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Objective: Lifestyle modification is an important part of non-surgical treatment for urinary incontinence (UI) and is strongly recommended. This study aims to explore the status and influencing factors of health-promoting lifestyle among pregnant women with UI., Design: A multicentre cross-sectional study., Setting: This study was conducted in obstetric clinics of three tertiary-level A hospitals in Zhejiang Province, mainland China., Participants: A total of 519 pregnant women with UI were enrolled in this study from May 2023 to August 2023., Outcome Measures: Lifestyle Profile Scale for Gravidas with Urinary Incontinence (LPG-UI) was used to assess health-promoting lifestyle status. Multivariate stepwise linear regression analysis was performed to identify significant influence factors., Results: Most participants reported mild-to-moderate UI, with over 60% experiencing UI starting from the first and second trimesters. The mean score of LPG-UI was 86.74 (SD=12.75) out of a score of 120. The results of multivariate stepwise linear regression analysis showed that those who had better environmental satisfaction ( β =0.22, p<0.001), self-efficacy ( β =0.168, p<0.001), social support ( β =0.153, p<0.001) and knowledge of UI ( β =0.104, p<0.01) have higher levels of health-promoting lifestyles, while those who had worse depression ( β =-0.214, p<0.001), fewer exercise before pregnancy ( β =-0.135, p<0.001) and physical work ( β =-0.076, p<0.05) have lower levels of health-promoting lifestyles. A total of 38.5% variation in the regression equation could be explained., Conclusions: The health-promoting lifestyle of pregnant women with UI needs to be further promoted. Governments and the social sector need to do more to improve the accessibility of environments such as sports and healthcare. Meanwhile, increasing the individual health responsibility of pregnant women with UI and promoting help-seeking behaviours are also top priorities. More social and emotional support should be added to improve self-efficacy and positive moods to enhance health promotion lifestyles., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Background: National treatment guidelines of China evolving necessitates population-level surveillance of transmitted drug resistance (TDR) to inform or update HIV treatment strategies., Methods: We analyzed the demographic, clinical, and virologic data obtained from people with HIV (PWH) residing in 31 provinces of China who were newly diagnosed between 2018 and 2023. Evidence of TDR was defined by the World Health Organization list for surveillance of drug resistance mutations., Results: Among the 22 124 PWH with protease and reverse transcriptase sequences, 965 (4.36%; 95% CI, 4.1-4.63) had at least 1 TDR mutation. The most frequent TDR mutations were nonnucleoside reverse transcriptase inhibitor (NNRTI) mutations (2.39%; 95% CI, 2.19%-2.59%), followed by nucleoside reverse transcriptase inhibitor mutations(1.35%; 95% CI, 1.2%-1.5%) and protease inhibitor mutations (1.12%; 95% CI, .98%-1.26%). The overall protease and reverse transcriptase TDR increased significantly from 4.05% (95% CI, 3.61%-4.52%) in 2018 to 5.39% (95% CI, 4.33%-6.57%) in 2023. A low level of integrase strand transfer inhibitor TDR was detected in 9 (0.21%; 95% CI, .1%-.38%) of 4205 PWH., Conclusions: Presently, the continued use of NNRTI-based first-line antiretroviral therapy regimen for HIV treatment has been justified., Competing Interests: Potential conflicts of interest. All authors: No reported conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed., (© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Objectives: A significant number of women may experience urinary incontinence (UI) during pregnancy. While lifestyle modifications are recommended as important measures for preventing and treating UI, little is known about the lifestyle status of gravida with UI. This study aimed to develop the Lifestyle Profile Scale for Gravida with Urinary Incontinence (LPG-UI) and to evaluate its psychometric properties., Design: It was an instrument design study carried out in two stages. In stage 1, a literature review was conducted to generate the initial item pool. Subsequently, a Delphi survey was conducted to obtain expert consensus and reduce the items. In stage 2, further item reduction was performed through item analysis. Then, psychometric properties of the instrument were evaluated, including structural validity, internal consistency, split-half reliability, test-retest reliability and criterion validity., Setting: This study was conducted in obstetric clinics of a tertiary maternity hospital in Zhejiang Province, mainland China., Participants: A sample of 447 pregnant women with UI were enrolled in stage 2., Results: A 24-item, 7-dimension lifestyle profile scale was ultimately obtained. The content validity was satisfactory. The split-half reliability and total-scale Cronbach's alpha coefficient were 0.890 and 0.819, respectively. The criterion validity was 0.598. The seven-factor model, which accounted for 63.667% of the total item variance, demonstrated a good fit with the data ([Formula: see text] =1.672, root mean square error of approximation=0.053, goodness of fit=0.884)., Conclusions: The LPG-UI has sufficient validity and reliability for assessing the lifestyle status of pregnant women with UI., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Soils support a highly diverse community of plant pathogens, which are highly responsive to global change. Climate and livestock grazing are the main global changes in grasslands, yet, how long-term grazing alone, and in interaction with climate, influence the distribution of soil-borne plant pathogens remain virtually unknown. Here, we present the first long-term regional-scale experimental investigation on the impacts of livestock grazing on soil-borne fungal plant pathogens and their association with plant community across 10 experimental sites spanning a climate gradient in the steppe in Northern China. Our results showed that long-term grazing effects on the diversity and proportion of soil-borne fungal plant pathogens are strongly controlled by temperature, with grazing increasing pathogen richness and proportions largely in cooler grasslands. We further show that long-term grazing supported stronger connections between soil-borne fungal pathogens and plant communities. Our work demonstrates that climate controls the effects of grazing on plant pathogens, which is critical to understand and manage grasslands in a changing world., Competing Interests: Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: In 2016, China has implemented the World Health Organization's "treat all" policy. We aimed to assess the impact of significant improvements in the 95-95-95 targets on population-level human immunodeficiency virus (HIV) transmission dynamics and incidence., Methods: We focused on 3 steps of the HIV care continuum: diagnosed, on antiretroviral therapy, and achieving viral suppression. The molecular transmission clusters were inferred using HIV-TRACE. New HIV infections were estimated using the incidence method in the European Centre for Disease Prevention and Control HIV Modelling Tool., Results: Between 2004 and 2023, the national HIV epidemiology database recorded 2.99 billion person-times of HIV tests and identified 1 976 878 new diagnoses. We noted a roughly "inverted-V" curve in the clustering frequency, with the peak recorded in 2014 (67.1% [95% confidence interval, 63.7%-70.5%]), concurrent with a significant improvement in the 95-95-95 targets from 10-13-<71 in 2005 to 84-93-97 in 2022. Furthermore, we observed a parabolic curve for a new infection with the vertex occurring in 2010., Conclusions: In general, it was suggested that the improvements in the 95-95-95 targets were accompanied by a reduction in both the population-level HIV transmission rate and incidence. Thus, China should allocate more effort to the first "95" target to achieve a balanced 95-95-95 target., Competing Interests: Potential conflicts of interest. All authors: No reported conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed., (© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

The Chinese government implemented air pollution control policies in its Five-Year Plans (FYPs), setting specific emission reduction targets for different regions. This study employed the generalized difference-in-differences (GDD) method to assess the impacts of air pollution control policies on pollutants and carbon emissions from 2003 to 2020. This study had three main findings. (1) Air pollution control policies promoted the reduction of total SO 2 and carbon emissions, indicating that these policies had synergic impacts on pollutants and carbon emissions. (2) The reduction in emissions due to air pollution control policies primarily originated from industrial emissions, particularly in reducing industrial SO 2 emissions from process of production. (3) The emission reduction targets of different pollutants showed varying effects; SO 2 reduction targets significantly lowered overall SO 2 emissions, whereas NO x reduction targets effectively reduced industrial NO x and carbon emissions., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

We investigated the control rate of hypertension across months of year and hours of day in a real-world database. The study participants were hypertensive patients from 142 community health centers across 16 districts in Shanghai, China, who measured their blood pressure with an automatic office blood pressure measurement platform between 2018 and 2023. The 343,400 hypertensive patients included 53.7% of women, and had average age of 70.2 (±8.1) years (range 50-90 years). For months of year, the control rate of hypertension was lowest in February and highest in August (51.9% vs 71.8%). For hours of day, the control rate of hypertension was lowest at 7:00 AM and highest at 12:00 PM (52.1% vs 76.0%). When the months of year and hour of day were considered together, the control rate was lowest at 7 AM in February (42.1%), and highest at 12 PM in July (86.8%). In 8516 patients who had uncontrolled blood pressure in the early morning and had their blood pressure also measured around noon, 45.7% had masked uncontrolled morning hypertension, with higher rates in spring and summer, and in women, those aged 50-69 years, and non-diabetic patients. The control rate of hypertension varies greatly across months of year and hours of day, suggesting that the evaluation of blood pressure control has to take into full consideration the measurement time in terms of months and hours., (© 2024. The Author(s).)

