Trends in psychological distress in Great Britain, 1991-2019: evidence from three representative surveys.

BACKGROUND: Previously improving UK mortality trends stalled around 2012, with evidence implicating economic policy as the cause. This paper examines whether trends in psychological distress across three population surveys show similar trends. METHODS: We report the percentages reporting psychological distress (4+ in the 12-item General Health Questionnaire) from Understanding Society (Great Britain, 1991-2019), Scottish Health Survey (SHeS, 1995-2019) and Health Survey for England (HSE, 2003-2018) for the population overall, and stratified by sex, age and area deprivation. Summary inequality indices were calculated and segmented regressions fitted to identify breakpoints after 2010. RESULTS: Psychological distress was higher in Understanding Society than in SHeS or HSE. There was slight improvement between 1992 and 2015 in Understanding Society (with prevalence declining from 20.6% to 18.6%) with some fluctuations. After 2015 there is some evidence of a worsening in psychological distress across surveys. Prevalence worsened notably among those aged 16-34 years after 2010 (all three surveys), and aged 35-64 years in Understanding Society and SHeS after 2015. In contrast, the prevalence declined in those aged 65+ years in Understanding Society after around 2008, with less clear trends in the other surveys. The prevalence was around twice as high in the most deprived compared with the least deprived areas, and higher in women, with trends by deprivation and sex similar to the populations overall. CONCLUSION: Psychological distress worsened among working-age adults after around 2015 across British population surveys, mirroring the mortality trends. This indicates a widespread mental health crisis that predates the COVID-19 pandemic.

Anxiety and depression among medical doctors in Catalonia, Italy, and the UK during the COVID-19 pandemic.

Healthcare workers have had the longest and most direct exposure to COVID-19 and consequently may suffer from poor mental health. We conducted one of the first repeated multi-country analysis of the mental wellbeing of medical doctors (n = 5,275) at two timepoints during the COVID-19 pandemic (June 2020 and November/December 2020) to understand the prevalence of anxiety and depression, as well as associated risk factors. Rates of anxiety and depression were highest in Italy (24.6% and 20.1%, June 2020), second highest in Catalonia (15.9% and 17.4%, June 2020), and lowest in the UK (11.7% and 13.7%, June 2020). Across all countries, higher risk of anxiety and depression symptoms were found among women, individuals below 60 years old, those feeling vulnerable/exposed at work, and those reporting normal/below-normal health. We did not find systematic differences in mental health measures between the two rounds of data collection, hence we cannot discard that the mental health repercussions of the pandemic are persistent.

COVID-19 and mental health of individuals with different personalities.

Several studies have been devoted to establishing the effects of the COVID-19 pandemic on mental health across gender, age, and ethnicity. However, much less attention has been paid to the differential effect of COVID-19 according to different personalities. We do this using the UK Household Longitudinal Study (UKHLS), a large-scale panel survey representative of the UK population. The UKHLS allows us to assess the mental health of the same respondent before and during the COVID-19 period based on their "Big Five" personality traits and cognitive skills. We find that during the COVID-19 period, individuals who have more extravert and open personality traits report a higher mental health deterioration, while those scoring higher in agreeableness are less affected. The effect of openness is particularly strong: One more SD predicts up to 0.23 more symptoms of mental health deterioration in the 12-item General Health Questionnaire (GHQ-12) test during the COVID-19 period. In particular, for females, cognitive skills and openness are strong predictors of mental health deterioration, while for non-British White respondents, these predictors are extraversion and openness. Neuroticism strongly predicts worse mental health cross-sectionally, but it does not lead to significantly stronger deterioration during the pandemic. The study's results are robust to the inclusion of potential confounding variables such as changes in physical health, household income, and job status (like unemployed or furloughed).

Understanding Health and Social Challenges for Aging and Long-Term Care in China.

The second King's College London Symposium on Ageing and Long-term Care in China was convened from 4 to 5th July 2019 at King's College London in London. The aim of the Symposium was to have a better understanding of health and social challenges for aging and long-term care in China. This symposium draws research insights from a wide range of disciplines, including economics, public policy, demography, gerontology, public health and sociology. A total of 20 participants from eight countries, seek to identify the key issues and research priorities in the area of aging and long-term care in China. The results published here are a synthesis of the top four research areas that represent the perspectives from some of the leading researchers in the field.

