The long-term cost-effectiveness of once-weekly semaglutide versus sitagliptin for the treatment of type 2 diabetes in China.

BACKGROUND: To estimate the long-term cost-effectiveness of once-weekly semaglutide versus sitagliptin as an add-on therapy for type 2 diabetes patients inadequately controlled on metformin in China, to better inform healthcare decision making. METHODS: The Cardiff diabetes model which is a Monte Carlo micro-simulation model was used to project short-term effects of once-weekly semaglutide versus sitagliptin into long-term outcomes. Short-term data of patient profiles and treatment effects were derived from the 30-week SUSTAIN China trial, in which 868 type 2 diabetes patients with a mean age of 53.1 years inadequately controlled on metformin were randomized to receive once-weekly semaglutide 0.5 mg, once-weekly semaglutide 1 mg, or sitagliptin 100 mg. Costs and quality-adjusted life years (QALYs) were estimated from a healthcare system perspective at a discount rate of 5%. Univariate sensitivity analysis, scenario analysis, and probabilistic sensitivity analysis were conducted to test the uncertainty. RESULTS: Over patients' lifetime projections, patients in both once-weekly semaglutide 0.5 mg and 1 mg arms predicted less incidences of most vascular complications, mortality, and hypoglycemia, and lower total costs compared with those in sitagliptin arm. For an individual patient, compared with sitagliptin, once-weekly semaglutide 0.5 mg conferred a small QALY improvement of 0.08 and a lower cost of $5173, while once-weekly semaglutide 1 mg generated an incremental QALY benefit of 0.12 and a lower cost of $7142, as an add-on to metformin. Therefore, both doses of once-weekly semaglutide were considered dominant versus sitagliptin with more QALY benefits at lower costs. CONCLUSION: Once-weekly semaglutide may represent a cost-effective add-on therapy alternative to sitagliptin for type 2 diabetes patients inadequately controlled on metformin in China.

A 4D Theoretical Framework for Measuring Topic-Specific Influence on Twitter: Development and Usability Study on Dietary Sodium Tweets.

BACKGROUND: Social media has emerged as a prominent approach for health education and promotion. However, it is challenging to understand how to best promote health-related information on social media platforms such as Twitter. Despite commercial tools and prior studies attempting to analyze influence, there is a gap to fill in developing a publicly accessible and consolidated framework to measure influence and analyze dissemination strategies. OBJECTIVE: We aimed to develop a theoretical framework to measure topic-specific user influence on Twitter and to examine its usability by analyzing dietary sodium tweets to support public health agencies in improving their dissemination strategies. METHODS: We designed a consolidated framework for measuring influence that can capture topic-specific tweeting behaviors. The core of the framework is a summary indicator of influence decomposable into 4 dimensions: activity, priority, originality, and popularity. These measures can be easily visualized and efficiently computed for any Twitter account without the need for private access. We demonstrated the proposed methods by using a case study on dietary sodium tweets with sampled stakeholders and then compared the framework with a traditional measure of influence. RESULTS: More than half a million dietary sodium tweets from 2006 to 2022 were retrieved for 16 US domestic and international stakeholders in 4 categories, that is, public agencies, academic institutions, professional associations, and experts. We discovered that World Health Organization, American Heart Association, Food and Agriculture Organization of the United Nations (UN-FAO), and World Action on Salt (WASH) were the top 4 sodium influencers in the sample. Each had different strengths and weaknesses in their dissemination strategies, and 2 stakeholders with similar overall influence, that is, UN-FAO and WASH, could have significantly different tweeting patterns. In addition, we identified exemplars in each dimension of influence. Regarding tweeting activity, a dedicated expert published more sodium tweets than any organization in the sample in the past 16 years. In terms of priority, WASH had more than half of its tweets dedicated to sodium. UN-FAO had both the highest proportion of original sodium tweets and posted the most popular sodium tweets among all sampled stakeholders. Regardless of excellence in 1 dimension, the 4 most influential stakeholders excelled in at least 2 out of 4 dimensions of influence. CONCLUSIONS: Our findings demonstrate that our method not only aligned with a traditional measure of influence but also advanced influence analysis by analyzing the 4 dimensions that contribute to topic-specific influence. This consolidated framework provides quantifiable measures for public health entities to understand their bottleneck of influence and refine their social media campaign strategies. Our framework can be applied to improve the dissemination of other health topics as well as assist policy makers and public campaign experts to maximize population impact.

