Depressive symptoms and all-cause mortality among middle-aged and older people in China and associations with chronic diseases.

Introduction: It remains unclear whether depressive symptoms are associated with increased all-cause mortality and to what extent depressive symptoms are associated with chronic disease and all-cause mortality. The study aims to explore the relationship between depressive symptoms and all-cause mortality, and how depressive symptoms may, in turn, affect all-cause mortality among Chinese middle-aged and older people through chronic diseases. Methods: Data were collected from the China Health and Retirement Longitudinal Study (CHARLS). This cohort study involved 13,855 individuals from Wave 1 (2011) to Wave 6 (2020) of the CHARLS, which is a nationally representative survey that collects information from Chinese residents ages 45 and older to explore intrinsic mechanisms between depressive symptoms and all-cause mortality. The Center for Epidemiological Studies Depression Scale (CES-D-10) was validated through the CHARLS. Covariates included socioeconomic variables, living habits, and self-reported history of chronic diseases. Kaplan-Meier curves depicted mortality rates by depressive symptom levels, with Cox proportional hazards regression models estimating the hazard ratios (HRs) of all-cause mortality. Results: Out of the total 13,855 participants included, the median (Q1, Q3) age was 58.00 (51.00, 63.00) years. Adjusted for all covariates, middle-aged and older adults with depressive symptoms had a higher all-cause mortality rate (HR = 1.20 [95% CI, 1.09-1.33]). An increased rate was observed for 55-64 years old (HR = 1.23 [95% CI, 1.03-1.47]) and more than 65 years old (HR = 1.32 [95% CI, 1.18-1.49]), agricultural Hukou (HR = 1.44, [95% CI, 1.30-1.59]), and nonagricultural workload (HR = 1.81 [95% CI, 1.61-2.03]). Depressive symptoms increased the risks of all-cause mortality among patients with hypertension (HR = 1.19 [95% CI, 1.00-1.40]), diabetes (HR = 1.41[95% CI, 1.02-1.95]), and arthritis (HR = 1.29 [95% CI, 1.09-1.51]). Conclusion: Depressive symptoms raise all-cause mortality risk, particularly in those aged 55 and above, rural household registration (agricultural Hukou), nonagricultural workers, and middle-aged and older people with hypertension, diabetes, and arthritis. Our findings through the longitudinal data collected in this study offer valuable insights for interventions targeting depression, such as early detection, integrated chronic disease care management, and healthy lifestyles; and community support for depressive symptoms may help to reduce mortality in middle-aged and older people.

Longitudinal associations between the frequency of playing Mahjong and cognitive functioning among older people in China: evidence from CLHLS, 2008-2018.

Background: Cognitive decline is prevalent among older adults, often resulting in decreased capabilities for self-care and a diminished quality of life. Mahjong, a culturally cherished and extensively played intellectual game in China, demands considerable cognitive function. While the cognitive benefits of playing Mahjong have been widely accepted, this study investigates an under explored aspect and aimed to ascertain the game's potential contributions toward bolstering self-care abilities, enhancing overall quality of life, and mitigating against rising societal healthcare costs. Methods: The data analyzed in the study is collected from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) with cognitive functioning being assessed through the Mini-Mental State Examination (MMSE). The frequency of playing Mahjong was measured through a self-reported questionnaire. Multiple linear regression models, latent variable growth models, and cross-lagged models were used to investigate the longitudinal relationship between game frequency and cognitive function in older people. Results: Of the 7,535 participants, the mean (SD) age was 81.96 (10.53) years. There were 7,308 (97%), 4,453 (59%), and 1,974 (26%) participants in 2011, 2014, and 2018, respectively. The results showed that Mahjong players had significantly higher MMSE scores compared to non-players from 2008 to 2018 (ß = 0.893; p < 0.001), and non-players had significantly lower scores in 2011, 2014, and 2018 than in 2008 (ß = -1.326, -0.912, -0.833; Ps > 0.05). Moreover, the frequency of playing Mahjong was associated with improved various cognitive domains. The declining frequency of playing Mahjong was substantially associated with the declining rate of MMSE scores (r = 0.336; p < 0.001). Mahjong frequency showed positive effects on MMSE scores, while the influence of Mahjong on MMSE scores were not significant. Conclusion: Playing Mahjong has a positive influence on the cognitive functioning among older people. It can help buffer against the decline in cognitive function and maintain cognitive function levels. The higher frequency of playing Mahjong is associated with improved reaction, attention and calculation, and self-coordination. A decline in the frequency of playing Mahjong was associated with a declining rate of cognitive function. The higher frequency of playing Mahjong among older people unilaterally influenced the improvement of cognitive function levels in older people in China.

