Exploring causal effects of gut microbiota and metabolites on body fat percentage using two-sample Mendelian randomization.

AIM: The relationship between the gut microbiota, metabolites and body fat percentage (BFP) remains unexplored. We systematically assessed the causal relationships between gut microbiota, metabolites and BFP using Mendelian randomization analysis. MATERIALS AND METHODS: Single nucleotide polymorphisms associated with gut microbiota, blood metabolites and BFP were screened via a genome-wide association study enrolling individuals of European descent. Summary data from genome-wide association studies were extracted from the MiBioGen consortium and the UK Biobank. The inverse variance-weighted model was the primary method used to estimate these causal relationships. Sensitivity analyses were performed using pleiotropy, Mendelian randomization-Egger regression, heterogeneity tests and leave-one-out tests. RESULTS: In the aspect of phyla, classes, orders, families and genera, we observed that o_Bifidobacteriales [ß = -0.05; 95% confidence interval (CI): -0.07 to -0.03; false discovery rate (FDR) = 2.76 × 10-3], f_Bifidobacteriaceae (ß = -0.05; 95% CI: -0.07 to -0.07; FDR = 2.76 × 10-3), p_Actinobacteria (ß = -0.06; 95% CI: -0.09 to -0.03; FDR = 6.36 × 10-3), c_Actinobacteria (ß = -0.05; 95% CI: -0.08 to -0.02; FDR = 1.06 × 10-2), g_Bifidobacterium (ß = -0.05; 95% CI: -0.07 to -0.02; FDR = 1.85 × 10-2), g_Ruminiclostridium9 (ß = -0.03; 95% CI: -0.06 to -0.01; FDR = 4.81 × 10-2) were negatively associated with BFP. G_Olsenella (ß = 0.02; 95% CI: 0.01-0.03; FDR = 2.16 × 10-2) was positively associated with BFP. Among the gut microbiotas, f_Bifidobacteriales, o_Bifidobacteriales, c_Actinobacteria and p_Actinobacteria were shown to be significantly associated with BFP in the validated dataset. In the aspect of metabolites, we only observed that valine (ß = 0.77; 95% CI: 0.5-1.04; FDR = 8.65 × 10-6) was associated with BFP. CONCLUSIONS: Multiple gut microbiota and metabolites were strongly associated with an increased BFP. Further studies are required to elucidate the mechanisms underlying this putative causality. In addition, BFP, a key indicator of obesity, suggests that obesity-related interventions can be developed from gut microbiota and metabolite perspectives.

Burden of unintentional drowning in China from 1990 to 2019 and exposure to water: findings from the Global Burden of Disease 2019 study.

BACKGROUND: Drowning is an important contributor to the burden of deaths in China. Exposure to open water is a risk factor for drowning, but few studies quantify its impact on drowning. The purpose of this study was to provide an up-to-date analysis of unintentional drowning in China, including impact of exposure to open water. METHODS: Chinese provincial data from the Global Burden of Disease Study 2019 were used to describe the burden of unintentional drowning in 33 provinces and changes from 1990 to 2019. Provincial outdoor open water resource data were used to explore the relationship between outdoor open water resources and drowning burden using K-median clustering analysis. RESULTS: Between 1990 and 2019, the unintentional drowning incidence, mortality and disability adjusted life years (DALY) rates declined by 31.2%, 68.6% and 74.9%, respectively, with differences by age, sex and province. In 2019, the DALY rate for drowning was relatively higher in children under 20 year, the elderly over 80 years than other age groups and was relatively higher in men. There was no statistical difference in overall incidence rate by sex. Provincial differences in unintentional drowning burden show a positive relationship with the availability and size of outdoor open water. CONCLUSIONS: As expected availability of water increases drowning risk. There is a need to address drowning environmental risk especially among children and the elderly. Localised water safety plans which consider drowning burden and environmental risk factors are needed in China to ensure a sustained decline of unintentional drowning.

Using a participatory design to develop an implementation framework for integrating falls prevention for older people within the Chinese primary health care system.

