Quality of asynchronous webchats vs in-person consultations for postpartum depression in China:a cross-sectional, mixed methods study using standardized patients

Background: Prompt professional care for postpartum depression (PPD) is difficult to obtain in China. Though online consultations improve accessibility and reduce stigma, the quality of services compared to in-person consultations is unclear. Methods: Five trained, undisclosed “standardized patients” (SPs) made “asynchronous webchats” visits and in-person visits with psychiatrists. Visits were made to 85 psychiatrists who were based in 69 hospitals in ten provincial capital cities. The care between online and in-person consultations with the same psychiatrist was compared, including diagnosis, guideline adherence, and patient-centeredness. False discovery rate (FDR) was used to adjust p values. Third visits using asynchronous webchats were made to psychiatrists who offered discrepant diagnoses. Thematic content analysis was used for the discrepancies. Findings: The proportion of diagnostic accuracy was lower for online than in-person visits (76.5% [65/85] vs 91.8% [78/85]; pFDR = 0.0066), as were the proportions of completing questions involving clinical history (16.6% vs 42.7%; pFDR < 0.0001), and management decisions (16.2% vs 27.5%; pFDR < 0.0001) consistent with recommended guidelines. Patient-centeredness was lower online than in-person (pFDR < 0.0001). Fifteen of 16 psychiatrists completed third visits, most of them considered lack of nonverbal information online as a key barrier. Interpretation: Online consultations using asynchronous webchats were inferior to in-person consultations, with respect to diagnostic accuracy, adherence to recommended clinical guidelines, and patient-centeredness. To fully realise the potential benefits of online consultations and to prevent safety issues, there is an urgent need for major improvement in the quality and oversight of these consultations. Funding:  China Medical Board, National Natural Science Foundation of China, and Swiss Agency for Development and Cooperation Global Cooperation Department

Childhood meat eating and inflammatory markers: The Guangzhou Biobank Cohort Study

BackgroundWe hypothesized that socio-economic development could, via nutritionally driven levels of pubertal sex-steroids, promote a pro-inflammatory state among men but not women in developing countries. We tested this hypothesis, using recalled childhood meat eating as a proxy for childhood nutrition, in southern China. MethodsWe used multivariable linear regression in the Guangzhou Biobank Cohort Study phase 3 (2006-8) to examine the adjusted associations of recalled childhood meat eating, \u3c1/week (n = 5,023), about once per week (n = 3,592) and almost daily (n = 1,252), with white blood cell count and its differentials among older (≥50 years) men (n = 2,498) and women (n = 7,369). ResultsAdjusted for age, childhood socio-economic position, education and smoking, childhood meat eating had sex-specific associations with white blood cell count and lymphocyte count, but not granulocyte count. Men with childhood meat eating almost daily compared to \u3c1/week had higher white blood cell count (0.33 109/L, 95% confidence interval (CI) 0.10 to 0.56) and higher lymphocyte count (0.16 109/L, 95% CI 0.07 to 0.25). Adjustment for obesity slightly attenuated these associations. ConclusionIf confirmed, this hypothesis implies that economic development and the associated improvements in nutrition at puberty may be less beneficial among men than women; consistent with the widening sex differentials in life expectancy with economic development

Prevalence of Postpartum Depression Based on Diagnostic Interviews:A Systematic Review and Meta-Analysis

Background. Postpartum depression (PPD) is common after childbirth. Previous reviews on the prevalence of PPD have mainly included results that relied on screening instruments or a mixture of such instruments and diagnostic interviews. In this study, we aimed to assess the prevalence of PPD based exclusively on studies using diagnostic interviews, as they provide the most reliable and valid approach for defining “caseness.” Methods. Using PubMed, Web of Science, Cochrane Library, Embase, CNKI, WANFANG DATA, and CBM up to September 18, 2022, we searched for original articles reporting data that could be used to calculate the prevalence of PPD based on diagnostic interviews. A random-effect meta-analysis model was then used to estimate the pooled prevalence. In addition, we assessed quality, heterogeneity, and publication bias across studies. Also, we did subgroup analyses to explore the pooled prevalence at different time points and settings. This study was registered with PROSPERO, CRD42021244539. Results. Of 17,115 articles retrieved, 54 studies were included (total sample size=15,586 women). The pooled prevalence of all depression and major depression within one year postpartum was 12.1% (95% CI 10.3%-14.1%; I2=91.0%) and 7.0% (95% CI 5.7%-8.4%; I2=83.0%), respectively. The peaks of all depression occurred during the first 6 months postpartum, especially 2-3 weeks and 6-8 weeks. Subgroup analyses showed that the prevalence of major depression was associated with the income level of countries (higher in low- and middle-income countries (LMICs) than in high-income countries (HICs)) and diagnostic criteria (higher using ICD than using DSM and RDC). No evidence of publication bias was found. Conclusions. Approximately one in eight postpartum women experiences a depressive condition, with one in fifteen suffering major depression. The pooled prevalence based on diagnostic interviews was lower than the existing consensus, which was largely based on self-reported screening instruments. The higher prevalence in LMICs underlines the importance of strengthening research and service provision among these populations

