Does unequal economic development contribute to the inequitable distribution of healthcare resources? Evidence from China spanning 2001-2020.

BACKGROUND: There is a dearth of research combining geographical big data on medical resource allocation and growth with various statistical data. Given the recent achievements of China in economic development and healthcare, this study takes China as an example to investigate the dynamic geographical distribution patterns of medical resources, utilizing data on healthcare resources from 290 cities in China, as well as economic and population-related data. The study aims to examine the correlation between economic growth and spatial distribution of medical resources, with the ultimate goal of providing evidence for promoting global health equity. METHODS: The data used in this study was sourced from the China City Statistical Yearbook from 2001 to 2020. Two indicators were employed to measure medical resources: the number of doctors per million population and the number of hospital and clinic beds per million population. We employed dynamic convergence model and fixed-effects model to examine the correlation between economic growth and the spatial distribution of medical resources. Ordinary least squares (OLS) were used to estimate the ß values of the samples. RESULTS: The average GDP for all city samples across all years was 36,019.31 ± 32,029.36, with an average of 2016.31 ± 1104.16 doctors per million people, and an average of 5986.2 ± 6801.67 hospital beds per million people. In the eastern cities, the average GDP for all city samples was 47,672.71 ± 37,850.77, with an average of 2264.58 ± 1288.89 doctors per million people, and an average of 3998.92 ± 1896.49 hospital beds per million people. Cities with initially low medical resources experienced faster growth (all ß < 0, P < 0.001). The long-term convergence rate of the geographic distribution of medical resources in China was higher than the short-term convergence rate (|ßi + 1| > |ßi|, i = 1, 2, 3, …, 9, all ß < 0, P < 0.001), and the convergence speed of doctor density exceeded that of bed density (bed: |ßi| >doc: |ßi|, i = 3, 4, 5, …, 10, P < 0.001). Economic growth significantly affected the convergence speed of medical resources, and this effect was nonlinear (doc: ßi < 0, i = 1, 2, 3, …, 9, P < 0.05; bed: ßi < 0, i = 1, 2, 3, …, 10, P < 0.01). The heterogeneity between provinces had a notable impact on the convergence of medical resources. CONCLUSIONS: The experiences of China have provided significant insights for nations worldwide. Governments and institutions in all countries worldwide, should actively undertake measures to actively reduce health inequalities. This includes enhancing healthcare standards in impoverished regions, addressing issues of unequal distribution, and emphasizing the examination of social determinants of health within the domain of public health research.

Association between cognitive functioning and lifetime suicidal ideation among Chinese older adults: the mediating effect of depression.

PURPOSE: Existing evidence indicates an association between cognitive functioning and both geriatric depression and suicidality, with mixed evidence regarding the direction of the relationship between cognitive functioning and aspects of geriatric lifetime suicidal ideation. This study aims to examine the relationship between cognitive functioning, depression, and suicide ideation and to explore the intermediary role of depression between cognitive functioning and suicidal ideation in the older adults. METHODS: A multi-stage random cluster sampling method was used to collect a sample of 3896 individuals aged 60 and above. Descriptive statistics of the sample data were analyzed using one-way ANOVA, and then the correlation between variables was obtained by binary logistic regression analysis. SPSS macro program PROCESS V3.5 was used to test the mediating role of depression in the relationship between cognitive function and lifetime suicidal ideation. RESULTS: The prevalence of lifetime suicidal ideation among older adults was 3.9%. Lifetime suicidal ideation was associated with depression (OR = 1.308, P < 0.001) but was not significantly correlated with cognitive function (OR = 0.972, P > 0.05). The relationship between cognitive function and depression was also supported in this study (ß = - 0.0841, P < 0.001). Depression completely mediated the relationship between cognitive function and lifetime suicidal ideation. CONCLUSION: There was no significant correlation between cognitive impairment in older adults and a heightened risk of lifetime suicidal ideation. However, this relationship was completely mediated by depression. It is crucial to prevent the onset of depression among older adults with cognitive impairment, as depression is strongly linked to lifetime suicidal ideation.

