Association between polypharmacy and chronic kidney disease among community-dwelling older people: a longitudinal study in southern China.

BACKGROUND: Polypharmacy would increase the risk of adverse drug events and the burden of renal drug excretion among older people. Nevertheless, the association between the number of medication and the risk of chronic kidney disease (CKD) remains controversial. Therefore, this study aims to investigate the association between the number of medication and the incidence of CKD in older people. METHODS: This study investigates the association between the number of medications and CKD in 2672 elderly people (≥ 65 years older) of the community health service center in southern China between 2019 and 2022. Logistic regression analysis was used to evaluate the relationship between polypharmacy and CKD. RESULTS: At baseline, the average age of the study subjects was 71.86 ± 4.60, 61.2% were females, and 53 (2.0%) suffer from polypharmacy. During an average follow-up of 3 years, new-onset CKD developed in 413 (15.5%) participants. Logistic regression analysis revealed that taking a higher number of medications was associated with increase of CKD. Compared with people who didn't take medication, a higher risk of CKD was observed in the older people who taken more than five medications (OR 3.731, 95% CI 1.988, 7.003), followed by those who take four (OR 1.621, 95% CI 1.041, 2.525), three (OR 1.696, 95% CI 1.178, 2.441), two drugs (OR 1.585, 95% CI 1.167, 2.153), or one drug (OR 1.503, 95% CI 1.097, 2.053). Furthermore, age, systolic blood pressure (SBP), white blood cell (WBC), blood urea nitrogen (BUN) and triglyceride (TG) were also independent risk factors CKD (P < 0.05). CONCLUSION: The number of medications was associated with CKD in older people. As the number of medications taken increased, the risk of CKD was increased.

The Topology of Polymer Brushes Determines Their Nanoscale Hydration.

Time-of-flight neutron reflectometry (ToF-NR) performed under different relative humidity conditions demonstrates that polymer brushes constituted by hydrophilic, cyclic macromolecules exhibit a more compact conformation with lower roughness as compared to linear brush analogues, due to the absence of dangling chain ends extending at the polymer-vapor interface. In addition, cyclic brushes feature a larger swelling ratio and an increased solvent uptake with respect to their linear counterparts as a consequence of the increased interchain steric repulsions. It is proposed that differences in swelling ratios between linear and cyclic brushes come from differences in osmotic pressure experienced by each brush topology. These differences stem from entropic constraints. The findings suggest that to correlate the equilibrium swelling ratios at different relative humidity for different topologies a new form of the Flory-like expression for equilibrium thicknesses of grafted brushes is needed.

Evaluating the efficiency of primary health care institutions in China: an improved three-stage data envelopment analysis approach.

BACKGROUND: Primary health care (PHC) institutions are key to realizing the main functions of the health care system. Since the new health care reform in 2009, the Chinese government has invested heavily in PHC institutions and launched favorable initiatives to improve the efficiency of such institutions. This study is designed to gauge the efficiency of PHC institutions by using 2012-2020 panel data covering 31 provinces in China. METHODS: This study applied an improved three-stage data envelopment analysis (DEA) model to evaluate the efficiency of PHC institutions in China. Unlike the traditional three-stage DEA model, the input-oriented global super-efficiency slack-based measurement (SBM) DEA model is used to calculate the efficiency in the first and third stages of the improved three-stage DEA model, which not only allows the effects of environmental factors and random noise to be taken into account but also deal with the problem of slack, super-efficiency and the comparability of interperiod efficiency values throughout the efficiency measurement. RESULTS: The results show that the efficiency of PHC institutions has been overestimated due to the impact of external environmental factors and random noise. From 2012 to 2020, the efficiency of PHC institutions displayed a downward trend. Moreover, there are significant differences in the efficiency of PHC institutions between regions, with the lowest efficiency being found in the northeast region. The efficiency of PHC institutions is significantly affected by residents' annual average income, per capita GDP, population density, the percentage of the population aged 0-14, the percentage of the population aged 65 and older, the number of people with a college education and above per 100,000 residents, and the proportion of the urban population. CONCLUSIONS: Substantial investment in PHC institutions has not led to the expected efficiency gains. Therefore, more effective measures should be taken to improve the efficiency of PHC institutions in China based on local conditions. This study provides a new analytical approach to calculating the efficiency of PHC institutions, and this approach can be applied to efficiency evaluation either in other fields or in other countries.

