Three-year follow-up study reveals improved survival rate in NSCLC patients underwent guideline-concordant diagnosis and treatment.

Background: No studies in China have assessed the guideline-concordance level of the first-course of non-small cell lung cancer (NSCLC) diagnosis and treatment and its relationship with survival. This study comprehensively assesses the current status of guideline-concordant diagnosis (GCD) and guideline-concordant treatment (GCT) of NSCLC in China and explores its impact on survival. Methods: First course diagnosis and treatment data for NSCLC patients in Liaoning, China in 2017 and 2018 (n=1828) were used and classified by whether they underwent GCD and GCT according to Chinese Society of Clinical Oncology (CSCO) guidelines. Pearson's chi-squared test was used to determine unadjusted associations between categorical variables of interest. Logistic models were constructed to identify variables associated with GCD and GCT. Kaplan-Meier analysis and log-rank tests were used to estimate and compare 3-year survival rates. Multivariate Cox proportional risk models were constructed to assess the risk of cancer mortality associated with guideline-concordant diagnosis and treatment. Results: Of the 1828 patients we studied, 48.1% underwent GCD, and 70.1% underwent GCT. The proportions of patients who underwent both GCD and GCT, GCD alone, GCT alone and neither GCD nor GCT were 36.7%, 11.4%, 33.5% and 18.4%, respectively. Patients in advanced stage and non-oncology hospitals were significantly less likely to undergo GCD and GCT. Compared with those who underwent neither GCD nor GCT, patients who underwent both GCD and GCT, GCD alone and GCT alone had 35.2%, 26.7% and 35.7% higher 3-year survival rates; the adjusted lung cancer mortality risk significantly decreased by 29% (adjusted hazard ratio[aHR], 0.71; 95% CI, 0.53-0.95), 29% (aHR, 0.71; 95% CI, 0.50-1.00) and 32% (aHR, 0.68; 95% CI, 0.51-0.90). Conclusion: The 3-year risk of death is expected to be reduced by 29% if patients with NSCLC undergo both GCD and GCT. There is a need to establish an oncology diagnosis and treatment data management platform in China to monitor, evaluate, and promote the use of clinical practice guidelines in healthcare settings.

Cross-sectional study of the association between burnout and work overload and work-life imbalance among medical personnel in Liaoning, China: role of specialty.

OBJECTIVES: Burnout is common among medical personnel in China and may be related to excessive and persistent work-related stressors by different specialties. The aims of this study were to assess the prevalence of burnout, work overload and work-life imbalance according to different specialties and to explore the effect of specialty, work overload and work-life imbalance on burnout among medical personnel. DESIGN: A cross-sectional study. SETTING: This study was conducted in 1 tertiary general public hospital, 2 secondary general hospitals and 10 community health service stations in Liaoning, China. PARTICIPANTS: A total of 3299 medical personnel participated in the study. METHODS: We used the 15-item Chinese version of the Maslach Burnout Inventory General Survey (MBI-GS) to measure burnout. Multivariable logistic regression models were used to explore the association between medical specialty, work overload, work-life imbalance and burnout. RESULTS: 3299 medical personnel were included in this study. The prevalence of burnout, severe burnout, work overload and work-life imbalance were 88.7%, 13.6%, 23.4% and 23.2%, respectively. Compared with medical personnel in internal medicine, working in obstetrics and gynaecology (OR=0.61, 95% CI 0.38, 0.99) and management (OR=0.45, 95% CI 0.28, 0.72) was significantly associated with burnout, and working in ICU （Intensive Care Unit）(OR=2.48, 95% CI 1.07, 5.73), surgery (OR=1.66, 95% CI 1.18, 2.35) and paediatrics (OR=0.24, 95% CI 0.07, 0.81) was significantly associated with severe burnout. Work overload and work-life imbalance were associated with higher ORs for burnout (OR=1.64, 95% CI 1.16, 2.32; OR=2.79, 95% CI 1.84, 4.24) and severe burnout (OR=4.33, 95% CI 3.43, 5.46; OR=3.35, 95% CI 2.64, 4.24). CONCLUSIONS: Burnout, work overload and work-life imbalance were prevalent among Chinese medical personnel but varied considerably by clinical specialty. Burnout may be reduced by decreasing work overload and promoting work-life balance across different specialties.

