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BMC Med Educ ; 22(1): 30, 2022 Jan 11.
Article En | MEDLINE | ID: mdl-35016672

BACKGROUND: Medical schools can contribute to the insufficient primary care physician workforce by influencing students' career preferences. Primary care career choice evolves between matriculation and graduation and is influenced by several individual and contextual factors. This study explored the longitudinal dynamics of primary care career intentions and the association of students' motives for becoming doctors with these intentions in a cohort of undergraduate medical students followed over a four-year period. METHODS: The sample consisted of medical students from two classes recruited into a cohort study during their first academic year, and who completed a yearly survey over a four-year period from their third (end of pre-clinical curriculum) to their sixth (before graduation) academic year. Main outcome measures were students' motives for becoming doctors (ten motives rated on a 6-point scale) and career intentions (categorized into primary care, non-primary care, and undecided). Population-level flows of career intentions were investigated descriptively. Changes in the rating of motives over time were analyzed using Wilcoxon tests. Two generalized linear mixed models were used to estimate which motives were associated with primary care career intentions. RESULTS: The sample included 217 students (60% females). Career intentions mainly evolved during clinical training, with smaller changes at the end of pre-clinical training. The proportion of students intending to practice primary care increased over time from 12.8% (year 3) to 24% (year 6). Caring for patients was the most highly rated motive for becoming a doctor. The importance of the motives cure diseases, saving lives, and vocation decreased over time. Primary care career intentions were positively associated with the motives altruism and private practice, and negatively associated with the motives prestige, academic interest and cure diseases. CONCLUSION: Our study indicates that career intentions are not fixed and change mainly during clinical training, supporting the influence of clinical experiences on career-related choices. The impact of students' motives on primary care career choice suggests strategies to increase the attractivity of this career, such as reinforcing students' altruistic values and increasing the academic recognition of primary care.

Intention , Students, Medical , Career Choice , Cohort Studies , Female , Humans , Longitudinal Studies , Male , Primary Health Care , Surveys and Questionnaires
BMC Musculoskelet Disord ; 23(1): 29, 2022 Jan 04.
Article En | MEDLINE | ID: mdl-34983488

BACKGROUND: Acute musculoskeletal (MSK) pain is very common and associated with impaired productivity and high economic burden. Access to timely and personalized, evidence-based care is key to improve outcomes while reducing healthcare expenditure. Digital interventions can facilitate access and ensure care scalability. OBJECTIVE: Present the feasibility and results of a fully remote digital care program (DCP) for acute MSK conditions affecting several body areas. METHODS: Interventional single-arm study of individuals applying for digital care programs for acute MSK pain. Primary outcome was the mean change between baseline and end-of-program in self-reported Numerical Pain Rating Scale (NPRS) score and secondary outcomes were change in analgesic consumption, intention to undergo surgery, anxiety (GAD-7), depression (PHQ-9), fear-avoidance beliefs (FABQ-PA), work productivity (WPAI-GH) and engagement. RESULTS: Three hundred forty-three patients started the program, of which 300 (87.5%) completed the program. Latent growth curve analysis (LGCA) revealed that changes in NPRS between baseline and end-of-program were both statistically (p < 0.001) and clinically significant: 64.3% reduction (mean - 2.9 points). Marked improvements were also noted in all secondary outcomes: 82% reduction in medication intake, 63% reduction in surgery intent, 40% in fear-avoidance beliefs, 54% in anxiety, 58% in depression and 79% recovery in overall productivity. All outcomes had steeper improvements in the first 4 weeks, which paralleled higher engagement in this period (3.6 vs 3.2 overall weekly sessions, p < 0.001). Mean patient satisfaction score was 8.7/10 (SD 1.26). STRENGTHS AND LIMITATIONS: This is the first longitudinal study demonstrating the feasibility of a DCP for patients with acute MSK conditions involving several body areas. Major strengths of this study are the large sample size, the wide range of MSK conditions studied, the breadth of outcomes measured, and the very high retention rate and adherence level. The major limitation regards to the absence of a control group. CONCLUSIONS: We observed very high completion and engagement rates, as well as clinically relevant changes in all health-related outcomes and productivity recovery. We believe this DCP holds great potential in the delivery of effective and scalable MSK care. TRIAL REGISTRATION: NCT, NCT04092946 . Registered 17/09/2019.

