Publications by authors named "Xinguang Chen"

195 Publications

Experiences of surveillance, influential factors, and prevention to end the global coronavirus disease 2019 (COVID-19) pandemic.

Glob Health J 2021 Mar 8;5(1):1-3. Epub 2021 Apr 8.

Department of Epidemiology, University of Florida, Gainesville, FL 32610, USA.

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http://dx.doi.org/10.1016/j.glohj.2021.02.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8032348PMC
March 2021

Experiences of surveillance, influential factors, and prevention to end the global coronavirus disease 2019 (COVID-19) pandemic.

Glob Health J 2021 Mar 8;5(1):1-3. Epub 2021 Apr 8.

Department of Epidemiology, University of Florida, Gainesville, FL 32610, USA.

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http://dx.doi.org/10.1016/j.glohj.2021.02.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8032348PMC
March 2021

Macrophage migration inhibitory factor facilitates the therapeutic efficacy of mesenchymal stem cells derived exosomes in acute myocardial infarction through upregulating miR-133a-3p.

J Nanobiotechnology 2021 Feb 27;19(1):61. Epub 2021 Feb 27.

Section of Pacing and Electrophysiology, Division of Cardiology, The First Affiliated Hospital With Nanjing Medical University, Nanjing, Guangzhou Road 300, Nanjing, 210029, People's Republic of China.

Background: Exosome transplantation is a promising cell-free therapeutic approach for the treatment of ischemic heart disease. The purpose of this study was to explore whether exosomes derived from Macrophage migration inhibitory factor (MIF) engineered umbilical cord MSCs (ucMSCs) exhibit superior cardioprotective effects in a rat model of AMI and reveal the mechanisms underlying it.

Results: Exosomes isolated from ucMSCs (MSC-Exo), MIF engineered ucMSCs (MIF-Exo) and MIF downregulated ucMSCs (siMIF-Exo) were used to investigate cellular protective function in human umbilical vein endothelial cells (HUVECs) and H9C2 cardiomyocytes under hypoxia and serum deprivation (H/SD) and infarcted hearts in rats. Compared with MSC-Exo and siMIF-Exo, MIF-Exo significantly enhanced proliferation, migration, and angiogenesis of HUVECs and inhibited H9C2 cardiomyocyte apoptosis under H/SD in vitro. MIF-Exo also significantly inhibited cardiomyocyte apoptosis, reduced fibrotic area, and improved cardiac function as measured by echocardiography in infarcted rats in vivo. Exosomal miRNAs sequencing and qRT-PCR confirmed miRNA-133a-3p significantly increased in MIF-Exo. The biological effects of HUVECs and H9C2 cardiomyocytes were attenuated with incubation of MIF-Exo and miR-133a-3p inhibitors. These effects were accentuated with incubation of siMIF-Exo and miR-133a-3p mimics that increased the phosphorylation of AKT protein in these cells.

Conclusion: MIF-Exo can provide cardioprotective effects by promoting angiogenesis, inhibiting apoptosis, reducing fibrosis, and preserving heart function in vitro and in vivo. The mechanism in the biological activities of MIF-Exo involves miR-133a-3p and the downstream AKT signaling pathway.
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http://dx.doi.org/10.1186/s12951-021-00808-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7916292PMC
February 2021

Levels of economic developement and the spread of coronavirus disease 2019 (COVID-19) in 50 U.S. states and territories and 28 European countries: an association analysis of aggregated data.

Glob Health J 2021 Mar 9;5(1):24-30. Epub 2021 Feb 9.

College of Public Health and Health Professions & College of Medicine, University of Florida, FL 32610, USA.

Background: The coronavirus disease 2019 (COVID-19) became a global pandemic within several months after it was first reported at the end of December, 2019. Countries in the Northern Hemisphere have been affected the most, including the United States and European countries. Contrary to the common knowledge that infectious diseases are more prevalent in low- and middle-income countries, COVID-19 appears to affect wealthy countries more. This paper attempts to quantify the relationship between COVID-19 infections and levels of economic development with data from the U.S. and Europe.

Methods: Public domain data on the confirmed COVID-19 cases during January 1 and May 31, 2020 by states and territories in the U.S. and by countries in Europe were included. Incidence rate was estimated using the 2019 total population. COVID-19 cases were associated with 2019 gross domestic product (GDP) using regression models after a logarithmic transformation of the data. The U.S. data and European data were analyzed separately, considering significant heterogeneity between the two.

Results: A total of 2 451 691 COVID-19 cases during a 5-month period were analyzed, including 1 787 414 from 50 U.S. states and territories and 664 277 from 28 European countries. The overall incidence rate was 5.393/1000 for the U.S. and 1.411/1 000 for European countries with large variations. Lg (total cases) was significantly associated with lg (GDP) for U.S. states (= 1.2579,  < 0.001) and European countries (= 0.7156,  < 0.001), respectively.

Conclusion: This study demonstrated a positive correlation between COVID-19 case incidence and GDP in the United States and 28 European countries. Study findings suggest a potential role of high-level development in facilitating infectious disease spread, such as more advanced transportation system, large metropolitan cities with high population density, better domestic and international travel for businesses, leisure, and more group activities. These factors must be considered in controlling the COVID-19 epidemic. This study focuses on the impact of economic development, many other factors might also have contributed to the rapid spread of COVID-19 in these countries and states, such as differences in national and statewide anti-epidemic strategies, people's behavior, and healthcare systems. Besides, low- and middle-income countries may have an artificially low COVID-19 case count just due to lack of diagnostic capabilities. Findings of this study also encourage future research with individual-level data to detect risk factors at the personal level to understand the risk of COVID-19.
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http://dx.doi.org/10.1016/j.glohj.2021.02.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7871881PMC
March 2021

Dynamics of the coronavirus disease 2019 (COVID-19) epidemic in Wuhan City, Hubei Province and China: a second derivative analysis of the cumulative daily diagnosed cases during the first 85 days.

Glob Health J 2021 Mar 6;5(1):4-11. Epub 2021 Feb 6.

Department of Preventive Medicine, School of Health Sciences, Wuhan University, Wuhan, Hubei 430072, China.

Background: Controlling the coronavirus disease 2019 (COVID-19) epidemic requires information beyond new and cumulative cases. This study aims to conduct an in-depth analysis by geographic strata: Wuhan City (hereafter referred to as Wuhan) only, Hubei Province (hereafter referred to as Hubei) excluding Wuhan, and China excluding Hubei.

Methods: Daily cumulative confirmed COVID-19 cases between December 8, 2019 (the date of symptom onset based on patients' recall during the investigation), and March 1, 2020, from official sources and published studies were analyzed. The second derivative model was used for information extraction. Data analysis was conducted separately for the three strata.

