A cost-effectiveness analysis of lung cancer screening with low-dose computed tomography and a polygenic risk score.

INTRODUCTION: Several studies have proved that Polygenic Risk Score (PRS) is a potential candidate for realizing precision screening. The effectiveness of low-dose computed tomography (LDCT) screening for lung cancer has been proved to reduce lung cancer specific and overall mortality, but the cost-effectiveness of diverse screening strategies remained unclear. METHODS: The comparative cost-effectiveness analysis used a Markov state-transition model to assess the potential effect and costs of the screening strategies incorporating PRS or not. A hypothetical cohort of 300,000 heavy smokers entered the study at age 50-74 years and were followed up until death or age 79 years. The model was run with a cycle length of 1 year. All the transition probabilities were validated and the performance value of PRS was extracted from published literature. A societal perspective was adopted and cost parameters were derived from databases of local medical insurance bureau. Sensitivity analyses and scenario analyses were conducted. RESULTS: The strategy incorporating PRS was estimated to obtain an ICER of CNY 156,691.93 to CNY 221,741.84 per QALY gained compared with non-screening with the initial start age range across 50-74 years. The strategy that screened using LDCT alone from 70-74 years annually could obtain an ICER of CNY 80,880.85 per QALY gained, which was the most cost-effective strategy. The introduction of PRS as an extra eligible criteria was associated with making strategies cost-saving but also lose the capability of gaining more LYs compared with LDCT screening alone. CONCLUSION: The PRS-based conjunctive screening strategy for lung cancer screening in China was not cost-effective using the willingness-to-pay threshold of 1 time Gross Domestic Product (GDP) per capita, and the optimal screening strategy for lung cancer still remains to be LDCT screening for now. Further optimization of the screening modality can be useful to consider adoption of PRS and prospective evaluation remains a research priority.

The correlation analysis of WeChat usage and depression among the middle-aged and elderly in China: the mediating role of social participation.

BACKGROUND: We aimed to explore the association between WeChat usage and depression in the Chinese middle-aged and elderly and the role of social participation. METHODS: Data were obtained from China Health and Retirement Longitudinal Study (CHARLS) of 2018. The dependent variable was depressive symptoms, measured with the 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10). We used the propensity score matching (PSM) to match the WeChat users with the non-WeChat users. Correlations between WeChat usage and depressive symptoms were verified by using logistic regression and linear regression, and the mediating role of social participation was verified by using stepwise regression and KHB method. RESULTS: Four thousand five hundred forty-five samples were ultimately matched for analysis in this study. After including all control variables, results of logistic regression showed that WeChat usage was significantly associated with a lower prevalence of depression (aOR:0.701,95% CI: 0.605-0.812). And the results of linear regression showed that WeChat usage was associated with lower levels of depression which was significant (p < 0.001). The results of the stepwise regression and the KHB method showed a mediating role of social participation in WeChat usage and depressive symptoms. Among the four types of social participation, the mediating effect of recreational activities was significant, while the mediating effects of voluntary activities, cultural activities, and other activities were not significant. Meanwhile, the effect of WeChat usage on depression and the mediating effect of social participation were heterogeneous because of differences in age and gender. CONCLUSION: Social participation partly mediated the effect between WeChat usage and depression in middle-aged and older adults. Among the four types of social participation, only recreational activities had a mediating effect. Encouraging more active social participation and other types of social activities should be considered to improve the mental health of the middle-aged and older adults in China through social media usage.

Effects of adverse childhood health experiences on cognitive function in Chinese middle-aged and older adults: mediating role of depression.

