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Xiru Zhang

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Sakarya University

University of Reading

Nikhil Chandra Shil, FCMA

East West University

Kansas State University

Armando Marques-Guedes

UNL - New University of Lisbon

Izmir University of Economics

ARCHIE B CARROLL

The University of Georgia

Marie Christine Duggan

Keene State College

Telkom University

Ruben Apressyan

The Institute of Philosophy of the Russian Academy of Sciences

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Papers by Xiru Zhang

Gut microbiota-mediated ursodeoxycholic acids regulate the inflammation of microglia through TGR5 signaling after MCAO

Brain, Behavior, and Immunity

Associations between Body Composition and Mortality: A Large Population-Based Cohort Study

Social Science Research Network, 2020

Association between Long-Term Concomitant Exposure to Various Ambient Air Pollutants and All-Cause and Cause-Specific Mortality: Data from a Nationwide Prospective Cohort Study

Social Science Research Network, 2022

Association between supportive attitudes and adoptive practice of control strategy against COVID-19 among college students in China, a cross-sectional study

Research Square (Research Square), Aug 21, 2020

Background: This study aimed to explore college students' attitudes and compliance toward the pre... more Background: This study aimed to explore college students' attitudes and compliance toward the prevention strategy of using non-pharmaceutical interventions (NPIs) in containing coronavirus disease 2019. Methods: We conducted a cross-sectional online survey in four universities in Guangdong Province (China) based on purposive sampling. We used a self-made questionnaire to measure the supportive attitude towards outbreak control strategy and adoption of NPIs in respondents. Results: A total of 44,446 college students participated between 31 January and 10 February 2020; 92.7% of respondents supported the outbreak control strategy. 94.8% would avoid public places, 92.8% would wear a facemask, 91.2% would avoid of gatherings and 86.9% would wash hands more frequent. 76.5% respondents adopted all four measures. Supportive attitude was associated with NPI adoption. Students who were female, postgraduate, anxious, and not depressed tended to have higher supportive attitude and higher NPI adoption rate. Conclusions: Higher supportiveness towards the disease control strategy for public may lead to higher adoption rate of NPIs for individuals. Psychosocial factors are related to supportive attitude and adoption

Association of sleep and circadian patterns and genetic risk with incident type 2 diabetes: a large prospective population-based cohort study

European journal of endocrinology, Nov 1, 2021

Objective: To examine the association of incident type 2 diabetes (T2D) risk with sleep factors, ... more Objective: To examine the association of incident type 2 diabetes (T2D) risk with sleep factors, genetic risk, and their combination effects. Design: Large prospective population-based cohort study. Methods: This population-based prospective cohort study included 360 403 (mean (s.d.) age: 56.6 (8.0) years) participants without T2D at baseline from the UK Biobank. Genetic risk was categorised as high (highest quintile), intermediate (quintiles: 2-4), and low (lowest quintile) based on a polygenic risk score for T2D. Sleep scores, including long or short sleep duration, insomnia, snoring, late chronotype, and excessive daytime sleepiness, were categorized as an unfavourable, intermediate, or favourable sleep and circadian pattern. Results: During a median follow-up of 9.0 years, 13 120 incident T2D cases were recorded. Among the participants with an unfavourable sleep and circadian pattern, 6.96% (95% CI: 6.68-7.24%) developed T2D vs 2.37% (95% CI: 2.28-2.46%) of participants with a favourable sleep and circadian pattern (adjusted hazard ratio (HR): 1.53, 95% CI: 1.45-1.62). Of participants with a high genetic risk, 5.53% (95% CI: 5.36-5.69%) developed T2D vs 2.01% (95% CI: 1.91-2.11%) of participants with a low genetic risk (adjusted HR: 2.89, 95% CI: 2.72-3.07). The association with sleep and circadian patterns was independent of genetic risk strata. Participants in the lowest quintile with an unfavourable sleep and circadian pattern were 3.97-fold more likely to develop T2D than those in the lowest quintile with a favourable sleep and circadian pattern. Conclusions: Sleep and circadian patterns and genetic risk were independently associated with incident T2D. These results indicate the benefits of adhering to a healthy sleep and circadian pattern in entire populations, independent of genetic risk.

Association of dietary diversity changes and mortality among older people: A prospective cohort study

Clinical Nutrition, May 1, 2021

BACKGROUND & AIMS The association between dietary diversity (DD) changes and mortality remain... more BACKGROUND & AIMS The association between dietary diversity (DD) changes and mortality remains unclear. We aimed to investigate the association between DD changes and all-cause mortality among older people. METHODS A total of 17,959 participants with a mean age of 84.8 years old were enrolled at baseline. Food groups were collected at baseline and follow-up using simplified food frequency questionnaire (FFQ), and then overall, plant-based and animal-based dietary diversity score (DDS) were calculated. DDS changes were calculated using DDS at baseline and the first follow-up. The association between three DDS changes (overall, plant-based and animal-based DDS) and subsequent all-cause mortality were evaluated. Nonparametrically restricted cubic splines and a multivariable-adjusted Cox proportional hazards model were used to estimate HRs and 95% CIs. RESULTS We documented 12,974 deaths over a 129,590 person-years of follow up. Compared with high-to-high DDS pattern, participants with lower overall DDS patterns had increased mortality risk with HRs (95%CI) of 1.39 (1.29-1.49), 1.53 (1.37-1.70), 1.38 (1.18-1.60) and 1.55 (1.31-1.83) for medium-to-medium, low-to-low, low-to-high and high-to-low patterns, respectively. And compared with high-to-high DDS pattern, the estimates were 1.34 (1.23-1.46), 1.49 (1.35-1.65), 1.43 (1.23-1.67) and 1.62 (1.40-1.88) for plant-based DDS, and 1.23 (1.15-1.31), 1.29 (1.20-1.40), 1.24 (1.12-1.37) and 1.28 (1.15-1.44) for animal-based DDS for medium-to-medium, low-to-low, low-to-high and high-to-low patterns, respectively. There was a U-shaped association between DDS change scores and mortality, and compared with participants with whose DDS remained stable, those with extreme declines and extreme improvements had higher risks of mortality with HRs (95% CI) of 1.15 (1.09-1.22) and 1.11 (1.04-1.17). CONCLUSIONS Maintaining a lower DDS, extreme declines and extreme improvements in DDS were all associated with an increased risk of all-cause mortality.

