Comparison of efficacy and safety of conventional transarterial chemoembolization and drug-eluting bead transarterial chemoembolization in unresectable intrahepatic cholangiocarcinoma: A multicenter retrospective cohort study.

PURPOSE: The efficacy and safety of drug-eluting bead transarterial chemoembolization (DEB-TACE) and conventional TACE (c-TACE) in the treatment of patients with unresectable intrahepatic cholangiocarcinoma (ICC) remained controversial. Therefore, we aimed to compare the efficacy and safety between c-TACE and DEB-TACE among patients with ICC. METHOD: Between June 10, 2016 and November 19, 2022, consecutive patients with pathological diagnoses of ICC were divided into the DEB-TACE group and the c-TACE group based on the type of TACE treatment they received. The Kaplan-Meier method and log-rank test were used to compare overall survival (OS) between the two groups. Propensity score matching (PSM) was used to balance the characteristics between the c-TACE group and the DEB-TACE group. RESULTS: A total of 132 patients were included in this study, with 64 patients in the c-TACE group and 68 patients in the DEB-TACE group. The median OS for c-TACE and DEB-TACE was 5 and 12 months, respectively. The objective response rate (ORR) for c-TACE and DEB-TACE was 0 % and 66.2 %, respectively; the disease control rate (DCR) was 37.5 % and 91.2 %. There were no significant differences between c-TACE and DEB-TACE among adverse effects at 3 months after treatment (P > 0.05). The results remained consistent after PSM. The Cox regression demonstrated that the DEB-TACE was an independent protective factor for OS. CONCLUSIONS: Patients in the DEB-TACE group had longer OS and higher ORR and DCR than those in the c-TACE group, but no significant difference was observed between the two groups regarding adverse effects.

Association of Frailty With Risk of Incident Hospital-Treated Infections in Middle-Aged and Older Adults: A Large-Scale Prospective Cohort Study.

BACKGROUND: Although frailty is associated with a range of adverse health outcomes, its association with the risk of hospital-treated infections is uncertain. METHODS: A total of 416 220 participants from the UK Biobank were included in this prospective cohort study. Fried phenotype was adopted to evaluate frailty, which included 5 aspects (gait speed, physical activity, grip strength, exhaustion, and weight). More than 800 infectious diseases were identified based on electronic health records. Cox proportional models were used to estimate the associations. RESULTS: During a median 12.3 years (interquartile range 11.4-13.2) of follow-up (4 747 345 person-years), there occurred 77 988 (18.7%) hospital-treated infections cases. In the fully adjusted model, compared with participants with nonfrail, the hazard ratios (HRs) (95% confidence intervals [CIs]) of those with prefrail and frail for overall hospital-treated infections were 1.22 (1.20, 1.24) and 1.78 (1.72-1.84), respectively. The attributable risk proportion of prefrail and frail were 18.03% and 43.82%. Similarly, compared to those without frailty, the HRs (95% CIs) of those with frailty for bacterial infections were 1.76 (1.70-1.83), for viral infections were 1.62 (1.44-1.82), and for fungal infections were 1.75 (1.47-2.08). No association was found between frailty and parasitic infections (HR: 1.17; 95% CI: 0.62-2.20). CONCLUSIONS: Frailty was significantly associated with a higher risk of hospital-treated infections, except for parasitic infections. Studies evaluating the effectiveness of implementing frailty assessments are needed to confirm our results.

Association between new-onset atrial fibrillation and dementia among individuals with type 2 diabetes.

AIM: To assess the association between new-onset atrial fibrillation and dementia among patients with type 2 diabetes, a group with a high prevalence of atrial fibrillation. MATERIALS AND METHODS: This cohort study included 22 989 patients with type 2 diabetes from the UK Biobank. New-onset atrial fibrillation was ascertained from hospital admission records. We used an algorithm officially released by the UK Biobank to identify all-cause dementia, Alzheimer's disease and vascular dementia. The algorithm was developed using multiple sources, including hospital admissions and the death registry. Time-varying Cox regression analyses were performed to investigate the association between new-onset atrial fibrillation and dementia. RESULTS: A total of 2843 participants developed atrial fibrillation, whereas the remaining 20 146 did not. During the median of 12.3 years of follow-up, 844 all-cause dementia, 342 Alzheimer's disease and 246 vascular dementia cases occurred. Compared with participants without atrial fibrillation, those with atrial fibrillation had higher risks of all-cause dementia (hazard ratio [HR] 2.15, 95% confidence interval [CI] 1.80-2.57), Alzheimer's disease (HR 1.44, 95% CI 1.06-1.96) and vascular dementia (HR 3.11, 95% CI 2.32-4.17). CONCLUSIONS: New-onset atrial fibrillation was associated with a substantially higher risk of all-cause dementia, Alzheimer's disease and vascular dementia in patients with type 2 diabetes. Our findings highlight the significance of atrial fibrillation management in mitigating the risk of dementia in this demographic.

