Loneliness, Internalizing and Externalizing Problems, and Suicidal Ideation Among Chinese Adolescents: A Longitudinal Mediation Analysis.

PURPOSE: Research indicates that loneliness and emotional and behavioral problems increase the risk of suicidal ideation in adolescents, but less is known about the distinct contributions of these problems. This study aimed to distinguish the pathways through which loneliness, internalizing problems, and externalizing problems contribute to suicidal ideation in Chinese adolescents. METHODS: We did a longitudinal mediation analysis with data collected at 3 time points (2021.05, 2021.10, and 2022.05) from 28 Taizhou high schools. Loneliness and suicidal ideation were assessed using the UCLA 3-Item Loneliness Scale and one suicide item from the Children's Depression Inventory, respectively. The Strength and Difficulties Questionnaire assessed internalizing (emotional and peer problems) and externalizing problems (conduct and hyperactivity problems). Structural equation modeling was used to construct complete longitudinal path models. RESULTS: Using data from 2,190 adolescents in junior and senior high schools, we found that loneliness, internalizing problems, and externalizing problems separately contributed to subsequent higher levels of suicidal ideation. Most notably, loneliness predicted worse subsequent internalizing problems (ß = 0.279, p < .001) and externalizing problems (ß = 0.159, p < .001), which in turn predicted more severe suicidal ideation (ß = 0.019, p < .001; ß = 0.018, p < .001). Loneliness also partially mediated the association between internalizing or externalizing problems and suicidal ideation. DISCUSSION: Loneliness, internalizing problems, and externalizing problems were strongly intertwined with suicidal ideation in adolescents. Public health initiatives could reduce loneliness and emotional and behavioral problems by implementing multifaceted interventions, thereby breaking the vicious circle and protecting against the development of suicidal ideation.

The microbiota in patients with interstitial cystitis/bladder pain syndrome: a systematic review.

OBJECTIVE: To comprehensively review and critically assess the literature on microbiota differences between patients with interstitial cystitis (IC)/bladder pain syndrome (BPS) and normal controls and to provide clinical practice guidelines. MATERIALS AND METHODS: In this systematic review, we evaluated previous research on microbiota disparities between IC/BPS and normal controls, as well as distinctions among IC/BPS subgroups. A comprehensive literature search was conducted across PubMed/MEDLINE, EMBASE, Web of Science, and the Cochrane Central Register of Controlled Trials. Relevant studies were shortlisted based on predetermined inclusion and exclusion criteria, followed by quality assessment. The primary focus was identifying specific taxonomic variations among these cohorts. RESULTS: A total of 12 studies met the selection criteria. Discrepancies were adjudicated by a third reviewer. The Newcastle-Ottawa Scale was used to assess study quality. Predominantly, the studies focused on disparities in urine microbiota between IC/BPS patients and normal controls, with one study examining gut microbiota differences between the groups, and two studies exploring vaginal microbiota distinctions. Unfortunately, analyses of discrepancies in other microbiota were limited. Our findings revealed evidence of distinct bacterial abundance variations, particularly involving Lactobacillus, alongside variations in specific metabolites among IC/BPS patients compared to controls. CONCLUSIONS: Currently, there is evidence suggesting significant variations in the diversity and species composition of the urinary microbiota between individuals diagnosed with IC/BPS and control groups. In the foreseeable future, urologists should consider urine microbiota dysbiosis as a potential aetiology for IC, with potential clinical implications for diagnosis and treatment.

Impact of coexisting type 2 diabetes mellitus on the urinary microbiota of kidney stone patients.

