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ObjectiveBlue sky has been considered to boost outdoor physical activity and social interaction, ameliorate work pressure and life stress, and enhance people's sense of happiness. However, the direct association between blue sky exposure and cardiovascular disease (CVD) still lacks epidemiological evidence. In this study, we aimed to quantify their relationship via a nationwide prospective cohort in China.MethodWe extracted the baseline data from the China Hypertension Survey (CHS), by enrolling 22,702 participants aged ≥ 35 years without self-reported medical history of CVD from 14 provinces of China between 2012 and 2015 and followed up from 2018 to 2019. A blue day was marked out with no rain, low cloud cover ≤ climatological mean at each station, and visibility at 2 pm ≥ 21.52 km. We calculated the number of blue days at baseline survey year to evaluate the chronic individual blue day exposure. Cox proportional hazards models were employed to calculate the multivariable-adjusted hazard ratio (HR). We implemented subgroup analyses as well to identify potential effect modifications.ResultsA total of 1,096, 993, and 597 incident cases of all-cause mortality, fatal or nonfatal CVD, and stroke occurred during a median follow-up around 5 years, respectively. A 10-day increase in annual blue day exposure was associated with a 3% (95% confidence interval [CI]: 1–6%) and 7% (95% CI: 5–10%) decreased risk of fatal or nonfatal CVD and stroke, respectively. Compared with those exposed to the worst tertile of blue days at baseline, subjects who exposed to the best tertile had a 32% (95% CI: 19–43%) and 43% (95% CI: 29–55%) lower likelihood of developing fatal or nonfatal CVD and stroke, respectively. Negative consistent exposure–response relationships were generally observed between them in the restricted cubic spline model. In the stratified analyses, the cardioprotective effects of blue sky were stronger for females, rural residents, and individuals residing in heavily contaminated areas.ConclusionThis study indicates that blue sky may serve as an independent environmental protective factor against CVD, and informs future policies on fighting air pollution and protecting the blue sky in China.

PurposeThe National Essential Public Health Services Package (NEPHSP), a set of community-based hypertension management programs, was launched by the Chinese government in 2009. However, the data are limited for the comprehensive evaluation of NEPHSP on hypertension management. This study was to estimate the effect of NEPHSP on hypertension control nationwide in China.MethodsData were from China Hypertension Survey (CHS). The participants (n = 119,412) aged ≥35 years with hypertension were included in the analysis. Further, a subset of 64,188 diagnosed hypertensive patients were analyzed to evaluate the effect of NEPHSP by comparing the ones covered and not covered by NEPHSP. Blood pressure (BP) was measured by trained staff using a validated digital portable monitor in local communities or clinics.ResultsAmong adults aged ≥35 years with hypertension, the coverage of NEPHSP was 25.6% and increased with age. The coverage was significantly higher in women than in men (P < 0.001). Among the 64, 188 diagnosed hypertensive patients, compared to the control group (not covered by NEPHSP), the mean systolic and diastolic BPs were 2 mmHg and 1.6 mmHg lower in NEPHSP group, respectively. The rate of treatment for hypertension was significantly higher in NEPHSP group than the control group (93.0% vs. 81.4%, P < 0.001), and the rate of BP control was also significantly higher in NEPHSP group than the control group (35.9% vs. 29.6%, P < 0.001). Furthermore, similar trends were found in rural and urban, as well as in men and women.ConclusionsOur results showed that NEPHSP is effective in improving hypertension treatment and control in hypertensive patients in China. However, the coverage of NEPHSP was still low.

Introduction: Research has demonstrated that higher social support is associated with better psychological health, quality of life, cognition, activities of daily living, and social participation, but the relationship between social support and sleep quality remains unknown. This study aims to investigate the mediating effects of anxiety and depression in the relationship between social support and sleep among community-dwelling patients with schizophrenia., Method: Purposive sampling was used to collect face-to-face data from 1,107 community-dwelling patients with schizophrenia in Chengdu, Sichuan Province, China, between April and July 2023. The Athens Insomnia Scale (AIS) was used to assess sleep quality; the Generalized Anxiety Disorder 7-item scale (GAD-7) was utilized to evaluate anxiety symptoms; and the Patient Health Questionnaire-9 (PHQ-9) was employed to assess depressive symptoms. The mediating effect of anxiety and depression symptoms was assessed using the bootstrap method via Model 6 (Serial multiple mediator model) of the SPSS PROCESS macro., Results: Among the 1,107 participants, the proportions of people with schizophrenia experiencing anxiety, depressive symptoms, and poor sleep quality were 22.8, 37.7, and 42.1%, respectively. Mediation analyses indicated that although social support had no direct effect on sleep quality, anxiety and depressive symptoms fully mediated the relationship between social support and sleep quality., Conclusion: Patients with schizophrenia experience low levels of social support and poor sleep quality. To enhance the sleep quality of individuals with schizophrenia, all levels of society (government, medical institutions, and communities) must pay more attention to mental health. Implementing diverse intervention measures to strengthen social support and improve symptoms of anxiety and depression should be considered. This approach may potentially lead to an improvement in sleep quality among individuals with schizophrenia., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Liu, Li, Chen, Tian, Liu, Liu, Liu, Yin, Wu, Zuo and He.)