L-shaped association between lean body mass to visceral fat mass ratio with hyperuricemia: a cross-sectional study.

BACKGROUND: Insufficient attention has been given to examining the correlation between body composition and hyperuricemia, leading to inconsistent findings. The primary objective of this research is to explore the association between lean body mass index (LMI), visceral fat mass index (VFMI), and hyperuricemia. A specific emphasis will be placed on assessing the link between the ratio of lean body mass to visceral fat mass (LMI/VFMI) and hyperuricemia. METHODS: The present study employed a cross-sectional design and involved a total of 9,646 individuals who participated in the National Health and Nutrition Examination Survey (NHANES). To explore the associations among the variables, logistic and linear regressions were employed. Additionally, subgroup analyses and sensitivity analyses were conducted based on various characteristics. RESULTS: The results showed that LMI was positively associated with hyperuricemia (for Per-SD: OR = 1.88, 95%CI: 1.75, 2.01; for quartiles [Q4:Q1]: OR = 5.37, 95%CI: 4.31, 6.69). Meanwhile, VFMI showed a positive association with hyperuricemia (for Per-SD: OR = 2.02, 95%CI: 1.88, 2.16; for quartiles [Q4:Q1]: OR =8.37, 95%CI: 6.70, 10.47). When considering the effects of In LMI/VFMI, an L-shaped negative association with hyperuricemia was observed (for Per-SD: OR = 0.45, 95%CI: 0.42, 0.49; for quartiles [Q4:Q1]: OR = 0.16, 95%CI: 0.13, 0.20). Subgroup and sensitivity analyses demonstrated the robustness of this association across different subgroups. Additionally, the segmented regression analysis indicated a saturation effect of 5.64 for the In LMI/VFMI with hyperuricemia (OR = 0.20, 95%CI: 0.17, 0.24). For every 2.72-fold increase of In LMI/VFMI, the risk of hyperuricemia was reduced by 80%. CONCLUSION: The LMI/VFMI ratio is non-linearly associated with serum uric acid. Whether this association is causal needs to be confirmed in further longitudinal studies or Mendelian randomization.

Association of Socioeconomic Status and a Broad Combination of Lifestyle Factors With Adult-Onset Asthma: A Cohort Study.

BACKGROUND: The prevalence of asthma is gradually increasing worldwide, and there are socioeconomic inequalities in the risk of developing asthma. OBJECTIVE: To evaluate whether the lifestyle is associated with asthma in adults, as well as whether and to what extent healthy lifestyles may modify socioeconomic status (SES) inequities in asthma. METHODS: This study included a total of 223,951 participants from the UK Biobank. Smoking, physical activity, alcohol consumption, healthy diet patterns, sedentary time, and sleep duration items were used to construct the lifestyle score. Income, education, and occupation were used to assess SES. Cases of adult-onset asthma were identified on the basis of electronic health records. The Cox proportional hazards regression was used to explore the association of socioeconomic inequality and lifestyle factors with asthma. RESULTS: Compared with the most healthy lifestyle category, the hazard ratios (95% CIs) of the moderately healthy lifestyle and least healthy lifestyle categories for asthma were 1.08 (1.01-1.15) and 1.29 (1.20-1.39), respectively. A significant interaction (Pinteraction < .05) was found between lifestyle categories and SES, and the association between them was more pronounced in participants with low SES (hazard ratioleast healthy vs most healthy, 1.58; 95% CI, 1.40-1.80). The joint analysis revealed that the risk of asthma was highest among participants with the lowest SES and the least healthy lifestyles (hazard ratio, 2.02; 95% CI, 1.74-2.33). CONCLUSIONS: Unhealthy lifestyle factors are associated with an increased risk of asthma in adults, and socioeconomically disadvantaged groups are more negatively affected by unhealthy lifestyles. Public health strategies for asthma prevention may need to be tailored according to SES, and social policies to reduce poverty are needed alongside lifestyle interventions in areas of deprivation.

