Trends in major non-communicable diseases and related risk factors in China 2002-2019: an analysis of nationally representative survey data.

Background: Prevention and control of non-communicable diseases (NCDs) are prioritized in both the Sustainable Development Goal and the Healthy China 2030 Initiatives. Efforts have been devoted to combating NCDs in China. This study examined changes in NCD trajectory. Methods: We described and analyzed the trends in prevalence and control of major NCDs including obesity, hypertension, diabetes, and dyslipidemia and examined selected main behavioral risk factors in China by sex, age group, and residence using nationally representative CDC survey data. Data included were from the China Chronic Disease Risk Factor Surveillance (CCDRFS, 2013 and 2018) and China National Nutrition Survey (CNNS, 2002, 2010-2013, 2015, and 2020). Annual and relative changes in rates were used. Rural-urban ratio of related indicators was assessed. Findings: NCD-attributed deaths increased from 80.0% in 2002 to 86.6% in 2012, and 88.5% in 2019, with cardiovascular diseases, cancer, chronic respiratory diseases, and diabetes accounted for 47.1%, 24.1%, 8.8%, and 2.5% of deaths in 2019, respectively. Prevalence of obesity (7.1%-16.4%), overweight/obesity (29.9%-50.7%), hypertension (18.8%-27.5%), diabetes (2.6%-11.9%), and dyslipidemia (18.6%-35.6%) all increased from 2002 to 2018. These rates increased faster in rural areas than in urban areas. Rates of awareness, treatment and control of hypertension and diabetes increased very slowly from 2012 to 2018. Most rates were between 30 and 40% with the lowest rate of 11% for hypertension control even in 2018. The rates were worse for rural residents compared to urban residents. Furthermore, many modifiable behavioral risk factors showed little improvement and some became worse over time, including smoking, excessive alcohol use, inadequate vegetable/fruit intake, excessive red meat intake, and physical inactivity. Interpretation: NCD burden in China increased during 2002-2019 despite of the intervention efforts. To reach the global and national targets, China must strengthen its actions, especially in rural areas, including improvement of NCD screening and management and reduction of behavioral risk factors. Funding: The study was supported in part by research grants of National Key R&D Program of China (2017YFC0907200, 2017YFC0907201), International Collaboration Project from the Chinese Ministry of Science and Technology-Prevention and control of chronic diseases and health promotion (G2021170007L), Natural Scientific Foundation of China (82103846), Key R&D and Transformation Program of Qinghai (2023-QY-204).

Associations of blood lead, cadmium, and mercury with resistant hypertension among adults in NHANES, 1999-2018.

BACKGROUND: Resistant hypertension (RHTN), a clinically complex condition with profound health implications, necessitates considerable time and allocation of medical resources for effective management. Unraveling the environmental risk factors associated with RHTN may shed light on future interventional targets aimed at reducing its incidence. Exposure to heavy metal has been linked to an increased risk of hypertension, while the relationship with RHTN remains poorly understood. METHODS: Using the 1999-2018 National Health and Nutrition Examination Survey (NHANES) data, we examined the association of blood lead (Pb), cadmium (Cd), and mercury (Hg) with RHTN using a multinomial logistic regression model. The combined effects of the metals and the contribution of each metal were assessed using a weighted quantile sum (WQS) analysis. RESULTS: A total of 38281 participants were included in the analysis. Compared with no resistant hypertension (NRHTN), per 1 µg/dL increase in blood Pb concentration, the proportion of RHTN increased by 16% [adjusted odds ratio (aOR), 1.16; 95% confidence interval (CI) 1.01-1.32]. When analyzed by quartiles (Q), the aOR [95% CI] for Pd was 1.30[1.01,1.67] (Q4 vs. Q1); there was a significant dose-response relationship (p < 0.05). Likewise, as a continuous variable, each 1 µg/dL increase in blood Cd level was associated with a 13% increase in the proportion of RHTN (aOR: 1.13; 95%CI: [1.00,1.27]); when analyzed as quartile, aOR [95% CI] for Cd were 1.30[1.01,1.69] (Q3 vs. Q1), and 1.35[1.03,1.75] (Q4 vs. Q1); the dose-response relationship was significant (p < 0.05). WQS analysis showed a significant combined effects of Pb, Cd, and Hg on RHTN, with Pb as the highest weight (0.64), followed by Cd (0.25) and Hg (0.11). Stratified analysis indicated that the associations for the two heavy metals were significant for participants who were male, ≼ 60 years old, and with kidney dysfunction. CONCLUSION: Findings of this study with national data provide new evidence regarding the role of environmental heavy metal exposure in RHTN. The prevention strategies aimed at reducing heavy metal exposure should particularly focus on Americans who are middle-aged, male, and afflicted with kidney dysfunction.