Cadmium-induced reproductive toxicity combined with a correlation to the oogenesis process and competing endogenous RNA networks based on a Caenorhabditis elegans model.

Accumulation of the heavy metal Cadmium (Cd) in the ovaries and placenta can affect the structure and function of these organs and induce female reproductive toxicity. This toxicity may be due to Cd's similarity to estrogen and its ability to disrupt endocrine systems. However, the exact molecular mechanism by which Cd causes reproductive toxicity at the transcriptome level remains poorly understood. Hence, this study aimed to observe Cd-induced reproductive damage at the gene level, scrutinize the repercussions of Cd exposure on oogenesis, and explicate the putative pathogenesis of Cd-induced oogenesis based on Caenorhabditis elegans (C. elegans) as an in vivo model. The results showed that Cd exposure significantly decreased the number of offspring and prolonged the reproductive span of C. elegans. Cd exposure also reduced the number of cells in mitosis and the pachytene and diakinesis stages of meiosis, thereby disrupting oogenesis. Combined with transcriptional sequencing and bioinformatics analysis, a total of 3167 DEmRNAs were identified. Regarding gene expression, cul-6, mum-2, and vang-1 were found to be related to Cd-induced reproductive toxicity, and their competing endogenous RNA networks were constructed. We observed that mutations of mom-2 and vang-1 in the Wnt pathway could induce susceptibility to Cd-caused meiosis injury. In conclusion, the results indicated that Cd could impair the oogenesis of C. elegans and the Wnt pathway might serve as a protective mechanism against Cd reproductive toxicity. These findings contribute to a better understanding of the damaging effects and molecular biological mechanisms of Cd on the human reproductive system.

The function and regulation network mechanism of circRNA in liver diseases.

Circular RNA (circRNA), a new type of endogenous non-coding RNA, is abundantly present in eukaryotic cells, and characterized as stable high conservation and tissue specific expression. It has been generated increasing attention because of their close association with the progress of diseases. The liver is the vital organ of humans, while it is prone to acute and chronic diseases due to the influence of multiple pathogenic factors. Moreover, hepatocellular carcinoma (HCC) is the one of most common cancer and the leading cause of cancer death worldwide. Overwhelming evidences indicate that some circRNAs are differentially expressed in liver diseases, such as, HCC, chronic hepatitis B, hepatic steatosis and hepatoblastoma tissues, etc. Additionally, these circRNAs are related to proliferation, invasion, migration, angiogenesis, apoptosis, and metastasis of cell in liver diseases and act as oncogenic agents or suppressors, and linked to clinical manifestations. In this review, we briefly summarize the biogenesis, characterization and biological functions, recent detection and identification technologies of circRNA, and regulation network mechanism of circRNA in liver diseases, and discuss their potential values as biomarkers or therapeutic targets for liver diseases, especially on HCC.

Poly(sulfobetaine)-Based Diblock Copolymer Thin Films in Water/Acetone Atmosphere: Modulation of Water Hydration and Co-nonsolvency-Triggered Film Contraction.

