Cumulative inequality in social determinants of health in relation to depression symptom: An analysis of nationwide cross-sectional data from U.S. NHANES 2005-2018.

Social determinants of health (SDoH) have been linked to a higher likelihood of experiencing mental health problems. This study aimed to investigate whether the accumulation of unfavorable SDoH is associated with depression symptom. Data was gathered from a representative population participating in the U.S. National Health and Nutrition Examination Survey spanning from 2005 to 2018. Self-reported SDoH were operationalized according to the criteria outlined in Healthy People 2030, with a cumulative measure of unfavorable SDoH calculated for analysis. The presence of depression symptom was identified using the Patient Health Questionnaire in a representative sample of 30,762 participants (49.2 % males) representing 1,392 million non-institutionalized U.S. adults, with 2,675 (8.7 %) participants showing depression symptom. Unfavorable SDoH were found to be significantly and independently associated with depression symptom. Individuals facing multiple unfavorable SDoHs were more likely to experience depression symptom (P for trend < 0.001). For instance, a positive association was observed in participants exposed to six or more unfavorable SDoHs with depression symptom (AOR = 3.537, 95 % CI: 1.781, 7.075, P-value < 0.001). The findings emphasize that the likelihood of developing depression symptom significantly increases when multiple SDoHs are present, compared to just a single SDoH.

Sexual orientation disparities in the prevalence of suicidal ideation among U.S adults aged 20 to 59 years: Results from NHANES 2005-2016.

Existing studies have been limited in providing nationally representative data on the relationship between sexual orientation and suicidal ideation (SI) among adults in the U.S. particularly in terms of gender and racial differences. To fill this research gap, we conducted a study using data from the NHANES conducted between 2005 and 2016. Survey-weighted logistic regression models were used to investigate the relationship between sexual orientation and SI risk. Additionally, we performed further analysis by stratifying the data based on demographic variables and performed sensitivity analysis to ensure the reliability of our findings. This study included a weighted sample of 16,564 adults, representing a noninstitutionalized U.S population of 840.1 million. The overall age-adjusted prevalence of SI was found to be 3.5 %. After adjusting for relevant covariates, the study revealed that individuals who identified as something else, homosexual, and bisexual had a higher prevalence risk of suicidal ideation (SI) compared to heterosexual participants. Additionally, the study found that heterosexual participants were 74.4 % less likely to experience SI compared to bisexual individuals. These findings highlight the urgent requirement for inclusive and supportive prevention strategies to effectively address SI among adult sexual minorities in the U.S.

Reinforced risk prediction with budget constraint using irregularly measured data from electronic health records.

Uncontrolled glycated hemoglobin (HbA1c) levels are associated with adverse events among complex diabetic patients. These adverse events present serious health risks to affected patients and are associated with significant financial costs. Thus, a high-quality predictive model that could identify high-risk patients so as to inform preventative treatment has the potential to improve patient outcomes while reducing healthcare costs. Because the biomarker information needed to predict risk is costly and burdensome, it is desirable that such a model collect only as much information as is needed on each patient so as to render an accurate prediction. We propose a sequential predictive model that uses accumulating patient longitudinal data to classify patients as: high-risk, low-risk, or uncertain. Patients classified as high-risk are then recommended to receive preventative treatment and those classified as low-risk are recommended to standard care. Patients classified as uncertain are monitored until a high-risk or low-risk determination is made. We construct the model using claims and enrollment files from Medicare, linked with patient Electronic Health Records (EHR) data. The proposed model uses functional principal components to accommodate noisy longitudinal data and weighting to deal with missingness and sampling bias. The proposed method demonstrates higher predictive accuracy and lower cost than competing methods in a series of simulation experiments and application to data on complex patients with diabetes.

Comprehensive Assessment for the Impacts of S/IVOC Emissions from Mobile Sources on SOA Formation in China.

