Study on the impact of COVID-19 pandemic on the mental health of Chinese college students: a cross-sectional analysis.

Background: The COVID-19 pandemic has significantly impacted the mental health of college students, prompting the need for universities to implement measures to mitigate these adverse effects. This study aims to assess the mental health status and mitigation measures of college students, identify the primary factors contributing to their mental health challenges, and provide suggestions for educational institutions to reduce negative psychological impacts. Methods: In February 2023, a questionnaire survey was conducted among 1,445 college students. Statistical analysis was performed on the survey results, and multiple regression models were used to identify significant influencing factors and optimize the model. Results: The study revealed correlations between factors affecting mental health during the pandemic, with interactions observed among some factors. Significant differences in mental health status were found among different groups of college students based on their information-sharing habits through apps and engagement in thesis research. Multiple regression analysis indicated that conducting academic research related to COVID-19 significantly increased the psychological stress of college students during the pandemic (p = 0.043). Among all mitigation measures, playing games demonstrated significant effectiveness in model analysis (p = 0.047). The optimization of the model showed that the multiple regression model considering the interaction of factors was more effective. Conclusion: Our research identifies crucial factors influencing the mental health of college students and investigates the mental health status of various student groups. We recommend that educational institutions adopt proactive strategies and a multifaceted approach to support the mental health of college students and address potential issues that may arise.

Injury Mortality of Children and Adolescents Aged 0-19 Years - China, 2010-2021.

Introduction: To examine the recent trends in child injury mortality in China. Methods: Injury mortality data of 2010-2021 for children and adolescents aged 0-19 years were from the China Health Statistics Yearbook. Injury mortality disparities across urban vs. rural locations, gender, and age groups were scrutinized. Annual percent change (APC), average annual percent change (AAPC), and their 95% confidence intervals (95% CI) were estiamted usimg Joinpoint regression models. Results: The age-standardized injury mortality significantly dropped from 21.87 to 9.41 per 100,000 population among children and youth aged 0-19 years during 2010-2021, with an AAPC of -6.7% (95% CI: -8.2%, -5.2%). The urban-rural disparity and gender gap in injury mortality reduced gradually. In 2021, drowning and road traffic crashes were the top two causes of child injury deaths, explaing 31.1% and 27.9% of total injury deaths, respectively. Suffocation accounted for 62.3% of injury deaths among infants younger than a year. Alarmingly, the suicide mortality rate rose from 2.16 to 3.42 per 100,000 population between 2010 and 2021 among teenagers aged 15-19 years. Subgroup analyses yielded similar results. Conclusions: During 2010-2021, the injury mortality decreased significantly among Chinese children and adolescents, and the responding urban-rural disparities narrowed.

Validity across four common street-crossing distraction indicators to predict pedestrian safety.

BACKGROUND: Multiple distraction indicators have been applied to measure street-crossing distraction but their validities in predicting pedestrian safety are poorly understood. METHODS: Based on a video-based observational study, we compared the validity of four commonly used distraction indicators (total duration of distraction while crossing a street, proportion of distracted time over total street-crossing time, duration of the longest distraction time, and total number of distractions) in predicting three pedestrian safety outcomes (near-crash incidence, frequency of looking left and right, and speed crossing the street) across three types of distraction (mobile phone use, talking to other pedestrians, eating/drinking/smoking). Change in Harrell's C statistic was calculated to assess the validity of each distraction indicator based on multivariable regression models including only covariates and including both covariates and the distraction indicator. RESULTS: Heterogeneous capacities in predicting the three safety outcomes across the four distraction indicators were observed: 1) duration of the longest distraction time was most predictive for the occurrence of near-crashes and looks left and right among pedestrians with all three types of distraction combined and talking with other pedestrians (Harrell's C statistic changes ranged from 0.0310 to 0.0335, P < 0.05), and for the occurrence of near-crashes for pedestrians involving mobile phone use (Harrell's C statistic change: 0.0053); 2) total duration of distraction was most predictive for speed crossing the street among pedestrians with the combination and each of the three types of distraction (Harrell's C statistic changes ranged from 0.0037 to 0.0111, P < 0.05), frequency of looking left and right among pedestrians distracted by mobile phone use (Harrell's C statistic change: 0.0115), and the occurrence of near-crash among pedestrians eating, drinking, or smoking (Harrell's C statistic change: 0.0119); and 3) the total number of distractions was the most predictive indicator of frequency of looking left and right among pedestrians eating, drinking, or smoking (Harrell's C statistic change: 0.0013). Sensitivity analyses showed the results were robust to change in grouping criteria of the four distraction indicators. CONCLUSIONS: Future research should consider the pedestrian safety outcomes and type of distractions to select the best distraction indicator.

