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Abstract Background Previous studies only considered the impact of a single physical or psychological disorder on dementia. Our study investigated the association of physical and psychological multimorbidity with dementia among older adults using two multinational prospective cohorts to supplement the limited joint evidence. Methods We utilized the Health and Retirement Study (HRS 2012 to 2018) in the United States (US) and the Survey of Health, Ageing and Retirement in Europe (SHARE 2012 to 2018). Physical disorder was defined as any one of seven self-reported physician-diagnosed conditions. Psychological disorder was assessed using the 8-item Center for Epidemiologic Research Depression (CES-D) scale or the EURO-D. Dementia was determined through a combination of self-reported physician diagnosis of dementia or Alzheimer’s disease, or the 27-point HRS cognitive scale. Competing risk models were utilized to estimate the hazard ratios (HRs) and 95% confidence intervals (95% CI). DerSimonian-Laird random-effects meta-analyses were conducted to obtain pooled estimates. Results The prevalence of physical and psychological multimorbidity was 17.29% (1027/5939) in continental Europe and 15.52% (1326/8543) in the US. The incidence of dementia was 6.21 per 1000 person-years in continental Europe and 8.27 per 1000 person-years in the US, respectively. It was highest among participants with physical and psychological multimorbidity in continental Europe (10.46 per 1000 person-years) and the US (14.82 per 1000 person-years), compared with the other three groups. In the univariate model, participants who reported physical and psychological multimorbidity had a higher risk of dementia compared with those who reported no physical and psychological disorders in continental Europe (HR = 2.59; 95% CI: 1.55, 4.33) and the US (HR = 4.11; 95% CI: 2.44, 6.94). After adjusting all covariates, the risk of dementia among participants who reported physical and psychological multimorbidity increased by 86% in continental Europe (aHR = 1.86; 95% CI: 1.08, 3.21) and by 176% in the US (aHR = 2.76; 95% CI: 1.61, 4.72), respectively. After pooling the outcomes, the risk of dementia among participants who reported physical and psychological multimorbidity increased by 115% (aHR = 2.15; 95% CI: 1.27, 3.03). Conclusions Physical and psychological multimorbidity was prevalent among older adults in the US and continental Europe. Given the consistent associations with dementia, it is imperative to increase awareness of the links and recognize the limitations of single-disorder care. Specific attention should be given to providing care coordination.

Abstract Senecavirus A (SVA), an emerging virus that causes blisters on the nose and hooves, reduces the production performance of pigs. RSAD2 is a radical S-adenosylmethionine (SAM) enzyme, and its expression can suppress various viruses due to its broad antiviral activity. However, the regulatory relationship between SVA and RSAD2 and the mechanism of action remain unclear. Here, we demonstrated that SVA infection increased RSAD2 mRNA levels, whereas RSAD2 expression negatively regulated viral replication, as evidenced by decreased viral VP1 protein expression, viral titres, and infected cell numbers. Viral proteins that interact with RSAD2 were screened, and the interaction between the 2 C protein and RSAD2 was found to be stronger than that between other proteins. Additionally, amino acids (aa) 43–70 of RSAD2 were crucial for interacting with the 2 C protein and played an important role in its anti-SVA activity. RSAD2 was induced by type I interferon (IFN-I) via Janus kinase signal transducer and activator of transcription (JAK-STAT), and had antiviral activity. Ruxolitinib, a JAK-STAT pathway inhibitor, and the knockdown of JAK1 expression substantially reduced RSAD2 expression levels and antiviral activity. Taken together, these results revealed that RSAD2 blocked SVA infection by interacting with the viral 2 C protein and provide a strategy for preventing and controlling SVA infection.

Abstract Background Environmental factors greatly impact infectious disease-related mortality, yet there's a lack of comprehensive global studies on the contemporary burden and trends. This study aims to evaluate the global burden and trends of infectious disease mortality caused by air pollution, unsafe water, poor sanitation, and non-optimal temperature across Socio-Demographic Index (SDI) regions from 1990 to 2019. Methods This observational study utilized data from the Global Burden of Diseases Study to examine mortality rates from infectious diseases attributed to environmental risk factors between 1990 and 2019, including air pollution, unsafe water, sanitation, handwashing facilities (UWSH), and non-optimal temperatures. Age-standardized mortality rates (ASMRs) and estimated annual percentage change (EAPC) were utilized to present infectious disease mortality, and its trajectory influenced by environmental risk factors over the years. Nonlinear regression was conducted to explore the association between the SDI and ASMRs across regions from 1990 to 2019. Results In 2019, global infectious disease deaths linked to air pollution, UWSH, and non-optimal temperature reached a startling 2,556,992. Disease mortality varied widely across SDI regions, with the highest number of deaths due to air pollution and UWSH in Low SDI regions, and deaths from non-optimal temperature primarily in High SDI regions. Age disparities emerged, with children under five and the elderly most affected. However, an increasing mortality trend was observed among seniors (65–69, 75–79, and over 80) in High SDI regions due to enteric infections linked to UWSH. Globally, a consistent decrease in ASMR was seen from 1990 to 2019 for all diseases connected to these factors, except for respiratory infections linked to non-optimal temperature. Conclusions Our study underscores the significant impact of air pollution, UWSH, and non-optimal temperatures on global infectious disease mortality, particularly among vulnerable groups such as children and the elderly. It's important to tackle these challenges with targeted interventions aiming to enhance environmental quality, improve water and sanitation systems, and control extreme temperatures. In addition, international cooperation is essential for bridging regional disparities and driving global public health initiatives forward, thereby helping achieve Sustainable Development Goals more effectively.

Background: Zika virus (ZIKV) infection during pregnancy presents a significant health risk in women of reproductive age and their offspring due to severe neurological complications. It is meaningful to assess its global burden and temporal trends. Methods: This study extracted annual incidence cases and rates of ZIKV among women of reproductive age (15–49 years) between 2011 and 2021 from Global Burden of Diseases (GBD) 2021, including global level, 21 GBD regions, 5 socio-demographic index (SDI) regions, 7 age groups, and 204 countries and territories. Relative percent change in cases and estimated annual percentage change (EAPC) of incidence rates were used to quantify the temporal trends. Results: The incidence rate of ZIKV infection exhibited a pronounced peak in 2016 at 174.27 per 100,000 population, with an EAPC of 158.30 % from 2011 to 2016 and −51.86 % from 2016 to 2021 at 3.06 per 100,000 population. And only 5 out of the 21 GBD regions reported ZIKV infection in 2021, predominantly concentrated in Latin America and Caribbean. The outbreaks were primarily concentrated in low-middle and middle SDI regions. In 2021, at the global level, the incidence rates of ZIKV infection among women of reproductive age were similar across different age groups, ranging from 2.41 to 3.39 per 100,000 population. The proportion of ZIKV infection cases was slightly higher in women aged 25–29 and 30–34 years compared to other age groups in 2021, whereas a higher proportion of cases were observed in younger age groups in 2011 and 2016. Conclusions: Women of reproductive age in Latin America and Caribbean continue to face the threat of ZIKV. Regions with lower SDI had a disproportionately severe burden. Future public health strategies should focus on high-risk areas and populations of reproductive age, enhancing surveillance, prevention, and education efforts to further mitigate the public health threat posed by ZIKV.

Malignant tumors are among the most important causes of death worldwide. The pathogenesis of a malignant tumor is complex and has not been fully elucidated. Studies have shown that such pathogenesis is related to abnormal cell cycle progression. The expression levels of cyclins, cyclin-dependent kinases (CDKs), and CDK inhibitors as well as functions of the cell cycle checkpoints determine whether the cell cycle progression is smooth. Cell-cycle-targeting drugs have the advantages of high specificity, low toxicity, low side effects, and low drug resistance. Identifying drugs that target the cell cycle and applying them in clinical treatments are expected to promote chemotherapeutic developments against malignant tumors. This article aims to review drugs targeted against the cell cycle and their action mechanisms.

