The association between socioeconomic status perception and mental health among Chinese older adults: the mediating roles of social trust and justice.

BACKGROUND: Mental health is a matter of quality of life among older adults. This study aimed to explore the association between the socioeconomic status (SES) perception and mental health of older adults using data from 2017 Chinese General Social Survey (CGSS). METHODS: Ordinary least squares (OLS) regression was used to analyse the association between SES perception and mental health, and the substitution model and variable methods were used to check the robustness of the results. Moreover, we adopted the Sobel model to analyse the mediating roles of social trust and justice. RESULTS: SES perception was positively associated with mental health, and this association was mediated by social trust and justice. This kind of positive association was mainly embodied in those groups with the highest or lowest objective SES. In other words, this study confirmed the phenomenon of "a contented mind is a perpetual feast" in Chinese society. CONCLUSIONS: Higher SES perception is associated with improved mental health for Chinese older adults. It is imperative to prioritize efforts to enhance the perceptual abilities of older adults, particularly those with the highest or lowest objective SES, to promote their overall subjective well-being.

The impact of physical activity on household out-of-pocket medical expenditure among adults aged 45 and over in urban China: The mediating role of spousal health behaviour.

Background: Increasing medical expenditure is viewed as one of the critical challenges in the context of population ageing. Physical activity (PA), as a primary prevention strategy for promoting health, is considered as an effective way to curb the excessive growth in medical expenditure. This study aimed to analyze the association between PA and the household out-of-pocket medical expenditure (HOPME) among Chinese urban adults aged 45 and over, and to explore the mediating role of spousal health behaviour. Methods: This study analyzed a nationally longitudinal survey: 2014-2018 China Family Panel Studies (CFPS). Fixed effects regression model was applied to estimate the association between PA and annual HOPME. Sobel model was utilized to test the mediating effect. Results: (1) PA was negatively associated with the annual HOPME among urban resident aged 45 and over in China. Exercising 1-5 times per week and maintaining the duration of each exercise session at 31-60 min were effective in reducing annual HOPME. (2) Spousal PA played a significant mediating role in the relationship between respondent's PA and annual HOPME. (3) The negative association between the respondent's PA and HOPME were found among women and those aged between 45 and 65, so was the mediating effect of spouse's PA. Conclusion: Individual PA not only directly reduces HOPME but also indirectly contributes to this reduction by enhancing the PA levels of their spouses. To capitalize on these benefits, more actions should be taken to increase the availability of PA facilities, enhance the public awareness of PA's benefits, and encourage residents to consistently engage in regular PA.

Performance of [18F]FDG PET/CT versus FAPI PET/CT for lung cancer assessment: a systematic review and meta-analysis.

PURPOSE: This article aims to compare the diagnostic performance of 18-fluorodeoxyglucose ([18F]FDG) PET/CT and fibroblast activating protein inhibitor (FAPI) PET/CT in the assessment of primary tumors, lymph nodes, and distant metastases in lung cancer patients. METHODS: A systematic search was conducted on the Cochrane Library, Embase, and PubMed/MEDLINE databases from inception until November 1, 2022. Included studies assessed the use of FAPI PET/CT and [18F]FDG PET/CT in patients with lung cancer. The Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool was used to evaluate the risk of bias. A random variable model was used to analyze the diagnostic tests of the two imaging modalities. RESULTS: The sensitivity of FAPI PET/CT in detecting primary lung cancer lesions was 0.98 (95% CI: 0.88-1.00), while the sensitivity of [18F]FDG PET/CT was 0.99 (95% CI: 0.74-1.00). For the detection of metastatic lesions (lymph node metastases and distant metastases), FAPI PET/CT had a sensitivity of 0.99 (95% CI: 0.90-1.00), while the sensitivity of [18F]FDG PET/CT was 0.77 (95% CI: 0.66-0.85). However, the specificity of the two imaging modalities could not be assessed due to the lack of sufficient information on pertinent true negatives. CONCLUSION: In the diagnosis of metastatic lung cancer lesions, FAPI PET/CT demonstrated a higher sensitivity compared to [18F]FDG PET/CT. Therefore, FAPI PET/CT may be considered an alternative imaging modality for the assessment of primary lung cancer tumors, lymph node metastases, and distant metastases. CLINICAL RELEVANCE STATEMENT: FAPI may be an alternative to [18F]FDG in the assessment of primary lung cancer tumors, lymph node metastases, and distant metastases, which plays a very important role in treatment. KEY POINTS: • This article is to compare the performance of [18F]FDG PET/CT with FAPI PET/CT in the assessment of primary tumors, lymph nodes, and distant metastases in lung cancer. • However, FAPI PET/CT has a higher sensitivity for the diagnostic assessment of metastatic lung cancer lesions.