BACKGROUND: Chinese National Essential Public Health Service Package (NEPHSP) has mandated primary health care providers to provide falls prevention for community-dwelling older people. But no implementation framework is available to guide better integration of falls prevention for older people within the primary health care system. METHODS: This is a two-stage online participatory design study consisting of eight workshops with stakeholders from three purposively selected cities. First, two workshops were organised at each study site to jointly develop the framework prototype. Second, to refine, optimise and finalise the prototype via two workshops with all study participants. Data analysis and synthesis occurred concurrently with data collection, supported by Tencent Cloud Meeting software. RESULTS: All participants confirmed that the integration of falls prevention for older people within the NEPHSP was weak and reached a consensus on five opportunities to better integrate falls prevention, including workforce training, community health promotion, health check-ups, health education and scheduled follow-up, during the delivery of NEPHSP. Three regional-tailored prototypes were then jointly developed and further synthesised into a generic implementation framework by researchers and end-users. Guided by this framework, 11 implementation strategies were co-developed under five themes. CONCLUSIONS: The current integration of falls prevention in the NEPHSP is weak. Five opportunities for integrating falls prevention in the NEPHSP and a five-themed implementation framework with strategies are co-identified and developed, using a participatory design approach. These findings may also provide other regions or countries, facing similar challenges, with insights for promoting falls prevention for older people.

KEYPOINTS: The integration of falls prevention for older people was weak in the Chinese PHC system.Five opportunities were identified for better integrating falls prevention for older people in the Chinese PHC system.We developed an implementation framework to strengthen the solid integration of falls prevention in the Chinese PHC system.

Strengthening China's National Essential Public Health Services Package for hypertension and diabetes care: protocol for an interrupted time series study with mixed-methods process evaluation and health economic evaluation.

BACKGROUND: Despite major primary health care (PHC) reforms in China with the 2009 launch of the National Essential Public Health Service Package, the country experiences many challenges in improving the management of non-communicable diseases in PHC facilities. "EMERALD" is a multifaceted implementation strategy to strengthen the management of hypertension and type-2 diabetes mellitus (T2DM) in PHC facilities. The study aims to: (1) examine the effectiveness of EMERALD in improving hypertension and T2DM management; (2) evaluate the implementation of the interventions; and (3) use the study findings to model the long-term health economic impact of the interventions. METHODS: The EMERALD intervention components include: (1) empowerment for PHC providers through training and capacity building; (2) empowerment for patient communities through multi-media health education; and  (3) empowerment for local health administrators through health data monitoring and strengthening governance of local PHC programs. An interrupted time series design will be used to determine the effectiveness of the interventions based on routinely collected health data extracted from local health information systems. The primary effectiveness outcome is the guideline-recommended treatment rates for people with hypertension and T2DM. Secondary effectiveness outcomes include hypertension and T2DM diagnosis and control rates, and enrolment and adherence rates to the recommended care processes in the National Essential Public Health Service Package. A mixed-methods process evaluation will be conducted to evaluate the implementation of the interventions, including the reach of the target population, adequacy of adoption, level of implementation fidelity, and maintenance. Qualitative interviews with policy makers, health administrators, PHC providers, and patients with hypertension and/or T2DM will be conducted to further identify factors influencing the implementation. In addition, health economic modelling will be performed to explore the long-term incremental costs and benefits of the interventions. DISCUSSION: This study is expected to generate important evidence on the effectiveness, implementation, and health economic impact of complex PHC interventions to strengthen the primary care sector's contribution to addressing the growing burden of non-communicable diseases in China. TRIAL REGISTRATION: The study has been registered on Chinese Clinical Trial Registry at https://www.chictr.org.cn/ (Registration number ChiCTR2400082036, on March 19th 2024).

Health literacy and falls among community-dwelling older people in China: is there a sex difference?

BACKGROUND: Health literacy is one of the important determinants of healthy aging, yet few studies have focused on the association between health literacy and falls. AIMS: This study aims to explore the relationship between health literacy and falls, with a focus on sex differences among older people in China. METHODS: This cross-sectional study enrolled 2,144 older people aged ≥ 60 years from Shandong Province, China in 2021. We used general health literacy screening scale to assess health literacy, and collected the incidence of falls in the past year. Logistic regression models were employed to analyze the relationship between health literacy and falls. We investigated the sex differences by subgroup analyses. RESULTS: The prevalence of adequate health literacy and falls was 21.7% (95% CI: 20.0-23.5%) and 25.4% (95% CI: 23.6-27.3%), respectively. In a fully-adjusted model, adequate health literacy was associated with a lower prevalence of falls in older adults (OR = 0.71, 95%CI: 0.52-0.96). Subgroup analysis revealed sex differences in this relationship (Pfor interaction <0.05). Specifically, the female group showed no significant relationship between health literacy and falls (OR = 0.92, 95% CI: 0.59-1.44); however, the male group demonstrated a robust and significant relationship (OR = 0.58, 95% CI: 0.37-0.90). CONCLUSIONS: Older people with adequate health literacy have lower prevalence of falls, which appears to differ by sex. This relationship was significant among men but not among women. These findings emphasize the need for policymakers and healthcare providers to consider sex differences when designing and implementing programs aimed at improving health literacy and preventing falls in the older population. Improving health literacy among older women could be a strategic component in bridging sex inequality in falls.