The water swelling and subsequent solvent exchange including co-nonsolvency behavior of thin films of a doubly thermo-responsive diblock copolymer (DBC) are studied via spectral reflectance, time-of-flight neutron reflectometry, and Fourier transform infrared spectroscopy. The DBC consists of a thermo-responsive zwitterionic (poly(4-((3-methacrylamidopropyl) dimethylammonio) butane-1-sulfonate)) (PSBP) block, featuring an upper critical solution temperature transition in aqueous media but being insoluble in acetone, and a nonionic poly(N-isopropylmethacrylamide) (PNIPMAM) block, featuring a lower critical solution temperature transition in water, while being soluble in acetone. Homogeneous DBC films of 50-100 nm thickness are first swollen in saturated water vapor (H2O or D2O), before they are subjected to a contraction process by exposure to mixed saturated water/acetone vapor (H2O or D2O/acetone-d6 = 9:1 v/v). The affinity of the DBC film toward H2O is stronger than for D2O, as inferred from the higher film thickness in the swollen state and the higher absorbed water content, thus revealing a pronounced isotope sensitivity. During the co-solvent-induced switching by mixed water/acetone vapor, a two-step film contraction is observed, which is attributed to the delayed expulsion of water molecules and uptake of acetone molecules. The swelling kinetics are compared for both mixed vapors (H2O/acetone-d6 and D2O/acetone-d6) and with those of the related homopolymer films. Moreover, the concomitant variations of the local environment around the hydrophilic groups located in the PSBP and PNIPMAM blocks are followed. The first contraction step turns out to be dominated by the behavior of the PSBP block, whereas the second one is dominated by the PNIPMAM block. The unusual swelling and contraction behavior of the latter block is attributed to its co-nonsolvency behavior. Furthermore, we observe cooperative hydration effects in the DBC films, that is, both polymer blocks influence each other's solvation behavior.

Equity and efficiency of public hospitals' health resource allocation in Guangdong Province, China.

BACKGROUND: To better meet people's growing demand for medical and health services, 21 cities in Guangdong Province were involved in the reform of public hospitals in 2017. This paper evaluates the equity and efficiency of public hospitals' health resource allocation in Guangdong Province and explores ways to change the current situation. METHODS: Data were collected from the Guangdong Health Statistical Yearbook 2016-2020 and Guangdong Statistical Yearbook 2017-2021. The Gini coefficient (G), Theil index (T), and health resource density index (HRDI) were used to measure the equity of health resource allocation. An improved three-stage DEA method was applied in efficiency evaluation. The entropy weight method was employed to calculate the weight of different indicators to obtain a comprehensive indicator representing the overall volume of health resources in each city. A two-dimensional matrix was drawn between the HRDI of the comprehensive indicator and efficiency and the per capita government financial subsidies and efficiency to observe the coordination of equity and efficiency across regions. RESULTS: From 2016 to 2020, the G of public hospital, bed, and health technician allocation by population remained below 0.2, while that by geographical area ranged from 0.4 to 0.6; the G of government financial subsidies by population was above 0.4, while that by geographical area was greater than 0.7. The results for T showed that inequality mainly comes from intraregional differences, and the Pearl River Delta contributes most to the overall differences. Although the HRDI of the Pearl River Delta is far greater than that of other regions, obvious differences exist across cities in the region. Only 38.1% of cities were found to be efficient in 2020. The Pearl River Delta was in the first quadrant, and the other three regions were in the third quadrant, accounting for a large proportion. CONCLUSION: The equity of government financial subsidies allocation was the worst, and there were distinct regional differences in the geographical distribution of health resources. The development of healthcare within the Pearl River Delta was highly unbalanced. The development of healthcare was uneven between the Pearl River Delta, eastern, western, and mountainous regions. In addition, most cities in the eastern, western, and mountainous regions bore the dual pressures of relatively insufficient health resources and inefficiency.

Salt-Dependent Phase Transition Behavior of Doubly Thermoresponsive Poly(sulfobetaine)-Based Diblock Copolymer Thin Films.

The water vapor-induced swelling, as well as subsequent phase-transition kinetics, of thin films of a diblock copolymer (DBC) loaded with different amounts of the salt NaBr, is investigated in situ. In dilute aqueous solution, the DBC features an orthogonally thermoresponsive behavior. It consists of a zwitterionic poly(sulfobetaine) block, namely, poly(4-(N-(3'-methacrylamidopropyl)-N,N-dimethylammonio) butane-1-sulfonate) (PSBP), showing an upper critical solution temperature, and a nonionic block, namely, poly(N-isopropylmethacrylamide) (PNIPMAM), exhibiting a lower critical solution temperature. The swelling kinetics in D2O vapor at 15 °C and the phase transition kinetics upon heating the swollen film to 60 °C and cooling back to 15 °C are followed with simultaneous time-of-flight neutron reflectometry and spectral reflectance measurements. These are complemented by Fourier transform infrared spectroscopy. The collapse temperature of PNIPMAM and the swelling temperature of PSBP are found at lower temperatures than in aqueous solution, which is attributed to the high polymer concentration in the thin-film geometry. Upon inclusion of sub-stoichiometric amounts (relative to the monomer units) of NaBr in the films, the water incorporation is significantly increased. This increase is mainly attributed to a salting-in effect on the zwitterionic PSBP block. Whereas the addition of NaBr notably shifts the swelling temperature of PSBP to lower temperatures, the collapse temperature of PNIPMAM remains unaffected by the presence of salt in the films.