Musculoskeletal Pain , Telerehabilitation , Humans , Longitudinal Studies , Musculoskeletal Pain/diagnosis , Musculoskeletal Pain/therapy , Prospective Studies , Surveys and Questionnaires
BMJ Open ; 12(1): e053094, 2022 01 03.
Article En | MEDLINE | ID: mdl-34980617

OBJECTIVES: COVID-19 is having a disproportionate impact on Black, Asian and minority ethnic (BAME) groups and women. Concern over direct and indirect effects may also impact on sleep. We explore the levels and social determinants of self-reported sleep loss among the UK population during the pandemic, focusing on ethnic and gender disparities. SETTING: This prospective longitudinal study analysed data from seven waves of the Understanding Society: COVID-19 Study collected from April 2020 to January 2021 linked to prepandemic data from the 2019 mainstage interviews, providing baseline information about the respondents prior to the pandemic. PARTICIPANTS: The analytical sample included 8163 respondents aged 16 and above who took part in all seven waves with full information on sleep loss, defined as experiencing 'rather more' or 'much more' than usual sleep loss due to worry, providing 57 141 observations. PRIMARY OUTCOME MEASURES: Self-reported sleep loss. Mixed-effects regression models were fitted to consider within-individual and between-individual differences. RESULTS: Women were more likely to report sleep loss than men (OR 2.1, 95% CI 1.9 to 2.4) over the 10-month period. Being female, having young children, perceived financial difficulties and COVID-19 symptoms were all predictive of sleep loss. Once these covariates were controlled for, the bivariate relationship between ethnicity and sleep loss (1.4, 95% CI 1.6 to 2.4) was reversed (0.7, 95% CI 0.5 to 0.8). Moreover, the strength of the association between gender and ethnicity and the risk of sleep loss varied over time, being weaker among women in July (0.6, 95% CI 0.5 to 0.7), September (0.7, 95% CI 0.6 to 0.8), November (0.8, 95% CI 0.7 to 1.0) and January 2021 (0.8, 95% CI 0.7 to 0.9) compared with April 2020, but positively stronger among BAME individuals in May (1.4, 95% CI 1.0 to 2.1), weaker only in September (0.7, 95% CI 0.5 to 1.0). CONCLUSIONS: The pandemic has widened sleep deprivation disparities, with women with young children, COVID-19 infection and BAME individuals experiencing sleep loss, which may adversely affect their mental and physical health.

COVID-19 , Pandemics , Child , Child, Preschool , Communicable Disease Control , Female , Humans , Longitudinal Studies , Male , Prospective Studies , SARS-CoV-2 , Sleep , United Kingdom/epidemiology
Health Res Policy Syst ; 20(1): 4, 2022 Jan 06.
Article En | MEDLINE | ID: mdl-34991612

BACKGROUND: The pharmaceutical industry is heavily regulated. Partly for this reason, new drugs generally take over 10 years from the product development stage to market entry. Although regulations affect the pharmaceutical industry over a long period, previous studies investigating the impact of new regulatory policies have usually focused on the short period before and after implementing that policy. Therefore, the purpose of this study is to examine whether and how significantly regulatory policies affect long-term innovation in the pharmaceutical industry in Korea. METHODS: This study focused on three significant regulatory policies: the introduction of the product patent system, changes in the Good Manufacturing Practice (GMP) system, and the Drug Expenditure Rationalization Plan (DERP). The study used interrupted time series (ITS) analysis to investigate the long-term impacts of the policies before and after implementation. RESULTS: Our results show that introducing the product patent system in 1987 significantly increased the number of Korean patent applications. The effect of the revised GMP policies was also statistically significant, both before and after implementation and between pre-emptive companies and non-pre-emptive ones. However, due to the companies' negotiations with the regulatory authorities or the regulatory system that links drug approval and price evaluation, the DERP did not significantly delay new drug registration in Korea. CONCLUSION: This study showed that the policies of the product patent system, GMP policies, and DERP regulations have significantly encouraged pharmaceutical companies to strive to meet regulatory requirements and promote innovation in Korea. The study suggests that it is necessary for companies to pre-emptively respond to systemic changes in development and production strategies to deal with regulatory changes and achieve sustainable growth. Also, our study results indicate that since government policies motivate the innovative system of the pharmaceutical industry, governmental authorities, when formulating pharmaceutical policies, need to consider the impact on the long-term innovation of the industry.

