Exposure to early-life adversity and long-term trajectories of multimorbidity among older adults in China: analysis of longitudinal data from the China Health and Retirement Longitudinal Study.

OBJECTIVES: This study aimed to identify long-term distinct trajectories of multimorbidity with ageing from 50 to 85 years among Chinese older adults and examine the relationship between exposure to early-life adversity (ELA; including specific types of adversity and accumulation of different adversities) and these long-term multimorbidity trajectories. DESIGN: The group-based trajectory models identified long-term multimorbidity trajectories. Multinomial logistic regression models were used to examine the relationship between ELA and the identified multimorbidity trajectories. SETTING: This study used data from the China Health and Retirement Longitudinal Study (CHARLS, 2011-2018) and the 2014 Life History Survey. PARTICIPANTS: We used data from 9112 respondents (aged 60 and above) of the 2018 wave of CHARLS. OUTCOME MEASURES: Each respondent's history of chronic conditions and experiences of ELA were collected from the 2011-2018 waves of CHARLS and the 2014 Life History Survey. RESULTS: Four heterogeneous long-term trajectories of multimorbidity development were identified: 'maintaining-low' (19.1%), 'low onset-rapidly increasing' (23.3%), 'middle onset-moderately increasing' (41.5%) and 'chronically-high' (16.2%). Our findings indicated that the heterogeneity can be explained by ELA experiences. Across various types of different ELA experiences, exposure to food insufficiency (relative risk ratios from 1.372 (95% CI 1.190 to 1.582) to 1.780 (95% CI 1.472 to 2.152)) and parental quarrel/divorce (relative risk ratios from 1.181 (95% CI 1.000 to 1.394) to 1.262 (95% CI 1.038 to 1.536)) had the most prominent associations with health deterioration. The accumulation of more different ELA experiences was associated with a higher relative risk of developing more severe multimorbidity trajectories (relative risk ratio for five to seven ELAs and chronically high trajectory: 7.555, 95% CI 4.993 to 11.431). CONCLUSIONS: There are heterogeneous long-term trajectories of multimorbidity in Chinese older adults, and the risk of multimorbidity associated with ELA accumulates over the lifespan. Our findings highlight the role of a supportive early-life family environment in promoting health development across the lifespan, advocating for the integration of life-course approaches to implementing health disparity interventions.

Viewpoint Recommendation for Point Cloud Labeling through Interaction Cost Modeling.

Semantic segmentation of 3D point clouds is important for many applications, such as autonomous driving. To train semantic segmentation models, labeled point cloud segmentation datasets are essential. Meanwhile, point cloud labeling is time-consuming for annotators, which typically involves tuning the camera viewpoint and selecting points with a lasso tool. To reduce the time cost of point cloud labeling, we propose a viewpoint recommendation approach to reduce annotators' labeling time costs. We adapt Fitts' law to model the time cost of lasso selection in point clouds. Using the modeled time cost, the viewpoint that minimizes the lasso selection time cost is recommended to the annotator. We build a data labeling system for semantic segmentation of 3D point clouds that integrates our viewpoint recommendation approach. The system enables users to navigate to recommended viewpoints for efficient annotation. Through a user study, we observed that our approach effectively reduced the data labeling time cost. We also qualitatively compare our approach with previous viewpoint selection approaches on different datasets.

Fabricating a photochromic benzonitrile Schiff base into a low-cost reusable paper-based wearable sensor for naked-eye dosimetry of UV radiations.

We report in this study a photochromic benzonitrile Schiff base, (E)-4-((2-hydroxy-4-methoxybenzylidene)amino)benzonitrile (HMBAB). The molecular design, synthesis, aggregation-induced emission (AIE) as well as the quantum chemical calculations were outlined. In particular, HMBAB would undergo a reversible tautomerism in response to UV exposure, exhibiting remarkable changes in both absorption and emission: the compound shows yellow color and green-yellow luminescence; after UV exposure, the changes into orange-red while the luminescence is dramatically quenched, accompanied by a large bathochromic-shift. In addition, the photochromic state can be fully recovered via thermal treatment. Such reversible dual-channel photochromism was investigated using UV-vis reflectance spectroscopy and colorimeter, wherein a gradient change with time and a high fatigue resistance in cycle use was recorded. The photochromism is quantified by well-established RGB and Lab color space, in which the color change can be accurately analyzed by the chromatic aberration (ΔE*Lab). Sensitivity test gives a two-stage linear relation between ΔE*Lab and UV intensity, by which a limit of detection (LOD) as low as 67 µW/cm2 is obtained. HMBAB was further fabricated into a paper-based wearable sensor, capable of being integrated into a chest card or a bracelet. It exhibits various degrees of color change in different sunlight environments, which can be readily observed by naked eyes, providing an early warning for high-dose UV radiations.