Multi-Level Social Capital and Subjective Wellbeing Among the Elderly: Understanding the Effect of Family, Workplace, Community, and Society Social Capital.

Background: Maintaining the subjective wellbeing of the elderly people is one of the major concerns in promoting health aging. This study concerned the influence of multi-level social capital on subjective welling and explored the affecting path among the elderly. Methods: A total of 1,078 elderly individuals anonymously and effectively surveyed in 2018, data was collected including their family, workplace, community, society social capital and subjective wellbeing, we used the structural equation modeling to test the hypothesis relationships among the variables. Results: We found that the total score of subjective wellbeing among the aging participants was 72.36 ± 10.08 on a range of 0-100. Family (ß = 0.151, P < 0.001), workplace (ß = 0.090, P < 0.001), community (ß = 0.163, P < 0.001) social capital had a direct positive effect on subjective wellbeing. Society social capital had a direct positive effect on family (ß = 0.253, P < 0.001), workplace (ß = 0.585, P < 0.001), community (ß = 0.438, P < 0.001) social capital. And society social capital had an indirect positive effect on subjective wellbeing through the mediating role of family, workplace, and community social capital. Conclusion: The research demonstrated that all the micro, meso and macro levels of social capital have protective effects for subjective wellbeing through direct or indirect way, inspiring to provide continuous improvement measures for multi-level social capital aimed at the elderly people.

Assessing the causal effects of long-term exposure to PM2.5 during pregnancy on cognitive function in the adolescence: Evidence from a nationwide cohort in China.

The effects of air pollution on adolescents need further consideration. Although there is evidence that maternal exposure to air pollution may affect the cognitive function of offspring, relevant studies remain limited and inconsistent, with a lack of studies assessing the causal effects and evidence from developing countries. Using data from Chinese Family Panel Studies, a representative Chinese nationwide cohort study, OLS combined with instrumental variable + two-stage least square (IV+2SLS) was used to explore the causal effects of exposure to PM2.5 concentrations during pregnancy on the cognitive function of offspring when they become adolescents. After detailed argumentation and multiple testing, Planetary Boundary Layer Height (PBLH) and Surface Pressure (SP) were selected as the instrumental variables for this study. One thousand five hundred fifty-five adolescents participated in this study, with a mean age of 13.3 years (sd = 2.3). There were 706 females (45.4%), the mean maternal PM2.5 exposure concentration was 64.9 µg/m3, and recorded a mean cognitive function score of 38.1 (sd = 9.4). The OLS results found that maternal exposure to air pollution increased cognitive function in offspring adolescents, corroborating the presence of endogeneity. Multi-domain knowledge, the results of the weak instrumental variable assessments of F-tests (F = 237 > 10) and Stock-yogo tests (minimum eigenvalue statistic = 153.16 > 16.38), and the results of the Hansen J overidentification test (p > 0.05) verified the plausibility and validity of the instrumental variables. The IV+2SLS results, following causal modeling, showed that PM2.5 exposure during pregnancy impairs the cognitive ability of offspring adolescents (ß = -0.040, p < 0.05). Robustness tests also validated the results. This study provides important policy implications for developing countries on protecting their adolescents and reminds parents that the protection of adolescents from air pollution should begin from conception.

Prevalence of HBsAg among reproductive age couples in Chongqing: A population-based, cross-sectional study.

