Altitude and metabolic syndrome in China: Beneficial effects of healthy diet and physical activity.

Background: The correlation between altitude and metabolic syndrome has not been extensively studied, and the mediation effects of diet and physical activity remain unclear. We evaluated the cross-sectional correlations between altitude and metabolic syndrome and the possible mediation effects of diet and physical activity in China. Methods: We included 89 485 participants from the China Multi-Ethnic Cohort. We extracted their altitude information from their residential addresses and determined if they had metabolic syndrome by the presence of three or more of the following components: abdominal obesity, reduced high-density lipoprotein cholesterol (HDL-C), elevated triglycerides, elevated glucose, and high blood pressure at recruitment. We conducted multivariable logistic regression and mediation analyses for all and separately for Han ethnic participants. Results: The participants had a mean age of 51.67 years and 60.56% were female. The risk difference of metabolic syndrome was -3.54% (95% confidence interval (CI) = -4.24, -2.86) between middle and low altitudes, -1.53% (95%CI = -2.53, -0.46) between high and low altitudes, and 2.01% (95% CI = 0.92, 3.09) between high and middle altitudes. Of the total estimated effect between middle and low altitude, the effect mediated by increased physical activity was -0.94% (95% CI = -1.04, -0.86). Compared to low altitude, the effects mediated by a healthier diet were -0.40% (95% CI = -0.47, -0.32) for middle altitude and -0.72% (95% CI = -0.87, -0.58) for high altitude. Estimates were similar in the Han ethnic group. Conclusions: Living at middle and high altitudes was significantly associated with lower risk of metabolic syndrome compared to low altitude, with middle altitude having the lowest risk. We found mediation effects of diet and physical activity.

Comorbid Depressive and Anxiety Symptoms and Their Correlates Among 93,078 Multiethnic Adults in Southwest China.

Background: Depressive symptoms and anxiety symptoms commonly coexist and severely increases the disease burden worldwide. Little is known about the patterns and correlates of comorbid depressive and anxiety symptoms among the multiethnic populations of China. Methods: This population-based study investigated the comprehensive associations of comorbid depressive and anxiety symptoms with lifestyles, stressful life events, chronic diseases, and physical and mental well-being among 93,078 participants (37,193 men, 55,885 women) aged 30-79 years across seven ethnic groups in Southwest China. Multivariable logistic regression models were used to estimate associations. Results: Overall, 2.9% (2.1% in men and 3.5% in women) participants had comorbid depressive and anxiety symptoms; there was considerable heterogeneity among multiethnic populations. Participants with chronic diseases were more likely to have comorbidity than those without them; people with rheumatic heart disease reported the highest risk, with an odds ratio (OR) of 6.25 and 95% confidence interval (CI) of 4.06-9.62. Having experienced 3 or more stressful life events (OR, 8.43, 95% CI: 7.27-9.77), very poor self-rated health status (OR, 33.60, 95%CI: 25.16-44.87), and very unsatisfied life (OR, 33.30, 95% CI: 23.73-46.74) had strong positive associations with comorbid depressive symptoms and anxiety symptoms, with a dose-response relationship (P < 0.05). High frequency of physical activity had negative associations. All the associations were stronger than depressive symptoms alone or anxiety symptoms alone. Conclusions: Our findings emphasize the need to focus on the vulnerable ethnic groups with comorbid depressive and anxiety symptoms, ultimate for help early prevention and improvement of health equity in the underdevelopment and high urbanization areas.

The Injuries and Helmet Use in Bike Share Programs: A Systematic Review.

To investigate the injury effects of bike share programs and the helmet usage status in bike share programs. We conducted a systematic review of peer reviewed scientific literature. Searches were conducted in three databases (Pubmed, Scopus, and Web of Science) on March 1 2020 to identify all articles on the injury incidence related to bike share programs and the helmet usage status in bike share programs. Titles, abstracts, and full-text articles were screened to identify all articles relevant to the themes by two authors independently, and discrepancies were resolved after discussion with the third author. Standardised data extraction and quality assessment (The Newcastle-Ottawa Scale) were implemented. A sum of 491 records after removing duplicates was identified, 181 fulltext articles were screened, and 13 studies were included in the review. The primary outcome are injuries of bike share users and unhelmeted rate among bike share users as well as the unhelmeted rate among personal bike users. Two studies evaluated the injuries related to bike share users, but have inconclusive results. A total of 11 studies reported the unhelmeted rates in bike share programs ranging from 36.0 to 88.9%. There is a significant change in bike injuries with the implementation of bike share programs. Moreover, the unhelmeted rate of bike share users was generally higher than that of personal bike users, which may result from helmets' accessibility and users' safety perception.

