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Li L, Feng X, Luo S, Lin L, Xiang H, Chen D, Qin K, Guo X, Chen W, Guo VY. Internet addiction and health-related quality of life in adolescents: The mediating role of sleep disturbance. Sleep Med 2024; 117:53-59. [PMID: 38507977 DOI: 10.1016/j.sleep.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 10/26/2023] [Accepted: 03/07/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Internet addiction (IA) has emerged as a recognized risk factor associated with impaired health-related quality of life (HRQOL) in adolescents. However, the role of sleep disturbance in this association remains unclear. This study aimed to investigate the association of IA with HRQOL in Chinese adolescents and to evaluate the potential mediating role of sleep disturbance. METHODS A cross-sectional study was conducted among adolescents attending six randomly selected middle schools in Guangzhou, China. Adolescents self-reported their internet use using the Young Diagnostic Questionnaire. HRQOL and sleep disturbance were assessed by the Pediatric Quality of Life Inventory version 4.0 and the Pittsburgh Sleep Quality Index, respectively. Multivariate linear regression analysis was employed to assess the association between IA and HRQOL. Baron and Kenny's causal steps method was used to examine the possible mediating role of sleep disturbance. RESULTS Of the 6473 adolescents included, 23.5% had maladaptive internet use (MIU) and 16.6% had pathological internet use (PIU). Compared to adolescents with adaptive internet use (AIU), those with IA had significantly lower scores across all HRQOL dimensions and summary scales. Mediation analysis revealed that sleep disturbance was a significant mediator. Specifically, sleep disturbance mediated 34.55% of the effects of MIU and 34.06% of the effects of PIU on the HRQOL total scale score , respectively. CONCLUSIONS IA was associated with poorer HRQOL, indicating the needs of preventing IA in Chinese adolescents. Additionally, our findings underscored the importance of enhancing sleep quality to mitigate the adverse impact of IA on adolescents' well-being.
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Affiliation(s)
- Lu Li
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, Guangdong, China
| | - Xiuqiong Feng
- Department of Public Health, Guangzhou Huangpu District Center for Disease Control and Prevention, Guangzhou, 510530, Guangdong, China
| | - Shengyu Luo
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, Guangdong, China
| | - Li Lin
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, Guangdong, China
| | - Hongyu Xiang
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, Guangdong, China
| | - Dezhong Chen
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, Guangdong, China
| | - Kang Qin
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, Guangdong, China
| | - Xun Guo
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, Guangdong, China
| | - Weiqing Chen
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, Guangdong, China
| | - Vivian Yawei Guo
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, Guangdong, China.
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Luo S, Feng X, Lin L, Li J, Chen W, Guo VY. Association of adverse and positive childhood experiences with health-related quality of life in adolescents. Public Health 2024; 228:92-99. [PMID: 38340507 DOI: 10.1016/j.puhe.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/28/2023] [Accepted: 01/07/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVES To investigate the independent impacts of adverse childhood experiences (ACEs) and positive childhood experiences (PCEs) on the health-related quality of life (HRQOL) of Chinese adolescents, and to explore the potential moderating role of PCEs in the association between ACEs and HRQOL. STUDY DESIGN This was a cross-sectional study. METHODS We surveyed 6982 students aged 11-20 in Guangzhou, China, from November to December 2021. Adolescents self-reported their ACEs, PCEs, and HRQOL by the Childhood Trauma Questionnaire Short Form, the Adverse Childhood Experiences-International Questionnaire, the Benevolent Childhood Experiences Scale, and the Paediatric Quality of Life Inventory Version 4.0, respectively. Multivariable linear regressions were performed to examine the associations between ACEs, PCEs, and HRQOL controlled for adolescents' age, gender, single-child status, boarding school attendance, primary caregivers, as well as parental age and occupational status. Likelihood-ratio tests were further applied to explore the moderating role of PCEs. RESULTS In the models that considered both ACEs and PCEs, ACEs were significantly associated with lower HRQOL scores in all dimensions, summary scales, and total scale (β = -13.88, 95% confidence interval [CI]: -14.82, -12.94 for total scale). Conversely, exposure to an above-average number of PCEs was associated with higher HRQOL scores in all measured aspects (β = 7.20, 95%CI: 6.57, 7.84 for total scale). PCEs significantly moderated the association between ACEs and all HRQOL dimensions, summary scales, and total scale, except school functioning. CONCLUSION ACEs and PCEs exert independent and opposite impacts on adolescents' HRQOL. PCEs could mitigate the negative impacts of ACEs. Enhancing resilience, like PCEs, may contribute to improving the HRQOL among adolescents who have exposed to ACEs.
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Affiliation(s)
- S Luo
- Department of Epidemiology, School of Public Health, Sun Yat-Sen University, 74 Zhongshan 2nd Road, Guangzhou, Guangdong, China
| | - X Feng
- Guangzhou Huangpu District Center for Disease Control and Prevention, Guangzhou, Guangdong, China
| | - L Lin
- Department of Epidemiology, School of Public Health, Sun Yat-Sen University, 74 Zhongshan 2nd Road, Guangzhou, Guangdong, China
| | - J Li
- Department of Biostatistics, School of Public Health, Sun Yat-Sen University, 74 Zhongshan 2nd Road, Guangzhou, Guangdong, China
| | - W Chen
- Department of Epidemiology, School of Public Health, Sun Yat-Sen University, 74 Zhongshan 2nd Road, Guangzhou, Guangdong, China
| | - V Y Guo
- Department of Epidemiology, School of Public Health, Sun Yat-Sen University, 74 Zhongshan 2nd Road, Guangzhou, Guangdong, China.
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Wang S, Deng Y, Zhang Y, Guo VY, Zhang B, Cheng X, Xin M, Hao Y, Hou F, Li J. The role of illness-related cognition in the relationships between resilience and depression/anxiety in nasopharyngeal cancer patients. Cancer Med 2023; 12:21408-21418. [PMID: 37991167 PMCID: PMC10726906 DOI: 10.1002/cam4.6688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/05/2023] [Accepted: 10/26/2023] [Indexed: 11/23/2023] Open
Abstract
OBJECTIVE Resilience has been reported as an important predictor of better mental health and prognoses in cancer patients, while its mechanisms were not clearly elucidated. In this study, we surveyed a large sample of nasopharyngeal carcinoma patients to investigate the mediating role of illness-related cognition (illness perception, stigma and meaning in life) on the associations between resilience and symptoms of anxiety and depression. METHODS This cross-sectional study involved 773 participants diagnosed with nasopharyngeal carcinoma. Participants completed a self-reported structured questionnaire to assess their illness perception, stigma and meaning in life, resilience and symptoms of anxiety and depression. Structural equation models (SEM) were employed to explore the relationship between resilience and symptoms of anxiety and depression in the entire sample, as well as in two subgroups: Subgroup I (0-1 year since diagnosis), and Subgroup II (over 1 year since diagnosis). RESULTS In the entire sample, after adjusting for potential confounders, illness perception, stigma and meaning in life were found to mediate the protective effect of resilience on symptoms of depression (mediating effect proportion: 65.25%) and anxiety (mediating effect proportion: 67.63%). In Subgroup I, direct effects were dominant in the associations between resilience and symptoms of anxiety (mediating effect proportion: 37.95%) and depression (mediating effect proportion: 29.13%). However, in Subgroup II, the associations between resilience and symptoms of anxiety (mediating effect proportion: 98.92%) and depression (mediating effect proportion: 81.04%) were completely mediated. CONCLUSIONS Our study suggests that direct and indirect effects of resilience on depression and anxiety dominate in early periods (0-1 year) and long-term periods (over 1 year) following the cancer diagnosis, respectively. The findings indicate that comprehensive intervention considering both the direct effect of resilience in early stages (e.g., health education prescription and social support groups) and the indirect effects of illness cognition in long-term periods (e.g., cognitive behavioral therapies) are likely to yield the most favorable outcomes for cancer patients.
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Affiliation(s)
- Shenghao Wang
- Department of Medical Statistics, School of Public HealthSun Yat‐sen UniversityGuangzhouChina
| | - Yang Deng
- Department of Medical Statistics, School of Public HealthSun Yat‐sen UniversityGuangzhouChina
| | - Yuan Zhang
- Sun Yat‐sen Global Health InstituteSun Yat‐sen UniversityGuangzhouChina
- Department of Radiation OncologySun Yat‐sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and TherapyGuangzhouChina
| | - Vivian Yawei Guo
- Department of Medical Statistics, School of Public HealthSun Yat‐sen UniversityGuangzhouChina
| | - Bo Zhang
- Department of Medical Statistics, School of Public HealthSun Yat‐sen UniversityGuangzhouChina
| | - Xi Cheng
- Department of Medical Statistics, School of Public HealthSun Yat‐sen UniversityGuangzhouChina
| | - Meiqi Xin
- Department of Rehabilitation SciencesThe Hong Kong Polytechnic UniversityHong KongChina
| | - Yuantao Hao
- Peking University Center for Public Health and Epidemic Preparedness & Response Peking UniversityBeijingChina
- Key Laboratory of Epidemiology of Major Diseases (Peking University)Ministry of EducationBeijingChina
| | - Fengsu Hou
- Sun Yat‐sen Global Health InstituteSun Yat‐sen UniversityGuangzhouChina
- Department of Public HealthShenzhen Kangning HospitalShenzhenChina
| | - Jinghua Li
- Department of Medical Statistics, School of Public HealthSun Yat‐sen UniversityGuangzhouChina
- Sun Yat‐sen Global Health InstituteSun Yat‐sen UniversityGuangzhouChina
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Guo X, Lin L, Qin K, Li J, Chen W, Guo VY. Adverse childhood experiences and depressive symptoms among middle-aged or older adults in China and the mediating role of short sleep duration. J Affect Disord 2023; 340:711-718. [PMID: 37597778 DOI: 10.1016/j.jad.2023.08.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 07/31/2023] [Accepted: 08/14/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND Limited research has simultaneously examined the link between adverse childhood experiences (ACEs), short sleep duration, and depressive symptoms among middle-aged or older Chinese adults. This study aims to investigate the association between ACEs and later-life depressive symptoms, and to examine the mediating role of short sleep duration (<6 h/night) in this association. METHODS Data of 11,452 participants aged ≥45 years were obtained from the China Health and Retirement Longitudinal Study. Information on ACEs, depressive symptoms, and sleep duration were reported via questionnaires. The mediating effect of short sleep duration in the association between ACEs and depressive symptoms was examined by Baron and Kenny's causal steps method and Karlson/Holm/Breen (KHB) method. RESULTS Compared to non-exposed group, exposure to ACEs was significantly associated with increased odds of depressive symptoms in a dose-response pattern. The odds ratio of depressive symptoms increased from 1.27 (95 % CI: 1.11-1.46) for one ACE to 3.38 (95 % CI: 2.92-3.90) for ≥4 ACEs. The KHB method identified significant mediating role of short sleep duration in the association between experiencing three or more ACEs and depressive symptoms, with the proportional mediation estimated at 8.96 % and 8.85 % for the groups with 3 ACEs and ≥4 ACEs, respectively. The results were consistent across genders and gender did not moderate these associations. LIMITATIONS The cross-sectional design limited the ability to make causal inference. CONCLUSIONS ACEs were positively associated with depressive symptoms, and short sleep duration partially mediated this association. Promoting optimal sleep duration among ACE-exposed individuals might improve their mental health.