Background: Physical activity during pregnancy has been recommended as an effective measure to prevent various pregnancy complications. However, global physical activity participation during pregnancy is not optimal, and the factors influencing physical activity participation during pregnancy need to be further investigated. In China, where there are no localized guidelines for physical activity during pregnancy, the prevalence of meeting recommended physical activity levels among Chinese pregnant women is still unclear., Objectives: This study aimed to comprehensively review the prevalence of meeting recommended physical activity levels among pregnant women in China and to further explore the factors influencing physical activity participation during pregnancy., Design: This was a systematic review and meta-analysis., Methods: A systematic review was conducted in both English and Chinese databases from inception until August 1, 2023. Two reviewers independently screened literature, assessed study eligibility and extracted data. The Agency for Healthcare Research and Quality was used to evaluate methodological quality of included studies. The pooled prevalence was calculated using a random-effects model. Subgroup analyses were conducted to explore sources of heterogeneity., Results: A total of 12 cross-sectional studies, including 11,323 Chinese pregnant women with a mean age ranging from 27.0 to 33.0 years, met the inclusion criteria. The prevalence of meeting recommended physical activity levels among pregnant women in China was 21.0 % (95 % confidence interval (CI):12.5 %-29.5 %). A higher prevalence of meeting recommended physical activity levels was observed among pregnant women who were in their second trimester, who were living in the southern region, who were assessed by validated questionnaires, and who used 150 min physical activity per week as a criterion for meeting recommendation., Conclusions: The findings suggested a low prevalence of meeting recommended physical activity levels among Chinese pregnant women, which was affected by a variety of factors. It is recommended that further research be conducted in the future to explore physical activity intervention strategies for women of childbearing age before and during pregnancy based on the factors affecting physical activity to improve physical activity compliance, maternal and child health and population quality., Registration Number: CRD42022372722 (PROSPERO)., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Aim: To determine the association of the presence of diabetes and, among persons with diabetes, the age at type 2 diabetes mellitus (T2DM) onset, BMI and the interactive effect with the subsequent thyroid cancer risk., Materials and Methods: We conducted a population register-based longitudinal cohort study in Shanghai, including 428 568 persons with new-onset T2DM matched with the general population. The risk of thyroid cancer among subgroups was calculated based on standardized incidence ratio (SIR), hazard ratio (HR) and Cox proportional hazards models., Results: In total, 1142 thyroid cancer cases were identified during 8 years of follow-up, with an incidence rate of 59.01/100 000 person-years and a higher risk (SIR = 1.21) compared with the general population. The earlier age at T2DM onset and higher BMI were associated with an increasing risk of thyroid cancer independently (onset age <50, SIR: 1.46; BMI ≥30.0 kg/m 2 , SIR: 1.93), with the highest risk in patients with both BMI ≥30.0 kg/m 2 and onset age <50 years (SIR = 3.91, HR = 3.04). Among patients with T2DM onset age <60 years, SIR increased with higher BMI, while there were no trends when onset age ≥60 years. Among patients with BMI ≥25.0 kg/m 2 , SIR increased with an earlier onset age, whereas no trends were shown in the BMI <24.9 kg/m 2 groups. Obese (BMI ≥30.0 kg/m 2 ) patients had a significantly higher HR of thyroid cancer only when T2DM onset age <60 years., Conclusions: Both earlier age of T2DM onset (<50 years) and higher BMI (≥30 kg/m 2 ) contributed to the higher risk of thyroid cancer. Patients with young-onset T2DM and obesity are considered more vulnerable to thyroid cancer development., (© 2024 John Wiley & Sons Ltd.)

Introduction: An intelligent office blood pressure measurement (IOBPM) model for community-based hypertension management was piloted in Shanghai, China, to overcome the conventional blood pressure management (CBPM) model's deficiencies., Methods: We selected adults aged 35-89 years who were being treated and managed for hypertension in two community health centers for the IOBPM and CBPM models. The IOBPM model consisted of two or three consecutive blood pressure (BP) measurements using a pre-programmed and validated automatic device. The BP data for the CBPM model were obtained from the routine follow-up records of hypertensive patients and derived from the Shanghai Non-communicable Diseases Management Information System. Subjects in the IOBPM model were selected by a simple random sampling method, and propensity score matching was used to select a comparable control population from the CBPM model based on important covariables. The BP levels, end-digit preferences, frequency distribution, and BP control were compared between the two models., Results: We selected 2,909 patients for the IOBPM model and 5,744 for the CBPM model. The systolic BP in the CBPM model was 12.3 mmHg lower than in the IOBPM model. In the CBPM model, there were statistically significant end-digit preferences ( P < 0.001), with zero being the most reported end-digit (23.3% for systolic BP and 27.7% for diastolic BP). There was no significant end-digit preference in the IOBPM model. Certain BP values below 140/90 mmHg in the CBPM model were more frequent, while the IOBPM model showed a normal distribution. The BP control in the CBPM model was significantly higher than the IOBPM model ( P < 0.001)., Conclusion: The IOBPM model appears to overcome the deficiencies of the CBPM model, leading to more accurate and reliable BP measurements., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2024 The Author(s).)

To practice standardized office blood pressure (OBP) measurement guidelines pragmatically, we developed an intelligent assisted OBP (IOBP) measurement system in the Chinese community, which can automatically obtain two or three BP values after a 5-min rest before the patients visit the doctor and transfer values to the community medical network in real time. We conducted a comparative study to investigate the agreement among IOBP, awake ambulatory BP (ABP), and conventional auscultatory OBP at different BP levels. Participants were divided into three groups according to BP, with 120/80 mmHg and 160/100 mmHg as the cut-off points. Attended IOBP, unattended IOBP, and auscultatory OBP were randomly measured before ABP monitoring. In total, 245 participants were included in the analysis. The mean systolic attended/unattended IOBP, auscultatory OBP, and awake ABP were 135.0, 136.7, 135.6, and 136.2 mmHg, respectively. Bland-Altman analysis revealed a bias of -1.1 and 0.5 mmHg for systolic attended/unattended IOBP compared with awake ABP in the overall sample. For auscultatory OBP, the bias was -0.4 (attended) and 1.2 mmHg (unattended). The discrepancy between the systolic attended/unattended IOBP and awake ABP was inconsistent at different BP levels. In Group 1 the values were -8.4 and -6.9 mmHg, whereas in Group 3, the values were 9.4 and 10.0 mmHg. BP measured using the IOBP measurement system was in accordance with awake ABP and conventional OBP, and can be a good choice in the Chinese community., (© 2024. The Author(s), under exclusive licence to The Japanese Society of Hypertension.)

Artificial intelligence (AI) telephone is reliable for the follow-up and management of hypertensives. It takes less time and is equivalent to manual follow-up to a high degree. We conducted a reliability study to evaluate the efficiency of AI telephone follow-up in the management of hypertension. During May 18 and June 30, 2020, 350 hypertensives managed by the Pengpu Community Health Service Center in Shanghai were recruited for follow-up, once by AI and once by a human. The second follow-up was conducted within 3-7 days (mean 5.5 days). The mean length time of two calls were compared by paired t-test, and Cohen's Kappa coefficient was used to evaluate the reliability of the results between the two follow-up visits. The mean length time of AI calls was shorter (4.15 min) than that of manual calls (5.24 min, P < .001). The answers related to the symptoms showed moderate to substantial consistency (κ:.465-.624, P < .001), and those related to the complications showed fair consistency (κ:.349, P < .001). In terms of lifestyle, the answer related to smoking showed a very high consistency (κ:.915, P < .001), while those addressing salt consumption, alcohol consumption, and exercise showed moderate to substantial consistency (κ:.402-.645, P < .001). There was moderate consistency in regular usage of medication (κ:.484, P < .001)., (© 2024 The Author(s). The Journal of Clinical Hypertension published by Wiley Periodicals LLC.)