Semivolatile/intermediate-volatility organic compounds (S/IVOCs) from mobile sources are essential SOA contributors. However, few studies have comprehensively evaluated the SOA contributions of S/IVOCs by simultaneously comparing different parameterization schemes. This study used three SOA schemes in the CMAQ model with a measurement-based emission inventory to quantify the mobile source S/IVOC-induced SOA (MS-SI-SOA) for 2018 in China. Among different SOA schemes, SOA predicted by the 2D-VBS scheme was in the best agreement with observations, but there were still large deviations in a few regions. Three SOA schemes showed the peak value of annual average MS-SI-SOA was up to 0.6 ± 0.3 µg/m3. High concentrations of MS-SI-SOA were detected in autumn, while the notable relative contribution of MS-SI-SOA to total SOA was predicted in the coastal areas in summer, with a regional average contribution up to 20 ± 10% in Shanghai. MS-SI-SOA concentrations varied by up to 2 times among three SOA schemes, mainly due to the discrepancy in SOA precursor emissions and chemical reactions, suggesting that the differences between SOA schemes should also be considered in modeling studies. These findings identify the hotspot areas and periods for MS-SI-SOA, highlighting the importance of S/IVOC emission control in the future upgrading of emission standards.

[Geographical Detection of Spatial Heterogeneity and Drivers of PM2.5 in the Yangtze River Economic Belt].

Based on ground monitoring data, we explored the spatiotemporal characteristics and drivers of PM2.5 in the Yangtze River Economic Belt (YREB) in 2018 using spatial autocorrelation analysis and geodetector modeling methods. The results showed that:① the PM2.5 concentration in the YREB posed the obvious characteristics of low values in summer and high values in winter, seasonal variation in spring and autumn, monthly U-shaped variation, and daily pulse variation. The low value area was mainly concentrated in the south bank of the upper reaches, whereas the high value area was located in the north of the middle-lower reaches of the YREB. ② PM2.5 pollution in the YREB had a stable positive spatial correlation, and the local association pattern showed a significant HH and LL spatial convergence. ③ The spatial correlation of PM2.5 in the YREB decreased with the increase in geographical distance, and its spatial autocorrelation threshold was approximately 870 km, within which the spatial agglomeration of PM2.5 pollution was strong. ④ The influences of natural and anthropogenic factors on PM2.5 had significant spatial differences. Altitude, relief, and population density were the high impact factors of PM2.5 pollution in the YREB. The interaction of factors had a far greater explanatory power on PM2.5 pollution than that of single factors. The dominant interaction factor was industrial structure ∩ altitude, which reflected the complexity of the drivers of air pollution in the YREB.

Assessment of summertime O3 formation and the O3-NOX-VOC sensitivity in Zhengzhou, China using an observation-based model.

Zhengzhou, the provincial capital of Henan province in Central China and a major hub of the country's transportation network, has been suffering from severe summertime ozone (O3) pollution. Simultaneous field measurements of O3 and its precursors, including NOx, CO, HONO, and 106 volatile organic compounds (VOCs), were conducted at an urban site (the municipal environmental monitoring station, MEM) in Zhengzhou in July 2019. The Community Multiscale Air Quality (CMAQ) model, which incorporates the Master Chemical Mechanism (MCMv3.3.1), was modified to work as a 0-D observation-based photochemical box model to assess the sources and sinks of HOx radicals and O3, and the OH reactivity (KOH) and ozone formation potential (OFP) of major VOC groups. In addition, the O3-NOx-VOC sensitivity was evaluated using the relative incremental reactivity (RIR) and O3 formation isopleth techniques. The OH radicals were mainly generated from the propagation reaction of HO2 + NO (91-95%). The daily average mixing ratios of OH and HO2 radicals were significantly higher during high O3 days, reaching as high as 4.8 × 106 and 7.7 × 108 molecules cm-3, respectively. Photochemical O3 formation was mostly due to the conversion of NO to NO2 by HO2 radicals (52-54%), while the NO2 + OH reaction was the main contributor to O3 destruction (70- 76%). Alkenes and aromatics were the main anthropogenic VOC contributors to KOH and OFP. Contributions of biogenic VOCs became much more important on high O3 days, correlating with the increase in temperature and solar radiation. RIR analysis showed that the O3 formation was under the VOC-limited on low O3 days but was in the transition regime during the O3 pollution buildup and persisting days. These results are generally consistent with those based on the O3 formation isopleth. This paper provides important corroborative scientific evidence urgently needed by local governments to formulate O3 pollution control strategies.