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Affiliation(s)
- Xun Guo
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Li Lin
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Kang Qin
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Jinghua Li
- Department of Biostatistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Weiqing Chen
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Vivian Yawei Guo
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China.
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Xiang H, Feng X, Lin L, Luo S, Liu X, Chen D, Qin K, Guo X, Chen W, Guo VY. Association between healthy lifestyle factors and health-related quality of life among Chinese adolescents: the moderating role of gender. Health Qual Life Outcomes 2023; 21:119. [PMID: 37904152 PMCID: PMC10617140 DOI: 10.1186/s12955-023-02201-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 10/20/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND To examine the associations of the independent and combined healthy lifestyle factors with health-related quality of life (HRQOL) in adolescents, and to test the moderating role of gender. METHODS This cross-sectional study included 5125 adolescents aged between 11 and 20 years. They provided self-reported data on six healthy lifestyle factors, including never smoking, never drinking, good sleep quality, sufficient sleep duration, appropriate Internet use, and adequate physical activity. Adolescents' HRQOL was evaluated using the Pediatric Quality of Life Inventory version 4.0. Linear regression models were conducted to explore the association of individual and combined healthy lifestyle factors with adolescents' HRQOL. We further performed stratified analyses and likelihood ratio test to explore the moderating role of gender in these associations. RESULTS Of the included adolescents, the proportions with 0-2, 3, 4, and 5-6 healthy lifestyle factors were 13.6%, 26.4%, 44.3%, and 15.7%, respectively. Compared to adolescents with composite healthy lifestyle scores of 0-2, those with scores of 3, 4, or 5-6 had significantly higher HRQOL scores across all dimensions, summary scales, and total scale in both unadjusted and adjusted models. Specifically, adolescents with 5-6 healthy lifestyle factors had a total scale score that was 19.03 (95%CI: 17.76 to 20.30) points higher than their counterparts who only had 0-2 healthy lifestyle factors. Significant dose-response patterns were also observed in aforementioned associations. Gender was a significant moderator in the associations between composite healthy lifestyle groups and HRQOL scores, except for the social functioning dimension. CONCLUSIONS Our results confirmed that combined healthy lifestyle factors were associated with improved HRQOL among adolescents, with a stronger association observed in girls. These findings underscore the necessity for education and healthcare authorities to design health-promoting strategies that encourage multiple healthy lifestyle factors in adolescents, with the objective of enhancing their overall health outcomes.
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Affiliation(s)
- Hongyu Xiang
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, 510080, China
| | - Xiuqiong Feng
- Department of Public Health, Guangzhou Huangpu District Center for Disease Control and Prevention, Guangzhou, Guangdong, 510530, China
| | - Li Lin
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, 510080, China
| | - Shengyu Luo
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, 510080, China
| | - Xinxia Liu
- Zhongshan Third People's Hospital, Nanlang Town, Zhongshan, Guangdong, 528451, China
| | - Dezhong Chen
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, 510080, China
| | - Kang Qin
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, 510080, China
| | - Xun Guo
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, 510080, China
| | - Weiqing Chen
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, 510080, China
| | - Vivian Yawei Guo
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, 510080, China.
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Zhang Y, Chen W, Cao B, Lin L, Li J, Guo VY. Associations of handgrip weakness and asymmetry with new-onset stroke in Chinese middle-aged and older adults: a cohort study. Front Public Health 2023; 11:1251262. [PMID: 37908684 PMCID: PMC10615130 DOI: 10.3389/fpubh.2023.1251262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 08/31/2023] [Indexed: 11/02/2023] Open
Abstract
Background Weak handgrip strength (HGS) has been linked to adverse health outcomes including stroke. However, the joint associations of HGS weakness and asymmetry between limbs with stroke incidence remain underexplored. Methods This cohort study analyzed data of participants aged ≥45 years from three waves (2011, 2013, and 2015) of the China Health and Retirement Longitudinal Study. Weak HGS was defined according to the recommendation of European Working Group on Sarcopenia in Older People. Asymmetric HGS was defined if the HGS ratio of both hands was over 1.1 or below 0.9. New-onset stroke was confirmed through self-report of physician's diagnosis. Results A total of 10,966 participants without stroke at baseline were included in the analysis. During the 4 years follow-up, there were 262 (2.39%) new-onset stroke cases. Compared to individuals with non-weak and symmetric HGS, those with HGS asymmetry alone and weakness alone were associated with hazards of 1.09 (95% confidence interval [CI]: 0.80-1.48) and 1.27 (95%CI: 0.86-1.88) for new-onset stroke, respectively, while co-occurrence of both HGS asymmetry and weakness was associated with 1.80 (95%CI: 1.24-2.60) greater hazard for new-onset stroke after controlling for confounders. Such associations were consistent in older adults aged ≥60 years, but not in those aged<60 years. Conclusion Individuals with both weak and asymmetric HGS tended to have greater risk of new-onset stroke, compared to those with normal HGS, or with either weak or asymmetric HGS alone. Our finding suggested that examining HGS asymmetry alongside weakness may help to improve the risk-stratification and target prevention of stroke, particularly in the older population.
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Affiliation(s)
- Yuying Zhang
- Department of Child Healthcare, Shenzhen Longhua Maternity and Child Healthcare Hospital, Shenzhen, China
| | - Weiqing Chen
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Bing Cao
- Department of Neurosurgery, Wu Tsai Neuroscience Institute, Stanford University School of Medicine, Stanford, CA, United States
| | - Li Lin
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Jinghua Li
- Department of Biostatistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Vivian Yawei Guo
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
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Cai Y, Zhang Y, Cao W, Guo VY, Deng Y, Luo L, Shen J, Zhu Y, Chen X, Yang X, Hou F, Li J. Preliminary Validation of the Revised Illness Perception Questionnaire for Patients with Nasopharyngeal Carcinoma in China. Healthcare (Basel) 2023; 11:2469. [PMID: 37761666 PMCID: PMC10530590 DOI: 10.3390/healthcare11182469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/15/2023] [Accepted: 09/03/2023] [Indexed: 09/29/2023] Open
Abstract
Nasopharyngeal carcinoma is a common and highly malignant cancer in southern China. It is important to accurately assess the illness perception of nasopharyngeal carcinoma according to the common-sense model of self-regulation. The purpose was to validate the Chinese version of the Revised Illness Perception Questionnaire for patients with Nasopharyngeal carcinoma. A cross-sectional survey of 631 patients with Nasopharyngeal carcinoma was conducted in Guangzhou, China. The reliability of the scale was evaluated using Cronbach's alpha. The factor structure was assessed using exploratory factor analysis (EFA) of each dimension. The EFA revealed that the 29-item self-rated scale has a seven-factor structure consistent with the original scale and explained 67.3% of the variance after extraction and rotation. The scale showed satisfactory reliability. The item-total correlations ranged from -0.16 to 0.64 (p < 0.05). The item-subscale correlations ranged from 0.46 to 0.91 (p < 0.05). The item-other subscale correlations ranged from -0.38 to 0.51 and from -0.21 to 0.56 (p < 0.05). Significant correlations were found between the timeline (acute/chronic) (r = 0.224, r = 0.166), consequences (r = 0.415, r = 0.338), timeline cyclical (r = 0.366, r = 0.284), emotional representations (r = 0.497, r = 0.465), personal control (r = -0.122, r = -0.134), treatment control (r = -0.135, r = -0.148), and illness coherence (r = -0.261, r = -0.213) subscales, and depression, anxiety (p < 0.05). The scale revealed acceptable reliability, factorial validity, and construct validity. It could be used to assess the illness representations of Chinese patients with nasopharyngeal carcinoma.
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Affiliation(s)
- Yuqi Cai
- School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China (J.L.)
| | - Yuan Zhang
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510080, China
| | - Wangnan Cao
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing 100871, China
| | - Vivian Yawei Guo
- School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China (J.L.)
| | - Yang Deng
- School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China (J.L.)
| | - Liying Luo
- School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China (J.L.)
| | - Jianling Shen
- School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China (J.L.)
| | - Yang Zhu
- School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China (J.L.)
| | - Xiaoting Chen
- School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China (J.L.)
| | - Xiao Yang
- School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China (J.L.)
| | - Fengsu Hou
- Shenzhen Kangning Hospital/Shenzhen Mental Health Center, Shenzhen 518020, China
| | - Jinghua Li
- School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China (J.L.)
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Luo S, Chen D, Li C, Lin L, Chen W, Ren Y, Zhang Y, Xing F, Guo VY. Maternal adverse childhood experiences and behavioral problems in preschool offspring: the mediation role of parenting styles. Child Adolesc Psychiatry Ment Health 2023; 17:95. [PMID: 37563663 PMCID: PMC10416370 DOI: 10.1186/s13034-023-00646-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 07/28/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Maternal history of adverse childhood experiences (ACEs) has been found to be associated with children's health outcomes. However, the underlying mechanisms were unclear. This study aimed to examine the association between maternal ACEs and behavioral problems in their preschool offspring and to explore the potential mediating role of maternal parenting styles in the association. METHODS A cross-sectional study was conducted involving 4243 mother-child dyads in Chengdu, China. Mothers completed the Adverse Childhood Experiences-International Questionnaire (ACE-IQ) to assess their history of ACEs (i.e., physical abuse, emotional abuse, physical neglect, emotional neglect, witnessing domestic violence, household substance abuse, household mental illness, incarcerated household member, parental separation or divorce, parental death, bullying, and community violence), the short Egna Minnen Beträffande Uppfostran Parent Form (S-EMBU-P) to evaluate their parenting styles (i.e., emotional warmth, rejection, and overprotection), and the 48-item Conners' Parent Rating Scale (CPRS-48) to measure behavioral problems in their children. Logistic regression models were established to examine the association between cumulative number of maternal ACEs and children's behavioral problems. The mediating role of parenting styles in this association was explored by generalized structural equation models (GSEM). RESULTS Of the participating mothers, 85.8% (n = 3641) reported having experienced at least one type of ACE. Children of mothers with ≥2 ACEs showed a significantly increased risk of behavioral problems across all dimensions, including conduct problems, learning problems, psychosomatic problems, impulsive-hyperactive, anxiety, and hyperactivity index, in both crude and adjusted models (all p-values < 0.05). Dose-response patterns were also observed between the cumulative number of maternal ACEs and children's behavioral problems. In addition, maternal parenting styles of rejection emerged as a significant mediator, accounting for approximately 8.4-15.0% of the associations. CONCLUSIONS Our findings indicated an intergenerational association of maternal ACEs with behavioral problems in preschool offspring, which was mediated by maternal parenting styles of rejection. Early screening and targeted intervention strategies are critical to mitigate the downstream consequences of maternal ACEs on young children's outcomes. Providing support and resources to improve parenting skills may prove beneficial.
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Affiliation(s)
- Shengyu Luo
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Dezhong Chen
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Chunrong Li
- School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
- Chengdu Jintang County Maternal and Child Health Hospital, Chengdu, Sichuan, China
| | - Li Lin
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Weiqing Chen
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yan Ren
- School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Yuchi Zhang
- Chengdu Jintang County Maternal and Child Health Hospital, Chengdu, Sichuan, China
| | - Fenglin Xing
- Chengdu Qingyang District Maternal and Child Health Hospital, Chengdu, Sichuan, China
| | - Vivian Yawei Guo
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China.
