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Background/Objectives: The association between egg consumption and dementia is unclear. We carried out a population-based case-control study in China to determine the independent association of egg consumption with dementia. Methods: We randomly recruited 233 participants with dementia and 233 without dementia from the community health service clinics and the dementia management system in Guangzhou, China to examine their dietary intakes over the past two years and other risk factors for chronic diseases. Egg consumption was categorised by frequency as Non-consuming/

Abstract Background Both internet addiction (IA) and non-suicidal self-injury (NSSI) are major public health concerns among adolescents, however, the association between IA and NSSI was not well understood. We aimed to investigate the association between IA and NSSI within a cohort study, and explore the mediated effect of depressive symptoms and the moderating effect of social support in the association. Methods A total of 1530 adolescents aged 11–14 years who completed both the baseline (T1) and 14-month follow-up (T2) survey of the Chinese Adolescent Health Growth Cohort were included for the current analysis. IA, NSSI, depressive symptoms and social support were measured at T1; depressive symptoms and NSSI were measured again at T2. Structural equation models were employed to estimate the mediated effect of depressive symptoms and the moderating effect of social support in the association between IA and NSSI at T2. Results IA was independently associated with an increased risk of NSSI at T2, with the total effect of 0.113 (95%CI 0.055–0.174). Depressive symptoms mediated the association between IA and NSSI at T2, and social support moderated the indirect but not the direct effect of IA on NSSI at T2. Sex differences were found on the mediated effect of depressive symptoms and the moderated mediation effect of social support. Conclusions Interventions that target adolescents’ NSSI who also struggle with IA may need to focus on reducing depressive symptoms and elevating social support.

Abstract Background This study aimed to explore whether and how self-rated health, depression and functional ability interactively associated with loneliness using a sample group of older adults residing in China rural communities. Methods Data on socio-demographic information, self-rated health, depressive symptoms, functional ability and loneliness (quantified via a single question) were collected from 1009 participants. Cross-tabulations with chi-square test, bivariate correlations, and Classification and Regression Tree (CART) models were employed for analysis. Results We found that 45.1% of the participants were classified as lonely. Our results gain insight into the hierarchical order of predictors for the presence of loneliness, suggesting that there was a significant interaction between functional ability and depressive symptoms while self-rated health was not a significant factor. The probability of loneliness increased with the combination of limited functional ability and depression, and varied with different interaction of functional ability, depressive symptoms, and marital status, respectively. Notably, while there were some differences, similar associations were observed among older male and female respondents. Conclusion To delay or reduce loneliness, early detection which focuses on older people who report limitations in functional ability, depression, and being female, offers opportunities to start early interventions. Our findings might be helpful not only in designing and implementing loneliness prevention programs but also in improving healthcare for older rural community-dwelling people.

Background and aimsEstimated pulse wave velocity (ePWV) and systemic inflammatory response index (SIRI) have been recently investigated as a marker of arterial stiffness and a novel systemic inflammatory indicator. This study aims to examine the independent and combined association of ePWV and SIRI with incident stroke and its subtypes.MethodsData of the Dongfeng-Tongji cohort study was analyzed for 9,154 middle-aged and older adults, who were free of cardiovascular disease and cancer and were followed up to document incident stroke. But their association with incident stroke events and its subtypes have not been well studied. Multivariable adjusted Cox regression models were used to determine the independent and combined association of ePWV and SIRI with incident stroke events.ResultsOver a 7.22-year follow-up, the cohort documented 491 stroke cases (387 ischemic stroke and 104 hemorrhagic stroke). The multivariate adjusted model showed that with each one-unit increase in the level of ePWV, the corresponding hazard ratios (HRs) (95% CI) for total stroke, ischemic stroke, and hemorrhagic stroke were 1.53 (95% CI, 1.23–1.90), 1.42 (95% CI, 1.11–1.83), and 1.92 (95% CI, 1.21–3.03), respectively. Similarly, with each one-unit increase in log-transformed levels of SIRI, the corresponding HRs (95% CI) for total stroke, ischemic stroke, and hemorrhagic stroke were 1.23 (95% CI,1.04–1.47), 1.16 (95% CI, 0.96–1.41), and 1.52 (95% CI, 1.05–2.20), respectively. There appeared to be a combined effect of ePWV and SIRI on stroke; Participants with high levels of both ePWV and SIRI had a higher risk of total stroke and hemorrhagic stroke, with multiple adjusted HR of 2.43 (95% CI, 1.09–5.42). Additionally, the incorporation of ePWV in addition to traditional cardiovascular risk factors significantly improved the predictive accuracy for total stroke with C statistic increased from 0.684 (95% CI, 0.661–0.707) to 0.687 (95% CI, 0.664–0.710; x2 = 6.65; p for difference = 0.010), and (suggestively) for ischemic stroke with C statistic increased from 0.684 (95% CI, 0.659–0.71) to 0.691(95% CI, 0.666–0.717; x2 = 3.13, p for difference = 0.077), respectively.ConclusionsThe presence of both high ePWV and SIRI individually, as well as together, was found to be associated with an increased incidence of stroke. The combined stroke risk assessment using these two indicators could potentially improve non-invasive assessment and treatment strategies for high-risk patients, as these indicators are easily accessible in clinical practice.

