Prevalence of and factors associated with potentially redundant randomized controlled trials: a cross-sectional study.

OBJECTIVES: To investigate the prevalence of meta-analyses containing potentially redundant randomized controlled trials (RCTs) and the factors associated with the presence of redundancy. STUDY DESIGN AND SETTING: This is a cross-sectional study, based on a random sample of references (n = 4500) that were published during 2020 and 2021, indexed in PubMed, Embase, or the Cochrane Database of Systematic Reviews, and retrieved through comprehensive searches using terms about systematic reviews and meta-analysis. From each systematic review, one meta-analysis fulfilling all the following criteria, if available, was included in this study: (1) assessing the effect of the intervention on a primary outcome of the systematic review; (2) combining RCTs only. The primary outcome was prevalence of meta-analyses containing potentially redundant RCTs. Potentially redundant RCTs referred to the trials that started 1 year after the overall effect estimate from cumulative meta-analysis had been statistically robust, as determined by trial sequential analysis when appropriate. The number of potentially redundant trials (if any) in each eligible meta-analysis and the number of participants involved in those trials were documented and contrasted across groups. Logistic regression analysis was conducted to explore the factors associated with presence of potential redundancy. RESULTS: Of the 448 eligible meta-analyses, 57 (12.7%, 95% confidence interval (CI) 9.8-16.2%) contained potentially redundant RCTs. When limited to the 333 low-heterogeneity meta-analyses, the prevalence was 17.1% (95% CI 13.5-21.5%). The total number of potentially redundant RCTs was 295 (involving 85,385 participants), accounting for 38.5% of the RCTs (and 30.3% of the participants) included in the 57 meta-analyses. In these meta-analyses, the median number of potentially redundant RCTs and the participants involved were 2 (range: 1-50) and 352 (range: 17-26997), respectively. Potentially redundant RCTs were more likely to be present in the meta-analyses evaluating pharmaceutical intervention (odds ratio [OR] 2.31, 95% CI 1.16-4.49), assessing efficacy outcomes (OR 7.25, 95% CI 0.85-61.87), containing more than 5 RCTs (OR 6.47, 95% CI 3.22-12.99), or with the earliest RCT reporting statistically significant effect estimate (OR 5.30, 95% CI 2.64-10.64). CONCLUSION: This study found that 12.7% to 17.1% of recently published meta-analyses contained potentially redundant RCTs, highlighting the importance of conducting or examining systematic reviews of existing evidence to justify new RCTs. More importantly, the study identified some scenarios in which redundancy was more likely to occur and thus has implications for trialists, funding agencies, ethics committees, and journal editors.

Constipation preceding depression: a population-based cohort study.

Background: Constipation is generally considered a common physical symptom of depression or a side effect of antidepressant treatments. However, according to the gut-brain axis hypothesis, the association between depression and constipation might be bi-directional. This study investigated the association between premorbid constipation and depression. Methods: We conducted a retrospective cohort study using data from UK Biobank. Individuals free of depression between 2006 and 2010 were included. Constipation status was determined using diagnostic codes from electronic health records or a baseline questionnaire. Data on covariates, including socio-demographic characteristics, lifestyle factors, health conditions, and regular medication use, were also collected through a baseline questionnaire. The primary outcome is incident depression, which was extracted from hospital inpatient admissions, primary care, self-report, and death data from baseline to 2022. The secondary outcome is depressive symptoms, which was assessed by Patient Health Questionnaire-9 (PHQ-9) from an online survey in 2016. Cox proportional hazard regression models were employed to assess the prospective association between constipation and incident depression. Logistic regression models were used to assess its association with depressive symptoms. Findings: Among the 449,459 participants included in the study, 18,596 (4.1%) experienced constipation at baseline, and 18,576 (4.1%) developed depression over a median follow-up period of 12.3 years. Premorbid constipation is associated with a 2.28-fold higher risk of depression. After adjusting the covariates, we found those with constipation still had a 48% higher risk of developing depression (adjusted hazard ratio [aHR] 1.48; 95% CI, 1.41-1.56) than those without constipation. Self-reported and diagnosed constipation were both associated with a higher risk of depression, with the aHR being 1.42 (95% CI: 1.34-1.51) and 1.66 (95% CI: 1.51-1.82), respectively. Participants with constipation were more likely to report depressive symptoms than people without (adjusted odds ratio 2.18; 95% CI, 1.97-2.43). These findings remained consistent in sensitivity analyses. Interpretation: Diagnosed and self-reported constipation are both prospectively associated with an elevated risk of depression. These explorative findings suggest that constipation may be an independent risk factor or a prodromal symptom of depression. Gastroenterologists and primary care physicians should pay more attention to the depressive symptoms of their constipation patients. Funding: The Shenzhen Science and Technology Program and the Strategic Priority Research Program of Chinese Academy of Sciences.

