There is a lack of human evidence concerning the cardiovascular effects of combined exposure to endocrine disruptors. This case-control study sought to investigate coronary heart disease (CHD) associations with exposure to organophosphate flame retardants (OFRs), phthalates (PAEs), and polycyclic aromatic hydrocarbons (PAHs) among 148 adults with coronary-angiography-diagnosed CHD and 320 healthy adults from southern China. The mediating role of glucose-lipid metabolism was also explored. Bayesian kernel machine regression suggested that when exposure status was fixed to the 75th percentile with the median value as the reference, exposure to OFRs, PAEs, and PAHs was associated with an 84% (95% CI: 36%-134%), 132% (12%-252%), and 214% (89%-331%) increased risk of developing CHD, respectively. Weighted quantile sum regression indicated urinary bis(2-butoxyethyl) phosphate (BBOEP), dibutyl phosphate (DBP), monoisononyl phthalate (miNP), and metabolites of phenanthrene may be major contributors to the overall effect of mixtures. In further analyses on identified chemical risk factors, mediation analyses suggested exposure to phenanthrene may increase the risk of CHD via elevating total cholesterol and blood glucose, while exposure to DiNP mainly associates with serum lipids. Besides, we observed a slight mediation effect of oxidative DNA damage between urinary BBOEP and risk of CHD. These results provide potential direction for further experimental studies. Longitudinal evidence is needed to clarify the causation of the results.

Parabens (PBs) and triclosan (TCS) are commonly found in pharmaceuticals and personal care products (PPCPs). As a result, they have been extensively found in the environment, particularly in aquaculture operations. Red swamp crayfish (Procambarus clarkii) consumption has significantly risen in China. Nevertheless, the levels of PBs and TCS in this species and the associated risk to human dietary intake remain undisclosed. This study assessed the amounts of five PBs, i.e., methyl-paraben (MeP), ethyl-paraben (EtP), propyl-paraben (PrP), butyl-paraben (BuP) and benzyl-paraben (BzP), as well as TCS in crayfish taken from five provinces of the middle-lower Yangtze River. MeP, PrP and TCS showed the highest detection rates (hepatopancreas: 46-86 %; muscle: 63-77 %) since they are commonly used in PPCPs. Significantly higher levels of ∑5PBs (median: 3.69 ng/g) and TCS (median: 7.27 ng/g) were significantly found in the hepatopancreas compared to the muscle (median: 0.39 ng/g for ∑5PBs and 0.16 ng/g for TCS) (p < 0.05), indicating bioaccumulation of these chemicals in the hepatopancreas. The estimated daily intake values of ∑5PBs and TCS calculated from the median concentrations of crayfish were 6.44-7.94 ng/kg bw/day and 11.4-14.0 ng/kg bw/day, respectively. Although no health risk was predicted from consuming crayfish (HQ <1), consumption of the hepatopancreas is not recommended.

Neonicotinoids (NEOs) are a class of novel insecticides which are used for pest control and crop protection all over the world. However, there is only scarce research concerning whether NEO exposure adversely affects pregnant women. For this reason, we quantified twelve NEOs, including six parent NEOs (p-NEOs) and six characteristic metabolites (m-NEOs), in 600 serum samples from pregnant women in south China. The detection rates of all target NEOs exceeded 60

The uptake of COVID-19 booster vaccination among older adults in China is suboptimal. Here, we report the results of a parallel-group cluster-randomized controlled trial evaluating the efficacy of promoting COVID-19 booster vaccination among grandparents (≥60 years) through a health education intervention delivered to their grandchildren (aged ≥16 years) in a Chinese cohort (Chinese Clinical Trial Registry: ChiCTR2200063240 ). The primary outcome was the uptake rate of COVID-19 booster dose among grandparents. Secondary outcomes include grandparents’ attitude and intention to get a COVID-19 booster dose. A total of 202 college students were randomized 1:1 to either the intervention arm of web-based health education and 14 daily reminders (n = 188 grandparents) or control arm (n = 187 grandparents) and reported their grandparents’ COVID-19 booster vaccination status at baseline and 21 days. Grandparents in the intervention arm were more likely to receive COVID-19 booster vaccination compared to control cohort (intervention, 30.6%; control, 16.9%; risk ratio = 2.00 (95% CI, 1.09 to 3.66)). Grandparents in the intervention arm also had greater attitude change (β = 0.28 (95% CI, 0.04 to 0.52)) and intention change (β = 0.32 (95% CI, 0.12 to 0.52)) to receive a COVID-19 booster dose. Our results show that an educational intervention targeting college students increased COVID-19 booster vaccination uptake among grandparents in China. Bian, Zhang, Guo, Li, Fu et al. present results of a parallel-group, cluster-randomized controlled trial demonstrating the efficacy of an educational intervention targeting college students in increasing COVID-19 booster vaccination uptake among grandparents in China.

