Sleep duration trajectories and all-cause mortality among Chinese elderly: A community-based cohort study.

BACKGROUND: China is among the largest and fastest aging countries. The elderly population is more vulnerable, with higher proportion of inappropriate sleep duration and risk of mortality, compared with young and middle-aged adults. Single-measured sleep duration has been associated with mortality, but the health effects of long-term sleep duration trajectories remain unknown. This study aimed to explore the prospective associations between sleep duration trajectories and all-cause mortality among Chinese elderly. METHODS: Participants (n = 3,895; median age: 82 years; females: 53.3%) who reported sleep duration in all three surveys (2005, 2008, and 2011) from the community-based Chinese Longitudinal Healthy Longevity Survey (CLHLS) were followed up until 2019 (about 8 years). We identified sleep duration trajectories by latent class mixed model and explored their association with all-cause mortality using Cox hazard proportional regression and Laplace regression models. Further, stratified analysis by demographic characteristics and lifestyles and sensitivity analysis by lag effect, health-related factors, and inverse probability weighting were used to verify the robustness of the association. In addition, we explored the threshold effect of baseline sleep duration on the risk of all-cause mortality. RESULTS: We documented 1,881 all-cause deaths during 16,689 person-years of follow-up. Five sleep duration trajectories were identified: moderately increased trajectory (28.1%), rapidly increased trajectory (7.2%), persistent sleep trajectory of 7 h (33.7%), moderately decreased trajectory (21.3%), and rapidly decreased trajectory (9.7%). Compared with the persistent sleep trajectory of 7 h, the multivariable-adjusted HRs (95%CI) for moderately increased trajectory, rapidly increased trajectory, moderately decreased trajectory, and rapidly decreased trajectory were 1.21 (1.08, 1.36), 1.21 (1.01, 1.44), 0.95 (0.82, 1.10), and 0.93 (0.78, 1.11), respectively; and the corresponding difference in median survival time (95%CI) were -0.53 (-1.01, -0.05), -0.43 (0.16, -1.02), 0.26 (-0.34, 0.86), and 0.25 (-0.51, 1.02), respectively. Stratified and sensitivity analyses showed consistent results. Threshold analysis indicated a sharply increased risk of mortality in participants whose sleep exceeds 9 h (HR = 1.20, 95%CI: 1.11, 1.30). CONCLUSION: Compared with the persistent sleep trajectory of 7 h, moderately and rapidly increased sleep duration trajectories were associated with higher subsequent mortality in Chinese elderly. Those who report sleep exceeding 9 h may be at high risk for all-cause mortality.

Production of artificial humic acid from corn straw acid hydrolysis residue with biogas slurry impregnation for fertilizer application.

This study investigated hydrothermal humification of corn straw acid hydrolysis residue with biogas slurry impregnation, aiming at producing water-soluble artificial humic acid fertilizer for fertilizer application and soil remediation. Hydrothermal humification parameters, including potassium hydroxide concentration (1-3 mol/L), retention time (2-6 h), and temperature (140-180 °C), were investigated using water as the liquid phase. The selected hydrothermal humification condition was 1.5 mol/L potassium hydroxide at 180 °C for 4 h. Moreover, biogas slurry impregnation (0-30 days) was evaluated to improve humic acid yield without introducing additional chemicals or energy input. Biogas slurry as the liquid phase increased the humic acid production by 73.24% with 5 days of impregnation compared to the control due to the alkalinity. The humic acid concentration was sufficient for China's national standard of water-soluble humic acid fertilizers in such conditions. The organic components in biogas slurry were involved in artificial humification as a precursor, forming C-N bonds with humic acid. The product with fortified nitrogen-containing functional groups enhanced the nutrient slow-release characteristics and water retention capabilities. The pot experiment further confirmed that artificial humic acid prepared in this study not only promoted the growth of plants but also achieved soil remediation.

[Early histological changes detected by confocal microscopy in patients with advanced keratoconus receiving collagen cross-linking therapy].