Associations between C-reactive protein and all-cause mortality among oldest old adults in Chinese longevity areas: A community-based cohort study

Background: Higher C-reactive protein (CRP) levels have been proposed as a predictor of all-cause... more Background: Higher C-reactive protein (CRP) levels have been proposed as a predictor of all-cause mortality in many existing studies from multiple populations, but the association for the oldest old adults (aged 80 and older) remains unclear. Objective: To examine the association between CRP and all-cause mortality among the oldest old Chinese adults. Design: This is a prospective, community-based longitudinal cohort study with 2206 adults aged 80 years old and older with available CRP test results. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) with 95% con dential intervals (95% CIs) for all-cause mortality according to CRP quartiles, adjusting for potential confounders. Results: The median age of the participants was 93 years old, and the median CRP concentration was 1.13 mg/L at baseline. During a median follow-up period of 36.7 months, 1106 deaths were veri ed. After full adjustment for potential confounders, a high CRP concentration was positively associated with an increased risk of all-cause mortality. Compared with the lowest quartile, the fully adjusted

Response to: ‘Correspondence to ‘Associations of regular glucosamine use with all-cause and cause-specific mortality: a large prospective cohort study’ by Li<i>et al</i>’ by Yueh<i>et al</i>

Annals of the Rheumatic Diseases, Aug 4, 2020

Patient and public involvement Patients and/or the public were not involved in the design, or con... more

Probable Causes and Risk Factors for Positive SARS-CoV-2 Testing in Recovered Patients: Evidence From Guangzhou, China

Frontiers in Medicine, Jul 12, 2021

Some patients retested positive for SARS-CoV-2 following negative testing results and discharge. ... more Some patients retested positive for SARS-CoV-2 following negative testing results and discharge. However, the potential risk factors associated with redetectable positive testing results in a large sample of patients who recovered from COVID-19 have not been well-estimated. A total of 745 discharged patients were enrolled between January 30, 2020, and September 9, 2020, in Guangzhou, China. Data on the clinical characteristics, comorbidities, drug therapy, RT-PCR testing, and contact modes to close contacts were collected. Patients who tested positive for SARS-CoV-2 after discharge were confirmed by guidelines issued by China. The repositive rate in different settings was calculated. Among 745 discharged patients, 157 (21.1%; 95% CI, 18.2-24.0%) tested repositive and the repositive rate was 16.8% (95% CI, 14.1-24.0%) for nasopharyngeal swabs and 9.7% (95% CI, 7.0-12.5%) for anal swabs. Among them, 55 (35.0%) were asymptomatic, 15 (9.6%) had mild symptoms, 83 (52.9%) had moderate symptoms, and 4 (2.6%) had severe symptoms at the first admission. The days from discharge to repositivity was 8.0 (IQR, 8.0-14.0). Most repositive patients were without clinical symptoms, and lymphocyte cell counts were higher than before being discharged. The likelihood of repositive testing for SARS-CoV-2 RNA was significantly higher among patients who were of younger age (OR, 3.88; 95% CI, 1.74-8.66, 0-17 years old), had asymptomatic severity (OR, 4.36; 95% CI, 1.47-12.95), and did not have clinical symptoms (OR, 1.89; 95% CI, 1.32-2.70, without fever). No other positive patients emerged within the families or close contacts of repositive patients. Our findings support prolonged but intermittent viral shedding as the probable cause for this phenomenon; we need to familiarize with the possibility that the virus will remain endemic.

Associations of long-term joint exposure to various ambient air pollutants with all-cause and cause-specific mortality: evidence from a large population-based cohort study

Environmental Science and Pollution Research, Jun 26, 2023

Association of Night Shifts and Lifestyle Risks With Incident Dementia

The Journals of Gerontology, Apr 28, 2023

Background Little is known about the combined relationship between night shifts and lifestyle ris... more Background Little is known about the combined relationship between night shifts and lifestyle risks with incident dementia or their potential interactions. To evaluate the association of night shifts and lifestyle risks with incident dementia and further analyze their interactions. Methods A total of 276 059 participants were included in this study from the UK Biobank cohort. Cox proportional hazards models were used to investigate the combined association of night shifts and lifestyle risks with incident dementia. Results Participants with always night shifts and 3 or 4 unhealthy lifestyle factors had the highest risk of incident all-cause dementia (hazard ratio: 3.15, 95% confidence interval [CI]: 1.74–5.69). An additive interaction was found between night shifts and lifestyle risks for incident all-cause dementia (p &lt; .001), with a relative excess risk due to the interaction of 0.14 (95% CI: 0.11–0.45). The attributable proportions of the combined effect on the incidence of all-cause dementia were 22.6% (95% CI: 20.91%–26.75%) for night shift work, 65.0% (95% CI: 63.12%–69.80%) for unhealthy lifestyle factors, and 12.1% (95% CI: 8.67%–18.04%) for their interaction. Conclusions Both night shifts and lifestyle risks were associated with a higher risk of incident dementia. The combined impact was higher than the increase in the risks related to each single factor. Our results indicated that most incident dementia cases might be prevented by a healthy lifestyle, and the benefits would be greater among night shift workers. Further studies are needed to confirm our results and explore the underlying mechanisms.

