The relationship between childhood adversity and sleep quality among rural older adults in China: the mediating role of anxiety and negative coping.

BACKGROUND: Studies have revealed the effects of childhood adversity, anxiety, and negative coping on sleep quality in older adults, but few studies have focused on the association between childhood adversity and sleep quality in rural older adults and the potential mechanisms of this influence. In this study, we aim to evaluate sleep quality in rural older adults, analyze the impact of adverse early experiences on their sleep quality, and explore whether anxiety and negative coping mediate this relationship. METHODS: Data were derived from a large cross-sectional study conducted in Deyang City, China, which recruited 6,318 people aged 65 years and older. After excluding non-agricultural household registration and lack of key information, a total of 3,873 rural older adults were included in the analysis. Structural equation modelling (SEM) was used to analyze the relationship between childhood adversity and sleep quality, and the mediating role of anxiety and negative coping. RESULTS: Approximately 48.15% of rural older adults had poor sleep quality, and older adults who were women, less educated, widowed, or living alone or had chronic illnesses had poorer sleep quality. Through structural equation model fitting, the total effect value of childhood adversity on sleep quality was 0.208 (95% CI: 0.146, 0.270), with a direct effect value of 0.066 (95% CI: 0.006, 0.130), accounting for 31.73% of the total effect; the total indirect effect value was 0.142 (95% CI: 0.119, 0.170), accounting for 68.27% of the total effect. The mediating effects of childhood adversity on sleep quality through anxiety and negative coping were significant, with effect values of 0.096 (95% CI: 0.078, 0.119) and 0.024 (95% CI: 0.014, 0.037), respectively. The chain mediating effect of anxiety and negative coping between childhood adversity and sleep quality was also significant, with an effect value of 0.022 (95% CI: 0.017, 0.028). CONCLUSIONS: Anxiety and negative coping were important mediating factors for rural older adult's childhood adversity and sleep quality. This suggests that managing anxiety and negative coping in older adults may mitigate the negative effects of childhood adversity on sleep quality.

The impact of hypertension follow-up management on the choices of signing up family doctor contract services: does socioeconomic status matter?

BACKGROUND: This study aimed to explore the association between hypertension follow-up management and family doctor contract services, as well as to examine whether socioeconomic status (SES) had an interaction effect on this relationship among older adults in China. METHODS: We used data from the sixth National Health Service Survey of Shandong Province, China, including 3,112 older adults (age ≥ 60 years) with hypertension in 2018. Logistic regression models and a margins plot were used to analyze the role of SES in the relationship between hypertension follow-up management and family doctor contract services. RESULTS: The regular hypertension follow-up management rate and family doctor contracting rate were 81.8% and 70.9%, respectively, among older adults with hypertension. We found that participants with regular hypertension follow-up management were more likely to sign family doctor contract services (OR=1.28, 95%CI: 1.04, 1.58, P=0.018). The interaction effect occurred in the groups who lived in rural areas (OR=1.55, 95%CI: 1.02, 2.35), with high education level (OR=0.53, 95%CI: 0.32, 0.88) and had high incomes (OR=0.53, 95%CI: 0.35, 0.81). CONCLUSIONS: Our findings suggested that regular hypertension follow-up management was associated with family doctor contract services and SES influenced this relationship. Primary health care should improve the contracting rate of family doctors by strengthening follow-up management of chronic diseases. Family doctors should focus on improving services quality and enriching the content of service packages especially for older adults with higher income and education level.

Association between physical activity and health-related quality of life among adults in China: the moderating role of age.

Objective: The aim of the study was to examine the association between physical activity (PA) and health-related quality of life (HRQOL) among adults and explore the role of age in the association between PA and HRQOL in Shandong, China. Methods: We investigated the relationship between PA and HRQOL and examined the moderated role of age in this association among adults with different age groups and physical activity levels. Data were obtained from the sixth China National Health Services Survey conducted in Shandong province in 2018. The multi-stage-stratified cluster random sampling method was used to selected respondents, with individuals aged 18 and above included in the present study. The tool of assessing HRQOL was the three-level EuroQol Five Dimensions Questionnaire (EQ-5D-3L). Results: The study found PA was significantly related to HRQOL (P < 0.05). The interaction analysis indicated that the relationship between PA and HRQOL was significantly different across young, middle-aged, and older adults (P < 0.05). Older adults with the sufficient PA (coefficient = 0.090, 95%CI: [0.081, 0.100]) and active PA (coefficient = 0.057, 95%CI: [0.043, 0.072]) had significantly higher HRQOL compared with young and middle-aged groups. Conclusion: PA was positively associated with HRQOL among the adults. Age played a moderate role between the association between PA and HRQOL. Guidelines for PA should be specifically tailored to adults of different age groups in order to enhance their HRQoL.

