Understanding the Pathways from Mindfulness to COVID-19 Vaccination Intention via Positive Psychology Attributes among Health Care Workers in China.

OBJECTIVE: The present study aims to examine the association between mindfulness and COVID-19 vaccination intention, and the mediating role of presence of meaning in life and moral elevation in such association. METHOD: In a cross-sectional study design, a total of 1733 health care workers (81.1% females, Mage = 34.16 ± 9.03) from four cities in China were recruited and completed an online survey that measured mindfulness, moral elevation, presence of meaning in life and COVID-19 vaccination intention. RESULTS: It has been found that 73.1% of the participants reported an intention to receive COVID-19 vaccination. Mindfulness was positively associated with COVID-19 vaccination intention; Mediation analyses using structural equation modeling showed a significant indirect effect of mindfulness on COVID-19 vaccination intention, accounting for 42.4% of the total effect. Mindfulness was positively associated with COVID-19 vaccination intention directly via presence of meaning in life, and indirectly via moral elevation and presence of meaning in life. CONCLUSIONS: The findings add knowledge of how mindfulness may increase COVID-19 vaccination intention, and underscore the potential need for mindfulness training, positive emotion promotion, presence of meaning in life interventions to improve acceptance of COVID-19 vaccination among health care workers.

Combination of absolute pitch and tone language experience enhances lexical tone perception.

Absolute pitch (AP), a unique ability to name or produce pitch without any reference, is known to be influenced by genetic and cultural factors. AP and tone language experience are both known to promote lexical tone perception. However, the effects of the combination of AP and tone language experience on lexical tone perception are currently not known. In the current study, using behavioral (Categorical Perception) and electrophysiological (Frequency Following Response) measures, we investigated the effect of the combination of AP and tone language experience on lexical tone perception. We found that the Cantonese speakers with AP outperformed the Cantonese speakers without AP on Categorical Perception and Frequency Following Responses of lexical tones, suggesting an additive effect due to the combination of AP and tone language experience. These findings suggest a role of basic sensory pre-attentive auditory processes towards pitch encoding in AP. Further, these findings imply a common mechanism underlying pitch encoding in AP and tone language perception.

Systemic administration of local anesthetic agents to relieve neuropathic pain.

BACKGROUND: Lidocaine, mexiletine, tocainide, and flecainide are local anesthetics which give an analgesic effect when administered orally or parenterally. Early reports described the use of intravenous lidocaine or procaine to relieve cancer and postoperative pain. Interest reappeared decades later when patient series and clinical trials reported that parenteral lidocaine and its oral analogs tocainide, mexiletine, and flecainide relieved neuropathic pain in some patients. With the recent publication of clinical trials with high quality standards, we have reviewed the use of systemic lidocaine and its oral analogs in neuropathic pain to update our knowledge, to measure their benefit and harm, and to better define their role in therapy. OBJECTIVES: To evaluate pain relief and adverse effect rates between systemic local anesthetic-type drugs and other control interventions. SEARCH METHODS: We searched MEDLINE (1966 through 15 May 2004), EMBASE (January 1980 to December 2002), Cancer Lit (through 15 December 2002), Cochrane Central Register of Controlled Trials (2nd Quarter, 2004), System for Information on Grey Literature in Europe (SIGLE), and LILACS, from January 1966 through March 2001. We also hand searched conference proceedings, textbooks, original articles and reviews. SELECTION CRITERIA: We included trials with random allocation, that were double blinded, with a parallel or crossover design. The control intervention was a placebo or an analgesic drug for neuropathic pain from any cause. DATA COLLECTION AND ANALYSIS: We collected efficacy and safety data from all published and unpublished trials. We calculated combined effect sizes using continuous and binary data for pain relief and adverse effects as primary and secondary outcome measurements, respectively. MAIN RESULTS: Thirty-two controlled clinical trials met the selection criteria; two were duplicate articles. The treatment drugs were intravenous lidocaine (16 trials), mexiletine (12 trials), lidocaine plus mexiletine sequentially (one trial), and tocainide (one trial). Twenty-one trials were crossover studies, and nine were parallel. Lidocaine and mexiletine were superior to placebo [weighted mean difference (WMD) = -11; 95% CI: -15 to -7; P < 0.00001], and limited data showed no difference in efficacy (WMD = -0.6; 95% CI: -7 to 6), or adverse effects versus carbamazepine, amantadine, gabapentin or morphine. In these trials, systemic local anesthetics were safe, with no deaths or life-threatening toxicities. Sensitivity analysis identified data distribution in three trials as a probable source of heterogeneity. There was no publication bias. AUTHORS' CONCLUSIONS: Lidocaine and oral analogs were safe drugs in controlled clinical trials for neuropathic pain, were better than placebo, and were as effective as other analgesics. Future trials should enroll specific diseases and test novel lidocaine analogs with better toxicity profiles. More emphasis is necessary on outcomes measuring patient satisfaction to assess if statistically significant pain relief is clinically meaningful.

