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Background: Atrial fibrillation (AF) is underdiagnosed and especially undertreated in China. We aimed to investigate the prevalence of unknown and untreated AF in community residents (≥65 years old) and to determine whether an education intervention could improve oral anticoagulant (OAC) prescription. Methods and findings: We performed a single–time point screening for AF with a handheld single-lead electrocardiography (ECG) in Chinese residents (≥65 years old) in 5 community health centers in Shanghai from April to September 2017. Disease education and advice on referral to specialist clinics for OAC treatment were provided to all patients with actionable AF (newly detected or undertreated known AF) at the time of screening, and education was reinforced at 1 month. Follow-up occurred at 12 months. In total, 4,531 participants were screened (response rate 94.7%, mean age 71.6 ± 6.3 years, 44% male). Overall AF prevalence was 4.0% (known AF 3.5% [n = 161], new AF 0.5% [n = 22]). The 183 patients with AF were older (p < 0.001), taller (p = 0.02), and more likely to be male (p = 0.01), and they had a higher prevalence of cardiovascular disease than those without AF (p < 0.001). In total, 85% (155/183) of patients were recommended for OAC treatment by the established guidelines (CHA2DS2-VASc ≥ 2 for men; ≥ 3 for women). OAC prescription rate for known AF was 20% (28/138), and actionable AF constituted 2.8% of all those screened. At the 12-month follow-up in 103 patients (81% complete), despite disease education and advice on specialist referral, only 17 attended specialist clinics, and 4 were prescribed OAC. Of those not attending specialist clinics, 71 chose instead to attend community health centers or secondary hospital clinics, with none prescribed OAC, and 15 had no review. Of the 17 patients with new AF and a class 1 recommendation for OAC, only 3 attended a specialist clinic, and none were prescribed OAC. Of the 28 AF patients taking OAC at baseline, OAC was no longer taken in 4. Ischemic stroke (n = 2) or death (n = 3) occurred in 5/126 (4%), with none receiving OAC. As screening was performed at a single time point, some paroxysmal AF cases may have been missed; thus, the rate of new AF may be underestimated. Conclusions: We demonstrated a noticeable gap in AF detection and treatment in community-based elderly Chinese: actionable AF constituted a high proportion of those screened. Disease education and advice on specialist referral are insufficient to close the gap. Before more frequent or intensive screening for unknown AF could be recommended in China, greater efforts must be made to increase appropriate OAC therapy in known AF to prevent AF-related stroke. Ji-Guang Wang and colleagues highlight the gap between AF screening and treatment in Chinese residents over 65 years of age. Author summary: Why was this study done?: Atrial fibrillation (AF) is a common heart rhythm problem that often has no symptoms, so it is often underdiagnosed. People with AF can have a very high stroke risk, which is highly preventable with appropriate oral anticoagulant (OAC) medications. Neither the prevalence of unknown and untreated AF in the Chinese community nor whether patient education in the community health center has the potential to improve OAC prescription are known. What did the researchers do and find?: We screened for AF in residents aged ≥65 years in community health centers in Shanghai and provided disease education and advice on referral to specialist clinics for OAC treatment to people with newly detected or undertreated known AF. We demonstrated a noticeable gap in AF detection and treatment: 2.8% of those screened had unknown or untreated AF. At 12 months, only 17/103 people with newly detected or undertreated known AF attended specialist clinics, and only 4/17 had commenced OAC therapy. What do these findings mean?: We highlight a serious public health issue in China with underdiagnosis and undertreatment of AF in the community that requires a whole-of-system approach. To prevent AF-related stroke in China, greater efforts must be made to increase appropriate OAC therapy in people with AF. [ABSTRACT FROM AUTHOR]

Research has found that self-esteem is negatively associated with problematic smartphone use (PSU). However, the internal mechanisms underlying that relationship need further investigation. The purpose of this study was to investigate the roles of depression and interpersonal trust in the relationship between self-esteem and PSU among adolescents. A questionnaire comprised of the Rosenberg Self-esteem Scale, Inclusive General Trust Scale (IGTS), Self-rating Depression Scale (SDS), and personal questions was administered to 637 students (female = 355) at two middle schools in Shanghai, China. Correlation analyses, mediation analysis, and moderated mediation analysis were performed. A moderated mediation model was established, which revealed: (1) a significant negative association between self-esteem and PSU, (2) depression mediated the relationship between self-esteem and PSU, and (3) the influence of depression on the relationship between self-esteem and PSU was moderated by interpersonal trust. The results indicated that low self-esteem was a risk factor, and interpersonal trust was a moderating factor for PSU among adolescents in the sample. Building adolescents' self-esteem and increasing their interpersonal trust might decrease their PSU. [ABSTRACT FROM AUTHOR]