Association between self-reported snoring and hypertension among Chinese Han population aged 30-79 in Chongqing, China.

BACKGROUND: We aim to explore the association between self-reported snoring and hypertension among adults aged 30-79 in Chongqing, China. METHODS: A total of 23,342 individuals aged 30-79 were included at baseline from August 2018 to January 2019, and the final sample size for the analysis was 22,423. Face-to-face interviews and physical examinations were conducted by trained investigators. Logistic regression was performed to study age-specific and gender-specific associations between snoring and hypertension. RESULTS: Frequent snoring was associated with the risk of hypertension for each age and gender group, and the frequency of snoring was positively correlated with the risk for hypertension. For the three age groups (< 45, 45-59, ≥ 60), compared with the non-snoring group, those who snore often had a 64.5%, 53.3%, and 24.5% increased risk of hypertension (< 45: OR = 1.65, 95%CI 1.34-2.02; 45-59: OR = 1.53, 95%CI 1.37-1.72; ≥ 60: OR = 1.25, 95%CI 1.09-1.42), respectively. For men and women, those who snore often had a 46.8% and 97.2% increased risk of hypertension, respectively, than the non-snoring group (men: OR = 1.47, 95%CI 1.33-1.63; women: OR = 1.97, 95%CI 1.75-2.23). CONCLUSIONS: People who snore frequently should pay close attention to their blood pressure levels in order to achieve early prevention of hypertension, particularly for snorers who are female and aged under 45; importance should be attached to their blood pressure control.

Variants in the PSCA gene associated with risk of cancer and nonneoplastic diseases: systematic research synopsis, meta-analysis and epidemiological evidence.

Variants in the prostate stem cell antigen (PSCA) gene have been linked with risk of multiple cancers and other diseases. But results have been inconclusive and no systematic research synopsis has been available. We did a comprehensive meta-analysis to investigate associations between variants in this gene and risk of nine cancers and four nonneoplastic diseases based on data from 55 publications including 81 961 cases and 442 932 controls. We graded levels of cumulative epidemiological evidence of a significant association using the Venice criteria and false-positive report probability tests. We performed functional annotation for these variants using data from the Encyclopedia of DNA Elements Project and other public databases. We found that six variants were nominally significantly associated with an increased or reduced risk of three cancers and three nonneoplastic diseases (P < 0.05). Cumulative evidence of an association was graded as strong for rs2294008 [odds ratio (OR) = 1.32, P = 5.1 × 10-33], rs2976392 (OR = 1.29, P = 1.8 × 10-8), rs9297976 (OR = 0.75, P = 1.4 × 10-7), rs2976391 (OR = 1.38, P = 6.1 × 10-5) and rs138377917 (OR = 0.53, P = 0.008) with gastric cancer, rs2294008 with bladder cancer (OR = 1.15, P = 8.0 × 10-19), gastritis (OR = 1.35, P = 1.2 × 10-5), duodenal ulcer (OR = 0.68, P = 2.4 × 10-57) and gastric ulcer (OR = 0.88, P = 1.7 × 10-7). Data from the Encyclopedia of DNA Elements Project and other databases showed that these variants and other variants correlated with them might fall in putative functional regions. In conclusion, this study provides summary evidence that variants in the PSCA gene are associated with risk of gastric and bladder cancer, gastritis, as well as duodenal and gastric ulcer and highlights the significant role of this gene in the pathogenesis of these diseases.

[Analysis of health self-management for diabetes self-efficacy].

OBJECTIVE: To evaluate the effect of health self-management on self-efficiency of diabetes patients.
 METHODS: A total of 184 eligible and voluntary diabetes patients were recruited for 6 consecutive weeks of knowledge and skills intervention, and interviewed with questionnaire by diabetes self-efficacy scale (DSES) before and after the intervention. The changes in self-efficiency were compared with two paired sample McNemar test.
 RESULTS: After the intervention, the total scores of self-efficiency on diet, medication, blood sugar monitoring, foot care and complications management were all increased significantly compared with those before the intervention (P<0.05).
 CONCLUSION: The intervention model of health self-management for self-efficiency in diabetes patients is effective, and the quality of patients' life can be improved.

[Impact of health educators' intervention on non-communicable diseases-related knowledge, attitude and behavior among rural residents].