Right Ventricular Function in Takayasu's Arteritis Patients With Pulmonary Artery Involvement Using MRI Feature Tracking.

BACKGROUND: Pulmonary artery involvement (PAI) is not rare in Takayasu arteritis (TA). Persistently elevated pulmonary arterial pressure in TA-PAI patients leads to pulmonary hypertension (PH), and eventually cardiac death. Thus, the early detection of right ventricular dysfunction before the onset of PH is important. PURPOSE: To explore the potential of right ventricular global peak longitudinal and circumferential strain (RVGLS and RVGCS, respectively) in detecting right ventricular myocardial damage in TA-PAI patients without PH. STUDY TYPE: Retrospective. POPULATION: One hundred and six TA patients (39.6 ± 13.9 years), of whom 52 were non-PAI and 54 were PAI patients (36 without PH and 18 with PH), along with 58 sex- and age-matched healthy volunteers (HVs) (36.7 ± 13.2 years). The involved arteries were validated by aorta magnetic resonance (MR) angiography and pulmonary artery computed tomography angiography. FIELD STRENGTH/SEQUENCE: 3 T/Cine imaging sequence with a steady-state free precession readout. ASSESSMENT: Cardiac MRI-derived parameters measured by two radiologists independently were compared among HVs, and TA patients with and without PAI. In addition, these indices were further compared among HVs, and TA-PAI patients with and without PH. STATISTICAL TESTS: Student's t test, one-way ANOVA analysis, Pearson and Spearman correlation analysis, and reproducibility analysis. A P-value of <0.05 was considered statistically significant. RESULTS: Although the TA-PAI patients without PH had a similar RV ejection fraction (RVEF) with HV (P = 0.348), RVGLS (non-PH 20.6 ± 3.7% vs. HV 24.0 ± 3.1%) was significantly lower and RVGCS (non-PH 14.8 ± 3.9% vs. HV 13.0 ± 2.7%) higher. The TA-PAI patients with PH had significantly poorer RVGLS (PH 13.5 ± 3.8% vs. non-PH 20.6 ± 3.7%) and RVGCS (PH 10.9 ± 3.2% vs. non-PH 14.8 ± 3.9%) than those without PH. DATA CONCLUSION: Right ventricular dysfunction was detected in the TA-PAI patients without PH. MR-feature tracking may be an effective method for detecting early cardiac damage in the TA-PAI patients without PH. LEVEL OF EVIDENCE: 3 TECHNICAL EFFICACY: Stage 3.

Defining indicators for the scoping stage of health impact assessment to evaluate tobacco control policy in the city of Beijing.

INTRODUCTION: Beijing initiated the nation's most comprehensive tobacco control program that adheres to the WHO Framework Convention on Tobacco Control. This study aimed to identify a set of indicators for the scoping of an Health Impact Assessment (HIA) to assess this policy. METHODS: This study used a modified Delphi process. It proposed a tobacco control health impact framework based on the Driving forces- Pressure- State- Exposure- Effect- Action model and the Determinants of Health Theory. After a review of current surveillance system and literature, a working group of 13 experts with multidisciplinary background was established to formulate indicator evaluation criteria and conduct indicator scoring. Each indicator was scored by experts according to four evaluation criteria chosen. Indicators that obtained a total score above 80% and with standard error less than 5 were selected as the final set of indicators. Kendall's coefficient of concordance was calculated. RESULTS: Twenty-three out of 36 indicators were selected. Smoking prevalence, mortality rate, hospital admission rate, tobacco consumption and hospital admission fees of smoking related diseases achieved more than 90% of total scores and ranked as the top five. Kendall's concordance coefficient was 0.218 for all indicators. For all model composition, Kendall's concordance coefficients were statistically significant. CONCLUSION: This study identified a set of twenty-three indicators for scoping of HIA of a comprehensive tobacco control policy in Beijing based on a tobacco control health impact conceptual framework. The set of indicators achieved high scores and statistically significant consistency and has great potential to promote the evaluation of tobacco control policy in a global city. Further study might use the set of indicators for HIA on tobacco control policy to analyze empirical data.