High Precision Positioning and Rotation Angle Estimation of a Flatbed Truck Based on BDS and Vision.

Centimeter-level localization and precise rotation angle estimation for flatbed trucks pose significant challenges in unmanned forklift automated loading scenarios. To address this issue, the study proposed a method for high-precision positioning and rotation angle estimation of flatbed trucks using the BeiDou Navigation Satellite System (BDS) and vision technology. First, an unmanned forklift equipped with a Time-of-Flight (ToF) camera and a dual-antenna mobile receiver for BDS positioning collected depth images and localization data near the front and rear endpoints of the flatbed. The Deep Dual-Resolution Network-23-slim (DDRNet-23-slim) model was used to segment the flatbed from the depth image and extract the straight lines at the edges of the flatbed using the Hough transform. The algorithm then computed the set of intersection points of the lines. A neighborhood feature vector was designed to identify the endpoint of a flatbed from a set of intersection points using feature screening. Finally, the relative coordinates of the endpoints were converted to a customized forklift navigation coordinate system by BDS positioning. A rotation angle estimation was then performed using the endpoints at the front and rear. Experiments showed that the endpoint positioning error was less than 3 cm, and the rotation angle estimation error was less than 0.3°, which verified the validity and reliability of the method.

Systemic chemotherapy plus transarterial chemoembolization versus systemic chemotherapy alone for unresectable intrahepatic cholangiocarcinoma: a multicenter retrospective cohort study.

PURPOSE: Systemic chemotherapy (SYS) is the first-line treatment of unresectable intrahepatic cholangiocarcinoma (ICC). However, the survival benefit of SYS is still limited. This study compared the efficacy and safety of patients with unresectable ICC treated with transarterial chemoembolization (TACE) plus SYS to SYS alone. MATERIAL AND METHODS: The multicenter retrospective cohort study included patients aged ≥ 18 years old with pathologically diagnosed ICC. Patients with unmeasurable lesions, not receiving SYS treatment, Child-Pugh grade C, Eastern Cooperative Oncology Group performance status score of 3 or higher, prior liver resection, incomplete medical information, or discontinuation of the first SYS treatment were excluded. Data collection was mainly from the hospital system, and the survival outcome of patients was obtained through follow-up. Overall survival (OS) was estimated using the Kaplan-Meier method and compared using the log-rank test. Propensity score matching at a 1:1 ratio using the nearest neighbor matching algorithm was performed to reduce selection bias between the TACE plus SYS and SYS alone groups. The Cox proportional hazards model was used to identify prognostic factors associated with OS and to estimate their hazard ratios. Modified Response Evaluation Criteria in Solid Tumors criteria were utilized to evaluate the response of tumors to therapy. RESULTS: Between June 2016 and February 2023, 118 unresectable ICC patients from three hospitals were included in this study. Of them, 37 were in the TACE plus SYS group and 81 were in the SYS alone group. The median OS in the combination group was 11.3 months, longer than the 6.4 months in the SYS alone group (P = 0.011). A greater objective response rate (ORR) and disease control rate (DCR) were observed in the combination group than in the SYS alone group (ORR, 48.65 vs. 6.17%, P < 0.001; DCR, 89.19 vs. 62.96%, P = 0.004). There were 16 patients in each group after matching, and the matched results remained consistent regarding OS and tumor response. Adverse events (AEs) were similar in the two groups after matching. CONCLUSION: Compared to SYS alone, the combination treatment of TACE plus SYS was more effective than SYS alone in improving OS, ORR, and DCR without any significant increase in AEs. TACE plus SYS may be a viable treatment option for patients with unresectable ICC.

Prevalence of self-medication with antibiotics and its related factors among the general public and health professionals during the COVID-19 pandemic: A cross-sectional study in China.

