As a new indicator of glycemic management, time in range (TIR) is significantly related to short-term glycemic variability, but whether it is also associated with long-term glycemic variability is still unclear.
To investigate the relationship of TIR with coefficient of variability (CV) of HbA1c and HbA1c variability score (HVS) during a long-term follow-up in elderly male patients with type 2 diabetes.
Two hundred elderly male type 2 diabetic inpatients from the Second Medical Center of PLA General Hospital were enrolled from January 2007 to January 2011. All of them underwent continuous glucose monitoring (CGM) during hospitalization, and by the baseline TIR derived from CGM, they were divided into TIR≥85% group (n=141) and TIR<85% group (n=59), and followed up for (12.5±1.1) years. The CV of HbA1c and HVS in the follow-up were compared between the groups. The relationships of TIR with the CV of HbA1c and HVS were analyzed using Pearson correlation analysis and multivariate linear regression analysis.
The long-term CV of HbA1c〔 (9.7±3.8) % vs (8.2±4.5) %, P=0.028〕 and HVS〔 (48.7±20.4) vs (32.5±20.8), P<0.001〕 in TIR<85% group were both significantly higher than those in TIR≥85% group. Pearson correlation analysis suggested that TIR showed a significant linear negative correlation with CV of HbA1c (r=-0.239, P<0.001) or HVS (r=-0.400, P<0.001). Multiple linear regression analysis indicated that TIR had an impact on long-term CV of HbA1c〔b (95%CI) =-0.07 (-0.12, -0.03), P<0.05〕or HVS〔b (95%CI) =-0.44 (-0.67, -0.21), P<0.05〕after adjusting for confounding factors.
TIR was independently associated with long-term CV of HbA1c or HVS in elderly male patients with type 2 diabetes. With the decrease of TIR, the long-term HbA1c glycemic variability increased gradually during follow-up.
There is no effective cure for Alzheimer's disease. Early identification of mild cognitive impairment (MCI) and determination of its sensitive warning indicators are current research hotspots.
To explore the relationship between taste recognition decline and cognitive function, and to clarify the value of taste recognition decline in early recognition of MCI.
From July to August 2022, 30 older adults with MCI were recruited from a Nanjing community by convenience sampling method, and were compared to age-, sex-, and years of education-matched 32 healthy controls. The General Information Questionnaire, the Montreal Cognitive Assessment-Beijing Version (MoCA-Beijing), the Mini-Mental State Examination (MMSE), the Activities of Daily Living (ADL), and the Clinical Dementia Rating (CDR) were used to assess demographics, cognitive function, status of activities of daily living, and severity of dementia, respectively. The taste function was examined by the whole mouth test. Correlation analysis and the receiver operating characteristic (ROC) curve were used to determine the value of taste recognition decline in early warning of MCI.
Two groups had no significant differences in average age, gender ratio and average years of education (P>0.05), but significantly differed in the average MoCA-Beijing score and MMSE score (P<0.05). Compared with healthy controls, MCI patients had much lower average scores in overall taste recognition, sweet taste recognition, salty taste recognition and bitter taste recognition (P<0.05). In MCI patients, the overall taste recognition score was positively correlated with overall cognitive function, attention, orientation (r=0.433, 0.540, 0.392, P<0.05), salty taste recognition score was positively correlated with delayed recall ability (r=0.379, P<0.05), bitter taste recognition score was positively correlated with attention (r=0.471, P<0.05), umami taste recognition score was positively correlated with language ability (r=0.408, P<0.05). The AUC of the total score of taste recognition ability in predicting MCI was 0.781, with 0.844 sensitivity, 0.600 specificity, and an optimal cut-off value of 18.5.
Decreased abilities of sweet, salty and bitter recognition were found in MCI patients. The decreased ability of taste recognition was closely related to cognitive function. The decrease in the total score of taste recognition ability may partially predict MCI, and is a key early warning indicator of MCI.
Since the Internet dependence of the supply and demand sides of health popularization is increasing, eHealth literacy has become a primary skill that chronic disease patients need to master.
To analyze the current situation and existing problems of online health information usage habits and eHealth literacy in middle-aged and elderly residents, and discuss the relationship between online health information usage habits and eHealth literacy, providing a reference for improving the level of eHealth literacy and developing appropriate Internet-based health popularization services for these populations.
From June to September 2021, a questionnaire survey was conducted among 1 061 middle-aged and elderly residents in Shanghai communities selected by multistage sampling using the General Information Questionnaire and the Chinese version of the eHealth Literacy Scale (eHEALS-C) to understand their habits of using online health information and levels of eHealth literacy. Stepwise multiple linear regression was used to assess the association of habit of using online health information and other potential candidate factors with the level of eHealth literacy.
Altogether, 1 019 cases (96.04%) who effectively responded to the survey were included for analysis. Following health care accounts〔411 cases (40.33%) 〕was a major channel used for seeking online health information, followed by the search functionality or engines〔336 cases (32.97%) 〕, while the health apps or mini programs〔254 cases (24.93%) 〕, and online health communities〔65 cases (6.38%) 〕were less used. The online health information was less sourced from medical institutions〔397 cases (38.96%) 〕and medical workers〔187 cases (18.35%) 〕. The average total score of the eHEALS-C for the respondents was (27.62±8.57). The respondents scored lower in item 2〔 (3.36±1.27) points〕and item 6〔 (3.38±1.23) points〕of the eHEALS-C, indicating that they had low awareness of applying online health information to health problems, and low perceived skills at evaluating the online health information. Multiple linear regression analysis showed that age, participation in both basic and commercial medical insurance, using at least two channels for seeking online health information, having at least two sources of online health information, the habit of forwarding and sharing online health information, participation in collective online learning, and having an attitude of acceptance towards online health information were influencing factors of the level of eHealth literacy.
The eHealth literacy of these middle-aged and elderly residents is at a medium level, which is affected by online health information usage habits and other factors. To help them make better use of online health information and to improve their eHealth literacy, it is suggested to spread integrated authoritative information and retrieval platforms among these populations, give priority to supervision and elderly-oriented transformation of online health information platforms, and mobilize community, family, health associations, and commercial medical insurance institutions to co-deliver health-promotion services targeting these people.
The family management style directly affects the prognosis of children with complex congenital heart disease (CCHD) after palliative surgery. But it is still unsatisfactory for these children in China. Research on family management of these children based on the Family Management Style Framework in foreign countries has achieved certain achievements while domestic research is still in its infancy.
To explore the family management style and its factors in children with CCHD after palliative surgery.
This study is a cross-sectional study. From May to September 2021, a total of 245 children after palliative surgery for CCHD and their families were selected from Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine from January 1, 2016 to August 31, 2021 by convenient sampling. The following questionnaires were used for collecting information from the major caregiver of the children (father or mother) : the Chinese version of the Family Management Measure (FaMM-C), the Chinese version of the Family Assessment Device (FAD-C), the Chinese version of the Parenting Stress Index Short Form (PSI-SF-C), and the socioeconomic status index. The children's height and body weight were measured to assess the prevalence of malnutrition, and their cardiac functions were also evaluated. The family management style of the children's families was classified by clustering the score of each dimension of FaMM-C using clustering analysis. Multinomial Logistic regression was used to analyze the factors associated with different types of family management style.
Four types of family management style were identified: the normal-perspective and collaborative〔28.6% (70/245) 〕, the chaotic and strenuous〔11.0% (27/245) 〕, the confident and concerning〔21.6% (53/245) 〕and the laissez faire〔38.8% (95/245) 〕. When the normal-perspective and collaborative group compared to the other three groups: the higher the score of the PSI-SF-C, the more inclined the family management was to the normal-perspective and collaborative style (P<0.05). Meanwhile the higher the score of the FAD-C, the less inclined the family management was to the normal-perspective and collaborative style (P<0.05). Moreover, compared the laissez faire group with the normal-perspective and collaborative group: the family of male children was more inclined to the normal perspective and collaborative style (P<0.05) ; the older the children were at follow-up or the time from surgery to follow-up of those children was less than one year, the less inclined the family management was to the normal perspective and collaborative style (P<0.05) .
Family caregivers cope with the situation of children with CCHD after palliative surgery through four different management styles, which are shaped by multiple factors from children and families. Findings of this study suggest the necessity to carry out long-term care for the children adopting a family-centered care model, and to develop individualized interventions for the families to establish a scientific and effective family management style based on the type of family management style and its related factors.
In China, 80% of the grandparents are taking part in caring for grandchildren. However, it has been found by available studies that involvement in taking care of grandchildren may increase the risk of depression among grandparents, which would seriously harm their quality of life, and the risk of depression is associated with parent-grandparent coparenting conflict, grandparents' sense of valued elder and sense of mastery, but the underlying mechanism still requires further investigation.
To investigate the influence of parent-grandparent coparenting conflict on grandparents' depression, and to explore the mediating and moderating mechanisms that grandparents' sense of mastery and sense of valued elder may play in it.
This study used two surveys. Grandparents (totally 626 cases) who participated in caring for grandchildren were selected by snowball sampling to attend an online survey or by convenience sampling to attend an offline survey from August to November 2021 using four questionnaires, namely the Coparenting Relationship Scale (CRS), the Pearlin Mastery scale (PMS), Grandparent Meaning Scale (GMS), and the 9-item Chinese version of the Center for Epidemiological Studies Depression Scale (CES-D-C). Pearson correlation was used to analyze the relationship of mother-grandparent coparenting conflict score, father-grandparent coparenting conflict score, PMS score, score of the valued elder dimension of the GMS and CES-D-C. PROCESS was used to examine the mediating effect of grandparents' sense of mastery and the moderating effect of their sense of valued elder between parent-grandparent coparenting conflict and grandparents' depression, and to draw a simple slope diagram.
