Genomic epidemiology of CVA10 in Guangdong, China, 2013-2021.

Hand, Foot and Mouth Disease (HFMD) is a highly contagious viral illness primarily affecting children globally. A significant epidemiological transition has been noted in mainland China, characterized by a substantial increase in HFMD cases caused by non-Enterovirus A71 (EV-A71) and non-Coxsackievirus A16 (CVA16) enteroviruses (EVs). Our study conducts a retrospective examination of 36,461 EV-positive specimens collected from Guangdong, China, from 2013 to 2021. Epidemiological trends suggest that, following 2013, Coxsackievirus A6 (CVA6) and Coxsackievirus A10 (CVA10) have emerged as the primary etiological agents for HFMD. In stark contrast, the incidence of EV-A71 has sharply declined, nearing extinction after 2018. Notably, cases of CVA10 infection were considerably younger, with a median age of 1.8 years, compared to 2.3 years for those with EV-A71 infections, possibly indicating accumulated EV-A71-specific herd immunity among young children. Through extensive genomic sequencing and analysis, we identified the N136D mutation in the 2 A protein, contributing to a predominant subcluster within genogroup C of CVA10 circulating in Guangdong since 2017. Additionally, a high frequency of recombination events was observed in genogroup F of CVA10, suggesting that the prevalence of this lineage might be underrecognized. The dynamic landscape of EV genotypes, along with their potential to cause outbreaks, underscores the need to broaden surveillance efforts to include a more diverse spectrum of EV genotypes. Moreover, given the shifting dominance of EV genotypes, it may be prudent to re-evaluate and optimize existing vaccination strategies, which are currently focused primarily target EV-A71.

The cross-cultural adaptation and psychometric evaluation of a learned helplessness scale for maintenance hemodialysis patients in China (LHS-MHD-C).

Learned helplessness (LH) is an important concept in nursing. This study aimed to adapt and translate the Arthritis Helplessness Index scale into a Chinese version of an LH scale for maintenance hemodialysis patients in China (LHS-MHD-C), and to validate its psychometric properties. Data collected included LHS-MHD-C, as well as the Hospital Depression Scale (HADS-D), and the Beck Hopelessness Scale (BHS) for assessing LHS-MHD-C's criterion validity (predictive and concurrent, respectively). The expert consultation and the pilot study demonstrated semantic and conceptual equivalence and content validity (except for Item 3, the item content validity ranged from 0.82 to 1, and the scale content validity was 0.95). An exploratory factor analysis (n = 146) eliminated three items and accepted 11 items for the two factors, explaining 63.87% of the total variance. A CFA (n = 218) showed that the two-factors structure was consistent with the LH theory. The LHS-MHD-C can distinguish between maintenance hemodialysis (MHD) patients of different ages, education, working status, monthly income, and MHD duration. The scale had good concurrent validity with the BHS (r = .78, p < 0.01). Using the HADS-D as a criterion, the LHS-MHD-C showed a sensitivity of 86.2% and a specificity of 96.8%. A total score of 36.5 may be the best cut-off value for predicting MHD patients' depression. The scale showed good reliabilities (Cronbach's α value of .759, test-retest reliability of 0.772, and split-half reliability of 0.774). This study found that the LHS-MHD-C is a reliable and valid scale for assessing Chinese MHD patients' helplessness.

Biotransformation of bisphenol F by white-rot fungus Phanerochaete sordida YK-624 under non-ligninolytic condition.