BACKGROUND: Self-medication with antibiotics (SMA) is a common public health concern. This study aimed to assess the prevalence of SMA in the general public and health professionals during the COVID-19 pandemic and identify the associated factors. METHODS: A cross-sectional study was conducted from October 28, 2022, to November 6, 2022. Logistics regression analysis was used to examine the associated factors. RESULTS: The rate of SMA was 10.25% in the general public and 12.69% in health professionals. For the public, those who perceived themselves as average or good health, had moderate antibiotic knowledge, and had easy access to nearby health facilities were less likely to SMA; while those who live in rural areas, found it easy to purchase antibiotics without prescriptions, and those who frequently encountered antibiotics recommended by pharmacy staff were more likely to SMA. For health professionals, those who were female, perceived themselves as good health, had moderate or high antibiotic knowledge, and had easy access to health facilities were less likely to SMA; while those who found it easy to purchase antibiotics without prescriptions were more likely to SMA. CONCLUSIONS: SMA is prevalent in both the general public and health professionals. Promoting the rational use of antibiotics requires joint participation and effort.

Prevalence of occupational injury and its associated factors among emergency department physicians in China: A large sample, cross-sectional study.

BACKGROUND: Medical personnel, particularly emergency department (ED) physicians, face a variety of occupational hazards. However, the current state of occupational injuries among ED physicians remains unknown. This study aimed to assess the occupational injury of Chinese ED physicians and to identify its associated factors. METHODS: From July to August 2018, a cross-sectional survey was conducted in Chinese emergency departments. A structured questionnaire covering sociodemographic characteristics, individual health behaviours, and work-related characteristics was completed by 10,457 ED physicians. Binary logistic regression was used to analyse the factors associated with occupational injuries. RESULTS: In this study, 81.13% of ED physicians reported occupational injuries in the previous 12 months. All participants who had experienced occupational injuries had suffered verbal violence. Among physicians who experienced at least one injury, 76.57% and 71.30% reported injuries sustained while moving patients and from falls, slips, and sprains during office visits, respectively. Occupational injuries were significantly associated with gender, education level, drinking behaviour, sleep quality, the frequency of night shifts per month, self-perceived physician shortage, and work-family conflict. Physicians who experienced effort-reward imbalance were at a higher risk of occupational injury. CONCLUSION: In China, occupational injuries are common among ED physicians. Individual factors as well as work-related factors are independently linked to occupational injuries. To reduce the rate of occupational injuries among ED physicians, health policymakers and healthcare facility managers should consider multi-injury interventions.

Prevalence and associated factors for depressive symptoms among the general population from 31 provinces in China: The utility of social determinants of health theory.

BACKGROUND: Depression is one of the most common types of mental disorders. Guided by the theory of social determinants of health (SDH), the study aimed to assess the prevalence of depressive symptoms and to identify factors related to depressive symptoms in the general population of China. METHODS: A cross-sectional, online survey was conducted among 101,392 residents from 31 provinces of mainland China from January to March 2019, and 97,126 survey responses were included in the final analysis. Multilevel linear regression models were used to identify SDH associated with depressive symptoms. RESULTS: The prevalence of depressive symptoms (PHQ-9 scores ≥10) in Chinese residents was 15.81 %. The results of the multilevel analysis demonstrated that depressive symptoms were affected by various factors on five levels, including individual characteristics, behavioral lifestyle, community support network, social structural factors, and macro social factors. LIMITATIONS: The cross-sectional design of the study makes it difficult to establish causality between variables. CONCLUSIONS: The prevalence of depressive symptoms is high among general population in China. According to the theory of SDH, the study shows that the depressive symptoms are complex and involves all areas of social life. Therefore, adopting a multi-level, cross-sectoral intervention approach will be instrumental to improving the mental health of residents in China.

Prevalence and related factors of non-adherence to antibiotics among the general public: a cross-sectional study in China.

OBJECTIVES: This study aims to assess the prevalence and associated factors of non-adherence to antibiotics (NAA) during COVID-19. METHODS: A cross-sectional study was conducted from 28 October 2022 to 6 November 2022. A structured questionnaire was widely distributed on an online survey platform. Of the 8664 respondents, 7730 were included in the final analysis. Logistic regression analysis was used to examine the associated factors of NAA. RESULTS: Of the 7730 participants, 17.83% reported antibiotic use in the past month, of which 53.05% had NAA. Those who aged over 60 years old, perceived their economy as good, had moderate or good antibiotic knowledge, and with high convenience to medical services and medicines were less likely to NAA (p < 0.05); while those with chronic diseases, living in Western or Northeastern China, and those who used non-prescription antibiotics were more likely to NAA (p < 0.05). CONCLUSION: The prevalence of NAA remains at high levels in the general public. Targeted health education needs to be conducted in communities, pharmacies and health facilities to overcome misconceptions about antibiotics and to encourage people to seek formal medical care when ill, in order to improve public adherence to antibiotics.

