Impact of COVID-19 on risks and deaths of non-communicable diseases in the Western Pacific region.

Countries and areas in the Western Pacific region (WPR) experienced the COVID-19 pandemic and took various preventive measures, which affected non-communicable diseases (NCDs) risks and mortality. Due to differences in COVID-19 prevention measures and other characteristics such as culture, religions, political systems, socioeconomic development, lifestyles, and health care systems, the effects of COVID-19 on NCDs varied greatly among WPR countries. Most countries had an increased all-cause and NCDs mortality during the pandemic, but some developed countries, including New Zealand, Singapore and Australia reported decreased mortality. The pandemic and the preventive measures increased NCD risk factors including unhealthy diet, lack of physical activity and sleep disorders. The effects varied by socioeconomic status and health conditions. COVID-19 related stress, food shortages, and confined lifestyle had immediate detrimental effects on NCDs, and also affected pregnancy outcomes with long-term effects on NCDs risks in coming years.

Trends in major non-communicable diseases and related risk factors in China 2002-2019: an analysis of nationally representative survey data.

Background: Prevention and control of non-communicable diseases (NCDs) are prioritized in both the Sustainable Development Goal and the Healthy China 2030 Initiatives. Efforts have been devoted to combating NCDs in China. This study examined changes in NCD trajectory. Methods: We described and analyzed the trends in prevalence and control of major NCDs including obesity, hypertension, diabetes, and dyslipidemia and examined selected main behavioral risk factors in China by sex, age group, and residence using nationally representative CDC survey data. Data included were from the China Chronic Disease Risk Factor Surveillance (CCDRFS, 2013 and 2018) and China National Nutrition Survey (CNNS, 2002, 2010-2013, 2015, and 2020). Annual and relative changes in rates were used. Rural-urban ratio of related indicators was assessed. Findings: NCD-attributed deaths increased from 80.0% in 2002 to 86.6% in 2012, and 88.5% in 2019, with cardiovascular diseases, cancer, chronic respiratory diseases, and diabetes accounted for 47.1%, 24.1%, 8.8%, and 2.5% of deaths in 2019, respectively. Prevalence of obesity (7.1%-16.4%), overweight/obesity (29.9%-50.7%), hypertension (18.8%-27.5%), diabetes (2.6%-11.9%), and dyslipidemia (18.6%-35.6%) all increased from 2002 to 2018. These rates increased faster in rural areas than in urban areas. Rates of awareness, treatment and control of hypertension and diabetes increased very slowly from 2012 to 2018. Most rates were between 30 and 40% with the lowest rate of 11% for hypertension control even in 2018. The rates were worse for rural residents compared to urban residents. Furthermore, many modifiable behavioral risk factors showed little improvement and some became worse over time, including smoking, excessive alcohol use, inadequate vegetable/fruit intake, excessive red meat intake, and physical inactivity. Interpretation: NCD burden in China increased during 2002-2019 despite of the intervention efforts. To reach the global and national targets, China must strengthen its actions, especially in rural areas, including improvement of NCD screening and management and reduction of behavioral risk factors. Funding: The study was supported in part by research grants of National Key R&D Program of China (2017YFC0907200, 2017YFC0907201), International Collaboration Project from the Chinese Ministry of Science and Technology-Prevention and control of chronic diseases and health promotion (G2021170007L), Natural Scientific Foundation of China (82103846), Key R&D and Transformation Program of Qinghai (2023-QY-204).

Role of electroanatomical mapping-guided superior vena cava isolation in paroxysmal atrial fibrillation patients without provoked superior vena cava triggers: a randomized controlled study.