Individualized treatment decision model for inoperable elderly esophageal squamous cell carcinoma based on multi-modal data fusion.

BACKGROUND: This research aimed to develop a model for individualized treatment decision-making in inoperable elderly patients with esophageal squamous cell carcinoma (ESCC) using machine learning methods and multi-modal data. METHODS: A total of 189 inoperable elderly ESCC patients aged 65 or older who underwent concurrent chemoradiotherapy (CCRT) or radiotherapy (RT) were included. Multi-task learning models were created using machine learning techniques to analyze multi-modal data, including pre-treatment CT images, clinical information, and blood test results. Nomograms were constructed to predict the objective response rate (ORR) and progression-free survival (PFS) for different treatment strategies. Optimal treatment plans were recommended based on the nomograms. Patients were stratified into high-risk and low-risk groups using the nomograms, and survival analysis was performed using Kaplan-Meier curves. RESULTS: The identified risk factors influencing ORR were histologic grade (HG), T stage and three radiomic features including original shape elongation, first-order skewness and original shape flatness, while risk factors influencing PFS included BMI, HG and three radiomic features including high gray-level run emphasis, first-order minimum and first-order skewness. These risk factors were incorporated into the nomograms as independent predictive factors. PFS was substantially different between the low-risk group (total score ≤ 110) and the high-risk group (total score > 110) according to Kaplan-Meier curves (P < 0.05). CONCLUSIONS: The developed predictive models for ORR and PFS in inoperable elderly ESCC patients provide valuable insights for predicting treatment efficacy and prognosis. The nomograms enable personalized treatment decision-making and can guide optimal treatment plans for inoperable elderly ESCC patients.

Assessment of sub-micron subsurface damage in glass.

We present a new, to the best of our knowledge, experimental method for assessing sub-micron level subsurface damage (SSD) on optical glass. The method correlates surface characteristics such as the fracture toughness and Young's modulus via nanoindentation with the penetration depth into the tested surfaces at different overall penetration depths, as revealed by magnetorheological finishing spotting techniques. Our results on ground surfaces suggest that low surface roughness does not necessarily imply the absence of SSD. We also compared SSD on surfaces processed by deterministic microgrinding and femtosecond (fs) laser polishing. The fs-laser polished surfaces revealed no detectable SSD, thus establishing the feasibility of fs-laser polishing for precision optical manufacturing.

An Intelligent Rehabilitation Assessment Method for Stroke Patients Based on Lower Limb Exoskeleton Robot.

The 6-min walk distance (6MWD) and the Fugl-Meyer assessment lower-limb subscale (FMA-LE) of the stroke patients provide the critical evaluation standards for the effect of training and guidance of the training programs. However, gait assessment for stroke patients typically relies on manual observation and table scoring, which raises concerns about wasted manpower and subjective observation results. To address this issue, this paper proposes an intelligent rehabilitation assessment method (IRAM) for rehabilitation assessment of the stroke patients based on sensor data of the lower limb exoskeleton robot. Firstly, the feature parameters of the patient were collected, including age, height, and duration, etc. The sensor data of the exoskeleton robot were also collected, including joint angle, joint velocity, and joint torque, etc. Secondly, a gait feature model was constructed to deduce the walking gait parameters of the patient according to the sensor data of the exoskeleton, including the support phase to swing phase ratio, step length and leg lift height of the patient, etc. Then, the 6MWD and FMA-LE values were collected by traditional methods, feature parameters, gait parameters and human-machine interaction parameters (joint torque) of the patient were adopted to train the rehabilitation assessment model. Finally, the assessment model was trained by a machine-learning based algorithm. The new stroke patients' the 6MWD and FMA-LE values can be predicted by the trained model. The experimental results present that the prediction accuracy for the 6MWD and FMA-LE values reach to 85.19% and 92.66%, respectively.

