills.

Rapid determination of volatile benzene derivatives and chlorobenzenes in goat's milk by HS-SPME-GC-MS/MS

A method for the determination of eight benzenes (BTEXs) and twelve chlorobenzenes (CBs) in goat's milk by headspace solid-phase microextraction-gas chromatography-mass spectrometry (HS-SPME-GC-MS/MS) was developed. The study investigated the impact of various factors such as extraction fiber type, salt amount, equilibrium conditions, and desorption conditions on the outcomes. Target analytes were separated on a DB-HeavyWAX column and quantified using the external standard method. The results showed that the target compounds had a good linear relationship in the range of 0.01 ∼ 50 μg/L (R2 > 0.997), the limit of detection (LOD) was 0.003 ∼ 0.150 μg/L, and the limit of quantification (LOQ) was 0.01 ∼ 0.50 μg/L. The average recoveries were 82%-116% and the relative standard deviation (RSD) was 0.8%-17.3% under the three addition levels of 1×, 2×, and 10 × LOQ. In a survey of twenty goat's milk samples, only ethylbenzene, xylenes, cumene, chlorobenzene, and 1,4-dichlorobenzene were detected at levels exceeding their respective limits of quantification. The method was evaluated using two ecological scales (Eco-Scale), GAPI and AGREEN, to verify its environmental friendliness and applicability. This method is simple, green, and efficient, which provides a certain theoretical basis for the production and quality safety evaluation of dairy products.

Detection and evolutionary characterization of arboviruses in mosquitoes and biting midges on Hainan Island, China, 2019-2023

We conducted a large-scale survey of arboviruses in mosquitoes and biting midges to assess the presence and spread of mosquito-borne pathogens currently circulating on Hainan Island, China. RT-PCR assays were used to detect the arbovirus species, distribution, and infection rates in mosquitoes and biting midges. Cell inoculation and high throughput sequencing were performed to isolate the viruses and assemble full viral genomes. Phylogenetic analysis was conducted to identify the viral genotypes and evolutionary relationships with known viruses. During 2019-2023, 32,632 mosquitoes and 21,000 biting midges were collected from 14 of 18 cities/counties on Hainan Island. Japanese encephalitis virus (JEV) was detected in Culex mosquitoes from five cities/counties, where the minimum infection rate (MIR) was 1.6 (0.6-2.6) per 1,000 females tested. Tembusu virus (TMUV) was detected in Culex mosquitoes from three cities/counties with MIR1.0 (0-2.2) per 1,000. Getah virus (GETV) was detected in Armigeres mosquitoes from Qionghai city with MIR 7.1 (0-15.2) per 1,000. Oya virus (OYAV) and Bluetongue virus (BTV) were detected in biting midges from Wanning city with MIRs of 0.4 (0-1.2) and 0.1 (0-10.2) per 1,000, respectively. Three JEV strains were isolated and clustered within the genotype I group, which is presently the dominant genotype in China. Three TMUV strains were isolated for the first time on Hainan Island that belonged to Cluster 3. Three isolated GETVs were identified as Group 3. BTV was reported for the first time on Hainan Island, and the complete genome for one BTV strain was successfully assembled, which was classified as serotype 1 based on the sequences of segment 2. These results stress the need to develop adequate surveillance plan measures to better control the public health threat of arboviruses carried by mosquitoes and biting midges in local regions.

