Toward Reliable Symptom Coding in Electronic Health Records for Symptom Assessment and Research: Identification and Categorization of International Classification of Diseases, Ninth Revision, Clinical Modification Symptom Codes.

To date, symptom documentation has mostly relied on clinical notes in electronic health records or patient-reported outcomes using disease-specific symptom inventories. To provide a common and precise language for symptom recording, assessment, and research, a comprehensive list of symptom codes is needed. The International Classification of Diseases, Ninth Revision or its clinical modification (International Classification of Diseases, Ninth Revision, Clinical Modification) has a range of codes designated for symptoms, but it does not contain codes for all possible symptoms, and not all codes in that range are symptom related. This study aimed to identify and categorize the first list of International Classification of Diseases, Ninth Revision, Clinical Modification symptom codes for a general population and demonstrate their use to characterize symptoms of patients with type 2 diabetes mellitus in the Cerner database. A list of potential symptom codes was automatically extracted from the Unified Medical Language System Metathesaurus. Two clinical experts in symptom science and diabetes manually reviewed this list to identify and categorize codes as symptoms. A total of 1888 International Classification of Diseases, Ninth Revision, Clinical Modification symptom codes were identified and categorized into 65 categories. The symptom characterization using the newly obtained symptom codes and categories was found to be more reasonable than that using the previous symptom codes and categories on the same Cerner diabetes cohort.

The location of pain in cluster headache: Data from the International Cluster Headache Questionnaire.

OBJECTIVE: To identify the most common locations of cluster headache pain from an international, non-clinic-based survey of participants with cluster headache, and to compare these locations to other cluster headache features as well as to somatotopic maps of peripheral, brainstem, thalamic, and cortical areas. BACKGROUND: Official criteria for cluster headache state pain in the orbital, supraorbital, and/or temporal areas, yet studies have noted pain extending beyond these locations, and the occipital nerve appears relevant, given the effectiveness of suboccipital corticosteroid injections and occipital nerve stimulation. Furthermore, cranial autonomic features vary between patients, and it is not clear if the trigeminovascular reflex is dermatome specific (e.g., do patients with maxillary or V2 division pain have more rhinorrhea?). Finally, functional imaging studies show early activation of the posterior hypothalamus in a cluster headache attack. However, the first somatosensory area to be sensitized is unclear; the first area can be hypothesized based on the complete map of pain locations. METHODS: The International Cluster Headache Questionnaire was an internet-based cross-sectional survey that included a clickable pain map of the face. These data were compared to several other datasets: (1) a meta-analysis of 22 previous publications of pain location in cluster headache (consisting of 6074 patients); (2) four cephalic dermatome maps; (3) participants' survey responses for demographics, autonomic features, and effective medications; and (4) previously published somatotopic maps of the brainstem, thalamus, primary somatosensory cortex, and higher order somatosensory cortex. RESULTS: One thousand five hundred eighty-nine participants completed the pain map portion of the survey, and the primary locations of pain across all respondents was the orbital, periorbital, and temporal areas with a secondary location in the lower occiput; these primary and secondary locations were consistent with our meta-analysis of 22 previous publications. Of the four cephalic dermatomes (V1, V2, V3, and a combination of C2-3), our study found that most respondents had pain in two or more dermatomes (range 85.7% to 88.7%, or 1361-1410 of 1589 respondents, across the four dermatome maps). Dermatomes did not correlate with their respective autonomic features or with medication effectiveness. The first area to be sensitized in the canonical somatosensory pathway is either a subcortical (brainstem or thalamus) or higher order somatosensory area (parietal ventral or secondary somatosensory cortices) because the primary somatosensory cortex (area 3b) and somatosensory area 1 have discontinuous face and occipital regions. CONCLUSIONS: The primary pain locations in cluster headache are the orbital, supraorbital, and temporal areas, consistent with the official International Classification of Headache Disorders criteria. However, activation of the occiput in many participants suggests a role for the occipital nerve, and the pain locations suggest that somatosensory sensitization does not start in the primary somatosensory cortex.

Association Between Adherence to 24-Hour Movement Guidelines and Noncommunicable Disease Risk in Chinese Adults: Prospective Cohort Study.

