Global pattern and determinants of coronavirus disease 2019(COVID-19)vaccine coverage and progression:a global ecological study

Background:Understanding and minimizing existing global coronavirus disease 2019(COVID-19)vaccination disparities is critical to global population health and eliminating health inequities.The study aims to investigate the disparities of vaccination coverage and progression and the associated economic and educational determinants to inform global COVID-19 vaccination strategies.Methods:COVID-19 vaccination coverage data from 206 countries used in the study were derived from“Our World in Data”website.After obtaining the vaccination coverage indicators,we fitted the progression indicators for vaccination.Correlation and multiple linear regression analysis were used to examine the effects of gross domestic product(GDP)per capita,Gini index,education,and their interactions on the coverage and progression of the COVID-19 vaccination.Results:The coverage of COVID-19 vaccination ranged from less than 30 doses to more than 150 doses per hun­dred people,from less than 15%to more than 75%for proportion of people vaccinated,from less than 15%to more than 60%for proportion of people fully vaccinated.Similarly,the progression of vaccination ranged from less than 0.1 to more than 0.6 for progression of total number of doses,from less than 0.1 to more than 0.3 for progression of proportion of people vaccinated,and from less than 0.1 to more than 0.4 for progression of propor­tion of people fully vaccinated.GDP per capita and education were positively associated with the coverage and progression,while Gini index was negatively associated with the coverage and progression.Negative interaction between GDP per capita and education was also observed for coverage(0=-0.012 to-0.011,P<0.05)and progression(0=-0.012 to-0.011,P<0.05).Conclusions:Substantial geographic disparities existed for the coverage and progression of COVID-19 vaccination.

A comparison study of prevalence,awareness,treatment and control rates of hypertension and associated factors among adults in China and the United States based on national survey data

Objective:This study compared the prevalence,awareness,treatment and control of hypertension and associated factors in China and the United States(US).Methods:Adult data from nationally representative samples were derived from the Chronic Disease and Risk Factors Surveillance in 2010 and 2013 in China and the National Health and Nutrition Examination Survey in 2010 and 2013 in the US.Multivariable logistic and Poisson regression analysis were conducted to assess associations of the four outcomes with body weight status and behavioral factors.Results:Age-standardized prevalence rates of hypertension was 35.7%(95%confidence interval[CI]:35.4%to 36.1%)in 2010 and 29.8%(95%CI:29.4%to 30.2%)in 2013 in China,and 35.3%(95%CI:33.6%to 37.1%)in 2010 and 37.9%(95%CI:36.0%to 39.7%)in 2013 in the US.Among hypertensive participants,the age-standardized rates of treatment were 18.4%(95%CI:17.9%to 1&9%)in 2010 and 23.8%(95%CI:23.1%to 24.6%)in 2013 in China and 54.5%(95%CI:50.3%to 5&7%)in 2010 and 50.9%(95%CI:46.5%to 55.3%)in 2013 in the US;the age-standardized hypertension control rates were 3.2%(95%CI:3.0%to 3.5%)and 5.7%(95%CI:5.3%to 6.0%)in 2010 and 2013 in China and 50.6%(95%CI:46.2%to 55.0%)and 55.3%(95%CI:50.3%to 60.3%)in the US.Obesity was significantly associated with prevalence,awareness and control rates in both countries.Different from the US,obesity was negatively associated with hypertension control in China.Conclusion:Hypertension prevalence in China is similar to that in the US,but the control rate in China was significantly lower.Obesity was a critical risk factor for poor hypertension control in China.

