Ethnic disparities in the prevalence of SARS-CoV-2 testing positivity comparing Hispanic and non-Hispanic populations.

Context: The Hispanics make up the largest ethnic minority in the United States (US). Hispanics have lower all-cause mortality and many chronic disease morbidities, despite lower socioeconomic status (SES), and barriers to health care. Whether this phenomenon, termed as the "Hispanic Paradox", holds during an infectious disease pandemic, warrants investigation. Objective: To examine the ethnic disparities in COVID-19 infection among general patients tested using PCR and understand risk factors of viral positivity other than Hispanic ethnicity. Study Design: Observational study design using retrospective electronic medical records (EMR). Setting or Dataset: All patients analyzed were ≥ 18 years old with at least one diagnostic Coronavirus molecular test in a community healthcare system in Washington State. Sociodemographic characteristics (age, sex, and race/ethnicity), date of testing, viral positivity, reasons for testing, body mass index (BMI), key comorbidities, and health insurance status were extracted from the EMR. Derived variables included Hispanic or non-Hispanic, no insurance, age groups, and obesity. Population Studied: Our analytical focus was on adult Hispanics. The study included both females and males and investigated non-Hispanics. All data were from community healthcare clinical patients. Outcome Measures: Viral positivity of COVID-19 infection. Results: Of 108,973 patients, Hispanics had a much higher overall viral positivity (16.9%) than non-Hispanics (8.5%, p = 0.000). Symptomatic Hispanic patients had 40.7% positivity at the peak point, compared to 21.0% for symptomatic non-Hispanics. The ethnic disparity also existed for asymptomatic patients (6.6% vs. 3.2%, p = 0.000). Symptomatic male Hispanics showed 29.5% positivity, 9.5 times that of non-Hispanic asymptomatic females (3.1%). Multivariate analysis showed that older age, male sex (OR = 1.42, p = 0.000), being symptomatic (OR = 6.03, 95% CI: 5.31-6.85), having no insurance (OR = 1.34, p = 0.041), obesity (OR = 1.18, p = 0.002), and Hispanic ethnicity (OR = 1.45, 95% CI: 1.16-1.82) were associated with higher likelihood of viral positivity, whilst being White (OR = 0.68, p = 0.000), having cancer (OR = 0.69, p = 0.005) or COPD (OR = 0.69, p = 0.000) were associated with lower test positivity. Conclusion: We found ethnic and racial disparities in COVID-19 viral positivity rates. The diminishing Hispanic Paradox warrants further investigation into SES, cultural, and behavioral factors.

Characterising percentage energy from ultra-processed foods by participant demographics, diet quality and diet cost: findings from the Seattle Obesity Study (SOS) III.

Higher consumption of 'ultra-processed' (UP) foods has been linked to adverse health outcomes. The present paper aims to characterise percentage energy from UP foods by participant socio-economic status (SES), diet quality, self-reported food expenditure and energy-adjusted diet cost. Participants in the population-based Seattle Obesity Study III (n 755) conducted in WA in 2016-2017 completed socio-demographic and food expenditure surveys and the FFQ. Education and residential property values were measures of SES. Retail prices of FFQ component foods (n 378) were used to estimate individual-level diet cost. Healthy Eating Index (HEI-2015) and Nutrient Rich Food Index 9.3 (NRF9.3) were measures of diet quality. UP foods were identified following NOVA classification. Multivariable linear regressions were used to test associations between UP foods energy, socio-demographics, two estimates of food spending and diet quality measures. Higher percentage energy from UP foods was associated with higher energy density, lower HEI-2015 and NRF9.3 scores. The bottom decile of diet cost ($216·4/month) was associated with 67·5 % energy from UP foods; the top decile ($369·9/month) was associated with only 48·7 % energy from UP foods. Percentage energy from UP foods was inversely linked to lower food expenditures and diet cost. In multivariate analysis, percentage energy from UP foods was predicted by lower food expenditures, diet cost and education, adjusting for covariates. Percentage energy from UP foods was linked to lower food spending and lower SES. Efforts to reduce UP foods consumption, an increasingly common policy measure, need to take affordability, food expenditures and diet costs into account.

Empiric evidence of ethnic disparities in coronavirus positivity in Washington State.