Disease burden of mental disorders among children and adolescents considering both co-morbidities and suicide in Northeastern China.

BACKGROUND: Few studies have assessed the burden of mental disorders among children and adolescents considering the impact of co-morbidities and suicide on disability adjusted life years (DALYs). METHODS: This was a multicenter cross-sectional study. Our survey data in Liaoning Province (LN) were used to estimate the burden of six mental disorders, supplemented with data from other investigative studies conducted in China to assess four other disorders. DALYs were derived from the sum of years lived with a disability (YLDs) adjusted for co-morbidities, and the years of life lost (YLLs) adjusted for suicide. The changes in DALYs, YLDs, and YLLs were compared with and without adjustment for co-morbidities and suicide. RESULTS: The DALYs rate of mental disorders among children and adolescents in LN decreased from 1579.6/105 to 1391.4/105, after adjusting for both co-morbidities and suicide (-11.9%). The DALYs rate for major depression, anxiety disorder, and conduct disorder (-80.8/105, -75.0/105 and -30.2/105, respectively) were the top three contributors to the DALYs reduction (-188.2/105). The YLDs decreased from 72724.8 to 62478.5 after co-morbidity adjustment (-17.8%), mainly due to the reduction by major depression (-35.3%) and attention deficit/hyperactivity disorder [ADHD] (-34.2%). The YLLs increased from 130 to 1697.8 after adjusting for suicides (+ 56.9% of all suicide YLLs), mainly due to the contribution of major depression (+ 32.4%) and anxiety disorder (+ 10.4%). Compared to GBD 2010, the estimated DALY rate for mental disorders in LN was to be about 80%, with the proportion of DALYs and DALY rates explained by major depressive disorder accounted for only approximately one-third (14.6% vs. 41.9% and 202.6 vs. 759.9, respectively). But the proportion and absolute level of DALY rates explained by anxiety disorders were approximately 2-fold higher (39.7% vs. 19.6% and 552.2 vs. 323.3, respectively). CONCLUSIONS: The DALYs of mental disorders among Chinese children and adolescents were approximately 80% of the global level, with anxiety disorders imposing about 2 times the global level. Co-morbidity and suicide must be adjusted when calculating DALYs.

Survival differences between the USA and an urban population from China for all cancer types and 20 individual cancers: a population-based study.

Background: The systematic comparison of cancer survival between China and the USA is rare. Here we aimed to assess the magnitude of survival disparities and disentangle the impact of the stage at diagnosis between a Chinese metropolitan city and the USA on cancer survival. Methods: We included 11,046 newly diagnosed cancer patients in Dalian Cancer Registry, China, 2015, with the follow-up data for vital status until December 2020. We estimated age-standardised 5-year relative survival and quantified the excess hazard ratio (EHR) of death using generalised linear models for all cancers and 20 individual cancers. We compared these estimates with 17 cancer registries' data from the USA, using the Surveillance, Epidemiology, and End Results database. We further estimated the stage-specific survival for five major cancers by region. Findings: Age-standardised 5-year relative survival for all patients in Dalian was lower than that in the USA (49.9% vs 67.9%). By cancer types, twelve cancers with poorer prognosis were observed in Dalian compared to the USA, with the largest gap seen in prostate cancer (Dalian: 55.8% vs USA: 96.0%). However, Dalian had a better survival for lung cancer, cervical cancer, and bladder cancer. Dalian patients had a lower percentage of stage Ⅰ colorectal cancer (Dalian: 17.9% vs USA: 24.2%) and female breast cancer (Dalian: 40.9% vs USA: 48.9%). However, we observed better stage-specific survival among stage Ⅰ-Ⅱ lung cancer patients in Dalian than in the USA. Interpretation: This study suggests that although the overall prognosis for patients was better in the USA than in Dalian, China, survival deficits existed in both countries. Improvement in cancer early detection and cancer care are needed in both countries. Funding: National Key R&D Program (2021YFC2501900, 2022YFC3600805), Major State Basic Innovation Program of the Chinese Academy of Medical Sciences (2021-I2M-1-010, 2021-I2M-1-046), and Talent Incentive Program of Cancer Hospital of Chinese Academy of Medical Sciences.

