The prevalence of hypertension and cognitive dysfunction in the elderly in China is not optimistic, and hypertension has been associated with an increased risk of developing cognitive dysfunction. It is of great significance to explore and promote the methods for prevention and control of cognitive dysfunction in elderly patients with hypertension in community.
To explore the effect of leisure physical activities on cognitive function in elderly patients with hypertension in community.
From August 2020 to December 2020, a total of 770 patients with hypertension aged ≥65 years who underwent chronic disease management were selected from community health service centers in Wuhan using the stratified random sampling method. A questionnaire was administered to obtain the general information of the subjects, leisure physical activity (including 6 cognitive activities and 11 physical activities) and cognitive function (using the Mini-Mental State Examination Scale). Multivariate Logistic regression was used to analyze the influencing factors of cognitive dysfunction in elderly patients with hypertension. Multiple linear regression was used to analyze the influence of leisure physical activity on cognitive function in elderly patients with hypertension. Multiple Logistic regression was used to analyze the influence of the weekly participation frequency of 17 leisure physical activity on cognitive dysfunction in elderly patients with hypertension.
The incidence of cognitive dysfunction in elderly hypertensive patients in community was 39.4% (303/770). There were significant differences in gender, age, education, duration of hypertension, leisure physical activity scores between patients with and without cognitive impairment (P<0.05). Multivariate Logistic regression analysis showed that duration of hypertension〔OR (95%CI) =1.02 (1.01, 1.03) 〕 and leisure physical activity score〔OR (95%CI) =0.98 (0.96, 0.99) 〕 were influencing factors for the development of cognitive impairment in older patients with hypertension. Further analysis found that the leisure physical activity score was an influential factor in the MMSE for scores on the attention and calculation power dimension〔b (95%CI) =0.02 (0.01, 0.03) 〕, the language ability dimension score〔b (95%CI) =0.02 (0.01, 0.03) 〕. After refining the categories to leisure physical activity style, the results of multivariate Logistic regression analysis showed that older adults with hypertension who participated in writing〔OR (95%CI) =0.34 (0.12, 0.95) 〕, board games〔OR (95%CI) =0.21 (0.06, 0.72) 〕 daily were less likely to be cognitively impaired than those who occasionally/never participated in this activity.
Leisure physical activity is a protective factor of cognitive function in elderly patients with hypertension, which mainly affects two dimensions of cognitive function: attention and calculating ability, and language ability. Daily participation in writing and checkerboard games play a positive role in cognitive function in elderly patients with hypertension.
The needs of outpatient services, a key accessible health resource, are increasing in an increasingly aging population in China. So rational allocation of outpatient service resources to meet older people's health needs is a key to improving their health level.
To explore the factors affecting the utilization of outpatient services in the elderly, to provide feasible suggestions for improving older people's health level and the allocation of medical resources.
This study was conducted in 2021 using the data of older people (≥60 years old) attending the CHARLS 2018. The number of using outpatient services in these people in the past month prior to the CHARLS 2018 and associated factors were studied using a system developed based on the framework of Anderson's Behavioral Model of Health Services Use, with sex, age, marital status, the type of hukou (rural or urban), education level, smoking and drinking were classified as predisposing factors, health insurance, monthly household income per capita and the average distance from home to medical institutions as enabling factors, and chronic disease prevalence and self-rated health as need factors. The zero-inflated negative binomial regression (ZINB) was used to identify factors associated with the use of outpatient services.
In all, 9 551 older people were included for analysis. Among them, non-users of outpatient services in the past month numbered 8 038 (84.16%), and one-time, two-time, and three or more-time users numbered 749 (7.84%), 367 (3.84%), and 397 (4.16%), respectively. The number of using outpatient services differed statistically by the type of hukou, education level, smoking, drinking, health insurance prevalence, monthly household income per capita, chronic disease prevalence, and self-rated health status (P<0.05). The results of Logit regression model (one part of the ZINB) in fitting the data indicated that older age, high school education or above, having health insurance, suffering from a chronic disease and poor self-rated health were associated with increased probability of utilizing outpatient services (P<0.05). And the results of negative binomial count model in fitting the data indicated showed that the age of 70-74 years was associated with decreased probability of utilizing outpatient services, while an average distance of greater than 1 km but less than 10 km between home and medical institutions, and three types of self-rated health (good, poor and very poor) were associated with increased probability of utilizing outpatient services (P<0.05) .
