General Population In China Research Articles

Internet Addiction Increases in the General Population During COVID-19: Evidence From China.

Background and ObjectivesCOVID‐19‐related quarantine and stress have likely escalated the crisis of Internet addiction. This study aimed to determine the impact of the COVID‐19 pandemic on Internet use and related risk factors among the general public in China.MethodsA large‐sample cross‐sectional online survey was conducted from March 24 to April 30, 2020, in China, and 20,472 participants completed the survey. We investigated the prevalence and severity of Internet addiction based on the Internet Addiction Test (IAT), and explored the risk factors related to increases in time spent on Internet use and severity of Internet addiction, as well as severe Internet addiction.ResultsThe overall prevalence of Internet addiction was 36.7% among the general population during the pandemic, and that of severe Internet addiction was 2.8%, according to IAT scores. Time spent on recreational Internet use had significantly increased during the pandemic, and almost half of participants reported increases in the severity of Internet addiction. Risk factors for increases in time spent on Internet use and severity of Internet addiction and severe Internet addiction included having fewer social supporters, perceiving pressure and impact on mental health status due to COVID‐19, and being over‐engaged in playing videogames.Discussion and ConclusionsThe COVID‐19 pandemic adversely impacted Internet use and increased the prevalence and severity of Internet addiction among the general population in China, especially in vulnerable populations.Scientific SignificanceThis study provides evidence for policymakers to refine public health policies to control the pandemic and make efforts to provide population‐specific prevention and interventions for people at risk of developing Internet addiction. (Am J Addict 2021;00:00–00)

The Changing Acceptance of COVID-19 Vaccination in Different Epidemic Phases in China: A Longitudinal Study.

COVID-19 vaccines have been conditionally used in a few countries, including China since December 2020. The present study aimed to examine whether the acceptance of COVID-19 vaccination changed in different COVID-19 epidemic phases in China. Two consecutive surveys were conducted among Chinese adults in March (n = 2058) (severe epidemic phase) and November–December (n = 2013) (well-contained phase, right before the COVID-19 vaccine was conditionally approved) 2020, and 791 respondents were longitudinally followed-up. The attitude, acceptance, and preferences for future COVID-19 vaccination were compared between two epidemic phases. Multivariate logistic regression was used to identify influencing factors of acceptance. Among the 791 respondents longitudinally followed, 91.9% in March and 88.6% of them in November–December 2020 would like to get COVID-19 vaccination in China. In March 58.3% wished to get vaccinated immediately, but the proportion declined to 23.0% in November–December 2020, because more respondents wanted to delay vaccination until the vaccine’s safety was confirmed. Similar results were found by comparing all respondents from the two cross-sectional surveys in different epidemic phases. The risk perception, attitude for the importance of vaccination against COVID-19, vaccination history, valuing doctor’s recommendations, vaccination convenience, or vaccine price in decision-making had impacts on respondents’ intention for immediate vaccination. The public acceptance for COVID-19 vaccination in China sustained at a high level in different COVID-19 epidemic phases. However, the intention of immediate vaccination declined substantially due to concerns about the vaccine’s safety. Information about vaccination safety from authoritative sources, doctor’s recommendations, and vaccination convenience were important in addressing vaccine hesitancy and promoting successful herd immunity for the general population in China.

Triglycerides to high-density lipoprotein cholesterol ratio is superior to triglycerides and other lipid ratios as an indicator of increased urinary albumin-to-creatinine ratio in the general population of China: a cross-sectional study