Gender differences in social environmental changes associated with smoking: a cross-sectional study from Chinese internal migrants.

OBJECTIVES: To identify clues for women's tobacco control, this study analyses the gender differences in social environmental changes associated with smoking and the interaction between the environment and individuals' social integration. DESIGN, SETTING AND PARTICIPANTS: A cross-sectional design and secondary analysis were used among Chinese internal migrants. Data were from the 2012 Migrant Dynamics Monitoring Survey in China with participants aged 15-59 years old (75 416 women and 83 140 men) who resided in cities for more than 1 month. PRIMARY AND SECONDARY OUTCOME MEASURES: Social environmental changes were measured by differences in smoking prevalence and women's empowerment between the migrant-receiving province (MRP) and migrant-sending province (MSP). Social participation and duration of stay (DOS) were adopted as indicators of social integration. Stratified analysis and binary logistic regression models were used to determine the dependent variable (smoking status) and environmental changes after controlling for age, education, income and happiness. RESULTS: Differences in the smoking prevalence environment (lower in MRP, OR 0.70, 95% CI 0.60 to 0.83; higher rate in MRP, OR 1.79, 95% CI 1.35 to 2.37) and women's empowerment (lower rate in MRP, OR 0.80, 95% CI 0.68 to 0.97; higher rate in MRP, OR 1.15, 95% CI 1.00 to 1.33) between MRP and MSP were positively correlated with women's smoking. In men, however, migrating to an area with lower smoking prevalence could not reduce smoking risk, whereas moving to an area with higher women's empowerment could. A long DOS was an independent risk factor for smoking in women (ranged from 1.20 to 2.00 in various environmental changes scenarios) but a protective factor for men. An interaction between environmental changes and social integration could not be verified. CONCLUSIONS: Tobacco control strategies should consider gender differences, especially women who are experiencing social environmental changes.

Protection motivation theory and smoking quitting intention: findings based on structural equation modelling and mediation analysis.

OBJECTIVE: Although many smoking cessation strategies have been implemented, only a few strategies at the population level are grounded in theory. Even in those interventions based on specific theories, most studies have focused only on the outcome. The main objective of this study was to demonstrate the utility of protection motivation theory (PMT) in explaining smoking quitting behaviour among adults, with the goal of providing valuable evidence for further intervention strategies. METHOD: This was a cross-sectional study. Participants were randomly selected on the street from 26 provinces in mainland China. Data were collected via face-to-face interviews. Cronbach's alpha coefficient and the interclass correlation coefficient (ICC) were used to assess the reliability of the individual PMT constructs. We applied structural equation modelling (SEM) to test how well the PMT constructs predicted intention. A bootstrap test was performed to test the potential mediators. RESULTS: The Cronbach's alpha coefficients of all the subscales ranged from 0.71 to 0.74. Greater intentions were significantly associated with higher threat appraisal (Coef. = 0.18, P < 0.01) and coping appraisal (Coef. = 0.24, P < 0.01). Threat appraisal was significantly associated with higher perceived severity and vulnerability but inversely associated with extrinsic rewards and intrinsic rewards. Coping appraisal was significantly associated with higher self-efficacy and response efficacy but inversely associated with response cost. The R2 of quitting intention was 0.12, which means that 12% of quitting intention was predicted by PMT constructs. For threat appraisal, approximately 19.8% of the effects on lower threat appraisal were mediated by higher extrinsic rewards. For coping appraisal, approximately 42.8% of the effects on higher coping appraisal were mediated by higher response efficacy. CONCLUSION: This study finds that PMT is a sound theoretical framework for predicting smoking quitting intention among adults. Coping appraisal has a stronger effect than threat appraisal for predicting quitting intention. Mediation analyses confirmed that extrinsic rewards and response efficacy mediated the relationship between PMT constructs and quitting intention. Our findings are essential for understanding quitting behaviour among adults and support more effective smoking cessation activities.

Factors Related to Diabetes Self-Management Among Patients with Type 2 Diabetes: A Chinese Cross-Sectional Survey Based on Self-Determination Theory and Social Support Theory.

