JOBS Program Germany for health promotion among the unemployed in the community setting with institutions for employment promotion (JobsProgramDtl): study protocol for a randomized controlled trial.

BACKGROUND: Compared to the employed, the unemployed are characterized by a substantially worse health status, particularly with regards to mental health. At the same time, conventional offers of prevention and health promotion rarely reach the unemployed. The JOBS Program is a health promotion program that combines job application training with elements of social learning theory and self-efficacy. Randomized field studies in the USA and Finland found significant positive effects on reintegration into the labor market and health amongst the unemployed. In this confirmatory study, we analyze whether the JOBS Program produces similar positive effects for the unemployed in Germany. METHODS: This study is designed as a country-wide, multi-center, non-blinded, two-armed, parallel-group, randomized controlled trial over 6 months. A total of approximately 1500 unemployed, who are willing to participate, are randomly assigned either to an intervention group or a waiting control group with an allocation ratio of 1:1. Guided by a team of two trainers, the intervention group completes JOBS Program Germany in small groups of 8 to 15 unemployed for a period of 1 week in units of 5 h a day. Primary outcome measures are the reintegration into the labor market, self-efficacy, life satisfaction, subjective state of health, depressive symptoms, and psychological distress. Of secondary interest are moderating variables such as socio-demographic characteristics, the duration of unemployment, and the job-search intensity. Outcomes will be repeatedly assessed via computer-assisted telephone interviews at three points in time: immediately before the intervention (pre-test), immediately after the intervention (post-test), and 6 months after the intervention has ended (6-months follow-up). DISCUSSION: This confirmatory study will provide empirical evidence on the effectiveness of the JOBS Program on the reintegration and (mental) health of the unemployed in Germany. If our results from the randomized controlled trail in a country-wide field experiment confirm its effectiveness, the JOBS Program Germany could, perspectively, be implemented into the German employment promotion and social security system on a long-term basis. TRIAL REGISTRATION: German Clinical Trials Register (DRKS), DRKS00022388 . Registered on 20 July, 2020.

[Assessment of health risks due to heat and fine particles in Germany: an epidemiological study approach]. / Erfassung von hitze- und feinstaubbedingten Gesundheitsrisiken in Deutschland: Ein epidemiologischer Studienansatz.

BACKGROUND: Exposure to heat and particulate matter is a cause of increased mortality. Climate change and increasing climate variability exacerbate these problems. Experts require assessments with which health risks and the success of preventative measures can be estimated. We implemented an ecological study approach to assess these risks at both small and large scales of reference levels (Federal Republic of Germany and territorial authority). METHODS: We utilised a case-crossover design to investigate the relationship between exposure and mortality. This study design uses a logistic regression model. Analogously to a matched case-control study, the odds ratio maps the effect strength. The study period included the years 2002-2006. RESULTS: The analysis demonstrated health risks from exposure to heat for the German population (OR 1.1529, 95% CI 1.1517-1.1541; adjusted OR 1.0658). Significant evidence of a health risk was also documented for exposure to particulate matter (PM10; OR 1.2987, 95% CI 1.2951-1.3024; adjusted OR 1.0128). The risk does not significantly differ for women versus men; the variable age was also not significant at the level of the country-wide analysis, but for a few subordinate units of space. This study approach can be adapted for assessments at varying levels of reference and periods of time as well as for different populations. DISCUSSION: The methodological approach is useful for a reproducible study design. Nevertheless, other influencing factors such as ozone or PM2.5 should be incorporated in subsequent analyses to clarify whether these factors skew the results. Further analysis would also be useful to investigate if and to what extent socio-structural and socio-economic factors affect the associated risk.

Sense of coherence and associated factors among university students in China: cross-sectional evidence.

