Associations between perceived care quality, self-care behaviors, and glycemic control in Chinese adults with type 2 diabetes under the national essential public health services program.

BACKGROUND: The rising prevalence of Type 2 diabetes (T2D) in China poses a critical health challenge, necessitating effective management strategies. The National Essential Public Health Services Program (NEPHSP), initiated in 2009, focuses on equitable access to health services, including T2D management. This study investigates the associations between perceived care quality, self-care behaviors, and glycemic control in Chinese adults with T2D under NEPHSP, particularly examining the mediating role of self-care behaviors. METHODS: Conducted from April to November 2020 in Huai'an City, Jiangsu Province, this study involved 1,577 T2D patients enrolled in NEPHSP. We assessed perceived care quality using the Patient Assessment of Chronic Illness Care (PACIC) scale and developed a comprehensive self-care behavior score, covering nine essential health practices. Glycemic control was evaluated using HbA1c levels. Linear regression models were used to explore these associations, adjusting for demographic and clinical factors, while causal mediation analyses examined the role of intermediate variables. RESULTS: Higher PACIC scores significantly correlated with improved self-care behaviors (ß = 0.294, 95% CI: 0.233 to 0.354) and were negatively associated with HbA1c levels (ß=-0.109, 95% CI: -0.192 to -0.026). The self-care behavior score inversely related to HbA1c levels (ß=-0.197, 95% CI: -0.263 to -0.132). Notably, self-care behaviors mediated 50.41% (P < 0.05) of the effect of perceived care quality on HbA1c levels. CONCLUSIONS: This study demonstrates a substantial association between perceived care quality and better glycemic control in Chinese adults with T2D under NEPHSP, with self-care behaviors playing a crucial mediating role. These findings suggest that patient-centered care and comprehensive self-care practices are essential for effective T2D management within NEPHSP.

Factors affecting T2DM patients' behaviors associated with integrated treatment and prevention services in China.

OBJECTIVE: To explore the relationship between type 2 diabetes mellitus (T2DM) patients' attitude, subjective norms (SN), perceived behavioral control (PBC), behavioral intention (BI) and behavior associated with integrated treatment and preventive (ITP) services. METHODS: A convenient sampling method was employed at a community health center in Nanjing, China between January and July 2022. The collected data were processed using Epidata 3.1, SPSS 26.0, and AMOS 24.0. Descriptive statistics and a structural equation model based on the theory of planned behavior (TPB) were used to explore the correlation between the study variables. RESULTS: 430 participants were eventually included, with a response rate of 98.6%. The mean age was 72.50 ± 5.69 years. The TPB model proved to be suitable and explained 41% of the variance in the BI. Attitude (ß = 0.289, P < 0.001), SN (ß = 0.314, P < 0.001) and PBC (ß = 0.261, P < 0.001) were the main predictors of BI, and the SN was the strongest. BI (ß = 0.452, P < 0.001) and PBC (ß = 0.452, P < 0.001) had similar direct effects on patients' behavior. CONCLUSION: The TPB model explained the behavioral variations associated with ITP services and provided a framework for developing targeted interventions and improving community-based ITP services for T2DM. To encourage patients to engage in desirable behaviors, interventions should focus on modifying patients' SN towards behavior associated with ITP services by promoting peer pressure and increasing the family's emphasis on health.

Mediating effect of BMI on the relation of dietary patterns and glycemic control inT2DM patients: results from China community-based cross-sectional study.

