Publications by authors named "Yuantao Hao"

139 Publications

HIV diagnosis period influences ART initiation: findings from a prospective cohort study in China.

AIDS Res Ther 2021 09 9;18(1):59. Epub 2021 Sep 9.

School of Public Health, Sun Yat-sen University, No. 74 Zhongshan Road 2, Guangzhou, 510080, Guangdong, China.

Background: We estimated the predictive effects of ART-related perceptions on the actual ART uptake behavior among ART naïve PLWH stratified by different time of HIV diagnosis under the new strategy.

Methods: A prospective cohort study was conducted among ART naïve PLWH in Guangzhou, China from June 2016 to June 2017. Cox regression model was used to evaluate the predictive effects of ART-related perceptions on ART initiation among PLWH stratified by different timepoint of HIV diagnosis (i.e., before or after the update of the new treatment policy).

Results: Among 411 participants, 150 and 261 were diagnosed before (pre-scaleup group) and after (post-scaleup group) the implementation of the new strategy, respectively. The ART initiation rate in the post-scaleup group (88.9%) was higher than that in the pre-scaleup group (73.3%) (p < 0.001). A significant difference of mean score was detected in each HBM construct between pre- and post-scaleup groups (p < 0.05). After adjusting for significant background variables, among all participants, only the self-efficacy [adjusted HR (HRa) = 1.23, 95% CI 1.06 to 1.43, p = 0.006], has a predictive effect on ART initiation; in pre-scaleup group, all constructs of HBM-related ART perceptions were predictors of ART initiation (HRa = 0.71 to 1.83, p < 0.05), while in post-scaleup group, no significant difference was found in each construct (p > 0.05).

Conclusions: The ART initiation rate was high particularly among participants who diagnosed after the new treatment strategy. The important role of the time of HIV diagnosis on ART initiation identified in this study suggested that future implementation interventions may consider to modify the ART-related perceptions for HIV patients who diagnosed before the implementation of the new ART strategy, while expand the accessibility of ART service for those who diagnosed after the implementation of the new strategy.
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http://dx.doi.org/10.1186/s12981-021-00379-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8428057PMC
September 2021

Moderating effect of self-efficacy on the association of intimate partner violence with risky sexual behaviors among men who have sex with men in China.

BMC Infect Dis 2021 Sep 1;21(1):895. Epub 2021 Sep 1.

School of Public Health, Sun Yat-Sen University, North Campus, 74# Zhongshan 2nd Road, Guangzhou, 510000, China.

Background: In China, men who have sex with men (MSM) face a high risk of HIV infection. Intimate partner violence (IPV) is common in this population and leads to various adverse consequences, including risky sexual behaviors, substance abuse, and poor mental health, which pose huge challenges to HIV prevention and control.

Methods: An anonymous cross-sectional study was conducted to investigate the lifetime prevalence of IPV and prevalence of risky sexual behaviors during the previous 6 months in a convenience sample of 578 MSM from 15 cities covering seven geographical divisions in mainland China. The associations between IPV and risky sexual behaviors and the moderating effect of self-efficacy on these associations were explored through univariate and multivariate regression analyses.

Results: The prevalence rates of IPV perpetration and victimization were 32.5% and 32.7%, respectively. The proportions of participants who reported inconsistent condom use with regular or casual partners and multiple regular or casual sexual partners were 25.8%, 8.3%, 22.2%, and 37.4%, respectively. Multiple IPV experiences were positively associated with risky sexual behaviors; for example, any IPV victimization was positively associated with multiple regular partners, adjusted odds ratio (ORa) = 1.54, 95% CI [1.02,2.32], and multiple casual partners, ORa = 1.93, 95% CI [1.33, 2.80]. Any IPV perpetration was positively associated with inconsistent condom use with regular partners, ORa = 1.58, 95% CI [1.04, 2.40], and multiple casual partners, ORa = 2.11, 95% CI [1.45, 3.06]. Self-efficacy was identified as a significant moderator of the association between multiple casual sexual partnership and emotional IPV.

Conclusions: In conclusion, given the high prevalence of both IPV and risky sexual behaviors among Chinese MSM in this study, the inclusion of self-efficacy in interventions targeting IPV and risky sexual behaviors should be considered.
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http://dx.doi.org/10.1186/s12879-021-06618-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8408951PMC
September 2021

Impact of the gate-keeping policies of China's primary healthcare model on the future burden of tuberculosis in China: a protocol for a mathematical modelling study.

BMJ Open 2021 08 25;11(8):e048449. Epub 2021 Aug 25.

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

Introduction: In the past three decades, China has made great strides in the prevention and treatment of tuberculosis (TB). However, the TB burden remains high. In 2019, China accounted for 8.4% of global incident cases of TB, the third highest in the world, with a higher prevalence in rural areas. The Healthy China 2030 highlights the gate-keeping role of primary healthcare (PHC). However, the impact of PHC reforms on the future TB burden is unclear. We propose to use mathematical models to project and evaluate the impacts of different gate-keeping policies.

Methods And Analysis: We will develop a deterministic, population-level, compartmental model to capture the dynamics of TB transmission within adult rural population. The model will incorporate seven main TB statuses, and each compartment will be subdivided by service providers. The parameters involving preference for healthcare seeking will be collected using discrete choice experiment (DCE) method. We will solve the deterministic model numerically over a 20-year (2021-2040) timeframe and predict the TB prevalence, incidence and cumulative new infections under the status quo or various policy scenarios. We will also conduct an analysis following standard protocols to calculate the average cost-effectiveness for each policy scenario relative to the status quo. A numerical calibration analysis against the available published TB prevalence data will be performed using a Bayesian approach.

Ethics And Dissemination: Most of the data or parameters in the model will be obtained based on secondary data (eg, published literature and an open-access data set). The DCE survey has been reviewed and approved by the Ethics Committee of the School of Public Health, Sun Yat-sen University. The approval number is SYSU [2019]140. Results of the study will be disseminated through peer-reviewed journals, media and conference presentations.
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http://dx.doi.org/10.1136/bmjopen-2020-048449DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8390147PMC
August 2021

Evaluation of China's Hubei control strategy for COVID-19 epidemic: an observational study.

BMC Infect Dis 2021 Aug 16;21(1):820. Epub 2021 Aug 16.

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

Background: To fight against COVID-19, many policymakers are wavering on stricter public health interventions. Examining the different strategies both in and out of China's Hubei province, which contained the epidemic in late February 2020, could yield valuable guidance for the management of future pandemics. This study assessed the response process and estimated the time-varying effects of the Hubei control strategy. Analysis of these strategies provides insights for the design and implementation of future policy interventions.

Methods: We retrospectively compared the spread and control of COVID-19 between China's Hubei (excluding Wuhan) and non-Hubei areas using data that includes case reports, human mobility, and public health interventions from 1 January to 29 February 2020. Static and dynamic risk assessment models were developed to statistically investigate the effects of the Hubei control strategy on the virus case growth after adjusting importation risk and policy response timing with the non-Hubei strategy as a control.

Results: The analysis detected much higher but differential importation risk in Hubei. The response timing largely coincided with the importation risk in non-Hubei areas, but Hubei areas showed an opposite pattern. Rather than a specific intervention assessment, a comprehensive comparison showed that the Hubei control strategy implemented severe interventions characterized by unprecedentedly strict and 'monitored' self-quarantine at home, while the non-Hubei strategy included physical distancing measures to reduce contact among individuals within or between populations. In contrast with the non-Hubei control strategy, the Hubei strategy showed a much higher, non-linear and gradually diminishing protective effect with at least 3 times fewer cases.

Conclusions: A risk-based control strategy was crucial to the design of an effective response to the COVID-19 outbreak. Our study demonstrates that the stricter Hubei strategy achieves a stronger controlling effect compared to other strategies. These findings highlight the health benefits and policy impacts of precise and differentiated strategies informed by constant monitoring of outbreak risk.
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http://dx.doi.org/10.1186/s12879-021-06502-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8366153PMC
August 2021

Difficulties encountered by public health workers in COVID-19 outbreak: a cross-sectional study based on five provinces.