AIMS: Data about whether empirical superior vena cava (SVC) isolation (SVCI) improves the success rate of paroxysmal atrial fibrillation (PAF) are conflicting. This study sought to first investigate the characteristics of SVC-triggered atrial fibrillation and secondly investigate the impact of electroanatomical mapping-guided SVCI, in addition to circumferential pulmonary vein isolation (CPVI), on the outcome of PAF ablation in the absence of provoked SVC triggers. METHODS AND RESULTS: A total of 130 patients undergoing PAF ablation underwent electrophysiological studies before ablation. In patients for whom SVC triggers were identified, SVCI was performed in addition to CPVI. Patients without provoked SVC triggers were randomized in a 1:1 ratio to CPVI plus SVCI or CPVI only. The primary endpoint was freedom from any documented atrial tachyarrhythmias lasting over 30 s after a 3-month blanking period without anti-arrhythmic drugs at 12 months after ablation. Superior vena cava triggers were identified in 30 (23.1%) patients with PAF. At 12 months, 93.3% of those with provoked SVC triggers who underwent CPVI plus SVCI were free from atrial tachyarrhythmias. In patients without provoked SVC triggers, SVCI, in addition to CPVI, did not increase freedom from atrial tachyarrhythmias (87.9 vs. 79.6%, log-rank P = 0.28). CONCLUSION: Electroanatomical mapping-guided SVCI, in addition to CPVI, did not increase the success rate of PAF ablation in patients who had no identifiable SVC triggers. REGISTRATION: ChineseClinicalTrials.gov: ChiCTR2000034532.

Associations of blood lead, cadmium, and mercury with resistant hypertension among adults in NHANES, 1999-2018.

BACKGROUND: Resistant hypertension (RHTN), a clinically complex condition with profound health implications, necessitates considerable time and allocation of medical resources for effective management. Unraveling the environmental risk factors associated with RHTN may shed light on future interventional targets aimed at reducing its incidence. Exposure to heavy metal has been linked to an increased risk of hypertension, while the relationship with RHTN remains poorly understood. METHODS: Using the 1999-2018 National Health and Nutrition Examination Survey (NHANES) data, we examined the association of blood lead (Pb), cadmium (Cd), and mercury (Hg) with RHTN using a multinomial logistic regression model. The combined effects of the metals and the contribution of each metal were assessed using a weighted quantile sum (WQS) analysis. RESULTS: A total of 38281 participants were included in the analysis. Compared with no resistant hypertension (NRHTN), per 1 µg/dL increase in blood Pb concentration, the proportion of RHTN increased by 16% [adjusted odds ratio (aOR), 1.16; 95% confidence interval (CI) 1.01-1.32]. When analyzed by quartiles (Q), the aOR [95% CI] for Pd was 1.30[1.01,1.67] (Q4 vs. Q1); there was a significant dose-response relationship (p < 0.05). Likewise, as a continuous variable, each 1 µg/dL increase in blood Cd level was associated with a 13% increase in the proportion of RHTN (aOR: 1.13; 95%CI: [1.00,1.27]); when analyzed as quartile, aOR [95% CI] for Cd were 1.30[1.01,1.69] (Q3 vs. Q1), and 1.35[1.03,1.75] (Q4 vs. Q1); the dose-response relationship was significant (p < 0.05). WQS analysis showed a significant combined effects of Pb, Cd, and Hg on RHTN, with Pb as the highest weight (0.64), followed by Cd (0.25) and Hg (0.11). Stratified analysis indicated that the associations for the two heavy metals were significant for participants who were male, ≼ 60 years old, and with kidney dysfunction. CONCLUSION: Findings of this study with national data provide new evidence regarding the role of environmental heavy metal exposure in RHTN. The prevention strategies aimed at reducing heavy metal exposure should particularly focus on Americans who are middle-aged, male, and afflicted with kidney dysfunction.

Saikosaponin A protects against uremic toxin indole­3 acetic acid­induced damage to the myocardium.