Comparison of several blood lipid-related indexes in the screening of non-alcoholic fatty liver disease in women: a cross-sectional study in the Pearl River Delta region of southern China.

BACKGROUND: Lipid metabolism disorders play a critical role in the progression of non-alcoholic fatty liver disease (NAFLD). However, the number of studies on the relationships among blood lipid-related indexes and NAFLD is limited, and few studies have emphasized the comparison of blood lipid-related indexes in the same population to identify the optimal index for NAFLD screening. This study aimed to investigate the relationships among several blood lipid-related indexes and NAFLD, and to find the index with the best screening value for NAFLD. METHODS: Based on a general health examination at community health service agencies in the Pearl River Delta region of China in 2015, 3239 women were recruited in this cross-sectional study. The relationships among blood lipid-related indexes and NAFLD were assessed separately by constructing multivariate logistic regression models. Receiver operating characteristic analysis was used to evaluate and compare the screening abilities of the indexes for NAFLD. All data analyses were conducted in SPSS and MedCalc software. RESULTS: Whether in the crude model or each model adjusted for possible confounding factors, the risk of NAFLD significantly rose with increasing cardiometabolic index (CMI), triglyceride glucose index (TyG), triglycerides (TG) to high-density lipoprotein cholesterol (HDL-C) ratio (TG/HDL-C), total cholesterol (TC) to HDL-C ratio (TC/HDL-C) and low-density lipoprotein (LDL-C) to HDL-C ratio (LDL-C/HDL-C). Moreover, the area under the curve (AUC) of CMI was 0.744, which was better than that of TyG (0.725), TG/HDL-C (0.715), TC/HDL-C (0.650), and LDL-C/HDL-C (0.644) (P < 0.001). In addition, the optimal cut-off points were 0.62 for CMI, 8.55 for TyG, 1.15 for TG/HDL-C, 4.17 for TC/HDL-C, and 2.22 for LDL-C/HDL-C. CONCLUSIONS: CMI is easy to obtain, is a recommended index in the screening of NAFLD in women and may be useful for detecting populations that are at high risk of NAFLD.

Association between sleep quality and central obesity among southern Chinese reproductive-aged women.

BACKGROUND: The connections between sleep quality and central obesity among reproductive-aged women are not clear. The study aimed to explore the association between sleep quality and central obesity among Chinese reproductive-aged women and identify the independent contributions of sociodemographic characteristics, health-related factors, and sleep quality to central obesity. METHODS: In this cross-sectional survey, the minimal sample sizes were 2404 subjects; 2449 Chinese women aged 18-49 participated in this study. Sleep quality was assessed by the Chinese version of the Pittsburgh Sleep Quality Index (PSQI). Central obesity as the outcome of interest was a binary variable; women were categorized as with versus without central obesity measured by waist circumference (WC). The independent contribution of sociodemographic characteristics (Cluster 1), health-related variables (Cluster 2), and sleep quality (Cluster 3) to central obesity was derived from the corresponding R2 change (individual R2 change/total R2 × 100%), using clustered multiple logistic regression analyses. RESULTS: The risk of central obesity increased significantly with poor sleep quality (assessed by global PSQI score) [adjusted odds ratio (OR) = 2.20 per SD increase; 95% confidence interval (CI) = 1.28-3.78; P = 0.004], increased sleep disturbance score (adjusted OR = 1.11 per SD increase; 95% CI = 1.01-1.22; P = 0.042) and decreased subjective sleep quality score (adjusted OR = 0.81 per SD increase; 95% CI = 0.73-0.90; P < 0.001). The independent contribution of sleep quality was 9.9%, less than those of sociodemographic (73.3%) and health-related (16.8%) variables. Among complaints related to sleep disturbance, the inability to breathe comfortably, and having bad dreams showed significant associations with central obesity. CONCLUSIONS: There exists some degree of correlation between sleep quality and central obesity among Chinese reproductive-aged women. These findings underscore the need for future public health guidelines to formulate some detailed strategies to improve sleep quality, such as preventing and intervening risk factors that influence sleep quality and suggesting optimal sleep duration, which might effectively reduce the incidence of central obesity in this population group.