CONTEXTE: La lidocaïne, le mexilétine, la tocainide et la flécainide sont des anesthésiques locaux qui apportent un effet analgésique lorsqu'ils sont administrés par voie orale ou parentérale. Des études anciennes décrivaient l'utilisation de lidocaïne ou de procaïne par voie intraveineuse pour soulager la douleur due au cancer ou la douleur postopératoire. Un regain d'intérêt a eu lieu quelques décennies plus tard lorsque des séries de patients et des essais cliniques ont rapporté que la lidocaïne par voie parentérale ou ses analogues oraux, tocainide, méxiléine et flécainide, soulageaient la douleur neuropathique chez certains patients. Avec la publication récente d'essais cliniques suivant des normes de qualité, nous avons révisé l'utilisation de lidocaïne systémique et de ses analogues oraux en douleur neuropathique pour mettre à jour nos connaissances, mesurer leurs bénéfices et effets délétères et mieux définir leur rôle dans le traitement. OBJECTIFS: Évaluer le soulagement de la douleur et les effets indésirables entre les médicaments de type anesthésique local systémique et d'autres interventions de contrôle. STRATÉGIE DE RECHERCHE DOCUMENTAIRE: Nous avons effectué une recherche dans MEDLINE (de 1966 au 15 mai 2004), EMBASE (de janvier 1980 à décembre 2002), Cancer Lit (jusqu'au 15 décembre 2002), le registre Cochrane des essais contrôlés (2ème trimestre 2004),le Système pour l'Information en Littérature Grise en Europe (SIGLE), et LILACS, de janvier 1966 à mars 2001. Nous avons également recherché des actes de conférences, des ouvrages, des articles originaux et des revues. CRITÈRES DE SÉLECTION: Nous avons inclus des essais à assignation aléatoire, en double aveugle, avec un plan d'étude parallèle ou croisé. L'intervention de contrôlé était un placebo ou un médicament analgésique contre la douleur neuropathique quelle qu'en soit la cause. RECUEIL ET ANALYSE DES DONNÉES: Nous avons recueilli des données sur l'efficacité et la sécurité à partir de tous les essais publiés et non publiés. Nous avons calculé les quantités d'effet combinées en utilisant les données continues et binaires pour le soulagement de la douleur et les effets indésirables en tant que critères de jugement principal et secondaire, respectivement. RÉSULTATS PRINCIPAUX: Trente­deux essais cliniques contrôlés satisfaisaient aux critères de sélection ; deux d'entre eux étaient des articles en double. Les médicaments de traitement étaient la lidocaïne intraveineuse (16 essais), la mexilétine (12 essais), la lidocaïne plus la mexilétine séquentiellement (un essai) et la tocainide (un essai). Vingt­et­un essais étaient des études croisées et neuf étaient des études parallèles. La lidocaïne et la mexilétine se sont avérées supérieures au placebo [différence moyenne pondérée (DMP) = ­11 ; IC à 95 % : ­15 à ­7 ; P < 0,00001], et des données limitées n'ont mis en évidence aucune différence de l'efficacité (DMP = ­0,6 ; IC à 95 % : ­7 à 6) ou des événements indésirables versus carbamazépine, amantadine, gabapentine ou morphine. Dans ces essais, les anesthésiques locaux systémiques étaient sûrs, avec la non occurrence de toxicités mortelles ou dangereuses. L'analyse de la sensibilité a permis d'identifier la distribution des données dans trois essais comme étant une source probable d'hétérogénéité. Aucun biais de publication n'a été observé. CONCLUSIONS DES AUTEURS: Ces essais cliniques contrôlés sur la douleur neuropathique ont permis de déterminer qu la lidocaïne et ses analogues oraux sont des médicaments sûrs, plus efficaces que le placebo et aussi efficaces que d'autres analgésiques. Les prochains essais devraient porter sur des maladies spécifiques et tester de nouveaux analogues de la lidocaïne avec de meilleurs profils de toxicité. Il est nécessaire de se centrer plus particulièrement sur les résultats mesurant la satisfaction des patients pour déterminer si le soulagement de la douleur significatif du point de vue statistique est pertinent cliniquement.

Interactive effects of linguistic abstraction and stimulus statistics in the online modulation of neural speech encoding.