A gender perspective on the global migration of scholars.

Although considerable progress toward gender equality in science has been made in recent decades, female researchers continue to face significant barriers in the academic labor market. International mobility has been increasingly recognized as a strategy for scientists to expand their professional networks, and that could help narrow the gender gap in academic careers. Using bibliometric data on over 33 million Scopus publications, we provide a global and dynamic view of gendered patterns of transnational scholarly mobility, as measured by volume, distance, diversity, and distribution, from 1998 to 2017. We find that, while female researchers continued to be underrepresented among internationally mobile researchers and migrate over shorter distances, this gender gap was narrowing at a faster rate than the gender gap in the population of general active researchers. Globally, the origin and destination countries of both female and male mobile researchers became increasingly diversified, which suggests that scholarly migration has become less skewed and more globalized. However, the range of origin and destination countries continued to be narrower for women than for men. While the United States remained the leading academic destination worldwide, the shares of both female and male scholarly inflows to that country declined from around 25% to 20% over the study period, partially due to the growing relevance of China. This study offers a cross-national measurement of gender inequality in global scholarly migration that is essential for promoting gender-equitable science policies and for monitoring the impact of such interventions.

Association between multimorbidity patterns and healthcare costs among middle-aged and older adults in China.

BACKGROUND: This study investigated multimorbidity patterns among middle-aged and older Chinese people and whether healthcare costs varied among different multimorbidity patterns. METHODS: Data were from the 2011-2018 waves of the China Health and Retirement Longitudinal Study (CHARLS). We included 20,855 unique observations with information coming from their last wave of interviews and aged at least 45 years or older. Latent class analysis (LCA) was performed to classify individuals with common multimorbidity clusters based on 14 self-reported chronic diseases. Healthcare costs were from participants' self-reports and categorized into outpatient, inpatient, and self-treatment. Two-part regression was performed to analyze the association of multimorbidity patterns with healthcare costs. RESULTS: Five multimorbidity clusters were identified: minimal disease, arthritis, cardiovascular disease (CVD), lung/asthma, and multisystem morbidity. The multisystem morbidity group had the highest use in all three types of healthcare and the highest self-treatment cost. Compared with the minimal disease group, the other four groups did not show significant differences in outpatient costs. Relative to the minimal disease group, the lung/asthma group reported lower inpatient costs. CONCLUSION: Healthcare use and costs varied across multimorbidity patterns among middle-aged and older Chinese people. Implementing an integrated care plan for multimorbidity is suggested to improve the cost-effectiveness of healthcare provision and reduce the financial burden of the healthcare system. Reimbursement policy design should also take multimorbidity patterns into account.

Association between multimorbidity patterns and catastrophic health expenditure among Chinese older adults living alone.

BACKGROUND: Multimorbidity is prevalent among older adults and may result in catastrophic health expenditures (CHEs) on older adults' households. However, whether older adults living alone suffer such a financial burden is unknown. We aimed to investigate the association between multimorbidity patterns and CHE in Chinese older adults living alone. METHODS: We included 884 participants aged 60 years and over and living alone from the 2018 wave of the China Health and Retirement Longitudinal Study (CHARLS). Latent class analysis was performed to identify multimorbidity patterns based on 14 self-reported chronic diseases. The logit model and Tobit model were adopted to analyze the association of multimorbidity patterns with the incidence and intensity of CHE, respectively. RESULTS: Approximately 20.2% of the older adults living alone experienced CHE. Among the four multimorbidity groups (minimal disease, cardiovascular, lung and asthma, and multisystem), the multisystem group and cardiovascular group had significantly higher incidence and intensity of CHE than the minimal disease group. CONCLUSIONS: Older adults living alone had high risks of CHE, especially those belonging to the multisystem pattern and cardiovascular pattern. Integrated care should be adopted in the treatment of multimorbidity to reduce health costs. More elder services and social assistance should be provided to solitary older adults with certain patterns of multimorbidity.

Social affiliation moderates the link between depressive symptoms and heart rate variability in healthy middle-aged and older individuals: An intensive ecologic momentary assessment study.

