BackgroundLittle is known about the adverse effects of frailty transitions. In this study, we aimed to characterize the transitions between frailty states and examine their associations with the type of death among older adults in China, a developing country with a rapidly growing aging population.MethodsWe used data of 11,165 older adults (aged 65–99 years) from the 2002 and 2005 waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Overall, 44 health deficits were used to construct frailty index (FI; range: 0–1), which was then categorized into a three-level variable: nonfrail (FI ≤0.10), prefrail (0.10< FI ≤0.21), and frail (FI >0.21). Outcome was four types of death based on bedridden days and suffering state (assessed in the 2008 wave of CLHLS).ResultsDuring the 3-year period, 3,394 (30.4%) participants had transitioned between different frailty states (nonfrail, prefrail, and frail), one-third transitioned to death, and one-third remained in previous frailty states. Transitions to greater frailty (ie, “worsening”) were more common than transitions to lesser frailty (ie, “improvement”). Among four categories of frailty transitions, “worsening” and “remaining frail” had increased risks of painful death, eg, with odds ratios of 1.92 (95% confidence interval [CI] =1.41, 2.62) and 4.75 (95% CI =3.32, 6.80), respectively, for type 4 death (ie, ≥30 bedridden days with suffering before death).ConclusionThis large sample of older adults in China supports that frailty is a dynamic process, characterized by frequent types of transitions. Furthermore, those who remained frail had the highest likelihood of experiencing painful death, which raises concerns about the quality of life in frail populations.

PurposeTo further observe and verify the effect of nonalcoholic fatty liver disease (NAFLD) on the response to antiviral therapy in patients with chronic hepatitis B (CHB) and investigate the relationship between the virologic response and insulin resistance.Patients and methodsA retrospective study was adopted and 61 NAFLD patients with HBeAg-positive CHB were included as the observation group (group A), and 64 patients with simple CHB were included as the control group (group B).ResultsAfter 12 weeks of treatment with entecavir, the total virologic response rate in group A was statistically significantly lower than that in group B (P<0.05). During weeks 24–96, the difference was not statistically significant (P>0.05). In weeks 48 and 96, there was no significant difference in the HBeAg seroconversion rates between the two groups (P>0.05). In weeks 12 and 24, there was also no significant difference in the alanine transaminase (ALT) normalization rate between the two groups (P>0.05). Then, in weeks 48 and 96, the ALT normalization rate of group A was obviously lower than that of group B (P<0.05). Group A patients were divided into group A1 (≤M) and group A2 (>M) according to the median value (M=2.79) of the baseline homeostatic model assessment method insulin resistance levels. In weeks 48 and 96, the ALT normalization rate of group A1 was significantly higher than that of group A2 (P<0.05). The correlation coefficient (r) of the baseline homeostatic model assessment method insulin resistance level and the severity of fatty liver in group A was 0.426 (P=0.001).ConclusionNAFLD cannot affect the long-term total virologic response rate and HBeAg seroconversion rate in CHB patients treated with entecavir but can reduce the long-term biochemical response rate, which has a positive correlation with the severity of fatty liver and the insulin resistance index.

Objective Suicidal ideation is an important public health challenge among people living with HIV (PLWH) across the world and in China. HIV stigma, depression, and self-esteem have been associated with suicidal ideation. However, the underlying mechanisms remain not fully understood. Methods Study data were derived from a sample of 465 PLWH in China. Suicidal ideation after HIV diagnosis was used as outcome variable. HIV stigma, depressive symptoms, and self-esteem were measured using reliable instruments and used as predictor, mediator, and moderator, respectively. Mediation and moderated mediation model were used for data analysis. Results 31.6% of PLWH in China had suicidal ideation after HIV diagnosis. The association between perceived HIV stigma and suicidal ideation was partially mediated by depression (indirect effect = 0.02, 95% CI = [0.02, 0.03]) with the path from perceived HIV stigma to depressive symptoms being moderated by self-esteem (interaction effect = − 0.02, 95% CI [− 0.03, − 0.01]). Conclusions Study findings suggested a mediation mechanism of HIV stigma on suicidal ideation through depressive symptoms, and self-esteem might weaken the mediation mechanism by moderating the perceived HIV stigma-depressive symptoms pathway.

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BackgroundYoung men who have sex with men (YMSM) are at high risk of HIV infection that accounts for an increasing proportion of new human immunodeficiency virus (HIV) infections in China. However, little is known about the trajectories of sexual risk behaviors in this population. The study aimed to investigate longitudinal patterns of sexual risk behaviors among YMSM in China.MethodsStudy data were collected from a prospective cohort study among 460 YMSM from 2017 to 2020. Based on the predicted HIV infection risk scores, distinct sexual risk behaviors trajectories of YMSM were estimated and plotted using the group-based censored normal model to identify the predictors of trajectories change over time.ResultsThree sexual risk behaviors trajectories were identified: a decreasing low-risk group (7.6%), an intermediate-risk group (67.4%), and an ascending high-risk group (25.0%).Compared to the decreasing low-risk group, intermediate-risk group membership was associated with being from rural areas, current smoker and higher depressive symptoms; ascending high-risk group membership was associated with an education level of high school or lower, being from rural areas, younger age at sex debut with a man, current smoker, higher depressive symptoms and sexual minority stress.ConclusionsSexual risk behaviors among YMSM changed over time within different trajectories. Identifying YMSM belonging to high-risk trajectories before HIV infection is vital for the intervention and may reduce HIV transmission.

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