Efficacy and Safety of High-Dose Vitamin D Supplementation vs Solifenacin or Standard Urotherapy for Overactive Bladder Dry in Children: A Randomized Clinical Trial.

PURPOSE: We investigated the efficacy and safety of high-dose vitamin D supplementation (VDS) plus standard urotherapy (SU) in managing overactive bladder dry in children. MATERIALS AND METHODS: A 3-arm, randomized clinical trial was performed at an academic center in China between January 2023 and June 2023. Eligible patients (n=303) were randomized to receive 8 weeks of high-dose VDS (vitamin D3 drops encapsulated as soft capsules, 2400 IU/d) plus SU (VDS + SU group; n=100), solifenacin (5-10 mg/d) plus SU (SOL + SU group; n=102), or SU alone (SU group; n=101). Reduction in voiding frequency was the primary outcome. Secondary outcomes encompassed improvement in urgency, nocturia, quality of life score, pediatric lower urinary tract symptom score, and participant satisfaction. Treatment-emergent adverse events were recorded within each group. RESULTS: Participants had a median age of 82.0 months and their baseline mean vitamin D level was 22.64 ng/mL. The VDS + SU group showed greater improvements in voids/d than the SOL + SU group (median difference 3.0; 95% CI, 2.0 to 3.5; P < .001) and the SU group (median difference 4.0; 95% CI, 3.0 to 5.0; P < .001) after intervention. The VDS + SU group also showed the greatest improvement in quality of life and pediatric lower urinary tract symptom scores. Patient satisfaction was similar between the SOL + SU and SU groups. The VDS + SU group did not exhibit a heightened risk of treatment-emergent adverse events compared to the other groups. CONCLUSIONS: High-dose VDS plus SU was effective and well-tolerated in managing overactive bladder dry in children, suggesting its potential as a novel therapeutic option for this population.

Dietary polyunsaturated fatty acids intake, air pollution, and the risk of lung cancer: A prospective study in UK biobank.

BACKGROUND: Epidemiological evidence on the association between specific types of polyunsaturated fatty acids (PUFAs) intake and lung cancer risk is limited. However, whether dietary-specific PUFAs intake can modify the association between air pollutants and incident lung cancer remains unknown. METHODS: Cox proportional hazard models and restricted cubic spline regression were used to evaluate the associations of omega-3 PUFAs, omega-6 PUFAs and the ratio of omega-6 PUFAs to omega-3 PUFAs intake with lung cancer risk. Furthermore, we evaluated the associations between air pollutants and incident lung cancer, and whether dietary-specific PUFAs intake would modify the relationship using stratification analyses. RESULTS: This study found significant associations between the risk of lung cancer and omega-3 PUFAs intake (hazard ratio [HR], 0.82; 95 % confidence interval [CI], 0.73-0.93; per 1 g/d), and omega-6 PUFAs intake (HR, 0.98; 95 % CI, 0.96-0.99; per 1 g/d). We did not observe an association between the omega-6 to omega-3 PUFAs intake ratio and incident lung cancer. With regard to air pollution, omega-3 PUFAs intake attenuated the positive relationship between nitrogen oxides (NOx) pollution and lung cancer risk, and an increased incidence of lung cancer was found only in the low omega-3 PUFAs intake group (p < 0.05). Surprisingly, PUFAs intake (regardless of omega-3 PUFAs, omega-6 PUFAs, or in total) reinforced the pro-carcinogenic effects of PM2.5 on lung cancer, and a positive association between PM2.5 pollutants and incident lung cancer was observed only in the high PUFAs groups (p < 0.05). CONCLUSIONS: Higher dietary omega-3 and omega-6 PUFAs intake was associated with a decreased risk of lung cancer in the study population. As omega-3 PUFAs have different modification effects on NOX and PM2.5 air pollution related lung cancer incidence, precautions should be taken when using omega-3 PUFAs as health-promoting dietary supplements, especially in high PM2.5 burden regions.

Cost-Effectiveness of Mobile Health-Based Integrated Care for Atrial Fibrillation: Model Development and Data Analysis.

BACKGROUND: Mobile health (mHealth) technology is increasingly used in disease management. Using mHealth tools to integrate and streamline care has improved clinical outcomes of patients with atrial fibrillation (AF). OBJECTIVE: The aim of this study was to investigate the potential clinical and health economic outcomes of mHealth-based integrated care for AF from the perspective of a public health care provider in China. METHODS: A Markov model was designed to compare outcomes of mHealth-based care and usual care in a hypothetical cohort of patients with AF in China. The time horizon was 30 years with monthly cycles. Model outcomes measured were direct medical cost, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER). Sensitivity analyses were performed to examine the robustness of the base-case results. RESULTS: In the base-case analysis, mHealth-based care gained higher QALYs of 0.0730 with an incurred cost of US $1090. Using US $33,438 per QALY (three times the gross domestic product) as the willingness-to-pay threshold, mHealth-based care was cost-effective, with an ICER of US $14,936 per QALY. In one-way sensitivity analysis, no influential factor with a threshold value was identified. In probabilistic sensitivity analysis, mHealth-based care was accepted as cost-effective in 92.33% of 10,000 iterations. CONCLUSIONS: This study assessed the expected cost-effectiveness of applying mHealth-based integrated care for AF according to a model-based health economic evaluation. The exploration suggested the potential cost-effective use of mHealth apps in streamlining and integrating care via the Atrial fibrillation Better Care (ABC) pathway for AF in China. Future economic evaluation alongside randomized clinical trials is highly warranted to verify the suggestion and investigate affecting factors such as geographical variations in patient characteristics, identification of subgroups, and constraints on local implementation.

Predictors of willingness to use HIV pre-exposure prophylaxis among female sex workers in Southwest China.

This research examined predictors of willingness to use pre-exposure prophylaxis (PrEP) among female sex workers (FSW) in Southwest China. The final sample included 395 women (mean age=26.73 years, SD=6.74 years) who were predominantly of Han majority ethnicity (84.6%) and had completed middle-school education or lower (63.0%). Participants were recruited initially from commercial sex venues (e.g., saunas, massage parlors) in the cities of Nanchang, Luizhou, Nanning, Urumqi, and Karamay as well as two districts of Chongqing municipality and subsequently via snowball procedures. They completed a battery of self-report measures assessing beliefs about HIV and PrEP, psychosocial influences, demographics and willingness to use HIV PrEP. Willingness to use HIV PrEP was predicted by high levels of trust in physicians and more reported unmet interpersonal belongingness needs. Beyond these factors, willing and unwilling groups were differentiated on the basis of intervention-specific beliefs (perceived stigma and self-efficacy in use of PrEP). Together, findings suggested interpersonal factors should be considered in concert with perceptions of intervention characteristics in assessing motivations to enroll in PrEP within this particular at-risk group.