Background: Coccidiosis is one of the most frequently reported diseases in chickens, causing a significant economic impact on the poultry industry. However, there have been no previous studies evaluating the prevalence of this disease in broiler farms in Guangdong province. Therefore, this study aims to conduct an epidemiological investigation into the occurrence of Eimeria species and associated risk factors in intensive management conditions across four regions in Guangdong province, China. A total of 394 fecal samples were collected from 89 broiler farms in Guangdong province. The prevalence of Eimeria species infection was determined using PCR, and the occurrence of Clostridium perfringens type A was assessed using quantitative real-time PCR., Results: The results showed an overall prevalence of 98.88% (88/89) at the farm level and 87.06% (343/394) at the flock level. All seven Eimeria species were identified, with E. acervulina (72.53%; 64/89), E. tenella (68.54%; 61/89), and E. mitis (66.29%; 59/89) at the farm level, and E. acervulina (36.55%; 144/394), E. mitis (35.28%; 139/394), and E. tenella (34.01%; 134/394) at the flock level. The predominant species combination observed was a co-infection of all seven Eimeria species (6.74%; 6/89), followed by a combination of E. acervulina, E. tenella, E. mitis, E. necatrix, E. brunetti, and E. maxima (5.62%, 5/89). A combination of E. acervulina, E. tenella, E. mitis, E. necatrix, E. brunetti, and E. praecox (4.49%; 4/89) was also observed at the farm level. Furthermore, the study identified several potential risk factors associated with the prevalence of Eimeria species, including farm location, chicken age, drinking water source, control strategy, and the presence of C. perfringens type A were identified as potential risk factors associated with prevalence of Eimeria species. Univariate and multivariate analyses revealed a significant association between E. necatrix infection and both grower chickens (OR = 10.86; 95% CI: 1.92-61.36; p < 0.05) and adult chickens (OR = 24.97; 95% CI: 4.29-145.15; p < 0.001) compared to starter chickens at the farm level. Additionally, farms that used groundwater (OR = 0.27; 95% CI: 0.08-0.94; p < 0.05) were less likely to have E. maxima compared to those that used running water. At the flock level, the prevalence of E. tenella was significantly higher in the Pearl River Delta (OR = 2.48; 95% CI: 1.0-6.15; p = 0.05) compared to eastern Guangdong. Interestingly, flocks with indigenous birds were less likely to have E. brunetti (OR = 0.48; 95% CI: 0.26-0.89; p < 0.05) compared to flocks with indigenous crossbred birds. Furthermore, flocks that used anticoccidial drugs (OR = 0.09; 95% CI: 0.03-0.31; p < 0.001) or a combination of vaccines and anticoccidial drugs (OR = 0.06; 95% CI: 0.01-0.25; p < 0.001) were less likely to be positive for E. tenella compared to flocks that only used vaccines. Finally, flocks with C. perfringens type A infection were significantly more likely to have E. necatrix (OR = 3.26; 95% CI: 1.96-5.43; p < 0.001), E. tenella (OR = 2.14; 95% CI: 1.36-3.36; p < 0.001), E. brunetti (OR = 2.48; 95% CI: 1.45-4.23; p < 0.001), and E. acervulina (OR = 2.62; 95% CI: 1.69-4.06; p < 0.001) compared to flocks without C. perfringens type A., Conclusions: This study conducted an investigation on the prevalence, distribution, and risk factors associated with Eimeria species infection in broiler chickens in Guangdong. The farm-level prevalence of Eimeria species was higher than the previous prevalence figures for other areas and countries. E. brunetti was identified at higher prevalence in Guangdong than previously survived prevalence in different regions in China. Farm location, chicken age, drinking water source, control strategy, and the presence of C. perfringens type A were considered as potential risk factors associated with prevalence of Eimeria species. It is imperative to underscore the necessity for further surveys to delve deeper into the occurrence of Eimeria species under intensive management conditions for different flock purposes., (© 2024. The Author(s).)

Objective: Diabetes presenting at a younger age has a more aggressive nature. We aimed to explore the association of age at type 2 diabetes mellitus (T2DM) diagnosis with subsequent cancer incidence in a large Chinese population., Research Design and Methods: The prospective population-based longitudinal cohort included 428,568 newly diagnosed T2DM patients from 2011 to 2018. Participants were divided into six groups according to their age at diagnosis: 20-54, 55-59, 60-64, 65-69, 70-74, and ≥75 years. The incidence of overall and 14 site-specific cancers was compared with the Shanghai general population including 100,649,346 person-years., Results: A total of 18,853 and 582,643 overall cancer cases were recorded in the T2DM cohort and the general population. The age-standardized rate of overall cancer in T2DM patients was 501 (95% CI: 491, 511) per 100,000 person-years, and the standardized incidence ratio (SIR) was 1.10 (1.09, 1.12). Younger age at T2DM diagnosis was associated with higher incidence of overall and site-specific cancers. SIRs for overall cancer with T2DM diagnosis at ages 20-54, 55-59, 60-64, 65-69, 70-74, and ≥75 years were 1.48 (1.41, 1.54), 1.30 (1.25, 1.35), 1.19 (1.15, 1.23), 1.16 (1.12, 1.20), 1.06 (1.02, 1.10), and 0.86 (0.84, 0.89), respectively. Similar trends were observed for site-specific cancers, including respiratory, colorectum, stomach, liver, pancreatic, bladder, central nervous system, kidney, and gallbladder cancer and lymphoma among both males and females., Conclusions: Our findings highlight the necessity of stratifying management for T2DM according to age of diagnosis. As with a range of vascular outcomes, age-standardized cancer risks are greater in earlier compared with later onset T2DM., (© 2024 by the American Diabetes Association.)

In China, few molecular epidemiological data on hepatitis C virus (HCV) are available and all previous studies were limited by small sample sizes or specific population characteristics. Here, we report characterization of the epidemic history and transmission dynamics of HCV strains in China. We included HCV sequences of individuals belonging to three HCV surveillance programs: 1) patients diagnosed with HIV infection at the Beijing HIV laboratory network, most of whom were people who inject drugs and former paid blood donors, 2) men who have sex with men, and 3) the general population. We also used publicly available HCV sequences sampled in China in our study. In total, we obtained 1,603 Ns5b and 865 C/E2 sequences from 1,811 individuals. The most common HCV strains were subtypes 1b (29.1%), 3b (25.5%) and 3a (15.1%). In transmission network analysis, factors independently associated with clustering included the region (OR: 0.37, 95% CI: 0.19-0.71), infection subtype (OR: 0.23, 95% CI: 0.1-0.52), and sampling period (OR: 0.43, 95% CI: 0.27-0.68). The history of the major HCV subtypes was complex, which coincided with some important sociomedical events in China. Of note, five of eight HCV subtype (1a, 1b, 2a, 3a, and 3b), which constituted 81.8% HCV strains genotyped in our study, showed a tendency towards decline in the effective population size during the past decade until present, which is a good omen for the goal of eliminating HCV by 2030 in China., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Ye et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: To estimate secular trends and disease burden of diabetes and prediabetes among Chinese adults., Methods: Three population-based surveys were performed among Chinese adults in Shanghai in 2002-2003 (n = 12 302), 2009 (n = 7414), and 2017 (n = 18 960). Diabetes and prediabetes were defined using the 1999 World Health Organization (WHO) criteria. Cochran-Armitage trend test was used to examine the trends in prevalence, awareness, and glycemic control status. Disability adjusted life years (DALYs) were estimated to evaluate the disease burden of diabetes-related complications using the population attribution fraction approach based on published data., Results: The age-adjusted prevalence of diabetes increased during the 15-year period (p for trend <.001) and reached 23.0% (95% CI: 22.1 ~ 24.0%) in men and 15.7% (95% CI: 15.1 ~ 16.4%) among women in 2017. The prevalence of impaired glucose tolerance peaked in 2009, whereas that of impaired fasting glucose increased continuously (p for trend <.001). The awareness of diabetes was found to increase and the glycemic control rates decreased over the three surveys. The estimated DALYs of diabetes complications were found to have increased rapidly due to the increasing prevalence of diabetes and the decreasing glycemic control rates., Conclusions: Prediabetes and diabetes affect a considerable proportion of Chinese adults in Shanghai. Our results highlight the necessary to strengthen the community healthcare system in China to guarantee extensive management of diabetes and prediabetes., (© 2023 The Authors. Journal of Diabetes published by Ruijin Hospital, Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.)

Based on the relationship between industrial agglomeration, green finance development, and carbon emissions, some relevant theoretical hypotheses are proposed, and this paper employs the combination of spatial Durbin model and panel threshold model to empirically test data from 30 provincial regions in China from 2006 to 2019. The results show that the agglomeration of high energy-consuming industries has an inverse U-curve relationship with carbon emission intensity, and the development of green finance will inhibit the growth of carbon emission intensity. There are significant spatial characteristics of high energy-consuming industrial agglomeration, green financial development, and carbon emissions. And the intensity of local carbon emissions will be influenced by the agglomeration of high energy-consuming industrial agglomeration and green financial development in local and neighboring areas. Moreover, green financial development plays a moderating role in the relationship between high energy-consuming industrial agglomeration and carbon emissions, and the role of high energy-consuming industrial agglomeration and green financial development on carbon emissions has a threshold effect due to the mismatch between the two developments. Under different levels of green financial development, the influence of high energy-consuming industrial agglomeration on carbon emissions varies widely, and green financial development helps to suppress the negative impact of high energy-consuming industrial agglomeration on carbon emissions. Accordingly, we argue that inter-regional joint prevention and control mechanism should be established for pollution control. And China should build more effective high energy-consuming industrial clusters to make them play an active role in reducing emissions. At the same time, China should accelerate the construction of green finance, strengthen the disclosure and transparency of green financial information, and establish a joint mechanism for the development of inter-regional green finance, so that it can contribute to regional industrial transformation and pollution control., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Quarantine due to the COVID-19 pandemic may have created great psychological stress among vulnerable populations. We aimed to investigate the prevalence of anxiety and explore the association between physical activities (PA) and anxiety risk in people with non-communicable diseases during the period of COVID-19 lockdown., Methods: We conducted a cross-sectional telephone survey from February 25 to April 20, 2020, the period of COVID-19 lockdown in Shanghai. Up to 8000 patients with type 2 diabetes and/or hypertension were selected using multi-stage cluster random sampling. PA level was measured based on the International Physical Activity Questionnaire using Metabolic Equivalent for Task scores, while symptoms of anxiety were assessed by the 7-item Generalized Anxiety Disorder scale. Multiple logistic regression analyses were performed to evaluate the associations of type and level of PA with the risk of anxiety., Results: Of a total 4877 eligible patients, 2602 (53.4%) reported with anxiety, and 2463 (50.5%), 123 (2.5%) and 16 (0.3%) reported with mild, moderate, and severe anxiety. The prevalence of anxiety was higher in the females, the elders, non-smokers, non-drinkers, and patients with diabetes, and the associations of anxiety with sex, age, smoking, drinking and diagnosis of diabetes were significant. A significant negative association was observed for housework activities (OR 0.53, 95%CI: [0.45, 0.63], p < 0.001) and trip activities (OR 0.55, 95%CI: [0.48, 0.63], p < 0.001) with anxiety, but no significant was found for exercise activities (OR 1.06, 95%CI: [0.94, 1.20], p = 0.321). Compared with patients with a low PA level, those with a moderate (OR 0.53, 95%CI: [0.44, 0.64], p < 0.001) or a high PA level (OR 0.51, 95%CI: [0.43, 0.51], p < 0.001) had a lower prevalence of anxiety., Conclusion: This study demonstrates a higher prevalence of anxiety in patients with hypertension, diabetes, or both during the COVID-19 lockdown. The negative associations of housework and trip activities with anxiety highlight the potential benefit of PA among patients with non-communicable diseases., (© 2023. The Author(s).)