Drug Approval , Drug Industry , Commerce , Longitudinal Studies , Republic of Korea
Reprod Health ; 19(1): 4, 2022 Jan 06.
Article En | MEDLINE | ID: mdl-34991651

BACKGROUND: The hormonal Intrauterine Device (IUD) is a highly effective contraceptive option growing in popularity and availability in many countries. The hormonal IUD has been shown to have high rates of satisfaction and continuation among users in high-income countries. The study aims to understand the profiles of clients who choose the hormonal IUD in low- and middle-income countries (LMICs) and describe their continuation and satisfaction with the method after 12 months of use. METHODS: A prospective longitudinal study of hormonal IUD acceptors was conducted across three countries-Madagascar, Nigeria, and Zambia-where the hormonal IUD had been introduced in a pilot setting within the of a broad mix of available methods. Women were interviewed at baseline immediately following their voluntary hormonal IUD insertion, and again 3 and 12 months following provision of the method. A descriptive analysis of user characteristics and satisfaction with the method was conducted on an analytic sample of women who completed baseline, 3-month, and 12-month follow-up questionnaires. Kaplan-Meier time-to-event models were used to estimate the cumulative probability of method continuation rates up to 12 months post-insertion. RESULTS: Each country had a unique demographic profile of hormonal IUD users with different method-use histories. Across all three countries, women reported high rates of satisfaction with the hormonal IUD (67-100%) and high rates of continuation at the 12-month mark (82-90%). CONCLUSIONS: Rates of satisfaction and continuation among hormonal IUD users in the study suggest that expanding method choice with the hormonal IUD would provide a highly effective, long-acting method desirable to many different population segments, including those with high unmet need.

Contraceptive Agents, Female , Intrauterine Devices, Copper , Intrauterine Devices , Female , Humans , Levonorgestrel , Longitudinal Studies , Madagascar , Nigeria , Pilot Projects , Prospective Studies , Zambia
Vet Rec ; 190(1): 5, 2022 01.
Article En | MEDLINE | ID: mdl-34994458
BMC Bioinformatics ; 23(1): 28, 2022 Jan 10.
Article En | MEDLINE | ID: mdl-35012447

BACKGROUND/AIM: The polygenic risk score (PRS) shows promise as a potentially effective approach to summarize genetic risk for complex diseases such as alcohol use disorder that is influenced by a combination of multiple variants, each of which has a very small effect. Yet, conventional PRS methods tend to over-adjust confounding factors in the discovery sample and thus have low power to predict the phenotype in the target sample. This study aims to address this important methodological issue. METHODS: This study proposed a new method to construct PRS by (1) approximating the polygenic model using a few principal components selected based on eigen-correlation in the discovery data; and (2) conducting principal component projection on the target data. Secondary data analysis was conducted on two large scale databases: the Study of Addiction: Genetics and Environment (SAGE; discovery data) and the National Longitudinal Study of Adolescent to Adult Health (Add Health; target data) to compare performance of the conventional and proposed methods. RESULT AND CONCLUSION: The results show that the proposed method has higher prediction power and can handle participants from different ancestry backgrounds. We also provide practical recommendations for setting the linkage disequilibrium (LD) and p value thresholds.

Alcoholism , Genetic Predisposition to Disease , Alcoholism/genetics , Genome-Wide Association Study , Humans , Linkage Disequilibrium , Longitudinal Studies , Multifactorial Inheritance , Risk Factors
Codas ; 34(3): e20210109, 2022.
Article Pt, En | MEDLINE | ID: mdl-35019088

PURPOSE: The aim of this study was to analyze the repercussion of the implementation of PECS on the burden index of mothers of children with Autism Spectrum Disorder (ASD). METHODS: This was a longitudinal study (CEP 0403/2017). The sample consisted of 20 mother and child with ASD. The mothers were on average 41 years and 5 months and the children were 7 years and 2 months old. Fifteen children were male and five were female. The brazilian version of the Burden Interview scale was applied to verify the level of caregiver burden. The Autism Behavior Checklist (ABC) was applied to the analysis of non-adaptive behaviors and to analyze the lexical repertoire: Auditory and Expressive Vocabulary Tests. The PECS Implementation Program was composed of 24 sessions of individual speech therapy with the active presence of mothers. At the end all children and mothers were reevaluated with part of the instruments. RESULTS: There was a tendency to reduce maternal overload indexes after the implementation of the PECS. There was a significant decrease in non-adaptive behaviors and an increase in the expressive and auditory vocabulary indexes of the children at the final moment of the study. We did not observe a significant correlation between the degrees of overload with age, schooling and intellectual quotient of children, nor schooling and maternal socioeconomic status. CONCLUSION: It was possible to analyze the repercussion of the implementation of the PECS on the burden of mothers of children with ASD assisted by the Program.