Estimation of Aromatic Secondary Organic Aerosol Using a Molecular Tracer-A Chemical Transport Model Assessment.

A modified community multiscale air quality model, which can simulate the regional distributions of 2,3-dihydroxy-4-oxopentanoic acid (DHOPA), a marker species for monoaromatic secondary organic aerosol (SOA), was applied to assess the applicability of using the DHOPA to aromatic SOA mass ratio (fSOA) from smog chamber experiments to estimate aromatic SOA during a three-week wintertime air quality campaign in urban Shanghai. The modeled daily DHOPA concentrations based on the chamber-derived mass yields agree well with the organic marker field measurements (R = 0.79; MFB = 0.152; and MFE = 0.440). Two-thirds of the DHOPA are from the oxidation of ARO1 (lumped less-reactive aromatic species; mostly toluene), with the rest from ARO2 (lumped more-reactive aromatic species; mostly xylenes). Modeled DHOPA is mainly in the particle phase under ambient organic aerosol (OA) loading but could exhibit significant gas-particle partitioning when a higher estimation of the DHOPA vapor pressure is used. The modeled fSOA shows a strong dependence on the OA loading when only semivolatile aromatic SOA components are included in the fSOA calculations. However, this OA dependence becomes weaker when non-volatile oligomers and dicarbonyl SOA products are considered. A constant fSOA value of ∼0.002 is determined when all aromatic SOA components are included, which is a factor of 2 smaller than the commonly applied chamber-based fSOA value of 0.004 for toluene. This model-derived fSOA value does not show much spatial variation and is not sensitive to alternative estimates of DHOPA vapor pressures and SOA yields, and thus provides an appropriate scaling factor to assess aromatic SOA from DHOPA measurements. This result helps refine the quantification of SOA attributable to monoaromatic hydrocarbons in urban environments and thereby facilitates the evaluation of control measures targeting these specific precursors.

Molecular characteristics, source contributions, and exposure risks of polycyclic aromatic hydrocarbons in the core city of Central Plains Economic Region, China: Insights from the variation of haze levels.

In this study, molecular characteristics, source contributions, and health risks of polycyclic aromatic hydrocarbons (PAHs) in PM2.5 for four haze levels in Zhengzhou, a megacity in central China with severe air pollution problems, have been analyzed. The concentrations of PAHs and PM2.5 on heavy haze (HH) days were 63% and 122% higher than non-haze (NH) days. The occurrence of high PAH concentration was often accompanied by the northwest wind along with adverse meteorological conditions that limit regional dispersion. The source apportionment results indicated that almost all sources contributed more PAH concentration on haze days. In particular, coal combustion and vehicle emissions contributions were almost doubled on HH days. The incremental lifetime cancer risk (ILCR) of PAHs has been assessed. BaP and DahA showed relatively high contributions to ILCR, and 31%-48% of ILCR is due to exposure to PAHs on high HH days.

Assessment of mobile source contributions in El Paso by PMF receptor modeling coupled with wind direction analysis.

It is well-known that El Paso is the only border area in Texas that has violated national air quality standards. Mobile source emissions (including vehicle exhaust) contribute significantly to air pollution, along with other sources including industrial, residential, and cross-border. This study aims at separating unobserved vehicle emissions from air-pollution mixtures indicated by ambient air quality data. The level of contributions from vehicle emissions to air pollution cannot be determined by simply comparing ambient air quality data with traffic levels because of the various other contributors to overall air pollution. To estimate contributions from vehicle emissions, researchers employed advanced multivariate receptor modeling called positive matrix factorization (PMF) to analyze hydrocarbon data consisting of hourly concentrations measured from the Chamizal air pollution monitoring station in El Paso. The analysis of hydrocarbon data collected at the Chamizal site in 2008 showed that approximately 25% of measured Total Non-Methane Hydrocarbons (TNMHC) was apportioned to motor vehicle exhaust. Using wind direction analysis, researchers also showed that the motor vehicle exhaust contributions to hydrocarbons were significantly higher when winds blow from the south (Mexico) than those when winds blow from other directions. The results from this research can be used to improve understanding source apportionment of pollutants measured in El Paso and can also potentially inform transportation planning strategies aimed at reducing emissions across the region.

