Elevated remnant cholesterol was associated with the increased metabolically unhealthy obesity risk in Chinese youth.

BACKGROUND AND OBJECTIVES: Metabolically unhealthy obesity is characterized by the presence of cardiovascular metabolic risks such as hypertension, dyslipidemia, and hyperglycemia. Research has shown a correlation between remnant cholesterol (RC) concentrations and abdominal obesity in children. However, the effect of RC concentration on metabolically unhealthy obesity remains unclear. METHODS AND STUDY DESIGN: This study included 3114 Chinese adolescents who received health check-ups. We used logistic regression models and receiver operating characteristic analysis to evaluate the correlation between RC concentration and metabolically unhealthy obesity in a cross-sectional design. RESULTS: After controlling for possible confounding variables, we found that individuals in the top and fourth quintiles of RC concentrations had a significantly higher likelihood of developing metabolically unhealthy obesity compared to those in the bottom quintile (ORs, 4.810 and 1.836; 95% CIs, 3.209-7.212 and 1.167-2.890, respectively). The risk of metabolically unhealthy obesity tended to increase with RC concentration (ptrend<0.001). In addition, boys showed positive associations between RC concentration and both BMI (r = 0.305, p<0.001) and waist circumference (r = 0.306, p<0.001). According to the analysis, the predictive accuracy of metabolically unhealthy obesity was 0.736 (95% CI, 0.690-0.781) for boys and 0.630 (95% CI, 0.573-0.687) for girls. The ideal prediction threshold was 0.66 for boys and 0.59 for girls. CONCLUSIONS: Our findings indicate that elevated RC concen-tration is linked to a higher likelihood of developing metabolically unhealthy obesity in young individuals, regardless of other known risk factors.

Associations of CKIP-1 and LOX-1 polymorphisms with the risk of type 2 diabetes mellitus with hypertension among Chinese adults.

AIMS: Type 2 diabetes mellitus (T2DM) and hypertension are common high-incidence diseases, closely related, and have common pathogenic basis such as oxidative stress. Casein kinase 2 interacting protein-1 (CKIP-1) and low-density lipoprotein receptor (LOX-1) are considered to be important factors affect the level of oxidative stress in the body. The main purpose of this study was to explore the relationship between CKIP-1 (rs6693817 A > T, rs2306235 C > G) and LOX-1 (rs1050283 G > A, rs11053646 C > G) polymorphisms and the risk of hypertension and diabetes, and try to find new candidate genes for diabetes and diabetes with hypertension etiology in Chinese population. METHODS: 574 T2DM patients and 597 controls frequently matched by age and sex were selected for genotyping of CKIP-1 (rs6693817 A > T, rs2306235 C > G) and LOX-1 gene (rs1050283 G > A, rs11053646 C > G). Logistic regression was used to analyze the correlation between different genotypes and the risk of T2DM and T2DM with hypertension, and the results were expressed as odds ratio (OR) and 95% confidence interval (95% CI). RESULTS: We found that the risk of T2DM in the AA + AT genotype of rs6693817 was higher than that in the TT genotype in Chinese population (OR = 1.318, 95%CI: 1.011-1.717, P = 0.041), and the difference was still significant after adjustment (OR = 1.370, 95%CI: 1.043-1.799, Padjusted = 0.024), the difference of heterozygotes (AT vs TT: OR = 1.374, 95%CI: 1.026-1.840, Padjusted = 0.033) was statistically significant. But after Bonferroni correction, the significance of the above sites disappeared. And rs6693817 was associated with the risk of T2DM combined with hypertension before and after adjustment in dominant model (OR = 1.424, 95% CI: 1.038-1.954, P = 0.028; OR = 1.460, 95% CI: 1.057-2.015, Padjusted = 0.021, respectively) and in heterozygote model (OR = 1.499, 95% CI: 1.069-2.102, P = 0.019; OR = 1.562, 95% CI: 1.106-2.207, Padjusted = 0.011, respectively). However, only the statistical significance of the heterozygous model remained after Bonferroni correction. rs2306235, rs1050283 and rs11053646 were not significantly correlated with T2DM and T2DM combined with hypertension risk (P > 0.05). CONCLUSIONS: The results suggest that CKIP-1 rs6693817 is related to the susceptibility of Chinese people to T2DM with hypertension, providing a new genetic target for the treatment of diabetes with hypertension with in the future.