Understanding the mechanisms of grassland productivity variation is critical for global carbon cycling and climate change mitigation. Heretofore, it is unknown how different environmental factors drive small-scale spatial variation in productivity, and whether land use intensification, one of the most important global changes, can regulate the processes that drive productivity change. Here we performed an 18-year exclosure experiment across six sites with high-intensity mowing/grazing history in northern China to examine the effects of land use intensification on plant functional diversity, soil properties, and their relative contributions to above-ground net primary productivity (ANPP). We found that plant functional diversity and soil properties contributed to the variation in ANPP both independently and equally in enclosed grasslands (plant diversity: 20.6%; soil properties: 19.5%). Intensive land use significantly decreased the Rao's quadratic entropy (RaoQ) and community-weighted mean value (CWM) of plant height, and further suppressed the contributions of plant functional diversity to ANPP. In contrast, intensive land use increased soil available N, P, pH, electrical conductivity, and homogeneity of soil available P, and strengthened their contributions to ANPP (31.5%). Our results indicate that high-intensity land use practices in grasslands decrease the role of plant functional diversity, but strengthen the effects of soil properties on productivity. We, therefore, suggest that plant functional diversity can be used effectively to boost productivity in undisturbed grasslands, while soil properties might be a more critical consideration for grassland management in an areas with increased land use., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: The purpose of this study was to evaluate the accuracy and reliability of steps tracked by smartphone-based WeChat app compared with Actigraph-GT3X accelerometer in free-living conditions., Design: A cross-sectional study and repeated measures., Methods: A total of 103 employees in the Pudong New Area of Shanghai, China, participated in this study. The participants wore an ActiGraph-GT3X accelerometer during the period of August to September 2019 (Time 1), December 2019 (Time 2) and September 2020 (Time 3). Each time, they wore the ActiGraph-GT3X accelerometer continuously for 7 days to assess their 7-day step counts. The smartphone-based WeRun step counts were collected in the corresponding period when subjects wore accelerometers. The subjects were invited to complete basic demographic characteristics questionnaires and to perform physical examination to obtain health-related results such as height, body weight, body fat percentage, waist circumference, hip circumference, and blood pressure., Results: Based on 103 participants' 21 days of data, we found that the Spearman correlation coefficient between them was 0.733 ( P < 0.01). The average number of WeRun steps measured by smartphones was 8,975 (4,059) per day, which was higher than those measured by accelerometers (8,462 ± 3,486 per day, P < 0.01). Demographic characteristics and different conditions can affect the consistency of measurements. The consistency was higher in those who were male, older, master's degree and above educated, and traveled by walking. Steps measured by smartphone and accelerometer in working days and August showed stronger correlation than other working conditions and time. Mean absolute percent error (MAPE) for step counts ranged from 0.5 to 15.9%. The test-retest reliability coefficients of WeRun steps ranged from 0.392 to 0.646. A multiple regression analysis adjusted for age, gender, and MVPA/step counts measured during Time 1 showed that body composition (body weight, BMI, body fat percentage, waist circumference, and hip circumference) was correlated with moderate-to-vigorous intensity physical activity, but it was not correlated with WeRun step counts., Conclusions: The smartphone-based WeChat app can be used to assess physical activity step counts and is a reliable tool for measuring steps in free-living conditions. However, WeRun step counts' utilization is potentially limited in predicting body composition., Competing Interests: YS was employed by Winning Ringnex Technology (Shanghai) Co., Ltd. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Yao, Wang, Sun, Zhang, Sun, Cheng, Yang, Wang, Huang, Lin and Jia.)

The siting of enterprises is important for enterprises to formulate business objectives and business strategies, both of which are crucial to the development of enterprises in the future. Although there exists an irrefutable fact that the increasingly serious environmental problems are affecting the behaviors of enterprises, how air pollution affects the siting of enterprises has received little academic attention. Therefore, using the dataset of Chinese prefecture-level cities from 2014 to 2020, this paper employs the Spatial Durbin Model to investigate the direct and spatial spillover effects of air pollution on the site selection of enterprises. In addition, this paper also establishes a mediation effect model to explore the impact mechanism of air pollution on the site selection of enterprises. The empirical results show that air pollution exerts a negative impact on both the local and spatially related regions' enterprises' site selection, and the above conclusion is reinforced through a series of robustness checks. The heterogeneity analysis demonstrates that air pollution has a greater inhibitory effect on the siting of low-cleaning enterprises and small-scale enterprises for the local and adjacent regions. The mechanism analysis results indicate that air pollution inhibits the siting of enterprises by reducing the local labor endowment and market scale. Our study enriches the relevant theory of air pollution and enterprises' location nexus, and it also provides an empirical basis for the Chinese government to formulate policies related to air governance and the siting of enterprises.

Background: Physical activity (PA) brings many benefits to pregnant women and fetuses; however, the majority of pregnant women do not participate actively in PA during pregnancy., Objectives: This study aimed to: (1) assess the utility of Multi-Theory Model (MTM) to explain the intentions of PA behavior in Chinese pregnant women; (2) analyze the predictors in initiating and maintaining PA behavior based on MTM., Methods: A cross-sectional study including pregnant women was conducted from March to June 2022 at a university hospital in Hangzhou, Zhejiang Province, China. Participants completed measures that included a self-developed demographic questionnaire and a 29-item MTM questionnaire. Descriptive statistics and stepwise multiple regression were used to analyze the data. The reliability was assessed by Cronbach's alpha and test-retest stability. The construct validity was evaluated by using exploratory factor (EFA) analysis and confirmatory factor analysis (CFA)., Results: A total of 450 pregnant women participated in this study. The score of the magnitude of intention to initiate and maintain PA behavior during pregnancy was 2.30 (1.08) and 2.24 (1.09). The overall Cronbach's alpha value was 0.857. A four-factor structure for initiation model and a three-factor structure for maintenance model were determined. Results of the CFA confirmed construct validity of subscales (initiation model: χ 2 = 206.123, df = 140, p < 0.001, χ 2 /df = 1.472, RMSEA = 0.046, SRMR = 0.0432, GFI = 0.913, CFI = 0.982; maintenance model: χ 2 = 49.742, df = 29, p < 0.001, χ 2 /df = 1.715, RMSEA = 0.057, SRMR = 0.0432, GFI = 0.958, CFI 0.985). The result of regression indicated that participatory dialogue (β = 0.030; p = 0.002), behavioral confidence (β = 0.128; p < 0.001), changes in physical environment (β = 0.041; p = 0.005), trimester (β = -0.192; p = 0.001), and Gestational Diabetes Mellitus (GDM) (β = 0.408; p < 0.001) explained 52.1% variance in initiating PA behavior. Emotional transformation (β = 0.197; p < 0.001), practice for change (β = 0.083; p = 0.001), changes in social environment (β = 0.063; p < 0.001), pre-pregnancy exercise habit (β = -0.251; p = 0.001), and GDM (β = 0.298; p = 0.003) were significantly associated with pregnant women's intentions to maintain PA behavior and explained 49.1% variance., Conclusions: The constructs of MTM were effective in explaining the intention to initiate and maintain PA behavior among Chinese pregnant women.

Background: Cryptosporidium is one of the most prevalent parasites infecting both birds and mammals. To examine the prevalence of Cryptosporidium species and evaluate the public health significance of domestic chickens in Guangdong Province, southern China, we analyzed 1001 fecal samples from 43 intensive broiler chicken farms across six distinct geographical regions., Methods: Individual DNA samples were subjected to nested PCR-based amplification and sequencing of the small subunit of the nuclear ribosomal RNA gene (SSU rRNA). Analysis of the 60 kDa glycoprotein gene (gp60) was performed to characterize the subtypes of C. meleagridis., Results: The overall prevalence of Cryptosporidium was 13.2% (95% CI 11.1-15.3) (24 of 43 farms), with C. meleagridis (7.8%), C. baileyi (4.8%) and mixed infections (0.6%). Using the gp60 gene, three subtype families, IIIb, IIIe and IIIg, were identified, including six subtypes: one novel (IIIgA25G3R1a) and five previously reported (IIIbA23G1R1c, IIIbA24G1R1, IIIbA21G1R1a, IIIeA17G2R1 and IIIeA26G2R1). Within these subtypes, five known subtypes were genetically identical to those identified in humans., Conclusions: This is the first report of C. meleagridis in chickens from Guangdong. The frequent occurrence of C. meleagridis in domestic chickens and the common C. meleagridis subtypes identified in both humans and chickens is of public health significance. Our study indicates that broiler chickens represent a potential zoonotic risk for the transmission of Cryptosporidium in this region., (© 2022. The Author(s).)