Objectives To estimate the interaction between economic status (ES) and healthy lifestyle in long COVID among Chinese older people infected with SARS-CoV-2.Design A cross-sectional study based on the Peking University Health Cohort in Anning, Yunnan.Setting All primary health institutions in Anning, Yunnan Province, China, from April to May 2023.Participants A total of 4804 people aged 60 and older infected with SARS-CoV-2 were included in this study.Primary and secondary outcome measures Long COVID was measured by participants’ self-reported symptoms using structured questionnaires. ES was measured by last-month personal income, and participants’ ES was defined as low if their income was below the per capita monthly income of local residents. Lifestyle score was equal to the number of healthy behaviours (including smoking, drinking, weight, exercise and diet) and grouped using the median score as the cut-off point. Univariate and multivariate logistic models were employed to estimate the association of ES with long COVID. Interaction between ES and lifestyle in long COVID was assessed by multiplicative interaction term.Results We enrolled a total of 4804 participants infected with SARS-CoV-2, of whom 57.3% (2754 of 4804) had at least one long COVID symptom. Fatigue (1546, 56.1%), cough (1263, 45.9%) and muscle pain (880, 32.0%) were the top three common symptoms. Patients with low ES had a 48% (adjusted OR: 1.48; 95% CI 1.22, 1.82) increased risk of long COVID. A significant interaction was observed between ES and lifestyle (p value for interaction

On April 29, 2020, China entered a normalization stage of prevention and control. By December 2021, more than 40 outbreaks had occurred in China, which reflected the shortcomings of the pandemic prevention and control measures in China at that time. As the capital city of China, Beijing faces more pressure in epidemic prevention and control. We used the COVID-19 cluster containment evaluation indicators to determine the effects of prevention and control measures on four COVID-19 outbreaks in Beijing. After considering the specificity and operability of evaluation indicators and the availability of evaluation data, the evaluation system in our study consisted of six dimensions: epidemic prevention and control effect, discovery and detection ability, precision prevention and control capability, public protection effect, medical treatment and nosocomial infection prevention and control ability, and information release and public opinion response ability. The composite scores of the prevention and control effects of the Xinfadi, Shunyi, Daxing, and Ejina Banner–associated COVID-19 outbreaks in Beijing were 62, 82, 87, and 76, respectively. In the six dimensions, the epidemic prevention and control effect, discovery and detection ability, precision prevention and control capability, and public protection effect scores for the Xinfadi outbreak were lower than those for the Shunyi, Daxing and Ejina Banner–associated outbreaks. The medical treatment and nosocomial infection prevention and control ability scores for the outbreak associated with Ejina Banner were lower than those for the Xinfadi, Shunyi, and Daxing outbreaks. In managing cluster outbreaks, Beijing was able to detect index cases early enough to reduce the scale and duration of the outbreak and consistently release official information to reduce public panic, standardize the management of centralized quarantine sites to prevent cross-infection, adhere to the “dynamic COVID‐zero” strategy to accurately prevent and control outbreaks, reduce the societal influence of the pandemic, and coordinate the epidemic prevention and control and socio-economic development.

Abstract To enable high performance of all solid-state batteries, a catholyte should demonstrate high ionic conductivity, good compressibility and oxidative stability. Here, a LaCl3-based Na+ superionic conductor (Na1 − x Zr x La1 − x Cl4) with high ionic conductivity of 2.9 × 10−4 S cm−1 (30 °C), good compressibility and high oxidative potential (3.80 V vs. Na2Sn) is prepared via solid state reaction combining mechanochemical method. X-ray diffraction reveals a hexagonal structure (P6 3 /m) of Na1 − x Zr x La1 − x Cl4, with Na+ ions forming a one-dimensional diffusion channel along the c-axis. First-principle calculations combining with X-ray absorption fine structure characterization etc. reveal that the ionic conductivity of Na1 − x Zr x La1 − x Cl4 is mainly determined by the size of Na+-channels and the Na+/La3+ mixing in the one-dimensional diffusion channels. When applied as a catholyte, the NaCrO2||Na0.7Zr0.3La0.7Cl4||Na3PS4||Na2Sn all-solid-state batteries demonstrate an initial capacity of 114 mA h g−1 and 88% retention after 70 cycles at 0.3 C. In addition, a high capacity of 94 mA h g−1 can be maintained at 1 C current density.

Abstract Background Intravenous immunoglobulin (IVIG) is the primary treatment for Kawasaki disease (KD). However, 10–20% of KD patients show no response to IVIG treatment, making the early prediction of IVIG resistance a key focus of KD research. Our aim is to explore the application of the C-reactive protein to albumin ratio (CAR) for predicting IVIG resistance in children with KD through meta-analysis. Methods Cochrane Library, PubMed, MEDLINE, EMbase, CNKI, WanFang, the Chinese Biomedical Database, and CQVIP were searched up to November 2023 for cohort studies on predicting IVIG-resistant KD using the CAR. Articles were selected based on pre-established inclusion and exclusion criteria after extracting literature data and assessing them using the QUADAS-2.0 tool for evaluating the accuracy of diagnostic tests. Stata 15.0 software was used for meta-analysis. Results Four Chinese and English literature reports were included in this meta-analysis. The results revealed the presence of a threshold effect and high heterogeneity among the included studies. The combined sensitivity for CAR predicting IVIG-resistant KD was calculated as 0.65 (95% CI 0.58–0.72), specificity as 0.71 (95% CI 0.57–0.81), and the area under the curve (AUC) as 0.70 (95% CI 0.66–0.74) using the random-effects model. The combined positive likelihood ratio was 2.22 (95% CI 1.35–3.65), the combined negative likelihood ratio was 0.49 (95% CI 0.35–0.69), and the diagnostic odds ratio was 5 (95% CI 2–10). Conclusion CAR is an auxiliary predictive indicator with moderate diagnostic value that provides guidance in the early treatment of the disease, demonstrating a certain predictive value that warrants further investigation. However, CAR cannot yet be considered as a definitive diagnostic or exclusionary marker for IVIG-resistant KD. Therefore, multi-center, large sample, and high-quality long-term follow-up trials are warranted to confirm the current findings.

Summary: Background: Dengue remains a global threat to public health, however, its disease burden among children and adolescents has always been poorly quantified. Therefore, we aimed to systematically estimate the global, regional, and national burden and temporal trends of dengue infection in children and adolescents from 1990 to 2021. Methods: Data on the number and rate of incidence and disability-adjusted life-years (DALYs) of dengue infection among children and adolescents under 20 years were obtained from the Global Burden of Disease Study (GBD) 2021. Estimated annual percentage changes (EAPCs) of the age-standardised incidence rate (ASIR) and age-standardised DALYs rate (ASDR), by age, sex, and different countries and regions, were calculated to quantify the temporal trends of dengue burden. The association between development levels (measured using the socio-demographic index [SDI]) and dengue burden was also determined. Findings: From 1990 to 2021, the global burden of dengue incidence and its associated DALYs was consistently higher in children and adolescents than in the entire population. Globally, among children and adolescents, there were 21,641,016 incident cases in 2021, an increase of 64.43% compared to 13,241,719 in 1990. The ASIR per 100,000 population increased from 587.81 in 1990 to 812.16 in 2021, with an EAPC of 1.39% (95% confidence interval [CI], 1.13%–1.65%). Besides, the number of dengue-associated DALYs among children and adolescents increased by 16.36%, from 910,458.60 in 1990 to 1,059,428.31 in 2021. The increase in DALYs was less pronounced than incidence, with the ASDR per 100,000 population increasing from 40.17 in 1990 to 41.50 in 2021, and the EAPC was only 0.67% (95% CI, 0.40%–0.95%). The incidence and DALYs burden of dengue in children and adolescents was highest in middle SDI regions, followed by low-middle SDI regions, with the lowest burden in high SDI regions. Furthermore, Tropical Latin America had an extremely high ASIR (6040.29 per 100,000 population in 2021), and Southeast Asia had an extremely high ASDR (298.20 per 100,000 population in 2021), much higher than other regions around the world. Interpretation: The global dengue burden in children and adolescents is high and has been increasing from 1990 to 2021, even though the distribution patterns vary across different countries and territories. This study first reported the global disease burden and temporal trends of children and adolescents, which has significant implications for policymakers and public health officials, as it underscores the need for age- and region-specific strategies to mitigate the growing global burden of dengue. Funding: National Natural Science Foundation of China.

Avian metapneumovirus subgroup C (aMPV/C) is an emerging pathogen that causes acute respiratory infection in chickens and turkeys. Sequestosome 1 (SQSTM1), a selective autophagy receptor, regulates cellular activity or viral replication by recognizing ubiquitinated substrates. Here, we found that SQSTM1 expression inhibits aMPV/C replication through selective autophagy. In particular, SQSTM1 interacts with the aMPV/C M2-2 protein via its PB1 domain, and by recognizing a ubiquitinated lysine at position 67 of viral M2-2 protein. This recognition leads to the autophagic degradation of the aMPV/C M2-2 protein, suppressing viral replication.

