Changes of campus tobacco control environment and the impact on tobacco control behaviors among secondary school personnel in Shanghai, China.

INTRODUCTION: Youth smoking is a serious public health problem. Nevertheless, a rigorous tobacco-free environment within schools, combined with exemplary tobacco control behavior among school personnel can effectively contribute to reducing adolescent smoking. This study compared the tobacco control environment in Shanghai secondary schools in 2017 and 2021, and explored how the tobacco control environment influenced the tobacco control behaviors of school personnel. METHODS: Two cross-sectional studies were conducted from October to December 2017 and October to December 2021, using stratified cluster random sampling method, and 2403 and 1761 valid questionnaires were collected, respectively. The chi-squared test was used to test the differences between categorical variables. Binary logistic regression was conducted using survey data from 2021 to explore the influencing factors of staff's tobacco control behaviors. RESULTS: Compared with 2017, the percentages of staff members who were current smokers, had smoked on campus in the past year and were exposed to secondhand smoke (SHS) on campus in the past 7 days in 2021 decreased by 2.95%, 2.30% and 8.91%, respectively. However, the proportion of personnel who knew the school had organized tobacco control education decreased. Furthermore, school personnel who had received tobacco control education and agreed the school should strictly prohibit students from smoking (AOR=1.64; 95% CI: 1.25-2.15) were more likely to inform about the harm of tobacco to students. Those who had participated in tobacco control education activities or tobacco control trainings (AOR=1.87; 95% CI: 1.30-2.69) and believed that the school did not strictly prohibit either students (AOR=0.30; 95% CI: 0.22-0.41) or personnel (AOR=0.46; 95% CI: 0.36-0.59) from smoking were more inclined to stop students from smoking. CONCLUSIONS: Compared with 2017, the rates of smoking and secondhand smoke exposure among school personnel decreased in 2021, but some schools still lacked comprehensive education on tobacco control behaviors for the staff. Enhancing the health literacy and strengthening tobacco control education among staff were effective strategies to encouraging their active adoption of tobacco control behaviors.

Radiomics Based on Multimodal magnetic resonance imaging for the Differential Diagnosis of Benign and Malignant Vertebral Compression Fractures.

OBJECTIVES: Recent studies have indicated that radiomics may have excellent performance and clinical application prospects in the differential diagnosis of benign and malignant vertebral compression fractures (VCFs). However, multimodal magnetic resonance imaging (MRI)-based radiomics model is rarely used in the differential diagnosis of benign and malignant VCFs, and is limited to lumbar. Herein, this study intends to develop and validate MRI radiomics models for differential diagnoses of benign and malignant VCFs in patients. METHODS: This cross-sectional study involved 151 adult patients diagnosed with VCF in The First Affiliated Hospital of Soochow University in 2016-2021. The study was conducted in three steps: (i) the original MRI images were segmented, and the region of interest (ROI) was marked out; (ii) among the extracted features, those features with Pearson's correlation coefficient lower than 0.9 and the top 15 with the highest variance and Lasso regression coefficient less than and more than 0 were selected; (iii) MRI images and combined data were studied by logistic regression, decision tree, random forest and extreme gradient boosting (XGBoost) models in training set and the test set (ratio of 8:2), respectively; and the models were further verified and evaluated for the differential diagnosis performance. The evaluated indexes included area under receiver (AUC) of operating characteristic curve, accuracy, sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and 95% confidence intervals (CIs). The AUCs were used to assess the predictive performance of different machine learning modes for benign and malignant VCFs. RESULTS: A total of 1144 radiomics features, and 14 clinical features were extracted. Finally, 12 radiomics features were included in the radiomics model, and 12 radiomics features with 14 clinical features were included in the combined model. In the radiomics model, the differential diagnosis performance in the logistic regression model with the AUC of 0.905 ± 0.026, accuracy of 0.817 ± 0.057, sensitivity of 0.831 ± 0.065, and negative predictive value of 0.813 ± 0.042, was superior to the other three. In the combined model, XGBoost model had the superior differential diagnosis performance with specificity (0.979 ± 0.026) and positive predictive value (0.971 ± 0.035). CONCLUSION: The multimodal MRI-based radiomics model performed well in the differential diagnosis of benign and malignant VCFs, which may provide a tool for clinicians to differentially diagnose VCFs.

Association between weight, weight perception, weight teasing and mental health among adolescents.