Global Deaths Associated with Population Aging - 1990-2019.

Introduction: Published global and country-specific deaths associated with population aging are based on decomposition methods that have significant limitations. Methods: A new decomposition method was developed and its performance was compared with two frequently used methods. The new method was employed to calculate global deaths associated with population aging between 1990 and 2019, using estimates from the Global Burden of Disease Study 2019 (GBD 2019). Results: Compared to the two frequently-used existing methods, the new decomposition method generated results that are more consistent with logical expectations. Using the new method, the number of global deaths associated with population aging between 1990 and 2019 was 23.3 million. Upper middle-income countries accounted for 43% of global deaths related to population aging. The most deaths associated with population aging occurred from three types of disease: ischemic heart disease (5.0 million), stroke (3.8 million), and chronic obstructive pulmonary disease (2.2 million). China, India, Japan, the United States of America, and Brazil had the largest number of deaths related to population aging. Loss related to population aging was completely or partially counteracted by the reduction in mortality in 195 of the 200 countries and territories experiencing population aging (97.5%). Conclusions: The new decomposition method achieves more justifiable results associated with population aging than existing methods. Globally, population aging was associated with a substantial increase of deaths between 1990 and 2019, but it was totally or partially offset by the reduction in mortality in 97.5% of countries and territories.

Road traffic death coding quality in the WHO Mortality Database.

Objective: To evaluate the precision and dependability of road traffic mortality data recorded in the World Health Organization Mortality Database and investigate how uncorrected data influence vital mortality statistics used in traffic safety programmes worldwide. Methods: We assessed country and territory-specific data quality from 2015 to 2020 by calculating the proportions of five types of nonspecific cause of death codes related to road traffic mortality. We compared age-adjusted road traffic mortality and changes in the average annual mortality rate before and after correcting the deaths with nonspecific codes. We generated road traffic mortality projections with both corrected and uncorrected codes, and redistributed the data using the proportionate method. Findings: We analysed data from 124 countries and territories with at least one year of mortality data from 2015 to 2020. The number of countries and territories reporting more than 20% of deaths with ill-defined or unknown cause was 2; countries reporting injury deaths with undetermined intent was 3; countries reporting unspecified unintentional injury deaths was 21; countries reporting unspecified transport crash deaths was 3; and countries reporting unspecified unintentional road traffic deaths was 30. After redistributing deaths with nonspecific codes, road traffic mortality changed by greater than 50% in 7% (5/73) to 18% (9/51) of countries and territories. Conclusion: Nonspecific codes led to inaccurate mortality estimates in many countries. We recommend that injury researchers and policy-makers acknowledge the potential pitfalls of relying on raw or uncorrected road traffic mortality data and instead use corrected data to ensure more accurate estimates when improving road traffic safety programmes.

Value of the short physical performance battery (SPPB) in predicting fall and fall-induced injury among old Chinese adults.

BACKGROUND: The short physical performance battery (SPPB) is an easy-to-use tool for fall risk prediction, but its predictive value for falls and fall-induced injuries among community dwellers has not been examined through a large-sample longitudinal study. METHODS: We analyzed five-round follow-up data (2, 3, 4, 5, 7 years) of the China Health and Retirement Longitudinal Study (CHARLS) (2011-2018). Data concerning falls and fall-induced injuries during multi-round follow-ups were collected through participant self-report. The Cochran-Armitage trend test examined trends in fall incidence rate across SPPB performance levels. Multivariable logistic regression and negative binomial regression models examined associations between SPPB performance and subsequent fall and fall-induced injury. The goodness-of-fit and area under the receiver operating curve (AUC) were used together to quantify the value of the SPPB in predicting fall and fall-induced injury among community-dwelling older adults. RESULTS: The CHARLS study included 9279, 6153, 4142, 4148, and 3583 eligible adults aged 60 years and older in the five included follow-up time periods. SPPB performance was associated with fall and fall-induced injury in two and three of the five follow-up time periods, respectively (P < 0.05). The goodness-of-fit for all predictive models was poor, with both Cox-Snell R2 and Nagelkerke R2 under 0.10 and AUCs of 0.53-0.57 when using only SPPB as a predictor and with both Cox-Snell R2 and Nagelkerke R2 lower than 0.12 and AUCs of 0.61-0.67 when using SPPB, demographic variables, and self-reported health conditions as predictors together. Sex and age-specific analyses displayed highly similar results. CONCLUSIONS: Neither use of SPPB alone nor SPPB together with demographic variables and self-reported health conditions appears to offer good predictive performance for falls or fall-induced injuries among community-dwelling older Chinese adults.