BACKGROUND: Sense of Coherence (SOC) is considered as a health-promoting resource; it is mainly developed before the age of 30. The multiple demands university students face, such as study-related stress and financial difficulty, could challenge their SOC development. This study aimed to: 1) investigate the association between SOC, socio-demographic and lifestyle-related characteristics; 2) assess the effect of perceived stress on SOC controlling for other variables among the Chinese university students. Analyses were done to derive a better view on possible strategies to strengthen students' SOC and with that to promote their health. METHODS: The data used were from a Chinese university student health survey (N = 1,853). Logistic regression analyses were used to explore the effects of varied socio-demographic, lifestyle-related variables on students' level of SOC, as well as the association between perceived stress and SOC controlling for other variables in the analysis. RESULTS: Both social support (OR = 2.56 [1.87-3.50]) and better performance compared with peers (OR = 1.64 [1.15-2.34]) were associated with a stronger SOC. Not feeling isolated at university (OR = 1.60 [1.04-2.47]) and satisfaction with the political situation (OR = 2.05 [1.57-2.67]) were also associated with a stronger SOC. This counts also for high health awareness (OR = 1.40 [1.05-1.87]) and nutrition importance (OR = 1.67 [1.04-2.69]). Perceived stress (OR = 0.81 [0.79-0.83]) was negatively associated with a strong SOC when controlling for socio-demographic and lifestyle-related variables. CONCLUSION: We suggest integrating stress coping, emotion management training programmes as well as measures promoting social integration for students and teachers at campus, promoting healthy behaviours, and creating a supportive learning environment as strategies for enhancing the SOC level of university students in China.

High HIV prevalence and risk of infection among rural-to-urban migrants in various migration stages in China: a systematic review and meta-analysis.

BACKGROUND: Rural-to-urban migrants represent 17% of the total Chinese population and are considered a potential high-risk bridging population of HIV infection between urban and rural China. METHOD: Based on a systematic review and meta-analysis, this study determined HIV prevalence among rural-to-urban migrants in different stages of migration. This review was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS: We identified 54 studies reporting 59 HIV prevalence levels among rural-to-urban migrants in China. Overall, 53.4% (95% confidence interval, 33.5%-72.4%) of urban patients with HIV have migratory background. The floating-out population showed a higher HIV prevalence (0.15% [0.06%-0.34%]) than did the Chinese population (0.057%; odds ratio, 2.63 [1.35-5.14]). The floating-in population showed a higher HIV prevalence (0.38% [0.29%-0.50%]), corresponding to 6.70 (6.05-7.41) times greater odds of HIV infection. Higher prevalence levels were observed among female migrants (0.69% [0.51%-0.93%]), reflecting a much higher odds of HIV infection (12.18 [11.11-13.35]). Infection risk among returning migrants (0.18% [0.12%-0.29%]) was 3.16 (2.06-4.84) times higher than the overall Chinese population. Chinese internal migrants contribute to a substantial amount of the overall HIV epidemic in China. CONCLUSION: Migrants are at greater risk for HIV infection than the general Chinese population and likely to facilitate the geographical spread of HIV in China. Targeted strategies for health promotion and HIV prevention for migrants in China should be developed.

Quantifying the burden of disease due to premature mortality in Hong Kong using standard expected years of life lost.