Influence of Changes in Obesity Indicators on the Risk of Hypertension: A Cohort Study in Southern China.

OBJECTIVES: The objective of this study was to demonstrate the association between changes in different obesity indicators and the risk of incident hypertension by the age-group among community-dwelling residents in southern China. METHODS: A total of 6,959 non-hypertensive participants aged ≥18 years old were enrolled in this cohort study and completed questionnaire interviews and anthropometric measurements at baseline (2010) and follow-up (2017). A time-dependent covariate Cox proportional hazard model considered the changes in obesity indicators during the follow-up period and calculated the hazard ratios (HRs) to analyze the risk of incident hypertension according to different obesity indicators. RESULTS: During a mean follow-up of 7.1 years, 1,904 participants were newly diagnosed with hypertension. The body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR) were significantly positively associated with an increased future risk of incident hypertension, and BMI was the best predictive indicator of hypertension (obesity in men: HR = 2.65, 95% confidence interval (CI) = 2.20-3.20; obesity in women: HR = 2.80, 95% CI = 2.27-3.45). Compared with the middle-aged and older group, the risk of incident hypertension was highest in the younger group which had the highest baseline obesity indicators. CONCLUSIONS: Changes in obesity indicators were significantly associated with the risk of incident hypertension in all age-groups, and the risk of future incident hypertension increased with the increase in baseline obesity indicators.

The changes in socioeconomic inequalities and inequities in health services utilization among patients with hypertension in Pearl River Delta of China, 2015 and 2019.

BACKGROUND: Assessing inequities in health services utilization contributes to build effective strategies for health equity promotion. This study aimed to evaluate the socioeconomic inequalities and inequities in health services utilization among hypertensive patients and explore the changes between 2015 and 2019 in Pearl River Delta of China. METHODS: The cross-sectional surveys were conducted using the questionnaire. Eight hundred thirty and one thousand one hundred sixty-six hypertensive patients in 2015 and 2019 were interviewed, respectively. The concentration index (CI) and the horizontal inequity index (HI) were used to access the socioeconomic inequalities and horizontal inequities in outpatient and inpatient health services use. The contribution of influential factors to the overall inequalities was estimated via the concentration index decomposition. Oaxaca-type decomposition technique was utilized to measure the changes in socioeconomic inequalities between the observation periods. RESULTS: In 2015 and 2019, the CIs for outpatient and inpatient utilization decreased from 0.1498 to 0.1198, 0.1982 to 0.1648, respectively, and the HIs for outpatient and inpatient utilization decreased from 0.1478 to 0.1078, 0.1956 to 0.1390, respectively. Economic status contributed the maximum ratio of the socioeconomic inequalities in the use of outpatient service (81.05% in 2015, 112.89% in 2019) and inpatient service (82.46% in 2015, 114.68% in 2019) in these 2 years. Oaxaca decomposition revealed that educational level (78.30% in outpatient, 53.79% in inpatient) and time to the nearest health facilities (66.78% in outpatient, 31.06% in inpatient) made the main positive contributions to decline the inequalities. While the main factor pushing the equalities toward deterioration was economic status (- 46.11% in outpatient, -76.56% in inpatient). CONCLUSION: There were certain declines in the socioeconomic inequalities and inequities in health services utilization by hypertensive patients in Pearl River Delta of China over time. The widening economic gap was the largest contribution to the observed inequalities. Interventions to protect the vulnerable group deserve further concern from policy makers.