Characteristics of falls among older hip fracture patients from six Chinese hospitals: a post-hoc descriptive analysis.

BACKGROUND: There is well-established evidence to understand the characteristics of falls among the older patients with hip fracture in many countries, but very little knowledge existed in China. This study described the characteristics of falls in older patients with hip fractures from six Chinese hospitals. METHODS: This cross-sectional study is a post-hoc descriptive analysis of a recently completed trial. Eligible patients were aged 65 years and older, with confirmed hip fractures due to falls, and were admitted to the hospital within 21 days of the fracture. All patients were consecutively enrolled and screened within one year (November 15, 2018, to November 14, 2019). The collected data included patient demographics and fall-related information. RESULTS: A total of 1,892 patients' fall-related information were described. Most patients with hip fractures caused by falls were in the oldest old age group (60.4% in age group ≥ 80), with an overall average age of 80.7 (7.6) years. There were more females (n = 1,325, 70.0%) than males (n = 567, 30.0%). The majority lived in urban (n = 1,409, 74.5%). Most falls (n = 1,237, 67.3%) occurred during the daytime (6:01-18:00). There were 1,451 patients had their falls occurring at home (76.7%). Lost balance (n = 1,031, 54.5%) was reported as the primary reason to cause falls. The most common activity during a fall was walking (n = 1,079, 57.0%). CONCLUSIONS: Although the incidence of fall-related hip fractures in China is unclear, preventing falls and fall-related hip fractures in older people remains an urgent health concern as the ageing society increases. Studies with larger sample size and diverse population are needed to robustly understand this growing epidemic.

Development of a conceptual framework to scale up co-managed care for older patients with hip fracture in China: a qualitative study.

BACKGROUND: Hip fracture creates a major burden on society due to high mortality, loss of independence and excess medical costs for older people. A multidisciplinary co-managed model of care is widely considered as the best practice for the management of older patients with hip fracture. The study aims to develop a conceptual framework to inform the future scale-up of this model of care through the identification of barriers and enablers that may influence successful uptake. METHODS: This qualitative study was conducted within an interventional study, which aimed to test the effectiveness of co-managed model of care for older patients with hip fracture. Health providers and health administrators from three hospitals were purposively selected and interviewed in-depth. The Consolidated Framework for Implementation Research (CFIR) was used to develop interview guides, collect and analyse data. Inductive and deductive approaches were used to generate enablers or barriers, aligned with the CFIR constructs. All barriers or enablers were inductively summarised to a conceptual framework with essential components to guide the implementation of co-managed model of care in other hospitals. RESULTS: A total of 13 health providers and 3 health administrators were recruited. The main barriers to co-managed care implementation included perceived complexity of implementation, insufficient international collaboration and incentives, the absence of national guideline support and lack of digital health applications for communication between health providers, insufficient number of health providers and beds, and poor understanding about the effectiveness of this care model. A conceptual framework for future scale-up was then developed, consisting of the following essential components: hospital authority support, enabling environment, adequate number of beds, sufficient and skilled health providers, use of digital health technology, regular quality supervision, evaluation and feedback, and external collaborations. CONCLUSIONS: Despite the complexity of the intervention, the co-managed model of care has the potential to be implemented and promoted in China and in similar settings, although there is a need to demonstrate feasibility in different settings.

Effect of integrated intervention to prevent child drowning in rural areas of Guangdong, China: a cluster randomized controlled trial.