Autism Spectrum Disorder , Communication Aids for Disabled , Child , Female , Humans , Infant , Longitudinal Studies , Male , Mothers , Speech
BMJ Open ; 12(1): e055696, 2022 01 07.
Article En | MEDLINE | ID: mdl-34996798

BACKGROUND: A growing body of literature shows profound effects of the COVID-19 pandemic on mental health, among which increased rates of post-traumatic stress disorder (PTSD) and adjustment disorder (AD). However, current research efforts have largely been unilateral, focusing on psychopathology and not including well-being, and are dominated by examining average psychopathology levels or on disorder absence/presence, thereby ignoring individual differences in mental health. Knowledge on individual differences, as depicted by latent subgroups, in the full spectrum of mental health may provide valuable insights in how individuals transition between health states and factors that predict transitioning from resilient to symptomatic classes. Our aim is to (1) identify longitudinal classes (ie, subgroups of individuals) based on indicators of PTSD, AD and well-being in response to the pandemic and (2) examine predictors of transitioning between these subgroups. METHODS AND ANALYSIS: We will conduct a three-wave longitudinal online survey study of n≥2000 adults from the general Dutch population. The first measurement occasion takes place 6 months after the start of the pandemic, followed by two follow-up measurements with 6 months of intervals. Latent transition analysis will be used for data analysis. ETHICS AND DISSEMINATION: Ethical approval has been obtained from four Dutch universities. Longitudinal study designs are vital to monitor mental health (and predictors thereof) in the pandemic to develop preventive and curative mental health interventions. This study is carried out by researchers who are board members of the Dutch Society for Traumatic Stress Studies and is part of a pan-European study (initiated by the European Society for Traumatic Stress Studies) examining the impact of the pandemic in 11 countries. Results will be published in peer-reviewed journals and disseminated at conferences, via newsletters, and media appearance among (psychotrauma) professionals and the general public.

COVID-19 , Stress Disorders, Post-Traumatic , Adjustment Disorders , Adult , Humans , Longitudinal Studies , Pandemics , SARS-CoV-2 , Stress Disorders, Post-Traumatic/epidemiology
Environ Int ; 158: 107003, 2022 01.
Article En | MEDLINE | ID: mdl-34991263

BACKGROUND: Accumulating evidence indicates early life exposure to air pollution, a suspected neurotoxicant, is negatively associated with children's neurodevelopment. OBJECTIVES: To explore the role of multiple exposure periods to ambient particulate matter with diameter <2.5 µm (PM2.5) and nitrogen dioxide (NO2) on emotion and behaviour, and early development in children <13 years. METHODS: We used data from Mothers and their Children's Health (MatCH) study, a 2016/17 sub-study from a prospective longitudinal study, the Australian Longitudinal Study on Women's Health. Annual PM2.5 and NO2 estimates since 1996 were obtained from a land-use regression model. Maternal residential proximity to roadways were used as a proxy measure of exposure to traffic-related air pollution. Child outcomes were maternal-rated emotional and behavioural problems (Strengths and Difficulties Questionnaire; SDQ, aged 2-12 years, n = 5471 children) and developmental delay in communication and gross motor skills (Ages and Stages Questionnaire; ASQ, aged 1-66 months, n = 1265 children). Defined exposure periods were early life exposure ('during pregnancy' and 'first year of life') and 'children's lifetime exposure'. Ambient air pollution was divided into tertiles and logistic regression was performed to estimate odds ratio (OR) for each child outcome, adjusting for potential confounders. RESULTS: Children exposed to moderate and high PM2.5 exposure, compared to low exposure, across all periods, had higher odds of emotional and behavioural problems, and gross motor delay. Children's lifetime exposure to moderate levels of PM2.5 (5.9-7.1 µg/m3) was associated with 1.27 (95% confidence interval 1.03, 1.57) fold higher odds of emotional/behavioural problems. Similar associations were found for moderate PM2.5 levels at 'first year of life' in a two-pollutant model only (OR: 1.30; 1.05, 1.60). However, there was insufficient evidence to suggest that NO2 exposure or living within 200 m of major roads was associated with emotional and behaviour problems or developmental delay across any exposure periods. CONCLUSION: We found isolated evidence that early life and childhood exposure to PM2.5 may be associated with emotional and behavioural problems and delays in gross motor skills, but most associations were null. Due to the limited number of longitudinal studies on low-exposure settings, further studies with more temporally refined exposure assessment are warranted.

