Female urinary incontinence in China after 15 years' efforts: Results from large-scale nationwide surveys.

Urinary incontinence (UI) is a disease that quietly yet seriously impacts women's health and represents a global health burden that is often neglected. This study aims to systematically assess the prevalence and dynamics of female UI in China, and can inform further policies and have international implications. This study used three nationwide investigations: A national cross-sectional survey in 2021; another nationwide cross-sectional survey in 2006; and data regarding the institutions and physicians providing pelvic floor rehabilitation services from 2005 to 2019. The weighted prevalence of female UI and its subtypes, including stress UI (SUI), urgency UI (UUI), and mixed UI (MUI), were estimated as primary outcomes. Knowledge, attitude and care-seeking behaviors of UI were evaluated. It was found that the weighted prevalence of female UI was 16.0 % (95% CI, 13.3 %-19.1%) with SUI remaining the predominant subtype (7.0%) in 2021, followed by MUI (6.5%) and UUI (1.9%). The estimated absolute number of Chinese adult women with UI was 85.8 million in 2021. 52.7% (95% CI, 45.9%-59.4 %) of women were aware that UI was a medical condition, and only 10.1% of women with UI sought health care. After 15 years of development, there were 8400 pelvic floor rehabilitation institutions and nearly 10,000 relevant physicians in China-they were found to be associated with UI prevalence. The UI prevalence in China was significantly lower in 2021 compared to that in 2006. Despite the achievement, UI remains a public health problem, especially given China's fast aging and three-child policy. More innovations, especially those that can facilitate care seeking, are needed to address this prevalent yet treatable condition.

Preserved Ratio Impaired Spirometry and COPD Accelerate Frailty Progression: Evidence From a Prospective Cohort Study.

BACKGROUND: COPD has been found to be associated with frailty. However, longitudinal evidence for associations of COPD with frailty progression is inadequate. Furthermore, recent studies revealed a new phenotype of lung function impairment: preserved ratio impaired spirometry (PRISm) findings. Associations of PRISm findings and their transitions with frailty progression are unclear. RESEARCH QUESTION: What are the associations of PRISm findings, transitions of PRISm findings, and COPD with frailty progression? STUDY DESIGN AND METHODS: To analyze the associations of PRISm findings and COPD with frailty progression, 5,901 patients were included from the English Longitudinal Study of Ageing. Patients were classified into three lung function patterns of normal spirometry (NS) findings, PRISm findings, and COPD. Frailty progression was assessed by repeated measurements of the frailty index (FI) during follow-up. Among these 5,901 patients, 3,765 patients were included to analyze the associations of PRISm findings transitions with frailty progression. PRISm findings transitions were assessed based on the changes of lung function patterns after a 4-year interval. Linear mixed-effect models were used for statistical analyses. RESULTS: The median follow-up periods were 9.5 years for the analyses of PRISm findings and COPD with frailty progression and 5.8 years for PRISm findings transitions with frailty progression. When compared with participants with NS findings, patients with PRISm findings and COPD demonstrated accelerated FI progression with additional annual increases of 0.301 (95% CI, 0.211-0.392; P < .001) and 0.172 (95% CI, 0.102-0.242; P < .001), respectively. Patients who transitioned from NS findings to PRISm findings also demonstrated accelerated FI progression when compared with those with stable NS findings (ß = 0.242; 95% CI, 0.008-0.476; P = .042). However, no accelerated FI progression was found in patients with PRISm findings who transitioned to NS findings (ß = 0.119; 95% CI, -0.181 to 0.418; P = .438). INTERPRETATION: Our findings indicate that PRISm findings and COPD are associated with accelerated frailty progression. Further studies are needed to elucidate the causality of the association of PRISm findings and COPD with frailty.

Radiology Residents' Perceptions of Artificial Intelligence: Nationwide Cross-Sectional Survey Study.

BACKGROUND: Artificial intelligence (AI) is transforming various fields, with health care, especially diagnostic specialties such as radiology, being a key but controversial battleground. However, there is limited research systematically examining the response of "human intelligence" to AI. OBJECTIVE: This study aims to comprehend radiologists' perceptions regarding AI, including their views on its potential to replace them, its usefulness, and their willingness to accept it. We examine the influence of various factors, encompassing demographic characteristics, working status, psychosocial aspects, personal experience, and contextual factors. METHODS: Between December 1, 2020, and April 30, 2021, a cross-sectional survey was completed by 3666 radiology residents in China. We used multivariable logistic regression models to examine factors and associations, reporting odds ratios (ORs) and 95% CIs. RESULTS: In summary, radiology residents generally hold a positive attitude toward AI, with 29.90% (1096/3666) agreeing that AI may reduce the demand for radiologists, 72.80% (2669/3666) believing AI improves disease diagnosis, and 78.18% (2866/3666) feeling that radiologists should embrace AI. Several associated factors, including age, gender, education, region, eye strain, working hours, time spent on medical images, resilience, burnout, AI experience, and perceptions of residency support and stress, significantly influence AI attitudes. For instance, burnout symptoms were associated with greater concerns about AI replacement (OR 1.89; P<.001), less favorable views on AI usefulness (OR 0.77; P=.005), and reduced willingness to use AI (OR 0.71; P<.001). Moreover, after adjusting for all other factors, perceived AI replacement (OR 0.81; P<.001) and AI usefulness (OR 5.97; P<.001) were shown to significantly impact the intention to use AI. CONCLUSIONS: This study profiles radiology residents who are accepting of AI. Our comprehensive findings provide insights for a multidimensional approach to help physicians adapt to AI. Targeted policies, such as digital health care initiatives and medical education, can be developed accordingly.