The coverage of SARS-CoV-2 vaccination and the willingness to receive the SARS-CoV-2 variant vaccine among employees in China

BMC Public Health, Mar 22, 2023

Background COVID-19, which is caused by SARS-CoV-2, is a major global health threat. The dominant... more Background COVID-19, which is caused by SARS-CoV-2, is a major global health threat. The dominant variant of SARS-CoV-2 has changed over time due to continuous evolution. We aimed to evaluate the coverage of SARS-CoV-2 vaccination among employees in China, explore their willingness to receive the SARS-CoV-2 variant vaccine and examine the potential factors influencing vaccination coverage and willingness. Methods A cross-sectional epidemiological survey was conducted online from January 1, 2022, to January 30, 2022. The information collected in the survey included sociodemographic characteristics, lifestyle habits, vaccination coverage, willingness to be vaccinated against SARS-CoV-2 variants and the reasons for vaccination and willingness. Multivariable logistic regression models were used to assess the associations of potential factors with the rate of vaccination and the willingness to be vaccinated. Results Among 62,395 eligible participants, the coverage of SARS-CoV-2 vaccination was 98.9% for at least one dose and 70.1% for a booster. The great majority of vaccinated individuals (94.4%) voluntarily received the vaccine. A total of 60,694 respondents (97.7%) were willing to be vaccinated against SARS-CoV-2 variants, mainly due to confidence in the effectiveness of vaccines (92.8%). A total of 1431 respondents were unwilling to be vaccinated, mainly because of concerns about the adverse effects of vaccines (77.6%). Longer education duration was associated with a higher rate of SARS-CoV-2 vaccination and willingness to be vaccinated. General or poor health status and having no history of influenza vaccination were associated with a lower rate of SARS-CoV-2 vaccination and willingness to be vaccinated. Additionally, we observed a significant positive association of abuse experience with the willingness to be vaccinated. Conclusion Although the rate of SARS-CoV-2 vaccination and the willingness to be vaccinated were relatively high in the study population, there were still some respondents with vaccine hesitancy. Relevant strategies based on significant related factors should be developed and implemented to encourage vaccination.

Habitual fish oil supplementation and incident chronic obstructive pulmonary disease: Data from a prospective cohort study

Clinical Nutrition, Dec 1, 2022

Risk factors associated with PCR repositivity in patients with COVID-19 after recovery in Guangzhou, China: a retrospective cohort study

Authorea (Authorea), Mar 30, 2022

Association of Soft Drink Intake With Cardiovascular Disease Mortality and Morbidity: A Large Prospective Cohort Study

Research Square (Research Square), Jun 7, 2021

Background The associations of SSBs, ASBs and pure fruit/vegetable juices with CVD events have no... more Background The associations of SSBs, ASBs and pure fruit/vegetable juices with CVD events have not been thoroughly evaluated. The present study determined the association of soft drinks with CVD and effects of the substitution of alternative beverages for soft drinks and the population-attributable fraction of CVD mortality due to soft drinks. Methods A cohort study was performed using data from UK Biobank and 168007 participants (mean (SD) age, 55.6 (7.9) years) without CVD/cancer at baseline were eligible for this analysis. Dietary consumption of SSBs, ASBs and pure fruit/vegetable juices was self-reported via a 24-hour dietary questionnaire between 2009 and 2012 and followed up to 2018. Results During a median follow-up of 7.0-year, we recorded 5922 incident CVD cases and 884 CVD deaths. Multivariable adjusted analyses revealed that compared to non-consumers, participants who consumed >2.5 drinks/day had a higher risk of CVD mortality and incidence with HR (95% CI) of 1.63 (1.22-2.17) and 1.23 (1.09-1.39) for SSBs, and 1.77 (1.23-2.56) and 1.20 (1.02-1.42) for ASBs, respectively. Compared to non-consumers, moderate pure fruit/vegetable juice consumers (>0-2.5 drinks/day) have an 8% (2%-13%)-34% (16%-48%) lower risk for CVD incidence and mortality. There was a positive doseresponse association of SSBs per 5% energy with CVD mortality and incidence with HR (95% CI) of 1.15 (1.17-1.25) and 1.06 (1.03-1.10), respectively. Substituting one drink/day of pure fruit/vegetable juice, un-sweetened tea/coffee for SSBs and ASBs was associated with 4%-24% lower risks for CVD mortality and incidence. A reduced SSB intake to below 5% energy may prevent 4% (1%-8%) of CVD mortality. Conclusion SSBs and ASBs was associated with a higher CVD mortality and morbidity. Pure fruit/vegetable juice and un-sweetened tea/coffee are suitable alternatives to SSBs and ASBs to reduce CVD risk.

Response to: ‘Glucosamine and mortality: a note of caution’ by Conway

Annals of the Rheumatic Diseases, Aug 11, 2020

We appreciate the comments by Conway 1 on our manuscript which investigated the association of re... more We appreciate the comments by Conway 1 on our manuscript which investigated the association of regular glucosamine use with all-cause and cause-specific mortality. 2 First, we agree that the underlying mechanisms, including inhibition of nuclear factor-κB thereby reducing inflammation and glucosamine triggering a mimic response of low carbohydrate diet, might partially explain the association between glucosamine use and mortality. Future studies are needed to better understand underlying pharmacological roles of glucosamine on health outcomes. Second, the association of mortality with glucosamine use might be confused by unmeasured underlying lifestyle-related factors or other confounders. Nevertheless, in our analyses, we had carefully adjusted for several important confounders, including sociodemographic factors, lifestyle behaviours, health status, drug use and other supplements use. In total, 27 confounders were included in our fully adjusted models, and the adjustment for confounding was sufficient. Third, randomised controlled trial (RCT) is indeed the ideal study design to clarify these issues. However, most previous RCTs, investigating the association between glucosamine use and health outcomes, mainly focused on the therapy in treating patients with osteoarthritis or other chronic diseases, 3-5 who might have relatively poorer prognoses than healthy people in primary prevention trials. Moreover, several previous largescale cohort studies found the similar magnitude of benefit of glucosamine on mortality, 6-8 which are generally consistent with our study. Therefore, in the absence of sufficient sample size and sufficient trail duration, it might be difficult for previous RCTs to find such magnitude of benefit of glucosamine. Further studies are necessary to better clarify the association between glucosamine use and mortality.

