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Dietary antioxidant indices (DAI) may be potentially associated with relative telomere length (RTL) of leucocytes. This study aimed to investigate the relationship between DAI and RTL. A cross-sectional study involving 1656 participants was conducted. A generalised linear regression model and a restricted cubic spline model were used to assess the correlation of DAI and its components with RTL. Generalised linear regression analysis revealed that DAI (β = 0·005, P = 0·002) and the intake of its constituents vitamin C (β = 0·043, P = 0·027), vitamin E (β = 0·088, P < 0·001), Se (β = 0·075, P = 0·003), and Zn (β = 0·075, P = 0·023) were significantly and positively correlated with RTL. Sex-stratified analysis showed that DAI (β = 0·006, P = 0·005) and its constituents vitamin E (β = 0·083, P = 0·012), Se (β = 0·093, P = 0·006), and Zn (β = 0·092, P = 0·034) were significantly and positively correlated with RTL among females. Meanwhile, among males, only vitamin E intake (β = 0·089, P = 0·013) was significantly and positively associated with RTL. Restricted cubic spline analysis revealed linear positive associations between DAI and its constituents' (vitamin E, Se and Zn) intake and RTL in the total population. Sex-stratified analysis revealed a linear positive correlation between DAI and its constituents' (vitamin E, Se and Zn) intake and RTL in females. Our study found a significant positive correlation between DAI and RTL, with sex differences. [ABSTRACT FROM AUTHOR]

The research reported in this paper investigated the effects of semantic relatedness of words (closely related vs. distantly related) and morpheme type (free morpheme vs. bound morpheme) on young Chinese children's homophone awareness, an aspect of morphological awareness, in two experiments. The first experiment was a cross-sectional study including 39 children in a beginning kindergarten class, 39 children in an intermediate kindergarten class, and 36 children in a senior kindergarten class. The second experiment was a 7-month longitudinal study involving 43 first graders and 50 second graders at the beginning of the study. In both experiments, the children judged whether orally presented words shared the same morpheme or contained homophonous morphemes. The results suggest that homophone awareness emerges in Chinese children in the kindergarten years. Children's morpheme identification is facilitated by the semantic proximity of words that share a morpheme, and awareness of free morphemes is developed before that of bound morphemes. Furthermore, although semantic relatedness is the most prominent factor in kindergarten, its effect varies as a function of morpheme type in the early primary grades. Our research sheds light on the developmental course of morphological awareness and the factors that influence it. [ABSTRACT FROM PUBLISHER]

China's urban population has experienced rapid fertility decline over the past six decades. This drastic change will have a significant impact on China's demographic, social and economic future. However, the patterns and characteristics of urban China's fertility decline have not been systematically examined. This study analyses the trends and age patterns of fertility in urban China since the 1950s, and summarizes the major characteristics of reproductive behaviours into four 'lows': extremely 'low' level of fertility; 'low' proportion of two and higher parity births; 'low' mean age at birth; and 'low' level of childlessness. The paper argues that the highly homogenous reproductive behaviours found in China's now near 800 million urban population have been in part shaped by the country's unprecedented government intervention in family planning. The 'later, longer, fewer' campaign in the 1970s and the 'one-child' policy, in particular, have left clear imprints on China's reproductive norms and fertility patterns. The government-led family planning programme, however, has not been the only driving force of fertility decline. A wide range of social, economic, political and cultural changes have also affected the transition in family formation, reproductive behaviour and fertility patterns, and this has become increasingly prominent in the past two decades. [ABSTRACT FROM AUTHOR]

It has been suggested that added sugar intake is associated with non-alcoholic fatty liver disease (NAFLD). However, previous studies only focused on sugar-sweetened beverages; the evidence for associations with total added sugars and their sources is scarce. This study aimed to examine the associations of total added sugars, their physical forms (liquid v. solid) and food sources with risk of NAFLD among adults in Tianjin, China. We used data from 15 538 participants, free of NAFLD, other liver diseases, CVD, cancer or diabetes at baseline (2013–2018 years). Added sugar intake was estimated from a validated 100-item FFQ. NAFLD was diagnosed by ultrasonography after exclusion of other causes of liver diseases. Multivariable Cox proportional hazards models were fitted to calculate hazard ratios (HR) and corresponding 95 % CI for NAFLD risk with added sugar intake. During a median follow-up of 4·2 years, 3476 incident NAFLD cases were documented. After adjusting for age, sex, BMI and its change from baseline to follow-up, lifestyle factors, personal and family medical history and overall diet quality, the multivariable HR of NAFLD risk were 1·18 (95 % CI 1·06, 1·32) for total added sugars, 1·20 (95 % CI 1·08, 1·33) for liquid added sugars and 0·96 (95 % CI 0·86, 1·07) for solid added sugars when comparing the highest quartiles of intake with the lowest quartiles of intake. In this prospective cohort of Chinese adults, higher intakes of total added sugars and liquid added sugars, but not solid added sugars, were associated with a higher risk of NAFLD. [ABSTRACT FROM AUTHOR]

