Optimal Glycated Hemoglobin Cutoff for Diagnosis of Diabetes and Prediabetes in Chinese Breast Cancer Women.

Purpose: Glycated hemoglobin (HbA1c) is widely used in diabetes management and now recommended for diagnosis and risk assessment. Our research focused on investigating the optimal cutoff points of HbA1c for diagnosis of diabetes and prediabetes in Chinese breast cancer women, aiming to enhance early detection and tailor treatment strategies. Patients and Methods: This study involved 309 breast cancer women without diabetes history in China. Patients were categorized into groups of newly diagnosed diabetes, prediabetes, and normal glucose tolerance using oral glucose tolerance test (OGTT) according to the 2010 ADA criteria. HbA1c data were collected from all patients. Receiver operating characteristic (ROC) curve analysis was used to assess the effectiveness of the HbA1c screening. Results: Among the 309 breast cancer women without diabetes history, 96 (31.0%) were identified with diabetes and 130 (42.1%) had prediabetes according to OGTT, and the incidence of normal glucose tolerance was only 26.9% (83). ROC curve analysis, using OGTT as a reference, revealed that the area under the curve of 0.903 (P<0.001, 95% CI, 0.867-0.938) for HbA1c alone, indicating high accuracy. The optimal HbA1c cutoff for identifying diabetes was determined to be 6.0%, with a sensitivity of 78.1% and specificity of 86.4%. For prediabetes, the ROC curve for HbA1c alone showed that the area under the ROC curve of 0.703 (P<0.001, 95% CI, 0.632-0.774), with an optimal cutoff of 5.5% (sensitivity of 76.9% and specificity of 51.8%). Conclusion: The prevalence of undiagnosed diabetes is very high in breast cancer women without diabetes history in China. The optimal cutoff points of HbA1c for identifying diabetes and prediabetes are 6.0% and 5.5% in Chinese breast cancer women, respectively.

Accelerated Screening of Alternative DNA Base-Organic Molecule-Base Architectures via Integrated Theory and Experiment.

Organic molecule-mediated noncanonical DNA self-assembly expands the standard DNA base-pairing alphabets. However, only a very limited number of small molecules have been recognized as mediators because of the tedious and complicated experiments like crystallization and microscopy imaging. Here we present an integrative screening protocol incorporating molecular dynamics (MD) for fast theoretical simulation and native polyacrylamide gel electrophoresis for convenient experimental validation. Melamine, the molecule that was confirmed mediating noncanonical DNA base-pairing, and 38 other candidate molecules were applied to demonstrate the feasibility of this protocol. We successfully identified seven stable noncanonical DNA duplex structures, and another eight novel structures with sub-stability. In addition, we discovered that hairpins at both ends can significantly stabilize the noncanonical DNA structures, providing a guideline to design small organic molecule-incorporated DNA structures. Such an efficient screening protocol will accelerate the design of alternative DNA-molecule architectures beyond Watson-Crick pairs. Considering the wide range of potential mediators, it will also facilitate applications such as noncovalent, highly dense loading of drug molecules in DNA-based delivery system and probe design for sensitive detection of certain molecules.

Prevalence and risk factors of thyroid nodules in breast cancer women with different clinicopathological characteristics: a cross-sectional study.

BACKGROUND: Association between breast cancer (BC) and thyroid nodules (TNs) is still unclear. This research was to estimate the prevalence and risk factors of TN in Chinese BC women at initial diagnosis. METHODS: 1731 Chinese early-stage BC women at initial diagnosis underwent thyroid ultrasound and 1:1 age-matched Chinese healthy women underwent health examination in corresponding period were enrolled for analysis. RESULTS: Prevalence of TN and TI-RADS ≥ 4 TN in BC patients (56.27% and 9.76%) were higher than healthy people (46.04% and 5.49%), respectively, P < 0.001. Among BC patients, prevalence of TN and TI-RADS ≥ 4 TN in hormone receptor (HR)-positive patients (59.57% and 11.81%) were higher than HR-negative patients (48.77% and 5.10%), respectively, P < 0.001, while without difference between HR-negative patients and healthy people. After adjusting for age and BMI, HR-positive patients had higher risk of TN (OR = 1.546, 95%CI 1.251-1.910, P < 0.001) and TI-RADS ≥ 4 TN (OR = 3.024, 95%CI 1.943-4.708, P < 0.001) than HR-negative patients. Furthermore, the risk of TI-RADS ≥ 4 TN was higher in patients with estrogen receptor (ER) positive (OR = 2.933, 95%CI 1.902-4.524), progesterone receptor (PR) positive (OR = 1.973, 95%CI 1.378-2.826), Ki-67 < 20% (OR = 1.797, 95%CI 1.280-2.522), and tumor size < 2 cm (OR = 1.804, 95%CI 1.276-2.552), respectively, P < 0.001. CONCLUSIONS: Prevalence of TN, especially TI-RADS ≥ 4 TN, in Chinese early-stage BC women was higher than healthy people. HR-positive patients had higher prevalence and risk of TN, while without difference between HR-negative patients and healthy people. The increased risk of TN was correlated with ER-positive, PR-positive, lower Ki-67 expression, and smaller tumor size.

