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Background: The burgeoning incidence and mortality rates of tumors, exacerbated by an aging population, pose a significant public health challenge in China. While global and domestic trends from 2018 to 2022 indicate a stabilization or decline in liver cancer rates, the spatiotemporal dynamics and disease burden among the elderly in Yunnan, China, remain insufficiently characterized. Methods: This study encompasses a retrospective analysis of 26,328 liver cancer patients aged 60 and above, drawn from the household population of Yunnan, China, between 2012 and 2020. The evaluation adheres to the China Cancer Registry Guidance Manual (2016) and aligns with data standards set by the International Agency for Research on Cancer (IARC) and the International Association of Cancer Registries (I-ACR). The Joinpoint software was utilized to ascertain the annual percentage change (APC) in liver cancer incidence and mortality from 2012 to 2020. Findings: Between 2012 and 2020, the incidence rate of liver cancer among the elderly in Yunnan, China, stood at 71.76 per 100,000 (CSR of 70.87 per 100,000 and WSR of 69.55 per 100,000), with a male incidence rate of 99.39 per 100,000 (CSR 99.10 per 100,000 and WSR 97.78 per 100,000) and a female rate of 45.91 per 100,000 (CSR 43.95 per 100,000 and WSR 42.54 per 100,000). The mortality rate for liver cancer in this demographic was 70.12 per 100,000 (CSR 68.43 per 100,000 and WSR 66.73 per 100,000), with males at 96.65 per 100,000 (CSR 95.61 per 100,000 and WSR 93.69 per 100,000) and females at 45.31 per 100,000 (CSR 42.63 per 100,000 and WSR 41.05 per 100,000). Liver cancer incidence among elderly males in Yunnan Province ranked third among all malignant tumors in 2012 and maintained this ranking in 2020. For elderly females, liver cancer rose from the fourth to the third position, marking an increase of one rank. Mortality rankings placed liver cancer second among males and third among females, with no change observed. Over the 2012-2020 period, the incidence rate of liver cancer in Yunnan's elderly exhibited an overall upward trajectory (APC 95% CI: 0.37%-3.8%), with male and female trends remaining stable (males: APC 95% CI: -0.35%-5.83%; females: APC 95% CI: -3.67%-7.26%). The overall mortality trend for liver cancer in the elderly was upward (APC 95% CI: 1.35% to 4.12%), with males showing an increasing trend (APC 95% CI: 0.74% to 4.51%) and females maintaining a stable rate (APC 95% CI: -0.85% to 8.0%). Interpretation: The incidence of malignant tumors correlates with the Human Development Index (HDI), with liver cancer prevalent in regions of lower HDI. While the incidence rate of liver cancer among the elderly in China has been on a downward trajectory in recent years, mirroring trends in Asia, Yunnan's elderly population defies this pattern with increasing incidence and mortality rates. This divergence from the national trend underscores the need for a focused, precision public health approach to liver cancer prevention and control, particularly among the elderly population in this underdeveloped region. more...