Regular proton pump inhibitor use and incident dementia: population-based cohort study

BMC Medicine, Sep 1, 2022

Background: To examine the association between regular use of proton pump inhibitors and the risk... more Background: To examine the association between regular use of proton pump inhibitors and the risk of incident dementia, including dementia subtypes, and whether the association differs between APOE genotypes. Methods: Based on a prospective analysis of data from the UK Biobank, 501,002 individuals (female, 54.4%) aged between 40 and 70 years, who had no prevalent dementia at baseline, were enrolled between 2006 and 2010 and followed up to 2018. We compared all-cause dementia, Alzheimer's disease (AD), and vascular dementia (VaD) incidence rates between proton pump inhibitor users and non-users by the Cox proportional hazard model. Results: During 4,438,839 person-years of follow-up (median length of follow-up, 9.0 years), there were 2505 incident cases of all-cause dementia, including 932 cases of AD and 524 cases of VaD. The incident rate of all-cause dementia among proton pump inhibitor users was 1.06 events per 1000 person-years, compared with 0.51 events per 1000 person-years among non-users. After adjustment for multiple confounders and indications, the hazard ratios (HRs) of the proton pump inhibitor users were 1.20 (95% CI, 1.07-1.35) for incident all-cause dementia, 1.23 (95% CI, 1.02-1.49) for incident AD, and 1.32 (95% CI, 1.05-1.67) for incident VaD. In addition, the association between proton pump inhibitor use and all-cause dementia differed by APOE genotype (P for interaction = 0.048). Among APOE ε4 heterozygotes, the fully adjusted HR of proton pump inhibitor use was 1.46 (95% CI, 1.22-1.75) and 1.68 (95% CI, 1.36-2.07), especially for individuals aged 65 years and older. Conclusions: The finding of this large population-based cohort study indicates that the use of proton pump inhibitors is associated with an increased risk of incident dementia, particularly among APOE ε4 heterozygotes.

Association of screening status, polygenic risk score and environmental risk factors with colorectal cancer incidence and mortality risks

International Journal of Cancer, Dec 30, 2022

Whether screening can attenuate the influence of genetic risk and environmental risk factors for ... more Whether screening can attenuate the influence of genetic risk and environmental risk factors for colorectal cancer (CRC) mortality risk remains unknown. Our study is to investigate the association of the screening history, genetic risk and environmental risk factors with CRC incidence and mortality risks using UK Biobank data. Screening history was associated with lower CRC incidence (hazard ratio [HR]: 0.63, 95% confidence interval [CI]: 0.58‐0.69) and mortality risk (HR: 0.56, 95% CI: 0.49‐0.63). Compared to the HRs of participants with a low genetic risk, low environmental risk and no screening history, the HRs of participants with a high genetic risk, high environmental risk and no screening history were 3.42 (95% CI: 2.76‐4.24) for CRC incidence and 3.36 (95% CI: 2.48‐4.56) for CRC mortality. In contrast, the HRs of participants with a high genetic risk and no screening history, but a low environmental risk, were 1.92 (95% CI: 1.55‐2.36) for CRC incidence and 1.88 (95% CI: 1.39‐2.53) for CRC mortality. Furthermore, the HRs of participants with a high genetic risk and a low environmental risk, but a screening history were 1.62 (95% CI: 1.15‐2.28) for CRC incidence and 1.77 (95% CI: 1.08‐2.89) for CRC mortality. Participants benefited more substantially from screenings for CRC mortality than for CRC incidence risk. A higher environmental risk was associated with higher risk of CRC incidence and mortality within each category of genetic risk. These findings emphasize the importance of CRC screening and identifying environmental factors to reduce CRC incidence and mortality risks.

Air and surface contamination in non-health care settings among 641 environmental specimens of 39 COVID-19 cases

bioRxiv (Cold Spring Harbor Laboratory), Jul 9, 2020

Background: Little is known about the SARS-CoV-2 contamination of environmental surfaces and air ... more Background: Little is known about the SARS-CoV-2 contamination of environmental surfaces and air in non-health care settings among COVID-19 cases. Methods and findings: We explored the SARS-CoV-2 contamination of environmental surfaces and air by collecting air and swabbing environmental surfaces among 39 COVID-19 cases in Guangzhou, China. The specimens were tested by RT-PCR testing. The information collected for COVID-19 cases included basic demographic, clinical severity, onset of symptoms, radiological testing, laboratory testing and hospital admission. A total of 641 environmental surfaces and air specimens were collected among 39 COVID-19 cases before disinfection. Among them, 20 specimens (20/641, 3.1%) were tested positive from 9 COVID-19 cases (9/39, 23.1%), with 5 (5/101, 5.0%) positive specimens from 3 asymptomatic cases, 5 (5/220, 2.3%) from 3 mild cases, and 10 (10/374, 2.7%) from 3 moderate cases. All positive specimens were collected within 3 days after diagnosis, and 10 (10/42, 23.8%) were found in toilet (5 on toilet bowl, 4 on sink/faucet/shower, 1 on floor drain), 4 (4/21, 19.0%) in anteroom (2 on water dispenser/cup/bottle, 1 on chair/table, 1 on TV remote),

[Influence of visual impairment on mortality in the elderly aged 65 years and older in 8 longevity areas in China]

PubMed, Jan 10, 2020

Objective: To understand the relationship between visual impairment and risk of all-cause mortali... more Objective: To understand the relationship between visual impairment and risk of all-cause mortality in the elderly aged 65 years and older in 8 longevity areas in China. Methods: The data of the elderly aged 65 years and older in the project in 2012 were obtained from Healthy Aging and Biomarkers Cohort Study, a sub-cohort of the Chinese Longitudinal Healthy Longevity Survey, including physical measurement and survival status, and a follow-up for survival outcomes were conducted in 2014 and 2017 respectively. Cox proportional hazard regression model was used to analyze the influence of visual impairment on mortality. Gender and age specific analysis was conducted. Results: A total of 1 736 elderly adults were included. A total of 943 deaths occurred during the 5-year follow-up period with a 5-year mortality rate of 54.3%. The 5-year mortality rate was 76.7% in the group with visual impairment, and 47.6% in the group without visual impairment (P<0.001). After adjusting for demographic information, life style and some disease factors, the risk of 5-year mortality in the group with visual impairment group was 1.30 times higher than that in the group without visual impairment (HR=1.30, 95%CI: 1.09-1.55). In the females, the risk for mortality in the group with visual impairment was 1.48 times higher than that in the group without visual impairment (HR=1.48, 95%CI:1.20-1.84). However, vision status was not associated with the risk for mortality in males (HR=1.02, 95%CI: 0.72-1.43). The risk for mortality in the group with visual impairment was 1.39 times higher than that in the group without visual impairment in the elderly aged over 90 years (HR=1.39, 95%CI: 1.13-1.70). Vision status was not associated with mortality risk in the elderly aged 65-79 years and 80-89 years (HR=1.37, 95%CI: 0.61-3.07; HR=0.95, 95%CI: 0.61-1.48). Conclusion: In the elderly people in China, visual impairment is a risk factor for mortality.