Associations among sexuality-related factors, recent two-week morbidity and annual hospitalization in female migrant workers: a cross-sectional study in southern China.

To explore the influence of sexuality-related factors on recent two-week morbidity and annual hospitalization in female migrant workers, 880 Chinese rural-to-urban female migrant workers aged 16-57 years were studied. Clustered logistic regression analyses revealed that women who never or seldom experienced lubrication difficulties had a lower risk of recent two-week morbidity (adjusted odds ratio [OR] = 0.32, 95% confidence interval [CI] = 0.17-0.60, P< 0.001; adjusted OR = 0.35, 95% CI = 0.18-0.69, P= 0.003) than those who always experienced lubrication difficulties; women who never felt a lack of sexual interest had a significantly lower risk of annual hospitalization (adjusted OR = 0.40, 95% CI = 0.20-0.79, P= 0.009) than those who always or seldom lacked sexual interest, and women who never felt sexual satisfaction had a higher risk of annual hospitalization (adjusted OR = 3.08, 95% CI = 1.75-5.42, P< 0.001) than those who always or seldom experienced sexual satisfaction. The independent contributions of sexuality-related factors to the risk of recent two-week morbidity and annual hospitalization were 5.8% and 29.5%, respectively. This study suggests that sexuality may have a modest influence on recent two-week morbidity and a dominant impact on annual hospitalization.

The mediating effect of pain on the association between multimorbidity and disability and impaired physical performance among community-dwelling older adults in southern China.

AIM: To investigate the association between multimorbidity and disability and impaired physical performance, and to further evaluate the mediating effect of physical pain in this association. METHODS: 1321 community-dwelling older adults, who were over 60 years old in southern China, were regarded as participants in this cross-sectional study. Subjects completed a multi-instrument questionnaire including essential characteristics and physical function assessments. Physical function was assessed by activities of daily living (ADL), instrumental activities of daily living (IADL), index of mobility scale (NAGI), index of basic physical activities scale (RB), and short physical performance battery (SPPB). Multimorbidity was defined as the simultaneous presence of two or more chronic conditions. Multivariable regression and mediation analyses were conducted and gender differences were explored. RESULTS: The prevalence of multimorbidity was 44.6% in our study. In gender stratification analysis, multimorbidity was significantly associated with ADL disability (OR = 2.16), IADL disability (OR = 1.97), NAGI disability (OR = 2.84), RB disability (OR = 2.65) and lower SPPB score (ß = - 0.83) in women. The rate of pain increased with the number of chronic diseases and the multimorbidity patients with higher pain prevalence. Moreover, the presence of pain was also significantly associated with disability and impaired physical performance. Mediation analysis illustrated that pain was accounted for 16.5% to 22.1% of the adverse effects of multimorbidity on disability and impaired physical performance in women. CONCLUSIONS: Multimorbidity was significantly associated with disability and impaired physical performance, and pain might be a mediating factor for adverse effects of multimorbidity on disability and impaired physical performance in women.

Association of handgrip strength with hypertension among middle-aged and elderly people in Southern China: A cross-sectional study.

Backgroud and Purpose: Hypertension has been regarded as one of the most common chronic diseases reported in different studies, and handgrip strength is a good indicatorof anindividual's overall health. However, few studies have concentrated on investigating the relationship between hypertension and handgrip strength, especially for the middle-aged and elderly population in the community. Therefore, the purpose of this study was to explore the association of handgrip strength with the risk of hypertension.Methods: A cross-sectional study was conducted using a multi-instrument questionnaire. A total of 1152 participants aged 45 and older were included in this study. Handgrip strength, social-demographiccharacteristics, behavioral lifestyle and health-related variables were collected. Binary logistic regression was employed to analyse the relationship.Results: Handgrip strength was positively related to the risk of hypertension. Binary logistic regression models revealed that the increase of handgrip strength was significantly associated with the reduction of hypertension risk in female after adjusting forsocial-demographic characteristics, behavioral lifestyle and health-related variables (OR [95%CI] =0.265 [0.089-0.787]). In addition, after stratifying by age groups, the significant association was still existing in 60-74 years and ≥75 years of female groups, respectively(OR [95%CI] =0.158 [0.032-0.779]; (OR [95%CI] =0.009 [0.000-0.409]). No significant associations were observed in male after adjusting variables.Conclusion: stronger handgrip strength was association with the lower risk ofhypertension for the elderly female population.Abbreviations: BMI: body mass index; DBP: diastolic blood pressure; HC: hip circumference; SBP, systolic blood pressure; WC: waist circumference; WHC: hip-waist relation.

