Theta Signal Transfer from Parietal to Prefrontal Cortex Ignites Conscious Awareness of Implicit Knowledge during Sequence Learning.

Unconscious acquisition of sequence structure from experienced events can lead to explicit awareness of the pattern through extended practice. Although the implicit-to-explicit transition has been extensively studied in humans using the serial reaction time (SRT) task, the subtle neural activity supporting this transition remains unclear. Here, we investigated whether frequency-specific neural signal transfer contributes to this transition. A total of 208 participants (107 females) learned a sequence pattern through a multisession SRT task, allowing us to observe the transitions. Session-by-session measures of participants' awareness for sequence knowledge were conducted during the SRT task to identify the session when the transition occurred. By analyzing time course RT data using switchpoint modeling, we identified an increase in learning benefit specifically at the transition session. Electroencephalogram (EEG)/magnetoencephalogram (MEG) recordings revealed increased theta power in parietal (precuneus) regions one session before the transition (pretransition) and a prefrontal (superior frontal gyrus; SFG) one at the transition session. Phase transfer entropy (PTE) analysis confirmed that directional theta transfer from precuneus → SFG occurred at the pretransition session and its strength positively predicted learning improvement at the subsequent transition session. Furthermore, repetitive transcranial magnetic stimulation (TMS) modulated precuneus theta power and altered transfer strength from precuneus to SFG, resulting in changes in both transition rate and learning benefit at that specific point of transition. Our brain-stimulation evidence supports a role for parietal → prefrontal theta signal transfer in igniting conscious awareness of implicitly acquired knowledge.SIGNIFICANCE STATEMENT There exists a pervasive phenomenon wherein individuals unconsciously acquire sequence patterns from their environment, gradually becoming aware of the underlying regularities through repeated practice. While previous studies have established the robustness of this implicit-to-explicit transition in humans, the refined neural mechanisms facilitating conscious access to implicit knowledge remain poorly understood. Here, we demonstrate that prefrontal activity, known to be crucial for conscious awareness, is triggered by neural signal transfer originating from the posterior brain region, specifically the precuneus. By employing brain stimulation techniques, we establish a causal link between neural signal transfer and the occurrence of awareness. Our findings unveil a mechanism by which implicit knowledge becomes consciously accessible in human cognition.

Perceptions of and responses of young adults who use e-cigarettes to flavour bans in China: a qualitative study.

BACKGROUND: China has banned all flavoured e-cigarettes to reduce e-cigarette use among young people, but little is known about the views and reactions of people who use e-cigarettes. This study explored the perceptions of, and responses by, young adults who use e-cigarettes to the flavour ban. METHODS: Semistructured interviews were conducted with 25 Chinese young adults aged 18-25 years who had used e-cigarettes daily in the past 3 months. Thematic analysis was used to analyse the interview data. FINDINGS: Four themes were identified from the data: (1) understanding of the public health benefits, (2) resistance to and misperceptions of the flavour ban, (3) circumvention of the flavour ban and (4) acceptance of the flavour ban. Some participants expressed support for the ban due to perceived public health benefits, while others who resisted the ban emphasised their right to choose preferred flavours and questioned the rationale behind the policy. Participants responded to the flavour ban by utilising a variety of adaptive strategies, including purchasing flavoured e-cigarettes through illegal channels or exploring alternative ways to obtain flavours. Those who complied with the ban responded with different strategies, including switching back to combustible cigarettes, using tobacco-flavoured e-cigarettes, or quitting vaping. CONCLUSIONS: The findings suggest the need for comprehensive regulatory measures, including stringent enforcement measures, transparent health communication and vigilant monitoring of e-cigarette manufacturers' tactics, to reduce e-cigarette use among young adults.

How positive mental well-being influences professional identity and the mediating mechanisms in Chinese nursing students.