Metabolic effect of adrenaline infusion in people with type 1 diabetes and healthy individuals.

AIMS/HYPOTHESIS: As a result of early loss of the glucagon response, adrenaline is the primary counter-regulatory hormone in type 1 diabetes. Diminished adrenaline responses to hypoglycaemia due to counter-regulatory failure are common in type 1 diabetes, and are probably induced by exposure to recurrent hypoglycaemia, however, the metabolic effects of adrenaline have received less research attention, and also there is conflicting evidence regarding adrenaline sensitivity in type 1 diabetes. Thus, we aimed to investigate the metabolic response to adrenaline and explore whether it is modified by prior exposure to hypoglycaemia. METHODS: Eighteen participants with type 1 diabetes and nine healthy participants underwent a three-step ascending adrenaline infusion during a hyperinsulinaemic-euglycaemic clamp. Continuous glucose monitoring data obtained during the week before the study day were used to assess the extent of hypoglycaemia exposure. RESULTS: While glucose responses during the clamp were similar between people with type 1 diabetes and healthy participants, plasma concentrations of NEFAs and glycerol only increased in the group with type 1 diabetes (p<0.001). Metabolomics revealed an increase in the most common NEFAs (p<0.01). Other metabolic responses were generally similar between participants with type 1 diabetes and healthy participants. Exposure to hypoglycaemia was negatively associated with the NEFA response; however, this was not statistically significant. CONCLUSIONS/INTERPRETATION: In conclusion, individuals with type 1 diabetes respond with increased lipolysis to adrenaline compared with healthy participants by mobilising the abundant NEFAs in plasma, whereas other metabolic responses were similar. This may suggest that the metabolic sensitivity to adrenaline is altered in a pathway-specific manner in type 1 diabetes. TRIAL REGISTRATION: ClinicalTrials.gov NCT05095259.

Development and Test of Geogrid with Distributed Deformation Monitoring Function.

In recent years, there is a growing demand for materials that can both improve the mechanical properties of structures and carry out health monitoring and risk warning. In this case, in order to realize distributed deformation monitoring, a new method of making geogrid by 3D printing technology is proposed. The grille rib is made by embedding the conductive polymer (ground carbon fiber as conductive filler) into the insulating shell (PLA material) in the specified path, and then the rib is vertically crossed into each other to form a grille sample. In order to study the distributed deformation monitoring function of this grid, a manual push-pull testing machine was used to conduct a load-unload experiment to analyze the change rule of resistance on the grid plane. The following conclusions were obtained: the closer the ribs are to the load bearing point, the greater the change in resistance, and conversely, the farther the ribs are from the load bearing point, the smaller the change in resistance. Depending on the geogrid network characteristics, the electrical resistance distribution on the geogrid plane can be obtained by superimposing the resistance values of the horizontal and longitudinal ribs, then the location and the magnitude of deformation can be estimated. Additionally, this study carried out numerical simulation of the grid model based on ANSYS 15.0 software and compared with the loading experiment results to verify that the force deformation position can be retrieved through the change of resistance.

Evaluating the Effect of Artificial Liver Support on Acute-on-Chronic Liver Failure Using the Quantitative Difference Algorithm: Retrospective Study.