Changes in epidemiological and treatment-related characteristics among newly reported HIV/AIDS cases in an urban area in Shanghai, China from 2001 to 2019: A population-based retrospective study

The HIV/AIDS epidemic has changed significantly over the past 40 years. Changes in AIDS intervention strategies over time and across regions may have influenced epidemiological characteristics and intervention strategies. The aim of the current study was to analyze the changes in multi-year epidemiological characteristics of newly reported HIV/AIDS cases in an urban area (the Fengxian District of Shanghai) from 2001 to 2019 based on the national AIDS comprehensive data information system and Shanghai Statistical Yearbook. In total, the average annual incidence of HIV/AIDS was 1.92 per 100,000 persons. The annual incidence fluctuated and tended to increase from 2001 to 2019 (χ2 = 128.38, p < 0.001). More male patients were reported compared to female patients, accounting for 82.9%. The proportion of patients over 65 years of age increased from 5% in 2009 to 12% in 2019. The majority of cases involved sexual contact (97.7%), early diagnosis (58.8%), full virologic suppression (72.9%), and early antiretroviral therapy (ART) (44.3%). Migrant patients have significantly increased over the years. There were significant differences between local and migrant patients in terms of the age at diagnosis, transmission route, and baseline CD4 count. The disparity in high-risk temporal clusters was also explored to indicate the delay of an epidemic between local patients and migrant patients. HIV remains at a low endemic level. AIDS prevention and control measures have been highly effective, and especially in virologic suppression of ART and early diagnosis. More efforts should be made to enhance early diagnosis and treatment among key vulnerable groups, including the elderly in the local population and young male migrants, and the scale of HIV/AIDS testing should be expanded to the general population to control HIV transmission.

Correlation between notifiable infectious diseases and transportation passenger traffic from 2013 to 2019 in mainland China

PURPOSE

Population mobility significantly contributes to the spread and prevalence of infectious diseases, posing a serious threat to public health safety and sustainable development across the globe. Understanding the impact of population mobility on the prevention and control of infectious diseases holds profound significance.

METHODS

In this study, we collected the data on the incidence of notifiable infectious diseases in mainland China from 2013 to 2019, and analyzed the characteristics of notifiable infectious diseases, as well as their correlation with transportation passenger traffic.

RESULTS

Among 29 common notifiable infectious diseases, the incidence rate of intestinal diseases per 100,000 people was the highest (256.35 cases), while the mortality rate was the lowest (0.017 cases). The mortality rate per 100,000 people due to sexually transmitted and bloodborne diseases was the highest (1.154 cases). A significant linear correlation was noted between commercial passenger traffic and the number of cases of tuberculosis (r = 0.83, P = 0.022), hepatitis A (r = 0.87, P = 0.012), bacillary and amebic dysentery (r = 0.90, P = 0.006), typhoid/paratyphoid (r = 0.94, P = 0.002), leptospirosis (r = 0.90, P = 0.005), AIDS(r=-0.90, P = 0.006), gonorrhea (r=-0.79, P = 0.035) and scarlet fever (r=-0.85, P = 0.016). A significant linear correlation was noted between public transportation passenger traffic and the number of cases of measles (r = 0.94, P = 0.002), hepatitis A (r = 0.96, P = 0.001), parasitic and vector-borne diseases (r = 0.96, P = 0.001), brucellosis (r = 0.95, P = 0.001), leptospirosis (r = 0.88, P = 0.008), other infectious diarrhea (r = 0.86, P = 0.013) and gonorrhea (r = 0.84, P = 0.018).

CONCLUSION

The results of this study indicated that transportation passenger traffic significantly affected the incidence of infectious diseases, and reasonable management of passenger traffic was a potentially important means of prevention and control of infectious diseases.

The association between HIV infection and perimenopausal syndrome: A matched cross-sectional study of women living with HIV/ AIDS and their uninfected counterparts in rural areas of Anhui, China

The study compared the level of perimenopausal syndrome (PS) among women age 40 or older living with HIV/AIDS (WLWH) and their HIV-negative counterparts in rural areas of Anhui, China and it analyzed the association between HIV infection and PS. From March 2018 to February 2019, WLWH ≥ the age of 40 and their aged-matched HIV-negative female neighbors in 8 townships in the cities of Fuyang and Bozhou in Anhui Province, China were selected by cluster random sampling to respond to a questionnaire survey. Multivariable logistic regression analysis was performed. Responses from a total of 464 participants were analyzed, including 220 HIV-positive women and 244 HIV-negative female neighbors. The average score for PS was 18.02 and the prevalence of PS was 85.0% in the HIV-positive group, both of which were higher than those in the control group (p < 0.05). The most common PS symptoms among WLWH were irritability (83.2%), followed by fatigue (79.5%) and arthralgia myalgia (68.2%). The risk of developing moderate to severe PS in HIV-uninfected women was 0.605 times that in WLWH. Other significant risk factors included being older, a history of chronic diseases, poor sleep quality, and poor appetite. In the future, more attention should be paid to the prevention of PS in WLWH while actively providing antiretroviral therapy and follow-up.

