Efflux-Related Carbapenem Resistance in Acinetobacter baumannii Is Associated with Two-Component Regulatory Efflux Systems' Alteration and Insertion of ΔAbaR25-Type Island Fragment.

The efflux pumps, beside the class D carbapenem-hydrolysing enzymes (CHLDs), are being increasingly investigated as a mechanism of carbapenem resistance in Acinetobacter baumannii. This study investigates the contribution of efflux mechanism to carbapenem resistance in 61 acquired blaCHDL-genes-carrying A. baumannii clinical strains isolated in Warsaw, Poland. Studies were conducted using phenotypic (susceptibility testing to carbapenems ± efflux pump inhibitors (EPIs)) and molecular (determining expression levels of efflux operon with regulatory-gene and whole genome sequencing (WGS)) methods. EPIs reduced carbapenem resistance of 14/61 isolates. Upregulation (5-67-fold) of adeB was observed together with mutations in the sequences of AdeRS local and of BaeS global regulators in all 15 selected isolates. Long-read WGS of isolate no. AB96 revealed the presence of AbaR25 resistance island and its two disrupted elements: the first contained a duplicate ISAba1-blaOXA-23, and the second was located between adeR and adeA in the efflux operon. This insert was flanked by two copies of ISAba1, and one of them provides a strong promoter for adeABC, elevating the adeB expression levels. Our study for the first time reports the involvement of the insertion of the ΔAbaR25-type resistance island fragment with ISAba1 element upstream the efflux operon in the carbapenem resistance of A. baumannii.

Analysis of Electricity and Water Consumption in Existing Mosque Buildings in the UAE

According to the World Economic Forum, the building sector is responsible for 40% of global energy consumption and 33% of greenhouse gas (GHG) emissions, and this is expected to increase due to population growth and the subsequent impact on the environment, economy and health. To tackle the problem, countries have set new construction codes, policies and regulations for the construction of new buildings in an effort to make them greener. However, there is a need to enhance the status of the existing buildings, especially mosques, as they are the main contributors to energy usage and water consumption in the United Arab Emirates (UAE). Therefore, this research seeks to fill this gap, aiming to evaluate the energy usage and water consumption practices employed in the existing mosque buildings within the UAE and to provide recommendations for improving the sustainability of mosques, with a focus on the environmental and economic pillars. The methodology relies mainly on data collected from 146 existing mosque buildings that have undergone energy saving audits across the UAE. Descriptive statistical analysis is performed to analyze the data from the period of 2018–2019 in order to determine the most significant factors related to energy inefficiency in existing mosque buildings in the UAE and to determine the most cost-effective and energy-saving corrective measures for energy and water conservation. The findings further enhance the standard of experience for mosque visitors (social aspect);reduce energy bill expenses, providing an acceptable return on investment from the proposed energy conservation measures for stakeholders (economic);and reduce the overall energy consumption, which can reduce the total CO2 emissions from mosque buildings (environmental).

Brief Epidemiological Consideration on the COVID-19 Pandemic

Three years have passed since the first case of coronavirus disease 2019 (COVID-19) caused by the novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Although the pandemic has slowed down gradually, the situation is not yet stable. Since COVID-19 has spread mainly in developed European and American countries, it is considered to be said a peculiar infectious disease. It has a significant impact on medical systems in developed countries in across the globe. In the past three years, the COVID-19 epidemic has changed gradually, both globally and regionally. © Fuji Technology Press Ltd.