Environmental bisphenol F (BPF) has a cyclic endocrine disruption effect, seriously threatening animal and human health. It is frequently detected in environmental samples worldwide. For BPF remediation, biological methods are more environmentally friendly than physicochemical methods. White-rot fungi have been increasingly studied due to their potential capability to degrade environmental pollutants. Phanerochaete sordida YK-624 has been shown to degrade BPF by ligninolytic enzymes under ligninolytic conditions. In the present study, degradation of BPF under non-ligninolytic conditions (no production of ligninolytic enzymes) was investigated. Our results showed that BPF could be completely removed after 7-d incubation. A metabolite of BPF, 4,4'-dihydroxybenzophenone (DHBP) was identified by mass spectrometry and nuclear magnetic resonance, and DHBP was further degraded by this fungus to form 4-hydroxyphenyl 4-hydroxybenzoate (HPHB). DHBP and HPHB were the intermediate metabolites of BPF and would be further degraded by P. sordida YK-624. We also found that cytochrome P450s played an important role in BPF degradation. Additionally, transcriptomic analysis further supported the involvement of these enzymes in the action of BPF degradation. Therefore, BPF is transformed to DHBP and then to HPHB likely oxidized by cytochrome P450s in P. sordida YK-624. Furthermore, the toxicological studies demonstrated that the order of endocrine-disrupting activity for BPF and its metabolites was HPHB > BPF > DHBP. KEY POINTS: • White-rot fungus Phanerochaete sordida YK-624 could degrade BPF. • Cytochrome P450s were involved in the BPF degradation. • The order of endocrine disrupting activity was: HPHB > BPF > DHBP.

Risk factors of medical device-related pressure injury in intensive care units.

OBJECTIVES: Intensive care unit (ICU) patients are at high risk of medical device related pressure injury (MDRPI). This study aims to ascertain the MDRPI prevalence in ICU patients and analyse the risk factors of MDRPI. BACKGROUND: The occurrence of MDRPI not only increases hospitalisation time with pain and economic burden, but also causes medical disputes. A better understanding of this condition will increase knowledge and facilitate the ability to recognise and prevent MDRPI for clinical nursing staff. However, there are few multicentre studies of MDRPI prevalence in ICU patients in China. DESIGN: A cross-sectional study design was employed. METHODS: Data from 694 patients in 66 adult ICU at 30 hospitals in China were included between October 2018 and March 2019. The stage of each MDRPI was determined according to the definitions of National Pressure Ulcer Advisory Panel. The study methods were followed by the STORBE guidelines. RESULTS: The overall prevalence rate of MDRPI was 13.1% (91/694), with 98 anatomic locations in total. The most common stages of MDRPI were stage 1 (54.1%, 53/98), stage 2 (15.3%, 15/98) and mucosal membrane pressure injury (15.3%, 15/98). MDRPI mainly occurred in the finger (32.7%, 32/98), followed by nose (18.4%, 18/98). The prevalence rate of MDRPI caused by CPAP or BiPAP masks (25%) was highest. Lower Braden scores and having skin oedema were risk factors for MDRPI in adult ICU patients. CONCLUSION: The prevalence of MDRPI in this study was still high. Nurses should take these related factors into consideration when taking care of ICU patients, and appropriate prevention measures should be adopted to decrease the prevalence of MDRPI. RELEVANCE TO CLINICAL PRACTICE: The study can help to improve the PI prevention efforts in ICU patients specific to medical device related PI.

Associations of long-term exposure to air pollution with blood pressure and homocysteine among adults in Beijing, China: A cross-sectional study.