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Lin L, Cao B, Chen W, Li J, Zhang Y, Guo VY. Association of childhood threat and deprivation with depressive symptoms and the moderating role of current economic status among middle-aged and older adults in China. Soc Psychiatry Psychiatr Epidemiol 2023; 58:1227-1236. [PMID: 36418644 DOI: 10.1007/s00127-022-02384-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 11/14/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate the independent impact of threat-related and deprivation-related adverse childhood experiences (ACEs) on depressive symptoms among middle-aged and older adults, and to evaluate the moderating role of current economic status in these associations. METHODS This cross-sectional study included 11,048 participants aged ≥ 45 years from the China Health and Retirement Longitudinal Study. We captured five threat-related ACEs and five deprivation-related ACEs by questionnaires. Depressive symptoms were assessed using the 10-item Centre for Epidemiological Studies Depression Scale. Current economic status was reflected by annual per capita household consumption expenditure. We performed logistic regression analyses to evaluate the independent association of childhood threat and deprivation with depressive symptoms, and conducted stratified analyses and tests for interaction to explore the moderation effect of current economic status in such associations. RESULTS Compared with the nonexposed group, the experience of both childhood threat and deprivation were independently associated with greater risks of depressive symptoms later in life (odds ratio [OR] 1.75, 95% CI 1.49-2.05 for ≥ 2 threat-related ACEs; OR 2.02, 95% CI 1.67-2.43 for ≥ 2 deprivation-related ACEs). High current economic status significantly ameliorated the impact of childhood deprivation, but not threat, on depressive symptoms (P value for interaction 0.038). CONCLUSIONS Both threat-related and deprivation-related ACEs were associated with the risk of depressive symptoms among middle-aged and older adults, while current economic status was a significant moderator in such risks only for childhood deprivation. The findings implied that prioritising targeted interventions for individuals with ACEs, especially for childhood deprivation victims who were economically disadvantaged in adulthood, may help mitigate depressive symptoms in later life.
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Affiliation(s)
- Li Lin
- Department of Epidemiology, School of Public Health, Sun Yat-Sen University, 74 Zhongshan Second Road, Guangzhou, 510080, Guangdong, China
| | - Bing Cao
- Department of Neurosurgery, Wu Tsai Neuroscience Institute, Stanford University School of Medicine, Stanford, CA, USA.
| | - Weiqing Chen
- Department of Epidemiology, School of Public Health, Sun Yat-Sen University, 74 Zhongshan Second Road, Guangzhou, 510080, Guangdong, China
| | - Jinghua Li
- Department of Biostatistics, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Yuying Zhang
- Department of Child Healthcare, Shenzhen Longhua Maternity and Child Healthcare Hospital, Shenzhen, China
| | - Vivian Yawei Guo
- Department of Epidemiology, School of Public Health, Sun Yat-Sen University, 74 Zhongshan Second Road, Guangzhou, 510080, Guangdong, China.
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Qin K, Bai S, Chen W, Li J, Guo VY. Association of comorbid depression and obesity with cardiometabolic multimorbidity among middle-aged and older Chinese adults: A cohort study. Arch Gerontol Geriatr 2023; 107:104912. [PMID: 36565606 DOI: 10.1016/j.archger.2022.104912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 11/24/2022] [Accepted: 12/18/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE To evaluate the association of comorbid depression and obesity with the risk of incident cardiometabolic multimorbidity among middle-aged and older Chinese adults. METHODS This cohort study extracted data from the 2011 and 2015 waves of the China Health and Retirement Longitudinal Study (CHARLS). Depression was confirmed by the 10-item Center for Epidemiologic Studies Depression Scale (CESD-10) with a cut-off score ≥10. Obesity was defined as a body mass index ≥28 kg/m2. Participants were categorized into four groups based on depression and obesity status at baseline, i.e., with neither condition, depression only, obesity only, and with both conditions. Cardiometabolic multimorbidity was defined as the coexistence of two or more of heart diseases, stroke, and diabetes mellitus. Logistic regression models were established to estimate the associations. RESULTS A total of 9,308 participants without cardiometabolic multimorbidity at baseline were included (mean [SD] age, 58.8 [9.0] years; 4,449 [47.8%] were males). During four-year of follow-up, 349 (3.8%) participants developed cardiometabolic multimorbidity. Compared to participants without depression or obesity, comorbid depression and obesity was associated with greater risk of cardiometabolic multimorbidity (adjusted OR: 4.79, 95% CI: 3.09-7.43) than that in participants with depression alone (adjusted OR: 1.84, 95% CI: 1.37-2.46) or obesity alone (adjusted OR: 2.26, 95% CI: 1.48-3.45). The findings were consistent in different gender and age groups. CONCLUSIONS Comorbid depression and obesity was associated with excessive risk of cardiometabolic multimorbidity. Intervention targeting at individuals with both depression and obesity might have substantial benefit in minimizing the risk of cardiometabolic multimorbidity.
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Affiliation(s)
- Kang Qin
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Shigen Bai
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Weiqing Chen
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Jinghua Li
- Department of Biostatistics, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Vivian Yawei Guo
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong 510080, China.
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Chen D, Lin L, Li C, Chen W, Zhang Y, Ren Y, Guo VY. Maternal adverse childhood experiences and health-related quality of life in preschool children: a cross-sectional study. Child Adolesc Psychiatry Ment Health 2023; 17:19. [PMID: 36747212 PMCID: PMC9903527 DOI: 10.1186/s13034-023-00570-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 01/31/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The intergenerational association between maternal adverse childhood experiences (ACEs) and their children's health-related quality of life (HRQOL) is underexplored. This study aimed to examine such association in Chinese preschool children and to test the moderation role of children's sex. METHODS A cross-sectional study was conducted among 4243 mother-child dyads who attended randomly selected preschools. Mothers self-reported their experience of 12 forms of ACEs, including emotional abuse, physical abuse, emotional neglect, physical neglect, intimate partner violence, substance abuse in the household, incarcerated household member, mental illness in household, parental death, parental separation or divorce, bullying, and community violence. Children's HRQOL was evaluated through mother report of the Pediatric Quality of Life Inventory version 4.0. Linear regression models were established to estimate the associations between maternal ACEs and their children's HRQOL sub-scores and total scores. Stratified analysis and test for interaction were further conducted to evaluate whether the associations were moderated by children's sex. RESULTS Of the included mothers, 85.8% (n = 3641) had reported exposure to at least one ACE, and 22.3% (n = 948) were exposed to three or more ACEs. Compared to children of mothers without any ACE exposure, those of mothers with 1, 2, or ≥ 3 ACEs all had significantly lower scores of physical, social, and school functioning, as well as lower psychosocial health summary score and total scale score in both crude and adjusted models. However, only children of mothers with two or more ACEs had significantly poorer emotional functioning when compared to their counterparts whose mothers had no ACE exposure. A significant dose-response pattern was also observed between the number of maternal ACEs and children's HRQOL sub-scores and total scores. Stratified analysis revealed sex-specific pattern between maternal ACEs and their children's HRQOL. Nonetheless, children's sex was not a significant moderator. CONCLUSIONS Our study showed that preschool children of mothers who had any experience of ACEs were at risk of poorer HRQOL. Our findings indicated that screening maternal ACEs in young children and promoting targeted interventions might be a feasible way to mitigate or stop the potential negative intergenerational health and wellbeing implications of ACEs.
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Affiliation(s)
- Dezhong Chen
- grid.12981.330000 0001 2360 039XDepartment of Epidemiology, School of Public Health, Sun Yat-Sen University, 74 Zhongshan Second Road, Guangzhou, 510080 Guangdong China
| | - Li Lin
- grid.12981.330000 0001 2360 039XDepartment of Epidemiology, School of Public Health, Sun Yat-Sen University, 74 Zhongshan Second Road, Guangzhou, 510080 Guangdong China
| | - Chunrong Li
- grid.54549.390000 0004 0369 4060Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Weiqing Chen
- grid.12981.330000 0001 2360 039XDepartment of Epidemiology, School of Public Health, Sun Yat-Sen University, 74 Zhongshan Second Road, Guangzhou, 510080 Guangdong China
| | - Yuying Zhang
- Department of Child Healthcare, Shenzhen Longhua Maternity and Child Healthcare Hospital, Shenzhen, China
| | - Yan Ren
- grid.54549.390000 0004 0369 4060Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Vivian Yawei Guo
- Department of Epidemiology, School of Public Health, Sun Yat-Sen University, 74 Zhongshan Second Road, Guangzhou, 510080, Guangdong, China.
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Zhang Y, Lu D, Guo VY, Wang Y, Qiu S, Zhang J, Zhang Y, Chen W, Wang B, Yang W. Association between maternal polycystic ovary syndrome and attention-deficit/hyperactivity disorder in offspring aged 3-6 years: A Chinese population-based study. Front Public Health 2023; 10:1032315. [PMID: 36699874 PMCID: PMC9868860 DOI: 10.3389/fpubh.2022.1032315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 12/20/2022] [Indexed: 01/11/2023] Open
Abstract
Background Maternal polycystic ovary syndrome (PCOS) may increase the risk of attention-deficit/hyperactivity disorder (ADHD) in offspring; however, their association remains unexplored in Asian populations. Hence, this study aimed to investigate the association between maternal PCOS and ADHD in offspring aged 3-6 years and whether it differed by offspring sex. Methods This was a district-wide population-based study of 87,081 preschoolers from 234 kindergartens in Longhua District, Shenzhen, China. The parents were invited to complete a self-administrated questionnaire covering information on socio-demographics, maternal disease history, and child behavior. ADHD symptoms were measured with the parent-rating 26-item Swanson, Nolan, and Pelham Rating Scale (SNAP-IV). Logistic regression was performed to examine the associations between maternal PCOS and ADHD symptoms in offspring. Results The response rate was 80% and 63,390 mother-child pairs were included. Of the mothers, 1,667 (2.6%) reported PCOS diagnoses. The mean age of children at ADHD assessment was 4.86 ± 0.84[SD] years, and 53.6% were boys. Children with maternal PCOS had a higher risk of developing ADHD symptoms than other children (12.0 vs. 9.4%, adjusted odds ratio [OR] = 1.32, 95% CI: 1.13-1.54). The risk estimate was significant in boys (adjusted OR = 1.38, 95% CI: 1.14-1.66) but not in girls (adjusted OR = 1.23, 95% CI: 0.94-1.57, P for interaction = 0.391). Treatment of PCOS tended to be associated with a lower risk of ADHD symptoms than untreated PCOS albeit risk confidence intervals were overlapped (treated: adjusted OR = 1.28, 95% CI: 1.06-1.54 vs. untreated: adjusted OR = 1.14, 95% CI: 1.08-1.83). Conclusion Maternal PCOS increases the risk of developing ADHD in offspring, especially boys. Further studies are warranted to confirm our findings, and early neurodevelopmental screening may be needed in children born to mothers with PCOS.