Chronic kidney disease (CKD)­associated cardiac injury is a common complication in patients with CKD. Indole­3 acetic acid (IAA) is a uremic toxin that injures the cardiovascular system. Saikosaponin A (SSA) protects against pressure overload­induced cardiac fibrosis. However, the role and molecular mechanisms of IAA and SSA in CKD­associated cardiac injury remain unclear. The present study investigated the effects of IAA and SSA on CKD­associated cardiac injury in neonatal mouse cardiomyocytes and a mouse model of CKD. The expression of tripartite motif­containing protein 16 (Trim16), receptor interacting protein kinase 2 (RIP2) and phosphorylated­p38 were assessed using western blotting. The ubiquitination of RIP2 was measured by coimmunoprecipitation, and mouse cardiac structure and function were evaluated using hematoxylin and eosin staining and echocardiography. The results demonstrated that, SSA inhibited IAA­induced cardiomyocyte hypertrophy, upregulated Trim16 expression, downregulated RIP2 expression and decreased p38 phosphorylation. Furthermore, Trim16 mediated SSA­induced degradation of RIP2 by ubiquitination. In a mouse model of IAA­induced CKD­associated cardiac injury, SSA upregulated the protein expression levels of Trim16 and downregulated those of RIP2. Moreover, SSA alleviated heart hypertrophy and diastolic dysfunction in IAA­treated mice. Taken together, these results suggest that SSA is a protective agent against IAA­induced CKD­associated cardiac injury and that Trim16­mediated ubiquitination­related degradation of RIP2 and p38 phosphorylation may contribute to the development of CKD­associated cardiac injury.

Secular trends of suicide risk for residents in mainland China (2004 to 2019): An updated age-period-cohort analysis.

BACKGROUND: The overall suicide rate in China has dropped substantially since the 1990s, but a slowdown in the decrease and even a reversing trend was observed in specific groups in recent years. This study aims to investigate the latest suicide risk in mainland China by using the age-period-cohort (APC) analysis. METHOD: This population-based multiyear cross-sectional study included Chinese ages 10 to 84 years using data from the China Health Statistical Yearbook (2005-2020). Data were analyzed by the APC analysis and intrinsic estimator (IE) technique. RESULTS: The data satisfactorily fit the constructed APC models. The cohort effect indicated a high risk of suicide among people birth in 1920-1944 and a sharp decline in the 1945-1979 cohort. The lowest risk occurred in the 1980-1994 cohort before a sharp increase in generation Z (birth years in 1995-2009). The period effect showed a declining trend since 2004. The age effect indicated that the suicide risk increased over time, except for a gradual decline from age 35 to 49. The suicide risk increased greatly in adolescents and reached the highest among the elderly. LIMITATIONS: The aggregated population-level data and the non-identifiability of the APC model could result in bias in the accuracy of results in this study. CONCLUSIONS: This study successfully updated the Chinese suicide risk from the age, period and cohort perspective using the latest available data (2004-2019). The findings enhance the understanding of suicide epidemiology and provide evidence supporting policies and strategies at the macro-level for suicide prevention and management. Immediate action is needed to focus on a national suicide prevention strategy that targets generation Z, adolescents and the elderly which will require a collaborative effort by government officials, public/community health planners and health care agencies.

Global pattern and determinants of coronavirus disease 2019 (COVID-19) vaccine coverage and progression: a global ecological study.

Background: Understanding and minimizing existing global coronavirus disease 2019 (COVID-19) vaccination disparities is critical to global population health and eliminating health inequities. The study aims to investigate the disparities of vaccination coverage and progression and the associated economic and educational determinants to inform global COVID-19 vaccination strategies. Methods: COVID-19 vaccination coverage data from 206 countries used in the study were derived from "Our World in Data" website. After obtaining the vaccination coverage indicators, we fitted the progression indicators for vaccination. Correlation and multiple linear regression analysis were used to examine the effects of gross domestic product (GDP) per capita, Gini index, education, and their interactions on the coverage and progression of the COVID-19 vaccination. Results: The coverage of COVID-19 vaccination ranged from less than 30 doses to more than 150 doses per hundred people, from less than 15% to more than 75% for proportion of people vaccinated, from less than 15% to more than 60% for proportion of people fully vaccinated. Similarly, the progression of vaccination ranged from less than 0.1 to more than 0.6 for progression of total number of doses, from less than 0.1 to more than 0.3 for progression of proportion of people vaccinated, and from less than 0.1 to more than 0.4 for progression of proportion of people fully vaccinated. GDP per capita and education were positively associated with the coverage and progression, while Gini index was negatively associated with the coverage and progression. Negative interaction between GDP per capita and education was also observed for coverage (ß = -0.012 to -0.011, P < 0.05) and progression (ß = -0.012 to -0.011, P < 0.05). Conclusions: Substantial geographic disparities existed for the coverage and progression of COVID-19 vaccination. Economy and education are two important factors contributing to the disparities. Different countries may adopt varied strategies to promote the national distribution and vaccination of COVID-19 vaccines.