Suicide Mortality by Place, Gender, and Age Group - China, 2010-2021.

Introduction: Suicide is an important public health concern in China. We examined suicide mortality by place, sex, and age group from 2010 to 2021 to identify and quantify significant suicide mortality changes in China. Methods: We retrieved age-standardized and age-specific suicide mortality rates by place (urban vs. rural) and sex from the Chinese Health Statistical Yearbook and population data from the 2010 and 2020 Chinese National Population Census. Line graphs were used to demonstrate trends in suicide mortality. Joinpoint regression models were fitted to detect the time periods experiencing significant suicide mortality changes, and average annual percent change (AAPC) and annual percent change were reported to quantify changes in suicide mortality from 2010 to 2021. Results: The overall age-standardized suicide mortality rate decreased from 10.88 to 5.25 per 100,000 population between 2010 and 2021 (AAPC=-5.3%, 95% confidence interval: -6.5%, -4.0%). Similar reductions in suicide mortality were observed for both males and females, as well as in urban and rural settings during this period. From 2010 to 2021, significant declines in suicide mortality were observed among the three older age groups (25-44 years, 45-64 years, and 65 years or above), while a substantial increase was noted in the youngest age group (5-14 years). No significant change was found in suicide mortality rates for the 15-24 year age group. Subgroup analyses based on location and sex revealed consistent findings. Conclusion: The findings of this study suggest a probable overall success of suicide prevention efforts in China over the past decade. However, the recent increase in suicide mortality among children aged 5-14 years calls for the attention of injury researchers, policymakers, and public health practitioners.

Content Quality of Web-Based Short-Form Videos for Fire and Burn Prevention in China: Content Analysis.

BACKGROUND: Web-based short-form videos are increasingly popular for disseminating fire and burn prevention information, but their content quality is unknown. OBJECTIVE: We aimed to systematically assess the characteristics, content quality, and public impact of web-based short-form videos offering primary and secondary (first aid) prevention recommendations for fires and burns in China between 2018 and 2021. METHODS: We retrieved short-form videos offering both primary and secondary (first aid) information to prevent fire and burn injuries published on the 3 most popular web-based short-form video platforms in China: TikTok, Kwai, and Bilibili. To assess video content quality, we calculated the proportion of short-form videos that included information on each of the 15 recommendations for burn prevention education from the World Health Organization (WHO; P1) and that correctly disseminated each recommendation (P2). High P1 and P2 indicated better content quality. To assess their public impact, we calculated the median (IQR) of 3 indicators: the number of comments, likes, and saves as a favorite by viewers. Chi-square test, trend chi-square test, and Kruskal-Wallis H test examined differences in indicators across the 3 platforms, years, content, and time duration of videos and between videos disseminating correct versus incorrect information. RESULTS: Overall, 1459 eligible short-form videos were included. The number of short-form videos increased by 16 times between 2018 and 2021. Of them, 93.97% (n=1371) were about secondary prevention (first aid) and 86.02% (n=1255) lasted <2 minutes. The proportion of short-form videos including each of the 15 WHO recommendations ranged from 0% to 77.86% (n=1136). Recommendations 8, 13, and 11 had the highest proportions (n=1136, 77.86%; n=827, 56.68%; and n=801, 54.9%, respectively), whereas recommendations 3 and 5 were never mentioned. Among the short-form videos that included the WHO recommendations, recommendations 1, 2, 4, 6, 9, and 12 were always disseminated correctly, but the other 9 recommendations were correctly disseminated in 59.11% (120/203) to 98.68% (1121/1136) of videos. The proportion of short-form videos including and correctly disseminating the WHO recommendations varied across platforms and years. The public impact of short videos varied greatly across videos, with a median (IQR) of 5 (0-34) comments, 62 (7-841) likes, and 4 (0-27) saves as a favorite. Short-form videos disseminating correct recommendations had larger public impact than those disseminating either partially correct or incorrect knowledge (median 5 vs 4 comments, 68 vs 51 likes, and 5 vs 3 saves as a favorite, respectively; all P<.05). CONCLUSIONS: Despite the rapid increase in the number of web-based short-form videos about fire and burn prevention available in China, their content quality and public impact were generally low. Systematic efforts are recommended to improve the content quality and public impact of short-form videos on injury prevention topics such as fire and burn prevention.

Evaluating the effectiveness of the safety experience room, an affordable interactive education intervention to prevent unintentional injury among rural preschoolers in China: protocol for a cluster randomized controlled trial.