Background Obesity classifications vary globally and the impact of older age adiposity on incident diabetes has not been well-studied. Methods We examined a random sample of 2,809 participants aged ≥60 years in China, who were free of diabetes at baseline and were followed up for up to 10 years to document diabetes (n=178). The incidence of diabetes was assessed in relation to different cut-off points of body mass index (BMI) and waist circumference (WC) in multiple adjusted Cox regression models. Results The diabetic risk in the cohort increased linearly with the continuous and quartile variables of BMI and WC. The BMI-World Health Organization (WHO) and BMI-China criteria analysis did not show such a linear relationship, however, the BMI-Asian/Hong Kong criteria did; adjusted hazards ratio (HR) was 0.42 (95% confidence interval [CI], 0.20 to 0.90) in BMI

Background Studies on the associations between maternal complications during pregnancy and childhood asthma are exclusively conducted in Western countries. The findings are mixed and may not be translated to other populations. We aimed to investigate the associations among the Chinese population and to determine whether the associations were mediated through pre-term birth, caesarean delivery, low birthweight and not breastfeeding in the first 6 months. Methods We conducted a retrospective cohort study of 166 772 children in Guangzhou, China. Information on maternal gestational hypertension, gestational diabetes and gestational anaemia during pregnancy was extracted from medical records. Ever-diagnosis of asthma in children aged 6–12 years was obtained by questionnaire. Logistic regression models and mediation analyses were used to estimate the adjusted odds ratios (aORs) and 95% confidence intervals for childhood asthma. Results Gestational hypertension, gestational diabetes and gestational anaemia during pregnancy were associated with an increased risk of ever-diagnosed childhood asthma: aOR 1.48 (95% CI 1.37–1.60), 1.71 (95% CI 1.65–1.78) and 1.34 (95% CI 1.26–1.45), respectively. A stronger association was observed for two or three gestational complications (aOR 2.02 (95% CI 1.93–2.16)) than one gestational complication (aOR 1.64 (95% CI 1.52–1.77)). The aOR for the three gestational complications was 1.35 (95% CI 1.26–1.45), 1.63 (95% CI 1.58–1.70) and 1.32 (95% CI 1.24–1.43), respectively, after controlling for the mediators, including pre-term birth, caesarean delivery, low birthweight and not breastfeeding in the first 6 months. Conclusions Gestational hypertension, gestational diabetes and gestational anaemia were associated with childhood asthma, and the associations were partially explained by the mediation effects.

BackgroundStudies have confirmed that social factors, including social capital and eHealth literacy, are important in later life. Currently, few studies are available for determining the relationship between social capital and eHealth literacy, and whether such a relationship exists among older people and there are age and gender differences in the relationship remain unclear. Consequently, this study aimed to investigate the association between social capital and eHealth literacy, specifically examing its variations in age and gender.MethodsA cross-sectional study of 4,257 residents aged ≥ 60 years and dwelling in the community was conducted across four cities in China. A structured questionnaire was used to collect data on general characteristics, socioeconomic status, social capital, and eHealth literacy. Generalized linear models were employed to assess these associations.ResultsThere were 4,218 respondents (age 71.9 ± 7.2 years; 64.8% women). Overall, social participation, social connection, trust, cohesion, and reciprocity were all statistically associated with eHealth literacy (p 0.05). Specifically, a higher level of social participation was associated with better eHealth literacy scores among participants aged 70–79 years (p

