Prediction of Cognitive Impairment Risk among Older Adults: A Machine Learning-Based Comparative Study and Model Development.

INTRODUCTION: The prevalence of cognitive impairment and dementia in the older population is increasing, and thereby, early detection of cognitive decline is essential for effective intervention. METHODS: This study included 2,288 participants with normal cognitive function from the Ma'anshan Healthy Aging Cohort Study. Forty-two potential predictors, including demographic characteristics, chronic diseases, lifestyle factors, anthropometric indices, physical function, and baseline cognitive function, were selected based on clinical importance and previous research. The dataset was partitioned into training, validation, and test sets in a proportion of 60% for training, 20% for validation, and 20% for testing, respectively. Recursive feature elimination was used for feature selection, followed by six machine learning algorithms that were employed for model development. The performance of the models was evaluated using area under the curve (AUC), specificity, sensitivity, and accuracy. Moreover, SHapley Additive exPlanations (SHAP) was conducted to access the interpretability of the final selected model and to gain insights into the impact of features on the prediction outcomes. SHAP force plots were established to vividly show the application of the prediction model at the individual level. RESULTS: The final predictive model based on the Naive Bayes algorithm achieved an AUC of 0.820 (95% CI, 0.773-0.887) on the test set, outperforming other algorithms. The top ten influential features in the model included baseline Mini-Mental State Examination (MMSE), education, self-reported economic status, collective or social activities, Pittsburgh sleep quality index (PSQI), body mass index, systolic blood pressure, diastolic blood pressure, instrumental activities of daily living, and age. The model demonstrated the potential to identify individuals at a higher risk of cognitive impairment within 3 years from older adults. CONCLUSION: The predictive model developed in this study contributes to the early detection of cognitive impairment in older adults by primary healthcare staff in community settings.

The prevalence and factors of willingness to accept circumcision among MSM in Maanshan City, China.

To investigate the prevalence of male circumcision and the willingness to undergo male circumcision and influencing factors among MSM in Maanshan City, we conducted a cross-sectional study from June 2016 to December 2019. Respondent-driven sampling (RDS) was used to recruit participants. Influential factors of willingness to accept circumcision were identified by a multivariable logistic regression model. The multivariable logistic regression model revealed that five variables were independent influential factors for willingness to participate. The factors include that used condoms during last anal intercourse (OR = 1.87, 95% CI:1.03-3.41, P = 0.04), sex with female sex partners (OR = 0.499, 95% CI:0.298-0.860, P = 0.012, level of education (junior college: OR = 0.413, 95% CI:0.200-0.854, P = 0.017; bachelor's degree or higher: OR = 0.442, 95% CI:0.208-0.938, P = 0.033), condom use during oral sex in the last six months (OR = 4.20, 95% CI:1.47-12.0, P = 0.007) and level of knowledge of PrEP (OR = 5.09, 95% CI:1.39-18.7, P = 0.014). Given the willingness of MSM to accept circumcision was low in China, establishing a proper understanding of circumcision is essential if it is to be used as a strategy to prevent HIV infection among MSM. Therefore, publicity and education on the operation should be strengthened to increase the willingness to undergo male circumcision.

Inflammatory burden of adolescents with childhood maltreatment: results from baseline data of a school cohort.

Increasing studies have investigated inflammatory burden of adults with childhood adversity, but less is known about how childhood maltreatment affects the inflammation level of adolescents. Baseline data of a school cohort of physical and mental health status and life experience survey on primary and secondary school students in Anhui Province, China was used. Childhood maltreatment of children and adolescents was assessed by Chinese version of Childhood Trauma Questionnaire-Short Form (CTQ-SF). Urine samples were collected to assess levels of soluble urokinase Plasminogen Activator Receptor (suPAR), C-reactive protein (CRP) and cytokines interleukin-6 (IL-6) by enzyme-linked immunosorbent assay (ELISA). Logistic regression was conducted to examine the association between childhood maltreatment exposure and risk of high inflammation burden. A total of 844 students were included with mean age 11.41 ± 1.57 years old. Adolescents with emotional abuse were significantly more likely to have high level of IL-6 (OR = 3.59, 95% CI 1.16-11.14). In addition, adolescents with emotional abuse were more likely to show high IL-6 and high suPAR combination (OR = 33.41, 95% CI 1.69-659.22), and high IL-6 and low CRP combination (OR = 4.34, 95% CI 1.29-14.55). Subgroup analyses showed that emotional abuse was associated with high IL-6 burden among boys or adolescents with depression. Childhood emotional abuse was positively associated with higher burden of IL-6. Early detection and prevention of emotional abuse for children and adolescents, especially for boys or adolescents with depression status, may be helpful for preventing elevated inflammatory burden and related health problems.