Hepatitis B is a leading cause of death worldwide. Here, we performed a large, population-based, cross-sectional study in Chongqing, China from 2011 to 2016 to assess the prevalence of HBsAg among couples of reproductive age, to predict subsequent trends, and to provide evidence for the WHO goal of "the elimination of viral hepatitis as a public health threat by 2030". A total of 386,286 couples aged 20 to 49 years were enrolled in the study. Approximately 14.35% of couples were HBsAg positive, including 95.00% with discordant HBsAg positivity. HBsAg prevalence was higher in men than in women. Among different occupations, the two categories of "houseworker" (female 6.73%, male 9.99%) and "unemployed" (female 6.64%, male 9.94%) showed the highest HBsAg positivity. In different regions, the lowest prevalence appeared in southeastern Chongqing (female 4.87%, male 7.71%). In 2030, the HBsAg positivity rate is expected to be 2.79%, 7.27% and 5.13% in females, males, and the whole population, respectively. According to the trends, this rate would drop to less than 2% in 2034, 2078 and 2051. In conclusion, the HBsAg prevalence in Chongqing is still relatively high compared with that in other parts of western China, especially among reproductive-age men. HBsAg-positive couples should be taken as an important unit of care. Vaccination is necessary before pregnancy if no antibody is found. More attention should be given to people without stable jobs. HBsAg-positive rate will decrease perceptibly by 2030 and will reach the level of low in epidemic areas by 2050.

Serum uric acid and risk of incident chronic kidney disease: a national cohort study and updated meta-analysis.

BACKGROUND: We prospectively examined the association between serum uric acid (SUA) levels and chronic kidney disease (CKD) in China and updated the evidence through a comprehensive meta-analysis of prospective studies worldwide. METHODS: Our original analyses were based on data from the China Health and Retirement Longitudinal Study. The primary exposure of interest was SUA at baseline, and the main outcome was incident CKD. Logistic regression models were used to examine the association between SUA levels and incident CKD. A meta-analysis was performed to pool our effect estimate and those from other cohort studies. RESULTS: During a 4-year follow-up, 180 participants developed incident CKD. Participants in the highest SUA quartile were 2.73 times as likely to develop incident CKD compared to those in the lowest quartile (multivariable-adjusted OR, 2.73; 95% CI, 1.65-4.50). Each 1 mg/dL increment in the SUA levels was associated with a 49% increased risk of incident CKD (multivariable-adjusted OR, 1.49; 95% CI, 1.28-1.74). In the meta-analysis of 30 cohort studies (including the current study), pooled relative risks (95% CIs) of incident CKD were 1.15 (1.10-1.21) for SUA each 1 mg/dL increment, 1.22 (1.14-1.30) for the highest versus lowest SUA group, and 1.17 (1.12-1.23) for hyperuricemia versus no hyperuricemia. CONCLUSIONS: Baseline SUA levels were associated with higher risk of incident CKD in middle-aged and elderly Chinese adults, and this positive association was confirmed in the meta-analysis of multiple cohort studies. Our findings may imply that SUA levels need to be routinely monitored for future CKD risk.

[Analysis of the Status of Depression and the Influencing Factors in Middle-Aged and Older Adults in China].

OBJECTIVE: To understand the status of depression and its influencing factors in the middle-aged and older adult populations aged 45 and above in China on the basis of data from the 2018 China Family Panel Studies (CFPS), and to provide empirical evidence for the improvement of the mental health of the middle-aged and older adults and the alleviation of their depressive symptoms. METHODS: The source of the research data was the 2018 CFPS. The Center for Epidemiologic Studies Depression Scale (CES-D) was used to assess the prevalence of depression. A two-level two-category unconditional logistics regression method was used to analyze the influencing factors of the prevalence of depressive symptoms. RESULTS: The 80th percentile interval score of depression score was used as the critical value, and the detection rate of depressive symptoms was 23.61%. It was more likely for women to suffer from depressive symptoms than it was for men. Widowed individuals were at an even higher risk for having depression. The more education one had, the lower the possibility of developing depression. Middle-aged and older adults in rural areas were more likely to suffer from depression. Middle-aged and older adults with chronic diseases and self-rated poor health were at higher risk of depression. Sleep time is a protective factor that suppressed symptoms. After controlling the above-mentioned individual-level factors, middle-aged and older adults in coastal and economically developed areas were less likely to suffer from depression than those from inland and economically underdeveloped areas did. CONCLUSION: The health departments concerned should focus on the depressive symptoms of women, widowed individuals, and middle-aged and older adults with chronic diseases. In rural areas and underdeveloped inland regions, the state should invest more health resources in the prevention and improvement of depression among middle-aged and older adults.

