Trends in migraine incidence among women of childbearing age from 1990 to 2019 and the prediction for 2030: an analysis of national data in China.

BACKGROUND: Migraine is a primary headache, which has been producing heavy disease burden globally. There is no data on the incidence of migraine among women of childbearing age worldwide, including China. This study aimed to investigate the time trend in incidence rate of migraine among women of childbearing age in China from 1999 to 2019, and to make a prediction for 2030. METHODS: Data on migraine incidence and population among women of childbearing age in China were derived from the Global Burden of Diseases Study 2019. Crude and age-standardized incidence rates of migraine (CIR, ASIR) were presented. The trend in migraine during 1990-2019 was examined using annual percent change and average annual percent change based on Joinpoint regression models. Age-period-cohort model was introduced to estimate the independent effect of age, period and cohort on migraine incidence rate among participants over the three decades. Bayesian age-period-cohort analysis was conducted to predict migraine incidence rate for 2030 among women of childbearing age in China. RESULTS: For women of childbearing age in China, the case number, CIR and ASIR of migraine kept rising, with a cumulative percentage increase of 10.87%, 2.01% and 5.65%, respectively, from 1990 to 2019. An annual percent increase of 0.18% in the ASIR was observed over the three decades. As for the age, period and cohort effects, the adjusted cohort-specific relative risks constantly increased from 0.91 (95% CI: 0.90, 0.93) in the 1940-1949 cohort to 1.04 (95% CI: 1.03, 1.05) in the 1995-2004 cohort, while the period-specific relative risks initially declined from 1.00 (95% CI: 0.99, 1.00) in 1990-1994 cohort to 0.99 (95% CI: 0.98, 0.99) in 1995-1999 cohort, and then increased to 1.04 (95% CI: 1.03, 1.04) in 2015-2019 cohort. Moreover, the age-specific relative risks of migraine followed a bimodal pattern with peaks at the age-group of 25-29 years (CIR = 1718.27/100000) and 35-39 years (CIR = 1635.18/100000). Projection modeling showed that the CIR and ASIR of migraine will continue to significantly increase from 2020 to 2030. CONCLUSION: Migraine incidence remained an increasing trend from 1990 to 2019 and is projected to continually increase till 2030 among women of childbearing age in China. This study has important public health implication for population-level migraine prevention in China. Precision intervention strategies and approaches shall be considered in campaigns initiated for migraine prevention among Chinese women of childbearing age.

The joint association of physical activity and sedentary behavior with health-related quality of life among children and adolescents in Mainland China.

Objectives: The objective of this study was to investigate the joint association of physical activity (PA) and sedentary behavior (SB) with health-related quality of life (HRQoL) among children in Mainland China. Methods: Children were randomly recruited from primary, junior, and senior high schools (graders 4-12) in Nanjing municipality of China in this cross-sectional survey in 2018. The outcome variable, HRQoL, was assessed using the validated Chinese version of Child Health Utility 9D (CHU9D-CHN) instrument. PA and SB were measured using a validated Physical Activity Scale and Food Frequency Questionnaire for Chinese school-aged children. The associations of PA and SB with HRQoL were assessed using mixed-effects linear regression models and reported as mean difference (MD) and 95% confidence interval (CI). Results: Totally, 4,388 participants completed the survey (response rate = 97.6%). After adjustment for potential confounders and class-level clustering effects, relative to those with insufficient PA and prolonged SB, students with insufficient PA and shortened SB (MD = 0.054, 95%CI = 0.018, 0.089), or children with sufficient PA and prolonged SB (MD = 0.034, 95%CI = -0.030, 0.098), or students with sufficient PA and shortened SB (MD = 0.083, 95%CI = 0.045, 0.120), respectively, reported increased HRQoL scores. Conclusion: PA was positively associated with HRQoL, and SB was in negative relation to HRQoL. Furthermore, sufficient PA and shortened SB might exert additive influence on HRQoL among children and adolescents in China. This study has public health implications that PA promotion and SB reduction are encouraged to be considered simultaneously for the purpose to maximally improve HRQoL in population-based behavior intervention campaigns among children and adolescents.

The prevalence of functional gastrointestinal disorders related symptoms and the association with working place among healthcare workers who were in the fighting against COVID-19 in regional China.

