Background HIV/AIDS remains a major global health issue, and young students are a key affected group. Conventional interventions have overlooked students’ psychological and behavioural differences, reducing their impact. This study will identify specific psychosocial factors that drive college students to get HIV testing.Methods We surveyed 4451 college students in various regions in China from December 2022 to March 2023. Analysis occurred in two steps. First, we used partial least squares structural equation modelling (PLS-SEM) to test linear causal relationships among psychosocial constructs. Second, we used fuzzy set qualitative comparative analysis (fsQCA) to pinpoint combinations leading to high willingness for HIV testing.Results In PLS-SEM, lower HIV stigma (β=0.352, 95% CI 0.311 to 0.391) and higher condom-use self-efficacy (β=0.087, 95% CI 0.056 to 0.120) were associated with stronger safe-sex intention, which was associated with higher testing willingness (β=0.067, 95% CI 0.053 to 0.081). FsQCA identified five distinct pathways leading to high HIV testing willingness (coverage=0.788, consistency=0.790). The main types were (1) students with strong condom use intention; (2) students with low HIV stigma and supportive environments; (3) students with high risk perception and preventive actions; (4) students with high self-efficacy and HIV knowledge and (5) students confident in risk management and willing to test despite risk. These findings show there are multiple clear ways students reach a high willingness for HIV testing.Conclusion Using a dual analytic approach, we found that lower HIV stigma and higher condom-use self-efficacy were associated with greater safe-sex intention, which in turn was associated with higher HIV testing willingness. fsQCA further suggested multiple psychosocial configurations linked to high willingness. These findings may inform a combined universal-plus-tailored approach to campus HIV testing promotion, while longitudinal and intervention studies are needed to test causality.

Despite the proven efficacy of pre-exposure prophylaxis (PrEP) for HIV prevention, uptake among men who have sex with men (MSM) in China remains low. Guided by the PrEP care cascade framework, we conceptualized PrEP literacy as a social practice shaped by structural and community dynamics, encompassing four dimensions: essential knowledge, eligibility self-assessment, access to medication, and adherence to follow-up care. We examine how social support, community norms, and structural barriers intersect to shape PrEP literacy disparities. A cross-sectional study was conducted in partnership with 20 community-based organizations (CBOs) across 20 Chinese cities (December 2023). We surveyed 1,400 MSM with an electronic questionnaire assessing demographics, sexual behaviors, PrEP-related norms, social support, and PrEP literacy using a validated 14-item scale aligned with the cascade framework. Multivariable logistic regression models were used to identify factors associated with PrEP literacy, adjusting for sociodemographic confounders. Participants exhibited stark disparities across PrEP literacy dimensions. Eligibility assessment proficiency was the lowest, with widespread misperceptions about clinical indications. Social-structural factors significantly predicted PrEP literacy: MSM reporting stronger PrEP-supportive norms (adjusted odds ratio [AOR] = 1.05, p < 0.001) and social support (AOR = 1.03, p < 0.001) had higher odds of adequate literacy. PrEP literacy gaps among Chinese MSM reflect structural inequities in health education and community-level misperceptions about eligibility. Interventions must address social-structural barriers through norm-driven, community-led strategies —peer navigation programs to reframe eligibility awareness and partnerships with CBOs to decentralize PrEP access. Policymakers should integrate PrEP literacy into national HIV prevention frameworks by leveraging China’s existing CBO infrastructure.