The microeconomic behavior of enterprises is influenced by the government system and its policies. In this article, we investigate how environmental regulation and environmental decentralization affect enterprise environmental protection investment using the data of China's listed companies from 2009 to 2020 and examine the effect of environmental decentralization on the relationship between environmental regulation and environmental protection investment. First, we find that there is a "U-shaped" relationship between environmental regulation and enterprise environmental protection investment. Second, the estimation results indicate that environmental decentralization can promote enterprise environmental protection investment. Finally, we further provide evidence to show that environmental decentralization has a negative moderating impact on the relationship between environmental regulation and enterprise environmental protection investment. Accordingly, the conclusion of this study is helpful to optimize the environmental decentralization management system, reasonably guide the local government behavior, alleviate the contradiction between environmental protection and economic development, and promote the green transformation of economic development mode., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Liu, Ren, He and Zheng.)

HIV subtypes convey important epidemiological information and possibly influence the rate of disease progression. In this study, HIV disease progression in patients infected with CRF01&#95;AE, CRF07&#95;BC, and subtype B was compared in the largest HIV molecular epidemiology study ever done in China. A national data set of HIV pol sequences was assembled by pooling sequences from public databases and the Beijing HIV laboratory network. Logistic regression was used to assess factors associated with the risk of AIDS at diagnosis ([AIDSAD], defined as a CD4 count < 200 cells/µL) in patients with HIV subtype B, CRF01&#95;AE, and CRF07&#95;BC. Of the 20,663 sequences, 9,156 (44.3%) were CRF01&#95;AE. CRF07&#95;BC was responsible for 28.3% of infections, followed by B (13.9%). In multivariable analysis, the risk of AIDSAD differed significantly according to HIV subtype (OR for CRF07&#95;BC vs. B: 0.46, 95% CI 0.39─0.53), age (OR for ≥ 65 years vs. < 18 years: 4.3 95% CI 1.81─11.8), and transmission risk groups (OR for men who have sex with men vs. heterosexuals: 0.67 95% CI 0.6─0.75). These findings suggest that HIV diversity in China is constantly evolving and gaining in complexity. CRF07&#95;BC is less pathogenic than subtype B, while CRF01&#95;AE is as pathogenic as B., (© 2022. The Author(s).)

Green finance is one of the most important ways to help companies achieve green transformation and development. We construct a quasi-natural experiment with the "Green Credit Guidelines" and establish a difference-in-differences model to empirically test the implementation effect of the green credit policy in China. The results show that after the implementation of China's green credit policy, the debt financing scale of listed companies in heavily polluting industries has decreased significantly, the debt financing cost has increased significantly, and the debt financing maturity has been shortened significantly, indicating that the green credit policy has inhibited the debt financing of heavily polluting enterprises. We further find that this inhibition has also been affected by the nature of controlling shareholders, environmental information disclosure levels, regional environmental regulations and regional financial development levels. China's green credit policy has played a role in guiding listed companies to go green through the redistribution of debt financing., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Aims/introduction: Metabolic syndrome (MS) has been increasing worldwide. The secular change in MS components, however, remains unclear. This study aimed to examine the dynamic change in metabolic health status in Chinese adults., Materials and Methods: Three population-based surveys using multistage stratified sampling were performed in Chinese aged 35-74 years in Shanghai in 2002-2003 (n = 12,302), 2009 (n = 7,400), and 2017 (n = 19,023). MS was defined according to the Adult Treatment Panel III criteria for Asian-Americans. Generalized Estimating Equations and Cochran-Armitage Trend Test was used to assess the prevalence trend over the years., Results: The prevalence of MS doubled in Chinese adults over the period (P for trend < 0.001). The largest increase occurred in younger men. Among MS components, the prevalence of high waist-circumference (HWC), high blood glucose (HBG) and high blood pressure (HBP) increased in all subjects, whereas the prevalence of high triglycerides (HTG) and low high-density lipoprotein cholesterol (LHC) increased in men but decreased in women. The increase in HBP contributed most to elevated MS, followed by HBG and HWC, resulting in the HBP-HBG-HWC the most common cluster of MS components. Metabolically unhealthy overweight also grew over the period., Conclusions: Metabolic health status has been exacerbating in Chinese adults and may increase burden of non-communicable diseases., (© 2021 The Authors. Journal of Diabetes Investigation published by Asian Association for the Study of Diabetes (AASD) and John Wiley & Sons Australia, Ltd.)

Background: COVID-19 lockdowns may lead to physical inactivity, a major risk factor for non-communicable diseases. This study aims to determine: 1) the trajectory in daily step counts before, during and after the lockdown in China, and 2) the characteristics associated with the trajectories., Methods: From December 2019 to July 2020, smartphone-based step counts were continuously collected in 815 Chinese adults residing in Shanghai over 202 days across three phases: before, during, and after the lockdown. Participant characteristics were reported, and height, weight and body composition measured before the lockdown. A 'sharp' regression discontinuity design with cluster robust standard errors was used to test the effect of the lockdown and reopening on daily steps and a linear mixed model was used to examine the characteristics associated with trajectories during the observed period., Results: Based on 164,630 person-days of data, we found a sharp decline in daily step counts upon the lockdown (24/01/2020) by an average of 3796 (SE = 88) steps, followed by a significant trend of increase by 34 steps/day (SE = 2.5; p < .001) until the end of the lockdown (22/03/2020). This increasing trend continued into the reopening phase at a slower rate of 5 steps per day (SE = 2.3; p = 0.029). Those who were older, married, university educated, insufficiently active, had an 'at risk' body composition, and those in the control group, were slower at recovering step counts during the lockdown, and those who were older, married, without university education and with an 'at risk' body composition recovered step counts at a slower pace after the reopening., Conclusions: Despite later increases in step counts, COVID-19 lockdown led to a sustained period of reduced physical activity, which may have adverse health implications. Governments and health professionals around the world should continue to encourage and facilitate physical activity during the pandemic.

Background: The impacts of temperature variability on cardiac autonomic function remain unclear., Objective: To explore the short-term associations between daily temperature variability and parameters of heart rate variability (HRV)., Methods: This is a repeated-measure study among 78 eligible participants in Shanghai, China. We defined temperature variability as diurnal temperature range (DTR), the standard-deviation of temperature (SDT) and temperature variability (TV). We evaluated 3 frequency-domain HRV parameters (VLF, LF and HF) and 4 time-domain parameters (SDNN, SDANN, rMSSD and pNN50). We used linear mixed-effect models to analyze the data after controlling for environmental and individual confounders., Results: Temperature variability was significantly associated with decreased HRV, especially on the concurrent day. The exposure-response relationships were almost inversely linear for most parameters. Every one interquartile range (IQR) increase of DTR was associated with a decrease of 3.92% for VLF, 6.99% for LF, 5.88% for HF, 3.94% for rMSSD and 1.30% for pNN50. Each IQR increase of SDT was associated with a decline of 6.48% for LF, 5.91% for HF, 4.26% for rMSSD and 1.87% for pNN50. Every IQR increase of SDT was associated with a decrease of 4.39% for VLF, 7.67% for LF, 6.52% for HF, 3.22% for SDNN, 2.98% for SDANN, 4.05% for rMSSD, and 1.41% for pNN50. The decrements in HRV associated with temperature variability were more prominent in females., Conclusion: Temperature variability on the concurrent day could significantly decrease cardiac autonomic function, especially in females., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Available information is still insufficient for a comprehensive understanding of the global distribution of polybrominated diphenyl ethers (PBDEs) in the environment. In particular, little is known about the changing trend of their distribution in urban soils. We conducted a survey of 21 PBDEs in urban soils from Tianjin, China. The chemicals were widely present in the area and summed concentrations ranged from 0.65 to 108 ng/g in soil, indicating low to moderate levels of pollution relative to other areas. BDE-209 was the predominant congener, contributing 88.9% of the concentrations of total soil PBDEs. Source assessment indicated that soil PBDEs in the area were mainly derived from the release of commercial deca-BDE from local industrial production processes and consumer products. We found that the soil concentrations of PBDEs appear to have declined in recent years, compared with other previous reports in this region. However, more studies are needed on this possible change trend of PBDE pollution, especially its impact on human health, although their calculated non-carcinogenic health risks in this study were low.