Objectives: To investigate the prevalence of functional gastrointestinal disorders (FGIDs) related symptoms among healthcare workers (HWs) who were in the fighting against COVID-19 in Nanjing of China, and further to examine the association between working place and FGIDs-related symptoms among HWs during the period of COVID-19 epidemic. Methods: An online anonymous survey was conducted among those HWs without history of FGIDs, who took part in the fighting against the COVID-19 epidemic between July and September of 2021 in Nanjing, China. All the 15 FGIDs-related symptoms included in the Rome IV diagnostic questionnaire for adults were investigated in this study. The outcome variable was the presence of FGIDs-related symptoms ("Yes" or "No"), while the independent measure was participants' working place ("in-ward" or "out-ward"). Logistics regression models were applied to calculate odds ratios (ORs) and 95% confidence intervals (CIs) to assess the association of working place with FGIDs-related symptoms among those healthcare workers. Results: Totally, 336 eligible participants completed the survey. The prevalence of FGIDs-related symptoms was 48.8% (95%CI = 43.4%, 54.3%) among overall participants, with 40.7% (95%CI = 33.14%, 48.71%) and 56.3% (95%CI = 48.59%, 63.73%) for in-ward and out-ward HWs, respectively. Compared to their in-ward counterparts, those out-ward HWs were at a 1.88-fold likelihood (95%CI = 1.22, 2.89) to experience FGIDs-related symptoms during the period of fighting against the COVID-19 epidemic. After adjustment for potential confounders, such a positive association attenuated but still remained significant. Conclusions: A high prevalence of FGIDs-related symptoms was observed among those HWs who were without history of FGIDs during the fighting against COVID-19, and out-ward HWs were at a significantly higher risk to experience FGIDs-related symptoms relative to their in-ward counterparts in regional China. It has important implications that particular attention shall be paid to functional gastrointestinal issues for healthcare workers, especially those who are at uncertain risks of infectious diseases, when they participate in response to public health emergencies in future.

The relationship between health literacy and health-related quality of life among school-aged children in regional China.

OBJECTIVES: To examine the association between health literacy (HL) and health-related quality of life (HRQoL) among primary and high school students in Nanjing, China. METHODS: A cross-sectional study was conducted among randomly selected primary (graders 4-6), junior (graders 7-9) and senior (graders 10-12) high school students in 2018 in Nanjing Municipality of China. HRQoL, the outcome variable, was assessed with the validated Chinese version of Child Health Utility 9D (CHU9D) and used as continuous variable, while HL, our independent variable, was measured with the validated Chinese Students' Health literacy Assessment Scale and treated as categorical variable ("adequate" or "inadequate") in the analysis. Mixed-effects linear regression models were introduced to calculate mean difference and 95% confidence interval (CI) for examining the association between HL and HRQoL. RESULTS: Totally, 4388 of 4498 students completed the survey. Among these responders, the mean score of CHU9D was 0.78 ± 0.17, and the proportion of participants with adequate HL was 85.8% (95% CI = 84.7%, 86.8%). After adjustment for potential confounders and class-level clustering effects, participants who had adequate HL were observed having, on average, an elevated HRQoL score of 0.08 (95% CI = 0.06, 0.11) units compared to their counterparts with inadequate HL. Such a positive HL-HRQoL association was also identified among each stratum of participants' age, gender and residence. CONCLUSIONS: HL was positively associated with HRQoL score among primary and high school students in China. It has public health implications that HRQoL may be improved through school-based health literacy intervention among children and adolescents in China.

Additional value of auricular intradermal acupuncture alongside selective serotonin reuptake inhibitors: a single-blinded, randomized, sham-controlled preliminary clinical study.

