Search

Abstract Background Community-based participatory research (CBPR) is a collaborative research approach that engages academic researchers and community stakeholders as equal partners in all research steps to address community concerns and achieve health equity. The CBPR approach has been widely used in vaccination promotion programmes. However, the elements and steps of CBPR-based programmes varied among studies. The purpose of this scoping review was to synthesize the elements and steps, and establish an implementation framework to guide the utilisation of CBPR approaches in vaccination promotion. Methods This scoping review was performed in accordance with Arksey and O’Malley’s five-stage framework. A systematic search was conducted on a set of electronic databases and grey literature sources. The retrieved articles were screened according to the criteria of CBPR and vaccination promotion, and data were extracted and recorded on a calibrated and predefined form in terms of study characteristics and CBPR components. Two authors worked independently to complete literature search, study selection, and data extraction. A narrative summary was used in categorising characteristics, and the contents of the included studies were summarised through qualitative analysis. Results A total of 8557 publications were initially screened, and 23 articles were finally included. According to the CBPR conceptual model, the elements in each CBPR component specifically for vaccination promotion included (1) the establishment of community–academic partnership (CAP)s, (2) community capacity building by partner training vaccination knowledge, research literacy, and service abilities and skills, (3) development and implementation of community-based intervention and (4) Outcome evaluation. A CAP was established between academic researchers or institutes and eight types of partners, including community service organisation–related non-government organisations (NGOs), health service institution–related NGOs, religious organisations, government agencies, educational institutions, media agencies, business agencies, and community representatives. The maintenance of CAP was achieved with four key strategies, namely, strengthening communication, forming management groups, sharing resources and information, and providing incentives. Twelve studies provided comprehensive insights into the strategies employed for intervention development, utilising either quantitative surveys, qualitative methods or a combination of both approaches. The contents of interventions included health service supports, health education activities, social marketing campaigns, community mobilisation, interactive discussions, vaccination reminders and incentives. As for outcome evaluation, vaccination rate and the effectiveness of interventions were assessed. A considerable increase was observed in 95.7% of the included studies (22/23), and the highest increase (92.9%) was attained after the intervention. An implementation framework was generated to summarise the elements and steps of CBPR approaches for vaccination promotion. Conclusions This review summarised current evidence and generated an implementation framework to elucidate the elements and steps in the development and application of CBPR approaches in vaccination promotion. CBPR approaches are recommended for future vaccination promotion programmes, involving community stakeholders and research professionals, to ensure equitable access to vaccinations across diverse populations.

Abstract Background Long-term care insurance (LTCI) is essential to alleviate the challenges of rapid aging. Research on LTCI in developing countries is limited and conclusions remain controversial. This study aims to empirically evaluate how the LTCI pilot in selected cities influences healthcare utilization and expenditures among middle-aged and older Chinese adults. Methods Data was from 2013, 2015, and 2018 China Health and Retirement Longitudinal Study. 167 LTCI and 8225 non-LTCI group participants were identified. Propensity score matching difference-in-difference method was used to evaluate the net effect of LTCI. The robustness of the findings was tested using a placebo test. Results In the pilot cities, around 17.8% of the population had LTCI coverage, with approximately 59.9% participating in urban employee medical insurance and 81.4% being urban residents. LTCI significantly reduced the monthly out-of-pocket outpatient expenditure by 313.764 yuan (P

To sort out the requirements for enhancing the capacity and informatization construction of CDC laboratories in the context of high-quality development of disease prevention and control. To investigate and analyze the current situation, problems faced and development needs for laboratory informatization construction of disease prevention and control institutions in Shanghai, so as to provide an evidence for putting forward targeted suggestions. In addition, it will provide ideas for comprehensively improving the informatization construction of laboratories in disease prevention and control institutions and constructing a smart and accurate modern disease prevention and control system under the new context.

An AI-empowered indoor digital contact-tracing system was developed using a centralized architecture and advanced low-energy Bluetooth technologies for indoor positioning, with careful preservation of privacy and data security. We analyzed the contact pattern data from two RCHs and investigated a COVID-19 outbreak in one study site. To evaluate the effectiveness of the system in containing outbreaks with minimal contacts under quarantine, a simulation study was conducted to compare the impact of different quarantine strategies on outbreak containment within RCHs. The significant difference in contact hours between weekdays and weekends was observed for some pairs of RCH residents and staff during the two-week data collection period. No significant difference between secondary cases and uninfected contacts was observed in a COVID-19 outbreak in terms of their demographics and contact patterns. Simulation results based on the collected contact data indicated that a threshold of accumulative contact hours one or two days prior to diagnosis of the index case could dramatically increase the efficiency of outbreak containment within RCHs by targeted isolation of the close contacts. This study demonstrated the feasibility and efficiency of employing an AI-empowered system in indoor digital contact tracing of outbreaks in RCHs in the post-pandemic era.

BackgroundAttention-deficit/hyperactivity disorder (ADHD) usually begins in childhood and is often accompanied by impairments in social functioning. Virtual reality (VR) has emerged as an adjunctive tool to embed in social skills training to enhance the social skills of children with ADHD, but its effectiveness requires further investigation. ObjectiveThis study aims to enhance the social skills of children with ADHD by examining the feasibility and effectiveness of VR-based training in comparison to traditional social skills training. MethodsA 3-arm randomized controlled trial was conducted with 90 children with ADHD aged 6-12 years. Participants were randomly assigned to 3 weeks of 12-session VR-based social skills training, traditional social skills training, or a waitlist control group of equivalent duration. Outcome measures included assessments by a clinical psychologist who was blinded to group assignments, the Social Skills Improvement System Rating Scale, the Behavior Rating Inventory of Executive Function, and the Simulator Sickness Questionnaire, conducted at baseline and after the intervention. ResultsThe preliminary results support the feasibility and acceptability of VR training for children with ADHD aged 6-12 years. Analysis showed that the VR and traditional social skills training groups experienced a statistically significant improvement in the clinical psychologist assessment of social skills and parent-rated self-control, initiative, and emotional control after the intervention compared with baseline. The VR group performed significantly better than the traditional social skills group on social skills assessed by clinical psychologists (F2,85=76.77; P.05). ConclusionsThe findings provide preliminary evidence supporting the feasibility and superior effectiveness of VR-based social skills training compared to traditional approaches for enhancing social skills and related executive functions in children with ADHD. These results suggest that VR may be a valuable tool to embed within social skills interventions for this population. Further research is warranted to explore the long-term impacts and generalizability of these benefits. Trial RegistrationClinicalTrials.gov NCT05778526; https://clinicaltrials.gov/study/NCT05778526 International Registered Report Identifier (IRRID)RR2-10.2196/48208

