Bidirectional relationship between C-reactive protein and depressive symptoms considering cumulative effect among Chinese middle-aged and older adults.

Introduction: Research examining the bidirectional relationship between C-reactive protein (CRP) and depressive symptoms, while accounting for cumulative effect of repeated episodes of CRP or depressive symptoms, is currently deficient in non-Western populations. Methods: A nationally representative population-based cohort data from the Chinese Health and Retirement Longitudinal Study (CHARLS) was utilized. In bi-directional analysis, we considered both single determinations and two successive determinations of CRP or depressive symptoms. Multivariate logistic regression assessed the association between elevated CRP levels at baseline or repeated episodes of CRP elevations over two successive determinations and subsequent elevated depressive symptoms, and vice versa. Results: Although single determinations of CRP or depressive symptoms yielded non-significant results in both directions, full multivariate models, adjusting for baseline depressive symptoms, socio-demographic characteristics, health-related behaviors, metabolic measures, and health status, revealed a significantly positive association based on two successive determinations of CRP or depressive symptoms. This significant association was observed between cumulative effects of sustained CRP elevations over two successive determinations (2 vs. 0) and subsequent elevated depressive symptoms (OR=1.58; 95% CI: 1.15 to 2.17) and between cumulative effect of repeated episodes of depression (2 vs. 0) and later elevated CRP (OR=1.26; 95% CI: 1.02 to 1.56). Furthermore, sex-stratified analyses confirmed the robustness of these relationships. Conclusion: There are bidirectional associations between depressive symptoms and CRP, driven by the cumulative effect of repeated episodes of CRP or depressive symptoms among middle-aged and older Chinese adults. These findings hold significant clinical implications, highlighting the potential of both anti-inflammatory and anti-depression approaches.

The effect of gradually lifting the two-child policy on demographic changes in China.

Low-fertility rate has been a common problem in many industrialized countries. To reverse the declining trend of new births, Chinese government gradually lifted its restrictions on the number of births per family, allowing for a household to have no more than two children. Little is known about the additional births or population increase contributed by the gradual relaxation of birth restrictions. To fill this gap, this quasi-experimental design study including data from 124 regions used the synthetic control method and controlled interrupted time series analysis to evaluate the differences in birth rates and rates of natural population increase between China and its synthetic control following implementation of the two-child policy from 2011 to 2020. A total of 123 regions were included in the control pool. Data collected during 1990-2010 were used to identify the synthetic China for each study outcome. The mean rate differences of birth rates and rates of natural increase between China and synthetic China after two-child policy implementation were 1.16 per 1000 population and 1.02 per 1000, respectively. These rate differences were distinguished from variation due to chance (one-sided pseudo-P-values: P for birth rates = 0.047, P for rates of natural increase = 0.020). However, there were statistically significant annual reductions in the pre-post trend of birth rates and rates of natural increase compared with those of controls of <0.340 per 1000 population per year [P = 0.007, 95% CI = (-0.584, -0.096)] and <0.274 per 1000 per year [P = 0.028, 95% CI = (-0.518, -0.031)]. The results suggested that lifting birth restrictions had a short-term effect on the increase in birth rates and rates of natural population increase. However, birth policy with lifting birth restrictions alone may not have sustained impact on population growth in the long run.

Trajectories of post-stroke quality of life and long-term prognosis: Results from an eleven-year prospective study.