Objective: To investigate the early histological changes by confocal microscopy of patients with advanced keratoconus receiving collagen cross-linking therapy. Methods: In this prospective case series study, confocal microscopy was used to observe 23 patients (32 eyes) who were diagnosed with advanced keratoconus and treated with collagen cross-linking at the Department of Ophthalmology, Chinese PLA General Hospital from September 2017 to March 2019, aged (26±10) year. All patients were examined before and at 1 week, 1 month and 3 months after the therapy. The tissue structure changes, the density of nerve fibers, stromal cells and endothelial cells, and the depth of the corneal stroma were recorded and compared. The overall differences at different times were compared by repeated measurement analysis of variance or Friedman test, and the pairwise comparison was corrected by LSD-t test or Bonferroni test. Results: One week after collagen cross-linking, the epithelial cells were in the repair stage, showing an increased nucleolar size and an enhanced reflection, and the activated cells could be detected under the epithelium. The superficial corneal stroma was swollen and spongiform, while the deep corneal stroma was patchy or cord-like, scattered and with a strong reflection. One month after the therapy, epithelial cells recovered, subepithelial nerves began to grow, the superficial corneal stroma still showed a spongy structure, and the reflection was further enhanced. The activation of the deep corneal stroma exhibited as thicker plaques or cord-like structure. Three months after the therapy, the continuous elongation of single nerve fibers could be detected occasionally. There was statistically significant difference in the density of nerve fibers before and early after the therapy (F=233.30, P<0.001). Compared with the preoperative value [(14.60±2.57) mm/mm2], the density of subepithelial nerve fibers decreased significantly in the early postoperative period, which was (0.51±0.31), (3.65±2.21) and (8.50± 4.02) mm/mm2, respectively, at 1 week, 1 month and 3 months, and there were significant differences between different time points (all P<0.05). There was also statistically significant differences in the density of anterior stromal cells before and early after the therapy (χ2=92.48, P<0.001). Compared with the preoperative value [347.00(345.00,395.75) cells/mm2] the density of anterior stromal cells decreased significantly in the early postoperative period, which was 2.00(1.00,5.75), 2.50(1.00,5.75) and 79.00(64.25,94.00) cells/mm2, respectively, at 1 week, 1 month and 3 months, and there were significant differences between different time points (all P<0.05). Within 3 months after the therapy, the depth of the corneal stroma observed by confocal microscopy ranged from 245 to 536 µm, with an average of (400.56±86.12) µm. Histologically, the depth of the corneal stroma ranged from 245 to 536 µm [average, (402.13±89.20) µm], from 251 to 527 µm [average, (399.88±85.92) µm] and from 259 to 530 µm [average, (399.69±85.94) µm] at 1 week, 1 month and 3 months, respectively, with no significant difference (F=0.797, P=0.455). There was no significant difference in the density of posterior stromal cells [(260.6±33.2) cells/mm2 preoperatively, (264.4±44.5) cells/mm2 at 1 week, (263.9±37.6) cells/mm2 at 1 month and (266.3±40.2) cells/mm2 at 3 months] and endothelial cells [(2 707±152.6) cells/mm2 preoperatively, (2 704±148.5) cells/mm2 at 1 week, (2 705±152.6) cells/mm2 at 1 month and (2 704±150.1) cells/mm2 at 3 months] between different time points (F=1.380, 1.011; P=0.259, 0.351). Conclusions: Confocal microscopy is able to clearly document the early morphological characteristics after collagen cross-linking in the treatment of keratoconus, including the epithelial and subepithelial nerve injury repair, the spongiform superficial corneal stroma, the patchy or cord-like deep corneal stroma, and the relatively stable stromal depth change.

Overweight, obesity and coronary artery lesions among Kawasaki disease patients.

BACKGROUND AND AIMS: Overweight is associated with increased cardiovascular disease in general populations. However, a similar relationship among Kawasaki Disease (KD) patients was unclear. The study aimed to investigate the relation between weight-for-height and coronary artery lesions (CAL) among KD patients, and whether laboratory indices modified this relation. METHODS AND RESULTS: All consecutive KD patients from January 2009 to December 2014 in a city in China were reviewed, and classified into overweight/obese and control groups. All patients were followed to assess the occurrence of CAL by echocardiography for two months from disease onset. The independent effect of overweight/obesity on CAL was evaluated after adjustment for confounders. The interaction effect between overweight and laboratory indices was examined. The prevalence of overweight/obesity among KD patients was 18.5% (95%CI: 16.0%, 21.0%). The proportion of male patients and the proportion of non-standard IVIG treatment were significantly higher in overweight/obese children in comparison with their counterparts. Overweight/obesity was associated with increased odds of total CAL (aOR = 1.69, 95%CI: 1.16, 2.45) and also increased odds of CAL after treatment (aOR = 1.96, 95%CI: 1.09, 3.51); after adjustment for age, gender, KD type, change of medical departments, number of days before admission, treatment regimen and laboratory index. Similar results were found using stratification analysis. In addition, patients at risk of overweight were also associated with significantly increased risk of CAL. There was interaction between weight-for-height and platelet, WBC, and albumin. CONCLUSIONS: Overweight/obesity may be an independent risk factor for CAL among KD patients. Some laboratory indicators may modify this association.