ObjectiveTo investigate the entrance surface dose （ESD） of digital radiography （DR）adult examinees in a grade A tertiary hospital in Shanghai， to analyze the dose level of the DR adult examinees， and to provide data for the development of DR typical dose reference.MethodsA DR equipment in the hospital was selected and the irradiation parameters and dose were determined in two randomly selected age groups （15‒39 years and 40‒69 years） of DR adult examinees. The examinations included chest PA， chest LAT， abdominal AP， pelvic AP， lumbar AP， lumbar LAT， thoracic AP， and thoracic LAT. The number of examinees in each exposure position was 20. ESD and effective dose were calculated for each age group and each position.ResultsA total of 320 examinees were investigated. The 75th percentiles of ESD in different exposure positions were as follows： chest PA 0.19 mGy；chest LAT 0.96 mGy；abdominal AP 3.63 mGy；pelvic AP 3.16 mGy；lumbar AP 9.27 mGy；lumbar LAT 18.29 mGy；thoracic AP 6.85 mGy；and thoracic LAT 13.40 mGy.ConclusionsThe differences between the estimated ESD and effective dose were large in different exposure positions、in the same exposure positions、and in the same positions with different exposure types， and there were statistically significant differences in ESD of examinees with different exposure positions. The estimated typical values of different exposure positions were apparently lower than the diagnostic reference level.

Abstract Background Alcohol screening and brief intervention (SBI) is an evidence-based intervention recommended by the World Health Organization. This study applied the Consolidated Framework for Implementation Research (CFIR) to understand facilitators and barriers of SBI implementation in primary care settings in Hong Kong, China. Methods This was a sequential mixed-method study. In-depth interviews of 21 physicians and 20 nurses working in the primary care settings from the public and private sectors were first conducted to identify CFIR constructs that were relevant to SBI implementation in the Chinese context and potential factors not covered by the CFIR. A questionnaire was then developed based on the qualitative findings to investigate factors associated with SBI implementation among 282 physicians and 295 nurses. Results The in-depth interviews identified 22 CFIR constructs that were facilitators or barriers of SBI implementation in Hong Kong. In addition, the stigmatization of alcohol dependence was a barrier and the belief that it was important for people to control the amount of alcohol intake in any situation was mentioned as a facilitator to implement SBI. In the survey, 22% of the participants implemented SBI in the past year. Factors associated with the SBI implementation echoed most of the qualitative findings. Among physicians and nurses in both sectors, they were more likely to implement SBI when perceiving stronger evidence supporting SBI, better knowledge and self-efficacy to implement SBI, more available resources, and clearer planning for SBI implementation in the clinics but less likely to do so when perceiving SBI implementation to be complicated and of higher cost, and drinking approved by the Chinese culture. Participants were more likely to implement SBI when perceiving SBI fit better with the existing practice and better leadership engagement in the public sector, but not in the private sector. Perceiving a stronger need and greater importance to implement SBI were associated with higher likelihood of SBI implementation among physicians, but not among nurses. Perceiving better organizational culture supporting SBI was positively associated with SBI implementation among nurses, but not among physicians. Conclusions There was a significant gap between SBI evidence and its implementation. Some strategies to improve SBI implementation may be different between physicians and nurses and between those in the public and private sectors. The CFIR is a useful framework for understanding facilitators and barriers of SBI implementation in primary care settings.

Purpose Evidence about the associations of migraine features with cardiovascular risk profiles in Chinese population is lacking. The Migraine Exposures and Cardiovascular Health in Hong Kong Chinese Women (MECH-HK) cohort was constructed to investigate longitudinal migraine features and their cardiovascular implications in Hong Kong Chinese women.Participants We enrolled 4221 Hong Kong Chinese women aged 30 years or above from October 2019 to December 2020. Demographics, reproductive information, lifestyle factors, disease history, blood lipids and glucose, anthropometrics and body compositions were measured during baseline and follow-up. Migraine diagnosis followed the International Classification of Headache Disorders-3 criteria. Migraine features were longitudinally tracked using a migraine diary and summarised by a wide range of epidemiological metrics. Cardiovascular health was assessed using the Framingham risk score (FRS).Findings to date From October 2021 to June 2023, 3455 women completed the first follow-up measurement. The retention rate was 81.9%. The average age at baseline was 54.40 years. The mean blood glucose, high-density lipoprotein cholesterol and low-density lipoprotein cholesterol levels were 6.44 mmol/L, 65.06 mg/dL and 102.40 mg/dL, respectively. The average FRS was 0.06. Participants had a 10.3% prevalence of migraine or probable migraine. After 1.27 years of follow-up, the median migraine attack frequency was 0.99 attacks/month, with an incidence rate of 2.55 attacks/person-month and a median duration of 7.70 hours/attack. Sleep problems (64.7%) and stress (54.0%) were the top triggers, while prevalent accompanying symptoms were nausea (67.4%), photophobia (39.9%), phonophobia (30.0%) and vomiting (26.2%). Migraine auras included blurred visions (59.6%), flashing lights (41.3%), blind spots (33.0%), pins and needles (6.4%) and halo (1.8%).Future plans The follow-up for the cohort will be implemented every 2 years. MECH-HK will provide unique longitudinal data on migraine features in Hong Kong women. The linkage between migraine features and cardiovascular disease risk progression will be identified by a long-term observation.