Investigating the paradox of increasing obesity and declining heart disease mortality in the United States: Age-period-cohort model.

Background: Obesity as a risk factor of heart disease (HD) is confirmed through observational, laboratory, and intervention studies. However, it cannot explain why HD declines, but obesity increases in the United States in recent decades. This study attempted to understand this paradox. Methods: Annual data of national HD mortality (1999-2018) were derived from Wide-Ranging Online Data for Epidemiologic Research, biannual obesity data (1999-2016) from the National Health and Nutrition Examination Survey, and smoking data (1965-1990) were from the National Health Interview Survey. Age-period-cohort method was used to decompose HD mortality into age, period, and cohort effects, and to estimate age-cohort adjusted mortality rates. To explain the paradox, age-cohort adjusted rates were associated with obesity rates to verify the positive obesity-HD relationship, while smoking rates were associated with cohort effects to explain the current declines in HD mortality. Results: During 1999-2018, the prevalence of obesity increased while the crude HD mortality rate declined for both sex and all races. After controlling for the curvilinear age effect and consistent declining cohort effect, the age-cohort adjusted HD mortality sustained stable in 1999-2007 and increased thereafter. The age-cohort adjusted rate in 1999-2018 (per 100,000) increased from 189.31 to 238.56 for males, 67.23 to 90.28 for females, 115.54 to 157.39 for White, 246.40 to 292.59 for Black, 79.79 to 101.40 for Hispanics, and 49.95 to 62.86 for Asian. The age-cohort adjusted HD mortality rates were positively associated with obesity rates (r = 0.68 for males, 0.91 for females, 0.89 for White, and 0.69 for Hispanic, p < 0.05), but not significant for Black and Asian. Further, during 1965-1990, the estimated cohort effect showed a decline in HD risk and was positively associated with smoking rates (r = 0.98 for both sex, 0.99 for White, and 0.98 for Black, p < 0.01). Conclusion: Study findings reveal potential increase of HD risk and support the positive relationship between obesity and HD risk. Declines in HD mortality in the past two decades are primarily due to tobacco use reduction and this protective effect was entangled in the mortality rates as cohort effect.

Screening Intention Prediction of Colorectal Cancer among Urban Chinese Based on the Protection Motivation Theory.

Colorectal cancer poses a serious threat worldwide. Although early screening has been proved to be the most effective way to prevent and control colorectal cancer, the current situation of colorectal cancer screening remains not optimistic. The aim of this article is to apply the protection motivation theory (PMT) to examine the influencing factors on screening intention of colorectal cancer (CRC). This cross-sectional survey was launched in five communities in Wuhan, China. All the eligible urban Chinese were recruited and interviewed using paper-and-pencil questionnaires. The intention of colorectal cancer screening (CRCS) was measured using six PMT subconstructs, including perceived risk, perceived severity, fear arousal, response efficacy, response cost, and self-efficacy. Data on sociodemographic variables and knowledge of CRC were also collected. The structural equation modeling (SEM) method was used for data analysis. Among all the 569 respondents, 83.66% expressed willingness to participate in CRCS. Data of the research fit the proposed SEM model well (Chi-square/df = 2.04, GFI = 0.93, AGFI = 0.91, CFI = 0.91, IFI = 0.91, RMSEA = 0.04). Two subconstructs of PMT (response efficacy and self-efficacy) and CRC knowledge were directly and positively associated with screening intention. Age, social status, medical history, physical activity, and CRC knowledge were indirectly related to the screening intention through at least one of the two PMT subconstructs (response efficacy and self-efficacy). The findings of this study suggest the significance of enhancing response efficacy and self-efficacy in motivating urban Chinese adults to participate in CRC screening. Knowledge of CRC is significantly associated with screening intention. This study can provide useful information for the formulation and improvement of colorectal cancer screening strategies and plans.

Sociodemographic and Clinical Characteristics Associated With Worst Pain Intensity Among Cancer Patients.