BACKGROUND: Adolescent mental health problems are becoming increasingly prevalent, and there are correlations between weight-related concerns and adolescent mental health. The aim of this study is to explore the association between three weight-related factors (actual weight, weight perception, and weight teasing) and mental health problems (depressive symptoms, anxiety symptoms, and loneliness) in Chinese adolescents. METHODS: 10,070 adolescents between the ages of 11-18 from schools in Shanghai, China were selected using a stratified random cluster sampling method. Self-reported questionnaires were collected to investigate weight-related factors and mental health problems. Logistic regression analysis was used to examine the relationship. RESULTS: The prevalence of depressive symptoms, loneliness, mild anxiety symptoms, and moderate to severe anxiety symptoms among adolescents were 18.0%, 53.8%, 26.5%, and 12.3%, respectively, with a higher prevalence found in females. After adjusting for weight perception and weight teasing, actual weight had no harmful impact on adolescents' mental health. Adolescents' perception of being overweight increased the risk of depressive symptoms, loneliness, mild anxiety symptoms, and moderate to severe anxiety symptoms, while the perception of being underweight had a similar but more profound impact (depressive symptoms OR = 1.590, 95% CI: 1.342-1.883; loneliness OR = 1.537, 95% CI: 1.353-1.746; mild anxiety symptoms OR = 1.368, 95% CI: 1.178-1.589; moderate to severe anxiety symptoms OR = 1.780, 95% CI: 1.449-2.186). Experiencing weight teasing more than once a year had a greater effect on adolescents' mental health, especially among adolescents with overweight/obesity (depressive symptoms OR = 2.970, 95% CI: 2.325-3.793; loneliness OR = 3.839, 95% CI: 3.119-4.727; mild anxiety symptoms OR = 2.822, 95% CI: 2.236-3.562; moderate to severe anxiety symptoms OR = 5.212, 95% CI: 3.846-7.065). CONCLUSIONS: The prevalence of mental health problems among adolescents was high, especially loneliness. Weight perception and weight teasing, but not the actual weight, independently influenced adolescent mental health.

Prognostic value of native T1 and extracellular volume in patients with immunoglubin light-chain amyloidosis.

BACKGROUND: Cardiac involvement in patients with immunoglubin light-chain amyloidosis (AL) is a major determinant of treatment choice and prognosis, and early identification of high-risk patients can initiate intensive treatment strategies to achieve better survival. This study aimed to investigate the prognostic value of native T1 and ECV in patients with AL-cardiac amyloidosis (CA). METHODS: A total of 38 patients (mean age 59 ± 11 years) with AL diagnosed histopathologically from July 2017 to October 2021 were collected consecutively. All patients were performed 3.0-T cardiac magnetic resonance (CMR) including cine, T1 mapping, and late gadolinium enhancement (LGE). Pre- and post-contrast T1 mapping images were transferred to a dedicated research software package (CVI42 v5.11.3) to create parametric T1 and ECV values. In addition, clinical and laboratory data of all patients were collected, and patients or their family members were regularly followed up by telephone every 3 months. The starting point of follow-up was the time of definitive pathological diagnosis, and the main endpoint was all-cause death. Kaplan-Meier analysis and Cox proportional risk model were used to evaluate the association between native T1 and ECV and death in patients with CA. RESULTS: After a median follow-up of 27 (16, 37) months, 12 patients with CA died. Kaplan-Meier analysis showed that elevated native T1 and ECV were closely associated with poor prognosis in patients with CA. The survival rate of patients with ECV > 44% and native T1 > 1389ms were significantly lower than that of patients with ECV ≤ 44% and native T1 ≤ 1389ms (Log-rank P < 0.001), and was not associated with the presence of LGE. After adjusting for clinical risk factors and CMR measurements in a stepwise multivariate Cox regression model, ECV [risk ratio (HR):1.37, 95%CI: 1.09-1.73, P = 0.008] and native T1 (HR:1.01, 95%CI: 1.00-1.02, P = 0.037) remained independent predictors of all-cause mortality in patients with CA. CONCLUSIONS: Both native T1 and ECV were independently prognostic for mortality in patients with CA, and can be used as important indicators for clinical prognosis assessment of AL.

The characteristics and risk factors of e-cigarette use among adolescents in Shanghai: A case-control study.

INTRODUCTION: This study was conducted to explore the characteristics and risk factors of e-cigarette use in adolescents, aiming for tobacco control and reducing e-cigarette use in this population. METHODS: Using 1:1 matching, 88 students from three vocational high schools in Shanghai were recruited to conduct a case (using e-cigarettes) - control (not using e-cigarettes) study. Group interviews and questionnaire surveys were used for this qualitative and quantitative mixed-methods study. The keywords were extracted from the interview data and analyzed by the Colaizzi seven-step method. RESULTS: The characteristics of adolescents' use of e-cigarettes include young age at first use, consumption of a large amount, as well as smoking in discrete locations in order to hide from adults. The reasons for using e-cigarettes include curiosity and wanting to replace traditional cigarettes. The risk factors of using e-cigarettes include insufficient understanding of the harm of e-cigarettes at the individual level (The positive outcome expectancy points: Z= -3.746, p<0.001; The negative outcome expectancy points: Z= -3.882, p<0.001), peer influence at the interpersonal level (χ2=6.510, p<0.01), and the influence of social and environmental factors such as e-cigarette sales in the stores and WeChat Moments (p<0.05 for all associations). CONCLUSIONS: Having friends who use e-cigarettes, curiosity and sales exposure about e-cigarettes are important factors affecting the use of e-cigarettes by adolescents. It is necessary to strengthen the publicity of the potential hazards of e-cigarettes and to reduce overall usage by improving relevant laws and regulations.