Betulinic acid in the treatment of breast cancer: Application and mechanism progress.

Betulinic acid (BA) is a pentacyclic triterpene compound, which can be obtained by separation, chemical synthesis and biotransformation. BA has excellent biological activities, especially its role in the treatment of breast cancer deserves attention. Its mechanisms mainly include inducing mitochondrial oxidative stress, regulating specific protein (Sp) transcription factors, inhibiting breast cancer metastasis, inhibiting glucose metabolism and NF-κB pathway. In addition, BA can also increase the sensitivity of breast cancer cells to other chemotherapy drugs such as paclitaxel and reduce its toxic side effects. This article reviews the application and possible mechanism of BA in the treatment of breast cancer.

Positive correlation between snoring and dyslipidemia in adults: results from NHANES.

BACKGROUND: A few studies have shown that snoring, in certain populations, is associated with dyslipidemia. However, there are currently no large-scale national studies available that explore this association. Thus, for further clarification, studies using a large sample of the general population need to be conducted. This study aimed to explore this association using the National Health and Nutrition Examination Survey (NHANES) database. METHODS: A cross-sectional survey was conducted using data from the NHANES database; 2005 to 2008 and 2015 to 2018 datasets were used (weighted to be representative of United States adults aged ≥ 20 years). Information on snoring status, lipid levels, and confounding factors were included. Logistic regression of the generalized linear model was used to analyze the relationship between snoring and dyslipidemia, and hierarchical analysis, interaction analysis, and sensitivity analysis were used to explore the stability of the results. RESULTS: Data from 28,687 participants were analyzed, and 67% of the participants had some degree of snoring. The fully adjusted multivariate logistic regression results demonstrated that snoring frequency was significantly positively associated with dyslipidemia (P < 0.001 for linear trend). Adjusted odds ratios (aORs) of dyslipidemia among those who snored rarely, occasionally, and frequently were 1.1 (95% confidence interval [CI], 1.02-1.18), 1.23 (95% CI, 1.10-1.38), and 1.43 (95% CI, 1.29-1.58), respectively, compared with that among those who never snored. In addition, age and snoring frequency showed a correlation (P = 0.02). Sensitivity analysis demonstrated that frequent snoring was significantly associated with lipid levels (all P ≤ 0.01 for linear trend), including increased low-density lipoprotein cholesterol (LDL-C) (ß = 0.09 mmol/L; 95% CI, 0.02-0.16), triglyceride (TG) (ß = 0.18 mmol/L; 95% CI, 0.10-0.26), total cholesterol (TC) (ß = 0.11 mmol/L; 95% CI, 0.05-0.16), and decreased high-density lipoprotein cholesterol (HDL-C) (ß=-0.04 mmol/L; 95% CI, -0.06--0.03). CONCLUSIONS: A statistically significant positive association was identified between sleep snoring and dyslipidemia. It was suggested that sleep snoring interventions may reduce the risk of dyslipidemia.

Use of honokiol in lung cancer therapy: a mini review of its pharmacological mechanism.

Honokiol (3',5-di-(2-propenyl)-1,1'-biphenyl-2,2'-diol) is a biologically active natural product derived from Magnolia and has been shown to have excellent biological activities. This paper discusses research progress on the use of honokiol in the treatment of lung cancer, as studies have confirmed that honokiol can exert anti-lung-cancer effects through multiple pathways and multiple signaling pathways, such as inhibiting angiogenesis, affecting mitochondrial function and apoptosis, regulating of autophagy and epithelial-mesenchymal transition (EMT). In addition, honokiol combined with other chemotherapy drugs is also a way in which it can be applied.