Association between adverse childhood experiences and sleep quality, emotional and behavioral problems and academic achievement of children and adolescents.

The impact of adverse childhood experiences (ACEs) on adult health has been extensively examined, but the association between ACEs and sleep, emotion, behavior and academic outcomes of children and adolescents is not well known. A total of 6363 primary and middle school students were included to examine the effect of ACEs on sleep quality, emotional and behavioral problems and academic achievement and further explore the mediation role of sleep quality and emotional and behavioral problems. Children and adolescents with ACE exposure had 1.37 times risk of poor sleep quality (adjusted odds ratio [OR] = 1.37, 95% confidence interval [CI]: 1.21-1.55), 1.91 times risk of emotional and behavioral problems (adjusted OR = 1.91, 95%CI: 1.69-2.15) and 1.21 times risk of self-reported lower academic achievement (adjusted OR = 1.21, 95%CI: 1.08-1.36). Most types of ACEs were significantly associated with poor sleep quality, emotional and behavioral problems and lower academic achievement. There were dose-response relationships between cumulative ACE exposure and risk of poor sleep quality, emotional and behavioral problems, and lower academic achievement. Sleep quality and emotional and behavioral performance mediated 45.9% of the effect of ACEs exposure on math scores and 15.2% of the effect of ACEs exposure on English scores. Early detection and prevention of ACEs among children and adolescents are urgent and essential, and targeted interventions for sleep and emotional and behavioral performance as well as early educational interventions are recommended for children with ACEs exposure.

Longitudinal association of nighttime sleep duration with emotional and behavioral problems among rural preschool children.

This study aimed to examine the association between nighttime sleep duration and emotional and behavioral problems (EBPs) among rural preschool children. This longitudinal study including 1595 preschool children aged 3-6 years from 26 kindergartens in four counties was conducted in Anhui Province rural areas. Cross-lagged panel models and multivariable logistic regressions were performed to examine the bidirectional association between nighttime sleep duration and EBPs and further explore the predictive effect of nighttime sleep duration on EBPs. Compared to baseline, preschool children at follow-up had significantly more nighttime sleep duration (10.01 ± 0.68 vs. 10.15 ± 0.69) and lower EBPs (total difficulties: 15.8% vs. 11.2%; prosocial behavior problems: 12.4% vs. 7.0%). Results of cross-lagged panel models indicated that nighttime sleep duration was a predictor for EBPs, but not vice versa. Results of logistic regression analysis showed that each 1-h increase in nighttime sleep duration at T1 was associated with a 0.77-fold reduction in the risk of total difficulties at T2 (the most adjusted OR = 0.774, 95% CI 0.607-0.988, P = 0.040), but not with the prosocial behavior. Interestingly, the predictive effect of nighttime sleep duration at T1 on EBPs at T2 was only found in girls, children aged 3 years and children with lower maternal education. The decreased nighttime sleep duration may predict future EBPs, especially in girls, younger preschool children and children with lower maternal education. Extending sleep duration may improve EBPs in preschool children.

HIV associated factors among men who have sex with men in Maanshan, China: a cross-sectional study.