BACKGROUND: The increasing annual global deaths are attributable to noncommunicable chronic diseases (NCDs). Adhering to healthy lifestyle behaviors is associated with lower NCD risk, particularly among individuals with ample movement, enough sleep, and reduced sedentariness. Nevertheless, there are only few prospective assessments on the association of interactions between daily activities with NCD prevention, while the associations between adhering to Canadian 24-Hour Movement Guidelines (24HGs) for adults and NCD risks are still unknown. Compared to the general population, obese and overweight populations are at a higher risk of developing NCDs. Currently, it is unclear whether the health benefits of adhering to 24HGs differ between the general population and the obese population. OBJECTIVE: This study explores prospective associations between adherence to 24HGs and NCD risks by weight status among overweight and obese adults in China. METHODS: This decadal study consists of 9227 adults aged 35 years and older without any major NCDs at enrolment in the China Health and Nutrition Survey (2004-2011) and followed up until 2015. The exposure of interest was the overall score of compliance with 24HGs measured by participants' self-report, wherein 1 point was assigned for compliance to each component, resulting in an aggregated score ranging from 0 to 3. The primary outcome was the first occurrence of major NCDs (high blood pressure, stroke, diabetes, cancer, and acute myocardial infarction). Log-binomial regression models were used to evaluate the associations. RESULTS: : Overall, 4315 males and 4912 females, with 25,175 person-years of follow-up, were included in our analyses. The average baseline age was 50.21 (SD 11.04) years. Among the overweight and obese groups, those adhering to 1 (risk ratio [RR] 0.37, 95% CI 0.19-0.74; P=.004), 2 (RR 0.37, 95% CI 0.19-0.72; P=.003), and 3 (RR 0.32, 95% CI 0.14-0.73; P=.006) recommendations of 24HGs had a significantly lower NCD risk than those not adhering to any of the activity guidelines. Among the normal or underweight groups, those adhering to 1 (RR 0.49, 95% CI 0.27-0.96; P=.03) and 3 (RR 0.40, 95% CI 0.17-0.94; P=.03) components had a significantly lower NCD risk than those not adhering to any of the activity guidelines. CONCLUSIONS: In this prospective study, we found that active adherence to recommendations of 24HGs was associated with lower risks of NCDs, especially among overweight and obese participants. Additionally, overweight and obese individuals who met at least 1 component of 24HGs were at a significantly lower risk for NCDs, but this protective effect was not found among individuals in the normal and underweight groups. Individuals with excess body weight who tend to be more susceptible to health risks may gain greater health benefits than the general population by adhering to the recommendations of 24HGs.

Validity of food and nutrient intakes assessed by a food frequency questionnaire among Chinese adults.

BACKGROUND: Studies regarding the validity of the food frequency questionnaire (FFQ) and the food composition table (FCT) are limited in Asian countries. We aimed to evaluate the validity of a 64-item FFQ and different methods of constructing the FFQ FCTs for assessing dietary intakes of foods and nutrients among adults in eastern China. METHODS: A total of 2325 participants (aged 56.2 ± 14.9 years, 51.6% female) from nine cities in Zhejiang province who completed a 64-item FFQ and 3-day 24-hour dietary recalls (24HRs) in 2015 were included. Eight FFQ FCTs were generated covering food items and specific weights estimated using professional knowledge, representative 24HRs data, or the Chinese FCT (CFCT). Energy-adjusted intakes of foods and nutrients were estimated by residual and energy density methods. Spearman correlation coefficients (SCCs) of intakes of 14 food groups and 17 nutrients between FFQ and 24HRs were calculated to evaluate the overall validity of FFQ. RESULTS: The average intakes of most food groups and nutrients assessed with FFQ were higher than those assessed using the 24HRs. For the food groups, the averaged energy-adjusted (residual method) SCC between FFQ and 24HRs was 0.27, ranging from 0.14 (starch-rich beans) to 0.49 (aquatic products). For nutrient assessment, the weighted FCT (WFCT) performs the best, and the averaged energy-adjusted (residual method) SCC was 0.26, ranging from 0.16 (iron) to 0.37 (potassium). Similar correlations with 24HRs were observed when using other FFQ FCT in the calculation of nutrient intakes. CONCLUSION: The 64-item Chinese FFQ and the WFCT were reasonably valid to assess the dietary intakes of certain foods and nutrients among adults in eastern China.

Comparative analysis of aptamers binding to SARS-CoV-2 N protein using capillary electrophoresis and bio-layer interferometry.