[Influence of Social Capital on the Life Quality of Patients with Chronic Diseases-A Study Based on EQ-5D-5L Scale].

OBJECTIVE: To explore the influence of social capital on the quality of life of patients with chronic non-communicable diseases. METHODS: A multi-phase stratified cluster sampling method was adopted to select the survey respondents. Professionally trained surveyors made home visits in order to conduct face-to-face questionnaire surveys in person. European Quality of Life Five Dimension Five Level Scale (EQ-5D-5L) and a self-developed social capital scale were used to investigate the quality of life and social capital of the respondents. Factor analysis and Cronbach's α coefficient test were done to verify the reliability and validity of the self-developed social capital scale. The χ 2 test and robust Tobit regression model were used to analyze the impact of social capital on the quality of life of patients with chronic non-communicable diseases. RESULTS: The self-developed social capital scale showed excellent performance. The Cronbach's α coefficient was 0.728, the KMO value was 0.716, and the result of Bartlett's test of sphericity was statistically significant ( P<0.001), indicating that the data were well suited for factor analysis. The four common factors cumulatively explained 68.27% of the total variation. The health utility value of the survey respondents was 0.869±0.181. Those who could walk around, shower and dress themselves, and perform usual activities without any problem accounted for 75.70%, 80.10%, and 74.1% of the respondents, respectively. Those who had pain or discomfort and anxiety or depression, with no self-perceived problem were 43.40% and 58.90%, respectively. In the EQ-5D-5L scale, the self-rated health influencing factors of the physical health dimension were community safety and interpersonal network relationships. The influencing factors of social function health was community safety and mental health was affected by community safety, community trust and interpersonal network relationships. When community safety improved by one level, the health utility value of patients with chronic non-communicable diseases increased by 0.046, and when interpersonal network relationships improved by an additional level, their health utility value increased by 0.037. CONCLUSION: The main problem of the quality of life of patients with chronic non-communicable diseases was found in the mental health dimension. In the process of treating chronic non-communicable diseases, attention should also be given to psychological counseling. Community safety and interpersonal network relationships are the protective factors for self-rated health status. Providing a safe community environment and expanding interpersonal networks help improve the health of patients.

Association between baseline and changes in serum uric acid and incident metabolic syndrome: a nation-wide cohort study and updated meta-analysis.

BACKGROUND: To prospectively examine the associations of baseline serum uric acid (SUA) and SUA changes with incident metabolic syndrome (MetS) and update the evidence through a meta-analysis. METHODS: Our analyses were based on the China Health and Retirement Longitudinal Study from 2011-2012 to 2015-2016. The exposures were baseline SUA and SUA changes, and the outcome was incident MetS assessed in 2015-2016. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). A meta-analysis was conducted to synthesize evidence from all cohort studies on the same topic. RESULTS: Of 3779 participants (47.2% men; mean age: 59.5 years) without MetS, 452 participants developed MetS after a follow-up of 4 years. Compared to the lowest quartiles, the adjusted ORs (95% CIs) for MetS were 1.08 (0.77-1.50), 1.32 (0.95-1.82), and 1.55 (1.12-2.16) for three higher quartiles of baseline SUA, and 1.23 (0.89-1.71), 1.39 (1.00-1.93), and 1.89 (1.38-2.58) for three higher quartiles of SUA changes. Each increment of 1 mg/dL of baseline SUA level was associated with 19% higher odds of MetS (adjusted OR 1.19; 95% CI 1.07-1.33). In the meta-analysis of 24 cohort studies among 140,913 participants, the pooled relative risk (95% CI) was 1.32 (1.25-1.40) for the highest versus lowest SUA category, and 1.15 (1.09-1.21) for each 1 mg/dL increase in the SUA level. CONCLUSIONS: Both baseline SUA and longitudinal SUA changes were positively associated with risk of MetS among middle-aged and elderly Chinese, which was supported by findings from a comprehensive meta-analysis across multiple populations. SUA levels might need to be monitored closely for subsequent risk of MetS in clinical practice.

The relationship between urban and rural health insurance and the self-rated health of migrant workers in Southwest China.