OBJECTIVES: Early reports from the initial months of the coronavirus pandemic reveal ethnic disparities in coronavirus incidence, severity, and mortality. This study aimed to evaluate the relationship between ethnicity and outcomes of coronavirus positivity and hospitalization. DESIGN: An observational cohort study using electronic health record (EHR) data from a large community healthcare system in Washington State across the first phase of the pandemic (March 5 - June 7, 2020). RESULTS: A total of 18,667 patients (65.9% of all tested) with EHR-documented ethnicity were included. Overall, 6.4% of patients tested positive for coronavirus. Among Latinx patients, 18.6% of those tested were positive, compared to only 4.0% of tested White patients. Multivariable logistic regression revealed significantly higher odds of positivity for Latinxs (aOR = 4.96, 95% CI 4.19-5.87), Asians (aOR = 2.33, 95% CI 1.74-3.08), Blacks (aOR = 1.82, 95% CI 1.43-2.31), and members of other ethnic minority groups (aOR = 2.34, 95% CI 1.80-2.95), compared to Whites in models adjusting for relevant confounders. Latinxs had a higher percentage of self-pay insurance (22.2%) compared to other ethnic groups (7.9-15.8%) and, among those who tested positive, were the only ethnic subpopulation with significantly higher odds than Whites to be hospitalized for COVID-19 (aOR = 2.19, 95% CI 1.45-3.33). We observed a positive correlation between infection and the percentage of Latinxs (r = 0.61, 95% CI 0.45-0.74), Blacks (r = 0.51, 95% CI 0.32-0.66), or Asians (r = 0.64, 95% CI 0.49-0.76) in a given zip-code. This correlationwas negative for Whites (r = -0.63, 95% CI -0.75, -0.45). CONCLUSIONS: We present empirical evidence of higher rates of coronavirus positivity among People of Color compared to White people in Washington State. Social determinants of health, such as occupation, housing, healthcare access, and community structure, may contribute to health disparities in the coronavirus pandemic. Targeted capture of these variables in electronic health records is warranted to inform health equity analyses.

Maternal Marijuana Exposure and Birth Weight: An Observational Study Surrounding Recreational Marijuana Legalization.

OBJECTIVE: This study aimed to study the relationship between prenatal marijuana and infant birth weight using natural cohorts established before, during and after the 20-month lapse between legalization and legal recreational sales in Washington State. STUDY DESIGN: Over 5 years, 5,343 pregnant women with documented urine drug screen (UDS) results delivered at Tacoma General Hospital or Good Samaritan Hospital. Maternal medical data were extracted for three delivery cohorts established based on before (T1), during (T2), and after legalization (T3) of recreational marijuana and legalized availability. Univariate and multivariate models were created to study marijuana exposure on infants' birth weight. RESULTS: Marijuana exposure increased the risk of low birth weight (LBW; odds ratio [OR] = 1.42, 95% confidence interval [CI]: 1.01-2.01). This was more pronounced in full-term babies (OR = 1.72, 95% CI: 1.10-2.69), and was independently associated with a higher risk for small for gestational age (SGA; OR = 1.51, 95% CI: 1.49-1.53). The associations between marijuana exposure and SGA were maintained in cohort-specific models (OR = 1.53, 95% CI: 1.01-2.32 for T2, and OR = 1.43, 95% CI: 1.01-2.02 for T3, respectively). CONCLUSION: Marijuana exposure verified by UDS was associated with LBW and SGA. However, recreational marijuana legalization and availability did not have direct impact on newborns' risk of LBW or SGA.

Exercise Training in Patients With Heart Failure With Preserved Ejection Fraction: A Community Hospital Pilot Study.

BACKGROUND: Patients with heart failure with preserved ejection fraction (HFpEF) experience poor exercise tolerance and quality of life. Little is known about the feasibility or effects of HFpEF exercise training (ET) in a community hospital setting. OBJECTIVE: The aim of this study was to examine the feasibility and pilot data of a community-based HFpEF ET intervention. METHODS: This was a single-group (n = 16), pretest-posttest, 9-week ET intervention. The Minnesota Living With Heart Failure Questionnaire, Patient Health Questionnaire-9, cardiopulmonary exercise test (peak VO2), and 6-minute walk test were used for evaluation. RESULTS: Participants (n = 16) attended 88% of prescribed ET sessions and 94% completed all pretest-posttest assessments. Significant improvements in Minnesota Living With Heart Failure Questionnaire (P = .01), Patient Health Questionnaire-9 (P ≤ .01), exercise test time (P = .01) and 6-minute walk test (P = .001), but not in peak VO2 (P = .16), were found. CONCLUSIONS: The ET intervention was feasible and safe, and findings support improved quality of life, depressive symptoms, and exercise tolerance. Larger controlled trials are warranted.