PURPOSE: The relationship between quality of life (QoL) and long-term prognosis in stroke patients is still unclear. We explored physical and mental QoL trajectories during the first six months after stroke and determined the associations between trajectories and long-term prognosis in patients with first-ever ischemic stroke. METHODS: Included were 733 participants from a prospective study. QoL was assessed with the 12-item Short Form Survey (SF-12) at baseline, 3 and 6 months. Patients' prognoses (stroke recurrence and death) were identified from 2010 to 2021. The latent class growth model (LCGM) was used to identify distinct trajectories of physical and mental QoL measured over the first 6 months. We employed the Cox model or Fine-Gray model for prognoses to examine the associations between QoL trajectories and prognosis. RESULTS: Five trajectories of physical QoL and five trajectories of mental QoL were identified. For physical QoL of the Poor-Improved, and Moderate-Impaired trajectory versus Moderate-Improved trajectory, the hazard ratio (HR) for death was 2.39 (1.14 to 5.02), and 2.03(0.93 to 4.44); the HR for recurrence was 1.56 (0.83 to 2.94) and 2.33 (1.28 to 4.24). For mental QoL of the Moderate-Impaired trajectory versus the Moderate-Improved trajectory, the HR for death was 2.48 (1.21 to 5.07). The results were robust in the sensitivity analysis. CONCLUSION: QoL during the first six months after ischemic stroke can be categorized into distinct groups. Change in QoL was associated with long-term survival. Secondary prevention of recurrent strokes might rely more on improving patients' physical QoL.

Association between post-stroke smoking and stroke recurrence in first-ever ischemic stroke survivors: based on a 10-year prospective cohort.

BACKGROUND: Whether smoking is a risk factor for ischemic stroke (IS) recurrence in IS survivors is still uncovered, and evidences are sparse. Meanwhile, an add-on effect of clopidogrel was observed in myocardial infarction patients who smoked, but whether the paradox exists in IS patients is still unsolved. The objectives of this study are to explore the association between smoking behavior after index stroke and IS recurrence and to explore whether the paradox exists. METHODS: A prospective cohort of first-ever IS patients was conducted between 2010 and 2019. The prognosis and smoking features of enrolled patients were obtained via telephone follow-up every 3 months. Fine-gray model with interaction terms was applied to measure the relationships between stroke recurrence and smoking behaviors after index stroke and to explore the add-on effect of clopidogrel in smoking patients. RESULTS: There were 171 (24.26%) recurrences and 129 (18.30%) deaths during follow-up in 705 enrolled IS patients. One hundred forty-six (20.71%) patients smoked after index stroke. The hazard ratios (HRs) and 95% confidence intervals (CIs) of interaction terms between antiplatelet drug and follow-up smoking (smoking status and daily smoking amount) were 1.092 (95% CI: 0.524, 2.276) and 0.985 (95% CI: 0.941, 1.031), respectively. A significantly higher risk of recurrence was observed in patients with a higher daily smoking amount during follow-up (per cigarette), with HR being 1.027 (95% CI: 1.003, 1.052). CONCLUSIONS: Smoking could elevate the risk of IS recurrence, and IS survivor should be advised to quit or smoke less. Add-on effect of clopidogrel may not exist in smoking strokers taking clopidogrel.

Probing the affinity of noble metal nanoparticles to the segments of the SARS-CoV-2 spike protein.

Currently, scientists have devoted great efforts to finding effective treatments to combat COVID-19 infections. Although noble metal nanoparticles are able to realize protein modifications, their interactions with the protein are still unclear from the atomic perspective. To supply a general understanding, in this work, we have carried out theoretical calculations to investigate the interaction between protein segments (RBD1, RBD2, RBD3) of SARS-Cov-2 spike protein and a series of noble metal (Au, Ag, Cu, Pd, Pt) surfaces regarding the binding strength, protein orientations, and electronic modulations. In particular, the Au surface has shown the strongest binding preferences for the protein segments, which induces electron transfer between the Au and receptor-binding domain (RBD) segments. This further leads to the polarization of segments for virus denaturation. This work has offered a direct visualization of protein interactions with noble metal surfaces from the atomic level, which will benefit anti-virus material developments in the future.

Cost-effectiveness of two screening strategies based on Chinese diabetes risk score for pre-diabetes in China.