BackgroundAssociations of depressive and anxiety symptoms with non-suicidal self-injury (NSSI) and suicide attempt (SA) are not well understood. We aimed to examine these associations among Chinese adolescents, and whether any potential association is mediated through sleep quality.MethodsWe conducted a cross-sectional study among 1,771 (994 boys [56.1%] and 777 girls [43.9%], mean [SD] age was 12.9 [0.6] years) adolescents who participated in the baseline survey of the Chinese Adolescent Health Growth Cohort (CAHGC) study. Depressive symptoms, anxiety symptoms, NSSI, SA and sleep quality were measured by validated questionnaire. Logistic regression models were employed to estimate the associations of depression and anxiety with NSSI and SA. Mediation analyses were conducted to explore the mediate effect of sleep quality.ResultsThe 12-month prevalence of NSSI and SA was 17.1 and 8.3%, respectively. Depressive and anxiety symptoms were significantly associated with NSSI (the adjusted odds ratio [aOR] was 1.89 [95% CI 1.34–2.65] for depressive symptoms and 2.84 [95% CI 2.05–3.94] for anxiety symptoms) and SA (the aOR was 3.20 [95% CI 2.03–5.05] for depressive symptoms and 2.98 [95% CI 1.84–4.84] for anxiety symptoms). No significant gender differences were found in the associations. The mediation proportion of sleep quality on the association of depressive and anxiety symptoms with NSSI, as well as depressive and anxiety symptoms with SA were 21.1, 13.9, 13.6, and 14.7, respectively.ConclusionIndependent associations of depressive and anxiety symptoms with NSSI and SA were observed in Chinese adolescents, and there were no significant gender differences in the associations. Moreover, these associations were partially mediated through sleep quality. Targeted interventions for adolescents’ NSSI and SA should focus on those who have depressive and anxiety symptoms, and poor sleep quality.

BackgroundMultimorbidity has become a new challenge for medical systems and public health policy. Understanding the patterns of and associations among multimorbid conditions should be given priority. It may assist with the early detection of multimorbidity and thus improve quality of life in older adults. ObjectiveThis study aims to comprehensively analyze and compare associations among multimorbid conditions by age and sex in a large number of middle-aged and older Chinese adults. MethodsData from the home pages of inpatient medical records in the Shenzhen National Health Information Platform were evaluated. From January 1, 2017, to December 31, 2018, inpatients aged 50 years and older who had been diagnosed with at least one of 40 conditions were included in this study. Their demographic characteristics (age and sex) and inpatient diagnoses were extracted. Association rule mining, Chi-square tests, and decision tree analyses were combined to identify associations between multiple chronic conditions. ResultsIn total, 306,264 hospitalized cases with available information on related chronic conditions were included in this study. The prevalence of multimorbidity in the overall population was 76.46%. The combined results of the 3 analyses showed that, in patients aged 50 years to 64 years, lipoprotein metabolism disorder tended to be comorbid with multiple chronic conditions. Gout and lipoprotein metabolism disorder had the strongest association. Among patients aged 65 years or older, there were strong associations between cerebrovascular disease, heart disease, lipoprotein metabolism disorder, and peripheral vascular disease. The strongest associations were observed between senile cataract and glaucoma in men and women. In particular, the association between osteoporosis and malignant tumor was only observed in middle-aged and older men, while the association between anemia and chronic kidney disease was only observed in older women. ConclusionsMultimorbidity was prevalent among middle-aged and older Chinese individuals. The results of this comprehensive analysis of 4 age-sex subgroups suggested that associations between particular conditions within the sex and age groups occurred more frequently than expected by random chance. This provides evidence for further research on disease clusters and for health care providers to develop different strategies based on age and sex to improve the early identification and treatment of multimorbidity.

Background: Both ambient ozone exposure and residential greenness are linked to the aging process. However, their interactive effect on molecular biomarkers of aging (telomere length (TL) and mitochondrial DNA copy number (mtDNA-CN)) remains unclear. Methods: This study was conducted among 6418 rural Chinese adults. The concentration of ambient ozone was assessed using a random forest model. Residential greenness was represented by the normalized difference vegetation index (NDVI). Molecular biomarkers of aging (relative TL and relative mtDNA-CN) were determined by quantitative real-time polymerase chain reaction. Generalized linear regression models were applied to investigate the independent and combined effects of ambient ozone and residential greenness on relative TL and relative mtDNA-CN. Results: The estimated percent changes and 95 % confidence intervals (CIs) of relative TL in response to per-unit increase in ambient ozone were –22.43 % (–23.74 %, −21.18 %), −14.19 % (−15.63 %, −12.72 %) and −4.50 % (−6.57 %, −2.27 %) for participants with low (NDVI ≤ 0.53), moderate (0.54–0.55) and high (≥0.56) residential greenness exposure, respectively, while the corresponding figures of relative mtDNA-CN were −12.63 % (−13.84 %, −11.31 %), −9.52 % (−10.60 %, −8.33 %) and 2.12 % (0.20 %, 4.19 %). Furthermore, negative interactive effects between ambient ozone and residential greenness exposure on molecular biomarkers of aging were observed (P for interaction

