The association between ambient PM2.5's constituents exposure and cervical cancer survival.

Increasing evidence links exposure to ambient particulate matter with a diameter less than 2.5 µm (PM2.5) with reduced survival in cancer survivors, but little was known about the association between PM2.5 exposure and cervical cancer survival. We analyzed data from 5144 cervical cancer patients diagnosed between January 2014 and December 2020, who completed recommended treatments. Exposure levels were determined by the monthly average concentration of ambient PM2.5 and its five constituents, obtained from Tracking Air Pollution in China (TAP) based on individual residential addresses. Log-rank tests and multivariate Cox Proportional Hazardous regression were performed to examine the impacts of PM2.5 and its constituents on overall survival (OS) of cervical cancer patients. We observed that for every increase of 1 µg/m3 in average individual exposure, the hazard ratios (95%CI) for ambient PM2.5, sulfate (SO42-), ammonium (NH4+), and nitrates (NO3-) were 1.078(1.069-1.086), 6.755(5.707-7.996), 2.123(1.935-2.329), and 3.717(3.237-4.267), respectively. Subgroups with longer OS had larger HRs of PM2.5 and its constituents, which might attributed to more cumulative exposure. No evidence of a threshold for the hazardous effects of PM2.5 on the OS of cervical cancer patients was identified. Furthermore, long-term exposure to PM2.5 was negatively associated with pretreatment counts of monocytes, neutrophils, and lymphocytes in peripheral blood of cervical cancer patients. In conclusion, elevated levels of PM2.5 mass, SO42-, NH4+, and NO3- in ambient PM2.5 exposure were associated with reduced OS among cervical cancer patients. There may be no discernible threshold effect of PM2.5 on the risk for cervical cancer patients.

Association between daily circulatory emergency ambulance dispatches and short-term PM2.5 exposure in a heavily polluted area.

Emergency ambulance dispatches (EAD) have been proven to be associated with ambient particulate matter with diameter < 2.5 µm (PM2.5) concentration, but the associations of circulatory EAD remained inconclusive, especially in heavily polluted areas. In this time series conducted in Shenyang City, Northeastern China, we explored the associations between circulatory EAD and ambient PM2.5 and its constituents. Data including 113,508 circulatory EAD records, five types of PM2.5 constituents, and meteorological information spanning from 2014 to 2019 were retrieved. Using generalized additive models (GAMs), we explored the association between circulatory EAD and calculated excess risks induced by a 10 µg/m3 increase (ERR10) in PM2.5 mass and its constituents. ERR by percentage change (ERRpc) to compare among the different constituents were also calculated. Positive associations between circulatory EAD and PM2.5 mass, sulfates, organic matters, and black carbon, were found particularly at lag0 and lag0-5, with the ERR10 of 3.8% (3.2%-4.4%), 6.5% (2.2%-10.8%), 4.2% (1.7%-6.6%), and 30.2% (17.2%-43.4%) at lag0-5, respectively. Similar associations were observed for cardiovascular EAD, while cerebrovascular EAD suggested a positive association with O3 rather than PM2.5 or its constituents. Notably, PM2.5 mass exhibited the largest ERRpc for circulatory and cardiovascular EAD, followed by sulfates and black carbon. Moreover, the risks were enhanced for circulatory and cardiovascular EAD in males compared to females and during warmer seasons compared to colder seasons. Our findings contribute new evidence on PM2.5 exposure and circulatory EAD in relatively polluted areas.

A Bayesian network predicting survival of cervical cancer patients-Based on surveillance, epidemiology, and end results.

This study aimed to build a comprehensive model for predicting the overall survival (OS) of cervical cancer patients who received standard treatments and to build a series of new stages based on the International Federation of Gynecologists and Obstetricians (FIGO) stages for better such predictions. We collected the cervical cancer patients diagnosed since the year 2000 from the Surveillance, Epidemiology, and End Results (SEER) database. Cervical cancer patients who received radiotherapy or surgery were included. Log-rank tests and Cox regression were used to identify potential factors of OS. Bayesian networks (BNs) were built to predict 3- and 5-year survival. We also grouped the patients into new stages by clustering their 5-year survival probabilities based on FIGO stage, age, and tumor differentiation. Cox regression suggested black ethnicity, adenocarcinoma, and single status as risks for poorer prognosis, in addition to age and stage. A total of 43,749 and 39,333 cases were finally eligible for the 3- and 5-year BNs, respectively, with 11 variables included. Cluster analysis and Kaplan-Meier curves indicated that it was best to divide the patients into nine modified stages. The BNs had excellent performance, with area under the curve and maximum accuracy of 0.855 and 0.804 for 3-year survival, and 0.851 and 0.787 for 5-year survival, respectively. Thus, BNs are excellent candidates for predicting cervical cancer survival. It is necessary to consider age and tumor differentiation when estimating the prognosis of cervical cancer using FIGO stages.