Prevalence of sleep disturbances and associated factors among Chinese residents: A web-based empirical survey of 2019.

Background: To identify the prevalence of sleep disorders in China through a large sample study. To explore the relevant social determinants affecting residents' sleep status at both individual and provincial levels based on the theoretical framework of the Dahlgren-Whitehead model. Methods: A nationwide cross-sectional web-based survey was conducted from January 20 to February 28, 2019 across 31 provinces of China. The Pittsburgh Sleep Quality Index was used to evaluate residents' sleep quality. Multilevel linear regression analysis was used to analyse the influencing factors of sleep disorder. Results: A sample of 107 650 residents completed the survey, and 94 454 questionnaires were included in the final analysis. The crude incidence rate and the age-adjusted rate of sleep disorder in Chinese residents were 19.16% and 21.25%, respectively. Those who were older, female, smokers, drinkers, married, divorced, or widowed, retired, more educated (regression coefficient (b) = 0.172, P < 0.05), had worse self-perceived economic status, and lived far away from community health services (b = 0.758, P < 0.05) were more likely to have sleep problems. Physical exercise, social support (b = -1.705, P < 0.05), and greening coverage of residential areas (b = -1.769, P < 0.05) were protective factors for residents' sleep quality. Conclusions: Sleep disorders are prevalent in the Chinese population, with varying incidence rates across provinces. To improve sleep quality, the Chinese government and health management departments should pay more attention to vulnerable groups and promote healthy lifestyles through education. Additionally, the social network can be utilized to provide social support. Improving the ecological environment and daily living environment is also essential.

Lifestyle Factors in the Association of Shift Work and Depression and Anxiety.

IMPORTANCE: Shift work may lead to adverse health outcomes. Whether shift work is associated with depression and anxiety, and to what extent lifestyle mediates the associations, remains unknown. OBJECTIVE: To explore the associations of shift work, its type, frequency, and working years with anxiety and depression and to examine the potential mediating role of lifestyles. Design, Setting, and Participants: This cohort study included 175 543 employed or self-employed workers who participated in the UK Biobank baseline survey (2006-2010). Data analysis was conducted from November 2022 to January 2023. EXPOSURES: Employment and shift work status information was obtained from baseline. Lifestyles included smoking, physical activity, alcohol consumption, dietary characteristics, sleep duration, sedentary time, and body mass index (BMI). MAIN OUTCOMES AND MEASURES: Depression and anxiety were identified based on electronic health records. Cox proportional hazard regression models were used to calculate the association of shift work with anxiety and depression, and cause mediation analyses we used to test the mediating role of lifestyle factors in this association. RESULTS: Of the 175 543 included participants (mean [SD] age, 52.6 [7.1] years; 88 290 men [50.3%]; 167 495 White participants [95.4%]), 27 637 participants (16.2%) reported shift work. During a median (IQR) follow-up of 9.06 (8.35-9.75) years, 3956 workers (2.3%) developed depression and 2838 (1.7%) developed anxiety. In the fully adjusted model, individuals who reported engaging in shift work, or shift workers, had a higher risk of depression (HR, 1.22; 95% CI, 1.12-1.33; P < .001) and anxiety (HR, 1.16; 95% CI, 1.04-1.28; P < .001), and the risk was positively associated with shift frequency. Among shift workers, there was no significant difference between night shifts and nonnight shifts. In the dose-association analyses, years of shift work were negatively associated with the risk of depression and anxiety. Smoking, sedentary time, BMI, and sleep duration were identified as the main potentially modifiable mediators. These mediators together explained 31.3% of the association between shift work and depression and 21.2% of the association between shift work and anxiety. CONCLUSIONS AND RELEVANCE: In this cohort study, shift work was significantly associated with a higher risk of depression and anxiety, and lifestyle factors partially mediated the associations. These findings not only support that shift work should be considered an occupational hazard, but also provide evidence for the urgent need for the development of public health interventions that promote healthy lifestyles aimed at improving the mental health of shift workers.

