Viral Vaping: A systematic review and meta analysis of e-cigarette and Tobacco-Related social media content and its influence on youth behaviours and attitudes

AIMS

E-cigarette and tobacco-related content on social media continues to rise from lax restrictions on both personal and promotional posts. This content has been linked to various mechanisms of increased e-cigarette and tobacco use (i.e., lower risk perceptions and increased susceptibility). This study aimed to synthesis the association between exposure to e-cigarette and tobacco-related content and youth behaviours and attitudes.

METHODS

A comprehensive search was conducted on PubMed, Scopus, PsycINFO and Web of Science. Studies published post-2004 reporting effect estimates for exposure or engagement with e-cigarette or tobacco content on social media and behaviour or attitude outcomes were included.

RESULTS

Thirty-two studies (N = 274,283, aged 9 to 25 years) were included for synthesis. Meta-analyses revealed significant associations between engagement with tobacco content and use (OR 2.21; 95% CI = 1.27-3.82, p =.005; I2 = 96.4%), exposure to tobacco content and never users' lower risk perceptions (OR 0.68; 95% CI = 0.49-0.91; p =.011; I2 = 78.2%), and exposure to e-cigarette content and use (OR 1.37; 95% CI = 0.99-1.88; p = 0.058; I2 = 64.4%). There was no observed relationship between exposure to tobacco content and ever users' risk perceptions (OR 0.83; 95% CI = 0.61-1.13; p =.231; I2 = 83.5%). Qualitative synthesis found significant associations between tobacco exposure and increased current use and pro-tobacco attitudes; e-cigarette exposure and increased susceptibility and lower risk perceptions; tobacco engagement and increased susceptibility; e-cigarette engagement and increased use; dual exposure and increased susceptibility; and dual engagement and increased dual use. Mixed findings were identified for the influence of e-cigarette exposure on attitudes, tobacco exposure on susceptibility, dual exposure on dual use behaviours, and dual engagement on dual susceptibility.

CONCLUSIONS

Findings suggest an association between exposure and engagement to e-cigarette or tobacco products on social media and use or pro-use attitudes among youth. Further substantive research in the area of youth-specific use and attitudes following exposure and engagement with e-cigarette and tobacco content is needed to quantify this association.

Association between uncontrolled diabetes and periodontal disease in US adults: NHANES 2009-2014

This study examined the relationship between uncontrolled diabetes and periodontal disease (PD) among adults in the United States. We used data from the 2009-2014 National Health and Nutrition Examination Survey (NHANES) with a sample of 6108 adults ages 30 and over. To measure PD status, we used the Centers for Disease Control and Prevention/American Academy of Periodontology's standards. To classify DM status (no DM, DM with HbA1c < 9%, diabetes with HbA1c ≥ 9%),we used self-reported Diabetes Mellitus (DM) diagnosis and laboratory report of HbA1c. Approximately 8.5% of the sample had controlled DM, and 1.7% had uncontrolled DM, for a total of 10.2% DM in the analysis. Multivariate logistic regression showed that compared to those without DM, PD was significantly increased with controlled DM (adjusted odds ratio (aOR) = 1.32, 95% confidence interval (CI) 1.01-1.73, p < 0.05) and even more with uncontrolled DM (aOR = 2.48, 95% CI 1.52-4.04, p < 0.001), after adjusting for covariates. Factors that reduced the prevalence of PD included annual dental visits, female gender, and college education. Factors that significantly increased PD prevalence were cigarette smoking, non-white race, income < 200% Federal Poverty Level, and older age (age > 50 years). In conclusion, uncontrolled DM was significantly associated with higher odds of PD among adults in the US.

COVID-19 infection and mortality among non-pregnant indigenous adults in Mexico 2020-2022: Impact of marginalisation

Background

Indigenous individuals have higher rates of mortality and poverty in Mexico and more than half are marginalised, and COVID-19 pandemic aggravated the existing burden of health disparities. We aimed to analyse the effects of being indigenous and marginalised on coronavirus (COVID-19) infection fatality in Mexico.

