Effect modification of greenness on PM2.5 associated all-cause mortality in a multidrug-resistant tuberculosis cohort.

RATIONALE: Evidence for the association between fine particulate matter (PM2.5) and mortality among patients with tuberculosis (TB) is limited. Whether greenness protects air pollution-related mortality among patients with multidrug-resistant tuberculosis (MDR-TB) is completely unknown. METHODS: 2305 patients reported in Zhejiang and Ningxia were followed up from MDR-TB diagnosis until death, loss to follow-up or end of the study (31 December 2019), with an average follow-up of 1724 days per patient. 16-day averages of contemporaneous Normalised Difference Vegetation Index (NDVI) in the 500 m buffer of patient's residence, annual average PM2.5 and estimated oxidant capacity Ox were assigned to patients regarding their geocoded home addresses. Cox proportional hazards regression models were used to estimate HRs per 10 µg/m3 exposure to PM2.5 and all-cause mortality among the cohort and individuals across the three tertiles, adjusting for potential covariates. RESULTS: HRs of 1.702 (95% CI 1.680 to 1.725) and 1.169 (1.162 to 1.175) were observed for PM2.5 associated with mortality for the full cohort and individuals with the greatest tertile of NDVI. Exposures to PM2.5 were stronger in association with mortality for younger patients (HR 2.434 (2.432 to 2.435)), female (2.209 (1.874 to 2.845)), patients in rural (1.780 (1.731 to 1.829)) and from Ningxia (1.221 (1.078 to 1.385)). Cumulative exposures increased the HRs of PM2.5-related mortality, while greater greenness flattened the risk with HRs reduced in 0.188-0.194 on average. CONCLUSIONS: Individuals with MDR-TB could benefit from greenness by having attenuated associations between PM2.5 and mortality. Improving greener space and air quality may contribute to lower the risk of mortality from TB/MDR-TB and other diseases.

Evaluation of a package of risk-based pharmaceutical and lifestyle interventions in patients with hypertension and/or diabetes in rural China: A pragmatic cluster randomised controlled trial.

BACKGROUND: Primary prevention of cardiovascular disease (CVD) requires adequate control of hypertension and diabetes. We designed and implemented pharmaceutical and healthy lifestyle interventions for patients with diabetes and/or hypertension in rural primary care, and assessed their effectiveness at reducing severe CVD events. METHODS AND FINDINGS: We used a pragmatic, parallel group, 2-arm, controlled, superiority, cluster trial design. We randomised 67 township hospitals in Zhejiang Province, China, to intervention (34) or control (33). A total of 31,326 participants were recruited, with 15,380 in the intervention arm and 15,946 in the control arm. Participants had no known CVD and were either patients with hypertension and a 10-year CVD risk of 20% or higher, or patients with type 2 diabetes regardless of their CVD risk. The intervention included prescription of a standardised package of medicines, individual advice on lifestyle change, and adherence support. Control was usual hypertension and diabetes care. In both arms, as usual in China, most outpatient drug costs were out of pocket. The primary outcome was severe CVD events, including coronary heart disease and stroke, during 36 months of follow-up, as recorded by the CVD surveillance system. The study was implemented between December 2013 and May 2017. A total of 13,385 (87%) and 14,745 (92%) participated in the intervention and control arms, respectively. Their mean age was 64 years, 51% were women, and 90% were farmers. Of all participants, 64% were diagnosed with hypertension with or without diabetes, and 36% were diagnosed with diabetes only. All township hospitals and participants completed the 36-month follow-up. At 36 months, there were 762 and 874 severe CVD events in the intervention and control arms, respectively, yielding a non-significant effect on CVD incidence rate (1.92 and 2.01 per 100 person-years, respectively; crude incidence rate ratio = 0.90 [95% CI: 0.74, 1.08; P = 0.259]). We observed significant, but small, differences in the change from baseline to follow-up for systolic blood pressure (-1.44 mm Hg [95% CI: -2.26, -0.62; P < 0.001]) and diastolic blood pressure (-1.29 mm Hg [95% CI: -1.77, -0.80; P < 0.001]) in the intervention arm compared to the control arm. Self-reported adherence to recommended medicines was significantly higher in the intervention arm compared with the control arm at 36 months. No safety concerns were identified. Main study limitations include all participants being informed about their high CVD risk at baseline, non-blinding of participants, and the relatively short follow-up period available for judging potential changes in rates of CVD events. CONCLUSIONS: The comprehensive package of pharmaceutical and healthy lifestyle interventions did not reduce severe CVD events over 36 months. Improving health system factors such as universal coverage for the cost of essential medicines is required for successful risk-based CVD prevention programmes. TRIAL REGISTRATION: ISRCTN registry ISRCTN58988083.