Objective: Surgical management is the mainstay of treatment for tumours in the parapharyngeal space. This study aimed to evaluate the indications, limits and technical nuances of the endoscopic transoral approach. Method: Thirteen patients with parapharyngeal space tumours that were treated between May 2017 and November 2020 were included in this retrospective study. Results: All patients underwent surgery for complete oncological resection except one patient who received treatment for diagnostic purposes. No major complications were reported, with excellent control of the vital structures of the parapharyngeal space. Conclusion: The endoscopic transoral approach to the parapharyngeal space is a promising alternative approach for selected parapharyngeal space tumours with satisfactory outcomes. [ABSTRACT FROM AUTHOR]

The low retirement age has imposed a heavy economic burden on the pension system in China, leading to an ongoing debate about raising the retirement age. To understand the potential costs of raising the retirement age, we need to consider the health effects of retirement policies. Using the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2015, this study employs the statutory retirement age as the exogenous variable of retirement and applies a fuzzy regression discontinuity design (RDD) to examine the effect of retirement on the health of Chinese elderly people. We find that retirement has a non-significant effect on health with respect to a series of health indicators, different bandwidths of RDD and sub-sample groups. The finding is also robust across different retirement definitions and retirement ages. This result may be attributed to the minimal changes in income and lifestyles before and after retirement. Moreover, the findings of this study provide important evidence for policy makers to increase retirement ages in China. [ABSTRACT FROM AUTHOR]

The purpose of the current study was to research the factors influencing thyroid volume (TVOL) in 6–12-year-old children and update the reference values. A cross-sectional study was carried out in iodine-sufficient areas of four provinces in China. Urine, edible salt and drinking water samples were collected from children. Children's height, weight and TVOL were measured. Ridge regression was used to screen variables for solving the multicollinearity problem. Quantile regression was used to analyse the relationship between the quantiles of TVOL and other variables. In total, 5653 children aged 6–12 years were enrolled in this study, including 2838 boys and 2815 girls. There was no significant difference in TVOL between boys and girls (P > 0·05). Spearman correlation analysis showed that total TVOL was positively correlated with age, height, weight, body surface area (BSA) and BMI, and the correlation coefficients were 0·616, 0·663, 0·669, 0·685 and 0·479, respectively. Among them, the correlation between TVOL and BSA was the strongest. According to the ridge regression results, age and BSA influenced TVOL, and the ridge regression coefficients were 0·13 and 0·94, respectively. Quantile regression further showed that age and BSA had significant influences on the whole TVOL distribution (P < 0·001). Therefore, the TVOL of children aged 6–12 years in China was mainly influenced by age and BSA, and reference values for TVOL of different genders based on age and BSA were established. [ABSTRACT FROM AUTHOR]

Background: The outbreak and rapid spread of coronavirus disease 2019 (COVID-19) not only caused an adverse impact on physical health, but also brought about mental health problems among the public. Methods: To assess the causal impact of COVID-19 on psychological changes in China, we constructed a city-level panel data set based on the expressed sentiment in the contents of 13 million geotagged tweets on Sina Weibo, the Chinese largest microblog platform. Results: Applying a difference-in-differences approach, we found a significant deterioration in mental health status after the occurrence of COVID-19. We also observed that this psychological effect faded out over time during our study period and was more pronounced among women, teenagers and older adults. The mental health impact was more likely to be observed in cities with low levels of initial mental health status, economic development, medical resources and social security. Conclusions: Our findings may assist in the understanding of mental health impact of COVID-19 and yield useful insights into how to make effective psychological interventions in this kind of sudden public health event. [ABSTRACT FROM AUTHOR]