Methods

We identified 3 424 690 non-pregnant, COVID-19 positive adults ≥19 years in the Mexico national COVID-19 database with known date of symptom. We used demographic information, indigenous status, marginalisation status, and co-morbidities in binary logistic regression to predict mortality, adjusting for covariates, including hospitalisation, admission to the intensive care unit (ICU), and mechanical ventilation use. We also assessed the interaction between indigenous status and marginalisation.

Results

Marginalisation was much higher among indigenous (53.7%) compared to non-indigenous individuals (4.8%). COVID-19 fatalities were approximately 20 years older (64.4 and 63.0 years) than survivors (44.7 and 41.2 years) among indigenous vs non-indigenous individuals, respectively. The unadjusted risk of COVID-19 fatality among indigenous individuals was nearly two-fold (odds ratio (OR) = 1.92)) compared to non-indigenous individuals (OR = 1.05). COVID-19 fatality was higher among highly marginalised individuals (upper quartile) (OR = 1.51; 95% confidence interval (CI) = 1.49-1.54). Marginalised indigenous individuals had a significantly lower likelihood of ICU admission compared to non-indigenous non-marginalised individuals. The likelihood of mechanical ventilation for indigenous individuals was 4% higher compared to non-indigenous individuals. Indigenous marginalised individuals had a significantly lower probability of mechanical ventilation compared to non-indigenous non-marginalised individuals. COVID-19 comorbidity risks of fatality significantly differed between the two groups in the Cox survival analysis. In the fully adjusted model, indigenous individuals were 4% more likely to die from COVID-19 compared to non-indigenous.

Conclusions

Indigenous, marginalised individuals with COVID-19 had higher risk of hospitalisation and ICU admission than non-indigenous patients. Marginalised, indigenous individuals were less likely to receive mechanical ventilation compared to non-indigenous, but had a higher risk of COVID-19. Indigenous individuals had a 4% higher COVID-19 mortality risk COVID-19 compared to non-indigenous individuals. Improved community medical care and augmented health services in rural hospitals could mitigate barriers to health care access in indigenous, marginalised populations.

Predicting the long-term effects of electronic cigarette use on population health: a systematic review of modelling studies

OBJECTIVE

To systematically review and synthesise the findings of modelling studies on the population impacts of e-cigarette use and to identify potential gaps requiring future investigation.

DATA SOURCE AND STUDY SELECTION

Four databases were searched for modelling studies of e-cigarette use on population health published between 2010 and 2023. A total of 32 studies were included.

DATA EXTRACTION

Data on study characteristics, model attributes and estimates of population impacts including health outcomes and smoking prevalence were extracted from each article. The findings were synthesised narratively.

DATA SYNTHESIS

The introduction of e-cigarettes was predicted to lead to decreased smoking-related mortality, increased quality-adjusted life-years and reduced health system costs in 29 studies. Seventeen studies predicted a lower prevalence of cigarette smoking. Models that predicted negative population impacts assumed very high e-cigarette initiation rates among non-smokers and that e-cigarette use would discourage smoking cessation by a large margin. The majority of the studies were based on US population data and few studies included factors other than smoking status, such as jurisdictional tobacco control policies or social influence.

CONCLUSIONS

A population increase in e-cigarette use may result in lower smoking prevalence and reduced burden of disease in the long run, especially if their use can be restricted to assisting smoking cessation. Given the assumption-dependent nature of modelling outcomes, future modelling studies should consider incorporating different policy options in their projection exercises, using shorter time horizons and expanding their modelling to low-income and middle-income countries where smoking rates remain relatively high.

Diabetes and dental caries in US adults: an analysis of data from the National Health and Nutrition Examination Survey, 2011-2018

OBJECTIVES

To determine the relationship between diabetes and dental caries among US adults participating in the 2011-2018 National Health and Nutrition Examination Survey (NHANES).

BASIC RESEARCH DESIGN

The NHANES was a cross-sectional study including clinical assessments, laboratory analysis, and interviews. The sample included 16,635 participants aged 20 years and older that represent 187,596,215 individuals in the US in a probability weighted sample. Outcome variables included overall total caries score (or number of decayed, missing, filled permanent teeth - DMFT index) and the presence of caries. Bivariate analysis, Poisson regression for total caries score, logistic regression for the presence of caries were used for analysis.

