Association of Physical Activity With Cognitive Function Among Older Adults in Rural Sichuan, China.

The purpose of this study was to explore the relationship between total physical activity and different dimensions of cognitive function (orientation, attention, and memory) among older adults in rural Sichuan, China. This cross-sectional study involved 715 older adults (average age of 72 years). Total PA was measured by the Physical Activity Scale for the Elderly, and cognitive function was assessed by the Telephone Interview for Cognitive Status (TICS) questionnaire. The multivariate linear regression analysis indicated that total PA and household PA were significantly associated with the overall Telephone Interview for Cognitive Status score (ß = 0.143, p < .001; ß = 0.115, p = .002, respectively), the orientation dimension (ß = 0.142, p < .001; ß = 0.131, p = .001, respectively), and the memory dimension (ß = 0.179, p < .001; ß = 0.134, p = .001, respectively). The study showed a positive association between total PA, household PA, and cognitive function in older adults, especially in the orientation dimension and the memory dimension of cognitive function.

Residential greenness and atherosclerotic cardiovascular disease risk in a rural Chinese adult population.

Residential greenness may be beneficial for cardiovascular health, but the evidence is still scarce, especially in developing countries. This study aimed to assess the associations between exposure to residential greenness and 10-year atherosclerotic cardiovascular disease (ASCVD) risk in a large rural Chinese adult population. This was a cross-sectional study based on 31,162 participants aged 35-74 years with complete data on predictors of the 10-year ASCVD risk from the Henan Rural Cohort Study. The satellite-derived Normalized Difference Vegetation Index (NDVI) and Enhanced Vegetation Index (EVI) were used to quantify residential greenness in a buffer radius of 500 m, 1000 m, and 3000 m. The high 10-years ASCVD risk was defined as the estimated risk ≥10% based on prediction equations from the China-PAR Project for Chinese populations. Multivariable-adjusted logistic regression models were performed to estimate the associations of greenness exposures with high 10-year ASCVD risk, and mediation analyses were employed to the potential mediators. For per interquartile range (IQR) increase in NDVI500-m, NDVI1000-m, NDVI3000-m, EVI500-m, EVI1000-m, and EVI3000-m, the adjusted OR (95% CI) of high 10-years ASCVD risk was 0.828 (0.793-0.866), 0.850 (0.817-0.885), 0.823 (0.792-0.855), 0.848 (0.809-0.889), 0.863 (0.826-0.901), 0.843 (0.805-0.883), respectively. Strong associations of NDVI500-m and EVI500-m with high 10-years ASCVD risk were found among participants with lower education level and lower averaged monthly income. The associations of greenness exposures with high 10-year ASCVD risk were partially explained by particulate matter with an aerodynamic diameter ≤1 µm, BMI, and physical activity. Enhancing residential greenness exposure may be beneficial for reducing the high 10-year ASCVD risk in rural Chinese adults.

Study on illness perceptions of Chinese rural-dwelling adults with hypertension: A descriptive study.

OBJECTIVE: The aim of this study was to describe the levels of illness perception and identify interrelations among the variables of illness perception, demographic, and health-related characteristics in a sample of rural Chinese adults with hypertension (HTN). DESIGN: This is a cross-sectional descriptive study using descriptive and correlation analysis. SAMPLE: It included 163 people diagnosed with HTN for at least 3 years who lived in two rural villages in Zhejiang Province of mainland China during 2014-2015. MEASUREMENTS: Illness perception was measured by the Chinese Illness Perception Questionnaire-Revised. Demographic and illness characteristics were collected by the researcher. Weight, height, and blood pressure (BP) were, respectively, measured by calibrated scale and digital sphygmomanometers. RESULTS: The findings showed that the BP control rate was 28.80% in the village. The highest average item score found in timeline (3.98 ± 0.76) and control (3.29 ± 0.67) subscales indicated that rural Chinese adults believe in the chronicity and controllability of HTN. Negative illness representation presented the lowest mean item score (2.64) suggesting that the participants neither perceive symptom variation of the illness nor their illness as serious. Interrelations existed among the illness perception variables with variation from that in other previous study. The cause of HTN was attributed to balance factors, psychological factors, risk factors, and cultural factors in sequence. Age, education, body mass index, and household annual income were correlated with illness perception. CONCLUSION: These findings suggested that misconceptions about HTN perception existed among rural adults in the villages. Comprehensive health education program is needed to increase rural adults' knowledge and management of HTN.