Contributions of subjective status to eating behaviors, obesity, and metabolic health across development

Subjective status is the evaluation of one's social or socioeconomic status relative to others. Lower subjective status has been associated with risk of overweight/obesity, poorer metabolic health, and obesogenic food preferences and eating behaviors. However, these findings are predominantly based on studies of adolescents and young adults. This indicates major gaps in knowledge and application of this social determinant of obesity and metabolic health, given that perceived status develops throughout the life course along with food environments and eating habits. Here, we review the relationships that subjective status shares with the outcomes of eating behaviors, obesity, and metabolic health across milestones and periods of development: during the prenatal period, as caregivers who feed children, during childhood (prior to age 10) and from adolescence into emerging adulthood (until mid-20's). For each developmental period, we explore why the period critically contributes to these outcomes and how subjective status may affect eating behaviors and metabolic health. We propose that subjective status contributes to eating/feeding behaviors and metabolic health both within and across developmental periods, such that the effect of low subjective status at an earlier period may contribute to obesogenic eating behaviors and metabolic health in later developmental periods and intergenerationally. The influence of low subjective status on higher body weight may also threaten subjective status later in development through heightened vulnerability to social stressors, such as weight-based stigma. Overall, subjective status may be a broadly influential factor to consider when examining social determinants of obesity and metabolic health across development.

A novel unilateral extrapedicular approach applied to percutaneous vertebral augmentation to treat thoracic and lumbar Osteoporotic Vertebral Compression Fracture: a retrospective study

OBJECTIVE

To design and apply a novel puncture method, named P TO P technique, and to evaluate its efficacy and safety.

METHOD

The data of patients treated with PVA in medical institution from January 2020 to December 2022 were reviewed and analyzed. The degree of pain relief and recovery from daily activities were evaluated using VAS and LAS scores, and radiological parameters were evaluated using local kyphosis angle and excellent cement distribution. Complications such as cement leakage and recurrent vertebral fractures were also recorded.

RESULTS

157 patients with thoracolumbar OVCF were successfully treated with novel puncture techniques. All postoperative clinical and radiological parameters significantly decreased in all patients, except for an increase in local kyphosis angle at the last follow-up compared to postoperative. All other above indicators remained statistically significant at the last follow-up compared to postoperative improvement. Except for 2 patients with poor cement distribution, the remaining 155 patients successfully achieved satisfactory results in unilateral puncture and bilateral cement distribution, achieving an excellent rate of 98.73%. In addition, 18 cases (11.46%) of cement leakage occurred during the operation, fortunately none of them were uncomfortable. During the postoperative follow-up period, 4 cases (2.55%) of recurrent fractures occurred. No other serious complications such as neurologic or named vascular injuries occurred.

CONCLUSION

The application of P TO P technology in thoracolumbar OVCF patients is safe and effective. It can not only reduce pain and quickly recover daily activities, but also achieve the perfect effect of unilateral puncture and bilateral cement filling.

Role of dormancy survival regulator and resuscitation-promoting factors antigens in differentiating between active and latent tuberculosis: a systematic review and meta-analysis

BACKGROUND

Dormancy survival regulator (DosR) and resuscitation-promoting factor (Rpf) antigens of Mycobacterium tuberculosis are activated during dormant phase of tuberculosis (TB). This study evaluates the differential immunogenicity potentials of DosR and Rpf antigens in individuals with latent tuberculosis infection (LTBI) and active TB patients.