While the health benefits of urban green spaces for perinatal outcomes are established, evidence on how landscape configuration relates to preterm birth (PTB) and its subtypes remains limited. We estimated associations between landscape metrics of urban green space and PTB risk, and quantified potential mediating effects of ambient temperature and fine particulate matter (PM2.5). We conducted a retrospective cohort study of 1,058,772 singleton live births in Chengdu, China (2014-2022). For each participant, we characterized green space within a 2-km residential buffer using three metrics: total area (TA), patch density (PD; fragmentation), and landscape shape index (LSI; morphological complexity). Multilevel logistic regression models were used to estimate associations with overall, early, and late PTB. We also performed stratified and mediation analyses to assess effect modification and indirect effects. Increases in TA and LSI were associated with reduced overall PTB risk (TA: odds ratios [OR] = 0.98, 95% confidence interval [CI]: 0.96-0.99 per 133.75-ha increase; LSI: OR = 0.98, 95% CI: 0.97-0.99 per 17.46-unit increase). These associations were primarily observed for late PTB. Mediation analyses revealed that PM2.5 mediated 8.08% of the total effect of TA, 1.51% of PD, and 12.15% of LSI. The protective effects of TA and LSI were more pronounced in areas characterized by higher temperatures, lower PM2.5, and higher ozone levels. Our results suggest that large and more morphologically complex green spaces may reduce PTB risk, partly through alleviating of air pollution and temperature, and highlight the importance of considering spatial configuration in urban planning for maternal health.

Abstract BackgroundDespite high pre-exposure prophylaxis (PrEP) awareness and willingness among Chinese men who have sex with men (MSM), actual uptake remains critically low. The health action process approach (HAPA) is a 2-phase theory that addresses both the motivational and volitional phases of health behavior change, making it suitable for tackling the intention-behavior gap in PrEP use. In China, where PrEP is not covered by national health insurance, financial barriers further hinder uptake. Group-based conditional economic incentives (GCEIs) represent an innovative strategy to address cost-related disincentives by leveraging peer influence. ObjectiveThis randomized controlled trial aims to evaluate the effectiveness of HAPA-driven interventions, both alone and combined with GCEI, to enhance PrEP initiation and adherence among high-risk, PrEP-naive MSM in China. MethodsHigh-risk HIV-negative MSM naïve to PrEP were recruited via community-based organizations in 3 Chinese cities. Participants underwent individual randomization to 3 arms: (1) HAPA-based cognitive behavioral intervention featuring tailored WeChat messages and 2 structured motivational interviews targeting stage-specific barriers; (2) combined HAPA intervention with GCEI linked to peer group initiation rates, incorporating facilitated offline group activities; or (3) standard care control receiving nonpersonalized HIV prevention information. The physician-prescribed PrEP initiation rate at 3 months serves as the primary outcome. Secondary outcomes include PrEP adherence, HIV risk perception, PrEP-related stigma, and intervention acceptability. Analysis follows intention-to-treat principles using mixed-effects models. ResultsThe study protocol received ethics approval in December 2024 and was funded in December 2025. As of August 2025, 3 community-based organizations in Mianyang, Zibo, and Hohhot have agreed to participate. Preliminary testing has led to refinements in the WeChat mini-program, questionnaires, and motivational interview scripts. Data collection commenced in October 2025 and is projected to be completed by August 2026. As of February 2026, baseline recruitment is complete, with 381 eligible participants enrolled and randomized. The baseline characteristics were balanced across the 3 arms. Outcome data will be collected after the intervention. Data analysis is ongoing, with full results expected to be published before December 2026. ConclusionsThis study rigorously tests a novel intervention integrating the HAPA with a GCEI model. By addressing both individual cognitive-behavioral barriers and financial disincentives within a supportive group context, this approach offers a potentially scalable strategy to bridge the PrEP uptake gap in China. Findings will provide critical evidence on combining theory-driven behavioral techniques with peer-group economic incentives for HIV prevention.