RESULTS

Controlling for covariates, multiple Poisson regression revealed that total DMFT scores were associated with diabetes status (adjusted relative risk ratio (RR)controlled diabetes = 1.13, RRuncontrolled diabetes = 1.18; p⟨0.001), no college education, female sex, white race, elderly (≥ 65 years), cigarette smoking, obesity, yearly dental visits, seeing a dentist only for treatment. Similarly, multiple logistic regression shows that the odds of adults with diabetes having dental caries were higher than among those without diabetes (adjusted risk ratio (OR)controlled diabetes = 1.84, ORuncontrolled diabetes = 1.87; p⟨0.05).

CONCLUSIONS

Diabetes was associated with a higher caries score and a greater risk for dental caries among US adults.

Cadmium exposure is associated with chronic kidney disease in a superfund site lead smelter community in Dallas, Texas

Background: The study was conducted in a Dallas lead smelter community following an Environmental Protection Agency (EPA) Superfund Cleanup project. Lead smelters operated in the Dallas community since the mid-1930s.Aim: To test the hypothesis that cadmium (Cd) exposure is associated with chronic kidney disease (CKD) ≥ stage 3.Subjects and methods: Subjects were African American residents aged ≥19 to ≤ 89 years (n=835). CKD ≥ stage 3 was predicted by blood Cd concentration with covariates.Results: In logistic regression analysis, CKD ≥ stage 3 was predicted by age ≥ 50 years (OR = 4.41, p < 0.0001), Cd level (OR = 1.89, p < .05), hypertension (OR = 3.15, p < 0.03), decades living in the community (OR = 1.34, p < 0.003) and T2DM (OR = 2.51, p < 0.01). Meta-analysis of 11 studies of Cd and CKD ≥ stage 3 yielded an ORRANDOM of 1.40 (p < 0.0001). Chronic environmental Cd exposure is associated with CKD ≥ stage 3 in a Dallas lead smelter community controlling covariates.Conclusion: Public health implications include screening for heavy metals including Cd, cleanup efforts to remove Cd from the environment and treating CKD with newer renal-sparing medications (e.g., SGLT-2 inhibitors, GLP-1s).

Assessing changes in nicotine consumption over two years in a population of Hanoi by wastewater analysis with benchmarking biomarkers

Monitoring the actual change in consumption of nicotine (a proxy for smoking) in the population is essential for formulating tobacco control policies. In recent years, wastewater-based epidemiology (WBE) has been applied as an alternative method to estimate changes in consumption of tobacco and other substances in different communities around the world, with high potential to be used in resource-scarce settings. This study aimed to conduct a WBE analysis in Hanoi, Vietnam, a lower-middle-income-country setting known for high smoking prevalence. Wastewater samples were collected at two sites along a sewage canal in Hanoi during three periods: Period 1 (September 2018), Period 2 (December 2018-January 2019), and Period 3 (December 2019-January 2020). Concentrations of cotinine, 3-hydroxycotinine, and nicotine ranged from 0.73 μg/L to 3.83 μg/L, from 1.09 μg/L to 5.07 μg/L, and from 0.97 μg/L to 9.90 μg/L, respectively. The average mass load of cotinine estimated for our samples was 0.45 ± 0.09 mg/day/person, which corresponds to an estimated daily nicotine consumption of 1.28 ± 0.25 mg/day/person. No weekly trend was detected over the three monitoring periods. We found the amount of nicotine consumption in Period 1 to be significantly lower than in Period 2 and Period 3. Our WBE estimates of smoking prevalence were slightly lower than the survey data. The analysis of benchmarking biomarkers confirmed that cotinine was stable in the samples similar to acesulfame, while paracetamol degraded along the sewer canal. Further refinement of the WBE approach may be required to improve the accuracy of analyzing tobacco consumption in the poor sewage infrastructure setting of Vietnam.

Tooth loss and uncontrolled diabetes among US adults

BACKGROUND

The objective of this study was to analyze the association between tooth loss and uncontrolled diabetes among US adults.

METHODS

The authors used National Health and Nutrition Examination Survey data from 2011 through 2018. The sample included 16,635 participants 20 years and older who represent 187,596,215 people in the United States in a probability weighted sample. The authors used bivariate analysis and multiple regressions to analyze factors associated with edentulism and number of missing teeth.