BMC Health Serv Res 2021 Jul 5;21(1):656. Epub 2021 Jul 5.

School of Public Health, Global Health Institute, Key Laboratory of Tropical Disease Control, Sun Yat-sen University, 510080, Guangzhou, China.

Objectives: The aim of this study is to address the difficulties encountered by public health workers in the early and middle stages of their efforts to combat COVID-19, compare the gaps among different types of institutions, and identify shortcomings in epidemic control.

Methods: Using multi-stage sampling, a survey of public health workers involved in the prevention and control of COVID-19 was conducted from 18 February to 1 March 2020 through a self-administered questionnaire. These public health workers were from the primary health care center (defined as "primary-urban" and "primary-rural" for those in urban and rural areas, respectively) and the center for disease control and prevention (defined as "non-primary") in five provinces including Hubei, Guangdong, Sichuan, Jiangsu and Gansu, China.

Results: A total of 9,475 public health workers were surveyed, of which 40.0 %, 27.0 % and 33.0 % were from the primary-rural, primary-urban and non-primary, respectively. The resources shortage were reported by 27.9 % participants, with the primary-rural being the worst affected (OR = 1.201, 95 %CI: 1.073-1.345). The difficulties in data processing were reported by 31.5 % participants, with no significant differences among institutions. The difficulties in communication and coordination were reported by 29.8 % participants, with the non-primary being the most serious (primary-rural: OR = 0.520, 95 %CI: 0.446-0.606; primary-urban: OR = 0.533, 95 %CI: 0.454-0.625). The difficulties with target audiences were reported by 20.2 % participants, with the primary-urban being the worst (OR = 1.368, 95 %CI: 1.199-1.560). The psychological distress were reported by 48.8 % participants, with no significant differences among institutions.

Conclusions: Psychological distress is the most serious problem in the prevention and control of COVID-19. Resources shortage in primary-rural, difficulties in communication and coordination in non-primary, and difficulties with target audiences in the primary-urban deserve attention. This study will provide scientific evidences for improving the national public health emergency management system, especially for reducing the urban-rural differences in emergency response capacity.
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http://dx.doi.org/10.1186/s12913-021-06699-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8256394PMC
July 2021

Difficulties encountered by public health workers in COVID-19 outbreak: a cross-sectional study based on five provinces.

BMC Health Serv Res 2021 Jul 5;21(1):656. Epub 2021 Jul 5.

School of Public Health, Global Health Institute, Key Laboratory of Tropical Disease Control, Sun Yat-sen University, 510080, Guangzhou, China.

Objectives: The aim of this study is to address the difficulties encountered by public health workers in the early and middle stages of their efforts to combat COVID-19, compare the gaps among different types of institutions, and identify shortcomings in epidemic control.

Methods: Using multi-stage sampling, a survey of public health workers involved in the prevention and control of COVID-19 was conducted from 18 February to 1 March 2020 through a self-administered questionnaire. These public health workers were from the primary health care center (defined as "primary-urban" and "primary-rural" for those in urban and rural areas, respectively) and the center for disease control and prevention (defined as "non-primary") in five provinces including Hubei, Guangdong, Sichuan, Jiangsu and Gansu, China.

Results: A total of 9,475 public health workers were surveyed, of which 40.0 %, 27.0 % and 33.0 % were from the primary-rural, primary-urban and non-primary, respectively. The resources shortage were reported by 27.9 % participants, with the primary-rural being the worst affected (OR = 1.201, 95 %CI: 1.073-1.345). The difficulties in data processing were reported by 31.5 % participants, with no significant differences among institutions. The difficulties in communication and coordination were reported by 29.8 % participants, with the non-primary being the most serious (primary-rural: OR = 0.520, 95 %CI: 0.446-0.606; primary-urban: OR = 0.533, 95 %CI: 0.454-0.625). The difficulties with target audiences were reported by 20.2 % participants, with the primary-urban being the worst (OR = 1.368, 95 %CI: 1.199-1.560). The psychological distress were reported by 48.8 % participants, with no significant differences among institutions.

Conclusions: Psychological distress is the most serious problem in the prevention and control of COVID-19. Resources shortage in primary-rural, difficulties in communication and coordination in non-primary, and difficulties with target audiences in the primary-urban deserve attention. This study will provide scientific evidences for improving the national public health emergency management system, especially for reducing the urban-rural differences in emergency response capacity.
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http://dx.doi.org/10.1186/s12913-021-06699-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8256394PMC
July 2021

Mental Health Help-Seeking and Associated Factors Among Public Health Workers During the COVID-19 Outbreak in China.

Front Public Health 2021 11;9:622677. Epub 2021 May 11.

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

The COVID-19 outbreak in China has created multiple stressors that threaten individuals' mental health, especially among public health workers (PHW) who are devoted to COVID-19 control and prevention work. This study aimed to investigate the prevalence of mental help-seeking and associated factors among PHW using Andersen's Behavioral Model of Health Services Use (BMHSU). A cross-sectional survey was conducted among 9,475 PHW in five provinces across China between February 18 and March 1, 2020. The subsample data of those who reported probable mental health problems were analyzed for this report ( = 3,417). Logistic and hierarchical regression analyses were conducted to examine the associations of predisposing, enabling, need, and COVID-19 contextual factors with mental health help-seeking. Only 12.7% of PHW reported professional mental help-seeking during the COVID-19 outbreak. PHW who were older, had more days of overnight work, received psychological training, perceived a higher level of support from the society, had depression and anxiety were more likely to report mental help-seeking (OR range: 1.02-1.73, all < 0.05) while those worked in Centers for Disease Control and Prevention were less likely to seek help (OR = 0.57, < 0.01). The belief that mental health issues were not the priority (64.4%), lack of time (56.4%), and shortage of psychologists (32.7%) were the most frequently endorsed reasons for not seeking help. The application of BMHSU confirmed associations between some factors and PHW's mental health help-seeking. Effective interventions are warranted to promote mental health help-seeking of PHW to ameliorate the negative impact of mental illness and facilitate personal recovery and routine work.
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http://dx.doi.org/10.3389/fpubh.2021.622677DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8144452PMC
June 2021

High-resolution age-specific mapping of the two-week illness prevalence rate based on the National Health Services Survey and geostatistical analysis: a case study in Guangdong province, China.

Int J Health Geogr 2021 05 3;20(1):20. Epub 2021 May 3.

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

Background: The two-week illness prevalence rate is an important and comparable indicator of health service needs. High-spatial-resolution, age-specific risk mapping of this indicator can provide valuable information for health resource allocation. The age-prevalence relationships may be different among areas of the study region, but previous geostatistical models usually ignored the spatial-age interaction.

Methods: We took Guangdong province, the province with the largest population and economy in China, as a study case. We collected two-week illness data and other potential influencing predictors from the fifth National Health Services Survey in 2013 and other open-access databases. Bayesian geostatistical binary regression models were developed with spatial-age structured random effect, based on which, high-resolution, age-specific two-week illness prevalence rates, as well as number of people reporting two-week illness, were estimated. The equality of health resource distribution was further evaluated based on the two-week illness mapping results and the health supply data.

Results: The map across all age groups revealed that the highest risk was concentrated in the central (i.e., Pearl River Delta) and northern regions of the province. These areas had a two-week illness prevalence > 25.0%, compared with 10.0-20.0% in other areas. Age-specific maps revealed significant differences in prevalence between age groups, and the age-prevalence relationships also differed across locations. In most areas, the prevalence rates decrease from age 0 to age 20, and then increase gradually. Overall, the estimated age- and population-adjusted prevalence was 16.5% [95% Bayesian credible interval (BCI): 14.5-18.6%], and the estimated total number of people reporting illness within the two-week period was 17.5 million (95% BCI: 15.5-19.8 million) in Guangdong Province. The Lorenz curve and the Gini coefficient (resulted in 0.3526) showed a moderate level of inequality in health resource distribution.

