Evaluating recommendation-based dietary and physical activity strategies for prostate cancer prevention: a target trial emulation in the Health Professionals Follow-up Study.

The 2018 World Cancer Research Fund/American Institute for Cancer Research recommends sustained strategies of physical activity and diet for cancer prevention, but evidence for long-term prostate cancer risk is limited. Using observational data from 27,859 men in the Health Professionals Follow-up Study, we emulated a target trial of recommendation-based physical activity and dietary strategies and 26-year risks of prostate cancer, adjusting for risk factors via the parametric g-formula. Compared with no intervention, limiting sugar-sweetened beverages showed a 0.4% (0.0-0.9%) lower risk of lethal (metastatic or fatal) disease and 0.5% (0.1-0.9%) lower risk of fatal disease. Restricting consumption of processed foods showed a 0.4-0.9% higher risk of all prostate cancer outcomes. Estimated risk differences for clinically significant disease were close to null for strategies involving fruits and non-starchy vegetables, whole grains and legumes, red meat, and processed meat, as well as under a joint strategy of physical activity and diet. Compared with a "low adherence" strategy, maintaining recommended physical activity levels showed a 0.4% (0.1-0.8%) lower risk of lethal and 0.5% (0.2-0.8%) lower risk of fatal disease. Adhering to specific components of current physical activity and dietary recommendations may help to prevent lethal and fatal prostate cancer over 26 years.

Fabrication of bimetallic MOF-74 derived materials for high-efficiency adsorption of iodine.

Owing to their high porosity, open metal sites, and huge surface area, metal-organic framework (MOF) materials are commonly employed in iodine adsorption processes. Bimetallic MOFs have drawn a lot of attention since mono-metal MOFs have been unable to keep up with the demand. Bimetallic MOF materials still have drawbacks, including limited adsorption capacity, extended adsorption time, poor stability, and poor selectivity, despite their positive performance in radioactive iodine capture. It has been therefore difficult to develop adsorbents with quick iodine adsorption rates and high iodine adsorption efficiency. This study investigated the adsorption properties of a series of bimetallic MOF-74 materials (Mn-Co-MOF-74, Mn-Zn-MOF-74, and Mn-Ni-MOF-74) for radioactive iodine, as well as their design and synthesis utilizing the reflux approach. It was discovered that the adsorption performance of Mn-Ni-MOF-74 for radioiodine was superior to that of the other two bimetallic MOF-74 materials. Using the bimetallic Mn-Ni-MOF-74 as a precursor, a variety of bimetallic MOF-74 derived carbon compounds (Mn-Ni-CX) were prepared by high-temperature pyrolysis. Simultaneously, the structure of the material and the iodine adsorption characteristics have been thoroughly studied.

Development and validation of nomograms to predict survival of neuroendocrine carcinoma in genitourinary system: A population-based retrospective study.

Neuroendocrine carcinoma (NEC) is a rare yet potentially perilous neoplasm. The objective of this study was to develop prognostic models for the survival of NEC patients in the genitourinary system and subsequently validate these models. A total of 7125 neuroendocrine neoplasm (NEN) patients were extracted. Comparison of survival in patients with different types of NEN before and after propensity score-matching (PSM). A total of 3057 patients with NEC, whose information was complete, were extracted. The NEC influencing factors were chosen through the utilization of the least absolute shrinkage and selection operator regression model (LASSO) and the Fine & Gary model (FGM). Furthermore, nomograms were built. To validate the accuracy of the prediction, the efficiency was verified using bootstrap self-sampling techniques and receiver operating characteristic curves. LASSO and FGM were utilized to construct three models. Confirmation of validation was achieved by conducting analyses of the area under the curve and decision curve. Moreover, the FGS (DSS analysis using FGM) model produced higher net benefits. To maximize the advantages for patients, the FGS model disregarded the influence of additional occurrences. Patients are expected to experience advantages in terms of treatment options and survival assessment through the utilization of these models.