Subjective Socioeconomic Status, Class Mobility and Health Disparities of Older People.

The aim of this study is threefold: (1) investigate the impact of subjective socioeconomic status on the health of older people with a further exploration of its extent, (2) explore the relationship between diverse class mobility trajectories and health disparities among older people, and (3) examine the health disparities among older people with different subjective socioeconomic statuses in groups of various class mobility. The data for this study came from the Chinese General Social Survey (CGSS) of 2017, and regression and moderation models are used. The results indicate that for each level of increase in the subjective socioeconomic status of older people, the health score significantly increased by 0.159. The health status of older people who experienced upward class mobility is significantly better than those who did not; therefore, different class mobility trajectories also shape health disparities. The moderation role of class mobility on the impact of subjective socioeconomic status on the health of older people is also confirmed. The results provide further support for the subjective socioeconomic status having a significant impact on the health of older people with different class mobility trajectories. An upward class mobility trajectory somewhat diminishes this influence. Therefore, policy interventions should be provided to enhance the subjective socioeconomic status of older people and increase their opportunities for upward class mobility.

Responses of leaf functional traits to different hydrological regimes and leaf economics spectrum in the water level fluctuation zone of Three Gorges Reservoir, China.

A unique riparian ecosystem has been created as a result of anti-seasonal flooding after reservoir operations, which notably influences the distribution patterns of plant communities and their functional characteristics in the riparian zone. Plant functional traits which reflect the physiological and ecological processes of plants in particular ecosystems are crucial for indicating the variations in the ecosystem structure and function. To better understand the adaptation strategies of plants to hydrological changes and provide a scientific basis for the selection of species in the re-vegetation of the newly formed ecosystems, 14 leaf functional traits and leaf economics spectrum (LES) of 19 dominant plants under different hydrological conditions were investigated in the water level fluctuation zone (WLFZ) of the Three Gorges Reservoir (TGR). The results showed that anti-seasonal flooding has significant effects on the leaf functional traits of plants (P < 0.05). The net photosynthetic rate of annual plants was significantly higher than that of perennial plants (P < 0.05), and there was a significant correlation between leaf phenotypic and photosynthetic traits (P < 0.05). Canonical correspondence analysis showed that soil water content and available phosphorus were the main factors affecting the leaf function of dominant species, indicating that hydrologic factors were still important environmental factors affecting leaf functional traits of dominant species in the WLFZ. And annuals from the WLFZ have characteristics of thick leaves, high photosynthetic rate, short lifespan, and high nutrient concentrations, which make them close to the fast investment-return end of LES. On the contrary, perennials are close to the slow investment-return end of LES. The high productivity investment of annuals is better than the high defense investment of perennials for adapting to the special habitats in the WLFZ. These results indicated that different functional plants in the WLFZ of the TGR under different hydrological regimes can adopt different strategies by weighing the associations and trade-offs between their economic traits.

Longitudinal transition of body mass index status and its associated factors among Chinese middle-aged and older adults in Markov model.

Introduction: Body mass index (BMI) has a strong correlation with chronic diseases and all-cause mortality. However, few studies have previously reported the longitudinal transition of BMI status and its influential factors, especially among Chinese middle-aged and older adults. Methods: This population-based cohort study involved 6,507 participants derived from the China Health and Retirement Longitudinal Study from 2011 to 2015, including objectively measured BMI recorded in 26,028 person-year of all observations followed up. Multistate Markov model was performed to estimate the BMI state transition intensity and hazard ratios of each potential exposure risk. Results: The mean intensity of the population that shifted from normal to overweight was more than twice than shifted to underweight. Besides, a predicted probability was up to 16.16% that the population with overweight would suffer from obesity and more than half of the population with underweight would return to normal weight over a 6-year interval. The study also implied significant effects of baseline age, gender, marital status, education level, alcohol consumption, smoking, depression symptoms, and activities of daily living impairment on BMI status transition to varying degrees. Conclusions: Findings of this study indicated that the mean transition probability between different BMI statuses varied, specific exposure factors serving as barriers or motivators to future transitions based on current BMI status was clarified for the health promotion strategies.

Assessment of bone mineral density and bone metabolism in young men with obstructive sleep apnea: a cross-sectional study.