BACKGROUND: To complement available information on mortality in a population Standard Expected Years of Life Lost (SEYLL), an indicator of premature mortality, is increasingly used to calculate the mortality-associated disease burden. SEYLL consider the age at death and therefore allow a more accurate view on mortality patterns as compared to routinely used measures (e.g. death counts). This study provides a comprehensive assessment of disease and injury SEYLL for Hong Kong in 2010. METHODS: To estimate the SEYLL, life-expectancy at birth was set according to the 2004 Global Burden of Disease study at 82.5 and 80 years for females and males, respectively. Cause of death data for 2010 were corrected for misclassification of cardiovascular and cancer causes. In addition to the baseline estimates, scenario analyses were performed using alternative assumptions on life-expectancy (Hong Kong standard life-expectancy), time-discounting and age-weighting. To estimate a trend of premature mortality a time-series analysis from 2001 to 2010 was conducted. RESULTS: In 2010 524,706.5 years were lost due to premature death in Hong Kong with 58.3% of the SEYLL attributable to male deaths. The three overall leading single causes of SEYLL were "trachea, bronchus and lung cancers", "ischaemic heart disease" and "lower respiratory infections" together accounting for about 29% of the overall SEYLL. Further, self-inflicted injuries (5.6%; ranked 5) and liver cancer (4.9%; ranked 7) were identified as important causes not adequately captured by classical mortality measures. Scenario analyses highlighted that by using a 3% time-discount rate and non-uniform age-weights the SEYLL dropped by 51.6%. Using Hong Kong's standard life-expectancy values resulted in an overall increase of SEYLL by 10.8% as compared to the baseline SEYLL. Time-series analysis indicates an overall increase of SEYLL by 6.4%. In particular, group I (communicable, maternal, perinatal and nutritional) conditions showed highest increases with SEYLL-rates per 100,000 in 2010 being 1.4 times higher than 2001. CONCLUSIONS: The study stresses the mortality impact of diseases and injuries that occur in earlier stages of life and thus presents the SEYLL measure as a more sensitive indicator compared to classical mortality indicators. SEYLL provide useful additional information and supplement available death statistics.

Sexual dysfunction during methadone maintenance treatment and its influence on patient's life and treatment: a qualitative study in South China.

Methadone maintenance treatment (MMT) has become an important modality of substitution treatment for opioid addicts in China since 2006. However, data are limited regarding the change in sexual function from heroin use to MMT and the influence of sexual dysfunction (SD) during MMT on patient's life and treatment. Face-to-face in-depth interviews were conducted with 13 male and 14 female MMT patients, five of their partners, and three clinicians. The interviews took place in four MMT clinics in Guangdong Province between August 2010 and February 2011. The patients and their partners were asked separately for their perceptions of patient's sexual function during MMT, and the influence of SD on personal/family life and treatment. The main SD problems patients perceived were libido inhibition and decreased sexual pleasure. Methadone was thought to have a stronger inhibition effect on sexual desire than heroin. SD decreased quality of patient's sexual life and damaged intimate relationships. There was a gender difference in coping with SD. Men generally tended to refuse, escape, or alienate their partners. Women tended to hide sexual listlessness, endure sexual activity and tried to satisfy their partners. SD might increase risk of voluntary dropout from treatment and illicit drug use during treatment. Patients with SD did not get any effective therapy from clinicians and they also lacked skills on coping with SD-related problems. Sexual dysfunction prevented patients from reconstructing a normal intimate relationship, and affected stability of maintenance treatment. Response to patient's SD and SD-related problems from clinicians was inadequate. There is a need to develop a clinical guide to deal with both SD itself and SD-related problems.

Results from a Nationwide Evaluation Study of Labor Market-Integrative Health Promotion for the Unemployed: Impact of the JOBS Program Germany.

Compared to the employed, the unemployed suffer from poorer health, especially in terms of mental health. At the same time, health promotion rarely reaches unemployed people. The "JOBS Program" is an intervention to promote health and labor market integration and has shown positive effects in the USA and Finland. In this confirmatory study, we investigated whether the JOBS Program achieves similar effects in Germany. We applied a randomized controlled trial to compare an intervention group (IVG) with a waiting control group (WCG) before (T0; N = 94) and shortly after (T1; n = 65) the intervention. Concerning our primary outcomes, the JOBS Program Germany was beneficial: Compared to the WCG, the regression estimated that the IVG had (1) a 2.736 scale point higher level of life satisfaction (p = 0.049), (2) a 0.337 scale point higher level of general health (p = 0.025), and (3) a 14.524 scale point higher level of mental well-being (p = 0.004). Although not statistically significant, job search-specific self-efficacy also appeared to be positively associated with the intervention. This study provides evidence of the effectiveness of JOBS Program on the abovementioned outcomes, including for older and long-term unemployed people, supporting the benefits of regular implementation of this program for a wide range of unemployed people in Germany.