OBJECTIVE: To analyze the effects of different dietary types on in type 2 diabetes mellitus (T2DM) and determine the mediating effects of Body Mass Index (BMI) on dietary type with Fasting Plasma Glucose (FPG), Glycosylated Hemoglobin (HbA1c) on the associations in T2DM. METHODS: Data of community-based cross-sectional study with 9602 participants including 3623 men and 5979 women were collected from the project 'Comprehensive Research in prevention and Control of Diabetes mellitus (CRPCD)' conducted by Jiangsu Center for Disease Control and Prevention in 2018. The dietary data were collected from a food frequency qualitative questionnaire (FFQ) and dietary patterns were derived through Latent Class Analysis (LCA). Then, Logistics regression analyses were used to evaluate the associations of FPG, HbA1c with different dietary patterns. The BMI (BMI = height/weight2) was used as a moderator to estimate the mediating effect. Mediation analysis was performed using hypothetical variables, the mediation variables, to identify and explain the observed mechanism of association between the independent and dependent variables while the moderation effect was tested with multiple regression analysis with interaction terms. RESULTS: After completing Latent Class Analysis (LCA), the dietary patterns were divided into three categories: TypeI, TypeII, TypeIII. After adjusting for confounding factors such as gender, age, education level, marital status, family income, smoking, drinking, disease course, HDL-C, LDL-C, TC, TG, oral hypoglycemic drugs, insulin therapy, Hypertension, Coronary heart disease, Stroke, Type III were all significantly associated with HbA1c compared to those with Type I (P < 0.05), and the research showed the patients with Type III had High glycemic control rate. Taking type I as the reference level, the 95% Bootstrap confidence intervals of the relative mediating effect of TypeIII on FPG were (-0.039, -0.005), except 0, indicating that the relative mediating effect was significant (αIII = 0.346*, ßIIIFPG = -0.060*). The mediating effect analysis was performed to demonstrate that BMI was used as a moderator to estimate the moderation effect. CONCLUSIONS: Our findings demonstrate that consuming Type III dietary patterns associates with good glycemic control in T2DM and the BMI associations would be playing a two-way effect between diet and FPG in Chinese population with T2DM, indicated that Type III could not only directly affect FPG, but also affect FPG through the mediating effect of BMI.

Association of urbanization with psychological well-being in Chinese adults aged 50 years and older: a population-based study.

OBJECTIVE: To examine the association between urbanization and psychological well-being (PWB) in China. METHODS: Data were obtained from the 2015 China Health and Nutrition Survey (CHNS) and included 3,071 men and 3,385 women aged 50 years or older who lived in 288 communities across 12 provinces and municipalities. The urbanization index, which summarizes 12 urbanization dimensions at community level, was categorized into tertiles representing low, medium, and high levels of urbanization. PWB was assessed by scoring three self-reported questions. Gender-stratified multilevel analyses were used to estimate the association between urbanization and PWB. RESULTS: After controlling for individual-level factors, the urbanization index was associated positively with PWB. More specifically, an increase of one SD in the score of community population density, economic activity, housing, education, sanitation, or diversity was associated significantly with PWB in both genders. In addition, increases in the score of community communications, social services, transportation, or modern markets were associated significantly with PWB in women, but not in men. CONCLUSION: Urbanization has, on average, had an independent and positive effect on PWB in middle-aged and older Chinese populations, with many components of urbanization being separately and positively associated with PWB, especially in women.

Association between perceived stress and hypertension in Chinese adults: a population-based survey.

It still remains unclear whether perceived stress is associated with hypertension. We aimed to investigate the association between perceived stress with hypertension in Chinese adults. Data on 10,823 participants aged 18 years or older were obtained from the 2015 China Health and Nutrition Survey (CHNS). Hypertension was defined as a mean systolic blood pressure ≥140 mmHg, diastolic blood pressure ≥90 mmHg, self-reported physician diagnosis of hypertension, and/or use of antihypertensive medications. Perceived stress was assessed by the 14-item perceived stress scale, with the scale data then divided into quartiles. Logistic regression models and restricted cubic spline regression were performed to evaluate the association between perceived stress and hypertension. After adjustment for age, gender, marital status, education level, per capita household income, employment status, residential areas, current smoking and alcohol consumption, the odds ratio (OR) [95% confidence interval (CI)] for every standard deviation (SD) increment in perceived stress was 0.94 (0.90-0.98); compared to the lowest quartile of perceived stress (Q1), the ORs (95% CIs) for hypertension were 0.88 (0.78-1.01) for Q2, 0.91 (0.81-1.03) for Q3, and 0.82 (0.72-0.92) for Q4 (P for trend < 0.001). The inverse association between perceived stress and hypertension was persistent in the subgroup analyses stratified by age, gender, employment status, residential areas, smoking status, and alcohol consumption. In addition, the restricted cubic spline curve revealed a linear and negative association between perceived stress and hypertension (P for nonlinearity = 0.872). Because this study was a cross-sectional design, future prospective studies are needed to confirm these findings.