Hierarchical and nested associations of suicide with marriage, social support, quality of life, and depression among the elderly in rural China: Machine learning of psychological autopsy data.

Objectives: To identify mechanisms underpinning the complex relationships between influential factors and suicide risk with psychological autopsy data and machine learning method. Design: A case-control study with suicide deaths selected using two-stage stratified cluster sampling method; and 1:1 age-and-gender matched live controls in the same geographic area. Setting: Disproportionately high risk of suicide among rural elderly in China. Participants: A total of 242 subjects died from suicide and 242 matched live controls, 60 years of age and older. Measurements: Suicide death was determined based on the ICD-10 codes. Influential factors were measured using validated instruments and commonly accepted variables. Results: Of the total sample, 270 (55.8%) were male with mean age = 74.2 (SD = 8.2) years old. Four CART models were used to select influential factors using the criteria: areas under the curve (AUC) ≥ 0.8, sensitivity ≥ 0.8, and specificity ≥ 0.8. Each model included a lead predictor plus 8-10 hierarchically nested factors. Depression was the first to be selected in Model 1 as the lead predictor; After depression was excluded, quality of life (QOL) was selected in Model 2; After depression and QOL were excluded, social support was selected in Model 3. Finally, after all 3 lead factors were excluded, marital status was selected in Model 4. In addition, CART demonstrated the significance of several influential factors that would not be associated with suicide if the data were analyzed using the conventional logistic regression. Conclusion: Associations between the key factors and suicide death for Chinese rural elderly are not linear and parallel but hierarchically nested that could not be effectively detected using conventional statistical methods. Findings of this study provide new and compelling evidence supporting tailored suicide prevention interventions at the familial, clinical and community levels.

Three-dimensional electroanatomic mapping characteristics of superior vena cava myocardial sleeve and sinoatrial node in patients with atrial fibrillation.

Background: Three-dimensional activation mapping during sinus rhythm can demonstrate the earliest atrial activation (EAA) site, which could be the sinoatrial node (SAN). We aimed to compare the electroanatomical characteristics of superior vena cava (SVC), myocardial sleeve, and SAN between patients with atrial fibrillation (AF) and non-AF. Materials and methods: In this study, 136 patients with AF were assigned to the study group, and 20 patients with premature ventricular contractions (PVCs) who had no history of AF were assigned to the control group. The right atrium (RA) and SVC anatomical activation models were constructed, and the EAA of SAN was delineated using the CARTO3 mapping system. The length of the SVC myocardial sleeve (LSVC) was measured. Results: Of the 136 patients, 93 patients had paroxysmal AF (PAF), and 43 patients had persistent AF (PsAF). The LSVC was not significantly different among AF and non-AF, PAF, and PsAF. The LSVC in men was longer than in women (42.1 ± 9.4 mm vs. 35.4 ± 8.1 mm, p < 0.001). The LSVC was longer in patients with EAA of SAN above the RA-SVC junction than in those with below the RA-SVC junction (p < 0.001). The EAA of SAN was below the RA-SVC junction in 64/136 (47.1%) and was above the junction in 72/136 (52.9%) patients with AF. The spatial distribution of the EAA of SAN between PAF and PsAF was not different. There was a trend of statistical difference in the distribution of the EAA of SAN between PsAF and non-AF. Conclusion: The EAA of SAN was located in the SVC in most of the patients, especially in patients with PsAF.

Investigating the paradox of increasing obesity and declining heart disease mortality in the United States: Age-period-cohort model.