The association between three prevalent autoimmune disorders and the likelihood of developing prostate cancer: a Mendelian randomization study.

Numerous studies establish a significant correlation between autoimmune disorders (AIDs) and prostate cancer (PCa). Our Mendelian randomization (MR) analysis investigates the potential connection between rheumatoid arthritis (RA) and PCa, aiming to confirm causal links between systemic lupus erythematosus (SLE), hyperthyroidism, and PCa. Summary statistics from genome-wide association studies provided data on PCa and three AIDs. MR analysis, using IVW as the main approach, assessed causal relationships, validated by sensitivity analysis. IVW revealed a correlation between genetically anticipated RA and PCa, notably in Europeans (OR = 1.03; 95% CI 1.01-1.04, p = 2*10-5). Evidence supported a lower PCa risk in individuals with SLE (OR = 0.94; 95% CI 0.91-0.97, p = 2*10-4) and hyperthyroidism (OR = 0.02; 95% CI 0.001-0.2, p = 2*10-3). Weighted mode and median confirmed these findings. No pleiotropic effects were observed, and MR heterogeneity tests indicated dataset homogeneity. Our study establishes a causal link between RA, SLE, hyperthyroidism, and PCa.

Earthworm gut bacteria facilitate cadmium immobilization through the formation of CdS nanoparticles.

Gut bacteria of earthworm Amynthas hupeiensis exhibit significant potential for the in-situ remediation of cadmium (Cd)-contaminated soil. However, the mechanisms by which these gut bacteria immobilize and tolerate Cd remain elusive. The composition of the gut bacterial community was characterized by high-throughput sequencing. Cd-tolerant bacteria were isolated from the gut, and their roles in Cd immobilization, as well as their tolerance mechanisms, were explored through chemical characterization and transcriptome analysis. The predominant taxa in the gut bacterial community included unclassified Enterobacteriaceae, Citrobacter, and Bacillus, which were distinctly different from those in the surrounding soil. Notably, the most Cd-tolerant gut bacterium, Citrobacter freundii DS strain, immobilized 63.61% of Cd2+ within 96 h through extracellular biosorption and intracellular bioaccumulation of biosynthetic CdS nanoparticles, and modulation of solution pH and NH4+ concentration. Moreover, the characteristic signals of CdS were also observed in the gut content of A. hupeiensis when the sterilized Cd-contaminated soil was inoculated with C. freundii. The primary pathways involved in the response of C. freundii to Cd stress included the regulation of ABC transporters, bacterial chemotaxis, cell motility, oxidative phosphorylation, and two-component system. In conclusion, C. freundii facilitates Cd immobilization both in vitro and in vivo, thereby enhancing the host earthworm's adaptation to Cd-contaminated soil.

Renal pelvis metastasis following surgery for breast angiosarcoma: a case report and literature review.

Renal metastasis of breast angiosarcoma is rare. This article reports the medical records of a patient diagnosed with breast angiosarcoma who underwent radical mastectomy and was found to have multiple lung metastases 3 years after surgery and renal pelvic metastasis 4 years after surgery. The patient underwent robot-assisted laparoscopic radical nephroureterectomy and sleeve resection of the intramural segment of the ureter, and postoperative pathology and immunohistochemical staining confirmed the diagnosis of renal pelvic metastasis of breast angiosarcoma. The patient received anlotinib for lung metastases following surgery and was followed up for 4 months after surgery. Currently, the patient has symptoms of coughing and hemoptysis but no other discomfort. The diagnosis and treatment of this rare malignant tumor remain challenging.

The toxicity of polystyrene micro- and nano-plastics on rare minnow (Gobiocypris rarus) varies with the particle size and concentration.