BACKGROUND: Studies on the hypertensive effect of long-term exposure to air pollution are mixed, and sparse evidence exists regarding its effects on homocysteine (Hcy), another crucial risk factor for cardiovascular disease (CVD). METHODS: We collected data from 23,256 participants aged 18-74 years at baseline (years 2017-2018) from a community-based cohort in China. A linear combination of concentrations from monitoring stations at the participants' home and work addresses, weighted by the time, was used to estimate two-year exposures to particulate matter with fine particles≤2.5 µm (PM2.5), aerodynamic diameter≤10 µm (PM10), nitrogen dioxide (NO2) and sulfur dioxide (SO2). Generalized linear regressions and logistic regressions were conducted to examine the associations between air pollution and systolic blood pressure (SBP), diastolic blood pressure (DBP), Hcy, hypertension and co-occurrence of hypertension and hyperhomocysteinemia (HHcy). RESULTS: The results showed that each interquartile range (IQR) increase in PM2.5 (16.1 µg/m3), PM10 (19.3 µg/m3) and SO2 (3.9 µg/m3) was significantly associated with SBP (changes: 0.64-1.86 mmHg), DBP (changes: 0.35-0.70 mmHg) and Hcy (changes: 0.77-1.04 µmol/L) in the fully adjusted model. These air pollutants were also statistically associated with the prevalence of co-occurrence of hypertension and HHcy (ORs: 1.22-1.32), which were stronger than associations with the prevalence of hypertension (ORs: 1.09-1.19). The hypertensive effects of exposure to PM2.5, PM10 and SO2 were more pronounced among elder participants, obese participants, those with established CVD or a high 10-year CVD risk and those with a family history of hypertension. However, interaction analyses of Hcy showed different patterns. Additionally, moderate level of physical activity and active travel mode benefited individuals in resisting the health impacts of air pollution on both blood pressure (BP) and Hcy. CONCLUSIONS: Our study supports a positive relationship between air pollution and BP and Hcy among adults in Beijing, and close attention to vulnerable populations and healthy lifestyles could effectively benefit further cardiovascular health.

Maternal dietary uridine supplementation reduces diarrhea incidence in piglets by regulating the intestinal mucosal barrier and cytokine profiles.

BACKGROUND: Nucleotides play an important role in the regulation of cellular energy and protein homeostasis, which facilitate the repair, recovery and repletion of tissue function. This study tested the effects of maternal uridine (UR) supplementation during late pregnancy and lactation of sows on the immune function of the small intestine in neonatal and suckling piglets. RESULTS: Results showed that compared to the control group, maternal dietary UR supplementation significantly decreased incidence of diarrhea in suckling piglets (P < 0.01); and increased both duodenal and ileal average villus height (P < 0.01) as well as villus height/crypt depth in ileum (P = 0.017) in neonatal piglets. RT-qPCR results showed that maternal UR supplementation decreased mRNA expression of claudin-1 in jejunum and ileum of neonatal piglets (P < 0.05), while significantly increased mRNA expression of claudin-1 in duodenum and jejunum of suckling piglets. Furthermore, in suckling piglets, maternal dietary UR supplementation increased mRNA expression of IL-6, IL-8 and IL-1ß in duodenum, jejunum and ileum (P < 0.05), increased IL-10 expression in both jejunal and ileal mucosa (P < 0.05) and increased mRNA expression of IKB and TLR4 in ileal mucosa (P < 0.05). CONCLUSIONS: These results suggest that maternal dietary supplementation with UR contributed to reducing incidence of diarrhea by regulating cytokine secretion and intestinal mucosal barrier function in suckling piglets. © 2020 Society of Chemical Industry.

How the health institution combinative contracting mechanism influences community residents' patient experiences in Shanghai: A comparative study of data from two cross-sectional surveys.

OBJECTIVE: To understand the effect of the health institution combinative contracting mechanism (which make participating residents make a "combinative contracting" involving family doctor of community health center, one secondary hospital, and one tertiary hospital) on community residents' patient experiences in Shanghai, China. METHODS: We conducted two questionnaire surveys (2016 and 2018) on the patient experiences of 1200 permanent residents of 12 subdistricts of Shanghai, who were selected via stratified random sampling. Of these, 926 participants were included after propensity score matching. We compared five dimensions of patient experience-accessibility, environment and facilities, service attitude and emotional support, communication and patient engagement, and service integration-before and after implementation of the health institution combinative contracting mechanism in June 2016. Furthermore, logistic regression analysis was used to explore the factors related to residents' overall experience. RESULTS: The health institution combinative contracting mechanism influenced most dimensions of residents' patient experience, such as accessibility, service attitude and emotional support, communication and patient participation, and service integration. The mechanism in general helped contracted residents obtain a better patient experience than before its implementation. Referral had a significant effect on participants' overall experience. CONCLUSION: Contracted family doctors play active roles in improving nearly every dimension of residents' service experience, as well as their overall experience of services. The health institution combinative contracting mechanism not only increases interaction and strengthens trust between doctors and patients but also makes it possible for residents to obtain integrated health services.