Association between left ventricular ejection fraction and Kawasaki disease shock syndrome.

OBJECTIVE: This study was performed to explore the clinical features of Kawasaki disease shock syndrome and analyse the association between the left ventricular ejection fraction and Kawasaki disease shock syndrome. METHODS: We retrospectively reviewed the medical records of all consecutive inpatients with Kawasaki disease at Wenzhou Medical University Second Affiliated Hospital and Yuying Children's Hospital in Wenzhou, China from January 2009 to December 2016. We compared the clinical characteristics, laboratory data, and left ventricular ejection fraction between patients with and without Kawasaki disease shock syndrome and analysed the effect of the left ventricular ejection fraction on Kawasaki disease shock syndrome under different clinical conditions of Kawasaki disease. RESULTS: In total, 1147 patients were diagnosed with Kawasaki disease. Of these 1147 patients, 17 were diagnosed with Kawasaki disease shock syndrome; 68 patients admitted to the hospital at the same time, ±2 weeks, with Kawasaki disease but without Kawasaki disease shock syndrome served as the control group. Compared with the control group, the Kawasaki disease shock syndrome group had a significantly higher incidence of coronary artery lesions, cardiac troponin I concentration, N-terminal prohormone of brain natriuretic peptide concentration, neutrophil count and ratio, alanine aminotransferase concentration, aspartate aminotransferase concentration, and C-reactive protein concentration and a significantly lower platelet count, serum albumin concentration, and left ventricular ejection fraction. A low left ventricular ejection fraction was associated with Kawasaki disease shock syndrome under different conditions of Kawasaki disease. CONCLUSION: Among patients with Kawasaki disease, cardiac injury is more likely in those with Kawasaki disease shock syndrome than without, and a low left ventricular ejection fraction may be associated with the development of Kawasaki disease shock syndrome.

Neutropenia after intravenous immunoglobulin therapy is associated with coronary artery lesions in children with Kawasaki disease: a case control study.

BACKGROUND: To evaluate differences in laboratory parameters, clinical presentation, and incidence of coronary artery lesions (CAL) between children with neutropenic and non-neutropenic Kawasaki disease (KD). METHODS: All consecutive KD patients that presented to the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University in Wenzhou, China between January 2005 and December 2015 were included in this study. Patients were divided into two groups (KD with neutropenia (NKD) and KD without neutropenia (NNKD)) based on whether or not they developed neutropenia during the course of treatment. We compared differences in clinical manifestations, laboratory parameters, and treatment protocols between groups. We also evaluated the relationship between neutropenia with immunoglobulin dosage and incidence of CAL. RESULTS: An IVIG treatment regimen of 2 g/kg*1d was associated with a lower incidence of neutropenia compared to the 1 g/kg*2d protocol. The incidence of CAL was higher in KD patients with neutropenia than in those without. Subgroup analysis showed no difference in the incidence of CAL among the different age groups between KD patients with and without neutropenia. CONCLUSIONS: Follow up ultrasonic echocardiography should be performed in KD patients with neutropenia in order to allow for early detection of CAL and timely intervention.

Prognostic value of platelet-to-lymphocyte ratios among critically ill patients with acute kidney injury.

BACKGROUND: Inflammation plays an important role in the initiation and progression of acute kidney injury (AKI). However, evidence regarding the prognostic effect of the platelet-to-lymphocyte ratio (PLR), a novel systemic inflammation marker, among patients with AKI is scarce. In this study, we investigated the value of the PLR in predicting the outcomes of critically ill patients with AKI. METHODS: Patient data were extracted from the Multiparameter Intelligent Monitoring in Intensive Care Database III version 1.3. PLR cutoff values were determined using smooth curve fitting or quintiles and were used to categorize the subjects into groups. The clinical outcomes were 30-day and 90-day mortality in the intensive care unit (ICU). Cox proportional hazards models were used to evaluate the association between the PLR and survival. RESULTS: A total of 10,859 ICU patients with AKI were enrolled. A total of 2277 thirty-day and 3112 ninety-day deaths occurred. A U-shaped relationship was observed between the PLR and both 90-day and 30-day mortality, with the lowest risk being at values ranging from 90 to 311. The adjusted HR (95% CI) values for 90-day mortality given risk values < 90 and > 311 were 1.25 (1.12-1.39) and 1.19 (1.08-1.31), respectively. Similar trends were observed for 30-day mortality or when quintiles were used to group patients according to the PLR. Statistically significant interactions were found between the PLR and both age and heart rate. Younger patients (aged < 65 years) and those with more rapid heart rates (≥89.4 beats per minute) tended to have poorer prognoses only when the PLR was < 90, whereas older patients (aged ≥ 65 years) and those with slower heart rates (<89.4 beats per minute) had higher risk only when the PLR was > 311 (P < 0.001 for age and P < 0.001 for heart rate). CONCLUSIONS: The preoperative PLR was associated in a U-shaped pattern with survival among patients with AKI. The PLR appears to be a novel, independent prognostic marker of outcomes in critically ill patients with AKI.