Effects of the COVID-19 pandemic on the uptake of routine immunization vaccines in Swat District in Pakistan

The COVID-19 pandemic affected life-saving childhood immunization globally and affected Vaccine-Preventable Diseases eradication and elimination efforts. During the initial phase of the pandemic, some countries temporarily stopped vaccination campaigns against measles, meningitis, polio, tetanus, typhoid, and yellow fever. This study was conducted to quantify the effect of COVID-19 on EPI vaccination. A cross-sectional study was conducted in the district Swat of Khyber-Pakhtunkhwa from June to August 2022. The data was extracted from the EPI Management Information System for the four months of the pre-pandemic period and four months of the lockdown period. The pre-pandemic four-month data was taken as a baseline and was compared with the four-months lockdown period. A 7-19% decrease was found during the lockdown period in various antigen coverage. Coverage of Penta-3 was most affected having a 19% decrease while measles coverage was less affected showing a 7% decrease during the lockdown period. BCG coverage was affected by 14%, PCV by 11 to 18%, Rota by 12 to 16%, and IPV by 18%. The vaccination coverage improved in the later months of the lockdown, but the number of defaulters and zero-dose children increased. To fill this gap, a robust strategy for vaccination is recommended.

Illness Risk Perceptions and Efficacy Beliefs among Indonesian in the Course of COVID-19 Pandemic

COVID-19, a worldwide pandemic, has posed a significant challenge to public health systems worldwide. Health risk perception and efficacy belief are primary constructs influencing individuals' protective behavior due to the outbreak. Our study investigated each item of illness risk perception, efficacy belief, and its related factors concerning the COVID-19 pandemic. An analytical cross-sectional study was conducted among 227 respondents aged 17 to 70. Data collection was conducted using convenience sampling by distributing the web questionnaire between April and July 2020. Mann-Whitney or Kruskal-Wallis bivariate analysis was performed using SPSS version 21.0 to assess the relationship between individual characteristic factors, illness risk perception, and efficacy belief. The study established that respondents had a medium to a high level of illness risk perception and a reasonable efficacy belief in dealing with the COVID-19 pandemic. Region (p=0.027) and occupation (p=0.036) differences were significantly associated with the threat and severity perception, respectively. Smoking history (p=0.037), supplement use (p=0.029), and occupation (p=0.018) differences were significantly associated with self-efficacy. Meanwhile, gender (p=0.045) differences were significantly associated with response efficacy. Therefore, the public's illness risk perception and efficacy belief could be substantial in planning, modifying, and implementing a coordinated response for risk communication in current and future epidemics. Copyright © 2022 Institute for Research and Community Services, Universitas Muhammadiyah Palangkaraya. All right reserved.

Who is protected? Determinants of hepatitis B infant vaccination completion among a prospective cohort of migrant workers in Thailand during the COVID-19 pandemic.

BACKGROUND: Hepatitis B causes significant disease and death globally, despite the availability of effective vaccination. Migration likewise affects hundreds of millions of people annually, many of whom are women and children, and increases risks for poor vaccine completion and mother to child transmission of hepatitis B. In the neighbouring countries of Thailand and Myanmar, vaccine campaigns have made progress but little is known about the reach of these programs into migrant worker communities from Myanmar living in Thailand. METHODS: A cohort of 253 postpartum women (53 urban migrants in Chiang Mai and 200 rural migrants in Tak Province) were surveyed about their Hepatitis B knowledge and willingness to vaccinate their children between September 10, 2019 and March 30, 2019. They were subsequently followed to determine vaccine completion. When records of vaccination were unavailable at the birth facility, or visits were late, families were contacted and interviewed about vaccination elsewhere, and reasons for late or missed vaccines. RESULTS: Though women in Tak province displayed better knowledge of Hepatitis B and equal intention to vaccinate, they were 14 times less likely to complete Hepatitis B vaccination for their children compared to migrants in Chiang Mai. Tak women were largely undocumented, had private (non-profit) insurance and had more transient residence. In Chiang Mai migrant women were mostly documented and had full access to the Thai national health services. Though minor individual and facility-level differences may have contributed, the major driver of the disparity seems to be the place of migrants within local socio-political-economic systems. The COVID-19 pandemic further disproportionately affected Tak province migrants who faced severe travel restrictions hampering vaccination. Sixty percent of families who were lost to vaccine follow-up in Tak province could not be contacted by phone or home visit. Chiang Mai migrants, with 86.8% vaccine completion, nearly reached the target of 90%. CONCLUSIONS: Achievement of high levels of hepatitis B vaccination in migrant communities is important and feasible, and requires inclusive policies that integrate migrants into national health and social services. This is more urgent than ever during the COVID-19 era.

