The impact of the length of proximal margin on the prognosis in adenocarcinoma of gastroesophageal junction: A real-world study and strategies.

BACKGROUND: The optimal proximal margin (PM) length for Siewert II/III adenocarcinoma of the esophagogastric junction (AEJ) remains unclear. This study aimed to determine the optimal PM length using an abdominal approach to guide surgical decision-making. METHODS: A prospective study analyzed 304 consecutive patients diagnosed with Siewert II/III AEJ between January 2019 and December 2021. Total gastrectomy was performed via the abdominal approach, and PM length was measured on fixed gross specimens. X-Tile software determined the optimal PM cut-point based on progression-free survival (PFS). Univariate analyses compared baseline characteristics across PM groups, while survival analyses utilized Kaplan-Meier estimation and Cox proportional hazards regression for assessing the impact of margin length on survival. Multivariable analyses were conducted to adjust for confounding variables. RESULTS: The study included 264 AEJ cases classified as Siewert II (71.97%) or III (28.03%). The median gross PM length was 1.0 cm (IQR: 0.5 cm-1.5 cm, range: 0 cm-6 cm). PM length ≥1.2 cm was associated with a lower risk of disease progression compared to PM length 0.4 cm on PFS (HR = 0.41, 95% CI 0.20-0.84, P = 0.015). Moreover, PM ≥ 1.2 cm improved prognosis in subgroups of T4 or N3, tumor size <4 cm, Siewert II, and Lauren classification. CONCLUSIONS: For Siewert type II/III AEJ, a proximal margin length ≥1.2 cm (1.65 cm in situ) is associated with improved outcomes. These findings offer valuable insights into the association between PM length and outcomes in Siewert II/III AEJ, providing guidance for surgical approaches and aiding clinical decision-making to enhance patient outcomes.

Two chromosome-level genome assemblies of Rhodiola shed new light on genome evolution in rapid radiation and evolution of the biosynthetic pathway of salidroside.

Rhodiola L. is a genus that has undergone rapid radiation in the mid-Miocene and may represent a typic case of adaptive radiation. Many species of Rhodiola have also been widely used as an important adaptogen in traditional medicines for centuries. However, a lack of high-quality chromosome-level genomes hinders in-depth study of its evolution and biosynthetic pathway of secondary metabolites. Here, we assembled two chromosome-level genomes for two Rhodiola species with different chromosome number and sexual system. The assembled genome size of R. chrysanthemifolia (2n = 14; hermaphrodite) and R. kirilowii (2n = 22; dioecious) were of 402.67 and 653.62 Mb, respectively, with approximately 57.60% and 69.22% of transposable elements (TEs). The size difference between the two genomes was mostly due to proliferation of long terminal repeat-retrotransposons (LTR-RTs) in the R. kirilowii genome. Comparative genomic analysis revealed possible gene families responsible for high-altitude adaptation of Rhodiola, including a homolog of plant cysteine oxidase 2 gene of Arabidopsis thaliana (AtPCO2), which is part of the core molecular reaction to hypoxia and contributes to the stability of Group VII ethylene response factors (ERF-VII). We found extensive chromosome fusion/fission events and structural variations between the two genomes, which might have facilitated the initial rapid radiation of Rhodiola. We also identified candidate genes in the biosynthetic pathway of salidroside. Overall, our results provide important insights into genome evolution in plant rapid radiations, and possible roles of chromosome fusion/fission and structure variation played in rapid speciation.

Group V Chitin Deacetylases Influence the Structure and Composition of the Midgut of Beet Armyworm, Spodoptera exigua.

