Global job satisfaction and fluctuation among community general practitioners: a systematic review and meta-analysis.

INTRODUCTION: Community General Practitioners (CGPs) are crucial to primary healthcare worldwide. Their job satisfaction significantly impacts the quality and accessibility of healthcare. However, a comprehensive global perspective on this issue remains absent, necessitating this systematic review and meta-analysis. METHODS: This systematic review and meta-analysis sourced literature from PubMed, Web of Science, CNKI, and Wanfang, up to June 14, 2023. Of the 2,742 identified studies, 100 articles were selected for meta-analysis to assess satisfaction levels, and 97 studies were chosen for comparative analysis of influential factors. We employed both meta-analytic and comparative analytic methodologies, focusing on varying geographical, economic, and temporal contexts. RESULTS: The pooled rate and corresponding 95% confidence interval (CI) for job satisfaction among CGPs was 70.82% (95%CI: 66.62-75.02%) globally. Studies utilizing 5-point score scale obtained a random effect size of 3.52 (95%CI: 3.43-3.61). Diverse factors influenced satisfaction, with remuneration and working conditions being predominant. A noticeable decline in job satisfaction has been observed since the coronavirus disease 2019 outbreak, with satisfaction rates dropping from an average of 72.39% before 2009 to 63.09% in those published after 2020. CONCLUSIONS: The downward trend in CGPs' job satisfaction is concerning and warrants urgent attention from policymakers, especially in regions with an acute shortage of CGPs. The findings from this comprehensive review and meta-analysis provide essential insights for informed healthcare policy-making. It highlights the urgency of implementing strategies to enhance CGP satisfaction, thereby improving the effectiveness of primary healthcare systems globally.

Association between multiple vitamins and bone mineral density: a cross-sectional and population-based study in the NHANES from 2005 to 2006.

BACKGROUND: Bone mineral density (BMD) alterations in response to multivitamin exposure were rarely studied. Our study assessed the association of coexposure to six types of vitamins (i.e., vitamins B12, B9, C, D, A and E) with BMD measurements in adults in the US. METHODS: Data were collected from participants aged ≥ 20 years (n = 2757) in the U.S. National Health and Nutrition Examination Surveys (NHANES) from 2005 to 2006. Multiple linear regression, restricted cubic splines, principal component analysis (PCA) and weighted quantile sum (WQS) regression were performed for statistical analysis. RESULTS: The circulating levels of vitamins B12 and C were positively associated with BMDs, and an inverted L-shaped exposure relationship was observed between serum vitamin C and BMDs. PCA identified two principal components: one for 'water-soluble vitamins', including vitamins B12, B9 and C, and one for 'fat-soluble vitamins', including vitamins A, D and E. The former was positively associated with total femur (ß = 0.009, 95%CI: 0.004, 0.015) and femoral neck (ß = 0.007, 95%CI: 0.002, 0.013) BMDs, and the latter was negatively associated with BMDs with non-statistical significance. The WQS index constructed for the six vitamins was significantly related to total femur (ß = 0.010, 95%CI: 0.001, 0.018) and femoral neck (ß = 0.008, 95%CI: 0.001, 0.015) BMDs, and vitamins B12 and C weighted the most. The WQS index was inversely related to BMDs with non-statistical significance, and vitamins E and A weighted the most. CONCLUSION: Our findings suggested a positive association between water-soluble vitamin coexposure and BMD, and the association was mainly driven by vitamins B12 and C. Negative association between fat-soluble vitamin coexposure and BMD was indicated, mainly driven by vitamins E and A. An inverted L-shaped exposure relationship was found between vitamin C and BMD.

A Piezo-Fenton System with Rapid Iron Cycling and Hydrogen Peroxide Self-Supply Driven by Ultrasound.