RESULTS

The multiple logistic regression model significantly predicted edentulism using diabetes status (adjusted odds ratio controlled diabetes, 1.44 [95% CI, 1.12 to 1.86]; adjusted odds ratio uncontrolled diabetes, 2.26 [95% CI, 1.33 to 3.85]), missing annual dental visits, seeing a dentist only for treatment, family income below 200% of the federal poverty guideline, being female, being 65 years or older, tobacco smoking, and no college education. After controlling for the same covariates, multiple Poisson regression analysis showed that dentate adults with controlled and uncontrolled diabetes had higher relative risk of tooth loss than those without diabetes (adjusted risk ratio controlled diabetes, 1.52 [95% CI, 1.35 to 1.71]; adjusted risk ratio uncontrolled diabetes, 1.57 [95% CI, 1.35 to 1.83]).

CONCLUSIONS

US adults with uncontrolled (glycated hemoglobin ≥ 9%) and controlled diabetes (glycated hemoglobin < 9%) were more likely to be edentulous and experience tooth loss than adults without diabetes.

PRACTICAL IMPLICATIONS

US health policy officials should adopt benefits policies to provide regular dental examinations to people who have diabetes, have low income (< 200% of the federal poverty guideline), or are 65 years or older to reduce tooth loss and improve their quality of life. Dentists should work with physicians to help patients control glycemic levels.

Oral health-related quality of life in US adults with type 2 diabetes

OBJECTIVES

The objective of this study was to analyze factors associated with oral health-related quality of life (OHRQoL) between type 2 diabetes mellitus (T2DM) and nondiabetic US adults.

METHODS

The study sample included 2945 participants (aged ≥20) selected from National Health and Nutrition Examination Survey (NHANES) 2003-2004 that represented 130,689,262 million persons in a probability weighted sample. Oral health outcomes were measured by the NHANES version of Oral Health Impact Profile (OHIP) for OHRQoL and summarized as additive scores (OHIP-ADD) and as prevalence of negative impacts (OHIP-SC). Multiple logistic regression models used dichotomous outcome variables OHIP-ADD and OHIP-SC. The cut-off values for poor OHRQoL were heuristically defined as OHIP-ADD ≥6 and as OHIP-SC > 0.

RESULTS

Poor OHRQoL was significantly (p < 0.0001) predicted by T2DM (OR_{SC-controlled}  = 1.43, OR_{SC-uncontrolled}  = 1.73), obesity (OR_SC  = 1.24), untreated dental caries (OR_SC  = 1.79), periodontal disease (OR_ADD  = 1.07), evaluated unmet denture need (OR_SC  = 1.72), low income (OR_ADD  = 1.22), smoking (OR_{SC-former-smoker}  = 1.04, OR_{SC-current-smoker}  = 1.99), African-American (OR_SC  = 1.19), and female (OR_SC  = 1.66) in both logistic regression models. In contrast, protective factors significantly (p < 0.0001) associated with poor OHRQoL were private dental insurance (OR_SC  = 0.81), college education (OR_SC  = 0.85), and annual dental prophylaxis (OR_SC  = 0.83), after adjustment for covariates.

CONCLUSIONS

This study showed that private insurance coverage and annual prophylaxis are associated with better average OHRQoL among individuals with T2DM. Improved OHRQoL may be associated with glycaemia control, decreased BMI, and smoking cessation. The highest odds for poor OHRQoL were found among US adults with T2DM with uncontrolled HbA1c, untreated dental caries, and current smoking.

An Asia-Pacific study on healthcare workers' perceptions of, and willingness to receive, the COVID-19 vaccination

OBJECTIVE

In the fight against COVID-19, vaccination is vital in achieving herd immunity. Many Asian countries are starting to vaccinate frontline workers; however, expedited vaccine development has led to hesitancy among the general population. We evaluated the willingness of healthcare workers to receive the COVID-19 vaccine.

METHODS

From 12 to 21 December 2020, we recruited 1720 healthcare workers from 6 countries: China, India, Indonesia, Singapore, Vietnam and Bhutan. The self-administrated survey collected information on willingness to vaccinate, perception of COVID-19, vaccine concerns, COVID-19 risk profile, stigma, pro-socialness scale, and trust in health authorities.