Work engagement as a mediator between organizational commitment and job satisfaction among community health-care workers in China: a cross-sectional study.

The purpose of this study was to explore levels of organizational commitment, job satisfaction and work engagement among community health-care workers in China, and to examine spatial relationships of variables. Data were collected by Organizational Commitment Scale, Job Satisfaction Scale and Utrecht Work Engagement Scale from 1404 community health-care workers in Guangzhou and Shenzhen cities. Structural equation model was used to analyze relationships among three variables. Medium levels of organizational commitment, job satisfaction and work engagement were found among community health-care workers. Organizational commitment was positively correlated to work engagement (r = 0.564) and job satisfaction (r = 0.550). The path analysis indicated that total effect (ß = 0.598) of organizational commitment on job satisfaction (R2 = 0.52) consisted of a direct effect (ß = 0.264) and an indirect effect (ß = 0.334), which was mediated positively by work engagement. Improvement in work engagement may lead to higher level of job satisfaction and organizational commitment.

The association between multimorbidity and health-related quality of life: a cross-sectional survey among community middle-aged and elderly residents in southern China.

BACKGROUND: Multimorbidity is common among the middle-aged and elderly residents. And it is associated to the reduction of health-related quality of life (HRQoL), including physical and psychological dimensions. However, there are few studies that have paid attention to the HRQoL of residents with multimorbidity in China. Therefore, this study aims to investigate the relationships between different multimorbidity patterns and HRQoL among middle-aged and elderly adults in China. METHODS: Based on a cross-sectional survey, the information regarding 18,137 adults, who were at least 45 years of age, was collected through interviews. Self-perceived HRQoL was assessed with the EQ-5D-3 L instrument, and the EQ-5D-3 L index score was calculated using the Chinese EQ-5D-3 L value set. The Tobit regression was used to explore the impacts of multimorbidity groups on HRQoL. RESULTS: Of 18,137 respondents, more than a fifth (3773,20.8%) of people had multimorbidity. Mean (SD) of EQ-5D index and VAS values were 0.95(0.14) and 76.02(13.66), respectively. Significant correlations were found between a lower HRQoL and increasing numbers of chronic conditions (P < 0.001). Most of chronic diseases co-occurred frequently, and the association between hypertension and diabetes mellitus was the strongest (adjusted OR = 3.82). The most prevalent disease is hypertension (5052,27.9%), and the most prevalent chronic diseases pair is hypertension and diabetes mellitus (841,4.6%). Among those chronic diseases with high prevalence, the effects on HRQoL ranged from chronic pain to hypertension (adjust b = - 0.036 to - 0.008). In the common multimorbidity patterns, co-occurrence of chronic pain and bone disease (adjust b = - 0.039) had the greatest impact on HRQoL. CONCLUSIONS: The HRQoL of middle-aged and elderly adults declines by multimorbidity. More attention should be paid to the HRQoL of residents with multimorbidity in China. The effect of different multimorbidity patterns on HRQoL is not simply added by two diseases, but changes by the different combination. Identifying different multimorbidity patterns of residents can provide more targeted measures to improve the HRQoL.

Associations between objectively assessed physical fitness levels and sleep quality in community-dwelling elderly people in South China.