Chitin deacetylase (CDA) can accelerate the conversion of chitin to chitosan, influencing the mechanical properties and permeability of the cuticle structures and the peritrophic membrane (PM) in insects. Putative Group V CDAs SeCDA6/7/8/9 (SeCDAs) were identified and characterized from beet armyworm Spodoptera exigua larvae. The cDNAs of SeCDAs contained open reading frames of 1164 bp, 1137 bp, 1158 bp and 1152 bp, respectively. The deduced protein sequences showed that SeCDAs are synthesized as preproteins of 387, 378, 385 and 383 amino acid residues, respectively. It was revealed via spatiotemporal expression analysis that SeCDAs were more abundant in the anterior region of the midgut. The SeCDAs were down-regulated after treatment with 20-hydroxyecdysone (20E). After treatment with a juvenile hormone analog (JHA), the expression of SeCDA6 and SeCDA8 was down-regulated; in contrast, the expression of SeCDA7 and SeCDA9 was up-regulated. After silencing SeCDAV (the conserved sequences of Group V CDAs) via RNA interference (RNAi), the layer of intestinal wall cells in the midgut became more compact and more evenly distributed. The vesicles in the midgut were small and more fragmented or disappeared after SeCDAs were silenced. Additionally, the PM structure was scarce, and the chitin microfilament structure was loose and chaotic. It was indicated in all of the above results that Group V CDAs are essential for the growth and structuring of the intestinal wall cell layer in the midgut of S. exigua. Additionally, the midgut tissue and the PM structure and composition were affected by Group V CDAs.

Connexin43 hemichannels contribute to working memory and excitatory synaptic transmission of pyramidal neurons in the prefrontal cortex of rats.

The gap junction is essential for the communication between astrocytes and neurons by various connexins. Connexin43 hemichannels (Cx43 HCs), one of important subunits of gap junction protein, is highly expressed in astrocytes. It has been demonstrated that Cx43 HCs is involved in synaptic plasticity and learning and memory. However, whether the role of Cx43 HCs in the prefrontal cortex (PFC), a key brain region mediating cognitive and executive functions including working memory, still remains unclear. Here, we investigate that the role of Cx43 HCs in working memory through pharmacological inhibition of Cx43 HCs in the PFC. Gap26, a specific hemichannels blocker for Cx43 HCs, was bilaterally infused into the prelimbic (PrL) area of the PFC and then spatial working memory was examined in delayed alternation task in T-maze. Furthermore, the effect of Gap26 on synaptic transmission of prefrontal pyramidal neurons was examined using whole-cell patch recording in slice containing PFC. The demonstrate that inhibition of prefrontal cortex Cx43 HCs impairs the working memory and excitatory synaptic transmission of PFC neurons, suggesting that Cx43 HCs in the PFC contributes to working memory and excitatory synaptic transmission of neurons in rats.

RNA interference-mediated functional characterization of Group I chitin deacetylases in Holotrichia parallela Motschulsky.

Chitin deacetylases (CDAs, EC 3.5.1.41) catalyze the N-deacetylation of chitin to produce chitosan, which is essential for insect survival. Hence, CDAs are promising targets for the development of novel insecticidal drugs. In this study, the putative Group I chitin deacetylase genes HpCDA1, HpCDA2-1 and HpCDA2-2 were identified from Holotrichia parallela. Conserved domain database search identified a chitin-binding peritrophin-A domain (ChBD), a low-density lipoprotein receptor class A domain (LDLa), and a putative CDA-like catalytic domain. RT-qPCR analysis showed that the Group I HpCDAs were expressed in various tissues and predominant in the integument. The developmental expression patterns from the first-instar to third-instar larvae showed that HpCDAs were highly expressed on the first day and gradually declined after molting. The functional characteristics of the Group I CDAs in cuticle organization were examined using RNA interference (RNAi) and transmission electron microscopy (TEM) methods. Administration of double-stranded HpCDA (dsHpCDA) through larval injection could suppress the expression levels of HpCDA1 and HpCDA2, thus resulting in abnormal or lethal phenotypes. TEM analysis revealed that RNAi of either HpCDA1 or HpCDA2 remarkably affected the cuticle integrity, as evidenced by cuticle disorganization and chitin laminae disruption, suggesting the crucial role of CDAs in chitin modification. These experimental results demonstrate the important contribution of putative key genes involved in chitin metabolism, and provide a foundation for developing new strategies to control H. parallela.

Real-world data on the effectiveness and safety of interferon-alpha-2a intralesional injection for the treatment of focally recalcitrant mycosis fungoides.