Sedentary Behaviors, Light-Intensity Physical Activity, and Healthy Aging.

Importance: Sleep duration and moderate-to-vigorous physical activity (MVPA) are associated with healthy aging, but the associations of sedentary behaviors and light-intensity physical activity (LPA) with healthy aging are still unclear. Objective: To examine the independent association of sedentary behaviors and LPA with healthy aging, and to estimate the theoretical association of replacing sedentary behavior with LPA, MVPA, or sleep with healthy aging. Design, Setting, and Participants: In this cohort study using data from the Nurses' Health Study, participants aged 50 years or older and free of major chronic diseases in 1992 were prospectively followed up for 20 years. Data were analyzed from January to May 2022. Exposures: Three measures for sedentary behaviors (hours watching television, sitting at work, and other sitting at home) and 2 measures for LPA (hours of standing or walking around at home [LPA-Home] and at work [LPA-Work]). Main Outcomes and Measures: Healthy aging was defined as survival to at least age 70 years with maintenance of 4 health domains (ie, no major chronic diseases and no impairment in subjective memory, physical function, or mental health). The isotemporal substitution model was used to evaluate the potential impact on healthy aging of replacing 1 hour of 1 behavior with equivalent duration of another. Results: Among 45 176 participants (mean [SD] age, 59.2 [6.0] years), 3873 (8.6%) women achieved healthy aging. After adjustment for covariates including MVPA, each increment of 2 hours per day in sitting watching television was associated with a 12% (95% CI, 7%-17%) reduction in the odds of healthy aging. In contrast, each increase of 2 hours per day in LPA-Work was associated with a 6% (95% CI, 3%-9%) increase in the odds of healthy aging. Replacing 1 hour of sitting watching television with LPA-Home (OR, 1.08; 95% CI, 1.05-1.12), LPA-Work (OR, 1.10; 95% CI, 1.07-1.14), or MVPA (OR, 1.28; 95% CI, 1.23-1.34) was associated with increased odds of healthy aging. Among participants who slept 7 hours per day or less, replacing television time with sleep was also associated with increased odds of healthy aging. Conclusions and Relevance: In this cohort study, longer television watching time decreased odds of healthy aging, whereas LPA and MVPA increased odds of healthy aging and replacing sitting watching television with LPA or MVPA, or with sleep in those who slept 7 hours per day or less, was associated with increased odds of healthy aging, providing evidence for rearranging 24-hour behavior to promote overall health.

Impact of baseline and longitudinal allostatic load changes on incident cardiovascular disease and all-cause mortality: A 7-year population-based cohort study in China.

BACKGROUND: We aimed to prospectively examine the association of baseline allostatic load (AL) and longitudinal AL changes with incident cardiovascular disease (CVD) and all-cause mortality among middle-aged and elderly Chinese populations and evaluate the relative contributions of each physiological system of AL. METHODS: Data from the China Health and Retirement Longitudinal Study (CHARLS) among adults aged 45 years or older were analyzed. Cox regression models were used to estimate the hazard ratios (HRs) and 95 % confidence intervals (95 % CIs) for the associations between baseline AL/longitudinal AL changes with incident CVD and all-cause mortality. RESULTS: Compared with adults with AL 0-1, HRs of those with baseline AL 2-3 and AL ≥ 4 were 1.24 (95 % CI: 1.06, 1.45) and 1.51 (95 % CI: 1.27, 1.80) for incident CVD, and 1.39 (95 % CI: 1.11, 1.75) and 2.02 (95 % CI: 1.60, 2.54) for all-cause mortality. Similar results were found when we treated baseline AL as a continuous variable. We also found per AL score increase during 4 years of follow-up was related to a 11 % (HR, 1.11; 95 % CI: 1.03, 1.20) and 21 % (HR, 1.21; 95 % CI: 1.10, 1.34) increase in incident CVD and all-cause mortality, respectively. LIMITATIONS: Self-reported physician-diagnosed CVD was used to assess the incident CVD. CONCLUSIONS: Both baseline AL and longitudinal increases in AL were positively associated with incident CVD and all-cause mortality in middle-aged and elderly adults. Individuals with high AL need to be dynamically monitored for CVD and pre-mature mortality prevention.