Body Fat Mass, Fat Distribution and Egg Consumption: a Population-Based Study in Chinese Adults.

Objective: Egg is the vital source for many nutrients. The present study aimed to evaluate how egg consumption contributes to body fat mass and fat distribution in general Chinese adults.Methods: In a representative study of Chinese adults, 2241 rural adults aged 18-80 years completed physical measurements and semi quantitative food frequency questionnaire (FFQ). Body fat percentage (BF%) was estimated through validated Chinese-specific equations including age, body mass index (BMI), waist circumference (WC), gender and their interaction.Results: The prevalence of excessive body fat and central obesity in males were 44.2% and 31.3%, lower than that in females (60.7% and 36.1%, p < 0.05). 37.3% of lean or normal-weight individuals by BMI experienced excessive body fat given their BF% and 43.5% were central obesity according to WC. In females, egg consumption was associated with better body fat mass and its distribution. Compared with non-consumers, individuals consumed egg >50 g/d had a 34% lower risk of central obesity (OR:0.66, 0.39-0.99) and 38% lower risk of excessive body fat (OR:0.62, 0.37-1.00). There were significant dose-response relationships between egg consumption and overweight with excessive body fat/central obesity (p for linear trend <0.05). However, these associations were not significant in males.Conclusion: Our findings underscore the necessity for future public health guidelines to assess body fat mass and distribution simultaneously in Chinese adults. Egg consumption might be beneficial for weight regulation, especially for overweight with excessive body fat/central obesity in females. Further research is warrant to establish the causal inference.

The association between frequency of away-from home meals and type 2 diabetes mellitus in rural Chinese adults: the Henan Rural Cohort Study.

PURPOSE: There is a paucity of data on the association between away-from home meals (AFHs) and type 2 diabetes mellitus (T2DM). The aim of this cross-sectional study was to explore the dose-response relationship between AFHs and T2DM in a Chinese population. METHODS: A total of 29,910 participants were enrolled from the Henan Rural Cohort Study. Information on the weekly frequency of AFHs was collected by face-to-face questionnaires. Logistic regression and restricted cubic splines were used to estimate the relationship between the frequencies of AFHs and T2DM. Mediation analysis was performed to examine the contribution of body mass index (BMI) to the frequency of AFH-related T2DM. RESULTS: Compared with those who reported 0 AFHs per week, those who consumed ≥ 11 AFHs/week were associated with a 39% increase in the prevalence of T2DM. A nonlinear dose-response relationship between the frequency of AFHs and T2DM was found. Compared with the 0 AFHs/week group, in males, the multivariate odds ratios (OR) and 95% confidence interval (95% CI) of the groups with 11 or more AFHs/week for T2DM were 1.36 (1.01-1.84). However, no such association was found in females. BMI partly mediated the effects of the frequency of AFHs on T2DM, and the proportion explained was 23.4%. CONCLUSIONS: A relationship between the frequency of AFHs and T2DM was observed in the rural Chinese population. An excessive frequency of AFHs was likely to increase the prevalence of T2DM. Meanwhile, BMI partially mediates the effects of the frequency of AFHs on T2DM. TRIAL REGISTRATION: The Henan Rural Cohort Study, ChiCTR-OOC-15006699, Registered 6 July 2015, https://www.chictr.org.cn/showproj.aspx?proj=11375 .

Intergenerational relationships and the trajectory of depressive symptoms among older Chinese adults in rural migrant families.