BackgroundThe metabolic score for insulin resistance (METS-IR) has emerged as a noninsulin-based index for the approximation of insulin resistance (IR), yet longitudinal evidence supporting the utility of METS-IR in the primary prevention of type 2 diabetes mellitus (T2DM) remains limited. ObjectiveWe aimed to investigate the longitudinal association between METS-IR, which combines fasting plasma glucose (FPG), lipid profiles, and anthropometrics that can be routinely obtained in resource-limited primary care settings, and the incidence of new-onset T2DM. MethodsWe conducted a closed-cohort analysis of a nationwide, prospective cohort of 7583 Chinese middle-aged and older adults who were free of T2DM at baseline, sampled from 28 out of 31 provinces in China. We examined the characteristics of participants stratified by elevated blood pressure (BP) at baseline and new-onset T2DM at follow-up. We performed Cox proportional hazard regression analysis to explore associations of baseline METS-IR with incident T2DM in participants overall and in participants stratified by baseline BP. We also applied net reclassification improvement and integrated discrimination improvement to examine the incremental value of METS-IR. ResultsDuring a mean follow-up period of 6.3 years, T2DM occurred in 527 participants, among which two-thirds (332/527, 62.9%; 95% CI 58.7%-67.1%) had baseline FPG

Abstract Background Prior research has shown that individual lifestyles were associated with migraine. Yet, few studies focused on combined lifestyles, particularly in Chinese populations. This cross-sectional study aimed to investigate the relationships of a combined lifestyle index with migraine in Hong Kong Chinese women. Methods Baseline data from a cohort study named Migraine Exposures and Cardiovascular Health in Hong Kong Chinese Women (MECH-HK) were used for analysis. In total 3510 women aged 55.2 ± 9.1 years were included. The combined lifestyle index comprised eight lifestyle factors: smoking, physical activity, sleep, stress, fatigue, diet, body mass index, and alcohol. Each component was attributed a point of 0 (unhealthy) or 1 (healthy). The overall index was the sum of these points, ranging from 0 (the least healthy) to 8 points (the healthiest). Migraine was diagnosed by the International Classification of Headache Disorders 3rd edition. Additionally, for women with migraine, the data on migraine attack frequency (attacks/month) was collected. Results A total of 357 women with migraine (10.2%) were identified. The prevalence of migraine for the 0–3-point, 4-point, 5-point, 6-point, and 7–8-point groups were 18.0% (162/899), 10.9% (86/788), 6.6% (51/776), 6.0% (38/636), and 4.9% (20/411), respectively. In the most-adjusted model, compared to the 0–3-point group, the odds ratios and 95% confidence intervals for the 4-point, 5-point, 6-point, and 7–8-point groups were 0.57 (0.43–0.75), 0.33 (0.24–0.46), 0.30 (0.21–0.44), and 0.25 (0.15–0.41), respectively (all p

BackgroundCommunity engagement plays a vital role in global immunization strategies, offering the potential to overcome vaccination hesitancy and enhance vaccination confidence. Although there is significant backing for community engagement in health promotion, the evidence supporting its effectiveness in vaccination promotion is fragmented and of uncertain quality. ObjectiveThis review aims to systematically examine the effectiveness of different contents and extent of community engagement for promoting vaccination rates. MethodsThis study was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A comprehensive and exhaustive literature search was performed in 4 English databases (PubMed, Embase, Web of Science, and Cochrane Library) and 2 Chinese databases (CNKI and Wan Fang) to identify all possible articles. Original research articles applying an experimental study design that investigated the effectiveness of community engagement in vaccination promotion were eligible for inclusion. Two reviewers independently performed the literature search, study selection, quality assessment, and data extraction. Discrepancies were resolved through discussion, with the arbitration of a third reviewer where necessary. ResultsA total of 20 articles out of 11,404 records from 2006 to 2021 were retrieved. The studies used various designs: 12 applied single-group pre-post study designs, 5 were cluster randomized controlled trials (RCTs), and 3 were non-RCTs. These studies targeted multiple vaccines, with 8 focusing on children’s immunization, 8 on human papillomavirus vaccine, 3 on hepatitis B virus vaccine, and 1 on COVID-19 vaccine. The meta-analysis revealed significant increases in vaccination rates both in pre-post comparison (rate difference [RD] 0.34, 95% CI 0.21-0.47, I2=99.9%, P

Abstract Background Migraine is a complex neurovascular disorder with considerable clinical, social and economic issues. Tai chi has the potential to be an alternative prophylactic treatment for migraine with high safety since the adverse effects and limited efficacy of available medications. Aims The proposed study aims to compare the prophylaxis efficacy of 24-week Tai Chi training on migraine attacks with the standard prophylactic medication; and to explore the mechanism of Tai Chi in preventing migraine attacks by analyzing the associations between changes of migraine attacks and changes of neurovascular functions and inflammatory makers. Method This is a two-arm parallel non-inferiority randomized controlled trial. In total 220 Hong Kong Chinese women aged 18–65 years with diagnosis of episodic migraine will be recruited and randomized to either the Tai Chi training group or the standard prophylactic medication group with 1:1 ratio, and receive the 24 weeks of modified 33-short form Yang-style Tai Chi training and the standard prophylactic medications, respectively. A 24-week follow-up will be implemented for both groups. For efficacy examination, the primary outcome was the frequency of migraine attacks measured by the migraine diary; and for the mechanism exploration, the primary outcome was the volume and number of white matter hyperintensity (WMH) measured by magnetic resonance imaging (MRI). The measurements will be conducted at the baseline, 24th weeks, and 48th weeks. Linear mixed model will be adopted to comprehensively analyze the changes of variables within and between groups. Discussion Given the importance of reducing disease burden and financial cost of migraine attacks, the findings of this study will provide new insights regarding the role of Tai Chi in alleviating migraine burden and further shed light on the mechanism action of Tai Chi on preventing headache attacks. Trial registration ClinicalTrials.gov NCT05690737. Registered on January 28, 2023.