Association between occupational stress and subclinical depression in Chinese primary healthcare workers.

Background: Wellbeing of healthcare workers is crucial for the effective functioning of primary health systems. This study aimed to examine the association between occupational stress and subclinical depression among primary healthcare workers, and to establish the foundation for future preventive strategies. Methods: A cross-sectional study was conducted in Tai'an City, Shandong Province, China. Data were collected from 832 medical staff in primary health institutions using a structured self-administered questionnaire. The participants completed the Challenge and Hindrance-Related Self-Reported Stress (C-HSS) Scale and Patient Health Questionnaire-9. Multivariable logistic regression analysis was conducted to explore the relationship between occupational stress and subclinical depression among primary healthcare workers. Results: The prevalence of subclinical depression among primary healthcare workers was 11.66%. Participants with subclinical depression have a significant higher level of occupational stress (including challenge-stress and hindrance-stress). Regression analysis result indicated that higher level of occupational stress was significantly associated with more severe subclinical depression, and the risk of subclinical depression remained after adjusting other covariates (OR = 4.57, 95%CI, 3.14-6.63). The association between challenge-stress and subclinical depression was not statistically significant when controlling for hindrance-stress. Subgroup analysis showed that male healthcare workers who perceived higher level of challenge stress were more likely to develop subclinical depression than female healthcare workers. Conclusion: The level of subclinical depression among Chinese primary healthcare workers was high, and occupational stress especially hindrance stress may contribute to subclinical depression. Findings were also robust in subgroup analysis after adjusting for other covariates. These findings emphasize the importance of occupational stress psychosocial interventions to decrease the risk of developing depression among the primary healthcare workers.

The mechanisms underlying the negative effect of socioeconomic status on depressive symptoms among older adults: The roles of social support and living arrangement.

OBJECTIVES: Previous studies have found an association between socioeconomic status (SES) and depressive symptoms among older adults, however the mechanisms underlying this association remained unclear. This study aimed to examine the mediating role of social support and the moderating role of living arrangement in the association between SES and depressive symptoms. METHODS: Data was collected from the 2020 Household Health Interview Survey in Taian city, Shandong Province, China. A total of 3896 older adults aged 60 and above were included in this study. Depressive symptoms was measured by the Patient health Questionnaire-9 (PHQ-9), Social support by the Multidimensional Scale of Perceived Social Support (MSPSS), and other variables by related demographic scales. The moderated mediation model was examined using HAYES PROCESS 3.5. RESULTS: SES negatively predicted depressive symptoms among older adults, and social support could mediate this association. Living arrangement played a moderating role in the relationship between social support and depressive symptoms (the second half of the mediating effect), and the effect was stronger among older adults who lived alone. CONCLUSIONS: Social support partially mediated the relationship between SES and depressive symptoms among older adults, and living alone strengthened the effect of social support on depressive symptoms. Interventions that address older adults' social support and living arrangement may ameliorate depressive symptoms among older adults.

Gender differences in the modifying effect of living arrangements on the association of sleep quality with cognitive function among community-dwelling older adults: a cross-sectional study.

Background: Sleep quality is considered to be associated with cognitive function for older adults, but little is known about whether living with others can buffer mild cognitive impairment in older adults with poor sleep quality. The objective of this study was to examine the role of living arrangements in sleep quality and cognitive function among older adults aged 65 and over. Methods: 2,859 older adults over 65 years old were selected by using multi-stage stratified sampling method. Cognitive function and sleep quality were measured using Mini-Mental State Examination (MMSE) and Pittsburgh Sleep Quality Index (PSQI). Binary logistic regression was performed to examine the relationship between sleep quality and mild cognitive impairment, and the interaction effects of sleep quality and living arrangements on mild cognitive impairment stratified by gender. Results: Poor sleep quality was associated with mild cognitive impairment among men and women regardless of living arrangements. The significantly protective role of living with others in reducing the incidence of mild cognitive impairment was found in men with poor sleep quality, but not in women. Conclusion: Targeted support for older adults with poor sleep quality may be effective in preventing mild cognitive impairment, and gender differences should be taken into account when promoting cohabitations.