吸毒社会规范及吸毒倾向对青少年药物滥用的影响

目的研究青少年吸毒社会规范、吸毒倾向与药物滥用的关系,为预防青少年吸毒提供指导。方法采用分层随机整群抽样方法,抽取武汉市初中、高中、职业高中和大学学生共3018名进行问卷调查,调查是无记名和自愿的。采用多因素Logistic回归分析模型进行分析。结果武汉市青少年药物滥用率为3.58%,其中男、女生分别为5.37%和2.0%。控制性别、学校类型和年龄的影响,Logistic回归分析结果显示,吸毒社会规范、吸毒倾向与青少年吸毒有很强的联系,OR值分别为1.723和14.608。结论吸毒社会规范、吸毒倾向可能增加青少年吸毒的风险,提示在青少年吸毒预防中,应提高他们对毒品的认识,帮助他们树立良好的社会规范,降低吸毒倾向。

武汉市青少年应激性生活事件和吸烟行为的关系

目的 :了解武汉市青少年应激性生活事件及其与吸烟的关系。方法 :采用匿名的方式 ,在武汉市 11个区随机抽取 2 2所中学初一至初三的学生 6994名 ,进行问卷调查。应激性生活事件的测量采取记数的方式 ,分别统计家庭、学校和小伙伴三个方面的正性和负性生活事件数 ,作为生活事件得分 ;吸烟的测量采用 4个变量 ,即尝试吸烟 ,30天吸烟 ,7天吸烟和是否吸 10 0支烟 (吸烟习惯 )。采取单因素 χ2 检验和多因素Logistic回归模型进行分析。结果 :武汉市青少年吸烟主要与家庭和学校方面的负性生活事件正相关 ,而与学校方面的正性生活事件呈负相关。结论 :应激性生活事件与青少年吸烟有关 ,提示我们应大力提高青少年应对生活事件的能力 ,预防和减少青少年吸烟。

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

Background:The coronavirus disease 2019(COVID-19)became a global pandemic within several months after it was first reported at the end of December,2019.Countries in the Northern Hemisphere have been affected the most,including the United States and European countries.Contrary to the common knowledge that infectious diseases are more prevalent in low-and middle-income countries,COVID-19 appears to affect wealthy countries more.This paper attempts to quantify the relationship between COVID-19 infections and levels of economic development with data from the U.S.and Europe.Methods:Public domain data on the confirmed COVID-19 cases during January 1 and May 31,2020 by states and territories in the U.S.and by countries in Europe were included.Incidence rate was estimated using the 2019 total population.COVID-19 cases were associated with 2019 gross domestic product(GDP)using regression models after a logarithmic transformation of the data.The U.S.data and European data were analyzed separately,considering significant heterogeneity between the two.Results:A total of 2451691 COVID-19 cases during a 5-month period were analyzed,including 1787414 from 50 U.S.states and territories and 664277 from 28 European countries.The overall incidence rate was 5.393/1000 for the U.S.and 1.411/1000 for European countries with large variations.Lg(total cases)was significantly associated with lg(GDP)for U.S.states(=1.2579,P<0.001)and European countries(=0.7156,P<0.001),respectively.Conclusion:This study demonstrated a positive correlation between COVID-19 case incidence and GDP in the United States and 28 European countries.Study findings suggest a potential role of high-level development in facilitating infectious disease spread,such as more advanced transportation system,large metropolitan cities with high population density,better domestic and international travel for businesses,leisure,and more group activities.These factors must be considered in controlling the COVID-19 epidemic.This study focuses on the impact of economic development,many other factors might also have contributed to the rapid spread of COVID-19 in these countries and states,such as differences in national and statewide anti-epidemic strategies,people's behavior,and healthcare systems.Besides,low-and middle-income countries may have an artificially low COVID-19 case count just due to lack of diagnostic capabilities.Findings of this study also encourage future research with individual-level data to detect risk factors at the personal level to understand the risk of COVID-19.