BackgroundThe mpox pandemic has caused widespread public concern around the world. The spread of misinformation through the internet and social media could lead to an infodemic that poses challenges to mpox control. ObjectiveThis review aims to summarize mpox-related infodemiology studies to determine the characteristics, influence, prevention, and control measures of the mpox infodemic and propose prospects for future research. MethodsThe scoping review was conducted based on a structured 5-step methodological framework. A comprehensive search for mpox-related infodemiology studies was performed using PubMed, Web of Science, Embase, and Scopus, with searches completed by April 30, 2024. After study selection and data extraction, the main topics of the mpox infodemic were categorized and summarized in 4 aspects, including a trend analysis of online information search volume, content topics of mpox-related online posts and comments, emotional and sentiment characteristics of online content, and prevention and control measures for the mpox infodemic. ResultsA total of 1607 articles were retrieved from the databases according to the keywords, and 61 studies were included in the final analysis. After the World Health Organization’s declaration of an mpox public health emergency of international concern in July 2022, the number of related studies began growing rapidly. Google was the most widely used search engine platform (9/61, 15%), and Twitter was the most used social media app (32/61, 52%) for researchers. Researchers from 33 countries were concerned about mpox infodemic–related topics. Among them, the top 3 countries for article publication were the United States (27 studies), India (9 studies), and the United Kingdom (7 studies). Studies of online information search trends showed that mpox-related online search volume skyrocketed at the beginning of the mpox outbreak, especially when the World Health Organization provided important declarations. There was a large amount of misinformation with negative sentiment and discriminatory and hostile content against gay, bisexual, and other men who have sex with men. Given the characteristics of the mpox infodemic, the studies provided several positive prevention and control measures, including the timely and active publishing of professional, high-quality, and easy-to-understand information online; strengthening surveillance and early warning for the infodemic based on internet data; and taking measures to protect key populations from the harm of the mpox infodemic. ConclusionsThis comprehensive summary of evidence from previous mpox infodemiology studies is valuable for understanding the characteristics of the mpox infodemic and for formulating prevention and control measures. It is essential for researchers and policy makers to establish prediction and early warning approaches and targeted intervention methods for dealing with the mpox infodemic in the future. more...

BackgroundYunnan province borders Myanmar, Laos, and Vietnam, giving it one of the longest borders in China. We aimed to determine the trends in prevalence and impact of COVID-19 on depressive symptoms among adolescents (12-18 years) from 2018 to 2022 in Yunnan, southwest China. ObjectiveWe evaluated the impact of the COVID-19 epidemic on adolescents’ mental health, with the aim of reducing the effect of psychological emergency syndrome and promoting healthy, happy adolescent growth. MethodsThis longitudinal, observational study used Students’ Health Survey data on adolescents’ depressive symptoms from 2018 to 2022 (before and during COVID-19) in Yunnan. We used multistage, stratified sampling in 3 prefectures in 2018 and 16 prefectures from 2019 to 2022. In each prefecture, the study population was classified by gender and residence (urban or rural), and each group was of equal size. Depressive symptoms were diagnosed based on Center for Epidemiological Studies Depression Scale (CES-D) scores. We used ANOVA to assess the differences in mean CES-D scores stratified by gender, age, residence, grade, and ethnicity. Chi-square tests were used to compare depressive symptoms by different variables. For comparability, the age-standard and gender-standard population prevalences were calculated using the 2010 China Census as the standard population. The association between COVID-19 and the risk of a standardized prevalence of depressive symptoms was identified using unconditional logistic regression analysis. ResultsThe standardized prevalence of depressive symptoms for all participants was 32.98%: 28.26% in 2018, 30.89% in 2019, 29.81% in 2020, 28.77% in 2021, 36.33% in 2022. The prevalences were 30.49% before COVID-19,29.29% in early COVID-19, and 36.33% during the COVID-19 pandemic. Compared with before COVID-19, the risks of depressive symptoms were 0.793 (95% CI 0.772-0.814) times higher in early COVID-19 and 1.071 (95% CI 1.042-1.100) times higher than during COVID-19. The average annual increase in depressive symptoms was 1.61%. During the epidemic, the prevalence of depressive symptoms in girls (36.87%) was higher than that in boys (28.64%), and the acceleration rate of girls was faster than that of boys. The prevalences of depressive symptoms and acceleration rates by age group were as follows: 27.14% and 1.09% (12-13 years), 33.99% and 1.8% (14-15 years), 36.59% and 1.65% (16-18 years). Prevalences did not differ between Han (32.89%) and minority (33.10%) populations. However, the acceleration rate was faster for the former than for the latter. The rate for senior high school students was the highest (34.94%). However, the acceleration rate for vocational high school students was the fastest (2.88%), followed by that for junior high school students (2.32%). Rural residents (35.10%) had a higher prevalence and faster acceleration than urban residents (30.16%). ConclusionsFrom 2018 to 2022, there was a significant, continuous increase in the prevalence of depressive symptoms among adolescents in Yunnan, China, especially during the COVID-19 pandemic. This represents an emergency public health problem that should be given more attention. Effective, comprehensive psychological and lifestyle intervention measures should be used to reduce the prevalence of mental health issues in adolescents. more...