Polycyclic aromatic hydrocarbons (PAHs) in river sediments in China have been extensively investigated. However, most previous studies only reported information about specific locations. As a result, the distribution and changes of these chemicals in sediments nationwide remain unknown. Based on published data during 1997-2020, we conducted a systematic meta-analysis to understand the concentration, risk and the spatiotemporal variation of PAHs in river sediments from the seven major river systems in China. The report provides a national picture of PAHs in river sediments of China. Among the seven river systems, higher concentrations of sediment PAHs are found in the basins of Liaohe River and Haihe River. In the study sediments, high-molecular-mass (4-6-ring) PAHs were predominated, reflecting the widespread combustion of coal and fossil fuels across China. In addition, PAH source assessment also suggests that raw coal and crude oil are important contributors to PAH concentrations in the rivers in northeastern China. Over the past 20 years, there is no downward trend in the concentrations of Σ 16 PAHs in sediments in the seven river basins; but the contribution of high-temperature combustion to the pollution has declined. In addition, our calculated risks from sediment PAHs seem to decline between 1997-2006 and 2007-2017 periods, although the differences were not statistically significant (p > 0.05). Of note, the data collection and the risk assessment methods used in this preliminary survey may result in some uncertainty. Our results suggest that the PAHs in river sediments in China still need to be paid attention to due to the complexity of their sources and harms to aquatic organisms., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: It remains unclear which size of particles has the strongest effects on heart rate variability (HRV)., Objective: To explore the association between HRV parameters and daily variations of size-fractionated particle number concentrations (PNCs)., Methods: We conducted a longitudinal repeated-measure study among 78 participants with a 24-h continuous ambulatory Holter electrocardiographic recorder in Shanghai, China, from January 2015 to June 2019. Linear mixed-effects models were employed to evaluate the changes of HRV parameters associated with PNCs of 7 size ranges from 0.01 to 10 μm after controlling for environmental and individual confounders., Results: On the concurrent day, decreased HRV parameters were associated with increased PNCs of 0.01-0.3 μm, and smaller particles showed greater effects. For an interquartile range increase in ultrafine particles (UFP, those < 0.1 μm, 2453 particles/cm 3 ), the declines in very-low-frequency power, low-frequency power, high-frequency power, standard deviation of normal R-R intervals, root mean square of the successive differences between R-R intervals and percentage of adjacent normal R-R intervals with a difference ≥ 50 ms were 5.06% [95% confidence interval (CI): 2.09%, 7.94%], 7.65% (95%CI: 2.73%, 12.32%), 9.49% (95%CI: 4.64%, 14.09%), 5.10% (95%CI: 2.21%, 7.91%), 8.09% (95%CI: 4.39%, 11.65%) and 24.98% (95%CI: 14.70%, 34.02%), respectively. These results were robust to the adjustment of criteria air pollutants, temperature at different lags, and the status of heart medication., Conclusions: Particles less than 0.3 μm (especially UFP) may dominate the acute effects of particulate air pollution on cardiac autonomic dysfunction., (Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.)

Polybrominated diphenyl ethers (PBDEs) in sediments of China have been extensively investigated; however, most studies conducted to date have focused on specific locations, and the pollution and risk posed by these chemicals in sediments at the national scale remain unknown. Therefore, we analyzed the concentrations and risks of PBDEs in sediments in China and their spatiotemporal variations based on available literature. Overall, the sediments across China contain moderate to high levels of PBDEs, with BDE-209 being the dominant congener, followed by BDE-47 and BDE-99. The sediment concentrations of PBDEs were highest in southern China and lowest in northeastern China. Additionally, based on their PBDE concentrations, 18.4%, 30.0%, and 11.9% of sediment samples from rivers, lakes, and coastal waters, respectively, posed low to moderate eco-toxicological risks, but 6.90% of river sediments posed high risks. Between 2001 and 2017, the concentrations and risks of PBDEs in the sediments from rivers and coastal waters tended to decrease gradually. Additionally, there were low to moderate risks from PBDEs in lake sediments, and the risks in 2012-2017 were 3.30 times higher than those in 2006-2011. However, more studies about the spatial and temporal trends in PBDEs in sediment across China and their impacts on aquatic organisms are needed because there is still a general lack of relevant information., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Short-term exposure to fine particulate matter (PM 2.5 ) has been associated with reduced heart rate variability (HRV), an established indicator of cardiac autonomic function, but it remains uncertain which specific constituents of PM 2.5 had key impacts., Objective: To examine the short-term associations between various PM 2.5 constituents and HRV measures., Methods: We conducted a retrospective panel study among 78 participants who received repeated 24-h electrocardiogram testing in Shanghai, China from 2015 to 2019. We obtained daily concentrations of 14 main chemical constituents of PM 2.5 from a fixed-site monitor. During 3 or 4 rounds of follow-ups, we measured 6 HRV parameters, including 3 frequency-domain parameters (power in very low frequency, low frequency and high frequency) and 3 time-domain parameters (standard deviation of normal-to-normal intervals, root mean square successive difference and percent of adjacent normal R-R intervals with a difference ≥50 msec). We used linear mixed-effects models to analyze the data after controlling for time trends, environmental and individual risk factors., Results: The average daily PM 2.5 exposure was 45.8 μg/m 3 during the study period. The present-day exposure to PM 2.5 had the strongest negative influences on various HRV indicators. These associations attenuated greatly on lag 1 d or lag 2 d. Elemental carbon, organic carbon, nitrate, sulfate, arsenic, cadmium, chromium and nickel were consistently associated with reduced HRV parameters in both single-constituent models and constituent-PM 2.5 models., Conclusion: Our study highlighted the key roles of traffic-related components of PM 2.5 in inhibiting cardiac autonomic function., Competing Interests: Declaration of competing interest The authors declared no conflicts of interests., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Cryptosporidium spp., Giardia duodenalis, and Blastocystis sp. are common intestinal protozoans that infect humans and animals worldwide. A survey that assessed the prevalence, molecular characteristics, and zoonotic potential of these pathogens was conducted on a variety of dogs in Guangzhou, southern China. A total of 651 canine stool samples from household (n = 199), shelter (n = 149), breeding (n = 237), and pet market dogs (n = 66) were collected from eight districts in Guangzhou. Cryptosporidium spp., Giardia duodenalis, and Blastocystis sp. were detected by PCR amplification of the SSU rRNA gene. Giardia duodenalis-positive specimens were further assigned into assemblages using the glutamate dehydrogenase gene. Cryptosporidium spp., G. duodenalis, and Blastocystis sp. were found in 21 (3.2%), 20 (3.1%), and 35 (5.4%) samples, respectively. The overall prevalence of shelter dogs (40.28%, 60/149) was significantly higher than that of household (3.0%, 6/199), breeding (2.1%, 5/237), and pet market dogs (7.5%, 5/66) (χ 2  = 154.72, df = 3, P < 0.001). Deworming in the past 12 months had a strong protective effect on the risk of contracting parasite infections (P < 0.001). No significant differences were detected between age or sex groups (P > 0.05). Dog-specific C. canis (n = 19) and zoonotic C. parvum (n = 2) were the only two Cryptosporidium species. Sequence analysis revealed the presence of three G. duodenalis assemblages: dog-specific assemblages D (n = 14) and C (n = 5), and cat-specific F (n = 1). Zoonotic Blastocystis ST3 (n = 28) was the dominant subtype, followed by ST1 (n = 6) and ST10 (n = 1). To our knowledge, this is the first large-scale investigation on the occurrence and molecular characteristics of Blastocystis sp. in dogs in China. Our results indicated that the dogs seemed to play a negligible role as reservoirs for Cryptosporidium spp. and G. duodenalis transmission to humans, but they are potential novel suitable hosts of Blastocystis sp. A strict sentinel surveillance system of dogs should be established to minimise the zoonotic risk of spreading blastocystosis among humans and dogs.

Background: The aim of this study was to explore the utility of circulating free DNA (cfDNA) in the evaluation of clinical tumor burden and survival in Chinese patients with metastatic colorectal cancer (mCRC) and to preliminarily summarize some metastatic characteristics associated with mutational status., Methods: A panel covering a total of 197 hotspot mutations of KRAS, NRAS, BRAF and PIK3CA was used to evaluate the mutational status in plasma by next-generation sequencing (NGS) technology in 126 patients with mCRC. An amplification-refractory mutation system (ARMS) was used to analyze genomic DNA from matched tissue samples. Clinical markers including carcinoembryonic antigen (CEA), carbohydrate antigen 199 (CA199), carbohydrate antigen 125 (CA125), neuron-specific enolase (NSE) and lactate dehydrogenase (LDH) in serum and the sum of all tumor diameters on CT or PET/CT were collected to indicate clinical tumor burden. The correlations between cfDNA and clinical tumor burden were analyzed using Pearson correlation and linear regression models. The median progression-free survival (PFS) and 1-year overall survival (OS) rates were calculated by Kaplan-Meier (K-M) survival analysis., Results: Of the 126 enrolled patients, patients who were tested positive for mutations in plasma accounted for 45.2% (57/126). Mutations in KRAS, NRAS, BRAF and PIK3CA were detected in 37.3% (47/126), 1.6% (2/126), 3.2% (4/126) and 13.5% (17/126) of patients, respectively. The overall concordance rate of mutational status between plasma and matched tissues was 78.6% (99/126). Sixteen patients had mutations in plasma that were not detected in tissue, including some rare hotspot mutations. The cfDNA concentration was significantly correlated with the levels of clinical markers, especially CEA (P < 0.0001, Pearson r = 0.81), LDH (P < 0.0001, Pearson r = 0.84) and the sum of tumor diameters (P < 0.0001, Pearson r = 0.80). Patients with a high cfDNA concentration (> 17.91 ng/ml) had shorter median progression-free survival (6.6 versus 11.7 months, P < 0.0001) and lower 1-year overall survival rate (56% versus 94%, P < 0.0001) than those with a low cfDNA concentration (≤17.91 ng/ml). The most common metastatic site was the liver (77.8%), followed by the lymph nodes (62.7%), lung (40.5%), peritoneum (14.3%) and bone (10.3%), in all patients. There was no significant difference in metastasis between different mutational statuses., Conclusion: Analyzing mutations in plasma could provide a more comprehensive overview of the mutational landscape than analyzing mutations in tissue. The cfDNA concentration could be a quantitative biomarker of tumor burden and could predict survival in Chinese patients with mCRC.