How the particle size and concentration of microplastics impact their toxicity is largely unknown. Herein, the effects of polystyrene microplastics (1 µm, MPs) and nanoplastics (100 nm, NPs) exposed at 1 mg/L (L) and 10 mg/L (H), respectively, on the growth, histopathology, oxidative stress, gut microbiome, and metabolism of rare minnow (Gobiocypris rarus) were investigated by chemical analysis and multi-omics. MPs and NPs inhibited the growth, induced histopathological injury and aggravated oxidative stress markedly with contrasting significance of particle size and concentration. The composition of core gut microbiota changed dramatically especially for the MPs-H. Similarly, gut bacterial communities were reshaped by the MPs and NPs but only NPs-H decreased both richness and Shannon indexes significantly. Co-occurrence network analysis revealed that the potential keystone genera underwent great changes in exposed groups compared to the control. MPs-H increased the network complexity and the frequency of positive interactions which was opposite to other exposed groups. Moreover, the metabolomic profiles associated with amino acid, lipid, unsaturated fatty acid and hormone metabolism were disturbed significantly especially for MPs-H and NPs-H. In conclusion, the toxicity of MPs depends on both the particle size and concentration, and varies with the specific indicators as well.

Comparison between inverse-probability weighting and multiple imputation in Cox model with missing failure subtype.

Identifying and distinguishing risk factors for heterogeneous disease subtypes has been of great interest. However, missingness in disease subtypes is a common problem in those data analyses. Several methods have been proposed to deal with the missing data, including complete-case analysis, inverse-probability weighting, and multiple imputation. Although extant literature has compared these methods in missing problems, none has focused on the competing risk setting. In this paper, we discuss the assumptions required when complete-case analysis, inverse-probability weighting, and multiple imputation are used to deal with the missing failure subtype problem, focusing on how to implement these methods under various realistic scenarios in competing risk settings. Besides, we compare these three methods regarding their biases, efficiency, and robustness to model misspecifications using simulation studies. Our results show that complete-case analysis can be seriously biased when the missing completely at random assumption does not hold. Inverse-probability weighting and multiple imputation estimators are valid when we correctly specify the corresponding models for missingness and for imputation, and multiple imputation typically shows higher efficiency than inverse-probability weighting. However, in real-world studies, building imputation models for the missing subtypes can be more challenging than building missingness models. In that case, inverse-probability weighting could be preferred for its easy usage. We also propose two automated model selection procedures and demonstrate their usage in a study of the association between smoking and colorectal cancer subtypes in the Nurses' Health Study and Health Professional Follow-Up Study.

Development and validation of machine-learning models for the difficulty of retroperitoneal laparoscopic adrenalectomy based on radiomics.

Objective: The aim is to construct machine learning (ML) prediction models for the difficulty of retroperitoneal laparoscopic adrenalectomy (RPLA) based on clinical and radiomic characteristics and to validate the models. Methods: Patients who had undergone RPLA at Shanxi Bethune Hospital between August 2014 and December 2020 were retrospectively gathered. They were then randomly split into a training set and a validation set, maintaining a ratio of 7:3. The model was constructed using the training set and validated using the validation set. Furthermore, a total of 117 patients were gathered between January and December 2021 to form a prospective set for validation. Radiomic features were extracted by drawing the region of interest using the 3D slicer image computing platform and Python. Key features were selected through LASSO, and the radiomics score (Rad-score) was calculated. Various ML models were constructed by combining Rad-score with clinical characteristics. The optimal models were selected based on precision, recall, the area under the curve, F1 score, calibration curve, receiver operating characteristic curve, and decision curve analysis in the training, validation, and prospective sets. Shapley Additive exPlanations (SHAP) was used to demonstrate the impact of each variable in the respective models. Results: After comparing the performance of 7 ML models in the training, validation, and prospective sets, it was found that the RF model had a more stable predictive performance, while xGBoost can significantly benefit patients. According to SHAP, the variable importance of the two models is similar, and both can reflect that the Rad-score has the most significant impact. At the same time, clinical characteristics such as hemoglobin, age, body mass index, gender, and diabetes mellitus also influenced the difficulty. Conclusion: This study constructed ML models for predicting the difficulty of RPLA by combining clinical and radiomic characteristics. The models can help surgeons evaluate surgical difficulty, reduce risks, and improve patient benefits.