Educational degree differences in the association between work stress and depression among Chinese healthcare workers: Job satisfaction and sleep quality as the mediators.

Background: Depressive status of medical personnel worldwide and especially in China is an important public health and social problem. There is a strong relationship between education and depression, but no studies have studied grouping healthcare workers (HCWs) with different educational degree to discuss whether there are differences in the factors that affect depression. This study aims to examine the role of job satisfaction and sleep quality in the relationship between work stress and depression among Chinese HCWs, and teste whether the mediation models are differed by the differences of educational degree. Methods: Patient Health Questionnaire-9 (PHQ-9) scale was used to test depression. Work stress was assessed using the Challenge-blocking stress scale (CBSS). Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). HCWs' satisfaction with their current work was assessed using the Job Satisfaction Index (JSI). The representative sample of HCWs was chosen using a multi-stage stratified cluster random sampling procedure and 844 HCWs were utilized to the statistical analysis of the study. Results: In the overall sample, sleep quality could mediate the relationship between work stress and depression in healthcare workers (p < 0.001, CMIN/DF = 3.816, GFI = 0.911, AGFI = 0.886, IFI = 0.943, TLI = 0.933, CFI = 0.942, RMSEA = 0.058, SRMR = 0.055, AIC = 1039.144), and the mediating effect accounted for 36.5%. After grouping educational qualifications, the model with sleep quality and job satisfaction as mediating variables reported a better fit in the group with low educational qualifications. The intermediary effect accounted for 50.6 and 4.43%, respectively. The highly educated group only has sleep quality as an intermediary variable in the structural model, and the mediating effect accounted for 75.4% (p < 0.001, CMIN/DF = 2.596, GFI = 0.887, AGFI = 0.857, IFI = 0.937, TLI = 0.926, CFI = 0.937, RMSEA = 0.044, SRMR = 0.056, AIC = 1481.322). Conclusion: In the overall sample, sleep quality could mediate the relationship between work stress and depression in HCWs. Among HCWs with technical secondary school education and below, job satisfaction can mediate the positive relationship between work stress and depression, while this mediating effect is not significant among HCWs with college degree and above.

Pathways linking relative deprivation to blood pressure control: the mediating role of depression and medication adherence among Chinese middle-aged and older hypertensive patients.

BACKGROUND: Studies have demonstrated that individuals of low socioeconomic status have higher blood pressure. Yet, whether socioeconomic inequality would influence blood pressure control and the underlying mechanisms associated with socioeconomic inequality in blood pressure control are unknown. Central to socioeconomic inequality is relative deprivation. We aim to examine the association between relative deprivation and blood pressure control and to investigate the pathways of the association among middle-aged and older adults with hypertension. METHODS: Data were collected from the 2020 Household Health Interview Survey in Taian City, Shandong province. This study included 2382 eligible respondents aged 45 years and older with a diagnosis of hypertension. Our primary outcome was dichotomous blood pressure control. Relative deprivation was calculated with the Deaton Index. Depressive symptoms and medication adherence were considered as mediators. Multivariable binary logistic regression models were used to estimate the effect of relative deprivation on blood pressure control. The "KHB-method" was used to perform mediation analysis. RESULTS: Among 2382 middle-aged and older adults with hypertension, the mean age was 64.9 years (SD 9.1), with 61.3% females. The overall proportion of participants with uncontrolled blood pressure was 65.1%. Increased relative deprivation was likely to have higher odds of uncontrolled blood pressure (OR: 2.35, 95%CI: 1.78-7.14). Furthermore, depressive symptoms and medication adherence partially mediated the overall association between relative deprivation and blood pressure control, with depressive symptoms and medication adherence explaining 5.91% and 37.76%, respectively, of the total effect of relative deprivation on blood pressure control. CONCLUSIONS: Individual relative deprivation could threaten blood pressure control among middle-aged and older hypertension patients through the mechanisms of depression and medication adherence. Hence, improving blood pressure control may require more than just health management and education but fundamental reform of the income distribution and social security system to narrow the income gap, reducing relative economic deprivation. Additionally, interventions tailoring psychological services and medication adherence could be designed to reduce the harmful effect of relative deprivation on blood pressure control among disadvantaged individuals.