Body weight, weight change and the risk of cardiovascular disease in patients with hypertension: a primary-care cohort study.

BACKGROUND/OBJECTIVES: Obesity and cardiovascular disease (CVD) often co-occur. However, the effects of excessive body weight and weight change on CVD in patients with hypertension are not clearly established. We examined the associations of BMI, weight change and the risk of CVD in patients with hypertension. SUBJECTS/METHODS: Our Data were drawn from the medical records of primary-care institutions in China. A total of 24,750 patients with valid weight measurements attending primary healthcare centers were included. Body weight were grouped in BMI categories of underweight ( < 18.5 kg/m2), healthy weight (18.5-22.9 kg/m2), overweight (23.0-24.9 kg/m2) and obesity ( ≥ 25.0 kg/m2). Weight change over 12 months was divided into: gain >4%, gain 1-4%, stable (-1 to 1%), loss 1-4%, and loss ≥4%. Cox regression analyses were used to estimate hazard ratio (HR) and 95% confidence interval (95% CI) between BMI, weight change and the risk of CVD. RESULTS: After multivariable adjustment, patients with obesity were related to higher risks of CVD (HR = 1.48, 95% CI: 1.19-1.85). Higher risks were seen in participants with loss ≥4% and gain >4% of body weight compared to stable weight (loss ≥4%: HR = 1.33, 95% CI: 1.04-1.70; gain >4%: HR = 1.36, 95% CI: 1.04-1.77). CONCLUSION: Obesity and weight change of loss ≥4% and gain >4% were related to higher risks of CVD. Close monitoring and appropriate interventions aimed at achieving an optimal weight are needed to prevent adverse cardiovascular outcomes for patients with hypertension.

Association between neck circumference and diabetes mellitus: a systematic review and meta-analysis.

BACKGROUND: Despite that several original researchers have investigated the association between neck circumference (NC) and the risk of diabetes mellitus (DM), their results remain controversial. This review aimed to quantitatively determine the risk of DM in relation to the NC. METHODS: We conducted a literature search of PubMed, Embase, and the Web of Science from these databases' inception through September 2022 to identify observational studies that examined the association between NC and the risk of DM. A meta-analysis of the random-effects model was applied to combine the results of the enrolled studies. RESULTS: Sixteen observational studies involving 4,764 patients with DM and 26,159 participants were assessed. The pooled results revealed that NC was significantly associated with the risk of type 2 DM (T2DM) (OR = 2.17; 95% CI: 1.30-3.62) and gestational DM (GDM) (OR = 1.31; 95% CI: 1.17-1.48). Subgroup analysis revealed that after controlling for BMI, the relationship between the NC and T2DM remained statistically significant (OR = 1.94; 95% CI: 1.35-2.79). Moreover, the pooled OR of T2DM was found to be 1.16 (95% CI: 1.07-1.27) for an increment per each centimeter in the NC. CONCLUSIONS: Integrated epidemiological evidence supports the hypothesis that a greater NC is associated with an increased risk of T2DM and GDM.

Associations of social jetlag with depressive symptoms among adults in Southern China: a cross-sectional study.

To investigate the associations between social jetlag and depressive symptoms and further analyze the interaction of social jetlag and chronic diseases on depressive symptoms among adults. Data were derived from a cross-sectional survey. Information on social jetlag, depressive symptoms, demographic characteristics, lifestyles, and health situations were collected via a structured self-administered questionnaire. The multivariable logistic regression analyses and restricted cubic splines regression were performed to test the association between social jetlag and depressive symptoms. The multiplicative model was applied to analyze the interaction of social jetlag and chronic disease on depressive symptoms. A total of 5818 adults were included and the prevalence of social jetlag was 22.95%. After multivariable adjustment, adults who experienced more than 2 hours of social jetlag had a significantly greater risk of depressive symptoms (OR = 1.43,95%CI:1.00-2.05, P = 0.049). Compared with participants having<1 hour of social jetlag and no chronic disease, participants having chronic disease were more likely to report depressive symptoms(OR = 3.22,95%CI = 2.59-4.00, P < 0.001). Moreover, among those who have chronic disease, the greater the social jetlag they reported, the greater risk of depressive symptoms they have (OR = 3.81,95%CI = 2.77-5.33, P < 0.001; OR = 4.08,95%CI = 2.24-7.43, P < 0.001). Social jetlag was linearly associated the with risk of depressive symptoms, according to restricted cubic splines. This study shows that 22.95% adults experience more than 1 hour of social jetlag. Social jetlag was positively associated with an increased risk of depressive symptoms. Among those who have chronic disease, the greater the social jetlag they reported, the greater risk of depressive symptoms they have.