Conclusions: We developed a Bayesian geostatistical modeling framework with spatial-age structured effect to produce age-specific, high-resolution maps of the two-week illness prevalence rate and the numbers of people reporting two-week illness in Guangdong province. The methodology developed in this study can be generalized to other global regions with available relevant survey data. The mapping results will support plans for health resource allocation.
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http://dx.doi.org/10.1186/s12942-021-00273-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8094611PMC
May 2021

HIV incidence and sexual behavioral correlates among 4578 men who have sex with men (MSM) in Chengdu, China: a retrospective cohort study.

BMC Public Health 2021 04 26;21(1):802. Epub 2021 Apr 26.

School of Public Health, Sun Yat-sen University (North Campus), No.74, Zhongshan second road, Guangzhou, China.

Background: The prevalence of HIV among men who have sex with men (MSM) in southwest China is still increasing. This study aimed to investigate the trend in HIV incidence and its associated risk factors among MSM in Chengdu, China.

Method: Incidence data were collected from the largest local non-governmental organization (NGO) serving MSM in Chengdu between 2012 and 2018, while information on sexual behaviors was collected from 2014. All MSM who received voluntary counseling and testing services (VCT) in the collaborating NGO at least twice during the study period were included. We calculated the HIV incidence density among MSM every 2 years and the overall incidence rate. A Cox proportional hazards regression model was employed to identify risk factors for HIV infection.

Result: A total of 4578 HIV-negative participants were included in the cohort. The total incidence density was 5.95 (95% CI: 5.37-6.56)/100 person-years (PYs) between 2012 and 2018. The segmented incidence density was 9.02 (95% CI: 7.46-10.78), 5.85 (95% CI: 4.86-6.97), 5.43 (95% CI: 4.53-6.46), and 3.09 (95% CI: 2.07-4.41)/100 PYs in 2012-2013, 2014-2015, 2016-2017, and 2018, respectively. After adjusting for sociodemographic characteristics, compared to participants without sexual partners within 6 months, MSM with one fixed partner (Adjusted Hazard Ratio, AHR = 1.18, 95% CI: 0.44-3.19) and more than five partners (AHR = 2.24, 95% CI: 0.81-6.20) had increased risk of HIV infection. MSM who used condom inconsistently had a higher risk of HIV infection (AHR = 1.87, 95% CI: 1.46-2.38) compared to consistent condom users.

Conclusion: The decreased HIV incidence density among MSM was potentially related to the successful comprehensive HIV prevention strategies in Chengdu. Multiple male sexual partnerships and inconsistent condom use during anal intercourse were risk factors associated with HIV occurrence.
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http://dx.doi.org/10.1186/s12889-021-10835-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8077884PMC
April 2021

Prevalence of mental health problems and associated factors among front-line public health workers during the COVID-19 pandemic in China: an effort-reward imbalance model-informed study.

BMC Psychol 2021 Apr 12;9(1):55. Epub 2021 Apr 12.

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

Background: Poor mental health status and associated risk factors of public health workers have been overlooked during the COVID-19 pandemic. This study used the effort-reward imbalance model to investigate the association between work-stress characteristics (effort, over-commitment, reward) and mental health problems (anxiety and depression) among front-line public health workers during the COVID-19 pandemic in China.

Methods: A total of 4850 valid online questionnaires were collected through a self- constructed sociodemographic questionnaire, the adapted ERI questionnaire, the 9-item Patient Health Questionnaire (PHQ-9) and the 7-item General Anxiety Disorder Scale (GAD-7). Hierarchical logistic regression analysis was conducted to investigate the association between ERI factors and mental health problems (i.e., depression and anxiety), with reward treated as a potential moderator in such associations.

Results: The data showed that effort and over-commitment were positively associated with depression and anxiety, while reward was negatively associated with depression and anxiety. Development and job acceptance were the two dimensions of reward buffered the harmful effect of effort/over-commitment on depression and anxiety, whereas esteem was non-significant.

Conclusions: This study confirmed the harmful effects of effort and over-commitment on mental health among public health workers during the COVID-19 pandemic in China. Such effects could be alleviated through an appropriate reward system, especially the development and job acceptance dimensions of such a system. These findings highlight the importance of establishing an emergency reward system, comprising reasonable work-allocation mechanism, bonuses and honorary titles, a continuous education system and better career-development opportunities.
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http://dx.doi.org/10.1186/s40359-021-00563-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8040352PMC
April 2021

Time trends of major cancers incidence and mortality in Guangzhou, China 2004-2015: A Joinpoint and Age-Period-Cohort Analysis.

Cancer Med 2021 04 16;10(8):2865-2876. Epub 2021 Mar 16.

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

Background: Cancer is an important focus of public health worldwide. This study aims to provide a comprehensive overview of temporal trends in incidence and mortality of leading cancer in Guangzhou, China from 2004 to 2015.

Methods: Data were collected from the population-based registry in Guangzhou. Age-standardized incidence rate (ASIR) and age-standardized mortality rate (ASMR) were calculated and Joinpoint regression was used for evaluating the average annual percent changes (AAPC) among the entire study period and the estimated annual percent changes (EAPC) in time segments. The effects of age, period, and birth cohort were assessed by the age-period-cohort model.

Results: The age-standardized incidence and mortality by the world standard population decreased significantly among males with AAPC of -1.7% (95% CI: -3.0%, 0.2%) and -2.7% (95% CI: -4.3%, -1.1%) for all malignancies during 2004-2015, while among females, the age-standardized incidence had a non-significant reduction with AAPC of -1.3% (95% CI: -2.8%, 0.2%) and the age-standardized mortality demonstrated a remarkable decline (AAPC -2.0%, 95% CI: -3.6%, -0.3%). For males, the most commonly diagnosed cancers were trachea, bronchus, and lung (TBL), liver, colorectal, nasopharyngeal, stomach, and prostate cancer. For females, breast, TBL, colorectal, liver stomach, and thyroid cancer ranked the top. Unfavorable trends were observed in ASIR of colorectal, thyroid, and prostate cancer. APC models yielded different ages, periods, and birth cohort effect patterns by cancer sites.

Conclusions: Cancer burden remained a public health challenge in Guangzhou as the aging population and lifestyles changes, despite declines in incidence and mortality rates in some cancers. Surveillance of cancer trends contributed to valuable insights into cancer prevention and control.
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http://dx.doi.org/10.1002/cam4.3744DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8026941PMC
April 2021

The immediate effects of winter storms and power outages on multiple health outcomes and the time windows of vulnerability.

Environ Res 2021 05 6;196:110924. Epub 2021 Mar 6.

Department of Environmental Health Sciences, University at Albany, State University of New York, Rensselaer, NY, USA.

Background: While most prior research has focused on extreme heat, few assessed the immediate health effects of winter storms and associated power outages (PO), although severe storms have become more frequent. This study evaluates the joint and independent health effects of winter storms and PO, snow versus ice-storm, effects by time window (peak timing, winter/transitional months) and the impacts on critical care indicators including numbers of comorbidity, procedure, length of stay and cost.

Methods: We use distributed lag nonlinear models to assess the impacts of winter storm/PO on hospitalizations due to cardiovascular, lower respiratory diseases (LRD), respiratory infections, food/water-borne diseases (FWBD) and injuries in New York State on 0-6 lag days following storm/PO compared with non-storm/non-PO periods (references), while controlling for time-varying factors and PM. The storm-related hospitalizations are described by time window. We also calculate changes in critical care indicators between the storm/PO and control periods.