Association between Dietary Patterns and Depression in Chinese Older Adults: A Longitudinal Study Based on CLHLS.

(1) Objective: This study aimed to investigate the relationship between dietary patterns and depression in Chinese older adults. (2) Method: A cohort study was conducted on the relationship between dietary patterns and the risk of depression in older adults based on the China Health and Longevity Longitudinal Survey (CLHLS) from 2011 to 2014. Exploratory factor analysis was used to identify dietary patterns. The relationship between dietary patterns and the risk of depression after four years was examined using logistic regression, and subgroup analysis was carried out to determine whether the association differed by gender. (3) Results: A total of 2873 older adults were included in our cohort study. Three dietary patterns were identified: vegetable-egg-bean-milk pattern, meat-fish pattern, and salt-preserved vegetable-garlic pattern. The vegetable-egg-beans-milk pattern was negatively correlated with the risk of geriatric depression development (adjusted OR = 0.65 (95%CI: 0.49-0.87)), and the salt-preserved vegetable-garlic pattern was positively associated with aged depression risk (adjusted OR = 1.33 (95CI: 1.00-1.77)). The meat-fish pattern was not associated with the risk of depression in older adults. These associations were consistent in both men and women. (4) Conclusions: In this cohort study, the vegetable-egg-beans-milk dietary pattern was associated with lower risk of depression, while the salt-preserved vegetable-garlic dietary pattern was associated with higher risk of depression, and there were no gender differences in these associations.

The relationship between living arrangements and depression among older adults in Shandong, China: The mediating role of social support.

Background: Living arrangements and social support have an impact on depression among older adults. However, the underlying mechanism between those variables remains unknown. This study aims to investigate the mediating role of social support in the relationship between living arrangements and depression among older adults. Materials and methods: Multi-stage stratified sampling method was used to select 3,859 older adults from Taian City, Shandong Province, China, for cross-sectional investigation. Living arrangements were measured by a question. Social support and depression were measured using the Multidimensional Scale of Perceived Social Support and Patient Health Questionnaire-9. Multiple linear regression models were used to assess the relationship between living arrangements and depression and the possible influence of social support on the relationship between living arrangements and depression. Results: Statistics showed that 15.08% of older adults lived alone. After controlling for covariates, living arrangements (ß = 0.45, t = 2.87, P < 0.01) and social support (ß =-0.08, t =-16.93, P < 0.001) were significantly associated with depression. The linear regression model showed that social support mediated the relationship between living arrangements and depression, and the mediating effect accounted for 18.20% of the total effect. Conclusion: This study revealed that living arrangements played an essential role in indirectly predicting depression in older adults through social support. This provided evidence for how to reduce depression in older adults.

The Mediating Effect of Perceived Social Support on Mental Health and Life Satisfaction among Residents: A Cross-Sectional Analysis of 8500 Subjects in Taian City, China.