Aptamers are increasingly employed in SARS-CoV-2 theragnostics in recent years. Characterization of aptamers, testing affinity and kinetic parameters (e.g., equilibrium dissociation constant (KD), kon, and koff), can be done by several methods and influenced by many factors. This study aims to characterize the binding of aptamers to SARS-CoV-2 nucleocapsid (N) protein using capillary electrophoresis (CE) and bio-layer interferometry (BLI). These two analytical methods differ by how the aptamer binds to its target protein once the aptamer, as a capture ligand, is partitioned in solution (CE) or immobilized on the biosensor (BLI). With CE, the KD values of the N-binding aptamers (tNSP1, tNSP2, and tNSP3) were determined to be 18 ± 4 nM, 45 ± 11 nM, and 32 ± 7 nM, respectively, while the KD measurements by BLI yielded 4.8 ± 0.6, 4.5 ± 0.5, and 2.9 ± 0.3 nM, respectively. CE results showed a higher KD across all aptamers tested. The differences in the steric hindrance and confirmational structures of the aptamers immobilized on the BLI biosensors versus those suspended in the CE sample solution affect the molecular interactions between aptamers and the target proteins. Moreover, the buffer composition including pH and ionic strength can influence the stability of aptamer structures, or aptamer-protein complexes. All these variables affect the binding and calculated KD. In this sense, a KD value alone is not sufficient to make comparisons between aptamers; instead, the entire experimental setup should also be considered. This is particularly important when implementing aptamers in different bioanalytical systems.

Adherence to 24-Hour Movement Guidelines in Relation to the Risk of Overweight and Obesity Among Children and Adolescents.

PURPOSE: Adherence to overall 24-hour Movement Guidelines (24HGs) has been associated with childhood obesity in cross-sectional studies. However, few longitudinal studies have examined such associations, especially in China. We aimed to explore prospective associations between adherence to recommendations of 24HGs and risks of developing overweight and obesity among children and adolescents. METHODS: We included participants (aged 6-17 years) without overweight and obesity at enrollment from the China Health and Nutrition Survey in 2004-2011 surveys and followed them till 2015. We assigned one point each to the adherence of guidelines for moderate-to-vigorous physical activity, recreational screen time and sleep, and summed them up to indicate the overall level of adherence to 24HGs (range: 0-3 points). The primary outcome was the first occurrence of overweight or obesity. Multivariable cox proportional hazard models were used to evaluate the corresponding associations. RESULTS: Among 1,382 participants (mean age: 10.3 ± 3.2 years; 48.4% girls), a total of 152 (11%) individuals were identified as incident overweight and obesity during an average of 4.7 years of follow-up. Compared with participants nonadherent to any of the guidelines, those adhering to one (hazard ratio [HR] = 0.38, 95% confidence interval [CI]: 0.21-0.71, p < .01), two (HR = 0.49, 95% CI: 0.28-0.88, p = .02), and three (HR = 0.40, 95% CI: 0.17-0.91, p = .03) recommendations had significantly lower risks of developing overweight and obesity. DISCUSSION: Children and adolescents who met any recommendations of 24HGs had significantly lower risks of developing subsequent overweight and obesity. Setting achievable goals such as adopting at least one recommendation could be considered in future public health recommendations to accelerate progress in childhood obesity prevention.

Comparing the role of social connectivity with friends and family in depression among older adults in China: evaluating the moderating effect of urban-rural status.

Background: Social connectivity and support can reduce depressive symptoms. Few studies have examined urban-rural differences in the relationship between social support and depressive symptoms in the context of urbanization for Chinese older adults. The overall aim of this study is to examine urban-rural differences in the relationship between family support and social connectivity on depression among Chinese older adults. Methods: This cross-sectional study used data from the 2010 Sample Survey on Aged Population in Urban/Rural China (SSAPUR). Depressive symptoms were measured using the Geriatric Depression Scale short-form (GDS-15). Family support was measured by structural, instrumental, and emotional support. Social connectivity was measured using the Lubben Social Network Scale-6 (LSNS-6). Descriptive analysis was conducted using chi-square and independent t-tests to examine urban-rural differences. Adjusted multiple linear regressions were conducted to examine the moderating effect of urban-rural status on the association between types of family support and social connectivity with depressive symptoms. Results: In rural areas, respondents who felt their children exhibited filial piety (ß = -1.512, p < 0.001) and had more social connectivity with family (ß = -0.074, p < 0.001) were more likely to report fewer depression symptoms. In urban areas, respondents who received instrumental support from their children (ß = -1.276, p < 0.01), who thought their children exhibited filial piety (ß = -0.836, p < 0.01), and who had more social connectivity with friends (ß = -0.040, p < 0.01) were more likely to report fewer depression symptoms. In the fully adjusted regression model, social connectivity with family was associated with decreased depressive symptoms, although to a lesser degree among urban-dwelling older adults (urban-rural interaction effect, ß = 0.053, p < 0.05). Social connectivity with friends was similarly associated with decreased depressive symptoms, although this effect was greater among urban-dwelling older adults (urban-rural interaction effect, ß = -0.053, p < 0.05). Conclusion: The results of this study suggested that older adults both in rural and urban areas with family support and social connectivity were associated with fewer depression symptoms. Differences observed in the role of family and friend social connectivity by urban-rural status may provide practical information for developing targeted social support strategies for improving depressive symptoms among Chinese adults, and call for further mixed-methods research to disentangle mechanisms behind these differing associations.