OBJECTIVES: This study examined the trajectory patterns of depressive symptoms of older rural Chinese adults in migrant families and the role of intergenerational relationships in predicting trajectory class memberships. METHOD: Data were derived from the 2001, 2003, 2006, and 2009 waves of a longitudinal survey titled The Well-being of Older People in Anhui Province. The sample featured 486 respondents who had at least one migrant adult children at all four waves. Growth mixture modeling was used to investigate the trajectory classifications of depressive symptoms from 2001 to 2009 and antecedents in differentiating among class memberships. RESULTS: The findings suggested a two-class model to interpret depressive symptom trajectory patterns: persistently high symptoms and low but increasing symptoms. Older adults who had better intergenerational relationships at baseline were more likely to have low but increasing depressive symptoms after controlling for other covariates. DISCUSSION: The findings suggest that intergenerational relationships have long-term impacts on depressive symptom trajectory classes. Policy and intervention implications are discussed.

Cardiovascular metabolic risk factors and glomerular filtration rate: a rural Chinese population study.

METHODS: A total of 2426 study subjects from rural China aged 35 years and above (934 men and 1492 women) were enrolled in a cross-sectional survey. The eGFR calculation was based on the Modification of Diet in Renal Disease (MDRD) equation. The strength of the association between cardiovascular metabolic risk factors and eGFR was analyzed using a linear regression model. RESULTS: Cardiovascular metabolic risk factors, including age, body weight, waist circumference, fasting plasma glucose (FPG), creatinine (Cr), high-density lipoprotein-cholesterol (HDL-C), total cholesterol (TC), triglyceride (TG), systolic pressure, and diastolic pressure, were associated with eGFR. Additionally, the eGFR level gradually decreased and showed a linear trend with the increase in metabolic syndrome risk factors. CONCLUSION: Metabolic risk factors are correlated with a reduction in renal function and CKD.

The Vulnerability of Rural Migrants Under COVID-19 Quarantine in China and its Global Implications: A Socio-Ethical Analysis.

Despite the role of public health interventions in controlling disease transmission and protecting the public during the COVID-19 emergency, the implementation of quarantine restrictions has raised serious ethical concerns, especially in relation to the well-being of vulnerable populations. Drawing on the lived experiences of rural Chinese migrants who are subject to pandemic control, the authors highlight their inadequate capacities to manage the risks associated with the pandemic and adjust to quarantine restrictions. Informed by an ethical discourse of vulnerability, we show that underpinning this group's deficient coping strategies is a range of detrimental social structures and institutions that have developed under the persistent rural-urban divide in China. These structural constraints and pathologies expose rural migrants to serious risks and uncertainties while depriving them of the means and resources necessary to protect their own interests in the process of complying with quarantine restrictions. Understanding the plight of rural Chinese migrants as a structural problem also has implications for the global response to the COVID-19 pandemic. We further suggest a need for state intervention to mitigate structural deficiencies and empower the vulnerable during the COVID-19 era.

Reciprocal relationship between interpersonal communication and depressive symptoms and the mediating role of resilience across two years: Three-wave cross-lagged panel model.

BACKGROUND: Depression among children has been a growing public health concern. It is generally recognized that individuals with depression are likely to have interpersonal malfunctioning. However, there remains a limited scientific understanding of the reciprocal relationship between interpersonal communication and depressive symptoms among rural Chinese children in a longitudinal approach. METHODS: Therefore, guided by the interpersonal model of depression and the developmental cascade model, the present study conducted a cross-lagged panel analysis study to explore the bidirectional relationship between interpersonal communication and depressive symptoms across three waves among 2188 elementary school students in rural areas of one county of Gansu Province, China. We also examined the mediating effect of resilience and sex differences of the models. RESULTS: Our results showed that depressive symptoms negatively predicted interpersonal communication from T1 to T2 and T2 to T3. Interpersonal communication negatively predicted depressive symptoms from T1 to T2, but not T2 to T3. Furthermore, resilience showed significant partial mediating effects in the reciprocal relationship between interpersonal communication and depressive symptoms. In terms of sex differences, the significant relationship between depressive symptoms at T1 and interpersonal communication at T2 was found to be significant among male students and marginally significant among female students. The full mediating effect of resilience at T1 was found only among male students, whereas resilience at T2 functioned as a full mediator between depressive symptoms at T2 and interpersonal communication at T3 only among female students. LIMITATIONS: First, the present sample consisted of only third and fourth grade (i.e., in T1) students from one county in rural China. Second, the present study examined depressive symptoms instead of depression as a clinical diagnosis. Third, the third wave of the data was collected during COVID-19. The impact of the COVID-19 pandemic could unexpectedly pose on child mental health. CONCLUSIONS: The finding underlined the importance of providing comprehensive depression prevention and intervention from fostering children's inner resilience and promoting their ability to navigate interpersonal resources.