Speech processing is highly modulated by context. Prior studies examining frequency-following responses (FFRs), an electrophysiological 'neurophonic' potential that faithfully reflects phase-locked activity from neural ensembles within the auditory network, have demonstrated that stimulus context modulates the integrity of speech encoding. The extent to which context-dependent encoding reflects general auditory properties or interactivities between statistical and higher-level linguistic processes remains unexplored. Our study examined whether speech encoding, as reflected by FFRs, is modulated by abstract phonological relationships between a stimulus and surrounding contexts. FFRs were elicited to a Mandarin rising-tone syllable (/ji-TR/, 'second') randomly presented with other syllables in three contexts from 17 native listeners. In a contrastive context, /ji-TR/ occurred with meaning-contrastive high-level-tone syllables (/ji-H/, 'one'). In an allotone context, TR occurred with dipping-tone syllables /ji-D/, a non-meaning-contrastive variant of /ji-TR/. In a repetitive context, the same /ji-TR/ occurred with other speech tokens of /ji-TR/. Consistent with prior work, neural tracking of /ji-TR/ pitch contour was more faithful in the repetitive condition wherein /ji-TR/ occurred more predictably (p = 1) than in the contrastive condition (p = 0.34). Crucially, in the allotone context, neural tracking of /ji-TR/ was more accurate relative to the contrastive context, despite both having an identical transitional probability (p = 0.34). Mechanistically, the non-meaning-contrastive relationship may have augmented the probability to /ji-TR/ occurrence in the allotone context. Results indicate online interactions between bottom-up and top-down mechanisms, which facilitate speech perception. Such interactivities may predictively fine-tune incoming speech encoding using linguistic and statistical information from prior context.

Monosodium Glutamate Reduces 68Ga-PSMA-11 Uptake in Salivary Glands and Kidneys in a Preclinical Prostate Cancer Model.

We evaluated the ability of monosodium glutamate (MSG) to reduce salivary and kidney uptake of a prostate-specific membrane antigen (PSMA) radioligand without affecting tumor uptake. Methods: LNCaP tumor-bearing mice were intraperitoneally injected with MSG (657, 329, or 164 mg/kg) or phosphate-buffered saline (PBS). Fifteen minutes later, the mice were intravenously administered 68Ga-PSMA-11. PET/CT imaging and biodistribution studies were performed 1 h after administration. Results: Tumor uptake (percentage injected dose per gram [%ID]) was not statistically different between groups, at 8.42 ± 1.40 %ID in the 657 mg/kg group, 7.19 ± 0.86 %ID in the 329 mg/kg group, 8.20 ± 2.44 %ID in the 164 mg/kg group, and 8.67 ± 1.97 %ID in the PBS group. Kidney uptake was significantly lower in the 657 mg/kg group (85.8 ± 24.2 %ID) than in the 329 mg/kg (159 ± 26.2 %ID), 164 mg/kg (211 ± 27.4 %ID), and PBS groups (182 ± 33.5 %ID) (P < 0.001). Salivary gland uptake was lower in the 657 mg/kg (3.72 ± 2.12 %ID) and 329 mg/kg (5.74 ± 0.62 %ID) groups than in the PBS group (10.04 ± 2.52 %ID) (P < 0.01). Conclusion: MSG decreased salivary and kidney uptake of 68Ga-PSMA-11 in a dose-dependent manner, whereas tumor uptake was unaffected.

Media exposure related to the 2008 Sichuan Earthquake predicted probable PTSD among Chinese adolescents in Kunming, China: A longitudinal study.

OBJECTIVE: This study examined the prevalence and the psychosocial predictors of probable PTSD among Chinese adolescents in Kunming (approximately 444 miles from the epicenter), China, who were indirectly exposed to the Sichuan Earthquake in 2008. METHOD: Using a longitudinal study design, primary and secondary school students (N = 3577) in Kunming completed questionnaires at baseline (June 2008) and 6 months afterward (December 2008) in classroom settings. Participants' exposure to earthquake-related imagery and content, perceptions and emotional reactions related to the earthquake, and posttraumatic stress symptoms were measured. Univariate and forward stepwise multivariable logistic regression models were fit to identify significant predictors of probable PTSD at the 6-month follow-up. RESULTS: Prevalences of probable PTSD (with a Children's Revised Impact of Event Scale score ≥30) among the participants at baseline and 6-month follow-up were 16.9% and 11.1% respectively. In the multivariable analysis, those who were frequently exposed to distressful imagery had experienced at least two types of negative life events, perceived that teachers were distressed due to the earthquake, believed that the earthquake resulted from damages to the ecosystem, and felt apprehensive and emotionally disturbed due to the earthquake reported a higher risk of probable PTSD at 6-month follow-up (all ps < .05). CONCLUSION: Exposure to distressful media images, emotional responses, and disaster-related perceptions at baseline were found to be predictive of probable PTSD several months after indirect exposure to the event. Parents, teachers, and the mass media should be aware of the negative impacts of disaster-related media exposure on adolescents' psychological health. (PsycINFO Database Record

Context-dependent plasticity in the subcortical encoding of linguistic pitch patterns.