BackgroundAdverse childhood experiences (ACEs) tend to cluster together in daily life, and most studies focus on the level of depression at certain points, but the dynamic process of depression is often neglected. Thus, research is urgently needed to explore the relationship between ACEs pattern and trajectory of depressive symptom levels at multiple time points in order to provides early targeted interventions to those who are most at risk.ObjectiveWe aimed to explore patterns of ACEs, including types and timing, associated with depression trajectories in college students.MethodsA school-based health survey was used to collect data as part of a longitudinal study in two medical college in Anhui province, China. Questionnaires were issued to 3,662 participants aged 17–22 and recorded details of ACEs (types and timing) and depression. Latent class analysis (LCA) was used to identify “patterns” of ACEs type and timing. Depressive symptom trajectories employed latent class growth analysis (LCGA). Multiple logistic regressions were employed to evaluate the relationships between ACEs patterns and depressive symptom trajectories.ResultsWe identified five ACEs patterns: “High neglect/emotional abuse/community violence,” “High neglect/emotional abuse,” “High neglect/family dysfunction,” “High neglect,” “Low ACEs.” We traced three depression trajectories: “High depressive symptom” “Moderate depressive symptom,” “Low depressive symptom.” “High neglect/emotional abuse/community violence,” “High neglect/emotional abuse” and “High neglect/family dysfunction” demonstrated a high risk for “High depressive symptom” and “Moderate depressive symptom.” “High neglect” showed a high risk for “Moderate depressive symptom” but not for “High depressive symptom” (P < 0.05).ConclusionsThe findings address the need for a comprehensive consideration of exposure to childhood adversity associated with the risk of depression in young adults through identifying more problematic ACEs patterns amongst exposed children.

Abstract This study investigated the association between pre-pregnancy body mass index (BMI) and adverse pregnancy outcomes among women participated in the National Free Preconception Health Examination Project in Guangdong Province, China, and explored these associations according to maternal age. Pre-pregnancy BMI was classified into underweight (BMI

BackgroundChina has stepped into an era of aging society, where the impending considerable economic burden attributed to high prevalence of dementia in the elderly appears to be one of the most important health and social issues to deal with for the country. However, population-based quantification and projections for the economic burden of dementia in China are lacking for further health action and policy making.ObjectiveTo estimate and predict the costs of managing dementia in the elderly population aged 60 and above from 2010 to 2050 in China.MethodsData were collected from a six-province study (n = 7072) and other multiple sources for calculation of the economic burden of dementia. With the convincing data from published studies, we quantified and projected the costs attributed to dementia in China from 2010 to 2050.ResultsThe national cost of dementia in 2010 was estimated to be US$22.8 billion by the opportunity cost method and US$26.4 billion by the proxy method. In 2050, the costs would increase to US$372.3 billion by the opportunity cost method and US$430.6 billion by the proxy method, consuming 0.53% and 0.61% of China's total GDP, respectively. A series of sensitivity analyses showed that the changes in the proportions of informal caregiving led to the most robust changes in the total burden of care for dementia in China.ConclusionDementia represents an enormous burden on China's population health and economy. Due to the changes in policies and population structure, policymakers should give priority to dementia care.

Background: Although exposure to ambient air pollution (AAP) increases the risk for arteriosclerotic cardiovascular disease (ASCVD), evidence on the association of solid fuel use with ASCVD and its association modified by ambient air pollution remains limited. Methods: A total of 16,779 adults were derived from the Henan Rural Cohort Study. Concentrations of ambient air pollutants (PM1, PM2.5, PM10, and NO2) were estimated by a spatiotemporal model based on satellites data. Solid fuel use was assessed by a self-reported questionnaire. The associations of solid fuel use with high 10-year ASCVD risk and the modified association by exposure to air pollutants were explored using logistic regression models. Results: There were positive associations of AAP exposure with high 10-year ASCVD risk among individuals with self-cooking. The joint associations between high AAP exposures and solid fuel use with high 10-year ASCVD risk were found. Compared to clean fuel user with low PM2.5 exposure, the odds ratios (ORs) and 95% confidence intervals (CIs) of high 10-year ASCVD risk was 1.25 (1.09, 1.42) for solid fuel user with low PM2.5 exposure, 1.93 (1.75, 2.12) for clean fuel user with high PM2.5 exposure, and 3.08 (2.67, 3.54) for solid fuel user with high PM2.5 exposure, respectively. Their additive effect on high 10-year ASCVD risk was observed (relative excess risk due to interaction (RERI): 0.90 (95 %CI: 0.50, 1.30), attributable proportion due to interaction (AP): 0.29 (95 %CI: 0.19, 0.40), and synergy index (SI): 1.77 (95 %CI: 1.38, 2.26)). Conclusion: This study showed a synergistic effect of AAP and household air pollution reflected by solid fuel use on high 10-year ASCVD risk, suggesting that reducing solid cooking fuels and controlling air pollution may have a joint effect on public health improvement.