AIMS: Patients with cancer have pain due to their cancer, the cancer treatment and other causes, and the pain intensity varies considerably between individuals. Additional research is needed to understand the factors associated with worst pain intensity. Our study aim was to determine the association between worst pain intensity and sociodemographics and cancerspecific factors among patients with cancer. DESIGN: A total of 1,280 patients with cancer recruited from multiple cancer centers over 25 years in the United States were asked to complete a questionnaire that collected respondents' demographic, chronic pain, and cancer-specific information. SETTINGS: Worst, least, and current pain intensities were captured using a modified McGill Pain Questionnaire (pain intensity measured on 0-10 scale). A generalized linear regression analysis was utilized to assess the associations between significant bivariate predictors and worst pain intensity scores.Our study sample was non-Hispanic White (64.5%), non-Hispanic Black (28.3%), and Hispanic (7.2%). On average, participants were 59.4 (standard deviation = 14.4) years old. The average worst pain intensity score was 6.6 (standard deviation = 2.50). After controlling for selected covariates, being Hispanic (ß = 0.6859), previous toothache pain (ß = 0.0960), headache pain (ß = 0.0549), and stomachache pain (ß = 0.0577) were positively associated with worse cancer pain. Notably, year of enrollment was not statistically associated with pain. CONCLUSIONS: Our study sample was non-Hispanic White (64.5%), non-Hispanic Black (28.3%), and Hispanic (7.2%). On average, participants were 59.4 (standard deviation = 14.4) years old. The average worst pain intensity score was 6.6 (standard deviation = 2.50). After controlling for selected covariates, being Hispanic (ß = 0.6859), previous toothache pain (ß = 0.0960), headache pain (ß = 0.0549), and stomachache pain (ß = 0.0577) were positively associated with worse cancer pain. Notably, year of enrollment was not statistically associated with pain. Findings identified being Hispanic and having previous severe toothache, stomachache, and headache pain as significant predictors of worst pain intensity among patients with cancer. After controlling for selected covariates, we did not note statistical differences in worst pain during a 25-year period. Therefore,studies focused on improving the management of pain among patients with cancer should target interventions for those with Hispanic heritage and those with past history of severe common pain.

Determinants of Intention to Participate in Breast Cancer Screening among Urban Chinese Women: An Application of the Protection Motivation Theory.

Despite the significance of early detection of breast cancer through screening, the screening uptake in China remains relatively low. Protection motivation theory (PMT) suggested by Rogers is one of the theories concerning threat appeal. This study aimed to apply the protection motivation theory (PMT) in predicting breast cancer screening intention. In this cross-sectional study, a sample of Chinese urban women was recruited using the convenient sampling method from five communities in Wuhan. Data were collected using a self-report questionnaire that included demographic variables, knowledge about breast cancer, six PMT subconstructs, and screening intention. We used the structural equation modeling (SEM) to identify the predictor factors associated with screening intention. Of the total sample (n = 412), 86.65% had intention to participate in screening. Our data fit the hypothesized SEM model well (Goodness of fit index (GFI) = 0.91, adjusted GFI (AGFI) = 0.89, comparative fit index (CFI) = 0.91, root mean square error of approximation (RMSEA) = 0.05, standardized root mean residual (SRMR) = 0.06, and Chi-square/df = 2.01). Three PMT subconstructs (perceived severity, response cost, and self-efficacy) were significantly associated with screening intention. Knowledge, social status, and medical history had significantly indirect associations with screening intention through the mediating effect of PMT subconstructs. Considering the utility of PMT, intervention programs might be more effective based on the subconstructs of PMT, especially to improve self-efficacy, perceived severity, and knowledge, reduce response cost, as well as targeting specific demographic groups.

Macrophage migration inhibitory factor facilitates the therapeutic efficacy of mesenchymal stem cells derived exosomes in acute myocardial infarction through upregulating miR-133a-3p.

BACKGROUND: Exosome transplantation is a promising cell-free therapeutic approach for the treatment of ischemic heart disease. The purpose of this study was to explore whether exosomes derived from Macrophage migration inhibitory factor (MIF) engineered umbilical cord MSCs (ucMSCs) exhibit superior cardioprotective effects in a rat model of AMI and reveal the mechanisms underlying it. RESULTS: Exosomes isolated from ucMSCs (MSC-Exo), MIF engineered ucMSCs (MIF-Exo) and MIF downregulated ucMSCs (siMIF-Exo) were used to investigate cellular protective function in human umbilical vein endothelial cells (HUVECs) and H9C2 cardiomyocytes under hypoxia and serum deprivation (H/SD) and infarcted hearts in rats. Compared with MSC-Exo and siMIF-Exo, MIF-Exo significantly enhanced proliferation, migration, and angiogenesis of HUVECs and inhibited H9C2 cardiomyocyte apoptosis under H/SD in vitro. MIF-Exo also significantly inhibited cardiomyocyte apoptosis, reduced fibrotic area, and improved cardiac function as measured by echocardiography in infarcted rats in vivo. Exosomal miRNAs sequencing and qRT-PCR confirmed miRNA-133a-3p significantly increased in MIF-Exo. The biological effects of HUVECs and H9C2 cardiomyocytes were attenuated with incubation of MIF-Exo and miR-133a-3p inhibitors. These effects were accentuated with incubation of siMIF-Exo and miR-133a-3p mimics that increased the phosphorylation of AKT protein in these cells. CONCLUSION: MIF-Exo can provide cardioprotective effects by promoting angiogenesis, inhibiting apoptosis, reducing fibrosis, and preserving heart function in vitro and in vivo. The mechanism in the biological activities of MIF-Exo involves miR-133a-3p and the downstream AKT signaling pathway.