Several studies have explored the relationship between mental health and life satisfaction. However, few studies have clarified the mechanisms underlying the relationship between mental health and life satisfaction among a large sample of the whole population. The aim of this study was to explore the mediating role of perceived social support between mental health and life satisfaction among the residents in Taian City, China. A total of 8500 residents were included in the analysis. A descriptive analysis was conducted to describe the sample characteristics. Pearson correlation was employed to explore the correlation between mental health and life satisfaction. The mediating role of perceived social support was analyzed using SPSS26.0. This study found that the residents' average score of life satisfaction was 24.60 ± 4.12. Mental health was significantly correlated with perceived social support and life satisfaction. After adjusting for controlling variables, perceived social support played a partially mediating effect on mental health and life satisfaction, accounting for 21.04% of the total effect. However, data are cross-sectional, and causal conclusions cannot be drawn. Attention should be paid to the residents' mental health and intervention should be considered for residents with mental disorders to improve the residents' life satisfaction.

Relative deprivation, depression and quality of life among adults in Shandong Province, China: A conditional process analysis based on social support.

BACKGROUND: Relative deprivation has been confirmed as one of the pathways underlying the link between income inequality and health. However, the mechanism between relative deprivation and health was still unclear. This study aimed to test the mediating role of depression and the moderating role of social support in the association between relative deprivation and quality of life. METHODS: Data were collected from the 2020 Household Health Interview Survey in Taian City, Shandong province. In total, 8496 adults were included to complete the measures of relative deprivation, depressive symptoms, perceived social support, and quality of life. RESULTS: Relative deprivation was negatively associated with quality of life, and depressive symptoms could mediate this association. Furthermore, the direct effect of relative deprivation on quality of life and the indirect effect of depressive symptoms in this relationship were moderated by perceived social support. Both these two effects were stronger for individuals with a low level of perceived social support. LIMITATIONS: Data are cross-sectional, and causal conclusions cannot be drawn. All measures were based on participant self-report. CONCLUSIONS: Personal relative deprivation has negative effects on quality of life. Social support moderated the direct effect of relative deprivation and the mediating effect of depressive symptoms on quality of life. For individuals with a high level of relative deprivation, particularly those with a low level of social support, interventions tailoring psychological services and community-based activities could be designed to reduce relative deprivation and promote social support for disadvantaged individuals.

Relationship between hearing loss and depression symptoms among older adults in China: The mediating role of social isolation and loneliness.

OBJECTIVES: To evaluate whether social isolation and loneliness mediates the relationship between hearing loss and depression symptoms in older adults in China. METHODS: A cross-sectional analysis was conducted of 3769 participants (aged≥60 years) in Shandong province of China. Hearing loss was assessed using Pure-Tone Audiometry test, depression symptoms using 15-item Geriatric Depression Scale, loneliness through UCLA Loneliness Scale and social isolation using Lubben Social Network Scale. Regression and bootstrap analyses were performed to test both direct associations of hearing loss and depression symptoms, and whether the mediating role of social isolation and loneliness. RESULTS: Overall, 44% of older adults had hearing loss, which was generally mild (30%) rather than moderate (10%), severe (3%) or profound (0.6%). Increasing levels of hearing loss was associated with increasing levels of social isolation and depressions. Hearing loss was also associated with loneliness, but here a threshold effect was apparent and no trend for increasing loneliness with increasing hearing loss. Models that included social isolation and loneliness showed an amelioration in the association of hearing loss and depression, although it remained significant at all levels of hearing loss. Overall, 8% of the total effect of hearing loss on depression symptoms was explained by the mediated effect through social isolation and 42% by loneliness. CONCLUSIONS: Psychosocial factors such as social isolation and loneliness might explain the association between hearing loss and depression. Interventions that address older adults' social isolation and loneliness may ameliorate depression in older adults with hearing loss.

Do Residents and Healthcare Providers Differ in Preference for Family Doctor Contract Service? Evidence From a Discrete Choice Experiment.