Introduction:In China, the increase in high-risk pregnancies along with rising maternal age and complications has underscored the need for the development of maternal and newborn risk management programmes. The Chinese National Maternal and Newborn Safety Action Plan (CNMNSAP) was initiated in 2017. Given that neonatal mortality is a key indicator of healthcare quality, we evaluate the real-world effects of CNMNSAP against neonatal mortality among pregnant women with high-risk conditions. Methods:In this retrospective, matched, population-based cohort study, we collected information on all pregnant women with clinically diagnosed conditions from electronic medical records in Chengdu, China, between July 2014 and December 2019. Individual-level data, covering all healthcare services and testing records in public hospitals, were obtained and categorised into two groups based on the timing of CNMNSAP implementation (pre-CNMNSAP vs post-CNMNSAP). After 1:1 propensity score matching, we calculated the annual percentage change (APC) of neonatal mortality within 7 days post-delivery and compared outcomes between two groups of pregnant women with conditions. We then employed multivariate log-binomial regression models to examine the association between the CNMNSAP implementation and temporal changes in neonatal mortality. Results:During the 5-year study period, a total of 241 343 women with high-risk conditions delivered prior to CNMNSAP and 163 367 after its implementation. After 1:1 propensity score matching, 299 190 mothers were included for analysis. We estimated that the APC changed from 10.0% (95% CI -0.4% to 21.5%) prior to the maternal risk management programme to -28.5% (95% CI -44.2% to -8.4%) after its implementation, with an attributed risk reduction of 1.29 neonatal deaths per 1000 deliveries annually. In subgroup analysis, we found a significant reduction in neonatal mortality after policy implementation among mothers aged 18-34 years, those with a normal body mass index and those having a history of abortion. Conclusions:The CNMNSAP was found to be associated with a significant annual reduction in early neonatal mortality risk among pregnant women with high-risk conditions in Chengdu, China. The maternal risk management programme effectively improved outcomes for high-risk pregnancies, highlighting the importance of maternal risk classification and management throughout pregnancy.

Evidence on the association between ambient fine particulate matter (PM2.5) exposure and thyroid dysfunction remains inconsistent, with limited evidence from community-based populations encompassing both minors and adults while accounting for iodine nutrition. We aimed to evaluate the associations of ambient PM2.5 exposure with complementary dimensions of thyroid health in a community-based population in Zhejiang Province, China. We conducted a cross-sectional study of 24,333 participants between 2022 and 2025. PM2.5 exposure was estimated using participants' geocoded residential addresses. Linear and generalised linear mixed-effects models were used to estimate the associations of PM2.5 with free thyroxine (FT4), thyroid-stimulating hormone (TSH), subclinical hypothyroidism, and autoimmune thyroiditis. Stratified analyses were conducted by age, sex, and body mass index (BMI). Our results showed that each 10 μg/m3 increase in PM2.5 was associated with lower FT4 [-3.57% (95% confidence interval (CI): -4.39%, -2.75%)], higher TSH [12.15% (95% CI: 7.92%, 16.56%)], and higher odds of subclinical hypothyroidism [odds ratio (OR) 1.27 (95% CI: 1.06, 1.51)]. Exposure to PM2.5 was not clearly associated with autoimmune thyroiditis. The association with lower FT4 was more pronounced among participants aged < 18 years and those with BMI < 18.5 kg/m2, whereas the associations with higher TSH and higher odds of subclinical hypothyroidism were more pronounced among participants aged ≥ 50 years and those with BMI ≥ 24.0 kg/m2. Overall, our findings suggest that higher ambient PM2.5 exposure was associated with lower thyroid function.

