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Emotional neglect is an under-recognized but relatively common type of childhood maltreatment. Although it has been reported that adolescents will facilitate positive growth after experiencing childhood maltreatment, such as sexual abuse, it is unknown whether adolescents could also get a promotion after experiencing emotional neglect. Thus, we aimed to examine the association between emotional neglect and posttraumatic growth (PTG) and further explored the potential influence factors underlying such association. Six hundred and thirty-five adolescents (55.2% female, M[subscript age] = 14.12 years old, SD = 1.47) were asked to complete self-report questionnaires regarding emotional neglect, school engagement, psychological suzhi, and PTG. Results showed that emotional neglect was negatively associated with PTG, and school engagement mediated such association. Further, psychological suzhi moderated the direct pathway from emotional neglect to PTG in which the deleterious effect of emotional neglect on PTG was weaker for adolescents who reported higher psychological suzhi. Meanwhile, psychological suzhi moderated the indirect pathway from emotional neglect to school engagement in the mediated model in which the deleterious effect of emotional neglect on school engagement was weaker for adolescents who reported higher psychological suzhi. Overall, the current study advances our understanding of the relationship between emotional neglect and PTG, and further tests the potential roles of school engagement and psychological suzhi in this relationship.

Previous research has identified that unmet needs are associated with adverse mental health outcomes in older adults. However, the unmet needs of older adults' spousal caregivers are unknown. The present study examined the association between unmet needs and depression among spousal caregivers, and whether marital satisfaction mediated this association. We included 1,856 participants who provided care to their spouses with difficulties in activities of daily living (ADL) and instrumental activities of daily living (IADL) from the 2018 China Health and Retirement Longitudinal Survey. Unmet needs of spousal caregivers were assessed as the total number of ADL/IADL tasks with which respondents had unmet needs. Path models were conducted to evaluate the associations between unmet needs, marital satisfaction, and depression. Subgroup analyses by sex were conducted to examine the sex differences regarding the associations. Spousal caregivers with more unmet ADL/IADL needs reported higher levels of depression (p < 0.001). Additionally, for wife caregivers, unmet ADL/IADL needs were associated with lower marital satisfaction, and lower marital satisfaction was associated with higher degrees of depression, indicating that marital satisfaction partially mediated the association between unmet needs and depression (p < 0.01). However, marital satisfaction did not mediate the association between unmet needs and depression among husband caregivers. The mediating effect of marital satisfaction on the association between unmet needs and depression only existed in wife caregivers. Social services should be provided to meet the needs of caregivers with ADL/IADL difficulties, and interventions should be implemented to promote the marital satisfaction of wife caregivers. [ABSTRACT FROM AUTHOR]

With sociodemographic changes, men are increasingly taking responsibility for spousal caregiving. Previous studies have described gender differences in the psychological outcomes of caregiving; however, few have focused exclusively on husband caregivers. This study investigates the influence of starting spousal caregiving on the psychological well-being of older husbands in rural areas and examines whether living arrangements can moderate this relationship. A total of 1,167 baseline non-caregiver husbands aged 60 and above in rural areas were taken from the 2011–2015 China Health and Retirement Longitudinal Study (CHARLS). The generalized estimating equation (GEE) was employed to examine the effects of spousal caregiving transitions and living arrangement changes on depressive symptoms over four years. Compared with rural husbands who remained non-caregivers, those transitioning into activities of daily living (ADL) caregiving reported higher depressive symptoms at follow-up (B = 1.67, p < 0.05). Moreover, the increase in depressive symptoms when transitioning into ADL caregiving was significantly lower among participants who changed from living with spouse alone to living with spouse and other family members together (B = − 5.37, p < 0.05). There was an association between transitioning into ADL caregiving and an elevated level of depression over four years among older husbands, which could be alleviated by living with family members. Co-residence with family members could serve as a natural support resource, buffering adverse mental health outcomes when older husbands start a demanding caregiving role. [ABSTRACT FROM AUTHOR]

In recent years, the prevalence of allergic diseases has increased significantly, causing great concern, and wheat, as one of the top 8 food allergens, is a common allergy trigger. Nevertheless, reliable estimates of the positivity rate of wheat allergens in the allergic population in China are still lacking. The systematic review and meta-analysis aims to evaluate the positive detection rate of wheat allergens in the Chinese allergic population and further provide a reference for the prevention of allergy. CNKI, CQVIP, WAN-FANG DATA, Sino Med, PubMed, Web of Science, Cochrane Library, and Embase databases were retrieved. Related research and case reports about the positive rate of wheat allergen in the Chinese allergic population published from inception to June 30, 2022, were searched, and meta-analysis was performed using Stata software. The pooled positive rate of wheat allergens and 95% confidence interval were calculated by random effect models, and the publication bias was evaluated using Egger's test. A total of 13 articles were included for the final meta-analysis, in which wheat allergen detection methods involved only serum sIgE testing and SPT assessment. The results showed that the wheat allergen positivity detection rate in Chinese allergic patients was 7.30% (95% CI 5.68–8.92%). Subgroup analysis showed that the positivity rate of wheat allergens was influenced by region, but hardly by age and assessment method. The positive rates of wheat allergy in the population with allergic diseases were 2.74% (95% CI 0.90–4.58%) and 11.47% (95% CI 7.08–15.87%) in southern and northern China, respectively. In particular, the positive rates of wheat allergens were greater than 10% in Shaanxi, Henan and Nei Mongol, all of which belong to the northern region. These results suggest that wheat allergens are an important cause of sensitization in allergic populations from northern China, and therefore attention should be paid to early prevention in high-risk populations. [ABSTRACT FROM AUTHOR]