Our study indicates that the use of outpatient services was insufficient in these older people, which was associated with predisposing, enabling and need factors. To improve this, it is suggested to rationally strengthen the provision of outpatient services to vulnerable groups with underuse of such services and individuals with needs of high-quality services. In addition, attention should be given to chronic disease management and self-rated health of the elderly to improve their awareness and level of health management.
Osteosarcopenic obesity syndrome (OSO) is a disease that seriously endangers the health of older people. The rational classification of the disease can guide the clinical diagnosis and treatment. Therefore, classifying OSO based on inter-correlations of its diagnostic variables and exploring its structural properties may offer insights into clinical prevention and treatment of OSO.
To explore the structural properties of OSO, providing a theoretical basis for individualized diagnosis and treatment of the disease.
A cross-sectional study was conducted with a random sample of OSO patients (≥60 years old) who underwent physical examination in Physical Examination Center, the 2nd Affiliated Hospital of Harbin Medical University from January 2018 to December 2020. The data collected include 9 diagnostic variables for OSO〔skeletal muscle index, grip strength, body fat percentage, BMD of the lumbar spine (L1-L4), hip and femoral neck, BMI, waist circumference, walking pace〕, sociodemographic characteristics, lifestyle and prevalence of common chronic diseases. KMO test and Bartlett's test of sphericity were used to evaluate the suitability of diagnostic variables for factor analysis. The components with an eigenvalue equal to or greater than 1.000 were extracted by principal component analysis, and the varimax orthogonal rotation matrix was obtained by the varimax orthogonal rotation method. The common factors were named according to the orthogonal rotation matrix of factors. On the basis of factor analysis, thesum of squares and systematic cluster analysis were used to develop a dendrogram for classifying patients. The structural properties of OSO were analyzed by comparing the values of diagnostic variables and clinical features among patients of different categories.
A total of 107 cases were included. The KMO value (0.688) and the result of Bartlett's test of sphericity (χ2=492.374, P<0.001) indicated that the data of diagnostic variables were suitable for factor analysis. Three common factors (osteoporosis factor, muscle + body fat factor and obesity factor) with an eigenvalue greater than 1.000 were extracted, explaining 81.408% variance of the total. The load value of each diagnostic variable on its common factor ranged from 0.770 to 0.918. The patients were divided into 3 categoriesby cluster analysis using the common factors. The skeletal muscle index, grip strength, body fat percentage, BMD of L1-L4, hip and femoral neck, BMI and waist circumference varied significantly across patients of different categories (P<0.05). The values of BMD of L1-L4, hip and femoral neck of OSO patients in the first category were significantly lower than those of the other two categories (P<0.05). The BMI and waist circumference values of OSO patients in the second category were lower than those of the other two categories (P<0.05). OSO patients in the third category had higher values of skeletal muscle index, grip strength and BMD of L1-L4, hip and femoral neck, but lower body fat percentage than those of the other two categories (P<0.05). There were statistically significant differences in sex ratio, distribution of education level and total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), uric acidand creatinine in the serum among different categories of patients (P<0.05). OSO patients in the first category had higher prevalence of below the undergraduate education level than those in the third category (P<0.017). OSO patients in the second category had higher level of TC than those in the third category (P<0.05). In comparison with those in other two categories, OSO patients in the third category had higher personal monthly income equal to or greater than 5 000 yuan, and lower female ratio (P<0.017). Moreover, OSO patients in the third category also demonstrated higher levels of uric acid and creatinine in the serum (P<0.05) .
OSO diagnostic variables can be generalized and interpreted in terms of osteoporosis, muscle and body fat, and obesity. And OSO patients have different structural properties. The application of multivariate statistical methods to study the structural properties of OSO patients will contribute to the individualized management of such patients.
In the social situation of "three child" policy opening and late marriage to become the norm, the topic of female reproduction and health has attracted increasing attention. As one of the important markers of ovarian reserve in women, the relationship between anti-Mullerian hormone (AMH) and cardiovascular disease and cardiovascular risk indicators has become a hot research issue.