BACKGROUND: Liver failure, including acute-on-chronic liver failure (ACLF), occurs mainly in young adults and is associated with high mortality and resource costs. The prognosis evaluation is a crucial part of the ACLF treatment process and should run through the entire diagnosis process. As a recently proposed novel algorithm, the quantitative difference (QD) algorithm holds promise for enhancing the prognosis evaluation of ACLF. OBJECTIVE: This study aims to examine whether the QD algorithm exhibits comparable or superior performance compared to the Model for End-Stage Liver Disease (MELD) in the context of prognosis evaluation. METHODS: A total of 27 patients with ACLF were categorized into 2 groups based on their treatment preferences: the conventional treatment (n=12) and the double plasma molecular absorption system (DPMAS) with conventional treatment (n=15) groups. The prognosis evaluation was performed by the MELD and QD scoring systems. RESULTS: A significant reduction was observed in alanine aminotransferase (P=.02), aspartate aminotransferase (P<.001), and conjugated bilirubin (P=.002), both in P values and QD value (Lτ>1.69). A significant decrease in hemoglobin (P=.01), red blood cell count (P=.01), and total bilirubin (P=.02) was observed in the DPMAS group, but this decrease was not observed in QD (Lτ≤1.69). Furthermore, there was a significant association between MELD and QD values (P<.001). Significant differences were observed between groups based on patients' treatment outcomes. Additionally, the QD algorithm can also demonstrate improvements in patient fatigue. DPMAS can reduce alanine aminotransferase, aspartate aminotransferase, and unconjugated bilirubin. CONCLUSIONS: As a dynamic algorithm, the QD scoring system can evaluate the therapeutic effects in patients with ACLF, similar to MELD. Nevertheless, the QD scoring system surpasses the MELD by incorporating a broader range of indicators and considering patient variability.

RobustMat: Neural Diffusion for Street Landmark Patch Matching Under Challenging Environments.

For autonomous vehicles (AVs), visual perception techniques based on sensors like cameras play crucial roles in information acquisition and processing. In various computer perception tasks for AVs, it may be helpful to match landmark patches taken by an onboard camera with other landmark patches captured at a different time or saved in a street scene image database. To perform matching under challenging driving environments caused by changing seasons, weather, and illumination, we utilize the spatial neighborhood information of each patch. We propose an approach, named RobustMat, which derives its robustness to perturbations from neural differential equations. A convolutional neural ODE diffusion module is used to learn the feature representation for the landmark patches. A graph neural PDE diffusion module then aggregates information from neighboring landmark patches in the street scene. Finally, feature similarity learning outputs the final matching score. Our approach is evaluated on several street scene datasets and demonstrated to achieve state-of-the-art matching results under environmental perturbations.

Effect of chemotherapy and different chemotherapy regimens on bone health among Chinese breast cancer women in different menstrual status: a self-control study.

PURPOSE: Although the therapy-related bone loss attracts increasing attention nowadays, the differences in chemotherapy-induced bone loss and bone metabolism indexes change among breast cancer (BC) women with different menstrual statuses or chemotherapy regimens are unknown. The aim of the study is to explore the effects of different regimens of chemotherapy on bone health. METHOD: The self-control study enrolled 118 initially diagnosed BC women without distant metastasis who underwent dual-energy X-ray absorptiometry (DXA) bone mineral density (BMD) screening and (or) bone metabolism index monitoring during chemotherapy at Chongqing Breast Cancer Center. Mann-Whitney U test, Cochran's Q test, and Wilcoxon sign rank test were performed. RESULTS: After chemotherapy, the BMD in the lumbar 1-4 and whole lumbar statistically decreased (- 1.8%/per 6 months), leading to a significantly increased proportion of osteoporosis (27.1% vs. 20.5%, P < 0.05), which were mainly seen in the premenopausal group (- 7.0%/per 6 months). Of the chemotherapeutic regimens of EC (epirubicin + cyclophosphamide), TC (docetaxel + cyclophosphamide), TEC (docetaxel + epirubicin + cyclophosphamide), and EC-T(H) [epirubicin + cyclophosphamide-docetaxel and/or trastuzumab], EC regimen had the least adverse impact on BMD, while the EC-TH regimen reduced BMD most (P < 0.05) inspite of the non-statistical difference between EC-T regimen, which was mainly seen in the postmenopausal group. Chemotherapy-induced amenorrhea (estradiol 94 pg/ml vs, 22 pg/ml; FSH 9.33 mIU/ml vs. 61.27 mIU/ml) was proved in premenopausal subgroup (P < 0.001). Except the postmenopausal population with calcium/VitD supplement, the albumin-adjusted calcium increased significantly (2.21 mmol/l vs. 2.33 mmol/l, P < 0.05) after chemotherapy. In postmenopausal group with calcium/VitD supplement, ß-CTX decreased significantly (0.56 ng/ml vs. 0.39 ng/ml, P < 0.05) and BMD were not affected by chemotherapy (P > 0. 05). In premenopausal group with calcium/VitD supplement, PTH decreased significantly (52.90 pg/ml vs. 28.80 pg/ml, P = 0. 008) and hip BMD increased after chemotherapy (0.845 g/m2 vs. 0.952 g/m2, P = 0. 006). As for both postmenopausal and premenopausal group without calcium/VitD supplement, there was a significant decrease in bone mass in hip and lumbar vertebrae after chemotherapy (0.831 g/m2 vs. 0.776 g/m2; 0.895 g/m2 vs. 0.870 g/m2, P < 0.05). CONCLUSION: Chemotherapy might induce lumbar vertebrae BMD loss and spine osteoporosis with regimen differences among Chinese BC patients. Calcium/VitD supplementation could improve bone turnover markers, bone metabolism indicators, and bone mineral density. Early interventions on bone health are needed for BC patients during chemotherapy.