Energy Poverty and Depression in Rural China: Evidence from the Quantile Regression Approach.

Despite the growing awareness and interest in the impact of energy poverty on depression, studies in developing economies are relative limited, and there is a gap of knowledge of such impact among rural individuals in China. In this study, we investigate the impact of energy poverty on depression among rural Chinese individuals aged 16 and above, and our sample includes 13,784 individuals from 6103 households. With data from the 2018 China Family Panel Studies, we apply the instrumental variable (IV) quantile regression approach to address the potential endogeneity of energy poverty and allow for heterogeneous effects of energy poverty on depression across individuals with different levels of depression. Our estimates from the IV quantile regression suggest a strong positive impact of energy poverty on depression at the upper quantile of depression scores, but no impact at the middle and lower quantiles. The primary results are robust and consistent with alternative energy poverty measures, and we find that energy poverty does not affect depression of low-risk individuals (with low depression scores), but it does affect that of high-risk individuals. We also find individual socio-demographic factors of age, gender, household size, religious belief, education, marriage and employment status play roles in affecting depression. The findings of this study generate policy implications for energy poverty alleviation and mental health promotion.

Hierarchical and nested associations of suicide with marriage, social support, quality of life, and depression among the elderly in rural China: Machine learning of psychological autopsy data.

Objectives: To identify mechanisms underpinning the complex relationships between influential factors and suicide risk with psychological autopsy data and machine learning method. Design: A case-control study with suicide deaths selected using two-stage stratified cluster sampling method; and 1:1 age-and-gender matched live controls in the same geographic area. Setting: Disproportionately high risk of suicide among rural elderly in China. Participants: A total of 242 subjects died from suicide and 242 matched live controls, 60 years of age and older. Measurements: Suicide death was determined based on the ICD-10 codes. Influential factors were measured using validated instruments and commonly accepted variables. Results: Of the total sample, 270 (55.8%) were male with mean age = 74.2 (SD = 8.2) years old. Four CART models were used to select influential factors using the criteria: areas under the curve (AUC) ≥ 0.8, sensitivity ≥ 0.8, and specificity ≥ 0.8. Each model included a lead predictor plus 8-10 hierarchically nested factors. Depression was the first to be selected in Model 1 as the lead predictor; After depression was excluded, quality of life (QOL) was selected in Model 2; After depression and QOL were excluded, social support was selected in Model 3. Finally, after all 3 lead factors were excluded, marital status was selected in Model 4. In addition, CART demonstrated the significance of several influential factors that would not be associated with suicide if the data were analyzed using the conventional logistic regression. Conclusion: Associations between the key factors and suicide death for Chinese rural elderly are not linear and parallel but hierarchically nested that could not be effectively detected using conventional statistical methods. Findings of this study provide new and compelling evidence supporting tailored suicide prevention interventions at the familial, clinical and community levels.

Relationship between higher serum selenium level and adverse blood lipid profile.