AIM: To examine the association between positive mental well-being and professional identity in nursing students. The mediating effects of resilience and nurse-patient relationship were explored. BACKGROUND: Professional identity of nursing students can influence their pursuit of a nursing career. Negative mental health problems, such as anxiety, depression, and high stress, are known risk factors for professional identity. Few studies have examined the association of professional identity with positive mental well-being and underlying mechanisms. METHODS: This was a cross-sectional study of Chinese nursing students on clinical placement. The Warwick-Edinburgh Mental Well-being Scale, Professional Identity Scale, Connor-Davidson Resilience Scale, Nurse-Patient Relationship Scale, and Patient Health Questionnaire were used, and demographic and study-related characteristics were measured. Multivariable linear regression and mediation analyses analyzed the associations. We followed the STROBE reporting guidelines. RESULTS: Of 208 participants, the total scores of positive mental well-being and professional identity were at a moderate level. Positive mental well-being was associated with professional identity after adjusting for confounders including the main reason for choosing nursing and negative mental health. Resilience was a full mediator of the association between positive mental well-being and professional identity, whereas nurse-patient relationship was a partial mediator. DISCUSSION AND CONCLUSION: Positive mental well-being was associated with professional identity in Chinese nursing students on clinical placement, mediated through resilience and nurse-patient relationship. Positive mental well-being can be a facilitator for the professional identity of nursing students, and resilience and nurse-patient relationship could be potential mechanisms for nurse professional development. IMPLICATIONS FOR NURSING AND/OR HEALTH POLICY: Nurse researchers, educators, and policymakers are informed to increase the awareness of positive mental well-being and develop interventions targeting resilience and nurse-patient relationship for building a stable and satisfied nursing team.

Effectiveness of enhancing contact model on reducing family caregiving burden and improving psychological wellbeing among caregivers of persons with schizophrenia in rural China.

BACKGROUND: It is unclear whether the enhancing contact model (ECM) intervention is effective in reducing family caregiving burden and improving hope and quality of life (QOL) among family caregivers of persons with schizophrenia (FCPWS). METHODS: We conducted a cluster randomized controlled trial in FCPWS in eight rural townships in Xinjin, Chengdu, China. In total, 253 FCPWS were randomly allocated to the ECM, psychoeducational family intervention (PFI), or treatment as usual (TAU) group. FCPWS in three groups were assessed caregiving burden, QOL and state of hope at baseline (T0), post-intervention (T1), 3-month (T2), and 9-month (T3) follow-up, respectively. RESULTS: Compared with participants in the TAU group, participants in the ECM group had statistically significantly lower caregiving burden scores both at T1 and T2 (p = 0.0059 and 0.0257, respectively). Compared with participants in the TAU group, participants in the PFI group had statistically significantly higher QOL scores in T1 (p = 0.0406), while participants in the ECM group had statistically significantly higher QOL scores in T3 (p = 0.0240). Participants in both ECM and PFI groups had statistically significantly higher hope scores than those in the TAU group at T1 (p = 0.0160 and 0.0486, respectively). CONCLUSIONS: This is the first study to explore the effectiveness of ECM on reducing family caregiving burden and improving hope and QOL in rural China. The results indicate the ECM intervention, a comprehensive and multifaceted intervention, is more effective than the PFI in various aspects of mental wellbeing among FCPWS. Future research needs to confirm ECM's effectiveness in various population.

Dissociating value-based neurocomputation from subsequent selection-related activations in human decision-making.

Human decision-making requires the brain to fulfill neural computation of benefit and risk and therewith a selection between options. It remains unclear how value-based neural computation and subsequent brain activity evolve to achieve a final decision and which process is modulated by irrational factors. We adopted a sequential risk-taking task that asked participants to successively decide whether to open a box with potential reward/punishment in an eight-box trial, or not to open. With time-resolved multivariate pattern analyses, we decoded electroencephalography and magnetoencephalography responses to two successive low- and high-risk boxes before open-box action. Referencing the specificity of decoding-accuracy peak to a first-stage processing completion, we set it as the demarcation and dissociated the neural time course of decision-making into valuation and selection stages. The behavioral hierarchical drift diffusion modeling confirmed different information processing in two stages, that is, the valuation stage was related to the drift rate of evidence accumulation, while the selection stage was related to the nondecision time spent in response-producing. We further observed that medial orbitofrontal cortex participated in the valuation stage, while superior frontal gyrus engaged in the selection stage of irrational open-box decisions. Afterward, we revealed that irrational factors influenced decision-making through the selection stage rather than the valuation stage.