What Matters When It Comes to Trust in One's Physician: Race/Ethnicity, Sociodemographic Factors, and/or Access to and Experiences with Health Care?

Purpose: Interpersonal trust is linked to therapeutic factors of patient care, including adherence to treatment, continuity with a provider, perceived effectiveness of care, and clinical outcomes. Differences in interpersonal trust across groups may contribute to health disparities. We explored whether differences in interpersonal trust varied across three racial/ethnic groups. Additionally, we explored how different health care factors were associated with differences in trust. Methods: We conducted a cross-sectional, computer-administered survey with 600 racially and ethnically diverse adults in Chicago, IL, from a wide variety of neighborhoods. We used staged ordinal logistic regression models to analyze the association between interpersonal trust and variables of interest. Results: Interpersonal trust did not differ by racial or ethnic group. However, individuals with 0-2 annual doctor visits, those reporting having a "hard time" getting health care services, those answering "yes" to "Did you not follow advice or treatment plan because it cost too much?," and those reporting waiting more than 6 days/never getting an appointment had significantly increased odds of low trust. We did not find differences across racial/ethnic groups. Conclusion: Our study suggests that access to health care and interactions within the health care setting negatively impact individual's trust in their physician.

Estimating population exposure to ambient polycyclic aromatic hydrocarbon in the United States - Part II: Source apportionment and cancer risk assessment.

A revised Community Multiscale Air Quality (CMAQ) model was developed to simulate the emission, reactions, transport, deposition and gas-to-particle partitioning processes of 16 priority polycyclic aromatic hydrocarbons (PAHs), as described in Part I of the two-part series. The updated CMAQ model was applied in this study to quantify the contributions of different emission sources to the predicted PAH concentrations and excess cancer risk in the United States (US) in 2011. The cancer risk in the continental US due to inhalation exposure of outdoor naphthalene (NAPH) and seven larger carcinogenic PAHs (cPAHs) was predicted to be significant. The incremental lifetime cancer risk (ILCR) exceeds 1×10-5 in many urban and industrial areas. Exposure to PAHs was estimated to result in 5704 (608-10,800) excess lifetime cancer cases. Point sources not related with energy generation and the oil and gas processes account for approximately 31% of the excess cancer cases, followed by non-road engines with 18.6% contributions. Contributions of residential wood combustion (16.2%) are similar to that of transportation-related sources (mostly motor vehicles with small contributions from railway and marine vessels; 13.4%). The oil and gas industry emissions, although large contributors to high concentrations of cPAHs regionally, are only responsible of 4.3% of the excess cancer cases, which is similar to the contributions of non-US sources (6.8%) and non-point sources (7.2%). The power generation units pose the most minimal impact on excess cancer risk, with contributions of approximately 2.3%.

Efficient Assessment of Developmental, Surgical and Pathological Lymphangiogenesis Using a Lymphatic Reporter Mouse and Its Embryonic Stem Cells.

Several lymphatic reporter mouse lines have recently been developed to significantly improve imaging of lymphatic vessels. Nonetheless, the usage of direct visualization of lymphatic vessels has not been fully explored and documented. Here, we characterized a new Prox1-tdTomato transgenic lymphatic reporter mouse line, and demonstrated how this animal tool enables the researchers to efficiently assess developmental, surgical and pathological lymphangiogenesis by direct visualization of lymphatic vessels. Moreover, we have derived embryonic stem cells from this reporter line, and successfully differentiated them into lymphatic vessels in vivo. In conclusion, these experimental tools and techniques will help advance lymphatic research.

Comparing guideline-based care quality for inflammatory bowel disease and rheumatoid arthritis patients within a medical home.