Dietary supplement with nucleotides in the form of uridine monophosphate or uridine stimulate intestinal development and promote nucleotide transport in weaned piglets.

BACKGROUND: Nucleotides are key constituents of milk, where they are utilized in cell replication, although there are limited studies for weaned piglets. This study evaluated the effects of uridine monophosphate (UMP) with uridine (UR) feed supplementation on the intestinal development and nucleotide transport in weaned piglets. RESULTS: Supplementation with UMP significantly increased (P < 0.05) plasma glucose, and UR supplementation significantly reduced (0.05 < P < 0.10) the plasma total cholesterol (TC) of piglets when compared with that of the control group, although non-significant difference (P > 0.05) in growth performance was observed among three groups. Piglets fed supplementary UR exhibited greater (P < 0.05) crypt depth in the duodenum and ileum when compared with those in the supplementary UMP and control groups. Real-time quantitative polymerase chain reaction (RT-qPCR) results revealed that UR supplementation increased (P < 0.05) the relative mRNA levels of genes encoding the transmembrane proteins ZO-1 and occludin in the duodenum mucosa, and ZO-1 in the jejunum mucosa (P < 0.05). Similarly, UR supplementation increased (P < 0.05) expression of solute carriers SLC28A1 and SLC29A1 in the duodenum mucosa. Conversely, claudin-1 expression in the duodenum mucosa was inhibited (P < 0.05) by dietary supplementation with UMP or UR. CONCLUSION: Collectively, our data indicated that dietary supplementation with UMP or UR was conducive to stimulating intestinal development and promoting nucleotide transport in weaned piglets. © 2019 Society of Chemical Industry.

Maternal supplementation with calcium varying with feeding time daily during late pregnancy affects lipid metabolism and transport of placenta in pigs.

To investigate effects of Ca level varying with feeding time daily in sows during late pregnancy on placental lipid metabolism and transport in pigs, sixty pregnant sows were assigned to 3 groups: the CON group was fed low-Ca diet with 11.25 g CaCO3 at 0600 h and 1500 h, H-L group was fed low-Ca diet with 22.5 g CaCO3 at 0600 h and low-Ca diet at 1500 h, and L-H group was fed low-Ca diet at 0600 h and low-Ca diet with 22.5 g CaCO3 at 1500 h, respectively. Serum from sows and umbilical cord and placenta were collected during delivery. Results showed that, compared with the CON group, H-L feeding significantly increased maternal serum total triglyceride (TG) and umbilical serum high-density lipoprotein (HDL) (P < 0.05). The results showed that long chain fatty acid (FA) contents in placenta were significantly increased in H-L and L-H groups (P < 0.05). Experiments on genes involved in glycolipid metabolism showed that H-L or L-H feeding inhibited mRNA expression of GLUT3, GLUT4, FAS, FABP1, FABPpm, FAT/CD36, while activated the mRNA expression of FASD1, FASD2 and SCD in placenta (P < 0.05). In addition, experiments on genes involved in biological clock showed that L-H feeding sequence activated the mRNA expression of per1 and clock, while H-L and L-H feeding sequence inhibited mRNA expression of per2 in placenta (P < 0.05). It is concluded that maternal supplementation with Ca varying with feeding time daily during late pregnancy affects placental lipid metabolism and transport in pigs by regulating the mRNA expression related to lipid metabolism and the circadian clock.