Objectives: Type 2 diabetes mellitus (T2DM) commonly complicates kidney stone disease (KSD). Our objective is to investigate the variations in the urinary microbiota between individuals with KSD alone and those with KSD plus T2DM. This exploration could have implications for disease diagnosis and treatment strategies. Methods: During lithotripsy, a ureterscope was employed, and 1 mL of urine was collected from the renal pelvis after bladder disinfection. Sequencing targeting the V3-V4 hypervariable region was performed using the 16S rRNA and Illumina Novaseq platform. Results: The Shannon index showed a significant decrease in the KSD plus T2DM group compared to the KSD-only group (false discovery rate = 0.041). Principal Coordinate Analysis (PCoA) demonstrated a distinct bacterial community in the KSD plus T2DM group compared to the KSD-only group (false discovery rate = 0.027). The abundance of Sphingomonas, Corynebacterium, and Lactobacillus was significantly higher in the KSD plus T2DM group than in the KSD-only group (false discovery rate < 0.05). Furthermore, Enhydrobacter, Chryseobacterium, and Allobaculum were positively correlated with fasting blood glucose and HbA1c values (P < 0.05). Conclusions: The urinary microbiota in the renal pelvis exhibits differences between patients with KSD plus T2DM and those with KSD alone. Further studies employing animal models are necessary to validate these distinctions, potentially paving the way for therapeutic developments based on the urinary microbiota.

A Comparative Study on the Degradation Behaviors of Ferroelectric Gate GaN HEMT with PZT and PZT/Al2O3 Gate Stacks.

In this paper, the degradation behaviors of the ferroelectric gate Gallium nitride (GaN) high electron mobility transistor (HEMT) under positive gate bias stress are discussed. Devices with a gate dielectric that consists of pure Pb(Zr,Ti)O3 (PZT) and a composite PZT/Al2O3 bilayer are studied. Two different mechanisms, charge trapping and generation of traps, both contribute to the degradation. We have observed positive threshold voltage shift in both kinds of devices under positive gate bias stress. In the devices with a PZT gate oxide, we have found the degradation is owing to electron trapping in pre-existing oxide traps. However, the degradation is caused by electron trapping in pre-existing oxide traps and the generation of traps for the devices with a composite PZT/Al2O3 gate oxide. Owing to the large difference in dielectric constants between PZT and Al2O3, the strong electric field in the Al2O3 interlayer makes PZT/Al2O3 GaN HEMT easier to degrade. In addition, the ferroelectricity in PZT enhances the electric field in Al2O3 interlayer and leads to more severe degradation. According to this study, it is worth noting that the reliability problem of the ferroelectric gate GaN HEMT may be more severe than the conventional metal-insulator-semiconductor HEMT (MIS-HEMT).

Short Video-Based Mental Health Intervention for Depressive Symptoms in Junior High School Students: A Cluster Randomized Controlled Trial.

Purpose: Digital interventions for adolescent mental health are emerging in high-income countries, but have faced challenges and are scarce in China. This study investigated the effect of a short video-based mental health intervention on depressive symptoms in Chinese adolescents. Methods: A three-arm cluster randomized controlled trial was conducted in four junior high schools in Shanghai from December 2020 to December 2021 with the measurement at baseline, 6 months after study entry, and 12 months. Outcomes were collected by self-completed questionnaires administered by teachers masked to allocation. The primary outcome was depressive symptoms assessed by the Depression Self-Rating Scale for Children (DSRSC). Mixed effects models were used to compare psychologist-led intervention (n=428 students) and teacher-led intervention (n=385) including six short video-based sessions to usual school provision (n=751). Results: Using intention-to-treat analyses, psychologist-led intervention showed more reduction in depressive symptoms compared to usual school provision at 6 months (coefficient -1.00, 95% CI -1.94 to -0.05), but not at 12 months. Using per-protocol analyses among participants who watched at least three video episodes, both psychologist-led (-1.14, -2.20 to -0.09) and teacher-led intervention (-1.23, -2.45 to -0.02) reduced depressive symptoms compared to usual school provision at 6 months, and the effect of teacher-led intervention persisted at 12 months (-1.58, -3.13 to -0.03). Further exploration found that compared with urban students, the between-group differences for depressive symptoms in rural students were more significant (p<0.05 for interaction) and the effects were maintained at 12 months. Conclusion: The short video-based mental health intervention showed potential to reduce depressive symptoms among Chinese adolescents, and the effects were more significant if the minimum video viewing frequency was reached.