METHODS

After a literature search in electronic databases, studies were selected by following precise eligibility criteria. Outcomes were synthesized systematically, and meta-analyses were performed to estimate standardized mean differences (SMDs) in interferon-gamma (IFNγ) levels, and IFNγ positive immune cells between individuals with LTBI and active TB patients.

RESULTS

Twenty-six studies (1278 individuals with LTBI and 1189 active TB patients) were included. DosR antigens Rv0569 (Standardized mean difference; SMD 2.44 [95%CI: 1.21, 3.66]; p < 0.0001), Rv1733c (SMD 0.60 [95%CI: 0.14, 1.07]; p = 0.011), Rv1735c (SMD 1.16 [95%CI: 0.44, 1.88]; p = 0.002), Rv1737c (SMD 1.26 [95%CI: 0.59, 1.92]; p < 0.0001), Rv2029c (SMD 0.89 [95%CI: 0.35, 1.42]; p = 0.002), RV2626c (SMD 1.24 [95%CI: 0.45, 2.02); p = 0.002), and Rv2628 (SMD 0.65 [95%CI: 0.38, 0.91]; p < 0.0001) and Rpf antigens Rv0867c (SMD 1.33 [95%CI: 0.48, 2.18]; p = 0.002), Rv1009 (SMD 0.65 [95%CI: 0.05, 1.25]; p = 0.034), and Rv2450c (SMD 1.54 [95%CI: 0.92, 2.16]; p < 0.0001) elicited higher IFNγ levels in individuals with LTBI in comparison with active TB patients. IFNγ-positive immunoresponsive cells were significantly higher in individuals with LTBI than in active TB patients for antigens Rv1733c (SMD 1.02 [95%CI: 0.15, 1.88]; p = 0.021), Rv2029c (SMD 0.57 [95%CI: 0.05, 1.09]; p = 0.031), and Rv2628 [SMD 0.38 [95%CI: 0.15, 0.61]; p = 0.001).

CONCLUSION

DosR antigens Rv0569, Rv1733c, Rv1735c, Rv1737c, RV2626c, Rv2628, and Rv2029c, and Rpf antigens Rv0867c, Rv1009, and Rv2450c are found to elicit immune responses differently in individuals with LTBI and active TB patients.

Association between night blindness history and risk of diabetes in the Chinese population: a multi-center, cross sectional study

AIMS

Night blindness (NB), an important manifestation of VA deficiency, may be associated with the odds of diabetes. The aim of this study was to explore the probable association between NB history and diabetes in Chinese community-dwelling adults.

METHODS

This multi-center, cross-sectional study enrolled a total of 5664 participants aged 18-82 years from eight sites in China. Information on demographics and medical history was collected using a standardized questionnaire. Diabetes was diagnosed based on the oral glucose tolerance test or a self-reported history. NB history was ascertained by a face-to-face interview with reference to the recommendation by the World Health Organization. Logistic regression analysis was used to evaluate the association between NB history and the odds of diabetes.

RESULTS

A total of 5049 participants were finally included, with 252 ascertained with NB history and 1076 with diabetes. The mean age of included participants was 52.9 years, and the percentage of participants with NB history was significantly higher in participants with diabetes than those without (7.0% vs. 4.5%). The multivariable adjusted odds ratio for diabetes was 1.41 (95% confidence interval 1.06, 1.89) in participants with NB history compared with those without. Furthermore, mediation analysis showed that obesity, as assessed by waist-height ratio, partially mediated the relationship between NB history and increased odds of diabetes.

CONCLUSIONS

The results suggest that NB history might be associated with increased odds of diabetes in Chinese community-dwelling adults.