Human papillomavirus genotypes and the risk factors associated with multicentric intraepithelial lesions of the lower genital tract: a retrospective study.

BACKGROUND: Multicentric intraepithelial lesions of the lower genital tract (multicentric lesions) were defined as intraepithelial lesions of two or three sites within cervix, vagina, and vulva occurring synchronously or sequentially. The characteristics of multicentric lesions has been poorly understood. This study aimed to evaluate the risk factors for multicentric lesions, including specific HPV genotypes. METHODS: A retrospective case-control study was performed involving patients histologically diagnosed with multicentric lesions between January 2018 and October 2019. Controls were patients histologically diagnosed with single cervical intraepithelial neoplasia (CIN) and admitted during the same period. Univariable and multivariable analyses were used to assess the risk factors for multicentric lesions. RESULTS: Of 307 patients with multicentric lesions, the median age was 50 years (interquartile range: 43-55.5), and they were older than patients with single CIN (median age: 43 years, interquartile range: 36-50). In the multicentric lesion group, the proportions of cytologic abnormalities, HPV positivity, and multiple HPV infections were 68.9, 97.0, and 36.5%, respectively. In the multivariable analysis, menopause, a history of malignant tumors beyond the lower genital tract and multiple HPV infections were associated with the incidence of multicentric lesions (Odd ratio (OR) = 3.14, 95% confidence interval (CI) 2.24-4.41; OR = 9.58, 95% CI 1.02-89.84; OR = 1.47, 95% CI 1.03-2.10). The common HPV genotypes were HPV16, HPV53, HPV58, HPV52, HPV51, HPV56 and HPV18 in patients with multicentric lesions. The proportion of HPV16 infection was higher in high-grade lesions group than that in low-grade lesions group (OR = 2.54, 95% CI 1.34-4.83). The OR for multicentric lesions, adjusted for menopause, smoking, gravidity, parity, a history of malignant tumor beyond the lower genital tract and multiple HPV infection, was 1.97 (95% CI 1.04-3.75) in patients with HPV51 infection. CONCLUSIONS: Multicentric lesions were associated with menopause, a history of malignant tumors and multiple HPV infections. HPV16 was the most common genotype, especially in high grade multicentric lesions and HPV51 infection was found to be a risk factor for detecting multicentric lesions.

The effects of psychological interventions on depression and anxiety among Chinese adults with cancer: a meta-analysis of randomized controlled studies.

BACKGROUND: Our previous studies found the high prevalence of depression and anxiety among Chinese cancer patients, and many empirical studies have been conducted to evaluate the effects of psychological interventions on depression and anxiety among Chinese cancer patients. This study aimed to conduct a meta-analysis in order to assess the effects of psychological interventions on depression and anxiety in Chinese adults with cancer. METHODS: The four most comprehensive Chinese academic database- CNKI, Wanfang, Vip and CBM databases-were searched from their inception until January 2014. PubMed and Web of Science (SCIE) were also searched from their inception until January 2014 without language restrictions, and an internet search was used. Randomized controlled studies assessing the effects of psychological interventions on depression and anxiety among Chinese adults with cancer were analyzed. Study selection and appraisal were conducted independently by three authors. The pooled random-effects estimates of standardized mean difference (SMD) and 95% confidence intervals (CI) were calculated. Moderator analysis (meta-regression and subgroup analysis) was used to explore reasons for heterogeneity. RESULTS: We retrieved 147 studies (covering 14,039 patients) that reported 253 experimental-control comparisons. The random effects model showed a significant large effect size for depression (SMD = 1.199, p < 0.001; 95% CI = 1.095-1.303) and anxiety (SMD = 1.298, p < 0.001; 95% CI = 1.187-1.408). Cumulative meta-analysis indicated that sufficient evidence had accumulated since 2000-2001 to confirm the statistically significant effectiveness of psychological interventions on depression and anxiety in Chinese cancer patients. Moderating effects were found for caner type, patients' selection, intervention format and questionnaires used. In studies that included lung cancer, preselected patients with clear signs of depression/anxiety, adopted individual intervention and used State-Trait Anxiety Inventory (STAI), the effect sizes were larger. CONCLUSIONS: We concluded that psychological interventions in Chinese cancer patients have large effects on depression and anxiety. The findings support that an adequate system should be set up to provide routine psychological interventions for cancer patients in Chinese medical settings. However, because of some clear limitations (heterogeneity and publication bias), these results should be interpreted with caution.