Current status of premature mortality from four non-communicable diseases and progress towards the Sustainable Development Goal target 3.4: a population-based study in northeast China, 2004-2017.

BACKGROUND AND AIM: According to the United Nations' Sustainable Development Goal (SDG) target 3.4, premature mortality from four non-communicable diseases (cardiovascular diseases, cancer, chronic respiratory diseases, and diabetes mellitus, collectively referred to as NCD4) should achieve a minimum decline of 33% in 2030 relative to 2015. This remains a challenge for China. This study aimed to evaluate the current status and progress towards this target in Liaoning Province, one of the three provinces in northeast China. METHODS: We calculated the premature mortality rates (PMRs) per year and average annual percentage changes (AAPCs) from NCD4 using mortality data between 2004 and 2017. The trend was analyzed in the whole population, as well as in subpopulations of gender (male/female) and inhabiting area (urban/rural). PMRs from NCD4 for 2030 were projected by fitting a linear regression based on the current trend, which was identified by a Joinpoint model. FINDINGS: In the whole population, only chronic respiratory diseases showed a significant decline (AAPC: - 6.5%, p < 0.05), while only cancer showed a significant increase (AAPC: + 1.3%, p < 0.05); taken together, NCD4 showed a significant increase (AAPC: + 0.6%, p < 0.05). In the subpopulations, while males showed a significant increase in NCD4 (AAPC: + 1.5%, p < 0.05), cardiovascular diseases (AAPC: + 1.7%, p < 0.05), cancer (AAPC: + 1.8%, p < 0.05), and diabetes mellitus (AAPC: + 4.2%, p < 0.05), females showed a significant decline in NCD4 (AAPC: - 1.2%, p < 0.05), cardiovascular diseases (AAPC: - 1.8%, p < 0.05), diabetes mellitus (AAPC: - 2.1%, p < 0.05), but showed a mild increase in cancer (AAPC: + 0.5%, p > 0.05). A comparative analysis of the projected PMRs for 2030 with the 2015 levels revealed that only chronic respiratory diseases are expected to achieve the SDG target 3.4, apart from in the urban male subpopulation. CONCLUSION: Except for chronic respiratory diseases, NCD4 cannot be expected to achieve the SDG target 3.4 in the whole population of Liaoning Province. Under these circumstances, special attention should be paid to reducing the risks of cancer and providing preventative interventions for men.

Combined Effects of Mother's, Father's and Teacher's Psychological Distress on Schoolchildren's Mental Health Symptoms.

PURPOSE: Few studies have assessed the individual and joint effects of the mother's, father's and teacher's mental health symptoms on schoolchildren's behavior and emotional well-being simultaneously in the same study. PATIENTS AND METHODS: A cross-sectional survey was conducted among 8488 Chinese schoolchildren aged 6-17 years in northeast China. The Strengths and Difficulties Questionnaire (SDQ) and General Health Questionnaire (GHQ) were used to measure the mental health of the students, their parents and the teacher in charge of the class, respectively. A total of 6173 students (72.73%) with full mental health information from all three caretakers were included in the final analysis. RESULTS: We found a significantly elevated risk of mental health symptoms in children when their mothers (odds ratios (OR)=2.30, 95% CI=1.93-2.73), fathers (OR=2.08, 95% CI=1.73-2.50) and teachers (OR=1.18, 95% CI=1.01-1.39) reported poorer mental health, and the risk increased significantly with the number of the caretakers with mental symptoms. A father with poor mental health has both direct and indirect effects on a child's emotional health, by worsening the influence of a mother's poor mental health. CONCLUSION: All three caretakers have a significant negative influence on schoolchildren's emotional well-being, in the order of mother > father > teacher. It is desirable to assess and manage students' mental health in the both the family and school contexts.

Prevalence of mental health problems in Chinese schoolchildren: The influence of measuring impact score and combining information from multiple informants.