Association between the MCP-1 -2518 A > G (rs1024611) polymorphism and susceptibility to type 2 diabetes mellitus and diabetic nephropathy: a meta-analysis.

BACKGROUND: Studies evaluating the association between monocyte chemoattractant protein-1 (MCP-1) -2518 A > G (rs1024611) polymorphism and type 2 diabetes mellitus (T2DM) and diabetic nephropathy (DN) are contradictory. The present study aims to provide a comprehensive assessment and more reliable estimation of the relationship between the MCP-1 rs1024611 polymorphism and T2DM and DN risk. METHODS: Eligible articles were retrieved from the PubMed, Web of Science, EMBASE, Cochrane, and China National Knowledge Infrastructure databases. The effect summary odds ratios (ORs) and 95% confidence intervals (CIs) were obtained to calculate the summary effect size. Heterogeneity was analyzed by subgroup analysis and meta-regression. Publication bias was tested using funnel plots and Egger's test. RESULTS: In total, sixteen studies were included. Thirteen studies involving 2,363 patients with T2DM and 4,650 healthy controls found no significant association between the MCP-1 rs1024611 polymorphism and T2DM in the overall population. Ethnicity stratification found an association between the GG + GA genotype and decreased T2DM risk in Caucasians (OR = 0.79, 95% CI: 0.66-0.93, P = 0.006; PQ = 0.372). No significant risks were found in the Asian population for any genetic models. Seven studies found an association between the GG + GA genotype and DN risk in the Asian population (OR = 1.37, 95% CI: 1.11-1.71, P = 0.004, PQ = 0.222). No significant risks were found in the Caucasian population with any genetic models. There were no statistically significant differences in genotype distribution between patients with T2DM and DN in Asians or Caucasians. Meta-regression revealed that genotyping method was a major driver of heterogeneity in five genetic models (GG + GA vs. AA: P = 0.032; GG vs. GA + AA: P = 0.028; GG vs. AA: P = 0.035; GG vs. GA: P = 0.041; G vs. A: P = 0.041). CONCLUSION: The MCP-1 rs1024611 polymorphism is associated with susceptibility to T2DM in Caucasians and DN in Asians. Larger, well-designed cohort studies are needed in the future to verify this association.

Frailty and medication adherence among older adult patients with hypertension: a moderated mediation model.

Objective: Medication adherence has a critical impact on the well-being of older adult patients with hypertension. As such, the current study aimed to investigate the mediating role of health literacy between frailty and medication adherence and the moderating role of educational level. Methods: This cross-sectional study included patients admitted to the geriatric unit of a hospital. Participants were interviewed using the four-item Morisky Medication Adherence Scale, the Frailty Phenotype Scale, and the Health Literacy Management Scale. Spearman's correlation coefficients were used to assess the association between variables. Mediation and moderated mediation analyses were performed using Process version 4.1 via Model 4 and 14, respectively. Results: Data from 388 participants were analyzed. The median (IQR [P25-P75]) score for medication adherence was 4.00 (2.00-4.00). Results revealed that after controlling for age, sex, hypertension complication(s) and body mass index, frailty significantly contributed to medication adherence (ßtotal -0.236 [95% confidence interval (CI) -0.333 to -0.140]). Medication adherence was influenced by frailty (ßdirect -0.192 [95% CI -0.284 to -0.099]) both directly and indirectly through health literacy (ßindirect -0.044 [95% CI -0.077 to -0.014]). Educational level moderated the pathway mediated by health literacy; more specifically, the conditional indirect effect between frailty and medication adherence was significant among older adult hypertensive patients with low, intermediate, and high educational levels (effect -0.052 [95% CI -0.092 to -0.106]; effect -0.041 [95% CI -0.071 to -0.012]; effect -0.026 [95% CI -0.051 to -0.006]). The relationship between frailty and medication adherence in older adult patients with hypertension was found to have mediating and moderating effects. Conclusion: A moderated mediation model was proposed to investigate the effect of frailty on medication adherence. It was effective in strengthening medication adherence by improving health literacy and reducing frailty. More attention needs to be devoted to older adult patients with hypertension and low educational levels.

Chronotypes and their association with sleep quality among Chinese college students of Anhui Province: a cross-sectional study.