Immunization programs to support primary health care and achieve universal health coverage.

Gains in immunization coverage and delivery of primary health care service have stagnated in recent years. Remaining gaps in service coverage reflect multiple underlying reasons that may be amenable to improved health system design. Immunization systems and other primary health care services can be mutually supportive, for improved service delivery and for strengthening of Universal Health Coverage. Improvements require that dynamic and multi-faceted barriers and risks be addressed. These include workforce availability, quality data systems and use, leadership and management that is innovative, flexible, data driven and responsive to local needs. Concurrently, improvements in procurement, supply chain, logistics and delivery systems, and integrated monitoring of vaccine coverage and epidemiological disease surveillance with laboratory systems, and vaccine safety will be needed to support community engagement and drive prioritized actions and communication. Finally, political will and sustained resource commitment with transparent accountability mechanisms are required. The experience of the impact of COVID-19 pandemic on essential PHC services and the challenges of vaccine roll-out affords an opportunity to apply lessons learned in order to enhance vaccine services integrated with strong primary health care services and universal health coverage across the life course.

COVID 19: A New Insight Into Organ Failure and Complications Caused by Novel SARS-CoV-2 Virus and Discussion on the Role of Nanotechnology in Detection, Treatment and Prevention of the Disease

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, which first appeared in Chinese individuals in December 2019, is now causing the COVID-19 pandemic, with 5,79,319 deaths and 13,338,364 confirmed cases as of January 31st, a total of 56.7 lakhs. COVID-19 causes dysregulated immunological responses, metabolic dysfunctions, and negative consequences on a variety of organ functions. Significant risk factors are typically connected with older people who have medical comorbidities including cancer and diabetes. Scientists and doctors have battled to understand the unique virus and its pathogenesis in order to develop suitable treatment drugs and vaccines for COVID-19. The spike protein SARS-CoV-2 has recently been discovered to attach to the enzyme that converts human angiotensin I. The purpose of this study was to examine the involvement of many organs in COVID-19 patients, particularly in severe cases. We also wanted to know what was driving the multiorgan failure caused by SARS-CoV-2. Multi-organ dysfunction manifests itself in a variety of ways, including acute lung failure, acute liver failure, acute kidney damage, cardiovascular disease, a variety of haematological abnormalities, and neurological problems. The most important processes are associated to SARS-direct coV-2's and indirect pathogenic features. Although SARS-CoV2 receptor angiotensin-converting enzyme 2 (ACE-2) was found in the lung, heart, kidney, testis, liver, lymphocytes, and nervous system, the presence of SARS-CoV-2 RNA in these organs was unknown. These epidemics have strained healthcare systems and prompted serious concerns about how to deal with them using traditional drugs and diagnostic tools. In this regard, the application of nanotechnology opens up new avenues for the creation of ground-breaking preventative, diagnostic, and treatment solutions. We examine how nanotechnology can be applied to control the COVID-19 virus by designing nano-based materials such as disinfectants, personal protective equipment, diagnostic systems, and nanocarrier systems for treatments and vaccine development, as well as the challenges and drawbacks that must be overcome. Copyright © 2022, Association of Biotechnology and Pharmacy. All rights reserved.