Risk of stroke in patients with patent foramen ovale: an updated meta-analysis of observational studies.

BACKGROUND: Although patent foramen ovale (PFO) is considered to be associated with cryptogenic stroke (CS), there remains an ongoing disputation on this issue because of unstable results from randomized controlled trials. The aim of this study was to reassess the PFO effect on stroke through observational data. METHODS: An electronic search of PubMed, Web of Science, and China National Knowledge Infrastructure (CNKI) were finished. Only case-control studies and cohort studies in Chinese or English were included in the analysis. Then random-effected meta-analysis models were performed to assess the association between PFO and stroke. RESULTS: Twelve case-control studies and 6 cohort studies were eligible. Case-control studies showed strong association between PFO and CS (odds ratio [OR]: 2.94, 95% confidence interval [CI]: 2.06, 4.20; P < .001), but cohort studies failed to demonstrate a significant association (hazard ratio [HR]: 1.28, 95% CI: .91, 1.80; P = .155). Subgroup analysis revealed that the pooled OR decreased significantly when the region was limited to the United States (OR: 1.52, 95% CI: 1.00, 2.32; P = .083). OR of studies that adjusted major confounders was 1.74 (95% CI: 1.22, 2.47; P = .119) and high-quality studies was 1.68 (95% CI: 1.14, 2.47; P = .072). For cohort studies, a weak statistical association was observed in using transesophageal echocardiography (TEE) studies (HR: 1.45, 95% CI: 1.06, 2.01; P = .138) and follow-up years less than 4 years' studies (HR: 1.45, 95% CI: 1.00, 2.09; P = .064). CONCLUSIONS: Although case-control studies still show a positive effect of PFO on stroke, the results of cohort challenged the credibility. Further trial data are needed to confirm the effect of PFO on stroke.

Age-specific performance of human papillomavirus E6/E7 mRNA assay versus cytology for primary cervical cancer screening and triage: community-based screening in China.

Background: In the general population, primary human papillomavirus (HPV) testing is advocated for cervical cancer (CC) screening. HPV E6/E7 mRNA (Aptima HPV, AHPV) assays have garnered considerable traction due to their higher specificity when compared with HPV DNA assays. Here, we investigated age-specific primary AHPV screening assays and different triage strategies versus cytology to identify the best approach. Methods: Between April 2018 and December 2021, we recruited female participants from 34 communities across Liaoning province and Qingdao City, China. Primary cervical screening protocols included liquid-based cytology (LBC) and AHPV assays, with females positive for any assays undergoing colposcopy. Genotyping (AHPV-GT) was conducted on all HPV-positive samples. Our primary outcomes were the identification of age-specific detection rates, colposcopy referral rates, and sensitivity and specificity values for high-grade squamous intraepithelial lesions or worse (HSIL+). AHPV and different triage strategy performances were also examined across different age cohorts. Results: Our investigation included 9911 eligible females. Age-specific abnormal cytology rates were in the 6.1%-8.0% range, and were highest in 45-54-year olds. When compared with 35-44-or 45-54-year olds, HPV prevalence was highest in 55-64-year olds (12.2% or 11.6% vs.14.1%, P = 0.048 and P = 0.002, respectively). In 35-44-year olds, AHPV sensitivity for detecting HSIL+ was 96.6 (95% confidence interval [CI]: 89.7-100) - significantly higher than LBC sensitivity (65.5 [95% CI: 48.3-82.8], P < 0.001). When compared with LBC, HSIL+ detection rates by AHPV-GT using reflex LBC triage increased by 31.5% (9.6‰ vs. 7.3‰), and colposcopy referral rates decreased by 16.4% (5.1% vs. 6.1%). In 45-54-year olds, HSIL+ detection rates for AHPV-GT using reflex LBC triage were lower than LBC rates (6.2‰ vs. 6.6‰). In 55-64-year olds, AHPV sensitivity (97.2 [95% CI: 91.7-100.0]) was higher than LBC sensitivity (66.7 [95% CI: 50.0-80.6], P = 0.003). The area under the curve (AUC) value was not significantly different between AHPV-GT with reflex LBC triage and LBC (0.845 [95% CI: 0.771-0.920] vs. 0.812 [95% CI: 0.734-0.891], P = 0.236). Conclusions: Primary AHPV screening using different triage strategies were different across different age cohorts. Thus, AHPV may be an appropriate primary screening method for 35-44 and 55-64 year old females, while AHPV-GT with reflex LBC triage may be more apt for 35-44 year old females.