Factors associated with opioid prescriptions among women proximal to pregnancy in the United States.

BACKGROUND: Pregnant women are a vulnerable population exposed to opioids in the United States. OBJECTIVE: To examine trends and factors associated with opioid prescribing to women proximal to pregnancy. METHODS: The 2011 to 2015 Medical Expenditure Panel Survey (MEPS) was used to identify participants (n = 3020) with self-reported pregnancy or pregnancy-relevant events aged between 18 and 44 years old. To investigate factors associated with opioid prescriptions, we categorized participants into two subgroups: having one or more opioid prescription or having none during the observational period. We used survey multivariable logistic regression to identify factors associated with opioid prescribing accounting for the complex survey design in MEPS. RESULTS: From 2011 to 2015, the prevalence of opioid prescribing among study participants was 31%. Opioids were more likely to be prescribed to women who had psychiatric conditions (odds ratio, 1,76, 95%CI: 1.27-2.44, p < 0.001). Other significant factors included being non-Hispanic white or black, living in the South, active tobacco users, and those with lower Physical Component Summary Scores. CONCLUSION: Receipt of an opioid prescription in the perinatal period is associated with maternal psychiatric disorders in the United States. Study findings add new data to the literature on opioid use among pregnant women and provide evidence for healthcare providers and policy makers to tailor treatment and educational programs to avoid opioid overuse among pregnant women.

Historical trends in breast Cancer among women in China from age-period-cohort modeling of the 1990-2015 breast Cancer mortality data.

BACKGROUND: Evidence on historical trends extracted embedded in recent data can advance our understanding of the epidemiology of breast cancer for Chinese women. China is a country with significant political, socioeconomic, and cultural events since the 1900s; however, no such studies are reported in the literature. METHODS: Age-specific mortality rates of breast cancer during 1990-2015 in China were analyzed using APC modeling (age-period-cohort modeling) method. Net effect from birth cohort was derived to measure cancer mortality risk during 1906-1990 when no mortality data were collected, and net effect from time period was derived to measure cancer mortality risk during 1990-2015 when data were collected. Model parameters were estimated using intrinsic estimator, a novel method to handle collinearity. The estimated effects were numerical differentiated to enhance presentations of time/age trend. RESULTS: Breast cancer mortality rate per 100,000 women increased from 6.83 in 1990 to 12.07 in 2015. After controlling for age and period, the risk of breast cancer mortality declined from 0.626 in 1906-10 to - 1.752 in 1991-95 (RR = 0.09). The decline consisted of 3 phases, a gradual phase during 1906-1940, a moderate phase with some fluctuations during 1941-1970, and a rapid phase with large fluctuations during 1971-1995. After controlling for age and cohort, the risk of breast cancer mortality increased from - 0.141 in 1990 to 0.258 in 2015 (RR = 1.49) with an acceleration after 2005. The time trends revealed by both the cohort effect and the period effect were in consistency with the significant political and socioeconomic events in China since the 1900s. CONCLUSIONS: With recent mortality data in 1990-2015, we detected the risk of breast cancer mortality for Chinese women over a long period from 1906 to 2015. The risk declined more than 90% from the highest level in 1906-10 to the lowest in 1990-95, followed by an increase of 49% from 1990 to 2015. Findings of this study connected historical evidence with recent data, supporting further research to exam the relationship between development and risk of breast cancer for medical and health decision-making at the population level and prevention and treatment at the individual level.

Early prediction of moderate to severe bronchopulmonary dysplasia in extremely premature infants.