PURPOSE: The aim of this study was to explore associations between objectively assessed physical fitness levels and sleep quality in community-dwelling elderly people in South China. METHODS: One thousand one hundred thirty-six (504 males and 632 females) community-dwelling adults aged ≥ 50 years old in Dongguan City, South China, were included in the cross-sectional study. All the participants were asked to complete all prepared multi-instrument questionnaire, including the Pittsburgh Sleep Quality Index (Chinese version), for the assessment of the sleep quality and information regarding socio-demographic characteristics, lifestyle, and physical health data. Physical fitness was measured by grip strength, one-leg standing test (OLST) with eyes open, back scratch test, and the forced vital capacity (FVC). RESULTS: The percentage of poor sleep quality among elderly people (≥ 50 years old) was up to 18.2%. Lower FVC was associated with the poorer sleep quality (adjusted OR = 0.74 per SD increase; P = 0.009), and participants with lower performance in back scratch test were more likely to suffer poor sleep quality (adjusted OR = 1.17 per SD increase; P = 0.035). The independent contribution of physical fitness tests results on the risk of poor sleep quality was 22.1%. CONCLUSIONS: Our results indicated that sleep quality was strongly associated with physical fitness among community-dwelling elderly people; the lower of the physical fitness predicted poorer sleep quality.

The association between obesity indices and hypertension: Which index is the most notable indicator of hypertension in different age groups stratified by sex?

OBJECTIVE: This study aimed to investigate the most notable obesity index and its optimal cut-off point of hypertension in different age groups stratified by sexes among community residents in southern China. METHODS: In this cross-sectional study, 620 men and 631 women aged 18-59 years were enrolled. The independent-samples t-test and chi-square test were conducted to analyze continuous and categorical variables, respectively. Multivariate logistic regression analysis and receiver operating characteristic (ROC) curve analysis assessed the association between the obesity indices and hypertension risk. RESULTS: Waist-stature ratio (WSR) and waist-hip ratio (WHR) were the most notable risk factors for hypertension in young men and women, respectively. The odds ratios (ORs) of hypertension risk increased with per standard deviation (SD) in WSR and WHR (WSR: OR = 2.877, 95% confidence interval [CI] = 1.602 to 5.167; WHR: OR = 10.683, 95%CI = 2.179 to 52.376). In the middle-aged group of both sexes, body mass index (BMI) was the most distinctive risk factor for hypertension, the ORs of hypertension risk increased with per SD in BMI (men: OR = 2.297, 95%CI = 1.683 to 3.136; women: OR = 1.810, 95%CI = 1.338 to 2.450). ROC curve analysis demonstrated WSR and PI were better indicators than other indices among young men, and WSR was the best marker among young women. However, BMI and WC were the most sensitive markers in middle-aged men and women, respectively. CONCLUSIONS: In this Chinese population, the association of obesity indices and hypertension is inconsistent in different age groups and sexes. It is important to choose appropriate indicators for specific groups of people.

Combining Click Sulfur(VI)-Fluoride Exchange with Photoiniferters: A Facile, Fast, and Efficient Strategy for Postpolymerization Modification.

"Click" type reactions represent the currently most prevalent postpolymerization strategy for the preparation of functional polymeric materials. Herein, a novel photoiniferter agent 4-(fluorosulfonyl)benzyl diethylcarbamodithioate (FSB-DECT) containing both dithiocarbamates and sulfonyl fluoride moieties is developed to act as both photoinitiator and click sulfur(VI)-fluoride exchange (SuFEx) agent. The photopolymerization behavior of FSB-DECT is demonstrated via standard photoiniferter-mediated polymerization for various types of monomer including N-isopropylacrylamide (NIPAAm), glycidyl methacrylate, and vinyl acetate (VAc). Gel permeation chromatography data show that the polymerization is relatively well controlled, with polydispersity indices of the product homopolymers in the range of 1.3-1.6. 1 H and 19 F NMR spectra and "reinitiated" photopolymerization indicate that the sulfonyl fluoride and diethyldithiocarbamyl groups remain at the respective ends of the homopolymer chains. Furthermore, using the sulfonyl fluoride end-functionalized poly(N-isopropylacrylamide) as a model polymer, the utility of the SuFEx reaction for efficient postpolymerization functionalization is demonstrated.