Machine learning based on gadoxetic acid-enhanced MRI for differentiating atypical intrahepatic mass-forming cholangiocarcinoma from poorly differentiated hepatocellular carcinoma.

PURPOSE: The study was to develop a Gd-EOB-DTPA-enhanced MRI radiomics model for differentiating atypical intrahepatic mass-forming cholangiocarcinoma (aIMCC) from poorly differentiated hepatocellular carcinoma (pHCC). MATERIALS AND METHODS: A total of 134 patients (51 aIMCC and 83 pHCC) who underwent Gadoxetic acid-enhanced MRI between March 2016 and March 2022 were enrolled in this study and then randomly assigned to the training and validation cohorts by 7:3 (93 patients and 41 patients, respectively). The radiomics features were extracted from the hepatobiliary phase of Gadoxetic acid-enhanced MRI. In the training cohort, the SelectKBest and the least absolute shrinkage and selection operator (LASSO) were used to select the radiomics features. The clinical, radiomics, and clinical-radiomics model were established using four machine learning algorithms. The performance of the model was evaluated by the receiver operating characteristic (ROC) curve. Comparison of the radiomics and clinical-radiomics model was done by the Delong test. The clinical usefulness of the model was evaluated using decision curve analysis (DCA). RESULTS: In 1132 extracted radiomic features, 15 were selected to develop radiomics signature. For identifying aIMCC and pHCC, the radiomics model constructed by random forest algorithm showed the high performance (AUC = 0.90) in the training cohort. The performance of the clinical-radiomics model (AUC = 0.89) was not significantly different (P = 0.88) from that of the radiomics model constructed by random forest algorithm (AUC = 0.86) in the validation cohort. DCA demonstrated that the clinical-radiomics model constructed by random forest algorithm had a high net clinical benefit. CONCLUSION: The clinical-radiomics model is an effective tool to distinguish aIMCC from pHCC and may provide additional value for the development of treatment plans.

Impact of smoking exposure on human papillomavirus clearance among Chinese women: A follow-up propensity score matching study.

INTRODUCTION: Smoking has been proven to increase the risk of cervical cancer, but it is still controversial whether smoking reduces women's ability to clear human papillomavirus (HPV) infection. This study investigated the association between smoking behaviors during follow-up and clearance of HPV infection in women with HPV-positive and pathologically normal uterine cervix in China, using a propensity score matching (PSM) analysis. METHODS: The present prospective study included data from women examined in the Gynecology Department of Shanghai General Hospital from January 2018 to June 2020. Twenty patients who smoked throughout follow-up were selected and matched with 60 patients using the 1:3 PSM method on age, marital status, and whether infected with high-risk HPV (HR-HPV). At each visit, smoking and sexual behaviors were collected. The Kaplan-Meier method and a Cox proportional hazard regression model were used to evaluate the probability of clearing HPV infection within a 2-year follow-up. RESULTS: A total of 80 patients were included in the study, all of whom were infected with at least one HR-HPV type at baseline. Current smokers had a lower likelihood of clearing the HPV infection than current non-smokers, after adjusting for a history of sexually transmitted diseases (STD), HPV infection status, and sexual behaviors during follow-up (AHR=0.478; 95% CI: 0.239-0.958, p=0.037). Additionally, longer duration, higher frequency and larger doses of smoking correlated with the lower clearance possibility of HPV infection (p for trend=0.029, 0.022 and 0.026, respectively). CONCLUSIONS: This study showed that the use of tobacco throughout follow-up could increase the risk of a persistent HPV infection, this risk being higher for smokers with heavier tobacco consumption. Our results should alert HPV-positive women to reiterate the advice to cut-back on or stop smoking.

Nomogram based on MRI for preoperative prediction of Ki-67 expression in patients with intrahepatic mass cholangiocarcinoma.