BACKGROUND: Following health insurance reforms, China's health care system has made great progress. However, there are still huge differences between the urban and rural health insurance systems. For rural-to-urban migrant workers, there may be differences in the use of urban and rural health insurance to improve their health status. This study aimed to determine whether any disparities exist in the relationship between urban and rural health insurance and the self-rated health (SRH) of migrant workers in Southwest China from the perspective of urban and rural segmentation. METHODS: Using cross-sectional survey data on Southwest China in 2016, a representative data sample drawn from 8507 migrant workers was analysed. An ordinary least squares (OLS) model and instrumental variable (IV) estimation were used to analyse the relationship between urban and rural health insurance and the SRH of migrant workers. RESULTS: Using the IV method to control the endogeneity problems associated with health insurance, this study found that there are differences in the relationship between urban and rural health insurance and the SRH of migrant workers. Urban health insurance is associated with significant improvements in the SRH of migrant workers. Compared with the NRCMS, participating in urban health insurance, including urban employee basic medical insurance (UEBMI) and urban resident basic medical insurance (URBMI), increases the likelihood of migrant workers having better SRH. CONCLUSIONS: There are disparities in the relationship between urban and rural health insurance and the SRH of migrant workers in China. Compared to rural health insurance, urban health insurance has a more positive correlation with the health of migrant workers. Our study shows that it is necessary to integrate urban and rural health insurance to promote social equity.

Association between metabolic syndrome and incident chronic kidney disease among Chinese: A nation-wide cohort study and updated meta-analysis.

AIMS: We prospectively examined the relationship between metabolic syndrome (MetS) and incident chronic kidney disease (CKD) among middle-aged and elderly Chinese, and conducted a systematic review and meta-analysis of all cohort studies on this topic. MATERIALS AND METHODS: Our research data were derived from the China Health and Retirement Longitudinal Study. Participants (n=5752, age ≥45 years) without CKD (defined as estimated glomerular filtration rate <60 ml/min/1.73m2 ) at baseline were followed up for 4 years. We applied logistic regressions to examine the association of MetS with incident CKD. In addition, we pooled our effect estimates and those from previous cohort studies in the meta-analysis. RESULTS: In a 4-years follow-up, 61 (4.27%) developed CKD in participants with MetS versus 102 (2.36%) in participants without MetS. After adjustment for potential confounders, odds ratio for incident CKD was 1.82 [95% confidence interval (95% CI): 1.19-2.78] comparing participants with MetS with those without MetS. There was a linear positive association between the number of MetS components and incident CKD (p for trend <0.001). In the updated meta-analysis of 25 studies among 350,655 participants with 29,368 incident cases of CKD, the pooled relative risk of developing CKD in participants with MetS was 1.34 (95% CI: 1.28-1.39), compared with those without MetS. CONCLUSIONS: Individuals with MetS had higher risk of incident CKD in middle-aged and elderly Chinese adults, which was supported by a comprehensive review of cohort studies from multiple populations. It may be advisable to routinely monitor renal functions among individuals with MetS.

Mediating effect of social support on the association between life events and depression: A cross-sectional study of adolescents in Chongqing China.

ABSTRACT: Depression is one of the most common mental health problems in adolescents. The link between negative life events and depression has been well established. However, our understanding about the role of social support in the link, which is likely culture-dependent, is quite limited. This study aimed to determine the mediating effect of social support on the association between life events and depression in adolescents in Chongqing China.A total of 1512 adolescents aged 12 to 17 years old in Chongqing of China were selected using a stratified cluster sampling strategy. Depression symptoms, negative life events, and perceived social support of the participants were measured using the Children's Depression Inventory, Adolescent Life Event Scale, and Child and Adolescent Social Support Scale, respectively. Pearson correlation analyses were performed to detect their associations. A multivariate linear regression model was established to determine the association between life events and depression after adjustment for variations in socio-demographic variables. The mediating effect of social support on the association between negative life events and depression was tested using the structural equation model.About 16.8% of the participants were detected with depression. Depression was associated with negative life events and low levels of social support (P < .05). Both frequency and perceived importance of social support showed a mediating effect on the association between life events and depression.Social support has a mediating effect on the association between life events and depression. Strengthening social support may be considered as an effective interventional strategy on depression in adolescents.