BACKGROUND: To measure the effects of using different combinations of multiple informants and the impact score on the estimated prevalence of mental health problems in Chinese schoolchildren. METHODS: Complete information on the Strengths and Difficulties Questionnaire (SDQ) were obtained from students (S), parents (P), and teachers (T) for 4986 schoolchildren (11-17 years-old). We used 3 criteria to determine the prevalence of mental health problems: SDQ cut-off value (previously established in the United Kingdom), SDQ cut-off value plus an impact score of 1 or more, or plus an impact score of 2 or more. A student was defined as having a mental health problem if any informant (S, P, or T) classified the child as 'abnormal'. We compared the prevalence of mental health problems determined from 1 informant, 2 informants, and 3 informants. RESULTS: The prevalence of overall mental health problems increased with rising number of informants, but decreased with increasing impact score. When the impact score was not considered, the prevalence was 8.2% to 14.2% when rated by 1 informant, 18.8% to 24.7% when rated by 2 informants, and 28.3% when rated by all 3 informants. Failure to measure the impact score led to a two to threefold greater estimate of the prevalence of mental health problems. CONCLUSIONS: The types, number, and combinations of multiple informants and use of the impact score must be considered when comparing the results of different studies. It is preferable to use multiple informants and have the impact score taken the impact into account to reflect the real burden of mental health burden in children and adolescent.

Current heterosexual marriage is associated with significantly decreased levels of anxiety symptoms among Chinese men who have sex with men.

BACKGROUND: The high heterosexual marriage rate could be a 'double-edge' sword for the emotional health of Chinese men who have sex with men (MSM). The aim of this study was to determine if current marriage and breakdown of marriage (divorce) have different effects on the mental health of Chinese MSM. METHODS: Eight hundred seven MSM were recruited using respondent-driven sampling from four cities in northeastern China. Gay-related stressful events (GRSE) were measured using the Gay Related Stressful Life Events Scale; social support was measured by the Social Support Rating Scale (SSRS); and depressive and anxiety symptoms were assessed using the Self-Rating Depression Scale (SDS) and Self-Rating Anxiety Scale (SAS), respectively. RESULTS: Of the study participants, 13.4% were married to women and 4.5% were divorced. The rates of marriage or divorce were 35.3 and 75.8% for participants 30-39 and > 40 years of age, respectively. The current married MSM had the highest SDS (50.0 ± 10.9) and SSRS (35.8 ± 8.6) levels, but the lowest SAS (38.7 ± 12.1) levels. Divorced MSM had the highest SAS (44.4 ± 9.6) and lowest SSRS (30.8 ± 8.1) levels. Age, GESE number, and HIV infection were predictors for SDS and SAS, and current marriage was associated with significantly decreased level of SAS (ß = - 0.136, P = 0.001) based on multiple linear analysis. CONCLUSIONS: Current marriage is associated with significantly decreased levels of anxiety symptoms among Chinese MSM. More studies are needed to understand the mechanisms underlying the effects of different marriage status on the emotional distress of Chinese MSM.

Changing cancer survival in China during 2003-15: a pooled analysis of 17 population-based cancer registries.

