Effects of loneliness and isolation on cardiovascular diseases:a two sample Mendelian Randomization Study

BACKGROUND Loneliness and isolation are associated with multiple cardiovascular diseases(CVDs),but there is a lack of research on whether they were causally linked.We conducted a Mendelian Randomization(MR)study to explore causal relationships between loneliness and isolation and multiple CVDs.METHODS Single nucleotide polymorphisms associated with loneliness and isolation were identified from a genome-wide association study(GWAS)of 455,364 individuals of European ancestry in the IEU GWAS database.Summary data for 15 CVDs were also obtained from the IEU GWAS database.We used three MR methods including inverse variance weighting,MR-Egger,and weighted median estimation to assess the causal effect of exposure on outcomes.Cochran's Q test and MR-Egger intercept test were used to evaluate the heterogeneity and pleiotropy.RESULTS MR analysis showed that loneliness and isolation were significantly associated with essential hypertension(OR=1.07,95%CI:1.03-1.12),atherosclerotic heart disease(OR=1.04;95%CI:1.02-1.06),myocardial infarction(OR=1.02;95%CI:1-1.04)and angina(OR=1.04;95%CI=1.02-1.06).No heterogeneity and pleiotropy effects were found in this study.CONCLUSIONS Causal relationship of loneliness and isolation with CVDs were found in this study.

Status of cardiovascular disease in China

Cardiovascular disease(CVD)has become the leading cause of death and disability in the global population and imposes a significant economic burden on global health systems.Prevalent cases of total CVD nearly doubled from 271 million in 1990 to 523 million in 2019,and the number of CVD deaths steadily increased from 12.1 million in 1990,reaching 18.6 million in 2019.The global trends for disabilityadjusted life years and years of life lost also increased significantly,and years lived with disability doubled from 17.7 million to 34.4 million over that period.

Utilization of online systems to promote youth participation in research:A methodological study

BACKGROUND Online surveys can align with youth’s increased use of the internet and can be a mechanism for expanding youth participation in research.This is particularly important during the coronavirus disease 2019(COVID-19)pandemic,when inperson interactions are limited.However,the advantages and drawbacks of online systems used for research need to be carefully considered before utilizing such methodologies.AIM To describe and discuss the strengths and limitations of an online system developed to recruit adolescent girls for a sexual health research study and conduct a three-month follow up survey.METHODS This methodology paper examines the use of an online system to recruit and follow participants three months after their medical visit to evaluate a mobile sexual and reproductive health application,Health-E You/Salud iTuTM,for adolescent girls attending school-based health centers(SBHCs)across the United States.SBHC staff gave adolescent girls a web link to an online eligibility and consent survey.Participants were then asked to complete two online surveys(baseline and 3-month follow-up).Surveys,reminders,and incentives to complete them were distributed through short message service(SMS)text messages.Upon completing each survey,participants were also sent an email with a link to an electronic gift card as a thank-you for their participation.Barriers to implementing this system were discussed with clinicians and staff at each participating SBHC.RESULTS This online recruitment and retention system enabled participant recruitment at 26 different SBHCs in seven states across the United States.Between September 2021 and June 2022,415 adolescent girls were screened using the Qualtrics online survey platform,and 182 were eligible to participate.Of those eligible,78.0%(n=142)completed the baseline survey.Participants were racially,geographically,and linguistically diverse.Most of the participants(89.4%)were non-White,and 40.8%spoke Spanish.A total of 62.0%(n=88)completed the 3-month follow-up survey.Limitations of this system included reliance on internet access(via Wi-Fi or cell service),which was not universally available or reliable.In addition,an individual unrelated to the study obtained the survey link,filled out multiple surveys,and received multiple gift cards before the research team discovered and stopped this activity.As a result,additional security protocols were instituted.CONCLUSION Online systems for health research can increase the reach and diversity of study participants,reduce costs for research personnel time and travel,allow for continued study operation when in-person visits are limited(such as during the COVID-19 pandemic),and connect youth with research using technology.However,there are challenges and limitations to online systems,which include limited internet access,intermittent internet connection,data security concerns,and the potential for fraudulent users.These challenges should be considered prior to using online systems for research.