BackgroundThe Dulong people are one of the minorities in China with the lowest population. In recent years, the lifestyle of the Dulong people has also changed drastically due to income growth and urbanization. This study aims to identify cigarette smoking prevalence and potential risk factors among Dulong adults in China.MethodsThis study was conducted among 1,018 adults based on the Dulong Health Status Investigation and Evaluation (DHSIE) in Gongshan Dulong and Nu Autonomous County of Yunnan province, Southwest China. A cross-sectional design and face-to-face questionnaire were used to collect cigarette smoking habits and demographic information. Data were weighted by post-stratification weights according to the age and gender composition of Dulong resident. We also analyzed univariate and multivariate unconditional logistic regression to explore current smoking correlates.ResultsThe weighted prevalence of ever-smoking, currently smoking, and formerly smoking among Dulong adults is 31.3, 27.7, and 3.6%, respectively. The prevalence of ever-smoking and currently smoking among male participants (57.0 and 50.6%) is much higher than that of female participants (4.0 and 3.4%). Nearly 60% of ever-smokers and current smokers smoked more than 20 cigarettes per day, which are higher than former smokers (35.2%). Among current smokers, 33.1% relapsed, and 28.3% intend to quit smoking. By adjusting for potential confounding variables, multiple logistic regression analysis indicated that male participants (OR = 48.982, 95% CI: 25.026–95.869) and current drinkers (OR = 4.450, 95% CI: 2.556–7.746) are more likely to be current smokers. On the contrary, current smokers are also more likely to be exposed to secondhand smoke (OR = 4.269, 95% CI: 2.330–7.820) and have a higher risk of chronic respiratory disease (OR = 4.955, 95% CI: 1.669–14.706).ConclusionCigarette smoking is highly prevalent among the Dulong people in Southwest China. An appropriate and effective tobacco control strategy is an urgent need for this population. more...

ObjectivesTo provide us with some evidence to develop more targeted stroke intervention strategies, improve the health awareness of stroke among children, and advocate the health promotion campaign of “small hands holding big hands” among parents and children, we have conducted a health education program on stroke among primary school students in Dali.MethodsThis study has applied stratified random cluster sampling in Dali of Yunnan, China. We compared the improvement of students' knowledge of stroke before and after our health education program in primary school students of Dali in October 2020. Data were collected through 3 rounds of survey by using the same questionnaire.ResultsThere were 215 participants aged 7–8 years old sampled in the first phase of the study and 145 participants in the follow-up study. The knowledge of stroke among the participants was relatively low in the pre-intervention survey. After the health education, all the indicators on stroke knowledge were improved. The correct rates in stroke definition, sequelae, and “1-2-0” identification were increased from 0 to 66.05%, to 53.95% and 64.19%, respectively, in both pre-intervention and post-intervention surveys. The correct rate of stroke knowledge was about 4.83–92.41% 3 months after the intervention. The mean score of the questionnaire was 4.25 ± 0.19 in the pre-intervention survey, and that was 15.85 ±0.27 in the post-intervention one. The mean score was 14.02 ± 0.28 post-3-month test. The score in the 3-month survey after the intervention was 11.55% lower than that in the post-intervention score.ConclusionsThe effect of stroke-related knowledge in the health education program for children is improved significantly and this can last for 3 months but it also had attenuation. We should repeat pertinent health education among students. more...