Background: Although independent association of socioeconomic status (SES) or physical activity (PA) with obesity has been well-documented in urban settings, their independent and joint associations on obesity measures are limited in rural regions.Methods: Almost 38,000 (n = 37,922) individuals were included from the Henan Rural Cohort Study. The International Physical Activity Questionnaire (IPAQ) was used to evaluate PA. Obesity was reflected by body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), body fat percentage (BFP), and visceral fat index (VFI). The independent and interactive effects of SES and PA on obesity were analyzed by logistic regression models and generalized linear regression models, respectively.Results: Compared with high education level, the OR (95%CI) of obesity defined by BMI with low education level was 1.466 (1.337, 1.608), 1.064 (0.924, 1.225), and 1.853 (1.625, 2.114) in total population, men and women, respectively. Besides, the OR (95%CI) of obesity defined by BMI associated with per capita monthly income were 1.089 (1.015, 1.170), 1.192 (1.055, 1.347), 1.038 (0.951, 1.133) in total population, men and women, respectively. Similar results had been observed in other obesity measures. Negative interactive association of low education level and PA on obesity measures were observed only in women (all P < 0.05).Conclusions: This study suggests that women are more susceptible to obesity concerning low SES and that adequate PA may be a potential target for mitigating the negative effect of low SES on obesity in women.Clinical Trial Registration: The Henan Rural Cohort Study has been registered at Chinese Clinical Trial Register (Registration number: ChiCTR-OOC-15006699) http://www.chictr.org.cn/showproj.aspx?proj=11375.

Background: Global risks of suicidal behaviours (SB) and being bullied as well as their association among adolescents have been poorly understood. We aimed to determine the risks of suicidal ideation (SI), suicide planning (SP), suicide attempt (SA) and being bullied in adolescents and their related associations across gender, countries and different WHO regions. Methods: We examined data from the Global School-based Health Survey (GSHS), which recorded health behaviours among adolescents aged 12 to 15 years from 83 countries. We computed prevalence rates of SB and being bullied and their 95% confidence intervals (CIs). Multilevel models were employed to examine the association of being bullied with risks of SI, SP and SA. Results: The overall prevalence of SI was 16·5%, SP 16·5%, SA 16·4%, and being bullied 35·3%. The highest risks of SB and being bullied were in Africa (SI 19·9%, SP 23·2%, SA 20·8%, being bullied 48·0%). Compared to boys, girls had an increased risk for SI (18·2%) and SP (17·3%) but similar risk for SA (16·7%) and being bullied (33·3%). Being bullied was associated with SA (adjusted odds ratio ‒ aOR 2·14, 95%CI 2·06–2·23), more strongly than SI (1·83, 1·78–1·89) and SP (1·70, 1·65–1·76). The strongest association with SA was in the Western Pacific (2·68, 2·45–2·92) and with SI (2·04, 1·74–2·39) and SP (1·81, 1·68–1·95) were in Southeast Asia. There were no gender differences in aOR for SI and SP, but the aOR for SA among boys (2·28, 2·14–2·42) was significantly greater than among girls (2·04, 1·93–2·15), ratio of two odds ratios was 1.12 (P = 0.008). Interpretation: SB and being bullied were common among adolescents worldwide. The findings of gender differences in SB, being bullied and their association could inform the design of prevention programmes to reduce the risks of SI, SP and SA in adolescents worldwide. Keywords: Adolescent, Being bullied, Gender differences, Global health, Regional variation, Suicidal behaviours

There are few studies examining which types of sleep problems are independently associated with suicide attempt (SA) and gender difference in adolescents. The aim of the present study was to examine whether specific sleep problems were uniquely associated with suicide attempt in adolescents and explore gender differences in the association. A school-based health survey was conducted in four provinces within China from November 2014 to January 2015. A total of 15,132 students aged 10–21 years completed standard questionnaires assessing past 12 month suicide attempt in addition to measures of sleep quality, quantity and sleep beliefs. 5.4% of participants reported a suicide attempt within the last 12 months. After adjustment for sociodemographic variables and psychological symptoms, almost all sleep problems remained significantly associated with a greater endorsement of suicide attempt. Further adjustment for co-occurring sleep problems revealed that weekday sleep duration (