Background: Obesity as a risk factor of heart disease (HD) is confirmed through observational, laboratory, and intervention studies. However, it cannot explain why HD declines, but obesity increases in the United States in recent decades. This study attempted to understand this paradox. Methods: Annual data of national HD mortality (1999-2018) were derived from Wide-Ranging Online Data for Epidemiologic Research, biannual obesity data (1999-2016) from the National Health and Nutrition Examination Survey, and smoking data (1965-1990) were from the National Health Interview Survey. Age-period-cohort method was used to decompose HD mortality into age, period, and cohort effects, and to estimate age-cohort adjusted mortality rates. To explain the paradox, age-cohort adjusted rates were associated with obesity rates to verify the positive obesity-HD relationship, while smoking rates were associated with cohort effects to explain the current declines in HD mortality. Results: During 1999-2018, the prevalence of obesity increased while the crude HD mortality rate declined for both sex and all races. After controlling for the curvilinear age effect and consistent declining cohort effect, the age-cohort adjusted HD mortality sustained stable in 1999-2007 and increased thereafter. The age-cohort adjusted rate in 1999-2018 (per 100,000) increased from 189.31 to 238.56 for males, 67.23 to 90.28 for females, 115.54 to 157.39 for White, 246.40 to 292.59 for Black, 79.79 to 101.40 for Hispanics, and 49.95 to 62.86 for Asian. The age-cohort adjusted HD mortality rates were positively associated with obesity rates (r = 0.68 for males, 0.91 for females, 0.89 for White, and 0.69 for Hispanic, p < 0.05), but not significant for Black and Asian. Further, during 1965-1990, the estimated cohort effect showed a decline in HD risk and was positively associated with smoking rates (r = 0.98 for both sex, 0.99 for White, and 0.98 for Black, p < 0.01). Conclusion: Study findings reveal potential increase of HD risk and support the positive relationship between obesity and HD risk. Declines in HD mortality in the past two decades are primarily due to tobacco use reduction and this protective effect was entangled in the mortality rates as cohort effect.

Quality of Life, Hopelessness, Impulsivity, and Suicide in the Rural Elderly in China: A Moderated Mediation Analysis of Psychological Autopsy Data.

Background: People who had died by suicide always being associated with negative emotions and even mental disorders. Understanding mechanisms underlying the association between quality of life (QOL), hopelessness, and suicide are of great significance. In this study, we aimed to test a model in which the QOL-suicide relationship was mediated by hopelessness and moderated by impulsivity. Methods: Participants (N = 484, including 242 suicide deaths and 242 matched controls) were rural residents 60 years of age and older, randomly selected from 12 rural counties in China using a two-stage stratified cluster sampling method. Data were collected with standard psychological autopsy technique from informants (n = 968). The outcome variable was a suicide death. QOL, hopelessness, and impulsivity were assessed using validated scales. The proposed relationships were tested using mediation and moderated mediation models. Results: Of the total sample, 55.8% were men with a median age of 75.5 years. Results from the moderated mediation analysis indicated that QOL was negatively associated with suicide (beta = -0.141, p < 0.01); this association was mediated by hopelessness (indirect effect: beta =0.578, p < 0.01), accounting for 73% of the total effect. Impulsivity significantly moderated the mediation effect from QOL to hopelessness (beta =0.005, p < 0.01). Conclusions: Study findings have confirmed the negative association between QOL and suicide with psychological autopsy data, and demonstrated the role of hopelessness in mediating the QOL-suicide relation that is further modified by impulsiveness. These findings depend on our understanding of the suicide epidemiology among the elder in rural China and provide information much needed for suicide prevention.

Screening Intention Prediction of Colorectal Cancer among Urban Chinese Based on the Protection Motivation Theory.

Colorectal cancer poses a serious threat worldwide. Although early screening has been proved to be the most effective way to prevent and control colorectal cancer, the current situation of colorectal cancer screening remains not optimistic. The aim of this article is to apply the protection motivation theory (PMT) to examine the influencing factors on screening intention of colorectal cancer (CRC). This cross-sectional survey was launched in five communities in Wuhan, China. All the eligible urban Chinese were recruited and interviewed using paper-and-pencil questionnaires. The intention of colorectal cancer screening (CRCS) was measured using six PMT subconstructs, including perceived risk, perceived severity, fear arousal, response efficacy, response cost, and self-efficacy. Data on sociodemographic variables and knowledge of CRC were also collected. The structural equation modeling (SEM) method was used for data analysis. Among all the 569 respondents, 83.66% expressed willingness to participate in CRCS. Data of the research fit the proposed SEM model well (Chi-square/df = 2.04, GFI = 0.93, AGFI = 0.91, CFI = 0.91, IFI = 0.91, RMSEA = 0.04). Two subconstructs of PMT (response efficacy and self-efficacy) and CRC knowledge were directly and positively associated with screening intention. Age, social status, medical history, physical activity, and CRC knowledge were indirectly related to the screening intention through at least one of the two PMT subconstructs (response efficacy and self-efficacy). The findings of this study suggest the significance of enhancing response efficacy and self-efficacy in motivating urban Chinese adults to participate in CRC screening. Knowledge of CRC is significantly associated with screening intention. This study can provide useful information for the formulation and improvement of colorectal cancer screening strategies and plans.