BackgroundDyslipidemia contributes to the pathogenesis of renal dysfunction. Previous research demonstrated that triglycerides (TG), instead of other individual lipid indexes, has a significant link with elevated urinary albumin-to-creatinine ratio (UACR). However, it is unclear whether lipid ratios are superior indicators of increased UACR compared with TG. This research is to determine whether there are close relationships of lipid ratios with UACR in a general population.Methods35,751 participants from seven centers across China were enrolled. UACR equal or higher than 30 mg/g was recognized as increased albuminuria. The associations of TG, low-density lipoprotein cholesterol (LDL-C)/ high-density lipoprotein cholesterol (HDL-C), TG/HDL-C and non-high-density lipoprotein cholesterol (non-HDL-C)/HDL-C with increased UACR were evaluated by linear and logistic regression analyses in females and males separately.ResultsThere were 3692 (14.8%) female subjects, and 1307 (12.0%) male subjects characterized as having increased UACR. There were significantly differences in TG/HDL-C and non-HDL-C/HDL-C between the normal UACR group and the increased UACR group, while LDL-C/HDL-C was not. Furthermore, linear regression analysis was implemented and showed that TG and TG/HDL-C were both positively related to UACR even after a variety of potential confounders were adjusted regardless of sexes, while the correlation between non-HDL-C/HDL-C and elevated UACR were only significant in females. Further analyses utilizing logistic regression demonstrated that compared with non-HDL-C/HDL-C and TG, TG/HDL-C showed the strongest association with increased UACR (quartile 1 of TG/HDL-C as a reference; OR [95% CI] of quartile 4: 1.28 [1.13–1.44] in women, 1.24 [1.02–1.50] in men) after fully adjusting for potential confounding factors. Stratified analyses revealed that in males who were overweight and in females who were overweight or over 55 years or had prediabetes or prehypertension, TG/HDL-C had significant associations with abnormal UACR.ConclusionsCompared with TG and other routine lipid ratios, TG/HDL-C is a superior indicator for increased UACR.

Phthalate exposure in association with the use of personal care products among general population from Shanghai.

Phthalates are used in a wide variety of personal care products (PCPs) as solubilizer, denaturant or color fixative. However, there are few studies referring the correlation between phthalate exposure and PCPs use among general population in China. In this study, ten metabolites of phthalates in spot urine samples (N = 500) were quantified using ultra-performance liquid chromatography tandem mass spectrometry. The frequency and duration of 12 types of PCPs were collected by questionnaire survey. The associations of phthalate metabolites and PCPs use were assessed by multivariable liner regression models. Median concentration of mono-benzylphthalate (MBzP) was significantly higher among frequent users of almost all PCPs. Low molecular weight phthalates (monomethyl phthalate (MMP), mono-n-butylphthalate (MnBP) and monoisobutylphthalate (MiBP)) were significantly lower among frequent user of some rinse-off PCPs (e.g., shampoo, facial cleanser, and body wash). Meanwhile, monoethylphthalate (MEP) was positive correlated with frequently use of facial moisturizer. Mono-2-ethylhexylphthalate (MEHP) and MBzP showed a significant positive association with frequently use of body lotion. Univariate linear analyses indicated a significant decreasing trend between urinary concentrations of MMP, MnBP, and the number of rinse-off PCPs being frequently used, and a significant increasing trend between urinary MBzP and the number of leave-on products being frequently used. These findings indicated that the use of some PCPs, especially leave-on PCPs, could be a potential source of exposure to some phthalates.

The Prevalence and Risk Factors of Cerebral Microbleeds: A Community-Based Study in China.