Development and validation of nomograms to predict survival of primary adrenal lymphoma: a population-based retrospective study.

While it is known that accurate evaluation of overall survival (OS) and disease-specific survival (DSS) for patients with primary adrenal lymphoma (PAL) can affect their prognosis, no stable and effective prediction model exists. This study aimed to develop prediction models to evaluate survival. This study enrolled 5448 patients with adrenal masses from the SEER Program. The influencing factors were selected using the least absolute shrinkage and selection operator regression model (LASSO) and Fine and Gray model (FGM). In addition, nomograms were constructed. Receiver operating characteristic curves and bootstrap self-sampling methods were used to verify the discrimination and consistency of the nomograms. The independent influencing factors for PAL survival were selected by LASSO and FGM, and three models were built: the OS, DSS, and FGS (DSS analysis by FGM) model. The areas under the curve and decision curve analyses indicated that the models were valid. This study developed survival prediction models to predict OS and DSS of patients with PAL. The FGS model was more accurate than the DSS model in the short term. Above all, these models should offer benefits to patients with PAL in terms of the treatment modality choice and survival evaluation.

Effects of Sexuality Education on Sexual Knowledge, Sexual Attitudes, and Sexual Behaviors of Youths in China: A Cluster-Randomized Controlled Trial.

PURPOSE: There is a lack of trained educators and age-appropriate teaching materials for sex education in China. This study aims to assess the effects of an internet-based sexuality education programme on sexual knowledge, attitudes, and behaviors among adolescents in China. METHODS: We undertook a multicentre, cluster-randomized controlled trial in 29 vocational high schools in Guangdong and Yunnan, China. Students in the intervention group received weekly sexuality education delivered over two months based on a sexuality education package named "You and Me". A questionnaire was completed at baseline by all students, after receiving a sexuality education by the intervention group, and once a year after receiving sexuality education by the intervention group or at a similar time point by the control group. RESULTS: Between October 2018 and December 2019, 3,151 participants from 29 schools/clusters were recruited, from which 1,760 students were randomly assigned to receive an eight-session internet-based sexuality education package. Significant improvements were observed for both sexual knowledge and sexual attitudes immediately after the intervention and one year after the intervention. However, no significant effects were observed for sexual behaviors. DISCUSSION: The internet-based sexuality education package was found to positively affect the sexual knowledge and sexual attitudes among adolescents, providing a potential solution to the lack of trained educators and teaching resources for implementing country-wide sexuality education in China. However, further research is still needed to determine the effects of sexuality education packages on sexual behaviors.

The PM2.5 concentration reduction improves survival rate of lung cancer in Beijing.

INTRODUCTION: Long-term exposure to ambient fine particulate matter (PM2.5) has been linked to increases in the incidence of lung cancer. However, more evidence is needed to conclude its effects on lung cancer survival. OBJECTIVES: The study aimed to explore the relationship between long-term PM2.5 exposure and lung cancer survival and evaluated the benefits of clean air actions in Beijing. METHODS: A whole-population cohort study was conducted on lung cancer patients diagnosed between 2001 and 2017. An atmospheric chemical transport model was used to estimate exposure under a counterfactual scenario without the policy and then quantified the effect of the policy. Cox regression models were used with the seasonality-adjusted PM2.5 as the main effect. RESULTS: A 10 µg/m3 increase in PM2.5 was estimated to be with a 6.5 % (95 % CI: 4.8 %, 8.2 %) increase in the mortality rates. The association was heterogeneous and modified by individual-level characteristics. The clean air actions were estimated to have prevented 3548 (95 % CI: 3280, 3825) premature deaths and to have prolonged survival time by 4.29 months (95 % CI: 0.01, 25.11). CONCLUSION: Our findings suggest that PM2.5 exposure lowers the survival rate for lung cancer. The clean air actions implemented in Beijing can protect lung cancer patients by increasing their survival time. SYNOPSIS: Long-term exposure to PM2.5 can lower lung patients' survival rates whereas the clean air actions in Beijing have prolonged these patients' survival time by reducing PM2.5 level.