OBJECTIVES: To describe the prevalence of chronotype and sleep quality among Chinese college students and explore the relationship between chronotype and sleep quality. DESIGN: A cross-sectional study. SETTING: Four colleges and universities in Anhui, China, between November and December 2020. PARTICIPANTS: A total of 4768 college students were recruited using a stratified, multistage, cluster sampling survey. OUTCOME MEASURES: Morningness-Eveningness Questionnaire 19 was used to determine the chronotype of the students and the Pittsburgh Sleep Quality Index (PSQI) was used to measure their sleep quality. The multiple logistic regression model was used to explore the potential association between chronotype and sleep quality. RESULTS: The self-reported proportions of evening-type (E-type), neutral-type and morning-type among college students were 51.17%, 45.14% and 3.69%, respectively. The mean PSQI score was 4.97±2.82 and the prevalence of poor sleep quality was 18.2%. After adjusting the covariates by multiple logistic regression analysis, E-type was positively associated with subjective sleep quality (OR=1.671, 95% CI 1.414 to 1.975), sleep latency (OR=1.436, 95% CI 1.252 to 1.647), sleep duration (OR=2.149, 95% CI 1.506 to 3.067), habitual sleep efficiency (OR=1.702, 95% CI 1.329 to 2.180), daytime dysfunction (OR=1.602, 95% CI 1.412 to 1.818) and overall poor sleep quality (OR=1.866, 95% CI 1.586 to 2.196). CONCLUSIONS: College students mainly exhibited E-type, and an elevated prevalence of poor sleep quality existed among these students. The E-type was positively associated with poor sleep quality.

OLDER FARMERS OR ILLITERATE OLDER ADULTS ARE MORE LIKELY TO FALL：A COMMUNITY-BASED STUDY FROM CHINA.

The aim of this study was to determine the incidence of falls and its risk factors among community-dwelling older adults in a community from Wuhu city (China). This cross-sectional study recruited 1075 older adults. The history of injury history was assessed in the last year. Descriptive statistics was used for distribution of injury. Risk factors of falls were measured using logistic regression analysis. The results showed that the prevalence of falls in the last year was 8.47%. According to the results, farmer and illiteracy older adults were found as risk factors for falls. In our study, falls were the highest incidence of injury among community-dwelling older adults, farmer and illiteracy older adults were high risk population of falls. Therefore, farmers and illiteracy older adults should be addressed when prevention of falls among community-dwelling older adults.

Preoperative Ultrasound-Guided Internal Branch Block of Superior Laryngeal Nerve Reduces Postoperative Sore Throat Caused by Double Lumen Endotracheal Intubation: A Randomized Trial.

BACKGROUND: Postoperative sore throat (POST) is one of the more common side effects of tracheal intubation patients under general anesthesia (GA) after extubation using double-lumen endobronchial tubes (DLTs). The internal branches of the superior laryngeal nerve (SLN) block (iSLNB) have been reported to anesthetize the larynx for airway manipulation (such as awake tracheal intubation) and pain treatment efficiently. We hypothesized that ultrasound-guided iSLNB (US-guided iSLNB) combined with GA would ameliorate the incidence and severity of POST and hoarseness. METHODS: Patients (n = 82) undergoing thoracoscopic resection of pulmonary nodules/lobes/segments with one-lung ventilation (OLV) under GA were randomized into 2 groups depending on whether performed with iSLNB (S group, n = 41) or not (C group, n = 41) under GA. Patients in the S group received US-guided iSLNB bilaterally before surgery. POST and hoarseness were assessed at 2, 6, and 24 hours after surgery. The primary outcome of this study was the incidence of POST at 6 hours after surgery between groups. RESULTS: The overall accumulated incidence of POST was lower in the S goup than in the C group (9/41 vs 20/41; 95% CI, 0.30 [0.11-0.77]; P = .011). The incidence and severity of POST was lower in the S group than in the C group at 2 hours (9/41 vs 20/41; 95% CI, 0.30 [0.11-0.77]; P = .008 and P = .004) and 6 hours after (7/41 vs 17/41; 95% CI, 0.29 [0.10-0.81]; P = .012 and P = .015) surgery. The incidence and severity of POST at 24 hours after surgery was nonsignificant. However, the incidence and severity of hoarseness was comparable between the 2 groups at 2, 6, and 24 hours after surgery. CONCLUSIONS: Preoperative US-guided iSLNB could significantly ameliorate the incidence and severity of POST induced by double-lumen bronchial catheter intubation.