Solar UV exposure at eye is different from environmental UV: diurnal monitoring at different rotation angles using a manikin.

Solar ultraviolet radiation (UVR) promotes pterygium and cataract development in the human eye. When outdoors, people are subject to varying ocular UVR exposure intensity depending on time of day and orientation to the sun. To assess this variability, a manikin eye was exposed to solar UVR at 12 rotation angles relative to the sun with a solar elevation angle (SEA) ranging from 24.6° to 88.2°. At rotation angles of 0°, 30°, and 330°, the diurnal variation of ocular UVR exposure intensity showed a bimodal distribution that peaked at a SEA of about 40°, which was 3 to 4 hr both before and after noon. This timing differed from peak environmental UVR exposure intensity. At the other rotation angles, diurnal variations in ocular UV exposure exhibited unimodal curves, with maximum intensity around noon, the same as for environmental UVR. Thus, the idea that UVR exposure is most intense at midday is true for skin surfaces positioned somewhat horizontally but not for the eyes in a 60° arc with a centerline toward the sun (i.e., ranging 30° clockwise or counter-clockwise from the centerline). Maintaining certain orientations relative to the sun's position (for example, being clockwise or counter-clockwise by 30° from the sun) should effectively reduce ocular UVR exposure, especially at times when the SEA is 40°.

PM2.5 exposure and cervical cancer survival in Liaoning Province, northeastern China.

Particulate matter with a diameter of 2.5 µm or less (PM2.5) has frequently been reported to be associated with an increased incidence of cancer, but few studies have explored the association between PM2.5 exposure and cancer survival. We retrospectively analyzed the association between PM2.5 exposure and the overall survival (OS) of cervical cancer patients residing in 14 urban areas of Liaoning Province, northeastern China, during January 2014-October 2021. Patients from urban areas who completed the recommended treatments with complete follow-up information were included. The PM2.5 monitoring data of each urban area of Liaoning Province were retrieved, and individual exposure to PM2.5 after diagnosis was calculated as the average daily concentration in the city of residence from the date of discharge to the date of death or the last follow-up. Log-rank tests and Cox regression were performed to examine the relationship between PM2.5 exposure and cervical cancer survival. A total of 1753 cervical cancer patients were finally included, among whom 804 (45.9%) were from Shenyang City, the capital of Liaoning Province. The median average daily concentration of PM2.5 to which the patients were exposed was 45.0 (interquartile range 38.2-50.0) µg/m3. Both log-rank tests (grouped by quartiles, p < 0.001) and Cox regression (continuous, HR = 1.06, 95% CI 1.04-1.08) indicated that PM2.5 was significantly associated with shorter OS. Sensitivity analysis also confirmed the robustness of our findings. From the subgroup analysis, only the OS of stage II and stage III patients was associated with PM exposure. Our findings provide the insight that PM2.5 exposure might be associated with shorter OS of cervical cancer patients.

Performance of human papillomavirus E6/E7 mRNA assay for primary cervical cancer screening and triage: Population-based screening in China.