BACKGROUND: Adverse childhood experiences are critical factors in depression and cognitive decrease, but the effect of adverse childhood health experiences (ACHEs) on cognitive function and the role of depression have not been fully studied. METHODS: Data were taken from the China Health and Retirement Longitudinal Study (CHARLS) of 2014 and 2018. This study used indicators of situational memory ability and mental status to measure cognitive capacity. Besides analyzing the different types of ACHEs, scores for ACHEs were calculated to represent the severity of ACHEs. The Center for Epidemiologic Studies Depression Scale (CES-D) was used to assess depression. The analysis of this study employed two different analytical strategies in order to examine the mediated effects of depression. We used Sobel's test and Baron and Kenny's causal step approach, which utilized a generalized least squares regression model. Furthermore, a logistic regression model was used to evaluate the robustness of the Karlson-Holm-Breen (KHB) approach. RESULTS: In this study, 6301 individuals who met the requirements of the study were included. We found that being confined to bed (ACHE3) (ß=-0.3846, p = 0.022) in childhood had a negative impact on cognitive function. Similarly, ACHEs had a negative effect on cognitive function (ß=-0.0819, p = 0.090). And after the depression had been introduced into the model, the regression coefficient of ACHEs on cognitive function was no longer significant (ß=-0.0170, p = 0.727). The Sobel test showed that for ACHE3, the mediated proportion of the total effect of depression was 36.92%. While for ACHEs, the proportion of the mediated effect of depression was 70.11%. Finally, a robustness test of the mediating effect using the KHB method revealed that the mediating effect still existed. Further, based on different gender, age, and educational levels, the heterogeneity test indicated that the relationship between ACHEs and cognitive function and mediating effects of the depression were different as well as passing the robustness test of the interaction. CONCLUSION: The decline in cognition had been shown to be correlated with ACHEs and depression mediated this relationship. Positive interventions might help to improve cognitive performance in individuals suffering from ACHEs and depression.

The impact of informal social support on the health poverty vulnerability of the elderly in rural China: based on 2018 CHARLS data.

OBJECTIVE: From the perspective of informal social support, this paper analysed the impact of factors such as "Relationship with spouse", "Relationship with Children", "Financial support from children", "Sibling support", "Support from other friends and relatives" and "Borrowing costs" on the health poverty vulnerability of elderly people in rural China. METHODS: Based on the data of the China Health and Retirement Longitudinal Study (CHARLS) in 2018, the vulnerability of the rural elderly to health poverty was measured from two dimensions of health status and influencing factors of health status by the three-stage feasible generalized least square method. A quantile regression model was used to analyse the impact of six variables in the informal social support network on health poverty vulnerability: "Relationship with spouse", "Relationship with children", "Financial support from children", " Sibling support", " Support from other friends and relatives", and "Borrowing costs". RESULTS: When the poverty line standards were 2995 CNY/year and 4589 CNY/year, the health poverty vulnerability of the elderly population in rural China was 0.397 and 0.598 in 2018. In the analysis of informal social support, factors such as the relationship with spouse, relationship with children, borrowing costs, support from other friends and relatives, and sibling support had different impacts on the health poverty vulnerability of the rural elderly, who were classified into three groups according to their different vulnerabilities. CONCLUSION: According to the analysis of the 2018 CHARLS database, the health poverty vulnerability of the elderly population was related to the informal social support network, and it is necessary to pay attention to the role of informal channels such as children, spouses, relatives and friends in daily care and financial support for rural elderly individuals. Meanwhile, the government and other formal organizations should also give full play to their supporting role for elderly individuals, who are highly vulnerable to health poverty, and their families.

The effect of childhood social isolation on behavioral cognition in Chinese middle-aged and older adults: The moderating effect of family support.

