Untangling Socioeconomic Health Inequalities:Reinforcing the Evidence Base for Public Health

Health inequalities persist as a major challenge to public health. We hypothesized that public health policy may have mis-prioritized the determinants and risks for poor health and, consequently may have been barking up the wrong tree because of unmeasured, biased, and neglected risk factors at population level. This thesis investigated those hypotheses using data from the Dutch Lifelines Cohort and Biobank. The first part focused on unraveling the complexity of socioeconomic determinants of health and highlights socioeconomic disparities in health status and health outcomes. The second part explored the use of objective measurements of nutritional factors to uncover blind spots to make good quality data on diet available for promotion of public health. The results indicate that 1) public health policy should give particular attention to individuals with low socioeconomic status because they are at higher risks of practicing unhealthy lifestyle and of chronic and infectious diseases; 2) it is crucial to consider not only individual factors, but also neighborhood conditions in prevention policies, especially when targeting behavioral changes, as we neighborhood conditions independently influence both lifestyle and health; 3) regulatory authorities need to create healthier food environments to make healthy choices easier and discourage unhealthy ones; 4) objective measurements of nutritional factors are powerful for better prioritizing of nutrition targets in public health policy.Addressing socioeconomic determinants and broader determinants of health in disease prevention and health promotion is needed for the health and prosperity of both individual citizens and society as a whole

Socio-economic gradients in diagnosed and undiagnosed Type 2 diabetes and its related health complications

Background and aims Diagnosed and undiagnosed Type 2 Diabetes (T2D) remains a challenge in high-income countries. In addition, the presence of T2D can cause further disease burden because of its high susceptibility to complications. Nevertheless, there is limited evidence of socio-economic gradients in undiagnosed T2D and its complications in a large population cohort. We investigated this using the Dutch Lifelines Cohort Study (Lifelines). Methods and results Within Lifelines, baseline data of 102 163 adults aged 30 and above were collected from 2007 to 2013. The associations of Socio-Economic Status (SES), indicated by monthly household income, with the prevalence of T2D status and the number of T2D complications were assessed using multinomial Poisson and linear regressions with adjustments for age and sex. The prevalence of diagnosed and undiagnosed T2D was, respectively, 3.0% and 3.0% in the low SES group compared to 1.1% and 1.8% in the high SES group. Individuals with lower SES were at higher risk of having undiagnosed T2D (relative risk ratio (rrr) [95% CI]: 1.63 [1.47–1.81] for low SES and 1.16 [1.05–1.29] for middle SES) and diagnosed T2D, compared with those with high SES. Lower SES was positively associated with the number of T2D complications (low SES vs. high SES (ref); B [95% CI]: 0.15 [0.13–0.16]). Conclusion Complementing the known socio-economic gradients in diagnosed T2D, we document socio-economic gradients in undiagnosed T2D and T2D complications in a single, large general representative population. Furthermore, individuals with low SES with diagnosed or undiagnosed T2D were more susceptible to T2D complications

Review of research on evaluating the ecological security of cultivated land

Cultivated land provides fundamental land-related resources, and its ecological security is, thus, an important means of protecting it. The ecological security of cultivated land has emerged as an important and challenging area of research in recent years. In this study, we summarize the progress in research on the evaluation of the ecological security of cultivated land through visual analysis. We review the concepts, characteristics, driving factors, scales and methods of evaluation, technologies, and simulations used in the relevant literature. The results show that while the relevant concept has been preliminarily established, research on the ecological security of cultivated land remains in its infancy, and comprehensive work on the subject is lacking. The Prevalent research has mainly focused on analyzing the current situation, but lacks a dynamic analysis of the driving mechanism of the ecological security of cultivated land based on simulations. This has made it difficult to understand the spatiotemporal mechanism of the ecological security of cultivated land. Future research in the area should discuss the complex driving mechanism of interactions between the social economy system and the ecological system and focus on an integrated model to assess its dynamic spatial and multi-scale characteristics of ecological security of cultivated land because this can inform the theory of protecting cultivated land and the design of plans for land use to mitigate global climate change

Association between socioeconomic status and self-reported, tested and diagnosed COVID-19 status during the first wave in the Northern Netherlands:a general population-based cohort from 49 474 adults