Objective: Cervical cancer screening is very important in the prevention and treatment of cervical cancer. In China, the cervical screening strategy needs to be improved. To explore a suitable cervical screening strategy in China, we evaluated the performance of the human papillomavirus (HPV) E6/E7 mRNA (Aptima HPV (AHPV)) assay in primary screening and different triage strategies for women undergoing routine cervical screening. Methods: A total of 10,002 women aged 35 to 65 years of age were recruited in Liaoning Province and Qingdao City, China. Specimens were tested by liquid-based cytology (LBC) and the AHPV assay, and women who tested positive on any test were referred for colposcopy. Genotyping was performed on all high-risk HPV (HR-HPV)-positive samples. Test characteristics were calculated based on histological review. Results: We identified 109 women with high-grade squamous intraepithelial lesion or worse (HSIL+), including six with cervical cancer. The sensitivity of AHPV was clearly higher than that of LBC (92.7 [95% CI: 87.2, 97.2] vs. 67.9 [95% CI: 59.6, 76.1], p < 0.001). The specificity of AHPV was 93.0 (95% CI: 92.5, 93.5), which was lower than that of LBC (95.2 [95% CI: 94.8, 95.6], p < 0.001). There was no statistical difference between the positive predictive value of AHPV and LBC (13.5 [95% CI: 11.2, 16.2] vs. 14.3 [95% CI: 11.4, 17.6], p = 0.695). The difference of area under the curve (AUC) values between the AHPV test (0.928 [95% CI: 0.904, 0.953]) and LBC test (0.815 [95% CI: 0.771, 0.860]) in detecting HSIL+ was statistically significant (p < 0.001). Finally, among the three triage strategies, both the sensitivity (73.4 [95% CI: 65.1, 81.7]) and AUC (0.851 [95% CI: 0.809, 0.892]) of AHPV genotyping with reflex LBC triage were the greatest. Conclusion: In summary, the AHPV assay is both specific and sensitive for detecting HSIL+ and may be suitable for use in primary cervical cancer screening in China. AHPV genotyping with reflex LBC triage may be a feasible triage strategy.

D2 lymphadenectomy with complete mesogastrium excision vs. conventional D2 gastrectomy for advanced gastric cancer.

BACKGROUND: The complete mesogastrium excision (CME) based on D2 radical gastrectomy is believed to significantly reduce the local-regional recurrence compared with D2 radical gastrectomy in advanced gastric cancer, and it is widely used in China. This study aimed to explore whether D2 + CME is superior to D2 on surgical outcomes during gastrectomy from Chinese data. METHODS: Feasible studies comparing the D2 + CME (D2 + CME group) and D2 (D2 group) published up to March 2020 are searched from electronic databases. The data showing surgical and complication outcomes are extracted to be pooled and analyzed. RESULTS: Fourteen records including 1352 patients were included. The D2 + CME group had a shorter mean operative time (weighted mean difference [WMD] = -16.72 min, 95% confidence interval [CI]: -26.56 to -6.87 min, P   <  0.001), lower mean blood loss (WMD = -39.08 mL, 95% CI: -49.94 to -28.21 mL, P  < 0.001), higher mean number of retrieved lymph nodes (WMD = 2.13, 95% CI: 0.58-3.67, P  = 0.007), shorter time to first flatus (WMD = -0.31 d, 95% CI: -0.53 to - 0.10 d, P  = 0.005), and postoperative hospital days (WMD = -1.09, 95% CI: -1.92 to -0.25, P  = 0.010) than the D2 group. Subgroup analysis suggested that the advantages from the D2 + CME group were obvious in traditional open radical gastrectomy, proximal gastrectomy, and distal gastrectomy compared with D2 group. The evaluations of post-operative complications showed that the patients who underwent D2 + CME had a lower incidence of post-operative complications than the patients who underwent D2 surgery alone (relative risk [RR] = 0.65, 95% CI: 0.45-0.87, P  = 0.003). The D2 radical gastrectomy plus CME improved 3-year overall survival (OS) (RR = 1.16, 95% CI: 1.02-1.32, P  = 0.020) and lowered the local recurrence rate (RR = 0.51, 95% CI: 0.28-0.94, P  = 0.030). The patients undergoing laparoscopic surgery or total gastrectomy had more significant advantages compared between D2 + CME and D2 groups in 3-year OS. CONCLUSION: The data from China show that D2 radical gastrectomy plus CME are reliable procedures and safety compared to D2 radical gastrectomy with faster recovery, lower risk, and better prognosis.

Efficacy evaluation of vaginal-assisted laparoscopic radical hysterectomy and laparoscopic radical hysterectomy for cervical cancer: a single-center retrospective case series study.