Objectives: This study aimed to tailor and pilot a health education program using the PRECEDE-PROCEED model to promote vaccination and enhance self-protective behaviors against COVID-19 in Hong Kong populations. Study design: Quasi-experimental study. Methods: Phases 1–4 of the PRECEDE-PROCEED model were used to identify the needs for COVID-19 prevention. Strategies to address predisposing, reinforcing, and enabling factors in the PRECEDE-PROCEED model were developed, and an intervention package was generated thereafter. A pre–post experimental study was conducted among 50 participants to preliminarily assess the effects of the intervention based on Phases 5 and 8 of the PRECEDE-PROCEED model. Results: The 3-month intervention package contained 16 health education videos, 36 health tips, individual consultations, regular reminders of vaccination, incentive of anti-epidemic packages, and vaccine booking services. By the third month, 33 participants took a new dose of COVID-19 vaccine, and 5 participants withdrew. The vaccination rate for new dose achieved 73.3% (95% CI: 58.06–85.40%). Compared with the Hong Kong population in the same period, our study demonstrated higher increase in vaccination rate (9.97 vs. 1.36 doses per 1000 person-days). The percentage of early testing in personal and family level increased to 86.7% and 84.4%, respectively (both p < 0.05). For correct mask wearing and hand washing, the scores increased from a baseline score of 9.1 ± 1.6 and 4.9 ± 1.3 to 9.5 ± 1.0 and 5.3 ± 1.2, respectively (both p < 0.05). Conclusions: The application of the PRECEDE-PROCEED model effectively facilitated the stepwise development, implementation, and evaluation of a health education program for improving vaccination rates and fostering self-protective behaviors against infections.

Abstract Background Few studies have investigated how the effectiveness of hand washing in removing hand contaminants is influenced by the performance and duration of each step involved. We conducted an observational study by recruiting participants from a university campus, with the aim to comprehensively evaluate how performance, duration and demographic factors influence hand washing effectiveness. Methods A total of 744 videos were collected from 664 participants in July-October 2022 and independently evaluated by two infection control experts through labelling videos for correct and incorrect performance of each step. The individual hand washing effectiveness was determined by quantifying the percentage of residual fluorescent gel on the dorsum and palm areas of each participant’s hands. A logistic regression analysis was conducted to identify factors that were significantly associated with better hand washing effectiveness. An exposure-response relationship was constructed to identify optimal durations for each step. Approximately 2300 hand images were processed using advanced normalization algorithms and overlaid to visualize the areas with more fluorescence residuals after hand washing. Results Step 3 (rub between fingers) was the most frequently omitted step and step 4 (rub the dorsum of fingers) was the most frequently incorrectly performed step. After adjustment for covariates, sex, performance of step 4 and step 7 (rub wrists), rubbing hands during rinsing, and rinsing time were significantly associated with hand washing effectiveness. The optimal overall hand washing time was 31 s from step 1 to step 7, and 28 s from step 1 to step 6, with each step ideally lasting 4–5 s, except step 3. The palms of both hands had less fluorescence residuals than the dorsums. The areas where residuals most likely appeared were wrists, followed by finger tips, finger webs and thumbs. Conclusions Performance and duration of some hand washing steps, sex and rinsing time were associated with hand washing effectiveness. The optimal duration might be applied to all seven steps to achieve the best decontamination results. Further studies are needed to refine hand hygiene standards and enhance compliance.

Objective To evaluate the feasibility of long ⁃tunnelled external ventricular drainage (LTEVD) in neurosurgery. Methods A total of 187 patients who underwent external ventricular drainage in The Second Nanning People's Hospital from June 2020 to August 2022 were included. They were respectively treated with LTEVD (LTEVD group, n = 82) and short⁃tunnelled external ventricular drainage (STEVD group, n = 105). The indwelling time of postoperative drainage tube were recorded in detail. Drainage tube displacement, drainage tube blockage, cerebrospinal fluid leakage, and the incidence of secondary intracranial infection, as well as the incidence of secondary intracranial infection during drainage tube indwelling days. Results The comparison of safety between 2 groups showed that the drainage tube indwelling time in LTEVD group was significantly longer than that in STEVD group [23.00 (14.00, 33.50) d vs. 7.00 (5.00, 10.00) d; Z = ⁃ 10.126, P = 0.000], and the secondary intracranial infection rate during drainage tube indwelling days was lower than that in STEVD group [1.92‰ (4/2087) vs. 16.35‰ (13/795); χ2 = 187.000, P = 0.000]. Conclusions LTEVD can significantly prolong the indewelling time of drainage tube, the incidence of secondary intracranial infection during drainage tube indwelling days can clarify the effect of drainage tube indwelling time on the incidence of secondary intracranial infection.

Abstract Background Maternal mortality due to pregnancy, childbirth and postpartum is a global challenge. Particularly, in low-and lower-income countries, the outcomes of these complications are quite substantial. In recent years, studies exploring the effect of mobile health on the improvement of maternal health are increasing. However, the effect of this intervention on the improvement of institutional delivery and postnatal care utilization was not well analyzed systematically, particularly in low and lower-middle-income countries. Objective The main aim of this review was to assess the effect of mobile heath (mHealth) interventions on improving institutional delivery, postnatal care service uptake, knowledge of obstetric danger signs, and exclusive breastfeeding among women of low and lower-middle-income countries. Methods Common electronic databases like PubMed, EMBASE, the Web of Science, Medline, CINAHL, Cochrane library, Google scholar, and gray literature search engines like Google were used to search relevant articles. Articles that used interventional study designs and were conducted in low and lower-middle-income countries were included. Sixteen articles were included in the final systematic review and meta-analysis. Cochrane’s risk of bias tool was used to assess the quality of included articles. Results The overall outcome of the systematic review and meta-analysis showed that MHealth intervention has a positive significant effect in improving the institutional delivery (OR = 2.21 (95%CI: 1.69–2.89), postnatal care utilization (OR = 4.13 (95%CI: 1.90–8.97), and exclusive breastfeeding (OR = 2.25, (95%CI: 1.46–3.46). The intervention has also shown a positive effect in increasing the knowledge of obstetric danger signs. The subgroup analysis based on the intervention characteristics showed that there was no significant difference between the intervention and control groups based on the intervention characteristics for institutional delivery (P = 0.18) and postnatal care utilizations (P = 0.73). Conclusions The study has found out that mHealth intervention has a significant effect on improving facility delivery, postnatal care utilization, rate of exclusive breastfeeding, and knowledge of danger signs. There were also findings that reported contrary to the overall outcome which necessitates conducting further studies to enhance the generalizability of the effect of mHealth interventions on these outcomes.