OBJECTIVE Atrial fibrillation (AF) and hypertension are prevalent chronic disease conditions in the elderly population. In the present cross-sectional study, we investigated the association between blood pressure (BP) and AF in an elderly Chinese population. METHOD Our elderly (≥65 years) subjects were residents recruited from 6 communities in Shanghai from 2006 to 2017. Atrial fibrillation was systematically screened by rest 12-lead electrocardiogram (ECG) or by a handheld single-lead ECG. BP status was defined according to the European hypertension guidelines as optimal, normal, or high-normal BP, and stage 1, 2, or 3 hypertension. RESULT In the 6,966 participants (women 56.0%, mean age: 72.3 years), the prevalence of AF was 3.3%, and the prevalence of hypertension was 58.7% (83.7% treated). In all participants, the association with prevalent AF was negative for systolic BP (odds ratio [OR] per 10-mm Hg increase 0.79, 95% confidence interval [CI]: 0.71–0.88, P < 0.0001) but positive for diastolic BP (OR per 5-mm Hg increase 1.11, 95% CI: 1.02–1.22, P = 0.02). In untreated participants (n = 3,544), the association with prevalent AF was U-shaped for both systolic and diastolic BP, with the nadir at high-normal BP and a significantly higher risk of prevalent AF in optimal systolic BP (OR: 3.11, 95% CI: 1.65–5.85, P = 0.004) and stage 2 or 3 diastolic hypertension relative to the nadir (OR: 8.04, 95% CI: 2.28–28.3, P = 0.001). CONCLUSION In the elderly population, BP shows a complicated relationship with prevalent AF, with high-normal BP at the lowest risk and optimal systolic BP and stage 2 or 3 diastolic hypertension at increased risks. [ABSTRACT FROM AUTHOR]

Airborne particulate samples (including dust storm period samples) were collected from the Putuo, Qingpu and Minhang districts of Shanghai city from October, 2009 to October, 2010, and also tracked the dust transporting pathways from NW (Northwest) to SE (Southeast) including the cities of Xi'an, Beijing, Zhengzhou and Nantong, as a means of sampling the dust storm particulate matter in the spring of 2010. After measuring the magnetic parameters and the concentrations of particles and heavy metals, their magnetic properties were analyzed to track the source locations of heavy metal pollution during dust storm events, and then combined for backward trajectory analysis. It was found that the slightly polluted dust particles carried many contaminants during dust storm periods when the dust palls were transported by winter monsoon winds from the NW desert region towards the SE. The contaminants were further increased by contributions of fine SP&SD grains derived from local automobile exhausts in Shanghai as well as being enriched also in Northern cities during non-dust storm periods. A significantly positive linear relation was found between the χ and SIRM of loess and the storm dust, indicating a similar material source for these two kinds of samples. A higher χ and SIRM in storm dust content compared to loess suggests that storm dust contains not only materials from natural sources, but also those from partly anthropogenic sources. Backward trajectory analysis indicates intuitively the source region of the Shanghai storm dust. These conclusions have important scientific significance for research on long-distance transportation of contaminants (such as heavy metals) adsorbed onto airborne particulate matter during dust storm events. [ABSTRACT FROM AUTHOR]

Intensive blood pressure (BP) lowering in patients with hypertension has been associated with a lowered risk of atrial fibrillation (AF). It is still uncertain what is the optimal BP levels to prevent AF in the general elderly population. In the present prospective study, we investigated the association between incident AF and BP in an elderly Chinese population. Elderly (≥65 years) residents were recruited from 6 communities in Shanghai. 9019 participants who did not have AF at baseline and had at least one ECG recording during follow-up were included in the present analysis. During a median of 3.5 years follow-up, the overall incidence rate of AF was 5.6 per 1000 person-years (n = 178). Systolic BP was associated with increased AF risk (age- and sex-adjusted hazard ratio [HR] per 20-mmHg increase for systolic BP 1.21, 95% CI 1.04–1.39, P = 0.01), but risk estimate was attenuated after adjustment for common AF risk factors. In categorical analyses, statistical significance was achieved for HR relative to optimal BP only in stage 2 or 3 systolic and diastolic hypertension (multivariate-adjusted HR 1.76, 95% CI 1.00–3.08, P = 0.05). The association between AF incidence and BP status tended to be stronger in the absence than presence of a history of cardiovascular disease at baseline (P for interaction = 0.06). In this Chinese population of 65 years and older, linear increases in systolic and diastolic BP were not independently associated with increased risk of AF, and only exposure to stage 2 or 3 hypertension carries a higher risk of AF. • Linear increases of BP were not independently associated with increased risk of AF. • Only stage 2 or 3 hypertension carries a higher risk of AF. • Stringent BP control may be more useful in younger patients to prevent AF. [ABSTRACT FROM AUTHOR]