BACKGROUND: Drowning is the leading cause of death for children under the age of 15 years in Guangdong Province, China. This serious public health issue also exists in low- and middle-income countries (LMICs), which have few value-integrated intervention programs. The current study presents an integrated intervention project that aims to explore an effective pattern of prevention for child drowning in rural areas and feasibility to perform in other LMICs. METHODS: We conducted a cluster randomized controlled trial by comparing the incidence of non-fatal drowning among children in two groups in rural areas of southern China. We recruited the participants in two phases and reached a total of 10 687 students from 23 schools at two towns in Guangdong Province, China. At the first and second phases, 8966 and 1721 students were recruited, respectively. RESULTS: The final evaluation questionnaires were collected after 18 months of integrated intervention, where we obtained 9791 data from Grades 3-9. The incidence of non-fatal drowning between the intervention and control groups after intervention did not differ significantly from the baseline according to the total number of students, male students, female students and Grades 6-9 [0.81; 95% confidence interval (CI): [0.66, 1.00]; p = 0.05, 1.17; 95% CI: [0.90, 1.51]; p = 0.25, 1.40; 95% CI: [0.97, 2.02]; p = 0.07 and 0.97; 95% CI: [0.70, 1.34]; p = 0.86], except for Grades 3-5 (1.36; 95% CI: [1.02, 1.82]; p = 0.037). The study observed a significantly positive benefit of awareness and risk behaviours of non-fatal drowning between the intervention and control groups (0.27, 95% CI: [0.21, 0.33]; p = 0.00, -0.16; 95% CI: [-0.24, -0.08]; p = 0.00). CONCLUSIONS: The integrated intervention exerted a significant impact on the prevention and management of child non-fatal drowning, especially in rural areas.

Spatiotemporal trends and ecological determinants of cardiovascular mortality among 2844 counties in mainland China, 2006-2020: a Bayesian modeling study of national mortality registries.

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of death in China. No previous study has reported CVD mortality at county-level, and little was known about the nonmedical ecological factors of CVD mortality at such small scale in mainland China. Understanding the spatiotemporal variations of CVD mortality and examining its nonmedical ecological factors would be of great importance to tailor local public health policies. METHODS: By using national mortality registration data in China, this study used hierarchical spatiotemporal Bayesian model to demonstrate spatiotemporal distribution of CVD mortality in 2844 counties during 2006 to 2020 and investigate how nonmedical ecological determinants have affected CVD mortality inequities from the spatial perspectives. RESULTS: During 2006-2020, the age-standardized mortality rate (ASMR) of CVD decreased from 284.77 per 100,000 in 2006 to 241.34 per 100,000 in 2020. Among 2844 counties, 1144 (40.22%) were hot spots counties with a higher CVD mortality risk compared to the national average and located mostly in northeast, north central, and westernmost regions; on the contrary, 1551 (54.53%) were cold spots counties and located mostly in south and southeast coastal counties. CVD mortality risk decreased from 2006 to 2020 was larger in counties where CVD mortality rate had been higher in 2006 in most of the counties, vice versa. Nationwide, nighttime light intensity (NTL) was the major influencing factor of CVD mortality, a higher NTL appeared to be negatively associated with a lower CVD mortality, with one unit increase in NTL, and the CVD mortality risk will decrease 11% (relative risk of NTL was estimated as 0.89 with 95% confidence interval of 0.83-0.94). CONCLUSIONS: Substantial between-county discrepancies of CVD mortality distribution were observed during past 15 years in mainland China. Nonmedical ecological determinants were estimated to significantly explain the overall and local spatiotemporal patterns of this CVD mortality risk. Targeted considerations are needed to integrate primary care with clinical care through intensifying further strategies to narrow unequally distribution of CVD mortality at local scale. The approach to county-level analysis with small area models has the potential to provide novel insights into Chinese disease-specific mortality burden.

Body pain and functional disability predict falls in Chinese older adults: a population-based cohort study.

BACKGROUND: Falls are major health care concerns for older adults. Pain is associated with increased falls in older adults. However, the impact of pain on functional disability and how this might predispose Chinese older adults to fall is unclear. AIM: The aim of the current study was to examine whether functional disability mediates the association of any pain, back and/or shoulder pain (B-S pain) and leg and/or knees pain (L-K pain) with falls and serious falls. METHODS: The study included 7619 community-dwelling older adults aged 60 years and above from the China Health and Retirement Longitudinal Study. Baseline data were from Wave 3 and fall outcomes were from Wave 4. Functional disability was measured by the ADLs and IADLs scales. We used a logistic regression model to investigate associations between pain and fall outcomes and KHB method to estimate the mediating effects of ADL/IADL disability on pain-fall relationship. RESULTS: After fully adjusting for covariates, the three pain measures (any pain, back and/or shoulder pain, leg and/or knees pain) were significantly associated with fall outcomes. When body pain was compared with no body pain, the proportion mediated by the ADL disability was 28.43% for falls, while the proportion mediated by IADL disability was 17.96% for falls. For associations between specific parts of body pain and falls, the proportions mediated by the ADL disability were 34.18% and 35.89% in back and/or shoulder pain and leg and/or knees pain, respectively, but the proportions reduced to 21.98% and 20.82% when mediated by the IADL disability. However, there were no significant contributions of ADL/IADL disability for the association between specific part of body pain and serious falls. CONCLUSIONS: Pain in general and pain in specific body sites were significantly associated with an increased risk of fall among older adults living in community in China. Functional disability partially mediated the relationship of pain with falls.