OBJECTIVE: Few are known on how and to what extent residents and healthcare providers have different preferences for family doctor contract service (FDCS). This study aimed to elicit and compare the residents' and healthcare providers' preferences for FDCS through a discrete choice experiment (DCE). METHODS: Residents and healthcare providers recruited for the DCE were asked to choose repeatedly between two hypothetical service plans, which differed in six attributes: cost, service package, service delivery, type of service, accessibility of medicine, and level of healthcare team. We use mixed logit regression models to determine preferences for potential attributes. RESULTS: A total of 2,159 residents and 729 healthcare providers completed valid DCE questionnaires. The mixed logit model results suggested that cost, service package, service delivery, type of service, accessibility of medicine, and level of healthcare team all had a significant impact on residents' and healthcare providers' preference. The level of healthcare team was the most important characteristic of FDCS to both residents and healthcare providers, followed by types of service. They have different preferences on the cost and way of service delivery. CONCLUSIONS: This study provides new evidence on how and to what extent residents and healthcare providers have different preferences for FDCS by determining their perception of various service attributes. These findings suggested that the optimal design and improvement of FDCS plans should consider not only residents but also healthcare providers' preferences to maximize contract service uptake.

Warfarin maintenance dose prediction for Chinese after heart valve replacement by a feedforward neural network with equal stratified sampling.

Patients requiring low-dose warfarin are more likely to suffer bleeding due to overdose. The goal of this work is to improve the feedforward neural network model's precision in predicting the low maintenance dose for Chinese in the aspect of training data construction. We built the model from a resampled dataset created by equal stratified sampling (maintaining the same sample number in three dose-groups with a total of 3639) and performed internal and external validations. Comparing to the model trained from the raw dataset of 19,060 eligible cases, we improved the low-dose group's ideal prediction percentage from 0.7 to 9.6% and maintained the overall performance (76.4% vs. 75.6%) in external validation. We further built neural network models on single-dose subsets to invest whether the subsets samples were sufficient and whether the selected factors were appropriate. The training set sizes were 1340 and 1478 for the low and high dose subsets; the corresponding ideal prediction percentages were 70.2% and 75.1%. The training set size for the intermediate dose varied and was 1553, 6214, and 12,429; the corresponding ideal prediction percentages were 95.6, 95.1%, and 95.3%. Our conclusion is that equal stratified sampling can be a considerable alternative approach in training data construction to build drug dosing models in the clinic.

Income, Relative Deprivation and the Self-Rated Health of Older People in Urban and Rural China.

Background: Substantial evidence indicated that absolute income is directly associated with health. Few studies have, however, examined if relative income may be equally associated with health. This study aimed to investigate the association between absolute income/relative deprivation (RD) and self-rated health (SRH). We also investigated whether the urban-rural difference was existing in these associations. Methods: Using cross-sectional data of 7,070 participants in the Shandong Family Health Service Survey of older people, this study applied binary logistic model and semi-parametric model to estimate the effect of absolute income and relative deprivation on SRH of older people. The Kakwani Index was used as a measure of relative deprivation at the individual level. Results: Absolute income has a significant positive effect on the SRH among both urban and rural older people. When considered RD as a variable, both absolute income and RD have negative significant effects on SRH among all older people. In addition, the negative effect of RD on rural elderly is more pronounced than that of urban older populations. Semi-parametric regression results show that there was a complex non-linear relationship between income and SRH. Psychological distress substantially attenuated the association between relative deprivation and SRH. Conclusions: Relative deprivation is negatively associated with self-rated health in both urban and rural older people after controlling the absolute income. RD may partly explain the association between income inequality and worse health status. Compared with the urban elderly, the effect of income-based relative deprivation on SRH was more pronounced among the rural elderly, and more care should be given to the lower income and rural older populations.

Prevalence and risk factors of depression symptoms among Chinese seafarers during the COVID-19 pandemic: a cross-sectional study.