Long-term exposure to fine particulate matter (PM2.5) has been linked to increased risks of morbidity and mortality, yet its association with age-related diseases (ARDs) and the underlying molecular mechanisms remains unclear. Leveraging data from 502,128 participants (mean age 56.5 years) in the UK Biobank, we systematically estimated the associations between exposure to 3-year moving-average PM2.5 and 83 ARDs and 9 recognized aging hallmarks. We additionally integrated large-scale plasma proteomics to explore potential biological pathways. Long-term exposure to PM2.5 was associated with increased risks of 12 ARDs and 6 aging hallmarks. Hazard Ratios (HRs) per 10 μg/m3 increase in PM2.5 ranged from 1.12 to 2.38 across the 12 ARDs, with the most pronounced associations observed for primary thrombocytopaenia and plasma cell cancer. Among aging hallmarks, long-term exposure to PM2.5 was linked to increased risks of loss of proteostasis (HR: 1.07, 95% CI: 1.03, 1.10), stem cell exhaustion (HR: 1.06, 95% CI: 1.03, 1.09), telomere attrition (HR: 1.06, 95% CI: 1.02, 1.09), deregulated nutrient-sensing (HR: 1.05, 95% CI: 1.02, 1.09), mitochondrial dysfunction (HR: 1.05, 95% CI: 1.02, 1.08), and cellular senescence (HR: 1.04, 95% CI: 1.01, 1.07). Compared with no intervention, a hypothetical PM2.5 reduction to the annual standards of 10 μg/m3 could substantially lower 10-year risks for most of the 12 ARDs, particularly for hypertension and cataract, and significantly attenuate all aging hallmarks. Proteomic profiling of 2,923 circulating proteins identified 35 aging-related proteins that were jointly associated with both chronological age and PM2.5 exposure. These proteins were enriched in pathways involving immune regulation, epithelial integrity, vascular biology, extracellular matrix organization, and environmental responses. Mediation analyses showed that these 35 proteins collectively explained 59%-83% of the PM2.5-aging hallmark associations, with key contributors including WFDC2, TFF1, and CXCL17. Collectively, these findings provide large-scale population evidence linking long-term exposure to PM2.5 to multiple age-related diseases and aging hallmarks, and highlight candidate circulating proteins that may partially explain these associations.

Despite efforts to control the HIV epidemic, prevalence among men who have sex with men (MSM) in China remains high, largely driven by risky sexual behaviors. Sexualized drug use (SDU) is common among MSM and associated with depression and psychological problems, which may further exacerbate risky sexual behaviors and HIV transmission. Therefore, this study aimed to investigate the prevalence of depression, SDU, and risky sexual behaviors among MSM in Southwest China, and examine the associations between depression, SDU, and their co-occurrence, with risky sexual behaviors. Participants were recruited with the assistance of a local MSM-friendly organization through venue-based and online approaches. A total of 1,277 participants were recruited from November 2021 to May 2022. An online questionnaire collected data on demographic information, depressive symptoms, SDU and six types of risky sexual behaviors: casual sex, commercial sex, group sex, multiple sexual partners, inconsistent condom use, and history of sexually transmitted infections (STIs). Multivariate logistic regression models were used to examine the associations between depression, SDU, their co-occurrence, and risky sexual behaviors. Among respondents, 34.8

Abstract Aims Pronounced variations in suicide mortality persist across Europe. Understanding long-term temporal patterns through age, period and cohort (APC) effects, alongside suicide means, is essential for tailored prevention. This study aims to determine how suicide mortality rates in Europe have changed across APC dimensions at national and subregional levels. Methods Our analysis was restricted to European countries with complete age- and sex-specific suicide mortality data from 1990 to 2019 within the World Health Organization mortality database. The analysis comprised two components. The first component disentangled long-term suicide mortality trends (1990–2019) into APC dimensions using an age-period-cohort model via the National Cancer Institute’s APC Web Tool. The second component involved an assessment of suicide means, restricted to 2010–2019 and to countries with detailed International Classification of Diseases, 10th Revision (ICD-10) cause-of-death data. Results In 2019, Europe recorded 47,793 male and 13,111 female suicide deaths. Overall suicide mortality rates declined in most subregions from 1990 to 2019, with the largest reductions among Eastern European men, from 77.81 (95% CI: 77.17–78.45) per 100,000 in the mid-1990s to 22.93 (95% CI: 22.58–23.28) per 100,000 by 2019, although this region retained the highest male suicide burden. Age-specific risk patterns differed markedly: among men, risk peaked in early adulthood and then declined in Eastern Europe, while in Western and Southern Europe, it was lower and more stable but rose after age 60; for women, risk was generally lower, with peaks in early adulthood in Eastern Europe and in midlife elsewhere. Period reflected continued improvement, especially in Eastern Europe where the period risk in 2015–2019 was approximately 60% lower than 2000–2004. Cohort effects similarly showed progressive declines. However, upward trends emerged among younger generations. In Northern Europe, the cohort relative risk for females increased from 0.73 (95% CI: 0.68–0.78) in the 1980 cohort to 0.90 (95% CI: 0.70–1.04) in the 2000 cohort. While the completeness of suicide means analysis varied by subregion, the primary data indicated that hanging was the predominant means for both sexes during 2010–2019. Conclusions Despite an overall decline, suicide mortality in Europe exhibits persistent regional and demographic differences. This study reveals emerging risks among younger cohorts, specifically Northern European women and Southern European men, signalling shifting patterns that are not apparent from overall temporal trends alone. This evolving risk profile calls for sustained surveillance and research to investigate the drivers of these population-specific vulnerabilities.

