Though indoor air pollution (IAP) is associated with elevated lung cancer risk, an integrated measure is imperative to thoroughly investigate this association. The interplay between sex and IAP on lung cancer remains unclear. We conducted a population-based case-control study in Jiangsu Province, China, from 2003 to 2010, with 2871 lung cancer cases and 8019 controls. Exposures and covariates information were collected via in-person interviews using a standardized questionnaire. An integrated weighted risk score (WRS), accounting for the effect sizes of each source of IAP, was introduced. Unconditional logistic regression was employed to estimate adjusted odds ratios (aORs) and their 95% confidence intervals (CIs). Interactions between sex and IAP by tobacco smoking status were evaluated. Environmental tobacco smoking (ETS) (aOR = 1.54, 95% CI: 1.40, 1.69), poor ventilation (aOR = 1.18, 95% CI: 1.07, 1.30), and coal used for cooking (aOR = 1.27, 95% CI: 1.15, 1.41) were associated with lung cancer. Dose-response relationships between lung cancer and WRS were observed, with p for trend less than 0.001. aOR for individuals at the highest quartile of the WRS of IAP was 1.74 (95% CI: 1.52, 2.00) compared to the lowest quartile. The associations were more profound among never-smokers than ever-smokers. Females tended to be more vulnerable to IAP, and sex interacted with IAP beyond multiplicativity on the odds scale. IAP is associated with lung cancer, with a stronger impact among never-smokers. An interaction between IAP and sex was observed. These results underscore the importance of controlling IAP, especially ETS in order to reduce the risk of lung cancer.

INTRODUCTION:The COVID-19 pandemic strained public health infrastructure in low-income and middle-income countries (LMICs), leading them to leverage resources of existing public health programmes including HIV, tuberculosis (TB) and malaria. This manuscript systematically documents how these programmes were used in response to understand both the barriers and facilitators encountered in the process. METHODS:From March through August 2023, we conducted 72 structured interviews with staff in 13 countries who played central roles in the response. Countries were purposively selected from the pool of countries that receive Global Fund support, are classed as LMIC by the World Bank and speak either French or English. Semistructured, in-depth, individual interviews collected data on experiences, challenges and lessons learnt during COVID-19 response and recommendations for future pandemics. A content and thematic analysis using the framework method was used to identify how resources were leveraged in the response and what facilitated or hindered their engagement. RESULTS:All interviewees reported leveraging of HIV, TB and malaria resources, notably contributing personnel to the response and use of laboratory networks to support COVID-19 testing. Surveillance systems, community networks, infection control and active case finding were also used. Challenges included lack of cross-training among healthcare workers, non-integrated systems and slow funding procedures. CONCLUSIONS:HIV, TB and malaria programmes were important in COVID-19 response. Funding agencies should consider the use of programme-specific infrastructure in 93 emergency response when planning programme-specific financing.