BACKGROUND: From 2003 to 2005, standardised 5-year cancer survival in China was much lower than in developed countries and varied substantially by geographical area. Monitoring population-level cancer survival is crucial to the understanding of the overall effectiveness of cancer care. We therefore aimed to investigate survival statistics for people with cancer in China between 2003 and 2015. METHODS: We used population-based data from 17 cancer registries in China. Data for the study population was submitted by the end of July 31, 2016, with follow-up data on vital status obtained on Dec 31, 2015. We used anonymised, individual cancer registration records of patients (aged 0-99 years) diagnosed with primary, invasive cancers from 2003 to 2013. Patients eligible for inclusion had data for demographic characteristics, date of diagnosis, anatomical site, morphology, behaviour code, vital status, and last date of contact. We analysed 5-year relative survival by sex, age, and geographical area, for all cancers combined and 26 different cancer types, between 2003 and 2015. We stratified survival estimates by calendar period (2003-05, 2006-08, 2009-11, and 2012-15). FINDINGS: There were 678 842 records of patients with invasive cancer who were diagnosed between 2003 and 2013. Of these records, 659 732 (97·2%) were eligible for inclusion in the final analyses. From 2003-05 to 2012-15, age-standardised 5-year relative survival increased substantially for all cancers combined, for both male and female patients, from 30·9% (95% CI 30·6-31·2) to 40·5% (40·3-40·7). Age-standardised 5-year relative survival also increased for most cancer types, including cancers of the uterus (average change per calendar period 5·5% [95% CI 2·5-8·5]), thyroid (5·4% [3·2-7·6]), cervix (4·5% [2·9-6·2]), and bone (3·2% [2·1-4·4]). In 2012-15, age-standardised 5-year survival for all patients with cancer was higher in urban areas (46·7%, 95% CI 46·5-47·0) than in rural areas (33·6%, 33·3-33·9), except for patients with oesophageal or cervical cancer; but improvements in survival were greater for patients residing in rural areas than in urban areas. Relative survival decreased with increasing age. The increasing trends in survival were consistent with the upward trends of medical expenditure of the country during the period studied. INTERPRETATION: There was a marked overall increase in cancer survival from 2003 to 2015 in the population covered by these cancer registries in China, possibly reflecting advances in the quality of cancer care in these areas. The survival gap between urban and rural areas narrowed over time, although geographical differences in cancer survival remained. Insight into these trends will help prioritise areas that need increased cancer care. FUNDING: National Key R&D Program of China, PUMC Youth Fund and the Fundamental Research Funds for the Central Universities, and Major State Basic Innovation Program of the Chinese Academy of Medical Sciences.

Association of recent gay-related stressful events and emotional distress with suicidal behaviors over 12 months in Chinese men who have sex with men.

INTRODUCTION: The study was designed to assess the association of gay-related stressful events (GRSEs) and emotional distress with suicidal behaviors over a 12-month period in Chinese men who have sex with men (MSM). METHODS: A total of 807 MSM were recruited using a respondent-driven sampling method from 4 cities in northeastern China. The GRSEs were measured using the Gay-related Stressful Life Events Scale, depression using the Self-rating Depression Scale, and anxiety using the Self-rating Anxiety Scale. RESULTS: A total of 26.0% of study participants experienced GRSEs during the 3 months, and their average Self-rating Depression Scale and Self-rating Anxiety Scale scores were significantly lower than the national norms. Over a 12-month period, the prevalence of suicidal ideation, plan, and attempt was 9.7%, 4.0%, and 3.0%, respectively, each of which is at least 3 to 4 times greater than that of male adults in the general population of China. Multiple logistic regression analysis showed that GRSEs significantly increased the risk of suicidal ideation (odds ratio [OR] = 2.3, 95% confidence interval [CI], 1.4-3.7) and plan (OR = 2.8, 95% CI, 1.3-6.0). Depressive symptoms significantly increased the risk of suicidal ideation (OR = 3.5, 95% CI, 2.1-5.8), plan (OR = 4.4, 95% CI, 2.0-9.6), and attempt (OR = 5.6, 95% CI, 21.94.8). Anxiety symptoms (OR = 3.4, 95% CI, 1.4-8.4) and cohabitation with a same sex partner (OR = 3.0, 95% CI, 1.2-7.9) significantly increased the risk of suicide attempt. DISCUSSION: More efforts to reduce GRSE are worth investigating as a strategy to reduce suicidal thoughts and behaviors in Chinese MSM.

Survival of Cancer Patients in Northeast China: Analysis of Sampled Cancers from Population-Based Cancer Registries.