BACKGROUND: Focally recalcitrant mycosis fungoides (MF) is challenging to treat. Despite interferon (IFN)-α intralesional injection having been tested in randomized controlled trials for the treatment of patch or early plaque lesions of MF, no real-world data regarding this therapy for focally recalcitrant MF has been reported. This study aimed to evaluate the effectiveness and safety of IFN-α-2a intralesional injection in focally recalcitrant MF. METHODS: Data on all cases of focally recalcitrant MF treated by IFN-α-2a intralesional injection in Peking Union Medical College Hospital from January 1, 2015 to December 31, 2019 were retrospectively retrieved. Based on clearance of injected lesions and the proportion of adverse events (AEs), the effectiveness and safety of the treatment were analyzed, respectively. RESULTS: Of the 15 patients included, 10 (66.7%) achieved complete response (CR), and 1 (6.7%) patient had partial response. The overall response rate was 73.3%. The clearance rate of lesions in the sun-exposed areas was significantly higher than that in the non-sun-exposed areas (P<0.01). The CR rate in patients with disease duration of less than 20 years was significantly higher than that in the patients with disease duration of at least 20 years (P<0.05). Four (26.7%) patients had stable disease (SD). The median event-free survival (EFS) was 4.0 months (95% CI, 1.8-6.1 months; range, 1-28+ months). There were no severe acute or chronic side effects. CONCLUSIONS: IFN-α-2a intralesional injection is an effective and safe treatment modality for the treatment of focally recalcitrant MF.

Efficacy of cognitive behavioural therapy with medication for patients with obsessive-compulsive disorder: A multicentre randomised controlled trial in China.

BACKGROUND: Meta-analyses support the efficacy of cognitive behavioural therapy (CBT) for obsessive-compulsive disorder (OCD) in Western cultures. However, there are no adequately powered multicentre studies in China. This study aimed to compare the effectiveness of treatment with CBT combined with medication and medication alone in OCD patients in China. METHODS: OCD patients (N = 167) were recruited from outpatient clinics at three large tertiary psychiatric hospitals and one general hospital in China. Participants were randomly allocated to receive either CBT combined with medication (n = 92) or medication alone (n = 75) for a 24-week treatment period. Participants' symptoms and social functioning were assessed using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Hamilton Anxiety Rating Scale (HAM-A), Global Assessment of Functioning (GAF) and Clinical Global Impression Scale for Severity (CGI-S) at 0, 4, 8, 12 and 24 weeks, and the effectiveness of the two treatments compared using linear mixed-effects models. RESULTS: At 24 weeks, both groups showed large within-group effects in all measures. Significantly more patients receiving combined therapy than medication alone had a decrease in symptom severity of at least 35% (based on Y-BOCS total score). The CGI-S and GAF scores decreased in both groups, and significant differences were found between the groups. LIMITATIONS: Study limitations included lack of consideration of medication types and dosages, and the absence of a CBT-only arm. CONCLUSIONS: CBT combined with medication may be effective in alleviating symptoms and social functioning impairment associated with OCD, and is more effective than medication alone in China, particularly for the treatment of compulsive behaviours.

Survey on the use of mental health services and help-seeking behaviors in a community population in Northwestern China.

There is little research into the patterns of mental health services use, related factors, and barriers in help-seeking behaviors among the community population in northwestern China. We conducted a community-based survey among the general population in Xi'an City with the stratified two-stage systematic selection scheme using the World Health Organization Composite International Diagnostic Interview version 3.0 computer-assisted personal interview (CIDI-CAPI 3.0). We interviewed 2447 individuals aged 16 years or older. The lifetime prevalence estimate of mental disorders was 21%. However, the lifetime use rate of mental health services of the 2447 responding subjects was 2.45% and 4.67% among those subjects who reported a mental disorder. Several variables were associated with lower use of mental health services: rural residence and divorced or unmarried. Among the group with mental disorders, 15/21 sought help from non-mental health specialty services such as a general physician (13/21). The high prevalence rate of mental disorders but low rate of mental health services use raises a significant public health issue in northwestern China. Reduction in the resource gap and encouraging people to seek treatment remain a challenge to the mental health services system.

A Cross-sectional Survey of Disability Attributed to Mental Disorders and Service Use in China.

