Publications by authors named "Ciyong Lu"

101 Publications

Longitudinal associations between problematic Internet use, self-esteem, and depressive symptoms among Chinese adolescents.

Eur Child Adolesc Psychiatry 2022 Jan 15. Epub 2022 Jan 15.

Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen University, 74 Zhongshan Rd 2, Guangzhou, 510080, China.

Problematic Internet use (PIU) has a negative impact on self-esteem among adolescents, thereby making them be vulnerable to developing depressive symptoms. However, there is a lack of longitudinal studies focusing on the process. This study aimed to explore the longitudinal associations between PIU, self-esteem, and depressive symptoms. A total of 1,736 adolescents completed this longitudinal study. The baseline survey was conducted in 2019, and the follow-up surveys were performed at 1-year and 2-year later. PIU, self-esteem, and depressive symptoms were measured. A cascade model was used to examine the longitudinal associations between PIU, self-esteem, and depressive symptoms. The mean age of participants was 13.6 (1.5) years at baseline. The final results observed significant within-time associations between PIU, self-esteem, and depressive symptoms at each time point. PIU and low level of self-esteem could predict subsequent depressive symptoms among adolescents, and depressive symptoms were also associated with subsequent PIU and self-esteem. Both PIU and self-esteem show bidirectional predictions with depressive symptoms among Chinese adolescents. Schools and parents should give more attention to adolescents prone to developing depressive symptoms and more social support to reduce their negative emotions. Health-related professionals should incorporate practical knowledge and skills into the education of adolescents to help them better control Internet use, attenuating the risk of future depressive symptoms.
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http://dx.doi.org/10.1007/s00787-022-01944-5DOI Listing
January 2022

The Role of Problematic Smartphone Uses and Psychological Distress in the Relationship Between Sleep Quality and Disordered Eating Behaviors Among Chinese College Students.

Front Psychiatry 2021 13;12:793506. Epub 2021 Dec 13.

Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China.

Sleep problems and eating disorders (EDs) are both serious public health concerns often seen in young adults. Yet, the underlying mechanisms for such associations are largely unknown. This study aims to examine potential serial multiple mediation effects of problematic smartphone use (PSU) and psychological distress (i.e., depressive and anxiety symptoms) in the relationship between sleep quality and disordered eating behaviors/attitudes (DEBs). A total of 4,325 students from two Tibet universities in China (2,657 females and 1,668 males) completed an online survey that included the following measurements: Eating Attitude Test-26 for disordered eating behaviors/attitudes, the Chinese Version of Pittsburgh Sleep Quality Index (CPSQI), Smartphone Addiction Scale-Short Version (SAS-SV) for problematic smartphone use, Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) for psychological distress. While the direct path linking sleep quality and DEBs was not found to be significant (Standardized β = 0.006, 95% CI = -0.0667~0.0970), both PSU (Standardized β = 0.016, 95% CI = 0.0256~0.0591) and anxiety symptoms (Standardized β = 0.014, 95% CI = 0.0203~0.0526) may mediate a link between sleep quality and DEBs; serial multiple mediation analysis revealed that a serial indirect pathway of "sleep quality -> PSU -> anxiety symptoms -> DEBs" existed(Standardized β = 0.001, 95% CI = 0.0002~0.0012). Similarly, while the direct path linking sleep quality and DEBs was not found to be significant (Standardized β = 0.006, 95% CI = -0.0667~0.0970), both PSU (Standardized β = 0.020, 95% CI = 0.0337~0.0692) and depressive symptoms (Standardized β = 0.015, 95% CI = 0.0139~0.0652) may mediate a link between sleep quality and DEBs; serial multiple mediation analysis revealed that a serial indirect pathway of "sleep quality -> PSU -> depressive symptoms -> DEBs" existed (Standardized β = 0.001, 95% CI = 0.0006~0.0038). Psychological and behavioral factors may comprehensively work together, leading to flow-on effects from sleep problems to disordered eating behaviors among university students. Appropriate interventions that target problematic smartphone use could thus potentially reduce anxiety and depression levels, which in turn will provide a buffer against the negative impact of poor sleep quality on eating disorder symptoms.
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http://dx.doi.org/10.3389/fpsyt.2021.793506DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8710586PMC
December 2021

Nighttime sleep duration, restlessness and risk of multimorbidity - A longitudinal study among middle-aged and older adults in China.

Arch Gerontol Geriatr 2021 Nov 15;99:104580. Epub 2021 Nov 15.

Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China. Electronic address:

Purpose: To assess the associations of nighttime sleep duration and restlessness with the risk of multimorbidity in Chinese middle-aged and older adults.

Methods: We used the 2011 and 2015 surveys of the China Health and Retirement Longitudinal Study (CHARLS). Sleep duration was grouped into ≤ 5, (5-6], (6-8], (8-9], and > 9 h/night. Restlessness days in the past week were categorized into < 1, 1-2, 3-4, and 5-7 days/week. Multimorbidity was defined as the co-existence of two or more of 14 chronic conditions (hypertension, dyslipidemia, diabetes mellitus, cancer, chronic lung disease, liver disease, heart problems, stroke, kidney disease, digestive disease, psychiatric problems, memory-related disease, arthritis, and asthma). Log-binomial regression models were used to estimate the associations.

Results: A total of 6,037 participants free of multimorbidity at baseline were included. During four-years of follow-up, 2,203 (36.5%) participants developed multimorbidity. Compared to participants who slept 6-8 h/night, those with short sleep duration ≤ 5 h/night and 5-6 h/night were associated with 33.3% (95% CI: 14.8%-54.7%) and 24.2% (95% CI: 5.9%-45.6%) increased risk of multimorbidity, respectively. Long sleep duration was not significantly associated with incident multimorbidity. Compared to those who rarely or never had a restless sleep in the past week, participants with 5-7 days of restless sleep had increased risk of multimorbidity (RR: 1.750, 95% CI: 1.476-2.076). Similar findings were confirmed in subgroups by age, gender, and baseline chronic condition status.

Conclusions: Short nighttime sleep duration and restlessness were associated with increased risk of multimorbidity in China.
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http://dx.doi.org/10.1016/j.archger.2021.104580DOI Listing
November 2021

Associations of FKBP5 polymorphisms and methylation and parenting style with depressive symptoms among Chinese adolescents.

BMC Psychiatry 2021 11 9;21(1):552. Epub 2021 Nov 9.

Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan Rd 2, Guangzhou, 510080, People's Republic of China.

Background: Genetic factors may interplay with environmental stressors to contribute to risks of depressive symptoms. This study aimed to investigate the association of FKBP5 polymorphisms and DNA methylation with depressive symptoms among Chinese adolescents, considering the role of parenting style.

Methods: This study used a nested case-control study design based on a cohort study, and the case (n = 120) and control groups (n = 118) were matched with age. Depressive symptoms, parenting style, and other demographics were measured. Fourteen potential polymorphisms and one promoter region in the FKBP5 gene were selected for genotyping and methylation analysis.

Results: In the adjusted models, a significant association between FKBP5 rs7757037 and depressive symptoms was found in the codominant model (AG vs. GG; adjusted odds ratio [AOR] = 2.56, 95% CI = 1.13-5.78) and dominant model (AA+AG vs. GG; AOR = 2.38, 95% CI = 1.11-5.120); rs2817032 and rs2817035 polymorphisms were associated with depressive symptoms in the codominant model and dominant model. Significant interactions between rs7757037 and the father's parenting style were found in the codominant model (P = 0.043) and dominant model (P = 0.043), but the gene-environment interactions were not significant after correcting for multiple testing. Moreover, the significant main effects of FKBP5 methylation status on depressive symptoms were not observed, and there was no significant interaction between FKBP5 methylation status and parenting style on depressive symptoms.