PURPOSE: The cancer survival was characterized by following up sampled subgroups of cancer cases from three population-based cancer registries in Northeast China. MATERIALS AND METHODS: Survival analysis was used to analyze 6,871 patients, who had one of the 21 most common cancers based on sampling from the population-based cancer registries of three cities in Liaoning Province. All patients were diagnosed between 2000 and 2002 and were followed up to the end of 2007 by active and passive methods. The 5-year age standardized relative survival rates (ASRS) were estimated for all cancers combined and each of the 21 individual cancers. RESULTS: The survival status was traced for 80.8% of 8,506 sampled cancer cases. The 5-year ASRS for all 21 cancers combined was 41.5% (95% confidence interval, 40.3 to 42.7), the highest ASRS was observed for thyroid cancer (85.2%), breast cancer (78.9%), uterine corpus cancer (75.9%), and urinary bladder cancer (70.2%); the lowest 5-year ASRS was noted in pancreatic cancer (8.8%), liver cancer (11.0%), esophageal cancer (18.8), and lung cancer (19.6%). The cancer survival rates in Liaoning cities were similar to those of urban areas in mainland China, but significantly lower than those in Hong Kong, Korea, and Japan. CONCLUSION: The strikingly poor cancer survival rates in three cities of Liaoning Province and in other places in China highlight the need for urgent investment in cancer prevention, early detection, and standardized and centralized treatment.

Prevalence and risk factors for lifetime suicide ideation, plan and attempt in Chinese men who have sex with men.

BACKGROUND: To describe the level and risk factors for suicidal behaviors in Chinese men who have sex with men (MSM). METHODS: A total of 807 MSM were recruited using a respondent-driven sampling method from Anshan, Benxi, Dandong, and Shenyang cities in northeastern China. RESULTS: Chinese MSM had lifetime prevalences of suicide ideation (18.3%), plan (8.7%) and attempt (4.6%) that were about 2.8, 5.8 and 5.8 times greater than that of male adults in the general population of China. The MSM with any psychiatric disorders were 4-7 times more likely to think about, plan or attempt suicide than those MSM with no disorder, and there was a clear relationship between the number of comorbid disorders and suicidal behaviors. Multiple regression analysis showed that major depression, bipolar disorder, dysthymia and alcohol use disorder significantly increased the risk for suicide ideation, but not for suicide attempt. Drug dependence disorder, panic disorder and generalized anxiety disorder significantly increased the risk for suicide attempt, but not for suicide ideation. More advanced education reduced the risk of suicidal behaviors, sexual orientations revealed to or discovered by family members or friends significantly increased risk of these suicidal behaviors. CONCLUSIONS: Chinese MSM have significantly increased risk for suicidal behaviors, mental disorders and their comorbidities could be the largest risk factors for the elevated suicidal behaviors in Chinese MSM. Reducing the family and social stigma and rejection of homosexual behavior and early detection and effective treatment of psychiatric disorders and their comorbidities in MSM may help to decrease suicidal behaviors of Chinese MSM.

Shape of concentration-response curves between long-term particulate matter exposure and morbidities of chronic bronchitis: a review of epidemiological evidence.

Numerous studies have assessed the concentration-response (C-R) relationships between long-term exposure to particulate matter (PM) and mortality from cardiopulmonary diseases, but few studies have evaluated the C-R relationships between PM exposure and morbidity of chronic respiratory diseases or their symptoms, and to date no systematic review has been published on the characteristics of the C-R curves between PM exposure and respiratory disease morbidity. Screening of all available studies in Medline identified ten studies with figures or scatter plots showing the C-R relationships between PM exposure and chronic bronchitis or chronic cough/phlegm. The C-R relationships showed ballistic 'S' shaped curves, linear in the low to moderate PM range and flattening out in the high PM range. Moreover, the shape and level of the C-R curves differed markedly between susceptible and nonsusceptible populations. New evidence from a prospective cohort study confirmed that the C-R relationship between PM reduction and beneficial effects on respiratory health may be due to the decreased incidence of respiratory symptoms and increased recovery in individuals with symptoms of bronchitis. Additional studies are needed to assess the C-R relationships between different PM contents and chronic health parameters, especially in geographic areas with high PM pollution and in more susceptible populations. Evidence from prospective cohort studies in developing countries with areas of high PM pollution may help evaluate the burden of chronic respiratory disease attributable to PM pollution and air quality standards.

Elevated 12-month and lifetime prevalence and comorbidity rates of mood, anxiety, and alcohol use disorders in Chinese men who have sex with men.