Catastrophic health expenditure and health-related quality of life among older adults in Shandong, China: the moderation effect of daily care by adult children.

BACKGROUND: Catastrophic health expenditure (CHE) has a considerable impact on older people in later life, but little is known about the relationship between catastrophic health expenditure and health-related quality of life (HRQOL). The aim of this study was to examine the relationship between catastrophic health expenditure and health-related quality of life in older people, and to explore whether the daily care provided by adult children is a moderator in this relationship. METHODS: Data from the sixth National Health Services Survey in Shandong Province, China. The sample consisted of 8599 elderly people (age ≥ 60 years; 51.7% of female). Health-related quality of life was measured by the health utility value of EQ-5D-3 L. Interaction effects were analyzed using Tobit regression models and marginal effects analysis. RESULTS: The catastrophic health expenditure prevalence was 60.5% among older people in Shandong, China. catastrophic health expenditure was significantly associated with lower health-related quality of life (ß= - 0.142, P < 0.001). We found that adult children providing daily care services to their parents mitigated the effect of catastrophic health expenditure on health-related quality of life among older people (ß = 0.027, P = 0.040). CONCLUSIONS: Our findings suggested that catastrophic health expenditure was associated with health-related quality of life and the caring role of older adult children moderated this relationship. Reducing the damage caused by catastrophic health expenditure helps to improve health-related quality of life in older people. Adult children should increase intergenerational contact, provide timely financial and emotional support to reduce the negative impact of catastrophic health expenditure on health-related quality of life.

The threaten of typhoons to the health of residents in inland areas: a study on the vulnerability of residents to death risk during typhoon "Lekima" : In Jinan, China.

BACKGROUND: Studies had suggested increased risk of death of residents was associated with typhoons, particularly coastal regions. However, these findings ignored the impact of inland typhoons on the health of residents, especially the indirect death risk caused by typhoons. This study aimed to investigate the acute death risk of residents during inland typhoon Lekima in Jinan, further identify vulnerable populations and areas. METHODS: We selected the daily death from 11 to 27th August 2019 in Jinan as case period, and conducted a time-stratified case-crossover design to match the contemporaneous data from 2016 to 2018 as control period. We used the generalized linear Poisson models to estimate the related effects of death risk during typhoon Lekima and lag days. RESULTS: During the Lekima typhoon month, there were 3,366 deaths occurred in Jinan. Compared to unexposed periods, the acute death risk of non-accidental diseases (especially circulatory diseases), female and the older adults increased significantly in the second week after the typhoon. The maximum significant effect of circulatory disease deaths, female and older adult deaths were appeared on lag9, lag9, and lag13 respectively. And the typhoon-associated RR were 1.19 (95%CI:1.05,1.34), 1.28 (95%CI:1.08,1.52), and 1.22 (95%CI:1.06,1.42) respectively. The acute death risk of residents living in TQ and CQ increased significantly on Lag2 and Lag6 after the typhoon, respectively, while those living in LX, LC, HY, JY, and SH occurred from Lag 8 to Lag 13 after the typhoon. LC lasted the longest days. CONCLUSIONS: Typhoons would increase the vulnerability of residents living in Jinan which mainly occurred from the seventh day after the typhoon. Residents suffering from non-accidental diseases (circulatory diseases), female and the older adults were more vulnerable. The vulnerability of TQ and CQ occurred on Lag2 and Lag6 after typhoon Lekima, respectively, and the other areas except ZQ and PY occurred from Lag 8 to Lag 13. LC lasted the longest duration. Our findings emphasized the importance of the emergency response, which would help policymakers to identify vulnerable regions and populations accurately during typhoons and formulate the emergency response plan.

Smoking Susceptibility and Trends Among Nonsmoking Adolescents: An International Study.

