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.