Image Patch-Matching With Graph-Based Learning in Street Scenes.

Matching landmark patches from a real-time image captured by an on-vehicle camera with landmark patches in an image database plays an important role in various computer perception tasks for autonomous driving. Current methods focus on local matching for regions of interest and do not take into account spatial neighborhood relationships among the image patches, which typically correspond to objects in the environment. In this paper, we construct a spatial graph with the graph vertices corresponding to patches and edges capturing the spatial neighborhood information. We propose a joint feature and metric learning model with graph-based learning. We provide a theoretical basis for the graph-based loss by showing that the information distance between the distributions conditioned on matched and unmatched pairs is maximized under our framework. We evaluate our model using several street-scene datasets and demonstrate that our approach achieves state-of-the-art matching results.

Decreased branched-chain amino acids and elevated fatty acids during antecedent hypoglycemia in type 1 diabetes.

INTRODUCTION: Hypoglycemia is a major limiting factor in achieving recommended glycemic targets for people with type 1 diabetes. Exposure to recurrent hypoglycemia results in blunted hormonal counter-regulatory and symptomatic responses to hypoglycemia. Limited data on metabolic adaptation to recurrent hypoglycemia are available. This study examined the acute metabolic responses to hypoglycemia and the effect of antecedent hypoglycemia on these responses in type 1 diabetes. RESEARCH DESIGN AND METHODS: Twenty-one outpatients with type 1 diabetes with normal or impaired awareness of hypoglycemia participated in a study assessing the response to hypoglycemia on 2 consecutive days by a hyperinsulinemic glucose clamp. Participants underwent a period of normoglycemia and a period of hypoglycemia during the hyperinsulinemic glucose clamp. Plasma samples were taken during normoglycemia and at the beginning and the end of the hypoglycemic period. Metabolomic analysis of the plasma samples was conducted using comprehensive two-dimensional gas chromatography with time-of-flight mass spectrometry. RESULTS: In total, 68 metabolites were studied. On day 1, concentrations of the branched-chain amino acids, leucine (p=3.8×10-3) and isoleucine (p=2.2×10-3), decreased during hypoglycemia. On day 2, during hypoglycemia, five amino acids (including leucine and isoleucine) significantly decreased, and two fatty acids (tetradecanoic and oleic acids) significantly increased (p<0.05). Although more metabolites responded to hypoglycemia on day 2, the responses of the single metabolites were not statistically significant between the 2 days. CONCLUSIONS: In individuals with type 1 diabetes, one episode of hypoglycemia decreases leucine and isoleucine concentrations. Antecedent hypoglycemia results in the decrement of five amino acids and increases the concentrations of two fatty acids, suggesting an alteration between the two hypoglycemic episodes, which could indicate a possible adaptation. However, more studies are needed to gain a comprehensive understanding of the consequences of these alterations. TRIAL REGISTRATION NUMBER: NCT01337362.