BACKGROUND: Interactive and experiential learning programs have proven effective to teach children safety and prevent child unintentional injury. However, previously-published programs were designed primarily to address safety concerns of children living in urban, well-resourced areas, and therefore might be less effective or economically infeasible to distribute to children in resource-limited areas, such as those living in rural areas or underdeveloped regions. This proposed study will evaluate the effectiveness of teaching children safety lessons to rural preschoolers in China through the preschool-based Safety Experience Room intervention that was developed based on relevant theories, the lessons of previous intervention research, the characteristics of child injuries in underdeveloped rural areas, and the needs and circumstances of rural families and preschools in China. The study will also evaluate the cost-effectiveness of delivering the program. METHODS AND ANALYSIS: A single-blinded, 12-month follow-up, parallel-group cluster randomized controlled trial with a 1:1 allocation ratio will be implemented in two selected counties. In total, at least 2378 rural preschoolers aged 3-6 years old will be recruited from 12 preschools, 6 in Yang County and 6 in Shicheng County. Clusters will be randomized at the preschool level and allocated to the control group (routine school-based education) or the intervention group (routine school-based education plus the Safety Experience Room education). External support strategies will be implemented by local partners to minimize attrition. Data collection will be conducted at baseline and then every 3 months during a 12-month follow-up time period. Intention-to-treat (ITT) data analysis will be used. Generalized estimation equations (GEE) will evaluate the effectiveness of the program and generalized cost-effectiveness analysis (GCEA) will evaluate the cost-effectiveness of it. A per-protocol (PP) sensitivity analysis will assess the robustness of ITT results. Subgroup analyses will be performed to evaluate the impact of socio-demographic factors on the intervention effect, following the same strategies as the primary analyses. DISCUSSION: The newly-designed Safety Experience Room program is expected to be feasible, effective, and financially beneficial. If these hypotheses prove true, we will take steps to disseminate the program to rural preschools across China. TRIAL REGISTRATION: Chinese Clinical Trial Registry ( http://www.chictr.org.cn ), CHiCTR2000038025, registered on 8 September 2020.

Injury mortality and morbidity changes due to the COVID-19 pandemic in the United States.

Introduction: The COVID-19 pandemic significantly changed society. We aimed to examine the systematic impact of the COVID-19 on injury burden in the United States. Methods: We extracted mortality and morbidity data from CDC WONDER and WISQARS. We estimated age-standardized injury mortality rate ratio and morbidity rate ratio (MtRR and MbRR) with 95% confidence interval (95% CI) for all injuries, all unintentional injuries, homicide/assault by all methods, suicide/self-harm by all methods, as well as other 11 specific unintentional or intentional injury categories. Injury rate ratios were compared for 2020 vs. 2019 to those of 2019 vs. 2018 to demonstrate the influence of the COVID-19 pandemic on fatal and nonfatal injury burden. The ratio of MtRRs (RMtRR) and the ratio of MbRRs (RMbRR) with 95% CI between 2020 vs. 2019 and 2019 vs. 2018 were calculated separately. Results: The COVID-19 pandemic was associated with an increase in injury mortality (RMtRR = 1.12, 95% CI: 1.11, 1.13) but injury morbidity decreased (RMbRR = 0.88, 95% CI: 0.88, 0.89) when the changes of these rates from 2019 to 2020 were compared to those from 2018 to 2019. Mortality disparities between the two time periods were primarily driven by greater mortality during the COVID-influenced 2020 vs. 2019 from road traffic crashes (particularly motorcyclist mortality), drug poisoning, and homicide by firearm. Similar patterns were not present from 2019 vs. 2018. There were morbidity reductions from road traffic crashes (particularly occupant and pedestrian morbidity from motor vehicle crashes), unintentional falls, and self-harm by suffocation from 2019 to 2020 compared to the previous period. Change patterns in sexes and age groups were generally similar, but exceptions were observed for some injury types. Conclusions: The COVID-19 pandemic significantly changed specific injury burden in the United States. Some discrepancies also existed across sex and age groups, meriting attention of injury researchers and policymakers to tailor injury prevention strategies to particular populations and the environmental contexts citizens face.

ARTCDP: An automated data platform for monitoring emerging patterns concerning road traffic crashes in China.