IntroductionCerebral microbleeds (CMBs) are frequently found in the healthy elderly. However, data on the prevalence and risk factors of CMBs in the general population of China are lacking.MethodsA cross-sectional study focusing on the prevalence and risk factors of CMBs was conducted in stroke-free elderly from Shanghai Wuliqiao community. MRI was performed at 3Tesla and cardiovascular risk factors (eg, age, smoking history, and hypertension), cerebral small vessel disease (CSVD) markers (eg, white matter hyperintensities, lacunar infarction, and enlarged perivascular space) and genetic information (eg, APOE, CR1) were recorded. Poisson regression was used to analyze the risk factors of the presence and location of microbleeds.ResultsA total of 199 participants (70.8±7.2 years old; male 31.2%) were finally included in our analysis. The overall prevalence of CMBs was 12.6% (25/199) and increased with age from 7.5% (55–64 years old) to 19.3% (over 75 years old). Of those with CMBs, most of them (16/25) located in the deep/mixed region and had 1–2 CMBs (18/25). Poisson regression analysis showed that white matter hyperintensities (OR=1.22, 95% CI: 1.16–1.29), APOE ε4+ carrier (OR=2.16, 95% CI: 1.18–3.96) and CR1 non-F/F isoform (OR=7.78, 95% CI: 4.34–13.96) were associated with CMBs. Further analysis found that in addition to the above three risk factors, hypertension (OR=2.98, 95% CI: 1.16–7.64), lacunar infarction (OR=2.39, 95% CI: 1.19–4.81) also increased the risk of deep/mixed CMBs.ConclusionThe prevalence of cerebral microbleeds is similar to other countries. Cardiovascular risk factors, CSVD markers, and genetic factors (APOE ε4, CR1 non-F/F isoform) were associated with CMBs, suggesting an interaction of multiple pathogenesis in Chinese stroke-free community population.

Mitochondrial tRNA Mutation and Regulation of the Adiponectin Pathway in Maternally Inherited Hypertension in Chinese Han.

Some essential hypertension (EH) patients show maternal inheritance, which is the mode of mitochondrial DNA inheritance. This study examines the mechanisms by which mitochondrial mutations cause EH characterized by maternal inheritance. The study enrolled 115 volunteers, who were divided into maternally inherited EH (group A, n = 17), non-maternally inherited EH (group B, n = 65), and normal control (group C, n = 33) groups. A mitochondrial tRNA (15910 C>T) gene mutation was significantly correlated with EH and may play an important role in the pathogenesis of maternally inherited EH. Examining two families carrying the mitochondrial tRNA 15910 C>T mutation, which disrupted base pairing and may affect the stability and function of mitochondrial tRNAThr, we find that the overall incidence of EH was 59.3% in the maternal family members and 90% in males, significantly higher than in the general population in China (23.2%), and that the EH began at a younger age in those carrying mitochondrial tRNA 15910 C>T. To reveal the mechanism through which mitochondrial tRNA 15910 C>T causes maternally inherited EH, we cultured human peripheral blood mononuclear cells from family A2 in vitro. We find that cells carrying mitochondrial tRNA 15910 C>T were more viable and proliferative, and the increased ATP production resulted in raised intracellular reactive oxygen species (ROS). Moreover, the mitochondrial dysfunction resulted in reduced APN levels, causing hypoadiponectinemia, which promoted cell proliferation, and produced more ROS. This vicious cycle promoted the occurrence of EH with maternally inherited mitochondrial tRNA 15910 C>T. The mitochondrial tRNA 15910 C>T mutation may induce hypertension by changing the APN, AdipoR1, PGC-1α, and ERRα signaling pathways to elevate blood pressure. We discover a new mitochondrial mutation (tRNA 15910 C>T) related to EH, reveal part of the mechanism by which mitochondrial mutations lead to the occurrence and development of maternally inherited EH, and discuss the role of APN in it.

The impact of quarantine on mental health status among general population in China during the COVID-19 pandemic.

Quarantine and isolation measures urgently adopted to control the COVID-19 pandemic might potentially have negative psychological and social effects. We conducted this cross-sectional, nationwide study to ascertain the psychological effect of quarantine and identify factors associated with mental health outcomes among population quarantined to further inform interventions of mitigating mental health risk especially for vulnerable groups under pandemic conditions. Sociodemographic data, attitudes toward the COVID-19, and mental health measurements of 56,679 participants from 34 provinces in China were collected by an online survey from February 28 to March 11, 2020. Of the 56,679 participants included in the study (mean [SD] age, 36.0 [8.2] years), 27,149 (47.9%) were male and 16,454 (29.0%) ever experienced home confinement or centralized quarantine during COVID-19 outbreak. Compared those without quarantine and adjusted for potential confounders, quarantine measures were associated with increased risk of total psychological outcomes (prevalence, 34.1% vs 27.3%; odds ratio [OR], 1.34; 95% CI, 1.28-1.39; P < 0.001). Multivariable logistic regression analyses showed that vulnerable groups of the quarantined population included those with pre-existing mental disorders or chronic physical diseases, frontline workers, those in the most severely affected areas during outbreak, infected or suspected patients, and those who are less financially well-off. Complying with quarantine, being able to take part in usual work, and having adequate understanding of information related to the outbreak were associated with less mental health issues. These results suggest that quarantine measures during COVID-19 pandemic are associated with increased risk of experiencing mental health burden, especially for vulnerable groups. Further study is needed to establish interventions to reduce mental health consequences of quarantine and empower wellbeing especially in vulnerable groups under pandemic conditions.