Falls prevention interventions for community-dwelling older people living in mainland China: a narrative systematic review.

BACKGROUND: Falls in community-dwelling older people have been recognised as a significant public health issue in China given the rapidly growing aged population. Although there are several reviews documenting falls prevention programs for community-dwelling older adults, no systematic reviews of the scope and quality of falls prevention interventions in Mainland China exist. Therefore, the aim of this study was to systematically review falls prevention interventions for community-dwelling older people living in Mainland China. METHODS: We systematically reviewed literature from Chinese and English databases. All types of randomised controlled trials (RCTs) and quasi-experimental studies published from 1st January 1990 to 30th September 2019 were included. Observational studies and studies in care facilities and hospitals were excluded. Narrative synthesis was performed to summarise the key features of all included studies. Quality assessment was conducted using the Cochrane Risk of Bias Tool and ROBINS-I tool for randomised and non-randomised studies respectively. RESULTS: A total of 1020 studies were found, and 101 studies were included in the analysis. Overall, very few high quality studies were identified, and there was insufficient rigor to generate reliable evidence on the effectiveness of interventions or their scalability. Most interventions were multiple component interventions, and most studies focused on outcomes such as self-reported falls incidence or awareness of falls prevention. CONCLUSION: There is an opportunity to undertake an evaluation of a rigorously-designed, large-scale falls prevention program for community-dwelling older people in Mainland China. To help mitigate the rising burden of falls in Mainland China, recommendations for future falls prevention interventions have been made. These include: (1) target disadvantaged populations; (2) incorporate personalised interventions; and (3) investigate the effectiveness of those under-explored interventions, such as psychological, social environment, management of urinary incontinence, fluid or nutrition therapy and surgery. The study results will also potentially provide a useful evidence base for other low-and-middle income countries in a similar situation.

Effect of apparent temperature on daily emergency admissions for mental and behavioral disorders in Yancheng, China: a time-series study.

BACKGROUND: Very few studies have focused on the relationship between ambient apparent temperature (AT) and admission of mental and behaviour disorders (MDs). Therefore, a time-series study was conducted in Yancheng, China, to explore the effects of AT on the daily emergency admissions of patients with MDs over the period of 2014-17. METHODS: A quasi-Poisson generalized linear model (GLM) combined with a distributed lag non-linear model (DLNM) was adopted to explore the associations after adjusting for time trend, day of the week, humidity, sunshine duration, rainfall, holidays and air pollutants. In the subgroup analysis, the modification effects of age and sex were also examined. RESULTS: Overall, 8438 cases of MDs emergency admissions were identified. With the apparent temperature with the minimum number of admissions (- 3.4 °C) serving as a reference, a positive correlation emerged between high AT and daily emergency admissions of patients with MDs in Yancheng, China, with the lagged effect of 1 to 5 days. The subgroup analysis demonstrated a positive relationship between AT and MDs emergency admissions among males and individuals younger than 45 years old, with no lagged effect. CONCLUSIONS: The results will provide important scientific evidence for mental health policy-makers and practitioners for possible intervention, especially among the vulnerable populations.

Violence prevalence and prevention status in China.

OBJECTIVES: To describe the prevalence status of violence and its prevention in China, and to provide reference for the development of strategies regarding violence prevention. METHODS: Violence mortality data between 2006 and 2015 were obtained from the national disease/death surveillance data set in 2006-2015. Data on violence-related medical cases were collected from the 2015 National Injury Surveillance System. The laws and policies about violence prevention and violence prevention programmes in China were described. RESULTS: Violence mortality declined by 57.02% during 2006-2015 from 1.21/100 000 to 0.52/100 000. Violent death rate in males peaked in the age group 25-29 years (1.05/100 000) and it was low in the age group <15 years. Female violence mortality rate peaked during infancy (0.54/100 000), aged 25-29 (0.53/100 000) and age above 85 (0.98/100 000). The laws and policies about violence prevention were more perfect, while most prevention programmes were limited in scale and duration. CONCLUSIONS: The mortality of violence declined in China during 2006-2015. It is necessary to conduct gender-specific prevention strategies and improve the data collection and prevention service.