OBJECTIVE: To evaluate the impact of health educators' intervention on knowledge, attitude and behavior among rural residents and the feasibility of this intervention mode. METHODS: Using stratified cluster random sampling method, three towns and five villages in Yongchuan district, Chongqing municipality were selected from February to November, 2013. One or two health educators from each village were recruited by recommendation or voluntary registration. A total of 30 health educators were recruited and trained. Health educators who passed the exam of the training conducted the intervention and training of knowledge and skill about non-communicable disease (NCD) prevention and control for over 30 rural residents who lived nearby aged over 18 years old, could take care of themselves and complete questionnaire independently. 900 residents were selected as the study samples before and after the intervention. Questionnaire surveys were conducted before and after the intervention to evaluate the effect. Changes of knowledge and behavior among participants were compared by Chi-square test. Changes of attitude towards NCD prevention and control among participants were compared by two independent t-test. RESULTS: Before and after the intervention, the cognition rate about diagnostic criteria of hypertension among rural adults was 29.8% (268/900) and 67.9% (611/900), respectively(χ(2)=261.58, P<0.001). The cognition rate about risk factors of hypertension was 22.9% (206/900) and 78.2% (704/900), respectively(χ(2)=551.19, P<0.001). The cognition rate about the prevention measure of hypertension was 37.2% (335/900) and 88.0% (792/900) , respectively(χ(2)=495.64, P<0.001). The cognition rate about complications of hypertension was 15.4% (139/900) and 68.9% (620/900), respectively(χ(2)=527.07, P<0.001). The cognition rate about diagnostic criteria of diabetes was 12.9% (116/900) and 50.3% (453/900), respectively(χ(2)=291.85, P<0.001). The cognition rate about the criteria of risk population of diabetes was 8.6% (77/900) and 62.0% (558/900), respectively(χ(2)=562.94, P<0.001). The cognition rate about the symptom of diabetes was 29.8% (268/900) and 83.3% (750/900), respectively(χ(2)=525.31, P<0.001). The cognition about the preventive measure of diabetes was 44.7% (402/900) and 89.3% (804/900), respectively(χ(2)=406.06, P<0.001). The cognition rate about 6 g salt intake per person per day among rural adults was 28.0% (252/900) and 84.3% (759/900), respectively(χ(2)=580.04, P<0.001). The cognition about 25 g oil intake per person per day among rural adults was 26.7% (240/900) and 71.4% (643/900), respectively(χ(2)=361.04, P<0.001). The cognition about self-perception of body weight among rural adults was 62.9% (566/900) and 91.9% (827/900), respectively (χ(2)=216.28, P<0.001). The cognition about self-circumference among rural adult was 54.8% (493/900) and 87.7% (789/900), respectively(χ(2)=237.49, P<0.001). The cognition rate of self-blood pressure was 60.5% (544/900) and 70.4% (634/900), respectively(χ(2)=14.92, P<0.001). Before and after the intervention, the scores of the necessity about conducting health education for the public among rural adults was (3.1±0.9 ) and (3.7±0.5 ), respectively(t=20.09, P<0.001). The score of the necessity about unhealthy lifestyle change among rural adults was (3.0±0.9 ) and (3.7±0.6), respectively(t=20.84, P<0.001). The score of the necessity about testing blood pressure and blood glucose regularly among rural adults was (3.0±0.9) and (3.7±0.6), respectively(t=21.07, P<0.001). The score of the necessity about body weight control was (2.9±1.0) and (3.6± 0.8), respectively(t=20.04, P<0.001). The score of the necessity about conducting hypertension screen among high risk population was (3.0±0.9) and (3.7±0.5), respectively(t=22.99, P<0.001). The score of the necessity about conducting diabetes screen among high risk population was (3.0 ± 0.9) and (3.7 ± 0.5), respectively(t=23.22, P<0.001). The score of the necessity about providing instruction service of diet and physical activity for high risk population was (3.0±0.9) and (3.7±0.5), respectively(t=22.41 and 22.87, P< 0.001). Before and after the intervention, the proportion of rural adults seeking counseling service about NCD was 44.0% (396/900) and 64.9% (584/900), respectively(χ(2)=79.17, P<0.001). The proportion of rural adults testing blood pressure in the recent six months was 43.4% (391/900) and 63.1% (568/900), respectively(χ(2)=69.92, P<0.001). The proportion of rural adults who tested blood glucose in the recent six months was 28.6%(257/900) and 48.1% (433/900), respectively(χ(2)=72.80,P<0.001). The proportion of rural adults who controlled body weight consciously was 34.7%(312/900) and 29.3% (264/900), respectively(χ(2)= 5.88,P<0.05). CONCLUSION: Health educators' intervention could raise rural participants' awareness and confidence about NCD significantly, but this intervention mode might have little impact on healthy behaviors change in a short time.

[Cross-section survey on smoking behavior and cognition in Chongqing, 2014].