Gut microbiota-mediated ursodeoxycholic acids regulate the inflammation of microglia through TGR5 signaling after MCAO

Brain, Behavior, and Immunity

Associations between Body Composition and Mortality: A Large Population-Based Cohort Study

Social Science Research Network, 2020

Association between Long-Term Concomitant Exposure to Various Ambient Air Pollutants and All-Cause and Cause-Specific Mortality: Data from a Nationwide Prospective Cohort Study

Social Science Research Network, 2022

Association between supportive attitudes and adoptive practice of control strategy against COVID-19 among college students in China, a cross-sectional study

Research Square (Research Square), Aug 21, 2020

Background: This study aimed to explore college students' attitudes and compliance toward the pre... more Background: This study aimed to explore college students' attitudes and compliance toward the prevention strategy of using non-pharmaceutical interventions (NPIs) in containing coronavirus disease 2019. Methods: We conducted a cross-sectional online survey in four universities in Guangdong Province (China) based on purposive sampling. We used a self-made questionnaire to measure the supportive attitude towards outbreak control strategy and adoption of NPIs in respondents. Results: A total of 44,446 college students participated between 31 January and 10 February 2020; 92.7% of respondents supported the outbreak control strategy. 94.8% would avoid public places, 92.8% would wear a facemask, 91.2% would avoid of gatherings and 86.9% would wash hands more frequent. 76.5% respondents adopted all four measures. Supportive attitude was associated with NPI adoption. Students who were female, postgraduate, anxious, and not depressed tended to have higher supportive attitude and higher NPI adoption rate. Conclusions: Higher supportiveness towards the disease control strategy for public may lead to higher adoption rate of NPIs for individuals. Psychosocial factors are related to supportive attitude and adoption

Association of sleep and circadian patterns and genetic risk with incident type 2 diabetes: a large prospective population-based cohort study

European journal of endocrinology, Nov 1, 2021

Objective: To examine the association of incident type 2 diabetes (T2D) risk with sleep factors, ... more Objective: To examine the association of incident type 2 diabetes (T2D) risk with sleep factors, genetic risk, and their combination effects. Design: Large prospective population-based cohort study. Methods: This population-based prospective cohort study included 360 403 (mean (s.d.) age: 56.6 (8.0) years) participants without T2D at baseline from the UK Biobank. Genetic risk was categorised as high (highest quintile), intermediate (quintiles: 2-4), and low (lowest quintile) based on a polygenic risk score for T2D. Sleep scores, including long or short sleep duration, insomnia, snoring, late chronotype, and excessive daytime sleepiness, were categorized as an unfavourable, intermediate, or favourable sleep and circadian pattern. Results: During a median follow-up of 9.0 years, 13 120 incident T2D cases were recorded. Among the participants with an unfavourable sleep and circadian pattern, 6.96% (95% CI: 6.68-7.24%) developed T2D vs 2.37% (95% CI: 2.28-2.46%) of participants with a favourable sleep and circadian pattern (adjusted hazard ratio (HR): 1.53, 95% CI: 1.45-1.62). Of participants with a high genetic risk, 5.53% (95% CI: 5.36-5.69%) developed T2D vs 2.01% (95% CI: 1.91-2.11%) of participants with a low genetic risk (adjusted HR: 2.89, 95% CI: 2.72-3.07). The association with sleep and circadian patterns was independent of genetic risk strata. Participants in the lowest quintile with an unfavourable sleep and circadian pattern were 3.97-fold more likely to develop T2D than those in the lowest quintile with a favourable sleep and circadian pattern. Conclusions: Sleep and circadian patterns and genetic risk were independently associated with incident T2D. These results indicate the benefits of adhering to a healthy sleep and circadian pattern in entire populations, independent of genetic risk.

Association of dietary diversity changes and mortality among older people: A prospective cohort study

Clinical Nutrition, May 1, 2021

BACKGROUND & AIMS The association between dietary diversity (DD) changes and mortality remain... more BACKGROUND & AIMS The association between dietary diversity (DD) changes and mortality remains unclear. We aimed to investigate the association between DD changes and all-cause mortality among older people. METHODS A total of 17,959 participants with a mean age of 84.8 years old were enrolled at baseline. Food groups were collected at baseline and follow-up using simplified food frequency questionnaire (FFQ), and then overall, plant-based and animal-based dietary diversity score (DDS) were calculated. DDS changes were calculated using DDS at baseline and the first follow-up. The association between three DDS changes (overall, plant-based and animal-based DDS) and subsequent all-cause mortality were evaluated. Nonparametrically restricted cubic splines and a multivariable-adjusted Cox proportional hazards model were used to estimate HRs and 95% CIs. RESULTS We documented 12,974 deaths over a 129,590 person-years of follow up. Compared with high-to-high DDS pattern, participants with lower overall DDS patterns had increased mortality risk with HRs (95%CI) of 1.39 (1.29-1.49), 1.53 (1.37-1.70), 1.38 (1.18-1.60) and 1.55 (1.31-1.83) for medium-to-medium, low-to-low, low-to-high and high-to-low patterns, respectively. And compared with high-to-high DDS pattern, the estimates were 1.34 (1.23-1.46), 1.49 (1.35-1.65), 1.43 (1.23-1.67) and 1.62 (1.40-1.88) for plant-based DDS, and 1.23 (1.15-1.31), 1.29 (1.20-1.40), 1.24 (1.12-1.37) and 1.28 (1.15-1.44) for animal-based DDS for medium-to-medium, low-to-low, low-to-high and high-to-low patterns, respectively. There was a U-shaped association between DDS change scores and mortality, and compared with participants with whose DDS remained stable, those with extreme declines and extreme improvements had higher risks of mortality with HRs (95% CI) of 1.15 (1.09-1.22) and 1.11 (1.04-1.17). CONCLUSIONS Maintaining a lower DDS, extreme declines and extreme improvements in DDS were all associated with an increased risk of all-cause mortality.