Purpose: Self-management behavior (SMB) plays a significant role in glycemic control. This study aimed to explore the factors related to SMB among patients with type 2 diabetes and how these factors interacted with each other. Patients and Methods: Patients diagnosed with type 2 diabetes were recruited from 18 community healthcare stations (CHSs) from six community healthcare centers (CHCs) in Beijing, China from April to May in 2017. Motivation, competence, autonomy support, social support, self-management skills, adherence to self-monitoring of blood glucose (SMBG) and haemoglobin A1c (HbA1c) measurement were tested by questionnaire. Correlation analysis and path analysis were performed so as to identify the factors associated with patients' SMB. Results: A total of 532 participants completed this study. Participants who have good compliance to SMBG got higher scores in social support (F = 7.68, p = 0.01), competence (F = 10.47, p = 0.01), and skills (F = 12.34, p < 0.01). Higher competence (ß = 0.03, P < 0.001), higher social support (ß = 0.01, P < 0.001), better skills(ß = 0.01, P < 0.001) directly led to better adherence to SMBG. Social support had a positive effect on autonomy support (ß = 0.69, P < 0.001), motivation (ß = 0.45, P < 0.001), competence (ß = 0.28, P < 0.001), skills (ß = 0.14, P < 0.001), which was also indirectly linked to better adherence to SMBG. Better self-management skills directly led to better adherence to HbA1c measurement (ß = 0.03, P < 0.001). Social support had a positive effect on autonomy support (ß = 0.69, P < 0.001), motivation (ß = 0.45, P < 0.001), competence (ß = 0.28, P < 0.001), skills (ß = 0.14, P < 0.001), which was also indirectly linked to better adherence to HbA1c measurement. Conclusion: Self-determination theory and social support theory were practical in explaining SMB in Chinese population. Competence, motivation and social support played an important role in diabetic self-management. Paying attention to the promotion of individual's intrinsic motivation and self-efficacy may be able to help patients maintain self-management behavior in the long-term routine.

The characteristics and patterns of e-cigarette use and its association with cigarette cessation intention in a Chinese smoking population: A mediation analysis.

INTRODUCTION: The use of e-cigarettes has become more common in China, but the research on e-cigarettes in China, while growing, is still limited. This study examined the characteristics and patterns of e-cigarette use, and analyzed the possible mediators between cigarette cessation intention and e-cigarette use in a Chinese smoking population. METHODS: This was a cross-sectional study conducted in mainland China. By convenience sampling method, the participants were recruited from 85 major commercial streets of several large cities in China. The study interviewers completed face-to-face interviews and uploaded the completed questionnaires into the online survey platform. The participants were contacted for clarification if any problems were detected. Logistic regression yielded adjusted odds ratios (ORs) for ever use of e-cigarettes. We further conducted a mediation analysis to estimate the effect of possible mediators. RESULTS: From July to August 2020, a total of 738 smokers were invited to participate in this study; 613 smokers were identified as eligible and 609 smokers were included in this analysis. Of them, 24 (3.94%) participants were currently using e-cigarettes, and 165 (27.09%) participants have ever used e-cigarettes. The participants with younger age were more likely to have ever used e-cigarettes, ranging from 37.5% in the 18-29 years age group to 6.5% in the 60-69 years age group. After controlling for demographic characteristics and nicotine dependence, the ever use of e-cigarettes was significantly associated with younger age, higher education level, higher monthly income, previous smoking cessation attempts and quitting intention. With the mediation analysis, the education level is confirmed as a mediating factor, and approximately 42.86% of the effects were mediated through the channel of higher socioeconomic status. CONCLUSIONS: This is the first study to examine the possible mediators between cigarette cessation intention and e-cigarette use in a Chinese smoking population. The findings revealed that high socioeconomic status, particularly higher education level, was a major mediating factor.

Family Support and Social Support Associated with National Essential Public Health Services Utilization among Older Migrants in China: A Gender Perspective.

China provides National Essential Public Health Services (NEPHS) free of charge to all citizens to ensure access to essential health services. The present study aimed to explore the associations between different sources of support and NEPHS service utilization among older migrants in China with a gender perspective. We used a national cross-sectional dataset derived from the 2015 China Migrants Dynamic Survey. Participants were included if they were aged ≥60 years and without household registration at the residence. Among 1989 participants, 35.2% enrolled in a free physical examination in the past year: 34.6% for males and 35.9% for females. Among male participants, having more local friends (OR = 1.47, 95% CI: 1.09, 1.99) and having insurance at the residence (OR = 1.75, 95% CI: 1.03, 2.96) were associated with enrolment in a free physical examination after controlling for age, education, and self-reported health status. Two additional factors, marital status and family structure, were found for female participants to be associated with enrolment in a free physical examination. NEPHS service utilization was far from satisfactory among older migrants in China, and both family support and social support played a role in it. There are common and unique factors associated with NEPHS service utilization in terms of gender.