Background: Carpal tunnel syndrome (CTS), as the most common compression neuropathy in the upper limb, can lead to upper limb dysfunction in patients. The effectiveness of acupuncture in treating CTS has been validated based on numerous clinical trials and meta-analyses, but questions remain, such as how to select the best acupoints. Our purpose is to conduct the first data mining analysis to identify the most effective acupoint selection and combinations for treating CTS. Methods: We will search 7 electronic bibliographic databases (PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, Wanfang Database, Chinese Biomedical Literature Database and Chongqing VIP Database) from inception to March 2023. Clinical trials assessing the effectiveness of acupuncture therapy on the management of CTS will be selected. Reviews, protocols, animal trials, case reports, systematic reviews, and meta-analyses will be excluded. The primary outcome measure will be clinical result associated with CTS. Descriptive statistics will be performed in Excel 2019. Association rule analysis will be performed in SPSS Modeler 18.0. Exploratory factor analysis and cluster analysis will be performed in SPSS Statistics 26.0. Results: This study will investigate the most effective acupoint selection and combinations for patients with CTS. Conclusion: Our findings will provide evidence for the effectiveness and potential treatment prescriptions of acupoint application for patients with CTS, helping clinicians and patients make a more informed decision together. [ABSTRACT FROM AUTHOR]

The current study examined the relationship between napping duration and metabolic syndrome (MetS) among Chinese middle-aged and older adults over 4 years. We included 4,526 individuals aged ≥50 years who completed the 2011 and 2015 waves of the China Health and Retirement Longitudinal Study. General linear models were conducted to analyze the association of napping duration (none, 1 to 29 minutes, 30 to 59 minutes, 60 to 89 minutes, and ≥90 minutes) with MetS. At baseline, a higher prevalence of MetS was observed among participants with longer napping durations (60 to 89 minutes or ≥90 minutes) compared to non-nappers (odds ratio [OR] = 1.27, OR = 1.51, respectively). Among all participants, a napping duration ≥90 minutes at baseline was correlated with an increased risk of MetS 4 years later (OR = 1.58). Among participants without MetS at baseline, excessive napping (≥90 minutes) was predictive of a higher incidence of MetS 4 years later (OR = 1.46). Results revealed that excessive napping was related to an increased prevalence and incidence of MetS among Chinese middle-aged and older adults. [Research in Gerontological Nursing, 16(3), 115–124.] [ABSTRACT FROM AUTHOR]

Based on the precipitation records of 2474 meteorological stations, this study investigated precipitation characteristics and trends in China from 1961 to 2010, including spatiotemporal distribution and changes in average annual precipitation amount, number of days when daily precipitation > = 1, 5, 10, 25, 50 mm, and extreme precipitation indices. The results showed that: (1) in terms of annual average precipitation amount, both dry to wet, wet to wetter, and shifting between wet and dry showed decadal and climatical fluctuations in annual precipitation totals in space and time, with a clear shift in space from the 0 to 200 mm and above 400 mm precipitation levels to the 200 to 400 mm precipitation level. (2) In terms of graded precipitation days, three kinds of trend changes were observed: (a) enhancement, manifested as an increase in precipitation events, mainly in the northwest and northeast of China; (b) reduction, manifested as a decrease in precipitation events, mainly in the central parts of China; and (c) polarization, which is manifested as a decrease in gentle and light precipitation events but an increase in dry days, heavy, and rainstorm precipitation events, primarily along coastal area in southeast China. (3) In terms of extreme precipitation events, precipitation persistence showed a decreasing trend, but an increasing trend in precipitation intensity and magnitude in most regions of China. This paper also presents the relationship between certain atmospheric circulation indices and the seasonal precipitation of summer and winter. The distribution characteristics and changes in minor precipitation events were highlighted, including gentle and light rain events. Relevant findings can provide scientific guidance for water resource management and conservation. [ABSTRACT FROM AUTHOR]

Aims and objectives: To examine the joint effects of self and spousal frailty status on functional and mental health in Chinese older adults and determine whether such effects vary by urban versus rural residency. Background: Frailty is a clinical syndrome among old adults and would lead to adverse outcomes. However, studies on the interactive patterns of frailty status between spouses and the joint effects of such patterns on health outcomes are scarce. Design: Data were from the China Health and Retirement Longitudinal Study (CHARLS). A total of 2,581 married seniors who participated both 2011 and 2015 waves of the CHARLS were categorised into four groups: robust self–robust spouse (RR), robust self–frail spouse (RF), frail self–robust spouse (FR) and frail self–frail spouse (FF). Methods: Frailty was measured using the physical frailty phenotype scale. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale (CESD). Functional health was measured by difficulties in activities of daily living (ADL) and instrumental activities of daily living (IADL). The generalised estimating equation was used to estimate the effects of concordant frailty on mental and functional outcomes, stratified by rural/urban residency. This study followed the STROBE checklist. Results: The FF group reported higher levels of ADL/IADL difficulties and depressive symptoms at follow‐up than the RR group; urban individuals in the RF group reported higher follow‐up depression than the RR group; and rural individuals from the FR or RF groups reported more follow‐up ADL/IADL difficulties than the RR group. Conclusion: Frailty and subsequent health decline are interdependent in older couples, and the rural/urban context is important for understanding this interdependence in the older Chinese population. Relevance to clinical practice: Couples‐based intervention strategies are needed to tackle situations in which one or both spouses are concurrently facing frailty. [ABSTRACT FROM AUTHOR]