The mediating role of coping strategies between depression and social support and the moderating effect of the parent-child relationship in college students returning to school: During the period of the regular prevention and control of COVID-19.

Objective: According to the WHO, compared to before the COVID-19 pandemic, young people showed a significant increase in depressive symptoms. In light of the recent coronavirus pneumonia pandemic, this study was conducted to determine how social support, coping style, parent-child relationships, and depression are associated. We investigated how these factors interacted and affected the prevalence of depression during this challenging and unheard-of time. Our research may help both individuals and healthcare professionals better comprehend and assist those who are coping with the pandemic's psychological effects. Design and main outcome measures: 3,763 students from a medical college in Anhui Province were investigated with Social Support Rate Scale, Trait Coping Style Questionnaire, and Self-rating Depression Scale. Results: When the pandemic situation was normalizing, social support was associated with depression and the coping style of college students (p < 0.01). During the period of pandemic normalization, the parent-child relationship moderated the relationship between social support and positive coping (t = -2.45, p < 0.05); the parent-child relationship moderated the relationship between social support and negative coping (t = -4.29, p < 0.01); and the parent-child relationship moderated the association between negative coping and depression (t = 2.08, p < 0.05). Conclusion: Social support has an impact on depression in the period of the regular prevention and control of COVID-19 through the mediating role of coping style and the moderating effect of the parent-child relationship.

Self-report Sleep Quality and its Risk Factors Among Community-dwelling Older Adults in China.

Context: Researchers have associated insomnia with many disorders, making insomnia a serious public health issue in China. Sleep quality in older adults isn't well characterized in China. Objective: The study intended to explore the sleep quality and subjective duration of sleep in a community-dwelling older population in China and identify potential risk factors for poor sleep. Design: The research team performed a cross-sectional survey using the convenience sampling method. Setting: The study took place in a community in Wuhu, Anhui, China in 2015. Participants: Participants were 1075 members of the community from Wuhu city. Outcome Measures: The research team collected self-reported information on sleep quality. Results: The overall prevalence of self-reported insomnia among older adults were 40.8%. The prevalence of insomnia in females, 259 (59.00%), was significantly higher than in males, 180 (41.00%), with P = .00. For income status, the prevalence of insomnia was significantly higher for participants with less than 10 000 RMB per year income for a family, 191 participants (43.51%), than for participants with higher family incomes, with P = .00. For marital status, the prevalence of insomnia was significantly higher for the widowed participants, 121 participants (24.56%), with P = .01. Conclusions: Sleep quality for females, low-income families, and widowed people were significantly worse than for people in other categories among older adults in China. Older adults in China need proper interventions for the factors causing poor sleep hygiene.

Sex-specific genetic association of brain and muscle Arnt-like protein-1 (BMAL1) and obesity in Chinese youth.

BACKGROUND: The circadian clock gene brain and muscle Arnt-like protein-1 (BMAL1) regulates energy metabolism, adipocyte proliferation and differentiation, glucose metabolism, and other functions. This study aimed to examine the association of potential polymorphisms in BMAL1 with obesity among Chinese youth. METHODS: A total of 2973 participants were included in this study. According to the body mass index obesity standard of China, 208 subjects were defined as experiencing general obesity. According to the waist-to-hip ratio obesity standard, 335 participants were defined as experiencing central obesity. Four single nucleotide polymorphisms (SNPs) (rs9633835, rs6486121, rs7107287, and rs12364562) were genotyped using TaqMan probe techniques. RESULTS: There was no significant difference in the either genotypic or allelic frequencies between the non-general and general obesity groups, while a positive association was observed between BMAL1 rs6486121 variant and central obesity risk (CC＋CT vs. TT: OR:2.139, 95% CI:1.164-3.930; P = 0.014) after adjusting for covariates. Stratification analyses revealed significant associations with central obesity risk for rs6486121 polymorphism in women according to the additive model (CC vs. CT vs. TT: OR：1.409; 95 % CI: 1.029-1.930; P = 0.032). Haplotype analysis showed that only paired haplotypes, including rs9633835G with rs6486121T, had a significant effect on central obesity with OR (95%CI) was 1.035 (1.011-1.060) and P = 0.004. CONCLUSION: our findings suggest that BMAL1 polymorphisms are significantly associated with central obesity and sex-specific genetic effects on BMAL1-mediated genetic susceptibility to obesity.