A study on the impact of health shocks on subjective wellbeing of middle-aged people and older adults-Evidence from China.

Introduction: The health issues that afflict middle-aged people and older individuals are a significant factor that affects their quality of life. It is crucial to investigate the impact of health shocks on the subjective wellbeing of this demographic and the mechanisms that underlie this impact to promote healthy aging. Methods: This study utilized data from the China Family Panel Study in 2018 and 2020 to analyze the effects of HSs and their categories on the subjective wellbeing of middle-aged people and older individuals using the propensity score matching difference-in-differences method. Additionally, the study explored the mediating role of social participation. Results: The findings indicate that health shocks, both chronic and acute, diminish the subjective wellbeing of middle-aged people and older adults. Furthermore, these shocks have a more significant negative effect on the subjective wellbeing of individuals aged 60 and above, women in the middle-aged and older demographic, individuals in rural areas who belong to the middle-aged and older age groups, and individuals possessing activities of daily living. The mechanism analysis revealed that health shocks, both chronic and acute, reduce the subjective wellbeing of middle-aged people and older individuals by disrupting partnerships. Discussion: Lowering the possibility of health shocks, the government should build a strong health management system and improve the health insurance system to enable timely treatment for persons suffering from health shocks. Individuals and families should live healthy lives and engage in social activities to avoid health shocks and improve subjective wellbeing.

Healthcare Expenditures among the Elderly in China: The Role of Catastrophic Medical Insurance.

China has been piloting the catastrophic medical insurance (CMI) program since 2012 and rolled it out nationally in 2016 to reduce the incidence of catastrophic health expenditure among Chinese residents. Few studies have been conducted to determine its effect on healthcare expenditures, particularly among the elderly. The purpose of this study is to examine the effect of CMI on healthcare expenditures among China's elderly population. The data for this study were derived from 4 waves of the Chinese Longitudinal Healthy Longevity Survey, which included 344 and 1199 individuals in the treatment and control groups, respectively. To examine the effect of CMI on healthcare expenditures among the elderly, we used difference-in-differences and fixed-effects models. Additionally, a heterogeneity analysis was used to examine the differences in the impact of CMI on different groups. Finally, we confirmed the robustness of the results using robustness and placebo tests. CMI increased total health and out-of-pocket expenditures significantly, as well as inpatient and corresponding out-of-pocket expenditures. The reassults of the heterogeneity analysis indicated that CMI had a greater impact on elderly residents of rural areas. Economic burden protection has been enhanced for low-income groups and patients with serious diseases over the last two years. Our research indicated that CMI can promote the use of inpatient medical services for the elderly to a certain extent. Targeted measures such as expanding the CMI compensation list, establishing a more precise compensation scheme, and specific diseases associated with high healthcare expenditures can be considered in the practice of CMI implementation.

Effects of dietary structure on the incidence of gestational diabetes mellitus and macrosomia.

OBJECTIVES: To explore the relationship between dietary structure and the incidence of gestational diabetes mellitus and macrosomia. MATERIAL AND METHODS: In this retrospective study, the diet records of pregnant women admitted to the Sixth People's Hospital affiliated to Shanghai Jiaotong University between August 2017 and August 2018 were collected with the approval of the local ethics committee. Corresponding medical and clinical information of pregnant women were obtained from the medical system. The relationship between diet structure and the incidence of gestational diabetes and macrosomia was analyzed. RESULTS: A total of 93 pregnant women with elevated blood sugar (including new gestational diabetes mellitus and diabetes mellitus with pregnancy) were enrolled. There were 21 newborns with macrosomia. The consumption of tofu was negatively correlated with the occurrence of macrophages. The consumption of pork eaten was negatively correlated with blood sugar levels two hours after eating. The consumption of vegetables was positively correlated with the blood glucose level one hour after eating. Eggs may increase triglycerides and blood sugar, which is an important inducer of pregnancy complicated with diabetes and macrosomia. CONCLUSIONS: The diet structure of pregnant women is correlated with the occurrence of diabetes mellitus and macrosomia in pregnancy. It is recommended to eat more potato and not fried noodles with edible oil and to eat more high-quality protein, such as vegetable protein and lean pork.