Biology of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)and the humoral immunoresponse:a systematic review of evidence to support global policy-level actions and research

Background Both population-level epidemiological data and individual-level biological data are needed to control the coronavirus disease 2019(COVID-19)pandemic.Population-level data are widely available and efforts to combat COVID-19 have generated proliferate data on the biology and immunoresponse to the causative pathogen,severe acute respiratory syndrome coronavirus 2(SARS-CoV-2).However,there remains a paucity of systemized data on this subject.Objective In this review,we attempt to extract systemized data on the biology and immuno-response to SARS-CoV-2 from the most up-to-date peer-reviewed studies.We will focus on the biology of the virus and immunological variations that are key for determining long-term immunity,transmission potential,and prognosis.Data Sources and Methods Peer-reviewed articles were sourced from the PubMed database and by snowballing search of selected publications.Search terms included:“Novel Coronavirus”OR“COVID-19”OR“SARS-CoV-2”OR“2019-nCoV”AND“Immunity”OR“Immune Response”OR“Antibody Response”OR“Immunologic Response”.Studies published from December 31,2019 to December 31,2020 were included.To ensure validity,papers in pre-print were excluded.Results Of 2889 identified papers,36 were included.Evidence from these studies suggests early seroconversion in patients infected with SARS-CoV-2.Antibody titers appear to markedly increase two weeks after infection,followed by a plateau.A more robust immune response is seen in patients with severe COVID-19 as opposed to mild or asymptomatic presentations.This trend persists with regard to the length of antibody maintenance.However,overall immunity appears to wane within two to three months post-infection.Conclusion Findings of this study indicate that immune responses to SARS-CoV-2 follow the general pattern of viral infection.Immunity generated through natural infection appears to be short,suggesting a need for long-term efforts to control the pandemic.Antibody testing will be essential to gauge the epidemic and inform decision-making on effective strategies for treatment and prevention.Further research is needed to illustrate immunoglobulin-specific roles and neutralizing antibody activity.

The evaluation of global epidemic of HIV/AIDS with a novel approach using country-specific counts of HIV infections and three rates controlled for population and geographic area

Background:The human immunodeficiency virus/acquired immunodeficiency syndrome(HIV/AIDS)epidemic is a typical global health concern.The impact of HIV/AIDS is global,and we cannot effectively solve the problem without a global effort.In this study,we report our research on global HIV/AIDS control with an innovative fourdimensional approach.Methods:Countries(n=148)with data available on area size,total population,and the total number of persons living with HIV(PLWH)were included.The HIV epidemic across the globe was described using 4 indicators,including the total count,population-based P rate,geographic area-based G rate,and population and geographic area-based PG rate.Results:A total of 35,426,911 PLWH were included,with a global prevalence rate of 0.51 per 1,000 population.The total PLWH count provided data on resource allocation in individual countries to improve HIV/AIDS care;and the top five countries with the highest PLWH counts were South Africa(7,000),Nigeria(3,500),India(2,100),Kenya(1,500),and Mozambique(1,500).The other three indicators provide a measure to assess the global risk profile of HIV transmission and to provide information on HIV/AIDS prevention strategies.The top five countries with the highest P rates(per 1,000 persons)were Swaziland(170.9),Botswana(154.7),Lesotho(145.2),South Africa(127.4),and Zimbabwe(89.7);the top five countries with the highest G rates(per 100 km2)were Swaziland(1,279.1),Malawi(1,039.5),Lesotho(1,021.1),Rwanda(810.7),and Uganda(748.1);and the top five countries with highest PG rates(per 1,000,000 persons per 100 km2)were Barbados(2,127.9),Swaziland(993.8),Lesotho(478.3),Malta(375.0),and Mauritius(319.7).With PG rate,we detected countries in two hotspots(south and middle Africa and the Caribbean region)and one belt across the Euro-Asian region with high risks of HIV transmission.Conclusions:This study expanded the conventional measures by adding two new indicators,thus forming a new four-dimensional framework to quantify the global HIV epidemic.In addition to gaining a better insight into the epidemic than before,study findings provide new data on country-level and global efforts to end the AIDS epidemic by 2030.