Chronic viral infection induces immunosenescence and systemic low-grade inflammation, leading to worsened long-term outcomes. We sought to explore the short- and long-term effects of chronic viral infection on cardiovascular disease (CVD). Based on UK Biobank data, exposed group was identified as individuals who had chronic virus infection-related hospitalization (IRH). Unexposed group was randomly selected, matched by 5-year age interval, sex, and Charlson comorbidity index at a ratio up to 1:10. Restricted cubic splines were used to model time-varying effects of IRH in nonproportional Cox models. A cut-off value of 5 years was recorded and used in piecewise Cox proportional hazards models as we estimated short- and long-term effects of IRH on CVD. A total of 2826 exposed participants and 28 212 matched unexposed participants were included. Chronic viral IRH was associated with increased risk of CVD (0-5 years: hazard ratio, 1.57 [95% confidence interval: 1.32, 1.87] and 5+ years: 1.31 [1.06, 1.61]). Elevated risk of stroke was only observed within the initial 5-year follow-up (0-5 years: 1.91 [1.30, 2.81]). The short- and long-term associations were observed in herpes or hepatitis virus IRH with risk of CVD (all p < 0.05). Subgroup analysis revealed long-term association between chronic viral IRH and CVD among female (5+ years: 1.68 [1.27, 2.22]) but not among male. The association between chronic viral infection and elevated CVD risk appeared to be stronger among individuals who did not take cholesterol-lowering medication, antithrombotic medication, or certain antihypertensive medications (all p for interaction < 0.05). The risk of CVD event remained persistently higher within and over 5 years following chronic viral IRH, especially in individuals infected with herpes and hepatitis virus.

Dyslipidemia is a prevalent metabolic disorder in older adults and has negative effects on cardiovascular health. However, the combined effect of paraben, bisphenol A (BPA), and triclosan (TCS) exposure on dyslipidemia and the underlying mechanisms remain unclear. This cross-sectional study recruited 486 individuals ≥60 years in Shenzhen, China. Morning spot urine samples were collected and analyzed for four parabens, BPA, TCS, and 8-hydroxy-2’-deoxyguanosine (8-OHdG), a typical biomarker for oxidative stress, using mass spectrometry. Blood samples were tested for lipid levels using an automated biochemical analyzer. Quantile-based g-computation (QGC) was used to assess the combined effects of exposures on dyslipidemia. Mediation analysis was applied to investigate the mediating role of 8-OHdG between exposure and dyslipidemia. QGC showed that co-exposure to parabens, BPA, and TCS was positively linked with hypercholesterolemia (OR: 1.17, 95%CI: 1.10-1.24, P<0.001) and hyper-LDL-cholesterolemia (OR: 1.35, 95%CI: 1.05-1.75, P=0.019). Methylparaben (MeP), n-propyl paraben (PrP), and butylparaben (BtP) were the major contributors. 8-OHdG mediated 6.5% and 13.0% of the overall effect of the examined chemicals on hypercholesterolemia and hyper-LDL-cholesterolemia, respectively (all P<0.05). Our study indicated that co-exposure to parabens, BPA, and TCS is associated with dyslipidemia and oxidative stress partially mediate the association. Future research is needed to explore additional mechanisms underlying these relationships.

Exposure to tobacco smoke and essential metals is linked with metabolic syndrome (MS). However, the joint effect of them on MS in older adults and the underlying mechanisms are still unclear. This large-scale study measured the urinary concentrations of 8 nicotine metabolites and 8 essential metals in 4564 older adults from Shenzhen, China. The biomarker of insulin resistance, triglyceride-glucose index (TyG), was also calculated. Restricted cubic splines (RCS), Bayesian kernel machine regression and quantile-based g-computation were used to access the single and joint effects of urinary nicotine metabolites and essential metals on MS and insulin resistance. Mediation analysis was performed to investigate the role of TyG in these relationships.Single urinary nicotine metabolite and essential metal had non-linear relationships with MS in RCS. The overall effect of urinary nicotine metabolites and essential metals was positively associated with MS. Urinary zinc (52.2 %) and copper (20.1 %) were the major contributors to MS, whereas molybdenum had a negative association with MS. TyG mediated 64.7 % of the overall effect of urinary nicotine metabolites and essential metals on MS. Overall, the mixture of urinary nicotine metabolites and essential metals had a dose-response relationship with MS. Insulin resistance was as a crucial mediated pathway in this association.