Abstract Introduction Sleep duration, efficiency, and irregularity are associated with increased risks of cardiovascular, neurodegenerative, and immune-related diseases, highlighting sleep as a multidimensional construct. Sleep plays an important role in regulating diverse biological processes and shapes immune and genomic processes with relevance to biological aging. Evidence suggests that sleep disturbances may accelerate biological aging by triggering cellular and molecular impairments. However, few studies have examined how multidimensional sleep patterns linked to cellular and metabolic hallmarks of aging. Methods We analyzed accelerometer-derived sleep data from the UK Biobank and extracted six sleep characteristics using a validated self-supervised deep neural network: total sleep duration, REM, deep sleep, light sleep, wake after sleep onset (WASO), and sleep irregularity (SD of daily sleep duration). K-means clustering identified multidimensional sleep patterns. Diagnoses of 83 age-related diseases (ICD-10) were mapped to nine hallmarks of aging: genomic instability, telomere attrition, epigenetic alterations, loss of proteostasis, deregulated nutrient sensing, mitochondrial dysfunction, cellular senescence, stem cell exhaustion and altered intercellular communication. Cox proportional hazards models estimated associations between sleep patterns, age-related diseases and aging hallmarks. Results Among 93,249 participants, three distinct sleep patterns were identified, including pattern 1 distinguished by higher WASO and light sleep; pattern 2 marked by adequate total sleep duration and lower sleep irregularity; pattern 3 characterized by elevated sleep irregularity. Compared with pattern 2, pattern 1 was associated with increased risks of 18 diseases (P-FDR < 0.05), most notably Parkinson's disease (HR = 2.40, 95% CI = 1.82 to 3.05) and immunodeficiency (HR = 1.96, 95% CI = 1.00 to 3.82). Pattern 3 was associated with 24 diseases (P-FDR < 0.05), particularly Parkinson's disease (HR = 1.93, 95% CI = 1.48 to 2.53) and dementia (HR = 1.67, 95% CI = 1.38 to 2.02). Both cluster 1 and cluster 3 linked to higher risk of hallmarks of aging except genomic stability (P-FDR < 0.001). Conclusion Our findings identified three distinct sleep patterns using accelerometry-derived metrics in a large population cohort, each showing different associations with aging. These results demonstrated the importance of multidimensional sleep assessment and provide a framework for targeted strategies to promote healthy aging. Support (if any)