BACKGROUND: As the key component of glutathione peroxidase with unique antioxidant properties, selenium has been considered to play an important part on lipid metabolism. However, the associations of serum selenium concentrations with lipid concentrations and dyslipidemia are still controversial. METHODS: We analyzed cross-sectional data including serum selenium levels, lipid concentrations and other related indexes of 8198 rural Chinese. Serum selenium was measured by inductively coupled plasma mass spectrometry, and total cholesterol (TC), triglyceride (TG), high density lipoprotein-cholesterol (HDL-c) and low density lipoprotein-cholesterol (LDL-c) of serum were measured with kits. RESULTS: Overall, mean serum selenium was 120 µg/l. Multivariate liner regression revealed that selenium concentrations were positively correlated with TC (P < 0.001), HDL-c (P < 0.001), TG (P < 0.001) and LDL-c (P < 0.001). Compared with the lowest quintile of serum selenium, participants in quintile 3, 4 and 5 had higher risks of High-TC dyslipidemia (P ≤ 0.02) and High-LDLC dyslipidemia (P < 0.02) after adjusting for covariates. In the stratified analyses, we found that the selenium-dyslipidemia associations were significantly stronger in post-menopausal women (OR: 2.72; 95% CI: 1.97, 4.17) and diabetics (OR: 9.40; 95% CI: 3.02, 29.26). CONCLUSION: Elevated serum selenium levels were correlated with the increased concentrations of TC, LDL-c, HDL-c and TG, and increased the risk of High-TC and High-LDLC dyslipidemia among rural Chinese. However, the real associations between serum selenium and lipid profile should be verified in specifically designed randomized trials in future.

Domestic Violence Counseling in Rural Northern China: Gender, Social Harmony, and Human Rights.

Domestic violence (DV) affects over a third of Chinese women in a relationship. Focusing on ethnographic data from six staff members and six DV survivors at a rural, state-affiliated women's center in China in 2010, this article relies on Henrietta Moore's notion of the poststructuralist gendered subject to examine how the staff draw on discourses about gender and social harmony in persuading women to stay in their marriages, rather than on human rights discourses that emphasize survivor safety. It shows that DV survivors are frequently sent back to dangerous homes where their health is placed at risk.

Using confirmatory factor analysis to explore associated factors of intimate partner violence in a sample of Chinese rural women: a cross-sectional study.

OBJECTIVES: To estimate the prevalence of intimate partner violence (IPV) among a sample of rural Chinese women and to explore associated factors. DESIGN: Cross-sectional study. SETTING: Rural areas of Guangyuan City, Sichuan, China. PARTICIPANTS: We recruited 1501 women, aged 16 years and older, who had been living locally for at least 2 years and reported being married or in a relationship during the past 12 months. They were among a sample of 1898 potential participants from our larger parent study on the prevalence of depressive-distress symptoms. METHODS: Participants completed demographic and social economic measures, the Short Form of the Revised Conflict Tactics Scale and the Duke Social Support Index. We applied χ2 test, analysis of variance and confirmatory factor analysis for analysis. RESULTS: The overall prevalence of IPV in the past 12 months was 29.05%; the prevalence of physical, psychological and sexual violence was 7.66%, 26.58% and 3.20%, respectively. The overall prevalence was highest among women aged 16-29 years, and was more common among those without a high school diploma and who saw their family's financial status as very poor or stagnant. Women who were not victims of IPV had higher levels of social support. Confirmatory factor analysis showed that the total effects of social support on physical, psychological and sexual violence were -0.12, -0.35 and -0.12, respectively. The indirect effects of objective economic status on physical, psychological and sexual violence were -0.047, -0.014 and -0.047, respectively, but the total effect was not significant. The indirect effect of education on psychological violence was -0.056. CONCLUSION: IPV is common in rural Guangyuan. Our data are comparable with the findings from north-west of China. Social support is an important protective factor. Future work is needed to develop, test and later disseminate potential IPV interventions, with a focus on building actual and perceived supportive social networks.

Sex-Specific Difference in the Association Between Poor Sleep Quality and Abdominal Obesity in Rural Chinese: A Large Population-Based Study.