Hengqin,located at the southern end of Zhuhai city and connected to Macao by a bridge and a river,serves as a key platform for promoting Macao's moderately diversified economic development,leveraging the inherent advantages of Guangdong-Macao cooperation.To enhance the capability of responding to public health emergency is very important for the development of cultural tourism and exhibition industries in the Guangdong-Macao In-Depth Cooperation Zone in Hengqin due to high population mobility in the region.In this article,we briefly discussed the role,strength and future development of community engagement-based public health emergency response in the in-depth cooperation zone.

Bisphenol analogs (BPs) are extensively employed in commercial and industrial products and they have been found in a variety of environmental matrices and human samples. The red swamp crayfish (Procambarus clarkii) has been a trendy food in China in recent decades. However, the levels of BPs in Chinese crayfish and the associated hazards of human exposure remain unknown. Thus, in this study, the levels of eight BPs in crayfish gathered from five major provinces engaged in crayfish within the Yangtze River Basin were analyzed. Additionally, the health risks for humans by ingesting crayfish were calculated. BPs were frequently detected in crayfish tissues, indicating the wide occurrence of these chemicals. In comparison to other substitutions, BPA remains the dominant bisphenol analog. Most of the BPs were observed to accumulate in the hepatopancreas compared to the muscle, so consuming the hepatopancreas of crayfish is not recommended. With the exception of BPS, the Estimated Daily Intakes (EDIs) of the remaining BPs exceeded the Tolerable Daily Intake (TDI) specified by the European Food Safety Authority (EFSA) by a factor of 1.75-69.0. The mean hazard index (HI) values exceeded 1 for both hepatopancreas and muscle in all provinces, and the mean HI values for hepatopancreas were significantly higher than those for muscle, indicating potential health risks for local consumers.

Background: During a vaccination plateau phase, traditional vaccination promotion strategies such as the mobilization of government and community appear to have limited impact on expanding the coverage. New strategies to promote vaccination are needed especially in older adults. Our study aimed to assess college students' intention to encourage coronavirus disease 2019 (COVID-19) vaccination among their grandparents and its correlates. Methods: A cross-sectional survey was conducted in China from May to June 2022. We collected information on socio-demographics of college students and their grandparents, constructs of health belief model (HBM) and theory of planned behavior (TPB) for college students, and college students' intention to encourage COVID-19 vaccination among their grandparents. Multilevel logistic regression models were performed to assess correlates of intention. Results: We enrolled 2681 college students who reported information for 6302 grandparents. 2272 students (84.7 %) intended to encourage COVID-19 vaccination for 4744 (75.3 %) grandparents. Intention was associated with having received a booster dose of COVID-19 vaccine (AOR 3.28, 95 % CI 1.68-6.42), having ever lived with their grandparents (2.07, 1.46-2.93), and having grandparents who regularly went outdoors (2.85, 1.70-4.76). HBM and TPB models showed that college students who had higher levels of perceived susceptibility (1.79, 1.12-2.87), perceived severity (1.52, 1.12-2.06) of COVID-19 among their grandparents, and higher levels of subjective norms (2.88, 1.61-5.15) were more likely to have the intention. Conclusion: College students' intention to encourage COVID-19 vaccination among their grandparents was high. It may be potentially viable to engage college students in promoting COVID-19 and other routine vaccination among older adults.

The extensive utilization of per- and polyfluoroalkyl substances (PFASs) has led to their pervasive presence in the environment, resulting in contamination of aquatic products. Prolonged exposure to PFASs has been linked to direct hepatic and renal damage, along with the induction of oxidative stress, contributing to a spectrum of chronic ailments. Despite the recent surge in popularity of red swamp crayfish as a culinary delicacy in China, studies addressing PFASs’ exposure and associated health risks from their consumption remain scarce. To address this gap, our study investigated the PFASs’ content in 85 paired edible tissue samples sourced from the five primary red swamp crayfish breeding provinces in China. The health risks associated with dietary exposure were also assessed. Our findings revealed widespread detection of PFASs in crayfish samples, with short-chain perfluoroalkyl carboxylic acids (PFCAs) exhibiting the highest concentrations. Notably, the total PFAS concentration in the hepatopancreas (median: 160 ng/g) significantly exceeded that in muscle tissue (5.95 ng/g), as did the concentration of every single substance. The hazard quotient of perfluorohexanesulfonic acid (PFHxS) via consuming crayfish during peak season exceeded 1. In this case, a potential total non-cancer health risk of PFASs, which is mainly from the hepatopancreas and associated with PFHxS, is also observed (hazard index>1). Thus, it is recommended to avoid consuming the hepatopancreas of red swamp crayfish. Greater attention should be paid to governance technology innovation and regulatory measure strengthening for short-chain PFASs.