Demographic Discrepancies in Prenatal Urine Drug Screening in Washington State Surrounding Recreational Marijuana Legalization and Accessibility.

OBJECTIVES: This study evaluated demographic patterns related to prenatal cannabinoid urine drug screening (UDS) over a 5-year period during which recreational marijuana was legalized and became accessible in Washington State. METHODS: Using electronic health record data, we performed a retrospective analysis for deliveries occurring over a 5-year period that encapsulated the transitions to marijuana legalization and legal access. For three cohorts of women delivering prior to legalization, between legalization and accessibility, and following accessibility, the UDS completion rate and screening demographic characteristics were assessed using Chi-squared tests and multivariate logistic regression. RESULTS: 25,514 deliveries occurred between March 2011 and March 2016. A significantly higher percentage of women underwent UDS post-accessibility (24.5%) compared to pre-legalization (20.0%, p < 0.001). A corresponding increase was not observed in the percentage of marijuana-positive UDS in tested patients (22.7% vs. 23.3%, p = 0.86). African American women had 2.8 times higher odds than Latinas of being tested, 2.1 times higher odds than Asian women, 1.7 times higher odds than White women, and 1.4 times higher odds than women of other races (all p < 0.001). Subsidized insurance status was also strongly associated with increased likelihood of testing (aOR = 3.5, p < 0.001). CONCLUSIONS FOR PRACTICE: Prenatal UDS testing patterns changed as recreational marijuana possession and accessibility became legal. Demographic discrepancies in testing reveal biases related to race and insurance status, which may be a proxy for socioeconomic status. As such discrepancies are potential contributors to health outcome disparities, it is important for providers and health care systems to examine their practices and ensure they are being appropriately, equally, and justly applied.

The discriminative power of STOP-Bang as a screening tool for suspected obstructive sleep apnea in clinically referred patients: considering gender differences.

PURPOSE: Obstructive sleep apnea (OSA) is the most commonly seen clinical sleep disorder. STOP-Bang, a widely used screening tool, yields a composite score based on eight dichotomized items including male gender. This study was designed to validate STOP-Bang among clinically referred patients and tested alternative scoring designs on tool performance, with a focus on gender differences in OSA. METHOD: STOP-Bang was administered to 403 female and 532 male subjects, followed by comprehensive sleep evaluation that included measurement of apnea-hypopnea indexes. Gender differences in STOP-Bang scores, OSA diagnosis, and severities were explored, and gender-specific alternative score cutoffs evaluated. Optimal operating points (OOP) were tested for female body mass index (BMI) and male neck circumference to inform STOP-Bang threshold refinement. Receiver operating characteristic curves were used to compare conventional and modified STOP-Bang. RESULTS: STOP-Bang performance by gender showed extremely low specificity in males at the recommended cutoff of ≥3. Better utility was presented at a cutoff of 4 or 5 among clinically referred patients irrespective of gender differences. Screening performance was improved by modifying BMI and/or neck circumference thresholds using gender-triaged OOP estimation. Three gender-based model revisions outperformed conventional STOP-Bang. CONCLUSION: Our study suggests that gender-specific consideration needs to be incorporated into the application of STOP-Bang in a clinically referred patient population with a higher risk of OSA. Alternative scoring systems may improve predictive performance of STOP-Bang.

Does Mentoring by Orthopedic Surgeons Improve Forearm Fracture Reduction Outcomes by Pediatric Emergency Physicians? Evaluation of a Process Improvement Intervention Program.