Abstract Background We aim to describe the prevalence and trends of hypertension among 9–17 school-aged students from 2017 to 2019 in Yunnan, China. Methods We conducted a cross-sectional study by using data from the Students’ Health Surveillance Surveys of 2017, 2018 and 2019 in Yunnan. The Students’ Health Surveillance Surveys in Yunnan collected date on physical fitness and health status of students in Yunnan through multistage-stratified sampling in 3 prefectures. In each prefecture, the study population were classified by gender and region (urban or rural), and each group had an equal size. Diagnosing criteria of hypertension was set with reference to Chinese age-specific and height-specific blood pressure (BP), to identify the abnormal status of boys and girls separately. ANOVA test was adopted to measure the differences in the mean BP stratified by gender, age, prefecture and area, and Chi-square test was used to compare the percentages of hypertension in different areas. For comparability, the age-standard and gender-standard population prevalence was calculated by directly using China Census in 2010 as a standard population. Totally 24,890 participants aged 9–17 years were included in this study. Results From 2017 to 2019, there were 24,872 students completed physical examinations and included in the analysis, of which 3288 were diagnosed with hypertension. The total prevalence of hypertension was 13.72, 12.49 and 13.45% among 9–17 years school-aged population in Yunnan, respectively. The total age-standardized hypertension prevalence trended to decrease from 13.82 to 13.48%. For urban population, the age-standardized hypertension prevalence decreased slightly from 11.24 to 10.13%. While, for rural population, it increased from 17.58 to 19.16%. The average annual growth rate in rural population was 0.53%. Conclusions From 2017to 2019, there was a significant and continuous increase in the prevalence of hypertension in 9–17 years school-aged population in Yunnan. Hypertension is epidemic among children and adolescents in Yunnan. We should take effective and comprehensive intervention measures to reduce its prevalence among school-aged children. more...

BackgroundLeprosy is associated with different dermatologic and neurologic manifestations within a wide clinical spectrum, causing a great diagnostic challenge. Therefore, we aimed to examine associations between common presenting symptoms of leprosy and stage at diagnosis.Methodology/principal findingsIn this cross-sectional study, we analyzed population-level data from the Leprosy Management Information System (LEPMIS) in Yunnan, China, from 2010-2020 and enrolled patients with newly detected leprosy. The data of 2125 newly detected leprosy patients, with 5000 symptoms, were analyzed. Numbness (828/5000, 16.56%), erythema (802/5000, 16.04%), Painless nor pruritic skin lesions (651/5000, 13.02%), eyebrow hair loss (467/5000, 9.34%), and tubercles (442/5000, 8.84%) were common symptoms of leprosy. The symptoms related to skin (1935/2533, 76.39%) and leprosy reaction (279/297, 93.94%) were mainly existed in MB group. While the symptoms related to disability (263/316, 83.49%), clinical feature (38/56, 69.09%), and facial features (19/23, 82.61%) were predominantly presented in delayed diagnostic group. Despite low proportions, formic sensation (99/5000, 1.98%), pain (92/5000, 1.84%), pruritus (56/5000, 1.12%), finger contracture (109/5000, 2.18%), muscle atrophy (71/5000, 1.42%), and motor dysfunction (18/5000, 0.36%) were reported during the diagnosis of leprosy. The proportions of skin, skin and nerve, and nerve symptoms as initial symptoms were 33.25%, 44.95%, and 21.80% and as only symptoms were 28.66%, 57.81%, and 13.91%, respectively. In those with physical disability, nerve symptoms were the most frequent symptoms (57.65% and 65.36% for the initial and only symptoms, respectively) compared with skin and skin and nerve symptoms. In the delayed diagnosis group, nerve symptoms were the most frequent symptoms (15.73% and 17.25%) and were associated with the longest diagnostic intervals (mean±SD: 38.88±46.02 and 40.35±49.36 months for initial and only symptoms, respectively) when compared with skin and skin and nerve symptoms.ConclusionsUnderstanding the nature of presenting symptoms and developing symptom awareness campaigns would improve the level of leprosy awareness in the community. As nerve symptoms were related to a higher proportion of physical disability and longer diagnosis interval, we should increase awareness about nerve symptoms. Individuals with nerve symptoms should be considered the target group. Neurology outpatient visits may provide potential screening opportunities, and holding focused training for specialized neurology medical staff would enhance the capacity of the health system to recognize leprosy early. more...