BACKGROUND: Mental disorders are strongly associated with disabilities. National survey on disability could provide a reliable basis for policymaking in care and rehabilitation of disabled persons. This study aimed to describe the disability prevalence rates attributed to mental disorders, their distribution by sociodemographic factors, and utilizations of service. METHODS: This study is a secondary data analysis of the Second National Sample Survey on Disability in 2006. The disability and severity were assessed using the World Health Organization Disability Assessment Schedule 2.0. Mental disorders were diagnosed according to the International Statistical Classification of Diseases and Related Health Problems 10th Revision Classification of Mental and Behavioral Disorders. Using descriptive and analytic epidemiological methods, prevalence rates of disability attributed to mental disorders and service use were calculated. RESULTS: Data of 2,526,145 respondents were analyzed. The disability prevalence rate attributed to mental disorders in China was 6.3‰, accounting for 9.9% of all disabled people. Regarding disability prevalence attributed to mental disorders, it showed that gender, residential area, marital status, education level, and economic area were related to the prevalence distributions. The proportions of mild disability were highest in the disabled people with onset age of 18-64 years, while the proportion of extremely severe disability was highest in the disabled people with onset age of 65 years and above. Only 58.6% of disabled people attributed to mental disorders used some of the services. CONCLUSIONS: There are statistical differences of disability prevalence attributed to mental disorders by people and region in China. Service use in disabled people with mental disorders is insufficient.

ß-Aescin shows potent antiproliferative activity in osteosarcoma cells by inducing autophagy, ROS generation and mitochondrial membrane potential loss.

PURPOSE: Osteosarcoma is one of the frequent bone tumor affecting mainly children and is associated with considerable mortality. The limited availability of anticancer drugs and less efficacious treatment options have led to poor survival rates of patients with osteosarcoma. Therefore, there is need to look for more viable treatment options and against this backdrop, natural products may prove handy. Therefore the aim of the present study was to evaluate the anticancer activity of a natural product of plant origin, ß-aescin, against U2OS human osteosarcoma cells. METHODS: U205 human osteosarcoma cell line was used in this study. Antiproliferative activity was determined by MTT assay. Reactive oxygen species (ROS) and mitochondrial membrane potential (MMP) were evaluated by flow cytometry. Autophagy was detected by monodansylcadaverine (MDC) staining and immunofluorescence. Protein expression was examined by western blotting. RESULTS: The results indicated that ß-aescin showed significant anticancer activity against U2OS human osteosarcoma cells and exhibited an IC50 of 40 µM. ß-aescin treatment caused significant increase in ROS and decrease in the MMP. The anticancer effect of ß-aescin was found to be due mainly to autophagic cell death as evidenced from MDC staining and immunofluorescence. Moreover, ß-aescin caused significant increase in the expression levels of LC3- II protein in U2OS osteosarcoma cells in a time and dosedependent manner. CONCLUSION: Taken together we propose that ß-aescin may prove a lead molecule in the management of osteosarcoma and deserves further research efforts.

Distribution and Risk Factors of Disability Attributed to Personality Disorders: A National Cross-sectional Survey in China.

BACKGROUND: Personality disorders can lead to some disability. However, little is known about the disability prevalence and function impairments. This study aimed to describe the disability prevalence attributed to personality disorders, its distribution, impairments of daily activities and social functions, and risk factors in China. METHODS: Using a descriptive and analytic epidemiological method, data from the Second China National Sample Survey on Disability in 2006 were analyzed. The disability prevalence attributed to personality disorders, its distribution in different people and regions, and risk factors were statistically calculated. RESULTS: Respondents included 1,909,205 adults. The disability prevalence rate attributed to personality disorders in China was 5.9/100,000. The disability rate attributed to personality disorders of males was higher than that of females (P = 0.012), while the rate of the unemployed was higher than that of the employed (P < 0.001). Furthermore, the rates of unmarried/divorced/widowed people and the illiterate population were higher than those of married and educated people (P < 0.001). Regarding the severity of disability attributable to personality disorders, mild disability accounted for a majority or 60% of the respondents. The data showed that disability mainly impaired respondents' ability to engage in daily activities, get along with people, and participate in social situations. According to the case-control study, marriage, employment, and higher education were protective factors of disability. CONCLUSIONS: The prevalence of disability attributed to personality disorders is low in China and always leads to mild disability. The distribution of disability attributed to personality disorders also varies in the Chinese population.

