F2^2AT: Feature-Focusing Adversarial Training via Disentanglement of Natural and Perturbed Patterns

Deep neural networks (DNNs) are vulnerable to adversarial examples crafted by well-designed perturbations. This could lead to disastrous results on critical applications such as self-driving cars, surveillance security, and medical diagnosis. At present, adversarial training is one of the most effective defenses against adversarial examples. However, traditional adversarial training makes it difficult to achieve a good trade-off between clean accuracy and robustness since spurious features are still learned by DNNs. The intrinsic reason is that traditional adversarial training makes it difficult to fully learn core features from adversarial examples when adversarial noise and clean examples cannot be disentangled. In this paper, we disentangle the adversarial examples into natural and perturbed patterns by bit-plane slicing. We assume the higher bit-planes represent natural patterns and the lower bit-planes represent perturbed patterns, respectively. We propose a Feature-Focusing Adversarial Training (F$^2$AT), which differs from previous work in that it enforces the model to focus on the core features from natural patterns and reduce the impact of spurious features from perturbed patterns. The experimental results demonstrated that F$^2$AT outperforms state-of-the-art methods in clean accuracy and adversarial robustness

Sleep Problems Associate With Multimorbidity: A Systematic Review and Meta-analysis

Objectives: To summarize the evidence on the association between sleep problems and multimorbidity.Methods: Six electronic databases (PubMed, Web of Science, Embase, China National Knowledge Infrastructure, VIP, and Wan fang) were searched to identify observational studies on the association between sleep problems and multimorbidity. A random-effects model was used to estimate the pooled odds ratios (ORs) and 95% confidence intervals for multimorbidity.Results: A total of 17 observational studies of 133,575 participants were included. Sleep problems included abnormal sleep duration, insomnia, snoring, poor sleep quality, obstructive sleep apnea (OSA) and restless legs syndrome (RLS). The pooled ORs (95% CIs) for multimorbidity were 1.49 (1.24–1.80) of short sleep duration, 1.21 (1.11–1.44) of long sleep duration and 2.53 (1.85–3.46) for insomnia. The association of other sleep problems with multimorbidity was narratively summarized due to limited number of comparable studies.Conclusion: Abnormal sleep duration and insomnia are associated with higher odds of multimorbidity, while the evidence on association of snoring, poor sleep quality, obstructive sleep apnea and restless legs syndrome with multimorbidity remains inconclusive. Interventions targeting sleep problems should be delivered for better management of multimorbidity

Association of birth and childhood weight with risk of chronic diseases and multimorbidity in adulthood

Abstract Background Little is known about the relationship between early life body size and occurrence of life-course multiple chronic diseases (multimorbidity). We aim to evaluate associations of birth weight, childhood body size, and their changes with the risks of chronic diseases and multimorbidity. Methods This prospective cohort study included 246,495 UK Biobank participants (aged 40–69 years) who reported birth weight and childhood body size at 10 years old. Birth weight was categorized into low, normal, and high; childhood body size was reported as being thinner, average, or plumper. Multimorbidity was defined as having two or more of 38 chronic conditions retrieved from inpatient hospital data until 31 December, 2020. The Cox regression and quasi-Poisson mixed effects models were used to estimate the associations. Results We show that 57,071 (23.2%) participants develop multimorbidity. Low birth weight (hazard ratio [HR] 1.29, 95% confidence interval [CI] 1.26–1.33), high birth weight (HR 1.02, 95% CI > 1.00–1.05), thinner (HR 1.21, 95% CI 1.18–1.23) and plumper body size (HR 1.06, 95% CI 1.04–1.09) are associated with higher risks of multimorbidity. A U-shaped relationship between birth weight and multimorbidity is observed. Changing to be thinner or plumper is associated with multimorbidity and many conditions, compared to changing to be average. Conclusions Low birth weight, being thinner and changing to have a thinner body size in childhood are associated with higher risks of developing multimorbidity and many chronic conditions in adulthood. Early monitoring and maintaining a normal body size in childhood could have life-course benefits for preventing multimorbidity above and beyond individual conditions

Immunization coverage, knowledge, satisfaction, and associated factors of non-National Immunization Program vaccines among migrant and left-behind families in China: evidence from Zhejiang and Henan provinces