Background Leprosy is potentially debilitating. The risk factors related to physical disabilities associated with leprosy disease in Yunnan, China was not clear. Methodology/Principal findings We studied 10644 newly detected leprosy patients from Yunnan, China, from 1990 to 2019. Factors associated with Grade 1 (G1D) and Grade 2 (G2D) physical disabilities or overall physical disabilities (combined G1D and G2D) associated with leprosy were analyzed using multinomial and ordinal logistic regression analyses. The following factors were associated with the development of physical disability in these patients with leprosy: delayed diagnosis [odds ratio (OR): 5.652, 4.399, and 2.275; 95% confidence intervals (CIs): 4.516–7.073, 3.714–5.212, and 2.063–2.509; for ≥ 10, 5–10 y, and 2–5 years, respectively], nerve damage (OR: 3.474 and 2.428; 95% CI: 2.843–4.244, and 1.959–3.008; for 2 and 1 damaged nerves, respectively), WHO classification of PB (OR: 1.759; 95% CI: 1.341–2.307), Ridley-Jopling classification (OR: 1.479, 1.438, 1.522 and 1.239; 95% CI: 1.052–2.079, 1.075–1.923, 1.261–1.838, and 1.072–1.431; for TT, BT, BB, and BL when compared with LL, respectively), advanced age (OR: 1.472 and 2.053; 95% CI: 1.106–1.960 and 1.498–2.814; for 15–59 and over 60 years old, respectively), zero skin lesions (OR: 1.916; 95% CI: 1.522–2.413), leprosy reaction (OR: 1.528; 95% CI: 1.195–1.952), rural occupation (OR: 1.364; 95% CI: 1.128–1.650), Han ethnicity (OR: 1.268; 95% CI: 1.159–1.386), and male sex (OR: 1.128; 95% CI: 1.024–1.243). Conclusions Delayed diagnosis, nerve damage, no skin lesions, WHO and Ridley-Jopling classifications, leprosy reactions, advanced age, rural occupation, Han ethnicity, and male sex were associated with disability in leprosy patients. Identifying risk factors could help to prevent physical disability. Author summary Leprosy, caused by Mycobacterium leprae (M. leprae), is a potentially disabling infectious disease. After achieving the national elimination target, the focus of leprosy care is now shifting from implementing multidrug therapy (MDT) to accelerating the reduction in disease burden, especially stopping leprosy and its complications, with targets for 2020 of 0 new child cases with Grade 2 disability (G2D) and more...

IntroductionAlthough parenting is a worthwhile and joyful process, it can also cause stress, potentially leading to parental burnout. With the implementation of the three-child policy in China, more parenting hours and higher economic costs may increase the risk of parental burnout.ObjectivesThis study investigated how was maternal parenting stress related to mothers’ parental burnout, as well as the potential mediating effect of their marital satisfaction and the moderating effect of their socioeconomic status on this relationship.MethodsData were collected from 314 mothers living in mainland China. The Chinese versions of the Parenting Burnout Assessment Scale, Parenting Stress Index, and Marriage Perception Scale were used to measure mothers’ parental burnout, parenting stress, and marital satisfaction.ResultsMothers‘ parenting stress was significantly and positively related to mothers’ parenting burnout. Mothers’ marital satisfaction mediated this relationship. Mothers’ socioeconomic status moderated the first half of the mediation model, and parenting stress exhibited a greater effect on marital satisfaction when mothers had a higher socioeconomic status.DiscussionThese findings indicated that mothers’ parenting stress could be alleviated by increasing marital satisfaction, which, in turn, reduced the risk of parental burnout. Furthermore, socioeconomic status may enhance the negative effects of parenting stress on marital satisfaction among mothers. more...