BACKGROUND: Rheumatoid arthritis (RA) and inflammatory bowel disease (IBD) patient populations face similar risks of chronic immunosuppression including corticosteroid use. We compared the receipt of preventive services between IBD and RA populations according to published quality metrics. METHODS: We defined a single-center cohort of patients with IBD or RA receiving specialty and primary care. Electronic health record abstraction assessed quality metrics, sociodemographics, comorbidity, and utilization. Comparisons used multivariate odds ratios and Student's t-tests. RESULTS: 218 RA and 190 IBD patients were included. In multivariate analysis, IBD patients were less likely to receive pneumococcal vaccination (OR=0.29, 95% CI: 0.11-0.85), while RA patients underwent glucocorticoid-induced osteoporosis screening more often (100% vs. 82.5%, p = 0.023). CONCLUSIONS: Gastroenterologists can improve care quality for IBD patients by assuming greater responsibility for preventive care in IBD patients and/or collaborating with primary care and health systems to improve preventive care delivery.

Preterm birth and air pollution: Critical windows of exposure for women with asthma.

BACKGROUND: Ambient air pollutants may increase preterm birth (PTB) risk, but critical exposure windows are uncertain. The interaction of asthma and pollutant exposure is rarely studied. OBJECTIVE: We sought to assess the interaction of maternal asthma and air pollutant exposures in relation to PTB risk. METHODS: Electronic medical records for 223,502 US deliveries were linked with modified Community Multiscale Air Quality model outputs. Logistic regression with generalized estimating equations estimated the odds ratio and 95% CIs for PTB on the basis of the interaction of maternal asthma and particulate matter with aerodynamic diameter of less than 2.5 microns and particulate matter with aerodynamic diameter of less than 10 microns, ozone (O3), nitrogen oxides (NOx), sulfur dioxide (SO2), and carbon monoxide (CO) per interquartile range. For each gestational week 23 to 36, exposures among women who delivered were compared with those remaining pregnant. Three-month preconception, whole pregnancy, weeks 1 to 28, and the last 6 weeks of gestation averages were also evaluated. RESULTS: On assessing PTB by gestational week, we found that significant asthma interactions were sporadic before 30 weeks but more common during weeks 34 to 36, with higher risk among mothers with asthma for NOx, CO, and SO2 exposure and an inverse association with O3 in week 34. Odds of PTB were significantly higher among women with asthma for CO and NOx exposure preconception and early in pregnancy. In the last 6 weeks of pregnancy, PTB risk associated with particulate matter with aerodynamic diameter of less than 10 microns was higher among women with asthma. CONCLUSIONS: Mothers with asthma may experience a higher risk for PTB after exposure to traffic-related pollutants such as CO and NOx, particularly for exposures 3-months preconception and in the early weeks of pregnancy.

Spatial illustration of health-care workforce accessibility index in China: How far has our 2009 health-care reform brought us?

OBJECTIVE: The objective of the study was to evaluate the effectiveness of China's health-care reform from 2009 to 2011 by examining China's annual health-care workforce statistics of 2008 and 2011. DESIGN: The design of the study was a secondary data analysis. MAIN OUTCOME MEASURE: The main outcome measure used was the Primary Health Care Worker Accessibility Index (PHCWA). RESULTS: The statistics illustrated the impact health-care reform had on the provision of primary health care in rural areas. The results showed that the health-care reform of 2009 generally improved access to the primary health-care workforce in all 28 areas (range of increase: 13.18-324.0%). However, an increasing disparity in regional health care based on the increase of the standard deviations of PHCWA (range of increase: 36.44-77.10%) may be an issue that policy-makers and analysts will have to face. CONCLUSIONS: Concerted policy efforts from both the provincial and central governments are needed to narrow the gaps. Regional development should not only focus on the economic aspect, but also account for the fact that the adequate provision of primary health care is part of the infrastructure that makes development possible and sustainable.

Electronic health records and community health surveillance of childhood obesity.