Health promotion for the unemployed: the evaluation of the JOBS Program Germany from the trainers' perspective.

BACKGROUND: The JOBS Program Germany is a labor market integrative and health promotion intervention for unemployed people. This study examines JOBS Program Germany trainers' view of (1) the theoretical concept of the JOBS Program, (2) its practical implementation in Germany on-site, (3) its acceptance by participants, and (4) the training effects. The study aimed at identifying potential for adaption allowing adjustments to improve the practical implementation and the training effectiveness. METHODS: JOBS Program Germany trainers (two for each training) were interviewed via voluntary survey (computer-assisted web interviews) after each training. RESULTS: Fourteen JOBS Program trainings have been conducted and all trainers responded resulting in 28 interviews. 78.5% and 85.7% of the respondents were rather or very satisfied with the theoretical contents and its practical implementation, respectively. Almost all trainers (96.4-100.0%) were satisfied with the on-site coordination, the cooperation with the organizer's employees, the room equipment, the training room size, and the environmental conditions in the training rooms. In 89.3% of all responses the trainers rated the last training a success. However, the trainers also provided valuable suggestions for further improvement in Germany. This concerns the revision of the training manual, the adjustment of the trainer training and the preparation of participants. CONCLUSION: Besides the trainers' positive view on the different dimensions of the training content and implementation, their suggestions can help ensure that many unemployed people in Germany could benefit from a continued regular implementation of the JOBS Program Germany in the future. TRIAL REGISTRATION: German Clinical Trials Register (DRKS), DRKS00022388. Registered on 20 July, 2020.

Could oral hygiene prevent cases of at-home-acquired Legionnaires' disease? - Results of a comprehensive case-control study on infection sources, risk, and protective behaviors.

Introduction: The "LeTriWa study" on community-acquired cases of Legionnaires' disease (LD) found that most cases likely acquired their infection at home (AHALD). However, which sources confer the infection is largely unknown. We therefore analyzed the data set from the LeTriWa study to find out if individual sources were associated with AHALD and if specific behavioral habits may increase or lower the risk for AHALD. Methods: During the study we had used two comparison groups: (i) controls matched for age group and hospital ("controls"), (ii) household members of cases with AHALD ("AHALD-HHM"). We inquired about exposure to water sources, such as showering or wearing dentures, as well as behavioral factors and habits related to oral hygiene. We took standardized household bathroom water and biofilm samples of both cases with AHALD and controls, and in addition from households of cases with AHALD only samples from suspect residential (non-)drinking water sources. We first conducted bivariate analyses for infection sources and behaviors, followed by multivariable analyses. Results: There were 124 cases with AHALD, 217 controls and 59 AHALD-HHM. In bivariate analyses using controls for comparison, wearing dentures was the only variable significantly positively associated (odds ratio (OR) = 1.7, 95% confidence interval (CI) = 1.1-2.7, p-value = 0.02). Behavioral factors such as showering, letting water run before use and not being alcohol abstinent were significantly negatively associated, smoking was significantly positively associated. In a multivariable analysis, we identified good oral hygiene as a preventive factor for both denture wearers (OR = 0.33, 95% CI = 0.13-0.83, p-value = 0.02) and non-denture wearers (OR = 0.32, 95% CI = 0.10-1.04, p-value = 0.06). Analyses of comparisons with AHALD-HHM showed similar effects but lacked statistical power. We identified Legionella in 16 residential (non-)drinking water sources, one of which was a PCR-positive scratch sample of dentures. Discussion: Wearing (inadequately cleaned) dentures or poor oral hygiene might confer an increased risk for AHALD, and oral hygiene may prevent AHALD. The hypothesis that Legionella in oral biofilm or dental plaque may be the cause of cases with AHALD should be examined further. If confirmed this may open new and simple avenues for the prevention of LD.