Results: We found the joint effects of storm/PO are the strongest (risk ratios (RR) range: 1.01-1.90), followed by that of storm alone (1.02-1.39), but not during PO alone. Ice storms have stronger impacts (RRs: 1.04-3.15) than snowstorms (RRs: 1.03-2.21). The storm/PO-health associations, which occur immediately, and some last a whole week, are stronger in FWBD, October/November, and peak between 3:00-8:00 p.m. Comorbidity and medical costs significantly increase after storm/PO.

Conclusion: Winter storms increase multiple diseases, comorbidity and medical costs, especially when accompanied by PO or ice storms. Early warnings and prevention may be critical in the transitional months and afternoon rush hours.
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http://dx.doi.org/10.1016/j.envres.2021.110924DOI Listing
May 2021

The short-term association of ambient fine particulate air pollution with hypertension clinic visits: A multi-community study in Guangzhou, China.

Sci Total Environ 2021 Jun 6;774:145707. Epub 2021 Feb 6.

Department of Medical Statistics and Epidemiology & Health Information Research Center & Guangdong Key Laboratory of Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, Guangdong, China; Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou 510080, Guangdong, China. Electronic address:

Background: The association of ambient fine particulate pollution with daily outpatient clinic visits (OCV) for hypertension in China remains to be investigated.

Objectives: This study aimed to examine short-term impacts of exposure to fine particulate matter of aerodynamic diameter < 2.5μm (PM) on daily OCV for hypertension, using a large-scale multi-center community database in Guangzhou, one of the most densely-populated cities in Southern China.

Methods: We collected a total of 28,548 individual records of OCV from 22 community healthcare facilities in Guangzhou from January 1st to May 7th 2020. Hourly data on air pollutants and daily information on meteorological factors were obtained. According to the World Health Organization air-quality guidelines, daily excessive concentration hours (DECH) was calculated. PM daily mean, hourly-peak concentration and DECH were used as the exposure variables. Based on a case-time-control design, the Cox regression model was applied to evaluate the short-term relative risks (RR) of daily OCV for hypertension. Sensitivity analyses were conducted, with nitrogen dioxide, sulfur dioxide, carbon monoxide, and ozone being adjusted.

Results: Daily mean and hourly-peak of PM were significantly associated with daily OCV for hypertension, while weaker associations were observed for DECH. The estimated RRs at lag day 0 were 1.039 (95% confidence interval [CI]: 1.037, 1.040), 1.851 (95%CI: 1.814, 1.888), and 1.287 (95%CI: 1.276, 1.298), respectively, in association with a 1-unit increase in DECH, daily mean, and hourly-peak concentration of PM. For the lagged effect, lag models estimated the greatest RRs for PM DECH and hourly-peak, whereas a lag model produced the highest for PM daily mean.

Discussion: This study consolidates the evidence for a positive correlation between ambient PM exposure and risks of hypertensive OCV. It also provides profound insight regarding planning for health services needs and establishing early environmental responses to the worsening air pollution in the communities.
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http://dx.doi.org/10.1016/j.scitotenv.2021.145707DOI Listing
June 2021

Global Patterns and Trends in Lung Cancer Incidence: A Population-Based Study.

J Thorac Oncol 2021 06 16;16(6):933-944. Epub 2021 Feb 16.

Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China; Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, People's Republic of China. Electronic address:

Introduction: Lung cancer (LC) has been the most common cancer worldwide for several decades. This study comprehensively examines recent geographic patterns and temporal trends in LC incidence from 1978 to 2012 in 43 countries and evaluates the effects of birth cohort and period on temporal trends.

Methods: Data were retrieved from the Cancer Incidence in Five Continents database. Joinpoint regression and age-period-cohort models were applied.

Results: The age-standardized rate was highest in Turkey (69.3 per 100,000 person-years) for men and in Denmark (36.7) for women in the period 2008 to 2012. Sex disparities were noted in most countries. From 1978 to 2012, a total of 19 countries had significantly declining trends among men, whereas 26 countries had significantly increasing trends among women (all p < 0.05). Quasi-reversed V-shaped and U-shaped incidence rate ratio trends indicating birth cohort effects were detected in 26 countries for men, with the highest risks mainly occurring in the 1930 to 1950 birth cohorts. However, the risks among recent generations have moderately increased in the People's Republic of China and Japan for men and sharply increased in Lithuania, Belarus, and Republic of Korea for women. Incidence rate ratio increases were steep among earlier birth cohorts and gradual among the post-1930s cohorts in 15 countries for women. Period effects were more evident than birth cohort effects in five countries for both sexes.

Conclusions: Disparities in LC incidence and carcinogenic risk persist worldwide. Our findings identified high-risk target populations for primary prevention to reduce the LC incidence and highlighted the urgent need for etiologic studies to identify the reasons for pronounced cohort-specific risk increases in certain countries.
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http://dx.doi.org/10.1016/j.jtho.2021.01.1626DOI Listing
June 2021

High-resolution mapping of reproductive tract infections among women of childbearing age in Bangladesh: a spatial-temporal analysis of the demographic and health survey.

BMC Public Health 2021 02 12;21(1):342. Epub 2021 Feb 12.

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

Background: Reproductive tract infections (RTIs) have become major but silent public health problems devastating women's lives in Bangladesh. Accurately and precisely identifying high-risk areas of RTIs through high-resolution risk maps is meaningful for resource-limited settings.

Methods: We obtained data reported with RTI symptoms by women of childbearing age in the years 2007, 2011 and 2014 from Bangladesh Demographic and Health Survey. High-spatial Environmental, socio-economic and demographic layers were downloaded from different open-access data sources. We applied Bayesian spatial-temporal models to identify important influencing factors and to estimate the infection risk at 5 km spatial resolution across survey years in Bangladesh.

Results: We estimated that in Bangladesh, there were approximate 11.1% (95% Bayesian credible interval, BCI: 10.5-11.7%), 13.9% (95% BCI: 13.3-14.5%) and 13.4% (95% BCI: 12.8-14.0%) of women of childbearing age reported with RTI symptoms in 2007, 2011 and 2014, respectively. The risk of most areas shows an obvious increase from 2007 to 2011, then became stable between 2011 and 2014. High risk areas were identified in the southern coastal areas, the western Rajshahi Division, the middle of Khulna Division, and the southwestern Chittagong Division in 2014. The prevalence of Rajshahi and Nawabganj District were increasing during all the survey years.

Conclusion: The high-resolution risk maps of RTIs we produced can guide the control strategies targeted to priority areas cost-effectively. More than one eighth of women of childbearing age reported symptoms suggesting RTIs and the risk of RTIs varies in different geographical area, urging the government to pay more attention to the worrying situation of female RTIs in the country.
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http://dx.doi.org/10.1186/s12889-021-10360-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7881647PMC
February 2021

Association between relationship characteristics and willingness to use PrEP among same-sex male couples: a cross-sectional actor-partner analysis in Guangzhou, China.

Int J STD AIDS 2021 03 8;32(3):228-238. Epub 2021 Feb 8.

Department of Medical Statistics & Sun Yat-sen Global Health Institute, School of Public Health and Institute of State Governance, 26469Sun Yat-sen University, Guangzhou, China.

The association between relationship characteristics and pre-exposure prophylaxis (PrEP) acceptability among same-sex male couples has been limitedly examined. Dyadic survey data of 139 concordant HIV-negative same-sex male couples in Guangzhou, China were collected. The willingness to use PrEP was measured assuming that the participant's partner was HIV-positive. The actor-partner interdependence model was used to examine how one's relationship characteristics affected the PrEP willingness of the subject and his partner. Most participants (79.5%) were willing to use PrEP. The two individuals of the couple were distinguished by sex role in relationship, namely one usually playing the insertive role and the other usually playing the receptive role in anal intercourse. The former was labeled as "top" and the latter labeled as "bottom". The PrEP willingness of the top partner increased when he would think his partner is having sex with other people if the partner requests condom use in relationship (AOR: 5.74, 95% CI: 1.10-29.87), and decreased when his partner would get violent upon condom use requests in relationship (AOR: 0.19, 95% CI: 0.04-0.88). The PrEP willingness of the bottom partner increased when he trusted his partner (AOR: 1.13, 95% CI: 1.02-1.25) and when he or his partner disclosed the relationship to parents (AOR: 10.57, 95% CI: 1.91-58.61). Considering the sex role and relationship characteristics in couple-based interventions are important to optimize PrEP uptake among HIV-discordant same-sex male couples.
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http://dx.doi.org/10.1177/0956462420953007DOI Listing
March 2021

Mortality risk of COVID-19 in elderly males with comorbidities: a multi-country study.