BackgroundVisceral adipose tissue plays an active role in the pathogenesis of type 2 diabetes and vascular dysfunction. The lipid accumulation product (LAP), visceral adiposity index (VAI), and Chinese VAI (CVAI) have been proposed as simple and validated surrogate indices for measuring visceral adipose tissue. However, the evidence from prospective studies on the associations between these novel indices of visceral obesity and diabetic retinopathy (DR) remains scant. ObjectiveThis study aimed to investigate the longitudinal associations of LAP, VAI, and CVAI with incident DR in Chinese patients with diabetes. MethodsThis was a prospective cohort study conducted in Guangzhou in southern China. We collected baseline data between November 2017 and July 2020, while on-site follow-up visits were conducted annually until January 2022. The study participants consisted of 1403 patients with a clinical diagnosis of diabetes, referred from primary care, who were free of DR at baseline. The LAP, VAI, and CVAI levels were calculated by sex-specific equations based on anthropometric and biochemical parameters. DR was assessed using 7-field color stereoscopic fundus photographs and graded according to the modified Airlie House Classification scheme. Time-dependent Cox proportional hazard models were constructed to estimate the hazard ratios with 95% CIs. Restricted cubic spline curves were fitted to examine the dose-response relationship between the 3 indices of visceral obesity and new-onset DR. Subgroup analyses were performed to investigate the potential effect modifiers. ResultsThe mean age of study participants was 64.5 (SD 7.6) years, and over half (816/1403, 58.2%) were female. During a median follow-up of 2.13 years, 406 DR events were observed. A 1-SD increment in LAP, VAI, or CVAI was consistently associated with increased risk for new-onset DR, with a multivariable‑adjusted hazard ratio of 1.24 (95% CI 1.09-1.41; P=.001), 1.22 (95% CI 1.09-1.36; P.10). ConclusionsVisceral obesity, as measured by LAP, VAI, or CVAI, is independently associated with increased risk for new-onset DR in Chinese patients with diabetes. Our findings may suggest the necessity of incorporating regular monitoring of visceral obesity indices into routine clinical practice to enhance population-based prevention for DR.

How to optimize course learning resources and learning methods to promote higher-order learning is an important research topic in current teaching reform. Based on the background of the big data era, this paper uses the MOOC network to build an open-sharing platform for physical education teaching course resources. Firstly, the MOOC network classroom teaching model is summarized through the analysis paradigm of the MOOC platform analyzing indicators to deal with teaching big data. The third-order nonlinear model is used in the teaching model to dynamically express the physical education teaching resource-sharing design system and establish a physical education simulation model. In the simulation model, the search optimal solution is improved for resource platform search, and global search is performed when the inertia factor is large and local search is performed when it is small. The univariate validation test for group S students revealed that the mean value of the performance of the answers selected by group S students before the test compared to after the test changed from negative to positive, from -0.46 to 0.16, which was a significant improvement. It can be seen that the teaching model based on the MOOC web-supported open-sharing platform of physical education course resources has positively contributed to students’ learning performance, learning interest, and independent learning ability.

Abstract BackgroundIdentifying persons with a high risk of developing osteoporosis and preventing the occurrence of the first fracture is a health care priority. Most existing osteoporosis screening tools have high sensitivity but relatively low specificity. ObjectiveWe aimed to develop an easily accessible and high-performance preclinical risk screening tool for osteoporosis using a machine learning–based method among the Hong Kong Chinese population. MethodsParticipants aged 45 years or older were enrolled from 6 clinics in the 3 major districts of Hong Kong. The potential risk factors for osteoporosis were collected through a validated, self-administered questionnaire and then filtered using a machine learning–based method. Bone mineral density was measured with dual-energy x-ray absorptiometry at the clinics; osteoporosis was defined as a t ResultsAmong the 800 participants enrolled in this study, the prevalence of osteoporosis was 10.6% (n=85). The machine learning–based Boruta algorithm identified 15 significantly important predictors from the 113 potential risk factors. Seven variables were further selected based on their accessibility and convenience for daily self-assessment and health care practice, including age, gender, education level, decreased body height, BMI, number of teeth lost, and the intake of vitamin D supplements, to construct the POST. The AUC of the POST was 0.86 and the sensitivity, specificity, and accuracy were all 0.83. The positive predictive value, negative predictive value, and F1 ConclusionsThe machine learning–based POST was conveniently accessible and exhibited accurate discriminative capabilities for the prediction of osteoporosis; it might be useful to guide population-based preclinical screening of osteoporosis and clinical decision-making.

BackgroundAttention-deficit/hyperactivity disorder (ADHD) is relatively common among school-age children. Technology-based interventions, such as computer-assisted training programs, neurofeedback training, and virtual reality, show promise in regulating the behaviors and cognitive functions of children with ADHD. An increasing number of randomized controlled trials have been conducted to evaluate the effectiveness of these technologies in improving the conditions of children with ADHD. ObjectiveThis study aims to conduct a systematic review of technological interventions for school-age children with ADHD and perform a meta-analysis of the outcomes of technology-based interventions. MethodsA total of 19 randomized controlled studies involving 1843 participants were selected from a pool of 2404 articles across 7 electronic databases spanning from their inception to April 2022. ADHD behaviors, cognitive functions, learning ability, and quality of life were addressed in this study. ResultsRandom effects meta-analyses found that children with ADHD receiving technology-based intervention showed small and significant effect sizes in computer-rated inattention (standardized mean difference [SMD] −0.35; P

Optical materials with nearly zero refractive indices have driven emerging applications ranging from geometry-invariant optical tunneling, nonlinear optics, optical cloaking to thermal emission manipulation. In conventional dielectric photonic circuits, light scattering and back reflection at the waveguide bends and crossings leads to significant optical loss. Here we propose to use near-zero-index materials as a cladding layer for low-loss optical waveguides, where optical modes are tightly confined within the dielectric core region. Compared to conventional waveguides, the near-zero-index waveguides are superior in maintaining a high mode-filling factor for small device sizes close to the diffraction limit and reducing the crosstalk in between at a sub-wavelength separation. In addition, we found that light propagation is robust to waveguide bends in a small radius (∼µm) and geometry variation in the cross section. Hollow waveguides with near-zero-index cladding layers further support low-loss light propagation because materials absorption is minimized from the air core. Our work offers critical insights into future designs of low-loss and miniaturized photonic devices.