Network structure of emotional and behavioral problems, loneliness, and suicidal thoughts in adolescents at the school closure and reopening stage in China.

Background: Public restriction and school closure policies during the pandemic may have long-term effects on adolescents' mental health, and adolescents' feelings and needs may change as the pandemic progresses. This study was conducted to explore the network structure and differences in emotional and behavioral problems (EBPs), loneliness, and suicidal thoughts in adolescents during different pandemic periods in China. Methods: Based on two cross-sectional studies conducted in Taizhou, China, during school closure (April 16 to May 14, 2020) and reopening (May 25 to July 10, 2021) using online questionnaire, a total of 14,726 adolescents (school closure: 6,587, school reopening: 8,139) were recruited. EBPs were evaluated based on the student version of the Strengths and Difficulties Questionnaire (SDQ). Loneliness and suicidal thoughts were measured by item 20 and item 9 of the Chinese version of the Children's Depression Inventory (CDI), respectively. Network analysis was used to estimate the network connections and properties between EBPs, loneliness, and suicidal thoughts. Results: The prevalence of psychosocial problems significantly increased at the school reopening compared with the school closure: EBPs: 36.8% vs. 31.6%; loneliness: 40.3% vs. 33.9%; suicidal thoughts: 40.8% vs. 15.4%. Suicidal thoughts showed the closest connections with being unhappy and lonely. Being bullied was strongly connected with conduct problems of lying and stealing. The links between hyperactivity symptoms and the other domains of EBPs were stronger after the school reopened. Being unhappy and showing the hyperactivity symptoms of "nonpersistent, distractible, and fidgety" presented high network and bridge (increasing transference from one symptom domain to another) centrality. Loneliness showed high expected influence and bridge centrality. Conclusions: This study highlighted the high prevalence of EBPs, loneliness, and suicidal thoughts in Chinese adolescents. It also presented the network structure of these psychological problems over different pandemic stages. It is recommended that psychological support should be provided for adolescents, especially focusing on the central and bridge symptoms highlighted in this study.

Psychosocial problems and suicidal ideation in Chinese adolescents: findings from a longitudinal study.

Background: Few studies have explored the important role of different dimensions of emotional and behavioral problems (EBPs), perceived social support and loneliness in predicting suicidal ideation among Chinese adolescents. Based on a 6-month longitudinal study conducted in Taizhou high schools, we aimed to explore the associations between psychosocial problems and suicidal ideation in Chinese adolescents, and to ascertain whether co-occurring psychosocial problems increase suicidal ideation. Methods: A total of 3,267 students were eligible for this analysis. Perceived social support was assessed using the Multidimensional Scale of Perceived Social Support. Loneliness and suicidal ideation were assessed using the University of California, Los Angeles (UCLA) 3-Item Loneliness Scale and one item from the Children's Depression Inventory. The Strength and Difficulties Questionnaire assessed EBPs. Multivariable logistic regression models were used to estimate longitudinal associations between each psychosocial problem (lack of perceived social support from family, friends, and significant others, loneliness, emotional, conduct and peer problems, hyperactivity, and poor prosocial behavior) at baseline and suicidal ideation at follow-up. Multinomial logistic regression models were used to examine the association between the number of psychosocial problems at baseline and suicidal ideation at follow-up. Results: The multivariable logistic regression results showed that after adjusting for baseline suicidal ideation, sociodemographic covariates and depressive symptoms, low level of perceived social support from family (OR =1.78; 95% CI: 1.10-2.87), emotional problems (OR =2.35; 95% CI: 1.41-3.79), and poor prosocial behavior (OR =1.74; 95% CI: 1.08-2.79) were significant predictors of suicidal ideation among the adolescents. The risk of suicidal thoughts increased as the number of psychosocial problems increased. The participants with five or more psychosocial problems had a higher risk of having serious suicidal thoughts than those with no problem (relative risk ratio =4.50; 95% CI: 2.13-9.49). Conclusions: The study confirmed the predictive role of multiple psychosocial problems on suicidal ideation, and the accumulative effect of co-occurring psychosocial problems in magnifying the risk of suicidal ideation. More integrated and holistic approaches need to be taken to identify high-risk groups and provide interventions of suicidality in adolescents.