Uptake of HIV Self-testing among Men Who have Sex with Men in Beijing, China： a Cross-sectional Study

Objective To examine HIV self-testing uptake and its determinates among men who have sex with men （MSM） in Beijing, China. Methods A cross-sectional online survey was conducted in Beijing, China in 2016. Participants were users of a popular Chinese gay networking application and had an unknown or negative HIV status. Univariate and multivariate logistic regression analyses were conducted to examine factors associated with HIV self-testing based on adjusted odds ratio （AOR） and 95% confidence interval （CI）. Results Among the 5,996 MSM included in the study, 2,383 （39.7%） reported to have used HIV self-testing kits. Willingness to use an HIV self-test kit in the future was expressed by 92% of the participants. High monthly income （AOR = 1.49; CI = 1.10-2.02; P = 0.010）, large number of male sex partners （≥2： AOR = 1.24; CI = 2.09-1.43; P = 0.002）, sexual activity with commercial male sex partners （〉 2： AOR = 1.94; CI = 1.34 -2.82; P = 0.001）, long-term drug use （AOR = 1.42; CI = 1.23-1.62; P 〈 0.001）, and long-term HIV voluntary counseling and testing （VCT） attendance （AOR = 3.62; CI = 3.11-4.22; P 〈 0.001） were all associated with increased odds of HIV self-testing uptake. Conclusion The nearly 40% rate of HIV self-testing uptake among MSM in our sample was high. In addition, an over 90% willingness to use kits in the future was encouraging. HIV self-testing could be an important solution to help China achieve the global target of having 90% of all people living with HIV diagnosed by 2020.

The prevalence of hypertension overweight/obesity and its relation with cardiovascular disease among middle-aged Chinese population

Objective To investigate the prevalence of hypertension overweight/obesity and the combined effect on the incidence of cardiovascular disease(CVD).Methods The study population(aged from 35 to 64)were selected from 9 regions of China by cluster sampling method.The baseline was conducted in 2010,and the follow-up survey was done in 2017.Participants with 24≤BMI28 kg/m^2 was defined as overweight,BMI≥28 kg/m^2 was defined as obesity.

Effectiveness of a workplace-based multicomponent intervention to improve hypertension control among Chinese working population:a cluster-controlled trial

Objective To determine whether a workplace-based multicomponent intervention strategy could improve BP control among Chinese working population.Methods A cluster-controlled trail,with workplaces assigned to either the intervention or control group.60 workplaces across 20 urban regions of China were selected.4,548 hypertensive employees aged 18-60 years were assigned intervention(n=3,470)or control(n=1,078),of whom 4,205(92.5%;intervention,n=3,209;control,n=996)were included in this analysis.

Effect of comprehensive intervention on hypertension control among employees in the Chinese stated-owned enterprise:a cluster controlled trial

Objective To evaluate the effect of a workplace-based comprehensive intervention strategy on the improvement of blood pressure (BP) control.Methods A cluster controlled trail, with workplaces (clusters)assigned to either the intervention or control group. Totally, 30 statedowned enterprises across China were included, among which 20were allocated to the intervention group and 10 to the control group.

Exploration for the Priority of HIV Intervention:Modelling Health Impact and Cost-Effectiveness—Six Cities,Eastern China,2019-2028

Introduction:In order to enhance the effectiveness of resource allocation,regions must tailor their responses to their specific epidemiological and economic situations.Methods:Utilizing Spectrum software,we projected the cost-effectiveness of 10 chosen HIV interventions in six cities in eastern China from 2019 to 2028.We assessed three scenarios—Base,Achievable,and Idealized—for each city.The analysis included the projected number of HIV infections and deaths averted,as well as the incremental costeffectiveness ratios for each intervention in the six cities.Results:In Shijiazhuang,Wuxi,Yantai,and Zhenjiang,cities with initially low antiretroviral therapy(ART)coverage,ART showed significant effectiveness,especially for males.Conversely,in Foshan and Ningbo,where ART coverage was notably high,oral pre-exposure prophylaxis(PrEP)for men who have sex with men(MSM)proved effective in the Idealized scenario.MSM outreach,ART for males,and ART for females demonstrated cost-effectiveness across all six cities in both Achievable and Idealized scenarios at the predefined thresholds for each city.Discussion:Maintaining an appropriate coverage rate for outreach to MSM can lead to costeffectiveness.In cities with low ART coverage,scaling up ART remains a crucial intervention.In regions with high ART coverage,consideration may be given to the utilization of oral PrEP for MSM individuals,requiring budget allocation.