Objectives Studies in clinical settings showed a potential relationship between socioeconomic status (SES) and lifestyle factors with COVID-19, but it is still unknown whether this holds in the general population. In this study, we investigated the associations of SES with self-reported, tested and diagnosed COVID-19 status in the general population. Design, setting, participants and outcome measures Participants were 49 474 men and women (46±12 years) residing in the Northern Netherlands from the Lifelines cohort study. SES indicators and lifestyle factors (i.e., smoking status, physical activity, alcohol intake, diet quality, sleep time and TV watching time) were assessed by questionnaire from the Lifelines Biobank. Self-reported, tested and diagnosed COVID-19 status was obtained from the Lifelines COVID-19 questionnaire. Results There were 4711 participants who self-reported having had a COVID-19 infection, 2883 participants tested for COVID-19, and 123 positive cases were diagnosed in this study population. After adjustment for age, sex, lifestyle factors, body mass index and ethnicity, we found that participants with low education or low income were less likely to self-report a COVID-19 infection (OR [95% CI]: low education 0.78 [0.71 to 0.86]; low income 0.86 [0.79 to 0.93]) and be tested for COVID-19 (OR [95% CI]: low education 0.58 [0.52 to 0.66]; low income 0.86 [0.78 to 0.95]) compared with high education or high income groups, respectively. Conclusion Our findings suggest that the low SES group was the most vulnerable population to self-reported and tested COVID-19 status in the general population.</p

Vote2Cap-DETR++: Decoupling Localization and Describing for End-to-End 3D Dense Captioning

3D dense captioning requires a model to translate its understanding of an input 3D scene into several captions associated with different object regions. Existing methods adopt a sophisticated "detect-then-describe" pipeline, which builds explicit relation modules upon a 3D detector with numerous hand-crafted components. While these methods have achieved initial success, the cascade pipeline tends to accumulate errors because of duplicated and inaccurate box estimations and messy 3D scenes. In this paper, we first propose Vote2Cap-DETR, a simple-yet-effective transformer framework that decouples the decoding process of caption generation and object localization through parallel decoding. Moreover, we argue that object localization and description generation require different levels of scene understanding, which could be challenging for a shared set of queries to capture. To this end, we propose an advanced version, Vote2Cap-DETR++, which decouples the queries into localization and caption queries to capture task-specific features. Additionally, we introduce the iterative spatial refinement strategy to vote queries for faster convergence and better localization performance. We also insert additional spatial information to the caption head for more accurate descriptions. Without bells and whistles, extensive experiments on two commonly used datasets, ScanRefer and Nr3D, demonstrate Vote2Cap-DETR and Vote2Cap-DETR++ surpass conventional "detect-then-describe" methods by a large margin. Codes will be made available at https://github.com/ch3cook-fdu/Vote2Cap-DETR

Evidence for Exciton Crystals in a 2D Semiconductor Heterotrilayer

Two-dimensional (2D) transition metal dichalcogenides (TMDC) and their moire interfaces have been demonstrated for correlated electron states, including Mott insulators and electron/hole crystals commensurate with moire superlattices. Here we present spectroscopic evidences for ordered bosons - interlayer exciton crystals in a WSe2/MoSe2/WSe2 trilayer, where the enhanced Coulomb interactions over those in heterobilayers have been predicted to result in exciton ordering. While the dipolar interlayer excitons in the heterobilayer may be ordered by the periodic moire traps, their mutual repulsion results in de-trapping at exciton density larger than 10^11 cm^-2 to form mobile exciton gases and further to electron-hole plasmas, both accompanied by broadening in photoluminescence (PL) peaks and large increases in mobility. In contrast, ordered interlayer excitons in the trilayer are characterized by negligible mobility and by sharper PL peaks persisting to nex larger than 10^12 cm^-2. We find that an optically dark state attributed to the predicted quadrupolar exciton crystal transitions to the bright dipolar excitons either with increasing nex or by an applied electric field. These ordered interlayer excitons may serve as models for the exploration of quantum phase transitions and quantum coherent phenomena.Comment: 16 pages, 4 figures, S

A Transformer-Based Multi-Entity Load Forecasting Method for Integrated Energy Systems