OBJECTIVES: Smoking susceptibility is defined as a lack of firm decision against smoking, usually starts in the preparation and/or initiation stages of smoking behavior, and is a strong predictor of smoking experimentation during adolescence. However, the recent global prevalence and trends in smoking susceptibility among adolescents are not well documented. This study assessed global smoking susceptibility and secular trends among nonsmoking adolescents. METHODS: Smoking susceptibility was analyzed using the most recent data from the Global Youth Tobacco Survey from 129 countries, where the data from each country were drawn from at least 1 survey conducted at any time between 1999 and 2020. Moreover, data from 82 countries were used to assess the average annual rate of change (AARC) in smoking susceptibility over time. RESULTS: Smoking susceptibility among nonsmoking adolescents was 19.6%. A U-shaped relationship was observed between susceptibility and a country's economic level. Most countries showed no changes in susceptibility over time. Countries with a significant upward trend in susceptibility were primarily high-income and upper middle-income countries in the American region. At the World Health Organization regional level, susceptibility significantly decreased in the European region (AARC: -3.5%; 95% confidence interval, -5.8 to -0.8); however, it significantly increased in the American region (AARC: 2.2%; 95% confidence interval, 1.3-3.1). CONCLUSIONS: Smoking susceptibility remains a serious public health challenge among adolescents worldwide. More public health policies are needed to reduce susceptibility and to control its upward trend in the American region and high-income countries.

Activities of daily living limitations and the use of physical examination among older adults with informal care in China: do gender and residence make differences?

BACKGROUND: This study investigated the relationship between activities of daily living (ADL) limitations and the use of physical examination among older adults receiving informal care, and to further examine whether this relationship varies by gender and urban-rural areas. METHODS: The data in this study were obtained from the sixth Health Service of Shandong province, China. In total, 8,358 older adults aged 60 years or older who received informal care were included in the analysis. Binary logistic regression models were conducted to explore the association between ADL limitations and the use of physical examination and examine the differences between gender and urban-rural areas. RESULTS: The prevalence of limitations in ADL and physical examination utilization rate among older adults receiving informal care in Shandong Province were 14.12% and 72.31%, respectively. After adjusting for confounders, ADL limitations were negatively correlated with the utilization of physical examination services among older adults receiving informal care (OR = 0.74, 95% CI: 0.64, 0.87, P < 0.001), and there were gender and rural-urban differences. The association between ADL limitations and the use of physical examination was statistically significant in older women receiving informal care (OR = 0.65, 95% CI: 0.53, 0.80, P < 0.001). And only among urban older adults receiving informal care, those with ADL limitations had lower utilization of physical examination services than participants without ADL limitations (OR = 0.59, 95% CI: 0.47, 0.74, P < 0.001). CONCLUSIONS: Our study suggested that the relationship between ADL limitations and the use of physical examination among older adults receiving informal care differed by gender and urban-rural areas in Shandong, China. These findings implied that the government should provide more health resources and personalized physical examination service programs, especially to meet the differential needs of women and urban old adults receiving informal care, to contribute to the implementation of healthy aging strategies.

Sedentary Behavior and Physical Frailty Among Rural Older Adults in China: The Moderating Effect of Social Isolation.

OBJECTIVES: Few studies have explored the mechanisms underlying the relationship between sedentary behavior and physical frailty. The aim of this study was to investigate the moderating effect of social isolation on the association between sedentary behavior and physical frailty among older adults in rural China. DESIGN: Cross-sectional study. SETTING AND PARTICIPANTS: Data were from 3238 individuals aged ≥60 years from rural areas in China. METHODS: Binary logistic regression was used to explore the association between sedentary behavior and physical frailty and the moderating effect of social isolation. RESULTS: The prevalence of physical frailty was 18.7% among the older adults, and 17.0% of them were sedentary for ≥8 h/d. Compared with older adults with sedentary behavior for <4 h/d, participants with sedentary behavior for ≥8 h/d were more likely to suffer from physical frailty [odds ratio (OR), 2.26; 95% CI, 1.57-3.27]. We found that social isolation may aggravate this relationship (OR, 3.31; 95% CI, 2.06-5.32), especially for rural older adults who were sedentary for ≥8 h/day. CONCLUSION AND IMPLICATIONS: More sedentary behavior was associated with higher risk of physical frailty, which was especially apparent among older adults with social isolation, suggesting that sedentary older people who experienced social isolation were more vulnerable to physical frailty. Decreasing sedentary behavior in older adults and encouraging them to participate in interactive social activities could help prevent physical frailty.