Effects of a daily three-meal pattern with different dietary protein contents on pig growth performance, carcass and muscle quality traits.

BACKGROUND: Recent research related to phase-feeding programmes for pig nutrition do not always account for the variation among individuals, and feeds are usually formulated to optimise the performance of the whole pig population. This study aimed at measuring the effects of a daily three-meal pattern with different dietary protein contents on pig growth performance, carcass and muscle quality traits. RESULTS: The results showed that compared with the 3C treatment, average daily gain (ADG) of pigs in the HCL treatment increased by 14.75% (P < 0.05) during period 1. The carcass weight (P = 0.006) and slaughter weight (P = 0.021) in the HCL group increased when compared with those in the 3C and LCH treatments. Moreover, the LCH feeding sequences contributed to reduce the drip loss in longissimus dorsi (LD) muscle (P < 0.05) when compared with the 3C treatment. The HCL or LCH feeding sequence contributed to increase the meat quality when compared with those receiving the 3C treatment. CONCLUSION: Collectively, our results indicate that feeding high protein meal in the morning and a gradual reduction of the protein content in meals over the day may improve muscle quality characteristics, maximise performance, and reduce the pig feed cost. © 2017 Society of Chemical Industry.

Light and Magnetic Dual-Responsive Pickering Emulsion Micro-Reactors.

Emulsion droplets can serve as ideal compartments for reactions. In fact, in many cases, the chemical reactions are supposed to be triggered at a desired position and time without change of the system environment. Here, we present a type of light and magnetic dual-responsive Pickering emulsion microreactor by coadsorption of light-sensitive titania (TiO2) and super paramagnetic iron oxide (Fe3O4) nanoparticles at the oil-water interface of emulsion droplets. The droplets encapsulating different reactants in advance can be driven close to each other by an external magnetic field, and then the chemical reaction is triggered by UV illumination due to the contact of the isolated reactants as a result of droplet coalescence. An insight into the incorporation of hydrophobic TiO2 and hydrophilic Fe3O4 nanoparticles simultaneously at the emulsion interface is achieved. On the basis of that, an account is given of the coalescence mechanism of the Pickering emulsion microreactors. Our work not only provides a novel Pickering emulsion microreactor platform for triggering chemical reactions in a nonintrusive and well-controlled way but also opens a promising avenue to construct multifunctional Pickering emulsions by assembly of versatile building block nanoparticles at the interface of emulsion droplets.

Prevalence and risk factors for attempted suicide in the elderly: a cross-sectional study in Shanghai, China.

BACKGROUND: Previous studies have thoroughly investigated the prevalence and risk factors for completed suicide. In marked contrast is the lack of a better understanding of attempted suicide in the elderly. The aim of this study was to estimate the prevalence of attempted suicide in the elderly and examine the associated factors. METHODS: Using a multi-stage cluster sampling approach, a cross-sectional survey of 8,399 elderly house-dwelling residents was conducted in Shanghai, China. RESULTS: The two-week prevalence of attempted suicide in the elderly was 0.75%. In the bivariate analysis, having no caregivers, depressive, anxiety, sad, fear, obsessive-compulsive and anger symptom, and lower scores on the Barthel Index of Activities of Daily Living and the Lawton Instrumental Activities of Daily Living Scale were significantly associated with an increased risk of attempted suicide in the elderly. In the multivariate analysis, sad and fear symptoms were significantly and independently associated with a higher risk of attempted suicide in the elderly. CONCLUSION: The two-week prevalence of attempted suicide in the elderly is relatively high when compared with the annualized or lifetime prevalence reported in China and foreign settings. Elderly individuals with certain mental symptoms should be targeted for suicide prevention and provided with timely mental health support.

Developmental changes in hepatic glucose metabolism in a newborn piglet model: A comparative analysis for suckling period and early weaning period.