BACKGROUND:Monkeypox (mpox) is an emerging zoonotic disease that has persistently impacted public health in endemic regions of West and Central Africa for over half a century. The Democratic Republic of the Congo (DRC) remains one of the countries most affected. Understanding the risk factors for disease transmission from a One Health perspective is of great importance in the risk assessment, prevention, and control of zoonotic diseases. Therefore, this study aimed to investigate the risk factors for human mpox transmission at the human-animal-environment interface in the DRC. METHODS:Epidemiological, environmental, socioeconomic, and sociocultural data from the DRC from 2000 to 2015 were obtained from publicly available dataset. Using these data, we applied negative binomial regression model, least absolute shrinkage and selection operator regression model, and principal component analysis (PCA) to identify key environmental, socioeconomic, and sociocultural factors contributing to mpox transmission. Moreover, a grey prediction model GM (1, n) was constructed to predict the epidemic trend of mpox post-2015 and validated using suspected mpox case data in the DRC from 2016 to 2021, sourced from the United States Centers for Disease Control and Prevention. RESULTS:Between 2000 and 2021, a total of 43,628 suspected mpox cases were reported in the DRC, with a peak of 6216 cases in 2020. From 2016 to 2021, suspected cases accounted for over half (24,379/43,628, 55.9%) of the total reported during the 2000-2021 period. The proportion of primary forest [incidence rate ratio (IRR): 1.023, 95% confidence interval (CI): 1.018-1.027], index of economic well-being (IRR: 1.046, 95% CI: 1.039-1.052), and mean annual precipitation (IRR 1.040, 95% CI: 1.031-1.049) were positively associated with mpox incidence. PCA identified five principal components, explaining 69% of the variance in the environmental, socioeconomic, and sociocultural variables. The first component was characterized by socioeconomic factors. The GM (1, n) model, based on the proportion of primary forest, index of economic well-being, and mean annual precipitation, predicted the epidemic trend (revealed relative error: 2.69). CONCLUSIONS:Both socioeconomic and environmental factors play important roles in mpox transmission. Our study further highlighted the importance of considering the interconnectedness among humans, animals, and the environment, and treating these factors as a whole to explain the transmission and emergence of mpox outbreaks in the DRC according to the One Health concept.

Despite the World Health Organization’s recommendations, the uptake of Intermittent Preventive Treatment in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) in Senegal remains suboptimal, with disparities observed between urban and rural areas. More remains to be known about how malaria service readiness would affect the utilization of IPTp-SP. Data were obtained from seven annual rounds of Demographic and Health Surveys (DHS) and Service Provision Assessments (SPA) in Senegal from 2012 to 2019. Using sample domain linkage to link the databases at the regional level. A malaria service readiness index was calculated to quantify the malaria service delivery capacity within the service environment where women reside. The Heckman selection model was utilized to analyze the relationship between malaria service readiness and IPTp-SP utilization. From 2012 to 2019, the average number of IPTp-SP doses received in Senegal was 1.66 (95

Background/Objectives: Identifying dietary factors influencing liver cancer is crucial for developing preventive measures. While tea polyphenols have demonstrated cancer-preventive activities in animal models, the evidence in humans is not definitive. This study aims to explore the association between tea consumption and liver cancer, as well as the interaction between tea drinking and other risk factors, in China, a country with a high incidence of liver cancer and substantial tea consumption. Methods: A population-based case-control study was conducted in Jiangsu Province from 2003 to 2010. Socio-demographic data, history of tea consumption, and serum markers of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections were evaluated. Unconditional logistic regression was used to examine the associations between tea consumption and the odds of liver cancer. Potential interactions between tea consumption and other major liver cancer risk factors were assessed. Results: A total of 2011 incident liver cancer cases and 7933 controls were included in the analysis. Regular tea drinking showed an inverse association with the risk of liver cancer compared with those who never drank tea (OR: 0.79; 95% CI: 0.63-0.99). Current tea drinking showed an inverse association with liver cancer (OR: 0.51; 95% CI: 0.39-0.66), while former tea drinking showed a positive association (OR: 3.56; 95% CI: 2.42-5.23). Current tea consumption was inversely associated with liver cancer incidence among both hepatitis B surface antigen (HBsAg) positive (OR: 0.45; 95% CI: 0.28-0.73) and HBsAg negative participants (OR: 0.51, 95% CI: 0.36-0.73), among both never and ever tobacco smokers, ever alcohol drinkers (OR: 0.46; 95% CI: 0.33-0.63), and among those without family history of liver cancer. Multiplicative and additive interactions were observed between tea drinking and HBsAg, alcohol consumption, and history of raw water drinking. Conclusions: Tea consumption is inversely associated with the development of primary liver cancer, with potential interactions involving HBV infection, alcohol consumption, and raw (unsafe) water drinking. Increasing tea consumption-particularly among high-risk populations such as individuals who consume alcohol-may serve as an additional preventive measure for liver cancer. This should be considered alongside established strategies, including HBV vaccination, alcohol cessation, and avoidance of drinking raw water, to help reduce liver cancer risk.