Assessing Determinants of Online Medical Services Adoption Willingness of General Hospital Physicians Using the Information-Motivation-Behavioral Skills Model: A Multi-Group Structural Equation Modeling Approach.

PURPOSE: Physician adoption of online medical services (OMS) has been hastened by the COVID-19 pandemic, but their adoption willingness still requires to be improved. This study aims to construct a physician's OMS adoption willingness model based on the information-motivation-behavioral skill (IMB) theory, explore the determinants affecting adoption willingness and its influencing pathways, and evaluate the moderating effects of OMS use experience on willingness through multi-group analysis. PARTICIPANTS AND METHODS: A cross-sectional survey was conducted among physicians in three public hospitals of Jiangsu province, China, from June to July 2020, using a multi-stage sampling method. Structural equation modeling was applied to analyze the valid data from 531 respondents. RESULTS: Physicians' willingness to adopt OMS was at a moderate level, with an average score of 14.27±3.34 (range: 4-20). The behavior model for physician's OMS adoption willingness fitted well. Information (In), motivation (Mo), and behavioral skill (BS) explained 69% of the variance in adoption willingness (AW). Information could only exert completely indirect effect on willingness via behavioral skills (b = 0.202, 95% CI[0.122, 0.314]); motivation could both generate direct effect (ß=0.368, p < 0.001) and partial indirect effect on willingness via behavioral skills (b = 0.160, 95% CI[0.092, 0.248]); and behavioral skills had a positive effect on willingness (ß=0.424, p < 0.001). Furthermore, OMS use experience showed a significant moderating effect on the Mo → AW pathway, with inexperienced physicians' willingness being significantly stronger influenced by motivation compared to experienced ones. CONCLUSION: Findings from this study revealed the role of IMB model in interpreting and predicting physicians' willingness to adopt OMS and the moderating effect of uptake experience, providing practitioners with a theoretical foundation and intervention framework for supporting OMS development efforts.

Inequalities in health-related quality of life and the contribution from socioeconomic status: evidence from Tibet, China.

BACKGROUND: This study aimed to understand the association between socioeconomic status (SES) and Health Related Quality of Life (HRQoL) and the contribution of SES to health inequality among Tibetans of agricultural and pastoral areas (APA) in Tibet, China. METHODS: The data were from Health Survey of Tibetans in APA conducted in 2014. A total of 816 respondents were enrolled for the analysis Multiple linear regression was employed to examine the relationship between SES and HRQoL. Concentration index (CI) was used to measure the degree of health inequality and a Wagstaff-type CI decomposition method was applied to measure the contribution of SES to inequality. RESULTS: SES had significant association with HRQoL among the Tibetans in APA. The high SES group was more likely to have a higher Eq-5d index (0.77 vs. 0.67, P < 0.001) and VAS (72.94 vs. 62.41, P < 0.001) than the low SES group. The Concentration index of the Eq-5d index and VAS for total sample was 0.022 and 0.026 respectively, indicating a slight pro-rich inequality among this population. The decomposition analyses showed the SES is the main contributor to health inequality and contributed 45.50 and 41.39% to inequality for the Eq-5d index and VAS, respectively. CONCLUSION: The results showed SES is positively associated with HRQoL among Tibetans in APA. There was a slight pro-rich inequality in the health of the participants and most health inequality was attributable to SES. This study is helpful in gaining an insight into the HRQoL, health inequality and the relationship between SES and health inequality among Tibetans of APA in China.

Correction to: Effect of closure of live poultry markets in China on prevention and control of human infection with H7N9 avian influenza: a case study of four cities in Jiangsu Province.

Due to an unfortunate oversight the acknowledgements has been omitted.

Effect of closure of live poultry markets in China on prevention and control of human infection with H7N9 avian influenza: a case study of four cities in Jiangsu Province.

As of August 2017, China had encountered five seasonal epidemics of H7N9 avian influenza. To prevent people from contracting H7N9 avian influenza, most cities closed live poultry markets (LPMs) to cut off the source of H7N9 virus. The objective of this study is to assess the impact of LPMs closure on reducing zoonotic transmission of avian influenza A (H7N9) virus and to make specific recommendations on the duration of closing the LPMs. Results show that the closure of LPMs can effectively control the spread of H7N9 avian influenza and reduce the incidence of human infection with H7N9. If cases of H7N9 avian influenza continue to occur, LPMs should close for at least 3-4 weeks in susceptible areas to control the spread of infection.