BACKGROUND: To evaluate the antidepressant effects of auricular intradermal acupuncture (AIA) of areas innervated by both the auricular branch of the vagus nerve and the trigeminal nerve. METHODS: Forty-nine patients with depression were randomly allocated into an AIA group (n = 25) and a sham AIA group (n = 24). Both groups received selective serotonin reuptake inhibitors (SSRIs) as conventional treatment. The AIA group received AIA stimulation, and the sham AIA group received sham AIA, which constituted being subjected to an attached needle that did not penetrate the skin. The needles were retained for 4 h each session, with five sessions a week for a total duration of 2 weeks. The outcomes were assessed by the 17-item Hamilton depression rating scale (HAMD-17), five factors (sleep disorder, retardation, cognitive dysfunction, anxiety/somatization, and weight) and self-rating depression scale (SDS) at weeks 0, 1, and 2. RESULTS: Fifty-four patients were randomly assigned to the AIA (n = 27) and sham AIA group (n = 27), of whom 25 patients in the AIA and 24 patients in the sham AIA group were analyzed. AIA-treated patients displayed a significantly greater reduction from baseline in HAMD-17 scores (p = 0.03) and SDS scores (p = 0.02) at week 2 compared to patients receiving sham AIA. The AIA intervention also produced a higher rate of clinically significant responses in sleep disorders (p = 0.07) compared to sham AIA. No adverse events occurred in either group. CONCLUSION: According to the findings of this preliminary study, AIA appears to have additional value compared to SSRIs alone in treating patients with depressive disorder.

Traumatic Experiences and PTSD Symptoms in the Chinese Male Intrafamilial Physical Violence Perpetrators: A Comparative and Structural Equation Modeling Study.

We aimed to compare traumatic experiences among the groups of perpetrators with or without violent pedigree, and establish a structural model of posttraumatic stress disorder (PTSD) symptoms as mediators of traumatic experiences and severe intrafamilial physical violence among Chinese male perpetrators. A cross-sectional survey and a face-to-face interview were conducted to examine intimate partner violence (IPV) perpetration and violent pedigree, childhood maltreatment, other traumatic events, PTSD symptoms, and severe intrafamilial physical violence in a community sample of 229 abusive men and 303 controlled men in China. Using structural equation modeling (SEM) techniques, the scores of the questionnaires were entered into the theoretical model and calculated. Findings demonstrated that the numbers of the traumatic events in four groups were significantly different with a declining trend, and the SEM data had an adequate fit. The loadings of pathways from childhood witness domestic violence (DV) to severe physical violence (SPV) were more salience than other pathways, and the indirect effect of every pathway, except for the childhood witness DV to PTSD symptoms, on severe intrafamilial physical violence in the model was significant. The results suggest that PTSD symptoms cluster as mediator of the intergenerational transmission of SPV perpetration in Chinese abusive men. Childhood witness IPV has effects on adulthood perpetration of IPV.

Association of academic performance, general health with health-related quality of life in primary and high school students in China.

PURPOSE: To explore the association of academic performance and general health status with health-related quality of life (HRQoL) in school-aged children and adolescents in China. METHODS: In this cross-sectional study conducted in 2018, students (grade 4-12) were randomly chosen from primary and high schools in Nanjing, China. HRQoL, the outcome measure, was recorded using the Child Health Utility 9D, while self-rated academic performance and general health were the independent variables. Mixed-effects regression models were applied to compute mean difference (MD) and 95% confidence interval (CI) of HRQoL utility score between students with different levels of academic performance and general health. RESULTS: Totally, 4388 participants completed the study, with a response rate of 97.6%. The mean HRQoL utility score was 0.78 (SD: 0.17). After adjustment for socio-demographic attributes, physical activity, sedentary behavior, dietary patterns, body weight status and class-level clustering effects, students with fair (MD = 0.048, 95% CI 0.019, 0.078) and good (MD = 0.082, 95% CI 0.053, 0.112) self-rated academic performance reported higher HRQoL utility scores than those with poor academic performance, respectively. Meanwhile, students with fair (MD = 0.119, 95% CI 0.083, 0.154) and good (MD = 0.183, 95% CI 0.148, 0.218) self-assessed general health also recorded higher HRQoL utility scores than those with poor health, separately. Consistent findings were observed for participants by gender, school type and residential location. CONCLUSIONS: Both self-rated academic performance and general health status were positively associated with HRQoL among Chinese students, and such relationships were independent of lifestyle-related behaviors and body weight status.

Role stress, social support and occupational burnout among physicians in China: a path analysis approach.