Results: A total of 80 026 diagnosed COVID-19 cases were reported during the first 85 days of the epidemic, with 49 315 cases from Wuhan, 17 788 from Hubei excluding Wuhan, and 12 923 from China excluding Hubei. Analytical results indicate that the COVID-19 epidemic consists of an Acceleration, a Deceleration, and a Stabilization Phase in all three geographic strata, plus a Silent Attack Phase for Wuhan only. Given the reported incubation period of 14 days, effects of the massive anti-epidemic actions were revealed by both the Acceleration and Deceleration Phases. The Acceleration Phase signaled the effect of the intervention to detect the infected; the Deceleration Phase signaled the declines in new infections after the infected were detected, treated and quarantined.

Conclusion: Findings of the study provide new evidence to better monitor the epidemic, evaluate its response to intervention, and predict the trend long. In addition to re-evaluating the control of the COVID-19 epidemic in China, this study provided a model for monitoring outbreaks of COVID-19 in different countries across the world.
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http://dx.doi.org/10.1016/j.glohj.2021.02.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7866847PMC
March 2021

State fragility and the coronavirus disease 2019 (COVID-19) pandemic: an ecologic analysis of data from 146 countries.

Glob Health J 2021 Mar 6;5(1):18-23. Epub 2021 Feb 6.

Department of Global Health, School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, Beijing 100191, China.

Background: Global spread and impact of the coronavirus disease 2019 (COVID-19) pandemic are determined to a large extent, by resistance to the pandemic and public response of all countries in the world; while a country's resistance and response are in turn determined by its political and socio economic conditions. To inform future disease prevention and control, we analyzed global data to exam the relationship between state vulnerabilities and COVID-19 incidences and deaths.

Methods: Vulnerability was measured using the Fragile States Index (FSI). FSI is created by the Fund for Peace to assess levels of fragility for individual countries. Total FSI score and scores for 12 specific indicators were used as the predictor variables. Outcome variables were national cumulative COVID-19 cases and deaths up to September 16, 2020, derived from the World Health Organization. Cumulative incidence rates were computed using 2019 National population derived from the World Bank, and case fatality rates were computed as the ratio of deaths/COVID-19 cases. Countries with incomplete data were excluded, yielding a final sample of 146 countries. Multivariate regression was used to examine the association between the predictor and the outcome measures.

Results: There were dramatic cross-country variations in both FSI and COVID-19 epidemiological measurements. FSI total scores were negatively associated with both COVID-19 cumulative incidence rates (β = -0.0135, < 0.001) and case fatality rates (β = -0.0147, < 0.05). Of the 12 FSI indicators, three negatively associated with COVID-19 incidences were E1(Economic Decline and Poverty), E3 (Human Flight and Brain Drain), and S2 (Refugees and Internally Displaced Persons); two positively associated were P1 (State Legitimacy) and X1 (External Intervention). With regard to association with case fatality rates, C1 (Security Apparatus) was positive, and P3 (Human Rights and Rule of Law) and X1 was negative.

Conclusion: With FSI measures by the Fund of Peace, overall, more fragile countries are less likely to be affected by the COVID-19 pandemic, and even if affected, death rates were lower. However, poor in state legitimacy and lack of external intervention are risk for COVID-19 infection and lack of security apparatus is risky for COVID-19 death. Implications of the study findings are discussed and additional studies are needed to examine the mechanisms underpinning these relationships.
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http://dx.doi.org/10.1016/j.glohj.2021.02.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7866846PMC
March 2021

Levels of economic growth and cross-province spread of the COVID-19 in China.

J Epidemiol Community Health 2021 Jan 28. Epub 2021 Jan 28.

School of Public Health, Guangxi Medical University, Nanning, China

Background: After the first COVID-19 case detected on 8 December 2019 in Wuhan, the Provincial Capital of Hubei, the epidemic quickly spread throughout the whole country of China. Low developmental levels are often associated with infectious disease epidemic, this study attempted to test this notion with COVID-19 data.

Methods: Data by province from 8 December 2019 to 16 February 2020 were analysed using regression method. Outcomes were days from the first COVID-19 case in the origin of Hubei Province to the date when case was first detected in a destination province, and cumulative number of confirmed cases. Provincial gross domestic products (GDPs) were used to predict the outcomes while considering spatial distance and population density.

Results: Of the total 70 548 COVID-19 cases in all 31 provinces, 58 182 (82.5%) were detected in Hubei and 12 366 (17.5%) in other destination provinces. Regression analysis of data from the 30 provinces indicated that GDP was negatively associated with days of virus spreading (β=-0.2950, p<0.10) and positively associated with cumulative cases (β=97.8709, p<0.01) after controlling for spatial distance. The relationships were reversed with β=0.1287 (p<0.01) for days and β=-54.3756 (p<0.01) for cumulative cases after weighing in population density and controlling for spatial distance.

Conclusion: Higher levels of developmental is a risk factor for cross-province spread of COVID-19. This study adds new data to literature regarding the role of economic growth in facilitating spatial spreading of infectious diseases, and provides timely data informing antiepidemic strategies and developmental plan to balance economic growth and people's health.
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http://dx.doi.org/10.1136/jech-2020-214169DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7844933PMC
January 2021

Aerosolized Beractant in neonatal respiratory distress syndrome: A randomized fixed-dose parallel-arm phase II trial.

Pulm Pharmacol Ther 2021 Feb 16;66:101986. Epub 2020 Dec 16.

Department of Epidemiology, University of Florida College of Medicine, 665 W 8th Street, Jacksonville, FL, 32209, USA.

Purpose: There is increasing research into novel techniques of administering surfactant to preterm infants (PTIs) with respiratory distress syndrome (RDS) receiving non-invasive respiratory support (NIRS). Although aerosolized surfactant (AS) is promising in PTIs receiving NIRS, the optimal surfactant dose and formulation, drug-device combination and patient profile is not known. The objective of this randomized clinical trial was to investigate the feasibility, safety, efficacy and impact of four dosing schedules of AS using two nebulizers in PTIs with RDS stratified by gestational age (GA).

Methods: PTIs with RDS receiving pre-defined NIRS for ≤8 h were assigned to 4 A S dosing schedules and 2 nebulizers within three GA strata (I = 24-28, II = 29-32, III = 33-36 weeks). There was no contemporaneous control group; at the recommendation of the Data Monitoring Committee, data was collected retrospectively for control infants.

Results: Of 149 subjects that received AS, the median age at initiation of the 1st dose and duration was 5.5 and 2.4 h respectively. There were 29 infants in stratum I, and 60 each in strata II and III. Of infants <32 weeks GA, 94% received caffeine prior to AS. Fifteen infants (10%) required intubation within 72 h; the rates were not significantly different between GA strata, dosing schedules and nebulizers for infants who received aerosolized surfactant. Compared to retrospective controls, infants who received AS were less likely to need intubation within 72 h in both the intention-to-treat (32% vs. 11%) and the per-protocol (22% vs. 10%) analyses (p < 0.05) with GA stratum specific differences. AS was well tolerated by infants and clinical caregivers. Commonest adverse events included surfactant reflux from nose and mouth (18%), desaturations (11%), and increased secretions (7%).