Type A personality, hostility, time urgency and unintentional injuries among Chinese undergraduates: a matched case-control study.

BACKGROUND: Associations between type A behaviour pattern (TABP) and injuries are inconsistent. These inconsistencies may be due to different effects of various components of TABP, namely time urgency/impatience, hostility and competitive drive. It is important to examine the relationship between the global TABP, its two components, and unintentional injuries, among undergraduates in China. METHODS: On the basis of a previous cross-sectional study, we conducted a matched case-control study. 253 cases and an equal number of age-, gender-, and major-matched controls were included. The questionnaire solicited socio-demographic information, the experience of injuries, the scale of TABP, and other potential confounding factors. Besides the correlation between the global TABP and injuries, the influences of the two components of TABP on injuries were also evaluated. Conditional logistic regression was used to determine the crude odds ratios (ORs) and adjusted ORs of injury events. RESULTS: A dose-response relationship was apparent among students who rated themselves higher on the TABP scale (P-value for trend, 0.002), with a crude OR of 2.93 (95% CI: 0.93-9.19) for injuries comparing those with TABP to those with type B behaviour pattern (TBBP). After adjustment for potential confounding factors, TABP remained statistically significant, and the adjusted OR was 5.52 (95% CI: 1.43-21.27); from a comparison of students with TABP to those with TBBP. A dose-response relationship was also apparent between the hostility component and nonfatal injuries, both in crude analysis and after adjusting for other confounders. The relationship between time-hurry and injuries was not statistically significant, based on univariate and multivariate analyses. CONCLUSIONS: Both the global TABP and the hostility component were associated with a dose response increase in the risk of non-fatal unintentional injuries among Chinese undergraduates. Further studies need to be conducted to confirm or reject this correlation.

Successful treatment of granulomatosis with polyangiitis using tocilizumab combined with glucocorticoids: A case report.

BACKGROUND: Tocilizumab is a humanized monoclonal antibody against the interleukin-6 (IL-6) receptor that is commonly used to treat large vessel vasculitis and antineutrophil cytoplasmic antibody-related small vessel vasculitis. However, tocilizumab in combination with glucocorticoids for successfully treating granulomatosis with polyangiitis (GPA) has rarely been reported. CASE SUMMARY: Here, we report a 40-year-old male patient who suffered GPA for 4 years. He was treated with multiple rounds of drugs, including cyclophosphamide, Tripterygium wilfordii, mycophenolate mofetil, and belimumab, with no improvement. In addition, he exhibited persistently high IL-6 levels. After tocilizumab treatment, his symptoms improved, and his inflammatory marker levels returned to normal. CONCLUSION: Tocilizumab may be effective for treating GPA.

Analysis of Basketball Technical Movements Based on Human-Computer Interaction with Deep Learning.

With the continuous development of computer technology, analysis techniques based on various types of sports data sets are also evolving. One typical representative is image-based motion recognition technology, which enables video action recognition with a certain degree of feasibility. In basketball technical action videos, technical action has obvious characteristics. The athletes in the footage in sports videos are relatively fixed, and the scenes are relatively homogeneous, so technical action analysis of basketball technical action videos has certain advantages. However, there are many challenges in basketball technical action recognition, mainly including the fact that basketball techniques are numerous and complex. To address the above issues, this research proposes a 3D convolutional neural network framework that two different resolution image inputs are performed on the basketball technical action dataset. The experimental results show that the algorithmic process designed in this study is effective for action recognition on the basketball technical action dataset.

Rotating Night Shift Work and Healthy Aging After 24 Years of Follow-up in the Nurses' Health Study.