Sociodemographic and Clinical Characteristics Associated With Worst Pain Intensity Among Cancer Patients.

AIMS: Patients with cancer have pain due to their cancer, the cancer treatment and other causes, and the pain intensity varies considerably between individuals. Additional research is needed to understand the factors associated with worst pain intensity. Our study aim was to determine the association between worst pain intensity and sociodemographics and cancerspecific factors among patients with cancer. DESIGN: A total of 1,280 patients with cancer recruited from multiple cancer centers over 25 years in the United States were asked to complete a questionnaire that collected respondents' demographic, chronic pain, and cancer-specific information. SETTINGS: Worst, least, and current pain intensities were captured using a modified McGill Pain Questionnaire (pain intensity measured on 0-10 scale). A generalized linear regression analysis was utilized to assess the associations between significant bivariate predictors and worst pain intensity scores.Our study sample was non-Hispanic White (64.5%), non-Hispanic Black (28.3%), and Hispanic (7.2%). On average, participants were 59.4 (standard deviation = 14.4) years old. The average worst pain intensity score was 6.6 (standard deviation = 2.50). After controlling for selected covariates, being Hispanic (ß = 0.6859), previous toothache pain (ß = 0.0960), headache pain (ß = 0.0549), and stomachache pain (ß = 0.0577) were positively associated with worse cancer pain. Notably, year of enrollment was not statistically associated with pain. CONCLUSIONS: Our study sample was non-Hispanic White (64.5%), non-Hispanic Black (28.3%), and Hispanic (7.2%). On average, participants were 59.4 (standard deviation = 14.4) years old. The average worst pain intensity score was 6.6 (standard deviation = 2.50). After controlling for selected covariates, being Hispanic (ß = 0.6859), previous toothache pain (ß = 0.0960), headache pain (ß = 0.0549), and stomachache pain (ß = 0.0577) were positively associated with worse cancer pain. Notably, year of enrollment was not statistically associated with pain. Findings identified being Hispanic and having previous severe toothache, stomachache, and headache pain as significant predictors of worst pain intensity among patients with cancer. After controlling for selected covariates, we did not note statistical differences in worst pain during a 25-year period. Therefore,studies focused on improving the management of pain among patients with cancer should target interventions for those with Hispanic heritage and those with past history of severe common pain.

Perception of Peer Condom Use Buffers the Associations Between HIV Knowledge, Self-efficacy, and Condom-Use Intention Among Adolescents: a Moderated Mediation Model.

A better understanding of the complex relationships between HIV knowledge, self-efficacy, perception of peer condom use, and condom-use intention is needed for improving HIV prevention among adolescents. The study analyzed survey data collected from high school students (N = 1970) in the Bahamas. Mediation and moderated mediation modeling analyses were used for data analysis. Results showed that self-efficacy mediated the association between HIV knowledge and condom-use intention. Perception of peer condom use moderated the mediation model by modifying the HIV knowledge-self-efficacy and self-efficacy-condom-use intention associations among males, but not for females. Findings of the study suggest the significant impact of perception of peer condom use in competition with HIV knowledge and self-efficacy in promoting condom use. Effective intervention program may consider targeting the modification of adolescents' perception of peer condom use to promote condom use among adolescents.

Relationship Among Social Capital, Employment Uncertainty, Anxiety, and Suicidal Behaviors: A Chained Multi-mediator Mediation Modeling Analysis.