The relationship between handgrip strength and cognitive function among older adults in China: Functional limitation plays a mediating role.

BACKGROUND: The deterioration of cognitive function with age has become a major public health issue. To date, the underlying mechanisms of the association between handgrip strength and cognitive function were poorly understood. This study aimed to examine the mediating effect of functional limitation in the longitudinal relationship between handgrip strength and subsequent cognitive function. METHODS: This research recruited 4416 participants aged 60 and above from wave 2015 and 2018 of the China Longitudinal Study of Health and Retirement (CHARLS). We conducted the linear regression model and bootstrap analyses to test the mediating role of functional limitation in the relationship between handgrip strength and cognitive function. RESULTS: After adjusting the confounders, handgrip strength was positively associated with subsequent cognitive function (ß = 0.12, P < 0.001) and was negatively associated with functional limitation (ß = -0.14, P < 0.001). The mediation effect of functional limitation accounted for 23.33 % of the total effect regarding the handgrip strength with cognitive function, and the magnitude of mediation effect was a*b = 0.021 (95%CI: 0.017-0.027). LIMITATIONS: The variable of functional limitations was self-reported. And this study did not analyse the severity and duration of handgrip strength loss and functional limitations, which may lose some information. CONCLUSIONS: Our findings revealed that handgrip strength not only directly influenced cognitive function among older individuals but also indirectly via functional limitation over 3-year follow-up. Physical exercise targeting handgrip strength and functional limitation may be an effective approach to prevent and delay cognitive decline.

The Short-Term Effects and Burden of Ambient Air Pollution on Hospitalization for Type 2 Diabetes: Time-Stratified Case-Crossover Evidence From Sichuan, China.

Type 2 diabetes mellitus (T2DM), a complicated metabolic disease, might be developed or exacerbated by air pollution, resulting in economic and health burden to patients. So far, limited studies have estimated associations between short-term exposure to air pollution and disease burden of T2DM in China. Hence, we aimed to estimate the associations and burden of ambient air pollutants (NO2, PM10, PM2.5, SO2, and CO) on hospital admissions (HAs) for T2DM using a time-stratified case-crossover design. Data on HAs for T2DM during 2017-2019 were collected from hospital electronic health records in nine cities in Sichuan Province using conditional poisson regression. Totally, 92,381 T2DM hospitalizations were recorded. There were significant short-term effects of NO2, PM10, PM2.5, SO2 and CO on HAs for T2DM. A 10 µg/m3 increment of NO2, PM10, PM2.5, SO2 and CO as linked with a 3.39% (95% CI: 2.26%, 4.54%), 0.33% (95% CI: 0.04%, 0.62%), 0.76% (95% CI: 0.35%, 1.16%), 12.68% (95% CI: 8.14%, 17.42%) and 79.00% (95% CI: 39.81%, 129.18%) increase in HAs for T2DM at lag 6. Stratified analyses modified by age, sex, and season showed old (≥65 years) and female patients linked with higher impacts. Using WHO's air quality guidelines of NO2, PM10, PM2.5, and CO as the reference, the attributable number of T2DM HAs exceeding these pollutants exposures were 786, 323, 793, and 2,127 during 2017-2019. Besides, the total medical costs of 25.83, 10.54, 30.74, and 67.78 million China Yuan were attributed to NO2, PM10, PM2.5, and CO. In conclusion, short-term exposures to air pollutants were associated with higher risks of HAs for T2DM.

Improving the accessibility of health care for internal migrants in China: Achieving the aim of equalization.

Although equitable access to healthcare is considered key to the health of internal migrants, more concerted efforts are needed to improve the accessibility of healthcare in low- and middle-income countries. The software CiteSpace was used to analyze scientific literature on healthcare utilization among internal migrants in China since 2000. We focused on factors influencing access to healthcare, including geographical, economic, sociocultural, and institutional aspects. The government is urged to play a role in ensuring equal access to healthcare through policies, resource distribution, and information technology. Improving the accessibility of healthcare for internal migrants and achieving egalitarian goals is of great significance to promoting public health and fostering social equity and inclusivity.