Global prevalence of congenital heart disease in school-age children: a meta-analysis and systematic review.

BACKGROUND: Congenital heart disease (CHD) is the commonest birth defect. Studies estimating the prevalence of CHD in school-age children could therefore contribute to quantifying unmet health needs for diagnosis and treatment, particularly in lower-income countries. Data at school age are considerably sparser, and individual studies have generally been of small size. We conducted a literature-based meta-analysis to investigate global trends over a 40-year period. METHODS AND RESULTS: Studies reporting on CHD prevalence in school-age children (4-18 years old) from 1970 to 2017 were identified from PubMed, EMBASE, Web of Science and Google Scholar. According to the inclusion criteria, 42 studies including 2,638,475 children, reporting the prevalence of unrepaired CHDs (both pre-school diagnoses and first-time school-age diagnoses), and nine studies including 395,571 children, specifically reporting the prevalence of CHD first diagnosed at school ages, were included. Data were combined using random-effects models. The prevalence of unrepaired CHD in school children during the entire period of study was 3.809 (95% confidence intervals 3.075-4.621)/1000. A lower proportion of male than female school children had unrepaired CHD (OR = 0.84 [95% CI 0.74-0.95]; p = 0.001). Between 1970-1974 and 1995-1999, there was no significant change in the prevalence of unrepaired CHD at school age; subsequently there was an approximately 2.5-fold increase from 1.985 (95% CI 1.074-3.173)/1000 in 1995-1999 to 4.832 (95% CI 3.425-6.480)/1000 in 2010-2014, (p = 0.009). Among all CHD conditions, atrial septal defects and ventricular septal defects chiefly accounted for this increasing trend. The summarised prevalence (1970-2017) of CHD diagnoses first made in childhood was 1.384 (0.955, 1.891)/1000; during this time there was a fall from 2.050 [1.362, 2.877]/1000 pre-1995 to 0.848 [0.626, 1.104]/1000 in 1995-2014 (p = 0.04). CONCLUSIONS: Globally, these data show an increased prevalence of CHD (mainly mild CHD conditions) recognised at birth/infancy or early childhood, but remaining unrepaired at school-age. In parallel there has been a decrease of first-time CHD diagnoses in school-age children. These together imply a favourable shift of CHD recognition time to earlier in the life course. Despite this, substantial inequalities between higher and lower income countries remain. Increased healthcare resources for people born with CHD, particularly in poorer countries, are required.

[Evaluation of Reliability and Validity of EQ-5D-5L Based on Residents in Southwest China].

OBJECTIVE: To explore the reliability and validity of the EQ-5D-5L scale in the population of southwest China. METHODS: The internal consistency reliability is measured by Cronbach's α coefficient and the structural validity is measured by factor analysis. The difference in health utility value of different characteristic populations is compared by t test and analysis of variance. RESULTS: Cronbach's α coefficient was 0.857. Exploratory factor analysis extracts two common factors whose cumulative contribution rate is 77.311%. The first common factor represents mobility, self-care and uaual activities. The second common factor represents pain/discomfort and anxiety/depression. The results of confirmatory factor analysis showed that the correlation of the two common factors was 0.659, the average variance of the first common factor was 0.862 and the combination reliability was 0.949, and the average variance extracted of the second common factor was 0.587 and the composite reliability was 0.739. The factor loadings for mobility, self-care and uaual activities on the first common factor were 0.871, 0.945 and 0.967, respectively. The loadings for pain/discomfort and anxiety/depression on the second common factor were 0.708 and 0.820, respectively. CONCLUSION: EQ-5D-5L has good reliability and validity when it is applied to the measurement of healthy life quality of residents in Southwest China.

Association between obesity status and successful aging among older people in China: evidence from CHARLS.