Air Pollutants , Air Pollution , Air Pollutants/analysis , Air Pollutants/toxicity , Air Pollution/analysis , Air Pollution/statistics & numerical data , Australia/epidemiology , Child , Environmental Exposure/analysis , Environmental Exposure/statistics & numerical data , Female , Humans , Longitudinal Studies , Mental Health , Nitrogen Dioxide/analysis , Particulate Matter/analysis , Particulate Matter/toxicity , Pregnancy , Prospective Studies
Environ Int ; 158: 107012, 2022 01.
Article En | MEDLINE | ID: mdl-34991268

OBJECTIVE: The aim of this study was to explore the association between exposure to particulate matter with an aerodynamic diameter of 2.5 mm or less (PM2.5) and blood pressure (BP) levels in children and adolescents and to illustrate the impact of PM2.5 levels on BP growth curves in a cohort study. METHODS: A longitudinal study was designed and included 4303 children (7617 BP measurements) living in the selected areas, and evaluations were conducted in 2014-2015 (visit 1) and followed up in 2019 (visit 2). Two-stage stratified cluster sampling was used to include urban-rural areas. A mixed linear regression model and mixed logistic regression model were used to analyze the effect of PM2.5 exposure on BP and the incidence of prehypertension and hypertension in children. RESULTS: After adjusting for covariates, systolic blood pressure (SBP) (2.21 (95% CIs: 0. 81, 3.62), mmHg), diastolic blood pressure (DBP) (1.92 (95% CIs: 0.74, 3.11), mmHg), mean arterial pressure (MAP) (2.03 (95% CIs: 0.89, 3.17), mmHg) and heart rate (HR) (2.24 (95% CIs: 0.11, 4.37), beats/min) increased significantly in the fourth quartile of PM2.5 exposure levels compared with the first quartile (all P < 0.01). In addition, long-term exposure to PM2.5 was significantly positively correlated with SBP, DBP and MAP, and the effect was more notable in urban areas than that in rural areas. Moreover, the risk of prehypertension and hypertension incidence increased by 1.17 (95% CIs: 1.03, 1.33) fold with a one-quartile increase in PM2.5 exposure. The long-term effects of annual mean PM2.5 exposure on SBP, DBP and MAP were significant from pregnancy to 7, 3 and 4 years of age, respectively. CONCLUSION: Long-term exposure to PM2.5 was positively associated with growth curves of hemodynamics indexed from pregnancy to childhood and adolescence, and the effect was more significant in urban areas than in rural areas.

Air Pollutants , Air Pollution , Hypertension , Adolescent , Air Pollutants/analysis , Air Pollutants/toxicity , Air Pollution/analysis , Air Pollution/statistics & numerical data , Blood Pressure , Child , Cohort Studies , Environmental Exposure/analysis , Environmental Exposure/statistics & numerical data , Female , Humans , Hypertension/epidemiology , Longitudinal Studies , Particulate Matter/analysis , Pregnancy , Prospective Studies
BMJ Open ; 12(1): e047748, 2022 01 11.
Article En | MEDLINE | ID: mdl-35017230

OBJECTIVES: To explore clinically important increases in depression/anxiety from before to during the first UK COVID-19 lockdown and factors related to this change, with a particular focus on ethnic differences. DESIGN: Pre-COVID-19 and lockdown surveys nested within two longitudinal Born in Bradford cohort studies. PARTICIPANTS: 1860 mothers with a child aged 0-5 or 9-13, 48% Pakistani heritage. MAIN OUTCOME MEASURES: ORs for a clinically important increase (5 points or more) in depression (eight item Patient Health Questionnaire (PHQ-8)) and anxiety (Generalised Anxiety Disorder Assessment (GAD-7)) in unadjusted regression analyses, repeated with exposures of interest separated by ethnicity to look for differences in magnitude of associations, and lived experience of mothers captured in open text questions. RESULTS: The number of women reporting clinically important depression/anxiety increased from 11% to 20% (95% CI 10%-13%; 18%-22%) and from 10% to 16% (95% CI 8%-11%; 15%-18%), respectively. Increases in depression/anxiety were associated with loneliness (OR=8.37, 95% CI 5.70 to 12.27; 8.50, 95% CI 5.71 to 12.65, respectively); financial (6.23, 95% CI 3.96 to 9.80; 6.03, 95% CI 3.82 to 9.51), food (3.33, 95% CI 2.09 to 5.28; 3.46, 95% CI 2.15 to 5.58) and housing insecurity (3.29, 95% CI 2.36 to 4.58; 3.0, 95% CI 2.11 to 4.25); a lack of physical activity (3.13, 95% CI 2.15 to 4.56; 2.55, 95% CI 1.72 to 3.78); and a poor partner relationship (3.6, 95% CI 2.44 to 5.43; 5.1, 95% CI 3.37 to 7.62). The magnitude of associations between key exposures and worsening mental health varied between ethnic groups.Responses to open text questions illustrated a complex interplay of challenges contributing to mental ill health including: acute health anxieties; the mental load of managing multiple responsibilities; loss of social support and coping strategies; pressures of financial and employment insecurity; and being unable to switch off from the pandemic. CONCLUSIONS: Mental ill health has worsened for many during the COVID-19 lockdown, particularly in those who are lonely and economically insecure. The magnitude of associations between key exposures and worsening mental health varied between ethnic groups. Mental health problems may have longer term consequences for public health and interventions that address the potential causes are needed.