Burden of colorectal cancer in China, 1990-2017: Findings from the Global Burden of Disease Study 2017.

OBJECTIVE: Our goal is to analyze the trend of colorectal cancer (CRC) regarding the death, incidence and prevalence rates over time, and to provide epidemiological knowledge basis for health policy revision by comparing data about fatal outcomes of CRC in 2017 to those data in 1990, which was extracted from the Global Burden of Disease (GBD). METHODS: The time trend and changes of CRC burden from 1990 to 2017 were measured by using the methods and results from the Institute for Health Metrics and Evaluation (IHME) GBD 2017, based on the rates of death, incidence and prevalence. RESULTS: The death rate of CRC is 13.24/100,000, accounting for 1.79% of total deaths in China in 2017. In 1990, CRC ranked 21st in all causes of death in China compared to its 11th ranking in 2017. The death, incidence and prevalence rate of CRC were standardized by the age scale of the global population in 2010, the change of standardized death rate of CRC was not significant, from 9.33/100,000 in 1990 to 10.10/100,000 in 2017. The standardized incidence rate of CRC significantly increased from 12.18/100,000 in 1990 to 22.42/100,000 in 2017. The standardized prevalence rate of CRC significantly increased from 44.55/100,000 in 1990 to 118.40/100,000 in 2017. The trend of the prevalence rate in both genders grow higher in 2017 compared to the 1990, resulting in 141.6%, 209.8% and 189.0% for the studied three age groups (15-49, 50-69 and 70+ years old), respectively. The death rate increased in the age groups of 50-69 and 70+ years in both genders (8.6% and 31.0% respectively), in contrast to a decrease of death rate in the age group of 15-49 years old (-10.8%). CONCLUSIONS: China experienced a stunning increase in terms of incidence and prevalence rate of CRC from 1990 to 2017. To decrease the burden of CRC, prevention and management of known risk factors should be promoted through national polices.

Comparing health-related quality of life of Dutch and Chinese patients with traumatic brain injury: do cultural differences play a role?

BACKGROUND: There is growing interest in health related quality of life (HRQoL) as an outcome measure in international trials. However, there might be differences in the conceptualization of HRQoL across different socio-cultural groups. The objectives of current study were: (I) to compare HRQoL, measured with the short form (SF)-36 of Dutch and Chinese traumatic brain injury (TBI) patients 1 year after injury and; (II) to assess whether differences in SF-36 profiles could be explained by cultural differences in HRQoL conceptualization. TBI patients are of particular interest because this is an important cause of diverse impairments and disabilities in functional, physical, emotional, cognitive, and social domains that may drastically reduce HRQoL. METHODS: A prospective cohort study on adult TBI patients in the Netherlands (RUBICS) and a retrospective cohort study in China were used to compare HRQoL 1 year post-injury. Differences on subscales were assessed with the Mann-Whitney U-test. The internal consistency, interscale correlations, item-internal consistency and item-discriminate validity of Dutch and Chinese SF-36 profiles were examined. Confirmatory factor analysis was performed to assess whether Dutch and Chinese data fitted the SF-36 two factor-model (physical and mental construct). RESULTS: Four hundred forty seven Dutch and 173 Chinese TBI patients were included. Dutch patients obtained significantly higher scores on role limitations due to emotional problems (p < .001) and general health (p < .001), while Chinese patients obtained significantly higher scores on physical functioning (p < .001) and bodily pain (p = .001). Scores on these subscales were not explained by cultural differences in conceptualization, since item- and scale statistics were all sufficient. However, differences among Dutch and Chinese patients were found in the conceptualization of the domains vitality, mental health and social functioning. CONCLUSIONS: One year after TBI, Dutch and Chinese patients reported a different pattern of HRQoL. Further, there might be cultural differences in the conceptualization of some of the SF-36 subscales, which has implications for outcome evaluation in multi-national trials.

Association between cerebral blood flow variation and cognitive decline in older patients undergoing hemodialysis.