OBJECTIVES: To validate a new nomogram based on magnetic resonance imaging (MRI) for pre-operative prediction of Ki-67 expression in patients with intrahepatic mass cholangiocarcinoma (IMCC). METHODS: A total of 78 patients with clinicopathologically confirmed IMCC who underwent pre-operative gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid enhanced MRI between 2016 and 2022 were enrolled in the training and validation group (53 patients and 25 patients, respectively). Images including qualitative, quantitative MRI features and clinical data were evaluated. Univariate analysis and multivariate logistic regression were used to select the independent predictors and establish different predictive models. The predictive performance was validated by operating characteristic curve (ROC) analysis, calibration curve, and decision curve analysis (DCA). The validation cohort was used to test the predictive performance of the optimal model. The nomogram was constructed with the optimal model. RESULTS: In the training cohort, independent predictors obtained from the combined model were DWI (OR 1822.741; 95% CI 6.189, 536,781.805; P = 0.01) and HBP enhancement pattern (OR 14.270; 95% CI 1.044, 195.039; P = 0.046). The combined model showed the good performance (AUC 0.981; 95% CI 0.952, 1.000) for predicting Ki-67 expression. In the validation cohort, The combined model (AUC 0.909; 95% CI 0.787, 1.000)showed the best performance compared to the clinical model (AUC 0.448; 95% CI 0.196, 0.700) and MRI model (AUC 0.770; 95% CI 0.570, 0.970). CONCLUSION: This new nomogram has a good performance in predicting Ki-67 expression in patients with IMCC, which could help the decision-making of the patients' therapy strategies.

Social environment exposure to electronic cigarettes and its association with e-cigarette use among adolescents in Shanghai, China.

Objective: This study investigated adolescents' social-environmental exposure to e-cigarettes in association with e-cigarette use in Shanghai, China. We also explored these differences by gender and school type. Methods: Sixteen thousand one hundred twenty-three students were included by a stratified random cluster sampling, and the number was weighted according to selection probability. Association between social environment exposure and e-cigarette use was examined by multivariate logistic regressions. Results: There were 35.07, 63.49, 75.19, 9.44, and 18.99% students exposed to secondhand e-cigarette aerosol (SHA), e-cigarette sales, e-cigarette information, parents' and friends' e-cigarette use. Students exposed to SHA (aOR = 1.73, 95% CI 1.40-2.14), e-cigarette sales from ≥2 sources (aOR = 1.55, 95% CI 1.18-2.03), e-cigarette information exposure from ≥2 sources (aOR = 1.39, 95% CI 1.05-1.83), and having a social e-smoking environment (friends' e-cigarette use: aOR = 2.56, 95% CI 2.07-3.16; parents' e-cigarette use: aOR = 1.54, 95% CI 1.17-2.02) were significantly associated with their intention to use e-cigarettes. More girls were exposed to e-cigarette sales in the malls, e-cigarette information at points of sale and on social media (P < 0.01), and exposure to sales from ≥2 sources were associated with girls' intention to use e-cigarettes (aOR = 1.84, 95% CI 1.22-2.78). However, boys were more likely to be exposed to friends' e-cigarette use (P < 0.001), and having friends using e-cigarettes was associated with greater intention to use them in boys (aOR = 2.64, 95% CI 1.97-3.55). Less vocational high school students were exposed to parents' e-cigarette use (P < 0.001), but they were more likely to use e-cigarettes in the future after being exposed (aOR = 2.27, 95% CI 1.50-3.43). A similar phenomenon was observed between junior high students and their exposure to SHA. Conclusions: This study reported adolescents' high exposure rates to the social environment of e-cigarettes. Exposure to SHA, e-cigarette sales from ≥2 sources, e-cigarette information from ≥2 sources and having a social e-smoking environment were related to adolescents' intention to use e-cigarettes. Differences in gender and school type were observed. More attention should be paid to girls, and different interventions should be designed for different types of school students. Additionally, comprehensive tobacco control policies are needed.

Status quo and problem analysis of cervical cancer screening program in China: Based on RE-AIM framework.

Background: An organized cervical cancer screening program is an effective method to prevent and control cervical cancer. This study aims to find barriers and facilitators in the implementation process of National Cervical Cancer Screening Program in Rural Areas (NACCSPRA) in China through program evaluation, and thus propose suggestions for optimization of the program. Methods: Through stratified sampling, 8 provinces (autonomous cities/districts) in eastern, southern, western, northern, and central China were selected for evaluation of NACCSPRA based on the RE-AIM framework. We obtained 15 program providers' experience and perspectives through semi-structured interviews. The data was analyzed using a combination of deductive and inductive analysis methods. Results: The study found that NACCSPRA mainly serves women with rural household registration or urban minimum living guarantee. Population mobility and certain demographic characteristics such as low education and poor health awareness are common participation barriers, while program publicity acts as a facilitator. A screening program's direct benefit is to promote early detection and treatment of cervical cancer, and its perceived indirect effect is to raise people's health awareness. The proportion of regions adopting the project is relatively high, and factors affecting employees' participation are screening workload, working environment, welfare benefits, degree of preference for grassroots work, and whether the project is included in the performance appraisal; In terms of implementation, there are disparities in screening methods, network informatization levels, and capital investment in various regions. Poor development of screening information system and insufficient screening funds are significant barriers to improvement of project implementation. In contrast, the overall implementation of follow-up is better; related policies issued by the local government and financial subsidies for poor women ensure the maintenance of the project. Conclusion: Shortage of funds is an important problem faced by current screening project, which negatively influences upgrade of cervical cancer prevention strategy, implementors' working environment, and impedes improvement of information network. In addition, defects in population coverage, especially in mobile population also deserves attention. The study found barriers and facilitators of NACCSPRA perceived by project providers and provided a theoretical foundation for project optimization.