OBJECTIVE: Social capital is a significant predictor of suicidal behaviors among Chinese rural migrants. However, the mechanism, including the impact of employment and mental health, has not been fully understood. This study aims to examine the complex relationships linking social capital to suicidal behaviors. METHOD: Data were collected from a probability sample (n = 1,245) of rural migrants in Wuhan, China. Social capital was used to predict suicidal behaviors, with employment uncertainty as step 1 mediator and anxiety as step 2 mediator. Suicidal ideation and attempt were analyzed separately using a chained moderated mediation model. Years of migration was included as moderator in all models to control its confounding effect. RESULTS: Of the total sample, 50.9% were male with mean age of 32.0 (SD = 7.8) years. The association between social capital and suicidal ideation was significantly mediated by employment uncertainty (indirect effect [95% CI] = -0.14 [-0.24, -0.04]), but not for suicidal attempt (-0.02 [-0.20, 0.15]). Anxiety significantly mediated the same association for both suicidal ideation (-0.19 [-0.37, -0.01]) and attempt (-0.20 [-0.40, -0.01]). The chained relationship from social capital to employment uncertainty, anxiety, and suicidal behaviors was also significant with indirect effect of -0.05 [-0.09, -0.01] for both suicidal ideation and attempt. Similar results were observed for bonding and bridging capital. CONCLUSIONS: Social capital may exert an effect on suicidal behaviors through employment and mental health among rural migrants in China. Social capital-based suicide prevention must consider both employment and mental health problems to obtain better effects.HighlightsEmployment and anxiety mediate social capital-suicidal behavior relation.Bonding capital affects anxiety and bridging capital affects employment.There is a chained relation among social capital, employment, anxiety, and suicidal behaviors.

Biology of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the humoral immunoresponse: a systematic review of evidence to support global policy-level actions and research.

BACKGROUND: Both population-level epidemiological data and individual-level biological data are needed to control the coronavirus disease 2019 (COVID-19) pandemic. Population-level data are widely available and efforts to combat COVID-19 have generated proliferate data on the biology and immunoresponse to the causative pathogen, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, there remains a paucity of systemized data on this subject. OBJECTIVE: In this review, we attempt to extract systemized data on the biology and immuno-response to SARS-CoV-2 from the most up-to-date peer-reviewed studies. We will focus on the biology of the virus and immunological variations that are key for determining long-term immunity, transmission potential, and prognosis. DATA SOURCES AND METHODS: Peer-reviewed articles were sourced from the PubMed database and by snowballing search of selected publications. Search terms included: "Novel Coronavirus" OR "COVID-19" OR "SARS-CoV-2" OR "2019-nCoV" AND "Immunity" OR "Immune Response" OR "Antibody Response" OR "Immunologic Response". Studies published from December 31, 2019 to December 31, 2020 were included. To ensure validity, papers in pre-print were excluded. RESULTS: Of 2 889 identified papers, 36 were included. Evidence from these studies suggests early seroconversion in patients infected with SARS-CoV-2. Antibody titers appear to markedly increase two weeks after infection, followed by a plateau. A more robust immune response is seen in patients with severe COVID-19 as opposed to mild or asymptomatic presentations. This trend persists with regard to the length of antibody maintenance. However, overall immunity appears to wane within two to three months post-infection. CONCLUSION: Findings of this study indicate that immune responses to SARS-CoV-2 follow the general pattern of viral infection. Immunity generated through natural infection appears to be short, suggesting a need for long-term efforts to control the pandemic. Antibody testing will be essential to gauge the epidemic and inform decision-making on effective strategies for treatment and prevention. Further research is needed to illustrate immunoglobulin-specific roles and neutralizing antibody activity.

Determinants of Intention to Participate in Breast Cancer Screening among Urban Chinese Women: An Application of the Protection Motivation Theory.