BACKGROUND: Hypoxia in obstructive sleep apnea (OSA) patients during sleep may have an effect on bone metabolism. Few data regarding evaluation of bone metabolism in young individuals diagnosed with OSA. In this study, we aim to identify the association between bone mineral density and OSA in young men (≤ 40 years old of age). METHODS: Consecutive male subjects who underwent polysomnography were enrolled. Serum calcium, 25-hydroxyvitamin-D3, ß-isomerized form C-terminal telopeptide of type I collagen, osteocalcin and procollagen type 1 N-propeptide were measured in all participants, and bone mineral density (BMD) at lumbar spine (L1-L4), femoral neck and hip total were determined by dual energy X-ray absorption (DXA). RESULTS: The population consisted of 85 subjects (mean age 35.53 years). The BMD at lumbar spine (L1-L4) in moderate OSA patients was higher than control and severe OSA group significantly (p = 0.036). After adjustment for confounding factors, stepwise multiple linear regression analyses showed LaSO2 (ß = 0.340, p = 0.008) as an independent explanatory variable for Lumbar L1-L4 BMD, LaSO2 (ß = 0.304, p = 0.037), BMI (ß = 0.393, p = 0.008) for femur neck BMD and BMI (ß = 0.720, p = 0.002) for hip total BMD. CONCLUSIONS: Our finding indicated that there was a relationship between OSA and bone metabolism in younger men, and moderate OSA-related hypoxia positively related with BMD. This study also showed that different degrees of recurrent hypoxia had different effects on bone metabolism, a finding that required further investigation.

Simplified, Low-Cost Method on Glucose Tolerance Testing in High-Risk Group of Diabetes, Explored by Simulation of Diagnosis.

Objective: Explore the distribution of basic characteristics of high-risk groups of diabetes; verify the practical significance and diagnostic value of the "three-point method"; layered analysis of glycated hemoglobin and glycated serum albumin, and study its value and significance in the diagnosis of diabetes mellitus, Type II and pre-diabetes mellitus, Type II.Methods: 1304 high-risk individuals with T2D in Shanghai, 529 males and 841 females with an average of (50.5 ± 15.2) years old, were examined by oral glucose tolerance test (OGTT), HbA1c and GA were determined. Process the data by Python and GraphPad; judge the diagnostic value of HbA1C, GA by ROC.Results: (1) The numbers of DM, NGT, HOG, IFG, Mild-IGT and Mid-IGT in the objects were 647, 141, 70, 4, 208 and 234 respectively. In the 43-49 age group with a higher incidence, the proportion of selected high-risk groups is low. (2) The sensitivity and specificity about "three-point method" used to determine NGT is 100% and 90.11%; to determine IGR is 75.11% and 97.32%; to determine HOG is 97.14% and 100%; to determine DM is 94.67% and 100%. (3) According to ROC judgment, it is found that these 2 did not have the function of separate diagnoses, the optimal critical point of HbA1C related to DM status is 5.95%, (P<.01); HbA1C related to IGR status is 5.75% (P<.01); of GA related to DM status is 15.25% (P<.01); GA related to IGR status is 14.95% (P<.01).

Development and Assessment of Screening Nomogram for Biliary Atresia Based on Hepatobiliary Ultrasonographic Features.

Objectives: Biliary atresia (BA) is a rare neonatal liver disease of which the early diagnosis remains a challenge for clinicians. Our center has established a nomogram diagnostic model based on clinical characteristics and liver function characteristics. We aim to develop and validate a nomogram that includes additional ultrasound and finds hepatobiliary abnormality with better BA early screening performance. Methods: In this single-center, retrospective cohort analysis, 1,001 neonatal obstructive jaundice (NOJ) patients between 2012 and 2015 were enrolled. Multivariable analysis was used to identify clinical characteristics, laboratory liver function characteristics, and ultrasonic features that may early screen BA. A nomogram was developed to predict the probability of BA using multiple logistic regression analysis. This nomogram was subsequently validated using another cohort of 501 NOJ patients between 2015 and 2017. Calibration curve analysis and decision curve analyses were performed to evaluate and interpret the nomogram's clinical benefits. Results: Gender, direct bilirubin (DB), alkaline phosphatase (ALP), gamma-glutamyl transpeptidase (GGT), fasting gallbladder visibility, fasting gallbladder filling, and common bile duct visibility were found to have profound statistical significance between the BA and non-BA groups (P < 0.05). The significant features were used to build the nomogram. The area under the receiver operating characteristic (ROC) curve (AUC) value of the novel nomogram (0.87) was superior to those of the former nomogram (0.83) and GGT alone (0.81) in the prediction of BA. The calibration curve revealed a close resemblance between the predicted and actual BA probabilities. Also, the net benefit from the decision curve analysis (DCA) of the nomogram (0.54) was superior to those of the former nomogram (0.49) and GGT alone (0.45) at 80% of threshold possibility. Conclusions: The nomogram has demonstrated better performance for BA screening by including additional information of the US finding, holding a promising future as a non-invasive method for BA patients.