Aims: To investigate the longitudinal association of metabolic syndrome (MetS) and its components with disability outcomes. Methods: A total of 5875 participants aged 60 and above completed the 2011 and 2015 waves of the China Health and Retirement Longitudinal Study (CHARLS). MetS at baseline was measured by the National Cholesterol Education Program Adult Treatment Panel III criteria. Logistic regressions were conducted to analyze the associations between baseline MetS and incident disability, measured as the onset of limitations regarding instrumental activities of daily living (IADL) and activities of daily living (ADL) 4 years later. Linear regression was adopted to analyze the longitudinal impact of baseline MetS on the number of IADL and ADL limitations in 2015. A comprehensive list of baseline covariates was adjusted in all regression analyses. Results: Baseline MetS was related to increased odds of incident IADL disability (OR = 1.28, 95% CI 1.05–1.55) and incident ADL disability (OR = 1.27, 95% CI 1.05–1.53) among disability-free participants at baseline. Baseline MetS was also associated with an increase in the number of IADL (beta = 0.15, 95% CI 0.07–0.23) and ADL limitations (beta = 0.10, 95% CI 0.01–0.18), while adjusting for baseline functional performance. Significant MetS component predictors of disability outcomes include abdominal obesity, high blood pressure, and a low level of high-density lipoprotein cholesterol. Conclusions: Our findings suggest an increased risk of incident disability and deteriorated functional performance over 4 years, associated with the presence of MetS and its components. [ABSTRACT FROM AUTHOR]

Background: It is unknown whether and how poverty influences the long-term outcome of persons with severe mental illness (SMI). Aims: To explore the change of poverty status in persons with SMI from 1994 to 2015 and examine the impact of poverty status on patients' outcome in rural China. Method: Two mental health surveys using identical methods and International Classification of Disease (ICD-10) were conducted in 1994 and 2015 in the same six townships of Xinjin County, Chengdu, China. Results: The annual net income per person was 19.8% and 100.2% higher for the general population than for persons with SMI in 1994 and 2015 respectively. Compared with 1994 (48.2%), persons with SMI in 2015 had significantly higher rates of poor family economic status (

Objectives: To determine the effects of baseline and changes in frailty states on subsequent depressive symptoms, and whether sleep duration would modify these effects. Design Prospective, cohort study. Setting: The 2011 baseline and 2013 follow‐up waves of the China Health and Retirement Longitudinal Study (CHARLS). Participants: Community‐dwelling old adults who were aged 60 or above at baseline and participated in the 2011 and 2013 waves of the CHARLS (N = 5,026). Measurements: Frailty was measured using the physical frailty phenotype (PFP) scale. Levels of depressive symptoms were measured by the 10‐item Center for Epidemiologic Studies Depression Scale (CES‐D). Using the generalized estimating equations (GEE), the effects of baseline and transitions in frailty states were examined on subsequent depressive symptoms, adjusting for a range of confounding variables. Results: Baseline prefrail (b = 0.97, P <.05) and frail states (b = 0.35, P <.05) were associated with higher subsequent level of depressive symptoms 2 years later. Within individuals who were robust at baseline, transitioning into prefrail/frail (b = 3.04, P <.001) was associated with a higher subsequent level of depressive symptoms, and this association was accelerated by short sleep duration. Within individuals who were prefrail at baseline, transitioning into frail (b = 1.76, P <.001) was associated with higher subsequent levels of depressive symptoms, and this association was stronger among those who reported short sleep duration. Conclusion: Baseline and transitions in frailty states were significantly related with higher subsequent levels of subsequent depressive symptoms. Short sleep duration significantly moderated the effects of baseline or transitions of frailty on subsequent depressive symptoms. Targeted interventions could be implemented to improve sleep quality for prefrail and frail older adults. [ABSTRACT FROM AUTHOR]

Few studies have linked social factors to air pollution exposure in China. Unlike the race or minority concepts in western countries, the Hukou system (residential registration system) is a fundamental reason for the existence of social deprivation in China. To assess the differences in ozone (O 3 ) exposure among social groups, especially groups divided by Hukou status, we assigned estimates of O 3 exposure to the latest census data of the Beijing urban area using a kriging interpolation model. We developed simultaneous autoregressive (SAR) models that account for spatial autocorrelation to identify the associations between O 3 exposure and social factors. Principal component regression was used to control the multicollinearity bias as well as explore the spatial structure of the social data. The census tracts (CTs) with higher proportions of persons living alone and migrants with non-local Hukou were characterized by greater exposure to ambient O 3 . The areas with greater proportions of seniors had lower O 3 exposure. The spatial distribution patterns were similar among variables including migrants, agricultural population and household separation (population status with separation between Hukou and actual residences), which fit the demographic characteristics of the majority of migrants. Migrants bore a double burden of social deprivation and O 3 pollution exposure due to city development planning and the Hukou system. [ABSTRACT FROM AUTHOR]