Background Malaria infection during pregnancy is associated with an increased risk of maternal death, as well as adverse birth outcomes. Intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) is known to improve pregnancy outcomes. However, the coverage of IPTp-SP in antenatal care (ANC) in sub-Saharan Africa remains well below the target. This study aims to estimate to what extent malaria service readiness affects the uptake of IPTp-SP during ANC visits in sub-Saharan African countries. Methods This study included 3267 pregnant women attending ANC for the first time and 2797 pregnant women who had attended ANC more than a month ago in six sub -Sahara n African countries. The readiness of malaria services at each institution includes four indicators: the presence of IPTp-SP guidelines, SP availability, integration of IPTp-SP service into ANC, and provider training on IPTp-SP. The outcome variable indicates whether a pregnant woman received IPTp-SP at her current ANC visit. A modified Poisson regression model estimated the associations between malaria service readiness and IPTp-SP uptake for women eligible for the first and subsequent doses. Results For women eligible for their first dose, visiting an institution with available SP was associated with an increased probability of receiving IPTp-SP (risk ratio (RR) = 1.43; 95% confidence interval (CI) = 1.22 to 1.67, P < 0.001). For women who were eligible for their next dose, the availability of SP (RR = 1.17; 95% CI = 1.04 to 1.32, P = 0.008) and integration of IPTp-SP service into ANC (RR = 1.82; 95% CI = 1.21 to 2.74, P = 0.004) in the institution were associated with increased likelihood of IPTp-SP uptake. Counterfactual predictions indicated that enhanced provider training could boost IPTp-SP uptake in high-uptake countries, while better SP availability and IPTp-SP integration into ANC would significantly impact low-uptake countries. Conclusions For better IPTp-SP coverage, strategies should be customized. High uptake countries should focus on provider training, while low uptake ones should ensure IPTp-SP availability and service integration.

This study assesses the enduring impact of combined school- and family-based interventions on reducing the consumption of sugar-sweetened beverages (SSBs) among schoolchildren in China. Two primary schools were assigned at random to either the Intervention Group or the Control Group, in Nanjing, eastern China. All students were in grade three and received an invitation to participate. In the first year, students in the Intervention Group received one-year intervention measures, including monthly monitoring, aiming to decrease the consumption of SSBs. Students in the Control Group only received regular monitoring without interventions. In the second year, both groups received only regular monitoring, without active interventions. A generalized estimating equations model (GEE) was used to assess the intervention effects. After two years, relative to the Control Group, the Intervention Group had a significantly improved knowledge of SSBs and an improved family environment with parents. In the Intervention Group, 477 students (97.3%) had adequate knowledge about SSBs, compared to 302 students (83.2%) in the Control Group (X2 = 52.708, p < 0.001). Two years later, the number of students who stated ‘my home always has SSBs’ in the Intervention Group (7.8%) was fewer than that in the Control Group (12.4%), which was a statistically significant finding (p < 0.05). One year later, both the frequency and the quantity of SSB consumption in the Intervention Group were less than those in the Control Group; such differences between the groups remained statistically significant for the quantity but not for the frequency of SSB consumption two years later. In the Intervention Group, the frequency of SSB consumption was significantly reduced by 1.0 times per week, compared to a reduction of 0.1 times per week in the Control Group in the first year (p < 0.05). In the second year, the frequency of SSB consumption was reduced by 0.8 times per week in the Intervention Group, compared to 0.5 times per week in the Control Group (p > 0.05). In the first year, the volume of SSB consumption was significantly reduced by 233 mL per week in the Intervention Group, compared to an increase of 107 mL per week in the Control Group (p < 0.05). In the second year, the volume of SSB consumption was reduced by 122 mL per week in the Intervention Group compared to an increase of 31 mL per week in the Control Group (p > 0.05). The combined school-based and family-based interventions had a positive effect on the students’ knowledge of SSBs and their family dynamics during the first and second year. Relative to the Control Group, the Intervention Group had a statistically significant reduction in SSB consumption after 1 year, but not after 2 years.