Cusp Catastrophe Polynomial Model: Power and Sample Size Estimation

Guastello’s polynomial regression method for solving cusp catastrophe model has been widely applied to analyze nonlinear behavior outcomes. However, no statistical power analysis for this modeling approach has been reported probably due to the complex nature of the cusp catastrophe model. Since statistical power analysis is essential for research design, we propose a novel method in this paper to fill in the gap. The method is simulation-based and can be used to calculate statistical power and sample size when Guastello’s polynomial regression method is used to do cusp catastrophe modeling analysis. With this novel approach, a power curve is produced first to depict the relationship between statistical power and samples size under different model specifications. This power curve is then used to determine sample size required for specified statistical power. We verify the method first through four scenarios generated through Monte Carlo simulations, and followed by an application of the method with real published data in modeling early sexual initiation among young adolescents. Findings of our study suggest that this simulation-based power analysis method can be used to estimate sample size and statistical power for Guastello’s polynomial regression method in cusp catastrophe modeling.

Anteroposterior Airway Diameter during Sedation for Brain MRI in Children with and without Developmental Disabilities

Objective: Our study objective was to compare the anteroposterior (AP) oropharyngeal airway diameter measured using static MRI images in children with and without developmental disabilities during sedation. Methods: We performed a secondary analysis on a prospective, observational age-matched, 1:2 case-control study of children aged 3 - 10 years who were sedated for brain MRI. AP airway diameters were determined at the level of soft palate (airway_SP) and tongue (airway_T) from midline sagittal images by a single blinded radiologist. Results: Airway diameter was evaluated in 134 controls (C) and 68 cases (D). There was no difference in the overall adverse events (D: 30% C: 32.9%;p = 0.7) as well as hypoxia (D: 10%;C: 9.3%, p = 0.9). There was no significant difference in mean airway_T (D: 10.62 ± 3.48 vs. C: 10.38 ± 3.47;p = 0.64) and airway_SP diameter (D: 4.59 ± 2.36 vs. C: 5.17 ± 3.9;p = 0.14) between the two groups. There was no significant difference in airway_T and airway_SP diameters amongst those who experienced and those who did not experience hypoxia in cases. Amongst controls however, the airway_SP was smaller in those who experienced hypoxia compared to those who did not experience hypoxia. Conclusions: There was no difference in the AP airway_T and airway_SP diameter during sedation using static MRI images in children with and without developmental disabilities. Changes in airway_SP was associated with hypoxia amongst controls in our study cohort.

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

Background:Controlling the coronavirus disease 2019(COVID-19)epidemic requires information beyond new and cumulative cases.This study aims to conduct an in-depth analysis by geographic strata:Wuhan City(hereafter referred to as Wuhan)only,Hubei Province(hereafter referred to as Hubei)excluding Wuhan,and China excluding Hubei.Methods:Daily cumulative confirmed COVID-19 cases between December 8,2019(the date of symptom onset based on patients'recall during the investigation),and March 1,2020,from official sources and published studies were analyzed.The second derivative model was used for information extraction.Data analysis was conducted separately for the three strata.Results:A total of 80026 diagnosed COVID-19 cases were reported during the first 85 days of the epidemic,with 49315 cases from Wuhan,17788 from Hubei excluding Wuhan,and 12923 from China excluding Hubei.Analytical results indicate that the COVID-19 epidemic consists of an Acceleration,a Deceleration,and a Stabilization Phase in all three geographic strata,plus a Silent Attack Phase for Wuhan only.Given the reported incubation period of 14 days,effects of the massive anti-epidemic actions were revealed by both the Acceleration and Deceleration Phases.The Acceleration Phase signaled the effect of the intervention to detect the infected;the Deceleration Phase signaled the declines in new infections after the infected were detected,treated and quarantined.Conclusion:Findings of the study provide new evidence to better monitor the epidemic,evaluate its response to intervention,and predict the trend long.In addition to re-evaluating the control of the COVID-19 epidemic in China,this study provided a model for monitoring outbreaks of COVID-19 in different countries across the world.