• Five multimorbidity clusters were identified among middle-aged and older adults in China: minimal disease, arthritis, cardiovascular disease, lung/asthma, and multisystem morbidity. • The multisystem morbidity group had the highest use in outpatient, inpatient and self-treament healthcare, and the highest cost in self-treatment. • The five groups did not show significant differences in outpatient costs. While the lung/asthma and arthritis groups reported lower inpatient costs than other groups. This study investigated multimorbidity patterns among middle-aged and older Chinese people and whether healthcare costs varied among different multimorbidity patterns. Data were from the 2011–2018 waves of the China Health and Retirement Longitudinal Study (CHARLS). We included 20,855 unique observations with information coming from their last wave of interviews and aged at least 45 years or older. Latent class analysis (LCA) was performed to classify individuals with common multimorbidity clusters based on 14 self-reported chronic diseases. Healthcare costs were from participants' self-reports and categorized into outpatient, inpatient, and self-treatment. Two-part regression was performed to analyze the association of multimorbidity patterns with healthcare costs. Five multimorbidity clusters were identified: minimal disease, arthritis, cardiovascular disease (CVD), lung/asthma, and multisystem morbidity. The multisystem morbidity group had the highest use in all three types of healthcare and the highest self-treatment cost. Compared with the minimal disease group, the other four groups did not show significant differences in outpatient costs. Relative to the minimal disease group, the lung/asthma group reported lower inpatient costs. Healthcare use and costs varied across multimorbidity patterns among middle-aged and older Chinese people. Implementing an integrated care plan for multimorbidity is suggested to improve the cost-effectiveness of healthcare provision and reduce the financial burden of the healthcare system. Reimbursement policy design should also take multimorbidity patterns into account. [ABSTRACT FROM AUTHOR]

Cadmium (Cd) is one of the most serious soil contaminants in China, and it poses an increasing risk to human health as large amounts of Cd are emitted into the environment. However, knowledge about soil Cd concentrations and the human health risks of these concentrations at a national scale is limited. In this study, we conducted a review of 190 articles about soil Cd concentrations during 2001 to 2010. The study involved 146 cities in China, and we quantified the risks to human health according to different regions. The results showed that elevated Cd levels were present compared to the background value of soil in 1990, and the soil Cd concentrations in the Guangxi province exceeded even the class III Soil Environmental Quality standard, which is the limit for the normal growth of plants. The Chinese soil Cd concentrations ranged from 0.003 mg kg to 9.57 mg kg. The soil Cd concentrations had the following trend: northwest > southwest > south central > east > northeast > north. The sources of soil Cd are mainly from smelting, mining, waste disposal, fertilizer and pesticide application, and vehicle exhaust, etc. but differentiated in various regions. The soil Cd contamination in urban areas was more serious than contamination in the agricultural areas. Currently, there is no significant non-carcinogenic risk in any of the provinces. Regarding the different exposure pathways, the dermal pathway is the primary source of soil Cd exposure, and the risk associated with this pathway is generally hundreds of times higher than the risk for an ingestion pathway. For most of the provinces, the health risk to the urban population was higher than the risk to the rural population. For each population, the carcinogenic risk was less than 10 in most of the provinces, except for the urban population in the Hunan province. If the other exposure pathways are fully considered, then the people in these areas may have a higher carcinogenic risk. This review provides a comprehensive assessment of soil Cd pollution in China, and it identifies policy recommendations for pollution mitigation and environmental management in the relevant regions. [ABSTRACT FROM AUTHOR]

Meteorological data and heat stress indices from 1958 to 2007 in the Three Gorges area were investigated in this study. It is found that there is a (1) mild augmentation of the diurnal temperature range in the region (2) antithetical trends in mean\maximum\minimum temperatures, indicated by warmer winters and slightly cooler summers and (3) declining linear trends of the number of (very) hot days and annual frequencies of (long) heat waves, despite rising frequencies of (very) hot days and annual short heat waves. A U-shape was detected for all the climatic indices, with low values occurring mostly in the 1980s. However, spatial variations exist. Decreasing trends of hot days and frequency of heat waves were more evident in areas like Shapingba, where high annual temperatures were recorded. The finding also suggests a positive impact of the subtropical high on high temperatures and extreme temperature events. [ABSTRACT FROM AUTHOR]

The article presents a study which analyzed the precipitation in the three Gorges from 1958 to 2007 in China. The study performed the examination of the monthly and annual precipitation trend concerning the precipitation, drought, and the number of rainy days (NRDs) in the three gorges to determine the precipitation data. The result of the study shows that the frequent drought and precipitation in the three gorges occurred during 1980s which is said to be influenced by the multiple systems.

Exposure to long-term ambient air pollution is believed to have adverse effects on human health. However, the mechanisms underlying these impacts are poorly understood. DNA methylation, a crucial epigenetic modification, is susceptible to environmental factors and likely involved in these processes. We conducted a whole-genome bisulfite sequencing study on 120 participants from a highly polluted region (HPR) and a less polluted region (LPR) in China, where the HPR had much higher concentrations of five air pollutants (PM 2.5 , PM 10 , SO 2 , NO 2 , and CO) (fold difference 1.6 to 6.6 times; P value 1.80E-07 to 3.19E-23). Genome-wide methylation analysis revealed 371 DMRs in subjects from the two areas and these DMRs were located primarily in gene regulatory elements such as promoters and enhancers. Gene enrichment analysis showed that DMR-related genes were significantly enriched in diseases related to pulmonary disorders and cancers and in biological processes related to mitochondrial assembly and cytokine production. Further, HPR participants showed a higher mtDNA copy number. Of those identified DMRs, 15 were significantly correlated with mtDNA copy number. Finally, cytokine assay indicated that an increased plasma interleukin-5 level was associated with greater air pollution. Taken together, our findings suggest that exposure to long-term ambient air pollution can lead to alterations in DNA methylation whose functions relate to mitochondria and immune responses. Image 1 • We used whole-genome bisulfite sequencing to study the influence of air pollution on DNA methylation in blood leukocyte. • DNA methylation levels were compared between residents from two areas with distinct air quality in China. • Differentially methylated regions were enriched in gene regulatory elements. • Genes involved in mitochondrial function and immune response are preferentially impacted by air pollution. Summary: By comparing DNA methylation of subjects from two areas with distinct air quality in China, we identified differential methylation regions whose functions are mostly related to mitochondria and immune responses. [ABSTRACT FROM AUTHOR]