Relationships between the changes in sleep patterns and sleep quality among Chinese people during the 2019 coronavirus disease outbreak

ObjectiveRapidly increasing numbers of confirmed cases and deaths during the 2019 coronavirus disease outbreak (COVID-19) resulted in widespread psychological problems in the Chinese population. The purpose of this study was to investigate the sleep quality and changes in sleep patterns before and during the outbreak in the general population in China and to determine factors related to sleep quality. MethodsThis cross-sectional study was conducted using an online questionnaire from 20 February to 29 February 2020 in China. Socio-demographic data, self-designed COVID-19-related characteristics, sleep patterns, and Pittsburgh Sleep Quality Index (PSQI) scores were obtained. Single factor analysis and multivariate binary logistic regression analysis were used. ResultsA total of 1897 individuals were included in our study, and 30.0% of participants reported suffering poor sleep quality (PSQI≥8). Logistic regression analysis found that the factors related to sleep quality included poor physical health (OR = 3.382, p < 0.001), respiratory disease (OR = 1.629, p = 0.008), other diseases (OR = 2.504, p = 0.012), suspected case of COVID-19 in the same community (OR = 1.928, p = 0.002), confirmed case of COVID-19 in the same community (OR = 2.183, p = 0.007), worry about being infected (OR = 2.336, p < 0.001), ≥1 h/day spent hearing COVID-19 information (OR = 1.960, p < 0.001), time difference in midpoint time in bed (OR = 1.230, p < 0.001), and time difference in time in bed (OR = 0.711, p < 0.001). ConclusionsOur study revealed that more than one-fourth of the participants suffered poor sleep quality during the COVID-19 outbreak. In addition to the poor health status and COVID-19-related anxiety, delayed sleep phase and reduced time in bed impacted sleep quality in the general population in China.

Prevalence and correlates of suicidal ideation among the general population in China during the COVID-19 pandemic.

The coronavirus disease 2019 (COVID-19) pandemic is a major threat to the public. However, the comprehensive profile of suicidal ideation among the general population has not been systematically investigated in a large sample in the age of COVID-19. A national online cross-sectional survey was conducted between February 28, 2020 and March 11, 2020 in a representative sample of Chinese adults aged 18years and older. Suicidal ideation was assessed using item 9 of the Patient Health Questionnaire-9. The prevalence of suicidal ideation and its risk factors was evaluated. A total of 56,679 participants (27,149 males and 29,530 females) were included. The overall prevalence of suicidal ideation was 16.4%, including 10.9% seldom, 4.1% often, and 1.4% always suicidal ideation. The prevalence of suicidal ideation was higher in males (19.1%) and individuals aged 18-24years (24.7%) than in females (14.0%) and those aged 45years and older (11.9%). Suicidal ideation was more prevalent in individuals with suspected or confirmed infection (63.0%), frontline workers (19.2%), and people with pre-existing mental disorders (41.6%). Experience of quarantine, unemployed, and increased psychological stress during the pandemic were associated with an increased risk of suicidal ideation and its severity. However, paying more attention to and gaining a better understanding of COVID-19-related knowledge, especially information about psychological interventions, could reduce the risk. The estimated prevalence of suicidal ideation among the general population in China during COVID-19 was significant. The findings will be important for improving suicide prevention strategies during COVID-19.