IntroductionSince their identification in 1974, circoviruses have caused clinicopathological diseases in various animal species, including humans. However, their origin, transmission, and genetic evolution remain poorly understood.MethodsIn this study, the genome sequences of circovirus were obtained from GenBank, and the Bayesian stochastic search variable selection algorithm was employed to analyzed the evolution and origin of circovirus.ResultsHere, the evolutionary origin, mode of transmission, and genetic recombination of the circovirus were determined based on the available circovirus genome sequences. The origin of circoviruses can be traced back to fish circovirus, which might derive from fish genome, and human contributes to transmission of fish circovirus to other species. Furthermore, mosquitos, ticks, bats, and/or rodents might play a role as intermediate hosts in circovirus intra- and inter-species transmission. Two major lineages (A and B) of circoviruses are identified, and frequent recombination events accelerate their variation and spread. The time to the most recent common ancestor of circoviruses can be traced back to around A.D. 600 and has been evolving at a rate of 10-4 substitutions site-1 year-1 for a long time.DiscussionThese comprehensive findings shed light on the evolutionary origin, population dynamics, transmission model, and genetic recombination of the circovirus providing valuable insights for the development of prevention and control strategies against circovirus infections.

In order to monitor the growth and development of tomatoes, and improve the efficiency of flower and fruit thinning and tomato picking, this paper constructs a tomato flower and fruit dataset and proposes a TF-YOLOv5s model for the detection of tomato flowers and fruits in natural environments. Based on the YOLOv5s model, a C3Faster module is introduced to reduce the number of parameters and calculations while maintaining detection accuracy. The regular convolution is replaced by depth-wise separable convolution (DWConv) to avoid parameter redundancy. To improve the convergence and accuracy of the model, this paper replaces Complete Intersection over Union (CIoU) loss with Efficient Intersection over Union (EIoU) loss. The Squeeze-and-Excitation (SE) module is added to improve the model’s sensitivity to the features of the tomato flowers and fruits. Compared with the baseline model, the number of parameters is reduced by 54.5%, the weight file is reduced by 52.8%, the Floating-point Operation Per second (FLOPs) is reduced by 48.7%. The detection accuracy of tomato flowers and fruits mAP@0.5 has improved by 1.4% and 1.2% respectively. TF-YOLOv5s is used to detect three types of targets: tomato flowers, red tomatoes, and green tomatoes, and mAP@0.5 of which can reach as high as 95.2%. Furthermore, the improved algorithm is deployed on two edge computing devices to verify its effectiveness. Experimental results show that the algorithm in this paper can achieve high detection with less computational resources. This algorithm has the potential value of application in practical tomato production.

Abstract Background The associations between trajectories of different health conditions and cognitive impairment among older adults were unknown. Our cohort study aimed to investigate the impact of various trajectories, including sleep disturbances, depressive symptoms, functional limitations, and multimorbidity, on the subsequent risk of cognitive impairment. Methods We conducted a prospective cohort study by using eight waves of national data from the Health and Retirement Study (HRS 2002–2018), involving 4319 adults aged 60 years or older in the USA. Sleep disturbances and depressive symptoms were measured using the Jenkins Sleep Scale and the Centers for Epidemiologic Research Depression (CES-D) scale, respectively. Functional limitations were assessed using activities of daily living (ADLs) and instrumental activities of daily living (IADLs), respectively. Multimorbidity status was assessed by self-reporting physician-diagnosed diseases. We identified 8-year trajectories at four examinations from 2002 to 2010 using latent class trajectory modeling. We screened participants for cognitive impairment using the 27-point HRS cognitive scale from 2010 to 2018 across four subsequent waves. We calculated hazard ratios (HR) using Cox proportional hazard models. Results During 25,914 person-years, 1230 participants developed cognitive impairment. In the fully adjusted model 3, the trajectories of sleep disturbances and ADLs limitations were not associated with the risk of cognitive impairment. Compared to the low trajectory, we found that the increasing trajectory of depressive symptoms (HR = 1.39; 95% CI = 1.17–1.65), the increasing trajectory of IADLs limitations (HR = 1.88; 95% CI = 1.43–2.46), and the high trajectory of multimorbidity status (HR = 1.48; 95% CI = 1.16–1.88) all posed an elevated risk of cognitive impairment. The increasing trajectory of IADLs limitations was associated with a higher risk of cognitive impairment among older adults living in urban areas (HR = 2.30; 95% CI = 1.65–3.21) and those who smoked (HR = 2.77; 95% CI = 1.91–4.02) (all P for interaction

Abstract Background Ovarian cancer (OC) is a malignant neoplasm that displays increased vascularization. Angiopoietin-like 4 (ANGPTL4) is a secreted glycoprotein that functions as a regulator of cell metabolism and angiogenesis and plays a critical role in tumorigenesis. However, the precise role of ANGPTL4 in the OC microenvironment, particularly its involvement in angiogenesis, has not been fully elucidated. Methods The expression of ANGPTL4 was confirmed by bioinformatics and IHC in OC. The potential molecular mechanism of ANGPTL4 was measured by RNA-sequence. We used a series of molecular biological experiments to measure the ANGPTL4-JAK2-STAT3 and ANGPTL4-ESM1 axis in OC progression, including MTT, EdU, wound healing, transwell, xenograft model, oil red O staining, chick chorioallantoic membrane assay and zebrafish model. Moreover, the molecular mechanisms were confirmed by Western blot, Co-IP and molecular docking. Results Our study demonstrates a significant upregulation of ANGPTL4 in OC specimens and its strong association with unfavorable prognosis. RNA-seq analysis affirms that ANGPTL4 facilitates OC development by driving JAK2-STAT3 signaling pathway activation. The interaction between ANGPTL4 and ESM1 promotes ANGPTL4 binding to lipoprotein lipase (LPL), thereby resulting in reprogrammed lipid metabolism and the promotion of OC cell proliferation, migration, and invasion. In the OC microenvironment, ESM1 may interfere with the binding of ANGPTL4 to integrin and vascular-endothelial cadherin (VE-Cad), which leads to stabilization of vascular integrity and ultimately promotes angiogenesis. Conclusion Our findings underscore that ANGPTL4 promotes OC development via JAK signaling and induces angiogenesis in the tumor microenvironment through its interaction with ESM1.

Abstract Background Congenital antithrombin deficiency is an autosomal dominant disease that results in deep venous thrombosis and pulmonary embolism, which is mainly caused by mutations in the antithrombin gene (SERPINC1). Since SERPINC1 is highly susceptible to alterations, severe structural and functional changes that promote thrombosis may occur. Clinical presentations vary from different alterations. We report a pregnant case with novel mutation in SERPINC1 presenting transient antithrombin deficiency and multiple venous thromboembolisms. Case presentation We report a case of a 36-year-old pregnant patient who was diagnosed with congenital antithrombin deficiency for carrying a novel heterozygous mutation, NM_000488:exon5:c.T9 38 C:p. M313T in SERPINC1 presenting transient antithrombin deficiency and multiple venous thromboembolisms. Thrombolytic with alteplase and anticoagulant therapies with low-molecular-weight heparin and warfarin were administrated. After confirming the genetic analysis and the termination of pregnancy, rivaroxaban was administrated, and the thrombosis reduced. Conclusions Our study enriched the mutation database of SERPINC1 gene, provided some new theoretical basis for gene diagnosis and genetic counseling of patients with transient antithrombin deficiency. While it still needs for subsequent exploration of molecular pathogenesis.

IntroductionIn many parts of Asia Pacific (APAC), insufficient intake of micronutrients that are important for conception and pregnancy remains a prevalent issue among women of reproductive age. It is crucial to gain insights into women's nutritional awareness and nutrition-related behaviors, as well as how these relate to their health literacy (HL). This understanding can help identify gaps and guide the development of appropriate intervention strategies. However, there appears to be limited relevant data available for the APAC region. We therefore examined nutritional awareness and behaviors among preconception and pregnant women in three APAC countries, and explored how these were related to women's HL.MethodsCross-sectional online surveys were conducted among preconception (i.e., planning to conceive within the next 12 months or currently trying to conceive) and pregnant women in Australia (N = 624), China (N = 600), and Vietnam (N = 300). The survey questionnaire included a validated tool for HL (Newest Vital Sign) and questions to examine awareness and behaviors relating to healthy eating and prenatal supplementation during preconception and pregnancy.ResultsDespite recommendations for a quality diet complemented by appropriate supplementation during preconception and pregnancy, many respondents in each country were not aware of the specific impact of adequate nutrition during these stages. While many respondents reported changes in their diet to eat more healthily during preconception and pregnancy, a substantial proportion were not taking prenatal supplements. Higher HL was related to greater nutritional awareness and higher use of prenatal supplements.DiscussionOur findings suggest that there are gaps in nutritional awareness and practices of many preconception or pregnant women in the three countries. Interventions to improve HL would be valuable to complement conventional knowledge-centric nutrition education, and enhance understanding and empower women to adopt appropriate nutritional practices throughout their preconception/pregnancy journey.