Background: Fine particulate matter (PM 2.5 ) air pollution has been associated with increased risks of acute myocardial infarction (AMI), but it remains unknown about the potentially differentiated effects of size-fractionated particulate matter on AMI risk., Objective: To identify the specific size ranges that dominate the effects of particulate matter on AMI onset., Methods: We conducted a time-series study in Shanghai, China from January 2014 to December 2018. We evaluated particle size distribution of 0.01 μm to 2.5 μm from an environmental supersite and AMI emergency hospitalizations from the largest cardiovascular hospital in Shanghai. We used over-dispersed generalized additive models to estimate the associations of size-fractionated particle number concentrations (PNC) with AMI and its types., Results: We identified a total of 4720 AMI emergency hospitalizations. PM 2.5 was significantly associated with increased AMI risk on the concurrent day. The associations were significant only for PNC < 0.3 μm. For an IQR increase of PNCs for size ranges 0.01-0.03 μm, 0.03-0.05 μm, 0.05-0.10 μm and 0.10-0.30 μm, AMI hospitalizations increased by 6.68% (95% CI: 2.77%, 10.74%), 6.53% (95% CI: 2.08%, 11.17%), 5.78% (95% CI: 0.92%, 10.88%) and 5.92% (95% CI: 1.31%, 10.74%), respectively. The associations of PNC < 0.05 μm remained significant when adjusting for other air pollutants. There were consistently much stronger associations of particles with ST-segment elevation AMI than those with non-ST-segment elevation AMI., Conclusions: This epidemiological investigation suggested that ultrafine particles, especially those <0.05 μm, may be mainly responsible for the acute AMI risk induced by PM 2.5 ., Competing Interests: Declaration of competing interest The authors declared no conflicts of interests., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Introduction: To compare the performance and the costs of various assumed screening strategies for type 2 diabetes mellitus (T2DM) among Chinese adults, and identify an optimal one for the population., Research Design and Methods: Two multistage-sampling surveys were conducted in Shanghai, China, in 2009 and 2017. All participants were interviewed, had anthropometry, measured fasting plasma glucose (FPG), hemoglobin A1c (A1c) and/or postprandial glucose. The 1999 WHO diagnostic criteria was used to identify undiagnosed T2DM. A previously developed Chinese risk assessment system and a specific risk assessment system developed in this study were applied to calculate diabetes risk score (DRS) 1 and 2. Optimal screening strategies were selected based on the sensitivity, Youden index and the costs using the 2009 survey data as the training set and the 2017 survey data as the validation set. A twofold cross-validation was also performed., Results: Of numerous assumed strategies, FPG ≥5.6 mmol/L alone performed well (Youden index of 71.8%) and cost least (US$18.4 for each case detected), followed by the strategy of DRS2 ≥8 combining with FPG ≥5.6 mmol/L (Youden index of 71.7% and US$20.2 per case detected) and the strategy of DRS1 ≥17 combining with FPG ≥5.6 mmol/L (Youden index of 72.0% and US$21.6 per case detected). However, FPG alone resulted in more subjects requiring oral glucose tolerance test (OGTT) than did combining with DRS. The strategy of FPG ≥5.6 mmol/L combining with A1c ≥4.7% achieved a Youden index of 72.1%, but had a cost as high as US$48.8 for each case identified. Twofold cross-validation also supported the use of FPG alone, but with an optimal cut-off of 6.1 mmol/L., Conclusions: Our results support the use of FPG alone in T2DM screening in Chinese adults. DRS may be used combining with FPG in populations with available electronic health records to reduce the number of OGTT and save costs of screening., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Enterocytozoon bieneusi, a common opportunistic fungal pathogen, has a wide range of hosts. Limited epidemiological data on E. bieneusi intestinal infections in companion animals (dogs and cats) in China exists. In this study, fecal samples (651 from dogs and 389 from cats) in Guangzhou city, Guangdong Province, China, were collected, and the ribosomal internal transcribed (ITS) spacer region from the DNA extracted from them was Polymerase Chain Reaction (PCR)-amplified and sequenced., Results: Based on the sequencing data, E. bieneusi was identified in the fecal samples collected from 149 (22.9%) and 79 (20.3%) dogs and cats. Of the factors investigated, poor living conditions appeared to be the major risk factor for contracting the pathogen. Eleven E. bieneusi genotypes, six known (PtEb IX, GD1, D, CD9, EbpC, I) and five novel (designated here as GD2- GD6), were found in dogs. Eight genotypes, six known (PtEb IX, GD1, D, CD9, EbpC, Type IV) and two novel (GD2 and GC1), were identified in cats. Genotype PtEb IX was most common in both dogs and cats, followed by genotype GD1., Conclusions: Although PtEb IX was the most common E. bieneusi genotype in dogs, this is the first report of this genotype dominating in cats. The same genotype distribution of the pathogen between the two different companion animals species in the same geographic area indicates that inter-species transmission is probable. The widespread existence of zoonotic E. bieneusi genotypes (D, EbpC, Type IV) in companion animals indicates that they are potential sources of environmental contamination and infections in humans.

Background: The benefits of physical activity (PA) have been well documented, and the worksite is a promising setting for PA promotion. The aims of this study were as follows: 1. To evaluate the effect of a group-based worksite intervention on PA and health-related outcomes by using pedometers. 2. To examine the associations between the change in vigorous physical activity (VPA)/moderate physical activity (MPA)/walking and health related outcomes., Methods: A total of 398 participants (221 in the intervention group (IG) and 177 in the control group (CG)) from 17 worksites were recruited for a prospective self-controlled trial of a worksite physical activity intervention program in China. In the IG, a pedometer was utilized to self-monitor the PA, together with group competition, goal setting, and other incentives. No intervention was applied to the CG. Physical activity, sedentary behavior, and health-related outcomes were measured at baseline and immediately after the 100-day period intervention., Results: A total of 262 participants completed the program (68.3% adherence). Adherence in the intervention group was 67.9% (n = 150/221). Improvements between baseline and follow-up among intervention participants were observed in the following parameters: VPA (+ 109.7 METs/week; p < 0.05), walking (+ 209.2 METs/week; p < 0.01), systolic blood pressure (SBP; - 2.1 mmHg; p < 0.01), waist circumference (WC; - 2.3 cm; p < 0.01), body fat percentage (BF); - 1.0%; p < 0.01), and body mass index (BMI; - 0.5 kg/m 2 ; p < 0.01). VPA was related to changes in body fat percentage (p < 0.05) and body mass index (p < 0.05)., Conclusion: This integrated group-based intervention program contributed to comprehensive improvement in health-related outcomes. The study was useful for establishing associations between change in VPA/MPA/walking and health-related outcomes in a natural setting. Long-term evaluation is required to examine the potential of such an integrated intervention to promote PA., Registration: This study was prospectively registered in the Chinese Clinical Trial Registry., Trial Registration Number: ChiCTR-1,800,015,529. Date of registration: April 5, 2018.

To estimate the incidence of pulmonary tuberculosis (PTB) in Chinese diabetes patients and to evaluate the effect of blood glucose on PTB risk, a retrospective cohort study was built based on the diabetes management system in Shanghai and included 240,692 adults aged 35 or above. Incidences of PTB in all diabetes patients and by subgroups were calculated and compared. Multivariable Cox regression models with restricted cubic splines were used to evaluate the association of fasting plasma glucose (FPG) with the risk of PTB. A total of 439 incident PTB cases were identified in the cohort after an average of 3.83 years of follow-up. The overall PTB incidence rate was 51.3/100,000 in diabetes patients, and annual incidence remained higher than that in general population. The PTB incidence rate of diabetes patients was higher in men than in women (86.2 vs. 22.1 per 100,000) and was highest in patients with body mass index (BMI) < 18.5 kg/m 2 (215.2/100,000) or FPG ≥ 10 mmol/L (143.2/100,000). Our results suggest that the risk of tuberculosis may be greater at higher levels of FPG in diabetes patients of normal weight. Specific tuberculosis screening strategies for different characteristic diabetes population should be provided to prevent and control tuberculosis in China.

The benefits of physical activity for successful aging are well established. Few interventions however, target older Asian Americans who may have distinct needs for cultural and linguistic tailoring. The heterogeneity among Asian Americans underscores the need to elucidate specific physical activity preferences by ethnic subgroup. To better understand older Chinese Americans' perceptions about physical activity, we conducted a community-engaged, mixed methods study with 60 participants. Through survey and focus groups, four emerging themes characterized perceptions of physical activity: (a) physical activities benefit the body and mind, (b) traditional Chinese culture influences perceptions and preferences for physical activity, (c) physical activity presents opportunities for social engagement, and (d) physical activity facilitates family harmony. Design recommendations includes encouraging mind-body approaches, incorporating culturally specific practices, highlighting opportunities for social engagement, and emphasizing the potential for improved harmony.