BACKGROUND: The paper aimed to examine the association between obesity status and successful aging among elderly adults in China and further find gender differences in the effect of components of successful aging on obesity status. METHODS: The data came from the follow-up survey(2015) of China Health and Retirement Longitudinal Study (CHARLS) and 4019 dwellers age 60 and over are included. Obesity status were defined by the body mass index (BMI) according to Chinese criteria. Successful aging was defined following Rowe and Kahn's multidimensional model. Multivariable logistic regression was used to estimate the relationship between obesity status and successful aging. RESULTS: The rate of successful aging in men and women was 18.87 and 9.48% respectively. For BMI, the proportion of population with underweight, overweight and obesity in men was 10.29, 23.04 and 29.63% respectively and that in women was 1.40, 11.69 and 9.47%. Men with obesity (OR = 1.587 95% CI 1.087 ~ 2.316) has an positive relationship with successful aging than normal weight men; Women with underweight (OR = 0.197 95% CI 0.058 ~ 0.824) has an negative relationship with successful aging than normal weight women; Meanwhile, no matter men and women, the relationship between obesity status and successful aging were not significant among oldest adults(≥75 years). CONCLUSION: Obesity status was significantly association with successful aging in young older adults (60-74 years), and the components of successful aging differently were related with the obesity status of male and female.

The influence of job satisfaction, resilience and work engagement on turnover intention among village doctors in China: a cross-sectional study.

BACKGROUND: As the gatekeepers of rural residents' health, teams of village doctors play a vital role in improving rural residents' health. However, the high turnover of village doctors, both individually and collectively, threaten the stability of village medical teams. This research evaluated the influence of job satisfaction, resilience, and work engagement on the village doctors' turnover intention, and explored the mediating role of work engagement and resilience between job satisfaction and the turnover intention of village doctors in China. METHODS: A quantitative study using a self-administered questionnaire containing mostly structured items was conducted among village doctors with a sample size of 2693 from 1345 rural clinics in Shandong province, China, during May and June 2019. All variables including demographic characteristics, job satisfaction, resilience, work engagement and turnover intention were based on available literature, and measured on a 5- or 6-point Likert scale. Such statistical methods as one-way ANOVA, bivariate correlation, exploratory factor analysis (EFA), and Structural Equation Modelling (SEM) were used. RESULTS: Up to 46.9% of the subjects had a higher turnover intention and more than 26.3% of them had a medium turnover intention. The job satisfaction of village doctors could not only have a direct negative effect on turnover intention (ß = - 0.37, p < 0.001), but also have an indirect effect through work engagement (ß = - 0.04,=< 0.001). Meanwhile, work engagement also had a direct negative impact on turnover intention (ß = - 0.13, p < 0.001), and resilience had an indirect negative impact on turnover intention through work engagement (ß = - 0.09, p < 0.001). The above results of this study strongly confirmed that job satisfaction, resilience, and work engagement were early, powerful predicators of village doctors' turnover intention. CONCLUSION: According to the results, the following should be taken seriously to improve job satisfaction: reasonable and fair income, effective promotion mechanism, fair social old-age security, reasonable workload, and strong psychological coping mechanisms for work stress. The turnover intention of village doctors could be reduced through improving job satisfaction, resilience and work engagement.

[The Study of the Relationship Between Community Social Capital and Quality of Life among the Middle-aged and Elderly Rural-to-Urban Residents].

OBJECTIVE: To analyze the relationship between community social capital and quality of life among the middle-aged and elderly rural-to-urban residents, and to provide the policy reference for improving the health status. METHODS: A multi-stage random sampling method was used to select the research objects. Univariate analysis and logistic regression model were used to explore the effect of social capital on quality of life among the middle-aged and elderly rural-to-urban urbanized residents. RESULTS: The scores of self-rated physical health and mental health in the rural-to-urban residents were lower than those of urban residents ( P<0.05). The total score of community social capital, community participation and community cohesion in the rural-to-urban residents were lower than those of urban residents ( P<0.05). The result of multivariate analysis showed that community attachment and community cohesion were the protective factors of physical health ( P<0.05), and community cohesion was the protective factor of mental health ( P<0.05). CONCLUSION: There is a correlation between community belonging, community cohesion and quality of life among the elderly rural-to-urban residents. Attention should be paid to the promotion of community social capital so as to improve the health status of middle-aged and elderly rural-to-urban residents.

[The Effects of Social Capital on Depressive Symptoms of Elderly Patients with Chronic Diseases in Urbanized Communities].