The associations between objectively measured sleep patterns, the hallmarks of aging, and their shared proteomic signatures remain poorly understood. In this study, we utilized wrist-worn accelerometer data, plasma proteomic profiles, and health records from the UK Biobank to examine the associations between six defined sleep patterns and nine established hallmarks of aging. We further identified proteins jointly associated with both sleep patterns and aging hallmarks. Longer total sleep duration, greater deep sleep, and increased rapid eye movement (REM) sleep were associated with lower risk of most aging hallmarks. In contrast, higher wakefulness after sleep onset (WASO) and greater sleep irregularity were associated with higher risk, whereas light sleep showed no significant associations. The number of overlapping proteins varied substantially across sleep-hallmark associations, ranging from 1 to 558. These proteins were predominantly enriched in immune and inflammatory pathways. Several proteins, including IL1RN, FABP1, GDF15, and LEP, were consistently observed across multiple sleep patterns and aging hallmarks. These findings may help generate hypotheses about shared underlying biological processes between sleep and the aging process.

Abstract Introduction Circadian sleep–wake abnormalities are common in older adults and frequently accompany neurodegenerative and psychiatric disorders. Evidence suggests that reduced circadian amplitude may be linked to conditions such as Parkinson’s disease and depression, independent of nocturnal sleep quality. However, it remains unclear whether circadian disruption precedes disease onset and contributes to risk through alterations in brain structure or blood-based biomarkers. Methods We analyzed wrist-worn accelerometer data from 95,552 participants in the UK Biobank prospective cohort and derived key circadian rhythm metrics using an extended cosine model, including amplitude, mesor, and acrophase. Brain health–related diseases were defined as psychiatric and neurodegenerative disorders using ICD-10 codes. Quality-controlled biomarker data from the UK Biobank imaging center and blood assays were incorporated, covering measures of brain structure, neurobiomarkers, blood counts, and blood biochemistry. Cox proportional hazards models were used to estimate associations between circadian metrics and incident diseases. Causal mediation analyses were performed to quantify the proportion of disease risk explained by each biomarker. Results Among 95,552 participants included in the analysis, 5,185 (5.4%) developed a brain health–related disease during 11 years of follow-up. After full adjustment, the risk of incident neurodegenerative diseases, most notably dementia, decreased with increasing circadian amplitude (HR, 0.71; 95% CI, 0.67–0.76) and mesor (HR, 0.89; 95% CI, 0.81–0.97), but increased with a delayed circadian phase (HR, 5.64; 95% CI, 2.18–14.56). For psychiatric disorders, particularly depression, risk decreased with higher circadian amplitude (HR, 0.88; 95% CI, 0.85–0.90), whereas increased with elevated mesor (HR, 1.12; 95% CI, 1.08–1.16) and an advanced circadian phase (HR, 1.60; 95% CI, 1.40–1.83). Causal mediation analyses showed that brain atrophy primarily mediated the association between circadian amplitude and neurodegenerative disease risk (proportion mediated, 0.16–0.85), whereas blood count and biochemical markers served as the main mediators for psychiatric disorders (proportion mediated,0.03–0.20). Conclusion Our findings indicate that circadian rhythm disruption exerts distinct effects on neurodegenerative and psychiatric disorders and may serve as an early indicator of disease onset. These results provide new insights for the prevention of related diseases. Support (if any)