Increase of unmotivated and hardened smokers in Hong Kong: a repeated cross-sectional trend analysis.

OBJECTIVES: To examine the trends in the prevalence of hardening indicators and hardened smokers in Hong Kong, where the low smoking prevalence has plateaued in the recent decade. METHODS: This is an analysis of repeated cross-sectional data from 9 territory-wide smoking cessation campaigns conducted annually from 2009 to 2018 (except 2011). Participants were 9837 biochemically verified daily cigarette smokers aged ≥18 years (18.5% female, mean age 43.2±14.2 years) recruited from the communities. Hardening indicators included heavy smoking (>15 CPD), high nicotine dependence (Heaviness of Smoking Index ≥5), no intention to quit within next 30 days and no past-year quit attempt. Perceived importance, confidence and difficulty of quitting were measured (each ranged 0-10). Multivariable regressions were used to model the changes in hardening indicators by calendar year, adjusting for sociodemographic characteristics. RESULTS: From 2009 to 2018, the prevalence of heavy smoking decreased from 57.6% to 39.4% (p<0.001), high nicotine dependence also decreased from 10.5% to 8.6% (p=0.06). However, the proportion of smokers with no intention to quit (12.7%-69.0%) and no past-year quit attempt (74.4%-80.4%) significantly increased (both p values <0.001). Hardened smokers (heavy smoking, no intention to quit, no past-year attempt quit attempt) significantly increased from 5.9% to 20.7% (p<0.001). Mean perceived importance (from 7.9±2.3 to 6.6±2.5) and confidence (from 6.2±2.6 to 5.3±2.4) of quitting also decreased significantly (all p values <0.001). CONCLUSIONS: Daily cigarette smokers in Hong Kong were motivational hardening, but not dependence hardening. Effective tobacco control policies and interventions are warranted to motivate quitting to further reduce smoking prevalence.

Association of heated tobacco product use with smoking cessation in Chinese cigarette smokers in Hong Kong: a prospective study.

INTRODUCTION: Heated tobacco products (HTPs) are increasingly popular worldwide, but whether they aid or undermine cigarette abstinence remains uncertain. We examined the predictors of HTP initiation and the prospective association of HTP use with cigarette abstinence in community-based smokers in Hong Kong. DESIGN: Secondary analysis of a randomised clinical trial aimed to evaluate the effectiveness of brief advice and referral for smoking cessation. The interventions were not related to HTP use. PARTICIPANTS AND SETTINGS: 1213 carbon monoxide-verified daily cigarette smokers with intentions to quit or reduce smoking proactively recruited from community sites throughout Hong Kong MAIN EXPOSURE: Current (past 7 day) use of HTP at baseline. MAIN OUTCOME: Self-reported 7-day point-prevalence cigarette abstinence at 6 months (exclusive use of HTP permitted). RESULTS: At baseline, 201 (16.6%) and 60 (4.9%) were ever and current HTP users, respectively. During the 6-month follow-up period, 110 of 1012 (10.9%) never users at baseline initiated HTPs. Younger age and higher education significantly predicted initiation. After adjusting for sociodemographic, smoking-related and quitting-related factors, current HTP use at baseline was not associated with cigarette abstinence at 6 months (adjusted prevalence ratio (aPR) 1.08, 95% CI 0.63 to 1.85). The results were similar in persistent users from baseline to 1-month/3-month follow-up (vs non-users; aPR 1.14, 95% CI 0.57 to 2.29). Use of smoking cessation service between baseline and 3-month follow-up significantly predicted cigarette abstinence (aPR 1.70, 95% CI 1.26 to 2.30). CONCLUSION: HTP use was not associated with cigarette abstinence at 6 months in a community-based cohort of smokers with intentions to quit or reduce smoking. Trial registration details ClinicalTrials.gov, NCT03565796.

Exposure to health misinformation about COVID-19 and increased tobacco and alcohol use: a population-based survey in Hong Kong.