Abstract Background Gastric cancer is a major public health problem worldwide. Social media has affected public’s daily lives in ways no one ever thought possible. Both TikoTok and its Chinese version Douyin are the most popular short video posting platform. This study aimed to evaluate the quality, accuracy, and completeness of videos for gastric cancer on TikTok and Douyin. Methods The terms “gastric cancer” was searched on TikTok in both English and Japanese, and on Douyin in Chinese. The first 100 videos in three languages (website’s default setting) were checked. QUality Evaluation Scoring Tool (QUEST) and DISCERN as the instrument for assessing the quality of the information in each video. Content was analysed under six categories (aetiology, anatomy, symptoms, preventions, treatments, and prognosis). The educational value and completeness were evaluated with a checklist developed by the researchers. Results A total of 78 videos in English, 63 in Japanese, and 99 in Chinese were analyzed. The types of sources were as follows: 6.4% in English, 4.8% in Japanese, and 57.6% in Chinese for health professionals; 93.6% in English, 95.2% in Japanese, and 3.0% in Chinese for private users; none in English and Japanese, but 39.4% in Chinese for other sources. In all, 20.5% in English, 17.5% in Japanese, and 93.9% in Chinese of videos had useful information about gastric cancer. Among the useful videos, the videos published in Chinese had the highest QUEST(p more...

Summary: Background: Leprosy is an infectious disease that mostly affects underserved populations. Although it has been largely eliminated, still about 200’000 new patients are diagnosed annually. In the absence of a diagnostic test, clinical diagnosis is often delayed, potentially leading to irreversible neurological damage and its resulting stigma, as well as continued transmission. Accelerating diagnosis could significantly contribute to advancing global leprosy elimination. Digital and Artificial Intelligence (AI) driven technology has shown potential to augment health workers abilities in making faster and more accurate diagnosis, especially when using images such as in the fields of dermatology or ophthalmology. That made us start the quest for an AI-driven diagnosis assistant for leprosy, based on skin images. Methods: Here we describe the accuracy of an AI-enabled image-based diagnosis assistant for leprosy, called AI4Leprosy, based on a combination of skin images and clinical data, collected following a standardized process. In a Brazilian leprosy national referral center, 222 patients with leprosy or other dermatological conditions were included, and the 1229 collected skin images and 585 sets of metadata are stored in an open-source dataset for other researchers to exploit. Findings: We used this dataset to test whether a CNN-based AI algorithm could contribute to leprosy diagnosis and employed three AI models, testing images and metadata both independently and in combination. AI modeling indicated that the most important clinical signs are thermal sensitivity loss, nodules and papules, feet paresthesia, number of lesions and gender, but also scaling surface and pruritus that were negatively associated with leprosy. Using elastic-net logistic regression provided a high classification accuracy (90%) and an area under curve (AUC) of 96.46% for leprosy diagnosis. Interpretation: Future validation of these models is underway, gathering larger datasets from populations of different skin types and collecting images with smartphone cameras to mimic real world settings. We hope that the results of our research will lead to clinical solutions that help accelerate global leprosy elimination. Funding: This study was partially funded by Novartis Foundation and Microsoft (in-kind contribution). more...

In China, the health of the elderly has long been discussed, but few have investigated the diversity of the aging pattern in later life of this population. Although a large body of literature has approved the positive association between socioeconomic status (SES) and health, it still remains controversial regarding whether the association becomes convergent or divergent in old ages. Using data from China's 2010 and 2015 Inter-census Survey (1‰ sample), this paper explored the role of two key SES indicators, educational attainment and housing condition in modifying the self-rated health of Chinese elders aged 60 and above. We observed the diversified patterns of how educational attainment and housing condition have made an impact on the health of these elders in their old age and the temporal changes of the two SES indicators. We found higher educational attainment and better housing condition can lead to higher self-rated health. This positive significance however diminished with age over time, as we observed from 2010 to 2015, indicating the convergent effects of SES on health in old age. We also found that although educational attainment and housing condition were both positively correlated with health, their effects were differentiated. The influence of educational attainment on health waxed, whereas on housing conditions waned over time. These findings suggested the heterogeneity of health and SES effects among Chinese elders. more...