Energy load forecasting is a critical component of energy system scheduling and optimization. This method, which is classified as a time-series forecasting method, uses prior features as inputs to forecast future energy loads. Unlike a traditional single-target scenario, an integrated energy system has a hierarchy of many correlated energy consumption entities as prediction targets. Existing data-driven approaches typically interpret entity indexes as suggestive features, which fail to adequately represent interrelationships among entities. This paper, therefore, proposes a neural network model named Cross-entity Temporal Fusion Transformer (CETFT) that leverages a cross-entity attention mechanism to model inter-entity correlations. The enhanced attention module is capable of mapping the relationships among entities within a time window and informing the decoder about which entity in the encoder to concentrate on. In order to reduce the computational complexity, shared variable selection networks are adapted to extract features from different entities. A data set obtained from 13 buildings on a university campus is used as a case study to verify the performance of the proposed approach. Compared to the comparative methods, the proposed model achieves the smallest error on most horizons and buildings. Furthermore, variable importance, temporal correlations, building relationships, and time-series patterns in data are analyzed with the attention mechanism and variable selection networks, therefore the rich interpretability of the model is verified

Separate and combined effects of individual and neighbourhood socio-economic disadvantage on health-related lifestyle risk factors:a multilevel analysis

BACKGROUND: Socio-economic disadvantage at both individual and neighbourhood levels has been found to be associated with single lifestyle risk factors. However, it is unknown to what extent their combined effects contribute to a broad lifestyle profile. We aimed to (i) investigate the associations of individual socio-economic disadvantage (ISED) and neighbourhood socio-economic disadvantage (NSED) in relation to an extended score of health-related lifestyle risk factors (lifestyle risk index); and to (ii) investigate whether NSED modified the association between ISED and the lifestyle risk index. METHODS: Of 77 244 participants [median age (IQR): 46 (40-53) years] from the Lifelines cohort study in the northern Netherlands, we calculated a lifestyle risk index by scoring the lifestyle risk factors including smoking status, alcohol consumption, diet quality, physical activity, TV-watching time and sleep time. A higher lifestyle risk index was indicative of an unhealthier lifestyle. Composite scores of ISED and NSED based on a variety of socio-economic indicators were calculated separately. Linear mixed-effect models were used to examine the association of ISED and NSED with the lifestyle risk index and to investigate whether NSED modified the association between ISED and the lifestyle risk index by including an interaction term between ISED and NSED. RESULTS: Both ISED and NSED were associated with an unhealthier lifestyle, because ISED and NSED were both positively associated with the lifestyle risk index {highest quartile [Q4] ISED beta-coefficient [95% confidence interval (CI)]: 0.64 [0.62-0.66], P < 0.001; highest quintile [Q5] NSED beta-coefficient [95% CI]: 0.17 [0.14-0.21], P < 0.001} after adjustment for age, sex and body mass index. In addition, a positive interaction was found between NSED and ISED on the lifestyle risk index (beta-coefficient 0.016, 95% CI: 0.011-0.021, Pinteraction < 0.001), which indicated that NSED modified the association between ISED and the lifestyle risk index; i.e. the gradient of the associations across all ISED quartiles (Q4 vs Q1) was steeper among participants residing in the most disadvantaged neighbourhoods compared with those who resided in the less disadvantaged neighbourhoods. CONCLUSIONS: Our findings suggest that public health initiatives addressing lifestyle-related socio-economic health differences should not only target individuals, but also consider neighbourhood factors

Associations of 24 h urinary excretions of alpha- and gamma-carboxyethyl hydroxychroman with plasma alpha- and gamma-tocopherol and dietary vitamin E intake in older adults:the Lifelines-MINUTHE Study