Conclusions: Further studies are required to confirm the effect of FKBP5 polymorphisms and methylation as well as their interactions with parenting styles in larger samples.
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http://dx.doi.org/10.1186/s12888-021-03576-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8579536PMC
November 2021

Adverse Childhood Experiences and Subsequent Chronic Diseases Among Middle-aged or Older Adults in China and Associations With Demographic and Socioeconomic Characteristics.

JAMA Netw Open 2021 10 1;4(10):e2130143. Epub 2021 Oct 1.

School of Public Health, Sun Yat-sen University, Guangzhou, China.

Importance: Associations between adverse childhood experiences (ACEs) and chronic diseases among middle-aged or older Chinese individuals have not been well documented. In addition, whether demographic and socioeconomic characteristics modify any such associations has been underexplored.

Objectives: To examine associations between ACEs and subsequent chronic diseases and to assess whether age, sex, educational level, annual per capita household expenditure level, and childhood economic hardship modify these associations.

Design, Setting, And Participants: This population-based cross-sectional study used data from the China Health and Retirement Longitudinal Study (CHARLS), a survey of residents aged 45 years or older in 28 provinces across China; specifically, the study used data from the CHARLS life history survey conducted from June 1 to December 31, 2014, and a CHARLS follow-up health survey conducted from July 1 to September 30, 2015. The study population included 11 972 respondents aged 45 years or older who had data on at least 1 of 14 specified chronic diseases and information on all 12 of the ACE indicators included in this study. Data analysis was performed from December 1 to 30, 2020.

Exposures: Any of 12 ACEs (physical abuse, emotional neglect, household substance abuse, household mental illness, domestic violence, incarcerated household member, parental separation or divorce, unsafe neighborhood, bullying, parental death, sibling death, and parental disability), measured by indicators on a questionnaire. The number of ACEs per participant was summed and categorized into 1 of 5 cumulative-score groups: 0, 1, 2, 3, and 4 or more.

Main Outcomes And Measures: Hypertension, dyslipidemia, diabetes, heart disease, stroke, chronic lung disease, asthma, liver disease, cancer, digestive disease, kidney disease, arthritis, psychiatric disease, and memory-related disease were defined by self-reported physician diagnoses or in combination with health assessment and medication data. Multimorbidity was defined as the presence of 2 or more of these 14 chronic diseases. Logistic regression models were used to assess associations of the 12 ACEs with the 14 chronic diseases and with multimorbidity. Modification of the associations by demographic and socioeconomic characteristics was assessed by stratified analyses and tests for interaction.

Results: Of the 11 972 individuals included (mean [SD] age, 59.85 [9.56] years; 6181 [51.6%] were females), 80.9% had been exposed to at least 1 ACE and 18.0% reported exposure to 4 or more ACEs. Compared with those without ACE exposure, participants who experienced 4 or more ACEs had increased risks of dyslipidemia, chronic lung disease, asthma, liver disease, digestive disease, kidney disease, arthritis, psychiatric disease, memory-related disease, and multimorbidity. The estimated odds ratios (ORs) ranged from 1.27 (95% CI, 1.02-1.59) for dyslipidemia to 2.59 (95% CI, 2.16-3.11) for digestive disease. A dose-response association was also observed between the number of ACEs and the risk of most of the chronic diseases (excluding hypertension, diabetes, and cancer) (eg, chronic lung disease for ≥4 ACEs vs none: OR, 2.01; 95% CI, 1.59-2.55; P < .001 for trend) and of multimorbidity (for individuals among the overall study population with ≥4 ACEs vs none: OR, 2.03; 95% CI, 1.70-2.41; P < .001 for trend). The demographic or socioeconomic characteristics of age, sex, educational level, annual per capita household expenditure level, or childhood economic hardship were not shown to significantly modify the associations between ACEs and multimorbidity.

Conclusions And Relevance: In this population-based, cross-sectional study of adults in China, exposure to ACEs was associated with higher risks of chronic diseases regardless of demographic and socioeconomic characteristics during childhood or adulthood. These findings suggest a need to prevent ACEs and a need for a universal life-course public health strategy to reduce potential adverse health outcomes later in life among individuals who experience them.
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http://dx.doi.org/10.1001/jamanetworkopen.2021.30143DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8546496PMC
October 2021

Comparing mortality from covid-19 to mortality due to overdose: A micromort analysis.

J Affect Disord 2022 01 24;296:514-521. Epub 2021 Sep 24.

Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, Toronto, ON, Canada, M5T 2S8; Institute of Medical Science, University of Toronto, Toronto, ON, Canada, M5S 1A8; Department of Psychiatry, University of Toronto, Toronto, ON, Canada, M5S 1A8; Department of Pharmacology, University of Toronto, Toronto, ON, Canada, M5S 1A8. Electronic address:

Objective: To compare the mortality risk due to covid-19 with death due to overdose in British Columbia, Canada. The opioid epidemic was declared a public health emergency in 2016.

Methods: Mortality risk was calculated in micromorts with covid-19 data for January-October 2020, derived from the BC center for Disease Control, and illicit drug toxicity deaths for January 2010-September 2020, derived from the BC Coroners Service. Age-stratified covid-19 incidence and deaths per 100,000 population and age-stratified illicit drug toxicity death rates per 100,000 population were calculated. A micromort is a unit of risk equivalent to a one-in-a-million chance of death.

Results: During the covid-19 pandemic, illicit drug toxicity deaths reached 1.0 micromorts per day, representing an increase of 0.5 micromorts per day relative to 2019 rates. In comparison, covid-19 mortality risk was 0.05 micromorts per day among individuals from the general population living in British Columbia and 21.1 micromorts per day among those infected with covid-19. Covid-related mortality risk was significantly lower among individuals aged <60 years, relative to older adults, whereas drug toxicity-related mortality was highest for individuals aged 30-59 years.

Conclusions: The mortality associated with covid-19 is apparent and distributed unevenly across subpopulations. The mortality due to overdose has increased during covid-19 and exceeds mortality due to covid-19. Our results instantiate the triple threat caused by covid-19 (i.e., public health crisis, economic crisis and mental health crisis) and quantitatively highlight the externality of increased mortality due to deaths of despair in response to public health efforts to reduce covid-related mortality.
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http://dx.doi.org/10.1016/j.jad.2021.09.059DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8461265PMC
January 2022

Association between systemic inflammation and activities of daily living disability among Chinese elderly individuals: the mediating role of handgrip strength.

Aging Clin Exp Res 2021 Oct 16. Epub 2021 Oct 16.

Department of Epidemiology, School of Public Health, Sun Yat-Sen University, 74 Zhongshan 2nd Road, Guangzhou, 510080, Guangdong, China.

Background: Aging is accompanied by chronic low-grade inflammation (inflammaging), which is a risk factor for low handgrip strength (HGS) and activities of daily living (ADL) disability.

Aims: To explore the association between C-reactive protein (CRP) and ADL disability in Chinese elderly individuals and to further evaluate the mediating role of HGS in this association.

Methods: We used data from the China Health and Retirement Longitudinal Study (CHARLS) that were collected in 2015. A total of 3601 elderly individuals aged ≥ 60 years were included. Baron and Kenny's causal steps method was used to explore the possible mediating role of HGS in the associations between CRP and ADL disability. Karlson-Holm-Breen method was further applied to decompose total effect into direct effect and indirect effect via HGS. Subgroup analysis was conducted by sex and age.