The mediating role of sexually selected traits in the association of androgynous tendencies with lower sexual activeness among Chinese youths.

Androgynous tendencies and persistently low fertility rates have been observed in many countries, causing major social concerns. The theory of sexual selection suggests a possible mechanism between androgyny and decreased sexual activeness, as masculinity and femininity constitute an important aspect of reproductive strategies. This theory has also been proven by evolutionary and societal evidence. Therefore, we investigate the association between masculinity and femininity with sexual activeness, as well as the influence of gender-role conformity on the frequency of sexual intercourse through sexually selected traits among 42,492 Chinese youths. Sexual activeness was measured using sexual attitudes, experience, behaviors, and pleasure. Mediation analysis was employed to investigate the effects of sexually selected traits on the association between masculinity and femininity with sexual activeness, and gender-role conformity with the frequency of sexual intercourse. Low sexual activeness was found to be associated with low gender-role conformity. Our findings also suggest that physical attractiveness, sexual motivation, and interpersonal relationships may mediate the association between sexual activeness and gender-role conformity, supporting the males-compete/females-choose model.

Horizontal and Vertical Transport of Uranium in an Arid Weapon-Tested Ecosystem.

Armor-penetrating projectiles and fragments of depleted uranium (DU) have been deposited in soils at weapon-tested sites. Soil samples from these military facilities were analyzed by inductively coupled plasma-optical emission spectroscopy and X-ray diffraction to determine U concentrations and transport across an arid ecosystem. Under arid conditions, both vertical transport driven by evaporation (upward) and leaching (downward) and horizontal transport of U driven by surface runoff in the summer were observed. Upward vertical transport was simulated and confirmed under laboratory-controlled conditions, to be leading to the surface due to capillary action via evaporation during alternating wetting and drying conditions. In the field, the 92.8% of U from DU penetrators and fragments remained in the top 5 cm of soil and decreased to background concentrations in less than 20 cm. In locations prone to high amounts of water runoff, U concentrations were reduced significantly after 20 m from the source due to high surface runoff. Uranium was also transported throughout the ecosystem via plant uptake and wild animal consumption between trophic levels, but with limited accumulation in edible portions in plants and animals.

Indigenous earthworms and gut bacteria are superior to chemical amendments in the remediation of cadmium-contaminated seleniferous soils.

The natural selenium (Se)-rich areas in China are generally characterized by high geological background of cadmium (Cd) which poses potential risks to human health. Therefore, immobilization of Cd is the prerequisite to ensure the safe utilization of natural seleniferous soil resources. A pot experiment was conducted to compare the effects of indigenous earthworm (Amynthas hupeiensis) and its gut bacteria (Citrobacter freundii DS strain) on the remediation of Cd-contaminated seleniferous soil with two traditional chemical amendments. The results indicated that earthworms and DS strain decreased DGT-extractable Cd by 25.52 - 41.53% and reduced Cd accumulation in lettuce leaves by 20.83 - 37.50% compared with control through converting the exchangeable Cd (EX-Cd) into residual Cd (RE-Cd) fractions. Overall, earthworms and DS strain were more effective in Cd immobilization, growth and quality promotion, oxidative stress alleviation, Cd accumulation and bioaccessibility reduction in the soil-lettuce-human continuum than biochar and lime. Moreover, all amendments induced the antagonism between Se and Cd through increasing bioavailable Se/Cd molar ratios in soil. However, all the Cd concentrations in lettuce exceeded the maximum permissible limit of Cd for leaf vegetables, indicating that soil amendment alone could not ensure food safety. This study confirmed that biological amendments were superior to chemical amendments in the remediation of Cd-contaminated seleniferous soil.

Deaths attributable to anomalous temperature: A generalizable metric for the health impact of global warming.