The piezo-Fenton system has attracted attention not only because it can enhance the Fenton reaction activity by mechanical energy input, but also because it is expected to realize a class of stimuli-responsive advanced oxidation systems by regulating energy input and hydrogen peroxide self-supply, thus greatly enriching the application possibilities of Fenton chemistry. In this work, a series of Fe-doped g-C3 N4 (g-C3 N4 -Fe) as a piezo-Fenton system were synthesized where the iron stably immobilized through Fe-N interaction. The piezo-induced electrons generate on g-C3 N4 matrix support the conversion of Fe(III) to Fe(II) and promote rate-limiting step of Fenton reaction. With the optimal Fe loading, g-C3 N4 -0.5Fe can achieve methylene blue (MB) degradation under ultrasonic treatment with first-order kinetic rate constants of 75×10-3  min-1 . Most importantly, the g-C3 N4 -Fe can maintain good catalytic activity in a wide pH range (pH=2.0∼9.0) and be cyclic used without iron leaching to solution (<0.001 µg ⋅ L-1 ), overcoming the disadvantage of traditional Fe-based Fenton catalysts that can only be applied under acidic conditions and prone to secondary pollution. In addition, g-C3 N4 -0.5Fe also exhibits antibacterial properties of Escherichia coli and Staphylococcus aureus under ultrasound. Hydroxyl radicals mainly contribute to the degradation of MB and the sterilization process. Our work is an attempt to clarify the role of g-C3 N4 -Fe in the conversion of mechanical energy to ROS and provide inspirations for the piezo-Fenton system design.

Association between long-term exposure to PM2.5 and hypertension: A systematic review and meta-analysis of observational studies.

BACKGROUND: Numerous studies have examined the association between long-term exposure to particulate matter with an aerodynamic diameter of ≤2.5 µm (PM2.5) and hypertension. However, the results are inconsistent. OBJECTIVES: Considering the limitations of previous meta-analyses and the publication of many new studies in recent years, we conducted this meta-analysis to assess the relationship between long-term PM2.5 exposure and the incidence and prevalence of hypertension in a healthy population. METHODS: We searched PubMed, Web of Science, Embase, and Scopus for relevant studies published until April 2, 2021 and reviewed the reference lists of previous reviews. A total of 28 observational studies reporting RR or OR with 95% CI for the association between long-term PM2.5 exposure and the risk of hypertension were included. RESULTS: After the sensitivity analysis, we excluded one study with a high degree of heterogeneity, resulting in 27 studies and 28 independent reports. Approximately 42 million participants were involved, and the cases of hypertension in cohort and cross-sectional studies were 508,749 and 1,793,003, respectively. The meta-analysis showed that each 10 µg/m3 increment in PM2.5 was significantly associated with the risks of hypertension incidence (RR = 1.21, 95% CI: 1.07, 1.35) and prevalence (OR = 1.06, 95% CI: 1.03, 1.09). Subgroup analyses showed that occupational exposure had a significant effect on the association of PM2.5 and hypertension incidence (p for interaction = 0.042) and that the PM2.5 concentration level and physical activity had a noticeable effect on the association of PM2.5 and hypertension prevalence (p for interaction = 0.005; p for interaction = 0.022). CONCLUSIONS: A significantly positive correlation was observed between long-term PM2.5 exposure and risks of hypertension incidence and prevalence, and a high PM2.5 concentration resulted in an increased risk of hypertension.

An evaluation index system for regional mobile SARS-CoV-2 virus nucleic acid testing capacity in China: a modified Delphi consensus study.