The willingness to attend the first dental visit within 1 year of age: An analysis applying Andersen's behavioral model of health service utilization.

BACKGROUND: The first dental visit (FDV) within 1 year of age is important for establishing good oral health behaviors for young children, but delayed FDVs are common. AIM: This study aimed to investigate the predisposing, enabling, and need factors of maternal willingness to attend the FDV for infants. DESIGN: A cross-sectional survey was conducted among mothers of infants aged 11-14 months. A questionnaire was developed based on Andersen's behavioral model of health service utilization. Data regarding the FDV, FDV willingness, and reasons for not attending the FDV were collected. Logistic regression models were used to investigate the associated factors. RESULTS: Of 658 infants, only 2.7% (18) had a Thirty percent (191/640) of mothers reported their willingness to attend the FDV in the next 3 months. Nearly two-thirds of mothers reported not attending the FDV since their children's teeth were healthy. Maternal perceptions of their infants' oral health status were negatively associated with willingness to undergo the FDV, whereas family social support was positively associated with willingness to undergo the FDV. CONCLUSIONS: Need factors play a key role in the utilization of FDV. Improving parental awareness of FDV might help parents voluntarily attend the FDV, and offering support from the family and healthcare system levels enables access to paediatric dental care.

Would Older Adults Perform Preventive Practices in the Post-COVID-19 Era? A Community-Based Cross-Sectional Survey in China.

During the post-COVID-19 era, preventive practices, such as washing hands and wearing a mask, remain key measures for controlling the spread of infection for older adults. This study investigated the status of preventive practices among older adults and identified the related influencing factors. Participants who were ≥60 years old were recruited nationwide. Data were collected through self-designed questionnaires, including demographic variables, knowledge, perceived vulnerability, response efficacy, anxiety and preventive practices. Descriptive statistics and chi-square tests were performed. Hierarchical logistic regression was conducted to determine the predictors. A total of 2996 participants completed this study. Of them, 2358 (78.7%) participants reported washing hands regularly in the last two weeks, and 1699 (56.7%) always wore masks outside this year. Knowledge (hand washing: OR = 1.09, p < 0.01; mask wearing: OR = 1.17, p < 0.01) and response efficacy (hand washing: OR = 1.61, p < 0.01; mask wearing: OR = 1.70, p < 0.01) were positively associated with preventive practices, whereas perceived vulnerability had a negative effect (hand washing: OR = 0.54, p < 0.01; mask wearing: OR = 0.72, p < 0.01). Knowledge, response efficacy and perceived vulnerability were found to be significant predictors of the preventive practice among older adults in the post-COVID-19 era. This study provides new insights into preventive suggestions after the peak of the pandemic and also has significant implications in improving the life quality of older adults.

Tobacco dependence affects determinants related to quitting intention and behaviour.

This study uses protection motivation theory (PMT) to examine the quitting intentions and behaviours of smokers who have varying levels of nicotine dependence. Our goals are to identify the psychological factors that influence smoking cessation and to provide valuable evidence to promote theory-guided interventions. This is a cross-sectional study that was conducted from July to August 2020. Participants were randomly selected on the streets of 26 provinces on mainland China. Data were collected via face-to-face interviews. Our analysis was conducted in three steps. First, we employed descriptive statistics to present the overall characteristics of our sample. Second, we analysed the association between PMT constructs and quitting intentions stratified by nicotine dependence. Third, we tested how quitting intentions were associated with quitting behaviours in each subgroup using logistic regression models. For intention, almost all the PMT constructs were significantly associated with quitting intention in the low-dependence group. For the moderate- and high-dependence groups, only perceived vulnerability (coefficient = 0.35, P = 0.04) was positively associated with quitting intention. For behaviour, we found a stronger association between quitting intention and behaviour in the low-dependence group (Coef. = 1.67, P = 0.00) than for the other groups. We found a significant association between e-cigarette use and quitting behaviour only in the low-dependence group (Coef. = 1.34, P = 0.00). Coefficients for the moderate- and high-dependence groups were not statistically significant. Smokers at various levels of nicotine dependence have different psychological factors that influence their intentions to stop smoking. Quitting intention was more significantly associated with quitting behaviour for the low nicotine-dependence group than for the other groups. More convincing research is necessary to determine how e-cigarette use affects quitting behaviour in the long term.