To establish a reference range of AMH in healthy women of reproductive age in Urumqi region, and to investigate the association between AMH and risk factors associated with cardiovascular disease.
From May to July 2018, healthy women aged 19-50 years who met the criteria were selected from the natural population of a community-based epidemiological survey with four living residents area in Urumqi city by targeted sampling, and the serum AMH, fasting plasma glucose, total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triacylglyceride (TG), serum uric acid, and thyroid stimulating hormone (TSH) levels of the survey subjects were tested. Height, body mass, abdominal circumference, hip circumference, blood pressure, and other indicators were measured to analyze the relationship between AMH and the above indicators related to cardiovascular risk factors.
The median AMH among 855 healthy women of reproductive age was 1.58 (0.01, 8.78) μg/L. The reference range of AMH in healthy women of reproductive age in our region was established, that was, 0.89 to 10.94μg/L for 19-24 years old, 0.66 to 11.77 μg/L for 25-29 years old, 0.27 to 8.25μg/L for 30-34 years old, 0.01 to 6.87μg/L for 35-39 years old, 0.01 to 3.98μg/L for 40-44 years old, <0.01-1.87μg/L for 45-50 years old. Spearman correlation analysis showed that AMH was negatively correlated with age, body fat index (BMI), abdominal circumference, hip circumference, systolic blood pressure, diastolic blood pressure, TSH, TC, LDL-C (P<0.05), but not with blood glucose, TG, HDL-C, uric acid (P>0.05) .
In this study, the reference range of serum AMH in healthy women of reproductive age in Urumqi was established, which may provide a basis for the functional assessment of ovarian reserve in women of different ages. Low AMH levels in women of reproductive age are associated with cardiovascular risk factors such as increased age, obesity, abdominal obesity, hypertension, and hyperlipidemia.
Female railway workers are a high-risk group for obesity. Information technology is increasingly used in interventions for weight loss in overweight and obese populations. Daily self-weighing is a cognitive-behavioral strategy for self-monitoring of weight, but its effect on weight loss remains still controversial.
To investigate the effect of daily self-weighing plus online group interaction on weight loss and development of healthy lifestyle in overweight and obese female workers in Beijing Railway Bureau.
A prospective randomized controlled study was conducted. Participants were 72 overweight or obese female workers of Beijing Railway Bureau voluntarily recruited from June 1 to September1, 2019. They were equally randomized into an experimental group and a control group, receiving different weight loss interventions for 3 months (intervention scheme for the experimental group: individualized diet and exercise recommendations, daily self-weighing plus online group-based cognitive-behavioral therapy for weight loss, and that for the control group: individualized diet and exercise recommendations, and self-measurement of body weight with weight management counseling during the telephone or hospital follow-up once a month). Baseline and post-intervention data of both groups were collected, including composition indices (body weight, BMI, body fat percentage, fat content, waist circumference, hip circumference, waist-to-hip ratio), blood lipid indices〔total cholesterol (TC), triacylglyceride (TG), high-density liptein cholesterol (HDL-C), low-density liptein cholesterol (LDL-C) 〕and total score and dimension scores of the Health Promoting Lifestyle Profile-Ⅱ (HPLP-Ⅱ). Univariate and multivariate Logistic regression was used to explore factors associated with a 5% or more weight loss from baseline.
Seventy-one participants (35 cases and 36 controls) who completed the study were finally included for analysis. The each body composition index, each blood lipid index, and total score and dimension scores of the HPLP-Ⅱ were similar in both groups at baseline (P>0.05). After the intervention, the experimental group showed a significant decrease in the body composition indices (except the waist-to-hip ratio), blood lipid indices (except the HDL-C), and a significant increase in the total score and dimension scores of the HPLP-Ⅱ (P<0.05). However, no significant differences were found in each observation index in the control group before and after the intervention (P>0.05). Compared with the control group, the experimental group showed lower post-intervention body composition indices (except the waist-to-hip ratio) and blood lipid indices (except the HDL-C), and higher post-intervention total score and dimension scores of the HPLP-Ⅱ (P<0.05). A total of 22 participants (31.0%) had a weight loss of ≥5% from the baseline, including 16 cases (72.7%), and 6 controls (27.3%). Both univariate and multivariate Logistic regression analyses showed that intervention scheme and baseline nutrition status were the influencing factors of a 5% or more weight loss from baseline.