The global health crisis posed by increasing antimicrobial resistance (AMR) implicitly requires solutions based a One Health approach, yet multisectoral, multidisciplinary research on AMR is rare and huge knowledge gaps exist to guide integrated action. This is partly because a comprehensive survey of past research activity has never performed due to the massive scale and diversity of published information. Here we compiled 254,738 articles on AMR using Artificial Intelligence (AI; i.e., Natural Language Processing, NLP) methods to create a database and information retrieval system for knowledge extraction on research perfomed over the last 20 years. Global maps were created that describe regional, methodological, and sectoral AMR research activities that confirm limited intersectoral research has been performed, which is key to guiding science-informed policy solutions to AMR, especially in low-income countries (LICs). Further, we show greater harmonisation in research methods across sectors and regions is urgently needed. For example, differences in analytical methods used among sectors in AMR research, such as employing culture-based versus genomic methods, results in poor communication between sectors and partially explains why One Health-based solutions are not ensuing. Therefore, our analysis suggest that performing culture-based and genomic AMR analysis in tandem in all sectors is crucial for data integration and holistic One Health solutions. Finally, increased investment in capacity development in LICs should be prioritised as they are places where the AMR burden is often greatest. Our open-access database and AI methodology can be used to further develop, disseminate, and create new tools and practices for AMR knowledge and information sharing.

Abstract

Sleep disturbances are highly prevalent during the COVID-19 pandemic, especially among older adults. We aimed to evaluate sleep heath during COVID-19 pandemic and assess the differences among geographical regions and pandemic periods. We searched three databases (PubMed, Embase, Web of Science) to find articles up to March 12, 2023. We included observational studies that reported the prevalence of sleep disturbances among adults aged 60 years or older in any setting. Two researchers independently reviewed the literature and retrieved the data. We used Der Simonian-Laird random effects meta-analyses to pool the data, followed by subgroup analysis, sensitivity analysis, and meta-regression. A total of 64 studies with 181,224 older adults during the pandemic were included. The prevalence of poor sleep quality, short sleep duration, long sleep duration, and insomnia symptoms were 47.12% (95% CI: 25.97%, 68.27%), 40.81% (95% CI: 18.49%, 63.12%), 31.61% (95% CI: 24.83%, 38.38%), and 21.15% (95% CI: 15.30%, 27.00%), respectively. The prevalence of sleep problems reported by self-constructed items was 26.97% (95% CI: 20.73%, 33.22%). When compared to America (64.13%), Europe (20.23%) and the Western Pacific (21.31%) showed a lower prevalence of sleep problems (all P

Abstract Reversible lattice oxygen redox reactions offer the potential to enhance energy density and lower battery cathode costs. However, their widespread adoption faces obstacles like substantial voltage hysteresis and poor stability. The current research addresses these challenges by achieving a non-hysteresis, long-term stable oxygen redox reaction in the P3-type Na2/3Cu1/3Mn2/3O2. Here we show this is accomplished by forming spin singlet states during charge and discharge. Detailed analysis, including in-situ X-ray diffraction, shows highly reversible structural changes during cycling. In addition, local CuO6 Jahn-Teller distortions persist throughout, with dynamic Cu-O bond length variations. In-situ hard X-ray absorption and ex-situ soft X-ray absorption study, along with density function theory calculations, reveal two distinct charge compensation mechanisms at approximately 3.66 V and 3.99 V plateaus. Notably, we observe a Zhang-Rice-like singlet state during 3.99 V charging, offering an alternative charge compensation mechanism to stabilize the active oxygen redox reaction.

Abstract Background Stroke is a major cause of acute neurological symptoms in children with significant long-term neurological sequelae. However, data of diseases burden on stroke among children was lack. We aimed to be dedicated to analyze and compare global trends as well as regional and sociodemographic differences in stroke prevalence, incidence, mortality and disability-adjusted life-years (DALYs) among children aged 0 ~ 14 years. Method We obtained data on annual number of incident strokes, prevalent strokes, deaths, and DALYs, age-standardized incidence rates (ASIRs), prevalence rates (ASPRs), mortality rates (ASMRs) and DALY rates (ASDRs) of stroke among individuals aged 14 years and younger during 1990–2019 from the 2019 Global Burden of Disease Study. To quantify the temporal trends, we calculated changes (%) in number, and used joinpoint regression analysis to identify the average annual percentage changes (AAPCs) of age standardized rates. Result Globally, the incident strokes and prevalent strokes increased by 18.51% and 31.97%, respectively, but DALYs due to stroke and deaths due to stroke decreased by 60.18% and 65.03%, respectively, from 1990 to 2019. During the same period, ASIR increased by 0.21% (95%CI: 0.17, 0.24) from 18.02 to 100,000 population in 1990 to 19.11 per 100,000 in 2019; ASPR increased by 0.66% (95%CI: 0.36, 0.96) from 68.88 to 100,000 population in 1990 to 81.35 per 100,000 in 2019; while ASMR (AAPC= -3.94; 95%CI: -4.07, -3.81) and ASDR (AAPC= -3.50; 95%CI: -3.64, -3.36) both decreased. In 2019, the highest age standardized incidence, prevalence, mortality, and DALY rates all occurred in low sociodemographic index (SDI) regions. The greatest increase of age standardized incidence rate (AAPC = 0.21; 95%CI: 0.18, 0.25) and prevalence rate (AAPC = 1.15; 95%CI: 0.34, 1.96) both were in high SDI regions. Eastern Sub-Saharan Africa had the highest ASIR and ASPR in 2019, and Oceania had the highest ASMR and ASDR in 2019 across 21 GBD regions. High-income North America had the largest increase in ASIR (AAPC = 0.63; 95%CI: 0.59, 0.66) and ASPR (AAPC = 1.58; 95%CI: 0.54, 2.63). Against the overall decreasing trend of ASMR, an increasing trend of ASMR was found in Zimbabwe (AAPC = 0.91; 95%CI: 0.44, 1.37) and Botswana (AAPC = 0.74; 95%CI: 0.02, 1.47). Conclusion The overall increasing stroke incidence and prevalence indicated that prevention and management of stroke among younger population should be critical in the future. Despite stroke mortality with falling trend worldwide, specific countries or territories present worrying increase in stroke mortality. Without urgent implementation of effective primary prevention strategies, the stroke burden of children will probably continue to grow across the world, particularly in high-SDI countries.

Abstract Background Migrants is a large population in China. To improve the health and wellbeing of migrants is a critical policy and social issue in China, and to enhance the utilization of primary health care by migrants is one of the most important approaches in promoting equity in health. However, there exists little research about the association between social integration and the utilization of primary health care. To address the research gap, this research aims at exploring the relation between social integration and the utilization of primary health care among migrants in China. Methods Using the national data from China Migrants Dynamic Survey (CMDS) in 2017, 169,989 migrants were included in this study. Social integration was measured by social communication, acculturation and self-identity, with 8 indicators. The utilization of primary health care was measured by the receiving of health education on infectious diseases (ID) and noncommunicable diseases (NCD) as well as the first visit institution when migrants were sick. After the descriptive statistical analysis, binary logistic regression was employed to evaluate the association between social integration and the utilization of primary health care. Results 65.99% of the migrants received health education on infectious diseases (ID), 40.11% of the migrants received health education on noncommunicable diseases (NCD) and 8.48% of the migrants chose to go to Community Health Center (CHC) seeking for health services. There was a positive effect of social organization participation, the influence of hometown customs, differences of hygiene habits between migrants and local people, integration willingness and evaluation of identity on the receiving of health education on ID and NCD, as well as a positive effect of civil activities engagement and differences of hygiene habits between migrants and local people on the utilization of CHC after getting sick. Conclusions Social integration was associated with the utilization of primary health care among migrants in China. Generally speaking, greater social integration was associated with higher possibility of receiving health education on ID and NCD. However, the effect of social integration on the utilization of CHC was more complex among different indicators. There should be more policy interventions to improve the social integration of migrant which help them to get familiar with the health resource available, as well as improve the capacity of CHC.