Increase in kawasaki disease incidence observed in 30-year population-based study in scandinavia

Background and Aim: World-wide, Kawasaki disease (KD) is known to affect predominantly children under the age of 5, mostly boys. An increasing incidence has been reported from select countries, as well as seasonal differences, although with great variation among reports. Sweden has unique population-based health registers which can be linked to population registers via a personal number. In this study we therefore utilized population-based data over a period of more than 30 years to investigate demographics and epi-demiology of Kawasaki disease in a Scandinavian country. Method(s): Individuals receiving a diagnosis of Kawasaki disease in Sweden from 1987-2018 (before the occurrence of MIS-C) were identified by ICD9 and ICD10 discharge diagnoses in the Patient register at the National Board of Health and Welfare, and basic demographic information obtained by cross-linking with popula-tion registers at Statistics Sweden. Age-stratified population statis-tics were also retrieved during the corresponding time-period. Result(s): A total of 1,785 individuals with a KD diagnosis during the study period were identified, confirming a relatively low incidence in the Scandinavian population. Less than 5% of the cases were born in another country. The majority of cases (78%) occurred before 5 years of age, and there was a male dominance (61%). Sweden has a temperate climate of the northern hemisphere, and analysis of case distribution over the yearly cycle revealed peak incidence during the winter months. Notably, the incidence rose from around 6/100,000 lt;5-year-olds to 15/100,000 lt;5-year-olds during the 30-year study period. Two years with prominently higher incidence than prior and following years were observed. A large part of the rise in incidence seems to be associated with immigration and occurred before the occurrence of Multisystem Inflammatory Syndrome in Children related to SARS-CoV-2. Conclusion(s): Demographic parameters for Kawasaki disease in Sweden regarding age and sex distribution are similar to previous reports from other countries. Our data from a 30-year study period of population-based observations confirm peak incidence during the cold period, and a rising incidence during recent years, even before the occurrence of MIS-C. Our data also indicate outbursts during two years and immigration-associated patterns in rise in incidence.

The Mann-Kendall-Sneyers test to identify the change points of COVID-19 time series in the United States.

BACKGROUND: One critical variable in the time series analysis is the change point, which is the point where an abrupt change occurs in chronologically ordered observations. Existing parametric models for change point detection, such as the linear regression model and the Bayesian model, require that observations are normally distributed and that the trend line cannot have extreme variability. To overcome the limitations of the parametric model, we apply a nonparametric method, the Mann-Kendall-Sneyers (MKS) test, to change point detection for the state-level COVID-19 case time series data of the United States in the early outbreak of the pandemic. METHODS: The MKS test is implemented for change point detection. The forward sequence and the backward sequence are calculated based on the new weekly cases between March 22, 2020 and January 31, 2021 for each of the 50 states. Points of intersection between the two sequences falling within the 95% confidence intervals are identified as the change points. The results are compared with two other change point detection methods, the pruned exact linear time (PELT) method and the regression-based method. Also, an open-access tool by Microsoft Excel is developed to facilitate the model implementation. RESULTS: By applying the MKS test to COVID-19 cases in the United States, we have identified that 30 states (60.0%) have at least one change point within the 95% confidence intervals. Of these states, 26 states have one change point, 4 states (i.e., LA, OH, VA, and WA) have two change points, and one state (GA) has three change points. Additionally, most downward changes appear in the Northeastern states (e.g., CT, MA, NJ, NY) at the first development stage (March 23 through May 31, 2020); most upward changes appear in the Western states (e.g., AZ, CA, CO, NM, WA, WY) and the Midwestern states (e.g., IL, IN, MI, MN, OH, WI) at the third development stage (November 19, 2020 through January 31, 2021). CONCLUSIONS: This study is among the first to explore the potential of the MKS test applied for change point detection of COVID-19 cases. The MKS test is characterized by several advantages, including high computational efficiency, easy implementation, the ability to identify the change of direction, and no assumption for data distribution. However, due to its conservative nature in change point detection and moderate agreement with other methods, we recommend using the MKS test primarily for initial pattern identification and data pruning, especially in large data. With modification, the method can be further applied to other health data, such as injuries, disabilities, and mortalities.

How I Use It: The Exosome Diagnostics (EPI) prostate cancer biomarker utility in urology and primary care.