BACKGROUND: Large-scale detection has great potential to bring benefits for containing the COVID-19 epidemic and supporting the government in reopening economic activities. Evaluating the true regional mobile severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus nucleic acid testing capacity is essential to improve the overall fighting performance against this epidemic and maintain economic development. However, such a tool is not available in this issue. We aimed to establish an evaluation index system for assessing the regional mobile SARS-CoV-2 virus nucleic acid testing capacity and provide suggestions for improving the capacity level. METHODS: The initial version of the evaluation index system was identified based on massive literature and expert interviews. The Delphi method questionnaire was designed and 30 experts were consulted in two rounds of questionnaire to select and revise indexes at all three levels. The Analytic Hierarchy Process method was used to calculate the weight of indexes at all three levels. RESULTS: The evaluation index system for assessing the regional mobile SARS-CoV-2 virus nucleic acid testing capacity, including 5 first-level indexes, 17 second-level indexes, and 90 third-level indexes. The response rates of questionnaires delivered in the two rounds of consultation were 100 and 96.7%. Furthermore, the authority coefficient of 30 experts was 0.71. Kendall's coordination coefficient differences were statistically significant (P < 0.001). The weighted values of capacity indexes were established at all levels according to the consistency test, demonstrating that 'Personnel team construction' (0.2046) came first amongst the five first-level indexes, followed by 'Laboratory performance building and maintenance' (0.2023), 'Emergency response guarantee' (0.1989), 'Information management system for nucleic acid testing resources' (0.1982) and 'Regional mobile nucleic acid testing emergency response system construction' (0.1959). CONCLUSION: The evaluation system for assessing the regional mobile SARS-CoV-2 virus nucleic acid testing capacity puts forward a specific, objective, and quantifiable evaluation criterion. The evaluation system can act as a tool for diversified subjects to find the weak links and loopholes. It also provides a measurable basis for authorities to improve nucleic acid testing capabilities.

A Novel Fluorescent Nanoparticle for Sensitive Detection of Cry1Ab Protein In Vitro and In Vivo.

Here, we report the synthesis and characterization of CoFe2O4 doping Ag2S dendrimer-modified nanoparticles (CoFe2O4-Ag2S DMNs) in Cry1Ab protein detection and imaging. The near-infrared Ag2S quantum dots were first prepared by using the thermal decomposition method, followed by modification of the water-soluble quantum dots using the method of solvent evaporation and ligand exchange, and finally the fluorescent magnetic bifunctional nanoparticles were obtained by binding with CoFe2O4. As-prepared CoFe2O4-Ag2S DMNs were characterized by fluorescence (FL) spectroscopy and transmission electron microscopy (TEM). Results showed that Ag2S DMNs could sensitively detect Cry1Ab both in vitro and in vivo. In vitro, the enhanced FL intensity as a function of the concentration is notably consistent with the Langmuir binding isotherm equation in the range of 0-200 ng/mL of Cry1Ab proteins. The detection limit of this method was found to be 0.2 ng/mL. Meanwhile, the fluorescence wavelength was extended to the second near-infrared range (NIR-II, 1.0~1.4 µm), which enables in vivo imaging. This study highlights the importance of NIR QDs doping magnetic materials as a new method to trace Bacillus thuringiensis (Bt) in insects and their potential applications in in vivo NIR tissue imaging.

Quaternary Ammonium Polyamidoamine Dendrimer Modified Quantum Dots as Fluorescent Probes for p-Fluorophenoxyacetic Acid Detection in Aqueous Solution.

The wide use of pesticide p-fluorophenoxyacetic acid has caused the serious environmental contaminant. A novel fluorescent probe for sensitive detection of p-fluorophenoxyacetic acid in aqueous solutions based on 3.0G quaternary ammonium polyamidoamine (PAMAM) dendrimer modified quantum dots (QDs) (PAMAM@QDs) was reported. Through the solvent-evaporation method, quaternary ammonium PAMAM was employed to modify the QDs. Poloxamer 188 was used to improve the solubility and stability. The resultant PAMAM@QDs dispersed well in water. Fluorescence (FL) spectroscopic study showed that the FL intensity of the PAMAM@QDs was enhanced in the presence of p-fluorophenoxyacetic acid. Under optimal conditions, the enhanced FL intensity as a function of concentration matched very well in the range of 1 ~ 200 µg/mL of p-fluorophenoxyacetic acid, while the lower limits of detection were found to be 0.16 µg/mL. These results show that PAMAM@QDs is a promising luminescent probe for the detection of pesticides.