ObjectiveTo determine the individual dose level and changing trend in the occupational external exposure of radiation workers in Shanghai， and provide scientific evidence for health risk assessment for radiation workers.MethodsIn the Occupational Health Management System for Radiation Workers of the National Health Commission-External Exposure Personal Monitoring and Management Subsystem， we retrieved the monitoring data of 38 077 external exposure individual dose of all medical radiation workers in Shanghai from 2015 to 2019. Using clustered sampling method， a total of 11 370 radiation workers in medical institutions （including tertiary， secondary， and primary hospitals） were selected in the study. Statistical analyses were conducted using SPSS 22.0.ResultsThe collective annual effective dose of 11 370 radiation workers was determined to be 4.340 person Sv， including 2.270 man·mSv in diagnostic radiology， 1.112 man·mSv in interventional radiology， and

AimsTo assess longitudinal changes in blood pressure (BP) and fasting plasma glucose (FPG) in primary care patients with concomitant hypertension and type 2 diabetes mellitus (T2DM), and to explore factors associated with patients' inability to improve BP and FPG at follow-up.MethodsWe constructed a closed cohort in the context of the national basic public health (BPH) service provision in an urbanised township in southern China. Primary care patients who had concomitant hypertension and T2DM were retrospectively followed up from 2016 to 2019. Data were retrieved electronically from the computerised BPH platform. Patient-level risk factors were explored using multivariable logistic regression analysis.ResultsWe included 5,398 patients (mean age 66 years; range 28.9 to 96.1 years). At baseline, almost half [48.3% (2,608/5,398)] of patients had uncontrolled BP or FPG. During follow-up, more than one-fourth [27.2% (1,467/5,398)] of patients had no improvement in both BP and FPG. Among all patients, we observed significant increases in systolic BP [2.31 mmHg, 95% confidence interval (CI): 2.04 to 2.59, p

BackgroundTai Chi has been broadly applied as alternative treatment for many neurological and psychological disorders. Whereas no study using Tai Chi as prophylactic treatment for migraine. The purpose of this study was to preliminarily examine the efficacy and feasibility of a 12-week Tai Chi training on migraine attack prevention in a sample of Chinese women.MethodsA two-arm randomized controlled trial was designed. Women aged 18 to 65 years and diagnosed with episodic migraine were randomized to either Tai Chi group (TC group) or the waiting list control group. A modified 33-short form Yang-style Tai Chi training with 1 h per day, 5 days per week for 12 weeks was implemented in the TC group, with a 12-week follow up period. The control group received a “delayed” Tai Chi training at the end of the trial. The primary outcome was the differences in attack frequency between 4 weeks before baseline and at the 9–12 weeks after randomization. The intensity and duration of headache were also measured. The feasibility was evaluated by the maintenance of Tai Chi practice and satisfactory level of the participants toward training.ResultsEighty-two women were randomized, finally 40 in TC group and 33 in control group were involved in the analysis. On average, women in TC group had 3.0 times (95% CI: −4.0 to −2.0, P < 0.01) and 3.6 days (95% CI: −4.7 to −2.5, P < 0.01) reduction of migraine attack per month. Compared with the control group, the differences were statistically significant (−3.7 attacks/month, 95% CI: −5.4 to −1.9; and −3.0 migraine days/month, 95% CI: −4.5 to −1.5; both P < 0.001). The intensity and duration of headache had 0.6 (95% CI: −1.2 to −0.0, P < 0.05) units and 1.2 (IQR: −5.0 to 1.1, P < 0.05) hours reduction in TC group, respectively. Most of the participants (69.2%−97.4%) were satisfied with the training. At the end of 24 weeks, on average, the participants maintained 1.5 times of practice per week and 20 min for each practice.ConclusionThe 12-week Tai Chi training significantly decreased the frequency of migraine attack. It was acceptable and practicable among female migraineurs.Clinical trial registrationwww.ClinicalTrials.gov, identifier: NCT03015753.

A questionnaire was used to investigate the knowledge and experience of university students in Jilin Province regarding innovation and entrepreneurship. A non-parametric test was used to analyze whether there were significant differences in knowledge perception, and experience of innovation and entrepreneurship between paired samples and independent samples. The results showed significant disparities in students’ knowledge perception, and experience of innovation and entrepreneurship. No significant differences in knowledge perception, or experience of innovation and entrepreneurship were found between the male and female samples. Significant differences in both aspects were found between samples at different stages. All this suggests that as students grow in age and work experience, their knowledge perception, and experience of innovation and entrepreneurship are continuously enriched. To ease the pressure on employment, university students should be actively encouraged to innovate and start businesses.

Objective To investigate the synergistic effect of dichloroacetate (DCA) and sorafenib on the inhibition of proliferation in hepatocellular carcinoma (HCC) cells. Methods Hep3B cells were treated respectively, with DMSO (control), DCA (5 mmol/L), sorafenib (10 μmol/L), and DCA (5 mmol/L) combined with sorafenib (10 μmol/L) for 24 h, then the cells were stained with crystal violet and observed under a microscope for cell morphology. CCK-8 assay was used to detect the changes of cell proliferation, and flow cytometry was employed to measure cell apoptosis. Then, Western blotting was utilized to detect the protein expression of apoptosis-related protein PARP and p-JNK, and the production of reactive oxygen species (ROS) was measured by ROS detection kits, Finally, flow cytometry was performed to detect the changes of apoptosis after addition of anti-oxidant, NAC and JNK inhibitor, SP600125. Results DCA combined with sorafenib significantly changed the cell morphology and killed the cells. Compared with DCA alone or sorafenib alone, DCA combined sorafenib significantly enhanced the inhibitory effect on the proliferation in Hep3B cells (P < 0.05), increased the cleavage of PARP and the phosphorylation of JNK. Moreover, the combination induced the production of intracellular ROS (P < 0.05). Co-treatment of antioxidant NAC resulted in significant inhibition of elevated JNK phosphorylation and inhibitory effect on proliferation induced by DCA combined sorafenib in Hep3B cells. Conclusion Combination of DCA and sorafenib significantly inhibits proliferation in Hep3B cells, which may be related with the activation of ROS/JNK signal pathway.