Objective:Based on protection motivation theory(PMT),this study aimed to examine the current status of e-cigarette cessation intention and cessation behavior,as well as their associated factors,among adult e-cigarette users in China.Methods:This was a cross-sectional study.The data were de-rived from a nationwide"E-cigarette Use Survey"conducted in 2023,covering 31 provinces(municipali-ty,autonomous region)in China.A total of 550 current e-cigarette users aged 18-44 years were selec-ted as the study population.After adjusting for sociodemographic variables,multiple linear regression models were used to identify factors associated with e-cigarette cessation intention,while binary Logistic regression models were applied to examine factors associated with e-cigarette cessation behavior.In addi-tion,subgroup analyses were conducted according to smoking status to explore potential differences among exclusive e-cigarette users and dual users of e-cigarettes and combustible cigarettes.Results:The mean score of e-cigarette cessation intention was 3.52±0.96,and 31.64％of participants reported having at-tempted to quit e-cigarettes.After adjustment for covariates,cessation intention was associated with both the threat appraisal and coping appraisal pathways within the PMT framework.Specifically,in the threat appraisal pathway,severity(β=0.14)and vulnerability(β=0.12)were positively associated with ces-sation intention,whereas perceived extrinsic rewards(β=-0.12)were negatively associated.In the coping appraisal pathway,both response efficacy(β=0.26)and self-efficacy(β=0.28)were positive-ly associated with cessation intention.Regarding cessation behavior,only severity(OR=1.58)in the threat appraisal pathway was positively associated,and cessation intention was also positively associated with cessation behavior.Subgroup analyses further showed that,regardless of smoking status,cessation intention was positively associated with both the threat appraisal pathway(β=0.20,β=0.31)and the coping appraisal pathway(β=0.23,β=0.21).Conclusion:PMT provides a valuable theoretical framework for understanding e-cigarette cessation among adults.Factors related to the threat appraisal pathway are associated not only with cessation intention but also with actual cessation behavior.More-over,the associations of PMT-related factors vary across different smoking status subgroups.These findings suggest that future e-cigarette control policies and interventions could focus on enhancing risk perception and cognitive awareness,and develop more targeted cessation strategies for specific subgroups.

Background. Older adults often mount a weak immune response to standard inactivated influenza vaccines. To induce a stronger response and better protection, a high-dose (HD) version of the inactivated Fluzone vaccine is recommended for individuals >65 years of age. While better immunogenicity and protection against the vaccine strain have been shown, it is not known if the HD vaccine also induces a robust antibody response to heterologous strains. Methods. We fit bayesian multilevel regression models to hemagglutination inhibition antibody data from an influenza vaccine cohort spanning the influenza seasons of 2013-2014 to 2021-2022. We used this model to estimate the average causal effect of obtaining the HD vaccine relative to the standard-dose vaccine. Results. We show that while there is generally a benefit derived from the HD vaccine, the impact is small and inconsistent. For some strains, the HD vaccine might even result in less robust heterologous responses. Conclusions. We suggest that further increases in dose might be worth investigating to help induce a stronger broad response.

Limited evidence is available regarding the association between ambient particulate matter exposure and reproductive outcomes in women undergoing in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) treatments. In this prospective cohort study, we included 1237 women who underwent IVF/ICSI procedures in Hubei, China, between 2018 and 2020. We performed multivariate regression models to estimate the associations between exposure to particulate matter with diameters of ≤ 2.5 microns (PM2.5), ≤ 10 microns (PM10), and 2.5-10 microns (PM2.5-10) and ten pregnancy outcomes: the number of mature oocytes, number of zygotes with two pronuclei, maturation rate, fertilization rate, cleavage rate, best-quality embryos rate, ovarian sensitivity index, implantation, clinical pregnancy, and live birth. We found that exposure to particulate matter was associated with declines in maturation rate and fertilization rate but showed no significant associations with clinical pregnancy outcomes. Specifically, each interquartile range increase in PM2.5 was associated with a 1.01 % (95 % CI: 0.17 %, 1.84 %) reduction in the maturation rate and a 1.42 % (95 % CI: 0.29 %, 2.55 %) decrease in the fertilization rate. These associations were particularly pronounced during the follicle maturation stage (from 10 days before oocyte retrieval to retrieval day). Our findings provide novel evidence that exposure to ambient particulate matter may adversely affect early reproductive outcomes among women undergoing IVF/ICSI.