Graphite oxide-dispersed CdTe quantum dots nanocomposite for flexible display luminescent membranes.

A quantum dot (QD) dispersant material was prepared using graphite oxide (GO). Luminescent films were prepared using polyvinyl alcohol as the polymer matrix. First, water-soluble CdTe QDs were prepared by wet chemistry and GO was synthesized using a modified Hummers method. X-Ray diffraction tests showed that the GO reflection peak [001] was 11.9°, which indicates that the d-spacing is 0.7431 nm; atomic force microscopy showed a GO thickness of 200 nm. Fourier transform infrared spectra showed vibrations at 1624 cm-1 for the carbonyl groups, and 3260 cm-1 for the GO samples; the -C-O vibration was at 1320 cm-1 and -COOH, -OH vibrations were at 950 cm-1 . Fluorescent tests showed that pH had an impact on the QD colloidal stability. GO was neutralized before use as the host media for the GO/QDs nanocomposite. The results proved that the resultant nanocomposite is promising for use in brightness enhancement films in flexible displays.

High Sensitivity Bacillus thuringiensis Cry1Ac Protein Detections Using Fluorescein Diacetate Nanoparticles.

A highly sensitive transgenic protein analysis method was proposed here based on fluorescein diacetate (FDA). First, FDA was prepared by the ball mill to harvest the nano-sized organic particles. Further examines showed that the FDA size can be controlled by the speed of centrifugation which can obtain FDA in well-distributed size. Cy3 antibody immobilization tests showed that the proteins can attach onto the FDA particles while keep bioactivities. FDA and Cry1Ac antibody immunoassay tests showed that when the FDA particle was in 150 nm, the linear range was 0.01 ng/L-30 µg/mL. And it has the lower detection limitation of 0.01 ng/L, which is 100 times more sensitive than the ELISA methods. These results indicate that the FDA related immunoassays are the promising approach in the transgenic analysis.

Coffee consumption and risk of prostate cancer: a meta-analysis of prospective cohort studies.

Observational studies and animal evidence suggest an association between coffee consumption and the risk of prostate cancer. However, the results are inconsistent. We evaluated the association by conducting a meta-analysis of prospective cohort studies. PubMed and Embase were searched through June 2013 to identify studies that met predetermined inclusion criterion. A random-effects model was used to calculate the pooled risk estimates. Ten prospective cohort studies involving 8973 patients with prostate cancer and 206 096 participants were included in this systematic review. Compared with individuals who seldom or never drink coffee, the pooled relative risk of prostate cancer was 0.88 (95% confidence interval: 0.82-0.95) for regular coffee drinkers. Exclusion of any single study did not materially alter the combined risk estimate. Visual inspection of a funnel plot and Begg's and Egger's tests did not indicate evidence of publication bias. In summary, integrated evidence from prospective cohort studies supports the hypothesis that coffee consumption may decrease the risk of prostate cancer.

Association of quantity and duration of smoking with erectile dysfunction: a dose-response meta-analysis.

INTRODUCTION: Some original studies and a recent meta-analysis suggested that smoking could be associated with the risk of erectile dysfunction (ED), but the dose-response relationship between them was unclear. AIM: The aim of this study was to investigate the potential association between quantity and duration of smoking and the risk of ED. METHODS: We conducted a literature search of PubMed, Embase, Web of Science, and Scopus from these databases' inception through March 2014 for observational epidemiological studies examining the association between smoking and risk of ED. Random-effects meta-analyses were used to combine the results of included studies. MAIN OUTCOME MEASURE: Quantitative review of published observational epidemiological studies on the association between smoking and risk of ED was the main outcome measure. RESULTS: One cohort study and nine cross-sectional studies were eligible for inclusion in the meta-analysis (50,360 participants and 12,218 cases with ED). No evidence of a curve linear association was observed between smoking and risk of ED. The summary odds ratio of ED for an increase of 10 cigarettes smoked per day was 1.14 (95% confidence interval 1.09 to 1.18), with moderate heterogeneity (P = 0.061, I(2) = 44.7%). For an increment of 10 years of smoking, the combined odds ratios of ED was 1.15 (95% confidence interval 1.10 to 1.19), without substantial heterogeneity (P = 0.522, I(2) = 0.0%). CONCLUSIONS: Evidence from observational studies suggests that there is a positive dose-response association between quantity and duration of smoking and risk of ED.