Heart failure and left ventricular dysfunction in older patients with chronic kidney disease: the China Hypertension Survey (2012‒2015)

Background Heart failure(HF)is a leading cause of hospitalization and mortality for older chronic kidney disease(CKD)patients.However,the epidemiological data is scarce.We aimed to determine the prevalence of left ventricular(LV)dysfunction and HF,and to explore the risk factors for HF among those patients.Methods This is a cross-sectional analysis of the China Hypertension Survey conducted between October 2012 and December 2015.A total of 5,808 participants aged≥65 years were included in the analysis.Self-reported history of HF and any other cardiovascular diseases was acquired.2-D and Doppler echocardiography were used to assess LV dysfunction.CKD was defined as either estimated glomerular filtration rate(eGFR)<60 mL/min per 1.73 m2 or urinary albumin to creatinine ratio(ACR)≥30 mg/g.Results Among CKD patients aged≥65 years,the weighted prevalence of HF,heart failure with preserved ejection fraction(HFpEF),heart failure with mid-range ejection fraction(HFmrEF),and heart failure with reduced ejection fraction(HFrEF)was 4.8%,2.5%,0.8%,and 1.7%,respectively.The weighted prevalence of HF was 5.0%in patients with eGFR<60 mL/min per 1.73 m2,and was 5.9%in patients with ACR≥30 mg/g.The prevalence of LV systolic dysfunction was 3.1%,and while it was 8.9%for moderate/severe diastolic dysfunction.Multivariate analysis showed that smoking was significantly associated with the risk of HF.Furthermore,age,smoking,and residents in rural areas were significantly associated with a risk of LV diastolic dysfunction.Conclusions The prevalence of HF and LV dysfunction was high in older patients with CKD,suggesting that particular strategies will be required.

Genome-Wide Linkage and Positional Association Analyses Identify Associations of Novel AFF3 and NTM Genes with Triglycerides:The GenSalt Study

We conducted a genome-wide linkage scan and positional association study to identify genes and variants influencing blood lipid levels among participants of the Genetic Epidemiology Network of Salt-Sensitivity （GenSalt） study. The GenSalt study was conducted among 1906 participants from 633 Han Chinese families. Lipids were measured from overnight fasting blood samples using standard methods. Multipoint quantitative trait genome-wide linkage scans were performed on the high-density lipoprotein, low-density lipoprotein, and log- transformed triglyceride phenotypes. Using dense panels of single nucleotide polymorphisms （SNPs）, single-marker and gene-based association analyses were conducted to follow-up on promising linkage signals. Additive associations between each SNP and lipid phenotypes were tested using mixed linear regression models. Gene-based analyses were performed by combining P-values from single- marker analyses within each gene using the truncated product method （TPM）. Significant associations were assessed for replication among 777 Asian participants of the Multi-ethnic Study of Atherosclerosis （MESA）. Bonferroni correction was used to adjust for multiple testing. In the GenSalt study, suggestive linkage signals were identified at 2p11.2-2q12.1 [maximum multipoint LOD score （MML） = 2.18 at 2q11.2] and t lq24.3-11q25 （MML = 2.29 at 11q25） for the log-transformed triglyceride phenotype. Follow-up analyses of these two regions revealed gene-based associations of charged multivesicular body protein 3 （CHMP3）, ring finger protein 103 （RNF103）, AF4/FMR2 family, member 3 （AFF3）, and neurotrirnin （NTM） with triglycerides （P = 4 ×10^-4, 1.00 × 10^-5, 2.00 × 10^-5, and 1.00 × 10^-7, respectively）. Both the AFF3 and NTM triglyceride associations were replicated among MESA study participants（P = 1.00 × 10^-7 and 8.00× 10^-5, respectively）. Furthermore, NTM explained the linkage signal on chromosome 11, In conclusion, we identified novel genes associated with lipid phenotypes in linkage regions on chromosomes 2 and 11.

Estimating Costs of the HIV Comprehensive Intervention Using the Spectrum Model--China,2015-2019

Introduction:In order to facilitate human immunodeficiency virus(HIV)treatment and prevention,the resource needs for HIV national strategic planning in developing regions were estimated based on Spectrum,the universal HIV costeffectiveness analysis software.Methods:Based on the theoretical framework of Spectrum,the study developed a cost measurement tool for HIV,and calculated the cost of HIV prevention and control in 6 sampled cities in China during 2015–2019 using the Spectrum model.Results:From 2015 to 2019,the average annual costs for HIV prevention and control for Shijiazhuang,Yantai,Ningbo,Zhenjiang,Foshan,and Wuxi cities were 46.78,47.55,137.49,24.73,74.37,and 58.30 million Chinese yuan(CNY),respectively.The per capita costs were 4.37,6.73,17.33,7.77,17.56,and 8.91 CNY,respectively.In terms of the cost structure,the ratio of preventive intervention funds to therapeutic intervention funds(antiviral treatment)varied in sampled cities.Discussion:Developing comprehensive and systematic HIV fund calculation methods can provide a research basis for rational resource allocation in the field of HIV.