The porcine circovirus type 3 (PCV3) infection is an emerging disease associated with clinical signs of porcine dermatitis and nephropathy syndrome (PDNS)-like clinical signs. Currently, there is a lack of effective vaccines and therapeutics against this disease. Therefore, rapid, effective, sensitive, and specific detection methods are crucial for the timely identification, prevention, and control of PCV3. In this study, we developed one- and two-pot visual detection methods for PCV3 using a clustered regularly interspaced short palindromic repeat (CRISPR)/Cas12a detection system combined with recombinase polymerase amplification (RPA). These two methods demonstrated no cross-reactivity with eight other swine viruses and exhibited minimum detection limits of five and two copies of viral DNA, respectively, revealing their high specificity and sensitivity. During a clinical sample detection within 30 min, the coincidence rates between the one- and two-pot detection methods and real-time quantitative polymerase chain reaction (qPCR) were 100%. In conclusion, both one- and two-pot RPA-CRISPR/Cas12a detection methods have significant potential for the rapid, sensitive, and specific visual detection of PCV3.

Abstract Objective This study aims to investigate the 10-year trends and disparities in underweight, overweight, and obesity among older adults aged 65 years and older in China from 2008 to 2018. Methods We used four waves (2008, 2011, 2014, and 2018) of data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), a national community-based cross-sectional survey conducted every 2–3 years. Body weight and height were measured by trained assessors following standardized procedures. BMI was calculated and divided into underweight (

Abstract Background People in China and the countries in the Association of Southeast Asian Nations (ASEAN) are affected by neglected tropical diseases and malaria (NTDM). In this study, we aimed to assess the current status and trends of NTDM burden from 1990 to 2019 in China and ASEAN countries, and also explore the association of NTDM burden with socio-demographic index (SDI). Methods The data from the Global Burden of Diseases Study 2019 (GBD 2019) results were used. Absolute incidence and death number, and age-standardized incidence and mortality rate (ASIR and ASMR) of NTDM in China and ASEAN were extracted. The estimated annual percentage change (EAPC) and join-point regression in the rates quantified the trends. Nonlinear regression (second order polynomial) was used to explore the association between SDI and ASRs. Results The ASIR of NTDM increased in China, Philippines, Singapore and Brunei, at a speed of an average 4.15% (95% CI 3.83–4.47%), 2.15% (1.68–2.63%), 1.03% (0.63–1.43%), and 0.88% (0.60–1.17%) per year. Uptrends of ASIR of NTDM in recent years were found in China (2014–2017, APC = 10.4%), Laos (2005–2013, APC = 3.9%), Malaysia (2010–2015, APC = 4.3%), Philippines (2015–2019, APC = 4.2%), Thailand (2015–2019, APC = 2.4%), and Vietnam (2014–2017, APC = 3.2%, all P

Abstract Background Vaccination is proved to be one of the most effective and efficient way to prevent illness and reduce health inequality. Studies about association between vaccination inequalities in the childhood and awareness of basic public health services program among internal migrants in China are lacking. In this study, we aimed to explore the association between migrants’ vaccination status between 0 and 6 years old and their awareness of the National Basic Public Health Services (BPHSs) project in China. Methods We included 10,013 respondents aged 15 years old or above of eight provinces from 2017 Migrant Population Dynamic Monitoring Survey in China, a nationwide cross-sectional study. Univariate and multivariable logistic regressions were used to assess vaccination inequalities and the awareness of public health information. Results Only 64.8% migrants were vaccinated in their childhood, which is far below the goal of national requirement of 100% vaccination. This also indicated the vaccination inequalities among migrants. Female, the middle-aged, married or having a relationship, the highly educated and the healthy population had higher awareness of this project than others. Both univariate and multivariate logistic regressions showed greatly significant association between vaccination status and some vaccines. Specifically, after adding convariates, the results showed that there were significant associations between the vaccination rates of eight recommended vaccines in the childhood and their awareness of BPHSs project (all p values

Abstract Introduction China has implemented Basic Public Health Service (BPHS) in 2009, aiming to improve the health status of the people, and the content of service includes implying health education for residents. As an important group of people, the migrants can easily become main reason for major infectious diseases such as HIV between different provinces, but the effect of receiving health education is still unknown for migrants. Therefore, the health education of China’s migrant population has received widespread attention. Methods This study used the data of the China Migrants Dynamic Survey (CMDS) from 2009 to 2017, and evaluated the trend of HIV health education acceptance rate of different migrant groups across the country (n = 570,614). Logistic regression model was used to test the influencing factors of HIV health education rate. Results: The study found that the overall HIV health education rate of Chinese migrants decreased from 2009 to 2017, and different types of migrants showed different trends. The proportion of migrants aged 20–35 who receive education fluctuates, and ethnic minorities, western regions, and migrants with high education were more likely to receive HIV health education. Conclusion: These findings identify when implementing health education for migrants, we can carry out more education for specific groups to promote the health equity of the migrant population.

Bone age assessment is of great significance to genetic diagnosis and endocrine diseases. Traditional bone age diagnosis mainly relies on experienced radiologists to examine the regions of interest in hand radiography, but it is time-consuming and may even lead to a vast error between the diagnosis result and the reference. The existing computer-aided methods predict bone age based on general regions of interest but do not explore specific regions of interest in hand radiography. This paper aims to solve such problems by performing bone age prediction on the articular surface and epiphysis from hand radiography using deep convolutional neural networks. The articular surface and epiphysis datasets are established from the Radiological Society of North America (RSNA) pediatric bone age challenge, where the specific feature regions of the articular surface and epiphysis are manually segmented from hand radiography. Five convolutional neural networks, i.e., ResNet50, SENet, DenseNet-121, EfficientNet-b4, and CSPNet, are employed to improve the accuracy and efficiency of bone age diagnosis in clinical applications. Experiments show that the best-performing model can yield a mean absolute error (MAE) of 7.34 months on the proposed articular surface and epiphysis datasets, which is more accurate and fast than the radiologists. The project is available at https://github.com/YameiDeng/BAANet/, and the annotated dataset is also published at https://doi.org/10.5281/zenodo.7947923.

Abstract Background Seasonal patterns of preterm birth were identified in previous studies, but the effect of conception season on preterm birth has not been extensively studied. Based on the notion that the etiological roots of preterm birth lie in the beginning of pregnancy, we did a population-based retrospective cohort study in Southwest China to examine the effects of season of conception and month of conception on preterm birth. Methods We did a population-based retrospective cohort study in women (aged 18–49) who participated in the NFPHEP from 2010 to 2018, and had a singleton livebirth in southwest China. According to the time of the last menstruation reported by the participants, month of conception and season of conception were then ascertained. We used multivariate log-binomial model to adjust the potential risk factors for preterm birth and obtained adjusted risk ratio (aRR) and 95% confidence intervals (95%CI) for conception season, conception month and preterm birth. Results Among 194 028 participants, 15 034 women had preterm birth. Compared with pregnancies that were conceived in the summer, pregnancies that were conceived in the spring, autumn and winter had the higher risk of preterm birth (Spring: aRR = 1.10, 95% CI: 1.04–1.15; Autumn: aRR = 1.14, 95% CI: 1.09–1.20; Winter: aRR = 1.28, 95% CI: 1.22–1.34) and also had a higher risk of early preterm birth (Spring: aRR = 1.09, 95% CI: 1.01–1.18; Autumn: aRR = 1.09, 95% CI: 1.01–1.19; Winter: aRR = 1.16, 95% CI: 1.08–1.25). Pregnancies in December, and January had a higher risk of preterm birth and early preterm birth than pregnancies that were conceived in July. Conclusions Our study found that preterm birth was significantly related to season of conception. Preterm and early preterm birth rates were the highest among pregnancies that were conceived in winter, and the lowest among pregnancies in summer.