Background: To investigate the survival outcomes of abdominal radical hysterectomy (ARH), laparoscopic radical hysterectomy (LRH), and vaginal-assisted laparoscopic radical hysterectomy (VALRH) in the treatment of cervical cancer patients. Methods: This was a retrospective study. We collected the clinical data of 654 patients with cervical cancer (406 ARH, 172 LRH, and 76 VALRH), then compared the effects of different surgical methods on recurrence and survival. Results: Total overall survival (OS) were no significant differences in three groups (P>0.05). Total disease-free survival (DFS) was significantly higher in ARH group than in LRH group [hazard ratio (HR) =2.8, 95% confidence interval (CI): 1.199-3.607, P=0.004]; however, there were no significant differences between the VALRH (94.7%) and ARH (93.3%) groups. Subgroup stratification analysis showed that the overall recurrence rate in LRH group was significantly higher than that of the ARH groups for patients with a tumor size from ≥2 to <4 cm, negative postoperative lymph nodes, and no postoperative adjuvant therapy (all P<0.05). However, in the subgroup with tumor sizes of ≥2, <4, and ≥4 cm, no matter whether the lymph nodes were positive or not, and those with no postoperative supplementary adjuvant therapy, LRH was associated with a significantly higher local pelvic recurrence rate than ARH (all P<0.05). No significant differences between VALRH and ARH in any of the subgroup analyses (all P>0.05). A Cox analysis indicated that LRH increased the risk of overall and local pelvic recurrence after surgery compared with ARH (HR =2.338, 95% CI: 1.186-4.661, P=0.014; HR =10.313, 95% CI: 2.839-37.460, P<0.001); however, no significant difference between VALRH and ARH (all P>0.05). Sensitivity analysis of surgeons did not change the conclusions. Conclusions: Our analyses showed that the local pelvic recurrence rates and overall recurrence rates of LRH were significantly higher than ARH. VALRH could avoid tumor intraperitoneal exposure and achieve the same tumor prognosis as open surgery. By improving the standardization of minimally invasive surgery for early cervical cancer and paying close attention to the tumor-free concept, minimally invasive radical hysterectomy may achieve the same tumor outcome as open surgery.

Risk assessment of chronic obstructive pulmonary disease using a Bayesian network based on a provincial survey.

INTRODUCTION: The diagnosis of chronic obstructive pulmonary disease (COPD) is based on spirometry tests that are difficult to perform in some populations. OBJECTIVES: We aimed to construct a risk assessment model using a Bayesian Network (BN) that would enable screening high-risk populations. PATIENTS AND METHODS: A provincial survey of COPD was performed with face-to-face interviews and spirometry tests among the population aged ≥40 years in Liaoning Province, northeastern China. The potential risk factors were initially identified by multivariable logistic regression, and then a BN was built. To validate its performance, cross-validation and external dataset validation were performed, and area under the curve (AUC) and accuracy of the BN were calculated. RESULTS: The estimated age-adjusted prevalence of COPD in the entire population was 21.23% (95% confidence interval [CI]: 18.35%-24.11%). The logistic regression revealed that low education level (OR=2.35, p<0.001), elderly age (OR=4.19, p<0.001), ever smoking (OR=1.49, p=0.03), lower air quality satisfaction (OR=1.55, p=0.03) were associated with COPD. For the BN, frequent cough was the strongest single risk indicator of COPD (risk=0.374). The risks increased as more factors were specified, and the top risk was 0.738, which included the combination of elderly age, smoking, wheezing during sickness, and frequent cough. The cross-validation indicated that BN performed better than logistic regression, with a mean AUC of 0.85 and the optimum accuracy of 0.87 (cutoff=0.473). CONCLUSIONS: The BN had a favorable performance in predicting COPD risks based on questionnaires. The risks associated with the combination of several risk factors should be noted.

The Gender-Based Differences in Vulnerability to Ambient Air Pollution and Cerebrovascular Disease Mortality: Evidences Based on 26781 Deaths.

The gender-based differences in the vulnerability to ambient air pollution have not been widely explored. This study aimed to investigate vulnerability differences to the short-term effects of PM2.5, PM10 and O3 between cerebrovascular diseases (CEVD) deaths of men and women. The general additive models (GAMs) and distributed lag non-linear models (DLNMs) were adopted, and both single-pollutant and two-pollutant models were performed to analyze the associations between ambient air pollution and daily CEVD deaths. Both models indicated that O3 was the most suspicious pollutant that could induce excess CEVD deaths, and women tended to be more vulnerable to O3. These results were confirmed by seasonal analysis, in which we also found both genders were more vulnerable to O3 in winter. The exposure-response relationships revealed that women were usually more vulnerable to ambient air pollution than men, and the exposure-response curves differed significantly between genders. Our findings suggested that more attention should be paid on the adverse effects of ambient O3, and the protection of women CEVD population against air pollution should be emphasized.

Associations of workplace violence and psychological capital with depressive symptoms and burn-out among doctors in Liaoning, China: a cross-sectional study.