BACKGROUND:Key population HIV programmes in sub-Saharan Africa require epidemiological information to ensure equitable and universal access to effective services. We aimed to consolidate and harmonise survey data among female sex workers, men who have sex with men, people who inject drugs, and transgender people to estimate key population size, HIV prevalence, and antiretroviral therapy (ART) coverage for countries in mainland sub-Saharan Africa. METHODS:Key population size estimates, HIV prevalence, and ART coverage data from 39 sub-Saharan Africa countries between 2010 and 2023 were collated from existing databases and verified against source documents. We used Bayesian mixed-effects spatial regression to model urban key population size estimates as a proportion of the gender-matched, year-matched, and area-matched population aged 15-49 years. We modelled subnational key population HIV prevalence and ART coverage with age-matched, gender-matched, year-matched, and province-matched total population estimates as predictors. FINDINGS:We extracted 2065 key population size data points, 1183 HIV prevalence data points, and 259 ART coverage data points. Across national urban populations, a median of 1·65% (IQR 1·35-1·91) of adult cisgender women were female sex workers, 0·89% (0·77-0·95) were men who have sex with men, 0·32% (0·31-0·34) were men who injected drugs, and 0·10% (0·06-0·12) were women who were transgender. HIV prevalence among key populations was, on average, four to six times higher than matched total population prevalence, and ART coverage was correlated with, but lower than, the total population ART coverage with wide heterogeneity in relative ART coverage across studies. Across sub-Saharan Africa, key populations were estimated as comprising 1·2% (95% credible interval 0·9-1·6) of the total population aged 15-49 years but 6·1% (4·5-8·2) of people living with HIV. INTERPRETATION:Key populations in sub-Saharan Africa experience higher HIV prevalence and lower ART coverage, underscoring the need for focused prevention and treatment services. In 2024, limited data availability and heterogeneity constrain precise estimates for programming and monitoring trends. Strengthening key population surveys and routine data within national HIV strategic information systems would support more precise estimates. FUNDING:UNAIDS, Bill & Melinda Gates Foundation, and US National Institutes of Health.

Esophageal cancer continues to pose a significant public health issue in areas with increased incidence rates such as China. Although involuntary smoking was defined as a group 1 carcinogen for lung cancer, few studies have explored the impact of environmental tobacco smoking (ETS) on esophageal cancer. In this paper, we examined the association between ETS and esophageal cancer in high-risk groups in Jiangsu Province, China. Epidemiologic data were collected for 2969 newly diagnosed cases and 8019 population controls including exposure to active/passive smoking and risk factors. The unconditional logistic regression model and the semi-Bayes (SB) method were applied to assess adjusted odds ratios (ORs) and confidence intervals (CIs). ETS exposure (ever vs. never) was positively associated with esophageal cancer with an SB-adjusted OR (95% CI) of 1.44 (1.31-1.58) among overall population, and 1.56 (1.35-1.82) among non-smokers (i.e., non-active smokers), with corresponding population attributable fractions of 15.0% (95% CI: 10.3%-18.9%) and 12.1% (95% CI: 8.8%-19.8%), respectively. The association was more prominent in men at work and in women at home, with SB-adjusted OR (95% CI) of 1.36 (1.17-1.58) and 1.61 (1.35-1.58), respectively. A dose-response relationship between ETS exposure and the disease was detected across the entire population as well as in non-smokers. This is the largest population-based case-control study of ETS and esophageal cancer and the first study to evaluate such association among non-smokers in a Chinese population. We recommend strengthening the ongoing anti-tobacco public health initiatives in China with a particular emphasis on creating a tobacco-free work/home environment.