Reproductive health service use and social determinants among the floating population: a quantitative comparative study in Guangzhou City.

BACKGROUND: The World Health Assembly has pledged to achieve universal reproductive health (RH) coverage by 2015. Therefore, China has been vigorously promoting the equalisation of basic public health services (i.e. RH services). The floating population (FP) is the largest special group of internal migrants in China and constitutes the current national focus. However, gaps exist in the access of this group to RH services in China. METHODS: A total of 453 members of the FP and 794 members of the residential population (RP) aged 18 to 50 years from five urban districts in Guangzhou City were recruited to participate in a cross-sectional survey in 2009. Information on demographics and socioeconomic status (SES) were collected from these two groups to evaluate the utilisation of RH knowledge and skills and family planning services (FPS), and to identify social determinants. RESULTS: The proportion of individuals with low SES in the FP (19.2%) was higher than that in the RP (6.3%) (P <0.001). Of the FP, 9.7% to 35.8% had no knowledge of at least one skill, a proportion higher than the counterpart values (6.2% to 27.5%) for the RP (P <0.05). The frequency of FPS use among the FP and RP was low. However, FPS use was higher among the FP than among the RP (3.51 vs. 2.99) (P =0.050). Logistic regression analysis was used to analyse the social determinants that influence FPS use in the FP and RP. The factors that affect FPS utilisation of the RP included SES (OR =4.652, 95% CI =1.751, 12.362), whereas those of the FP excluded SES. CONCLUSIONS: The FPS use of the FP in Guangzhou City was higher under equalised public health services. However, a need still exists to help the FP with low SES to improve their RH knowledge and skills through access to public RH services.

A systematic review of antibiotic utilization in China.

OBJECTIVES: Reliable data about antibiotic utilization in the large pharmaceutical market of the world's most populous country, the People's Republic of China, are in short supply. Although many primary studies have investigated the use of antibiotics in China, most of the relevant studies were published in the Chinese language. This systematic review aims to summarize reported percentages of outpatient encounters resulting in the prescription of antibiotics in China. METHODS: We systematically searched and reviewed studies of antibiotic prescribing patterns in China, published in Chinese or English between 2000 and August 2012. The study quality was assessed and the overall percentage of outpatient encounters resulting in the prescription of antibiotics was calculated using random-effects meta-analysis. Subgroup analyses were conducted to investigate heterogeneity across studies. RESULTS: We included 57 eligible studies (with a total of 556 ,435 outpatient encounters). The overall percentage of outpatients prescribed antibiotics was 50.3% (95% CI: 47.4%-53.1%). Of the outpatients prescribed antibiotics, 74.0% (95% CI: 71.3%-76.6%) were prescribed one antibiotic, 23.3% (95% CI: 21.1%-25.7%) were prescribed two antibiotics and 2.0% (95% CI: 1.3%-2.8%) were prescribed three or more antibiotics. The proportion of antibiotic utilization differed greatly across hospital levels and geographical regions and fluctuated over time. CONCLUSIONS: The percentage use of antibiotics is high in China. The excessive use of antibiotics is particularly more problematic in lower-level hospitals and in less developed western China. The implementation and impact of the national efforts to control the excessive use of antibiotics should be appropriately evaluated.

A hybrid seasonal prediction model for tuberculosis incidence in China.