We examined the mechanics of online experience-dependent auditory plasticity by assessing the influence of prior context on the frequency-following responses (FFRs), which reflect phase-locked responses from neural ensembles within the subcortical auditory system. FFRs were elicited to a Cantonese falling lexical pitch pattern from 24 native speakers of Cantonese in a variable context, wherein the falling pitch pattern randomly occurred in the context of two other linguistic pitch patterns; in a patterned context, wherein, the falling pitch pattern was presented in a predictable sequence along with two other pitch patterns, and in a repetitive context, wherein the falling pitch pattern was presented with 100% probability. We found that neural tracking of the stimulus pitch contour was most faithful and accurate when listening context was patterned and least faithful when the listening context was variable. The patterned context elicited more robust pitch tracking relative to the repetitive context, suggesting that context-dependent plasticity is most robust when the context is predictable but not repetitive. Our study demonstrates a robust influence of prior listening context that works to enhance online neural encoding of linguistic pitch patterns. We interpret these results as indicative of an interplay between contextual processes that are responsive to predictability as well as novelty in the presentation context. NEW & NOTEWORTHY: Human auditory perception in dynamic listening environments requires fine-tuning of sensory signal based on behaviorally relevant regularities in listening context, i.e., online experience-dependent plasticity. Our finding suggests what partly underlie online experience-dependent plasticity are interplaying contextual processes in the subcortical auditory system that are responsive to predictability as well as novelty in listening context. These findings add to the literature that looks to establish the neurophysiological bases of auditory system plasticity, a central issue in auditory neuroscience.

A Randomized Control Trial for Evaluating Efficacies of Two Online Cognitive Interventions With and Without Fear-Appeal Imagery Approaches in Preventing Unprotected Anal Sex Among Chinese Men Who Have Sex with Men.

Fear appeal approach has been used in health promotion, but its effectiveness has been mixed. It has not been well applied to HIV prevention among men who have sex with men (MSM). The present study developed and evaluated the relative efficacy of three online interventions (SC: STD-related cognitive approach, SCFI: STD-related cognitive plus fear appeal imagery approach, Control: HIV-related information based approach) in reducing prevalence of unprotected anal intercourse (UAI) among 396 MSM using a randomized controlled trial design. Participants' levels of fear-related emotions immediately after watching the assigned intervention materials were also assessed. Participants were evaluated at baseline and 3 months after the intervention. Results showed that participants in the SCFI scored significantly higher in the instrument assessing fear after the watching the intervention materials. However, no statistically significant differences were found across the three groups in terms of UAI at Month 3. Some significant within-group reductions in some measures of UAI were found in three groups. Further studies are warranted to test the role of fear appeal in HIV prevention.

Omega-3 Fatty Acids and Cardiovascular Disease: An Updated Systematic Review.