Breastfeeding in infancy and mortality in middle and late adulthood: A prospective cohort study and meta-analysis.

BACKGROUND: Breastfeeding in infancy is associated with a lower risk of mortality among children, but the impact on mortality in middle and late adulthood remains unknown. OBJECTIVES: To assess the association between breastfeeding in infancy and mortality in middle and late adulthood. METHODS: We included 383,627 participants aged 40-73 from the UK Biobank (2006-2010) and followed up until 2021. Hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause and cause-specific mortality according to breastfeeding in infancy were estimated with Cox proportional hazards regression models. We further did a meta-analysis, including results from our present study and three other cohort studies (PROSPERO; number CRD42022348925). RESULTS: During a total of 4732,751 person-years of follow-up, 25,581 deaths were identified. Breastfeeding in infancy was associated with lower risks of mortality in middle and late adulthood, with adjusted HRs (95% CIs) of 0.95 (0.93-0.98) for all-cause mortality; 0.91 (0.87-0.96) for cardiovascular mortality and 0.94 (0.874-0.999) for respiratory mortality. Specifically, the association with mortality seemed to attenuate with age - stronger in middle-aged adults than in older adults. A similar association between breastfeeding in infancy and all-cause mortality was found in the meta-analysis. CONCLUSION: Breastfeeding in infancy is associated with a lower risk of mortality - even decades later - in middle and late adulthood.

Associations of metabolic heterogeneity of obesity with frailty progression: Results from two prospective cohorts.

BACKGROUND: Previous studies indicated that obesity would accelerate frailty progression. However, obesity is heterogeneous by different metabolic status. The associations of metabolic heterogeneity of obesity with frailty progression remain unclear. METHODS: A total of 6730 participants from the China Health and Retirement Longitudinal Study (CHARLS) and 4713 from the English Longitudinal Study of Ageing (ELSA) were included at baseline. Metabolic heterogeneity of obesity was evaluated based on four obesity and metabolic phenotypes as metabolically healthy normal weight (MHNW), metabolically unhealthy normal weight (MUNW), metabolically healthy overweight/obesity (MHOO), and metabolically unhealthy overweight/obesity (MUOO). Frailty status was assessed by the frailty index (FI) ranging from 0 to 100 and frailty was defined as FI ≥ 25. Linear mixed-effect models were used to analyse the associations of metabolic heterogeneity of obesity with frailty progression. RESULTS: In the CHARLS, MUOO and MUNW presented the accelerated FI progression with additional annual increases of 0.284 (95% CI: 0.155 to 0.413, P < 0.001) and 0.169 (95% CI: 0.035 to 0.303, P = 0.013) as compared with MHNW. MHOO presented no accelerated FI progression (ß: -0.011, 95% CI: -0.196 to 0.173, P = 0.904) as compared with MHNW. In the ELSA, the accelerated FI progression was marginally significant for MUOO (ß: 0.103, 95% CI: -0.005 to 0.210, P = 0.061) and MUNW (ß: 0.157, 95% CI: -0.011 to 0.324, P = 0.066), but not for MHOO (ß: -0.047, 95% CI: -0.157 to 0.062, P = 0.396) in comparison with MHNW. The associations of MUOO and MUNW with the accelerated FI progression were stronger after excluding the baseline frail participants in both cohorts. The metabolic status changed over time. When compared with stable MHNW, participants who changed from MHNW to MUNW presented the accelerated FI progression with additional annual increases of 0.356 (95% CI: 0.113 to 0.599, P = 0.004) and 0.255 (95% CI: 0.033 to 0.477, P = 0.024) in the CHARLS and ELSA, respectively. The accelerated FI progression was also found in MHOO participants who transitioned to MUOO (CHARLS, ß: 0.358, 95% CI: 0.053 to 0.663, P = 0.022; ELSA, ß: 0.210, 95% CI: 0.049 to 0.370, P = 0.011). CONCLUSIONS: Metabolically unhealthy overweight/obesity and normal weight, but not metabolically healthy overweight/obesity, accelerated frailty progression as compared with metabolically healthy normal weight. Regardless of obesity status, transitions from healthy metabolic status to unhealthy metabolic status accelerated frailty progression as compared with stable metabolically healthy normal weight. Our findings highlight the important role of metabolic status in frailty progression and recommend the stratified management of obesity based on metabolic status.

LncRNA and mRNA expression profiles in brown adipose tissue of obesity-prone and obesity-resistant mice.

Obesity-prone or obesity-resistant phenotypes can exist in individuals who consume the same diet type. Brown adipose tissue functions to dissipate energy in response to cold exposure or overfeeding. Long noncoding RNAs play important roles in a wide range of biological processes. However, systematic examination of lncRNAs in phenotypically divergent mice has not yet been reported. Here, the lncRNA expression profiles in BAT of HFD-induced C57BL/6J mice were investigated by high-throughput RNA sequencing. Genes that play roles in thermogenesis and related pathways were identified. We found lncRNA (Gm44502) may play a thermogenic role in obesity resistance by interacting with six mRNAs. Our results also indicated that seven differentially expressed lncRNAs (4930528G23Rik, Gm39490, Gm5627, Gm15551, Gm16083, Gm36860, Gm42002) may play roles in reducing heat production in obesity susceptibility by interacting with seven differentially expressed mRNAs. The screened lncRNAs may participate in the pathogenesis of weight regulation and provide insight into obesity therapy.