A total of 626 cases returned responsive questionnaires, with a response rate of 99.2%. The prevalence of depression tendency was 12.0% (75/626) in this study. The score of CES-D-C〔 (5.36±4.14) 〕 was found to be significantly positively correlated with mother-grandparent coparenting conflict score〔 (9.87±3.08), r=0.28, P<0.05〕, and father-grandparent coparenting conflict score〔 (7.34±3.25), r=0.35, P<0.05〕, but was negatively correlated with the PMS score 〔 (12.61±5.48), r=-0.25, P<0.05〕and the score of valued elder dimension〔 (84.13±8.58), r=-0.21, P<0.05〕. Grandparents' sense of mastery partially mediated the relationship of grandparents' depression with mother-grandparent coparenting conflict (with a size of indirect effect of 0.05, accounting for 17.2% of the total effects) and father-grandparent coparenting conflict (with a size of indirect effect of 0.04, accounting for 11.4% of the total effects). Grandparents' sense of valued elder moderated the relationship of grandparents' depression with mother-grandparent coparenting conflict (b=-0.06, P<0.05), and father-grandparent coparenting conflict (b=-0.07, P<0.05). The results of simple slope tests showed that among those with lower sense of valued elder, father-grandparent or mother-grandparent co-parenting conflict had a stronger influence on their depression than their counterparts with higher sense of valued elder.
Parent-grandparent (either mother-grandparent or father-grandparent) coparenting conflict is an important associated factor for grandparent's depression In this association, grandparent's sense of mastery plays a mediating role, while grandparent's sense of valued elder exerts a moderating effect. To reduce the risk of depression and promote the metal health among elders who take part in coparenting, efforts can be made to reduce coparenting conflicts and enhance the elders' sense of mastery and sense of valued elder.
Diabetes is highly prevalent in China, the prevention and treatment of it and its related complications need a lot of medical resources. Local reports have revealed that although the mortality of diabetes is declining, the burden of diabetes is still increasing.
To understand the epidemiological characteristics and burden of diabetes in China from 1990—2019, forecast the incidence of diabetes in China from 2020 to 2030, to provide data for evaluating and formulating diabetes-related prevention and treatment policies and measures.
In August 2022, this study used data from the Global Burden of Disease Study 2019. Temporal trends of the incidence, mortality, disability-adjusted life years (DALY), years of life lost (YLL), and years lost due to a disability (YLD) of diabetes in China from 1990 to 2019 were described. The Bayesian-age-period-cohort analysis was used to predict the incidence of diabetes in China from 2020 to 2030.
Compared with 1990, in 2019, the crude prevalence of diabetes increased to 265.45/100 000, with an increase of 63.12%, the standardized prevalence of diabetes increased to 204.31/100 000, with an increase of 15.93%, the crude mortality rate of diabetes increased to 12.16/100 000, with an increase of 105.41%, and the standardized mortality rate of diabetes increased to 9.44/100 000, with an increase of 2.61%. The YLL rate decreased from 204.71/100 000 in 1990 to 178.45/100 000 in 2019. The YLD rate increased from 260.74/100 000 in 1990 to 316.30/100 000 in 2019. The DALY rate increased from 465.46/100 000 in 1990 to 494.76/100 000 in 2019. Compared with 1990, the DALY rate of diabetes increased by 21.08% in males and decreased by 6.68% in females. The YLL rate, YLD rate and DALY rate increased with age in 2019. According to the prediction of the standardized incidence of diabetes in China from 2020 to 2030, the overall standardized incidence of diabetes would present a decreasing trend during the period, and the standardized incidence of diabetes in 2030 would decrease by 11.45% in men and 18.60% in women compared with 2020.
The burden of diabetes in China is still heavy, with a large number of illness cases and decreased cases, mainly manifested by a high burden caused by diabetes-related disability. Attention should be paid to early prevention of diabetes to reduce the occurrence of complications. The disease burden of males and middle-aged and elderly people is heavy, so sufficient attention should be paid to them. Although the predicted diabetes incidence will reduce between 2020 and 2030, the number of patients is still increasing, so the prevention and control of diabetes should not be slack.
In 2018, the weighted prevalence rate of hypertension among adults aged ≥18 years was 27.5%. Rural areas demonstrated a faster increase in the prevalence rate of hypertension, but lower awareness rate, treatment rate and control rate of hypertension compared with urban areas. Hypertension is the primary risk factor for cardiovascular diseases, and also a major contributor to the disease burden in the population. Understanding the costs of hospitalizations due to hypertension and related comorbidities and complications in rural areas can provide data support for the development of hypertension management and containment strategies in counties.
To analyze the costs of hospitalizations due to hypertension and related comorbidities and complications in county-level healthcare institutions.
This study selected inpatients with a diagnosis of hypertension via checking the home page of medical records in two county-level hospitals (people's hospital and TCM hospital) of a poverty-stricken county in Henan Province from 2017 to 2019. Patients' clinical information was collected from the medical records, and their healthcare costs were collected from the municipal and county medical insurance information systems.
A total of 36 565 hospitalizations related information was obtained. During the period, these county-level healthcare institutions had 139 169 hospitalizations in total, 36 565 of them (26.27%) were due to hypertension and related comorbidities and complications. Age, occupational type, marital status, and payment method differed significantly across inpatients due to hypertension and related comorbidities and complications (P<0.05). The severity of disease varied significantly among patients hospitalized due to hypertension and related comorbidities and complications by gender, age, occupational type, marital status, year of admission, and payment method (P<0.05). The average cost of hospitalization due to hypertension and related comorbidities and complications was 7 364.88 yuan in 2017, 6 724.36 yuan in 2018, and 7 134.09 yuan in 2019. And total costs of hospitalizations due to hypertension and related comorbidities and complications in the three years were 62 653 116.87 yuan, 84 394 889.48 yuan and 109 633 058.60 yuan, respectively, showing an increase trend, and the percent of which reimbursed by health insurance was 24.86% in 2017, 31.41% in 2018, and 33.25% in 2019, demonstrating an increasing trend year by year. The average hospitalization expenses, treatment expenses, and drug expenses due to hypertension and related comorbidities and complications differed significantly by year (P<0.05), while the average examination expenses did not (P>0.05). Moreover, the average hospitalization cost, treatment cost, drug cost and examination cost due to hypertension and related comorbidities and complications differed significantly by the severity of disease during the period (P<0.05) .
In these county-level healthcare institutions during the period, the number of hospitalizations due to hypertension and comorbidities and complications accounted a large percent of the total hospitalizations, and the percentages of relevant hospitalization costs and reimbursed costs showed an increase trend gradually. In view of this, it is suggested to strengthen the standardized management of people with a definite diagnosis of hypertension, enhance the capacities of primary medical institutions in identifying, diagnosing and managing hypertension, and reduce healthcare costs by delaying the progression of hypertension. Moreover, priority should be given to special groups to improve their health status to reduce the disease burden of hypertension, and multiple measures should be taken to improve people's awareness rate of hypertension and self-health management abilities.
The trend of prevalence and severity of the overweight problem in young children, reduces the general quality of the future population to a certain extent, inducing a great risk to the sustainable development of health human capital stock in China.
To scientifically understand the spatio-temporal evolutionary patterns and future development trends of overweight rates among children under 5 in China, in order to provide support for controlling overweight in children, improve the efficiency of local governance and support for the implementation of precise interventions.
In April 2022, the 5 km×5 km gridded dataset in 105 middle-and low-income countries provided by the Institute for Health and Evaluation at the University of Washington (IHME) was used as the data source to extract the gridded data of overweight rates among children under 5 in China (excluding Hong Kong Special Administrative Region, Macao Special Administrative Region and Taiwan District) from 2000 to 2019 in this study. The average overweight rate of children under 5 from 2000 to 2019 was calculated pixel-to-pixel, the Theil-Sen estimator, Mann-Kendall test and Hurst index estimation method was used to characterize the spatio-temporal evolutionary patterns and future development trends among children under 5 pixel-to-pixel.
Overweight among children under 5 is more prevalent in most regions of Shandong Province, Hunan Province and local regions of Fujian Province, Guangdong Province, Hainan Province, Beijing Municipality and Tianjin Municipality during the 20-year period from 2000 to 2019, with the average overweight rate of children under 5 in Hunan Province reaching 29.42%. The area of the regions with significant increase in overweight rates among children under 5 accounts for 60.59% of the total area of the regions in the study (excluding regions with missing data) . The area of the central and eastern regions with a significantly increasing trend in the overweight rates among children under 5 accounts for a higher proportion of the total area of central and eastern regions (excluding regions with missing data) than the proportion accounted by the area of the western regions with a significantly increasing trend in the overweight rates among children under 5 of the total area of western regions (excluding regions with missing data) . The area of the regions with no significant change in the evolution trend of overweight rates accounts for 25.33% of the total area of the regions in the study, which is scattered in patches in parts of provinces, such as cities cluster in the middle reaches of the Yangtze River urban agglomeration. The area of the regions with significant change in the evolution trend of overweight rates accounts for 14.08% of the total area of the regions in the study, concentrated in some regions in the Xinjiang Uygur Autonomous Region, Qinghai Province, Sichuan Province and Yunnan Province in the west of China, and local regions of Hebei Province, Liaoning Province and Shandong Province in the east of China. According to the Hurst index, the area of the regions with persistent or trend-enhancing characteristics of the time series of overweight rates of children under 5 accounts for 84.87% of the total area of the regions in the study.