BACKGROUND: This study conducted a survey of men who have sex with men (MSM) in Maanshan City of Anhui Province to assess the risk behaviors related to human immunodeficiency virus (HIV) infection. METHODS: A cross-sectional survey was conducted from June 2016 to June 2019. The MSM were recruited by a peer-driven sampling method. A face-to-face interview with anonymous questionnaire was used for data collection. The information collected by the survey was summarized and epidemiology described the basic characteristics of MSM, and then the related factors were statistically analyzed. RESULTS: A total of 934 MSM were recruited with a average age was 30.5 (SD = 8.90) years old, including 816 (87.4%) HIV negative participants and 118 (12.6%) HIV positive ones. This study showed that freelancer (OR = 4.02, 95% CI: 1.96-8.23), scope of sexual partners distribution (OR = 1.78, 95% CI: 1.36-2.33), number of male sexual partners (OR = 2.11, 95% CI: 1.47-3.02), role of anal sex with men was receptive (OR = 2.54, 95% CI: 1.25-5.13) and versatile (OR = 2.34, 95% CI: 1.31-4.19) and non-steady sex partners (OR = 2.14, 95% CI: 1.56-2.93) were risk factors for HIV infection, while monthly income (OR = 0.68, 95% CI: 0.57-0.82), education level (OR = 0.79, 95% CI: 0.66-0.95), frequency of condom use (OR = 0.53, 95% CI: 0.35-0.81) and number of oral sex partners (OR = 0.35, 95% CI: 0.24-0.51) in the past 6 months were protective factors for HIV infection. CONCLUSION: Risk behaviors were common in MSM, and urgent need for targeted and comprehensive interventions to reduce risky sexual behaviour and to prevent HIV infection in MSM.

Development of psychological resilience and associations with emotional and behavioral health among preschool left-behind children.

PURPOSE: This study aimed to explore the development of psychological resilience and its associations with emotional and behavioral health among preschool left-behind children (LBC). METHODS: LBC in 26 preschools of Fuyang City, Hefei City, and Maanshan City of Anhui Province were included at baseline survey; and baseline children in the junior and middle classes of preschools as targeted samples were recruited for the 1-year follow-up. Multivariable linear regression models were performed to examine associations of psychological resilience with emotional and behavioral health. RESULTS: In total, 1463 LBC were included at baseline and 568 of the 905 targeted LBC completed the 1-year follow-up. Change patterns of psychological resilience were identified as the stable-high pattern (19.0%), increasing pattern (18.3%), declining pattern (15.9%), and stable-low pattern (46.8%). The results showed that psychological resilience at baseline was positively associated with later dietary behavior habits and prosocial behaviors, and negatively associated with later problematic behaviors and sleep problems. In addition, children with the declining pattern had more problematic behaviors and sleep problems, and fewer prosocial behaviors at follow-up. Children with the increasing pattern and stable-high pattern had more prosocial behaviors, better dietary behavior habits, and fewer problematic behaviors and sleep problems at follow-up. CONCLUSIONS: The majority of preschool LBC had lower psychological resilience and its level among some LBC changed during the follow-up. Higher psychological resilience was a protective factor for emotional and behavioral health. Timely assessing psychological resilience and then strengthening it are needed to promote the emotional and behavioral health of preschool LBC.

The association between family function and sleep disturbances of preschool children in rural areas of China: a cross-sectional study.

This study aimed to explore the association between family function and sleep disturbances in preschool children in rural areas of China. Caregivers of preschool children completed sociodemographic questionnaires, the Children's Sleep Habits Questionnaire (CSHQ), the Self-rating Anxiety Scale (SAS) and the Family APGAR scale. Using sleep disturbances in children as the dependent variable, family function and other related factors as independent variables, binary logistic regression analyses were performed to examine associations between family function and sleep disturbances in children. A total of 3,636 caregivers of preschool children were enrolled in our study, and the prevalence of sleep disturbances among their preschool children was 89.4%. In our study, lower family function was associated with higher risk of sleep disturbances among preschool children. After adjusting for age (years), education level of mother, discipline attitudes of father and mother, only child status and caregivers' anxiety, the associations were statistically significant both in families of which caregivers of children are their parents or other relatives. (AOR for parents = 1.487, 95% CI:1.152-1.919, P = 0.002; AOR for other relatives = 1.963, 95% CI:1.302-2.958, P = 0.001). Our study results indicated that family function was associated with sleep disturbances in preschool children, and future high-quality cohort studies are needed to explore this topic in more detail.