Association of rs2910164 in miR-146a with type 2 diabetes mellitus: A case-control and meta-analysis study.

Objective: Several studies have shown that miR-146a rs2910164 (C > G) is associated with type 2 diabetes mellitus (T2DM) susceptibility, but the results are still controversial. This study is divided into two parts, and one is to explore the relationship between miR-146a rs2910164 polymorphism and the genetic susceptibility of T2DM in Chinese Han population. Second, a meta-analysis on the basis of a larger sample size was used to determine whether this is a susceptibility gene for T2DM. Methods: A case-control study including 574 T2DM patients and 596 controls was used to evaluate the association of miR-146a rs2910164 polymorphism with the risk of T2DM in Chinese Han People. Then, we systematically searched studies investigating the correlation between miR-146a rs2910164 polymorphism and T2DM susceptibility published before April 2022 from PubMed, Web of Science, Wanfang, and China National Knowledge Infrastructure database, and a meta-analysis including six studies was carried out. The results were expressed by odds ratio (OR) and its 95% confidence interval (95% CI). Results: In a case-control study, we found that there were no statistical differences in genotype frequencies between T2DM and control group. Subgroup analysis showed that, compared with the CC genotype, CG + GG genotype was associated with a decreased risk of T2DM in the subgroup of individuals ≥ 65 years old (OR = 0.75; 95% CI: 0.58-0.98; P adjusted = 0.032) and BMI < 18.5 (OR = 0.16; 95% CI: 0.03-0.89; P adjusted = 0.037). In overall meta-analysis, significant heterogeneity was detected. No significant association between miR-146a rs2910164 polymorphism and T2DM was observed in all genetic models under random effects models. Subgroup analysis revealed that there was a significant difference in genotype frequencies between the T2DM and control group in recessive model (CC vs. CG + GG: OR = 1.79; 95% CI: 1.08-2.96; PQ = 0.307, I 2 = 4.0%) and homozygote model (CC vs. GG: OR = 1.79; 95% CI: 1.07-3.00; PQ = 0.216, I 2 = 34.7%) in Caucasians. Conclusion: The results of our study demonstrate that the miR-146a rs2910164 polymorphism might have ethnicity-dependent effects in T2DM and may be related to T2DM susceptibility in Caucasians.

Influencing factors of stroke occurrence and recurrence in hypertensive patients: A prospective follow-up studies.

OBJECTIVE: To understand the related risk factors of occurrence and recurrence of hypertension and provide scientific basis for relevant departments to better guide prevention and control work. METHODS: From September 2017 to September 2018, a prospective follow-up study was performed on patients with hypertension who visited the Second People's Hospital of Wuhu City, Anhui Province. Multivariate Cox regression was used to analyze influencing factors of stroke occurrence and recurrence in follow-up of hypertensive patients. RESULTS: A total of 769 hypertensive patients were enrolled in this study. The average age of hypertensive patients was 65.66 ± 11.70 years old and the BMI index was 24.99 ± 4.17. In this study, 769 patients with hypertension were followed up for 1 year, and the incidence of stroke was 14.69%. This study found that higher levels of blood glucose (RR = 2.027, 95% CI: 1.195-3.438), HCY (RR = 5.928,95% CI: 1.438-24.440), aggravated extent of carotid artery stenosis (RR = 2.620, 95% CI: 1.532-4.481), and drinking (RR = 3.867, 95% CI: 2.038-7.339) were risk factors, and maintaining exercise (RR = 0.325, 95% CI: 0.117-0.907) was a protective factor for stroke occurrence; however, aggravated extent of carotid artery stenosis (RR = 3.158, 95% CI: 1.797-5.550) and smoking (RR = 2.271, 95% CI: 1.142-4.517) were risk factors for stroke recurrence for hypertensive patients. CONCLUSIONS: For people with high blood pressure, it is necessary to exercise properly, control body weight, avoid obesity, quit smoking, reduce alcohol consumption, and reasonably control blood pressure, blood sugar, and blood lipid.

Association of learning environment and self-directed learning ability among nursing undergraduates: a cross-sectional study using canonical correlation analysis.