Aging (Albany NY) 2020 12 31;13(1):27-60. Epub 2020 Dec 31.

Institute of Hepatology and Department of Infectious Diseases, The Second Xiangya Hospital, Central South University, Changsha, China.

The COVID-19 pandemic causes severe morbidity and mortality. This multi-country study aimed to explore risk factors that drive mortality in COVID-19 patients who received neither dexamethasone nor remdesivir. We analyzed a cohort of 568 survivors and 507 non-survivors from China, European regions, and North America. Elderly males ≥70 years accounted for only 25% of survivors, but this rate was significantly higher in non-survivors from China (55%), European regions (63%), and North America (47%). Compared with survivors, non-survivors had more incidences of comorbidities such as cerebrovascular disease and chronic obstructive pulmonary disease (COPD, p-values<0.05). Survival analyses revealed age, male gender, shortness of breath, cerebrovascular disease, and COPD as mortality-associated factors. Survival time from symptom onset was significantly shorter in elderly versus young patients (median: 29 versus 62 days), males versus females (median: 46 versus 59 days), and patients with versus without comorbidities (mean: 41 versus 61 days). Mortality risk was higher in elderly males with comorbidities than in young females without comorbidities (p-value<0.01). Elderly male survivors with comorbidities also had longer hospital stays than other survivors (25 versus 18.5 days, p-value<0.01). Overall, the high mortality risk in elderly males with COVID-19-associated comorbidities supports early prevention and critical care for elderly populations.
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http://dx.doi.org/10.18632/aging.202456DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7835001PMC
December 2020

Working conditions and health status of 6,317 front line public health workers across five provinces in China during the COVID-19 epidemic: a cross-sectional study.

BMC Public Health 2021 01 9;21(1):106. Epub 2021 Jan 9.

School of Public Health, Sun Yat-sen University, No. 74, Zhongshan Second Road, Guangzhou, 510080, China.

Background: Public health workers at the Chinese Centre for Disease Control and Prevention (China CDC) and primary health care institutes (PHIs) were among the main workers who implemented prevention, control, and containment measures. However, their efforts and health status have not been well documented. We aimed to investigate the working conditions and health status of front line public health workers in China during the COVID-19 epidemic.

Methods: Between 18 February and 1 March 2020, we conducted an online cross-sectional survey of 2,313 CDC workers and 4,004 PHI workers in five provinces across China experiencing different scales of COVID-19 epidemic. We surveyed all participants about their work conditions, roles, burdens, perceptions, mental health, and self-rated health using a self-constructed questionnaire and standardised measurements (i.e., Patient Health Questionnaire and General Anxiety Disorder scale). To examine the independent associations between working conditions and health outcomes, we used multivariate regression models controlling for potential confounders.

Results: The prevalence of depression, anxiety, and poor self-rated health was 21.3, 19.0, and 9.8%, respectively, among public health workers (27.1, 20.6, and 15.0% among CDC workers and 17.5, 17.9, and 6.8% among PHI workers). The majority (71.6%) made immense efforts in both field and non-field work. Nearly 20.0% have worked all night for more than 3 days, and 45.3% had worked throughout the Chinese New Year holiday. Three risk factors and two protective factors were found to be independently associated with all three health outcomes in our final multivariate models: working all night for >3 days (multivariate odds ratio [ORm]=1.67~1.75, p<0.001), concerns about infection at work (ORm=1.46~1.89, p<0.001), perceived troubles at work (ORm=1.10~1.28, p<0.001), initiating COVID-19 prevention work after January 23 (ORm=0.78~0.82, p=0.002~0.008), and ability to persist for > 1 month at the current work intensity (ORm=0.44~0.55, p<0.001).

Conclusions: Chinese public health workers made immense efforts and personal sacrifices to control the COVID-19 epidemic and faced the risk of mental health problems. Efforts are needed to improve the working conditions and health status of public health workers and thus maintain their morale and effectiveness during the fight against COVID-19.
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http://dx.doi.org/10.1186/s12889-020-10146-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7794632PMC
January 2021

Leading Enterovirus Genotypes Causing Hand, Foot, and Mouth Disease in Guangzhou, China: Relationship with Climate and Vaccination against EV71.

Int J Environ Res Public Health 2021 01 2;18(1). Epub 2021 Jan 2.

Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China.

(1) Background: Assignment of pathogens to the correct genus, species, and type is vital for controlling infectious epidemics. However, the role of different enteroviruses during hand, foot, and mouth disease (HFMD) epidemics and the major contributing factors remain unknown. (2) Methods: HFMD cases from 2016 to 2018 in Guangzhou, China were collected. The relationship between HFMD cases and genotype frequency, as well as the association between genotype frequency and climate factors, were studied using general linear models. We transformed the genotype frequency to the isometric log-ratio (ILR) components included in the model. Additionally, vaccination rates were adjusted in the climate-driven models. (3) Results: We observed seasonal trends in HFMD cases, genotype frequency, and climate factors. The model regressing case numbers on genotype frequency revealed negative associations with both the ILRs of CAV16 (RR = 0.725, < 0.001) and EV71 (RR = 0.421, < 0.001). The model regressing genotype frequency on driven factors showed that the trends for EV71 proportions were inversely related to vaccination rate (%, β = -0.152, = 0.098) and temperature (°C, β = -0.065, = 0.004). Additionally, the trends for CVA16 proportions were inversely related to vaccination rate (%, β = -0.461, = 0.004) and temperature (°C, β = -0.068, = 0.031). The overall trends for genotype frequency showed that EV71 decreased significantly, while the trends for CVA16 increased annually. (4) Conclusions: Our findings suggest a potential pathway for climate factors, genotype frequency, and HFMD cases. Our study is practical and useful for targeted prevention and control, and provides environmental-based evidence.
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http://dx.doi.org/10.3390/ijerph18010292DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7795377PMC
January 2021

The time course of chest CT lung changes in COVID-19 patients from onset to discharge.

Eur J Radiol Open 2021 5;8:100305. Epub 2020 Dec 5.

Department of Liver Diseases, The Third People's Hospital of Shenzhen, The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, Guangdong, 518100, China.

Background & Aims: Computed tomography (CT) is widely used to evaluate the severity of COVID-19 infection and track disease progression. We described the changes in chest CT to enable better understanding of the progression of COVID-19 during hospitalization.

Methods: Consecutively hospitalized COVID-19 patients admitted from January 11, 2020 to February 16, 2020 and followed until March 26, 2020 at the Third People's Hospital of Shenzhen, China were included. Semi- quantitative analysis was used to assess the shape, distribution, and range of lung lesions. For each image, the lungs were divided into six regions. The total CT score was the sum of individual region scores.

Results: 305 patients underwent a total of 1442 chest CT scans with a mean interval of 5 days (interquartile range (IQR) = 3-6 days). All patients were discharged after an average hospitalization of 25 days (IQR = 20-33 days). From the onset of initial symptoms, the total CT score peaked at an earlier date in the non-severe than the severe cases (13 days versus 15 days). Typical CT image of non-severe cases mainly presented as ground-glass opacities (GGO), whilst GGO mixed with consolidation was more seen in severe cases. In addition, severe versus non-severe cases had higher prevalence of fibrosis and air bronchogram in CT scans (P from <0.001 to 0.05, P = 0.001, respectively). The proportion of patients with fibrosis and air bronchogram appeared to decrease from the fourth (20 days from onset, IQR = 16-24) and the third pulmonary CT scan (15 days from onset, IQR = 12-19), respectively.