Adverse childhood experiences of emotional and physical abuse and emotional and behavioral problems: the mediating effects of family function and resilience.

Adverse childhood experiences are a widespread phenomenon that can have a variety of negative effects on children. Emotional and behavioral problems (EBP) in children have been gaining interest in recent years. Therefore, this study aims to explore the association between emotional and physical abuse (EPA) and preschool children's EBP, as well as to assess the mediating effects of family function and resilience in this association. A cross-sectional study was conducted, and we recruited 3,636 participants from 26 kindergartens in three cities. Correlation analysis and regression analysis were used to test the relationships between EPA, mediators (family function and resilience), and EBP. Structural equation modeling was used to perform the mediation analyses. The results of this study showed that EPA predicted EBP in preschool children, family function, and resilience independently and in combination to mediate the relationship. Therefore, improving family function and increasing children's level of resilience are beneficial methods for the prevention and intervention of EBP in preschool children who experience EPA, but most fundamentally to avoid or reduce the occurrence of abuse. Further longitudinal studies are needed to confirm our findings and explore possible mediating mechanisms.

Interaction of biomass fuels use and metals exposure on hypertension: A prospective cohort study in rural areas along the Yangtze River, China.

Humans maybe simultaneously exposed to multiple-metals and indoor air pollution in daily life. However, limited prospective studies have assessed the interaction between multiple metals exposure and biomass fuels use on hypertension in China. The prospective cohort study in rural areas along the Yangtze River included 2625 adults in 2014-2015, and they were followed up till 2019. Among 1248 rural residents who were without hypertension at baseline, 377 hypertension events (30.21%) were observed after 4.5 years of average follow-up time. First-morning urine samples of residents were collected at baseline, the association between urinary metals level and hypertension were assessed using quantile g-computation. Additionally, we also examined the effect of biomass fuels use, fuels switching, and cookstove ventilation on the association of metals exposure with hypertension. Quantile g-computation analyses showed a positive joint effect of 17 metals on hypertension, with the odds ratio (OR) of 1.68 (95% CI: 0.89, 3.14) when increasing all seventeen metals by one quartile, and cadmium, lithium, copper contributed the largest positive weights. Biomass fuels use can interact with cadmium exposure on hypertension with OR for interaction of 1.28 (95%CI: 1.00, 1.73), and increase the association between copper, manganese and zinc exposure and systolic blood pressure, lithium exposure and diastolic blood pressure at the follow-up visit. Moreover, switching from biomass fuels to clean fuels during follow up, cookstove ventilation can alleviate the risk of higher blood pressure from metals exposure. In rural areas along the Yangtze River, China, biomass fuels use for cooking can interact with multiple-metals exposure on hypertension. Residents who switched from biomass fuels to clean fuels and who used ventilation had a lower risk of hypertension. Further cohort studies are needed to clarify the mechanism of combined effects of metals exposure and biomass fuels use on the human health.

Urinary Metal Concentrations and the Incidence of Hypertension Among Adult Residents Along the Yangtze River, China.

Metals from the natural environment have potential hypertension effects. However, relevant studies on this topic are few. A total of 1358 adults aged 18-74 years from Chizhou, Maanshan, and Tongling of Anhui Province participated in the baseline study from 2014 to 2015. The follow-up study was performed from 2016 to 2017. Inductively coupled plasma optical emission spectrometry (7000 DV) was used to measure urinary Cr, Mn, Fe, Cu, and Zn of residents. Urinary concentrations of Cd determined via TAS-900 atomic absorption spectrophotometry at 228.8 nm wavelength. A total of 275 hypertension cases were identified. After adjusting for sociodemographic factors and risk factors for hypertension, four metals (Cd, Cr, Cu, and Mn) were significantly associated with hypertension in the single-metal model. Upon including all metals in the same model, the hazard ratios of the highest quartiles Cd and Cu compared with the reference group were 1.42 (95% confidence interval [CI] 1.09-2.02) and 1.56 (95% CI 1.16-2.09) for cases of hypertension. Our findings suggested that high levels of Cd and Cu might increase the incidence of hypertension. Further studies involving larger population should be conducted to confirm these findings.