OBJECTIVE: To investigate the prevalence of smoking, smoking cessation, passive smoking and awareness of the dangers of tobacco in population in Chongqing and provide evidence for developing prevention and control measures. METHODS: A total of 5 400 residents aged ≥18 years were selected from 9 districts/counties in Chongqing through stratified multi-stage cluster sampling and face-to-face interviews were conducted among them. Indicators as current smoking rates, smoking cessation rates and passive smoking rates were calculated by the weight of age proportions from 2010 population census. The analytical method was based on complex sampling design. RESULTS: The current smoking rate of the residents aged ≥18 years was 27.4% (male: 53.5% and female: 1.1%), which was highest in age group 40-50 years (58.4%) for males. The current smoking rate among rural residents was higher than that in urban residents. The prevalence of daily cigarette smoking was 27.5%, which was significantly higher in southeastern Chongqing. The rate of passive smoking was 52.4%. Among daily smokers, the mean number of cigarettes smoked was 17.5 per day (men: 17.6 per day; women: 13.5 per day). The daily smoked cigarette number in males was higher in age group 40-50 years (20.1 per day) and those with junior middle school education level (18.9 per day). The proportion of the current smokers who smoked more than 20 cigarettes per day (the rate of heavy smoker) was higher in males than in females and in rural residents than in urban residents. The proportion of heavy smokers was 59.3%, which was highest in age group 40-50 years (66.8%), followed by those with junior middle school educational level (65.2%). The average age of smokers when they stared to smoke was 20.8 years old, which was low in males and rural residents. About 80.2% of the smokers stared to smoke under 25 years old, and 70.3% of the smokers stared to smoke between 15 and 25 years old. The overall rate of smoking cessation was 20.1% and the successful smoking cessation rate was 13.7%. The two rates increased with age, the successful smoking cessation rate was lowest in age group 18-40 years (4.8%). The awareness of the tobacco risk related knowledge seemed poor among the residents, only 19.6% of the residents were aware that smoking could cause serious diseases (stoke, heart disease and lung cancer). 21.9% of the residents were aware that passive smoking could cause serious diseases (heart disease, lung disease and lung cancer). CONCLUSION: Current prevalence of smoking in males in Chongqing remains at a high level, indicating that the publicity programs on the tobacco risk related knowledge needs to be strengthened and the tobacco control needs more efforts. The tobacco control in Chongqing is still facing serious challenge.

[Application of multilevel models in the evaluation of bioequivalence (II).].

The main purpose of this paper is to explore the applicability of multivariate multilevel models for bioequivalence evaluation. Using an example of a 4 x 4 cross-over test design in evaluating bioequivalence of homemade and imported rosiglitazone maleate tablets, this paper illustrated the multivariate-model-based method for partitioning total variances of ln(AUC) and ln(C(max)) in the framework of multilevel models. It examined the feasibility of multivariate multilevel models in directly evaluating average bioequivalence (ABE), population bioequivalence (PBE) and individual bioequivalence (IBE). Taking into account the correlation between ln(AUC) and ln(C(max)) of rosiglitazone maleate tablets, the proposed models suggested no statistical difference between the two effect measures in their ABE bioequivalence via joint tests, whilst a contradictive conclusion was derived based on univariate multilevel models. Furthermore, the PBE and IBE for both ln(AUC) and ln(C(max)) of the two types of tablets were assessed with no statistical difference based on estimates of variance components from the proposed models. Multivariate multilevel models could be used to analyze bioequivalence of multiple effect measures simultaneously and they provided a new way of statistical analysis to evaluate bioequivalence.

[Applying multilevel models in evaluation of bioequivalence (I)].

This study aims to explore the application value of multilevel models for bioequivalence evaluation. Using a real example of 2 x 4 cross-over experimental design in evaluating bioequivalence of antihypertensive drug, this paper explores complex variance components corresponding to criteria statistics in existing methods recommended by FDA but obtained in multilevel models analysis. Results are compared with those from FDA standard Method of Moments, specifically on the feasibility and applicability of multilevel models in directly assessing the bioequivalence (ABE), the population bioequivalence (PBE) and the individual bioequivalence (IBE). When measuring ln (AUC), results from all variance components of the test and reference groups such as total variance (sigma(TT)(2) and sigma(TR)(2)), between-subject variance (sigma(BT)(2) and sigma(BR)(2)) and within-subject variance (sigma(WT)(2) and sigma(WR)(2)) estimated by simple 2-level models are very close to those that using the FDA Method of Moments. In practice, bioequivalence evaluation can be carried out directly by multilevel models, or by FDA criteria, based on variance components estimated from multilevel models. Both approaches produce consistent results. Multilevel models can be used to evaluate bioequivalence in cross-over test design. Compared to FDA methods, this one is more flexible in decomposing total variance into sub components in order to evaluate the ABE, PBE and IBE. Multilevel model provides a new way into the practice of bioequivalence evaluation.