The spatial heterogeneity of overweight rates among children under 5 in China is obvious. There is a synergistic "U"-shaped association between the overweight rates of children under 5 and the overall level of regional development, the association implies a multi-stage, cascading developmental process of "declining stage of stunting" "stabilization stage" "rising stage of overweight with overnutrition". Focusing on social problems derived from the coupling of multidimensional factors of overweight in young children, the results of the study provide scientific support and policy reference for the government to formulate region-specific policies, build a three-level governance network of "government policy regulation - social concept penetration - family health management", and scientifically and precisely solve the overweight problem among children under 5.
Helicobacter pylori (H. pylori) infection is the main cause of gastric cancer, but with the increase of H. pylori antibiotic resistance, the eradication rate has not substantially improved in many areas.
To understand the H. pylori antibiotic resistance situation in Wenzhou from 2013—2020, and analyse the difference of H. pylori antibiotic resistance with time period, age and gender.
From 2013-01-01 to 2020-12-31, a total of 47 658 patients undergoing gastroscopy in Wenzhou Central Hospital were selected. Gastric mucosa specimens were collected for H. pylori isolation and culture, and the isolated H. pylori strains obtained from the culture were analyzed for drug susceptibility to six antibiotics, including levofloxacin, clarithromycin, amoxicillin, metronidazole, tetracycline and furazolidone. A chi-square test was used to compare H. pylori antibiotic resistance rate between years, age groups and sexes.
Multiple antibiotic resistance existed in 16 847 H. pylori strains isolated in Wenzhou from 2013—2020. Separate statistics on the resistance rates of H. pylori to the six commonly used antibiotics revealed that the resistance rates to levofloxacin, clarithromycin and metronidazole were high in the region, respectively 32.81% (5 536/16 874) 、26.02% (4 390/16 874) 、95.67% (16 144/16 874) . The resistance rate to amoxicillin was low, only 0.28% (47/16 874) , and 1.36% (25/1 844) in 2017. No strains were found with resistance to tetracycline hydrochloride and furazolidone. From 2013 to 2020, there were statistically significant differences in H. pylori resistance rates to levofloxacin, clarithromycin and amoxicillin (P<0.01) . The metronidazole resistance rate in H. pylori was consistently high (>88.00%) with no statistical difference (P>0.05) . There was statistically significant difference in the H. pylori resistance rate for evofloxacin, clarithromycin and metronidazole between female and male (P<0.01) , with no statistical difference for amoxicillin (P>0.05) . There was statistically significant difference in the H. pylori resistance rate for levofloxacin or clarithromycin among different age groups in the region (P<0.01) , with no statistical difference for amoxicillin and metronidazole (P>0.05) .
The H. pylori antibiotic resistance rate differed by year, and varied across different age and sex groups of H. pylori-positive cases in Wenzhou during the period. The overall H. pylori resistance rate was high. The eradication regimens based on metronidazole, clarithromycin or levofloxacin are difficult to achieve satisfactory results, so clinical H. pylori eradication treatment based on drug sensitivity test results should be encouraged.
With the severe situation of the increasingly population aging in China, the health problems of the middle-aged and older adults can not be ignored, attracting much attention on the health equity among the rural-dewlling middle-aged and older adults. The geographic remoteness of southern mountainous area in the Ningxia Hui Autonomous Region causes the health conditions of the middle-aged and older adults more unoptimistic. However, there are relatively few studies on the health equity among the middle-aged and older adults in this area.
To investigate the health equity of the middle-aged and older adults in the pilot counties of medical reform in the Ningxia Hui Autonomous Region (Haiyuan County and Yanchi County) and analyze the contribution degree of various influencing factors to health inequality, so as to provide a basis for improving the health of the middle-aged and older adults and relevant health policies.
From January to March in 2022, from the follow-up data of 2019 from the Family Health Inquiry Survey of Rural Residents, the middle-aged and older adults (age≥45 years old) from resident families (living in the corresponding counties for more than one year) were selected as subjects (n=5 908) . The analysis was conducted with the two-week prevalence rate, chronic disease prevalence rate, two-week bedridden rate and two-week leaving rate as dependent variables, with sex, age, marital status, level of education, occupation, type of drinking water and per capita family income as independent variables. The concentration index was used to analyze the health equity of the middle-aged and older adults, and the centralized index decomposition method was used to analyze the contribution of various influencing factors to health inequality.
The concentration indexes of two-week prevalence rate, chronic disease prevalence rate, two-week bedridden rate and two-week leaving rate among the middle-aged and older adults in Haiyuan County were 0.030 0, 0.002 9, 0.011 4 and 0.032 7, respectively, while those of two-week prevalence rate, chronic disease prevalence rate, two-week bedridden rate and two-week leaving rate among the middle-aged and older adults in Yanchi County were 0.000 4, -0.000 1, 0.037 4 and 0.037 4, respectively. The concentration index decomposition analysis showed that gender, age, level of education, occupation, type of drinking water and per capita family income are the main causes for health inequality among the middle-aged and older adults, among which age and per capita family income contribute more to health inequality. The contribution ratio of age to the two-week prevalence rate, hronic disease prevalence rate, two-week bedridden rate and two-week leaving rate in Haiyuan County were -11.92%, -152.57%, -27.76% and 7.80%, respectively. The contribution ratio of age to the two-week prevalence rate, chronic disease prevalence rate, two-week bedridden rate and two-week leaving rate in Yanchi County were -334.79%, 1 117.94%, -45.45% and-25.44%, respectively. The contribution ratio of per capita family income to the two-week prevalence rate, chronic disease prevalence rate, two-week bedridden rate and two-week leaving rate among the middle-aged and older adults in Haiyuan County were 35.41%, -0.31%, 2.08% and 22.03%, respectively. The contribution ratio to the two-week prevalence rate, chronic disease prevalence rate, two-week bedridden rate and two-week leaving rate among the middle-aged and older adults in Yanchi County were 86.88%, -165.24%, 37.13% and 1.50%, respectively.
Overall, the health equity among the middle-aged and older adults in the pilot counties of the Ningxia Hui Autonomous Region is better but tilted towards those with higher incomes. Age contributes the most to health inequity among the middle-aged and older adults. The society should give higher priority to the middle-aged and older adults; Local primary health care institutions can increase the health awareness of the middle-aged and older adults by providing free health check-ups regularly and promoting health literacy to them. The health administration should adjust relevant health policies to better meet the health needs of the middle-aged and older adults and ultimately achieve health equity.
With the aggravation of aging trend, the influence of intergenerational support on the health of the elderly has gradually attracted attention, and the absence of spiritual care and life care is an important factor for the occurrence of health problems in the elderly, but there is a lack of scientific evaluation tools to evaluate the cognitive level of old-age care.
To develop a Knowledge, Attitude and Practice about Filial Piety Ethics Questionnaires for Offspring and Grandchildren in the process of elderly care, and to test its reliability and validity.
From April to July 2021, the first draft of the questionnaire was determined by searching relevant contents in databases such as PubMed, Web of Science, China Knowledge Network and Wanfang Data Knowledge Service Platform, and using the theory of knowledge, attitude and practice and Maslow's hierarchy of needs as the theoretical framework, combined with literature review, national maintenance laws, qualitative interviews, the questionnaire was refined with results of the Delphi expert consensus and pre-survey. From October 2021 to March 2022, 270 subjects from each generation were selected for the formal survey and 50 subjects from the offspring and 38 subjects from the grangchildren were selected for test-retest reliability using the random cluster sampling method. A total of 540 questionnaires were distributed, 270 questionnaires for each generation. A total of 528 valid questionnaires were returned, 264 valid questionnaires for each generation, with a valid return rate of 97.8%. Its reliability and validity were analyzed to determine the final questionnaire entry.
The Knowledge, Attitude and Practice about Filial Piety Ethics Questionnaires for Offsprings included 3 dimensions and 34 items. Exploratory factor analysis produced 3 factors, with a cumulative variance contribution rate of 64.455%. The content validity of each item ranged from 0.867 to 1.000, and the average content validity of the questionnaire was 0.967. Cronbach's α coefficient was 0.953, split-half reliability was 0.811, and test-retest reliability was 0.987. The Knowledge, Attitude and Practice about Filial Piety Ethics Questionnaires for Grandchildren consisted of 31 items in 3 dimensions. Exploratory factor analysis produced three factors, the cumulative variance contribution rate was 64.641%; the content validity of each item ranged from 0.867 to 1.000, the average content validity of the questionnaire was 0.964; Cronbach's α coefficient was 0.952, split-half reliability was 0.837, and test-retest reliability was 0.991.
The developed questionnaire has good reliability and validity, and can be used as a research tool to evaluate the current status of filial piety ethic knowledge, attitude and behavior of offsprings and grandchildren in the process of elderly care.
AIDS is a very hazardous infectious disease. The analysis of AIDS incidence and mortality trends and the age-period-cohort influence on them, may provide insights into the formulation of AIDS related prevention and control policies.
To assess AIDS incidence and mortality trends, and the impact of age, period and cohort on the incidence and mortality of AIDS in China from 2004 to 2018.