BACKGROUND: Tuberculosis (TB) is a serious public health issue in developing countries. Early prediction of TB epidemic is very important for its control and intervention. We aimed to develop an appropriate model for predicting TB epidemics and analyze its seasonality in China. METHODS: Data of monthly TB incidence cases from January 2005 to December 2011 were obtained from the Ministry of Health, China. A seasonal autoregressive integrated moving average (SARIMA) model and a hybrid model which combined the SARIMA model and a generalized regression neural network model were used to fit the data from 2005 to 2010. Simulation performance parameters of mean square error (MSE), mean absolute error (MAE) and mean absolute percentage error (MAPE) were used to compare the goodness-of-fit between these two models. Data from 2011 TB incidence data was used to validate the chosen model. RESULTS: Although both two models could reasonably forecast the incidence of TB, the hybrid model demonstrated better goodness-of-fit than the SARIMA model. For the hybrid model, the MSE, MAE and MAPE were 38969150, 3406.593 and 0.030, respectively. For the SARIMA model, the corresponding figures were 161835310, 8781.971 and 0.076, respectively. The seasonal trend of TB incidence is predicted to have lower monthly incidence in January and February and higher incidence from March to June. CONCLUSIONS: The hybrid model showed better TB incidence forecasting than the SARIMA model. There is an obvious seasonal trend of TB incidence in China that differed from other countries.

Exposure to phenols, chlorophenol pesticides, phthalate and PAHs and mortality risk: A prospective study based on 6 rounds of NHANES.

OBJECTIVES: Human exposure to various endocrine disrupting chemicals (EDCs) is widespread and long-lasting. The primary objective of this study was to prospectively evaluate the association of combined exposure of phenols, chlorophenol pesticides, phthalate and polycyclic aromatic hydrocarbons (PAHs) and mortality risk in a representative US population. METHODS: The data on urinary levels of phenols, chlorophenol pesticides, phthalates, and PAH metabolites, were collected from participants aged ≥20 years in six rounds of the National Health and Nutrition Examination Survey (NHANES) (2003-2014). NHANES-linked death records up to December 31, 2015 were used to ascertain mortality status and cause of death. Cox proportional hazards and competing risk models were mainly used for chemical and mortality risk association analysis. The weighted quantile sum (WQS) regression and the least absolute shrinkage and selection operator regression were employed to estimate the association between EDC co-exposure and mortality risk. RESULTS: High levels of mono-n-butyl phthalate, monobenzyl phthalate, and 1-napthol were significantly associated with increased risk of all cause, cardiovascular disease (CVD) and cancer mortality among all participants. WQS index was associated with the risks of all-cause (hazard ratio [HR] = 1.389, 95%CI: 1.155-1.669) and CVD mortality (HR = 1.925, 95%CI: 1.152-3.216). High co-exposure scores were associated with elevated all-cause (HR = 2.842, 95% CI: 1.2.094-3.858), CVD (HR = 1.855, 95% CI: 1.525-2.255), and cancer mortality risks (HR = 2.961, 95% CI: 1.468-5.972). The results of subgroup analysis, competing risk model, and sensitivity analysis were generally consistent with the findings from the main analyses, indicating the robustness of our findings. CONCLUSIONS: This study provided the first epidemiological evidence that co-exposure to EDC at fairly low levels contributed to elevated mortality risk among US adults. The underlying mechanisms for the effects of EDC co-exposure on human health are worthy of future exploration.

L-ribose specific recognition surface constructed by pillar[5]arene-based host-guest interaction.

In living organisms, chiral molecules have specific chiral conformations that produce different physiological effects. Ribose is one of the components of RNA, which mainly plays a role in regulating biological activity. Inspired by the biological recognition of sugars, functional chiral surfaces for recognizing L-ribose through non-covalent interactions were constructed. In the strategy of this study, a functional chiral gold surface based on host-guest interactions was constructed through the assembly of the host molecule single-function alynyl pillar[5]arene(SAP5) and the guest molecule (S) -mandelate-violet (SMV). The association constant of SMV and SAP5 was calculated to be 2.95×104 M-1, with a binding ratio of 1:1. By impedance and contact angle detection, the constructed functional interface has good detection effect on L-ribose in the range of 1×10-7 M to1× 10-2 M. In addition, CV was disassembled from the aromatic cavity of pillar[5]arene after adding zinc powder and it can repeat five times with good recyclability, thus achieving the organic combination of interface recognition and intelligence.