Decreased incidence followed by comeback of pediatric infections during the COVID‑19 pandemic in Japan

During the coronavirus disease 2019(COVID-19)pandemic,the Japanese government implemented several infection control measures,such as states of emergency(SoE)and school closures,and encouraged universal masking and hand hygiene.Initial activity restrictions and improved hygiene were found to be associated with declines in the incidence of infuenza during the 2019–2020 winter season[1].Prior studies have found that the incidence of seven pediatric infections,such as pharyngoconjunctivitis and varicella,decreased during and after the school closures in Japan[2].As activity restrictions continue to be lifted,there is growing concern that pediatric infections may suddenly return given that the pool of susceptible children increased during the pandemic[3].In this study,we use national infectious disease sentinel data from January 2012 to October 2021 to assess changes in the reported number of pediatric infections in Japan during the COVID-19 pandemic.We hypothesize that the reporting of many infectious diseases decreased during the early stages of the pandemic but ultimately returned to normal when activity restrictions were lifted.

HIV care-seeking behaviour after HIV selftesting among men who have sex with men in Beijing,China:a cross-sectional study

Background:Men who have sex with men(MSM)has become the group with the fastest growing HIV epidemic in China.Since many Chinese MSM are conducting HIV self-testing,we aimed to determine the rate of HIV care seeking after self-testing,examine characteristics of“seekers”compared to“non-seekers,”and explore factors associated with HIV care-seeking behaviour.Methods:A cross-sectional study design was used and an online survey was conducted in Beijing,China in 2016,among users of a popular Chinese gay networking smart phone application.Chi-square test was used to compare characteristics of those who sought HIV care(“seekers”)and those who did not(“non-seekers”).Univariate and multivariate logistic regression analyses were conducted to assess factors associated with HIV care seeking.Results:Among 21,785 screened,2383 participants(10.9%)were included in the study.A total of 380 participants(15.9%)reported seeking HIV care after HIV self-testing while 2003(84.1%)did not.Lack of knowledge of the“window period”(adjusted odds ratio[AOR]=0.68,95%confidence interval[95%CI]=0.47-0.97,P=0.04)was associated with reduced odds of seeking HIV care,while lower monthly income(AOR=1.29,95%CI=1.03-1.62,P=0.03)and obtaining HIV self-testing kits from health facilities(AOR=2.40,95%CI=1.81-3.17,P<0.001),and non-governmental organizations(AOR=2.44,95%CI=1.79-3.34,P<0.001)was associated with increased odds of seeking HIV care.Among those who sought HIV care,a large majority(92.4%)had non-reactive HIV self-testing results.Only 29 out of 265 with reactive,uncertain,or unknown results sought HIV care.Conclusions:We found a very low rate of HIV care seeking among our sample of urban Chinese MSM.The observation that most with reactive,uncertain,or unknown results did not seek HIV care is a cause for concern.These people should be paid more attention and helped to enter the care cascade.Our findings highlight that interventions aimed at improving linkage to care after HIV self-testing are urgently needed.However,further study is required to inform the design and implementation of future interventions aiming to encourage HIV care-seeking behaviour.

Fasting glucose and its association with 20-year all-cause and cause-specific mortality in Chinese general population

Objective: The aim of this study was to explore the relationship between fasting glucose levels and all-cause and cause-specific mortality in Chinese population. Methods: The role of fasting blood glucose levels as a predictor of all-cause and cause-specific mortality was estimated in 9930 participants from four Chinese general populations with a 20-year follow-up. Multivariate Cox proportional hazard models were used to identify the relationship between fasting glucose and mortality. Results: There were 1471 deaths after a median follow-up of 20.2 years (a total of 187,374 person-years), including 310 cardiovascular deaths, 581 cancer deaths, and 580 other-cause deaths. After adjustment for age, sex, urban or rural, northern or southern of China, types of work, education level, physical exercise, smoking status, drinking status, body mass index, systolic blood pressure, and serum total cholesterol at baseline, the hazard ratios (HRs) and 95% confidence intervals (C/s) for all-cause mortality in the fasting blood glucose categories of <60, 60—69, 70—79, 90—99, 100—109, 110—125, and >126 mg/dl were 1.38 (1.04-1.84), 1.20 (1.01-1.43), 1.18 (1.03-1.36), 1.18 (0.99-1.41), 1.48 (1.16-1.88), 1.17 (0.84-1.62), and 2.23 (1.72—2.90), respectively, in contrast to the reference group (80—89 mg/dl). The HRs, and 95% C/s for cardiovascular disease mortality in these groups were 2.58 (1.44-4.61), 1.41 (0.95-2.10), 1.56 (1.15-2.11), 1.29 (0.88-1.89), 1.36 (0.78-2.37), 1.05 (0.52—2.11), and 2.73 (1.64—4.56), respectively. Conclusions: Both low and high fasting glucose were significantly associated with increased risk of all-cause and cardiovascular mortality in Chinese general population.