HIV self-testing (HIVST) has been shown to complement existing facility-based testing services and promote regular HIV testing among men who have sex with men (MSM). However, HIVST uptake among Chinese MSM remains suboptimal, with existing studies reporting a testing rate below 50

Despite the alarming prevalence of loneliness in adolescents, few studies addressed its impact on health-related quality of life (HRQOL). This study aimed to investigate the association between loneliness and HRQOL in adolescents, as well as the mediating role of depressive symptoms and the moderating role of age in this association. A cross-sectional study surveyed 6743 middle school adolescents, assessing loneliness with the 6-item UCLA Loneliness Scale and HRQOL through the Pediatric Quality of Life Inventory Version 4.0. Depressive symptoms were assessed by the Patient Health Questionnaire-9. Pearson correlation analysis was performed to determine the correlation among the main variables. A moderated mediation analysis was established to evaluate the mediating role of depressive symptoms and the moderating role of age in the association between loneliness and HRQOL. Of the participating adolescents, 25.0

BACKGROUND:The onset of the COVID-19 pandemic has had a detrimental impact on the healthcare system. Patients with kidney failure and related kidney disease are notably vulnerable to the COVID-19 pandemic. However, it remains unclear how mortality trends associated with kidney failure have evolved over the past three years. In this study, we investigated temporal trends in excess kidney failure-related mortality during the first three years of the pandemic in the United States. METHODS:We aim to estimate time-varying excess kidney failure-related mortality, which is defined as the difference between observed mortality and expected mortality predicted by a Poisson log-linear regression model, in the United States (March 2020-March 2023). RESULTS:Our findings revealed two distinct peaks in excess kidney failure-related mortality during the first year (March 2020-February 2021) and the second year (February 2021-March 2022), whereas a notable decline in excess mortality was observed in the third year (March 2022-March 2023). Additionally, disparities in mortality were evident among various demographic groups, including age, sex, racial/ethnic subgroups, and geographic regions. Across all age subgroups, an increase in kidney failure-related mortalities was observed, with individuals aged 85 years and above experiencing the most substantial relative increase, reaching 9595.8 per million persons (95% CI: 9438.8, 9752.9). Moreover, excess kidney failure-related mortalities were recorded at 510.3 per million persons (95% CI: 502.6, 517.9) and 721.8 per million persons (95% CI: 713.4, 730.1) for women and men, respectively. Notably, non-Hispanic Blacks exhibited the highest excess mortality within the racial/ethnic group, registering at 772.6 per million persons (95% CI: 756.3, 788.9). CONCLUSIONS:Our study observed high levels of excess kidney failure-related mortality during the first two years of the pandemic, followed by a notable decline in the third year. This highlights the effectiveness of current policies and prevention measures implemented to mitigate the impact of the pandemic.

BACKGROUND:Exposure to ambient ozone may be associated with a decline in ovarian reserve; however, epidemiological evidence remains limited. We aimed to estimate the association between ambient ozone exposure and ovarian reserve, and to identify critical exposure windows. METHODS:We included 2815 women aged 20-45 years who attended an infertility clinic in Chengdu, Sichuan Province, China, between 2014 and 2022. We calculated average concentrations of ozone exposure according to the development of follicles (2-month, 4-month, 6- month) and 1-year period prior to measurement, using a satellite-based spatiotemporal model. Multivariate linear and Poisson regression models were used to assess associations between exposure to ambient ozone and ovarian reserve biomarkers, including antral follicle count (AFC), anti-Müllerian hormone (AMH), and estradiol (E2). Stratified analyses were performed by age, body mass index (BMI), and education to evaluate potential effect modification. RESULTS:Each 10 μg/m3 increase in ozone concentration during 4-month and 6-month were associated with a 0.88 % (95 % CI: 0.44 %, 1.32 %) and 0.85 % (95 % CI: 0.28 %, 1.43 %) decrease in AFC, respectively. The associations were stronger among women with middle school or lower, and those with BMI ≥24 kg/m2 during both the 4-month and 6-month exposure windows. We observed no associations between exposure to ambient ozone and AMH or E2. CONCLUSIONS:Exposure to ambient ozone was associated with decreased ovarian reserve among adult women attending an infertility clinic in China. These findings suggest that exposure to ozone could serve as a potential environmental risk factor for diminished ovarian reserve.