Translation and validation of the Chinese version of medical maximizer-minimizer scale: a cross-sectional study

ObjectiveMedical overutilisation and underutilisation affect optimal healthcare. The Medical Maximizer-Minimizer Scale (MMS) was developed to assess individual medical maximising and minimising tendencies. Despite significant improvement in the healthcare system over...

Effects of Smoking on ACE2 Expression Pattern: Risk and Severity of SARS-CoV-2 Infection.

Respiratory epithelium expressing angiotensin-converting enzyme 2 (ACE2) is the entry for novel coronavirus (SARS-CoV-2), pathogen of the COVID-19 pneumonia outbreak, although a few recent studies have found different ACE2 expression in lung tissue of smokers. The effect of smoking on ACE2 expression and COVID-19 is still not clear. So, we did this research to determine the effect of smoking on ACE2 expression pattern and its relationship with the risk and severity of COVID-19. The clinical data of COVID-19 patients with smoking and non-smoking were analyzed, and ACE2 expression of respiratory and digestive mucosa epithelia from smoker and non-smoker patients or healthy subjects were detected by immunohistochemical (IHC) staining. Of all 295 laboratory-confirmed COVID-19 patients, only 24 (8.1%) were current smokers with moderate smoking or above, which accounted for 54.2% of severe cases with higher mortality than non-smokers (8.3% vs. 0.4%, p = 0.018). Data analysis showed the proportion of smokers in COVID-19 patients was lower than that in general population of China (Z = 11.65, P < 0.001). IHC staining showed ACE2 expression in respiratory and digestive epithelia of smokers were generally downregulated. The proportion of smokers in COVID-19 patients was lower, which may be explained by ACE2 downregulation in respiratory mucosa epithelia. However, smoking COVID-19 patients accounted for a higher proportion in severe cases and higher mortality than for non-smoking COVID-19 patients, which needs to be noted.

Self-Reported Allergic Rhinitis Prevalence and Related Factors in Civil Aviation Aircrew of China.

INTRODUCTION: Allergic rhinitis (AR) is a global health problem with gradually increasing prevalence. No large-scale, systematic, and comprehensive study on AR among civil aviation aircrew of China has been reported. We aimed to demonstrate the prevalence of and risk factors for self-reported AR among Chinese civil aviation aircrew.METHODS: This study randomly surveyed 4059 civil aviation aircrew members from 12 cities in mainland China. A structured questionnaire was tailored, designed, and electronically delivered to all participants. Based on self-reported results, prevalence of and risk factors for AR were calculated/analyzed.RESULTS: The prevalence of self-reported AR was 23.38%. Among aircrew members, 10.37% presented with ear barotraumas, whereas 9.95% reported symptom aggravation during flight. Of aircrew members, 10.32% had symptoms related to flight duration, whereas 4.43% of symptoms related to flight altitude. Significant differences between rhinorrhea and sneezing, as well as between nasal itching and sneezing, were observed in the Total Nasal Symptoms Scores (TNSS). The Rhino-conjunctivitis Quality of Life Questionnaire (RQLQ) showed significant correlation between each section. TNSS was significantly related to RQLQ. Both TNSS and RQLQ significantly correlated with flight time.CONCLUSIONS: The prevalence of self-reported AR among civil aviation aircrew is higher than the general population in China. The severity of nasal symptoms and complications are significantly associated with quality of life and flying duties.Bai Y, Hu M, Ma F, Liu K, Xu H, Wu X, Wang H. Self-reported allergic rhinitis prevalence and related factors in civil aviation aircrew of China. Aerosp Med Hum Perform. 2021; 92(1):2531.

Prevalence and Associated Factors for Depressive Symptomatology in Chinese Adults During COVID-19 Epidemic.