BACKGROUND: Forearm fractures are among the most frequently encountered orthopedic injuries in children. The maintenance of satisfactory alignment can be problematic and postreduction displacement with resultant malunion can occur. OBJECTIVES: The objective of the study was to evaluate pediatric emergency medicine (PEM) physicians' performance on forearm fracture reduction to determine the impact of a Process Improvement Intervention Program (PIIP) on postreduction displacement rates after initial reduction. The PIIP was designed to improve our PEM physicians' skills and knowledge in how to properly apply and mold casts to better maintain the alignment of reduced forearm fractures. METHODS: A PIIP was implemented during 2015-2016 when orthopedic surgeons mentored postfellowship-trained PEM physicians. Patient cohorts from pre- and post-PIIP implementation were investigated and compared to evaluate the impact of the PIIP on PEM physicians' initial fracture reduction success rates and postreduction displacement rates. Descriptive and analytical statistics including univariate and multivariate models were tested to understand changes in physicians' performance. RESULTS: Pre- and postcohorts had similar demographic and clinical characteristics and similarly high initial reduction success rates. When distal and midshaft fracture types were combined, there was no significant difference in postreduction displacement rates between the 2 cohorts, but when stratified based on fracture type, the distal radius postcohort showed a statistically significant improvement in postreduction maintenance. CONCLUSIONS: A PIIP by pediatric orthopedic surgeons did not change the PEM physicians' initial fracture reduction success rate, but it did result in a statistically significant improvement in maintenance of reduction rates.

Changing outpatient referral patterns in a small pediatric nephrology practice.

BACKGROUND: We have noted a large number of referrals for abnormal kidney imaging and laboratory tests and postulated that such referrals have increased significantly over time. Understanding changes in referral patterns is helpful in tailoring education and communication between specialists and primary providers. METHODS: We performed a retrospective chart review of new patient referrals to Mary Bridge Children's Nephrology clinic for early (2002 to 2004) and late (2011 to 2013) cohorts. The overall and individual frequencies of referrals for various indications were compared. RESULTS: The overall number of new visits was similar for early (511) and late (509) cohorts. The frequency of referrals for solitary kidneys and multi-cystic dysplastic kidneys, microalbuminuria and abnormal laboratory results increased significantly (Odds Ratio (OR) and 95% Confidence Interval of OR: 1.920 [1.079, 3.390], 2.862 [1.023, 8.006], 2.006 [1.083, 3.716], respectively) over the time interval while the proportion of referrals for urinary tract infections (UTIs) and vesicoureteral reflux (VUR) decreased by half (OR: 0.472, 95% CI: 0.288, 0.633). Similarly, referrals for urinary tract dilation and hydronephrosis occurred significantly less often (8% versus 6%, OR: 0.737, 95% CI: 0.452, 1.204) with similar changes in referrals for voiding issues (OR: 0.281, 95% CI: 0.137, 0.575). However, these changes were not statistically significant. Frequencies for other indications showed little variation. CONCLUSIONS: Changes in indications for referral likely reflect evolution of practice in management of UTIs and VUR and increased use of imaging and laboratory testing by pediatric providers. These findings have relevance for ongoing education of pediatricians and support the need for collaboration between primary providers and nephrologists to assure the judicious use of resources.

Patient Satisfaction with Virtual Obstetric Care.

Introduction The importance of patient satisfaction in US healthcare is increasing, in tandem with the advent of new patient care modalities, including virtual care. The purpose of this study was to compare the satisfaction of obstetric patients who received one-third of their antenatal visits in videoconference ("Virtual-care") compared to those who received 12-14 face-to-face visits in-clinic with their physician/midwife ("Traditional-care"). Methods We developed a four-domain satisfaction questionnaire; Virtual-care patients were asked additional questions about technology. Using a modified Dillman method, satisfaction surveys were sent to Virtual-care (N = 378) and Traditional-care (N = 795) patients who received obstetric services at our institution between January 2013 and June 2015. Chi-squared tests of association, t-tests, logistic regression, and ANOVA models were used to evaluate differences in satisfaction and self-reported demographics between respondents. Results Overall satisfaction was significantly higher in the Virtual-care cohort (4.76 ± 0.44 vs. 4.47 ± 0.59; p < .001). Parity ≥ 1 was the sole significant demographic variable impacting Virtual-care selection (OR = 2.4, 95% CI: 1.5-3.8; p < .001). Satisfaction of Virtual-care respondents was not significantly impacted by the incorporation of videoconferencing, Doppler, and blood pressure monitoring technology into their care. The questionnaire demonstrated high internal consistency as measured by domain-based correlations and Cronbach's alpha. Discussion Respondents from both models were highly satisfied with care, but those who had selected the Virtual-care model reported significantly higher mean satisfaction scores. The Virtual-care model was selected by significantly more women who already have children than those experiencing pregnancy for the first time. This model of care may be a reasonable alternative to traditional care.

Risk Factors for Vibrio parahaemolyticus Infection in a Southern Coastal Region of China.