Patient Choice of Health Care Providers in China: Primary Care Facilities versus Hospitals.

As China's health system is faced with challenges of overcrowded hospitals, there is a great need to better understand the recent patterns and determinants of people's choice between primary care facilities and hospitals for outpatient care. Based on recent individual-level data from the China Health and Retirement Longitudinal Survey (CHARLS) and official province-level data from China health statistical yearbooks, we examine the patterns of outpatient visits to primary care facilities versus hospitals among middle-aged and older individuals and explore both supply- and demand-side correlates that explain these patterns. We find that 53% of outpatient visits were paid to primary care facilities as opposed to hospitals in 2015, compared to 60% in 2011. Both supply and demand factors were associated with this decline. On the supply side, we find that the density of primary care facilities did not account for this decline, but higher densities of hospitals and licensed doctors were associated with lower use of primary care facilities. On the demand side, we find that individuals with higher socioeconomic status and greater health care needs were less likely to use primary health care facilities. Our findings suggest that a high concentration of health care professionals in hospitals diverts patients away from primary care facilities. Staffing the primary care facilities with a well-trained health care workforce is the key to a well-functioning primary care system. The findings also suggest a need to address demand-side inequality issues.

Parental migration and self-reported health status of adolescents in China: A cross-sectional study.

BACKGROUND: Over 100 million children are parented by migrant workers in China. The aim of this study was to investigate how self-reported adolescent physical and mental health are associated with parental migration. METHODS: Based on cross-sectional data of 13996 students in 112 schools drawn from a nationally representative sample of middle school students in China, this study used self-reported measures for adolescent physical and mental health. Ordered logistic regression was used for the analysis of self-reported physical health, and linear regression was used for the analysis of self-reported mental health, both adjusting for socio-economic covariates and school fixed effects, to determine how adolescent health is associated with parental migration. FINDINGS: In urban areas, migrant adolescents were physically healthier (OR=1.19, 95% CI: 1.03-1.36), and similarly mentally healthy (b=-0.07, 95% CI: -0.37-0.23), compared to urban adolescents from intact families; in rural areas, left-behind adolescents were less physically (OR=0.84, 95% CI: 0.76-0.94) and mentally (b=0.45, 95% CI: 0.24-0.66) healthy than rural-intact adolescents, holding other variables constant. Left-behind adolescents had less close parent-adolescent relationships than rural-intact adolescents with both father (OR=0.63, 95% CI: 0.56-0.71) and mother (OR=0.62, 95% CI: 0.54-0.70). INTERPRETATION: Our study highlights a great need for health interventions aimed at left-behind adolescents in China and globally, and the important roles of parent-adolescent relationships in addressing the health needs of left-behind adolescents.

Religion and Depression in Adolescence.

Depression is the leading cause of illness and disability in adolescence. Many studies show a correlation between religiosity and mental health, yet the question remains whether the relationship is causal. We exploit within-school variation in adolescents' peers to deal with selection into religiosity. We find robust effects of religiosity on depression that are stronger for the most depressed. These effects are not driven by the school social context; depression spreads among close friends rather than through broader peer groups that affect religiosity. Exploration of mechanisms suggests that religiosity buffers against stressors in ways that school activities and friendships do not.

Self-reported Symptoms of Depression Among Chinese Rural-to-Urban Migrants and Left-Behind Family Members.