Background: The coronavirus disease 2019 (COVID-19) has been rapidly transmitted worldwide, which contributed to various psychological problems (such as fear, depression, and anxiety) among the general population in China. The purpose of this study is to investigate the prevalence and associated factors of depressive symptoms among Chinese adults.Methods: A cross-sectional study of Chinese adults was conducted during 17–29 February 2020. Symptoms of depression were assessed using the Center for Epidemiologic Studies Depression scale (CES-D).Results: A total of 3,399 respondents were included in the analysis. It was observed that 14.2% (481/3,399) of the participants were screened positive for depressive symptoms. In a multivariate logistic regression analysis, older age (OR = 0.98; 95% CI, 0.97–0.99), smoking (OR = 1.57; 95% CI, 1.10–2.26), self-rated health (good: OR = 0.49; 95% CI, 0.37–0.66; fairly: OR = 0.60; 95% CI, 0.45–0.80), having greater support scores (OR = 0.95; 95% CI, 0.94–0.96), knowledge about the main symptom of COVID-19 (very clearly: OR = 0.58; 95% CI, 0.42–0.79; relatively clearly: OR = 0.59; 95% CI, 0.44–0.79), and staying in Wuhan within 3 months before the outbreak of epidemic (OR = 1.78; 95% CI, 1.34–2.38) were associated with depressive symptoms.Conclusion: A considerable proportion of the general population in China had depressive symptoms during the COVID-19 epidemic. Routine screening and targeted interventions for depression are needed among high-risk depressed individuals during the COVID-19 epidemic.

Psychological status of TMD patients, orthodontic patients and the general population during the COVID-19 pandemic

ABSTRACT Confronting the outbreak of COVID-19, this cross-sectional study was aimed to assess psychological status of temporomandibular disorders (TMD) patients, orthodontic patients and the general population in China during the pandemic. An online anonymous questionnaire was developed in Chinese, including the individual background information, the perception of the epidemic, and level of anxiety and depression through Kessler Psychological Distress Scale (K10). The respondents were divided into ORTHO group, TMD group and Control group. Descriptive analysis and multiple linear regression modelling were performed. In total, 1241 valid questionnaires were collected, covering 587 orthodontic patients and 220 TMD patients. It is shown that the overall mental health is not quite optimistic during the COVID-19 pandemic with the mean score of K10 being 18.65. TMD patients have higher level of anxiety and depression than orthodontic patients as well as the general population. Younger age, female gender, having close contact with individuals from Hubei province, higher self-rated infection possibility, concern about psychological barriers and distrust are negatively affecting patients’ psychological status. Mental health care should be emphasized when hospitals and clinics reopen after the COVID-19 pandemic, especially to patients with these relevant characteristics.

PNS248 A Hierarchical Bayes Approach in Exploring Individual Heterogeneity: An Application on Health State Valuation Using a Discrete Choice Experiment

Hierarchical Bayes (HB) is widely used in market research to estimate choice models and generate respondents’ utilities. HB is known for the advantage of including individual heterogeneity when evaluating preferences. Herein we demonstrate the usability, advantage and performance of HB in estimating health preference utilities for the Short Form 6 Dimension version 2 (SF-6Dv2) from an online Discrete Choice Experiments (DCE). An online panel of general population in China participated in a web survey. Each participant was randomized to complete 8 DCE tasks, in which a pairwise choice was firstly made between two health states based on SF-6Dv2, followed by a comparison between the worse of them and death. This second task further allows the direct anchoring of the latent utilities onto the 0-1 death-full health scale. Socio-demographic characteristics and self-assessed health, quality of life were also collected. Both conditional logit model (CL, which assumes a homogeneous preference) and an HB model that allows for preference heterogeneity were used. Monotonicity, the number of significant levels and other model fit statistics were employed for the comparison. A total of 447 participants (41.6% <40 years old, 51.5% female, 69% healthy) who passed the quality threshold were utilized in the analysis. The CL model weighted by trading life had the best fit with 3 inconsistencies, 6 insignificances, and a Root Likelihood (RLH) statistics of 0.57. The HB model also had 3 inconsistencies, one insignificant level, and an RLH of 0.73. The ‘Pits’ state utility was estimated to be 0.44, 0.24 and 0.06 for respondents preferring painful life over peaceful death, neutrals and first group opponents, respectively, based on the HB model. The HB demonstrated a better fit and a more realistic model for estimating utilities than CL. It had the power to elicit the differences preferences between subgroups based on different choice behaviours.