The liver glucose metabolism, supplying sufficient energy for glucose-dependent tissues, is important in suckling or weaned animals, although there are few studies with piglet model. To better understand the development of glucose metabolism in the piglets during suckling period and early weaning period, we determined the hepatic glycogen content, and investigated the relative protein expression of key enzymes of glucogenesis (GNG) and mRNA levels of some glucose metabolism-related genes. During suckling period, the protein level of G6Pase in the liver of suckling piglets progressively declined with day of age compared with that of newborn piglets (at 1 day of age), whereas the PEPCK level stabilized until day 21 of age, indicating that hepatic GNG capacity gradually weakened in suckling piglets. The synthesis of hepatic glycogen, which was consistent with the fluctuation of glycolytic key genes PFKL and PKLR that gradually decreased after birth and was more or less steady during latter suckling period, although both the mRNA levels of GCK and key glucose transporter GLUT2 presented uptrend in suckling piglets. However, early weaning significantly suppressed the hepatic GNG in the weaned piglets, especially at d 3-5 of weaning period, then gradually recovered at d 7 of weaning period. Meanwhile, PFKL, PKLR and GLUT2 showed the similar trend during weaning period. On the contrast, the hepatic glycogen reached the maximum value when the G6Pase and PEPCK protein expression were at the lowest level, although the GCK level maintained increasing through 7 days of weaning period. Altogether, our study provides evidence that hepatic GNG and glycolysis in newborn piglets were more active than other days during suckling period, and early weaning could significantly suppressed glucose metabolism in liver, but this inhibition would progressively recover at day 7 after weaning.

Light-Triggered Release from Pickering Emulsions Stabilized by TiO2 Nanoparticles with Tailored Wettability.

In this work, a new strategy for developing light-triggered Pickering emulsions as smart soft vehicles for on-demand release is proposed. Initially, UV-induced tailored wettability allows anchoring of TiO2 nanoparticles at the interface to prepare stable water in oil emulsions. Such emulsions show the efficacy of microencapsulation and controlled release by demulsification due to the hydrophilic conversion of the TiO2 nanoparticles using a noninvasive light irradiation trigger. A molecule of interest is selected as a model cargo to quantitatively evaluate the as-prepared Pickering emulsions for their encapsulation and release behaviors. Moreover, light-responsive emulsion destabilization mechanism is studied as a function of particle concentration, light wavelength, and light intensity, respectively, determined by drop diameter evolution and droplet coalescence kinetics plots. For consideration of application in life sciences, Pickering emulsions sensitive to visible light are also established based on nitrogen doping of TiO2 nanoparticle emulsifiers.

Chitosan oligosaccharide affects antioxidant defense capacity and placental amino acids transport of sows.

BACKGROUND: Chitosan oligosaccharide (COS) is widely consumed as a functional food due to its multiple health effects, but few studies about COS supplement on placental antioxidant and nutrition transport capacity were reported. Taken pregnant sow as a model, we aimed to investigate the effects of dietary COS supplementation during late gestation on placental amino acids transport and antioxidant defense capacity of sows. From day (d) 85 of gestation to parturition, sixteen pregnant sows were divided into a control group (basal diet without COS supplementation) and a COS group (30 mg COS/kg basal diet). Plasma sample of sow was collected on d 110 of gestation, and placenta tissue was obtained during parturition. Then plasma antioxidant enzyme's activities, the relative level of oxidant stress related genes, amino acids transport related genes and mTOR pathway molecules in placenta were determined. RESULTS: Results showed that maternal dietary supplementation with COS increased (P < 0.05) plasma total SOD, caused a downtrend in plasma MDA (0.05 < P < 0.10) on d 110 of gestation. Interestingly, the mRNA expression of some antioxidant genes in the placenta were increased (P < 0.05) and pro-inflammatory cytokines were reduced (P < 0.05) by COS supplement, whereas no significant difference was observed in the activities of placental total SOD and CAT between two groups. Additionally, further study demonstrated that COS feeding stimulated mTOR signaling pathway, increased amino acids transporters expression in placenta. CONCLUSIONS: These observations suggested that COS supplement in sow's diet during late gestation enhanced antioxidant defense capacity of sows, promoted placental amino acids transport, which may contribute to the health of sows and development of fetus during gestation.