Conclusions: We have demonstrated the feasibility, absence of serious adverse events and short-term efficacy of four dosing schedules of AS in the largest Phase II clinical trial of PTIs 24-36 weeks' GA with RDS receiving NIRS (ClinicalTrials.gov NCT02294630). The commonest adverse events noted were surfactant reflux and desaturations; no serious adverse effects were observed. Infants who received AS were less likely to receive intubation within 72 h compared to historical controls. AS is a promising new therapy for PTIs with RDS.
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http://dx.doi.org/10.1016/j.pupt.2020.101986DOI Listing
February 2021

Factors associated with opioid prescriptions among women proximal to pregnancy in the United States.

Res Social Adm Pharm 2020 Nov 17. Epub 2020 Nov 17.

Department of Epidemiology, College of Public Health, University of Florida, Gainesville, FL, USA. Electronic address:

Background: Pregnant women are a vulnerable population exposed to opioids in the United States.

Objective: To examine trends and factors associated with opioid prescribing to women proximal to pregnancy.

Methods: The 2011 to 2015 Medical Expenditure Panel Survey (MEPS) was used to identify participants (n = 3020) with self-reported pregnancy or pregnancy-relevant events aged between 18 and 44 years old. To investigate factors associated with opioid prescriptions, we categorized participants into two subgroups: having one or more opioid prescription or having none during the observational period. We used survey multivariable logistic regression to identify factors associated with opioid prescribing accounting for the complex survey design in MEPS.

Results: From 2011 to 2015, the prevalence of opioid prescribing among study participants was 31%. Opioids were more likely to be prescribed to women who had psychiatric conditions (odds ratio, 1,76, 95%CI: 1.27-2.44, p < 0.001). Other significant factors included being non-Hispanic white or black, living in the South, active tobacco users, and those with lower Physical Component Summary Scores.

Conclusion: Receipt of an opioid prescription in the perinatal period is associated with maternal psychiatric disorders in the United States. Study findings add new data to the literature on opioid use among pregnant women and provide evidence for healthcare providers and policy makers to tailor treatment and educational programs to avoid opioid overuse among pregnant women.
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http://dx.doi.org/10.1016/j.sapharm.2020.11.008DOI Listing
November 2020

Factors associated with opioid prescriptions among women proximal to pregnancy in the United States.

Res Social Adm Pharm 2020 Nov 17. Epub 2020 Nov 17.

Department of Epidemiology, College of Public Health, University of Florida, Gainesville, FL, USA. Electronic address:

Background: Pregnant women are a vulnerable population exposed to opioids in the United States.

Objective: To examine trends and factors associated with opioid prescribing to women proximal to pregnancy.

Methods: The 2011 to 2015 Medical Expenditure Panel Survey (MEPS) was used to identify participants (n = 3020) with self-reported pregnancy or pregnancy-relevant events aged between 18 and 44 years old. To investigate factors associated with opioid prescriptions, we categorized participants into two subgroups: having one or more opioid prescription or having none during the observational period. We used survey multivariable logistic regression to identify factors associated with opioid prescribing accounting for the complex survey design in MEPS.

Results: From 2011 to 2015, the prevalence of opioid prescribing among study participants was 31%. Opioids were more likely to be prescribed to women who had psychiatric conditions (odds ratio, 1,76, 95%CI: 1.27-2.44, p < 0.001). Other significant factors included being non-Hispanic white or black, living in the South, active tobacco users, and those with lower Physical Component Summary Scores.

Conclusion: Receipt of an opioid prescription in the perinatal period is associated with maternal psychiatric disorders in the United States. Study findings add new data to the literature on opioid use among pregnant women and provide evidence for healthcare providers and policy makers to tailor treatment and educational programs to avoid opioid overuse among pregnant women.
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http://dx.doi.org/10.1016/j.sapharm.2020.11.008DOI Listing
November 2020

Historical trends in breast Cancer among women in China from age-period-cohort modeling of the 1990-2015 breast Cancer mortality data.

BMC Public Health 2020 Aug 25;20(1):1280. Epub 2020 Aug 25.

Department of epidemiology and health statistics, School of Health Sciences, Wuhan University, 115 Donghu Road, Wuhan, 430071, China.

Background: Evidence on historical trends extracted embedded in recent data can advance our understanding of the epidemiology of breast cancer for Chinese women. China is a country with significant political, socioeconomic, and cultural events since the 1900s; however, no such studies are reported in the literature.

Methods: Age-specific mortality rates of breast cancer during 1990-2015 in China were analyzed using APC modeling (age-period-cohort modeling) method. Net effect from birth cohort was derived to measure cancer mortality risk during 1906-1990 when no mortality data were collected, and net effect from time period was derived to measure cancer mortality risk during 1990-2015 when data were collected. Model parameters were estimated using intrinsic estimator, a novel method to handle collinearity. The estimated effects were numerical differentiated to enhance presentations of time/age trend.

Results: Breast cancer mortality rate per 100,000 women increased from 6.83 in 1990 to 12.07 in 2015. After controlling for age and period, the risk of breast cancer mortality declined from 0.626 in 1906-10 to - 1.752 in 1991-95 (RR = 0.09). The decline consisted of 3 phases, a gradual phase during 1906-1940, a moderate phase with some fluctuations during 1941-1970, and a rapid phase with large fluctuations during 1971-1995. After controlling for age and cohort, the risk of breast cancer mortality increased from - 0.141 in 1990 to 0.258 in 2015 (RR = 1.49) with an acceleration after 2005. The time trends revealed by both the cohort effect and the period effect were in consistency with the significant political and socioeconomic events in China since the 1900s.

Conclusions: With recent mortality data in 1990-2015, we detected the risk of breast cancer mortality for Chinese women over a long period from 1906 to 2015. The risk declined more than 90% from the highest level in 1906-10 to the lowest in 1990-95, followed by an increase of 49% from 1990 to 2015. Findings of this study connected historical evidence with recent data, supporting further research to exam the relationship between development and risk of breast cancer for medical and health decision-making at the population level and prevention and treatment at the individual level.
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http://dx.doi.org/10.1186/s12889-020-09375-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7445908PMC
August 2020

Historical trends in breast Cancer among women in China from age-period-cohort modeling of the 1990-2015 breast Cancer mortality data.

BMC Public Health 2020 Aug 25;20(1):1280. Epub 2020 Aug 25.

Department of epidemiology and health statistics, School of Health Sciences, Wuhan University, 115 Donghu Road, Wuhan, 430071, China.