BACKGROUND: Bronchopulmonary Dysplasia (BPD) is the commonest morbidity in extremely preterm infants (PTIs). Risk factors for BPD have been described in the era before the widespread availability of non-invasive ventilation (NIV) in the delivery room (DR). The objective of this study is to identify risk factors for Moderate/Severe BPD in an era of widespread availability of NIV in the DR. METHODS: Detailed antenatal and postnatal data were abstracted for PTIs, 230/7-276/7 weeks GA. Multivariate logistic regression and classification and regression tree analyses (CART) identified predictors for the primary outcome of Moderate/Severe BPD. RESULTS: Of 263 eligible infants, 59% had Moderate/Severe BPD. Moderate/Severe BPD was significantly associated with birthweight, gender, DR intubation and surfactant compared to No/Mild BPD. Of infants not intubated in the DR, 40% with No/Mild BPD and 80% with Moderate/Severe BPD received intubation by 48 hours (p < 0.05). Infants with Moderate/Severe BPD received longer duration of oxygen and mechanical (MV). On logistic regression, birthweight, gender, oxygen concentration, cumulative duration of oxygen and MV, surfactant, and blood transfusions predicted Moderate/Severe BPD. Both CART analysis and logistic regression showed duration of oxygen and MV to be the most important predictors for Moderate/Severe BPD. CONCLUSIONS: In an era of increasing availability of NIV in the DR, lower birthweight, male gender, surfactant treatment, blood transfusions and respiratory support in the first 2-3 weeks after birth predict Moderate/Severe BPD with high sensitivity and specificity. The majority of these infants received intubation within 48 hours of birth (97%). These data suggest that early failures of NIV represent opportunities for improvement of NIV techniques and of non-invasive surfactant to avoid intubation in the first 48 hours. Furthermore, these risk factors may allow earlier identification of infants most likely to benefit from interventions to prevent or decrease severity of BPD.

Electrocardiogram Characteristics and Arrhythmic Events during Fever in Patients with Fever-Induced Brugada Syndrome.

INTRODUCTION: Changes in electrocardiogram (ECG) parameters and the incidence of arrhythmic events in patients with fever-induced Brugada syndrome (BrS) remain unknown. OBJECTIVE: We aimed to investigate the effect of hyperthermia on the ECG pattern and the occurrence of fever-triggered arrhythmic events (FTAEs) in patients with fever-induced BrS. METHODS: We retrospectively analyzed a series of fever-induced BrS cases from January 1966 to November 2018. Clinical characteristics and ECG parameters were evaluated in the presence or absence of fever. RESULTS: Syncope and implantable cardioverter defibrillator implantation occurred more frequently in BrS patients with FTAEs than in patients without FTAEs. In BrS patients <16 years old, more arrhythmia events occurred in patients with FTAEs than in patients without FTAEs (p = 0.04). During follow-up, 2 patients in the FTAEs group suffered new malignant arrhythmic events. Compared to the afebrile state, the J point increased significantly in precordial leads V1, V2, and V3 during the febrile state (all p < 0.01). The corrected QTpeak intervals in V1 and V2 were significantly longer in the FTAEs group than in the non-FTAEs group (354.5 ± 37.0 vs. 334.3 ± 45.5 ms, p < 0.01 and 368.0 ± 43.4 vs. 330.9 ± 41.5 ms, p < 0.01, respectively). An increased corrected QT dispersion and a lengthened corrected Tpeak-Tend dispersion were also observed during fever. CONCLUSIONS: Fever may not only reveal BrS but also induce life-threatening arrhythmic events, especially in children and adolescents.

Cumulative HIV Viremia Copy-Years and Hypertension in People Living with HIV.

BACKGROUND: Evidence regarding the association between HIV viral load (VL) and hypertension is inconsistent. In this study, we investigated the relationship using viremia copy-years (VCY), a cumulative measure of HIV plasma viral burden. METHODS: Data were analyzed for 686 PLWH in the Florida Cohort Study, who had at least five years of VL data before the baseline. VL data were extracted from Enhanced HIV/AIDS Reporting System (eHARS) and used to define peak VL (pVL), recent VL (rVL), and undetectable VL (uVL: rVL<50copies/mL). A five-year VCY (log10 copy × years/mL) before the baseline investigation, was calculated and divided into 5 groups (≤2.7, 2.8-3.7, 3.8-4.7, 4.8-5.7 and >5.7) for analysis. Hypertension was determined based on hypertension diagnosis from medical records. Multivariable logistic regression was used for association analysis. RESULTS: Of the total sample, 277 (40.4%) participants were hypertensive. Compared to the participants with lowest VCY (≤2.7 log10 copy × years/mL), the odds ratios (OR) and 95% confidence interval [95% CI] for hypertension of the remaining four groups, in order, were 1.91 [1.11, 3.29], 1.91 [1.03, 3.53], 2.27 [1.29, 3.99], and 1.25 [0.65, 2.42], respectively, controlling for confounders. The association was independent of pVL, rVL, and uVL, each of which was not significantly associated with hypertension. CONCLUSION: Persistent HIV infection is a risk factor for hypertension among PLWH. Information provided by VCY is more effective than single time-point VL measures in investigating HIV infection- hypertension relationship. The findings of this study support the significance of continuous viral suppression in hypertension prevention among PLWH.