Choice of Glucose-Lowering Drugs as Initial Monotherapy for Type 2 Diabetes Patients with Contraindications or Intolerance to Metformin: A Systematic Review and Meta-Analysis.

BACKGROUND: There are multiple glucose-lowering drugs available as alternative initial monotherapy for type 2 diabetes patients with contraindications or intolerance to metformin. However, little comparative and systematic data are available for them as initial monotherapy. This study estimated and compared the treatment effects of glucose-lowering drugs as initial monotherapy for type 2 diabetes. METHODS: PubMed, Web of Science, Embase, CNKI, Chongqing VIP, and WanFang Data from 1 January 1990 until 31 December 2020 were searched for randomized controlled trials which compared a glucose-lowering drug with placebo/lifestyle-intervention for type 2 diabetes. Drug classes included metformin, sulfonylureas (SUs), thiazolidinediones (TZDs), glinides (NIDEs), α-glucosidase inhibitors (AGIs), dipeptidyl peptidase-4 inhibitors (DPP-4is), sodium-glucose cotransporter-2 inhibitors (SGLT2is), insulins (INSs), and glucagon-like peptide-1 receptor agonists (GLP-1RAs). RESULTS: A total of 185 trials were included, identifying 38,376 patients from 56 countries across six continents. When choosing an initial drug monotherapy alternative to metformin, SUs were most efficacious in reducing HbA1c (-1.39%; 95% CI -1.63, -1.16) and FPG (-2.70 mmol/L; 95% CI -3.18, -2.23), but increased hypoglycemia risks (5.44; 95% CI 2.11, 14.02). GLP-1RAs were most efficacious in reducing BMI (-1.05 kg/m2; 95% CI -1.81, -0.29) and TC (-0.42 mmol/L; 95% CI -0.61, -0.22). TZDs were most efficacious in increasing HDL-C (0.12 mmol/L; 95% CI 0.07, 0.17). SGLT2is were most efficacious in lowering SBP (-4.18 mmHg; 95% CI -4.84, -3.53). While AGIs conferred higher risk of AE-induced discontinuations (2.57; 95% CI 1.64, 4.03). Overall, only GLP-1RAs showed an integrated beneficial effect on all outcomes. Our results also confirmed the intraclass differences in treatment effects across drugs. Most trials were short-term, and no significant differences in mortality, total vascular events, myocardial infarction, heart failure, stroke, or diabetic nephropathy were observed across drug classes. CONCLUSIONS: Our results suggest a potential treatment hierarchy for decision-makers, with GLP-1RAs being the preferred alternative therapy to metformin regarding their favorable efficacy and safety profiles.

Trends in activities of daily living disability among Chinese older adults from 1998 to 2018: an age-period-cohort analysis.

This study aims to investigate the age, period, and cohort effects on trends in activities of daily living (ADL) disability among Chinese older adults; and to explore these three temporal effects on gender and residence disparities in disability. We utilized multiple cross-sectional waves of the Chinese Longitudinal Healthy Longevity Survey data (1998-2018), including 89,511 participants aged above 65 years old. Our measurement of disability is the number of ADL items (dressing, bathing, indoor transferring, toileting, eating, and continence) participants can't perform independently. Hierarchical age-period-cohort cross-classified random effects models were conducted to investigate age, period and cohort trends in ADL disability. Results showed that ADL disability increased with age at an increasing rate. A V-shaped cohort trend and a fluctuated period trend were identified. Females and urban residents were associated with more ADL limitations. When age increased, the gender and residence gaps in disability further increased. The cohort-based gender and residence inequalities in ADL limitations converged with successive cohorts. The period-based residence gap in ADL limitations diverged throughout the 20-year period, while the corresponding period-based change in gender disparity was not significant. These findings suggested that age, period, and cohort had different and independent effects on ADL disability among Chinese older adults. The age effect on trends in ADL is stronger compared to period and cohort effects. The gender and residence disparities in disability increased with age and decreased with successive cohorts. These patterns might help inform healthcare planning and the priorities for medical resource allocation accordingly.