Ten-year changes in children's oral health disparities: Findings from the 3rd and 4th oral health surveys in Beijing, China.

OBJECTIVES: Little is known about children's oral health disparities and their changes in developing countries. This study aimed to measure rural-urban and maternal education-related disparities in dental visits and untreated caries among Chinese children, and to describe their changes between 2005 and 2015. METHODS: The 12-year-old children's oral health data were from the 3rd (2005) and 4th (2015) oral health surveys in Beijing, China. Rural-urban disparities and maternal education-related disparities in dental visits and untreated caries were measured. The slope index of inequality (SII) and a relative index of inequality (RII) were applied to reflect the absolute and relative disparities respectively. These were estimated using a generalized linear regression model. RESULTS: Data were analysed from 388 children in 2005 and 1926 children in 2015. The proportion of 12-year-old schoolchildren who visited the dentist was 24.0% in 2005 and 36.0% in 2015. Untreated caries prevalence in 2005 and 2015 was 20.9% and 16.2% respectively. Rural-urban disparities in dental visits narrowed between 2005 and 2015 (SII: -10.75 to -3.30, RII: 0.55 to 0.87), and maternal education-related disparities in dental visits also decreased during this decade (SII: -18.52 to -8.49, RII: 0.38 to 0.65). These changes were statistically significant. For disparities in untreated caries, only maternal education-related disparities in untreated caries in 2015 were found. The SII and RII were 6.39% (95% CI: 1.65, 11.13) and 1.57 (95% CI: 1.13, 2.20) respectively. The change in disparities in untreated caries was not statistically significant for rural-urban disparities (P = .319) or maternal education-related disparities (P = .501). CONCLUSIONS: These findings indicate that in Beijing, China, disparities in children's dental visits narrowed between 2005 and 2015. However, maternal education-related disparities in dental visits and in untreated caries were still apparent, suggesting that policies to improve children's oral healthcare utilization equality should target the children with less-educated mothers.

The association of workplace health education with smoking-related behaviour and unequal gains by job position in China: ABWMC programme findings.

BACKGROUND: Although the Chinese government has introduced a series of regulations to promote tobacco-related health education in workplaces, their implementation has been far from satisfactory. The aim of the present study was to explore the association of company-level tobacco-related health education and employee smoking behaviour. METHODS: Data from the 2018 Asia Best Workplace Mainland China programme were used to address these aims. This was a cross-sectional study that included 14,195 employees from 79 companies in mainland China. Spearman correlation tests were used to examine unadjusted correlations between the study variables, and binary logistic regression was used for multivariable analysis. The dependent variables included smoking-related variables or health information-seeking behaviour. The explanatory variable was the company-level tobacco-related health education. RESULTS: Tobacco-related health education was associated with better smoking harm awareness (OR = 2.23; 95% CI = 1.94-2.56), lower second-hand smoke exposure (OR = 0.73; 95% CI = 0.66-0.81), better perception of the workplace environment (OR = 2.04; 95% CI = 1.84-2.26) and positive health information-seeking behaviour (OR = 2.07; 95% CI = 1.86-2.30). Job position interacted with health education, suggesting that the positive association of health education was lower for general employees than employees who held an administrative position. CONCLUSIONS: Tobacco-related health education is not only associated with lower SHS exposure but also related to more positive environmental perceptions and health attitudes, and these effects are significant for higher-ranking employees. Policy makers should recognize and reduce these potential health disparities.

Estimating the generation interval and inferring the latent period of COVID-19 from the contact tracing data.

The coronavirus disease 2019 (COVID-19) emerged by end of 2019, and became a serious public health threat globally in less than half a year. The generation interval and latent period, though both are of importance in understanding the features of COVID-19 transmission, are difficult to observe, and thus they can rarely be learnt from surveillance data empirically. In this study, we develop a likelihood framework to estimate the generation interval and incubation period simultaneously by using the contact tracing data of COVID-19 cases, and infer the pre-symptomatic transmission proportion and latent period thereafter. We estimate the mean of incubation period at 6.8 days (95 %CI: 6.2, 7.5) and SD at 4.1 days (95 %CI: 3.7, 4.8), and the mean of generation interval at 6.7 days (95 %CI: 5.4, 7.6) and SD at 1.8 days (95 %CI: 0.3, 3.8). The basic reproduction number is estimated ranging from 1.9 to 3.6, and there are 49.8 % (95 %CI: 33.3, 71.5) of the secondary COVID-19 infections likely due to pre-symptomatic transmission. Using the best estimates of model parameters, we further infer the mean latent period at 3.3 days (95 %CI: 0.2, 7.9). Our findings highlight the importance of both isolation for symptomatic cases, and for the pre-symptomatic and asymptomatic cases.