The U-shaped association between health outcomes and ambient temperatures has been extensively investigated. However, such analyses cannot fully estimate the mortality burden of climate change because the features of the association (e.g., minimum mortality temperature) vary with human adaptation; thus, they are not generalizable to different locations. In this study, we assumed that humans could adapt to regular temperature variations; and thus examined the all-cause mortality attributable to temperature anomaly (TA), an indicator widely utilized in climate science to measure irregular temperature fluctuations, across 115 cities in the United States (US). We first used quasi-Poisson regressions to obtain the city-specific TA-mortality associations, then used meta-regression to pool these city-specific estimates. Finally, we calculated the number of TA-related deaths using the uniform pooled association, then compared it to the estimates from city-specific associations, which had been controlled for adaptation. Meta-regression showed a U-shaped TA-mortality association, centered at a TA near 0. According to the pooled association, 0.579 % (95 % confidence interval [CI]: 0.465-0.681 %), 0.394 % (95 % CI: 0.332-0.451 %), and 0.185 % (95 % CI: 0.107-0.254 %) of all-cause deaths were attributable to all anomalous temperatures (TA ≠ 0), anomalous heat (TA > 0), and anomalous cold (TA < 0), respectively. At the city level, heat-related deaths estimated from the pooled association were in good agreement with heat-related deaths estimated from the city-specific associations (R2 = 0.84). However, the cold-related deaths estimated from the two methods showed a weaker correlation (R2 = 0.07). Our findings suggest that TA constitutes a generalizable indicator that can uniformly evaluate deaths attributable to anomalous heat in distinct geographical locations.

Association Between Ambient Fine Particulate Matter and Physical Functioning in Middle-Aged and Older Chinese Adults: A Nationwide Longitudinal Study.

BACKGROUND: Exposure to air pollution is associated with several chronic diseases and subclinical processes that could subsequently contribute to physical disability. However, whether and to what extent air pollution exposure is associated with objective measures of physical functioning remains understudied. METHODS: We used longitudinal data from the China Health and Retirement Longitudinal Study (CHARLS) and included 10 823 participants who were surveyed at least twice. Annual average exposure to fine particulate matter (PM2.5) was assessed using a state-of-the-art estimator. Physical functioning was assessed with 4 objective tests covering hand-grip strength, balance, repeated chair stands, and gait speed. Mixed-effects models with participants as a random term were used to estimate associations with multiple adjustments. RESULTS: We found a significant and robust association between exposure to increased PM2.5 and the reduction in hand-grip strength and balance ability. Each 10 µg/m3 increase in annual averaged concentrations of PM2.5 was associated with a 220-g (95% confidence interval [CI]: 127, 312 g) reduction in hand-grip strength per 60 kg of body weight and a 5% risk (95% CI: 2, 7) of reduced balance ability. The estimated effect of each 10 µg/m3 increase in PM2.5 on hand-grip strength and balance ability was equivalent to the effect of aging (1.12 [95% CI: 0.76, 1.48] and 0.98 [95% CI: 0.50, 1.50] years, respectively). CONCLUSIONS: PM2.5 may be differentially associated with various dimensions of physical functioning. Improving air quality can prevent physical disability.

Trends of maternal health service coverage in the Democratic Republic of the Congo: a pooled cross-sectional study of MICS 2010 to 2018.