Background: The mechanism of cognitive impairment in hemodialysis patients is multifactorial. The relationship between cerebral blood flow and the decline of cognitive function is poorly understood. Objective: To investigate the association between cerebral blood flow variation and decline of cognitive function in older patients undergoing hemodialysis. Methods: In this prospective observational cohort study of 121 older patients undergoing hemodialysis, we used transcranial Doppler ultrasound (TCD) to measure cerebral arterial mean flow velocity (MFV) throughout dialysis, assessed cognitive function at baseline and 12-month follow-up, and then analyzed associations between MFV and changes on cognitive scores. Results: TCD recordings demonstrated a significant reduction in MFV throughout dialysis, which were significantly correlated with cumulative ultrafiltration volume (rho 0.356, p < 0.001), ΔSBP (rho 0.251, p = 0.005), and ΔMAP (rho 0.194, p = 0.032). Compared with the baseline assessments, cognitive scores of participants at the 12-month follow-up were significantly worsened in global cognition (MOCA), some tests of memory (CFT-memory), executive function (TMT-B, SCWT-C, and SCWT-T), attention/processing speed (SDMT), and visuospatial function (CFT-copy) (p < 0.05). The worsening scores in global cognition (MOCA) (ß = 0.066, 95% CI 0.018-0.113, p = 0.007) and some tests of memory (AVLT5) (ß = 0.050, 95% CI 0.004-0.097, p = 0.035) and executive function (TMT-B, SCWT-C, SCWT-T) (ß = 1.955, 95% CI 0.457-3.453, p = 0.011; ß = 0.298, 95% CI 0.112-0.484, p = 0.002 and ß = 1.371, 95% CI 0.429-2.303, p = 0.004, respectively) were significantly associated with the reduction of MFV. Conclusion: Hemodialysis may significantly reduce cerebral blood flow in older patients; Repetitive intradialytic decreases in CBF may be one of the mechanisms underlying the decline of cognitive function. Clinical trial registration: https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S000C5B5&selectaction=Edit&uid=U0003QEL&ts=4&cx=-djoi2.

Global, regional, and national burdens of mild traumatic brain injuries from 1990-2019: findings from the Global Burden of Disease Study 2019 - a cross-sectional study.

BACKGROUND: The objective of this study was to utilize data from the Global Burden of Disease Study (GBD) 2019 to estimate the patterns and prevalence of mild traumatic brain injury (mTBI) from 1990 to 2019, with the intention of informing the development of efficacious intervention strategies. MATERIAL AND METHODS: Data from the GBD 2019 were examined to determine the prevalence, incidence, and rates of years lived with disability (YLDs) associated with mTBI across global geographic populations from 1990 to 2019. To assess temporal patterns, estimated annual percentage changes (EAPCs) and age-standardized rates were computed. Additionally, an age-period-cohort model (APC model) framework was employed to analyze potential trends in incidence based on age, period, and birth cohort. RESULTS: In 2019, there were a total of 12,268.5 thousand incident cases (95% uncertainty interval [UI] 992.66 to 1,602.07), 11,482.5 thousand prevalent cases (95% UI 107.59 to 123.52), and 1,366.9 thousand YLDs (95% UI 96.36 to 183.35) of mTBI worldwide. The age-standardized rates (ASRs) of incidence, prevalence, and YLDs exhibited a decline from 1990 to 2019. Across all age groups, males had higher prevalence, incidence and YLDs rates. Furthermore, middle-aged and elderly adults experienced a greater disease burden. The primary causes of the global mTBI burden in 2019 were falls and road injuries. According to the APC model, the age effect trend exhibited a similar pattern across individual sociodemographic index (SDI) groups, characterized by an initial increase, followed by a decrease and a subsequent increase. Regarding the period effect, each SDI group demonstrated variation, with the middle SDI group notably displaying a consistent increase. Furthermore, in terms of the birth effect, the middle-SDI group experienced the most substantial and continuous increase. CONCLUSION: The global incident cases and prevalent cases of mTBI increased significantly from 1990 to 2019, with a heavier burden observed in males, older adults, and in low SDI such as Afghanistan. More efforts are needed in the prevention and management of mTBI, such as reducing the incidence of falls among older people and building safer road transport facilities to reduce the burden of mTBI.

Antimicrobial Peptides From the Gut Microbiome of the Centenarians: Diversification of Biosynthesis and Youthful Development of Resistance Genes.