Association of siblings' presence and oral health-related quality of life among children: a cross-sectional study.

BACKGROUND: The quantity-quality trade-off theory indicates that an increase in siblings might decrease a child's well-being, but little is known about the impacts of sibling number on children's oral health-related quality of life (OHRQoL). This study aims to investigate the effects of presence of siblings on children's OHRQoL, and to further test whether there is an interaction effect between siblings' presence and locations on children's OHRQoL. METHODS: Data were obtained from an oral-health survey of 12-year-old children in Beijing, China, which was a part of the 4th National Oral Health Survey in the Mainland of China (2015-2016). This study included 2158 children data for analysis. OHRQoL was assessed by the child's Oral Impacts on Daily Performance (OIDP). OIDP prevalence served as an indicator of OHRQoL. Children with and without siblings were recorded as non-single and single children, respectively. Dental variables, including active caries, gingival bleeding, and calculus, were reported. A logistic regression model was applied to investigate the association of siblings' presence and OIDP prevalence. A synergy index was used to assess the possible interaction effect between siblings' presence and location on OIDP prevalence. RESULTS: Sixty percent of Chinese children reported suffering OIDP in the previous six months. OIDP prevalence for non-single and single children were 68.3% and 56.9%, respectively. The adjusted odds ratio (OR) of OIDP for non-single children was 1.31 (95% CI: 1.05, 1.63), and the adjusted OR of OIDP for non-single and rural children was 2.03 (95% CI: 1.47, 2.81). The synergy index between siblings' presence and location on OIDP was 2.18 (85% CI: 1.30, 3.67), which indicates that an excessive risk increase for OIDP was observed among non-single and rural children. CONCLUSIONS: Children with siblings are more likely to report OIDP and have lower OHRQoL, especially those from rural areas. These findings indicate that oral-health interventions should be given priority for non-single and rural children.

Epidemiological Parameters of COVID-19: Case Series Study.

BACKGROUND: The estimates of several key epidemiological parameters of the COVID-19 pandemic are often based on small sample sizes or are inaccurate for various reasons. OBJECTIVE: The aim of this study is to obtain more robust estimates of the incubation period, serial interval, frequency of presymptomatic transmission, and basic reproduction number (R0) of COVID-19 based on a large case series. METHODS: We systematically retrieved and screened 20,658 reports of laboratory-confirmed COVID-19 cases released by the health authorities of China, Japan, and Singapore. In addition, 9942 publications were retrieved from PubMed and China National Knowledge Infrastructure (CNKI) through April 8, 2020. To be eligible, a report had to contain individual data that allowed for accurate estimation of at least one parameter. Widely used models such as gamma distributions were fitted to the data sets and the results with the best-fitting values were presented. RESULTS: In total, 1591 cases were included for the final analysis. The mean incubation period (n=687) and mean serial interval (n=1015 pairs) were estimated to be 7.04 (SD 4.27) days and 6.49 (SD 4.90) days, respectively. In 40 cases (5.82%), the incubation period was longer than 14 days. In 32 infector-infectee pairs (3.15%), infectees' symptom onsets occurred before those of infectors. Presymptomatic transmission occurred in 129 of 296 infector-infectee pairs (43.58%). R0 was estimated to be 1.85 (95% CI 1.37-2.60). CONCLUSIONS: This study provides robust estimates of several epidemiological parameters of COVID-19. The findings support the current practice of 14-day quarantine of persons with potential exposure, but also suggest the need for additional measures. Presymptomatic transmission together with the asymptomatic transmission reported by previous studies highlight the importance of adequate testing, strict quarantine, and social distancing.

Family SES, family social capital, and general health in Chinese adults: exploring their relationships and the gender-based differences.