OBJECTIVE: To understand the effects of social capital on depressive symptoms of elderly patients with chronic diseases in urbanized communities, and to explore preventive measures to promote their mental health. METHODS: A multi-stage stratified cluster sampling method was used to extract 740 elderly patients with chronic diseases in the urbanized communities in Chengdu and Kunming. The questionnaire survey was conducted by using the center of depression rating scale (CES-D) and the self-made social capital scale. Multivariate unconditional logistic regression was used to analyze the impact of urbanized residents' social capital on depressive symptoms. RESULTS: The self-made social capital scale has good reliability and validity. The incidence of depressive symptoms in this study was 24.9%. The incidence of depressive symptoms in elderly females with chronic diseases was higher (P < 0.05); the residents with high "sense of social trust and security" had lower risk of incidence of depressive symptoms 〔odds ratio (OR)=0.489〕; the residents with higher "community belonging" had a lower risk of incidence of depressive symptoms (OR=0.570), and the residents with higher "social support" scores had a lower risk of incidence of depressive symptoms (OR=0.233). CONCLUSION: Targeted measures should be taken to intervene in the social capital factors affecting the depressive symptoms of elderly patients with chronic diseases in urbanized communities to improve their mental health.

[Multilevel Modelling on the Prevalence and Determinants of Depressive Symptoms in Middle and Old-aged Rural-to-urban Immigrants in Chengdu].

OBJECTIVE: To determine the prevalence and determinants of depressive symptoms in middle and old-aged rural-to-urban immigrants in Chengdu. METHODS: A total of 1 645 middle and old-aged rural-to-urban immigrants aged over 45 yr. were selected to participate in a questionnaire survey through a multi-stage random sampling method in Chengdu. Multilevel (households and individuals) models were established to identify predictors of depressive symptoms. RESULTS: About 14.5% of respondents reported depressive symptoms. The multilevel model indicated that family clustering of depressive symptoms existed. Household income and length of urban life at the household level, and age, chronic diseases, smoking, and social support at the individual level were significant predictors of depressive symptoms. CONCLUSION: The prevalence of depressive symptoms in middle and old-aged rural-to-urban immigrants deserves increasing policy attention for the purpose of promoting mental health in the population.

Comparison of the psychometric properties of the EQ-5D-3L and SF-6D in the general population of Chengdu city in China.

The EQ-5D-3L and SF-6D are the most commonly used economic evaluation instruments. Data comparing the psychometric properties of the instruments are scarce in the Chinese population. This study compared the psychometric properties of these measures in the Chinese general population in Chengdu.From October to December 2012, 2186 respondents (age ≥18) were selected from urban and rural areas of Chengdu, China, via multistage stratified cluster sampling. Correlations, scatter plots and Bland-Altman plots were used to explore the relationships between the 2 measures. Ceiling and floor effects were used to analyze the score distribution. The known-groups method was used to evaluate discriminant validity.Among 2186 respondents, 2182 completed the questionnaire, and 2178 (18-82 years old, mean 46.09 ±â€Š17.49) met the data quality requirement. The mean scores for the EQ-5D-3LCN, EQ-5D-3LUK, and SF-6DUK were 0.95 (Std: 0.11), 0.93 (Std: 0.15), and 0.79 (Std: 0.12), respectively. The correlations between domains ranged from 0.16 to 0.51. The correlation between the EQ-5D-3LCN and SF-6DUK and between the EQ-5D-3LUK and SF-6DUK was 0.46. The scatter plots and Bland-Altman plots demonstrated poor agreement between the EQ-5D-3L and SF-6D. The floor and ceiling effects were respectively 0.05% and 74.60% for the EQ-5D-3L and 0.05% and 2.53% for the SF-6DUK. The EQ-5D-3LCN, EQ-5D-3LUK and SF-6D have good discriminant validity in different sociodemographic and health condition groups. The SF-6D has higher level of discriminant validity in moderately healthy groups in the EQ-5D-3L full-health population.Both the EQ-5D-3L and SF-6D are valid economic evaluation instruments in the Chinese general population in Chengdu but do not seem to be interchangeable. The EQ-5D-3L has a higher ceiling effect and higher level of discriminant validity among different sociodemographic groups, and the SF-6D has a lower ceiling effect and higher level of discriminant validity in health condition groups. Users may consider the evidence in the choice of these instruments.