Association of Mushrooms and Algae Consumption with Mortality among Chinese Older Adults: A Prospective Cohort Study.

Mushrooms and algae are important sources of dietary bioactive compounds, but their associations with mortality remain unclear. We examined the association of mushrooms and algae consumption with subsequent risk of all-cause mortality among older adults. This study included 13,156 older adults aged 65 years and above in the Chinese Longitudinal Healthy Longevity Survey (2008-2018). Consumption of mushrooms and algae at baseline and age of 60 were assessed using a simplified food frequency questionnaire (FFQ). We used Cox proportional hazards models to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs). During 74,976 person-years of follow-up, a total of 8937 death cases were documented. After adjustment for demographic, lifestyle, and other dietary factors, participants who consumed mushrooms and algae at least once per week had a lower risk of all-cause mortality than rare consumers (0-1 time per year) (HR = 0.86; 95% CI: 0.80-0.93). Compared to participants with rare intake at both age 60 and the study baseline (average age of 87), those who maintained regular consumptions over time had the lowest hazard of mortality (HR = 0.86; 95% CI: 0.76-0.98). Our findings supported the potential beneficial role of long-term consumption of mushrooms and algae in reducing all-cause mortality among older adults. Further studies are warranted to evaluate the health benefit for longevity of specific types of mushrooms and algae.

AntiGQ1b antibody positive with MFS/GBS overlapped syndrome with diplopia and hemiplegia onset: Case report and retrospective analysis.

RATIONALE: GBS and MFS have been divided into several subtypes, constituting a series of independent and overlapping syndromes that share similar pathophysiology, leading to common clinical features, including history of previous infection, single-phase course, symmetry, skull or limbs weakness, CFS albumin cell separation (high protein, normal cell count), antiganglioside antibodies and axon, or evidence of demyelinating neuropathy neurophysiology. Part of the MFS in patients with clinical manifestations may be complicated, and even symptoms are not typical. A few patients may overlap with BBE or GBS. PATIENT CONCERNS: Most patients with MFS/GBS overlap syndrome have a good prognosis, and a few patients may experience fluctuations or re-exacerbations. In most patients, after treatment, their neurological function basically recovers within a few weeks or months. DIAGNOSIS INTERVENTIONS: The patient had ophthalmoplegia, ataxia, weak force, and protein-cell separation in cerebrospinal fluid during the development of the disease. The diagnosis of MFS overlapped with typical GBS was considered. The CSF specific IgG oligoclonal zone and anti-Sulfatide antibody were positive. Anti-GT1a IgG was positive. Anti-GQ1b IgG was positive, which supported the diagnosis of GBS spectrum disorders. According to their common immunological basis, plasma exchange or intravenous immunoglobulin (IVIG) therapy is recommended, which can effectively improve the symptoms and shorten the course of the disease. OUTCOMES: After treatment with glucocorticoids and gamma globulin, the symptoms improved and the patient was discharged. LESSONS: MFS/GBS Superimposed syndrome is a rare clinical disease. Therefore, more attention should be paid to early diagnosis and treatment of similar patients to avoid misdiagnosis. Cerebral spinal fluid (CFS) examination, neuroelectrophysiology, and GQ1b antibody detection can be used to confirm the diagnosis.

Comparison of Glucose-Lowering Drugs as Second-Line Treatment for Type 2 Diabetes: A Systematic Review and Meta-Analysis.