Online media reports provide valuable information for road traffic injury prevention, but technical challenges concerning data acquisition and processing limit analysis and interpretation of such data. Integrating injury epidemiology theory and big data technology, we developed a data platform consisting of four layers (data acquisition, data processing, application and data storage) to automatically collect reports from online Chinese media concerning road traffic crashes every 24 h. We built a text classification model using 20,000 manually annotated news stories based on the Bidirectional Encoder Representations from Transformers (BERT) and then used natural language processing algorithms to extract data concerning 27 structured variables from the news sources. The accuracy of the BERT-based text classification model was 0.9271, with information extraction accuracy exceeding 80% for 22 variables. As of November 30, 2021, the data platform collected 244,650 eligible media reports covering all 333 prefecture-level divisions in China. These reports were from 37,073 websites or social media accounts, which were geographically located in all 31 provinces and over 98% of prefecture-level divisions. Data availability varied greatly from 0.9% to 100% across the 27 structured variables. Additionally, the platform identified 645,787 potentially relevant keywords when applying natural language processing techniques to the textual media reports. Platform data were highly correlated with road police data in province-based road traffic crash statistics (crashes, rs = 0.799; non-fatal injuries, rs = 0.802; deaths, rs = 0.775). In particular, the platform offers valuable data (like crashes involving electric vehicles) that are not included in official road traffic crash statistics. The new automated data platform shows great potential for timely detection of emerging characteristics of road traffic crashes. Further research is needed to improve the platform and apply it to real-time monitoring and analysis of road traffic injuries.

Effectiveness of a helmet promotion campaign, China.

Objective: To evaluate the effectiveness of a 2020 nationwide helmet promotion campaign, in terms of helmet wearing and correct helmet wearing, aimed at electric bike riders and motorcyclists in China. Methods: We obtained 192 hours of film of traffic before (2019) and after (2021) implementation of the campaign at eight road intersections in Changsha, recording cyclist (traditional and electric) and motorcyclist helmet-wearing behaviour during both weekdays and the weekend, and peak and off-peak traffic. We extracted data on rider characteristics and helmet-wearing behaviour. We applied a logistic regression to obtain estimates of helmet wearing and correct helmet wearing, and calculated odds ratios adjusted for rider variables. Findings: We filmed 11 525 cyclists and motorcyclists, 5256 (45.6%) before and 6269 (54.4%) after the campaign. We estimated a substantial increase in the overall percentage of helmet wearing from 8.8% (95% confidence interval, CI: 8.0-9.6) to 62.0% (95% CI: 60.8-63.2). After controlling for covariates, we noted that helmet wearing increased in all groups. However, we observed a decrease in the overall percentage of correct helmet wearing from 91.9% (95% CI: 89.4-94.3) to 83.5% (95% CI: 82.3-84.7). Post-campaign, we estimated the highest percentage of helmet wearing for delivery riders (88.8%) and lowest for traditional cyclists (3.8%); we estimated the lowest percentage of correct helmet wearing for three-wheeled motorcyclists (58.8%). Conclusion: To increase helmet wearing and correct helmet wearing, we recommend amending the campaign to include traditional cyclists as well as education and legislation on the correct fastening of helmet chinstraps.

Conflicts between bus drivers and passengers in Changsha, China.

Bus safety represents an important topic for injury prevention. When drivers experience conflict with their passengers, it likely distracts them from the driving task, both physically and mentally, and jeopardizes the safety of all passengers. However, detailed information concerning the frequency and type of conflicts between bus drivers and passengers is unavailable. We conducted a driver-reported cross-sectional survey to investigate the characteristics of driver-passenger conflict in the past month. The survey was completed in Changsha city, China in August 2019. In total, 779 bus drivers were surveyed. Of 732 drivers who completed the questionnaire, 635 (86.7%; 95% confidence interval: 84.3-89.1%) drivers reported experiencing at least one conflict with passengers in the past month. After adjusting for other demographic variables, drivers who were male, younger, less educated, less experienced as a bus driver, and with a comparatively high self-reported work intensity were more likely to report experiencing conflicts. Of the reported conflicts, verbal quarrels and abuses were most common, followed by "passengers attacked driver with physical objects like sticks or knives" and "passengers spat on or threw objects toward the driver". Most drivers reported that they had experienced only conflicts causing no physical injury or financial loss in the past month, but a small portion experienced conflicts causing injuries to themselves. The most frequent reasons for driver-passenger conflicts were "passenger refused to pay fare", "passenger requested to get off the bus at a location that was not a bus stop", and "passenger was drunk or deliriously attacked the driver". Bus drivers responded to some of the passengers' verbal or physical attacks, but not all. Some preventive measures were adopted frequently by bus companies (e.g., bus alarms, protective shields for drivers) but others were not. Least often adopted were efforts to offer safety training for drivers (46.6%) and to offer psychological counseling services for drivers (39.1%). We conclude that bus driver-passenger conflicts are common in Changsha city, China. The conflicts impose a substantial threat to the safety of both drivers and passengers. We recommend multiple preventive actions to reduce driver-passenger conflicts and improve bus safety.

Coding quality of deaths and its impact on elderly unintentional fall mortality data from 1990 to 2019: a retrospective analysis of the WHO Mortality Database.