We appreciate Chiang et al 1 for their interest and comments on our research article entitled ‘Incidence trend of five common musculoskeletal disorders from 1990 to 2017 at the global, regional and national level: results from the global burden of disease study 2017’.2 For exact occupations, it is unfortunately impossible to divide patients with musculoskeletal (MSK) disorders into groups according to their occupations since there are no corresponding estimates from the Global Burden of Disease study 2017.3 4 We agree with your comments on effects of social risk factors and occupational risks between high and low human development index (HDI) countries1; in our study, a stable or increasing trend of age-standardised incidence rate (ASR) for low back pain (LBP) was observed.2 However, occupational risks attributable to ASR might be more likely to be modified among countries …

Introduction The Global AIDS Strategy 2021-2026 calls for equitable and equal access to HIV prevention and treatment programmes for all populations to reduce HIV incidence and end HIV/AIDS as a public health threat by 2030. Transgender populations (TGP), including transmen (TGM) and transwomen (TGW) are populations that have been marginalised and are at high risk of HIV infection in sub-Saharan Africa (SSA). Limited surveillance data on HIV among TGP are available in the region to guide programmatic responses and policymaking. Surveillance data on cisgender men who have sex with men (cis-MSM) are comparatively abundant and may be used to infer TGP HIV prevalence. Methods Data from key population surveys conducted in SSA between 2010-2022 were identified from existing databases and survey reports. Studies that collected HIV prevalence on both TGP and cis-MSM populations were analysed in a random effect meta-analysis to estimate the ratio of cis-MSM:TGW HIV prevalence. Results Eighteen studies were identified encompassing 8,052 TGW and 19,492 cis-MSM. TGW HIV prevalence ranged from 0-71.6% and cis-MSM HIV prevalence from 0.14-55.7%. HIV prevalence in TGW was 50% higher than in cis-MSM (prevalence ratio (PR) 1.50 95% CI 1.26-1.79). TGW HIV prevalence was highly correlated with year/province-matched cis-MSM HIV prevalence (R 2 = 0.62), but poorly correlated with year/province-matched total population HIV prevalence (R 2 = 0.1). Five TGM HIV prevalence estimates were identified ranging from 1-24%. Insufficient TGM data were available to estimate cis-MSM:TGM HIV prevalence ratios. Conclusion Transgender women experience a significantly greater HIV burden than cis-MSM in SSA. Bio-behavioural surveys designed and powered to measure determinants of HIV infection, treatment coverage, and risk behaviours among transgender populations, distinct from cis-MSM, will improve understanding of HIV risk and vulnerabilities among TGP and support improved programmes.

Female sex workers (FSW) are affected by individual, network, and structural risks, making them vulnerable to poor health and well-being. HIV prevention strategies and local community-based programs can rely on estimates of the number of FSW to plan and implement differentiated HIV prevention and treatment services. However, there are limited systematic assessments of the number of FSW in countries across sub-Saharan Africa to facilitate the identification of prevention and treatment gaps. Here we provide estimated population sizes of FSW and the corresponding uncertainties for almost all sub-national areas in sub-Saharan Africa. We first performed a literature review of FSW size estimates and then developed a Bayesian hierarchical model to synthesize these size estimates, resolving competing size estimates in the same area and producing estimates in areas without any data. We estimated that there are 2.5 million (95% uncertainty interval 1.9 to 3.1) FSW aged 15 to 49 in sub-Saharan Africa. This represents a proportion as percent of all women of childbearing age of 1.1% (95% uncertainty interval 0.8 to 1.3%). The analyses further revealed substantial differences between the proportions of FSW among adult females at the sub-national level and studied the relationship between these heterogeneities and many predictors. Ultimately, achieving the vision of no new HIV infections by 2030 necessitates dramatic improvements in our delivery of evidence-based services for sex workers across sub-Saharan Africa.