• LB children were more vulnerable to psychological problems and more attention should be paid to how psychological trait resilience interplays with protective support for LB children and affects their psychological status. • LB children with higher level of trait resilience would perceive themselves as more confident and valuable, therefore, their self-esteem would be higher. • LB children with higher level of protective support would feel warmth and goodwill from the surroundings, and pay more attention to positive aspects of life and had lower depression. The left-behind children phenomenon appeared in the process of development of industrialization and urbanization in China has become a social problem that needs close attention. Meanwhile, the importance of resilience on the psychological health of left-behind children has been highlighted in academic field. This study examined the mediating effect of psychological trait resilience on the relationship between protective factors from social network and self-esteem/depression of the left-behind children in China. A total of 345 left-behind children at middle schools completed the questionnaire of Healthy Kids Resilience Assessment (HKRA), Self-Esteem Scale (SES) and Children's Depression Inventory (CDI). Path analysis showed that psychological trait resilience played a fully mediating role on the relationship between protective factors and self-esteem, as well on the association between the relationship between protective factors and depression. Building protective social network may be helpful to improve trait resilience of left-behind children, which further increase self-esteem and mitigate depression of them. The implications of these findings on social work practice were discussed. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to identify long-term distinct trajectories of multimorbidity with ageing from 50 to 85 years among Chinese older adults and examine the relationship between exposure to early-life adversity (ELA; including specific types of adversity and accumulation of different adversities) and these long-term multimorbidity trajectories., Design: The group-based trajectory models identified long-term multimorbidity trajectories. Multinomial logistic regression models were used to examine the relationship between ELA and the identified multimorbidity trajectories., Setting: This study used data from the China Health and Retirement Longitudinal Study (CHARLS, 2011-2018) and the 2014 Life History Survey., Participants: We used data from 9112 respondents (aged 60 and above) of the 2018 wave of CHARLS., Outcome Measures: Each respondent's history of chronic conditions and experiences of ELA were collected from the 2011-2018 waves of CHARLS and the 2014 Life History Survey., Results: Four heterogeneous long-term trajectories of multimorbidity development were identified: 'maintaining-low' (19.1%), 'low onset-rapidly increasing' (23.3%), 'middle onset-moderately increasing' (41.5%) and 'chronically-high' (16.2%). Our findings indicated that the heterogeneity can be explained by ELA experiences. Across various types of different ELA experiences, exposure to food insufficiency (relative risk ratios from 1.372 (95% CI 1.190 to 1.582) to 1.780 (95% CI 1.472 to 2.152)) and parental quarrel/divorce (relative risk ratios from 1.181 (95% CI 1.000 to 1.394) to 1.262 (95% CI 1.038 to 1.536)) had the most prominent associations with health deterioration. The accumulation of more different ELA experiences was associated with a higher relative risk of developing more severe multimorbidity trajectories (relative risk ratio for five to seven ELAs and chronically high trajectory: 7.555, 95% CI 4.993 to 11.431)., Conclusions: There are heterogeneous long-term trajectories of multimorbidity in Chinese older adults, and the risk of multimorbidity associated with ELA accumulates over the lifespan. Our findings highlight the role of a supportive early-life family environment in promoting health development across the lifespan, advocating for the integration of life-course approaches to implementing health disparity interventions., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Aim: This study aimed to assess the trends in disabilities in activities of daily living (ADL) and instrumental activities of daily living (IADL) among older Chinese adults and explore the influence of multimorbidity and unhealthy behaviors on ADL/IADL disability over time., Methods: Data were obtained from four waves (2011-2018) of the China Health and Retirement Longitudinal Study. Disability in ADL/IADL was defined as inability to perform any ADL/IADL task. Latent class analysis was used to identify multimorbidity patterns. The generalized estimating equation was used to test disability trends. Logistic regression was used to investigate the factors influencing disability., Results: The prevalence of IADL and ADL disability showed significant increasing trends among older Chinese adults from 2011 to 2018 (p trend  < 0.001). The negative association between alcohol intake more than once per month and IADL disability strengthened over time (p trend  < 0.05). The influence of the "arthritis/digestive diseases" pattern, "cardiometabolic disease" pattern and "high multimorbidity" pattern on ADL disability weakened over time (p trend  < 0.05)., Conclusions: The prevalence of IADL and ADL disability among Chinese older adults increased over time. The "arthritis/digestive diseases" pattern, "cardiometabolic disease" pattern and "high multimorbidity" pattern appeared to be less disabling in ADL over time. Improving the prevention and treatment of multimorbidity and developing age-friendly living conditions could be helpful to reduce the risks of disability., (© 2024. The Author(s).)