Prostate-specific antigen (PSA) screening remains the mainstay for early detection of prostate cancer. Although PSA is a nonspecific prostate cancer biomarker, its specificity for high grade prostate cancer can be enhanced by pre-biopsy liquid biomarkers including the Exosome Dx Prostate IntelliScore (EPI) test. EPI is a stand-alone urine genomic test that measures 3 exosome-derived gene expression signatures without the need for digital rectal examination (DRE) or inclusion of standard of care parameters in the test algorithm. EPI has broad clinical utility as a risk stratification tool for clinically significant high grade prostate cancer in men considering diagnostic prostate biopsy (MRI-targeted and systematic biopsy). During the COVID-19 pandemic, the EPI At-Home Collection Kit was introduced and quickly became an important component of tele-urology. The EPI test has emerged as a prioritization tool for primary care referral to urologists and for prostate biopsy scheduling. EPI provides an objective and actionable genomic risk assessment tool for high grade prostate cancer and is a critical part of the informed decision-making regarding biopsy (targeted, systematic or both) in both urology and primary care practices.

Extreme Heat and COVID-19: A Dual Burden for Farmworkers.

Currently, there is an extensive literature examining heat impacts on labor productivity and health, as well as a recent surge in research around COVID-19. However, to our knowledge, no research to date examines the dual burden of COVID-19 and extreme heat on labor productivity and laborers' health and livelihoods. To close this research gap and shed light on a critical health and livelihood issue affecting a vulnerable population, we urge researchers to study the two topics in tandem. Because farmworkers have a high incidence of COVID-19 infections and a low rate of inoculation, they will be among those who suffer most from this dual burden. In this article, we discuss impacts from extreme heat and COVID-19 on farm laborers. We provide examples from the literature and a conceptual framework showing the bi-directional nature of heat impacts on COVID-19 and vice versa. We conclude with questions for further research and with specific policy recommendations to alleviate this dual burden. If implemented, these policies would enhance the wellbeing of farmworkers through improved unemployment benefits, updated regulations, and consistent implementation of outdoor labor regulations. Additionally, policies for farmworker-related health needs and cultural aspects of policy implementation and farmworker outreach are needed. These and related policies could potentially reduce the dual burden of COVID-19 and extreme heat impacts while future research explores their relative cost-effectiveness.

From Genetics to Epigenetics: Top 4 Aspects for Improved SARS-CoV-2 Vaccine Designs as Paradigmatic Examples.

This literature review described the genetic and biochemical factors that may have been overlooked in the formulation of vaccines and that most likely underlie possible issues with mass vaccination.

Millions of Bangladeshi Children Missed Their Scheduled Vaccination Amidst COVID-19 Pandemic.

The Government of Bangladesh imposed a movement control order as a mass quarantine strategy to control the outbreak of coronavirus disease 2019 (COVID-19). Adherence to the home quarantine may put children at risk by missing routine vaccination. In this study, we investigated the impact of COVID-19 on child routine immunization in a rural area of Bangladesh and consider the broader implications. Data for this study comes from the Chakaria Health and Demographic Surveillance System (HDSS) of icddr,b with a population of 90,000 people residing in 16,000 households in 49 villages in a rural, coastal area of Southeast Bangladesh. We used an explanatory sequential mixed methods design which involved two phases between March 1, 2020, and May 31, 2020: first, we observed 258 outreach sessions of 86 EPI centers. We calculated the number of Expanded Program on Immunization (EPI) outreach sessions suspended and the number of children who missed their routine vaccination due to the COVID-19. We extrapolated the number of Bangladeshi children who missed their routine vaccination using Chakaria HDSS observations. Secondly, we conducted in-depth interviews to explain the quantitative results. The EPI outreach session (EOS) declined to 74.42% (95% CI 63.97-83.22), 10.45% (95% CI 5.00-18.94), and 3.45% (95% CI 1.00-9.75) from 2019 levels in March, April, and May 2020, respectively. By extrapolation, in Bangladesh, between March and May 2020, 3.2 million children missed their scheduled vaccination compared to 2019. Results from in-depth interviews showed that the unwillingness of villagers to hold EOS and the absenteeism of the vaccinators due to social distancing recommendations and lack of personal safety measures were the main reasons for the discontinuation of the EOS. Resuming EPI outreach sessions and introducing a special catch-up program is essential to prevent future outbreaks and deaths due to vaccine-preventable diseases in Bangladesh and the countries where children missed their routine vaccination due to COVID-19. This health system failure should be considered a factor in all future pandemic preparedness plans.