STUDY OBJECTIVES: Existing studies on sleep quality and associated obesity are inconsistent, and few studies have prospectively evaluated the association between sleep quality and abdominal obesity among Chinese individuals. To fill this void, the current study aimed to assess the association between sleep quality and abdominal obesity in a rural Chinese population. METHODS: A representative sample of 9,404 adults aged 20-93 years in northeastern China was selected between 2012 and 2013 by a multistage cluster and random sampling method. Sleep quality was evaluated by the Pittsburgh Sleep Quality Index (PSQI), where a score of 6 or higher indicated sleep disorder. Abdominal obesity was measured by waist circumference (WC), with abdominal obesity defined as WC > 90 cm for men and WC > 80 cm for women. RESULTS: Male participants with abdominal obesity had higher global PSQI scores in addition to higher subscores in almost all of the elements compared to normal values. The odds ratios of abdominal obesity among participants with sleep disorders were 1.64 (95% confidence interval [CI]: 1.39-1.95) and 1.14 (95% CI: 0.98-1.32) for males and females compared to the reference group. The risk in all sleep elements was significantly increased, with odds ratios ranging from 1.28 (95% CI: 1.08-1.51) to 5.81 (95% CI: 3.54-9.53) for males. The risk only in four elements was significantly increased, from 1.28 (95% CI: 1.12-1.47) to 2.27 (95% CI: 1.36-3.80) for females. CONCLUSIONS: Poor sleep quality was associated with abdominal obesity in Chinese. Furthermore, effects in males were larger than those in females.

Effect of B Vitamins from Diet on Hypertension.

BACKGROUND: In western populations, a higher level of dietary B vitamins intake has been associated with a lower risk of hypertension. However, data in Chinese is limited, whose B vitamins consumption is low and rates of hypertension are high. AIM OF THE STUDY: To investigate whether the three B vitamins are associated with hypertension in rural Chinese. METHODS: Cross-sectional survey among 2241 rural Chinese aged 18-80 years was conducted in northwestern China in 2010. Blood pressure was measured by trained medical staff and dietary nutrients were assessed with a semiquantitative food frequency questionnaire. RESULTS: 592 cases of hypertension were newly diagnosed. The deficiency proportions were 20.5% for vitamin B-6, 43.9% for folate and 98.5% for B-12. For females, participants in the highest quartile of B-6 intake had a significantly lower risk of hypertension (OR = 0.69; 95% CI: 0.50-0.93; p for trend <0.05). For males, the multivariable OR for the same comparison was 0.75 (95% CI: 0.56-0.99, p for trend >0.05). No significant associations were observed between B-12, folate intake and hypertension. For females, the highest quartile of both folate and B-6 intake was associated with a reduced risk of hypertension (OR = 0.53; 95% CI: 0.29-0.89), compared with in the middle quartile of both vitamins. CONCLUSIONS: Higher intake of vitamin B-6 is independently associated with lower risk of hypertension in Chinese rural adults. Among females with high folate intake, the association between B-6 and hypertension was strongest. Additional studies are warrant to establish the causal inference.

Metabolic syndrome, but not insulin resistance, is associated with an increased risk of renal function decline.

BACKGROUND & AIMS: The purpose of this study was to evaluate the effect of metabolic syndrome (Mets) and insulin resistance (IR) on the risk of renal function decline (RFD) in a rural Chinese cohort. METHODS: A total of 2696 subjects aged 40-71 years with normal renal function were followed-up for 7 years. RFD was defined using the Kidney Disease: Improving Global Outcome definition, i.e., a drop in estimated glomerular filtration rate (eGFR) category accompanied by a 25% or greater drop in eGFR from baseline or a sustained decline in eGFR of more than 5 mL/min/1.73 m(2)/year. RESULTS: During the 7-year follow-up, 9.0% of the subjects developed RFD. Subjects with Mets at baseline had an increased risk of RFD with an adjusted odds ratio (OR) of 1.77 (95%CI: 1.25-2.52), and there was a graded relationship between the numbers of Mets components and the risk for RFD. Exclusion of the subjects with hypertension (1.65; 0.99-2.75) or diabetes (1.86; 1.30-2.67) at baseline or further adjustment for IR (1.72; 1.15-2.57) did not substantially change the association between Mets and the risk of RFD. Moreover, the ORs of Mets status for RFD in the older group (≥55 years) were 2.14 (1.06-4.33) times of that in the younger group (<55 years) and 2.26 (1.07-4.78) times in hypercholesterolemia group (≥5.2 mmol/L) of that in the normal (<5.2 mmol/L) group. The baseline IR was not associated with the risk for RFD. CONCLUSIONS: Mets, but not IR, was associated with an increased risk for RFD. And there was a detrimental interaction of Mets with older age and hypercholesterolemia on the risk of RFD.