Exposure to secondhand smoke and risk of peripheral arterial disease in southern Chinese non-smokers: the Guangzhou Biobank Cohort Study-Cardiovascular Disease Sub-cohort

Objectives: We studied the association between secondhand smoke (SHS) exposure and peripheral arterial disease (PAD) in Chinese non-smokers. Methods: We conducted a cross-sectional study using baseline data from the Guangzhou Biobank Cohort Study: Cardiovascular Disease Sub-cohort Study (GBCS-CVD). Guangzhou residents aged ≥ 50 years were recruited between 2003 and 2008. Baseline data included measurement of ankle brachial pressure index (ABPI) and self-reported smoking status and SHS exposure. Univariate and multivariate logistic regression analyses were used to analyze the association between SHS and PAD (defined as ABPI < 0.9). Results: Of the 1507 non-smokers, 24 (1.6%) had PAD. Of these, 12 were men and 12 were women. Exposure to SHS at home of ≥25 h per week was reported by 16.7% of PAD cases compared with 3.8% of those without PAD (χ2 test, p = 0.003). After adjustment for potential confounders, exposure to ≥25 h per week at home was still associated with PAD (adjusted OR 7.86, 95% CI 2.00–30.95, p = 0.003), with suggestion of a dose-response relationship. Conclusions: Our results extend the US Surgeon General’s 2006 report that SHS exposure is an independent risk factor for PAD. National smoke-free legislation is needed to protect all people from exposure

Genetically predicted 17beta-estradiol, cognitive function and depressive symptoms in women: A Mendelian randomization in the Guangzhou Biobank Cohort Study

© 2016.Objective: The role of estrogen in cognitive function and depressive symptoms is controversial due to discrepancies between results from randomized controlled trials (RCT) and observational studies. Mendelian randomization analysis may provide further insights concerning the role of estrogen in these outcomes as it assesses the effect of lifelong endogenous exposure but is less vulnerable to confounding than observational studies. Method: We used separate sample instrumental variable analysis to estimate the association of log 17β estradiol with cognitive function (Delayed 10 word recall, and Mini Mental State Examination (MMSE)) and depressive symptoms (Geriatric Depression Scale (GDS)) in older Chinese women of the Guangzhou Biobank Cohort Study (GBCS, n = 3086). The estimate was derived based on the Wald estimator, the ratio of the association of genetic determinants (rs1008805 and rs2175898) of log 17β-estradiol with cognitive function and depressive symptoms in GBCS and the association of log 17β-estradiol with genetic determinants in the sample of young women in Hong Kong (n = 236). Results: Genetically predicted 17β-estradiol was not associated with delayed 10-word recall (0.42 words per log increase in 17β-estradiol (pmol/L), 95% confidence interval (CI) -. 0.49 to 1.34) MMSE (0.39 per log increase in 17β-estradiol (pmol/L), 95% CI -. 0.87 to 1.65) or GDS (0.24 per log increase in 17β-estradiol (pmol/L), 95% CI -. 0.57 to 1.05). Conclusion: These results were largely consistent with evidence from RCTs and did not show any beneficial effect of estrogen on cognitive function and depressive symptoms. However, larger Mendelian randomization analyses are needed to identify any minor effects.postprin

Association of adverse childhood experiences with anemia in older Chinese:Guangzhou Biobank Cohort Study