Protection motivation theory in predicting cervical cancer screening participation: A longitudinal study in rural Chinese women.

OBJECTIVE: To examine factors longitudinally associated with cervical cancer screening uptake among rural Chinese women, guided by protection motivation theory (PMT). METHODS: A large sample of women (n = 2408, aged 35-65 years old) was randomly selected from a rural county in China in 2015 and followed up for 2 years. Data for demographic factors, knowledge of cervical cancer screening, screening outcome, and six PMT constructs measured at the baseline in 2015 were used to predict cervical cancer screening participation at the follow-up in 2017 using structural equation model method. RESULTS: Among the 2408 women at the baseline, 1879 (78.03%) participated in the screening services at the follow-up. In addition to significant direct effect of age, social status and baseline screening outcome, and three (perceived severity, fear arousal and response efficacy) of the six PMT subconstructs, four variables (age, social status, knowledge of cervical cancer screening, and baseline screening outcome) at the baseline were indirectly associated with screening participation, mediated by the three significant PMT subconstructs. CONCLUSIONS: Findings of this study indicate that the rate of participating in cervical cancer screening for rural women needs to be further improved. In addition to the commonly reported influential factors, PMT subconstructs play important roles in encouraging rural women in China to participate in cervical cancer screening. These longitudinal findings provided data much needed for future research to develop evidence-based intervention programs to enhance cervical cancer screening among rural women in China.

Association of Long-Term Dynamics in Circulating Testosterone with Serum PSA in Prostate Cancer-Free Men with Initial-PSA < 4 ng/mL.

We previously reported that an accelerated decline in circulating testosterone level is associated with a higher risk of prostate cancer (PCa). This study is to examine whether testosterone change rate is related to serum prostate-specific antigen (PSA) concentration among PCa-free men. Longitudinal data were derived from electronic medical records at a tertiary hospital in the Southeastern USA. PCa-free men with initial-PSA < 4 ng/mL and ≥ 2 testosterone measurements were included (n = 632). Three PSA measures (peak, the most recent, and average PSA) during the study period (from first testosterone measurement to the most recent hospital visit) were examined using multivariable-adjusted geometric means and were compared across quintiles of testosterone change rate (ng/dL/month) and current testosterone level (cross-sectional). Mean (standard deviation, SD) age at baseline was 59.3 (10.5) years; mean study period was 93.0 (55.3) months. After adjusting for covariates including baseline testosterone, the three PSA measures all significantly increased across quintile of testosterone change rate from increase to decline (peak PSA: quint 1 = 1.09, quint 5 = 1.41; the most recent PSA: quint 1 = 0.85, quint 5 = 1.00; average PSA: quint 1 = 0.89, quint 5 = 1.02; all Ptrend < 0.001). But current testosterone level was not associated with PSA levels. Stratified analyses indicated men with higher adiposity (body mass index > 24.1 kg/m2) or lower baseline testosterone (≤ 296 ng/dL) were more sensitive to testosterone change in regard to PSA. Among PCa-free men, accelerated testosterone decline might correlate with higher serum PSA concentration. It will help to elucidate the mechanisms relating aging-accompanying testosterone dynamics to prostate carcinogenesis.

Association of statin use with risk of Gleason score-specific prostate cancer: A hospital-based cohort study.

BACKGROUND: Conflicting evidence suggests that statins act chemopreventively against prostate cancer (PCa). Whether the association of statin use with PCa risk is Gleason score-dependent, time-, dose-respondent is not well studied. METHODS: We conducted a cohort study at a tertiary hospital in the Southeastern US using longitudinal data of electronic medical records (EMR) from 1994 to 2016. Only cancer-free men aged >18 years at baseline with follow-up time of ≥12 months were included. Time-dependent Cox proportional hazards regression was used to estimate adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs). RESULTS: Among 13 065 men, 2976 were diagnosed with PCa over median follow-up of 6.6 years. Statin use was associated with lower risk of both Gleason low- (score <7: aHR, 0.85; 95% CI, 0.74-0.96) and high-grade PCa (score ≥7: aHR, 0.54; 95% CI, 0.42-0.69). The protective association was observed only when statins had been used for a relatively longer duration (≥11 months) or higher dose (≥121 defined daily doses), and were more pronounced for PCa of higher Gleason score (<7: aHR, 0.85, 95% CI, 0.74-0.96; 7 [3 + 4]: aHR, 0.62, 95% CI, 0.43-0.90; 7 [4 + 3]: aHR, 0.49, 95% CI, 0.29-0.82; 8: aHR, 0.60, 95% CI, 0.37-0.96; 9-10: aHR, 0.24, 95% CI, 0.11-0.54). Lipophilic statins (aHR, 0.83; 95% CI, 0.72-0.95) might be more protective than hydrophilic statins (aHR, 0.91, 95% CI, 0.63-1.33) against PCa. CONCLUSION: Statin use might be associated with reduced PCa risk only when used for a relatively longer duration, and the risk reduction was higher for PCa of higher Gleason score.