Daily self-weighing and online group-based cognitive-behavioral interventions contributed to weight loss, formation of a healthy lifestyle, and improvement in quality of life in overweight and obese female workers in Beijing Railway Bureau.
As the aging society develops, multimorbidity is increasingly prevalent in an increased number of older adults, which imposes a heavy treatment burden on the group, but the composition of treatment burden of elderly patients with chronic comorbidity in China is not clear.
To understand the real experience of treatment burden in elderly patients with multimorbidity, providing a theoretical basis for promoting the research on treatment burden in China.
By use of purposive sampling, 21 older inpatients with multimorbidity were selected from three hospitals (one is primary level, another is secondary and another is tertiary) in Chengdu from January to June 2021. Individual, face-to-face, in-depth, semi-structured interviews were utilized to collect their experiences of treatment burden, and the data were recorded, and analyzed using Colaizzi's method of data analysis.
Of the participants, eight were women, and 13 were men; 10 were selected from the tertiary hospital, seven from the secondary hospital, and four from the primary hospital. Six themes were summarized: economic burden, drug burden, self-management burden, medical service burden, social burden and psychological burden.
Taken overall, the treatment burden was relatively heavy in older inpatients with multimorbidity. To reduce the treatment burden and improve the efficacy in this group, it is recommended that medical workers should pay attention to their treatment burden, and formulate individualized treatment plan for them.
The changing disease spectrum of Chinese residents poses great challenges to the healthcare delivery. Understanding patients' health literacy and influencing factors is helpful to improve doctor-patient communication, promote patients' health and alleviate the pressure of healthcare delivery. However, the number of studies on patients' health literacy is insufficient, and most of them focus on those with a special illness.
To understand the status of health literacy and its influencing factors among Chinese outpatients, providing a scientific basis for improving patients' health status and self-management ability, and for medical workers to perform patient education and instruction, disease management and relevant improvement.
A systematic sampling method was used to select 14 secondary or tertiary general hospitals in eight regions in eastern, central and western China as survey settings, and outpatients (≥15 years old) of them during January to May 2021 were randomly selected and surveyed using the Patient Health Literacy Scale (PHLS) 〔those with scores <41 were deemed unlikely to have health literacy; those with scores ≥55 were judged as having high level of health literacy; those with scores between 41 and 54 were regarded as having moderate level of health literacy〕. The health literacy level of outpatients was compared by various personal factors. Ordinal and multinomial Logistic regression analyses were used to analyze the influencing factors of health literacy.
Altogether, 2 808 cases who handed in responsive questionnaires were included for final analysis. The average score of PHLS in the respondents was (43.38±6.25) . The prevalence of health literacy, and high level of health literacy was 68.38% (1 920/2 808) , and 6.93% (133/2 808) , respectively. The level of health literacy varied obviously by age, education level, occupation, average household monthly income per person, prevalence of a family member working as a healthcare worker, and prevalence of using the way of acquiring health information (from medical workers, family members, friends or coworkers, activities conducted by the work unit or the community, listening to the radio, watching television, reading a newspaper/book, searching the Internet, or other approaches) (P<0.001) . Higher educational level and average household monthly income per person were associated with higher level of health literacy (P<0.001) . Being a student, worker of an industrial/mining enterprise, retailer or server was associated with higher level of health literacy (P<0.05) . Acquiring heath information from healthcare workers and searching the Internet were associated with higher level of health literacy (P<0.05) .
On the whole, the health literacy was moderate in outpatients of the 14 general hospitals. To improve the health literacy level in this population, it is suggested to improve the levels of health education and guidance for them by strengthening the key role of healthcare workers in health information delivery, giving more concerns to the low educated or low-income earners, and increasing the ways of acquiring health information.
Microcirculation dysfunction is closely associated with the development of obesity. Exercise intervention could effectively improve the microcirculation in obese people, but the intensity of an exercise intervention schemes often lacks of individualization and precision. FATmax is a precise and individualized exercise intensity determined on the basis of individual fat oxidation rate.