Importance: There were an estimated 247 million rural-to-urban migrant workers in China in 2016, yet at a national level, there is scant evidence on the association of migration with mental health among migrants and their left-behind family members. Objective: To examine the association of rural-to-urban migration with symptoms of depression among migrants and left-behind family members aged 45 years and older. Design, Setting, and Participants: Using representative cross-sectional data of 14 332 middle-aged and older adults from the 2015 China Health and Retirement Longitudinal Survey, regression analyses were conducted to examine the association of depressive symptoms with rural-to-urban migration status in urban areas and the association of depressive symptoms with left-behind status in rural areas. The statistical analysis was performed from January to August 2018. Exposures: Migration status (defined as having a rural hukou [household registration record]) in urban areas and left-behind status (defined as having a spouse or child living in another area) in rural areas. Main Outcomes and Measures: Depressive symptoms measured on the 10-item Center for Epidemiological Studies Depression (CES-D-10) scale. Results: A total of 14 332 middle-aged and elderly participants (mean [SD] age, 59.84 [9.51] years; 7394 [51.6%] women) were included, of whom 4404 (30.7%) lived in urban areas and 9928 (69.3%) lived in rural areas. In urban areas, 1607 participants (36.2%) were rural-to-urban migrants, and the remaining 2797 participants (72.8%) were local residents. In rural areas, 3405 participants (34.3%) were left-behind family members, and the remaining 6523 participants (65.7%) were not. Compared with urban residents, rural-to-urban migrants had higher CES-D-10 scores after adjustment for covariates (ß = 0.74; 95% CI, 0.08-1.40; P = .03; standard errors clustered at the household level henceforth). Compared with intact-family rural residents, left-behind spouses had higher CES-D-10 scores after adjustment for covariates (ß = 0.54; 95% CI, 0.05-1.03; P = .03). Conclusions and Relevance: Rural-to-urban migration in China was associated with poor mental health for migrants and their left-behind spouses. Short-term policies, such as building community social facilities, may prove effective, but long-term solutions should address issues related to economic and social exclusions and the lack of a social security system in rural China.

Co-Delivery of Paclitaxel and PLK1-Targeted siRNA Using Aptamer-Functionalized Cationic Liposome for Synergistic Anti-Breast Cancer Effects In Vivo.

Cancer cells can develop in several ways to escape from death induced by chemotherapeutic agents, thereby weakening the anti-tumor efficacy of single-target chemotherapy. Therefore, the efficacy of conventional chemotherapy hits a single target in tumor cells subject to strict limits. In this article, an AS1411 aptamer-functionalized liposome is prepared, which can simultaneously deliver paclitaxel (PTX) and siRNA into MCF-7 cells in vitro and in vivo. The simultaneous delivery of PTX and siRNA synergistically increased the number of apoptotic cells and reduced angiogenesis. This delivery method exhibited significant advantages over combined delivery of PTX and siRNA separately by different liposomal drug delivery systems. Therefore, the simultaneous delivery of PTX and PLK1-targeted siRNA using AS1411 aptamer-functionalized liposome may have good potential clinical value for the therapy of breast cancer. Nanomedicine based on simultaneous delivery of chemotherapy drugs and siRNA gene provides an effective platform for improving tumor treatment methods.

Antitumor and immunomodulatory activities of total flavonoids extract from persimmon leaves in H22 liver tumor-bearing mice.

Persimmon (Diospyros kaki L.) leaves are commonly used in Asia as tea infusion and as an agent in traditional medicine. The present study aims to explore the antitumor and immunomodulatory effects of total flavonoids extract from persimmon leaves (PLF) in H22 liver tumor-bearing mice. We found that the PLF showed significant inhibition on the liver tumor growth in mice with a tumor inhibition rate of up to 49.35%. In contrast to the severe side effects of cyclophosphamide (CTX), the PLF exhibited anti-cachexia effect and showed no alternation in the body weight and food intake in mice. Moreover, compared with the vehicle control and CTX group, the PLF significantly enhanced the thymus and spleen indices, level of serum interleukin-18 (IL-18), monocyte/macrophage phagocytosis, level of serum hemolysin, and activity of natural killer (NK) cells. This study demonstrated that the PLF could effectively inhibit liver tumor growth in vivo via enhancement of the immune function in mice, and it displayed the potential to be a safe and effective anticancer agent or functional immune-enhancing agent.

SMAD7 methylation as a novel marker in atherosclerosis.