Association of Marijuana Use with Changes in Cognitive Processing Speed and Flexibility for 17 Years in HIV-Seropositive and HIV-Seronegative Men.

BACKGROUND: The long-term effects of marijuana on cognition, particularly in the context of HIV is not clear, as extant research shows mixed findings. OBJECTIVE: To determine associations between current and cumulative exposure to marijuana and changes in cognitive processing speed and flexibility in 788 HIV-seropositive (HIV+) and 1,132 HIV-seronegative (HIV-) men followed for up to 17 years in the Multicenter AIDS Cohort Study. RESULTS: Among HIV+ men only, current daily marijuana use compared to none-use, was significantly associated with a greater annual percentage decline in cognitive processing speed assessed with the Trail Making Test A (TMTA) (ß=-0.41, 95% confidence interval (CI): -0.88, -0.03, p=0.03)] and Symbol Digit Modalities Test (SDMT) (ß= -0.14, 95% CI: -0.28, -0.01, p=0.04). Further, monthly marijuana use was associated with greater annual percentage decline in cognitive flexibility assessed with the Trail Making Test B (TMTB) (ß= -0.70, 95% CI: -1.34, -0.05; p=0.03] and cognitive processing speed (SDMT) (ß= -0.21, 95% CI: -0.40, -0.01, p=0.03). Among the HIV- men only, each 5-marijuana use-years (equivalent to 5-years of daily marijuana use) was significantly associated with a 0.17 annual percentage decline in cognitive processing speed only (TMTA) (ß= -0.18, 95% CI: -0.36, -0.01; p=0.04). CONCLUSIONS: Our findings suggest that marijuana use, particularly current use, may be associated with worse cognitive processing speed, but the magnitude of the estimates was not clinically meaningful.

The Impact of Past and Current Alcohol Consumption Patterns on Progression of Carotid Intima-Media Thickness Among Women and Men Living with HIV Infection.

BACKGROUND: The relationship between alcohol consumption and atherosclerosis has not been sufficiently examined among people living with HIV (PLWH). METHODS: We analyzed data from PLWH in the Women's Interagency HIV Study (WIHS; n = 1,164) and the Multicenter AIDS Cohort Study (MACS; n = 387) with no history of cardiovascular disease (CVD). Repeated measures of intima-media thickness of the right common carotid artery (CCA-IMT) were assessed using B-mode ultrasound from 2004 to 2013. Current alcohol consumption was collected at time of CCA-IMT measurement and was categorized according to gender-specific weekly limits. Group-based trajectory models categorized participants into past 10-year consumption patterns (1994 to 2004). Multivariate generalized estimating equations were conducted to assess the association of past and current alcohol use patterns on change in CCA-IMT by cohort, controlling for age, race, cigarette and illicit drug use, probable depression, HIV RNA viral load, antiretroviral therapy exposure, and hepatitis C coinfection. RESULTS: Among the WIHS, past heavy alcohol consumption was associated with increased CCA-IMT level over time (ß = 8.08, CI 0.35, 15.8, p = 0.04), compared to abstinence. Among the MACS, compared to abstinence, all past consumption patterns were associated with increased CCA-IMT over time (past low: ß = 15.3, 95% CI 6.46, 24.2, p < 0.001; past moderate: ß = 14.3, CI 1.36, 27.2, p = 0.03; past heavy: ß = 21.8, CI 4.63, 38.9, p = 0.01). Current heavy consumption was associated with decreased CCA-IMT among the WIHS (ß = -11.4, 95% CI -20.2, -2.63, p = 0.01) and MACS (ß = -15.4, 95% CI -30.7, -0.13, p = 0.04). No statistically significant time by consumption pattern effects were found. CONCLUSIONS: In both cohorts, 10-year heavy consumption was associated with statistically significant increases in carotid artery thickness, compared to abstinence. Long-term patterns of drinking at any level above abstinence were particularly significant for increases in IMT among men, with heavy consumption presenting with the greatest increase. Our results suggest a potentially different window of risk among past and current heavy drinkers. Further studies are needed to determine whether alcohol consumption level is associated with intermediate measures of atherosclerosis. Alcohol screening and interventions to reduce heavy consumption may benefit PLWH who are at risk of CVD.