Worldwide dispensing of non-prescription antibiotics in community pharmacies and associated factors: a mixed-methods systematic review.

This mixed-method systemic review estimated the pooled prevalence of non-prescription antibiotic dispensing in community pharmacies worldwide and identified associated factors influencing the practice. 162 studies covering 52 countries were included. The pooled prevalence of community pharmacy non-prescription antibiotic dispensing was 63·4% (95% CI 59·6-67·1). The prevalence was significantly higher in low-income countries than in high-income countries. Additionally, the situation of dispensing antibiotics without prescriptions has not improved over time in the past two decades. Quantitative studies showed that pharmacies located in poorer economic areas, pharmacy staff who were also the pharmacy owners, and private pharmacies were more likely to dispense non-prescription antibiotics. Qualitative findings suggested four major factors driving antibiotics being dispensed without a prescription. First, strong customer demand for non-prescription antibiotics and a lack of relevant knowledge; second, pharmacy staff motivated by financial or personal viewpoints; third, alternative health-care services being expensive or inconvenient, or having irregular prescribing practices; and finally, weak social, industry, and legal regulation. The current antibiotic stewardship needs to be strengthened.

How work-family conflict influences emergency department nurses' turnover intention: The mediating role of positive and negative affect.

BACKGROUND: Turnover has significant impact on nursing management and nursing safety. Nurses working in the Emergency Department are especially vulnerable to high turnover intention because of their increased risk of work-family conflict associated with the work characteristics. OBJECTIVE: This study aimed to investigate the effects of work-family conflict on emergency nurses' turnover intention and the role of positive and negative affect between work-family conflict and turnover intention. METHODS: A cross-sectional study. Data were collected from 17582 nurses working in emergency department in China. We employed a standardized questionnaire to collect sociodemographic information and target work-family conflict, affect and turnover intention. Mediation analyses were performed for the data analyses. RESULTS: On turnover intention, work-family conflict exerted both direct effect and indirect effect. The results also indicated that positive and negative affect partially mediated the effect of work-family conflict on turnover intention, and that 35.7% of this effect could be explained by mediating effects totally. CONCLUSIONS: The findings highlight positive and negative affect concern during the process of nursing management and nursing managers should take active measures to reduce negative affect and improve positive affect in order to reduce turnover intention and maintain the stability of the emergency nursing workforce.

Engagement in leisure activities and cognitive function by socioeconomic groups in China: A prospective cohort study.

OBJECTIVE: To investigate whether the effects of leisure activities on cognition differ among socioeconomic groups and the effects of changes in the frequency of habitual leisure activities on cognition. METHODS: We included 5869 older adults from the Chinese Longitudinal Healthy Longevity Survey (2008-2014). Five typical leisure activities were used to calculate the Leisure Activity Index (LAI). The Mini-Mental State Examination was used to assess cognition. Latent class analysis was used to construct the overall socioeconomic status (SES). Cox proportional hazard regression was applied to explore the associations and further stratified the analysis by SES. RESULTS: Participants in the highest quartile of LAI had a 50 % lower risk of developing cognitive impairment compared with the lowest quartile of LAI (HR: 0.50, 95 % CI: 0.40-0.62) (Ptrend < 0.01). Compared with participants who participated in leisure activities with increased frequency during the follow-up period, the HR (95 % CIs) of participants with no change in frequency was 3.10 (2.39-4.01), and that of participants with decreased frequency was 2.34 (1.81-3.04). A significant interaction between LAI and SES were found (Pinteraction = 0.02). The association between LAI and cognitive function was more pronounced in participants with high SES (HRQ4 vs Q1: 0.31, 95 % CI: 0.16-0.59) than in participants with low SES (HRQ4 vs Q1: 0.61, 95 % CI: 0.45-0.83). CONCLUSIONS: Leisure activities may have significant benefits in preventing cognitive impairment. However, promoting leisure activities alone may not substantially reduce socioeconomic inequalities in cognitive health. Measures addressing the social determinants of cognitive health still need to be further explored.