Pre-treatment spectral CT combined with CT perfusion can predict hemorrhagic transformation after thrombolysis in patients with acute ischemic stroke.

OBJECTIVE: To investigate the value of pre-treatment spectral CT angiography (CTA) in predicting hemorrhagic transformation (HT) after intravenous thrombolysis (IVT) treatment in acute ischemic stroke (AIS) patients. MATERIALS AND METHODS: AIS patients who underwent IVT with recombinant tissue plasminogen activator and pre-treatment head and neck spectral CTA and head CT perfusion (CTP) from January 2018 to June 2020 were reviewed retrospectively. Finally, 20 patients were included in the HT group and 22 age-matched patients were included in the non-HT group. Spectral and CTP parameters of the region of interest on pre-treatment CTA axial raw images and CTP images, including the infarct core (IC) and ischemic penumbral (IP) regions, were recorded. The differences in clinical variables, CTP, collateral scores and spectral parameters between the two groups were analyzed. Three multivariate logistic regression models were then developed, where model 1 included clinical and spectral parameters, model 2 included clinical and CTP parameters and a combined model included clinical, CTP, and spectral parameters. Receiver operating characteristic analysis was used to evaluate the performance of the multivariate model. RESULTS: Patients with HT had higher Safe Implementation of Treatments in Stroke (SITS) score (p = 0.023), the volume of perfusion lesions (p = 0.005), the volume of IP (p = 0.003), the mean transit time (MIT) in the IC area (p = 0.012), as well as the TTP in IP area (p = 0.015) compared with patients without HT. The HT group showed significantly lower CBF in the IC area (p = 0.019), iodine concentration (p = 0.017) and the effective atomic number (p = 0.024) in the IP area than non-HT group. And the slope of the spectral curve of the HT group in the IP region was larger than that of the non-HT group (p = 0.023). Gender, age, SITS score, the volume of entire perfusion lesion, CBF and MIT in the IC area, TTP in the IP area, as well as iodine concentration in the IP area were included in the final multivariate model for predicting HT. And CBF in the IC area (OR = 0.779, 95 % CI:0.609-0.996, p = 0.046) as well as the iodine concentration of IP area (OR = 0.343, 95 % CI: 0.131-0.901, p = 0.030) were proved to be independent predictors for HT. The combined model including clinical, spectral, and CTP parameters, showed improved accuracy compared to the other two models, while the Delong test did not suggest a statistically significant difference (both p values > 0.05). CONCLUSIONS: The iodine concentration of IP area derived from pre-treatment spectral CTA was an independent predictor of HT after IVT treatment for AIS patients. Moreover, multivariate models combined with clinical, spectral, and CTP parameters may be able to predict HT.

3.0T cardiac magnetic resonance quantification of native T1 and myocardial extracellular volume for the diagnosis of late gadolinium enhancement-negative cardiac amyloidosis.

Background: Late gadolinium enhancement (LGE) by cardiac magnetic resonance (CMR) is useful for the detection of cardiac amyloidosis (CA), but characteristic LGE patterns do not always occur or they appear late in the disease. Native T1 and extracellular volume (ECV) by T1 mapping may improve disease detection and quantify myocardial amyloid load. Methods: Thirty patients with definite CA, 10 patients with possible CA, 20 patients with hypertrophic cardiomyopathy (HCM) and 40 healthy volunteers were performed 3.0-T CMR including cine, pre- and postcontrast T1 mapping and LGE. Receiver-operating characteristic (ROC) curves were constructed to assess the diagnostic ability of native T1 and ECV for CA. Correlation analysis between native T1 or ECV and cardiac biomarkers, structure, and function indexes were assessed using Pearson or Spearman correlation, as appropriate. Results: Native T1 values were 1,429±93, 1,290±49, 1,304±42, and 1,225±21 ms, in definite CA, possible CA, HCM, and healthy controls, respectively. ECV values were 44%±9%, 34%±5%, 33%±4%, and 24%±3%, in definite CA, possible CA, HCM, and healthy controls, respectively. Native T1 [area under curve (AUC) =0.89, 95% confidence interval (CI): 0.75-1.00, P<0.001] and ECV (AUC =0.99, 95% CI: 0.98-1.00, P<0.001) showed good ability to differentiate LGE-negative patients with possible CA from healthy controls, especially ECV. Positive correlations were found between native T1 or ECV and New York Heart Association (NYHA) functional class (r=0.673 and r=0.594, respectively; P<0.001), NT-proBNP (r=0.668 and r=0.603, respectively; P<0.001), troponin T (r=0.724 and r=0.591, respectively; P<0.001), left ventricular (LV) mass index (r=0.668 and r=0.579, respectively; P<0.001), and global LV wall thickness (r=0.765 and r=0.629, respectively; P<0.001). Negative correlations were found between native T1 or ECV and left ventricular ejection fraction (LVEF) (r=-0.761 and r=-0.668, respectively; P<0.001) and left ventricular stroke volume (LVSV) (r=-0.777 and r=-0.729, respectively; P<0.001). Conclusions: Native T1 and ECV, which are able to reflect cardiac biochemistry, structure, and function, have high diagnostic accuracy for detecting CA, especially in LGE-negative patients, and thus could be used for early diagnosis of CA.