Sonoactivated Cascade Fenton Reaction Enhanced by Synergistic Modulation of Electron-Hole Separation for Improved Tumor Therapy.

Chemodynamic therapy (CDT) is an emerging targeted treatment technique for tumors via the generation of highly cytotoxic hydroxyl radical (·OH) governed by tumor microenvironment-assisted Fenton reaction. Despite high effectiveness, it faces limitations like low reaction efficiency and limited endogenous H2 O2 , compromising its therapeutic efficacy. This study reports a novel platform with enhanced CDT performance by in situ sono-activated cascade Fenton reaction. A piezoelectric g-C3 N4 (Au-Fe-g-C3 N4 ) nanosheet is developed via sono-activated synergistic effect/H2 O2 self-supply mediated cascade Fenton reaction, realizing in situ ultrasound activated cascade Fenton reaction kinetics by synergistic modulation of electron-hole separation. The nanosheets consist of piezoelectric g-C3 N4 nanosheet oxidizing H2 O to highly reactive H2 O2 from the valence band, Fe3+ /Fe2+ cycling activated by conduction band to generate ·OH, and Au nanoparticles that lower the bandgap and further adopt electrons to generate more 1 O2 , resulting in improved CDT and sonodynamic therapy (SDT). Moreover, the Au-Fe-g-C3 N4 nanosheet is further modified by the targeted peptide to obtain P-Au-Fe-g-C3 N4 , which inhibits tumor growth in vivo effectively by generating reactive oxygen species (ROS). These results demonstrated that the sono-activated modulation translates into a high-efficiency CDT with a synergistic effect using SDT for improved anti-tumor therapy.

Factors Associated With the Vaccination Behavior Among COVID-19 Vaccine Hesitant College Students in Wuhan, China: A Survey Based on Social Psychological Dimension.

Background: During the COVID-19 pandemic, vaccine hesitancy (VH) on COVID-19 vaccination still exists in different populations, which has a negative impact on epidemic prevention and control. The objectives were to explore college students' willingness to vaccinate, determine the factors influencing the vaccination behavior of students with COVID-19 vaccine hesitancy, and provide a basis for improving the compliance of college students with COVID-19 vaccination. Methods: The universities in Wuhan are categorized into three levels according to their comprehensive strength and randomly sampled at each level, of which ten universities were selected. A self-designed anonymous electronic questionnaire was distributed online from May 12 to 31, 2021 to investigate the hesitancy, vaccination status, and influencing factors of COVID-19 vaccination among college students in Wuhan. Results: Of the 1,617 participants (1,825 students received the electronic questionnaire) surveyed, 19.0% reported COVID-19 vaccine hesitancy. Among the vaccine-hesitant students, 40.1% were vaccinated against COVID-19. The binary logistic regression analysis shows that families' attitudes "Uncertain" (odds ratio (OR) = 0.258 [0.132-0.503]), vaccination risk psychology (OR = 0.242 [0.079-0.747]) and wait-and-see mentality (OR = 0.171 [0.068-0.468]) are negative factors for the vaccination behavior of hesitant students, while herd mentality (OR = 7.512 [2.718-20.767]) and uncertainty of free policy's impact on vaccine trust (OR = 3.412 [1.547-7.527]) are positive factors. Conclusion: The vaccine hesitancy among college students in Wuhan was relatively high. Family support, herd mentality and free vaccination strategies can help improve vaccination among hesitant students, while vaccination risk psychology and "wait-and-see" psychology reduce the possibility of vaccination. The vaccination strategy of college students should be strengthened from the perspective of social psychological construction.

Association Between Water Intake and Mortality Risk-Evidence From a National Prospective Study.