To investigate the impact of low socioeconomic status (SES), indicated by low level of education, occupation and income, on 3 months functional outcome after ischemic stroke.We analyzed data from the China National Stroke Registry (CNSR), a multicenter and prospective registry of consecutive patients with acute cerebrovascular events occurred between September 2007 and August 2008. 11226 patients with ischemic stroke had SES and clinical characteristics data collected at baseline and mRS measured as indicator of functional outcome in 3 months follow up. Multinomial and ordinal logistic regression models were performed to examine associations between SES and the functional outcome.At 3 months after stroke, 5.3% of total patients had mRS scored at 5, 11.3% at score 4, 11.1% at score 3, 14.4% at score 2, 34.2% at score 1 and 23.7% at score 0. Compared to patients with educational level of ≥ 6 years and non-manual laboring, those < 6 years and manual laboring tended to have higher mRS score (P

Hypercholesterolemia is common in older adults and less treated, but little is known about correlates of untreated hypercholesterolemia. Using a standard interview method we examined a random sample of 7,572 participants aged ≥60 years in a community-based household survey across 7 provinces of China during 2007-2012, and documented 328 cases of hypercholesterolemia from self-reported doctor diagnosis. Compared to participants with normal cholesterol, older adults with hypercholesterolemia had higher socioeconomic position and larger body mass index. In patients with hypercholesterolemia, 209 were not treated using lipid-lowering medications (63.7%, 95% confidence interval (CI) 58.5%-68.9%). Untreated hypercholesterolemia was significantly associated with female sex (adjusted odds ratio 2.13, 95%CI 1.17-3.89), current smoking (3.48, 1.44-8.44), heavy alcohol drinking (3.13,1.11-8.84), chronic bronchitis (2.37,1.14-4.90) and high level of meat consumptions (2.85,1.22-6.65). Although having coronary heart disease exposed participants for treatment, half of participants with coronary heart disease did not receive lipid-lowering medications. Among hypercholesterolemia participants with stroke, hypertension or diabetes, more than half of them did not receive lipid-lowering medications. The high proportion of untreated hypercholesterolemia in older, high-risk Chinese adults needs to be mitigated through multi-faceted primary and secondary prevention strategies to increase population opportunities of treating hypercholesterolemia.

Fatigue after stroke is common and has a negative impact on rehabilitation and survival. However, its pathogenesis and contributing factors remain unclear. The purpose of this study was to identify factors influencing the occurrence of fatigue after first-ever ischemic stroke in acute phase.We examined 265 consecutive patients with first-ever ischemic stroke during acute phase (within 2 weeks) in two tertiary stroke care hospitals in Henan, China. We documented patients' demographic and clinical characteristics through face-to-face interviews using structured questionnaires and reviews of medical records. Post-stroke fatigue was defined as a score of ≥4 using the Fatigue Severity Scale. Multivariate logistic regression was used to examine post-stroke fatigue in relation to socio-demographic, lifestyle, clinical characteristics and family function.About 40% first-ever ischemic stroke patients experienced post-stroke fatigue in acute phase. Post-stroke fatigue was associated with lack of exercise before stroke (adjusted odds ratio 4.01, 95% CI 1.95-8.24), family dysfunction (2.63, 1.20-5.80), depression (2.39, 1.02-5.58), the presence of pre-stroke fatigue (4.89, 2.13-11.21), use of sedative medications (4.14, 1.58-10.88), coronary heart disease (3.38, 1.46-7.79) and more severe Modified Rankin Scale (2.55, 1.65-3.95).The causes of post-stroke fatigue are multifaceted. More physical exercise, improving family function, reducing depression and appropriate use of sedative medications may be helpful in preventing post-stroke fatigue.

With the gradual aging of the population, geriatric depression has become a major public health issue in China owing to its overall upward trend and associated negative socio-economic impact. Dearth of information regarding the burden and correlates of geriatric depression among Uyghur minority population in Xinjiang Autonomous Region, called for a comprehensive survey involving representative sample for designing efficient targeted intervention to control this disabling disease.A cross-sectional study was conducted among 1329 consenting Uyghur elderly in 2011 in six randomly selected communities/villages in Xinjiang. Information about socio-demographics, behavior, negative life-events, satisfaction regarding income/quality of life and other chronic diseases were collected while assessment of geriatric depression was done using Geriatric Mental State Schedule (GMS).Among these participants, majority were currently married, had attended elementary school or less, had an average annual family income of less than 3000 Yuan/person, had strong religious beliefs while 10.61% (2.77% in urban and 23.60% in rural area) had geriatric depression (5.91% among male and 14.58% among females). 61.83% were suffering from other chronic diseases, 96.16% could take care of themselves and 39.28% had experienced negative events during last two years. Religious belief (AOR = 3.92, 95% CI 1.18-13.03), satisfaction regarding quality of life (AOR = 0.53, 95% CI 0.37-0.84) and income (AOR = 0.75, 95% CI 0.35-1.60), suffering from more chronic diseases (AOR = 1.70, 95% CI 1.42-2.04), experiencing three or more negative events (AOR = 1.72, 95% CI 0.92-3.22) and lack of ability to take self-care (AOR = 2.20, 95% CI 1.09-4.48) were all associated with having geriatric depression with or without adjustment for gender, education and occupation.High prevalence of geriatric depression among Uyghur elderly in Xinjiang seemed to call for urgent interventions, specifically targeting rural residents, who experienced more negative life-events, were suffering from chronic diseases and were dissatisfied with their income and quality of life.