Conclusion: COVID-19 pneumonia demonstrated progressions in early stage, with the greatest pulmonary damage on CT occurred at approximately 13 days after initial onset of symptoms. Worse bilateral pulmonary infiltrates were found in severe cases, indicating continuous health care for pulmonary rehabilitation and consecutive follow-up to monitor irreversible fibrosis and consolidation are necessary.
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http://dx.doi.org/10.1016/j.ejro.2020.100305DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7773583PMC
December 2020

Mobile Texting and Lay Health Supporters to Improve Schizophrenia Care in a Resource-Poor Community in Rural China (LEAN Trial): Randomized Controlled Trial Extended Implementation.

J Med Internet Res 2020 12 1;22(12):e22631. Epub 2020 Dec 1.

Acacia Lab for Health Systems Strengthening and Department of Health Management, School of Health Management, Southern Medical University, Guangzhou, China.

Background: Schizophrenia is a severe and disabling condition that presents a dire health equity challenge. Our initial 6-month trial (previously reported) using mobile texting and lay health supporters, called LEAN, significantly improved medication adherence from 0.48 to 0.61 (adjusted mean 0.11, 95% CI 0.03 to 0.20, P=.007) for adults with schizophrenia living in a resource-poor village in rural China.

Objective: We explored the effectiveness of our texting program in improving participants' medication adherence, functioning, and symptoms in an extended implementation of the intervention after its initial phase.

Methods: In an approximated stepped-wedge wait-list design randomized controlled trial, 277 community-dwelling villagers with schizophrenia were assigned 1:1 in phase 1 into intervention and wait-list control groups. The intervention group received (1) lay health supporters (medication or care supervisors), (2) e-platform (mobile-texting reminders and education message) access, (3) a token gift for positive behavioral changes, and (4) integration with the existing government community-mental health program (the 686 Program) while the wait-listed control group initially only received the 686 Program. Subsequently (in the extended period), both groups received the LEAN intervention plus the 686 Program. The primary outcome was antipsychotic medication adherence (percentage of dosages taken over the past month assessed by unannounced home-based pill counts). The secondary outcomes were symptoms measured during visits to 686 Program psychiatrists using the Clinical Global Impression scale for schizophrenia and functioning measured by trained student assessors using the World Health Organization Disability Assessment Schedule 2.0. Other outcomes included data routinely collected in the 686 Program system (refill records, rehospitalization due to schizophrenia, death for any reason, suicide, wandering, and violent behaviors). We used intention-to-treat analysis and missing data were imputed. A generalized estimating equation model was used to assess program effects on antipsychotics medication adherence, symptoms, and functioning.

Results: Antipsychotics medication adherence improved from 0.48 in the control period to 0.58 in the extended intervention period (adjusted mean difference 0.11, 95% CI 0.04 to 0.19; P=.004). We also noted an improvement in symptoms (adjusted mean difference -0.26, 95% CI -0.50 to -0.02; P=.04; Cohen d effect size 0.20) and a reduction in rehospitalization (0.37, 95% CI 0.18 to 0.76; P=.007; number-needed-to-treat 8.05, 95% CI 4.61 to 21.41). There was no improvement in functioning (adjusted mean difference 0.02, 95% CI -0.01 to 0.06; P=.18; Cohen d effect size 0.04).

Conclusions: In an extended implementation, our intervention featuring mobile texting messages and lay health workers in a resource-poor community setting was more effective than the 686 Program alone in improving medication adherence, improving symptoms, and reducing rehospitalization.

Trial Registration: Chinese Clinical Trial Registry; ChiCTR-ICR-15006053 https://tinyurl.com/y5hk8vng.
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http://dx.doi.org/10.2196/22631DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7738261PMC
December 2020

Relationship Between Patient Engagement and Depressive Symptoms Among People Living With HIV in a Mobile Health Intervention: Secondary Analysis of a Randomized Controlled Trial.

JMIR Mhealth Uhealth 2020 10 29;8(10):e20847. Epub 2020 Oct 29.

Department of Social Work & Social Administration, The University of Hong Kong, Hong Kong, China.

Background: Associations between higher levels of patient engagement and better health outcomes have been found in face-to-face interventions; studies on such associations with mobile health (mHealth) interventions have been limited and the results are inconclusive.

Objective: The objective of this study is to investigate the relationship between patient engagement in an mHealth intervention and depressive symptoms using repeated measures of both patient engagement and patient outcomes at 4 time points.

Methods: Data were drawn from a randomized controlled trial (RCT) of an mHealth intervention aimed at reducing depressive symptoms among people living with HIV and elevated depressive symptoms. We examined the association between patient engagement and depressive symptoms in the intervention group (n=150) where participants received an adapted cognitive-behavioral stress management (CBSM) course and physical activity promotion on their WeChat social media app. Depressive symptoms were repeatedly measured using the Patient Health Questionnaire (PHQ-9) at baseline and 1 month, 2 months, and 3 months. Patient engagement was correspondingly measured by the completion rate, frequency of items completed, and time spent on the program at 1 month, 2 months, and 3 months. Latent growth curve models (LGCMs) were used to explore the relationship between patient engagement and depressive symptoms at multiple time points in the intervention.

Results: The mean PHQ-9 scores were 10.2 (SD 4.5), 7.7 (SD 4.8), 6.5 (SD 4.7), and 6.7 (SD 4.1) at baseline, 1 month, 2 months, and 3 months, respectively. The mean completion rates were 50.6% (SD 31.8%), 51.5% (SD 32.2%), and 50.8% (SD 33.7%) at 1, 2, and 3 months, respectively; the average frequencies of items completed were 18.0 (SD 14.6), 32.6 (SD 24.8), and 47.5 (SD 37.2) at 1, 2, and 3 months, respectively, and the mean times spent on the program were 32.7 (SD 66.7), 65.4 (SD 120.8), and 96.4 (SD 180.4) minutes at 1, 2, and 3 months, respectively. LGCMs showed good model fit and indicated that a higher completion rate (β at 3 months=-2.184, P=.048) and a greater frequency of items completed (β at 3 months=-0.018, P=.04) were associated with fewer depressive symptoms at 3 months. Although not significant, similar trends were found in the abovementioned relationships at 1 and 2 months. There was no significant relationship between time spent on the program and depressive symptoms.

Conclusions: This study revealed a positive association between patient engagement and health outcomes at 3 months of an mHealth intervention using LGCMs and repeated measures data. The results underscore the importance of improving patient engagement in mHealth interventions to improve patient-centered health outcomes.

Trial Registration: Chinese Clinical Trial Registry ChiCTR-IPR-17012606; https://tinyurl.com/yxb64mef.

International Registered Report Identifier (irrid): RR2-10.1186/s12889-018-5693-1.
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http://dx.doi.org/10.2196/20847DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7661233PMC
October 2020

Bayesian network to predict hepatitis B surface antigen seroclearance in chronic hepatitis B patients.

J Viral Hepat 2020 12 23;27(12):1326-1337. Epub 2020 Sep 23.

Department of Clinical Laboratory, the Third Affiliated Hospital, Southern Medical University, Guangzhou, China.