OBJECTIVES: The objectives of the study were to identify dietary and medical risk factors for Vibrio parahaemolyticus (VP) infection in the coastal city Shenzhen in China. METHODS: In April-October 2012, we conducted a case-control study in two hospitals in Shenzhen, China. Laboratory-confirmed VP cases (N = 83) were matched on age, sex, and other social factors to healthy controls (N = 249). Subjects were interviewed using a questionnaire on medical history; contact with seawater; clinical symptoms and outcome; travel history over the past week; and dietary history 3 days prior to onset. Laboratory tests were used to culture, serotype, and genotype VP strains. We used logistic regression to calculate the odds ratios for the association of VP infection with potential risk factors. RESULTS: In multivariate analysis, VP infection was associated with having pre-existing chronic disease (adjusted odds ratio [aOR], 6.0; 95% confidence interval [CI], 1.5-23.7), eating undercooked seafood (aOR, 8.0; 95% CI, 1.3-50.4), eating undercooked meat (aOR, 29.1; 95% CI, 3.0-278.2), eating food from a street food vendor (aOR, 7.6; 95% CI, 3.3-17.6), and eating vegetable salad (aOR, 12.1; 95% CI, 5.2-28.2). CONCLUSIONS: Eating raw (undercooked) seafood and meat is an important source of VP infection among the study population. Cross-contamination of VP in other food (e.g., vegetables and undercooked meat) likely plays a more important role. Intervention should be taken to lower the risks of cross-contamination with undercooked seafood/meat, especially targeted at people with low income, transient workers, and people with medical risk factors.

Vibrio parahaemolyticus, Southern Coastal Region of China, 2007-2012.

We analyzed the prevalence and characteristics of Vibrio parahaemolyticus among patients with acute infectious diarrhea in the southern coastal region of China. V. parahaemolyticus was the leading cause of bacterial infectious diarrhea in this region during 2007-2012. Serotype O3:K6 strains were most common, followed by serotypes O4:K8 and O3:K29.

Screening for differentially expressed genes in endophytic fungus strain 39 during co-culture with herbal extract of its host Dioscorea nipponica Makino.

Strain 39 is an endophytic fungus which was isolated from Dioscorea nipponica Makino (DNM). After Strain 39 co-cultured with ethanol extract of DNM rhizomes for several days, the content of saponins in this culture mixture would be obviously increased. To analyze the mechanism of this microbial transformation, we used the differential display reverse transcription polymerase chain reaction (DDRT-PCR) method to compare the transcriptomes between Strain 39 cultured in normal PD medium and in PD medium which added ethanol extract of DNM rhizomes. We amplified 29 DDRT-PCR bands using 12 primer combinations of three anchored primers and five random primers, and six bands were re-amplified. Analysis of real-time PCR and sequence alignment showed that three clones were up-regulated in sample group: squalene epoxidase, squalene synthase, and catalase, one clone was expressed only in sample group. The possible roles and origins of the above genes were discussed, and the molecular mechanism of Strain 39 biotransformation was speculated. This study is the first report of the molecular biotransformation mechanism of saponins production by endophytic fungus of DNM.

Comparison of perceived quality amongst migrant and local patients using primary health care delivered by community health centres in Shenzhen, China.

BACKGROUND: Providing good quality primary health care to all inhabitants is one of the Chinese Government's health care objectives. However, information is scarce regarding the difference in quality of primary health care delivered to migrants and local residents respectively. This study aimed to compare patients' perceptions of quality of primary health care between migrants and local patients, and their willingness to use and recommend primary health care to others. METHODS: A cross-sectional survey was conducted. 787 patients in total were chosen from four randomly drawn Community Health Centers (CHCs) for interviews. RESULTS: Local residents scored higher than migrants in terms of their satisfaction with types of drugs available (3.62 vs. 3.45, p=0.035), attitude of health workers (4.41 vs. 4.14, p=0.042) and waiting time (4.30 vs. 3.86, p<0.001). Even though there was no significant difference in overall satisfaction between local residents and migrants (4.16 vs. 3.91, p=0.159), migrants were more likely to utilize primary health care as the first choice for their usual health problems (94.1% vs. 87.1%, p=0.032), while local residents were more inclined to recommend Traditional Chinese Medicine to others (65.6% vs. 56.6%, p=0.026). CONCLUSIONS: Quality of primary health care given to migrants is less satisfactory than to local residents in terms of attitude of health workers and waiting time. Our study suggests quality of care could be improved through extending opening hours of CHCs and strengthening professional ethics education. Considering CHCs as the first choice by migrants might be due to their health insurance scheme, while locals' recommendations for traditional Chinese medicine were possibly because of cultural differences.