[Prevalence of hypertension and its influencing factors in rural areas along the Yangtze River in Anhui Province in 2014-2015].

OBJECTIVE: To investigate the prevalence, awareness, treatment, control and related influence factors of hypertension among rural adult residents in areas along the Yangtze River in Anhui Province. METHODS: Totally 2873 rural adult residents in seven typical towns along the Yangtze River of Chizhou, Tongling and Ma'anshan Cities, Anhui Province were selected, with multistage-stratified random cluster sampling, to perform questionnaires and physical measurements from year 2014 to 2015. RESULTS: The prevalence of hypertension was 30. 7%( standardized prevalence was 18. 4%), the awareness rate was 50. 6%( standardized rate was 29. 0%), the treatment rate was40. 4%( standardized rate was 18. 7%), the control rate was 17. 7%( standardized ratewas 9. 3%) in rural areas along the Yangtze River in Anhui Province. The prevalence, awareness, treatment and control rates of hypertension were increased with age increase. Abdominal obesity( OR = 1. 855, 95% CI 1. 467-2. 344), family history of hypertension( OR = 1. 594, 95% CI 1. 265-2. 008), the average annual household income < 60 000 yuan and increased BMI were risk factors of hypertension in rural areas along the Yangtze River. Female( OR = 0. 734, 95% CI 0. 604-0. 891) was its protective factors. While the factors of awareness, treatment and control rates of hypertension were not same. CONCLUSION: The prevalence of hypertension is higher in the areas along the Yangtze River in Anhui Province. However, the awareness, treatment and control rate of hypertension are lower.

Depressive Symptoms Were Prevalent Among Left-Behind Women in Ma'anshan, China.

The present study was aimed at exploring the prevalence and factors associated with depressive symptoms among left-behind women in China. A sample of 938 participants (439 left-behind women and 499 non-left-behind women) was surveyed with self-rating questionnaire. The scores of depressive symptoms were higher in the left-behind women; and the overall prevalence of depressive symptoms was 34.54% for all participants and 46.69% for the left-behind women (mild, 40.77%; moderate/major, 5.92%). The status of left-behind is an independent risk factor of depressive symptoms in rural women. The multinomial logistic regression in the left-behind women indicated age, religious belief, annual individual income, impulsiveness, and active coping were associated with mild depressive symptoms; whereas age, religious belief, domestic violence, and active coping were associated with moderate/major depressive symptoms. Results suggest that depressive symptoms were prevalent among the left-behind women. The findings should be considered for the psychological intervention in the left-behind women.

Suicidal ideation among rural immigrant daughters-in-law with multi-roles as females, farmers and immigrants in China.

Suicide is a major public health issue in China, and suicidal ideation is an important step in the suicidal process. The purpose of this study was to understand the prevalence and correlates of suicidal ideation among rural immigrant daughters-in-law with multi-role of female, farmer and immigrant in China. A total of 939 participants including 474 local daughters-in-law and 465 immigrant daughters-in-law were surveyed using the self-rating questionnaire. Demographic characteristics, depression, anxiety, impulsivity and suicidal ideation were assessed. Results indicated that the lifetime prevalence of suicidal ideation among rural immigrant daughters-in-law was 9.68%. Physical disability, domestic violence and negative events demonstrated statistical significance by suicidal ideation (p < .05), and participants with suicidal ideation had higher scores of depression, anxiety and impulsiveness in the univariate analysis. Multivariate logistic regression showed that physical disability (OR = 7.43, 95%CI: 2.84-19.46), domestic violence (OR = 2.65, 95%CI: 1.02-6.88), depression (OR = 1.07, 95%CI: 1.01-1.12), impulsiveness (OR = 1.04, 95%CI: 1.01-1.08) and motor impulsiveness (OR = 1.07, 95%CI: 1.01-1.14) were significantly associated with suicidal ideation. Suicidal ideation is an issue that can't be ignored among rural immigrant daughters-in-law. And the findings should be considered for the intervention of the suicide among the rural immigrant daughters-in-law.

Acceptability of early anti-retroviral therapy among HIV-infected people in Anhui province in China.