Background: Owing to the long penetration depth of gamma (γ)-rays, individuals working in ionizing radiation environments are chronically exposed to low-dose γ-radiation, resulting in cognitive changes. Dose rate significantly affects radiation-induced biological effects; however, its role in chronic low-dose γ-irradiation-induced cognitive impairment remains unclear. We aimed to investigate whether chronic low-dose γ-irradiation at low-dose-rate (LDR) could induce cognitive impairment and to compare the cognitive alteration caused by chronic low-dose γ-irradiation at LDR and high-dose-rate (HDR)., Methods: The rats were exposed to γ-irradiation at a LDR of 6 mGy/h and a HDR of 20 mGy/h for 30 days (5 h/day). Functional imaging was performed to assess the brain inflammation and blood-brain barrier (BBB) destruction of rats. Histological and immunofluorescence analyses were used to reveal the neuron damage and the activation of microglia and astrocytes in the hippocampus. RNA sequencing was conducted to investigate changes in gene expression in hippocampus., Results: The rats in the LDR group exhibited more persistent cognitive impairment than those in the HDR group. Furthermore, irradiated rats showed brain inflammation and a compromised BBB. Histologically, the number of hippocampal neurons were comparable in the LDR group but were markedly decreased in the HDR. Additionally, activated M1-like microglia and A1-like astrocytes were observed in the hippocampus of rats in the LDR group; however, only M1-like microglia were activated in the HDR group. Mechanistically, the PI3K-Akt signaling pathway contributed to the different cognitive function change between the LDR group and HDR group., Conclusion: Compared with chronic low-dose γ-irradiation at HDR, LDR induced more severe cognitive impairment which might involve PI3K/Akt signaling pathway., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Ma, Li, Sang, Liu, Luo, Peng, Wang, Luo, Fang, Wang, Wang and Zuo.)

Aim: To evaluate the impact of a telemedicine medication management service in patients with hypertension., Methods: Participants were allocated to either a telemedicine service ( N = 173) or usual care (UC) ( N = 179). The primary outcome was blood pressure (BP) reduction from baseline to the 6-month follow-up visit, the proportion of the target BP achievement, overall adherence to prescribed medication as well as a composite of non-fatal stroke, non-fatal myocardial infarction and cardiovascular death., Results: At 6 months, BP was controlled in 89.6% ( n = 155) of intervention patients and 78.8% ( n = 141) of UC patients (OR = 1.14, 95% CI = 1.04-1.25, P = 0.006), giving a mean difference of -6.0 (-13.0 to -2.5 mmHg) and -2.0 mmHg (-4.0 to -0.1 mmHg) in SBP and DBP, respectively. 17.9% ( n = 31) of the patients in the intervention group were non-adherent with medications, compared with 29.1% ( n = 52) in the UC group ( P = 0.014). The composite clinical endpoints were reached by 2.9% in the intervention group and 4.5% in the control group with no significant differences (OR = 1.566, 95% CI = 0.528-4.646)., Conclusion: Telemedicine medication management for hypertension management had led to better BP control and medication adherence improvement than UC during COVID-19 epidemic, resulting in a reduction of overall adverse cardiovascular events occurrence., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Li, Hu, Yao, Zuo, Wang, Li and Lv.)

The vaccines are considered to be important for the prevention and control of coronavirus disease 2019 (COVID-19). However, considering the limited vaccine supply within an extended period of time in many countries where COVID-19 vaccine booster shot are taken and new vaccines are developed to suppress the mutation of virus, designing an effective vaccination strategy is extremely important to reduce the number of deaths and infections. Then, the simulations were implemented to study the relative reduction in morbidity and mortality of vaccine allocation strategies by using the proposed model and actual South Africa's epidemiological data. Our results indicated that in light of South Africa's demographics, vaccinating older age groups (>60 years) largely reduced the cumulative deaths and the "0-20 first" strategy was the most effective way to reduce confirmed cases. In addition, "21-30 first" and "31-40 first" strategies have also had a positive effect. Partial vaccination resulted in lower numbers of infections and deaths under different control measures compared with full vaccination in low-income countries. In addition, we analyzed the sensitivity of daily testing volume and infection rate, which are critical to optimize vaccine allocation. However, comprehensive reduction in infections was mainly affected by the vaccine proportion of the target age group. An increase in the proportion of vaccines given priority to "0-20" groups always had a favorable effect, and the prioritizing vaccine allocation among the "60+" age group with 60% of the total amount of vaccine consistently resulted in the greatest reduction in deaths. Meanwhile, we observed a significant distinction in the effect of COVID-19 vaccine allocation policies under varying priority strategies on relative reductions in the effective reproduction number. Our results could help evaluate to control measures performance and the improvement of vaccine allocation strategy for COVID-19 epidemic., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Zuo, Meng, Zhu, Zheng and Ling.)

Information awareness about COVID-19 spread through multiple channels can stimulate individuals to vaccinate to protect themselves and reduce the infection rate. However, the awareness individuals may lose competency over time due to the decreasing quality of the information and fading of awareness. This paper introduces awareness programs, which can not only change people from unaware to aware state, but also from aware to unaware state. Then an SEIRM/V mathematical model is derived to study the influence of awareness programs on individual vaccination behavior. We evaluate the dynamical evolution of the system model and perform the numerical simulation, and examine the effects of awareness transformation based on the COVID-19 vaccination case in China. The results show that awareness spread through various information sources is positively associated with epidemic containment while awareness fading negatively correlates with vaccination coverage., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Zuo, Zhu and Ling.)