Spatiotemporal or temporal index to assess the association between temperature variability and mortality in China?

Epidemiological studies increasingly provide evidence about the adverse health effects of temperature variability (TV), which reflects short-term intra- and inter-day temperature change. However, calculation of TV only considers the temporal variability and lacks spatial variability. This study intends to investigate whether the lack of spatial variability in TV calculations has biased the health effect estimates. We collected daily data from the fine-gridded hourly temperatures and more than 2 million all-cause mortality counts in Zhejiang province in China from 2009 to 2015. A spatiotemporal TV index was developed by calculating the standard deviation of the hourly temperatures based on records from multiple sites. This new index could be compared to the two typical temporal TV indices that are calculated based on the hourly temperatures from one-site and area-average records. The three types of TV are compared using a three-stage analytical approach: district-specific time series Poisson regression, meta-analysis, and calculation of attributable mortality fraction. We observe that both spatiotemporal and temporal TVs produce very similar TV-mortality associations, attributable mortality fractions, and model fits at the district level. For example, the mortality increase associated for every increase of 1 °C during 0-7 exposure days is 1.53% (95% CI: 1.31, 1.73) in spatiotemporal TV, whereas it is 1.48% (95% CI: 1.27, 1.68) and 1.45% (95% CI: 1.24, 1.67) in the one-site and area-average temporal TV, respectively. Thus, time series models using temporal TV index are equally good at estimating the associations between TV and mortality as spatiotemporal TV at the district level in population-based epidemiological studies in China. Epidemiological studies using temperature from one site or the averages of multiple sites in TV calculation will not bias the effect estimates of TV. Our study could provide an important guidance method for future TV-related research in China and even in other countries.

Analysis of differential expression profile of miRNA in peripheral blood of patients with lung cancer.

PURPOSE: To identify potential molecular targets for lung cancer intervention and diagnosis, we analyzed the differential miRNA expression of peripheral blood between lung cancer patients and healthy controls. METHODS: Three pairs of cases' and controls' peripheral blood samples were evaluated for miRNA expression by microarray. 12 miRNAs were selected for RT-PCR validation and target genes prediction. In addition, 4 miRNAs were selected for future validation by RT-PCR in a large sample of 145 cases and 55 frequency-matched healthy controls. RESULTS: A total of 338 differentially expressed miRNAs were screened and identified by microarray. According to the fold changes, the top ten upregulated miRNAs were hsa-miR-124-3p, hsa-miR-379-5p, hsa-miR-3655, hsa-miR-450b-5p, hsa-miR-29a-5p, hsa-miR-200a-3p, hsa-miR-542-3p, hsa-miR-138-5p, hsa-miR-219a-2-3p, and hsa-miR-4701-3p, and the top ten downregulated miRNAs were hsa-miR-34c-5p, hsa-miR-135a-5p, hsa-miR-132-3p, hsa-miR-3178, hsa-miR-4449, hsa-miR-4999-3p, hsa-miR-1246, hsa-miR-4424, hsa-miR-1252-5p, and hsa-miR-24-2-5p. RT-PCR verification of the 12 miRNAs revealed that 5 of 8 upregulated miRNAs, 2 of 4 downregulated miRNAs showed a significant difference between the cases and controls (P < .05). A large number of target genes and their functional set showed overlapping among the 453 predicted target genes of the 12 miRNAs (P < .01). RT-PCR in the large sample confirmed the significant differential expression level of hsa-miR-29a-5p, hsa-miR-135a-5p, hsa-miR-542-3p, and hsa-miR-4491 between cases and controls (P < .05), and three of these microRNA, except hsa-miR-29a-5p, were significant after Bonferroni correction for adjustment of multiple comparisons. CONCLUSION: There was a significant difference in miRNAs expression in the peripheral blood between lung cancer patients and healthy controls, and 4 miRNAs were validated by a large-size sample.

Relationship of being threatened or injured with a weapon in school with suicidal ideation and attempt among school students: a school-based study in Zhejiang Province, China.