Abstract Background Migrant and left-behind families are vulnerable in health services utilization, but little is known about their disparities in immunization of non-National Immunization Program (NIP) vaccines. This study aims to evaluate the immunization coverage, knowledge, satisfaction, and associated factors of non-NIP vaccines among local and migrant families in the urban areas and non-left-behind and left-behind families in the rural areas of China. Methods A cross-sectional survey was conducted in urban areas of Zhejiang and rural areas of Henan in China. A total of 1648 caregivers of children aged 1–6 years were interviewed face-to-face by a pre-designed online questionnaire, and their families were grouped into four types: local urban, migrant, non-left-behind, and left-behind. Non-NIP vaccines included Hemophilus influenza b (Hib) vaccine, varicella vaccine, rotavirus vaccine, enterovirus 71 vaccine (EV71) and 13-valent pneumonia vaccine (PCV13). Log-binomial regression models were used to calculate prevalence ratios (PRs) and 95% confidence intervals (CIs) for the difference on immunization coverage of children, and knowledge and satisfaction of caregivers among families. The network models were conducted to explore the interplay of immunization coverage, knowledge, and satisfaction. Logistic regression models with odds ratios (ORs) and 95% CIs were used to estimate the associated factors of non-NIP vaccination. Results The immunization coverage of all non-NIP vaccines and knowledge of all items of local urban families was the highest, followed by migrant, non-left-behind and left-behind families. Compared with local urban children, the PRs (95% CIs) for getting all vaccinated were 0.65 (0.52–0.81), 0.29 (0.22–0.37) and 0.14 (0.09–0.21) among migrant children, non-left-behind children and left-behind children, respectively. The coverage-knowledge-satisfaction network model showed the core node was the satisfaction of vaccination schedule. Non-NIP vaccination was associated with characteristics of both children and caregivers, including age of children (> 2 years-OR: 1.69, 95% CI: 1.07–2.68 for local urban children; 2.67, 1.39–5.13 for migrant children; 3.09, 1.23–7.76 for non-left-behind children); and below caregivers’ characteristics: family role (parents: 0.37, 0.14–0.99 for non-left-behind children), age (≤ 35 years: 7.27, 1.39–37.94 for non-left-behind children), sex (female: 0.49, 0.30–0.81 for local urban children; 0.31, 0.15–0.62 for non-left-behind children), physical health (more than average: 1.58, 1.07–2.35 for local urban children) and non-NIP vaccines knowledge (good: 0.45, 0.30–0.68 for local urban children; 7.54, 2.64–21.50 for left-behind children). Conclusions There were immunization disparities in non-NIP vaccines among migrant and left-behind families compared with their local counterparts. Non-NIP vaccination promotion strategies, including education on caregivers, and optimization of the immunization information system, should be delivered particularly among left-behind and migrant families. Graphical Abstrac

Additional file 1 of Immunization coverage, knowledge, satisfaction, and associated factors of non-National Immunization Program vaccines among migrant and left-behind families in China: evidence from Zhejiang and Henan provinces

Additional file 1: Questionnaire. immunization coverage, knowledge and satisfaction of non-NIP vaccines

DataSheet1_Sleep Problems Associate With Multimorbidity: A Systematic Review and Meta-analysis.docx

Objectives: To summarize the evidence on the association between sleep problems and multimorbidity.Methods: Six electronic databases (PubMed, Web of Science, Embase, China National Knowledge Infrastructure, VIP, and Wan fang) were searched to identify observational studies on the association between sleep problems and multimorbidity. A random-effects model was used to estimate the pooled odds ratios (ORs) and 95% confidence intervals for multimorbidity.Results: A total of 17 observational studies of 133,575 participants were included. Sleep problems included abnormal sleep duration, insomnia, snoring, poor sleep quality, obstructive sleep apnea (OSA) and restless legs syndrome (RLS). The pooled ORs (95% CIs) for multimorbidity were 1.49 (1.24–1.80) of short sleep duration, 1.21 (1.11–1.44) of long sleep duration and 2.53 (1.85–3.46) for insomnia. The association of other sleep problems with multimorbidity was narratively summarized due to limited number of comparable studies.Conclusion: Abnormal sleep duration and insomnia are associated with higher odds of multimorbidity, while the evidence on association of snoring, poor sleep quality, obstructive sleep apnea and restless legs syndrome with multimorbidity remains inconclusive. Interventions targeting sleep problems should be delivered for better management of multimorbidity.</p