Porcine circovirus type 2 (PCV2) is the etiological agent of PCV2-associated diseases that pose a serious threat to the swine industry. PCV2 capsid (Cap) protein has been shown to interact with DEAD-box RNA helicase 21 (DDX21), an important protein that regulates RNA virus replication. However, whether the interaction between DDX21 and the PCV2 Cap regulates PCV2 replication remains unclear. Herein, by using western blotting, interaction assays, and knockdown analysis, we found that PCV2 infection induced the cytoplasmic relocation of DDX21 from the nucleolus in cultured PK-15 cells. Moreover, the nuclear localization signal (NLS) of PCV2 Cap interacted directly with DDX21. The NLS of PCV2 Cap and 763GSRSNRFQNK772 residues at the C-terminal domain (CTD) of DDX21 were essential for the dual interaction. Upon shRNA-mediated DDX21 depletion in PK-15 cells, we observed impaired PCV2 replication via a lentivirus-delivered system, as evidenced by decreased levels of viral protein expression and virus production. In contrast, the replication of PCV2 increased in transiently DDX21-overexpressing cells. Our results indicate that DDX21 interacts with PCV2 Cap and plays a crucial role in virus replication. These results provide a reference for developing novel potential targets for prevention and control of PCV2 infection.

Background: The burden of neonatal infections in low- and middle-income countries and territories (LMICs) is a critical public health challenge, while our understanding of specific burden and secular trends remains limited. Methods: We gathered annual data on 15 types of neonatal infections in LMICs from 1990 to 2019 from the Global Burden of Disease 2019. Numbers, rates, percent changes, and estimated annual percentage changes of incidence and deaths were calculated. We also explored the association between disease burden, socio-demographic index (SDI), and universal health coverage index (UHCI). Results: Enteric infections and upper respiratory infections owned the top highest incidence rates for neonates in 2019. Neonatal sepsis and other neonatal infections, as well as otitis media, demonstrated an increasing trend of incidence across all 3 low- and middle-income regions. The top 3 causes of neonatal mortality in 2019 were neonatal sepsis and other neonatal infections, lower respiratory infections, and enteric infections. Between 1990 and 2019, all of the neonatal infection-related mortality rates suggested an overall decline. Sex differences could be found in the incidence and mortality of some neonatal infections, but most disease burdens decreased more rapidly in males. SDI and UHCI were both negatively associated with most of the disease burden, but there were exceptions. Conclusions: Our study serves as a vital exploration into the realities of neonatal infectious diseases in LMICs. The identified trends and disparities not only provide a foundation for future research but also underscore the critical need for targeted policy initiatives to alleviate on a global scale.

Problem: Chest radiography is a crucial tool for diagnosing thoracic disorders, but interpretation errors and a lack of qualified practitioners can cause delays in treatment. Aim: This study aimed to develop a reliable multi-classification artificial intelligence (AI) tool to improve the accuracy and efficiency of chest radiograph diagnosis. Methods: We developed a convolutional neural network (CNN) capable of distinguishing among 26 thoracic diagnoses. The model was trained and externally validated using 795,055 chest radiographs from 13 datasets across 4 countries. Results: The CNN model achieved an average area under the curve (AUC) of 0.961 across all 26 diagnoses in the testing set. COVID-19 detection achieved perfect accuracy (AUC 1.000, [95% confidence interval {CI}, 1.000 to 1.000]), while effusion or pleural effusion detection showed the lowest accuracy (AUC 0.8453, [95% CI, 0.8417 to 0.8489]). In external validation, the model demonstrated strong reproducibility and generalizability within the local dataset, achieving an AUC of 0.9634 for lung opacity detection (95% CI, 0.9423 to 0.9702). The CNN outperformed both radiologists and nonradiological physicians, particularly in trans-device image recognition. Even for diseases not specifically trained on, such as aortic dissection, the AI model showed considerable scalability and enhanced diagnostic accuracy for physicians of varying experience levels (all P < 0.05). Additionally, our model exhibited no gender bias (P > 0.05). Conclusion: The developed AI algorithm, now available as professional web-based software, substantively improves chest radiograph interpretation. This research advances medical imaging and offers substantial diagnostic support in clinical settings.

Aims: Association between perceived discrimination and depression has been demonstrated in some sources of discrimination, such as age, sex, and race. However, the effects of perceived discrimination both in any domain and each domain on development of depression are still unclear. We aimed to estimate the association of any and each domain of perceived discrimination with the risk of depression among US older adults. Methods: We did a population-based cohort study using eight waves (from 2006 to 2020) of data from the Health and Retirement Study (HRS), a nationally representative study of US older adults aged 51 years and above. Perceived discrimination was measured by the shortened 5-item version of Williams’ discrimination scale, including five domains (less courtesy, service setting, not smart, threatened or harassed, and medical setting). Depressive symptoms were assessed with shortened 8-item version of the Center for Epidemiological Depression scale (8-item CES-D). Cox proportional hazards models were used to estimate the crude and adjusted hazards ratio (HRs) and their 95 % confidence intervals (CIs) between perceived discrimination and risk of depression, after controlling for potential confounders. Results: A total of 18502 participants were included in our final analyses. 42.8 % of them had any perceived discrimination at baseline, and the most prevalent perceived discrimination was feeling less courtesy, which was observed in 5893 people (31.6 %). During a median of 9.8 years follow-up, 44.7 % of participants developed depression. The risk of depression was 46 % (adjusted HR: 1.46, 95 % CI: 1.39–1.52) higher among people with perceived discrimination than those without. The associations between perceived discrimination in each domain and risk of depression were all prominent. Conclusions: Both any and each domain of perceived discrimination were associated with an increased risk of depression. Considering the high prevalence of perceived discrimination and the following poor health outcomes, our findings suggested the integrated measures of providing public education and diversified communication to reduce discrimination, as well as accessible emotional supports to prevent depression are urgently needed.

ABSTRACTThis anonymous cross-sectional study aimed to investigate the relationships between HIV infection and mpox-related focus issues among Chinese men who have sex with men (MSM). This study involved in 27 MSM social organizations and was conducted from July 31 to August 4, 2023. Mpox vaccination hesitancy was defined as the proportion of participants who expressed unwillingness to receive self-funded and free vaccines. Logistic regression models were employed to estimate odds ratios (OR) and 95% confidence interval (95%CI). Of 7196 MSMs, the prevalence of mpox differed between people living with HIV (PLWH) (1.04%, 20/1920) and people living without HIV (PLWoH) (0.55%, 29/5276) (P = .037). However, after adjusting for all covariates, there was no significant association between HIV status and mpox (aOR = 1.17; 95%CI = 0.58, 2.39; P = .658). Furthermore, the crude rates of vaccination hesitation (PLWoH: 5.91%, PLWH: 4.11%; P = .004) and consultation hesitation (PLWoH: 16.22%, PLWH: 10.78%; P

AbstractBackground Corona Virus Disease 2019 (COVID-19) has a significant impact on sleep quality. However, the effects on sleep quality in the post-COVID-19 pandemic era remain unclear, and there is a lack of a screening tool for Chinese older adults. This study aimed to understand the prevalence of poor sleep quality and determine sensitive variables to develop an effective prediction model for screening sleep problems during infectious diseases outbreaks.Materials and Methods The Peking University Health Cohort included 10,156 participants enrolled from April to May 2023. The Pittsburgh Sleep Quality Index (PSQI) scale was used to assess sleep quality. The data were randomly divided into a training-testing cohort (n = 7109, 70%) and an independent validation cohort (n = 3027, 30%). Five prediction models with 10-fold cross validation including the Least Absolute Shrinkage and Selection Operator (LASSO), Stochastic Volatility Model (SVM), Random Forest (RF), Artificial Neural Network (ANN), and XGBoost model based on the area under curve (AUC) were used to develop and validate predictors.Results The prevalence of poor sleep quality (PSQI >7) was 30.69% (3117/10,156). Among the generated models, the LASSO model outperformed SVM (AUC 0.579), RF (AUC 0.626), ANN (AUC 0.615) and XGBoost (AUC 0.606), with an AUC of 0.7. Finally, a total of 12 variables related to sleep quality were used as parameters in the prediction models. These variables included age, gender, ethnicity, educational level, residence, marital status, history of chronic diseases, SARS-CoV-2 infection, COVID-19 vaccination, social support, depressive symptoms, and cognitive impairment among older adults during the post-COVID-19 pandemic. The nomogram illustrated that depressive symptoms contributed the most to the prediction of poor sleep quality, followed by age and residence.Conclusions This nomogram, based on twelve-variable, could potentially serve as a practical and reliable tool for early identification of poor sleep quality among older adults during the post-pandemic period.