In March 2022, from the online direct reporting system of the Data-center of China Health Science, number of AIDS patients, AIDS incidence, number of patients dying of AIDS, AIDS mortality in China during 2004—2018 were extracted from the overall information during the period. The Joinpoint regression model was used to estimate the trend of AIDS incidence and mortality, and to calculate the annual percent change (APC) and average annual percent change (AAPC) . The age-period-cohort model was used to assess the influence of age, period and cohort on the trend of AIDS incidence and mortality.
During the period from 2004 to 2018, the incidence of AIDS in China increased from 0.248 9/100 000 to 4.956 9/100 000, and AIDS mortality increased from 0.060 5/100 000 to 1.431 2/100 000. Joinpoint regression analysis revealed that the incidence and mortality of AIDS in China had an average annual increase of 22.70%〔95%CI (20.70%, 24.80%) 〕and 18.80%〔95%CI (12.10%, 25.90%) 〕in the period, respectively (P<0.05) . The age-period-cohort analysis indicated that age, period and cohort all affected AIDS incidence and mortality (P<0.05) . The temporal trend in age-specific AIDS incidence or mortality showed a J-shaped curve of growth. The AIDS incidence increased from 0.000 4/100 000 in 5-9-year-olds to 2 828.828 5/100 000 in 75-79-year-olds, and the AIDS mortality increased from 0.000 4 in 5-9-year-olds to 740.297 4 in 75-79-year-olds. With the passage of time, the risk of AIDS incidence and mortality increased gradually: compared with the rate ratio of AIDS incidence and mortality (RR=1.000 0) in 2009—2013, the RR of AIDS incidence increased from 0.315 6〔95%CI (0.277 2, 0.359 4) 〕during 2004—2008 to 2.024 4〔95%CI (1.877 1, 2.183 2) 〕during 2014—2018. The RR of AIDS mortality increased from 0.329 1〔95%CI (0.291 7, 0.371 3) 〕in the period 2004—2008 to 1.522 6 in the period 2014—2018. The later the cohort was born, the greater the risk of AIDS incidence and mortality: compared with the relative risk of AIDS incidence and mortality (RR=1.000 0) in 1969—1973 cohort, the RR of AIDS incidence increased from 0.000 1〔95%CI (0, 0.000 4) 〕in the 1929—1933 cohort to 471.385 3〔95%CI (118.524 3, 1 874.755 6) 〕in the 2009—2013 cohort; the RR for mortality increased from 0.000 1 〔95%CI (0, 0.000 6) 〕in the 1929—1933 cohort to 93.634 5〔95%CI (21.168 0, 414.182 4) 〕in the 2009—2013 cohort.
AIDS incidence and mortality were on the rise in China during 2004—2018. AIDS incidence and mortality increased with age, and the period and cohort effects on the risk of incidence and mortality increased. More efforts need to be made to strengthen AIDS prevention and treatment in middle-aged and elderly people.
As intestinal infectious diseases are one major public health issue in China, there remains an urgent need to dynamically track the incidence trend and epidemiological characteristics of these diseases on the whole or by category.
To analyze the epidemiological characteristics, spatial distribution and clustering features of types A and B intestinal infectious diseases in China from 2008 to 2018, providing a theoretical basis for optimizing the prevention and control strategies of these two types of diseases.
Data on the incidence of types A and B intestinal infectious diseases〔including typhoid and paratyphoid, viral hepatitis (hepatitis A, hepatitis E and undifferentiated type of hepatitis) and dysentery〕in all regions of China (n=31, except for Hong Kong, Macao and Taiwan) from January 2008 to December 2018 were extracted in March 2022, using the Data-center China Public Health Science as the data source. The chi-square test for trend was used to examine the temporal trend of incidence of these two types of diseases. Descriptive epidemiology, spatial autocorrelation, and spatial and temporal clustering analysis were used to analyze the spatio-temporal epidemiological characteristics of the diseases, and to determine the key seasons and regions for epidemic prevention and control.
A cumulative total of 3 220 480 cases of types A and B intestinal infectious diseases were reported in China from 2008 to 2018, with an average annual incidence rate of 7.25/100 000, showing a decline in overall incidence rate (P<0.05) . The incidence rate of typhoid and paratyphoid, viral hepatitis and dysentery demonstrated a downward trend during the period (P<0.05) . The incidence rate of typhoid and paratyphoid decreased from 1.18 per 100 000 population in 2008 to 0.78 per 100 000 population in 2018. The incidence rate of viral hepatitis decreased from 9.81 per 100 000 population in 2008 to 4.34 per 100 000 population in 2018. The incidence rate of dysentery decreased from 23.65 per 100 000 population in 2008 to 6.56 per 100 000 population in 2018. Typhoid, paratyphoid and dysentery occurred more frequently in summer and autumn (from May to October) , while the incidence of viral hepatitis had no obvious changes across seasons. The spatial distribution map of types A and B intestinal infectious diseases in China indicated that, typhoid and paratyphoid had a high incidence rate in Yunnan, Guizhou and Guangxi in western China, viral hepatitis showed a high incidence rate in western China, and dysentery had a high incidence rate in Beijing and Tianjin. The spatial autocorrelation analysis showed that the incidence rate of typhoid and paratyphoid (except that in 2014) , viral hepatitis (except that in 2016) and dysentery in China over the years from 2008 to 2018 was spatially clustered (global Moran's I ranged from 0.09 to 0.24, P<0.05) . The spatial clustering of typhoid and paratyphoid and viral hepatitis was decreased first and then increased, and that of viral hepatitis declined first and then rose, but was weakened in general. The spatial clustering of dysentery was strong. The spatio-temporal scan statistics detected that Yunnan was the region with the highest incidence rate (the primary geographic cluster) of typhoid and paratyphoid during 2009 to 2013, nine regions with Tibet as the center had the highest incidence rate of viral hepatitis from 2008 to 2011, and Beijing and Tianjin were the regions with the highest incidence rate of dysentery from 2008 to 2012.
Having obvious spatial and temporal clustering characteristics, the incidence of types A and B intestinal infectious diseases in China decreased significantly during the period due to effective prevention and control. Our study may be used as a guide to identify key prevention and control areas and to develop prevention and control strategies according to the spatial clustering patterns of different intestinal infectious diseases.
Health education and health promotion are at the top of the list of population health promotion strategies. It is essential to provide community-dwelling residents with health education to improve their health literacy. However, few studies focus on the needs of health education (including the contents, acquisition methods and forms) in community-dwelling residents.
To investigate the perceived needs of health education and associated factors in community-dwelling residents, providing a scientific basis for meeting their health education needs and improving their health literacy level.
From January 19 to March 12, 2020, 2 846 residents aged >12 years were selected from 10 cities of China using multistage sampling to attend a questionnaire survey. The questionnaire used contains two parts: the first part is socio-demographic characteristics. And the second part is the perceived health education needs of community-dwelling residents, with 5-point Likert scale items belonging to three dimensions (contents, forms, and acquisition methods) . The total score for each dimension was obtained by summing the score of items in the dimension. Residents' needs of the contents, forms or acquisition methods were graded as "low", "moderate", or "high" by the average total score of each dimension. Univariate and multivariate ordinal Logistic regression were used to explore the associated factors of level of health education needs in community-dwelling residents.
Altogether, 2 679 cases (94.13%) who handed in responsive questionnaires were finally included. The average total score for dimensions of contents, acquisition methods and forms were (21.49±5.91) , (15.11±5.48) and (13.61±4.41) , respectively. Among the content items of health education, the top three relatively strongly needed/strongly needed were food safety〔2 081 (77.68%) 〕, disease prevention and control〔2 020 (75.44%) 〕, and rational medication〔1 963 (73.28%) 〕. Among the acquisition methods of health education, the top two relatively strongly needed/strongly needed were health education columns in the community built using digital media technologies〔1 519 (56.70%) 〕 and interactive health education〔1 518 (56.66%) 〕. In terms of the health education form, the proportions of residents who needed various forms of health education were similar. Specifically, the proportion of residents who relatively strongly needed/strongly needed video-based health education was the highest〔64.91% (1 739/2 679) 〕, while that of residents who relatively strongly needed/strongly needed written health educational materials was the lowest〔50.84% (1 362/2 679) 〕. Multivariate ordinal Logistic regression analysis showed that age and current occupation were associated with residents' needs of the content of health education (P<0.05) . Moreover, gender, the highest educational attainment, current occupation, and current place of residence were associated with residents' needs of methods for acquiring health education (P<0.05) . And age, the highest educational attainment, current occupation, and current place of residence were associated with residents' needs of the form of health education (P<0.05) .
Community-dwelling residents showed high demand for the contents, acquisition methods, and forms of health education, which presented a diversified trend. They paid special attention to the content about food safety and disease prevention and treatment, and preferred interactive and video-based health education in terms of form.
As population ageing accelerates and life expectancy increases, multimorbidity and disability pose challenges to health and social care systems worldwide. Although multimorbidity is closely related to disability, there is still a lack of research on the impact of multimorbidity on disability in rural middle-aged and elderly people.
To evaluate the influence of multimorbidity on disability in rural middle-aged and elderly people using the propensity-score matching (PSM) , providing a reference for formulating strategies for the management of multimorbidity and disability in this population.