BACKGROUND: Multiple glucose-lowering drugs are available as add-ons to metformin for a second-line treatment for type 2 diabetes. However, no systematic and comparative data are available for them in China. We aimed to compare the effects of glucose-lowering drugs added to metformin in China. METHODS: PubMed, Embase, Web of Science, CNKI, WanFang Data, and Chongqing VIP from 1 January 2000 until 31 December 2020 were systematically searched for randomized controlled trials comparing a glucose-lowering drug added to metformin with metformin in Chinese type 2 diabetes patients. Drug classes included sulfonylureas (SUs), glinides (NIDEs), thiazolidinediones (TZDs), α-glucosidase inhibitors (AGIs), dipeptidyl peptidase-4 inhibitors (DPP-4is), sodium-glucose cotransporter-2 inhibitors (SGLT2is), glucagon-like peptide-1 receptor agonists (GLP-1RAs), and insulins (INSs). Two reviewers independently screened studies, extracted data, and appraised the risk of bias. RESULTS: 315 trials were included. In patients receiving metformin alone, the addition of NIDEs produced the greatest additional HbA1c reductions (1.29%; 95% CI 0.97, 1.60); while INSs yielded both the largest additional FPG reductions (1.58 mmol/L; 95% CI 1.22, 1.94) and 2 hPG reductions (2.52 mmol/L; 95% CI 1.83, 3.20). INS add-ons also conferred the largest additional HDL-C increases (0.40 mmol/L; 95% CI 0.16, 0.64), whereas AGI add-ons generated the greatest TC reductions (1.08 mmol/L; 95% CI 0.78, 1.37). The greatest incremental SBP reductions (6.65 mmHg; 95% CI 4.13, 9.18) were evident with SGLT2i add-ons. GLP-1RA add-ons had the greatest BMI reductions (1.96 kg/m2, 95% CI 1.57, 2.36), meanwhile with the lowest (0.54 time) hypoglycemia risk. Overall, only the GLP-1RA add-ons demonstrated a comprehensive beneficial effect on all outcomes. Furthermore, our results corroborated intraclass differences among therapies. Given the limited evidence, we could not reach a conclusion about the optimal therapies regarding mortality and vascular outcomes. CONCLUSION: The results suggested a potential treatment hierarchy for clinicians and patients, with the GLP-1RA add-ons being most preferred based on their favorable efficacy and safety profiles; and provided a unified hierarchy of evidence for conducting country-specific cost-effectiveness analyses.

The Disease and Economic Burdens of Esophageal Cancer in China from 2013 to 2030: Dynamic Cohort Modeling Study.

BACKGROUND: Esophageal cancer (EC) is the sixth leading cause of tumor-related deaths worldwide. Estimates of the EC burden are necessary and could offer evidence-based suggestions for local cancer control. OBJECTIVE: The aim of this study was to predict the disease burden of EC in China through the estimation of disability-adjusted life years (DALYs) and direct medical expenditure by sex from 2013 to 2030. METHODS: A dynamic cohort Markov model was developed to simulate EC prevalence, DALYs, and direct medical expenditure by sex. Input data were collected from the China Statistical Yearbooks, Statistical Report of China Children's Development, World Population Prospects 2019, and published papers. The JoinPoint Regression Program was used to calculate the average annual percentage change (AAPC) of DALY rates, whereas the average annual growth rate (AAGR) was applied to analyze the changing direct medical expenditure trend over time. RESULTS: From 2013 to 2030, the predicted EC prevalence is projected to increase from 61.0 to 64.5 per 100,000 people, with annual EC cases increasing by 11.5% (from 835,600 to 931,800). The DALYs will increase by 21.3% (from 30,034,000 to 36,444,000), and the years of life lost (YLL) will account for over 90% of the DALYs. The DALY rates per 100,000 people will increase from 219.2 to 252.3; however, there was a difference between sexes, with an increase from 302.9 to 384.3 in males and a decline from 131.2 to 115.9 in females. The AAPC was 0.8% (95% CI 0.8% to 0.9%), 1.4% (95% CI 1.3% to 1.5%), and -0.7% (95% CI -0.8% to -0.7%) for both sexes, males, and females, respectively. The direct medical expenditure will increase by 128.7% (from US $33.4 to US $76.4 billion), with an AAGR of 5.0%. The direct medical expenditure is 2-3 times higher in males than in females. CONCLUSIONS: EC still causes severe disease and economic burdens. YLL are responsible for the majority of DALYs, which highlights an urgent need to establish a beneficial policy to reduce the EC burden.

Trends in Cognitive Function Among Chinese Elderly From 1998 to 2018: An Age-Period-Cohort Analysis.