There is a need for an interpretable, accurate and interactions-considered model for predicting hepatitis B surface antigen (HBsAg) seroclearance. We aimed to construct a Bayesian network (BN) model using available medical records to predict HBsAg seroclearance in chronic hepatitis B (CHB) patients, and to evaluate the model's performance. This was a case-control study. A total of 1966 consecutive CHB patients (mean age 39.04 ± 11.23 years) between January 2006 and June 2015 were included. The demographic and clinical characteristics, laboratory data and imaging parameters were obtained and used to build a BN model to estimate the probability of HBsAg seroclearance. Baseline serum HBsAg and hepatitis Be antigen (HBeAg) levels, virological response and HBeAg seroclearance were the most significant predictors of HBsAg seroclearance. The post-test probability table showed that patients with baseline HBsAg concentrations ≤2000 IU/mL, negative baseline HBeAg, an initial virological response and without HBeAg seroclearance (i.e. no recurrence of HBeAg positivity during follow-up) were most likely to have HBsAg seroclearance. The constructed BN model had an area under the receiver operating characteristic curves of 0.896 (95% confidence interval [CI]: 0.892, 0.899), a sensitivity of 0.840 (95% CI: 0.833, 0.846), a specificity of 0.880 (95% CI: 0.876, 0.884) and an accuracy of 0.878 (95% CI: 0.874, 0.882) for predicting HBsAg seroclearance. The established BN model accurately estimated the probability of HBsAg seroclearance and is a promising tool to assist clinical decision-making.
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http://dx.doi.org/10.1111/jvh.13368DOI Listing
December 2020

Association of hepatitis B surface antigen seropositivity and hepatitis B surface antibody seropositivity with diabetes: a cross-sectional study based on two Chinese populations in Guangdong, China.

BMJ Open 2020 07 20;10(7):e028968. Epub 2020 Jul 20.

Guangzhou No.12 Hospital, Guangzhou, Guangdong, China.

Objectives: To examine whether hepatitis B surface antigen (HBsAg) seropositivity and hepatitis B surface antibody (HBsAb) seropositivity were associated with the presence of diabetes in two population-based studies in southern China, the Guangzhou Biobank Cohort Study (GBCS) and the Major Infectious Disease Prevention and Control (MIDPC) study.

Design: A cross-sectional study.

Setting: The GBCS was conducted among a community social and welfare organisation with branches in all 10 districts of Guangzhou. The MIDPC was conducted among the community residents in two districts of Guangzhou and three districts of Zhongshan.

Participants: 4947 participants from the GBCS and 4357 participants from the MIDPC were included in this study.

Primary And Secondary Outcome Measures: Type 2 diabetes was the main study outcome, which was diagnosed by fasting blood glucose ≥7.0 mmol/L, and/or self-reported history of diabetes.

Results: After adjusting for age, sex, education, occupation, smoking status, alcohol use, physical activity and body mass index, we found no association of HBsAg seropositivity in GBCS or MIDPC (OR=1.12, 95% CI 0.74 to 1.69, and OR=0.83, 95% CI 0.59 to 1.17, respectively), and HBsAb seropositivity (OR=0.85, 95% CI 0.65 to 1.12, OR=1.00, 95% CI 0.86 to 1.16, respectively) with the presence of diabetes. Null associations were found for analysis pooling GBCS and MIDPC data after similar adjustment. The adjusted OR for the associations of HBsAg seropositivity and HBsAb seropositivity with the presence of diabetes in the pooled sample was 0.91 (95% CI 0.70 to 1.19) and 0.98 (95% CI 0.86 to 1.12), respectively.

Conclusions: Taking advantage of data from two large cross-sectional studies, we found no association of serological status of HBsAg and HBsAb with the presence of diabetes or glucose measures.
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http://dx.doi.org/10.1136/bmjopen-2019-028968DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7375506PMC
July 2020

Assessing the vaccine effectiveness for hand, foot, and mouth disease in Guangzhou, China: a time-series analysis.

Hum Vaccin Immunother 2021 01 12;17(1):217-223. Epub 2020 Jun 12.

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

: Hand, foot, and mouth disease (HFMD) is an important public health issue in China. Although efficacy has been demonstrated by randomized controlled trials, the evidence for effectiveness of the monovalent Enterovirus 71 (EV71) vaccine against HFMD remains unknown. This study aimed to assess the vaccine effectiveness for HFMD in Guangzhou, China. : Routinely collected vaccination and HFMD surveillance data were captured from the China Information System for Disease Control and Prevention. We estimated the EV71 vaccine effectiveness using spatial ecologic and time-series analysis approaches. : A total of 174,002 HFMD cases under 5 years of age were reported to the Guangzhou, China surveillance system from January 2016 to December 2018. A total of 408,664 children completed a two-dose EV71 vaccination series. In an ecologic analysis, a two-dose EV71 vaccination rate above the median conferred lower HFMD risk relative to a vaccination rate below the median (ratio ratio = 0.955, 95% confidence interval (CI): 0.949, 0.962; < .001). In the time-series approach, 0.9% fewer HFMD cases were associated with a 1% increase in the two-dose EV71 vaccination rate, but without statistical significance ( = .094). However, we detected statistically significant protective associations for HFMD among children 3 years of age (0.9% fewer HFMD cases with a 1% increased vaccination rate; = .046), and for EV71 (1.4%; = .012) and "other viruses" (1.3%; = .002), although not for Coxsackievirus A16 (CVA16). : Our findings, based on real-world data, provide evidence of EV71 vaccine effectiveness for preventing EV71 and "other" viruses associated with HFMD. An expanded program of EV71 vaccination is urgently needed.
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http://dx.doi.org/10.1080/21645515.2020.1763076DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7872061PMC
January 2021

Power Outage: An Ignored Risk Factor for COPD Exacerbations.

Chest 2020 12 2;158(6):2346-2357. Epub 2020 Jun 2.

Department of Environmental Health Sciences, University at Albany, State University of New York, Rensselaer, NY; Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, NY. Electronic address:

Background: COPD is the third leading cause of death in the United States, with 16 million Americans currently experiencing difficulty with breathing. Power outages could be life-threatening for those relying on electricity. However, significant gaps remain in understanding the potential impact of power outages on COPD exacerbations.

Research Question: The goal of this study was to determine how power outages affect COPD exacerbations.

Study Design And Methods: Using distributed lag nonlinear models controlling for time-varying confounders, the hospitalization rate during a power outage was compared vs non-outage periods to determine the rate ratio (RR) for COPD and its subtypes at each of 0 to 6 lag days in New York State from 2001 to 2013. Stratified analyses were conducted according to sociodemographic characteristics, season, and clinical severity; changes were investigated in numerous critical medical indicators, including length of stay, hospital cost, the number of comorbidities, and therapeutic procedures between the two periods.

Results: The RR of COPD hospitalization following power outages ranged from 1.03 to 1.39 across lag days. The risk was strongest at lag and lag days and lasted significantly for 7 days. Associations were stronger for the subgroup with acute bronchitis (RR, 1.08-1.69) than for cases of acute exacerbation (RR, 1.03-1.40). Compared with non-outage periods, the outage period was observed to be $4.67 thousand greater in hospital cost and 1.38 greater in the number of comorbidities per case. The average cost (or number of comorbidities) was elevated in all groups stratified according to cost (or number of comorbidities). In contrast, changes in the average length of stay (-0.43 day) and the average number of therapeutic procedures (-0.09) were subtle.

Interpretation: Power outages were associated with a significantly elevated rate of COPD hospitalization, as well as greater costs and number of comorbidities. The average cost and number of comorbidities were elevated in all clinical severity groups.
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http://dx.doi.org/10.1016/j.chest.2020.05.555DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7768937PMC
December 2020

Peer education for HIV prevention among high-risk groups: a systematic review and meta-analysis.

BMC Infect Dis 2020 May 12;20(1):338. Epub 2020 May 12.

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

Background: Peer education has become a strategy for health promotion among high-risk groups for HIV infection worldwide. However, the extent to which peer education could have an impact on HIV prevention or the long-term effect of this impact is still unknown. This study thus quantifies the impact of peer education over time among high-risk HIV groups globally.

Method: Following the PRISMA guidelines, a systematic review and meta-analysis was used to assess the effects and duration of peer education. A thorough literature search of PubMed, Web of Science, Embase and Cochrane Library was performed, and studies about peer education on high-risk HIV groups were reviewed. Pooled effects were calculated and the sources of heterogeneity were explored using meta-regression and subgroup analysis.