Results: A high level of CRP (≥ 3 mg/L) was significantly associated with ADL disability after adjustment for covariates (OR = 1.50, 95% CI = 1.17-1.94). After introducing HGS into the model, the risk estimate was reduced but still significant (OR = 1.40, 95% CI = 1.08-1.81). The proportional mediation through HGS was 14.71%. Similar results were observed in both sexes and in participants aged < 70 years.

Conclusion: CRP was positively associated with the risk of ADL disability in Chinese elderly individuals, and this association was mediated by HGS. Improving muscle strength in combination with anti-inflammatory treatment may have a beneficial effect to maintain ADL ability. Further randomized controlled trials on this topic are necessary.
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http://dx.doi.org/10.1007/s40520-021-02003-wDOI Listing
October 2021

Association between Hypertriglyceridemic-Waist Phenotype and Risk of Type 2 Diabetes Mellitus in Middle-Aged and Older Chinese Population: A Longitudinal Cohort Study.

Int J Environ Res Public Health 2021 09 12;18(18). Epub 2021 Sep 12.

School of Public Health, Sun Yat-Sen University, 74 Zhongshan Second Road, Guangzhou 510080, China.

Current evidence remains inconsistent with regard to the association between different triglyceridemic-waist phenotypes and the risks for type 2 diabetes mellitus (T2DM). We aimed to investigate this association among a retrospective cohort analysis of 6918 participants aged ≥ 45 years in the China Health and Retirement Longitudinal Study (CHARLS). Participants were categorized into four triglyceridemic-waist phenotypes consisting of NWNT (normal waist circumference and normal triglycerides), NWHT (normal waist circumference and high triglycerides), EWNT (enlarged waist circumference and normal triglycerides), and EWHT (enlarged waist circumference and high triglycerides) based on participants' baseline information. Multivariate log-binomial regression was used to assess the T2DM risk in different phenotypes. Subgroup analysis was conducted to test the robustness of the findings. After 4-years of follow-up, participants with EWHT (Relative Risk [RR]: 1.909, 95% Confidence Interval [CI]: 1.499 to 2.447) or EWNT (RR: 1.580, 95%CI: 1.265 to 1.972) phenotypes had significantly higher likelihood of incident T2DM compared to the NWNT phenotype, whereas the association was not significant for the NWHT phenotype (RR: 1.063, 95%CI: 0.793 to 1.425). The subgroup analyses generally revealed similar associations across all subgroups. Among middle-aged and older adults, we suggested a combined use of waist circumference and triglycerides measures in identifying participants who are at high risk of developing T2DM.
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http://dx.doi.org/10.3390/ijerph18189618DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8466002PMC
September 2021

A Robust Seven-Gene Signature Associated With Tumor Microenvironment to Predict Survival Outcomes of Patients With Stage III-IV Lung Adenocarcinoma.

Front Genet 2021 6;12:684281. Epub 2021 Sep 6.

Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China.

Background: Due to the relatively insidious early symptoms of lung adenocarcinoma (LUAD), most LUAD patients are at an advanced stage at the time of diagnosis and lose the best chance of surgical resection. Mounting evidence suggested that the tumor microenvironment (TME) was highly correlated with tumor occurrence, progress, and prognosis. However, TME in advanced LUAD remained to be studied and reliable prognostic signatures based on TME in advanced LUAD also had not been well-established. This study aimed to understand the cell composition and function of TME and construct a gene signature associated with TME in advanced LUAD.

Methods: The immune, stromal, and ESTIMATE scores of each sample from The Cancer Genome Atlas (TCGA) database were, respectively, calculated using an ESTIMATE algorithm. The LASSO and Cox regression model were applied to select prognostic genes and to construct a gene signature associated with TME. Two independent datasets from the Gene Expression Omnibus (GEO) were used for external validation. Twenty-two subsets of tumor-infiltrating immune cells (Tiics) were analyzed using the CIBERSORT algorithm.

Results: Favorable overall survival (OS) and progression-free survival (PFS) were found in patients with high immune score ( = 0.048 and = 0.028; respectively) and stromal score ( = 0.024 and = 0.025; respectively). Based on the immune and stromal scores, 453 differentially expressed genes (DEGs) were identified. Using the LASSO and Cox regression model, a seven-gene signature containing AFAP1L2, CAMK1D, LOXL2, PIK3CG, PLEKHG1, RARRES2, and SPP1 was identified to construct a risk stratification model. The OS and PFS of the high-risk group were significantly worse than that of the low-risk group ( < 0.001 and < 0.001; respectively). The receiver operating characteristic (ROC) curve analysis confirmed the good potency of the seven-gene signature. Similar findings were validated in two independent cohorts. In addition, the proportion of macrophages M2 and Tregs was higher in high-risk patients ( = 0.041 and = 0.022, respectively).

Conclusion: Our study established and validated a seven-gene signature associated with TME, which might serve as a prognosis stratification tool to predict survival outcomes of advanced LUAD patients. In addition, macrophages M2 polarization may lead to worse prognosis in patients with advanced LUAD.
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http://dx.doi.org/10.3389/fgene.2021.684281DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8450538PMC
September 2021

A Robust Seven-Gene Signature Associated With Tumor Microenvironment to Predict Survival Outcomes of Patients With Stage III-IV Lung Adenocarcinoma.

Front Genet 2021 6;12:684281. Epub 2021 Sep 6.

Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China.

Background: Due to the relatively insidious early symptoms of lung adenocarcinoma (LUAD), most LUAD patients are at an advanced stage at the time of diagnosis and lose the best chance of surgical resection. Mounting evidence suggested that the tumor microenvironment (TME) was highly correlated with tumor occurrence, progress, and prognosis. However, TME in advanced LUAD remained to be studied and reliable prognostic signatures based on TME in advanced LUAD also had not been well-established. This study aimed to understand the cell composition and function of TME and construct a gene signature associated with TME in advanced LUAD.

Methods: The immune, stromal, and ESTIMATE scores of each sample from The Cancer Genome Atlas (TCGA) database were, respectively, calculated using an ESTIMATE algorithm. The LASSO and Cox regression model were applied to select prognostic genes and to construct a gene signature associated with TME. Two independent datasets from the Gene Expression Omnibus (GEO) were used for external validation. Twenty-two subsets of tumor-infiltrating immune cells (Tiics) were analyzed using the CIBERSORT algorithm.

Results: Favorable overall survival (OS) and progression-free survival (PFS) were found in patients with high immune score ( = 0.048 and = 0.028; respectively) and stromal score ( = 0.024 and = 0.025; respectively). Based on the immune and stromal scores, 453 differentially expressed genes (DEGs) were identified. Using the LASSO and Cox regression model, a seven-gene signature containing AFAP1L2, CAMK1D, LOXL2, PIK3CG, PLEKHG1, RARRES2, and SPP1 was identified to construct a risk stratification model. The OS and PFS of the high-risk group were significantly worse than that of the low-risk group ( < 0.001 and < 0.001; respectively). The receiver operating characteristic (ROC) curve analysis confirmed the good potency of the seven-gene signature. Similar findings were validated in two independent cohorts. In addition, the proportion of macrophages M2 and Tregs was higher in high-risk patients ( = 0.041 and = 0.022, respectively).