Body Weight, Weight Self-Perception, Weight Teasing and Their Association with Health Behaviors among Chinese Adolescents-The Shanghai Youth Health Behavior Survey.

Weight-related status has been associated with the physical and psychological health of adolescents. This cross-sectional study evaluated three different kinds of weight-related statuses (Body Mass Index (BMI), weight self-perception and weight teasing from others) among Chinese adolescents and identified their associations with health risk behaviors (lack of healthy dietary behavior, unhealthy dietary behavior, binge eating behavior, lack of physical activity (PA), sedentary behaviors (SB) and sleep disturbance). A stratified random cluster sampling method was used to select 10,070 students aged 11−18 years old from schools in Shanghai. Self-reported questionnaires were collected, weight-related statuses were divided into three categories and six specific health risk behaviors were classified into two groups: positive or negative. Overall, 27.82% of the adolescents were classified as being overweight and obese (35.61% of boys and 18.21% of girls), 43.45% perceived themselves as too heavy and 30.46% experienced weight teasing in the past. Among overweight or obese participants, 50.55% have been teased about their weight, and 77.48% perceived themselves as too heavy. Weight perception and weight teasing were significantly associated with health risk behaviors rather than the actual body weight status based on BMI, especially regarding binge eating behavior (body weight status (BMI): p > 0.05, underweight perception: OR = 1.18, 95%CI 1.03−1.34; weight teasing for more than once a year: OR = 2.00, 95%CI 1.76−2.27). In addition, weight perception and weight teasing were significantly associated with health risk behaviors, mainly in normal and overweight/obese groups but not in underweight groups. Weight teasing and weight self-perception play an independent and stronger role than actual body weight in the health behaviors of adolescents. This calls for more attention and intervention to reduce peer bullying and stigmas on weight among adolescents.

Awareness of tobacco control policies and anti-tobacco attitudes and behaviors among school personnel.

INTRODUCTION: Adolescent smoking is a serious public health concern, and the role of personnel in reducing students'tobacco use has been proven. Anti-tobacco policies are strong factors for tobacco control but most are newly implemented in China. This study aimed to examine the awareness of anti-tobacco policies among school personnel in a southern city of China, and assess its influence on personnel's anti-tobacco attitudes and behaviors towards students. METHODS: An online cross-sectional study was conducted between September 2017 and January 2018 in schools of Shanghai, China. A total of 3194 subjects from 33 schools were selected by a two-stage stratified cluster randomized sampling design. Prevalence of anti-tobacco policy awareness is presented. Crude (ORs) and adjusted odds ratios (AORs) and their 95% confidence intervals (CIs) were estimated to assess the association between policy awareness and anti-tobacco attitudes or behaviors. RESULTS: In all, 22.4% of surveyed participants knew four or five polices presented in the survey and 13.0% of personnel knew none of these policies. Most of the participants fully support prohibiting indoor (94.6%) and outdoor (86.3%) smoking in public places, bans on tobacco advertising (90.9%), and printing warning pictures on cigarette boxes (89.5%). Less than half of the personnel had taken action to stop students from smoking (45.7%), encourage students to quit smoking (42.4%) or participated in relevant educational activities held by schools (37.4%) in the previous year. The school personnel's anti-tobacco attitudes (AOR=1.28; 95% CI: 1.21-1.36) and behaviors (AOR=1.10; 95% CI: 1.03-1.17) were strengthened with increasing level of policy awareness. CONCLUSIONS: The involvement of school personnel can be an important part of intervention to improve anti-tobacco campaigns on campus. The study calls for the implementation of projects or activities to improve anti-tobacco policy awareness in the school environment as part of school tobacco control strategy.