Background: Evidence on historical trends extracted embedded in recent data can advance our understanding of the epidemiology of breast cancer for Chinese women. China is a country with significant political, socioeconomic, and cultural events since the 1900s; however, no such studies are reported in the literature.

Methods: Age-specific mortality rates of breast cancer during 1990-2015 in China were analyzed using APC modeling (age-period-cohort modeling) method. Net effect from birth cohort was derived to measure cancer mortality risk during 1906-1990 when no mortality data were collected, and net effect from time period was derived to measure cancer mortality risk during 1990-2015 when data were collected. Model parameters were estimated using intrinsic estimator, a novel method to handle collinearity. The estimated effects were numerical differentiated to enhance presentations of time/age trend.

Results: Breast cancer mortality rate per 100,000 women increased from 6.83 in 1990 to 12.07 in 2015. After controlling for age and period, the risk of breast cancer mortality declined from 0.626 in 1906-10 to - 1.752 in 1991-95 (RR = 0.09). The decline consisted of 3 phases, a gradual phase during 1906-1940, a moderate phase with some fluctuations during 1941-1970, and a rapid phase with large fluctuations during 1971-1995. After controlling for age and cohort, the risk of breast cancer mortality increased from - 0.141 in 1990 to 0.258 in 2015 (RR = 1.49) with an acceleration after 2005. The time trends revealed by both the cohort effect and the period effect were in consistency with the significant political and socioeconomic events in China since the 1900s.

Conclusions: With recent mortality data in 1990-2015, we detected the risk of breast cancer mortality for Chinese women over a long period from 1906 to 2015. The risk declined more than 90% from the highest level in 1906-10 to the lowest in 1990-95, followed by an increase of 49% from 1990 to 2015. Findings of this study connected historical evidence with recent data, supporting further research to exam the relationship between development and risk of breast cancer for medical and health decision-making at the population level and prevention and treatment at the individual level.
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http://dx.doi.org/10.1186/s12889-020-09375-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7445908PMC
August 2020

Reconstructing and forecasting the COVID-19 epidemic in the United States using a 5-parameter logistic growth model.

Glob Health Res Policy 2020 15;5:25. Epub 2020 May 15.

4Department of Statistics and Data Science, Cornell University, Ithaca, USA.

Background: Many studies have modeled and predicted the spread of COVID-19 (coronavirus disease 2019) in the U.S. using data that begins with the first reported cases. However, the shortage of testing services to detect infected persons makes this approach subject to error due to its underdetection of early cases in the U.S. Our new approach overcomes this limitation and provides data supporting the public policy decisions intended to combat the spread of COVID-19 epidemic.

Methods: We used Centers for Disease Control and Prevention data documenting the daily new and cumulative cases of confirmed COVID-19 in the U.S. from January 22 to April 6, 2020, and reconstructed the epidemic using a 5-parameter logistic growth model. We fitted our model to data from a 2-week window (i.e., from March 21 to April 4, approximately one incubation period) during which large-scale testing was being conducted. With parameters obtained from this modeling, we reconstructed and predicted the growth of the epidemic and evaluated the extent and potential effects of underdetection.

Results: The data fit the model satisfactorily. The estimated daily growth rate was 16.8% overall with 95% CI: [15.95, 17.76%], suggesting a doubling period of 4 days. Based on the modeling result, the tipping point at which new cases will begin to decline will be on April 7th, 2020, with a peak of 32,860 new cases on that day. By the end of the epidemic, at least 792,548 (95% CI: [789,162, 795,934]) will be infected in the U.S. Based on our model, a total of 12,029 cases were not detected between January 22 (when the first case was detected in the U.S.) and April 4.

Conclusions: Our findings demonstrate the utility of a 5-parameter logistic growth model with reliable data that comes from a specified period during which governmental interventions were appropriately implemented. Beyond informing public health decision-making, our model adds a tool for more faithfully capturing the spread of the COVID-19 epidemic.
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http://dx.doi.org/10.1186/s41256-020-00152-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7225094PMC
January 2021

Contact- versus noncontact-guided ablation of the right ventricular outflow tract arrhythmias: A propensity score matched analysis.

Pacing Clin Electrophysiol 2020 08 11;43(8):822-827. Epub 2020 Jul 11.

Section of Pacing and Electrophysiology, Division of Cardiology, Jiangsu Province Hospital and the First Affiliated Hospital with Nanjing Medical University, Nanjing, China.

Background: There are unique advantages and disadvantages in the choice of contact mapping (CM) versus noncontact mapping (NCM) systems during ablation of right ventricular outflow tract (RVOT) arrhythmias. This study compared acute procedural success and clinical outcomes in matched patients undergoing CM- versus NCM-guided RVOT ablation.

Methods: A total of 167 consecutive patients with idiopathic RVOT ventricular arrhythmias underwent NCM- or CM-guided ablation. Propensity scoring was used to match each patient undergoing NCM-guided ablation to one control patient undergoing CM-guided ablation.

Results: A total of 120 patients were included in this final analysis. If initial ablation was acutely unsuccessful in either group, patients crossed over to the other group. Ablation was acutely successful in 47 of 60 (78.3 %) patients in the NCM group and 55 of 60 (91.7%) in the CM group (P = .002). Thirteen NCM patients required CM and two CM patients crossed over to utilize NCM (P = .002). Procedural duration, fluoroscopy time, and dose in NCM were greater than that in CM (P < .05, respectively). However, procedural complications were not different between two groups. During a mean follow-up of 51 ± 20.6 months, 51 of the 60 NCM patients remained free of arrhythmia, while 48 of the 60 CM patients had no recurrent arrhythmias (P = .47).

Conclusion: Contact mapping, compared to NCM, is the superior initial technique to guide RVOT arrhythmia ablation due to a higher procedural success without the need to switch to alternative mapping techniques and shorter procedural and fluoroscopic times.
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http://dx.doi.org/10.1111/pace.13935DOI Listing
August 2020

What is global health? Key concepts and clarification of misperceptions: Report of the 2019 GHRP editorial meeting.

Glob Health Res Policy 2020 7;5:14. Epub 2020 Apr 7.

3School of Health Sciences, Wuhan University, Wuhan, China.

The call for "W requires us to improve people's health across the globe, while global health development entails a satisfactory answer to a fundamental question: "What is global health?" To promote research, teaching, policymaking, and practice in global health, we summarize the main points on the definition of global health from the Editorial Board Meeting of Global Health Research and Policy, convened in July 2019 in Wuhan, China. The meeting functioned as a platform for free brainstorming, in-depth discussion, and post-meeting synthesizing. Through the meeting, we have reached a consensus that global health can be considered as a general guiding principle, an organizing framework for thinking and action, a new branch of sciences and specialized discipline in the large family of public health and medicine. The word "global" in global health can be subjective or objective, depending on the context and setting. In addition to dual-, multi-country and global, a project or a study conducted at a local area can be global if it (1) is framed with a global perspective, (2) intends to address an issue with global impact, and/or (3) seeks global solutions to an issue, such as frameworks, strategies, policies, laws, and regulations. In this regard, global health is eventually an extension of "international health" by borrowing related knowledge, theories, technologies and methodologies from public health and medicine. Although global health is a concept that will continue to evolve, our conceptualization through group effort provides, to date, a comprehensive understanding. This report helps to inform individuals in the global health community to advance global health science and practice, and recommend to take advantage of proposed by China.
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http://dx.doi.org/10.1186/s41256-020-00142-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7136700PMC
April 2020

Early prediction of moderate to severe bronchopulmonary dysplasia in extremely premature infants.