Associations between C-reactive protein and all-cause mortality among oldest old adults in Chinese longevity areas: A community-based cohort study

Background: Higher C-reactive protein (CRP) levels have been proposed as a predictor of all-cause... more Background: Higher C-reactive protein (CRP) levels have been proposed as a predictor of all-cause mortality in many existing studies from multiple populations, but the association for the oldest old adults (aged 80 and older) remains unclear. Objective: To examine the association between CRP and all-cause mortality among the oldest old Chinese adults. Design: This is a prospective, community-based longitudinal cohort study with 2206 adults aged 80 years old and older with available CRP test results. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) with 95% con dential intervals (95% CIs) for all-cause mortality according to CRP quartiles, adjusting for potential confounders. Results: The median age of the participants was 93 years old, and the median CRP concentration was 1.13 mg/L at baseline. During a median follow-up period of 36.7 months, 1106 deaths were veri ed. After full adjustment for potential confounders, a high CRP concentration was positively associated with an increased risk of all-cause mortality. Compared with the lowest quartile, the fully adjusted

Response to: ‘Correspondence to ‘Associations of regular glucosamine use with all-cause and cause-specific mortality: a large prospective cohort study’ by Li<i>et al</i>’ by Yueh<i>et al</i>

Annals of the Rheumatic Diseases, Aug 4, 2020

Patient and public involvement Patients and/or the public were not involved in the design, or con... more

Probable Causes and Risk Factors for Positive SARS-CoV-2 Testing in Recovered Patients: Evidence From Guangzhou, China

Frontiers in Medicine, Jul 12, 2021

Some patients retested positive for SARS-CoV-2 following negative testing results and discharge. ... more Some patients retested positive for SARS-CoV-2 following negative testing results and discharge. However, the potential risk factors associated with redetectable positive testing results in a large sample of patients who recovered from COVID-19 have not been well-estimated. A total of 745 discharged patients were enrolled between January 30, 2020, and September 9, 2020, in Guangzhou, China. Data on the clinical characteristics, comorbidities, drug therapy, RT-PCR testing, and contact modes to close contacts were collected. Patients who tested positive for SARS-CoV-2 after discharge were confirmed by guidelines issued by China. The repositive rate in different settings was calculated. Among 745 discharged patients, 157 (21.1%; 95% CI, 18.2-24.0%) tested repositive and the repositive rate was 16.8% (95% CI, 14.1-24.0%) for nasopharyngeal swabs and 9.7% (95% CI, 7.0-12.5%) for anal swabs. Among them, 55 (35.0%) were asymptomatic, 15 (9.6%) had mild symptoms, 83 (52.9%) had moderate symptoms, and 4 (2.6%) had severe symptoms at the first admission. The days from discharge to repositivity was 8.0 (IQR, 8.0-14.0). Most repositive patients were without clinical symptoms, and lymphocyte cell counts were higher than before being discharged. The likelihood of repositive testing for SARS-CoV-2 RNA was significantly higher among patients who were of younger age (OR, 3.88; 95% CI, 1.74-8.66, 0-17 years old), had asymptomatic severity (OR, 4.36; 95% CI, 1.47-12.95), and did not have clinical symptoms (OR, 1.89; 95% CI, 1.32-2.70, without fever). No other positive patients emerged within the families or close contacts of repositive patients. Our findings support prolonged but intermittent viral shedding as the probable cause for this phenomenon; we need to familiarize with the possibility that the virus will remain endemic.

Associations of long-term joint exposure to various ambient air pollutants with all-cause and cause-specific mortality: evidence from a large population-based cohort study

Environmental Science and Pollution Research, Jun 26, 2023

Association of Night Shifts and Lifestyle Risks With Incident Dementia

The Journals of Gerontology, Apr 28, 2023

Background Little is known about the combined relationship between night shifts and lifestyle ris... more Background Little is known about the combined relationship between night shifts and lifestyle risks with incident dementia or their potential interactions. To evaluate the association of night shifts and lifestyle risks with incident dementia and further analyze their interactions. Methods A total of 276 059 participants were included in this study from the UK Biobank cohort. Cox proportional hazards models were used to investigate the combined association of night shifts and lifestyle risks with incident dementia. Results Participants with always night shifts and 3 or 4 unhealthy lifestyle factors had the highest risk of incident all-cause dementia (hazard ratio: 3.15, 95% confidence interval [CI]: 1.74–5.69). An additive interaction was found between night shifts and lifestyle risks for incident all-cause dementia (p &lt; .001), with a relative excess risk due to the interaction of 0.14 (95% CI: 0.11–0.45). The attributable proportions of the combined effect on the incidence of all-cause dementia were 22.6% (95% CI: 20.91%–26.75%) for night shift work, 65.0% (95% CI: 63.12%–69.80%) for unhealthy lifestyle factors, and 12.1% (95% CI: 8.67%–18.04%) for their interaction. Conclusions Both night shifts and lifestyle risks were associated with a higher risk of incident dementia. The combined impact was higher than the increase in the risks related to each single factor. Our results indicated that most incident dementia cases might be prevented by a healthy lifestyle, and the benefits would be greater among night shift workers. Further studies are needed to confirm our results and explore the underlying mechanisms.

The coverage of SARS-CoV-2 vaccination and the willingness to receive the SARS-CoV-2 variant vaccine among employees in China