Validity of Chinese Version of the Composite International Diagnostic Interview-3.0 in Psychiatric Settings.

BACKGROUND: The Composite International Diagnostic Interview-3.0 (CIDI-3.0) is a fully structured lay-administered diagnostic interview for the assessment of mental disorders according to ICD-10 and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria. The aim of the study was to investigate the concurrent validity of the Chinese CIDI in diagnosing mental disorders in psychiatric settings. METHODS: We recruited 208 participants, of whom 148 were patients from two psychiatric hospitals and 60 healthy people from communities. These participants were administered with CIDI by six trained lay interviewers and the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I, gold standard) by two psychiatrists. Agreement between CIDI and SCID-I was assessed with sensitivity, specificity, positive predictive value and negative predictive value. Individual-level CIDI-SCID diagnostic concordance was evaluated using the area under the receiver operator characteristic curve and Cohen's K. RESULTS: Substantial to excellent CIDI to SCID concordance was found for any substance use disorder (area under the receiver operator characteristic curve [AUC] = 0.926), any anxiety disorder (AUC = 0.807) and any mood disorder (AUC = 0.806). The concordance between the CIDI and the SCID for psychotic and eating disorders is moderate. However, for individual mental disorders, the CIDI-SCID concordance for bipolar disorders (AUC = 0.55) and anorexia nervosa (AUC = 0.50) was insufficient. CONCLUSIONS: Overall, the Chinese version of CIDI-3.0 has acceptable validity in diagnosing the substance use disorder, anxiety disorder and mood disorder among Chinese adult population. However, we should be cautious when using it for bipolar disorders and anorexia nervosa.

[Descriptive epidemiological study on disabilities attributed to non-dementia organic mental disorder in China].

OBJECTIVE: To describe the prevalence rates of disabilities attributed to non-dementia organic mental disorder and their demographic and regional distributions in China for supporting policy maker to prevent mental disabilities. METHODS: Using the data from the second China National Survey on Disability, the prevalence rates were statistically analysed. RESULTS: There were 1 200 people with non-dementia organic mental disabilities in 2 526 145 respondents, the point prevalence rate of disabilities attributed to non-dementia organic mental disorder was 0.475‰, ranking the third in all mental disabilities. Among the disabled, more male and more people with lower education level, being unemployed, divorced, widowed and unmarried were found. The decline of disability prevalence rates in different ethnic groups was found in the sequence of Uighur, Tibetan, Hui-Chinese (Muslims), Han-Chinese and Mongolian. The disability prevalence rates in Uighur and Tibetan were double higher than those in Han-Chinese and Hui-Chinese with statistical significances. The disability prevalence rates increased with age. Regarding the region distribution of non-dementia organic mental disabilities, the prevalence rate in western region was higher than that in eastern region. Among the eight economic regions, the prevalence rates in the underdeveloped southwest, south, northwest regions were significantly higher than those in the others. The proportions of extremely severe, severe, moderate, and mild disability were 36.8%, 17.0%, 14.3%, and 31.9%. The severest impairment on function of daily activities was found in the disabled. CONCLUSION: The proportion of non-dementia organic mental disabilities is relative high in all mental disabilities, therefore it should be focused for prevention and treatment. The disabled in males, with lower economic and education level, worse marital status, and being unemployed should receive more attention.

Psychological symptoms and associated risk factors in Chinese freshmen: a three-year follow-up study.

