摘要： Introduction The COVID-19 pandemic was associated with a dramatic increase of chest CT scanning in Wuhan. This was partly a COVID effect: some private and public employers required employees to have CT examinations to confirm they were healthy before going back to work. But it also likely reflects the growing enthusiasm for low-dose computed tomography (LDCT) screening. This investigation examines the resulting impact in the under 40 population. Methods The relevant de-identified information of the patients under age 40 who had also received thoracic surgery from 2018 to 2022 was analyzed using the medical record information system of Tongji Hospital in Wuhan. Results The volume of thoracic surgeries increased continuously in young patients under the age of 40, from 219 in 2018 to 732 in 2022. The number of surgeries for pulmonary nodules or masses in this group increased over 6-fold, from 91 to 576. The number of surgeries leading to a diagnosis of adenocarcinoma of the lung increased more than 15-fold, from 26 to 415. The median adenocarcinoma size fell in half (from 15 mm to 7 mm) and the most common stage changed from Stage I invasive (46 % of adenocarcinomas in 2018) to microinvasive (60 % of adenocarcinomas in 2022). 70 % of lung adenocarcinomas were found in females. Conclusions There had been an explosion of thoracic surgery for adenocarcinomas among the under-40 population in Wuhan. The decrease in tumor size and the increase in microinvasive and in situ lesions in this young age group suggest considerable overdiagnosis. We should be vigilant about the risk of overdiagnosis and overtreatment especially in young women.

关键词： COVID-19   vaccines   vaccine hesitancy   preventive care   healthcare access   health equity  

摘要： Introduction COVID-19 hospitalization rates among unvaccinated children are double of that of vaccinated children, and this difference is greater among racial and ethnic minority children. Vaccination rates among children remain suboptimal. Few studies have characterized barriers to COVID-19 vaccination among historically marginalized communities. Methods From January 2022 to May 2022, parents and guardians of children aged 12 months to 18 years presenting for pediatric care at a hospital-based primary care clinic were surveyed about perceptions of COVID-19 vaccines, intentions to vaccinate their child, and trusted sources of information. Results A total of 113 parents/guardians participated, with 92% self-identifying with a historically marginalized racial/ethnic group. A total of 54% of respondents either did not plan to vaccinate their child against COVID-19 or were unsure. The obstacles to vaccination most frequently cited were related to (1) unknown side effects, (2) the rapid development of the vaccine, and (3) unsafe ingredients. Worries about being used as experimental subjects and potential impacts on fertility were also reported. Parents who planned to vaccinate their child reported higher rates of trust in doctors, local clinics, hospitals, and health departments. Conclusions High rates of COVID-19 vaccination hesitancy exist among parents/guardians from historically marginalized groups. Barriers to vaccination were frequently related to side effects, whereas a high level of trust in healthcare providers as sources of information may be a facilitator. Strategies to improve health outcomes and boost vaccination rates should focus on equipping pediatric healthcare providers with the knowledge and skills necessary to address these known barriers to COVID-19 vaccination.

关键词： Cryptocurrencies   Stock market indexes   Downside risk   COVID-19 pandemic   DOWNSIDE RISK   BITCOIN   HAVEN   HEDGE   GOLD  

摘要： This study examines the safe-haven properties of cryptocurrencies during the COVID-19 pandemic by exploring various cryptocurrency allocation strategies and their impact on downside risk compared to holding only the stock market index. Spanning from 2019 to 2021, the analysis includes seven cryptocurrencies-Bitcoin, Ethereum, Litecoin, Dash, Maker, Monero, and NEO-and six stock market indexes-SP500, FTSE, CAC40, IBEX, AEX, and DJIM. The research introduces a portfolio optimization approach focused on mitigating significant losses during crises, employing Value at Risk (VaR), Modified Value at Risk (MVaR), and Conditional Value at Risk (CVaR) metrics across different portfolio compositions. Findings highlight several key insights: higher cryptocurrency allocations correlate with increased downside risk, with none of the studied cryptocurrencies acting as a safe haven for international equity indexes during the COVID-19 pandemic. Relative MVaR exceeds CVaR across most combinations, and Maker demonstrates the highest downside risk, while Bitcoin and Litecoin exhibit the lowest risk levels based on CVaR and MVaR, respectively. Integration of the FTSE index is associated with peak risk levels, whereas incorporating DJIM and AEX shows reduced risk exposure. The study contributes novel insights into cryptocurrency risk dynamics during the COVID-19 pandemic, offering valuable implications for risk management strategies in investment portfolios.