To examine whether reducing sugar-sweetened beverage (SSB) consumption is associated with reduced body mass index z-score gain among Chinese schoolchildren in Nanjing, China, a randomized controlled trial (RCT) was conducted in four selected primary schools from September 2019 to September 2020. Students in the third grade in the Intervention Group received school-based and home-based interventions for two consecutive semesters to reduce SSB consumption, while two schools in the Control Group did not receive any interventions. Weight changes were expressed as body mass index (BMI) z-scores as standard deviations of the BMI distribution per age and sex group. Changes in SSB consumption before and after the interventions were categorized into Level-Up if it increased, Level-Same if it was maintained and Level-Down if it decreased. Multivariable linear regression models were used to explore the association of different levels of changes in SSB consumption pre- and post-intervention with the BMI z-score. Among 1633 participants who completed the trial, the mean age at baseline was 9.36 years (±0.48 SD).The median baseline BMI z-score was −0.24 (25th percentile −0.72; 75th percentile 0.58). After the intervention, the median BMI z-score increased by 0.06 (−0.17~0.37) in the Intervention Group and by 0.14 (−0.08~0.41) in the Control Group (p < 0.001). A higher increase in BMI was found in the Control Group than in the Intervention Group (1.20 vs. 0.94) during the 12-month period. Among participants whose parents’ educational attainment was above 9 years, the median BMI z-score increased by 0.07 (−0.17~0.37) in the Intervention Group and by 0.16 (−0.06~0.41) in the Control Group (p < 0.001). In a linear regression analysis adjusted for potential confounders, the BMI z-score decreased by 0.057 more in Level-Down than in Level-Up (95% CI: −0.103 to −0.012, p = 0.014). These results indicate that the decreased consumption of SSBs might have reduced the prevalence of overweight in schoolchildren in China, especially in students whose parents had high educational levels.

Background: Sampling frames rarely exist for key populations at highest risk for HIV, such as sex workers, men who have sex with men, people who use drugs, and transgender populations. Without reliable sampling frames, most data collection relies on non-probability sampling approaches including networkbased methods (e.g. respondent driven sampling) and venue-based methods (e.g. time-location sampling). Quality of implementation and reporting of these studies is highly variable, making wide-ranging estimates often difficult to compare. Here, a modified quality assessment tool, Global.HIV Quality Assessment Tool for Data Generated through Non-Probability Sampling (GHQAT), was developed to evaluate the quality of HIV epidemiologic evidence generated using non-probability methods. Methods: The GHQAT assesses three main domains: study design, study implementation, and indicatorspecific criteria(prevalence, incidence, HIV continuum of care, and population size estimates). The study design domain focuses primarily on the specification of the target and study populations. The study implementation domain is concerned with sampling implementation. Each indicator-specific section contains items relevant to that specific indicator. A random subset of 50 studies from a larger systematic review on epidemiologic data related to HIV and key populations was generated and reviewed using the GHQAT by two independent reviewers. Inter-rater reliability was assessed by calculating intraclass correlation coefficients for the scores assigned to study design, study implementation and each of the indicator-specific criteria. Agreement was categorized as poor(0.00-0.50), fair(0.51-0.70), and good(0.711.00). The distribution of good, fair, and poor scores for each section was described. Results: Overall, agreement between the two independent reviewers was good(ICC >0.7). Agreement was best for the section evaluating the HIV continuum of care(ICC = 0.96). For HIV incidence, perfect agreement was observed, but this is likely due to the small number of studies reviewed that assessed incidence(n = 3). Of the studies reviewed, 2% (n = 1) received a score of "poor" for study design, while 50% (n = 25) received a score of "poor" for study implementation. Conclusions: Addressing HIV prevention and treatment needs of key populations is increasingly understood to be central to HIV responses across HIV epidemic settings, though data characterizing specific needs remains highly variable with the least amount of information in the most stigmatizing settings. Here, we present an efficient tool to guide HIV prevention and treatment programs as well as epidemiological data collection by reliably synthesizing the quality of available non-probability based epidemiologic information for key populations. This tool may help shed light on how researchers may improve not only the implementation of, but also the reporting on their studies. (c) 2021 Elsevier Inc. All rights reserved.