COVID-19 , Mental Health , Anxiety/epidemiology , Child , Communicable Disease Control , Depression/epidemiology , Female , Humans , Longitudinal Studies , Mothers , SARS-CoV-2 , United Kingdom
BMC Health Serv Res ; 22(1): 57, 2022 Jan 12.
Article En | MEDLINE | ID: mdl-35022052

BACKGROUND: Large system transformation in health systems is designed to improve quality, outcomes and efficiency. Using empirical data from a longitudinal study of national policy-driven transformation of maternity services in England, we explore the utility of theory-based rules regarding 'what works' in large system transformation. METHODS: A longitudinal, qualitative case study was undertaken in a large diverse urban setting involving multiple hospital trusts, local authorities and other key stakeholders. Data was gathered using interviews, focus groups, non-participant observation, and a review of key documents in three phases between 2017 and 2019. The transcripts of the individual and focus group interviews were analysed thematically, using a combined inductive and deductive approach drawing on simple rules for large system transformation derived from evidence synthesis and the findings are reported in this paper. RESULTS: Alignment of transformation work with Best et al's rules for 'what works' in large system transformation varied. Interactions between the rules were identified, indicating that the drivers of large system transformation are interdependent. Key challenges included the pace and scale of change that national policy required, complexity of the existing context, a lack of statutory status for the new 'system' limiting system leaders' power and authority, and concurrent implementation of a new overarching system alongside multifaceted service change. CONCLUSIONS: Objectives and timescales of transformation policy and plans should be realistic, flexible, responsive to feedback, and account for context. Drivers of large system transformation appear to be interdependent and synergistic. Transformation is likely to be more challenging in recently established systems where the basis of authority is not yet clearly established.

Government Programs , England , Female , Focus Groups , Humans , Longitudinal Studies , Pregnancy , Qualitative Research
Eur Respir Rev ; 31(163)2022 Mar 31.
Article En | MEDLINE | ID: mdl-35022257

Commercially available since 2007, e-cigarettes are a popular electronic delivery device of ever-growing complexity. Given their increasing use by ex-smokers, smokers and never-smokers, it is important to evaluate evidence of their potential pulmonary effects and predict effects of long-term use, since there has been insufficient time to study a chronic user cohort. It is crucial to evaluate indicators of harm seen in cigarette use, and those potentially unique to e-cigarette exposure. Evaluation must also account for the vast variation in e-cigarette devices (now including at least five generations of devices) and exposure methods used in vivo and in vitroThus far, short-term use cohort studies, combined with in vivo and in vitro models, have been used to probe for the effects of e-cigarette exposure. The effects and mechanisms identified, including dysregulated inflammation and decreased pathogen resistance, show concerning overlaps with the established effects of cigarette smoke exposure. Additionally, research has identified a signature of dysregulated lipid processing, which is unique to e-cigarette exposure.This review will evaluate the evidence of pulmonary effects of, and driving mechanisms behind, e-cigarette exposure, which have been highlighted in emerging literature, and highlight the gaps in current knowledge. Such a summary allows understanding of the ongoing debate into e-cigarette regulation, as well as prediction and potential mitigation of future problems surrounding e-cigarette use.

Electronic Nicotine Delivery Systems , Vaping , Humans , Longitudinal Studies , Smokers , Vaping/adverse effects
Sci Total Environ ; 807(Pt 1): 150755, 2022 Feb 10.
Article En | MEDLINE | ID: mdl-34619215