Introduction: Drawing from the life course and person-environment fit perspectives, this study examined whether life-course SES disadvantages during childhood, adulthood and old- age influence frailty development in late- life and how community environment resources moderated the association between life-course SES disadvantages and frailty trajectories over a seven-year follow-up period., Methods: Data from 11,675 participants aged ≥ 50 years at baseline who participated in the four waves (2011-2018) of the China Health and Retirement Longitudinal Survey (CHARLS) were used. Life-course SES disadvantages were self-reported, and community environment resources (basic infrastructure and voluntary organizations) were ascertained from informed officials in the community. Frailty development was measured at each wave by the Frailty Index (FI) based on 39 potential deficits. Multilevel growth modeling was used to examine the interactive effect of life-course SES disadvantages and community environment resources on frailty development., Results: Life-course SES disadvantage exerted cumulatively negative effects on frailty trajectory, and individuals with SES disadvantages in two or three life stages reported higher initial levels of and faster increases in frailty scores. Community environmental resources (basic infrastructure and voluntary organizations) had a protective effect on frailty development and buffered the negative effects of SES vulnerability experiences accumulated over the life course. Community basic infrastructure resources played an important role in slowing the progression of frailty for individuals with cumulative SES disadvantage and downward mobility., Discussion: Our findings provided new evidence of person-environmental docility among older adults, documenting the role of community resources in buffering SES disparities in health during later-life., Competing Interests: Declaration of Competing Interest The authors declare no conflicts of interest., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Objective: Recent studies suggest air pollution as an underlying factor to kidney disease. However, there is still limited knowledge about the short-term correlation between glomerulonephritis (GN) and air pollution. Thus, we aim to fill this research gap by investigating the short-term correlation between GN clinical visits and air pollution exposure., Methods: Between 2015 and 2019, daily GN visit data from two grade A tertiary hospitals in Hefei City were collected, along with corresponding air pollution and meteorological data. A generalized linear model integrated with a distributed lag nonlinear model was employed to analyze the relationship between GN visits and air pollutants. Moreover, we incorporated a dual pollutant model to account for the combined effects of multiple pollutants. Furthermore, subgroup analyses were performed to identify vulnerable populations based on gender, age, and season., Results: The association between 23,475 GN visits and air pollutants was assessed, and significant positive associations were found between CO and NO 2 exposure and GN visit risk. The single-day lagged effect model for CO showed increased risks for GN visits from lag0 (RR: 1.129, 95% CI: 1.031-1.236) to lag2 (RR: 1.034, 95% CI: 1.011-1.022), with the highest risk at lag0. In contrast, NO 2 displayed a more persistent impact (lag1-lag4) on GN visit risk, peaking at lag2 (RR: 1.017, 95% CI: 1.011-1.022). Within the dual-pollutant model, the significance persisted for both CO and NO 2 after adjusting for each other. Subgroup analyses showed that the cumulative harm of CO was greater in the cold-season and older adult groups. Meanwhile, the female group was more vulnerable to the harmful effects of cumulative exposure to NO 2 ., Conclusion: Our study indicated that CO and NO 2 exposure can raise the risk of GN visits, and female and older adult populations exhibited greater susceptibility., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher., (Copyright © 2023 Chen, Duan, Zhu, Wan, Zhao, Ye and Fang.)

Although considerable progress toward gender equality in science has been made in recent decades, female researchers continue to face significant barriers in the academic labor market. International mobility has been increasingly recognized as a strategy for scientists to expand their professional networks, and that could help narrow the gender gap in academic careers. Using bibliometric data on over 33 million Scopus publications, we provide a global and dynamic view of gendered patterns of transnational scholarly mobility, as measured by volume, distance, diversity, and distribution, from 1998 to 2017. We find that, while female researchers continued to be underrepresented among internationally mobile researchers and migrate over shorter distances, this gender gap was narrowing at a faster rate than the gender gap in the population of general active researchers. Globally, the origin and destination countries of both female and male mobile researchers became increasingly diversified, which suggests that scholarly migration has become less skewed and more globalized. However, the range of origin and destination countries continued to be narrower for women than for men. While the United States remained the leading academic destination worldwide, the shares of both female and male scholarly inflows to that country declined from around 25% to 20% over the study period, partially due to the growing relevance of China. This study offers a cross-national measurement of gender inequality in global scholarly migration that is essential for promoting gender-equitable science policies and for monitoring the impact of such interventions.