We investigated the acceptability of early anti-retroviral therapy (ART) among HIV-infected people in Anhui Province, China. A cross-sectional study was conducted in 11 convenience selected cities of Anhui Province from September 2012 to December 2013. Study participants were convenience recruited from local Centers for Disease Control and Prevention when they attended for CD4(+) cell counts testing and HIV counselling. Answers to questionnaires were obtained through face-to-face structured interviews. Factors influencing the acceptability of early ART were identified by multiple logistic regression analysis. A total of 287 HIV-infected people met the criteria and completed the survey. The acceptability of early ART was 65.2%. The results of multiple logistic regression analysis indicated that the acceptability of early ART was associated with the following factors: CD4(+) T cell count (above 750 cells/µL vs. 350 cells/µL to 550 cells/µL: OR = 0.144, P < 0.001), years of HIV diagnosis confirmation (1 year to 5 years vs. <1 year: OR = 0.418, P = 0.005; above 5 years vs. <1 year: OR = 0.160, P < 0.001), whether had sexual behaviour after HIV diagnosis confirmation (yes vs. no: OR = 2.342, P = 0.005) and the awareness of two early ART-related questions (OR = 4.101, P = 0.015; OR = 3.294, P < 0.001). In summary, the present study showed that most HIV-infected people can accept early ART. Early ART interest in Anhui HIV-infected population was high. The awareness of early ART-related knowledge in HIV-infected population was low and should be improved to achieve higher acceptability and keep adherence to early ART for HIV prevention.

Prediction of positive pulmonary nodules based on machine learning algorithm combined with central carbon metabolism data.

BACKGROUND: Lung cancer causes a huge disease burden, and early detection of positive pulmonary nodules (PPNs) as an early sign of lung cancer is extremely important for effective intervention. It is necessary to develop PPNs risk recognizer based on machine learning algorithm combined with central carbon metabolomics. METHODS: The study included 2248 participants at high risk for lung cancer from the Ma'anshan Community Lung Cancer Screening cohort. The Least Absolute Shrinkage and Selection Operator (LASSO) was used to screen 18 central carbon-related metabolites in plasma, recursive feature elimination (RFE) was used to select all 42 features, followed by five machine learning algorithms for model development. The performance of the model was evaluated using area under the receiver operator characteristic curve (AUC), accuracy, precision, recall, and F1 scores. In addition, SHapley Additive exPlanations (SHAP) was performed to assess the interpretability of the final selected model and to gain insight into the impact of features on the predicted results. RESULTS: Finally, the two prediction models based on the random forest (RF) algorithm performed best, with AUC values of 0.87 and 0.83, respectively, better than other models. We found that homogentisic acid, fumaric acid, maleic acid, hippuric acid, gluconic acid, and succinic acid played a significant role in both PPNs prediction model and NPNs vs PPNs model, while 2-oxadipic acid only played a role in the former model and phosphopyruvate only played a role in the NPNs vs PPNs model. This model demonstrates the potential of central carbon metabolism for PPNs risk prediction and identification. CONCLUSION: We developed a series of predictive models for PPNs, which can help in the early detection of PPNs and thus reduce the risk of lung cancer.

Sexual behaviours and correlates of condom use among HIV-discordant couples from eastern China: a cross-sectional study.

OBJECTIVES: To investigate sexual behaviours among HIV-discordant heterosexual couples and assess the correlates of condom use at the couple level. DESIGN: Cross-sectional study. SETTING: Seven prefectures along the Yangtze River in the Anhui Province, China. PARTICIPANTS: We included 412 participants aged 18 years or older (206 married HIV-discordant couples). PRIMARY AND SECONDARY OUTCOME MEASURES: In this study, sexual behaviours included marital or extramarital sex in the past 6 months, as well as the frequency of marital sex and condom use (always, sometimes or never) if having marital sex in the past 6 months. We used stepwise ordinal logistic regression modelling to determine the correlates of condom use. RESULTS: In total, 63.1% (130 of 206) of couples had marital sex in the past 6 months, of which 89.2% (116 of 130) used condoms consistently. Couples with more marital duration (OR=1.15; 95% CI: 1.03, 1.28) were more inclined to adhere to condom use, whereas those lacking support and care (OR=0.25; 95% CI: 0.07, 0.94) and being remarried (OR=0.08; 95% CI: 0.02, 0.43) were associated with less condom use. In addition, HIV-positive respondents were more likely to have extramarital sex than HIV-negative respondents (p=0.015). CONCLUSIONS: The extramarital sex of HIV-positive spouses should be considered. Implementation of interventions, such as increasing support and care between spouses to promote marital intimacy and stability, could reduce unprotected sexual behaviour.