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Affiliation(s)
- Yuying Zhang
- Department of Child Healthcare, Shenzhen Longhua Maternity and Child Healthcare Hospital, Shenzhen, China
| | - Dali Lu
- Department of Child Healthcare, Shenzhen Longhua Maternity and Child Healthcare Hospital, Shenzhen, China
| | - Vivian Yawei Guo
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yuqing Wang
- Health Management Center, Guangzhou First People's Hospital, Guangzhou, China
| | - Shuangyan Qiu
- Department of Child Healthcare, Shenzhen Longhua Maternity and Child Healthcare Hospital, Shenzhen, China
| | - Jingyu Zhang
- Department of Child Healthcare, Shenzhen Longhua Maternity and Child Healthcare Hospital, Shenzhen, China
| | - Yan Zhang
- Department of Child Healthcare, Shenzhen Longhua Maternity and Child Healthcare Hospital, Shenzhen, China
| | - Weiqing Chen
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Baoping Wang
- Department of Infertility and Reproductive Medicine, Shenzhen Longhua Maternity and Child Healthcare Hospital, Shenzhen, China,Baoping Wang ✉
| | - Weikang Yang
- Department of Child Healthcare, Shenzhen Longhua Maternity and Child Healthcare Hospital, Shenzhen, China,*Correspondence: Weikang Yang ✉
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Chen D, Lin L, Feng X, Luo S, Xiang H, Qin K, Guo X, Chen W, Guo VY. Adverse childhood experiences, problematic internet use, and health-related quality of life in Chinese adolescents. Eur J Psychotraumatol 2023; 14:2218248. [PMID: 37335002 DOI: 10.1080/20008066.2023.2218248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 05/16/2023] [Accepted: 05/17/2023] [Indexed: 06/21/2023] Open
Abstract
Background: The influence of adverse childhood experiences (ACEs) on an individual's health is substantial. However, the associations between ACEs, problematic internet use (PIU), and health-related quality of life (HRQOL) in adolescents remain underexplored.Objective: To assess the association between ACEs and HRQOL in Chinese adolescents and to evaluate the mediating role of PIU in this association.Method: A sample of 6,639 adolescents (3,457 boys and 3,182 girls) aged between 11-20 years (mean [SD] age: 14.5 [1.6] years) were recruited from 6 junior and senior middle schools using a proportional sampling approach in a cross-sectional study. Data on ACE exposure was collected through the short form of Childhood Trauma Questionnaire, the ACE-International Questionnaire, and two additional questions. HRQOL was assessed by the Pediatric Quality of Life Inventory version 4.0. The associations between ACEs and HRQOL were estimated using linear regression models. Mediation analysis was further conducted to explore the possible mediating role of PIU in the association between ACEs and HRQOL.Results: Our study collected 13 different ACEs. We found that adolescents exposed to any ACE had significantly lower scores in all HRQOL dimensions, psychosocial health summary scale, and total scale, than those without such exposure. Specifically, adolescents with ≥ 3 ACE exposure had a total scale score that was 14.70 (95%CI: 15.53 to 13.87) points lower than their non-exposed counterparts. Mediation analysis identified PIU as a significant mediator, with the proportion of the total effect attributable to PIU ranging from 14.38% for social functioning to 17.44% for physical functioning.Conclusions: Exposure to ACEs was associated with poorer HRQOL in Chinese adolescents, underscoring the importance to prevent ACEs and their negative impacts on adolescent well-being. These findings also highlighted the need of promoting appropriate internet use among adolescents exposed to ACEs, in order to avert potential impairment in their HRQOL.HIGHLIGHTSAdolescents with adverse childhood experiences have poorer health-related quality of life.The association between adverse childhood experiences and health-related quality of life shows a dose-response pattern.Problematic internet use partially mediates the associations between adverse childhood experiences and health-related quality of life in adolescents.
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Affiliation(s)
- Dezhong Chen
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Li Lin
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Xiuqiong Feng
- Department of Public Health, Guangzhou Huangpu District Center for Disease Control and Prevention, Guangzhou, People's Republic of China
| | - Shengyu Luo
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Hongyu Xiang
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Kang Qin
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Xun Guo
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Weiqing Chen
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Vivian Yawei Guo
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
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Cai Y, Zhang Y, Cao W, Hou F, Xin M, Guo VY, Deng Y, Wang S, You X, Li J. Preliminary validation of the Chinese version of the Shame and Stigma Scale among patients with facial disfigurement from nasopharyngeal carcinoma. PLoS One 2022; 17:e0279290. [PMID: 36548282 PMCID: PMC9778931 DOI: 10.1371/journal.pone.0279290] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 12/04/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE This study examined the reliability and validity of a Shame and Stigma Scale (SSS) and assessed shame and stigma among patients with facial disfigurement from nasopharyngeal carcinoma (NPC). METHODS Data were collected from 218 patients with NPC through a cross-sectional survey between January 14, 2020, and December 1, 2020. The original SSS is a 20-item scale with four dimensions (i.e., shame with appearance, sense of stigma, regret, and social/speech concern). We used Cronbach's alpha and McDonald's omega to assess reliability and exploratory factor analysis (EFA) to assess the factor structure. We also used Pearson correlation analysis to examine the relationship between each item and total score of scale items and convergent validity. RESULTS The final 18-item SSS had a Cronbach's alpha coefficient of .89. The EFA revealed that the SSS has a four-factor structure: sense of stigma, social/speech concern, shame with appearance, and regret. These factors showed satisfactory reliability, with McDonald's omega coefficients of .87, .77, .86, and .79, respectively. The scale showed significant relationship between each item and total score of scale items with respect to item-total correlations, item-subscale correlations, and item-other-subscale correlations. Convergent validity was supported by the significant positively correlated with the total scores for depression and anxiety. CONCLUSION The SSS is valid and reliable in assessing shame and stigma and monitoring treatment compliance among patients with NPC.
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Affiliation(s)
- Yuqi Cai
- School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yuan Zhang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, Guangdong, China
- Sun Yat-sen University Global Health Institute, School of Public Health and Institute of State Governance, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Wangnan Cao
- Department of Social Medicine and Health Education, School of Public Health, Peking University, China
| | - Fengsu Hou
- Sun Yat-sen University Global Health Institute, School of Public Health and Institute of State Governance, Sun Yat-sen University, Guangzhou, Guangdong, China
- Department of Public Health, Shenzhen Kangning Hospital, Shenzhen, Guangdong, China
| | - Meiqi Xin
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Vivian Yawei Guo
- School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yang Deng
- School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Shenghao Wang
- School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xinyi You
- School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Jinghua Li
- School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
- Sun Yat-sen University Global Health Institute, School of Public Health and Institute of State Governance, Sun Yat-sen University, Guangzhou, Guangdong, China
- * E-mail:
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Lin L, Cao B, Chen W, Li J, Zhang Y, Guo VY. Association of Adverse Childhood Experiences and Social Isolation With Later-Life Cognitive Function Among Adults in China. JAMA Netw Open 2022; 5:e2241714. [PMID: 36367722 PMCID: PMC9652754 DOI: 10.1001/jamanetworkopen.2022.41714] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
IMPORTANCE Studies investigating the association of threat-related and deprivation-related adverse childhood experiences (ACEs) with later-life cognitive decline are lacking. OBJECTIVES To evaluate the independent association of threat-related and deprivation-related ACEs with cognitive decline over time among middle-aged and older Chinese adults and to examine the modifying role of social isolation in such associations. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study used cognitive data from the China Health and Retirement Longitudinal Study (CHARLS) baseline survey that was administered between June 1, 2011, and March 31, 2012, and the CHARLS follow-up survey administered between July 1 and September 30, 2015. The life history survey with information of ACEs was additionally administered between June 1 and December 31, 2014. Statistical analysis was performed from March 1 to July 31, 2022. The study population consisted of middle-aged and older adults (age range, 45-97 years) with complete data on ACEs and 2 cognitive assessments and without cognitive impairment at baseline. EXPOSURES Five threat-related ACEs (ie, physical abuse, household substance abuse, domestic violence, unsafe neighborhood, and bullying) and 5 deprivation-related ACEs (ie, emotional neglect, household mental illness, incarcerated household member, parental separation or divorce, and parental death) before 17 years of age were queried by questionnaires. The cumulative scores of the 2 ACE dimensions were calculated and grouped into 3 categories as 0, 1, and 2 or more in main analyses. MAIN OUTCOMES AND MEASURES Cognitive function was measured by episodic memory and executive function. Global cognition was further calculated as the total score of these 2 dimensions. The raw scores of each cognitive test were standardized to z scores using baseline means and SDs. Linear mixed-effects models were constructed to examine the association between 2 dimensions of ACEs and the rate of annual cognitive decline. The modifying role of baseline social isolation in such associations was assessed with 3-way interaction tests. RESULTS Of the 6466 participants included in main analyses, 3301 (51.1%) were men and the mean (SD) age was 57.2 (8.3) years. Compared with no exposures, experience of 1 deprivation-related ACE was associated with faster cognitive decline in global cognition (β = -0.012 [95% CI, -0.022 to -0.002] SD/y) and executive function (β = -0.010 [95% CI, -0.020 to -0.00002] SD/y), whereas individuals with at least 2 childhood deprivations had faster cognitive declines in all cognitive tests (β = -0.035 [95% CI, -0.050 to -0.019] SD/y for global cognition; β = -0.047 [95% CI, -0.068 to -0.025] SD/y for episodic memory; β = -0.019 [95% CI, -0.034 to -0.004] SD/y for executive function). However, such an association was not observed for threat-related ACEs. In addition, baseline social isolation was a significant modifier in the associations between deprivation-related ACEs and cognitive declines in global cognition (β = -0.033 [95% CI, -0.061 to -0.005] SD/y; P = .02 for 3-way interaction) and executive function (β = -0.032 [95% CI, -0.059 to -0.005] SD/y; P = .02 for 3-way interaction). CONCLUSIONS AND RELEVANCE Deprivation-related ACEs, but not threat-related ACEs, were associated with faster decline in later-life cognitive function, whereas social isolation could modify such detrimental impact. These findings highlight the potential benefits of promoting social integration in maintaining later-life cognitive function among individuals who have experienced childhood deprivation.
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Affiliation(s)
- Li Lin
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Bing Cao
- Department of Neurosurgery, Wu Tsai Neuroscience Institute, Stanford University School of Medicine, Stanford, California
| | - Weiqing Chen
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Jinghua Li
- Department of Biostatistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yuying Zhang
- Department of Child Healthcare, Shenzhen Longhua Maternity and Child Healthcare Hospital, Shenzhen, China
| | - Vivian Yawei Guo
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
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Zou C, Wang Z, Huang W, Lu J, Guo VY, Zhang Y, Zang S, Yang J, Han L, Jiang G. Linear and non-linear Mendelian randomization analyses of sex-specific associations between sleep duration and hyperuricemia. Front Nutr 2022; 9:920791. [PMID: 36337652 PMCID: PMC9632753 DOI: 10.3389/fnut.2022.920791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 09/13/2022] [Indexed: 11/15/2022] Open
Abstract
Background Observational studies have suggested a potential non-linear association between sleep duration and hyperuricemia. However, the causal nature and sex-specific differences are poorly understood. We aimed to determine the shape of sex-specific causal associations between sleep duration and hyperuricemia in the UK Biobank. Methods Logistic regression was used to investigate the observational association between self-reported sleep duration and hyperuricemia among 387,980 white British participants (mean age: 56.9 years and 46.0% males). Linear and non-linear Mendelian Randomization (MR) analyses were performed to assess the causal association between continuous sleep duration and hyperuricemia. The causal effects of genetically predicted short (<7 h) and long (>8 h) sleep durations on hyperuricemia were further estimated, respectively. Results Traditional observational analysis suggested U- and J-shaped associations between sleep duration and hyperuricemia in females and males, respectively. Linear MR did not support the causal effect of sleep duration on hyperuricemia. Non-linear MR demonstrated an approximately U-shaped causal association between continuous sleep duration and hyperuricemia in overall participants and females, but not in males. Genetically predicted short sleep duration was significantly associated with hyperuricemia in females (OR [95% CI]: 1.21 [1.08–1.36]; P = 0.001), but not in males (1.08 [0.98–1.18]; P = 0.137). By contrast, genetically predicted long sleep duration was not significantly associated with the risk of hyperuricemia in either females or males. Conclusion Genetically predicted short sleep duration is a potential causal risk factor for hyperuricemia for females but has little effect on males. Long sleep duration does not appear to be causally associated with hyperuricemia.