OBJECTIVES: This study explores the relationship between the perception of the learning environment and self-directed learning (SDL) ability among nursing undergraduates. DESIGN, SETTING AND PARTICIPANTS: A cross-sectional study was conducted in December 2020 with 1096 junior and senior undergraduate nursing students (aged 16-22) from Wannan Medical College in Anhui Province, China. OUTCOME MEASURES: The Chinese version of the Dundee Ready Educational Environment Measure questionnaire and a validated Chinese version of college students' SDL ability scale were used to assess students' perceptions about their learning environment and their SDL ability. Canonical correlation analysis was performed to evaluate their correlation. RESULTS: The total score for the learning environment was 120.60 (scoring rate: 60.30%), and the score for SDL ability was 89.25 (scoring rate: 63.75%). Analysis indicated that the first canonical correlation coefficient was 0.701 and the contribution rate was 94.26%. The perception of the learning environment was mainly determined by students' perception of learning (SPL) and academic self-perceptions (SASP), with SDL ability mainly determined by self-management ability and cooperative learning ability. SPL and SASP were positively correlated with self-management ability and cooperative learning ability. Multiple linear regression analysis revealed that SPL, SASP, students' perceptions of atmosphere and students' social self-perceptions had a significant impact on SDL ability. CONCLUSIONS: The SDL ability of nursing undergraduates was not high. SPL and SASP were positively correlated with self-management ability and cooperative learning ability. Nursing educators can improve students' SDL ability by changing their learning environment, using, for example, new student-centred teaching methods.

Associations between Chinese college students' anxiety and depression: A chain mediation analysis.

OBJECTIVE: Anxiety and depression are great public health concerns among college students. The purpose of this study was to explore whether sleep quality and quality of life (QoL) play mediating roles in anxiety and depression among Chinese college students. METHOD: A total of 2757 college students (mean age = 19.07; SD = 1.14) completed the questionnaires, including a brief demographic survey. The 2-item General Anxiety Disorder (GAD-2) and the 2-item Patient Health Questionnaire (PHQ-2) were used to assess the symptoms of anxiety and depression, respectively. And the Pittsburgh Sleep Quality Index (PSQI) and the Short-Form 36 Health Survey (SF-36) were used to evaluate college students' sleep quality and QoL, respectively. Mediation analyses were conducted by using PROCESS macro in the SPSS software. RESULT: Anxiety had both direct and indirect effects on depression. Sleep quality and QoL were not only independent mediators in the relationship between anxiety and depression but also chain mediators. CONCLUSION: The results of the current study highlight the crucial role of early intervention for depression with a focus on college students with anxiety, more especially, on those with poorer sleep quality and lower QoL.

[Relationship between sleep-wake circadian chronotype and anxiety and depression of medical students in a university in Wuhu City in 2020].

OBJECTIVE: To explore the circadian rhythm of sleep-wake and its relationship with anxiety and depression among medical students. METHODS: A stratified cluster random sampling method was adopted in this study, 2231 medical students in grades 1 to 3 from a medical college in Wuhu City(1004 boys and 1227 girls, aged(19.09±1.13) years) were selected in November 2020. The sleep wake circadian chronotype and mental health of medical students were evaluated by the Morningness-Eveningness Questionnaire 19(MEQ-19), the Patient Health Questionnaire 2(PHQ-2), and the Generalized Anxiety Disorder scale(GAD-2), respectively. RESULTS: The detection rates of evening chronotype, intermediate circadian chronotype, and morning chronotype were 59.84%(n=1335), 37.92%(n=846), and 2.24%(n=50), respectively. The detection rates of anxiety, depression, and anxiety combined with depression were 12.86%(n=287), 14.12%(n=315), and 9.59%(n=214), respectively. After adjusting for gender, age, grade, class performance in the last half semester, and learning burden, the result of multivariate logistic regression analysis showed that compared with medical students with intermediate circadian chronotype, medical students with evening chronotype were more likely to have anxiety(OR_(adj. )=1.403, 95% CI 1.066-1.846, P=0.016) and depression(OR_(adj. )=1.639, 95% CI 1.251-2.146, P < 0.001). CONCLUSION: The detection rate of anxiety and depression in medical students is high. The circadian chronotype of medical students is mainly evening chronotype, which is a risk factor affecting anxiety and depression among medical students.

Effectiveness of seminar-case learning for use in practice teaching of statistics for undergraduates majoring in preventive medicine: a prospective cluster-randomized controlled trial.