Impact of Thyroid Function on the Prevalence and Mortality of Metabolic Dysfunction-Associated Fatty Liver Disease.

CONTEXT: Thyroid function variation within the thyroxine reference range has negative metabolic effects. Metabolic dysfunction-associated fatty liver disease (MAFLD) is a recently proposed definition. OBJECTIVE: We aim to explore the effects of thyroid function status on prevalence and mortality of MAFLD. METHODS: Data of 10 666 participants from the Third National Health and Nutrition Examination Survey (NHANES III) were used. MAFLD was diagnosed based on the new definition. Thyroid function variation within the thyroxine reference range was defined based on thyroid-stimulating hormone (TSH) levels: subclinical hyperthyroidism, <0.39 mIU/L; strict-normal thyroid function, 0.39-2.5 mIU/L; and low thyroid function, >2.5 mIU/L, which comprised low-normal thyroid function (2.5-4.5 mIU/L) and subclinical hypothyroidism (> 4.5 mIU/L). Logistic and Cox regression were used in multivariate analysis. RESULTS: Low thyroid function is independently associated with MAFLD (odds ratio: 1.27). Compared with strict-normal thyroid function, subclinical hypothyroidism was significantly associated with increased risk for all-cause and cardiovascular mortality in the total population (hazard ratio [HR] for all-cause: 1.23; cardiovascular: 1.65) and MAFLD population (HR for all-cause: 1.32; cardiovascular: 1.99); meanwhile, in the low-normal thyroid function group, an increasing trend in mortality risk was observed. Furthermore, low thyroid function also showed significant negative impact on mortality in the total and MAFLD population. Among thyroid function spectrum, mild subclinical hypothyroidism showed the highest HRs on mortality. CONCLUSIONS: Low thyroid function is independent risk factor of MAFLD and is associated with increased risk for all-cause and cardiovascular mortality in the MAFLD population. Reevaluation of TSH reference range should be considered.

Prevalence and gender disparity of those who screen positive for depression in China by the classification of the employer and industry: a cross-sectional, population-based study.

BACKGROUND: The important role of mental health in sustainable economic development is gradually being recognized. This study aimed to evaluate the prevalence and gender disparity of those who screen positive for depression in China by the employer and industrial classification. METHODS: We used data from a nationally representative survey, the China Family Panel Studies. Depression was judged by the Centre for Epidemiologic Studies Depression Scale. Employer classifications were categorized according to the local characteristics of Mainland China. Industrial classifications were defined using level-1 of the China version of the International Standard Industrial Classification of All Economic Activities. Weighted logistic regressions were fitted to estimate the gender disparities, controlling for confounders. RESULTS: Forty eight thousand six hundred twenty eight adults were included. 18.7% (95%CI 18.1-19.4) of sampled adults were screened positive for depression symptoms, with 16.6% (95%CI 15.8-17.5) in males vs 21.0% (95%CI 20.1-22.0) in females. By classification of the employer, the prevalence was lowest among those employed by Government/party organisations (11.8%, 95%CI 8.9-15.4), and highest in those self-employed (21.8%, 95%CI 20.8-22.9); the gender disparity was mainly found in those employed by Sole proprietorship (Adjusted odds ratio [AOR] = 1.95, 95%CI 1.19-3.19) and Private enterprise (AOR = 1.34, 95%CI 1.13-1.59), as well as those self-employed (AOR = 1.49, 95%CI 1.3-1.17). By industrial classification, the prevalence was lowest among those who worked in the industry of Real estate (7.2%, 95%CI 4.8-10.6), and highest among those who worked in the industry of Agriculture, forestry, animal husbandry and fishing (22.9%, 95%CI 15.5-32.4); the gender disparity was mainly found in those who worked in the industry of Agriculture, forestry, animal husbandry and fishing (AOR = 3.29, 95%CI 1.18-9.15), Manufacturing (AOR = 1.41, 95% CI 1.09-1.82), Wholesale and retail trade (AOR = 1.48, 95% CI 1.07-2.06), and Accommodation and food service (AOR = 1.91, 95% CI 1.15-3.18). CONCLUSION: The prevalence of depression in China had a wide variation by classifications of the employer and industry. Gender disparities were identified among workers from Sole proprietorship, Private enterprise, and self-employed, or workers from the industry of Agriculture, forestry, animal husbandry and fishing, Manufacturing, Wholesale and retail trade, and Accommodation and food service.