Objective: Studies have shown that screening for pre-diabetes mellitus (pre-DM) is essential to prevent type 2 diabetes mellitus (T2DM). This study evaluates the cost-effectiveness of two screening strategies that apply the Chinese Diabetes Risk Score (CDRS) to screen for pre-DM in China. Methods: A Markov microsimulation model was conducted from a social perspective, and the input parameters were obtained from published literature or publicly available data. Two screening strategies for pre-DM based on CDRS were built and compared with the control group to determine the cost-effective strategy. The screening strategy of the control group was screening for pre-DM by fasting plasma glucose (FPG) test in adults undergoing annual health examination and no screening in adults without an annual health examination (status quo). Two screening strategies were strategy 1: screening for pre-DM using CDRS in all adults (including with or without an annual health examination); and strategy 2: supplemental self-screening for pre-DM using CDRS in adults without an annual health examination, based on the status quo. We focus on the cumulative prevalence of T2DM and the incremental cost-effectiveness ratio which signifies the cost per case of T2DM prevented. We also evaluated the cost-effectiveness from the health system perspective. One-way and probabilistic sensitivity analyses were conducted to verify the robustness of the results. Results: The costs a case of T2DM prevented for strategy 1 compared with the control group and strategy 2 were $299.67 (95% CI 298.88, 300.46) and $385.89 (95% CI 381.58, 390.20), respectively. In addition, compared with the control group, the cost of strategy 2 to prevent a case of T2DM was $272.23 (95% CI 271.50, 272.96). Conclusions: Screening for pre-DM using CDRS in all adults was the most cost-effective health policy. We suggest that medical institutions replace FPG with CDRS for pre-DM screening; at the same time, self-screening for pre-DM using CDRS is widely promoted among adults without an annual health examination. There were still some disputes about how CDRS is included in the health examination projects, so strategy 2 should be considered as an alternative screening strategy. Findings provide a reference for the application of the CDRS in pre-DM screening and contribute to T2DM prevention.

A versatile cellulose nanocrystal­carbon dots architecture: Preparation and environmental/biological applications.

In this work, a versatile cellulose nanocrystal­carbon dots (CNC-CDs) architecture is prepared and applied in environmental remediation and biological sensing. The citric acid (CA) is employed to extract CNCs and in-situ synthesize blue-emissive CDs. The carboxyl-rich surface of CNC-CDs enables the chelation of Hg2+ and fluorescence quenching of CDs, realizing the detection and adsorption of Hg2+ with a film comprised of the architecture. The limit of detection (LOD) is measured as 12.8 nM with satisfying retention efficiency. The versatility of CNC-CDs is demonstrated by the fabrication of a fluorescence resonance energy transfer (FRET) sensor using m-tetrakis(4-sulfonatophenyl)porphine (TSPP) as FRET acceptor and Fe3+ receptor. Fluorescence of the sensor is responsive to Fe3+ in a ratiometric manner, which significantly contributes to the visualized and sensitive Fe3+ detection (6.9 nM). In combination with excellent biocompatibility, the FRET sensor is capable of imaging intracellular Fe3+.

Association between usual alcohol consumption and risk of falls in middle-aged and older Chinese adults.

BACKGROUND: Previous studies exploring usual alcohol consumption and falls risk were scarce in China. In addition, the dose-response relationship has not been explored so far. This study aims to estimate the association between usual alcohol consumption and risk of falls among middle-aged and older Chinese adults based on data from the China Health and Retirement Longitudinal Study (CHARLS), which is representative of the population of the entire country. METHODS: Baseline survey data in 2015 and follow-up data in 2018 in CHARLS were utilized. Alcohol consumption was calculated in grams per day (gr/day) according to self-reported drinking data and categorized accordingly to The Dietary Guidelines for Chinese Residents (DGC) 2016. Fall was obtained from self-reported information. Multivariable logistic regression analyses were performed to estimate the association of usual alcohol consumption with risk of falling. The dose-response relationship was also explored using restricted cubic splines. RESULTS: A total of 12,910 middle-aged and older participants were included from the CHARLS 2015, of which 11,667 were followed up in 2018. We found that former, moderate, and excessive drinkers were at higher fall risk compared to never drinkers (former: OR, 1.24; 95% CI, 1.05-1.46; moderate: OR, 1.22; 95% CI, 1.06-1.41; excessive: OR, 1.36; 95% CI, 1.15-1.61) in the longitudinal analysis. Similarly, individuals with moderate and excessive alcohol consumption were at increased risk of falling in the cross-sectional analysis (moderate: OR, 1.18; 95% CI, 1.02-1.37; excessive: OR, 1.32; 95% CI, 1.11,1.57). No significant increased risk of falls was found for former drinkers (former: OR, 1.13; 95% CI, 0.96-1.34). We observed a significant non-linear relationship. CONCLUSIONS: Our study suggests that usual alcohol consumption was associated with a higher risk of falls, highlighting the key role of alcohol intake on the fall risk, which needed consideration in developing intervention and prevention strategies for reducing falls among middle-aged and older Chinese adults.