OBJECTIVES: The purpose of this study was to (1) Identify the prevalence of workplace violence among doctors in Liaoning, China. (2) Examine the relationships between workplace violence and psychological capital with depressive symptoms and burn-out in Chinese doctors. DESIGN: A quantitative, cross-sectional study. SETTING: Eight hospitals in Liaoning Province were surveyed using a self-reported questionnaire. PARTICIPANTS: The study population comprised 1800 doctors. Ultimately 1392 doctors completed valid questionnaires with a response rate of 77.3%. RESULTS: The prevalence of workplace violence was 77.5%. Compared with other types of workplace violence, the prevalence of psychological aggression was the highest (72.7%). Workplace violence (depressive symptoms: ß[95% CI]=0.11 [0.06, 0.16]; emotional exhaustion: ß[95% CI]=0.18 [0.13, 0.23]; depersonalisation: ß[95% CI]=0.17 [0.12, 0.22]) and psychological capital (depressive symptoms: ß[95% CI]=-0.32 [-0.37, -0.27]; emotional exhaustion: ß[95% CI]=-0.23 [-0.28, -0.18]; depersonalisation: ß[95% CI]=-0.23 [-0.28, -0.18]) were associated with depressive symptoms and burn-out. Workplace violence increased the level of depressive symptoms and burn-out by damaging psychological capital (depressive symptoms: a*b=1.61, bias-corrected and accelerated [BCa] 95% CI 1.08 to 2.25; emotional exhaustion: a*b=1.29, BCa 95% CI 0.86 to 1.83; depersonalisation: a*b=0.70, BCa 95% CI 0.45 to 1.00). CONCLUSIONS: In China, most doctors will be exposed to workplace violence, especially psychological aggression. A safer work environment and psychological capital development may be considered in prevention and treatment strategies for improving mental health.

Short-term exposure to ambient air pollution and daily atherosclerotic heart disease mortality in a cool climate.

The associations between exposure to short-term ambient air pollution and daily atherosclerotic heart disease (ASHD) mortality in cool climate have not been established. We performed a time-series analysis in Shenyang, the largest city of Northeastern China. We identified 7659 ASHD deaths and obtained deaths, ambient air pollution levels, and meteorological data for Shenyang during 2014-2017. The impact of ambient air pollution on daily ASHD deaths was analyzed using generalized additive models (GAMs). Cumulative lag effects were investigated using distributed lag non-linear models (DLNM). We found ASHD deaths significantly increased during days with higher air pollution. Particulate matter with diameter < 2.5 µm (PM2.5), PM10, and sulfur dioxide (SO2) were positively associated with ASHD deaths among the total population. Both single- and multi-pollutants models indicated that PM2.5, PM10, and sulfur dioxide (SO2) were positively associated with the deaths of women with AHSD, whereas only SO2 was significant in men. This suggests significant gender-based differences in the fatal effects of ambient air pollution. Up to 28 days of single-day lag effects were observed for PM2.5 and PM10 in women. The cumulative lag effects of PM2.5 and PM10 showed increasing trends in both men and women; however, exposure to higher pollutant concentrations did not necessarily translate to greater risks. The ERRs differences between women and men were larger in cold days than in hot days, suggesting that lower temperature may exacerbate the adverse effects of air pollution on vulnerable women.

The association between ambient air pollution exposure and mental health status in Chinese female college students: a cross-sectional study.

The association between exposure to air pollution and mental health has not been adequately studied. Accordingly, this study aimed to explore the association between exposure to ambient air pollution and mental health status among female college students. We performed a cross-sectional study involving female students attending college located in Anshan, a heavy industry city in Northeast China. The investigation was performed using electronic questionnaires including the Symptom Checklist-90 (SCL-90), Pittsburgh Sleep Quality Index (PSQI), Cornell Medical Index (CMI), and general well-being (GWB) scale between March and April 2017. The individual daily average of time spent outdoors in each season was used as an indicator of exposure to ambient air pollution. The association between mental health status and exposure to ambient air pollution was analyzed using general linear regression. Of the 412 female participants, 346 (83.98%) submitted valid questionnaires. Multivariate linear regression indicated that GWB was negatively associated with the SCL-90 score, and annual average daily outdoor time and sleep quality were positively associated with the SCL-90 score. This study demonstrated that exposure to ambient air pollution may be a risk factor for mental health problems among female college students.

The Long-Term Effects of Maternal Postnatal Depression on a Child's Intelligence Quotient: A Meta-Analysis of Prospective Cohort Studies Based on 974 Cases.