Depressive symptoms have been associated with lower cardiac autonomic control, thus contributing to cardiovascular diseases, especially among older adults. Interpersonal factors have been found to attenuate physiologic stress responses, but little is known about whether these factors (e.g., perceived affiliation) would moderate the relation of depressive symptoms and cardiovascular activation. The present research aimed to investigate the interplay of depressive symptoms and momentary-assessed interpersonal perceptions on cardiac vagal tone as indexed by heart rate variability (HRV). The sample consisted of 78 late middle-aged and older community-dwelling participants (48.7% male, mean age = 59.15 years). Participants reported on depressive symptoms and other personal characteristics by questionnaire. Perceptions of interpersonal affiliation, ambulatory HRV, and contextual variables were recorded using ecologic momentary assessment and portable electrocardiogram (ECG) monitoring device throughout 1 week (with a maximum of seven times daily). Multilevel analyses found that depressive symptoms were correlated with lower HRV, whereas momentary interpersonal perceptions of higher affiliation were associated with elevated HRV. A significant association was revealed between depressive symptoms and momentary affiliation perceptions on HRV. When individuals were involved in social interactions with higher affiliation, the effect of depressive symptoms on reducing HRV was attenuated. These findings suggested that the effects of subthreshold depressive symptoms on vagal control of the heart could be altered by the quality of interpersonal experiences.

An efficient and cost-effective method for the purification of human basophils.

Human basophils are terminally differentiated granulocytes that are least abundant in the peripheral blood but play important roles in allergic diseases. Studies on human basophils are limited by the high cost on the isolation of human basophils by magnetic-activated cell sorting (MACS) for negative depletion of non-basophils, followed by CD123-based positive selection of basophils. Moreover, such CD123-based purification of basophils may be limited by blocking of the binding of IL-3/anti-CD123 to the surface CD123. Here we identified SSClow CD4- CD127- HLA-DR- CRTH2high as unique markers for the identification of human basophils through stringent flow cytometric analysis of leukocytes from buffy coat. We established an efficient and cost-effective method for isolating human basophils from buffy coat based on positive magnetic selection of CRTH2+ cells followed by flow cytometric sorting of SSClow CD4- CD127- HLA-DR- CRTH2high cells. Approximately 1 to 1.5 million basophils were isolated from one buffy coat with a purity of >97%. Basophils purified by this method were viable and efficiently responded to key regulators of basophils including IL-3 and anti-IgE. This method can be used for purifying human basophils for subsequent functional studies.

An exploration of older Hong Kong residents' willingness to make copayments toward vouchers for community care.

Because of its rapidly aging population, Hong Kong faces great challenges in the provision and financing of long-term care (LTC) and needs to explore sustainable funding mechanisms. However, there is a paucity of research on older people's willingness to pay (WTP) for LTC services in Hong Kong. This study utilizes data collected in Hong Kong in 2011 (N = 536) to investigate older people's receptivity to this financing mode by assessing their co-payments for a community care service voucher scheme and then testing how potential factors affect respondents' amount of co-payment. Results show that respondents' WTP was positively associated with family financial support, financial condition, and positive attitudes toward this novel policy and negatively associated with family caregiving support. Direct and moderating effects of family financial support on WTP were found. The policy-related implications of LTC financing to improve older people's acceptance of co-payment mechanisms, financial condition, and shared responsibility of care are discussed.

Effect of Community Health Worker Support on Clinical Outcomes of Low-Income Patients Across Primary Care Facilities: A Randomized Clinical Trial.