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Affiliation(s)
- Chenfeng Zou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Zhenqian Wang
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Wenyu Huang
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Jiawen Lu
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Vivian Yawei Guo
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yuying Zhang
- Shenzhen Longhua Maternity and Child Healthcare Hospital, Shenzhen, China
| | - Shufei Zang
- Department of Endocrinology, Shanghai Fifth People’s Hospital, Fudan University, Shanghai, China
| | - Jinying Yang
- Department of Obstetrics, Longgang District Maternal & Child Healthcare Hospital of Shenzhen City, Shenzhen, China,*Correspondence: Guozhi Jiang, ;
| | - Liyuan Han
- Department of Global Health, Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China,*Correspondence: Guozhi Jiang, ;
| | - Guozhi Jiang
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong, China,*Correspondence: Guozhi Jiang, ;
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Lin L, Sun W, Lu C, Chen W, Guo VY. Correction: Adverse childhood experiences and handgrip strength among middle-aged and older adults: a cross-sectional study in China. BMC Geriatr 2022; 22:533. [PMID: 35764939 PMCID: PMC9238243 DOI: 10.1186/s12877-022-03159-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Li Lin
- Department of Epidemiology, School of Public Health, Sun Yat-Sen University, 74 Zhongshan Second Road, Guangzhou, 510080, Guangdong, China
| | - Weidi Sun
- Department of Epidemiology, School of Public Health, Sun Yat-Sen University, 74 Zhongshan Second Road, Guangzhou, 510080, Guangdong, China
| | - Ciyong Lu
- Department of Epidemiology, School of Public Health, Sun Yat-Sen University, 74 Zhongshan Second Road, Guangzhou, 510080, Guangdong, China
| | - Weiqing Chen
- Department of Epidemiology, School of Public Health, Sun Yat-Sen University, 74 Zhongshan Second Road, Guangzhou, 510080, Guangdong, China
| | - Vivian Yawei Guo
- Department of Epidemiology, School of Public Health, Sun Yat-Sen University, 74 Zhongshan Second Road, Guangzhou, 510080, Guangdong, China.
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Lin L, Chen W, Sun W, Chen M, Li J, Shen J, Guo VY. Associations between Adverse Childhood Experiences and Obesity in a Developing Country: A Cross-Sectional Study among Middle-Aged and Older Chinese Adults. Int J Environ Res Public Health 2022; 19:ijerph19116796. [PMID: 35682379 PMCID: PMC9180433 DOI: 10.3390/ijerph19116796] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 05/27/2022] [Accepted: 05/31/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND The association between adverse childhood experiences (ACEs) and obesity in developing countries has been underexplored and inconsistent. METHODS This cross-sectional study used data of 10,054 adults aged ≥ 45 years from the China Health and Retirement Longitudinal Study. Information on 12 ACE indicators was collected via questionnaires. General obesity was defined as a body mass index (BMI) of ≥28 kg/m². Central obesity was defined as a waist circumference of ≥90 cm for males and ≥85 cm for females. Logistic and linear regression analyses were conducted to evaluate the association of ACEs with general obesity, central obesity, BMI, and waist circumference where appropriate. RESULTS Compared to the non-exposed group, the experience of ≥3 ACEs was significantly associated with decreased risks of general obesity (OR = 0.83, 95% CI: 0.69, 0.999), central obesity (OR = 0.88, 95% 0.77, 0.997), and smaller BMI (β = -0.27, 95% CI: -0.50, -0.04) and waist circumference (β = -0.89, 95% CI: -1.52, -0.26). Compared to the high socioeconomic status (SES) group, such associations were more evident in those with a low SES, except for central obesity. CONCLUSION ACEs were shown to be inversely associated with later-life obesity in China, especially in socioeconomically disadvantaged populations. The context-specific impacts reflect divergent roles of socioeconomic position in the obesity epidemic between developed and developing countries. Further investigations are needed to confirm whether physical activity could shift the direction of this association.
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Affiliation(s)
- Li Lin
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China; (L.L.); (W.C.); (W.S.); (M.C.)
| | - Weiqing Chen
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China; (L.L.); (W.C.); (W.S.); (M.C.)
| | - Weidi Sun
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China; (L.L.); (W.C.); (W.S.); (M.C.)
| | - Minyan Chen
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China; (L.L.); (W.C.); (W.S.); (M.C.)
- Department of Health Education, Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China;
| | - Jinghua Li
- Department of Biostatistics, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China;
| | - Jichuan Shen
- Department of Health Education, Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China;
| | - Vivian Yawei Guo
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China; (L.L.); (W.C.); (W.S.); (M.C.)
- Correspondence:
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Lin L, Bai S, Qin K, Wong CKH, Wu T, Chen D, Lu C, Chen W, Guo VY. Comorbid depression and obesity, and its transition on the risk of functional disability among middle-aged and older Chinese: a cohort study. BMC Geriatr 2022; 22:275. [PMID: 35366819 PMCID: PMC8976974 DOI: 10.1186/s12877-022-02972-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 03/24/2022] [Indexed: 12/27/2022] Open
Abstract
Background Evidence has indicated that depression and obesity were associated with functional disability, independently. However, little is known about the detrimental impact of comorbid depression and obesity, as well as its transition on functional disability. This study investigated the association of baseline depression-obesity status and its dynamic change with incident functional disability among middle-aged and older Chinese. Methods This cohort study included 5507 participants aged ≥45 years from the 2011 and 2015 waves of China Health and Retirement Longitudinal Study. Depression was defined with a score ≥ 10 using the 10-item Centre for Epidemiologic Studies Depression Scale. Obesity was defined as body mass index ≥28 kg/m2. Participants were cross-classified by depression and obesity status at baseline, and its change during follow-up. Logistic regression models were constructed to evaluate the association of baseline depression-obesity status and its transition with incident functional disability defined by the Katz index of activities of daily living scale. Results Over four-year follow-up, 510 (9.3%) participants developed functional disability. Individuals with baseline comorbid depression and obesity had the highest risk of functional disability (OR = 2.84, 95% CI: 1.95–4.15) than non-depressive participants without obesity, or those with depression or obesity alone. When investigating the dynamic changes of depression-obesity status on functional disability incidence, those with stable comorbidity throughout two surveys had the greatest risk of functional disability (OR = 4.06, 95% CI: 2.11–7.80). Progression of depression-obesity status was associated with increased risk of functional disability, while regression from baseline to follow-up was linked to attenuated risk estimates. Conclusions Among middle-aged and older Chinese adults, the risk of functional disability was exaggerated with comorbid depression and obesity. Our data further suggest that transitions of depression and obesity over time are associated with the risk of developing functional disability. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-02972-1.
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Zou C, Sun H, Lu C, Chen W, Guo VY. Nighttime sleep duration, restlessness and risk of multimorbidity - A longitudinal study among middle-aged and older adults in China. Arch Gerontol Geriatr 2022; 99:104580. [DOI: 10.1016/j.archger.2021.104580] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/29/2021] [Accepted: 11/11/2021] [Indexed: 01/02/2023]
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Chen D, Sun H, Lu C, Chen W, Guo VY. The association between hypertriglyceridemic-waist phenotype and chronic kidney disease: a cohort study and meta-analysis. Sci Rep 2022; 12:1935. [PMID: 35121773 PMCID: PMC8817025 DOI: 10.1038/s41598-022-05806-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 12/20/2021] [Indexed: 12/20/2022] Open
Abstract
Evidence on the association between hypertriglyceridemic-waist phenotype (HTGW) and chronic kidney disease (CKD) is limited and inconsistent. We aimed to explore such association among 7406 Chinese aged ≥ 45 years in a cohort setting, followed by a meta-analysis. Participants were categorized into four phenotypes: NTNW (normal triglycerides and normal waist circumference), NTGW (isolated enlarged waist circumference), HTNW (isolated high triglycerides), and HTGW (high triglycerides and enlarged waist circumference). We used multivariate logistic regression to determine the association between different phenotypes and risk of CKD in the cohort study. For meta-analysis, we searched relevant studies from Embase, Medline, PubMed, and Web of Science from dataset inception up to May 1, 2021. A random-effect model was used to estimate the pooled effect and I2 statistic was applied to evaluate heterogeneity. In the cohort study, compared to the NTNW phenotype, HTGW (OR 1.82, 95% CI 1.32 to 2.51, p < 0.01) and NTGW (OR 1.48, 95% CI 1.13 to 1.94, p = 0.004) were significantly associated with CKD risk after 4 years follow-up, but not for the HTNW phenotype. The meta-analysis also showed a positive association between HTGW phenotype and CKD risk (pooled OR 1.53, 95% CI 1.31 to 1.79, I2 = 62.4%). Assessment of triglyceridemic-waist phenotypes might help to identify individuals with high-risk of developing CKD.
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Affiliation(s)
- Dezhong Chen
- Department of Epidemiology, School of Public Health, Sun Yat-Sen University, 74 Zhongshan Second Road, Guangzhou, 510080, Guangdong, China
| | - Huimin Sun
- Department of Epidemiology, School of Public Health, Sun Yat-Sen University, 74 Zhongshan Second Road, Guangzhou, 510080, Guangdong, China
| | - Ciyong Lu
- Department of Epidemiology, School of Public Health, Sun Yat-Sen University, 74 Zhongshan Second Road, Guangzhou, 510080, Guangdong, China
| | - Weiqing Chen
- Department of Epidemiology, School of Public Health, Sun Yat-Sen University, 74 Zhongshan Second Road, Guangzhou, 510080, Guangdong, China
| | - Vivian Yawei Guo
- Department of Epidemiology, School of Public Health, Sun Yat-Sen University, 74 Zhongshan Second Road, Guangzhou, 510080, Guangdong, China.
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Luo S, Lin L, Chen W, Li C, Ren Y, Zhang M, Guo VY. Association between maternal intimate partner violence and health-related quality of life in their preschool children: The mediating role of maternal parenting styles. Front Psychiatry 2022; 13:996971. [PMID: 36424988 PMCID: PMC9679020 DOI: 10.3389/fpsyt.2022.996971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 10/25/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Although intimate partner violence (IPV) against women is a public health issue around the world, there is a lack of evidence regarding the impact of maternal IPV on preschool children's health-related quality of life (HRQOL). Therefore, the aim of this study was to investigate the association between maternal IPV and HRQOL among Chinese preschool children, as well as the mediating role of maternal parenting styles. METHODS A cross-sectional study was conducted with 4,243 mother-child dyads who attended preschools. Mothers self-reported their parenting styles and experience of IPV. Children's HRQOL was collected through mother-proxy report with the Pediatric Quality of Life Inventory version 4.0 (PedsQL 4.0). Multivariate linear regression analysis was conducted to evaluate the association between maternal IPV and children's HRQOL. Mediation models were further applied to explore the possible mediating role of maternal parenting styles. RESULTS Of the included mothers, 7.4% had experience of IPV. Compared to children of mothers without any IPV exposure, those of mothers with experience of IPV had significantly lower scores in all HRQOL dimensions and summary scales. After adjustment for covariates, maternal IPV was significantly associated with children's lower physical health summary score, psychosocial health summary score, and total scale score. Mediation analysis showed that both rejection and overprotection mediated such associations, but not for the emotional warmth. CONCLUSION Our findings indicated the need to screen maternal IPV supplemented with targeted interventions focusing on parenting styles, in order to mitigate the negative impact of maternal IPV on children's HRQOL.