Background: Multimorbidity is prevalent among older adults and may result in catastrophic health expenditures (CHEs) on older adults' households. However, whether older adults living alone suffer such a financial burden is unknown. We aimed to investigate the association between multimorbidity patterns and CHE in Chinese older adults living alone., Methods: We included 884 participants aged 60 years and over and living alone from the 2018 wave of the China Health and Retirement Longitudinal Study (CHARLS). Latent class analysis was performed to identify multimorbidity patterns based on 14 self-reported chronic diseases. The logit model and Tobit model were adopted to analyze the association of multimorbidity patterns with the incidence and intensity of CHE, respectively., Results: Approximately 20.2% of the older adults living alone experienced CHE. Among the four multimorbidity groups (minimal disease, cardiovascular, lung and asthma, and multisystem), the multisystem group and cardiovascular group had significantly higher incidence and intensity of CHE than the minimal disease group., Conclusions: Older adults living alone had high risks of CHE, especially those belonging to the multisystem pattern and cardiovascular pattern. Integrated care should be adopted in the treatment of multimorbidity to reduce health costs. More elder services and social assistance should be provided to solitary older adults with certain patterns of multimorbidity., Competing Interests: Declarations of Competing Interest All the authors have no financial or any other kind of personal conflicts with this manuscript., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Background: This study aimed to investigate multimorbidity patterns and their associated factors among elderly population in China., Methods: A total of 10,479 participants aged at least 60 years were drawn from the 2018 wave of the China Health and Retirement Longitudinal Study (CHARLS). Latent class analysis (LCA) was performed to identify distinct multimorbidity classes based on 14 self-reported chronic conditions. The multinomial logit model was used to analyze the associated factors of multimorbidity patterns, focusing on individuals' demographic characteristics, socioeconomic status (SES), and health behaviors., Results: Among the 10,479 participants (mean age [SD]: 69.1 [7.1]), 65.6% were identified with multimorbidity. Five multimorbidity clusters were identified by LCA: relatively healthy class (49.8%), vascular class (24.7%), respiratory class (5.6%), stomach-arthritis class (14.5%), and multisystem morbidity class (5.4%). Multinomial logit analysis with the relatively healthy class as the reference showed that participants of older age and female sex were more likely to be in the vascular class and multisystem morbidity class. The probability of being in the vascular class was significantly higher for those with high SES. Ever smoking was associated with a higher probability of being in the respiratory class and multisystem morbidity class. Physical activity was associated with lower odds of being assigned to the vascular class, respiratory class, and multisystem class., Conclusion: The distinct multimorbidity patterns imply that the prevention and care strategy should target a group of diseases instead of a single condition. Prevention interventions should be paid attention to for individuals with risk factors., (© 2022. The Author(s).)

This study investigates the association between the C14orf119 gene rs6736 polymorphism and ischemic stroke (IS) susceptibility, and explores the influence of the rs6736 polymorphism on the binding between miR-7-1 and the C14orf119 gene. mRNA expression levels were determined in 45 IS patients and 45 matched controls via real-time quantitative PCR. A total of 774 IS patients and 793 matched controls were recruited from a Han Chinese population for genotyping, performed with the Sequenom MassARRAY iPLEX platform. A dual-luciferase reporter assay was used for the analysis of miRNA-mRNA binding. The results showed that the mRNA expression of C14orf119 differed significantly between IS patients and controls (t =  -2.235, P = 0.030). Significant associations were noted between the C14orf119 gene rs6736 polymorphism and IS susceptibility in Han Chinese individuals under the additive model [OR adj (95% CI) = 0.87 (0.76-1.00) P adj  = 0.048] and dominant model [OR adj (95% CI) = 0.76 (0.61-0.94), P adj  = 0.014], with adjustment for age and sex. Mutations in the rs6736 polymorphism disrupted the binding of miR-7-1 and the C14orf119 gene. The results of this study show that the rs6736 polymorphism in the 3'-untranslated region of the C14orf119 gene not only is associated with IS but also modifies the binding between miR-7-1 and the C14orf119 gene. The C14orf119 gene may participate in the relationship between IS and miR-7-1., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Long noncoding RNAs (lncRNAs) were reported to play important roles in the pathogenesis of ischemic stroke (IS). Our study aimed to investigate the role of lncRNA SERPINB9P1 expression in ischemic stroke and the association between SERPINB9P1 polymorphisms and IS risk, as well as examine the correlation of SERPINB9P1 expression and variants with clinical parameters of IS. The SERPINB9P1 levels in human participants and oxygen-glucose deprivation (OGD)-treated human A172 cells were measured by qRT-PCR. The SERPINB9P1 polymorphisms (rs375556 and rs318429) were genotyped by the MassARRAY platform. We found that the SERPINB9P1 expression was significantly downregulated in patients with IS compared with that in healthy controls. On the 14th day in the hospital, the SERPINB9P1 level in patients with moderate and severe stroke was significantly downregulated compared with the normal group. After stratification by gender, the rs375556 polymorphism was significantly associated with susceptibility to female IS in the recessive model, and the significant association remained after adjusting for age. After adjusting for gender and age, rs318429 was significantly associated with FPG and D-D levels, and rs375556 was significantly associated with INR and PTA levels in IS cases. Besides, the lncRNA SERPINB9P1 expressed downregulated in OGD/reoxygenation-treated human A172 cells. In conclusion, the lncRNA SERPINB9P1 may protect against cerebral ischemia-reperfusion injury and neurological impairment after IS. The SERPINB9P1 rs375556 polymorphism was associated with susceptibility to female IS, and SERPINB9P1 polymorphisms may influence the metabolism of blood glucose and regulation of coagulation function in patients with IS., (© 2021. Fondazione Società Italiana di Neurologia.)