INTRODUCTION: Health information about COVID-19 has been circulating in social networking sites, including unproven claims that smoking and alcohol drinking could protect against COVID-19. We examined if exposure to such claims was associated with changes in tobacco and alcohol consumption. METHODS: We conducted a population-based, landline and mobile phone survey of 1501 randomly sampled adults aged 18 years or older (47.5% male) in Hong Kong in April 2020. Respondents reported if they had ever seen claims that 'smoking/alcohol drinking can protect against COVID-19' from popular social networking platforms. Current tobacco and alcohol users reported if they had increased or reduced their consumption since the outbreak. Prevalence data were weighted by sex, age and education of the general adult population. RESULTS: 19.0% (95% CI 16.8% to 21.4%) of all respondents reported having seen claims that 'smoking/alcohol drinking can protect against COVID-19' from social networking sites. Multinomial logistic regression showed that exposure to the claims was significantly associated with increased tobacco use (OR 2.37, 95% CI 1.08 to 5.20) in current tobacco users (N=280) and increased alcohol use (OR 4.16, 95% CI 2.00 to 8.67) in current drinkers (N=722), adjusting for sex, age, education level, alcohol/tobacco use status, home isolation, anxiety and depressive symptoms, and survey method. CONCLUSION: Our results first showed that exposure to health misinformation that smoking/alcohol drinking can protect against COVID-19 was associated with self-reported increases in tobacco and alcohol consumption in Chinese during the pandemic.

Socioeconomic Disparities in eHealth Literacy and Preventive Behaviors During the COVID-19 Pandemic in Hong Kong: Cross-sectional Study.

BACKGROUND: eHealth literacy can potentially facilitate web-based information seeking and taking informed measures. OBJECTIVE: This study aimed to evaluate socioeconomic disparities in eHealth literacy and seeking of web-based information on COVID-19, and their associations with COVID-19 preventive behaviors. METHODS: The COVID-19 Health Information Survey (CoVHIns), using telephonic (n=500) and web-based surveys (n=1001), was conducted among adults in Hong Kong in April 2020. The Chinese eHealth literacy scale (eHEALS; score range 8-40) was used to measure eHealth literacy. COVID-19 preventive behaviors included wearing surgical masks, wearing fabric masks, washing hands, social distancing, and adding water or bleach to the household drainage system. Adjusted beta coefficients and the slope indices of inequality for the eHEALS score by socioeconomic status, adjusted odds ratios (aORs) for seeking of web-based information on COVID-19 by socioeconomic status, and aORs for the high adherence to preventive behaviors by the eHEALS score and seeking of web-based information on COVID-19 were calculated. RESULTS: The mean eHEALS score was 26.10 (SD 7.70). Age was inversely associated with the eHEALS score, but education and personal income were positively associated with the eHEALS score and seeking of web-based information on COVID-19 (for all, P for trend<.05). Participants who sought web-based information on COVID-19 showed high adherence to the practice of wearing surgical masks (aOR 1.56, 95% CI 1.15-2.13), washing hands (aOR 1.33, 95% CI 1.05-1.71), social distancing (aOR 1.48, 95% CI 1.14-1.93), and adding water or bleach to the household drainage system (aOR 1.67, 95% CI 1.28-2.18). Those with the highest eHEALS score displayed high adherence to the practice of wearing surgical masks (aOR 3.84, 95% CI 1.63-9.05), washing hands (aOR 4.14, 95% CI 2.46-6.96), social distancing (aOR 2.25, 95% CI 1.39-3.65), and adding water or bleach to the household drainage system (aOR 1.94, 95% CI 1.19-3.16), compared to those with the lowest eHEALS score. CONCLUSIONS: Chinese adults with a higher socioeconomic status had higher eHealth literacy and sought more web-based information on COVID-19; both these factors were associated with a high adherence to the guidelines for preventive behaviors during the COVID-19 pandemic.

Anxiety, depression and social support across pregnancy in women with a history of recurrent miscarriage: A prospective study.