Conclusion: Our study established and validated a seven-gene signature associated with TME, which might serve as a prognosis stratification tool to predict survival outcomes of advanced LUAD patients. In addition, macrophages M2 polarization may lead to worse prognosis in patients with advanced LUAD.
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http://dx.doi.org/10.3389/fgene.2021.684281DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8450538PMC
September 2021

A Robust Seven-Gene Signature Associated With Tumor Microenvironment to Predict Survival Outcomes of Patients With Stage III-IV Lung Adenocarcinoma.

Front Genet 2021 6;12:684281. Epub 2021 Sep 6.

Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China.

Background: Due to the relatively insidious early symptoms of lung adenocarcinoma (LUAD), most LUAD patients are at an advanced stage at the time of diagnosis and lose the best chance of surgical resection. Mounting evidence suggested that the tumor microenvironment (TME) was highly correlated with tumor occurrence, progress, and prognosis. However, TME in advanced LUAD remained to be studied and reliable prognostic signatures based on TME in advanced LUAD also had not been well-established. This study aimed to understand the cell composition and function of TME and construct a gene signature associated with TME in advanced LUAD.

Methods: The immune, stromal, and ESTIMATE scores of each sample from The Cancer Genome Atlas (TCGA) database were, respectively, calculated using an ESTIMATE algorithm. The LASSO and Cox regression model were applied to select prognostic genes and to construct a gene signature associated with TME. Two independent datasets from the Gene Expression Omnibus (GEO) were used for external validation. Twenty-two subsets of tumor-infiltrating immune cells (Tiics) were analyzed using the CIBERSORT algorithm.

Results: Favorable overall survival (OS) and progression-free survival (PFS) were found in patients with high immune score ( = 0.048 and = 0.028; respectively) and stromal score ( = 0.024 and = 0.025; respectively). Based on the immune and stromal scores, 453 differentially expressed genes (DEGs) were identified. Using the LASSO and Cox regression model, a seven-gene signature containing AFAP1L2, CAMK1D, LOXL2, PIK3CG, PLEKHG1, RARRES2, and SPP1 was identified to construct a risk stratification model. The OS and PFS of the high-risk group were significantly worse than that of the low-risk group ( < 0.001 and < 0.001; respectively). The receiver operating characteristic (ROC) curve analysis confirmed the good potency of the seven-gene signature. Similar findings were validated in two independent cohorts. In addition, the proportion of macrophages M2 and Tregs was higher in high-risk patients ( = 0.041 and = 0.022, respectively).

Conclusion: Our study established and validated a seven-gene signature associated with TME, which might serve as a prognosis stratification tool to predict survival outcomes of advanced LUAD patients. In addition, macrophages M2 polarization may lead to worse prognosis in patients with advanced LUAD.
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http://dx.doi.org/10.3389/fgene.2021.684281DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8450538PMC
September 2021

Effect of School-Based Family Health Education via Social Media on Children's Myopia and Parents' Awareness: A Randomized Clinical Trial.

JAMA Ophthalmol 2021 11;139(11):1165-1172

Department of Medical Statistics and Epidemiology, Sun Yat-Sen University School of Public Health, Guangzhou, China.

Importance: Myopia is a common cause of vision loss, and its prevalence is increasing globally.

Objective: To evaluate the effects of school-based family health education via WeChat in raising parents' awareness of myopia prevention and behavior and in controlling the development of myopia in children.

Design, Setting, And Participants: A single-masked cluster randomized clinical trial of children was conducted from October 1, 2018, to December 31, 2020, among grade 1 students from 12 primary schools in Guangzhou, China. The 12 primary schools were randomly selected in 2 districts and randomized to the intervention and control groups. All grade 1 students were invited to participate, and 688 students were included in the intervention group and 752 in the control group.

Interventions: Weekly health education via the social media platform WeChat was provided to the parents in the intervention group.

Main Outcomes And Measures: Data include results of eye examinations of children and questionnaires completed by parents. The primary outcome was the 2-year cumulative incidence rate of myopia. Myopia was defined as a spherical equivalent (SE) refractive error (sphere of +0.5 cylinder) of at least -0.50 diopters (D). The secondary outcomes were the 2-year changes in the axis length and SE refraction, parental awareness, children's screen time, outdoor activities, and learning tools during COVID-19.

Results: Among the 1525 children included at baseline (835 boys [54.8%]; mean [SD] age, 6.3 [0.5] years), 1244 competed the final assessment; the 2-year cumulative incidence rate of myopia was 106 of 544 (19.5%) in the intervention group and 171 of 700 (24.4%) in the control group (difference, 4.9% [95% CI, 0.3%-9.5%]; P = .04). The mean myopic shift in SE refraction in the intervention group (-0.82 D) was lower than that in the control group (-0.96 D; difference, -0.14 [95% CI, -0.22 to -0.06] D; P < .001). No difference in change in axial length was detected (difference, 0.02 [95% CI, -0.06 to 0.09] mm; P = .70).

Conclusions And Relevance: School-based weekly family health education via WeChat resulted in a small decrease in the 2-year cumulative incidence rate of myopia with a difference in SE of less than 0.25 D not accompanied by any axial length differences. Whether these findings extrapolate elsewhere in the world or are clinically relevant in the short or long term remain to be determined.

Trial Registration: Chinese Clinical Trial Registry Identifier: ChiCTR1900022236.
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http://dx.doi.org/10.1001/jamaophthalmol.2021.3695DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8446904PMC
November 2021

Rates of Myopia Development in Young Chinese Schoolchildren During the Outbreak of COVID-19.

JAMA Ophthalmol 2021 10;139(10):1115-1121

State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China.

Importance: During the outbreak of COVID-19, outdoor activities were limited and digital learning increased. Concerns have arisen regarding the impact of these environmental changes on the development of myopia.

Objective: To investigate changes in the development of myopia in young Chinese schoolchildren during the outbreak of COVID-19.

Design, Setting, And Participants: In this observational study, 2 groups of students from 12 primary schools in Guangzhou, China, were prospectively enrolled and monitored from grade 2 to grade 3. Comparisons between the exposure and nonexposure groups were made to evaluate any association between environmental changes during the COVID-19 outbreak period and development of myopia. The exposure group received complete eye examinations in November and December 2019 and November and December 2020. The nonexposure group received examinations in November and December 2018 and November and December 2019.

Main Outcomes And Measures: Changes in cycloplegic spherical equivalent refraction (SER), axial length (AL) elongation, and myopia incidence from grade 2 to grade 3.

Results: Among the 2679 eligible students in grade 2 (mean [SD] age, 7.76 [0.32] years; 1422 [53.1%] male), 2114 (1060 in the nonexposure group and 1054 in the exposure group) were reexamined in grade 3. Compared with the period from November and December 2018 to November and December 2019, the shift of SER, AL elongation, and myopia incidence from grade 2 to grade 3 from November and December 2019 to November and December 2020 was 0.36 D greater (95% CI, 0.32-0.41; P < .001), 0.08 mm faster (95% CI, 0.06-0.10; P < .001), and 7.9% higher (95% CI, 5.1%-10.6%; P < .001), respectively. In grade 3 students, the prevalence of myopia increased from 13.3% (141 of 1060 students) in November and December 2019 to 20.8% (219 of 1054 students) in November and December 2020 (difference [95% CI], 7.5% [4.3-10.7]; P < .001); the proportion of children without myopia and with SER greater than -0.50 D and less than or equal to +0.50 D increased from 31.1% (286 of 919 students) to 49.0% (409 of 835 students) (difference [95% CI], 17.9% [13.3-22.4]; P < .001).