Background: Metabolic syndrome (MetS) may adversely influence muscle strength. However, the relationship remains poorly understood in China, despite its large older population and the high prevalence of MetS., Objectives: We aimed to investigate the association between MetS and muscle weakness among older Chinese., Methods: We included 2,418 older adults who completed the 2011 and 2015 waves of the China Health and Retirement Longitudinal Study (CHARLS) and had normal handgrip strength at baseline. Data were analyzed using descriptive statistics and logistic regressions., Results: Baseline MetS was associated with increased risks for incident muscle weakness (OR = 1.35, 95% CI: 1.08-1.67). Among all the MetS components, baseline central obesity component was predictive of muscle weakness. The association between MetS and declined muscle strength existed in men but not women., Conclusion: There was an increased risk of muscle strength decline associated with MetS, which was more prominent in men., Competing Interests: Conflict of Interest None., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Objectives: Previous studies documented that caregiving affects the mental health of spousal caregivers, and social participation is a favorable contributor to late-life well-being. However, it remains unclear whether changing social participation influences caregivers' mental health during their transition into spousal caregiving. The present study investigated the influence of transitioning into spousal caregiving, continuity and changes in social participation, and their interactions on older adults' depressive symptoms over time., Method: Information on caregiving transitions and social participation for 2,436 baseline noncaregivers was drawn from the 2011‒2015 China Health and Retirement Longitudinal Survey. Generalized estimating equations were used for estimating the effects of caregiving transitions (transition into low-intensity caregiving, transition into high-intensity caregiving versus no caregiving) and changing social participation (increased participation, decreased participation, continuous participation versus no participation) on follow-up depressive symptoms., Results: Individuals who transitioned into spousal care provision over a four-year period reported more elevated depressive symptoms than those who remained noncaregivers. Individuals who continued or increased social participation reported fewer depressive symptoms than those who reported no participation over the four-year period. Increases in depressive symptoms were less severe among individuals who maintained continuous or increased social participation when transitioning into high-intensity care provision than among their counterparts who were not continuously involved in social participation during the transition., Conclusions: Continuous social participation protected against adverse psychological consequences during the transition into high-intensity spousal caregiving. Clinical attention should be directed at supporting spousal caregivers who meet difficulties in maintaining social participation when starting a demanding caregiving role.

(1) Background: The heavy workload and understaffed personnel of village doctors is a challenge to the rural healthcare system in China. Previous studies have documented the predictors of doctors' burnout; however, little attention has been paid to village doctors. This study aims to investigate the prevalence and influential factors of burnout among village doctors. (2) Methods: Data was collected by a self-administered questionnaire from 1248 village doctors who had worked at rural clinics for more than a year. Burnout was measured using the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) with three dimensions-emotional exhaustion (EE), depersonalization (DP), and reduced personal accomplishment (PA). A logistic regression model was applied to estimate the influential factors of burnout. (3) Results: The prevalence of overall burnout was 23.6%. Being male (OR = 0.58, 95%CI: 0.41-0.82), poor health status (OR = 0.80, 95%CI: 0.67-0.94), low income (OR = 0.62, 95%CI: 0.40-0.95), and a poor doctor-patient relationship (OR = 0.57, 95%CI: 0.48-0.67) were significantly related to burnout. Conclusion: Burnout is prevalent among Chinese village doctors. Policies such as increasing village doctors' income and investing more resources in rural healthcare system should be carried out to mitigate and prevent burnout.

Background: Frailty, which is defined as aging-related multisystem impairments, can lead to adverse health outcomes. However, evidence for such a connection in Chinese older adults remains lacking. This study examined the association between frailty and future falls and disability among community-dwelling Chinese older adults., Methods: Data were obtained from the 2011 and 2015 waves of the China Health and Retirement Longitudinal Study. Participants were aged 60 years and above at baseline in 2011 and completed the follow-up survey in 2015. Outcome measures were future falls, incident disability in activities of daily living (ADLs) and instrumental activities of daily living (IADLs), and worsening performance of ADLs and IADLs. A multivariate logistic regression was conducted to examine the association between frailty phenotype and falls, incident disability, and worsening disability during a four-year period., Results: We found that frail participants were at increased risk at follow-up for: falls (OR 1.54, 95% CI, 1.14-2.08); developing new ADL difficulties (OR 4.10, 95% CI, 2.79-6.03) and IADL difficulties (OR 3.06, 95% CI, 2.03-4.61); and worsening ADLs performance (OR 2.27, 95% CI, 1.27-4.06), after adjusting for potential confounders. Prefrailty was also significantly associated with future falls, incident disability in ADLs and IADLs, but with a lower magnitude of effect., Conclusions: Frailty phenotype is an independent predictor of future falls, incident disability, and worsening performance in ADLs among Chinese older adults. The association suggests the need to pay special attention in caring for frail and prefrail elders and improving individuals' frailty status.

Background: Since 2000, a series of national policies have been released to tackle mental health problems in China; however, their promotion and implementation at local level are under-evaluated. This study will evaluate the case of Liuyang Municipality, to present a deeper understanding of China's problems and lessons on implementation of mental health policy in developing countries., Methods: A rapid appraisal was conducted on Liuyang's mental health policy and plan, under two evaluation frameworks: (1) the WHO checklists for mental health policy and plan, (2) activities and time frames stated in Liuyang's mental health policy and plan. Documentation review, semi-structured interviews with nine key informants, and surveys on 32 front-line implementers were performed. Descriptive statistics and framework analysis were employed respectively to analyze quantitative and qualitative data., Results: As a local-level promotion of national mental health policies, Liuyang's mental health policy and plan had evidence base and received highest-level approval within local health system, but without stakeholders' consultation. The vision, principles and objectives were consistent with national policies. Twelve WHO-suggested areas for actions were unequally covered. Policy content had operational defects of lacking necessary details on evaluation, funding and activity. For implementation, health departments generally outperformed non-health ones. Discrepancies between planning and practices, and uneven regional implementation compromised implementation quality. Insufficient and poorly trained human resources, unguaranteed funding and low client acceptability were identified as implementation barriers., Conclusions: The case of Liuyang is an active attempt to promote and implement national mental health policies at local level. As a reflection of mental health policy in China and developing countries, its highlights and problems demonstrate that evidence base, high-level approval, multi-sector involvement, operational content, and clear focuses promote policy implementation.