Objective: This study aimed to evaluate the television (TV) viewing and computer and mobile phone usage duration in a community sample of Chinese adults and examine their associations with BMI and obesity.Methods: We conducted a community-based health needs assessment study from February to December 2018 among 2,873 Chinese adults in Nanshan District of Shenzhen, China. We used self-administered questionnaires to collect the data from 24 community health service centers in Nanshan District. The participants individually recorded the time they spent watching TV and using computers and mobile phones. They also answered questions about their sociodemographic and lifestyle factors. We measured their height and weight by using ultrasonic height and weight scales. Then, we calculated and categorized their BMI in accordance with the standards prescribed by the World Health Organization for Asians.Results: Most of the participants were young adults (aged 18–44 years, 74.2%). The overall prevalence of obesity was 15.30%. The prevalence of TV, computer, and mobile phone usage was 75.5, 71.2, and 93.8% in females and 71.1, 75.7, and 94.2% in males, respectively. The youth (18–24 years) and the elderly (65 years or older) had the longest time using mobile phones (3.78 ± 2.51 h) and watching TV programs (2.12 ± 1.38 h), respectively. Longer usage of computers and mobile phones was evident in males (p < 0.05) and participants with a high education level (p < 0.01). The univariate analysis results showed an association between high BMI and obesity and short duration of using computers and mobile phones (all p < 0.05). By contrast, no significant associations were found between the length of TV program viewing and mobile phone usage and BMI (p > 0.05). After we adjusted for potential confounders, we found that computer usage time and the overall usage time of the three electronic devices had an inverse association with BMI (p < 0.05).Conclusions: Mobile phones were the most popular electronic device in Nanshan residents of Shenzhen. Unlike most previous studies, we found an inverse association between screen time and BMI. Nevertheless, scholars should conduct further studies to explore this association. Overall, we strongly encourage the appropriate use of electronic devices.

The novel coronavirus (COVID-19) infection has spread worldwide since late 2019. People who have social contacts with COVID-19 patients might be at higher risk of physical or mental health problems. This study investigated whether people who had social contacts with COVID-19 patients would have poorer physical or mental outcomes, and different attitudes and behaviors. Chinese adults were recruited to fill in an online survey using snowball sampling during 21st-26nd February 2020. Physical symptoms, psychological outcomes, quality of life, COVID-19 related attitudes, and behaviors were measured. The differences in the outcomes between participants who had COVID-19 social contacts and those who had not were analyzed. The survey included 1,447 non-infected eligible participants. Among those, 173 (12.0%) reported at least one confirmed/suspected case in their social contacts. In the multiple regression adjusted for demographic data, the presence of confirmed/suspected infection cases in one's social contacts was significantly associated with poorer physical and mental outcomes, lower health-related quality of life, and different COVID-19 related attitudes and behaviors (p

Objectives This study aims to investigate the potential factors associated with mental health outcomes among Chinese adults during the Coronavirus disease 2019 (COVID-19) epidemic. Methods This is an online cross-sectional survey conducted among Chinese adults in February 2020. Outcome measurements included the three-item UCLA Loneliness Scale (UCLA-3), two-item Patient Health Questionnaire (PHQ-2), two-item Generalized Anxiety Disorder Questionnaire (GAD-2), and two items from the Clinician-Administered Post-traumatic Stress Disorder (PTSD) Scale. COVID-19 related factors, physical health, lifestyle, and self-efficacy were also measured. Univariable and multivariable logistic regressions were performed. Results This study included 1456 participants (age: 33.8±10.5 years; female: 59.1%). The prevalence of depressive symptoms, anxiety symptoms, loneliness, and PTSD symptoms were 11.3%, 7.6%, 38.7%, and 33.9%, respectively. In multivariable analysis, loneliness was associated with being single, separated/divorced/widowed, low level of education, current location, medication, more somatic symptoms, lower self-efficacy, and going out frequently. Depression was associated with fear of infection, binge drinking, more somatic symptoms, lower self-efficacy, and longer screen time. Anxiety was associated with more somatic symptoms and lower self-efficacy. PTSD symptoms were associated with more somatic symptoms, lower self-efficacy, higher perceived risk of infection, fear of infection, and self-rated more negative influence due to the epidemic (pConclusions Mental health problems during the COVID-19 epidemic were associated with various biopsychosocial and COVID-19 related factors. Psychological interventions should be aware of these influencing factors and prioritize support for those people at higher risk.

Antiferromagnets are promising platforms for transduction and transmission of quantum information via magnons—the quanta of spin waves—and they offer advantages over ferromagnets in regard to dissipation, speed of response and robustness to external fields. Recently, transduction was shown in a van der Waals antiferromagnet, where strong spin-exciton coupling enables readout of the amplitude and phase of coherent magnons by photons of visible light. This discovery shifts the focus of research to transmission, specifically to exploring the non-local interactions that enable magnon wave packets to propagate. Here we demonstrate that magnon propagation is mediated by long-range dipole–dipole interaction. This coupling is an inevitable consequence of fundamental electrodynamics and, as such, will likely mediate the propagation of spin at long wavelengths in the entire class of van der Waals magnets currently under investigation. Successfully identifying the mechanism of spin propagation provides a set of optimization rules, as well as caveats, that are essential for any future applications of these promising systems.