Nexus of food waste and climate change framework: Unravelling the links between impacts, projections, and emissions.

This communication explores the intricate relationship between food waste and climate change, considering aspects such as impacts, projections, and emissions. It focuses on the pressing issue of waste generation and its potential consequences if current trends persist, and emphasises the importance of efficient solid waste management in improving environmental quality and fostering economic development. It also highlights the challenges faced by developing countries in waste collection and disposal, drawing comparisons with the waste utilisation methods used by developed nations. The review delves into the link between food waste and climate change, noting the paradoxical situation of food wastage against the backdrop of global hunger and malnutrition. It underscores the scientific evidence connecting food waste to climate change and its implications for food security and climate systems. Additionally, it examines the environmental burden imposed by food waste, including its contribution to greenhouse gas emissions and the depletion of resources such as energy, water, and land. Besides environmental concerns, this communication also highlights the ethical and socioeconomic dimensions of food waste, discussing its influence on Sustainable Development Goals, poverty, and social inequality. The communication concludes by advocating for collective action and the development of successful mitigation strategies, technological solutions, and policy interventions to address food waste and its climate impacts. It emphasises the need for collaboration, awareness, and informed decision-making to ensure a more sustainable and equitable future.

Identification of microplastics in raw and treated municipal solid waste landfill leachates in Hong Kong, China.

Plastics are indispensable in modern society but also pose a persistent threat to the environment. In particular, microplastics (MPs) have a substantial environmental impact on ecosystems. Municipal solid waste landfill leachates are a source of MPs, but leakage of MPs from leachates has only been reported in a few studies. As a modern city, Hong Kong has a remarkably high population density and a massive plastic waste generation. However, it depends on conventional landfilling for plastic waste management and traditional thermal ammonia stripping for leachate treatment. Yet, the MP leakage from landfill leachates in Hong Kong has not been disclosed. This is the first study that aimed to identify, quantify, and characterise MPs in raw and treated leachates, respectively, from major landfill sites in Hong Kong. The concentrations of MPs varied from 49.0 ± 24.3 to 507.6 ± 37.3 items/L among the raw leachate samples, and a potential correlation was found between the concentration of MPs in the raw leachate sample from a given landfill site and the annual leachate generation of the site. Most MPs were 100-500 µm fragments or filaments and were transparent or yellow. Regarding the polymeric materials among the identified MPs, poly(ethylene terephthalate) and polyethylene were the most abundant types, comprising 45.30% and 21.37% of MPs, respectively. Interestingly, leachates treated by ammonia stripping contained higher concentrations of MPs than raw leachate samples, which demonstrated that the traditional treatment process may not be sufficient regarding the removal of emerging pollutants, such as MPs. Overall, our findings provide a more comprehensive picture of the pollution of MPs in landfill leachates in Hong Kong and highlight the urgent need for adopting the consideration of MPs into the conventional mindset of waste management systems in Hong Kong.

Protocol to measure validity and reliability of colorectal, breast, cervical and lung cancer screening questions from the 2021 National Health Interview Survey: Methodology and design.

Previous studies demonstrate that self-reports of mammography screening for breast cancer and colonoscopy screening for colorectal cancer demonstrate concordance, based on adherence to screening guidelines, with electronic medical records (EMRs) in over 90% of those interviewed, as well as high sensitivity and specificity, and can be used for monitoring our Healthy People goals. However, for screening tests for cervical and lung cancers, and for various sub-populations, concordance between self-report and EMRs has been noticeably lower with poor sensitivity or specificity. This study aims to test the validity and reliability of lung, colorectal, cervical, and breast cancer screening questions from the 2021 and 2022 National Health Interview Survey (NHIS). We present the protocol for a study designed to measure the validity and reliability of the NHIS cancer screening questions compared to EMRs from four US-based healthcare systems. We planned a randomized trial of a phone- vs web-based survey with NHIS questions that were previously revised based on extensive cognitive interviewing. Our planned sample size will be 1576 validity interviews, and 1260 interviews randomly assigned at 1 or 3 months after the initial interview. We are enrolling people eligible for cancer screening based on age, sex, and smoking history per US Preventive Services Task Force recommendations. We will evaluate question validity using concordance, sensitivity, specificity, positive predictive value, negative predictive value, and report-to-records ratio. We further are randomizing participants to complete a second survey 1 vs 3 months later to assess question reliability. We suggest that typical measures of concordance may need to be reconsidered in evaluating cancer screening questions.