BACKGROUND: The effect and association of omega-3 fatty acids (n-3 FA) intake and biomarker levels with cardiovascular (CV) clinical and intermediate outcomes remains controversial. We update prior Evidence Reports of n-3 FA and clinical and intermediate CV disease (CVD) outcomes. OBJECTIVES: Evaluate the effect of n-3 FA on clinical and selected intermediate CV outcomes and the association of n-3 FA intake and biomarkers with CV outcomes. The n-3 FA under review include eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), docosapentaenoic acid (DPA), stearidonic acid (SDA), and alphalinolenic acid (ALA). DATA SOURCES: MEDLINE®, Embase®, the Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and CAB Abstracts from 2000 or 2002 to June 8, 2015, and eligible studies from the original reports and relevant existing systematic reviews. REVIEW METHODS: We included randomized controlled trials (RCTs) of any n-3 FA intake compared to no, lower, or other n-3 FA intake with an outcome of interest conducted in healthy adults, those at risk for CVD, or those with CVD. We also included prospective observational studies of the association between baseline n-3 FA intake or biomarker level and followup outcomes. We required 1 year or more of followup for clinical outcomes and 4 weeks for intermediate outcomes (blood pressure [BP] and lipids). RESULTS: From 11,440 citations (from electronic literature searches and existing systematic reviews), 829 abstracts met basic eligibility criteria; 61 RCTs and 37 longitudinal observational studies (in 147 articles) were included. Most RCTs and observational studies had few risk-of-bias concerns.Total n-3 FA: There is low strength of evidence (SoE) of no association between total n-3 FA intake and stroke death or myocardial infarction. There is insufficient evidence for other outcomes.Marine oils, total: There is moderate to high SoE that higher marine oil intake lowers triglycerides (Tg), raises high density lipoprotein cholesterol (HDL-c), and lowers the ratio of total cholesterol to HDL-c but raises low density lipoprotein cholesterol (LDL-c); also that higher marine oil intake does not affect major adverse CV events, all-cause death, total stroke, sudden cardiac death, coronary revascularization, atrial fibrillation, or BP. There is low SoE of associations between higher marine oil intake and decreased risk of CVD death, coronary heart disease (CHD), myocardial infarction, ischemic stroke, and congestive heart failure (CHF). There is low SoE of no association with CHD death or hemorrhagic stroke. There is insufficient evidence for other outcomes.Marine oil FA individually: There is low SoE of no associations between EPA or DHA intake (separately) and CHD, and between EPA or DPA and atrial fibrillation. There is low SoE of no association between EPA biomarkers and atrial fibrillation, but moderate SoE of no effect of purified DHA supplementation on BP or LDL-c. There is insufficient evidence for other specific marine oil FA and outcomes.ALA: There is moderate SoE of no effect of ALA intake on BP, LDL-c, HDL-c, or Tg. There is low SoE of no association between ALA intake or biomarker level and CHD, CHD death, atrial fibrillation, and CHF. There is insufficient evidence for other outcomes.Other n-3 FA analyses: There is insufficient evidence comparing n-3 FA with each other or for SDA.Subgroup analyses: Nineteen of 22 studies found no interaction of sex on any effect of n-3 FA. Likewise, 19 of 20 studies found no differential effect by statin co-use. Within 16 studies evaluating diabetes subgroups, 2 found statistically significant beneficial effects of n-3 FA in those with diabetes but not in those without diabetes, but no test of interaction was reported. CONCLUSIONS: The 61 RCTs mostly compared marine oil supplements with placebo on CVD outcomes in populations at risk for CVD or with CVD, while the 37 observational studies mostly examined associations between various individual n-3 FA and long-term CVD events in generally healthy populations. Compared with the prior report on n-3 FA and CVD, there is more robust RCT evidence on ALA and on clinical CV outcomes; also, by design there are newly added data on associations between n-3 FA biomarkers and CV outcomes. However, conclusions regarding the effect of n-3 FA intake on CV outcomes or associations with outcomes remain substantially unchanged. Marine oils statistically significantly raise HDL-c and LDL-c by similar amounts (≤2 mg/dL), while lowering Tg in a dose-dependent manner, particularly in individuals with elevated Tg; they have no significant effect on BP. ALA has no significant effect on intermediate outcomes. Limited data were available from RCTs on the effect of n-3 FA on clinical CVD outcomes. Observational studies suggest that higher marine oil intake (including from dietary fish) is associated with lower risk of several CVD outcomes. No clear differences in effects or associations were evident based on population, demographic features, or cointerventions. Future RCTs would be needed to establish adequate evidence of the effect of n-3 FA on CVD outcomes or to clarify differential effects in different groups of people. However, future trials are unlikely to alter conclusions about the effects of n-3 FA supplementation on intermediate cardiovascular outcomes (BP, LDL-c, HDL-c, or Tg).

Gambling in China: socio-historical evolution and current challenges.

AIMS: This paper provides an overview of gambling issues in China, including historical development, governmental responses and social consequences. METHODS: Based on materials written in Chinese or English available at academic databases and other online resources, historical, cultural and policy analyses were conducted. The focus is on mainland China, but reference is made to Hong Kong and Macao to illustrate differences. RESULTS: Throughout Chinese history, gambling was strictly prohibited by law. In contrast, small-stakes betting for entertainment instead of monetary gain, defined as 'gaming' in this paper, has been culturally acceptable and tolerated by governments. After banning gambling for three decades, the Chinese government attempts to meet public demand for 'gaming' and to confine gambling to 'gaming' by issuing national lotteries. In response to increased economic wealth, gambling opportunities were allowed to develop, but were restricted to Macao. Social problems such as illegal and youth gambling are, however, emerging. The 'gaming' perception may predispose Chinese individuals to wagering activities and increase the risk of gambling disorder, which has been widely seen as misconduct rather than a mental disorder. Currently, the country has a dearth of gambling research and limited prevention and rehabilitation services, almost none at national level. CONCLUSIONS: A distinction between small-stakes 'gaming' and large-stakes 'gambling', which has cultural roots, plays an important role in relevant governmental policies and social responses in mainland China. Gambling disorder prevention and treatment is not yet on the national agenda. The country's knowledge and services gaps on gambling problems need to be filled out.

Situation-specific factors predicting nonadherence to methadone maintenance treatment: a cross-sectional study using the case-crossover design in Guangzhou, China.