To examine the association of adverse childhood experiences (ACEs) with anemia among older people. 24,116 participants aged 50 years or above were recruited. Multivariable linear and logistic regression was used to assess the associations of self-reported ACEs number with hemoglobin concentrations (g/dL) and presence of anemia. Older individuals with two or more ACEs, versus no ACEs, showed lower hemoglobin concentrations (β = − 0.08 g/dL, 95% confidence intervals (CI) − 0.12 to − 0.03) and higher odds of anemia (odds ratio = 1.26, 95% CI 1.01–1.59). A more pronounced association between ACEs and anemia in the lower education group was found, while the association became non-significant in those with higher education (P for ACEs-education interaction = 0.02). ACEs was associated with anemia in older people, and the association was stronger in those with lower education, highlighting the significance of early-life psychological stressors assessment and consideration of education background in geriatric care

The evolution of negotiation and impasse in two-party multi-issue bargaining

Automated negotiation systems are becoming increasingly important and pervasive. Most previous research on automated negotiation has focused on understanding and formalizing “successful” negotiations, i.e., negotiations that do not become contentious to the point of impasse. This paper shifts the emphasis to negotiations that are “difficult” to resolve and can hit an impasse. It analyses a situation where two agents bargain over the division of the surplus of several distinct issues to demonstrate how a procedure to avoid impasses can be utilized in a specific negotiation setting. The procedure is based on the addition of new issues to the agenda during the course of negotiation and the exploration of the differences in the valuation of these issues to capitalize on Pareto optimal agreements. This paper also lays the foundation for performing an experiment to investigate how the evolution of negotiation contributes to the avoidance of impasses, paying particular attention to the expansion of the number of issues to be deliberated and its impact on the frequency of impasse

Age at menarche and cardiovascular risk factors using Mendelian randomization in the Guangzhou Biobank Cohort Study

Observational studies show earlier age at menarche associated with higher risk of cardiovascular disease although these studies could be confounded by childhood obesity or childhood socioeconomic position. We tested the hypothesis that earlier age at menarche is associated with poorer cardiovascular risk factors using a Mendelian randomization design. We conducted a Mendelian randomization study in a large Southern Chinese cohort, the Guangzhou Biobank Cohort Study (n = 12,279), to clarify the causal role of menarche in cardiovascular disease risk factors including blood pressure, lipids, fasting glucose, adiposity and type 2 diabetes. A genetic allele score was obtained from single nucleotide polymorphisms associated with age at menarche using stepwise regression and with cross validation. Estimates of the association of age at menarche with cardiovascular disease risk factors were obtained using two stage least squares regression. Height was included as a positive control outcome. The F-statistic for the allele score (rs17268785, rs1859345, rs2090409, rs4452860 and rs4946651) was 19.9. Older age at menarche was associated with lower glucose (− 0.39 mmol/L per year older menarche, 95% confidence interval (CI) − 0.78 to − 0.001) but not clearly with any other cardiovascular risk factors. Older age at menarche was also associated with taller height. Age at menarche did not appear to affect cardiovascular disease risk factors except for glucose in an inverse manner. However, these results need to be confirmed in larger Mendelian randomization studies

A Mendelian randomization study of testosterone and cognition in men

Testosterone replacement for older men is increasingly common, with some observations suggesting a protective effect on cognitive function. We examined the association of endogenous testosterone with cognitive function among older men in a Mendelian randomization study using a separate-sample instrumental variable (SSIV) analysis estimator to minimize confounding and reverse causality. A genetic score predicting testosterone was developed in 289 young Chinese men from Hong Kong, based on selected testosterone-related single nucleotide polymorphisms (rs10046, rs1008805 and rs1256031). The association of genetically predicted testosterone with delayed 10-word recall score and Mini-Mental State Examination (MMSE) score was assessed at baseline and follow-up using generalized estimating equation among 4,212 older Chinese men from the Guangzhou Biobank Cohort Study. Predicted testosterone was not associated with delayed 10-word recall score (−0.02 per nmol/L testosterone, 95% confidence interval (CI) −0.06–0.02) or MMSE score (0.06, 95% CI −0.002–0.12). These estimates were similar after additional adjustment for age, education, smoking, use of alcohol, body mass index and the Framingham score. Our findings do not corroborate observed protective effects of testosterone on cognitive function among older men