AIM: Women with a history of recurrent miscarriage are a vulnerable population. This study aimed to examine changes and relationships among anxiety, depression and social support across three trimesters of pregnancy in women with a history of recurrent miscarriage. METHODS: A prospective, longitudinal study was employed. A convenience sample of 166 pregnant women with a history of recurrent miscarriage completed the measures at their 6-12, 20-24 and 32-36 gestational weeks. RESULTS: The prevalence of anxiety at early, middle and late pregnancy was 47.6%, 36.1% and 32.5%, respectively, whereas that of depression was 38%, 34.3% and 31.3%, respectively. Social support scores increased from early pregnancy to middle pregnancy then remained in late pregnancy. There were correlations among anxiety, depression and social support across pregnancy. CONCLUSIONS: Anxiety and depression were highly prevalent in pregnant women with a history of recurrent miscarriage, especially in early pregnancy when the level of social support was the lowest. Social support is an essential buffer against anxiety and depression throughout the pregnancy.

Effect of prepaid and promised financial incentive on follow-up survey response in cigarette smokers: a randomized controlled trial.

BACKGROUND: Monetary incentive is often used to increase response rate in smokers' survey, but such effect of prepaid and promised incentives in a follow-up survey is unknown. We compared the effect of different incentive schemes on the consent and retention rates in a follow-up survey of adult cigarette smokers. METHODS: This was a randomized controlled trial (RCT) in Hong Kong, China. Smokers who completed a non-incentivized baseline telephone smoking survey were invited to a 3-month follow-up, with randomization into (1) the control group (no incentive), (2) a promised HK$100 (US$12.8) incentive upon completion, (3) a promised HK$200 (US$25.6) incentive upon completion, or (4) a prepaid HK$100 incentive plus another promised HK$100 incentive ("mixed incentive"). Crude risk ratios from log-binomial regression models were used to assess if the 3 incentive schemes predicted higher rates of consent at baseline or retention at 3-month than no incentive. RESULTS: In total, 1246 smokers were enrolled. The overall consent and retention rates were 37.1 and 23.0%, respectively. Both rates generally increased with the incentive amount and offer of prepaid incentive. The mixed incentive scheme marginally increased the retention rate versus no incentive (26.8% vs 20.3%; risk ratio (RR) = 1.32; 95% CI: 1.00-1.76; P = 0.053), but not the consent rate (RR = 1.13; 95% CI: 0.93-1.38; P = 0.22). Among the consented participants, approximately 50% in the mixed incentive group received the mailed prepaid incentive, who achieved a higher retention rate than the group without incentives (82.8% vs 56.1%; RR = 1.48; 95% CI: 1.21-1.80; P < 0.01). CONCLUSION: The mixed incentive scheme combining the prepaid and promised incentive was effective to increase the follow-up retention rate by 48%. We recommend this mixed incentive scheme to increase the follow-up retention rate. More efficient methods of delivering the incentive are needed to maximize its effects. TRIAL REGISTRATION: U.S. Clinical Trials registry (clinicaltrials.gov, retrospectively registered, reference number: NCT03297866 ).

Comparing different intensities of active referral to smoking cessation services in promoting smoking cessation among community smokers: a study protocol of a cluster randomized controlled trial.

BACKGROUND: Actively referring smokers to smoking cessation (SC) services could increase quitting and is scalable for the population. The objective of this study is to compare 2 different intensities of SC active referral for smokers in the community of Hong Kong. METHODS/DESIGN: This is a single-blind, parallel 3-armed cluster randomized controlled trial (cRCT) consisting of high-intensity SC active referral (HAR Group), low-intensity SC referral by text messaging on promoting SC services use (Text Group) and a control group receives general very brief advice. Biochemically validated daily smokers will be proactively recruited in the community from 68 clusters (recruitment sessions). The primary outcome is self-reported 7-days point prevalence abstinence (PPA) at the 3- and 6- month follow-ups. Secondary outcomes are SC service use, smoking reduction rate (SRR, daily cigarette consumption reduced by ≥50%; excluding quitters) and biochemically validated quit rate (exhaled CO < 4 ppm and salivary cotinine < 10 ng/ml). Outcome assessors and data analysts will be blinded to group allocation. Intention-to-treat principle and Generalized Estimating Equation (GEE) regressions will be used for data analysis. DISCUSSION: This will be the first trial on evaluating the efficacy of the 2 different intensities of SC active referral on smoking cessation in community smokers. It is anticipated that the results from this trial can provide evidence to the effectiveness of high-intensity active referral to SC services and low intensity SC referral by using text messaging in achieving smoking abstinence. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02804880 , June 17, 2016.