Changes of HFRS Incidence Caused by Vaccine Intervention in Yichun City, China, 2005-2013.

BACKGROUND: Since 2009, the Hemorrhagic Fever with Renal Syndrome (HFRS) Targeted Expanded Program on Immunization (EPI) has been carried out in the 16-60 age population in Yichun City of Jiangxi Province. However, the annual reported incidences of HFRS in Yichun City Increased significantly from 2009 to 2013. MATERIAL/METHODS: The information on HFRS reported cases were obtained from the China Information System for Disease Control and Prevention (CISDCP), and demographic data was collected from the Basic Information System. Hantavirus-specific antigen and antibody of rodent specimens were tested by enzyme-linked immunosorbent assay (ELISA) or immune fluorescent assay. RESULTS: The annual HFRS incidences among all age subgroups presented growth tendencies in non-EPI targeted regions and EPI targeted regions, except for the EPI target population. The annual incidences of EPI target population were stable at around 10 per 100,000 population from 2008 to 2013. HFRS annual incidence was significantly related to rat virus index among all age subgroups in non-EPI targeted regions and >60 age subgroup in EPI targeted regions. CONCLUSIONS: HFRS vaccine implement has had a notable effect in HFRS prevention and control.

The association of multimorbidity and disability in a community-based sample of elderly aged 80 or older in Shanghai, China.

BACKGROUND: Both multimorbidity and activities of daily living (ADL) disability and instrument activities of daily living (IADL) disability are common among elderly individuals. ADL/IADL disability may reduce individuals' capacities for independent living and quality of life. This study aimed to examine the association between multimorbidity and ADL/IADL disability. METHODS: A multi-stage cluster sample of 2058 residents aged 80 or older was investigated in Shanghai, China. Multimorbidity was defined as the simultaneous presence of two or more chronic diseases with ten common chronic conditions under consideration. Subjects who responded that they "need partial or full assistance" to any ADL/IADL items were defined as having ADL/IADL disability. We examined the association of multimorbidity with ADL/IADL disability, adjusted for socio-demographic characteristics by using logistic regression. RESULTS: Of respondents, 23.23 % had ADL disability, 37.90 % had IADL disability, and 49.17 % had multimorbidity. After adjusted socio-demographic characteristics, a graded association was showed between ADL disability and the quantity of chronic conditions: odds ratio (OR) for 1 condition, 1.53(95 % confidence interval [CI], 1.04-2.24); OR for 2 conditions, 2.06(95 % CI, 1.43-2.96); OR for 3 conditions, 3.23(95 % CI, 2.14-4.86); OR for 4 or more conditions, 5.61(95 % CI, 3.26-9.66). Similar associations were also observed between the quantity of chronic conditions and IADL disability. CONCLUSIONS: The quantity of chronic conditions had relatively strong association with both ADL and IADL disability. Initiating prevention of additional chronic conditions and interventions on clusters of diseases may decrease the potential risk of ADL/IADL disability. Additionally, more attention should been given to the older low-income women living with relatives/non-relatives with multimorbidity.

Higher Incidence of Deteriorated Mental Health in Older People Being Mistakenly Labeled as Dementia: A Two-Year Consecutive Community-Dwelling Study in Shanghai, China.