RESULTS

More than 95% of the healthcare workers surveyed were willing to vaccinate. These respondents were more likely to perceive the pandemic as severe, consider the vaccine safe, have less financial concerns, less stigmatization regarding the vaccine, higher pro-socialness mindset and trust in health authorities. A high perceived pandemic risk index, low vaccine harm index and high pro-socialness index were independent predictors in multivariable analysis.

CONCLUSIONS

The majority of healthcare workers in Asia are willing to receive COVID-19 vaccination. Perceived COVID-19 susceptibility, low potential risk of vaccine harm and pro-socialness are the main drivers. These findings may help formulate vaccination strategies in other countries.

A chain mediation model on COVID-19 symptoms and mental health outcomes in Americans, Asians and Europeans

The novel Coronavirus-2019 (COVID-19) was declared a pandemic by the World Health Organization (WHO) in March 2020, impacting the lifestyles, economy, physical and mental health of individuals globally. This study aimed to test the model triggered by physical symptoms resembling COVID-19 infection, in which the need for health information and perceived impact of the pandemic mediated the path sequentially, leading to adverse mental health outcomes. A cross-sectional research design with chain mediation model involving 4612 participants from participating 8 countries selected via a respondent-driven sampling strategy was used. Participants completed online questionnaires on physical symptoms, the need for health information, the Impact of Event Scale-Revised (IES-R) questionnaire and Depression, Anxiety and Stress Scale (DASS-21). The results showed that Poland and the Philippines were the two countries with the highest levels of anxiety, depression and stress; conversely, Vietnam had the lowest mean scores in these areas. Chain mediation model showed the need for health information, and the perceived impact of the pandemic were sequential mediators between physical symptoms resembling COVID-19 infection (predictor) and consequent mental health status (outcome). Excessive and contradictory health information might increase the perceived impact of the pandemic. Rapid COVID-19 testing should be implemented to minimize the psychological burden associated with physical symptoms, whilst public mental health interventions could target adverse mental outcomes associated with the pandemic.

The impact of COVID-19 pandemic on physical and mental health of Asians: A study of seven middle-income countries in Asia

The coronavirus disease (COVID-19) pandemic has impacted the economy, livelihood, and physical and mental well-being of people worldwide. This study aimed to compare the mental health status during the pandemic in the general population of seven middle income countries (MICs) in Asia (China, Iran, Malaysia, Pakistan, Philippines, Thailand, and Vietnam). All the countries used the Impact of Event Scale–Revised (IES-R) and Depression, Anxiety and Stress Scale (DASS-21) to measure mental health. There were 4479 Asians completed the questionnaire with demographic characteristics, physical symptoms and health service utilization, contact history, knowledge and concern, precautionary measure, and rated their mental health with the IES-R and DASS-21. Descriptive statistics, One-Way analysis of variance (ANOVA), and linear regression were used to identify protective and risk factors associated with mental health parameters. There were significant differences in IES-R and DASS-21 scores between 7 MICs (p<0.05). Thailand had all the highest scores of IES-R, DASS-21 stress, anxiety, and depression scores whereas Vietnam had all the lowest scores. The risk factors for adverse mental health during the COVID-19 pandemic include age <30 years, high education background, single and separated status, discrimination by other countries and contact with people with COVID-19 (p<0.05). The protective factors for mental health include male gender, staying with children or more than 6 people in the same household, employment, confidence in doctors, high perceived likelihood of survival, and spending less time on health information (p<0.05). This comparative study among 7 MICs enhanced the understanding of metal health in the general population during the COVID-19 pandemic.

A Global Bibliometric Analysis of Services for Children Affected by HIV/AIDS: Implications for Impact Mitigation Programs (GAPRESEARCH)