Importance: Addressing the social determinants of health has been difficult for health systems to operationalize. Objective: To assess a standardized intervention, Individualized Management for Patient-Centered Targets (IMPaCT), delivered by community health workers (CHWs) across 3 health systems. Design, Setting, and Participants: This 2-armed, single-blind, multicenter randomized clinical trial recruited patients from 3 primary care facilities in Philadelphia, Pennsylvania, between January 28, 2015, and March 28, 2016. Patients who resided in a high-poverty zip code, were uninsured or publicly insured, and who had a diagnosis for 2 or more chronic diseases were recruited, and patients were randomized to either the CHW intervention or the control arm (goal setting only). Follow-up assessments were conducted at 6 and 9 months after enrollment. Data were analyzed using an intention-to-treat approach from June 2017 to March 2018. Intervention: Participants set a chronic disease management goal with their primary care physician; those randomized to the CHW intervention received 6 months of tailored support. Main Outcomes and Measures: The primary outcome was change in self-rated physical health. The secondary outcomes were self-rated mental health, chronic disease control, patient activation, patient-reported quality of primary care, and all-cause hospitalization. Results: Of the 592 participants, 370 (62.5%) were female, with a mean (SD) age of 52.6 (11.1) years. Participants in both arms had similar improvements in self-rated physical health (mean [SD], 1.8 [11.2] vs 1.6 [9.9]; P = .89). Patients in the intervention group were more likely to report the highest quality of care (odds ratio [OR], 1.8; 95% CI, 1.4-2.4; risk difference [RD], 0.12; P < .001) and spent fewer total days in the hospital at 6 months (155 days vs 345 days; absolute event rate reduction, 69%) and 9 months (300 days vs 471 days; absolute event rate reduction, 65%). This reduction was driven by a shorter average length of stay (difference, -3.1 days; 95% CI, -6.33 to 0.22; P = .06) and a lower mean number of hospitalizations (difference, -0.3; 95% CI, -0.6 to 0.0; P = .07) among patients who were hospitalized. Patients in the intervention group had a lower odds of repeat hospitalizations (OR, 0.4; 95% CI, 0.2-0.9; RD, -0.24; P = .02), including 30-day readmissions (OR, 0.3; 95% CI, 0.1-0.9; RD, -0.17; P = .04). Conclusions and Relevance: A standardized intervention did not improve self-rated health but did improve the patient-perceived quality of care while reducing hospitalizations, suggesting that health systems may use a standardized intervention to address the social determinants of health. Trial Registration: ClinicalTrials.gov identifier: NCT02347787.

Spatial associations between social groups and ozone air pollution exposure in the Beijing urban area.

Few studies have linked social factors to air pollution exposure in China. Unlike the race or minority concepts in western countries, the Hukou system (residential registration system) is a fundamental reason for the existence of social deprivation in China. To assess the differences in ozone (O3) exposure among social groups, especially groups divided by Hukou status, we assigned estimates of O3 exposure to the latest census data of the Beijing urban area using a kriging interpolation model. We developed simultaneous autoregressive (SAR) models that account for spatial autocorrelation to identify the associations between O3 exposure and social factors. Principal component regression was used to control the multicollinearity bias as well as explore the spatial structure of the social data. The census tracts (CTs) with higher proportions of persons living alone and migrants with non-local Hukou were characterized by greater exposure to ambient O3. The areas with greater proportions of seniors had lower O3 exposure. The spatial distribution patterns were similar among variables including migrants, agricultural population and household separation (population status with separation between Hukou and actual residences), which fit the demographic characteristics of the majority of migrants. Migrants bore a double burden of social deprivation and O3 pollution exposure due to city development planning and the Hukou system.

A review of soil cadmium contamination in China including a health risk assessment.

Cadmium (Cd) is one of the most serious soil contaminants in China, and it poses an increasing risk to human health as large amounts of Cd are emitted into the environment. However, knowledge about soil Cd concentrations and the human health risks of these concentrations at a national scale is limited. In this study, we conducted a review of 190 articles about soil Cd concentrations during 2001 to 2010. The study involved 146 cities in China, and we quantified the risks to human health according to different regions. The results showed that elevated Cd levels were present compared to the background value of soil in 1990, and the soil Cd concentrations in the Guangxi province exceeded even the class III Soil Environmental Quality standard, which is the limit for the normal growth of plants. The Chinese soil Cd concentrations ranged from 0.003 mg kg(-1) to 9.57 mg kg(-1). The soil Cd concentrations had the following trend: northwest > southwest > south central > east > northeast > north. The sources of soil Cd are mainly from smelting, mining, waste disposal, fertilizer and pesticide application, and vehicle exhaust, etc. but differentiated in various regions. The soil Cd contamination in urban areas was more serious than contamination in the agricultural areas. Currently, there is no significant non-carcinogenic risk in any of the provinces. Regarding the different exposure pathways, the dermal pathway is the primary source of soil Cd exposure, and the risk associated with this pathway is generally hundreds of times higher than the risk for an ingestion pathway. For most of the provinces, the health risk to the urban population was higher than the risk to the rural population. For each population, the carcinogenic risk was less than 10(-6) in most of the provinces, except for the urban population in the Hunan province. If the other exposure pathways are fully considered, then the people in these areas may have a higher carcinogenic risk. This review provides a comprehensive assessment of soil Cd pollution in China, and it identifies policy recommendations for pollution mitigation and environmental management in the relevant regions.