BMI trajectories and risk of overall and grade-specific prostate cancer: An observational cohort study among men seen for prostatic conditions.

BACKGROUND: Dynamic longitudinal patterns in body mass index (BMI) have been suggested to better predict health outcomes than static measures. Effects of BMI trajectories on prostate cancer (PCa) risk have not been thoroughly explored. METHODS: Cohort data were derived from electronic medical records of patients who were admitted to a tertiary-care hospital in the Southeastern USA during 1994-2016. Patients with a history of urologic clinic visit because of any prostatic condition and with repeatedly measured BMI (n = 4857) were included. BMI trajectories prior to PCa diagnosis were assessed using the developmental trajectory analysis method. Cox proportional hazards regression modeling was used to estimate adjusted hazard ratio (aHR) with 95% confidence intervals (CIs) for overall and grade-specific PCa. RESULTS: The median age (interquartile range, IQR) of the participants at baseline was 63 (54, 72) years. Over a median follow-up (IQR) of 8.0 (2.0, 13.0) years, 714 (14.7%, 714/4857) were diagnosed with PCa. Men with growing BMI trajectory progressing from normal weight to overweight/obese had a 76% increased PCa risk (aHR = 1.76; 95% CI: 1.25, 2.48), and men being obese and experiencing progressive weight gain had 3.72-fold increased PCa risk (aHR = 3.72; 95% CI: 1.60, 8.66), compared to men with persistently normal BMI. The associations were more pronounced for PCa with Gleason score ≥7. No significant association of decreasing BMI trajectory progressing from obese to normal BMI was found with PCa risk. CONCLUSIONS: Progressively body weight gain during middle-to-late adulthood was associated with increased PCa risk for both normal weight and overweight men. Further studies are warranted to confirm this finding.

The role of benzathine penicillin G in predicting and preventing all-cause acute respiratory disease in military recruits: 1991-2017.

The adenovirus vaccine and benzathine penicillin G (BPG) have been used by the US military to prevent acute respiratory diseases (ARD) in trainees, though these interventions have had documented manufacturing problems. We fit Poisson regression and random forest models (RF) to 26 years of weekly ARD incidence data to explore the impact of the adenovirus vaccine and BPG prophylaxis on respiratory disease burden. Adenovirus vaccine availability was among the most important predictors of ARD in the RF, while BPG was the ninth most important. BPG was a significant protective factor against ARD (incidence rate ratio (IRR) = 0.68; 95% confidence interval (CI) 0.67-0.70), but less so than either the old or new adenovirus vaccine (IRR = 0.39, 95% CI 0.38-0.39 and IRR = 0.11, 95% CI 0.11-0.11), respectively. These results suggest that BPG is moderately predictive of, and significantly protective against ARD, though to a lesser extent than either the old or new adenovirus vaccine.

Probabilistic Discrete Event Systems Modeling of Nonlinear Transitions between Electronic and Combustible Cigarette Smoking with the 2014 National Youth Tobacco Survey Data.

A growing number of young people smoke electronic (e-) cigarettes, presenting an emerging challenge to tobacco control. Analyses are needed to better understand the dynamics of mutual transitions between e-cigarette and conventional combustible (c-) cigarette smoking to advance evidence-based tobacco control. In this study we modeled the nonlinear dynamics of c- and e-cigarette smoking behavior transitions using the 2014 National Youth Tobacco Survey (NYTS) data. A model with five Markov-Chain transition stages linked by 21 transitional paths/probabilities was constructed, guided by the probabilistic discrete event systems (PDES) theory. The Moore-Penrose generalized inverse matrix was used to solve the proposed model that was under-determined. The estimated transitional probabilities indicate that each year, 7-8% of middle school students and 11% of high school students initiated smoking. E-cigarettes were more attractive then c-cigarettes but the behavior of smoking c-cigarettes was more stable than that of smoking e-cigarettes. Female students were more likely to remain as quitters or ex-smokers while male students were more likely to relapse and smoke again. Findings of this nonlinear dynamics modelling indicate potential increases in both e- and c-cigarette smoking among U.S. middle and high school students if no further measures are taken. The PDES-based approach is effective to investigate the nonlinear dynamics of mutual transitions of two risk behaviors in adolescents with one wave cross-sectional data.