Background Urinary metabolites of vitamin E, i.e., alpha- and gamma-carboxyethyl hydroxychroman (alpha- and gamma-CEHC), have gained increasing attention and have been proposed as novel biomarkers of vitamin E intake and status. However, there are insufficient data on the relationship of plasma alpha-tocopherol and gamma-tocopherol and dietary vitamin E intake with 24 h urinary excretions of alpha- and gamma-CEHC. Objectives We aimed to (1) investigate the associations of urinary alpha- and gamma-CEHC/creatinine ratios and 24 h urinary excretions of alpha- and gamma-CEHC with plasma alpha- and gamma-tocopherol, respectively; (2) investigate the associations of urinary alpha- and gamma-CEHC/creatinine ratios and 24 h urinary excretions of alpha- and gamma-CEHC with dietary vitamin E intake, and we hypothesize that 24 h urinary excretions of alpha- and gamma-CEHC will better correlate with vitamin E intake than urinary alpha- and gamma-CEHC/creatinine ratios. Design 24 h Urine and plasma samples were collected from 1519 participants (60-75 years, male: 50%) included in the Lifelines-MINUTHE Study for the assessments of urinary alpha- and gamma-CEHC/creatinine ratios and 24 h urinary excretions of alpha- and gamma-CEHC, and plasma alpha- and gamma-tocopherol. Among those participants, dietary vitamin E intake data from 387 participants were available from an externally validated Flower-Food Frequency Questionnaire (FFQ). The associations of plasma alpha- and gamma-tocopherol, dietary vitamin E intake, with urinary alpha- and gamma-CEHC were assessed using multivariate linear regressions. Results 24 h Urinary excretion of alpha-CEHC (median (IQR): 0.9 (0.3-2.4) mu mol) was less than that of gamma-CEHC (median (IQR): 1.5 (0.5-3.5) mu mol). After adjustment for covariates, we found that 24 h urinary alpha-CEHC excretion and urinary alpha-CEHC/creatinine ratio were both positively associated with plasma alpha-tocopherol (std.beta: 0.06, p = 0.02; std.beta: 0.06, p = 0.01, respectively). Furthermore, the sum of 24 h urinary alpha- and gamma-CEHC excretions was positively associated with dietary vitamin E intake (std.beta: 0.08; p = 0.03), whereas there was no relation between urinary alpha- and gamma-CEHC/creatinine ratios and vitamin E intake. No association was observed neither between plasma alpha- and gamma-tocopherol and dietary vitamin E intake, nor between urinary gamma-CEHC and plasma gamma-tocopherol. Conclusion Our study confirmed our hypothesis that 24 h urinary alpha- and gamma-CEHC excretions would be a better marker for dietary vitamin E intake than urinary alpha- and gamma-CEHC/creatinine ratios. Considering that both 24 h urinary alpha- and gamma-CEHC excretions and alpha- and gamma-CEHC/creatinine ratios were also associated with plasma alpha-tocopherol status, we suggest that 24 h urinary alpha- and gamma-CEHC excretions could be used to assess overall vitamin E status

Circulating de novo lipogenesis fatty acids and all-cause mortality in a prospective Dutch population cohort

Background: Circulating fatty acids (FA) from de novo lipogenesis (DNL) are associated with all-cause mortality in individuals with elevated CVD risk. However, compared to FA early in the DNL synthetic pathway, cis-vaccenic acid, one of the FA distal in the DNL synthetic pathway, has rarely been studied in a general population cohort. We hypothesized that circulating cis-vaccenic acid is more strongly related to all-cause mortality than other circulating DNL-related FA. Objectives: The primary and secondary objectives of this study were to investigate the prospective associations of plasma levels of cis-vaccenic acid and other DNL-related FA with all-cause mortality in a general population, respectively. Methods: We included 850 participants (mean ± SD age 53 ± 15 years) from the Dutch Lifelines cohort study. Circulating levels of palmitic (C16:0), palmitoleic (C16:1n7), cis-vaccenic (cis-C18:1n7), stearic (C18:0), oleic acid (C18:1n9) in plasma phospholipids (PL) and triglycerides (TG) were measured by gas chromatography. The associations of circulating cis-C18:1n7 and other DNL-related FA with all-cause mortality were assessed using Cox regression analyses. Results: During a median follow-up of 9.3 (IQR: 5.4–10.8) years, 34 (4.0%) participants had died. In plasma PL, a 1-SD increase in cis-C18:1n7 was associated with an increased risk of all-cause mortality in univariate and multivariate models (p<0.02 for all), with a HR [95% CI] of 1.60 [1.13–2.25] after adjustment for age and sex. Conclusions: Circulating plasma PL cis-C18:1n7 was associated with a higher risk for all-cause mortality. More studies are needed in different cohorts to verify and validate our results