Despite the significance of early detection of breast cancer through screening, the screening uptake in China remains relatively low. Protection motivation theory (PMT) suggested by Rogers is one of the theories concerning threat appeal. This study aimed to apply the protection motivation theory (PMT) in predicting breast cancer screening intention. In this cross-sectional study, a sample of Chinese urban women was recruited using the convenient sampling method from five communities in Wuhan. Data were collected using a self-report questionnaire that included demographic variables, knowledge about breast cancer, six PMT subconstructs, and screening intention. We used the structural equation modeling (SEM) to identify the predictor factors associated with screening intention. Of the total sample (n = 412), 86.65% had intention to participate in screening. Our data fit the hypothesized SEM model well (Goodness of fit index (GFI) = 0.91, adjusted GFI (AGFI) = 0.89, comparative fit index (CFI) = 0.91, root mean square error of approximation (RMSEA) = 0.05, standardized root mean residual (SRMR) = 0.06, and Chi-square/df = 2.01). Three PMT subconstructs (perceived severity, response cost, and self-efficacy) were significantly associated with screening intention. Knowledge, social status, and medical history had significantly indirect associations with screening intention through the mediating effect of PMT subconstructs. Considering the utility of PMT, intervention programs might be more effective based on the subconstructs of PMT, especially to improve self-efficacy, perceived severity, and knowledge, reduce response cost, as well as targeting specific demographic groups.

Studying suicide using proxy-based data: reliability and validity of a short version scale for measuring quality of life in rural China.

BACKGROUND: To evaluate the reliability and validity of the short version six-item Quality of Life Scale (QOLS-6) and the consistency of subject-proxy data in a case-control psychological autopsy study on elderly suicide in rural China. METHODS: A two-stage stratified cluster sampling method was used to select research sites. We used self-administered questionnaires to collect proxy-based information from informants and subject-based information from living comparisons. RESULTS: A total of 242 pairs of suicide cases and living comparisons were selected in our research. Subject-proxy consistency for QOLS-6 was good (Intraclass correlation coefficient (ICC) was 0.688) in living controls. Good internal consistency of QOLS-6 was validated by Cronbach's α being greater than 0.6 among suicide cases and living comparisons. The mean scores of quality of life were lower among suicide cases than living controls. Quality of life was negatively correlated with depression, loneliness, hopelessness, impulsiveness and stressful life events, while it was positively correlated with activities of daily living and family function. CONCLUSIONS: QOLS-6 has good reliability and validity, which can be used for assessing quality of life among Chinese rural older adults. It is shorter and easier than any other scale for measuring quality of life and can be used as a screening tool in future studies.

Predator-Prey Dynamics of Intra-Host Simian Immunodeficiency Virus Evolution Within the Untreated Host.

The dynamic nature of the SIV population during disease progression in the SIV/macaque model of AIDS and the factors responsible for its behavior have not been documented, largely owing to the lack of sufficient spatial and temporal sampling of both viral and host data from SIV-infected animals. In this study, we detail Bayesian coalescent inference of the changing collective intra-host viral effective population size (Ne ) from various tissues over the course of infection and its relationship with what we demonstrate is a continuously changing immune cell repertoire within the blood. Although the relative contribution of these factors varied among hosts and time points, the adaptive immune response best explained the overall periodic dynamic behavior of the effective virus population. Data exposing the nature of the relationship between the virus and immune cell populations revealed the plausibility of an eco-evolutionary mathematical model, which was able to mimic the large-scale oscillations in Ne through virus escape from relatively few, early immunodominant responses, followed by slower escape from several subdominant and weakened immune populations. The results of this study suggest that SIV diversity within the untreated host is governed by a predator-prey relationship, wherein differing phases of infection are the result of adaptation in response to varying immune responses. Previous investigations into viral population dynamics using sequence data have focused on single estimates of the effective viral population size (Ne ) or point estimates over sparse sampling data to provide insight into the precise impact of immune selection on virus adaptive behavior. Herein, we describe the use of the coalescent phylogenetic frame- work to estimate the relative changes in Ne over time in order to quantify the relationship with empirical data on the dynamic immune composition of the host. This relationship has allowed us to expand on earlier simulations to build a predator-prey model that explains the deterministic behavior of the virus over the course of disease progression. We show that sequential viral adaptation can occur in response to phases of varying immune pressure, providing a broader picture of the viral response throughout the entire course of progression to AIDS.