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Affiliation(s)
- Shengyu Luo
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Li Lin
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Weiqing Chen
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Chunrong Li
- Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yan Ren
- Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Meng Zhang
- Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Vivian Yawei Guo
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
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Lin L, Wang HH, Liu Y, Lu C, Chen W, Guo VY. Indoor solid fuel use for heating and cooking with blood pressure and hypertension: A cross-sectional study among middle-aged and older adults in China. Indoor Air 2021; 31:2158-2166. [PMID: 34118166 DOI: 10.1111/ina.12872] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 04/30/2021] [Accepted: 05/27/2021] [Indexed: 06/12/2023]
Abstract
A cross-sectional study was conducted to investigate the impact of solid fuel use for heating and cooking on blood pressure (BP) and hypertension, using data from the China Health and Retirement Longitudinal Study (CHARLS). The primary fuels used for indoor heating and cooking were collected by questionnaires, respectively. Hypertension was defined based on self-report of physician's diagnosis, and/or measured BP, and/or anti-hypertensive medication use. Multivariate logistic regression models were constructed to assess the associations. Among 10 450 eligible participants, 68.2% and 57.2% used indoor solid fuel for heating and cooking, respectively. Compared with none/clean fuel users, solid fuel for heating was associated with elevated BP (adjusted β: 2.02, 95% CI: 1.04-3.01 for systolic BP; adjusted β: 1.36, 95% CI: 0.78-1.94 for diastolic BP) and increased risk of hypertension (adjusted odds ratio: 1.15, 95% CI: 1.03-1.29). The impact of indoor solid fuel for heating on BP was more evident in rural and north residents, and hypertensive patients. We did not detect any significant associations between solid fuel use for cooking and BP/hypertension. Indoor solid fuel use is prevalent in China, especially in the rural areas. Its negative impact on BP suggested that modernization of household fuel use may help to reduce the burden of hypertension in China.
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Affiliation(s)
- Li Lin
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | | | - Yuewei Liu
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Ciyong Lu
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Weiqing Chen
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Vivian Yawei Guo
- School of Public Health, Sun Yat-sen University, Guangzhou, China
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Lin L, Wang HH, Lu C, Chen W, Guo VY. Adverse Childhood Experiences and Subsequent Chronic Diseases Among Middle-aged or Older Adults in China and Associations With Demographic and Socioeconomic Characteristics. JAMA Netw Open 2021; 4:e2130143. [PMID: 34694390 PMCID: PMC8546496 DOI: 10.1001/jamanetworkopen.2021.30143] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Associations between adverse childhood experiences (ACEs) and chronic diseases among middle-aged or older Chinese individuals have not been well documented. In addition, whether demographic and socioeconomic characteristics modify any such associations has been underexplored. OBJECTIVES To examine associations between ACEs and subsequent chronic diseases and to assess whether age, sex, educational level, annual per capita household expenditure level, and childhood economic hardship modify these associations. DESIGN, SETTING, AND PARTICIPANTS This population-based cross-sectional study used data from the China Health and Retirement Longitudinal Study (CHARLS), a survey of residents aged 45 years or older in 28 provinces across China; specifically, the study used data from the CHARLS life history survey conducted from June 1 to December 31, 2014, and a CHARLS follow-up health survey conducted from July 1 to September 30, 2015. The study population included 11 972 respondents aged 45 years or older who had data on at least 1 of 14 specified chronic diseases and information on all 12 of the ACE indicators included in this study. Data analysis was performed from December 1 to 30, 2020. EXPOSURES Any of 12 ACEs (physical abuse, emotional neglect, household substance abuse, household mental illness, domestic violence, incarcerated household member, parental separation or divorce, unsafe neighborhood, bullying, parental death, sibling death, and parental disability), measured by indicators on a questionnaire. The number of ACEs per participant was summed and categorized into 1 of 5 cumulative-score groups: 0, 1, 2, 3, and 4 or more. MAIN OUTCOMES AND MEASURES Hypertension, dyslipidemia, diabetes, heart disease, stroke, chronic lung disease, asthma, liver disease, cancer, digestive disease, kidney disease, arthritis, psychiatric disease, and memory-related disease were defined by self-reported physician diagnoses or in combination with health assessment and medication data. Multimorbidity was defined as the presence of 2 or more of these 14 chronic diseases. Logistic regression models were used to assess associations of the 12 ACEs with the 14 chronic diseases and with multimorbidity. Modification of the associations by demographic and socioeconomic characteristics was assessed by stratified analyses and tests for interaction. RESULTS Of the 11 972 individuals included (mean [SD] age, 59.85 [9.56] years; 6181 [51.6%] were females), 80.9% had been exposed to at least 1 ACE and 18.0% reported exposure to 4 or more ACEs. Compared with those without ACE exposure, participants who experienced 4 or more ACEs had increased risks of dyslipidemia, chronic lung disease, asthma, liver disease, digestive disease, kidney disease, arthritis, psychiatric disease, memory-related disease, and multimorbidity. The estimated odds ratios (ORs) ranged from 1.27 (95% CI, 1.02-1.59) for dyslipidemia to 2.59 (95% CI, 2.16-3.11) for digestive disease. A dose-response association was also observed between the number of ACEs and the risk of most of the chronic diseases (excluding hypertension, diabetes, and cancer) (eg, chronic lung disease for ≥4 ACEs vs none: OR, 2.01; 95% CI, 1.59-2.55; P < .001 for trend) and of multimorbidity (for individuals among the overall study population with ≥4 ACEs vs none: OR, 2.03; 95% CI, 1.70-2.41; P < .001 for trend). The demographic or socioeconomic characteristics of age, sex, educational level, annual per capita household expenditure level, or childhood economic hardship were not shown to significantly modify the associations between ACEs and multimorbidity. CONCLUSIONS AND RELEVANCE In this population-based, cross-sectional study of adults in China, exposure to ACEs was associated with higher risks of chronic diseases regardless of demographic and socioeconomic characteristics during childhood or adulthood. These findings suggest a need to prevent ACEs and a need for a universal life-course public health strategy to reduce potential adverse health outcomes later in life among individuals who experience them.
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Affiliation(s)
- Li Lin
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | | | - Ciyong Lu
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Weiqing Chen
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Vivian Yawei Guo
- School of Public Health, Sun Yat-sen University, Guangzhou, China
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Lin L, Qin K, Chen D, Lu C, Chen W, Guo VY. Systematic review and meta-analysis of the association between paediatric obesity and telomere length. Acta Paediatr 2021; 110:2695-2703. [PMID: 34101251 DOI: 10.1111/apa.15971] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 04/29/2021] [Accepted: 06/03/2021] [Indexed: 02/06/2023]
Abstract
AIM This systematic review and meta-analysis aimed to assess the association between paediatric obesity and telomere length. METHODS We conducted a comprehensive literature search for original studies assessing the associations between obesity and telomere length in children. Fixed or random effects with inverse-variance meta-analysis were used to estimate the standardised mean difference (SMD) and its 95% confidence interval (95% CI) between overweight or obese and normal-weight children. Heterogeneity was assessed using the I2 statistic, and meta-regression analyses were used to evaluate the potential source of heterogeneity. Subgroup analysis was further conducted by sex. RESULTS A total of 11 studies were included. The meta-analysis showed that children who were overweight or obese had shorter telomere length than normal-weight children (SMD: -0.85; 95% CI: -1.42 to -0.28; p < 0.01). However, significant heterogeneity was present (I2 = 97%; p < 0.01). Study design, methods used for measuring telomere length, tissue types, mean age, and percentage of boys were not the source of heterogeneity revealed by meta-regression analysis. The inverse trend was significant only in boys, but not in girls. CONCLUSION There was a negative association between paediatric obesity and telomere length. Weight control in children might have beneficial effect on telomere length.
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Affiliation(s)
- Li Lin
- Department of Epidemiology School of Public Health Sun Yat‐sen University Guangzhou Guangdong China
| | - Kang Qin
- Department of Epidemiology School of Public Health Sun Yat‐sen University Guangzhou Guangdong China
| | - Dezhong Chen
- Department of Epidemiology School of Public Health Sun Yat‐sen University Guangzhou Guangdong China
| | - Ciyong Lu
- Department of Epidemiology School of Public Health Sun Yat‐sen University Guangzhou Guangdong China
| | - Weiqing Chen
- Department of Epidemiology School of Public Health Sun Yat‐sen University Guangzhou Guangdong China
| | - Vivian Yawei Guo
- Department of Epidemiology School of Public Health Sun Yat‐sen University Guangzhou Guangdong China
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Lin L, Lu C, Chen W, Li C, Guo VY. Parity and the risks of adverse birth outcomes: a retrospective study among Chinese. BMC Pregnancy Childbirth 2021; 21:257. [PMID: 33771125 PMCID: PMC8004392 DOI: 10.1186/s12884-021-03718-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 03/01/2021] [Indexed: 11/30/2022] Open
Abstract
Background Nulliparity is considered to be a risk factor of preterm birth (PTB), low birth weight (LBW) and small for gestational age (SGA). With the new two-child policy launched in 2016, more Chinese women have delivered their 2nd baby. Yet few studies have assessed the impact of parity on adverse birth outcomes in China. This study aimed to examine the association between parity and risks of PTB, LBW and SGA in a Chinese population. The combined effects of maternal age and parity on adverse birth outcomes were also assessed. Methods This retrospective study included all non-malformed live births born during January 1, 2014 and December 31, 2018 in Chengdu, China. A total of 746,410 eligible live singletons with complete information were included in the analysis. Parity was classified into nulliparity (i.e. has never delivered a newborn before) and multiparity (i.e. has delivered at least one newborn before). Log-binomial regression analyses were applied to evaluate the association between parity and PTB, LBW and SGA. We further divided maternal age into different groups (< 25 years, 25–29 years, 30–34 years and ≥ 35 years) to assess the combined effects of maternal age and parity on adverse birth outcomes. Results Multiparity was associated with reduced risks of PTB (aRR = 0.91, 95% CI: 0.89–0.93), LBW (aRR = 0.74, 95% CI: 0.72–0.77) and SGA (aRR = 0.67, 95% CI: 0.66–0.69) compared with nulliparity. In each age group, we observed that multiparity was associated with lower risks of adverse birth outcomes. Compared to nulliparous women aged between 25 and 29 years, women aged ≥35 years had greater risks of PTB and LBW, regardless of their parity status. In contrast, multiparous women aged ≥35 years (aRR = 0.73, 95% CI: 0.70–0.77) and those aged < 25 years (aRR = 0.88, 95% CI: 0.84–0.93) were at lower risk of SGA compared with nulliparous women aged between 25 and 29 years. Conclusion Multiparity was associated with lower risks of all adverse birth outcomes. Special attention should be paid to nulliparous mothers and those with advanced age during antenatal care, in order to reduce the risks of adverse birth outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03718-4.
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Affiliation(s)
- Li Lin
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, Guangdong, China
| | - Ciyong Lu
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, Guangdong, China
| | - Weiqing Chen
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, Guangdong, China
| | - Chunrong Li
- Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, Sichuan, China.
| | - Vivian Yawei Guo
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, Guangdong, China.