Pediatr Neonatol 2020 06 23;61(3):290-299. Epub 2019 Dec 23.

Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Wayne State University, Detroit, MI 48201, USA; Hutzel Women's Hospital, Detroit, MI 48201, USA; Children's Hospital of Michigan, Detroit, MI 48201, USA. Electronic address:

Background: Bronchopulmonary Dysplasia (BPD) is the commonest morbidity in extremely preterm infants (PTIs). Risk factors for BPD have been described in the era before the widespread availability of non-invasive ventilation (NIV) in the delivery room (DR). The objective of this study is to identify risk factors for Moderate/Severe BPD in an era of widespread availability of NIV in the DR.

Methods: Detailed antenatal and postnatal data were abstracted for PTIs, 23-27 weeks GA. Multivariate logistic regression and classification and regression tree analyses (CART) identified predictors for the primary outcome of Moderate/Severe BPD.

Results: Of 263 eligible infants, 59% had Moderate/Severe BPD. Moderate/Severe BPD was significantly associated with birthweight, gender, DR intubation and surfactant compared to No/Mild BPD. Of infants not intubated in the DR, 40% with No/Mild BPD and 80% with Moderate/Severe BPD received intubation by 48 hours (p < 0.05). Infants with Moderate/Severe BPD received longer duration of oxygen and mechanical (MV). On logistic regression, birthweight, gender, oxygen concentration, cumulative duration of oxygen and MV, surfactant, and blood transfusions predicted Moderate/Severe BPD. Both CART analysis and logistic regression showed duration of oxygen and MV to be the most important predictors for Moderate/Severe BPD.

Conclusions: In an era of increasing availability of NIV in the DR, lower birthweight, male gender, surfactant treatment, blood transfusions and respiratory support in the first 2-3 weeks after birth predict Moderate/Severe BPD with high sensitivity and specificity. The majority of these infants received intubation within 48 hours of birth (97%). These data suggest that early failures of NIV represent opportunities for improvement of NIV techniques and of non-invasive surfactant to avoid intubation in the first 48 hours. Furthermore, these risk factors may allow earlier identification of infants most likely to benefit from interventions to prevent or decrease severity of BPD.
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http://dx.doi.org/10.1016/j.pedneo.2019.12.001DOI Listing
June 2020

The novel coronavirus outbreak: what can be learned from China in public reporting?

Glob Health Res Policy 2020 9;5. Epub 2020 Mar 9.

3School of Political Science and Public Administration, Wuhan University, Wuhan, 430072 China.

The new coronavirus outbreak gets everyone's attention. China's national actions against the outbreak have contributed great contributions to the world. China has been learning from practice for better reporting and is fast to adapt itself. In this article we discuss China's practice in public reporting and its implications to global health. Confirmed cases, dynamic suspected cases, recovered cases, and deaths have been reported both in accumulative numbers and their daily updates. Some ratio indictors reporting (fatality rate, recovery rate, etc.), trend reporting, and global surveillance have been applied as well. Some improvements can still be made. It is necessary to further explore the influential factors behind the indicators for interventions. Recommendations are made to the World Health Organization and other countries for better public reporting and surveillance.
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http://dx.doi.org/10.1186/s41256-020-00140-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7061470PMC
January 2021

First two months of the 2019 Coronavirus Disease (COVID-19) epidemic in China: real-time surveillance and evaluation with a second derivative model.

Glob Health Res Policy 2020 2;5. Epub 2020 Mar 2.

1Department of Epidemiology, University of Florida, 2004 Mowry Road, Gainesville, FL USA.

Background: Similar to outbreaks of many other infectious diseases, success in controlling the novel 2019 coronavirus infection requires a timely and accurate monitoring of the epidemic, particularly during its early period with rather limited data while the need for information increases explosively.

Methods: In this study, we used a second derivative model to characterize the coronavirus epidemic in China with cumulatively diagnosed cases during the first 2 months. The analysis was further enhanced by an exponential model with a close-population assumption. This model was built with the data and used to assess the detection rate during the study period, considering the differences between the true infections, detectable and detected cases.

Results: Results from the second derivative modeling suggest the coronavirus epidemic as nonlinear and chaotic in nature. Although it emerged gradually, the epidemic was highly responsive to massive interventions initiated on January 21, 2020, as indicated by results from both second derivative and exponential modeling analyses. The epidemic started to decelerate immediately after the massive actions. The results derived from our analysis signaled the decline of the epidemic 14 days before it eventually occurred on February 4, 2020. Study findings further signaled an accelerated decline in the epidemic starting in 14 days on February 18, 2020.

Conclusions: The coronavirus epidemic appeared to be nonlinear and chaotic, and was responsive to effective interventions. The methods used in this study can be applied in surveillance to inform and encourage the general public, public health professionals, clinicians and decision-makers to take coordinative and collaborative efforts to control the epidemic.
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http://dx.doi.org/10.1186/s41256-020-00137-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7050133PMC
January 2021

Electrocardiogram Characteristics and Arrhythmic Events during Fever in Patients with Fever-Induced Brugada Syndrome.

Cardiology 2020 3;145(3):130-135. Epub 2020 Feb 3.

Section of Pacing and Electrophysiology, Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China,

Introduction: Changes in electrocardiogram (ECG) parameters and the incidence of arrhythmic events in patients with fever-induced Brugada syndrome (BrS) remain unknown.

Objective: We aimed to investigate the effect of hyperthermia on the ECG pattern and the occurrence of fever-triggered arrhythmic events (FTAEs) in patients with fever-induced BrS.

Methods: We retrospectively analyzed a series of fever-induced BrS cases from January 1966 to November 2018. Clinical characteristics and ECG parameters were evaluated in the presence or absence of fever.

Results: Syncope and implantable cardioverter defibrillator implantation occurred more frequently in BrS patients with FTAEs than in patients without FTAEs. In BrS patients <16 years old, more arrhythmia events occurred in patients with FTAEs than in patients without FTAEs (p = 0.04). During follow-up, 2 patients in the FTAEs group suffered new malignant arrhythmic events. Compared to the afebrile state, the J point increased significantly in precordial leads V1, V2, and V3 during the febrile state (all p < 0.01). The corrected QTpeak intervals in V1 and V2 were significantly longer in the FTAEs group than in the non-FTAEs group (354.5 ± 37.0 vs. 334.3 ± 45.5 ms, p < 0.01 and 368.0 ± 43.4 vs. 330.9 ± 41.5 ms, p < 0.01, respectively). An increased corrected QT dispersion and a lengthened corrected Tpeak-Tend dispersion were also observed during fever.