Anxiety Status and Influencing Factors of Rural Residents in Hunan During the Coronavirus Disease 2019 Epidemic: A Web-Based Cross-Sectional Survey.

Objective: To explore the status quo of anxiety and its influencing factors among rural residents in Hunan Province during the coronavirus disease 2019 epidemic, and to provide an effective basis for prevention of and intervention for anxiety symptoms among rural residents.Methods: Convenience sampling was used. An online questionnaire was distributed to Hunan rural residents through the questionnaire star platform from February 26–29, 2020. The general data and anxiety of Hunan rural residents were investigated, and the data were analyzed using SPSS 18.0.Results: The mean Self-Rating Anxiety Scale score of 179 rural residents in Hunan was 40.93 ± 9.36. Based on the cutoff criteria, 32 residents had anxiety, including 26 with mild anxiety, five with moderate anxiety, and one with severe anxiety. The detection rate of anxiety was 17.88%. Self-rated health status, level of concern about the epidemic, and self-rated impact of the epidemic on one's life were the factors influencing the anxiety score of rural residents in Hunan (P < 0.05).Conclusion: During the coronavirus disease 2019 epidemic, the detection rate of anxiety in rural residents in Hunan was higher than that of the general population in China. The relevant departments should pay attention to the mental health of rural residents and implement targeted mental health prevention and intervention measures during the epidemic situation.

Association between Neck Circumference and the Risk of Decreased Estimated Glomerular Filtration Rate in the General Population of China: A Cross-Sectional Study.

Background The burden of chronic kidney disease is increasing substantially worldwide. Neck circumference (NC), an anthropometric index for upper-body adiposity, has been recognized as an indicator of cardiometabolic diseases. However, the association between NC and renal dysfunction has not been fully disclosed. Objectives The aim of this study was to investigate the association between NC and estimated glomerular filtration rate (eGFR) in the general population in China. Methods A total of 8805 participants (3322 men and 5483 women) were enrolled in this study. Logistic regression analysis was conducted to examine the association between NC and eGFR. The male and female subjects were divided into four groups according to the NC quartiles. The primary outcome was defined as an eGFR ≤ 90 mL/min/1.73 m2. Results Logistic regression analysis revealed that in both sexes, higher NC was significantly associated with a higher risk of decreased eGFR even after fully adjusting for age, other anthropometric indexes, traditional risk factors for chronic kidney diseases, and sociologic risk factors (quartile 1 as a reference; the odds ratios [95% confidence intervals] were as follows: quartile 2, 1.26 [0.99-1.59]; quartile 3, 1.40 [1.07-1.83]; and quartile 4, 1.71 [1.22-2.38], in men; quartile 2, 1.14 [0.95-1.37]; quartile 3, 1.31 [1.03-1.66]; and quartile 4, 1.32 [1.04-1.68], in women). Stratified analyses suggested that the association was significant among subjects with prediabetes or normal serum uric acid levels and those without cardiovascular diseases (CVD). Among subjects with CVD, the association persisted only in males. When the subjects were stratified according to blood pressure or BMI, the association persisted among male subjects with abnormal blood pressure and was strengthened among male subjects who were overweight/obese, while the association disappeared among female subjects. Conclusions NC is independently associated with the risk of decreased eGFR in the general population in China, indicating that NC could contribute to renal dysfunction risk assessment.