BACKGROUND: Suicide is the second leading cause of death among 15-29 year old youths globally, and the third most common external cause of death in China. School bullying can cause serious consequences among adolescents, including psychosocial problems, low self-esteem and post-traumatic stress disorder. Most studies examining the associations between being bullied in school and suicide are from Western, developed countries. Moreover, few studies focus on being threatened or injured with a weapon, which may cause serious body injury. Our study aimed to explore the relationship of being threatened or injured with a weapon in school with suicidal ideation and attempt among middle and high school students in Zhejiang Province, China. METHODS: A cross-sectional study of 23,543 students in grades 7-12 from 442 schools was carried out through an anonymous self-administered questionnaire between April and May 2017. Multivariable logistic regression models were used to examine the relationship of being threatened or injured with a weapon in school with suicidal ideation and attempt. RESULTS: 51.3% of participants were boys, and mean (SD) age was 15.6 (1.7) years. The overall prevalence of suicidal ideation and attempt were 16.1% (95%CI: 15.3-16.9) and 3.6% (95%CI: 3.3-4.0), respectively. Prevalence was higher among girls than boys (ideation: 19.1% vs. 13.3%. attempt: 4.4% vs. 2.9%). 13.2% of students reported being threatened or injured with a weapon in school in the past 12 months (95%CI: 11.9-14.5), higher among boys than girls (15.7% vs. 10.5%), and among rural students than urban students (13.9% vs. 11.6%). After adjustment for socio-demographic status, lifestyle factors, academic performance, self-reported health and mental health, the odds ratios for suicidal ideation and attempt among students who reported being threatened or injured with a weapon were 1.46 (1.31-1.61) and 1.68 (1.31-2.13) respectively, as compared with those who did not report being threatened or injured. CONCLUSIONS: Preventive measures for physical bullying in school need to be reinforced in China. Being threatened or injured with a weapon is associated with both suicidal ideation and attempt among middle and high school students. Suicide prevention should be an important component of psychological interventions for threatened or injured students.

CYP2E1 and GSTM1 gene polymorphisms, environmental factors, and the susceptibility to lung cancer.

OBJECTIVE: To investigate the relationships between the CYP2E1 RsaI polymorphism, GSTM1 polymorphism, and the susceptibility to lung cancer, along with the interactions between environmental factors and these genes. METHODS: A case-control study was carried out to explore the independent effect of gene polymorphisms on risk of lung cancer, and the combined effects of gene loci. The stratification analysis of age, sex, smoking, and drinking combined with positive loci was also analyzed, and any interaction was identified. RESULTS: The logistic regression analysis showed that there were statistical relationships between the CYP2E1 RsaI TT genotype and lung cancer, GSTM1 (-) and lung cancer. The combined effect's analysis of these 2 loci showed that, with an increase in the number of risk alleles, the risk of lung cancer also increased (supposing 0 risk allele as the reference group). Subjects carrying 3 risk alleles had the highest risk of developing lung cancer with an adjusted OR = 10.38 (95% CI 2.10-51.35). Stratified analysis showed that, in women, nonsmoking subjects, or nondrinking subjects, the combined effects could increase the risk of lung cancer; no heterogeneity was found between these layers except sex. The interaction analysis showed that, supposing the male, GSTM1 (+) genotype as the reference, the female, GSTM1 (-) genotype had a significantly increased risk of lung cancer (OR = 2.17 [1.01-4.70]); when the non-smoking, GSTM1 (+) genotype subjects was the reference group, smoking, GSTM1 (+) genotype subjects and smoking, GSTM1 (-) genotype subjects had significantly higher risk of lung cancer (OR = 2.00 [1.01-3.96], OR = 2.89 [1.28-6.54]). CONCLUSION: CYP2E1 RsaI TT genotype was a protective factor against the development of lung cancer, while GSTM1 (-) genotype was a risk factor for lung cancer. Increases in the number of the risk alleles also increased lung cancer risk. GSTM1 (-) genotype, sex, and smoking status might interact in the incidence of lung cancer.

Spatially Explicit Mapping of Heat Health Risk Utilizing Environmental and Socioeconomic Data.