BMC Public Health, Mar 22, 2023

Background COVID-19, which is caused by SARS-CoV-2, is a major global health threat. The dominant... more Background COVID-19, which is caused by SARS-CoV-2, is a major global health threat. The dominant variant of SARS-CoV-2 has changed over time due to continuous evolution. We aimed to evaluate the coverage of SARS-CoV-2 vaccination among employees in China, explore their willingness to receive the SARS-CoV-2 variant vaccine and examine the potential factors influencing vaccination coverage and willingness. Methods A cross-sectional epidemiological survey was conducted online from January 1, 2022, to January 30, 2022. The information collected in the survey included sociodemographic characteristics, lifestyle habits, vaccination coverage, willingness to be vaccinated against SARS-CoV-2 variants and the reasons for vaccination and willingness. Multivariable logistic regression models were used to assess the associations of potential factors with the rate of vaccination and the willingness to be vaccinated. Results Among 62,395 eligible participants, the coverage of SARS-CoV-2 vaccination was 98.9% for at least one dose and 70.1% for a booster. The great majority of vaccinated individuals (94.4%) voluntarily received the vaccine. A total of 60,694 respondents (97.7%) were willing to be vaccinated against SARS-CoV-2 variants, mainly due to confidence in the effectiveness of vaccines (92.8%). A total of 1431 respondents were unwilling to be vaccinated, mainly because of concerns about the adverse effects of vaccines (77.6%). Longer education duration was associated with a higher rate of SARS-CoV-2 vaccination and willingness to be vaccinated. General or poor health status and having no history of influenza vaccination were associated with a lower rate of SARS-CoV-2 vaccination and willingness to be vaccinated. Additionally, we observed a significant positive association of abuse experience with the willingness to be vaccinated. Conclusion Although the rate of SARS-CoV-2 vaccination and the willingness to be vaccinated were relatively high in the study population, there were still some respondents with vaccine hesitancy. Relevant strategies based on significant related factors should be developed and implemented to encourage vaccination.

Habitual fish oil supplementation and incident chronic obstructive pulmonary disease: Data from a prospective cohort study

Clinical Nutrition, Dec 1, 2022

Risk factors associated with PCR repositivity in patients with COVID-19 after recovery in Guangzhou, China: a retrospective cohort study

Authorea (Authorea), Mar 30, 2022

Association of Soft Drink Intake With Cardiovascular Disease Mortality and Morbidity: A Large Prospective Cohort Study

Research Square (Research Square), Jun 7, 2021

Background The associations of SSBs, ASBs and pure fruit/vegetable juices with CVD events have no... more Background The associations of SSBs, ASBs and pure fruit/vegetable juices with CVD events have not been thoroughly evaluated. The present study determined the association of soft drinks with CVD and effects of the substitution of alternative beverages for soft drinks and the population-attributable fraction of CVD mortality due to soft drinks. Methods A cohort study was performed using data from UK Biobank and 168007 participants (mean (SD) age, 55.6 (7.9) years) without CVD/cancer at baseline were eligible for this analysis. Dietary consumption of SSBs, ASBs and pure fruit/vegetable juices was self-reported via a 24-hour dietary questionnaire between 2009 and 2012 and followed up to 2018. Results During a median follow-up of 7.0-year, we recorded 5922 incident CVD cases and 884 CVD deaths. Multivariable adjusted analyses revealed that compared to non-consumers, participants who consumed >2.5 drinks/day had a higher risk of CVD mortality and incidence with HR (95% CI) of 1.63 (1.22-2.17) and 1.23 (1.09-1.39) for SSBs, and 1.77 (1.23-2.56) and 1.20 (1.02-1.42) for ASBs, respectively. Compared to non-consumers, moderate pure fruit/vegetable juice consumers (>0-2.5 drinks/day) have an 8% (2%-13%)-34% (16%-48%) lower risk for CVD incidence and mortality. There was a positive doseresponse association of SSBs per 5% energy with CVD mortality and incidence with HR (95% CI) of 1.15 (1.17-1.25) and 1.06 (1.03-1.10), respectively. Substituting one drink/day of pure fruit/vegetable juice, un-sweetened tea/coffee for SSBs and ASBs was associated with 4%-24% lower risks for CVD mortality and incidence. A reduced SSB intake to below 5% energy may prevent 4% (1%-8%) of CVD mortality. Conclusion SSBs and ASBs was associated with a higher CVD mortality and morbidity. Pure fruit/vegetable juice and un-sweetened tea/coffee are suitable alternatives to SSBs and ASBs to reduce CVD risk.

Response to: ‘Glucosamine and mortality: a note of caution’ by Conway

Annals of the Rheumatic Diseases, Aug 11, 2020

We appreciate the comments by Conway 1 on our manuscript which investigated the association of re... more We appreciate the comments by Conway 1 on our manuscript which investigated the association of regular glucosamine use with all-cause and cause-specific mortality. 2 First, we agree that the underlying mechanisms, including inhibition of nuclear factor-κB thereby reducing inflammation and glucosamine triggering a mimic response of low carbohydrate diet, might partially explain the association between glucosamine use and mortality. Future studies are needed to better understand underlying pharmacological roles of glucosamine on health outcomes. Second, the association of mortality with glucosamine use might be confused by unmeasured underlying lifestyle-related factors or other confounders. Nevertheless, in our analyses, we had carefully adjusted for several important confounders, including sociodemographic factors, lifestyle behaviours, health status, drug use and other supplements use. In total, 27 confounders were included in our fully adjusted models, and the adjustment for confounding was sufficient. Third, randomised controlled trial (RCT) is indeed the ideal study design to clarify these issues. However, most previous RCTs, investigating the association between glucosamine use and health outcomes, mainly focused on the therapy in treating patients with osteoarthritis or other chronic diseases, 3-5 who might have relatively poorer prognoses than healthy people in primary prevention trials. Moreover, several previous largescale cohort studies found the similar magnitude of benefit of glucosamine on mortality, 6-8 which are generally consistent with our study. Therefore, in the absence of sufficient sample size and sufficient trail duration, it might be difficult for previous RCTs to find such magnitude of benefit of glucosamine. Further studies are necessary to better clarify the association between glucosamine use and mortality.