[Clinical effectiveness of Subjective Global Nutritional Assessment in hospitalized children with cerebral palsy].

OBJECTIVE: To investigate the nutritional status of children with cerebral palsy (CP) and the clinical effectiveness of Subjective Global Nutritional Assessment (SGNA) in nutritional assessment of hospitalized children with CP. METHODS: A total of 208 children with CP, aged 1-5 years, who were hospitalized from April to October 2019 were enrolled as subjects. SGNA was used to investigate nutritional status, and the Z-score method recommended by the World Health Organization was used as a reference standard to validate the clinical effectiveness of SGNA. RESULTS: The detection rate of malnutrition in children with CP was 42.3% by SGNA and 39.4% by the Z-score method (P>0.05). The application of SGNA showed high consistency between different evaluators (κ=0.621, P<0.001). With the Z-score method as the reference standard, SGNA had a sensitivity of 80.5%, a specificity of 82.5%, a positive predictive value of 75.0%, and a negative predictive value of 86.7%, and high consistency was observed between the two evaluation methods (κ=0.622, P<0.001). SGNA was moderately consistent with weight-for-age Z-score and height-for-age Z-score (κ=0.495 and 0.478 respectively, P<0.001) and was poorly consistent with weight-for-height Z-score (κ=0.197, P<0.05). CONCLUSIONS: There is a relatively high incidence rate of malnutrition in children with CP. SGNA can be used as a tool to assess the nutritional status of children with CP.

Impact of Medical Debt on the Financial Welfare of Middle- and Low-Income Families across China.

BACKGROUND: Medical debt is a persistent global issue and a crucial and effective indicator of long-term family medical financial burden. This paper fills a research gap on the incidence and causes of medical debt in Chinese low- and middle-income households. METHOD: Data were obtained from the 2015 China Household Finance Survey, with medical debt measured as borrowings from families, friends and third parties. Tobit regression models were used to analyze the data. The concentration index was employed to measure the extent of socioeconomic inequality in medical debt incidence. RESULTS: We found that 2.42% of middle-income families had medical debt, averaging US$6278.25, or 0.56 times average household yearly income and 3.92% of low-income families had medical debts averaging US$5419.88, which was equivalent to 2.49 times average household yearly income. The concentration index for low and middle-income families' medical debt was significantly pro-poor. Medical debt impoverished about 10% of all non-poverty households and pushed poverty households deeper into poverty. While catastrophic health expenditure (CHE) was the single most important factor in medical debt, age, education, and health status of householder, hospitalization and types of medical insurance were also significant factors determining medical debt. CONCLUSIONS: Using a narrow definition of medical debt, the incidence of medical debt in Chinese low- and middle-income households was relatively low. But, once medical debt happened, it imposed a long-term financial burden on medical indebted families, tipping many low and middle-income households into poverty and imposing on households several years of debt repayments. Further studies need to use broader definitions of medical debt to better assess the long-term financial impact of medical debt on Chinese families. Policy makers need to modify China's basic medical insurance schemes to manage out-of-pocket, medical debt and CHE and to take account of pre-existing medical debt.

Unmarried Youth Pregnancy, Outcomes, and Social Factors in China: Findings From a Nationwide Population-Based Survey.