Extreme heat events, a leading cause of weather-related fatality worldwide, are expected to intensify, last longer, and occur more frequently in the near future. In heat health risk assessments, a spatiotemporal mismatch usually exists between hazard (heat stress) data and exposure (population distribution) data. Such mismatch is present because demographic data are generally updated every couple of years and unavailable at the subcensus unit level, which hinders the ability to diagnose human risks. In the present work, a human settlement index based on multisensor remote sensing data, including nighttime light, vegetation index, and digital elevation model data, was used for heat exposure assessment on a per-pixel basis. Moreover, the nighttime urban heat island effect was considered in heat hazard assessment. The heat-related health risk was spatially explicitly assessed and mapped at the 250 m × 250 m pixel level across Zhejiang Province in eastern China. The results showed that the accumulated heat risk estimates and the heat-related deaths were significantly correlated at the county level (Spearman's correlation coefficient = 0.76, P ≤ 0.01). Our analysis introduced a spatially specific methodology for the risk mapping of heat-related health outcomes, which is useful for decision support in preparation and mitigation of heat-related risk and potential adaptation.

Gender disparity in the associations of overweight/obesity with occupational activity, transport to/from work, leisure-time physical activity, and leisure-time spent sitting in working adults: A cross-sectional study.

BACKGROUND: The associations of occupational activity (OA), commuting, leisure-time physical activity (LTPA), and sitting with overweight/obesity in working adults are controversial. This study explored these factors with the risk of overall and abdominal overweight/obesity in a Chinese working population and whether these associations differ by gender. METHODS: A cross-sectional study was conducted. Data analysis was done among 6739 employed participants. Multivariate logistic regression was used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for the studied associations. RESULTS: For male employees, those with heavy OA had a lower overall (OR 0.76; 95% CI, 0.62-0.93) and abdominal (OR 0.76; 95% CI, 0.62-0.93) overweight/obesity risk than those with light OA. Those with LTPA ≥150 min/week had a lower risk of overall (OR 0.73; 95% CI, 0.56-0.96) and abdominal (OR 0.70; 95% CI, 0.53-0.91) overweight/obesity than those with LTPA <150 min/week. Men with leisure-sitting time <2.5 h/day had a significantly lower risk of abdominal overweight/obesity than those sitting ≥4 h/day (OR 0.80; 95% CI, 0.65-0.99). And men who cycled to/from work had a lower risk of overall (OR 0.69; 95% CI, 0.53-0.90) and abdominal overweight/obesity (OR 0.71; 95% CI, 0.54-0.92) than passive transports. However, the above significant associations disappeared among female employees. CONCLUSIONS: Heavy OA, cycling to/from work, and LTPA were associated with lower risk of overall or abdominal overweight/obesity in male employees. Reducing leisure sitting time can also help male employees reduce the risk of abdominal overweight/obesity. More research on gender disparity in the risk of overweight and obesity should be done.

Impact of injury-related mortality on life expectancy in Zhejiang, China based on death and population surveillance data.

BACKGROUND: Life expectancy is a statistical measure of the average time an organism is expected to live. The purpose of this study was to evaluate the impact of injury-related mortality on life expectancy in Zhejiang Province. METHODS: Our study used standard life tables to calculate life expectancy and cause-removed life expectancy based on mortality data from the Zhejiang Chronic Disease Surveillance System. RESULTS: Life expectancy of residents in Zhejiang was 77.83 years in 2013, with females having a higher life expectancy than males. The decrease in life expectancy caused by injury-related deaths was 1.19 years, the effect of which was reduced for females and urban residents compared with males and rural residents. The greatest impact on life expectancy was road traffic injuries (RTIs), (0.29 years lost overall, 0.36 for men vs. 0.21 for women and 0.26 for urban residents vs. 0.31 for rural residents). The main causes were falls (0.29 years lost overall, 0.30 for men vs. 0.28 for women and 0.28 for urban residents vs. 0.30 for rural residents), followed by drowning (0.15 years lost), suicide (0.11 years lost), and poisoning (0.04 years). For children less than 5 years old and elders aged over 65, drowning had a greater impact than falls. CONCLUSIONS: Our findings indicate that injury deaths had a major impact on life expectancy in Zhejiang. More attention should be paid to road traffic injury, and preventive action should be taken to reduce injury-related deaths to increase life expectancy, especially in children under five years of age and the elders over 65 years of age.

Incidence and time trends of type 2 diabetes mellitus in youth aged 5-19 years: a population-based registry in Zhejiang, China, 2007 to 2013.