Different outcomes of never-treated and treated patients with schizophrenia: 14-year follow-up study in rural China.

BACKGROUND: The long-term outcome of never-treated patients with schizophrenia is unclear. AIMS: To compare the 14-year outcomes of never-treated and treated patients with schizophrenia and to establish predictors for never being treated. METHOD: All participants with schizophrenia (n = 510) in Xinjin, Chengdu, China were identified in an epidemiological investigation of 123 572 people and followed up from 1994 to 2008. RESULTS: The results showed that there were 30.6%, 25.0% and 20.4% of patients who received no antipsychotic medication in 1994, 2004 and 2008 respectively. Compared with treated patients, those who were never treated in 2008 were significantly older, had significantly fewer family members, had higher rates of homelessness, death from other causes, being unmarried, living alone, being without a caregiver and poor family attitudes. Partial and complete remission in treated patients (57.3%) was significantly higher than that in the never-treated group (29.8%). Predictors of being in the never-treated group in 2008 encompassed baseline never-treated status, being without a caregiver and poor mental health status in 1994. CONCLUSIONS: Many patients with schizophrenia still do not receive antipsychotic medication in rural areas of China. The 14-year follow-up showed that outcomes for the untreated group were worse. Community-based mental healthcare, health insurance and family intervention are crucial for earlier diagnosis, treatment and rehabilitation in the community.

Experiences of quitting smoking in prisons: A qualitative study of people in custody.

INTRODUCTION: Smoking prevalence among people in custody (PIC) is extremely high, and prison-based smoking cessation interventions are needed. The study explored the quitting experiences of PIC who participated in the 'Quit to Win' contest (QTW). METHODS: This qualitative study, conducted from 2019 to 2021 in two Hong Kong prisons, included semi-structured individual interviews with 26 PIC (13 men and 13 women) who were participants in QTW and two correctional staff who coordinated QTW. A semi-structured interview guide with open-ended questions was developed to examine multilevel factors that promote or impede smoking cessation in prisons. Maximum variation sampling was used to ensure a diverse range of social, demographic, and smoking profiles. Data were managed and analyzed using thematic analysis. RESULTS: Two themes were identified from the data: 1) quitting in prison: barriers and facilitators; and 2) QTW in prison: a trigger for behavior change. Barriers (i.e. stress, boredom, isolation, lack of self-autonomy, nicotine dependence and lack of cessation medication, barriers to moving to a different wing) and facilitators (i.e. concerns about health, money savings, and the smoke-free wing) that impeded or supported smoking cessation during incarceration were identified. QTW provided health education, quitting incentives, and social support that helped PIC overcome the barriers of quitting by serving as a trigger for behavior change. Notably, social visits with family were identified as key drivers of PIC's quitting success, whereas their suspension during the COVID-19 pandemic disincentivized their abstinence. CONCLUSIONS: This study introduced the QTW contest to prisons and provided qualitative evidence on the multilevel factors promoting or impeding smoking cessation in prison. QTW helped PIC overcome the barriers of quitting by serving as a trigger for behavior change. Future prison-based interventions should leverage social support, enhance stress-coping skills, facilitate access to pharmacotherapy, and collaborate with correctional services agencies.

Temporal and spatial variation characteristics of surface water area in the Yellow River Basin from 1986 to 2021.

The Yellow River Basin is short of water resources. The dynamic monitoring of surface water area is helpful to clarify the distribution and change trend of water resources in this area. It is of great scientific significance to deeply understand the impacts of climate change and human activities on water resources and ensure the ecological security of the basin. Based on the Google Earth Engine (GEE) cloud platform, we analyzed the spatial variations of surface water area in the Yellow River Basin from 1986 to 2021 by using the mixed index algorithm, and revealed the driving factors of surface water area change in the Yellow River Basin. The results showed that the overall recognition accuracy of the water extraction algorithm based on mixing index was 97.5%. Compared with available water data products, the proposed algorithm can guarantee the integrity of the whole water area to a certain extent. The surface water area in the upper, middle, and lower reaches of the Yellow River Basin was 71.7%, 18.4%, and 9.9% of the total surface water area, respectively. From 1986 to 2021, the surface water area of the basin showed an overall upward trend, with a total increase of 3163.6 km2. The surface water area of the upper, middle, and downstream regions increased by 72.0%, 22.4%, and 5.6%, respectively. The increase of precipitation was the main reason for the increase of water area, with a contribution of 55%. Vegetation restoration and construction of water conservancy projects had increased the water area of the basin. The intensification of human water extraction activity reduced the water area of the basin.