Measurement and decomposition of income-related inequality in self-rated health among the elderly in China.

BACKGROUND: Population ageing in China has brought increasing attention to the health inequalities of the elderly. The purpose of this paper is to measure income-related health inequality among the elderly in China and decompose its causes. METHODS: The data are from the China Health and Retirement Longitudinal Study (CHARLS) survey in 2013, which contains 6176 individuals aged 60 years and above. A multiple linear regression model was used to analyze the influencing factors of self-rated health (SRH) among the elder people. Furthermore, the corrected concentration index were used to measure income-related health inequality. Wagstaff-type decomposition analysis was employed to explore the cause of inequality. The measurement and decomposition of health inequality was also performed separately in the male and female subgroups. RESULTS: Most elderly declared their health status as "fair" (51.33%) or "poor" (21.88%). Income, gender, residence, region, health insurance and other factors had significant association with SRH (P < 0.05). The corrected concentration index (CCI) was 0.06, indicating pro-rich inequality in health among the elderly. Decomposition analyses revealed that the main contributors to health inequality included income, residence, region, health insurance, and employment. For female elderly, most of the inequality was due to residence (50.78%) and income (49.51%); for male elderly, most of the inequality was due to insurance (38.65%) and income (22.26%); for the total sample, employment had a negative contribution to health inequality (- 25.83%). CONCLUSION: The findings confirm a high proportion of elderly with poor SRH, and health inequality in the Chinese. Some socioeconomic strategies should be conducted to reduce this health inequality among the elderly, such as reducing income disparities, consolidating health insurance schemes, and narrowing urban-rural and regional gaps. Older females with low incomes in rural areas are a vulnerable subgroup and warrant targeted policy attention.

Association between body mass index and health-related quality of life among Chinese elderly-evidence from a community-based study.

BACKGROUND: This study aimed to explore the effects of (body mass index) BMI on health related quality of life (HRQoL) among the elderly in Jiangsu, China. METHODS: A total of 10,257 community dwelling elderly (≥60 years old) were enrolled in a cross-sectional study. HRQoL was measured via the Eq-5d-3 L. Chi-square tests and one-way ANOVA analyses were used to compare the frequencies and scores of Eq-5d responses among different BMI groups (defined as "underweight", "normal weight", "overweight" and "obese"). Logistic regression analyses were conducted to examine the associations between BMI and HRQoL. RESULTS: Among the subjects, the proportion of "normal weight", "underweight", "overweight" and "obese" were 66.0, 8.3, 23.1, and 2.6%, respectively. The score of the Eq-5d index among total participants was 0.8036 and the Visual Analog Scale (VAS) score was 75.47. For both the responses frequency and scores of Eq-5d-3 L, there were significant differences among BMI groups (P < 0.001). The Logistic regression model showed that both in men and women, underweight elderly were more likely to suffer low HRQoL. The adjusted odds ratio (OR) with a 95% confidence interval (CI) for Eq-5d index/VAS was 2.03 (1.48, 2.79)/1.83 (1.34, 2.50) in men and 1.47(1.09,1.98)/1.52(1.20,1.91) in women. Overweight women more likely to have a low Eq-5d index, while overweight men were less likely to have a low Eq-5d VAS. CONCLUSION: This study shows that underweight is an explicit risk factor of low HRQoL in both the male and female elderly, while the effect of overweight on low HRQoL varies slightly by gender.

Ultrasound prediction of abnormal infant development in hypertensive pregnant women in the second and third trimester.