Objectives: To investigate the effects of age, period, and cohort (APC) on trends in cognitive function among the Chinese elderly, and to explore how gender gaps in cognitive function change with age, period, and cohort. Methods: This study used data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 1998 to 2018, and included 90,432 participants aged above 65 years old. The measurement of cognitive function was the score of the Mini-Mental State Examination (MMSE). Cross-classified random-effect models were used to investigate age, period, and cohort trends in cognitive function. Results: Mini-Mental State Examination scores decreased with age at an increasing rate. While the cohort effect was nearly stable, the period effect demonstrated a downward trend from 1998 to 2002 followed by a nearly flat line. Females were associated with lower MMSE scores than males. When age increased, the gender gaps in MMSE scores further increased. The period-based gender gaps in MMSE scores diverged throughout the 20 years, while the cohort-based gender disparities in MMSE scores converged with successive cohorts. Conclusions: Age, period, and cohort had different and independent effects on cognitive function among the Chinese elderly. The effect of age was stronger than that of period and cohort. Gender disparities in cognitive function increased with age and period, and decreased with successive cohorts.

Associations between Food Pantry Size and Distribution Method and Healthfulness of Foods Received by Clients in Baltimore City Food Pantries.

This study aimed to evaluate the association of the overall nutritional quality and the weight share of specific types of foods received by food pantry clients with food pantry size and distribution method. Data on healthy food weights using the gross weight share (GWS) of select foods and the validated Food Assortment Score Tool (FAST) were collected from 75 food pantry clients in Baltimore, Maryland. The average FAST score across the study population was 63.0 (SD: 10.4). Overall, no statistically significant differences in average FAST scores by pantry size and distribution method were found. However, among client-choice pantries, clients of small pantries had higher scores (p < 0.05) while among medium pantries, clients of traditional pantries had higher scores (p < 0.01). Subgroup analysis of GWS was stratified by pantry size and distribution methods. Findings suggested multi-level, multi-component interventions combining environmental strategies are needed to enhance the healthfulness of foods received by clients. Our analysis provided data to consider further refinements of pantry interventions and planning of more rigorous research on factors influencing the effectiveness of pantry interventions.

Cost-utility analysis of imrecoxib compared with celecoxib for patients with osteoarthritis.

BACKGROUND: The objective of this study is to compare the long-term cost-utility of imrecoxib and celecoxib for patients with osteoarthritis (OA) from the perspective of the Chinese healthcare system. METHODS: An economic model was built based on the model from the National Institute for Health and Care Excellence (NICE). The simulation was carried out initially for 100 cycles of 3 months each, starting with 10,000 patients. A discount rate of 5% was applied both for cost and utility. Quality-adjusted life years (QALYs) were adopted as the utility indicator, and real-world data from the hospital information systems of 170 hospitals was collected to indicate cost. The relative incidence rates of adverse events (AEs) with imrecoxib and celecoxib were collected from randomized controlled trials. Sensitivity analysis was performed to validate the robustness of the model. RESULTS: In the base case analysis (6-month treatment duration, 55 years old and above), imrecoxib was the more cost-effective option compared to celecoxib, with an incremental cost-effectiveness ratio (ICER) of $3,041.14. This finding remained unchanged after varying the treatment duration and the age of the patients. The main drivers of the results were the relative incidence of myocardial infarction (MI), the cost of imrecoxib, and the utility of OA patients without any AEs. Probability sensitivity analysis (PSA) showed that there was a 59.02% probability of imrecoxib as the more cost-effective option, with a threshold of $30,000. CONCLUSIONS: Although there were uncertainties, imrecoxib was the more cost-effective option compared to celecoxib, with a definite possibility. Due to the limitations of the original model and this study, the results of this study should be adopted with caution.

Cost-utility analysis of imrecoxib compared with diclofenac for patients with osteoarthritis.

BACKGROUND: To estimate the cost -utility of imrecoxib compared with diclofenac, as well as the addition of a proton pump inhibitor to both two treatment strategies, for patients with osteoarthritis, from a Chinese healthcare perspective. METHODS: A Markov model was built. Costs of managing osteoarthritis and initial adverse events were collected from a Medical Database which collected information from 170 hospitals. Other parameters were obtained from the literature. Subgroup analyses were conducted for people at high risk of gastrointestinal or cardiovascular adverse events. Deterministic and probabilistic sensitivity analyses were performed. RESULTS: Imrecoxib was highly cost-effective than diclofenac (the ICER was $401.58 and $492.77 in patients at low and high gastrointestinal and cardiovascular risk, respectively). The addition of a proton pump inhibitor was more cost -effective compared with single drug for both treatment strategies. Findings remained robust to sensitivity analyses. 59.04% and 57.16% probability for the co-prescription of imrecoxib and a proton pump inhibitor to be the most cost-effective strategy in all patients considered using the cost-effectiveness threshold of $30,000. CONCLUSIONS: The addition of a proton pump inhibitor to both imrecoxib and diclofenac was advised. Imrecoxib provides a valuable option for patients with osteoarthritis. Uncertainties existed in the model, and the suggestions can be adopted with caution.