BACKGROUND: The first year of attending university induces a stressful experience for many college students. The experience exposes these students to challenging circumstances and raises expectations, which consequently increases the risk of psychiatric disorders and may exacerbate pre-existing problems. This study was designed to explore the risk factors of psychological symptoms among freshmen in China. METHODS: A three-year follow-up study was designed in a sample of Chinese college freshmen. To set up the baseline interviews, subjects from 25 high schools in Beijing were interviewed during the first year in high school. Three years later, we followed up with the 1547 students from 15 of the previously-selected 25 high schools after they had entered universities. Association between potential risk factors and the occurrence of psychological symptoms measured by the Symptoms Check List-90 was evaluated in unconditional logistic regression models with Wald test. RESULTS: Among the 1547 interviewed college freshmen in the study, 120 students (7.8%) manifested at least one psychological symptom. Personality dysfunction (OR = 3.655, 95% CI 1.967-6.793), parental rejection (OR = 2.619, 95% CI 1.544-4.442), age ≥ 20 (OR = 2.578, 95% CI 1.227-5.418), disfavored university (OR = 2.054, 95% CI 1.376-3.066), non-first-choice academic major (OR = 1.887, 95% CI 1.255-2.837) and no orientation (OR = 1.739, 95% CI 1.025-2.951) were determined to be the risk factors of psychological symptoms among the college freshmen in China. CONCLUSIONS: Psychological symptoms of college freshmen are associated with personality traits, parental rearing behavior and study environment. Therefore, it is important to pay attention to changes in mental health as students enter or decide on colleges and increase education geared towards mental health issues for students in high school and universities in China.

Poststroke depression and risk of recurrent stroke at 1 year in a Chinese cohort study.

BACKGROUND: Studies show that poststroke depression (PSD) increases mortality risk at 1 year. However, whether PSD increases the risk of recurrent stroke at 1 year remains unclear. This study was to investigate whether PSD at 2 weeks following a stroke could increase risk of recurrent stroke at 1 year. METHODS AND RESULTS: This was a multi-centered prospective cohort study. A total of 2306 patients with acute stroke were enrolled in our study. PSD was diagnosed according to the criteria set by the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV). The outcomes of recurrent stroke were followed up via face-to-face or phone interview. A total of 1713 patients had complete follow-up data, with 481 (28.1%) cases of PSD and 158 (9.2%) cases of cumulative recurrent stroke at 1 year. Multivariate logistic regression analysis showed a 49% increase of OR of recurrent stroke at 1 year in patients with PSD, compared to patients without PSD following a stroke (OR=1.49, 95%CI: 1.03-2.15). There was no significant correlation between anti-depressant drugs and the risk of recurrent stroke at 1 year following a stroke (OR=1.96, 95%: CI 0.95-4.04). CONCLUSIONS: Based on the DSM-IV diagnostic criteria, nearly 3 out of 10 hospitalized stroke patients in China were diagnosed with PSD at 2 weeks following a stroke. PSD is associated with a higher risk of recurrent stroke at 1 year. Our study did not find benefit of anti-depressant drugs in reducing such risk.

Time course of depression and one-year prognosis of patients with stroke in mainland China.

AIMS: To investigate the incidence of depression at different time points within the first year after stroke in mainland China and to identify risk factors related to a poor 1-year prognosis in stroke patients. METHODS: Subjects with acute cerebrovascular diseases were recruited and enrolled from 56 hospitals in mainland China between April 2008 and April 2010. Demographic data, previous disease history, and clinical data were collected. Four follow-up visits were occurred within the first year after stroke. The modified Rankin Scale ≥ 2 represents an unfavorable prognosis. Depression was diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition and was divided into persistent, recurrent and transient types. RESULTS: The 1-year cumulative incidence of depression in stroke patients was 41.8%. Logistic regression analysis showed that the 1-year prognosis level was associated with age, disability before onset, neurological functional deficit level at admission, and a range of depression types. The odds ratio for persistent depression is the highest (OR = 7.615, P < 0.0001, 95% confidence interval 5.011-11.572). CONCLUSIONS: In our study, depression occurred in >40% of patients within the first year after stroke. Persistent depression is the first independent determinant of prognosis during the first year after stroke.

Perceived barriers to mental health treatment in metropolitan China.

OBJECTIVES: This community-based study examined perceived barriers to the initiation of mental health treatment among individuals with anxiety, mood, and alcohol use disorders. METHODS: Face-to-face interviews were conducted with 5,201 respondents in Beijing and Shanghai using the World Mental Health Composite International Diagnostic Interview. Perceived barriers to initiating treatment from various health practitioners were examined among 211 individuals who met criteria for 12-month DSM-IV disorders and did not receive treatment. RESULTS: Most respondents (92%) with DSM-IV disorders perceived a low need for treatment. Among respondents who perceived a need, 47% reported structural barriers and 83% reported attitudinal barriers. Respondents who had severe mental disorders and perceived a need reported more structural barriers (72%) than attitudinal barriers (65%). Lack of knowledge about service availability was the most common structural barrier. CONCLUSIONS: Future studies should examine the reasons for perceived low need for treatment and other treatment barriers among people with mental disorders.