BACKGROUND: Maternal health services are essential for reducing maternal and newborn mortality. However, maternal health service status in the Democratic Republic of the Congo (DRC) remains poorly understood. This study aims to explore the trends of antenatal care (ANC) and skilled birth attendance coverage in the past decade in the DRC. METHODS: The 13,361 participants were from two rounds of Multiple Indicators Cluster Survey (MICS) conducted by the National Institute of Statistics of the Ministry of Planning of the DRC, in collaboration with the United Nations Children's Fund (UNICEF), in 2010 and 2017-2018. A regression-based method was adopted to calculate adjusted coverage of ANC and skilled birth attendance. Subgroup analysis based on different socioeconomic status (SES) was conducted to explore the impact of domestic conflicts. RESULTS: From 2010 to 2018, the overall weighted ANC coverage in the DRC declined from 87.3 % (95 % CI 86.1-88.0 %) to 82.4 % (95 % CI 81.1-84.0 %), while the overall weighted skilled birth attendance coverage increased from 74.2 % (95 % CI 72.5-76.0 %) to 85.2 % (95 % CI 84.1-86.0 %). Adjusted ANC coverage and adjusted skilled birth attendant coverage both declined in Kasai Oriental, but increased in Nord Kivu and Sud Kivu. In Kasai Occidental, ANC coverage declined, but skilled birth coverage increased. In the Kasai region, the largest decline in adjusted coverage of ANC was found among the poorest women. However, in the Kivu region, both the adjusted coverage of ANC and skilled birth attendance increased among the poorest women. CONCLUSIONS: Due to ongoing conflicts, there has been a systemic deterioration of maternal healthcare coverage in some regions of the DRC, particularly among people with low SES. However, in other regions, maternal healthcare services were not severely disrupted possibly due to substantial international health assistance.

Effects of an Internet-Based and Teacher-Facilitated Sexuality Education Package: A Cluster-Randomized Trial.

BACKGROUND: This study aimed to evaluate the effects of an internet-based and teacher-facilitated sexuality education package on the sexual knowledge and attitudes of Chinese adolescents. METHODS: Six middle schools where no sexuality education had been performed with a total of 501 adolescent students (245 males and 256 females) were included in the trial. In total, 14 classes were randomly assigned to the intervention (internet-based sexuality education package) or the control group (classes were conducted as per normal). Students' sexual knowledge and attitudes were assessed at the baseline, at the end of the intervention, and 12 months after the intervention. Generalized linear models were employed to assess the effects of the intervention. RESULTS: Positive effects of the intervention were observed on sexual knowledge (ß = 4.65, 95% CI: 4.12-5.17) and attitudes (ß = 1.25, 95% CI: 1.00-1.50) at the end of the intervention. After 12 months, the effects sustained but the magnitude declined for sexual knowledge (ß = 2.39, 95% CI: 1.85-2.93) and attitudes (ß = 0.49, 95% CI: 0.23-0.75). There were no significant differences between male and female students. CONCLUSIONS: Although further modifications are required, the sexuality education package can increase the accessibility of comprehensive sexuality education to adolescents in rural areas in China.

Exposure to landscape fire smoke reduced birthweight in low- and middle-income countries: findings from a siblings-matched case-control study.

Background: Landscape fire smoke (LFS) has been associated with reduced birthweight, but evidence from low- and middle-income countries (LMICs) is rare. Methods: Here, we present a sibling-matched case-control study of 227,948 newborns to identify an association between fire-sourced fine particulate matter (PM2.5) and birthweight in 54 LMICs from 2000 to 2014. We selected mothers from the geocoded Demographic and Health Survey with at least two children and valid birthweight records. Newborns affiliated with the same mother were defined as a family group. Gestational exposure to LFS was assessed in each newborn using the concentration of fire-sourced PM2.5. We determined the associations of the within-group variations in LFS exposure with birthweight differences between matched siblings using a fixed-effects regression model. Additionally, we analyzed the binary outcomes of low birthweight (LBW) or very low birthweight (VLBW). Results: According to fully adjusted models, a 1 µg/m3 increase in the concentration of fire-sourced PM2.5 was significantly associated with a 2.17 g (95% confidence interval [CI] 0.56-3.77) reduction in birthweight, a 2.80% (95% CI 0.97-4.66) increase in LBW risk, and an 11.68% (95% CI 3.59-20.40) increase in VLBW risk. Conclusions: Our findings indicate that gestational exposure to LFS harms fetal health. Funding: PKU-Baidu Fund, National Natural Science Foundation of China, Peking University Health Science Centre, and CAMS Innovation Fund for Medical Sciences.