Loneliness and depressive symptoms among men who have sex with men in China: A cross-sectional study.

Background: While psychosocial problems and their related factors in men who have sex with men (MSM) have been well documented in developed countries, there are still not many studies addressing this issue in China and the results are inconsistent. This study aimed to assess the prevalence of loneliness and depressive symptoms among MSM, examine their associated factors, and investigate potential factors moderating the link between depressive symptoms and loneliness. Methods: A cross-sectional study was conducted in Taizhou of Zhejiang Province in China between April and November 2021. Loneliness was assessed using the 3-item UCLA Loneliness Scale (UCLA-3), and depressive symptoms were measured using the Patient Health Questionaire-9 (PHQ-9). Data from 655 MSM were eligible for analysis. Logistic regression models were used to examine the associations between independent variables and the outcomes of loneliness and depression. The interaction terms were added in the models to assess the moderating effects. Results: Of the MSM sample, 13.28 and 7.48% perceived loneliness and reported moderate-to-severe depressive symptoms, respectively. We found that participants who experienced loneliness were more likely to have younger age (OR 0.44, 95% CI 0.21, 0.93, 15-32 years as reference group), low social support (OR 3.60, 95% CI 2.14, 6.04), low self-esteem (OR 3.03, 95% CI 1.45, 6.32) and moderate-to-severe depressive symptoms (OR 5.45, 95% CI 2.66, 11.15). The participants with moderate-to-severe depressive symptoms were more likely to have low self-esteem (OR 6.78, 95% CI 3.08, 14.95) and feelings of loneliness (OR 5.51, 95% CI 2.66, 11.40). Stratified analyzes showed that the magnitude of the associations between depressive symptoms and loneliness varied in MSM with different age, marital status, and self-esteem. Conclusion: Our study suggests that we need to pay attention to feelings of loneliness and depressive symptoms and their closely associated factors such as social support and self-esteem among MSM in China. The MSM who were young, not married, and had low self-esteem were especially vulnerable to the impact of depressive symptoms on loneliness.

Antibiotic residues of drinking-water and its human exposure risk assessment in rural Eastern China.

Trace levels of antibiotics were frequently found in drinking-water, leading a growing concern that drinking-water is an important exposure source to antibiotics in humans. In this study, we investigated antibiotics in tap water and well water in two rural residential areas in Eastern China to assess the related human health exposure risks in drinking-water. Twenty-seven antibiotics were analyzed using ultra performance liquid chromatography coupled with triple quadrupole tandem mass spectrometry (UPLC-MS/MS). The average daily dose (ADD) and the health risk quotient (HRQ) for exposure to antibiotics in humans were evaluated using 10000 times of Monte Carlo simulations. Ten antibiotics were detected in drinking-water samples, with the maximum concentrations of antibiotic mixture of 8.29 ng/L in tap water and 2.95 ng/L in well water, respectively. Macrolides and sulfonamides were the predominant contaminants and showed the seasonality. Azithromycin had the highest detection frequencies (79.71-100%), followed by roxithromycin (25.71-100%) and erythromycin (21.43-86.96%). The estimated ADD and HRQ for human exposure to antibiotic mixture through drinking-water was less than 0.01 µg/kg/day and 0.01, respectively, which varied over sites, water types, seasons and sex. Ingestion route was more important than dermal contact route (10-6 to 10-4 µg/kg/day magnitude vs. 10-11 to 10-8 µg/kg/day magnitude). Macrolides also contributed mainly to health exposure risks to antibiotics through drinking-water, whose HRQ accounted for 46% to 67% of the total HRQs. Although the individual antibiotic and their combined effects contributed to acceptable health risks for human, the long-term exposure patterns to low-dose antibiotics in drinking-water should not be ignored.