Validity of using ambient concentrations as surrogate exposures at the individual level for fine particle and black carbon: A systematic review and meta-analysis.

Exposure measurement error is an important source of bias in epidemiological studies. We assessed the validity of employing ambient (outdoor) measurements as proxies of personal exposures at individual levels focusing on fine particles (PM2.5) and black carbon (BC)/elemental carbon (EC) on a global scale. We conducted a systematic review and meta-analysis and searched databases (ISI Web of Science, Scopus, PubMed, Ovid MEDLINE®, Ovid Embase, and Ovid BIOSIS) to retrieve observational studies in English language published from 1 January 2006 until 5 May 2021. Correlation coefficients (r) between paired ambient (outdoor) concentration and personal exposure for PM2.5 or BC/EC were standardized as effect size. We used random-effects meta-analyses to pool the correlation coefficients and investigated the causes of heterogeneity and publication bias. Furthermore, we employed subgroup and meta-regression analyses to evaluate the modification of pooled estimates by potential mediators. This systematic review identified thirty-two observational studies involving 1744 subjects from ten countries, with 28 studies for PM2.5 and 11 studies for BC/EC. Personal PM2.5 exposure is more strongly correlated with ambient (outdoor) concentrations (0.63, 95% confidence interval [CI]: 0.57-0.68) than personal BC/EC exposure (0.49, 95% CI: 0.38-0.59), with significant differences in r (0.14, 95% CI: 0.03-0.25; p < 0.05). The results demonstrated that the health status of participants was a significant modifier of pooled correlations. In addition, the personal to ambient (P/A) ratio for PM2.5 and average ambient BC/EC levels were potential effect moderators of the pooled r. The funnel plots and Egger's regression test indicated inevident publication bias. The pooled estimates were robust through sensitivity analyses. The results support the growing consensus that the validity coefficient of proxy measures should be addressed when interpreting results from epidemiological studies to better understand how strong health outcomes are affected by different levels of PM2.5 and their components.

Probable reinfection with Legionella pneumophila - A case report.

In Germany community-acquired Legionnaires' disease is usually caused by the species Legionella pneumophila. Recurrent cases of Legionnaires' disease are rarely reported and are due either to a second infection (reinfection) or a relapse of a previous case. We report a case of recurrent Legionnaires' disease in an 86-year-old female patient infected with Legionella pneumophila serogroup 1, monoclonal antibody-subtype Knoxville, sequence type unknown. Between the two disease incidents the patient had completely recovered. Legionella pneumophila was detected with the monoclonal antibody-subtype Knoxville, sequence type 182, in the drinking water of the patient's apartment. Exposure to contaminated drinking water was interrupted after the first incident exposure through the application of point-of-use water filters. The filters were later removed due to low water pressure, and the second illness occurred thereafter. It is unclear if immunological predisposition has contributed to this case of probable reinfection of Legionnaires' disease. Clinical, microbiological and epidemiological information combined suggest this is a case of reinfection of Legionnaires' disease. In cases of recurrent Legionnaires' disease complete collection of patient and water samples is necessary to differentiate relapse from reinfection cases, to implicate the source of infection and to gain more evidence for the role of immunological predisposition.

Chemical characterization and sources of personal exposure to fine particulate matter (PM2.5) in the megacity of Guangzhou, China.