Atherosclerosis is a complicated process comprising inflammation, accumulation of collagen matrix and aberrant DNA methylation. SMAD7 is known to play an important role in fibrosis and inflammation. In recent years, increasing research has concentrated on the connection between DNA methylation and atherosclerosis. The current study was designed to investigate methylation status of some specific gene with a focus on SMAD7 in atherosclerosis and elucidate their relationship. We found that SMAD7 expression was decreased and its promoter region was markedly methylated in atherosclerotic plaques when compared with normal artery walls. Using MALDI-TOF MS, increased DNA methylation levels of SMAD7 promoter at CpG unit 5.8.15.16 were found in peripheral blood of atherosclerosis patients relative to matched normal controls, respectively. Correlation analysis revealed that mean DNA methylation levels of SMAD7 promoter of CpG unit 5.8.15.16 were positively associated with homocysteine levels (r = 0.724, p < .001) and carotid plaque scores(r = 0.790, p < .001). SMAD7 promoter is hyper-methylated both in human atherosclerotic plaques and atherosclerosis patients, which is positively associated with homocysteine levels and carotid plaque scores. Thus, methylated SMAD7 may be a novel predicted marker and therapeutics target for atherosclerosis.

Availability, cost, and prescription patterns of antihypertensive medications in primary health care in China: a nationwide cross-sectional survey.

BACKGROUND: Around 200 million adults in China have hypertension, but few are treated or achieve adequate control of their blood pressure. Available and affordable medications are important for successfully controlling hypertension, but little is known about current patterns of access to, and use of, antihypertensive medications in Chinese primary health care. METHODS: We used data from a nationwide cross-sectional survey (the China Patient-Centered Evaluative Assessment of Cardiac Events Million Persons Project primary health care survey), which was undertaken between November, 2016 and May, 2017, to assess the availability, cost, and prescription patterns of 62 antihypertensive medications at primary health-care sites across 31 Chinese provinces. We surveyed 203 community health centres, 401 community health stations, 284 township health centres, and 2474 village clinics to assess variation in availability, cost, and prescription by economic region and type of site. We also assessed the use of high-value medications, defined as guideline-recommended and low-cost. We also examined the association of medication cost with availability and prescription patterns. FINDINGS: Our study sample included 3362 primary health-care sites and around 1 million people (613 638 people at 2758 rural sites and 478 393 people at 604 urban sites). Of the 3362 sites, 8·1% (95% CI 7·2-9·1) stocked no antihypertensive medications and 33·8% (32·2-35·4) stocked all four classes that were routinely used. Village clinics and sites in the western region of China had the lowest availability. Only 32·7% (32·2-33·3) of all sites stocked high-value medications, and few high-value medications were prescribed (11·2% [10·9-11·6] of all prescription records). High-cost medications were more likely to be prescribed than low-cost alternatives. INTERPRETATION: China has marked deficiencies in the availability, cost, and prescription of antihypertensive medications. High-value medications are not preferentially used. Future efforts to reduce the burden of hypertension, particularly through the work of primary health-care providers, will need to improve access to, and use of, antihypertensive medications, paying particular attention to those with high value. FUNDING: CAMS Innovation Fund for Medical Science, the Entrusted Project from the China National Development and Reform Commission, and the Major Public Health Service Project from the Ministry of Finance of China and National Health and Family Planning Commission of China.

MiR-375: A prospective regulator in medullary thyroid cancer based on microarray data and bioinformatics analyses.