Perceived stress and depressive symptoms among Chinese college students: A moderated mediation model of biorhythm and ego resilience.

Objective: To explore whether biological rhythm disturbance mediates the association between perceived stress and depressive symptoms and to investigate whether ego resilience moderates the mediation model. Methods: A cross-sectional study was carried out using an online self-report questionnaire distributed to college students from September 2021 to October 2021. Patient Health Questionnaire-9 (PHQ-9), Perceived Stress Severity (PSS-10), the Biological Rhythms Assessment in Neuropsychiatry (BRIAN), and Ego Resilience (ER-96) were used for investigation. SPSS 23 was used for data analyses. The significance of mediation was determined by the PROCESS macro using a bootstrap approach. Results: Among the participants, 9.2% (N = 1,282) exhibited significant symptoms of depression. Perceived stress was positively associated with depressive symptoms, and biorhythm partially mediated this relationship. The direct and indirect effects were both moderated by ego resilience. Perceived stress had a greater impact on depressive symptoms and biorhythm for college students with lower ego resilience, and the impact of biorhythm on depressive symptoms was also stronger for those with lower ego resilience. Perceived stress had an impact on depressive symptoms directly and indirectly via the mediation of biorhythm. Conclusion: Schools and educators should guide college students to identify stress correctly and provide effective suggestions to deal with it. Meanwhile, maintaining a stable biorhythm can protect college students from developing depressive symptoms. Students with low resilience should be given more attention and assistance.

Associations between trajectories of depressive symptoms and rate of cognitive decline among Chinese middle-aged and older adults: An 8-year longitudinal study.

OBJECTIVE: To investigate the associations between trajectories of depressive symptoms and rate of cognitive decline among Chinese middle-aged and older adults. METHODS: A population-based cohort data from the Chinese Health and Retirement Longitudinal Study (CHARLS) were utilized. The cohort was followed up for 8 years and assessments of depressive symptoms and cognitive performance were conducted in 2011, 2013, 2015, and 2018. Group-based trajectory modeling (GBTM) was conducted to identify heterogeneous trajectories of depressive symptoms. Linear mixed models (LMMs) were performed to examine the associations between trajectories of depressive symptoms and rate of decline in global cognitive function, episodic memory, and executive function. RESULTS: Among 9264 middle-aged and older adults, five depressive symptoms trajectory groups were determined: constantly low (n = 3206, 34.6%), constantly medium (n = 3747, 40.5%), increasing (n = 899, 9.7%), decreasing (n = 929, 10.0%), and constantly high (n = 483, 5.2%). Individuals with increasing depressive symptoms exhibited the fastest decline in global cognitive function and episodic memory, followed by participants reporting constantly high or medium depressive symptoms. A significantly higher rate of decline in executive function was only observed among subjects who had increasing depressive symptoms in comparison with their counterparts with constantly low depressive symptoms. There was no significant difference in rate of cognitive decline between individuals with decreasing depressive symptoms and those demonstrating constantly low depressive symptoms. CONCLUSION: Increasing depressive symptoms co-occurred with the steepest cognitive decline among Chinese middle-aged and older adults, which potentially suggested that interventions targeting to alleviating cognitive decline should be given priority among individuals with deterioration of depressive symptoms.