Concurrent ambient and personal measurements of fine particulate matter (PM2.5) were conducted in eight districts of Guangzhou during the winter of 2011. Personal-to-ambient (P-C) relationships of PM2.5 chemical components were determined and sources of personal PM2.5 exposures were evaluated using principal component analysis and a mixed-effects model. Water-soluble inorganic ions (e.g., SO42-, NO3-, NH4+, C2O42-) and anhydrosugars (e.g., levoglucosan, mannosan) exhibited median personal-to-ambient (P/C) ratios < 1 accompanied by strong P-C correlations, indicating that these constituents in personal PM2.5 were significantly affected by ambient sources. Conversely, elemental carbon (EC) and calcium (Ca2+) showed median P/C ratios greater than unity, illustrating significant impact of local traffic, indoor sources, and/or personal activities on individual's exposure. SO42- displayed very low coefficient of divergence (COD) values coupled with strong P-C correlations, implying a uniform distribution of SO42- in the urban area of Guangzhou. EC, Ca2+, and levoglucosan were otherwise heterogeneously distributed across individuals in different districts. Regional air pollution (50.4 ± 0.9%), traffic-related particles (8.6 ± 0.7%), dust-related particles (5.8 ± 0.7%), and biomass burning emissions (2.0 ± 0.2%) were moderate to high positive sources of personal PM2.5 exposure in Guangzhou. The observed positive and significant contribution of Ca2+ to personal PM2.5 exposure, highlighting indoor sources and/or personal activities, were driving factors determining personal exposure to dust-related particles. Considerable discrepancies (COD values ranging from 0.42 to 0.50) were shown between ambient concentrations and personal exposures, indicating caution should be taken when using ambient concentrations as proxies for personal exposures in epidemiological studies.

Characterization of ambient-generated exposure to fine particles using sulfate as a tracer in the Chinese megacity of Guangzhou.

Total personal exposures can differ from the concentrations measured at stationary ambient monitoring sites. To provide further insight into factors affecting exposure to particles, chemical tracers were used to separate total personal exposure into its ambient and non-ambient components. Simultaneous measurements of ambient and personal exposure to fine particles (PM2.5) were conducted in eight districts of Guangzhou, a megacity in South China, during the winter of 2011. Considerable significant correlations (Spearman's Rho, rs) between personal exposures and ambient concentrations of sulfate (SO42-; rs>0.68) were found in contrast to elemental carbon (EC; rs>0.37). The average fraction of personal SO42- to ambient SO42- resulting in an adjusted ambient exposure factor of α=0.72 and a slope of 0.73 was determined from linear regression analysis when there were minimal indoor sources of SO42-. From all data pooled across the districts, the estimated average ambient-generated and non-ambient-generated exposure to PM2.5 were 55.3µg/m3 (SD=23.4µg/m3) and 18.1µg/m3 (SD=29.1µg/m3), respectively. A significant association was found between ambient-generated exposure and ambient PM2.5 concentrations (Pearson's r=0.51, p<0.001). As expected, the non-ambient generated exposure was not related to the ambient concentrations. This study highlights the importance of both ambient and non-ambient components of total personal exposure in the megacity of Guangzhou. Our results support the use of SO42- as a tracer of personal exposure to PM2.5 of ambient origin in environmental and epidemiological studies.

Alcohol consumption among university students: a Sino-German comparison demonstrates a much lower consumption of alcohol in Chinese students.

BACKGROUND: Alcohol use is reported in university students with discrepancy between countries. The study objectives were to assess prevalence and associated factors of alcohol consumption among university students in Germany and China. METHODS: Data used were from 1853 Chinese and 3306 German university students. Alcohol consumption frequency was measured by a question "How often did you drink alcohol in the last three months?" with six possible responses, which were later collapsed into three categories of "At least once a week", "Less than once a week" and "Never". Problem drinking was measured by the CAGE test and defined as a CAGE score of two or more (four as the maximum). Simple and multivariable logistic regressions were used for association analyses. RESULTS: German students reported more often "At least once a week" drinking (59.8 vs. 9.0 %). Among Germans, women drank less often "At least once a week" (OR = 0.40, 0.30-0.53). Among Chinese, a higher BMI was associated with drinking "At least once a week" (OR = 1.09, 1.02-1.18). Age revealed a positive association with "At least once a week" drinking in Chinese (1.33, 1.21-1.46) but a negative association in Germans (OR = 0.97, 0.94-0.99). Having a father with high educational level was positively related to "At least once a week" drinking in both countries (OR = 4.25, 2.67-6.78 for Chinese; OR = 1.32, 1.01-1.72 for Germans). Doing less than once a week physical exercise was negatively associated with "At least once a week" drinking in Chinese and German students (OR = 0.27, 0.15-0.48 for Chinese; OR = 0.69, 0.49-0.96 for Germans). Among the German students, 20.3 % reported problem drinking. Being a female (OR = 0.32, 0.26-0.40) and performing less than once a week physical activity (OR = 0.73, 0.56-0.95) were negatively associated with problem drinking, while having a father with high educational level (OR = 1.32, 1.09-1.60) and experiencing higher level of perceived stress (OR = 1.08, 1.04-1.13) were positively related to problem drinking. CONCLUSIONS: Country-specific strategies for reducing alcohol consumption, e.g. educational awareness programmes of alcohol use on Chinese campuses and alcohol prevention schemes among German youth before entering university, are sensible.