Importance: Rotating night shift work is associated with higher mortality. Whether it is also associated with overall health among those who survive to older ages remains unclear. Objective: To examine whether rotating night shift work is associated with healthy aging after 24 years of follow-up in the Nurses' Health Study, a cohort study among registered female nurses. Design, Setting, and Participants: For this cohort study, a composite healthy aging phenotype was ascertained among 46 318 participants who were aged 46 to 68 years and free of major chronic diseases in 1988 when the history of night shift work was assessed. In a secondary analysis in which cognitive function decline was considered in the healthy aging definition, 14 273 nurses were involved. Data were analyzed from March 1 to September 30, 2021. Exposures: Duration of rotating night shift work. Main Outcomes and Measures: Healthy aging was defined as reaching at least 70 years of age and being free of 11 major chronic diseases, memory impairment, physical limitation, or deteriorated mental health. Results: Of 46 318 female nurses (mean [SD] age at baseline, 55.4 [6.1] years), 3695 (8.0%) achieved healthy aging after 24 years of follow-up. After adjusting for established and potential confounders, compared with women who never worked rotating night shifts, the odds of achieving healthy aging decreased significantly with increasing duration of night shift work. The odds ratios were 0.96 (95% CI, 0.89-1.03) for 1 to 5 years, 0.92 (95% CI, 0.79-1.07) for 6 to 9 years, and 0.79 (95% CI, 0.69-0.91) for 10 or more years of night shift work (P = .001 for trend). This association did not differ substantially by age and lifestyles and was consistent for 4 individual dimensions of healthy aging. Results were similar in a secondary analysis, with an odds ratio of 0.73 (95% CI, 0.60-0.89; P < .001 for trend) comparing 10 or more years of night shift work vs no night shift work. Conclusions and Relevance: In this cohort study, rotating night shift work was associated with decreased probability of healthy aging among US female nurses. These data support the notion that excess night shift work is a significant health concern that may also lead to deteriorated overall health among older individuals.

Independent and joint effects of sleep duration and sleep quality on suboptimal self-rated health in medical students: A cross-sectional study.

Objective: Studies on the association between sleep behavior and health often ignored the confounding effects of biorhythm-related factors. This study aims to explore the independent and joint effects of sleep duration and sleep quality on suboptimal self-rated health (SRH) in medical students. Methods: Cross-sectional study. Proportional stratified cluster sampling was used to randomly recruit students from various medical specialties at a medical university in eastern China. Our questionnaire mainly included information on basic demographic characteristics, SRH, sleep behavior, and biorhythm-related factors. The independent and joint effects of sleep duration and sleep quality on suboptimal SRH were assessed by logistic regression after controlling for potential confounders. Results: Of 1,524 medical students (mean age = 19.9 years, SD = 1.2 years; 59.1% female), 652 (42.8%) had suboptimal SRH. Most medical students (51.5%) slept for 7 h/night, followed by ≥8 (29.1%) and ≤ 6 h (19.4%). After adjusting for basic demographic characteristics and biorhythm-related factors, compared with students who slept for ≥8 h/night, the adjusted ORs (95%CI) for those who slept 7 and ≤ 6 h/night were 1.36 (1.03, 1.81) and 2.28 (1.60, 3.26), respectively (P < 0.001 for trend); compared with those who had good sleep quality, the adjusted ORs (95%CI) for those who had fair and poor sleep quality were 4.12 (3.11, 5.45) and 11.60 (6.57, 20.46), respectively (P < 0.001 for trend). Further, compared with those who slept for ≥8 h/night and good sleep quality, those who slept ≤ 6 h and poor sleep quality had the highest odds of suboptimal SRH (OR 24.25, 95%CI 8.73, 67.34). Conclusions: Short sleep and poor sleep quality were independently and jointly associated with higher odds of suboptimal SRH among medical students.

Albumin level and progression of coronary artery lesions in Kawasaki disease: A retrospective cohort study.