About 2.8 billion people around the world still depend on biomass as their primary energy source. This traditional custom affects the environment and severely impacts the health and life quality of the rural residents, especially in the elderly group. Based on the published data from the China Health and Retirement Longitudinal Study (CHARLS) conducted in 2018, this paper carefully explores the impact of the energy consumption revolution on the health of rural elderly adults and its response mechanism. The results from the empirical analysis show that: (1) The positive response of rural families to the energy consumption revolution can significantly improve the elderly adults' health condition; (2) The energy consumption revolution can improve the rural elderly adults' health by enhancing the home environmental sanitation (home environmental effect) and life satisfaction (psychological effect); (3) In the process of energy consumption revolution affecting the rural elderly's health, the factor age plays a negative regulatory role, in other words, the older the elderly, the lower the marginal effect of energy consumption revolution on their health improvement. This paper uses the propensity score matching method to deal with the endogenous problem of the regression model, and uses a placebo test and the substitution estimation method to check the robustness of the empirical results. As well, this research puts forward some policy suggestions, such as increasing investment in energy infrastructure in rural areas, reducing the cost of using clean energy, combining environmental energy protection with increasing energy income, and improving medical security conditions in rural areas.

Income , Rural Population , Adult , Aged , China , Humans , Longitudinal Studies , Retirement
Biosens Bioelectron ; 196: 113699, 2022 Jan 15.
Article En | MEDLINE | ID: mdl-34653716

Traditional microbial detection methods often rely on the overall property of microbial cultures and cannot resolve individual growth event at high spatiotemporal resolution. As a result, they require bacteria to grow to confluence and then interpret the results. Here, we demonstrate the application of an integrated ptychographic sensor for lensless cytometric analysis of microbial cultures over a large scale and with high spatiotemporal resolution. The reported device can be placed within a regular incubator or used as a standalone incubating unit for long-term microbial monitoring. For longitudinal study where massive data are acquired at sequential time points, we report a new temporal-similarity constraint to increase the temporal resolution of ptychographic reconstruction by 7-fold. With this strategy, the reported device achieves a centimeter-scale field of view, a half-pitch spatial resolution of 488 nm, and a temporal resolution of 15-s intervals. For the first time, we report the direct observation of bacterial growth in a 15-s interval by tracking the phase wraps of the recovered images, with high phase sensitivity like that in interferometric measurements. We also characterize cell growth via longitudinal dry mass measurement and perform rapid bacterial detection at low concentrations. For drug-screening application, we demonstrate proof-of-concept antibiotic susceptibility testing and perform single-cell analysis of antibiotic-induced filamentation. The combination of high phase sensitivity, high spatiotemporal resolution, and large field of view is unique among existing microscopy techniques. As a quantitative and miniaturized platform, it can improve studies with microorganisms and other biospecimens at resource-limited settings.

Biosensing Techniques , Longitudinal Studies , Microscopy
J Affect Disord ; 297: 18-25, 2022 01 15.
Article En | MEDLINE | ID: mdl-34670129

The Covid-19 pandemic resulted in repeated, prolonged restrictions in daily life. Social distancing policies as well as health anxiety are thought to lead to mental health impairment. However, there is lack of longitudinal data identifying at-risk populations particularly vulnerable for elevated Covid-19-related distress. We collected data of N = 1268 participants (n = 622 healthy controls (HC), and n = 646 patients with major depression, bipolar disorder, schizophrenia or schizoaffective disorder) at baseline before (2014-2018) and during (April-May 2020) the first lockdown in Germany. We obtained information on Covid-19 restrictions (number and subjective impact of Covid-19 events), and Covid-19-related distress (i.e., subjective fear and isolation). Using multiple linear regression models including trait variables and individual Covid-19 impact, we sought to predict Covid-19-related distress. HC and patients reported similar numbers of Covid-19-related events, and similar subjective impact rating. They did not differ in Covid-19-related subjective fear. Patients reported significantly higher subjective isolation. 30.5% of patients reported worsened self-rated symptoms since the pandemic. Subjective fear in all participants was associated with trait anxiety (STAI-T), conscientiousness (NEO-FFI), Covid-19 impact, and sex. Subjective isolation in HC was associated with social support (FSozu), Covid-19 impact, age, and sex; in patients, it was associated with social support and Covid-19 impact. Our data shed light on differential effects of the pandemic in psychiatric patients and HC. Low social support, high conscientiousness and high trait anxiety are associated with elevated distress during the pandemic. These variables might be valuable for the creation of risk profiles of Covid-19-related distress for direct translation into clinical practice.