Methadone maintenance treatment (MMT) is a key risk reduction measure for controlling HIV transmission among drug users. Studies using traditional methods exist to distinguish between drop outs and nondrop outs. However, many nondrop outs use MMT discontinuously and no study has identified situation-specific factors predicting their showing or not showing up. This study used a case-crossover design comparing situation-specific factors appearing on the last episode of attendance versus those of the last episode of nonattendance. A total of 133 participants were recruited from two MMT clinics in Guangzhou, China. Participants were asked separately whether various situation-specific factors existed in the last episodes of nonattendance and attendance of MMT. Matched odds ratios (ORs) based on conditional logistic regression analysis were presented. The results showed that the participants attended the MMT clinics on average for 25 days in the last month. Situation-specific factors significantly predicting nonattendance included: (1) physical and mental health status: in illness (OR = 33.0, P < 0.001), in a bad mood (OR = 7.5, P < 0.001), and occurrence of an unhappy event (OR = 18.0, P < 0.001); (2) other engagement: work engagement (OR = 40.0, P < 0.001), trip to other places (OR = 83.0, P < 0.001), and social activities (OR = 10.0, P = 0.012); (3) interpersonal relationship: conflicts with family (OR = 19.0, P = 0.004); and (4) structural situational factors: financial difficulty (OR = 19.0, P = 0.004) and worrying about police arrest (OR = 12.0, P = 0.003). Other factors such as interaction with drug users and heroin use were marginally significant, while reduced methadone dosage was nonsignificant. Interventions to improve MMT adherence need to consider situation-specific factors. Ancillary psychosocial services should be integrated with current MMT; MMT should also provide more flexible services to the clients. Furthermore, efforts should be taken to build up interdisciplinary teams and to connect with MMT in order to provide holistic harm reduction, rehabilitation, and health care.

Gay saunas and the risks of HIV and syphilis transmissions in China--results of a meta-analysis.

INTRODUCTION: Previous studies suggest the risk of human immunodeficiency virus (HIV) transmission among men who have sex with men (MSM) is associated with characteristics of venues. However, very few studies have systematically compared HIV/sexually transmitted disease (STD) prevalence among MSM according to key venue type for sourcing sex partners. AIMS: The aim of this study was to investigate the associations between HIV/syphilis prevalence and the types of venues, namely saunas, parks, gay bars, and the Internet, which are mostly used for sourcing male sex partners by MSM in China. METHODS: Meta-analyses using fixed-effect and random-effect methods were conducted. Secondary data were obtained from 10 concurrent surveys conducted in 10 cities basing on a common protocol. Pairwise comparisons (e.g., "saunas" vs. "parks") were made. MAIN OUTCOMES MEASURES: Odds ratios (OR) for HIV/syphilis infection in relations to venue type for partner sourcing. RESULTS: The distribution of the most commonly used source to recruit male sex partner was 59.32% (Internet), 18.47% (gay bars), 14.18% (gay saunas), and 8.02% (parks). The median prevalence of HIV/syphilis was 10.49% and 19.38% (gay saunas), 2.12% and 16.25% (parks), 6.06% and 15.45% (Internet), and 4.41% and 11.90% (gay bars). We found significant between-group differences when comparing "sauna" against "Internet" (HIV: OR= 2.27, 95% confidence interval [CI] = 1.65-3.12; syphilis: OR = 1.61, 95% CI= 1.07-2.41), "sauna" against "bars" (HIV: OR= 1.65, 95% CI= 1.14-2.39; syphilis: OR= 1.35, 95% CI= 1.02-1.78), and "parks" against "Internet" (syphilis: OR= 1.55, 95% CI= 1.12-2.15) as the main source to recruit male sex partners. Other pairwise comparisons were not statistically significant. CONCLUSIONS: The results of this study suggest that those sourcing partners mainly from gay saunas have higher prevalence of HIV/syphilis when compared with those doing so via the Internet or gay bars. Venue based (sauna-based) interventions using socio-ecological approaches are greatly warranted in order to reduce HIV and syphilis prevalence among MSM in China.

Empirical evaluation of meta-analytic approaches for nutrient and health outcome dose-response data.

The objective of this study is to empirically compare alternative meta-analytic methods for combining dose-response data from epidemiological studies. We identified meta-analyses of epidemiological studies that analyzed the association between a single nutrient and a dichotomous outcome. For each topic, we performed meta-analyses of odds ratios with five approaches: using extreme exposure categories only, two-step approach (first calculated study-specific effects then combined across studies) using unadjusted data, two-step approach using adjusted data, one-step approach (analyzed all data in one regression model) using unadjusted data, and one-step approach using adjusted data. Meta-analyses including only extreme exposure categories gave consistently bigger effects and wider confidence intervals than meta-analyses using all data. Confidence intervals of effect sizes were generally wider in meta-analyses with the two-step approach, compared with the one-step approach. Meta-analyses using unadjusted data and adjusted data differed, with no consistent pattern of discordance in direction, statistical significance, or magnitude of effect. We discourage using meta-analysis approaches that only use data from extreme exposure categories. The one-step approach generally has higher precision than the two-step approach. Sensitivity analysis comparing results between meta-analyses of adjusted and unadjusted data may be useful in indicating the presence of confounding.

Concordance of randomized and nonrandomized studies was unrelated to translational patterns of two nutrient-disease associations.