BACKGROUND: The incidence of type 2 diabetes mellitus (T2DM) has been increasing globally over the past two decades in children and adolescents. There are currently a dearth of comprehensive population-based estimates of T2DM incidence and time trends in Chinese youth. METHODS: A population-based diabetes registry system in 30 representative districts in Zhejiang has been established for diabetes surveillance. All newly cases diagnosed by physicians in local hospitals and wards were registered using the registry system through web services and direct network report. The data were primarily abstracted from medical records in hospitals and wards. Annual incidence rates and their 95% confidence intervals (CIs) by age groups and sex were calculated per 100 000 person-years. Poisson regression models were applied to assess the effects of diagnosis year, age groups, sex and residence area on T2DM incidence and to examine the average annual percentage change in incidence. RESULTS: There were 392 newly diagnosed cases of T2DM (210 boys and 182 girls) over the study period. The mean annual age-standardized incidence was 1.96/100 000 person-years (95% CIs: 1.85-2.08). No statistically significant difference in incidence was found between boys and girls. However, the risk for T2DM was 1.49 times higher in urban area than in rural area. Besides, the mean annual incidence in youth increased with age. The age-standardized incidence was about 5 times higher in 2013 than in 2007. Steep rising incidence was observed, with an average annual increase of 26.6% in youth aged 10-19 years. CONCLUSIONS: The incidence of T2DM in children and adolescents was low in Zhejiang relative to other countries, whereas it increased markedly over the study period. Preventive strategies for T2DM are necessary in pediatric population.

Association Between Frequency of Muscle-Strengthening Exercise and Depression Symptoms Among Middle and High School Students: Cross-Sectional Survey Study.

BACKGROUND: Existing literature on the association between the frequency of muscle-strengthening exercise (MSE) and depression among adolescents is limited and contradictory. OBJECTIVE: This study aimed to elucidate the association of MSE frequency with depression symptoms among middle and high school students in China. METHODS: A total of 27,070 students in grades 7-12 from 376 middle and high schools were surveyed using an anonymous self-administered questionnaire between April and June 2022. Information on engaging in MSE was self-reported, and depression symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9). Poisson regression was used to examine the association between MSE frequency and depression symptoms. RESULTS: Among the 27,006 eligible students, 51.6% (n=13,933) were boys, and the mean age was 15.6 (SD 1.7) years. The overall prevalence of meeting MSE recommendations (ie, engaging in MSE ≥3 days/week) was 34.6% (95% CI 32.6%-36.6%; n=9145); the prevalence was higher in boys (43.8%, 95% CI 41.8%-45.8%; 6067/13,933) than in girls (24.3%, 95% CI 22%-26.6%; 3078/13,073; P<.001). A total of 5882 (21.8%) students reported having depression symptoms. After adjustment for sociodemographic status, lifestyle factors, academic performance, and experience of physical fighting, compared to students who did not engage in MSE, the prevalence ratios (PRs) for depression symptoms were 0.98 (95% CI 0.97-0.99) for those engaging in MSE once a week, 0.95 (95% CI 0.93-0.97) for 2 days/week, 0.93 (95% CI 0.90-0.96) for 3 days/week, 0.90 (95% CI 0.87-0.94) for 4 days/week, 0.88 (95% CI 0.84-0.93) for 5 days/week, 0.86 (95% CI 0.81-0.92) for 6 days/week, and 0.84 (95% CI 0.78-0.90) for 7 days/week, respectively. CONCLUSIONS: The overall prevalence of meeting MSE recommendations among Chinese adolescents is low. The frequency of MSE was inversely associated with depression symptoms.

Association between metabolic syndrome severity score and cardiovascular disease: results from a longitudinal cohort study on Chinese adults.

Objective: This study aimed to quantify the severity of metabolic syndrome(MetS) and investigate its association with cardiovascular disease(CVD) risk on Chinese adults. Methods: 13,500 participants from the Zhejiang Adult Chronic Disease Study were followed up between 2010 and 2021. A continuous MetS severity score derived from the five components of MetS was used to quantify MetS severity, and the association between MetS severity and the risk of incident CVD was assessed using Cox proportional hazard and restricted cubic spline regression. Results: Both the presence and severity of MetS were strongly associated with CVD risk. MetS was related to an increased risk of CVD (hazard ratio(HR):1.700, 95% confidence interval(CI): 1.380-2.094). Compared with the hazard ratio for CVD in the lowest quartile of the MetS severity score, that in the second, third, and highest quartiles were 1.812 (1.329-2.470), 1.746 (1.265-2.410), and 2.817 (2.015-3.938), respectively. A linear and positive dose-response relationship was observed between the MetS severity and CVD risk (P for non-linearity = 0.437). Similar results were found in various sensitivity analyses. Conclusion: The MetS severity score was significantly associated with CVD risk. Assessing MetS severity and further ensuring intervention measures according to the different severities of MetS may be more useful in preventing CVD.