Associations Between the Prevalence, Treatment, Control of Hypertension and Cognitive Trajectories Among Chinese Middle-Aged and Older Adults.

OBJECTIVE: To investigate the associations between the prevalence, treatment, control of hypertension, and trajectories of cognitive performance among Chinese middle-aged and older adults. DESIGN: An 8-year longitudinal study. SETTING: China. PARTICIPANTS: Chinese middle-aged and older adults. MEASUREMENTS: Data from the China Health and Retirement Longitudinal Study were utilized. Group-based trajectory modeling was performed to identify heterogeneous trajectories of episodic memory and executive function. Multinomial logistic regression models were established to examine the relationships between hypertension status and cognitive trajectories, stratified by sex. RESULTS: Three episodic memory trajectories and four executive function trajectories were identified in males and females. Hypertension prevalence was associated with worse episodic memory and executive function trajectories in females. Compared with treated hypertensives, untreated hypertensives were more likely to have worse executive function trajectories, both in males and females. Among male treated hypertensives, those with uncontrolled blood pressure (BP) had worse episodic memory trajectories compared with their counterparts with controlled at standard targets, while females with uncontrolled BP demonstrated worse executive function trajectories compared with females controlled at standard targets. There was basically no significant difference in cognitive trajectory memberships between individuals with controlled hypertension corresponding to intensive or standard BP targets. CONCLUSIONS: The prevalence of hypertension was associated with worse cognitive trajectories, and the treatment and control of hypertension were related to more favorable cognitive trajectories. Intensive BP control target was not associated with additional benefit beyond the recognized protective effect of standard BP targets on cognitive trajectories.

Heterogeneity in longitudinal trajectories of cognitive performance among middle-aged and older individuals with hypertension: Growth mixture modeling across an 8-year cohort study.

Hypertension is one of the most prevalent chronic conditions and has been proven to be related to cognitive function. However, there is no evidence regarding the heterogeneity in cognitive trajectories among persons with hypertension. The aims of the current study were to characterize the heterogeneity in longitudinal trajectories of cognitive performance among Chinese middle-aged and older individuals with hypertension and to explore the potential determinants of trajectory memberships. Data from the 2011 to 2018 Chinese Health and Retirement Longitudinal Study (CHARLS) were utilized. Two cognitive measures of executive function and episodic memory were assessed, and conditional growth mixture modeling (GMM) was performed to identify the trajectories of cognitive performance and explore the related factors of cognitive change. The findings revealed three trajectory classes of executive function (stable, sharp decline, smooth decline) and two trajectory classes of episodic memory (stable, decline). Individuals with hypertension who had a higher educational level, moderate nighttime sleep duration, and lower depressive symptoms as well as those who reported consuming alcohol at least once a month were more likely to belong to the optimal stable executive function group. Subjects with a higher educational level, adequate daytime napping duration, and higher BMI were more likely to exhibit stable episodic memory over time. Other factors, including age, sex, community type, marital status, and hypertension treatment, exhibited class-specific effects on growth parameters of cognitive trajectory. Targeting intervention designation is proposed to ameliorate the burdens of cognitive impairment among individuals with hypertension.

The Full Mediating Role of Loneliness on the Relationship Between Social Support and Depression Among Rural Family Caregivers of Persons With Severe Mental Illness.

Objective: Depression is a common and overwhelming psychiatric disorder among family caregivers of persons with severe mental illness (SMI). The interrelationships among social support, loneliness, and depression, especially among this relatively vulnerable group, are poorly understood. The aim of the present study was to test the hypothesis that the social support contributes to the alleviation of depression, through its effect on reducing loneliness. Methods: A survey of 256 rural family caregivers of persons with SMI was conducted between December 2017 and May 2018 in Chengdu City, Sichuan Province, China. Social support, loneliness and depression were measured. A series of multiple linear regression models and bootstrapping procedure were performed to examine the mediating effects of loneliness on the association between social support as well as its components and depression. Results: The proportion of family caregivers of persons with SMI who reported significant depressive symptoms was 53.5%. Loneliness fully mediated the negative association between social support and depression. As to three components of social support, subjective support and objective support only had indirect associations with depression mediated by loneliness, while support utilization had both direct and indirect relationships with depression. Conclusion: The current study highlighted that social support and its three components may acted as protective factors by decreasing the feelings of loneliness, which created a beneficial effect on depression among family caregivers of persons with SMI.