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Bedford LE, Guo VY, Yu EYT, Wong CKH, Fung CSC, Lam CLK. Do Negative Emotional States Play a Role in the Association Between Intimate Partner Violence and Poor Health-Related Quality of Life in Chinese Women From Low-Income Families? Violence Against Women 2020; 26:2041-2061. [PMID: 31896311 DOI: 10.1177/1077801219892648] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
A cross-sectional analysis of a dataset of 156 participants in a health assessment program explored whether negative emotional states mediated the association between intimate partner violence (IPV) and health-related quality of life (HRQoL). Compared with IPV screen-negative participants, those who screened positive had significantly lower HRQoL and significantly higher levels of depression, anxiety, and stress. The inverse associations between the presence of IPV and HRQoL were found to be mediated by depression, anxiety, and stress. Therefore, interventions to alleviate negative emotions in women suffering from IPV have the potential to be useful in improving their HRQoL.
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Affiliation(s)
- Laura Elizabeth Bedford
- Department of Family Medicine and Primary Care, University of Hong Kong, Hong Kong SAR, China
| | | | - Esther Yee Tak Yu
- Department of Family Medicine and Primary Care, University of Hong Kong, Hong Kong SAR, China
| | - Carlos King Ho Wong
- Department of Family Medicine and Primary Care, University of Hong Kong, Hong Kong SAR, China
| | - Colman Siu Cheung Fung
- Department of Family Medicine and Primary Care, University of Hong Kong, Hong Kong SAR, China
| | - Cindy Lo Kuen Lam
- Department of Family Medicine and Primary Care, University of Hong Kong, Hong Kong SAR, China
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Lam CLK, Guo VY, Wong CKH, Yu EYT, Fung CSC. Poverty and health-related quality of life of people living in Hong Kong: comparison of individuals from low-income families and the general population. J Public Health (Oxf) 2018; 39:258-265. [PMID: 27222238 DOI: 10.1093/pubmed/fdw046] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background To assess health-related quality of life (HRQOL) among Chinese adults from low-income households in Hong Kong, and to explore any threshold of household income that impaired HRQOL. Methods A cross-sectional analysis was conducted on 298 adults from low-income families when they enrolled into a cohort study between 2012 and 2014. HRQOL was measured by the 12-item Short-Form Health Survey-version 2 (SF-12v2). Their mean SF-12v2 subscale and summary scores were compared with those of 596 age-sex-matched subjects randomly selected from a database of 2763 adults from the Hong Kong general population (ratio = 1:2). Multiple linear regressions were conducted to determine any association between monthly household income and HRQOL. Results Subjects from low-income households had significantly lower SF-12v2 bodily pain, general health, vitality and physical component summary (PCS) scores than the age-sex matched subjects from the general population. Subgroup analysis showed that a household income <50% of the median monthly household income in Hong Kong (HK$10 000 ≈ US$1290, i.e. poverty line in Hong Kong) was independently associated with poorer PCS and mental component summary (MCS) scores after adjustment for socio-demographics and co-morbidities. Conclusion Chinese adults from low-income households had poorer HRQOL, and <50% of the median monthly household income seems to be the threshold for impairment of both physical and mental HRQOL. The findings support the current definition of the poverty line.
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Affiliation(s)
- Cindy Lo Kuen Lam
- Department of Family Medicine and Primary Care, The University of Hong Kong, 3F, Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong
| | - Vivian Yawei Guo
- Department of Family Medicine and Primary Care, The University of Hong Kong, 3F, Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong
| | - Carlos King Ho Wong
- Department of Family Medicine and Primary Care, The University of Hong Kong, 3F, Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong
| | - Esther Yee Tak Yu
- Department of Family Medicine and Primary Care, The University of Hong Kong, 3F, Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong
| | - Colman Siu Cheung Fung
- Department of Family Medicine and Primary Care, The University of Hong Kong, 3F, Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong
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Wong RSM, Yu EYT, Guo VY, Wan EYF, Chin WY, Wong CKH, Fung CSC, Tung KTS, Wong WHS, Ip P, Tiwari AFY, Lam CLK. A prospective cohort study to investigate parental stress and child health in low-income Chinese families: protocol paper. BMJ Open 2018; 8:e018792. [PMID: 29472262 PMCID: PMC5855257 DOI: 10.1136/bmjopen-2017-018792] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Chronic stress has adverse effects on health. Adults and children from low-income families are subject to multiple sources of stress. Existing literature about economic hardship mostly focuses on either adults or children but not both. Moreover, there is limited knowledge on the relationship between parental generalised stress and child health problems. This study aims to explore the bidirectional relationship between parental stress and child health in Chinese low-income families and to identify other modifiable factors influencing this relationship. METHODS AND ANALYSIS This prospective cohort study will sample 254 low-income parent-child pairs and follow them up for 24 months with assessments at three time points (baseline, 12 and 24 months) on parental stress, health-related quality of life (HRQOL) and child health and behaviour using both subjective measures and objective physiological parameters. This study will collect data using standardised measures on HRQOL and behaviours of children as well as on HRQOL, mental health and stress levels of parents along with physiological tests of allostatic load and telomere length. The mediating or moderating effect of family harmony, parenting style and neighbourhood conditions will also be assessed. Data will be analysed using latent growth modelling and cross-lagged path analysis modelling to examine the bidirectional effect of parental stress and child health over time. Mediation and moderation analysis will also be conducted to examine the mechanism by which the variables relate. ETHICS AND DISSEMINATION This study was approved by the institutional review board of the University of Hong Kong-the Hospital Authority Hong Kong West Cluster, reference no: UW 16-415. The study findings will be disseminated through peer-reviewed publications and international conferences. TRIAL REGISTRATION NUMBER NCT03185273; Pre-results.
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Affiliation(s)
- Rosa Sze Man Wong
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong
| | - Esther Yee Tak Yu
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong
| | - Vivian Yawei Guo
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong
| | - Eric Yuk-Fai Wan
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong
| | - Weng-Yee Chin
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong
| | - Carlos King Ho Wong
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong
| | | | - Keith Tsz Suen Tung
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong
| | - Wilfred Hing-Sang Wong
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong
| | - Patrick Ip
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong
| | | | - Cindy Lo Kuen Lam
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong
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Guo VY, Cao B, Cai C, Cheng KKY, Cheung BMY. Fetuin-A levels and risk of type 2 diabetes mellitus: a systematic review and meta-analysis. Acta Diabetol 2018; 55:87-98. [PMID: 29127490 DOI: 10.1007/s00592-017-1068-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 10/23/2017] [Indexed: 12/31/2022]
Abstract
AIMS Fetuin-A has been linked to insulin resistance and obesity. Its role in the pathogenesis of type 2 diabetes (T2DM) has also been discussed. We aimed to investigate the prospective association of fetuin-A and the risk of T2DM in a systematic review and meta-analysis. METHODS A systematic search of studies from the MEDLINE, EMBASE, Pubmed and Web of Science using fetuin-A, diabetes and various synonyms was conducted up to June 5, 2017. Relevant studies were extracted by two reviewers independently. The quality of studies was assessed using Newcastle-Ottawa scales. Overall estimates were pooled using fixed effect with inverse variance meta-analysis. Subgroup analyses by gender, study population, techniques of assessing fetuin-A, diabetes ascertainment methods, follow-up duration and measures of association were conducted. RESULTS Seven studies comprising a total of 11,497 individuals and 2176 cases of T2DM were included in the systematic review and meta-analysis. Overall, one SD increment of fetuin-A level was associated with a 23% greater risk of incident T2DM (RR: 1.23, 95% CI 1.16-1.31). No significant heterogeneity or publication bias was found. The association was relatively stable across different subgroups. However, the association seemed only evident in women, but not in men. CONCLUSIONS Higher circulating fetuin-A levels were associated with increased risk of T2DM. However, the causality deserved further analysis.
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Affiliation(s)
- Vivian Yawei Guo
- Department of Family Medicine and Primary Care, Faculty of Medicine, The University of Hong Kong, 3F, Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong.
| | - Bing Cao
- Department of Biomedical Sciences, City University of Hong Kong, Kowloon, Hong Kong
| | - Chunyan Cai
- Biostatistics/Epidemiology/Research Design Core, Center for Clinical and Translational Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Kenneth King-Yip Cheng
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Bernard Man Yung Cheung
- Department of Medicine, Faculty of Medicine, The University of Hong Kong, Hong Kong Island, Hong Kong
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Wong RSM, Guo VY, Ip P, Wong CKH, Yu EYT, Fung CSC, Lam CLK. Mothers’ health-related quality of life: Its relationship with children’s health-related quality of life and behavior in low-income families. Fam Med Community Health 2016. [DOI: 10.15212/fmch.2016.0124] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Wu L, Guo VY, Wong CKH, Kung K, Han L, Wang X, Luo Y. Innovative non-invasive model for screening reduced estimated glomerular filtration rate in a working population. Nephrology (Carlton) 2016; 22:892-898. [PMID: 27628290 DOI: 10.1111/nep.12921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 07/17/2016] [Accepted: 09/06/2016] [Indexed: 11/28/2022]
Abstract
AIM Most of the existing risk scores for identifying people with reduced estimated glomerular filtration rate (eGFR) involve laboratory-based factors, which are not convenient and cost-effective to use in a large population-based screening programme. We aimed at using non-invasive variables to identify subjects with reduced eGFR in a Chinese working population. METHODS Two study populations were recruited in 2012 and 2015, respectively. The 2012 study population (n = 14 374) was randomly separated as the training dataset (n = 9621) or the internal testing dataset (n = 4753) at a ratio of 2:1, and the 2015 study population (n = 4371) was used as the external testing dataset. Stepwise logistic regression analysis with age, gender, hypertension and body mass index (BMI) status were first performed in the training dataset and then validated in both internal and external testing dataset. A nomogram was further developed based on the final model. RESULTS Results showed that older females with higher BMI status were more likely to have reduced eGFR. The model had excellent discrimination (AUC: 0.887 [95%CI: 0.865, 0.909] in the internal validation and 0.880 [95%CI: 0.829, 0.931] in the external validation) and calibration (Hosmer-Lemeshow test, P = 0.798 and 0.397 for internal and external dataset, respectively). The probability of having reduced eGFR increased gradually from <0.1% at a total score of 0 to 26% at a total score of 58 shown in the nomogram. CONCLUSION Non-invasive variables could help identify individuals at high risk of reduced eGFR for further kidney function testing or intervention, aiding in decision-making and resource allocation in large population screening.
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Affiliation(s)
- Lan Wu
- Department of Endocrinology, The People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang, China
| | - Vivian Yawei Guo
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, SAR, China
| | - Carlos King Ho Wong
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, SAR, China
| | - Kenny Kung
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, SAR, China
| | - Li Han
- Department of Endocrinology, The People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang, China
| | - XinLing Wang
- Department of Endocrinology, The People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang, China
| | - Yunzhi Luo
- Department of Endocrinology, The People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang, China
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Guo VY, Cao B, Wu X, Lee JJW, Zee BCY. Prospective Association between Diabetic Retinopathy and Cardiovascular Disease-A Systematic Review and Meta-analysis of Cohort Studies. J Stroke Cerebrovasc Dis 2016; 25:1688-1695. [PMID: 27068777 DOI: 10.1016/j.jstrokecerebrovasdis.2016.03.009] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 02/17/2016] [Accepted: 03/06/2016] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Diabetic retinopathy (DR) is linked to increased risk of cardiovascular (CV) disease. However, the effect size of the association was not consistent. In this study, we performed a systematic review and meta-analysis of available cohort studies to determine the association between DR and CV disease, and to investigate the factors that influence the association. METHODS Terms related to DR and CV disease were searched from MEDLINE and EMBASE database. High-quality articles (Newcastle-Ottawa scales above 6) conducted in cohort studies reporting the association between DR and CV disease were identified. Study-specific estimates were pooled using random effects with inverse variance meta-analysis. Subgroup analysis was performed according to diabetes types. Heterogeneity of included studies was assessed using the I(2) test. The cause of the heterogeneity was examined using metaregression analyses. RESULTS A total of 13 studies representing 17,611 patients without CV disease at baseline were included. At follow-up, there were 1457 CV disease-related incidences. Overall, DR was associated with increased risk of CV disease (relative risk [RR]: 2.42, 95% confidence interval [CI]: 1.77-3.31) in diabetes. Specifically, the RR was 3.59 (95% CI: 1.79-7.20) for type 1 diabetes and 1.81 (95% CI: 1.47-2.23) for type 2 diabetes. Significant heterogeneity was found in studies with type 1 diabetes. Metaregression analysis showed that baseline systolic blood pressure was a key factor leading to the heterogeneity. CONCLUSION In conclusion, DR is significantly associated with CV disease incidence and CV disease-related mortality in diabetes. Patients with DR may need more intensive management to control future CV disease attacks.