Correction: Parental Factors Associated With Internet Gaming Disorder Among First-Year High School Students: Longitudinal Study.

[This corrects the article DOI: 10.2196/33806.].

[Christmas article: The search for the (glycaemic) optimal christmas dinner].

INTRODUCTION: The Danish Christmas meal is not the healthiest and might increase blood glucose fluctuations, which can affect health negatively. Studies have shown that these large blood sugar fluctuations can be reduced by eating a meal in a particular order rather than eating it all at once. We investigated if sequential eating of a Danish Christmas meal affected post-prandial glucose fluctuations. METHODS: In a prospective randomised trial, 11 healthy subjects ate a standardised Danish Christmas meal. The subjects ate the meal three times with a wash-out day in between. On the first day, the subjects consumed the meal as they preferred. The following meals were divided into a starter (fresh red cabbage or pork roast) and the rest of the meal, and the opposite starter on the last intervention day. The glucose levels of the participants were monitored by continuous glucose monitoring (Freestyle Libre 2). We used a linear mixed model to compare the effects of the different orders of meal intake on glucose fluctuations. RESULTS: Nine of 11 participants were women with a mean age of 41.2 (range 25.0-64.0) years and mean glucose levels of 5.2 mmol/L. No differences in the postprandial glucose levels between the meals were found (all p > 0,05). CONCLUSION: We found no differences in the postprandial glucose levels in relation to the order of intake of fibers (salad) or protein (roast pork) before carbohydrates. We conclude that it is safe in terms of glycaemic control for healthy people without diabetes to eat a traditional Danish Christmas meal in any order. FUNDING: none. TRIAL REGISTRATION: not relevant.

Disparities in the unmet mental health needs between LGBTQ+ and non-LGBTQ+ populations during COVID-19 in the United States from 21 July 2021 to 9 May 2022.

Background: Evidence highlighted the likelihood of unmet mental health needs (UMHNs) among LGBTQ+ than non-LGBTQ+ populations during COVID-19. However, there lacks evidence to accurately answer to what extent the gap was in UMHN between LGBTQ+ and non-LGBTQ+ populations. We aim to evaluate the difference in UMHN between LGBTQ+ and non-LGBTQ+ during COVID-19. Methods: Cross-sectional data from Household Pulse Survey between 21 July 2021 and 9 May 2022 were analyzed. LGBTQ+ was defined based on self-reported sex at birth, gender, and sexual orientation identity. UMHN was assessed by a self-reported question. Multivariable logistic regressions generated adjusted odds ratios (AODs) of UMHN, both on overall and subgroups, controlling for a variety of socio-demographic and economic-affordability confounders. Findings: 81267 LGBTQ+ and 722638 non-LGBTQ+ were studied. The difference in UMHN between LGBTQ+ and non-LGBTQ+ (as reference) varied from 4.9% (95% CI 1.2-8.7%) in Hawaii to 16.0% (95% CI 12.2-19.7%) in Utah. In multivariable models, compared with non-LGBTQ+ populations, LGBTQ+ had a higher likelihood to report UMHN (AOR = 2.27, 95% CI 2.18-2.39), with the highest likelihood identified in transgender (AOR = 3.63, 95% CI 2.97-4.39); compared with LGBTQ+ aged 65+, LGBTQ+ aged 18-25 had a higher likelihood to report UMHN (AOR = 1.34, 95% CI 1.03-1.75); compared with White LGBTQ+ populations, Black and Hispanic LGBTQ+ had a lower likelihood to report UMHN (AOR = 0.72, 95% CI 0.63-0.82; AOR = 0.85, 95% CI 0.75-0.97, respectively). Interpretation: During the COVID-19, LGBTQ+ had a substantial additional risk of UMHN than non-LGBTQ+. Disparities among age groups, subtypes of LGBTQ+, and geographic variance were also identified.

Parental Factors Associated With Internet Gaming Disorder Among First-Year High School Students: Longitudinal Study.