The objective was to assess the sensitivities and accuracies of Doppler ultrasound parameters in the second and third trimester of hypertensive pregnancies in determining perinatal outcomes. 1,054 pregnancies were retrospectively categorized into three groups (healthy pregnancies (HP, n = 988), pregnancies of hypertensive women (HypP, n = 30) and high-risk hypertension pregnancies (HRHypP, n = 36), depending on gestational hypertension as well as fetal birth weights and pregnancy outcomes. Systolic/diastolic ratio (S/D), resistance index (RI), pulsatility index (PI) of the bilateral uterine artery, umbilical artery and vein as well as venous flow velocity data were monitored by Doppler ultrasound. At 20-27 and 28-32 gestational weeks, uterine artery PIs and RIs were significantly higher in the HRHypP group than in the HP and HypP patients. At gestational weeks 20-27 and 28-32 left plus right PI data with cut-off values of 2.35 and 1.73 indicated a risk of stillbirth, premature pregnancy termination and a birth weight of less than 2,500 g with sensitivities of 94.4% and 93.1% as well as specificities of 95.2% and 90.1%, respectively.

Preeclampsia serum-induced collagen I expression and intracellular calcium levels in arterial smooth muscle cells are mediated by the PLC-γ1 pathway.

In women with preeclampsia (PE), endothelial cell (EC) dysfunction can lead to altered secretion of paracrine factors that induce peripheral vasoconstriction and proteinuria. This study examined the hypothesis that PE sera may directly or indirectly, through human umbilical vein ECs (HUVECs), stimulate phospholipase C-γ1-1,4,5-trisphosphate (PLC-γ1-IP3) signaling, thereby increasing protein kinase C-α (PKC-α) activity, collagen I expression and intracellular Ca(2+) concentrations ([Ca(2+)]i) in human umbilical artery smooth muscle cells (HUASMCs). HUASMCs and HUVECs were cocultured with normal or PE sera before PLC-γ1 silencing. Increased PLC-γ1 and IP3 receptor (IP3R) phosphorylation was observed in cocultured HUASMCs stimulated with PE sera (P<0.05). In addition, PE serum significantly increased HUASMC viability and reduced their apoptosis (P<0.05); these effects were abrogated with PLC-γ1 silencing. Compared with normal sera, PE sera increased [Ca(2+)]i in cocultured HUASMCs (P<0.05), which was inhibited by PLC-γ1 and IP3R silencing. Finally, PE sera-induced PKC-α activity and collagen I expression was inhibited by PLC-γ1 small interfering RNA (siRNA) (P<0.05). These results suggest that vasoactive substances in the PE serum may induce deposition in the extracellular matrix through the activation of PLC-γ1, which may in turn result in thickening and hardening of the placental vascular wall, placental blood supply shortage, fetal hypoxia-ischemia and intrauterine growth retardation or intrauterine fetal death. PE sera increased [Ca(2+)]i and induced PKC-α activation and collagen I expression in cocultured HUASMCs via the PLC-γ1 pathway.

Effect of preeclampsia serum on human uterine spiral artery smooth muscle cell apoptosis in a coculture model with cytotrophoblasts.

BACKGROUND/AIMS: To investigate cytotrophoblast (CTB) invasive ability and human uterine spiral artery smooth muscle cell (HUSASMC) apoptosis in a coculture model with serum from preeclamptic pregnancies. METHODS: Transwell migration assay was used to detect the invasive ability of CTBs. Cocultured CTBs and HUSASMCs were incubated with normal or preeclamptic serum for 24 h. Monocultures of CTBs and HUSASMCs were treated identically to the cocultures and served as controls. HUSASMC viability and apoptosis rates were determined by MTT and annexin V-FITC assays. The expressions of Fas ligand (FasL) mRNA in CTBs and Fas mRNA in HUSASMCs were detected by RT-PCR. The expression of the Fas protein in HUSASMCs was detected by Western blotting. RESULTS: In a model of CTBs cocultured with HUSASMCs, preeclamptic serum effectively decreased the invasive ability and FasL mRNA expression of the CTBs. Preeclampsia serum also increased HUSASMC viability, decreased their apoptotic rate, and decreased the expression of Fas mRNA and protein. CONCLUSION: The abnormal invasive ability of CTBs and decreased expression of the Fas/FasL system may be directly involved in the defective remodeling of the uterine spiral arteries during preeclampsia. Furthermore, the decrease in HUSASMC apoptosis may be related to the abnormal expression of Fas/FasL.

Protein kinase C-alpha activation induces NF-kB-dependent VCAM-1 expression in cultured human umbilical vein endothelial cells treated with sera from preeclamptic patients.