China has the largest number of people with diabetes in the world. Over the last 30 years China has experienced rapid economic growth and a growing income gap between rich and poor. The population is ageing, however diabetes in older people has not been well studied to date. In this study we determined incidence and predictors of diabetes in older Chinese people.During 2001, using a standard interview method, we examined 1,317 adults aged ≥65 years who did not have diabetes in the city of Hefei, and characterized baseline risk factors. Over 7.5 years of follow up, we documented incident diabetes using self-reported doctor diagnosis and the cause of death in the whole cohort, and HbA(1C) ≥48 mmol/mol in a nested case-control sample. A multivariate Cox regression model was employed to investigate risk of diabetes in relation to baseline risk factors.During follow up, 119 persons had newly diagnosed diabetes. World age-standardised incidence of diabetes was 24.5 (95% CI 19.5-29.5) per 1,000 person-years. Risk of diabetes was significantly and positively associated with income, waist circumference and body mass index, smoking and uncontrolled hypertension, but negatively associated with having a hobby of walking and frequency of visiting children/other relatives and contacting neighbours/friends. Higher income was significantly associated with increased diabetes risk regardless of cardiovascular and psychosocial risk factors. Compared to those with middle income and no psychosocial risk factors, the hazard ratio for incident diabetes among participants with high income and psychosocial risk was 2.13 (95% CI 1.02-4.45).Increasing incidence of diabetes in relation to high income has become an important public health issue in China. Maintaining social networks and gentle physical activities and reducing psychosocial factors may be integrated into current multi-faceted preventive strategies for curbing the epidemic of diabetes in the older population.

BACKGROUND: With growing recognition of the social determinants of health, social capital is an increasingly important construct in international health. However, the application of social capital discourse in response to HIV infection remains preliminary. The aim of this study was to assess the impact of social capital on quality of life (QoL) among adult patients with acquired immune deficiency syndrome (AIDS). METHODS: A convenient sample of 283 patients receiving antiretroviral treatment (ART) was investigated in Anhui province, China. QoL data were collected using the Medical Outcomes Study HIV Survey (MOS-HIV) questionnaire. Social capital was measured using a self-developed questionnaire. Logistic regression models were used to explore associations between social capital and QoL. RESULTS: The study sample had a mean physical health summary (PHS) score of 50.13 ± 9.90 and a mean mental health summary (MHS) score of 41.64 ± 11.68. Cronbach's α coefficients of the five multi-item scales of social capital ranged from 0.44 to 0.79. When other variables were controlled for, lower individual levels of reciprocity and trust were associated with a greater likelihood of having a poor PHS score (odds ratio [OR] =2.02) or PHS score (OR=6.90). Additionally, the factors of social support and social networks and ties were associated positively with MHS score (OR=2.30, OR=4.17, respectively). CONCLUSIONS: This is the first report to explore the effects of social capital on QoL of AIDS patients in China. The results indicate that social capital is a promising avenue for developing strategies to improve the QoL of AIDS patients in China, suggesting that the contribution of social capital should be fully exploited, especially with enhancement of QoL through social participation. Social capital development policy may be worthy of consideration.

BackgroundLow haemoglobin concentration has been associated with adverse prognosis in patients with angina and myocardial infarction (MI), but the strength and shape of the association and the presence of any threshold has not been precisely evaluated.Methods and findingsA retrospective cohort study was carried out using the UK General Practice Research Database. 20,131 people with a new diagnosis of stable angina and no previous acute coronary syndrome, and 14,171 people with first MI who survived for at least 7 days were followed up for a mean of 3.2 years. Using semi-parametric Cox regression and multiple adjustment, there was evidence of threshold haemoglobin values below which mortality increased in a graded continuous fashion. For men with MI, the threshold value was 13.5 g/dl (95% confidence interval [CI] 13.2-13.9); the 29.5% of patients with haemoglobin below this threshold had an associated hazard ratio for mortality of 2.00 (95% CI 1.76-2.29) compared to those with haemoglobin values in the lowest risk range. Women tended to have lower threshold haemoglobin values (e.g, for MI 12.8 g/dl; 95% CI 12.1-13.5) but the shape and strength of association did not differ between the genders, nor between patients with angina and MI. We did a systematic review and meta-analysis that identified ten previously published studies, reporting a total of only 1,127 endpoints, but none evaluated thresholds of risk.ConclusionsThere is an association between low haemoglobin concentration and increased mortality. A large proportion of patients with coronary disease have haemoglobin concentrations below the thresholds of risk defined here. Intervention trials would clarify whether increasing the haemoglobin concentration reduces mortality.