BACKGROUND: The seminar-case learning (SCL) method is a case-oriented teaching model, with teachers and students as the main body of teaching, characterized by communication, interaction, and mutual inspiration. This study explored the effects of the SCL method versus traditional lecture-based learning (LBL) in the statistics curriculum for undergraduate students majoring in preventive medicine. Research questions were: 1) whether the scores of students in the experimental group (the SCL model) were higher than those in the control group (the LBL model); 2) whether the students' satisfaction in the experimental group was better than that in the control group; and 3) whether the self-report benefit of students in the experimental group was better than that in the control group. METHODS: We conducted a two-armed cluster-randomized education intervention trial in practice teaching of health statistics among undergraduates majoring in preventive medicine. Two administrative classes (classes 1-4 and classes 5-8) were divided into the experimental group and the control group according to the principle of drawing lots. The students in two groups received the same statistical theory course. For the arrangement of statistical practice course, the experimental group adopted the SCL model, and the control group used the LBL model. The teaching effect was evaluated via an examination and an anonymous questionnaire survey. RESULTS: Scores for noun explanation questions in the experimental group showed no statistical significance with that of the control group(U = 2911.0, P = 0.964). The scores of single choice, calculation, and case analysis questions, and the total scores were significantly higher than that of the control group (P < 0.05). Students' satisfaction with arrangements of the practice course in the experimental group (92.41%) was significantly higher than that of in the control group (77.03%), the difference was statistically significant (χ2 = 7.074, P = 0.008). The self-report benefit of students in the experimental group was better than that in the control group (P < 0.05). CONCLUSION: As an effective method of high-quality education, the SCL model is worthy of further promotion in the practice teaching of preventive medicine.

Incident Stroke and Its Influencing Factors in Patients With Type 2 Diabetes Mellitus and/or Hypertension: A Prospective Cohort Study.

OBJECTIVE: To understand the incidence of stroke in patients with type 2 diabetes mellitus (T2DM) and/or hypertension (HTN), and provide a basis for the prevention of stroke in these patients. METHODS: A prospective cohort study was performed for adults with T2DM and/or HTN. The follow-up period was 1 year. The incidence and recurrence rate of stroke was calculated and a multivariate Cox proportional hazard was used to analyze influencing factors of stroke occurrence and recurrence in the follow-up of patients with T2DM and/or HTN. RESULTS: Of the 1,650 patients with T2DM and/or HTN, 1,213 patients had no history of stroke. After 1 year of follow-up, 147 new stroke cases occurred, and the incidence rate of stroke was 12.1%. Among the patients who had stroke history (413), there were 116 cases of stroke with a recurrence rate of 26.5%. Seven risk factors were independently associated with stroke occurrence among patients without stroke history, included smoking, abnormal total cholesterol abnormal low-density lipoprotein patients with comorbid T2DM with HTN, physical inactivity, carotid artery stenosis (CAS), and higher scores of National Institutes of Health Stroke Scale (NIHSS). Higher scores of NHISS and CAS were independent risk factors for the recurrence of stroke among patients with stroke history. CONCLUSIONS: Patients with T2DM and/or HTN have a higher rate of new stroke and recurrence after 1-year follow-up. Actively identifying the controllable risk factors, such as smoking and physical inactivity, will help reduce the risk of stroke and recurrence in patients with T2DM and HTN.

Serial Multiple Mediation of the Correlation Between Internet Addiction and Depression by Social Support and Sleep Quality of College Students During the COVID-19 Epidemic.

OBJECTIVE: This cross-sectional study explores the serial multiple mediation of the correlation between internet addiction and depression by social support and sleep quality of college students during the COVID-19 epidemic. METHODS: We enrolled 2,688 students from a certain university in Wuhu, China. Questionnaire measures of internet addiction, social support, sleep quality, depression and background characteristics were obtained. RESULTS: The prevalence of depression, among 2,688 college students (median age [IQR]=20.49 [20.0, 21.0] years) was 30.6%. 32.4% of the students had the tendency of internet addiction, among which the proportion of mild, moderate and severe were 29.8%, 2.5% and 0.1%, respectively. In our normal internet users and internet addiction group, the incidence of depression was 22.6% and 47.2%, respectively. The findings indicated that internet addiction was directly related to college students' depression and indirectly predicted students' depression via the mediator of social support and sleep quality. The mediation effect of social support and sleep quality on the pathway from internet addiction to depression was 41.97% (direct effect: standardized estimate=0.177; total indirect effect: standardized estimate=0.128). The proposed model fit the data well. CONCLUSION: Social support and sleep quality may continuously mediate the link between internet addiction and depression. Therefore, the stronger the degree of internet addiction, the lower the individual's sense of social support and the worse the quality of sleep, which will ultimately the higher the degree of depression. We recommend strengthening monitoring of internet use during the COVID-19 epidemic, increasing social support and improving sleep quality, so as to reduce the risk of depression for college students.