BACKGROUND: This study aimed to assess whether Chinese men who have sex with men (MSM) had a significantly elevated prevalence of psychiatric disorders compared to urban males in China. METHODS: 807 MSM were recruited using a respondent-driven sampling (RDS) method in urban area of northeast China. Psychiatric disorders were assessed employing the Composite International Diagnostic Interview (CIDI. Version 1.0) according to the criteria of the DSM-III-R. RESULTS: Chinese MSM had a significantly elevated standardized prevalence ratios (SPR) for lifetime prevalence of any disorder (SPR = 2.8; 95%CI: 2.5-3.2), mood disorder (SPR = 3.0; 95%CI: 2.3-3.7), anxiety disorder (SPR = 5.5; 95% CI: 4.6-6.5), alcohol use disorder (SPR = 2.4, 95%CI: 2.0-2.8), and combination of disorders (SPR = 4.2; 95%CI: 3.4-5.1). CONCLUSIONS: Chinese MSM had significantly elevated prevalence and comorbidity of psychiatric disorders. RDS is a suitable sampling method for psychiatric epidemiological survey in MSM population.

[Mortality trend on chronic obstructive pulmonary disease in Liaoning province, 1984-2010].

OBJECTIVE: To evaluate the mortality trend of chronic obstructive pulmonary disease (COPD) among residents in Liaoning province during the period of 1984-2010. METHODS: The cut-points were ascertained by Monte Carlo Permutation test in COPD mortality trend lines of Poisson regression with Joinpoint Regression Program. The annual percent changes (APC) before and after the cut-points and the average annual percent change (AAPC) of COPD mortality were examined during the period. RESULTS: Significant declining trends on COPD mortality among the urban population during 1984-2010 and that of rural population during 1999-2009 were found. The standardized urban COPD mortality rate by Chinese population declined from 243.93 per 100 thousand in 1984 to 33.13 per 100 thousand in 2010. The urban 26 years AAPC was -5.8%. While the mortality in the rural population decreased from 251.33 per 100 thousand in 1999 to 102.25 per 100 thousand in 2009 in the same population. The rural 10 years' AAPC was -6.8%. The total trend of COPD mortality reduction was mainly resulted from the fast decline of bronchitis mortality. The AAPC of COPD mortality of the urban population was -9.0% and greater than that of the rural population (-6.8%) from 1999 to 2009. The urban population had a lower COPD mortality than that of the rural population. In urban area, males had a higher COPD mortality than females, however, in the rural area, males had a lower COPD mortality than the females. CONCLUSION: The COPD mortality among the residents of Liaoning province declined significantly from 1984 to 2010. Further studies are needed to confirm the viewpoint of WHO that the prevalence of COPD would have a continuous increasing trend in China.

[Decomposition of life expectancy at birth by age and causes of death among residents of Liaoning province, 1975 - 2005].

OBJECTIVE: To analyze the impact of mortality by age and causes of death on life expectancy at birth among residents of Liaoning province. METHODS: The study included mortality data of urban and rural residents in two periods (1973 - 1975 and 2004 - 2005). Both Abridged Life Table and Arriaga method were used to calculate and to decompose life expectancy changes by age and causes of death. RESULTS: From 1975 - 2005, the life expectancy increased by 4.68 years in urban residents and 4.91 for rural residents with a higher increment among females than males. Most part of the increase (76.27% and 82.81% for urban and rural male, 58.76% and 62.13% for urban and rural female) in life expectancy within the last 30 years could be explained by the decrease of mortality in the populations at age 0 - 4 and 55 - 74. Diseases related to respiratory system and infectious disease were contributing the most to the gap in life expectancy between the two periods. Mortality of heart disease was a negative contributor to the changes in life expectancy among both rural and urban residents while the mortalities of cerebro-vascular diseases and malignant tumors were the negative contributors for rural residents. CONCLUSION: The increase of life expectancy in the last 30 years was mainly resulted from the decrease of mortality on both respiratory and infectious diseases. Control of chronic diseases is the key point to increase the life expectancy among the residents of Liaoning province.