The alarming surge in electronic waste (e-waste) in Hong Kong has heightened concerns regarding occupational exposure to a myriad of pollutants. Among these, polycyclic aromatic hydrocarbons (PAHs), phthalates (PAEs), and per- and polyfluoroalkyl substances (PFASs) are prevalent and known for their harmful effects, including the induction of oxidative stress and DNA damage, thereby contributing to various diseases. This study addresses gaps in knowledge by investigating exposure levels of these pollutants—measured via hydroxylated PAHs (OH-PAHs), phthalate metabolites (mPAEs), and PFASs—in urine from 101 e-waste workers and 100 office workers. E-waste workers exhibited higher concentrations of these substances compared to office workers. Elevated urinary levels of OH-PAHs, mPAEs, and PFASs correlated significantly with increased 8-hydroxy-2-deoxyguanosine (8-OHdG) levels (β = 2.53, 95 % CI: 2.12–3.02). The association between short-chain PFASs (Perfluoropentanoic acid, PFPeA) and DNA damage was discovered for the first time. Despite most participants (95 %) showing hazard index (HI) values below non-carcinogenic risk thresholds for PAHs and PAEs, certain pollutants posed higher risks among e-waste workers, necessitating enhanced protective measures. Moreover, the 95th percentile of carcinogenic risk associated with diethylhexyl phthalate (DEHP) exceeded 10−4 in both groups, highlighting the urgent need for regulatory measures to mitigate DEHP exposure risks in Hong Kong.

Background College students generally have good knowledge about COVID-19 and may facilitate COVID-19 vaccination in family. The purpose of this study is to understand college students’ willingness to persuade their grandparents to initiate COVID-19 vaccination and the effect of their persuasion. Methods A combined cross-sectional and experimental study will be conducted online. In the cross-sectional study (Phase I), eligible participants are college students who are aged ≥ 16 years and have at least one living grandparent aged ≥ 60 years who has/have not completed the COVID-19 vaccination. Participants self-complete Questionnaire A to collect information on the socio-demographics of themselves and their grandparents, their knowledge about older adults’ COVID-19 vaccination, as well as Health Belief Model (HBM) and Theory of Planned Behavior (TPB) predictor variables. The primary outcome at Phase I is college students’ willingness to persuade grandparents to receive COVID-19 vaccines. Those who are willing to persuade grandparents and participate in a follow-up survey will be invited to participate in a randomized controlled trial (Phase II). At Phase II, eligible participants are those who have at least one living grandparent aged ≥ 60 years who completed the COVID-19 initial vaccination series but has/have not received a booster dose. At the baseline, participants self-complete Questionnaire B to collect information on individual grandparents’ COVID-19 vaccination status, attitude towards and intention to COVID-19 booster dose. Participants will then be randomly allocated 1:1 to either intervention arm (one-week smartphone-based health education on older adults’ COVID-19 vaccination plus two weeks’ waiting period) or control arm (three weeks’ waiting period). At the end of week three, participants in both arms self-complete Questionnaire C to collect information on their grandparents’ COVID-19 vaccination status. The primary outcome at Phase II is the uptake rate of COVID-19 booster dose among grandparents. Secondary outcomes include grandparents’ attitude and intention to get a COVID-19 booster dose. Discussion No previous study had measured the effect of college students’ persuasion on COVID-19 vaccination uptake in older adults. Findings from this study will provide evidence for innovative and potentially feasible interventions that further promote COVID-19 vaccination in older adults. Trial registration Chinese Clinical Trial Registry: ChiCTR2200063240. Registered 2 September 2022.