Associations of overweight and obesity with drug-resistant epilepsy.

BACKGROUND: Obesity and overweight have been well established as comorbidities of epilepsy in adults. However, the effects of overweight and obesity on the risk of adult drug-resistant epilepsy (DRE) has not been fully assessed. Thus, the objective of this study was to investigate the relationships between categories of body mass index (BMI) and DRE. METHODS: This was a case-control study. Patients with epilepsy hospitalized for Video electroencephalogram were included in the study from 2015 to 2020. Low/normal weight, overweight, and obesity were defined as BMI<23 and 23-24.9 and ≥25 kg/m2, respectively. The proportions of patients diagnosed with DRE in each category were calculated. RESULTS: A total of 1272 patients with drug-responsive epilepsy and 345 patients with DRE were included in this study. More men than women had DRE (P=0.012). Higher proportions of patients with DRE had a history of status epilepticus (P<0.001), CNS infection (P=0.027), developmental delay (P=0.001), and comorbidity (P<0.001). Obesity (BMI≥25 kg/m2) was associated with an increased risk of DRE (adjusted OR, 2.339; 95% CI, 1.724-3.171). No significant increase in the risk of DRE was found to be associated with overweight. Further stratified analyses by valproic acid (VPA) treatment attenuated the obesity-DRE relationship, but the associations remained statistically significant (adjusted OR, 1.79; 95% CI, 1.15-2.80). CONCLUSION: Obesity, but not overweight, potentially plays a role in DRE, although confounders, such as antiseizure medications (ASMs) use, need to be explored. In the future, well-designed trials are needed to elucidate this issue.

Network Pharmacology-Based Dissection of the Active Ingredients and Protective Mechanism of the Salvia Miltiorrhiza and Panax Notoginseng Herb Pair against Insulin Resistance.

The Salvia miltiorrhiza and Panax notoginseng herb pair (DQ) has been widely utilized in traditional Chinese medicine for the longevity and for preventing and treating cardio-cerebrovascular diseases. Often associated with cardio-cerebrovascular diseases are comorbidities such as insulin resistance. However, the protective mechanisms of DQ against insulin resistance remain not well understood. Through network pharmacology analysis, a total of 94 candidate active compounds selected from DQ (61 from S. miltiorrhiza Bunge and 33 from P. notoginseng (Burk.) F. H. Chen) interacted with 52 corresponding insulin resistance-related targets, which mainly involved insulin resistance and the AMPK signaling pathway. Furthermore, the contribution index calculation results indicated 25 compounds as the principal components of this herb pair against insulin resistance. Among them, ginsenoside F2, protocatechuic acid, and salvianolic acid B were selected and validated to promote glucose consumption through activating AMPK phosphorylation and upregulating GLUT4 in insulin-resistant cell model (HepG2/IR) cells. These findings indicated that DQ has the potential for repositioning in the treatment of insulin resistance mainly through the AMPK signaling pathway.

Association of consciousness impairment and mortality in people with COVID-19.