Antimicrobial peptides (AMPs) offer a potential solution to the antibiotic crisis owing to their antimicrobial properties, and the human gut biome may be a source of these peptides. However, the potential AMPs and AMP resistance genes (AMPRGs) of gut microbes in different age groups have not been thoroughly assessed. Here, we investigated the potential development of AMPs and the distribution pattern of AMPRGs in the gut microbiome at different ages by analyzing the intestinal metagenomic data of healthy individuals at different life stages (CG: centenarians group n = 20; OAG: older adults group: n = 15; YG: young group: n = 15). Age-related increases were observed in the potential AMPs within the gut microbiome, with centenarians showing a greater diversity of these peptides. However, the gut microbiome of the CG group had a lower level of AMPRGs compared to that of the OAG group, and it was similar to the level found in the YG group. Additionally, conventional probiotic strains showed a significant positive correlation with certain potential AMPs and were associated with a lower detection of resistance genes. Furthermore, comparing potential AMPs with existing libraries revealed limited similarity, indicating that current machine learning models can identify novel peptides in the gut microbiota. These results indicate that longevity may benefit from the diversity of AMPs and lower resistance genes. Our findings help explain the age advantage of the centenarians and identify the potential for antimicrobial peptide biosynthesis in the human gut microbiome, offering insights into the development of antimicrobial peptide resistance and the screening of probiotic strains.

Associations of ambient temperature with the CO poisoning risk in China.

Although studies have explored the relationship between temperature and CO poisoning, the results are not consistent, and there is still a lack of early warning criteria of temperature related to CO poisoning. In order to comprehensively study the exposure-response relationship between daily average temperature and CO poisoning, and to further explore the early warning criteria of temperature related to CO poisoning, we used daily cases of CO poisoning in 31 National Injury Surveillance System (NISS) surveillance sites in seven administrative geographical regions of China and daily meteorological data obtained from the China Meteorological Science Data Sharing Service Platform from 2009 to 2019 to do the analysis. Daily meteorological data of 698 weather stations across China were interpolated at a 0.01° × 0.01°spatial resolution, which were then applied to extract the daily meteorological data of all included NISS sites. The Distributed Lag Non-linear Model (DLNM) model was applied to estimate the exposure-response associations (relative risk, RR) of daily mean temperature with CO poisoning, which was then further used to identify early warning criteria of temperature related to CO poisoning. A total of 10,618 CO poisoning cases were included in this study, with an average of 0.4 cases per day. There was generally a reverse J-shaped association between temperature and CO poisoning risk, indicating that both low and high temperature may increase the risk of CO poisoning, but low temperature usually has a longer lagged effects than high temperature. Spatialy, the exposure-response associations between temperatue and CO poisoning largely varied among regions, with greater effects of low temperatures in Southern China than in Northern China. The cumulative effects (RR, lag0-6 days) of 10 % percentile temperature ranged from 1.13 (95%CI: 1.01,1.26) in East China to 1.73 (95%CI:1.63,1.83) in South China. We also observed significant spatial variations in the early warning criteria of temperature related to CO poisoning across China. However, the patterns of high temperature effects on CO poisoning and the warning criteria of high temperature were mixed across China. In conclusions, both low temperature and high temperature may increase the risk of CO poisoning in China, and the effect of low temperature is more obvious, especially in South China, Northeast China, and North China. In addition, there is an urgent need to establish air temperature early warning and grading criteria for CO poisoning in different areas of China.

Knowledge and practices related to salt consumption in China: findings from a national representative cross-sectional survey.

There is limited information on the knowledge and practice of salt-reduction in China. The purpose of this study was to describe the status of the knowledge and practice of salt-reduction among the Chinese population from a nationally representative survey stratified according to hypertension status. The association between hypertensive status and salt-reduction knowledge and practice was calculated using multivariate hierarchical logistic regression adjusting for related confounders. The study included 179,834 participants; 51.7% were women, and the mean age was 44 years. The levels of overall salt-reduction knowledge (7.9%) and practice (37.1%) were low. The percentage of the use of salt-control spoons and low-sodium salt was 10.7% and 12.2%. The aging population (≥60 years) had the lowest levels of salt-reduction knowledge (5.7%) than other age groups (P < 0.0001). People living in rural areas (OR = 0.64; 95% CI: 0.51, 0.81) had lower odds of using salt-control spoons. Females (OR = 1.23; 95% CI: 1.10, 1.36) had higher odds of using salt-control spoons. People living in rural areas (OR = 0.48; 95% CI: 0.36, 0.63) had lower odds of using low-sodium salt. Females (OR = 1.26; 95% CI: 1.13, 1.41) and people living in the southern region (OR = 1.43; 95% CI: 1.11, 1.83) had higher odds of using low-sodium salt. Our work highlights the need to promote education related to hypertension, salt-reduction knowledge and methods among the public and the need to strengthen strategies for the popularization of salt-reduction knowledge and practices among males, people living in rural areas, people living in the northern region and the aging population in China.