INTRODUCTION: This study aimed to analyze the association of childhood social isolation and behavioral cognition, and moderating effect of family support in middle-aged and older adults. METHODS: The study samples were from the China Health and Retirement Longitudinal Study (CHARLS) of 2014 and 2018. The dependent variable was behavioral cognitive ability, measured by episodic memory and mental state; The independent variable was childhood social isolation, and the moderating variable was family support. The baseline OLS regression model was used to explore the correlation among independent variables, dependent variables and moderating variables, the least square regression model was used to analyze the moderating effect of family support, and the replacement model and the method of replacing characteristic variables were used for the robustness test. Hierarchical regression heterogeneity analysis was performed to further verify the results of the moderating effect. RESULTS: In this study, 3459 samples were selected for analysis. OLS baseline regression results showed that the deepening of childhood social isolation was significantly correlated with the decline of behavioral cognitive ability in middle-aged and elderly people (ß=-0.9664, t = 0.0893). After adding all covariates, we found that childhood social isolation was significantly negatively correlated with behavioral cognitive ability in middle-aged and elderly people (ß=-0.4118, t = 0.0785). Among the moderating variables of family support, we found that there is a moderating effect on female guardians' efforts of caring in early parental support (ß=0.0948, t = 0.0320) and the frequency of children's visits in late children support (ß=0.0073, t = 0.0036). Finally, through the heterogeneity test, we found that there were differences in the relationship between childhood social isolation and behavioral cognitive ability among middle-aged and elderly people of different ages, genders and places of residence. Moreover, there are significant differences in the moderating effect of female guardian's effort of caring and the frequency of children's visits in heterogeneous groups. CONCLUSIONS: The greater the degree of childhood social isolation experienced by middle-aged and elderly people, the worse their behavioral cognitive ability. Female guardian's effort of caring and the frequency of children's visits have a moderating effect to suppress this negative effect.

A bacterial ghost improves the immunological efficacy of a Newcastle disease virus inactivated vaccine.

Newcastle disease (ND) is one of the most common contagious viral infectious diseases of poultry. Vaccination is an effective way to protect chickens from Newcastle disease virus (NDV), and large efforts have been made to acquire not only new vaccines but also new adjuvants to improve the efficiency of existing inactivated vaccines. Here, we observed the adjuvanticity of the bacterial ghost (BG) on the effectiveness of inactivated NDV vaccine in a chicken model. We found that BG, as an adjuvant with inactivated NDV vaccine, substantially strengthened the ND-specific antibody response and protection against lethal challenge in a chicken model, reduced viral shedding, strengthened the time duration of antibody titers, produced an available immunization effect with a low dose of vaccine, and improved serum IL-2 and IFN-γ concentrations. Our results demonstrate that BG significantly improved the immunogenicity of an inactivated NDV vaccine and is a new immune adjuvant candidate.

Linear antigenic mapping of flagellin (FliC) from Salmonella enterica serovar Enteritidis with yeast surface expression system.

Salmonella enterica serovar Enteritidis (S. Enteritidis) is a major cause of food-borne illness around the world and can have significant health implications in humans, poultry and other animals. Flagellin (FliC) is the primary component of bacterial flagella. It has been shown that the FliC of S. Enteritidis is a significant antigenic structure and can elicit strong humoral responses against S. Enteritidis infection in chickens. Here, we constructed a FliC antigen library using a yeast surface expression system. Yeast cells expressing FliC peptide antigens were labeled with chicken sera against S. Enteritidis and sorted using FACS. The analyses of FliC peptides revealed that the FliC linear antigenicity in chickens resided on three domains which were able to elicit strong humoral responses in vivo. Animal experiments further revealed that the antibodies elicited by these antigenic domains were able to significantly inhibit the invasion of S. Enteritidis into the liver and spleen of chickens. These findings will facilitate our better understanding of the humoral responses elicited by FliC in chickens upon infection by S. Enteritidis.

Comprehensive Analysis and Characterization of Linear Antigenic Domains on HN Protein from Genotype VII Newcastle Disease Virus Using Yeast Surface Display System.

Circulation of genotype VII Newcastle disease virus (NDV) has posed a great threat for the poultry industry worldwide. Antibodies against Hemagglutinin-neuraminidase (HN), a membrane protein of NDV with critical roles in NDV infection, have been reported to provide chickens protection from NDV infection. In this study, we comprehensively analyzed the in vivo antibody responses against the linear antigenic domains of the HN protein from genotype VII NDV using a yeast surface display system. The results revealed four distinct regions of HN, P1 (1-52aa), P2 (53-192aa), P3 (193-302aa) and P4 (303-571aa), respectively, according to their antigenic potency. Analysis by FACS and ELISA assay indicated P2 to be the dominant linear antigenic domain, with the immunogenic potency to protect the majority of chickens from NDV challenge. In contrast, the P1, P3 and P4 domains showed weak antigenicity in vivo and could not protect chickens from NDV challenge. These results provide important insight into the characteristic of humoral immune responses elicited by HN of NDV in vivo.