Tremendous progress has been made over the past three decades in the fight against the HIV epidemic; however, children experienced substantial physical and psychosocial effects of HIV infection. To inform services and policy development, we analyzed research growth and current trends in studies on children with HIV/AIDS. A total of 17,598 research papers and reviews in English, which were published on Web of Science, were downloaded. VOSviewer was used to generate an author keyword cooccurrence network and a network illustrating the connection among countries by shared coauthorships. Exploratory factor analysis was employed to identify research domains emerging from the abstracts' contents. The number of papers and their impacts had grown significantly in the past decade. The majority of study settings were in African countries. Research topics related to HIV in children were robust in areas of prevention of mother-to-child transmission and HIV and comorbidities treatments. Although psychosocial and behavioral disorders were recognized in previous studies, the number of interventions in these fields is still limited or not sustained. This study presents the global research trends and interests, points out research gaps of available publications and suggests several implications for services and intervention programs for children infected with HIV/AIDS. While preventions of mother-to-child transmission have been extensively studied, more efforts should be made to fulfill the lack of research on young people who are at risk of being infected or who are already infected with HIV. System thinking approach is needed in the design and implementation of future studies.

Fertility Desire in HIV/AIDS Research During 1992-2019: A Systematic Text Mining of Global Literature

There has been an increase of fertility desire among people living with HIV/AIDS (PLWH) thanks to the advancement of HIV treatment and prevention of mother-to-children transmission programs. However, the development of research focusing on this topic over the past three decades is not well documented. We aimed to explore the trend of global publications regarding fertility desires among PLWH and identify their contents through the natural language processing technique. Dataset from 1992 to 2019 was downloaded using the Web of Science Core Collection. Bibliometric indicators such as change in total publications, citations, and countries' collaboration were examined. Main topics of selected publications were determined using the latent Dirichlet allocation. There were 303 articles published during the period 1992-2019, with a rapid increase in the number of publications in the past 5 years. Common themes included determinants of fertility desire, HIV prevention for adolescents, and safer conception for couples affected with HIV. However, publications on HIV care and antenatal care for women with HIV had been still limited. Findings suggested a call for the future support and collaborations for fertility intention, as well as the promotion of HIV care and service for adolescents and pregnant women with HIV, especially in countries with poor resources and a high burden of HIV/AIDS.

Pre-exposure Prophylaxis in HIV Research: A Latent Dirichlet Allocation Analysis (GAPRESEARCH)

Pre-exposure prophylaxis (PrEP) has been shown to be an effective approach to prevent human immunodeficiency virus (HIV) infections; however, implementation of the service remains challenging. This global bibliometric analysis aims to describe the current trends in HIV research prevention through PrEP to reveal the potential gaps of knowledge and to put forward recommendations for future research. A bibliometric analysis was conducted through Web of Science from 1990 to 2017. Exploratory factor analysis was also employed to find research domains emerging from the abstracts' contents. Latent Dirichlet allocation, which is a topic modeling algorithm, was utilized to perform text mining and determine relationships among text documents. A total of 4852 papers regarding HIV PrEP research were retrieved. The number of papers and their impact has significantly increased. Preventing sexual transmissions, improving access, and quality of health-care services for current users, as well as men who have sex with men, pregnant women and children, were the research domains most related to PrEP. We found a data gap in research regarding sex workers, potential side effects of PrEP, and misjudgment toward PrEP users. Despite the growth in research about HIV PrEP, there exist barriers to scaling up the implementation of PrEP worldwide and for such intervention to reach its fWull potential. International research collaboration efforts to investigate the potential safety concerns of PrEP and develop strategies to eliminate social misjudgment against PrEP users are warranted. Addressing these knowledge gaps might facilitate the development of effective global implementation strategies for PrEP in the future.

Cadmium Is Associated with Type 2 Diabetes in a Superfund Site Lead Smelter Community in Dallas, Texas

OBJECTIVE

To test the hypothesis that cadmium (Cd) exposure is associated with type 2 diabetes mellitus (T2DM).

MATERIALS AND METHODS

A two-phase health screening (physical examination and laboratory tests) was conducted in a lead smelter community following a Superfund Cleanup. Participants were African Americans aged >19 years to <89 years. Multiple logistic regression was used to analyze T2DM regressed on blood Cd level and covariates: body mass index (BMI), heavy metals (Ar, Cd, Hg, Pb), duration of residence, age, smoking status, and sex.