The data of 11 088 rural middle-aged and elderly people (≥45 years old) were collected from the 2018 China Health and Retirement Longitudinal Study in March 2022, including demographics, chronic disease prevalence, and disability measured by activities of daily living (ADLs) , and instrumental activities of daily living (IADLs) . Participants were divided into multimorbidity and non-multimorbidity groups by the prevalence of multimorbidity (defined as having ≥2 chronic conditions) , and then matched using PSM with a 1∶1 ratio. Conditional Logistic regression model for paired binary data was used to assess the impact of multimorbidity on ADL disability and IADL disability.
Of 11 088 ural middle-aged and elderly people with chronic diseases, 2 711 (24.45%) had ADL disability, 4 216 (38.02%) had IADL disability, and 7 673 (69.20%) were multimorbidity patients. The prevalence of ADL disability or IADL disability differed significantly by gender, age, marital status, education level, sleep duration, smoking, drinking, disability status, participation in social activities, and prevalence of multimorbidity (P<0.05) . There were statistically significant differences in gender, age, marital status, education level, sleep duration, smoking, drinking, disability status, and participation in social activities between the two groups before matching (P<0.05) . A total of 3 391 pairs were derived after PSM with matched covariates. Logistic regression analysis showed that multimorbidity prevalence increased the risk of ADL disability by a factor of 2.25〔OR (95%CI) =2.25 (1.96, 2.59) , P<0.001〕 and elevated the risk of IADL disability by a factor of 1.52〔OR (95%CI) =1.52 (1.36, 1.71) , P<0.001〕.
PSM is beneficial for reducing confounding bias in study groups. Multimorbidity would increase the risk of disability in rural middle-aged and elderly people. It is suggested to value the government input on resources and policies to strengthen the prevention and management of multimorbidity and disability in this group of people.
The right to health of children has been a general concern of the society. The rate of systematic health management for children is a core indicator effectively reflecting the monitoring and management of children's physical growth and psycho-behavioral development. Most of the studies on systematic health management for children use an empirical design, mainly focusing on explorations of management models, while few have made in-depth analysis of the national status from temporal and geographical perspectives.
To analyze the temporal changes and regional differences in terms of the rate of systematic health management of children under three years old from 2010 to 2019, providing valuable evidence for the consolidation and improvement of the health management level in this group, and for promoting health level in children.
In November 2021, data about health management of children under three years old in China during 2011—2020 were extracted from 10 volumes of China Health Statistics Yearbook published annually from 2011 to 2020. A descriptive analysis was used to conduct temporal and geographical analysis of the systematic health management for children.
As a whole, the national health management rate for children under three years old showed a continuous upward trend increased from 81.5% in 2010 to 91.9% in 2019, with a 12.8% increase. The annual rate of systematic health management of the children during the period was greater than 90.0% in Beijing, Inner Mongolia Autonomous Region, Liaoning Province, Shanghai, Jiangsu Province, Zhejiang Province, Shandong Province, Guangdong Province and Shaanxi Province, but was relatively low in the Tibet Autonomous Region (71.9% in 2019) , indicating that there was still a certain gap between the local level and policy goals in this region. The analysis from temporal changes and regional differences as well as regional perspective revealed the following findings: the rate of systematic health management for children under three years during 2010—2019 was higher than the national level in 13 (41.9%) out of 31 regions in China, lower than the national level in 7 regions (22.6%) , and moved around the national level in 11 regions (35.5%) . The systematic health management rate of children under 3 years old varied greatly between regions during 2010—2012, but the inter-regional differences gradually narrowed after 2015. The rate of systematic health management for children under 3 years old was the highest in northeast China, followed by eastern China, western China and central China. In 2019, there was still large differences in the rate of systematic health management for these children among regions in western China.
China has achieved remarkable results in systematic health management for children under 3 years old. More attention should be given to the regions in western China, especially the Tibet Autonomous Region during the improvement of the management for these children. To further improve and consolidate the health management level of children, it is suggested to make efforts to improve the equity and accessibility of essential medical services, narrow the inter-regional differences between health resource allocation and public health services, learn and apply relevant good management methods from advanced regions, make full use of big data and internet techniques, and strengthen the construction of community pediatric health management team.
Breast cancer is the leading cause of death among women worldwide, characterized by high incidence and heavy disease burden.
To assess the secular trend of breast cancer incidence and mortality in Chinese females from 1990 to 2019.
The data on breast cancer incidence and mortality in Chinese females aged ≥15 years from 1990 to 2019 were extracted from the Global Burden of Disease Study 2019. The Bayesian age-period-cohort (APC) model was used to fit breast cancer incidence and mortality trends during 1990—2019 to assess the effects of age, period and cohort on breast cancer incidence and mortality.
The crude incidence of breast cancer among Chinese females increased from 14.14/100 000 to 52.81/100 000, and the crude mortality increased from 7.22/100 000 to 13.40/100 000 during 1990—2019.The standardized incidence of breast cancer showed an increasing trend in general (17.07/100 000 in 1990, 35.61/100 000 in 2019) , while the standardized breast cancer mortality was basically stable (9.16/100 000 in 1990, 8.98/100 000 in 2019) .The results of the APC model showed that the average net drift value of breast cancer incidence in females of all age groups was 2.58%〔95%CI (2.34%, 2.83%) 〕, and the highest value of local drift was 3.46%〔95%CI (3.11%, 3.80%) 〕 in the 65-69 years old group. The average net drift value of mortality was -0.75%〔95%CI (-1.09%, -0.41%) 〕. The local drift value was stable in 15-44-year-olds, and was above 0 in age groups above 60 years old. The incidence and mortality of breast cancer increased with age. The period effect of incidence showed an increasing trend (RR: 0.79-1.47) , while the period effect of mortality showed a decreasing trend (RR: 1.08-0.90) when the period of 2000—2004 was set as the control group. The cohort effect of breast cancer incidence increased (RR: 0.27-2.48) , and the cohort effect of breast cancer mortality risk increased firstly and decreased after then (RR: 0.78-1.06-0.44) when the cohort of 1955—1959 was set as the control group.
The incidence and mortality of breast cancer in Chinese females increased continuously from 1990 to 2019, which was dominantly influenced by age and cohort.
Chinese aging population degree will transform mild to moderate. During addressing aging issues by proactive national strategies and healthy aging strategies, the sleep health of older peoplecannot be ignored.
To explore the effect of working after retirement on sleep quality in Chinese older people, providing relevant reference data for improving sleep quality in this group of people.
In August 2021, data of working after retirement prevalence and sleep health in subjects aged ≥60 years (n=7 862) were obtained from the 2018 China Family Panel Studies (CFPS) conducted by Peking University with permission. They were divided into working after retirement and non-working after retirement groups by working after retirement prevalence. Normal sleep duration (within 4 to 10 hoursper night) , abnormal sleep duration (≤4 or ≥10 hours per night) , sleeping late (going to bed after 23 o'clock) in accordance with relevant diagnostic criteria used in international studies on sleep health in middle-aged and older people. Self-reported perceptions of sleep quality were classified into optimistic and pessimistic according to subjective evaluation of sleep efficiency and effect. Binary Logistic regression model was used to explore the effect of working after retirement on sleep duration, perception of sleep quality and the time to go to sleep.
Among the subjects, 5 705 (72.56%) had optimistic sleep quality, 6 508 (82.78%) had normal sleep duration, and 7 464 (94.94%) went to sleep earlier than 23: 00, and 4 005 (50.94%) still worked after retirement. After controlling for age, gender, maritalstatus, education level, personality traits and other factors, working after retirement was associated with increased probability of higher optimism with sleep quality〔OR (95%CI) =1.205 (1.069, 1.358) 〕, more normal sleep duration〔OR (95%CI) =1.306 (1.137, 1.499) 〕, and earlier time to go to sleep〔OR (95%CI) =1.596 (1.253, 2.033) 〕.Working after retirement was associated with increased probability of good sleep quality (P<0.05) .
As working after retirement may be contributive to good sleep quality in older people, it should be supported and guaranteed by governmental policies.
The problem of population aging is serious in China, and chronic diseases comorbidity is becoming more and more common.
Based on the health ecology model, to systematically understand the main influencing factors of chronic disease comorbidity among the elderly in China, and to provide scientific reference for the prevention and control of chronic disease comorbidity among the elderly in China.
Based on the follow-up data of China Health and Retirement Longitudinal Study (CHARLS) 2018, a total of 10 779 samples aged ≥60 years were selected in March 2021. After excluding the samples with missing data and unqualified data, a total of 7 354 samples was included in this study. With the occurrence of chronic comorbidities (having ≥2 chronic conditions) as the dependent variable and the inclusion of independent variables according to the 5 dimensions of the health ecology model, a multivariate Logistic regression model was used to analyze the influencing factors of chronic disease comorbidity in the elderly.