Exploring the Reasons for Low Usage and Informing Strategies to Improve Use of a Nonprofit Grocery Store in Baltimore City.

Introducing new grocery stores into low-income communities has been a focus of policy efforts to improve the food environment. Yet, evidence of the impact of this strategy on diet and health outcomes is inconsistent. In Baltimore, a not-for-profit grocery store was opened by the Salvation Army in March 2018 with the goal of improving healthy food access. Unfortunately, the store has so far failed to attract sufficient customers. This study explored the reasons for low usage from the perspective of community members and staff members. A qualitative, formative research study was conducted at the store, which included semi-structured interviews (n = 21), direct observations (n = 8), and sociodemographic surveys (n = 152). Reasons for low store usage included high prices, confusion regarding the nature of the store, and lack of product variety. Reducing prices, increasing community engagement, and using promotional materials were all recommended strategies to increase usage. The Salvation Army is interested in potentially opening other nonprofit grocery stores. The results of this study will be used to help the Salvation Army refine their nonprofit grocery store model and in their future planning.

Inhalable nanovaccine with biomimetic coronavirus structure to trigger mucosal immunity of respiratory tract against COVID-19.

The COVID-19 pandemic caused by SARS-CoV-2 seriously threatens global public health. It has previously been confirmed that SARS-CoV-2 is mainly transmitted between people through "respiratory droplets". Therefore, the respiratory tract mucosa is the first barrier to prevent virus invasion. It is very important to stimulate mucosal immunity to protect the body from respiratory virus infection. Inspired by this, we designed a bionic-virus nanovaccine, which can induce mucosal immunity by nasal delivery to prevent virus infection from respiratory tract. The nanovaccine that mimic virosome is composed of poly(I:C) mimicking viral genetic material as immune adjuvant, biomimetic pulmonary surfactant (bio-PS) liposomes as capsid structure of virus and the receptor binding domains (RBDs) of SARS-CoV-2 as "spike" to completely simulate the structure of the coronavirus. The nanovaccine can be administered by inhaling to imitate the process of SARS-CoV-2 infection through the respiratory tract. Our results demonstrated that the inhalable nanovaccine with bionic virus-like structure has a stronger mucosal protective effect than routine muscle and subcutaneous inoculation. In particular, high titer of secretory immunoglobulin A (sIgA) was detected in respiratory secretions, which effectively neutralize the virus and prevent it from entering the body through the respiratory tract. Through imitating the structure and route of infection, this inhalable nanovaccine strategy might inspire a new approach to the precaution of respiratory viruses.

Fruit and Vegetable Intake and All-Cause Mortality in a Chinese Population: The China Health and Nutrition Survey.

This study was to investigate the association of long-term fruit and vegetable (FV) intake with all-cause mortality. We utilized data from the China Health and Nutrition Survey (CHNS), a prospective cohort study conducted in China. The sample population included 19,542 adult respondents with complete mortality data up to 31 December 2011. Cumulative FV intake was assessed by 3 day 24 h dietary recalls. Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of all-cause mortality. Covariates included sociodemographic characteristics, lifestyle factors, health-related factors, and urban index. A total of 1409 deaths were observed during follow-up (median: 14 years). In the fully adjusted model, vegetable intake of the fourth quintile (327~408 g/day) had the greatest negative association with death compared to the lowest quintile (HR = 0.63, 95% CI: 0.53-0.76). Fruit intake of the fifth quintile (more than 126 g/day) had the highest negative association (HR = 0.24, 95% CI: 0.15-0.40) and increasing general FV intake were also negatively associated with all-cause mortality which demonstrated the greatest negative association in the amount of fourth quintile (HR = 0.59, 95% CI: 0.49-0.70) compared to the lowest quintile. To conclude, greater FV intake is associated with a reduced risk of total mortality for Chinese adults. High intake of fruit has a stronger negative association with mortality than differences in intake of vegetables. Our findings support recommendations to increase the intake of FV to promote overall longevity.