Background: Social cognition has not previously been assessed in treatment-naive patients with chronic schizophrenia, in patients over 60 years of age, or in patients with less than 5 years of schooling. Methods: We revised a commonly used measure of social cognition, the Reading the Mind in the Eyes Test (RMET), by expanding the instructions, using both self-completion and interviewer-completion versions (for illiterate respondents), and classifying each test administration as 'successfully completed' or 'incomplete'. The revised instrument (RMET-CV-R) was administered to 233 treatment-naive patients with chronic schizophrenia (UT), 154 treated controls with chronic schizophrenia (TC), and 259 healthy controls (HC) from rural communities in China. Results: In bivariate and multivariate analyses, successful completion rates and RMET-CV-R scores (percent correct judgments about emotion exhibited in 70 presented slides) were highest in HC, intermediate in TC, and lowest in UT (adjusted completion rates, 97.0, 72.4, and 49.9%, respectively; adjusted RMET-CV-R scores, 45.4, 38.5, and 34.6%, respectively; all p < 0.02). Stratified analyses by the method of administration (self-completed v. interviewer-completed) and by education and age ('educated-younger' v. 'undereducated-older') show the same relationship between groups (i.e. NC>TC>UT), though not all differences remain statistically significant. Conclusions: We find poorer social cognition in treatment-naive than in treated patients with chronic schizophrenia. The discriminant validity of RMET-CV-R in undereducated, older patients demonstrates the feasibility of administering revised versions of RMET to patients who may otherwise be considered ineligible due to education or age by changing the method of test administration and carefully assessing respondents' ability to complete the task successfully. [ABSTRACT FROM AUTHOR]

A continuous rise of female life expectancy above that of males among older adults in India and China may give the impression that the relative gender gap in health in these countries is decreasing. However, given the systemic gender bias against older females in these countries across multiple dimensions of health, a fuller understanding of the gender gap in health calls for a multi-dimensional perspective. We estimate a multi-dimensional old-age threshold (MOAT) that specifies different old-age thresholds for female and male populations which accommodates multiple dimensions related to physical, intellectual and general health. We use the MOAT to evaluate the multi-dimensional gender gap in India and China by differencing the MOAT for females with that of males. Females in both countries have a lower MOAT than their male counterparts, indicating an earlier advent of 'old age' for females. The multi-dimensional estimates of the gender gap are also higher than the estimates based on only one dimension of health. A considerable level of variation is also observed in the gender gap across provinces. The study illustrates the need to understand the gender gap in health in India and China from a multi-dimensional perspective and provides an innovative way to quantify such a gap. Province-specific as well as health dimension-specific interventions are vital in reducing the gender gap among older adults in these countries. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present study was to identify reports of the prevalence of tinnitus in China and to present these findings in a review format. Method: This study assessed and collated published prevalence estimates of tinnitus and tinnitus severity, creating a narrative synthesis of the data from publications identified from a combination of Chinese and English language databases. Results: A total of 23 studies were included. Tinnitus prevalence ranged from 4.3 per cent to 51.33 per cent but varied with age and gender. The highest increase in prevalence from previous decade in age occurs during the fifth and sixth decades, and the highest prevalence was in the seventh decade at 32.47 per cent. There is also evidence that tinnitus prevalence is related to certain risk factors including comorbid disorders. Conclusion: The prevalence of tinnitus in mainland China in this study is consistent with global data. With increasing awareness of the prevalence of tinnitus in China, the development of epidemiological standards is a priority. [ABSTRACT FROM AUTHOR]

Objective: To evaluate vitamin D deficiency prevalence and risk factors among pregnant Chinese women.Design: A descriptive cross-sectional analysis.Setting: China National Nutrition and Health Survey (CNNHS) 2010-2013.Subjects: A total of 1985 healthy pregnant women participated. Possible predictors of vitamin D deficiency were evaluated via multiple logistic regression analyses.Results: The median serum 25-hydroxyvitamin D level was 15·5 (interquartile range 11·9-20·0, range 3·0-51·5) ng/ml, with 74·9 (95 % CI 73·0, 76·7) % of participants being vitamin D deficient (25-hydroxyvitamin D <20 ng/ml). According to the multivariate logistic regression analyses, vitamin D deficiency was positively correlated with Hui ethnicity (P=0·016), lack of vitamin D supplement use (P=0·021) and low ambient UVB level (P<0·001). In the autumn months, vitamin D deficiency was related to Hui ethnicity (P=0·012) and low ambient UVB level (P<0·001). In the winter months, vitamin D deficiency was correlated with younger age (P=0·050), later gestational age (P=0·035), higher pre-pregnancy BMI (P=0·019), low ambient UVB level (P<0·001) and lack of vitamin D supplement use (P=0·007).Conclusions: Vitamin D deficiency is prevalent among pregnant Chinese women. Residing in areas with low ambient UVB levels increases the risk of vitamin D deficiency, especially for women experiencing advanced stages of gestation, for younger pregnant women and for women of Hui ethnicity; therefore, vitamin D supplementation and sensible sun exposure should be encouraged, especially in the winter months. Further studies must determine optimal vitamin D intake and sun exposure levels for maintaining sufficient vitamin D levels in pregnant Chinese women. [ABSTRACT FROM AUTHOR]