Conclusions And Relevance: In this study, development of myopia increased during the COVID-19 outbreak period in young schoolchildren in China. Consequently, myopia prevalence and the proportion of children without myopia who were at risk of developing myopia increased. Future studies are needed to investigate long-term changes in myopia development after the COVID-19 pandemic.
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http://dx.doi.org/10.1001/jamaophthalmol.2021.3563DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8446907PMC
October 2021

Sexual orientation and sleep problem among Chinese college students: Mediating roles of interpersonal problems and depressive symptoms.

J Affect Disord 2021 12 1;295:569-577. Epub 2021 Sep 1.

Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, People's Republic of China; Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou, People's Republic of China.

Background: This study aimed to investigate disparities in sleep quality between sexual minority and heterosexual college students, and to examine the serial multiple mediation effects of interpersonal relationships and depressive symptoms on sexual minority disparities in sleep quality. We also explored the sex differences in the mediating effects.

Methods: Data were drawn from the 2019 School-based Chinese College Students Health Survey using a multi-stage, stratified-cluster, random-sampling method to examine the risk factors of sleep disparities and the mediation effects. Measures included sexual orientation, perceived interpersonal relationships (i.e., family, teachers, and peer relationship), depressive symptoms, sleep quality, and other covariates.

Results: Of all the college students in the analysis, 95.8% were heterosexual, 4.2% were sexual minorities. In the adjusted model without mediation, sexual minority students were at a higher risk of poor sleep quality (P < 0.001). Serial multiple mediation analysis revealed that: both interpersonal relationships and depressive symptoms mediated the link between sexual orientation and sleep quality; a serial indirect pathway (i.e., sexual orientation → interpersonal relationships → depressive symptoms → sleep quality) existed. Moreover, the serial indirect pathway might be moderated by sex.

Limitations: Causal inference is limited due to the cross-sectional design.

Conclusions: Interventions to prevent or manage sleep disorders of sexual minority college students may yield better results if they consider the effects of improving interpersonal relationships and depression symptoms comprehensively than targeting sleep problems alone.
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http://dx.doi.org/10.1016/j.jad.2021.08.075DOI Listing
December 2021

Correction: Efficacy of omega-3 PUFAs in depression: A meta-analysis.

Transl Psychiatry 2021 Sep 7;11(1):465. Epub 2021 Sep 7.

Mood Disorders Psychopharmacology Unit, University Health Network; Department of Psychiatry, University of Toronto; Institute of Medical Science, University of Toronto; Department of Pharmacology, University of Toronto, Toronto, Ontario, Canada.

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http://dx.doi.org/10.1038/s41398-021-01582-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8423804PMC
September 2021

The association of nighttime sleep duration and quality with chronic kidney disease in middle-aged and older Chinese: a cohort study.

Sleep Med 2021 10 13;86:25-31. Epub 2021 Aug 13.

School of Public Health, Sun Yat-sen University, Guangzhou, China. Electronic address:

Objective: This cohort study aimed to assess the associations between sleep duration and quality with the risk of incident chronic kidney disease (CKD) in middle-aged and older Chinese.

Methods: We used the 2011 and 2015 surveys of the China Health and Retirement Longitudinal Study (CHARLS). Nighttime sleep duration was categorized into five groups: ≤4, (4-6], (6-8], (8-10], and >10 h/night. Sleep quality was assessed by restless days in the past week (<1, 1-2, 3-4, and 5-7 days/week). Multivariate logistic regression was used to assess the association between sleep duration and quality with incident CKD.

Results: A total of 11,339 participants free of CKD at baseline were included in this study. After four years follow-up, the incidence of CKD was 7.8%. There was a "U-shaped" association between sleep duration and risk of CKD. Compared to 6-8 h of nighttime sleep duration, those who slept ≤4 h/night (RR: 1.639, 95% CI: 1.287-2.087) or >10 h/night (RR: 2.342, 95% CI: 1.007-5.451) had increased risk of developing CKD after adjustment for confounders. Participants with 5-7 restless days per week had significantly increased risk of CKD (adjusted RR: 1.686, 95% CI: 1.352-2.102), compared to those who rarely or never had a restless sleep.

Conclusions: Extreme nighttime sleep duration and poor sleep quality were associated with increased risk of CKD in middle-aged and older Chinese. Obtaining an optimal nighttime sleep duration and better sleep quality might reduce the risk of CKD.
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http://dx.doi.org/10.1016/j.sleep.2021.08.007DOI Listing
October 2021

Associations Between Child Maltreatment and Depressive Symptoms Among Chinese College Students: An Analysis of Sex Differences.

Front Psychiatry 2021 9;12:656646. Epub 2021 Jul 9.

Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China.

Depressive symptoms and child maltreatment are both global public health problems among young adults. This study aimed to investigate the associations between five types of child maltreatment and depressive symptoms among Chinese college students, with a focus on potential sex differences. A cross-sectional study of a nationally representative sample of Chinese college students was conducted from March to June 2019 with a multistage, stratified cluster, random sampling method. In total, 30,179 college students from 60 colleges of 10 Chinese province-level regions completed standard questionnaires, including a history of child maltreatment and current depressive symptoms. The prevalence of depressive symptoms among college students in China was 7.3%. After adjusting for control variables, physical abuse (adjusted odds ratio [aOR] = 1.20, 95% confidence interval [CI] = 1.17-1.23), emotional abuse (aOR = 1.21, 95% CI = 1.19-1.23), sexual abuse (aOR = 1.19, 95% CI = 1.16-1.22), physical neglect (aOR = 1.14, 95% CI = 1.12-1.16) and emotional neglect (aOR = 1.08, 95% CI = 1.07-1.09) were all positively associated with depressive symptoms. Notably, a cumulative effect of child maltreatment on depressive symptoms among Chinese college students was observed. Moreover, sex differences in the associations of emotional abuse, emotional neglect, and the number of maltreatment types with depressive symptoms were statistically significant ( < 0.05). Further stratification analyses showed that female students who experienced emotional abuse and emotional neglect had a higher risk of depressive symptoms than male students, and the cumulative effect of maltreatment types was stronger for females than males. Five types of child maltreatment and their co-occurrence were associated with an increased risk of depressive symptoms among college students. Furthermore, the effects of emotional abuse, emotional neglect and the number of maltreatment types on depressive symptoms were stronger for females than for males. These findings can promote understanding of the effects of child maltreatment on depressive symptoms, and prevention and intervention strategies for depressive symptoms should consider the type of child maltreatment and sex differences.
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http://dx.doi.org/10.3389/fpsyt.2021.656646DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8298832PMC
July 2021

Indoor solid fuel use for heating and cooking with blood pressure and hypertension: A cross-sectional study among middle-aged and older adults in China.

Indoor Air 2021 11 12;31(6):2158-2166. Epub 2021 Jun 12.

School of Public Health, Sun Yat-sen University, Guangzhou, China.

A cross-sectional study was conducted to investigate the impact of solid fuel use for heating and cooking on blood pressure (BP) and hypertension, using data from the China Health and Retirement Longitudinal Study (CHARLS). The primary fuels used for indoor heating and cooking were collected by questionnaires, respectively. Hypertension was defined based on self-report of physician's diagnosis, and/or measured BP, and/or anti-hypertensive medication use. Multivariate logistic regression models were constructed to assess the associations. Among 10 450 eligible participants, 68.2% and 57.2% used indoor solid fuel for heating and cooking, respectively. Compared with none/clean fuel users, solid fuel for heating was associated with elevated BP (adjusted β: 2.02, 95% CI: 1.04-3.01 for systolic BP; adjusted β: 1.36, 95% CI: 0.78-1.94 for diastolic BP) and increased risk of hypertension (adjusted odds ratio: 1.15, 95% CI: 1.03-1.29). The impact of indoor solid fuel for heating on BP was more evident in rural and north residents, and hypertensive patients. We did not detect any significant associations between solid fuel use for cooking and BP/hypertension. Indoor solid fuel use is prevalent in China, especially in the rural areas. Its negative impact on BP suggested that modernization of household fuel use may help to reduce the burden of hypertension in China.
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http://dx.doi.org/10.1111/ina.12872DOI Listing
November 2021

Systematic review and meta-analysis of the association between paediatric obesity and telomere length.