BACKGROUND: To curb the spread of COVID-19, most countries have adopted measures such as banning shore leave at ports and placed restrictions on crew change. Seafarers may bear an excess pressure during the COVID-19 pandemic. This study aimed to investigate the prevalence and risk factors associated with depression symptoms among Chinese seafarers during the COVID-19 pandemic. DESIGN: Cross-sectional study. METHODS: This field survey-based study was conducted at Rongcheng Port, Shandong Province, China, from 10 June 2020 to 25 July 2020. Sociodemographic and occupational characteristics and health-related behaviours were collected through a face-to-face questionnaire. The Self-Rating Depression Scale was used to evaluate depression status during the preceding week. Logistic regression models were used to explore factors related to depression. RESULTS: 441 male Chinese seafarers were enrolled. Overall, the proportions of seafarers with low, moderate and severe depression symptoms were 23.35%, 9.30% and 9.07%, respectively. Compared with those with good self-rated health (SRH), seafarers with poor SRH had higher odds of depression (OR, 2.24, 95% CI 1.22 to 4.11). Less leisure time or physical exercise was associated with more severe self-reported depression symptoms (1-3 per week vs ≥4 per week: OR, 1.72, 95% CI 0.71 to 4.14; none vs ≥4 per week: OR, 3.93, 95% CI 1.67 to 9.26). Poor sleep quality was associated with higher likelihood of reporting severe depression (fair vs good: OR, 2.78, 95% CI 1.54 to 5.01; poor vs good: OR, 4.30, 95% CI 1.65 to 11.24). The more frequent seafarers worked overtime a week, the higher the likelihood of reporting severe depression symptoms (1-2 per week vs none: OR, 1.82, 95% CI 1.04 to 3.18; ≥3 per week vs none: OR, 2.49, 95% CI 1.05 to 5.92). Also, high perceived work stress was linked to higher odds of being depressed (intermediate vs low: OR, 2.06, 95% CI 0.78 to 5.46; high vs low: OR, 3.83, 95% CI 1.35 to 10.90). CONCLUSIONS: There is a high burden of depression associated with COVID-19 among seafarers. Special interventions that protect the mental health of seafarers are more critical than ever in the context of the pandemic.

Network-Based Online Survey Exploring Self-Reported Depression Among University and College Students During the Early Days of the COVID-19 Outbreak.

Background: The psychology of university and college students is immature, they are thus more likely to suffer from depression due to the COVID-19 pandemic. The present study aims to investigate the self-reported depression status of Chinese university and college students and explore its influencing factors. Methods: We conducted a network-based online survey, and a total of 17,876 participants completed the questionnaire. Depression was measured by the Self-Rating Depression Scale (SDS). Univariate analysis and multivariate logistic analysis were performed to explore the influencing factors of self-reported depression symptoms. Results: The proportion of self-reported depression symptoms, mild self-reported depression symptoms, and moderate to severe (M/S) self-reported depression symptoms was 65.2, 53.7, and 11.5%, respectively. The mean score of self-reported depression was 54.8 ± 9.0. Female, personality type of partial introversion, junior college educational level, "moderate" or "high" self-perceived risk of infection, "moderately" or "highly" impacted by the outbreak, and being eager to go back to school were risk factors for M/S self-reported depression symptoms (p < 0.05). While, "moderate" or "high" concern about the outbreak, "moderate" or "high" satisfaction with pandemic prevention and control measures, and having health literacy on communicable diseases were protective factors for M/S self-reported depression symptoms (p < 0.05). Conclusion: The status of self-reported depression symptoms among university and college students was severer than expected, and the influencing factors were multifaceted. Government and school administrators should strengthen the dissemination of knowledge on disease prevention and control. Moreover, much attention should be paid to female and junior college students.

Online-Based Survey on College Students' Anxiety During COVID-19 Outbreak.