Regular proton pump inhibitor use and incident dementia: population-based cohort study

BMC Medicine, Sep 1, 2022

Background: To examine the association between regular use of proton pump inhibitors and the risk... more Background: To examine the association between regular use of proton pump inhibitors and the risk of incident dementia, including dementia subtypes, and whether the association differs between APOE genotypes. Methods: Based on a prospective analysis of data from the UK Biobank, 501,002 individuals (female, 54.4%) aged between 40 and 70 years, who had no prevalent dementia at baseline, were enrolled between 2006 and 2010 and followed up to 2018. We compared all-cause dementia, Alzheimer's disease (AD), and vascular dementia (VaD) incidence rates between proton pump inhibitor users and non-users by the Cox proportional hazard model. Results: During 4,438,839 person-years of follow-up (median length of follow-up, 9.0 years), there were 2505 incident cases of all-cause dementia, including 932 cases of AD and 524 cases of VaD. The incident rate of all-cause dementia among proton pump inhibitor users was 1.06 events per 1000 person-years, compared with 0.51 events per 1000 person-years among non-users. After adjustment for multiple confounders and indications, the hazard ratios (HRs) of the proton pump inhibitor users were 1.20 (95% CI, 1.07-1.35) for incident all-cause dementia, 1.23 (95% CI, 1.02-1.49) for incident AD, and 1.32 (95% CI, 1.05-1.67) for incident VaD. In addition, the association between proton pump inhibitor use and all-cause dementia differed by APOE genotype (P for interaction = 0.048). Among APOE ε4 heterozygotes, the fully adjusted HR of proton pump inhibitor use was 1.46 (95% CI, 1.22-1.75) and 1.68 (95% CI, 1.36-2.07), especially for individuals aged 65 years and older. Conclusions: The finding of this large population-based cohort study indicates that the use of proton pump inhibitors is associated with an increased risk of incident dementia, particularly among APOE ε4 heterozygotes.

Association of screening status, polygenic risk score and environmental risk factors with colorectal cancer incidence and mortality risks

International Journal of Cancer, Dec 30, 2022

Whether screening can attenuate the influence of genetic risk and environmental risk factors for ... more Whether screening can attenuate the influence of genetic risk and environmental risk factors for colorectal cancer (CRC) mortality risk remains unknown. Our study is to investigate the association of the screening history, genetic risk and environmental risk factors with CRC incidence and mortality risks using UK Biobank data. Screening history was associated with lower CRC incidence (hazard ratio [HR]: 0.63, 95% confidence interval [CI]: 0.58‐0.69) and mortality risk (HR: 0.56, 95% CI: 0.49‐0.63). Compared to the HRs of participants with a low genetic risk, low environmental risk and no screening history, the HRs of participants with a high genetic risk, high environmental risk and no screening history were 3.42 (95% CI: 2.76‐4.24) for CRC incidence and 3.36 (95% CI: 2.48‐4.56) for CRC mortality. In contrast, the HRs of participants with a high genetic risk and no screening history, but a low environmental risk, were 1.92 (95% CI: 1.55‐2.36) for CRC incidence and 1.88 (95% CI: 1.39‐2.53) for CRC mortality. Furthermore, the HRs of participants with a high genetic risk and a low environmental risk, but a screening history were 1.62 (95% CI: 1.15‐2.28) for CRC incidence and 1.77 (95% CI: 1.08‐2.89) for CRC mortality. Participants benefited more substantially from screenings for CRC mortality than for CRC incidence risk. A higher environmental risk was associated with higher risk of CRC incidence and mortality within each category of genetic risk. These findings emphasize the importance of CRC screening and identifying environmental factors to reduce CRC incidence and mortality risks.

Air and surface contamination in non-health care settings among 641 environmental specimens of 39 COVID-19 cases

bioRxiv (Cold Spring Harbor Laboratory), Jul 9, 2020

Background: Little is known about the SARS-CoV-2 contamination of environmental surfaces and air ... more Background: Little is known about the SARS-CoV-2 contamination of environmental surfaces and air in non-health care settings among COVID-19 cases. Methods and findings: We explored the SARS-CoV-2 contamination of environmental surfaces and air by collecting air and swabbing environmental surfaces among 39 COVID-19 cases in Guangzhou, China. The specimens were tested by RT-PCR testing. The information collected for COVID-19 cases included basic demographic, clinical severity, onset of symptoms, radiological testing, laboratory testing and hospital admission. A total of 641 environmental surfaces and air specimens were collected among 39 COVID-19 cases before disinfection. Among them, 20 specimens (20/641, 3.1%) were tested positive from 9 COVID-19 cases (9/39, 23.1%), with 5 (5/101, 5.0%) positive specimens from 3 asymptomatic cases, 5 (5/220, 2.3%) from 3 mild cases, and 10 (10/374, 2.7%) from 3 moderate cases. All positive specimens were collected within 3 days after diagnosis, and 10 (10/42, 23.8%) were found in toilet (5 on toilet bowl, 4 on sink/faucet/shower, 1 on floor drain), 4 (4/21, 19.0%) in anteroom (2 on water dispenser/cup/bottle, 1 on chair/table, 1 on TV remote),

[Influence of visual impairment on mortality in the elderly aged 65 years and older in 8 longevity areas in China]

PubMed, Jan 10, 2020

Objective: To understand the relationship between visual impairment and risk of all-cause mortali... more Objective: To understand the relationship between visual impairment and risk of all-cause mortality in the elderly aged 65 years and older in 8 longevity areas in China. Methods: The data of the elderly aged 65 years and older in the project in 2012 were obtained from Healthy Aging and Biomarkers Cohort Study, a sub-cohort of the Chinese Longitudinal Healthy Longevity Survey, including physical measurement and survival status, and a follow-up for survival outcomes were conducted in 2014 and 2017 respectively. Cox proportional hazard regression model was used to analyze the influence of visual impairment on mortality. Gender and age specific analysis was conducted. Results: A total of 1 736 elderly adults were included. A total of 943 deaths occurred during the 5-year follow-up period with a 5-year mortality rate of 54.3%. The 5-year mortality rate was 76.7% in the group with visual impairment, and 47.6% in the group without visual impairment (P<0.001). After adjusting for demographic information, life style and some disease factors, the risk of 5-year mortality in the group with visual impairment group was 1.30 times higher than that in the group without visual impairment (HR=1.30, 95%CI: 1.09-1.55). In the females, the risk for mortality in the group with visual impairment was 1.48 times higher than that in the group without visual impairment (HR=1.48, 95%CI:1.20-1.84). However, vision status was not associated with the risk for mortality in males (HR=1.02, 95%CI: 0.72-1.43). The risk for mortality in the group with visual impairment was 1.39 times higher than that in the group without visual impairment in the elderly aged over 90 years (HR=1.39, 95%CI: 1.13-1.70). Vision status was not associated with mortality risk in the elderly aged 65-79 years and 80-89 years (HR=1.37, 95%CI: 0.61-3.07; HR=0.95, 95%CI: 0.61-1.48). Conclusion: In the elderly people in China, visual impairment is a risk factor for mortality.