BACKGROUND: Several studies have assessed the reporting quality of all-cause mortality data from the WHO Mortality Database, but little is known about coding quality and its impact on elderly unintentional fall mortality data worldwide. We aimed to assess the coding quality of deaths and its impact on elderly unintentional fall mortality. METHODS: Using data from the WHO Mortality Database, 1990-2019, we calculated the number of countries/territories that had mortality data in the database, and the proportion of deaths with five types of problematic codes based on the 10th International Classification of Disease (unspecified deaths, injury deaths with undetermined intent, unspecified unintentional injury, unintentional falls with unspecified mechanism, unintentional falls with unknown occurrence place). We estimated age-adjusted unintentional fall mortality before and after correcting problematic codes. RESULTS: Only 64% (124/194) of WHO member states had at least 1 year of mortality data in the database during 1990-2019, and data unavailability was more common for underdeveloped countries/territories than for developed countries/territories. Coding quality was poor for many countries/territories. Among the study years when countries/territories possessed mortality data, 80, 53, 51, and 63% had a proportion of unintentional fall deaths with unspecified mechanism over 50% in low-income, lower middle-income, upper middle-income, and high-income countries/territories, respectively; comparable proportions for unintentional fall deaths with unknown occurrence place were 100, 42, 71, and 62%. Among the 94 countries/territories having mortality data, problematic codes caused a relative mortality difference ≥ 50% in 59 countries/territories (63%). After correcting problematic codes, 5 of 55 countries/territories with data witnessed a reverse in mortality changes between 2005 and 2015. Among the 82 countries/territories with mortality data for 5 or more years, 18 countries/territories (22%) experienced a directional reverse in linear regression coefficient. CONCLUSIONS: The availability and coding quality of global data related to elderly unintentional fall mortality was poor between 1990 and 2019. When data are available, varying coding quality across countries/territories and over time have a substantial impact on mortality estimates and mortality comparisons. Global agencies plus each individual government should be aware of the importance of collecting and sharing high-quality mortality data, and take action to improve data quality for inclusion in the WHO Mortality Database.

A survey on the public's discrimination rate of typical rumors during the coronavirus disease 2019 epidemic. / æ–°åž‹å† çŠ¶ç— æ¯’è‚ºç‚Žæµè¡ŒæœŸé—´å ¬ä¼—å¯¹å ¸åž‹è°£è¨€æ­£ç¡®ç”„åˆ«çŽ‡çš„è°ƒæŸ¥.

OBJECTIVES: During the epidemic of coronavirus disease-2019 (COVID-19), the wide spread of rumors caused significant public hazards. This study aims to understand the situation of discrimination for typical COVID-19 rumors by the public and related factors. METHODS: An anonymous online survey was carried out using Questionnaire Star. The contents included participants' gender, age, education level, the COVID-19 information sources, and the judgmental questions about 14 representative COVID-19 rumors. The discrimination rate and 95% confidence interval of 14 rumors were estimated, and the association of discrimination rate with gender, age, and education level was analyzed by binary logistic regression. RESULTS: A total of 2 087 valid questionnaires were collected. The participants were mainly female (62.7%) and below 35 years old (63.4%); the education level was predominantly college/bachelor's degree (47.3%) and master's degree or above (39.1%); the participants, who accessed to COVID-19 information included internet media, accounted for 91%. The participants with different gender, age, and education level had significant differences in the distribution of COVID-19 information sources (all P<0.01). The participants' discrimination rate for 14 rumors ranged from 67.4% to 98.6%, with 4 rumors less than 80%. Women's discrimination rate of 9 rumors was significantly higher than men's (all P<0.05). There was no significant difference in the discrimination rate of rumors among the different age groups (all P>0.05), but the differences in the discrimination rate of other rumors among the different age groups varied according to the rumor. Compared to those with high school or less education levels, the discrimination rates were also higher in the respondents with high education levels (P<0.05). CONCLUSIONS: A few publics are still unable to identify typical rumors during the COVID-19 epidemic. There are associations among genders, age, and the education levels with the discrimination of some rumors. The government authorities should strengthen the true information regarding COVID-19, and therefore enhance the public's ability to identify rumors.

COVID-19-Related Rumor Content, Transmission, and Clarification Strategies in China: Descriptive Study.