Results: A total of 60 articles with 96,484 subjects were identified, and peer education was associated with 36% decreased rates of HIV infection among overall high risk groups (OR: 0.64; 95%CI: 0.47-0.87). Peer education can promote HIV testing (OR = 3.19; 95%CI:2.13,4.79) and condom use (OR = 2.66, 95% CI: 2.11-3.36) while reduce equipment sharing (OR = 0.50; 95%CI:0.33,0.75) and unprotected sex (OR = 0.82; 95%CI: 0.72-0.94). Time trend analysis revealed that peer education had a consistent effect on behavior change for over 24 months and the different follow-up times were a source of heterogeneity.

Conclusion: Our study shows that peer education is an effective tool with long-term impact for behavior change among high-risk HIV groups worldwide. Low and middle-income countries are encouraged to conduct large-scale peer education.
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http://dx.doi.org/10.1186/s12879-020-05003-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7218508PMC
May 2020

Implementation of Clinical Diagnostic Criteria and Universal Symptom Survey Contributed to Lower Magnitude and Faster Resolution of the COVID-19 Epidemic in Wuhan.

Engineering (Beijing) 2020 Oct 7;6(10):1141-1146. Epub 2020 May 7.

Department of Epidemiology and Biostatistics, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing 211166, China.

The majority of cases infected with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in China centered in the city of Wuhan. Despite a rapid increase in the number of cases and deaths due to the coronavirus disease 2019 (COVID-19), the epidemic was stemmed via a combination of epidemic mitigation and control measures. This study evaluates how the implementation of clinical diagnostics and universal symptom surveys contributed to epidemic control in Wuhan. We extended the susceptibles-exposed-infectious-removed (SEIR) transmission dynamics model by considering three quarantined compartments (SEIR). The SEIR dynamics model was fitted using the daily reported number of confirmed infections and unconfirmed cases by clinical diagnostic criteria up to February 14, 2020, in Wuhan. Applying the model to carry forward the pre-February 14 trend in Wuhan, the number of daily new diagnosed cases would be expected to drop below 100 by March 25, below 10 by April 29, and reach 0 by May 31, 2020. The observed case counts after February 14 demonstrated that the daily new cases fell below 100 by March 6, below 10 by March 11, and reached 0 by March 18, respectively, 19, 49, and 74 d earlier than model predictions. By March 30, the observed number of cumulative confirmed cases was 50 006, which was 19 951 cases fewer than the predicted count. Effective reproductive number () analysis using observed frequencies showed a remarkable decline after the implementation of clinical diagnostic criteria and universal symptom surveys, which was significantly below the () curve estimated by the model assuming that the pre-February 14 trend was carried forward. In conclusion, the proposed SEIR dynamics model was a good fit for the epidemic data in Wuhan and explained the large increase in the number of infections during February 12-14, 2020. The implementation of clinical diagnostic criteria and universal symptom surveys contributed to a contraction in both the magnitude and the duration of the epidemic in Wuhan.
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http://dx.doi.org/10.1016/j.eng.2020.04.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7204764PMC
October 2020

Diarrhea in under Five Year-Old Children in Nepal: A Spatiotemporal Analysis Based on Demographic and Health Survey Data.

Int J Environ Res Public Health 2020 03 23;17(6). Epub 2020 Mar 23.

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

Background: Diarrhea in children under five years of age remains a challenge in reducing child mortality in Nepal. Understanding the spatiotemporal patterns and influencing factors of the disease is important for control and intervention.

Methods: Data regarding diarrhea prevalence and its potential influencing factors were extracted from the Demographic and Health Surveys in Nepal and other open-access databases. A Bayesian logistic regression model with district-specific spatio-temporal random effects was applied to explore the space and time patterns of diarrhea risk, as well as the relationships between the risk and the potential influencing factors.

Results: Both the observed prevalence and the estimated spatiotemporal effects show a decreasing diarrhea risk trend from 2006 to 2016 in most districts of Nepal, with a few exceptions, such as Achham and Rasuwa. The disease risk decreased with mothers' years of education ( 0.93, 95% Bayesian Credible Interval (BCI) 0.87, 0.997). Compared to spring, autumn and winter had lower risks of diarrhea. The risk firstly increased and then decreased with age and children under 12-24 months old were the highest risk group ( 1.20, 95% BCI 1.04, 1.38). Boys had higher risk than girls ( 1.24, 95% BCI 1.13, 1.39). Even though improved sanitation wasn't found significant within a 95% BCI, there was 93.2% of chance of it being a protective factor. There were no obvious spatiotemporal clusters among districts and each district tended to have its own spatiotemporal diarrhea prevalence pattern.

Conclusions: The important risk factors identified by our Bayesian spatial-temporal modeling provide insights for control and intervention on children diarrhea in Nepal. Special attention should be paid to high risk groups of children and high risk seasons, as well as districts with high risk or increased trend of risk. Effective actions should be implemented to improve sanitation and women's education level. District-specific control planning is recommended for local governments for effective control of children diarrhea in Nepal.
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http://dx.doi.org/10.3390/ijerph17062140DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7142451PMC
March 2020

Effect of a WeChat-Based Intervention (Run4Love) on Depressive Symptoms Among People Living With HIV in China: A Randomized Controlled Trial.

J Med Internet Res 2020 02 9;22(2):e16715. Epub 2020 Feb 9.

Department of Psychology, University of Miami, Coral Gables, FL, United States.

Background: People living with HIV (PLWH) have high rates of depressive symptoms. However, only a few effective mental health interventions exist for this vulnerable population.

Objective: The aim of this study was to assess the efficacy of a WeChat-based intervention, Run4Love, with a randomized controlled trial among 300 people living with HIV and depression (PLWHD) in China.

Methods: We recruited PLWH from the HIV outpatient clinic in South China. Participants were screened based on the Center for Epidemiologic Studies-Depression (CES-D) scale. Those who scored 16 or higher were eligible to participate. A total of 300 eligible patients were enrolled. After obtaining informed consent from the participants, completion of a baseline survey, and collection of participants' hair samples for measuring cortisol, the participants were randomly assigned to an intervention or a control group in a 1:1 ratio. The intervention group received the Run4Love program, delivered via the popular social media app WeChat. Cognitive behavioral stress management courses and weekly reminders of exercise were delivered in a multimedia format. Participants' progress was monitored with timely and tailored feedback. The control group received usual care and a brochure on nutrition for PLWH. Data were collected at 3, 6, and 9 months. The primary outcome was depression, which was measured by a validated instrument.

Results: Participants in the intervention and control groups were comparable at baseline; about 91.3% (139/150), 88.3% (132/150), and 86.7% (130/150) participants completed the 3-, 6-, and 9-month follow-ups, respectively. At the 3-month follow-up, a significant reduction in CES-D score was observed in the intervention group (from 23.9 to 17.7 vs from 24.3 to 23.8; mean difference=-5.77, 95% CI -7.82 to -3.71; P<.001; standard effect size d=0.66). The mean changes in CES-D score from baseline to the 6- and 9-month follow-ups between the two groups remained statistically significant. No adverse events were reported.

Conclusions: The WeChat-based mobile health (mHealth) intervention Run4Love significantly reduced depressive symptoms among PLWHD, and the effect was sustained. An app-based mHealth intervention could provide a feasible therapeutic option for many PLWHD in resource-limited settings. Further research is needed to assess generalizability and cost-effectiveness of this intervention.

Trial Registration: Chinese Clinical Trial Registry ChiCTR-IPR-17012606; http://www.chictr.org.cn/showproj.aspx?proj=21019 (Archived by WebCite at https://www.webcitation.org/78Bw2vouF).
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http://dx.doi.org/10.2196/16715DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7058168PMC
February 2020
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