Association of urbanization with psychological well-being in Chinese adults aged 50 years and older: a population-based study

Objective: To examine the association between urbanization and psychological well-being (PWB) in China. Methods: Data were obtained from the 2015 China Health and Nutrition Survey (CHNS) and included 3,071 men and 3,385 women aged 50 years or older who lived in 288 communities across 12 provinces and municipalities. The urbanization index, which summarizes 12 urbanization dimensions at community level, was categorized into tertiles representing low, medium, and high levels of urbanization. PWB was assessed by scoring three self-reported questions. Gender-stratified multilevel analyses were used to estimate the association between urbanization and PWB. Results: After controlling for individual-level factors, the urbanization index was associated positively with PWB. More specifically, an increase of one SD in the score of community population density, economic activity, housing, education, sanitation, or diversity was associated significantly with PWB in both genders. In addition, increases in the score of community communications, social services, transportation, or modern markets were associated significantly with PWB in women, but not in men. Conclusion: Urbanization has, on average, had an independent and positive effect on PWB in middle-aged and older Chinese populations, with many components of urbanization being separately and positively associated with PWB, especially in women.

Gender differences in association of urbanization with psychological stress in Chinese adults: A population-based study.

Objective: To investigate the gender-specific associations between exposure to urbanization and psychological stress in China experiencing rapid urbanization. Methods: Data were obtained from the 2015 China Health and Nutrition Survey. A total of 4,388 men and 5,098 women aged at least 18 years were obtained from 288 communities across 12 provinces and municipalities. Tertiles of the urbanization index, summarizing 12 urbanization dimensions at the community level, were used to define low, medium, and high levels of urbanization. The psychological stress was measured based on the 10-item Perceived Stress Scale. The gender-stratified multilevel analysis (Level-1: Individuals, Level-2: Communities, and Level-3: provinces/municipalities) was used to estimate the association between exposure to urbanization and psychological stress. Results: After controlling for age, education status, marital status, work status, household income per capita, current smoking, alcohol drinking, sleep duration, BMI, and chronic conditions, the urbanization index was negatively associated with psychological stress in women (P trend = 0.017) but not men (P trend = 0.476). More specifically, a one-standard deviation increase in the score of community population density (ß = -0.329, P = 0.329), modern markets (ß = -0.247, P = 0.044), education (ß = -0.448, P = 0.002), and housing (ß = -0.380, P = 0.005) was negatively associated with psychological stress only in women, separately. Conclusion: Our data revealed that living in the most urbanized communities is associated with lower levels of psychological stress for women but not men. Thus, this study can help empower decision-makers to accurately target vulnerable communities and plan effective strategies to address psychological outcomes.

Ambulatory blood pressure and blood pressure load responses to low sodium intervention in Han Chinese population.

We aimed to illustrate ambulatory blood pressure monitoring parameters responses to low sodium intake and their differences between salt-sensitive and non-salt-sensitive individuals. A total of 186 participants were included in this analysis. Twenty-four hour, day-time and night-time blood pressure (BP) and BP load decreased during low sodium intervention, especially in salt-sensitive (SS) group. After multivariable adjustment, 24-h systolic BP, diastolic BP, mean arterial pressure and BP load responses to low sodium intervention of SS individuals were more pronounced than those of non-salt-sensitive individuals. Thus, reducing salt intake is potentially needed for the prevention of hypertension, especially in SS individuals.

Hypertension burden and control in mainland China: Analysis of nationwide data 2003-2012.