Comments on Epidemics in the New Keynesian model by Eichenbaum, Rebelo, and Trabandt".

With this paper, Eichenbaum, Rebelo, and Trabandt have made another insightful and influential contribution to the growing literature on the macroeconomics of epidemics. Their papers are paving the way to a new fascinating research program whose objective is to develop empirically plausible macroeconomic models of epidemics. I argued that estimating synthetic COVID shocks in familiar DSGE models provides a good benchmark to evaluate progress toward this goal (Ferroni et al., 2021). Furthermore, evaluating alternative containment measures and how these measures should be deployed (e.g., should containment measures be targeted to the workplaces or somewhere else?) are important matters this research agenda should address. My work with Rottner (Melosi and Rottner, 2020) contributes to developing methods allowing researchers to study contact tracing and testing in macro-epidemiological models of the type studied in Eichenbaum, Rebelo, and Trabandt's influential works.

Prognostic value of biochemical parameters among severe COVID-19 patients admitted to an intensive care unit of a tertiary hospital in South Africa.

Background: Data on biochemical markers and their association with mortality rates in patients with severe coronavirus disease 2019 (COVID-19) admitted to intensive care units (ICUs) in sub-Saharan Africa are scarce. An evaluation of baseline routine biochemical parameters was performed in COVID-19 patients admitted to the ICU, in order to identify prognostic biomarkers. Methods: Demographic, clinical, and laboratory data were collected prospectively from patients with PCR-confirmed COVID-19 admitted to the adult ICU of a tertiary hospital in Cape Town, South Africa, between October 2020 and February 2021. Robust Poisson regression methods and the receiver operating characteristic (ROC) curve were used to explore the association of biochemical parameters with severity and mortality. Results: A total of 82 patients (median age 53.8 years, interquartile range 46.4-59.7 years) were enrolled, of whom 55 (67%) were female and 27 (33%) were male. The median duration of ICU stay was 10 days (interquartile range 5-14 days); 54/82 patients died (66% case fatality rate). Baseline lactate dehydrogenase (LDH) (adjusted relative risk 1.002, 95% confidence interval 1.0004-1.004; P = 0.016) and N-terminal pro B-type natriuretic peptide (NT-proBNP) (adjusted relative risk 1.0004, 95% confidence interval 1.0001-1.0007; P = 0.014) were both found to be independent risk factors of a poor prognosis, with optimal cut-off values of 449.5 U/l (sensitivity 100%, specificity 43%) and 551 pg/ml (sensitivity 49%, specificity 86%), respectively. Conclusions: LDH and NT-proBNP appear to be promising predictors of a poor prognosis in COVID-19 patients in the ICU. Studies with a larger sample size are required to confirm the validity of this combination of biomarkers.

[POCT-management during the first wave of Covid-19 in France. Results of a national survey leaded by the SFBC-POCT Working Group]. / Gestion de la biologie délocalisée lors de la première vague de Covid-19 en France. Résultats de l'enquête nationale menée par le groupe de travail des EBMD de la SFBC.