Modifying temperature-related cardiovascular mortality through green-blue space exposure.

Green-blue spaces (GBS) are pivotal in mitigating thermal discomfort. However, their management lacks guidelines rooted in epidemiological evidence for specific planning and design. Here we show how various GBS types modify the link between non-optimal temperatures and cardiovascular mortality across different thermal extremes. We merged fine-scale population density and GBS data to create novel GBS exposure index. A case time series approach was employed to analyse temperature-cardiovascular mortality association and the effect modifications of type-specific GBSs across 1085 subdistricts in south-eastern China. Our findings indicate that both green and blue spaces may significantly reduce high-temperature-related cardiovascular mortality risks (e.g., for low (5%) vs. high (95%) level of overall green spaces at 99th vs. minimum mortality temperature (MMT), Ratio of relative risk (RRR) = 1.14 (95% CI: 1.07, 1.21); for overall blue spaces, RRR = 1.20 (95% CI: 1.12, 1.29)), while specific blue space types offer protection against cold temperatures (e.g., for the rivers at 1st vs MMT, RRR = 1.17 (95% CI: 1.07, 1.28)). Notably, forests, parks, nature reserves, street greenery, and lakes are linked with lower heat-related cardiovascular mortality, whereas rivers and coasts mitigate cold-related cardiovascular mortality. Blue spaces provide greater benefits than green spaces. The severity of temperature extremes further amplifies GBS's protective effects. This study enhances our understanding of how type-specific GBS influences health risks associated with non-optimal temperatures, offering valuable insights for integrating GBS into climate adaptation strategies for maximal health benefits.

Does the integration of TB medical services in the general hospital improve the quality of TB care? Evidence from a case study in China.

BACKGROUND: Moving the clinical services from tuberculosis (TB) dispensary to the integrated county hospital (called integrated approach) has been practiced in China; however, it is unknown the quality of TB care in the integrated approach and in the dispensary approach. METHODS: A total of 202 new TB patients were investigated using structured questionnaires in three counties implementing the integrated approach and one county implementing the dispensary approach. The quality of TB care is measured based on success rate of treatment, medical expenditure, health system delay and second-line drug use. RESULTS: The integrated approach showed a high success treatment rate. The medical expenditure in the integrated approach was USD 432, significantly lower than that in the dispensary approach (Z = -5.771, P < 0.001). The integrated approach had a shorter health system delay (5 days) than the dispensary approach (32 days). Twenty-six percent of patients in integrated hospitals were prescribed with second-line TB drugs, significantly lower than that in the TB dispensary (47%, χ(2) = 7.452, P = 0.006). However, the medical expenditure, use of second-line anti-TB drug and liver-protection drugs indeed varied greatly across the three integrated hospitals. CONCLUSIONS: The integrated approach showed better quality of TB care, but the performance of the integrated hospitals varied greatly. A method to standardize TB treatment and management of this approach is urgent.

Association of 24-h urinary sodium excretion with microalbuminuria in a Chinese population.

To assess the relationship of sodium, potassium and the ratio of sodium to potassium (Na/K) with albuminuria, a cross-sectional study was carried out in China in 2017. Sodium, potassium and albumin excretions were examined in a 24-h (h) urine sample collected from 1486 participants. Microalbuminuria was defined as 24-h urinary albumin excretion between 30 and 300 mg/24 h. The participants had an average age of 46.2 ± 14.1 years old, and 48.9% were men. The proportion of patients with microalbuminuria was 9.0%. As illustrated by the adjusted generalized linear mixed model, sodium concentration increased significantly with the increase in 24-h urinary albumin (ß = 1.16, 95% confidence interval (CI) 0.38-1.93; P = 0.003). Multivariable-adjusted logistic regression analyses demonstrated that the odds ratio (OR) of microalbuminuria increased with the quartiles of sodium [OR = 2.20, 95% CI 1.26-3.84 (the maximum quartile vs. the minimum quartile), Pfor trend = 0.006]. Potassium and the Na/K ratio did not have any association with outcome indicators. A high amount of sodium intake was potentially correlated with early renal function impairment.

Association of bullying victimization with suicidal ideation and suicide attempt among school students: A school-based study in Zhejiang Province, China.