Background: Albumin (ALB) level is closely associated with the occurrence of intravenous immunoglobulin (IVIG) resistance and coronary artery lesions (CALs) in Kawasaki disease (KD). The association between ALB level and CALs progression, is critical to the prognosis of KD patients. But little is known about it. This study aims to investigate the effect of the ALB level on CALs progression in KD patients. Methods: A total of 3,479 KD patients from 1 January 2005 to 30 November 2020, in Wenzhou, China were recruited. A total of 319 KD patients who had CALs and ALB data, and finish the follow-up as requested were enrolled in this study. They were classified into the low ALB group and the normal ALB group, divided by 30 g/L. CALs outcomes were classified into two categories according to the CALs changes from the time that CALs were detected within 48 h before or after IVIG treatment to 1 month after disease onset: progressed and no progressed. Multiple logistic regression models were used to assess the independent effect of ALB level on CALs progression among KD patients. Stratified analysis was performed to verify the ALB level on CALs progression among patients in different subgroups. Results: Higher proportion of IVIG resistance (P < 0.001), receiving non-standard therapy (P < 0.001), and receiving delayed IVIG treatment (P = 0.020) were detected in patients with lower ALB level. Patients with lower ALB level had higher C-reactive protein (CRP) level (P = 0.097) and white blood cell count (WBC) (P = 0.036). After adjustment for confounders, patients with lower ALB level had higher odds of CALs progression; the adjusted odds ratio (OR) was 3.89 (95% CI: 1.68, 9.02). Similar results were found using stratification analysis and sensitivity analysis. Male gender and age over 36 months, as covariates in multiple logistic regression models, were also associated with CALs progression. Conclusion: Low ALB level is identified as an independent risk factor for CALs progression in KD patients. Male gender and age over 36 months are also proved to be risk factors for CALs progression. Further investments are required to explore its mechanisms.

Status and risk factors of unintentional injuries among Chinese undergraduates: a cross-sectional study.

BACKGROUND: Injuries affect all age groups but have a particular impact on young people. To evaluate the incidence of non-fatal, unintentional, injuries among undergraduates in Wenzhou, China, assess the burden caused by these injuries, and explore the associated risk factors for unintentional injuries among these undergraduates, we conducted a college-based cross-sectional study. METHODS: Participants were selected by a multi-stage random sampling method, and 2,287 students were asked whether they had had an injury in the last 12 months; the location, cause, and consequences of the event. The questionnaire included demographic and socioeconomic characteristics, lifestyle habits, and the scale of type A behaviour pattern (TABP). Multivariate logistic regression models were used; crude odds ratios (ORs), adjusted ORs and their 95% confidence intervals (CIs) were estimated, with students having no injuries as the reference group. RESULTS: The incidence of injuries among undergraduates in Wenzhou was 18.71 injuries per 100 person-years (95%CI: 17.12~20.31 injuries per 100 person-years). Falls were the leading cause of injury, followed by traffic injuries, and animal/insect bites. Male students were more likely to be injured than female students. Risk factors associated with unintentional injuries among undergraduates were: students majoring in non-medicine (adjusted OR: 1.53; 95% CI: 1.19-1.96); type A behaviour pattern (adjusted OR: 2.99; 95% CI: 1.45-6.14); liking sports (adjusted OR: 1.86; 95% CI: 1.41-2.45). CONCLUSIONS: Injuries have become a public health problem among undergraduates. Falls were the major cause of non-fatal injury. Therefore, individuals, families, schools and governments should promptly adopt preventive measures aimed at preventing and controlling morbidity due to non-fatal injury, especially among students identified to be at high-risk; such as male students with type A behaviour pattern who like sports.

[Effects of intervene on occupational health knowledge, attitude and practice of people with occupational disease risk in private enterprises].

OBJECTIVE: To evaluate the effects of health promotion on occupational health based on the changes in knowledge, attitude and practice (KAP) before and after intervention of people with occupational disease risk in private enterprises. METHODS: 202 people with occupational disease risk in private leather enterprises of Wenzhou were surveyed, who were rechecked with the same questionnaire after three months intervention. RESULTS: The knowledge, attitude and practice scores (9.34 ± 2.57, 7.79 ± 2.58 and 7.24 ± 2.50, respectively) of post-intervention group were significantly increased more than those of pre-intervention (8.06 ± 2.71, 7.63 ± 2.67, 7.11 ± 2.60, respectively) (P < 0.01, P < 0.05). The net increases of knowledge, attitude and practice scores were significantly different with different length of service, educational level, registered residence and training experience (P < 0.05, P < 0.01). CONCLUSIONS: Health promotion could increase knowledge, attitude and practice levels; The effect of intervention on people with short length of service, low educational level, coming from country and had not attended training is significant.

Risk factors associated with early childhood caries among Wenzhou preschool children in China: a prospective, observational cohort study.