Acta Paediatr 2021 Oct 21;110(10):2695-2703. Epub 2021 Jun 21.

Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China.

Aim: This systematic review and meta-analysis aimed to assess the association between paediatric obesity and telomere length.

Methods: We conducted a comprehensive literature search for original studies assessing the associations between obesity and telomere length in children. Fixed or random effects with inverse-variance meta-analysis were used to estimate the standardised mean difference (SMD) and its 95% confidence interval (95% CI) between overweight or obese and normal-weight children. Heterogeneity was assessed using the I statistic, and meta-regression analyses were used to evaluate the potential source of heterogeneity. Subgroup analysis was further conducted by sex.

Results: A total of 11 studies were included. The meta-analysis showed that children who were overweight or obese had shorter telomere length than normal-weight children (SMD: -0.85; 95% CI: -1.42 to -0.28; p < 0.01). However, significant heterogeneity was present (I  = 97%; p < 0.01). Study design, methods used for measuring telomere length, tissue types, mean age, and percentage of boys were not the source of heterogeneity revealed by meta-regression analysis. The inverse trend was significant only in boys, but not in girls.

Conclusion: There was a negative association between paediatric obesity and telomere length. Weight control in children might have beneficial effect on telomere length.
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http://dx.doi.org/10.1111/apa.15971DOI Listing
October 2021

Childhood maltreatment predicts subsequent anxiety symptoms among Chinese adolescents: the role of the tendency of coping styles.

Transl Psychiatry 2021 06 2;11(1):340. Epub 2021 Jun 2.

Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 510080, Guangzhou, People's Republic of China.

Childhood maltreatment may have an influence on anxiety symptoms and coping styles. This longitudinal study aimed to estimate the prospective associations between different types of childhood maltreatment and anxiety symptoms among Chinese adolescents, with a particular focus on investigating whether these associations vary by the tendency of coping styles. Data were from the Longitudinal Study of Adolescents' Mental and Behavioral Well-being Research. The baseline sample included 1957 participants (response rate: 99.03%) and followed up at 1-year later (n = 1836, retention rate: 93.8%). Anxiety symptoms, childhood maltreatment, the tendency of coping styles, morning cortisol level, depressive symptoms, self-esteem, and other demographics were measured. Overall, the mean age of the baseline students was 13.6 (SD: 1.5) years. The final results showed that childhood emotional abuse (unstandardized β-estimate = 0.13, 95% CI = 0.07-0.18), physical abuse (unstandardized β-estimate = 0.08, 95% CI = 0.01-0.16), and sexual abuse (unstandardized β-estimate = 0.17, 95% CI = 0.04-0.29) were positively associated with anxiety symptoms at follow-up after adjusting for significant covariates at baseline. Additionally, the stratified analyses demonstrated that only among students with negative coping styles, childhood emotional abuse, physical abuse, and sexual abuse were associated with subsequent anxiety symptoms; the differences between the positive and negative coping style strata were significant (P < 0.05). Childhood maltreatment appears to be a predictor of anxiety symptoms among adolescents, and the tendency of coping styles may have a moderating role in these longitudinal associations. The efforts to prevent anxiety symptoms are recommended to be focused on adolescents with the experience of childhood maltreatment and negative coping styles.
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http://dx.doi.org/10.1038/s41398-021-01463-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8172629PMC
June 2021

Daytime Napping and Nighttime Sleep Duration with Incident Diabetes Mellitus: A Cohort Study in Chinese Older Adults.

Int J Environ Res Public Health 2021 05 9;18(9). Epub 2021 May 9.

Department of Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China.

Background: We aimed to examine the longitudinal associations between daytime napping and nighttime sleep duration with the risk of diabetes mellitus (DM) among Chinese elderly using data from the China Health and Retirement Longitudinal Study (CHARLS).

Methods: A cohort study was conducted among 2620 participants aged 60 years or above. Information on daytime napping and nighttime sleep duration was self-reported during the 2011 baseline survey. DM status during the 2015 follow-up survey was confirmed according to the American Diabetes Association criteria.

Results: Individuals with long daytime napping (>1 h/day) had increased risk of developing DM than non-nappers (adjusted RR = 1.52, 95%CI: 1.10, 2.10). In addition, we observed a U-shaped association between nighttime sleep duration and incident DM risk. We further found that nappers with <4 h of nighttime sleep, and those with >1 h of daytime napping and >6 h nighttime sleep had approximately two-fold elevated risk of DM, compared to non-nappers with 6-8 h of nighttime sleep.

Conclusion: Long daytime napping and extreme nighttime sleep duration were associated with increased DM risk among Chinese elderly. There was a joint effect of long daytime napping and nighttime sleep duration on the risk of DM.
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http://dx.doi.org/10.3390/ijerph18095012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8125963PMC
May 2021

Government response moderates the mental health impact of COVID-19: A systematic review and meta-analysis of depression outcomes across countries.

J Affect Disord 2021 07 27;290:364-377. Epub 2021 May 27.

Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, Toronto, ON, Canada M5T 2S8; Institute of Medical Science, University of Toronto, Toronto, ON, Canada M5S 1A8; Department of Psychiatry, University of Toronto, Toronto, ON, Canada M5S 1A8; Department of Pharmacology, University of Toronto, Toronto, ON, Canada M5S 1A8.

Background: The COVID-19 pandemic represents a public health, economic and mental health crisis. We hypothesized that timely government implementation of stringent measures to reduce viral transmission would benefit mental health, as evidenced by reduced rates of depressive symptoms (i.e., Patient Health Questionnaire [PHQ]-9≥10, PHQ-2≥3).

Methods: The systematic review herein (PROSPERO CRD42020200647) evaluated to what extent differences in government-imposed stringency and timeliness of response to COVID-19 moderate the prevalence of depressive symptoms across 33 countries (k=114, N=640,037). We included data from six lower-middle-income countries, nine upper-middle-income countries, and 18 higher-income countries. Government-imposed stringency and timeliness in response were operationalized using the Oxford COVID-19 Government Response ("Stringency") Index.

Results: The overall proportion of study participants with clinically significant depressive symptoms was 21.39% (95% CI 19.37-23.47). The prevalence of clinically significant depressive symptoms was significantly lower in countries wherein governments implemented stringent policies promptly. The moderating effect of government response remained significant after including the national frequency of COVID cases at the time of study commencement, Healthcare Access and Quality index, and the inclusion of COVID patients in the study.

Limitations: Factors that may have confounded our results include, for example, differences in lockdown duration, lack of study participant and outcome assessor blinding, and retrospective assessment of depressive symptom severity.

Conclusions: Governments that enacted stringent measures to contain the spread of COVID-19 benefited not only the physical, but also the mental health of their population.
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http://dx.doi.org/10.1016/j.jad.2021.04.050DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8159271PMC
July 2021

The associations between sleep situations and mental health among Chinese adolescents: A longitudinal study.

Sleep Med 2021 06 13;82:71-77. Epub 2021 Mar 13.

Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada.

Objective: Few studies are conducted to explore the longitudinal relationships between sleep situations and mental health among adolecents. This study aimed to explore the sleep situations (ie, sleep habits and sleep problems) among Chinese adolescents and the longitudinal associations between sleep situations and mental disorder symptoms (ie, depressive and anxiety symptoms).

Methods: This longitudinal study included 1957 high school students from ten schools in Guangzhou in January 2019, with 1836 students contributing valid data at a one-year follow-up (retention rate: 93.9%). Data of depressive and anxiety symptoms, sleep habits, and sleep problems were collected using a self-reported questionnaire.

Results: The current study found that over half of the adolescents did not reach the recommended 8-h sleep-time on weekdays (63.3%). Short sleep duration, especially on weekdays, was significantly associated with subsequent depressive (AOR = 0.86, 95%CI: 0.80-0.92) and anxiety symptoms (AOR = 0.86, 95%CI: 0.77-0.96). In addition, longer weekday-weekend catch-up sleep and more sleep problems were risk factors of depressive and anxiety symptoms.

Conclusions: The health effects of insufficient sleep and suboptimal sleep quality on adolescents should not be neglected. Our longitudinal research showed that adolescents would demonstrate severer depressive and anxiety symptoms if lacking of a healthy sleeping practice. A regular sleep schedule and close attention to adolescents' mental disorders are highly recommended.
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http://dx.doi.org/10.1016/j.sleep.2021.03.009DOI Listing
June 2021

The relationship between childhood emotional abuse and depressive symptoms among Chinese college students: The multiple mediating effects of emotional and behavioral problems.

J Affect Disord 2021 06 31;288:129-135. Epub 2021 Mar 31.

Department of Psychiatry, University of Toronto, Toronto, ON, Canada.

Background: This study aims to explore the mediational effects of emotional and behavioral problems on the association between childhood emotional abuse and depressive symptoms among college students.

Methods: Data were drawn from 60 universities from 10 provinces in China (n=30,374). Information about childhood maltreatment, depressive symptoms, emotional and behavioral problems were gathered through the Childhood Trauma Questionnaire-Short Form (CTQ-SF), the Center for Epidemiologic Studies Depression Scale (CES-D) and the Strengths and Difficulties Questionnaire (SDQ), respectively. Univariable and multivariable logistic regression models and mediating models were used.

Results: After controlling for demographic factors, childhood emotional abuse was the strongest risk factor for depressive symptoms (adjusted odds ratio (aOR)=2.54, 95%CI=2.27-2.85). The relationship between childhood emotional abuse and depressive symptoms was partially mediated by emotional and behavioral problems with 68.7% total indirect effect. Among the 5 identified subtypes of emotional and behavioral problems, the mediating effects of emotional problems (57.3%) and hyperactivity (28.6%) were higher than peer problems (7.8%) and prosocial behavior (3.6%). Conduct problems did not show a significant mediating effect (p>0.05).

Limitations: The cross-sectional design is limited to make inferences about causality.

Conclusions: Childhood emotional abuse was strongly associated with depressive symptoms in college students. Of the five identified subtypes of emotional and behavioral problems, four subtypes mediated the relationship between childhood emotional abuse and depressive symptoms, including emotional problems, hyperactivity, peer problems and prosocial behavior.
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http://dx.doi.org/10.1016/j.jad.2021.03.074DOI Listing
June 2021

Associations of emotional and behavioral problems with Internet use among Chinese young adults: the role of academic performance.

J Affect Disord 2021 05 23;287:214-221. Epub 2021 Mar 23.

Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, People's Republic of China; Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou, 510080, People's Republic of China. Electronic address:

Background: To investigate the independent association between different types of emotional and behavioral problems and Internet use (i.e., Internet use time and problematic Internet use [PIU]) among Chinese young adults, and to test whether these associations vary by academic performance.

Methods: Data was drawn from the 2019 National School-based Chinese Adolescents Health Survey, and 30,581 undergraduates (mean age: 19.9 [SD: 1.6] years) completed standard questionnaires qualifiedly. Daily hours of Internet use, PIU, emotional and behavioral problems, and academic performance were measured.

Results: After adjusting for control variables and academic performance, students who reported having emotional problems (daily hours: adjusted unstandardized β estimate=0.14, 95% CI=0.12~0.15; PIU: adjusted unstandardized β estimate=1.82, 95% CI=1.77~1.89), conduct problems (daily hours: adjusted unstandardized β estimate=0.12, 95% CI=0.09~0.15; PIU: adjusted unstandardized β estimate=1.76, 95% CI=1.67~1.84), hyperactivity (daily hours: adjusted unstandardized β estimate=0.08, 95% CI=0.06~0.12; PIU: adjusted unstandardized β estimate=1.46, 95% CI=1.38~1.54), and peer problems (daily hours: adjusted unstandardized β estimate=0.03, 95% CI=0.002~0.05; PIU: adjusted unstandardized β estimate=0.53, 95% CI=0.44~0.62) were more likely to engaged in prolonged daily Internet use and PIU. In contrast, prosocial behavior was negatively associated with Internet use time and PIU. Stratified analyses showed that some of the associations in poor academic performers were stronger than in students with good and average academic performance.

Limitations: The cross-sectional design limited the ability to make causal inferences.

Conclusions: The findings suggest that the efforts to prevent abnormal Internet use should be focused on students with emotional and behavioral problems or poor academic performance.
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http://dx.doi.org/10.1016/j.jad.2021.03.050DOI Listing
May 2021

Parity and the risks of adverse birth outcomes: a retrospective study among Chinese.

BMC Pregnancy Childbirth 2021 Mar 26;21(1):257. Epub 2021 Mar 26.

Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, Guangdong, China.

Background: Nulliparity is considered to be a risk factor of preterm birth (PTB), low birth weight (LBW) and small for gestational age (SGA). With the new two-child policy launched in 2016, more Chinese women have delivered their 2nd baby. Yet few studies have assessed the impact of parity on adverse birth outcomes in China. This study aimed to examine the association between parity and risks of PTB, LBW and SGA in a Chinese population. The combined effects of maternal age and parity on adverse birth outcomes were also assessed.

Methods: This retrospective study included all non-malformed live births born during January 1, 2014 and December 31, 2018 in Chengdu, China. A total of 746,410 eligible live singletons with complete information were included in the analysis. Parity was classified into nulliparity (i.e. has never delivered a newborn before) and multiparity (i.e. has delivered at least one newborn before). Log-binomial regression analyses were applied to evaluate the association between parity and PTB, LBW and SGA. We further divided maternal age into different groups (< 25 years, 25-29 years, 30-34 years and ≥ 35 years) to assess the combined effects of maternal age and parity on adverse birth outcomes.

Results: Multiparity was associated with reduced risks of PTB (aRR = 0.91, 95% CI: 0.89-0.93), LBW (aRR = 0.74, 95% CI: 0.72-0.77) and SGA (aRR = 0.67, 95% CI: 0.66-0.69) compared with nulliparity. In each age group, we observed that multiparity was associated with lower risks of adverse birth outcomes. Compared to nulliparous women aged between 25 and 29 years, women aged ≥35 years had greater risks of PTB and LBW, regardless of their parity status. In contrast, multiparous women aged ≥35 years (aRR = 0.73, 95% CI: 0.70-0.77) and those aged < 25 years (aRR = 0.88, 95% CI: 0.84-0.93) were at lower risk of SGA compared with nulliparous women aged between 25 and 29 years.