Construction of a Home Hospice Care Program for Older Adults at the End of Life with Chronic Diseases in China: A Delphi Method

Purpose

With the increasing aging of the population and the increasing incidence of chronic diseases in China, home hospice care services can meet the desire of the older adult with chronic diseases to receive care and die at home. In order to ensure the real application of hospice in families, the goal of the study was to construct a home hospice care program for the older adult at the end of life with chronic diseases based on Harmony Nursing Theory (composed of three parts: harmony needs assessment, harmony mechanism establishment and interpersonal interaction).

Methods

Through literature review, a qualitative interview and group discussion, the first draft of a home hospice care program for the older adult at the end of life with chronic diseases based on the harmony nursing theory was developed, which was further revised and finalized by combining the Delphi method of expert correspondence with 19 experts and a pilot study with a home hospice care team.

Results

A total of two rounds of expert correspondence were conducted. In the first round, 21 questionnaires were distributed and 19 were returned, yielding a recovery rate of 90.48%. In the second round, 19 questionnaires were distributed, and 19 questionnaires were collected. The recovery rate was 100%. The authority of the two rounds of expert correspondence was 0.96, and Kendall's coefficient of concordance (W) was 0.268 and 0.310, respectively. After the first round of Delphi expert consultation, 3 items were deleted, and 12 items were revised. In the second round of Delphi expert consultation, two items were revised. The final version of the home hospice program includes 4 first-level items, 20 second-level items, and 59 third-level items.

Conclusion

The home hospice care program based on harmony nursing theory is authoritative and scientific and can provide a reference for the practice of home hospice care for the older adult with chronic diseases.

Is ignorance bliss? Evaluating information awareness and life satisfaction through the lens of perceived air pollution: The case of Beijing, China

Our study presents fresh insight into the impacts of air-related information accessibility and policy awareness on citizen's life satisfaction, through the lens of perceived air pollution sources. It is widely accepted that disclosing information about air pollution adversely affects an individual's life satisfaction. However, the impact of information accessibility and public policy awareness on life satisfaction remains poorly understood in real-life contexts and their interrelationship warrants exploration. Earlier studies suggested that public scrutiny via information disclosure is a means to lower air pollution levels, potentially enhancing life satisfaction through improved air quality perception and reduced health risks. However, much of that research was based on the flawed presumption that all individuals can access and understand this officially disclosed information. They overlooked the actual availability of information and public reflections on relevant policies that were influenced by their perception of air pollution. This research gap highlights the need for in-depth evidence of the impacts of information accessibility and policy awareness on life satisfaction. Employing a covariance-based Structural Equation Modelling, our study analyses the views of 1867 Beijing residents in 2022. We assessed information accessibility, policy awareness, perceived air pollution sources, life satisfaction, and socio-demographic characteristics covering two time periods: a) before the COVID-19 pandemic and b) during its normalisation phase. Our findings reveal that both information accessibility and policy awareness significantly and positively affect life satisfaction in both periods. Moreover, the indirect parameter analysis underscores the presence of significant heterogeneity when considering the mediating role of impacts of perceived air pollutants. The results of this study offer a novel contribution regarding the relationship between air pollution information accessibility, policy awareness, and life satisfaction.

Whether and What to Tell: A Qualitative Study of HIV Disclosure Among Heterosexually Married Men Who Have Sex with Men in China

In China, HIV transmission increasingly affected men who have sex with men (MSM) and those in heterosexual marriages. This study addressed a critical gap in understanding HIV and sexual orientation disclosure within conventional heterosexual marriages, framed within a family-oriented cultural context. Heterosexually married MSM living with HIV (HIV+ MMSM) faced complex identity dynamics and interactions between "gay circles" and marital life. Such disclosure was fraught with potential repercussions, including accusations of "marriage fraud", HIV-related stigma, and divorce. This descriptive qualitative study, conducted in 2022, aimed to explore the common factors influencing HIV status disclosure to wives among Chinese HIV+ MMSM. Sixteen semi-structured interviews were conducted to analyze the factors related to the disclosure process model. Four key themes emerged: (a) concern for wives' well-being, (b) perceived marriage strength, (c) the degree of social support they had, and (d) a desire to maintain their status in a heterosexual society. The decision to (non)disclose was shaped by both approach-focused and avoidant-focused goals related to these four themes. The findings underscored the need for culturally sensitive strategies that balance family dynamics, stigma reduction, and HIV care management, emphasizing tailored approaches to effectively support this population.