Only-Child Status in Relation to Perceived Stress and Studying-Related Life Satisfaction among University Students in China: A Comparison with International Students.

OBJECTIVES: University students in general face multiple challenges, which may affect their levels of perceived stress and life satisfaction. Chinese students currently face specific strains due to the One-Child Policy (OCP). The aim of this study was to assess (1) whether the levels of perceived stress and studying-related life satisfaction are associated with only-child (OC) status after controlling for demographic and socio-economic characteristics and (2) whether these associations differ between Chinese and international students. MATERIALS AND METHODS: A cross-sectional health survey based on a self-administrated standardised questionnaire was conducted among 1,843 (1,543 Chinese, 300 international) students at two Chinese universities in 2010-2011. Cohen's Perceived Stress Scale (PSS-14) and Stock and Kraemer's Studying-related Life Satisfaction Scale were used to measure perceived stress and studying-related life satisfaction respectively. Multivariable logistic regression analyses were used to examine the associations of OC status with perceived stress and studying-related life satisfaction by sex for Chinese students and international students separately. RESULTS: The Chinese non-only-children (NOCs) were more likely to come from small cities. Multivariable regression models indicate that the Chinese NOCs were more stressed than OCs (OR = 1.39, 1.11-1.74) with a stronger association in men (OR = 1.48, 1.08-2.02) than women (OR = 1.26, 0.89-1.77). NOCs were also more dissatisfied than their OC fellows in the Chinese subsample (OR = 1.37, 1.09-1.73). Among international students, no associations between OC status and perceived stress or studying-related life satisfaction were found. CONCLUSIONS: To promote equality between OCs and NOCs at Chinese universities, the causes of more stress and less studying-related life satisfaction among NOCs compared to OCs need further exploration.

Comparison of Subjective Health Complaints between Chinese and German University Students: A Cross-Sectional Study.

High rates of health complaints (HCs) with substantial variation are reported in different university populations, which can be linked to socio-demographic, lifestyle-related factors, and cultural differences. HCs can be categorized into distinct components. This study aimed to identify and compare underlying dimensions of HCs (HC components); to access and compare HC prevalence, and the associations between HC components, socio-demographic, lifestyle-related factors, and perceived stress in German and Chinese university students. Two health surveys were conducted among 5159 university students (1853 Chinese, 3306 German). Factor analysis and logistic regression were applied. The prevalence of HC ranged from 4.6% to 40.2% over the two countries. Germans reported at least three HCs more often (47.2% vs. 35.8%). Chinese students more often reported gastrointestinal complaints. Perceived stress was positively associated with all three HC components in both countries (OR = 1.03-1.50) with stronger associations among Germans. Women more often reported HCs (OR = 1.32-2.43) with stronger associations among the Germans. Having a father with a low educational level was associated with high psychological symptoms among the Chinese (OR = 1.51), but with low gastrointestinal complaints among the Germans (OR = 0.79). The high prevalence of HCs in students requires country-specific interventions.

Assessing spatial associations between thermal stress and mortality in Hong Kong: a small-area ecological study.