Conclusion: Multiparity was associated with lower risks of all adverse birth outcomes. Special attention should be paid to nulliparous mothers and those with advanced age during antenatal care, in order to reduce the risks of adverse birth outcomes.
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http://dx.doi.org/10.1186/s12884-021-03718-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8004392PMC
March 2021

Association of FKBP5 gene variants with depression susceptibility: A comprehensive meta-analysis.

Asia Pac Psychiatry 2021 Jun 20;13(2):e12464. Epub 2021 Mar 20.

Department of Medical statistics and Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou, China.

Background: This comprehensive meta-analysis aimed to combine data from different studies and to estimate the association between FKBP5 polymorphisms and depression.

Methods: We performed a meta-analysis of observational studies. An electronic search was conducted on four databases for articles published before July 1, 2020.

Results: A total of 5125 patients with depression and 8399 controls from 16 independent studies were included in the analysis. The results showed that FKBP5 rs1360780 was associated with the risk of depression in the codominant model (CT vs. CC; OR = 1.10, 95% CI = 1.00-1.20, P = .04); rs4713916 polymorphism was associated with depression in the codominant model (AG vs. GG; OR = 1.19, 95% CI = 1.05-1.34, P = .008) and recessive model (AA vs. AG + GG; OR = 0.74, 95% CI = 0.56-0.99, P = .04); a significant association between rs3800373 and depression was found in the codominant genetic model (AC vs. AA; OR = 1.18, 95% CI = 1.05-1.34, P = .007) and dominant model (CC + AC vs. AA; OR = 1.15, 95% CI = 1.03-1.30, P = .02); there was no significant association of FKBP5 rs9470080 or rs9296158 with depression in any genetic model (P > .05). No publication bias was observed in our analysis. Moreover, sensitivity analyses demonstrated the Zobel's study significantly affected the heterogeneity for rs4713916 and rs3800373.

Conclusions: FKBP5 rs1360780 was associated with an increased risk of depression in the codominant model. We also found that rs4713916 and rs3800373 were involved in depression, rs4713916 was positively associated with depression in the codominant model and recessive model, and rs3800373 was related to an elevated risk of depression in the codominant model and dominant model.
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http://dx.doi.org/10.1111/appy.12464DOI Listing
June 2021

Association between problematic internet use and behavioral/emotional problems among Chinese adolescents: the mediating role of sleep disorders.

PeerJ 2021 22;9:e10839. Epub 2021 Feb 22.

Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou, China.

Background: Studies that focus on the relationships of problematic Internet use (PIU), sleep disorders, and behavioral/emotional problems were limited. This study aimed to explore (1) the relationship between PIU and behavioral/emotional problems among Chinese adolescents and (2) whether sleep disorders mediate the relationship between PIU and behavioral/emotional problems.

Methods: A total of 1,976 adolescents were recruited by cluster sampling from ten secondary schools in Guangzhou between January and April 2019, and 1,956 of them provided valid information (response rate: 98.9% ). Among them, 50.8% were males and the mean age was 13.6±1.5 years, ranging from 11 to 18 years. Data on behavioral/emotional problems, sleep disorders, and PIU were collected using a self-reported questionnaire. Linear regression models and mediation analyses were performed.

Results: Of the participants, 14.5% (284/1,956) reported moderate to severe PIU, and their average score for total difficulties was significantly higher than the score for average users (14.9±5.5 Vs 9.8±4.7). After adjusting for controlled variables, PIU was further proven to be positively related to elevated levels of behavioral/emotional problems (unstandardized  = 0.16,  < 0.05). In addition, sleep disorders partially mediated the forgoing associations.

Conclusions: Adolescents with problematic Internet habits were at higher risk of developing behavioral and emotional problems than their normal-use peers, and sleep disorders partially mediated the effect. Close attention and effective guidance for adolescents with PIU and behavioral/emotional problems were recommended for parents and schools.
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http://dx.doi.org/10.7717/peerj.10839DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7906038PMC
February 2021

Association between problematic internet use and behavioral/emotional problems among Chinese adolescents: the mediating role of sleep disorders.

PeerJ 2021 22;9:e10839. Epub 2021 Feb 22.

Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou, China.

Background: Studies that focus on the relationships of problematic Internet use (PIU), sleep disorders, and behavioral/emotional problems were limited. This study aimed to explore (1) the relationship between PIU and behavioral/emotional problems among Chinese adolescents and (2) whether sleep disorders mediate the relationship between PIU and behavioral/emotional problems.

Methods: A total of 1,976 adolescents were recruited by cluster sampling from ten secondary schools in Guangzhou between January and April 2019, and 1,956 of them provided valid information (response rate: 98.9% ). Among them, 50.8% were males and the mean age was 13.6±1.5 years, ranging from 11 to 18 years. Data on behavioral/emotional problems, sleep disorders, and PIU were collected using a self-reported questionnaire. Linear regression models and mediation analyses were performed.

Results: Of the participants, 14.5% (284/1,956) reported moderate to severe PIU, and their average score for total difficulties was significantly higher than the score for average users (14.9±5.5 Vs 9.8±4.7). After adjusting for controlled variables, PIU was further proven to be positively related to elevated levels of behavioral/emotional problems (unstandardized  = 0.16,  < 0.05). In addition, sleep disorders partially mediated the forgoing associations.

Conclusions: Adolescents with problematic Internet habits were at higher risk of developing behavioral and emotional problems than their normal-use peers, and sleep disorders partially mediated the effect. Close attention and effective guidance for adolescents with PIU and behavioral/emotional problems were recommended for parents and schools.
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http://dx.doi.org/10.7717/peerj.10839DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7906038PMC
February 2021

Associations Among Screen Time, Sleep Duration and Depressive Symptoms Among Chinese Adolescents.

J Affect Disord 2021 04 2;284:69-74. Epub 2021 Feb 2.

Department of Medical statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China. Electronic address:

Objectives: Relatively few studies have explored the inter-relationship between screen time (ST), sleep duration and depressive symptoms. The study herein sought to determine (1) the relationships between ST, sleep duration and depressive symptoms among Chinese adolescents; (2) whether sleep duration mediates the relationships between ST and depressive symptoms.

Methods: 1 grade students (n=1,976) from ten high schools in Guangzhou, China were invited through cluster sampling between January and April 2019. Self-reported ST with electronic devices and Internet, sleep duration, and The Center for Epidemiology Scale for Depression (CES-D) score were collected. Generalized mixed linear models and mediation analyses were conducted.

Results: There were 1,956 self-reported questionnaires received (response rate: 98.99%). Approximately 25% (471/1,929 for Internet use, 399/1,928 for electronic device) of the total sample reported ST >2 hours/day. Approximately 8.9% (169/1,894) reported a CES-D score >28. Longer ST with electronic devices (estimate=0.52, 95%CI: 0.24~0.80), Internet usage (estimate=0.82, 95%CI: 0.53~1.11) were positively associated with depressive symptoms, while less sleep (estimate=-1.85, 95%CI: -2.27~-1.43) was negatively associated with depressive symptoms. There is significant indirect effect of electronic device usage on depressive symptoms through sleep duration (indirect effect=0.08, 95%CI: 0.01~0.15).

Limitations: This study only included school students from Guangzhou. Causal relationship cannot be inferred by this cross-sectional design.

Conclusions: ST and sleep duration were significantly associated with depressive symptoms severity. The indirect effect of sleep duration suggests a possible mechanism of the association between ST and depressive symptoms. Future interventions to manage depressive symptoms should target sleep time and decrease ST among adolescents.
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April 2021
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