Patient delay, diagnosis delay, and treatment outcomes among migrant patients with tuberculosis in Shanghai, China, 2018-2020: a mixed-methods study

OBJECTIVES

This study aimed to examine patient delay, diagnosis delay and treatment performance among patients with tuberculosis (TB) in Shanghai, China in 2018-2020 focusing on disparities between migrant and local patients with TB.

DESIGN

Mixed-method study.

SETTING AND PARTICIPANTS

Quantitative data were collected from the TB information management system in Shanghai; 17 533 bacteriologically confirmed and clinically diagnosed patients with pulmonary TB registered in 2018-2020 were included. Qualitative interviews were conducted with TB administrators (n=3) and community healthcare providers (two groups, n=10 in total) from Shanghai.

MAIN OUTCOME MEASURES

Patient delay, diagnosis delay and treatment completion were examined by resident type using descriptive analysis and logistic regressions. Qualitative interviews were conducted to understand factors associated with the disparities.

RESULTS

From 2018 to 2020, migrant patients with TB accounted for 44.40% of total cases. There was no significant difference in patient delay between migrant and local patients (18.47 days on average). 22.12% of migrants and 16.52% of locals experienced diagnosis delays exceeding 14 days, respectively. After adjusting for all variables, migrant patients (OR 1.30, 95% CI 1.18 to 1.44) and initial care seeking at general hospitals (OR 3.76, 95% CI 3.45 to 4.09) were associated with a higher probability of diagnosis delay. 93.9% of migrant patients and 89.4% of the local patients had a successful TB treatment without statistically significant difference after adjusting for all variables. Qualitative interviews revealed a standard approach to managing patients with TB in Shanghai no matter their resident type. Young migrant patients who were able to maintain their jobs in Shanghai often had better treatment adherence. Despite patients' COVID-19 fear and limited care access in 2020, TB treatment minimally affected for both due to community-based case management.

CONCLUSIONS

Migrant patients were more likely to experience diagnosis delay. It should improve awareness and knowledge of TB among healthcare professionals at general hospitals to mitigate the risk of diagnosis delay.

Physical activity levels and musculoskeletal disease risk in adults aged 45 and above: a cross-sectional study

BACKGROUND

Musculoskeletal disease (MSD) is a major cause of disability among older adults, and understanding the role of physical activity (PA) in preventing these conditions is crucial. This study aimed to explore the association between PA levels and MSD risk among adults aged 45 and above, clarify the dose‒response relationship, and provide tailored guidelines.

METHODS

Using data from the China Health and Retirement Longitudinal Study (CHARLS), a cross-sectional analysis was conducted on 15,909 adults aged 45 and over. The study population was divided into MSD (n = 7014) and nMSD (n = 8895) groups based on musculoskeletal health status. PA levels were assessed using the International Physical Activity Questionnaire and categorized into low intensity physical activity (LIPA), moderate vigorous physical activity (MVPA), and vigorous physical activity (VPA). Multivariable logistic regression models and restricted cubic spline regression were used to examine the relationship between PA levels and MSD risk in middle-aged and older adults. Sensitivity analyses and stratified analyses were also performed.

RESULTS

The main outcome measures were musculoskeletal diseases prevalence and PA levels. MVPA and VPA reduced MSD risk by 19% [OR = 0.81, 95% CI (0.72, 0.90), P < 0.001] and 12% [OR = 0.88, 95% CI (0.79, 0.98), P < 0.05], respectively. What's more, after adjusting for confounding factors, VPA increased risk by 32% [OR = 1.32, 95% CI (1.04, 1.66), P < 0.05]. The relationship was nonlinear, showing a U-shaped pattern with age and hypertension status as significant moderators. The optimal PA energy expenditure was identified as approximately 1500 metabolic equivalents of tasks (METs) per week for adults aged 45-74, 1400 METs per week for those aged 75 and above, and 1600 METs per week for hypertensive adults aged 45 and older.