BACKGROUND: Evidence of associations between type-specific bullying victimization and suicidal ideation and suicide attempt among adolescents is scant. This study examined these associations among middle and high school students in China. METHODS: A cross-sectional study of 27,030 students with mean age of 15.7 ± 1.7 years, including 13,946 boys and 13,084 girls, was carried out between April and June 2022. RESULTS: The prevalence of suicidal ideation and attempt was 19.7 % and 2.9 %, respectively. 30.0 % (95%CI: 28.8-31.1) of students reported being bullied (i.e., bullying victimization) in the past 30 days, and the corresponding figs. (95%CI) for verbal bullying, relational bullying, property-related bullying, physical bullying, and cyberbullying were 11.0 % (10.4-11.7), 2.8 % (2.5-3.0), 1.9 % (1.7-2.2), and 5.7 % (5.3-6.0), respectively. After adjustment for socio-demographic status, lifestyle factors, academic performance, self-reported health and mental health, compared to those who reported not being bullied in the past 30 days, the odds ratios (95%CI) for suicidal ideation and suicide attempt among students who reported being bullied were 1.75 (1.60-1.90) and 2.01 (1.63-2.52), respectively. The corresponding odds ratios (95%CI) for verbal bullying were 1.77 (1.61-1.93) and 2.09 (1.67-2.61), respectively, for relational bullying were 1.77 (1.57-2.00) and 2.31 (1.79-2.98), respectively, for property-related bullying were 1.88 (1.48-2.37) and 2.44 (1.60-3.70), respectively, for physical bullying were 1.79 (1.30-2.47) and 2.86 (1.67-4.90), respectively, and for cyberbullying were 2.02 (1.71-2.39) and 2.83 (2.08-3.84), respectively. CONCLUSION: All types of bullying victimization are strongly associated with both suicidal ideation and suicide attempt among middle and high school students.

Association between multimorbidity and falls and fear of falling among older adults in eastern China: a cross-sectional study.

Background: Growing evidence has reported an association between multimorbidity and falls and fear of falling (FOF) in older adults, however, the results regarding this association from China are limited. Our study aimed to investigate the association between multimorbidity and falls and FOF in older adults in eastern China. Methods: We conducted a cross-sectional study in Zhejiang Province, Eastern China, which recruited a provincial representative sample of adults aged ≥ 60 years. A structured questionnaire including demographic characteristics, chronic diseases, history of falls in the past 12 months, and FOF, was administered by all participants. The exposure variable was multimorbidity, which was defined as the presence of two or more chronic diseases and medical conditions in the same individual. The outcomes included a history of falls and FOF. Multivariate logistic regression was used to evaluate the association between multimorbidity and falls and FOF in older adults. Results: In total of 7,774 participants were included in the analysis, among whom 3,898 (50.1%) were female, with a mean ± standard deviation age is 72.9 ± 8.4 years. Multimorbidity was associated with the increased risk of falling in older adults [adjusted odds ratio (OR), 1.99; 95% confidence interval (CI):1.55-2.36]. The ORs for having experienced single fall and repeated falls were 1.85 (95% CI: 1.42-2.42) and 3.45 (95% CI: 1.47-6.97), respectively, with multimorbidity compared with those without chronic diseases. The older adults with multimorbidity were more likely to report FOF compared with those without chronic diseases (adjusted OR, 1.49; 95%CI:1.30-1.70). Moreover, the association between multimorbidity and FOF remained significant in the older adults with a history of fall (OR, 1.57; 95%CI:1.04-2.38). Conclusion: The association between multimorbidity and falls and FOF is significant in the Chinese population and the effects of multimorbidity on falls and FOF do not vary according to the frequency and history of falls in older adults.

Association between duration of electronic screen use for non-educational purposes and depression symptoms among middle and high school students: a cross-sectional study in Zhejiang Province, China.