Adverse childhood experiences on internet gaming disorder mediated through insomnia in Chinese young people.

Background: Adverse childhood experiences (ACEs) have been associated with addictions such as substance use disorders. Few have examined ACEs on internet gaming disorder (IGD) as a newly established behavioral addiction, and the potential mediating role of insomnia remains unclear. We examined the associations between ACE number and types, IGD, and insomnia. Methods: Participants included 1, 231 Chinese university students (54.5% male; 56.9% aged 18-20 years) who had played internet games at least once in the previous month. ACEs were measured using the 10-item ACE questionnaire (yes/no). Symptoms of insomnia and IGD were measured using the Insomnia Severity Index and the 9-item Internet Gaming Disorder Scale-Short-Form, respectively. Multivariable regressions examined the associations, adjusting for sex, age, maternal and paternal educational attainment, monthly household income, smoking, and alcohol drinking. The mediating role of insomnia symptoms was explored. Results: The prevalence of ACEs≥1 was 40.0%. Childhood verbal abuse was the most prevalent (17.4%), followed by exposure to domestic violence (17.1%) and childhood physical abuse (15.5%). More ACE numbers showed an association with IGD symptoms (adjusted OR = 1.11, 95% CI 1.04, 1.17). Specifically, IGD symptoms were observed for childhood physical neglect, emotional neglect, sexual abuse, parental divorce or separation, and household substance abuse. Insomnia symptoms mediated the associations of ACE number and types with IGD symptoms (proportion of total effect mediated range 0.23-0.89). Conclusion: The number and specific types of ACEs showed associations with IGD mediated through insomnia. Screening of ACEs is recommended in future studies on IGD. Longitudinal data are warranted to determine the causality of the observed associations.

Affiliate stigma and caregiving burden among family caregivers of persons with schizophrenia in rural China.

BACKGROUND: Although stigma and caregiving burden are important in relation to mental health recovery, few studies have been conducted on affiliate stigma and caregiving burden among family caregivers of persons with schizophrenia (FCPWS) in rural China. AIMS: This study aimed to examine the severity level of affiliate stigma and caregiving burden, and identify the correlates among FCPWS in rural China. METHODS: A mental health survey was conducted (N = 253 FCPWS) in Xinjin county, Sichuan province, China. Affiliate Self-Stigma Scale and Zarit Burden Interview Short Form were used. The regression analysis was performed to explore the correlates of stigma and burden. RESULTS: Most FCPWS reported experiencing high and severe level of affiliate stigma (78.66%) and caregiving burden (95.26%). Family caregivers who were middle aged, unemployed, with high caregiving burden and low quality of life (QoL), showed more severe affiliate stigma. Family caregivers who were female, older, with low income, high affiliate stigma and low QoL, experienced greater caregiving burden. CONCLUSIONS: The large majority of FCPWS in rural China experienced severe affiliate stigma, caregiving burden and poor QoL. It is crucial to develop culture-specific anti-stigma interventions to reduce caregivers' stigma and caregiving burden, and improve QoL. Specific risk factors of family caregivers' affiliate stigma and caregiving burden should be considered for development of health policy and community-based mental health services.

Effect of smoking-related COVID-19 risk messaging on smoking cessation in community smokers: A pragmatic randomized controlled trial.