关键词： Adolescence   Physical activity   Depressive symptoms   Random-intercept cross-lagged panel model   Within-person   YOUNG-PEOPLE   EXERCISE   HEALTH   INTENSITY   GENDER   TRAJECTORIES   CHILDREN   MODERATE   ANXIETY   UPDATE  

摘要： Background and aims: It is generally theorized that adolescents' physical activity and depressive symptoms are inversely correlated. There is some empirical evidence on the temporal sequencing from physical activity to depressive symptoms, and vice versa. However, traditional methods for studying these temporal bidirectional associations have faced criticism, as they conflate within- and between-person variance. Methods: We used random intercept cross-lagged panel models to study whether within-person increases in depressive symptoms preceded decreases in physical activity, and vice versa. In this pre-registered study, we exploratorily examined the potential moderating role of physical activity intensity and sex. We analyzed data from 766 adolescents (Mage at baseline = 12.86; 52% females) over 3 timepoints, each 1.5 years apart, using validated questionnaires. Results: There were negative within-person prospective effects from depressive symptoms to physical activity, indicating that, relative to adolescents' own expected scores, increases in depressive symptoms were associated with decreases in physical activity later onThis effect seemed to be driven by moderate, but not vigorous, physical activity, regardless of sex. Although no general within-person prospective effects from physical activity to depressive symptoms were found, for adolescent females, but not males, increases in moderate physical activity were found to be related to decreases in depressive symptoms 1.5 years later. Conclusion: Future studies and interventions should consider that the effects from physical activity on depressive symptoms, and vice versa, seem sex- and/or intensity-specific, and may need to be tailored to the specific target group.

关键词： Intermittent hypoxia exposure   Post-acute sequelae of COVID-19   Dyspnea   Fatigue   Long COVID-19   CONSEQUENCES   SCALE  

摘要： Background: Post-acute sequelae of COVID-19 (PASC) is incurring a huge health and economic burden worldwide. There is currently no effective treatment or recommended drug for PASC. Methods: This prospective randomized controlled study was conducted in a hospital in China. The effect of intermittent hypoxia exposure (IHE; 5-min hypoxia alternating with 5-min normal air, repeated five times) on dyspnea and fatigue was investigated in patients meeting the NICE definition of PASC. Patients were computationally randomized to receive normoxia exposure (NE) and routine therapy or IHE and routine therapy. Sixminute walk distance (6MWD) and spirometry were tested before and after the interventions; the Borg Dyspnea Scale (Borg) and the modified Medical Research Council Dyspnea Scale (mMRC) were used to assess dyspnea; and the Fatigue Assessment Scale (FAS) and the Chalder Fatigue Scale-11 (CFQ-11) were used to assess fatigue. The study was registered in the Chinese Clinical Trial Registry (ChiCTR2300070565).
Findings: Ninety-five participants (33 males and 62 females) were recruited between March 1, 2023 and December 30, 2023. Forty-seven patients in the IHE group received 10.0 (9.0, 15.0) days of IHE, and 48 patients in NE group received 10.0 (8.0, 12.0) days of NE. 6MWD, forced vital capacity (FVC), FVC %pred, forced expiratory volume in 1 s (FEV1), FEV1 %pred, tidal volume (VT), and dyspnea and fatigue scales markedly improved after IHE (p < 0.05), and improvements were greater than in the NE group (all p < 0.05). Furthermore, participants in IHE group had better subjective improvements in dyspnea and fatigue than those in the NE group (p < 0.05). Compared with <10 days of IHE, >= 10 days of IHE had a greater impact on 6MWD, FVC, FEV1, FEV1 % pred, VT, FAS, and CFQ-11. No severe adverse events were reported. Interpretation: IHE improved spirometry and 6MWD and relieved dyspnea and fatigue in PASC patients. Larger prospective studies are now needed to verify these fi