INTRODUCTION: Early pregnancies and their poor reproductive outcomes remain increasing concerns. AIM: This study aims to investigate the pregnancy rate and outcomes and to identify social factors associated with pregnancy among Chinese unmarried youths aged 15-24 years. METHODS: Data were obtained from the Survey of Youth Access to Reproductive Health in China, and 11,076 unmarried female youths were analyzed. Prevalence of pregnancy by various demographic and socioeconomic characteristics was calculated. Univariate and multivariable logistic regression models were used to identify factors associated with pregnancy. MAIN OUTCOME MEASURE: The main outcome is pregnancy among unmarried female youths during their lifetime. RESULTS: Among 11,076 female youths, 501 individuals reported 697 premarital pregnancies during their lifetime until the survey was conducted, approximately 62.9 (95% CI: 58.5-67.6) pregnancies per 1,000 female youths. Older age group (odds ratio [OR] = 4.49; 95% CI = 3.60-5.59), low education levels (primary school and below: OR = 1.78, 95% CI = 1.33-2.37; junior and senior high school: OR 1.44, 95% CI = 1.15-1.80), living in non-eastern regions (central: OR 1.34, 95% CI = 1.06-1.68; west: OR 1.62, 95% CI = 1.28-2.04), cigarette smoking (OR 3.60, 95% CI = 2.76-4.70), alcohol drinking (OR 1.59, 95% CI = 1.28-1.97), from family with mother's education of primary school and below (OR 1.65, 95% CI = 1.11-2.46), and the bottom economic status (OR 1.48, 95% CI = 1.14-1.91) were associated with higher risk of premarital pregnancy among female youths. CONCLUSION: The findings justify the national concern for pregnancy among unmarried youth in China. Strategies to improve sexual education in school and family, to enhance the reproductive services for youth, and to increase public awareness of the reproductive health of young people were warranted. Guo C, Pang L, Ding R, et al. Unmarried Youth Pregnancy, Outcomes, and Social Factors in China: Findings From a Nationwide Population-Based Survey. Sex Med 2019;7:396-402.

Mental health service utilization and its associated social factors among elderly people with a mental disability in China: A national population-based survey.

AIM: This study explored patterns of service use and associated socioeconomic factors among Chinese elders with mental disabilities. METHODS: Data from the second China National Sample Survey on Disability (CNSSD) were used in this study. Univariate and multivariate logistic regression models were used to calculate the odds ratios and 95% confidence intervals for factors associated with utilization of mental health services among Chinese elderly people with a mental disability. RESULTS: Among elderly people with a mental disability in the CNSSD, 46.35% had used mental health services. Urban residence, higher education level, being married, medical insurance coverage, and higher annual family income per capita were associated with more utilization of mental health services. CONCLUSIONS: This study revealed a low level of mental health service utilization among the Chinese population with mental disorders or a mental disability. Strategies to improve the insurance coverage of mental healthcare, to increase public awareness of mental disorders, and to reduce regional inequality of mental health resources are warranted.

Markov-state model for CO2 binding with carbonic anhydrase under confinement.

Enzyme immobilization with a nanostructure material can enhance its stability and facilitate reusability. However, the apparent activity is often compromised due to additional diffusion barriers and complex interactions with the substrates and solvent molecules. The present study elucidates the effects of the surface hydrophobicity of nano-confinement on CO2 diffusion to the active site of human carbonic anhydrase II (CA), an enzyme that is able to catalyze CO2 hydration at extremely high turnover rates. Using the Markov-state model in combination with coarse-grained molecular dynamics simulations, we demonstrate that a hydrophobic cage increases CO2 local density but hinders its diffusion towards the active site of CA under confinement. By contrast, a hydrophilic cage hinders CO2 adsorption but promotes its binding with CA. An optimal surface hydrophobicity can be identified to maximize both the CO2 occupation probability and the diffusion rate. The simulation results offer insight into understanding enzyme performance under nano-confinement and help us to advance broader applications of CA for CO2 absorption and recovery.

The role of parental education in child disability in China from 1987 to 2006.

This paper aimed to investigate the role of parental education in child disability in China. We used nationally representative data from China's National Sample Survey on Disability, iterated twice, in 1987 and 2006, with data of 764,718 children aged 0-14 years. Logit models were used for statistical analysis. Results showed that the prevalence of child disability was significantly associated with each parent's education. Maternal education was more important than paternal education in child disability in both surveys. The analysis of marginal effect indicated a one-year increase in maternal and paternal schooling led to an average decrease of 0.121% and 0.091% in the probability of child disability in 1987, and 19 years later, these figures had dwindled to 0.091% and 0.072%, respectively.