Abstract Objective Primary liver cancer is not only one of the most common causes of cancer deaths but also the second most common cause of premature death worldwide. Understanding the trends in incidence and mortality of primary liver cancer and its etiologies is crucial for development of effective prevention and mitigation strategies. This study aimed to quantify the trends in incidence and mortality of primary liver cancer and its etiologies at the global, regional and national levels using data from Global Burden of Disease (GBD) study. Method Annual incident cases, deaths, age-standardized incidence rates (ASIRs), and age-standardized mortality rates (ASMRs) of primary liver cancer and its etiologies, including hepatitis B, hepatitis C, alcohol use, nonalcoholic steatohepatitis, and other causes, between 1990 and 2019 were collected from GBD study 2019. Percentage changes in incident cases and deaths and estimated annual percentage changes (EAPCs) in ASIRs and ASMRs of primary liver cancer and its etiologies were calculated to quantify their temporal trends. Correlations of EAPC in ASIRs and ASMRs with socio-demographic index (SDI) and universal health coverage index (UHCI) in 2019 were separately evaluated by Pearson correlation analyses. Results Globally, the incident cases and deaths of primary liver cancer increased by 43.11% from 373 393 in 1990 to 534 365 in 2019 and 32.68% from 365 213 in 1990 to 484 584 in 2019, respectively. ASIR and ASMR of primary liver cancer decreased by an average of 2.23% (95% CI 1.83%, 2.63%) and 1.93% (95% CI 1.55%, 2.31%) per year between 1990 and 2019 worldwide, respectively. ASIRs and ASMRs of primary liver cancer varied between regions, with an increasing trend in ASIR (EAPC = 0.91; 95% CI 0.47, 1.35) and a stable trend in ASMR (EAPC = 0.42, 95% CI − 0.01, 0.85) of primary liver cancer in high SDI region between 1990 and 2019. Nearly half (91/204) of the countries suffered an increasing trend in ASIR of primary liver cancer and more than one-third (71/204) of the countries suffered an increasing trend in ASIRs of primary liver cancer from all etiologies between 1990 and 2019 worldwide. Positive correlations of EAPC in ASIR and ASMR of primary liver cancer with SDI and UHCI were observed in nations with SDI ≥ 0.7 or UHCI ≥ 70. Conclusion Primary liver cancer remains a major public health concern globally, with an increasing trend in the numbers of incident cases and deaths in the past three decades. We observed an increasing trend in ASIR of primary liver cancer in nearly half of the countries and an increasing trend in ASIRs of primary liver cancer by etiology in more than one-third of the countries worldwide. In line with the Sustainable Development Goals, the identification and elimination of risk factors for primary liver cancer will be required to achieve a sustained reduction in liver cancer burden.

Malaria is one of major global public health problems. Although China′s success in eliminating indigenous malaria cases having been recognized by World Health Organization in 2021, China is still at risk of imported malaria from abroad and local transmission of the disease. Therefore, it is necessary to fully understand global malaria epidemic and to assess the risk of imported malaria in China for consolidating the achievement of malaria elimination. In this paper, we reviewed research progress in global malaria epidemiology, malaria-related health risk, malaria prevention and control measures, and imported malaria epidemic from 2017 through 2021 in China.

Abstract Background Multimorbidity of non-communicable diseases (NCDs) is increasingly prevalent among older adults around the world, leading a higher risk of household catastrophic health expenditure (CHE). As current powerful evidence was insufficient, we aimed to estimate the association between multimorbidity of NCDs and the risk of CHE in China. Methods We designed a cohort study using data investigated in 2011–2018 from the China Health and Retirement Longitudinal Study, which is a nationally-representative study covering 150 counties of 28 provinces in China. We used mean ± standard deviation (SD) and frequencies and percentages to describe baseline characteristics. Person χ2 test was employed to compare the differences of baseline characteristics between households with and without multimorbidity. Lorenz curve and concentration index were used to measure the socioeconomic inequalities of CHE incidence. Cox proportional hazards models were applied to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for the association between multimorbidity and CHE. Results Among 17,708 participants, 17,182 individuals were included for the descriptive analysis of the prevalence of multimorbidity in 2011, and 13,299 individuals (8029 households) met inclusion criteria and were included in the final analysis with a median of 83 (interquartile range: 25–84) person-months of follow-up. 45.1% (7752/17,182) individuals and 56.9% (4571/8029) households had multimorbidity at baseline. Participants with higher family economic level (aOR = 0.91, 95% CI: 0.86–0.97) had lower multimorbidity prevalence than those with lowest family economic level. 82.1% of participants with multimorbidity did not make use of outpatient care. The CHE incidence was more concentrated among participants with higher socioeconomic status (SES) with a concentration index of 0.059. The risk of CHE was 19% (aHR = 1.19, 95% CI: 1.16–1.22) higher for each additional NCD. Conclusions Approximately half of middle-aged and older adults in China had multimorbidity, causing a 19% higher risk of CHE for each additional NCD. Early interventions for preventing multimorbidity among people with low SES could be intensified to protect older adults from financial hardship. In addition, concerted efforts are needed to increase patients’ rational healthcare utilization and strengthen current medical security for people with high SES to reduce economic disparities in CHE.

Objectives: To assess the duration of viable virus shedding and polymerase chain reaction (PCR) positivity of the SARS-CoV-2 Omicron variant in the upper respiratory tract. Methods: We systematically searched PubMed, Cochrane, and Web of Science for original articles reporting the duration of viable virus shedding and PCR positivity of the SARS-CoV-2 Omicron variant in the upper respiratory tract from November 11, 2021 to December 11, 2022. This meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was registered with PROSPERO (CRD42022357349). We used the DerSimonian-Laird random-effects meta-analyses to obtain the pooled value and the 95% confidence intervals. Results: We included 29 studies and 230,227 patients. The pooled duration of viable virus shedding of the SARS-CoV-2 Omicron variant in the upper respiratory tract was 5.16 days (95% CI: 4.18-6.14), and the average duration of PCR positivity was 10.82 days (95% CI: 10.23-11.42). The duration of viable virus shedding and PCR positivity of the SARS-CoV-2 Omicron variant in symptomatic patients was slightly higher than that in asymptomatic patients, but the difference was not significant (P >0.05). Conclusion: The current study improves our understanding of the status of the literature on the duration of viable virus shedding and PCR positivity of Omicron in the upper respiratory tract. Our findings have implications for pandemic control strategies and infection control measures.

Ultrafine copper powders were prepared by the air-jet milling of copper oxide (CuO) powders and a subsequent hydrogen (H2) reduction. After milling, the particle size and grain size of CuO powders decreased, while the specific surface area and structural microstrain increased, thereby improving the reaction activity. In a pure H2 atmosphere, the process of CuO reduction was conducted in one step, and followed a pseudo-first-order kinetics model. The smaller CuO powders after milling exhibited higher reduction rates and lower activation energies compared with those without milling. Based on the unreacted shrinking core model, the reduction of CuO powders via H2 was controlled by the interface reaction at the early stage, whereas the latter was limited by the diffusion of H2 through the solid product layer. Additionally, the scanning electron microscopy (SEM) indicated that copper powders after H2 reduction presented a spherical-like shape, and the sintering and agglomeration between particles occurred after 300 °C, which led to a moderate increase in particle size. The preparing parameters (at 400 °C for 180 min) were preferred to obtain ultrafine copper powders with an average particle size in the range of 5.43–6.72 μm and an oxygen content of less than 0.2 wt.%.

During the COVID-19 pandemic, a series of outbreaks and related investigations have indicated that the virus can be transmitted via cold-chain environment media. The causal relationship between the cold chain and the introduction and spread of viruses has been established. However, due to its stealthy nature, cold-chain environment media is often overlooked. Herein, we aim to provide a systematic review of the existing evidences and logical chains of virus transmission and introduction through cold-chain, from the perspectives of epidemiological investigations, laboratory researches, and molecular epidemiological evidences of cold-chain-related outbreaks. Additionally, scientific evidences also include the survival capacity of the virus in cold-chain environments, as well as modeling of virus transmission and risk assessment. These evidences and the logical framework related to cold-chain transmission put forward the initiation of cold-chain-based epidemiology (CCBE) as one of the important portions of the epidemiology of infectious diseases. Close multidisciplinary collaboration in this field will be essential for the preparation of future pandemics.