Researches have suggested Mediterranean diet might lower the risk of chronic diseases, but data on skeletal muscle mass (SMM) are limited. This community-based cross-sectional study examined the association between the alternate Mediterranean diet score (aMDS) and SMM in 2230 females and 1059 males aged 40–75 years in Guangzhou, China. General information and habitual dietary information were assessed in face-to-face interviews conducted during 2008–2010 and 3 years later. The aMDS was calculated by summing the dichotomous points for the items of higher intakes of whole grain, vegetables, fruits, legumes, nuts, fish and ratio of MUFA:SFA, lower red meat and moderate ethanol consumption. The SMM of the whole body, limbs, arms and legs were measured using dual-energy X-ray absorptiometry during 2011–2013. After adjusting for potential covariates, higher aMDS was positively associated with skeletal muscle mass index (SMI, SMM/height2, kg/m2) at all of the studied sites in males (all Ptrend<0·05). The multiple covariate-adjusted SMI means were 2·70 % (whole body), 2·65 % (limbs), 2·50 % (arms) and 2·70 % (legs) higher in the high (v. low) category aMDS in males (all P<0·05). In females, the corresponding values were 1·35 % (Ptrend=0·03), 1·05, 0·52 and 1·20 %, (Ptrend>0·05). Age-stratified analyses showed that the favourable associations tended to be more pronounced in the younger subjects aged less than the medians of 59·2 and 62·2 years in females and males (Pinteraction>0·10). In conclusion, the aMDS shows protective associations with SMM in Chinese adults, particularly in male and younger subjects. [ABSTRACT FROM PUBLISHER]

We aimed to examine the contribution of blood lipids to the association between BMI and blood pressure (BP) in children with overweight and obesity. Data were collected in elementary and high schools of Chaoyang District, Beijing, China in 2012. Participants' weight, height, BP and fasting plasma lipid profile were measured by standard protocols. Mediation analysis was used to examine the mediation role of blood lipids on the relation between BMI and BP, with age included as a covariate. We found that in boys 8.29% (mediation effect =0.106, P= 0.012) of the association between BMI and systolic BP was mediated through TAG. TAG mediated 12.53% (mediation effect= 0.093, P =0.018) and LDL-cholesterol mediated 7.75% (mediation effect=0.57, P=0.046) of the association between BMI and diastolic BP was mediated by TAG and LDL-cholesterol, respectively. However, blood lipids did not show the mediation effect in girls. Our findings suggested that there was a sex difference in the contribution of blood lipids to the association between BMI and BP. Controlling TAG or LDL-cholesterol may be beneficial for reducing the risk of the BMI-related high BP in overweight boys; however, this outcome is not the case when controlling TAG or LDL-cholesterol in girls. This study may provide clues to explore the underlying mechanism of the association between obesity and hypertension. [ABSTRACT FROM AUTHOR]

BackgroundSuicide in China has declined since the 1990s. However, there has been limited investigation of the potential spatiotemporal variation and social determinants of suicide during subsequent periods.MethodAnnual suicide counts from 2006 to 2012 stratified by county, 5-year age group (⩾15 years) and gender were obtained from the Chinese Disease Surveillance Points system. Trends and geographic differentials were examined using multilevel negative binomial regression models to explore spatiotemporal variation in suicide, and the role of key sociodemographic factors associated with suicide.ResultsThe suicide rate (per 100 000) in China decreased from 14.7 to 9.1, 2006–2012. Rates of suicide were higher in males than females and increased substantially with age. Suicide rates were higher in rural areas compared with urban areas; however, urban–rural disparities reduced over time with a faster decline for rural areas. Within both urban and rural areas, higher rates of suicide were evident in areas with lower socio-economic circumstances (SEC) [rate ratio (RR) 1.85, 95% confidence interval (CI) 1.31–2.62]. Suicide rates varied more than twofold (median RR 2.06) across counties, and were highest in central and southwest regions of China. A high proportion of the divorced population, especially for younger females, was associated with lower suicide rates (RR 0.60, 95% CI 0.46–0.79).ConclusionsGeographic variations for suicide should be taken into account in policy making, particularly for older males living in rural areas and urban areas with low SEC. Measures to reduce disparities in socio-economic level and alleviate family relation stress are current priorities. [ABSTRACT FROM PUBLISHER]