Synergistic and stepwise treatment of resveratrol and catechol in Haematococcus pluvialis for the overproduction of biomass and astaxanthin.

To increase the production of biomass and astaxanthin from Haematococcus pluvialis to meet the high market demand for astaxanthin, this study recruited two typical and negligible phytohormones (namely resveratrol and catechol) for the stepwise treatments of H. pluvialis. It was found that the hybrid and sequential treatments of resveratrol (200 µmol) and catechol (100 µmol) had achieved the maximum astaxanthin content at 33.96 mg/L and 42.99 mg/L, respectively. Compared with the hybrid treatment, the physiological data of H. pluvialis using the sequential strategy revealed that the enhanced photosynthetic performance via the Calvin cycle by RuBisCO improved the biomass accumulation during the macrozooid stage; meanwhile, the excessive ROS production had occurred to enhance astaxanthin production with the help of NADPH overproduction during the hematocyst stage. Overall, this study provides improved knowledge of the impacts of phytohormones in improving biomass and astaxanthin of H. pluvialis, which shed valuable insights for advancing microalgae-based biorefinery.

Health of China's rural-urban migrants and their families: a review of literature from 2000 to 2012.

BACKGROUND: Socioeconomic transformation in China at the beginning of the twenty-first century has led to rapid urbanization and accelerated rural-urban migration. As a result, the concerns about public health problems triggered by increasing internal population mobility have been more widely studied in recent years. SOURCES OF DATA: Published data in Chinese and English on health of migrants and their families in mainland China from 2000 to 2012. AREAS OF AGREEMENT: The shifting patterns of disease distribution due to rural-urban migration, health equity and health reform strategies that cater for this specific yet substantial subpopulation are outstanding concerns. Infectious diseases, mental health, occupational health and women's health are emerging public health priorities related to migration. AREAS OF CONTROVERSY: The high mobility and large numbers of Chinese rural-urban migrants pose challenges to research methods and the reliability of evidence gained. GROWING POINTS: While the theme of working migrants is common in the literature, there have also been some studies of health of those left behind but who often remain unregistered. Migration within China is not a single entity and understanding the dynamics of new and emerging societies will need further study. AREAS TIMELY FOR DEVELOPING RESEARCH: Social, economic, emotional, environmental and behavioural risk factors that impact on health of migrants and their families call for more attention from health policy-makers and researchers in contemporary China.

Tobacco smoking among migrant factory workers in Shenzhen, China.

BACKGROUND: While several studies of smoking behaviors in rural-to-urban Chinese migrants exist, none to our knowledge have focused on factory workers, estimated to represent between 10% and 20% of China's total rural-to-urban migratory population. This paper assesses factors associated with smoking behavior among rural-to-urban migrant factory workers in Shenzhen, China. METHODS: A cross-sectional survey of migrant workers from 44 randomly selected factories in Shenzhen, China. Participants were migrant factory workers aged 16-59 years and holding nonlocal household registration. The main outcome measures were demographic, migration-related, and behavioral factors associated with smoking status. RESULTS: Four thousand and eighty-eight completed questionnaires were obtained (response rate 95.5%). Overall smoking prevalence (including occasional, daily, and heavy daily smoking) was 19.1%. The prevalence of daily smoking (including heavy daily smoking) was higher in men (27.3%) than women (0.7%). These rates are significantly lower than national smoking rates (59.5% in men, 3.7% in women) and rates found in a similar study. A high-risk group of men who smoke heavily and consume alcohol frequently was identified. Longer working hours and less rest were associated with higher rates of smoking. Frequent Internet use and lack of insurance were associated with lifetime smoking. Gender-adjusted models showed that poorer mental health and an accumulated working time in Shenzhen of 2-3 years increased female workers' likelihood of smoking. CONCLUSIONS: Migrant factory workers in Shenzhen had lower rates of smoking than other population groups in China. The identification of risk factors for heavy smoking may help to effectively target health promotion interventions.