Among the elderly≥60 years old in China, the comorbidity rate of chronic diseases was 65.16% (4 792/7 354) , with 32.16% (1 541/4 792) patients suffered from two kinds of chronic diseases, and the diseases with the largest combination of two comorbidities were hypertension with arthritis or rheumatism〔16.42% (253/1 541) 〕. The results of the multivariate Logistic analysis showed that for the risk of comorbidities of chronic diseases in the elderly, females were higher than that in males〔OR (95%CI) =1.371 (1.177, 1.596) 〕, those over 70 years old were higher than those aged 60-70 years old〔OR (95%CI) =1.189 (1.061, 1.333) 〕, those who slept for 6-8 hours or more than 8 hours at night were lower than those who slept for less than 6 hours at night〔OR (95%CI) =0.759 (0.678, 0.850) , OR (95%CI) =0.686 (0.572, 0.821) 〕, those who took nap time of 0.5-1.0 h and over 1.0 h were higher than those of less than 0.5 h 〔OR (95%CI) =1.238 (1.102, 1.391) , OR (95%CI) =1.219 (1.604, 1.396) 〕, those who felt general and less satisfied with their health were higher than those who were very satisfied〔OR (95%CI) =1.755 (1.537, 2.004) , OR (95%CI) =5.890 (4.930, 7.037) 〕, those who registered in urban areas were higher than those in the rural areas〔OR (95%CI) =1.167 (1.036, 1.315) 〕, those living in the central and western regions were higher than those in the eastern region〔OR (95%CI) =1.311 (1.158, 1.483) , OR (95%CI) =1.491 (1.315, 1.692) 〕, those who were working were lower than those who had worked〔OR (95%CI) =0.768 (0.680, 0.866) 〕, and those with annual income > 50 000 per capita were higher than that of less than 20 000 yuan〔OR (95%CI) =1.413 (1.009, 1.978) 〕.
The incidence of chronic diseases comorbidity is higher in the elderly in China. The influencing factors of comorbidity of chronic diseases are multi-level and multi-dimensional. There are complex relationships between different influencing factors, which suggest strengthening multi-dimensional intervention and management of chronic diseases from individual to environment, so as to improve the health level of the population.
Sleep duration is strongly associated with hypertension, but its effect on H-type hypertension in female population is not well characterized.
The examine the effect of sleep duration on the prevalence of H-type hypertension in female population.
A cross-sectional study design was used. One thousand seven hundred and nine female hypertensive inpatients were selected from Department of General Medicine and Geriatric Department of Hunan Provincial People's Hospital from July 2018 to December 2020, among whom those who with serum Hcy≥10 μmol/L and the others were assigned into H-type hypertension and non-H-type hypertension groups, respectively. Binary Logistic regression was used to assess the correlation of between sleep duration and H-type hypertension across three groups with different self-reported mean daily sleep durations in the past month (<7 h, 7-8 h, and >8 h) , and to further assess the correlation between the two across by age (≤60 and >60) .
The distribution of age, education level and marital status differed across three groups with different daily sleep durations (P<0.05) . 901 (52.72%) with daily sleep duration of <7 h, 697 (40.78%) with daily sleep duration of 7-8 h, and 111 (6.50%) with daily sleep duration of >8 h. The distribution of age, education level, living area (urban or rural) , marital status, BMI, exercise status, and daily sleep duration, as well as prevalence of drinking between H-type hypertension group〔973 (56.93%) 〕 and non-H-type hypertension group〔736 (43.07%) 〕 (P<0.05) . The risk of H-type hypertension in those with <7 h of daily sleep duration was 1.291 times higher than that in those with 7-8 h of daily sleep duration〔95%CI (1.032, 1.615) , P<0.05〕after adjusting for confounding factors such as age, education level, living area, marital status, BMI and exercise status. Further analysis revealed that <7 h of daily sleep duration was associated with increased risk of H-type hypertension only in those aged greater than 60 years〔OR (95%CI) =1.421 (1.021, 1.978) , P<0.05〕.
Less than 7 h of daily sleep duration was a risk factor for H-type hypertension in female over 60 years old. In view of this, it is suggested to put more attention to sleep health to improve blood pressure in this group.
Both motoric cognitive risk (MCR) syndrome and subjective cognitive decline (SCD) are early stages of cognitive decline in the elderly. MCR syndrome is currently considered as a new effective predictor of preclinical dementia. Identifying the risk factors of dementia in older people with SCD by early MCR syndrome screening is of great significance for reducing the incidence of dementia and related adverse health events in this group.
To investigate the prevalence and influencing factors of MCR syndrome in the elderly with SCD in the community.
A long-term cohort study conducted from January 2019 to January 2022 in a community in Beijing selected 459 cases of the elderly (≥60 years old) with SCD as the study population. SCD was assessed using the memory-related questions in the Geriatric Depression Scale-15 and the Chinese version of Montreal Cognitive Assessment-Basic. The the 6-metre walking test was used to assess gait status. MCR syndrome was defined as SCD in combination with gait decline. A self-designed questionnaire was used to collect the demographic data, physiological factors, psychological factors, lifestyle indicators, psychological factors, nutritional status, conditions of illness and medication history. Stepwise multinomial Logistic regression was used to explore the influencing factors of MCR syndrome.
The prevalence of MCR syndrome was 27.2% (125/459) . The elderly in the MCR and non-MCR groups were compared for age, basic activities of daily living (BADL) , instrumental activities of daily living (IADL) , weekly exercise hours, anxiety status, nutritional status, conditions of illness〔hypertension, chronic heart failure, arrhythmia, stroke/transient ischaemic attack (TIA) , multiple lacunar infarction, diabetes mellitus, peripheral vascular disease, cancers, osteoarthritis, history of fracture in the last 2 years, oculopathy, oral disease〕, and medication history, and the difference was statistically significant (P<0.05) . Stepwise multinomial Logistic regression analysis showed that older age〔OR (95%CI) =1.083 (1.034, 1.134) 〕, lower ability to perform BADL〔OR (95%CI) =0.952 (0.914, 0.991) 〕, lower ability to perform IADL〔OR (95%CI) =0.623 (0.486, 0.798) 〕, weekly exercise hours〔OR (95%CI) =0.505 (0.295, 0.864) 〕, anxiety status〔OR (95%CI) =2.442 (1.225, 4.866) 〕, conditions of hypertension〔OR (95%CI) =1.948 (1.086, 3.497) 〕, and conditions of stroke/TIA〔OR (95%CI) =3.154 (1.745, 5.699) 〕were associated with MCR syndrome (P<0.05) .
The prevalence of MCR syndrome was high in older adults with SCD in the community. In view of this, during the MCR syndrome screening in this population, attention should be paid to risk factors such as older age, the ability to perform BADL and IADL, weekly exercise hours, anxiety status, conditions of hypertension, and conditions of stroke/TIA, and support should be provided for these people to control chronic disease and develop a healthy lifestyle, thereby improving their cognitive status.
With the aging of the population, it is essential to implement fall prevention programs for the elderly. Although China has carried out fall prevention programs sporadically, among which comprehensive fall prevention programs centered on exercise intervention are rare, and there have been no investigations about the willingness of elderly people at high risk of falls in the community to participate in comprehensive fall prevention programs.
To examine the intention of community-living elderly residents at high risk of falls to participate in comprehensive fall-prevention programs, and associated factors, providing a theoretical basis for the implementation of such programs.
By economic level and geographical location, we selected three communities from Shanghai as research settings, namely, Tangqiao Community in Pudong New Area (central urban area) , Zhaoxiang Community in Qingpu District (outer suburb) and Gangyan Community in Chongming County (outer suburb) . Elderly people aged 65 and above who participated in physical examinations in the three communities from 2018 to 2019 were invited to attend a survey using a questionnaire consisting of demographics, FROP-Com Screen, MFROP-Com Tool, self-designed fall risk questionnaire, Patient Health Questionnaire-9 (PHQ-9) , and Generalized Anxiety Disorder scale (GAD-7) . Individuals with the FROP-Com Screen scale score >3 points were identified with risk of falls, among whom those with total score of MFROP-Com Tool≥11.5 points (high risk of falls) were included finally.
In total, 318 cases were detected with high risk of falls, among whom 62 (19.5%) thought falls were unpreventable. Slippery floor〔73 respondents (23.0%) 〕, inattention〔64 respondents (20.1%) 〕and physical discomfort〔64 respondents (20.1%) 〕were reported to be the three leading causes of falls. Two hundred and fourteen (67.3%) were willing to participate in fall prevention programs. The level of intention to participate in fall prevention programs differed significantly in the participants according to living setting, educational level, use of a walker, self-assessed sleep quality, number of chronic diseases, foot disease prevalence, exercise habits, history of falls in the past year, and cognition of whether falls can be prevented (P<0.05) . Binary Logistic regression analysis showed that living in urban area〔OR (95%CI) =7.828 (2.898, 21.149) 〕, having an exercise habit〔OR (95%CI) =3.474 (1.703, 7.087) 〕, previous history of falls〔OR (95%CI) =2.806 (1.364, 5.773) 〕, and having an idea of falls are preventable〔OR (95%CI) =4.124 (1.749, 9.726) 〕 were associated with higher level of intention to participate in an fall prevention program (P<0.05) .
In general, the community-living elderly residents with high risk of falls had limited understanding of fall prevention, but most of them were willing to participate in fall prevention programs. To promote the implementation of comprehensive fall prevention programs, it is necessary to improve their awareness of fall prevention and enhance their willingness to participate.
Neck and shoulder pain ranks the 21st in terms of global economic burden of diseases, but it could be effectively treated and relieved by timely standardized interventions. The application of goal attainment scaling (GAS) will help to assess the effectiveness of interventions in a more targeted manner.
To measure the effectiveness of traditional Chinese medicine (TCM) health management delivered by Hangzhou community health centers for community-dwelling individuals with chronic neck and shoulder pain using GAS, and to identify the associated factors.