To compare the effects of aerobic exercise and combined aerobic and resistance exercise at FATmax intensity on improving the microcirculation in obese college students, and to explore the mechanism of action by analyzing the changes in nitric oxide (NO) , endogenous NO synthase (eNOS) , endothelin-1 (ET-1) and endothelial growth factor (VEGF) .
In March, 2021, Sixty-six obese college students were recruited from Hubei University for Nationalities, and equally randomized into sex-matched three groups with different 10-week interventions: aerobic exercise group (performing aerobic exercise at the FATmax intensity, 4 times a week, 60 minutes each time) , combined aerobic and resistance exercise group〔performing combined aerobic and resistance exercise at FATmax intensity, 4 times a week, 60 minutes each time (40 minutes for aerobic exercise and 20 minutes for resistance exercise) 〕, and control group (maintaining their normal living habits) . Body weight, body fat percentage, BMI, microvascular reactivity, transcutaneous oxygen pressure (TcPO2) , muscle oxygen saturation (SmO2) , NO, eNOS, ET-1, VEGF and HOMA-IR were tested on March 18 and June 2, 2021, respectively.
The intervention modality and duration had significant interactive effects on body weight, BMI and body fat percentage of three groups (P<0.05) . In particular, the average body weight, BMI and body fat percentage decreased significantly in both aerobic exercise group and combined aerobic and resistance exercise group after the intervention (P<0.05) . What's more, the average post-intervention levels of the above-mentioned three indicators in the two groups were significantly lower than those of the control group (P<0.05) . The intervention modality and duration had significant interactive effects on microvascular reactivity, TcPO2 and SmO2 of three groups (P<0.05) . In particular, the average microvascular reactivity, TcPO2 and SmO2 increased significantly in both aerobic exercise group and combined aerobic and resistance exercise group after the intervention (P<0.05) . In addition, the average post-intervention levels of the average microvascular reactivity and TcPO2 in the two groups were significantly higher than those of the control group (P<0.05) . The intervention modality and duration produced obvious interactive effects on NO, eNOS, VEGF and HOMA-IR of three groups (P<0.05) . In particular, the average NO, eNOS, and VEGF increased significantly and HOMA-IR decreased significantly in both aerobic exercise group and combined aerobic and resistance exercise group after the intervention (P<0.05) . Moreover, these two groups showed higher average post-intervention levels of NO and lower average post-intervention level of HOMA-IR than the control group (P<0.05) .
Both 10-week aerobic exercise and combined aerobic and resistance exercise at FATmax intensity could reduce body weight, body fat percentage, BMI and HOMA-IR in obese college students, and the latter may be more effective in improving microvascular reactivity and HOMA-IR. These two modalities of exercise improved microcirculation may be by improving the levels of NO, ET-1, VEGF and other factors.
The prognosis of patients with primary lymphoma of the central nervous system (PCNSL) is poor, and identifying the prognostic predictors is the key to improving their prognosis. Biopsychosocial models suggest the important prognostic value of psychosocial factors, but the association of marital status, one important psychosocial factor, with the prognosis of PNSCL patients remains unclear.
To assess the association of marital status with the overall survival (OS) and cancer-specific survival (CSS) in patients with PCNSL.
The data of 3 993 patients diagnosed with PCNSL between 2000 and 2016 were extracted from the Surveillance, Epidemiology and End Results database in 2020, including sociodemographics〔marital status (married, or single containing unmarried, divorced or widowed) , age of diagnosis, year of diagnosis, ethnicity, gender〕, clinicopathological features (pathological type and location of the PCNSL) , treatment (surgery, radiotherapy and chemotherapy) and outcome data (survival and follow-up time) . The propensity score matching (PSM) was used to balance the baseline variables of the married and singles. The Log-rank test was used to compare the Kaplan-Meier curves of OS and CSS by marital status. Cox regression was used to identify the association of marital status with OS and CSS.