INTRODUCTION: Observational and experimental studies have suggested that messaging on smoking-related COVID-19 risk may promote smoking abstinence, but evidence from randomized clinical trials (RCTs) is lacking. METHODS: This was a pragmatic RCT in Hong Kong, China, to compare the effectiveness of communicating smoking-related COVID-19 risk with generic cessation support on abstinence. Both groups received brief cessation advice at baseline. The intervention group received messaging on smoking-related COVID-19 risk and cessation support via instant messaging for three months (16 messages in total), which highlighted the increased risk of severe COVID-19 and deaths, and potentially higher risk of viral exposure (e.g. due to mask removal) for smokers. The control group received generic text messaging support for three months (16 messages). The primary outcomes were biochemically validated 7-day point prevalence abstinence (PPA) at 3 and 6 months. Intention to treat analyses was used. RESULTS: Between 13 June and 30 October 2020, 1166 participants were randomly assigned to an intervention (n=583) or control (n=583) group. By intention-to-treat, validated 7-day PPA did not significantly differ between the intervention and control groups at three months (9.6% and 11.8%, relative risk, RR=0.81; 95% CI: 0.58-1.13, p=0.22) or six months (9.3% and 11.7%, RR=0.79; 95% CI: 0.57-1.11, p=0.18). A higher perceived severity of COVID-19 in smokers at baseline was associated with a greater validated 7-day PPA at six months, and a marginally significant intervention effect on changes in perceived severity from baseline through 6 months was found (p for group × time interaction = 0.08). CONCLUSIONS: Communicating smoking-related COVID-19 risk via instant messaging was not more effective in increasing smoking abstinence than generic cessation support. TRIAL REGISTRATION: The study is registered on ClinicalTrials.gov Identifier: NCT04399967.

Associations among Bullying Victimization, Family Dysfunction, Negative Affect, and Bullying Perpetration in Macanese Adolescents.

Bullying has become one of the most significant problem behaviors that school-aged adolescents face. The current study examines the strain-delinquency relationship by employing General Strain Theory as a guiding framework. "Strain" was operationalized as bullying victimization and family dysfunction, "delinquency" was operationalized as bullying perpetration, and "negative affect" was operationalized as anxiety and depression. Analyses were carried out based on a group of 2,139 Macanese schoolchildren. Using a structural equation modeling technique, the results revealed that exposure to family dysfunction and bullying victimization was associated with adolescents' negative affect, such as anxiety and depression. Contrary to our expectations, the indirect effect of victimization on bullying through negative affect was negative, though the mediation effect was relatively small and only significant in boys. In addition, gender analyses of invariance showed that male adolescents who experienced more family conflict and parental control were less likely to engage in bullying. This study could lead to further anti-bullying interventions and practical efforts designed to improve positive parenting and adolescents' interpersonal skills.

Factors Affect the Eradication Rate of Helicobacter pylori by Modified Quadruple Therapy: A Prospective Cohort Study.

Objective: This study aimed to investigate related factors affecting the eradication rate of Helicobacter pylori (Hp) by modified quadruple therapy. Methods: Between September 2020 and March 2021, 341 patients who were diagnosed with Hp infection and whose infections were confirmed by gastroscopy, a histological examination, and a C13-UBT without culturing and antimicrobial susceptibility studies received a two-week anti-Hp treatment, a modified quadruple therapy, in our department. The result of C13-UBT was rechecked 4 weeks after the drug withdrawal, and the patients were divided into two groups-a success group and a failure group-according to the final breath result. The general clinical information and related laboratory indexes of each patient were collected, and the factors affecting the eradication rate were analyzed. Results: The total clinical eradication rate was 80.06% (273/341), and the failure rate was 19.94% (68/341), correspondingly. Univariate analysis identified statistically significant differences between the two groups in serum 25-hydroxyvitamin D levels, presence of oral diseases, positive cytotoxin-associated gene A (CagA), and medical compliance (P < 0.05). Meanwhile, the use of a proton pump inhibitor (PPIs) and antibiotics was statistically different (P < 0.05). Logistic regression analysis revealed that vitamin D level (<20 ng/mL) [OR = 98.56, 95% CI (29.01-334.83), P < 0.001] and medical compliance [OR = 148.18, 95% CI (37.64-583.33), P < 0.001] were independent effecting factors for eradication rate. Conclusion: Serum 25-hydroxyvitamin D level lower than 20 ng/mL may affect the success of eradication of Hp and is an independent risk factor for eradication failure.