Typical sampling was adopted to choose 262 patients with chronic neck and shoulder pain from three community health centers of Hangzhou from August to September 2020. They were randomly divided into control group (n=131) and intervention group (n=131) , received one-month acupuncture treatment, and one-month acupuncture treatment plus TCM management, respectively. The intervention effect survey was carried out in November 2020 using a self-compiled questionnaire for understanding participants' demographics, level of pain assessed using the Changhai Pain Rating Scale, and effectiveness measured using GAS.
All the participants were included for analysis (n=244, 122 in each group) except for nine missing cases in each group. The post-intervention GAS scores for intervention group and control group were (51.20±7.81) and (42.94±7.57) , showing statistically significant difference (P<0.05) . The intervention group and control group also had statistically significant difference in terms of the number reaching or exceeding the expected target after intervention〔92 (75.4%) vs 44 (36.1%) 〕 (P<0.05) . The post-intervention GAS score in cases in the intervention group differed significantly by education level, marital status, employment status, TCM constitution, and self-assessment health status (P<0.05) . In accordance with the results of stepwise multiple linear regression analysis, TCM constitution, self-rated health, and drinking were associated with the GAS score after acupuncture treatment plus TCM management (P<0.05) .
The comprehensive TCM health management have significant effect on patients with chronic neck and shoulder pain. In view of this, the management is suggested to be implemented in primary care.
The latest epidemiological data show that the prevalence of diabetes (diagnosed by the WHO diagnostic criteria) in Chinese population was 11.2% in 2020. Diabetes may induce many serious complications, and poor glycemic control will greatly impair the quality of life of people with glycemic management, so self-monitoring of blood glucose (SMBG) is particularly important.
To explore the prevalence and associated factors of effective frequency of SMBG in community-living people with glycemic management.
Convenience sampling was used to select individuals from Shantou communities who received online or offline glycemic management from primacy hospitals from August 2019 to August 2020 to attend a survey using a questionnaire consisting of three parts, namely demographic information, the Chinese version of the Brief IMB-SMBG Instrument, and the frequency of SMBG. Effective SMBG frequency was defined as measuring fasting blood glucose or 2-hour postprandial blood glucose 2 to 4 times per week, and by which participants were divided into effective and ineffective SMBG groups. Multivariate Logistic regression was used to analyze the influencing factors of effective SMBG frequency.
Two thousand cases attended the survey, and 1 636 (81.80%) of them who handed in responsive questionnaires were finally included for analysis, including 403 (24.63%) with effective SMBG frequency and 1 233 (75.37%) with ineffective SMBG frequency. Effective and SMBG ineffective frequency groups had significant difference in the average total score of 〔 (211.76±38.36) vs (166.33±40.24) 〕 (t=19.901, P<0.01) . Two groups also had significant differences in sex ratio, distribution of education attainment, occupation type, and monthly income, prevalence of glycemic control through pharmaceutical treatment, drinking, complications, awareness of glycosylated hemoglobin and SMBG frequency, having a blood glucose monitor, catching up the blood glucose measurement missed due to forgetting, getting good access to blood glucose test strips, and massaging fingers to promote blood flow (P<0.05) . Multivariate Logistic regression analysis showed that occupation type, glycemic control through pharmaceutical treatment, good access to blood glucose test strips, catching up the blood glucose measurement missed due to forgetting and massaging fingers to promote blood flow were associated with effective SMBG frequency (P<0.05) .
The rate of effective SMBG frequency in community-living people with glycemic management needs to be improved further. To achieve this, it is suggested that education on SMBG skills should be provided for this group.
High blood pressure can cause damages of target organs such as the heart, brain, kidneys and retina, while diabetes can cause a series of metabolic disorders, resulting in a variety of complications. Both are major risk factors for cardiovascular and cerebrovascular diseases. Eating a healthy diet may significantly contribute to the prevention and control of hypertension and diabetes.
To investigate the effects of a Chinese-style DASH diet in improving the nutritional status of community-living patients with type 2 diabetes and hypertension.
Sixty-one hypertensive patients with type 2 diabetes with medical records created in Chongqing Sihai Community Health Center were selected to undergo an eight-week Chinese-style DASH diet intervention, including dietary guidance (at 1 and 2 weeks) , eating the Chinese-style DASH diet provided using a group-based approach (at 3 and 4 weeks) , and home-based medical care (at 5 to 8 weeks) . Food frequency survey and 24-hour dietary recall were used to investigate the dietary structure and nutritional intake at baseline and after intervention. Anthropometric indicators (BMI and waist-to-hip ratio) , blood lipids (triacylglycerol, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol) , glycemic control and hypertension control status at baseline and after intervention were compared.
A total of 59 cases were included in the study. Regarding dietary structure after intervention, the average daily intake of soy, nuts, pickled products, fried foods and salt significantly decreased in subjects, while that of fresh fruit, milk and dairy products increased significantly (P<0.05) . Regarding nutritional status, the daily average intake of fat and sodium was significantly reduced, while that of dietary fiber, calcium, potassium and magnesium was significantly increased (P<0.05) . The number of participants eating a diet with a recommended ratio of fat increased significantly (P<0.05) . Health monitoring showed that total cholesterol, low-density lipoprotein cholesterol, systolic blood pressure, diastolic blood pressure and 2-hour postprandial glucose were partially improved after intervention (P<0.05) . From the 4th week of the intervention, the control rate of 2-hour postprandial glucose at follow-up was significantly higher than the baseline level (P<0.05) , and it reached 69.5% at the end of the intervention. Except for the 2nd week of the intervention, the blood pressure control rate at follow-up was notably higher than the baseline level (P<0.05) , and it reached 67.8% at the end of the intervention.
Eating the Chinese-style DASH diet helps to promote the health in community-living hypertension patients with type 2 diabetes via effectively adjusting the inappropriate diet structure and improving the nutritional status.
As the pace of population aging accelerates, the estimated people aged≥65 years will account for more than 20% of the total population in China by 2030, among them those with disability will expand to 77 million, possessing more than 57% of the total disability population. Decline in the basic movement ability can lead to reduced quality of life, and increased burden on society and families.
To explore the correlation of basic movement ability with disability status in the elderly.
The study was carried out in March 2021. Data were collected from the database of China Health and Retirement Longitudinal Study (CHARLS) in 2015, involving 5 276 surveyees aged≥60 years with complete values of assessed basic movement ability and disability and key variables (gender, age, household location, education level) . The grip strength test, five-repetition sit-to-stand (FRSTS) test, standing balance test and gait speed test were used to evaluate the basic movement ability. Disability prevalence was evaluated by the Instrumental Activities of Daily Living (IADL) Scale. The grip strength level, gait speed, and prevalence of completion of standing balance test and FRSTS test were compared by the prevalence of disability. Logistic regression was used to analyze the correlation of basic movement ability and disability status.
The average grip strength value for all individuals was 27.92 (9.02) kg. The prevalence of poor, fair and good grip strength was 32.47% (1 713/5 276) , 33.55% (1 770/5 276) , and 33.98% (1 793/5 276) , respectively. 3 930 cases (74.49%) completed the standing balance test. 5 128 cases (97.19%) completed the FRSTS test. The average gait speed was 0.96 (3.12) m/s for all elderly persons. The prevalence of slow, moderate and fast gait speed was 33.17% (1 750/5 276) , 33.34% (1 759/5 276) , and 33.49% (1 767/5 276) , respectively. 1 419 cases (26.90%) were assessed with disabilities. The prevalence of disability varied significantly by grip strength, standing balance and FRSTS test performance, and gait speed (P<0.05) . Logistic regression results showed that, poor grip strength, inability to complete the standing balance test and the FRSTS test, and low gait speed were associated with increased risk of disability in both 60-74 years and ≥75 years age groups (P<0.05) . The inability to complete the FRSTS test was associated with 3.045 times higher risk of disability in the 60-74 age group, and 4.126 times higher risk of disability in the≥75 age group (P<0.05) .
The elderly with poor basic movement ability are prone to disability. In view of this, it is recommended to take measures to improve the basic movement ability of the elderly to delay the onset of disability or relieve the level of disability, thereby improving the quality of life and reducing the health care needs of them, and alleviating the caregiving burden of their family caregivers.
The number of migrant population in China remains high, primarily driven by the developments in industrialisation and urbanisation. The health status and healthcare-seeking experience of this group has become a hot social issue, and promoting their access to equitable essential healthcare services is an important part of China's healthcare system reform.
To compare the experience of using essential medical services between migrant and permanent populations in Guangzhou, to provide evidence for improving the level of using essential medical services in migrant population and for promoting the healthcare equity.
From September to November 2019, we used a multistage random sampling method to select 1 568 cases (including migrant and permanent residents) treated by six general practitioner teams from six community health centers in Guangzhou. Their demographics and experiences of using essential medical services were collected by a questionnaire survey using a self-developed General Data Questionnaire and the simplified Primary Care Assessment Tool-Adult Edition (PCAT-AE) . We compared the total score of the PCAT-AE and its domains scores between the two groups. We used the generalized linear model to analyze the association between the residency status and the experience of using essential medical services.