Antibiotic governance and use on commercial and smallholder farms in eastern China.

Introduction: China is one of the largest consumers of agricultural antibiotics in the world. While the Chinese government has been tightening its regulations to control antimicrobial resistance (AMR) from animal sources in recent years, the extent of antimicrobial oversight and the practices of antibiotic use in animal agriculture in China has not yet been explored. This study describes the practices of antimicrobial management in eastern China and current scenarios of antibiotic use in commercial farms and smallholder backyard farming. Methods: 33 semi-structured interviews were conducted with government agriculture officials, veterinary drug sellers, farmers and smallholders in two contrasting areas of rural Zhejiang and Jiangsu provinces, China. Interview transcripts were analyzed in NVivo12 using a thematic approach. Results: Findings revealed that although the governance of antibiotic use has made progress, especially in controlling irrational antibiotic use in commercial farms, smallholders are under-regulated due to a lack of resources and assumptions about their marginal role as food safety governance targets. We also found that smallholders resort to human antibiotics for the treatment of backyard animals because of economic constraints and lack of access to professional veterinary services. Discussion: More attention needs to be devoted to the local structural needs of farmers to reduce antibiotic misuse. Considering the extensive links of AMR exposure under the One Health framework, efforts to integrate smallholders in antibiotic governance are required to address the AMR burden systematically in China.

Associations between depression and the incident risk of obesity in southwest China: A community population prospective cohort study.

Objective: This study aimed to describe the incidence of obesity and investigate associations between depression and the risk of incident obesity among residents in Southwest China. Methods: A 10-year prospective cohort study of 4,745 non-obese adults was conducted in Guizhou, southwest China from 2010 to 2020. Depression was assessed by the Patient Health Questionnaire-9 (PHQ-9) while the obesity was identified by waist circumference (WC) and/or body mass index (BMI). Cox proportional hazard models were used to estimate hazard ratios (HR), and 95% confidence intervals (CIs) of depression and incident obesity. Results: A total of 1,115 incident obesity were identified over an average follow-up of 7.19 years, with an incidence of 32.66 per 1,000 PYs for any obesity, 31.14 per 1,000 PYs and 9.40 per 1,000 PYs for abdominal obesity and general obesity, respectively. After adjustment for potential confounding factors, risks of incident abdominal obesity for subjects with minimal (aHR: 1.22, 95% CI: 1.05, 1.43), and mild or more advanced depression (aHR: 1.27, 95% CI: 1.01, 1.62) were statistically higher than those not depressed, while there was no significant association with incident general obesity. The risks of any incident obesity among subjects with minimal (aHR: 1.21, 95% CI: 1.04, 1.40), mild or more advanced depression (aHR: 1.30, 95% CI: 1.03, 1.64) were significantly higher than those not depressed and positive association was found for PHQ score per SD increase (aHR: 1.07, 95%CI: 1.01, 1.13), too. The association was stronger significantly in Han Chinese (minimal: aHR: 1.27, 95% CI: 1.05, 1.52; mild or more advanced: aHR: 1.70, 95% CI: 1.30, 2.21) and farmers (minimal: aHR: 1.64, 95% CI: 1.35, 2.01; mild or more advanced: aHR: 1.82, 95% CI: 1.32, 2.51). Conclusion: Depression increased the risk of incident obesity among adults in Southwest China, especially among Han Chinese and farmers. This finding suggests that preventing and controlling depression may benefit the control of incident obesity.

Assessing the association between smoking and hypertension: Smoking status, type of tobacco products, and interaction with alcohol consumption.

