Background: To inform policy and implementation that can enhance prevention and improve tuberculosis (TB) care cascade outcomes, this review aimed to summarize the impact of various interventions on care cascade outcomes for active TB. Methods and findings: In this systematic review and meta-analysis, we retrieved English articles with comparator arms (like randomized controlled trials (RCTs) and before and after intervention studies) that evaluated TB interventions published from January 1970 to September 30, 2022, from Embase, CINAHL, PubMed, and the Cochrane library. Commentaries, qualitative studies, conference abstracts, studies without standard of care comparator arms, and studies that did not report quantitative results for TB care cascade outcomes were excluded. Data from studies with similar comparator arms were pooled in a random effects model, and outcomes were reported as odds ratio (OR) with 95% confidence interval (CI) and number of studies (k). The quality of evidence was appraised using GRADE, and the study was registered on PROSPERO (CRD42018103331). Of 21,548 deduplicated studies, 144 eligible studies were included. Of 144 studies, 128 were from low/middle-income countries, 84 were RCTs, and 25 integrated TB and HIV care. Counselling and education was significantly associated with testing (OR = 8.82, 95% CI:1.71 to 45.43; I² = 99.9%, k = 7), diagnosis (OR = 1.44, 95% CI:1.08 to 1.92; I² = 97.6%, k = 9), linkage to care (OR = 3.10, 95% CI = 1.97 to 4.86; I² = 0%, k = 1), cure (OR = 2.08, 95% CI:1.11 to 3.88; I² = 76.7%, k = 4), treatment completion (OR = 1.48, 95% CI: 1.07 to 2.03; I² = 73.1%, k = 8), and treatment success (OR = 3.24, 95% CI: 1.88 to 5.55; I² = 75.9%, k = 5) outcomes compared to standard-of-care. Incentives, multisector collaborations, and community-based interventions were associated with at least three TB care cascade outcomes; digital interventions and mixed interventions were associated with an increased likelihood of two cascade outcomes each. These findings remained salient when studies were limited to RCTs only. Also, our study does not cover the entire care cascade as we did not measure gaps in pre-testing, pretreatment, and post-treatment outcomes (like loss to follow-up and TB recurrence). Conclusions: Among TB interventions, education and counseling, incentives, community-based interventions, and mixed interventions were associated with multiple active TB care cascade outcomes. However, cost-effectiveness and local-setting contexts should be considered when choosing such strategies due to their high heterogeneity.

Much remains unknown regarding the associations of adversities in childhood and adulthood with incident cardiovascular diseases (CVD). We aimed to examine the independent and cumulative relations of adversities in childhood and adulthood with incident CVD and whether these associations can be mitigated by adopting a healthy lifestyle later in life. We included 136,073 men and women [38–72 years at baseline] free of diagnosed CVD at baseline who responded to surveys on adversities in childhood and adulthood in the United Kingdom Biobank prospective cohort. They were recruited between 2006 and 2010 and were followed-up until 28 January 2021. Adversities included physical abuse, emotional abuse, sexual abuse, emotional neglect, and physical neglect. Participants were categorised into four groups according to the exposure periods, which were no adversity, childhood adversity only, adulthood adversity only, and cumulative adversity (both childhood and adulthood). The primary outcomes included incident fatal and non-fatal CVD events. The modifiable lifestyle factors were smoking, physical activity, diet, sleeping, social or leisure activities, and friend or family visits. We identified 16,415 (10.71/1000 person-year) incident CVD during a median follow-up of 11.8 years. Compared with participants with no adversity, CVD incidence increased by 11% in those with childhood adversity only (adjusted hazard ratio [HR]: 1.11 [95% CI 1.06–1.17], p < 0.001), 4% in those with adulthood adversity only (1.04 [1.00–1.09], p = 0.05), and 21% in those with cumulative adversity (1.21 [1.16–1.26], p < 0.001). Analysis of interactions showed that adulthood adversity amplified the childhood adversity-CVD association (p for interaction = 0.03). Compared with the participants with one or fewer ideal lifestyle factors, those with more than four ideal factors had a 25%–36% lower risk of CVD across the three adversity groups. Our findings suggested that childhood adversities were associated with an increased risk of CVD which can be magnified by adulthood adversities and substantially mitigated by adopting a healthy lifestyle later in life. The National Natural Science Foundation of China and Guangzhou Foundation for Basic and Applied Basic Research.