BACKGROUND: Parents play central roles in adolescents' socialization, behavioral development, and health, including the development of internet gaming disorder (IGD). However, longitudinal research on the parental predictors of adolescent IGD is limited. OBJECTIVE: This study aimed to investigate the reciprocal associations between various parental factors and adolescent IGD using 2-wave cross-lagged models. METHODS: A sample of 1200 year-one high school students in central China completed a baseline assessment in 2018 (mean age 15.6 years; 633/1200, 52.8% male) and a follow-up survey in 2019. IGD was measured using the 9-item DSM-5 IGD Symptoms checklist. Perceptions related to parental variables, including psychological control, parental abuse, parental support, and the parent-child relationship, were also collected from the adolescents. RESULTS: Of all the participants, 12.4% (148/1200) and 11.7% (140/1200) were classified as having IGD at baseline (T1) and follow-up (T2), respectively. All 4 cross-lagged models fit the data well (range for the comparative fit index .91-.95; range for the standardized root mean square residual .05-.06). Parental support (ß=-.06, P=.02) and parental abuse (ß=.08, P=.002) at T1 predicted IGD symptoms at T2, while parental psychological control (ß=.03, P=.25) and a positive relationship with parents (ß=-.05, P=.07) at T1 had nonsignificant effects on IGD symptoms at T2, when controlling for background variables. In addition, IGD symptoms at T1 did not predict parental factors at T2. CONCLUSIONS: The findings suggest that parental factors may be significant predictors of adolescent IGD. Health interventions should consider involving parents to increase the effectiveness of treatment to prevent and reduce adolescent IGD.

Understanding the Pathways from Mindfulness to COVID-19 Vaccination Intention via Positive Psychology Attributes among Health Care Workers in China.

OBJECTIVE: The present study aims to examine the association between mindfulness and COVID-19 vaccination intention, and the mediating role of presence of meaning in life and moral elevation in such association. METHOD: In a cross-sectional study design, a total of 1733 health care workers (81.1% females, Mage = 34.16 ± 9.03) from four cities in China were recruited and completed an online survey that measured mindfulness, moral elevation, presence of meaning in life and COVID-19 vaccination intention. RESULTS: It has been found that 73.1% of the participants reported an intention to receive COVID-19 vaccination. Mindfulness was positively associated with COVID-19 vaccination intention; Mediation analyses using structural equation modeling showed a significant indirect effect of mindfulness on COVID-19 vaccination intention, accounting for 42.4% of the total effect. Mindfulness was positively associated with COVID-19 vaccination intention directly via presence of meaning in life, and indirectly via moral elevation and presence of meaning in life. CONCLUSIONS: The findings add knowledge of how mindfulness may increase COVID-19 vaccination intention, and underscore the potential need for mindfulness training, positive emotion promotion, presence of meaning in life interventions to improve acceptance of COVID-19 vaccination among health care workers.

Comorbidity in patients with first-ever ischemic stroke: Disease patterns and their associations with cognitive and physical function.

The present study examined the prevalence and pattern of comorbidity among Chinese patients with first-ever acute ischemic stroke, and assessed the associations of specific comorbidity patterns with physical and cognitive functioning after stroke occurrence. A hospital-based cross-sectional study was conducted among 2,151 patients with first-ever ischemic stroke (age ≥40 years; 64.2% men) who were admitted to two university hospitals in Shandong, China between 2016 and 2017. Data on demographics, lifestyles, chronic health conditions, and use of medications were collected through in-person interviews, clinical examinations, and laboratory tests. Physical functioning was assessed by the Barthel index (BI) and the modified Rankin Scale (mRS) while cognitive functioning was assessed by the Montreal Cognitive Assessment test. The results showed that comorbidity was present in 90.9% of the stroke patients (women vs. men: 95.2 vs. 88.7%, P < 0.001). Exploratory factor analysis identified three patterns of comorbidity, i.e., patterns of degenerative-cardiopulmonary, heart-gastrointestinal-psychiatric, and metabolic-kidney diseases. The number of comorbidities was significantly associated with a higher likelihood of moderate-to-severe physical dependence [odds ratio (95% CI) = 1.15 (1.06-1.25) for BI and 1.12 (1.04-1.21) for mRS, all P < 0.01] and cognitive impairment [odds ratio (95% CI) = 1.11 (1.02-1.20), P = 0.017], after adjusting for multiple covariates. Almost all the three comorbidity patterns were associated with increased likelihoods of physical dependence (range for odds ratios: 1.26-1.33) and cognitive impairment (range for odds ratios: 1.25-1.34). No significant association was found between degenerative-cardiopulmonary pattern and mRS. These findings suggest that comorbidity is associated with poor physical and cognitive functioning during the acute phase of ischemic stroke. Routine assessments of comorbidity and cognitive and physical function among patients with acute ischemic stroke should be considered in stroke research and clinical practice.