Background: The association between tobacco use and hypertension risk has been extensively researched but remains controversial, and few existing studies have considered the role of tobacco type and dosage response in this association. In this context, this study aims to provide epidemiological evidence for the possible relationship between tobacco smoking and future hypertension risk, with the tobacco type and consumption dose into consideration. Methods: This study was based on 10-year follow-up data from the Guizhou Population Health Cohort conducted in southwest China. Multivariate Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals [95% confidence intervals (CIs)], and restricted cubic spline analyses were performed to visualize the dose-response association. Results: A total of 5,625 participants (2,563 males and 3,062 females) were included in the final analysis. Heavy smokers of machine-rolled cigarettes had an elevated hypertension risk compared with non-smokers (HR: 1.50, 95% CI: 1.05-2.16). The interaction effects of heavy smoking-heavy drinking patterns increased the future hypertension risk, with an adjusted HR of 2.58 (95% CI: 1.06-6.33). Conclusion: This study did not find a significant association between overall tobacco use status and the risk of hypertension. However, heavy machine-rolled cigarette smokers had a statistically significant increased risk of hypertension compared with non-smokers, and a J-shape association has been found between the average daily consumption of machine-rolled cigarettes and the risk of hypertension. Besides, tobacco and alcohol consumption jointly increased the long-term hypertension risk.

Associations between educational burden and depression and anxiety symptoms among middle school students in Taizhou City / 中国学校卫生

Objective@#To investigate the prevalence of depression and anxiety symptoms among middle school students in Taizhou, Zhejiang Province, and its associations with their educational burden, so as to provide a theoretical reference for making more targeted psychological interventional measures.@*Methods@#A cross sectional study was conducted by multi stage cluster sampling from September to November 2022 from 30 schools in five districts and counties of Taizhou, with a final sample of 8 128 junior and senior high school students completing the online surveys on the Questionnaire Star platform. The Educational Stress Scale for Adolescents (ESSA) was used to measure academic stress; the Child Depression Inventory (CDI) and the Generalized Anxiety Disorder Scale (GAD-7) were used to screen students depression and anxiety, respectively. The relationships between educational burden and depression and anxiety symptoms were analyzed by Logistic regression models.@*Results@#The prevalence of depression and anxiety were 19.3% and 11.1%, respectively. The average score of middle school students study pressure was (52.8±11.5). The number of extracurricular classes was <1, the time length of extracurricular courses was <1 hour per day, and students averagely spend 3.6 hours per day on homework assigned by school teachers. Nearly 30.0% students had ≤0.5 of discretionary time school days and 28.5% students had ≤2 on weekends. About 30.8% students though they do worse in their academic performance. According to the results of binary Logistic regression analysis, after controlling the demographic variables, the score in Study Pressure Scale, the number of extracurricular classes, the volume of homework and the time length of extracurricular courses were positively associated with depression and anxiety ( OR =1.09, 1.07, 1.08, 1.05, 1.04, 1.08, 1.08, 1.08, 1.06, 1.09, 1.07, 1.47, 1.34, 2.84 ; 1.08, 1.06, 1.08, 1.04, 1.03, 1.05, 1.05, 1.05, 1.05, 1.07, 1.06, 1.48, 1.23, 1.75, P <0.05). Students with overage grades had a higher risk of depression symptoms ( OR=1.34, P <0.05).@*Conclusions@#Academic burden has negative effects on depression and anxiety of students in Taizhou. It is advisable to alleviate academic stress, so as to improve the mental health of students.

Intention and Attitude to Accept a Pertussis Cocooning Vaccination among Chinese Children's Guardians: A Cross-Sectional Survey.