Conclusions: Fever may not only reveal BrS but also induce life-threatening arrhythmic events, especially in children and adolescents.
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http://dx.doi.org/10.1159/000505642DOI Listing
October 2020

Marijuana legalization and historical trends in marijuana use among US residents aged 12-25: results from the 1979-2016 National Survey on drug use and health.

BMC Public Health 2020 Feb 4;20(1):156. Epub 2020 Feb 4.

Department of Epidemiology and Health Statistics School of Health Sciences, Wuhan University, Wuhan, 430071, China.

Background: Marijuana is the most commonly used illicit drug in the United States. More and more states legalized medical and recreational marijuana use. Adolescents and emerging adults are at high risk for marijuana use. This ecological study aims to examine historical trends in marijuana use among youth along with marijuana legalization.

Method: Data (n = 749,152) were from the 31-wave National Survey on Drug Use and Health (NSDUH), 1979-2016. Current marijuana use, if use marijuana in the past 30 days, was used as outcome variable. Age was measured as the chronological age self-reported by the participants, period was the year when the survey was conducted, and cohort was estimated as period subtracted age. Rate of current marijuana use was decomposed into independent age, period and cohort effects using the hierarchical age-period-cohort (HAPC) model.

Results: After controlling for age, cohort and other covariates, the estimated period effect indicated declines in marijuana use in 1979-1992 and 2001-2006, and increases in 1992-2001 and 2006-2016. The period effect was positively and significantly associated with the proportion of people covered by Medical Marijuana Laws (MML) (correlation coefficients: 0.89 for total sample, 0.81 for males and 0.93 for females, all three p values < 0.01), but was not significantly associated with the Recreational Marijuana Laws (RML). The estimated cohort effect showed a historical decline in marijuana use in those who were born in 1954-1972, a sudden increase in 1972-1984, followed by a decline in 1984-2003.

Conclusion: The model derived trends in marijuana use were coincident with the laws and regulations on marijuana and other drugs in the United States since the 1950s. With more states legalizing marijuana use in the United States, emphasizing responsible use would be essential to protect youth from using marijuana.
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http://dx.doi.org/10.1186/s12889-020-8253-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6998313PMC
February 2020

Cumulative HIV Viremia Copy-Years and Hypertension in People Living with HIV.

Curr HIV Res 2020 ;18(3):143-153

Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, Florida, United States.

Background: Evidence regarding the association between HIV viral load (VL) and hypertension is inconsistent. In this study, we investigated the relationship using viremia copy-years (VCY), a cumulative measure of HIV plasma viral burden.

Methods: Data were analyzed for 686 PLWH in the Florida Cohort Study, who had at least five years of VL data before the baseline. VL data were extracted from Enhanced HIV/AIDS Reporting System (eHARS) and used to define peak VL (pVL), recent VL (rVL), and undetectable VL (uVL: rVL<50copies/mL). A five-year VCY (log10 copy × years/mL) before the baseline investigation, was calculated and divided into 5 groups (≤2.7, 2.8-3.7, 3.8-4.7, 4.8-5.7 and >5.7) for analysis. Hypertension was determined based on hypertension diagnosis from medical records. Multivariable logistic regression was used for association analysis.

Results: Of the total sample, 277 (40.4%) participants were hypertensive. Compared to the participants with lowest VCY (≤2.7 log10 copy × years/mL), the odds ratios (OR) and 95% confidence interval [95% CI] for hypertension of the remaining four groups, in order, were 1.91 [1.11, 3.29], 1.91 [1.03, 3.53], 2.27 [1.29, 3.99], and 1.25 [0.65, 2.42], respectively, controlling for confounders. The association was independent of pVL, rVL, and uVL, each of which was not significantly associated with hypertension.

Conclusion: Persistent HIV infection is a risk factor for hypertension among PLWH. Information provided by VCY is more effective than single time-point VL measures in investigating HIV infection- hypertension relationship. The findings of this study support the significance of continuous viral suppression in hypertension prevention among PLWH.
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http://dx.doi.org/10.2174/1570162X18666200131122206DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7877548PMC
January 2020

Protection motivation theory in predicting cervical cancer screening participation: A longitudinal study in rural Chinese women.

Psychooncology 2020 03 11;29(3):564-571. Epub 2019 Dec 11.

Department of Epidemiology, School of Health Sciences, Wuhan University, Wuhan, China.

Objective: To examine factors longitudinally associated with cervical cancer screening uptake among rural Chinese women, guided by protection motivation theory (PMT).

Methods: A large sample of women (n = 2408, aged 35-65 years old) was randomly selected from a rural county in China in 2015 and followed up for 2 years. Data for demographic factors, knowledge of cervical cancer screening, screening outcome, and six PMT constructs measured at the baseline in 2015 were used to predict cervical cancer screening participation at the follow-up in 2017 using structural equation model method.

Results: Among the 2408 women at the baseline, 1879 (78.03%) participated in the screening services at the follow-up. In addition to significant direct effect of age, social status and baseline screening outcome, and three (perceived severity, fear arousal and response efficacy) of the six PMT subconstructs, four variables (age, social status, knowledge of cervical cancer screening, and baseline screening outcome) at the baseline were indirectly associated with screening participation, mediated by the three significant PMT subconstructs.

Conclusions: Findings of this study indicate that the rate of participating in cervical cancer screening for rural women needs to be further improved. In addition to the commonly reported influential factors, PMT subconstructs play important roles in encouraging rural women in China to participate in cervical cancer screening. These longitudinal findings provided data much needed for future research to develop evidence-based intervention programs to enhance cervical cancer screening among rural women in China.
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http://dx.doi.org/10.1002/pon.5307DOI Listing
March 2020

Association of Long-Term Dynamics in Circulating Testosterone with Serum PSA in Prostate Cancer-Free Men with Initial-PSA < 4 ng/mL.

Horm Cancer 2019 12 16;10(4-6):168-176. Epub 2019 Oct 16.

Department of Epidemiology, University of Florida, Gainesville, FL, USA.