Serum/Plasma Zinc Is Apparently Increased in Ischemic Stroke: a Meta-analysis.

Zinc (Zn) is found in many neuronal pathways in the brain and has implications for neuromodulation and cerebrovascular disease. However, the association between Zn levels and stroke risk remains controversial. Therefore, we conducted a meta-analysis to explore these relationships. A systematic literature search using PubMed, EMBASE database, and Google Scholar was performed for relevant articles from inception to August 2020. Standardized mean differences (SMDs) and 95% confidence intervals (CIs) were considered the effect sizes and statistical analyses were performed using Stata 12.0. A total of 12 studies involving 1878 cases of stroke and 1754 controls were enrolled. Overall, the meta-analysis demonstrated no significant difference in Zn levels between the stroke group and control group (SMD =-0.18, 95% CI =-0.69 to 0.32, P = 0.480). Subgroup analysis showed that type of stroke had an influence on the Zn levels. A meta-analysis of nine ischemic stroke (IS) studies, which included 1645 cases and 1585 controls, revealed that the Zn levels were significantly higher in IS patients than in controls (SMD (95% CI): 0.61(0.04, 1.19), P = 0.036), but no significant association was found between Zn levels and risk of hemorrhagic stroke (P = 0.113). Egger's test indicated no significant publication bias. This meta-analysis indicates that higher Zn levels may be associated with increased risk of IS; however, these findings should be further confirmed.

Association Between Online Self-Directed Learning Ability and Negative Emotions Among College Students During the COVID-19 Pandemic: A Cross-Sectional Study in Anhui Province, East China.

Background: This study investigated the correlation between depression, anxiety, and stress among college students engaged in online learning during the coronavirus disease 2019 (COVID-19) pandemic and self-directed learning (SDL) ability, which could provide a scientific basis for mental health education of the college students. Methods: A cross-sectional study was conducted among 5,558 students from two universities in Anhui province, East China. The Depression, Anxiety, and Stress Scale-21 (DASS-21) and the Self-directed Learning Ability Scale were used to conduct an online questionnaire survey. Results: A total of 35.15, 36.32, and 17.24% of college students reported symptoms of depression, anxiety, and stress, respectively. Males and nonmedical students were at higher risks to suffer from depression, anxiety, and stress. In adjusted model, compared with Q1 of self-management ability, the odds ratio (OR) of the Q2, Q3, and Q4 were as follows: 0.635 (0.531-0.759), 0.504 (0.415-0.611), and 0.312 (0.248-0.392) for depression; 0.639 (0.535-0.764), 0.653 (0.540-0.789), and 0.421 (0.338-0.525) for anxiety; and 0.649 (0.523-0.805), 0.579 (0.457-0.733), and 0.482 (0.364-0.637) for stress. For information capability, decrease in risk was even more pronounced: Q2 (0.654, 0.540-0.794), Q3 (0.560, 0.454-0.690), and Q4 (0.233, 0.181-0.301) for depression; Q2 (0.781, 0.646-0.945), Q3 (0.616, 0.501-0.757), and Q4 (0.276, 0.216-0.353) for anxiety; and Q2 (0.444, 0.357-0.553), Q3 (0.454, 0.357-0.578), and Q4 (0.272, 0.202-0.368) for stress. Compared with the Q2 group of cooperation learning ability, cooperation learning ability quartiles were positively associated with depression (Q1: 1.382, 95% CI: 1.138-1.678), anxiety (Q4: 1.260, 95% CI: 1.008-1.576), and stress (Q1: 2.002, 95% CI: 1.583-2.532; Q3: 1.600, 95% CI: 1.252-2.044; Q4: 1.674, 95% CI: 1.243-2.255). Conclusion: The prevalence of depression, anxiety, and stress among college students was high for those studying online at home during the COVID-19 pandemic, especially among nonmedical students and males. SDL ability was negatively associated with negative emotions of the college students during this period of online learning.