During the first wave of Covid-19 in France, in spring 2020, healthcare institution's laboratory had to adapt itself quickly to the growing demand for emergency biology, in particular by reorganizing their POCT analyzers: redeployment of analyzers and/or new installations. In order to analyze this management, a subgroup of 15 hospital biologists from the SFBC Working Group "Biochemical markers of Covid-19" sent, in fall 2020, an on-line survey to French hospital laboratories using POCT. Answers analysis (n = 86) shows a territorial disparity related to the severity of the first wave: increased activity essentially in red zones, management of unexpected situations, training of additional nursing staff for 40 % of the laboratories... The survey also showed simplification of aspects related to accreditation those periods of health crisis. An additional survey, carried out in the spring of 2021, showed good overall satisfaction of the healthcare services (n = 139) concerning the services provided by biology in the POCT sector. Because of their great adaptation capacity, the laboratories and their POCT-teams have played a key role in the management of the first wave of Covid-19 in France. However, the success of these organizations requires an essential collaboration between laboratories and healthcare services. The results of this survey are fundamental in the context of the prolongation of the pandemia throughout the world with a POCT sector appearing to be growing.

Nordic Walking Rather Than High Intensity Interval Training Reduced Myostatin Concentration More Effectively in Elderly Subjects and the Range of This Drop Was Modified by Metabolites of Vitamin D.

The COVID-19 pandemic and subsequent self-isolation exacerbated the problem of insufficient amounts of physical activity and its consequences. At the same time, this revealed the advantage of vitamin D. Thus, there was a need to verify the effects of those forms of training that can be performed independently. In this study, we examined the effects of Nordic walking (NW) and high intensity interval training (HIIT) with regard to the impact of the metabolite vitamin D. We assigned 32 overweight adults (age = 61 ± 12 years) to one of two training groups: NW = 18 and HIIT = 14. Body composition assessment and blood sample collection were conducted before starting the training programs and a day after their completion. NW training induced a significant decrease in myostatin (p = 0.05) concentration; however, the range was dependent on the baseline concentrations of vitamin D metabolites. This drop was accompanied by a significant negative correlation with the decorin concentration. Unexpectedly, NW caused a decrement in both forms of osteocalcin: undercarboxylated (Glu-OC) and carboxylated-type (Gla-OC). The scope of Glu-OC changes was dependent on a baseline concentration of 25(OH)D2 (r = -0.60, p = 0.01). In contrast, the HIIT protocol did not induce any changes. Overall results revealed that NW diminished the myostatin concentration and that this effect is more pronounced among adults with a sufficient concentration of vitamin D metabolites.

Non-EPI Vaccine Hesitancy among Chinese Adults: A Cross-Sectional Study.

Vaccination against coronavirus disease 2019 (COVID-19) is paramount to curtailing the pandemic. However, the impact of the Non-Expanded Program on Immunization (non-EPI) and COVID-19 vaccine hesitancy on vaccine uptake among Chinese adults remain unclear. This study was an online survey performed in Eastern, Central, and Western China between February 2021 and March 2021 using proportional sampling (n = 7381). Adults aged ≥ 18 years were included, especially younger people (aged < 65). Vaccine hesitancy was assessed using the 3C model and relative scales; logistic regression was used to explore the factors affecting vaccination uptake; structural equation modeling was used to evaluate the correlations between variables. Overall, 67.6% and 24.7% of adults reported vaccine hesitancy toward the non-EPI and COVID-19 vaccines, respectively. Participants (66.3%) reported taking the vaccine mainly based on recommendations from medical staff. Vaccine-hesitant participants (60.5%) reported a fear of side effects as the deciding factor in vaccine rejection. Vaccine hesitancy interacted negatively with confidence (ß = -0.349, p < 0.001) and convenience (ß = -0.232, p < 0.001), and positively with complacence (ß = 0.838, p < 0.001). Nonmedical personnel, adults who had previously received the influenza vaccine, and older people had lower vaccine hesitancy than their counterparts. Most Chinese adults have non-EPI but not COVID-19 vaccine hesitancy. Vaccine safety remains a concern.