COVID-19 , Pandemics , Anxiety , Cohort Studies , Communicable Disease Control , Depression , Humans , Longitudinal Studies , SARS-CoV-2
Arch Gerontol Geriatr ; 98: 104545, 2022.
Article En | MEDLINE | ID: mdl-34700136

OBJECTIVES: This study aimed to explore the gender and residence (rural/urban) differences in the associations between the specific dimensions of social support and subjective well-being (SWB) among the Chinese oldest-old. METHODS: This study included 12,989 individuals aged ≥ 80 from 2011, 2014, and 2018 waves of the Chinese Longitudinal Healthy Longevity Survey. SWB was measured by ten items covering self-rated life satisfaction, positive emotions (optimism, happiness, personal control, and conscientiousness), and negative emotions (loneliness, anxiety, uselessness, depression, and boring feelings). Social support included the variables of marriage quality, living arrangements, contacts with others, children's and siblings' frequent visits and telecommunications, children and siblings living nearby, the main source of financial support, adequate financial support, social security and commercialized insurances, community social services, the caregiver when sick, and main medical expenses payer. Generalized estimating equation models were used to determine the effects of social support on the SWB. RESULTS: Gender differences were found in the associations of living arrangements, contacts with others, children's frequent visits and telecommunications, community social services, caregiver when sick, and main medical expenses payer with SWB. Residence differences were found in the associations of living arrangements, contacts with others, children's frequent visits and telecommunications, siblings' frequent visits, community social services, and main medical expenses payer with SWB. CONCLUSIONS: There are gender and residence differences in the relationships between many dimensions of social support and SWB. Gender and residence-tailored interventions for social support are necessary to promote the well-being of the oldest old.

Happiness , Social Support , Aged, 80 and over , China , Health Status , Humans , Longitudinal Studies
Arch Gerontol Geriatr ; 98: 104559, 2022.
Article En | MEDLINE | ID: mdl-34741896

OBJECTIVES: 1) examine the association between lifestyle and mortality; 2) examine the association between two aging measures and mortality; 3) evaluate the mediating effect of the two aging measures on the association between lifestyle and mortality among older Chinese adults. METHODS: We used data from 2039 older adults (≥ 65 years) from the 2011/2012 biomarker substudy of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). We created a healthy lifestyle index based on 5 factors (exercise, smoking, drinking, diet, and BMI, range: 0-5). We calculated two aging measures, the Klemera and Doubal method-biological age (KDM-BA) and physiological dysregulation (PD), based on 10 blood-based biomarkers using algorithms developed previously. A Cox proportional hazards model, general linear regression model, and formal mediation analysis were performed. RESULTS: After adjustment for age and sex, compared to participants without any healthy lifestyle factors, those with 5 healthy lifestyle factors had an 85% lower risk of mortality (hazard ratio [HR] = 0.15, 95% confidence interval [CI]: 0.04, 0.60). PD, but not KDM-BA, was significantly associated with mortality (HR = 1.69, 95% CI: 1.25, 2.29). The healthy lifestyle index was negatively associated with PD (ß = -0.021, P = 0.012). PD mediated 9% (95% CI: 1%, 52%, P = 0.043) of the total effect of the healthy lifestyle index on mortality. CONCLUSIONS: In the older Chinese population, healthy lifestyle reduces mortality risk and aging partially mediates this association. The findings highlight the importance of adherence to a healthy lifestyle for promoting phenotypic aging even in late life.

Aging , Life Style , Aged , China/epidemiology , Humans , Longevity , Longitudinal Studies , Middle Aged , Mortality , Risk Factors
J Affect Disord ; 298(Pt A): 1-8, 2022 02 01.
Article En | MEDLINE | ID: mdl-34744027

The negative impact of the COVID-19 pandemic on the economy has raised concerns about negative coping behaviours to offset financial losses. We used a subset of a longitudinal study of UK adults (N = 19,963) to examine a range of predictors of (i) gambling during the first strict lockdown, (ii) gambling more frequently during this strict lockdown compared to before lockdown, and (iii) continued increased frequency of gambling during the relaxation of restrictions. Results from logistic regressions indicated that amongst other factors, those with progressively lower levels of education, were stressed due to boredom, frequently drank alcohol, and had high risk-taking tendencies were more likely to gamble during strict lockdown. Individuals who were more likely to have increased their frequency of gambling during strict lockdown compared to before the lockdown were stressed by boredom, employed, frequently drank alcohol, and had depression and anxiety, whilst men and current smokers were less likely. As lockdown restrictions eased, individuals of ethnic minority backgrounds, who were current smokers, and with lower educational attainment were more likely to continue gambling more than usual. Findings contribute to knowledge of who is most at risk for increasing their gambling during the COVID-19 pandemic.

COVID-19 , Gambling , Adult , Cohort Studies , Communicable Disease Control , Gambling/epidemiology , Humans , Longitudinal Studies , Male , Minority Groups , Pandemics , SARS-CoV-2 , United Kingdom/epidemiology