OBJECTIVE: to assess Chinese children's guardians' intentions and attitudes toward accepting a pertussis cocooning vaccination and its determinants. METHODS: a self-administered questionnaire was designed based on a theoretical framework that originated mainly from the reasoned action approach. Associations between questionnaire variables and outcomes were assessed using univariate and multivariate analyses with odds ratios (OR), regression coefficients (ß), and their 95% confidence intervals (CIs). RESULTS: among 762 eligible participants, most (80.71%) reported a positive intention to accept a pertussis cocooning vaccination. The guardians' positive intention was related to the children's pertussis vaccination experience (OR = 2.483, 95% CI: 1.340-4.600). Guardians who had a positive attitude towards pertussis vaccination (OR = 1.554, 95% CI: 1.053-2.296), higher subjective norms (OR = 1.960, 95% CI: 1.371-2.802) and better perceived behavioral control (OR = 7.482, 95% CI: 4.829-11.591) stated a higher intention to receive a pertussis cocooning vaccination. The mean attitude score was 3.88 ± 0.863. Greater risk perception about pertussis (ß = 0.390, 95% CI: 0.298-0.483), stronger obligation from moral norms (ß = 0.355, 95% CI: 0.279-0.430), and good knowledge (ß = 0.108, 95% CI: 0.070-0.146) were significantly related to positive attitude toward pertussis cocooning vaccination among guardians. CONCLUSIONS: Chinese children's guardians held positive intentions and attitudes toward accepting a pertussis cocooning vaccination. The current findings described the determinants of such intention and attitude and provided knowledge based on improving guardians' intentions for policymakers if cocooning vaccinations or related immunization strategies are implemented in China in the future.

Impact of the COVID-19 Outbreak on the Antibiotic Use Patterns among a Rural Community Population in Eastern China.

There are growing concerns that the coronavirus disease of 2019 (COVID-19) pandemic may change antibiotic use patterns and accelerate antibiotic resistance, but evidence from the community level is lacking. This study aims to estimate the impact of the COVID-19 outbreak on the antibiotic use patterns among a community population in Eastern China. A self-administered medicine diary was used to collect information on antibiotic use from July 2019 to June 2021 among a rural community in Eastern China. We analyzed the changes in antibiotic use patterns over five months from August to December 2019 and the corresponding months in 2020. The risk of antibiotic use and its changes were measured with the incidence rate (IR) and relative risk (RR). In total, 1111 participants were eligible for the final analysis (440 in 2019 and 671 in 2020). After the COVID-19 outbreak, antibiotic use increased by 137% (5.43 per 100 person months in the 2019 vs. 12.89 per 100 person months in the 2020), and after the adjustment of covariates, the adjusted RR was 1.72 (95% CI: 1.10~2.34). It was higher among those who were women (RR = 2.62), aged 35−59 years old (RR = 2.72), non-farmers (RR = 2.75), had less than six years of education (RR = 2.61), had an annual household income over CNY 100,000 (USD 14,940) (RR = 2.60), and had no history of chronic diseases (RR = 2.61) (all p < 0.05). The proportion of cephalosporins consumed increased from 54.29% in 2019 to 64.92% in 2020 (p = 0.011). Among those aged 35 years and older, the proportion of antibiotics obtained from medical facilities increased, while the proportion obtained from retail pharmacies, homes, and other sources decreased (all p < 0.05). The COVID-19 outbreak changed antibiotic use patterns in this study population (Eastern China) significantly. More efforts to monitor and enhance antibiotic stewardship activities at the community level are needed in future.

Central Adiposity Indicators Maintain a Stronger Association With the Risk of Hypertension: A Prospective Cohort Study in Southwest China.

Objectives: Studies have linked obesity to an increased risk of hypertension, but the optimal adiposity indicators to predict hypertension remains controversial. We comprehensively explored the correlation between body mass index, waist circumference (WC), waist-to-height ratio (WHtR), long-term weight and WC change, and hypertension in an adult population in Southwest China. Methods: We studied 9,280 participants from 48 townships of 12 districts with a follow-up of 10 years in the Guizhou Population Health Cohort Study. We used Pearson's correlation coefficients combined with Dunn and Clark's z test and Zou's confidence interval test, receiver operating characteristic (ROC) analyses, and multivariate Cox proportional hazards regressions adjusting for demographic characteristics, lifestyle habits, disease history, and lipid information of participants. Results: Baseline central adiposity indicators (WC and WHtR) had closer associations with hypertension than BMI, and long-term WC change was more predictive of hypertension compared with weight change in the studied population. Conclusion: Central adiposity indicators maintain a stronger association with the risk of hypertension, hinting at the importance of WC management in the precaution of hypertension.