Association Between Night Shift and Hypertension: A Cross-Sectional Study in Chinese Adults.

OBJECTIVE: The purpose of this study was to explore the effect of night-shift work on the risk of hypertension for improving workers' health. METHODS: A total of 10,038 Chinese participants were constituted in the cross-sectional study. Logistic regression and restricted cubic spline were used to estimate the effect of night shift on hypertension. RESULTS: There were higher odds of having hypertension in any night-shift workers (odds ratio [OR], 1.16 [95% confidence interval, 1.03-1.30]) when compared with day workers. Having 5 to 10 night shifts per month were significantly more likely to be hypertensive (OR, 1.19 [95% confidence interval, 1.03-1.38]). The OR for hypertension increased as the number of night shifts increased as the result of the restricted cubic spline. CONCLUSIONS: Our results support the hypothesis that night shift is associated with an elevated risk of hypertension.

Association between sleep change patterns and mental health among preschoolers: The mediating role of resilience.

Sleep disturbance has been recognized as an important factor influencing mental health problems in preschool children. However, no longitudinal studies have investigated the association between sleep change patterns and mental health in preschoolers or the mediating role of resilience. Here, data were collected from 1595 preschool children in 26 kindergartens in four counties in Anhui Province, China, who were followed up (T2) 1 year apart based on baseline surveys (T1). The primary caregivers of the children were asked to complete a structured questionnaire through face-to-face interviews or by completing it themselves. Pearson's correlation and linear regression were used to analyze the relationships among sleep patterns, mental health, and resilience in preschoolers. A structural equation model was used for the mediation analysis. Four patterns of sleep change were identified: persistent-low pattern (1.7%), decreasing pattern (9.8%), increasing pattern (7.3%), and persistent-high pattern (81.3%). Compared to the persistent-low pattern, the increasing pattern and persistent-high pattern were associated with emotional behavioral problems (EBPs) and anxiety. Resilience played a fully mediating role in the relationship between increasing pattern, persistent-high pattern, and EBPs. Resilience partially mediated the effects of increasing and persistent-high pattern on anxiety. More attention should be paid to sleep problems in children with increasing and persistent-high sleep patterns. Resilience is important for understanding the mechanism underlying the correlation between sleep patterns, EBPs, and anxiety. Considering the EBPs and anxiety of preschool children, early intervention for resilience should be considered.

Family function and emotional behavior problems in Chinese children and adolescents: A moderated mediation model.

BACKGROUND: Studies have shown that family function is associated with emotional behavior problems. However, the underlying relationship mechanisms between family function and emotional behavior problems in children and adolescents is not fully understood. Therefore, the purpose of this study is to explore the mediating effect of resilience and the moderating effect of sleep quality using a moderated mediation model. METHODS: 6363 children and adolescents in grades four to nine were surveyed in some areas of Anhui Province, China. Family function, resilience, sleep quality, and emotional behavior problems were measured through a self-administered questionnaire. All data analysis was by performed by SPSS 23.0. RESULTS: The results showed that family function was negatively associated with emotional behavior problems (r = -0.307, p < 0.01). Resilience partially mediated the relationship between family function and emotional behavior problems (indirect effect = -0.108, accounted for 38.4 %). Sleep quality moderated the relationship between family function and resilience (ß = -0.039, P < 0.001). CONCLUSION: Resilience and sleep quality respectively played a mediating and moderating effect in the relationship between family function and emotional behavior problems. These findings suggest that we should pay attention to the family function of children and adolescents in time, improve their resilience and sleep quality, so as to effectively reduce the occurrence of emotional behavior problems.