Background: In response to worries that a strict closed-loop management might affect athletes' physical and mental states, and therefore their final competition performance, we attempted to simulate the scenarios in the Beijing 2022 Olympic and Paralympic Winter Games under the non-closed-loop management (NCLM) in order to predict whether NCLM will lead to the large-scale spread of COVID-19 in China.Methods: We assumed that foreign event-related personnel (AAO) and local community residents would adhere to non-pharmaceutical interventions (NPIs), including surveillance and contact tracing strategies. The optima nucleic acid test (NAT) strategy was estimated by a Markov Model. Different schemes in the Beijing 2022 Olympic and Paralympic Winter Games under NCLM were simulated by a compartmental model according to different background infection rates of AAO, the effectiveness of vaccine and vaccination rate of local community residents. The total number of infections and detection rate both in AAO and local residents during the period of 40-day were calculated respectively.Findings: A total of 567 schemes of NCLM in the Beijing 2022 Olympic and Paralympic Winter Games were simulated. If the local community was universally fully vaccinated with an effectiveness against infection of 50%, the optimal NAT strategy for AAO were once every three days, every other day, and daily according to their background infectious rates of 0.10%, 0.20-0.50% and more than 0.70% at entrance respectively. The total number of infections rising from AAO and local community residents were respectively 6.00-120.02 cases and 20.34-307.33 cases, while the detection rates were 96.20-97.61% and 85.95-85.97% respectively in AAO and local community residents. The transmission of COVID-19 caused by AAO traveling across mainland China is similar to that caused by local travel in Beijing and Hebei where the Beijing 2022 Olympic and Paralympic Winter Games will be held. In any optimal scheme, local community residents need a weekly NAT, and limit their daily contacts below 7 persons.Interpretation: It might be a manageable choice to implement NCLM in the upcoming Beijing 2022 Olympic and Paralympic Winter Games.Funding Information: NSCF (No. 91546203, 72174004) and the Ministry of Science and Technology of the People's Republic of China (No. 2021YFF0306004).Declaration of Interests: The authors declare that they have no competing interests.

To examine whether environmental interventions, student awareness and parents’ model roles are associated with the consumption of sugar-sweetened beverages (SSBs), a randomized controlled trial was conducted among Chinese schoolchildren. A multi-stage cluster random sampling method was applied to select four primary schools, two in urban areas and two in rural areas, in Nanjing, eastern China. Classes of the third grade in the selected four schools were randomly assigned to the intervention group and control group. Among selected students in those classes, aged 9–10 years, those in the intervention group received intervention measures comprising school-based and family-based measures and accepted monthly monitoring along with interventions, for two consecutive semesters, while those in the control group did not receive any specific interventions. After intervention, there was a significant increase in SSB knowledge and an improvement in the family environment with parents in the intervention group. The proportion of frequent consumption (≥4 times/week) of any SSBs in the intervention group was lower than that in the control group (31.5% vs. 56.2%, p < 0.01). Multivariate analysis indicated that parental education level is positively associated with reduced SSB consumption. Interventions showed an average decrease in SSBs consumption by 1.77 units, those living in urban areas decreased by 2.05 units. The combination of school-based and family-based interventions appears effective in reducing SSB consumption among Chinese schoolchildren, especially in urban areas and for those with parents with lower educational levels.