Altogether, 1 568 cases who handed in responsive questionnaires were included for final analysis, among whom 186 (11.86%) were migrant residents. The average total score of the PCAT-AE of all participants, permanent and migrant cases was 3.19 (1.22) , 3.24 (1.23) , and 2.93 (0.75) , respectively. Compared with the permanent residents, the migrants showed lower total score and dimension scores of the PCAT-AE (P<0.05) . The results of the generalized linear model demonstrated that compared with the permanent residents, migrants had worse experience in using services〔b (95%CI) =-0.128 (-0.218, -0.037) , P=0.006〕, such as the use of first-contact care〔b (95%CI) =-0.245 (-0.341, -0.148) , P<0.001〕, continuing care〔b (95%CI) =-0.175 (-0.292, -0.059) , P=0.003〕, family-centered care〔b (95%CI) =-0.112 (-0.225, 0.001) , P=0.050〕, community-oriented care〔b (95%CI) =-0.176 (-0.286, -0.066) , P=0.002〕, and culturally competent care〔b (95%CI) =-0.270 (-0.383, -0.156) , P<0.001〕.
The migrants had worse experience of using essential medical services than the permanent residents. In view of this, it is recommended for primary healthcare institutions to provide continuous, accessible, and comprehensive life-cycle essential healthcare services for migrants according to their characteristics, so as to promote the quality development of community health services.
The overall incidence of breast cancer in Chinese women is on the rise, seriously threatening their physical and mental health. Breast cancer prevention and treatment behaviors are critical to the outcomes of affected women in the community. However, these behaviors vary across individuals. And measures should be explored to improve the efficacy of such behaviors.
To perform a latent class analysis of breast cancer prevention and treatment behaviors among community-living women, and to explore the associated factors, providing evidence for individualized prevention and management of female breast cancer in the community.
A total of 1 355 community-living women were selected from in 15 towns/subdistricts of 5 counties/districts in Yinchuan and Zhongwei cities of Ningxia, China by use of convenience sampling method from November 2019 to August 2020. They were surveyed using a questionnaire consisting of baseline characteristics, and breast cancer prevention and treatment behaviors (relevant questions used are belonging to the part of breast cancer prevention and treatment in the Knowledge, Attitude and Practice of Breast and Cervical Cancer Prevention and Treatment Among Women in Ningxia) . The latent classes of breast cancer prevention and treatment behaviors were presented, and their influencing factors were identified by multivariable logistic regression analysis.
The survey achieved a response rate of 97.93% (1 327/1 355) .By use of latent class analysis, breast cancer prevention and treatment behaviors of the respondents were classified into four latent classes, including positive prevention and treatment (n=522, 39.34%) , high-risk behaviors plus positive treatment (n=449, 33.83%) , high-risk behaviors plus negative treatment (n=229, 17.26%) , and general prevention and treatment (n=127, 9.57%) . The overall median score of breast cancer prevention and treatment behaviors was 9.00 (7.00, 11.00) points for all respondents. The median score of breast cancer prevention and treatment behaviors was 11.00 (11.00, 12.00) points for respondents with positive prevention and treatment behaviors, 9.00 (8.00, 10.00) points for those with high-risk behaviors plus positive treatment behaviors, 6.00 (5.00, 6.00) points for those with high-risk behaviors plus negative treatment behaviors, and 8.00 (6.00, 9.00) points for those with general prevention and treatment behaviors, with significant difference across the groups (H=1 008.493, P<0.001) . Multivariable Logistic regression analysis showed that, compared with general prevention and treatment behaviors, living in Zhongwei and having a history of childbirth were associated with increased possibility of being classified into positive prevention and treatment behaviors, having health insurance〔urban resident basic medical insurance (URBMI) , commercial health insurance, or other types〕, self-pay treatment, and a history of hormone replacement therapy were associated with increased possibility of being classified into general prevention and treatment behaviors (P<0.05) , having a history of childbirth were associated with increased possibility of being classified into high-risk behaviors plus positive treatment behaviors, having health insurance (URBMI or commercial health insurance) , as well as a history of hormone replacement therapy were associated with increased possibility of being classified into general prevention and treatment behaviors (P<0.05) , and primary education or below, household monthly income per person of 1 000-2 999 yuan were associated with increased possibility of being classified into high-risk behaviors plus negative treatment behaviors, and having URBMI were associated with increased possibility of being classified into general prevention and treatment behaviors (P<0.05) .
In general, breast cancer prevention and treatment behaviors in this group could be definitely classified, all being performed at a moderate level. To improve the level of breast cancer prevention and treatment behaviors of Ningxia's community-living women, focus should be on those who have high-risk behaviors and negatively seek for treatment. Moreover, the problems in positive breast cancer prevention and treatment behaviors in women with other three classes of behaviors should also be intervened and corrected to improve the outcomes of them.
Functional constipation (FC) is highly prevalent with complex associated factors in children, posing great health risk to the affected children. So far, the results of studies on the prevalence of FC and its influencing factors vary widely, and those focusing on FC in urban children in China are relatively few.
The purpose was to investigate the prevalence and influencing factors of FC in children in urban communities, so as to provide data support for establishing a database of FC in children in the community and for carrying out standardized, multidisciplinary and continuous management of FC in children in the community.
Children aged 6 to 48 months who were registered as recipients of health services delivered by Yuetan Community Health Center, Beijing were selected from the Beijing Maternal and Child Healthcare Information System (Phase 2) during the period from April to July 2021. A questionnaire designed by our research group was used to survey the primary guardians of the included children, focusing on questions related to defecation habits prepared according to the RomeⅣ criteria for FC in the Childhood Functional Gastrointestinal Disorders: Neonate/Toddler issued in 2016, and factors possibly influencing FC including history of allergies, family history of constipation, mode of delivery, feeding practices, appetite, eating habits, daily water intake, frequency of physical activity, and family parenting practices. In total, 1 458 guardians attended the survey, and children of the 1 264 (86.69%) guardians who handed in responsive questionnaires were finally included for analysis.
The overall prevalence of FC was 9.89% (125/1 264) . Specifically, the prevalence of FC in age groups of 6 to 12, 13 to 36, and 37 to 48 months was 10.39% (16/154) , 8.75% (69/789) , and 12.46% (40/321) , respectively, demonstrating no significant difference in FC prevalence by age group (P>0.05) . The results of multivariate Logistic regression analysis showed that allergy history and feeding practices were influential factors for FC in 6-12-month-old children (P<0.05) , allergy history, feeding practices and parenting style were influential factors for FC in 13-36-month-old children (P<0.05) , and allergy history and parenting style were influential factors for FC in 37-48-month-old children (P<0.05) .
The prevalence of FC in 6-48-month-old children in urban communities is high, which is associated with multiple preventable and controllable factors, suggesting that the prevention of FC in this age group of children should be carried out in accordance with individual factors, family relationship, and social environment.
The status of patients with HIV/AIDS co-infected with HCV considerably varies in different parts of China. The co-infection of HIV and HCV accelerates the clinical progress of the disease, thereby reducing the patients' quality of life and exacerbating the occurrence of death. Currently, there are relatively few studies on patients with HIV/AIDS co-infected with HCV in Guizhou.
To analyze the status of patients with HIV/AIDS co-infected with HCV in Guizhou and its influencing factors and consequently provide basis for its early detection, diagnosis, and treatment.
The cases included in this study were a cohort of HIV/AIDS patients who received antiviral therapy (ART) in the public health rescue center of Guangzhou from March 2006 to December 2020. Finally, 3 084 patients who met the study requirements were included. Patients' sex, age, ethnicity, education level, occupation, marital status, route of infection, year of diagnosis, and CD4+ T-lymphocytes before ART and anti HCV levels were collected. Multivariate Logistic regression model were used to identify influencing factors of patients with HIV/AIDS co-infected with HCV.
Among the 3 084 patients with HIV/AIDS, 202 were co-infected with HCV, and the co-infection rate was 6.55%. There were significant differences in HCV infection rates among patients with HIV/AIDS of different age groups, education levels, occupations, route of infection (P<0.05) . There were no significant differences in HCV infection rates among patients with HIV/AIDS by gender, ethnicity, and marital status (P>0.05) . The prevalence of HCV infection among HIV/AIDS patients tended to decrease with increasing year of diagnosis and increasing levels of CD4+ T lymphocytes (P<0.05) . Multivariate Logistic regression analysis showed that the risk of HCV infection was higher among HIV/AIDS patients aged 30-39 and 40-49 years than among those ≥50 years〔OR (95%CI) =2.512 (1.374, 4.593) , 2.802 (1.521, 5.163) , respectively〕, and the risk of HCV infection was higher among HIV/AIDS farmers than among those in other occupations〔OR (95%CI) =1.926 (1.201, 3.090) 〕. Route of infection of intravenous drug user was higher for HIV/AIDS patients with HCV infection than for MSM〔OR (95%CI) =39.038 (17.559, 86.790) 〕, and for HIV / AIDS patients diagnosed 2006—2010, 2011—2015, the risk of HCV infection was higher than that for those diagnosed 2016—2020〔OR (95%CI) =10.890 (6.428, 18.447) , 4.613 (2.928, 7.269) , respectively〕. Those with baseline CD4+ T lymphocytes <200, 200-350, 351-499/μl had higher risk of HCV infection among HIV/AIDS patients than those with baseline CD4+ T lymphocytes≥500/μl, respectively〔OR (95%CI) =7.120 (3.731, 13.589) , 3.614 (1.818, 7.184) , 2.795 (1.319, 5.922) 〕.
Although the strategy of "exhaustive treatment" for HIV/AIDS has decreased HCV infection rates among patients with HIV/AIDS in Guizhou, the status still need to be carefully monitored. Early HCV screening should be conducted for the HIV/AIDS population, focusing on individuals aged 30-49 years, intravenous drug users, farmers, and those with low CD4+ T-lymphocyte levels.