OBJECTIVE: There are several examples in nutrition of discordance between the results of observational studies and randomized controlled trials (RCTs). We hypothesized that this discordance is attributable to differences in the translational paths of nutrient-disease associations. Translational paths can be assessed using citation analysis. STUDY DESIGN AND SETTING: We compared the characteristics of citation networks using examples, where RCTs and observational studies agreed (long-chain n-3 polyunsaturated fatty acids [n-3 PUFA]) or disagreed (vitamin E). We performed systematic reviews in each example, constructed citation networks, and compared them with respect to the number of articles and citation relationships between them, as well as the distribution of articles' hub and authority scores. RESULTS: For n-3 PUFA, meta-analyses of 14 RCTs and 10 observational studies both suggested that higher intake was associated with lower cardiovascular mortality. For vitamin E, the meta-analysis of 14 RCTs excluded a clinically significant effect, whereas 14 observational studies reported a significant inverse association. The respective citation networks consisted of 392 (n-3 PUFA) and 351 (vitamin E) articles. No differences between the characteristics of the two networks were identified. There was no evidence that the observational studies predated RCTs in the translational process in either example. CONCLUSION: In the two examples, citation network characteristics do not predict concordance in the results of observational studies and RCTs.

Vitamin D with or without calcium supplementation for prevention of cancer and fractures: an updated meta-analysis for the U.S. Preventive Services Task Force.

BACKGROUND: Studies suggest that vitamin D supplementation may reduce cancer and fracture risks. PURPOSE: To examine the benefits and harms of vitamin D with or without calcium supplementation on clinical outcomes of cancer and fractures in adults. DATA SOURCES: English-language studies identified from MEDLINE and the Cochrane Central Register of Controlled Trials through July 2011. STUDY SELECTION: Randomized, controlled trials (RCTs), prospective cohort studies, and nested case-control studies reporting incidence of or death from cancer and fracture outcomes. DATA EXTRACTION: Multiple reviewers extracted details about participant characteristics, including baseline vitamin D status and use of supplements; details of statistical analyses, including adjustments for confounding; and methodological quality. Differences were resolved by consensus. DATA SYNTHESIS: 19 RCTs (3 for cancer and 16 for fracture outcomes) and 28 observational studies (for cancer outcomes) were analyzed. Limited data from RCTs suggested that high-dose (1000 IU/d) vitamin D supplementation can reduce the risk for total cancer, and data from observational studies suggested that higher blood 25-hydroxyvitamin D (25-[OH]D) concentrations might be associated with increased risk for cancer. Mixed-effects dose-response meta-analyses showed that each 10-nmol/L increase in blood 25-(OH)D concentration was associated with a 6% (95% CI, 3% to 9%) reduced risk for colorectal cancer but no statistically significant dose-response relationships for prostate and breast cancer. Random-effects model meta-analysis showed that combined vitamin D and calcium supplementation reduced fracture risk (pooled relative risk, 0.88 [CI, 0.78 to 0.99]) in older adults, but the effects differed according to study setting: institution (relative risk, 0.71 [CI, 0.57 to 0.89]) versus community-dwelling (relative risk, 0.89 [CI, 0.76 to 1.04]). One RCT showed adverse outcomes associated with supplementation, including increased risk for renal and urinary tract stones. LIMITATIONS: Most trial participants were older (aged≥65 years) postmenopausal women. Observational studies were heterogeneous and were limited by potential confounders. CONCLUSION: Combined vitamin D and calcium supplementation can reduce fracture risk, but the effects may be smaller among community-dwelling older adults than among institutionalized elderly persons. Appropriate dose and dosing regimens, however, require further study. Evidence is not sufficiently robust to draw conclusions regarding the benefits or harms of vitamin D supplementation for the prevention of cancer. PRIMARY FUNDING SOURCE: Agency for Healthcare Research and Quality.

Sociocultural facilitators and barriers to condom use during anal sex among men who have sex with men in Guangzhou, China: an ethnographic study.

This ethnographic study explored how cultural belief systems shaped sexual risk practices among men who have sex with men (MSM) in Guangzhou, China. A specific focus was on how these men's sexual practices varied across sexual venues and among different partners in order to better understand sociocultural facilitators and barriers to condom use in the Guangzhou community. Qualitative data were obtained through semi-structured in-depth interviews with MSM and ethnographic observations in MSM sexual venues in the city. The thematic analysis focused specifically on the accounts of unprotected sex occasions. We found that an erotic idea of "rouyu" (desire of physical flesh) embedded in a subculture of MSM and a metaphor for condom use as being inferior and promoting distance posed a considerable barrier to condom use among these MSM. Some men reported gaining a positive self-concept related to same-sex identity through unprotected sex. These MSM's subjective evaluations of HIV risk were closely tied to the perceived characteristics of sex partners and sexual venues. We conclude by advocating specific sociocultural interventions in emerging risk venues, such as saunas/bathhouses, to better meet the needs of the MSM community in Guangzhou.