BACKGROUND: To investigate the association between impairment of consciousness and risk of death in people with COVID-19. METHODS: In this multicentre retrospective study, we enrolled people with confirmed COVID-19 from 44 hospitals in Wuhan and Sichuan, China, between 18 January and 30 March 2020. We extracted demographics, clinical, laboratory data and consciousness level (as measured by the Glasgow Coma Scale (GCS) score) from medical records. We used Cox proportional hazards regression, structural equation modelling and survival time analysis to compare people with different progressions of impaired consciousness. RESULTS: We enrolled 1,143 people (average age 51.3 ± standard deviation 17.1-year-old; 50.3% males), of whom 76 died. Increased mortality risk was identified in people with GCS score between 9 and 14 (hazard ratio (HR) 46.76, p < .001) and below 9 (HR 65.86, p < .001). Pathway analysis suggested a significant direct association between consciousness level and death. Other factors, including age, oxygen saturation level and pH, had indirect associations with death mediated by GCS scores. People who developed impaired consciousness more rapidly either from symptoms onset (<10 days vs. 10-19 days, p = .025, <10 days vs. ≥20 days and 10-19 days vs. ≥20 days, <.001) or deterioration of oxygen saturation (≤2 days vs.>2 days, p = .028) had shorter survival times. CONCLUSION: Altered consciousness and its progression had a direct link with death in COVID-19. Interactions with age, oxygen saturation level and pH suggest possible pathophysiology. Further work to confirm these findings explore prevention strategies and interventions to decrease mortality is warranted.

Impact of immediate initiation of antiretroviral therapy among men who have sex with men infected with HIV in Chengdu, southwest China: trends analysis, 2008-2018.

BACKGROUND: Given the rampant HIV epidemic among men who have sex with men (MSM) in Chengdu, southwest China, Treat All policy, defined as immediate antiretroviral therapy (ART) initiation after HIV diagnosis, was implemented since 2014. Real-world research evaluating impacts of immediate ART on HIV epidemics is needed to optimize policy-making as national and international guidelines have been lowering ART eligibility threshold. The purpose of this study is to: assess temporal trends of the HIV epidemic and impacts of Treat All policy among MSM; and lay foundation for HIV-related policy evaluation using longitudinal routine data from health information systems. METHODS: Data used in this study were HIV sentinel seroprevalence, annual reported HIV cases and ART coverage rate among MSM in Chengdu from 2008 to 2018, derived from national HIV/AIDS information system. Temporal trends of the HIV epidemic were described using Joinpoint Regression Program. Interrupted time-series method was deployed to evaluate Treat All policy. RESULTS: HIV sentinel seroprevalence rose from 11.20% in 2008 to 17.67% in 2013 and Annual Percent Change (APC) was 8.25% (95% CI - 2.40%, 20.07%), then decreased to 5.17% in 2018 (APC = - 19.63%, 95% CI - 27.54%, - 10.86%). Newly reported HIV cases increased from 168 cases in 2008 to 1232 cases in 2015 (APC = 26.99%, 95% CI 21.32%, 32.93%), and reduced to 1014 cases in 2018 (APC = - 8.80%, 95% CI - 18.45%, 2.01%). ART coverage rate has been climbing from 11.11% in 2008 to 92.29% in 2018 and Average Annual Percent Change was 16.09% (95% CI 11.76%, 20.59%). Results of interrupted time-series models showed that compared to an annual increase of 0.87% during pre-policy period, there was a decline of 3.08% (95% CI - 0.0366%, - 0.0250%) per year of HIV sentinel seroprevalence since 2014; and compared to an annual increase of 116 cases before 2014, there was an annual drop of 158 newly reported HIV cases (95% CI - 194.87%, - 121.69%) during the post-policy period. CONCLUSIONS: Immediate ART after HIV diagnosis could potentially curb HIV transmission at population level among MSM, along with other strategies. Future assessment of HIV prevention and control policy can be carried out using routinely collected longitudinal data from health information systems.

Social support and quality of life among rural family caregivers of persons with severe mental illness in Sichuan Province, China: mediating roles of care burden and loneliness.