Background: Adults with chronic conditions such as heart disease, diabetes, or lung disease are more likely to develop complications from a number of vaccine-preventable diseases, including influenza and pneumonia. In this study, we use the data from a chronic disease management information system in Shanghai to estimate vaccination coverage and characterize predictors of seasonal influenza and 23-valent pneumococcal polysaccharide vaccine (PPSV23) vaccination among people with chronic disease in Shanghai., Methods: The Shanghai Centers for Disease Control and Prevention have information systems related to chronic disease management, hospital records, and immunizations. Data from individuals with hypertension, diabetes and chronic obstructive pulmonary disease (COPD) were abstracted during July 2017. The main outcome was coverage of pneumococcal and influenza vaccination. Vaccination coverage was calculated across demographic groups. Significance in bivariate associations was assessed through Pearson's chi-square tests, and in multivariable models through logistic regression models with a forward stepwise method to select variables., Results: In the sample of 2,531,227 individuals ≥15 years, 22.8% were vaccinated for pneumonia from January 2013 to July 2017, and the vaccination coverage of influenza in the 2016/17 influenza season was 0.4%. Vaccination coverage was highest in those 70-79 and lowest in those younger than 60. Compared to urban areas, uptake in rural areas was higher for pneumonia vaccination (OR: 2.43, 95% CI: 2.41, 2.45), but lower for influenza vaccination (OR: 0.55, 95% CI: 0.51, 0.59). Having a greater number of chronic diseases was associated with higher likelihood of pneumonia vaccination (3 vs 1: OR: 1.68, 95% CI: 1.64, 1.71), but this relationship was not statistically significant for influenza vaccination., Conclusions: We found low levels with of pneumococcal vaccination, and extremely low uptake of influenza vaccination among individuals with high risk conditions in Shanghai who should be priority groups targeted for vaccination. Interventions could be designed to target groups with low uptake - like younger adults, and individuals who have not yet retired.

China has 747,000 confirmed HIV/AIDS cases and sexual transmission between men who have sex with men (MSM) is the most prevalent mode of transmission. Our study aims to (a) examine HIV prevalence and behavioral risk factors for HIV infection among 1900 MSM recruited from a community-based organization in Tianjin, China, and (b) describe HIV treatment outcomes for those diagnosed with HIV. We used multivariable logistic regression to identify which socio-demographics and behaviors were associated with HIV infection. The overall HIV prevalence was 3.95%. Key behavioral risk factors included: receptive sex role, older age at first sex with man, condomless anal sex, and having used 2+ drugs. Of those living with HIV, 83% were successfully enrolled in antiretroviral therapy and those enrolled were all virally suppressed after one year. These findings highlight key behavioral risk factors for HIV infection in Tianjin, China and can inform interventions to preventing further HIV transmission.

Background Evaluating the tumor RAS/BRAF status is important for treatment selection and prognosis assessment in metastatic colorectal cancer (mCRC) patients. Correction of artifacts from library preparation and sequencing is essential for accurately analyzing circulating tumor DNA (ctDNA) mutations. Here, we assessed the analytical and clinical performance of a novel amplicon-based next-generation sequencing (NGS) assay, Firefly™, which employs a concatemer-based error correction strategy. Methods Firefly assay targeting KRAS/NRAS/BRAF/PIK3CA was evaluated using cell-free DNA (cfDNA) reference standards and cfDNA samples from 184 mCRC patients. Plasma results were compared to the mutation status determined by ARMS-based PCR from matched tissue. Samples with a mutation abundance below the limit of detection (LOD) were retested again by droplet digital polymerase chain reaction (ddPCR) or NGS. Results The Firefly assay demonstrated superior sensitivity and specificity with a 98.89% detection rate at an allele frequency (AF) of 0.2% for 20 ng cfDNA. Generally, 40.76% and 48.37% of the patients were reported to be positive by NGS of plasma cfDNA and ARMS of FFPE tissue, respectively. The concordance rate between the two platforms was 80.11%. In the pre-treatment cohort, the concordance rate between plasma and tissue was 93.33%, based on the 17 common exons that Firefly™ and ARMS genotyped, and the positive percent agreement (PPA) and negative percent agreement (NPA) for KRAS/NRAS/BRAF/PIK3CA were 100% and 99.60%, respectively. Conclusions Total plasma cfDNA detected by Firefly offers a viable complement for mutation profiling in CRC patients, given the high agreement with matched tumor samples. Together, these data demonstrate that Firefly could be routinely applied for clinical applications in mCRC patients.

Objectives: The study aimed to examine the diabetes-related self-care activities (DRSCA) in association with positive health consisting of resilience, subjective well-being (SWB) and disease-related quality of life (DRQoL), and the associations of background information with resilience, SWB and DRQoL., Design: A cross-sectional study., Methods: A convenience sample of people with type 2 diabetes (T2DM) was recruited from two tertiary hospitals in eastern China. Self-reported survey data included DRSCA, resilience, SWB, DRQoL, and background information comprising demographics and social support. Data were analysed using hierarchical multiple regression analyses., Results: Two hundred and forty-six valid questionnaires were analysed. Among the components of positive health, hierarchical multiple regression analysis showed that DRSCA were significantly associated with improved SWB (β=0.140, p=0.020), but not with resilience and DRQoL after adjusting for background information. Participants with higher level of education had higher resilience and men had higher SWB than women. Social support (β=0.186, p=0.003) in Model 1 and resilience (β=0.298, p<0.001) in Model 2 were positively associated with SWB., Conclusions: This study indicated an association between DRSCA and one component of positive health, namely SWB. This finding could help motivate patients to perform DRSCA and to improve SWB in people with T2DM. In addition, the fact that demographics, for example, gender, were associated with SWB and education was associated with resilience also needs to be accommodated when aiming to improve SWB and build resilience., Trial Registration Number: NCT02594748., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: Leptin may be associated with cardiovascular disease. We tested to determine whether leptin is a marker for first-ever acute ischemic stroke (AIS) in a nested case-referent study., Methods: Consecutive patients with first-ever AIS from May 2017 to December 2017 were included. Referents were matched for sex, age and body mass index. Serum leptin levels and routine tests were examined in both groups., Results: The median serum level of leptin in the stroke patients was 14.3 (interquartile range [IQR], 7.2-21.7) ng/ml, which was significantly higher (P < 0.001) than in the referents (10.7; 5.7-13.6 ng/ml). There was a positive correlation between serum level of leptin and National Institute of Health Stroke Scale score (r[Spearman] = 0.43, P < 0.001). In addition, serum leptin levels paralleled lesion size. Median serum level of leptin in patients with small lesions, medium lesions and large lesions was 7.3 (IQR, 5.3-14.3) ng/ml, 13.9 (IQR, 7.0-21.3) ng/ml, 20.5 (IQR, 12.4-32.7) ng/ml, respectively (analysis of variance: P < 0.001). In the univariate model matching for sex and age, leptin as a continuous variable was associated with AIS, after adjustment for possible confounders (odds ratio [OR] 1.07, 95% confidence interval [CI]: 1.04-1.11; P < 0.001). After adjusting for all other factors, leptin remained an independent stroke predictor with an adjusted OR of 1.03 (95% CI, 1.00-1.10; P = 0.006). Interestingly, the association between AIS and leptin level was more pronounced among men (adjusted OR = 1.05, 95% CI: 1.01-1.12; P < 0.001) when compared with women (adjusted OR = 1.03, 95% CI: 1.10-1.11; P = 0.009)., Conclusion: Serum leptin is associated with first-ever AIS, lesion size and stroke severity in a Chinese cohort.

HIV prevalence and incidence is high among men who have sex with men (MSM) in China, underscoring the need to support and optimize HIV risk reduction strategies for this population. We sought to estimate the prevalence of condomless anal sex among MSM living in Tianjin, China. We recruited 595 HIV-negative MSM living in Tianjin to participate in a HIV study between 2013 and 2014. Data were collected after a voluntary counseling and testing session through a face-to-face survey. We used multivariable logistic regressions to examine the association between sociodemographic characteristics and HIV risk correlates and MSM's likelihood of engaging in condomless anal intercourse with main and casual partners in the prior 6 months. Results are presented. HIV risk reduction efforts should be developed to be sensitive and responsive to the unique experiences of Chinese MSM. We discuss opportunities for future work, including the development HIV risk reduction interventions.

Bluetongue virus (BTV) mainly infects sheep but can be transmitted to other domestic and wild ruminants, resulting in a considerable financial burden and trade restriction. Our understanding of the origin, movement, and distribution of BTV has been hindered by the fact that this virus has a segmented genome with the possibility of reassortment, the existence of 27 identified serotypes, and a lack of complete sequences of viruses isolated from different parts of the world. BTV serotype 7 is one of the prevalent BTV serotypes in Asia. Nonetheless, no complete genomic sequence of an Asian isolate of this serotype is available. In an effort to understand the molecular epidemiology of BTV infection in China, for the first time, we report here the complete genome sequence of a BTV serotype 7 strain, GDST008, which was isolated in 2014 in China. This sequence also represents the first complete genome sequence of a BTV serotype 7 from Asia and the third one in the world. Sequence analysis suggests that GDST008 consists of segments from BTV viruses of African lineage as well as those from China. Together, these results improve our understanding of the origin, emergence/re-emergence, and movement of BTV and thus can be applied in the development of vaccines and diagnostics.