Randomized trial of radiotherapy plus concurrent-adjuvant chemotherapy vs radiotherapy alone for regionally advanced nasopharyngeal carcinoma.

BACKGROUND: Current practice of adding concurrent-adjuvant chemotherapy to radiotherapy (CRT) for treating advanced nasopharyngeal carcinoma is based on the Intergroup-0099 Study published in 1998. However, the outcome for the radiotherapy-alone (RT) group in that trial was substantially poorer than those in other trials, and there were no data on late toxicities. Verification of the long-term therapeutic index of this regimen is needed. METHODS: Patients with nonkeratinizing nasopharyngeal carcinoma staged T1-4N2-3M0 were randomly assigned to RT (176 patients) or to CRT (172 patients) using cisplatin (100 mg/m(2)) every 3 weeks for three cycles in concurrence with radiotherapy, followed by cisplatin (80 mg/m(2)) plus fluorouracil (1000 mg per m(2) per day for 4 days) every 4 weeks for three cycles. Primary endpoints included overall failure-free rate (FFR) (the time to first failure at any site) and progression-free survival. Secondary endpoints included overall survival, locoregional FFR, distant FFR, and acute and late toxicity rates. All statistical tests were two-sided. RESULTS: The two treatment groups were well balanced in all patient characteristics, tumor factors, and radiotherapy parameters. Adding chemotherapy statistically significantly improved the 5-year FFR (CRT vs RT: 67% vs 55%; P = .014) and 5-year progression-free survival (CRT vs RT: 62% vs 53%; P = .035). Cumulative incidence of acute toxicity increased with chemotherapy by 30% (CRT vs RT: 83% vs 53%; P < .001), but the 5-year late toxicity rate did not increase statistically significantly (CRT vs RT: 30% vs 24%; P = .30). Deaths because of disease progression were reduced statistically significantly by 14% (CRT vs RT: 38% vs 24%; P = .008), but 5-year overall survival was similar (CRT vs RT: 68% vs 64%; P = .22; hazard ratio of CRT = 0.81, 95% confidence interval = 0.58 to 1.13) because deaths due to toxicity or incidental causes increased by 7% (CRT vs RT: 1.7% vs 0, and 8.1% vs 3.4%, respectively; P = .015). CONCLUSIONS: Adding concurrent-adjuvant chemotherapy statistically significantly reduced failure and cancer-specific deaths when compared with radiotherapy alone. Although there was no statistically significant increase in major late toxicity, increase in noncancer deaths narrowed the resultant gain in overall survival.

Systematic review: Vitamin D and cardiometabolic outcomes.

BACKGROUND: Vitamin D may modify risk for cardiometabolic outcomes (type 2 diabetes, hypertension, or cardiovascular disease). PURPOSE: To examine the association between vitamin D status, including the effect of vitamin D supplementation, and cardiometabolic outcomes in generally healthy adults. DATA SOURCES: English-language studies in MEDLINE (inception to 4 November 2009) and the Cochrane Central Register of Controlled Trials (fourth quarter of 2009). STUDY SELECTION: 11 reviewers screened citations to identify longitudinal cohort studies that reported associations between vitamin D status and cardiometabolic outcomes, including randomized trials of vitamin D supplementation. DATA EXTRACTION: 5 independent reviewers extracted data about study conduct, participant characteristics, outcomes, and quality. Differences were resolved by consensus. DATA SYNTHESIS: 13 observational studies (14 cohorts) and 18 trials were eligible. Three of 6 analyses (from 4 different cohorts) reported a lower incident diabetes risk in the highest versus the lowest vitamin D status groups. Eight trials found no effect of vitamin D supplementation on glycemia or incident diabetes. In meta-analysis of 3 cohorts, lower 25-hydroxyvitamin D concentration was associated with incident hypertension (relative risk, 1.8 [95% CI, 1.3 to 2.4]). In meta-analyses of 10 trials, supplementation nonsignificantly reduced systolic blood pressure (weighted mean difference, -1.9 mm Hg [CI, -4.2 to 0.4 mm Hg]) and did not affect diastolic blood pressure (weighted mean difference, -0.1 mm Hg [CI, -0.7 to 0.5 mm Hg]). Lower 25-hydroxyvitamin D concentration was associated with incident cardiovascular disease in 5 of 7 analyses (6 cohorts). Four trials found no effect of supplementation on cardiovascular outcomes. LIMITATIONS: Studies included primarily white participants. Observational studies were heterogeneous. Several trials reported post hoc analyses. CONCLUSION: The association between vitamin D status and cardiometabolic outcomes is uncertain. Trials showed no clinically significant effect of vitamin D supplementation at the dosages given. PRIMARY FUNDING SOURCE: National Institute of Diabetes and Digestive and Kidney Disease, the National Institutes of Health Office of Dietary Supplements, U.S. Food and Drug Administration, Agency for Healthcare Research and Quality, and Public Health Agency of Canada.