Background: We described the prevalence of anxiety and depression related to COVID-19 pandemic among different types of population and examined their potential risk factors.Methods: A cross-sectional survey was conducted to collect demographic characteristics, exposure histories, and many other concerns about COVID-19. The Zung's self-rating anxiety scale (SAS) and self-rating depression scale (SDS), followed by a four-step multiple logistic regression analysis was performed to identify factors associated with mental health outcomes.Results: Out of 3,303 participants, the quarantined people (40.9%), community workstation staffs-policemen-volunteers (CPV) (36.4%) and general public (30.7%) reported higher percentages of depression than the general medical staff (18.4%). Moreover, the quarantined people (19.1%) also showed higher prevalence of anxiety than the general public (9.1%) and the general medical staff (7.8%). The quarantined people had the highest risk of anxiety and depression, whereas the self-rated health was negatively associated with the risks of anxiety and depression. Younger age group (18 to 30 years) showed higher risks of anxiety (OR = 6.22, 95% CI = 2.89–13.38, p < 0.001) and depression (OR = 3.69, 95% CI = 2.40–5.69, p < 0.001). People who had exposure history or contact from Hubei province after December 1, 2019 (OR = 1.57, 95% CI = 1.07–2.30, p < 0.001), had family or friends engaged in front-line health care work (OR = 1.47, 95% CI = 1.02–2.14, p < 0.001), had confirmed case nearby (OR = 2.44, 95% CI = 1.43–4.18, p < 0.001) were all more likely to suffer from anxiety. Moreover, the negligence (OR = 1.85, 95% CI = 1.37–2.51, p < 0.001) or overindulgence (OR = 1.45, 95% CI = 1.03–2.04, p < 0.001) toward the epidemic information was associated with a higher risk of depression and anxiety.Conclusions: Our findings show that the CPV and quarantined people were most at-risk population. We have identified that the young people, people with exposure histories and negligence or overindulgence toward epidemic information are in grave need of attention.

Migrants from Sub-Saharan Africa to China faced challenges in accessing healthcare. Less is known about their depression prevalence. We aim to address this gap by providing an initial estimation on symptoms indicative of depression. A cross-sectional survey was conducted from August to October in 2019. Eligibility was defined as being originally from a Sub-Saharan African country and cumulative residence in China for at least one month. A convenience sample was drawn from snowball sampling online and venue-based sampling by community outreach. The primary outcome, symptoms indicative of depression, were measured by the Centre for Epidemiologic Studies Depression Scale using 16 as the cutoff. Multivariable logistic regressions were employed to examine the association between depression symptoms and their migration-related correlates. Data were analyzed using SAS 9.4. The prevalence of symptoms indicative of depression assessed by CES-D was high at 44% among 928 participants when using 16 as a cutoff. Depression symptoms were associated with unsatisfactory housing conditions (aOR: 1.7, 95%CI: 0.8 to 3.3) and perception of very unfriendly attitudes from the local people (aOR: 4.5, 95%CI: 1.2 to 16.1) after adjusting for covariates. Depression symptoms were prevalent among SSA migrants in China and warrants attention and intervention. Support should be provided during the post-migration period in China to mitigate depression risks. Future studies are needed to build more evidence on SSA migrants' mental health and to inform global health policies and programming.

Background: Peritoneal dialysis (PD) and conventional in‐center hemodialysis (HD) are treatment options for patients with end‐stage kidney disease (ESKD). However, their impact on all‐cause mortality is unclear.Methods: We conducted a multicenter, open‐label, randomized, non‐inferiority trial to determine the effect of dialysis modality on mortality in patients with ESKD. Eligible patients were recruited from 30 sites across China and assigned to receive either PD or HD in a ratio of 1:1. The primary outcome was all‐cause mortality. Non‐inferiority was defined as the upper bound of the one‐sided 95% confidence interval (CI) for the hazard ratio (HR) being ≤1.25.Results: A total of 414 patients with incident ESKD were randomly assigned to PD (n = 213) or HD (n = 201). During a median follow‐up of 1.7 years, 37 patients in the PD group and 31 in the HD group died, giving respective event rates per patient‐year of 0.061 and 0.071. The HR for mortality on PD in comparison with HD was 0.76 (95% CI 0.47–1.24) after adjustment for age, sex, and diabetes status, achieving the limit for non‐inferiority. There were more adverse events (p = 0.003), serious adverse events (p = 0.009), and adverse events leading to hospitalization (p = 0.003) in the PD group than in the HD group; however, there was no significant between‐group difference in adverse events leading to death or discontinuation of treatment.Conclusions: PD was non‐inferior to conventional in‐center HD in terms of survival in patients with ESKD. Our findings underscore the need for shared decision‐making between physicians and patients regarding the selection of dialysis modality.Trial registration: Registered at ClinicalTrials.gov (NCT01413074).