OBJECTIVE: To explore the relationship between social support and quality of life (QoL) among family caregivers of persons with severe mental illness (SMI) and examine the mediating roles of care burden and loneliness. METHODS: A cross-sectional study was carried out between December 2017 and May 2018. A random sample of 256 family caregivers of persons with SMI in rural areas of Sichuan Province, China was recruited for participation. Survey data on socio-demographics, social support, care burden, loneliness, and QoL were collected via in-person interviews. Multiple linear regression analysis and structural equation modeling (SEM) were used to test the hypothesized relationships. RESULTS: The majority (72.7%) of family caregivers of persons with SMI in this study reported having low QoL. Social support was positively associated with QoL and negatively associated with care burden and loneliness. The findings suggested the mediating roles of care burden and loneliness on the association between social support and QoL. CONCLUSION: The hypothesized model was found to be a suitable model for predicting QoL among family caregivers of persons with SMI. The findings can help inform the design of future interventions aimed at enhancing social support, reducing care burden and loneliness, which may be helpful to improve caregivers' QoL. Future study is required to find a causal path to promote QoL among family caregivers of persons with SMI.

Physical Comorbidity and Health Literacy Mediate the Relationship Between Social Support and Depression Among Patients With Hypertension.

Depression is a common comorbidity among patients with hypertension. Patients with hypertension and depression have worse health outcomes compared to those without depression. The combined effects of social support, physical comorbidity, and health literacy on depression among individuals with hypertension remain unclear. A survey was conducted between December 2017 and May 2018 to investigate the relationships among social support, physical comorbidity, health literacy, and depression in a population of patients with hypertension in rural areas of Sichuan province, China. Multiple linear regression was used to examine factors that influenced depression, and structural equation modeling (SEM) was used to examine the relationships among the four study variables. The mean scores of 549 patients with hypertension were 37.17 ± 6.84 for social support, 14.62 ± 6.26 for health literacy, and 3.56 ± 3.05 for depression; furthermore, 34.2% of participants had physical comorbidity. Gender and per capita annual family income were significantly associated with depression. Physical comorbidity was directly positively related to depression while health literacy was directly negatively related to depression. Social support had an indirect negative association with depression by the mediating effects of health literacy and physical comorbidity. Adequate social support and health literacy, and less physical comorbidity could potentially contribute to reducing depression. The study highlights the importance of social support in maintaining mental health among patients with hypertension. Strategies that target the enhancement of social support and health literacy should be prioritized to relieve depression among patients with hypertension. More attention should be paid to women, low-income individuals, and patients with physical comorbidities.

Daytime napping and successful aging among older adults in China: a cross-sectional study.

BACKGROUND: The study aimed to examine the association between daytime napping and successful aging (including its five dimensions, "low probability of disease," "no disease-related disability," "high cognitive functioning," "high physical functioning," and "active engagement with life") among China's older adults using data from the Chinese Health and Retirement Longitudinal Study conducted in 2015. METHODS: Cross-sectional data were used in the analysis. Multivariable logistic regressions were conducted to investigate the association between daytime napping and successful aging, and stratified analyses were performed to explore differences in nighttime sleep duration. RESULTS: A total of 7469 participants were included in the analysis. Daytime napping was prevalent in China's older adults (59.3%). The proportion of study participants with "successful aging" was 13.7%. Additionally, 48.6, 91.7, 54.1, 78.5, and 49.1% participants achieved "low probability of disease," "no disease-related disability," "high cognitive functioning," "high physical functioning," and "active engagement with life," respectively. Compared with the 0 min/day napping group, the > 60 min/day napping group was associated with a lower probability of achieving successful aging (OR, 0.762; 95% CI, 0.583-0.996). In the nighttime sleep duration stratification, the findings showed that in the ≥8 h/night group, napping > 60 min per day was associated with a lower likelihood of aging successfully (OR, 0.617; 95% CI, 0.387-0.984). Considering the five dimensions of successful aging, moderate and long daytime napping were negatively associated with "low probability of disease"; long daytime napping had negative associations with "no disease-related disability" and "high physical functioning"; moderate daytime napping had positive associations with "high cognitive functioning" and "active engagement with life." CONCLUSIONS: Long daytime napping showed a lower likelihood of successful aging among the elderly in China. Special attention is necessary for elderly people who sleep for longer duration both during day and night. Biological and social factors affecting the relationship between daytime napping and successful aging need to be explored in depth in the future.