Background: Natural flood disasters have a devastating effect on society, but the comprehensive assessment of their association with infectious diseases is lacking. We aimed to comprehensively assess the association of natural flood disasters with new cases and deaths of different infectious disease globally from 1990 to 2019, and provide scientific evidence for early warning and measures for the prevention and control of outbreaks and endemic of potential infectious disease following natural flood disasters. Methods: We used data on natural flood disasters from international disaster database from 1990 to 2019. Data on infectious diseases were from the Global Burden of Disease Study 2019. Quasi-Poisson generalized linear models (quasi-Poisson GLM) were used to calculate the effects size, after controlling other confounders. Results: From 1990 to 2019, natural flood disasters occurred on 47,368 cumulative days in 168 countries and territories, resulting in a total of 242,516 deaths and affecting 3.55 billion people. The duration of floods showed a trend of increase, with an average increased rate of 5.14% per year (Estimated annual percentage change [EAPC] =5.14%, 95% CI: 3.57%-7.16%; p < 0.05). The incidence rates of most infectious diseases showed decreasing trends in the past 30 years (all p

Newly emerging infectious diseases are vital issues that impact global health, social stability, economic development, and national security. While infectious disease prevention and control is a highly practical discipline, effective theoretical guidance remains indispensable in infectious disease prevention and control practices. During the past three years of responding to the Coronavirus Disease 2019 (COVID-19) pandemic, we have observed that the traditional “Three-Step Two-Factor” theory is not sufficient to meet the contemporary societal needs for newly emerging infectious disease prevention and control. Building upon years of experience in responding to infectious diseases, we have innovatively developed the “Triangle Model” theory for the prevention and control of infectious diseases. This model has been successfully applied in China's practices and management decisions during the COVID-19 pandemic. We introduce the definition, characteristics of the “Triangle Model” theory, as well as shared practical experience in China, to provide a theoretical reference for future prevention and control of newly emerging infectious diseases in China and other countries.

Background: Long-term impact of the COVID-19 pandemic on health services utilization is unknown. We aim to assess the long-term effect of the COVID-19 pandemic on health services utilization in China. Methods: Between Jan 2017 and Dec 2021, we conducted a nationwide longitudinal study using routinely collected data on health services utilization in the National Health Information System of China. We extracted national and provincial data of demographic characteristics, socio-economic characteristics, and health resources. Interrupted time-series segmented negative binominal regression models were used. Results: A total of 34.2 billion health facilities visits and 1.1 billion inpatients discharged were included. The largest negative impact of COVID-19 pandemic on the health services utilization was during containment period, that health facility visits were observed 32% reduction in hospitals (adjusted incidence risk ratios [aRRs] 0.68, 95%CI: 0.50–0.92), 27% reduction in community health centers (aRR 0.73, 95%CI: 0.57–0.93), and 22% reduction township centers (aRR 0.78, 95%CI: 0.67–0.91), respectively. The impact on health facility visits and inpatients discharged were reduced and eliminated over time (all p>0.05). However, the negative impact on utilization rate of beds, average length of stay, average inpatient costs, and average outpatient costs in different level of health facilities still existed two years later (all p

Abstract. Background:. Hepatitis B is a viral infection that attacks the liver and can cause both potentially life-threatening acute and chronic liver disease. China has the world's largest burden of hepatitis B and is considered to be a major contributor toward the goal of World Health Organization (WHO) of eliminating hepatitis B virus (HBV) as a global health threat by 2030. This study aimed to analyze data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to determine the trends in mortality of liver disease due to hepatitis B in China between 1990 and 2019 and the gap with the WHO's goal. Methods:. Annual deaths and age-standardized mortality rates (ASMRs) of liver disease due to hepatitis B in China between 1990 and 2019 were collected from GBD 2019. We calculated the percentage changes in deaths and estimated annual percentage changes (EAPCs) of ASMRs of liver disease due to hepatitis B. Results:. In China, deaths of total liver disease due to hepatitis B decreased by 29.13% from 229 thousand in 2016 to 162 thousand in 2019, and ASMR decreased by an average of 4.92% (95% confidence interval [CI]: 4.45–5.39%) per year in this period. For the spectrum of liver disease due to hepatitis B, deaths decreased by 74.83%, 34.71%, and 23.34% for acute hepatitis, cirrhosis and other chronic liver diseases, and liver cancer from 1990 to 2019, respectively, and ASMRs of acute hepatitis (EAPC = –7.63; 95% CI: –8.25, –7.00), cirrhosis and other chronic liver diseases (EAPC = –4.15; 95% CI: –4.66, –3.65), and liver cancer (EAPC = –5.17; 95% CI: –6.00, –4.33) decreased between 1990 and 2019. The proportions of older adults aged ≥70 years among all deaths of the spectrum of liver disease due to hepatitis B increased from 1990 to 2019. Deaths of liver cancer due to hepatitis B increased by 7.05% from 2015 to 2019. Conclusions:. Although a favorable trend in the mortality of liver disease due to hepatitis B was observed between 1990 and 2019, China still faces challenges in achieving the WHO's goal of eliminating HBV as a public threat by 2030. Therefore, efforts to increase the coverage of diagnosis and treatment of liver disease due to hepatitis B, especially of liver cancer due to hepatitis B, are warranted in China.

BackgroundDepression is one of the most common mental illnesses, and it may have a lasting effect on one’s whole life. As a form of financial hardship, catastrophic health expenditure (CHE) may be associated with depression. However, current evidence about the relationship between CHE and the risk of depression is insufficient. ObjectiveThis study aimed to explore the relationship between CHE and the risk of depression among Chinese adults. MethodsIn this study, we used 3 waves of the China Family Panel Studies (CFPS) from 2012, 2016, and 2018. The CFPS are a nationally representative study covering 25 of 31 provinces in Chinese mainland and representing nearly 94.5% of the total population. We selected eligible household heads as participants, divided them into 2 groups by CHE events at baseline (exposed group: with CHE; unexposed group: without CHE), and followed them up. Households with CHE were defined as having out-of-pocket medical expenditures exceeding 40% of the total household nonfood expenditure, and people with depression were identified by the 8-item Centre for Epidemiological Studies Depression Scale (CES-D). We first described the baseline characteristics and used logistical regression to estimate their effects on CHE events. Then, we used Cox proportional hazard models to estimate adjusted hazard ratios and 95% CIs of depression among participants with CHE compared with those without CHE. Finally, we analyzed the subgroup difference in the association between CHE and depression. ResultsOf a total of 13,315 households, 9629 were eligible for analysis. Among them, 6824 (70.9%) were men. The mean age was 50.15 (SD 12.84) years. Only 987 (10.3%) participants had no medical insurance. The prevalence of CHE at baseline was 12.9% (1393/9629). Participants with a higher family economic level (adjusted odds ratio [aOR] 1.15, 95% CI 1.02-1.31) and with the highest socioeconomic development level (aOR 1.18, 95% CI 1.04-1.34) had a higher prevalence of CHE than reference groups. During a median of 71 (IQR 69-72) person-months of follow-up, the depression incidence of participants with CHE (1.41 per 1000 person-months) was higher than those without CHE (0.73 per 1000 person-months). Multivariable models revealed that the adjusted hazard ratio for the incidence of depression in participants with CHE was 1.33 (95% CI 1.08-1.64), and this association appeared to be greater in participants without outpatient services (for interaction, P=.048). ConclusionsCHE was significantly associated with increased risk of depression among Chinese adults. Concentrated work should be done to monitor CHE, and more efforts to ensure financial protection need to be made to prevent depression, especially for people with high health care needs.

BackgroundResearch assessing trends in online search activity related to mpox in China is scarce. ObjectiveWe aimed to provide evidence for an overview of online information searching during an infectious disease outbreak by analyzing trends in online search activity related to mpox at geographical and economic levels in China and explore influencing factors. MethodsWe used the Baidu index to present online search activity related to mpox from May 19 to September 19, 2022. Segmented interrupted time-series analysis was used to estimate trends in online search activity. Factors influencing these trends were analyzed using a general linear regression (GLM) model. We calculated the concentration index to measure economic-related inequality in online search activity and related trends. ResultsOnline search activity was highest on the day the first imported case of mpox appeared in Chongqing compared to 3 other cutoff time points. After the day of the first imported mpox case in Taiwan, the declaration of a public health emergency of international concern, the first imported mpox case in Hong Kong, and the first imported mpox case in Chongqing, national online search activity increased by 0.642%, 1.035%, 1.199%, and 2.023%, respectively. The eastern regions had higher increases than the central and western regions. Across 31 provinces, municipalities, and autonomous regions, the top 3 areas with higher increases were Beijing, Shanghai, and Tianjin at 3 time points, with the exception of the day of the first imported mpox case in Chongqing (Chongqing replaced Tianjin on that day). When AIDS incidence increased by 1 per 100,000 people, there was an increase after the day of the first imported mpox case in Chongqing of 36.22% (95% CI 3.29%-69.15%; P=.04) after controlling for other covariates. Online search activity (concentration index=0.18; P