We previously reported that an accelerated decline in circulating testosterone level is associated with a higher risk of prostate cancer (PCa). This study is to examine whether testosterone change rate is related to serum prostate-specific antigen (PSA) concentration among PCa-free men. Longitudinal data were derived from electronic medical records at a tertiary hospital in the Southeastern USA. PCa-free men with initial-PSA < 4 ng/mL and ≥ 2 testosterone measurements were included (n = 632). Three PSA measures (peak, the most recent, and average PSA) during the study period (from first testosterone measurement to the most recent hospital visit) were examined using multivariable-adjusted geometric means and were compared across quintiles of testosterone change rate (ng/dL/month) and current testosterone level (cross-sectional). Mean (standard deviation, SD) age at baseline was 59.3 (10.5) years; mean study period was 93.0 (55.3) months. After adjusting for covariates including baseline testosterone, the three PSA measures all significantly increased across quintile of testosterone change rate from increase to decline (peak PSA: quint 1 = 1.09, quint 5 = 1.41; the most recent PSA: quint 1 = 0.85, quint 5 = 1.00; average PSA: quint 1 = 0.89, quint 5 = 1.02; all P < 0.001). But current testosterone level was not associated with PSA levels. Stratified analyses indicated men with higher adiposity (body mass index > 24.1 kg/m) or lower baseline testosterone (≤ 296 ng/dL) were more sensitive to testosterone change in regard to PSA. Among PCa-free men, accelerated testosterone decline might correlate with higher serum PSA concentration. It will help to elucidate the mechanisms relating aging-accompanying testosterone dynamics to prostate carcinogenesis.
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http://dx.doi.org/10.1007/s12672-019-00369-yDOI Listing
December 2019

Association of statin use with risk of Gleason score-specific prostate cancer: A hospital-based cohort study.

Cancer Med 2019 12 8;8(17):7399-7407. Epub 2019 Oct 8.

Department of Epidemiology, University of Florida, Gainesville, Florida.

Background: Conflicting evidence suggests that statins act chemopreventively against prostate cancer (PCa). Whether the association of statin use with PCa risk is Gleason score-dependent, time-, dose-respondent is not well studied.

Methods: We conducted a cohort study at a tertiary hospital in the Southeastern US using longitudinal data of electronic medical records (EMR) from 1994 to 2016. Only cancer-free men aged >18 years at baseline with follow-up time of ≥12 months were included. Time-dependent Cox proportional hazards regression was used to estimate adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs).

Results: Among 13 065 men, 2976 were diagnosed with PCa over median follow-up of 6.6 years. Statin use was associated with lower risk of both Gleason low- (score <7: aHR, 0.85; 95% CI, 0.74-0.96) and high-grade PCa (score ≥7: aHR, 0.54; 95% CI, 0.42-0.69). The protective association was observed only when statins had been used for a relatively longer duration (≥11 months) or higher dose (≥121 defined daily doses), and were more pronounced for PCa of higher Gleason score (<7: aHR, 0.85, 95% CI, 0.74-0.96; 7 [3 + 4]: aHR, 0.62, 95% CI, 0.43-0.90; 7 [4 + 3]: aHR, 0.49, 95% CI, 0.29-0.82; 8: aHR, 0.60, 95% CI, 0.37-0.96; 9-10: aHR, 0.24, 95% CI, 0.11-0.54). Lipophilic statins (aHR, 0.83; 95% CI, 0.72-0.95) might be more protective than hydrophilic statins (aHR, 0.91, 95% CI, 0.63-1.33) against PCa.

Conclusion: Statin use might be associated with reduced PCa risk only when used for a relatively longer duration, and the risk reduction was higher for PCa of higher Gleason score.
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http://dx.doi.org/10.1002/cam4.2500DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6885894PMC
December 2019

Association of statin use with risk of Gleason score-specific prostate cancer: A hospital-based cohort study.

Cancer Med 2019 12 8;8(17):7399-7407. Epub 2019 Oct 8.

Department of Epidemiology, University of Florida, Gainesville, Florida.

Background: Conflicting evidence suggests that statins act chemopreventively against prostate cancer (PCa). Whether the association of statin use with PCa risk is Gleason score-dependent, time-, dose-respondent is not well studied.

Methods: We conducted a cohort study at a tertiary hospital in the Southeastern US using longitudinal data of electronic medical records (EMR) from 1994 to 2016. Only cancer-free men aged >18 years at baseline with follow-up time of ≥12 months were included. Time-dependent Cox proportional hazards regression was used to estimate adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs).

Results: Among 13 065 men, 2976 were diagnosed with PCa over median follow-up of 6.6 years. Statin use was associated with lower risk of both Gleason low- (score <7: aHR, 0.85; 95% CI, 0.74-0.96) and high-grade PCa (score ≥7: aHR, 0.54; 95% CI, 0.42-0.69). The protective association was observed only when statins had been used for a relatively longer duration (≥11 months) or higher dose (≥121 defined daily doses), and were more pronounced for PCa of higher Gleason score (<7: aHR, 0.85, 95% CI, 0.74-0.96; 7 [3 + 4]: aHR, 0.62, 95% CI, 0.43-0.90; 7 [4 + 3]: aHR, 0.49, 95% CI, 0.29-0.82; 8: aHR, 0.60, 95% CI, 0.37-0.96; 9-10: aHR, 0.24, 95% CI, 0.11-0.54). Lipophilic statins (aHR, 0.83; 95% CI, 0.72-0.95) might be more protective than hydrophilic statins (aHR, 0.91, 95% CI, 0.63-1.33) against PCa.

Conclusion: Statin use might be associated with reduced PCa risk only when used for a relatively longer duration, and the risk reduction was higher for PCa of higher Gleason score.
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http://dx.doi.org/10.1002/cam4.2500DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6885894PMC
December 2019

Nonlinear Dynamics of Binge Drinking among U.S. High School Students in Grade 12: Cusp Catastrophe Modeling of National Survey Data.

Nonlinear Dynamics Psychol Life Sci 2019 10;23(4):465-490

University of North Carolina, Chapel Hill, NC.

Findings from cusp catastrophe modeling of binge drinking among college students in the United States (U.S.) and high school students in other countries (i.e., Japan) have advanced our understanding of alcohol abuse. No reported study has used the same method to investigate binge drinking among U.S. high school students, a high-risk population for alcohol abuse. In this study, we analyzed data for 12th graders (n = 1122) from the 2015 Monitoring the Future (MFT) Study with cusp catastrophe models. Guided by Kahneman's dual-system theory that integrates the theories of reasoned action and planned behavior, perceived alcohol harm (0-3, larger indicating less harm) was modeled as asymmetry variable (knowledge and beliefs), and drinking in social settings (contextual factors, 0 = no and 4 = always) as bifurcation variable to predict binge drinking in the past two weeks (0, 1, 2, 3 or more times). Analytical results indicated that a cusp model, depending on the method for parameter estimation could explain 36-88% of the variance in binge drinking while a linear model only explained up to 14%. Results from the indirect cusp modeling methods indicated that perceived alcohol harm and drinking in social settings both significantly predicted binge drinking. However, the estimated cusp point varied depending on the method for parameter estimation. In conclusion, the dynamics of binge drinking among U.S. high school students are nonlinear and discrete. Knowledge-based interventions to prevent binge drinking need to emphasize social and contextual factors that may trigger sudden behavior change to achieve greater intervention effect. To advance cusp catastrophe modeling, further research is needed to improve the method for parameter estimation.
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October 2019

The interaction between detectable plasma viral load and increased body mass index on hypertension among persons living with HIV.