Metabolic syndrome in patients with first-ever ischemic stroke: prevalence and association with coronary heart disease.

The metabolic syndrome (MetS) has been well linked with coronary heart disease (CHD) in the general population, but studies have rarely explored their association among patients with stroke. We examine prevalence of MetS and its association with CHD in patients with first-ever ischemic stroke. This hospital-based study included 1851 patients with first-ever ischemic stroke (mean age 61.2 years, 36.5% women) who were hospitalized into two university hospitals in Shandong, China (January 2016-February 2017). Data were collected through interviews, physical examinations, and laboratory tests. MetS was defined following the National Cholesterol Education Program (NCEP) criteria, the International Diabetes Federation (IDF) criteria, and the Chinese Diabetes Society (CDS) criteria. CHD was defined following clinical criteria. Data were analyzed using binary logistic regression models. The overall prevalence of MetS was 33.4% by NECP criteria, 47.2% by IDF criteria, and 32.5% by CDS criteria, with the prevalence being decreased with age and higher in women than in men (p < 0.05). High blood pressure, high triglycerides, and low HDL-C were significantly associated with CHD (multi-adjusted odds ratio [OR] range 1.27-1.38, p < 0.05). The multi-adjusted OR of CHD associated with MetS defined by the NECP criteria, IDF criteria, and CDS criteria (vs. no MetS) was 1.27 (95% confidence interval 1.03-1.57), 1.44 (1.18-1.76), and 1.27 (1.03-1.57), respectively. In addition, having 1-2 abnormal components (vs. none) of MetS was associated with CHD (multi-adjusted OR range 1.66-1.72, p < 0.05). MetS affects over one-third of patients with first-ever ischemic stroke. MetS is associated with an increased likelihood of CHD in stroke patients.

Would Illness Representations of COVID-19 and COVID-19 Fears During Clinic Visits Promote or Reduce Behavioral Intention to Seek Medical Consultations for Flu Symptoms? A Random Telephone Survey in Hong Kong, China.

Background: The study investigated the level of behavioral intention to consult doctors for flu symptoms (BICDFS) during the Coronavirus Disease 2019 (COVID-19) pandemic and examined its associations with illness representations of COVID-19 and fear of COVID-19 during clinic visits in a general Chinese adult population. Methods: A random telephone survey was conducted among 300 residents in Hong Kong, China in April 2020 when the second wave of COVID-19 was just ended in the region. The participants were asked about their intention to consult doctors if they had mild or severe flu symptoms in the next week (from 1 = definitely no to 5 = definitely yes). Illness representations of COVID-19 were measured by the Chinese version of the Brief Illness Perception Questionnaire (BIPQ). The fear of COVID-19 during clinic visits were assessed by two single items. Linear regression adjusted for background variables and hierarchical strategies were employed. Results: Of the participants, 52.3 and 92.0% showed an intention to consult doctors for mild and severe flu symptoms, respectively. Adjusted for background factors, COVID-19-related cognitive representations (consequences: standardized b = 0.15, p = 0.010; understanding: standardized b = 0.21, p = 0.001) and emotional representations (concern: standardized b = 0.17, p = 0.001; negative emotions: standardized b = 0.19, p = 0.001) were positively associated with BICDFS. In the hierarchical model, independent significant factors of BICDFS included understanding (standardized b = 0.16, p = 0.013) and negative emotions (standardized b = 0.17, p = 0.008). The fear-related variables showed non-significant associations with the BICDFS. Conclusions: Promotion of care-seeking behaviors for flu symptoms during the COVID-19 pandemic should consider improving people's understanding of COVID-19 and providing advice on related coping strategies for emotional responses to COVID-19.