OBJECTIVES: Early childhood caries (ECC) is a serious health public problem that affects a large proportion of children in China. This study aimed to assess risk factors for the incidence of ECC among Wenzhou (China) preschoolers. DESIGN: Prospective, observational cohort study. SETTING: Kindergartens (n=6) in Wenzhou, China. PARTICIPANTS: 606 children who were 3-4 years of age and newly arrived in the kindergartens in September 2011. METHODS: This was a longitudinal observational study with a 2-year follow-up of preschoolers of 3-4 years of age in Wenzhou (Southeast China). Oral health data were collected annually after the baseline survey. The risk factors associated with visible caries and increment of decayed, missing and filled teeth (dmft) were analysed through univariable and multivariable regression using generalised estimating equations. RESULTS: The prevalence of ECC was increasing during the follow-up period (59.8% at enrolment, 71.8% at first year, and 76.4% at second year). Older age (b=0.07; 95% CI: 0.05 to 0.09; p<0.001), caregivers (relatives or nannies) (b=-1.20; 95% CI: -2.23 to -0.16; p=0.023), lower annual family income (¥10 000-¥20 000: b=2.04; 95% CI: 1.04 to 3.04; p<0.001; <¥10 000: b=1.78; 95% CI: 0.65 to 2.92; p=0.002) and more frequent consumption of sugary snacks/drinks at night (sometimes: b=0.88; 95% CI: 0.20 to 1.56; p=0.011; always: b=1.19; 95% CI: 0.13 to 2.25; p=0.028) were independently associated with the increments of dmft. Older age (OR=1.04, 95% CI: 1.03 to 1.05, p<0.001) and more frequent consumption of sweet snacks (OR=1.86, 95% CI: 1.06 to 3.27; p=0.030) were independently associated with a higher risk of visible caries. CONCLUSIONS: The occurrence and severity of ECC were associated with older age, caregivers (relatives or nannies), lower annual family income and more frequent consumption of sweet snacks. It is imperative to strengthen oral health education for parents and limit sugary foods/snacks.

Sleep Duration and Snoring at Midlife in Relation to Healthy Aging in Women 70 Years of Age or Older.

PURPOSE: Both short and long sleep durations are associated with higher mortality. This study examined the association between sleep duration and overall health among those who survive to older ages. PARTICIPANTS AND METHODS: In the Nurses' Health Study, participants without major chronic diseases in 1986 and survived to age 70 years or older in 1995-2001 were included. Habitual sleep duration and snoring were self-reported in 1986. Healthy aging was defined as being free of 11 major chronic diseases and having no cognitive impairment, physical impairment, or mental health limitations. Logistic regression was used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for healthy aging. RESULTS: Of the 12,304 participants, 1354 (11.0%) achieved healthy aging. We observed a non-linear association between sleep duration and the odds of achieving healthy aging. Compared with women sleeping 7 hours per day, women with longer sleep duration were less likely to achieve healthy aging; there was also a suggestion of lower odds of healthy aging for shorter sleepers, although the associations did not reach statistical significance: the multivariate-adjusted ORs (95% CIs) of healthy aging for those sleeping ≤5, 6, 8, and ≥9 hours were 0.94 (0.70, 1.27), 0.88 (0.76, 1.02), 0.83 (0.72, 0.96), and 0.60 (0.43, 0.84), respectively. Similar non-linear associations were consistently observed for individual dimensions of healthy aging. Regular snoring was associated with 31% lower odds of healthy aging (95% CI: 0.54, 0.88), which was primarily due to lower odds of having no major chronic diseases. CONCLUSION: Both short and long sleep durations as well as regular snoring at midlife were associated with lower odds of healthy aging in later life.

Propensity score analysis for time-dependent exposure.

Propensity score analysis (PSA) is widely used in medical literature to account for confounders. Conventionally, the propensity score (PS) is calculated by a binary logistic regression model using time-fixed covariates. In the presence of time-varying treatment or exposure, the conventional method may cause bias because subjects with early and late exposure are treated as the same. In effect, subjects who are treated latter can be different from those who are treated early. Thus, the conventional PSA must be modified to address this bias. In this paper, we illustrate how to perform analysis in the presence of time-dependent exposure. We conduct a simulation study with a known treatment effect. In the simulation study, we find the PSA method that directly adjust PS estimated by either a binary logistic regression model or a Cox regression model using time-fixed covariates still introduce significant bias. On the other hand, the time-dependent PS matching can help to achieve a result approaching the true effect. After time-dependent PS matching, the matched cohort can be analyzed with conventional Cox regression model or conditional logistic regression (CLR) model with time strata. The performance is comparable to the correctly specified Cox regression model with time-varying covariates (i.e., adjusting the exposure in a multivariable model as a time-varying covariate). We further develop a function called TDPSM() for time-dependent PS matching and it is applied to a real world dataset.