Dementia has been increasingly paid attention by policymakers in China. However, the majority of the public has an indistinct concept of dementia and its diagnostic criteria. Therefore, many abnormal characteristics and actions of older people are labeled as having dementia while diagnosed without dementia. We examined a multi-stage cluster sample of 11,223 participants aged 60 years and above who have been clinically confirmed by general practitioners as not having dementia in 2013, and 7,861 participants were willing to participate the following study and were followed-up in 2014. To assess the differences of status of older people who were mistakenly labeled as having dementia or not, we asked main caregivers 'Do you think this older person suffers from dementia?', and found out that 244 participants had been mistakenly labeled as having dementia since 2013. Related effects were measured using international generic scales as well, and the results showed that participants with better physical status deteriorated more rapidly if they were mistakenly labeled as having dementia. Additionally, the mental health of these 244 participants also deteriorated more quickly. Older adults that were not labeled as having dementia were more willing to participate in social activities relative to their labeled counterparts. In conclusion, being mistakenly labeled as having dementia without a medical diagnosis impaired older adults' physical functioning and mental health. Moreover, the reduction of social activities of labeled older people leads to separation and social exclusion.

Does disability predict attempted suicide in the elderly? A community-based study of elderly residents in Shanghai, China.

OBJECTIVES: Disability, which has been proved to be associated with suicide and suicidal ideation, has received little attention in relation to suicidal attempts among the elderly. The aim of this study was to explore the influence of disability on attempted suicide within this demographic. METHOD: A multi-stage cluster sample of 8399 residents aged 60 or more was investigated from 15 communities in Shanghai, China. Disability was measured using the Lawton instrumental activities of daily living (IADL) scale. RESULTS: The prevalence of attempted suicide in the elderly was 0.75%. Specific IADL disabilities, including shopping (OR = 3.01, 95% CI = 1.56-5.81), preparing meals (OR = 4.12, 95% CI = 2.12-8.00), housekeeping (OR = 2.48, 95% CI = 1.01-6.06), doing laundry (OR = 2.82, 95% CI = 1.09-7.35), using transport (OR = 3.10, 95% CI = 1.36-6.99) and medical care (OR = 4.41, 95% CI = 2.10-9.17), were significantly and independently associated with attempted suicide in the elderly. The presence of at least one such disability was associated with an almost threefold increase in the attempted suicide rate, and the presence of five or more IADL disabilities was associated with an approximate fivefold increase in the attempted suicide rate. CONCLUSION: Specific IADL disabilities, such as preparing meals or dealing with medical care, may be significant predictive factors for risk of suicidal attempts among the elderly. Therefore, elderly people with certain disabilities should be considered for suicide prevention interventions and should be supported in IADL as much as possible.

Glutamate-glutamine cycle and exchange in the placenta-fetus unit during late pregnancy.

The present review focuses on the physiological functions of glutamate-glutamine exchange involving placental amino acid transport and umbilical amino acid uptake in mammals (particularly in sows), with special emphasis on the associated regulating mechanisms. Glutamate plus glutamine are among the most abundant and the most utilized amino acids in fetus during late gestation. During pregnancy, amino acids, notably as precursors of macromolecules including proteins and nucleotides are involved in fetal development and growth. Amino acid concentrations in fetus are generally higher than in the mother. Among amino acids, the transport and metabolism of glutamate and glutamine during fetal development exhibit characteristics that clearly emphasize the importance of the interaction between the placenta and the fetal liver. Glutamate is quite remarkable among amino acids, which originate from the placenta, and is cleared from fetal plasma. In addition, the flux of glutamate through the placenta from the fetal plasma is highly correlated with the umbilical glutamate delivery rate. Glutamine plays a central role in fetal carbon and nitrogen metabolism and exhibits one of the highest fetal/maternal plasma ratio among all amino acids in human and other mammals. Glutamate is taken up by placenta from the fetal circulation and then converted to glutamine before being released back into the fetal circulation. Works are required on the glutamate-glutamine metabolism during late pregnancy in physiological and pathophysiological situations since such works may help to improve fetal growth and development both in humans and other mammals. Indeed, glutamine supplementation appears to ameliorate fetal growth retardation in sows and reduces preweaning mortality of piglets.