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

Background:Global spread and impact of the coronavirus disease 2019(COVID-19)pandemic are determined to a large extent,by resistance to the pandemic and public response of all countries in the world;while a country's resistance and response are in turn determined by its political and socio economic conditions.To inform future disease prevention and control,we analyzed global data to exam the relationship between state vulnerabilities and COVID-19 incidences and deaths.Methods:Vulnerability was measured using the Fragile States Index(FSI).FSI is created by the Fund for Peace to assess levels of fragility for individual countries.Total FSI score and scores for 12 specific indicators were used as the predictor variables.Outcome variables were national cumulative COVID-19 cases and deaths up to September 16,2020,derived from the World Health Organization.Cumulative incidence rates were computed using 2019 National population derived from the World Bank,and case fatality rates were computed as the ratio of deaths/COVID-19 cases.Countries with incomplete data were excluded,yielding a final sample of 146 countries.Multivariate regression was used to examine the association between the predictor and the outcome measures.Results:There were dramatic cross-country variations in both FSI and COVID-19 epidemiological measurements.FSI total scores were negatively associated with both COVID-19 cumulative incidence rates(β=-0.0135,P<0.001)and case fatality rates(β=-0.0147,P<0.05).Of the 12 FSI indicators,three negatively associated with COVID-19 incidences were E1(Economic Decline and Poverty),E3(Human Flight and Brain Drain),and S2(Refugees and Internally Displaced Persons);two positively associated were P1(State Legitimacy)and X1(External Intervention).With regard to association with case fatality rates,C1(Security Apparatus)was positive,and P3(Human Rights and Rule of Law)and X1 was negative.Conclusion:With FSI measures by the Fund of Peace,overall,more fragile countries are less likely to be affected by the COVID-19 pandemic,and even if affected,death rates were lower.However,poor in state legitimacy and lack of external intervention are risk for COVID-19 infection and lack of security apparatus is risky for COVID-19 death.Implications of the study findings are discussed and additional studies are needed to examine the mechanisms underpinning these relationships.

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

The coronavirus disease 2019(COVID-19)is a highly contagious respiratory disease.COVID-19 is caused by the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2,previously provisionally named 2019 novel coronavirus or 2019-nCoV).1 This positive and enveloped single-strain RNA virus shares many similarities with two other coronavirus,including the Middle East respiratory syndrome coronavirus(MERS-CoV)and the severe acute respiratory syndrome coronavirus(SARS-CoV).

知识、态度、社会规范对青少年新型毒品使用的影响研究

目的研究知识、态度和社会规范与青少年新型毒品使用之间的关系并构建影响模式。方法采用分层随机整群抽样的方法进行抽样。来自武汉市初中、高中、职业高中和大学的共3018名学生参加了问卷调查,调查是无记名和自愿的。采用确证性因子分析构建测量模型,采用结构方法模型进行评价、修正以确定最佳模型。结果武汉市青少年新型毒品的滥用率为3.28%,其中男女生分别为4.81%和1.94%,普通初中、高中、职业高中和大学生的毒品滥用率分别为1.80%、2.91%、7.83%和3.25%。模型拟和效果较好。模型结果显示:知识、态度、社会规范影响青少年使用新型毒品,其中态度、社会规范直接影响青少年吸毒或吸毒倾向,而知识通过态度、社会规范的中介作用发挥效应。结论对新型毒品的了解不足、对待毒品的态度不正确以及吸毒社会规范不强增加青少年使用新型毒品的风险。

A nomogram predicting atrial fibrillation in patients with dilated cardiomyopathy

To the Editor:Dilated cardiomyopathy(DCM)is a type of primary myocardial disease with unknown etiology.[1]It is a disorder of the heart muscle mainly characterized by left ventricular dilation and systolic dysfunction,resulting from the response of the myocardium to genetic and environmental insults.The clinical manifestations arc progressive heart failure,arrhythmia,thromboembolism,and even sudden death.