PURPOSE: Studies have suggested that public health emergencies can have many psychological effects on college students, therefore, the aim of this study is to investigate current situation of college students' anxiety and its determinants in the time of an unexpected pandemic. PATIENTS AND METHODS: We conducted convenience sampling to collect the data through network-based online questionnaires in February 2020, a total of 17,876 college students were included in the analysis. Chi-square test and multivariate logistic were used to identify the associations between the outbreak experiences and anxiety detection. RESULTS: This study found that detection rate of anxiety among college students was 18.2%. The differences in male students, students whose self-perceived risk of infection were high, who were greatly affected by the outbreak, eager to go back to school, reluctant to leave home and stay at home enough were of statistical significance among different anxiety level (OR>1, P<0.05). And the severe anxiety rate of students who living in cities was significantly higher (2.337[1.468, 3.721]). CONCLUSION: Although our results show that anxiety among college students was at a low level, various universities should focus on the online activities and develop appropriate epidemic management plans to prevent their feelings of worry, tension and panic.

Long-term functional outcomes of hearing and speech rehabilitation efficacy among paediatric cochlear implant recipients in Shandong, China.

PURPOSE: To evaluate the auditory performance and speech intelligibility of 100 children with bilateral profound sensorineural hearing loss up to 3 years after cochlear implantation. METHODS: A cohort study was established consisting of 100 children who received cochlear implantation at Shandong Ear Nose and Throat Hospital from 2012 to 2015. Children were examined after 1 month, 1, 2, and 3 years of implantation to assess auditory performance and speech intelligibility using standard tools. The paired Wilcoxon signed-rank test was used to assess whether the scores obtained at different testing points differed significantly. The Mann-Whitney test was utilized to examine the between-group differences (e.g., age at implantation). RESULTS: Three years after implantation, 60% out of 100 children reached the maximal category (7) of categorical auditory performance and 37% achieved the highest category (5) of speech intelligibility rating. Significant improvements were found over time in categorical auditory performance category and speech intelligibility rating (from month 1 to year 1, p < 0.001; from year 1 to year 2, p < 0.001; and from year 2 to year 3, p < 0.001). Larger improvements in auditory outcomes and speech intelligibility were observed in children with a younger age at implantation and those who received speech therapy. CONCLUSIONS: Cochlear implantation appears to make a significant, positive contribution to the development of communication skills of young congenital and prelingually deaf children in China. These improvements continue for up to 3 years after implantation. Positive outcomes appear to be associated with earlier age at implantation and receipt of speech therapy.Implications for rehabilitationBilateral sensorineural hearing loss.Bilateral sensorineural hearing loss in children can cause delay in speech development, poor language skills and potentially disorders in psychological behaviour and social isolation.Cochlear implantation (CI) is an effective strategy that helps children with bilateral sensorineural hearing loss gain the ability to hear and continue to develop language.This study shows that the auditory performance and speech intelligibility of deaf children who speak Mandarin continued to improve up to 3 years of implantation, when follow-up ceased.

Hearing impairment and loneliness in older adults in Shandong, China: the modifying effect of living arrangement.

BACKGROUND: Hearing impairment is a highly prevalent condition and potential risk factor of loneliness in older adults. There is little evidence on whether living arrangement modifies the effects of hearing impairment on loneliness in older adults. AIMS: (1) Explore the relationship between hearing impairment and loneliness in old adults; (2) investigate the modifying effect of living arrangement on the association between hearing impairment and loneliness. METHODS: A cross-sectional analysis was conducted of 7070 participants (aged 60-101) in Shandong province of China. Hearing impairment was measured by a single self-reported question. Variables about social demography and physical functioning were assessed using self-administered questionnaires, and loneliness using short-form UCLA Loneliness Scale. Linear regression models were performed to evaluate the association between hearing impairment and loneliness and possible effect modified by living arrangement. RESULTS: After controlling variables, older adults with hearing impairment reported significantly higher levels of loneliness than those with normal hearing (ß = 0.024; P < 0.001). Living arrangement has a significant modifying effect on association between hearing impairment and loneliness. CONCLUSIONS: Our results underscored the potential impact of hearing impairment on loneliness in older adults, and also suggested that having adult children in the same village/community may play a protective role in reducing the loneliness of older adults with hearing impairment.