Spatial analysis of metformin use compared with nicotine and caffeine consumption through wastewater-based epidemiology in China

Monitoring the consumption of pharmaceuticals and licit drugs is important for assessing the needs of public health owing to the impact on individuals as well as society. The present work applied wastewater-based epidemiology to profile the spatial patterns of metformin, nicotine, and caffeine use and their correlations. Influent wastewater samples were collected from 27 wastewater treatment plants in 22 typical Chinese cities that covered all geographic regions of the country. The consumption of metformin ranged from 0.02 g/d/1000 inh to 8.92 g/d/1000 inh, whereas caffeine and nicotine consumption ranged from 4.33 g/d/1000 inh to 394 g/d/1000 inh and 0.17 g/d/1000 inh to 1.88 g/d/1000 inh, respectively. There were significant regional differences in the consumption of caffeine, with the highest consumption in East China and the lowest consumption in Northeast China. The consumption and concentration of caffeine were related to the gross domestic product and per capita disposable income of urban residents, respectively. There was a correlation between the concentrations of caffeine and cotinine (a nicotine metabolite), thereby indicating that individuals that use one of these substances are likely to use the other substance. A significant relationship was found between the concentration of metformin and cotinine, thereby implying that the use of tobacco may be correlated with type 2 diabetes. Co-analysis of these substances in wastewater may provide a more accurate picture of substance use situations within different communities and provide more information on human health, human behavior, and the economy. This report describes the newest study related to the consumption of metformin among the general population in China.

Risk communication on behavioral responses during COVID-19 among general population in China: A rapid national study

ObjectivesTo describe the risk perception and behavioral responses among Chinese adults and to assess the associations of risk communication, risk perception, and behavioral adherence during the COVID-19 epidemic. MethodsA national cross-sectional survey was conducted in 31 provinces in China with a total number of 5039 effective questionnaires collected. The questionnaire included sociodemographic characteristics, COVID-19 risk communication factors, mask and soap supply, and engagement in preventive behaviors during the epidemic. Multivariable Logistic regression was used. ResultsAn overwhelmingly high prevalence of Chinese people was exposed to COVID-19 related risk communication messages (86.5%) and an overwhelming majority of respondents reported engagement in preventive behaviors (88.3%). Exposed to risk communication messages were positively associated with engaging in preventive behaviors, whereas, believing in misinformation were negatively associated with wearing masks when in public (p < 0.01). Respondents encountered an inadequate supplies of personal protection materials were negatively associated with their outdoor hygiene behaviors. People who were male, in an older age group, minorities, with lower education, with lower income, and lived in rural area showed lower exposures to risk communication messages. ConclusionsFuture risk communication practices are recommended to better monitor population risk perceptions and pay attention to socio-demographically disadvantaged people.

Unmet needs for mental care services for older people in Bangladesh during the COVID-19 pandemic.

Dear Editor We read with interest the editorial by Qiu et al 1 about the psychological distress among the general population in China during the COVID-19 pandemic and policy recommendations. The elderly are more vulnerable to increased mental health problems during COVID-19, which has raised significant challenges for community mental health services.1 2 Older people with comorbid conditions, including cardiovascular diseases, lung diseases, diabetes and hypertension are more likely to be severely affected and die because of COVID-19, which is caused by SARS-CoV-2.3 Bangladesh is one of the most densely populated countries in the world, making it more vulnerable to the rapidly spreading COVID-19. As of 28 May 2020, 38 292 cases of COVID-19 have been confirmed in Bangladesh, including 501 deaths.4 Although only 8% of the total patients with COVID-19 were elderly persons (aged >60 years), they account for almost 42% of total deaths.4 In 2015, there were 12.5 million (7.5% of the total population) older people (aged ≥60 years) in Bangladesh.5 However, the proportion of older people is almost 5% lower than the overall ratio of geriatric people worldwide (ie, about 12.5% or 901 million people globally were aged 60 years or above in 2015).6 Among the older people in Bangladesh, around 53.8% have multicomorbidities,5 making them more vulnerable to the COVID-19 infection. As SARS-CoV-2 has high transmissibility and is mainly transmitted from person to person,3 to prevent the aggressive and rapid outbreak of the pandemic, the Government of Bangladesh has advised people to stay at home. Therefore, during the COVID-19 outbreak, older people are suffering from lack of social contacts and physical activities. The lack of social connections and the overall situation of the pandemic, including the rapid …