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Affiliation(s)
- Vivian Yawei Guo
- Division of Biostatistics, The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong; Department of Family Medicine and Primary Care, Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Bing Cao
- Neuroscience Laboratory, Department of Biology and Chemistry, City University of Hong Kong, Hong Kong
| | - Xinyin Wu
- Division of Family Medicine and Primary Health Care, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Jack Jock Wai Lee
- Division of Biostatistics, The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Benny Chung-Ying Zee
- Division of Biostatistics, The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong; Clinical Trials and Biostatistics Lab, Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China.
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Fung CSC, Yu EYT, Guo VY, Wong CKH, Kung K, Ho SY, Lam LY, Ip P, Fong DYT, Lam DCL, Wong WCW, Tsang SKM, Tiwari AFY, Lam CLK. Development of a Health Empowerment Programme to improve the health of working poor families: protocol for a prospective cohort study in Hong Kong. BMJ Open 2016; 6:e010015. [PMID: 26842271 PMCID: PMC4746471 DOI: 10.1136/bmjopen-2015-010015] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION People from working poor families are at high risk of poor health partly due to limited healthcare access. Health empowerment, a process by which people can gain greater control over the decisions affecting their lives and health through education and motivation, can be an effective way to enhance health, health-related quality of life (HRQOL), health awareness and health-seeking behaviours of these people. A new cohort study will be launched to explore the potential for a Health Empowerment Programme to enable these families by enhancing their health status and modifying their attitudes towards health-related issues. If proven effective, similar empowerment programme models could be tested and further disseminated in collaborations with healthcare providers and policymakers. METHOD AND ANALYSIS A prospective cohort study with 200 intervention families will be launched and followed up for 5 years. The following inclusion criteria will be used at the time of recruitment: (1) Having at least one working family member; (2) Having at least one child studying in grades 1-3; and (3) Having a monthly household income that is less than 75% of the median monthly household income of Hong Kong families. The Health Empowerment Programme that will be offered to intervention families will comprise four components: health assessment, health literacy, self-care enablement and health ambassador. Their health status, HRQOL, lifestyle and health service utilisation will be assessed and compared with 200 control families with matching characteristics but will not receive the health empowerment intervention. ETHICS AND DISSEMINATION This project was approved by the University of Hong Kong-the Hospital Authority Hong Kong West Cluster IRB, Reference number: UW 12-517. The study findings will be disseminated through a series of peer-reviewed publications and conference presentations, as well as a yearly report to the philanthropic funding body-Kerry Group Kuok Foundation (Hong Kong) Limited.
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Affiliation(s)
| | - Esther Yee Tak Yu
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong
| | - Vivian Yawei Guo
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong
| | - Carlos King Ho Wong
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong
| | - Kenny Kung
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong
| | - Sin Yi Ho
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong
| | - Lai Ying Lam
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong
| | - Patrick Ip
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong
| | | | | | - William Chi Wai Wong
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong
| | - Sandra Kit Man Tsang
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong
| | | | - Cindy Lo Kuen Lam
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong
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Guo VY, Chan JCN, Chung H, Ozaki R, So W, Luk A, Lam A, Lee J, Zee BCY. Retinal Information is Independently Associated with Cardiovascular Disease in Patients with Type 2 diabetes. Sci Rep 2016; 6:19053. [PMID: 26754623 PMCID: PMC4709555 DOI: 10.1038/srep19053] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 12/04/2015] [Indexed: 11/30/2022] Open
Abstract
To evaluate the association between a series of retinal information and cardiovascular disease (CVD) and to evaluate whether this association is independent of traditional CVD risk factors in type 2 diabetes patients, we undertook an age-sex matched case-control study with 79 CVD cases and 150 non-CVD controls. All the participants underwent standardized physical examinations and retinal imaging. Retinal information was extracted from the retinal images using a semi-automatic computer program. Three stepwise logistic regression models were evaluated: model 1 with cardiovascular risk factors only; model 2 with retinal information only and model 3 with both cardiovascular risk factors and retinal information. The areas under the receiver operating characteristic curves (AUCs) were used to compare the performances of different models. Results showed that the AUCs were 0.692 (95%CI: 0.622−0.761) and 0.661 (95%CI: 0.588−0.735) for model 1 and model 2, respectively. In addition, model 3 had an AUC of 0.775 (95%CI: 0.716−0.834). Compared to the previous two models, the AUC of model 3 increased significantly (p < 0.05 in both comparisons). In conclusion, retinal information is independently associated with CVD in type 2 diabetes. Further work is needed to validate the translational value of applying retinal imaging analysis into clinical practice.
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Affiliation(s)
- Vivian Yawei Guo
- Division of Biostatistics, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.,Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, China
| | - Juliana Chung Ngor Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, The Prince of Wales Hospital, Hong Kong, China.,Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, The Prince of Wales Hospital, Hong Kong, China.,Asia Diabetes Foundation, The Chinese University of Hong Kong, The Prince of Wales Hospital, Hong Kong, China
| | - Harriet Chung
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, The Prince of Wales Hospital, Hong Kong, China
| | - Risa Ozaki
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, The Prince of Wales Hospital, Hong Kong, China
| | - Wingyee So
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, The Prince of Wales Hospital, Hong Kong, China
| | - Andrea Luk
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, The Prince of Wales Hospital, Hong Kong, China
| | - Augustine Lam
- Department of Family Medicine, New Territories East Cluster, Hospital Authority (Ma On Shan Family Medicine Centre), Hong Kong, China
| | - Jack Lee
- Division of Biostatistics, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Benny Chung-Ying Zee
- Division of Biostatistics, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.,Clinical Trials and Biostatistics Lab, Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
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Chan KH, Lam KSL, Cheng OY, Kwan JSC, Ho PWL, Cheng KKY, Chung SK, Ho JWM, Guo VY, Xu A. Adiponectin is protective against oxidative stress induced cytotoxicity in amyloid-beta neurotoxicity. PLoS One 2012; 7:e52354. [PMID: 23300647 PMCID: PMC3531475 DOI: 10.1371/journal.pone.0052354] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Accepted: 11/12/2012] [Indexed: 12/19/2022] Open
Abstract
Beta-amyloid (Aβ ) neurotoxicity is important in Alzheimer’s disease (AD) pathogenesis. Aβ neurotoxicity causes oxidative stress, inflammation and mitochondrial damage resulting in neuronal degeneration and death. Oxidative stress, inflammation and mitochondrial failure are also pathophysiological mechanisms of type 2 diabetes (T2DM) which is characterized by insulin resistance. Interestingly, T2DM increases risk to develop AD which is associated with reduced neuronal insulin sensitivity (central insulin resistance). We studied the potential protective effect of adiponectin (an adipokine with insulin-sensitizing, anti-inflammatory and anti-oxidant properties) against Aβ neurotoxicity in human neuroblastoma cells (SH-SY5Y) transfected with the Swedish amyloid precursor protein (Sw-APP) mutant, which overproduced Aβ with abnormal intracellular Aβ accumulation. Cytotoxicity was measured by assay for lactate dehydrogenase (LDH) released upon cell death and lysis. Our results revealed that Sw-APP transfected SH-SY5Y cells expressed both adiponectin receptor 1 and 2, and had increased AMP-activated protein kinase (AMPK) activation and enhanced nuclear factor-kappa B (NF-κB) activation compared to control empty-vector transfected SH-SY5Y cells. Importantly, adiponectin at physiological concentration of 10 µg/ml protected Sw-APP transfected SH-SY5Y cells against cytotoxicity under oxidative stress induced by hydrogen peroxide. This neuroprotective action of adiponectin against Aβ neurotoxicity-induced cytotoxicity under oxidative stress involved 1) AMPK activation mediated via the endosomal adaptor protein APPL1 (adaptor protein with phosphotyrosine binding, pleckstrin homology domains and leucine zipper motif) and possibly 2) suppression of NF-κB activation. This raises the possibility of novel therapies for AD such as adiponectin receptor agonists.
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Affiliation(s)
- Koon-Ho Chan
- University Department of Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, Special Administrative Region, China.
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Chan KH, Zhang R, Kwan JSC, Guo VY, Ho PWL, Ho JWM, Chu ACY. Aquaporin-4 autoantibodies cause asymptomatic aquaporin-4 loss and activate astrocytes in mouse. J Neuroimmunol 2012; 245:32-8. [PMID: 22394609 DOI: 10.1016/j.jneuroim.2012.02.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2011] [Revised: 01/30/2012] [Accepted: 02/01/2012] [Indexed: 01/16/2023]
Abstract
BACKGROUND Neuromyelitis optica (NMO) is a central nervous system inflammatory demyelinating disorder. Up to 90% of patients are seropositive for aquaporin-4 autoantibodies (AQP4 Ab). The pathogenetic mechanisms underlying clinical onset and relapse of NMO are uncertain. OBJECTIVE Study the pathogenicity of AQP4 Ab in the absence of complement activation. METHODS Female C57BL/6N mice (human IgG cannot activate mouse complements) pretreated with complete Freund's adjuvant (CFA, day 0) and pertussis toxin (PTx, day 0 and day 2) were transferred with IgG isolated from serum of healthy subjects or NMO patients (AQP4 Ab-positive or negative) intraperitoneally (day 7-9). Mice were observed for signs of experimental autoimmune encephalomyelitis (EAE) by standard 6-grade EAE scores. Spinal cord was obtained at day 11 for immunohistochemistry. RESULTS None of the mice had clinical signs of encephalomyelitis, inflammatory cells infiltration or demyelination of spinal cord. CFA and PTx induce BBB breakdown evidenced by leakage of human IgG into cord parenchyma. Patchy areas of AQP4 loss were observed in spinal cord of mice transferred with IgG from AQP4 Ab-positive NMO patients but not in mice transferred with IgG from AQP4 Ab-negative NMO patients or healthy subjects; but there was no loss of glial fibrillary acidic protein immunoreactivity in all mice. Markedly increased proliferation of astrocytic processes suggestive of astrocytic activation was observed in mice transferred with IgG from AQP4 Ab-positive patients. CONCLUSION AQP4 Ab cause asymptomatic AQP4 loss and astrocytic activation but not myelitis, demyelination or astrocytic cytotoxicity in spinal cord of mouse in the absence of complement activation.
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Affiliation(s)
- K H Chan
- University Department of Medicine, Queen Mary Hospital, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong.
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