Type 2 diabetes (T2D) is a heterogeneous disease that develops through diverse pathophysiological processes1,2 and molecular mechanisms that are often specific to cell type3,4. Here, to characterize the genetic contribution to these processes across ancestry groups, we aggregate genome-wide association study data from 2,535,601 individuals (39.7% not of European ancestry), including 428,452 cases of T2D. We identify 1,289 independent association signals at genome-wide significance (P

2D layered materials with broken inversion symmetry are being extensively pursued as  spin source layers to realize high-efficiency magnetic switching. Such low-symmetry layered systems are, however, scarce. In addition, most layered magnets with perpendicular magnetic anisotropy show a low Curie temperature. Here, the experimental observation of spin-orbit torque magnetization self-switching at room temperature in a layered polar ferromagnetic metal, Fe2.5 Co2.5 GeTe2 is reported. The spin-orbit torque is generated from the broken inversion symmetry along the c-axis of the crystal. These results provide a direct pathway toward applicable 2D spintronic devices.

Abstract Objective This study aimed to assess the association between exposure to the Great Chinese Famine (1959–1961) during early life and hypertension in adulthood. Methods From July to September 2009, 1224 eligible adults were recruited in a cross-sectional survey using a multi-stage stratified random sampling method in Chongqing China. A questionnaire was used to collect information of hypertension and sociodemographic factors. Participants were categorized as childhood, fetal, and none exposure to famine based on the date of birth. Results Of the sample, 12.3% reported having hypertension. The prevalence of hypertension varied by famine status: 11.9% in childhood exposure, 16.1% in fetal exposure, and 10.2% in non-exposure group. After adjusting for sociodemographic and lifestyle factors, compared with non-exposure group, fetal exposure group had an increased likelihood of having hypertension with odds ratio of 1.79 (95%CI 1.13-2.84). Although there was no significant gender and famine interaction, the positive association between famine exposure and hypertension was stronger among women than men. Conclusion Fetal exposure to the Chinese famine may be associated with an increased risk of arthritis in adulthood in women.

Generation Z, as the first generation growing up in the environment of globalization, has emerged as a new important consumer group worldwide. Compared with other generations, members of Generation Z possess some notable characteristics such as lower brand loyalty and less interest in mainstream products. Meanwhile, they also display a strong tendency to nostalgia, which has been a widelyused theme in marketing and proved to enhance consumers' brand attitudes and purchasing intentions. Based on the unique preferences and needs of Generation Z, this study explored the innovative strategy of nostalgia-driven design of brand spokes-characters and related digitalization, which are popular design elements in brand promotion and advertising. Through a multi-method qualitative approach (including user interviews, creative exercises, and content analysis), it provided important consumer insights into the attitudes of Generation Z on brand spokes-characters that can trigger nostalgia, as well as their preferences for design strategies focusing on two types of nostalgia, i.e., personal nostalgia and historical nostalgia. Given the special preference of Generation Z for story-based brand spokes-characters, this study also emphasized the value of advanced digital media technology for creating truly nostalgic story scenes that could continue to impress consumers. Such findings have formed an important basis for ongoing quantitative studies that further examine the effectiveness of nostalgia-driven design for Generation Z.

BackgroundEpigenome-wide association studies have identified multiple DNA methylation sites (CpGs) associated with alcohol consumption, an important lifestyle risk factor for cardiovascular diseases. This study aimed to test the hypothesis that an alcohol consumption epigenetic risk score (ERS) is associated with blood pressure (BP) traits.ResultsWe implemented an ERS based on a previously reported epigenetic signature of 144 alcohol-associated CpGs in meta-analysis of participants of European ancestry. We found a one-unit increment of ERS was associated with eleven drinks of alcohol consumed per day, on average, across several cohorts (p

Stabilization of topological spin textures in layered magnets has the potential to drive the development of advanced low-dimensional spintronics devices. However, achieving reliable and flexible manipulation of the topological spin textures beyond skyrmion in a two-dimensional magnet system remains challenging. Here, we demonstrate the introduction of magnetic iron atoms between the van der Waals gap of a layered magnet, Fe3GaTe2, to modify local anisotropic magnetic interactions. Consequently, we present direct observations of the order-disorder skyrmion lattices transition. In addition, non-trivial topological solitons, such as skyrmioniums and skyrmion bags, are realized at room temperature. Our work highlights the influence of random spin control of non-trivial topological spin textures.

Coronary artery calcification (CAC) is a measure of atherosclerosis and a well-established predictor of coronary artery disease (CAD) events. Here we describe a genome-wide association study (GWAS) of CAC in 22,400 participants from multiple ancestral groups. We confirmed associations with four known loci and identified two additional loci associated with CAC (ARSE and MMP16), with evidence of significant associations in replication analyses for both novel loci. Functional assays of ARSE and MMP16 in human vascular smooth muscle cells (VSMCs) demonstrate that ARSE is a promoter of VSMC calcification and VSMC phenotype switching from a contractile to a calcifying or osteogenic phenotype. Furthermore, we show that the association of variants near ARSE with reduced CAC is likely explained by reduced ARSE expression with the G allele of enhancer variant rs5982944. Our study highlights ARSE as an important contributor to atherosclerotic vascular calcification, and a potential drug target for vascular calcific disease.

the purpose of this study was to explore the effect of “modular” nursing intervention on Ranoxifene in the treatment of patients with postmenopausal osteoporosis. A total of 108 patients with postmenopausal osteoporosis who were accepted by the Department of Orthopaedics in our hospital were selected as the research objects. According to the random number table method and they were divided into two groups (the intervention group and the control group), 54 cases in each group. The control group was given routine care, while the other was given “modular” interventional care. The patient satisfaction, adverse mood changes and quality of life changes in the two groups was observed in the treatment. The results of this study showed that the nursing satisfaction of the patients in the intervention group was significantly higher than that in the control group; however, the negative emotion of the two groups of patients after care were lower than that before the care, and the degree of reduction in the intervention group was significantly higher than that of the control group; the life quality of patient in the two groups was improved than before nursing, and the degree of improvement in the intervention group was significantly higher than that in the control group. Therefore, the clinical application of Raloxifene in the treatment of postmenopausal osteoporosis patients with “modular” nursing intervention can improve patient satisfaction, relieve negative emotions, and improve quality of life.