OBJECTIVE: Epidemiologists have explored the relationship between maternal postnatal depression (PND) and the intelligence quotient (IQ) of the resulting offspring, but the results remain inconclusive. This study aims to analyze the literature regarding the association between maternal PND and a child's IQ. DATA SOURCES: A search of articles in PubMed, Web of Science, and MEDLINE databases from inception to September 2015 was conducted and supplemented by a manual search of relevant reference lists. The following search terms were used: (postpartum OR postnatal OR puerperal) AND (depression OR depressive symptoms OR blues OR dysthymia OR disorders OR psychosis) AND (intelligence quotient OR IQ OR intelligence tests OR intelligence OR cognitive OR cognition) AND (children OR child OR adolescent OR offspring) AND (cohort OR prospective OR follow-up OR follow OR longitudinal). STUDY SELECTION: Articles exploring the association between maternal PND and IQ of offspring aged 2 years and older were included. A total of 510 records were retrieved. DATA EXTRACTION: Two authors independently selected eligible studies and extracted data. Three authors assessed the quality of the studies. To explore the associations between maternal PND and full IQ and verbal IQ, random-effects meta-analyses were performed, followed by subgroup analysis of impact on full IQ. RESULTS: Nine articles were eligible for review. On the basis of the Newcastle-Ottawa Scale, 7 studies were considered to be of high quality. When one study of participants aged 3.8 years was excluded from the meta-analysis, the pooled weighted mean difference of full IQ between the children of PND mothers and non-PND mothers was -4.086 (95% CI, -6.578 to -1.594), and the pooled standard mean difference of verbal IQ between the children of PND mothers and non-PND mothers was -0.361 (95% CI, -0.564 to -0.158). Subgroup analysis showed that the child's age at evaluation, diagnostic method of PND, study quality, and socioeconomic status did not affect the mean difference in full IQ between children of PND mothers and those of non-PND mothers. When the excluded study was included in the meta-analysis, the results did not vary. CONCLUSIONS: Maternal PND may be a risk factor for a child's lower IQ. More studies of high methodological quality may be needed.

The Effects of Being an Only Child, Family Cohesion, and Family Conflict on Behavioral Problems among Adolescents with Physically Ill Parents.

BACKGROUND: This study aimed to examine the parental physical illness' effect on behavioral problems among adolescents, and the effects of being an only child, family cohesion, and family conflict on behavioral problems among adolescents with physically ill parents in Liaoning province, China. METHODS: This cross-sectional study was performed in 2009. A questionnaire including two dimensions of the Family Environment Scale (family cohesion and family conflict), self-reported Strength and Difficulties Questionnaire (SDQ), and demographic factors was distributed to the subjects. RESULTS: Among the 5220 adolescents, 308 adolescents lived with physically ill parents. The adolescents with physically ill parents had more behavioral problems than adolescents with healthy parents. Among the girls who lived in families with physically ill parents, the SDQ score and the prevalence of SDQ syndromes were higher in the girls with siblings than the girls without siblings after adjusting for variables; the effect of family cohesion on SDQ was significant after adjusting for variables. CONCLUSION: Interventions targeting family cohesion may be effective to reduce behavioral problems of adolescents with physically ill parents.

Knowledge, attitude and practice regarding solar ultraviolet exposure among medical university students in Northeast China.

To assess the knowledge, attitudes and practices regarding the health effects of ultraviolet radiation (UVR) and sun exposure among medical university students in Northeast China, 385 subjects were investigated on October 2013 using a self-administered multiple-choice questionnaire. Most of the subjects knew the effects of UVR on skin cancer (95.6%) and sunburn (92.2%), but fewer knew of the eye damage that can result from UVR (27.8% cataract and 3.1% pterygium). Correspondingly, the main purpose of adopting sun protection was considered to be 'preventing sunburn' (55.4%), but 'preventing eye damage' was the least (1.8%). In actual behaviour, the eyes received the least protection as well. Although knowing the effects of UVR on vitamin D synthesis (87.3%), 66.8% of participants never or seldom increased sun exposure. Compared to men, women were more likely to reduce sun exposure (P<0.001). Only a small fraction of subjects (6.6%) thought that tanning was attractive. Considering the response variability to UVR in people with different skin colours, different sun protection programs should be provided. In China, especially in the North, the public should be educated to moderately increase sun exposure to maintain adequate vitamin D status while also protecting against eye damage from UVR.