BACKGROUND: Given the permeation of social media throughout society, rumors spread faster than ever before, which significantly complicates government responses to public health emergencies such as the COVID-19 pandemic. OBJECTIVE: We aimed to examine the characteristics and propagation of rumors during the early months of the COVID-19 pandemic in China and evaluated the effectiveness of health authorities' release of correction announcements. METHODS: We retrieved rumors widely circulating on social media in China during the early stages of the COVID-19 pandemic and assessed the effectiveness of official government clarifications and popular science articles refuting those rumors. RESULTS: We show that the number of rumors related to the COVID-19 pandemic fluctuated widely in China between December 1, 2019 and April 15, 2020. Rumors mainly occurred in 3 provinces: Hubei, Zhejiang, and Guangxi. Personal social media accounts constituted the major source of media reports of the 4 most widely distributed rumors (the novel coronavirus can be prevented with "Shuanghuanglian": 7648/10,664, 71.7%; the novel coronavirus is the SARS coronavirus: 14,696/15,902, 92.4%; medical supplies intended for assisting Hubei were detained by the local government: 3911/3943, 99.2%; asymptomatically infected persons were regarded as diagnosed COVID-19 patients with symptoms in official counts: 322/323, 99.7%). The number of rumors circulating was positively associated with the severity of the COVID-19 epidemic (ρ=0.88, 95% CI 0.81-0.93). The release of correction articles was associated with a substantial decrease in the proportion of rumor reports compared to accurate reports. The proportions of negative sentiments appearing among comments by citizens in response to media articles disseminating rumors and disseminating correct information differ insignificantly (both correct reports: χ12=0.315, P=.58; both rumors: χ12=0.025, P=.88; first rumor and last correct report: χ12=1.287, P=.26; first correct report and last rumor: χ12=0.033, P=.86). CONCLUSIONS: Our results highlight the importance and urgency of monitoring and correcting false or misleading reports on websites and personal social media accounts. The circulation of rumors can influence public health, and government bodies should establish guidelines to monitor and mitigate the negative impact of such rumors.

Assessing the effectiveness of an app-based child unintentional injury prevention intervention for caregivers of rural Chinese preschoolers: protocol for a cluster randomized controlled trial.

BACKGROUND: Compared to urban children, children living in rural areas of most countries, including China, are at higher risk of suffering unintentional injuries. Most proven injury prevention interventions, however, are rarely implemented in rural China due to lack of resources. Mobile health interventions are low-cost and easy-to-implement, facilitating implementing injury prevention in resource-limited areas (e.g., rural areas). This study is designed and implemented to examine the effectiveness of an app-based intervention for unintentional injury prevention among rural preschoolers in China. METHODS: A single-blind, 18-month, parallel-group cluster randomized controlled trial with 1:1 allocation ratio will be implemented in 2 rural areas of China (Yang County, Shaanxi Province, and Shicheng County, Jiangxi Province). In total, at least 3508 rural caregivers of preschoolers aged 3-6 years old who own a smartphone will be recruited from 24 preschools. Clusters will be randomized at the preschool level and allocated to the control group (receiving routine school-based education plus app-based parenting education excluding unintentional injury prevention) or the intervention group (receiving routine school-based education plus app-based parenting education including unintentional injury prevention). External support strategies will be adopted by local partners to minimize user fatigue, non-compliance, and attrition. Data collection will be conducted at baseline and then every 3 months during the 18-month follow-up time period. Intention-to-treat data analysis will be implemented. Missing values will be imputed by using the Expectation Maximization algorithm. Generalized estimating equation will test the overall effectiveness of the app-based intervention. A per-protocol sensitivity analysis will be conducted to test the robustness of results. Subgroup analyses will follow the strategies for primary analyses. The primary outcome measure is the incidence rate of unintentional injury among preschoolers during the study period. Secondary outcome measures comprise longitudinal changes in caregiver's attitudes, caregiver-reported supervision behaviors, and caregiver-assessed home environment safety surrounding child unintentional injury prevention in the last week using a standardized audit instrument. DISCUSSION: The app-based intervention is expected to be feasible and effective over the 18-month intervention period. If the app is demonstrated effective as hypothesized, we will initiate processes to generalize and popularize it broadly to rural child caregivers across China. TRIAL REGISTRATION: ChiCTR2000037606 , registered on August 29, 2020.

Disability-adjusted life years associated with population ageing in China, 1990-2017.