Current knowledge about incident dementia is mainly derived from studies undertaken in the West, showing that dementia is related to older age, low socio-economic status, lack of social network, depression and cardiovascular disease risk factors. We know little about incidence and predictors of dementia in China, where the prevalence is increasing and the patterns of risk factors are different.Using a standard interview method, we examined 1526 non-demented people aged ≥65 years who had at least minimal educational level in China in a 7.5-year follow up. Incident dementia was diagnosed by GMS-AGECAT algorithms and psychiatrists.Age-standardised incidence of dementia was 14.7 per 1000 person-years (95%CI 11.3-18.2 per 1000 person-years). The increased risk was significantly associated with age, female gender (adjusted odds ratio 2.48, 95%CI 1.20-5.13), low educational levels, smoking, angina (2.58, 1.01-6.59) and living with fewer family members. Among participants with low educational level, the increased risk was associated with higher income, and with the highest and lowest occupational classes; adjusted odds ratio 2.74 (95%CI 1.12-6.70) for officers/teachers, 3.11 (1.61-6.01) for manual labourers/peasants.Our findings of high incidence of dementia and increased risk among people having low education levels but high income suggest a more potential epidemic and burden of dementia populations in China. Maintaining social network and activities and reducing cardiovascular factors in late life could be integrated into current multi-faceted preventive strategies for curbing the epidemic of dementia.

Systematic evaluations of the quality of research on a single prognostic biomarker are rare. We sought to evaluate the quality of prognostic research evidence for the association of C-reactive protein (CRP) with fatal and nonfatal events among patients with stable coronary disease.We searched MEDLINE (1966 to 2009) and EMBASE (1980 to 2009) and selected prospective studies of patients with stable coronary disease, reporting a relative risk for the association of CRP with death and nonfatal cardiovascular events. We included 83 studies, reporting 61,684 patients and 6,485 outcome events. No study reported a prespecified statistical analysis protocol; only two studies reported the time elapsed (in months or years) between initial presentation of symptomatic coronary disease and inclusion in the study. Studies reported a median of seven items (of 17) from the REMARK reporting guidelines, with no evidence of change over time. The pooled relative risk for the top versus bottom third of CRP distribution was 1.97 (95% confidence interval [CI] 1.78-2.17), with substantial heterogeneity (I(2) = 79.5). Only 13 studies adjusted for conventional risk factors (age, sex, smoking, obesity, diabetes, and low-density lipoprotein [LDL] cholesterol) and these had a relative risk of 1.65 (95% CI 1.39-1.96), I(2) = 33.7. Studies reported ten different ways of comparing CRP values, with weaker relative risks for those based on continuous measures. Adjusting for publication bias (for which there was strong evidence, Egger's p

Background: Previous injury survey recall methods often use one-off questionnaires with varying periods of recall. These methods have proven to show injury incidence inaccuracies and limited information on injury etiology. Purpose: The present study aimed to examine the efficacy of a remote weekly self-report injury incidence and etiology tool. Methods: Two online questionnaires were developed based on the "Fit to Dance 2" survey and sent to volunteers. The first questionnaire was sent once and asked for complete injury history information. The second questionnaire was sent to each respondent on a weekly basis and it focused on new injuries and their causes and whether injuries that occurred in previous weeks were still affecting their dancing. The online survey was opened for full-time dance students from September 2020 to July 2021. All weekly data for each respondent were combined with a unique reference code using their account names, students' numbers, and schools' names. The proportion of participants who drop out is defined as the measurement of outcome. Results: A total of 756 respondents engaged in the survey from 16 different Chinese dance schools; the drop-out rate was 70.1%, with student respondents under 18 years old having a slightly lower drop-out rate than adult respondents (69%vs 71%). 33 respondents (4.4%) who completed all 30 weeks survey. These data allow other researchers to examine respondent compliance rates from a weekly survey. Conclusion: A reminder system and teacher engagement could potentially increase the response rate. For frequent completion questionnaires the design needs to be streamlined to increase compliance. It is concluded that the researchers would need to weigh reduced completion rates (<100%) against data efficacy to achieve generalizability. [ABSTRACT FROM AUTHOR]