RESULTS

Of 875 subjects environmentally exposed to Cd, 55 were occupationally exposed to by-products of lead smelting and 820 were community residents. In addition, 109 T2DM individuals lived in the community for an average of 21.0 years, and 766 non-T2DM individuals for 19.0 years. T2DM individuals (70.3%) were >50 years old. Blood Cd levels were higher among T2DM subjects (p < 0.006) compared to non-T2DM individuals. Logistic regression of T2DM status identified significant predictors: Cd level (OR = 1.85; 95% CI: 1.14-2.99, p < 0.01), age >50 years (OR = 3.10; 95% CI: 1.91-5.02, p < 0.0001), and BMI (OR = 1.07; CI: 1.04-1.09, 0.0001). In meta-analysis of 12 prior studies and this one, T2DM risk was OR = 1.09 (95% CI: 1.03-1.15, p < 0.004) fixed effects and 1.22 (95% CI: 1.04-1.44, p < 0.02) random effects.

DISCUSSION

Chronic environmental Cd exposure was associated with T2DM in a smelter community, controlling for covariates. T2DM onset <50 years was significantly associated with Cd exposure, but >50 years was not. Meta-analysis suggests that Cd exposure is associated with a small, but significant increased risk for T2DM. Available data suggest Cd exposure is associated with an increased propensity to increased insulin resistance.

Global Mapping of Interventions to Improve the Quality of Life of People Living with HIV/AIDS: Implications for Priority Settings

Enhancing the quality of life (QOL) of people living with HIV and AIDS (PLWHA) has become a significant global health goal, as combination antiretroviral therapy has helped to transform HIV/AIDS from a fatal illness to chronic disease. In this study, we aim to comprehensively describe the growth of research publications and the development of research landscapes regarding interventions to improve QOL among PLWH, as well as to characterize interdisciplinary topics and emerging interests of the research community. English articles and reviews published from 1991 to 2018 concerning interventions to improve QOL among PLWHA were retrieved from the Web of Science. Collaboration among organizations sharing coauthorships and co-occurrence network of authors' keywords was illustrated through network graphs. Latent Dirichlet Allocation was used for classifying papers into corresponding topics. A total of 2304 publications were included in the study. The USA continues to lead in research productivity, followed by South Africa, China, and India. Emerging research themes were found to be the application of multilevel interventions and long-term care, rehabilitation, along with topics relating to mental health issues, behavioral therapy and social supports for patients receiving treatments, and application of e-health approaches in designing and implementing interventions. There has been, however, a modest appearance of topics covering local, cultural, and environmental contexts of interventions. The findings of the study suggest expanding the coverage of psychosocial, behavioral, and contextualized interventions, increasing the involvement of family and community, improving the effectiveness of technology-based and e-health interventions, and developing strategies for lifelong treatment of HIV/AIDS.

A Global Bibliometric Analysis of Services for Children Affected by HIV/Acquired Immune Deficiency Syndrome: Implications for Impact Mitigation Programs (GAPRESEARCH)

Tremendous progress has been made over the past three decades in the fight against the human immunodeficiency virus (HIV) epidemic; however, children experienced substantial physical and psychosocial effects of HIV infection. To inform services and policy development, we analyzed research growth and current trends in studies on children with HIV/acquired immune deficiency syndrome (AIDS). A total of 17,598 research papers and reviews in English, which were published on Web of Science, were downloaded. VOSviewer was used to generate an author keyword cooccurrence network and a network illustrating the connection among countries by shared coauthorships. Exploratory factor analysis was employed to identify research domains emerging from the abstracts' contents. The number of papers and their impacts had grown significantly in the past decade. The majority of study settings were in African countries. Research topics related to HIV in children were robust in areas of prevention of mother-to-child transmission and HIV and comorbidities treatments. Although psychosocial and behavioral disorders were recognized in previous studies, the number of interventions in these fields is still limited or not sustained. This study presents the global research trends and interests, points out research gaps of available publications and suggests several implications for services and intervention programs for children infected with HIV/AIDS. While preventions of mother-to-child transmission have been extensively studied, more efforts should be made to fulfill the lack of research on young people who are at risk of being infected or who are already infected with HIV. System thinking approach is needed in the design and implementation of future studies.