Background: Existing literature on the association of electronic screen use duration with depression among adolescents is contradictory. The current study aimed to elucidate the association between duration of electronic screen use for non-educational purposes and depression symptoms among middle and high school students in Zhejiang Province, China. Methods: A cross-sectional study of 27,070 students in grades 7-12 from 376 middle and high schools was conducted through an anonymous self-administered questionnaire between April and June 2022. Poisson regression was utilized to examine the association between electronic screen use duration for non-educational purposes and depression symptoms. Results: Of the 27,006 eligible students, 51.6% (13932) were boys and the mean (SD) age was 15.6(1.7) years. The overall prevalence of symptoms of depression was 22.4% (95%CI 21.4-23.4); girls (27.6%, 26.2-29.0) had a higher prevalence than boys (17.7%, 16.7-18.8). After adjustment for socio-demographic status, lifestyle factors, self-perceived health, academic performance, loneliness and sadness, compared to those who did not use electronic screens for non-educational purposes, the prevalence ratios (PRs) for depression symptoms were 1.03 (95% CI 1.02-1.04) for those exposed to electronic screens for <1 h/day, 1.07 (1.05-1.09) for 1.0-1.9 h/day, 1.10 (1.07-1.13) for 2.0-2.9 h/day, 1.14 (1.10-1.18) for 3.0-3.9 h/day, 1.18 (1.12-1.23) for 4.0-4.9 h/day, and 1.21 (1.15-1.29) for ≥5 h/day. Conclusion: Duration of electronic screen use for non-educational purposes was positively associated with symptoms of depression among middle and high school students, even with a relatively short daily duration of use.

The association of body mass index and its interaction with family history of dyslipidemia towards dyslipidemia in patients with type 2 diabetes: a cross-sectional study in Zhejiang Province, China.

Objectives: This study aimed to investigate the association between body mass index (BMI) and dyslipidemia and to explore the interaction between BMI and family history of dyslipidemia towards dyslipidemia in patients with type 2 diabetes. Methods: This cross-sectional study was conducted between March and November 2018 in Zhejiang Province, China. A total of 1,756 patients with type 2 diabetes were included, physical examination data, fasting blood samples and face-to-face questionnaire survey data were collected. Restricted cubic spline analysis was used to evaluate the association between BMI and the risk of dyslipidemia. Unconditional multivariable logistic regression was used to estimate the interaction between BMI and family history of dyslipidemia towards dyslipidemia. Results: The prevalence of dyslipidemia was 53.7% in the study population. The risk of dyslipidemia elevated with increased BMI value (p for non-linearity <0.05). After adjusting for covariates, individuals with high BMI (≥24 kg/m2) and a family history of dyslipidemia had a 4.50-fold (95% CI: 2.99-6.78) increased risk of dyslipidemia compared to the normal reference group, which was higher than the risk associated with high BMI alone (OR = 1.83, 95% CI: 1.47-2.28) or family history of dyslipidemia alone (OR = 1.79 95% CI: 1.14-2.83). Significant additive interaction between high BMI and a family history of dyslipidemia was detected, with RERI, AP, and SI values of 1.88 (95% CI: 0.17-4.10), 0.42 (95% CI: 0.02-0.62), and 2.16 (95% CI: 1.07-4.37), respectively. However, stratified by status of diabetes control, this additive interaction was only find significant among patients with controlled diabetes. Conclusion: Both high BMI and a family history of dyslipidemia were related with high risk of dyslipidemia. Moreover, there were synergistic interaction between these two factors. Patients with type 2 diabetes who had a family history of dyslipidemia were more susceptible to the negative impact of being overweight or obesity on dyslipidemia.

Short-term effects of fine particulate matter constituents on mortality considering the mortality displacement in Zhejiang province, China.

BACKGROUND: Evidence linking mortality and short-term exposure to particulate matter (PM2.5) constituents was sparse. The mortality displacement was often unconsidered and may induce incorrect risk estimation. OBJECTIVES: To assess the short-term effects of PM2.5 constituents on all-cause mortality considering the mortality displacement. METHODS: Daily data on all-cause mortality and PM2.5 constituents, including sulfate (SO42-), nitrate (NO3-), ammonium (NH4+), organic matters (OM), and black carbon (BC), were collected from 2009 to 2020. The mortality effect of PM2.5 and its constituents was estimated using a distributed lag non-linear model. Stratified analyses were performed by age, sex, and season. RESULTS: Per interquartile range increases in SO42-, NO3-, NH4+, OM, and BC were associated with the 1.42% (95%CI: 0.98, 1.87), 3.76% (3.34, 4.16), 2.26% (1.70, 2.83), 2.36% (2.02, 2.70), and 1.26% (0.91, 1.61) increases in all-cause mortality, respectively. Mortality displacements were observed for PM2.5, SO42-, NH4+, OM, and BC, with their overall effects lasting for 7-15 days. Stratified analyses revealed a higher risk for old adults (>65 years) and females, with stronger effects in the cold season. CONCLUSIONS: Short-term exposures to PM2.5 constituents were positively associated with increased risks of mortality. The mortality displacement should be considered in future epidemiological studies on PM constituents. DATA AVAILABILITY: Data will be made available on request.