Online E-Cigarette Information Exposure and Its Association with E-Cigarette Use among Adolescents in Shanghai, China.

E-cigarettes are widely advertised, while the potential risks of e-cigarette use have been reported among adolescents. This study assessed online e-cigarette information exposure and its association with adolescents' e-cigarette use in Shanghai, China. A total of 12,470 students aged 13-18 years participated. A questionnaire collected information on students' sociodemographic factors, e-cigarette information exposure, cigarette use, e-cigarette use, and e-cigarette use intention. A multivariate logistic regression was performed to assess correlates of exposure to e-cigarette information and the association between e-cigarette information exposure and e-cigarette use. Overall, 73.9% of students knew about e-cigarettes and the primary sources of information were the internet (42.4%), movies/TV (36.4%), bulletin boards in retail stores or supermarkets (34.9%), advertising flyers (33.9%), and friends (13.8%). Students who had friends using e-cigarettes were curious about e-cigarettes and showed a greater monthly allowance; smokers and females were at a higher risk of social media and website exposure. Moreover, online information exposure (social media exposure, website exposure, and total internet exposure) was significantly associated with the intention to use e-cigarettes. The enforcement of regulations on online e-cigarette content should be implemented. Moreover, efforts to prevent young people from using e-cigarettes may benefit from targeting students at a higher risk of online e-cigarette information exposure.

Native T1-mapping and diffusion-weighted imaging (DWI) can be used to identify lung cancer pathological types and their correlation with Ki-67 expression.

Background: This study aimed to explore the value of native T1-mapping and diffusion-weighted imaging (DWI) in differentiating the pathological types and degree of tumor differentiation of lung cancer and their correlation with Ki-67 protein expression. Methods: A total of 78 consecutive lung cancer patients who received chest magnetic resonance imaging (MRI) scans between May 2020 and June 2021 were enrolled in this study. Two radiologists independently analyzed the apparent diffusion coefficient (ADC) and T1 values for each lesion. The intraclass correlation coefficient (ICC) and Bland-Altman plots were generated to assess interobserver agreement of the T1 and ADC mean values in lesions. The difference in ADC and T1 values among different pathological types, as well as between high- and low-differentiated lung cancers were analyzed, and diagnostic efficacy was evaluated by receiver operating characteristic (ROC) curve analysis. The correlation between ADC value, T1 value, and Ki-67 protein expression index was determined. Results: The ADC and T1 values showed excellent interobserver agreement (ICC 0.820, 0.942, respectively). There was a significant difference in ADC values between small cell carcinoma and squamous carcinoma (P<0.05), and between small cell carcinoma and adenocarcinoma (P<0.05), but not between squamous carcinoma and adenocarcinoma (P>0.05). A significant difference in T1 values was observed between small cell carcinoma (P<0.05) and adenocarcinoma, and between squamous carcinoma (P<0.05) and adenocarcinoma, but not between squamous carcinoma and small cell carcinoma (P>0.05). There were statistically significant differences in ADC and T1 values between the moderately and highly differentiated group and the poorly differentiated group (P<0.05). ROC curve analysis showed that the T1 combined with ADC value had high diagnostic value for the degree of differentiation of the tumor [area under the curve (AUC) =0.912]. Pearson correlation analysis showed a significant positive correlation between T1 value and Ki-67 index (r=0.66, P<0.001) and a significant negative correlation between ADC value and Ki-67 index (r=-0.45, P<0.01). Conclusions: T1 and ADC values can be used to distinguish the pathological type and differentiation degree of lung cancer.

Typology of Family Relationships, Psychological Distress, and Quality of Life in Chinese Patients With Advanced Lung Cancer: A Latent Profile Analysis.

BACKGROUND: Family relationships affect psychological adjustment and quality of life (QoL) in patients with advanced cancer. The typology of family relationships has not been examined in Chinese patients with advanced cancer. OBJECTIVE: The aims of this study were to identify profiles of family relationships and examine their relationships with psychological distress and QoL in Chinese patients with advanced lung cancer. METHODS: A total of 252 Chinese patients with advanced lung cancer at 2 hospitals in Shanghai participated in the study. They completed self-reported questionnaires. Latent profile analysis was used to identify the optimal classification of perceived family relationships based on 3 indicators (cohesiveness, expressiveness, and conflict resolution). RESULTS: Three profiles of family relationships were identified. The supportive profile (70.6%) showed high cohesiveness, expressiveness, and conflict resolution. The low-expressive profile (15.9%) showed low expressiveness but high cohesiveness and conflict resolution (15.9%). The conflictive profile (13.5%) showed low conflict resolution but high cohesiveness and expressiveness. Compared with supportive families, low-expressive and conflictive families were associated with worse depressive symptoms and anxiety symptoms, which could result in poorer QoL. CONCLUSIONS: Cohesiveness, expressiveness, and conflict resolution could be used to identify family relationship typology in Chinese patients with advanced lung cancer. Family relationship typology was associated with psychological distress and QoL. IMPLICATIONS FOR PRACTICE: The findings indicate a need for screening families and provide culturally sensitive family interventions to effectively support families at risk of poor outcomes.