BACKGROUND: Numerous studies have clarified that family socioeconomic status (SES) is positively associated with health. However, the mechanism of family SES on health needs to be further investigated from a social epidemiological perspective. This study aims to analyze the relationships among family SES, family social capital, and adult general health and tests whether gender-based differences exist in the relationship between family social capital and general health. METHODS: A cross-sectional survey was used to collect data from 4187 representative households in six Chinese provinces. Family SES was conceptualized based on household income, family education, and family occupational status. Family social capital was measured by using family cohesion and health-related family support. General health was assessed by using five general health perception items of the Health Survey Short Form. Structural equation modeling (SEM) was applied to examine the relationships among family SES, family social capital, and general health, and a linear regression model was used to test gender-based differences. RESULTS: The SEM showed that the direct effects of family SES, family cohesion, and health-related family support on health were 0.08 (P < 0.001), 0.17 (P < 0.001), and 0.10 (P < 0.001), respectively. Family SES had indirect effect (ß = 0.05, P < 0.01) on general health via health-related family support. The total effect of family social capital (ß = 0.27, P < 0.001) on general health was greater than that of family SES (ß = 0.13, P < 0.001). Besides, the regression showed that the effect of health-related family support on general health was greater for women (ß = 0.13, P < 0.001) than men (ß = 0.04, P > 0.05). CONCLUSIONS: The results provide strong support for the positive association between family SES, family social capital, and adult health. Family intervention programs should focus on establishing a harmonious family relationship to mobilize family support, particularly for the families with low cohesion and low SES.

Can autonomy support have an effect on type 2 diabetes glycemic control? Results of a cluster randomized controlled trial.

OBJECTIVES: To assess whether social support or autonomy support intervention for patients with type 2 diabetes can achieve glycemic control at the end of intervention, and to test whether the glycemic control effect can be maintained for a long time. RESEARCH DESIGN AND METHODS: In this cluster randomized controlled trial, 18 community healthcare stations (CHSs) were randomized to the following: (1) usual care group (UCG) offering regular public health management services, (2) social support group (SSG) providing 3-month social support intervention based on problem solving principles, and (3) autonomy support group (ASG) offering 3-month autonomy support intervention based on self-determination theory. A total of 364 patients registered in the CHSs were enrolled into either of the three groups. The primary outcome was hemoglobin A1c (HbA1c), and secondary outcomes were diabetes self-management (DSM) behaviors. Assessment was conducted at baseline and at 3 and 6 months. RESULTS: Patients in ASG achieved better HbA1c reduction at the end of intervention (0.53% or 7.23 mmol/mol, p<0.001) than those in the UCG and successfully maintained it up to 6 months (0.42% or 5.41 mmol/mol, p<0.001). However, patients in SSG did not experience significant change in HbA1c at 3 or 6 months when compared with patients in UCG. Besides, patients in both the SSG (0.12, p<0.05) and ASG (0.22, p<0.001) experienced improvement in exercise at 3 months. Patients in ASG sustained improvement in exercise up to 6 months (0.21, p<0.001), but those in the SSG did not. CONCLUSIONS: Autonomy support for patients with type 2 diabetes could help achieve glycemic control at the end of intervention and successfully maintain it up to 6 months. These findings indicate that autonomy support has positive long-term effects on DSM behaviors and glycemic control and can be recommended in future diabetes intervention programs. TRIAL REGISTRATION NUMBER: ChiCTR1900024354.

Agreement of self-reported and proposed standard on oral health among children / 中国学校卫生

Objective@#To analyze the consistency between self-reported oral health and proposed standard in evaluating children oral health status, and to test whether self-reported oral health can be used in children population.@*Methods@#The clinical examination data and questionnaire data were 2 158 children aged 12-year-old in Beijing, China. Child oral health status was measured by self-reported oral health and proposed standard from World Health Organization (WHO), and was classified into "good, general, poor" based on each method. Kappa test was used to evaluate the consistency of two measurements. Using multivariate nonordinal logistic regression to identify the influencing factors of self-reported oral health, and to explore the possible reasons for the consistency differences of two measurements.@*Results@#According to the WHO standard, 25.5%, 65.3% and 9.2% children oral health were rated as good, general and poor, respectively. The proportion was 50.6%, 37.7% and 11.8% respectively based on self-report method. Kappa value for two measurements was 0.04, indicating poor agreement between two methods. Results from regression model show that both the untreated caries (OR=2.47, P<0.01) and toothache (OR=3.54, P<0.01) were associated with self-reported oral health, while not observed in periodontal health (OR=1.34, P=0.18) and oral hygiene status(OR=0.95, P=0.75).@*Conclusion@#Self-reported oral health results can reflect caries status to some extents among children, but it failed to reflect other aspects, such as periodontal health status and oral hygiene. Self-reported oral health among children should be considered based on the requirements of assessment content and accuracy in the future work.