BACKGROUND: The Chinese population has aged significantly in the last few decades. Comprehensive health losses including both fatal and non-fatal health outcomes associated with ageing in China have not been detailed. METHODS: Based on freely accessible disability adjusted life years (DALYs) estimated by the Global Burden of Diseases (GBD) 2017, we adopted a robust decomposition method that ascribes changes in DALYs in any given country across two time points to changes resulting from three sources: population size, age structure, and age-specific DALYs rate per 100,000 population. Using the method, we calculated DALYs associated with population ageing in China from 1990 to 2017 and examined the counteraction between the effects of DALYs rate change and population ageing. This method extends previous work through attributing the change in DALYs to the three sources. RESULTS: Population ageing was associated with 92.8 million DALYs between 1990 and 2017 in China, of which 65.8% (61.1 million) were years of life lost (YLLs). Males had comparatively more DALYs associated with population ageing than females in the study period. The five leading causes of DALYs associated with population ageing between 1990 and 2017 were stroke (23.6 million), chronic obstructive pulmonary disease (COPD) (18.3 million), ischemic heart disease (13.0 million), tracheal, bronchus, and lung cancer (6.1 million) and liver cancer (5.0 million). Between 1990 and 2017, changes in DALYs associated with age-specific DALY rate reductions far exceeded those related to population ageing (- 196.2 million versus 92.8 million); 57.5% (- 112.8 million) of DALYs were caused by decreases in rates attributed to 84 modifiable risk factors. CONCLUSION: Population ageing was associated with growing health loss in China from 1990 to 2017. Despite the recent progress in alleviating health loss associated with population ageing, the government should encourage scientific research on effective and affordable prevention and control strategies and should consider investment in resources to implement strategies nationwide to address the future challenge of population ageing.

Media Reports about Violence against Medical Care Providers in China.

Improper, unprofessional, or misleading media reports about violence against medical care providers (typically doctors and nurses) may provoke copycat incidents. To examine whether media reports about violence against medical care providers in China follow professional journalism recommendations, we identified 10 influential incidents of violence against medical care providers in China through a systematic strategy and used standardized internet-based search techniques to retrieve media reports about these events from 2007-2017. Reports were evaluated independently by trained coders to assess adherence to professional journalism recommendations using a 14-item checklist. In total, 788 eligible media reports were considered. Of those, 50.5% and 47.3%, respectively, failed to mention the real and complete names of the writer and editor. Reports improperly mentioned specific details about the time, place, methods, and perpetrators of violence in 42.1%, 36.4%, 45.4%, and 54.6% of cases, respectively. Over 80% of reports excluded a suggestion to seek help from professional agencies or mediation by a third party and only 3.8% of reports mentioned the perspectives of all three key informants about an event: medical care providers, patients, and hospital administrators. Of those that mentioned medical care providers, patient, and/or hospital administrator perspectives, less than 20% indicated they had obtained the interviewee's consent to include their perspective. We concluded that most reports about violence against medical care providers in the Chinese media failed to strictly follow reporting recommendations from authoritative media bodies. Efforts are recommended to improve adherence to professional guidelines in media reports about violence against medical care providers in China, as adherence to those guidelines is likely to reduce future violent events against medical care providers like doctors and nurses.

Road traffic injury mortality and morbidity by country development status, 2011-2017.

PURPOSE: This research examined road traffic injury mortality and morbidity disparities across of country development status, and discussed the possibility of reducing country disparities by various actions to accelerate the pace of achieving Sustainable Development Goals target 3.6 - to halve the number of global deaths and injuries from road traffic accidents by 2020. METHODS: Data for road traffic mortality, morbidity, and socio-demographic index (SDI) were extracted by country from the estimates of the Global Burden of Disease study, and the implementation of the three types of national actions (legislation, prioritized vehicle safety standards, and trauma-related post-crash care service) were extracted from the Global Status Report on Road Safety by World Health Organization. We fitted joinpoint regression analysis to identify and quantify the significant rate changes from 2011 to 2017. RESULTS: Age-adjusted road traffic mortality decreased substantially for all the five SDI categories from 2011 to 2017 (by 7.52%-16.08%). Age-adjusted road traffic mortality decreased significantly as SDI increased in the study time period, while age-adjusted morbidity generally increased as SDI increased. Subgroup analysis by road user yielded similar results, but with two major differences during the study period of 2011 to 2017: (1) pedestrians in the high SDI countries experienced the lowest mortality (1.68-1.90 per 100,000 population) and morbidity (110.45-112.72 per 100,000 population for incidence and 487.48-491.24 per 100,000 population for prevalence), and (2) motor vehicle occupants in the high SDI countries had the lowest mortality (4.07-4.50 per 100,000 population) but the highest morbidity (428.74-467.78 per 100,000 population for incidence and 1025.70-1116.60 per 100,000 population for prevalence). Implementation of the three types of national actions remained nearly unchanged in all five SDI categories from 2011 to 2017 and was consistently stronger in the higher SDI countries than in the lower SDI countries. Lower income nations comprise the heaviest burden of global road traffic injuries and deaths. CONCLUSION: Global road traffic deaths would decrease substantially if the large mortality disparities across country development status were reduced through full implementation of proven national actions including legislation and law enforcement, prioritized vehicle safety standards and trauma-related post-crash care services.