BACKGROUND: Childhood obesity remains a public health concern, and tracking local progress may require local surveillance systems. Electronic health record data may provide a cost-effective solution. PURPOSE: To demonstrate the feasibility of estimating childhood obesity rates using de-identified electronic health records for the purpose of public health surveillance and health promotion. METHODS: Data were extracted from the Public Health Information Exchange (PHINEX) database. PHINEX contains de-identified electronic health records from patients primarily in south central Wisconsin. Data on children and adolescents (aged 2-19 years, 2011-2012, n=93,130) were transformed in a two-step procedure that adjusted for missing data and weighted for a national population distribution. Weighted and adjusted obesity rates were compared to the 2011-2012 National Health and Nutrition Examination Survey (NHANES). Data were analyzed in 2014. RESULTS: The weighted and adjusted obesity rate was 16.1% (95% CI=15.8, 16.4). Non-Hispanic white children and adolescents (11.8%, 95% CI=11.5, 12.1) had lower obesity rates compared to non-Hispanic black (22.0%, 95% CI=20.7, 23.2) and Hispanic (23.8%, 95% CI=22.4, 25.1) patients. Overall, electronic health record-derived point estimates were comparable to NHANES, revealing disparities from preschool onward. CONCLUSIONS: Electronic health records that are weighted and adjusted to account for intrinsic bias may create an opportunity for comparing regional disparities with precision. In PHINEX patients, childhood obesity disparities were measurable from a young age, highlighting the need for early intervention for at-risk children. The electronic health record is a cost-effective, promising tool for local obesity prevention efforts.

A novel dimeric thymosin beta 4 with enhanced activities accelerates the rate of wound healing.

OBJECTIVE: Thymosin beta 4 (Tß4) is a peptide with 43 amino acids that is critical for repair and remodeling tissues on the skin, eye, heart, and neural system following injury. To fully realize its utility as a treatment for disease caused by injury, the authors constructed a cost-effective novel Tß4 dimer and demonstrated that it was better able to accelerate tissue repair than native Tß4. METHODS: A prokaryotic vector harboring two complete Tß4 genes with a short linker was constructed and expressed in Escherichia coli. A pilot-scale fermentation (10 L) was performed to produce engineered bacteria and the Tß4 dimer was purified by one-step hydrophobic interaction chromatography. The activities of the Tß4 dimer to promote endothelial cell proliferation, migration, and sprouting were assessed by tetramethylbenzidine (methylthiazol tetrazolium), trans-well, scratch, and tube formation assays. The ability to accelerate dermal healing was assessed on rats. RESULTS: After fermentation, the Tß4 dimer accounted for about 30% of all the bacteria proteins. The purity of the Tß4 dimer reached 98% after hydrophobic interaction chromatography purification. An average of 562.4 mg/L Tß4 dimer was acquired using a 10 L fermenter. In each assay, the dimeric Tß4 exhibited enhanced activities compared with native Tß4. Notably, the ability of the dimeric Tß4 to promote cell migration was almost two times higher than that of Tß4. The rate of dermal healing in the dimeric Tß4-treated rats was approximately 1 day faster than with native Tß4-treated rats. CONCLUSION: The dimeric Tß4 exhibited enhanced activity on wound healing than native Tß4, and the purification process was simple and cost-effective. This data could be of significant benefit for the high pain and morbidity associated with chronic wounds disease. A better strategy to develop Tß4 as a treatment for other diseases caused by injuries such as heart attack, neurotrophic keratitis, and multiple sclerosis was also described.

Rapid and cost-effective gene targeting in rat embryonic stem cells by TALENs.

The rat is the preferred animal model in many areas of biomedical research and drug development. Genetic manipulation in rats has lagged behind that in mice due to the lack of efficient gene targeting tools. Previously, we generated a knockout rat via conventional homologous recombination in rat embryonic stem (ES) cells. Here, we show that efficient gene targeting in rat ES cells can be achieved quickly through transcription activator-like effector nuclease (TALEN)-mediated DNA double-strand breaks. Using the Golden Gate cloning technique, we constructed a pair of TALEN targeting vectors for the gene of interest in 5 days. After gene transfection, the targeted rat ES cell colonies were isolated, screened, and confirmed by PCR without the need of drug selection. Our results suggest that TALEN-mediated gene targeting is a superior means of establishing genetically modified rat ES cell lines with high efficiency and short turnaround time.