Background: Few studies have explored the association between water intake and mortality risk, and the findings were inconsistent. Objective: This study aimed to explore the water intake-mortality association, utilizing the data from the National Health and Nutrition Examination Survey (NHANES) and the 2015 public-linked mortality files released by the National Center for Health Statistics. Methods: We used the diet- and mortality-linked data of a total of 35,463 adults (17,234 men) aged ≥20 years in the NHANESs 1999-2014 to perform a prospective study. The multivariate-adjusted Cox proportional hazards model was used to explore the associations of the amount of water intake (expressed by total water, plain water, beverage, and food water) and water intake proportion (expressed by the percentage of each kind of water) with mortality risks due to all causes, malignant neoplasms/cancer, and heart disease. The restricted cubic spline plots were adopted to clarify the dose-response relationships among them. Results: With a median of 88 months (interquartile range: 49-136 months) follow-up, a total of 4,915 all-cause deaths occurred, including 1,073 and 861 deaths from malignant neoplasms/cancer and heart disease, respectively. The amount of water intake in either type was negatively associated with all-cause mortality risk. Additionally, the negative linear dose-response relationships of water intake and all-cause mortality risk were found for all types of water except for food water, which followed a non-linear pattern. Similarly, compared to the lowest quartile (beverage water intake: <676 g/day; food water intake: <532 g/day), beverage and food water intakes in the range of 1,033-1,524 and 1,612-3,802 g/day were associated with decreased malignant neoplasms/cancer mortality risk. A U-shaped dose-response relationship was found for beverage water intake and malignant neoplasms/cancer mortality risk and a negative linear dose-response relationship was found for food water intake and malignant neoplasms/cancer mortality risk. Coffee and/or tea consumption was/were negatively associated with mortality risks due to all causes and malignant neoplasms/cancer. No significant associations of water intake proportion and mortality risks were found. Conclusion: Our findings demonstrated that higher water intake is associated with lower mortality risks among the United States population.

Multiple vitamin co-exposure and mortality risk: A prospective study.

BACKGROUND & AIMS: Existing epidemiological studies explored the associations of circulating vitamins and mortality focusing on individual vitamin effects, and controversial findings were obtained. The joint effects of multiple vitamin co-exposure are worth studying. The study aimed to elucidate the associations of circulating vitamins and the joint effects of these vitamins' co-exposure with all-cause and cause-specific mortality risks. METHODS: We prospectively evaluated the associations of the concentrations of six kinds of vitamins (A, D, E, C, B12 and B9) in serum with risks for all-cause and cause-specific mortalities among U.S. adults. Mortality status and cause of death were determined by NHANES-linked public available files dated up to 31 December 2015. An unsupervised K-means clustering method was used to cluster the participants into several vitamin co-exposure patterns. The Cox proportional hazards model was used for statistical analysis. RESULTS: A total of 1404 deaths occurred during a median of 10.9 years follow-up among 8295 participants. In multivariable adjustment, increasing levels of vitamin D were associated with reduced all-cause and cause-specific mortality risks. A J-shaped nonlinear exposure-response relationship was observed between all studied vitamins (except for vitamin D) and all-cause mortality risk. Four co-exposure patterns were generated based on the studied vitamins, as follows: low-level exposure (cluster 1), vitamin A/D exposure (cluster 2), water-soluble vitamin exposure (cluster 3) and high-level exposure (cluster 4). Compared with those in cluster 1, participants in cluster 2 had lower all-cause and cancer mortality risks, with hazard ratios (95% confidence intervals [CIs]) of 0.67 (0.53, 0.85) and 0.45 (0.29, 0.71), respectively. CONCLUSIONS: The findings in this study indicated that high circulating vitamin D levels were associated with reduced mortality risk among U.S. adults. Vitamin co-exposure at moderate levels appropriately contributed to low all-cause and cancer mortality risks. Our findings provided a novel perspective for exploring the joint health effects of multivitamin co-exposure. Future investigations are needed to further unravel the underlying mechanisms of possible vitamin interactions.