AIMS: Physiological equivalent temperature (PET) is a widely used index to assess thermal comfort of the human body. Evidence on how thermal stress-related health effects vary with small geographical areas is limited. The objectives of this study are (i) to explore whether there were significant patterns of geographical clustering of thermal stress as measured by PET and mortality and (ii) to assess the association between PET and mortality in small geographical areas. METHODS: A small area ecological cross-sectional study was conducted at tertiary planning units (TPUs) level. Age-standardized mortality rates (ASMR) and monthly deaths at TPUs level for 2006 were calculated for cause-specific diseases. A PET map with 100 m × 100 m resolution for the same period was derived from Hong Kong Urban Climatic Analysis Map data and the annual and monthly averages of PET for each TPU were computed. Global Moran's I and local indicator of spatial association (LISA) analyses were performed. A generalized linear mixed model was used to model monthly deaths against PET adjusted for socio-economic deprivation. RESULTS: We found positive spatial autocorrelation between PET and ASMR. There were spatial correlations between PET and ASMR, particularly in the north of Hong Kong Island, most parts of Kowloon, and across New Territories. A 1°C change in PET was associated with an excess risk (%) of 2.99 (95% CI: 0.50-5.48) for all natural causes, 4.75 (1.14-8.36) for cardiovascular, 7.39 (4.64-10.10) for respiratory diseases in the cool season, and 4.31 (0.12 to 8.50) for cardiovascular diseases in the warm season. CONCLUSIONS: Variations between TPUs in PET had an important influence on cause-specific mortality, especially in the cool season. PET may have an impact on the health of socio-economically deprived population groups. Our results suggest that targeting policy interventions at high-risk areas may be a feasible option for reducing PET-related mortality.

A research agenda for aging in China in the 21st century.

China is encountering formidable healthcare challenges brought about by the problem of aging. By 2050, there will be 400 million Chinese citizens aged 65+, 150 million of whom will be 80+. The undesirable consequences of the one-child policy, rural-to-urban migration, and expansion of the population of 'empty nest' elders are eroding the traditional family care of the elders, further exacerbating the burden borne by the current public healthcare system. The challenges of geriatric care demand prompt attention by proposing strategies for improvement in several key areas. Major diseases of the elderly that need more attention include chronic non-communicable diseases and mental health disorders. We suggest the establishment of a home care-dominated geriatric care system, and a proactive role for researchers on aging in reforming geriatric care through policy dialogs. We propose ideas for preparation of the impending aging burden and the creation of a nurturing environment conducive to healthy aging in China.

Particulate matter pollution in the megacities of the Pearl River Delta, China - a systematic literature review and health risk assessment.

The exposure to ambient particulate matter (PM) pollution is a major threat to public health. Chinese megacities are coined by high levels of PM. Our aims were to examine the concentration levels of PM in megacities (Guangzhou, Hong Kong, and Shenzhen) of the Pearl River Delta (PRD), South China; to compare the results with international and national air quality guidelines; and to assess the health impact in terms of possible reductions in premature deaths due to PM reduction. The Medline(®) data base was used to identify published studies (systematic literature search). Based on our appraisal criteria 13 studies remained in the analysis. Additionally, publicly available data were extracted from data sources provided by municipal authorities of the cities under study. PM data reported in µg/m(3) were abstracted from single studies and municipal reports. If possible, the PM data were stratified for season of data collection (summer/winter half-year) and simple means were calculated for cities, seasons and months. Based on the abstracted data, a health impact assessment (HIA) was done in order to estimate potential preventable premature deaths due to PM pollution in the cities. Almost all PM data exceeded national and international air quality guidelines. Our HIA showed that in Guangzhou ten thousands of premature deaths could be prevented if the PM burden was reduced to these air quality limit values. We identified no suitable epidemiological study reporting PM according to our study protocol. Further epidemiological studies should be carried out to more precisely determine the spatial distribution of PM-related health risks in PRD. Environmental protection measures and public health interventions are required to reduce burden of PM-related diseases in PRD.