Men who have sex with men (MSM) have been recommended for targeted monkeypox vaccination. We aimed to investigate monkeypox awareness and explore the correlates of monkeypox vaccination hesitancy among MSM in China. We conducted a cross‐sectional survey from August 10 to September 9, 2022. Awareness related to monkeypox and attitude toward monkeypox vaccination among MSM aged ≥18 years were collected. Multivariable logistic regression was applied to evaluate correlates of vaccination hesitancy. The discrepancy in awareness between subgroups regarding HIV status was assessed. A total of 1090 MSM were included (age: median 30 years, interquartile range [IQR], 25–35; HIV‐infected: 53.12%). Only 13.85% of respondents expressed high monkeypox vaccination hesitancy. Hesitancy was associated with no fixed income (adjuster odds ratio [aOR], 2.46, 95% confidence interval [CI], 1.48–4.11), infrequent information following (sometimes, 3.01, 1.55–5.83; seldom or never, 5.66, 2.58–12.45), and lack of worries about monkeypox endemic (1.78, 1.11–2.87). Participants who believed that HIV‐infected cases accounted for a smaller proportion (1.62, 1.01–2.60), disagreed that monkeypox virus could be detected in semen (2.21, 1.26–3.88), and considered either replication‐competent (1.84, 1.14–2.96) or replication‐deficient (4.80, 2.26–10.21) monkeypox vaccine unsuitable for HIV‐infected people were generally more hesitant. Compared with HIV‐uninfected MSM, HIV‐infected MSM supported more for vaccination promotion. MSM in China had low hesitancy toward monkeypox vaccination. Safety and affordability of vaccine and availability of information were essential aspects to reduce hesitancy. Education on vaccination benefits should be encouraged to promote future vaccination plans.

Our study aims to assess the uptake of COVID-19 vaccination and its associated factors among Chinese college students. A web-based cross-sectional study was conducted from 18 May to 17 June 2022. A total of 3916 participants were included. The coverage of the first dose, complete vaccination and booster vaccination among college students was 99.49%, 81.96% and 79.25%, respectively. College students with an older age (AOR: 0.72, 95% CI: 0.57–0.90), non-medical major (0.47, 0.37–0.61) and studying in north-east China (0.35, 0.22–0.58) were less likely to complete vaccination. Individuals who were female (1.62, 1.35–1.94) and received a recombinant subunit vaccine (8.05, 5.21–12.45) were more likely to complete vaccination. Non-medical students (0.56, 0.43–0.73) and students studying in north-east China (0.28, 0.16–0.49) were less likely to receive a booster dose, while female students (1.51, 1.23–1.85) had a higher likelihood. The main reason for being unvaccinated was “contraindication” (75.00%), and the main reason for not receiving a booster dose was “being too busy to attend to it” (61.37%). This study demonstrated a high adherence to the COVID-19 vaccination policy among Chinese college students. Targeted strategies should be applied to remove barriers to COVID-19 vaccination among college students.

With a large population most susceptible to Omicron and emerging SARS-CoV-2 variants, China faces uncertain scenarios if reopening its border. Thus, we aimed to predict the impact of combination preventative interventions on hospitalization and death. An age-stratified susceptible-infectious-quarantined-hospitalized-removed-susceptible (SIQHRS) model based on the new guidelines of COVID-19 diagnosis and treatment (the ninth edition) was constructed to simulate the transmission dynamics of Omicron within 365 days. At baseline, we assumed no interventions other than 60% booster vaccination in individuals aged <= 60 years and 80% in individuals aged >60 years, quarantine and hospitalization. Oral antiviral medications for COVID-19 and nonpharmaceutical interventions (NPIs) such as social distancing and antigen self-testing were considered in subsequent scenarios. Sensitivity analyses were conducted to reflect different levels of interventions. A total of 0.73 billion cumulative quarantines (95% CI 0.53-0.83), 33.59 million hospitalizations (22.41-39.31), and 0.62 million deaths (0.40-0.75) are expected in 365 days. The case fatality rate with pneumonia symptoms (moderate, severe and critical illness) is expected to be 1.83% (1.68-1.99%) and the infected fatality rate is 0.38 parts per thousand (0.33-0.4 parts per thousand). The highest existing hospitalization and ICU occupations are 3.11 (0.30-3.85) and 20.33 (2.01-25.20) times of capacity, respectively. Sensitivity analysis showed that interventions can be adjusted to meet certain conditions to reduce the total number of infections and deaths. In conclusion, after sufficient respiratory and ICU beds are prepared and the relaxed NPIs are in place, the SARS-CoV-2 Omicron variant would not seriously impact the health system.