Objective To quantify the temporal trend of sex- and age-specific disability-adjusted life years (DALYs) for musculoskeletal (MSK) disorders by region and cause. Methods Data were collected from the Global Burden of Diseases Study 2019. The estimated annual percentage change (EAPC) by sex, age, region and cause was calculated to examine the temporal trend of the age-standardized DALYs rate (ASDR). The sociodemographic index (SDI) and risk exposures were also examined. Results Between 1990 and 2019, the global ASDR for MSK disorders remained almost stable by sex and age group but decreased among females ages 0-14 years (EAPC = -0.27). Such age and sex patterns were nearly the same by SDI, except for high SDI regions, where ASDR increased in all subgroups except those ages 15-49 years. The trend in ASDR of MSK disorders for females and males ages 50-74 and >= 75 years increased in similar to 80% of countries and territories. The greatest increase was in El Salvador for males ages 15-49 years (EAPC = 1.30), followed by Nicaragua. The association between EAPC and SDI was positive in developing regions, particularly among females ages 15-49 years, and negative in developed regions. A decreasing trend in ASDR was mainly driven by the decrease in low back pain, while the increasing trend was largely due to other MSK disorders and gout across sexes and age groups. Conclusions There are great disparities in the age- and sex-specific trends in ASDR by cause on the global, regional and national levels. More differentiated prevention and management strategies are needed for MSK disorders.

BACKGROUND:The Republic of Guinea-Bissau in West Africa has a high HIV/AIDS disease burden and has experienced political instability in the recent past. Our study used qualitative methods to better understand key stakeholders' perceptions of the effects of chronic political instability on the HIV/AIDS response in Guinea-Bissau from 2000 to 2015 and lessons learned for overcoming them. METHODS:Seventeen semi-structured in-depth key informant interviews were conducted in Bissau, Guinea-Bissau in 2018. Interviews were recorded and transcribed verbatim, coded thematically, and analyzed inductively. RESULTS:Four themes emerged: (1) constantly start over; (2) the effects of instability rippling from central level throughout the health pyramid; (3) vulnerable populations becoming more vulnerable; and (4) coping mechanisms. CONCLUSIONS:Stakeholders from government, civil society, and donor organizations have recognized instability's effects as a barrier to mounting an effective local response to HIV/AIDS in Guinea-Bissau. To mitigate the effects of the country's political instability on the health sector, concerted efforts should be made to strengthen the capacities of health officials within the Ministry of Health to shield them from the effects of the country's political instability.

Objectives Dietary factors are of importance in the development of stomach cancer. This study aims to examine index-based dietary patterns associated with stomach cancer in a Chinese population. Methods Using data from a population-based case-control study conducted in Jiangsu Province, China, we included a total of 8432 participants (1900 stomach cancer cases and 6532 controls). Dietary data collected by food frequency questionnaire was evaluated by modified Chinese Healthy Eating Index-2016 (mCHEI-2016) and the US Healthy Eating Index-2015 (HEI-2015). Multiple logistic regression analyses were applied to examine the association of mCHEI-2016 and HEI-2015 with stomach cancer while adjusting for potential confounders. The possible interactions between mCHEI-2016 or HEI-2015 and established risk factors were explored. Results Among nonproxy interviews, after adjusting for potential confounding factors, a higher score of sodium, reflecting lower intake per day, was inversely associated with stomach cancer [odds ratio (OR), 0.95; 95% CI, 0.91-0.99 for mCHEI-2016; OR, 0.97; 95% CI, 0.94-0.99 for HEI-2015]. No clear associations with stomach cancer were identified for total scores of HEI-2015 (OR, 0.98; 95% CI, 0.87-1.10 with a 10-point increase, P trend = 0.98) and mCHEI-2016 (OR, 1.05; 95% CI, 0.94-1.17 with a 10-point increase, P trend = 0.22). However, the relation between stomach cancer and the mCHEI-2016 was modified by BMI, with a possible inverse association in normal-weight subjects. Conclusions Our findings highlight that reduced intake of dietary sodium would prevent the development of stomach cancer. The data indicate a heterogeneity between normal weight and overweight's dietary factors in relation to stomach cancer.