Activities of daily living limitations and family doctor contract services among overweight and obese older adults: is there a rural-urban difference?

BACKGROUND: The purpose of this study was to evaluate the relationship between activities of daily living (ADL) limitations and family doctor contract services among overweight and obese older adults, as well as to examine whether this association varies by urban-rural residence. METHODS: Data for the present study were obtained from the sixth Health Service of Shandong province, China. A total of 4,249 overweight and obese older adults were included in this study. Binary logistic regression models were used to evaluate the relationship between ADL limitations and family doctor contract services, to examine the potential differences between urban and rural areas. RESULTS: Of 4,249 overweight and obese older adults, the prevalence of limitations in ADL and family doctor service contracting rate in Shandong province were 12.47% and 66.46%, respectively. The results of the regression analyses revealed that overweight and obese older adults with ADL limitations were more likely to sign up for family doctor services than those without ADL limitations (OR = 1.27, 95%CI: 1.02-1.58, P = 0.033). Only among rural overweight and obese older adults, the relationship between ADL limitations and family doctor contract services was statistically significant (OR = 1.50, 95%CI: 1.13-1.99, P = 0.005). CONCLUSIONS: Our study found a significant association between ADL limitations and family doctor contract services among overweight and obese older adults in Shandong, China. This relationship differed by urban-rural residence. To promote the positive development of the family doctor contract service system, the government should increase publicity, provide personalized contracted services, and prioritize the healthcare needs of overweight and obese older adults with ADL limitations, with special attention to rural areas.

Temperature extremes and infectious diarrhea in China: attributable risks and effect modification of urban characteristics.

Studies about the role of urban characteristics in modifying the health effect of temperature extremes are still unclear. This study is aimed at quantifying the morbidity risk of infectious diarrhea attributable to temperature extremes and the modified effect of a range of city-specific indicators. Distributed lag non-linear model and multivariate meta-regression were applied to estimate fractions of infectious diarrhea morbidity attributable to temperature extremes and to explore the effect modification of city-level characteristics. Extreme heat- and extreme cold-related infectious diarrhea amounted to 0.99% (95% CI: 0.57-1.29) and 1.05% (95% CI: 0.64-1.24) of the total cases, respectively. The attributable fraction of temperature extremes on infectious diarrhea varied between southern and northern China. Several city characteristics modified the association of extreme cold with infectious diarrhea, with a higher morbidity impact related to increased water consumption per capita and decreased latitude. Regions with higher levels of latitude or GDP per capita appeared to be more sensitive to extreme hot. In conclusion, exposure to temperature extremes was associated with increased risks of infectious diarrhea and the effect can be modified by urban characteristics. This finding can inform public health interventions to decrease the adverse effects of temperature extremes on infectious diarrhea.

Prevalence and Trends of Sexual Behaviors Among Young Adolescents Aged 12 Years to 15 Years in Low and Middle-Income Countries: Population-Based Study.