Individual and societal impact on earnings associated with serious mental illness in metropolitan China.

To evaluate individual-level and societal-level losses of income associated with serious mental illness in metropolitan China, a multi-stage probability survey was administered to adults aged 18-70 years in Beijing and Shanghai. We used data to estimate individual-level expected earnings from a model that included information about the respondents' education level, marital status, age, and gender. Expected earnings were compared to observed earnings among respondents with mental illness and serious disability. The result shows that the 12-month prevalence of such serious mental illness was 0.6%. Its impact on earnings was significant in the total sample and was higher for males (76% of gender-specific expected salary was lost) than for females (32%). When projected to societal level, the annual impact was estimated to be 466 million Renminbi (RMB 8.27=USD 1), less than 0.2% of the gross domestic product (GDP) of the two cities. Serious mental illness was associated with a substantial decrease in individual-level earnings, but the burden that resulted from societal-level loss of earnings was not large enough to help drive mental health policy and programs in China.

Impaired role functioning and treatment rates for mental disorders and chronic physical disorders in metropolitan China.

OBJECTIVES: To compare impairments in role functioning and treatment rate of mental disorders and chronic physical disorders in the general population of metropolitan China. METHOD: Face-to-face household interviews of 5201 people aged 18 to 70 years in Beijing and Shanghai were conducted from November 2001 to February 2002, using a multistage household probability sampling method. The World Mental Health version of the Composite International Diagnostic Interview (WMH-CIDI) was used for assessing sociodemographic characteristics, diagnoses, and treatment. The Sheehan Disability Scale (SDS) was used to measure disorder-specific role impairment. RESULTS: Respondents generally attributed greater impairment to mental disorders than to chronic physical disorders, although there were some variations among specific disorders. This general pattern was supported by within-person comparison of impairment associated with a mental disorder versus any chronic physical disorder. Depression, generalized anxiety disorder, and specific phobia were the most impairing mental disorders. Diabetes, headaches, and asthma were the most impairing physical disorders. Comorbid mental and physical disorders were associated with more severe impairment. A much lower percentage of respondents with mental disorders (3.0%) than chronic physical disorders (42.8%) received treatment in the previous 12 months. CONCLUSION: Common mental disorders were associated with greater impairment than chronic physical disorders but were markedly undertreated. They warrant prioritization in the allocation of healthcare resources in China.

Associations of cohort and socio-demographic correlates with transitions from alcohol use to disorders and remission in metropolitan China.

AIMS: To examine socio-demographic associations of transitions from alcohol use to disorders and of remission from disorders in metropolitan China. DESIGN AND SETTING: Face-to-face interviewing by trained lay-interviewers on a multi-staged, clustered sample from the general population of Beijing and Shanghai, China. PARTICIPANTS: A total of 5201 adults aged 18-70 years and with household registration. MEASUREMENTS: World Mental Health version of Composite International Diagnostic Interview. FINDINGS: Lifetime prevalence estimates for alcohol use, regular use (at least 12 drinks in a year), DSM-IV abuse and dependence with abuse were 65.4%, 39.5% (60.4% of ever-drinkers), 4.6% (11.6% of regular users) and 0.9% (20.4% of lifetime alcohol abusers), respectively. These estimates were higher among respondents from the recent cohort; 64.3% and 36.9% respondents with a history of lifetime abuse and dependence respectively had remitted. The number of socio-demographic associations for the onset of each transitional stage decreased from alcohol use to alcohol dependence. Onset of ever-use was more common in respondents who were male, 18-50 years of age, with middle education level and never married, but less common among the previously married and students. First onset of regular use among those with ever-use was more common in respondents who were male, less than 50 years of age and never married, but less common in students. Being male and less than 50 years of age was associated with more alcohol abusers among regular users. CONCLUSION: This study was the first to reveal in a Chinese population that qualitatively different risk factors might operate during the different stages of progression from alcohol use to disorders. Further research is needed to clarify the mechanisms underlying these differences in order to guide prevention programmes.