BACKGROUND: This research aims to investigate the prospective molecular mechanism of miR-375 in Medullary Thyroid Cancer (MTC). MATERIAL AND METHODS: The expression level of miR-375 in MTC was explored with microarray data from Gene Expression Omnibus (GEO). To gather the putative target genes of miR-375, we selected eligible datasets in GEO, in which antagomir-375 and premir-375 were transfected to provide the miR-375-related genes. Subsequently, we attained the intersection of the results of GEO microarray data and 12 online target genes prediction database as the prospective target genes. Furthermore, we conducted in silico analysis including gene ontology (GO) enrichment analysis, Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways annotations and Protein-Protein Interactions (PPI) analysis to provide an overview of the function of miR-375 in MTC. Finally, data from The Cancer Genome Atlas (TCGA) and The Human Protein Atlas (THPA) were used for a validation. RESULTS: Up-regulation could be confirmed with the data from GSE40807. GEO dataset GSE67742 provided 10,596 miR-375-related genes, while 12 online prediction databases showed that 3352 target genes appeared no less than four times. Finally, the intersection of the two groups of genes included 1132 prospective targets. In aspect of functional annotation, negative regulation of transcription from RNA polymerase II promoter (P=9.83E-06), golgi membrane (P=9.98E-05) and pathway of protein binding (P=3.63E-07) were highlighted as the most enriched terms with GO analysis. With regards to PPI network, 162 hub genes that interacted with no less than 10 other different genes was visualized, among which PI3K/Akt signaling pathway was the most enriched pathway as assessed by KEGG. Furthermore, two genes (JAK2 and NGFR) in PI3K/Akt signaling pathway showed down-regulated patterns in both mRNA and protein levels. CONCLUSION: The higher expression level of miR-375 might play a pivotal role in the tumorigenesis of MTC via targeting multiple key pathways, especially PI3K/Akt pathway. However, the exact molecular mechanism of miR-375 needs to be verified with in-depth investigation in the future.

Does health insurance reduce out-of-pocket expenditure? Heterogeneity among China's middle-aged and elderly.

China's recent healthcare reforms aim to provide fair and affordable health services for its huge population. In this paper, we investigate the association between China's health insurance and out-of-pocket (OOP) healthcare expenditure. We further explore the heterogeneity in this association. Using data of 32,387 middle-aged and elderly individuals drawn from the 2011 and 2013 waves of China Health and Retirement Longitudinal Study (CHARLS), we report five findings. First, having health insurance increases the likelihood of utilizing healthcare and reduces inpatient OOP expenditure. Second, healthcare benefits are distributed unevenly: while low- and medium-income individuals are the main beneficiaries with reduced OOP expenditure, those faced with very high medical bills are still at risk, owing to limited and shallow coverage in certain aspects. Third, rural migrants hardly benefit from having health insurance, suggesting that institutional barriers are still in place. Fourth, health insurance does not increase patient visits to primary care facilities; hospitals are still the main provider of healthcare. Nonetheless, there is some evidence that patients shift from higher-tier to lower-tier hospitals. Last, OOP spending on pharmaceuticals is reduced for inpatient care but not for outpatient care, suggesting that people rely on inpatient care to obtain reimbursable drugs, putting further pressure on the already overcrowded hospitals. Our findings suggest that China's health insurance system has been effective in boosting healthcare utilization and lowering OOP hospitalization expenditure, but there still remain challenges due to the less generous rural scheme, shallow outpatient care coverage, lack of insurance portability, and an underdeveloped primary healthcare system.

[Abnormal expressions of positive cell cycle control factors and thyroid carcinoma occurrence and progression].

OBJECTIVE: To explore the relationship between abnormal expressions of positive cell cycle control factors and thyroid carcinoma occurrence and progression, and assess the value of these factors in evaluating tumor cell proliferation activity and the prognosis of the patients. METHODS: Immunohistochemical SP method was used to detect the expressions of MCM7, CDK2 and Ki-67 proteins in 50 cases of thyroid carcinoma, 30 cases of thyroid adenoma, 30 cases of nodular goiter and 20 cases of normal thyroid gland tissues. RESULTS: The positive rates of MCM7, CDK2 and Ki-67 expressions in thyroid carcinoma were 100% (50/50), 80.00% (40/50) and 84.00% (42/50), significantly higher than the rates in thyroid adenoma, nodular goiter and normal thyroid tissue (P<0.01). In thyroid carcinoma tissues, positive correlations were observed between the expressions of MCM7 and CDK2 proteins (r=0.637, P<0.01), MCM7 and Ki-67 proteins (r=0.633, P<0.01), and CDK2 and Ki-67 proteins (r=0.862, P<0.01). CONCLUSION: The high expressions of MCM7, CDK2 and Ki-67 protein may contribute to the development of thyroid carcinoma, and their combined examination may serve as useful index for early diagnosis and prognostic evaluation of thyroid carcinoma. MCM7 is superior to Ki-67 in the evaluation of the thyroid tumor cell proliferation activity.