BACKGROUND: Risky sexual behaviors remain significant public health challenges among adolescents. Nearly 90% of adolescents live in low and middle-income countries (LMICs), but few studies have used standardized methodology to monitor the prevalence and trends of sexual behaviors among adolescents in LMICs. OBJECTIVE: This study aimed to assess the prevalence of sexual behaviors (ever had sexual intercourse, multiple sexual partners, and condom use) among adolescents aged 12 years to 15 years as well as the trends in prevalence between 2003 and 2017. METHODS: For this population-based study, we used recent data from the Global School-based Student Health Survey conducted in 69 LMICs from 2003 to 2017 to assess the recent prevalence of sexual behaviors by using complex analysis and a random effects meta-analyses method. Using the chi-square trend test, we also assessed the trends in the prevalence of sexual behaviors in 17 countries that had conducted ≥1 round of surveys from 2003 to 2017. RESULTS: We included 145,277 adolescents aged 12 years to 15 years (64,719/145,277, 44.5% boys) from the 69 LMICs that had conducted ≥1 survey and 80,646 adolescents aged 12 years to 15 years (34,725/80,646, 43.1% boys) from the 17 LMICs that had conducted ≥1 round of surveys. The recent global prevalence of ever had sexual intercourse was 6.9% (95% CI 6.2%-7.6%) and was higher among boys (10.0%, 95% CI 9.1%-11.1%) than girls (4.2%, 95% CI 3.7%-4.7%) and among those aged 14 years to 15 years (8.5%, 95% CI 7.7%-9.3%) than those aged 12 years to 13 years (4%, 95% CI 3.4%-4.7%). Among adolescents who had ever had sex, the recent global prevalence of having multiple sexual partners was 52% (95% CI 50.4%-53.6%) and was higher among boys (58%, 95% CI 56.1%-59.9%) than girls (41.4%, 95% CI 38.9%-43.9%) and among those aged 14 years to 15 years (53.5%, 95% CI 51.6%-55.4%) than those aged 12 years to 13 years (49.7%, 95% CI 45.9%-53.5%). Among adolescents who had ever had sex, the recent global prevalence of condom use was 58.1% (95% CI 56.2%-59.9%) and was higher among girls (59.2%, 95% CI 56.4%-61.9%) than boys (57.7%, 95% CI 55.7%-59.7%) and among those aged 14 years to 15 years (59.9%, 95% CI 58.0%-61.8%) than those aged 12 years to 13 years (51.6%, 95% CI 47.5%-55.7%). Between the earliest and latest surveys, the overall prevalence of ever had sexual intercourse (3.1% decrease) and condom use (2.0% decrease) showed downward trends. The overall prevalence of having multiple sexual partners increased by 2.6%. CONCLUSIONS: We provide evidence and important implication for policymakers to develop targeted policy support systems to prevent and reduce risky sexual behaviors among young adolescents in LMICs with a high prevalence of risky sexual behaviors.

Gender-Specific Association Between Perceived Stigma Toward Tuberculosis and Acceptance of Preventive Treatment Among College Students With Latent Tuberculosis Infection: Cross-Sectional Analysis.

BACKGROUND: With the increasing enrollment scale of colleges, the number of students on campus has risen sharply in China. The number of students with tuberculosis (TB) and rifampicin-resistant TB in colleges has increased significantly. Preventive treatment of latent tuberculosis infection (LTBI) is an important means for TB prevention and control in colleges. At present, the acceptance of LTBI treatment among college students remains unclear. In addition, evidence shows stigma may be one of the key factors affecting acceptance of LTBI treatment. To date, there is little direct evidence on the gender-specific association between perceived stigma toward TB and acceptance of LTBI treatment among college students. OBJECTIVE: This study aimed to describe the acceptance of LTBI treatment among college students in an eastern province of China to explore the association between perceived stigma toward TB and acceptance of LTBI treatment and to examine the moderating effect of gender on the association. METHODS: Data were derived from the project on the evaluation of LTBI treatment and its effectiveness among college students in Shandong, China. In total, 1547 college students were included in the analysis. We considered covariates at the individual and family levels. Multilevel mixed-effects logistic regression was used to examine the moderating role of gender and also explore the association between perceived stigma toward TB and acceptance of LTBI treatment. RESULTS: The acceptance rate of LTBI treatment among the diagnosed college students was 46.7% (n=723). The proportion of female students (n=361, 51.5%) accepting LTBI treatment was higher than that of male students (n=362, 42.8%; P=.001). There was an interaction between perceived stigma toward TB and gender (OR 0.93, 95% CI 0.87-1.00; P=.06). Among college students with LTBI, perceived stigma toward TB was positively associated with acceptance of preventive treatment (OR 1.03, 95% CI 1.00-1.08, P=.05). Perceived stigma toward TB was positively associated with accepting LTBI treatment only among male students (OR 1.07, 95% CI 1.02-1.12; P=.005). CONCLUSIONS: The acceptance rate of preventive treatment among college students with LTBI was low. Contrary to our expectations, perceived stigma toward TB was positively associated with acceptance of preventive treatment. Gender moderated this association; high perceived stigma toward TB was associated with acceptance of preventive treatment only in male gender. Gender-specific strategies are effective in improving the acceptability of LTBI treatment in colleges.

Quantifying the effects of cold waves on carbon monoxide poisoning: A time-stratified case-crossover study in Jinan, China.