Indices of Change, Expectations, and Popularity of Biological Treatments for Major Depressive Disorder between 1988 and 2017: A Scientometric Analysis

Background. Major Depressive Disorder (MDD) is the most common psychiatric disorder with high prevalence and disease burden. Biological treatments of MDD over the last several decades include a wide range of antidepressants and neurostimulation therapies. While recent meta-analyses have explored the efficacy and tolerability of antidepressants, the changing trends of biological treatments have not been evaluated. Our study measured the indices of change, expectations, and popularity of biological treatments of MDD between 1988 and 2017. Methods. We performed a scientometric analysis to identify all relevant publications related to biological treatments of MDD from 1988 to 2017. We searched the Web of Science websites for publications from 1 January 1988 to 31 December 2017. We included publications of fluoxetine, paroxetine, citalopram, sertraline, amitriptyline, fluvoxamine, escitalopram, venlafaxine, duloxetine, milnacipran, desvenlafaxine, levomilnacipran, clomipramine, nortriptyline, bupropion, trazodone, nefazodone, mirtazapine, agomelatine, vortioxetine, vilazodone, electroconvulsive therapy (ECT), repetitive transcranial magnetic stimulation (rTMS), vagus nerve stimulation (VNS), deep brain stimulation (DBS), and transcranial direct current stimulation (tDCS). We excluded grey literature, conference proceedings, books/book chapters, and publications with low quality as well as publications not related to medicine or human health. The primary outcomes assessed were indices of change, expectations, and popularity. Results. Of 489,496 publications identified, we included 355,116 publications in this scientometric analysis. For the index of change, fluoxetine, sertraline and ECT demonstrated a positive index of change in 6 consecutive periods. Other neurostimulation therapies including rTMS, VNS, DBS and tDCS had shown a positive index of change since 1998. We calculated the index of change of popularity index (PI), which indicates that from 2013 to 2017, the number of publications on tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) were reduced by 85.0% and 81.3% respectively, as compared with the period 2008–2012. For the index of expectation, fluoxetine and ECT showed the highest index of expectations in six consecutive periods and remained the highest in 2013–2017. For popularity, the three antidepressants with highest PI were fluoxetine (4.01), paroxetine (2.09), and sertraline (1.66); the three antidepressants with lowest PI were desvenlafaxine (0.08), vilazodone (0.04) and levomilnacipran (0.03). Among neurostimulation therapies, ECT has the highest PI (2.55), and tDCS the lowest PI (0.14). The PI of SSRI remained the highest among all biological treatments of MDD in 2013–2017. In contrast, the PI of ECT was reduced by approximately 50% during the period 2008 to2012 than that in the period 2013 to 2017. Conclusions. This scientometric analysis represents comprehensive evidence on the popularity and change in prospects of biological treatments for MDD from 1988 to 2017. The popularity of SSRI peaked between 1998 and 2002, when their efficacy, tolerability and safety profile allowed them to replace the TCAs and MAOIs. While the newer neurostimulation therapies are gaining momentum, the popularity of ECT has sustained.

Factors Associated with the Risk of Developing Coronary Artery Disease in Medicated Patients with Major Depressive Disorder

Background: The aim of this study was to identify factors associated with high Framingham Risk Score (FRS) in medicated patients with major depressive disorder (MDD). Methods: We examined 61 medicated patients with MDD (mean age 37.77 ± 7.67, 90.2% women) and 43 non-depressed controls (mean age 38.26 ± 9.20, 90.7% women). We administered the Hamilton Depression Rating Scale (HAM-D) and measured systolic blood pressure (SBP), diastolic BP (DBP), mean arterial BP (MAP), pulse wave velocity (PWV), intima-media thickness (IMT), interleukin-6 (IL-6) and triglycerides. Results: We found that medicated patients with MDD had significantly higher levels of HAM-D score (p < 0.01), SBP (p = 0.015), MAP (p = 0.037), IL−6 level (p = 0.007), as compared with controls. Medicated patients who remained moderately to severely depressed showed significantly higher SBP (p = 0.049), DBP (p = 0.009), MAP (p = 0.024), IL−6 level (p = 0.019), left PWV (p = 0.004) and average PWV (p = 0.026) than those with mild depression. Multivariate regression showed that the interaction effect between HAM-D score and triglyceride level (p = 0.018) was significantly associated with FRS in medicated patients with MDD. Conclusions: This study highlights that the interaction effect of the severity of depression and the triglyceride level, was a modifiable factor positively associated with high FRS.