BACKGROUND: Occupational burnout in physicians is prevalent and can have many negative effects. The purposes of this study were to explore the prevalence of occupational burnout and to analyze the effects of social support and role stress on occupational burnout among Chinese physicians. METHODS: Using multistage-stratified cluster random sampling, physicians were selected to participate in the study and completed three questionnaires: the Chinese Maslach Burnout Inventory; the Cross-Cultural Role Conflict, Ambiguity and Overload Scale; and the Social Support Rating Scale. A path analysis was run to test the effects of role stress and social support on occupational burnout. RESULTS: Of 2530 physicians, 864 (34.2%) were experiencing moderate occupational burnout and 140 (5.5%) were experiencing severe occupational burnout. The path analysis results indicated that role conflict had direct positive effects on emotional exhaustion (EE) and depersonalization (DP), and role ambiguity had direct positive effects on DP and decreased personal accomplishment (DPA). Coworker support had direct negative effects on EE and positive effects on DP, family support had direct negative effects on DP and DPA. Coworker support mediated the effects of role ambiguity on EE and DP, and family support mediated the effects of role ambiguity on DP and DPA. CONCLUSIONS: These findings suggest that occupational burnout is common in Chinese physicians, and that role stress and social support play important roles in occupational burnout. Interventions that aim to reduce role stress and increase social support can be effective approaches to prevent occupational burnout among physicians.

Abnormal resting state activity of left middle occipital gyrus and its functional connectivity in female patients with major depressive disorder.

BACKGROUND: Women are more susceptible to major depressive disorder (MDD). A possible explanation is that women have a trait tendency to engage in a ruminative response style. Depending on cognitive model of depression, attention bias, memory bias and self-referential bias were closely related among depressed patients. Previous studies have explored the neural mechanism of the cognitive biases by using amplitude of low frequency fluctuations (ALFF) or functional connectivity (FC), and few combined these two metrics, especially focusing on female patients. METHODS: We assessed 25 female patients diagnosed with MDD and 13 well matched healthy controls (HCs) using Rs-fMRI. Two metrics ALFF and FC based on abnormal ALFF were explored and made comparisons. RESULTS: Compared with HCs, female patients with MDD showed that one cluster with significantly decreased ALFF in the left middle occipital gyrus(L-MOG). Furtherly we founded depressed female subjects showed significantly lower FC between the L-MOG seed and left orbitofrontal cortex, and significantly higher FC between the L-MOG seed and left medial prefrontal gyrus and left hippocampus. CONCLUSIONS: Our results showed L-MOG may act as a connection, which involved in the processing of cognitive biases of MDD by connected with limbic-cortical regions in resting state. These findings may enhance the understanding of the neurobiological mechanism in female patients with MDD.

[Observation on effective characteristics of acupuncture combined with medicine on depression of different syndrome types].

OBJECTIVE: To evaluate and analyze the clinical therapeutic effect and characteristics of acupuncture combined with medicine on depression of different syndrome types. METHODS: Eighty cases of depression were dividede into liver qi stagnation and spleen deficiency group (group A, 35 cases), deficiency of both heart and spleen group (group B, 21 cases) and yang deficiency of both spleen and kidney group (group C, 24 cases) according to the syndrome differentiation. They were all treated with acupuncture at Baihui (GV 20), Yintang (EX-HN 3), Sishen-cong (EX-HN 1), Neiguan (PC 6) etc. and oral administration of 5-HT selective serotonin reuptake inhibitors (SSRI) tablets. The Hamilton depression scale (HAMD) and self-made syndrome differentiation symptoms evaluation scale were adopted to evaluate the therapeutic effect. RESULTS: After treatment of 4 weeks, the total effective rate of 91.4% in group A and of 90.5% in group B, both were superior to that of 87.5% in group C (P < 0.01,P<0. 05). There was a significant difference in comparison of HAMD scores between the group A and group C after treatment of 4 weeks (P < 0.05). The symptom scores of syndrome differentiation in all three groups were obviously decreased after 1 week, 2 weeks and 4 weeks treatment compared with those before treatment (all P < 0.001), the symptom scores of group C had significant differences compared with the group A and group B after treatment of 2 weeks (P < 0.01, P < 0.05). The reducing scores rate of the group A had singificant differences compared with the group B and the group C after treatment of 4 weeks (both P < 0.05). CONCLUSION: Acupuncture combined with SSRI has better therapeutic effect on depression of liver qi stagnation and spleen deficiency type. The syndrome differentiation symptoms evaluation scale is more exact and sensitive to evaluate the clinical therapeutic effect of TCM treatment.