Unhealthy Dietary Patterns Increased Risks of Incident Obesity: A Prospective Cohort Study in Southwest China.

Purpose: Few studies have explored the associations between diet patterns and incident obesity in China. This study aimed to explore associations between dietary patterns and incident obesity in a prospective community-population cohort in Southwest China. Patients and Methods: Totally, 5742 adult residents from Guizhou province were eligible for this analysis. Demographic characteristics, lifestyle, history of chronic diseases, and dietary patterns measured by hundred-item food frequency questionnaires (FFQs) were collected at the baseline study. Four dietary patterns were identified using factor analysis. Cox proportional hazard models stratified by physical activity were used to explore the association and estimate adjusted hazard ratio (aHR) and 95% confidence interval (CI). Results: Among 5742 subjects, the average age was 45.06 ± 15.21 years old and more than half were women. During the follow-up of 40,524.15 person years (PYs), the overall incidence rate of obesity was 10.54/1000PYs. After the adjustment for possible confounding factors, subjects with the third (aHR: 1.51, 95% CI: 1.14-2.00) and the fourth quartile (aHR: 1.46, 95% CI: 1.10-1.94) of junk food patterns had statistically increased risk of incident obesity compared to those with the first quartile. Also, subjects with the third quartile of the western pattern had significantly higher risk of incident obesity (aHR: 1.33, 95% CI: 1.01-1.75) than those with the first quartile. Conclusion: There was a high risk in incident obesity among Chinese community population of Southwest China and unhealthy diet significantly increased risk of developing obesity. The findings indicated that effective and targeted measures to improve dietary patterns need to be undertaken urgently in Southwest China.

Incidence rate, risk factors and behaviour changes for alcohol drinking: findings from a community-based cohort study in Southwest China.

OBJECTIVE: To describe changes in alcohol drinking behaviour, estimate the incidence rate of alcohol drinking and explore its risk factors in the Chinese community population. DESIGN: A community population prospective cohort study. SETTING: A total of 48 townships of 12 counties or districts in Guizhou province, China. PARTICIPANTS: With the multistage proportional stratified cluster sampling method, a total of 7343 adult residents were enrolled into this study and eligible to be analysed. PRIMARY AND SECONDARY OUTCOME MEASURES: The incidence rate and its risk factor (adjusted HR (aHR) and 95% CIs) as well as the prevalence of alcohol drinking. RESULTS: There was a little increase trend in the overall prevalence of alcohol drinking among 7343 subjects over an average of 7.22-year follow-up, and the prevalence in women increased by 2.5% statistically (p=0.001). Among 5005 non-drinkers in 7343 subjects at baseline, 1107 incident drinkers were identified, and the incidence rate of alcohol drinking was estimated at 30.63/1000 person-years with significant sex difference (57.46 vs 17.99 per 1000 person-years for men and women, respectively, p<0.001). The incidence rate decreased gradually with age, peaking in men aged 18-29 years old and women aged 30-39 years old at baseline. After the adjustment for covariates, being male (aHR=3.46, 95% CI: 3.02 to 3.96), being non-Han Chinese (aHR=1.65, 95% CI: 1.44 to 1.88), living in urban areas (aHR=3.50, 95% CI: 3.01 to 4.08), being employed (aHR=1.33, 95% CI: 1.16 to 1.52), smoking (aHR=1.17, 95% CI: 1.00 to 1.38) and having no history of chronic diseases (aHR=1.19, 95% CI: 1.04 to 1.35) were independent risk factors for incident drinkers. CONCLUSION: The number of women increased in the prevalence of alcohol drinking significantly although there was no significant overall change for the cohort population in Southwest China. Also, there was a high risk of developing alcohol drinking among the study population, especially for those non-drinkers who were younger men, non-Han Chinese, living in urban areas, employed, current smokers or without any chronic diseases. Interventions to prevent and manage alcohol consumption should be designed and implemented in Chinese communities as soon as possible.