AIM: To determine if activation of the NF-kappaB-VCAM-1 pathway is mediated by protein kinase C-alpha (PKC-alpha). METHODS: PKC inhibitor polymyxin B was added to cultured human umbilical vein endothelial cells (HUVECs) from normal pregnancies. Sera from women with uncomplicated pregnancies and with preeclampsia (PE) were added to the control and intervention groups of the HUVECs. Cytoplasmic and membrane PKC, cytoplasmic NF-kappaB inhibitory factor (I-kappaB), and NF-kappaBp65 were measured. Cell viability, cell apoptosis, and VCAM-1 expression were determined. RESULTS: Cytoplasmic PKC and I-kappaB in HUVECs incubated with sera from women with PE were significantly lower than in the control group, and the PKC content of the cell membrane, NF-kappaBp65, the expression of VCAM-1, and cell apoptosis were higher than in the normal pregnancy group. Cell viability was lower in the intervention than the control group. When HUVECs were pretreated with PKC inhibitor polymyxin B, the cytoplasmic PKC and I-kappaB content of the HUVECs increased in the PE group; the PKC content of the cell membrane, NF-kappaBp65, the expression of VCAM-1 and cell apoptosis decreased. Cell viability increased. CONCLUSIONS: Activation of the PKC-NF-kappaB signaling pathway may play an important role in the injury of HUVECs in women with PE.

[Effects of nuclear factor-kappaB decoy oligodeoxynucleotide on the function of human umbilical artery smooth muscle cells induced by umbilical sera in preeclampsia].

OBJECTIVE: To study the effects of nuclear factor-kappaB (NF-kappaB) decoy oligodeoxynucleotide (ODN) on the preeclamptic umbilical serum induced expression of precollagen I, III mRNA and tumor necrosis factor-alpha (TNF-alpha) in cultured human umbilical artery smooth muscle cells (HUASMC). METHODS: Primary cultured HUASMC of normal pregnancy were divided into four groups: group A (HUASMC were incubated with umbilical serum of normal pregnancy); group B (HUASMC were incubated with umbilical serum of preeclampsia); group C (HUASMC were transfected with NF-kappaB cis decoy ODN 48 h before incubation with umbilical serum of preeclampsia); group D (HUASMC were transfected with NF-kappaB scramble ODN 24 h before incubation with umbilical serum of preeclampsia). NF-kappaB cis decoy ODN and NF-kappaB scramble ODN were transfected with cationic lipofectamine to the latter two groups, respectively. The proliferation of human umbilical artery smooth muscle cells was evaluated by methyl thiazolyl tetrazolium and the apoptosis was analyzed by flow cytometry. The expression levels of precollagen I, III mRNA were detected by RT-PCR, the expression levels of TNF-alpha were detected by western blot. RESULTS: (1) The proliferation of group B (0.19 +/- 0.02) and group D (0.18 +/- 0.03) was significantly increased as compared with those of group A (0.11 +/- 0.02) and group C (0.14 +/- 0.02) (P < 0.05). (2) The apoptosis rates of group B [(7.8 +/- 1.3)%], group C [(10.1 +/- 1.2)%] and group D [(8.1 +/- 1.3)%] were significantly reduced as compared with that of group A [(14.3 +/- 1.2)%] (P < 0.05), and there was a significant difference between groups B and C (P < 0.05). (3) The expression levels of precollagen I mRNA of group B (0.31 +/- 0.04), group C (0.23 +/- 0.04) and group D (0.30 +/- 0.03) were significantly increased as compared with that of group A (0.16 +/- 0.02) (P < 0.05), and there was a significant difference between groups B and C (P < 0.05). (4) There were no significant differences among the four groups in the expression level of precollagen III mRNA (P > 0.05). (5) The expression of TNF-alpha of group B (0.74 +/- 0.11), group C (0.36 +/- 0.09) and group D (0.79 +/- 0.12) were significantly higher than that of group A (0.15 +/- 0.03) (P < 0.05), and the expression of TNF-alpha of groups B and D were significantly higher than that of group C (P < 0.05), while there was no significant difference between groups B and D (P > 0.05). CONCLUSIONS: NF-kappaB cis decoy ODN could down-regulate the proliferation, as well as the expression levels of precollagen and TNF-alpha of HUASMC induced by umbilical serum of preeclampsia. NF-kappaB may play an important role in the pathogenesis of placental artery abnormalities in preeclampsia.