BACKGROUND: No nationwide survey on hypertension was conducted in China since 2002. We assessed the prevalence, awareness, treatment, and control of hypertension in mainland China and in various regions using nationwide data from 2003 to 2012. METHODS AND RESULTS: We identified studies that reported age- and gender-specific prevalence and/or age-specific awareness, treatment and control of hypertension in representative population samples from 31 provinces, using China National Knowledge Infrastructure, Wanfang and PubMed, supplemented by a manual search of references of retrieved articles. All data were extracted independently by two investigators using a standardized data-collection form. Overall, 265 million adults (145 million men and 120 million women) had hypertension for a prevalence of 26.7% (28.9% among men and 24.5% among women) in 2010. Among hypertensive patients, only 44.6% were aware of their condition, 35.2% were taking antihypertensive medication, and 11.2% achieved adequate blood pressure control. There were substantial geographic variations in the prevalence and control of hypertension. Hypertension prevalence was the highest in east region (32.6%) followed by northeast region (31.8%). Worse still, the control rate among hypertensive people was very poor in southwest (4.8%) and northeast (5.9%) regions. CONCLUSIONS: Hypertension is highly prevalent in mainland China, with inadequate awareness, treatment, and control of hypertension. Effective strategies are urgently needed in China, especially in the regions with high prevalence and low control.

Effect of drinking on all-cause mortality in women compared with men: a meta-analysis.

BACKGROUND: Alcoholic beverages are consumed by humans for a variety of dietary, recreational, and other reasons. It is uncertain whether the drinking effect on risk of all-cause mortality is different between women and men. We conducted a meta-analysis to evaluate the effect of drinking on the risk of all-cause mortality in women compared with men. METHODS: We selected cohort studies with measures of relative risk (RR) and 95% confidence interval (CI) for all-cause mortality for drinkers versus nondrinkers by sex. Sex-specific RR and 95% CI were used to estimate the female-to-male ratio of RR (RRR) and 95% CI. Pooled estimates of RRR across studies were obtained by the fixed-effects model or the random-effects model (if heterogeneity was detected). Second-order fractional polynomials and random effects meta-regression models were used for modeling the dose-risk relationship. RESULTS: Twenty-four studies were considered eligible. A total of 2,424,964 participants (male: 1,473,899; female: 951,065) were enrolled and 123,878 deaths (male: 76,362; female: 47,516) were observed. Compared with nondrinkers, the pooled female-to-male RRR for drinkers was 1.07 (95% CI: 1.02, 1.12). Subgroup analyses showed that the increased risk among female drinkers appeared to be consistent. J-shaped dose-response relationship was confirmed between alcohol and all-cause mortality in men and women, respectively. Moreover, the female-to-male RRR of all-cause mortality were 1.52 (95% CI: 1.01, 2.29), 1.95 (95% CI: 1.08, 3.49), and 2.36 (95% CI: 1.15, 4.88), respectively, for those who consumed 75, 90, and 100 g/day of alcohol. CONCLUSIONS: Females had an increased risk for all-cause mortality conferred by drinking compared with males, especially in heavy drinkers. The present study suggested that female drinkers, particularly heavy drinkers, should moderate or completely reduce their level of consumption to have a health benefit.

Cigarette smoking and risk of completed suicide: a meta-analysis of prospective cohort studies.

BACKGROUND: Epidemiologic studies have reported conflicting results relating smoking to suicide risk. We conducted a meta-analysis of prospective cohort studies to evaluate the association of cigarette smoking with completed suicide. METHODS: Eligible prospective cohort studies were identified from PubMed and EMbase databases (from 1966 to May 2011) and the reference lists of retrieved articles. Two authors independently extracted data and assessed study quality using the Newcastle-Ottawa Scale. Study-specific risk estimates were pooled using random-effects model and generalized least squares trend estimation was used to assess dose-response relationship. RESULTS: Fifteen prospective cohort studies involving 2395 cases among 1,369,807 participants were included in the meta-analysis. Our data suggested that cigarette smoking significantly increased the risk of completed suicide. Compared with never smokers, the pooled RR was 1.28 (95% CI: 1.001-1.641) for former smokers, and 1.81 (95% CI: 1.50-2.19) for current smokers, respectively. Subgroup analyses showed that the increased suicide risk among current smokers appeared to be consistent, although there was heterogeneity among studies of current smoking (p < 0.001). Significant dose-response relationship was found between smoking and suicide, and the risk of suicide was increased by 24% for each increment of 10 cigarettes smoked per day (RR, 1.24; 95% CI: 1.20-1.28). CONCLUSIONS: Our meta-analysis robustly demonstrates that cigarette smoking is associated with an increased risk of completed suicide, consistent with a dose-response relationship. This conclusion has an important public health message for countries with high smoking prevalence and high suicide rate such as China.