AIDS Care 2020 07 18;32(7):890-895. Epub 2019 Sep 18.

Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, Florida, USA.

Increased body mass index (BMI) and HIV are each associated with hypertension. This study tested interactions between BMI and detectable plasma viral load (pVL) on hypertension among 659 persons living with HIV (PLWH). All participants were categorized into four subgroups based on BMI (<25 and ≥25 kg/m) and pVL (<200 and ≥200 copies/ml). Multiplicative interaction was assessed using logistic regression; addictive interaction was assessed using three measures: Relative Excess Risk due to Interaction (RERI), Attributable Proportion (AP), and Synergy index (S). Compared to the participants with normal BMI and undetectable pVL, those who had increased BMI with an undetectable pVL had an elevated risk of hypertension with OR [95%CI] = 1.80 [1.02, 3.20]; the risk was further increased for those who had increased BMI with detectable pVL with OR [95%CI] = 3.54 [1.71, 7.31]. The multiplicative interaction was significant ( = 0.01). Results from additive interaction indicated RERI [95%CI] =1.89 [0.76, 4.79] and AP [95%CI] = 0.64 [0.32, 0. 95]. The interaction effects of increased BMI and detectable pVL on hypertension on both multiplicative and additive scales suggested that PLWH with increased BMI and detectable pVL should be intensively managed and monitored for hypertension prevention and treatment.
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http://dx.doi.org/10.1080/09540121.2019.1668521DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7874985PMC
July 2020

The interaction between detectable plasma viral load and increased body mass index on hypertension among persons living with HIV.

AIDS Care 2020 07 18;32(7):890-895. Epub 2019 Sep 18.

Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, Florida, USA.

Increased body mass index (BMI) and HIV are each associated with hypertension. This study tested interactions between BMI and detectable plasma viral load (pVL) on hypertension among 659 persons living with HIV (PLWH). All participants were categorized into four subgroups based on BMI (<25 and ≥25 kg/m) and pVL (<200 and ≥200 copies/ml). Multiplicative interaction was assessed using logistic regression; addictive interaction was assessed using three measures: Relative Excess Risk due to Interaction (RERI), Attributable Proportion (AP), and Synergy index (S). Compared to the participants with normal BMI and undetectable pVL, those who had increased BMI with an undetectable pVL had an elevated risk of hypertension with OR [95%CI] = 1.80 [1.02, 3.20]; the risk was further increased for those who had increased BMI with detectable pVL with OR [95%CI] = 3.54 [1.71, 7.31]. The multiplicative interaction was significant ( = 0.01). Results from additive interaction indicated RERI [95%CI] =1.89 [0.76, 4.79] and AP [95%CI] = 0.64 [0.32, 0. 95]. The interaction effects of increased BMI and detectable pVL on hypertension on both multiplicative and additive scales suggested that PLWH with increased BMI and detectable pVL should be intensively managed and monitored for hypertension prevention and treatment.
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http://dx.doi.org/10.1080/09540121.2019.1668521DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7874985PMC
July 2020

Aerosolized surfactant in neonatal respiratory distress syndrome: Phase I study.

Early Hum Dev 2019 07 20;134:19-25. Epub 2019 May 20.

University of Florida College of Medicine, College of Public Health, 2004 Mowray Road, Gainesville, FL 32610, USA. Electronic address:

Background: Treating respiratory distress syndrome (RDS) with intratracheal surfactant requires endotracheal intubation and mechanical ventilation, (MV) with their attendant risks. Use of non-invasive respiratory support in the delivery room averts the need for MV but delays surfactant administration.

Objective: We hypothesized that aerosolized surfactant is feasible and safe in infants 24-36 weeks gestational age (GA) with RDS, receiving non-invasive respiratory support.

Design/methods: In an unblinded Phase I study, sequentially enrolled infants with RDS stratified by GA received increasing doses (100 or 200 mg/kg of phospholipid) and dilutions (12.5 or 8.3 mg/ml) of surfactant using a jet nebulizer. Infants were monitored clinically and with cerebral oximetry.

Results: Seventeen infants were enrolled. Age at start of first dose and dose duration were 4.9 (3.4-10.1) and 2.1 (1.0-2.8) hours respectively. Two infants in the lowest GA stratum (24-28) required intubation within 2 h after the first dose. Fifteen infants completed the study; 13 received two doses. Infants tolerated the aerosol treatment well. No other significant adverse events were identified. Parental permission for cerebral oximetry was obtained in 16 infants. In the two infants who later exited the study, values prior to start of aerosolized surfactant were lower compared to 14 infants who completed the study (p = 0.0835), increased after start of study intervention (p = 0.0105) and decreased after intubation (p = 0.0003).

Conclusions: We have demonstrated the feasibility and safety of aerosolized surfactant in preterm infants receiving non-invasive respiratory support. The treatment was well tolerated by infants and clinical caregivers.
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http://dx.doi.org/10.1016/j.earlhumdev.2019.05.005DOI Listing
July 2019

Willingness of individuals with eating disorders to participate in health research.

Int J Eat Disord 2019 08 7;52(8):914-923. Epub 2019 May 7.

Department of Epidemiology, University of Florida, Gainesville, Florida.

Background/aims: This study examines the association between eating disorders (EDs) and willingness to participate in health research studies among community members.

Materials & Method: Data were collected from Health Street, a University of Florida community engagement initiative which aims to reduce disparities in healthcare and health research by direct engagement of community members.

Results: Among 8,226 community members, 3.9% (n = 324) reported a lifetime ED. For all six types of health research studies queried, individuals with a lifetime ED reported a higher willingness to participate in health research compared to individuals without a history. After adjusting for selected covariates, individuals with ED were significantly more likely than individuals without ED to say they would be willing to volunteer for research studies that: ask questions about health (OR: 7.601, 95% CI: [1.874, 30.839]); require an overnight stay in a hospital (OR: 2.041, 95% CI: [1.442, 2.889]); and provide no remuneration (OR: 1.415, 95% CI: [1.022, 1.958]). Furthermore, when compared to individuals with anxiety or depression, individuals with ED reported increased interest in research participation and increased willingness to participate in most types of research studies assessed. After stratifying by gender and race, we observed few differences in willingness to participate in research among individuals with ED.

Discussion: These findings contribute to our current understanding of participant recruitment and enrollment in ED health research. Underrepresented populations who often do not seek treatment for EDs endorsed a high willingness to participate.

Conclusion: Future studies will likely benefit from including community members in ED research.
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http://dx.doi.org/10.1002/eat.23090DOI Listing
August 2019