After PSM, there were no significant differences in baseline variables between married and single patients (P>0.05) . The Log-rank test demonstrated that single patients had worse OS and CSS than the married (P<0.05) . Further analysis revealed that the widowed singles had worse OS and CSS than the married (P<0.05) . After adjusting for age of diagnosis, ethnicity, gender, year of diagnosis, pathological type and location of the PCNSL, surgery, radiotherapy and chemotherapy, multivariate analysis found that compared to those married, the risk of death was 1.24 times higher〔95%CI (1.14, 1.36) , P<0.001〕 and the risk of cancer-specific death was 1.22 times higher〔95%CI (1.11, 1.33) , P<0.001〕in singles. Further analysis revealed that compared with married patients, the risk of worse OS increased by a factor of 1.14〔95%CI (1.03, 1.27) , P=0.013〕 and that of worse CSS increased by a factor of 1.15〔95%CI (1.03, 1.29) , P=0.012〕in unmarried singles; the risk of worse OS and CSS increased by a factor of 1.23〔95%CI (1.07, 1.41) , P=0.004〕 and by a factor of 1.22〔95%CI (1.05, 1.41) , P=0.009〕, respectively, in divorced singles; the risk of worse OS and CSS increased by a factor of 1.37〔95%CI (1.21, 1.54) , P<0.001〕 and by a factor of 1.28〔95%CI (1.12, 1.46) , P=0.013〕, respectively, in widowed singles.
Marital status was associated with OS and CSS in PCNSL patients. The unmarried, divorced and widowed singles may have worse OS and CSS, suggesting that more attention should be given to the marital status of these patients besides biological characteristics of PCNSL during the clinical management.
Birth weight is closely related to individual health. Low birth weight is a high-risk factor for early neonatal death. Macrosomia is associated with higher risk of maternal and infant complications and various chronic diseases in adulthood. Therefore, it is very important to identify the influencing factors of neonatal birth weight.
To investigate the relationship between maternal intestinal flora and neonatal birth weight.
Participants were 516 singleton mothers and their babies〔24 with low birth weight (LW group) , 479 with normal birth weight (NW group) and 13 with macrosomia (OW group) 〕 delivered at term in Guangzhou Women and Children's Medical Center from January to September 2017. Maternal intestinal flora and clinical laboratory test parameters were collected, and the composition and diversity of intestinal flora were analyzed using QIIME. LEfSe analysis was used to compare the relative abundance of intestinal flora at the genus level of the mothers of three groups of babies to identify the flora with significant intergroup differences. MaAslin was used to assess associations of maternal laboratory test parameters and microbial genera. The Boruta was used to build models for predicting three types of neonatal birth weight using maternal laboratory test parameters and intestinal flora OTUs, to assess the association of maternal intestinal floras and neonatal birth weight.
The analysis of maternal intestinal floras showed that the abundance of Firmicutes was the highest at the phylum level, and Faecalibacterium was significantly enriched at the genus level. There were no significant differences in Simpson's Diversity Index and Shannon Diversity Index at the phylum level across the maternal intestinal floras of three groups of babies (P>0.05) . LEfSe analysis found that compared with intestinal flora of mothers of LW group, the intestinal flora of mothers of NW group showed significantly enriched Streptococcus and Roseburia (P<0.05) , and significantly reduced abundance of Bacillaceae, Raphanus, Methanosphaera, Barnesiella and Paraprevotella (P<0.05) , while the intestinal flora of mothers of OW group demonstrated significantly enriched Closrtidiaceae and Alistipes as well as significantly reduced abundance of Barnesiella (P<0.05) . Compared with intestinal flora of mothers of NW group, the intestinal flora of mothers of OW group indicated significantly enriched Megamonas, Coprococcus, Veillonellaceae, cc-115, Closrtidiaceae and Alistipes, and significantly reduced abundance of Blautia and Eggerthella (P<0.05) . The area under ROC curve (AUC value) based on laboratory test parameter OTUs model and intestinal flora OTUs model was 0.62 and 0.77, respectively, in discriminating LW from NW, and was 0.65, and 0.78 respectively, in discriminating OW from NW.
Neonatal birth weight varied by the features of maternal intestinal floras. The OTUs model based on maternal intestinal flora could distinguish the neonatal birth weight. Maternal intestinal flora may be a good predictor of neonatal birth weight.