The distribution and pathogenic risk of non-9-valent vaccine covered HPV subtypes in cervical lesions.

Human papillomavirus (HPV) infection is the main cause of female precancerous lesions and cervical cancer. The development and application of HPV prophylactic vaccines have been recognized as a major effective intervention for the control of cervical lesions. However, the infection rate and clinical characters of non-9-valent vaccine covered HPV subtypes are still worth studying. In this retrospective study, we included patients diagnosed and treated in the Department of Gynecology of Shanghai General Hospital between January 2017 and February 2021. The clinical features of non-9-valent vaccine covered HPV subtypes were explored in 2179 patients who have normal results, 338 patients with cervical intraepithelial neoplasia 1 (CIN1), and 153 patients with ≥CIN2. Univariate analysis showed that compared to the normal cervix group, age ≥50, pregnancy ≥5, delivery ≥3, menopause, no condom use, and cervical transformation zone type III were risk factors for CIN1 or ≥CIN2 (p < 0.05). Thirty-one percent of CIN1 and 26% of ≥CIN2 were attributed to HPV51, HPV53, HPV56, and HPV68. Multivariate analysis revealed that HPV53, HPV81, age, menopause, cervical transformation area and involved glands were independent risk factors for ≥CIN2 group compared to the CIN1 group (p < 0.05). Additionally, among the 14 non-9-valent vaccine covered HPV subtypes, the infection rates of HPV53, 56, 51, and 68 were higher in this study. In conclusion, our study demonstrated the distribution and pathogenic risk of non-9-valent vaccine covered HPV subtypes in cervical lesions. These findings might supply a foundation for optimizing cervical cancer prevention in the post-vaccine era.

Associations between sexual and reproductive health knowledge, attitude and practice of partners and the occurrence of unintended pregnancy.

Background: Although global contraceptive coverage has increased significantly, high rates of unintended pregnancy remain the current global status quo. A comparative analysis of the differences and correlations of knowledge, attitude and practice (KAP) of sexual and reproductive health (SRH) of both partners will help guide public health work according to gender characteristics and needs, and reduce the occurrence of unintended pregnancy. Methods: A questionnaire survey of people with unintended pregnancies including women and their male partners (n = 1,275 pairs) who sought help from the Shanghai General Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from October 2017 to October 2021. Data were collected on sexual and reproductive health knowledge, attitudes, and practices in both partners who had unintended pregnancies. Chi-square test and Logistic regression were used to analyze the relationship between the occurrence of unintended pregnancy and KAP and its influencing factors. Paired odds ratio and McNemar's test were used to estimate the difference and concordance of KAP between partners. Results: This study included 1,275 partners with a mean age of 30.0 years. The partner's overall level of KAP is good. Compared with women, men had better knowledge (χ2 = 3.93, p = 0.047) and more active contraceptive practices (χ2 = 19.44, p < 0.001). In the analysis of partner concordance, male contraceptive intention was found to be better than female [matched pairs odds ratio (ORMP) = 2.56, p < 0.001], and the concordance of positive contraceptive practice between partners increased with male education [adjusted odds ratio (aOR) = 1.556, 95% confidence interval (CI) = 1.185-2.044, p = 0.001]. In partner-paired regression analysis, compared with good contraceptive knowledge in both men and women in the partner, the risk of negative contraceptive practice was 1.7 times (aOR = 1.721, 95% CI = 1.234-2.400, p = 0.001) higher with good contraceptive knowledge in women but negative in men, while women with poor contraceptive knowledge but men with good knowledge are 1.3 times (aOR = 1.349, 95% CI = 1.000-1.819, p = 0.05) more likely to have negative contraceptive practices. In addition, compared with partners with positive contraceptive attitudes, women with positive attitudes but negative men and women with negative attitudes but positive men had 1.7 and 1.4 times the risk of negative contraceptive practices, respectively. Conclusion: The study found that unintended pregnancy occurs mainly in young people, and the younger age of first sexual intercourse, the low education background and the lack of discussion of contraception between partners are risk factors for not taking contraceptive measures. Men's better knowledge and contraceptive practices compared with female partners, and poor male contraceptive knowledge and attitudes may lead to a higher risk of negative contraceptive practices, the results suggest that male KAP plays an important role in promoting contraceptive use and reducing unintended pregnancy.