Background: Previous studies have shown that carbon monoxide (CO) poisoning occurs mostly in winter and is associated with severe cold weather (e.g., ice storms, temperature drops). However, according to previous studies, the impact of low temperature on health has a delayed effect, and the existing research cannot fully reveal the delayed effect of cold waves on CO poisoning. Objectives: The purpose of this study is to analyze the temporal distribution of CO poisoning in Jinan and to explore the acute effect of cold waves on CO poisoning. Methods: We collected emergency call data for CO poisoning in Jinan from 2013 to 2020 and used a time-stratified case-crossover design combined with a conditional logistic regression model to evaluate the impact of the cold wave day and lag 0-8 days on CO poisoning. In addition, 10 definitions of a cold wave were considered to evaluate the impact of different temperature thresholds and durations. Results: During the study period, a total of 1,387 cases of CO poisoning in Jinan used the emergency call system, and more than 85% occurred in cold months. Our findings suggest that cold waves are associated with an increased risk of CO poisoning in Jinan. When P01, P05, and P10 (P01, P05, and P10 refer to the 1st, 5th, and 10th percentiles of the lowest temperature, respectively) were used as temperature thresholds for cold waves, the most significant effects (the maximum OR value, which refers to the risk of CO poisoning on cold wave days compared to other days) were 2.53 (95% CI:1.54, 4.16), 2.06 (95% CI:1.57, 2.7), and 1.49 (95% CI:1.27, 1.74), respectively. Conclusion: Cold waves are associated with an increased risk of CO poisoning, and the risk increases with lower temperature thresholds and longer cold wave durations. Cold wave warnings should be issued and corresponding protective policies should be formulated to reduce the potential risk of CO poisoning.

Physical Mobility, Social Isolation and Cognitive Function: Are There Really Gender Differences?

OBJECTIVE: This study aimed to examine the mediating role of social isolation between physical mobility and cognitive function, and whether there are gender differences in the above mediating effects among Chinese older adults. METHODS: This is a prospective and cohort study. We obtained data from the 2011 (Time 1, T1), 2015 (Time 2, T2) and 2018 (Time 3, T3) waves of China Health and Retirement Longitudinal Study, including 3,395 participants aged 60 years or above. Cognition was evaluated by Telephone Interview of Cognitive Status, words recall, and figure drawing, which was widely used in previous research. We used a cross-lagged model to test the hypothesis that social isolation mediated the association between physical mobility and cognitive function among Chinese older adults. RESULTS: The total effects of T1 physical mobility limitations on T3 cognitive function (ß = -0.055, bootstrap p < 0.001) were significantly negative. Social isolation played a mediating role among both males and females (male: ß = -0.008, bootstrap p = 0.012; female: ß = -0.006, bootstrap p = 0.023), demonstrating that the mediating effect of social isolation between physical mobility and cognitive function was not gender specific. CONCLUSION: This study confirmed that social isolation mediated the association between physical mobility and cognitive function among both Chinese male and female older adults. These findings indicate that reversing social isolation can be a priority intervention target for cognitive decline prevention and promote successful ageing, particularly among older adults with impaired physical mobility.

Association of Sensory Impairment With Institutional Care Willingness Among Older Adults in Urban and Rural China: An Observational Study.

Background and Objectives: An aging population has contributed to increasing rates of sensory impairment (SI) among older adults and a boom in institutional elder care. However, little is known regarding the association between SI and institutional care willingness. This study identified the association between SI and institutional care willingness among older adults living both in urban and rural China. Research Design and Methods: This was an observational study using the sixth National Health Service Survey of Shandong Province, China, in 2018. A total of 8 583 individuals aged ≥60 years were included. The primary outcome was institutional care willingness. Self-reported SI was categorized as vision impairment (VI), hearing impairment (HI), and dual sensory impairment (DSI). We used multivariable logistic regression models to estimate the association between SI and institutional care willingness, stratified by the place of residence. Results: The overall proportion of older adults with institutional care willingness was 7.8%. In fully adjusted models, older adults with HI only (odds ratio [OR] = 1.57, 95% confidence interval [CI]: 1.12-2.20) or DSI (OR = 1.68, 95% CI: 1.14-2.49) were more likely to show institutional care willingness than those without SI in urban areas, but no significant associations between VI only (OR = 0.95, 95% CI: 0.68-1.31), HI only (OR = 0.99, 95% CI: 0.73-1.34), or DSI (OR = 0.95, 95% CI: 0.68-1.31) and institutional care willingness were observed among rural older adults. Discussion and Implications: Our results underscore that the relationship between SI and institutional care willingness varied by place of residence, and provide a reference for making targeted and appropriate endowment policies. Improving the quality of institutional elder care is vital for urban older adults with SI, whereas community-based care might be more appropriate for rural older adults with SI.