CONCLUSIONS

For adults aged 45 years and older, VPA significantly increases the risk of MSD. Adults aged 45 years and older should adjust their weekly METs based on their age. Additionally, those with hypertension should moderately increase their weekly METs to promote optimal musculoskeletal health.

Impacts of ectoparasite flea infestation on gut microbiota of the Meriones unguiculatus in a rodent-flea system

Fleas, along with one of their host species, Meriones unguiculatus, possess the capability to act as vectors in the transmission of plague. Parasitism by fleas may markedly influence the physiology and immune system of their hosts. Gut microbiota plays an important role in the growth and development of rodents. However, few studies have explored the impacts of ectoparasitic flea on the gut microbiome of rodents. This study investigated the immunological responses and changes in the gut microbial diversity and composition in both wild and laboratory rodents infested with fleas and laboratory rodents infested with Ctenocephalides felis. We measured immune reactions post-infestation by enzyme-linked immunosorbent assay (ELISA) and explored the effects of ectoparasitic infestation on the diversity and composition of the rodent gut microbiota in microbiome studies by 16S rRNA gene sequencing techniques. After flea infestation, results from 16S rRNA gene sequencing techniques indicated a significant increase in alpha diversity, affecting the composition of the gut microbiota. At the genus level, the abundance of the harmful bacterium Desulfovibrio increased. Beta diversity analyses showed significant differences between the gut microbiota of the experimental and control groups. ELISA results revealed significantly elevated levels of IgG in parasitized mice, while the differences in IgA levels were not significant. Flea infections affect the composition and diversity of the gut microbiota in the M. unguiculatu, and it has been found that the biomarker Desulfovibrio increases following flea infection in these rodents. Our results indicate that the gut microbiota can regulate the stability of the rodent-flea system. These findings may provide a foundation for exploring preventive measures against plague and aid in developing more effective treatments for the infection.

Racial and ethnic disparities in social isolation and 11-year dementia risk among older adults in the United States

AIMS

Social isolation has been implicated in the development of cognitive impairment, but research on this association remains limited among racial-ethnic minoritized populations. Our study examined the interplay between social isolation, race-ethnicity and dementia.

METHODS

We analyzed 11 years (2011-2021) of National Health and Aging Trends Study (NHATS) data, a prospective nationally representative cohort of U.S. Medicare beneficiaries aged 65 years and older. Dementia status was determined using a validated NHATS algorithm. We constructed a longitudinal score using a validated social isolation variable for our sample of 6,155 community-dwelling respondents. Cox regression determined how the interaction between social isolation and race-ethnicity was associated with incident dementia risk.

RESULTS

Average longitudinal frequency of social isolation was higher among older Black (27.6%), Hispanic (26.6%) and Asian (21.0%) respondents than non-Hispanic White (19.1%) adults during the 11-year period (t = -7.35, p < .001). While a higher frequency of social isolation was significantly associated with an increased (approximately 47%) dementia risk after adjusting for sociodemographic covariates (adjusted hazard ratio [aHR] = 1.47, 95% CI [1.15, 1.88], p < .01), this association was not significant after adjusting for health covariates (aHR = 1.21, 95% CI [0.96, 1.54], p = .11). Race-ethnicity was not a significant moderator in the association between social isolation and dementia.

CONCLUSIONS

Older adults from racial-ethnic minoritized populations experienced a higher longitudinal frequency of social isolation. However, race-ethnicity did not moderate the positive association observed between social isolation and dementia. Future research is needed to investigate the underlying mechanisms contributing to racial-ethnic disparities in social isolation and to develop targeted interventions to mitigate the associated dementia risk.