Association between hearing aid use and all-cause and cause-specific dementia: an analysis of the UK Biobank cohort.

BACKGROUND: Dementia and hearing loss are both highly prevalent conditions among older adults. We aimed to examine the association between hearing aid use and risk of all-cause and cause-specific dementia among middle-aged and older-aged adults, and to explore the roles of mediators and moderators in their association. METHODS: We used data from the UK Biobank, a population-based cohort study, which recruited adults aged 40-69 years between 2006 and 2010 across 22 centres in England, Scotland, and Wales. We used Cox proportional hazards models to estimate hazard ratios (HRs) and 95% CIs between self-reported hearing aid use status (hearing loss with or without hearing aids) at baseline and risk of dementia (all-cause dementia, Alzheimer's disease, vascular dementia, and non-Alzheimer's disease non-vascular dementia). Dementia diagnoses were ascertained using hospital records and death-register data. We also analysed the roles of mediators (self-reported social isolation, loneliness, and mood) and moderators (self-reported education and income, smoking, morbidity, and measured APOE allele status). FINDINGS: After the exclusion of people who did not answer the question on hearing difficulties (n=25 081 [5·0%]) and those with dementia at baseline visit (n=283 [0·1%]), we included 437 704 people in the analyses. Compared with participants without hearing loss, people with hearing loss without hearing aids had an increased risk of all-cause dementia (HR 1·42 [95% CI 1·29-1·56]); we found no increased risk in people with hearing loss with hearing aids (1·04 [0·98-1·10]). The positive association of hearing aid use was observed in all-cause dementia and cause-specific dementia subtypes (Alzheimer's disease, vascular dementia, and non-Alzheimer's disease non-vascular dementia). The attributable risk proportion of dementia for hearing loss was estimated to be 29·6%. Of the total association between hearing aid use and all-cause dementia, 1·5% was mediated by reducing social isolation, 2·3% by reducing loneliness, and 7·1% by reducing depressed mood. INTERPRETATION: In people with hearing loss, hearing aid use is associated with a risk of dementia of a similar level to that of people without hearing loss. With the postulation that up to 8% of dementia cases could be prevented with proper hearing loss management, our findings highlight the urgent need to take measures to address hearing loss to improve cognitive decline. FUNDING: National Natural Science Foundation of China and Shandong Province, Taishan Scholars Project, China Medical Board, and China Postdoctoral Science Foundation.

Tooth loss, body mass index and cognitive function among middle-aged and older adults in China: Does gender matter?

BACKGROUND: Previous studies have shown a longitudinal association between tooth loss and cognitive function. Body mass index (BMI) is an essential applicable indicator of health status screening. However, the underlying mechanism among these factors remains unclear. This study aimed to determine the mediating role of BMI in the tooth loss-cognition relationship by gender among Chinese middle-aged and older adults. METHODS: This is a prospective and cohort study. We used three waves of follow-up data (2011, 2013, and 2015) from the China Health and Retirement Longitudinal Survey, including 10,013 participants aged 45 years or above. Cognitive function was evaluated by Telephone Interview of Cognitive Status, words recall, and figure drawing. The cross-lagged panel model was applied to test the hypothesized model. RESULTS: Tooth loss is associated with higher BMI and lower level of cognitive function. We found significant total effects (B = -0.017, P = 0.008), direct effect (B = -0.015, P = 0.022) and indirect effects (B = -0.002, P = 0.010) of tooth loss on cognition mediated through BMI only among middle-aged and older men. For middle-aged and older women, the total effect (B = -0.010, P = 0.125) and direct effect (B = -0.007, P = 0.249) were no more significant. CONCLUSIONS: The longitudinal association between tooth loss and cognition was primarily indirect through BMI among middle-aged Chinese males but not women. Public health authorities should remind middle-aged and older males with tooth loss and high BMI to participate in timely medical checkups for improving cognition.